Effect of Neutralizing Monoclonal Antibody Treatment on Early Trajectories of Virologic and Immunologic Biomarkers in Patients Hospitalized With COVID-19

BACKGROUND: Neutralizing monoclonal antibodies (nmAbs) failed to show clear benefit for hospitalized patients with coronavirus disease 2019 (COVID-19). Dynamics of virologic and immunologic biomarkers remain poorly understood. METHODS: Participants enrolled in the Therapeutics for Inpatients with COVID-19 trials were randomized to nmAb versus placebo. Longitudinal differences between treatment and placebo groups in levels of plasma nucleocapsid antigen (N-Ag), anti-nucleocapsid antibody, C-reactive protein, interleukin-6, and D-dimer at enrollment, day 1, 3, and 5 were estimated using linear mixed models. A 7-point pulmonary ordinal scale assessed at day 5 was compared using proportional odds models. RESULTS: Analysis included 2149 participants enrolled between August 2020 and September 2021. Treatment resulted in 20% lower levels of plasma N-Ag compared with placebo (95% confidence interval, 12%-27%; P \u3c .001), and a steeper rate of decline through the first 5 days (P \u3c .001). The treatment difference did not vary between subgroups, and no difference was observed in trajectories of other biomarkers or the day 5 pulmonary ordinal scale. CONCLUSIONS: Our study suggests that nmAb has an antiviral effect assessed by plasma N-Ag among hospitalized patients with COVID-19, with no blunting of the endogenous anti-nucleocapsid antibody response. No effect on systemic inflammation or day 5 clinical status was observed. CLINICAL TRIALS REGISTRATION: NCT04501978

Laser heating of solid matter by light pressure-driven shocks

Heating by irradiation of a solid surface in vacuum with 5 x 10{sup 20} W cm{sup -2}, 0.8 ps, 1.05 {micro}m wavelength laser light is studied by x-ray spectroscopy of the K-shell emission from thin layers of Ni, Mo and V. A surface layer is heated to {approx} 5 keV with an axial temperature gradient of 0.6 {micro}m scale length. Images of Ni Ly{sub {alpha}} show the hot region has a {approx} 25 {micro}m diameter, much smaller than {approx} 70 {micro}m region of K{sub {alpha}} emission. 2D particle-in-cell (PIC) simulations suggest that the surface heating is due to a light pressure driven shock

Observation of extremely strong shock waves in solids launched by petawatt laser heating

Understanding hydrodynamic phenomena driven by fast electron heating is important for a range of applications including fast electron collimation schemes for fast ignition and the production and study of hot, dense matter. In this work, detailed numerical simulations modelling the heating, hydrodynamic evolution, and extreme ultra-violet (XUV) emission in combination with experimental XUV images indicate shock waves of exceptional strength (200 Mbar) launched due to rapid heating of materials via a petawatt laser. We discuss in detail the production of synthetic XUV images and how they assist us in interpreting experimental XUV images captured at 256 eV using a multi-layer spherical mirror

Hyperimmune immunoglobulin for hospitalised patients with COVID-19 (ITAC): a double-blind, placebo-controlled, phase 3, randomised trial

BACKGROUND: Passive immunotherapy using hyperimmune intravenous immunoglobulin (hIVIG) to SARS-CoV-2, derived from recovered donors, is a potential rapidly available, specific therapy for an outbreak infection such as SARS-CoV-2. Findings from randomised clinical trials of hIVIG for the treatment of COVID-19 are limited. METHODS: In this international randomised, double-blind, placebo-controlled trial, hospitalised patients with COVID-19 who had been symptomatic for up to 12 days and did not have acute end-organ failure were randomly assigned (1:1) to receive either hIVIG or an equivalent volume of saline as placebo, in addition to remdesivir, when not contraindicated, and other standard clinical care. Randomisation was stratified by site pharmacy; schedules were prepared using a mass-weighted urn design. Infusions were prepared and masked by trial pharmacists; all other investigators, research staff, and trial participants were masked to group allocation. Follow-up was for 28 days. The primary outcome was measured at day 7 by a seven-category ordinal endpoint that considered pulmonary status and extrapulmonary complications and ranged from no limiting symptoms to death. Deaths and adverse events, including organ failure and serious infections, were used to define composite safety outcomes at days 7 and 28. Prespecified subgroup analyses were carried out for efficacy and safety outcomes by duration of symptoms, the presence of anti-spike neutralising antibodies, and other baseline factors. Analyses were done on a modified intention-to-treat (mITT) population, which included all randomly assigned participants who met eligibility criteria and received all or part of the assigned study product infusion. This study is registered with ClinicalTrials.gov, NCT04546581. FINDINGS: From Oct 8, 2020, to Feb 10, 2021, 593 participants (n=301 hIVIG, n=292 placebo) were enrolled at 63 sites in 11 countries; 579 patients were included in the mITT analysis. Compared with placebo, the hIVIG group did not have significantly greater odds of a more favourable outcome at day 7; the adjusted OR was 1·06 (95% CI 0·77–1·45; p=0·72). Infusions were well tolerated, although infusion reactions were more common in the hIVIG group (18·6% vs 9·5% for placebo; p=0·002). The percentage with the composite safety outcome at day 7 was similar for the hIVIG (24%) and placebo groups (25%; OR 0·98, 95% CI 0·66–1·46; p=0·91). The ORs for the day 7 ordinal outcome did not vary for subgroups considered, but there was evidence of heterogeneity of the treatment effect for the day 7 composite safety outcome: risk was greater for hIVIG compared with placebo for patients who were antibody positive (OR 2·21, 95% CI 1·14–4·29); for patients who were antibody negative, the OR was 0·51 (0·29–0·90; pinteraction=0·001). INTERPRETATION: When administered with standard of care including remdesivir, SARS-CoV-2 hIVIG did not demonstrate efficacy among patients hospitalised with COVID-19 without end-organ failure. The safety of hIVIG might vary by the presence of endogenous neutralising antibodies at entry. FUNDING: US National Institutes of Health

Studies of electron and proton isochoric heating for fast ignition

Isochoric heating of inertially confined fusion plasmas by laser driven MeV electrons or protons is an area of great topical interest in the inertial confinement fusion community, particularly with respect to the fast ignition (FI) proposal to use this technique to initiate burn in a fusion capsule. Experiments designed to investigate electron isochoric heating have measured heating in two limiting cases of interest to fast ignition, small planar foils and hollow cones. Data from Cu K{alpha} fluorescence, crystal x-ray spectroscopy of Cu K shell emission, and XUV imaging at 68eV and 256 eV are used to test PIC and Hybrid PIC modeling of the interaction. Isochoric heating by focused proton beams generated at the concave inside surface of a hemi-shell and from a sub hemi-shell inside a cone have been studied with the same diagnostic methods plus imaging of proton induced K{alpha}. Conversion efficiency to protons has also been measured and modeled. Conclusions from the proton and electron heating experiments will be presented. Recent advances in modeling electron transport and innovative target designs for reducing igniter energy and increasing gain curves will also be discussed

Transport of energy by ultraintense laser-generated electrons in nail-wire targets

Nail-wire targets (20 μm diameter copper wires with 80 μm hemispherical head) were used to investigate energy transport by relativistic fast electrons generated in intense laser-plasma interactions. The targets were irradiated using the 300 J, 1 ps, and 2 × 1020 W · cm-2 Vulcan laser at the Rutherford Appleton Laboratory. A spherically bent crystal imager, a highly ordered pyrolytic graphite spectrometer, and single photon counting charge-coupled device gave absolute Cu Kα measurements. Results show a concentration of energy deposition in the head and an approximately exponential fall-off along the wire with about 60 μm 1/e decay length due to resistive inhibition. The coupling efficiency to the wire was 3.3 ± 1.7% with an average hot electron temperature of 620 ± 125 keV. Extreme ultraviolet images (68 and 256 eV) indicate additional heating of a thin surface layer of the wire. Modeling using the hybrid E-PLAS code has been compared with the experimental data, showing evidence of resistive heating, magnetic trapping, and surface transport. © 2009 American Institute of Physics