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.

These results confirm that lung metastasectomy is a safe and potentially curative procedure. Resectability, disease-free interval, and number of metastases enabled us to design a simple system of classification valid for different tumor types.

Abstract-The purpose of this study was to determine if ambulatory blood pressure measurement predicted total and cardiovascular mortality over and beyond clinic blood pressure measurement and other cardiovascular risk factors; 5292 untreated hypertensive patients referred to a single blood pressure clinic who had clinic and ambulatory blood pressure measurement at baseline were followed up in a prospective study of mortality outcome. Multiple Cox regression was used to model time to total and cause-specific mortality for ambulatory blood pressure measurement while adjusting for clinic blood pressure measurement and other risk factors at baseline. There were 646 deaths (of which 389 were cardiovascular) during a median follow-up period of 8. Key Words: blood pressure Ⅲ blood pressure monitoring, ambulatory Ⅲ cardiovascular diseases Ⅲ hypertension Ⅲ mortality T he most commonly used technique of blood pressure measurement in clinical practice is the auscultatory method with a mercury sphygmomanometer and stethoscope. A metaanalysis of clinic blood pressure measurement (CBPM) in 1 million adults participating in 61 prospective studies showed that a 10-mm Hg higher usual systolic blood pressure (SBP) or 5-mm Hg higher usual diastolic blood pressure (DBP) would be associated with Ϸ40% higher risk of stroke death and Ϸ30% higher risk of death from ischemic heart disease and other vascular causes. 1 There are, however, numerous criticisms of CBPM, which include interobserver and intraobserver variability, and terminal digit preferences, 2,3 all of which may bias the accuracy of measurement. Moreover, CBPM cannot detect white-coat hypertension, the prevalence of which can be as high as 30%. 4 There is growing evidence from a number of small studies that ambulatory blood pressure measurement (ABPM) is a better predictor of outcome than CBPM, 5-13 but only one large Japanese population study has shown ABPM to be better predictor of cardiovascular mortality than CBPM. 8 Similarly, evidence is accumulating to demonstrate that nighttime pressure is superior to daytime pressure in predicting cardiovascular outcome. 7,14 -21 The objective of this study, therefore, was to determine the additional predictive value of ABPM over and above CBPM, and also to estimate the superiority of nighttime pressure over daytime pressure in a large Western population of untreated hypertensive patients from a single center followed-up for up to 20 years. Methods Study PopulationThe Blood Pressure Unit (formerly located at the Charitable Infirmary and now based at Beaumont Hospital in Dublin) has been in operation for 22 years. The majority of patients are referred to the Correspondence to Eoin O'Brien,