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Dillman JR, Trout AT, Taylor AE, Khendek L, Kasten JL, Sheridan RM, Sharma D, Karns RA, Castro-Rojas C, Zhang B, Miethke AG. Association Between MR Elastography Liver Stiffness and Histologic Liver Fibrosis in Children and Young Adults With Autoimmune Liver Disease. AJR Am J Roentgenol 2024:1-12. [PMID: 38630086 DOI: 10.2214/ajr.24.31108] [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: 04/25/2024]
Abstract
BACKGROUND. Liver fibrosis is an important clinical endpoint of the progression of autoimmune liver disease (AILD); its monitoring would benefit from noninvasive imaging tools. OBJECTIVE. The purpose of this study was to assess the relationship between MR elastography (MRE) liver stiffness measurements and histologic liver fibrosis, as well as to evaluate the performance of MRE and biochemical-based clinical markers for stratifying histologic liver fibrosis severity, in children and young adults with AILD. METHODS. This retrospective study used an existing institutional registry of children and young adults diagnosed with AILD (primary sclerosing cholangitis [PSC], autoimmune sclerosing cholangitis [ASC], or autoimmune hepatitis [AIH]). The registry was searched to identify patients who underwent both a research abdominal 1.5-T MRI examination that included liver MRE (performed for registry enrollment) and a clinically indicated liver biopsy within 6 months of that examination. MRE used a 2D gradient-recalled echo sequence. One analyst measured mean liver shear stiffness (in kilopascals) for each examination. Laboratory markers of liver fibrosis (aspartate aminotransferase-to-platelet ratio index [APRI] and fibrosis-4 [FIB-4] score) were recorded. For investigational purposes, one pathologist, blinded to clinical and MRI data, determined histologic Metavir liver fibrosis stage. The Spearman rank order correlation coefficient was calculated between MRE liver stiffness and Metavir liver fibrosis stage. ROC analysis was used to evaluate diagnostic performance for identifying advanced fibrosis (i.e., differentiating Metavir F0-F1 from F2-F4 fibrosis), and sensitivity and specificity were calculated using the Youden index. RESULTS. The study included 46 patients (median age, 16.6 years [IQR, 13.7-17.8 years]; 20 female patients, 26 male patients); 12 had PSC, 10 had ASC, and 24 had AIH. Median MRE liver stiffness was 2.9 kPa (IQR, 2.2-4.0 kPa). MRE liver stiffness and Meta-vir fibrosis stage showed strong positive correlation (ρ = 0.68). For identifying advanced liver fibrosis, MRE liver stiffness had an AUC of 0.81, with sensitivity of 65.4% and specificity of 90.0%; APRI had an AUC of 0.72, with sensitivity of 64.0% and specificity of 80.0%; and FIB-4 score had an AUC of 0.71, with sensitivity of 60.0% and specificity of 85.0%. CONCLUSION. MRE liver stiffness measurements were associated with histologic liver fibrosis severity. CLINICAL IMPACT. The findings support a role for MRE in noninvasive monitoring of liver stiffness, a surrogate for fibrosis, in children and young adults with AILD. TRIAL REGISTRATION. ClinicalTrials.gov NCT03175471.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Ste ML5031, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
- Center for Autoimmune Liver Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Ste ML5031, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
- Center for Autoimmune Liver Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Amy E Taylor
- Center for Autoimmune Liver Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Leticia Khendek
- Center for Autoimmune Liver Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jennifer L Kasten
- Department of Pediatrics, Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rachel M Sheridan
- Department of Pediatrics, Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Divya Sharma
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rebekah A Karns
- Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Cyd Castro-Rojas
- Center for Autoimmune Liver Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bin Zhang
- Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Alexander G Miethke
- Center for Autoimmune Liver Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Xu J, Mao Y, Qu F, Hua X, Cheng J. Detection of placental stiffness using virtual magnetic resonance elastography in pregnancies complicated by preeclampsia. Arch Gynecol Obstet 2024:10.1007/s00404-024-07585-0. [PMID: 38884644 DOI: 10.1007/s00404-024-07585-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Jialu Xu
- Department of Radiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yajing Mao
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Feifei Qu
- MR Collaboration, Siemens Healthineers Ltd, Shanghai, China
| | - Xiaolin Hua
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jiejun Cheng
- Department of Radiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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Deng J, Cao Y, Lu Y, Song J, Zhang A, Zhao M, Zhou X, Mu X, Qu F, Wu F, Chen T. Value of placental virtual magnetic resonance elastography and intravoxel incoherent motion-based diffusion and perfusion in predicting adverse outcomes of small-for-gestational-age infants. Insights Imaging 2023; 14:153. [PMID: 37741945 PMCID: PMC10517907 DOI: 10.1186/s13244-023-01503-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/12/2023] [Indexed: 09/25/2023] Open
Abstract
OBJECTIVE It is critical to early monitor and manage small-for-gestational age (SGA) infants with truly adverse outcomes not detected by conventional methods. We aimed to explore the value of diffusion-weighted imaging (DWI)-based virtual magnetic resonance elastography (vMRE) and intravoxel incoherent motion (IVIM)-based biexponential and stretched exponential parameters in predicting adverse outcomes of SGA infants. METHODS Twenty SGA infants with adverse outcomes and forty without adverse outcomes were included in this prospective study. One DWI-based vMRE parameter [the stiffness value (μdiff)], five IVIM-based parameters [true diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), diffusion distribution coefficient (DDC), and diffusion heterogeneity index (Alpha)] and apparent diffusion coefficient (ADC) were calculated and compared between groups. The predictive efficiency was compared by the logistic regression analysis and receiver operating characteristic curve analysis. The relationship between the μdiff value with gestational age was also evaluated. RESULTS The placental μdiff value was remarkably higher, and the f, DDC, and ADC values were considerably lower in the SGA infants with adverse outcomes compared with those without adverse outcomes. The μdiff and f value were predictive risk factors for SGA infants with adverse outcomes. A combined predictive model (μdiff and f) improved the predictive efficacy. Moreover, there was no statistically significant correlation between the placental stiffness value and gestational age. CONCLUSIONS Functional MRI parameters to quantify placenta elastography and microcirculation in SGA patients. This might be a useful tool to assess placental function and a vital non-invasive supplement for predicting adverse outcomes of SGA infants. CRITICAL RELEVANCE STATEMENT This prospective study shows DWI-based virtual magnetic resonance elastography and intravoxel incoherent motion-based functional parameters to quantify placenta elastography and microcirculation in small-for-gestational-age patients, which could complement existing non-invasive methods for monitoring and predicting neonatal perinatal adverse outcome. KEY POINTS • vMRE is an emerging non-invasive imaging technique for evaluating placenta stiffness. • SGA infants with adverse outcome have stiffer placental elasticity and lower microcirculation. • Risk factors combination displayed better efficacy in predicting adverse outcomes of SGA.
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Affiliation(s)
- Jing Deng
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yuwei Cao
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yao Lu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jiacheng Song
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Aining Zhang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Meng Zhao
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xin Zhou
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xihu Mu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Feifei Qu
- MR Collaboration, Siemens Healthineers Ltd, Shanghai, China
| | - Feiyun Wu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Ting Chen
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Dillman JR, Tkach JA, Pedneker A, Trout AT. Quantitative abdominal magnetic resonance imaging in children-special considerations. Abdom Radiol (NY) 2022; 47:3069-3077. [PMID: 34196762 DOI: 10.1007/s00261-021-03191-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 01/18/2023]
Abstract
The use of quantitative MRI methods for assessment of the abdomen in children has become commonplace over the past decade. Increasingly employed methods include MR elastography, chemical shift encoded (CSE) MR imaging for determination of proton density fat fraction, diffusion-weighted imaging, and a variety of relaxometry techniques, such as T1 and T2* mapping. These techniques can be used in a variety of settings to distinguish normal from abnormal tissue as well as determine the severity of disease. The performance of quantitative MRI methods in the pediatric population presents unique challenges as compared to adult populations. These challenges relate to multiple factors, including patient size, pediatric physiology, inability to breath hold, and greater physical motion during the examination. The purpose of this review article is to review quantitative MRI methods that may be used in clinical practice to assess the pediatric abdomen and to discuss special considerations when performing these techniques in children.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amol Pedneker
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Associations between MRI T1 mapping, liver stiffness, quantitative MRCP, and laboratory biomarkers in children and young adults with autoimmune liver disease. Abdom Radiol (NY) 2022; 47:672-683. [PMID: 34932163 PMCID: PMC8847161 DOI: 10.1007/s00261-021-03378-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 12/15/2022]
Abstract
Purpose Define relationships between quantitative magnetic resonance imaging (MRI) metrics and clinical/laboratory data in a pediatric and young adult cohort with autoimmune liver disease (AILD). Materials and methods This prospective, cross-sectional study was institutional review board-approved. Patients enrolled in an institutional AILD registry were divided into groups: (1) autoimmune hepatitis (AIH) or (2) primary sclerosing cholangitis (PSC)/autoimmune sclerosing cholangitis (ASC). Participants underwent serum liver biochemistry testing and research MRI examinations, including 3D magnetic resonance cholangiopancreatography (MRCP), magnetic resonance elastography (MRE), and iron-corrected T1 mapping (cT1). MRCP + and LiverMultiScan (Perspectum Ltd., Oxford, UK) were used to post-process 3D MRCP and cT1 data. Multiple linear regression models were used to assess relationships. Results 58 patients, 35 male, median age 16 years were included; 30 in the AIH group, 28 in the PSC/ASC group. After statistical adjustments for patient age, sex, presence of inflammatory bowel disease (IBD), specific diagnosis (PSC/ASC vs. AIH), and time from diagnosis to MRI examination, left hepatic bile duct maximum diameter was a statistically significant predictor of whole liver mean cT1, cT1 interquartile range (IQR), and MRE liver stiffness (p = 0.01–0.04). Seven laboratory values were significant predictors of whole liver cT1 IQR (p < 0.0001–0.04). Eight laboratory values and right hepatic bile duct median and maximum diameter were significant predictors of liver stiffness (p < 0.0001–0.03). Conclusions Bile duct diameters and multiple laboratory biomarkers of liver disease are independent predictors of liver stiffness and cT1 IQR in pediatric patients with AILD. Supplementary Information The online version contains supplementary material available at 10.1007/s00261-021-03378-0.
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Associations Between Quantitative MRI Metrics and Clinical Risk Scores in Children and Young Adults With Autoimmune Liver Disease. AJR Am J Roentgenol 2022; 219:142-150. [PMID: 35080454 DOI: 10.2214/ajr.21.27204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The Mayo risk score and SCOPE (Sclerosing Cholangitis Outcomes in Pediatrics) Index are clinical risk scores for monitoring progression of primary sclerosing cholangitis (PSC) and predict clinically important endpoints. Objective: To evaluate relationships of quantitative MRI measures of liver disease with clinical risk scores in children and young adults with autoimmune liver disease (AILD). Methods: This prospective study included 58 patients (35 male, 23 female; mean age, 15 years; range, 6-24 years) with AILD [PSC (n=16), autoimmune hepatitis (n=30), autoimmune sclerosing cholangitis (n=12)] who underwent research liver MRI examinations including: MR elastography (MRE), T2*-corrected T1 (cT1), and quantitative MRCP measurements. Associations between quantitative MRI metrics and clinical risk scores were evaluated using Spearman rank-order correlation coefficients and multivariable regression analyses. Results: Mean Mayo risk score was -1.1±0.9 (range: -2.9-1.1); mean SCOPE Index was 2.7±2.2 (range: 0-9). Mean liver stiffness was 2.8±1.1 kPa, mean whole-liver mean cT1 was 875±78 ms, and mean cT1 interquartile range (IQR) was 151±56 ms. Mayo risk score was significantly correlated with liver stiffness (r=0.56; p<.001), cT1 IQR (r=0.58; p<.001), whole-liver mean cT1 (r=0.31; p=.02), and multiple quantitative MRCP measures (r=0.36-0.45, p<.001). SCOPE Index was significantly correlated with liver stiffness (r=0.68; p<.001), cT1 IQR (r=0.51; p<.001), and multiple quantitative MRCP measures (r=0.47-0.49, p<.001). Multivariable linear regression analyses identified liver stiffness, cT1 IQR, and left hepatic duct maximum diameter as significant independent predictors of Mayo risk score (adjusted R2=0.45), and liver stiffness, cT1 IQR, common bile duct maximum (CBD) diameter, and CBD median diameter as significant independent predictors of SCOPE Index (adjusted R2=0.69). On logistic regression analysis, greater than low risk by SCOPE Index was best predicted by liver stiffness [odds ratio (OR)=49.6; 95% CI: 3.1-793.6) and CBD maximum diameter (OR=2.5; 95% CI: 1.3-4.7). Conclusion: Increased liver stiffness, increased cT1 IQR, and larger bile duct diameters are independently associated with higher (worse) Mayo risk score and SCOPE Index in children and young adults with AILD and may be surrogate markers of clinically meaningful endpoints. Clinical Impact: Multiparametric liver MRI incorporating quantitative metrics may serve as a noninvasive diagnostic and prognostic tool in pediatric AILD.
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Mo C, Xie S, Liu B, Zhong W, Zeng T, Huang S, Lai Y, Deng G, Zhou C, Yan W, Chen Y, Huang S, Gao L, Lv Z. Indoleamine 2,3-dioxygenase 1 limits hepatic inflammatory cells recruitment and promotes bile duct ligation-induced liver fibrosis. Cell Death Dis 2021; 12:16. [PMID: 33414436 PMCID: PMC7791029 DOI: 10.1038/s41419-020-03277-0] [Citation(s) in RCA: 15] [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: 08/15/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
Liver fibrosis is a course of chronic liver dysfunction, can develop into cirrhosis and hepatocellular carcinoma. Inflammatory insult owing to pathogenic factors plays a crucial role in the pathogenesis of liver fibrosis. Indoleamine 2,3-dioxygenase 1 (IDO1) can affect the infiltration of immune cells in many pathology processes of diseases, but its role in liver fibrosis has not been elucidated completely. Here, the markedly elevated protein IDO1 in livers was identified, and dendritic cells (DCs) immune-phenotypes were significantly altered after BDL challenge. A distinct hepatic population of CD11c+DCs was decreased and presented an immature immune-phenotype, reflected by lower expression levels of co-stimulatory molecules (CD40, MHCII). Frequencies of CD11c+CD80+, CD11c+CD86+, CD11c+MHCII+, and CD11c+CD40+ cells in splenic leukocytes were reduced significantly. Notably, IDO1 overexpression inhibited hepatic, splenic CD11c+DCs maturation, mature DCs-mediated T-cell proliferation and worsened liver fibrosis, whereas above pathological phenomena were reversed in IDO1-/- mice. Our data demonstrate that IDO1 affects the process of immune cells recruitment via inhibiting DCs maturation and subsequent T cells proliferation, resulting in the promotion of hepatic fibrosis. Thus, amelioration of immune responses in hepatic and splenic microenvironment by targeting IDO1 might be essential for the therapeutic effects on liver fibrosis.
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Affiliation(s)
- Chan Mo
- School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China
| | - Shuwen Xie
- School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China
| | - Bin Liu
- Department of Emergency, Guangzhou Red Cross Hospital, Medical College, Jinan University, 510220, Guangzhou, China
| | - Weichao Zhong
- Shenzhen Traditional Chinese Medicine Hospital, No.1, Fuhua Road, Futian District, 518033, Shenzhen, Guangdong, People's Republic of China
| | - Ting Zeng
- School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China
| | - Sha Huang
- School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China
| | - Yuqi Lai
- School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China
| | - Guanghui Deng
- School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China
| | - Chuying Zhou
- School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China
| | - Weixin Yan
- School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China
| | - Yuyao Chen
- School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China
| | - Shaohui Huang
- School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China
| | - Lei Gao
- School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China.
- The Key Laboratory of Molecular Biology, State Administration of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China.
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, 510515, Guangzhou, People's Republic of China.
| | - Zhiping Lv
- School of Traditional Chinese Medicine, Southern Medical University, 510515, Guangzhou, Guangdong, People's Republic of China.
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