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Lee SY, Ahn YS, Moon HW. Comparison between the GastroPanel test and the serum pepsinogen assay interpreted with the ABC method-A prospective study. Helicobacter 2024; 29:e13056. [PMID: 38402559 DOI: 10.1111/hel.13056] [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: 10/30/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND AND AIMS This study aimed to validate Helicobacter pylori serological and pepsinogen (PG) assays for detecting infection and gastric neoplasm. METHODS Individuals who underwent serum Chorus H. pylori and HBI PG assays were included from May to September 2023. The GastroPanel test was performed using the same blood sample. HBI assay findings were interpreted with the ABC method using the criteria of corpus atrophy (PG I ≤ 70 ng/mL & I/II ≤3) and advanced corpus atrophy (PG I ≤ 30 ng/mL & I/II ≤2). RESULTS A total of 144 H. pylori-infected and 184 non-infected Koreans were analyzed. The Chorus test (sensitivity 97.2%, specificity 89.1%) showed higher area under the curve (0.993 vs. 0.972, p = 0.003) than the GastroPanel test (sensitivity 95.8%, specificity 86.4%). Using the GastroSoft application, the incidence of gastric neoplasms was highest in the corpus atrophy group (50%), followed by the low acid-output (25.8%), H. pylori infection (11.6%), and antral atrophy (9.1%) groups. There were no gastric neoplasms in the normal and high acid output groups. Using the ABC method, the incidence of gastric neoplasms was highest in the corpus atrophy groups (23.8% in Groups C and D), followed by Group B (12.3%) and Group A (2.4%). Corpus atrophy interpreted with the GastroSoft showed poor agreement (k = 0.225) with corpus atrophy interpreted with the ABC method, whereas it showed excellent agreement (k = 0.854) with advanced corpus atrophy. CONCLUSIONS Although the Chorus test was more accurate than the GastroPanel test, both assays discriminated high-risk individuals by detecting atrophy or infection. There were no gastric neoplasms in the normal or high acid-output groups (GastroSoft application), and gastric neoplasm incidence was lowest in Group A (ABC method). Corpus atrophy determined by GastroSoft application is more consistent with advanced corpus atrophy determined by the ABC method than is corpus atrophy.
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Affiliation(s)
- Sun-Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yeon-Sun Ahn
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hee-Won Moon
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
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Wang P, Li P, Chen Y, Li L, Lu Y, Zhou W, Bian L, Zhang B, Yin X, Li J, Chen J, Zhang S, Shi Y, Tang X. Chinese integrated guideline on the management of gastric precancerous conditions and lesions. Chin Med 2022; 17:138. [PMID: 36517854 PMCID: PMC9749368 DOI: 10.1186/s13020-022-00677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022] Open
Abstract
The standardized diagnosis and management of gastric precancerous conditions and lesions are important to prevent gastric cancer. This guideline, created by 5 traditional Chinese medicine and Western medicine associations, based on the current morbidity and diagnosis and treatment of gastric precancerous conditions and lesions, provides specific key points and strategies for diagnosis and treatment in the following five aspects: definition and epidemiology, diagnosis and stage, surveillance, treatment and efficacy evaluation. It is hoped that these aspects, assessed by integrating Western medicine and traditional Chinese medicine and involving multidisciplinary participation, will play a guiding role in clinical diagnosis and treatment and achieve effective secondary prevention of gastric cancer.
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Affiliation(s)
- Ping Wang
- China Academy of Chinese Medical Sciences, Xiyuan Hospital, Beijing, China
| | - Peng Li
- Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Yingxuan Chen
- Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Li Li
- China Academy of Chinese Medical Sciences, Guanganmen Hospital, Beijing, China
| | - Yuanyuan Lu
- Air Force Medical University Xijing Hospital, Xi'an, China
| | - Weixun Zhou
- Peking Union Medical College Hospital, Beijing, China
| | - Liqun Bian
- China Academy of Chinese Medical Sciences, Xiyuan Hospital, Beijing, China
| | - Beihua Zhang
- China Academy of Chinese Medical Sciences, Xiyuan Hospital, Beijing, China
| | - Xiaolan Yin
- China Academy of Chinese Medical Sciences, Xiyuan Hospital, Beijing, China
| | - Junxiang Li
- Beijing University of Chinese Medicine School of Traditional Chinese Medicine, Beijing, China.
| | - Jie Chen
- Peking Union Medical College Hospital, Beijing, China.
| | - Shutian Zhang
- Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China.
| | - Yongquan Shi
- Air Force Medical University Xijing Hospital, Xi'an, China.
| | - Xudong Tang
- China Academy of Chinese Medical Sciences, Xiyuan Hospital, Beijing, China.
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Teh JL, Shabbir A, Yuen S, So JBY. Recent advances in diagnostic upper endoscopy. World J Gastroenterol 2020; 26:433-447. [PMID: 32063692 PMCID: PMC7002908 DOI: 10.3748/wjg.v26.i4.433] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/10/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageo-gastro-duodenoscopy (EGD) is an important procedure used for detection and diagnosis of esophago-gastric lesions. There exists no consensus on the technique of examination.
AIM To identify recent advances in diagnostic EGDs to improve diagnostic yield.
METHODS We queried the PubMed database for relevant articles published between January 2001 and August 2019 as well as hand searched references from recently published endoscopy guidelines. Keywords used included free text and MeSH terms addressing quality indicators and technological innovations in EGDs. Factors affecting diagnostic yield and EGD quality were identified and divided into the follow segments: Pre endoscopy preparation, sedation, examination schema, examination time, routine biopsy, image enhanced endoscopy and future developments.
RESULTS We identified 120 relevant abstracts of which we utilized 67 of these studies in our review. Adequate pre-endoscopy preparation with simethicone and pronase increases gastric visibility. Proper sedation, especially with propofol, increases patient satisfaction after procedure and may improve detection of superficial gastrointestinal lesions. There is a movement towards mandatory picture documentation during EGD as well as dedicating sufficient time for examination improves diagnostic yield. The use of image enhanced endoscopy and magnifying endoscopy improves detection of squamous cell carcinoma and gastric neoplasm. The magnifying endoscopy simple diagnostic algorithm is useful for diagnosis of early gastric cancer.
CONCLUSION There is a steady momentum in the past decade towards improving diagnostic yield, quality and reporting in EGDs. Other interesting innovations, such as Raman spectroscopy, endocytoscopy and artificial intelligence may have widespread endoscopic applications in the near future.
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Affiliation(s)
- Jun-Liang Teh
- Department of Surgery, National University Hospital System, Singapore 119228, Singapore
- Department of Surgery, Jurong Health Campus, National University Health System, Singapore 609606, Singapore
| | - Asim Shabbir
- Department of Surgery, National University Hospital System, Singapore 119228, Singapore
| | - Soon Yuen
- Department of Surgery, National University Hospital System, Singapore 119228, Singapore
- Department of Surgery, Jurong Health Campus, National University Health System, Singapore 609606, Singapore
| | - Jimmy Bok-Yan So
- Department of Surgery, National University Hospital System, Singapore 119228, Singapore
- Department of Surgery, National University of Singapore, Singapore 119074, Singapore
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Zhang LY, Li WY, Ji M, Liu FK, Chen GY, Wu SS, Hao Q, Zhai HH, Zhang ST. Efficacy and safety of using premedication with simethicone/Pronase during upper gastrointestinal endoscopy examination with sedation: A single center, prospective, single blinded, randomized controlled trial. Dig Endosc 2018; 30:57-64. [PMID: 28816373 DOI: 10.1111/den.12952] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/14/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIM To investigate the efficacy and safety of premedication with simethicone/Pronase during esophagogastroduodenoscopy (EGD) with sedation. METHODS Six hundred and ten patients were randomly allocated to two groups based on type of premedication given. Premedication used in the control group was 10 mL lidocaine hydrochloride mucilage (LHM, N = 314) and premedication used in the intervention group was 80 mL simethicone/Pronase solution plus 10 mL lidocaine hydrochloride mucilage (SP/LHM, N = 296). EGD was done under sedation. Visibility scores, number of mucosal areas that needed cleansing, water consumption for cleansing, time taken for examination, diminutive lesions, pathological diagnosis, patients' gag reflex and oxygenation (pulse oximetry) were recorded. RESULTS SP/LHM has significantly lower total visibility score than LHM (7.978 ± 1.526 vs 6.348 ± 1.097, P < 0.01). During the procedure, number of intragastric areas that needed cleansing and amount of water consumed were significantly less in the SP/LHM than in the LHM group (P < 0.01). In SP/LHM (P = 0.01), endoscopy procedure duration was significantly longer. Although there was no significant difference in rate of detection of diminutive lesions between LHM and SP/LHM, the endoscopist carried out more biopsies in SP/LHM. This led to a higher rate of diagnosis of atrophic gastritis (P = 0.014) and intestinal metaplasia (P = 0.024). There was no significant difference in gag reflex (P = 0.604) and oxygenation during the endoscopy procedure for either group of patients. CONCLUSION Routine use of premedication with simethicone/Pronase should be recommended during EGD with sedation.
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Affiliation(s)
- Ling-Ye Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Wen-Yan Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Ming Ji
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Fu-Kun Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guang-Yong Chen
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shan-Shan Wu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Qian Hao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Hui-Hong Zhai
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Shu-Tian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
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Beg S, Ragunath K, Wyman A, Banks M, Trudgill N, Pritchard DM, Riley S, Anderson J, Griffiths H, Bhandari P, Kaye P, Veitch A. Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut 2017; 66:1886-1899. [PMID: 28821598 PMCID: PMC5739858 DOI: 10.1136/gutjnl-2017-314109] [Citation(s) in RCA: 211] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/26/2017] [Accepted: 07/12/2017] [Indexed: 12/18/2022]
Abstract
This document represents the first position statement produced by the British Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, setting out the minimum expected standards in diagnostic upper gastrointestinal endoscopy. The need for this statement has arisen from the recognition that while technical competence can be rapidly acquired, in practice the performance of a high-quality examination is variable, with an unacceptably high rate of failure to diagnose cancer at endoscopy. The importance of detecting early neoplasia has taken on greater significance in this era of minimally invasive, organ-preserving endoscopic therapy. In this position statement we describe 38 recommendations to improve diagnostic endoscopy quality. Our goal is to emphasise practices that encourage mucosal inspection and lesion recognition, with the aim of optimising the early diagnosis of upper gastrointestinal disease and improving patient outcomes.
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Affiliation(s)
- Sabina Beg
- Department of Gastroenterology, NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Krish Ragunath
- Department of Gastroenterology, NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Wyman
- Department of Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Matthew Banks
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Nigel Trudgill
- Department of Gastroenterology, Sandwell General Hospital, West Bromwich, UK
| | - D Mark Pritchard
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stuart Riley
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - John Anderson
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Helen Griffiths
- Department of Gastroenterology, Wye Valley NHS Trust, Herefordshire, UK
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Phillip Kaye
- Department of Histopathology, Nottingham University Hospitals NHS trust, Nottingham, UK
| | - Andrew Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
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Role of targeted biopsy under magnifying endoscopy with narrow band imaging may be not necessary: a prospective diagnostic accuracy study. Eur J Gastroenterol Hepatol 2017; 29:414-422. [PMID: 28248842 DOI: 10.1097/meg.0000000000000802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Targeted biopsy under the guidance of magnifying endoscopy with narrow band imaging (ME-NBI) has higher accuracy than endoscopic forceps biopsy (EFB) in the differential diagnosis of cancerous lesions from noncancerous lesions. The aims of this study were to validate diagnostic efficacy of targeted biopsy under the guidance of ME-NBI (MNTB) and further evaluate whether it is necessary to perform MNTB when combined with ME-NBI. METHODS This study prospectively analyzed 211 gastric lesions of suspected cancerous tissues. The sensitivity, specificity, positive predictive value, and negative predictive value of EFB, ME-NBI, MNTB, EFB plus ME-NBI, and MNTB plus ME-NBI for the diagnosis of cancerous lesions were determined, respectively. The accuracy, sensitivity, specificity of EFB and MNTB, EFB plus ME-NBI, and MNTB plus ME-NBI were also compared, respectively. RESULTS The accuracy, sensitivity, and specificity with 95% confidence intervals were 68.2% (61.4-74.4%), 62.3% (54.1-69.9%), 84.2% (71.6-92.1%) for EFB, 75.4% (68.9-80.9%), 72.7% (64.9-79.4%), 82.5% (69.6-90.8%) for MNTB, 76.8% (70.4-82.2%), 73.4% (65.5-80.0%), 86.0% (73.7-93.3%) for ME-NBI, 82.0% (76.0-86.8%), 85.7% (79.0-90.6%), 71.9% (58.3-82.6%) for EFB plus ME-NBI, 84.8% (79.1-89.3%), 89.6% (83.4-93.8%), and 71.9% (58.3-82.6%) for MNTB plus ME-NBI, respectively. The sensitivity of MNTB was significantly higher than that of EFB (P=0.048). There was no significant difference in the sensitivity (P=0.307), specificity (P=1.000), and accuracy (P=0.337) between EFB plus ME-NBI and MNTB plus ME-NBI. CONCLUSION Although MNTB has a higher diagnostic efficacy than EFB in the diagnosis of cancerous lesions, it may be not necessary to perform MNTB when combined with ME-NBI.
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Kim GH, Cho YK, Cha JM, Lee SY, Chung IK. Efforts to increase image quality during endoscopy: The role of pronase. World J Gastrointest Endosc 2016; 8:267-272. [PMID: 26981178 PMCID: PMC4781907 DOI: 10.4253/wjge.v8.i5.267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/04/2015] [Accepted: 12/21/2015] [Indexed: 02/05/2023] Open
Abstract
Clear visualization of the gastrointestinal mucosal surface is essential for thorough endoscopy. An unobstructed assessment can reduce the need for additional time-consuming manipulations such as frequent washing and suction, which tend to prolong total procedure time. However, mucus, foam, and bubbles often hinder clear visibility during endoscopy. Premedication with pronase, a compound of mixed proteolytic enzymes, has been studied in order to improve mucosal visibility during endoscopy. Although its effects differ according to the location in the stomach, premedication with pronase 10 to 20 min before endoscopy significantly improves mucosal visibility without affecting the accuracy of Helicobacter pylori identification. The effects of pronase as premedication also extend to chromoendoscopy, narrow-band imaging, magnifying endoscopy, and endoscopic ultrasonography. In addition, endoscopic flushing with pronase during endoscopy may improve the quantity and the quality of a biopsy to some degree. Although improved mucosal visibility does not necessarily improve clinical outcomes, premedication with pronase may be helpful for increasing the detection rate of early cancers.
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Zhang Q, Lian ZY, Chen ZY, Wang Z, di Chen C, An SL, Gong W, Zhi FC, de Liu S. Low Discrepancy Between Tissue Biopsy Plus Magnifying Endoscopy With Narrow-Band Imaging and Endoscopic Resection in the Diagnosis of Gastric Epithelial Neoplasia (STROBE). Medicine (Baltimore) 2015; 94:e1092. [PMID: 26166094 PMCID: PMC4504654 DOI: 10.1097/md.0000000000001092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Tissue biopsy is often not very accurate for the diagnosis of gastric epithelial neoplasia (GEN), and the results differ notably from endoscopic resection (ER) in terms of the pathological diagnosis. The aims of this study were to evaluate the diagnostic performances of biopsy, magnifying endoscopy with narrow-band imaging (ME-NBI), and biopsy plus ME-NBI for GEN.This study retrospectively analyzed 101 cases diagnosed as GEN using ER samples. The discrepancies between biopsy and ER, as well as between biopsy plus ME-NBI and ER in the diagnosis of GEN were evaluated. Factors that contributed to such discrepancies were analyzed. The sensitivity and specificity of biopsy and ME-NBI for the diagnosis of high-grade neoplasia (HGN) were determined.The discrepancy in the pathological diagnosis between biopsy and ER was 39.6% for GEN and 54.2% for HGN. The discrepancy between biopsy combined with ME-NBI and ER was 15.9% for GEN and 10.2% for HGN. Factors that undermined the diagnostic accuracy of biopsy included the lesion size (≤10 mm, odds ratio [OR] 1; 10-20 mm, OR 0.2, 95% confidence interval [CI] 0.1-0.7; >20 mm, OR 0.5, 95% CI 0.1-2.1, P = 0.03) and the number of biopsy fragments (OR 0.6, 95% CI 0.5-0.8, P = 0.001). The sensitivity and specificity for HGN were 45.8% (33.7%-58.3%) and 100% (87.5%-100%) for biopsy, and 88.1% (77.5%-94.1%) and 92.9% (81.0%-97.5%) for ME-NBI, respectively.In conclusion, biopsy-based diagnoses for GEN should be interpreted with caution. Biopsy combined with ME-NBI can contribute to the diagnosis of GEN, which improves diagnostic consistency with pathological result of ER specimens.
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Affiliation(s)
- Qiang Zhang
- From the Department of Gastroenterology (QZ, ZYC, ZW, CDC, WG, FCZ, SDL), Nanfang Hospital, Southern Medical University; Department of Radiology (ZYL), Guangdong General Hospital, Guangdong Academy of Medical Sciences; and Department of Bio-Statistics (SLA), School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China
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