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Wu F, Chen L, Du Y. Comparison of the efficacy and safety of benzbromarone and febuxostat in gout and hyperuricemia: a systematic review and meta-analysis. Clin Rheumatol 2024; 43:1745-1754. [PMID: 38492092 DOI: 10.1007/s10067-024-06933-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Urate-lowering therapy (ULT) is widely recognized as the primary treatment for hyperuricemia and gout. Xanthine oxidase inhibitors (XOI), particularly febuxostat, have gained popularity as a frontline approach. However, the divergent efficacy and safety between febuxostat and the traditional ULT drug, benzbromarone, remain poorly understood. This knowledge gap necessitates a comprehensive analysis and evidence update to guide drug selection for physicians and patients. METHOD We conducted a systematic analysis by extracting relevant clinical studies from four medical literature databases. Forest plots, funnel plots, sensitivity analysis, Egger's test, and subgroup analysis were utilized to compare relevant indicators. RESULTS The advantages and disadvantages of the two drugs were evaluated based on various indicators such as serum uric acid (SUA), triglyceride (TG), urinary uric acid (UUA), white blood cell count (WBC), total cholesterol (TC), blood urea nitrogen (BUN), alanine aminotransferase (ALT), aspartate aminotransferase (AST), estimated glomerular filtration rate (eGFR), and serum creatinine (SC). Benzbromarone demonstrated better efficacy in rapidly reducing SUA levels and inhibiting inflammation for hyperuricemia and gout patients. Febuxostat was slightly less effective in lowering SUA, but there was no significant difference in its impact on liver and kidney function after long-term use. CONCLUSION This study highlights the superiority of benzbromarone in rapidly reducing SUA and inhibiting inflammation. Febuxostat shows comparable effects on liver and kidney function after long-term use. These findings provide valuable insights for clinicians and patients in drug selection. Key Points • Benzbromarone stands out as a highly effective treatment for hyperuricemia and gout, offering rapid reduction of serum uric acid levels and potent anti-inflammatory effects. • When it comes to long-term use, febuxostat demonstrates comparable effects on liver and kidney function. This provides reassurance for patients who require extended treatment duration. • Moreover, our study goes beyond previous research by presenting a more comprehensive and detailed analysis.
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Affiliation(s)
- Fan Wu
- School of Pharmaceutical Sciences, South-Central Minzu University, No. 182 Minzu Avenue, Wuhan, 430074, Hubei, China
| | - Lvyi Chen
- School of Pharmaceutical Sciences, South-Central Minzu University, No. 182 Minzu Avenue, Wuhan, 430074, Hubei, China.
| | - Yimei Du
- Department of Cardiology, Union Hospital, Tongji Medical University, Huazhong University of Science and Technology, No. 1277, Jiefang Avenue, Wuhan, 430022, Hubei, China.
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Do H, Choi HJ, Choi B, Son CN, Kim SH, Choi SR, Kim JH, Kim MJ, Shin K, Kim HO, Song R, Lee SW, Ahn JK, Lee SG, Lee CH, Son KM, Moon KW. Factors for achieving target serum uric acid levels after initiating urate-lowering therapy in patients with gout: results from the ULTRA registry. Sci Rep 2023; 13:20511. [PMID: 37993515 PMCID: PMC10665459 DOI: 10.1038/s41598-023-47790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023] Open
Abstract
Achieving target serum uric acid (SUA) levels is important in gout management. Guidelines recommend lowering SUA levels to < 6 mg/dL; however, many patients fail to reach this target, even with uric acid-lowering therapy (ULT). This study investigated clinical characteristics of target SUA achievers among Korean patients with gout. This study used data from the ULTRA registry, a nationwide inception cohort established in September 2021 that enrolls patients with gout who initiate ULT. Demographic, clinical, and laboratory data were collected at baseline; the 6-month follow-up. Patients were divided into two groups: target achievers (SUA level < 6 mg/dL at 6 months) and non-achievers. The mean participant (N = 117) age was 56.1 years, and 88.0% were male. At 6 months, 83 patients (70.9%) reached target SUA levels. Target achievers had better drug adherence (≥ 80%) to ULT (97.6% vs. 76.5%; p < 0.01) than non-achievers. Target non-achievers had a higher percentage of a family history of gout (32.4% vs. 10.8%; p < 0.01) and less antihypertensive agent use (38.2% vs. 59.0%; p = 0.03) than target achievers. Multivariate regression analysis revealed that good adherence to ULT, the absence of a family history of gout, and antihypertensive agent use were key factors associated with achieving target SUA levels at 6 months.
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Affiliation(s)
- Hyunsue Do
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, 1 Kangwondaehak-gil, Chuncheon, 24341, South Korea
| | - Hyo Jin Choi
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Byoongyong Choi
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Seoul Medical Center, Seoul, South Korea
| | - Chang-Nam Son
- Division of Rheumatology, Department of Internal Medicine, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Sang-Hyon Kim
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Se Rim Choi
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji Hyoun Kim
- Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Min Jung Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hyun-Ok Kim
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Ran Song
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University, Seoul, South Korea
| | - Sung Won Lee
- Division of Rheumatology, Department of Internal Medicine, Soon Chun Hyang University Hospital, Cheonan, South Korea
| | - Joong Kyong Ahn
- Division of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Geun Lee
- Division of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Chang Hoon Lee
- Division of Rheumatology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, South Korea
| | - Kyeong Min Son
- Division of Rheumatology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea
| | - Ki Won Moon
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, 1 Kangwondaehak-gil, Chuncheon, 24341, South Korea.
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Okobi OE, Oletu H, Chukwuedozie-Echeazu AB, Keke VC, Nwachukwu OB, Akunne HS, Ekpemiro CU, Oranika US, Akueme NT, Akanle OE, Ogbuagu BC, Mbah LA. The Stiff Joint: Comparative Evaluation of Monotherapy and Combination Therapy With Urate Lowering Agents in Managing Acute Gout. Cureus 2023; 15:e45087. [PMID: 37842401 PMCID: PMC10568651 DOI: 10.7759/cureus.45087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Gout, an extremely painful form of arthritis, is triggered by the innate immune system's response to the accumulation of monosodium urate crystals in specific joints and surrounding tissues. This condition is characterized by recurring episodes of excruciating arthritis flares, interspersed with periods of disease quiescence. Over time, gout can result in disability, tophi formation, and severe pain. The treatment of gout is centered around two main objectives: alleviating inflammation and pain during acute gout attacks and long-term management to reduce serum urate levels and mitigate the risk of future attacks. Addressing inflammation and pain during acute attacks is often complicated by various factors, including underlying health conditions commonly associated with gout, such as hypertension, chronic kidney disease, cardiovascular disease, and diabetes mellitus. Moreover, gout patients are frequently older and have multiple coexisting health issues, necessitating complex medication regimens. Given the rising prevalence of gout and its associated comorbidities, there's a growing demand for improved treatment options. While existing treatments effectively manage gout in some patients, a significant portion, particularly those with comorbidities, face contraindications to these treatments and require alternative approaches. Innovative medications are required to enhance gout treatment, especially for individuals with concurrent health conditions. These considerations underscore the importance of reviewing both monotherapy and combination therapy approaches for acute gout treatment.
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Affiliation(s)
- Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, Maryland, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Helen Oletu
- Medicine and Surgery, University of Benin, Benin City, NGA
- Public Health, University of Wolverhampton, Wolverhampton, GBR
| | | | | | - Onyinyechukwu B Nwachukwu
- Neurosciences and Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Family Medicine, American International School of Medicine Georgetown, Guyana, USA
| | | | | | | | - Ngozi T Akueme
- Dermatology, University of Medical Sciences (UNIMEDTH), Ondo State, NGA
| | | | - Buchi C Ogbuagu
- Family Medicine, Deer Ridge Family Clinic (DRFC), Calgary, CAN
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Xue X, Liu Z, Li X, Lu J, Wang C, Wang X, Ren W, Sun R, Jia Z, Ji X, Chen Y, He Y, Ji A, Sun W, Zhang H, Merriman TR, Li C, Cui L. The efficacy and safety of citrate mixture vs sodium bicarbonate on urine alkalization in Chinese primary gout patients with benzbromarone: a prospective, randomized controlled study. Rheumatology (Oxford) 2021; 60:2661-2671. [PMID: 33211886 PMCID: PMC8213434 DOI: 10.1093/rheumatology/keaa668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/22/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives To compare the efficacy and safety of citrate mixture and sodium bicarbonate on urine alkalization in gout patients under benzbromarone treatment. Methods A prospective, randomized, parallel controlled trial was conducted among 200 gout patients in the dedicated gout clinic of the Affiliated Hospital of Qingdao University. The participants were randomly divided into two groups (1:1), sodium bicarbonate group (3 g/day) and citrate mixture group (7 g/day). All patients were prescribed with 25 mg/day benzbromarone at initiation and maintained at a dose of 50 mg/day. Clinical and biochemical data were collected at each follow-up time point (baseline, weeks 2, 4, 8 and 12). Results A total of 182 patients completed the 12-week urine alkalization study. The urine pH value of both groups increased significantly from the baseline to the final follow-up time point (sodium bicarbonate group, 5.50–6.00, P < 0.05; citrate mixture group, 5.53–5.93, P < 0.05). While the comparisons regarding urine pH between treatment groups showed no significant differences for each time point. The estimated glomerular filtration rate (eGFR) dropped significantly after 12 weeks’ trial in the sodium bicarbonate group (P < 0.01), while it was comparable between baseline and the last follow-up (P > 0.05) in the citrate mixture group. Results of urine analysis showed that the incident rate of occult blood in the sodium bicarbonate group was higher than that in the citrate mixture group (38 vs 24%, P < 0.05), accompanied by a similar occurrence of kidney stones. After 12-week follow-up, the frequency of twice gout flare in the citrate mixture group was significantly lower than that in sodium bicarbonate group (4 vs 12%, P = 0.037). No treatment-emergent adverse events occurred. Conclusion The efficacy of citrate mixture on urine alkalization is comparable to sodium bicarbonate under benzbromarone treatment without significant adverse events. Citrate mixture is superior to sodium bicarbonate in lowering the incidence of urine occult blood and the frequency of gout attacks. Trial registration Registered with ChiCTR (http://www.chictr.org.cn), No. ChiCTR1800018518.
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Affiliation(s)
- Xiaomei Xue
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Zhen Liu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Xinde Li
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Jie Lu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China.,Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Can Wang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Xuefeng Wang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Wei Ren
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Ruixia Sun
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Zhaotong Jia
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Xiaopeng Ji
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Ying Chen
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Yuwei He
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Aichang Ji
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Wenyan Sun
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Hui Zhang
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Tony R Merriman
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China.,Department of Biochemistry, University of Otago, Dunedin, New Zealand.,Division of Clinical Immunology and Rheumatology, University of Alabama Birmingham, Birmingham, AL, USA
| | - Changgui Li
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China.,Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Lingling Cui
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
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Zhou Z, Li K, Li X, Luan R, Zhou R. Independent and joint associations of body mass index, waist circumference, waist-height ratio and their changes with risks of hyperuricemia in middle-aged and older Chinese individuals: a population-based nationwide cohort study. Nutr Metab (Lond) 2021; 18:62. [PMID: 34120647 PMCID: PMC8201932 DOI: 10.1186/s12986-021-00590-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/10/2021] [Indexed: 02/04/2023] Open
Abstract
Background Previous reports regarding the predictive power of adiposity indices remain inconsistent, and longitudinal studies on this top are limited. The associations of hyperuricemia risk with changes in obesity status, as well as the joint effects of baseline adiposity indices and body adiposity change on hyperuricemia risk are not fully elucidated. This study aimed to explore the independent and joint associations of baseline adiposity indicators and body adiposity change with hyperuricemia risk among middle-aged and older population in China. Methods A total of 2895 participants aged ≥ 45 years from the baseline survey of the China Health and Retirement Longitudinal Study were followed up for 4 years. Anthropometric parameters (weight, height, and waist circumference) and serum uric acid were obtained using standard devices. Adjusted odds ratio and 95% confidential interval were calculated to estimate the associations between predictor variables and hyperuricemia risk using multivariate logistic regression. Results Of the 2895 participants, 293 (10.12%) cases of hyperuricemia were identified. Increased baseline body mass index (BMI), waist circumference, and waist-height ratio (WHtR) were significantly associated with higher risks of hyperuricemia. A slightly greater but non-significant area under the curve value was observed for waist circumference (0.622) than for BMI (0.611) and WHtR (0.614) (P = 0.447). Compared to subjects with stable adiposity status, participants with weight loss of ≥ 4 kg or waist circumference loss of ≥ 6 cm had a 56% or 55% lower risk of hyperuricemia, and those with weight gain of > 4 kg had a 1.62-fold higher risk of hyperuricemia. Compared to those without obesity, participants with incident or persistent obesity were more likely to develop hyperuricemia. Additionally, regardless of stable or increased weight/waist circumference during follow-up, individuals with obesity at baseline had a higher risk of incident hyperuricemia. Conclusion This study demonstrates that BMI, waist circumference, and WHtR equally predict the development of hyperuricemia, and weight loss and waist circumference reduction are favorable in preventing hyperuricemia.
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Affiliation(s)
- Zonglei Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Kunpeng Li
- Department of Neurorehabilitation, Shanghai Second Rehabilitation Hospital, Shanghai, 200441, China
| | - Xianzhi Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Rongsheng Luan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China.
| | - Ruzhen Zhou
- Department of Colorectal Surgery, Changhai Hospital of Shanghai, Shanghai, 200433, China.
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Gao L, Wang B, Pan Y, Lu Y, Cheng R. Cardiovascular safety of febuxostat compared to allopurinol for the treatment of gout: A systematic and meta-analysis. Clin Cardiol 2021; 44:907-916. [PMID: 34013998 PMCID: PMC8259158 DOI: 10.1002/clc.23643] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 12/16/2022] Open
Abstract
The cardiovascular safety of febuxostat compared to allopurinol for the treatment of gout remains equivocal. Febuxostat had a better safety outcome compared with allopurinol. In this systematic review and meta-analysis, we searched MEDLINE and Embase for articles published between March 1, 2000 and April 4, 2021, without any language restrictions. We did a systematic review and meta-analysis of included clinical trials to evaluate the cardiovascular safety of febuxostat compared to allopurinol for treatment of chronic gout. Two reviewers independently selected studies, assessed study quality, and extracted data. Risk ratios were calculated with random effects and were reported with corresponding 95% confidence intervals (CI). From 240 potentially relevant citations, 224 papers were excluded; 16 studies were ultimately included in the analysis. Febuxostat had a better safety outcome compared with allopurinol,which was the composite of urgent coronary revascularization (OR: 0.84, 95% CI: 0.77-0.90, p < .0001) and stroke (OR: 0.87, 95% CI: 0.79-0.97, p = .009). However, that difference was not found in nonfatal myocardial infarction (OR: 0.99, 95% CI: 0.80-1.22, p = .91), cardiovascular related mortality (OR: 0.98, 95% CI: 0.69-1.38, p = .89) and all-cause mortality (OR: 0.93, 95% CI: 0.75-1.15, p = .52). No significant differences in cardiovascular related mortality and all-cause mortality were observed across any subgroup. This meta-analysis adds new evidence regarding the cardiovascular safety of febuxostat in patients. Initiation of febuxostat in patients was not associated with an increased risk of death or serious cardiovascular related adverse events compared with allopurinol.
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Affiliation(s)
- Linggen Gao
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army & National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Bin Wang
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army & National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Ying Pan
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army & National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Yan Lu
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army & National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Rui Cheng
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army & National Clinical Research Center for Geriatric Disease, Beijing, China
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