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Article: A 50 Year-Old Woman with A Delayed Diagnosis of Neuromyelitis Optica Spectrum Disorder: The Clinical Course and Serial Neuroimaging Findings.

Huang, Yu-Ju / Chang, Wen-Neng

2021 Volume 303, Page(s) 108–112

Abstract: Purpose: Neuromyelitis optica (NMO) spectrum disorder and multiple sclerosis (MS) have similar clinical presentations which may make a diagnostic difficulty, especially when the data of aquaporin-4 (AQP4) antibody is not available. We reported the ... ...

Abstract	Purpose: Neuromyelitis optica (NMO) spectrum disorder and multiple sclerosis (MS) have similar clinical presentations which may make a diagnostic difficulty, especially when the data of aquaporin-4 (AQP4) antibody is not available. We reported the diagnostic and therapeutic dilemma of a woman with a delayed diagnosis of NMO spectrum disorder for more than 20 years. Case report: The patient was a 51 years old woman who suffered from several episodes of relapsing and remission of limbs weakness, visual impairment and gait disturbance since 29 years old. She was diagnosed as a case of MS and received treatment accordingly. Treatment with the use of Rebif was started since 2008-2012, and was then shifted to Fingolimod due to several minor attacks were still noted during this period. Serum AQP4-IgG was checked before the use of Fingolimod by using Enzyme-linked immunosorbent assay (ELISA) and the result showed sero-negative for this Ab. However, occasional minor attacks were still noted. In May 2018, severe relapsing developed and brain magnetic resonance imaging (MRI) showed marked progression of the brain lesion. Initially, progressive multifocal leukoencephalopathy was suspected, but both cerebrospinal fluid and serologic study for John Cunningham virus (JCV) were negative. AQP4-IgG was rechecked by using cell-based assay (CBA), and the result showed positive finding. Thereafter, her therapy was changed to NMO spectrum disorder regimen. Conclusion: It is worthwhile to recheck the serum AQP4-IgG if the initial study showed negative result by using ELISA since CBA has higher sensitivity than previous study method.
MeSH term(s)	Adult ; Aquaporin 4 ; Autoantibodies ; Delayed Diagnosis ; Female ; Humans ; Middle Aged ; Neuroimaging ; Neuromyelitis Optica/diagnostic imaging ; Neuromyelitis Optica/drug therapy
Chemical Substances	Aquaporin 4 ; Autoantibodies
Language	English
Publishing date	2021-11-29
Publishing country	China (Republic : 1949- )
Document type	Case Reports ; Journal Article
ZDB-ID	2192417-X
ISSN	1028-768X ; 1019-6099
ISSN	1028-768X ; 1019-6099
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Article ; Online: The clinical characteristics and therapeutic outcomes of adult patients with community-acquired spontaneous bacterial meningitis with a fulminant clinical course in Taiwan.

Lien, Chia-Yi / Chien, Chun-Chih / Lu, Cheng-Hsien / Chang, Wen-Neng

BMC infectious diseases

2023 Volume 23, Issue 1, Page(s) 859

Abstract: Purpose: To examine the clinical characteristics of adult patients with community-acquired spontaneous bacterial meningitis (CASBM) with a fulminant clinical course.: Materials and methods: The clinical features and therapeutic outcomes of 127 adult ... ...

Abstract	Purpose: To examine the clinical characteristics of adult patients with community-acquired spontaneous bacterial meningitis (CASBM) with a fulminant clinical course. Materials and methods: The clinical features and therapeutic outcomes of 127 adult CASBM patients were analyzed. The patients were divided into two groups as those with and without a fulminant clinical course. Fulminant clinical course was defined as meningitis presenting initially with marked consciousness disturbance (Glasgow Coma Scale score < 8) or a rapid deterioration in consciousness level within 48 h of hospitalization. Results: Among the 127 enrolled patients, 69 had a fulminant clinical course (47 men and 22 women) and 58 did not. The patients with a fulminant clinical course had a significantly higher incidence of end-stage renal disease (ESRD), severe clinical manifestations and higher mortality rate, and the survivors had significantly worse therapeutic outcomes. Klebsiella (K.) pneumoniae (50 strains) was the most important pathogen for the development of a fulminant clinical course, and all strains were susceptible to ceftriaxone and ceftazidime. With treatment, 50.7% (35/69) of the patients with a fulminant clinical course died, and the presence of K. pneumoniae infection was significant prognostic factor. Conclusions: The presence of ESRD, initial presentation of altered consciousness, septic shock, seizures and CSF total protein level and K. pneumoniae infection were significantly associated with a fulminant clinical course of adult CASBM, and patients with this specific infectious syndrome had high mortality and morbidity rates. The presence of K. pneumoniae infection is a significant prognostic factor.
MeSH term(s)	Adult ; Male ; Humans ; Female ; Taiwan/epidemiology ; Prognosis ; Community-Acquired Infections/diagnosis ; Community-Acquired Infections/drug therapy ; Community-Acquired Infections/epidemiology ; Meningitis, Bacterial/diagnosis ; Meningitis, Bacterial/drug therapy ; Meningitis, Bacterial/epidemiology ; Klebsiella pneumoniae ; Treatment Outcome ; Kidney Failure, Chronic/complications ; Disease Progression ; Retrospective Studies
Language	English
Publishing date	2023-12-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-023-08857-x
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Article ; Online: Using fiber tractography and diffusion kurtosis imaging to evaluate neuroimaging changes in patients with cerebrotendinous xanthomatosis after stopping chenodeoxycholic acid treatment for three years

Jun-Jun Lee / Chiung-Chih Chang / Wen-Neng Chang

Biomedical Journal, Vol 45, Iss 5, Pp 814-

2022 Volume 820

Abstract: Background: The aim of this study was to use tractography and diffusion kurtosis imaging (DKI) to evaluate cerebral white matter (WM) changes in patients with cerebrotendinous xanthomatosis (CTX) after stopping chenodeoxycholic acid (CDCA) treatment. ... ...

Abstract	Background: The aim of this study was to use tractography and diffusion kurtosis imaging (DKI) to evaluate cerebral white matter (WM) changes in patients with cerebrotendinous xanthomatosis (CTX) after stopping chenodeoxycholic acid (CDCA) treatment. Methods: Two siblings with CTX aged 40 and 38 years, respectively, who had been diagnosed with CTX for 16 years were enrolled. They had received CDCA treatment from 2005 until 2015, after which CDCA was no longer available in Taiwan. Serial brain magnetic resonance imaging (MRI) studies were used to record brain changes, and a seres of neuropsychiatric tests were used to evaluate cognitive changes 3 years after stopping CDCA treatment. Results: The conventional MRI studies revealed progressive changes in dentate nuclei and surrounding cerebellar hemispheres, but no obvious changes in cerebral white matter (WM). Tractography captured in 2018 showed a general reduction in fiber density, especially involving frontal lobe fibers, compared to 2015. In addition, the DKI studies performed in 2018 showed a decreased axonal water fraction in diffuse WM structures and increased RadEAD in frontal WM. Comparisons of the neuropsychiatric test results between 2015 and 2018 showed a marked decline in executive function including design fluency, digit backward span and digit forward span, and this cognitive impairment highly suggested frontal lobe dysfunction. Conclusions: This study may suggest that cerebral tractography and DKI study results can identify changes in cerebral WM in CTX patients shortly after stopping CDCA treatment, and that they may have a better correlation with the results of neuropsychiatric tests.
Keywords	Cerebrotendinous xanthomatosis ; Chenodeoxycholic acid ; Magnetic resonance imaging ; Tractography ; Diffusion kurtosis imaging ; Medicine (General) ; R5-920 ; Biology (General) ; QH301-705.5
Subject code	610
Language	English
Publishing date	2022-10-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
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Article ; Online: Using fiber tractography and diffusion kurtosis imaging to evaluate neuroimaging changes in patients with cerebrotendinous xanthomatosis after stopping chenodeoxycholic acid treatment for three years.

Lee, Jun-Jun / Chang, Chiung-Chih / Chang, Wen-Neng

Biomedical journal

2021 Volume 45, Issue 5, Page(s) 814–820

Abstract	Background: The aim of this study was to use tractography and diffusion kurtosis imaging (DKI) to evaluate cerebral white matter (WM) changes in patients with cerebrotendinous xanthomatosis (CTX) after stopping chenodeoxycholic acid (CDCA) treatment. Methods: Two siblings with CTX aged 40 and 38 years, respectively, who had been diagnosed with CTX for 16 years were enrolled. They had received CDCA treatment from 2005 until 2015, after which CDCA was no longer available in Taiwan. Serial brain magnetic resonance imaging (MRI) studies were used to record brain changes, and a seres of neuropsychiatric tests were used to evaluate cognitive changes 3 years after stopping CDCA treatment. Results: The conventional MRI studies revealed progressive changes in dentate nuclei and surrounding cerebellar hemispheres, but no obvious changes in cerebral white matter (WM). Tractography captured in 2018 showed a general reduction in fiber density, especially involving frontal lobe fibers, compared to 2015. In addition, the DKI studies performed in 2018 showed a decreased axonal water fraction in diffuse WM structures and increased RadEAD in frontal WM. Comparisons of the neuropsychiatric test results between 2015 and 2018 showed a marked decline in executive function including design fluency, digit backward span and digit forward span, and this cognitive impairment highly suggested frontal lobe dysfunction. Conclusions: This study may suggest that cerebral tractography and DKI study results can identify changes in cerebral WM in CTX patients shortly after stopping CDCA treatment, and that they may have a better correlation with the results of neuropsychiatric tests.
MeSH term(s)	Humans ; Xanthomatosis, Cerebrotendinous/drug therapy ; Xanthomatosis, Cerebrotendinous/pathology ; Chenodeoxycholic Acid/pharmacology ; Chenodeoxycholic Acid/therapeutic use ; Diffusion Tensor Imaging/methods ; Neuroimaging ; White Matter/diagnostic imaging ; White Matter/pathology
Chemical Substances	Chenodeoxycholic Acid (0GEI24LG0J)
Language	English
Publishing date	2021-09-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2698541-X
ISSN	2320-2890 ; 2320-2890
ISSN (online)	2320-2890
ISSN	2320-2890
DOI	10.1016/j.bj.2021.09.003
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Article: Correlation between Hypovitaminosis D and Nutritional Status with The Severity of Clinical Symptoms And Impaired Cognitive Function in Patients with Parkinson's Disease.

Lien, Chia-Yi / Lu, Cheng-Hsien / Chang, Chiung-Chih / Chang, Wen-Neng

Acta neurologica Taiwanica

2021 Volume 302, Page(s) 63–73

Abstract: Purpose: To evaluate the relationship between the severity of clinical symptoms and cognitive function of patients with Parkinson's disease (PD) and the serum vitamin D level and nutrition status.: Methods: Thirty-three adult PD patient were included ...

Abstract	Purpose: To evaluate the relationship between the severity of clinical symptoms and cognitive function of patients with Parkinson's disease (PD) and the serum vitamin D level and nutrition status. Methods: Thirty-three adult PD patient were included in the study (November 2016 to October 2018) and their clinical symptom severity (including the Hoehn and Yahr scale and unified Parkinson's disease rating scale (UPDRS)) and cognitive function (mini-mental state examination) were assessed in two visits (at time of enrollment and one year after the enrollment). In the meanwhile, their renal/liver function, serum level of vitamin D, vitamin B12, Folate and high-sensitive C-reactive protein were also measured for clinical correlation and comparisons. Results: From the two visits, we found our patients divided into two group, the well-nourished status group and at risk or malnutrition status group. In both visits, we uncovered patients at risk of malnutrition status had worse clinical severity and more impaired memory. As for hypovitaminosis D, the vitamin D level alone made no significant correlation with the clinical severity and cognitive function. Conclusion: This study revealed that PD patient with at risk of malnutrition status has impaired cognitive function but patients with abnormal serum vitamin D level did not have such influence. But PD patients with abnormal vitamin D level have a higher hs-CRP level which has an influence on the cognitive function of PD patients. Therefore, abnormal serum vitamin D level may have an indirect influence on the cognitive function of PD patients through the influence on the hs-CRP level. This study is limited by the small case-number and short follow-up time. Further large scale study and longer observation period are needed for a better delineation of the relationship between the serum vitamin D level and nutritional status with the clinical condition of the PD patients.
MeSH term(s)	Adult ; Cognition ; Humans ; Malnutrition ; Nutritional Status ; Parkinson Disease/complications ; Vitamin D Deficiency/complications
Language	English
Publishing date	2021-09-21
Publishing country	China (Republic : 1949- )
Document type	Journal Article
ZDB-ID	2192417-X
ISSN	1028-768X ; 1019-6099
ISSN	1028-768X ; 1019-6099
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Article: Klebsiella pneumoniae brain abscesses in an elderly patient without clinically evident neurological signs and symptoms.

Yang, Tsung-Pei / Chang, Wen-Neng / Lu, Cheng-Hsien / Lien, Chia-Yi

Acta neurologica Taiwanica

2019 Volume 281, Page(s) 12–16

Abstract: Purpose: It is difficult to diagnose a brain abscess if the patient does not have clinically evident neurological features. We present the diagnosis and therapeutic course of an elderly woman with multiple Klebsiella (K.) pneumoniae brain abscesses ... ...

Abstract	Purpose: It is difficult to diagnose a brain abscess if the patient does not have clinically evident neurological features. We present the diagnosis and therapeutic course of an elderly woman with multiple Klebsiella (K.) pneumoniae brain abscesses without neurological signs or symptoms. Case report: The patient was an 81-year-old woman without diabetes who had been discharged from our hospital about 7 days before this admission with a diagnosis of K. pneumoniae urinary tract and bloodstream infections. She did not have any clinically evident neurological features except for a fever, however focal suppurations were identified in the cerebral hemispheres and lungs by magnetic resonance imaging (MRI) and computed tomography, respectively. After an 11-week course of antibiotic treatment and serial cranial MRI follow-up studies, she was discharged in a stable condition with no neurological sequelae. Conclusion: Cranial MRI should be performed to identify the presence of brain abscesses in elderly patients with K. pneumoniae bloodstream infections but without clinically evident neurological signs or symptoms. Serial MRI studies are important to monitor the therapeutic course.
MeSH term(s)	Aged, 80 and over ; Brain Abscess ; Female ; Humans ; Klebsiella Infections ; Klebsiella pneumoniae ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed
Language	English
Publishing date	2019-07-03
Publishing country	China (Republic : 1949- )
Document type	Case Reports ; Journal Article
ZDB-ID	2192417-X
ISSN	1028-768X ; 1019-6099
ISSN	1028-768X ; 1019-6099
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Article ; Online: Beneficial Effect of TaON-Ag Nanocomposite Titanium on Antibacterial Capacity in Orthopedic Application.

Hu, Chih-Chien / Chang, Chih-Hsiang / Chang, Yuhan / Hsieh, Jang-Hsing / Ueng, Steve Wen-Neng

International journal of nanomedicine

2020 Volume 15, Page(s) 7889–7900

Abstract: Purpose: In this study, a novel oxygenated nanocomposite thin film, TaON-Ag, was investigated in vitro and in vivo to evaluate its biocompatibility and antibacterial ability.: Material and methods: The antibacterial ability of TaON-Ag nanocomposite- ... ...

Abstract	Purpose: In this study, a novel oxygenated nanocomposite thin film, TaON-Ag, was investigated in vitro and in vivo to evaluate its biocompatibility and antibacterial ability. Material and methods: The antibacterial ability of TaON-Ag nanocomposite-coated titanium (Ti) was evaluated using the Kirby-Bauer disk diffusion susceptibility test. The effects of TaON-Ag nanocomposite-coated metal on osteogenesis were further evaluated in an in vitro osteogenic culture model with rat marrow-derived mesenchymal stem cells (rMSCs). Furthermore, titanium rods coated with TaON-Ag were implanted into a rat femur fracture model either with or without osteomyelitis to investigate the effects of TaON-Ag in osteogenesis. Results: The TaON-Ag-coated Ti exhibited an effective antibacterial effect against Conclusion: Using the proposed novel oxygenation process, TaON-Ag nanocomposite-coated Ti yielded robust biocompatibility and antibacterial ability against common microorganisms in orthopedic infections, thereby demonstrating potential for use in clinical applications.
MeSH term(s)	Animals ; Anti-Bacterial Agents/chemistry ; Anti-Bacterial Agents/pharmacology ; Femoral Neck Fractures/microbiology ; Materials Testing ; Nanocomposites/chemistry ; Orthopedics ; Osteogenesis/drug effects ; Osteomyelitis/prevention & control ; Prostheses and Implants ; Rats ; Silver/chemistry ; Titanium/chemistry ; Titanium/pharmacology
Chemical Substances	Anti-Bacterial Agents ; Silver (3M4G523W1G) ; Titanium (D1JT611TNE)
Language	English
Publishing date	2020-10-13
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2364941-0
ISSN	1178-2013 ; 1176-9114
ISSN (online)	1178-2013
ISSN	1176-9114
DOI	10.2147/IJN.S264303
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Article: The Clinical Characteristics and Therapeutic Outcomes of Escherichia Coli Meningitis in Adults.

Hsiao, Wen-Chiu / Lee, Jun-Jun / Chien, Chun-Chih / Lu, Cheng-Hsien / Chang, Wen-Neng / Lien, Chia-Yi

Acta neurologica Taiwanica

2021 Volume 304, Page(s) 141–150

Abstract: Background: To examine the clinical characteristics and therapeutic outcome of Escherichia (E.) coli adult bacterial meningitis (ABM).: Methods: The demographic data, clinical and laboratory features and therapeutic outcome of 25 E. coli ABM patients ...

Abstract	Background: To examine the clinical characteristics and therapeutic outcome of Escherichia (E.) coli adult bacterial meningitis (ABM). Methods: The demographic data, clinical and laboratory features and therapeutic outcome of 25 E. coli ABM patients were examined retrospectively. The clinical features of the reported E. coli ABM cases were also included for analysis. Results: The 25 E. coli ABM patients included 12 women and 13 men, aged 33-78 years (mean= 59.9). Of these 25 patients, 13 had a postneurosurgical state as the underlying condition. As to the underlying medical conditions, diabetes mellitus was the most common, found in 9 of the 25 cases. Of the clinical manifestation, severe neurologic manifestations including altered consciousness (19), hydrocephalus (10), seizure (7) acute/subacute cerebral infarct (5), brain abscess (2), subdural empyema (1) and spinal abscess (1) were found, and the other clinical features included fever (21), septic shock (8), bacteremia (6) and hyponatremia (3). With treatment, the mortality rate was more than 44.0% and the presence of septic shock was a significant prognostic factor. With literature review, 29 community-acquired and 12 postneurosurgical E. coli ABM cases were enrolled, and severe neurologic manifestation and high mortality rate were also found. Conclusions: This preliminary overview of E. coli ABM revealed the underlying conditions, severe neurologic manifestation and high mortality rate. Further large-scale, prospective study is needed for a better delineation of this specific infectious syndrome of adult E. coli meningitis.
MeSH term(s)	Adult ; Escherichia coli ; Female ; Humans ; Male ; Meningitis, Bacterial/therapy ; Meningitis, Escherichia coli/therapy ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-11-29
Publishing country	China (Republic : 1949- )
Document type	Journal Article ; Review
ZDB-ID	2192417-X
ISSN	1028-768X ; 1019-6099
ISSN	1028-768X ; 1019-6099
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Article ; Online: Nationwide Population-Based Epidemiological Study for Outcomes of Adjunctive Steroid Therapy in Pediatric Patients with Bacterial Meningitis in Taiwan.

Hsieh, Dong-Yi / Lai, Yun-Ru / Lien, Chia-Yi / Chang, Wen-Neng / Huang, Chih-Cheng / Cheng, Ben-Chung / Kung, Chia-Te / Lu, Cheng-Hsien

International journal of environmental research and public health

2021 Volume 18, Issue 12

Abstract: Although corticosteroids can serve as an effective anti-inflammatory adjuvant therapy, the role of adjunctive steroid therapy in pediatric bacterial meningitis in Taiwan remains under-investigated. Cases of acute bacterial meningitis, aged between 1 ... ...

Abstract	Although corticosteroids can serve as an effective anti-inflammatory adjuvant therapy, the role of adjunctive steroid therapy in pediatric bacterial meningitis in Taiwan remains under-investigated. Cases of acute bacterial meningitis, aged between 1 month and 20 years, were divided into a steroid group (empirical antibiotics with adjunctive steroid therapy) and a non-steroid group (empirical antibiotics only). Data were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision codes. Of the 8083 episodes enrolled in this study, 26% (2122/8083) and 74% (5961/8083) were divided into the steroid and non-steroid groups, respectively. The fatality rates were 7.9% in the steroid group and 1.7% in the non-steroid group during hospitalization (
MeSH term(s)	Anti-Inflammatory Agents/therapeutic use ; Child ; Humans ; Infant ; Meningitis, Bacterial/drug therapy ; Meningitis, Bacterial/epidemiology ; Prospective Studies ; Steroids/therapeutic use ; Taiwan/epidemiology
Chemical Substances	Anti-Inflammatory Agents ; Steroids
Language	English
Publishing date	2021-06-12
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph18126386
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Article: The Clinical Features and Therapeutic Outcomes of Young Adults with Cryptococcal Meningitis.

Huang, Yu-Ju / Tsai, Wan-Chen / Lien, Chia-Yi / Lee, Jun-Jun / Lu, Cheng-Hsien / Chang, Wen-Neng

Acta neurologica Taiwanica

2021 Volume 301, Page(s) 11–20

Abstract: Objective: No previous study has reported on the clinical characteristics of cryptococcal meningitis (CM) focusing solely on young adults.: Patients and methods: Ninety-nine adult patients with CM (64 men and 35 women) were enrolled, of whom 26 were ... ...

Abstract	Objective: No previous study has reported on the clinical characteristics of cryptococcal meningitis (CM) focusing solely on young adults. Patients and methods: Ninety-nine adult patients with CM (64 men and 35 women) were enrolled, of whom 26 were classified into the young adult group (≤ 40 years) and 73 into the non-young adult group (> 40 years). The modified Rankin scale (mRS) was used to evaluate the outcomes of the survivors at the time of discharge and at 1 year of follow-up. The clinical characteristics and laboratory data between 1) the young adult CM patients with and without acquired immunecompromised syndrome and 2) the male and female young adult CM patients were compared. The prognostic factors of the young adult CM patients were also analyzed. Results: The young adult group had a higher incidence of headache as the clinical presentation which may have been due to the higher intracranial pressure in this group. The overall mortality rate of the young adults with CM was high (38.5%, 10/26), but no significant prognostic factors were found. In followup studies of the neurologic deficits, the young adult survivors had better outcomes (mRS scores = 0-2) than the non-young adult group at discharge and 1 year after discharge. Conclusion: The young adult CM patients had a higher incidence of headache as the clinical presentation. Although the mortality rate in the young adult CM patients was high, the survivors had better neurologic outcomes.
MeSH term(s)	Female ; Headache/etiology ; Humans ; Male ; Meningitis, Cryptococcal/drug therapy ; Meningitis, Cryptococcal/epidemiology ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2021-09-21
Publishing country	China (Republic : 1949- )
Document type	Journal Article
ZDB-ID	2192417-X
ISSN	1028-768X ; 1019-6099
ISSN	1028-768X ; 1019-6099
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