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Mechanical Thrombectomy for All LVO – Is It Feasible? – Recent Evidence to Expand the Current Stroke Guidelines 机械血栓切除术治疗所有 LVO - 可行吗?- 扩展现行卒中指南的最新证据
Pub Date : 2024-01-30 DOI: 10.33696/neurol.5.084
Jindong Xu, Cortney de la Torre, Devon Shafer, Margely Carrion-Carrero, Pramod Sethi
Mechanical thrombectomy (MT) has established its role as a standard care of acute ischemic stroke due to large vessel occlusion (LVO). Current early stroke management guidelines have defined certain selection criteria for LVO patients undergoing MT to achieve the most benefit. However, it is still uncertain if some other LVO patients who do not meet these criteria can also benefit from MT. In this review, we research the latest evidence on efficacy and safety of MT for LVO in various unique stroke populations, such as advanced age, pre-stroke disability, LVO with minor stroke, large infarct volume, poor mismatch profile, very late time window, posterior circulation LVO and distal medium-sized vessel occlusions. By comparing the benefits and risks of MT with best medical management only, we may develop further subgroup-specific criteria to expand our capacity to best treat these unique LVO populations.
机械取栓术(MT)已成为大血管闭塞(LVO)所致急性缺血性卒中的标准治疗方法。目前的早期卒中治疗指南已为接受机械取栓术的 LVO 患者确定了一定的选择标准,以获得最大疗效。然而,目前仍不确定其他一些不符合这些标准的 LVO 患者是否也能从 MT 中获益。在这篇综述中,我们研究了在各种特殊卒中人群中 MT 治疗 LVO 的疗效和安全性的最新证据,这些人群包括高龄、卒中前残疾、LVO 伴轻微卒中、大梗死体积、不匹配特征、极晚期时间窗、后循环 LVO 和远端中型血管闭塞。通过比较 MT 与最佳医疗管理的益处和风险,我们可以制定进一步的亚组特异性标准,以提高我们对这些独特 LVO 患者进行最佳治疗的能力。
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引用次数: 0
Could Neonatal Electroclinical Syndromes Orchestrate Diagnosis and Treatment? 新生儿临床电综合征能否协调诊断和治疗?
Pub Date : 2024-01-30 DOI: 10.33696/neurol.5.083
Rene Andrade Machado
Introduction: Neonatal seizures are associated with neurodevelopmental impairments. Implementing long-term video-EEG monitoring in the neonatal intensive care unit became the gold standard for seizure diagnosis. During the neonatal period, seizures can be associated with an acute brain insult called acute symptomatic seizures (ASS) or being part of neonatal epilepsy that may have a structural, metabolic, or genetic cause. This distinction impacts patient workup and management. Objectives: To facilitate a guide to differentiate ASS from neonatal epilepsy, and to correlate different electroclinical seizure patterns with a specific etiology. Methods: A narrative review was performed. MEDLINE, Embase, and PubMed were used to gather data for this narrative review. The following keywords were applied to focus on original research and case reports: epileptic encephalopathy, developmental Epileptic encephalopathy and neonatal seizures, neonatal genetic encephalopathies, Otahara syndrome, neonatal channelopathies, and neonatal seizure classification. Conclusions: Strict electroclinical semiology is the backbone for diagnosing neonatal seizures. The EEG and ictal semiology help with the diagnosis and the treatment. The neonatal seizure classification should be expanded to include the EEG pattern. Lumping them in a better classificatory system will prevent unnecessary and hazardous medication.
简介新生儿癫痫发作与神经发育障碍有关。在新生儿重症监护室实施长期视频脑电图监测已成为癫痫发作诊断的金标准。在新生儿期,癫痫发作可能与急性脑损伤有关,称为急性症状性癫痫发作(ASS),也可能是结构性、代谢性或遗传性原因导致的新生儿癫痫的一部分。这种区别会影响患者的治疗和管理。目标:为区分 ASS 和新生儿癫痫提供指南,并将不同的电临床发作模式与特定病因联系起来。方法进行叙述性综述。使用 MEDLINE、Embase 和 PubMed 收集数据进行叙述性综述。应用了以下关键词来关注原始研究和病例报告:癫痫性脑病、发育性癫痫性脑病和新生儿癫痫发作、新生儿遗传性脑病、小田原综合征、新生儿通道病和新生儿癫痫发作分类。结论严格的电临床半定量分析是诊断新生儿癫痫发作的基础。脑电图和发作性半身像有助于诊断和治疗。新生儿癫痫发作分类应扩展至包括脑电图模式。将它们归入一个更好的分类系统可避免不必要的危险用药。
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引用次数: 0
Definition and Characteristics of Multiple Sclerosis with Predominant Cognitive Presentation 以认知为主要表现的多发性硬化症的定义和特征
Pub Date : 2024-01-30 DOI: 10.33696/neurol.5.086
Amanda Fiori Cavassani, Álix Djone Berté, Andressa Ribeiro Pinto, Marcus Vinicius Magno Gonçalves, Gabriel de Deus Vieira
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引用次数: 0
Diagnosis and Treatment of Normal Pressure Hydrocephalus and Repeated Subdural Hematoma and Effusion after Ventriculoperitoneal Shunt in the Elderly: A Case Report 老年人脑室腹腔分流术后正常压力脑积水和反复硬膜下血肿及渗出的诊断与治疗:病例报告
Pub Date : 2024-01-30 DOI: 10.33696/neurol.5.085
Qing-Yong Wang, Qingjun Li
Idiopathic normal pressure hydrocephalus (iNPH) is a special type of hydrocephalus that is characterized by cognitive decline, gait disturbance, and urinary incontinence. It can lead to dementia and bedridden within 1-3 years. Without surgical treatment in time, the prognosis was bleak. We report an iNPH case misdiagnosed with Alzheimer’s disease, with a disease course of 3 years. The main manifestations of the patient were walking impairment, memory loss, urinary incontinence, repeated falls, and hallucinations, bedridden in the late stage, with a modified Rankin Scale (mRS):5. After undergoing the ventriculoperitoneal shunt, due to the low shunt pressure, the patient developed severe headache, repeated and severe subdural hemorrhage and effusion. After adjusting the shunt pressure in time, the patient recovered well with an mRS: 3, which was inconsistent with the previous belief that the operation was ineffective for patients with a disease course of more than 3 years. This case suggests that elderly patients with iNPH can still benefit from timely surgery even if the disease course of more than 3 years. Special attention should be paid after the operation, and the CSF shunt pressure should avoid setting too low, which may induce serious complications such as subdural hemorrhage or effusion.
特发性正常压力脑积水(iNPH)是一种特殊类型的脑积水,其特点是认知能力下降、步态障碍和尿失禁。它可导致痴呆,并在 1-3 年内卧床不起。如果不及时进行手术治疗,预后很不乐观。我们报告了一例被误诊为阿尔茨海默病的 iNPH 病例,病程 3 年。患者的主要表现为行走障碍、记忆力减退、尿失禁、反复跌倒和幻觉,晚期卧床不起,改良Rankin量表(mRS)为5。接受脑室腹腔分流术后,由于分流压力过低,患者出现剧烈头痛、反复严重硬膜下出血和渗出。在及时调整分流压力后,患者恢复良好,mRS:3,这与以往认为病程超过 3 年的患者手术无效的观点不符。本病例提示,即使病程超过 3 年,老年 iNPH 患者仍可从及时手术中获益。术后应特别注意,避免将 CSF 分流压力调得过低,以免诱发硬膜下出血或积液等严重并发症。
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引用次数: 0
A Case Report of Rheumatoid Meningitis – A Rare Condition Presenting with Neurological Deficits 类风湿性脑膜炎病例报告--一种表现为神经功能缺损的罕见疾病
Pub Date : 2024-01-10 DOI: 10.33696/neurol.4.081
Arun Swaminathan, Arvind Ramesh
Rheumatoid meningitis (RM) is a rare condition seen in patients with longstanding rheumatoid arthritis (RA). It can present with a variety of neurological symptoms and is often mistaken for other neurological conditions, especially in the setting of immune suppression in these patients. We present a rare case of RM in an elderly woman with RA that presented with focal neurological symptoms and was eventually diagnosed on brain biopsy. Our case serves to highlight the diagnostic dilemmas faced while evaluating and treating patients presenting with such an exceedingly rare condition and the importance of multidisciplinary collaboration in the management of such complex patients.
类风湿性脑膜炎(RM)是一种罕见的疾病,多见于长期患有类风湿性关节炎(RA)的患者。它可表现为多种神经系统症状,常被误诊为其他神经系统疾病,尤其是在这些患者免疫抑制的情况下。我们介绍了一例罕见的RM病例,患者是一名患有RA的老年女性,表现为局灶性神经症状,最终通过脑活检确诊。我们的病例强调了在评估和治疗这种极为罕见的疾病患者时所面临的诊断困境,以及多学科合作在治疗这类复杂患者时的重要性。
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引用次数: 0
CCR3 Expression in Relation to Delayed Microbleeds in a Rat Model of Large Vessel Occlusion. 大血管闭塞大鼠模型中 CCR3 表达与延迟性微出血的关系
Pub Date : 2024-01-01 DOI: 10.33696/neurol.5.082
Sydney M Claypoole, Jacqueline A Frank, Sarah J Messmer, Keith R Pennypacker

Thirty percent of ischemic stroke patients develop vascular cognitive impairment and dementia (VCID) within 1 year of stroke onset. The expression of C-C motif chemokine receptor 3 (CCR3) is associated with endothelial dysfunction and memory impairment. CCR3 has been reported to increase after experimental stroke and in human stroke patients. Using an in vivo model of stroke, our study aims to link CCR3 expression with endothelial dysfunction in this rodent stroke model.

Methods: 5-hour transient Middle Cerebral Artery Occlusion (5t-MCAO) or sham surgery was performed on rats and tissue collected at 3- and 30-days post-stroke. We measured the change in expression of CCR3 and its ligands in the venous blood before and after occlusion in the rat model.Immunohistochemistry was performed on consecutive coronal brain sections using Prussian blue to visualize microbleeds and DAB to visualize CCR3. Images were quantified using HALO.

Results: Using linear regression, we found that increased expression of CCR3 and its ligands after stroke were positively correlated with infarct volume. CCR3 expression was significantly increased in the ipsilateral hemisphere at 30 days post 5t-MCAO. Prussian blue staining was significantly increased in ipsilateral sections at 30 days post-stroke. Immunostaining for CCR3 was primarily detected in endothelium in areas of Prussian blue staining.

Conclusions: Our results demonstrate that CCR3 expression is associated with the presence of microbleeds at 30 days but not 3 days post-stroke in the ipsilateral hemisphere, and further supports the link between CCR3 and the endothelial dysfunction that is associated with VCID. CCR3 and its inflammatory pathway is a potential target for reducing endothelial dysfunction after ischemic stroke that may lead to VCID.

30%的缺血性中风患者会在中风发生后一年内出现血管性认知障碍和痴呆(VCID)。C-C motif趋化因子受体 3(CCR3)的表达与内皮功能障碍和记忆损伤有关。据报道,实验性中风后和人类中风患者体内的 CCR3 会增加。方法:对大鼠进行 5 小时瞬时大脑中动脉闭塞(5t-MCAO)或假手术,并在中风后 3 天和 30 天收集组织。我们测量了大鼠模型闭塞前后静脉血中 CCR3 及其配体的表达变化。在连续的冠状脑切片上进行免疫组化,用普鲁士蓝观察微出血,用 DAB 观察 CCR3。使用 HALO 对图像进行量化:结果:通过线性回归,我们发现脑卒中后 CCR3 及其配体表达的增加与梗死体积呈正相关。5t-MCAO 后 30 天,同侧半球的 CCR3 表达明显增加。卒中后30天,同侧切片的普鲁士蓝染色明显增加。CCR3的免疫染色主要在普鲁士蓝染色区域的血管内皮中检测到:我们的研究结果表明,CCR3 的表达与卒中后 30 天出现的微出血有关,但与同侧半球卒中后 3 天出现的微出血无关,这进一步证实了 CCR3 与 VCID 相关的内皮功能障碍之间的联系。CCR3 及其炎症通路是减少缺血性卒中后可能导致 VCID 的内皮功能障碍的潜在靶点。
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引用次数: 0
Cerebrovascular Dysfunction in Alzheimer's Disease and Transgenic Rodent Models. 阿尔茨海默病和转基因啮齿动物模型中的脑血管功能障碍
Pub Date : 2024-01-01 DOI: 10.33696/neurol.5.087
Xing Fang, Fan Fan, Jane J Border, Richard J Roman

Alzheimer's Disease (AD) and Alzheimer's Disease-Related Dementia (ADRD) are the primary causes of dementia that has a devastating effect on the quality of life and is a tremendous economic burden on the healthcare system. The accumulation of extracellular beta-amyloid (Aβ) plaques and intracellular hyperphosphorylated tau-containing neurofibrillary tangles (NFTs) in the brain are the hallmarks of AD. They are also thought to be the underlying cause of inflammation, neurodegeneration, brain atrophy, and cognitive impairments that accompany AD. The discovery of APP, PS1, and PS2 mutations that increase Aβ production in families with early onset familial AD led to the development of numerous transgenic rodent models of AD. These models have provided new insight into the role of Aβ in AD; however, they do not fully replicate AD pathology in patients. Familial AD patients with mutations that elevate the production of Aβ represent only a small fraction of dementia patients. In contrast, those with late-onset sporadic AD constitute the majority of cases. This observation, along with the failure of previous clinical trials targeting Aβ or Tau and the modest success of recent trials using Aβ monoclonal antibodies, has led to a reappraisal of the view that Aβ accumulation is the sole factor in the pathogenesis of AD. More recent studies have established that cerebral vascular dysfunction is one of the earliest changes seen in AD, and 67% of the candidate genes linked to AD are expressed in the cerebral vasculature. Thus, there is an increasing appreciation of the vascular contribution to AD, and the National Institute on Aging (NIA) and the Alzheimer's Disease Foundation recently prioritized it as a focused research area. This review summarizes the strengths and limitations of the most commonly used transgenic AD animal models and current views about the contribution of Aβ accumulation versus cerebrovascular dysfunction in the pathogenesis of AD.

阿尔茨海默病(AD)和阿尔茨海默病相关性痴呆(ADRD)是痴呆症的主要病因,对患者的生活质量造成毁灭性影响,也给医疗系统带来巨大的经济负担。细胞外β-淀粉样蛋白(Aβ)斑块和细胞内含神经纤维缠结(NFT)的高磷酸化tau在大脑中的积累是老年痴呆症的特征。它们也被认为是导致炎症、神经变性、脑萎缩和认知障碍的根本原因。在早发性家族性注意力缺失症家族中,APP、PS1 和 PS2 基因突变会增加 Aβ 的产生,这一发现促进了大量注意力缺失症转基因啮齿动物模型的开发。这些模型为了解 Aβ 在注意力缺失症中的作用提供了新的视角;然而,它们并不能完全复制患者的注意力缺失症病理。在痴呆症患者中,因突变导致 Aβ 生成增加的家族性 AD 患者只占一小部分。相比之下,晚发型散发性注意力缺失症患者占大多数。这一观察结果,加上以前针对 Aβ 或 Tau 的临床试验的失败,以及最近使用 Aβ 单克隆抗体的试验取得的些许成功,促使人们重新评估 Aβ 积累是 AD 发病机制中唯一因素的观点。最近的研究证实,脑血管功能障碍是注意力缺失症最早出现的变化之一,与注意力缺失症相关的候选基因中有 67% 在脑血管中表达。因此,人们越来越重视血管对阿兹海默症的影响,美国国家老龄化研究所(NIA)和阿兹海默症基金会最近将其列为重点研究领域。本综述总结了最常用的转基因AD动物模型的优势和局限性,以及目前关于Aβ积累和脑血管功能障碍在AD发病机制中的作用的观点。
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引用次数: 0
Protein Citrullination in Amyotrophic Lateral Sclerosis and Other Neurodegenerative Diseases. 肌萎缩性侧索硬化症和其他神经退行性疾病的瓜氨酸化蛋白。
Pub Date : 2024-01-01 DOI: 10.33696/neurol.5.101
Issa O Yusuf, Webb Camille, Paul R Thompson, Zuoshang Xu

Protein citrullination (PC) is a posttranslational modification (PTM) that converts a peptidyl arginine into a peptidyl citrulline. Aberrant PC is a hallmark of neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS), Alzheimer's disease, Parkinson's disease, prion disease, and multiple sclerosis. Common among these diseases is a dramatic increase of PC in reactive astrocytes. Some citrullinated proteins have been identified. The most prominent are astrocytic cytoskeletal proteins such as GFAP and vimentin, and myelin protein MBP. Recent investigation in ALS has revealed new changes, including a decreased PC in neurons and an association of PC with myelin protein aggregates. These findings suggest that PC contributes to protein aggregation, neuronal dysfunction, neuroinflammation, and axonal degeneration. However, how PC impact neurodegeneration remains to be understood. Further studies are needed to understand a range of questions, from how PC modulates individual protein functions to its impact on diseases. Because of the PC's robust changes in neurodegenerative diseases, there are also prospects that this PTM may be harnessed as biomarkers, and modulation of this PTM may be an avenue for therapy. In this review, we summarize the current understanding of PC in ALS and other neurodegenerative diseases, the investigative methods for PC, and PC's potential as a biomarker and a therapeutic target.

蛋白瓜氨酸化是将肽基精氨酸转化为肽基瓜氨酸的翻译后修饰(PTM)。异常PC是神经退行性疾病的标志,包括肌萎缩性侧索硬化症(ALS)、阿尔茨海默病、帕金森病、朊病毒病和多发性硬化症。在这些疾病中常见的是反应性星形胶质细胞中PC的急剧增加。已经鉴定出一些瓜氨酸化蛋白。最突出的是星形细胞骨架蛋白,如GFAP和vimentin,以及髓磷脂蛋白MBP。最近对ALS的研究揭示了新的变化,包括神经元中PC的减少和PC与髓鞘蛋白聚集的关联。这些发现表明,PC有助于蛋白质聚集、神经元功能障碍、神经炎症和轴突变性。然而,PC如何影响神经退行性变仍有待了解。需要进一步的研究来了解一系列问题,从PC如何调节个体蛋白质功能到其对疾病的影响。由于PTM在神经退行性疾病中的强大变化,PTM也有可能被利用为生物标志物,并且调节PTM可能是治疗的途径。在这篇综述中,我们总结了目前对肌萎缩侧索硬化症和其他神经退行性疾病中PC的认识,PC的研究方法,以及PC作为生物标志物和治疗靶点的潜力。
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引用次数: 0
Association of Conformationally Altered Tau with α-1-antichymotrypsin in the Nuclei of Neurons in the Alzheimer's Disease Brain 阿尔茨海默病大脑神经元细胞核中构象改变的 Tau 与 α-1-antichymotrypsin 的关系
Pub Date : 2023-11-24 DOI: 10.33696/neurol.4.080
Perla H. Horta-López, Jan Rícny, B. Florán-Garduño, F. García-Sierra
Conformational changes of Tau have been described to occur during its fibrillary and non-fibrillary aggregation inside neurons affected in the brain of Alzheimer’s disease (AD) patients. Two consecutive conformations have been described during the progression of the disease: an early conformation detected with the Alz-50 antibody, recognizing Tau molecules folding its amino terminus over its third repeated domain, and a later conformation involving the bending of the proline-rich region over the third repeated domain. α-1-antichymotrypsin (ACT) is an acute phase serum glycoprotein that is overexpressed in the brain of AD cases and associated with extracellular amyloid-ß aggregates. We have recently reported that in a large population of neurons affected in AD brains, Tau protein undergoing the conformational change detected by Tau-66 antibody accumulates as non-fibrillary aggregates and colocalizes with extensive accumulations of granular diffuse intracellular deposits of ACT. In this report, we further analyzed Tau-ACT interactions in the neurons from the hippocampus of AD brains. By using superresolution confocal microscopy and quantitative colocalization analysis, we corroborated the mutual association and mislocalization of conformationally altered Tau protein and ACT to the nuclear compartment. These results suggest that ACT can play an abnormal pathological role in AD by contributing to the abnormal transport of truncated and conformationally altered Tau protein to the nucleus.
据描述,在阿尔茨海默病(AD)患者大脑中受影响的神经元内,Tau的纤维状和非纤维状聚集过程中会发生构象变化。在疾病进展过程中出现了两种连续的构象:一种是用 Alz-50 抗体检测到的早期构象,即 Tau 分子将其氨基末端折叠到第三重复结构域上;另一种是涉及富脯氨酸区弯曲到第三重复结构域上的后期构象。α-1-antichymotrypsin(ACT)是一种急性期血清糖蛋白,在 AD 病例的大脑中过度表达,并与细胞外淀粉样蛋白-ß聚集相关。我们最近报告说,在大量受影响的AD脑神经元中,Tau-66抗体检测到的构象变化的Tau蛋白以非纤维状聚集体形式聚集,并与ACT的颗粒状弥漫性细胞内沉积物广泛聚集在一起。在本报告中,我们进一步分析了 AD 大脑海马区神经元中 Tau-ACT 的相互作用。通过使用超分辨率共聚焦显微镜和定量共聚焦分析,我们证实了构象改变的Tau蛋白和ACT相互关联并错位到核区。这些结果表明,ACT可通过促进截短的构象改变Tau蛋白向细胞核的异常转运,在AD中发挥异常病理作用。
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引用次数: 0
Change in Prevalence of Meningitis among Children with Febrile Seizure after the Pentavalent Vaccination 五价疫苗接种后发热性惊厥儿童脑膜炎患病率的变化
Pub Date : 2023-11-14 DOI: 10.33696/neurol.4.079
Shadi Shiva, Shokoufeh Khanzadeh, Vahid Shohanizad, Arshin Ghaedi, Brandon Lucke-Wold
Introduction: One of the most significant current discussions in pediatrics is whether lumbar puncture (LP) should be performed in children with febrile seizure (FS) as in the past. Objectives: We compared the prevalence of meningitis among FS children before and after the pentavalent vaccine to determine the importance of the LP in these children. Methods: We performed a retrospective cross-sectional study on the prevalence and etiology of bacterial meningitis (BM) in 1314 children with FS before and after pentavalent vaccination. Results: We found that complex FS was more prevalent in patients aged under 12 months compared to other patients. The peak incidence of aseptic meningitis and BM was in the age group of 12- to18- and 18- to 36-month-old, respectively (P value <0.001 and <0.05, respectively). Children with complex FS had a significantly higher rate of BM and a lower rate of seizure recurrence than those with simple FS (P value <0.05). There was a significant relationship between getting the pentavalent vaccine and reducing the prevalence of BM and Hib-induced BM, but no SP-induced BM (P value <0.05 and 0.05 and 0.104, respectively). Conclusion: This study offers some insights into the effectiveness of the pentavalent vaccine. In addition, the low prevalence of BM in vaccinated FS cases does not support strong recommendations for LP in FS children.
导读:目前儿科最重要的讨论之一是腰椎穿刺(LP)是否应该像过去一样在儿童热性惊厥(FS)中进行。目的:我们比较了五价疫苗接种前后FS儿童脑膜炎的患病率,以确定LP在这些儿童中的重要性。方法:我们对1314例FS患儿在五价疫苗接种前后的细菌性脑膜炎(BM)患病率和病因进行了回顾性横断面研究。结果:我们发现,与其他患者相比,复杂性FS在12个月以下的患者中更为普遍。无菌性脑膜炎和脑脊髓炎的发病率高峰分别出现在12 ~ 18月龄和18 ~ 36月龄年龄组(P值分别为0.001和0.05)。复合FS患儿脑梗死率显著高于单纯FS患儿,癫痫复发率显著低于单纯FS患儿(P值<0.05)。接种五价疫苗与降低乙型脑脊髓炎和hib诱导的乙型脑脊髓炎患病率有显著相关性,而sp诱导的乙型脑脊髓炎患病率无显著相关性(P值分别为0.05、0.05和0.104)。结论:本研究对五价疫苗的有效性提供了一些见解。此外,接种过疫苗的FS病例中BM的低患病率并不支持对FS儿童进行LP的强烈建议。
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引用次数: 0
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Journal of experimental neurology
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