COvid MEdicaTion (COMET) study: protocol for a cohort study

Various theories about drugs such as ACE inhibitors or angiotensin II receptor blockers (ARBs) in relation to severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) and clinical outcomes of COVID-19 are circulating in both mainstream media and medical literature. These are based on the fact that ACE2 facilitates SARSCoV-2 cell invasion via binding of a viral spike protein to ACE2. However, the effect of ACE inhibitors, ARBs and other drugs on ACE2 is unclear and all theories are based on conflicting evidence mainly from animal studies. Therefore, clinical evidence is urgently needed. The aim of this study is to investigate the relationship between use of these drugs on clinical outcome of patients with COVID-19. Patients will be included from several hospitals in Europe. Data will be collected in a user-friendly database (Digitalis) on an external server. Analyses will be adjusted for sex, age and presence of cardiovascular disease, hypertension and diabetes. These results will enable more rational choices for randomised controlled trials for preventive and therapeutic strategies in COVID-19

Waarde van lichte en intensieve begeleiding van patienten met hartfalen; resultaten van het COACH-onderzoek.

OBJECTIVE: To determine the efficacy of 2 nurse-directed programmes of different intensity for the counselling and follow-up of patients hospitalised for heart failure, compared with standard care by a cardiologist. DESIGN: Multicentre randomised clinical trial (www.trialregister.nl: NCT 98675639). METHOD: A total of 1023 patients were randomized after hospitalisation for heart failure to 1 of 3 treatment strategies: standard care provided by a cardiologist, follow-up care from a cardiologist with basic counselling and support by a nurse specialising in heart failure, or follow-up care from a cardiologist with intensive counselling and support by a nurse specialising in heart failure. Primary end points were the time to rehospitalisation due to heart failure or death and the number of days lost to rehospitalisation or death during the 18-month study period. Data were analysed on an intent-to-treat basis. RESULTS: Mean patient age was 71 years, 38% were women, 50% had mild heart failure and 50% had severe heart failure. During the study, 411 patients (40%) were rehospitalised due to heart failure or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (differences not significant). The time to rehospitalisation or death was similar in the 3 groups: hazard ratios for the basic and intensive support groups versus the control group were 0.96 (95% CI: 0.76-1.21; p = 0.73) and 0.93 (95% CI: 0.73-1.17; p = 0.53), respectively. The number of days lost to rehospitalisation or death was 39,960 in the control group; this number was 15% less in the intervention groups, but the difference was not significant. However, there was a trend toward lower mortality in the intervention groups. In all 3 groups, more visits occurred than planned, which may have had a considerable effect on care, notably in the control group. CONCLUSION: The results of this study indicated that the provision of additional counselling and support by a nurse specialising in heart failure as an adjuvant to intensive follow-up care provided by a cardiologist does not always lead to a reduction in rehospitalisation frequenc

Prognostic value of galectin-3, a novel marker of fibrosis, in patients with chronic heart failure: data from the DEAL-HF study

Biomarkers are increasingly being used in the management of patients with chronic heart failure (HF). Galectin-3 is a recently developed biomarker associated with fibrosis and inflammation, and it may play a role in cardiac remodeling in HF. We determined its prognostic value in patients with chronic HF. Patients with chronic HF (New York Heart Association functional class III or IV) who participated in the Deventer-Alkmaar heart failure study were studied. Galectin-3 levels were determined at baseline using a novel optimized enzyme-linked immunosorbent assay. Univariate and multivariate analyses were used to determine the prognostic value of this biomarker. We studied 232 patients; their mean age was 71 +/- A 10 years, 72% were male, and 96% were in NYHA class III. During a follow-up period of 6.5 years, 98 patients died. Galectin-3 was a significant predictor of mortality risk after adjustment for age and sex, and severity of HF and renal dysfunction, as assessed by NT-proBNP and estimated glomerular filtration rate, respectively (hazard ratio per standard deviation 1.24, 95% CI 1.03-1.50, P = 0.026). Plasma galectin-3 is a novel prognostic marker in patients with chronic HF. Its prognostic value is independent of severity of HF, as assessed by NT-proBNP levels, and it may potentially be used in the management of such patients

Optical bench development for LISA

For observation of gravitational waves at frequencies between 30 μHz and 1 Hz, the LISA mission will be implemented in a triangular constellation of three identical spacecraft, which are mutually linked by laser interferometry in an active transponder scheme over a 5 million kilometer arm length. On the end point of each laser link, remote and local beam metrology with respect to inertial proof masses inside the spacecraft is realized by the LISA Optical Bench. It implements further- more various ancillary functions such as point-ahead correction, acquisition sensing, transmit beam conditioning, and laser redundancy switching. A comprehensive design of the Optical Bench has been developed, which includes all of the above mentioned functions and at the same time ensures manufacturability on the basis of hydroxide catalysis bonding, an ultrastable integration technology already perfected in the context of LISA's technology demonstrator mission LISA Pathfinder. Essential elements of this design have been validated by dedicated pre-investigations. These include the demonstration of polarizing heterodyne interferometry at the required Picometer and Nanoradian performance levels, the investigation of potential non-reciprocal noise sources in the so-called backlink fiber, as well as the development of a laser redundancy switch breadboard

An elegant Breadboard of the optical bench for eLISA/NGO

The Laser Interferometer Space Antenna, as well as its reformulated European-only evolution, the New Gravitational-Wave Observatory, both employ heterodyne laser interferometry on million kilometer scale arm lengths in a triangular spacecraft formation, to observe gravitational waves at frequencies between 3 × 10−5 Hz and 1 Hz. The Optical Bench as central payload element realizes both the inter-spacecraft as well as local laser metrology with respect to inertial proof masses, and provides further functions, such as point-ahead accommodation, acquisition sensing, transmit beam conditioning, optical power monitoring, and laser redundancy switching. These functions have been combined in a detailed design of an Optical Bench Elegant Breadboard, which is currently under assembly and integration. We present an overview of the realization and current performances of the Optical Bench subsystems, which employ ultraprecise piezo mechanism, ultrastable assembly techniques, and shot noise limited RF detection to achieve translation and tilt metrology at Picometer and Nanoradian noise levels