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

retrospective analysis of sonomorphology and prospective investigation with echo-enhanced sonography

Titelblatt und Inhaltsverzeichnis Einleitung Material und Methoden Ergebnisse Diskussion Zusammenfassung Literaturverzeichnis Verzeichnisse und Danksagung Eidesstattliche ErklärungZielsetzung: Beschreibung der sonographischen Erscheinungsbilder neuroendokriner Tumoren im GEP und differentialdiagnostische Abgrenzung zu den häufiger vorkommenden Adenokarzinommetastasen in der Leber und dem Pankreaskarzinom. Vergleich mit anderen bildgebenden Verfahren aus der Literatur. Methodik: Retrospektive Analyse der Sonomorphologie und prospektive Untersuchung mit Echosignalverstärkern. 170 Patienten wurden in der B-Bild Sonographie, dann mit der fundamentalen und echosignalverstärkten Power-Doppler-Sonographie untersucht. Angewendet wurde die Pulsinversionstechnik (SonoVue®) oder die signalverstärkte Power-Doppler- Sonographie im 2nd Harmonic Imaging Modus (Levovist®). Ergebnisse: Neuroendokrine Tumoren waren: · überwiegend echoreich, · inhomogen, · unregelmäßig konturiert, · hypervaskularisiert, · zeigten ein früharterielles peritumorales Enhancement, · eine zentripetale Kontrasmittelausbreitung, · portalvenöse Kontrastmittelaussparung und · scharfe Tumorabgrenzung. In der Literaturrecherche zeigte sich, daß die echosignalverstärkte Sonographie mit den Sensitivitäten und Spezifitäten anderer bildgebender Verfahren (CT, MRT, ERCP, Szintigraphie) gleichwertig ist. Schlussfolgerung: Eine sonographische Diagnostik neuroendokriner Tumoren mit Echosignalverstärkern ist möglich. In der Differentialdiagnostik von neuroendokrinen Pankreastumoren erreicht sie sogar bessere Resultate als die Somatostatinrezeptorszintigraphie. Goldstandard in der Differentialdiagnostik von Pankreastumoren und Lebermetastasen bleibt die Histologie.Aim: To describe and discuss diagnostical signs of neuroendocrine tumors in sonography. Compiling the differences to the liver metastases of adenocarcinomas and the pancreas carcinoma. Methods: Retrospective analysis of the sonomorphology and prospective investigation with echo-enhancers. 170 patients were investigated by conventional sonography and then by echo- enhanced sonography. The pulse inversions technique (SonoVue®) or the power- Doppler-mode under the conditions of 2nd harmonic imaging (Levovist®) was used for echo-enhanced sonography. Results: Neuroendocrine tumors showed following behavior: · mostly echo-rich, · were inhomogeneously, · irregular contured, · hypervascularisated, · early-arterial peritumoral enhancement, · centripetal radiation of echo-enhancer, · portal-venous recess of echo-enhancer, · sharply delinated wall. In investigation of published articles echo-enhanced ultrasonography competes with sensitivities and specificities of other imaging techniques (CT, MRI, ERCP, scintigraphy). Conclusion: Neuroendocrine tumors can diagnosed by using echo-enhanced ultrasonography. It showes better results then somatostatine receptor scintigraphy in differentiation of neuroendocrine pancreas tumors. Histology is still the gold standard

The association between childhood motor performance and developmental trajectories of sport participation over 5 years in Danish students aged 6–16-year-old

Abstract Sports participation has potential to promote physical activity in youth. Unfortunately, sports participation and physical activity may decline from childhood to adolescence and into adulthood. Globally, only 20% of 13–15-year-olds meet the World Health Organisation recommendations for physical activity. This study aimed to investigate the 5-year trajectories of sports participation and their association with baseline motor performance in Danish school children as part of the Childhood Health Activity and Motor Performance School Study-Denmark (CHAMPS-DK), a school-based physical activity intervention study which investigated the health benefits of increased physical education lessons. Five distinct trajectories were identified, with group 1 maintained a stable trajectory of little to no sports participation, and group 2 showing a low decreasing trend. Group 3–5, the most sports active, demonstrated increasing sport participation at different rates. Baseline motor performance score was associated with the two most active sports participation groups. Students who were more physically active during school hours participated less in organised leisure time sports. This suggest focusing on improving motor performance in youth may support future sports participation and thus health-related physical activity. But also, that it might be necessary to engage and maintain children and adolescents in leisure time sports while implementing physical activity promotion interventions

Simulation-Based Training of the Rapid Evaluation and Management of Acute Stroke (STREAM)-A Prospective Single-Arm Multicenter Trial

Introduction: Acute stroke care delivered by interdisciplinary teams is time-sensitive. Simulation-based team training is a promising tool to improve team performance in medical operations. It has the potential to improve process times, team communication, patient safety, and staff satisfaction. We aim to assess whether a multi-level approach consisting of a stringent workflow revision based on peer-to-peer review and 2-3 one-day in situ simulation trainings can improve acute stroke care processing times in high volume neurocenters within a 6 months period. Methods and Analysis: The trial is being carried out in a pre-test-post-test design at 7 tertiary care university hospital neurocenters in Germany. The intervention is directed at the interdisciplinary multiprofessional stroke teams. Before and after the intervention, process times of all direct-to-center stroke patients receiving IV thrombolysis (IVT) and/or endovascular therapy (EVT) will be recorded. The primary outcome measure will be the door-to-needle time of all consecutive stroke patients directly admitted to the neurocenters who receive IVT. Secondary outcome measures will be intervention-related process times of the fraction of patients undergoing EVT and effects on team communication, perceived patient safety, and staff satisfaction via a staff questionnaire. Interventions: We are applying a multi-level intervention in cooperation with three STREAM multipliers from each center. First step is a central meeting of the multipliers at the sponsor's institution with the purposes of algorithm review in a peer-to-peer process that is recorded in a protocol and an introduction to the principles of simulation training and debriefing as well as crew resource management and team communication. Thereafter, the multipliers cooperate with the stroke team trainers from the sponsor's institution to plan and execute 2-3 one-day simulation courses in situ in the emergency department and CT room of the trial centers whereupon they receive teaching materials to perpetuate the trainings

ARIA masterclass 2018: From guidelines to real-life implementation

Over the past 20 years, ARIA (Allergic Rhinitis and its Impact on Asthma) has developed various guidelines for the treatment of allergic rhinitis (AR) and asthma multimorbidity. Over time, the ARIA initiative has evolved to ensure the highest level of bestpractices adoption in real life settings. It has evolved towards Integrated Care Pathways (ICPs) using mobile technology, and has now entered a new phase in which change management is key to provide an active and healthy life to all AR patients. With that in mind, the first ARIA masterclass was held on 12th September 2018 in Brussels, Belgium. The masterclass aimed at informing clinicians about the principles of change management, providing unbiased education on diagnosis and treatments, sharing the most recent research data on AR and multimorbidities, and creating a snowball effect to increase the adoption of best practices around the globe. This report provides an overview of the ARIA masterclass concept, summarizes the key lectures and discussions, and gives an outline of the future key development.status: publishe

ARIA masterclass 2018 : from guidelines to real-life implementation

Over the past 20 years, ARIA (Allergic Rhinitis and its Impact on Asthma) has developed various guidelines for the treatment of allergic rhinitis (AR) and asthma multimorbidity. Over time, the ARIA initiative has evolved to ensure the highest level of best-practices adoption in real life settings. It has evolved towards Integrated Care Pathways (ICPs) using mobile technology, and has now entered a new phase in which change management is key to provide an active and healthy life to all AR patients. With that in mind, the first ARIA masterclass was held on 12th September 2018 in Brussels, Belgium. The masterclass aimed at informing clinicians about the principles of change management, providing unbiased education on diagnosis and treatments, sharing the most recent research data on AR and multimorbidities, and creating a snowball effect to increase the adoption of best practices around the globe. This report provides an overview of the ARIA masterclass concept, summarizes the key lectures and discussions, and gives an outline of the future key development