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

Crystal structure of complexes of tin and platinum

Foram determinadas as estruturas de três complexos de Platina, dois complexos de estanho e um ligante orgânico. AS intensidades das reflexões foram medidas com umdifratômetro CAD-4. As estruturas foram resolvidas por métodos diretos ou pela função de Patterson e refinadas por mínimos quadrados. Bis (fenilsulfonil) etano, C14H14(SO2)2, foi obtido durante as tentativas de sintetizar ligantes para serem usados na complexação com diversos organo-estânicos, o cristal pertence ao sistema moniclínico, P21/n, a= 8,495(3), b= 10,159(1), c= 9,072(1)&#197, &#946= 116,23(2) &#176, V= 702,3(3) &#1973, Z= 2, dcalc= 1,467g.cm-3. Cis-dicloro[meso-1,2-bis(n-propilsulfinil)etano]platina(II), PtCl2. (PrSO)2C2H4, o cristal pertence ao sistema ortorrômbico, P212121, a= 7,360(2), b= 9,793(2), c= 19,369(2)&#197, V= 1396,1(4)&#1973, Z= 4, dcalc= 2,25g.cm-3. Trans-diclorol[(trietilfosfina) (2-metilsulfinil)piridina)]platina(II), Et3PPtCl 2.PySOMe, o cristal pertence ao sistema monoclínico, P21/c, a= 8,067(3), b= 8,5184(9), c= 25,592(3)&#197, &#946= 92,000(9)&#176, V= 1757,6(7)&#1973, Z= 4, dcalç= 1,98g.cm-3. Trans-dicloro [(trietilfosfina)(2-n-propilsulfinil)piridina)]platina(II), Et3PPtCl2.PySOPr, o cristal pertence ao sistema triclínico, P-1, a= 8,254(3), b= 8,377(4), c= 14,531(4)&#197, &#945= 87,14(3), &#946= 82,83(3), &#933= 84,10(3)&#176, V= 991,0(7)&#1973, Z= 2, dcalc= 1,78g.cm-3. Mer-tricloro [(2-metilsulfinil)benzotiazol)]metilestanho(IV), MeSnCl3.BtSOMe)2, o cristal pertence ao sistema monoclínico, C2/c, a= 20,083(2), b= 17,406(1), c= 14,415(2)&#197, &#946= 108,06(3), V= 4790,5(8)&#1973, Z= 8, dcalc= 1,78g.cm-3. Hidroxi cloreto de difenil estanho (IV) + mesobis (fenilsulfinil)metano, SnClOHPh2 + Ph2(SO) 2CH2, o cristal pertence ao sistema monoclínico, P21/c, a= 10,540(3), b= 9,743(1), c= 24,099(7)&#197, &#946= 92,95(2), V= 2471(1)&#1973, Z= 4, dcalç= 1,58g.cm-3The structures of three platinum complexes, two organotin compounds and organic ligand were determined. The reflection intensities were measured with a CAD-4 automatic diffractometer. The structures were solved by direct methods or the Patterson function and were refined by least squares method. Bis (phenylsulfonyl)ethane, C14H14(SO2)2, was obtained among attempts to synthesize ligands to be used for complexation with several organotins, the crystal belongs to the monoclinic system, P21/n, a= 8,495(3), b= 10,159(1), c= 9,072(1)&#197, &#946= 116,23(2) &#176, V= 702,3(3) &#1973, Z= 2, dcalc= 1,467g.cm-3. Cis-dichloro [ meso 1,2-bis(n-propylsulphinyl)ethane]platinum(II), PtCl2. (PrSO)2C2H4 the crystal belongs to the orthorhombic system, P212121, a= 7,360(2), b= 9,793(2), c= 19,369(2)&#197, V= 1396,1(4)&#1973, Z= 4, dcalc= 2,25g.cm-3. Trans-dichloro [(triethylphosphine) (2-methylsulphinyl)pyridine)]platinum(II), Et3PPtCl 2.PySOMe, the crystal belongs to the monoclinic system, P21/c, a= 8,067(3), b= 8,5184(9), c= 25,592(3)&#197, &#946= 92,000(9)&#176, V= 1757,6(7)&#1973, Z= 4, dcalç= 1,98g.cm-3. Trans-dichloro [(triethylphosphine) (2-npropylsulphinyl) pyridine)]platinum(II), Et3PPtCl2.PySOPr, the crystal belongs to the orthorhombic system, P-1, a= 8,254(3), b= 8,377(4), c= 14,531(4)&#197, &#945= 87,14(3), &#946= 82,83(3), &#933= 84,10(3)&#176, V= 991,0(7)&#1973, Z= 2, dcalc= 1,78g.cm-3. Mer-trichloro[(2-methylsulphinyl)benzothiazole)]methyltin(IV), MeSnCl3.BtSOMe)2 the crystal belongs to the monoclinic system, C2/c, a= 20,083(2), b= 17,406(1), c= 14,415(2)&#197, &#946= 108,06(3), V= 4790,5(8)&#1973, Z= 8, dcalc= 1,78g.cm-3. Hidroxe chloride diphenyl tin (IV) + mesobis (phenylsulphinyl)methane, SnClOHPh2 + Ph2(SO) 2CH2 the crystal belongs to the monoclinic system, P21/c, a= 10,540(3), b= 9,743(1), c= 24,099(7)&#197, &#946= 92,95(2), V= 2471(1)&#1973, Z= 4, dcalç= 1,58g.cm-

Introduction to bio-crystallography through the structural study of the kinase dependent of cycline 2 (CDK2) complexed with inhibitors

O ciclo celular é controlado pela atividade das quinases dependentes de ciclinas (Ciclin-dependent kinases, CDKs). As CDKs são inativas como monômeros, e a sua ativação necessita da ligação às ciclinas, uma família diversa de proteínas cujos os níveis oscilam durante o ciclo celular, e fosforilação pela CAK (CDK-activating kinase) sobre um resíduo de treonina específico. As CDKs são capazes de fosforilar muitas proteínas que estão envolvidas nos eventos do ciclo celular, incluindo histonas e proteínas supressoras de tumores como pRb. Além da função de regulação positiva das ciclinas e CAK, muitas proteínas inibidoras de CDKs (CDK inhibitors, CKIs) têm sido descobertas, tais como p16, p21 e p28. Visto que, a desregulação das ciclinas e/ou alteração ou ausência de CKIs têm sido associadas com muitos cânceres, há um forte interesse em inibidores químicos de CDKs que possam ter uma função importante na descoberta de novas famílias de agentes anti-tumores. Vistoque, ATP é o autêntico co-fator da CDK2 este pode ser considerado como um \"pseudo-composto líder\" para a descoberta de inibidores de CDK2. Entretanto, há duas preocupações maiores a serem consideradas: composto contendo adenina são ligantes comuns para muitas enzimas nas células, desta forma, qualquer composto altamente carregado como ATP não será absorvido pelas células. Nós descrevemos aqui as estruturas determinadas por difração de raios-X da CDK2 em complexo com dois inibidores diferentes, descloro-flavopiridol (DFP) e Roscovitine. A estrutura do complexo binário CDK2-DFP foi resolvida por substituição molecular e refinada até um Rfactor=20,3% e a estrutura da CDK-2Roscovitine foi refinada até um Rfactor=18%. O descloro-flavopiridol é uma flavona com uma nova estrutura,comparável àquelas de flavonas polihidroxiladas. Estudos prévios mostraram que flavopiridol, um flavonóide, pode inibir cânceres de mama e de pulmão. O Roscovitine é um derivado de adenina e um potente inibidor de CDK2. A comparação das estruturas tridimensionais de CDK2-DFP e CDK2-Roscovitine com a de CDK2-ATP mostraram que o bolsão hidrofóbico de ligação de adenina tem a habilidade surpreendente de acomodar estruturas moleculares diferentes daquelas da ATPCell cycle progression is tightly controlled by the activity of ciclin-dependent kinases (CDKs). CDKs are inactive as monomers, and activation requires binding to cyclins, a diverse family of proteins whose levels oscillate during cell cycle, and phosphorilation by CDK-activating kinase (CAK) on a specific threonine residue. CDKs are able to phosphorylate many proteins that are in volvedin cell cycle events, including histones and tumor suppressor proteins like the retinoblastoma gene product pRb. In addition to the positive regulatory role of cyclins and CAK, many negative regulatory proteins (CDK Inhibitors, CIGs) have been discovered, such as p16, p21, and p28. Since deregulation of cyclins and/or alteration or absence ofCKIs have been associated with many cancers, there is strong interest in chemical inhibitors of CDKs that could play an important role in the discovery of new family of antitumor agents. Since ATP is the authentic cofactor of CDK2 it can be considered as a \"pseudo-lead compound\" for discovery of CDK2 inhibitors. However there are two major concerns: adenine containing compounds are common ligants for many enzymes in cells, thus, any adenine derivatives may inhibit many enzymes in the cells: second, any highly charged compounds such as ATP will prevent them from uptake by cells. We report here the x-ray structures of CDK2 in complex with two different inhibitors, deschloro-flavopiridol(DFP) and Roscovitine. The structure of the binary complex CDK2-DFP was solved by molecular replacement and refined to Rfactor = 20.3% and the structure ofCDK2-Roscovitine was refined to Rfactor = 18.0 %. The deschloro-flavopiridol(DFP) is a flavone with a novel structure, compared to that of polyhydroxylated flavones. Previous studies have shown that flavopiridol, a flavonoid, can inhibit growth of breast and lung carcinoma cell lines. The Roscovitine is an adenine derivative and a potent CDK2 inhibitor. The two inhibitors are competitive inhibitors for ATP binding to CDK2 and bind to the ATP binding pocket ofCDK2. The comparison of the three-dimensional structures of CDK2-DFP and CDK2-Roscovitine with the CDK2-ATP shows that the hydrophobic adenine-binding pocket has a surprising ability to accommodate molecular structures that are different from ATP

Crystal structure of complexes of tin and platinum

Foram determinadas as estruturas de três complexos de Platina, dois complexos de estanho e um ligante orgânico. AS intensidades das reflexões foram medidas com umdifratômetro CAD-4. As estruturas foram resolvidas por métodos diretos ou pela função de Patterson e refinadas por mínimos quadrados. Bis (fenilsulfonil) etano, C14H14(SO2)2, foi obtido durante as tentativas de sintetizar ligantes para serem usados na complexação com diversos organo-estânicos, o cristal pertence ao sistema moniclínico, P21/n, a= 8,495(3), b= 10,159(1), c= 9,072(1)&#197, &#946= 116,23(2) &#176, V= 702,3(3) &#1973, Z= 2, dcalc= 1,467g.cm-3. Cis-dicloro[meso-1,2-bis(n-propilsulfinil)etano]platina(II), PtCl2. (PrSO)2C2H4, o cristal pertence ao sistema ortorrômbico, P212121, a= 7,360(2), b= 9,793(2), c= 19,369(2)&#197, V= 1396,1(4)&#1973, Z= 4, dcalc= 2,25g.cm-3. Trans-diclorol[(trietilfosfina) (2-metilsulfinil)piridina)]platina(II), Et3PPtCl 2.PySOMe, o cristal pertence ao sistema monoclínico, P21/c, a= 8,067(3), b= 8,5184(9), c= 25,592(3)&#197, &#946= 92,000(9)&#176, V= 1757,6(7)&#1973, Z= 4, dcalç= 1,98g.cm-3. Trans-dicloro [(trietilfosfina)(2-n-propilsulfinil)piridina)]platina(II), Et3PPtCl2.PySOPr, o cristal pertence ao sistema triclínico, P-1, a= 8,254(3), b= 8,377(4), c= 14,531(4)&#197, &#945= 87,14(3), &#946= 82,83(3), &#933= 84,10(3)&#176, V= 991,0(7)&#1973, Z= 2, dcalc= 1,78g.cm-3. Mer-tricloro [(2-metilsulfinil)benzotiazol)]metilestanho(IV), MeSnCl3.BtSOMe)2, o cristal pertence ao sistema monoclínico, C2/c, a= 20,083(2), b= 17,406(1), c= 14,415(2)&#197, &#946= 108,06(3), V= 4790,5(8)&#1973, Z= 8, dcalc= 1,78g.cm-3. Hidroxi cloreto de difenil estanho (IV) + mesobis (fenilsulfinil)metano, SnClOHPh2 + Ph2(SO) 2CH2, o cristal pertence ao sistema monoclínico, P21/c, a= 10,540(3), b= 9,743(1), c= 24,099(7)&#197, &#946= 92,95(2), V= 2471(1)&#1973, Z= 4, dcalç= 1,58g.cm-3The structures of three platinum complexes, two organotin compounds and organic ligand were determined. The reflection intensities were measured with a CAD-4 automatic diffractometer. The structures were solved by direct methods or the Patterson function and were refined by least squares method. Bis (phenylsulfonyl)ethane, C14H14(SO2)2, was obtained among attempts to synthesize ligands to be used for complexation with several organotins, the crystal belongs to the monoclinic system, P21/n, a= 8,495(3), b= 10,159(1), c= 9,072(1)&#197, &#946= 116,23(2) &#176, V= 702,3(3) &#1973, Z= 2, dcalc= 1,467g.cm-3. Cis-dichloro [ meso 1,2-bis(n-propylsulphinyl)ethane]platinum(II), PtCl2. (PrSO)2C2H4 the crystal belongs to the orthorhombic system, P212121, a= 7,360(2), b= 9,793(2), c= 19,369(2)&#197, V= 1396,1(4)&#1973, Z= 4, dcalc= 2,25g.cm-3. Trans-dichloro [(triethylphosphine) (2-methylsulphinyl)pyridine)]platinum(II), Et3PPtCl 2.PySOMe, the crystal belongs to the monoclinic system, P21/c, a= 8,067(3), b= 8,5184(9), c= 25,592(3)&#197, &#946= 92,000(9)&#176, V= 1757,6(7)&#1973, Z= 4, dcalç= 1,98g.cm-3. Trans-dichloro [(triethylphosphine) (2-npropylsulphinyl) pyridine)]platinum(II), Et3PPtCl2.PySOPr, the crystal belongs to the orthorhombic system, P-1, a= 8,254(3), b= 8,377(4), c= 14,531(4)&#197, &#945= 87,14(3), &#946= 82,83(3), &#933= 84,10(3)&#176, V= 991,0(7)&#1973, Z= 2, dcalc= 1,78g.cm-3. Mer-trichloro[(2-methylsulphinyl)benzothiazole)]methyltin(IV), MeSnCl3.BtSOMe)2 the crystal belongs to the monoclinic system, C2/c, a= 20,083(2), b= 17,406(1), c= 14,415(2)&#197, &#946= 108,06(3), V= 4790,5(8)&#1973, Z= 8, dcalc= 1,78g.cm-3. Hidroxe chloride diphenyl tin (IV) + mesobis (phenylsulphinyl)methane, SnClOHPh2 + Ph2(SO) 2CH2 the crystal belongs to the monoclinic system, P21/c, a= 10,540(3), b= 9,743(1), c= 24,099(7)&#197, &#946= 92,95(2), V= 2471(1)&#1973, Z= 4, dcalç= 1,58g.cm-

Introduction to bio-crystallography through the structural study of the kinase dependent of cycline 2 (CDK2) complexed with inhibitors

O ciclo celular é controlado pela atividade das quinases dependentes de ciclinas (Ciclin-dependent kinases, CDKs). As CDKs são inativas como monômeros, e a sua ativação necessita da ligação às ciclinas, uma família diversa de proteínas cujos os níveis oscilam durante o ciclo celular, e fosforilação pela CAK (CDK-activating kinase) sobre um resíduo de treonina específico. As CDKs são capazes de fosforilar muitas proteínas que estão envolvidas nos eventos do ciclo celular, incluindo histonas e proteínas supressoras de tumores como pRb. Além da função de regulação positiva das ciclinas e CAK, muitas proteínas inibidoras de CDKs (CDK inhibitors, CKIs) têm sido descobertas, tais como p16, p21 e p28. Visto que, a desregulação das ciclinas e/ou alteração ou ausência de CKIs têm sido associadas com muitos cânceres, há um forte interesse em inibidores químicos de CDKs que possam ter uma função importante na descoberta de novas famílias de agentes anti-tumores. Vistoque, ATP é o autêntico co-fator da CDK2 este pode ser considerado como um \"pseudo-composto líder\" para a descoberta de inibidores de CDK2. Entretanto, há duas preocupações maiores a serem consideradas: composto contendo adenina são ligantes comuns para muitas enzimas nas células, desta forma, qualquer composto altamente carregado como ATP não será absorvido pelas células. Nós descrevemos aqui as estruturas determinadas por difração de raios-X da CDK2 em complexo com dois inibidores diferentes, descloro-flavopiridol (DFP) e Roscovitine. A estrutura do complexo binário CDK2-DFP foi resolvida por substituição molecular e refinada até um Rfactor=20,3% e a estrutura da CDK-2Roscovitine foi refinada até um Rfactor=18%. O descloro-flavopiridol é uma flavona com uma nova estrutura,comparável àquelas de flavonas polihidroxiladas. Estudos prévios mostraram que flavopiridol, um flavonóide, pode inibir cânceres de mama e de pulmão. O Roscovitine é um derivado de adenina e um potente inibidor de CDK2. A comparação das estruturas tridimensionais de CDK2-DFP e CDK2-Roscovitine com a de CDK2-ATP mostraram que o bolsão hidrofóbico de ligação de adenina tem a habilidade surpreendente de acomodar estruturas moleculares diferentes daquelas da ATPCell cycle progression is tightly controlled by the activity of ciclin-dependent kinases (CDKs). CDKs are inactive as monomers, and activation requires binding to cyclins, a diverse family of proteins whose levels oscillate during cell cycle, and phosphorilation by CDK-activating kinase (CAK) on a specific threonine residue. CDKs are able to phosphorylate many proteins that are in volvedin cell cycle events, including histones and tumor suppressor proteins like the retinoblastoma gene product pRb. In addition to the positive regulatory role of cyclins and CAK, many negative regulatory proteins (CDK Inhibitors, CIGs) have been discovered, such as p16, p21, and p28. Since deregulation of cyclins and/or alteration or absence ofCKIs have been associated with many cancers, there is strong interest in chemical inhibitors of CDKs that could play an important role in the discovery of new family of antitumor agents. Since ATP is the authentic cofactor of CDK2 it can be considered as a \"pseudo-lead compound\" for discovery of CDK2 inhibitors. However there are two major concerns: adenine containing compounds are common ligants for many enzymes in cells, thus, any adenine derivatives may inhibit many enzymes in the cells: second, any highly charged compounds such as ATP will prevent them from uptake by cells. We report here the x-ray structures of CDK2 in complex with two different inhibitors, deschloro-flavopiridol(DFP) and Roscovitine. The structure of the binary complex CDK2-DFP was solved by molecular replacement and refined to Rfactor = 20.3% and the structure ofCDK2-Roscovitine was refined to Rfactor = 18.0 %. The deschloro-flavopiridol(DFP) is a flavone with a novel structure, compared to that of polyhydroxylated flavones. Previous studies have shown that flavopiridol, a flavonoid, can inhibit growth of breast and lung carcinoma cell lines. The Roscovitine is an adenine derivative and a potent CDK2 inhibitor. The two inhibitors are competitive inhibitors for ATP binding to CDK2 and bind to the ATP binding pocket ofCDK2. The comparison of the three-dimensional structures of CDK2-DFP and CDK2-Roscovitine with the CDK2-ATP shows that the hydrophobic adenine-binding pocket has a surprising ability to accommodate molecular structures that are different from ATP

Structural Basis for Interaction of Inhibitors with Cyclin-Dependent Kinase 2

Cell cycle progression is tightly controlled by the activity of cyclin-dependent kinases (CDKs). CDKs are inactive as monomers, and activation requires binding to cyclins, a diverse family of proteins whose levels oscillate during the cell cycle, and phosphorylation by CDK-activating kinase (CAK) on a specific threonine residue. The central role of CDKs in cell cycle regulation makes them a promising target for studying inhibitory molecules that can modify the degree of cell proliferation, the discovery of specific inhibitors of CDKs such as polyhydroxylated flavones has opened the way to investigation and design of antimitotic compounds. A chlorinated form, flavopiridol, is currently in phase II clinical trials as a drug against breast tumors. The aromatic portion of the inhibitor binds to the adenine-binding pocket of CDK2, and the position of the phenyl group of the inhibitor enables the inhibitor to make contacts with the enzyme not observed in the ATP complex structure, the analysis of the position of this phenyl ring not only explains the great differences of kinase inhibition among the flavonoid inhibitors but also explains the specificity of roscovitine and olomoucine to inhibit CDK2. There is strong interest in CDKs inhibitors that could play an important role in the discovery of a new family of antitumor agents. The crystallographic analysis together with bioinformatics studies of CDKs are generating new information about the structural basis for inhibition of CDKs. The relevant structural features that may guide the structure based-design of a new generation of CDK inhibitors are discussed in this review.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

A influência do fator de vibração térmica na densidade eletrônica de cristais bidimensionais

Este trabalho mostra o efeito da vibração térmica na densidade eletrônica de cristais bidimensionais, usando o programa Mathematica. É apresentado um modelo de cristal simples para ajudar no ensino de conceitos básicos relacionados à cristalografia.This work shows the effect of thermal vibration on the electron density for two dimensional crystals, using the program Mathematica. It is presented a simple crystal model to help on teaching the basic concepts related to crystallography.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES