Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

La economía del cambio climático en el Perú

Aborda cómo el cambio climático afectaría la actividad económica nacional, evaluando las potenciales modificaciones en la disponibilidad de los recursos naturales y las actividades productivas más sensibles a cambios en el clima (agricultura, ganadería altoandina, minería, energía hidroeléctrica, turismo y pesca), tanto en términos físicos como sociales. También se analizan dos sectores transversales, la infraestructura y la salud, que son condicionantes para el desempeño productivo. El citado documento es resultado de una investigación a nivel de país basada en la metodología establecida en el Informe Stern (2007). Así, mediante el uso de escenarios y modelos climáticos globales, los impactos económicos del calentamiento global en la economía del Perú se calculan como la diferencia entre el PBI con ausencia y presencia del cambio climático, en un periodo de análisis que se extiende hasta el año 2100. Además de caracterizar los principales impactos sectoriales, se identifican opciones de adaptación y mitigación que contribuyan al desarrollo sostenible del país

Genetic diversity of pacu and piapara broodstocks in restocking programs in the rivers Paraná and Paranapanema (Brazil) Diversidade genética de estoques de Pacu e Piapara em programas de repovoamento nos rios Paraná e Paranapanema (Brasil)

Abstract The genetic diversity of Piaractus mesopotamicus (pacu) and Leporinus elongatus (piapara) broodstocks used in restocking programs in the rivers Paraná and Paranapanema is analyzed. One hundred and twenty specimens (two broodstocks of each species) from fish ponds in Palotina PR Brazil and in Salto Grande SP Brazil were assessed. Ten primers produced 96 fragments, comprising 68 (70.83%) and 94 (97.92%) polymorphic fragments for P. mesopotamicus and L. elongatus broodstocks, respectively. Differences (p &lt;0.05) in the frequency of 15 and 27 fragments were detected for each species, without exclusive fragments. Shannon Index (0.347 -0.572) and the percentage of polymorphic fragments (57.3% -94.8%) revealed high intra-population genetic variability for all broodstocks. Results of molecular variance analyses (AMOVA) showed that most variations do not lie between the broodstocks but within each broodstock (89%). Genetic (0.088 and 0.142) and identity (0.916 and 0.868) distance rates demonstrated similarity between the broodstocks of each species, corroborated by Fst (0.1023 and 010.27) and Nm (4.18 and 4.33) rates, with a slight genetic difference due to genic flux. High intrapopulation genetic variability and similarity between the broodstocks of each species was also detected, proving a common ancestry. Resumo O objetivo da pesquisa foi analisar a diversidade genética de estoques de Pacu (Piaractus mesopotamicus) e Piapara (Leporinus elongatus) utilizados em programas de repovoamento dos rios Paraná e Paranapanema. Foram analisados 120 exemplares (dois estoques de cada espécie) de pisciculturas das cidades de Palotina (Paraná) e da cidade de Salto Grande (São Paulo). Os 10 iniciadores produziram 96 fragmentos, dos quais 68 (70,83%) e 94 (97,92%) foram polimórficos para os estoques de P. mesopotamicus e L. elongatus, respectivamente. Foram observadas diferenças (P &lt;0,05) na frequência de 15 e 27 fragmentos para cada espécie, sem a presença de fragmentos exclusivos. Os valores do índice de Shannon (0,347 a 0,572) e da porcentagem de fragmentos polimórficos (57,3% a 94,8%) mostraram uma alta variabilidade genética intra-populacional para todos os estoques. Os resultados das análises de variância molecular (AMOVA) mostraram que a maior parte da variação está dentro de cada estoque (89%) e não entre os estoques. Os valores da distância (0,088 e 0,142) e identidade (0,916 e 0,868) genética demonstraram que existe similaridade entre os estoques de cada espécie, sendo corroborado pelos valores de Fst (0,1023 e 010,27) e Nm (4,18 e 4,33) que mostraram uma moderada diferenciação genética com presença de fluxo gênico. Foi observada alta variabilidade genética intra-populacional e similaridade entre os estoques de cada espécie demonstrando uma origem em comum

Genetic diversity of pacu and piapara broodstocks in restocking programs in the rivers Paraná and Paranapanema (Brazil)

O objetivo da pesquisa foi analisar a diversidade genética de estoques de Pacu (Piaractus mesopotamicus) e Piapara (Leporinus elongatus) utilizados em programas de repovoamento dos rios Paraná e Paranapanema. Foram analisados 120 exemplares (dois estoques de cada espécie) de pisciculturas das cidades de Palotina (Paraná) e da cidade de Salto Grande (São Paulo). Os 10 iniciadores produziram 96 fragmentos, dos quais 68 (70,83%) e 94 (97,92%) foram polimórficos para os estoques de P. mesopotamicus e L. elongatus, respectivamente. Foram observadas diferenças (P < 0,05) na frequência de 15 e 27 fragmentos para cada espécie, sem a presença de fragmentos exclusivos. Os valores do índice de Shannon (0,347 a 0,572) e da porcentagem de fragmentos polimórficos (57,3% a 94,8%) mostraram uma alta variabilidade genética intra-populacional para todos os estoques. Os resultados das análises de variância molecular (AMOVA) mostraram que a maior parte da variação está dentro de cada estoque (89%) e não entre os estoques. Os valores da distância (0,088 e 0,142) e identidade (0,916 e 0,868) genética demonstraram que existe similaridade entre os estoques de cada espécie, sendo corroborado pelos valores de Fst (0,1023 e 010,27) e Nm (4,18 e 4,33) que mostraram uma moderada diferenciação genética com presença de fluxo gênico. Foi observada alta variabilidade genética intra-populacional e similaridade entre os estoques de cada espécie demonstrando uma origem em comum.The genetic diversity of Piaractus mesopotamicus (pacu) and Leporinus elongatus (piapara) broodstocks used in restocking programs in the rivers Paraná and Paranapanema is analyzed. One hundred and twenty specimens (two broodstocks of each species) from fish ponds in Palotina PR Brazil and in Salto Grande SP Brazil were assessed. Ten primers produced 96 fragments, comprising 68 (70.83%) and 94 (97.92%) polymorphic fragments for P. mesopotamicus and L. elongatus broodstocks, respectively. Differences (p < 0.05) in the frequency of 15 and 27 fragments were detected for each species, without exclusive fragments. Shannon Index (0.347 - 0.572) and the percentage of polymorphic fragments (57.3% - 94.8%) revealed high intra-population genetic variability for all broodstocks. Results of molecular variance analyses (AMOVA) showed that most variations do not lie between the broodstocks but within each broodstock (89%). Genetic (0.088 and 0.142) and identity (0.916 and 0.868) distance rates demonstrated similarity between the broodstocks of each species, corroborated by Fst (0.1023 and 010.27) and Nm (4.18 and 4.33) rates, with a slight genetic difference due to genic flux. High intrapopulation genetic variability and similarity between the broodstocks of each species was also detected, proving a common ancestry

Effects of dietary β-glucans on the productive performance, blood parameters, and intestinal microbiota of angelfish (Pterophyllum scalare) juveniles

Abstract Among the potential feed additives, β-glucans are known to positively affect the growth performance, blood parameters, and intestinal microbiota of fish, even the ornamental species. Therefore, the present study evaluated the effects of the dietary supplementation of different Saccharomyces cerevisiae β-glucans concentrations (0, 0.05, 0.1, and 0.2%) in juvenile angelfish (Pterophyllum scalare) over a 42-day period. Regarding growth performance, no effects were observed on most parameters. However, 0.2% β-glucans supplementation produced higher condition factor values, indicating a better nutritional status. Furthermore, β-glucans supplementation did not affect blood parameters. Regarding intestinal microbiota, β-glucans supplementation increased the abundance of the potentially beneficial bacterial genus Phascolarctobacterium. The high abundance of bacteria from the phylum Bacteroidetes, which can degrade β-glucans, may be attributed to the increased abundance of Phascolarctobacterium spp. In addition, 0.2% β-glucans supplementation produced more operational taxonomic units and higher Sobs (observed species richness), indicating effects on the overall bacterial community structure. These results demonstrate the potential application of β-glucans as a dietary supplement to improve the performance and modulate the intestinal microbiota of angelfish

Effects of dietary supplementation with a microalga (Schizochytrium sp.) on the hemato-immunological, and intestinal histological parameters and gut microbiota of Nile tilapia in net cages.

Nutritional improvements in intensive aquaculture production systems is necessary for the reduction of stress, maximum utilization of nutritional components, and expression of the genetic potential of fish. The objective of this study was to evaluate the hemato-immunological, and histological parameters and gut microbiota of Nile tilapia fed with the microalga Schizochytrium sp. Males of Nile tilapia were distributed among eight net cages (6 m3), and fed for 105 days with two diets: control (CON), without Schizochytrium sp., and supplemented (SUP), with 1.2% Schizochytrium sp. in the diet. The final weight, mortality, hematocrit, total erythrocyte count (RBC), hemoglobin, hematimetric indices, white blood cell count (WBC), total protein, and serum lysozyme were measured. Alterations in intestinal morphology were evaluated. The gut microbiota was evaluated with next-generation sequencing. No significant differences (p>0.05) were found in the final weight and mortality between diets. Regarding the hematological parameters, a difference (p0.05) in total protein and serum lysozyme concentrations or in WBCs between diets, except for lymphocytes, which presented lower values (p0.05) in the intestinal morphology between diets. Metagenomic data indicated greater richness (represented by the Chao index) and a higher abundance of the bacterial phylum Firmicutes in the gut microbiota of the tilapia fed with the SUP diet, demonstrating that the digestion and use of the components of the microalga could influence the microbial community. The results indicated that the microalga had modulatory effects on blood cells and the intestinal microbiota, without affecting the structure and integrity of the intestinal villi

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013