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

Efeito da suplementação de taurina na oxidação de substratos energéticos e no desempenho de atletas nadadores

A taurina é um aminoácido livre, abundante no meio intracelular, sendo indispensável para felinos e condicionalmente indispensável em humanos. É um composto final do metabolismo dos aminoácidos sulfurados (metionina e cisteína). Suas funções principais são osmorregulação, modulação do cálcio iônico, estabilização da membrana plasmática, detoxificação dos ácidos biliares, desenvolvimento do sistema nervoso central e da retina, neurotransmissor inibitório, imunomodulação e atividade antioxidante, diminuição da formação do ácido hipocloroso (HOCl-) na eclosão fagocitária e, também, possível modulação das citocinas pró-inflamatórias. Acredita-se que por meio da suplementação de taurina ocorrerão alterações no desempenho físico e oxidação de nutrientes em atletas de natação. O objetivo do presente trabalho é avaliar a taxa de oxidação de nutrientes em repouso, bem como o desempenho físico e a ingestão energética antes e após a suplementação de taurina durante o período de treinamento. Será avaliado o efeito da suplementação de taurina por oito semanas em 16 atletas nadadores de elite, do sexo masculino de Ribeirão Preto. Foram realizadas medidas de calorimetria indireta, oxidação de nutrientes e nitrogênio urinário, avaliação da taurina plasmática, avaliação da ingestão alimentar e avaliação de desempenho através de medidas de lactato. Os valores de taurina plasmática apresentaram diferença estatística. O lactato aumentou no grupo que recebeu taurina, sendo que este aumento apresentou diferença estatística, as outras variáveis não apresentaram diferenças. Conclui-se que a suplementação de taurina...Taurine is a free amino acid, abundant intracellularly, that is essential for cats and conditionally essential for humans. Thus, it is believed that taurine supplementation is able to promote positive changes in physical performance and oxidation of nutrients in elite swimmers. The purpose of this study is to evaluate the rate of oxidation of nutrients at rest as well as physical performance and energy intake before and after supplementation of taurine throughout the training period. The effect of taurine supplementation was assessed for eight weeks in 16 elite male swimmers from Ribeirão Preto. Measurements of indirect calorimetry, oxidation of nutrients and urinary nitrogen were performed and the assessments of plasma taurine and food intake as well as the performance evaluation through measurements of lactate. The values of plasma taurine showed statistical difference. Lactate increased in the group that received taurine, whereas this increase showed statistical difference, the other variables showed no differences. It is concluded that taurine supplementation increased plasma concentration of taurine, however caused no... (Complete abstract click electronic access below

Estilo de vida e estado nutricional de pacientes diabéticos

Objective: to assess the nutritional status, dietary profile and lifestyle of diabetic patients. Methods: Nutritional assessment and a semi-structured questionnaire were carried out. Results: 120 patients participated. 23.33% (28) male and 76.66% (92) female, age ≥ 60 years 74.1 %% (89). Arterial hypertension, 66.6% (80) and hypercholesterolemia 31.6% (38), family history of Diabetes and SAH 56% (46.6), constipation 35% (29.1), obesity 29% (24, 1), overweight 45% (37.5), do not follow a specific diet 70% (58.3), sedentary 70% (58.3), make use of metiformin 54% (45), insulin 32% (26), use only NPH 70% (58.3) and NPH associated with Regular 30% (25), antihypertensive 83% (69.1). Conclusions: Most of the participants presented overweight and obesity, associated comorbidities and do not follow a specific diet, a factor in reducing quality of life, where the FHS is the best space for health education.Objetivo: avaliar o estado nutricional, o perfil dietético e o estilo de vida de pacientes diabéticos Métodos: Realizouse avaliação nutricional e aplicação de questionário semi-estruturado. Resultados: 120 pacientes participaram. 23,33% (28) do sexo masculino e 76,66% (92) feminino, idade ≥ 60 anos 74,1%% (89). Hipertensão arterial, 66,6% (80) e hipercolesterolemia 31,6% (38), histórico familiar de Diabetes e HAS 56% (46,6), constipação intestinal 35% (29,1), obesidade 29% (24,1), sobrepeso 45% (37,5), não seguem dieta específica 70% (58,3), sedentários 70% (58,3), fazem uso de metiformina 54% (45), insulina 32% (26), usam apenas NPH 70% (58,3) e NPH associada à Regular 30% (25), antihipertensivos 83% (69,1). Conclusões: A maioria dos participantes apresentou sobrepeso e obesidade, comorbidades associadas e não segue dieta específica, fator de redução da qualidade de vida, onde a ESF é o melhor espaço para educação em saúde.Objetivo: evaluar el estado nutricional, el perfil dietético y el estilo de vida de los pacientes diabéticos. Metodos: Se realizó valoración nutricional y cuestionario semiestructurado. Resultados: Participaron 120 pacientes. 23,33% (28) hombres y 76,66% (92) mujeres, edad ≥ 60 años 74,1 %% (89). Hipertensión arterial, 66,6% (80) e hipercolesterolemia 31,6% (38), antecedentes familiares de Diabetes y HSA 56% (46,6), estreñimiento 35% (29,1), obesidad 29% (24, 1), sobrepeso 45% (37,5), no sigue una dieta específica 70% (58,3), sedentario 70% (58,3), hace uso de metiformina 54% (45), insulina 32% (26), use solo NPH 70% (58,3) y NPH asociado con Regular 30% (25), antihipertensivo 83% (69,1). Conclusiones: La mayoría de los participantes presentaban sobrepeso y obesidad, comorbilidades asociadas y no siguen una dieta específica, factor de reducción de la calidad de vida, donde la ESF es el mejor espacio para la educación para la salud

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

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field