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While some studies have not found a similar effect in Hepatitis B surface antigen (HBsAg)-seropositive patients regarding ALT levels, other research indicates an increased risk of cirrhosis in HBV carriers who smoke 20 or more cigarettes per day, an effect that is particularly pronounced when combined with habitual alcohol consumption [85, 86]

However, in a more recent study where strong involvement of the adaptive immune response in the brain was confirmed, further inflammatory stress by LPS was required to achieve spreading of pSYN into the brain (220)

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