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Wang C, Zhang C, Sun J, Yan R, Liu X, Jia L, Peng X. Risk of acute kidney injury following contrast-enhanced CT or MRI in a cohort of 3061 hospitalized children in China. BMC Pediatr 2024; 24:400. [PMID: 38898400 PMCID: PMC11186257 DOI: 10.1186/s12887-024-04875-z] [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: 12/22/2023] [Accepted: 06/09/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES To compare the risk of acute kidney injury (AKI) between hospitalized children who received intravenous contrast media for imaging examinations and those who did not. METHODS This retrospective cohort study enrolled patients aged 0-18 years with serum creatinine levels before and after imaging examinations from 2015 to 2020 at Beijing Children's Hospital. Participants were classified into an exposure group or a control group. Log-binomial regression analysis was used to estimate the adjusted risk ratio (aRR) value for the association between exposure to contrast media and consequential AKI. After which, inverse probability treatment weighting was used to reduce systematic differences in baseline characteristics among the groups. Moreover, subgroup and sensitivity analyses were performed. Finally, multivariate logistic regression analysis was performed to identify risk factors for pediatric AKI. RESULTS In total, 3061 pediatric patients were included in the analyses (median age, 4.5 [IQR, 1.3-8.9] years, 1760 males). According the KDIGO definition of AKI, the incidence of AKI in the exposure group, and the control group were 7.4% and 6.5%, respectively; furthermore, the aRR was 1.35 (95% CI: 1.31-1.39). In patients underwent CT, the risk of AKI in the exposure group of contrast media increased compared with the control group and the aRR was 1.39 (95% CI: 1.09-1.78). However, it is not observed in patients underwent MRI (aRR: 1.36; 95% CI: 0.96-1.95). According to our subgroup analysis of pediatric patients aged ≥ 2 years (aRR: 1.38; 95% CI: 1.05-1.82) and sensitivity analysis (aRR: 1.32, 95% CI: 1.08-1.61), the risk of AKI in the exposure group was greater than that in the control group. An increased risk to exposure to contrast media was seen in females (aRR: 1.41, 95% CI: 1.05-1.89) rather than males (aRR: 1.30, 95% CI: 0.99-1.70). According to the multivariate logistic regression analyses, the baseline eGFR (OR: 1.02; 95% CI: 1.01-1.03) and comorbidities (OR: 2.97; 95% CI: 1.89-4.65) were risk factors, while age (OR: 0.87; 95% CI: 0.84-0.91) was a protective factor against AKI. CONCLUSION The evidence from the present study suggested that the increased risk of AKI in hospitalized children induced by intravascular contrast should not be ignored.
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Affiliation(s)
- Chen Wang
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Beijing, 100045, China
| | - Chao Zhang
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Beijing, 100045, China
| | - Jihang Sun
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ruohua Yan
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Beijing, 100045, China
| | - Xiaohang Liu
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Beijing, 100045, China
| | - Lulu Jia
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi Road, Beijing, 100045, China.
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, No.56 Nanlishi Road, Beijing, 100045, China.
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He Q, Lin X, Zhou Z, Shen H, Ma K, Dou Z, Liu Y, Pan H, Li S. Failure to thrive in pediatric patients with congenital heart disease: a cross-sectional study of 13,256 patients. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 44:101002. [PMID: 38322730 PMCID: PMC10844746 DOI: 10.1016/j.lanwpc.2023.101002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/09/2023] [Accepted: 12/24/2023] [Indexed: 02/08/2024]
Abstract
Background The prevalence and risk factors for failure to thrive (FTT) in pediatric patients with congenital heart disease (CHD) remain ambiguous. We aimed to investigate the prevalence, growth profiles, risk factors, and vulnerable subtypes of CHD associated with FTT in pediatric patients with CHD. Methods This was a cross-sectional study based on Chinese Database for Congenital Heart Surgery. FTT was defined as either stunting or underweight (height or weight standard deviation score <-2), and they were standardized by references of normal Chinese population. Risk factors was determined with logistic regression model, and growth profiles were delineated in each subgroup. Findings A total of 13,256 CHD patients were included in this study, with 3994 patients of mild CHD, 7195 patients of moderate CHD and 2067 patients of complex CHD. The prevalence of stunting, underweight and FTT was 24%, 29.3% and 36.9%, respectively. Preoperative anaemia, left ventricle systolic dysfunction, younger age, more complex CHD types, lower birth weight and genetic syndrome were found to be the risk factors for FTT in CHD patients. Interrupted aortic arch was revealed to be the most severe group associated with FTT. Interpretation FTT is ubiquitous in patients with CHD and exacerbated in high-risk subgroups. Our findings hinted the necessity of early identification and intervention for FTT in patients with CHD during daily practice of pediatrics, as it has the potential to improve outcomes and enhance their quality of life. Furthermore, we advocate for the initiation of prospective research with longitudinal data to comprehensively investigate the association between FTT and CHD across the lifespan. Funding This study was supported by National High Level Hospital Research Funding (2022-GSP-GG-19), Capital Health Research and Development of Special Fund (2022-1-4032) and National Key R&D Program of China (2022YFC3600202 and 2022YFC3600203).
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Affiliation(s)
- Qiyu He
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Xinjie Lin
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Zhibo Zhou
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huayan Shen
- Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Kai Ma
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Zheng Dou
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Yuze Liu
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
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Badakhshan SN, Ghazizadeh H, Mohammadi‐Bajgiran M, Esmaily H, Khorasani MY, Bohn MK, Pashirzad M, Khodabandeh AK, Zadeh SG, Alami‐Arani I, Rahimi H, Ferns GA, Boskabadi H, Assaran‐Darban R, Adeli K, Ghayour‐Mobarhan M. Age-specific reference intervals for liver function tests in healthy neonates, infants, and young children in Iran. J Clin Lab Anal 2023; 37:e24995. [PMID: 38087776 PMCID: PMC10756939 DOI: 10.1002/jcla.24995] [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: 04/26/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND The reference intervals (RIs) for liver function tests (LFTs) were determined in Iranian children for the first time. METHODS A total of 344 healthy pediatrics aged 3 days to 30 months old were recruited. Serum levels of ALT, AST, ALP, direct bilirubin, and total bilirubin were measured. RIs were determined using CLSI Ep28-A3 guidelines. RESULTS All analytes demonstrated age-specific differences except AST. ALT and ALP demonstrated significantly elevated levels in infants 0 to <5 months relative to the remainder of the age range. Direct and total bilirubin demonstrated markedly elevated levels in early life with mean of 0.28 mg/dL and 1.64 mg/dL observed for direct and total bilirubin, respectively, decreasing by ~50% in the adjacent partition. CONCLUSION These novel data will help improve the clinical interpretation of biochemical test results in young Iranian neonates and children and can be of value to clinical laboratories with similar populations.
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Affiliation(s)
| | - Hamideh Ghazizadeh
- CALIPER Program, Division of Clinical Biochemistry, Pediatric Laboratory MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
| | - Maryam Mohammadi‐Bajgiran
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
| | - Habibollah Esmaily
- Social Determinants of Health Research CenterMashhad University of Medical SciencesMashhadIran
- Department of Biostatistics, School of HealthMashhad University of Medical SciencesMashhadIran
| | - Mahdiyeh Yaghooti Khorasani
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
| | - Mary Kathryn Bohn
- CALIPER Program, Division of Clinical Biochemistry, Pediatric Laboratory MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
- Department of Laboratory Medicine & PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Mehran Pashirzad
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
- Department of Clinical Biochemistry, School of MedicineMashhad University of Medical ScienceMashhadIran
| | - Atieh Kamel Khodabandeh
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
| | - Sara Ghazi Zadeh
- Department of BiologyMashhad Branch, Islamic Azad UniversityMashhadIran
| | - Iman Alami‐Arani
- Department of BiologyMashhad Branch, Islamic Azad UniversityMashhadIran
| | - Hamidreza Rahimi
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
| | - Gordon A. Ferns
- Brighton & Sussex Medical School, Division of Medical EducationFalmerBrightonUK
| | - Hassan Boskabadi
- Department of Pediatrics, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | | | - Khosrow Adeli
- CALIPER Program, Division of Clinical Biochemistry, Pediatric Laboratory MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
- Department of Laboratory Medicine & PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Majid Ghayour‐Mobarhan
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
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Ye Z, Zhang T, Xu M, Xu J. Association of soluble ST2 with disease activity in pediatric systemic lupus erythematosus. Clin Chim Acta 2023; 551:117609. [PMID: 37858712 DOI: 10.1016/j.cca.2023.117609] [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: 08/20/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE The aim of this study is to assess soluble ST2 (sST2) as a potential biomarker in pediatric systemic lupus erythematous patients (pSLEs), especially to reveal the association of the sST2 levels with the disease activity and other laboratory tests. METHODS A total of 65 pSLEs and 33 age- and sex- matched healthy controls (HCs) were enrolled in this study between July and December 2022 from Children's Hospital of Fudan University. Serum levels of sST2 were determined and clinical information and laboratory test results were collected. RESULTS Serum sST2 levels were significantly increased in pSLEs (36.7 ng/mL, IQR 16.6-76.9) compared with HCs (10.4 ng/mL, IQR 6.4-14.8). Patients with moderate to severe disease activities had significantly elevated levels of sST2 compared with those with inactive and mild disease activities. A positive correlation was found between sST2 levels and SLE Disease Activity Index-2000 (SLEDAI-2K) scores. The serum levels of sST2 also showed positive correlations with anti-dsDNA antibody, ALT, AST, GGT, blood urea, and negative correlations with C3, C4, CH50 and ALP. ROC analysis showed that sST2 could discriminate active disease (AUC: 0.959, 95 %CI 0.878-0.992) with an optimal cut-off of 30.2 ng/mL (sensitivity: 89.7 %, specificity: 100 %) and moderate/severe disease activities (AUC: 0.962, 95 %CI 0.883-0.994) with an optimal cut-off of 45.2 ng/mL (sensitivity: 91.7 %, specificity: 90.2 %). Decreased sST2 levels were observed after clinical treatment. CONCLUSIONS Elevated serum sST2 level in pSLEs were observed and were highly associated with disease activity, suggesting sST2 might be a potential biomarker for pSLEs.
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Affiliation(s)
- Zhicheng Ye
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - Tao Zhang
- Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - Menghua Xu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China; Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China.
| | - Jin Xu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China; Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China.
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Yan R, Zhang C, Wang C, Sun Z, Peng X. Evaluation of glomerular filtration rate estimation equations based on serum creatinine in healthy Chinese children and adolescents: a nationwide cross-sectional study. BMJ Paediatr Open 2023; 7:e002132. [PMID: 37827805 PMCID: PMC10582894 DOI: 10.1136/bmjpo-2023-002132] [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: 06/13/2023] [Accepted: 08/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Several equations for glomerular filtration rate (GFR) estimation based on serum creatinine (SCr) have been proposed for children, but most were developed among patients with kidney disease. The association between SCr and GFR may be distorted by kidney dysfunction and thus not applicable to healthy children. This study aimed to evaluate the applicability of existing SCr-based GFR estimation equations in healthy Chinese children. METHODS GFR estimation equations that developed in healthy children were mainly analysed, including the Flanders Metadata (FM), simple height-independent (Simple), full age spectrum (FAS) and FAS-height equations. The FM equation assumed that GFR is proportional to the ratio of height to SCr. The Simple, FAS and FAS-height equations assumed that the ratio of GFR to population mean is equal to the reciprocal ratio of SCr to population mean (denoted by Q). Estimated GFR were calculated using data of SCr, age, sex and height collected from 12 208 healthy Chinese children aged 3 months to <20 years. The performance of GFR estimation equations was evaluated by the sex and age distribution of the estimated GFR and the deviation from the measured GFR reported by other literatures. RESULTS The FM and Simple equations performed well in their applicable age of 1 month to 14 years, but presented undesirable sex difference after adolescence. The FAS and FAS-height equations showed reasonable development trend of estimated GFR throughout childhood, and the FAS equation had higher consistency than the FAS-height equation compared with measured GFR in healthy children. The GFR estimated by the FAS equation increased with age before 2 years, and reached the adult level thereafter without important sex difference. CONCLUSIONS The FAS equation is applicable to healthy Chinese children.
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Affiliation(s)
- Ruohua Yan
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
| | - Chao Zhang
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
| | - Chen Wang
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
| | - Zimo Sun
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
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Yu J, Liu X, Ji H, Zhang Y, Zhan H, Zhang Z, Wen J, Wang Z. Distribution of serum uric acid concentration and its association with lipid profiles: a single-center retrospective study in children aged 3 to 12 years with adenoid and tonsillar hypertrophy. Lipids Health Dis 2023; 22:48. [PMID: 37024876 PMCID: PMC10077755 DOI: 10.1186/s12944-023-01806-2] [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: 01/02/2023] [Accepted: 03/14/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Presently, there is no consensus regarding the optimal serum uric acid (SUA) concentration for pediatric patients. Adenoid and tonsillar hypertrophy is considered to be closely associated with pediatric metabolic syndrome and cardiovascular risk and is a common condition in children admitted to the hospital. Therefore, we aimed to evaluate the relationship between SUA and dyslipidemia and propose a reference range for SUA concentration that is associated with a healthy lipid profile in hospitalized children with adenoid and tonsillar hypertrophy. METHODS Preoperative data from 4922 children admitted for elective adenoidectomy and/or tonsillectomy surgery due to adenoid and tonsillar hypertrophy were collected. SUA concentrations were scaled to standard deviation (SD), and SUA deviations were expressed as SD from the mean SUA of children without dyslipidemia. RESULTS The mean SUA concentration of the participants was 4.27 ± 1.01 mg/dL, and the prevalence of hyperuricemia was 1.6% when it was defined using an SUA of ≥ 7.0 mg/dL. Participants with dyslipidemia (856, 17.4%) had a higher prevalence of hyperuricemia (3.4% vs. 1.2%, P < 0.001) and higher SUA concentrations (4.51 ± 1.15 vs. 4.22 ± 0.97 mg/dL, P < 0.001) than those with ortholiposis. The circulating lipid status of participants with SUAs < 1 SD below the mean value for the participants with ortholiposis (range 1.80-3.28 mg/dL) was more normal. Each 1-SD increase in SUA was associated with a 27% increase in the risk of dyslipidemia (OR = 1.270, 95% CI, 1.185-1.361). Adjustment for a number of potential confounders reduced the strength of the relationship, but this remained significant (OR = 1.125, 95% CI, 1.042-1.215). The higher risk of dyslipidemia was maintained for participants with SUAs > 1 SD above the mean value of the participants with ortholiposis. CONCLUSIONS SUA was independently associated with dyslipidemia in children with adenoid and tonsillar hypertrophy, and an SUA < 1 SD below the mean value for patients with ortholiposis was associated with a healthy lipid profile.
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Affiliation(s)
- Jiating Yu
- Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xin Liu
- Department of Clinical Laboratory, Key Clinical Laboratory of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Honglei Ji
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, China
| | - Yawei Zhang
- Department of Endocrinology and Metabolic Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hanqiang Zhan
- Department of Medical Record Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ziyin Zhang
- Department of Information, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jianguo Wen
- Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - Zhimin Wang
- Department of Endocrinology and Metabolic Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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