Evaluation of the efficacy and safety of recombinant erythropoietin on the improvement of hospitalised COVID-19 patients: A structured summary of a study protocol for a randomised controlled trial

Objectives To evaluate the effect of recombinant erythropoietin on hospitalised COVID-19 patients. Trial design Concealed, randomized, single-blinded, phase 2 controlled clinical trial with two arm parallel-group design of 20 patients allocated with 1:1 ratio and using the placebo in the control group. Participants This study will be performed at Shahid Mohammadi Hospital in Bandar Abbas, Hormozgan in Iran. All positive (PCR confirmed) COVID-19 patients ≤65 years old who have Hb≤9 and at least one of the severe COVID-19 symptoms (tachypnea (breathing rate> 30 beats per minute), hypoxemia (O2 ≤93 saturation, the partial pressure ratio of arterial oxygen <300), Lung infiltration (> 50% of lung field within 24 to 48 hours), progressive lymphopenia, LDH>245 U/I, CRP>100) and are willing to cooperate in this project will be included in the study. Patients with a history of coronary heart disease, thrombosis, deep vein thrombosis, chronic lung disease, diabetes mellitus, weakened immune system, end-stage renal disease, liver disease, and patients with a history of taking oral contraceptive pills, systolic blood pressure more than 160 mm Hg, diastolic blood pressure more than 90 mm Hg and age over 65 and erythropoietin above 500 are excluded. Intervention and comparator Patients will receive the standard of care (SOC) based on the treatment protocols of the Iranian National Committee of COVID-19 and recombinant erythropoietin (EPREX Manufactured by Johnson and Johnson Pharmaceutical Company) 300 units / Kg or 4000IU as subcutaneous (SQ) injection three times a day for 5 days and simultaneously Enoxaparin 1 mg/kg SQ daily is also taken to prevent thrombosis in the intervention group. Patients' blood pressure, along with other vital signs, are checked regularly and at regular intervals. In the control group, patients received SOC and the placebo (distilled water) is given as a subcutaneous injection three times a day for 5 days. We use sterile water for injection (EXIRpharmaceutical company) as the placebo. To the same appearance of the placebo and the recombinant erythropoietin, they are taken in a separate room in the same size syringes and cover with labels before injection. Main outcomes The main outcome for this study is a composite endpoint for Patient clinical symptoms (Respiratory rate, Oxygen saturation state and arterial oxygen partial pressure ratio, Lung infiltration status, blood pressure), Laboratory tests (LDH, CRP, Lymphocyte count, Endogenous erythropoietin, and Haemoglobin level). All of these will be assessed at the beginning of the study (before the intervention) and day 5 after the intervention. The study will also evaluate side effects and how to manage them. Randomisation Eligible participants (20) will be randomized in two arms in the ratio of 1: 1 (10 per arm) by permuted block randomization method using online web-based tools. Blinding (masking) Patients participating in the study will not be aware of the assignment to the intervention or control group. The principal investigator, health care personnel, data collectors, and those evaluating the outcome are aware of patient grouping. Numbers to be randomised (sample size) A total of 20 patients will participate in this study, who are randomly allocated to the 2 arms with a 1:1 ratio; 10 patients in the intervention group will receive SOC and recombinant erythropoietin, and 10 patients in the control group will receive SOC and placebo. Trial Status The protocol version is 3.0, approved by the Deputy of Research and Technology and the ethics committee of Hormozgan University of Medical Sciences on 6th June 2020, with the local grant number of 990108. The expected recruitment end date was on 21th December 2020 but since we had a wide and careful exclusion criteria because of the adverse reactions of the medication, the recruitment (for both cases and controls) was not so easy and did not finish on the expected date and we are still recruiting now. Recruitment began on 17th August 2020 and the updated expected recruitment end date is 1st August 2021. Trial registration The protocol was registered before starting subject recruitment under the title: Evaluation of the effect of recombinant erythropoietin on the improvement of COVID-19 patients, IRCT20200509047364N1, at Iranian Registry of clinical trials (https://en.irct.ir/trial/49282) on 2020/08/09. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).

Sulfide Stress Cracking of C-110 Steel in a Sour Environment

The scope of this study includes modeling and experimental investigation of sulfide stress cracking (SSC) of high-strength carbon steel. A model has been developed to predict hydrogen permeation in steel for a given pressure and temperature condition. The model is validated with existing and new laboratory measurements. The experiments were performed using C-110 grade steel specimens. The specimens were aged in 2% (wt.) brine saturated with mixed gas containing CH4, CO2, and H2S. The concentration H2S was maintained constant (280 ppm) while varying the partial pressure ratio of CO2 (i.e., the ratio of partial pressure of CO2 to the total pressure) from 0 to 15%. The changes occurring in the mechanical properties of the specimens were evaluated after exposure to assess material embrittlement and SSC corrosion. Besides this, the cracks developed on the surface of the specimens were examined using an optical microscope. Results show that the hydrogen permeation, and subsequently SSC resistance, of C-110 grade steel were strongly influenced by the Partial Pressure Ratio (PPR) of CO2 when the PPR was between 0 and 5%. The PPR of CO2 had a limited impact on the SSC process when it was between 10 and 15 percent.

Hydrodeoxygenation of Guaiacol Over Orthorhombic Molybdenum Carbide: A DFT and Microkinetic Study

The hydrodeoxygenation of guaiacol is modelled over a (100) <i>β</i>-Mo₂C surface using density functional theory and microkinetic simulations. The thermochemistry of the process shows that the demethoxylation of the guaiacol, to form phenol, will be the initial steps, with a reaction energy of 29 kJ/mol (i.e. endothermic) and a highest activation barrier of 112 kJ/mol. Subsequently, the dehydroxylation of the phenol, which has a rate-determining activation barrier of 145 kJ/mol, will lead to the formation of benzene, with an overall reaction energy for conversion from guaiacol of -91 kJ/mol (i.e. exothermic). The <i>sp2</i> and <i>sp</i> hybridized carbon atoms of the molecular functional groups are found to dissociate on the surface with minimum energy barriers, while the hydrogenation of the adsorbed molecules requires higher energy. The microkinetic modelling, which is performed considering typical reaction conditions of 500 to 700 K, and a partial pressure ratio H₂:guaiacol of 1, shows quick formation and accumulation of phenol on the surface with increasing temperature, although high temperatures mitigate the guaiacol adsorption step. Based on simulated temperature programmed desorption (TPD), maximum conversion of guaiacol can be expected at 70% surface coverage of this species.

Hydrodeoxygenation of Guaiacol Over Orthorhombic Molybdenum Carbide: A DFT and Microkinetic Study

The hydrodeoxygenation of guaiacol is modelled over a (100) <i>β</i>-Mo₂C surface using density functional theory and microkinetic simulations. The thermochemistry of the process shows that the demethoxylation of the guaiacol, to form phenol, will be the initial steps, with a reaction energy of 29 kJ/mol (i.e. endothermic) and a highest activation barrier of 112 kJ/mol. Subsequently, the dehydroxylation of the phenol, which has a rate-determining activation barrier of 145 kJ/mol, will lead to the formation of benzene, with an overall reaction energy for conversion from guaiacol of -91 kJ/mol (i.e. exothermic). The <i>sp2</i> and <i>sp</i> hybridized carbon atoms of the molecular functional groups are found to dissociate on the surface with minimum energy barriers, while the hydrogenation of the adsorbed molecules requires higher energy. The microkinetic modelling, which is performed considering typical reaction conditions of 500 to 700 K, and a partial pressure ratio H₂:guaiacol of 1, shows quick formation and accumulation of phenol on the surface with increasing temperature, although high temperatures mitigate the guaiacol adsorption step. Based on simulated temperature programmed desorption (TPD), maximum conversion of guaiacol can be expected at 70% surface coverage of this species.