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

Dynamics of Stripes in Doped Antiferromagnets

We study the dynamics of the striped phase, which has previously been suggested to be the ground state of a doped antiferromagnet. Starting from the t-J model, we derive the classical equation governing the motion of the charged wall by using a ficticious spin model as an intermediate step. A wave-like equation of motion is obtained and the wall elasticity and mass density constants are derived in terms of the t and J parameters. The wall is then regarded as an elastic string which will be trapped by the pinning potential produced by randomly distributed impurities. We evaluate the pinning potential and estimate the threshold electric field which has to be applied to the system in order to release the walls. Besides, the dynamics of the stripe in the presence of a bias field below the threshold is considered and the high- and low-temperature relaxation rates are derived

Dynamics of lattice pinned charge stripes

We study the transversal dynamics of a charged stripe (quantum string) and show that zero temperature quantum fluctuations are able to depin it from the lattice. If the hopping amplitude t is much smaller than the string tension J, the string is pinned by the underlying lattice. At t>>J, the string is depinned and allowed to move freely, if we neglect the effect of impurities. By mapping the system onto a 1D array of Josephson junctions, we show that the quantum depinning occurs at t/J = 2 / pi^2. Besides, we exploit the relation of the stripe Hamiltonian to the sine-Gordon theory and calculate the infrared excitation spectrum of the quantum string for arbitrary t/J values

Keyword spotting system based on biomimetic pattern recognition

The mandarin keyword spotting system was investigated, and a new approach was proposed based on the principle of homology continuity and point location analysis in high-dimensional space geometry theory which are both parts of biomimetic pattern recognition theory. This approach constructed a hyper-polyhedron with sample points in the training set and calculated the distance between each test point and the hyper-polyhedron. The classification resulted from the value of those distances. The approach was tested by a speech database which was created by ourselves. The performance was compared with the classic HMM approach and the results show that the new approach is much better than HMM approach when the training data is not sufficient