Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

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

Access to VizieR catalogues of the Solar System

International audienc

Access to VizieR catalogues of the Solar System

International audienc

VizieR catalogue system certified by the Data Seal of Approval

Astronomy is a fertile environment with collaborations leading to the elaboration of disciplinary standards. Deploying standards in data centers can be beneficial for long term preservation and it puts the discipline in the open data era. VizieR [1] is the CDS service dedicated to catalogues. It gathers data and tables, but also associated data like spectra or images coming from published papers or collaborations with various agencies. VizieR gives access to data through services to the astronomical community and preserves data for the long term. Several years ago, it became clear that it was worth applying for an external evaluation to certify that VizieR is a trustable data repository. The Data Seal of Approval (DSA) [2] is granted to repositories that are committed to archiving and providing access to scholarly research in a sustainable way. CDS applied to the DSA in particular for the VizieR catalogue service. The VizieR information system is based on accurate data documentation provided by specialists. The data life cycle from ingestion to access and preservation is presented, with reference to the Open Archive Information System (OAIS [3])

VizieR catalogue system certified by the Data Seal of Approval

International audienc

Toward Binding Database Interfaces with Scientific Papers

Despite a large variety of facilities helping to either select or manipulate data from Web interfaces, it remains diffcult to provide users with relevant scientific or technical annotations for those data. Introducing such content by hand into a Web interface is a tedious job with a risk of providing in complete or inadequate content. To overcome this diffculty, we are exploring the possibility of using the names of exposed quantities to index a text corpus. This index can be used to show the most relevant text snippets in a given context. The full text can be displayed by user request and automatically scroll down to that snippet. Our approach is based on the conversion of PDF papers into machinereadable files that are indexed by a search engine. Index entries are reported as PDF annotations that are used to control the display. This workflow has been tested on the IVOA standard corpus as a proof of concept. It has then been applied to the XMM-Newtonuser guides for our catalog interface. Finally, it has been adapted to find resources within portals exposing a lot of various data collections

Préface

International audienc

Interactive Submission of Data to be Published in VizieR

International audienceWe present the new interactive submission interface for VizieR and the VizieR associated data service (Landais (2016)). The step by step process supports description of tables and the generation of the CDS standard ReadMe description. This interface also guides authors through a workflow that allows them to describe their data in a standard way so that it can be integrated into the VizieR database (Ochsenbein et al. (2000)) and be published via Virtual Observatory protocols. The VizieR associated data service is a recent addition to the CDS VizieR service. It enables the publication of data associated to papers, such as spectra, images and time series. The interface automatically proposes a mapping of the FITS headers to the IVOA ObsCore meta-data standard (Tody et al. (2011)), which can be modified and validated by the authors. The process can be done in an asynchronous mode and is therefore suited to potentially large collections of FITS resources, and is instantaneous for small data sets.The associated data service today comprises of millions of associated data files. We describe the capabilities of the submission interface, and the lessons learned from initial tests by authors/beta-testers

Préface

International audienc