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Ge X, He J, Zheng Y, Wang Q, Cheng H, Bao Y, Lin S, Yang X. Association of Blood Metals and Metal Mixtures with the Myocardial Enzyme Profile: An Occupational Population-Based Study in China. Biol Trace Elem Res 2024:10.1007/s12011-024-04316-z. [PMID: 39069562 DOI: 10.1007/s12011-024-04316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Abstract
To investigate a cross-sectional association between blood metal mixture and myocardial enzyme profile, we quantified creatine kinase (CK), creatine kinase-MB (CK-MB), lactate dehydrogenase (LD), α-hydroxybutyrate dehydrogenase (α-HBD), and aspartate transaminase (AST) levels among participants from the manganese-exposed workers healthy cohort (MEWHC) (n = 544). The levels of 22 metals in blood cells were determined using inductively coupled plasma mass spectrometry. The least absolute shrinkage and selection operator (LASSO) penalized regression model was utilized for screening metals. The exposure-response relationship between specific metal and myocardial enzyme profile was identified by general linear regression and restricted cubic spline analyses. The overall effect and interactions were evaluated using Bayesian kernel machine regression (BKMR). Manganese was linearly and positively associated with CK (Poverall = 0.019, Pnon-linearity = 0.307), dominating the positive overall effect of mixture exposure (manganese, arsenic, and rubidium) on CK level. Calcium and zinc were linearly and negatively associated with LD levels (Poverall < 0.05, Pnon-linearity > 0.05), and asserted dominance in the negative overall effect of metal mixtures (rubidium, molybdenum, zinc, nickel, cobalt, calcium, and magnesium) on LD level. Interestingly, we observed a U-shaped dose-response relationship of molybdenum with LD level (Poverall < 0.001, Pnon-linearity = 0.015), an interaction between age and calcium on LD level (Pinteration = 0.041), and an interaction between smoking and molybdenum on LD level (Pinteration = 0.035). Our study provides evidence that metal mixture exposure affects the myocardial enzyme profile. Additional investigation is required to confirm these associations, and to reveal the fundamental mechanisms involved.
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Affiliation(s)
- Xiaoting Ge
- School of Medicine, Guangxi University of Science and Technology, Liuzhou, 545006, China
| | - Junxiu He
- School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Yuan Zheng
- School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Qiuyue Wang
- School of Medicine, Guangxi University of Science and Technology, Liuzhou, 545006, China
| | - Hong Cheng
- School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Yu Bao
- School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Sencai Lin
- School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Xiaobo Yang
- School of Public Health, Guangxi Medical University, Nanning, 530021, China.
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Dai J, Wang G, Wu C, Pan Z, Li H, Shen L, Wu Y. Exposure to Endocrine-Disrupting Chemicals and Congenital Heart Diseases: The Pooled Results Based on the Current Evidence. Pediatr Cardiol 2024:10.1007/s00246-024-03478-w. [PMID: 38602518 DOI: 10.1007/s00246-024-03478-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
The relationships between maternal exposure to endocrine-disrupting chemicals (EDCs) and congenital heart diseases (CHD) are not elucidated yet. The exposure levels of EDCs are generally estimated based on self-reported questionnaires or occupational exposure evaluations in the literature. Therefore, a study based on epidemiological data from human biospecimens is required to provide stronger evidence between maternal exposure to EDC and CHD. Embase, Pubmed, Scopus, and the Cochrane Library databases were searched for related research which provided risk estimates regarding the relationships between maternal EDC exposure and CHD in human offspring. Baseline characteristics and outcomes of CHD were extracted from each included study. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled to calculate the overall estimates of CHD. Subgroup and meta-regression analyses were performed to identify the sources of heterogeneity. Bootstrapping techniques were used in analyses where several studies originated from a similar population. A total of seventeen studies were involved in the meta-analyses. Maternal EDC exposure was significantly related to CHD in offspring (OR 2.15; 95%CI 1.64 to 2.83). EDC exposure was significantly associated with septal defects (OR 2.34; 95%CI 1.77 to 3.10), conotruncal defects (OR 2.54; 95%CI 1.89 to 3.43), right ventricular outflow tract obstruction (OR 2.65; 95%CI 1.73 to 4.07), left ventricular outflow tract obstruction (OR 3.58; 95%CI 2.67 to 4.79), anomalous pulmonary venous return (OR 2.31; 95%CI 1.34 to 4.00), and other heart defects (OR 2.49; 95%CI 1.75 to 3.54). In addition, maternal exposure to heavy metals, which included lead (OR 2.19; 95%CI 1.29 to 3.71), cadmium (OR 1.81; 95%CI 1.28 to 2.56), mercury (OR 2.23; 95%CI 1.13 to 4.44), and manganese (OR 2.65; 95%CI 1.48 to 4.74), increased risks for CHD significantly. In conclusion, based on the latest evidence, maternal EDC exposure may increase CHD risks in human offspring, especially in heavy metal exposure conditions.
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Affiliation(s)
- Jiangtao Dai
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Gang Wang
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lianju Shen
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqing Key Laboratory of Pediatrics, Chongqing, China.
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Li J, Zhang C, Mao B, Liu Q, Wang Y, Yi B, Liu Q. Association between aluminum and iron exposure in maternal blood and umbilical cord blood and congenital heart defects in children. PeerJ 2024; 12:e16755. [PMID: 38274332 PMCID: PMC10809980 DOI: 10.7717/peerj.16755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/13/2023] [Indexed: 01/27/2024] Open
Abstract
Background Congenital heart disease (CHDs) is the major cause of mortality from birth defects, affecting up to 1% of live births worldwide. However, the relationship between aluminum (Al) and iron (Fe) levels and the risk of CHDs has yielded inconsistent results. Methods We conducted a pair-matched case-control study that included 97 CHDs and 194 non-CHDs to investigate the association and interaction between Al/Fe exposure and the risk of CHDs in a birth cohort study in Lanzhou, China. Results Higher concentrations of cord blood Al were associated with a greater risk of total CHDs (aOR = 2.826, 95% CI [1.009-7.266]) and isolated CHDs (aOR = 10.713, 95% CI [1.017-112.851]) compared to the lowest Al level. Both in maternal blood and cord blood, a significant dose-effect was observed between Al level and total CHDs (Ptrend < 0.05), but a similar pattern was not observed for Fe. High Al in addition to high Fe appeared to elicit a stronger association with CHDs than both lowest tertile of Al and Fe level in umbilical cord blood, particularly for multiple CHDs, septal defects and patent ductus arteriosus. Conclusions Our study suggests that exposure to Al during pregnancy (≥2,408 μg/L) is significantly associated with an increased risk of CHDs in offspring, especially septal defects, and that high levels of Al and Fe are strongly correlated with fetal heart development. Further research is needed to understand the underlying mechanisms.
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Affiliation(s)
- Jing Li
- Department of Scientific Research Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu Provincial, China
- Laboratory Medicine Center, Lanzhou University Second Hospital, Lanzhou, Gansu Provincial, China
| | - Chunhua Zhang
- Department of Scientific Research Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu Provincial, China
| | - Baohong Mao
- Department of Scientific Research Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu Provincial, China
| | - Qian Liu
- Department of Scientific Research Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu Provincial, China
| | - Yanxia Wang
- Department of Scientific Research Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu Provincial, China
| | - Bin Yi
- Department of Neonatology, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu Provincial, China
| | - Qing Liu
- Department of Gynecology, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu Provincial, China
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de Souza Lima B, Sanches APV, Ferreira MS, de Oliveira JL, Cleal JK, Ignacio-Souza L. Maternal-placental axis and its impact on fetal outcomes, metabolism, and development. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166855. [PMID: 37633470 DOI: 10.1016/j.bbadis.2023.166855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/23/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
Maternal obesity could impact offspring's health. During "critical period" such as pregnancy insults have a significant role in developing chronic diseases later in life. Literature has shown that diet can play a major role in essential metabolic and development processes on fetal outcomes. Moreover, the placenta, an essential organ developed in pregnancy, seems to have its functions impaired based on pre-gestational and gestational nutritional status. Specifically, a high-fat diet has been shown as a potential nutritional insult that also affects the maternal-placental axis, which is involved in offspring development and outcome. Moreover, some classes of nutrients are associated with pregnancy complications such as reduced intake of micronutrients and diabetes, preeclampsia, and preterm delivery. Thus, we will summarize the current literature on maternal environment factors that impacts the placental development and consequently the fetal an offspring health, or the maternal-placental axis, and this on fetal outcomes, metabolism, and development.
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Affiliation(s)
- Bruna de Souza Lima
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, UNICAMP, Limeira, São Paulo, Brazil.
| | - Ana Paula Varela Sanches
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, UNICAMP, Limeira, São Paulo, Brazil
| | - Maíra Schuchter Ferreira
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, UNICAMP, Limeira, São Paulo, Brazil
| | - Josilene Lopes de Oliveira
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, UNICAMP, Limeira, São Paulo, Brazil
| | - Jane K Cleal
- The Institute of Developmental Sciences, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Letícia Ignacio-Souza
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, UNICAMP, Limeira, São Paulo, Brazil.
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Wang LT, Liu KY, Wang SN, Lin MH, Liao YM, Lin PC, Huang SK, Hsu SH, Chiou SS. Aryl hydrocarbon receptor-kynurenine axis promotes oncogenic activity in BCP-ALL. Cell Biol Toxicol 2023; 39:1471-1487. [PMID: 35687267 PMCID: PMC10425300 DOI: 10.1007/s10565-022-09734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
B-cell precursor acute lymphoblastic leukemia (BCP-ALL), the most common childhood cancer, originates from lymphoid precursor cells in bone marrow committed to the B-cell lineage. Environmental factors and genetic abnormalities disturb the normal maturation of these precursor cells, promoting the formation of leukemia cells and suppressing normal hematopoiesis. The underlying mechanisms of progression are unclear, but BCP-ALL incidence seems to be increasing in parallel with the adoption of modern lifestyles. This study hypothesized that air pollution and haze are risk factors for BCP-ALL progression. The current study revealed that indeno(1,2,3-cd)pyrene (IP), a major component of polycyclic aromatic hydrocarbons (PAHs) in air, promotes oncogenic activities (proliferation, transformation, and disease relapse) in vitro and in vivo. Mechanistically, IP treatment activated the aryl hydrocarbon receptor (AHR)-indoleamine-2,3-dioxygenase (IDOs) axis, thereby enhancing tryptophan metabolism and kynurenine (KYN) level and consequent promoting the KYN-AHR feedback loop. IP treatment decreased the time to disease relapse and increased the BCP-ALL cell count in an orthotopic xenograft mouse model. Additionally, in 50 clinical BCP-ALL samples, AHR and IDO were co-expressed in a disease-specific manner at mRNA and protein levels, while their mRNA levels showed a significant correlation with disease-free survival duration. These results indicated that PAH/IP exposure promotes BCP-ALL disease progression.
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Affiliation(s)
- Li-Ting Wang
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Kwei-Yan Liu
- Department of Respirology & Allergy, Third Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Shen-Nien Wang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Hong Lin
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Mei Liao
- Division of Hematology-Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Chin Lin
- Division of Hematology-Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pediatrics, School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shau-Ku Huang
- Department of Respirology & Allergy, Third Affiliated Hospital of Shenzhen University, Shenzhen, China
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shih-Hsien Hsu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Center of Applied Genomics, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Shyh-Shin Chiou
- Division of Hematology-Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Center of Applied Genomics, Kaohsiung Medical University, Kaohsiung City, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Wang M, Li L, Kang H, Xu H, Huang Q, Li N, Deng Y, Yu P, Liu Z. Maternal environmental, occupational, and urinary metabolite levels of benzene compounds and their association with congenital heart diseases in offspring: a case‒control study in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:66021-66032. [PMID: 37095212 PMCID: PMC10182929 DOI: 10.1007/s11356-023-27015-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
The conclusions about the association of maternal pregnancy environment, occupation, and benzene compounds with fetal CHD are not entirely consistent. Eight hundred seven CHD cases and 1008 controls were included in this study. All occupations were classified and coded against the Occupational Classification Dictionary of the People's Republic of China (2015 version). Logistic regressions were used to explore the correlation among environmental factors, occupation types, and CHDs in offspring. We found that living near public facilities and having exposure to chemical reagents and hazardous substances were significant risk factors for CHDs in offspring. We found that offspring of mothers who worked in agriculture and similar work during pregnancy suffered from CHD. The risk of all CHDs in the offspring of pregnant women working in production manufacturing and related work was significantly higher than that in unemployed pregnant women, the risk was also observed in 4 subtypes of CHDs. We compared the concentrations of the five metabolite (MA, mHA, HA, PGA, and SPMA) levels of benzene compounds in the urine of mothers in case and control groups and found no significant differences. Our study suggests that maternal exposure during pregnancy and certain environmental and occupational conditions are risk factors for CHD in offspring, but did not support an association between concentrations of metabolites of benzene compounds in the urine of pregnant women and CHDs in their offspring.
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Affiliation(s)
- Meixian Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Lu Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Hong Kang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Hongmei Xu
- Department of Gynaecology and Obstetrics, Leshan People's Hospital, Leshan, 614003, China
| | - Qian Huang
- Department of Gynaecology and Obstetrics, Shehong People's Hospital, Shehong, 629299, China
| | - Nana Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Ying Deng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Ping Yu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhen Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
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Liang Y, Pan Z, Zhu M, Gao R, Wang Y, Cheng Y, Zhang N. Exposure to essential and non-essential trace elements and risks of congenital heart defects: A narrative review. Front Nutr 2023; 10:1121826. [PMID: 36998909 PMCID: PMC10043220 DOI: 10.3389/fnut.2023.1121826] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
Congenital heart defects (CHDs) are congenital abnormalities involving the gross structures of the heart and large blood vessels. Environmental factors, genetic factors and their interactions may contribute to the pathogenesis of CHDs. Generally, trace elements can be classified into essential trace elements and non-essential trace elements. Essential trace elements such as copper (Cu), zinc (Zn), iron (Fe), selenium (Se), and manganese (Mn) play important roles in human biological functions such as metabolic function, oxidative stress regulation, and embryonic development. Non-essential trace elements such as cadmium (Cd), arsenic (As), lead (Pb), nickle (Ni), barium (Ba), chromium (Cr) and mercury (Hg) are harmful to health even at low concentrations. Recent studies have revealed the potential involvement of these trace elements in the pathogenesis of CHDs. In this review, we summarized current studies exploring exposure to essential and non-essential trace elements and risks of CHDs, in order to provide further insights for the pathogenesis and prevention of CHDs.
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Affiliation(s)
- Yipu Liang
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zijian Pan
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Mingzheng Zhu
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Ruonan Gao
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Yijue Wang
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yijuan Cheng
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Nannan Zhang
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- *Correspondence: Nannan Zhang,
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