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

Reflectance and SERS from an ordered array of gold nanorods

The optical properties of arrays of Au nanorods were studied by specular reflectance spectroscopy. The spectra were dominated by the surface plasmon modes of the Au nanoarrays superimposed on the effects of interference through the films. The longitudinal plasmon resonance moved to longer wavelength as the aspect ratio of the nanorods increased. The reflectance spectra were modelled by applying the Maxwell-Garnett approximation to a uniaxial thin film (composite Au/alumina) and this yielded a good match to the experimental data. SERS spectra on the Au nanorod arrays were recorded at different externally applied potentials and significant differences with respect to an electrochemically roughened Au electrode were revealed. These have been attributed to the nature of the composite nanoarrays, both their nanostructuring into rods and the regular arrangement of these rods

Measurement of the d(36) coefficient of mercury cadmium telluride by reflection second harmonic generation

The second order nonlinear coefficient (d36) of the narrow band gap semiconductor, mercury cadmium telluride (MCT), is measured. Because MCT is strongly absorbing at a 1.06 μm wavelength, the measurement was performed by comparing the second harmonic intensity reflected from the material surface to the second harmonic intensity measured for a quartz sample in transmission. The analysis depends on the derivation of comparable expressions for the reflected and transmitted intensities. Using this approach a value of d36=350±40 pm/V is obtained, a value much larger than those reported for similar zinc-blende type materials. The large magnitude of the MCT d36 is attributed to an electronic resonance enhancement

Transverse and longitudinal surface plasmon resonances of a hexagonal array of gold nanorods embedded in an alumina matrix

The specular reflectance from a hexagonal array of gold nanorods embedded in an alumina matrix supported on an aluminum substrate is reported. The rods were grown by electrodeposition of gold in an alumina template and were oriented with their long axis perpendicular to the film surface. Optical reflectance measurements performed with an incident light beam of S polarization only exhibited the transverse surface plasmon resonance whereas the measurements obtained with P polarization exhibited both transverse and longitudinal resonances. A model for the reflectance from a thin anisotropic film was developed and shown to be in agreement with the experimental data

Enhancement of the second harmonic signal from Hg1−xCdxTe (MCT) in the presence of an anodic oxide film

Second harmonic generation (SHG) is now widely regarded as a valuable tool for investigating electrode surfaces. Typically, most studies have been limited to substrates which lack bulk symmetry and monitoring events such as sub-monolayer formation and surface reconstruction. Here, the development of a model that can be used to quantitatively describe the enhanced SH signal observed in the presence of an anodic oxide film on a non-centrosymmetric substrate, Hg1xCdxTe (MCT), is described. The aim is to further expand the utility of SHG for probing different electrode systems. The growth of the high quality oxide films was first followed by in-situ ellipsometry. For thin films (<100 nm) grown at a constant current density of 150 A cm2, an effectively uniform oxide layer is found with a refractive index n of ~2.15 0.05 and exhibiting no absorption of the incident radiation at 632.8 nm (1.96 eV). In the presence of such an oxide film of 58 nm thickness, the second harmonic (SH) signal intensity measured in reflection is found to be significantly enhanced in both the PIN-POUT and PIN-SOUT polarization configurations. To quantify the changes observed, each layer in the model is assigned its own symmetry and optical constants (at the fundamental, and harmonic (= 2) frequencies and a defined thickness. Modeling of the SH rotational anisotropy experiments carried out at different angles of incidence indicated that most of this increase could be accounted for by multiple reflections of the fundamental wave = 1064 nm (1.17 eV) in the composite ambient/oxide/MCT layer, with little contribution from charge accumulation at the buried MCT/oxide interface for this oxide thickness

Optical characterisation of anodic sulphide films on hg1-xCdxTe (MCT) grown by the potential step method

The growth of native sulphide films on Hg1−xCdxTe (MCT) by potential steps to two different electrochemical growth regions has been studied by in-situ ellipsometry, photocurrent spectroscopy and second harmonic generation (SHG) rotational anisotropy. Films grown at −0.4 V versus SCE were porous and consisted mainly of cubic close packed (ccp) CdS. The photocurrent spectrum of the film exhibited a cut-off which closely conformed to the expected bandgap of CdS. The gradual increase in SH intensity as the sulphide film thickened was due to a contribution to the overall SH signal from the CdS film itself. No evidence of any hcp species was apparent in the rotational anisotropy patterns, with the four-fold pattern expected for the vicinal MCT surface being maintained even after film growth. When the potential was stepped to −0.3 V, the film grown absorbed the ellipsometer radiation once a thickness of 86 nm was reached. Photocurrent measurements showed a tail extending into the red region of the spectrum. These phenomena have been attributed to the incorporation of ccp HgS into the sulphide film as at this potential, the electrochemical reaction of the HgTe component of MCT can occur. SHG rotational anisotropy confirmed the four-fold symmetry of the ccp surface film

Interference between second harmonic waves in an anodically grown cadmium sulphide thin film

Second harmonic generation has been employed in-situ to follow the growth of a thin anodic sulphide film on CdxHg1−xTe (CMT). The anisotropy patterns recorded for the bare CMT surface show that the sample is a vicinal {100} face. This is supported in particular by the observation of a non-vanishing pattern in the SIN–SOUT configuration. Also, the observation of a four-fold pattern in the case of the CdS film confirms that the film has retained the ccp structure of the underlying CMT substrate. The SH signal recorded during the growth of the CdS film follows an oscillatory pattern with film thickness. This has been attributed to the interference between the two dominating SH waves generated within the CdS film

Surface second harmonic generation in the characterization of anodic sulphide and oxide films on Hg1-xCdxTe (MCT)

Rotation anisotropy by second harmonic generation (SHG) is carried out on epitaxial Hg1−xCdxTe (MCT) and oxide- and sulphide-covered MCT surfaces and shows the fourfold symmetry pattern expected from the {100} surface (C4v symmetry). The uneven nature of the four peaks confirm the vicinal surface obtained from the growth of the MCT on GaAs {100} substrate orientated 4° toward the 〈110〉 direction. The increase in the SH intensity observed for the oxide-covered MCT surface is associated with charge accumulation at the MCT/oxide interface since the oxide is centrosymmetric and cannot generate SH. The CdS layer on the other hand is strongly nonlinear active and generation here comes from a composite of one noncentrosymmetric layer on top of another. This leads to interactions in the observed SH arising from the coupling depths (∼40 nm) at the two interfaces and from the coherence length (∼1200 nm) in the CdS layer. The in-situ SHG measurements during the growth of the anodic oxide and sulphide layers would suggest that a species, most likely HgTe is embedded in the anodic layer during the initial stages and absorbs the SH radiation at 532 nm. The rotational anisotropy of the sulphide-covered MCT surface confirms that the CdS layer formed maintains the cubic closed pack symmetry of the underlying MCT