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Proudfoot A, Duffy S, Sinclair J, Abbott J, Armour M. A survey of cost, access and outcomes for cannabinoid-based medicinal product use by Australians with endometriosis. Aust N Z J Obstet Gynaecol 2024. [PMID: 38415783 DOI: 10.1111/ajo.13804] [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: 09/06/2023] [Accepted: 02/11/2024] [Indexed: 02/29/2024]
Abstract
People with endometriosis use cannabis to manage their symptoms. This study aimed to identify costs, modes of administration, product composition, and self-reported effectiveness for those accessing medicinal cannabis in Australia. There were 192 survey responses analysed. Most (63.5%) used a 'cannabis clinic' doctor, incurring an initial consultation cost of $100-$200+ (10.2% Medicare bulk-billed) and median cannabinoid medicine costs of $300AUD per month. Cost was a major barrier to access, necessitating reducing dosage (76.1%) and/or consuming illicit cannabis (42.9%), despite a prescription. Most (77%) medical consumers used two or more cannabis products, with delta-9-tetrahydrocannabinol predominant oil and flower products most frequently prescribed.
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Affiliation(s)
- Andrew Proudfoot
- NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Sarah Duffy
- School of Business, Western Sydney University, Sydney, New South Wales, Australia
| | - Justin Sinclair
- NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Jason Abbott
- School of Clinical Medicine, Health and Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
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Mehra K, Rup J, Wiese JL, Watson TM, Bonato S, Rueda S. Changes in self-reported cannabis use during the COVID-19 pandemic: a scoping review. BMC Public Health 2023; 23:2139. [PMID: 37915021 PMCID: PMC10621278 DOI: 10.1186/s12889-023-17068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic is affecting mental health and substance use (MHSU) issues worldwide. The purpose of this study was to characterize the literature on changes in cannabis use during the pandemic and the factors associated with such changes. METHODS We conducted a scoping review by searching peer-reviewed databases and grey literature from January 2020 to May 2022 using the Arksey and O'Malley Framework. Two independent reviewers screened a total of 4235 documents. We extracted data from 129 documents onto a data extraction form and collated results using content analytical techniques. RESULTS Nearly half (48%) of the studies reported an increase/initiation of cannabis use, while 36% studies reported no change, and 16% reported a decrease/cessation of cannabis use during the pandemic. Factors associated with increased cannabis use included socio-demographic factors (e.g., younger age), health related factors (e.g., increased symptom burden), MHSU factors (e.g., anxiety, depression), pandemic-specific reactions (e.g., stress, boredom, social isolation), cannabis-related factors (e.g., dependence), and policy-related factors (e.g., legalization of medical/recreational cannabis). CONCLUSION Public health emergencies like the COVID-19 pandemic have the potential to significantly impact cannabis use. The pandemic has placed urgency on improving coping mechanisms and supports that help populations adapt to major and sudden life changes. To better prepare health care systems for future pandemics, wide-reaching education on how pandemic-related change impacts cannabis use is needed.
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Affiliation(s)
- Kamna Mehra
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Jennifer Rup
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Jessica L Wiese
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Tara Marie Watson
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Sarah Bonato
- Library Services, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada.
- Institute of Health Policy, Management and Evaluation, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A1, Canada.
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Sinclair J, Abbott J, Proudfoot A, Armour M. The Place of Cannabinoids in the Treatment of Gynecological Pain. Drugs 2023; 83:1571-1579. [PMID: 37831340 PMCID: PMC10693518 DOI: 10.1007/s40265-023-01951-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
Cannabis sativa (L), a plant with an extensive history of medicinal usage across numerous cultures, has received increased attention over recent years for its therapeutic potential for gynecological disorders such as endometriosis, chronic pelvic pain, and primary dysmenorrhea, due at least in part to shortcomings with current management options. Despite this growing interest, cannabis inhabits an unusual position in the modern medical pharmacopoeia, being a legal medicine, legal recreational drug, and an illicit drug, depending on jurisdiction. To date, the majority of studies investigating cannabis use have found that most people are using illicit cannabis, with numerous obstacles to medical cannabis adoption having been identified, including outdated drug-driving laws, workplace drug testing policies, the cost of quality-assured medical cannabis products, a lack of cannabis education for healthcare professionals, and significant and persistent stigma. Although currently lacking robust clinical trial data, a growing evidence base of retrospective data, cohort studies, and surveys does support potential use in gynecological pain conditions, with most evidence focusing on endometriosis. Cannabis consumers report substantial reductions in pelvic pain, as well as common comorbid symptoms such as gastrointestinal disturbances, mood disorders such as anxiety and depression, and poor sleep. Substitution effects were reported, with >50% reduction or cessation in opioid and/or non-opioid analgesics being the most common. However, a substantial minority report not disclosing cannabis consumption to their health professional. Therefore, while such deprescribing trends are potentially beneficial, the importance of medical supervision during this process is paramount given the possibility for withdrawal symptoms.
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Affiliation(s)
- Justin Sinclair
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
| | - Jason Abbott
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Medicine and Health, UNSW, Sydney, NSW, Australia
- Gynaecological Research and Clinical Research (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
| | - Andrew Proudfoot
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand.
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Hanly C, Leonardi M, Eathorne A, Armour M. The impact of diagnostic method on sense of control and powerlessness and social support in endometriosis patients-A retrospective cohort study. Acta Obstet Gynecol Scand 2023; 102:1390-1395. [PMID: 36785932 PMCID: PMC10540921 DOI: 10.1111/aogs.14488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/23/2022] [Accepted: 10/30/2022] [Indexed: 02/15/2023]
Abstract
INTRODUCTION It is recognized that for individuals living with endometriosis, receiving a diagnosis is psychosocially beneficial, but little is known about whether this is influenced by the way in which the disease is diagnosed. The primary objective of this study was to determine the impact of the diagnostic test method (clinical, diagnostic imaging, or diagnostic laparoscopy) of endometriosis on the individual's sense of control over their disease and their perceived access to social supports. The secondary objectives were to identify the impact of the diagnostic method on perceived social support, and to explore if there was a difference in the diagnostic method utilization between countries. MATERIAL AND METHODS This retrospective cohort study reports on data collected using the Endometriosis Health Profile-30 (EHP-30) section of a previously published larger survey conducted between May and July 2020. Women aged 18-55 years who had received a diagnosis of endometriosis were recruited by social media platforms. The two domains of interest on the EHP-30 were control and powerlessness and social support. Scores on these domains were analyzed with diagnosis method as the variable of interest. RESULTS In all, 1634 valid survey responses were received. There was a small statistically significant difference found between control and powerlessness scores for patients that received a diagnosis via imaging (ultrasound/MRI; n = 120) vs clinical diagnosis (n = 121) (p = 0.049). However, this did not reach clinical significance when covariates were controlled for (p = 0.054). No other comparisons reached statistical significance. CONCLUSIONS The diagnostic method of endometriosis does not appear to have a clinically significant impact on an individual's sense of control over their disease nor their access to social supports. However, further research into these domains to delineate the true impact of the diagnostic method is required.
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Affiliation(s)
- Ciara Hanly
- Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Mathew Leonardi
- Department of Obstetrics and GynecologyMcMaster UniversityHamiltonCanada
- Robinson Research Institute, Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
| | - Allie Eathorne
- Medical Research Institute of New Zealand (MRINZ)WellingtonNew Zealand
| | - Mike Armour
- Medical Research Institute of New Zealand (MRINZ)WellingtonNew Zealand
- NICM Health Research InstituteWestern Sydney UniversitySydneyAustralia
- Translational Health Research Institute (THRI)Western Sydney UniversitySydneyAustralia
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Sinclair J, Abbott J, Mikocka-Walus A, Ng C, Sarris J, Evans S, Armour M. "A glimmer of hope" - Perceptions, barriers, and drivers for medicinal cannabis use amongst Australian and New Zealand people with endometriosis. REPRODUCTION AND FERTILITY 2023; 4:RAF-23-0049. [PMID: 37855429 PMCID: PMC10692678 DOI: 10.1530/raf-23-0049] [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: 07/16/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023] Open
Abstract
Previous quantitative research has shown that cannabis use, mostly illicit, is used for symptom management amongst those with endometriosis living in Australia or New Zealand, but the drivers and barriers for use of legal, medicinal cannabis in this population are currently unclear. This study sought to investigate, via online focus-groups, the perceptions, barriers, drivers, and experiences associated with cannabis use, whether legal or illicit, amongst 37 Australians and New Zealanders, aged 18-55, with a medical diagnosis of endometriosis. Previous cannabis usage was not required to participate. Discussion topics included strategies employed to manage symptoms, exploration of current medications, previous use of cannabis for pain management, and interest in using medicinal cannabis as a management strategy. Participants with moderate to severe symptoms of medically diagnosed endometriosis reported inadequacies with their current medical and self-management strategies and were inclined to try medicinal cannabis, both as part of their medical management and as part of a clinical trial. Barriers to medicinal cannabis adoption identified in this cohort included high costs of legal cannabis products, lack of clarity and fairness in current roadside drug testing laws and workplace drug testing policies, concern over the impact of stigma affecting familial, social and workplace life domains, and subsequent judgement and the lack of education/engagement from their medical providers regarding cannabis use. Given the interest in medicinal cannabis and the reported lack of effective symptom management, clinical trials are urgently required to determine the potential role that medicinal cannabis may play in reducing the symptoms of endometriosis.
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Affiliation(s)
- Justin Sinclair
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Jason Abbott
- School of Clinical Medicine, Medicine and Health, Division of Obstetrics and Gynaecology, UNSW, Sydney, NSW, Australia
- Gynaecological Research and Clinical Research (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney NSW Australia
| | | | - Cecilia Ng
- School of Clinical Medicine, Medicine and Health, Division of Obstetrics and Gynaecology, UNSW, Sydney, NSW, Australia
- Gynaecological Research and Clinical Research (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney NSW Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Subhadra Evans
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
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Gräfe EL, Reid HMO, Shkolnikov I, Conway K, Kit A, Acosta C, Christie BR. Women are Taking the Hit: Examining the Unique Consequences of Cannabis Use Across the Female Lifespan. Front Neuroendocrinol 2023; 70:101076. [PMID: 37217080 DOI: 10.1016/j.yfrne.2023.101076] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
Cannabis use has risen dramatically in recent years due to global decriminalization and a resurgence in the interest of potential therapeutic benefits. While emerging research is shaping our understanding of the benefits and harms of cannabis, there remains a paucity of data specifically focused on how cannabis affects the female population. The female experience of cannabis use is unique, both in the societal context and because of the biological ramifications. This is increasingly important given the rise in cannabis potency, as well as the implications this has for the prevalence of Cannabis Use Disorder (CUD). Therefore, this scoping review aims to discuss the prevalence of cannabis use and CUD in women throughout their lifespan and provide a balanced prospective on the positive and negative consequences of cannabis use. In doing so, this review will highlight the necessity for continued research that goes beyond sex differences.
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Affiliation(s)
- E L Gräfe
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - H M O Reid
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - I Shkolnikov
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - K Conway
- Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada
| | - A Kit
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - C Acosta
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - B R Christie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada; Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada.
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Armour M, Sinclair J. Cannabis for endometriosis-related pain and symptoms: It's high time that we see this as a legitimate treatment. Aust N Z J Obstet Gynaecol 2023; 63:118-120. [PMID: 36691911 DOI: 10.1111/ajo.13642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia.,Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand.,Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Justin Sinclair
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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Endometriosis and COVID-19: A Systematic Review and Meta-Analysis. Int J Mol Sci 2022; 23:ijms232112951. [PMID: 36361745 PMCID: PMC9657778 DOI: 10.3390/ijms232112951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/13/2022] [Accepted: 10/22/2022] [Indexed: 11/22/2022] Open
Abstract
Endometriosis is defined as ectopic endometrial tissues dispersed outside the endometrium. This can cause disruption in hormonal and immunological processes, which may increase susceptibility to SARS-CoV-2 infection. Worsening of endometriosis symptoms may occur as a result of this infection. The aim of our review was to estimate the pooled prevalence of SARS-CoV-2 infection and the health impacts of the COVID-19 pandemic in endometriosis patients. We conducted a systematic review and meta-analysis. MEDLINE, Science Direct, Scopus, and Google Scholar databases were searched, using the keywords: (endometriosis) AND (COVID-19 OR SARS-CoV-2). Forest plots and pooled estimates were created using the Open Meta Analyst software. After screening 474 articles, 19 studies met the eligibility criteria for the systematic review, and 15 studies were included in the meta-analyses. A total of 17,799 patients were analyzed. The pooled prevalence of SARS-CoV-2 infection in endometriosis patients was 7.5%. Pooled estimates for the health impacts were 47.2% for decreased access to medical care, 49.3% increase in dysmenorrhea, 75% increase in anxiety, 59.4% increase in depression, and 68.9% increase in fatigue. Endometriosis patients were undeniably impacted by the COVID-19 pandemic, which caused the worsening of symptoms such as dysmenorrhea, pelvic pain, anxiety, depression, and fatigue.
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Spencer J, Mezquita G, Shakir F. The ongoing impact of the Covid-19 pandemic on endometriosis patients: A survey of 1,089 UK patients. Facts Views Vis Obgyn 2022; 14:257-264. [DOI: 10.52054/fvvo.14.3.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The impact of Covid-19 on endometriosis patients is under-researched. Endometriosis has significant psychosocial effects on patients. Moreover, the mainstay of diagnosis and treatment of endometriosis is elective surgery, impacted as a result of healthcare strain.
Objective: To better understand the effect of the Covid-19 pandemic on endometriosis patients
Materials and Methods: An online survey sent to adult UK endometriosis patients between 27th August and 15th September 2021. The study received HRA and HCRW research ethic committee approval.
Main outcome measures: Effects of the Covid-19 pandemic on endometriosis symptoms and surgery
Results: We received 1,089 survey responses. Respondents had a median age of 34, and 82.0% of respondents were white British. 18.8% of respondents reported a previous positive Covid-19 PCR test. 84.6% of patients had been double vaccinated at time of response. 20 patients reported Covid-related hospital admission, with 1 requiring intubation. Large numbers of patients (31.4-55.2%) reported worsening of endometriosis symptoms during the pandemic. 69.2% of respondents reported worsening of associated mental health symptoms. Whilst 44% of respondents had elective endometriosis surgery planned, the majority of operations were disrupted, and 18.7% of total respondents did not have a new surgery date.
Conclusions: More research and support are needed for endometriosis patients as they wait longer for surgery. A holistic approach, encompassing mental health needs, may be particularly beneficial for patients.
What is new? This is the first survey examining the effects of Covid-19 on endometriosis patients including data beyond January 2021.
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Ye Z, Meng Q, Zhang W, He J, Zhao H, Yu C, Liang W, Li X, Wang H. Exploration of the Shared Gene and Molecular Mechanisms Between Endometriosis and Recurrent Pregnancy Loss. Front Vet Sci 2022; 9:867405. [PMID: 35601407 PMCID: PMC9120926 DOI: 10.3389/fvets.2022.867405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/14/2022] [Indexed: 12/14/2022] Open
Abstract
Endometriosis (EMs) is a common benign gynecological disease in women of childbearing age, which usually causes pelvic pain, secondary dysmenorrhea, and infertility. EMs has been linked to recurrent pregnancy loss (RPL) in epidemiological data. The relationship of both, however, remains unknown. The purpose of this study is to explore the underlying pathological mechanisms between EMs and RPL. We searched Gene Expression Omnibus (GEO) database to obtain omics data of EMs and RPL. Co-expression modules for EMs and RPL were investigated by using weighted gene co-expression network analysis (WGCNA). The intersections of gene modules with the strong correlation to EMs or RPL obtained by WGCNA analysis were considered as shared genes. MicroRNAs (miRNAs) and their corresponding target genes linked to EMs and RPL were found though the Human MicroRNA Disease Database (HMDD) and the miRTarbase database. Finally, we constructed miRNAs-mRNAs regulatory networks associated with the two disorders by using the intersection of previously obtained target genes and shared genes. We discovered as significant modules for EMs and RPL, respectively, by WGCNA. The energy metabolism might be the common pathogenic mechanism of EMs and RPL, according to the findings of a Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. We discovered several target genes that might be linked to these two disorders, as well as the potential mechanisms. RAB8B, GNAQ, H2AFZ, SUGT1, and LEO1 could be therapeutic candidates for RPL and EMs. The PI3K-Akt signaling pathway and platelet activation were potentially involved in the mechanisms of EM-induced RPL. Our findings for the first time revealed the underlying pathological mechanisms of EM-induced RPL and identified several useful biomarkers and potential therapeutic targets.
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Affiliation(s)
- Zhuang Ye
- Department of Rheumatology, The First Hospital of Jilin University, Changchun, China
| | - Qingxue Meng
- Department of Pediatrics, Shenzhen University General Hospital, Shenzhen, China
| | - Weiwen Zhang
- Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, China
| | - Junli He
- Department of Pediatrics, Shenzhen University General Hospital, Shenzhen, China
| | - Huanyi Zhao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chengwei Yu
- School of Future Technology, University of Chinese Academy of Sciences, Beijing, China
- *Correspondence: Chengwei Yu
| | - Weizheng Liang
- Department of Pediatrics, Shenzhen University General Hospital, Shenzhen, China
- Weizheng Liang
| | - Xiushen Li
- Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Key Laboratory, Shenzhen University General Hospital, Shenzhen, China
- Xiushen Li
| | - Hao Wang
- Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Key Laboratory, Shenzhen University General Hospital, Shenzhen, China
- Hao Wang
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