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81.
Interictal or ictal events in partial epilepsies may project on scalp EEG contralaterally to the side of the epileptogenic lesion. Such paradoxical lateralization can be observed in case of para-sagittal generators, and is likely due to the spatial orientation of the generator, presenting an oblique projection towards the midline. We present here a case of medial occipital epilepsy investigated using EEG, MEG and stereoelectroencephalography (SEEG). MRI displayed a focal cortical dysplasia in the superior margin of the right calcarine fissure. SEEG demonstrated bilateral medial occipital interictal spikes, with an inversion of polarity at the level of the lesion and a contralateral propagation occurring in 10 ms. Interictal iterative EEG cartographies showed a large posterior field, with a maximum contralateral to the initial generator (EEG paradoxical lateralization). With the same number of channels, interictal iterative MEG cartographies were more precise and more complex than EEG ones, indicating an onset accurately lateralized. A few milliseconds later, MEG cartographies were quadripolar, thus indicating two homotopic active generators. These MEG and EEG cartographies have been reproduced using BESA dipole simulator. Relative merits of MEG and EEG are still debated. With 151 channels, MEG source localizations indicated the right medial occipital area, as demonstrated by SEEG. An investigation with a corresponding number of EEG channels was not performed. After a down sampling to 64 sensors, this precision was lost. MEG and EEG source localization results, both with 64 channels, were quite comparable, indicating both medial occipital areas. However, a careful analysis of MEG/EEG iterative cartographies, performed with the same number of channels in both modalities, demonstrated that, in this configuration, MEG sensitivity was superior to the EEG one, allowing separating two medial occipital sources, characterized in SEEG by a time delay of 10 ms.  相似文献   
82.
We studied cross-reactive antibodies against avian influenza H5N1 and 2009 pandemic (p) H1N1 in 200 serum samples from US military personnel collected before the H1N1 pandemic. Assays used to measure antibodies against viral proteins involved in protection included a hemagglutination inhibition (HI) assay and a neuraminidase inhibition (NI) assay. Viral neutralization by antibodies against avian influenza H5N1 and 2009 pH1N1 was assessed by influenza (H5) pseudotyped lentiviral particle-based and H1N1 microneutralization assays. Some US military personnel had cross-neutralizing antibodies against H5N1 (14%) and 2009 pH1N1 (16.5%). The odds of having cross-neutralizing antibodies against 2009 pH1N1 were 4.4 times higher in subjects receiving more than five inactivated whole influenza virus vaccinations than those subjects with no record of vaccination. Although unclear if the result of prior vaccination or disease exposure, these pre-existing antibodies may prevent or reduce disease severity.Outbreaks of 1997 avian influenza H5N1 and 2009 pandemic (p) H1N1 in humans have provided an opportunity to gain insight into cross-reactive immunity. The US military periodically collects and stores serum samples from service members linked to medical records.1 We measured cross-reactive antibodies in stored serum to avian influenza H5N1 and 2009 pH1N1 from US military personnel and identified factors associated with presence of neutralizing antibodies.Two hundred archived serum samples were obtained from the US Department of Defense Serum Repository. They were representative of a wide cross-section of active military personnel at the times of collection, whereas specific geographic information was not available on the individual selected; the cohort represents the general US military population, which is deployed throughout the United States and globally. Fifty samples each were selected from four birth cohorts: (1) < 1949, (2) 1960–1965, (3) 1966–1971, and (4) 1972–1977. Within each cohort, 25 samples were collected in the year 2000 (before the introduction of intranasal live attenuated influenza vaccine [LAIV]), and 25 samples were collected in 2008 (where 51% of donors had received LAIV). It has been suggested that LAIV elicits cross-reactive immunity.2,3 The samples were all collected before the outbreak of 2009 pH1N1, and there have not been any reported outbreaks of H5N1 in US military personnel.Assays used to measure antibodies included a hemagglutination inhibition (HI) assay and a neuraminidase inhibition (NI) assay.4 Viral neutralization by antibodies against H5N1 and 2009 pH1N1 was assessed by influenza (H5) pseudotyped lentiviral particle-based (H5pp)5 and microneutralization assays, respectively. Electronic medical and vaccination records from the Defense Medical Surveillance System (DMSS), which captured records before the serum sample date, were linked to samples and compared with the in vitro results.1The odds ratios (ORs) and 95% confidence intervals (95% CIs) of univariate and multivariate binary logistic regression analyses were used to determine the association between donor characteristics and positive antibody responses. A multiple logistic regression model was constructed, and it included independent variables with a P value of < 0.05 in univariate logistic regression. A P value of < 0.05 was considered to indicate statistical significance. SPSS 12.0 for Windows (SPSS Inc., Chicago, IL) was used to perform all statistical analysis.Cross-reactivity is summarized in 5 and 22.5% for the NI assay. H5pp and NI antibody titers to H5N1 were evenly distributed among birth cohorts and did not differ substantially based on history of vaccination or prior respiratory infections. Of those individuals with neutralizing antibodies to H5N1 (N = 28), 32.1% also had neutralizing antibodies to pH1N1, whereas 19.3% of those individuals with any H5N1-specific antibody response also had neutralizing antibodies to pH1N1 (
Characteristics (n)H5N12009 pH1N1§
HI assay* % positive (GM titer)H5pp % positive (GM titer)NI assay % positive (GM titer)HI assay % positive (GM titer)Neutralization % positive (GM titer)NI assay % positive (GM titer)
Total
 2000.5 (5.1)14.0 (21.4)22.5 (121.6)5.5 (7.1)16.5 (20.4)9.0 (92.8)
Birth cohort
 1936–1949 (50)2.0 (5.3)18.0 (22.0)24.0 (126.0)6.0 (7.3)16.0 (19.5)12.0 (97.6)
 1960–1965 (50)0.0 (5.0)16.0 (20.3)26.0 (129.6)6.0 (7.7)30.0 (27.5)6.0 (90.3)
 1966–1971 (50)0.0 (5.0)12.0 (23.3)20.0 (117.9)10.0 (8.0)16.0 (23.6)10.0 (92.2)
 1972–1977 (50)0.0 (5.3)10.0 (20.0)20.0 (113.7)0.0 (5.7)4.0 (13.6)8.0 (91.5)
Serum collection year
 Y2000 (100)0.0 (5.1)15.0 (21.7)21.0 (120.3)7.0 (7.3)16.0 (20.6)11.0 (94.5)
 Y2008 (100)1.0 (5.2)13.0 (21.1)24.0 (123.0)4.0 (7.0)17.0 (20.1)7.0 (91.2)
Sex
 Female (32)3.1 (5.7)21.9 (26.3)12.5 (102.4)3.1 (6.9)12.5 (19.2)6.3 (96.7)
 Male (168)0.0 (5.0)12.5 (20.5)24.4 (125.7)6.0 (7.2)17.3 (20.6)9.5 (92.1)
Any cross-reactive antibody to
 H5N1 (57)8.8 (8.9)19.3 (25.2)22.8 (119.9)
 pH1N1 (45)2.2 (5.3)28.9 (31.2)37.8 (165.2)
Neutralizing antibodies to
 H5N1 H5pp (28)10.7 (9.5)32.1 (33.6)25.0 (116.9)
 2009 pH1N1 neutralization (33)3.0 (5.4)27.3 (28.9)30.3 (140.3)
Lifetime seasonal vaccinations
 No record (66)0.0 (5.1)10.6 (20.2)27.7 (128.1)7.6 (7.4)15.2 (20.6)12.1 (96.5)
 1–5 vaccinations (88)1.1 (5.2)15.9 (21.5)17.0 (109.2)5.7 (7.1)17.0 (20.5)6.8 (89.1)
  > 5 vaccinations (46)0.0 (5.1)15.2 (22.2)32.6 (138.8)2.2 (6.8)17.4 (19.7)8.7 (95.0)
Time since last vaccine
 No record (66)0.0 (5.1)10.6 (20.2)22.7 (128.1)7.6 (7.4)15.2 (20.6)12.1 (96.5)
  ≤ 1 year (96)0.0 (5.1)15.6 (21.5)24.0 (120.7)4.2 (7.1)19.8 (21.0)8.3 (91.2)
 > 1 year (38)2.6 (5.3)15.8 (22.4)18.4 (113.4)5.2 (6.8)10.5 (18.3)5.3 (90.6)
Vaccination history lifetime (at least one dose)
 No record of vaccination (66)0.0 (5.1)10.6 (20.2)22.7 (128.1)7.6 (7.4)15.2 (20.6)12.1 (96.5)
 Inactivated whole virus (71)0.0 (5.0)14.1 (20.4)22.5 (115.7)2.8 (6.4)15.5 (19.6)5.6 (87.1)
 Split type (102)1.0 (5.0)15.7 (20.4)21.6 (115.7)4.9 (6.4)19.6 (19.6)6.9 (87.1)
 Influenza vaccine not otherwise specified (16)0.0 (5.2)12.5 (27.9)37.5 (166.4)0.0 (6.2)6.3 (16.1)12.5 (102.3)
 Live attenuated intranasal (50)0.0 (5.1)10.0 (18.8)20.0 (112.2)4.0 (7.0)18.0 (20.3)4.0 (85.2)
History of respiratory illness
 No record of illness (119)0.0 (5.0)10.1 (18.5)18.5 (112.6)4.2 (7.0)15.1 (20.5)8.4 (90.7)
 Influenza-like illness (4)0.0 (5.0)25.0 (20.7)0.0 (80.0)0.0 (8.4)25.0 (28.3)25.0 (100.2)
 Upper respiratory infection (65)1.5 (5.4)23.1 (29.3)27.7 (135.0)7.7 (7.3)18.5 (20.7)9.2 (93.1)
 Lower respiratory infection (37)2.7 (5.6)18.9 (30.2)35.1 (157.6)8.1 (8.1)21.6 (22.4)13.5 (108.4)
 Respiratory illness past year (28)0 (5.1)25.0 (25.1)32.1 (154.9)7.1 (8.0)28.6 (24.4)3.6 (86.3)
Open in a separate windowTiters with a value of zero (below the detection limit) were assigned a value of five for calculation of geometric means (GMs).*H5N1, A/Vietnam/1203/2004; positive titer ≥ 40.H5 hemagglutinin (A/Cambodia/408008/05) pseudotyped lentiviral particle; positive titer ≥ 160.Reassortant H1N1 (HA, PB1, PB2, PA, NP, and M from H1N1 [A/PR/8/34]; N1 from H5N1 [A/Vietnam/DT-036/2005]); positive titer ≥ 160.§2009 H1N1, A/California/04/2009; same positive titer cutoffs as for H5N1.As with H5N1, samples with positive HI titers were low for 2009 pH1N1 at 5.5%, whereas neutralizing antibody titers were higher, with 16.5% positive in the microneutralization assay but only 9% positive in the NI assay. Positive neutralization titers were less evenly distributed among birth cohorts, with only 4% positive in the 1972–1977 birth cohort, whereas 30% were positive in the 1960–1965 cohort. Like H5N1, positive antibody titers to 2009 pH1N1 did not differ substantially based on history of vaccination or prior respiratory infections. Of those individuals with neutralizing antibodies to pH1N1 (N = 33), 27.3% also had neutralizing antibodies to H5N1, whereas 28.9% of those individuals with any pH1N1-specific antibody response also had neutralizing antibodies to H5N1.Univariate associations between the prevalence of cross-reactive antibodies to H5N1 and 2009 pH1N1 and independent variables, including year of birth, serum collection year, sex, and seasonal influenza vaccination history, are shown in Characteristic (n)2009 pH1N1H5N1PrevalenceOR (95% CI)Adjusted OR (95% CI)PrevalenceOR (95% CI)Positive neutralizing antibody33 (16.5%)28 (14.0%)Serum collection year 2000 (100)16 (16.0%)ReferenceReference15 (15.0%)Reference 2008 (100)17 (17.0%)1.1 (0.5–2.3)0.7 (0.3–1.8)13 (13.0%)0.9 (0.4–1.9)Birth cohort 1936–1949 (50)8 (16.0%)4.6 (0.9–22.7)5.3 (1.0–27.0)9 (18.0%)2.0 (0.6–6.4) 1960–1965 (50)15 (30.0%)10.3 (2.2–47.9)11.0 (2.3–52.9)8 (16.0%)1.7 (0.5–5.7) 1966–1971 (50)8 (16.0%)4.6 (0.9–22.7)5.1 (1.0–26.2)6 (12.0%)1.2 (0.4–4.3) 1972–1977 (50)2 (4.0%)ReferenceReference5 (10.0%)ReferenceSex Female (32)4 (12.5%)Reference7 (21.9%)Reference Male (168)29 (17.3%)1.5 (0.5–4.5)21 (12.5%)0.5 (0.2–1.3)Positive neutralizing antibody titers H5pp (57)11 (19.3%)1.3 (0.6–2.9) pH1N1 (45)13 (28.9%)3.8 (1.6–8.7)Vaccination record Number of seasonal influenza vaccinations  No record (66)10 (15.2%)Reference7 (10.6%)Reference  1–5 vaccinations (88)15 (17.0%)1.2 (0.5–2.8)14 (15.9%)1.6 (0.6–4.2)  > 5 vaccinations (46)8 (17.4%)1.2 (0.4–3.3)7 (15.2%)1.5 (0.5–4.7) Time since last vaccination  No record (66)10 (15.2%)Reference7 (10.61%)Reference   ≤ 1 year (96)19 (19.8%)1.4 (0.6–3.2)15 (15.6%)1.6 (0.6–4.1)  > 1 year (33)4 (10.5%)0.7 (0.2–2.3)6 (15.8%)1.6 (0.5–5.1) Number of inactivated whole virus vaccinations  No record (129)22 (17.1%)ReferenceReference18 (14.0%)Reference  1–5 vaccinations (53)4 (7.5%)0.4 (0.1–1.2)0.4 (0.1–1.4)7 (13.2%)0.9 (0.4–2.4)  > 5 vaccinations (18)7 (38.9%)3.1 (1.1–8.9)4.4 (1.3–15.6)3 (16.7%)1.2 (0.3–4.7) Time since last inactivated whole virus vaccination  No record (129)22 (17.1%)Reference18 (14.0%)Reference   ≤ 1 year (19)4 (21.1%)1.3 (0.4–4.3)3 (15.8%)1.2 (0.3–4.4)  > 1 year (52)7 (13.5%)0.8 (0.3–1.9)7 (13.5%)1.0 (0.4–2.5) Number of split type vaccinations  No record (98)13 (13.3%)Reference12 (12.2%)Reference  1–5 vaccinations (94)19 (20.2%)1.7 (0.8–3.6)14 (14.9%)1.3 (0.6–2.9)  > 5 vaccinations (8)1 (12.5%)0.9 (0.1–8.2)2 (25.0%)2.4 (0.4–13.2) Time since last split type vaccination  No record (98)13 (13.3%)Reference12 (12.2%)Reference   ≤ 1 year (44)10 (22.7%)1.9 (0.8–4.8)10 (22.7%)2.1 (0.8–5.3)  > 1 year (58)10 (17.2%)1.4 (0.6–3.3)6 (10.3%)0.8 (0.3–2.3) Number of intranasal LAIV vaccinations  No record (150)24 (16.0%)Reference23 (15.3%)Reference  1–5 vaccinations (50)9 (18.0%)1.2 (0.5–2.7)5 (10%)0.6 (0.2–1.7) Time since last intranasal LAIV vaccination  No record (150)24 (16.0%)Reference23 (15.3%)Reference   ≤ 1 year (34)7 (20.6%)1.4 (0.5–3.5)3 (8.8%)0.5 (0.2–1.9)  > 1 year (16)2 (12.5%)0.8 (0.2–3.5)2 (12.5%)0.8 (0.2–3.7)Open in a separate windowTo the best of our knowledge, the present study is the first report of cross-reactive antibodies to both H5N1 and 2009 pH1N1 in a US military population. Cross-reactive antibodies to both influenza viruses were common in this population. Most serum samples (86%) positive in the H5N1 neutralization assay had no detectable HI activity (titer ≥ 10), whereas 94% of samples that neutralized 2009 pH1N1 also had detectable HI activity (titer ≥ 10; data not shown). In addition, cross-reactive antibodies to avian influenza H5N1 were not necessarily accompanied by cross-reactive antibodies to 2009 pH1N1. Taken together, these findings suggest that the observed cross-reactive neutralization against the two influenza viruses was caused by different antibodies in serum samples.This report is also the first report to associate history of receiving more than five doses of inactivated whole influenza virus vaccine with neutralizing antibodies against 2009 pH1N1. This finding suggests a protective advantage of repeated vaccination with seasonal whole virus vaccine, generating cross-reactive antibodies against previously unencountered strains. It has been suggested that the high immunogenicity of the inactivated whole virus vaccine is partly caused by the adjuvant effect of the viral RNA presented, stimulating innate immunity through the Toll-like receptor (TLR) 7-dependent pathway.6 We hypothesize that the combined effect of adjuvant activity and the heterogenous mix of flu strains that an individual would be exposed to over the course of multiple seasonal vaccinations may enhance the breadth of antibody response and promote the generation of cross-reactive antibodies.A retrospective case-control study conducted in US military personnel after the outbreak of 2009 pH1N1 showed that both 2008–2009 seasonal influenza vaccine and history of seasonal vaccine in the prior 4 years afforded some protection against pH1N1. Vaccine effectiveness (VE) was high in persons ≥ 40 (55%) or < 25 (50%) years of age but very low in persons 25–39 years of age (< 10%).7 These findings correlate with the high levels of cross-reactive 2009 pH1N1 antibodies reported here, with 30% in the 1960–1965 cohort (age range = 35–48) but only 4% in the 1972–1977 cohort (age range = 23–36). Our findings are similar to the results found recently in an elderly population in the United States.8 The exception is in those individuals born before 1950, in whom antibody responses were much higher in this cohort. Both our study and the US study differ from two recent seroprevalence studies in Singapore and China, where cross-reactive antibodies were rare in various age groups.9,10 High seasonal influenza vaccination rates in US military personnel found here and prior studies11 may explain the differences observed in these populations, although results from small retrospective seroprevalence studies should be interpreted cautiously. Possible alternative explanations include differences in laboratory assay methods, natural influenza exposure in the sampled populations, and/or use of convenience sampling methods.Studies in humans suggest that the antibody to influenza neuraminidase is associated with resistance to influenza.12 A recent serological study in a small number of human serum samples showed that 24% had cross-reactive antibodies to avian N1,13 similar to our findings (22.5%). In addition, we observed that 9% of serum samples had cross-reactive antibodies to pH1N1.Like pH1N1, persons < 40 years old seem to be most affected by H5N1 infection, with infection rarer in older individuals.14 However, we did not find a difference in cross-reactive antibody prevalence to either neuraminidase or neutralizing antibodies (H5pp) with year of birth or other immunologic markers of exposure, including vaccination history or prior respiratory illness.A possible limitation of our study is that the DMSS may not have captured all relevant medical encounter and/or vaccination data, particularly for encounters that were not entered into the system electronically or coded accurately. Data in the DMSS are provider-dependent, and the DMSS captures data from various historical time periods, dating back to 1980 for immunization data, 1985 for Department of Defense Serum Repository specimens, 1990 for demographic data, and only 1996 for outpatient data. Interpretation of data presented on history of respiratory illness, which is entirely dependent on voluntary provider reporting and International Classification of Diseases (ICD-9) coding, is particularly limited by lack of virologic confirmation.Cross-reactive immunity to pathogenic influenza strains was found in a subset of US military service members, and it may serve to prevent or reduce the severity of influenza. A better understanding of the mechanisms underlying the development of cross-reactive antibodies will aid in the development of more effective preventive and therapeutic measures.  相似文献   
83.
Hypertension artérielle,atteinte rénale et génétique chez le sujet noir : mise au point     
J.-M. Halimi 《Annales de cardiologie et d'angeiologie》2014
The incidence and prevalence of hypertension is markedly elevated in Afro-American populations vs Caucasians. The development of end-stage renal disease is also more frequent in Afro-American subjects, independently of blood pressure control. As compared to Caucasians, Afro-American subjects have a higher risk of end-stage renal disease when they are infected with HIV or have lupus. For decades, these data remained mysterious. Within the last 3 years, results from studies in the field of genetics and infectious diseases have transformed our view on this problem. The aim of this paper is to explain how these results have changed our understanding of hypertension and its consequences in Afro-American subjects.  相似文献   
84.
Microparticle bearing tissue factor: A link between promyelocytic cells and hypercoagulable state     
Damien Gheldof  François Mullier  Nicolas Bailly  Bérangère Devalet  Jean-Michel Dogné  Bernard Chatelain  Christian Chatelain 《Thrombosis research》2014
Patients with hematological malignancies have a 28-fold increased risk of venous thromboembolism (VTE). Among patients with acute myelogenous leukemia (AML), the 2-year cumulative incidence of VTE is 5.2%. Several studies suggest that microvesicles (MVs) harboring TF may play a role in VTE and disseminated intravascular coagulation (DIC) in acute promyelocytic leukemia (APL).  相似文献   
85.
Viral hepatitis at a crossroad     
Lok AS  Pawlotsky JM 《Gastroenterology》2012,142(6):1261-1263
  相似文献   
86.
Further constraints on the Chauvet cave artwork elaboration     
Sadier B  Delannoy JJ  Benedetti L  Bourlès DL  Jaillet S  Geneste JM  Lebatard AE  Arnold M 《Proceedings of the National Academy of Sciences of the United States of America》2012,109(21):8002-8006
Since its discovery, the Chauvet cave elaborate artwork called into question our understanding of Palaeolithic art evolution and challenged traditional chronological benchmarks [Valladas H et al. (2001) Nature 413:419–479]. Chronological approaches revealing human presences in the cavity during the Aurignacian and the Gravettian are indeed still debated on the basis of stylistic criteria [Pettitt P (2008) J Hum Evol 55:908–917]. The presented 36Cl Cosmic Ray Exposure ages demonstrate that the cliff overhanging the Chauvet cave has collapsed several times since 29 ka until the sealing of the cavity entrance prohibited access to the cave at least 21 ka ago. Remarkably agreeing with the radiocarbon dates of the human and animal occupancy, this study confirms that the Chauvet cave paintings are the oldest and the most elaborate ever discovered, challenging our current knowledge of human cognitive evolution.  相似文献   
87.
Dynamics of a bacterial multidrug ABC transporter in the inward- and outward-facing conformations     
Mehmood S  Domene C  Forest E  Jault JM 《Proceedings of the National Academy of Sciences of the United States of America》2012,109(27):10832-10836
The study of membrane proteins remains a challenging task, and approaches to unravel their dynamics are scarce. Here, we applied hydrogen/deuterium exchange (HDX) coupled to mass spectrometry to probe the motions of a bacterial multidrug ATP-binding cassette (ABC) transporter, BmrA, in the inward-facing (resting state) and outward-facing (ATP-bound) conformations. Trypsin digestion and global or local HDX support the transition between inward- and outward-facing conformations during the catalytic cycle of BmrA. However, in the resting state, peptides from the two intracellular domains, especially ICD2, show a much faster HDX than in the closed state. This shows that these two subdomains are very flexible in this conformation. Additionally, molecular dynamics simulations suggest a large fluctuation of the Cα positions from ICD2 residues in the inward-facing conformation of a related transporter, MsbA. These results highlight the unexpected flexibility of ABC exporters in the resting state and underline the power of HDX coupled to mass spectrometry to explore conformational changes and dynamics of large membrane proteins.  相似文献   
88.
Assessment of the use of hypolipidemic agents (HAs), mainly statins, in elderly subjects aged 80 years and more in Burgundy: analysis of 13,211 patients     
Manckoundia P  Lorenzini M  Disson-Dautriche A  Petit JM  Lorcerie B  Debost E  Menu D  Pfitzenmeyer P 《Archives of gerontology and geriatrics》2012,55(1):101-105
  相似文献   
89.
Cytokine levels in human synovial fluid during the different stages of acute gout: role of transforming growth factor β1 in the resolution phase     
Scanu A  Oliviero F  Ramonda R  Frallonardo P  Dayer JM  Punzi L 《Annals of the rheumatic diseases》2012,71(4):621-624
  相似文献   
90.
Therapy-related classical Hodgkin lymphoma after a primary haematological malignancy: a report on 13 cases     
Cheminant M  Galicier L  Brière J  Boutboul D  Micléa JM  Venon MD  Robin M  Thieblemont C  Brice P 《British journal of haematology》2012,158(5):644-648
The risk of developing Hodgkin lymphoma (HL) is increased in immunodeficiencies or during the treatment of some autoimmune diseases. The development of new therapeutic agents has highlighted the risk of unusual lymphoid proliferations, particularly classical HL (cHL). We report the clinicopathological findings of 13 cHL arising in patients treated for a primary haematological malignancy. Eight patients had received an immunomodulator, protein tyrosine-kinase inhibitor or monoclonal antibody, which may have contributed to the cHL development. Most patients had disseminated disease with poor prognostic factors at cHL diagnosis. Despite the initial presentation, good outcomes were achieved with standard cHL chemotherapy.  相似文献   
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