I Diretriz brasileira de cardio-oncologia pediátrica da Sociedade Brasileira de Cardiologia

Sociedade Brasileira de Oncologia PediátricaUniversidade Federal de São Paulo (UNIFESP) Instituto de Oncologia Pediátrica GRAACCUniversidade Federal de São Paulo (UNIFESP)Universidade de São Paulo Faculdade de Medicina Instituto do Coração do Hospital das ClínicasUniversidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto AlegreInstituto Materno-Infantil de PernambucoHospital de Base de BrasíliaUniversidade de Pernambuco Hospital Universitário Oswaldo CruzHospital A.C. CamargoHospital do CoraçãoSociedade Brasileira de Cardiologia Departamento de Cardiopatias Congênitas e Cardiologia PediátricaInstituto Nacional de CâncerHospital Pequeno PríncipeSanta Casa de Misericórdia de São PauloInstituto do Câncer do Estado de São PauloUniversidade Federal de São Paulo (UNIFESP) Departamento de PatologiaHospital Infantil Joana de GusmãoUNIFESP, Instituto de Oncologia Pediátrica GRAACCUNIFESP, Depto. de PatologiaSciEL

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

Genetic Diversity Strategy For The Management And Use Of Rubber Genetic Resources: More Than 1,000 Wild And Cultivated Accessions In A 100-genotype Core Collection.

The rubber tree [Hevea brasiliensis (Willd. ex Adr. de Juss.) Muell. Arg.] is the only plant species worldwide that is cultivated for the commercial production of natural rubber. This study describes the genetic diversity of the Hevea spp. complex that is available in the main ex situ collections of South America, including Amazonian populations that have never been previously described. Genetic data were analyzed to determine the genetic structure of the wild populations, quantify the allelic diversity and suggest the composition of a core collection to capture the maximum genetic diversity within a minimal sample size. A total of 1,117 accessions were genotyped with 13 microsatellite markers. We identified a total of 408 alleles, 319 of which were shared between groups and 89 that were private in different groups of accessions. In a population structure and principal component analysis, the level of clustering reflected a primary division into the following two subgroups: cluster 1, which consisted of varieties from the advanced breeding germplasm that originated from the Wickham and Mato Grosso accessions; and cluster 2, which consisted of the wild germplasm from the Acre, Amazonas, Pará and Rondônia populations and Hevea spp. The analyses revealed a high frequency of gene flow between the groups, with the genetic differentiation coefficient (GST) estimated to be 0.018. Additionally, no distinct separation among the H. brasiliensis accessions and the other species from Amazonas was observed. A core collection of 99 accessions was identified that captured the maximum genetic diversity. Rubber tree breeders can effectively utilize this core collection for cultivar improvement. Furthermore, such a core collection could provide resources for forming an association panel to evaluate traits with agronomic and commercial importance. Our study generated a molecular database that should facilitate the management of the Hevea germplasm and its use for subsequent genetic and genomic breeding

Dispersion graphics based on a principal coordinates analysis (PCoA) of the groups.

<p>[A] Accessions (the dashed lines refer to the groups that were observed based on the analysis conducted using STRUCTURE software) [B] from the <i>Hevea</i> germplasm based on genotypic data from 13 microsatellite loci.</p

Descriptive results of the values observed in the characterization of the mean loci for each population of sample size (N), number of alleles (Na), information index (I), observed heterozygosity (H_o), expected genetic diversity (H_E), fixation index (F) and private alleles (Pa) in 1,117 accessions of <i>Hevea</i> spp.

<p>^a The 1,117 accessions were divided according to the locations of origin from which they were collected and assigned to groups.</p><p>^b Structure analysis results suggest that the set of genotypes can be partitioned into two clusters.</p><p>Descriptive results of the values observed in the characterization of the mean loci for each population of sample size (N), number of alleles (Na), information index (I), observed heterozygosity (H_o), expected genetic diversity (H_E), fixation index (F) and private alleles (Pa) in 1,117 accessions of <i>Hevea</i> spp.</p

Division of membership probability in the two clusters (K = 2) inferred based on Bayesian analyses considering the most probable number of groups (K); designated as Cluster 1, Cluster 2 and Mixture (membership q < 0.07).

<p>^a The 1,117 accessions were divided according to the locations of origin from which they were collected and assigned to a group.</p><p>Division of membership probability in the two clusters (K = 2) inferred based on Bayesian analyses considering the most probable number of groups (K); designated as Cluster 1, Cluster 2 and Mixture (membership q < 0.07).</p

Private allele frequencies obtained from the genotyping of microsatellite loci in the <i>Hevea</i> germplasm.

<p>The dashed line indicates the cutoff for the occurrence of rare alleles (frequency = 0.05).</p

Number of accessions per geographical origin and <i>ex situ</i> collection site.

<p>Number of accessions per geographical origin and <i>ex situ</i> collection site.</p

Triangular matrices for the computation of G_ST and F_ST tests among the <i>Hevea</i> germplasm; G_ST values are below the diagonal, and F_ST values are above the diagonal.

<p>Triangular matrices for the computation of G_ST and F_ST tests among the <i>Hevea</i> germplasm; G_ST values are below the diagonal, and F_ST values are above the diagonal.</p

Genetic diversity (expressed as a percentage of the total number of alleles) as a function of the number of accessions included in the rubber tree germplasm core collection.

<p>Genetic diversity (expressed as a percentage of the total number of alleles) as a function of the number of accessions included in the rubber tree germplasm core collection.</p