63 research outputs found

    Cellular Interactions in Hemopoietic Progenitor Cell Homing: A Review

    Get PDF
    Within the bone marrow microenvironment, dynamic cellular interactions are constantly occurring. These interactions involve hemopoietic stem cells, progenitor cells and maturing cells, physically interacting with other cells, some of which may function as accessory cells, and others which comprise the stromal elements; hemopoietic cells also interact with non-cellular elements, such as glycoproteins and fibrous proteins of the extracellular matrix (ECM). These interactions serve to regulate normal hemopoiesis by allowing the communication of regulatory information, migration and subsequent homing of stem cells within specific organs, and presentation of hemopoietic growth factors in a biologically relevant fashion. The goal of this review is to examine the specific cellular interactions that relate to the phenomenon of homing of intravenously transplanted stem cells to the bone marrow

    Reduced Neutrophil Count in People of African Descent Is Due To a Regulatory Variant in the Duffy Antigen Receptor for Chemokines Gene

    Get PDF
    Persistently low white blood cell count (WBC) and neutrophil count is a well-described phenomenon in persons of African ancestry, whose etiology remains unknown. We recently used admixture mapping to identify an approximately 1-megabase region on chromosome 1, where ancestry status (African or European) almost entirely accounted for the difference in WBC between African Americans and European Americans. To identify the specific genetic change responsible for this association, we analyzed genotype and phenotype data from 6,005 African Americans from the Jackson Heart Study (JHS), the Health, Aging and Body Composition (Health ABC) Study, and the Atherosclerosis Risk in Communities (ARIC) Study. We demonstrate that the causal variant must be at least 91% different in frequency between West Africans and European Americans. An excellent candidate is the Duffy Null polymorphism (SNP rs2814778 at chromosome 1q23.2), which is the only polymorphism in the region known to be so differentiated in frequency and is already known to protect against Plasmodium vivax malaria. We confirm that rs2814778 is predictive of WBC and neutrophil count in African Americans above beyond the previously described admixture association (P = 3.8×10−5), establishing a novel phenotype for this genetic variant

    The genetic architecture of the human cerebral cortex

    Get PDF
    The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

    The James Webb Space Telescope Mission

    Full text link
    Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least 4m4m. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the 6.5m6.5m James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

    New Approaches to Enforcement and Compliance with Labour Regulatory Standards: The Case of Ontario, Canada

    Full text link

    Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

    Get PDF
    Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≄18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

    Atrial fibrillation genetic risk differentiates cardioembolic stroke from other stroke subtypes

    Get PDF
    AbstractObjectiveWe sought to assess whether genetic risk factors for atrial fibrillation can explain cardioembolic stroke risk.MethodsWe evaluated genetic correlations between a prior genetic study of AF and AF in the presence of cardioembolic stroke using genome-wide genotypes from the Stroke Genetics Network (N = 3,190 AF cases, 3,000 cardioembolic stroke cases, and 28,026 referents). We tested whether a previously-validated AF polygenic risk score (PRS) associated with cardioembolic and other stroke subtypes after accounting for AF clinical risk factors.ResultsWe observed strong correlation between previously reported genetic risk for AF, AF in the presence of stroke, and cardioembolic stroke (Pearson’s r=0.77 and 0.76, respectively, across SNPs with p &lt; 4.4 × 10−4 in the prior AF meta-analysis). An AF PRS, adjusted for clinical AF risk factors, was associated with cardioembolic stroke (odds ratio (OR) per standard deviation (sd) = 1.40, p = 1.45×10−48), explaining ∌20% of the heritable component of cardioembolic stroke risk. The AF PRS was also associated with stroke of undetermined cause (OR per sd = 1.07, p = 0.004), but no other primary stroke subtypes (all p &gt; 0.1).ConclusionsGenetic risk for AF is associated with cardioembolic stroke, independent of clinical risk factors. Studies are warranted to determine whether AF genetic risk can serve as a biomarker for strokes caused by AF.</jats:sec

    Taking the pulse of Earth's tropical forests using networks of highly distributed plots

    Get PDF
    Tropical forests are the most diverse and productive ecosystems on Earth. While better understanding of these forests is critical for our collective future, until quite recently efforts to measure and monitor them have been largely disconnected. Networking is essential to discover the answers to questions that transcend borders and the horizons of funding agencies. Here we show how a global community is responding to the challenges of tropical ecosystem research with diverse teams measuring forests tree-by-tree in thousands of long-term plots. We review the major scientific discoveries of this work and show how this process is changing tropical forest science. Our core approach involves linking long-term grassroots initiatives with standardized protocols and data management to generate robust scaled-up results. By connecting tropical researchers and elevating their status, our Social Research Network model recognises the key role of the data originator in scientific discovery. Conceived in 1999 with RAINFOR (South America), our permanent plot networks have been adapted to Africa (AfriTRON) and Southeast Asia (T-FORCES) and widely emulated worldwide. Now these multiple initiatives are integrated via ForestPlots.net cyber-infrastructure, linking colleagues from 54 countries across 24 plot networks. Collectively these are transforming understanding of tropical forests and their biospheric role. Together we have discovered how, where and why forest carbon and biodiversity are responding to climate change, and how they feedback on it. This long-term pan-tropical collaboration has revealed a large long-term carbon sink and its trends, as well as making clear which drivers are most important, which forest processes are affected, where they are changing, what the lags are, and the likely future responses of tropical forests as the climate continues to change. By leveraging a remarkably old technology, plot networks are sparking a very modern revolution in tropical forest science. In the future, humanity can benefit greatly by nurturing the grassroots communities now collectively capable of generating unique, long-term understanding of Earth's most precious forests. Resumen Los bosques tropicales son los ecosistemas mĂĄs diversos y productivos del mundo y entender su funcionamiento es crĂ­tico para nuestro futuro colectivo. Sin embargo, hasta hace muy poco, los esfuerzos para medirlos y monitorearlos han estado muy desconectados. El trabajo en redes es esencial para descubrir las respuestas a preguntas que trascienden las fronteras y los plazos de las agencias de financiamiento. AquĂ­ mostramos cĂłmo una comunidad global estĂĄ respondiendo a los desafĂ­os de la investigaciĂłn en ecosistemas tropicales a travĂ©s de diversos equipos realizando mediciones ĂĄrbol por ĂĄrbol en miles de parcelas permanentes de largo plazo. Revisamos los descubrimientos mĂĄs importantes de este trabajo y discutimos cĂłmo este proceso estĂĄ cambiando la ciencia relacionada a los bosques tropicales. El enfoque central de nuestro esfuerzo implica la conexiĂłn de iniciativas locales de largo plazo con protocolos estandarizados y manejo de datos para producir resultados que se puedan trasladar a mĂșltiples escalas. Conectando investigadores tropicales, elevando su posiciĂłn y estatus, nuestro modelo de Red Social de InvestigaciĂłn reconoce el rol fundamental que tienen, para el descubrimiento cientĂ­fico, quienes generan o producen los datos. Concebida en 1999 con RAINFOR (SuramĂ©rica), nuestras redes de parcelas permanentes han sido adaptadas en África (AfriTRON) y el sureste asiĂĄtico (T-FORCES) y ampliamente replicadas en el mundo. Actualmente todas estas iniciativas estĂĄn integradas a travĂ©s de la ciber-infraestructura de ForestPlots.net, conectando colegas de 54 paĂ­ses en 24 redes diferentes de parcelas. Colectivamente, estas redes estĂĄn transformando nuestro conocimiento sobre los bosques tropicales y el rol de Ă©stos en la biĂłsfera. Juntos hemos descubierto cĂłmo, dĂłnde y porquĂ© el carbono y la biodiversidad de los bosques tropicales estĂĄ respondiendo al cambio climĂĄtico y cĂłmo se retroalimentan. Esta colaboraciĂłn pan-tropical de largo plazo ha expuesto un gran sumidero de carbono y sus tendencias, mostrando claramente cuĂĄles son los factores mĂĄs importantes, quĂ© procesos se ven afectados, dĂłnde ocurren los cambios, los tiempos de reacciĂłn y las probables respuestas futuras mientras el clima continĂșa cambiando. Apalancando lo que realmente es una tecnologĂ­a antigua, las redes de parcelas estĂĄn generando una verdadera y moderna revoluciĂłn en la ciencia tropical. En el futuro, la humanidad puede beneficiarse enormemente si se nutren y cultivan comunidades de investigadores de base, actualmente con la capacidad de generar informaciĂłn Ășnica y de largo plazo para entender los que probablemente son los bosques mĂĄs preciados de la tierra. Resumo Florestas tropicais sĂŁo os ecossistemas mais diversos e produtivos da Terra. Embora uma boa compreensĂŁo destas florestas seja crucial para o nosso futuro coletivo, atĂ© muito recentemente os esforços de mediçÔes e monitoramento foram amplamente desconexos. É essencial formarmos redes para obtermos respostas que transcendem fronteiras e horizontes de agĂȘncias financiadoras. Neste estudo nĂłs mostramos como uma comunidade global estĂĄ respondendo aos desafios da pesquisa de ecossistemas tropicais, com equipes diversas medindo florestas, ĂĄrvore por ĂĄrvore, em milhares de parcelas monitoradas Ă  longo prazo. NĂłs revisamos as maiores descobertas cientĂ­ficas deste trabalho, e mostramos tambĂ©m como este processo estĂĄ mudando a ciĂȘncia de florestas tropicais. Nossa abordagem principal envolve unir iniciativas de base a protocolos padronizados e gerenciamento de dados a fim de gerar resultados robustos em escalas ampliadas. Ao conectar pesquisadores tropicais e elevar seus status, nosso modelo de Rede de Pesquisa Social reconhece o papel-chave do produtor dos dados na descoberta cientĂ­fica. Concebida em 1999 com o RAINFOR (AmĂ©rica do Sul), nossa rede de parcelas permanentes foi adaptada para África (AfriTRON) e Sudeste asiĂĄtico (T-FORCES), e tem sido extensamente reproduzida em todo o mundo. Agora estas mĂșltiplas iniciativas estĂŁo integradas atravĂ©s de uma infraestrutura cibernĂ©tica do ForestPlots.net, conectando colegas de 54 paĂ­ses de 24 redes de parcelas. Estas iniciativas estĂŁo transformando coletivamente o entendimento das florestas tropicais e seus papĂ©is na biosfera. Juntos nĂłs descobrimos como, onde e por que o carbono e a biodiversidade da floresta estĂŁo respondendo Ă s mudanças climĂĄticas, e seus efeitos de retroalimentação. Esta duradoura colaboração pantropical revelou um grande sumidouro de carbono persistente e suas tendĂȘncias, assim como tem evidenciado quais direcionadores sĂŁo mais importantes, quais processos florestais sĂŁo mais afetados, onde eles estĂŁo mudando, seus atrasos no tempo de resposta, e as provĂĄveis respostas das florestas tropicais conforme o clima continua a mudar. Dessa forma, aproveitando uma notĂĄvel tecnologia antiga, redes de parcelas acendem faĂ­scas de uma moderna revolução na ciĂȘncia das florestas tropicais. No futuro a humanidade pode se beneficiar incentivando estas comunidades basais que agora sĂŁo coletivamente capazes de gerar conhecimentos Ășnicos e duradouros sobre as florestas mais preciosas da Terra. RĂ©sume Les forĂȘts tropicales sont les Ă©cosystĂšmes les plus diversifiĂ©s et les plus productifs de la planĂšte. Si une meilleure comprĂ©hension de ces forĂȘts est essentielle pour notre avenir collectif, jusqu'Ă  tout rĂ©cemment, les efforts dĂ©ployĂ©s pour les mesurer et les surveiller ont Ă©tĂ© largement dĂ©connectĂ©s. La mise en rĂ©seau est essentielle pour dĂ©couvrir les rĂ©ponses Ă  des questions qui dĂ©passent les frontiĂšres et les horizons des organismes de financement. Nous montrons ici comment une communautĂ© mondiale relĂšve les dĂ©fis de la recherche sur les Ă©cosystĂšmes tropicaux avec diverses Ă©quipes qui mesurent les forĂȘts arbre aprĂšs arbre dans de milliers de parcelles permanentes. Nous passons en revue les principales dĂ©couvertes scientifiques de ces travaux et montrons comment ce processus modifie la science des forĂȘts tropicales. Notre approche principale consiste Ă  relier les initiatives de base Ă  long terme Ă  des protocoles standardisĂ©s et une gestion de donnĂ©es afin de gĂ©nĂ©rer des rĂ©sultats solides Ă  grande Ă©chelle. En reliant les chercheurs tropicaux et en Ă©levant leur statut, notre modĂšle de rĂ©seau de recherche sociale reconnaĂźt le rĂŽle clĂ© de l'auteur des donnĂ©es dans la dĂ©couverte scientifique. Conçus en 1999 avec RAINFOR (AmĂ©rique du Sud), nos rĂ©seaux de parcelles permanentes ont Ă©tĂ© adaptĂ©s Ă  l'Afrique (AfriTRON) et Ă  l'Asie du Sud-Est (T-FORCES) et largement imitĂ©s dans le monde entier. Ces multiples initiatives sont dĂ©sormais intĂ©grĂ©es via l'infrastructure ForestPlots.net, qui relie des collĂšgues de 54 pays Ă  travers 24 rĂ©seaux de parcelles. Ensemble, elles transforment la comprĂ©hension des forĂȘts tropicales et de leur rĂŽle biosphĂ©rique. Ensemble, nous avons dĂ©couvert comment, oĂč et pourquoi le carbone forestier et la biodiversitĂ© rĂ©agissent au changement climatique, et comment ils y rĂ©agissent. Cette collaboration pan-tropicale Ă  long terme a rĂ©vĂ©lĂ© un important puits de carbone Ă  long terme et ses tendances, tout en mettant en Ă©vidence les facteurs les plus importants, les processus forestiers qui sont affectĂ©s, les endroits oĂč ils changent, les dĂ©calages et les rĂ©actions futures probables des forĂȘts tropicales Ă  mesure que le climat continue de changer. En tirant parti d'une technologie remarquablement ancienne, les rĂ©seaux de parcelles dĂ©clenchent une rĂ©volution trĂšs moderne dans la science des forĂȘts tropicales. À l'avenir, l'humanitĂ© pourra grandement bĂ©nĂ©ficier du soutien des communautĂ©s de base qui sont maintenant collectivement capables de gĂ©nĂ©rer une comprĂ©hension unique et Ă  long terme des forĂȘts les plus prĂ©cieuses de la Terre. Abstrak Hutan tropika adalah di antara ekosistem yang paling produktif dan mempunyai kepelbagaian biodiversiti yang tinggi di seluruh dunia. Walaupun pemahaman mengenai hutan tropika amat penting untuk masa depan kita, usaha-usaha untuk mengkaji dan mengawas hutah-hutan tersebut baru sekarang menjadi lebih diperhubungkan. Perangkaian adalah sangat penting untuk mencari jawapan kepada soalan-soalan yang menjangkaui sempadan dan batasan agensi pendanaan. Di sini kami menunjukkan bagaimana sebuah komuniti global bertindak balas terhadap cabaran penyelidikan ekosistem tropika melalui penglibatan pelbagai kumpulan yang mengukur hutan secara pokok demi pokok dalam beribu-ribu plot jangka panjang. Kami meninjau semula penemuan saintifik utama daripada kerja ini dan menunjukkan bagaimana proses ini sedang mengubah bidang sains hutan tropika. Teras pendekatan kami memberi tumpuan terhadap penghubungan inisiatif akar umbi jangka panjang dengan protokol standar serta pengurusan data untuk mendapatkan hasil skala besar yang kukuh. Dengan menghubungkan penyelidik-penyelidik tropika dan meningkatkan status mereka, model Rangkaian Penyelidikan Sosial kami mengiktiraf kepentingan peranan pengasas data dalam penemuan saintifik. Bermula dengan pengasasan RAINFOR (Amerika Selatan) pada tahun 1999, rangkaian-rangkaian plot kekal kami kemudian disesuaikan untuk Afrika (AfriTRON) dan Asia Tenggara (T-FORCES) dan selanjutnya telah banyak dicontohi di seluruh dunia. Kini, inisiatif-inisiatif tersebut disepadukan melalui infrastruktur siber ForestPlots.net yang menghubungkan rakan sekerja dari 54 negara di 24 buah rangkaian plot. Secara kolektif, rangkaian ini sedang mengubah pemahaman tentang hutan tropika dan peranannya dalam biosfera. Kami telah bekerjasama untuk menemukan bagaimana, di mana dan mengapa karbon serta biodiversiti hutan bertindak balas terhadap perubahan iklim dan juga bagaimana mereka saling bermaklum balas. Kolaborasi pan-tropika jangka panjang ini telah mendedahkan sebuah sinki karbon jangka panjang serta arah alirannya dan juga menjelaskan pemandu-pemandu perubahan yang terpenting, di mana dan bagaimana proses hutan terjejas, masa susul yang ada dan kemungkinan tindakbalas hutan tropika pada perubahan iklim secara berterusan di masa depan. Dengan memanfaatkan pendekatan lama, rangkaian plot sedang menyalakan revolusi yang amat moden dalam sains hutan tropika. Pada masa akan datang, manusia sejagat akan banyak mendapat manfaat jika memupuk komuniti-komuniti akar umbi yang kini berkemampuan secara kolektif menghasilkan pemahaman unik dan jangka panjang mengenai hutan-hutan yang paling berharga di dunia

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

    Get PDF
    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
    • 

    corecore