1.Effects and mechanisms of action of Yiqi wenyang huwei decoction in improving bronchial asthma in rats
Yunqing YANG ; Jianyu XIE ; Wei TANG ; Chao YE ; Qiangqiang YU ; Peng SUN ; Yuping YANG ; Jianwei YU
China Pharmacy 2026;37(10):1264-1271
OBJECTIVE To investigate the effects and potential mechanism of Yiqi wenyang huwei decoction (YQWY) in improving airway inflammation and remodeling in rats with bronchial asthma (BA) based on the Toll-like receptor 4 (TLR4)/myeloid differentiation primary response protein 88 (MyD88)/nuclear factor-κB (NF-κB) signaling pathway. METHODS Male SD rats were randomly divided into the normal group, the model group, the dexamethasone group (positive control, 0.5 mg/kg), and YQWY low-, medium- and high-dose groups (5, 10, 20 g/kg, calculated by the crude drug), with 8 rats in each group. Except for the normal group, rats in all other groups were sensitized twice with ovalbumin combined with aerosol challenge to establish a BA model. From day 14 to day 34 of the experiment, the rats in each group were administered the corresponding drug solution or normal saline intragastrically, once a day, 1 hour before aerosol challenge. At 24 hours after the final aerosol challenge, asthma symptom scores were assessed, serum levels of immunoglobulin E (IgE) were measured, and the levels of inflammatory cytokines (interleukin-4, interleukin-5, interleukin-13 and tumor necrosis factor-α) and the numbers of inflammatory cells (white blood cell, eosinophil, neutrophil, lymphocyte, monocyte and basophil) in bronchoalveolar lavage fluid were determined. Pathological changes in lung tissue were observed. The mRNA expressions of TLR4, MyD88 and NF-κB, as well as the protein expressions of TLR4, MyD88, NF-κB p65 and phosphorylated NF-κB p65 in lung tissue, were detected. RESULTS Compared with the model group, the pathological changes, such as inflammatory cell infiltration, abnormal deposition of collagen fibers, and goblet cell hyperplasia in the lung tissue of rats in each drug group, were alleviated to varying degrees. The asthma symptom scores (except for the YQWY low-dose group), the levels of IgE and inflammatory cytokines (except for interleukin-5 in the YQWY medium-dose group), the number of inflammatory cells (except for monocyte and basophil in the YQWY low-dose group), the mRNA expression of TLR4, MyD88 and NF-κB, as well as the protein expressions of TLR4, MyD88, NF-κB p65 and phosphorylated NF-κB p65 (except for MyD88 and NF-κB p65 proteins in the YQWY low-dose group as detected by Western blo t) were all significantly reduced or down-regulated ( P <0.05 or P <0.01). CONCLUSIONS YQWY can alleviate asthma-like manifestations in BA rats and improve their airway inflammation and remodeling; these effects may be related to the formula’s inhibition of the abnormal activation of the TLR4/MyD88/NF-κB signaling pathway.
2.Aquaporin 1 promotes proliferation and migration of tumor by up-regulating claudin-1 expression in colon cancer
Wei Wei XIE ; Lin XU ; Qian LI ; Dao Quan ZHANG ; Yu Bao ZHOU
Journal of Pathology and Translational Medicine 2026;60(3):307-318
With the rising incidence of colon cancer, several studies have indicated that aquaporin 1 (AQP1) expression is associated with the development of colon cancer. This study aims to elucidate the potential molecular mechanisms between them. Methods: We screened data from The Cancer Genome Atlas (TCGA) database and retrospectively examined AQP1 protein expression in 127 colon cancer patients to analyze the relationship between AQP1 expression and pathological stages, prognosis. We created stable colon cancer cell lines with differential AQP1 expression, the effect of AQP1 expression on the proliferation and migration of colon cancer cells was assessed by in vitro and in vivo studies, and explored potential molecular mechanisms through Western blotting. Results: High AQP1 expression was associated with poorer survival (overall survival [OS], p = .028) in colon cancer patients from the TCGA database. Similarly, retrospective clinical data indicated that high AQP1 expression was associated with reduced disease-free survival and OS (p = .036 and p = .017, respectively). The low-expressing AQP1 colon cancer cells exhibited a decrease in proliferation and migration ability of colon cancer cells compared to the overexpressing AQP1 group (p < .05) in vitro and in vivo. Immunohistochemistry and western blotting experiments validated heightened expression of N-cadherin, vimentin, and claudin- 1 in the tumor tissues of the overexpressing AQP1 group. Conversely, reduced AQP1 expression resulted in decreased expression of claudin- 1. Conclusions: AQP1 correlates with unfavorable prognosis in colon cancer and potentially enhances the proliferation and migration of colon cancer by up-regulating claudin-1 expression.
3.The Clinical and Genetics Characteristics of Oculopharyngodistal Myopathy
Jiaxi YU ; Zhihao QUAN ; Yilei ZHENG ; Jing AN ; Jing LIU ; Qingqing WANG ; Lingchao MENG ; Meng YU ; Zhiying XIE ; Jianwen DENG ; He LYU ; Wei ZHANG ; Yun YUAN ; Zhaoxia WANG
JOURNAL OF RARE DISEASES 2026;5(2):164-174
To analyze the clinical and genetic features of oculopharyngodistal myopathy (OPDM) patients and compare the phenotypic differences among various causative genes. A total of 65 genetically confirmed OPDM patients from 43 unrelated families, who were admitted to the Department of Neurology, Peking University First Hospital between January 2008 and December 2025, were retrospectively included.The general demographic data, clinical manifestations, laboratory/auxiliary examinations, muscle pathology, and genetic test results were systematically collected and analyzed. The clinical and pathological characteristics among different OPDM subtypes were compared. Among the 65 patients(39 male and 26 female), the mean age of onset was (31.20±10.43) years (range: 14 to 63 years). The initial symptom was predominantly distal limb weakness (67.44%), which gradually progressed to involve the extraocular muscles, pharyngeal muscles, facial muscles and proximal limb muscles. Serum creatine kinase levels were mildly to moderately elevated. Muscle pathological examinations revealed rimmed vacuoles and intranuclear inclusions (within muscle fibers). The mean duration from onset to diagnosis was (12.33±7.88) years (range: 1 to 32 years). All probands had negative results on conventional next-generation whole-exome sequencing; pathogenic variants were identified through third-generation long-read sequencing or OPDM-targeted repeat-primed polymerase chain reaction(RP-PCR). Among the 43 families, OPDM2 subtype was the most common genetic subtype ( OPDM2 was the predominant subtype in this study. All subtypes share similar age of onset and muscular pathological changes, yet exhibit distinct disease progression patterns. Future multicenter prospective cohort studies are warranted to further elucidate the clinical characteristics, pathogenetic mechanisms, and prognostic differences among OPDM subtypes.
4.Si Junzitang Ameliorates Alzheimer's Disease by Regulating Keap1/Nrf2/HO-1 Signaling Pathway
Minyan SUN ; Shaofeng WEI ; Xiaomin WANG ; Kehan GAO ; Jianhao YANG ; Ziran XIE ; Yu ZHANG ; Qin ZHENG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(17):23-37
ObjectiveTo explore the mechanisms through which Si Junzitang (SJZD) ameliorates Alzheimer's disease (AD) induced by scopolamine (SCOP) in mice and the PC12 cell model induced by H2O2 based on the Kelch-like ECH-associated protein 1 (Keap1)/nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling pathway. MethodsIn the animal experiments, an AD model was established in mice by intraperitoneal injection of SCOP (3 mg·kg-1). Morris water maze and open field tests (OFT) were conducted to assess learning and memory abilities. Hematoxylin-eosin (HE) staining and Nissl staining were performed to observe pathological changes in neurons. Immunofluorescence was used to detect amyloid β-protein1-42 (Aβ1-42) expression, and immunohistochemistry was employed to detect phosphorylated (p)-Tau expression. Transmission electron microscopy (TEM) was employed to observe ultrastructural changes in hippocampal neurons and synapses. Biochemical methods were used to measure the levels of acetylcholine (ACh), acetylcholinesterase (AChE), superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), and lactate dehydrogenase (LDH). Real-time PCR and Western blot were employed to measure the mRNA and protein levels of molecules in the Keap1/Nrf2/HO-1 pathway in the hippocampus. In the cell experiments, a PC12 cell model of oxidative damage model was established with H2O2. Cell count kit-8 (CCK-8) assays and flow cytometry were adopted to measure cell viability and apoptosis rates, and Western blot was employed to quantify the expression levels of proteins in the Keap1/Nrf2/HO-1 pathway. ResultsThe animal experiments showed that compared with the model group, the SJZD and donepezil groups showed shortened escape latency (P<0.01), increased time in the target quadrant and platform crossings, and increased movement distance and duration in the central area of the open field (P<0.05, P<0.01). HE and Nissl staining showed more organized neurons and increased Nissl bodies in the drug intervention groups (P<0.05, P<0.01), and the Aβ1-42 and p-Tau expression levels were downregulated (P<0.05, P<0.01). TEM revealed reduced ultrastructural damage in hippocampal neurons and synapses in the drug intervention groups. In addition, the drug intervention groups showed declined levels of MDA, LDH, and AChE (P<0.05, P<0.01), elevated levels of SOD, CAT, and ACh (P<0.05, P<0.01), reduced Keap1 expression and increased Nrf2, HO-1, and NQO1 expression in the hippocampus (P<0.05, P<0.01). The cell experiments showed that compared with the model group, the SJZD-containing serum increased the cell viability (P<0.05, P<0.01), and decreased total apoptosis rates (P<0.05, P<0.01). The drug intervention groups showed upregulated protein levels of Nrf2 and HO-1 and downregulated protein level of Keap1 (P<0.05, P<0.01). ConclusionSJZD demonstrates protective effects against SCOP-induced AD in mice and H2O2-induced damage in PC12 cells through antioxidant mechanisms mediated by the Keap1/Nrf2/HO-1 pathway.
5.Research Progress on the Risk of Excipients-Related Adverse Reactions in Pharmaceutical Preparations for IBD Treatment
Yanru ZHANG ; Qiuyue TU ; Ping WANG ; Zelin FENG ; Huizhen LI ; Yushan ZHU ; Haojia LIN ; Xinyue WEI ; Qinghua YI ; Hetong ZHANG ; Yueting LI ; Xiaoqin LI ; Yu WANG ; Dong XIE ; Xiaocang CAO
Medical Journal of Peking Union Medical College Hospital 2026;17(4):1135-1142
Patients with inflammatory bowel disease (IBD) require long-term pharmacotherapy. Due to the wide variety of clinically available drugs, medication safety has become increasingly concerning. As an indispensable component of pharmaceutical formulations, drug excipients may induce various adverse reactions, including rash, allergic responses, and gastrointestinal discomfort, and may even lead to severe organic injury. However, they are often overlooked in clinical practice. Therefore, identifying and managing excipient-related adverse reactions is crucial for ensuring medication safety. To address this issue, this article systematically reviews common excipients in IBD therapeutics, the underlying mechanisms of excipient-induced adverse reactions, and corresponding management strategies, aiming to enhance clinicians' awareness of excipient-related issues, improve their ability to recognize and manage such reactions, and ultimately ensure patient safety.
6.Mechanisms of Diabetic Tendinopathy and Exercise Intervention
Ya-Ke WU ; Rui DENG ; Yu-Miao XIE ; Fang ZOU ; Shuai-Wei QIAN
Progress in Biochemistry and Biophysics 2026;53(8):2041-2052
Diabetic tendinopathy is a common and disabling musculoskeletal complication of diabetes, clinically characterized by tendon thickening, pain, impaired healing capacity and compromised biomechanical performance, collectively undermining joint function and quality of life. Its pathogenesis is multifactorial. On the one hand, chronic hyperglycaemia promotes the abnormal accumulation of advanced glycation end products (AGEs) within tendon collagen, leading to non-enzymatic crosslinking and engagement of the receptor for AGEs (RAGE), which in turn triggers inflammasome activation and sustains inflammatory responses. On the other hand, the diabetic milieu disrupts collagen metabolic homeostasis, impairs microvascular function and induces peripheral neuropathy; together, these alterations drive extracellular matrix degeneration and weaken the mechanical properties of tendon. Exercise, as a non-pharmacological intervention, can ameliorate these pathological changes through multiple integrated mechanisms. First, exercise attenuates tendon inflammation and restores microenvironmental homeostasis. Regular physical activity reduces AGE-RAGE signalling, thereby suppressing downstream expression of tumour necrosis factor (TNF) and interleukin-1β (IL-1β), while upregulating the anti-inflammatory cytokine interleukin-10 (IL-10). This shift from a pro-inflammatory to a pro-resolving milieu not only restrains chronic inflammation but may also limit excessive inflammasome activation in tenocytes and tissue-resident immune cells. Second, exercise enhances local expression of insulin-like growth factor 1 (IGF-1), thereby activating the phosphoinositide 3-kinase (PI3K)-protein kinase B (Akt) signalling pathway. This axis stimulates tenocyte proliferation, augments synthesis of type I collagen —— the principal load-bearing component of tendon —— and thereby promotes tissue repair, preserves tensile strength and supports matrix synthesis and structural integrity. In addition, exercise improves blood supply and nutrient delivery to tendon by increasing the expression of vascular endothelial growth factor (VEGF), connective tissue growth factor (CTGF) and the small leucine-rich proteoglycan decorin (DCN), thereby enhancing capillary growth, coordinating collagen fibrillogenesis and actively suppressing pathological vascular calcification. Exercise also increases the expression of angiopoietin-like 4 (ANGPTL4), fibroblast growth factor 2 (FGF-2) and CD34. Through the concerted actions of these factors, exercise promotes angiogenesis, restores the microvascular network and ensures adequate oxygen and nutrient supply to relatively ischaemic tendon tissue. Finally, exercise elevates levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF), supporting neuronal survival, axonal growth and the function of sensory and sympathetic nerve endings within tendon, thereby exerting neurotrophic and neuromodulatory effects and improving tendon innervation and neuromuscular control. Moreover, exercise upregulates collapsin response mediator protein 2 (CRMP-2), a molecule involved in axonal guidance and regeneration, and moderately increases the activity of substance P (SP), thereby helping to regulate neurogenic inflammation, pain perception and trophic support for tenocytes. Drawing together current evidence, this review systematically summarizes the mechanisms underlying diabetic tendinopathy and examines the mechanistic basis of exercise intervention, with the aim of providing a theoretical framework for the development of precise exercise strategies for affected individuals. However, several key issues remain unresolved: the therapeutic efficacy and mechanistic specificity of different exercise modalities in diabetic tendinopathy have yet to be defined, and early diagnostic biomarkers remain insufficiently characterized. Future studies should apply multi-omics approaches to profile AGE subtypes, miRNA signatures and collagen metabolic products, and should also clarify the adverse effects and underlying mechanisms of excessive exercise or mechanical overloading in diabetic tendinopathy. Such efforts will further elucidate the therapeutic effects and mechanisms of exercise in diabetic tendinopathy and provide a stronger basis for precision exercise prescription and fitness guidance in patients with diabetes.
7.Comparative Analysis of Sex Differences Between Cyclophosphamide- and Paclitaxel-Induced Mouse Models of Chemotherapy-Induced Alopecia
Qiuming ZHONG ; Liping QIAN ; Yuanyuan CAI ; Deqiang LIU ; Wei LIN ; Chunying YU ; Jindong XIE ; Xunli WANG ; Sheng WU ; Biyin CHEN ; Zhen HUANG
Laboratory Animal and Comparative Medicine 2026;46(5):677-688
ObjectiveTo evaluate the effect of sex on phenotypic stability in mouse models of chemotherapy-induced alopecia (CIA) induced by cyclophosphamide (CYP) or paclitaxel (PTX), and to explore potential mechanisms underlying phenotypic heterogeneity in female mice. MethodsTwenty-eight wild-type specific pathogen-free (SPF) C57BL/6J mice (half male and half female) aged 6-8 weeks were selected for synchronous back hair removal. On the 9th day after hair removal (T0), the mice were randomly divided into a wild-type female CYP group, a wild-type male CYP group, a female negative control group and a male negative control group. Mice in the CYP groups were intraperitoneally injected with a single dose of 120 mg/kg CYP, and mice in the negative control groups were intraperitoneally injected with the same volume of normal saline. Subsequently, the phenotypic changes of the CIA model induced by CYP were continuously observed and photographed. Eleven 6-week-old SPF female C57BL/6J mice underwent bilateral ovariectomy (OVX group). Following successful surgery, these mice and five XY (Sry⁻) mice bred from Four Core Genotypes breeding stock were used to establish the chemotherapy-induced alopecia (CIA) model using the same protocol. Serum was collected from mice in the OVX group, wild-type female CYP group, and wild-type male CYP group on T7 after CYP administration for steroid hormone analysis by mass spectrometry to evaluate the effects of gonadal estrogen and sex chromosome background changes on the stability of the CYP-induced female alopecic phenotype. Finally, twenty SPF C57BL/6J mice aged 6-8 weeks (half male and half female) were randomly divided into a PTX low-dose group and a PTX high-dose group. On the 9th day after simultaneous hair removal, PTX was injected intraperitoneally at a single dose of 80 mg/kg or 120 mg/kg, respectively. Mice from the PTX low-dose group and the PTX high-dose group were continuously observed and photographed to compare the intra-group consistency of the phenotypes of female and male mice. Six SPF C57BL/6J mice (half male and half female) aged 6-8 weeks were used to repeat the construction method of the PTX low-dose group, and the hair follicle histological examination was performed at T0, T4, T7, T14 and T21, respectively, to observe the damage caused by PTX to hair follicle regeneration. ResultsThe phenotypes of CYP-induced male CIA mice are stable and reproducible. There are obvious individual differences in the alopecia phenotype in the CYP-induced female CIA model mice, which may be mainly caused by the differences in the relevant estrogens in the estrous cycle. The difference between OVX+CYP group and XY (Sry⁻) +CYP group disappeared, suggesting that ovarian-derived hormones and XY (Sry⁻) sex chromosome background may be involved in the formation of phenotypic heterogeneity of CYP-induced alopecia in female mice. The mice in the high-dose PTX group and the low-dose PTX group showed a relatively consistent alopecia and regrowth process, and there was no significant sex difference. ConclusionCYP-induced CIA is strongly influenced by sex, and ovariectomy or alteration of the sex chromosome background can improve the consistency of CYP-induced alopecic phenotypes in female mice. PTX-induced CIA shows good phenotypic consistency in both female and male mice, indicating broad applicability across sexes. Taken together, the choice of animal sex in CIA model construction, mechanistic studies, and evaluation of anti-alopecia interventions should take into account the type of chemotherapeutic agent, the study objective, and the required degree of phenotypic stability. Sex should therefore be considered an important variable in model standardization and interpretation of experimental findings.
8.MYH7 gene-related scapuloperoneal myosin storage myopathy: a case report
Qingyue YUAN ; Zhenyu LI ; Zhiying XIE ; Meng YU ; Zhaoxia WANG ; Wei ZHANG ; Yun YUAN
Chinese Journal of Neurology 2025;58(12):1277-1281
Objective:To report the clinical, imaging, and pathological features of a case of MYH7 gene-related scapuloperoneal myosin storage myopathy. Methods:Clinical data were collected from a patient with MYH7 gene-related scapuloperoneal myosin storage myopathy who presented to Peking University First Hospital in February 2025. The patient was evaluated with muscle magnetic resonance imaging, muscle biopsy, and whole-exome sequencing. Results:The patient was a 52-year-old female, with a 12-year history of progressive difficulty in foot dorsiflexion, exercise-induced fatigue, and lower limb pain. Over the past 3 years, she developed proximal upper limb weakness and post-exertional myalgia. Physical examination revealed scapuloperoneal weakness distribution accompanied by sensorineural hearing loss. Electromyography demonstrated myogenic changes in the deltoid and tibialis anterior muscles. Serum creatine kinase levels were within normal limits. Lower limb magnetic resonance imaging showed mild atrophy of the thigh muscles and significant fatty infiltration in the tibialis anterior, extensor hallucis longus, and extensor digitorum longus. Tibialis anterior muscle biopsy revealed dystrophic-like changes with sub-sarcolemmal hyaline bodies containing abundant granulofilamentous material. Whole exome sequencing identified a heterozygous pathogenic variant of c.5352_5354del(p.K1784del) in the MYH7 gene. Conclusions:This patient is the first reported one in China with MYH7 gene-related scapuloperoneal myosin storage myopathy, exhibiting characteristic scapuloperoneal weakness, selective fatty infiltration of the anterior lower leg muscles on imaging and sub-sarcolemmal hyaline body pathological changes. The diagnosis of this disease relies on characteristic pathological findings and genetic test results.
9.Effects of Hofmeister series ions on encapsulation efficiencies of three components in inclusion complex of volatile oils from Wenjing Decoction
Wen SHEN ; Zhuo-yuan LI ; Lin TAO ; Wei XIE ; Run SHI ; Yu-han CUI ; Wen LI ; Jun-song LI
Chinese Traditional Patent Medicine 2025;47(11):3571-3580
AIM To explore the effects of Hofmeister series ions on encapsulation efficiencies of cinnamaldehyde,paeonol,and ligustilide in inclusion complex of volatile oils from Wenjing Decoction.METHODS The volatile oils were extracted,after which the β-cyclodextrin inclusion complex was prepared,the thermal stability was evaluated,and encapsulation efficiencies and inclusion complex constants of various volatile components in Na2SO4,NaH2PO4,NaCl,NaI,NaSCN solutions were determined.RESULTS The β-cyclodextrin inclusion complex demonstrated good thermal stability within 10 d.After the addtion of Hofmeister series ions,various volatile components displayed increased encapsulation efficiencies and inclusion complex constants,and concentration-dependent manner was observable in the latter.CONCLUSION Hofmeister series ions can affect the binding affinities of volatile components and β-cyclodextrin in volatile oils from Wenjing Decoction,thus regulate their encapsulation efficiencies.
10.Analysis of hearing screening results for newborns with failed genetic screening of 23-cite chip
Yu RUAN ; Cheng WEN ; Xiaohua CHENG ; Wei ZHANG ; Jinge XIE ; Yue LI ; Lin DENG ; Shan GAO ; Lihui HUANG
Chinese Archives of Otolaryngology-Head and Neck Surgery 2025;32(4):215-220
OBJECTIVE To investigate the relationship between 23-site chip genetic screening failures and the results of newborns hearing screening,and to provide clinical reference for the diagnosis and treatment of genetic screening failures.METHODS There were 1 916 newborns born in the Beijing area from November 2022 to May 2024,who did not pass the 23-site chip genetic screening tests and underwent newborn hearing screening with definite initial screening results.Chi-square test was used to analyze the relationship between different mutation types and genotypes and the initial hearing screening results.RESULTS The overall neonatal hearing screening failure rate was 5.27%(101/1 916),with a higher failure rate of 61.54%(56/91)for homozygous and compound heterozygous mutations than the failure rate of 2.54%(45/1 772)for heterozygous mutations,0%(0/34)for digenic gene heterozygous mutations,and 0(0/19)for mtDNA 12S rRNA mutations,with a statistically significant difference(P<0.001).Among the homozygous and compound heterozygous mutations,the failure rates of homozygous and compound heterozygous for GJB2 gene and SLC26A4 gene were 59.76%(49/82)and 77.78%(7/9),respectively,with no statistically significant difference between the two groups(P=0.488).The homozygous and compound heterozygous for GJB2 gene were divided into three groups based on genotype:c.109G>A homozygous mutations,c.109G>A compound heterozygous mutations,and other homozygous and compound heterozygous mutations.The hearing screening failure rates of the three groups,from highest to lowest,were as follow:other homozygous and compound heterozygous mutations(88.89%,8/9),c.109G>A homozygous mutations(65.12%,28/43),and c.109G>A compound heterozygous mutations(43.33%,13/30),with a statistically significant difference(P=0.029).The failure rates of heterozygous for GJB2 gene,SLC26A4 gene and GJB3 gene were 2.86%(40/1 398),1.25%(4/321)and 1.89%(1/53),respectively,with no statistically significant difference among the three groups(P=0.241).The failure rate of hearing screening for individuals with GJB2 heterozygotes of different genotypes and individuals with SLC26A4 heterozygotes of different genotypes did not show statistically significant differences.CONCLUSION The failure rate of newborn hearing screening for homozygous and compound heterozygous mutation of 23-site chip genetic screening is higher than that of other mutation types,verifying the effectiveness of the newborn hearing screening program.Some newborns of homozygous and compound heterozygous mutation can pass the hearing screening,especially those with the c.109G>A homozygous and compound heterozygous mutation,who need clinical follow-up.

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