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脑膜炎双球菌疫苗的研究进展
Advances in the Development of Vaccines against Neisseria meningitidis
Tan LKK, Carlone GM, Borrow R  2010/9/13 18:02:14 
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N Engl J Med, 2010,
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Abstract
Although two centuries have passed since Vieusseux described epidemic meningococcal disease, Neisseria meningitidis remains a leading cause of meningitis and sepsis. Overwhelming meningococcal disease can develop rapidly and is associated with mortality rates exceeding 20%. Thus, efforts to control the disease have focused on vaccination. In the past, vaccines against meningococcal disease have failed to provide immunogenicity and long-term protection in infants, who are at greatest risk. Although recent vaccines have improved coverage for this age group, there is still no broadly effective vaccine against N. meningitidis group B (NMB), now the predominant disease-causing isolate in industrialized countries.

Developments during the past decade have renewed hopes for solving this seemingly intractable problem. Knowledge of the meningococcal genome has led to the identification of novel antigens that have been incorporated into the NMB vaccines now being studied in clinical trials. However, it remains unclear whether these vaccines will provide sufficient immunogenicity in infants as well as wide-ranging coverage. This review highlights the evolution of meningococcal vaccines in general and discusses strategies being used to overcome the barriers to developing vaccines against NMB.
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甲状腺功能亢进合并黄疸

 王燕燕 王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
 

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