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Thin-Section Computed Tomography Manifestations During Convalescence and Long-Term Follow-Up of Patients with Severe Acute Respiratory Syndrome (SARS)

Identifieur interne : 000659 ( Pmc/Checkpoint ); précédent : 000658; suivant : 000660

Thin-Section Computed Tomography Manifestations During Convalescence and Long-Term Follow-Up of Patients with Severe Acute Respiratory Syndrome (SARS)

Auteurs : Xiaohua Wu [République populaire de Chine] ; Dawei Dong [République populaire de Chine] ; Daqing Ma [République populaire de Chine]

Source :

RBID : PMC:4982531

Abstract

Background

SARS is not only an acute disease, but also leads to long-term impaired lung diffusing capacity in some survivors. However, there is a paucity of data regarding long-term CT findings in survivors after SARS. The aim of this study was to assess the changes in lung function and lung thin-section computed tomography (CT) features in patients recovering from severe acute respiratory syndrome (SARS), especially the dynamic changes in ground-glass opacity (GGO).

Material/Methods

Clinical and radiological data from 11 patients with SARS were collected. The serial follow-up thin-section CTs were evaluated at 3, 6, and 84 months after SARS presentation. The distribution and predominant thin-section CT findings of lesions were evaluated.

Results

The extent of the lesions on the CT scans of the 11 patients decreased at 6 and 84 months compared to 3 months. The number of segments involved on 84-month follow-up CTs was less than those at 6 months (P<0.05). The predominant thin-section CT manifestation at 84 months (intralobular and interlobular septal thickening) was different than that at 6 months, at which GGO was predominant.

Conclusions

During convalescence after SARS, GGO and intralobular and interlobular septal thickening were the main thin-section CT manifestation. Intralobular and interlobular septal thickening predominated over GGO at 84 months.


Url:
DOI: 10.12659/MSM.896985
PubMed: 27501327
PubMed Central: 4982531


Affiliations:


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PMC:4982531

Le document en format XML

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<p>During convalescence after SARS, GGO and intralobular and interlobular septal thickening were the main thin-section CT manifestation. Intralobular and interlobular septal thickening predominated over GGO at 84 months.</p>
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<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Wu</surname>
<given-names>Xiaohua</given-names>
</name>
<xref ref-type="aff" rid="af1-medscimonit-22-2793">1</xref>
<xref ref-type="author-notes" rid="fn1-medscimonit-22-2793">A</xref>
<xref ref-type="author-notes" rid="fn2-medscimonit-22-2793">B</xref>
<xref ref-type="author-notes" rid="fn3-medscimonit-22-2793">C</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dong</surname>
<given-names>Dawei</given-names>
</name>
<xref ref-type="aff" rid="af2-medscimonit-22-2793">2</xref>
<xref ref-type="author-notes" rid="fn3-medscimonit-22-2793">C</xref>
<xref ref-type="author-notes" rid="fn4-medscimonit-22-2793">D</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ma</surname>
<given-names>Daqing</given-names>
</name>
<xref ref-type="aff" rid="af1-medscimonit-22-2793">1</xref>
<xref ref-type="author-notes" rid="fn4-medscimonit-22-2793">D</xref>
<xref ref-type="author-notes" rid="fn5-medscimonit-22-2793">E</xref>
<xref ref-type="corresp" rid="c1-medscimonit-22-2793"></xref>
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<aff id="af1-medscimonit-22-2793">
<label>1</label>
Department of Radiology, Beijng Friendship Hospital, Capital Medical University, Beijing, P.R. China</aff>
<aff id="af2-medscimonit-22-2793">
<label>2</label>
Department of Radiology, Beijng Xiaotangshan Hospital, Beijing, P.R. China</aff>
<author-notes>
<corresp id="c1-medscimonit-22-2793">Corresponding Author: Daqing Ma, e-mail:
<email>cjr.madaqing@vip.163.com</email>
</corresp>
<fn id="fn1-medscimonit-22-2793">
<label>A</label>
<p>Study Design</p>
</fn>
<fn id="fn2-medscimonit-22-2793">
<label>B</label>
<p>Data Collection</p>
</fn>
<fn id="fn3-medscimonit-22-2793">
<label>C</label>
<p>Statistical Analysis</p>
</fn>
<fn id="fn4-medscimonit-22-2793">
<label>D</label>
<p>Data Interpretation</p>
</fn>
<fn id="fn5-medscimonit-22-2793">
<label>E</label>
<p>Manuscript Preparation</p>
</fn>
<fn id="fn6-medscimonit-22-2793">
<label>F</label>
<p>Literature Search</p>
</fn>
<fn id="fn7-medscimonit-22-2793">
<label>G</label>
<p>Funds Collection</p>
</fn>
</author-notes>
<pub-date pub-type="collection">
<year>2016</year>
</pub-date>
<pub-date pub-type="epub">
<day>08</day>
<month>8</month>
<year>2016</year>
</pub-date>
<volume>22</volume>
<fpage>2793</fpage>
<lpage>2799</lpage>
<history>
<date date-type="received">
<day>04</day>
<month>12</month>
<year>2015</year>
</date>
<date date-type="accepted">
<day>12</day>
<month>1</month>
<year>2016</year>
</date>
</history>
<permissions>
<copyright-statement>© Med Sci Monit, 2016</copyright-statement>
<copyright-year>2016</copyright-year>
<license>
<license-p>This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)</license-p>
</license>
</permissions>
<abstract>
<sec>
<title>Background</title>
<p>SARS is not only an acute disease, but also leads to long-term impaired lung diffusing capacity in some survivors. However, there is a paucity of data regarding long-term CT findings in survivors after SARS. The aim of this study was to assess the changes in lung function and lung thin-section computed tomography (CT) features in patients recovering from severe acute respiratory syndrome (SARS), especially the dynamic changes in ground-glass opacity (GGO).</p>
</sec>
<sec>
<title>Material/Methods</title>
<p>Clinical and radiological data from 11 patients with SARS were collected. The serial follow-up thin-section CTs were evaluated at 3, 6, and 84 months after SARS presentation. The distribution and predominant thin-section CT findings of lesions were evaluated.</p>
</sec>
<sec>
<title>Results</title>
<p>The extent of the lesions on the CT scans of the 11 patients decreased at 6 and 84 months compared to 3 months. The number of segments involved on 84-month follow-up CTs was less than those at 6 months (P<0.05). The predominant thin-section CT manifestation at 84 months (intralobular and interlobular septal thickening) was different than that at 6 months, at which GGO was predominant.</p>
</sec>
<sec>
<title>Conclusions</title>
<p>During convalescence after SARS, GGO and intralobular and interlobular septal thickening were the main thin-section CT manifestation. Intralobular and interlobular septal thickening predominated over GGO at 84 months.</p>
</sec>
</abstract>
<kwd-group>
<title>MeSH Keywords</title>
<kwd>Pneumonia, Viral</kwd>
<kwd>Severe Acute Respiratory Syndrome</kwd>
<kwd>Tomography Scanners, X-Ray Computed</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group>
<fig id="f1-medscimonit-22-2793" position="float">
<label>Figure 1</label>
<caption>
<p>Case 1, SARS survivor, female, 30 years old. (
<bold>A</bold>
) The CT scan at 3 months showed diffuse bilateral GGO (arrow). (
<bold>B</bold>
) Six months later, GGO was reduced. (
<bold>C</bold>
) At 84 months, GGO was greatly reduced and fine reticulation (intralobular and interlobular septal thickening) predominated (arrow). Patchy decreased attenuation was seen at 3-, 6-, and 84-month CT (triangle).</p>
</caption>
<graphic xlink:href="medscimonit-22-2793-g001"></graphic>
</fig>
<fig id="f2-medscimonit-22-2793" position="float">
<label>Figure 2</label>
<caption>
<p>Case 7, SARS survivor, male, 31 years old. (
<bold>A</bold>
) Chest radiography showed consolidation in the lower lobes of both lungs in acute phase. (
<bold>B</bold>
) Six months later, GGO (triangle) and reticulation (arrow) were observed in both lungs. (
<bold>C</bold>
) Fine reticulation (arrow) still persisted but GGO could not be found at 84-month CT.</p>
</caption>
<graphic xlink:href="medscimonit-22-2793-g002"></graphic>
</fig>
<fig id="f3-medscimonit-22-2793" position="float">
<label>Figure 3</label>
<caption>
<p>Case 6, SARS survivor, female, 32 years old. (
<bold>A</bold>
) X-ray radiography showed a large consolidation in the lower lobes of both lungs in acute phase. (
<bold>B</bold>
) Six months later, X-ray revealed GGO, septal thickening, and fine-mesh shadows (white arrow). Traction bronchiectasis was found in the left lower lobe. (
<bold>C</bold>
) At 84 months, GGO was reduced and interlobular thickening predominated. Traction bronchiectasis was still present.</p>
</caption>
<graphic xlink:href="medscimonit-22-2793-g003"></graphic>
</fig>
<table-wrap id="t1-medscimonit-22-2793" position="float">
<label>Table 1</label>
<caption>
<p>Characteristics of the patients.</p>
</caption>
<table frame="hsides" rules="rows">
<thead>
<tr>
<th valign="middle" rowspan="2" align="center" colspan="1">Case number</th>
<th valign="middle" rowspan="2" align="center" colspan="1">Gender</th>
<th valign="middle" rowspan="2" align="center" colspan="1">Age at onset</th>
<th colspan="2" valign="middle" align="center" rowspan="1">3 months</th>
<th colspan="2" valign="middle" align="center" rowspan="1">6 months</th>
<th colspan="3" valign="middle" align="center" rowspan="1">84 months</th>
</tr>
<tr>
<th valign="middle" align="center" rowspan="1" colspan="1">Predominant HRCT findings</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Segments involved</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Predominant HRCT findings</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Segments involved</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Predominant HRCT findings</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Segments involved</th>
<th valign="middle" align="center" rowspan="1" colspan="1">PFT</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="center" rowspan="1" colspan="1">1</td>
<td valign="middle" align="center" rowspan="1" colspan="1">F</td>
<td valign="middle" align="center" rowspan="1" colspan="1">30</td>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">15</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation and interlobular thickening</td>
<td valign="middle" align="center" rowspan="1" colspan="1">15</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation and interlobular thickening</td>
<td valign="middle" align="center" rowspan="1" colspan="1">15</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Mild</td>
</tr>
<tr>
<td valign="middle" align="center" rowspan="1" colspan="1">2</td>
<td valign="middle" align="center" rowspan="1" colspan="1">M</td>
<td valign="middle" align="center" rowspan="1" colspan="1">35</td>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">3</td>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">2</td>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">1</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Mild</td>
</tr>
<tr>
<td valign="middle" align="center" rowspan="1" colspan="1">3</td>
<td valign="middle" align="center" rowspan="1" colspan="1">M</td>
<td valign="middle" align="center" rowspan="1" colspan="1">54</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Consolidation and GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">8</td>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">6</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation and interlobular thickening</td>
<td valign="middle" align="center" rowspan="1" colspan="1">4</td>
<td valign="middle" align="left" rowspan="1" colspan="1">N</td>
</tr>
<tr>
<td valign="middle" align="center" rowspan="1" colspan="1">4</td>
<td valign="middle" align="center" rowspan="1" colspan="1">F</td>
<td valign="middle" align="center" rowspan="1" colspan="1">38</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Diffuse GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">9</td>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">3</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation and interlobular thickening</td>
<td valign="middle" align="center" rowspan="1" colspan="1">3</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Mild</td>
</tr>
<tr>
<td valign="middle" align="center" rowspan="1" colspan="1">5</td>
<td valign="middle" align="center" rowspan="1" colspan="1">F</td>
<td valign="middle" align="center" rowspan="1" colspan="1">42</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Consolidation and GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">13</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation and interlobular thickening</td>
<td valign="middle" align="center" rowspan="1" colspan="1">7</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation and interlobular thickening</td>
<td valign="middle" align="center" rowspan="1" colspan="1">5</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Mild</td>
</tr>
<tr>
<td valign="middle" align="center" rowspan="1" colspan="1">6</td>
<td valign="middle" align="center" rowspan="1" colspan="1">F</td>
<td valign="middle" align="center" rowspan="1" colspan="1">32</td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">14</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation and interlobular thickening</td>
<td valign="middle" align="center" rowspan="1" colspan="1">11.5</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Mild</td>
</tr>
<tr>
<td valign="middle" align="center" rowspan="1" colspan="1">7</td>
<td valign="middle" align="center" rowspan="1" colspan="1">M</td>
<td valign="middle" align="center" rowspan="1" colspan="1">31</td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">18</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation and interlobular thickening</td>
<td valign="middle" align="center" rowspan="1" colspan="1">9.5</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Mild</td>
</tr>
<tr>
<td valign="middle" align="center" rowspan="1" colspan="1">8</td>
<td valign="middle" align="center" rowspan="1" colspan="1">F</td>
<td valign="middle" align="center" rowspan="1" colspan="1">31</td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation and interlobular thickening</td>
<td valign="middle" align="center" rowspan="1" colspan="1">5</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation and interlobular thickening</td>
<td valign="middle" align="center" rowspan="1" colspan="1">3.5</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Mild</td>
</tr>
<tr>
<td valign="middle" align="center" rowspan="1" colspan="1">9</td>
<td valign="middle" align="center" rowspan="1" colspan="1">F</td>
<td valign="middle" align="center" rowspan="1" colspan="1">40</td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">9</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation and interlobular thickening</td>
<td valign="middle" align="center" rowspan="1" colspan="1">6.5</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Moderate</td>
</tr>
<tr>
<td valign="middle" align="center" rowspan="1" colspan="1">10</td>
<td valign="middle" align="center" rowspan="1" colspan="1">F</td>
<td valign="middle" align="center" rowspan="1" colspan="1">48</td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">18</td>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">16</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Mild</td>
</tr>
<tr>
<td valign="middle" align="center" rowspan="1" colspan="1">11</td>
<td valign="middle" align="center" rowspan="1" colspan="1">F</td>
<td valign="middle" align="center" rowspan="1" colspan="1">36</td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">9</td>
<td valign="middle" align="left" rowspan="1" colspan="1">Normal</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0</td>
<td valign="middle" align="left" rowspan="1" colspan="1">N</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="t2-medscimonit-22-2793" position="float">
<label>Table 2</label>
<caption>
<p>CT findings during follow-up.</p>
</caption>
<table frame="hsides" rules="rows">
<thead>
<tr>
<th valign="bottom" align="center" rowspan="1" colspan="1">CT findings</th>
<th valign="bottom" align="center" rowspan="1" colspan="1">3 months (n=5)</th>
<th valign="bottom" align="center" rowspan="1" colspan="1">6 months (n=11)</th>
<th valign="bottom" align="center" rowspan="1" colspan="1">84 months (n=11)</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO</td>
<td valign="middle" align="center" rowspan="1" colspan="1">5 (100.0%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">11 (100.0%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">10 (90.9%)</td>
</tr>
<tr>
<td valign="middle" align="left" rowspan="1" colspan="1">Consolidation</td>
<td valign="middle" align="center" rowspan="1" colspan="1">5 (100.0%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0</td>
</tr>
<tr>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation</td>
<td valign="middle" align="center" rowspan="1" colspan="1">5 (100.0%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">9 (81.7%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">10 (90.9%)</td>
</tr>
<tr>
<td valign="middle" align="left" rowspan="1" colspan="1">Subpleural line</td>
<td valign="middle" align="center" rowspan="1" colspan="1">1 (20.0%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">1 (9.1%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">1 (9.1%)</td>
</tr>
<tr>
<td valign="middle" align="left" rowspan="1" colspan="1">Traction brochiectasis</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0</td>
<td valign="middle" align="center" rowspan="1" colspan="1">2 (18.2%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">2 (18.2%)</td>
</tr>
<tr>
<td valign="middle" align="left" rowspan="1" colspan="1">Air trapping</td>
<td valign="middle" align="center" rowspan="1" colspan="1">1 (20.0%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">1 (9.1%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">1 (9.1%)</td>
</tr>
<tr>
<td valign="middle" align="left" rowspan="1" colspan="1">Small nodule</td>
<td valign="middle" align="center" rowspan="1" colspan="1">2 (40.0%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">2 (18.2%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">2 (9.1%)</td>
</tr>
<tr>
<td valign="middle" align="left" rowspan="1" colspan="1">GGO predominance</td>
<td valign="middle" align="center" rowspan="1" colspan="1">5 (100.0%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1">2 (18.2%)</td>
</tr>
<tr>
<td valign="middle" align="left" rowspan="1" colspan="1">Reticulation predominance</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0</td>
<td valign="middle" align="center" rowspan="1" colspan="1">3 (27.3%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">8 (72.7%)</td>
</tr>
<tr>
<td valign="middle" align="left" rowspan="1" colspan="1">Distribution of peripheral</td>
<td valign="middle" align="center" rowspan="1" colspan="1">3 (60.0%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">9 (81.7%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">9 (81.7%)</td>
</tr>
<tr>
<td valign="middle" align="left" rowspan="1" colspan="1">Distribution on axial section (anterior and posterior)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">5 (100.0%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">11 (100.0%)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">10 (90.9%)</td>
</tr>
<tr>
<td valign="middle" align="left" rowspan="1" colspan="1">Segments involved</td>
<td valign="middle" align="center" rowspan="1" colspan="1">48 (48/500)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">106 (106/2200)</td>
<td valign="middle" align="center" rowspan="1" colspan="1">75 (75/2200)</td>
</tr>
</tbody>
</table>
</table-wrap>
</floats-group>
</pmc>
<affiliations>
<list>
<country>
<li>République populaire de Chine</li>
</country>
<settlement>
<li>Pékin</li>
</settlement>
</list>
<tree>
<country name="République populaire de Chine">
<noRegion>
<name sortKey="Wu, Xiaohua" sort="Wu, Xiaohua" uniqKey="Wu X" first="Xiaohua" last="Wu">Xiaohua Wu</name>
</noRegion>
<name sortKey="Dong, Dawei" sort="Dong, Dawei" uniqKey="Dong D" first="Dawei" last="Dong">Dawei Dong</name>
<name sortKey="Ma, Daqing" sort="Ma, Daqing" uniqKey="Ma D" first="Daqing" last="Ma">Daqing Ma</name>
</country>
</tree>
</affiliations>
</record>

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