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Zhuang J, Chen Y, Zheng X, Wang C, Hu J, Liu T. The Application of Blood Products in Plastic Surgery: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6005. [PMID: 39050033 PMCID: PMC11268820 DOI: 10.1097/gox.0000000000006005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/31/2024] [Indexed: 07/27/2024]
Abstract
Background Due to their minimal trauma and relative safety, blood products are becoming increasingly popular in medical aesthetics. In recent years, research on the application of blood products has also been increased. This article will summarize the research progress of emerging blood products in plastic surgery in recent years. Methods We searched the PubMed database for literature related to the application of blood preparation in plastic surgery over the past 5 years and summarized them. Results Commonly used in plastic surgery are platelet-rich plasma, platelet-rich fibrin, concentrated growth factor, platelet-poor plasma, and mesenchymal stem cells derived from blood products. They can be used for wound repair and skin and autologous fat transplantation, and can be combined with laser therapy and facial rejuvenation. Conclusions Understanding the application pathways of blood products in plastic surgery and their respective advantages and disadvantages can help us better choose and use them.
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Affiliation(s)
- Jun Zhuang
- From the Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Chen
- Department of Endocrinology, Air Force Medical Hospital, Beijing, China
- Graduate School of China Medical University, Shenyang, China
| | | | - Cheng Wang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Jintian Hu
- Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tun Liu
- From the Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Jafarzadeh A, Pour Mohammad A, Keramati H, Zeinali R, Khosravi M, Goodarzi A. Regenerative medicine in the treatment of specific dermatologic disorders: a systematic review of randomized controlled clinical trials. Stem Cell Res Ther 2024; 15:176. [PMID: 38886861 PMCID: PMC11184747 DOI: 10.1186/s13287-024-03800-6] [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: 04/13/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
AIMS AND OBJECTIVES The aim of this study is to systematically review randomized controlled clinical trials (RCTs) studying various types of regenerative medicine methods (such as platelet-rich plasma, stromal vascular fraction, cell therapy, conditioned media, etc.) in treating specific dermatologic diseases. Rejuvenation, scarring, wound healing, and other secondary conditions of skin damage were not investigated in this study. METHOD Major databases, including PubMed, Scopus, and Web of Science, were meticulously searched for RCTs up to January 2024, focusing on regenerative medicine interventions for specific dermatologic disorders (such as androgenetic alopecia, vitiligo, alopecia areata, etc.). Key data extracted encompassed participant characteristics and sample sizes, types of regenerative therapy, treatment efficacy, and adverse events. RESULTS In this systematic review, 64 studies involving a total of 2888 patients were examined. Women constituted 44.8% of the study population, while men made up 55.2% of the participants, with an average age of 27.64 years. The most frequently studied skin diseases were androgenetic alopecia (AGA) (45.3%) and vitiligo (31.2%). The most common regenerative methods investigated for these diseases were PRP and the transplantation of autologous epidermal melanocyte/keratinocyte cells, respectively. Studies reported up to 68.4% improvement in AGA and up to 71% improvement in vitiligo. Other diseases included in the review were alopecia areata, melasma, lichen sclerosus et atrophicus (LSA), inflammatory acne vulgaris, chronic telogen effluvium, erosive oral lichen planus, and dystrophic epidermolysis bullosa. Regenerative medicine was found to be an effective treatment option in all of these studies, along with other methods. The regenerative medicine techniques investigated in this study comprised the transplantation of autologous epidermal melanocyte/keratinocyte cells, isolated melanocyte transplantation, cell transplantation from hair follicle origins, melanocyte-keratinocyte suspension in PRP, conditioned media injection, a combination of PRP and basic fibroblast growth factor, intravenous injection of mesenchymal stem cells, concentrated growth factor, stromal vascular fraction (SVF), a combination of PRP and SVF, and preserving hair grafts in PRP. CONCLUSION Regenerative medicine holds promise as a treatment for specific dermatologic disorders. To validate our findings, it is recommended to conduct numerous clinical trials focusing on various skin conditions. In our study, we did not explore secondary skin lesions like scars or ulcers. Therefore, assessing the effectiveness of this treatment method for addressing these conditions would necessitate a separate study.
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Affiliation(s)
- Alireza Jafarzadeh
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Rasool Akram Hospital, Iran University of Medical Sciences (IUMS), Niayesh Street, Sattar Khan Avenue, Tehran, 1445613131, Iran
| | - Arash Pour Mohammad
- Faculty of Medicine, Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran, 1449614535, Iran
| | - Haniyeh Keramati
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Rasool Akram Hospital, Iran University of Medical Sciences (IUMS), Niayesh Street, Sattar Khan Avenue, Tehran, 1445613131, Iran
| | - Roya Zeinali
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Rasool Akram Hospital, Iran University of Medical Sciences (IUMS), Niayesh Street, Sattar Khan Avenue, Tehran, 1445613131, Iran
| | - Mina Khosravi
- Faculty of Medicine, Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran, 1449614535, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Rasool Akram Hospital, Iran University of Medical Sciences (IUMS), Niayesh Street, Sattar Khan Avenue, Tehran, 1445613131, Iran.
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Rosenthal A, Conde G, Greco JF, Gharavi NM. Management of androgenic alopecia: a systematic review of the literature. J COSMET LASER THER 2024:1-16. [PMID: 38852607 DOI: 10.1080/14764172.2024.2362126] [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: 01/08/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
We aimed to determine the efficacy of the various available oral, topical, and procedural treatment options for hair loss in individuals with androgenic alopecia. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the National Library of Medicine was performed. Overall, 141 unique studies met our inclusion criteria. We demonstrate that many over the counter (e.g. topical minoxidil, supplements, low-level light treatment), prescription (e.g. oral minoxidil, finasteride, dutasteride), and procedural (e.g. platelet-rich plasma, fractionated lasers, hair transplantation) treatments successfully promote hair growth, highlighting the superiority of a multifaceted and individualized approach to management.
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Affiliation(s)
- Amanda Rosenthal
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Geena Conde
- Department of Dermatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph F Greco
- Department of Research, Greco Hair Restoration, Sarasota, FL, USA
| | - Nima M Gharavi
- Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Li G, Wang H. Novel Applications of Concentrated Growth Factors in Facial Rejuvenation and Plastic Surgery. Facial Plast Surg 2024; 40:112-119. [PMID: 36423628 DOI: 10.1055/a-1987-3459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Concentrated growth factor (CGF), which is a third-generation platelet concentrate product, exhibits good potential for repair and regeneration of soft and hard tissues, and has gradually attracted attention in the field of cosmetic plastic surgery. The purpose of this review is to summarize the application and research of CGF in the field of facial rejuvenation and plastic surgery. A comprehensive review of the literature about the applications of CGF in facial rejuvenation and plastic surgery was conducted in PubMed, Ovid MEDLINE, and Web of Science. According to the inclusion and exclusion criteria, a total of 22 articles were included in this review. In recent years, CGF has been applied in many aspects in the field of facial rejuvenation and plastic surgery, including skin photoaging, repairment of soft-tissue defects, rhinoplasty, hair loss, autologous fat transplantation, and scars. In addition, no significant adverse reactions have been reported so far. CGF is rich in high-concentration growth factors, which has great potential and application prospects in facial rejuvenation and plastic surgery. However, the applications of CGF still have some problems, such as the mechanism, time of decomposition, and long-term efficacy and safety, which are needed to be resolved in future.
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Affiliation(s)
- Guo Li
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, Sichuan University West China Hospital of Stomatology, Chengdu, People's Republic of China
| | - Hang Wang
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, Sichuan University West China Hospital of Stomatology, Chengdu, People's Republic of China
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Gupta AK, Wang T, Bamimore MA, Polla Ravi S, Talukder M. Relative Effects of Minoxidil 5%, Platelet-Rich Plasma, and Microneedling in Pattern Hair Loss: A Systematic Review and Network Meta-Analysis. Skin Appendage Disord 2023; 9:397-406. [PMID: 38058547 PMCID: PMC10697753 DOI: 10.1159/000534196] [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: 05/24/2023] [Accepted: 09/18/2023] [Indexed: 12/08/2023] Open
Abstract
Background Combination treatments may improve the utility of approved agents for the treatment of pattern hair loss (PHL); however, head-to-head comparisons are lacking. Objective The aim of the study was to compare the efficacy of 5% minoxidil, platelet-rich plasma (PRP), and microneedling across adults with PHL insofar as change in total hair density at 24 weeks. Methods We conducted a literature search in July 2022. Through our Bayesian network meta-analysis, we estimated treatments' surface under the cumulative ranking distribution (SUCRA) values and relative effects - in terms of mean difference (MD). Results Data from 27 trials, totaling 1,110 patients, were extracted. Interventions were ranked based on the probability of inducing hair density improvements: 5% minoxidil plus microneedling (SUCRA = 95.8%), 5% minoxidil plus PRP (SUCRA = 64.7%), 5% minoxidil (SUCRA = 53.9%), PRP (SUCRA = 34.9%), microneedling (SUCRA = 27.8%), and PRP with microneedling (SUCRA = 22.9%). The efficacy of 5% minoxidil plus microneedling in improving total hair density was significantly greater (p < 0.05) than 5% minoxidil monotherapy (MD = 13 hairs/cm2), PRP monotherapy (MD = 16 hairs/cm2), and microneedling monotherapy (MD = 17 hairs/cm2). Conclusion Five percent minoxidil plus microneedling is an effective treatment option for improving hair density at 6 months in adult PHL patients.
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Affiliation(s)
- Aditya K. Gupta
- Mediprobe Research Inc., London, ON, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tong Wang
- Mediprobe Research Inc., London, ON, Canada
| | | | | | - Mesbah Talukder
- Mediprobe Research Inc., London, ON, Canada
- School of Pharmacy, BRAC University, Dhaka, Bangladesh
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Kaiser MA, Ferrari LM, Gaumond SI, Issa N, Jimenez JJ, Issa NT. Platelet Rich Plasma Combination Therapies for Treatment of Androgenetic Alopecia: A Systematic Review. J Cutan Aesthet Surg 2023; 16:169-177. [PMID: 38189076 PMCID: PMC10768946 DOI: 10.4103/jcas.jcas_206_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Androgenetic alopecia (AGA) is the most common cause of alopecia in males and females. Minoxidil and finasteride are the only FDA-approved treatments for AGA. New treatments including Platelet Rich Plasma (PRP) and microneedling have shown promising results. The purpose of this literature review was to highlight recent studies examining the effects of topical minoxidil combined with PRP to minoxidil or PRP monotherapy. The method used for this paper includes a systematic review of the literature from 2010 to 2022 using the PubMed, EMBASE, and MEDLINE databases examining studies evaluating combination therapies for AGA. Three randomized control trials compared combination PRP + topical 5% minoxidil to either no treatment, 5% minoxidil, or PRP only. Two studies found increased hair growth at five months and at six months following combined therapy. Another study found an increase in hair density and improved patient satisfaction with combination therapy compared to monotherapy. A prospective study revealed that patients treated with combined 5% minoxidil, PRP, and microneedling reported the highest patient and physician satisfaction compared to minoxidil monotherapy. An observational study evaluating topical 5% minoxidil with PRP reported an increase in hair diameter after one year of combination treatment compared to minoxidil monotherapy. PRP therapy combined with minoxidil and microneedling in a retrospective study was shown to increase hair growth compared to PRP with minoxidil as well as PRP or minoxidil monotherapy. In conclusion, a variety of studies demonstrated superior treatment response with a combination of PRP and minoxidil therapy in patients with AGA. Limitations to this study include different PRP preparation protocols, few randomized control studies, and small sample sizes.
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Affiliation(s)
- Michael A Kaiser
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lina M Ferrari
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Simonetta I Gaumond
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Najy Issa
- St. George’s University School of Medicine, West Indies, Grenada
| | - Joaquin J Jimenez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Naiem T Issa
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Deoghare S, Sadick NS. Combination therapy in female pattern hair loss. J COSMET LASER THER 2023; 25:1-6. [PMID: 37289953 DOI: 10.1080/14764172.2023.2222942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/04/2023] [Indexed: 06/10/2023]
Abstract
Patterned hair loss is a common type of non-scarring alopecia, characterized by miniaturization of hair follicles. The etiology of female pattern hair loss (FPHL) is not clearly linked to androgens or other hormones thereby making it a challenging condition to treat. Various treatment modalities, like minoxidil (topical or oral), spironolactone, finasteride, have been tried alone or in combination with variable results. Combination therapy is superior to the monotherapy, since these multiple treatment modalities act by targeting different pathogenetic pathways, making the treatment aggressive and more effective.
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Affiliation(s)
- Shreya Deoghare
- AHRS Fellow, Sadick Dermatology, New York, USA and Senior Resident, Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Pune, India
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Zhao F, Hao L, Jin X. Clinical observation and evaluation of CGF in the treatment of androgenic alopecia. J Cosmet Dermatol 2022; 21:5723-5729. [PMID: 35608516 DOI: 10.1111/jocd.15109] [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: 03/17/2022] [Revised: 05/08/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the efficacy of concentrated growth factor (CGF) injections in patients with androgenic alopecia. METHODS Venous blood of 60 patients (aged 18-55 years old with a mean age of 38 years) with androgenic alopecia who were treated from September 2017 to September 2019 were collected to prepare CGF. 0.1 ml CGF was injected into the alopecia area with an interval of 30-35 days for a total of 6 times. The evaluation was performed before treatment and at 1, 3, and 6 months after the first injection and 3 and 6 months after the last injection. RESULTS Among the 60 patients, 58 cases received 6 treatments completely, 52 cases showed significant improvement, 8 cases improved, and no ineffective or worsening cases were found. Among the 58 patients, hair density, hair follicle density, and hair diameter increased significantly. Furthermore, the hair status of all patients was improved to varying degrees during the 6-month follow-up from the digital photographs. No complications such as redness, swelling, infection, and ulceration were found in the injection area, and the patient satisfaction was 93% (56/60). CONCLUSION Concentrated growth factor treatment can significantly improve the symptoms of hair loss and increase hair diameter in patients with androgenic alopecia. It is effective, safe, and worth popularizing.
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Affiliation(s)
- Fangning Zhao
- The 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lijun Hao
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaolei Jin
- The 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Jia L, Xiong J, Guo R, Li Y, Jiang H. Effects of microneedling with 5% minoxidil topical solution combination therapy in treatment of androgenetic alopecia. J Cosmet Dermatol 2022; 21:5665-5671. [PMID: 35861653 DOI: 10.1111/jocd.15263] [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: 05/27/2022] [Revised: 07/11/2022] [Accepted: 07/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Microneedling (MN) therapy is one of minimal invasive operations with needles rolled over skin to puncturing the epidermis, and it is becoming a widely used treatment during various dermatological diseases includes androgenetic alopecia (AGA). OBJECTIVE The purpose of the current study is to investigate the clinical observation and safety of MN combined with 5% minoxidil on triggering hair growth in AGA patients. MATERIAL AND METHODS This retrospective study has analyzed 18 AGA patients who were treated by MN in combination with 5% minoxidil topical solution between July 2021 and February 2022. All patients received six sessions of treatment under aseptic condition at an interval of 1 week. Assessment of hair regrowth was done at the baseline and 10 weeks by photography, investigator, and patient assessment global scoring table on clinical improvement, and the patient's final satisfaction was investigated. RESULTS According to the standardized 7-point scale, mean scores of investigator and participant assessments were 1.44 ± 0.61 and 1.66 ± 0.59, respectively, indicating that the hair appearance was considerably improved by MN combined with 5% minoxidil treatment. Fifteen patients (83.3%) were satisfied with the improvement in hair growth. No severe adverse events were noted in patients during and after the procedure. CONCLUSION The combination of the length of 1.5 mm MN and 5% minoxidil in the treatment of AGA showed efficacy with high safety, which is worthy of clinical application.
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Affiliation(s)
- Lingling Jia
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiachao Xiong
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rong Guo
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yufei Li
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hua Jiang
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Chen D, Yang X, Liu X, He Y, Fan W, Wang H, Lin Y. Efficacy comparison of monotherapies and combination therapies for androgenetic alopecia: A Bayesian network meta-analysis. Dermatol Ther 2021; 35:e15262. [PMID: 34897933 DOI: 10.1111/dth.15262] [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: 04/28/2021] [Revised: 10/14/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
Even though a variety of treatments for androgenetic alopecia (AGA) currently have been using in clinical, satisfactory therapeutic methods are still lacking. We aimed to compare and rank these treatments for AGA according to their differences in efficacy via Bayesian network meta-analysis, suggesting the optimal therapy for clinical utility to refer. A systematic search of PubMed, Embase, Web of Science, and Cochrane Library database was performed and we included eligible randomized controlled trials. We compared differences in treatment effects of monotherapies and combination therapies using the Bayesian network model. The average difference in alteration from baseline of hair density and hair diameter, and variation value (mean ± SD) between the pre- and post-intervention was selected for main outcome measure and secondary outcome measure. Total 49 RCTs involving 3133 patients and six interventions were included. Regardless of based on hair density or hair diameter, topical/systemic combined with adjunctive therapeutics had the best treatment efficacy among all interventions (MD: 40.11; 95% CrI 25.65-54.59), followed by topical combined with systemic medical therapeutics (MD: 36.41; 95% CrI 17.54-55.24). In addition, in terms of hair density, treatment efficacy had significant difference sequentially among topical medical therapeutics (MD: 22.15; 95% CrI 12.88-31.42), systemic medical therapeutics (MD: 19.91; 95% CrI 6.504-33.22), and adjunctive therapeutics (MD: 18.60; 95% CrI 8.020-29.10) compared to placebo. In recent years, combination therapies are showing significant promise as potential therapies. Taken together with the outcomes of this study, despite the specific mechanism of the effect of combination therapies was not clear and further studies are needed, it may be the best treatment for AGA.
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Affiliation(s)
- Dongyu Chen
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, China.,Liaobu Hospital, Guangdong Medical University, Dongguan, China
| | - Xiaoyu Yang
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, China.,Liaobu Hospital, Guangdong Medical University, Dongguan, China
| | - Xinghua Liu
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, China
| | - Yuqing He
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, China.,Liaobu Hospital, Guangdong Medical University, Dongguan, China
| | - Wenlong Fan
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, China.,Liaobu Hospital, Guangdong Medical University, Dongguan, China
| | - Hongxin Wang
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, China.,Liaobu Hospital, Guangdong Medical University, Dongguan, China
| | - Yonghuang Lin
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, China
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