Azithromycin, an antibiotic with potential antiviral and anti-inflammatory properties, has been used to treat COVID-19, but evidence from community randomised trials is lacking. We aimed to assess ...the effectiveness of azithromycin to treat suspected COVID-19 among people in the community who had an increased risk of complications.
In this UK-based, primary care, open-label, multi-arm, adaptive platform randomised trial of interventions against COVID-19 in people at increased risk of an adverse clinical course (PRINCIPLE), we randomly assigned people aged 65 years and older, or 50 years and older with at least one comorbidity, who had been unwell for 14 days or less with suspected COVID-19, to usual care plus azithromycin 500 mg daily for three days, usual care plus other interventions, or usual care alone. The trial had two coprimary endpoints measured within 28 days from randomisation: time to first self-reported recovery, analysed using a Bayesian piecewise exponential, and hospital admission or death related to COVID-19, analysed using a Bayesian logistic regression model. Eligible participants with outcome data were included in the primary analysis, and those who received the allocated treatment were included in the safety analysis. The trial is registered with ISRCTN, ISRCTN86534580.
The first participant was recruited to PRINCIPLE on April 2, 2020. The azithromycin group enrolled participants between May 22 and Nov 30, 2020, by which time 2265 participants had been randomly assigned, 540 to azithromycin plus usual care, 875 to usual care alone, and 850 to other interventions. 2120 (94%) of 2265 participants provided follow-up data and were included in the Bayesian primary analysis, 500 participants in the azithromycin plus usual care group, 823 in the usual care alone group, and 797 in other intervention groups. 402 (80%) of 500 participants in the azithromycin plus usual care group and 631 (77%) of 823 participants in the usual care alone group reported feeling recovered within 28 days. We found little evidence of a meaningful benefit in the azithromycin plus usual care group in time to first reported recovery versus usual care alone (hazard ratio 1·08, 95% Bayesian credibility interval BCI 0·95 to 1·23), equating to an estimated benefit in median time to first recovery of 0·94 days (95% BCI −0·56 to 2·43). The probability that there was a clinically meaningful benefit of at least 1·5 days in time to recovery was 0·23. 16 (3%) of 500 participants in the azithromycin plus usual care group and 28 (3%) of 823 participants in the usual care alone group were hospitalised (absolute benefit in percentage 0·3%, 95% BCI −1·7 to 2·2). There were no deaths in either study group. Safety outcomes were similar in both groups. Two (1%) of 455 participants in the azothromycin plus usual care group and four (1%) of 668 participants in the usual care alone group reported admission to hospital during the trial, not related to COVID-19.
Our findings do not justify the routine use of azithromycin for reducing time to recovery or risk of hospitalisation for people with suspected COVID-19 in the community. These findings have important antibiotic stewardship implications during this pandemic, as inappropriate use of antibiotics leads to increased antimicrobial resistance, and there is evidence that azithromycin use increased during the pandemic in the UK.
UK Research and Innovation and UK Department of Health and Social Care.
COPI mediates retrograde trafficking from the Golgi to the endoplasmic reticulum (ER) and within the Golgi stack, sorting transmembrane proteins bearing C-terminal KKxx or KxKxx motifs. The structure ...of KxKxx motifs bound to the N-terminal WD-repeat domain of β'-COP identifies electrostatic contacts between the motif and complementary patches at the center of the β'-COP propeller. An absolute requirement of a two-residue spacing between the terminal carboxylate group and first lysine residue results from interactions of carbonyl groups in the motif backbone with basic side chains of β'-COP. Similar interactions are proposed to mediate binding of KKxx motifs by the homologous α-COP domain. Mutation of key interacting residues in either domain or in their cognate motifs abolishes in vitro binding and results in mistrafficking of dilysine-containing cargo in yeast without compromising cell viability. Flexibility between β'-COP WD-repeat domains and the location of cargo binding have implications for COPI coat assembly.
► Dilysine motifs bind the top surface of β'- and α-COP N-terminal WD-repeat domains ► Mutation of key binding site residues abolishes in vitro binding to dilysine motifs ► Loss of binding site prevents retrograde trafficking of dilysine motifs in vivo ► Mutants lacking dilysine motif binding site can transport other retrograde cargoes
COPI facilitates trafficking of transmembrane proteins bearing C-terminal KKxx or KxKxx motifs between the Golgi and the ER and within the Golgi stacks. Jackson et al. now provide molecular characterization of COPI cargo binding through elucidation of the structure of β'-COP N-terminal WD-repeat domain in complex with a KxKxx motif.
Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal ...of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks versus benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed "remission" as the most appropriate descriptive term, and HbA1c < 6.5% (48 mmol/mol) measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.
A previous efficacy trial found benefit from inhaled budesonide for COVID-19 in patients not admitted to hospital, but effectiveness in high-risk individuals is unknown. We aimed to establish whether ...inhaled budesonide reduces time to recovery and COVID-19-related hospital admissions or deaths among people at high risk of complications in the community.
PRINCIPLE is a multicentre, open-label, multi-arm, randomised, controlled, adaptive platform trial done remotely from a central trial site and at primary care centres in the UK. Eligible participants were aged 65 years or older or 50 years or older with comorbidities, and unwell for up to 14 days with suspected COVID-19 but not admitted to hospital. Participants were randomly assigned to usual care, usual care plus inhaled budesonide (800 μg twice daily for 14 days), or usual care plus other interventions, and followed up for 28 days. Participants were aware of group assignment. The coprimary endpoints are time to first self-reported recovery and hospital admission or death related to COVID-19, within 28 days, analysed using Bayesian models. The primary analysis population included all eligible SARS-CoV-2-positive participants randomly assigned to budesonide, usual care, and other interventions, from the start of the platform trial until the budesonide group was closed. This trial is registered at the ISRCTN registry (ISRCTN86534580) and is ongoing.
The trial began enrolment on April 2, 2020, with randomisation to budesonide from Nov 27, 2020, until March 31, 2021, when the prespecified time to recovery superiority criterion was met. 4700 participants were randomly assigned to budesonide (n=1073), usual care alone (n=1988), or other treatments (n=1639). The primary analysis model includes 2530 SARS-CoV-2-positive participants, with 787 in the budesonide group, 1069 in the usual care group, and 974 receiving other treatments. There was a benefit in time to first self-reported recovery of an estimated 2·94 days (95% Bayesian credible interval BCI 1·19 to 5·12) in the budesonide group versus the usual care group (11·8 days 95% BCI 10·0 to 14·1 vs 14·7 days 12·3 to 18·0; hazard ratio 1·21 95% BCI 1·08 to 1·36), with a probability of superiority greater than 0·999, meeting the prespecified superiority threshold of 0·99. For the hospital admission or death outcome, the estimated rate was 6·8% (95% BCI 4·1 to 10·2) in the budesonide group versus 8·8% (5·5 to 12·7) in the usual care group (estimated absolute difference 2·0% 95% BCI –0·2 to 4·5; odds ratio 0·75 95% BCI 0·55 to 1·03), with a probability of superiority 0·963, below the prespecified superiority threshold of 0·975. Two participants in the budesonide group and four in the usual care group had serious adverse events (hospital admissions unrelated to COVID-19).
Inhaled budesonide improves time to recovery, with a chance of also reducing hospital admissions or deaths (although our results did not meet the superiority threshold), in people with COVID-19 in the community who are at higher risk of complications.
National Institute of Health Research and United Kingdom Research Innovation.
The penetration characteristics of electron beams into x-ray targets are investigated for incident electron kinetic energies in the range
50
–
150
keV
. The frequency densities of electrons ...penetrating to a depth
x
in a target, with a fraction of initial kinetic energy,
u
, are calculated using Monte Carlo methods for beam energies of 50, 80, 100, 120 and
150
keV
in a tungsten target. The frequency densities for
100
keV
electrons in Al, Mo and Re targets are also calculated. A mixture of simple modeling with equations and interpolation from data is used to generalize the calculations in tungsten. Where possible, parameters derived from the Monte Carlo data are compared to experimental measurements. Previous electron transport approximations in the semiempirical models of other authors are discussed and related to this work. In particular, the crudity of the use of the Thomson-Whiddington law to describe electron penetration and energy loss is highlighted. The results presented here may be used towards calculating the target self-attenuation correction for bremsstrahlung photons emitted within a tungsten target.
Lady Pereira Gray: an appreciation Evans, Philip H; Choules, Joy
British journal of general practice,
01/2021, Letnik:
71, Številka:
702
Journal Article
Recenzirano
Odprti dostop
Lady Jill Pereira Gray, the wife of former Chairman of Council and President of the College Sir Denis Pereira Gray for 58 years, died in September 2020 aged 83 after a long battle with cancer. Jill ...used her English degree from the University of London in publishing several of her works.
Clathrin-mediated endocytosis (CME) is key to maintaining the transmembrane protein composition of cells’ limiting membranes. During mammalian CME, a reversible phosphorylation event occurs on Thr156 ...of the μ2 subunit of the main endocytic clathrin adaptor, AP2. We show that this phosphorylation event starts during clathrin-coated pit (CCP) initiation and increases throughout CCP lifetime. μ2Thr156 phosphorylation favors a new, cargo-bound conformation of AP2 and simultaneously creates a binding platform for the endocytic NECAP proteins but without significantly altering AP2’s cargo affinity in vitro. We describe the structural bases of both. NECAP arrival at CCPs parallels that of clathrin and increases with μ2Thr156 phosphorylation. In turn, NECAP recruits drivers of late stages of CCP formation, including SNX9, via a site distinct from where NECAP binds AP2. Disruption of the different modules of this phosphorylation-based temporal regulatory system results in CCP maturation being delayed and/or stalled, hence impairing global rates of CME.
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•AP2 μ2T156 phosphorylation starts early at CCP inception and increases as CCP grows•Phosphorylation favors an AP2 conformational change and also triggers NECAP binding•NECAP PHear simultaneously binds P-AP2 and membrane-remodeling proteins on opposite faces•Disrupting the P-AP2:NECAP:membrane-remodeling protein network reduces CME rates
Wrobel et al. show that phosphorylation of the mammalian endocytic AP2 adaptor causes a conformational change that allows it to efficiently bind the protein NECAP. This, in turn, recruits membrane-remodeling proteins into clathrin-coated pits, which drive their formation toward final scission from the parent membrane.
Abstract
Smart grid solutions enable utilities and customers to better monitor and control energy use via information and communications technology. Information technology is intended to improve the ...future electric grid’s reliability, efficiency, and sustainability by implementing advanced monitoring and control systems. However, leveraging modern communications systems also makes the grid vulnerable to cyberattacks. Here we report the first use of quantum key distribution (QKD) keys in the authentication of smart grid communications. In particular, we make such demonstration on a deployed electric utility fiber network. The developed method was prototyped in a software package to manage and utilize cryptographic keys to authenticate machine-to-machine communications used for supervisory control and data acquisition (SCADA). This demonstration showcases the feasibility of using QKD to improve the security of critical infrastructure, including future distributed energy resources (DERs), such as energy storage.
Denis Pereira Gray and colleagues argue that a renewed focus on continuity could help reduce the pressures facing general practice and the wider health system
Basswood samples were exposed to oxygen glow-discharge plasmas for 30 min, and etching of radial and tangential longitudinal surfaces was measured. It was hypothesized that there would be a positive ...correlation between etching and plasma energy, and differential etching of wood surfaces because of variation in the microstructure and chemical composition of different woody tissues. Etching at the surface of basswood samples was examined using profilometry. Light and scanning electron microscopy were used to examine the microstructure of samples exposed to plasma. There was a large effect of plasma energy on etching of basswood surfaces, and radial surfaces were etched to a greater extent than tangential surfaces. However, rays at radial surfaces were more resistant to etching than fibers, resulting in greater variation in the etching of radial versus tangential surfaces. The same phenomenon occurred at radial surfaces of balsa wood, jelutong and New Zealand white pine subjected to plasma etching. The possible reasons for the greater resistance of rays to plasma etching are explored, and it is suggested that such differential etching of wood surfaces may impose a limitation on the use of plasma to precisely etch functional patterns at wood surfaces (raised pillars, grooves), as has been done with other materials.
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