tbuckley/cabot-search huggingface dataset:
AB0362 DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF BEHCET’S DİSEASE PATIENTS
Authors: S. Şan, Ö. Özdemir Işik, A. Yazici, A. Cefle
Journal: Annals of the Rheumatic Diseases (2021)

Background: Behcet’s Disease (BD) is a systemic variable vessel vasculitis that involves the skin, mucosa, joints, eyes, arteries, veins, nervous system and the gastrointestinal system. Objectives: In this study we aimed to present variety of involvements in patients who were followed up in our outpatient clinic with a diagnosis of BD. Methods: Data of 394 patients diagnosed with BD between 2000-2020 were retrospectively reviewed clinical, demographic characteristics and systemic involvements. Results: In our study 43.7% of BD patients were female, 56.3% were male and the mean age was 40±11years, disease average age of onset 36.5±10.6, disease duration was 12.8±6.8years. It was observed mucocutaneus involvement 98% of the patients, uveitis in 35%, retinal vasculitis in 2.8%, arthritis in 24.9%, arterial occlusion in 2.3%, arterial aneurysm in 3.8%, venous involvement in 19.8%, gastrointestinal (GIS) involvement in 4.3%, cardiac involvement in 1.5%, and cranial involvement 7.1 (Table 1). Table 1. The Data of Behçet Disease n (%) n= 394 Gender Female 172 (43.7 ) Male 222 (56.3 ) Family History 48 (12.2) Fever &amp; Weight Loss 21 (5.3) Mucocutaneus involvement 386 (98) Oral Aphthous Ulcer 379 (96.2 ) Genital Ulcer 256 (65 ) Papulopustular lesions 129 (32.7 ) Erythema Nodosum-like lesions 150 (38.1 ) Skin Pathergy Reaction 185 (47) Uveitis 138 (35) Retinal Vasculitis 11 (2.8) Venous involvement 76 (17.6) Thrombophlebitis 30 (7.6 ) 67 (17 ) Deep venous thrombosis Arthritis 98 (24.9) Monoarthritis 74 (75.5 ) Oligoarthritis 21 (21.4 ) Sacroiliitis 3 (3.0 ) Artery Occlusion 9 (2.3) Arterial Aneurysm 15 (3.8) GIS involvement 17 (4.3) İleum 9 (2.3 ) Colon 2 (0.5 ) Rectum 1 (0.3 ) İleocolonic 4 (1 ) Cardiac involvement 6 (1.5) Pericarditis 2 (0.5 ) Ventricular thrombosis 3 (0.7 ) Atrial thrombosis 1 (0.2 ) Cranial involvement 24 (5.6) Parenchymal involvement 13 (4.6 ) Cerebral Venous Thrombosis 11 (2.8 ) Pulse steroid 15 (3.8) 1mg/kg steroid 48 (12.2) Infliximab 13 (3.3) Azathioprine 184 (46.7) Cyclophosphamide 31 (7.9) When all patients evaluated in terms of renal findings, proteinuria was observed in 5 patients and hematuria was observed in 2 patients. 3 patients had proteinuria over than 500mg/day. Their renal biopsy findings; 2 of them were nonspecific involvements and one of them was minimal mesangioproliferative changes. Conclusion: As a multi-system disease, general data have been presented, as clinical symptoms involve almost all systems of the body (1). References: [1]Behcet’s disease Fereydoun Davatchi 1Int J Rheum Dis.2014 May;17(4):355-7. doi: 10.1111/1756-185X.12378. Disclosure of Interests: None declared
POS1337 BEHÇET`S DISEASE AND COURSE OF PREGNANCY - RESULTS FROM THE NATIONWIDE PREGNANCY REGISTER REVNATUS
Authors: H. S. Koksvik, B. Jakobsen, H. Bjørngaard, C. Skorpen, M. Wallenius
Journal: Annals of the Rheumatic Diseases (2021)

Background: Behçets disease (BD) is a complex and multisystemic disorder of unknown etiology. It is characterized by recurrent oral and genital ulcers and inflammatory eye involvement. It can also affect the cardiovascular, pulmonary and skeletal system. BD is commonly diagnosed in women in reproductive age. Pregnancy outcomes are reported in previous studies with discrepancies in the rate of pregnancy-related complications. Objectives: To describe the course of pregnancy in patients with BD. Methods: We prospectively collected data on pregnancy outcome in women with BD through the nationwide Norwegian registry on pregnancy and rheumatic diseases (RevNatus) from 2016-2020. All women were diagnosed with ICD-10 code M35.2. 13 pregnancies in 11 women were recorded. One women had two pregnancies including one twin birth. Results: Median age at conception was 30 years (range 25-32), with median disease duration 7 years (range 1-15). There were no serious organ manifestations. Tnf-alpha-inhibitors were used in 2 nd trimester in 3 pregnancies. All pregnancies resulted in live births with median gestational age at delivery of 38 weeks (range 36-41). No preeclampsia or HELLP were recorded. Table 1. Pregnancy outcome in 13 BD pregnancies Patient # Pregnancy # Medication at 2.nd trimester Oral or genital ulcers during pregnancy Disease activity during pregnancy CRP value at 2nd trimester Gestational age at delivery, week Mode of delivery Birth weight, gram A 1 Azathioprine Colchicine LMWH no persistent* 13 38 SVD 3475 B 2 Adalimumab Colchicine LDPrednisolon yes persistent * 4 40 SVD 3215 C 3 no yes persistent* 5 41 SVD 3355 D 4 Adalimumab LDPrednisolon yes persistent* 23 36 SVD 1940 E 5 Etanercept ASA no 2 41 SVD 3410 6a (twin) Etanercept ASA no 5 37 Elective Sectio 2400 6b (twin) 2410 F 7 LDPrednisolon yes flare** 15 38 SVD 3180 8 Adalimumab LDPrednisolon yes flare** 4 37 Acute Sectio 3049 G 9 no no remission*** 1 41 SVD 3150 H 10 LDPrednisolon yes persistent * 10 38 SVD 2480 I 11 ASA no persistent* 3 39 SVD 3410 J 12 no yes persistent* 1 37 SVD 3115 K 13 Ciklosporine no remission*** 3 37 SVD 3130 SVD = spontaneous vaginal delivery, ASA = acetylsalicylic acid, LDPrednisolon = Low dose Prednisolon &lt;10 mg/day, *= persistent throughout pregnancy, **= flare once during pregnancy, ***= remission throughout pregnancy Conclusion: Pregnancies in women with BD in this cohort were uncomplicated. We did not reveal any serious events, and they all resulted in live births. However, BD is a very heterogeneous disease, and the women in our cohort did not have any serious organ manifestations. Larger cohorts representing the heterogeneity are needed to study the course and outcome of pregnancies in BD. Disclosure of Interests: None declared
POS0377 FIBROCYTES IN EARLY AND LONGSTANDING RHEUMATOID ARTHRITIS: A 6-MONTH TRIAL WITH REPEATED SYNOVIAL BIOPSY, IMAGING, AND LUNG FUNCTION TEST
Authors: S. A. Just, C. Nielsen, J. Werlinrud, P. V. Larsen, E. K. Hejbøl, H. Tenstad, H. D. Schrøder, T. Barington, T. Torfing, F. Humby, H. M. Lindegaard
Journal: Annals of the Rheumatic Diseases (2021)

Background: Fibrocytes are bone marrow-derived cells, that express both hematopoietic and stromal markers. In murine collagen-induced arthritis models circulating fibrocytes have been found to home to inflamed joints and enhance arthritis activity. The cell has, therefore, been proposed to be precursor cells for the fibroblast-like synoviocytes (FLS), which are central in the Rheumatoid Arthritis (RA) pathogenesis. Fibrocytes levels are further correlated with disease progression and mortality in interstitial lung disease (ILD) and identified as a new treatment target. ILD is also an extra-articular manifestation of RA (RA-ILD), leading to a reduced lung diffusion capacity and increased mortality. Objectives: To correlate the level of fibrocytes in peripheral blood, synovial tissue, and in vitro culture in RA to changes in disease activity, imaging, and pulmonary function. Methods: Twenty patients with early RA (ERA) and 20 patients with longstanding RA (LRA) were enrolled in a six months prospective study. Sixteen patients undergoing wrist arthroscopy were healthy controls. RA patients underwent pulmonary function tests, ultrasound, and synovial ultrasound-guided needle biopsy of the same wrist, at baseline and six months. Wrist magnetic resonance imaging was performed at baseline (all) and six months (ERA). Circulating fibrocytes were measured by flow cytometry, in vitro by the number of monocytes that were differentiated to fibrocytes, and in synovial biopsies by counting in histological sections. Results: Fibrocyte levels did not decline during the trial despite effective RA treatment. Fibrocytes were primarily located around vessels and in the subintimal area in the synovium (Figure 1A and 1B, fibrocytes marked with arrows). In the ERA group, increased synovitis assessed by ultrasound was moderate and strongly correlated to respectively increase in circulating and synovial fibrocyte levels. Increased synovitis assessed by MRI during the trial in the ERA group, was moderately correlated to both increased numbers of circulating and cultured fibrocytes. Absolute diffusion capacity level was overall weakly negatively correlated to the level of circulating and synovial fibrocytes. The decline in forced ventilatory capacity and diffusion capacity during the trial was moderately correlated to increased levels of synovial fibrocytes (Figure 1C and 1D). Conclusion: Our findings point to fibrocytes as key mediators of RA pathogenesis, and as a possible pathogenic link between the disease process in the synovium and RA lung affection. Studies are needed to investigate if the new therapies targeting fibrocyte differentiation/migration could be a path forward in RA/RA-ILD treatment. Disclosure of Interests: None declared
AB0171 ACHILLES ENTHESITIS AND PLANTAR FASCIITIS IN RHEUMATOID ARTHRITIS PATIENTS: IMPACT OF BODY MASS INDEX
Authors: K. Maatallah, H. Boussaa, H. Riahi, H. Ferjani, M. Habechi, W. Triki, D. Ben Nessib, M. Bouaziz, D. Kaffel, W. Hamdi
Journal: Annals of the Rheumatic Diseases (2021)

Background: Enthesitis is known as a hallmark of spondyloarthitis. However, the growing use of ultrasonography (US) increased our opportunity to encounter enthesitis in rheumatoid arthritis (RA). The involvement of Achilles tendon and the plantar fascia is not rare in RA patients. Objectives: The aims of this study were to determine the prevalence of Achilles enthesitis and plantar fasciitis in RA patients, and to identify association with clinical data. Methods: We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic and clinical data were collected. Three groups were defined according to the BMI: normal (BMI&lt;25kg/m 2 ), overweight (BMI≥25kg/m 2 ) and obese (BMI≥30kg/m 2 ). US examination of Achilles tendon and plantar aponeurosis was performed by a blinded radiologist experienced in musculoskeletal US using a Philips HD11 device with a high-frequency linear transducer. Enthesitis was defined as hypoechoic and/or thickened insertion of the tendon close to the bone (within 2 mm from the bony cortex) which exhibits Doppler signal if active and that may show erosions, enthesophytes or calcifications as sign of structural damage. A p-value &lt;0.05 was considered significant. Results: Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7]. The mean BMI was 27.7±5.4 kg/m 2 [18.3-45.8]. Obesity was noted in 22.7 % of patients and overweight in 45.5% of patients. Clinical examination revealed pes planus valgus (PPV) in 55.6% of cases and pes cavus varus (PCV) in 18.5% of cases. Heel US revealed Achilles enthesitis in 79.6% of cases. The following elementary lesions were noted in the enthesis: thickness (24.1%), hypoechogenicity (37%), erosions (9.3%), enthésophytes (75.9%), and Doppler signal (3.7%). Plantar fasciitis was noted in 81.5% of cases. The following elementary lesions were found in the insertion of plantar aponeurosis: thickness (75.9%), hypoechogenicity (77.8%), erosions (16.7%), enthesophytes (13%), calcifications (1.9%), and Doppler signal (1.9%). An association was noted between BMI and Achilles enthesitis (p=0.002). This association was not found with plantar fasciitis (p=0.224). Achilles enthesitis was also associated with PCV (p=0.007) while plantar fasciitis was associated with PPV (p=0.039). Conclusion: Achilles enthesitis and plantar fasciitis are common in RA patients. These lesions seem to be associated with BMI and foot deformities rather than the inflammatory process. Disclosure of Interests: None declared
AB0652 FERRITIN IS ASSOCIATED WITH THE SEVERITY OF LUNG INVOLVEMENT BUT NOT WITH WORSE PROGNOSIS IN PATIENTS WITH COVID-19: DATA FROM TWO ITALIAN COVID-19 UNITS
Authors: F. Carubbi, A. Alunno, L. Salvati, C. Ferri, D. Grassi
Journal: Annals of the Rheumatic Diseases (2021)

Background: The coronavirus 2019 disease (COVID-19) is characterised by a heterogeneous clinical presentation and a wide range of imaging findings, depending on disease severity and time course. The pathophysiology is complex, involving immune and hematologic systems, epithelial cells and vascular system and to date reliable biomarkers aimed at stratifying patients and predicting worse outcomes have not been identified Objectives: The aim of this study was to describe clinical, serological and CT imaging features of a cohort of patients with COVID-19 pneumonia and identify possible relationships between the variables and disease outcomes (admission to intensive care unit (ICU) and/or death). Methods: We evaluated hospitalized patients with proven SARS-CoV-2 infection, clinical signs of COVID-19 and computed tomography (CT) scan-proven pulmonary involvement. Clinical and serological records of patients admitted to two COVID-19 Units in Italy with proven SARS-CoV-2 pulmonary involvement investigated with CT scan, assessed at the time of admission to the hospital, were retrospectively collected. Results: Sixty-one patients (22 females and 39 males) of median age 65 years were enrolled. Fifty-six patients were discharged while death occurred in 5 patients. None of the lung abnormalities detected by CT was different between discharged and deceased patients. No differences were observed in the features and extent of pulmonary involvement according to age and gender. Logistic regression analysis with age and gender as covariates demonstrated that ferritin levels over the 25 th percentile were associated with the involvement of all 5 pulmonary lobes (OR=14.5, 95% CI=2.3-90.9, p=0.004), the presence of septal thickening (OR=8.2, 95% CI=1.6-40.9, p=0.011) and the presence of mediastinal lymph node enlargement (OR=12.0, 95% CI=1.1-127.5, p=0.039) independently of age and gender. Conclusion: We demonstrated that ferritin levels over the 25 th percentile are associated with a more severe pulmonary involvement, independently of age and gender, but not with disease outcomes (admission to ICU/death). The identification of reliable biomarkers in patients with COVID-19 may help guiding clinical decision, tailoring therapeutic approaches and ultimately improving the care and prognosis of patients with this disease. Disclosure of Interests: None declared.
COVID-19 and stem cell transplantation; results from an EBMT and GETH multicenter prospective survey
Authors: Per Ljungman, Rafael de la Camara, Malgorzata Mikulska, Gloria Tridello, Beatriz Aguado, Mohsen Al Zahrani, Jane Apperley, Ana Berceanu, Rodrigo Martino Bofarull, Maria Calbacho, Fabio Ciceri, Lucia Lopez-Corral, Claudia Crippa, Maria Laura Fox, Anna Grassi, Maria-Jose Jimenez, Safiye Koçulu Demir, Mi Kwon, Carlos Vallejo Llamas, José Luis López Lorenzo, Stephan Mielke, Kim Orchard, Rocio Parody Porras, Daniele Vallisa, Alienor Xhaard, Nina Simone Knelange, Angel Cedillo, Nicolaus Kröger, José Luis Piñana, Jan Styczynski
Journal: Leukemia (2021)

This study reports on 382 COVID-19 patients having undergone allogeneic (n = 236) or autologous (n = 146) hematopoietic cell transplantation (HCT) reported to the European Society for Blood and Marrow Transplantation (EBMT) or to the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH). The median age was 54.1 years (1.0-80.3) for allogeneic, and 60.6 years (7.7-81.6) for autologous HCT patients. The median time from HCT to COVID-19 was 15.8 months (0.2-292.7) in allogeneic and 24.6 months (-0.9 to 350.3) in autologous recipients. 83.5% developed lower respiratory tract disease and 22.5% were admitted to an ICU. Overall survival at 6 weeks from diagnosis was 77.9% and 72.1% in allogeneic and autologous recipients, respectively. Children had a survival of 93.4%. In multivariate analysis, older age (p = 0.02), need for ICU (p < 0.0001) and moderate/high immunodeficiency index (p = 0.04) increased the risk while better performance status (p = 0.001) decreased the risk for mortality. Other factors such as underlying diagnosis, time from HCT, GVHD, or ongoing immunosuppression did not significantly impact overall survival. We conclude that HCT patients are at high risk of developing LRTD, require admission to ICU, and have increased mortality in COVID-19.
Epigenetic targeted therapy of stabilized BAP1 in ASXL1 gain-of-function mutated leukemia
Authors: Lu Wang, Noah Warren Birch, Zibo Zhao, Carson Meredith Nestler, Alexander Kazmer, Anthony Shilati, Alisha Blake, Patrick Alexander Ozark, Emily Jane Rendleman, Didi Zha, Caila Ann Ryan, Marc Alard Jonathan Morgan, Ali Shilatifard
Journal: Nature Cancer (2021)
Abstract 206: Feasibility and Three Dimensional Color-coded Maps of Tissue Characterization of Coronary Plaques Using 320-detector Row Computed Tomography - A Comparison With an Integrated Backscatter Intravascular Ultrasound
Authors: Shigekiyo Takahashi, Masanori Kawasaki, Masazumi Arai, Takahisa Ido, Akimitsu Tanaka, Masanao Takeya, Suguru Murase, Shinya Minatoguchi
Journal: Circulation (2009)

Background: Recently, a new generation of multi-detector row computed tomography (MDCT) with 320-detector rows (DR) has become available in clinical settings. However, tissue characterization of co...
Quality and Safety in Healthcare, Part LXXXVIII
Authors: Jay A. Harolds
Journal: Clinical Nuclear Medicine (2021)

The Toyota Production System (TPS) revolutionized automotive manufacturing and then spread more widely to other manufacturing and service industries, including healthcare. Many of the concepts in the TPS originated from ideas from the quality and production pioneers in the United States. Japanese experts built on these concepts and added many of their own to fashion them together into a comprehensive system. One of the key concepts in the TPS is to reduce waste without sacrificing quality.
Activated natural killer cells predict poor clinical prognosis in high-risk B- and T-cell acute lymphoblastic leukemia
Authors: Caroline Duault, Anil Kumar, Adeleh Taghi Khani, Sung June Lee, Lu Yang, Min Huang, Christian Hurtz, Bryan Manning, Lucy Ghoda, Tinisha McDonald, Norman J. Lacayo, Kathleen M. Sakamoto, Martin Carroll, Sarah K. Tasian, Guido Marcucci, Jianhua Yu, Michael A. Caligiuri, Holden T. Maecker, Srividya Swaminathan
Journal: Blood (2021)
Deep immune profiling reveals targetable mechanisms of immune evasion in immune checkpoint inhibitor-refractory glioblastoma
Authors: Erin F Simonds, Edbert D Lu, Oscar Badillo, Shokoufeh Karimi, Eric V Liu, Whitney Tamaki, Chiara Rancan, Kira M Downey, Jacob Stultz, Meenal Sinha, Lauren K McHenry, Nicole M Nasholm, Pavlina Chuntova, Anders Sundström, Vassilis Genoud, Shilpa A Shahani, Leo D Wang, Christine E Brown, Paul R Walker, Fredrik J Swartling, Lawrence Fong, Hideho Okada, William A Weiss, Mats Hellström
Journal: Journal for ImmunoTherapy of Cancer (2021)

Glioblastoma (GBM) is refractory to immune checkpoint inhibitor (ICI) therapy. We sought to determine to what extent this immune evasion is due to intrinsic properties of the tumor cells versus the specialized immune context of the brain, and if it can be reversed.
Risk Associated With Valvular Regurgitation During Pregnancy
Authors: Birgit Pfaller, Angelo Dave Javier, Jasmine Grewal, Nadia Gabarin, Jack Colman, Marla Kiess, Rachel M. Wald, Mathew Sermer, Samuel C. Siu, Candice K. Silversides
Journal: Journal of the American College of Cardiology (2021)
Diabetic Polyneuropathy Early in Type 2 Diabetes Is Associated With Higher Incidence Rate of Cardiovascular Disease: Results From Two Danish Cohort Studies
Authors: Lasse Bjerg, Sia K. Nicolaisen, Diana H. Christensen, Jens S. Nielsen, Signe T. Andersen, Marit E. Jørgensen, Troels S. Jensen, Annelli Sandbæk, Henning Andersen, Henning Beck-Nielsen, Henrik T. Sørensen, Daniel R. Witte, Reimar W. Thomsen, Morten Charles
Journal: Diabetes Care (2021)

OBJECTIVE Symptoms indicative of diabetic polyneuropathy (DPN) early in type 2 diabetes may act as a marker for cardiovascular disease (CVD) and death. RESEARCH DESIGN AND METHODS We linked data from two Danish type 2 diabetes cohorts, the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Denmark) and the Danish Centre for Strategic Research in Type 2 Diabetes (DD2), to national health care registers. The Michigan Neuropathy Screening Instrument questionnaire (MNSIq) was completed at diabetes diagnosis in ADDITION-Denmark and at a median of 4.6 years after diagnosis of diabetes in DD2. An MNSIq score ≥4 was considered as indicative of DPN. Using Poisson regressions, we computed incidence rate ratios (IRRs) of CVD and all-cause mortality comparing MNSIq scores ≥4 with scores &amp;lt;4. Analyses were adjusted for a range of established CVD risk factors. RESULTS In total, 1,445 (ADDITION-Denmark) and 5,028 (DD2) individuals were included in the study. Compared with MNSIq scores &amp;lt;4, MNSIq scores ≥4 were associated with higher incidence rate of CVD, with IRRs of 1.79 (95% CI 1.38–2.31) in ADDITION-Denmark, 1.57 (CI 1.27–1.94) in the DD2, and a combined IRR of 1.65 (CI 1.41–1.95) in a fixed-effect meta-analysis. MNSIq scores ≥4 did not associate with mortality; combined mortality rate ratio was 1.11 (CI 0.83–1.48). CONCLUSIONS The MNSIq may be a tool to identify a subgroup within individuals with newly diagnosed type 2 diabetes with a high incidence rate of subsequent CVD. MNSIq scores ≥4, indicating DPN, were associated with a markedly higher incidence rate of CVD, beyond that conferred by established CVD risk factors.
Triple stent-in-stent placement of novel braided metal stents with a slim delivery system via balloon-assisted enteroscopy
Authors: Tatsuya Sato, Hirofumi Kogure, Yousuke Nakai, Kazunaga Ishigaki, Ryunosuke Hakuta, Kei Saito, Kazuhiko Koike
Journal: Endoscopy (2021)

The placement of multiple metal stents for hilar malignant biliary obstruction (MBO) is technically challenging, especially for patients with surgically altered anatomy [1]. The laser-cut type of metal stent has been the only choice [2] until now, with the advent of a novel braided-type metal stent with a 6-Fr delivery system (Niti-S large cell SR slim delivery; 196-cm long; TaeWoong Medical, Gyeonggi-do, Korea) ([Fig. 1]) [3] [4], which can be deployed via balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP). With its improvement in pushability and trackability, multiple stent-in-stent placement may now be a feasible option for post-surgical MBO.
Vaccine Breakthrough Infections with SARS-CoV-2 Variants
Authors: Kirtan Rana, Ritin Mohindra, Lakshmi Pinnaka
Journal: New England Journal of Medicine (2021)

Vaccine Breakthrough Infections with SARS-CoV-2 VariantsTo the Editor: The article by Hacisuleyman et al. (published online on April 21) 1 reinforces concerns about SARS-CoV-2 variants and vaccine breakthrough.The authors describe two fully vaccinated women older than 50 years of age in whom subsequent vaccine breakthrough infection occurred with variants.The authors did not report on the measurement of SARS-CoV-2-specific T-cell responses.T-cell immunity is important in the control of SARS-CoV-2 2 and may be critical for potential cross-reactive protection against variants.SARS-CoV-2 messenger RNA (mRNA) vaccines generate weaker T-cell responses than other vaccine platforms. 3Although several mix-and-match vaccine studies are ongoing or planned, the effect of a vector boost of an mRNA vaccine prime on T-cell responses is currently unknown.Since Covid-19 vaccines vary with regard to immunogenicity and immune specificity, we would encourage consideration of a vaccine boost from a T-cell-skewed vaccine after mRNA vaccination to boost T-cell responses and potentially to reduce the chance of breakthrough infection through the generation of cross-protective T-cell immunity.The prevention of vaccine failure due to variants is a critical part of pandemic management.