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Jiao T, Kianmehr H, Lin Y, Li P, Singh Ospina N, Ghayee HK, Ruzieh M, Fonseca V, Shi L, Zhang P, Shao H. Some patients with type 2 diabetes may benefit from intensive glycaemic and blood pressure control: A post-hoc machine learning analysis of ACCORD trial data. Diabetes Obes Metab 2024; 26:1502-1509. [PMID: 38297986 PMCID: PMC10987080 DOI: 10.1111/dom.15453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/12/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Abstract
AIM The action to control cardiovascular risk in diabetes (ACCORD) trial showed a neutral average treatment effect of intensive blood glucose and blood pressure (BP) controls in preventing major adverse cardiovascular events (MACE) in individuals with type 2 diabetes. Yet, treatment effects across patient subgroups have not been well understood. We aimed to identify patient subgroups that might benefit from intensive glucose or BP controls for preventing MACE. MATERIALS AND METHODS As a post-hoc analysis of the ACCORD trial, we included 10 251 individuals with type 2 diabetes. We applied causal forest and causal tree models to identify participant characteristics that modify the efficacy of intensive glucose or BP controls from 68 candidate variables (demographics, comorbidities, medications and biomarkers) at the baseline. The exposure was (a) intensive versus standard glucose control [glycated haemoglobin (HbA1c) <6.0% vs. 7.0%-7.9%], and (b) intensive versus standard BP control (systolic BP <120 vs. <140 mmHg). The primary outcome was MACE. RESULTS Compared with standard glucose control, intensive one reduced MACE in those with baseline HbA1c <8.5% [relative risk (RR): 0.79, 95% confidence interval (CI): 0.67-0.93] and those with estimated glomerular filtration rate ≥106 ml/min/1.73 m2 (RR: 0.74, 95% CI: 0.55-0.99). Intensive BP control reduced MACE in those with normal high-density lipoprotein levels (women >55 mg/dl, men >45 mg/dl; RR: 0.51, 95% CI: 0.34-0.74). Risk reductions were not significant in other patient subgroups. CONCLUSIONS Our findings suggest heterogeneous treatment effects of intensive glucose and BP control and could provide biomarkers for future clinical trials to identify more precise HbA1c and BP treatment goals for individualized medicine.
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Affiliation(s)
- Tianze Jiao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
| | - Hamed Kianmehr
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Yilu Lin
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Piaopiao Li
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, GA
| | - Naykky Singh Ospina
- Division of Endocrinology, Diabetes, and Metabolism, University of Florida College of Medicine, FL, USA
| | - Hans K Ghayee
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Florida College of Medicine, Malcom Randall VA Medical Center, Gainesville, FL
| | - Mohammed Ruzieh
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Vivian Fonseca
- Department of Medicine and Pharmacology, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hui Shao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, GA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
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Bethel MA, Sourij H, Stevens SR, Hannan K, Lokhnygina Y, Adler AI, Peterson ED, Holman RR, Lopes RD. Time-dependent event accumulation in a cardiovascular outcome trial of patients with type 2 diabetes and established atherosclerotic cardiovascular disease. Cardiovasc Diabetol 2023; 22:72. [PMID: 36978066 PMCID: PMC10054031 DOI: 10.1186/s12933-023-01802-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Estimating cardiovascular (CV) event accrual is important for outcome trial planning. Limited data exist describing event accrual patterns in patients with type 2 diabetes (T2D). We compared apparent CV event accrual patterns with true event rates in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). METHODS Centrally adjudicated event dates and accrual rates for a 4-point major adverse CV event composite (MACE-4; includes CV death, nonfatal myocardial infarction, nonfatal stroke, or unstable angina hospitalization), MACE-4 components, all-cause mortality (ACM), and heart failure hospitalization were compiled. We used three graphical methods (Weibull probability plot, plot of negative log of the Kaplan-Meier survival distribution estimate, and the Epanechnikov kernel-smoothed estimate of the hazard rate) to examine hazard rate morphology over time for the 7 outcomes. RESULTS Plots for all outcomes showed real-time constant event hazard rates for the duration of the follow-up, confirmed by Weibull shape parameters. The Weibull shape parameters for ACM (1.14, 95% CI 1.08-1.21) and CV death (1.08, 95% CI 1.01-1.16) were not sufficiently > 1 as to require non-constant hazard rate models to accurately depict the data. The time lag between event occurrence and event adjudication being completed, the adjudication gap, improved over the course of the trial. CONCLUSIONS In TECOS, the nonfatal event hazard rates were constant over time. Small increases over time in the hazard rate for fatal events would not require complex modelling to predict event accrual, providing confidence in traditional modelling methods for predicting CV outcome trial event rates in this population. The adjudication gap provides a useful metric to monitor within-trial event accrual patterns. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT00790205.
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Affiliation(s)
- M Angelyn Bethel
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Eli Lilly & Co., Indianapolis, IN, USA
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Susanna R Stevens
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Karen Hannan
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Yuliya Lokhnygina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Amanda I Adler
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rury R Holman
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
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3
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Foote C, Hockham C, Sukkar L, Campain A, Kang A, Young T, Cass A, Chow CK, Comino E, Gallagher M, Jan S, Knight J, Liu B, McNamara M, Peiris D, Pollock C, Sullivan D, Wong G, Zoungas S, Rogers K, Jun M, Jardine M. EXamining ouTcomEs in chroNic Disease in the 45 and Up Study (the EXTEND45 Study): Protocol for an Australian Linked Cohort Study. JMIR Res Protoc 2020; 9:e15646. [PMID: 32285803 PMCID: PMC7189250 DOI: 10.2196/15646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 12/06/2019] [Accepted: 01/07/2020] [Indexed: 01/04/2023] Open
Abstract
Background Chronic kidney disease (CKD) and diabetes are the major causes of death and disability worldwide. They are associated with high health service utilization persisting over many years. Their slow progression and wide clinical variation make them eminently suitable for study in population-based cohorts. However, current understanding of their prevalence, incidence, and progression is largely based on studies conducted in clinical populations. Objective This study aims to establish a novel link between an existing population-based cohort (the 45 and Up Study) and routinely collected laboratory and administrative data to facilitate research across the full disease spectrum of CKD and diabetes. Methods In the EXTEND45 Study (EXamining OuTcomEs in chroNic Disease in the 45 and Up Study), baseline questionnaire responses of over 260,000 participants of the 45 and Up Study aged ≥45 years living in New South Wales (NSW), collected between January 2006 and December 2009, are linked to data from laboratory service providers as well as national- and state-based administrative datasets via probabilistic linkage. Routinely collected data were obtained for participants who could be linked between January 2005 and July 2013. Laboratory data will enable the identification of early cases of chronic disease and the assessment of clinically relevant biochemical targets during the disease course. Health administrative datasets will allow for the examination of health service use, pharmacological management, and clinical outcomes. Results The study received ethics approval from the NSW Population and Health Services Research Ethics Committee in February 2014. Data linkage for 267,153 of the 45 and Up Study participants was completed in June 2016, with congruent linkage achieved for 265,086 (99.23%) individuals. To date, the CKD and diabetes cohorts have been identified (published elsewhere), and a diverse portfolio of research projects relating to disease burden, risk factors, health outcomes, and health service utilization is in development. Conclusions The EXTEND45 Study represents an unparalleled opportunity to perform extensive research into diseases of considerable public health and clinical importance. Strengths include the population-based nature of the cohort and the availability of longitudinal information on the complete disease pathway for affected individuals. International Registered Report Identifier (IRRID) RR1-10.2196/15646
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Affiliation(s)
- Celine Foote
- The George Institute for Global Health, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia
| | - Carinna Hockham
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Louisa Sukkar
- The George Institute for Global Health, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Anna Campain
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Amy Kang
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Tamara Young
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Clara K Chow
- The George Institute for Global Health, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Elizabeth Comino
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Martin Gallagher
- The George Institute for Global Health, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - John Knight
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Bette Liu
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - David Peiris
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Carol Pollock
- Renal Division, Kolling Institute for Medical Research, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - David Sullivan
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
| | - Sophia Zoungas
- The George Institute for Global Health, Sydney, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kris Rogers
- The George Institute for Global Health, Sydney, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Min Jun
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Meg Jardine
- The George Institute for Global Health, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia
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Ryu KS, Bae JW, Jeong MH, Cho MC, Ryu KH. Risk Scoring System for Prognosis Estimation of Multivessel Disease Among Patients with ST-Segment Elevation Myocardial Infarction. Int Heart J 2019; 60:708-714. [PMID: 31105140 DOI: 10.1536/ihj.17-337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Multivessel disease (MVD) is an independent risk factor for poor prognosis in acute myocardial infarction patients. Although several global risk scoring systems (RSS) are in use in clinical practice, there is no dedicated RSS for MVD in ST-segment elevation myocardial infarction (STEMI). The primary objective of this study is to develop a novel RSS to estimate the prognosis of patients with MVD in STEMI.We used the Korean Acute Myocardial Infarction Registry (KAMIR) to identify 2,030 STEMI patients with MVD who underwent appropriate percutaneous coronary intervention (PCI). Their data were analyzed to develop a new RSS. The prognostic power of this RSS was validated with 2,556 STEMI patients with MVD in the Korean Working Group on Myocardial Infarction Registry (KORMI).Six prognostic factors related to all-cause death in STEMI patients with MVD were age, serum creatinine, Killip Class, lower body weight, decrease in left ventricular ejection fraction, and history of cerebrovascular disease. The RSS for all-cause death was constructed using these risk factors and their statistical weight. The RSS had appropriate performance (c-index: 0.72) in the KORMI validation cohort.We developed a novel RSS that estimates all-cause death in the year following discharge for patients with MVD in STEMI appropriately treated by PCI. This novel RSS was transformed into a simple linear risk score to yield a simplified estimate prognosis of MVD among STEMI patients.
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Affiliation(s)
| | - Jang-Whan Bae
- Department of Internal Medicine, College of Medicine, Chungbuk National University.,Regional Cardiovascular Disease Center, Chungbuk National University Hospital
| | | | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University.,Regional Cardiovascular Disease Center, Chungbuk National University Hospital
| | - Keun-Ho Ryu
- Database/Bioinformatics Lab, School of Electrical & Computer Engineering, Chungbuk National University
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Yang SJ, Kwak SY, Jo G, Song TJ, Shin MJ. Serum metabolite profile associated with incident type 2 diabetes in Koreans: findings from the Korean Genome and Epidemiology Study. Sci Rep 2018; 8:8207. [PMID: 29844477 PMCID: PMC5974077 DOI: 10.1038/s41598-018-26320-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 05/03/2018] [Indexed: 02/07/2023] Open
Abstract
The identification of metabolic alterations in type 2 diabetes (T2D) is useful for elucidating the pathophysiology of the disease and in classifying high-risk individuals. In this study, we prospectively examined the associations between serum metabolites and T2D risk in a Korean community-based cohort (the Ansan-Ansung cohort). Data were obtained from 1,939 participants with available metabolic profiles and without diabetes, cardiovascular disease, or cancer at baseline. The acylcarnitine, amino acid, amine, and phospholipid levels in fasting serum samples were analyzed by targeted metabolomics. During the 8-year follow-up period, we identified 282 cases of incident T2D. Of all metabolites measured, 22 were significantly associated with T2D risk. Specifically, serum levels of alanine, arginine, isoleucine, proline, tyrosine, valine, hexose and five phosphatidylcholine diacyls were positively associated with T2D risk, whereas lyso-phosphatidylcholine acyl C17:0 and C18:2 and other glycerophospholipids were negatively associated with T2D risk. The associated metabolites were further correlated with T2D-relevant risk factors such as insulin resistance and triglyceride indices. In addition, a healthier diet (as measured by the modified recommended food score) was independently associated with T2D risk. Alterations of metabolites such as amino acids and choline-containing phospholipids appear to be associated with T2D risk in Korean adults.
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Affiliation(s)
- Soo Jin Yang
- Department of Food and Nutrition, Seoul Women's University, Seoul, 01797, Republic of Korea
| | - So-Young Kwak
- Department of Public Health Sciences, BK21PLUS Program in Embodiment: Health-Society Interaction, Graduate School, Korea University, Seoul, 02841, Republic of Korea
| | - Garam Jo
- Department of Public Health Sciences, BK21PLUS Program in Embodiment: Health-Society Interaction, Graduate School, Korea University, Seoul, 02841, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, 07985, Republic of Korea
| | - Min-Jeong Shin
- Department of Public Health Sciences, BK21PLUS Program in Embodiment: Health-Society Interaction, Graduate School, Korea University, Seoul, 02841, Republic of Korea.
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6
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Yang D, Hao Y, Zi W, Wang H, Zheng D, Li H, Tu M, Wan Y, Jin P, Xiao G, Xiong Y, Xu G, Liu X. Effect of Retrievable Stent Size on Endovascular Treatment of Acute Ischemic Stroke: A Multicenter Study. AJNR Am J Neuroradiol 2017; 38:1586-1593. [PMID: 28596196 PMCID: PMC7960417 DOI: 10.3174/ajnr.a5232] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/24/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE In clinical practice, stent diameter is one of the variable properties important for endovascular treatment. A consensus guideline for stent retriever size selection has yet to be established. The aim of this study was to investigate the effects of different diameters of Solitaire retrievers on outcomes. MATERIALS AND METHODS Of 628 patients enrolled from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry, 256 were treated with the Solitaire 4-mm device and 372, with the 6-mm device. We matched patients treated with the 2 stent sizes using propensity score analysis. The successful outcome was reperfusion as measured by the modified Thrombolysis in Cerebral Infarction score immediately postprocedure and the dichotomized modified Rankin Scale score at 90 days. Symptomatic intracerebral hemorrhage and in-hospital mortality were also recorded. RESULTS After propensity score analysis, group outcomes did not differ. In addition, in patients with atherosclerosis-related occlusion, a higher reperfusion rate (P = .021) was observed in the Solitaire 4 group, as well as a shorter time interval (P = .002) and fewer passes (P = .025). Independent predictors of successful reperfusion in patients with atherosclerotic disease on logistic analysis were the small stent (OR, 3.217; 95% CI, 1.129-9.162; P = .029) and the propensity score acting as a covariate (OR, 52.84; 95% CI, 3.468-805.018; P = .004). CONCLUSIONS We found no evidence of a differential effect of intra-arterial therapy based on the size of Solitaire retrievers. In patients with atherosclerotic disease, favorable reperfusion was associated with deployment of a small stent.
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Affiliation(s)
- D Yang
- From the Department of Neurology (D.Y., H.W., X.L.), Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu Province, China
| | - Y Hao
- Department of Neurology (Y.H., G.Xu, X.L.), Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, China
- Department of Emergency Medicine (Y.H.), First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - W Zi
- Department of Neurology (W.Z., Y.X., G.Xu, X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - H Wang
- From the Department of Neurology (D.Y., H.W., X.L.), Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu Province, China
- Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang, Shandong Province, China
| | - D Zheng
- Department of Neurology (D.Z.), 175th Hospital of the People's Liberation Army, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, Fujian Province, China
| | - H Li
- Department of Neurology (H.L.), 476th Hospital of the People's Liberation Army, Fuzhou, Fujian Province, China
| | - M Tu
- Department of Neurology (M.T.), Hubei Wuchang Hospital, Wuhan, Hubei Province, China
| | - Y Wan
- Department of Neurology (Y.W.), Hubei Zhongshan Hospital, Wuhan, Hubei Province, China
| | - P Jin
- Department of Neurology (P.J.), Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, Anhui Province, China
| | - G Xiao
- Department of Neurology (G.Xiao), Second Affiliated Hospital of Soochow University; Suzhou, Jiangsu Province, China
| | - Y Xiong
- Department of Neurology (W.Z., Y.X., G.Xu, X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - G Xu
- Department of Neurology (Y.H., G.Xu, X.L.), Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, China
- Department of Neurology (W.Z., Y.X., G.Xu, X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - X Liu
- From the Department of Neurology (D.Y., H.W., X.L.), Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu Province, China
- Department of Neurology (Y.H., G.Xu, X.L.), Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, China
- Department of Neurology (W.Z., Y.X., G.Xu, X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
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