Serum lipidome reveals lipid metabolic dysregulation in severe fever with thrombocytopenia syndrome.


Journal

BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723

Informations de publication

Date de publication:
14 Oct 2024
Historique:
received: 21 06 2024
accepted: 30 09 2024
medline: 14 10 2024
pubmed: 14 10 2024
entrez: 13 10 2024
Statut: epublish

Résumé

Severe fever with thrombocytopenia syndrome (SFTS) is a rapidly progressing infectious disease with a high fatality rate caused by a novel bunyavirus (SFTSV). The role of lipids in viral infections is well-documented; however, the specific alterations in lipid metabolism during SFTSV infection remain elusive. This study aims to elucidate the lipid metabolic dysregulations in the early stages of SFTS patients. This study prospectively collected peripheral blood sera from 11 critical SFTS patients, 37 mild SFTS patients, and 23 healthy controls during the early stages of infection for lipidomics analysis. A systematic bioinformatics analysis was conducted from three aspects integrating lipid differential expressions, lipid differential correlations, and lipid-clinical indices correlations to reveal the serum lipid metabolic dysregulation in SFTSV-infected individuals. Our findings reveal significant lipid metabolic dysregulation in SFTS patients. Specifically, compared to healthy controls, SFTS patients exhibited three distinct modes of lipid differential expression: increased levels of lipids including phosphatidylserine (PS), hexosylceramide (HexCer), and triglycerides (TG); decreased levels of lipids including lysophosphatidylcholine (LPC), acylcarnitine (AcCa), and cholesterol esters (ChE); and lipids showing "dual changes" including phosphatidylcholine (PC) and phosphatidylethanolamine (PE). Finally, based on lipid metabolic pathways and literature analysis, we systematically elucidated the potential mechanisms underlying lipid metabolic dysregulation in the early stage of SFTSV infection. Our study presents the first global serum lipidome profile and reveals the lipid metabolic dysregulation patterns in the early stage of SFTSV infection. These findings provide a new basis for the diagnosis, treatment, and further investigation of the disease.

Sections du résumé

BACKGROUND BACKGROUND
Severe fever with thrombocytopenia syndrome (SFTS) is a rapidly progressing infectious disease with a high fatality rate caused by a novel bunyavirus (SFTSV). The role of lipids in viral infections is well-documented; however, the specific alterations in lipid metabolism during SFTSV infection remain elusive. This study aims to elucidate the lipid metabolic dysregulations in the early stages of SFTS patients.
METHODS METHODS
This study prospectively collected peripheral blood sera from 11 critical SFTS patients, 37 mild SFTS patients, and 23 healthy controls during the early stages of infection for lipidomics analysis. A systematic bioinformatics analysis was conducted from three aspects integrating lipid differential expressions, lipid differential correlations, and lipid-clinical indices correlations to reveal the serum lipid metabolic dysregulation in SFTSV-infected individuals.
RESULTS RESULTS
Our findings reveal significant lipid metabolic dysregulation in SFTS patients. Specifically, compared to healthy controls, SFTS patients exhibited three distinct modes of lipid differential expression: increased levels of lipids including phosphatidylserine (PS), hexosylceramide (HexCer), and triglycerides (TG); decreased levels of lipids including lysophosphatidylcholine (LPC), acylcarnitine (AcCa), and cholesterol esters (ChE); and lipids showing "dual changes" including phosphatidylcholine (PC) and phosphatidylethanolamine (PE). Finally, based on lipid metabolic pathways and literature analysis, we systematically elucidated the potential mechanisms underlying lipid metabolic dysregulation in the early stage of SFTSV infection.
CONCLUSIONS CONCLUSIONS
Our study presents the first global serum lipidome profile and reveals the lipid metabolic dysregulation patterns in the early stage of SFTSV infection. These findings provide a new basis for the diagnosis, treatment, and further investigation of the disease.

Identifiants

pubmed: 39396989
doi: 10.1186/s12916-024-03672-w
pii: 10.1186/s12916-024-03672-w
doi:

Substances chimiques

Lipids 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

458

Informations de copyright

© 2024. The Author(s).

Références

Liu Q, He B, Huang SY, Wei F, Zhu XQ. Severe fever with thrombocytopenia syndrome, an emerging tick-borne zoonosis. Lancet Infect Dis. 2014;14(8):763–72.
pubmed: 24837566 doi: 10.1016/S1473-3099(14)70718-2
Li H, Lu QB, Xing B, Zhang SF, Liu K, Du J, Li XK, Cui N, Yang ZD, Wang LY, et al. Epidemiological and clinical features of laboratory-diagnosed severe fever with thrombocytopenia syndrome in China, 2011–17: a prospective observational study. Lancet Infect Dis. 2018;18(10):1127–37.
pubmed: 30054190 doi: 10.1016/S1473-3099(18)30293-7
Yu XJ, Liang MF, Zhang SY, Liu Y, Li JD, Sun YL, Zhang L, Zhang QF, Popov VL, Li C, et al. Fever with thrombocytopenia associated with a novel bunyavirus in China. N Engl J Med. 2011;364(16):1523–32.
pubmed: 21410387 pmcid: 3113718 doi: 10.1056/NEJMoa1010095
Kim YR, Yun Y, Bae SG, Park D, Kim S, Lee JM, Cho NH, Kim YS, Lee KH. Severe Fever with Thrombocytopenia Syndrome Virus Infection, South Korea, 2010. Emerg Infect Dis. 2018;24(11):2103–5.
pubmed: 30334706 pmcid: 6199997 doi: 10.3201/eid2411.170756
Rattanakomol P, Khongwichit S, Linsuwanon P, Lee KH, Vongpunsawad S, Poovorawan Y. Severe Fever with Thrombocytopenia Syndrome Virus Infection, Thailand, 2019–2020. Emerg Infect Dis. 2022;28(12):2572–4.
pubmed: 36418010 pmcid: 9707585 doi: 10.3201/eid2812.221183
Kobayashi Y, Kato H, Yamagishi T, Shimada T, Matsui T, Yoshikawa T, Kurosu T, Shimojima M, Morikawa S, Hasegawa H, et al. Severe Fever with Thrombocytopenia Syndrome, Japan, 2013–2017. Emerg Infect Dis. 2020;26(4):692–9.
pubmed: 32186502 pmcid: 7101122 doi: 10.3201/eid2604.191011
Organization WH. 2017 Annual review of diseases prioritized under the Research and Development Blueprint. In WHO Meeting report: World Health Organization; 2017.
National guidelines for diagnosis and treatment of Severe Fever with Thrombocytopenia Syndrome 2023 in China ( http://www.nhc.gov.cn/cms-search/downFiles/39ddd92264f64094985fbef0439da17b.pdf ). Health Commission of the People's Republic of China.
Lorizate M, Kräusslich HG. Role of lipids in virus replication. Cold Spring Harb Perspect Biol. 2011;3(10): a004820.
pubmed: 21628428 pmcid: 3179339 doi: 10.1101/cshperspect.a004820
Zhang Z, He G, Filipowicz NA, Randall G, Belov GA, Kopek BG, Wang X. Host Lipids in Positive-Strand RNA Virus Genome Replication. Front Microbiol. 2019;10:286.
pubmed: 30863375 pmcid: 6399474 doi: 10.3389/fmicb.2019.00286
Girdhar K, Powis A, Raisingani A, Chrudinová M, Huang R, Tran T, Sevgi K, Dogus Dogru Y, Altindis E. Viruses and Metabolism: The Effects of Viral Infections and Viral Insulins on Host Metabolism. Annu Rev Virol. 2021;8(1):373–91.
pubmed: 34586876 pmcid: 9175272 doi: 10.1146/annurev-virology-091919-102416
Van Hoecke H, Vandenbulcke L, Van Cauwenberge P. Histamine and leukotriene receptor antagonism in the treatment of allergic rhinitis: an update. Drugs. 2007;67(18):2717–26.
pubmed: 18062720 doi: 10.2165/00003495-200767180-00006
Jaschonek K, Muller CP. Platelet and vessel associated prostacyclin and thromboxane A2/prostaglandin endoperoxide receptors. Eur J Clin Invest. 1988;18(1):1–8.
pubmed: 2452740 doi: 10.1111/j.1365-2362.1988.tb01157.x
Ricciotti E, FitzGerald GA. Prostaglandins and inflammation. Arterioscler Thromb Vasc Biol. 2011;31(5):986–1000.
pubmed: 21508345 pmcid: 3081099 doi: 10.1161/ATVBAHA.110.207449
Roncato R, Angelini J, Pani A, Talotta R. Lipid rafts as viral entry routes and immune platforms: A double-edged sword in SARS-CoV-2 infection? Biochim Biophys Acta Mol Cell Biol Lipids. 2022;1867(6): 159140.
pubmed: 35248801 pmcid: 8894694 doi: 10.1016/j.bbalip.2022.159140
Queiroz A, Pinto IFD, Lima M, Giovanetti M, de Jesus JG, Xavier J, Barreto FK, Canuto GAB, do Amaral HR, de Filippis AMB, et al. Lipidomic Analysis Reveals Serum Alteration of Plasmalogens in Patients Infected With ZIKA Virus. Front Microbiol. 2019;10:753.
pubmed: 31031729 pmcid: 6474330 doi: 10.3389/fmicb.2019.00753
Shan J, Qian W, Shen C, Lin L, Xie T, Peng L, Xu J, Yang R, Ji J, Zhao X. High-resolution lipidomics reveals dysregulation of lipid metabolism in respiratory syncytial virus pneumonia mice. RSC Adv. 2018;8(51):29368–77.
pubmed: 35548018 pmcid: 9084459 doi: 10.1039/C8RA05640D
Bowman ER, Kulkarni M, Gabriel J, et al. Altered Lipidome Composition Is Related to Markers of Monocyte and Immune Activation in Antiretroviral Therapy Treated Human Immunodeficiency Virus (HIV) Infection and in Uninfected Persons. Front Immunol. 2019;10:785.
pubmed: 31040846 pmcid: 6477036 doi: 10.3389/fimmu.2019.00785
Maile MD, Standiford TJ, Engoren MC, Stringer KA, Jewell ES, Rajendiran TM, Soni T, Burant CF. Associations of the plasma lipidome with mortality in the acute respiratory distress syndrome: a longitudinal cohort study. Respir Res. 2018;19(1):60.
pubmed: 29636049 pmcid: 5894233 doi: 10.1186/s12931-018-0758-3
Bursten SL, Federighi DA, Parsons P, Harris WE, Abraham E, Moore EE Jr, Moore FA, Bianco JA, Singer JW, Repine JE. An increase in serum C18 unsaturated free fatty acids as a predictor of the development of acute respiratory distress syndrome. Crit Care Med. 1996;24(7):1129–36.
pubmed: 8674324 doi: 10.1097/00003246-199607000-00011
Tam VC, Quehenberger O, Oshansky CM, Suen R, Armando AM, Treuting PM, Thomas PG, Dennis EA, Aderem A. Lipidomic profiling of influenza infection identifies mediators that induce and resolve inflammation. Cell. 2013;154(1):213–27.
pubmed: 23827684 pmcid: 3753192 doi: 10.1016/j.cell.2013.05.052
Kyle JE, Burnum-Johnson KE, Wendler JP, Eisfeld AJ, Halfmann PJ, Watanabe T, Sahr F, Smith RD, Kawaoka Y, Waters KM, Metz TO. Plasma lipidome reveals critical illness and recovery from human Ebola virus disease. Proc Natl Acad Sci U S A. 2019;116(9):3919–28.
pubmed: 30808769 pmcid: 6397561 doi: 10.1073/pnas.1815356116
Song JW, Lam SM, Fan X, Cao WJ, Wang SY, Tian H, Chua GH, Zhang C, Meng FP, Xu Z, et al. Omics-Driven Systems Interrogation of Metabolic Dysregulation in COVID-19 Pathogenesis. Cell Metab. 2020;32(2):188–202.e185.
pubmed: 32610096 pmcid: 7311890 doi: 10.1016/j.cmet.2020.06.016
Gai ZT, Zhang Y, Liang MF, Jin C, Zhang S, Zhu CB, et al. Clinical progress and risk factors for death in severe fever with thrombocytopenia syndrome patients. J Infect Dis. 2012;206:1095–102. https://doi.org/10.1093/infdis/jis472 .
doi: 10.1093/infdis/jis472 pubmed: 22850122
Huang T, Fan Y, Xia Y, Xu X, Chen X, Ye H, Chen Y, Wang S. Association of low HDL-c levels with severe symptoms and poor clinical prognosis in patients with severe fever and thrombocytopenia syndrome. Front Microbiol. 2023;14:1239420.
pubmed: 37720148 pmcid: 10501784 doi: 10.3389/fmicb.2023.1239420
SPLASH LipidoMIX™ Internal Standard Product Number 330707. ( https://avantilipids.com/assets/products/attachments/330707-Mixture-Components-and-Concentrations.pdf ) Avanti Polar Lipids, Inc.
Sarafian MH, Gaudin M, Lewis MR. Objective set of criteria for optimization of sample preparation procedures for ultra-high throughput untargeted blood plasma lipid profiling by ultra performance liquid chromatography-mass spectrometry. Anal Chem. 2014;86(12):5766–74.
pubmed: 24820162 doi: 10.1021/ac500317c
Cajka T, Smilowitz JT, Fiehn O. Validating Quantitative Untargeted Lipidomics Across Nine Liquid Chromatography-High-Resolution Mass Spectrometry Platforms. Anal Chem. 2017;89(22):12360–8.
pubmed: 29064229 doi: 10.1021/acs.analchem.7b03404
Zhu Z, Satten GA, Mitchell C, Hu YJ. Constraining PERMANOVA and LDM to within-set comparisons by projection improves the efficiency of analyses of matched sets of microbiome data. Microbiome. 2021;9(1):133.
pubmed: 34108046 pmcid: 8191060 doi: 10.1186/s40168-021-01034-9
Kayano M, Takigawa I, Shiga M, Tsuda K, Mamitsuka H. ROS-DET: robust detector of switching mechanisms in gene expression. Nucleic Acids Res. 2011;39(11): e74.
pubmed: 21459849 pmcid: 3113587 doi: 10.1093/nar/gkr130
Lam SM, Wang Z, Li B, Shui G. High-coverage lipidomics for functional lipid and pathway analyses. Anal Chim Acta. 2021;1147:199–210.
pubmed: 33485579 doi: 10.1016/j.aca.2020.11.024
Wiesner P, Leidl K, Boettcher A, Schmitz G, Liebisch G. Lipid profiling of FPLC-separated lipoprotein fractions by electrospray ionization tandem mass spectrometry. J Lipid Res. 2009;50(3):574–85.
pubmed: 18832345 doi: 10.1194/jlr.D800028-JLR200
Ruan J, Miao X, Schlüter D, Lin L, Wang X. Extracellular vesicles in neuroinflammation: Pathogenesis, diagnosis, and therapy. Mol Ther. 2021;29(6):1946–57.
pubmed: 33895328 pmcid: 8178458 doi: 10.1016/j.ymthe.2021.04.020
Subra C, Laulagnier K, Perret B, Record M. Exosome lipidomics unravels lipid sorting at the level of multivesicular bodies. Biochimie. 2007;89(2):205–12.
pubmed: 17157973 doi: 10.1016/j.biochi.2006.10.014
Clark SR, Thomas CP, Hammond VJ, Aldrovandi M, Wilkinson GW, Hart KW, Murphy RC, Collins PW, O’Donnell VB. Characterization of platelet aminophospholipid externalization reveals fatty acids as molecular determinants that regulate coagulation. Proc Natl Acad Sci U S A. 2013;110(15):5875–80.
pubmed: 23530199 pmcid: 3625294 doi: 10.1073/pnas.1222419110
Dolegowska B, Lubkowska A, De Girolamo L. Platelet lipidomic. J Biol Regul Homeost Agents. 2012;26(2 Suppl 1):23s–33s.
pubmed: 23648196
Lentz BR. Exposure of platelet membrane phosphatidylserine regulates blood coagulation. Prog Lipid Res. 2003;42(5):423–38.
pubmed: 12814644 doi: 10.1016/S0163-7827(03)00025-0
Fang L, Yu S, Tian X, Fu W, Su L, Chen Z, Yan C, He J, Hong J, Lian W, et al. Severe fever with thrombocytopenia syndrome virus replicates in platelets and enhances platelet activation. J Thromb Haemost. 2023;21(5):1336–51.
pubmed: 36792011 doi: 10.1016/j.jtha.2023.02.006
Chaurio RA, Janko C, Muñoz LE, Frey B, Herrmann M, Gaipl US. Phospholipids: key players in apoptosis and immune regulation. Molecules. 2009;14(12):4892–914.
pubmed: 20032867 pmcid: 6255253 doi: 10.3390/molecules14124892
Khovidhunkit W, Kim MS, Memon RA, Shigenaga JK, Moser AH, Feingold KR, Grunfeld C. Effects of infection and inflammation on lipid and lipoprotein metabolism: mechanisms and consequences to the host. J Lipid Res. 2004;45(7):1169–96.
pubmed: 15102878 doi: 10.1194/jlr.R300019-JLR200
Ishibashi Y, Kohyama-Koganeya A, Hirabayashi Y. New insights on glucosylated lipids: metabolism and functions. Biochim Biophys Acta. 2013;1831(9):1475–85.
pubmed: 23770033 doi: 10.1016/j.bbalip.2013.06.001
Li JF, Qu F, Zheng SJ, Ren JY, Wu HL, Liu M, Liu H, Ren F, Chen Y, Zhang JL, Duan ZP. Plasma sphingolipids as potential indicators of hepatic necroinflammation in patients with chronic hepatitis C and normal alanine aminotransferase level. PLoS ONE. 2014;9(4): e95095.
pubmed: 24736528 pmcid: 3988168 doi: 10.1371/journal.pone.0095095
Prokazova NV, Zvezdina ND, Korotaeva AA. Effect of lysophosphatidylcholine on transmembrane signal transduction. Biochemistry (Mosc). 1998;63(1):31–7.
pubmed: 9526092
Schmitz G, Ruebsaamen K. Metabolism and atherogenic disease association of lysophosphatidylcholine. Atherosclerosis. 2010;208(1):10–8. https://doi.org/10.1016/j.atherosclerosis.2009.05.029 .
doi: 10.1016/j.atherosclerosis.2009.05.029 pubmed: 19570538
Park DW, Kwak DS, Park YY, Chang Y, Huh JW, Lim CM, Koh Y, Song DK, Hong SB. Impact of serial measurements of lysophosphatidylcholine on 28-day mortality prediction in patients admitted to the intensive care unit with severe sepsis or septic shock. J Crit Care. 2014;29(5):882.e885–811.
doi: 10.1016/j.jcrc.2014.05.003
Cho WH, Park T, Park YY, Huh JW, Lim CM, Koh Y, Song DK, Hong SB. Clinical significance of enzymatic lysophosphatidylcholine (LPC) assay data in patients with sepsis. Eur J Clin Microbiol Infect Dis. 2012;31(8):1805–10.
pubmed: 22167258 doi: 10.1007/s10096-011-1505-6
Holloway GP, Bezaire V, Heigenhauser GJ, Tandon NN, Glatz JF, Luiken JJ, Bonen A, Spriet LL. Mitochondrial long chain fatty acid oxidation, fatty acid translocase/CD36 content and carnitine palmitoyltransferase I activity in human skeletal muscle during aerobic exercise. J Physiol. 2006;571(Pt 1):201–10.
pubmed: 16357012 doi: 10.1113/jphysiol.2005.102178
Feingold KR. The bidirectional interaction of COVID-19 infections and lipoproteins. Best Pract Res Clin Endocrinol Metab. 2023;37(4):101751.
pubmed: 36894344 doi: 10.1016/j.beem.2023.101751
Bassendine MF, Sheridan DA, Bridge SH, Felmlee DJ, Neely RD. Lipids and HCV. Semin Immunopathol. 2013;35(1):87–100.
pubmed: 23111699 doi: 10.1007/s00281-012-0356-2
Zheng H, Geng Y, Gu C, Li M, Mao M, Wan Y, et al. A Reservoir Computing with Boosted Topology Model to Predict Encephalitis and Mortality for Patients with Severe Fever with Thrombocytopenia Syndrome: A Retrospective Multicenter Study. Infect Dis Ther. 2023;12(5):1379–91.
pubmed: 37138177 pmcid: 10156074 doi: 10.1007/s40121-023-00808-y
Cole LK, Vance JE, Vance DE. Phosphatidylcholine biosynthesis and lipoprotein metabolism. Biochim Biophys Acta. 2012;1821(5):754–61.
pubmed: 21979151 doi: 10.1016/j.bbalip.2011.09.009
Skipski VP, Barclay M, Barclay RK, Fetzer VA, Good JJ, Archibald FM. Lipid composition of human serum lipoproteins. Biochem J. 1967;104(2):340–52.
pubmed: 6048776 pmcid: 1270593 doi: 10.1042/bj1040340
Scherer PG, Seelig J. Structure and dynamics of the phosphatidylcholine and the phosphatidylethanolamine head group in L-M fibroblasts as studied by deuterium nuclear magnetic resonance. EMBO J. 1987;6(10):2915–22.
pubmed: 3691475 pmcid: 553726 doi: 10.1002/j.1460-2075.1987.tb02595.x
Morita SY, Ikeda Y. Regulation of membrane phospholipid biosynthesis in mammalian cells. Biochem Pharmacol. 2022;206:115296.
pubmed: 36241095 doi: 10.1016/j.bcp.2022.115296
Eisfeld AJ, Halfmann PJ, Wendler JP, Kyle JE, Burnum-Johnson KE, Peralta Z, Maemura T, Walters KB, Watanabe T, Fukuyama S, et al. Multi-platform ’Omics Analysis of Human Ebola Virus Disease Pathogenesis. Cell Host Microbe. 2017;22(6):817–829.e818.
pubmed: 29154144 pmcid: 5730472 doi: 10.1016/j.chom.2017.10.011
Song P, Zheng N, Liu Y, Tian C, Wu X, Ma X, Chen D, Zou X, Wang G, Wang H, et al. Deficient humoral responses and disrupted B-cell immunity are associated with fatal SFTSV infection. Nat Commun. 2018;9(1):3328.
pubmed: 30127439 pmcid: 6102208 doi: 10.1038/s41467-018-05746-9
Li H, Li X, Lv S, Peng X, Cui N, Yang T, Yang Z, Yuan C, Yuan Y, Yao J, et al. Single-cell landscape of peripheral immune responses to fatal SFTS. Cell Rep. 2021;37(8): 110039.
pubmed: 34818556 doi: 10.1016/j.celrep.2021.110039
Li YH, Huang WW, He WQ, He XY, Wang XH, Lin YL, Zhao ZJ, Zheng YT, Pang W. Longitudinal analysis of immunocyte responses and inflammatory cytokine profiles in SFTSV-infected rhesus macaques. Front Immunol. 2023;14:1143796.
pubmed: 37033979 pmcid: 10073517 doi: 10.3389/fimmu.2023.1143796
Falasca L, Agrati C, Petrosillo N, Di Caro A, Capobianchi MR, Ippolito G, Piacentini M. Molecular mechanisms of Ebola virus pathogenesis: focus on cell death. Cell Death Differ. 2015;22(8):1250–9.
pubmed: 26024394 pmcid: 4495366 doi: 10.1038/cdd.2015.67

Auteurs

Shuai Guo (S)

Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China.
Department of Neurology, Shandong Provincial HospitalAffiliated to, Shandong First Medical University , Jinan, China.

Yunjun Yan (Y)

Jinan Dian Medical Laboratory CO., LTD, Shandong, China.

Jingyao Zhang (J)

Department of Infectious Diseases, Shandong Provincial Public Health Clinical Center, Jinan, China.

Zhangong Yang (Z)

Calibra Lab at DIAN Diagnostics, Hangzhou, 310030, China.

Lirui Tu (L)

Department of Infectious Diseases, Shandong Provincial Public Health Clinical Center, Jinan, China.

Chunjuan Wang (C)

Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China.
Department of Neurology, Shandong Provincial HospitalAffiliated to, Shandong First Medical University , Jinan, China.

Ziqing Kong (Z)

Calibra Lab at DIAN Diagnostics, Hangzhou, 310030, China.

Shuhua Wang (S)

Center of Health Management, Shandong Provincial HospitalAffiliated to, Shandong First Medical University , Jinan, China.

Baojie Wang (B)

Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China.
Department of Neurology, Shandong Second Provincial General Hospital, Jinan, China.

Danqing Qin (D)

Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China.
Department of Neurology, Shandong Provincial HospitalAffiliated to, Shandong First Medical University , Jinan, China.

Jie Zhou (J)

Department of Neurology, Shandong Provincial HospitalAffiliated to, Shandong First Medical University , Jinan, China.
Department of Neurology, The Fifth People's Hospital of Jinan, Jinan, China.

Wenjin Wang (W)

Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China.
Department of Neurology, Shandong Provincial HospitalAffiliated to, Shandong First Medical University , Jinan, China.

Yumei Hao (Y)

Institute of Reproduction and Development, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. yumeihao@zju.edu.cn.
Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group, Hangzhou, China. yumeihao@zju.edu.cn.

Shougang Guo (S)

Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China. guoshougang1124@163.com.
Department of Neurology, Shandong Provincial HospitalAffiliated to, Shandong First Medical University , Jinan, China. guoshougang1124@163.com.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH