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

A High-Performance Single-Molecule Magnet Utilizing Dianionic Aminoborolide Ligands

The first example of a homoleptic f-block borolide sandwich complex is presented and shown to be a high-performance single-molecule magnet (SMM). The bis(borolide) complex [K(2.2.2)][[1-(piperidino)-2,3,4,5-tetraphenylborolyl]2Dy] (1) features an unusual example of an anionic Ln3+ metallocene that supports short metal-ligand bonds and a high degree of linearity around the central Dy3+ ion, resulting in comparatively large barriers to magnetization reversal (Ueff = 1600 cm-1 for the most linear orientation) and, importantly, a high blocking temperature (TB, defined as T(τ100s)) of 66 K. These metrics put complex 1 among the very best performing SMMs reported to date and highlight the potential of dianionic borolide ligands to increase ligand field axiality, compared to monoanionic cyclic ligands, to ultimately maximize magnetic anisotropy in f-block-based SMMs

A High-Performance Single-Molecule Magnet Utilizing Dianionic Aminoborolide Ligands

The first example of a homoleptic f-block borolide sandwich complex is presented and shown to be a high-performance single-molecule magnet (SMM). The bis(borolide) complex [K(2.2.2)][[1-(piperidino)-2,3,4,5-tetraphenylborolyl]2Dy] (1) features an unusual example of an anionic Ln3+ metallocene that supports short metal-ligand bonds and a high degree of linearity around the central Dy3+ ion, resulting in comparatively large barriers to magnetization reversal (Ueff = 1600 cm-1 for the most linear orientation) and, importantly, a high blocking temperature (TB, defined as T(τ100s)) of 66 K. These metrics put complex 1 among the very best performing SMMs reported to date and highlight the potential of dianionic borolide ligands to increase ligand field axiality, compared to monoanionic cyclic ligands, to ultimately maximize magnetic anisotropy in f-block-based SMMs

Quelles mesures pour maîtriser le risque infectieux chez les patients immunodéprimés ? Recommandations formalisées d’experts

International audienceThe increase use of immunosuppressive treatments in patients with solid cancer and/or inflammatory diseases requires revisiting our practices for the prevention of infectious risk in the care setting. A review of the literature by a multidisciplinary working group at the beginning of 2014 wished to answer the following 4 questions to improve healthcare immunocompromised patients: (I) How can we define immunocompromised patients with high, intermediate and low infectious risk, (II) which air treatment should be recommended for this specific population? (III) What additional precautions should be recommended for immunocompromised patients at risk for infection? (IV) Which global environmental control should be recommended? Based on data from the literature and using the GRADE method, we propose 15 recommendations that could help to reduce the risk of infection in these exposed populations.L’intensification des traitements immunosuppresseurs et la généralisation de leur utilisation aux patients atteints de cancer solide et/ou de maladies inflammatoires nécessitent de revisiter nos pratiques de prévention du risque infectieux en milieu de soin. Cette révision est justifiée aussi par les modifications de nos pratiques avec une intensification des prises en charge en structures de soins de suites réhabilitation et en ambulatoire. Une revue de la littérature menée par un groupe de travail multidisciplinaire réuni début 2014 a souhaité répondre aux 4 questions suivantes : (i) Quelle définition des patients immunodéprimés à risque infectieux élevé, intermédiaire et faible, (ii) Quel traitement d’air recommander pour les patients immunodéprimés à risque d’infections ? (iii) Quelles précautions complémentaires recommander pour les patients immunodéprimés à risque d’infections ? (iv) Quelle maîtrise globale de l’environnement recommander pour les patients immunodéprimés à risque d’infections ? À partir des données de la littérature et en utilisant la méthode GRADE, nous proposons 15 recommandations qui permettront de réduire le risque infectieux dans ces populations exposées