{"id":560119,"date":"2025-09-07T11:02:44","date_gmt":"2025-09-07T11:02:44","guid":{"rendered":"https:\/\/liveutifree.com\/leva-ao-teu-medico-luf\/"},"modified":"2025-10-23T13:54:45","modified_gmt":"2025-10-23T13:54:45","slug":"leva-ao-teu-medico-luf","status":"publish","type":"page","link":"https:\/\/liveutifree.com\/pt-pt\/leva-ao-teu-medico-luf\/","title":{"rendered":"Leva ao teu m\u00e9dico"},"content":{"rendered":"<div id=\"cs-content\" class=\"cs-content\"><div class=\"x-section e560119-e1 mc06v-0\"><div class=\"x-row e560119-e2 mc06v-1 mc06v-2 mc06v-3\"><div class=\"x-row-inner\"><div class=\"x-col e560119-e3 mc06v-7 mc06v-8\"><div class=\"x-text x-text-headline e560119-e4 mc06v-9 mc06v-a heading-02\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h1 class=\"x-text-content-text-primary\">Falar com o teu m\u00e9dico sobre a UTI cr\u00f3nica<\/h1>\n<\/div><\/div><\/div><hr class=\"x-line e560119-e5-v0 mc06v-b mc06v-c\"\/><div class=\"x-div e560119-e6 mc06v-f\"><div class=\"x-text x-content e560119-e7 mc06v-g body-regular\">Passo 1<\/div><a class=\"x-anchor x-anchor-button e560119-e8 mc06v-i button-blue-primary\" tabindex=\"0\" href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2024\/04\/2024-Improving-Treatment-Pathways-for-Patients-with-Lower-Urinary-Tract-Symptoms.pdf\"><div class=\"x-anchor-content\"><div class=\"x-anchor-text\"><span class=\"x-anchor-text-primary\">Descarrega e partilha com o teu m\u00e9dico (pdf)<\/span><\/div><\/div><\/a><hr class=\"x-line e560119-e9-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-content e560119-e10 mc06v-g body-regular\">Passo 2<\/div><a class=\"x-anchor x-anchor-button e560119-e11 mc06v-i button-blue-primary\" tabindex=\"0\" href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2025\/03\/TTYD-Patient-Guidelines-1.pdf\"><div class=\"x-anchor-content\"><div class=\"x-anchor-text\"><span class=\"x-anchor-text-primary\">Descarrega para te preparares para a tua consulta (pdf)<\/span><\/div><\/div><\/a><\/div><hr class=\"x-line e560119-e12-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-content e560119-e13 mc06v-g mc06v-h body-medium\">Quer sejas novo no mundo dos sintomas persistentes do trato urin\u00e1rio inferior (LUTS) ou j\u00e1 lides com eles h\u00e1 tempo suficiente para te considerares um perito na pesquisa de UTI em casa, \u00e9 prov\u00e1vel que tenhas procurado informa\u00e7\u00f5es fi\u00e1veis para partilhar com o teu m\u00e9dico.<\/div><hr class=\"x-line e560119-e14-v0 mc06v-c mc06v-d\"\/><a class=\"x-image e560119-e15 mc06v-j\" href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2024\/04\/2024-Improving-Treatment-Pathways-for-Patients-with-Lower-Urinary-Tract-Symptoms.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><img decoding=\"async\" src=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2023\/04\/TTYD-landing-page.png\" width=\"700\" height=\"700\" alt=\"Uma pilha de documentos intitulada Improving Treatment Pathways for Patients with Persistent Lower Urinary Tract Symptoms (Melhorar as Vias de Tratamento para Pacientes com Sintomas Persistentes do Trato Urin\u00e1rio Inferior), incluindo informa\u00e7\u00f5es sobre as op\u00e7\u00f5es de testes no Reino Unido e nos EUA e pormenores sobre a Fun\u00e7\u00e3o do Trato Urin\u00e1rio Inferior (LUF) para discutir com um m\u00e9dico.\" loading=\"lazy\"><\/a><hr class=\"x-line e560119-e16-v0 mc06v-c mc06v-d\"\/><div class=\"x-text x-content e560119-e17 mc06v-g body-medium\"><p>Mas pode ser dif\u00edcil encontrar recursos de qualidade sobre este tema. Foi por isso que desenvolvemos materiais que fornecem informa\u00e7\u00f5es pr\u00e1ticas e incentivam o debate entre ti e o teu m\u00e9dico. Atrav\u00e9s das ferramentas listadas acima, podes aceder a  <span> <\/span><a href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2024\/04\/2024-Improving-Treatment-Pathways-for-Patients-with-Lower-Urinary-Tract-Symptoms.pdf\"><span style=\"text-decoration: underline;\">investiga\u00e7\u00e3o baseada em provas (pdf)<\/span><\/a><span> <\/span>para partilhares com o teu m\u00e9dico, e um<span> <\/span><a href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2025\/03\/TTYD-Patient-Guidelines-1.pdf\"><span style=\"text-decoration: underline;\">guia (pdf)<\/span><\/a><span> <\/span>para incentivar a comunica\u00e7\u00e3o.<\/p>\n<p>\u00c9 importante que qualquer informa\u00e7\u00e3o partilhada com m\u00e9dicos ocupados se baseie em investiga\u00e7\u00e3o revista por pares e seja de leitura r\u00e1pida.<\/p>\n<p>Tivemos tudo isto em considera\u00e7\u00e3o ao desenvolver os materiais \"Leva ao teu m\u00e9dico\". Escrito em parceria com os nossos consultores m\u00e9dicos e de investiga\u00e7\u00e3o, recolhemos e resumimos alguns dos estudos mais impactantes sobre a UTI e apresent\u00e1mo-los num formato f\u00e1cil de navegar. <\/p><\/div><\/div><\/div><\/div><hr class=\"x-line e560119-e18-v0 mc06v-c mc06v-e\"\/><div class=\"x-row e560119-e19 mc06v-1 mc06v-2 mc06v-4\"><div class=\"x-row-inner\"><div class=\"x-col e560119-e20 mc06v-7 mc06v-8\"><div class=\"x-text x-text-headline e560119-e21 mc06v-9 heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Como come\u00e7ar<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560119-e22-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-content e560119-e23 mc06v-g body-medium\"><ol>\n \t<li><a href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2024\/04\/2024-Improving-Treatment-Pathways-for-Patients-with-Lower-Urinary-Tract-Symptoms.pdf\"><span style=\"text-decoration: underline;\">Descarrega o recurso cl\u00ednico (pdf)<\/span><\/a><\/li>\n \t<li><a href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2025\/03\/TTYD-Patient-Guidelines-1.pdf\"><span style=\"text-decoration: underline;\">Descarrega o guia do paciente para partilhar estes recursos com o teu m\u00e9dico (pdf)<\/span><\/a><\/li>\n \t<li><a href=\"https:\/\/www.youtube.com\/watch?v=PRZEYZ6ctuY\" target=\"_blank\" rel=\"noopener\"><span style=\"text-decoration: underline;\">V\u00ea Compreender o recurso cl\u00ednico da UTI<\/span><\/a><\/li>\n \t<li><a href=\"https:\/\/www.youtube.com\/watch?v=VcUGOUjuEXY\" target=\"_blank\" rel=\"noopener\"><span style=\"text-decoration: underline;\">V\u00ea Como utilizar o guia do doente e a ficha de trabalho<\/span><\/a><\/li>\n<\/ol><\/div><hr class=\"x-line e560119-e24-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-content e560119-e25 mc06v-g body-medium\"><p>Obrigado por teres um papel ativo na educa\u00e7\u00e3o dos outros sobre as UTIs persistentes e dif\u00edceis de diagnosticar e gostar\u00edamos de ouvir a tua experi\u00eancia com estes recursos. Podes <span> <\/span><span style=\"color: #c74f4d;\"><a href=\"https:\/\/liveutifree.com\/pt-pt\/contacto-luf\/\" style=\"color: #c74f4d;\"><span style=\"text-decoration: underline;\">entra em contacto connosco diretamente<\/span><\/a><\/span>.<\/p>\n<p>Se achaste esta informa\u00e7\u00e3o \u00fatil, podes apoiar os esfor\u00e7os de educa\u00e7\u00e3o e outros projectos<span> <\/span><a href=\"https:\/\/liveutifree.com\/pt-pt\/contribui-para-a-luf\/\"><span style=\"text-decoration: underline;\">contribuindo para o trabalho que mais te interessa<\/span><\/a><span style=\"color: #800000;\">.<\/span><\/p><\/div><hr class=\"x-line e560119-e26-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-text-headline e560119-e27 mc06v-9 mc06v-a heading-04\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><p class=\"x-text-content-text-primary\">Excertos de Improving Treatment Pathways for Patients with Persistent Lower Urinary Tract Symptoms (Melhorar as Vias de Tratamento para Pacientes com Sintomas Persistentes do Trato Urin\u00e1rio Inferior)<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><hr class=\"x-line e560119-e28-v0 mc06v-c mc06v-e\"\/><div class=\"x-row e560119-e29 mc06v-1 mc06v-2 mc06v-5\"><div class=\"x-row-inner\"><div class=\"x-col e560119-e30 mc06v-7 mc06v-8\"><div class=\"x-text x-text-headline e560119-e31 mc06v-9 mc06v-a heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Compreender a liga\u00e7\u00e3o entre o microbioma vaginal e urin\u00e1rio<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560119-e32-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-content e560119-e33 mc06v-g body-medium\"><ul>\n \t<li>Embora os microbiomas do trato urin\u00e1rio e da bexiga sejam \u00fanicos, existe uma sobreposi\u00e7\u00e3o significativa entre as esp\u00e9cies e as fun\u00e7\u00f5es proteicas dos dois ambientes, o que d\u00e1 lugar \u00e0 teoria de que poderiam ser considerados um \u00fanico microbioma urogenital<sup>.5<\/sup><\/li>\n \t<li>Para as mulheres com disbiose vaginal, existe um risco acrescido de desenvolver uma UTI em compara\u00e7\u00e3o com as mulheres com um<span> <\/span> microbioma vaginal dominado por Lactobacillus<sup>.37<\/sup><\/li>\n<\/ul><\/div><hr class=\"x-line e560119-e34-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-content e560119-e35 mc06v-g body-medium\"><span>75%, 46% e 13% das mulheres com vaginose bacteriana, candid\u00edase ou tricomon\u00edase, respetivamente, tamb\u00e9m t\u00eam uma UTI.<\/span><sup>38<\/sup><\/div><hr class=\"x-line e560119-e36-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-text-headline e560119-e37 mc06v-9 mc06v-a heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Investiga\u00e7\u00e3o atual sobre o microbioma da bexiga<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560119-e38-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-content e560119-e39 mc06v-g body-medium\"><ul>\n \t<li>As comunidades bacterianas foram observadas em 80% das amostras obtidas por cateter transuretral de participantes do sexo feminino, sendo que at\u00e9 92% das amostras foram registadas como \"sem crescimento\" utilizando o SUC<sup>.1<\/sup><span> <\/span>Uma disbiose deste microbioma urin\u00e1rio saud\u00e1vel (o urobioma) est\u00e1 correlacionada com o desenvolvimento de sintomas e dist\u00farbios urin\u00e1rios<sup>.1-3<\/sup><\/li>\n \t<li>Os participantes com sintomas urin\u00e1rios demonstraram um urobioma mais diversificado com maiores quantidades de bact\u00e9rias do que os controlos assintom\u00e1ticos. A frequ\u00eancia de dete\u00e7\u00e3o de bact\u00e9rias situou-se entre 81% e 86% para as coortes sintom\u00e1ticas, em compara\u00e7\u00e3o com apenas 57% na coorte de controlo. <em><sup>1,2,4,5<\/sup><\/em><\/li>\n \t<li>Quando comparados com controlos assintom\u00e1ticos, os doentes com incontin\u00eancia de urg\u00eancia apresentavam diferen\u00e7as estatisticamente significativas no seu urobioma, com n\u00edveis mais baixos de<span> <\/span> Lactobacillus<em><span> <\/span> e n\u00edveis mais elevados de<\/em><span> <\/span><em>Gardnerella<\/em><sup>.6,7,8<\/sup><\/li>\n<\/ul><\/div><hr class=\"x-line e560119-e40-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-text-headline e560119-e41 mc06v-9 mc06v-a heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Evid\u00eancia de infe\u00e7\u00e3o polimicrobiana<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560119-e42-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-content e560119-e43 mc06v-g body-medium\"><ul>\n \t<li>As capacidades limitadas e<span> <\/span>O vi\u00e9s <em>centrado na E. coli<\/em> da cultura de urina padr\u00e3o (SUC) est\u00e1 bem estabelecido. A SUC identifica apenas 24% das bact\u00e9rias que n\u00e3o s\u00e3o E<em>. coli<\/em> <span> <\/span>Os uropatog\u00e9nios e a evid\u00eancia de infe\u00e7\u00e3o polimicrobiana surgiram. Price et al. utilizaram a Expanded Quantitative Urine Culture (EQUC) para examinar infec\u00e7\u00f5es polimicrobianas. 81% das amostras que detectaram  <span> <\/span><em>E. coli<\/em><span> <\/span>tamb\u00e9m continha pelo menos um agente patog\u00e9nico adicional<sup>.11<\/sup><\/li>\n \t<li>Vollstedt et al. utilizaram a rea\u00e7\u00e3o em cadeia da polimerase (PCR). Das 1.352 amostras que deram positivo para bact\u00e9rias, 56,1% foram registadas como sendo polimicrobianas. Embora nem todos os organismos de uma amostra sejam necessariamente patog\u00e9nicos, a possibilidade de uma infe\u00e7\u00e3o polimicrobiana deve ser considerada em doentes sintom\u00e1ticos<sup>.24<\/sup>  <\/li>\n \t<li>Quando as limita\u00e7\u00f5es do SUC s\u00e3o removidas, surge a oportunidade de tomar decis\u00f5es mais informadas. As intera\u00e7\u00f5es entre os organismos presentes no urobioma de um indiv\u00edduo devem ser consideradas, uma vez que t\u00eam impacto nos resultados relatados pelos doentes<sup>.7,12,25<\/sup> <\/li>\n<\/ul><\/div><hr class=\"x-line e560119-e44-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-text-headline e560119-e45 mc06v-9 mc06v-a heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Sintomas de uma UTI persistente<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560119-e46-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-content e560119-e47 mc06v-g body-medium\"><ul>\n \t<li>Os participantes em estudos com incontin\u00eancia urin\u00e1ria de urg\u00eancia (IUU) t\u00eam uma maior diversidade de urobiomas do que os controlos sem IUU<sup>.4,7<\/sup><span> <\/span>Quando est\u00e3o presentes sintomas do trato urin\u00e1rio inferior, a considera\u00e7\u00e3o do microbiota e do exame microsc\u00f3pico \u00fanicos de um paciente pode ter um impacto positivo nos resultados do tratamento.<\/li>\n \t<li>Um estudo prospetivo e em dupla oculta\u00e7\u00e3o realizado por Warren et al. demonstrou que 48% dos participantes diagnosticados com IC que foram submetidos a tratamento com antibi\u00f3ticos durante 18 semanas relataram uma redu\u00e7\u00e3o da urg\u00eancia e da dor, ou uma melhoria global dos sintomas, em compara\u00e7\u00e3o com 24% dos participantes no grupo do placebo. Embora sejam necess\u00e1rios mais estudos, este resultado sugere que os doentes com complexos de sintomas urin\u00e1rios podem ter uma UTI n\u00e3o diagnosticada<sup>.6,27<\/sup> <\/li>\n<\/ul><\/div><hr class=\"x-line e560119-e48-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-text-headline e560119-e49 mc06v-9 mc06v-a heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Como o Biofilme Contribui para Aproximadamente 80% das Infec\u00e7\u00f5es Recorrentes<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560119-e50-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-content e560119-e51 mc06v-g body-medium\"><ul>\n \t<li><strong>Taxa de recorr\u00eancia:<span> <\/span><\/strong>Ap\u00f3s o in\u00edcio de uma UTI aguda, o risco de recorr\u00eancia futura aumenta. 19-24% das mulheres ter\u00e3o uma ITU recorrente no prazo de 6 meses ap\u00f3s a sua primeira infe\u00e7\u00e3o, e para as pacientes com antecedentes de ITU, 70% ter\u00e3o uma recorr\u00eancia no prazo de um ano<sup>.10,29<\/sup> <span> <\/span>M\u00faltiplos factores anteriormente discutidos, como o vi\u00e9s da cultura de urina padr\u00e3o (SUC) e as limita\u00e7\u00f5es do relat\u00f3rio de sensibilidade, contribuem para o aumento das taxas de recorr\u00eancia. No entanto, a presen\u00e7a de Biofilm desempenha um papel significativo. <\/li>\n \t<li><strong>Biofilmes bacterianos:<\/strong><span> <\/span>Os biofilmes s\u00e3o comunidades bacterianas envoltas numa matriz de polissac\u00e1ridos capazes de aderir a superf\u00edcies e tecidos e no seu interior, expressando genes de resist\u00eancia a antibi\u00f3ticos e influenciando grandemente o desenvolvimento de infec\u00e7\u00f5es cr\u00f3nicas<sup>.28<\/sup><span> <\/span> A E<em>. coli<span> <\/span><\/em>\u00e9 especificamente uma bact\u00e9ria com elevada produ\u00e7\u00e3o de biofilmes, respons\u00e1vel por contribuir para infec\u00e7\u00f5es cr\u00f3nicas e recorrentes, com 62,5% das infec\u00e7\u00f5es por<span> <\/span> E<em>. coli<\/em><span> <\/span>a produzirem biofilme<sup>.6,30,31<\/sup><\/li>\n \t<li><strong>Preval\u00eancia:<span> <\/span><\/strong>Quando comparados com controlos assintom\u00e1ticos, 75% dos pacientes com sintomas do trato urin\u00e1rio inferior (LUTS) tinham evid\u00eancia de IBCs, em compara\u00e7\u00e3o com 17% encontrados nos controlos, indicando o potencial papel do biofilme nos sintomas urin\u00e1rios<sup>.6<\/sup><span> <\/span>Como explicado por Scott et al.,<span> <\/span><em>\"Os IBCs podem ter um papel n\u00e3o s\u00f3 na etiologia da UTI recorrente, mas tamb\u00e9m dos LUTS cr\u00f3nicos experimentados por algumas mulheres a quem \u00e9 dado o diagn\u00f3stico de OAB ou IC\/BPS.\"<\/em><em><sup>6<\/sup><\/em><\/li>\n \t<li><strong>Outras infec\u00e7\u00f5es associadas a biofilmes:<\/strong><span> <\/span>Os Biofilmes e IBCs s\u00e3o reconhecidos como estando associados a outras infec\u00e7\u00f5es tecidulares, tais como infec\u00e7\u00f5es dent\u00e1rias, infec\u00e7\u00f5es do trato respirat\u00f3rio, endocardite, prostatite, entre outras<sup>.28<\/sup><\/li>\n<\/ul><\/div><\/div><\/div><\/div><hr class=\"x-line e560119-e52-v0 mc06v-c mc06v-e\"\/><div class=\"x-row e560119-e53 mc06v-1 mc06v-2 mc06v-6\"><div class=\"x-row-inner\"><div class=\"x-col e560119-e54 mc06v-8\"><div class=\"x-text x-text-headline e560119-e55 mc06v-9 mc06v-a heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Refer\u00eancias<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560119-e56-v0 mc06v-b mc06v-c\"\/><div class=\"x-text x-content e560119-e57 mc06v-g body-medium\"><ol>\n \t<li>Hilt EE, Mckinley K, Pearce MM, et al. Urine Is Not Sterile: Use of Enhanced Urine Culture Techniques To Detect Resident Bacterial Flora in the Adult Female Bladder. <span> <\/span><em>Jornal de Microbiologia Cl\u00ednica<\/em>. 2013;52(3):871-876. doi:  <span> <\/span><span style=\"text-decoration: underline; color: #c74f4d;\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24371246\/\" target=\"_blank\" rel=\"noreferrer noopener\" style=\"color: #c74f4d; text-decoration: underline;\">10.1128\/jcm.02876-13<\/a><\/span><\/li>\n \t<li>Wolfe A, Toh E, Shibata N et al. Evidence of Uncultivated Bacteria in the Adult Female Bladder. <span> <\/span><em>J Clin Microbiol<\/em>. 2012;50(4):1376-1383. doi:  <span> <\/span><span style=\"text-decoration: underline; color: #c74f4d;\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3318548\/\" target=\"_blank\" rel=\"noreferrer noopener\" style=\"color: #c74f4d; text-decoration: underline;\">10.1128\/jcm.05852-11<\/a><\/span><\/li>\n \t<li>Thomas-White K, Brady M, Wolfe AJ, Mueller ER. The Bladder Is Not Sterile: History and Current Discoveries on the Urinary Microbiome (A bexiga n\u00e3o \u00e9 est\u00e9ril: hist\u00f3ria e descobertas actuais sobre o microbioma urin\u00e1rio). <span> <\/span><em>Relat\u00f3rios actuais de disfun\u00e7\u00e3o da bexiga<\/em>. 2016;11(1):18-24. doi:  <span> <\/span><span style=\"text-decoration: underline; color: #c74f4d;\"><a href=\"https:\/\/dx.doi.org\/10.1007%2Fs11884-016-0345-8\" target=\"_blank\" rel=\"noreferrer noopener\" style=\"color: #c74f4d; text-decoration: underline;\">10.1007\/s11884-016-0345-8<\/a><\/span><\/li>\n \t<li>Price T, Lin H, Gao X et al. 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