这个样品不能提供有用的关于熊猫队列的信息。不恰当的年龄和临床表现包括,使用的2年期和5年期的间隔太长,允许一个病因学的协会。诊断代码用于识别“SI”(见表e - 1[1])包括健康的儿童和患者诊断明确知他不气感染。此外,气体感染没有证实任何科目,因为“太少病人记录支持诊断证据从咽喉拭子(n = 67)和麻生太郎滴度(n = 6)。”[1] This fatal flaw should have precluded further analysis, since GAS can be distinguished from other etiologies only by throat culture.
此外,解释和意义是建立在错误的假设。作者写道,“寻找增加的数量如果不是使用抗生素治疗”的主题与强迫症或抽筋”预测的相反的方向。”An increase in untreated GAS infections is the expected result, as cross-reactive antibodies are produced only when the bacteria persist without treatment for 3-5 days or longer. [4] In PANDAS, as in the model disorder Sydenham chorea (SC), prompt recognition and treatment of GAS infections is effective in preventing neuropsychiatric sequelae. [4]
在社论中,吉尔伯特和Kurlan状态四个标准”建立SC是一种GAS-triggered、自身免疫性风湿病疾病。”[2] With the exception of an association with rheumatic carditis (which is an exclusionary criterion for PANDAS), all of these criteria also have been met for PANDAS. [5] Yaddanapudi et al. [6] recently demonstrated in a mouse model that passive transfer of the cross-reactive antibodies was sufficient to produce neuropsychiatric symptoms in naïve mice. The result supports the idea that post-streptococcal autoimmunity plays an etiologic role in PANDAS.
大熊猫仍被视为“有争议的”。A possible explanation is provided by the editorial, which stated that "dramatic waxing" is a distinguishing feature. [2] Actually, the criterion is "abrupt onset and an episodic course." [3] The difference in onset acuity is detectable and distinct, just as one can distinguish the speed with which a thoroughbred race horse leaves the gate from the pace of aged plow horse meandering around a pasture.
施拉格等。[1]发现“支持性证据不足熊猫和SI组:之间的因果关系(链球菌感染)导致吉尔伯特和Kurlan[2]将熊猫“罕见,无名马”逃检测和描述。
结论是合理的研究设计和它的结果,五个临床标准定义熊猫[3]没有用于选择调查的主题。的标准,唯一一个遇到强迫症或抽搐障碍的存在;相比之下,满足未满足的条件是青年期发病,情景,与A组链球菌(气)感染,和相关的神经系统异常。
这个样品不能提供有用的关于熊猫队列的信息。不恰当的年龄和临床表现包括,使用的2年期和5年期的间隔太长,允许一个病因学的协会。诊断代码用于识别“SI”(见表e - 1[1])包括健康的儿童和患者诊断明确知他不气感染。此外,气体感染没有证实任何科目,因为“太少病人记录支持诊断证据从咽喉拭子(n = 67)和麻生太郎滴度(n = 6)。”[1] This fatal flaw should have precluded further analysis, since GAS can be distinguished from other etiologies only by throat culture.
此外,解释和意义是建立在错误的假设。作者写道,“寻找增加的数量如果不是使用抗生素治疗”的主题与强迫症或抽筋”预测的相反的方向。”An increase in untreated GAS infections is the expected result, as cross-reactive antibodies are produced only when the bacteria persist without treatment for 3-5 days or longer. [4] In PANDAS, as in the model disorder Sydenham chorea (SC), prompt recognition and treatment of GAS infections is effective in preventing neuropsychiatric sequelae. [4]
在社论中,吉尔伯特和Kurlan状态四个标准”建立SC是一种GAS-triggered、自身免疫性风湿病疾病。”[2] With the exception of an association with rheumatic carditis (which is an exclusionary criterion for PANDAS), all of these criteria also have been met for PANDAS. [5] Yaddanapudi et al. [6] recently demonstrated in a mouse model that passive transfer of the cross-reactive antibodies was sufficient to produce neuropsychiatric symptoms in naïve mice. The result supports the idea that post-streptococcal autoimmunity plays an etiologic role in PANDAS.
大熊猫仍被视为“有争议的”。A possible explanation is provided by the editorial, which stated that "dramatic waxing" is a distinguishing feature. [2] Actually, the criterion is "abrupt onset and an episodic course." [3] The difference in onset acuity is detectable and distinct, just as one can distinguish the speed with which a thoroughbred race horse leaves the gate from the pace of aged plow horse meandering around a pasture.
吉尔伯特和点名Kurlan研究类似的施拉格等人已经被我们当前的“有限的生物标记。”[2]然而,这个问题不是与气体的实验室检测,但非代表性患者群体、不恰当的控制和方法忽略的基本病理生理学链球菌感染后遗症。调查人员解决这些问题之前,是没有意义的试图决定如果他们会发现马和斑马。他们甚至没有听到蹄节拍。
引用
1。施拉格,吉尔伯特R, Giovannoni G, et al .链球菌感染,妥瑞症,强迫症:有联系吗?首页神经学2009;73:1256 - 1263。
2。吉尔伯特DL Kurlan r .熊猫:马和斑马吗?首页神经学2009;73:1252 - 1253。
3所示。Swedo ES,伦纳德霍奇金淋巴瘤,加维M et al。儿童自身免疫性神经精神障碍与链球菌感染有关:第一个50例的临床描述。精神病学是J 1998:155:264 - 271。
4所示。坎宁安兆瓦,Fujinami RS、编辑。分子拟态、微生物和自身免疫。华盛顿特区:ASM出版社,2000年。
5。斯奈德,Swedo SE。熊猫:现状和研究方向。摩尔精神病学9:900 2004;907年。
6。何宁Yaddanapudi K、M,哔叽R, et al。被动转移streptococcus-induced抗体繁殖行为障碍儿童自身免疫性神经精神疾病的小鼠模型与链球菌感染有关。《分子精神病学》提前在线出版,2009年8月11日;doi: 10.1038 / mp.2009.77
披露:Swedo博士是美国国立卫生研究院的全职员工。