Neck shrivel in European plum is caused by cuticular microcracks, resulting from rapid lateral expansion of the neck late in development

Susceptibility to the commercially important fruit disorder ‘neck shrivel’ differs among European plum cultivars. Radial cuticular microcracking occurs in the neck regions of susceptible cultivars, but not in non-susceptible ones, so would seem to be causal. However, the reason for the microcracking is unknown. The objective was to identify potential relationships between fruit growth pattern and microcracking incidence in the neck (proximal) and stylar (distal) ends of selected shrivel-susceptible and non-susceptible cultivars. Growth analysis revealed two allometric categories: The first category, the ‘narrow-neck’ cultivars, showed hypoallometric growth in the neck region (i.e., slower growth than in the region of maximum diameter) during early development (stages I + II). Later (during stage III) the neck region was ‘filled out’ by hyperallometric growth (i.e., faster than in the region of maximum diameter). The second category, the ‘broad-neck’ cultivars, had more symmetrical, allometric growth (all regions grew equally fast) throughout development. The narrow-neck cultivars exhibited extensive radial cuticular microcracking in the neck region, but little microcracking in the stylar region. In contrast, the broad-neck cultivars exhibited little microcracking overall, with no difference between the neck and stylar regions. Across all cultivars, a positive relationship was obtained for the level of microcracking in the neck region and the difference in allometric growth ratios between stage III and stages I + II. There were no similar relationships for the stylar region. The results demonstrate that accelerated stage III neck growth in the narrow-neck plum cultivars is associated with more microcracking and thus with more shrivel

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

A Narrative Review of Personal Protective Equipment Uses in Coronavirus Disease 2019 and Its Disposable Practices

: Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for causing coronavirus disease 2019 (COVID-19), is transmitted through close contact and droplets, people, especially those at risk of infection, must follow preventive measures in the community and healthcare settings. Healthcare personnel (HCP) must appropriately select and use personal protective equipment (PPE) with sensible donning and doffing and disposal practices. A narrative review of the existing literature was conducted, in which articles from Scopus, PubMed, Google Scholar, ScienceDirect, and Web of Science were collected. The primary findings of the retained articles were reviewed according to official recommendations on PPE use. The World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), and European Center for Disease Control and Prevention (ECDC) recommend standard precautions for contact transmission, respiratory transmission, and droplet precautions among HCPs caring for patients with COVID-19. Indeed, healthcare workers working in high-risk areas, as well as the public, when social distancing cannot be assured, must wear PPE such as face mask and protective eyewear to prevent the transmission of SARS-CoV-2 infection. Due to the increased use of PPE, the potentially infectious waste stream has been rapidly increasing, requiring safe and adequate solid waste management. The proper use of PPE and management of waste generated from COVID-19 care centers can reduce the risk of COVID-19 infection. These measures should be implemented to counter the rapid spread and any long-term impacts of the current pandemic

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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