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Li Z, Li JL, Wang Q, Fan X, Gao Y, Li XZ. Correlation between GAL-3, Klotho, Calcium and Phosphorus Metabolism Indexes and Cardiovascular Complications in patients with Chronic Kidney Disease. Pak J Med Sci 2023; 39:1095-1100. [PMID: 37492290 PMCID: PMC10364255 DOI: 10.12669/pjms.39.4.6988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 07/27/2023] Open
Abstract
Objective To investigate the correlation between GAL-3, Klotho, calcium and phosphorus indexes and cardiovascular complications in patients with chronic kidney disease (CKD). Methods This is a retrospective study. Forty patients with CKD and cardiovascular complications admitted to the Affiliated Hospital of Hebei University from February 20, 2022 to February 20, 2023 were selected as the experimental group, and another 40 patients with CKD without cardiovascular complications were selected as the control group. The differences in serum Ca+2, PO- 4, GAL-3 and Klotho levels between the two groups were analyzed, and the correlations between the above indicators levels and creatinine levels were analyzed. The correlation between the above indicators levels and cardiac function classification was analyzed, and analyzed the risk factors of CKD complicated with cardiovascular complications. Results The levels of Ca+2, PO- 4 and GAL-3 in the experimental group were significantly higher than those in the control group, while the level of Klotho was significantly lower than that in the control group. The levels of Ca+2 and PO- 4 were positively correlated with the level of Creatinine (Cr), while the level of Klotho was negatively correlated with the Cr. The levels of Ca+2 and PO- 4 were positively correlated with cardiac function classification, while the level of Klotho was negatively correlated with cardiac function classification. Logistic regression analysis showed that hypertension, BMI, Cr, Ca+2, PO- 4 and VLDL were risk factors for cardiovascular complications, and Klotho level was a protective factor. Conclusion A positive correlation can be seen between the levels of Ca+2, PO- 4 and cardiac function classification in patients with CKD. Klotho is a protective factor for cardiovascular diseases.
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Affiliation(s)
- Zhe Li
- Zhe Li, Department of Nephrology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei, China
| | - Jian-Long Li
- Jian-Long Li, Department of Cardiology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei, China
| | - Qian Wang
- Qian Wang, Department of Nephrology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei, China
| | - Xing Fan
- Xing Fan, Department of Nephrology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei, China
| | - Yan Gao
- Yan Gao, Department of Nephrology, Affiliated Hospital of Hebei University, Baoding 071000, Hebei, China
| | - Xue-Zhong Li
- Xue-Zhong Li, Intensive Care Unit, Affiliated Hospital of Hebei University, Baoding 071000, Hebei, China
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Cordola Hsu AR, Fan W, Harrington D, Wong ND. Acute coronary syndromes in diabetes: Biomarkers of endothelial injury improve risk stratification and help identify predictors of risk. Diabetes Metab Syndr 2022; 16:102476. [PMID: 35378387 DOI: 10.1016/j.dsx.2022.102476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 02/19/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Patients with diabetes mellitus (DM) are at an increased risk of acute coronary syndrome (ACS); however, the factors predicting those at highest risk are not well understood. We identified risk factors in those with DM that best predict high ACS risk based on a multiple endothelial injury biomarker algorithm. METHODS We studied adults with DM from a clinical registry with measures of a coronary artery disease prediction algorithm (CADPA) score identifying 5-year ACS risk from nine markers. Stepwise logistic regression provided odds ratios for the relationship of age, gender, and individual risk factors not part of the CADPA algorithm with the likelihood of a high risk CADPA score. RESULTS We studied 1,613 adults with DM (women: 47.3%, ages 22 to 100, mean age 63.2 years). Of these, 6.1% had a low, 13.2% intermediate, and 80.7% high risk CADPA score. From stepwise logistic regression, women were less likely to have a high risk CADPA score (odds ratio [OR] 0.21, 95% confidence intervals [CI] 0.15-0.29, p<.0001), while age (per standard deviation [SD]) (OR 5.04, [4.12-6.17], p<.0001), body mass index (BMI per SD) (OR 1.34, [1.14-1.58], p = 0.004), hypertension (OR 1.60, [1.15-2.24], p = 0.006), current smoking (OR 2.55, [1.56-4.16], p = 0.0002), hsCRP (per SD) (OR 1.24, [1.01-1.53], p = 0.04), and triglycerides (per SD) (OR 1.26, [1.04-1.54], p = 0.02) were more likely to have a high risk CADPA score. CONCLUSIONS Age, men, hypertension, BMI, current smoking, hsCRP, and triglycerides are key factors in those with DM associated with higher ACS risk.
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Affiliation(s)
- Amber R Cordola Hsu
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine School of Medicine, Irvine, CA, United States
| | - Wenjun Fan
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine School of Medicine, Irvine, CA, United States
| | - Douglas Harrington
- Predictive Health Diagnostics Company, Irvine, CA, United States; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine School of Medicine, Irvine, CA, United States.
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Ye Z, Wu Y, Tu Y, Chen M, Gao Y, Shi L, Li P, Xie E, Guo Z, Li Q, Yu X, Li Y, Niu W, Ren J, Zheng J. Blood Group O Protect End-Stage Renal Disease Patients With Dialysis From Coronary Artery Disease. Front Cardiovasc Med 2022; 8:821540. [PMID: 35155621 PMCID: PMC8837269 DOI: 10.3389/fcvm.2021.821540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Our study aims to investigate the role of the ABO blood group in the development and severity of coronary artery disease (CAD) in end-stage renal disease (ESRD) patients with dialysis. Methods A total of 408 ESRD patients with dialysis between January 2010 and December 2020 were enrolled including 204 patients diagnosed with CAD undergoing coronary angiography for the first time, and baseline characteristics as well as Gensini score (GS) were collected. Logistic regression analysis and linear regression analysis were performed to evaluate the relation of ABO blood types to the risk and severity of CAD, respectively. Results Blood group O frequency was significantly low in dialysis ESRD patients with CAD (25 vs. 38.24%) compared with the non-CAD patients and multivariable logistic regression showed blood group O was negatively associated with the risk of CAD [adjusted odds ratio (OR) = 0.33, 95% CI = 0.19–0.60, p < 0.001] as well as the GS tertiles (adjusted OR = 0.23, 95% CI = 0.11–0.49, p < 0.001) compared with A blood group. Blood group A, B, and AB were positively associated with the high Gensini tertile compared with O blood group (adjusted OR = 4.26, 95% CI = 2.03–8.93, p < 0.001; adjusted OR = 2.39, 95% CI = 1.11–5.13, p < 0.05; adjusted OR = 4.33, 95% CI = 1.40–13.35, P < 0.05). Similarly, multivariable linear regression results revealed O blood type was negatively associated with the GS (β = −26.129, 95% CI = −40.094 to −12.164, p < 0.001). Conclusion This case-control study demonstrated that blood group O was a potential independent protective factor for the risk and severity of CAD in ESRD patients with dialysis.
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Affiliation(s)
- Zixiang Ye
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Yaxin Wu
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Yimin Tu
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mulei Chen
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yanxiang Gao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Linying Shi
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peizhao Li
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Enmin Xie
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziyu Guo
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Qing Li
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xiaozhai Yu
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yike Li
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenquan Niu
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Jingyi Ren
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
- Jingyi Ren
| | - Jingang Zheng
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Jingang Zheng
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Duan S, Sun L, Zhu H, Nie G, Zhang C, Huang Z, Zhang B, Xing C, Yuan Y. Association of urinary calcium and phosphorus excretion with renal disease progression in type 2 diabetes. Diabetes Res Clin Pract 2021; 178:108981. [PMID: 34311020 DOI: 10.1016/j.diabres.2021.108981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 06/07/2021] [Accepted: 07/21/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Diabetes is associated with a high incidence of microvascular disease, including nephropathy. The current study aimed to investigate the association of urinary calcium and phosphorus excretion with chronic kidney disease (CKD) progression in type 2 diabetes mellitus. METHODS A total of 159 T2DM patients with chronic kidney disease (CKD stage G1-G4) were retrospectively included. Patients were categorized into three groups according to the tertiles of 24-h urinary calcium and phosphorus excretion, respectively. Clinical parameters and laboratory findings were compared among the three groups. Cox proportional hazards models were used to estimate the associations of urinary calcium and phosphorus excretion with CKD progression and adjusted for baseline eGFR, urinary protein excretion, mean arterial pressure, and use of RAAS inhibitor. A cubic spline curve was used to explore the association between urinary calcium excretion and CKD progression, as well as urinary phosphorus excretion and CKD progression. Moreover, the subgroup effects of urinary calcium and phosphorus excretion on CKD progression were estimated using Cox regression. CKD progression was defined as double of baseline serum creatinine or occurrence of ESRD. RESULTS During a median of 18.23 months of follow-up, the composite renal outcomes were noted in 27%. Cumulative renal outcomes were significantly lower in the highest tertile of urinary calcium excretion and phosphorus excretion in Kaplan-Meier analyses. The multivariate Cox proportional hazards regression analyses indicated that both the highest tertile of urinary calcium and phosphorus excretion was associated with a lower risk for CKD progression compared with the lowest tertile. Restricted cubic spline analyses of the association between urinary calcium excretion and CKD progression indicated a linear association. Additionally, there was also a linear association between urinary phosphorus excretion and CKD progression. Subgroup analyses showed that higher urinary phosphorus excretion was particularly associated with a lower risk of CKD progression in non-diabetic kidney disease (NDKD) patients. CONCLUSION Higher urinary calcium and phosphorus excretion were associated with decreased risk of CKD progression in T2DM patients.
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Affiliation(s)
- Suyan Duan
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Lianqin Sun
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Huanhuan Zhu
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Guangyan Nie
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Chengning Zhang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Zhimin Huang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Bo Zhang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
| | - Changying Xing
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
| | - Yanggang Yuan
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
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King EK, Hsieh MH, Chang DR, Lu CT, Ting IW, Wang CCN, Chen PS, Yeh HC, Chiang HY, Kuo CC. Prediction of non-responsiveness to pre-dialysis care program in patients with chronic kidney disease: a retrospective cohort analysis. Sci Rep 2021; 11:13938. [PMID: 34230524 PMCID: PMC8260802 DOI: 10.1038/s41598-021-93254-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/16/2021] [Indexed: 12/29/2022] Open
Abstract
The responsiveness of patients with chronic kidney disease (CKD) to nephrologists’ care is unpredictable. We defined the longitudinal stages (LSs) 1–5 of estimated glomerular filtration rate (eGFR) by group-based trajectory modeling for repeated eGFR measurements of 7135 patients with CKD aged 20–90 years from a 13-year pre-end-stage renal disease (ESRD) care registry. Patients were considered nonresponsive to the pre-dialysis care if they had a more advanced eGFR LS compared with the baseline. Conversely, those with improved or stable eGFR LS were considered responsive. The proportion of patients with CKD stage progression increased with the increase in the baseline CKD stage (stages 1–2: 29.2%; stage 4: 45.8%). The adjusted times to ESRD and all-cause mortality in patients with eGFR LS-5 were 92% (95% confidence interval [CI] 86–96%) and 57% (95% CI 48–65%) shorter, respectively, than in patients with eGFR LS-3A. Among patients with baseline CKD stages 3 and 4, the adjusted times to ESRD and all-cause death in the nonresponsive patients were 39% (95% CI 33–44%) and 20% (95% CI 14–26%) shorter, respectively, than in the responsive patients. Our proposed Renal Care Responsiveness Prediction (RCRP) model performed significantly better than the conventional Kidney Failure Risk Equation in discrimination, calibration, and net benefit according to decision curve analysis. Non-responsiveness to nephrologists’ care is associated with rapid progression to ESRD and all-cause mortality. The RCRP model improves early identification of responsiveness based on variables collected during enrollment in a pre-ESRD program. Urgent attention should be given to characterize the underlying heterogeneous responsiveness to pre-dialysis care.
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Affiliation(s)
- Emily K King
- Department of Medical Media Design and Application, Interpedia Incorporated, Taichung, Taiwan.,Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, 2, Yude Rd., North Dist., Taichung City, 404, Taiwan
| | - Ming-Han Hsieh
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - David R Chang
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Ting Lu
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Wen Ting
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.,Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, 2, Yude Rd., North Dist., Taichung City, 404, Taiwan
| | - Charles C N Wang
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,Center for Artificial Intelligence and Precision Medicine Research, Asia University, Taichung, Taiwan
| | - Pei-Shan Chen
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, 2, Yude Rd., North Dist., Taichung City, 404, Taiwan
| | - Hung-Chieh Yeh
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.,Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, 2, Yude Rd., North Dist., Taichung City, 404, Taiwan.,AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, 2, Yude Rd., North Dist., Taichung City, 404, Taiwan
| | - Chin-Chi Kuo
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan. .,Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, 2, Yude Rd., North Dist., Taichung City, 404, Taiwan. .,AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
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Bird RP, Eskin NAM. The emerging role of phosphorus in human health. ADVANCES IN FOOD AND NUTRITION RESEARCH 2021; 96:27-88. [PMID: 34112356 DOI: 10.1016/bs.afnr.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Phosphorus, an essential nutrient, performs vital functions in skeletal and non-skeletal tissues and is pivotal for energy production. The last two decades of research on the physiological importance of phosphorus have provided several novel insights about its dynamic nature as a nutrient performing functions as a phosphate ion. Phosphorous also acts as a signaling molecule and induces complex physiological responses. It is recognized that phosphorus homeostasis is critical for health. The intake of phosphorus by the general population world-wide is almost double the amount required to maintain health. This increase is attributed to the incorporation of phosphate containing food additives in processed foods purchased by consumers. Research findings assessed the impact of excessive phosphorus intake on cells' and organs' responses, and highlighted the potential pathogenic consequences. Research also identified a new class of bioactive phosphates composed of polymers of phosphate molecules varying in chain length. These polymers are involved in metabolic responses including hemostasis, brain and bone health, via complex mechanism(s) with positive or negative health effects, depending on their chain length. It is amazing, that phosphorus, a simple element, is capable of exerting multiple and powerful effects. The role of phosphorus and its polymers in the renal and cardiovascular system as well as on brain health appear to be important and promising future research directions.
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Affiliation(s)
- Ranjana P Bird
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada.
| | - N A Michael Eskin
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada
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Wang H, Zhang L, Liao W, Huang J, Xu J, Yang J, Chen C, He Z. Hyperphosphatemia rather than hypophosphatemia indicates a poor prognosis in patients with sepsis. Clin Biochem 2021; 91:9-15. [PMID: 33600802 DOI: 10.1016/j.clinbiochem.2021.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/14/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Sepsis is the leading cause of hospitalization and death in the intensive care unit. It is vital to identify high-risk patients with poor prognosis in the early stages of sepsis. We aimed to investigate the prognostic value of serum phosphorus levels for sepsis. METHODS The data of 4767 patients with sepsis were collected from the Multiparameter Intelligent Monitoring in Intensive Care III database. The Locally Weighted Scatterplot Smoothing technique and Kaplan-Meier analysis were used to test the crude relationship between serum phosphorus levels and mortality or overall survival. The multivariable logistic regression was used to further analyze the relationship between serum phosphorus levels and in-hospital mortality. The subgroup analysis was performed according to renal failure, use of vasopressin and the Sequential Organ Failure Assessment (SOFA) score. RESULTS Only hyperphosphatemia significantly correlated with in-hospital mortality [odds ratio (OR) 1.48; 95% confidence interval (CI) 1.19-1.85], while the correlation between hypophosphatemia and in-hospital mortality was not significant (OR 0.91; 95% CI 0.70-1.19). The interactions between serum phosphorus and renal failure, use of vasopressin or the SOFA score were not significant. CONCLUSIONS Hyperphosphatemia rather than hypophosphatemia indicates a poor prognosis in patients with sepsis.
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Affiliation(s)
- Huabin Wang
- Division of Hematology/Oncology, Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China; Department of Pediatric Intensive Care Unit, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China
| | - Lidan Zhang
- Division of Hematology/Oncology, Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China; Department of Pediatric Intensive Care Unit, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China
| | - Wenhua Liao
- Department of Intensive Care Unit, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Junbin Huang
- Division of Hematology/Oncology, Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China; Department of Pediatric Intensive Care Unit, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China
| | - Jiannan Xu
- Center of Digestive Disease, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China
| | - Jing Yang
- Division of Hematology/Oncology, Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China; Department of Pediatric Intensive Care Unit, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China
| | - Chun Chen
- Division of Hematology/Oncology, Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China.
| | - Zhijie He
- Department of Intensive Care Unit, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510000, China.
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