Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Functional response of coniferous trees and stands to commercial thinning in eastern Canada

The overall objectives of commercial thinning are to increase individual stem growth and, arguably, to increase stand yield. Yet few empirical results are available that would confirm the treatment meets such expectations in an industrial context. We studied the response of stands to commercial thinning with a particular focus on variables that were related to processes of stemwood production at the tree and stand levels. We inventoried permanent sample plots established between 1980 and 2000 in naturally regenerated conifer stands of southern Quebec seven to ten years after thinning. We reconstituted tree leaf area and wood production per unit leaf area using field and dendrochronological data for different years following thinning. Mixed linear models showed that tree basal area and leaf area increments following treatment were strongly related to the tree distance from the nearest skid trail. Wood production per unit leaf area was significantly higher for trees located within 5 m of a skid trail compared to control trees as soon as one year following thinning application, while significant differences in tree leaf area required five years. Compared to control stands, thinned stands had higher wood production per unit leaf area, but merchantable volume increment did not differ. These results provided insight into growth processes that are involved in tree responses to mechanized thinning and could aid in the development of decision tools that determine the suitability of stands for receiving the treatment

Validation d'une méthode de mesurage de la pulvérulence des poudres en fractions conventionnelles d'aérosol

L'étude a pour objectif de doter une institution de prévention d'un outil maîtrisé et qualifié de la détermination de la pulvérulence des matériaux industriels (et/ou agricoles) pour le besoin d'évaluation du risque chimique. Les résultats de l'étude confirment la pertinence du choix méthodologique.41p., ill., bibliogr

Intoxications par plantes à hétérosides digitaliques : facteurs de risque et traitement

National audienc

Physical performances and kinetics of evaporation of the CIP 10-M personal sampler's rotating cup containing aqueous or viscous collection fluid

International audienceThe CIP 10-M personal sampler measures worker exposure to airborne particles by collecting particles in a rotating metal cup containing a few milliliters of a collection fluid. This device is mainly used to sample microorganisms or microbial components to measure bioaerosol concentrations in various occupational environments. Aqueous liquids are generally used, but their rapid evaporation limits the duration of sampling; alternative collection fluids could alleviate this problem. Indeed, the particle-collection efficiency of the rotating cup has not been extensively studied, and the only data available relate to a discontinued model. This study aimed to measure the collection efficiency of the current rotating cup model containing an aqueous (water) or viscous (ViaTrap mineral oil) collection fluid. The kinetics of evaporation confirmed that ViaTrap does not evaporate, making 8-h sampling campaigns in constant volumes feasible. Particles with a wide range of aerodynamic diameters (between around 0.1 and 10 µm) were produced using various test rigs and mono- or polydisperse test aerosols. Both new and older cup models performed similarly, with a collection efficiency of >80% for larger particles (aerodynamic diameters >2.8 µm), progressively decreasing to around 50% for aerodynamic diameters of 2.1 µm; with aerodynamic diameters of <1 µm, the collection efficiency was generally <10%. In physical terms, collection efficiency was unaffected by the type (aqueous or viscous) or volume (between 0 and 3 mL) of collection fluid used. Bias maps indicated that the inhalable fraction may be underestimated in occupational settings, particularly with aerosols mainly composed of particles with aerodynamic diameters of less than around 3 µm

Geochemistry of olivine-hosted melt inclusions of the ~ 7 ky basanitic Montcineyre eruption, Massif Central, France.

International audienc

Le nuage

Être dans les nuages ou répondre « Présent » ? Voilà la question posée par ce numéro... après Jacques Prévert. Si les signes du Ciel ont souvent une connotation funeste, les nuages invitent à une contemplation plus sereine. Leur multiplicité, leur mouvance est propice à l’abstraction scientifique mais aussi à une rêverie créatrice d’images nouvelles, inédites. Celles des artistes reconnus comme du quidam anonyme car le ciel est sans doute le dernier espace onirique accessible à tous. Il est partout et gratuit. Contempler un nuage particulier, puis des ensembles nuageux pour remonter à l’essence nuageuse permet de faire corps avec le cosmos et de cheminer vers une autre conscience du monde... Regarde le ciel ! Ce musée imaginaire est la réponse suggérée par les rêveurs philosophes (Bachelard, Schopenhauer, etc.) et les rêveurs géographes au rêveur poète