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Gonzalez-Martinez A, Fanjul V, Ramos C, Serrano Ballesteros J, Bustamante M, Villa Martí A, Álvarez C, García Del Álamo Y, Vivancos J, Gago-Veiga AB. Headache during SARS-CoV-2 infection as an early symptom associated with a more benign course of disease: a case-control study. Eur J Neurol 2021; 28:3426-3436. [PMID: 33417287 DOI: 10.1111/ene.14718] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Headache is an important manifestation during SARS-CoV-2 infection. In this study, the aim was to identify factors associated with headache in COVID-19 and headache characteristics. METHODS This case-control study includes COVID-19 hospitalized patients with pneumonia during March 2020. Controls comprise COVID-19 patients without headache and the cases are COVID-19 patients with headache. Demographic, clinical and laboratory data were obtained from the medical records. Headache characteristics were evaluated by semi-structured telephonic interview after discharge. RESULTS Of a total of 379 COVID-19 patients, 48 (13%) developed headache. Amongst these, 30 (62%) were men and the median age was 57.9 (47-73) years. Headache was associated with younger age, fewer comorbidities and reduced mortality, as well as with low levels of C-reactive protein, mild acute respiratory distress syndrome and oropharyngeal symptoms. A logistic multiple regression model revealed that headache was directly associated with D-dimer and creatinine levels, the use of high flow nasal cannula and arthromyalgia, whilst urea levels, beta-lactamic treatment and hypertension were negatively associated with headache. COVID-19-associated headache characteristics were available for 23/48 (48%) patients. Headache was the onset symptom in 8/20 (40%) patients, of mild or moderate intensity in 17/20 (85%) patients, with oppressive characteristics in 17/18 (94%) and of holocranial 8/19 (42%) or temporal 7/19 (37%) localization. CONCLUSIONS Our results show that headache is associated with a more benign SARS-CoV-2 infection. COVID-19-associated headache appears as an early symptom and as a novel headache with characteristics of headache attributed to systemic viral infection. Further research addressing the underlying mechanisms to confirm these findings is warranted.
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Affiliation(s)
- Alicia Gonzalez-Martinez
- Neurology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Víctor Fanjul
- Biostatistician at Savana and Headache Unit Collaborator at Department of Neurology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Ramos
- Neurology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.,Headache Unit, Neurology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Jorge Serrano Ballesteros
- Internal Medicine Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Marta Bustamante
- Internal Medicine Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Almudena Villa Martí
- Internal Medicine Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Claudia Álvarez
- Internal Medicine Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Yaiza García Del Álamo
- Internal Medicine Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - José Vivancos
- Neurology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Ana Beatriz Gago-Veiga
- Neurology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.,Headache Unit, Neurology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
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Scuteri D, Adornetto A, Rombolà L, Naturale MD, De Francesco AE, Esposito S, Zito M, Morrone LA, Bagetta G, Tonin P, Corasaniti MT. Pattern of triptans use: a retrospective prescription study in Calabria, Italy. Neural Regen Res 2020; 15:1340-1343. [PMID: 31960822 PMCID: PMC7047800 DOI: 10.4103/1673-5374.272630] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Triptans are 5-hydroxytryptamine 1B/1D receptor agonists used in moderate to severe migraine attacks as first line when non-specific, symptomatic, nonsteroidal anti-inflammatory drugs are not effective. To gain insight in the treatment of migraine in the regional context, this retrospective (from January to August of the years 2017 and 2018) study aimed at monitoring the use of triptans approved by the regional health authority in Calabria. The data demonstrate that the overall treatment of migraine with triptans in the different provinces of Calabria falls in the average regional prescription/dispensation. Interestingly, Crotone showed a trend to an increased amount of defined daily dose/1000 inhabitants per day. The present analysis might stand for homogeneity of treatment of migraineurs in Calabria and highlights the need for better understanding the apparent differences in the local pattern of almotriptan use to improve the appropriateness.
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Affiliation(s)
- Damiana Scuteri
- Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Cosenza, Italy
| | - Annagrazia Adornetto
- Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Cosenza, Italy
| | - Laura Rombolà
- Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Cosenza, Italy
| | - Maria Diana Naturale
- School of Hospital Pharmacy, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | | | | | | | - Luigi Antonio Morrone
- Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Cosenza, Italy
| | - Giacinto Bagetta
- Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Cosenza, Italy
| | - Paolo Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, Crotone, Italy
| | - Maria Tiziana Corasaniti
- School of Hospital Pharmacy; Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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Cheng XQ, Liang XZ, Wei S, Ding X, Han GH, Liu P, Sun X, Quan Q, Tang H, Zhao Q, Shang AJ, Peng J. Protein microarray analysis of cytokine expression changes in distal stumps after sciatic nerve transection. Neural Regen Res 2020; 15:503-511. [PMID: 31571662 PMCID: PMC6921340 DOI: 10.4103/1673-5374.266062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A large number of chemokines, cytokines, other trophic factors and the extracellular matrix molecules form a favorable microenvironment for peripheral nerve regeneration. This microenvironment is one of the major factors for regenerative success. Therefore, it is important to investigate the key molecules and regulators affecting nerve regeneration after peripheral nerve injury. However, the identities of specific cytokines at various time points after sciatic nerve injury have not been determined. The study was performed by transecting the sciatic nerve to establish a model of peripheral nerve injury and to analyze, by protein microarray, the expression of different cytokines in the distal nerve after injury. Results showed a large number of cytokines were up-regulated at different time points post injury and several cytokines, e.g., ciliary neurotrophic factor, were downregulated. The construction of a protein-protein interaction network was used to screen how the proteins interacted with differentially expressed cytokines. Kyoto Encyclopedia of Genes and Genomes pathway and Gene ontology analyses indicated that the differentially expressed cytokines were significantly associated with chemokine signaling pathways, Janus kinase/signal transducers and activators of transcription, phosphoinositide 3-kinase/protein kinase B, and notch signaling pathway. The cytokines involved in inflammation, immune response and cell chemotaxis were up-regulated initially and the cytokines involved in neuronal apoptotic processes, cell-cell adhesion, and cell proliferation were up-regulated at 28 days after injury. Western blot analysis showed that the expression and changes of hepatocyte growth factor, glial cell line-derived neurotrophic factor and ciliary neurotrophic factor were consistent with the results of protein microarray analysis. The results provide a comprehensive understanding of changes in cytokine expression and changes in these cytokines and classical signaling pathways and biological functions during Wallerian degeneration, as well as a basis for potential treatments of peripheral nerve injury. The study was approved by the Institutional Animal Care and Use Committee of the Chinese PLA General Hospital, China (approval number: 2016-x9-07) in September 2016.
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Affiliation(s)
- Xiao-Qing Cheng
- Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Xue-Zhen Liang
- Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Institute of Orthopedics, Chinese PLA General Hospital, Beijing; The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Shuai Wei
- Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Xiao Ding
- Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Gong-Hai Han
- Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Ping Liu
- Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Xun Sun
- Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Qi Quan
- Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - He Tang
- Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Qing Zhao
- Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Ai-Jia Shang
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province; Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Jiang Peng
- Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Institute of Orthopedics, Chinese PLA General Hospital, Beijing; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province, China
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Kogelman LJA, Esserlind AL, Francke Christensen A, Awasthi S, Ripke S, Ingason A, Davidsson OB, Erikstrup C, Hjalgrim H, Ullum H, Olesen J, Folkmann Hansen T. Migraine polygenic risk score associates with efficacy of migraine-specific drugs. NEUROLOGY-GENETICS 2019; 5:e364. [PMID: 31872049 PMCID: PMC6878840 DOI: 10.1212/nxg.0000000000000364] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/04/2019] [Indexed: 01/04/2023]
Abstract
Objective To assess whether the polygenic risk score (PRS) for migraine is associated with acute and/or prophylactic migraine treatment response. Methods We interviewed 2,219 unrelated patients at the Danish Headache Center using a semistructured interview to diagnose migraine and assess acute and prophylactic drug response. All patients were genotyped. A PRS was calculated with the linkage disequilibrium pred algorithm using summary statistics from the most recent migraine genome-wide association study comprising ∼375,000 cases and controls. The PRS was scaled to a unit corresponding to a twofold increase in migraine risk, using 929 unrelated Danish controls as reference. The association of the PRS with treatment response was assessed by logistic regression, and the predictive power of the model by area under the curve using a case-control design with treatment response as outcome. Results A twofold increase in migraine risk associates with positive response to migraine-specific acute treatment (odds ratio [OR] = 1.25 [95% confidence interval (CI) = 1.05–1.49]). The association between migraine risk and migraine-specific acute treatment was replicated in an independent cohort consisting of 5,616 triptan users with prescription history (OR = 3.20 [95% CI = 1.26–8.14]). No association was found for acute treatment with non–migraine-specific weak analgesics and prophylactic treatment response. Conclusions The migraine PRS can significantly identify subgroups of patients with a higher-than-average likelihood of a positive response to triptans, which provides a first step toward genetics-based precision medicine in migraine.
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Affiliation(s)
- Lisette J A Kogelman
- Danish Headache Center (L.J.A.K., A.-L.E., A.F.C., O.B.D., J.O., T.F.H.), Department of Neurology, Rigshospitalet Glostrup, Denmark; Department of Psychiatry and Psychotherapy (S.A., S.R.), Charité-Universitätsmedizin, Berlin, Germany; Analytic and Translational Genetics Unit (S.R.), Massachusetts General Hospital, Boston; Stanley Center for Psychiatric Research (S.R.), Broad Institute of MIT and Harvard, Cambridge, MA; Mental Health Centre Sct Hans (A.I.), Institute of Biological Psychiatry, Roskilde; Department of Clinical Immunology (C.E.), Aarhus University Hospital; Department of Epidemiology Research (H.H.), Statens Serum Institut, Copenhagen; and Department of Clinical Immunology (H.U.), the Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Ann-Louise Esserlind
- Danish Headache Center (L.J.A.K., A.-L.E., A.F.C., O.B.D., J.O., T.F.H.), Department of Neurology, Rigshospitalet Glostrup, Denmark; Department of Psychiatry and Psychotherapy (S.A., S.R.), Charité-Universitätsmedizin, Berlin, Germany; Analytic and Translational Genetics Unit (S.R.), Massachusetts General Hospital, Boston; Stanley Center for Psychiatric Research (S.R.), Broad Institute of MIT and Harvard, Cambridge, MA; Mental Health Centre Sct Hans (A.I.), Institute of Biological Psychiatry, Roskilde; Department of Clinical Immunology (C.E.), Aarhus University Hospital; Department of Epidemiology Research (H.H.), Statens Serum Institut, Copenhagen; and Department of Clinical Immunology (H.U.), the Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Anne Francke Christensen
- Danish Headache Center (L.J.A.K., A.-L.E., A.F.C., O.B.D., J.O., T.F.H.), Department of Neurology, Rigshospitalet Glostrup, Denmark; Department of Psychiatry and Psychotherapy (S.A., S.R.), Charité-Universitätsmedizin, Berlin, Germany; Analytic and Translational Genetics Unit (S.R.), Massachusetts General Hospital, Boston; Stanley Center for Psychiatric Research (S.R.), Broad Institute of MIT and Harvard, Cambridge, MA; Mental Health Centre Sct Hans (A.I.), Institute of Biological Psychiatry, Roskilde; Department of Clinical Immunology (C.E.), Aarhus University Hospital; Department of Epidemiology Research (H.H.), Statens Serum Institut, Copenhagen; and Department of Clinical Immunology (H.U.), the Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Swapnil Awasthi
- Danish Headache Center (L.J.A.K., A.-L.E., A.F.C., O.B.D., J.O., T.F.H.), Department of Neurology, Rigshospitalet Glostrup, Denmark; Department of Psychiatry and Psychotherapy (S.A., S.R.), Charité-Universitätsmedizin, Berlin, Germany; Analytic and Translational Genetics Unit (S.R.), Massachusetts General Hospital, Boston; Stanley Center for Psychiatric Research (S.R.), Broad Institute of MIT and Harvard, Cambridge, MA; Mental Health Centre Sct Hans (A.I.), Institute of Biological Psychiatry, Roskilde; Department of Clinical Immunology (C.E.), Aarhus University Hospital; Department of Epidemiology Research (H.H.), Statens Serum Institut, Copenhagen; and Department of Clinical Immunology (H.U.), the Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Stephan Ripke
- Danish Headache Center (L.J.A.K., A.-L.E., A.F.C., O.B.D., J.O., T.F.H.), Department of Neurology, Rigshospitalet Glostrup, Denmark; Department of Psychiatry and Psychotherapy (S.A., S.R.), Charité-Universitätsmedizin, Berlin, Germany; Analytic and Translational Genetics Unit (S.R.), Massachusetts General Hospital, Boston; Stanley Center for Psychiatric Research (S.R.), Broad Institute of MIT and Harvard, Cambridge, MA; Mental Health Centre Sct Hans (A.I.), Institute of Biological Psychiatry, Roskilde; Department of Clinical Immunology (C.E.), Aarhus University Hospital; Department of Epidemiology Research (H.H.), Statens Serum Institut, Copenhagen; and Department of Clinical Immunology (H.U.), the Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Andres Ingason
- Danish Headache Center (L.J.A.K., A.-L.E., A.F.C., O.B.D., J.O., T.F.H.), Department of Neurology, Rigshospitalet Glostrup, Denmark; Department of Psychiatry and Psychotherapy (S.A., S.R.), Charité-Universitätsmedizin, Berlin, Germany; Analytic and Translational Genetics Unit (S.R.), Massachusetts General Hospital, Boston; Stanley Center for Psychiatric Research (S.R.), Broad Institute of MIT and Harvard, Cambridge, MA; Mental Health Centre Sct Hans (A.I.), Institute of Biological Psychiatry, Roskilde; Department of Clinical Immunology (C.E.), Aarhus University Hospital; Department of Epidemiology Research (H.H.), Statens Serum Institut, Copenhagen; and Department of Clinical Immunology (H.U.), the Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Olafur B Davidsson
- Danish Headache Center (L.J.A.K., A.-L.E., A.F.C., O.B.D., J.O., T.F.H.), Department of Neurology, Rigshospitalet Glostrup, Denmark; Department of Psychiatry and Psychotherapy (S.A., S.R.), Charité-Universitätsmedizin, Berlin, Germany; Analytic and Translational Genetics Unit (S.R.), Massachusetts General Hospital, Boston; Stanley Center for Psychiatric Research (S.R.), Broad Institute of MIT and Harvard, Cambridge, MA; Mental Health Centre Sct Hans (A.I.), Institute of Biological Psychiatry, Roskilde; Department of Clinical Immunology (C.E.), Aarhus University Hospital; Department of Epidemiology Research (H.H.), Statens Serum Institut, Copenhagen; and Department of Clinical Immunology (H.U.), the Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Christian Erikstrup
- Danish Headache Center (L.J.A.K., A.-L.E., A.F.C., O.B.D., J.O., T.F.H.), Department of Neurology, Rigshospitalet Glostrup, Denmark; Department of Psychiatry and Psychotherapy (S.A., S.R.), Charité-Universitätsmedizin, Berlin, Germany; Analytic and Translational Genetics Unit (S.R.), Massachusetts General Hospital, Boston; Stanley Center for Psychiatric Research (S.R.), Broad Institute of MIT and Harvard, Cambridge, MA; Mental Health Centre Sct Hans (A.I.), Institute of Biological Psychiatry, Roskilde; Department of Clinical Immunology (C.E.), Aarhus University Hospital; Department of Epidemiology Research (H.H.), Statens Serum Institut, Copenhagen; and Department of Clinical Immunology (H.U.), the Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henrik Hjalgrim
- Danish Headache Center (L.J.A.K., A.-L.E., A.F.C., O.B.D., J.O., T.F.H.), Department of Neurology, Rigshospitalet Glostrup, Denmark; Department of Psychiatry and Psychotherapy (S.A., S.R.), Charité-Universitätsmedizin, Berlin, Germany; Analytic and Translational Genetics Unit (S.R.), Massachusetts General Hospital, Boston; Stanley Center for Psychiatric Research (S.R.), Broad Institute of MIT and Harvard, Cambridge, MA; Mental Health Centre Sct Hans (A.I.), Institute of Biological Psychiatry, Roskilde; Department of Clinical Immunology (C.E.), Aarhus University Hospital; Department of Epidemiology Research (H.H.), Statens Serum Institut, Copenhagen; and Department of Clinical Immunology (H.U.), the Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henrik Ullum
- Danish Headache Center (L.J.A.K., A.-L.E., A.F.C., O.B.D., J.O., T.F.H.), Department of Neurology, Rigshospitalet Glostrup, Denmark; Department of Psychiatry and Psychotherapy (S.A., S.R.), Charité-Universitätsmedizin, Berlin, Germany; Analytic and Translational Genetics Unit (S.R.), Massachusetts General Hospital, Boston; Stanley Center for Psychiatric Research (S.R.), Broad Institute of MIT and Harvard, Cambridge, MA; Mental Health Centre Sct Hans (A.I.), Institute of Biological Psychiatry, Roskilde; Department of Clinical Immunology (C.E.), Aarhus University Hospital; Department of Epidemiology Research (H.H.), Statens Serum Institut, Copenhagen; and Department of Clinical Immunology (H.U.), the Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jes Olesen
- Danish Headache Center (L.J.A.K., A.-L.E., A.F.C., O.B.D., J.O., T.F.H.), Department of Neurology, Rigshospitalet Glostrup, Denmark; Department of Psychiatry and Psychotherapy (S.A., S.R.), Charité-Universitätsmedizin, Berlin, Germany; Analytic and Translational Genetics Unit (S.R.), Massachusetts General Hospital, Boston; Stanley Center for Psychiatric Research (S.R.), Broad Institute of MIT and Harvard, Cambridge, MA; Mental Health Centre Sct Hans (A.I.), Institute of Biological Psychiatry, Roskilde; Department of Clinical Immunology (C.E.), Aarhus University Hospital; Department of Epidemiology Research (H.H.), Statens Serum Institut, Copenhagen; and Department of Clinical Immunology (H.U.), the Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Thomas Folkmann Hansen
- Danish Headache Center (L.J.A.K., A.-L.E., A.F.C., O.B.D., J.O., T.F.H.), Department of Neurology, Rigshospitalet Glostrup, Denmark; Department of Psychiatry and Psychotherapy (S.A., S.R.), Charité-Universitätsmedizin, Berlin, Germany; Analytic and Translational Genetics Unit (S.R.), Massachusetts General Hospital, Boston; Stanley Center for Psychiatric Research (S.R.), Broad Institute of MIT and Harvard, Cambridge, MA; Mental Health Centre Sct Hans (A.I.), Institute of Biological Psychiatry, Roskilde; Department of Clinical Immunology (C.E.), Aarhus University Hospital; Department of Epidemiology Research (H.H.), Statens Serum Institut, Copenhagen; and Department of Clinical Immunology (H.U.), the Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark
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