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Angelini L, Terranova R, Lazzeri G, van den Berg KRE, Dirkx MF, Paparella G. The role of laboratory investigations in the classification of tremors. Neurol Sci 2023; 44:4183-4192. [PMID: 37814130 PMCID: PMC10641063 DOI: 10.1007/s10072-023-07108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Tremor is the most common movement disorder. Although clinical examination plays a significant role in evaluating patients with tremor, laboratory tests are useful to classify tremors according to the recent two-axis approach proposed by the International Parkinson and Movement Disorders Society. METHODS In the present review, we will discuss the usefulness and applicability of the various diagnostic methods in classifying and diagnosing tremors. We will evaluate a number of techniques, including laboratory and genetic tests, neurophysiology, and neuroimaging. The role of newly introduced innovative tremor assessment methods will also be discussed. RESULTS Neurophysiology plays a crucial role in tremor definition and classification, and it can be useful for the identification of specific tremor syndromes. Laboratory and genetic tests and neuroimaging may be of paramount importance in identifying specific etiologies. Highly promising innovative technologies are being developed for both clinical and research purposes. CONCLUSIONS Overall, laboratory investigations may support clinicians in the diagnostic process of tremor. Also, combining data from different techniques can help improve understanding of the pathophysiological bases underlying tremors and guide therapeutic management.
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Affiliation(s)
- Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy.
| | - Roberta Terranova
- Department of Medical, Surgical Sciences and Advanced Technologies "GF Ingrassia," University of Catania, Catania, Italy
| | - Giulia Lazzeri
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Kevin R E van den Berg
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michiel F Dirkx
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
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Lu F, Zhao K, Wu Y, Kong Y, Gao Y, Zhang L. Voice-Related Outcomes in Deep Brain Stimulation in Patients with Vocal Tremor: A Systematic Review and Meta-Analysis. J Voice 2023:S0892-1997(23)00302-8. [PMID: 37880051 DOI: 10.1016/j.jvoice.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES The effectiveness of deep brain stimulation (DBS) in treating vocal tremors is currently a subject of debate. To assess the efficacy of DBS therapy in adults with vocal tremors (VT), we analyzed its impact on voice tremor severity, voice-related quality of life, fundamental frequency, voice intensity, and emotional state. METHODS We conducted a systematic review with meta-analysis to investigate the impact of DBS therapy on voice tremor severity, voice-related quality of life, fundamental frequency, voice intensity, and emotional state in adults with vocal tremors (PROSPERO/CRD42023420272). The PubMed, Embase, Cochrane Library, Cochrane Central Register of Controlled Trials databases were searched up to September 20, 2022. Primary outcome measures included voice tremor severity and voice-related quality of life (V-RQOL), while fundamental frequency (F0) and voice intensity, along with emotional state, were selected as secondary outcome indicators. We employed the Cochrane Collaboration's tool for assessing bias risk in randomized trials. Meta-analysis (standardized difference of means and weighted mean differences) and heterogeneity analysis (I2) were performed. RESULTS Our search identified 1186 studies, of which nine studies involving 61 patients met the inclusion criteria. The severity of voice tremor (SMD = -1.08; 95% CI: -1.80 to 0.35; P = 0.02) and V-RQOL (SMD = -1.39; 95% CI: -2.68 to -0.09; P = 0.04) in patients with vocal tremor significantly improved after DBS "on". Subgroup analyses revealed that the stimulation site may contribute to high heterogeneity. Specifically, Vim DBS showed significant improvement in voice tremor severity (SMD = -0.97; 95% CI: -1.84 to -0.09; I2 = 51.01%), while STN DBS did not demonstrate a clear benefit in addressing vocal tremor. There was no significant difference between DBS "on" and DBS "off" in terms of F0, voice intensity, or emotional status. CONCLUSION DBS therapy is effective in enhancing voice quality and voice-related quality of life in patients with vocal tremors. Notably, Vim DBS demonstrates a significant improvement in voice tremor severity, particularly in VT patients with ET and SD.
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Affiliation(s)
- Feiao Lu
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Kun Zhao
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yulun Wu
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yurou Kong
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yongxiang Gao
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Liya Zhang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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O’Flynn LC, Frucht SJ, Simonyan K. Sodium Oxybate in Alcohol-Responsive Essential Tremor of Voice: An Open-Label Phase II Study. Mov Disord 2023; 38:1936-1944. [PMID: 37448353 PMCID: PMC10615702 DOI: 10.1002/mds.29529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/10/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Essential tremor of voice (ETv) is characterized by involuntary oscillations of laryngeal and upper airway muscles, causing rhythmic alterations in pitch and loudness during both passive breathing and active laryngeal tasks, such as speaking and singing. Treatment of ETv is challenging and typically less effective compared with treatment of ET affecting extremities. OBJECTIVE We conducted a proof-of-concept, open-label phase II study to examine the efficacy and central effects of sodium oxybate in patients with alcohol-responsive ETv. METHODS All subjects received 1.0 to 1.5 g of oral sodium oxybate and underwent brain functional magnetic resonance imaging. The primary endpoint was the number of patients (% from total) with reduced ETv symptoms by at least 10% at about 40 to 45 minutes after sodium oxybate intake based on the combined visual analog scale score of ETv symptom severity. The secondary endpoint included changes in brain activity after sodium oxybate intake compared to baseline. RESULTS Sodium oxybate reduced ETv symptoms on average by 40.8% in 92.9% of patients. Drug effects were observed about 40 to 45 minutes after intake, lasting about 3.5 hours, and gradually wearing off by the end of the fifth hour. The central effects of sodium oxybate were associated with normalized activity in the cerebellum, inferior/superior parietal lobules, inferior frontal gyrus, and insula and re-established functional relationships between these regions. CONCLUSIONS Sodium oxybate showed high efficacy in ETv patients, with a likely central action on disorder pathophysiology. Sodium oxybate may be an effective novel oral drug for treatment of alcohol-responsive ETv patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lena C. O’Flynn
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
- Program in Speech Hearing Bioscience and Technology, Harvard University, 260 Longwood Avenue, Boston, MA 02115, USA
| | - Steven J. Frucht
- Department of Neurology, NYU Langone Health, New York, NY 10017, USA
| | - Kristina Simonyan
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
- Program in Speech Hearing Bioscience and Technology, Harvard University, 260 Longwood Avenue, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Chen Y, Lyu S, Xiao W, Yi S, Liu P, Liu J. Sleep Traits Causally Affect the Brain Cortical Structure: A Mendelian Randomization Study. Biomedicines 2023; 11:2296. [PMID: 37626792 PMCID: PMC10452307 DOI: 10.3390/biomedicines11082296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Background: Brain imaging results in sleep deprived patients showed structural changes in the cerebral cortex; however, the reasons for this phenomenon need to be further explored. Methods: This MR study evaluated causal associations between morningness, ease of getting up, insomnia, long sleep, short sleep, and the cortex structure. Results: At the functional level, morningness increased the surface area (SA) of cuneus with global weighted (beta(b) (95% CI): 32.63 (10.35, 54.90), p = 0.004). Short sleep increased SA of the lateral occipital with global weighted (b (95% CI): 394.37(107.89, 680.85), p = 0.007. Short sleep reduced cortical thickness (TH) of paracentral with global weighted (OR (95% CI): -0.11 (-0.19, -0.03), p = 0.006). Short sleep reduced TH of parahippocampal with global weighted (b (95% CI): -0.25 (-0.42, -0.07), p = 0.006). No pleiotropy was detected. However, none of the Bonferroni-corrected p values of the causal relationship between cortical structure and the five types of sleep traits met the threshold. Conclusions: Our results potentially show evidence of a higher risk association between neuropsychiatric disorders and not only paracentral and parahippocampal brain areas atrophy, but also an increase in the middle temporal zone. Our findings shed light on the associations of cortical structure with the occurrence of five types of sleep traits.
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Affiliation(s)
- Yanjing Chen
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, China; (Y.C.); (S.L.); (S.Y.); (P.L.)
| | - Shiyi Lyu
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, China; (Y.C.); (S.L.); (S.Y.); (P.L.)
| | - Wang Xiao
- Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China;
| | - Sijie Yi
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, China; (Y.C.); (S.L.); (S.Y.); (P.L.)
| | - Ping Liu
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, China; (Y.C.); (S.L.); (S.Y.); (P.L.)
| | - Jun Liu
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, China; (Y.C.); (S.L.); (S.Y.); (P.L.)
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha 410011, China
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Feltrin FS, Chopra R, Pouratian N, Elkurd M, El-Nazer R, Lanford L, Dauer W, Shah BR. Focused ultrasound using a novel targeting method four-tract tractography for magnetic resonance-guided high-intensity focused ultrasound targeting. Brain Commun 2022; 4:fcac273. [PMID: 36751499 PMCID: PMC9897190 DOI: 10.1093/braincomms/fcac273] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/03/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022] Open
Abstract
Magnetic resonance-guided high-intensity focused ultrasound thalamotomy is a Food and Drug Administration-approved treatment for essential tremor. The target, the ventral intermediate nucleus of the thalamus, is not visualized on standard, anatomic MRI sequences. Several recent reports have used diffusion tensor imaging to target the dentato-rubro-thalamic-tract. There is considerable variability in fibre tracking algorithms and what fibres are tracked. Targeting discrete white matter tracts with magnetic resonance-guided high-intensity focused ultrasound is an emerging precision medicine technique that has the promise to improve patient outcomes and reduce treatment times. We provide a technical overview and clinical benefits of our novel, easily implemented advanced tractography method: four-tract tractography. Our method is novel because it targets both the decussating and non-decussating dentato-rubro-thalamic-tracts while avoiding the medial lemniscus and corticospinal tracts. Our method utilizes Food and Drug Administration-approved software and is easily implementable into existing workflows. Initial experience using this approach suggests that it improves patient outcomes by reducing the incidence of adverse effects.
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Affiliation(s)
- Fabricio S Feltrin
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Rajiv Chopra
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UTSW Medical Center, Dallas, TX 75235, USA,O’Donnell Brain Institute, UTSW Medical Center, Dallas, TX 75235, USA
| | - Mazen Elkurd
- O’Donnell Brain Institute, UTSW Medical Center, Dallas, TX 75235, USA,Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Rasheda El-Nazer
- O’Donnell Brain Institute, UTSW Medical Center, Dallas, TX 75235, USA,Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Lauren Lanford
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA
| | - William Dauer
- O’Donnell Brain Institute, UTSW Medical Center, Dallas, TX 75235, USA,Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA
| | - Bhavya R Shah
- Correspondence to: Bhavya R. Shah UTSW Medical Center 1801 Inwood Rd, Dallas, TX 75235, USA E-mail:
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Riboldi GM, Frucht SJ. Is essential tremor a family of diseases or a syndrome? A family of diseases. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:7-29. [PMID: 35750371 DOI: 10.1016/bs.irn.2022.02.001] [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: 06/15/2023]
Abstract
It is now well-established that essential tremor (ET) can manifest with different clinical presentations and progressions (i.e., upper limb tremor, head tremor, voice tremor, lower limb tremor, task- or position-specific tremor, or a combination of those). Common traits and overlaps are identifiable across these different subtypes of ET, including a slow rate of progression, a response to alcohol and a positive family history. At the same time, each of these manifestations are associated with specific demographic, clinical and treatment-response characteristics suggesting a family of diseases rather than a spectrum of a syndrome. Here we summarize the most important clinical, demographic, neuropathological and imagingfeatures of ET and of its subtypes to support ET as a family of identifiable conditions. This classification has relevance for counseling of patients with regard to disease progression and treatment response, as well as for the design of therapeutic clinical trials.
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Affiliation(s)
- Giulietta M Riboldi
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University Langone Health, New York, NY, United States
| | - Steven J Frucht
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University Langone Health, New York, NY, United States.
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Valeriani D, Simonyan K. The dynamic connectome of speech control. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200256. [PMID: 34482717 DOI: 10.1098/rstb.2020.0256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Speech production relies on the orchestrated control of multiple brain regions. The specific, directional influences within these networks remain poorly understood. We used regression dynamic causal modelling to infer the whole-brain directed (effective) connectivity from functional magnetic resonance imaging data of 36 healthy individuals during the production of meaningful English sentences and meaningless syllables. We identified that the two dynamic connectomes have distinct architectures that are dependent on the complexity of task production. The speech was regulated by a dynamic neural network, the most influential nodes of which were centred around superior and inferior parietal areas and influenced the whole-brain network activity via long-ranging coupling with primary sensorimotor, prefrontal, temporal and insular regions. By contrast, syllable production was controlled by a more compressed, cost-efficient network structure, involving sensorimotor cortico-subcortical integration via superior parietal and cerebellar network hubs. These data demonstrate the mechanisms by which the neural network reorganizes the connectivity of its influential regions, from supporting the fundamental aspects of simple syllabic vocal motor output to multimodal information processing of speech motor output. This article is part of the theme issue 'Vocal learning in animals and humans'.
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Affiliation(s)
- Davide Valeriani
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Kristina Simonyan
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.,Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Chen X, Kong J, Pan J, Huang K, Zhou W, Diao X, Cai J, Zheng J, Yang X, Xie W, Yu H, Li J, Pei L, Dong W, Qin H, Huang J, Lin T. Kidney damage causally affects the brain cortical structure: A Mendelian randomization study. EBioMedicine 2021; 72:103592. [PMID: 34619639 PMCID: PMC8498227 DOI: 10.1016/j.ebiom.2021.103592] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Alterations in the brain cortical structures of patients with chronic kidney disease (CKD) have been reported; however, the cause has not been determined yet. Herein, we used Mendelian randomization (MR) to reveal the causal effect of kidney damage on brain cortical structure. METHODS Genome-wide association studies summary data of estimated glomerular filtration rate (eGFR) in 480,698 participants from the CKDGen Consortium were used to identify genetically predicted eGFR. Data from 567,460 individuals from the CKDGen Consortium were used to assess genetically determined CKD; 302,687 participants from the UK Biobank were used to evaluate genetically predicted albuminuria. Further, data from 51,665 patients from the ENIGMA Consortium were used to assess the relationship between genetic predisposition and reduced eGFR, CKD, and progressive albuminuria with alterations in cortical thickness (TH) or surficial area (SA) of the brain. Magnetic resonance imaging was used to measure the SA and TH globally and in 34 functional regions. Inverse-variance weighted was used as the primary estimate whereas MR Pleiotropy RESidual Sum and Outlier, MR-Egger and weighted median were used to detect heterogeneity and pleiotropy. FINDINGS At the global level, albuminuria decreased TH (β = -0.07 mm, 95% CI: -0.12 mm to -0.02 mm, P = 0.004); at the functional level, albuminuria reduced TH of pars opercularis gyrus without global weighted (β = -0.11 mm, 95% CI: -0.16 mm to -0.07 mm, P = 3.74×10-6). No pleiotropy was detected. INTERPRETATION Kidney damage causally influences the cortex structure which suggests the existence of a kidney-brain axis. FUNDING This study was supported by the Science and Technology Planning Project of Guangdong Province (Grant No. 2020A1515111119 and 2017B020227007), the National Key Research and Development Program of China (Grant No. 2018YFA0902803), the National Natural Science Foundation of China (Grant No. 81825016, 81961128027, 81772719, 81772728), the Key Areas Research and Development Program of Guangdong (Grant No. 2018B010109006), Guangdong Special Support Program (2017TX04R246), Grant KLB09001 from the Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, and Grants from the Guangdong Science and Technology Department (2020B1212060018).
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Affiliation(s)
- Xiong Chen
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China; Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, PR China
| | - Jianqiu Kong
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Jiexin Pan
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Kai Huang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, PR China
| | | | - Xiayao Diao
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Jiahao Cai
- Department of Pediatric Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, PR China
| | - Junjiong Zheng
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Xuefan Yang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Weibin Xie
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Hao Yu
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Jiande Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, PR China
| | - Lu Pei
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Wen Dong
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Haide Qin
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Jian Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China.
| | - Tianxin Lin
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China.
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