Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Analysis of microstructure, mechanical indentation and corrosive behavior of a thermally sprayed NiFeCrBSi-WC composite coating

Extending the lifetime of drilling bits primarily requires an in-depth understanding of the material's behavior from which they are made. Metal matrix composite coatings (MMCs) are mostly used to cover these industrial components to increase their efficiency and protect them from corrosion and wear. For the drilling bits, the best combination of characteristics can be assured through the design of an efficient multiphase metal matrix composite coating. Among these materials, nickel-based composites have been recently raised as alternatives to chromium and cobalt-based ones. This paper aims to unravel the underlying relationships between the microstructure and the mechanical indentation behavior and electrochemical response of thermally sprayed nickel-based composite coating. For that, a nickel-based composite coating is characterized. This coating was separately obtained after flame spraying of NiFeCrBSi feedstock wires by using acetylene as a fuel. The coatings were deposited in air on X18 carbon steel substrates. Our results reveal that the matrix of the coating mainly contains Ni-γ dendrites. The interdendritic space of the coating is filled withγ-Cr2.4W0.6Si eutectic. In this coating, The Ni- γ phase that represents a eutectic constituent is depleted in iron. The morphology of carbides differs from one precipitate to another. The indentation behavior differs depending on the elasto-plastic behavior of the present phases and the presence of voids. Moreover, the EIS curves proved that the increase in ion concentration augments the charge transfer at the coating/electrolyte interface and accelerates corrosion. In the sulfuric solutions, the coatings form a thin and compact passive film layer that makes the charge transfer permanently constant at high ion concentrations (35 g/l)

Archaeology and Sclerochronology of Marine Bivalves

International audienceIn a rapidly changing world, maintenance of the good health of the marine environment requires a detailed understanding of its mechanisms of change, and the ability to detect early signals of a shift away from the equilibrium state that we assume characterized it before there was any significant human impact. Given that instrumental measurements of the oceans go back no further than a few decades, the only way in which we can assess the long-term baseline variability that characterizes the pre-perturbation equilibrium state of the marine environment is by the use of proxy records contained in stratified or layered natural archives such as corals, fish otoliths and bivalve mollusc shells.In this chapter we will look at the ways in which the environmental signals recorded in the shells of bivalve molluscs can be used to shed light on marine variability both in the present and over past centuries and millennia, and specifically how they can be used to study marine climate, the marine environment and the economic and cultural history of the relationship between humans and the oceans.The chapter is divided into two parts: section one describes the morphological, geochemical and crystallographic techniques that are used to obtain information from the shells, while section two covers the use of bivalve shells in a wide range of applications, including ecosystem services, environmental monitoring, archaeology, climate reconstruction, and climate modeling