Objectives: COVID-19 has been the primary health problem and because of the virus affinity to endothelial cells, it has become an important reason of vascular problems and cardiac injury. After mild COVID-19 infection, patients frequently attend to the cardiology clinics with cardiac symptoms and their primary cardiac tests are mostly normal. The aim of the study is analysing if the difference of cardiac deterioration could be shown with 2D-speckle tracking echocardiography between symptomatic and asymptomatic patients when transthoracic echocardiography parameters are normal. Methods: In this retrospective single centre study, total of 2741 transthoracic echocardiography records were assessed and post-COVID patients (n:108) were detected and divided into ‘symptomatic’ and asymptomatic’ patient groups and left ventricular global longitudinal strain values were compared. Results: The number of patients with normal global longitudinal strain values were equal in the groups and the number of patients with impaired GLS values in the symptomatic group were more than the asymptomatic group (15 patients in the symptomatic group and 4 patients in the asymptomatic group) and the difference was statistically different (p=0,008). The average GLS values were -18,88±2,50 in the asymptomatic group and -17,40±3,68 in symptomatic group but the difference was not statistically significant (p=0,098) Conclusion: More symptomatic patients than the asymptomatic ones have impaired left ventricular GLS values according to the results of this study. Even if it is not statistically significant, the mean left ventricular GLS values are also reduced in symptomatic patients after mild COVID-19 infection.

The numerical solution of the Darcy-Forchheimer flow of a Williamson nanofluid across a spinning disc is discussed in this paper. This issue took into account the existence of mobile microorganisms and the consequences of radiation exposure. Parameters were used to build the fundamental governing equations, and then these partial differential equations were transformed into ordinary differential equations using the appropriate similarity transformations. The BVP4C is then used to perform a numerical solution of these equations. Several factors' impacts on tangential and radial velocities, temperatures, concentrations, and motile microorganisms were explored, along with their corresponding visual representations. The physical implications of the findings are also elaborated on in great detail.

Native mass spectrometry is a rapidly emerging technique for fast and sensitive structural analysis of protein constructs, maintaining the protein higher order structure. The coupling with electromigrative separation techniques under native conditions enables the characterization of proteoforms and highly complex protein mixtures. In this review, we present an overview of current native CE-MS technology. First, the status of native separation conditions is described for capillary zone electrophoresis (CZE), affinity capillary electrophoresis (ACE), and capillary isoelectric focusing (CIEF), as well as their chip-based formats, including essential parameters such as electrolyte composition and capillary coatings. Further, conditions required for native ESI-MS of (large) protein constructs, including instrumental parameters of QTOF and Orbitrap systems, as well as requirements for native CE-MS interfacing are presented. On this basis, methods and applications of the different modes of native CE-MS are summarized and discussed in the context of biological, medical, and biopharmaceutical questions. Finally, key achievements are highlighted and concluded, while remaining challenges are pointed out.

Estimating the accuracy of quaternary structural models of protein complexes and assemblies (EMA) is important for predicting quaternary structures and applying them to studying protein function and interaction. The pairwise similarity between structural models is proven useful for estimating the quality of protein tertiary structural models, but it has been rarely applied to predicting the quality of quaternary structural models. Moreover, the pairwise similarity approach often fails when many structural models are of low quality and similar to each other. To address the gap, we developed a hybrid method (MULTICOM_qa) combining a pairwise similarity score (PSS) and an interface contact probability score (ICPS) based on the deep learning inter-chain contact prediction for estimating protein complex model accuracy. It blindly participated in the 15th Critical Assessment of Techniques for Protein Structure Prediction (CASP15) in 2022 and ranked first out of 24 predictors in estimating the global accuracy of assembly models. The average per-target correlation coefficient between the model quality scores predicted by MULTICOM_qa and the true quality scores of the models of CASP15 assembly targets is 0.66. The average per-target ranking loss in using the predicted quality scores to rank the models is 0.14. It was able to select good models for most targets. Moreover, several key factors (i.e., target difficulty, model sampling difficulty, skewness of model quality, and similarity between good/bad models) for EMA are identified and analayzed. The results demonstrate that combining the multi-model method (PSS) with the complementary single-model method (ICPS) is a promising approach to EMA.

Processing of CASP15 targets into evaluation units (EUs) and assigning them to evolutionary-based prediction classes is presented in this study. The targets were first split into structural domains based on compactness and similarity to other proteins. Models were then evaluated against these domains and their combinations. The domains were joined into larger EUs if predictors’ performance on the combined units was similar to that on individual domains. Alternatively, if most predictors performed better on the individual domains, then they were retained as EUs. As a result, 112 evaluation units were created from 77 tertiary structure prediction targets. The EUs were assigned to four prediction classes roughly corresponding to target difficulty categories in previous CASPs: TBM (template-based modeling, easy or hard), FM (free modeling), and the TBM/FM overlap category. More than a third of CASP15 EUs were attributed to the historically most challenging FM class, where homology or structural analogy to proteins of known fold cannot be detected.

A document by Eduardo Howard. Click on the document to view its contents.

Background: For severe mitral valve (MV) degenerative disease, repair is recommended. Prediction of repair complexity and referral to centers of excellence can increase rates of successful repair. This study sought to demonstrate that TEE is a feasible imaging modality to predict the surgical MV complexity score previously developed by Anyanwu et al. Methods: Two hundred TEE examinations of patients who underwent MV repair (2009 – 2011) were retrospectively reviewed and scored by two cardiac anesthesiologists. TEE scores were compared to surgical complexity scores of same subset of patients. Kappa values were reported for the agreement of TEE and surgical scores. McNemar’s tests were used to test the homogeneity of the marginal probabilities of different scoring categories. Results: TEE scores were slightly lower (2[1,3]) than surgical scores (3[1,4]). Agreement was 66% between the scoring methods, with a moderate kappa (0.46). Using surgical scores as the gold standard, 70%, 71% and 46% of simple, intermediate and complex surgical scores, respectively, were correctly scored by TEE. P1, P2, P3, and A2 prolapse were easiest to identify with TEE and had the highest agreement with surgical scoring (P1 agreement 79% with kappa 0.55, P2 96% (kappa 0.8), P3 77% (kappa 0.51), A2 88% (kappa 0.6)). The lowest agreement between the two scores occurred with A1 prolapse (kappa 0.05) and posteromedial commissure prolapse (kappa 0.14) (Figure 3). In the presence of significant disagreement, TEE scores were more likely to be of higher complexity than surgical. McNemar’s test was significant for prolapse of P1 (p=0.005), A1 (p=0.025), A2 (p=0.041), and the posteromedial commissure (p<.0001).

As an important part of the construction industry, rural residential buildings are characterized by low energy utilization, unreasonable structures and low consumption levels, and it is particularly important to study their low-carbon transformation and evaluation system. In view of the many low-carbon transformation needs of rural residential buildings, the existing research results were analyzed in depth, and the coefficient of variation method was used to identify the important factors affecting the low-carbon transformation of rural residential buildings, and the evaluation system of rural residential buildings’ low-carbon transformation was determined by Analytic Hierarchy Process (APH), and the system was used in a rural residential building low-carbon evaluation study. The results show that the influence of “energy use”, “envelope structure” and “economic factors” on the decarbonization of buildings is obvious, with the weights of 36.4%, 24.5% and 19.5% respectively. Among the secondary indicators, “clean energy utilization”, “electricity consumption”, “external wall insulation system” and “window performance” are the most important factors in reducing carbon emissions in rural areas. The most critical influencing factors for the low carbonization level of clean energy in rural residential buildings are “window performance”. Finally, based on the constructed low carbonization evaluation system, we propose a targeted solution strategy to provide a theoretical basis for the establishment of an effective low carbonization evaluation system for clean energy in rural residential buildings.

In this paper, we propose a blockchain-based cold chain technology for vaccine cooling track. The COVID-19 pandemic has caused the death of millions of people. An important step towards ending the pandemic is vaccination. Vaccines must be kept under control temperature during the whole process, from fabrication to the hands of the health professionals who will immunize the population. However, there are numerous reports of vaccine loss due to temperature variations, and, currently, people getting vaccinated have no control if their vaccine was kept safe. Blockchain is a technology solution that can provide public and verifiable records. We review the World Health Organization (WHO) cool chain and Blockchain technology. Moreover, we describe current IoT temperature monitoring devices and propose Blockcoldchain to track vaccine cold chain using blockchain, thus proving an unalterable vaccine temperature history. Our experimental results using smart contracts demonstrate the system’s feasibility.

Radiotherapy is a mainstay treatment for malignant tumors in clinical. However, enhancing radiation damage to tumor cells meanwhile sparing normal tissues is still a great challenge in radiotherapy. Nanomaterials with high atomic number (Z) values are promising radiosensitizers by promoting the radiation energy deposition in irradiated tumor cells, thus enhancing the therapeutic ratio of radiotherapy. In this review, we described the mechanisms of high-Z element radiosensitizers and systematically summarized the recent progress on metal-based nanomaterials, including high-Z metal nanoparticles, metal-organic frameworks (MOFs) and other high-Z-containing nanomaterials. Finally, further potential and challenges in this field were discussed.

Background: Depression is one of the most common psychological disorders nowadays, with continuous and prolonged low mood as the main clinical feature, and it is the most important type of psychological disorders in modern people. The aim of this study is to develop a depression prediction model based on causal inference and machine learning. Methods: This case study included 7000 subjects. A feature selection model was built based on a causal inference algorithm. The selected features were entered as variables in seven machine learning (ML) models built to create a predictive model for the diagnosis of depression. Results: Among the seven ML models, the random forest model (RF) showed the best performance. For the prediction of depression, the area under receiver operating characteristic (AUC) of the RF model was 0.908(0.810-1.00) in 10-fold stratified cross-validation and 0.901 (0.893-0.91) in external validation.

Background COVID-19 vaccination program for adults in India is one of the highly successful vaccination drives globally but acceptance of COVID-19 for children and adolescents is largely unknown. As parents are primary decision-makers for their children, we aimed to assess parents’ perceptions and intentions regarding COVID-19 vaccination for children in India. Aim To assess parental perceptions and intention to get COVID-19 vaccination for their children (aged<18 years), Materials and Methods A cross-sectional anonymous web-based survey was designed. Healthcare workers of a tertiary care institute of Eastern U.P., India having any children aged <18 years were the study population. They were recruited through snowball sampling and were sent the study questionnaire in Google form through email and WhatsApp. Bi-variate analysis was performed to find out the predictors of child vaccination willingness among the parents. Results A total of 388 healthcare workers parents (HCWPs) having a child < 18 years of age completed the survey. Mean age of the parents were 40.28 ±11.34 years. Majority (96.9%) received recommended 2 doses of COVIID-19 vaccine. Around 91% of the parents agreed that COVID-19 vaccines are important for child’s health whereas 89% agreed that COVID-19 vaccines are effective. A total 356 (91.7%) participants shown willing to vaccinate their child with COVID-19 vaccine, 91.3% of them intended to do so as soon as possible Factors found to be significantly associated with the stated willingness for child COVID-19 vaccination among the participants were younger age, female gender, urban residence, absence of any chronic illness, lower monthly income, history of COVID-19 in child and the child immunized with all routine childhood vaccines. Parental concerns mainly centered around vaccine need and its safety. Conclusion The healthcare worker parents (HCWPs) have positive attitude and low vaccine hesitancy towards COVID-19 vaccination for children with around 92% of them currently willing to vaccinate their children with COVID-19 vaccine. Further longitudinal studies are required to be conducted to assess the trend of parental acceptance of COVID vaccine.

Numerous different complications have been reported following Covid-19 disease.Although the disease often improves after going through various clinical phases,some people have Various complications, including coagulation disorders. The patient is a 59-year-old man who developed extensive heart thrombosis following covid19 involvement a month ago and was hospitalized with extensive cardiac dysrhythmias

Aims: Older adults are vulnerable to medication-related harm mainly due to high use of medications and inappropriate prescribing. This study aimed to investigate the associations between inappropriate prescribing and number of medications identified at discharge from geriatric rehabilitation with subsequent post-discharge health outcomes. Method: REStORing health of acutely unwell adulTs (RESORT) is an observational, longitudinal cohort study of geriatric rehabilitation inpatients. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation, using version 2 of the STOPP/START criteria. Results: 1890 patients (mean age 82.6 ± 8.1 years, 56.3 % females) were included. The use of at least 1 PIMs, or PPOs at geriatric rehabilitation discharge were not associated with 30-day and 90-day readmission and 3-month and 12-month mortality. Central nervous system (CNS)/psychotropics and fall risk PIMs were significantly associated with 30-day hospital readmission (adjusted odds ratio (AOR) 1.53; 95%CI 1.09─2.15), and cardiovascular PPOs with 12-month mortality (AOR 1.34; 95%CI 1.00─1.78). Increased number of discharge medications was significantly associated with 30-day (AOR 1.03; 95%CI 1.00─1.07) and 90-day (AOR 1.06; 95%CI 1.03─1.09) hospital readmissions. The use and number of PPOs (including vaccine omissions) were associated with reduced independence in instrumental activities of daily living scores at 90-days post geriatric rehabilitation discharge. Conclusion: The number of discharge medications, CNS/psychotropics and fall risk PIMs were significantly associated with readmission, and cardiovascular PPOs with mortality. Interventions are needed to improve appropriate prescribing in geriatric rehabilitation patients to prevent hospital readmission and mortality.

TITLE PAGETitle: Comment on: evaluating age and sex-specific rates of gall bladder disease in children with sickle cell diseaseArticle type: Letter to the editorCorrespondence : 1. Ifra Eeman Ahmed contact : 03335890003 Email : ifraeemanahmed786@gmail.comInstitution : Federal medical & dental college,IslamabadAddress: House#2,Street#15g,Sector A,Bahria Enclave,IslamabadCo-author : 2. Satesh KumarContact: +92-3325252902 Email:Institute: Shaheed Mohtarma Benazir Bhutto Medical College Liyari, KarachiAddress: Parsa citi Garden east, KarachiWord count: 391Conflict of interest : NoneDeclaration : NoneAcknowledgment : None

Daratumumab induced Minimal Residual Disease Negative Remission in CD 38 (dim) Positive Pediatric Acute Myeloid LeukemiaPronamee Borah1, Dinah Ng1, Nitin Dayal2, Sangeeta Pathak3, Rahul Naithani11Hematology and Bone Marrow Transplant Division, Max Superspecialty Hospital, Delhi, India2Department of Lab Medicine, Max Superspecialty Hospital, Delhi, India3Department of Transfusion medicine, Max Superspecialty Hospital, Delhi, IndiaConflicts of interest: None to declare.No financial support was obtained in this study.Text word count 815Brief running title: Daratumumab in Pediatric AMLKey Words: Daratumumab, AML, ChildrenTables: 0; Figures: 0

Organic luminogens with persistent room temperature phosphorescence (RTP) have drawn tremendous attentions due to their prom-ising potentials in optoelectronic devices, information storage, biological imaging, and anti-counterfeiting. In this work, six triazatrux-ene-based lumiogens with different peripheral substituents and configurations are synthesized and systematically studied. The results show that their fluorescence quantum yields in solid states range from 15.73% to 37.58%. Dispersing the luminogens as guest into the host (PPh3) could turn on the persistent RTP, where PPh3 acts as not only a rigid matrix to suppress the non-radiative transitions of the guest, but also provides energy transfer channels to the guest. The maximum phosphorescence efficiency and the longest lifetime could reach 29.35% and 0.99 s in co-crystal films of 6-TAT-CN/PPh3 and 5-TAT-H/PPh3, respectively. Moreover, these host-guest co-crystalline films exhibit great potentials in advanced dynamic data encryption and anti-counterfeiting. This work deepens the insight for low cost, halogen-free, and facile fabrication of all-organic persistent RTP materials.

A methodology is proposed to aid parameter estimation in fundamental models of pharmaceutical processes. This methodology addresses situations with insufficient data to reliably estimate all parameters, when the estimation is complicated by uncertain independent variables. The proposed method uses an augmented sensitivity matrix to rank the combined set of parameters and uncertain inputs from most estimable to least estimable. An updated mean-squared-error criterion is then used to determine the appropriate parameters and inputs that should be estimated, based on the ranked list. A model for one step in a batch pharmaceutical production process with an uncertain initial reactant concentration is used to illustrate the method, revealing that the initial reactant concentration in each batch should be estimated along with three out of six model parameters. Non-estimable parameters are fixed at their initial values to prevent overfitting. The method will aid error-in-variables parameter estimation in many situations involving limited data.

This paper describes the key findings of a PhD study which critically analyses the construction of social class within UK media during the period 2010-2016-part of the 'age of austerity'. Focusing upon 240 newspaper articles covering 6 topics (emergency budget, welfare reform, workfare, bedroom tax, food banks, and zero-hour contracts), the study provides critical insights into how class is constructed in an important context: namely that of economic downturn and rising inequality. The findings suggest that a pro-austerity discourse dominates the coverage. Here austerity is described as necessary, and the idea of 'unavoidable scarcity' forms the basis for a 'moral divide' between a vague ingroup-the 'ordinary hardworking people', defined by their idealised struggle and selfless sense of duty-and an exploitative 'other'. This both legitimises austerity and masks its broader impact. As the impacts become more apparent, however, challenges to the dominant narrative begin to appear. In the course of these challenges, the struggle inherent to class is placed back on the agenda, and class is increasingly constructed as an 'anxious concept'-a slippery slope down which one might fall.

AbstractThyroid lobules with lymphoid contents are commonly called pseudonodules and micronodules. Ultrasound shows these lobules as significantly hypoechoic. They are referred to as Hashimoto's thyroiditis. However, in some cases, isoechoic areas of varying sizes are visible in hypoechoic lobules.Analysis and interpretation of the features of these isoechoic elements in hypoechoic lobules reveal their regenerative basis. It can be seen that this phenomenon has a phased course, where it is possible to distinguish the destruction and recovery phases. The recovery phase consists of the initial, active, and final periods, differing in the size of the new isoechoic tissue inside the lobule.The duration of each phase and period can vary (several months or many years). Probably, the phenomenon of intralobular regeneration can precede the appearance of reparative nodules. The recovery phase and its severity do not affect thyroid hormonal metabolism. Hypothyroidism may persist in patients regardless of the success of regeneration.Knowing the features of ultrasound signs of intralobular regeneration complements the understanding of diffuse and nodular processes in the thyroid.Keywords: thyroid ultrasound; pseudonodulation; micronodulation; thyroid regeneration; Hashimoto's thyroiditis. IntroductionUltrasound (US) allows to determine characteristic signs of changes in the thyroid gland in Hashimoto's thyroiditis (HT) [1-4]. Such ultrasound symptoms include local formations, more often called micronodules or pseudonodules by specialists [5, 6]. These areas in the gland look moderately or significantly hypoechoic, spherical and elliptical in shape, mainly with a clear edge, without microcalcifications, located separately or in groups, usually from 1.5 to several millimeters in size [5, 7, 8].These thyroid micronodules are clusters of lymphocytes formed as a result of their replacement of follicular tissue in the lobules and/or lymphoid germinal centers [5, 9, 10]. It is more correct to call micronodules by the term "lymphoid lobules" [11]. They are clearly different from thyroid nodules, but, according to some authors, nevertheless require puncture biopsy for differential diagnosis with microcarcinomas [12]. Despite such precautions, specialists assess this focal diffuse process as highly sensitive and highly specific in ultrasound and sonoelastographic diagnostics of Hashimoto's thyroiditis [7, 10]. In modern review articles and manuals on thyroid ultrasound, the pseudonodular process is considered only as a symptom of Hashimoto's thyroiditis, without explaining its variants of changes [13, 14]. At the same time, there are facts that significantly supplement the knowledge of thyroid pseudonodes, revealing the patterns and essence of this process. Among them is the regeneration process [15]. Analysis of ultrasound signs of thyroid lobule regeneration became the goal of this study.

A document by Nicola Tisato. Click on the document to view its contents.

New-onset pemphigus after COVID-19Yihang Xie1 Mei Yang1 Peimei Zhou1* Jiaming Fan1 Sijie Zhou11.Department of Dermatovenereology, Chengdu Second People’s Hospital, Chengdu, China* Corresponding Author: 46551704@qq.comrunning head: pemphigus after COVID‐19The category of the article: LetterKeywords: COVID‐19, pemphigusManuscript word count: 690 wordsThe number of figures: 2The number of tables: 0The number of references: 8Correspondence to: Peimei Zhou, M.D, Ph.D., Department of Dermatovenereology, Chengdu Second People’s Hospital, Qingyun Street, Chengdu, 610041, China.Tel: +86 18908176315; E-mail:46551704@qq.comFull conflict of interest statement: Y. Xie, and my co-authors have no conflict of interest to declare.Ethics statement: The patient has consented to publish this information.Data availability statement: Data sharing does not apply to this article as no new data were created or analyzed in this study.Funding sources: noneDear Editor,Cutaneous manifestations of coronavirus disease (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; family Coronaviridae, genus Betacoronavirus, subgenusSarbecovirus ), have been increasingly reported. SARS-CoV-2 infection is multisystemic and leads to potentially detrimental effects on various organs. Maculopapular, urticarial, vesicular, livedoid, and Chilblain-like lesions (CBLL) have been commonly reported to be associated with COVID-191. Here, we encountered an intriguing case of pemphigus that developed after COVID-19 infection.A 73-year-old male presented with a 42-day history of pruritic flaccid blisters that arose on the trunk and both upper limbs on normal and erythematous skin. Cutaneous lesions started 3 days after the positive reverse transcription polymerase chain reaction (RT-PCR) test diagnostic for SARS-CoV-2. He denied any history of systemic diseases, medication, and medicine or food allergies, and had not used any medication before symptom onset. The patient had first been diagnosed with allergic dermatitis caused by COVID-19 at another hospital and was prescribed oral prednisone (8 mg once daily for 4 days). The patient reported no new blisters, but the erythema did not fade; therefore, he visited our hospital. Physical examination revealed cutaneous lesions on the trunk and both upper limbs without mucosal involvement and scattered superficial blisters that developed into crusted erosions on an erythematous base(Figure1 A-D). Laboratory examination revealed normal white cell count (8.63 Ö109/L; normal 3.5-9.5 Ö109/L) with eosinophilia (6%; normal 0.5%-5.0%). Desmoglein (Dsg) 1 antibody levels were > 150 U/mL (positive: > 20), while Dsg3, BP(bullous pemphigoid)180, and BP230 antibody levels were within normal ranges. Other laboratory tests including RT-PCR targeting SARS-CoV-2, immunoglobulin, erythrocyte sedimentation rate, the spectrum of antinuclear antibodies, and T-spot were negative or normal. Chest and abdominal computed tomography revealed chronic inflammatory changes but no obvious tumors. Histological analysis of an incisional cutaneous biopsy taken from the patient’s abdomen showed subcorneal blister formation, acantholytic cells within the blister, and marked spongiotic edema in the spongiosa layer that had mixed inflammatory infiltrate with eosinophils, leukomonocytes, and neutrophils(Figure2A). Direct immunofluorescence (DIF) showed deposition of intracellular IgG and C3 in subepidermal 2/3 interspinous cells, though was negative for IgA and IgM, confirming pemphigus(Figure2B,C). Considering the good response to hormone treatment, the patient continued oral prednisone at 8 mg once daily along with the use of topical corticosteroids. Symptoms were completely absent after 3 weeks(Figure1 E-F).An increasing number of studies on cutaneous manifestations of COVID-19 have been reported; however, knowledge is still lacking on the common skin manifestations of this disease. Nonspecific cutaneous manifestations due to SARS-CoV-2 infection have also been reported, such as immune thrombocytopenic purpura (ITP), dengue-like exanthem, pityriasis rosea-like eruptions, acral ischemia, mucositis, dusky lesions, and bullae2.3.4. We searched all relevant articles and found only two cases of pemphigus vulgaris induced by COVID-19. In the case presented here, we realized that COVID-19 may be responsible for the rash eruption, possibly due to an inflammatory reaction5. The onset time of the rash was similar to that in the cases of pemphigus previously reported by De Medeiros5 and Mohaghegh F6 (within 1.5 months). In our case, although direct immunofluorescence showed subepidermal 2/3 deposition, we still diagnosed pemphigus foliaceus in combination with the pathological presentation, indirect immunofluorescence, and good treatment outcome. We speculate that the reason why direct immunofluorescence showed subepidermal 2/3 deposition may be the marked sponge edema of the epidermis, which may lead to a discontinuity of acantholysis, resulting in leakage of Dsg1 into the deeper epidermis.Pemphigus is defined as a group of rare mucocutaneous autoimmune diseases. Its etiology is unknown, though there are studies on autoimmune etiology which is believed to be related to stimulation by certain drugs, ultraviolet radiation, and malignant tumors; these induce autoimmune reactions by making the adhesive substances between the spiny cell layers become autoantigens7. It is rarely considered, however, that viral infections might cause pemphigus. The ability of SARS-CoV-2 to induce a hyper-stimulated immune state was discovered at the beginning of the pandemic8. As an instrumental trigger of autoimmunity, SARS-CoV-2 infection could be a trigger for autoimmune reactions, possibly through more than one mechanism. Because of this, all factors should be considered in any patient presenting with new-onset or exacerbating cutaneous reactions.

Over three years, humans have experienced multiple rounds of global transmission of SARS-CoV-2 and its variants. In addition, the widely used vaccines against SARS-CoV-2 involve multiple strategies of development and inoculation. Thus, the acquired immunity established among humans is complicated, and there is a lack of understanding within a panoramic vision. Here, we provide the special characteristics of the cellular and humoral responses in 2-year convalescents after inactivated vaccines, in parallel to vaccinated COVID-19 naïve persons and unvaccinated controls. The decreasing trends of the IgG, IgA, and NAb, but not IgM of the convalescents were reversed by the vaccination. Both cellular and humoral immunity in convalescents after vaccination were higher than the vaccinated COVID-19 naïve persons. Notably, inoculation with inactivated vaccine fueled the NAb to BA.1, BA.2, BA.4, and BA.5 in 2-year convalescents, much higher than the NAb during 6 months and 1 year after symptoms onset. And no obvious T cell escaping to the S protein was observed in 2-year convalescents after inoculation. The study provides insight into the complicated features of human acquired immunity to SARS-CoV-2 and variants in the real world, indicating that promoting vaccine inoculation is essential for achieving herd immunity against emerging variants, especially in convalescents.

Some of the most vexing problems of deep level relationship that remain in angiosperms involve the superrosids. The superrosid clade contains a quarter of all angiosperm species, with 18 orders in three subclades (Vitales, Saxifragales and core rosids) exhibiting remarkable morphological and ecological diversity. To help resolve deep-level relationships, we constructed a high-quality chromosome-level genome assembly for Tiarella polyphylla (Saxifragaceae) thus providing broader genomic representation of Saxifragales. Whole genome microsynteny analysis of superrosids showed that Saxifragales shared more synteny clusters with core rosids than Vitales, further supporting Saxifragales as more closely related with core rosids. To resolve the ordinal phylogeny of superrosids, we screened 122 single copy nuclear genes from genomes of 36 species, representing all 18 superrosid orders. Vitales were recovered as sister to all other superrosids (Saxifragales + core rosids). Our data suggest dramatic differences in relationships compared to earlier studies within core rosids. Fabids should be restricted to the nitrogen-fixing clade, while Picramniales, the Celastrales-Malpighiales (CM) clade, Huerteales, Oxalidales, Sapindales, Malvales and Brassicales formed an “expanded” malvid clade. The Celastrales-Oxalidales-Malpighiales (COM) clade (sensu APG IV) was not monophyletic. Crossosomatales, Geraniales, Myrtales and Zygophyllales did not belong to either of our well-supported malvids or fabids. There is strong discordance between nuclear and plastid phylogenetic hypotheses for superrosid relationships; we show that this is best explained by a combination of incomplete lineage sorting and ancient reticulation.