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

Efeito do período de exposição a concentrações de diquat no controle de plantas de Egeria densa, Egeria najas e Ceratophyllum demersum Effect of the period of exposure to diquat concentrations on the control of Egeria densa, Egeria najas and Ceratophyllum demersum

O período de permanência do herbicida na água pode ser influenciado pelo fluxo da água nos reservatórios e pela adsorção a partículas de argilas em suspensão, bem como pela degradação luminosa e por microrganismos. Objetivou-se com este trabalho avaliar diferentes períodos de exposição a concentrações do herbicida diquat no controle de Egeria densa, Egeria najas e Ceratophyllum demersum. O delineamento experimental utilizado foi o inteiramente casualizado, com quatro repetições, em esquema fatorial 6 x 5, mais uma testemunha. Foram testados seis períodos de exposição das plantas (30, 60, 120, 240, 480 e 960 minutos) a cinco concentrações do herbicida diquat (0,075; 0,15; 0,3; 0,6; e 1,2 ppm produto comercial Reward 240 g L ¹). As avaliações de controle das plantas daninhas imersas foram visuais e, no final do experimento, foi avaliada a massa seca das plantas, para determinar a porcentagem de redução da biomassa. Observou-se que apenas 30 minutos de exposição das espécies imersas E. densa e C. demersum à concentração de 0,075 ppm foi suficiente para proporcionar redução da massa seca em ambas as espécies. Para controle de E. najas aos 7 DAA houve necessidade de um período maior que 120 minutos de exposição, considerando a mesma concentração do herbicida. Esses resultados evidenciam o potencial de uso do diquat no controle de plantas daninhas aquáticas imersas em locais que apresentam rápida renovação de água.<br>The period of herbicide permanence in water can be influenced by the water flow in the reservoirs and the adsorption of clay particles in suspension, as well as by luminous degradation and microorganisms. Thus, the objective of this work was to evaluate the effect of different exposure periods to diquat concentrations on the control of Egeria densa, Egeria najas and Ceratophyllum demersum. The experimental design used was completely randomized, with four replicates, in a factorial scheme 6 x 5, plus a control. Six periods of plant exposure were tested (30, 60, 120, 240, 480 and 960 minutes) in relation to five diquat concentrations (0.075; 0.15; 0.3; 0.6 and 1.2 ppm - commercial product Reward 240 g L-1). Visual evaluations of the immersed weeds were carried out and at the end of the experiment, shoot dry matter was evaluated to determine biomass percentage reduction. Based on the results obtained, it was concluded that exposure of only 30 minutes of the immersed species E. densa and C. demersum to 0.075 ppm concentration was sufficient to reduce shoot dry matter in both species. For E. najas control after 7 DAA, an exposure period longer than 120 minutes was necessary, considering the same herbicide concentration. These results indicate the potential use of diquat to control immersed aquatic weeds in places presenting fast water renewal

High Speed MAS19F NMR Analysis of an Irradiated Fluorpolymer

The effect of gamma-radiation on a perfluoroalkoxy (PFA) resin was examined using solid-state high-speed magic angle spinning (MAS) F-19 NMR spectroscopy. Samples were prepared for analysis by subjecting them to gamma-radiation in the dose range 0.5-3 MGy at either 303, 473, or 573 K. New structures identified include new saturated chain ends, short and long branches, and unsaturated groups. The formation of branched structures was found to increase with increasing irradiation temperature; however, at all temperatures the radiation chemical yield (G value) of new chain ends was greater than the G value of long branch points, suggesting that chain scission is the net process