20 research outputs found

    Neandertal-Modern Human Contact in Western Eurasia: Issues of Dating, Taxonomy, and Cultural Associations

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    Supporting Assimilation views of Neandertal/modern human interaction, chronostratigraphic reasoning indicates that the “transitional” industries of Europe predate modern human immigration, in agreement with their association with Neandertals in the Châtelperronian at the Grotte du Renne and St.-Césaire. Supporting the Neandertals' species separateness and less developed cognition, those industries are alternatively claimed to relate to pioneer groups of modern humans; the latter would have been the true makers of the precocious instances of symbolic material culture that, under Assimilation, are assigned to the Neandertals. However, the taxonomy of the Kent's Cavern and Grotta del Cavallo dental remains is uncertain, and their poor stratigraphic context precludes dating by association. The opposite happens at the Grotte du Renne, whose stratigraphic integrity is corroborated by both taphonomy and dating. Not questioning that the Early Ahmarian is a cultural proxy for modern humans and a source for the Protoaurignacian of Europe, its claimed emergence ~46–49 ka ago at Kebara refl ects the dating of Middle Paleolithic charcoal—to be expected, because the Early Ahmarian units at the back of the cave are made up of reworked Middle Paleolithic sediments derived from the entrance. The dating of inherited material also explains the old results for the Aurignacian of Willendorf II and Geissenklösterle. At the latter, the dates on anthropically modified samples of the hunted taxa (reindeer and horse) place its Aurignacian occupations in the same time range as elsewhere in Europe, after ~40 ka ago. The hypothesis that Neandertal/modern human contact in Europe resulted in a process of assimilation in connection with the spread of the Protoaurignacian ~41.5 ka ago remains unfalsified.info:eu-repo/semantics/publishedVersio

    Sarilumab in patients admitted to hospital with severe or critical COVID-19: a randomised, double-blind, placebo-controlled, phase 3 trial

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    Background: Elevated proinflammatory cytokines are associated with greater COVID-19 severity. We aimed to assess safety and efficacy of sarilumab, an interleukin-6 receptor inhibitor, in patients with severe (requiring supplemental oxygen by nasal cannula or face mask) or critical (requiring greater supplemental oxygen, mechanical ventilation, or extracorporeal support) COVID-19. Methods: We did a 60-day, randomised, double-blind, placebo-controlled, multinational phase 3 trial at 45 hospitals in Argentina, Brazil, Canada, Chile, France, Germany, Israel, Italy, Japan, Russia, and Spain. We included adults (≥18 years) admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and pneumonia, who required oxygen supplementation or intensive care. Patients were randomly assigned (2:2:1 with permuted blocks of five) to receive intravenous sarilumab 400 mg, sarilumab 200 mg, or placebo. Patients, care providers, outcome assessors, and investigators remained masked to assigned intervention throughout the course of the study. The primary endpoint was time to clinical improvement of two or more points (seven point scale ranging from 1 [death] to 7 [discharged from hospital]) in the modified intention-to-treat population. The key secondary endpoint was proportion of patients alive at day 29. Safety outcomes included adverse events and laboratory assessments. This study is registered with ClinicalTrials.gov, NCT04327388; EudraCT, 2020-001162-12; and WHO, U1111-1249-6021. Findings: Between March 28 and July 3, 2020, of 431 patients who were screened, 420 patients were randomly assigned and 416 received placebo (n=84 [20%]), sarilumab 200 mg (n=159 [38%]), or sarilumab 400 mg (n=173 [42%]). At day 29, no significant differences were seen in median time to an improvement of two or more points between placebo (12·0 days [95% CI 9·0 to 15·0]) and sarilumab 200 mg (10·0 days [9·0 to 12·0]; hazard ratio [HR] 1·03 [95% CI 0·75 to 1·40]; log-rank p=0·96) or sarilumab 400 mg (10·0 days [9·0 to 13·0]; HR 1·14 [95% CI 0·84 to 1·54]; log-rank p=0·34), or in proportions of patients alive (77 [92%] of 84 patients in the placebo group; 143 [90%] of 159 patients in the sarilumab 200 mg group; difference −1·7 [−9·3 to 5·8]; p=0·63 vs placebo; and 159 [92%] of 173 patients in the sarilumab 400 mg group; difference 0·2 [−6·9 to 7·4]; p=0·85 vs placebo). At day 29, there were numerical, non-significant survival differences between sarilumab 400 mg (88%) and placebo (79%; difference +8·9% [95% CI −7·7 to 25·5]; p=0·25) for patients who had critical disease. No unexpected safety signals were seen. The rates of treatment-emergent adverse events were 65% (55 of 84) in the placebo group, 65% (103 of 159) in the sarilumab 200 mg group, and 70% (121 of 173) in the sarilumab 400 mg group, and of those leading to death 11% (nine of 84) were in the placebo group, 11% (17 of 159) were in the sarilumab 200 mg group, and 10% (18 of 173) were in the sarilumab 400 mg group. Interpretation: This trial did not show efficacy of sarilumab in patients admitted to hospital with COVID-19 and receiving supplemental oxygen. Adequately powered trials of targeted immunomodulatory therapies assessing survival as a primary endpoint are suggested in patients with critical COVID-19. Funding: Sanofi and Regeneron Pharmaceuticals
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