The impact of transcranial direct current stimulation on inhibitory control in young adults

In recent years, many important discoveries have been made to challenge current policy, guidelines, and practice regarding how best to prevent stroke associated with atherosclerotic stenosis of the origin of the internal carotid artery. TheUnited States Center forMedicare andMedicaid Services (CMS), for instance, is calling for expert advice as to whether its current policies should be modified. Using a thorough review of literature, 41 leading academic stroke-prevention clinicians from the United States and other countries, have united to advise CMS not to extend current reimbursement indications for carotid angioplasty/stenting (CAS) to patients with asymptomatic carotid stenosis or to patients with symptomatic carotid stenosis considered to be at low or standard risk from carotid endarterectomy (CEA). It was concluded that such expansion of reimbursement indications would have disastrous health and economic consequences for the United States and any other country that may follow such inappropriate action. This was an international effort because the experts to best advise CMS are relatively few and scattered around the world. In addition, US health policy, practice, and research have tended to have strong influences on other countries. © 2012 The Authors. Published by Wiley Periodicals, Inc

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

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

General discussion

SCOPUS: cp.jinfo:eu-repo/semantics/publishe

Underlying-event properties in pp and p–Pb collisions at √sNN = 5.02 TeV

We report about the properties of the underlying event measured with ALICE at the LHC in pp and p−Pb collisions at sNN−−−√=5.02 TeV. The event activity, quantified by charged-particle number and summed-pT densities, is measured as a function of the leading-particle transverse momentum (ptrigT). These quantities are studied in three azimuthal-angle regions relative to the leading particle in the event: toward, away, and transverse. Results are presented for three different pT thresholds (0.15, 0.5, and 1 GeV/c) at mid-pseudorapidity (|η|10 GeV/c, whereas for lower ptrigT values the event activity is slightly higher in p−Pb than in pp collisions. The measurements are compared with predictions from the PYTHIA 8 and EPOS LHC Monte Carlo event generators

Dielectron production at midrapidity at low transverse momentum in peripheral and semi-peripheral Pb–Pb collisions at √sNN = 5.02 TeV

The first measurement of the e+e− pair production at low lepton pair transverse momentum (pT,ee) and low invariant mass (mee) in non-central Pb−Pb collisions at sNN−−−√=5.02 TeV at the LHC is presented. The dielectron production is studied with the ALICE detector at midrapidity (|ηe|<0.8) as a function of invariant mass (0.4≤mee<2.7 GeV/c2) in the 50−70% and 70−90% centrality classes for pT,ee<0.1 GeV/c, and as a function of pT,ee in three mee intervals in the most peripheral Pb−Pb collisions. Below a pT,ee of 0.1 GeV/c, a clear excess of e+e− pairs is found compared to the expectations from known hadronic sources and predictions of thermal radiation from the medium. The mee excess spectra are reproduced, within uncertainties, by different predictions of the photon−photon production of dielectrons, where the photons originate from the extremely strong electromagnetic fields generated by the highly Lorentz-contracted Pb nuclei. Lowest-order quantum electrodynamic (QED) calculations, as well as a model that takes into account the impact-parameter dependence of the average transverse momentum of the photons, also provide a good description of the pT,ee spectra. The measured ⟨p2T,ee⟩−−−−−√ of the excess pT,ee spectrum in peripheral Pb−Pb collisions is found to be comparable to the values observed previously at RHIC in a similar phase-space region

Underlying-event properties in pp and p–Pb collisions at √sNN = 5.02 TeV

We report about the properties of the underlying event measured with ALICE at the LHC in pp and p−Pb collisions at sNN−−−√=5.02 TeV. The event activity, quantified by charged-particle number and summed-pT densities, is measured as a function of the leading-particle transverse momentum (ptrigT). These quantities are studied in three azimuthal-angle regions relative to the leading particle in the event: toward, away, and transverse. Results are presented for three different pT thresholds (0.15, 0.5, and 1 GeV/c) at mid-pseudorapidity (|η|10 GeV/c, whereas for lower ptrigT values the event activity is slightly higher in p−Pb than in pp collisions. The measurements are compared with predictions from the PYTHIA 8 and EPOS LHC Monte Carlo event generators

Dielectron production at midrapidity at low transverse momentum in peripheral and semi-peripheral Pb–Pb collisions at √sNN = 5.02 TeV

The first measurement of the e+e− pair production at low lepton pair transverse momentum (pT,ee) and low invariant mass (mee) in non-central Pb−Pb collisions at sNN−−−√=5.02 TeV at the LHC is presented. The dielectron production is studied with the ALICE detector at midrapidity (|ηe|<0.8) as a function of invariant mass (0.4≤mee<2.7 GeV/c2) in the 50−70% and 70−90% centrality classes for pT,ee<0.1 GeV/c, and as a function of pT,ee in three mee intervals in the most peripheral Pb−Pb collisions. Below a pT,ee of 0.1 GeV/c, a clear excess of e+e− pairs is found compared to the expectations from known hadronic sources and predictions of thermal radiation from the medium. The mee excess spectra are reproduced, within uncertainties, by different predictions of the photon−photon production of dielectrons, where the photons originate from the extremely strong electromagnetic fields generated by the highly Lorentz-contracted Pb nuclei. Lowest-order quantum electrodynamic (QED) calculations, as well as a model that takes into account the impact-parameter dependence of the average transverse momentum of the photons, also provide a good description of the pT,ee spectra. The measured ⟨p2T,ee⟩−−−−−√ of the excess pT,ee spectrum in peripheral Pb−Pb collisions is found to be comparable to the values observed previously at RHIC in a similar phase-space region