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SARS-CoV-2: a storm is raging
Open accessAbstract
A rapidly expanding pandemicIn early December 2019, several local health facilities first reported pneumonia cases of unknown origin in Wuhan, China.This new coronavirus infectious disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported on December 1, 2020 and identified as a previously unknown betacoronavirus (1, 2).Since then, studies have increasingly demonstrated that SARS-CoV-2 can be transmitted effectively among humans through aerosol or fomites (3-5).With transmission capabilities even before symptom onset (6, 7), this pandemic is rapidly evolving and expanding.As of April 2, 2020, a total of 962,977 confirmed cases of COVID-19 and 49,180 deaths have been reported across 180 countries and regions.Recent models indicated that as much as 86% of all infections early in the spread were undocumented, suggesting the real number of infections is likely much greater (8).As a public health emergency of international concern, COVID-19 was declared a pandemic by the World Health Organization.Public health authorities around the globe are now racing to contain the spread.
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“Patients infected with SARS-CoV-2 present elevated levels of IL-6, IL-10, IL-1β, INF-γ, CCL2, TNF-α, CXCL10, CCL7, IL-1 receptor antagonist and IL-2 receptor, supposedly associated with disease severity [9, 98–105].”
From Hyperactivation of P2X7 receptors as a culprit of COVID-19 neuropathology (2021) · cites this paper as [100]
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“Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has infected billions of people around the world [1].”
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Can, N. U., Kaya, Ö., & Kotan, D. (2020) · Düzce Tıp Fakültesi Dergisi · doi:10.18678/dtfd.776953 · Cited by 4
Bacca, E., Digaetano, M., Meschiari, M., Franceschini, E., Menozzi, M., Cuomo, G., & Mussini, C. (2020) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2020.11.084 · Cited by 4
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Correlation Between Anosmia and Severity Along with Requirement of Tocilizumab in COVID-19 Patients
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“In severe disease SARS-CoV-2 infection causes hyper immune response which leads to acute respiratory distress syndrome and there is cytokine storm in most critical patients which is characterized by long term damage and lung fibrosis due to increased production of variety of cytokines [14, 15].”
BackgroundThe association between different predictive biomarkers and mortality of COVID-19
Ansari, N., Jahangiri, M., Shirbandi, K., Ebrahimi, M., & Rahim, F. (2022) · Bulletin of the National Research Centre/Bulletin of the National Research Center · doi:10.1186/s42269-022-00844-7 · Cited by 3
“Cytokines The levels of TNFa, IL-6, IL-1b, IFNg, IL-2, and IL-10 have been reported as inflammatory cytokines in COVID-19 (Pedersen and Ho 2020).”
BackgroundCOVID-19: The question of genetic diversity and therapeutic intervention approaches
Figueiredo, D. L. A., Ximenez, J. P. B., Seiva, F. R. F., Panis, C., Bezerra, R. D. S., Ferrasa, A., Cecchini, A. L., de Medeiros, A. I., Fusco‐Almeida, A. M., Ramão, A., et al. (2021) · Genetics and Molecular Biology · doi:10.1590/1678-4685-gmb-2020-0452 · Cited by 4
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Multiplexed proteomics and imaging of resolving and lethal SARS-CoV-2 infection in the lungPreprint
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Wolszczak-Biedrzycka, B., Cieślikiewicz, B., Studniarz, F., Dąbrowski, Ł., Fąs, M., Matyszkiewicz–Suchodolska, K., Harasimowicz, M., & Dorf, J. (2025) · Frontiers in Immunology · doi:10.3389/fimmu.2025.1662643 · Cited by 4
Traditional Chinese medicine for long COVID-19: the potential roles of immunity remodeling
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Beurton, A., Kooistra, E. J., JONG, A. D., Schiffl, H., Jourdain, M., Garcia, B., Vimpère, D., Jaber, S., Pickkers, P., & Papazian, L. (2024) · Current Obesity Reports · doi:10.1007/s13679-024-00562-3 · Cited by 3
“Indeed, a “cytokine storm” was suspected to play a central role in the pathophysiology of the most severe forms of COVID-19, representing an uncontrolled systemic hyperinflammatory state characterized by an overproduction of circulating cytokines [18, 19].”
COVID-19 and Myocarditis: Pathogenetic Mechanisms and Histological Features
Salzillo, C., & Marzullo, A. (2025) · Acta Microbiologica Hellenica · doi:10.3390/amh70010003 · Cited by 4
“Recent studies have shown that SARS-CoV-2 infection can trigger an excessive inflammatory response, known as cytokine storm, which plays a crucial role in damaging cardiac tissue [4–6].”
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“Increased inflammatory cytokines such as TNF a , IL-6, and IL-1 b in COVID-19 patients cause vascular endothelial dysfunction in multiple organs [19].”
BackgroundAbdelmissih, S. (2022) · Cureus · doi:10.7759/cureus.30788 · Cited by 4
“The cytokine storm, the state of pro-inflammatory cytokines overproduction, corresponded to the COVID-19 adverse outcomes [40], as was seen when IL-6 was correlated to mortality and the need for ventilators in patients with COVID-19 [41].”
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Post-mortem findings in Spanish patients with COVID-19; a special focus on superinfections
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Extreme γ′ fibrinogen levels in COVID-19 patients
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“This ‘ cytokine storm ’ can cause viral sepsis, leading to other complications such as pneumonia, acute respiratory distress syndrome, respiratory failure, shock and death [5].”
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Hematological ratios and cytokine profiles in heterozygous beta-thalassemia
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“24,25 − 28 Most of these hematologic ratios, including SIRI, were associated with length of hospital stay and independent predictors of in-hospital mortality of patients undergoing on-pump cardiac surgery.”
Palmer, M., Seekins, D. W., Avigan, M., MARCINAK, J. F., Rockey, D. C., Regev, A., Shastri, V. K., Lewis, J. H., & Dash, A. (2025) · Drug Safety · doi:10.1007/s40264-025-01591-0 · Cited by 2
“Another well-described effect of the virus during acute infection is the induction of a massive systemic immune response or cytokine storm, driven by increased immune cell production of interleukin (IL)-6, IL-2R, IL-10, and tumor necrosis factor alpha (TNF-α) [23].”
Isihak, F. A., Hamad, M. A., & Mustafa, N. G. (2020) · Russian Journal of Infection and Immunity · doi:10.15789/2220-7619-cau-1443 · Cited by 3
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Joshi, T., Ahmed, A., & Cholankeril, G. T. (2021) · Current Opinion in Infectious Diseases · doi:10.1097/qco.0000000000000760 · Cited by 3
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In silico multi-epitope vaccine against covid19 showing effective interaction with HLA-B*15:03Preprint
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“FluAv/H1N1v infection, (135) 54 (40) 171 (127) 12 (44) 35 (152) 50 (53) 17 (45) 79 (33) 418 Dengue fever, (32) 9 (7) 24 (18) 1 (4) 14 (61) 11 (10) 10 (19) 14 (9) 83 Leptospirosis, (28) 17 (13) 20 (15) 4 (15) 4 (17) 9 (8) 5 (10) 12 (8) 71 ARDS/ALI, not specified, (73) 20 (15) 44 (33) 2 (7) 8 (35) 20 (18) 4 (8) 16 (11)…”
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“…95-100% for healthy lungs), a low PaO2/FiO2 ratio or P/F [the ratio between the blood pressure of the oxygen (partial pressure of oxygen, PaO2) and the percentage of oxygen supplied (fraction of inspired oxygen, FiO2)]<300 (normal: about 500), and/or lung infiltrates>50% within 24 to 48 h [10].”
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“13,68 In critically-ill patients with COVID-19, higher serum levels of in-fl ammatory markers (e.g., C-reactive protein and D-dimers) and an increase in neutrophil-lymphocyte ratio can be seen, also present in the in fl ammatory process of ICH.”
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Galati, D., Mallardo, D., Nicastro, C., Zanotta, S., Capitelli, L., Lombardi, C., Baino, B., Cavalcanti, E., Sale, S., Labonia, F., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13092481 · Cited by 2
“The engagement of these cells upon SARS-CoV-2 infection was found to actively contribute to the expression of pro-inflammatory cytokines and tissue damage [9,12,19–24].”
BackgroundSarıkaya, Z. T., Güçyetmez, B., Tüzüner, F., Dincer, O., Şahan, C., Doğan, L., Yildirim, S. A., Zengin, R., Kocagöz, A. S., Telci, L., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-71912-3 · Cited by 2
A20 as a Potential Therapeutic Target for COVID‐19
Wu, Y., Li, H., Li, R., Li, J., Zhao, Q., & Shao, B. (2025) · Immunity Inflammation and Disease · doi:10.1002/iid3.70127 · Cited by 2
“Elevated levels of these cytokines are closely associated with severe COVID ‐ 19 infection and the development of ARDS [47, 89].”
COVID-19 related deaths in an urban academic medical center in Brooklyn – a descriptive case series
McCracken, J. A., Nakeshbandi, M., Arace, J., Riley, W. J., & Sharma, R. (2020) · Translational Medicine Communications · doi:10.1186/s41231-020-00065-y · Cited by 2
“Abbreviations AKI: Acute kidney injury; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; BMI: Body mass index; CKD: Chronic kidney disease; COVID-19: Novel coronavirus disease 2019; CRP: C-reactive protein; CRS: Cytokine release syndrome; ESR: Erythrocyte sedimentation rate; ESRD: End-stage renal diseas…”
BackgroundResultInfluentialPeptide Drug Thymalin Regulates Immune Status in Severe COVID-19 Older Patients
Bi, K., Khavinson, V. K., Шаповалов, К. Г., Linkova, N. S., Lukyanov, S. А., Smolyakov, Y. N., Терешков, П. П., Shapovalov, Y. K., Коннов, В. А., & Цыбиков, Н. Н. (2021) · Advances in Gerontology · doi:10.1134/s2079057021040068 · Cited by 2
“Thymosin α1 effectively augmented the number of CD8+ or CD4+ T-cells in the older COVID-19 patients with severe lymphocytopenia [28].”
BackgroundKornitzky, F. W., Langen, H.-J., & Held, M. (2021) · Pneumologie · doi:10.1055/a-1458-4080 · Cited by 2
Quantitative Insight into Immunopathology of SARS-CoV-2 Infection
Soni, B., Kabra, R., & Singh, S. (2021) · Journal of Interferon & Cytokine Research · doi:10.1089/jir.2020.0156 · Cited by 2
“This increased and uncontrolled inflammation can also cause multiorgan damage especially cardiac, hepatic, and renal (Pedersen and Ho 2020; Zhang and others 2020a).”
The Role of the Immune System on the Cardiac Complications Observed in SARS-CoV-2
Vigário, L. C., Muradas, G., Paiva, C. N., & Medei, E. H. (2021) · International Journal of Cardiovascular Sciences · doi:10.36660/ijcs.20200266 · Cited by 2
Garifullina, A., & Shen, A. Q. (2021) · Journal of Materials Chemistry B · doi:10.1039/d1tb01556g · Cited by 2
COVID-19 in patients with glomerular disease
Turner‐Stokes, T., Edwards, H., & Lightstone, L. (2021) · Current Opinion in Nephrology & Hypertension · doi:10.1097/mnh.0000000000000769 · Cited by 2
Touzot, M., Lefèbvre, T., Maheas, C., Peoc’h, K., Ureña, P., Ridel, C., Puy, H., & Karim, Z. (2021) · Clinical Kidney Journal · doi:10.1093/ckj/sfab254 · Cited by 2
The effect of steroids used in the treatment of COVID-19 on infections in intensive care
Sarı, A. C. (2022) · Northern Clinics of Istanbul · doi:10.14744/nci.2022.43827 · Cited by 2
“It is accepted that cytokine storm, which develops in COVID-19 patients, plays an important role in the damage to the lungs and the development of ARDS.”
BackgroundInfluentialNeutrophils, lymphocytes and their ratio as predictors of outcome in patients with COVID-19
Bi, K., Smolyakov, Y. N., Хавинсон, В. Х., Шаповалов, К. Г., Лукьянов, С. А., Фефелова, Е. В., & Казанцева, Л. С. (2021) · Zhurnal «Patologicheskaia fiziologiia i eksperimental`naia terapiia» · doi:10.25557/0031-2991.2021.04.34-41 · Cited by 2
Emerging and re-emerging infections
Heymann, D. L., & Lee, V. J. (2021) · doi:10.1093/med/9780198816805.003.0075 · Cited by 2
Alexandrova, E. A., Валерьевна, П. Е., Вадимовна, Б. И., Yulin, V. S., Suslov, A. G., Михайлович, Б. К., & Fomin, S. V. (2022) · Meditsinskiy sovet = Medical Council · doi:10.21518/2079-701x-2022-16-2-76-84 · Cited by 5
Bagde, H. S., & Dhopte, A. (2022) · Cureus · doi:10.7759/cureus.26549 · Cited by 2
“Crude plant extracts can be beneficial or dangerous depending on the amount employed; if processed correctly, higher activity may be demonstrated [78-80].”
BackgroundImmunity benefits of yoga and physical exercises in the era of COVID-19 Pandemic
Govindasamy, K., Suresh, C., Anand, M., Saran, K. S., Pramanik, M., Kaur, D., Achouri, I., & Boughanmi, H. (2022) · Health sport rehabilitation · doi:10.34142/hsr.2022.08.03.08 · Cited by 2
“Severe COVID-19 infection is correlated with cytokine storms represented by increased cytokine levels (IL-6, IL-10, and TNF-a), lymphopenia (in CD4+ and CD8+ T cells), and decreased IFN-γ expression in CD4+ T cells [24].”
BackgroundEl‐Malah, A., Ibrahim, T. A., Attia, H., Eid, B. G., Bagher, A. M., Binmahfouz, L. S., & Sokkar, N. M. (2022) · Pharmacy Practice · doi:10.18549/pharmpract.2022.3.2700 · Cited by 2
Beltz, L. A. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-98809-4.00013-9 · Cited by 2
Relation of COVID-19 with liver diseases and their impact on healthcare systems: The Portuguese case
Fernandes, S., Sosa‐Napolskij, M., Lobo, G., & da Silva, I. C. B. (2023) · World Journal of Gastroenterology · doi:10.3748/wjg.v29.i6.1109 · Cited by 2
Acar, A. (2023) · Hacettepe Journal of Biology and Chemistry · doi:10.15671/hjbc.1232843 · Cited by 2
Characterization of T Helper 1 and 2 Cytokine Profiles in Newborns of Mothers with COVID-19
Moreira, A. L. E., da Silva, P. A. N., Gomes, R. S., Santos, M. D. O., Ito, C. R. M., Gonçalves, L. C., de Souza, P. P., Peixoto, F. A. D. O., Wastowski, I. J., Carneiro, L. C., et al. (2023) · Biomedicines · doi:10.3390/biomedicines11030910 · Cited by 2
Rosseto-Welter, E. A., Rodrigues, S. S., Figueiredo, A. B., França, C. N., Oliveira, D. B. L., Bachi, A. L. L., do Amaral, J. B., Siqueira, R. A., Bento, L. C., da Silva, A. P., et al. (2023) · Vaccines · doi:10.3390/vaccines11040840 · Cited by 2
Immunomodulation strategies against COVID-19 evidence: key nutrients and dietary approaches
Cundra, L. B., Vallabhaneni, M., Saadeh, M., Houston, K. V., Yoo, B. S., D’Souza, S. M., & Johnson, D. A. (2023) · Exploration of Medicine · doi:10.37349/emed.2023.00133 · Cited by 2
Convolutional Neural Networks for Face Detection and Face Mask Multiclass Classification
Campos, A., Melín, P., & Sánchez, D. (2023) · Lecture notes in networks and systems · doi:10.1007/978-3-031-27409-1_2 · Cited by 2
Yu, F., He, H., Huang, T., & Zhou, Y. (2023) · Open Life Sciences · doi:10.1515/biol-2022-0661 · Cited by 2
Wlazło, M., Zięba, N., Janota, B., Czapla, M., Mąkosza, K. M., Janion, K., & Szczepańska, E. (2023) · Roczniki Państwowego Zakładu Higieny · doi:10.32394/rpzh.2023.0264 · Cited by 2
Sharma, A., Rukmini, M. S., Manjrekar, P., Pawar, N. M., & Sowndarya, K. (2024) · Biomedicine · doi:10.51248/.v43i6.3665 · Cited by 2
Bifurcation Analysis of the Dynamics in COVID‐19 Transmission through Living and Nonliving Media
Wiraya, A., Fitriana, L., Triyanto, T., Adi, Y. A., Kusumadewi, Y. A., & Khoirunnisa, S. (2024) · Journal of Applied Mathematics · doi:10.1155/2024/5669308 · Cited by 2
Modelling the long-term health impact of COVID-19 using Graphical Chain Models
Gourgoura, K., Rivadeneyra, P., Stanghellini, E., Caroni, C., Bartolucci, F., Curcio, R., Bartoli, S., Ferranti, R., Folletti, I., Cavallo, M., et al. (2024) · BMC Infectious Diseases · doi:10.1186/s12879-024-09777-0 · Cited by 2
“These include increased expression of Angiotensin Converting Enzyme-2 (ACE2) receptor in adipocytes [32] and specific immunological signatures that predispose obese individuals to an enhanced cytokine storm [33].”
BackgroundCOVID-19/COMMEC, G. D. T. M. (2020) · Medicina Crítica · doi:10.35366/93964 · Cited by 4
Saliva as a Diagnostic Tool for Detection of Coronavirus: A Review
Lal, A., Saleem, M. K. M., & Ahmed, N. (2020) · Journal of Islamabad Medical & Dental College · doi:10.35787/jimdc.v9i3.570 · Cited by 2
“Particular emphasis has been given to the induction of cytokine storm by SARS-CoV-2, whereby increased cytokine levels (IL-6, IL-10, and TNF-α), lymphopenia, and decreased IFN-γ expression in CD4+ T cells has been associated with severe COVID-19 infection.(22) This can lead to respiratory distress in the affected indi…”
BackgroundCardiovascular Manifestations of SARS CoV-2: A Review
Kumar, N. P. (2020) · Journal of Advanced Research in Medicine · doi:10.24321/2349.7181.202005 · Cited by 2
Neuropathogenesis of SARS-CoV-2 Infection
Zahoor, I., Cerghet, M., & Giri, S. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-82691-4.00006-6 · Cited by 2
COVID-19 Impact on Male Fertility: Review
Жуковская, С. В. М., & Жуковская, С. В. М. (2021) · Репродуктивное здоровье Восточная Европа · doi:10.34883/pi.2020.10.6.006 · Cited by 2
Chiappelli, F., Khakshooy, A. M., & Gilardi, J. (2023) · Elsevier eBooks · doi:10.1016/b978-0-12-817558-3.00026-3 · Cited by 2
COVID ‐19: collaboration will keep us ahead of the curve
Shamdasani, P., Trubiano, J. A., Smibert, O. C., Owen, C., & Liew, D. F. L. (2020) · Internal Medicine Journal · doi:10.1111/imj.14888 · Cited by 2
Beta-adrenergic blocker treatment for COVID-19Preprint
Vasanthakumar, N. (2020) · doi:10.31219/osf.io/wdp4g · Cited by 2
Lorenz, G., Moog, P., Bachmann, Q., Rosée, P. G. L., Schneider, H., Schlegl, M., Spinner, C. D., Heemann, U. W., Schmid, R. M., Algül, H., et al. (2020) · doi:10.21203/rs.3.rs-31847/v1 · Cited by 2
Estivill‐Castro, V., Hernández-Jiménez, E., & Nettleton, D. (2021) · International Conference on Simulation and Modeling Methodologies, Technologies and Applications · doi:10.5220/0010600300002995 · Cited by 1
Küçük, M. P., Küçük, A. O., Pehlivanlar, A., Mürtezaoğlu, S. A., Çoban, K., Kılıç, G., Ayçiçek, O., Öztuna, F., Bülbül, Y., & Özlü, T. (2021) · TURKISH JOURNAL OF MEDICAL SCIENCES · doi:10.3906/sag-2106-42 · Cited by 1
Metadata
- Authors
- Pedersen, S. F., & Ho, Y.-C.
- Affiliations
- Yale University (US)
- Corresponding author
- Ho, Ya-Chi
- ORCID
- Ho, Ya-Chi
- Venue
- Journal of Clinical Investigation
- Published
- 2020-04-13
- Volume
- 130
- Issue
- 5
- Pages
- 2202-2205
- ISSN
- 0021-9738 (ISSN-L)
- 1558-8238
- PMC
- PMC7190904
- OpenAlex
- W3014001472
- Cited by
- 1,137
- References
- 23
- Citations by year
- 2026: 11 · 2025: 34 · 2024: 60 · 2023: 113 · 2022: 183 · 2021: 341 · 2020: 395
- FWCI
- 33.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Investigation (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- amfAR, The Foundation for AIDS Research
- Yale University
- Gilead Sciences
- National Institutes of Health (AI150464, DA047037, UL1TR001863)
- National Institute on Drug Abuse (R61DA047037)
- National Institute of Allergy and Infectious Diseases (UM1AI126620, P50AI150464, R01AI047868, R01AI141009, R37AI147868)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- SARS-CoV-2, COVID-19 pandemic, pandemic, Betacoronavirus, airborne transmission, fomite transmission, pre-symptomatic transmission, undetected infections, WHO pandemic declaration
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Age Factors, Humans, Lymphocytes, Pneumonia, Viral, Respiratory Distress Syndrome, Severity of Illness Index, Cytokines, Coronavirus Infections, Disease Progression, Pandemics
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