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Du L, Cao Z, Wei J, Li M, Han C, Zhang C. Fire needle pretreatment with 5-aminolevulinic acid photodynamic therapy combined with low-dose isotretinoin in the treatment of severe refractory nodulocystic acne. Photodiagnosis Photodyn Ther 2024; 47:104215. [PMID: 38735352 DOI: 10.1016/j.pdpdt.2024.104215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Nodulocystic acne is a severe form of acne, which is commonly treated with oral isotretinoin, hormones, or antibiotics. However, drug therapy often has some side effects and poor compliance. Fire needle combined with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a simple, effective, short-term treatment with few adverse reactions, which is expected to be an effective physiotherapy for nodulocystic acne. Moreover, the combination with isotretinoin can reduce the dosage of the drug, thereby reducing the side effects of isotretinoin. OBJECTIVES To evaluate the safety and efficacy of fire-needle pretreated ALA-PDT combined with low-dose isotretinoin in the treatment of severe refractory nodulocystic acne. METHODS This study reported 10 patients with refractory nodulocystic acne who received combined treatment. During the treatment period, all patients received a low dose of oral isotretinoin capsules daily. The acne lesions were pretreated with fire needle before ALA-PDT treatment. The number of acne lesions, including papules, pustules, and nodular cysts, was documented at weeks 0, 2, 4, 8, and 12 to assess the therapeutic efficacy. Concurrently, adverse reactions such as pain, pruritus, and pigmentation changes were recorded and evaluated throughout the treatment course. RESULTS After combined treatment, all patients achieved good therapeutic effects, with an overall effective rate of 90 % at week 12. After treatment, skin lesions such as nodules, and cysts subsided significantly. The combination therapy has no serious adverse effects and has a favorable safety profile. CONCLUSION Fire needle pretreatment ALA-PDT combined with low-dose isotretinoin is effective and safe in the treatment of severe refractory nodular cystic acne, which is worthy of clinical promotion and research.
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Affiliation(s)
- Lingyun Du
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan 250033, PR China
| | - Zhiqiang Cao
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, PR China
| | - Jingjing Wei
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan 250033, PR China
| | - Mingming Li
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan 250033, PR China
| | - Changyu Han
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan 250033, PR China
| | - Chunhong Zhang
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan 250033, PR China.
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Serra-Guillén C, Llombart B, Sanmartín O. Long-Term Improvement of Different Types of Acne Vulgaris Using a Mild Photodynamic Therapy Protocol with BF-200 ALA Gel: A Series of Cases. J Clin Med 2024; 13:2658. [PMID: 38731187 PMCID: PMC11084902 DOI: 10.3390/jcm13092658] [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: 04/08/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Photodynamic therapy (PDT) can be a promising alternative for patients with acne vulgaris. Our study aimed to evaluate the efficacy and safety of red light photodynamic therapy with BF-200 ALA gel in the treatment of different types of acne vulgaris. Methods: We performed a retrospective, observational study of a series of 22 cases. All patients were treated according to a mild PDT protocol. After a careful wash of the affected skin areas, BF-200 ALA gel was applied to the skin in a thin layer and incubated for 30 min, followed by illumination using narrow-spectrum red light (635 nm) at a dose of 4 J/cm2. Most patients received one (36.4%), two (27.3%), or three (22.7%) PDT sessions. About a third of the patients received concomitant acne treatment with topical retinoids. Results: Patients of 25.1 ± 8.9 years suffering from papulopustular (45.5%), nodular (27.3%), and comedonal acne (27.3%) in the face were included. Irrespective of acne type or severity, 95.5% of patients had good or excellent responses to the treatment with PDT (≥60% lesion clearance). We found no association between concomitant acne medication and the favorable results achieved by PDT. Most patients reported no adverse events (72.7%), except for six patients who experienced erythema. The good efficacy results were maintained over a follow-up period of 12.5 ± 10.8 months. Conclusions: In this study, we show that PDT with BF-200 ALA gel and low light dose is an effective and long-lasting option for the treatment of different acne types.
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Affiliation(s)
| | - Beatriz Llombart
- Clinica Dermatologica Dr. Onofre Sanmartín, 46930 Valencia, Spain; (B.L.); (O.S.)
| | - Onofre Sanmartín
- Clinica Dermatologica Dr. Onofre Sanmartín, 46930 Valencia, Spain; (B.L.); (O.S.)
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Hu Y, Cheng Y, Jie W. Analysis of the effectiveness of PDT with 5-aminolevulinic acid in comparison to blue/red light combined with intralesional triamcinolone injection in treatment of severe inflammatory acne: A retrospective study. J Cosmet Dermatol 2024; 23:849-856. [PMID: 37881149 DOI: 10.1111/jocd.16045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/19/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE In this study, the therapeutic effect of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in comparison to blue/red light combined with intralesional triamcinolone injection for severe inflammatory acne was evaluated and analyzed. METHODS One hundred and four cases of severe inflammatory acne were analyzed in this study. They were divided into two groups as control and observation groups, 52 cases in each group. The control group (group A) received red and blue light combined with triamcinolone injection and lidocaine injection (1:4), while the observation group (Group B) was treated with ALA-PDT. Finally, the therapeutic effect and the occurrence of adverse reactions were compared between the two groups. RESULTS After 2, 4 and 6 weeks, the effectiveness rates of group B was 28.85%, 75.00%, and 86.54%, respectively while it was 9.62%, 51.92%, and 69.23%, respectively in group A. The difference between A and B was statistically remarkable (χ2 = 6.1905, 5.9713, 4.5217, p = 0.0128, 0.0145, 0.0335 at p < 0.05). In addition, the incidence of adverse reactions in B was 5.77%, lower than A (32.69%). This difference between A and B was statistically remarkable (χ2 = 12.1333, p = 0.0005). After 2, 4, and 6 weeks of treatment, the number of residual lesions in the group B group was remarkably lower than group A (p < 0.01). There was remarkable difference in the incidence of pain, burning sensation, pigmentation and erythema between the two groups. CONCLUSIONS The therapeutic effect of ALA-PDT in the treatment of severe acne is better than red blue light combined with triamcinolone injection and lidocaine injection. In addition, ALA-PDT has an ideal effect in the treatment of severe acne.
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Affiliation(s)
- Yi Hu
- Department of Dermatology and Venereology, The Eighth Hospital of Wuhan, Wuhan, China
| | - Yang Cheng
- Dermatological Department, Wuhan No.1 Hospital, Wuhan, China
| | - Wang Jie
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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Huang F, Fu Q, Tang L, Zhao M, Huang M, Zhou X. Trends in photodynamic therapy for dermatology in recent 20 years: A scientometric review based on CiteSpace. J Cosmet Dermatol 2024; 23:391-402. [PMID: 37815144 DOI: 10.1111/jocd.16033] [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: 08/03/2023] [Revised: 09/18/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Analyze the research state and development trend of photodynamic therapy for dermatology using visual knowledge graphs derived from the Web of Science Core Collection database. METHODS The Web of Science Core Collection database was utilized as the search data source for the bibliometric analysis, and the associated articles published between January 1, 2000, and December 31, 2022, were obtained using the search terms "photodynamic therapy" and "dermatology". CiteSpace, VOSviewer, and additional tools were utilized for bibliometric analysis, and visual knowledge graphs were created. RESULTS Eight hundred and thirty two articles were retrieved in total, and 747 were included following de-duplication and transformation. The country with the greatest number of publications is the United States; the primary research institution was University of Copenhagen; and the references with the highest centrality were primarily concerned with the selection of photosensitizers; High frequency keywords primarily comprised 5 aminolevulinic acid and basal cell carcinoma; and the clustering graph revealed that all keywords fell into 11 categories. CONCLUSION In numerous areas of dermatology, photodynamic treatment is commonly employed. Current research focuses on nonneoplastic skin diseases and the choice of photosensitizers. Nonetheless, its specific mechanism and other applications merit further investigation.
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Affiliation(s)
- Fujun Huang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Qiang Fu
- Department of Cosmetic Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Lei Tang
- Department of Cosmetic Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Mingdan Zhao
- Department of Cosmetic Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Mengya Huang
- Department of Cosmetic Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xun Zhou
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
- Department of Cosmetic Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
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Luo OD, Bose R, Bawazir MA, Thuraisingam T, Ghazawi FM. A Review of the Dermatologic Clinical Applications of Topical Photodynamic Therapy. J Cutan Med Surg 2024; 28:NP1. [PMID: 38243786 DOI: 10.1177/12034754231216969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Topical photodynamic therapy is a widely approved therapy for actinic keratoses and low-risk nonmelanoma skin cancers with a rapidly growing range of emerging indications for other cutaneous diseases. This review summarizes the best-available evidence to provide a clinical update for dermatologists on the approved and emerging indications of photodynamic therapy. The body of evidence suggests that photodynamic therapy is superior or noninferior to other available treatment modalities for actinic keratoses, low-risk basal cell carcinomas, Bowen's disease, skin field cancerization, chemoprevention of keratinocyte carcinomas in organ transplant recipients, photoaging, acne vulgaris, and cutaneous infections including verrucae, onychomycosis, and cutaneous leishmaniasis. There is emerging evidence that photodynamic therapy plays a role in the management of actinic cheilitis, early-stage mycosis fungoides, extramammary Paget disease, lichen sclerosis, and folliculitis decalvans but there are no comparative studies with other active treatment modalities. Common barriers to topical photodynamic therapy include procedural pain, costs, and the time required for treatment delivery. There is significant heterogeneity in the photodynamic therapy protocols reported in the literature, including different photosensitizers, light sources, number of treatments, time between treatments, and use of procedural analgesia. Topical photodynamic therapy should be considered in the management of a spectrum of inflammatory, neoplastic, and infectious dermatoses. However, more comparative research is required to determine its role in the treatment algorithm for these dermatologic conditions and more methodological research is required to optimize photodynamic therapy protocols to improve the tolerability of the procedure for patients.
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Affiliation(s)
- Owen Dan Luo
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Reetesh Bose
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mohammed A Bawazir
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Thusanth Thuraisingam
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Feras M Ghazawi
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, Department of Medicine, McGill University, Montreal, QC, Canada
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Wei J, Du L, Cao Z, Li M, Zhang C, Zhang C, Meng L. 5-Aminolevulinic Acid Photodynamic Therapy Combined with Intralesional Triamcinolone and 5-Fluorouracil to Treat Acne Hypertrophic Scar. Clin Cosmet Investig Dermatol 2023; 16:3057-3064. [PMID: 37920822 PMCID: PMC10618392 DOI: 10.2147/ccid.s427427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023]
Abstract
Background Acne is a chronic inflammatory disease of the pilosebaceous unit. Improper treatment of acne can lead to skin lesions in some people. Acne hypertrophic scar is relatively rare, but it significantly affects the appearance and beauty, and usually has a great psychological and social impact on patients. Objective To evaluate the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with 5-fluorouracil (5-FU) injection and triamcinolone acetonide (TAC) solution in the treatment of acne hypertrophic scars. Methods This article included 13 outpatients with acne accompanied by acne hypertrophic scar who were treated from September 2018 to September 2022. All patients received ALA-PDT combined with intralesional injection of 5-FU and TAC. At first, patients received ALA-PDT once every two weeks. After the third ALA-PDT, 5-FU and TAC were mixed in a ratio of 3:7, and then immediately injected in the local scars. The effect was observed after 1 month. If the effect is not obvious, a further injection of 5-FU and TAC to the lesion is necessary. The patients were followed up for 6 months. The Vancouver Scars Scale (VSS) was used to evaluate the efficacy before and after treatment and photos of patients were collected. Results After ALA-PDT combined with intralesional 5-FU and TAC, all patients achieved good clinical efficacy. 23.08% of patients received one local injection and 76.92% received two local injections. After treatment, the scar lesions were reduced and flattened, and the scars became soft. The total score of VSS after treatment was significantly lower than before, and the difference was statistically significant (P<0.05). The main adverse reactions were pain, erythema, and pigmentation, which can subside within 3 weeks. There was no recurrence after 6 months of follow-up. Conclusion ALA-PDT combined with intralesional injection of 5-FU and TAC significantly affects acne hypertrophic scars, which is worthy of further in-depth and large-scale research.
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Affiliation(s)
- Jingjing Wei
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan, People’s Republic of China
| | - Lingyun Du
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan, People’s Republic of China
| | - Zhiqiang Cao
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan, People’s Republic of China
| | - Mingming Li
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan, People’s Republic of China
| | - Chunhong Zhang
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan, People’s Republic of China
| | - Chunmin Zhang
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan, People’s Republic of China
| | - Liya Meng
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan, People’s Republic of China
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Ping Y, Jian Bo Z, Xing Yun Z, Ali K, Jun C, Xu Lou I, Wu LM. Case report: Acne vulgaris treatment with 5-Aminolaevulinic acid photodynamic therapy and adalimumab: a novel approach. Front Med (Lausanne) 2023; 10:1187186. [PMID: 37250640 PMCID: PMC10213406 DOI: 10.3389/fmed.2023.1187186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Acne vulgaris is a common skin condition that affects a large proportion of teenagers and young adults. Despite the availability of various treatment options, many patients experience inadequate relief or intolerable side effects. Photodynamic therapy (PDT) is a growing interest in the treatment of acne vulgaris, with 5-Aminolaevulinic acid (ALA) being one of the most commonly used photosensitizers. Adalimumab is a biologic medication used to treat inflammatory skin conditions such as Psoriasis and Hidradenitis suppurativa (HS), which targets TNF-α. Combining different therapies, such as ALA-PDT and adalimumab, can often provide more effective and longer-lasting results. This report presents the case of a patient with severe and refractory acne vulgaris who was treated with a combination of ALA-PDT and adalimumab, resulting in significant improvement in the condition. The literature review highlights the significant comorbidity associated with acne, emphasizing the need for potential of TNF-α inhibitors for its effective treatments that address physical symptoms and ALA-PDT is known to treat scar hyperplasia, and to prevent or minimize the formation of post-acne hypertrophic scars. The combination of TNF inhibitors and ALA-PDT or adalimumab has shown promising results in treating inflammatory skin conditions, including severe and refractory acne vulgaris, as per recent studies.
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Affiliation(s)
- Yang Ping
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhong Jian Bo
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhao Xing Yun
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Kamran Ali
- Department of Oncology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
| | - Chen Jun
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Inmaculada Xu Lou
- Department of Cardiology, International Education College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Li Ming Wu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Tobiasz A, Nowicka D, Szepietowski JC. Acne Vulgaris-Novel Treatment Options and Factors Affecting Therapy Adherence: A Narrative Review. J Clin Med 2022; 11:jcm11247535. [PMID: 36556150 PMCID: PMC9788443 DOI: 10.3390/jcm11247535] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Acne vulgaris is an extremely common skin condition, affecting a large population of adolescents, but at the same time, remaining a quite common issue in the group of adult patients. Its complex pathogenesis includes increased sebum secretion, impaired follicular keratinization, colonization of sebaceous glands with Cutibacterium acne bacteria, and the development of inflammation in pilosebaceous units. Although there are many methods of treatment available targeting the mechanisms mentioned above, a large percentage of patients remain undertreated or non-compliant with treatment. Ineffective treatment results in the formation of acne scars, which has a major impact on the well-being and quality of life of the patients. The aim of this publication was a review of available evidence on widely used and novel methods of topical and systemic treatment of acne, additionally including current literature-based analysis of factors affecting patients' compliance. The strengths and limitations of novel substances for treating acne were discussed. We conclude that an effective acne treatment remains a challenge. A better understanding of current treatment options and factors affecting patients' compliance could be a helpful tool in choosing a proper treatment option.
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Huang Q, Chen D, Pan S, Hu M, Wang P, Wang H, Fan W, Yang X, He Y. Efficacy of alpha hydroxy acid combined with intense pulsed light in the treatment of acne vulgaris: A meta-analysis. J Cosmet Dermatol 2022; 21:5642-5650. [PMID: 35763391 DOI: 10.1111/jocd.15186] [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: 04/14/2022] [Revised: 05/28/2022] [Accepted: 06/23/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acne patients frequently receive combination therapy. However, there has been no rigorous review of the efficacy of combining alpha hydroxy acid with IPL for acne vulgaris treatment. OBJECTIVE Assessing the effectiveness and safeness of alpha hydroxy acids in combination with IPL in the treatment of people with acne vulgaris. METHODS A computer search of common biomedical databases, including PubMed, Web of Science, Cochrane Library, Embase, Wanfang, CNKI, SinoMed, and VIP, was extensively conducted to identify previous studies on randomized controlled trials of alpha hydroxy acid combined with IPL in the management of acne vulgaris. RESULTS A total of 18 publications were included (1435 patients with common acne met the inclusion criteria). The meta-analysis showed that alpha hydroxy acid (AHA) combined with IPL had higher overall efficacy than the control group (OR = 4.24; 95% CI 2.66 ~ 6.74; p < 0.01). In the case of acne vulgaris, AHA combined with IPL and the AHA alone showed a remarkable difference in total efficiency (OR = 4.10; 95% CI 2.12 ~ 7.91; p < 0.01), and AHA combined with IPL were more effective than IPL alone (OR = 4.02; 95% CI 2.25 ~ 7.16; p < 0.01). In addition, the occurrence of adverse reactions that occurred in AHA combined with IPL and control groups did not differ (OR = 0.86; 95% CI 0.46 ~ 1.60; p = 0.64). CONCLUSION AHA combined with IPL therapy was superior to other therapies. Although it was slightly more expensive, it was effective and had a wide range of applications.
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Affiliation(s)
- Qiao Huang
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Dongyu Chen
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Suyue Pan
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Min Hu
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Pu Wang
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Hongxin Wang
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Wenlong Fan
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Xiaoyu Yang
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Yuqing He
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China.,Guangdong Medical University Liaobu Hospital, Dongguan, Guangdong, China
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