1
|
Dzhus M, Mostbauer H. Coronary artery lesions in Takayasu arteritis. Reumatologia 2024; 61:460-472. [PMID: 38322104 PMCID: PMC10839913 DOI: 10.5114/reum/176483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Takayasu arteritis (TAK) is a granulomatous inflammation of vessels of large diameter, mainly affecting the aorta and its proximal branches, which is more common in young women. The incidence of coronary artery disease in TAK is unknown and not sufficiently studied. Material and methods A literature review was performed for the period 2003 to 2023 using a search of the PubMed and Scopus scientific databases. We used the following key words to search the academic journal databases: "Takayasu arteritis", "coronary angiography", "myocardial revascularization", "coronary artery disease", "angina pectoris", and "myocardial infarction". Results The analysis of studies showed that coronary artery lesions (CAL) in TAK are not uncommon, being identified particularly in children and young individuals. Pathology of the coronary arteries increases the morbidity and mortality of TAK patients. In TAK, the ostia and proximal segments of the coronary arteries are more frequently affected, presenting as stenosis or occlusion with the development of stable coronary artery disease, unstable coronary artery disease, acute myocardial infarction, and sudden death. The diagnosis of TAK and coronary artery pathology is often complicated due to nonspecific manifestations and frequently the absence of symptoms. The treatment of patients with TAK with CAL is challenging and requires both pharmacological therapy and interventional or surgical methods of myocardial revascularization. Conclusions Takayasu arteritis is a more prevalent cause of CAL development, especially in young patients, than previously believed, and cardiovascular death due to CAL is not rare. Early diagnosis of TAK with CAL, particularly occlusion or hemodynamically significant stenosis, and the prompt initiation of appropriate treatment prevent dangerous complications, reduce mortality, and improve prognosis.
Collapse
Affiliation(s)
- Marta Dzhus
- Department of Internal Medicine No. 2, O. Bohomolets National Medical University, Kyiv, Ukraine
| | - Halyna Mostbauer
- Department of Internal Medicine No. 2, O. Bohomolets National Medical University, Kyiv, Ukraine
| |
Collapse
|
2
|
Liang S, Yang J, Ma M, Zhou M, Liu Z, Huang H, He Y. Restenosis after excimer laser coronary atherectomy and drug-coated balloon dilation in Takayasu's arteritis: a case report and review of the literature. Thromb J 2023; 21:87. [PMID: 37563604 PMCID: PMC10413599 DOI: 10.1186/s12959-023-00529-9] [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: 03/20/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023] Open
Abstract
Takayasu's arteritis (TAK) is a rare chronic granulomatous arteritis that mainly affects the aorta and its major branches. Coronary artery (CA) involvement can be observed in 10-25% of TAK patients. We report a 21-year-old young female who was previously diagnosed with TAK and severe left main coronary artery (LMCA) stenosis and underwent numerous percutaneous coronary interventions (PCIs) in our hospital due to in-stent restenosis (ISR). This time, an excimer laser coronary atherectomy (ELCA) and drug-coated balloon (DCB) dilation was taken at the LMCA for the ISR. The blood flow was smooth after the operation, and she was symptom-free after discharge. Unfortunately, 5 months later, severe intimal hyperplasia was still seen in the stent of LMCA and left anterior descending (LAD) coronary artery. A coronary artery bypass graft surgery (CABG) was performed, and she has been symptom-free ever since. ELCA plus DCB is one of the novel ways we first reported. However, ensuring long-term inflammation control is equally important to restore blood flow. The combination of revascularization and anti-inflammation/immunosuppression is recommended to improve the outcomes of TAK patients with CA involvements.
Collapse
Affiliation(s)
- Shichu Liang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Jinming Yang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Ma
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Minggang Zhou
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Zhiyue Liu
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China.
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China.
| |
Collapse
|
3
|
Cobilinschi CO, Grădinaru E, Săulescu I, Cârstea N, Caraiola S, Bălănescu AR, Opriș-Belinski D. Refractory Takayasu's Arteritis with Severe Coronary Involvement-Case Report and Literature Review. J Clin Med 2023; 12:4394. [PMID: 37445428 DOI: 10.3390/jcm12134394] [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: 05/09/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
This report presents the case of a female patient diagnosed with Takayasu arteritis from childhood, with severe, refractory coronary involvement, leading to two acute coronary syndromes and multiple anginous episodes. Consequently, the patient suffered aorto-bicarotid bypass two times, multiple interventional procedures with stent implantation, balloon angioplasty, and up to ten repeated in-stent restenosis that required reinterventions, despite being on maximal immunosuppressive treatment. In recent years, various studies have been reported that aim to best characterize this particular type of vascular damage and to indicate optimal therapeutic options for treatment. The latter should be based on the activity of the underlying disease; however, no reliable markers are available in TA. The management of TA patients with coronary involvement continues to be a challenge and requires both drug and interventional techniques to avoid life-threatening events.
Collapse
Affiliation(s)
- Claudia Oana Cobilinschi
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Rheumatology and Internal Medicine, Sf Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
| | - Elena Grădinaru
- Department of Rheumatology and Internal Medicine, Sf Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
| | - Ioana Săulescu
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Rheumatology and Internal Medicine, Sf Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
| | - Nicolae Cârstea
- Department of Interventional Cardiology, Ares Excellency Centers, 021967 Bucharest, Romania
| | - Simona Caraiola
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Internal Medicine, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Andra Rodica Bălănescu
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Rheumatology and Internal Medicine, Sf Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
| | - Daniela Opriș-Belinski
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Rheumatology and Internal Medicine, Sf Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
| |
Collapse
|
4
|
Xu Y, Luo L, Su G, Zhu J, Kang M, Zhang D, Lai J, Li X. Clinical characteristics and risk factors of coronary artery lesions in chinese pediatric Takayasu arteritis patients: a retrospective study. Pediatr Rheumatol Online J 2023; 21:42. [PMID: 37118779 PMCID: PMC10148487 DOI: 10.1186/s12969-023-00820-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/13/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUD To summarize the clinical characteristics and identify the risk factors for pediatric Takayasu arteritis (TAK) with coronary artery lesions (CALs). METHODS Clinical data of pediatric TAK patients in our center were retrospectively assessed. Independent risk factors for CALs were identified using multivariate logistic regression analysis. Survival analysis was used to compare differences in survival rates between the groups. RESULTS Among the 66 pediatric TAK cases, the incidence of accompanying CALs was 39.4%. In the CAL group, 19 (73.1%) cases started within 36 months. None of the patients had symptoms of angina or ischemia on electrocardiogram (ECG), the CALs were detected using coronary ultrasound. The CALs most commonly were the left main and right coronary arteries. The lesions were mostly small or middle coronary artery aneurysms; some children may have giant coronary aneurysmal dilations, thrombosis and heart failure. The age of onset and symptom onset to diagnosis in TAK patients with CAL were lower than those in TAK patients without CAL(P < 0.005). TAK patients with CAL had significantly higher CRP,WBC, PLT,TNF-α and IL-2R levels (P < 0.05), lower HGB (P = 0.01), lower rate of renal artery stenosis (RAS) (P = 0.009). In multivariate logistic regression, the risk factors for pediatric TAK combined with CAL included the age of TAK onset (OR = 0.9835, 95% CI: 0.9710-0.9946, P = 0.006) and RAS (OR = 0.1901, 95% CI: 0.0386-0.7503, P = 0.03). In addition, there was no significant difference in survival rates between the two groups after regular treatment. CONCLUSION This study showed that the occurrence of CAL in pediatric TAK patients has a relatively more rapid clinical course, and a stronger inflammatory state at the time of diagnosis. The earlier the age of TAK onset and without RAS are more likely to cause CAL.
Collapse
Affiliation(s)
- Yingjie Xu
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
- Department of Rheumatology, Capital Institute of Pediatrics, Beijing, China
| | - Lingfeng Luo
- Department of Occupational and Environmental Health, School of Public Health, Suzhou Medical College, Soochow University, Suzhou, China
| | - Gaixiu Su
- Department of Rheumatology, Capital Institute of Pediatrics, Beijing, China
| | - Jia Zhu
- Department of Rheumatology, Capital Institute of Pediatrics, Beijing, China
| | - Min Kang
- Department of Rheumatology, Capital Institute of Pediatrics, Beijing, China
| | - Dan Zhang
- Department of Rheumatology, Capital Institute of Pediatrics, Beijing, China
| | - Jianming Lai
- Department of Rheumatology, Capital Institute of Pediatrics, Beijing, China.
| | - Xiaohui Li
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China.
- Department of Cardiology, Capital Institute of Pediatrics, Beijing, China.
| |
Collapse
|
5
|
Joseph G, Goel R, Thomson VS, Joseph E, Danda D. Takayasu Arteritis: JACC Focus Seminar 3/4. J Am Coll Cardiol 2022; 81:S0735-1097(22)07305-3. [PMID: 36599755 DOI: 10.1016/j.jacc.2022.09.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/06/2022] [Accepted: 09/21/2022] [Indexed: 01/03/2023]
Abstract
Takayasu arteritis is a rare idiopathic large-vessel vasculitis that typically affects young women. An early "prepulseless" stage is often missed, associated with nonspecific constitutional symptoms (fever, malaise, and weight loss) and elevated inflammatory markers. Unchecked disease progression leads to the "pulseless" stage, manifest clinically by missing pulses, vascular tenderness, and ischemic symptoms (limb claudication, dizziness, angina, and renovascular hypertension), and is characterized pathologically by arterial wall thickening and stenotic/occlusive lesions or aneurysm formation. Vascular complications (stroke, blindness, heart failure, and aneurysm rupture) could follow unless disease progression is halted by immunosuppressive therapy and critical lesions are palliated by timely endovascular therapy or open surgery. Early diagnosis, effective therapy, and lifelong surveillance for disease activity relapses and vascular disease progression are critical to successful long-term outcomes. The outlook for patients has improved significantly in recent years with the establishment of diagnostic and classification criteria, better investigational modalities, and more effective medical and invasive therapy.
Collapse
Affiliation(s)
- George Joseph
- Department of Cardiology, Christian Medical College, Vellore, India.
| | - Ruchika Goel
- Department of Clinical Rheumatology, Christian Medical College, Vellore, India
| | - Viji S Thomson
- Department of Cardiology, Christian Medical College, Vellore, India
| | - Elizabeth Joseph
- Department of Radiology, Christian Medical College, Vellore, India
| | - Debashish Danda
- Department of Clinical Rheumatology, Christian Medical College, Vellore, India
| |
Collapse
|
6
|
Five-year outcome with revascularisation therapy in Takayasu arteritis with multiple coronary involvement: a case review. Cardiol Young 2022; 32:1857-1859. [PMID: 35322772 DOI: 10.1017/s1047951122000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
7
|
Huo J, Wang B, Yu L, Gao D, Cheng R, Wang J, Zhou X, Tian T, Gao L. Clinical characteristics and outcomes in patients with Takayasu arteritis coexisting with myocardial ischemia and neurological symptoms: A multicenter, long-term, follow-up study. Front Cardiovasc Med 2022; 9:948124. [PMID: 35990973 PMCID: PMC9385106 DOI: 10.3389/fcvm.2022.948124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe incidence of coexisting myocardial ischemia and neurological symptoms in Takayasu arteritis (TA) is currently unknown. There is no standardized treatment algorithm in complex cases involving the coronary and intracranial arteries.ObjectiveThis study aimed to describe the clinical characteristics and outcomes in patients with TA coexisting with myocardial ischemia and neurological symptoms.MethodsWe retrospectively collected and assessed 1,580 patients with TA, and enrolled patients with myocardial ischemia and neurological symptoms from January 2002 to December 2021 in several hospitals. The incidence, clinical features, management strategy, and prognosis of these patients were evaluated.ResultsNinety-four (5.9%, 94/1,580) patients with TA coexisting with myocardial ischemia and neurological symptoms were included in the present study. Imaging results showed that the subclavian arteries were the most frequently affected arteries and 37 patients had intracranial vascular abnormalities, comprising the basilar artery (6.1%, 17/279), middle cerebral artery (2.5%, 7/279), anterior cerebral artery (2.9%, 8/279), and posterior cerebral artery (1.9%, 5/279). Among patients with neurological symptoms, 25 patients underwent percutaneous transluminal angioplasty and 20 patients underwent stent implantation. The most common site of stenosis was the ostial and proximal segments of the coronary artery, with 142 lesions among 188 (75.5%) lesions. Thirty-eight patients adopted interventional therapy, 21 patients underwent surgical treatment, and the remaining 35 patients received conservative treatment. There were 20 (21.27%, 20/94) late deaths during a mean follow-up of 57.79 months. The mortality rate in the conservative treatment group was significantly higher than that in the interventional therapy and surgical treatment groups.ConclusionPatients with TA involving both the coronary and intracranial vessels are not rare. Stenosis and occlusion lesions most frequently involve the ostia and proximal segment of the arteries. Severe vascular lesions should be revascularized as soon as possible. These patients should be supplemented with glucocorticoids, antiplatelet, nitrates, and statins.
Collapse
Affiliation(s)
- Junting Huo
- Department of Neurology, Affiliated Chuiyangliu Hospital of Tsinghua University, Beijing, China
| | - Bin Wang
- Department of Comprehensive Surgery, General Hospital of Chinese People’s Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - LiJun Yu
- Department of Comprehensive Surgery, General Hospital of Chinese People’s Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Dewei Gao
- Department of Comprehensive Surgery, General Hospital of Chinese People’s Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Rui Cheng
- Department of Comprehensive Surgery, General Hospital of Chinese People’s Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Xianliang Zhou
- Department of Cardiology, FuWai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Tian
- Department of Cardiology, FuWai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Tao Tian,
| | - Linggen Gao
- Department of Comprehensive Surgery, General Hospital of Chinese People’s Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
- Linggen Gao,
| |
Collapse
|
8
|
Ci W, Zhao Y, Bi T. Male Patients with Takayasu Arteritis and Coronary Artery Involvement are Prone to have Serious Coronary Stenosis and High Mortality. Curr Vasc Pharmacol 2021; 20:62-68. [PMID: 34303330 DOI: 10.2174/1570161119666210720114939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Takayasu arteritis (TAK) is a rare autoimmune vasculitis that predominantly affects the aorta and its major branches, including the coronary arteries. Limited information is available regarding sex-specific differences in coronary artery involvement among TAK patients. OBJECTIVE To assess the differences in coronary angiographic findings and the long-term outcomes between male and female TAK patients having coronary artery involvement. METHODS This retrospective cohort study included 87 TAK patients, grouped by sex, who underwent coronary angiography. General characteristics, clinical features, coronary angiographic findings, and therapeutic strategies were obtained from medical records. Major Adverse Cardiac Events (MACE), including death from any cause; myocardial infarction; repeated coronary artery revascularization; and rehospitalization due to unstable or progressive angina, or heart failure occurring during follow-up, were also recorded. RESULTS A total of 207 coronary lesions with stenosis were found in 87 TAK patients. The prevalence of ostial coronary lesions was lower in men than in women (9.1 vs. 23.9%, p=0.031). We observed less moderate stenosis (6.8 vs 22.7%, p=0.018) and more severe stenosis or occlusion (70.5 vs 46.0%, p=0.004) in the coronary lesions of male TAK patients. During the up to 7-year follow-up, death from any cause was greater in men than in women (21.4 vs. 1.5%, p=0.003); no other significant differences in MACE occurrence were observed between sexes. CONCLUSIONS Among TAK patients with coronary artery involvement, males tend to have more severe coronary stenosis and a higher risk for long-term mortality than females.
Collapse
Affiliation(s)
- Weiping Ci
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yinan Zhao
- Department of Endocrinology and Metabolism, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Tao Bi
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| |
Collapse
|
9
|
Li ZG, Hu JK, Li XP, Yang Y, Li XF, Xu JH, Zhang X, Xu J, Bao CD, He DY, Li ZJ, Wang GC, Zuo XX, Liu Y, Xiao ZY, Chen JW, Xin XF, Li JY, Jiang LD, Liu MR, Ji F, Li CG. Rapid Onset of Efficacy of Baricitinib in Chinese Patients with Moderate to Severe Rheumatoid Arthritis: Results from Study RA-BALANCE. Adv Ther 2021; 38:772-781. [PMID: 33237533 DOI: 10.1007/s12325-020-01572-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/11/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Baricitinib is an oral, selective inhibitor of Janus kinase which demonstrates clinical efficacy in patients with rheumatoid arthritis (RA). This report aims to analyze the onset time of baricitinib in Chinese patients with moderately to severely active RA who had an inadequate response to methotrexate. METHODS This post hoc analysis evaluated clinical improvements of Chinese patients treated with baricitinib 4 mg once daily compared with placebo, based on data from a phase 3 study RA-BALANCE. Efficacy measures including American College of Rheumatology 20% (ACR20) response, ACR core set values, Disease Activity Score modified to include the 28 diarthrodial joint count (DAS28) using high-sensitivity C-reactive protein (hsCRP), DAS28-erythrocyte sedimentation rate, Simplified Disease Activity Index, Clinical Disease Activity Index, DAS28-hsCRP ≤ 3.2 response (low disease activity), and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) were evaluated at weeks 1, 2, 4, 8, 12, 14, 16, 20, and 24 (except for FACIT-F evaluated every 4 weeks). A logistic regression model and an analysis of covariance model were used to analyze treatment comparisons of categorical and continuous measures, respectively. RESULTS Statistically significant (p ≤ 0.05) improvements were observed as early as week 1 or 2 for the baricitinib group compared to placebo in almost all main efficacy measures. For other outcomes including 66 swollen joint count, 68 tender joint count, FACIT-F, and DAS28-hsCRP ≤ 3.2 response rate, differences were evident (p ≤ 0.05) by week 4 in the baricitinib group compared with placebo. Significant improvements in all efficacy measures were sustained through 24 weeks. CONCLUSIONS Baricitinib demonstrated a rapid onset of efficacy on ACR20 response, ACR core set values, disease activity, and patient-reported outcome improvements in Chinese patients from RA-BALANCE. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02265705.
Collapse
Affiliation(s)
- Zhan-Guo Li
- Peking University People's Hospital, Beijing, China.
| | - Jian-Kang Hu
- Jiangxi Pingxiang People's Hospital, Pingxiang, China
| | - Xiang-Pei Li
- The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yue Yang
- Peking University People's Hospital, Beijing, China
| | - Xing-Fu Li
- Qilu Hospital of Shandong University, Jinan, China
| | - Jian-Hua Xu
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiao Zhang
- Guangdong General Hospital, Guangzhou, China
| | - Jian Xu
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chun-De Bao
- Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | - Zhi-Jun Li
- First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | | | - Xiao-Xia Zuo
- Xiangya Hospital of Central South University, Changsha, China
| | - Yi Liu
- West China Hospital of Sichuan University, Chengdu, China
| | - Zheng-Yu Xiao
- First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jin-Wei Chen
- The Second Xiangya Hospital of Central South University, Changsha, China
| | | | | | - Lin-Di Jiang
- Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Fei Ji
- Eli Lilly and Company, Shanghai, China
| | | |
Collapse
|