RESUMO
OBJECTIVES: To determine the association between mean airway pressure and 90-day mortality in patients with acute respiratory failure requiring mechanical ventilation and to compare the predictive ability of mean airway pressure compared with inspiratory plateau pressure and driving pressure. DESIGN: Prospective observational cohort. SETTING: Five ICUs in Lima, Peru. SUBJECTS: Adults requiring invasive mechanical ventilation via endotracheal tube for acute respiratory failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of potentially eligible participants (n = 1,500), 65 (4%) were missing baseline mean airway pressure, while 352 (23.5%) were missing baseline plateau pressure and driving pressure. Ultimately, 1,429 participants were included in the analysis with an average age of 59 ± 19 years, 45% female, and a mean PaO2/FIO2 ratio of 248 ± 147 mm Hg at baseline. Overall, 90-day mortality was 50.4%. Median baseline mean airway pressure was 13 cm H2O (interquartile range, 10-16 cm H2O) in participants who died compared to a median mean airway pressure of 12 cm H2O (interquartile range, 10-14 cm H2O) in participants who survived greater than 90 days (p < 0.001). Mean airway pressure was independently associated with 90-day mortality (odds ratio, 1.38 for difference comparing the 75th to the 25th percentile for mean airway pressure; 95% CI, 1.10-1.74) after adjusting for age, sex, baseline Acute Physiology and Chronic Health Evaluation III, baseline PaO2/FIO2 (modeled with restricted cubic spline), baseline positive end-expiratory pressure, baseline tidal volume, and hospital site. In predicting 90-day mortality, baseline mean airway pressure demonstrated similar discriminative ability (adjusted area under the curve = 0.69) and calibration characteristics as baseline plateau pressure and driving pressure. CONCLUSIONS: In a multicenter prospective cohort, baseline mean airway pressure was independently associated with 90-day mortality in mechanically ventilated participants and predicts mortality similarly to plateau pressure and driving pressure. Because mean airway pressure is readily available on all mechanically ventilated patients and all ventilator modes, it is a potentially more useful predictor of mortality in acute respiratory failure.
Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Respiração por Pressão Positiva Intrínseca/fisiopatologia , Respiração Artificial/mortalidade , Síndrome do Desconforto Respiratório/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Peru , Estudos Prospectivos , Volume de Ventilação PulmonarRESUMO
The Mediterranean monk seal (Monachus monachus) is an emblematic species of conservation concern. Anthropogenic pressures have led to severe population declines and significant fragmentation of the remaining populations. Because of their close relationship with coastal areas, Mediterranean monk seals may be potentially exposed to pollution from agricultural sources, as well as from oil tanker spills. Although monitoring of pollution has long been considered a priority for this species, data on monk seal contamination levels are scarce. In this study, 55 blubber samples of all genders and age classes collected during necropsies (1995-2013) from seals of the Eastern Mediterranean subpopulation were analyzed for organochlorine compounds (OCs), i.e., hexachlorobenzene (HCB), polychlorinated biphenyls (PCBs) and dichlorodiphenyltrichloroethane (DDTs), and polycyclic aromatic hydrocarbons (PAHs). Overall, PCBs > DDTs â« PAHs > HCB in all samples. Results showed a significant downward trend over the 19-year period for DDTs and HCB. No marked pattern was found for PAHs, even though relative abundance of cancerogenic PAH fraction rose in recent years. PCB levels in subadult specimens increased noticeably over time despite worldwide ban. Our findings did not suggest recent releases of DDT or new pesticides (e.g., Dicofol) in the environment, but may indicate an improper disposal of ancient storages of PCBs or a remobilization from reservoirs. OC levels exceeded thresholds that are commonly associated with immunosuppression and reproductive impairment in other pinnipeds. Hence, OCs could be responsible of potential toxicological effects in this subpopulation. This study represents the first report on PAH and one of the few reports on OC bioaccumulation in Mediterranean monk seals. Based on the levels found in the blubber of monk seals from the Eastern Mediterranean, and given the known harmful effects associated to the prolonged exposure to these substances and the reduced long-term expectations of species recovery, regular monitoring is advocated.
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Hidrocarbonetos Clorados , Bifenilos Policlorados , Hidrocarbonetos Policíclicos Aromáticos , Focas Verdadeiras , Poluentes Químicos da Água , Animais , Feminino , Masculino , Bifenilos Policlorados/análise , Hexaclorobenzeno/análise , Mar Mediterrâneo , Hidrocarbonetos Clorados/análise , DDT/análise , Monitoramento Ambiental , Poluentes Químicos da Água/análiseRESUMO
Dolphin-fishery interaction is a worldwide issue affecting dolphins through bycatch and fishers through catch or gear damages. Concerning the Mediterranean Sea, problematic interactions mainly occur between common bottlenose dolphin and small-scale fisheries. Acoustic Deterrent Devices such as pingers, are one of the most widespread measures used in attempts to face this issue. Therefore, the efficiency of interactive pingers (DiD01) in protecting the trammel nets from dolphin interactions was assessed in the Northern Tyrrhenian Sea. From March to October 2021, a total of 139 fishing trials using nets with pingers (TEST) and without pingers (CTRL), respectively n = 97 and n = 42, were carried out. Non-parametric statistic of the Catch per Unit Effort, comparing control and test nets, was not significantly different (p > 0.05) using catches weights (CPUEW) while it was significant (p < 0.01) considering the number of individuals (CPUEN). Moreover, richness and relative abundance of species resulted statistically higher in test nets (p < 0.05). This finding suggests that the absence of dolphin in the neighbourhood of fishing areas thanks to the use of pingers increases the diversity of target species. Catch damages caused by dolphins were statistically higher in nets without pinger than in nets with pinger (p < 0.05). No dolphin bycatch was recorded during fishing operations.
Assuntos
Golfinho Nariz-de-Garrafa , Pesqueiros , Animais , Mar MediterrâneoRESUMO
Nanoplastics (≤100 nm) represent the smallest fraction of plastic litter and may result in the aquatic environment as degradation products of larger plastic material. To date, few studies focused on the interactions of micro- and nanoplastics with freshwater Decapoda. The red swamp crayfish (Procambarus clarkii, Girard, 1852) is an invasive species able to tolerate highly perturbed environments. As a benthic opportunistic feeder, this species may be susceptible to plastic ingestion. In this study, adult P. clarkii, at intermolt stage, were exposed to 100 µg of 100 nm carboxylated polystyrene nanoparticles (PS NPs) through diet in a 72 h acute toxicity test. An integrated approach was conceived to assess the biological effects of PS NPs, by analyzing both transcriptomic and physiological responses. Total hemocyte counts, basal and total phenoloxidase activities, glycemia and total protein concentration were investigated in crayfish hemolymph at 0 h, 24 h, 48 h and 72 h from PS NPs administration to evaluate general stress response over time. Differentially expressed genes (DEGs) in the hemocytes and hepatopancreas were analyzed to ascertain the response of crayfish to PS NP challenge after 72 h. At a physiological level, crayfish were able to compensate for the induced stress, not exceeding generic stress thresholds. The RNA-Sequencing analysis revealed the altered expression of few genes involved in immune response, oxidative stress, gene transcription and translation, protein degradation, lipid metabolism, oxygen demand, and reproduction after PS NPs exposure. This study suggests that a low concentration of PS NPs may induce mild stress in crayfish, and sheds light on molecular pathways possibly involved in nanoplastic toxicity.
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Astacoidea , Vitelogeninas , Animais , Hepatopâncreas/metabolismo , Estresse Oxidativo , Poliestirenos/metabolismo , Vitelogeninas/genética , Vitelogeninas/metabolismoRESUMO
Bio-accumulation of high levels of persistent organic pollutants represent a serious conservation concern for Mediterranean marine odontocetes. In this study, blubber samples from 10 striped dolphins (Stenella coeruleoalba) stranded along the Italian coasts during 2015-2016 were analyzed. All specimens showed dl-PCBs > PBDEs â« PCDD/Fs. Median concentrations were 1820 ng/g l.w., 456 ng/g l.w. and 23.9 pg/g l.w., respectively. dl-PCBs accounted for 93.3% of total TEQs. PBDE concentrations suggest that the Mediterranean basin may be considered a hotspot for organobromine compounds. OCDD did not represent the greatest contributor to PCDD/Fs profile, most likely due to a change in dioxin environmental sources in the last two-three decades. Despite international regulations, the present study emphasized that POP exposure levels in Mediterranean striped dolphins have not declined significantly in recent years. Toxicological and risk assessment studies on this sentinel species may provide an early indication of potential adverse health effects on Mediterranean ecosystems.
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Dioxinas/análise , Bifenilos Policlorados/análise , Dibenzodioxinas Policloradas/análise , Stenella , Animais , Dibenzofuranos , Dibenzofuranos Policlorados , Ecossistema , Monitoramento Ambiental , Éteres Difenil Halogenados/análiseRESUMO
This study reports the identification of four novel proline-rich antimicrobial peptides (PR-AMP) from the transcriptome of the red swamp crayfish Procambarus clarkii. The newly identified putative peptides (PcAst-1b, -1c, -2 and -3), which are related with the previously identified hemocyte-specific PR-AMP astacidin-1, are encoded by the multi-genic astacidin gene family. The screening of available and proprietary transcriptomes allowed to define the taxonomical range of distribution of this gene family to Astacoidea and Parastacoidea. The antimicrobial properties of three synthetic PcAst peptides (PcAst-1a, -1b/c and -2), were characterized against reference bacteria or multidrug resistant clinical isolates, and their cytotoxicity was evaluated towards human transformed cell lines. The antimicrobial activity ranged from potent and broad-spectrum, in low-salt medium, to poor, whereas it was generally low in full nutrient broth. No significant toxic effects were observed on cultured human cells. RNA-seq data from 12 different tissues indicated a strong specificity for haemocytes under naïve physiological condition, with moderate expression (5-fold lower) in gills. Quantitative real time PCR revealed a rapid (within 2 h) and significant up-regulation of PcAst-1a (Astacidin 1) and PcAst-2 expression in response to LPS injection. Due to the variation in antimicrobial potency and inducibility, the roles of the other astacidins (PcAst-1b, -1c and -3) need to be further investigated to determine their significance to the immune responses of the red swamp crayfish.
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Peptídeos Catiônicos Antimicrobianos/imunologia , Proteínas de Artrópodes/imunologia , Astacoidea/imunologia , Células Epiteliais/fisiologia , Hemócitos/imunologia , Linfócitos/fisiologia , Peptídeos/imunologia , Animais , Peptídeos Catiônicos Antimicrobianos/genética , Peptídeos Catiônicos Antimicrobianos/metabolismo , Proteínas de Artrópodes/genética , Proteínas de Artrópodes/metabolismo , Células Cultivadas , Evolução Molecular , Regulação da Expressão Gênica , Humanos , Imunidade Inata , Lipopolissacarídeos/imunologia , Peptídeos/genética , Peptídeos/metabolismo , Filogenia , Prolina/genética , TranscriptomaRESUMO
INTRODUCTION: Mechanical ventilation is a cornerstone in the management of critically ill patients worldwide; however, less is known about the clinical management of mechanically ventilated patients in low and middle income countries where limitation of resources including equipment, staff and access to medical information may play an important role in defining patient-centred outcomes. We present the design of a prospective, longitudinal study of mechanically ventilated patients in Peru that aims to describe a large cohort of mechanically ventilated patients and identify practices that, if modified, could result in improved patient-centred outcomes and lower costs. METHODS AND ANALYSIS: Five Peruvian intensive care units (ICUs) and the Medical ICU at the Johns Hopkins Hospital were selected for this study. Eligible patients were those who underwent at least 24â h of invasive mechanical ventilation within the first 48â h of admission into the ICU. Information on ventilator settings, clinical management and treatment were collected daily for up to 28â days or until the patient was discharged from the unit. Vital status was assessed at 90â days post enrolment. A subset of participants who survived until hospital discharge were asked to participate in an ancillary study to assess vital status, and physical and mental health at 6, 12, 24 and 60â months after hospitalisation, Primary outcomes include 90-day mortality, time on mechanical ventilation, hospital and ICU lengths of stay, and prevalence of acute respiratory distress syndrome. In subsequent analyses, we aim to identify interventions and standardised care strategies that can be tailored to resource-limited settings and that result in improved patient-centred outcomes and lower costs. ETHICS AND DISSEMINATION: We obtained ethics approval from each of the four participating hospitals in Lima, Peru, and at the Johns Hopkins School of Medicine, Baltimore, USA. Results will be disseminated as several separate publications in different international journals.