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Abstract
Fracture management in pregnant patients is challenging. Anatomic and physiologic changes in pregnancy increase the complexity of treatment. Maternal trauma increases the risk of fetal loss, preterm birth, placental abruption, cesarean delivery, and maternal death. Initial resuscitation and treatment in a facility equipped to handle the orthopaedic injury and preterm births are paramount. Pelvic and acetabular injuries are potentially life threatening. The benefits and risks of surgical treatment must be carefully considered. The risks posed by anesthetic agents, antibiotic agents, anticoagulant agents, and radiation exposure must be understood. Positioning of the patient can affect the viability of the fetus. If surgery is necessary, the left lateral decubitus position decreases fetal hypotension. A specialized team including an obstetrician, perinatologist, orthopaedic surgeon, general trauma surgeon, critical care specialist, emergency medicine specialist, anesthesiologist, radiologist, and nurse must collaborate to improve maternal and fetal outcomes.
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Clough BH, Ylostalo J, Browder E, McNeill EP, Bartosh TJ, Rawls HR, Nakamoto T, Gregory CA. Theobromine Upregulates Osteogenesis by Human Mesenchymal Stem Cells In Vitro and Accelerates Bone Development in Rats. Calcif Tissue Int 2017; 100:298-310. [PMID: 27913821 PMCID: PMC5315589 DOI: 10.1007/s00223-016-0215-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/25/2016] [Indexed: 12/21/2022]
Abstract
Theobromine (THB) is one of the major xanthine-like alkaloids found in cacao plant and a variety of other foodstuffs such as tea leaves, guarana and cola nuts. Historically, THB and its derivatives have been utilized to treat cardiac and circulatory disorders, drug-induced nephrotoxicity, proteinuria and as an immune-modulator. Our previous work demonstrated that THB has the capacity to improve the formation of hydroxyl-apatite during tooth development, suggesting that it may also enhance skeletal development. With its excellent safety profile and resistance to pharmacokinetic elimination, we reasoned that it might be an excellent natural osteoanabolic supplement during pregnancy, lactation and early postnatal growth. To determine whether THB had an effect on human osteoprogenitors, we subjected primary human bone marrow mesenchymal stem cells (hMSCs) to osteogenic assays after exposure to THB in vitro and observed that THB exposure increased the rate of osteogenesis and mineralization by hMSCs. Moreover, THB exposure resulted in a list of upregulated mRNA transcripts that best matched an osteogenic tissue expression signature as compared to other tissue expression signatures archived in several databases. To determine whether oral administration of THB resulted in improved skeletal growth, we provided pregnant rats with chow supplemented with THB during pregnancy and lactation. After weaning, offspring received THB continuously until postnatal day 50 (approximately 10 mg kg-1 day-1). Administration of THB resulted in neonates with larger bones, and 50-day-old offspring accumulated greater body mass, longer and thicker femora and superior tibial trabecular parameters. The accelerated growth did not adversely affect the strength and resilience of the bones. These results indicate that THB increases the osteogenic potential of bone marrow osteoprogenitors, and dietary supplementation of a safe dose of THB to expectant mothers and during the postnatal period could accelerate skeletal development in their offspring.
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Affiliation(s)
- Bret H Clough
- Institute for Regenerative Medicine, Texas A&M Health Science Center, Module C 5701 Airport Road, Temple, TX, 76502, USA
| | - Joni Ylostalo
- Department of Biology, University of Mary Hardin Baylor, 900 College Street, Belton, TX, 76513, USA
| | - Elizabeth Browder
- Texas A&M Department of Comparative Medicine, College Station, TX, 77843, USA
| | - Eoin P McNeill
- Institute for Regenerative Medicine, Texas A&M Health Science Center, Module C 5701 Airport Road, Temple, TX, 76502, USA
| | - Thomas J Bartosh
- Institute for Regenerative Medicine, Texas A&M Health Science Center, Module C 5701 Airport Road, Temple, TX, 76502, USA
| | - H Ralph Rawls
- Department of Comprehensive Dentistry, UT Health Science Center, San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Tetsuo Nakamoto
- Department of Physiology, 7th Floor Medical Education Building, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Carl A Gregory
- Institute for Regenerative Medicine, Texas A&M Health Science Center, Module C 5701 Airport Road, Temple, TX, 76502, USA.
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O'Brien EC, Kilbane MT, McKenna MJ, Segurado R, Geraghty AA, McAuliffe FM. Calcium intake in winter pregnancy attenuates impact of vitamin D inadequacy on urine NTX, a marker of bone resorption. Eur J Nutr 2017; 57:1015-1023. [PMID: 28224220 DOI: 10.1007/s00394-017-1385-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/25/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE Pregnancy is characterised by increased bone turnover, but high bone turnover with resorption exceeding formation may lead to negative maternal bone remodelling. Recent studies are conflicting regarding the effect of calcium on skeletal health in pregnancy. The aim of this study was to examine the seasonal effect of serum 25-hydroxyvitamin D (25OHD) and dietary calcium on a marker of bone resorption. METHODS This was prospective study of 205 pregnant women [two cohorts; early pregnancy at 13 weeks (n = 96), and late pregnancy at 28 weeks (n = 109)]. Serum 25OHD and urine cross-linked N-telopeptides of type I collagen (uNTX) were measured at both time points. Intakes of vitamin D and calcium were recorded using 3-day food diaries at each trimester. RESULTS Compared to summer pregnancies, winter pregnancies had significantly lower 25OHD and significantly higher uNTX. Higher calcium intakes were negatively correlated with uNTX in winter, but not summer. In late pregnancy, compared to those reporting calcium intakes ≥1000 mg/day, intakes of <1000 mg/day were associated with a greater increase in uNTX in winter pregnancies than in summer (41.8 vs. 0.9%). Increasing calcium intake in winter by 200 mg/day predicted a 13.3% reduction in late pregnancy uNTX. CONCLUSIONS In late pregnancy, during winter months when 25OHD is inadequate, intakes of dietary calcium <1000 mg/day were associated with significantly increased bone resorption (uNTX). Additional dietary calcium is associated with reduced bone resorption in late pregnancy, with greater effect observed in winter. Further research regarding optimal dietary calcium and 25OHD in pregnancy is required, particularly for women gestating through winter.
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Affiliation(s)
- Eileen C O'Brien
- UCD Perinatal Research Centre, UCD Obstetrics and Gynaecology, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Mark T Kilbane
- Department of Clinical Chemistry, St Vincent's University Hospital, Dublin, Ireland
| | - Malachi J McKenna
- UCD Perinatal Research Centre, UCD Obstetrics and Gynaecology, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland.,Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland.,UCD School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Ricardo Segurado
- Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Aisling A Geraghty
- UCD Perinatal Research Centre, UCD Obstetrics and Gynaecology, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, UCD Obstetrics and Gynaecology, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland.
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55
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Clinical Recommendations for the Use of Islet Cell Autoantibodies to Distinguish Autoimmune and Non-Autoimmune Gestational Diabetes. Clin Rev Allergy Immunol 2016; 50:23-33. [PMID: 25392235 DOI: 10.1007/s12016-014-8461-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. The prevalence of GDM is highly variable, depending on the population studied, and reflects the underlying pattern of diabetes in the population. GDM manifests by the second half of pregnancy and disappears following delivery in most cases, but is associated with the risk of subsequent diabetes development. Normal pregnancy induces carbohydrate intolerance to favor the availability of nutrients for the fetus, which is compensated by increased insulin secretion from the maternal pancreas. Pregnancy shares similarities with adiposity in metabolism to save energy, and both conditions favor the development of insulin resistance (IR) and low-grade inflammation. A highly complicated network of modified regulatory mechanisms may primarily affect carbohydrate metabolism by promoting autoimmune reactions to pancreatic β cells and affecting insulin function. As a result, diabetes development during pregnancy is facilitated. Depending on a pregnant woman's genetic susceptibility to diabetes, autoimmune mechanisms or IR are fundamental to the development autoimmune or non-autoimmune GDM, respectively. Pregnancy may facilitate the identification of women at risk of developing diabetes later in life; autoimmune and non-autoimmune GDM may be early markers of the risk of future type 1 and type 2 diabetes, respectively. The most convenient and efficient way to discriminate GDM types is to assess pancreatic β-cell autoantibodies along with diagnosing diabetes in pregnancy.
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Vescini F, Attanasio R, Balestrieri A, Bandeira F, Bonadonna S, Camozzi V, Cassibba S, Cesareo R, Chiodini I, Francucci CM, Gianotti L, Grimaldi F, Guglielmi R, Madeo B, Marcocci C, Palermo A, Scillitani A, Vignali E, Rochira V, Zini M. Italian association of clinical endocrinologists (AME) position statement: drug therapy of osteoporosis. J Endocrinol Invest 2016; 39:807-34. [PMID: 26969462 PMCID: PMC4964748 DOI: 10.1007/s40618-016-0434-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/22/2016] [Indexed: 12/17/2022]
Abstract
Treatment of osteoporosis is aimed to prevent fragility fractures and to stabilize or increase bone mineral density. Several drugs with different efficacy and safety profiles are available. The long-term therapeutic strategy should be planned, and the initial treatment should be selected according to the individual site-specific fracture risk and the need to give the maximal protection when the fracture risk is highest (i.e. in the late life). The present consensus focused on the strategies for the treatment of postmenopausal osteoporosis taking into consideration all the drugs available for this purpose. A short revision of the literature about treatment of secondary osteoporosis due both to androgen deprivation therapy for prostate cancer and to aromatase inhibitors for breast cancer was also performed. Also premenopausal females and males with osteoporosis are frequently seen in endocrine settings. Finally particular attention was paid to the tailoring of treatment as well as to its duration.
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Affiliation(s)
- F. Vescini
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, P.le S.M. della Misericordia, 15, 33100 Udine, Italy
| | - R. Attanasio
- Endocrinology Service, Galeazzi Institute IRCCS, Milan, Italy
| | - A. Balestrieri
- Unit of Endocrinology and Diabetology, Department of Internal Medicine, M. Bufalini Hospital, Cesena, Italy
| | - F. Bandeira
- Division of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| | | | - V. Camozzi
- Unit of Endocrinology, Department of Medicine, University of Padova, Padua, Italy
| | - S. Cassibba
- Endocrinology and Diabetology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - R. Cesareo
- Endocrinology, S. Maria Goretti Hospital, Latina, Italy
| | - I. Chiodini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C. Maria Francucci
- Post Acute and Long Term Care Department, I.N.R.C.A., Ancona, Italy
- San Pier Damiano Hospital, Villa Maria Group Care and Research, Faenza, Ravenna Italy
| | - L. Gianotti
- Endocrinology and Metabolic Diseases, S. Croce e Carle Hospital, Cuneo, Italy
| | - F. Grimaldi
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, P.le S.M. della Misericordia, 15, 33100 Udine, Italy
| | - R. Guglielmi
- Endocrinology Unit, Regina Apostolorum Hospital, Albano Laziale, Rome Italy
| | - B. Madeo
- Integrated Department of Medicine, Endocrinology and Metabolism, Geriatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - C. Marcocci
- Endocrine Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - A. Palermo
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - A. Scillitani
- Endocrinology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - E. Vignali
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - V. Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - M. Zini
- Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
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Cavalier E, Bergmann P, Bruyère O, Delanaye P, Durnez A, Devogelaer JP, Ferrari SL, Gielen E, Goemaere S, Kaufman JM, Toukap AN, Reginster JY, Rousseau AF, Rozenberg S, Scheen AJ, Body JJ. The role of biochemical of bone turnover markers in osteoporosis and metabolic bone disease: a consensus paper of the Belgian Bone Club. Osteoporos Int 2016; 27:2181-2195. [PMID: 27026330 DOI: 10.1007/s00198-016-3561-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/03/2016] [Indexed: 01/22/2023]
Abstract
The exact role of biochemical markers of bone turnover in the management of metabolic bone diseases remains a topic of controversy. In this consensus paper, the Belgian Bone Club aimed to provide a state of the art on the use of these biomarkers in different clinical or physiological situations like in postmenopausal women, osteoporosis in men, in elderly patients, in patients suffering from bone metastasis, in patients with chronic renal failure, in pregnant or lactating women, in intensive care patients, and in diabetics. We also gave our considerations on the analytical issues linked to the use of these biomarkers, on potential new emerging biomarkers, and on the use of bone turnover biomarkers in the follow-up of patients treated with new drugs for osteoporosis.
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Affiliation(s)
- E Cavalier
- Department of Clinical Chemistry, UnilabLg, CIRM, University of Liège, CHU de Liège, Domaine du Sart-Tilman, 4000, Liège, Belgium.
| | - P Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - O Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - P Delanaye
- Department of Nephrology Dialysis Transplantation, University of Liège, CHU de Liège, Liège, Belgium
| | - A Durnez
- Pôle de Pathologie Rhumatismale, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - J-P Devogelaer
- Pôle de Pathologie Rhumatismale, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - S L Ferrari
- Department of Bone Diseases, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - E Gielen
- Gerontology and Geriatrics Section, Department of Clinical and Experimental Medicine, K.U. Leuven, Leuven, Belgium
| | - S Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - J-M Kaufman
- Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
- Centre Académique de Recherche et d'Expérimentation en Santé SPRL (CARES SPRL), Liège, Belgium
| | - A Nzeusseu Toukap
- Pôle de Pathologie Rhumatismale, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - J-Y Reginster
- Centre Académique de Recherche et d'Expérimentation en Santé SPRL (CARES SPRL), Liège, Belgium
| | - A-F Rousseau
- Burn Centre and General Intensive Care Department, University of Liège, CHU de Liège, Liège, Belgium
| | - S Rozenberg
- Department of Gynaecology-Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - A J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, University of Liège CHU de Liège, Liège, Belgium
| | - J-J Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Nakamura Y, Kamimura M, Ikegami S, Mukaiyama K, Komatsu M, Uchiyama S, Kato H. A case series of pregnancy- and lactation-associated osteoporosis and a review of the literature. Ther Clin Risk Manag 2015; 11:1361-5. [PMID: 26379439 PMCID: PMC4567231 DOI: 10.2147/tcrm.s87274] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The syndrome of pregnancy- and lactation-associated osteoporosis is a rare disorder whose precise etiology and treatment are largely unknown. We herein report two such cases occurring in the early postpartum period that led to multiple fragility compression fractures. Combination therapy of vitamin D and vitamin K enabled a marked gradual increase in bone mineral density.
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Affiliation(s)
- Yukio Nakamura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan ; Department of Orthopaedic Surgery, Showa Inan General Hospital, Komagane, Japan
| | - Mikio Kamimura
- Center of Osteoporosis and Spinal Disorders, Kamimura Clinic, Matsumoto, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Keijiro Mukaiyama
- Department of Orthopaedic Surgery, Azumi General Hospital, Azumino, Japan
| | - Masatoshi Komatsu
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeharu Uchiyama
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Markoula S, Sioka C, Exarchopoulos T, Chatzistefanidis D, Kalef-Ezra J, Fotopoulos A, Kyritsis AP. Gender specific association of decreased bone mineral density in patients with epilepsy. Neurol Neurochir Pol 2015; 49:267-71. [DOI: 10.1016/j.pjnns.2015.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/27/2015] [Accepted: 06/11/2015] [Indexed: 11/29/2022]
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Olmos-Ortiz A, Avila E, Durand-Carbajal M, Díaz L. Regulation of calcitriol biosynthesis and activity: focus on gestational vitamin D deficiency and adverse pregnancy outcomes. Nutrients 2015; 7:443-80. [PMID: 25584965 PMCID: PMC4303849 DOI: 10.3390/nu7010443] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/16/2014] [Indexed: 02/07/2023] Open
Abstract
Vitamin D has garnered a great deal of attention in recent years due to a global prevalence of vitamin D deficiency associated with an increased risk of a variety of human diseases. Specifically, hypovitaminosis D in pregnant women is highly common and has important implications for the mother and lifelong health of the child, since it has been linked to maternal and child infections, small-for-gestational age, preterm delivery, preeclampsia, gestational diabetes, as well as imprinting on the infant for life chronic diseases. Therefore, factors that regulate vitamin D metabolism are of main importance, especially during pregnancy. The hormonal form and most active metabolite of vitamin D is calcitriol. This hormone mediates its biological effects through a specific nuclear receptor, which is found in many tissues including the placenta. Calcitriol synthesis and degradation depend on the expression and activity of CYP27B1 and CYP24A1 cytochromes, respectively, for which regulation is tissue specific. Among the factors that modify these cytochromes expression and/or activity are calcitriol itself, parathyroid hormone, fibroblast growth factor 23, cytokines, calcium and phosphate. This review provides a current overview on the regulation of vitamin D metabolism, focusing on vitamin D deficiency during gestation and its impact on pregnancy outcomes.
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Affiliation(s)
- Andrea Olmos-Ortiz
- Department of Reproductive Biology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan 14000, Mexico City, Mexico.
| | - Euclides Avila
- Department of Reproductive Biology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan 14000, Mexico City, Mexico.
| | - Marta Durand-Carbajal
- Department of Reproductive Biology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan 14000, Mexico City, Mexico.
| | - Lorenza Díaz
- Department of Reproductive Biology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan 14000, Mexico City, Mexico.
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