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Effects of tetrandrine combined with acetylcysteine on exercise tolerance, pulmonary function and serum TNF-β1 and MMP-7 in silicosis patients

Identifieur interne : 000154 ( Pmc/Checkpoint ); précédent : 000153; suivant : 000155

Effects of tetrandrine combined with acetylcysteine on exercise tolerance, pulmonary function and serum TNF-β1 and MMP-7 in silicosis patients

Auteurs : Jing Zhang [République populaire de Chine] ; Yingchun Wang [République populaire de Chine] ; Shujuan Zhang [République populaire de Chine] ; Jing Li [République populaire de Chine] ; Hong Fang [République populaire de Chine]

Source :

RBID : PMC:7027229

Abstract

The aim of the study was to investigate the effects of tetrandrine combined with acetylcysteine on exercise tolerance, pulmonary function, transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase 7 (MMP-7) in silicosis patients. A retrospective analysis was performed on 149 silicosis patients admitted to the Maternal and Child Health Care Hospital of Zhangqiu District between August, 2015 and September, 2017. Of the 149 patients, 70 patients treated with acetylcysteine comprised the control group, and 79 treated with tetrandrine combined with acetylcysteine constituted the study group. The concentrations of serum TGF-β1 and MMP-7 before and after treatment were detected by enzyme-linked immunosorbent assay (ELISA), and the exercise tolerance and pulmonary function were compared. Chest distress, chest pain, cough, expectoration and dyspnea in the two groups were relieved after treatment, and the improvement rates of chest distress, chest pain and dyspnea in the study group were significantly higher than those in the control group (P<0.05). Before treatment, there was no significant difference in the results of the 6-minute walk test (6MWT) between the two groups (P>0.05). After treatment, the 6MWT in the two groups was significantly increased (P<0.05), and the improvement effect in the study group was more marked than that in the control group (P<0.05). There was no significant difference in the pulmonary function indexes between the two groups before treatment (P>0.05). Before treatment, there was no significant difference in serum TGF-β1 and MMP-7 expression levels between the two groups (P>0.05). By contrast, after treatment, the levels in the two groups were significantly decreased, with the levels in the study group being significantly lower than that the control group (P<0.05). In conclusion, tetrandrine combined with acetylcysteine can improve pulmonary function and exercise tolerance of patients with silicosis by inhibiting the expressions of TGF-β1 and MMP-7, thus improving clinical efficacy.


Url:
DOI: 10.3892/etm.2020.8431
PubMed: 32104284
PubMed Central: 7027229


Affiliations:


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<p>The aim of the study was to investigate the effects of tetrandrine combined with acetylcysteine on exercise tolerance, pulmonary function, transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase 7 (MMP-7) in silicosis patients. A retrospective analysis was performed on 149 silicosis patients admitted to the Maternal and Child Health Care Hospital of Zhangqiu District between August, 2015 and September, 2017. Of the 149 patients, 70 patients treated with acetylcysteine comprised the control group, and 79 treated with tetrandrine combined with acetylcysteine constituted the study group. The concentrations of serum TGF-β1 and MMP-7 before and after treatment were detected by enzyme-linked immunosorbent assay (ELISA), and the exercise tolerance and pulmonary function were compared. Chest distress, chest pain, cough, expectoration and dyspnea in the two groups were relieved after treatment, and the improvement rates of chest distress, chest pain and dyspnea in the study group were significantly higher than those in the control group (P<0.05). Before treatment, there was no significant difference in the results of the 6-minute walk test (6MWT) between the two groups (P>0.05). After treatment, the 6MWT in the two groups was significantly increased (P<0.05), and the improvement effect in the study group was more marked than that in the control group (P<0.05). There was no significant difference in the pulmonary function indexes between the two groups before treatment (P>0.05). Before treatment, there was no significant difference in serum TGF-β1 and MMP-7 expression levels between the two groups (P>0.05). By contrast, after treatment, the levels in the two groups were significantly decreased, with the levels in the study group being significantly lower than that the control group (P<0.05). In conclusion, tetrandrine combined with acetylcysteine can improve pulmonary function and exercise tolerance of patients with silicosis by inhibiting the expressions of TGF-β1 and MMP-7, thus improving clinical efficacy.</p>
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<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Exp Ther Med</journal-id>
<journal-id journal-id-type="iso-abbrev">Exp Ther Med</journal-id>
<journal-id journal-id-type="publisher-id">ETM</journal-id>
<journal-title-group>
<journal-title>Experimental and Therapeutic Medicine</journal-title>
</journal-title-group>
<issn pub-type="ppub">1792-0981</issn>
<issn pub-type="epub">1792-1015</issn>
<publisher>
<publisher-name>D.A. Spandidos</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">32104284</article-id>
<article-id pub-id-type="pmc">7027229</article-id>
<article-id pub-id-type="doi">10.3892/etm.2020.8431</article-id>
<article-id pub-id-type="publisher-id">ETM-0-0-8431</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Articles</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Effects of tetrandrine combined with acetylcysteine on exercise tolerance, pulmonary function and serum TNF-β1 and MMP-7 in silicosis patients</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Zhang</surname>
<given-names>Jing</given-names>
</name>
<xref ref-type="aff" rid="af1-etm-0-0-8431">1</xref>
<xref rid="fn1-etm-0-0-8431" ref-type="author-notes">*</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Wang</surname>
<given-names>Yingchun</given-names>
</name>
<xref ref-type="aff" rid="af2-etm-0-0-8431">2</xref>
<xref rid="fn1-etm-0-0-8431" ref-type="author-notes">*</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Zhang</surname>
<given-names>Shujuan</given-names>
</name>
<xref ref-type="aff" rid="af3-etm-0-0-8431">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Li</surname>
<given-names>Jing</given-names>
</name>
<xref ref-type="aff" rid="af4-etm-0-0-8431">4</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Fang</surname>
<given-names>Hong</given-names>
</name>
<xref ref-type="aff" rid="af5-etm-0-0-8431">5</xref>
<xref rid="fn1-etm-0-0-8431" ref-type="author-notes">*</xref>
<xref rid="c1-etm-0-0-8431" ref-type="corresp"></xref>
</contrib>
</contrib-group>
<aff id="af1-etm-0-0-8431">
<label>1</label>
Department of Pharmacy, Maternal and Child Health Care Hospital of Zhangqiu District, Jinan 250200, P.R. China</aff>
<aff id="af2-etm-0-0-8431">
<label>2</label>
Department of Pharmacy, Yantaishan Hospital, Yantai 264000, P.R. China</aff>
<aff id="af3-etm-0-0-8431">
<label>3</label>
Occupational Disease Department, Branch of Tai'an City Central Hospital, Tai'an 271000, P.R. China</aff>
<aff id="af4-etm-0-0-8431">
<label>4</label>
Department of Surgery, The People's Hospital of Zhangqiu Area, Jinan 250200, P.R. China</aff>
<aff id="af5-etm-0-0-8431">
<label>5</label>
Department of Hepatobiliary Surgery, Weifang Traditional Chinese Hospital, Weifang 261041, P.R. China</aff>
<author-notes>
<corresp id="c1-etm-0-0-8431">
<italic>Correspondence to</italic>
: Dr Hong Fang, Department of Hepatobiliary Surgery, Weifang Traditional Chinese Hospital, 1055 Weizhou Road, Kuiwen, Weifang 261041, P.R. China, E-mail:
<email>hhpr59@163.com</email>
</corresp>
<fn id="fn1-etm-0-0-8431">
<label>*</label>
<p>Contributed equally</p>
</fn>
</author-notes>
<pub-date pub-type="ppub">
<month>3</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>29</day>
<month>1</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="pmc-release">
<day>29</day>
<month>1</month>
<year>2020</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on the . </pmc-comment>
<volume>19</volume>
<issue>3</issue>
<fpage>2195</fpage>
<lpage>2201</lpage>
<history>
<date date-type="received">
<day>08</day>
<month>5</month>
<year>2019</year>
</date>
<date date-type="accepted">
<day>30</day>
<month>10</month>
<year>2019</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright: © Zhang et al.</copyright-statement>
<copyright-year>2020</copyright-year>
<license license-type="open-access">
<license-p>This is an open access article distributed under the terms of the
<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivs License</ext-link>
, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.</license-p>
</license>
</permissions>
<abstract>
<p>The aim of the study was to investigate the effects of tetrandrine combined with acetylcysteine on exercise tolerance, pulmonary function, transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase 7 (MMP-7) in silicosis patients. A retrospective analysis was performed on 149 silicosis patients admitted to the Maternal and Child Health Care Hospital of Zhangqiu District between August, 2015 and September, 2017. Of the 149 patients, 70 patients treated with acetylcysteine comprised the control group, and 79 treated with tetrandrine combined with acetylcysteine constituted the study group. The concentrations of serum TGF-β1 and MMP-7 before and after treatment were detected by enzyme-linked immunosorbent assay (ELISA), and the exercise tolerance and pulmonary function were compared. Chest distress, chest pain, cough, expectoration and dyspnea in the two groups were relieved after treatment, and the improvement rates of chest distress, chest pain and dyspnea in the study group were significantly higher than those in the control group (P<0.05). Before treatment, there was no significant difference in the results of the 6-minute walk test (6MWT) between the two groups (P>0.05). After treatment, the 6MWT in the two groups was significantly increased (P<0.05), and the improvement effect in the study group was more marked than that in the control group (P<0.05). There was no significant difference in the pulmonary function indexes between the two groups before treatment (P>0.05). Before treatment, there was no significant difference in serum TGF-β1 and MMP-7 expression levels between the two groups (P>0.05). By contrast, after treatment, the levels in the two groups were significantly decreased, with the levels in the study group being significantly lower than that the control group (P<0.05). In conclusion, tetrandrine combined with acetylcysteine can improve pulmonary function and exercise tolerance of patients with silicosis by inhibiting the expressions of TGF-β1 and MMP-7, thus improving clinical efficacy.</p>
</abstract>
<kwd-group>
<kwd>silicosis</kwd>
<kwd>tetrandrine</kwd>
<kwd>acetylcysteine</kwd>
<kwd>exercise tolerance</kwd>
<kwd>pulmonary function</kwd>
<kwd>TGF-β1</kwd>
<kwd>MMP-7</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group>
<fig id="f1-etm-0-0-8431" orientation="portrait" position="float">
<label>Figure 1.</label>
<caption>
<p>Comparison of exercise tolerance between the two groups. Before treatment, there was no significant difference in the 6MWT between the two groups (P>0.05). After treatment, the 6MWT of the two groups was significantly higher than that before treatment (P<0.05). The change of 6MWT in the study group was more significant than that in the control group (P<0.05). a vs. before treatment,
<sup>a</sup>
P<0.05; b vs. the study group after treatment,
<sup>b</sup>
P<0.05.</p>
</caption>
<graphic xlink:href="etm-19-03-2195-g00"></graphic>
</fig>
<fig id="f2-etm-0-0-8431" orientation="portrait" position="float">
<label>Figure 2.</label>
<caption>
<p>Comparison of lung function between the two groups. Before treatment, there was no significant difference in lung function between the two groups (P>0.05). After treatment, the lung function indexes MVV, PEF, FEV1, FEV1/FVC% were significantly higher than those before treatment (P <0.05). MVV, PEF, FEV1, FEV1/FVC% in the study group were significantly higher than those in the control group, with statistically significant differences (P<0.05). a vs. before treatment,
<sup>a</sup>
P<0.05; b vs. the study group after treatment,
<sup>b</sup>
P<0.05.</p>
</caption>
<graphic xlink:href="etm-19-03-2195-g01"></graphic>
</fig>
<fig id="f3-etm-0-0-8431" orientation="portrait" position="float">
<label>Figure 3.</label>
<caption>
<p>Changes of serum TGF-β1 before and after treatment in the two groups The results of ELISA showed that there was no significant difference in serum TGF-β1 expression level between the two groups before treatment (P>0.05). However, after treatment, the level in the two groups was significantly decreased, and the study group was statistically significantly lower than the control group (P<0.05). *P<0.05, compared with before treatment.
<sup>#</sup>
P<0.05, compared with the study group.</p>
</caption>
<graphic xlink:href="etm-19-03-2195-g02"></graphic>
</fig>
<fig id="f4-etm-0-0-8431" orientation="portrait" position="float">
<label>Figure 4.</label>
<caption>
<p>Changes of serum MMP-7 before and after treatment in the two groups. The results of ELISA showed that there was no significant difference in serum MMP-7 expression level between the two groups before treatment (P>0.05). However, after treatment, the level in the two groups was significantly decreased, and the study group was statistically significantly lower than the control group (P<0.05). *P<0.05, compared with before treatment.
<sup>#</sup>
P<0.05, compared with the study group.</p>
</caption>
<graphic xlink:href="etm-19-03-2195-g03"></graphic>
</fig>
<table-wrap id="tI-etm-0-0-8431" orientation="portrait" position="float">
<label>Table I.</label>
<caption>
<p>Comparison of general data between the two groups (mean ± SD) [n (%)].</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="bottom" rowspan="1" colspan="1">Characteristic</th>
<th align="center" valign="bottom" rowspan="1" colspan="1">Study group</th>
<th align="center" valign="bottom" rowspan="1" colspan="1">Control group</th>
<th align="center" valign="bottom" rowspan="1" colspan="1">Chi-square test</th>
<th align="center" valign="bottom" rowspan="1" colspan="1">P-value</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Sex</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td align="center" valign="top" rowspan="1" colspan="1">0.189</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.663</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">  Male</td>
<td align="center" valign="top" rowspan="1" colspan="1">55</td>
<td align="center" valign="top" rowspan="1" colspan="1">51</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">  Female</td>
<td align="center" valign="top" rowspan="1" colspan="1">24</td>
<td align="center" valign="top" rowspan="1" colspan="1">19</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Age (years)</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td align="center" valign="top" rowspan="1" colspan="1">0.502</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.479</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">≤50</td>
<td align="center" valign="top" rowspan="1" colspan="1">44</td>
<td align="center" valign="top" rowspan="1" colspan="1">43</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">>50</td>
<td align="center" valign="top" rowspan="1" colspan="1">35</td>
<td align="center" valign="top" rowspan="1" colspan="1">27</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Average age (years)</td>
<td align="center" valign="top" rowspan="1" colspan="1">52.87±5.12</td>
<td align="center" valign="top" rowspan="1" colspan="1">52.09±5.78</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.874</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.384</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Dust exposure duration (years)</td>
<td align="center" valign="top" rowspan="1" colspan="1">  7.92±1.21</td>
<td align="center" valign="top" rowspan="1" colspan="1">  8.01±1.18</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.458</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.647</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Smoking</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td align="center" valign="top" rowspan="1" colspan="1">0.237</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.626</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Yes</td>
<td align="center" valign="top" rowspan="1" colspan="1">42</td>
<td align="center" valign="top" rowspan="1" colspan="1">40</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">No</td>
<td align="center" valign="top" rowspan="1" colspan="1">37</td>
<td align="center" valign="top" rowspan="1" colspan="1">30</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Stage</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td align="center" valign="top" rowspan="1" colspan="1">0.012</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.994</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">I</td>
<td align="center" valign="top" rowspan="1" colspan="1">47</td>
<td align="center" valign="top" rowspan="1" colspan="1">42</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">II</td>
<td align="center" valign="top" rowspan="1" colspan="1">26</td>
<td align="center" valign="top" rowspan="1" colspan="1">23</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">III</td>
<td align="center" valign="top" rowspan="1" colspan="1">6</td>
<td align="center" valign="top" rowspan="1" colspan="1">5</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tII-etm-0-0-8431" orientation="portrait" position="float">
<label>Table II.</label>
<caption>
<p>Comparison of clinical symptoms between two groups before and after treatment/cases.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="bottom" rowspan="1" colspan="1">Item</th>
<th align="center" valign="bottom" rowspan="1" colspan="1">Chest distress</th>
<th align="center" valign="bottom" rowspan="1" colspan="1">Chest pain</th>
<th align="center" valign="bottom" rowspan="1" colspan="1">Cough</th>
<th align="center" valign="bottom" rowspan="1" colspan="1">Expectoration</th>
<th align="center" valign="bottom" rowspan="1" colspan="1">Dyspnea</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top" colspan="6" rowspan="1">Study group (n=79)</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">  Before treatment</td>
<td align="center" valign="top" rowspan="1" colspan="1">69</td>
<td align="center" valign="top" rowspan="1" colspan="1">73</td>
<td align="center" valign="top" rowspan="1" colspan="1">77</td>
<td align="center" valign="top" rowspan="1" colspan="1">72</td>
<td align="center" valign="top" rowspan="1" colspan="1">65</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">  After treatment</td>
<td align="center" valign="top" rowspan="1" colspan="1">7</td>
<td align="center" valign="top" rowspan="1" colspan="1">9</td>
<td align="center" valign="top" rowspan="1" colspan="1">11</td>
<td align="center" valign="top" rowspan="1" colspan="1">13</td>
<td align="center" valign="top" rowspan="1" colspan="1">6</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">  Improvement rate</td>
<td align="center" valign="top" rowspan="1" colspan="1">78.5%</td>
<td align="center" valign="top" rowspan="1" colspan="1">81.0%</td>
<td align="center" valign="top" rowspan="1" colspan="1">83.5%</td>
<td align="center" valign="top" rowspan="1" colspan="1">74.7%</td>
<td align="center" valign="top" rowspan="1" colspan="1">74.7%</td>
</tr>
<tr>
<td align="left" valign="top" colspan="6" rowspan="1">Control group (n=70)</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">  Before treatment</td>
<td align="center" valign="top" rowspan="1" colspan="1">63</td>
<td align="center" valign="top" rowspan="1" colspan="1">68</td>
<td align="center" valign="top" rowspan="1" colspan="1">70</td>
<td align="center" valign="top" rowspan="1" colspan="1">67</td>
<td align="center" valign="top" rowspan="1" colspan="1">60</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">  After treatment</td>
<td align="center" valign="top" rowspan="1" colspan="1">19</td>
<td align="center" valign="top" rowspan="1" colspan="1">21</td>
<td align="center" valign="top" rowspan="1" colspan="1">19</td>
<td align="center" valign="top" rowspan="1" colspan="1">15</td>
<td align="center" valign="top" rowspan="1" colspan="1">17</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">  Improvement rate</td>
<td align="center" valign="top" rowspan="1" colspan="1">62.9%
<sup>
<xref rid="tfn1-etm-0-0-8431" ref-type="table-fn">a</xref>
</sup>
</td>
<td align="center" valign="top" rowspan="1" colspan="1">67.1%
<sup>
<xref rid="tfn1-etm-0-0-8431" ref-type="table-fn">a</xref>
</sup>
</td>
<td align="center" valign="top" rowspan="1" colspan="1">72.9
<sup>
<xref rid="tfn1-etm-0-0-8431" ref-type="table-fn">a</xref>
</sup>
</td>
<td align="center" valign="top" rowspan="1" colspan="1">74.3%</td>
<td align="center" valign="top" rowspan="1" colspan="1">61.4%
<sup>
<xref rid="tfn1-etm-0-0-8431" ref-type="table-fn">a</xref>
</sup>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn1-etm-0-0-8431">
<label>a</label>
<p>P<0.05, compared with the study group.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations>
<list>
<country>
<li>République populaire de Chine</li>
</country>
</list>
<tree>
<country name="République populaire de Chine">
<noRegion>
<name sortKey="Zhang, Jing" sort="Zhang, Jing" uniqKey="Zhang J" first="Jing" last="Zhang">Jing Zhang</name>
</noRegion>
<name sortKey="Fang, Hong" sort="Fang, Hong" uniqKey="Fang H" first="Hong" last="Fang">Hong Fang</name>
<name sortKey="Li, Jing" sort="Li, Jing" uniqKey="Li J" first="Jing" last="Li">Jing Li</name>
<name sortKey="Wang, Yingchun" sort="Wang, Yingchun" uniqKey="Wang Y" first="Yingchun" last="Wang">Yingchun Wang</name>
<name sortKey="Zhang, Shujuan" sort="Zhang, Shujuan" uniqKey="Zhang S" first="Shujuan" last="Zhang">Shujuan Zhang</name>
</country>
</tree>
</affiliations>
</record>

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