Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Avaliação das características físicas e biológicas das sementes de urucu c.v. casca verde durante o desenvolvimento da maturação fisiológica

The annatto (Bixa orellana L.) is a Bixaceae and its seeds presented low percentage of germination. This work was carried out with the objective to study the maturation and germination of annatto seeds. The experimental follows a completely randomized design with four replication using 20 fruits or 50 seeds. In this research was evaluated vigor and germination capacity; and studied seed maturation process. The following experimental procedures was realized: At each inflorescence was identified in the anthesis; for each fruit harvested was determined: diameter, length, weight, color, moisture content and dry weight; and for extracted seeds were analyzed: color, moisture content, dry weight, weight of 1000 dried seeds, bixin content index, and the speed and percentage of germination. Also it was evaluated effects of temperatures and substrates in germination of intact and scarified seeds. In this case was employed the experimental design 2x4x6 factorial. It was utilized the following temperatures: 20, 25, 30 and 20-30ºC. Utilized substrates were: sand, vermiculite, fiber coconut, wood fiber, Plantmax® and paper roll. At the study of germination in vitro, it was utilized culture medium MS with different concentrations of agar and the experimental design was a 3x4 factorial considering: (i) intact seeds; (i) seeds without tegument; (iii) embryo axis; and (iv) four level of agar (4, 6, 8 e 10 g 1 L-1). Two replications were realized using five tubes with one seed per tube. The germination criterion adopted was the protrusion of the primary root with size equal or greater than 2 mm. Results show that: (i) the physiologic maturation, better vigor index and better drift of pigment of the seeds occurred for fruits harvest 77 days after anthesis; (ii) seeds presented dormancy before physiologic maturation; (iii) the utilization of the substrates sand, vermiculite and paper roll, under temperatures of 25, 30, 20-30ºC improved the germination; and (iv) seeds without tegument presented better percentage of germination in culture medium contained 4 g L-1 of agar.O urucu (Bixa orellana L.) é uma Bixaceae, cujas sementes apresentam baixa taxa de germinação. Este trabalho teve como objetivo estudar a maturação e a germinação de sementes de urucu. Os estudos foram conduzidos no delineamento experimental inteiramente casualizado, com quatro repetições de 20 frutos e/ou 50 sementes, onde foram avaliados o vigor e a capacidade germinativa. Na maturação, cada inflorescência foi identificada na antese, e nos frutos avaliados: diâmetro, comprimento, peso, coloração, teor de água e massa seca; e, nas sementes, avaliados: massa de mil sementes, velocidade e porcentagem de germinação. Nas fases de maturação foram feitas extração e dosagem de bixina e cortes para estudo citológico. Na avaliação em diferentes temperaturas e substratos, foram utilizadas sementes intactas e sementes escarificadas, em esquema fatorial 2x6x4. Os substratos utilizados foram: a areia, a vermiculita, o pó de coco, o pó de serra, o Plantmax® e o rolo de papel Germites® e as temperaturas foram de 20, 25, 30 e 20- 30ºC. Sementes intactas, sementes sem tegumento e apenas eixos embrionários foram avaliados na germinação in vitro, onde foi utilizado meio de cultivo MS, com diferentes concentrações de ágar (4, 6, 8 e 10 g L-1) em esquema fatorial 3x4, com duas repetições de cinco tubos e uma semente por tubo. Avaliou-se a protrusão da xii raiz principal com 2 mm de comprimento e o desenvolvimento da radícula para eixos embrionários. Concluiu-se que: a maturação fisiológica, maior índice de vigor e teor de corante das sementes, ocorre aos 77 dias após a antese; há dormência após a maturação; os substratos: areia, vermiculita e rolo de papel, sob temperaturas de 25, 30, 20-30ºC podem ser considerados os melhores para a germinação; e, as sementes sem tegumento, em meio contendo 4 g L-1 de ágar, apresentaram maior porcentagem de germinação

Germinação de sementes de urucu em diferentes temperaturas e substratos Germination of annatto seeds under different temperatures and substrates

Objetivou-se, neste trabalho, analisar o comportamento germinativo das sementes de urucu cultivar Casca Verde, com e sem escarificação, sob regime de diferentes temperaturas e substratos. O trabalho foi realizado no Laboratório de Tecnologia e Análise de Sementes do Centro de Ciências Agrárias da Universidade Federal do Espírito Santo (CCA-UFES). O delineamento experimental utilizado foi o inteiramente casualizado, num esquema fatorial 2x6x4 (dois tratamentos físicos nas sementes, seis substratos e quatro temperaturas), totalizando 48 tratamentos, com quatro repetições de 50 sementes. Os tratamentos físicos foram: as sementes intactas e as sementes escarificadas; os substratos foram: a areia, a vermiculita, a fibra de coco, o pó de serra, o Plantmax e o rolo de papel Germitest ; e, as temperaturas testadas foram constantes de 20, 25 e 30ºC e alternada de 20-30ºC. Os dados foram submetidos à análise de variância e as médias comparadas pelo teste de Tukey. Os resultados obtidos evidenciaram maior porcentagem de germinação das sementes de urucu, semeadas nos substratos areia, vermiculita e rolo de papel; as temperaturas de 25, 30 e 20-30ºC foram mais adequadas para testes de germinação dessas sementes.This work was carried out with the objective to verify the effect of temperature and substrate on germinative capacity of annatto seeds. This study was developed in the Laboratories of Seed Analysis of Agrarian Science Center that belongs to the Universidade Federal do Espirito Santo (CCA-UFES), located in Alegre ES, Brazil. The experimental design was 2x6x4 factorial involving: (i) two treatments in the seeds, (ii) six substrates, and (iii) four temperatures. Four replications were realized using 50 seeds at each experimental unit. Treatments refer to intact and scarified seeds. Substrates utilized were sand, vermiculite, coconut fiber, wood fiber, Plantmax and paper roll. Temperatures employed were 20, 25, 30 and 20-30ºC. Average contrasts were verified using Tukey test at 5% of significance. It can be concluded: (i) that better percentages of germination occurred by using sand substrate, vermiculite and paper roll; and (ii) temperatures of 25, 30 and 20-30ºC can be utilized in germination tests of annatto seeds

Determinação da maturidade fisiológica de frutos de maracujazeiro amarelo colhidos na região norte do estado do Rio de Janeiro, Brasil Determination of the physiologic maturity on yellow passion-fruit harvested in north of Rio de Janeiro State, Brazil

O trabalho teve como objetivo determinar o ponto de maturidade fisiológica dos frutos de maracujazeiro amarelo produzidos na região Norte Fluminense, na tentativa de se antecipar o ponto de colheita dos frutos, visando a qualidade e o aumento da vida de prateleira dos mesmos. Os frutos foram colhidos em três períodos diferentes. A colheita 1 foi realizada aos 45 dias após a antese (daa); a colheita 2 aos 54 daa e a colheita 3 aos 63 daa. Após cada colheita os frutos foram lavados, secos e divididos em dois lotes para avaliação. O primeiro lote foi avaliado imediatamente após a colheita, e o segundo foi armazenado em câmara (23 ± 3ºC e 85 ± 8% UR). Os frutos foram analisados periodicamente a cada 3 dias, quanto aos seguintes atributos de qualidade: coloração e espessura da casca, rendimento de suco e teores de sólidos solúveis (SS) e acidez titulável (AT). Os resultados indicaram que o tempo de desenvolvimento do fruto de maracujazeiro amarelo, dentro do período de 45 a 63 daa, influenciou na qualidade do fruto colhido na região. Para as condições deste trabalho, o ponto ideal de colheita foi aos 63 daa, podendo, também, ser colhido a partir do 54º daa, porém, com perda de cerca de 21,0 % no rendimento de suco. Verificou-se, também, que durante a fase de amadurecimento, a manutenção dos frutos na planta retarda a evolução da coloração, bem como, a redução na espessura da casca do fruto, em comparação ao colhido e armazenado.<br>This work aimed to determine the physiologic maturity of yellow passion-fruit produced in North Fluminense, with the aim of advancing the point of fruit harvest and improving the quality and shelf life the fruit. The fruit were harvested in three different periods. Harvest 1 occurred during the 45 days after anthesis (daa); harvest 2 from 54 daa and harvest 3 from 63 daa. After each harvest, the fruit were washed, dried and separated in two groups for evaluation. The first group was evaluated immediately after the harvest, and the second was stored in a chamber at room temperature (23 ± 3 ºC and RH 85 ± 8 %). The fruit were evaluated periodically in interval of 3 days, for the following quality attributes: skin color and thickness, juice yield, soluble solids (SS) and titratable acidity (TA) contents. Results indicate that the time of yellow passion-fruit development, between the periods of 45 to 63 daa, influenced the fruit quality of the harvest in the region. For the conditions of this study, the optimal time of harvest was at 63 daa, although fruit may however, be harvested by 54º daa, with loss around 21.0 % on juice yield. Also, during the ripening stages of the passion-fruit, it was seen that the attached fruit show a delay in color progress and reduction in the thickness of the skin, when compared with harvested and stocked fruit