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Müller J, Tanner R, Matsumiya M, Snowden MA, Landry B, Satti I, Harris SA, O’Shea MK, Stockdale L, Marsay L, Chomka A, Harrington-Kandt R, Thomas ZRM, Naranbhai V, Stylianou E, Mbandi SK, Hatherill M, Hussey G, Mahomed H, Tameris M, McClain JB, Evans TG, Hanekom WA, Scriba TJ, McShane H, Fletcher HA. Cytomegalovirus infection is a risk factor for tuberculosis disease in infants. JCI Insight 2019; 4:130090. [PMID: 31697647 PMCID: PMC6962026 DOI: 10.1172/jci.insight.130090] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/23/2019] [Indexed: 02/05/2023] Open
Abstract
Immune activation is associated with increased risk of tuberculosis (TB) disease in infants. We performed a case-control analysis to identify drivers of immune activation and disease risk. Among 49 infants who developed TB disease over the first 2 years of life, and 129 healthy matched controls, we found the cytomegalovirus-stimulated (CMV-stimulated) IFN-γ response to be associated with CD8+ T cell activation (Spearman's rho, P = 6 × 10-8). A CMV-specific IFN-γ response was also associated with increased risk of developing TB disease (conditional logistic regression; P = 0.043; OR, 2.2; 95% CI, 1.02-4.83) and shorter time to TB diagnosis (Log Rank Mantel-Cox, P = 0.037). CMV+ infants who developed TB disease had lower expression of NK cell-associated gene signatures and a lower frequency of CD3-CD4-CD8- lymphocytes. We identified transcriptional signatures predictive of TB disease risk among CMV ELISpot-positive (area under the receiver operating characteristic [AUROC], 0.98, accuracy, 92.57%) and -negative (AUROC, 0.9; accuracy, 79.3%) infants; the CMV- signature was validated in an independent infant study (AUROC, 0.71; accuracy, 63.9%). A 16-gene signature that previously identified adolescents at risk of developing TB disease did not accurately classify case and control infants in this study. Understanding the microbial drivers of T cell activation, such as CMV, could guide new strategies for prevention of TB disease in infants.
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Affiliation(s)
- Julius Müller
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rachel Tanner
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Magali Matsumiya
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Iman Satti
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stephanie A. Harris
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Matthew K. O’Shea
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Lisa Stockdale
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Leanne Marsay
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Agnieszka Chomka
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- The Kennedy Institute and
| | - Rachel Harrington-Kandt
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Zita-Rose Manjaly Thomas
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vivek Naranbhai
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Elena Stylianou
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stanley Kimbung Mbandi
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Gregory Hussey
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Hassan Mahomed
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Michele Tameris
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | | | | | - Willem A. Hanekom
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Thomas J. Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Helen McShane
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Helen A. Fletcher
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Liu Z, Liu S, Shu Y, Yang Z, Peng B, Xu H, Li Q, Luo Z, Dai J, Liu E, Fu Z, Zou L. Severe Bordetella pertussis infection and vaccine issue in Chongqing, from 2012 to 2018. Int J Infect Dis 2019; 84:102-108. [PMID: 31100420 DOI: 10.1016/j.ijid.2019.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Pertussis is a highly contagious respiratory illness mainly caused by the Gram-negative bacterium Bordetella pertussis. The infection of B. pertussis has been increasing and the current diagnosis of pertussis in children is challenging; little is known of B. pertussis infection in Chongqing. METHODS There were 25,441 children (14,863 male and 10,578 female) with suspected pertussis enrolled in our retrospective study from December 2012 to November 2018. Then 800 children with suspected B. pertussis infection were randomly chosen to be evaluated by simultaneous amplification and testing in this prospective study. RESULTS Infants younger than 12 months had the greatest burden of pertussis, and the incidence of pertussis in Chongqing appeared to have a periodic pattern. The problem of vaccine quality in China was more serious than previously reported based on the fluctuation of infection rates from 2012 to 2018. Simultaneous amplification and testing to detect B. pertussis RNA (Area Under Curve: 0.900 and Kappa value: 0.831) had better diagnostic performance than real-time PCR for B. pertussis DNA (Area Under Curve: 0.869 and Kappa value: 0.690). CONCLUSIONS We revealed the characteristics of B. pertussis infection and vaccine issues in Chongqing. Simultaneous amplification and testing could be a potential novel assay for measuring B. pertussis infection in the future.
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Affiliation(s)
- Zhidai Liu
- Center for Clinical Molecular Medicine, Children's Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China; Ministry of Education Key Laboratory of Development and Disorders, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Key Laboratory of Pediatrics in Chongqing, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Shan Liu
- Center for Clinical Molecular Medicine, Children's Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China; Ministry of Education Key Laboratory of Development and Disorders, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Key Laboratory of Pediatrics in Chongqing, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Yi Shu
- Center for Clinical Molecular Medicine, Children's Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China; Ministry of Education Key Laboratory of Development and Disorders, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Key Laboratory of Pediatrics in Chongqing, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Zuqun Yang
- Ministry of Education Key Laboratory of Development and Disorders, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Key Laboratory of Pediatrics in Chongqing, Children's Hospital, Chongqing Medical University, Chongqing, China; Department of Preventive Medicine, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Bin Peng
- Department of Health Statistics, School of Public Health, Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Hongmei Xu
- Department of Infectious Disease, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Ministry of Education Key Laboratory of Development and Disorders, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Key Laboratory of Pediatrics in Chongqing, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Qubei Li
- Department of Respiratory Medicine, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Ministry of Education Key Laboratory of Development and Disorders, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Key Laboratory of Pediatrics in Chongqing, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Ministry of Education Key Laboratory of Development and Disorders, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Key Laboratory of Pediatrics in Chongqing, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Jihong Dai
- Department of Respiratory Medicine, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Ministry of Education Key Laboratory of Development and Disorders, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Key Laboratory of Pediatrics in Chongqing, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Enmei Liu
- Department of Respiratory Medicine, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Ministry of Education Key Laboratory of Development and Disorders, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Key Laboratory of Pediatrics in Chongqing, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Zhou Fu
- Department of Respiratory Medicine, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Ministry of Education Key Laboratory of Development and Disorders, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Key Laboratory of Pediatrics in Chongqing, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Lin Zou
- Center for Clinical Molecular Medicine, Children's Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China; Ministry of Education Key Laboratory of Development and Disorders, Children's Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China; Key Laboratory of Pediatrics in Chongqing, Children's Hospital, Chongqing Medical University, Chongqing, China.
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Brief Report: Soluble CD163 in CMV-Infected and CMV-Uninfected Subjects on Virologically Suppressive Antiretroviral Therapy in the ICONA Cohort. J Acquir Immune Defic Syndr 2017; 74:347-352. [PMID: 27828874 DOI: 10.1097/qai.0000000000001232] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS To contribute to the understanding of the role played by cytomegalovirus (CMV) in sustaining monocyte/macrophage-mediated immune activation in antiretroviral therapy treated HIV-infected subjects. DESIGN AND METHODS We selected 23 CMV-uninfected and 46 CMV-infected HIV+ subjects, matched for age, CD4 nadir, HIV infection duration, and viral hepatitis serostatus. All subjects were on successful antiretroviral therapy since at least 1 year. A group of 16 healthy donors with similar age and sex was also included. Plasma levels of tumor necrosis factor-alpha, interleukin-6, sCD163, sCD14, and CMV immunoglobulin G levels were measured in duplicate with human enzyme-linked immunosorbent assay kits. RESULTS We found significantly higher sCD163 plasma levels in HIV+CMV+ compared with HIV+CMV- subjects and healthy donors. This augmentation was confirmed also when subjects positive for hepatitis C virus-Ab were excluded from analysis. Interestingly, a correlation between anti-CMV immunoglobulin G levels and sCD163, tumor necrosis factor-alpha, interleukin-6, and sCD14 in HIV+CMV+ subjects was found. CONCLUSIONS CMV coinfection could be a major driver of monocyte/macrophage activation in virally suppressed HIV+ individuals and might explain the increased risk of non-AIDS morbidity/mortality in HIV/CMV-coinfected subjects.
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Arnold M, Itzikowitz R, Young B, Machoki SM, Hsiao NY, Pillay K, Alexander A. Surgical manifestations of gastrointestinal cytomegalovirus infection in children: Clinical audit and literature review. J Pediatr Surg 2015; 50:1874-9. [PMID: 26265193 DOI: 10.1016/j.jpedsurg.2015.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/17/2015] [Accepted: 06/22/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Gastrointestinal sequelae of cytomegalovirus are rare, usually associated with significant immune compromise, and carry a high morbidity and mortality. Gastrointestinal disease frequently requires surgical intervention for diagnosis and management. AIM The aim of the study is to evaluate the incidence, presentation and management of gastrointestinal cytomegalovirus disease in a pediatric population. METHOD Between January 2003 and June 2011, a retrospective folder review was conducted of all symptomatic children with proven CMV disease, presenting to the surgical service. Eligible patients were identified using the surgical, histopathology and serology databases. RESULTS Thirty-eight patients (1.8/1000 surgical admissions) were identified with a median presenting age of 5months (range 3days-12years). Esophagitis (n=18) and small bowel disease (n=16) predominated, but CMV was seen throughout the gastrointestinal tract. Risk factors included HIV infection (n=21, 55%) and recent gastrointestinal surgery or infection (n=10, 26%). Characteristic multiple jejunoileal perforations were seen in six patients. Compared to upper GIT disease, intestinal involvement was associated with younger age and doubled mortality. In HIV-infected children, median CD4 (%) was lower in intestinal compared to upper gastrointestinal disease. Morbidities included anastomotic breakdowns (5), anastomotic strictures (3), relook laparotomies (10), resistant esophageal strictures (5) and prolonged parenteral nutrition (5). Anti-CMV drugs were given in 63%. Overall mortality was 32% (12/38) and was associated with lower GIT disease. CONCLUSION Invasive CMV gastrointestinal disease in our children was predominantly HIV-associated, or followed a major lower gastrointestinal inflammatory insult in infants younger than 6months. Successful therapy requires a high index of suspicion of active CMV disease to allow early implementation of CMV viral load control and aggressive treatment of the underlying immune impairment. Multiple surgical interventions are often required for both tissue diagnosis and management of acute and chronic complications. CMV-viral-load-tailored anti-CMV therapy is supported by recent literature.
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Affiliation(s)
- M Arnold
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - R Itzikowitz
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - B Young
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - S M Machoki
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - N Y Hsiao
- Division of Medical Virology, National Health Laboratory Service/University of Cape Town, Cape Town, South Africa
| | - K Pillay
- Department of Histopathology, NHLS, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - A Alexander
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Lichtner M, Vita S, Cozzi Lepri A, d'Arminio Monforte A. Reply to Manfredi. J Infect Dis 2015; 211:1357-9. [PMID: 25381368 PMCID: PMC4371768 DOI: 10.1093/infdis/jiu618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Miriam Lichtner
- Department of Infectious Disease, Polo Pontino, Sapienza University, Latina
| | - Serena Vita
- Department of Infectious Disease, Sapienza University, Rome, Italy
| | - Alessandro Cozzi Lepri
- Research Department of Infection and Population Health, Royal Free Campus, University College London, United Kingdom
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Liu Z, Zhang P, Tang S, He X, Zhang R, Wang X, Yuan Z, Tan J, Peng B, Liu E, Fu Z, Zou L. Urine real-time polymerase chain reaction detection for children virus pneumonia with acute human cytomegalovirus infection. BMC Infect Dis 2014; 14:245. [PMID: 24884393 PMCID: PMC4024271 DOI: 10.1186/1471-2334-14-245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 04/28/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Human cytomegalovirus (HCMV) is an important pathogen of viral pneumonia in children. The diagnosis of acute HCMV infection is complicated and difficult. METHODS Clinical and laboratory data of 6063 hospitalized children with respiratory infection and 509 with respiratory virus infection alone were retrospectively analyzed. Urine and respiratory specimens of 186 hospitalized children with pneumonia were also prospectively collected. Real-time polymerase chain reaction (PCR) and a chemiluminescent assay were used to detect HCMV DNA copy number, the pp65 gene, and HCMV IgM. RESULTS The patients with respiratory virus infection alone and those with pulmonary HCMV infection (n = 422) were mostly children aged <6 months old (82.91%, 422/509). The accuracy of urine HCMV DNA (82.32%) was higher than that of HCMV IgM (67.78%), indicating that PCR of urine samples is suitable for determining pediatric acute pulmonary HCMV infection. There was no significant difference in detecting HCMV DNA or the pp65 gene between urinary and respiratory specimens (P > 0.05) in 186 pediatric pneumonia cases. The accuracy of the pp65 gene measured in urine for determining acute pulmonary HCMV infection was the highest (93.01%). CONCLUSIONS Our study shows a novel method for investigating acute pulmonary HCMV infection in children by using real-time PCR and non-invasive samples. This study also highlights the superiority and potential use of the pp65 gene as an important target for the diagnosis of acute pulmonary HCMV infection.
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Affiliation(s)
- Zhidai Liu
- Center for Clinical Molecular Medicine, Children’s Hospital, Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
- Ministry of Education Key Laboratory of Development and Disorders, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Penghui Zhang
- Center for Clinical Laboratory, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Ministry of Education Key Laboratory of Development and Disorders, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Shi Tang
- Center for Clinical Molecular Medicine, Children’s Hospital, Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
- Ministry of Education Key Laboratory of Development and Disorders, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Xiaoyan He
- Center for Clinical Molecular Medicine, Children’s Hospital, Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
- Ministry of Education Key Laboratory of Development and Disorders, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Rong Zhang
- Center for Clinical Molecular Medicine, Children’s Hospital, Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
- Ministry of Education Key Laboratory of Development and Disorders, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Xinbin Wang
- Center for Clinical Molecular Medicine, Children’s Hospital, Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
- Ministry of Education Key Laboratory of Development and Disorders, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Zhaojian Yuan
- Center for Clinical Molecular Medicine, Children’s Hospital, Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
- Ministry of Education Key Laboratory of Development and Disorders, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Junjie Tan
- Center for Clinical Molecular Medicine, Children’s Hospital, Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
- Ministry of Education Key Laboratory of Development and Disorders, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Bin Peng
- Department of Health Statistics, School of Public Health, Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Enmei Liu
- Department of Respiratory Medicine, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Ministry of Education Key Laboratory of Development and Disorders, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Zhou Fu
- Department of Respiratory Medicine, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Ministry of Education Key Laboratory of Development and Disorders, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Lin Zou
- Center for Clinical Molecular Medicine, Children’s Hospital, Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing 400014, China
- Ministry of Education Key Laboratory of Development and Disorders, Children’s Hospital, Chongqing Medical University, Yuzhong District, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Children’s Hospital, Chongqing Medical University, Chongqing, China
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