Porto biomedical journal最新文献

英文中文

Tackling antimicrobial resistance in Africa, adopting lessons from Africa's success in navigating the COVID-19 pandemic. 应对非洲的抗微生物药物耐药性，借鉴非洲成功应对COVID-19大流行的经验教训。

Porto biomedical journal

Pub Date : 2023-03-01 DOI: 10.1097/j.pbj.0000000000000206

Habeeb Salami

Antimicrobial resistance (AMR) is a global health problem. Antibiotics that were once very efficient in treating bacterial infections are now inactive. When antibiotics were discovered about, we believed the battle against infectious diseases has been won but the age of antibiotics, spanning only 80 years, is now entering a period of progressive and widespread emergence of drugresistant organisms that threaten to bring this era to an end. The problem of AMR is serious because bacteria are almost resistant to all available classes of antibiotics, and a new pipeline of antibiotics is not produced. Although AMR is a natural phenomenon, we are responsible for accelerating it. The increased and unguided use of antibiotics across multiple sectors, that is, humans, animals, and agriculture, has further exacerbated this problem. When microorganisms are facedwith antibiotics selection pressure, they enhance their fitness by acquiring resistance determinants through mechanisms such as horizontal gene transfer (transduction, conjugation, and transformation) and then sharing them with other bacteria and by other mechanisms, for example, gene overexpression and silencing and phase variation. The effect of AMR in Africa could be catastrophic because of the poor health systems and infrastructure, inadequate surveillance of infectious diseases, and the inadequate health personnel, which is motivated partly by the mass exodus of health practitioners from Africa to foreign continents to seek greener pastures. The higher burden of AMR in low-resource health systems highlights the importance—both for themanagement of individual patients and for the surveillance of AMR—of welldeveloped national action plans and laboratory infrastructure in all African regions and countries. Surprisingly,Africawas one of the least affected continents indirect morbidity, mortality, and absolute cumulative cases of COVID-19. This is because most countries in Africa reacted quickly and imposed tough restrictions such as banning local and international travel, closing industries, schools and universities, banning public transportation, and restricting healthcare to emergency mode. Some of these countries in Africa adopted guidance from the WHO, stratifying their COVID-19 public health responses into several pillars, including surveillance, case management, infection prevention and control, ports of entry, logistics, security, risk communication and community engagement, and laboratory. Taking a cue fromhowAfrica handled theCOVID-19 pandemic, AMR can also be tackled effectively by adopting the strategies used in combating the COVID-19 pandemic. The report byMurray et al estimated that Africa had the highest number of deaths attributable to AMR infections, that is, 27.3 deaths per 100,000 compared with other continents, and surprisingly, Africa had a lower number of COVID-19 deaths. If the strategies such as surveillance, infection prevention, community engagement, collaborative research an

{"title":"Tackling antimicrobial resistance in Africa, adopting lessons from Africa's success in navigating the COVID-19 pandemic.","authors":"Habeeb Salami","doi":"10.1097/j.pbj.0000000000000206","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000206","url":null,"abstract":"Antimicrobial resistance (AMR) is a global health problem. Antibiotics that were once very efficient in treating bacterial infections are now inactive. When antibiotics were discovered about, we believed the battle against infectious diseases has been won but the age of antibiotics, spanning only 80 years, is now entering a period of progressive and widespread emergence of drugresistant organisms that threaten to bring this era to an end. The problem of AMR is serious because bacteria are almost resistant to all available classes of antibiotics, and a new pipeline of antibiotics is not produced. Although AMR is a natural phenomenon, we are responsible for accelerating it. The increased and unguided use of antibiotics across multiple sectors, that is, humans, animals, and agriculture, has further exacerbated this problem. When microorganisms are facedwith antibiotics selection pressure, they enhance their fitness by acquiring resistance determinants through mechanisms such as horizontal gene transfer (transduction, conjugation, and transformation) and then sharing them with other bacteria and by other mechanisms, for example, gene overexpression and silencing and phase variation. The effect of AMR in Africa could be catastrophic because of the poor health systems and infrastructure, inadequate surveillance of infectious diseases, and the inadequate health personnel, which is motivated partly by the mass exodus of health practitioners from Africa to foreign continents to seek greener pastures. The higher burden of AMR in low-resource health systems highlights the importance—both for themanagement of individual patients and for the surveillance of AMR—of welldeveloped national action plans and laboratory infrastructure in all African regions and countries. Surprisingly,Africawas one of the least affected continents indirect morbidity, mortality, and absolute cumulative cases of COVID-19. This is because most countries in Africa reacted quickly and imposed tough restrictions such as banning local and international travel, closing industries, schools and universities, banning public transportation, and restricting healthcare to emergency mode. Some of these countries in Africa adopted guidance from the WHO, stratifying their COVID-19 public health responses into several pillars, including surveillance, case management, infection prevention and control, ports of entry, logistics, security, risk communication and community engagement, and laboratory. Taking a cue fromhowAfrica handled theCOVID-19 pandemic, AMR can also be tackled effectively by adopting the strategies used in combating the COVID-19 pandemic. The report byMurray et al estimated that Africa had the highest number of deaths attributable to AMR infections, that is, 27.3 deaths per 100,000 compared with other continents, and surprisingly, Africa had a lower number of COVID-19 deaths. If the strategies such as surveillance, infection prevention, community engagement, collaborative research an","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 2","pages":"e206"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/73/pj9-8-e206.PMC10158896.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9485686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Epipericardial fat necrosis: a case report of an underdiagnosed disease. 心包外脂肪坏死:一例未确诊的疾病。

Porto biomedical journal

Pub Date : 2023-03-01 DOI: 10.1097/j.pbj.0000000000000205

Mariana L Matos, Paula C F Matias, Carlos M S P M Grijó, Rita B Gouveia, Marta F S Patacho, António J S Almeida

Introduction Epipericardial fat necrosis (EFN), first described in 1957, is an inflammatory process that affects the epipericardial fat. It is a benign and self-limited cause of acute chest pain. Chest computed tomography (CT) is the preferred imaging method to diagnose this condition. Its noninvasive treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) leads to the resolution of the symptoms. This case report illustrates the clinical presentation of this disease.

引用次数: 0

Marked PR interval variability in a patient with Brugada syndrome. Brugada综合征患者PR间期明显变异性。

Porto biomedical journal

Pub Date : 2023-03-01 DOI: 10.1097/j.pbj.0000000000000209

Miguel Martins de Carvalho, Ricardo Alves Pinto, Tânia Proença, Delfim Souteiro, Luís Adão, Filipe Macedo, Manuel Campelo

The authors present a clinical case of a 54-year-old woman without relevant medical history other than Brugada type 1 pattern in the electrocardiogram, without chronic medica-tion, who was referred for the cardiology outpatient clinic with palpitations. She had a strong family history of Brugada syndrome, but no history of sudden death, and she never had syncope. A transthoracic echocardiogram was performed, ruling out structural heart disease. Blood samples were analyzed, without thyroid function or electrolyte abnormalities. A 24-hour Holter examination was performed (digital Philips Zymed Holter, Model 1810 Plus Software, Philips Medical Systems) that revealed nocturnal periods of first-degree atrio-ventricular block (AVB) with a markedly variable PR interval and without nonconducted P waves; no other abnormalities were seen; the patient was asymptomatic. The P wave and QRS morphology were the same throughout the examination. The PR interval either increased or decreased, but it was always followed by a QRS complex. The number of P waves was the same as the QRS complexes. There was no relation between the PR interval variability and heart rate or circadian predomi-nance. The patient is kept under follow-up in the outpatient clinic, uneventful. No genetic test was performed. First-degree AVB is typically a benign situation 1 ; however, it is associated with increased incidence of atrial fibrillation, heart failure, and mortality during follow-up. 2 In some clinical settings, it can even be associated with markedly decreased survival. 3 Some data point out that first-degree AVB on a basal ECG is an independent predictor of malignant arrhythmic events in Brugada syndrome

{"title":"Marked PR interval variability in a patient with Brugada syndrome.","authors":"Miguel Martins de Carvalho, Ricardo Alves Pinto, Tânia Proença, Delfim Souteiro, Luís Adão, Filipe Macedo, Manuel Campelo","doi":"10.1097/j.pbj.0000000000000209","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000209","url":null,"abstract":"The authors present a clinical case of a 54-year-old woman without relevant medical history other than Brugada type 1 pattern in the electrocardiogram, without chronic medica-tion, who was referred for the cardiology outpatient clinic with palpitations. She had a strong family history of Brugada syndrome, but no history of sudden death, and she never had syncope. A transthoracic echocardiogram was performed, ruling out structural heart disease. Blood samples were analyzed, without thyroid function or electrolyte abnormalities. A 24-hour Holter examination was performed (digital Philips Zymed Holter, Model 1810 Plus Software, Philips Medical Systems) that revealed nocturnal periods of first-degree atrio-ventricular block (AVB) with a markedly variable PR interval and without nonconducted P waves; no other abnormalities were seen; the patient was asymptomatic. The P wave and QRS morphology were the same throughout the examination. The PR interval either increased or decreased, but it was always followed by a QRS complex. The number of P waves was the same as the QRS complexes. There was no relation between the PR interval variability and heart rate or circadian predomi-nance. The patient is kept under follow-up in the outpatient clinic, uneventful. No genetic test was performed. First-degree AVB is typically a benign situation 1 ; however, it is associated with increased incidence of atrial fibrillation, heart failure, and mortality during follow-up. 2 In some clinical settings, it can even be associated with markedly decreased survival. 3 Some data point out that first-degree AVB on a basal ECG is an independent predictor of malignant arrhythmic events in Brugada syndrome","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 2","pages":"e209"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10158892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9485688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lesbian shared IVF: the ROPA method: a systematic review. 女同性恋共享体外受精:ROPA方法:系统回顾。

Porto biomedical journal

Pub Date : 2023-03-01 DOI: 10.1097/j.pbj.0000000000000202

Pedro Brandão, Nathan Ceschin

The ROPA (Reception of Oocytes from PArtner) method, also known as lesbian shared IVF (in vitro fertilization), is an assisted reproduction technique for female couples, in which one of the women provides the oocytes (genetic mother) and the other receives the embryo and gestates (gestational mother). As a double parented method, it is the only way lesbian women may biologically share motherhood. This is a narrative review of data concerning ROPA published in PubMed, Scopus, and Cochrane Library. A total of 35 articles were included, 10 about motivations for undergoing ROPA, 13 about ethics or legislation, 4 about motherhood, and 8 studies reporting clinical outcomes. Despite being used for more than a decade, there is a paucity of data regarding this technique in scientific literature. Most women choose this technique to share biological motherhood, but medical issues may also justify its use. Many ethical and legal issues are still to be solved. Despite the small number of studies, data regarding the outcomes of this technique and the resulting motherhood are reassuring.

ROPA(从伴侣接收卵母细胞)方法，也被称为女同性恋共享体外受精(IVF)，是一种针对女性夫妇的辅助生殖技术，其中一名女性提供卵母细胞(遗传母亲)，另一名接受胚胎和妊娠(孕母)。作为一种双重父母的方式，这是女同性恋女性在生物学上分享母亲身份的唯一方式。这是一篇关于发表在PubMed、Scopus和Cochrane图书馆的ROPA数据的叙述性综述。共纳入35篇文章，10篇关于ROPA的动机，13篇关于伦理或立法，4篇关于母性，8篇报告临床结果的研究。尽管已经使用了十多年，但在科学文献中缺乏关于这种技术的数据。大多数妇女选择这种技术是为了分享亲生母亲的身份，但医学问题也可能证明使用这种技术是合理的。许多伦理和法律问题仍有待解决。尽管研究数量很少，但关于这项技术的结果和由此产生的母亲的数据令人放心。

引用次数: 1

Transpyloric misplacement and intramural dislocation: two novel complications related to balloon-type G-tubes. 球囊型g管的两种新并发症——幽门错位和壁内脱位。

Porto biomedical journal

Pub Date : 2023-03-01 DOI: 10.1097/j.pbj.0000000000000210

Vincent Zimmer

To the Editor: Percutaneous endoscopic gastrostomy (PEG) remains the standard enteral nutrition access in clinical practice with limited complication potential. Beyond mushroom and/or disk-tip tubes (pull technique), in the introducer technique balloon-type G-tubes are implanted, warranting regular, often nurse-led exchanges. Herein, two novel complications related to tube exchange are presented. A frail male patient with advanced diffuse idiopathic skeletal hyperostosis (DISH)–related dysphagia reported on worsening enteral nutrition tolerance (intermittent administration) due to abdominal pain since the last bedside tube exchange by a specialized nutrition team in the nursing home. On endoscopy, transpyloric misplacement likely related to inadvertent duodenal guidewire insertion (Fig. 1A), resistant to repositioning by external traction (Fig. 1B), was detected. Endoscopy-directed repositioning was easily performed after balloon deflation and withdrawal into the stomach, and other potential causes for deterioration of nutrition tolerance, such as ulcer disease, were excluded. In retrospective, this

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引用次数: 0

Time for implementation of local observational studies. 实施地方观察研究的时间。

Porto biomedical journal

Pub Date : 2023-03-01 DOI: 10.1097/j.pbj.0000000000000204

Gonçalo M C Rodrigues, Maria J Salgado, Ana P Fernandes, Ana R Jaime, Ana M Macedo, Manuel Salavessa

The importance of improving clinical research is a consensual topic. Observational studies represent a practical approach to measuring real-world outcomes and responding to health policy directives by their descriptive nature and hypothesis generators. Thus, in the era of evidence-based medicine, the prompt approval of these studies would benefit their implementation and data collection. Thispilotstudyevaluatedtheapprovaltimesforeightobservational

引用次数: 0

Risk factors for refracture after proximal femur fragility fracture. 股骨近端脆性骨折后再骨折的危险因素。

Porto biomedical journal

Pub Date : 2023-03-01 DOI: 10.1097/j.pbj.0000000000000207

Beatriz C Lourenço, Tiago Amorim-Barbosa, Carolina Lemos, Ricardo Rodrigues-Pinto

Introduction: Proximal femur fragility fractures (PFFFs) are a growing worldwide concern. Recognizing the risk factors for subsequent fracture is essential for secondary prevention. This study aimed to analyze the risk factors for refracture and mortality rates in patients who suffered a PFFF.

Methods: Patients aged 65 years or older with PFFF who underwent surgical treatment during the year of 2017 in the same institution were retrospectively analyzed and at least four years after the index fracture were evaluated.

Results: From a total of 389 patients, 299 patients were included, with a median age of 83 years, and 81% female. Thirty-two (10.7%) suffered a refracture, with a mean time to refracture of 19.8 ± 14.80 months, being the female sex a risk factor for refracture (OR-4.69; CI [1.05-20.95]). The 1-year mortality rate was 15.4%. Seventy-three (24.4%) patients had previous fragility fractures. After the index fracture, 79% remained untreated for osteoporosis. No statistical association was found between antiosteoporotic treatment and refracture. Patients with refracture had higher prefracture functional level compared with patients without refracture (OR-1.33; CI [1.08-1.63]) and were discharged more often to rehabilitation units (31% versus 16%, P =.028). After 4 years of follow-up, patients with refracture had lower functional level compared with patients without. Chronic kidney disease was a risk factor (P = .029) for early refracture (<24 months).

Conclusion: Female sex and higher prefracture functional level may increase the risk of refracture. Chronic kidney disease was associated with a shorter refracture time. Despite having a PFFF or other fragility fractures, the majority of patients remained untreated for osteoporosis.

股骨近端脆性骨折(pfff)在世界范围内日益受到关注。认识到继发骨折的危险因素对于二级预防至关重要。本研究旨在分析PFFF患者再骨折和死亡率的危险因素。方法:回顾性分析同一机构2017年接受手术治疗的65岁及以上PFFF患者，并评估其指数骨折后至少4年的情况。结果:共纳入389例患者299例，中位年龄83岁，81%为女性。32例(10.7%)发生再骨折，平均再骨折时间为19.8±14.80个月，女性是再骨折的危险因素(or = 4.69;CI[1.05 - -20.95])。1年死亡率为15.4%。73例(24.4%)患者既往有脆性骨折。在指数骨折后，79%的患者仍未接受骨质疏松治疗。抗骨质疏松治疗与再骨折之间无统计学关联。再骨折患者骨折前功能水平高于非再骨折患者(or = 1.33;CI[1.08-1.63])，并且更频繁地出院到康复单位(31%比16%，P = 0.028)。经过4年的随访，再骨折患者的功能水平低于非再骨折患者。慢性肾脏疾病是早期再骨折的危险因素(P = 0.029)(结论:女性和较高的骨折前功能水平可能增加再骨折的风险。慢性肾脏疾病与较短的再破裂时间相关。尽管有PFFF或其他脆性骨折，大多数患者仍未治疗骨质疏松症。

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引用次数: 0

Total knee arthroplasty coronal alignment and tibial base stress-a new numerical evaluation. 全膝关节置换术中冠状面对齐与胫骨基底应力——一种新的数值评估方法。

Porto biomedical journal

Pub Date : 2023-03-01 DOI: 10.1097/j.pbj.0000000000000208

João Vale, Luisa V Pinto, Bianca Barros, Sara Diniz, Filipe Rodrigues, Marco Marques, Jorge Belinha, Adélio Vilaça

Background: Total knee arthroplasty (TKA) is one of the most frequently performed orthopedic procedures. The correct positioning and alignment of the components significantly affects prosthesis survival. Considering the current controversy regarding the target of postoperative alignment of TKA, this study evaluated the tension at tibial component interface using two numerical methods.

Methods: The stress of the prosthesis/bone interface of the proximal tibial component was evaluated using two numerical methods: the finite element method (FEM) and the new meshless method: natural neighbor radial point interpolation method (NNRPIM). The construction of the model was based on Zimmers NexGen LPS-Flex Mobile® prosthesis and simulated the forces by using a free-body diagram.

Results: Tibiofemoral mechanical axis (TFMA) for which a higher number of nodes are under optimal mechanical tension is between 1° valgus 2° varus. For values outside the interval, there are regions under the tibial plate at risk of bone absorption. At the extremities of the tibial plate of the prosthesis, both medial and lateral, independent of the alignment, are under a low stress. In all nodes evaluated for all TFMA, the values of the effective stresses were higher in the NNRPIM when compared with the FEM.

Conclusion: Through this study, we can corroborate that the optimal postoperative alignment is within the values that are currently considered of 0 ± 3° varus. It was verified that the meshless methods obtain smoother and more conservative results, which may make them safer when transposed to the clinical practice.

背景:全膝关节置换术(TKA)是最常见的骨科手术之一。假体组件的正确定位和对齐显著影响假体的存活。考虑到目前关于TKA术后对准目标的争议，本研究采用两种数值方法评估胫骨组件界面张力。方法:采用有限元法(FEM)和新型无网格法:自然邻点径向插值法(NNRPIM)两种数值方法对胫骨近端假体/骨界面应力进行评估。模型的构建基于Zimmers NexGen LPS-Flex Mobile®假体，采用自由体图模拟受力。结果:胫骨股骨机械轴(TFMA)处于1°外翻和2°内翻之间，在最佳机械张力下有较多的节点。对于间隔之外的值，胫骨板下的区域存在骨吸收的风险。在假体胫骨板的末端，内侧和外侧，独立于对齐，处于低应力下。在所有TFMA评估的所有节点中，与FEM相比，NNRPIM的有效应力值更高。结论:通过本研究，我们可以证实，最佳的术后对齐值在目前认为的0±3°内翻范围内。结果表明，无网格方法得到的结果更平滑、更保守，应用于临床更安全。

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引用次数: 0

Erratum: From the challenge of assessing autonomy to the instruments used in practice: a scoping review. 勘误:从评估自主性的挑战到实践中使用的工具:范围审查。

Porto biomedical journal

Pub Date : 2023-01-01 DOI: 10.1097/j.pbj.0000000000000203

[This corrects the article DOI: 10.1097/j.pbj.0000000000000153.].

[这更正了文章DOI: 10.1097/j.p pbj.0000000000000153.]。

引用次数: 0

Associated factors to human papillomavirus vaccine adhesion in adult women: a cross-sectional study. 成年女性人乳头瘤病毒疫苗粘附的相关因素:一项横断面研究。

Porto biomedical journal

Pub Date : 2023-01-01 DOI: 10.1097/j.pbj.0000000000000181

Rita Sarabando, Ana Vilela-Gomes, Isabel Reis, Amália Pacheco, Cristina Nogueira-Silva

Background: The goal of human papillomavirus (HPV) vaccination is the decline of HPV related premalignant lesions, leading to prevention of cervical cancer. Vaccination against HPV is recommended until the age of 45 to prevent viral reinfections and reactivations. The aim of this study was to evaluate adhesion to HPV vaccination and their associated factors in adult women.

Methods: Cross-sectional study in two tertiary hospitals, with a questionnaire distributed to women born between 1974 and 1992, from September till November 2019. Data collected included sociodemographic information, clinical information, knowledge about HPV, and the HPV vaccine and data regarding vaccine recommendation. Factors associated with vaccination were searched by bivariate and multivariate statistical analysis.

Results: In 469 questionnaires, 25.4% (n = 119) women were vaccinated. The main reason for not vaccinating was the non-recommendation (n = 276; 70.2%). In bivariate analyses, vaccinated women were younger, predominantly not married, had higher educational level, and higher careers (P ≤ .001); an abnormal cytology, HPV infection or previous excision of the transformation zone were associated with a 3 to 4-fold increase in the odds of vaccination. Age, high-risk HPV infection, and knowing someone vaccinated remained factors independently associated with HPV vaccination in the multivariate analyses (P< .05). The recommendation of "vaccinate immediately" was independently associated with effectively doing it (P< .001).

Conclusions: HPV vaccination is associated with vaccine recommendation, especially if it is recommended to do immediately. These results reinforce the need of health professionals to be aware of the impact that their recommendation has on adhesion to HPV vaccination.

背景:人乳头瘤病毒(HPV)疫苗接种的目的是减少HPV相关的癌前病变，从而预防宫颈癌。建议在45岁之前接种HPV疫苗，以防止病毒再感染和再激活。本研究的目的是评估成年女性对HPV疫苗的粘附性及其相关因素。方法:横断面研究，于2019年9月至11月在两家三级医院对1974 ~ 1992年出生的妇女进行问卷调查。收集的数据包括社会人口统计信息、临床信息、关于HPV的知识、HPV疫苗和有关疫苗推荐的数据。通过双变量和多变量统计分析寻找与疫苗接种相关的因素。结果:在469份问卷中，25.4% (n = 119)的妇女接种了疫苗。不接种疫苗的主要原因是不推荐接种(n = 276;70.2%)。在双变量分析中，接种疫苗的女性更年轻，主要是未婚，具有更高的教育水平和更高的职业生涯(P≤0.001);细胞学异常、HPV感染或以前的转化区切除与疫苗接种几率增加3至4倍相关。在多变量分析中，年龄、高危HPV感染和知道有人接种HPV疫苗仍然是与HPV疫苗接种相关的独立因素(P< 0.05)。建议“立即接种”与有效接种独立相关(P< 0.001)。结论:HPV疫苗接种与疫苗推荐相关，特别是如果建议立即接种。这些结果加强了卫生专业人员意识到他们的建议对HPV疫苗粘附性的影响的必要性。

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