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Lu Q, Liu Z, He W, Chu X. Retracted article: Protective effects of ulinastatin on rats with acute lung injury induced by lipopolysaccharide. Bioengineered 2024; 15:1987083. [PMID: 34637694 PMCID: PMC10813561 DOI: 10.1080/21655979.2021.1987083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022] Open
Abstract
Qitong Lu, Zhiyong Liu, Wei He and Xin Chu. Protective effects of ulinastatin on rats with acute lung injury induced by lipopolysaccharide. Bioengineered. 2021 Oct. doi: 10.1080/21655979.2021.1987083.Since publication, significant concerns have been raised about the compliance with ethical policies for human research and the integrity of the data reported in the article.When approached for an explanation, the authors provided some original data but were not able to provide all the necessary supporting information. As verifying the validity of published work is core to the scholarly record's integrity, we are retracting the article. All authors listed in this publication have been informed.We have been informed in our decision-making by our editorial policies and the COPE guidelines. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as 'Retracted.'
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Affiliation(s)
- Qitong Lu
- Department of Cardiothoracic Surgery, Zhongda Hospital, Southeast University, Nanjing, P. R. China
| | - Zhiyong Liu
- Department of Cardiothoracic Surgery, Zhongda Hospital, Southeast University, Nanjing, P. R. China
| | - Wei He
- Department of Cardiothoracic Surgery, Zhongda Hospital, Southeast University, Nanjing, P. R. China
| | - Xin Chu
- Department of Cardiothoracic Surgery, Zhongda Hospital, Southeast University, Nanjing, P. R. China
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Wenying S, Jing H, Ying L, Hui D. The role of TLR4/MyD88/NF-κB in the protective effect of ulinastatin on the intestinal mucosal barrier in mice with sepsis. BMC Anesthesiol 2023; 23:414. [PMID: 38102579 PMCID: PMC10722746 DOI: 10.1186/s12871-023-02374-9] [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: 04/03/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE To investigate the effect of the TLR4/MyD88/NF-κB (Toll-like receptor 4/myeloid differentiation factor/nuclear factor kappa B) signalling pathway on the protective effect of ulinastatin on the intestinal mucosal barrier in mice with sepsis. METHODS A mouse model of sepsis was established by classical caecal ligation and perforation. Forty-four SPF C57BL/6 mice were randomly divided into the following four groups with 11 mice in each group: the control group (Con group), ulinastatin group (Uti group), Uti + LPS (lipopolysaccharide, LPS) group (Uti + LPS group) and LPS group. Mice in the Con group and Uti group received saline or ulinastatin injected 2 h after modelling; Mice in the Uti + LPS group received LPS injected 0 h after modelling, other procedures were the same as in the Uti group; Mice in the LPS group received LPS only. At 48 h after surgery, the levels of TNF-α (tumour necrosis factor-α, TNF-α), IL-6 (interleukin-6, IL-6) and IL-1β (interleukin-1β, IL-1β) in vein, and the expression of TLR4, MyD88 and NF-κB mRNA in small intestinal mucosa tissues using ELISA and RT‒PCR. RESULTS The pathological specimens showed increased inflammatory injury in the Con and LPS groups, while these injuries and changes improved in the Uti group. The scores of intestinal mucosal injury at 48 h of Uti injection were significantly lower than those of the Con group (P < 0.001), while the scores of intestinal mucosal injury of Uti + LPS were significantly higher than those of the Uti group (P = 0.044). The expression of TNF-α, IL-6 and IL-1β in the Uti decreased significantly at 48 h after surgery than that in the Con group (P = 0.001, P = 0.014, P = 0.004), while the expression of TNF-α, IL-6 and IL-1β in the Uti + LPS group increased significantly after surgery than that in the Uti group (P = 0.026, P = 0.040, P = 0.039). The expression of TLR4, MyD88 and NF-κB mRNA in the Uti group decreased significantly compared with that in the Con group (P = 0.001, P = 0.021, P = 0.007), while the expression of TLR4, MyD88 and NF-κB mRNA in the Uti + LPS group was higher than that in the Uti group (P = 0.023, P = 0.040, P = 0.045). CONCLUSION These findings indicate that the protective effect of ulinastatin on the intestinal mucosal barrier against sepsis may be mediated through the TLR4/MyD88/NF-κB pathway.
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Affiliation(s)
- Song Wenying
- Department of Anesthesiology, Shaanxi Provincial Hospital, The Third Affiliated Hospital of Xi'an JiaoTong University, Xi'an, 710068, Shaanxi Province, People's Republic of China
| | - Huang Jing
- Xi'an Medical University, Xi'an 710068, Shaanxi Province, People's Republic of China
| | - Li Ying
- Xi'an Medical University, Xi'an 710068, Shaanxi Province, People's Republic of China
| | - Ding Hui
- Department of Anesthesiology, Shaanxi Provincial Hospital, The Third Affiliated Hospital of Xi'an JiaoTong University, Xi'an, 710068, Shaanxi Province, People's Republic of China.
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Lysophosphatidylcholine Offsets the Protective Effects of Bone Marrow Mesenchymal Stem Cells on Inflammatory Response and Oxidative Stress Injury of Retinal Endothelial Cells via TLR4/NF- κB Signaling. J Immunol Res 2021; 2021:2389029. [PMID: 34692851 PMCID: PMC8531799 DOI: 10.1155/2021/2389029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/09/2021] [Accepted: 09/26/2021] [Indexed: 11/22/2022] Open
Abstract
Diabetic retinopathy (DR), as a major cause of blindness worldwide, is one common complication of diabetes mellitus. Inflammatory response and oxidative stress injury of endothelial cells play significant roles in the pathogenesis of DR. The study is aimed at investigating the effects of lysophosphatidylcholine (LPC) on the dysfunction of high glucose- (HG-) treated human retinal microvascular endothelial cells (HRMECs) after being cocultured with bone marrow mesenchymal stem cells (BMSCs) and the underlying regulatory mechanism. Coculture of BMSCs and HRMECs was performed in transwell chambers. The activities of antioxidant-related enzymes and molecules of oxidative stress injury and the contents of inflammatory cytokines were measured by ELISA. Flow cytometry analyzed the apoptosis of treated HRMECs. HRMECs were further treated with 10-50 μg/ml LPC to investigate the effect of LPC on the dysfunction of HRMECs. Western blotting was conducted to evaluate levels of TLR4 and p-NF-κB proteins. We found that BMSCs alleviated HG-induced inflammatory response and oxidative stress injury of HRMECs. Importantly, LPC offsets the protective effects of BMSCs on inflammatory response and oxidative stress injury of HRMECs. Furthermore, LPC upregulated the protein levels of TLR4 and p-NF-κB, activating the TLR4/NF-κB signaling pathway. Overall, our study demonstrated that LPC offsets the protective effects of BMSCs on inflammatory response and oxidative stress injury of HRMECs via TLR4/NF-κB signaling.
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Yang J, Jia Z, Xiao Z, Zhao J, Lu Y, Chu L, Shao H, Pei L, Zhang S, Chen Y. Baicalin Rescues Cognitive Dysfunction, Mitigates Neurodegeneration, and Exerts Anti-Epileptic Effects Through Activating TLR4/MYD88/Caspase-3 Pathway in Rats. Drug Des Devel Ther 2021; 15:3163-3180. [PMID: 34321866 PMCID: PMC8312624 DOI: 10.2147/dddt.s314076] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose This study aims to evaluate the beneficial effects of anti-epileptic mechanisms of baicalin (BA) on cognitive dysfunction and neurodegeneration in pentylenetetrazol (PTZ)-induced epileptic rats. Methods First, PTZ-induced epileptic rats were administered intraperitoneally a sub-convulsive dose of PTZ (40 mg/kg) daily, and the seizure susceptibility (the degree of seizures and latency) was evaluated using Racine’s criterion. Then, classical behavioral experiments were performed to test whether BA ameliorated cognitive dysfunction. Neurodegeneration was assessed using Fluoro Jade-B (FJB), and NeuN staining was used to determine whether BA offered a neuroprotective role. After BA had been proven to possess anti-epileptic effects, its possible mechanisms were analyzed through network pharmacology. Finally, the key targets for predictive mechanisms were experimentally verified. Results The epileptic model was successfully established, and BA had anti-epileptic effects. Epileptic rats displayed significant cognitive dysfunction, and BA markedly ameliorated cognitive dysfunction. Further, we also discovered that BA treatment mitigated neurodegeneration of the hippocampus CA3 regions, thereby ameliorated cognitive dysfunction of epileptic rats. Subsequent network pharmacology analysis was implemented to reveal a possible mechanism of BA in the anti-epileptic process and the TLR4/MYD88/Caspase-3 pathway was predicted. Finally, experimental studies showed that BA exerted an anti-epileptic effect by activating the TLR4/MYD88/Caspase-3 pathway in PTZ-induced epileptic rats. Conclusion In conclusion, BA had a protective effect against PTZ-induced seizures. BA improved cognitive dysfunction and exerted a neuroprotective action. The anti-epileptic effects of BA may be potentially through activation of the TLR4/MYD88/Caspase-3 pathway.
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Affiliation(s)
- Jiali Yang
- School of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, People's Republic of China
| | - Zhixia Jia
- School of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, People's Republic of China
| | - Zhigang Xiao
- School of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, People's Republic of China
| | - Jing Zhao
- Hebei Key Laboratory of Turbidity, Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Ye Lu
- Hebei Key Laboratory of Turbidity, Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Li Chu
- School of Pharmacy, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, People's Republic of China
| | - Hui Shao
- School of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, People's Republic of China.,Hebei Key Laboratory of Turbidity, Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Lin Pei
- School of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, People's Republic of China.,Hebei Key Laboratory of Turbidity, Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Shaodan Zhang
- Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yuan Chen
- Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
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Wang Y, Zou XM, Pan QM, Zhong LP. Clinical significance of changes of TLR4/MyD88/NF-κB signaling pathway in peripheral blood mononuclear cells of gastric cancer patients with Helicobacter pylori infection. Shijie Huaren Xiaohua Zazhi 2021; 29:319-324. [DOI: 10.11569/wcjd.v29.i6.319] [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] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The correlation between Helicobacter pylori (H. pylori) and gastric cancer has been widely recognized in the world. The abnormal expression of TLR4/MyD88/NF-κB signaling pathway related factors is obvious in gastric cancer patients, suggesting that this pathway is closely related to the occurrence and development of gastric cancer. However, there is also a correlation between the TLR4/MyD88/NF-κB signaling pathway and H. pylori infection in gastric cancer patients.
AIM To investigate the clinical significance of changes of the TLR4/MyD88/NF-κB signaling pathway in peripheral blood mononuclear cells (PBMCs) of patients with gastric cancer infected by H. pylori.
METHODS Eighty gastric cancer patients treated at Huzhou Third People's Hospital from October 2017 to October 2020 were selected as a study group, and 50 healthy ts volunteers were selected as a control group. The expression levels of TLR-4, NF-κB, and myeloid differentiation factor (MyD88) in PBMCs of gastric cancer patients with different pathological characteristics and H. pylori infection status were compared between the two groups, and the correlation between TLR-4, NF-κB, and MyD88 protein levels and H. pylori infection was analyzed.
RESULTS Compared with the control group, the expression levels of TLR-4, NF-κB, and MyD88 in the study group were significantly higher than those of the control group (P < 0.05). The expression of TLR4/MyD88/NF-κB signaling pathway related molecules differed significantly in gastric cancer patients with different clinical stages, lymph node metastasis status, and depth of invasion (P < 0.05), and TLR4/MyD88/NF-κB expression differed significantly in different gender and age groups (P < 0.05). The expression of TLR-4, NF-κB, and MyD88 in the H. pylori positive group was significantly higher than that of the H. pylori negative group (P < 0.05). Pearson analysis showed that H. pylori infection was positively correlated with the expression of TLR-4, NF-κB, and MyD88 (r = 0.726, 0.684, and 0.631, P < 0.01).
CONCLUSION The expression levels of TLR4/MyD88/NF-κB signaling pathway related molecules in peripheral blood mononuclear cells (PBMCs) of patients with gastric cancer increase significantly, and are significantly different among groups with different pathological characteristics and parameters. It is speculated that H. pylori infection may participate in the occurrence and development of gastric cancer by inducing the abnormal expression of the TLR4/MyD88/NF-κB signaling pathway.
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Affiliation(s)
- Yang Wang
- Department of Respiration and Digestion, Huzhou Third People's Hospital, Huzhou 313000, Zhejiang Province, China
| | - Xin-Mei Zou
- Department of Respiration and Digestion, Huzhou Third People's Hospital, Huzhou 313000, Zhejiang Province, China
| | - Qin-Mei Pan
- Department of Respiration and Digestion, Huzhou Third People's Hospital, Huzhou 313000, Zhejiang Province, China
| | - Li-Ping Zhong
- Department of Oncology, Huzhou Central Hospital, Huzhou 313000, Zhejiang Province, China
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Xie X, Cong L, Liu S, Xiang L, Fu X. Genistein alleviates chronic vascular inflammatory response via the miR‑21/NF‑κB p65 axis in lipopolysaccharide‑treated mice. Mol Med Rep 2021; 23:192. [PMID: 33495831 PMCID: PMC7809901 DOI: 10.3892/mmr.2021.11831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022] Open
Abstract
Chronic vascular inflammatory response is an important pathological basis of cardiovascular disease. Genistein (GEN), a natural compound, exhibits anti‑inflammatory effects. The aim of the present study was to investigate the effects of GEN on lipopolysaccharide (LPS)‑induced chronic vascular inflammatory response in mice and explore the underlying anti‑inflammatory mechanisms. C57BL/6 mice were fed with a high‑fat diet combined with intraperitoneal injection of LPS to induce chronic vascular inflammation. The expression levels of TNF‑α, IL‑6 and microRNA (miR)‑21 in the vasculature were detected via reverse transcription‑quantitative (RT‑q)PCR. The protein levels of inducible nitric oxide synthase (iNOS) and NF‑κB p65 were detected via western blotting. NF‑κB p65 was also analyzed via immunohistochemistry and immunofluorescence (IF). In addition, after transfection with miR‑21 mimic or inhibitor for 24 h, vascular endothelial cells (VECs) were treated with GEN and LPS. RT‑qPCR and western blot analyses were performed to detect the expression of TNF‑α, IL‑6, miR‑21 and iNOS, and the protein levels of iNOS and NF‑κB p65, respectively. IF was used to measure NF‑κB p65 nuclear translocation. The results revealed that GEN significantly decreased the expression of inflammation‑associated vascular factors in LPS‑treated C57BL/6 mice, including TNF‑α, IL‑6, iNOS, NF‑κB p65 and miR‑21. Furthermore, miR‑21 antagomir enhanced the anti‑inflammatory effects of GEN. In LPS‑induced VECs, miR‑21 mimic increased inflammation‑associated factor expression and attenuated the anti‑inflammatory effects of GEN, whereas miR‑21 inhibitor induced opposing effects. Therefore, the results of the present study suggested that GEN inhibited chronic vascular inflammatory response in mice, which may be associated with the inhibition of VEC inflammatory injury via the miR‑21/NF‑κB p65 pathway.
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Affiliation(s)
- Xiaolin Xie
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Hunan Normal University, Changsha, Hunan 410013, P.R. China
- Department of Basic Medicine, School of Medicine, Hunan Normal University, Changsha, Hunan 410013, P.R. China
| | - Li Cong
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Hunan Normal University, Changsha, Hunan 410013, P.R. China
| | - Sujuan Liu
- Department of Basic Medicine, School of Medicine, Hunan Normal University, Changsha, Hunan 410013, P.R. China
| | - Liping Xiang
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xiaohua Fu
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Hunan Normal University, Changsha, Hunan 410013, P.R. China
- Department of Basic Medicine, School of Medicine, Hunan Normal University, Changsha, Hunan 410013, P.R. China
- Correspondence to: Professor Xiaohua Fu, Department of Basic Medicine, School of Medicine, Hunan Normal University, 371 Tongzipo Road, Changsha, Hunan 410013, P.R. China, E-mail:
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Negative Regulation of Tec Kinase Alleviates LPS-Induced Acute Kidney Injury in Mice via theTLR4/NF- κB Signaling Pathway. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3152043. [PMID: 32685466 PMCID: PMC7322586 DOI: 10.1155/2020/3152043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023]
Abstract
Tec kinase is an important mediator in inflammatory immune response that enhances the activity of neutrophils and macrophages. However, information on its function in lipopolysaccharide- (LPS-) induced acute kidney injury (AKI) is limited. This study is aimed at determining whether Tec kinase was a regulator in AKI. An AKI model in mice was successfully established using intraperitoneal LPS. Results showed that the serum levels of creatinine (Cr), blood urea nitrogen (BUN), and cystatin-C (Cys-C) increased after intraperitoneal LPS injection. Renal tissue sustained significantly severe injury as measured by pathological scores. Pretreatment with LFM-A13 improved the function of the kidney in mice and decreased the renal injury score. Enzyme-linked immunosorbent assay showed that LFM-A13 significantly reduced the release of IL-1β and TNF-α in mice exposed to LPS. LFM-A13 can evidently abrogate the expression of Tec protein, MyD88, TLR4, NF-κB p65, and Tec's phosphorylated protein as determined by Western blot. Immunohistochemistry analysis revealed that LFM-A13 markedly downregulated the expression of Tec kinase in renal tubular epithelial cells. In vitro, Tec kinase protein was expressed highly in NRK-52E cells after LPS exposure. Tec-siRNA also decreased IL-1β and TNF-α production and obviously abolished phospho-p65 and phospho-IκBα expression in NRK-52E cell stimulated by LPS; however, Tec-siRNA increased the IκBα level. Altogether, these data suggested that Tec kinase can be a modulating protein in AKI through TLR4/NF-κB activation.
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Chen SJ, Lin GJ, Chen JW, Wang KC, Tien CH, Hu CF, Chang CN, Hsu WF, Fan HC, Sytwu HK. Immunopathogenic Mechanisms and Novel Immune-Modulated Therapies in Rheumatoid Arthritis. Int J Mol Sci 2019; 20:ijms20061332. [PMID: 30884802 PMCID: PMC6470801 DOI: 10.3390/ijms20061332] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/17/2019] [Accepted: 03/12/2019] [Indexed: 12/16/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease of unknown etiology. It is characterized by the presence of rheumatoid factor and anticitrullinated peptide antibodies. The orchestra of the inflammatory process among various immune cells, cytokines, chemokines, proteases, matrix metalloproteinases (MMPs), and reactive oxidative stress play critical immunopathologic roles in the inflammatory cascade of the joint environment, leading to clinical impairment and RA. With the growing understanding of the immunopathogenic mechanisms, increasingly novel marked and potential biologic agents have merged for the treatment of RA in recent years. In this review, we focus on the current understanding of pathogenic mechanisms, highlight novel biologic disease-modifying antirheumatic drugs (DMRADs), targeted synthetic DMRADs, and immune-modulating agents, and identify the applicable immune-mediated therapeutic strategies of the near future. In conclusion, new therapeutic approaches are emerging through a better understanding of the immunopathophysiology of RA, which is improving disease outcomes better than ever.
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Affiliation(s)
- Shyi-Jou Chen
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
- Department of Microbiology and Immunology, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
- Department of Pediatrics, Penghu Branch of Tri-Service General Hospital, National Defense Medical Center, No. 90, Qianliao, Magong City, Penghu County 880, Taiwan.
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
| | - Gu-Jiun Lin
- Department of Biology and Anatomy, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
| | - Jing-Wun Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
| | - Kai-Chen Wang
- School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei City 112, Taiwan.
- Department of Neurology, Cheng Hsin General Hospital, No. 45, Cheng Hsin St., Pai-Tou, Taipei City 112, Taiwan.
| | - Chiung-Hsi Tien
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
| | - Chih-Fen Hu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
| | - Chia-Ning Chang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
- Department of Pediatrics, Penghu Branch of Tri-Service General Hospital, National Defense Medical Center, No. 90, Qianliao, Magong City, Penghu County 880, Taiwan.
| | - Wan-Fu Hsu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
- Department of Pediatrics, Penghu Branch of Tri-Service General Hospital, National Defense Medical Center, No. 90, Qianliao, Magong City, Penghu County 880, Taiwan.
| | - Hueng-Chuen Fan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
- Department of Pediatrics, Tungs' Taichung MetroHarborHospital, No. 699, Section 8, Taiwan Blvd., Taichung City 435, Taiwan.
| | - Huey-Kang Sytwu
- Department of Microbiology and Immunology, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
- Graduate Institute of Life Sciences, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County 350, Taiwan.
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