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Kan L, Zheng Z, Fu W, Ma Y, Wang W, Qian H, Xu L. Recent progress on engineered micro/nanomaterials mediated modulation of gut microbiota for treating inflammatory bowel disease. J Control Release 2024; 370:43-65. [PMID: 38608876 DOI: 10.1016/j.jconrel.2024.04.014] [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: 01/10/2024] [Revised: 03/15/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024]
Abstract
Inflammatory bowel disease (IBD) is a type of chronic recurrent inflammation disease that mainly includes Crohn's disease and ulcerative colitis. Currently, the treatments for IBD remain highly challenging, with clinical treatment drugs showing limited efficacy and adverse side effects. Thus, developing drug candidates with comprehensive therapeutic effects, high efficiency, and low toxicity is urgently needed. Recently, micro/nanomaterials have attracted considerable interest because of their bioavailability, multitarget and efficient effects on IBD. In addition, gut modulation plays a substantial role in restoring intestinal homeostasis. Therefore, efficient microbiota-based strategies modulating gut microenvironment have great potential in remarkably treating IBD. With the development of micro- and nanomaterials for the treatment of IBD and more in-depth studies of their therapeutic mechanisms, it has been found that these treatments also have a tendency to positively regulate the intestinal flora, resulting in an increase in the beneficial flora and a decrease in the level of pathogenic bacteria, thus regulating the composition of the intestinal flora to a normal state. In this review, we first present the interactions among the immune system, intestinal barrier, and gut microbiome. In addition, recent advances in administration routes and methods that positively arouse the regulation of intestinal flora for IBD using probiotics, prebiotics, and redox-active micro/nanomaterials have been reviewed. Finally, the key challenges and critical perspectives of gut microbiota-based micro/nanomaterial treatment are also discussed.
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Affiliation(s)
- Lingling Kan
- School of Biomedical Engineering, Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, Anhui 230032, PR China; Anhui Engineering Research Center for Medical Micro-Nano Devices, Hefei, Anhui 230012, PR China
| | - Ziwen Zheng
- School of Biomedical Engineering, Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, Anhui 230032, PR China; Anhui Engineering Research Center for Medical Micro-Nano Devices, Hefei, Anhui 230012, PR China
| | - Wanyue Fu
- School of Biomedical Engineering, Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, Anhui 230032, PR China; Anhui Engineering Research Center for Medical Micro-Nano Devices, Hefei, Anhui 230012, PR China
| | - Yan Ma
- School of Biomedical Engineering, Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, Anhui 230032, PR China; Anhui Engineering Research Center for Medical Micro-Nano Devices, Hefei, Anhui 230012, PR China
| | - Wanni Wang
- School of Biomedical Engineering, Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, Anhui 230032, PR China; Anhui Engineering Research Center for Medical Micro-Nano Devices, Hefei, Anhui 230012, PR China.
| | - Haisheng Qian
- School of Biomedical Engineering, Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, Anhui 230032, PR China; Anhui Engineering Research Center for Medical Micro-Nano Devices, Hefei, Anhui 230012, PR China.
| | - Lingling Xu
- School of Biomedical Engineering, Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, Anhui 230032, PR China; Anhui Engineering Research Center for Medical Micro-Nano Devices, Hefei, Anhui 230012, PR China.
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2
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Cai R, Shan Y, Du F, Miao Z, Zhu L, Hang L, Xiao L, Wang Z. Injectable hydrogels as promising in situ therapeutic platform for cartilage tissue engineering. Int J Biol Macromol 2024; 261:129537. [PMID: 38278383 DOI: 10.1016/j.ijbiomac.2024.129537] [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: 11/06/2023] [Revised: 01/01/2024] [Accepted: 01/14/2024] [Indexed: 01/28/2024]
Abstract
Injectable hydrogels are gaining prominence as a biocompatible, minimally invasive, and adaptable platform for cartilage tissue engineering. Commencing with their synthesis, this review accentuates the tailored matrix formulations and cross-linking techniques essential for fostering three-dimensional cell culture and melding with complex tissue structures. Subsequently, it spotlights the hydrogels' enhanced properties, highlighting their augmented functionalities and broadened scope in cartilage tissue repair applications. Furthermore, future perspectives are advocated, urging continuous innovation and exploration to surmount existing challenges and harness the full clinical potential of hydrogels in regenerative medicine. Such advancements are crucial for validating the long-term efficacy and safety of hydrogels, positioning them as a promising direction in regenerative medicine to address cartilage-related ailments.
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Affiliation(s)
- Rong Cai
- Translational Medical Innovation Center, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, Zhangjiagang 215600, Jiangsu, China
| | - Yisi Shan
- Translational Medical Innovation Center, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, Zhangjiagang 215600, Jiangsu, China
| | - Fengyi Du
- Department of Gastroenterology, Affiliated Hospital of Jiangsu University, Jiangsu University, 212013, China
| | - Zhiwei Miao
- Translational Medical Innovation Center, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, Zhangjiagang 215600, Jiangsu, China
| | - Like Zhu
- Translational Medical Innovation Center, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, Zhangjiagang 215600, Jiangsu, China
| | - Li Hang
- Translational Medical Innovation Center, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, Zhangjiagang 215600, Jiangsu, China
| | - Long Xiao
- Translational Medical Innovation Center, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, Zhangjiagang 215600, Jiangsu, China.
| | - Zhirong Wang
- Translational Medical Innovation Center, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, Zhangjiagang 215600, Jiangsu, China.
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Zhang H, Liu Z, Fang H, Chang S, Ren G, Cheng X, Pan Y, Wu R, Liu H, Wu J. Construction of Probiotic Double-Layered Multinucleated Microcapsules Based on Sulfhydryl-Modified Carboxymethyl Cellulose Sodium for Increased Intestinal Adhesion of Probiotics and Therapy for Intestinal Inflammation Induced by Escherichia coli O157:H7. ACS APPLIED MATERIALS & INTERFACES 2023; 15:18569-18589. [PMID: 37037009 DOI: 10.1021/acsami.2c20437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The decreased number of viable bacteria and the ability of Bifidobacterium to adhere to and colonize the gut in the gastrointestinal environment greatly limit their efficacy. To solve this problem, thiolated carboxymethyl cellulose sodium (CMC) probiotic double-layered multinucleated microcapsules with Bifidobacterium adolescentis FS2-3 in the inner layer and Bacillus subtilis SN15-2 embedded in the outer layers were designed. First, the viable counts and release rates of microcapsules were examined by in vitro simulated digestion assays, and it was found that microcapsules were better protected from gastrointestinal digestion than the controls. Compared with free Bifidobacterium strains, double-layered multinucleated microcapsules have higher viable bacterial survival rates and storage stability. Second, through in vitro rheology, tensile tests, isotherm titration calorimetry, and adhesion tests, it was observed that thiolated CMC could enhance the strong interaction of Bifidobacterium with intestinal mucus and significantly promote the proliferation and growth of probiotics. Finally, double-layered multinucleated microcapsules containing B. adolescentis FS2-3 and B. subtilis SN15-2 modified with sulfhydryl-modified CMC were studied in the intestine. Alleviation of Escherichia coli O157:H7 induced intestinal inflammation. The results showed that microencapsulation could significantly increase the colon content of Bifidobacterium, relieve intestinal inflammation symptoms in mice with bacterial enteritis, and repair the intestinal microbiota disorder caused by inflammation. The probiotic double-layered multinucleated microcapsules prepared in this study can improve the survival rate of probiotics and promote proliferation, adhesion, and colonization of probiotics.
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Affiliation(s)
- Henan Zhang
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Engineering Research Center of Food Fermentation Technology, Shenyang 110161, P. R. China
| | - Zhili Liu
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Engineering Research Center of Food Fermentation Technology, Shenyang 110161, P. R. China
| | - Haitian Fang
- Ningxia Key Laboratory for Food Microbial-Applications Technology and Safety Control, School of Food and Wine, Ningxia University, Yinchuan 750021, P.R. China
| | - Shihan Chang
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Key Laboratory of Microbial Fermentation Technology Innovation, Shenyang, Liaoning, 110866, P.R. China
| | - Guangyu Ren
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Engineering Research Center of Food Fermentation Technology, Shenyang 110161, P. R. China
| | - Xinyu Cheng
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Engineering Research Center of Food Fermentation Technology, Shenyang 110161, P. R. China
| | - Yue Pan
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Engineering Research Center of Food Fermentation Technology, Shenyang 110161, P. R. China
| | - Rina Wu
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Engineering Research Center of Food Fermentation Technology, Shenyang 110161, P. R. China
| | - Huiyan Liu
- Ningxia Key Laboratory for Food Microbial-Applications Technology and Safety Control, School of Food and Wine, Ningxia University, Yinchuan 750021, P.R. China
| | - Junrui Wu
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, P. R. China
- Key Laboratory of Microbial Fermentation Technology Innovation, Shenyang, Liaoning, 110866, P.R. China
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Wang H, Huang X, Tan H, Chen X, Chen C, Nie S. Interaction between dietary fiber and bifidobacteria in promoting intestinal health. Food Chem 2022; 393:133407. [PMID: 35696956 DOI: 10.1016/j.foodchem.2022.133407] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 01/10/2023]
Abstract
Bifidobacteria are considered as probiotics due to their role in promoting intestinal health, including regulating intestinal flora, controlling glycolipid metabolism, anti-colitis effects. Dietary fiber is considered as prebiotic favoring gut health. It also can be used as carbon source to support the growth and colonization of probiotics like bifidobacteria. However, because of genetic diversity, different bifidobacterial species differ in their ability to utilize dietary fiber. Meanwhile, dietary fiber with different structural properties has different effects on the bifidobacteria proliferation. The interaction between dietary fiber and bifidobacteria will consequently lead to a synergistic or antagonistic function in promoting intestinal health, therefore affecting the application of combined use of dietary fiber and bifidobacteria. In this case, we summarize the biological function of bifidobacteria, and their interaction with different dietary fiber in promoting gut health, and finally provide several strategies about their combined use.
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Affiliation(s)
- Hui Wang
- State Key Laboratory of Food Science and Technology, China-Canada Joint Lab of Food Science and Technology (Nanchang), Nanchang University, 235 Nanjing East Road, Nanchang 330047, China
| | - Xiaojun Huang
- State Key Laboratory of Food Science and Technology, China-Canada Joint Lab of Food Science and Technology (Nanchang), Nanchang University, 235 Nanjing East Road, Nanchang 330047, China.
| | - Huizi Tan
- State Key Laboratory of Food Science and Technology, China-Canada Joint Lab of Food Science and Technology (Nanchang), Nanchang University, 235 Nanjing East Road, Nanchang 330047, China
| | - Xiaomin Chen
- State Key Laboratory of Food Science and Technology, China-Canada Joint Lab of Food Science and Technology (Nanchang), Nanchang University, 235 Nanjing East Road, Nanchang 330047, China
| | - Chunhua Chen
- State Key Laboratory of Food Science and Technology, China-Canada Joint Lab of Food Science and Technology (Nanchang), Nanchang University, 235 Nanjing East Road, Nanchang 330047, China
| | - Shaoping Nie
- State Key Laboratory of Food Science and Technology, China-Canada Joint Lab of Food Science and Technology (Nanchang), Nanchang University, 235 Nanjing East Road, Nanchang 330047, China
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Hiremath S, Viswanathan P. Oxalobacter formigenes: A new hope as a live biotherapeutic agent in the management of calcium oxalate renal stones. Anaerobe 2022; 75:102572. [PMID: 35443224 DOI: 10.1016/j.anaerobe.2022.102572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 02/05/2023]
Abstract
Recent advances in understanding the association of gut microbiota with the host have shown evidence of certain bacterial therapeutic potentiality in preventing and treating metabolic diseases. Hyperoxaluria is a severe challenge in nephrology and has led to the novel gut eubiosis as current therapy. The human gut commensal, obligate anaerobic, and intestinal oxalate-degrading strains of Oxalobacter formigenes have drawn a promising significant interest for the next-generation probiotics (NGPs). This nonpathogenic, potential probiotic, and specialist oxalotrophic properties of O. formigenes give a new hope as a live biotherapeutic agent for calcium oxalate renal therapy. Numerous satisfactory outcomes of in vitro and in vivo studies were achieved on evaluating O. formigenes functionality, but the commercial production of this bacterium is yet to be achieved. This bacterium finds diverse application in dietary and endogenous oxalate degradation and the improvement of gut health, on which we concentrated our attention in this review. The relationship between good anaerobic gut bacterial dysbiosis and renal complications is comprehensively discussed to address the need for the development probiotic formulation. However, the commercial production of this bacteria on a broad scale is complex, with numerous obstacles, mainly because they are oxygen-sensitive and difficult to culture. This review will coherently present the current and available methodologies in producing, stabilizing, and delivering these NGPs to treat calcium stones. Moreover, the study presents the extensive work and key milestones achieved in the research on O. formigenes from tale to the truth.
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Affiliation(s)
- Shridhar Hiremath
- Renal Research Laboratory, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, 632 014, Tamil Nadu, India.
| | - Pragasam Viswanathan
- Renal Research Laboratory, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, 632 014, Tamil Nadu, India.
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Talebian S, Schofield T, Valtchev P, Schindeler A, Kavanagh JM, Adil Q, Dehghani F. Biopolymer-Based Multilayer Microparticles for Probiotic Delivery to Colon. Adv Healthc Mater 2022; 11:e2102487. [PMID: 35189037 DOI: 10.1002/adhm.202102487] [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: 11/15/2021] [Revised: 01/16/2022] [Indexed: 11/06/2022]
Abstract
The potential health benefits of probiotics may not be realized because of the substantial reduction in their viability during food storage and gastrointestinal transit. Microencapsulation has been successfully utilized to improve the resistance of probiotics to critical conditions. Owing to the unique properties of biopolymers, they have been prevalently used for microencapsulation of probiotics. However, majority of microencapsulated products only contain a single layer of protection around probiotics, which is likely to be inferior to more sophisticated approaches. This review discusses emerging methods for the multilayer encapsulation of probiotic using biopolymers. Correlations are drawn between fabrication techniques and the resultant microparticle properties. Subsequently, multilayer microparticles are categorized based on their layer designs. Recent reports of specific biopolymeric formulations are examined regarding their physical and biological properties. In particular, animal models of gastrointestinal transit and disease are highlighted, with respect to trials of multilayer microencapsulated probiotics. To conclude, novel materials and approaches for fabrication of multilayer structures are highlighted.
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Affiliation(s)
- Sepehr Talebian
- School of Chemical and Biomolecular Engineering The University of Sydney Sydney NSW 2006 Australia
- Nano Institute (Sydney Nano) The University of Sydney Sydney NSW 2006 Australia
| | - Timothy Schofield
- School of Chemical and Biomolecular Engineering The University of Sydney Sydney NSW 2006 Australia
| | - Peter Valtchev
- School of Chemical and Biomolecular Engineering The University of Sydney Sydney NSW 2006 Australia
- Centre for Advanced Food Engineering The University of Sydney Sydney NSW 2006 Australia
| | - Aaron Schindeler
- School of Chemical and Biomolecular Engineering The University of Sydney Sydney NSW 2006 Australia
- Centre for Advanced Food Engineering The University of Sydney Sydney NSW 2006 Australia
- Bioengineering & Molecular Medicine Laboratory The Children's Hospital at Westmead and the Westmead Institute for Medical Research Westmead NSW 2145 Australia
| | - John M. Kavanagh
- School of Chemical and Biomolecular Engineering The University of Sydney Sydney NSW 2006 Australia
| | - Qayyum Adil
- PharmaCare Laboratories 18 Jubilee Ave Warriewood NSW 2102 Australia
| | - Fariba Dehghani
- School of Chemical and Biomolecular Engineering The University of Sydney Sydney NSW 2006 Australia
- Centre for Advanced Food Engineering The University of Sydney Sydney NSW 2006 Australia
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Cai R, Xiao L, Zhang M, Zhao L, Zhang J, Du F, Wang Z. Fabrication of microcapsules with core-shell structure for oral delivery of dual drugs and real-time computed tomography imaging. IET Nanobiotechnol 2021; 15:619-626. [PMID: 34695293 PMCID: PMC8675791 DOI: 10.1049/nbt2.12058] [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: 02/03/2021] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 01/22/2023] Open
Abstract
Although multidrug combinations are an effective therapeutic strategy for serious disease in clinical practice, their therapeutic effect may be reduced because they conflict with each other medicinally in certain cases. Hence, there is an urgent need to develop a single drug carrier for precise multidrug delivery to avoid this interference. A reverse coordination method is reported that fabricates a double‐layer barium sulphate microcapsule (DL@BS MS) for two drugs separately loading simultaneously. In addition, BS nanoclusters were synthesised in situ inside the DL@BS MSs for real‐time computed tomography (CT) imaging. The results showed that the DL@BS MSs with a particle size of approximately 2 mm exhibited a uniform sphere. Because BS nanoclusters have a high X‐ray attenuation coefficient, the retention of DL@BS MSs in the digestive tract could be monitored through CT imaging in real time. More important, the core‐shell structure of DL@BS MSs encapsulating two different drugs could be released in spatiotemporal order in an acidic stomach environment. The as‐synthesis DL@BS MSs with a core‐shell structure and real‐time imaging performance provide an ideal carrier for the oral administration of multiple drugs simultaneously loaded but sequentially released.
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Affiliation(s)
- Rong Cai
- Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
| | - Long Xiao
- Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
| | - Miaomiao Zhang
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Lulu Zhao
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jingjing Zhang
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Fengyi Du
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Zhirong Wang
- Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
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Chen Y, Meenu M, Baojun X. A Narrative Review on Microencapsulation of Obligate Anaerobe Probiotics Bifidobacterium, Akkermansia muciniphila, and Faecalibacterium prausnitzii. FOOD REVIEWS INTERNATIONAL 2021. [DOI: 10.1080/87559129.2020.1871008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Yining Chen
- Food Science and Technology Programme, BNU-HKBU United International College, Zhuhai, Guangdong, China
| | - Maninder Meenu
- Food Science and Technology Programme, BNU-HKBU United International College, Zhuhai, Guangdong, China
| | - Xu Baojun
- Food Science and Technology Programme, BNU-HKBU United International College, Zhuhai, Guangdong, China
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9
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Du F, Wu Y, Du F, Zhang L, Feng W, Zhao L, Cai R, Xu L, Bian G, Li J, Zou S, Gong A, Zhang M. Construction of catechol-grafted chitosan alginate/barium sulfate microcapsules for computed tomography real-time imaging and gastroretentive drug delivery. Int J Nanomedicine 2019; 14:6001-6018. [PMID: 31447554 PMCID: PMC6682768 DOI: 10.2147/ijn.s204237] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/23/2019] [Indexed: 12/21/2022] Open
Abstract
Background: The gastroretentive drug delivery system is an effective administration route, which can improve the bioavailability of the drug and the therapeutic effect by prolonging the release time of the drug and controlling the release rate in the stomach. Methods: Inspired by the excellent adhesion properties of mussel protein, we prepared novel catechol-grafted chitosan alginate/barium sulfate microcapsules (Cat-CA/BS MCs) with mucoadhesive properties and computed tomography (CT) imaging function for gastric drug delivery. First, barium sulfate nanoclusters used as CT contrast agent were synthesized in situ in the Cat-CA/BS MCs through a one-step electronic spinning method. Next, catechol-grafted chitosan as the mucoadhesive moiety was coated on the surface of Cat-CA/BS MCs by polyelectrolyte molecule self-assembly. Results: The prepared Cat-CA/BS MCs could effectively retained in the stomach for 48 hours and successively released ranitidine hydrochloride, which could be used for the treatment of gastric ulcer. Cat-CA/BS MCs exhibited superior CT contrast imaging properties for real-time tracking in vivo after oral administration. Conclusion: These findings demonstrate that Cat-CA/BS MCs serving as multifunctional oral drug carriers possess huge potential in gastroretentive drug delivery and non-invasive visualization.
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Affiliation(s)
- Fengyi Du
- Department of Hepatosis, The Affiliated Third Hospital of Zhenjiang, Jiangsu University, Zhenjiang212013, People’s Republic of China
- School of Medicine, Jiangsu University, Zhenjiang212013, People’s Republic of China
| | - Yunchao Wu
- School of Medicine, Jiangsu University, Zhenjiang212013, People’s Republic of China
| | - Fengting Du
- Department of Physiotherapy, Huangnihe Town Hospital, Huangnihe133704, People’s Republic of China
| | - Lirong Zhang
- Department of Physiotherapy, Huangnihe Town Hospital, Huangnihe133704, People’s Republic of China
| | - Weiwei Feng
- School of Environmental and Safety Engineering, Jiangsu University, Zhenjiang212013, People’s Republic of China
| | - Lulu Zhao
- School of Medicine, Jiangsu University, Zhenjiang212013, People’s Republic of China
| | - Rong Cai
- Department of Physiotherapy, Huangnihe Town Hospital, Huangnihe133704, People’s Republic of China
| | - Lixia Xu
- School of Medicine, Jiangsu University, Zhenjiang212013, People’s Republic of China
| | - Gaorui Bian
- Tianyi Health Sciences Institute (Zhenjiang) Co. Ltd, Zhenjiang212013, People’s Republic of China
| | - Jiangang Li
- Tianyi Health Sciences Institute (Zhenjiang) Co. Ltd, Zhenjiang212013, People’s Republic of China
| | - Shengqiang Zou
- Department of Hepatosis, The Affiliated Third Hospital of Zhenjiang, Jiangsu University, Zhenjiang212013, People’s Republic of China
| | - Aihua Gong
- School of Medicine, Jiangsu University, Zhenjiang212013, People’s Republic of China
| | - Miaomiao Zhang
- School of Medicine, Jiangsu University, Zhenjiang212013, People’s Republic of China
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