Objective The purpose of this study was to investigate the effect of disease modifying therapies on immune response to severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) vaccines in people with multiple sclerosis (MS). Methods Four hundred seventy‐three people with MS provided one or more dried blood spot samples. Information about coronavirus disease 2019 (COVID‐19) and vaccine history, medical, and drug history were extracted from questionnaires and medical records. Dried blood spots were eluted and tested for antibodies to SARS‐CoV‐2. Antibody titers were partitioned into tertiles with people on no disease modifying therapy as a reference. We calculated the odds ratio of seroconversion (univariate logistic regression) and compared quantitative vaccine response (Kruskal Wallis) following the SARS‐CoV‐2 vaccine according to disease modifying therapy. We used regression modeling to explore the effect of vaccine timing, treatment duration, age, vaccine type, and lymphocyte count on vaccine response. Results Compared to no disease modifying therapy, the use of anti‐CD20 monoclonal antibodies (odds ratio = 0.03, 95% confidence interval [CI] = 0.01–0.06, p < 0.001) and fingolimod (odds ratio = 0.04; 95% CI = 0.01–0.12) were associated with lower seroconversion following the SARS‐CoV‐2 vaccine. All other drugs did not differ significantly from the untreated cohort. Both time since last anti‐CD20 treatment and total time on treatment were significantly associated with the response to the vaccination. The vaccine type significantly predicted seroconversion, but not in those on anti‐CD20 medications. Preliminary data on cellular T‐cell immunity showed 40% of seronegative subjects had measurable anti‐SARS‐CoV‐2 T cell responses. Interpretation Some disease modifying therapies convey risk of attenuated serological response to SARS‐CoV‐2 vaccination in people with MS. We provide recommendations for the practical management of this patient group. ANN NEUROL 2021

The sequential activity of gut microbial and host processes can exert a powerful modulatory influence on dietary components, as exemplified by the metabolism of the amino acids tyrosine and phenylalanine to p -cresol by gut microbes, and then to p -cresol glucuronide (pCG) by host enzymes. Although such glucuronide conjugates are classically thought to be biologically inert, there is accumulating evidence that this may not always be the case. We investigated the activity of pCG, studying its interactions with the cerebral vasculature and the brain in vitro and in vivo . Male C57Bl/6 J mice were used to assess blood–brain barrier (BBB) permeability and whole-brain transcriptomic changes in response to pCG treatment. Effects were then further explored using the human cerebromicrovascular endothelial cell line hCMEC/D3, assessing paracellular permeability, transendothelial electrical resistance and barrier protein expression. Mice exposed to pCG showed reduced BBB permeability and significant changes in whole-brain transcriptome expression. Surprisingly, treatment of hCMEC/D3 cells with pCG had no notable effects until co-administered with bacterial lipopolysaccharide, at which point it was able to prevent the permeabilizing effects of endotoxin. Further analysis suggested that pCG acts as an antagonist at the principal lipopolysaccharide receptor TLR4. The amino acid phase II metabolic product pCG is biologically active at the BBB, antagonizing the effects of constitutively circulating lipopolysaccharide. These data add to the growing literature showing glucuronide conjugates to be more than merely metabolic waste products and highlight the complexity of gut microbe to host communication pathways underlying the gut–brain axis.

Social media (SoMe) are platforms that enable users to create and share content, or participate in social networking. Medical education is rapidly moving into a post-COVID world, with the use of SoMe becoming ever more prominent. We explore the risks and benefits of using this technology to assist learning and examine these in light of relevant educational theory.Benefits include accessibility to experts, opportunities for mentorship, access to support networks, resource sharing and global participation. Following the 'Black Lives Matter' movement, SoMe has provided the impetus to adapt medical curricula to address health inequities in minority ethnic individuals.Key criticisms focus on superficial learning, psychological safety, correctly identifying level of expertise, professionalism and ownership protections for content creators. Users have limited ways to manage risk.The medical education community must adapt and rapidly critique SoMe innovations so that they can be better developed and learned from, all the while remaining vigilant.

The COVID‐19 pandemic has left dermatology practice in disarray globally. Patient‐facing services have been compromised for patients and clinicians alike. The implications of such disruption for dermatology undergraduate education are unknown. Numerous undergraduate programmes have faced disruption, with teaching postponed or featuring reformatted, ad‐hoc delivery. Following the pandemic, it is anticipated UK medical education will face a ‘new normal’, with a much greater emphasis on technology‐enhanced learning 1 . This presents a challenge to dermatology educators as we reflect upon our undergraduate curriculum delivery in an uncertain climate.

Urbanization is an important part of economic development in China which directly related to industrial development. Industrial development is based on energy production, consumption, and trade. A new type of urbanization with low carbon city development is an urgent matter in the researcher community for developing an appropriate strategy, policy, technology, and action. The aim of this study is to explore the status and assess the strategy and policy of low carbon city development in the context of urbanization. It also finds out the effects of new type of urbanization on low carbon city development by finding out constraints and providing recommendations. An extensive literature review with meta-analysis has been done considering various indicators of low carbon city development. This study reveals that most of the large cities are already under the pilot projects of low carbon city development. It also finds out some major indicators of low carbon city like economic growth, energy using pattern, social and lifestyle factor, carbon and environment, urban mobilization, solid waste management, and water management in the context of urbanization. Rapid urbanization requires more building construction and energy which emits more GHG. It suggests that an assessment index system should be introduced by the government to control, monitor and motivate people to use low carbon technology. It further suggests that rules and regulations, awareness building, locality-based technology and practices, and participation of all stakeholders in policy making should be maintained by the government for sustainable low carbon city development in China.