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Cortical atrophy patterns in myelin oligodendrocyte glycoprotein antibody-associated disease 髓鞘少突胶质细胞糖蛋白抗体相关疾病的皮质萎缩模式。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-25 DOI: 10.1002/acn3.52137
Ruth Schneider, Ann-Kathrin Kogel, Theodoros Ladopoulos, Nadine Siems, Britta Krieger, Barbara Bellenberg, Ralf Gold, Ilya Ayzenberg, Carsten Lukas

Objectives

Global brain volume changes in patients with myelin oligodendrocyte glycoprotein antibody-associated disease compared with healthy controls (HC) could be revealed by magnetic resonance imaging, but specific atrophy patterns of cortical structures and relation to cognitive impairment are not yet comprehensively known. Thus, we aimed to investigate cortical thickness differences in patients with myelin oligodendrocyte glycoprotein antibody-associated disease compared with HC.

Methods

3-Tesla brain magnetic resonance imaging was performed in 23 patients with myelin oligodendrocyte glycoprotein antibody-associated disease and 49 HC for voxel-wise group comparisons and neuropsychological testing in patients. Surface-based morphometry with region of interest-based surface analysis and region of interest-based extraction of cortical thickness was performed in patients compared with HC and in patient subgroups with and without cognitive impairment.

Results

Comparing patients with myelin oligodendrocyte glycoprotein antibody-associated disease with HC, exploratory surface-based morphometry demonstrated cortical volume reduction in pericalcarine and lingual cortical regions. Region of interest-based surface analysis specified reduced cortical thickness in the adjacent pericalcarine and orbitofrontal regions in myelin oligodendrocyte glycoprotein antibody-associated disease, as well as reduced temporal cortical thickness in patients with cognitive impairment (n = 10). Patients without cognitive impairment (n = 13) showed only circumscribed cortical brain volume loss compared with HC in the pericalcarine region.

Interpretation

In conclusion, cortical atrophy in myelin oligodendrocyte glycoprotein antibody-associated disease was characterized by cortical thickness reduction in the adjacent pericalcarine and orbitofrontal regions, with a tendency of temporal thickness reduction in cognitively impaired patients.

目的:磁共振成像可显示髓鞘少突胶质细胞糖蛋白抗体相关疾病患者与健康对照组(HC)相比的整体脑容量变化,但皮质结构的具体萎缩模式以及与认知障碍的关系尚未得到全面了解。因此,我们旨在研究髓鞘少突胶质细胞糖蛋白抗体相关疾病患者与健康对照组相比皮质厚度的差异。方法:对 23 名髓鞘少突胶质细胞糖蛋白抗体相关疾病患者和 49 名健康对照组进行 3-Tesla 脑磁共振成像,进行体素组比较,并对患者进行神经心理学测试。对患者与 HC 以及有认知障碍和无认知障碍的患者亚组进行了基于兴趣区的表面形态分析和基于兴趣区的皮层厚度提取:结果:将髓鞘少突胶质细胞糖蛋白抗体相关疾病患者与HC患者进行比较,探索性基于表面的形态测量显示,脐周和舌侧皮质区域的皮质体积减少。基于兴趣区的表面分析表明,在髓鞘少突胶质细胞糖蛋白抗体相关疾病患者中,相邻的心周和眶额区皮质厚度减少,认知障碍患者(n = 10)的颞叶皮质厚度也减少。与HC相比,无认知障碍的患者(n = 13)仅表现出周围皮质脑容量减少:总之,髓鞘少突胶质细胞糖蛋白抗体相关疾病的皮质萎缩特点是邻近的卡林周围区和眶额区的皮质厚度减少,认知障碍患者的颞叶厚度有减少的趋势。
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引用次数: 0
Clinical utility of diffusion MRI-derived measures of cortical microstructure in a real-world memory clinic setting 弥散核磁共振成像衍生的皮质微结构测量方法在真实世界记忆诊所环境中的临床实用性。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-24 DOI: 10.1002/acn3.52097
Mario Torso, Giorgio Fumagalli, Gerard R. Ridgway, Valeria Elisa Contarino, Ian Hardingham, Elio Scarpini, Daniela Galimberti, Steven A. Chance, Andrea Arighi

Objective

To investigate cortical microstructural measures from diffusion MRI as “neurodegeneration” markers that could improve prognostic accuracy in mild cognitive impairment (MCI).

Methods

The prognostic power of Amyloid/Tau/Neurodegeneration (ATN) biomarkers to predict progression from MCI to AD or non-AD dementia was investigated. Ninety patients underwent clinical evaluation (follow-up interval 32 ± 18 months), lumbar puncture, and MRI. Participants were grouped by clinical stage and cerebrospinal fluid Amyloid and Tau status.

T1-structural and diffusion MRI scans were analyzed to calculate diffusion metrics related to cortical columnar structure (AngleR, ParlPD, PerpPD+), cortical mean diffusivity, and fractional anisotropy. Statistical tests were corrected for multiple comparisons. Prognostic power was assessed using receiver operating characteristic (ROC) analysis and related indices.

Results

A progressive increase of whole-brain cortical diffusion values was observed along the AD continuum, with all A+ groups showing significantly higher AngleR than A−T−.

Investigating clinical progression to dementia, the AT biomarkers together showed good positive predictive value (with 90.91% of MCI A+T+ converting to dementia) but poor negative predictive value (with 40% of MCI A−T− progressing to a mix of AD and non-AD dementias). Adding whole-brain AngleR as an N marker, produced good differentiation between stable and converting MCI A−T− patients (0.8 area under ROC curve) and substantially improved negative predictive value (+21.25%).

Interpretation

Results support the clinical utility of cortical microstructure to aid prognosis, especially in A−T− patients. Further work will investigate other complexities of the real-world clinical setting, including A−T+ groups. Diffusion MRI measures of neurodegeneration may complement fluid AT markers to support clinical decision-making.

目的研究将弥散核磁共振成像中的皮质微结构测量结果作为 "神经变性 "标志物,以提高轻度认知障碍(MCI)的预后准确性:研究了淀粉样蛋白/Tau/神经变性(ATN)生物标志物在预测MCI进展为AD或非AD痴呆方面的预后能力。90名患者接受了临床评估(随访间隔为32 ± 18个月)、腰椎穿刺和核磁共振成像检查。根据临床分期、脑脊液淀粉样蛋白和 Tau 状态对参与者进行分组。对 T1 结构和弥散 MRI 扫描进行分析,以计算与皮质柱状结构(AngleR、ParlPD、PerpPD+)、皮质平均弥散度和分数各向异性相关的弥散指标。统计检验经多重比较校正。使用接收器操作特征(ROC)分析和相关指数评估预后能力:结果:在AD连续体中观察到全脑皮层弥散值逐渐增加,所有A+组的AngleR都明显高于A-T-组。在对痴呆的临床进展进行调查时,AT生物标志物共同显示出良好的阳性预测价值(90.91%的MCI A+T+转为痴呆),但阴性预测价值较低(40%的MCI A-T-转为AD和非AD痴呆混合型)。将全脑AngleR作为N标记物,可以很好地区分稳定型和转化型MCI A-T-患者(ROC曲线下面积为0.8),并大大提高了阴性预测值(+21.25%):结果支持皮质微结构对预后的临床辅助作用,尤其是对A-T-患者。进一步的工作将研究真实世界临床环境的其他复杂性,包括 A-T+ 组。神经退行性变的弥散核磁共振成像测量可补充体液AT标记,为临床决策提供支持。
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引用次数: 0
ALS Identified: two-year findings from a sponsored ALS genetic testing program ALS Identified:一项由赞助的 ALS 基因检测计划两年来的研究结果。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-23 DOI: 10.1002/acn3.52140
Stephen A. Goutman, Namita A. Goyal, Katelyn Payne, Coro Paisán-Ruiz, Varant Kupelian, Melissa L. Kang, Adele A. Mitchell, Teresa E. Fecteau

Objective

To report initial results from the Amyotrophic Lateral Sclerosis (ALS) Identified genetic testing (GT) program on characteristics of individuals tested and frequency of reported disease-causing variants.

Methods

ALS Identified used the Invitae Amyotrophic Lateral Sclerosis panel (Invitae, San Francisco, CA, USA) to assay 22 ALS-associated genes. Sponsored by Biogen (Cambridge, MA, USA), the program was launched in June 2021 and was available at no charge to individuals ≥18 years in the United States and Puerto Rico with an ALS diagnosis or a known family history of ALS. Deidentified data were available to Biogen.

Results

As of 26 October 2023, 998 healthcare professionals ordered the panel at 681 unique care sites. Of 8054 individuals examined, 7483 (92.9%) were reported to have a clinical diagnosis of ALS, while 571 (7.1%) were asymptomatic relatives. Of the individuals with a clinical ALS diagnosis, 57.7% were male (n = 4319) and 42.3% female (n = 3164). Mean (SD) age at diagnosis is 62 (13) years. Out of the 7483 clinically diagnosed individuals, 1810 (24.2%) showed genetic variations in ALS-associated genes. Among these, 865 individuals (47.8%) carried pathogenic variants, and 44 (2.4%) had likely pathogenic variants, totaling 12.1% of the clinically diagnosed population.

Interpretation

Since 2021 there has been robust uptake and sustained use of the ALS Identified program, one of the largest samples of people with ALS to date across the United States, demonstrating the interest and need for genetic ALS testing.

目的:报告肌萎缩侧索硬化症(ALS)基因检测(GT)项目的初步结果:报告肌萎缩侧索硬化症(ALS)基因检测(GT)项目的初步结果,包括受检者的特征和报告的致病变异的频率:ALS Identified使用Invitae肌萎缩侧索硬化症面板(Invitae,美国加利福尼亚州旧金山)检测22个ALS相关基因。该项目由百健公司(Biogen)(美国马萨诸塞州剑桥市)赞助,于 2021 年 6 月启动,免费提供给美国和波多黎各年龄≥18 岁、确诊为 ALS 或已知有 ALS 家族史的人。百健公司可获得去身份化数据:截至 2023 年 10 月 26 日,998 名医疗保健专业人员在 681 个独特的医疗点订购了该面板。在接受检查的 8054 人中,有 7483 人(92.9%)被报告患有 ALS 临床诊断,571 人(7.1%)为无症状亲属。在临床诊断为 ALS 的患者中,57.7% 为男性(n = 4319),42.3% 为女性(n = 3164)。确诊时的平均(标清)年龄为 62(13)岁。在 7483 名临床诊断患者中,有 1810 人(24.2%)出现 ALS 相关基因的遗传变异。其中,865 人(47.8%)携带致病变异,44 人(2.4%)可能携带致病变异,共计占临床诊断人群的 12.1%:自 2021 年以来,ALS Identified 计划得到了广泛接受和持续使用,该计划是美国迄今为止最大的 ALS 患者样本之一,表明了人们对 ALS 基因检测的兴趣和需求。
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引用次数: 0
Investigating cortical hypoxia in multiple sclerosis via time-domain near-infrared spectroscopy 通过时域近红外光谱仪研究多发性硬化症患者的皮质缺氧状况。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-22 DOI: 10.1002/acn3.52150
Thomas Williams, Frédéric Lange, Kenneth J. Smith, Ilias Tachtsidis, Jeremy Chataway

Objectives

Hypoperfusion and tissue hypoxia have been implicated as contributory mechanisms in the neuropathology of multiple sclerosis (MS). Our objective has been to study cortical oxygenation in vivo in patients with MS and age-matched controls.

Methods

A custom, multiwavelength time-domain near-infrared spectroscopy system was developed for assessing tissue hypoxia from the prefrontal cortex. A cross-sectional case–control study was undertaken assessing patients with secondary progressive MS (SPMS) and age-matched controls. Co-registered magnetic resonance imaging was used to verify the location from which near-infrared spectroscopy data were obtained through Monte Carlo simulations of photon propagation. Additional clinical assessments of MS disease severity were carried out by trained neurologists. Linear mixed effect models were used to compare cortical oxygenation between cases and controls, and against measures of MS severity.

Results

Thirty-three patients with secondary progressive MS (median expanded disability status scale 6 [IQR: 5–6.5]; median age 53.0 [IQR: 49–58]) and 20 age-matched controls were recruited. Modeling of photon propagation confirmed spectroscopy data were obtained from the prefrontal cortex. Patients with SPMS had significantly lower cortical hemoglobin oxygenation compared with controls (−6.0% [95% CI: −10.0 to −1.9], P = 0.004). There were no significant associations between cortical oxygenation and MS severity.

Interpretation

Using an advanced, multiwavelength time-domain near-infrared spectroscopy system, we demonstrate that patients with SPMS have lower cortical oxygenation compared with controls.

目的:低灌注和组织缺氧被认为是多发性硬化症(MS)神经病理学的促成机制。我们的目标是研究多发性硬化症患者和年龄匹配的对照组的体内皮质氧含量:方法:我们开发了一套定制的多波长时域近红外光谱仪系统,用于评估前额叶皮层组织缺氧情况。对继发性进行性多发性硬化症(SPMS)患者和年龄匹配的对照组进行了横断面病例对照研究。通过对光子传播进行蒙特卡洛模拟,使用共聚焦磁共振成像来验证获取近红外光谱数据的位置。训练有素的神经学家对多发性硬化症的疾病严重程度进行了额外的临床评估。线性混合效应模型用于比较病例与对照组之间的皮质氧合情况,以及与多发性硬化症严重程度的测量结果:结果:共招募了 33 名继发性进行性多发性硬化症患者(中位数扩展残疾状态量表 6 [IQR:5-6.5];中位数年龄 53.0 [IQR:49-58])和 20 名年龄匹配的对照组患者。光子传播模型证实了从前额叶皮层获得的光谱数据。与对照组相比,SPMS 患者的皮质血红蛋白含氧量明显较低(-6.0% [95% CI:-10.0 至-1.9],P = 0.004)。皮质血红蛋白含氧量与多发性硬化症的严重程度无明显关联:我们利用先进的多波长时域近红外光谱仪系统证明,与对照组相比,SPMS 患者的皮质氧合较低。
{"title":"Investigating cortical hypoxia in multiple sclerosis via time-domain near-infrared spectroscopy","authors":"Thomas Williams,&nbsp;Frédéric Lange,&nbsp;Kenneth J. Smith,&nbsp;Ilias Tachtsidis,&nbsp;Jeremy Chataway","doi":"10.1002/acn3.52150","DOIUrl":"10.1002/acn3.52150","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Hypoperfusion and tissue hypoxia have been implicated as contributory mechanisms in the neuropathology of multiple sclerosis (MS). Our objective has been to study cortical oxygenation <i>in vivo</i> in patients with MS and age-matched controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A custom, multiwavelength time-domain near-infrared spectroscopy system was developed for assessing tissue hypoxia from the prefrontal cortex. A cross-sectional case–control study was undertaken assessing patients with secondary progressive MS (SPMS) and age-matched controls. Co-registered magnetic resonance imaging was used to verify the location from which near-infrared spectroscopy data were obtained through Monte Carlo simulations of photon propagation. Additional clinical assessments of MS disease severity were carried out by trained neurologists. Linear mixed effect models were used to compare cortical oxygenation between cases and controls, and against measures of MS severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-three patients with secondary progressive MS (median expanded disability status scale 6 [IQR: 5–6.5]; median age 53.0 [IQR: 49–58]) and 20 age-matched controls were recruited. Modeling of photon propagation confirmed spectroscopy data were obtained from the prefrontal cortex. Patients with SPMS had significantly lower cortical hemoglobin oxygenation compared with controls (−6.0% [95% CI: −10.0 to −1.9], <i>P</i> = 0.004). There were no significant associations between cortical oxygenation and MS severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>Using an advanced, multiwavelength time-domain near-infrared spectroscopy system, we demonstrate that patients with SPMS have lower cortical oxygenation compared with controls.</p>\u0000 </section>\u0000 </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141732874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Objective and subjective cognitive outcomes one year after COVID-19 COVID-19 一年后的客观和主观认知结果。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-19 DOI: 10.1002/acn3.52149
Laura Zamarian, Verena Rass, Elisabeth Goettfried, Valentina Mayr, Federico Carbone, Philipp Kindl, Margarete Delazer, Atbin Djamshidian, Alessandra Fanciulli, Philipp Mahlknecht, Beatrice Heim, Marina Peball, Alois Josef Schiefecker, Klaus Seppi, Judith Löffler-Ragg, Ronny Beer, Bettina Pfausler, Stefan Kiechl, Raimund Helbok

Objective

This study aimed to evaluate subjective cognitive, physical, and mental health symptoms as well as objective cognitive deficits in COVID-19 patients 1 year after infection.

Methods

This was a cross-sectional study. Seventy-four patients, who contracted a SARS-CoV-2 infection in 2020, underwent an in-person neuropsychological assessment in 2021. This included standardized tests of memory, attention, and executive functions. In addition, participants also responded to scales on subjective attention deficits, mental health symptoms, and fatigue. Patients' scores were compared to published norms.

Results

Patients (N = 74) had a median age of 56 years (42% female). According to the initial disease severity, they were classified as mild (outpatients, 32%), moderate (hospitalized, non-ICU-admitted, 45%), or severe (ICU-admitted, 23%). Hospitalized patients were more often affected than outpatients. In general, deficits were most common in attention (23%), followed by memory (15%) and executive functions (3%). Patients reported increased levels of fatigue (51%), anxiety (30%), distractibility in everyday situations (20%), and depression (15%). An additional analysis suggested an association between lower scores in an attention task and hyperferritinemia. As indicated by a hierarchical regression analysis, subjective distractibility was significantly predicted by current anxiety and fatigue symptoms but not by objective attention performance (final model, adj-R 2 = 0.588, P < 0.001).

Interpretation

One year after infection, COVID-19 patients can have frequent attention deficits and can complain about symptoms such as fatigue, anxiety, and distractibility. Anxiety and fatigue, more than objective cognitive deficits, have an impact on the patients' experienced impairments in everyday life.

研究目的本研究旨在评估 COVID-19 患者感染 1 年后的主观认知、身体和心理健康症状以及客观认知缺陷:这是一项横断面研究。在2020年感染SARS-CoV-2的74名患者在2021年接受了一次面对面的神经心理学评估。评估内容包括记忆力、注意力和执行功能的标准化测试。此外,参与者还对主观注意力缺陷、精神健康症状和疲劳程度进行了评分。患者的得分与已公布的标准值进行了比较:患者(N = 74)的中位年龄为 56 岁(42% 为女性)。根据最初的疾病严重程度,他们被分为轻度(门诊病人,32%)、中度(住院,非重症监护室收治,45%)或重度(重症监护室收治,23%)。住院病人比门诊病人更常受到影响。一般来说,注意力缺陷最常见(23%),其次是记忆力(15%)和执行功能(3%)。患者报告的疲劳程度(51%)、焦虑程度(30%)、日常注意力分散程度(20%)和抑郁程度(15%)均有所增加。另一项分析表明,注意力任务得分较低与高铁蛋白血症有关。分层回归分析表明,当前的焦虑和疲劳症状可显著预测主观注意力分散情况,但客观注意力表现却无法预测主观注意力分散情况(最终模型,adj-R2 = 0.588,P 解释):感染一年后,COVID-19 患者会经常出现注意力缺陷,并会抱怨疲劳、焦虑和注意力分散等症状。焦虑和疲劳比客观认知障碍更能影响患者在日常生活中的体验障碍。
{"title":"Objective and subjective cognitive outcomes one year after COVID-19","authors":"Laura Zamarian,&nbsp;Verena Rass,&nbsp;Elisabeth Goettfried,&nbsp;Valentina Mayr,&nbsp;Federico Carbone,&nbsp;Philipp Kindl,&nbsp;Margarete Delazer,&nbsp;Atbin Djamshidian,&nbsp;Alessandra Fanciulli,&nbsp;Philipp Mahlknecht,&nbsp;Beatrice Heim,&nbsp;Marina Peball,&nbsp;Alois Josef Schiefecker,&nbsp;Klaus Seppi,&nbsp;Judith Löffler-Ragg,&nbsp;Ronny Beer,&nbsp;Bettina Pfausler,&nbsp;Stefan Kiechl,&nbsp;Raimund Helbok","doi":"10.1002/acn3.52149","DOIUrl":"10.1002/acn3.52149","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to evaluate subjective cognitive, physical, and mental health symptoms as well as objective cognitive deficits in COVID-19 patients 1 year after infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a cross-sectional study. Seventy-four patients, who contracted a SARS-CoV-2 infection in 2020, underwent an in-person neuropsychological assessment in 2021. This included standardized tests of memory, attention, and executive functions. In addition, participants also responded to scales on subjective attention deficits, mental health symptoms, and fatigue. Patients' scores were compared to published norms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients (<i>N</i> = 74) had a median age of 56 years (42% female). According to the initial disease severity, they were classified as mild (outpatients, 32%), moderate (hospitalized, non-ICU-admitted, 45%), or severe (ICU-admitted, 23%). Hospitalized patients were more often affected than outpatients. In general, deficits were most common in attention (23%), followed by memory (15%) and executive functions (3%). Patients reported increased levels of fatigue (51%), anxiety (30%), distractibility in everyday situations (20%), and depression (15%). An additional analysis suggested an association between lower scores in an attention task and hyperferritinemia. As indicated by a hierarchical regression analysis, subjective distractibility was significantly predicted by current anxiety and fatigue symptoms but not by objective attention performance (final model, adj-<i>R</i>\u0000 <sup>2</sup> = 0.588, <i>P</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>One year after infection, COVID-19 patients can have frequent attention deficits and can complain about symptoms such as fatigue, anxiety, and distractibility. Anxiety and fatigue, more than objective cognitive deficits, have an impact on the patients' experienced impairments in everyday life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Utilizing thalamic deep brain stimulation for an electronic seizure diary in a definite sudden unexpected death in epilepsy case 在一例明确的癫痫意外猝死病例中利用丘脑深部脑刺激进行电子癫痫发作日记记录。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-19 DOI: 10.1002/acn3.52153
Surya Suresh, Yash Vakilna, Vladimir Vashin, Samden Lhatoo, Sandipan Pati

Objective

Sudden unexpected death in epilepsy (SUDEP) is a serious threat to individuals with intractable epilepsies, contributing to premature mortality. Understanding the elusive pathophysiological mechanisms of SUDEP, especially in cases without observable terminal events, remains a crucial area for investigation. This study aimed to shed light on the burden of epileptiform activity preceding SUDEP by utilizing an automated electronic seizure diary derived from a sensing-enabled thalamic deep brain stimulator (DBS).

Methods

Herein, we present the case of a 57-year-old man afflicted with intractable multifocal epilepsy secondary to cortical dysplasia and encephalomalacia resulting from severe traumatic brain injury. Despite an initial successful resection and subsequent resurgence of seizures necessitating DBS treatment, the patient tragically succumbed to SUDEP.

Results

In-depth analysis of the patient's electronic seizure diary, complemented by data from the sensing-enabled DBS, unveiled a terminal electrographic seizure. Notably, we observed a significant increase in power within specific frequency bands recorded from the thalamus preceding the terminal event. Furthermore, these heightened band power events displayed a discernible temporal clustering pattern, primarily manifesting during specific morning and evening hours. An autopsy conclusively confirmed the diagnosis of definite SUDEP.

Interpretation

This unique case report underscores the feasibility of harnessing thalamic DBS sensing capabilities to monitor seizure burden and, potentially, to tailor interventions aimed at reducing seizure frequency and associated mortality risks.

目的:癫痫意外猝死(SUDEP)对顽固性癫痫患者构成严重威胁,并导致过早死亡。了解癫痫猝死(SUDEP)难以捉摸的病理生理机制,尤其是在没有可观察到的终末事件的病例中,仍然是一个重要的研究领域。本研究旨在利用丘脑深部脑刺激器(DBS)感知功能产生的自动电子癫痫发作日记,揭示 SUDEP 发生前癫痫样活动的负担。尽管最初成功进行了切除手术,但随后癫痫再次发作,需要进行 DBS 治疗,患者最终不幸死于 SUDEP:对患者的电子癫痫发作日记进行深入分析,并辅以感知型 DBS 的数据,揭示了终末电图癫痫发作。值得注意的是,我们观察到在终末事件发生之前,丘脑记录到的特定频段的功率明显增加。此外,这些频段功率增高事件显示出明显的时间聚集模式,主要表现在特定的早晨和傍晚时段。尸检最终确诊为明确的 SUDEP:这份独特的病例报告强调了利用丘脑 DBS 传感功能监测癫痫发作负担的可行性,并有可能为减少癫痫发作频率和相关死亡风险而量身定制干预措施。
{"title":"Utilizing thalamic deep brain stimulation for an electronic seizure diary in a definite sudden unexpected death in epilepsy case","authors":"Surya Suresh,&nbsp;Yash Vakilna,&nbsp;Vladimir Vashin,&nbsp;Samden Lhatoo,&nbsp;Sandipan Pati","doi":"10.1002/acn3.52153","DOIUrl":"10.1002/acn3.52153","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Sudden unexpected death in epilepsy (SUDEP) is a serious threat to individuals with intractable epilepsies, contributing to premature mortality. Understanding the elusive pathophysiological mechanisms of SUDEP, especially in cases without observable terminal events, remains a crucial area for investigation. This study aimed to shed light on the burden of epileptiform activity preceding SUDEP by utilizing an automated electronic seizure diary derived from a sensing-enabled thalamic deep brain stimulator (DBS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Herein, we present the case of a 57-year-old man afflicted with intractable multifocal epilepsy secondary to cortical dysplasia and encephalomalacia resulting from severe traumatic brain injury. Despite an initial successful resection and subsequent resurgence of seizures necessitating DBS treatment, the patient tragically succumbed to SUDEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In-depth analysis of the patient's electronic seizure diary, complemented by data from the sensing-enabled DBS, unveiled a terminal electrographic seizure. Notably, we observed a significant increase in power within specific frequency bands recorded from the thalamus preceding the terminal event. Furthermore, these heightened band power events displayed a discernible temporal clustering pattern, primarily manifesting during specific morning and evening hours. An autopsy conclusively confirmed the diagnosis of definite SUDEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>This unique case report underscores the feasibility of harnessing thalamic DBS sensing capabilities to monitor seizure burden and, potentially, to tailor interventions aimed at reducing seizure frequency and associated mortality risks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Axonal injury, sleep disturbances, and memory following traumatic brain injury 脑外伤后的轴突损伤、睡眠障碍和记忆。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-19 DOI: 10.1002/acn3.52145
Emma M. Tinney, Goretti España-Irla, Aaron E.L. Warren, Lauren N. Whitehurst, Alexandra M Stillman, Charles H. Hillman, Timothy P. Morris, for the Alzheimer's Disease Neuroimaging Initiative

Objectives

Traumatic brain injury (TBI) is associated with sleep deficits, but it is not clear why some report sleep disturbances and others do not. The objective of this study was to assess the associations between axonal injury, sleep, and memory in chronic and acute TBI.

Methods

Data were acquired from two independent datasets which included 156 older adult veterans (69.8 years) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) with prior moderate-to-severe TBIs and 90 (69.2 years) controls and 374 (39.6 years) from Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) with a recent mild TBI (mTBI) and 87 controls (39.6 years), all who completed an MRI, memory assessment, and sleep questionnaire.

Results

Older adults with a prior TBI had a significant association between axonal injury and sleep disturbances [β = 9.52, 95% CI (4.1, 14.9), p = 0.01]. Axonal injury predicted changes in memory over 1-year in TBI [β = −8.72, 95% CI (−18, −2.7), p = 0.03]. We externally validated those findings in TRACK-TBI where axonal injury within 2 weeks after mTBI was significantly associated with higher sleep disturbances in the TBI group at 2 weeks[β = −7.2, 95% CI (−14, −0.50), p = 0.04], 6 months [β = −16, 95% CI (−24, −7.6), p ≤ 0.01], and 12 months post-injury [β = −11, 95% CI (−19, −0.85), p = 0.03]. These associations were not significant in controls.

Interpretations

Axonal injury, specifically to the left anterior internal capsule is robustly associated with sleep disturbances in multiple TBI populations. Early assessment of axonal injury following mTBI could identify those at risk for persistent sleep disturbances following injury.

目的:创伤性脑损伤(TBI)与睡眠障碍有关,但目前尚不清楚为什么有些人报告有睡眠障碍,而有些人则没有。本研究旨在评估慢性和急性创伤性脑损伤中轴索损伤、睡眠和记忆之间的关联:数据来自两个独立的数据集,其中包括阿尔茨海默病神经影像学倡议(ADNI)的156名曾有中重度创伤性脑损伤的老年退伍军人(69.8岁)和90名对照组(69.2岁),以及TRACK-TBI研究与临床知识转化(TRACK-TBI)的374名曾有轻度创伤性脑损伤(mTBI)的老年退伍军人(39.6岁)和87名对照组(39.6岁),所有这些人都完成了核磁共振成像、记忆评估和睡眠问卷调查:曾有过创伤性脑损伤的老年人的轴突损伤与睡眠障碍之间存在显著关联[β = 9.52,95% CI (4.1, 14.9),p = 0.01]。轴突损伤可预测创伤性脑损伤患者一年内记忆力的变化[β = -8.72,95% CI (-18, -2.7),p = 0.03]。我们在 TRACK-TBI 中对这些发现进行了外部验证,结果表明,在 mTBI 后 2 周内发生的轴突损伤与 TBI 组在损伤后 2 周[β = -7.2,95% CI (-14,-0.50),p = 0.04]、6 个月[β = -16,95% CI (-24,-7.6),p ≤ 0.01]和 12 个月[β = -11,95% CI (-19,-0.85),p = 0.03]的睡眠障碍显著相关。这些关联在对照组中并不显著:轴突损伤,特别是左前内囊损伤与多种创伤性脑损伤人群的睡眠障碍密切相关。对mTBI后的轴突损伤进行早期评估,可识别出损伤后有持续睡眠障碍风险的人群。
{"title":"Axonal injury, sleep disturbances, and memory following traumatic brain injury","authors":"Emma M. Tinney,&nbsp;Goretti España-Irla,&nbsp;Aaron E.L. Warren,&nbsp;Lauren N. Whitehurst,&nbsp;Alexandra M Stillman,&nbsp;Charles H. Hillman,&nbsp;Timothy P. Morris,&nbsp;for the Alzheimer's Disease Neuroimaging Initiative","doi":"10.1002/acn3.52145","DOIUrl":"10.1002/acn3.52145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Traumatic brain injury (TBI) is associated with sleep deficits, but it is not clear why some report sleep disturbances and others do not. The objective of this study was to assess the associations between axonal injury, sleep, and memory in chronic and acute TBI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were acquired from two independent datasets which included 156 older adult veterans (69.8 years) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) with prior moderate-to-severe TBIs and 90 (69.2 years) controls and 374 (39.6 years) from Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) with a recent mild TBI (mTBI) and 87 controls (39.6 years), all who completed an MRI, memory assessment, and sleep questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Older adults with a prior TBI had a significant association between axonal injury and sleep disturbances [<i>β</i> = 9.52, 95% CI (4.1, 14.9), <i>p</i> = 0.01]. Axonal injury predicted changes in memory over 1-year in TBI [<i>β</i> = −8.72, 95% CI (−18, −2.7), <i>p</i> = 0.03]. We externally validated those findings in TRACK-TBI where axonal injury within 2 weeks after mTBI was significantly associated with higher sleep disturbances in the TBI group at 2 weeks[<i>β</i> = −7.2, 95% CI (−14, −0.50), <i>p</i> = 0.04], 6 months [<i>β</i> = −16, 95% CI (−24, −7.6), <i>p</i> ≤ 0.01], and 12 months post-injury [<i>β</i> = −11, 95% CI (−19, −0.85), <i>p</i> = 0.03]. These associations were not significant in controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretations</h3>\u0000 \u0000 <p>Axonal injury, specifically to the left anterior internal capsule is robustly associated with sleep disturbances in multiple TBI populations. Early assessment of axonal injury following mTBI could identify those at risk for persistent sleep disturbances following injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neutrophil-to-lymphocyte ratio and longitudinal cognitive performance in Parkinson's disease 帕金森病患者的中性粒细胞与淋巴细胞比率和纵向认知能力。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-19 DOI: 10.1002/acn3.52144
Jenniffer Lucero, Ashita Gurnani, Janice Weinberg, Ludy C Shih

Objective

Previous studies have suggested a link between peripheral inflammation and cognitive outcomes in the general population and individuals with Parkinson's disease (PD). We sought to test the association between peripheral inflammation, measured by the neutrophil-to-lymphocyte ratio (NLR), cognitive performance, and mild cognitive impairment (MCI) status in individuals with PD.

Methods

A retrospective, longitudinal analysis was carried out using data from the Parkinson's Progression Markers Initiative (PPMI), including 422 participants with PD followed over 5 years. Cognitive performance was assessed using a neuropsychological battery including the Montreal Cognitive Assessment (MoCA) and tests of verbal learning, visuospatial function, processing speed, and executive function. Mixed-effect regression models were used to analyze the association between NLR, cognitive performance, and MCI status, controlling for age, sex, education, APOE genotype, and motor severity.

Results

There was a negative association between NLR and MoCA, even after adjusting for covariates (b = −0.12, p = 0.033). MoCA scores for individuals in the high NLR category exhibited a more rapid decline over time compared to the low NLR group (b = −0.16, p = 0.012). Increased NLR was associated with decreased performance across all cognitive domains. However, NLR was not associated with MCI status over 5 years of follow-up.

Interpretation

This study demonstrates a link between elevated NLR and cognitive performance in PD, but not with MCI status over 5 years. This suggests that NLR is more strongly associated with day-to-day cognitive performance than with incident MCI, but this requires further study in more heterogeneous cohorts.

研究目的以往的研究表明,外周炎症与普通人群和帕金森病(PD)患者的认知结果之间存在联系。我们试图检验帕金森病患者外周炎症(通过中性粒细胞与淋巴细胞比值(NLR)测量)、认知能力和轻度认知障碍(MCI)状态之间的关联:我们利用帕金森病进展标志物倡议(PPMI)的数据进行了一项回顾性纵向分析,其中包括对422名帕金森病患者进行了为期5年的随访。认知能力的评估采用神经心理学测试,包括蒙特利尔认知评估(MoCA)以及言语学习、视觉空间功能、处理速度和执行功能测试。在控制年龄、性别、教育程度、APOE 基因型和运动严重程度的情况下,采用混合效应回归模型分析 NLR、认知能力和 MCI 状态之间的关系:结果:NLR与MoCA之间存在负相关,即使在调整了协变量后也是如此(b = -0.12,p = 0.033)。与低 NLR 组相比,高 NLR 组的 MoCA 分数随着时间的推移下降得更快(b = -0.16,p = 0.012)。NLR 增加与所有认知领域的表现下降有关。然而,在5年的随访中,NLR与MCI状态无关:这项研究表明,NLR升高与帕金森病患者的认知能力有关,但与5年后的MCI状态无关。这表明,NLR与日常认知表现的关系比与MCI事件的关系更密切,但这需要在更多异质性队列中进行进一步研究。
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引用次数: 0
Epidemiology of autoimmune encephalitis and comparison to infectious causes—Experience from a tertiary center 自身免疫性脑炎的流行病学及与感染性病因的比较--一家三级医疗中心的经验。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-19 DOI: 10.1002/acn3.52147
Yahel Segal, Ofer Rotschild, Yair Mina, Gadi Maayan Eshed, Tal Levinson, Yael Paran, Michal Dekel, Ronit Cohen-Poradosu, Adi Ashkenazi, Itamar Moreno, Orna Aizenstein, Ora Halutz, Yifat Alcalay, Avi Gadoth

Objectives

The incidence of autoimmune encephalitis (AIE) has risen in the last decade, yet recent studies are lacking. We compared the epidemiology of autoimmune and infectious encephalitis cases in Tel-Aviv Sourasky Medical Center (TASMC) between 2010 and 2020.

Methods

All encephalitis cases, aged 18 and above, admitted to TASMC between the years 2010 and 2020 were reviewed for demographic, clinical, laboratory, and imaging data and categorized based on etiology.

Results

Two hundred and twenty-five patients with encephalitis were identified. The most common identifiable cause was viral (42%), followed by autoimmune encephalitis (35%), bacterial (18%), and fungal/parasitic (5%). The incidence of AIE cases out of the yearly admitted cases increased substantially, from 3.8/100 K in 2010 to 18.8/100 K in 2020. The incidence of viral cases also increased while those of bacterial and fungal/parasitic infections remained stable. Patients with AIE were younger compared to infectious patients (p-value <0.001) and had lower markers of systemic and cerebrospinal fluid inflammation (p-value for all <0.001). Seizures were more common among AIE patients (p-value <0.001), yet one-year mortality rates were higher among infectious patients (p-value <0.001).

Interpretation

AIE incidence has risen significantly in our institution during the past decade, with current rates comparable to those of all infectious causes combined. Based on this cohort, clinical clues for an autoimmune etiology include a non-inflammatory cerebrospinal fluid profile, the presence of seizures, and temporal lobe imaging abnormalities (also common in herpetic encephalitis). In light of its rising incidence and the importance of early treatment, AIE should be considered in the differential diagnosis of all encephalitis cases.

目的:在过去十年中,自身免疫性脑炎(AIE)的发病率有所上升,但近期却缺乏相关研究。我们比较了特拉维夫苏拉斯基医疗中心(TASMC)2010 年至 2020 年间自身免疫性脑炎和传染性脑炎病例的流行病学情况:对特拉维夫苏拉斯基医疗中心 2010 年至 2020 年期间收治的所有 18 岁及以上脑炎病例进行人口统计学、临床、实验室和影像学数据审查,并根据病因进行分类:结果:共发现 225 名脑炎患者。最常见的病因是病毒性脑炎(42%),其次是自身免疫性脑炎(35%)、细菌性脑炎(18%)和真菌/寄生虫性脑炎(5%)。在每年的入院病例中,自身免疫性脑炎的发病率大幅上升,从 2010 年的 3.8/100 K 增至 2020 年的 18.8/100 K。病毒感染的发病率也有所上升,而细菌和真菌/寄生虫感染的发病率则保持稳定。与感染性患者相比,AIE 患者更年轻(P 值 解释:AIE 的发病率从 2010 年的每 100 千人上升到 2020 年的每 100 千人 18.8 人:过去十年间,我院的AIE发病率大幅上升,目前的发病率与所有感染性病因的发病率总和相当。根据该队列,自身免疫性病因的临床线索包括非炎症性脑脊液特征、癫痫发作和颞叶影像学异常(也常见于疱疹性脑炎)。鉴于其发病率不断上升以及早期治疗的重要性,在所有脑炎病例的鉴别诊断中都应考虑到自身免疫性脑炎。
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引用次数: 0
CSF biomarkers of neurotoxicity in childhood cancer survivors after cranial radiotherapy or surgery 颅脑放疗或手术后儿童癌症幸存者神经毒性的 CSF 生物标志物。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-19 DOI: 10.1002/acn3.52152
Erik Fernström, Marianne Jarfelt, Malin Blomstrand, Birgitta Lannering, Markus Axelsson, Pontus Wasling, Thomas Björk-Eriksson, Henrik Zetterberg, Marie Kalm

Objective

Treatment of pediatric brain tumors is associated with potential long-term cognitive sequelae. Patients treated with craniospinal irradiation for posterior fossa tumors are at high risk. New biomarkers that could help to differentiate treatment effects from other causes of cognitive dysfunction would be valuable in tailoring optimal survivorship care. Biomarkers that reflect biological mechanisms behind treatment-associated cognitive decline would also be important in the evaluation of future treatment regimens for pediatric brain or skull base tumors.

Methods

In this biomarker-finding study, 10 adult survivors of pediatric medulloblastoma, skull base tumors, and posterior fossa low-grade glioma underwent study specific lumbar puncture at a minimum of 17 years following treatment. We analyzed cerebrospinal fluid biomarkers reflecting neuron and astrocyte integrity, amyloid metabolism, inflammation, extracellular matrix, synaptic integrity, and blood–brain barrier function. The values were compared with biomarker levels in healthy controls of comparable age.

Results

Biomarkers reflecting neuronal injury (neurofilament light chain protein), astrocyte injury or activation (glial fibrillary acidic protein) as well as inflammation (YKL-40) were significantly elevated in cancer survivors compared to controls. Biomarkers reflecting amyloid metabolism showed a pattern of decrease in patients treated for medulloblastoma.

Interpretation

The results suggest a potential chronic low-grade neurodegeneration and astrocyte activation in patients treated for pediatric brain or skull base tumors. Protein biomarkers of CNS disease could potentially be used to increase our understanding of the contribution from different tumor treatments with regard to long-term symptoms in cancer patients.

目的:小儿脑肿瘤的治疗与潜在的长期认知后遗症有关。接受颅骨照射治疗后窝肿瘤的患者是高危人群。新的生物标志物可帮助区分治疗效果和认知功能障碍的其他原因,这对定制最佳的生存护理非常有价值。反映治疗相关认知功能下降背后生物机制的生物标志物对于评估未来小儿脑肿瘤或颅底肿瘤的治疗方案也很重要:在这项寻找生物标志物的研究中,10 名小儿髓母细胞瘤、颅底肿瘤和后窝低级别胶质瘤的成年幸存者在治疗后至少 17 年接受了特定的腰椎穿刺研究。我们分析了反映神经元和星形胶质细胞完整性、淀粉样蛋白代谢、炎症、细胞外基质、突触完整性和血脑屏障功能的脑脊液生物标志物。结果显示:反映神经元损伤的生物标志物水平与年龄相当的健康对照组的生物标志物水平进行了比较:结果:与对照组相比,癌症幸存者体内反映神经元损伤(神经丝蛋白轻链)、星形胶质细胞损伤或激活(胶质纤维酸性蛋白)以及炎症(YKL-40)的生物标志物明显升高。反映淀粉样蛋白代谢的生物标志物在接受髓母细胞瘤治疗的患者中呈下降趋势:结果表明,接受小儿脑肿瘤或颅底肿瘤治疗的患者可能会出现慢性低度神经变性和星形胶质细胞活化。中枢神经系统疾病的蛋白质生物标志物可用于加深我们对不同肿瘤治疗对癌症患者长期症状的影响的了解。
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引用次数: 0
期刊
Annals of Clinical and Translational Neurology
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