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Uncommon Causes of Rhabdomyolysis. Crit Care Clin 2022; 38:271-285. [DOI: 10.1016/j.ccc.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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da Silva Júnior FMR, dos Santos M. Haff's disease in Brazil - the need for scientific follow-up and case notification. LANCET REGIONAL HEALTH. AMERICAS 2021; 5:100100. [PMID: 36776457 PMCID: PMC9903946 DOI: 10.1016/j.lana.2021.100100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022]
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Gao X, Song X, Zuo R, Yang D, Ji C, Ji H, Peng L, Qiu Y, Guo D, Jiang S. Ionophore Toxin Maduramicin Produces Haff Disease-Like Rhabdomyolysis in a Mouse Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217882. [PMID: 33121157 PMCID: PMC7663665 DOI: 10.3390/ijerph17217882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 11/21/2022]
Abstract
Maduramicin is a toxic ionophore antibiotic that is isolated from Streptomyces, frequently occurring in an aquatic environment. To understand the potential role of maduramicin in crayfish consumption related Haff disease, a mouse model was established in this study. Two exposure routes of maduramicin in the abdominal muscle and the hepatopancreas tissue homogenates of crayfish were given intragastrically to mice in different doses for seven days. Action changes, clinical symptoms, feed consumption, body weight, blood biochemistry, and histopathology examination of mice were observed and analyzed. In the natural exposure group, relatively low concentration of maduramicin in crayfish muscle and hepatopancreas had no obvious effects on mental state, body weight, blood biochemical indexes, or histologic appearance. However, in the artificial exposure group, with increasing concentrations, maduramicin in crayfish muscle and hepatopancreas homogenates both induced mental sluggishness and weight loss of mice. Blood biochemical examination showed that 3.5 mg·kg−1 and 7 mg·kg−1 maduramicin in crayfish tissue homogenates significantly increased levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), lactate dehydrogenase (LDH), and creatine kinase (CK). Additionally, histopathological examination showed that multiple organs were damaged by maduramicin, including degeneration of liver cells, shedding of renal epithelial cells, and disturbance and partial lysis of myocardial and skeletal muscle filaments in the mice. In summary, maduramicin may not cause Haff disease through contamination of the aquatic environment under normal conditions. Maduramicin can be used as a potential toxin tool to establish a rhabdomyolysis disease animal model for drug development.
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Affiliation(s)
- Xiuge Gao
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Xinhao Song
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Runan Zuo
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Dan Yang
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Chunlei Ji
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Hui Ji
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Lin Peng
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Yawei Qiu
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Dawei Guo
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Shanxiang Jiang
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Correspondence:
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Aleckovic-Halilovic M, Pjanic M, Mesic E, Storrar J, Woywodt A. From quail to earthquakes and human conflict: a historical perspective of rhabdomyolysis. Clin Kidney J 2020; 14:1088-1096. [PMID: 33841854 DOI: 10.1093/ckj/sfaa075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/13/2020] [Indexed: 12/19/2022] Open
Abstract
Rhabdomyolysis is a common cause of acute kidney injury, featuring muscle pain, weakness and dark urine and concurrent laboratory evidence of elevated muscle enzymes and myoglobinuria. Rhabdomyolysis is often seen in elderly and frail patients following prolonged immobilization, for example after a fall, but a variety of other causes are also well-described. What is unknown to most physicians dealing with such patients is the fascinating history of rhabdomyolysis. Cases of probable rhabdomyolysis have been reported since biblical times and during antiquity, often in the context of poisoning. Equally interesting is the link between rhabdomyolysis and armed conflict during the 20th century. Salient discoveries regarding the pathophysiology, diagnosis and treatment were made during the two world wars and in their aftermath. 'Haff disease', a form of rhabdomyolysis first described in 1920, has fascinated scientists and physicians alike, but the marine toxin causing it remains enigmatic even today. As a specialty, we have also learned a lot about the disease from 20th-century earthquakes, and networks of international help and cooperation have emerged. Finally, rhabdomyolysis has been described as a sequel to torture and similar forms of violence. Clinicians should be aware that rhabdomyolysis and the development of renal medicine are deeply intertwined with human history.
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Affiliation(s)
- Mirna Aleckovic-Halilovic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Tuzla, Bosnia and Herzegovina
| | - Mirha Pjanic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Tuzla, Bosnia and Herzegovina
| | - Enisa Mesic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Tuzla, Bosnia and Herzegovina
| | - Joshua Storrar
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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He F, Ni J, Huang JA, Liu Y, Wu C, Wang J. Clinical features of Haff disease and myositis after the consumption of boiled brackish water crayfish: a retrospective study of 96 cases at a single centre. Intern Emerg Med 2018; 13:1265-1271. [PMID: 29737466 DOI: 10.1007/s11739-018-1870-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/30/2018] [Indexed: 01/04/2023]
Abstract
The present study describes the difference in clinical features between the patients with Haff disease and crayfish-related myositis (CRM) after crayfish consumption. This was a single-centre, retrospective analysis at the Emergency Department of the Drum Tower Hospital of Nanjing University School of Medicine from July to August of 2016. The baseline information came from the Electronic Medical Record System at the institution. Totally 96 patients were included, of whom 52 patients were confirmed to have Haff disease and 44 patients were CRM. The illness predominately occurs in summer and most of them (55/96) are female. The primary clinical features are myalgia, muscle allodynia and back and body pain. Statistical differences in the baseline CK, CK-MB, myoglobin, and the WBC count exist between the Haff disease and CRM groups (P < 0.05). The serum levels of CK and CK-MB increase in the second (a median time 29.2 ± 7.4 h) or third day (a median time 54.8 ± 9.3 h) of disease course, and then rapidly decreased to normal levels, while the levels of myoglobin peak at the admission (a median time 7.7 ± 6.4 h) and became normal after admission. There were no fatalities or complications during this study. All 96 patients recovered in a week. Of them, 75 were followed-up within 1 month and none had recurrence. The Haff disease and CRM after boiled crayfish consumption reflect a different severity of muscle injury, and reveal similar clinical characteristics and most of the laboratory values. The overall prognosis of both is good.
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Affiliation(s)
- Fei He
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China
| | - Jun Ni
- Department of Clinical Laboratory, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China
| | - Jun-Ai Huang
- Department of Clinical Laboratory, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China
| | - Yao Liu
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China
| | - Chao Wu
- Department of Infectious Disease, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China.
| | - Jun Wang
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China.
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Guo B, Xie G, Li X, Jiang Y, Jin D, Zhou Y, Dai Y, Zhen S, Sun G. Outbreak of Haff disease caused by consumption of crayfish (Procambarus clarkii) in nanjing, China. Clin Toxicol (Phila) 2018; 57:331-337. [PMID: 30451016 DOI: 10.1080/15563650.2018.1529318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CONTEXT This paper reports a detailed epidemiological investigation of a large Haff disease outbreak in Nanjing, China, including laboratory analysis of water, river sediment, and fish. METHODS Structured questionnaires were administered to all case-patients. An unmatched case-control study was conducted to identify the factors affecting the incidence of Haff disease. Thirteen samples of crayfish, together with four samples of water and four samples of sediment were collected and sent for laboratory analysis. RESULTS The disease onset of 494 patients occurred between 2 am on 30 June 2016 and 3 am on 29 August 2016. The median incubation time for onset of symptoms after crayfish ingestion was 7.1 hours (range: 1-20 hours). All patients presented with or developed local or diffuse myalgia. However, no kidney injury was observed. Serum creatinine kinase was elevated in all patients (mean: 4614 U/L, median: 2000 U/L, range: 81-55200 U/L). The average number of crayfish consumed by patients on the day of illness was 20 (2-80). The case-control study revealed that eating a large quantity of crayfish, drinking alcohol, and eating the crayfish head and/or intestines were associated with an increased risk of disease. Chemical analysis of crayfish, river water and sediment did not identify known or novel toxins including anticoccidiosis drugs, niclosamide, organophosphorus pesticides, and microcystins. CONCLUSION An outbreak of Haff Disease was associated with consumption of crayfish from the Yangtze River and its surrounding water system. Eating a large quantity of crayfish, eating the head and/or intestines, and consuming alcohol with the crayfish were associated with the development of Haff Disease.
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Affiliation(s)
- Baofu Guo
- a Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health , Southeast University , Nanjing , China.,b Nanjing Municipal Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Guoxiang Xie
- b Nanjing Municipal Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Xiaocheng Li
- b Nanjing Municipal Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Yun Jiang
- b Nanjing Municipal Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Di Jin
- b Nanjing Municipal Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Yonglin Zhou
- c Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Yue Dai
- c Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Shiqi Zhen
- c Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Guiju Sun
- a Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health , Southeast University , Nanjing , China
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Bandeira AC, Campos GS, Ribeiro GS, Cardoso CW, Bastos CJ, Pessoa TL, Araujo KA, Grassi MFR, Castro AP, Carvalho RH, Prates APPB, Gois LL, Rocha VF, Sardi SI. Clinical and laboratory evidence of Haff disease - case series from an outbreak in Salvador, Brazil, December 2016 to April 2017. ACTA ACUST UNITED AC 2017; 22:30552. [PMID: 28661391 PMCID: PMC5479974 DOI: 10.2807/1560-7917.es.2017.22.24.30552] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/14/2017] [Indexed: 11/20/2022]
Abstract
We describe a series of 15 Haff disease cases from an outbreak in Salvador, Brazil, starting early December 2016. Eleven cases were grouped in four family clusters of two to four individuals, four were isolated cases. All but one patient consumed cooked fish; 11 within 24h before symptoms onset. Cases consumed ‘Olho de Boi’ (Seriola spp.) and ’Badejo’ (Mycteroperca spp.). A total of 67 cases were detected, the last case was reported on 5 April 2017.
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Affiliation(s)
- Antonio C Bandeira
- Faculdade de Tecnologia e Ciencias - FTC - Medical School, Salvador, Brazil.,Hospital Aliança, Salvador, Brazil.,Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Brazil
| | - Gubio S Campos
- Virology Laboratory, Federal University of Bahia, Salvador, Brazil
| | - Guilherme S Ribeiro
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Brazil.,Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
| | | | | | - Tiago L Pessoa
- Faculdade de Tecnologia e Ciencias - FTC - Medical School, Salvador, Brazil
| | | | | | | | | | | | - Luana L Gois
- Universidade Catolica do Salvador, Salvador, Brazil
| | | | - Silvia I Sardi
- Virology Laboratory, Federal University of Bahia, Salvador, Brazil
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The Emergence and Epidemiology of Haff Disease in China. Toxins (Basel) 2016; 8:toxins8120359. [PMID: 27916937 PMCID: PMC5198553 DOI: 10.3390/toxins8120359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/23/2016] [Accepted: 11/28/2016] [Indexed: 11/17/2022] Open
Abstract
Haff disease is a rare syndrome of unexplained myalgia and rhabdomyolysis occurring within 24 h of consumption of certain types of cooked freshwater fish or crustacean. It is caused by a yet unidentified heat-stable toxin. In the present review of published case studies and official press releases, the main objective is to report the emergence and epidemiology of Haff disease in China. Haff disease first occurred in Beijing in 2000 and in Lianzhou and Liannan, Guangdong Province in 2009. Subsequent outbreaks mostly occurred in the Jiangsu Province—Nanjing, Yangzhou, Huai’an, and Yancheng. Isolated outbreaks occurred in other cities since 2010—Shijiazhuang, Yueyang, Shanghai, Wuhu, Baoding, Shenzhen, and Hong Kong (imported cases from Shenzhen). Outbreaks occurred predominately in the summer. Crayfish accounted for almost all the outbreaks. Two large outbreaks occurred in Lianzhou and Liannan in 2009 (n = 54) after eating pomfrets and in Nanjing in 2010 (n = 42) after eating crayfish. Other reports or outbreaks involved only 1–9 subjects (median 2 subjects). Variability in individual susceptibility and attack rates were noted, with many subjects remaining asymptomatic despite sharing the same seafood meal as the index cases. Adults were predominately involved. Symptoms occurred within 3–20 h of seafood ingestion, including myalgia, weakness, and, less frequently, nausea, vomiting, abdominal pain, and diarrhea. Myalgia and muscle weakness should normally subside within 2–3 days. Serum creatine phosphokinase became normal within 5–6 days. Abnormal renal function was uncommon. Serious complications (renal failure, multi-organ failure, and prolonged myopathy) and death were rare. In any subjects with unexplained myalgia and rhabdomyolysis, seafood consumption should be included in the history. All suspected cases of Haff disease, including milder presentations, should be reported to public health authorities.
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Feng G, Luo Q, Zhuang P, Guo E, Yao Y, Gao Z. Haff disease complicated by multiple organ failure after crayfish consumption: a case study. Rev Bras Ter Intensiva 2016; 26:407-9. [PMID: 25607271 PMCID: PMC4304470 DOI: 10.5935/0103-507x.20140062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/02/2014] [Indexed: 11/20/2022] Open
Abstract
Haff disease is a syndrome consisting of unexplained rhabdomyolysis. Patients suffering from Haff disease report having eaten fish within 24 hours before the onset of illness. Most patients survive and recover quickly. The present study is the first report of Haff disease complicated by multiple organ failure after crayfish consumption. A 66-year-old Chinese man ate cooked crayfish on the night of June 23, 2013. He arrived at our hospital 2 days later and was admitted to the intensive care unit. After admission, the patient was diagnosed with Haff disease complicated by multiple organ failure. Despite supportive and symptomatic treatments, the condition of the patient deteriorated, and he died due to his illness. Haff disease is a rare clinical syndrome that is sometimes misdiagnosed. Early diagnosis and proper treatment are essential to prevent progression to multiple organ failure.
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Affiliation(s)
- Gang Feng
- Intensive Care Unit, Gongli Hospital, Second Military Medical University, Shanghai, China
| | - Qiancheng Luo
- Intensive Care Unit, Gongli Hospital, Second Military Medical University, Shanghai, China
| | - Ping Zhuang
- Intensive Care Unit, Gongli Hospital, Second Military Medical University, Shanghai, China
| | - Enwei Guo
- Intensive Care Unit, Gongli Hospital, Second Military Medical University, Shanghai, China
| | - Yulan Yao
- Intensive Care Unit, Gongli Hospital, Second Military Medical University, Shanghai, China
| | - Zhongyu Gao
- Office of Teaching, Gongli Hospital, Second Military Medical University, Shanghai, China
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