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Biomedical subjects

K C Chung

Publications and source records attributed to K C Chung.

At least 55 records · Page 3Linked to original sources
PubMed1999

Kinematics of cervical spine discectomy with and without bone grafting: quantitative evaluation of late fusion in a sheep model.

OBJECTIVE: This study was conducted to evaluate the kinematic response of late fusion results for cervical spine discectomies with and without bone grafting. MATERIALS AND METHODS: Fifteen Barbados Black Belly sheep underwent sham operations (Group A, n = 5), C2-C3 discectomies only (Group B, n = 5), and C2-C3 discectomies with autologous iliac bone grafting (Group C, n = 5). Ten months after surgery, the animals were killed. Fresh ligamentous spines (C1-C5) were subjected to the relevantly applied loads through a loading frame attached to the C1. Each vertebra (from C2 to C4) was attached with a set of three infrared light-emitting diodes to record the spatial location relating to each load application using a Selspot II system (Selcom Selective Electronics, Inc., Valdese, NC). The load-deformation data of the C2-C3 and C3-C4 motion segments were recorded and analyzed for the three groups. RESULTS: At the C2-C3 motion segment, the results indicated that Group B displayed larger motion ranges of rotation and lateral bending loads than did the other two groups. Significantly larger motion ranges of rotation loads were found in Group B than in Group C (P<0.05, for both comparisons). In contrast, Group C had the smallest motion ranges of flexion, lateral bending, and rotation loads. At the C3-C4 motion segment, both groups that had undergone discectomies had a significantly larger motion range of flexion load compared with Group A (P<0.05, for both comparisons). A significant increase in the motion range of right axial rotation was found in Group B (P<0.05), but not in Group C, compared with Group A. Group B exhibited larger motion ranges responding to all six tested loads than did Group C. CONCLUSION: The results indicate that anterior fusion after C2-C3 cervical discectomies, regardless of the presence or absence of bone grafting, decreases the motion range of flexion load at the C2-C3 motion segment, and contrary data were seen at the C3-C4 motion segment. For axial rotation loads, discectomies without bone grafting resulted in increased motion ranges of both C2-C3 and C3-C4 motion segments whereas discectomies with bone grafting did not. The data may have clinical relevance regarding the role of bone grafting in cases of cervical spine disease.

Animals↗
PubMed1999

Quadrangular space syndrome associated with superficial radial sensory neuropathy.

Compression of the axillary nerve in the quadrangular space is an unusual cause of pain and paresthesia of the upper extremity. In this report, the authors present a patient with a 1-year history of an undiagnosed axillary nerve compression associated with radial sensory neuropathy who improved after surgical decompression of the quadrangular space.

Adult↗
PubMed1998

Expression of immediate early gene cyr61 during the differentiation of immortalized embryonic hippocampal neuronal cells.

Growth factor-mediated signal transduction is a process that is of fundamental importance in understanding cellular growth and differentiation. In order to elucidate the signaling pathways leading to neuronal differentiation, we have tried to identify intermediates that are selectively induced in the differentiation of immortalized neuronal hippocampal cell line H19-7. In the present study we found that immediate early gene cyr61 is expressed in a rapid and transient manner by bFGF during the differentiation of H19-7 cells. To clarify the signal transduction pathway for the induction of cyr61 by bFGF, we checked whether Raf-1 and mitogen-activated protein kinase (MAPK) is activated during the induction of cyr61. It is identified that cyr61 is induced by bFGF via at least two signaling pathways; MAPK-dependent as well as MAPK-independent signaling pathways. This study suggested that cyr61 is likely to play an important role in neuronal differentiation process.

Animals↗
PubMed1998

Frequent allelic loss on chromosomes 4q and 16q associated with human hepatocellular carcinoma in Taiwan.

To define the critical region of liver-specific tumor suppressor genes in human hepatocellular carcinoma (HCC), we analyzed 30 cases of hepatocellular carcinoma using nine 4q and six 16q microsatellite polymorphic DNA markers. We observed one major common deleted region which was flanked by D4S175-D4S1625 and there may be two tumor suppressor genes on chromosome 16q associated with HCC. An extensive study of allelotyping of human HCC was therefore carried out in the candidate region on arms of chromosome 4q with additional tumor tissues and more informative microsatellite DNA markers. These data imply that at least one putative tumor suppressor gene is located in the human chromosome 4q26-q27 region and provides very useful information for further construction of a long-range physical restriction map and thereafter cloning of the putative tumor suppressor gene.

Carcinoma, Hepatocellular↗
PubMed1998

Phentolamine effect on the spontaneous electrical activity of active loci in a myofascial trigger spot of rabbit skeletal muscle.

OBJECTIVE: To investigate the effect of phentolamine, a sympathetic blocking agent, on the spontaneous electrical activity (SEA) recorded from a locus of a myofascial trigger spot (MTrS), equivalent to a human trigger point, in rabbit skeletal muscle. DESIGN: Randomized control trial. SETTING: A university medical laboratory. PATIENTS OR OTHER PARTICIPANTS: Nine adult New Zealand rabbits. INTERVENTION: In the experimental group phentolamine mesylate (1mg/kg) was injected into the external iliac artery, followed by flushing with normal saline. The control group was treated with normal saline instead of phentolamine using the same procedure. MAIN OUTCOME MEASURES: SEA was recorded from multiple active loci of MTrSs in the biceps femoris muscle: initially SEA in the same locus was recorded before and immediately after phentolamine (or normal saline) injection; then SEA was recorded from 25 different active loci. The mean of the average integrated signal (AIS) of SEA was analyzed, comparing the effects of phentolamine and normal saline on SEA. RESULTS: In the same active locus, the AIS of SEA showed statistically a linear decay with time after phentolamine injection, with a correlation coefficient of .56 at p < .05. However, no statistical relationship could be derived for the control group data with time by using regression analysis, probably because of large variations among the rabbits and movement artifacts during the experiment. In 25 different loci in the phentolamine group, the mean of the AIS of SEA (7.92 microV) was significantly lower than that of the control group (9.89 microV) at p < .05. CONCLUSIONS: The results support the hypothesis that the autonomic nervous system is involved in the pathogenesis of myofascial trigger points. The application of the AIS as an evaluation index seems to be feasible in the quantitative measurement of SEA.

Adrenergic alpha-Antagonists↗
PubMed1998

Reliability and validity testing of the Michigan Hand Outcomes Questionnaire.

In this study, psychometric principles were used to develop an outcomes questionnaire capable of measuring health state domains important to patients with hand disorders. These domains were hypothesized to include (1) overall hand function, (2) activities of daily living (ADL), (3) pain, (4) work performance, (5) aesthetics, and (6) patient satisfaction with hand function. An initial pool of 100 questions was pilot-tested for clarity in 20 patients; following factor analysis, the number of questions was reduced to a 37-item Michigan Hand Outcomes Questionnaire (MHQ). The MHQ, along with the Short Form-12, a generic health status outcomes questionnaire, was then administered to 200 consecutive patients at a university-based hand surgery clinic and was subjected to reliability and validity testing. The mean time required to complete the questionnaire was 10 minutes (range, 7-20 minutes). Factor analysis supported the 6 hypothesized scales. Test-retest reliability using Spearman's correlation demonstrated substantial agreement, ranging from 0.81 for the aesthetics scale to 0.97 for the ADL scale. In testing for internal consistency, Cronbach's alphas ranged from 0.86 for the pain scale to 0.97 for the ADL scale (values >0.7 for Cronbach's alpha are considered a good internal consistency). Correlation between scales gave evidence of construct validity. In comparing similar scales in the MHQ and the Short Form-12, a moderate correlation (range, 0.54-0.79) for the ADL, work performance, and pain scales was found. In evaluating the discriminate validity of the aesthetics scale, a significant difference (p = .0012) was found between the aesthetics scores for patients with carpal tunnel syndrome and patients with rheumatoid arthritis. The MHQ is a reliable and valid instrument for measuring hand outcomes. It can be used in a clinic setting with minimal burden to patients. The questions in the MHQ have undergone rigorous psychometric testing, and the MHQ is a promising instrument for evaluation of outcomes following hand surgery.

Factor Analysis, Statistical↗
PubMed1998

Type II (beta) errors in the hand literature: the importance of power.

When a study concludes that there is no difference between 2 treatments ("negative studies"), it is essential to determine whether the study has sufficient power to find a clinically significant difference. Insufficient power precludes an adequate assessment of therapeutic efficacy and may result in a type II error, an erroneous conclusion that the null hypothesis is correct. In evaluating 39 studies that highlighted negative findings in The Journal of Hand Surgery, we found that 32 (82%) papers had a power of less than .80 to detect a 25% treatment effect and, when the treatment effect was increased to 50%, more than one half of the studies still had a power of 0.80. These "negative studies" frequently have inadequate statistical power to support their conclusions. These findings have important implications for researchers, editors, and readers.

Animals↗
PubMed1998

Factors influencing the functional outcome of patients with acute epidural hematomas: analysis of 200 patients undergoing surgery.

OBJECTIVE: To determine the prognostic factors of the functional outcome of patients surgically treated for acute epidural hematomas. METHODS: Two hundred patients who consecutively underwent neurosurgery for acute epidural hematomas over the past 9-year period were studied. Clinical characteristics, radiologic findings, and the time intervals with regard to treatment course were investigated to determine the interactions between all these factors and functional outcome. RESULTS: Functional outcome showed a significant correlation with preoperative consciousness state, Glasgow Coma Scale score, pupillary sizes, and motor posturing (chi2 test, p < 0.05). Functional outcome correlated with the period of brain herniation, the length of time of the operation, as well as the period of hospitalization (chi2 test, p < 0.05), but not with the length of time of craniotomy decompression relative to the length of time from the injury until admission. The radiologic findings of the associated brain injury, the size and the density of the clot, the degree of the brain shift, and the obliteration of the basal cisterns significantly correlated with functional outcome (chi2 test, p < 0.05), whereas no significance was attributable to skull fracture. Multivariate analysis indicated that the following four factors independently correlated with functional outcome: (1) associated brain injury, (2) best motor response, (3) hematoma volume, and (4) period of hospitalization (chi2 test, p < 0.05). A combination of the four factors led to the prediction of the functional outcome with 91% accuracy (1.5 % falsely pessimistic predictions and 7.5 % falsely optimistic prediction) and 82.1% at over 90% confidence level. These four parameters correlated significantly with preoperative neurologic deterioration (chi2 test, p < 0.05). CONCLUSION: This study identifies the risk factors involved in the functional outcome of patients who underwent surgical treatment for acute epidural hematomas. Our results indicate that associated brain injury plus best motor response are the optimal set of two prognostic indicants, with 87% correct predictions and 70.1% at over a 90% confidence level. Prevention of in-hospital neurologic deterioration would improve the patients' functional outcome with a resultant unfavorable recovery rate ranging from 11.5% to 17%.

Acute Disease↗
PubMed1998

Decision-analysis methodology in the work-up of women with suspected silicone breast implant rupture.

Despite numerous studies advocating ultrasonography and magnetic resonance imaging (MRI) in the evaluation of women with possible silicone breast implant rupture, an appropriate algorithm has not been published for the optimal use of these tests. To derive a diagnostic algorithm using ultrasonography and MRI, we applied a decision-analytic model using Bayes' theorem to calculate the probabilities of implant rupture for three representative patient characteristics. A Medline search was conducted to identify literature related to the diagnosis of silicone breast implant rupture using ultrasonography and MRI since 1994. Also examined were case series of implant rupture to obtain rupture prevalence in cases in which rupture was dependent on patient presentation (symptomatic versus asymptomatic) and dependent on implant age. Test characteristics (sensitivity and specificity) and implant rupture prevalence are used to calculate the probability of rupture by using Bayes' theorem. These probabilities are derived for three patient categories: (1) asymptomatic, (2) symptomatic with implant age < or = 10 years, and (3) symptomatic with implant age >10 years. In asymptomatic patients, the pretest rupture prevalence is 6.5 percent. If a screening ultrasonography shows no rupture, the probability of rupture drops to 2.2 percent. If ultrasonography shows rupture, the probability of true rupture increases to 37.8 percent. Removal of implants in this setting will result in a high probability of extracting normal implants. However, if MRI after the ultrasonography shows rupture, the probability of true rupture increases to 86 percent, which gives better assurance of removing true-ruptured implants. In "symptomatic" patients (i.e., breast asymmetry, capsular contracture) with implants < or = 10 years old, the prevalence of rupture is estimated at 31 percent. If ultrasonography shows no rupture, the probability of rupture drops to 16 percent. If ultrasonography shows rupture, the probability of true rupture is 79.7 percent, and this probability increases to 97.5 percent if a follow-up MRI also shows rupture. In symptomatic patients with implants >10 years old, the prevalence of rupture is estimated at 64 percent. If ultrasonography shows rupture, the probability of true rupture increases to 94 percent, and no further diagnostic work-up is necessary. In an asymptomatic patient who is worried about the integrity of her implants, ultrasonography should be used as an initial diagnostic test because of its lower cost. If ultrasonography shows no rupture, no further work-up is necessary. If ultrasonography shows rupture, the low probability (37.8 percent) of true rupture requires a confirmatory test using MRI. In "symptomatic" patients, the high prevalence of rupture markedly raises the posttest probability of rupture for positive ultrasonography findings. Particularly in "symptomatic" patients with implants >10 years old, the high posttest probability of rupture (94 percent) with a positive ultrasonography obviates the need for any further diagnostic testing. This diagnostic algorithm will assist plastic surgeons in counseling women who are worried about the integrity of their silicone breast implants.

Bayes Theorem↗
PubMed1998

Endoscopic versus open carpal tunnel release: a cost-effectiveness analysis.

Endoscopic carpal tunnel release is a controversial procedure used in the treatment of carpal tunnel syndrome. Although endoscopic carpal tunnel release is associated with less incisional pain and faster recovery time than the open carpal tunnel release, opponents of endoscopic carpal tunnel release suggest that its benefits are outweighed by its higher complication rates from median nerve transection and transient numbness of the fingers. Because of the huge economic and social impact of carpal tunnel syndrome in this country, we performed a cost-effectiveness analysis comparing endoscopic carpal tunnel release and open carpal tunnel release using guidelines established by the Panel on Cost-Effectiveness in Health and Medicine of the U.S. Public Health Service. A decision analytic model was used to measure differences in cost and effectiveness--expressed as quality-adjusted life-years (QALYs)--between endoscopic carpal tunnel release and open carpal tunnel release. The societal perspective was chosen, and probabilities for various outcomes for the two procedures were obtained from published randomized-controlled trials. Cost data were derived from the Medicare Resource-Based Relative Value Units published in the Federal Register. QALYs were obtained from two groups of health care providers using a utility-assessment questionnaire. Using probabilities for various outcomes from the two published randomized-controlled trials comparing endoscopic carpal tunnel release and open carpal tunnel release, we constructed a decision tree to derive both the cost and the QALYs for the two procedures. The incremental cost difference between endoscopic carpal tunnel release and open carpal tunnel release was $46, using Medicare cost and probabilities of various outcomes derived from a study by Brown et al. in 1993. We calculated QALYs for five age groups--25, 35, 45, 55, 65--assuming a life expectancy of 75 years. The marginal effectiveness (QALY of endoscopic carpal tunnel release minus QALY of open carpal tunnel release) ranged from 0.235 QALY for the 25-year-old age group to 0.066 QALY for the 65-year-old age group, giving a cost-effectiveness ratio of $195/QALY and $693/QALY, respectively. When compared with other accepted medical interventions such as breast cancer screening ($4836/QALY) and exercise to prevent coronary heart disease ($13,508/QALY), endoscopic carpal tunnel release seems to be cost-effective. However, our sensitivity analysis indicated that the cost-effectiveness ratio was very sensitive to a major complication such as median nerve injury. For endoscopic carpal tunnel release to be a cost-effective procedure, the incidence of median nerve injury must be one percentage point less for endoscopic carpal tunnel release than for open carpal tunnel release. Based on the data from the randomized-controlled trials, endoscopic carpal tunnel release seems to be a cost-effective procedure; however, before it can be recommended, greater emphasis must be given to the training of surgeons in this new technique, so that major complications such as median nerve injuries can be avoided. In addition, future studies must better define the actual incidence of nerve injuries for both endoscopic carpal tunnel release and open carpal tunnel release in the community setting.

Adult↗
PubMed1998

Raf and fibroblast growth factor phosphorylate Elk1 and activate the serum response element of the immediate early gene pip92 by mitogen-activated protein kinase-independent as well as -dependent signaling pathways.

Previous studies have shown that a mitogen activated protein (MAP) kinase (MEK)-independent signaling pathway is required by activated Raf or fibroblast-derived growth factor (FGF) for the differentiation of rat hippocampal neuronal H19-7 cells. We now demonstrate that both Raf and FGF similarly induce prolonged transcription and translation of the immediate early gene pip92 in the absence of activation of the MAP kinases (MAPKs) ERK1 and ERK2. To determine the mechanism by which this occurs and to identify novel Raf-activated signaling pathways, we investigated the induction of the pip92 promoter by both FGF and an estradiol-activated Raf-1-estrogen receptor fusion protein (deltaRaf-1:ER) in H19-7 cells. Deletion analysis of the pip92 promoter indicated that activation by the MAPK-independent pathway occurs primarily within the region containing a serum response element (SRE). Further analysis of the SRE by using a heterologous thymidine kinase promoter showed that both an Ets and CArG-like site are required. Elk1, which binds to the Ets site, was phosphorylated both in vitro and in vivo by the MAPK-independent pathway, and phosphorylation of an Elk1-GAL4 fusion protein by this pathway was sufficient for transactivation. Finally, at least two Elk1 kinases were fractionated by gel filtration, and analysis by an in-gel kinase assay revealed at least three novel Raf-activated Elk1 kinases. These results indicate that both FGF and Raf activate MAPK-independent kinases that can stimulate Elk1 phosphorylation and immediate early gene transcription.

Animals↗
PubMed1998

Superior sagittal sinus thrombosis and transient ischemic attacks: possible mechanism.

Clinical manifestations of superior sagittal sinus (SSS) thrombosis are nonspecific but characterized by headache, papilledema, seizures, focal deficits, progressive coma and death. Recurrent transient focal neurologic deficit is an extremely rare manifestation in superior sagittal sinus thrombosis and the mechanism is unknown. A 45-year-old man presented with headache for two weeks and four episodes of transient (5-10 minutes) right or left hemiparesis for two days. Magnetic resonance image and transfemoral cerebral angiography revealed superior sagittal sinus thrombosis with numerous prominent collateral venous channels. There was no parenchymal lesion. After four days of heparinization, no further transient focal neurologic deficits developed. Follow-up angiography showed partial recanalization of the SSS. Possible mechanism of transient ischemic attacks in this patient is thought to be a transient functional disturbance due to a temporal reduction of tissue perfusion in the process of operating fully-enough collateral channels.

Cerebral Angiography↗
PubMed1998

Airborne contaminant exposure control in a partitioned work environment by exhaust ventilation systems.

The evaluation of contaminant removal effectiveness can play a key role in a working environment quality investigation and in remediation efforts. In this study a computer simulation technique was developed for assessing the efficiency of contaminant removal within a partitioned working environment. To determine the effect of the physical parameters of each partitioned space on contaminant removal effectiveness, a relative contaminant concentration unit was used to show the simulation results. In addition, tracer gas techniques were adopted to validate the accuracy of the prediction model. A comparison of measured CO2 concentrations in a controlled environment chamber with the results of a simulation model is presented. This study investigated the partition configuration of work environment and environment parameters including openings operation, constant concentration, and exhaust air volume mode. Results indicated that variations of the above three parameters can produce great differences in overall ventilation performance. Through this type of study, the interaction of airflow and contaminant concentration between partitioned spaces can be understood in advance and adequate knowledge can be provided to maintain a high-quality and healthy environment for workers.

Air Movements↗
PubMed1997

Pharmacokinetics of meropenem in animals, healthy volunteers, and patients.

Meropenem is a carbapenem antibiotic that appears to be widely distributed in tissues and is eliminated by both excretion and metabolism. Approximately 70% of meropenem is excreted via the kidneys, thus dosage adjustments are required for patients with renal impairment. The pharmacokinetic parameters for meropenem are similar to those for imipenem/cilastatin, with the exception of meropenem's smaller volume of distribution. The urinary recovery of meropenem is as high as that of imipenem in combination with cilastatin, an inhibitor of renal dehydropeptidase. Therefore, unlike imipenem, meropenem can be used without dehydropeptidase inhibitors to obtain a consistently high concentration in the urine without nephrotoxic effects.

Adult↗
PubMed1997

Efficacy of magnetic resonance angiography in the evaluation of vascular malformations of the hand.

Conventional arteriography has been the accepted standard technique for demonstrating the anatomic details in vascular malformations of the hand. The technique of magnetic resonance angiography provides detailed anatomy for vascular anomalies of the hand without the use of an invasive technique or contrast enhancement. When magnetic resonance angiography is combined with magnetic resonance imaging, the extent of the lesion with respect to the surrounding tissues and the flow characteristics of the lesion can be determined noninvasively. In our institution, magnetic resonance angiography has replaced conventional arteriography as the technique of choice for the evaluation of these lesions. This report evaluates the efficacy of magnetic resonance imaging/ magnetic resonance angiography in the management of vascular malformations of the hand. Ten consecutive patients over 30 months (median age 37 years) underwent magnetic resonance imaging/magnetic resonance angiography evaluation after the clinical diagnosis of a vascular malformation of the hand was made. Four patients in the group had conventional arteriography performed before referral. Magnetic resonance imaging/magnetic resonance angiography clearly defined the anatomic extent of the lesion, its relationship to surrounding tissues, and the flow characteristics in each patient. In the four patients in whom conventional arteriography had been performed, the magnetic resonance angiography findings matched the arteriographic findings. On the basis of the magnetic resonance imaging/magnetic resonance angiography findings, six patients were treated nonoperatively with compressive garments and four patients had operative treatment (resection of lesion n = 2, digital ray resection n = 2). In this series, magnetic resonance imaging/magnetic resonance angiography was efficacious in the management of vascular malformations of the hand. This technique provides detailed images of both the arterial and venous components of the lesions without the requirements of contrast enhancement, ionizing radiation, or an invasive procedure. Furthermore, the resectability can be determined based on the extent of involvement and the flow characteristics.

Adolescent↗
PubMed1997

Differentiation of central nervous system neuronal cells by fibroblast-derived growth factor requires at least two signaling pathways: roles for Ras and Src.

To evaluate the role of mitogen-activated protein (MAP) kinase and other signaling pathways in neuronal cell differentiation by basic fibroblast-derived growth factor (bFGF), we used a conditionally immortalized cell line from rat hippocampal neurons (H19-7). Previous studies have shown that activation of MAP kinase kinase (MEK) is insufficient to induce neuronal differentiation of H19-7 cells. To test the requirement for MEK and MAP kinase (ERK1 and ERK2), H19-7 cells were treated with the MEK inhibitor PD098059. Although the MEK inhibitor blocked the induction of differentiation by constitutively activated Raf, the H19-7 cells still underwent differentiation by bFGF. These results suggest that an alternative pathway is utilized by bFGF for differentiation of the hippocampal neuronal cells. Expression in the H19-7 cells of a dominant-negative Ras (N17-Ras) or Raf (C4-Raf) blocked differentiation by bFGF, suggesting that Ras and probably Raf are required. Expression of dominant-negative Src (pcSrc295Arg) or microinjection of an anti-Src antibody blocked differentiation by bFGF in H19-7 cells, indicating that bFGF also signals through a Src kinase-mediated pathway. Although neither constitutively activated MEK (MEK-2E) nor v-Src was sufficient individually to differentiate the H19-7 cells, coexpression of constitutively activated MEK and v-Src induced neurite outgrowth. These results suggest that (i) activation of MAP kinase (ERK1 and ERK2) is neither necessary nor sufficient for differentiation by bFGF; (ii) activation of Src kinases is necessary but not sufficient for differentiation by bFGF; and (iii) differentiation of H19-7 neuronal cells by bFGF requires at least two signaling pathways activated by Ras and Src.

Animals↗
PubMed1997

Encephalitis and polyradiculoneuritis following rubella virus infection--a case report.

Amongst neurological complications of rubella virus infection, polyradiculoneuritis as well as encephalitis is very rare. Only one case of postrubella polyradiculoneuritis combined with encephalitis has been reported to our knowledge. A 17-years-old male presented with suspected meningoencephalitis in a recent epidemic of rubella in a southern district of Korea. He developed symmetrical hyporeflexic weakness of all four extremities with urinary disturbance several days later. Rubella IgM antibody titer (enzyme linked immunosorbent assay) was 58 AU/mL in serum and 12 AU/mL in cerebrospinal fluid. Electrophysiologic studies showed peripheral polyradiculoneuropathy with multifocal conduction block. Considering the involvement of the central nerve as well as the peripheral nerve in an adult patient, this case is thought to be valuable in view of the pathophysiology of neurologic complication in rubella virus infection.

Adolescent↗