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

Evaluation Of Tocopherol Recovery Through Simulation Of Molecular Distillation Process.

DISMOL simulator was used to determine the best possible operating conditions to guide, in future studies, experimental works. This simulator needs several physical-chemical properties and often it is very difficult to determine them because of the complexity of the involved components. Their determinations must be made through correlations and/or predictions, in order to characterize the system and calculate it. The first try is to have simulation results of a system that later can be validated with experimental data. To implement, in the simulator, the necessary parameters of complex systems is a difficult task. In this work, we aimed to determe these properties in order to evaluate the tocopherol (vitamin E) recovery using a DISMOL simulator. The raw material used was the crude deodorizer distillate of soya oil. With this procedure, it is possible to determine the best operating conditions for experimental works and to evaluate the process in the separation of new systems, analyzing the profiles obtained from these simulations for the falling film molecular distillator.113-116689-71

Variações qualitativas e quantitativas na microbiota do solo e na fixação biológica do nitrogênio sob diferentes manejos com soja Qualitative and quantitative changes in soil microbiota and biological nitrogen fixation under different soybean managements

Neste estudo foram avaliados atributos qualitativos e quantitativos da microbiota do solo, visando monitorar alterações por diferentes manejos do solo e das culturas. As avaliações foram feitas em um ensaio a campo, conduzido há 14 anos em Londrina, PR, sob plantio convencional (PC) ou plantio direto (PD) e com sucessão (S) (soja/trigo) ou rotação (R) (tremoço/milho/aveia-preta/soja/trigo/soja/trigo/soja) de culturas, quando todos os sistemas estavam com soja no estádio de florescimento pleno. Os incrementos no C e N da biomassa microbiana (CBM e NBM) no PD foram de 114 e 157 %, respectivamente, em comparação ao PC; além disso, o quociente metabólico (qCO2) foi inferior em 37 % no PD, indicando maior eficiência metabólica da microbiota do solo. Não foram detectadas diferenças nesses atributos em função dos sistemas de rotação e sucessão de culturas. A diversidade genética da comunidade bacteriana total do solo foi superior no PD e inferior no PC com sucessão de culturas. Em relação à fixação biológica do N2, a massa, o N total e a fração de N-ureídos acumulados na parte aérea e a eficiência dos nódulos em fixar N2 foram superiores no PD. A diversidade genética dos rizóbios foi afetada, principalmente, pelo manejo das culturas, sendo superior com a rotação, provavelmente pelo maior número de espécies de plantas. Contudo, com a rotação ocorreu decréscimo na eficiência do processo de fixação biológica do N2, o que pode estar relacionado com os teores mais elevados de N no solo, ou com a menor pressão de seleção por bactérias eficientes. Desse modo, para microrganismos do solo com função específica, como os rizóbios, a diversidade genética pode ser distinta da funcionalidade.<br>In this study, quantitative and qualitative microbiological parameters were evaluated to detect differences related to soil and crop management. The study was carried out in a field experiment installed 14 years ago on a Rhodic Eutrudox, in Londrina, PR, Brazil. Treatments were a combination of a crop sequence (S) (soybean/wheat) and a crop rotation (R) (lupin/maize/black oat/soybean/wheat/soybean/wheat/soybean), either under conventional tillage (CT) or no-tillage (NT). Evaluations were performed when all systems were under the soybean cropping season, at full flowering. Amounts of microbial biomass carbon and nitrogen (MB-C and MB-N, respectively) were 114 and 157 % higher in NT than in CT. Furthermore, the metabolic quotient (qCO2) was lower under NT, indicating higher metabolic efficiency of the soil microbes. These parameters were not affected by the crop sequence/rotation. Genetic diversity of the total soil bacterial community was higher under NT and lower in the CT system with crop sequence. Regarding the biological N2 fixation, it was found that plant biomass, total N and fraction of N-ureides in shoots, as well as nodule efficiency, were higher under NT. Genetic diversity of rhizobia was affected mainly by crop management and was higher under crop rotation, probably due to the greater number of plant species. However, crop rotation decreased the efficiency of the biological N2 fixation process, which may be related to more abundant N in the soil or to a lower selection pressure for efficient rhizobia. For soil microbes with specific functions, e.g., rhizobia, genetic diversity may therefore differ from functionality

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.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt