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

ACETATO DE TRIANCINOLONA COMO PRÉ-INDUTOR DO PARTO DE RECEPTORAS DE EMBRIÃO NELORE PRODUZIDOS IN VITRO INDUCTION OF PARTURITION USING TRIAMCINOLONE PRETREATMENT IN PREGNANT RECIPIENTS OF IN VITRO PRODUCED EMBRYO

Este estudo teve como objetivo avaliar o efeito de diferentes doses e momentos da gestação para a administração do acetato de triancinolona (TRI) na pré-indução de partos. Utilizaram-se como modelo experimental receptoras de embriôes Nelore produzidos in vitro (PIV). Cento e setenta e cinco receptoras gestantes foram distribuídas em quatro grupos experimentais de acordo com o tempo gestacional (280 ou 285 dias) e a dose de TRI (1mg/60 Kg ou 1mg/100 Kg de Peso Vivo). Avaliaram-se o momento da gestação, as taxas de sincronização e de assistência aos partos, a viabilidade e o peso dos bezerros e ainda a taxa de retenção de placenta. A dose de TRI não alterou os parâmetros avaliados (p>0,05). Houve maior sincronização dos partos (p<0,05) quando o TRI foi administrado aos 280 dias em relação aos 285 dias de gestação. Os partos de bezerros mais pesados (?42 kg) necessitaram maior assistência (p?0,05). Trata-se de produtos que apresentaram menor viabilidade (p?0,05) quanto aos partos de bezerros mais leves. Conclui-se que, independente da dose de TRI, a pré-indução aos 280 dias de gestação resulta em maior sincronização e melhor previsibilidade dos nascimentos, quando comparada à pré-indução aos 285 dias, sem comprometer a viabilidade dos bezerros.<br /><br />PALAVRAS-CHAVES: Corticoide de longa ação, indução de parto, retenção de placenta. The aim of the present study was to evaluate the effect of two doses of acetonide triamcinolone (TRI) at two distinct moments of gestation in the pre induction of parturition. Embryo recipients pregnant of the in vitro produced embryo were utilized as experimental model. A total of 175 pregnant embryo recipients were assigned into one of the four groups according to gestational period (280 or 285 days) and utilized dose of the TRI (1mg/60Kg or 1mg/100kg of body weight). The synchronization and assistance rates of the calving, the viability and body weight of calves at calving as well as retained placenta rate were evaluated. The TRI dose did not effect any variables responses (p>0.05). Least spread of the calving moment was observed in the recipients treated at the 280 days of gestation (p?0.05). The cow calving calf with ?42kg needed more assistance to calving (p?0.05) and these calves had lower viability than calves with <42Kg of the body weight (p?0.05). The data suggested that, independent of dose of the TRI, the pre induction with TRI at 280 days of gestation promote a good synchronization in the calving with a high predictable calving time without compromise the calf viability when compared with the pre induction at 285 days of gestation.<br /><br />KEY WORDS: Induction of parturition, long action corticoid, retention placenta.<br /&gt

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

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