Evolution of SARS-CoV-2 in immunocompromised hosts may result in novel variants with changed properties. While escape from humoral immunity certainly contributes to intra-host evolution, escape from cellular immunity is poorly understood. Here, we report a case of long-term COVID-19 in an immunocompromised patient with non-Hodgkin’s lymphoma who received treatment with rituximab and lacked neutralizing antibodies. Over the 318 days of the disease, the SARS-CoV-2 genome gained a total of 40 changes, 34 of which were present by the end of the study period. Among the acquired mutations, 12 reduced or prevented the binding of known immunogenic SARS-CoV-2 HLA class I antigens. By experimentally assessing the effect of a subset of the escape mutations, we show that they resulted in a loss of as much as ~1% of effector CD8 T cell response. Our results indicate that CD8 T cell escape represents a major underappreciated contributor to SARS-CoV-2 evolution in humans.

The paper considers the possibilities, prospects, and drawbacks of the mixed reality (MR) technology application using mixed reality smartglasses Microsoft HoloLens 2. The main challenge was to find and develop an approach that would allow surgeons to conduct operations using mixed reality on a large scale, reducing the preparation time required for the procedure and without having to create custom solutions for each patient. Research was conducted in three clinical cases: two median neck and one branchial cyst excisions. In each case, we applied a unique approach of hologram positioning in space based on mixed reality markers. As a result, we listed a series of positive and negative aspects related to MR surgery, along with proposed solutions for using MR in surgery on a daily basis.

Evolution of SARS-CoV-2 in immunocompromised hosts may result in novel variants with changed properties, but the mode of selection underlying this process remains unclear. While escape from humoral immunity certainly plays a role in intra-host evolution, escape from cellular immunity is poorly understood. Here, we report a case of long-term COVID-19 in an immunocompromised patient with non-Hodgkin’s lymphoma who received treatment with rituximab and lacked neutralizing antibodies. Over the 318 days of the disease, the SARS-CoV-2 genome gained a total of 40 changes, 34 of which were present by the end of the study period. Among the acquired mutations, 12 reduced or prevented binding of known immunogenic SARS-CoV-2 HLA class I antigens, suggesting that virus immunoediting is largely driven by cytotoxic CD8 T cell clones. The two changes with the strongest effect, nsp3:T504A and nsp3:T504P, were experimentally assessed in a cytotoxic assay of the patient's CD8 T cells. Both these changes were associated with immune escape, with a stronger effect observed for nsp3:T504P, the change which ultimately got fixed. Together, these results suggest that CD8 T cell escape may be an underappreciated contributor to SARS-CoV-2 evolution in humans.

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Введение. Совместная работа клиницистов, врачей отделений интенсивной терапии, специалистов ультразвуковой диагностики, врачей-рентгенологов является ключевым аспектом диагностики патоло-гических изменений в легких, в особенности сейчас, на фоне пандемии коронавирусной инфекции [1]. Лучевая диагностика в условиях пандемии новой коронавирусной инфекции имеет ключевое значе-ЛЕКЦИИ И ОБЗОРЫ / LECTURES AND REVIEWS