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

Studies on sustainable use of agricultural farmlands from the perspectives of erosion and salinity control

博士論文 (Doctoral dissertation

Boron Nitride Nanotubes for Curcumin Delivery as an Anticancer Drug: A DFT Investigation

The electrical properties and characteristics of the armchair boron nitride nanotube (BNNT) that interacts with the curcumin molecule as an anticancer drug were studied using ab initio calculations based on density functional theory (DFT). In this study, a (5,5) armchair BNNT was employed, and two different interactions were investigated, including the interaction of the curcumin molecule with the outer and inner surfaces of the BNNT. The adsorption of curcumin molecules on the investigated BNNT inside the surface is a more favorable process than adsorption on the outside surface, and the more persistent and stronger connection correlates with curcumin molecule adsorption in this case. Furthermore, analysis of the HOMO–LUMO gap after the adsorption process showed that the HOMO value increased marginally while the LUMO value decreased dramatically in the curcumin-BNNT complexes. As a result, the energy gaps between HOMO and LUMO (Eg) are narrowed, emphasizing the stronger intermolecular bonds. As a result, BNNTs can be employed as a drug carrier in biological systems to transport curcumin, an anticancer medication, and thereby improve its bioavailability

Evaluation of the Effectiveness of Loose and Compressed Wood Chip Mulch in Field-Grown Blueberries—A Preliminary Study

Blueberry production in the field faces several challenges, including competition from weeds and soil suitability. Different mulch types are widely used in blueberry cultivation to control weeds, conserve moisture, and mitigate soil erosion. However, the comparative effects of loose and compressed wood chips on fruit quality and weed control in blueberry production systems have not been studied. Many farmers use expensive imported peat moss as soil covers, while others apply organic mulches such as chips or chaff, which can be easily washed away by runoff. This study aimed to evaluate the effects of compressed mulching boards (MB) fabricated without the use of chemical adhesives using pressurized steam and compression technologies in blueberry cultivation. During the two growing seasons, the effectiveness of compressed MB on soil moisture retention, fruit quality, and weed biomass was compared to that of wood chip (WC) and control treatments in a blueberry field. Although a significant difference was observed in the fruit fresh weight, no significant differences were observed in the other fruit growth parameters for all the treatments. Generally, the compressed MB significantly improved soil moisture retention capacity compared to WC and control during the two-year study. The compressed MB showed effective weed suppression ability by significantly reducing the weed biomass at all sampling times

International pellet watch: Global monitoring of polybrominated diphenyl ethers (PBDEs) in plastic resin pellets

International audiencePolybrominated diphenyl ethers (PBDEs) were measured in plastic resin pellets collected from 65 beaches across 27 countries worldwide. They were detected at 49 locations at concentrations of the sum of 49 congeners of up to 46 ng/g-pellet and a median of 2 ng/g-pellet. These values are one to two orders of magnitude lower than those of polychlorinated biphenyls (PCBs) (median, 51 ng/g-pellet). This difference can be attributed to lower production of the Penta-BDE technical mixture, which is used extensively in some countries, and lower availability of brominated flame retardants for equilibrium partitioning than PCBs. Tetra-, penta-, and hexa-brominated congeners (BDE-47, 99, 100, 153, 154) were dominant over a deca-substituted congener (BDE-209) in many samples; this was significantly detected in pellets from some locations. Results indicate that pellets reflect the pollution status of PBDEs in the dissolved phase in seawater. From the ranking of the summed concentrations of six major PBDE congeners (Σ6PBDEs), we propose five levels of pollution categorization (ng/g-pellet): no (8.5) local pollution. The USA and neighboring countries were categorized as extreme (17–36 ng/g-pellet), western Europe and Japan were categorized as high (≤8.8), and most Asian and African countries were categorized as slight (<0.8). Notably, extreme or high pollution levels were also observed in countries with no history of PBDE production, such as Ghana (Σ6PBDEs up to 16 ng/g-pellet), the Philippines (7.5), and Hong Kong (7.7). Scrapped electrical and electronic waste might explain these anomalously high values

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

International audienc