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.

Proteomic Approaches Identify Members of Cofilin Pathway Involved in Oral Tumorigenesis

The prediction of tumor behavior for patients with oral carcinomas remains a challenge for clinicians. The presence of lymph node metastasis is the most important prognostic factor but it is limited in predicting local relapse or survival. This highlights the need for identifying biomarkers that may effectively contribute to prediction of recurrence and tumor spread. In this study, we used one-and two-dimensional gel electrophoresis, mass spectrometry and immunodetection methods to analyze protein expression in oral squamous cell carcinomas. Using a refinement for classifying oral carcinomas in regard to prognosis, we analyzed small but lymph node metastasis-positive versus large, lymph node metastasis-negative tumors in order to contribute to the molecular characterization of subgroups with risk of dissemination. Specific protein patterns favoring metastasis were observed in the "more-aggressive'' group defined by the present study. This group displayed upregulation of proteins involved in migration, adhesion, angiogenesis, cell cycle regulation, anti-apoptosis and epithelial to mesenchymal transition, whereas the "less-aggressive'' group was engaged in keratinocyte differentiation, epidermis development, inflammation and immune response. Besides the identification of several proteins not yet described as deregulated in oral carcinomas, the present study demonstrated for the first time the role of cofilin-1 in modulating cell invasion in oral carcinomas.

Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

Abstract Background Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil. Methods The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach. Results The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country. Conclusions The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.

Petrology of Gameleira potassic lamprophyres, São Francisco Craton

Gameleira lamprophyres are dykes and mafic microgranular enclaves associated with the shoshonitic Gameleira monzonite. This association belongs to the Paleoproterozoic alkaline magmatism from Serrinha nucleus, northeast Brazil. The liquidus paragenesis is diopside, pargasite, apatite and mica. Reverse zoning was identified in the groundmass alkali feldspar and was related to the undercooling of lamprophyric magma during the emplacement, with high growth rate of pargasite/edenite inducing disequilibrium between feldspars and liquid. Chemical data indicate that the lamprophyres are basic rocks (SiO2 < 48 wt%), with alkaline character (Na2O + K2O > 3 wt%) and potassic signature (K2O/Na2O ≈ 2). High contents of MgO and Cr are consistent with a signature of a primary liquid, and such concentrations, as well as Al, K, P, Ba, Ni- and light rare earth elements, are consistent with an olivine-free metasomatic mantle source enriched in amphibole, clinopyroxene and apatite. By contrast, the ultrapotassic lamprophyres from Morro do Afonso, contemporaneous alkaline ultrapotassic magmatism in Serrinha nucleus, were probably produced by melting of a clinopyroxene-phlogopite-apatite enriched-source. The identification of different mineral paragenesis in the source of potassic and ultrapotassic lamprophyres from Serrinha nucleus can contribute to the understanding of the mantle heterogeneities and tectonic evolution of this region.

Water transfer from São Francisco river to semiarid northeast of Brazil: technical data, environmental impacts, survey of opinion about the amount to be transferred

The transposition of the São Francisco River is considered one of the greatest engineering works in Brazil of all time since it will cross an extensive agricultural region of continental dimensions, involving environmental impacts, water, soil, irrigation, water payment and other multidisciplinary themes. Taking into account its importance, this subject was incorporated into a discipline of UFSCar (Federal University of São Carlos - Brazil) named "Pollution and Environmental Impacts". It was noted strong reaction against the project, even before the presentation. To allow a critical analysis, the first objective was to compile the main technical data and environmental impacts. The second objective was to detect the three most important aspects that cause reaction, concluding for the following reasons: assumption that the volume of water to be transferred was much greater than it actually is proposed in the project; lack of knowledge about similar project already done in Brazil; the idea that the artificial canal to be built was much broader than that proposed by the project. The participants' opinion about "volume to be transferred" was raised quantitatively four times: 2-undergraduate students; 1-graduate; 1-outside community. The average resulted 14 times larger than that proposed in the project, significant according to t-test. It was concluded that the reaction to water transfer project is due in part to the ignorance combined with a preconceived idea that tend to overestimate the magnitude of environmental impacts.

400 anos do De Legibus de Francisco SUAREZ (1548-1617)

O artigo destaca a importância da contribuição de Francisco SUAREZ (1548- 1617) para a evolução do direito internacional, com ênfase nas questões práticas que este teve de enfrentar para formular soluções legais – o dado central da obra é a afirmação da unidade intrínseca da humanidade, em comunidade internacional formando um todo, apesar de dividida em povos e reinos. Observa o caráter de continuidade histórica entre o legado medieval e o Direito Internacional moderno, do qual o tratado Das leis e Deus legislador (1612) foi marco relevante.

Reflexões sobre a formação do acervo da Academia de Direito do Largo de São Francisco: do século XIX aos nossos dias

O trabalho apresenta algumas reflexões sobre a história da formação do acervo acadêmico dos cursos jurídicos do Brasil criados no século XIX, especificamente da Faculdade de Direito da Universidade de São Paulo. A primeira Biblioteca Pública de São Paulo, fundada em 1825, exerceu forte influência para que o Convento dos frades franciscanos recebesse a escola de direito criada por Decreto Imperial, em razão de seu fundo bibliográfico de 5.000 mil livros, preponderantemente de cunho eclesiástico, e considerável para os padrões culturais do Brasil à época. Atualmente configura-se como uma importante biblioteca jurídica acadêmica da América Latina e, ao longo da sua história tem sido uma instituição de depósito moral, isto é, recebe doações das mais diversas localidades do país, encaminhadas espontaneamente pelos autores para ter sua obra disponibilizada no acervo do primeiro e um dos mais tradicionais cursos de Direito do Brasil. Atualmente, este acervo está estimado em aproximadamente 400 mil itens, com doações de personalidades brasileiras. Outro ponto estudado refere-se ao estabelecimento de critérios para seleção de material – corpo editorial, autores de renome, relevância nos temas abordados etc. – em razão do boom editorial ocorrido na década de 1990, concomitante com o aumento de escolas de Direito no país. Chama-se à reflexão de quem atua na seara jurídica para atentar a pontos relevantes no momento da seleção para não incorrer no erro de avaliar com preconceito, modernidade, ideológico, interesse de estudo pessoal ou embasado apenas na data de publicação da obra. As ciências humanas, diferentemente de outras áreas, têm sua obsolescência mais lenta ou inexistente, decorrendo em grave erro para o Direito julgar exclusivamente pela data de publicação, o que torna premente aos profissionais bibliotecários dominarem conceitos básicos na área de atuação para que as bibliotecas sejam depositárias de material bibliográfico de qualidade.

Concienciación y educación ambiental en Canarias : los inicios del conservacionismo en las islas, a partir de las campañas a favor del arbolado de Francisco González Diaz, 1901-1936

Programa de doctorado en Análisis geográfico y ordenación territorial

Clase magistral del catedrático de la Escuela de Arquitectura de la Universidad Politécnica de Madrid, Francisco Javier Neila González

[ES]Celebrada en la Escuela de Arquitectura de la Universidad de Las Palmas de Gran Canaria, miércoles 21 de octubre de 2015. Clase del Máster universitario Arquitectura y acondicionamiento con tecnologías de comunicaciones para hoteles sustentables, A2TECHS. Dentro de la asignatura Análisis de Modelos Hoteleros Sustentables.

Proposta di traduzione in italiano commentata del racconto “O Verdadeiro Pecado de Xoán Zalzívar” della scrittrice portoghese Leonor Xavier

Lo scopo di questo elaborato è di presentare una proposta di traduzione verso l’italiano del racconto O Verdadeiro Pecado de Xoán Zalzívar della scrittrice portoghese Leonor Xavier, pubblicato all’interno della raccolta Picante – Histórias que ardem na boca. Dopo aver presentato brevemente la biografia e la bibliografia dell’autrice, ci si è soffermati sulla raccolta e sul racconto stesso. In particolare, sono state presentate le tematiche narrate e il filo conduttore della raccolta e successivamente è stata illustrata la trama del racconto. Al centro di questo elaborato vi è la traduzione e la rispettiva analisi. Infatti, è stata rivolta una particolare attenzione alle difficoltà nella resa in italiano, come la ricetta e i suoi ingredienti, le espressioni idiomatiche presenti nel testo di partenza, l’uso delle formule di cortesia e le scelte stilistiche della scrittrice.