The bivalent mRNA COVID-19 vaccine booster dose, composed of mRNA from ancestral and Omicron BA.4/BA.5 strains, was recommended for adolescents aged ≥12 years on September 1, 2022, and for children aged 5–11 years on October 12, 2022. However, data demonstrating the effectiveness of bivalent boosters among children and adolescents are limited. During Omicron variant sublineage predominance, September 4, 2022 – February 4, 2023, we conducted a multicenter prospective cohort study at 7 sites in the United States to assess vaccine effectiveness (VE) of bivalent COVID-19 vaccine boosters against laboratory-confirmed SARS-CoV-2 virus infection among children aged 5–17 years.Participants collected weekly nasal swabs, irrespective of symptoms, and at onset of symptoms if present outside of their weekly swab cadence. Vaccination status was captured from periodic surveys (self-report), supplemented with queries from the state immunization information systems, and abstraction of electronic medical records system, when available. All respiratory swabs were tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction. Symptomatic infection was defined as ≥2 COVID-like illness symptoms within 7 days of specimen collection. Cox proportional hazards models were used to estimate hazard ratios of infections comparing participants with receipt of a bivalent booster to participants without , adjusting for age, sex, race/ethnicity, underlying health conditions, prior infection status, geographic site, and local virus prevalence.Among 3,331 participants aged 5-17 years, adjusted VE against infection was 51% (95% CI: 29–66%). When stratified by age, adjusted VE was 48% (95% CI: 15-68%) for 5-11 year old participants and 55% (95% CI: 17-76%) for 12-17 year old participants. Against symptomatic infection, adjusted VE among 5-17 year old participants was 51% (95% CI: 14-72%).These results demonstrate that the COVID-19 bivalent booster reduces risk of SARS-CoV-2 infection and symptomatic illness among children and adolescents. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations.Helen Y. Chu, MD, MPH, Abbvie: Advisor/Consultant|Ellume: Advisor/Consultant|Ellume: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Vir: Advisor/Consultant Janet A. Englund, MD, Ark Biopharma: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Emily T. Martin, PhD, MPH, Merck: Grant/Research Support Arnold Monto, MD, Roche: Advisor/Consultant|Roche: Honoraria


Pulmonary sarcoidosis is typically recognized as an interstitial lung disease with an infrequent occurrence of alveolar filling or acinar pattern. This rare form of alveolar sarcoidosis is known to have a rapid progression. Several case reports showed the development/worsening of sarcoidosis after COVID-19 infection. We present a case of a 60-year-old male with chronic hypoxic respiratory failure since having COVID-19 disease followed by gradual progression in symptoms, who had atypical sarcoid-like alveolar opacities on radiography, two prior negative bronchoscopies, transbronchial biopsy and BAL, and third bronchoscopic transbronchial biopsy suggestive of findings of poorly formed granulomas with high suspicion of alveolar sarcoidosis after ruling out other comparative possibilities, and later having a drastic improvement with sarcoidosis management. Our patient’s worsening symptoms after COVID-19 infection suggest impaired immunoregulation role of the infection in developing the disease process. Sarcoidosis affects approximately 60 per 100,000 individuals in the US, with diffuse organ involvement . A few CThis article was previously presented as an oral presentation at the 2022 Annual Northwest ACP Clinical Vignette competition on May 6, 2022.2) nine months ago, presented to the emergency department with worsening dyspnea, non-productive cough, back pain, weight loss, lack of appetite and subjective cognitive decline over several months.A 60-year-old Caucasian male with a medical history of type 2 diabetes, hypertension, stage III anorectal carcinoma (s/p neoadjuvant chemoradiation therapy), and COVID-19 pneumonia followed by chronic hypoxemic respiratory failure  with no pathogens seen on stains and negative AFB, fungal and viral cultures and negative for malignancy. The pathology demonstrated extensive areas of chronic inflammation with epithelioid histiocytes, reactive pneumocytes, chronic interstitial inflammation, poorly formed non-caseating granulomas, no fibrosis, and negative cytology for malignancy. CD68 highlights admixed histiocytes Figures , 2b. CD3This rapid clinical presentation, hypercalcemia, radiographic images, poorly formed granulomata, and positive CD68 histiocytes by immunostaining were suspected of having a diagnosis of alveolar sarcoidosis. He was started on methylprednisolone 60mg IV q6hr, which led to a significant improvement in clinical status within three days, further reinforced our diagnosis, and was discharged home on hospital day fifteen with a continuous treatment regimen of prednisone 60 mg oral daily with a follow-up in the outpatient setting.A 2-month post-hospitalization follow-up HRCT on prednisone Fig  showed mSarcoidosis is a multisystem disorder that can affect practically any body organ, of which the lungs and intrathoracic lymph nodes are the most common (over 90% of patients). The annual incidence of sarcoidosis varies across ethnic groups, with the highest incidence observed among African Americans  and a slight female predominance which is entirely the opposite compared to our patient, in addition to his other atypical imaging and histopathologic features . AlveolaThe probable diagnosis of alveolar sarcoidosis in our case was suggested by severe hypoxemia, rapid progression of multiple ill-defined pulmonary nodules, histopathology demonstrating chronic inflammation with poorly formed granulomata with negative vasculitis workup, and no risk factors of hypersensitivity pneumonitis, and the laboratory results significant for hypercalcemia, elevated 1, 25 OH vitamin D, along with his clinical and radiographic response to steroid treatment.The pathophysiology of sarcoidosis is still a very challenging and dynamic topic, possibly related to environmental exposures, occupational insults to the pulmonary microenvironment, epigenetics, and familial clustering. A case report of a sarcoid patient with COVID-19 revealed increased CCR6+ Th17 in CD4 T cells. Considering the changes in the T-cell populations and levels of TH17-related cytokines, interleukin (IL) - 17, and interleukin-22, groups have postulated that sarcoid is a fundamentally immune-mediated response to an antigen that may be environmental or infectious [Systemic therapy should be reserved only for patients with progressive, symptomatic disease, persistent pulmonary infiltration, and progressive lung function decline . First-lAlveolar sarcoidosis is a less-studied type of pulmonary sarcoidosis. Its rapid progression and typical radiographic findings significantly distinguish it from the interstitial type of sarcoidosis. The pathophysiology of sarcoidosis is still a very challenging topic with many possible etiologies. This case highlights a novel role of inflammatory markers and T-cell-mediated immune dysregulation in COVID-19 infection and sarcoidosis, further strengthening their connection. Additional studies are needed to delineate the role of COVID-19 disease in either development or worsening of pulmonary sarcoidosis. Alveolar sarcoidosis should be considered in patients with non-improving post-COVID-19 syndrome symptoms, especially when findings suggest interstitial lung disease.


Several studies have found that erectile dysfunction (ED) is associated with interstitial lung disease. However, the causal relationship between idiopathic pulmonary fibrosis (IPF) and ED risk remains unclear. The present two-sample Mendelian randomization (MR) study aimed to reveal the causal effect of IPF on ED risk.Q test was applied to examine heterogeneity. The leave-one-out analysis ensured the robustness and reliability of the results.This study included two GWAS summary statistics of IPF  and ED  of European ancestry. The inverse-variance weighted (IVW) was applied as the primary method, and MR-Egger, weighted median, weighted mode, and simple mode were applied as complementary methods to estimate the causal impact of IPF on ED risk. The MR-PRESSO global test and MR-Egger regression were applied to evaluate the pleiotropy. The Cochran’s IVW = 1.046, 95% CI: 1.020–1.073, p = 0.001), and consistent results were obtained with MR-Egger, weighted median, and weighted mode. The leave-one-out analysis showed that no instrumental variables unduly influenced the results.Twenty-one genetic variants were obtained as IPF instrumental variables without pleiotropy and heterogeneity. MR analysis using the IVW showed a potential causal relationship between IPF and increased ED risk (ORThis study suggested that IPF may increase the ED risk of the European population. ED is dAt the onset of ED, various associated factors have been identified, such as depression, hypertension, diabetes, obesity, and smoking –9. SeverTwo-sample Mendelian randomization (MR) examines the causal link between exposure and outcome by extracting genetic variants as instrumental variables (IVs) . Because2.2.1.Our analyses used summary data from published studies or available genome-wide association studies (GWAS) and did not require ethics committee approval. The institutional ethics review board corresponding to GWAS approved each research, and all subjects signed informed consent.2.2.Three critical assumptions of the MR study are illustrated in 2.3.To identify genetic variants associated with IPF, we used the IPF GWAS study in the FinnGen Biobank  . To avoi2.4.p < 5 × 10−6)   from the IPF GWAS study. First, based on assumption 1, we extracted SNPs significantly related to IPF ( × 10−6) . Second,0,000 kb . Third, 0,000 kb , 21. In ta2/SE2) . If the ta2/SE2) .2.5.p < 0.05), we utilized a random effect model. Otherwise, a fixed effect model was utilized  , MR-Eggeutilized . The MR-utilized . The weiutilized . The weiutilized . The simutilized . MR analutilized . p < 0.02.6.p < 0.05. Heterogeneity was quantified by the Cochran’s Q statistic and deemed significant when p < 0.05 . Also, MR-Egger , weighted median  and weighted mode  approaches also obtained consistent results. In addition, the MR estimates of SNPs on both IPF and ED are shown in the scatter plot  associated with fibrosis. However, the effect of these IVs on ED risk is via IPF rather than directly associated with ED, and IVs cannot be associated with ED susceptibility factors (confounders), including diabetes, obesity, hypertension, smoking, and metabolic syndrome. So, through what pathways does IPF increase ED risk? A recent study of COPD patients suffering from ED found that hypoxemia may be the mechanism by which COPD patients develop ED . And patF > 10)  . FinallyThe study also has some limitations. First, the summary data of the GWAS involved only European ancestry, and our conclusions may only apply to European populations. Therefore, we ought to use our findings with caution in racially and ethnically diverse populations. Second, since the exact functions of some SNPs in IVs are not known, there may be residual bias. Furthermore, given the binary assessment of IPF and the lack of individual statistics, it was impossible to explore nonlinear associations between IPF and ED risk, perform stratified analyses, and adjust for other covariates.5.In this study, we showed an apparent causal effect of genetically predicted IPF on ED risk in the European population using a two-sample MR analysis. However, further mechanistic studies are necessary to explain the deeper link between IPF and increased ED risk. Most importantly, our study reminds clinicians that measures to prevent and intervene early in ED should be considered when diagnosing male patients with IPF.The original contributions presented in the study are included in the article/KZ and MC conceived the study and wrote the manuscript. KZ, JZ, and AL collected the data and conducted the analysis. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Studies have shown that high humidity is a condition that aggravates the pain of rheumatoid arthritis (RA), but the relevant mechanism is controversial. Currently, there is a lack of experimental animal studies on high humidity as an adverse factor related to the pathogenesis of RA. We used healthy SD rats and collagen-induced arthritis (CIA) rats to investigate the effects of high humidity on arthritis. Integrated metabolomics analyses of faeces and 16S rRNA sequencing of the faecal microbiota were performed to comprehensively assess the diversity of the faecal microbiota and metabolites in healthy and CIA rats. In this study, high humidity aggravated arthritis in CIA rats, which manifested as articular cartilage lesions, increased arthritis scores, and an increase in proinflammatory cytokines. High humidity had a certain effect on the articular cartilage extent, arthritis score and proinflammatory cytokines of healthy rats as well. Furthermore, high humidity caused significant changes in faecal microbes and metabolites in both healthy and CIA rats. 16S rRNA sequencing of faecal samples showed that high humidity increased the amount of inflammation-related bacteria in healthy and CIA rats. Faecal metabolomics results showed that high humidity significantly altered the level of faecal metabolites in healthy rats and CIA rats, and the changes in biological functions were mainly related to the inflammatory response and oxidative stress. Combined analysis showed that there was a strong correlation between the faecal microbiota and faecal metabolites. High humidity is an adverse factor for the onset and development of RA, and its mechanism is related to the inflammatory response and oxidative stress. However, the question of how high humidity impacts RA pathogenesis needs to be further investigated. The aetiology of RA remains unclear, and previous studies have shown that genetic and environmental factors can promote the development of RA3. Periodontal disease, smoking and diet can induce RA onset in genetically susceptible individuals6. It is also commonly reported that climate and the environment are associated RA pathogenic factors7.Rheumatoid arthritis (RA) is an autoimmune disease characterized by inflammatory changes in synovial tissues, cartilage, and bone11. Studies have shown that weather can affect the pain of RA in middle-aged patients12, especially in female patients aged 41–65 years13. Low temperature, high air pressure and high humidity are significantly correlated with pain in RA patients14. Humidity is a frequently studied climate and environmental factor. An animal experiment showed that high humidity aggravated the severity of arthritis in CIA mice by upregulating xylitol and L-pyroglutamate expression15. The results confirmed clinical observations that high humidity could aggravate pain and stiffness in RA patients16. Research has shown that the combination of temperature and humidity creates a microclimate near the skin, and the humidity of the microclimate is affected by skin sweat glands on the water vapour surface. The microclimate could increase pain in RA patients by producing local vapour pressure. There is a positive correlation between humidity in the microclimate and RA-related pain17. Furthermore, researchers found that women living in damp houses had a higher risk of knee aches18, which may be linked to the autoimmune response that is increased based on relative humidity. In a clinical study from 1998 to 2001, humid conditions at a health centre directly induced rheumatic symptoms, including RA19.Cold and humidity are climate and environmental factors associated with an increased risk for RA21. The structure of healthy faecal microbiota can maintain immune balance and inhibit inflammatory responses. The microbiota significantly influences the development of joint lesions in inflammatory diseases, including RA and osteoarthritis23. Furthermore, dysregulated faecal microbes are associated with a variety of autoimmune diseases, including psoriasis, RA, and other immune system diseases25. The faecal microbiota and RA are closely related. On the one hand, dysbiosis of the faecal microbiota is common in RA patients27; on the other hand, regulating a faecal microbiota imbalance can effectively alleviate the occurrence and development of RA28. Clinical studies have shown that actinomycetes are bacteria that may directly induce RA29. Moreover, early biomarkers of RA found in the body’s blood or other body and tissue fluids can be used for the early diagnosis of RA patients and the prediction of treatment effects30. The metabolism of the host is regulated by its own genes and the gene composition of the symbiotic microbiota in the body; furthermore, metabolomics can efficiently screen biomarkers and comprehensively analyse the molecular mechanism underlying the health of the body31. The combination of microbiome and metabolome analyses can provide a comprehensive picture of host-microbiome interactions32.The microbiome is critical to the balance of the human immune system and regulates a variety of functions as part of the human immune systemIn this study, to investigate the relationship between humidity and the onset and development of RA, healthy SD rats and collagen-induced arthritis (CIA) rats were exposed to high humidity (80 ± 5%). Foot and ankle histopathology and joint analysis were used to evaluate the effect of high humidity on the onset and development of arthritis in healthy and CIA rats. The abundance of faecal microorganisms was analysed by 16S rRNA high-throughput sequencing technology. Differentially activated metabolic pathways and differentially expressed metabolites were identified by untargeted metabolomics via gas chromatography‒mass spectrometry (GC–MS). This study aimed to (1) explore the effects of high humidity on the joints of healthy rats and CIA rats, (2) determine the composition and abundance within the faecal microbiota in healthy rats and CIA rats under high-humidity conditions, (3) measure the composition of faecal metabolites in healthy rats and CIA rats under high-humidity conditions, and 4) correlate faecal microbial diversity with GC–MS untargeted metabolomics results to explore the relationship between high humidity and the onset and development of RA. Furthermore, this study aimed to determine the potential biological impact of high humidity to provide novel insights into the impact of high humidity on RA.To evaluate the effect of high humidity on arthritis, we observed changes in arthritis symptoms in healthy rats and CIA rats under normal-humidity  and high-humidity  conditions. Compared to those in the CON group 1a), ankle redness and swelling were observed in the HH group (1b). Compared to the CIA group (1c), the HH + CIA group exhibited more severe ankle swelling and joint deformation (1d). The effects of high humidity on articular cartilage in healthy rats and CIA rats are shown in Fig. a, ankle We investigated inflammation based on three proinflammatory cytokines in the rats of each group. Compared to the CON group, high humidity caused the upregulation of TNF-α in the HH group, and the difference was statistically significant Fig. j. High hWe analyzed colonic pathology and fecal moisture levels on Day 28 and Day 60 to assess potential early changes in fecal characteristics. The impact of elevated humidity on the colon is depicted in Fig. Regarding faecal moisture content, a significant increase was observed in the HH group relative to the CON group. Similarly, the H + CIA group showed a significantly higher faecal moisture content than the CIA group Fig. j. Of parAlpha diversity analysis usually reflects faecal microbiome abundance. Good’s diversity index 3a), Shannon’s diversity index (3b) and the Specaccum species accumulation curve (3c) are shown in Fig. a, ShannoThen, linear discriminant analysis coupled with effect size measurement analysis (LEfSe) was used to identify biomarkers with significantly different abundances between each group Fig. c. ComparThe score chart of PLS-DA showed significant differences (spectrum separation) between each group, and the ratios of R2 X (CUM), R2 Y (CUM) and Q2 (CUM) are shown in Fig.  p value < 0.05. The results showed that a total of 108 metabolites were significantly expressed between the HH group and CON group, and 119 different metabolites were significantly differentially expressed in the HH + CIA group and CIA group. In the HH group vs. CON group comparison, the subclasses of differentially expressed metabolites were associated with amino acids, peptides and analogues , carbohydrates and conjugates , and fatty acids and conjugates . In the HH + CIA group vs. CIA group comparison, the subclasses of differentially expressed metabolites were associated with organic acids and derivatives , lipids and function-like molecules , and organic oxygen compounds . The top 50 differentially expressed metabolites between each group are presented as a heatmap in Fig. Differentially expressed metabolites were determined based on a VIP > 1 and an adjustedKyoto Encyclopedia of Genes and Genomes (KEGG) analysis was used to further analyse the function of different metabolites, and the results of significant pathway enrichment analysis are presented on a scatterplot graph Fig. . The folTo comprehensively analyse the relationship between faecal metabolism and the faecal microbiota, Spearman correlation analysis was performed for the HH vs. CON groups Fig. a and the35. To date, there has been a lack of experimental studies regarding high humidity as an adverse factor associated with the pathogenesis of RA. In this study, healthy and CIA rats were exposed to high-humidity, and it was confirmed that high humidity can aggravate the extent of arthritis symptoms, including pathological changes, arthritis score and inflammatory factor expression. At the same time, the mechanism of the effect of high humidity on the joints of healthy rats and CIA rats was explored from the perspective of faecal microbial and metabolite homeostasis.Weather and environmental factors can directly impact human health. Relative humidity has been shown to play an important role in the study of climate sensitivity in patients with chronic pain. Studies have shown that high humidity is a direct or indirect factor affecting many diseases36. In this study, Prevotella, Clostridia, and Ruminococcaceae_UCG_010 were the most common bacteria after high humidity intervention in CIA rats, while Deltaproteobacteria, Bacteroidaceae, and Actinobacteria were the most common bacteria in high humidity intervention healthy rats. The faecal microbiome influences innate and adaptive immunity, and its imbalance can trigger inflammatory responses and increase the risk of autoimmune disease, leading to joint damage38. Animal experiments have shown that Prevotella, Ruminococcaceae and Clostridia were associated with RA because they induce the inflammatory response mediated by IL-6, IL-17 and IFN-γ cytokines39. In addition, studies have shown that Prevotella bacteria exhibit properties that increase inflammatory responses, possibly related to its ability to drive immune responses to Th17 cytokines40. In this study, high humidity aggravated joint injury in CIA rats, which may be related to the high abundance of bacterial species such as Prevotella, Clostridia, and Ruminococcaceae_UCG_010 induced by high humidity, which could promote the immune response of Th17 cells. It is possible that Th17 cell differentiation is activated and inflammatory cytokines increase, which would then induce an inflammatory response and aggravate joint injury. Notably, Deltaproteobacteria, Bacteroidaceae and Actinobacteria were significantly abundant in the HH group in this study. Previous studies have shown that Bacteroidaceae and Deltaproteobacteria are associated with RA42, while Actinobacteria, as a pathogen closely related to RA, may be an important factor that directly induces RA in damp environments29. At the same time, compared with the CON group, the abundance of Prevotellaceae in the HH group was significantly reduced, suggesting that high humidity intervention reduced the abundance of Prevotellaceae in healthy rats. Previous animal studies have shown that the abundance of Prevotellaceae decreased during the immune activation stage of CIA43, which is consistent with our results. We speculate that high humidity may cause a certain degree of immune response, which may be related to RA. However, the objectivity of this conclusion still needs to be further explored.To account for these changes, faecal microbiome analysis was performed on the faeces of rats from each group. The faecal microbiota may indicate environmental risk factors for RA44. The pathogenesis of RA is multifactorial, and oxidative stress and inflammatory responses are associated with the onset and development of RA. In this study, ABC transporter pathways, primary bile acid biosynthesis, and glutathione metabolism were found to be the metabolic pathways that were significantly enriched, and all of these are associated with oxidative stress45. Carbohydrate digestion and absorption and steroid biosynthesis were also metabolic pathways with significant enrichment, and these pathways are both related to digestion and absorption of the diet. Thus, we provide the following two explanations for these phenomena: 1. It has been confirmed in relevant reports46 and our previous reports48 that cholestasis may cause oxidative stress. ABC transporters play an important role in the pathogenesis of cholestasis, as they participate in the regulation of tryptophan metabolism and promote the synthesis of glutathione. Inhibition of ABC transporters could cause an inflammatory response, which would induce the production of reactive oxygen species (ROS). The content of mitochondrial ROS in monocytes of RA patients increases fivefold. Oxidative stress caused by ROS may be associated with the pathogenesis of RA. The onset and development of RA in the HH and HH + CIA groups may be closely related to oxidative stress. The mechanism by which high humidity interferes with ABC transporter pathways and primary bile acid biosynthesis could be related to ROS production and glutathione synthesis disorder, which are induced by the abnormal metabolism of bile acid. 2. Diet metabolism is closely related to the inflammatory process. Studies have shown that the abnormal metabolism of carbohydrates and fatty acids can promote inflammatory responses49. Disturbed carbohydrate absorption50 stimulates the inflammatory response by interfering with TNF-α and IL-6 production. Dysregulation of lipid metabolism homeostasis causes an immune reaction by increasing inflammatory factors such as TNF-α51. Therefore, high humidity may promote the inflammatory response by regulating metabolic pathways such as digestion and absorption, steroid biosynthesis and the biosynthesis of other metabolites, thus promoting the development of arthritis in CIA rats. In conclusion, high humidity can lead to the occurrence and development of RA by affecting oxidative stress and promoting the inflammatory response. Interestingly, these pathways also appeared in the comparison between the HH and CON groups. We speculated that high humidity may impact RA by inducing oxidative stress and promoting the inflammatory response; however, this result still needs further verification. In addition, Spearman correlation analysis was used to establish a correlation matrix to comprehensively analyse the relationship between faecal metabolites and the faecal microbiota. Our results suggest a potential interrelationship between faecal metabolites and faecal microbes.Combined studies on the microbiome and metabolome are considered to be one of the best ways to assess host-microbiome interactionsIn conclusion, the results of our study indicate that high humidity can impact the onset and development of RA, and the mechanism is likely related to the inflammatory response and oxidative stress. Nevertheless, it is crucial to acknowledge that our study represents a preliminary exploration, warranting further investigation into the impact of high humidity on the risk of RA in healthy rats. Next, we need to make experiments on how high humidity causes faecal microbiota changes and how these changes affect joint inflammation. In particular, the relationship between environmental humidity and the onset and development of RA can be further explored by extending the experimental observation period, adjusting the environmental humidity and verifying these results in clinical trials, cell and microorganism, and vitro and vivo mechanism validation experiments.Six-week-old healthy male SD rats were used in accordance with the Guidelines for the Care and Use of Laboratory Animals of the Institute of Laboratory Animal Resources, Institutional Animal Care and Use Committee of Beijing University of Chinese Medicine. The study is reported in accordance with ARRIVE guidelines. The animal weights were between 135 and 165 g at the beginning of the first study. All rats (n = 40) were housed with 5 animals per cage on a 12 h/12 h light/dark cycle in the animal facility of the Experimental Center of Beijing University of Chinese Medicine . All animals were allowed ad libitum access to food and water.33. Two fresh stool pellets from each rat were collected after Day 59. Faecal moisture levels were measured on Day 28 and Day 56. Samples were placed in sterile conical tubes and immediately frozen at −80 °C. Rats were anaesthetized by intraperitoneal injection of 2% sodium pentobarbital (0.2 ml/100 g). Ten rats from each group were randomly selected and euthanized after 28 days to isolate colonic tissues to observe histopathological changes. The remaining rats were euthanized and the hind limbs of the rats were collected on Day 60. Blood samples were collected from the inferior vena cava of rats and centrifuged at 3500×g and 4 °C for 15 min to collect the serum, which was immediately frozen at −80 °C. The group information and experimental process are shown in Fig. Bovine type II collagen   emulsified with complete Freund’s adjuvant   was obtained. All animals were divided into the following 4 groups (N = 20) with the random number method after acclimation for 1 week: ① control (CON) group, kept at 25 ± 1 °C, 50 ± 5% humidity and injected with 0.9% NaCl solution (0.2 ml/rat) on Days 7 and 14; ② high humidity (HH) group, kept at 25 ± 1 °C, 80 ± 5% humidity and injected with 0.9% NaCl solution (0.2 ml/rat) on Days 7 and 14; ③ CIA model (CIA) group, kept at 25 ± 1 °C, 50 ± 5% humidity and injected with CII-CFA emulsion  on Days 7 and 14; and ④ CIA model with high humidity (HH + CIA) group, kept at 25 ± 1 °C, 80 ± 5% humidity and injected with CII-CFA emulsion  on Days 7 and 14. Arthritis scores were measured every 7 days after Day 21Arthritis scores were measured every 7 days after Day 21. The assessment criteria of arthritis scores were as follows: 0, no redness and swelling in the foot joints and claws; 1, mild swelling or redness of the foot joint and claws; 2, moderate swelling or mild redness of the foot joint and claws; 3, the claws are red and swollen below the ankle joint; and 4, severe redness, swelling and deformation of the ankle foot joint.The articular cartilage was fixed in 4.0% paraformaldehyde for 3 days and then decalcified in 10% ethylenediamine tetraacetic acid (EDTA) decalcification solution. The tissues were dehydrated by an ethanol gradient, embedded in paraffin, and sliced into 4 μm sections by pathological sectioning. Then, the slides were stained with safranin O to assess articular cartilage damage.The levels of TNF-α, IL-6 and IL-17 in serum were measured by enzyme-linked immunosorbent assay (ELISA). All reagents were purchased from CUSABIO , and analyses were conducted according to the manufacturer’s instructions. The absorbance was measured at 450 nm.According to the manufacturer's instructions, a DNeasy PowerSoil kit  was utilized to extract DNA from different samples. The purity and concentration of DNA were detected by agarose gel electrophoresis. Extracted DNA was diluted to a concentration of 1 ng/μl and stored at −20 °C for further processing. The DNA genome was utilized as a template for PCR amplification to ensure the efficiency and accuracy of amplification with barcode-specific primers and Takara Ex Taq hi-fi enzyme . The corresponding areas of bacterial diversity identification were as follows: The V3-V4 region of the 16S rRNA genes was amplified with universally primed 343F (5' -TACgGRaggCAGCAGG-3') and 798R (5' -AgggTATCtaatCCT-3') using a commercial PCR kit .PCR products were detected by gel electrophoresis and purified by AMPure XP beads after detection. The purified products were used as second round PCR templates and amplified by a second round of PCR. After a second purification step with AMPure XP beads, PCR products were quantitatively analysed by a Qubit dsDNA detection kit . The samples were mixed in equal quantities according to the concentration of PCR products and then sequenced. An equal amount of purified amplicon was pooled for sequencing with a NovaSeq PE250 instrument.Raw sequencing data were in FASTQ format. Paired-end reads were then pre-processed using Trimmomatic software (version 0.35) to detect and cut off ambiguous bases (N). The sliding window method was used to evaluate the average base quality. If the average mass value in the window was lower than 20, the back-end base was cut from the window. Paired-end reads were assembled using FLASH software (version 1.2.11). The stitching parameters were as follows: the smallest overlap was 10 bp, the largest overlap was 200 bp, and the maximum error matching rate was 20%. Sequences were further filtered as follows: sequences containing ambiguity were removed and reads with 75% of bases above Q20 were retained. Moreover, Quantitative Insights into Microbial Ecology  was used to detect and remove chimeric sequences.After the sequencing data were pre-processed to generate high-quality sequences, Vsearch software (Version 2.4.2) was used to classify the sequences into multiple operational taxonomic units (OTUs) according to their similarity. A parameter sequence similarity greater than or equal to 97% was classified as an OTU unit. The QIIME software package was used to select representative sequences of each OTU, and all representative sequences were annotated and blasted against the Unite database (ITS rDNA) using pynast (v0.1).g, at 4 °C), and 300 μl of the supernatant was put into a glass-derived bottle and dried in a centrifugal freeze dryer. Next, 80 μl of methoxamine hydrochloride pyridine solution (15 mg/ml) was added to each sample, followed by vortexing for 2 min and ice water ultrasonic treatment for 3 min. The oxime reaction was carried out for 90 min in an incubating shaker at 37 °C. A total of 80 μl of trifluoroacetamide (containing 1% chlorotrimethylsilane) derivatizing reagent and 20 μl n-hexane were added, and 11 internal standards  were added at a volume of 10 μl, followed by vortexing for 2 min and reaction at 70 °C for 60 min. After the samples were removed, they were placed at room temperature for 30 min for GC–MS metabolomics analyses. All extraction reagents were precooled at −20 °C before use.The samples stored at −80 °C were thawed on ice, 60 mg of stool sample was accurately weighed and placed into a 1.5-ml centrifugation tube, 40 μl of internal standard  was added to each sample, and 2 small steel balls and 360 μl of cold methanol were successively added. Samples were stored at −20 °C for 2 min and ground in a grinding machine . Samples were sonicated in an ice water bath for 30 min, 200 μl of chloroform was added, and the mixture was vortexed . Then, 400 μl of water was added, and the mixture was vortexed . Ultrasonic extraction was performed in an ice water bath for 30 min, and the samples were allowed to stand at −20 °C for 30 min. Then, the extract was centrifuged for 10 min . Separation was performed by loading a 30-m × 0.25-mm × 0.25-μm DB-5MS fused silica capillary column . The flow rate of the carrier gas, high-purity helium (purity not less than 99.999%), was 1.0 ml/min, and the inlet temperature was 260 °C. The injection volume was 1 μl, and the solvent delay was 5 min. The temperature programme was achieved using the following gradient: The initial temperature of the GC oven was 60 °C, and then the temperature was ramped to 125 °C at 8 °C/min, to 210 °C at 5 °C/min, to 270 °C at 10 °C/min, and to 305 °C at 20 °C/min and held steady for 5 min. Mass spectrometric conditions were as follows: ionization source, electron impact ionization; ion source temperature, 230 °C; quadrupole temperature, 150 °C; collision energy, 70 eV; solvent delay, 3 min; scan mode, full scan (scan mode); and mass scan range, m/z 50–500.https://webbook.nist.gov/chemistry/) was used for material qualitative analysis. Principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were performed to visualize the changes in metabolites between the experimental groups after mean centering (Ctr) and Pareto variance (Par) scaling, respectively. Variable importance in the projection (VIP) values were calculated according to the PLS-DA model. A VIP > 1 was used to identify potential biomarkers. The PLS-DA model was tested for 200 response sequencing tests; the x-matrix was fixed, the variables of the previously defined classification Y matrix (such as 0 or 1) were randomly arranged n times (n = 200), and the corresponding PLS-DA model was established to obtain R2 and Q2 values of the random model. Linear regression was performed with R2Y and Q2Y of the original model, and the intercept values of the regression line and Y-axis were R2 and Q2, respectively, which were used to measure whether the model was overfitting. The VIP values were calculated based on the PLS-DA model, and p values were derived from a two-tailed Student’s t test using the normalized peak areas. The criteria for screening differentially expressed metabolites were VIP > 1 and p < 0.05.Raw GC–MS mass spectra were converted to ABF format files by Analysis Base File Converter software (version 4.0). Then, the data were imported into MS-DIAL software (version 3.9) for pre-processing. Finally, the raw data matrix including the sample information, the name of each peak, retention time, mass-to-charge ratio, and mass spectral response intensity (peak area) were derived. The NIST database  was used for comparisons between each group using GraphPad Prism . The data are expressed as the mean ± standard deviation of the mean (S.D.). One-way analysis of variance (ANOVA) was used for measurement data of multiple groups, and least-significant difference (LSD) was used for pial comparison between groups. If homogeneity of variance was not satisfied, the rank sum test was used for comparison of multiple independent samples. Error bars represent the standard deviation. The degree of significance is indicated as *The animal study was reviewed and approved by Ethics Committee of Beijing University of Traditional Chinese Medicine .


Although usually more associated with the lungs, sarcoidosis can have multiple extrapulmonary manifestations. We present a case of a patient with previous biopsy-proven sarcoidosis who was admitted to the hospital secondary to worsening shortness of breath. The patient was found to be positive for Respiratory Syncytial Virus (RSV) which was believed to have exacerbated his pulmonary symptoms. He was treated with IV steroids, nebulizers, and antibiotics which ultimately helped relieve his symptoms. In terms of his sarcoidosis, he was previously treated in the past with steroids in regards to this pathology (which is the mainstay of treatment); while on the regimen, the patient noted his breathing was improved. Of note, he did also have a history of renal cell carcinoma (RCC) status post nephrectomy which was initially evaluated for possible sarcoidosis involvement. This medical therapy could also have been the reason his sarcoidosis did not progress to involve other organs. Although typically associated with respiratory complications, sarcoidosis can affect many other organs; symptoms can mimic each other and so can lead to deviations in diagnosis paths. With its characteristic noncaseating granulomas, it is more typically seen in African American females . In one A 56-year-old male with a past medical history of renal carcinoma status post nephrectomy, hypertension, and IV drug use presented to the emergency room with complaints of progressively increasing shortness of breath over a period of four days. Symptoms were associated with acute onset of yellowish sputum production. The patient denied any fevers, weight loss, or chest pain. He was an active smoker with a 40-pack-year history. Lab work was remarkable for elevated troponins and positive Respiratory Syncytial Virus (RSV) testing; the remainder was within normal limits. CT chest noted multiple pulmonary nodules in the mediastinal, subcarinal and paratracheal lymph nodes, and a 4.5 cm upper pole right kidney density with increased area of calcification. He was admitted for an acute chronic obstructive pulmonary disease (COPD) exacerbation thought to be triggered by the RSV virus. He was initiated on IV methylprednisolone, Duonebs, and Doxycycline. Prior to this, in 2007 he had a granuloma on the left arm which was thought to be secondary to a foreign body as the pathology had talc and cotton, and he was an IV drug user. Of note, in 2008 he underwent Endobronchial Ultrasound (EBUS) with pathology-proven granulomatous disease; he was prescribed a short duration of prednisone in May of 2008 following which he had modest improvement in his Forced Expiratory Volume (FEV1) as well as his symptoms. Upon cessation of steroid therapy, however, he quickly returned to his diminished baseline respiratory function. Additionally, during his hospital stay, the patient had multiple episodes of symptomatic bradycardia for which Cardiology was consulted; Zio-patch was placed on discharge and he was recommended to undergo further screening for cardiac involvement of his sarcoidosis.Laboratory testingSarcoidosis is a disease that can affect multiple organs and so various workup and diagnostic testing must be performed to help differentiate it from other similar presenting pathologies. Diagnosis can be narrowed down via imaging, symptoms, biopsy-proven noncaseating granulomas, as well as exclusion of other pathology/malignancy Figure  3]. Som. Som3]. Bronchoalveolar lavage (BAL) can be a useful tool in differentiating sarcoidosis from other lung pathologies. In one study that compared BAL fluid analysis of healthy lungs to those of symptomatic untreated sarcoidosis patients, it was noted that the lymphocyte count, CD4/CD8 ratio, as well as total cell count were all elevated .Angiotensin-converting enzyme (ACE) is also a marker of disease severity. Although also elevated in other granulomatous diseases, ACE levels in patients with sarcoidosis are correlated to the severity of whole-body granuloma presence . These lImagingWith regards to imaging, chest radiography is the most common modality utilized and can help with the initial staging (0-4) based off criteria such as bilateral hilar lymphadenopathy and the presence of fibrosis Table  7]..7].CT and MR imaging can also be utilized to help further investigate the extent of disease, especially when evaluating for extrapulmonary spread; they are more sensitive in detecting parenchymal pathology and lymphadenopathy. CT in particular can be useful for guidance when trying to obtain biopsy specimens as well .ManagementAt this time treatment of asymptomatic sarcoidosis is not currently indicated; those with pulmonary and extrapulmonary manifestations, however, do warrant further management.Although there is no official guideline regarding treatment, current therapy recommendations involve IV vs oral corticosteroids based on disease severity. They have been shown to be an effective management strategy, especially in patients with sarcoid-induced renal impairment . In a stSubgroupsLöfgren syndrome is one disease associated with sarcoidosis. Its pathology can be indicated by the acuteness of symptoms when compared to the more chronic ones seen in general sarcoidosis. Other manifestations can include Erythema Nodosum, arthritis, constitutional symptoms, as well as similar hilar lymphadenopathy. The overall prognosis is generally noted to be better in this subgroup .Heerfordt-Waldenström syndrome is another rare presentation. It can be characterized by its neurologic involvement. Patients with this subgroup can present with facial nerve palsy, parotid gland involvement, as well as uveitis . These mExtrapulmonary manifestationsWith regards to renal manifestations, sarcoidosis can present in a number of different ways including electrolyte imbalances, masses, nodules, etc. These can therefore be confused with primary renal pathologies or malignancies, for which our patient did have history of .Due to the granuloma formation associated with the disease, there is an activation of enzymes; predominantly alpha-1-hydroxylase. The overall effect is the net conversion of inactive 25-hydroxyvitamin D to its active form of 1,25 Hydroxyvitamin D; this can lead to an increase in calcium absorption causing hypercalcemia and hypercalciuria . ElevateRhythm issues in patients with known sarcoidosis can warrant evaluation for possible cardiac involvement. As with our patient, he did have multiple episodes of symptomatic bradycardia when hospitalized. Other known manifestations of cardiac sarcoidosis involve heart block, chest pain, arrhythmias, and shortness of breath; the latter of which the patient also endorsed and was hospitalized for . FurtherAnemia is also another manifestation that can be due to the formation of non-caseating granulomas produced in the bone marrow and kidneys. Renal cell carcinoma (RCC) can also present with similar findings. This can be due to the involved kidney damage from the RCC causing decrease in erythropoietin release . The incSarcoidosis can have vague presentations when affecting the renal or other system and so its involvement can potentially be overlooked. Similar manifestations  can mimic other pathologies. Granulomas, in particular, can be of concern as their etiology can be from the sarcoidosis or various other reasons. It is then crucial that proper workup be done to be able to differentiate it, as the management can be very different; possible nephrectomy in those with RCC, for example, as opposed to steroid management with sarcoid-induced kidney injury. Mortality from sarcoidosis has been slowly rising, but early interventions and younger diagnosis age can be good prognostic factors that can help significantly decrease the risk of death and long-term complications.


This paper reports on an experimental investigation of thermophysiological and psychological responses during and after an incremental low- to high-intensity exercise at 27 °C and 45% humidity. Five t-shirt garments were produced from different yarn types, their weights and yarn counts were close to each other. During the wear trials, heat and humidity sensors were placed at four body locations . In addition, dynamic comfort measurements of the upper body were examined using a datalogger and subjective rating scales. This study aimed to investigate the effects of garment type on aerobic performance, microclimate temperature and humidity values, and psychological comfort. It was observed that the relative humidity and temperature of the microclimate were low in fabrics with high air permeability and low thermal resistance values of the Tencel single jersey and polyester mesh knitted fabrics. There was a significant difference in microclimate temperature results of TS coded Tencel single jersey t-shirt sample and other t-shirt samples according to statistical analysis results. On the other hand, the statistical results of the PM coded fabric sample measured at lower humidity in the three body regions were found to be a significantly different from those of the other samples (except TS). Although not statistically significant, the VO2 values and heart rates of these fabrics were lower than those of other fabrics. It was concluded that garments made from Tencel single jersey (TS) and polyester mesh (PM) fabrics affected the performance of athletes positively. Athletes were less forced during the training, and the activity could be maintained more than the others when wearing these clothes. Thermophysiological comfort is related to the thermal balance of the human body, which maintains an internal body temperature of approximately 37 °C2. Cooling of the human body by sweat evaporation is the only natural means to remove heat from the body in conditions of a hot environment and to maintain the clothing wearer in conditions of thermal comfort.Athletes need comfortable clothes to continue the motion during high intensity ativities. Therefore, sports clothes must keep the wearer cool and dry. During high-intensity exercise, athletes sweat and lose excess heat and humidity from the microclimate. A microclimate is defined as the air layer between the skin and clothing, from which heat and vapour transfer occur. During sweating, the moisture transfer rate of clothing is slow, and the relative and absolute humidity levels of the clothing microclimate increase, thereby suppressing the evaporation of sweat. This increases rectal and skin temperatures, and resulting in heat stressThe heat and moisture transfer properties of clothing also affect the performance of athletes. Clothing that makes an athlete feel wet and warmer negatively affects the maximum oxygen consumption capacity , causing the athlete to feel tired in a shorter time. The following studies were conducted on subjective wear trials.3.Two different studies investigated the effects of clothing openings and ventilative designs, such as the mesh, on thermophysiological comfort. The design of pit zipper openings at both the arm and side seams had an effect on thermal regulation and limited the rate of temperature rise. However, ventilative clothing designs, such as placing mesh fabrics in clothing systems, can influence the heat and moisture transfer performance. In addition, skin temperature, clothing microclimate temperature, oxygen uptake, respiratory exchange ratio, sweat efficiency, and comfort sensations were significantly different between mesh fabrics and control piece t-shirts4. In studies where specially designed fabrics and clothes  were used in wear trials. The results showed that the fabric type and construction had no effect on psychological, thermoregulation, and comfort sensations. In contrast, the tested t-shirt exhibited superior evaporative characteristics and lower regain quality5. In a study investigating the effect of cotton and polyester t-shirts on physiological and psychological thermal responses during exercise and recovery, it was found that PES t-shirts allowed the skin temperature to return to the pre-exercise level faster, and thermal sensation improved, but did not improve any thermophysiological and subjective sensory responses6. On the other hand, the thermal-wet comfort of ten t-shirts made of ten types of hygroscopic fibers, such as cotton, wool, lyocell, modal, soybean, bamboo, and their mixtures was investigated, and it was observed that the thermal-wet comfort changed with fiber type7. In studies on tracksuits and outdoor jackets, athletes prioritized comfort and lightness when purchasing clothes, and a higher WVP was shown to benefit moisture management during submaximal exercise in a cold environment by reducing the relative humidity in the clothing system9. The relationship between the subjective evaluation of wearing comfort in a warm environment and objectively determined physiological parameters with five different raw materials was investigated and it was found that the subjective and objective results were related10. Skin temperature and heart rate were measured in a study comparing generally used men's work clothes and clothes in which phase change materials are used in work clothes. It has been observed that the use of PCM slightly increases the temperature at low temperatures and slightly lowers the temperature at high temperatures11. In another study, the thermal comfort properties of wool and wool blended workwear were evaluated using subjective evaluation methods, and it was observed that the perception of comfort depended on activity level, environmental conditions, and clothing12. The tactile comfort, fit, and aesthetic properties of commercially available cycling clothing in a wear trial were investigated, and it was found that tactile comfort and thermal comfort were perceived differently by subjects13. Stojanovic et al.14 developed a smart t-shirt that contained temperature and humidity sensors to monitor the thermal situation of athletes. Higher temperature values were measured on the subject’s back at the selected ambient temperatures14. The effects of wetted inner clothing on thermal strain in young and older males were investigated using a wear trial test when wearing a ventilative jacket. The results showed that wearing a water-soaked inner T-shirt while using a ventilation jacket reduced thermal and cardiovascular strains in young and old individuals working under hot conditions15. In another study, sports t-shirts made from cotton and polyester were used in a wear trial, and the skin temperature, heart rate, body sweat loss and sweat absorption of garments were investigated. It was found that wearers preferred smooth, lightweight, and breathable fabrics under neutral environmental conditions16.Examining the thermophysiological and psychological effects of aerobic clothing, in a study in which body temperature and relative humidity were measured using sensors placed on six different body regions. It was observed that body temperature and relative humidity changed with different trends according to time, clothing type and body region, showing remarkable changes at different timesThe objective of the current study was to expose the t-shirt samples to a submaximal exercise test conducted by athletes with a specific rate of oxygen consumption value. This allowed for the assessment of various fibers’ effects on athletes’ performace. While previous studies have mostly focused on cotton and polyester single jersey, different fibers and mesh structure were used in this study. In addition, the effects of fiber differences on the microclimate temperature and relative humidity values of four distinct body locations were investigated using a wear trial test. The best fiber type and garment for athlete performance during high intensity activities, especially for long distance runners were determined. Because the oxygen consumption value was high, the athletes became more tired when that garment was worn.The properties of the fabrics measured using standard methods are listed in Table 2 test area (EN ISO 9237 Standard). The thermal resistance and water vapour resistance of fabrics were measured in a previous study used for comparing the garments17. The thermal resistance and water vapour resistance properties of the fabrics were measured using an SDL Atlas Sweating Hot Plate instrument according to the EN 31092 and ISO 11092 standards with a plate surface temperature of 35 °C. Thermal resistance measurements were collected in a controlled room at a temperature of 20 °C and a humidity of 65%. The water vapour resistance measurements were collected at a temperature of 20 °C and humidity of 40%. Five kinds of short sleeve T-shirts were tailored for use in experiments on these fabrics. All fabrics were knitted using the same design and medium size. The design of the T-shirts is shown in Fig. The thicknesses of the fabrics were measured according to ASTM D1777 standard test method for thickness of textile materials using James H. Heal R&B cloth thickness tester. The air permeability properties of the fabrics were measured using an SDL Atlas air permeability instrument according to the EN ISO 9237 standard determination of the permeability of fabrics to air, with a 100 Pa air pressure and a 20 mmEach participant visited the laboratory of the Sports Medicine Department on six separate occasions. During the first visit, body weight and height were measured and each participant performed a maximal graded exercise test on a treadmill. In order to assess the maximal aerobic capacity of the participants, an exercise test protocol was employed. This protocol involved conducting a treadmill exercise test to determine maximum aerobic capacity and maximum oxygen consumption values. The test duration averaged 12–15 min on the treadmill, during which the running speed was incrementally increased every 3 min. At the end of this test, the maximal oxygen consumption value (VO2max) for each participant was calculated. During the measurement, the oxygen consumption values of the subjects were analyzed with a metabolic measuring device from the expiratory air by taking the average values for each breath (breath-by-breath) at 30-s intervals. The oxygen consumption value attained at the point of reaching the maximum heart rate was reached (220-years), when the VE/VO2 value reached 30 l/min, or when the subject could no longer sustain the exercise due to its difficulty, was considered as the maximal aerobic capacity (VO2max). VO2max was defined as the maximum capacity of oxygen consumption achieved during exercise. On the following 5 days, the athletes participated in an incremental low- to high-intensity submaximal aerobic exercise. Athletes with a VO2max = 59–64 ml/kg/min value were included in this study and performed the submaximal aerobic exercise. An activity that reaches up to a maximum of 70–80% of the aerobic capacity is defined as submaximal activity. The athletes performed the submaximal exercises at the same time of day and after 3 days of relaxation. Each participant performed the submaximal exercise five times in total at intervals of 4–7 days, wearing four different testing clothes and a control garment at 27 °C and 45% humidity laboratory contions on a treadmill. Participants wore the same shoes, socks, and underwear during each trial. On the morning of each test, the participants were instructed to consume 1 L of water 2 h before the start of the test to ensure proper hydration.CS coded t-shirt made from cotton single jersey fabric was chosen as the control garment. At the beginning of the test, the participants wore the t-shirts and rested for 10 min in the laboratory conditions to acclimate to the experimental environment. Subjective thermal, wetness, and comfort sensations were recorded during this period. Afterward, the participants performed a wear trial protocol , which consisted of 50 min of followed by 15 min of relaxation. The exercise started with 9.5 km/h running speed at a 1° slope and the speed was increased every ten minutes. The exercise finished with 13.5 km/h speed on a 1° slope. The relaxation period consisted of 5 min of 5 km/h speed at 0° slope and 15 min of sitting on a chair. Measurements were taken immediately before, during, and after the submaximal exercise.A datalogger  was used in the experiments to measure the microclimate temperature and relative humidity from four different body locations  during all exercise protocol. The sensors are shown in Fig. 18. The maximum oxygen consumption of the athletes was measured with a Fitmate™, which is a new small (20 × 24) metabolic analyzer . FitMate™ uses standard metabolic formulas to calculate oxygen uptake, and energy expenditure is calculated using a fixed respiratory quotient (RQ) of 0.8519.Before and after applying the wear trial test protocol, participants were weighed with and without garments. Body sweat loss and the amount of sweat absorbed by t-shirt samples were calculated. Furthermore, cardiovascular responses (HR) were measured during and after exercise using a heart rate monitor (Polar). A Polar V800 HRM with a Polar H7 Heart Rate Sensor chest strap  recorded RR intervals at a sampling frequency of 1000 Hz20. The lowest temperatures were measured during and at the end of the activity in the TS Tencel single jersey T-shirt, which has the highest air permeability and the lowest thermal resistance value.Datalogger measurements of microclimate temperature and relative humidity for the four body regions are examined in this section. Changes in chest microclimate temperature and relative humidity with activity speed are shown in Fig. 21. The chest microclimate temperature varied between 32 and 35 °C. The highest temperature values were reached when the speed was 10.5 km/h, and the lowest temperature value was reached when the speed was 12.5 km/h which sweating occurs at this rate. For all garment samples, the relative humidity value increased with increasing speed (starting at 60% and reaching approximately 90%). The greatest increase in the relative humidity value occurred in the speed range of 9.5–10.5 km/h, where it was measured at the highest temperature in the clothes. In the 10.5–11.5 speed range, where the humidity increase rate decreased, the temperature values of the clothes also decreased owing to perspiration.The highest relative humidity value at the beginning of the activity was observed in the CS coded sample, which also exhibited the highest water vapour resistance value. Lower relative humidity values were observed in one of the lowest water vapour resistance and second highest air permeability value PM polyester mesh knitted fabric. Similar to a previous study, water vapour diffusion was mainly dependent on the porosity of the fabrics22.Changes in the back microclimate temperatures and relative humidity at different activity speeds are shown in Fig. 23. The lowest temperature values were observed in the speed range 11.5 km/h. The back microclimate relative humidity values were in the same range as those of the chest microclimate relative humidity values 2. Although the TS coded Tencel fabric had the highest air permeability value, its microclimate relative humidity value was higher than that of the fabric with the mesh knit structure. This is most probably due to the porous nature of the mesh structure; liquid sweat can be discharged to the outside more easily. From this point of view, among the examined T-shirts, POS, CS, and CPS are the ones that keep the wearer damper than others.Changes in abdomen microclimate temperatures and relative humidity at different activity speeds are shown in Fig. Abdomen microclimate temperatures were measured lower than the chest and back microclimate temperatures. Unlike the chest and back, the highest microclimate temperatures were observed at the beginning of the activity, and this value decreased with increasing speed throughout the activity. Owing to the basic model of the T-shirt, it did not fit the body in the abdomen and waist regions and allowed air exchange. The relative humidity values of the abdomen were higher than those of the chest and back regions (between 70 and 95%).Changes in waist microclimate temperatures and relative humidity at different activity speeds are shown in Fig. 24, significant effects of fiber type on the temperature and humidity values of clothing microclimate were observed.Statistical analysis of the datalogger measurements was performed using SPSS 23.0 program. A two-factor (fabric type × time) repeated measures analysis of variance (ANOVA) was used to analyze the effect of different fabric types and the changes in time for temperature measurements of different body locations. If there is a difference between variables, post-hoc tests can be used to define the relationships between the parameters. Post-hoc statistical tests provide a consistent and appropriate approach for research. Homogeneous characteristics of variance and equality of sample size characteristics are important factors in the selection of post-hoc tests. Where a significant main effect was found a post-hoc test with Bonferroni correction was applied to locate the difference. For all statistical analyses, p ˂ 0.05 was considered significant. The significance of fabric type (p = 0.000 ˂ 0.05), time (p = 0.000 ˂ 0.05), and fabric type × time (p = 0.617 > 0.05) on microclimate temperature results were measured using ANOVA tests. There was a statistically significant difference between the TS Tencel single jersey knitted fabric and the other four t-shirt samples according to the microclimate temperature values . The point that draws attention here is that the temperature values of the sensor data in four body regions of this t-shirt sample were measured lower than the other four fabrics. As in the study by LiThe humidity values of the tested T-shirt samples were compared using SPSS 23.0, and a two factor (Fabric Type * Time) repeated measures analysis of variance (ANOVA) was used to analyze the effect of different fabric types and the changes in humidity for different body locations. The two-way ANOVA test results showed the significance of fabric type (p = 0.000 ˂ 0.05), time (p = 0.000 ˂ 0.05) and fabric type × time (p = 0.998 > 0.05). When the moisture results were examined, a significant difference was observed between the PM and TS coded samples and the other three samples. Statistical analysis results were obtained in conjunction with the sensor measurement results. Clothing made of PM coded polyester mesh fabric measured at lower humidity in the chest, abdomen, and waist region showed a statistically significant difference from the other samples  except for the TS coded sample (p = 1 > 0.05). In addition, the Post-Hoc Bonferroni test results showed that there was a significant difference between the TS coded fabric and the other two samples .2) is defined as the amount of oxygen that a person can use per unit of time; the higher this value, the higher the aerobic capacity of the person. Delaying the rise in oxygen uptake during an activity, thus reaching the maximal values (VO2max) later, means that the garment has a positive effect on aerobic performance. The changes in VO2 and heart rate with respect to time for the five different types of test garments are shown in Fig. 2 values of all garments showed a similar change. At the beginning of the activity, VO2 values were 30 (ml/kg/min), which reached 50 (ml/kg) at the end of the activity. It was seen that the heart rate reached about 180 bpm at the end of the activity while it was in the range of 130–140 bpm at the beginning of the activity. TS coded Tencel single jersey knitted sample showed the lowest VO2 value between 9.5 and 12.5 km/h speeds. PM coded polyester mesh fabric exhibited the lowest oxygen uptake value at the end of the activity. When wearing PM and TS garments, the heart rate was generally lower than that of the other garments. In addition, the microclimate temperature and relative humidity of these garments were lower than those of the others, indicating that the increase in microclimate temperature and relative humidity due to the garment increased the heart rate at the same activity level.Oxygen uptake . There was a statistically significant difference between the cotton polyester single jersey fabric (CPS) and the other four garment types according to Post-Hoc test results . This fabric was measured uncomfortable than other garments according to the results of the statistical analysis. The point that draws attention here is that the objectively measured thermal resistance value of this fabric is higher than other fabrics.The subjective comfort sensations of the different garments are shown in Fig. 27.Studies on sportswear are generally based on measurements in the form of fabrics or systems such as thermal manikins. Because the measurements made in the form of fabric are carried out in a static environment, they cannot provide information about the human-clothing interaction in the environment where the clothing is used, and thermal manikin systems have a limited area of use because the tests are very expensive. A wear trial test is defined as a test using human subjects in a specific activity and environmental conditions. Although the variability of some physiological data is high owing to the use of people in wear trials, it is only possible to determine the actual performance of the clothing during use with wear trials. With the help of these tests, the most suitable garment can be selected for that climatic and activity conditions. We explored the thermophysiological and physiological comfort of five different yarn knitted, same model T-shirt samples in a 50-min training program by athletes with a certain oxygen consumption value (VO2max = 59–64 ml/kg/min). We compared the effects of objectively measured thermal resistance, water vapour resistance and air permeability values in the fabric form of garment on the microclimate temperature and microclimate relative humidity values of four body regions obtained from datalogger data. In addition, to compare the subjective evaluations with the data obtained from the datalogger measurements, we asked the subjects to evaluate the garments subjectively with the help of scales during the wear trials. Studies in the literature generally focus on cotton, polyester and their different compositions, a total of five garments which also included a new generation regenerated cellulose (Tencel) were tested in this study. Delaying the increase in oxygen uptake during an activity, thereby reaching maximum values (VO2max) later, means that the suit has a positive effect the aerobic performance. This was an interdisciplinary study, and the effects of clothing on the performance of athletes were investigated by measuring VO2max and heart rhythm values. The result of the statistical tests show that the parameters that affect the microclimate temperature and relative humidity are the fabric type and time. There were no statistically significant effects of regional differences  on microclimate temperature and relative humidity characteristics. In terms of garment type, it was observed that the microclimate temperature values of the Tencel fabric were statistically different from those of the other four garments. Similar to the literature, Tencel is suitable for activities performed in hot climates because of the high air permeability and low water vapor resistance values of the fabrics produced with Tencel, which provides a cooler touch even in blends2 and heart rate values were achieved with these garments compared than with the others. It can be concluded that, the athlete is forced less during training and that the activity can be maintained longer when these garments are worn (TS and PM). Although there was no statistical difference between the regions  due to microclimate temperature and relative humidity values, it can be said that the temperatures in the back area are higher than those in the chest area, and sweating starts in this area earlier than in the chest area.The contribution of this study to the literature is to determine the garments that will enable the activities of long distance athletes to continue for a long time. For this purpose, sensors placed in four different parts of the body and subjective scales were used for subjective comfort measurements. In addition, the effects of clothing on VO2max and heart rate were measured during activity. The highest thermal resistance and water vapour resistance value Cotton single jersey (CS) and Cotton-Polyester single jersey (CPS) coded fabrics showed the highest microclimate temperature and relative humidity values in almost all body regions. For garments with a lower water vapour transfer rate, the relative humidity in the microclimate increases, making it more difficult to throw out the sweat from the microclimate. Statistical analyses showed that there was a statistically significant difference between the Tencel single jersey garment (TS) and the other four T-shirt samples according to microclimate temperature values. When the microclimate humidity results were examined, a significant difference was observed between the polyester mesh (PM) and Tencel single jersey (TS) samples and the other three samples according to the Post-hoc Bonferroni test results. Although the subjective temperatures and wetness scale values of the TS and PM coded fabrics were found to be lower than those of the other fabrics, by considering the subjective temperature, wetness, and thermal comfort evaluations there was no statistically significant difference between these fabrics and the others. When the subjective general comfort properties were evaluated, a significant difference was observed between the CPS coded fabric, which had the highest thermal resistance value, and other garments. It was concluded that the objective test results (sensor tests) and subjective evaluation results supported each other. Garments made from Tencel single jersey and polyester mesh fabrics affect the performance of athletes positively, especially considering the results of wear trial tests. In addition, lower VOAll data generated or analysed during this study are included in this published article [and its supplementary information files].