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Jiang J, Shu H, Wang DW, Hui R, Li C, Ran X, Wang H, Zhang J, Nie S, Cui G, Xiang D, Shao Q, Xu S, Zhou N, Li Y, Gao W, Chen Y, Bian Y, Wang G, Xia L, Wang Y, Zhao C, Zhang Z, Zhao Y, Wang J, Chen S, Jiang H, Chen J, Du X, Chen M, Sun Y, Li S, Ding H, Ma X, Zeng H, Lin L, Zhou S, Ma L, Tao L, Chen J, Zhou Y, Guo X. Chinese Society of Cardiology guidelines on the diagnosis and treatment of adult fulminant myocarditis. SCIENCE CHINA. LIFE SCIENCES 2024; 67:913-939. [PMID: 38332216 DOI: 10.1007/s11427-023-2421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/25/2023] [Indexed: 02/10/2024]
Abstract
Fulminant myocarditis is an acute diffuse inflammatory disease of myocardium. It is characterized by acute onset, rapid progress and high risk of death. Its pathogenesis involves excessive immune activation of the innate immune system and formation of inflammatory storm. According to China's practical experience, the adoption of the "life support-based comprehensive treatment regimen" (with mechanical circulation support and immunomodulation therapy as the core) can significantly improve the survival rate and long-term prognosis. Special emphasis is placed on very early identification,very early diagnosis,very early prediction and very early treatment.
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Affiliation(s)
- Jiangang Jiang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hongyang Shu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dao Wen Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Rutai Hui
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Chenze Li
- Zhongnan Hospital of Wuhan University, Wuhan, 430062, China
| | - Xiao Ran
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jing Zhang
- Fuwai Huazhong Cardiovascular Hospital, Zhengzhou, 450003, China
| | - Shaoping Nie
- Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Guanglin Cui
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dingcheng Xiang
- Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China
| | - Qun Shao
- Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Shengyong Xu
- Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ning Zhou
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuming Li
- Taida Hospital, Tianjin, 300457, China
| | - Wei Gao
- Peking University Third Hospital, Beijing, 100191, China
| | - Yuguo Chen
- Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Yuan Bian
- Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Guoping Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Liming Xia
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yan Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chunxia Zhao
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhiren Zhang
- Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Yuhua Zhao
- Kanghua Hospital, Dongguan, Guangzhou, 523080, China
| | - Jianan Wang
- Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Shaoliang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Hong Jiang
- Renmin Hospital of Wuhan University, Wuhan, 430060, Wuhan, China
| | - Jing Chen
- Renmin Hospital of Wuhan University, Wuhan, 430060, Wuhan, China
| | - Xianjin Du
- Renmin Hospital of Wuhan University, Wuhan, 430060, Wuhan, China
| | - Mao Chen
- West China Hospital, Sichuan University, Chengdu, 610044, China
| | - Yinxian Sun
- First Hospital of China Medical University, Shenyang, 110002, China
| | - Sheng Li
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hu Ding
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xueping Ma
- General Hospital of Ningxia Medical University, Yinchuan, 750003, China
| | - Hesong Zeng
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Li Lin
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shenghua Zhou
- The Second Xiangya Hospital, Central South University, Changsha, 410012, China
| | - Likun Ma
- The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230002, China
| | - Ling Tao
- The First Affiliated Hospital of Air Force Medical University, Xi'an, 710032, China
| | - Juan Chen
- Central Hospital of Wuhan City, Wuhan, 430014, China
| | - Yiwu Zhou
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaomei Guo
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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Wu L, Ji W, Huang Y, Zeng H, Chen J, Zou Y, Lin W, Lin Y. Establishment and validation of a prediction model for myocarditis in Chinese children below 14 years old: a protocol for a retrospective cohort study. BMJ Open 2023; 13:e075453. [PMID: 38128930 DOI: 10.1136/bmjopen-2023-075453] [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] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Paediatric myocarditis, a rare inflammatory disease, often presents without clear early symptoms. Although cardiac troponin I levels can aid in diagnosing myocarditis, they are not definitive indicators. Troponin I levels frequently fluctuate within and outside the reference range, potentially causing misinterpretations by clinicians. Although a negative troponin I result is valuable for excluding myocarditis, its specificity is low. Moreover, the clinical diagnosis of paediatric myocarditis is exceptionally challenging, and accurate early-stage diagnosis and treatment pose difficulties. Currently, the Dallas criteria, involving cardiac biopsy, serves as the gold standard for myocarditis diagnosis. However, this method has several drawbacks and is unsuitable for children, resulting in its limited use. METHODS AND ANALYSIS In this study, we will employ multiple logistic regression analysis to develop a predictive model for early childhood myocarditis. This model will assess the patient's condition at onset and provide the probability of a myocarditis diagnosis. Model performance will be evaluated for accuracy and calibration, and the results will be presented through receiver operating characteristic (ROC) curves and calibration plots. Clinical decision curve analysis, in conjunction with ROC curve analysis, will be employed to determine the optimal cut-off value and calculate the net clinical benefit value for assessing clinical effectiveness. Finally, internal model validation will be conducted using bootstrapping. ETHICS AND DISSEMINATION Approval from the Clinical Research Ethics Committee of The Third Affiliated Hospital of Wenzhou Medical University has been obtained. The research findings will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals.
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Affiliation(s)
- Lifeng Wu
- Department of Clinical Laboratory, The Third Affiliated Hospital of Wenzhou Medical University, Ruian 325200, Zhejiang, People's Republic of China
| | - Weidan Ji
- Department of Clinical Laboratory, The Third Affiliated Hospital of Wenzhou Medical University, Ruian 325200, Zhejiang, People's Republic of China
| | - Yumao Huang
- Pediatric Department, The Third Affiliated Hospital of Wenzhou Medical University, Ruian 325200, Zhejiang, People's Republic of China
| | - Huanxuan Zeng
- Pediatric Department, The Third Affiliated Hospital of Wenzhou Medical University, Ruian 325200, Zhejiang, People's Republic of China
| | - Jie Chen
- Pediatric Department, The Third Affiliated Hospital of Wenzhou Medical University, Ruian 325200, Zhejiang, People's Republic of China
| | - Yueling Zou
- Department of Clinical Laboratory, Ruian Maternity and Child Care Hospital, Ruian 325200, Zhejiang, People's Republic of China
| | - Weiguo Lin
- Urological Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Ruian 325200, Zhejiang, People's Republic of China
| | - Yuzhan Lin
- Department of Clinical Laboratory, The Third Affiliated Hospital of Wenzhou Medical University, Ruian 325200, Zhejiang, People's Republic of China
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Hou W, Shi T, Li Y, Li W, Xu M, Peng F. Soluble suppression of tumorigenicity 2 associated with fulminant myocarditis in children: A retrospective observational study. Medicine (Baltimore) 2023; 102:e34784. [PMID: 37653801 PMCID: PMC10470680 DOI: 10.1097/md.0000000000034784] [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: 03/14/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
Fulminant myocarditis (FM) is associated with high mortality, and studies on soluble suppression of tumorigenicity 2 (sST2) and myocarditis are still scarce. The aim of this study was to investigate the relationship between sST2 and FM in children with myocarditis. This was a single-center retrospective clinical observational study. We continuously included patients diagnosed as suspected viral myocarditis from December 2019 to December 2022. A total of 203 patients younger than 11 years old were enrolled in this study, 22 of whom were diagnosed with FM. The level of sST2 was positively correlated with N-terminal B-type natriuretic peptide (NT-proBNP) (R = 0.5588, P < .0001). After including multiple factors, creatinine (odd ratio [OR] 0.911; 95% confidence interval [CI], 0.842-0.986; P = .021), NT-proBNP (OR 1.000; 95% CI, 1.000-1.000; P = .01), left ventricular ejection fraction (OR 1.306; 95% CI, 1.153-1.478; P < .001) and sST2 (OR 0.982; 95% CI, 0.965-0.999; P = .038) were still risk factors for FM. The area under curve values were 0.852 for the NT-proBNP, 0.817 for the creatinine, 0.914 for the left ventricular ejection fraction, and 0.865 for the sST2, which showed good sensitivity and specificity for FM. Elevated level of sST2 was associated with fulminant myocarditis. sST2 might be used as a potential biomarker for the diagnosis of fulminant myocarditis.
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Affiliation(s)
- Wenquan Hou
- Department of Laboratory Medicine, The First People’s Hospital of Yuhang District, Hangzhou, Zhejiang, China
| | - Tongtong Shi
- Department of Cardiology, Xuzhou Children’s Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yong Li
- Department of Cardiology, The First People’s Hospital of Yuhang District, Hangzhou, Zhejiang, China
| | - Wen Li
- Department of Cardiology, The First People’s Hospital of Yuhang District, Hangzhou, Zhejiang, China
| | - Menghua Xu
- Department of Cardiology, The First People’s Hospital of Yuhang District, Hangzhou, Zhejiang, China
| | - Feng Peng
- Department of Pediatrics, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, China
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Avci Y, Demir AR, Güler A, Aktemur T, Bulut U, Demirci G, Memiç Sancar K, Ersoy B, Celik O, Erturk M. A simplified acute kidney injury predictor following endovascular aortic repair: ACEF score. Vascular 2023; 31:26-32. [PMID: 35077260 DOI: 10.1177/17085381211059403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Treatment of abdominal aortic aneurysms (AAA) with endovascular aortic repair (EVAR) has become quite common in recent years. This method, which has many advantages compared to the open surgical procedure, also has some complications. One of these complications is acute kidney injury (AKI). ACEF (age, creatinine, and ejection fraction) score, which is gaining popularity, can be an easy-to-use and cost-effective method in detecting this condition that causes increased morbidity and mortality. We aimed to evaluate whether this ACEF score may predict a development of AKI in patients who underwent EVAR. METHODS A total of 133 consecutive patients with AAA who underwent EVAR were analyzed. The primary endpoint of the study was the development of AKI. The best cut-off value for the ACEF score to predict the development of AKI was calculated and according to this value, the patients were divided into two groups as those with high ACEF scores and those with low ACEF scores. ACEF score was calculated by the formula of age/EF + 1 (if baseline creatinine > 2 mg/dL). RESULTS After the exclusion criteria, a total of 118 patients were included in the study, and 20 (16.9%) of them developed AKI after EVAR. In the ROC curve analysis, a cut-off value of 1.34 was found for the ACEF score, and scores above this value were found to be independent predictors of AKI development after EVAR. In addition to the ACEF score, the contrast media volume was also found to be an independent predictor of the development of AKI. CONCLUSION In conclusion, ACEF is a simple and effective scoring system in patients undergoing EVAR. To the best our knowledge, our study is the first study which applies ACEF score to predict AKI in EVAR patients.
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Affiliation(s)
- Yalcin Avci
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, 484473University of Health Sciences, Istanbul, Turkey
| | - Ali Riza Demir
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, 484473University of Health Sciences, Istanbul, Turkey
| | - Arda Güler
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, 484473University of Health Sciences, Istanbul, Turkey
| | - Tugba Aktemur
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, 484473University of Health Sciences, Istanbul, Turkey
| | - Umit Bulut
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, 484473University of Health Sciences, Istanbul, Turkey
| | - Gökhan Demirci
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, 484473University of Health Sciences, Istanbul, Turkey
| | - Kadriye Memiç Sancar
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, 484473University of Health Sciences, Istanbul, Turkey
| | - Burak Ersoy
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, 484473University of Health Sciences, Istanbul, Turkey
| | - Omer Celik
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, 484473University of Health Sciences, Istanbul, Turkey
| | - Mehmet Erturk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, 484473University of Health Sciences, Istanbul, Turkey
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Predictive Value of the Age, Creatinine, and Ejection Fraction (ACEF) Score in Cardiovascular Disease among Middle-Aged Population. J Clin Med 2022; 11:jcm11226609. [PMID: 36431085 PMCID: PMC9692582 DOI: 10.3390/jcm11226609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To explore the predictive value of ACEF scores for identifying the risk of cardiovascular disease (CVD) in the general population. METHODS A total of 8613 participants without a history of CVD were enrolled in the follow-up. The endpoint was CVD incidence, defined as stroke or coronary heart disease (CHD) diagnosed during the follow-up period. Cox regression analyses were used to calculate hazard ratios (HRs) with respect to the age, creatinine, and ejection fraction (ACEF) scores and CVD. A Kaplan-Meier curve was used to analyze the probability of CVD in different quartiles of ACEF. Restricted cubic spline was used to further explore whether the relationship between ACEF and CVD was linear. Finally, we assessed the discriminatory ability of ACEF for CVD using C-statistics, net reclassification index, and integrated discrimination improvement (IDI). RESULTS During a median follow-up period of 4.66 years, 388 participants were diagnosed with CVD. The Kaplan-Meier curve showed that ACEF was associated with CVD, and participants with high ACEF scores were significantly more likely to be diagnosed with CVD compared to participants with low ACEF scores in the general population. In the multivariate Cox regression analysis, the adjusted HRs for four quartiles of ACEF were as follows: the first quartile was used as a reference; the second quartile: HR = 2.33; the third quartile: HR = 4.81; the fourth quartile: HR = 8.00. Moreover, after adding ACEF to the original risk prediction model, we observed that new models had higher C-statistic values of CVD than the traditional model. Furthermore, the results of both NRI and IDI were positive, indicating that ACEF enhanced the prediction of CVD. CONCLUSIONS Our study showed that the ACEF score was associated with CVD in the general population in northeastern China. Furthermore, ACEF could be a new tool for identifying patients at high risk of primary CVD in the general population.
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Xie T, Zang X, Xiong Y, Yang C, Li F, Wang D, Shu Y, Mo X, Chen M. Myoglobin and left ventricular ejection fraction as predictive markers for death in children with fulminant myocarditis. Front Pediatr 2022; 10:949628. [PMID: 36186650 PMCID: PMC9518840 DOI: 10.3389/fped.2022.949628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fulminant myocarditis (FM) is an inflammatory process of the myocardium and an important cause of cardiac dysfunction in children; it is characterized by rapid onset, acute progression, and high mortality. The study sought to describe the clinical characteristics and prognostic factors in children with FM. METHODS The study population consists of 37 consecutive patients admitted from May 2014 to December 2021 with a diagnosis of FM. According to the prognosis of children with FM during hospitalization, they were divided into "survival" group (25 cases) and "death" group (12 cases). A multivariate logistic regression analysis was performed to identify the independent predictors of in-hospital mortality in the patients, and receiver operating characteristic (ROC) curve was used to explore the predictive value of related factors. RESULTS The 37 children with FM had an average age of 8.35 ± 4.36 years old. Twenty-five of the patients survived and 12 died. Twenty-five of the children were discharged from the hospital after a series of active rescue treatments such as nutritional myocardial drugs, high-dose intravenous immunoglobulin (IVIG), glucocorticoids (GCs), temporary pacemaker (TP), extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT).Twelve of the children were classified into the death group because the resuscitation failed. The levels of procalcitonin (PCT), creatine kinase (CK), and myoglobin (MYO) in the death group were all higher than in the survival group (all P < 0.05), and the left ventricular ejection fraction (LVEF) in the death group was significantly lower than in the survival group (P = 0.002). The binary logistic regression analysis revealed that MYO [OR:1.006; 95%CI:(1-1.012); P = 0.045] and LVEF [OR: 0.876; 95% CI: (0.785-0.978); P = 0.019] were independent predictors of FM. ROC curve analysis showed that the area under ROC curve (AUC) of MYO and LVEF was [AUC:0.957; 95%CI:0.897~1] and [AUC:0.836; 95%CI:0.668~1], and the area under the combined ROC curve for MYO + LVEF was significantly higher than that for MYO or LVEF alone (P < 0.05), indicating that the MYO + LVEF combined diagnosis had a higher predictive value for FM. CONCLUSION The levels of MYO and LVEF can be markers for prognosis of FM and can effectively evaluate the disease severity. Their combination can improve forecast accuracy; thus, the detection of the above-mentioned indexes possesses a higher value for clinical applications.
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Affiliation(s)
- Tingting Xie
- Department of Pediatrics, Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Xiaodong Zang
- Division of Life Sciences and Medicine, Department of Pediatrics, The First Affiliated Hospital of Science and Technology of China, University of Science and Technology of China (USTC), Hefei, China
| | - Yingying Xiong
- Division of Life Sciences and Medicine, Department of Pediatrics, The First Affiliated Hospital of Science and Technology of China, University of Science and Technology of China (USTC), Hefei, China
| | - Chaolei Yang
- Division of Life Sciences and Medicine, Department of Pediatrics, The First Affiliated Hospital of Science and Technology of China, University of Science and Technology of China (USTC), Hefei, China
| | - Fei Li
- Division of Life Sciences and Medicine, Department of Pediatrics, The First Affiliated Hospital of Science and Technology of China, University of Science and Technology of China (USTC), Hefei, China
| | - Dandan Wang
- Division of Life Sciences and Medicine, Department of Pediatrics, The First Affiliated Hospital of Science and Technology of China, University of Science and Technology of China (USTC), Hefei, China
| | - Yaqin Shu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mingwu Chen
- Department of Pediatrics, Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.,Division of Life Sciences and Medicine, Department of Pediatrics, The First Affiliated Hospital of Science and Technology of China, University of Science and Technology of China (USTC), Hefei, China
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