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

Zwei Turmgehöfte in der Chora von Limyra

Konecny Andreas. Zwei Turmgehöfte in der Chora von Limyra. In: Anatolia Antiqua, Tome 5, 1997. pp. 101-121

Militärisches Formengut - zivile Nutzung : die lykischen Türme

In Lycia there are still standing several hellenistic towers which were not connected with any larger-scale fortification. Buildings of this kind are known to have existed from classical times onward in Greece proper as well as in other greek-inhabited areas. Masonry- styles and architectonic peculiarities show, that they were strongly related to fortification- building of the epoque. Their siting, however, at mostly not so well défendable spots in the landscape and several agriculturally usable structures in their immediate neighbourhood, as oil- presses and -mills plus threshing floors strongly indicate, that those towers were not buildt out of military purpose but that they constituted a prominent part of an agricultural structure. This point is supported by some architectonical peculiarities and by secondary buildings, very closely connected with the towers, which appear frequently and whould have made no sense in the context of a purely military design.Il existe en Lycie plusieurs tours encore debout datant de l'époque hellénistique qui n'étaient reliées à aucune grande fortification. Nous savons que des constructions de ce genre existaient depuis l'époque classique aussi bien en Grèce que dans d'autres régions peuplées par les Grecs. Le style de la maçonnerie et les particularités architectoniques sont caractéristiques de certains aspects des techniques de construction des fortifications de l'époque. Toutefois, le choix de leur emplacement, généralement sur des sites naturels difficiles à défendre et à proximité de constructions agricoles telles que pressoirs à huile, moulins et aires de battage, semble indiquer que ces tours n'ont pas été édifiées à des fins militaires mais qu'elles constituent une partie importante d'une structure à usage agricole. Certaines particularités architectoniques ainsi que la présence fréquente de bâtiments secondaires, très liés aux tours, viennent conforter cette hypothèse, dans la mesure où ces dernières n'auraient aucun sens dans un contexte purement militaire.Konecny Andreas. Militärisches Formengut - zivile Nutzung : die lykischen Türme. In: Revue des Études Anciennes. Tome 96, 1994, n°1-2. Fortifications et défense du territoire en Asie Mineure occidentale et méridionale. Table ronde CNRS, Istanbul 20-27 mai 1993, sous la direction de Pierre Debord et Raymond Descat. pp. 315-326

Plataiai

Plataiai, in SW-Boiotia, is famous above all for the events which took place in its vicinity in the autumn of 479 B.C. This victory of the Greeks over the Persian army, in concert with the Battle of Salamis, was an event of the utmost significance for European history and is often the topic of modern scientific analysis. Nevertheless, the ancient polis which gave its name to the battle has been overlooked by modern historians and all the more by archaeologists, in a rather curious way. The Plataiai Project was consequently inaugurated in 1996 in order to gain a better understanding of the history and chronology of this ancient place. Results from the investigations have made it possible to establish a settlement sequence for Plataiai; this sequence spans seven millennia, from the Middle Neolithic Age to the modern era. Plataiai is situated in a relatively secure location on the lower slopes of Mt. Kithairon where the first settlers established a small hamlet. The site continued to be inhabited in a nearly unbroken sequence into historical times. During the formative period of Classical Hellas Plataiai developed into an independent polis. The town became entangled in the internecine struggles of 6th and 5th century B.C. Greece and suffered accordingly. Plataiai was twice destroyed and depopulated as a result of the wars between Athens, Sparta and Thebes. Only a final shift of the political and strategic focusses under Philip and Alexander helped secure the existence of the town. During Hellenistic times and the time of the Roman Empire Plataiai remained undisturbed. Plataiai's existence during the 6th, 5th and 4th centuries B.C. is documented mainly by way of surface finds and its earliest known fortification. In addition to the discovery of fragmentary dwellings from the 6th century B.C., small scale excavations appear to have uncovered a cult deposit from the same period. The main characteristics of Plataiai in the late 4th century B.C. and beyond consist of an ambitious extension of the settlement, structured internally along an orthogonal grid of urban blocks and roads which was protected by an extended belt of fortifications. Geophysical survey has helped to locate and document the main urban monuments, such as the Agora, the precinct of Dionysos, the Temple of Hera, and other public buildings, in addition to an extended area covered by private dwellings, some of truly impressive size. The evidence of such large buildings confirms, beyond a doubt, that several very wealthy families existed in Plataiai, who made good use of their dwellings to express their social and political status. Late Antiquity seems to have severely curtailed Plataiai's prosperity. Urgent military threats led to the building of an emergency fortification which re-used the building materials of many Hellenistic and Roman structures. Nevertheless, a bishopric at Plataiai, a note in Procopius' de aedeficiis and the remains of several churches at the site prove that the town still existed during the reign of the emperor Justinian, whereas it is possible that the site was abandoned after this time. Only from the 11th and 12th centuries A.D. onwards does the surface material again corroborate the existence of a settlement at the site. The modern village of Kokla was renamed Plataies during the 1920s and thus continues the tradition of the ancient polis right into the 21st century A.D.Plataiai im südwestlichen Boiotien ist vor allem durch die Ereignisse im Jahr 479 v. Chr. bekannt. Der Sieg der Griechen über die persische Armee hat gemeinsam mit Salamis den Lauf der europäischen Geschichte signifikant beeinflusst und war oftmals Gegenstand neuzeitlicher und moderner wissenschaftlicher Betrachtung. Die antike Polis, die der Schlacht ihren Namen gegeben hat, ist von der historischen, besonders aber von der archäologischen Forschung jedoch vergleichsweise vernachlässigt worden. Um das auszugleichen, hat das Plataiai-Projekt im Jahr 1996 mit der Erforschung der ausgedehnten Ruinenstätte begonnen. Die in der Laufzeit des Projekts erzielten Ergebnisse ermöglichen es, die Besiedlungsgeschichte des Platzes über eine Zeit von beinahe 7 Jahrtausenden nachzuzeichnen. In der relativen Sicherheitslage von Plataiai am Fuß des Kithairon beginnt kleinmaßstäbliche Siedlungstätigkeit im Mittelneolithikum und setzt sich beinahe ungebrochen bis in historische Zeit fort. Im Werdeprozess des klassischen Hellas entwickelt sich auch Plataiai zur unabhängigen Polis. Ihre Verstrickung in die Machtkämpfe der späten Archaik und der Klassik macht die Stadt zum Brennpunkt historischer Ereignisse auch über die Perserkriege hinaus - nicht immer zu ihrem Vorteil. Im Spannungsfeld zwischen Sparta, Athen und Theben erleidet Plataiai zweimal Zerstörung und Entvölkerung. Erst die Verschiebung der politischen und strategischen Gewichte durch Philipp II und Alexander den Großen sichert der Stadt die weitere Existenz, die im Hellenismus und während der Kaiserzeit relativ ungestört verläuft. Das 6., 5. und frühere 4. Jh. sind am Platz vor allem durch oberflächige Keramikfunde und die früheste bekannte Befestigung von Plataiai dokumentiert. Kleinräumige Grabungen haben ein kultisch konnotiertes Materialdepot aus dem 6. Jh. angeschnitten, dazu Bebauung aus der Zeit. Die endklassisch-hellenistische Siedlungsgeschichte der Stadt spiegelt sich in einem groß angelegten Ausbau der Stadt, mit einem ausgedehnten Mauerring und einer Binnengliederung auf orthogonalem Grundriss. Geophysikalische Prospektion dokumentiert den Staßenraster, die Agora, das Heiligtum der Hera, ein Dionysosheiligtum und andere öffentliche Bauten ebenso, wie eine ausgedehnte private Binnenbebauung. Gerade letztere liefert auch Anhaltspunkte dafür, dass sich in Plataiai einige reiche Familien etablieren konnten, die ihren sozialen und politischen Status auch mittels großer Stadthäuser ausdrückten. Das Oberflächensurvey liefert weitere signifikante Daten zur Siedlungsgeschichte und zur Besiedlungsdichte der Stadt. Die Spätantike bringt eine scharfe Zäsur. Zunehmende militärische Bedrohung veranlasst Plataiai zur Errichtung einer Notfallsbefestigung. Doch belegen mehrere Kirchen gemeinsam mit der Erwähnung Plataiais als Bischofssitz und einer Notiz bei Procopius die weitere Existenz der städtischen Siedlung zumindest bis in die Regierungszeit Iustinians. Im Frühmittelalter könnte der Platz aufgegeben worden sein, doch belegt Oberflächenkeramik eine (erneute?) Besiedlung ab dem 11. Jh. Das neuzeitliche Dorf Kokla trägt seit den 1920er Jahren den antiken Namen Plataies und führt damit die Siedlungstradition von Plataiai ungebrochen bis in die Jetztzeit fort

‘…SOME OF THEM CRUSHED AND PERISHING UNDER THE WEIGHT OF THE BUILDINGS PRESSING UPON THEM’. THE EARTHQUAKE IN CARNUNTUM - COIN FINDS IN ARCHAEOLOGICAL CONTEXT

The present study presents the connection between the earthquakes and the Roman coinage from iconography to relief funds from the state. The main part is dedicated to the case of the ‘civilian’ settlement of Carnuntum in Pannonia Superior (nowadays, Petronell-Carnuntum, Austria). The archaeological excavations and the coin finds related to the pre- and post-earthquake phases reveal the way the Romans have reconstruct/repair the edifices after this event at the mid-4th century AD.</span

Plataiai

Plataiai, in SW-Boiotia, is famous above all for the events which took place in its vicinity in the autumn of 479 B.C. This victory of the Greeks over the Persian army, in concert with the Battle of Salamis, was an event of the utmost significance for European history and is often the topic of modern scientific analysis. Nevertheless, the ancient polis which gave its name to the battle has been overlooked by modern historians and all the more by archaeologists, in a rather curious way. The Plataiai Project was consequently inaugurated in 1996 in order to gain a better understanding of the history and chronology of this ancient place. Results from the investigations have made it possible to establish a settlement sequence for Plataiai; this sequence spans seven millennia, from the Middle Neolithic Age to the modern era. Plataiai is situated in a relatively secure location on the lower slopes of Mt. Kithairon where the first settlers established a small hamlet. The site continued to be inhabited in a nearly unbroken sequence into historical times. During the formative period of Classical Hellas Plataiai developed into an independent polis. The town became entangled in the internecine struggles of 6th and 5th century B.C. Greece and suffered accordingly. Plataiai was twice destroyed and depopulated as a result of the wars between Athens, Sparta and Thebes. Only a final shift of the political and strategic focusses under Philip and Alexander helped secure the existence of the town. During Hellenistic times and the time of the Roman Empire Plataiai remained undisturbed. Plataiai's existence during the 6th, 5th and 4th centuries B.C. is documented mainly by way of surface finds and its earliest known fortification. In addition to the discovery of fragmentary dwellings from the 6th century B.C., small scale excavations appear to have uncovered a cult deposit from the same period. The main characteristics of Plataiai in the late 4th century B.C. and beyond consist of an ambitious extension of the settlement, structured internally along an orthogonal grid of urban blocks and roads which was protected by an extended belt of fortifications. Geophysical survey has helped to locate and document the main urban monuments, such as the Agora, the precinct of Dionysos, the Temple of Hera, and other public buildings, in addition to an extended area covered by private dwellings, some of truly impressive size. The evidence of such large buildings confirms, beyond a doubt, that several very wealthy families existed in Plataiai, who made good use of their dwellings to express their social and political status. Late Antiquity seems to have severely curtailed Plataiai's prosperity. Urgent military threats led to the building of an emergency fortification which re-used the building materials of many Hellenistic and Roman structures. Nevertheless, a bishopric at Plataiai, a note in Procopius' de aedeficiis and the remains of several churches at the site prove that the town still existed during the reign of the emperor Justinian, whereas it is possible that the site was abandoned after this time. Only from the 11th and 12th centuries A.D. onwards does the surface material again corroborate the existence of a settlement at the site. The modern village of Kokla was renamed Plataies during the 1920s and thus continues the tradition of the ancient polis right into the 21st century A.D