Associação entre a ooforectomia bilateral precoce e o desenvolvimento do parkinsonismo e Doença de Parkinson em mulheres na pré-menopausa

O parkinsonismo é um distúrbio do sistema nervoso de maior incidência masculina do que feminina, visto que, por mecanismos fisiológicos, o estrogênio possui efeitos neuroprotetores, com funções como aumento da dopamina, um neurotransmissor essencial para o controle das funções motoras. Além disso, previne a formação dos corpúsculos de Lewy e da agregação da α-sinucleína, responsáveis pela progressão da Doença de Parkinson. Por isso, a doença se apresenta diferentemente nas mulheres. A remoção cirúrgica de ambos os ovários em mulheres na pré-menopausa para a prevenção do câncer de ovário parece favorecer o surgimento da doença, tendo em vista a perda da produção do hormônio protetor. Assim, o objetivo do estudo é analisar a associação entre a ooforectomia bilateral precoce e o desenvolvimento de parkinsonismo e Doença de Parkinson em mulheres na pré-menopausa. Trata-se de uma revisão bibliográfica sistemática, do tipo quantitativa, que utilizou as plataformas do PubMed, SciELO e Cochrane Library como bases de dados para seleção dos artigos, todos na língua inglesa. Foram utilizadas literaturas publicadas com recorte temporal de 2017 a 2022. De acordo com as literaturas analisadas, a ooforectomia bilateral precoce em mulheres na pré-menopausa aumenta o risco do desenvolvimento de parkinsonismo. Desse modo, a diminuição dos procedimentos cirúrgicos profiláticos para câncer de ovário nas pacientes com risco médio de malignidade reduziria o risco dessa condição

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