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Day DB, Melough MM, Flynn JT, Zhu H, Kannan K, Ruzinski J, de Boer IH, Sathyanarayana S. Environmental exposure to melamine and its derivatives and kidney outcomes in children. ENVIRONMENTAL RESEARCH 2024; 252:118789. [PMID: 38555096 PMCID: PMC11156556 DOI: 10.1016/j.envres.2024.118789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024]
Abstract
Melamine caused acute nephrotoxicity in a past food adulteration incident, but it is unclear whether and how widespread ambient exposure to melamine and related compounds might affect pediatric kidney health. We assessed cross-sectional associations between childhood exposure to melamine and its derivatives and biomarkers of kidney injury and health and explored potential heterogeneity by sex suggested by sex-dependent differences in renal physiology. We measured melamine and its derivatives ammeline, ammelide, and cyanuric acid (CYA) in spot urine samples collected from 192 children from an urban site (Seattle, WA) and 187 children from a rural site (Yakima, WA) aged 4-8 years in the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) Study. In addition, biomarkers of kidney injury were measured in the same urine samples, including albumin, total protein, KIM-1, NAG, NGAL, and EGF. We utilized linear regressions to examine associations between individual chemical exposures and kidney biomarkers. Interaction terms examined association modification by sex, as well as potential interactions between melamine and CYA. Despite comparable exposures, girls had higher levels of many kidney injury biomarkers compared to boys. A ten-fold higher melamine concentration was associated with a 18% (95% CI: 5.6%, 31%) higher EGF in the full sample, while ten-fold higher melamine was associated with a 76% (14.1%, 173%) higher KIM-1 in boys but not in girls (-10.1% (-40.6%, 36.1%), interaction p = 0.026). Melamine exhibited significant negative interactions with CYA in association with total protein and NAG that appeared to be specific to girls. Our results suggest possible associations between melamine exposure and markers of kidney injury that may be more pronounced in boys. These findings provide novel insights into melamine and related derivative compound health effects at low levels of exposure in children and emphasize the role of sex in mediating the relationship between nephrotoxicant exposure and kidney injury.
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Affiliation(s)
- Drew B Day
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA.
| | - Melissa M Melough
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, DE, 19713, USA.
| | - Joseph T Flynn
- Division of Nephrology, Seattle Children's Hospital, 4800 Sand Point NE, Seattle, WA, 98105, USA; Department of Pediatrics, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA.
| | - Hongkai Zhu
- Department of Environmental Medicine, Nankai University, No. 38 Tongyan Road, Jinnan District, Tianjin, 300350, China.
| | | | - John Ruzinski
- Kidney Research Institute, Department of Nephrology, University of Washington, 908 Jefferson St, Seattle, WA, 98104, USA.
| | - Ian H de Boer
- Kidney Research Institute, Department of Nephrology, University of Washington, 908 Jefferson St, Seattle, WA, 98104, USA.
| | - Sheela Sathyanarayana
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA; Department of Pediatrics, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA.
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2
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Chen HC, Feng WW, Audira G, Kurnia KA, Hung SH, Castillo AL, Roldan MJM, Hsiao CD, Hung CH. Evaluation of sub-chronic toxicity of melamine via systematic or oral delivery in adult zebrafish based on behavioral endpoints. Neurotoxicology 2024; 102:68-80. [PMID: 38599288 DOI: 10.1016/j.neuro.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/01/2024] [Accepted: 04/08/2024] [Indexed: 04/12/2024]
Abstract
Melamine-tainted products have been found in the market and raised issues about food safety. Recent studies done in rodents and humans demonstrated the toxicities of melamine, especially in causing kidney damage and bladder stone formation. However, very few studies assessed its behavior toxicity in organisms, including fish. Therefore, in this study, the researchers aim to determine whether sub-chronic exposure to melamine via oral and systematic administration could induce behavioral abnormality in zebrafish. After 14 days of systematic exposure to melamine at doses of 0.1 and 10 ppm levels, zebrafish were subjected to multiple behavioral assays. Results from both exposure routes showed that melamine indeed slightly increased fish locomotion and altered their exploratory behaviors in the novel tank assay. Furthermore, tightened shoaling formation was also displayed by the treated fish in the waterborne exposure group. However, melamine exposure did not cause any obvious alterations in fish behaviors during other behavioral tests. In addition, in comparison with previously published data on the behavior toxicities of several solvents in zebrafish, our phenomic analysis suggests the relatively low behavior toxicities of melamine via either systematic exposure or oral administration to zebrafish compared to those solvents. Nevertheless, our data indicate that the potential neurotoxicity of chronic low-dose melamine should not be ignored.
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Affiliation(s)
- Hsiu-Chao Chen
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Da-Shu, Kaohsiung 84001, Taiwan; Department of Dermatology, E-Da Cancer Hospital, Kaohsiung 824005, Taiwan; Dr. Feng's Dermatology Clinic, Kaohsiung 811022, Taiwan
| | - Wen-Wei Feng
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Da-Shu, Kaohsiung 84001, Taiwan; Department of Dermatology, E-Da Cancer Hospital, Kaohsiung 824005, Taiwan; Dr. Feng's Dermatology Clinic, Kaohsiung 811022, Taiwan
| | - Gilbert Audira
- Department of Bioscience Technology, Chung Yuan Christian University, Taoyuan 320314, Taiwan
| | - Kevin Adi Kurnia
- Department of Bioscience Technology, Chung Yuan Christian University, Taoyuan 320314, Taiwan; Department of Chemistry, Chung Yuan Christian University, Taoyuan 320314, Taiwan
| | - San-Ho Hung
- Department of Physical Therapy, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung 83102, Taiwan; Department of Radiology, Fooyin University Hospital, No. 5, Zhongshan Road, Donggang Township, Pingtung 92847, Taiwan
| | - Agnes L Castillo
- Faculty of Pharmacy, The Graduate School and Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila 1008, Philippines
| | - Marri Jmelou M Roldan
- Faculty of Pharmacy and The Graduate School, University of Santo Tomas, Manila 1008, Philippines
| | - Chung-Der Hsiao
- Department of Bioscience Technology, Chung Yuan Christian University, Taoyuan 320314, Taiwan; Department of Chemistry, Chung Yuan Christian University, Taoyuan 320314, Taiwan; Research Center for Aquatic Toxicology and Pharmacology, Chung Yuan Christian University, Taoyuan 320314, Taiwan.
| | - Chih-Hsin Hung
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Da-Shu, Kaohsiung 84001, Taiwan.
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Chen Z, Su Y, Chen J, Li Z, Wang T. Study on the health risk of cyanuric acid in swimming pool water and its prevention and control measures. Front Public Health 2024; 11:1294842. [PMID: 38259736 PMCID: PMC10801151 DOI: 10.3389/fpubh.2023.1294842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Cyanuric acid is a widely used fine chemical intermediate that acts as a free chlorine buffer in swimming pool water, wherein it is often used as a stabilizer to maintain the germicidal efficacy of chlorinated disinfectants. However, it has also been associated with health risks. Herein, we introduced the sources and functions of cyanuric acid in swimming pool water, focusing on potential health risks associated with excessive concentration of the component and the current control standards worldwide. Also, the prevention and control measures were summarized in terms of physical chemistry, biodegradation, and ultraviolet radiation to provide a basis for the development of public health policies for swimming pool management.
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Habotta OA, Abdeen A, Roomi AB, Elgndy AI, Sorour SM, Morsi MH, Kamal KM, Ibrahim SF, Abdelrahaman D, Fericean L, Banatean-Dunea I, Ghamry HI, El-Nablaway M, Atawia RT, Abdelhady D. Nootkatone Mitigated Melamine-Evoked Hepatotoxicity by Featuring Oxidative Stress and Inflammation Interconnected Mechanisms: In Vivo and In Silico Approaches. TOXICS 2023; 11:784. [PMID: 37755794 PMCID: PMC10535958 DOI: 10.3390/toxics11090784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023]
Abstract
Melamine (ML) is a common environmental contaminant, commonly used in food fraud, representing a serious health hazard and jeopardizing human and animal health. Recently, nootkatone (NK), a naturally occurring sesquiterpenoid, has garnered considerable attention due to its potential therapeutic advantages. We investigated the potential mechanisms underlying the protective effects of NK against ML-induced liver injury in rats. Five groups were utilized: control, ML, NK10, ML-NK5, and ML-NK10. ML induced substantial hepatotoxicity, including considerable alterations in biochemical parameters and histology. The oxidative distress triggered by ML increased the generation of malondialdehyde (MDA) and nitric oxide (NO) and decreased levels of reduced glutathione (GSH), catalase (CAT), and superoxide dismutase (SOD) activities. In addition, decreased expression of nuclear factor-erythroid 2-related factor 2 (Nrf2) and increased nuclear factor kappa beta (NF-κB) expression levels were observed in hepatocytes, which indicated the occurrence of inflammatory changes following ML exposure. These alterations were alleviated by NK supplementation in a dose-dependent manner. The data revealed that the favorable effects of NK were attributed, at least in part, to its antioxidant and anti-inflammatory properties. Moreover, our results were supported by molecular docking studies that revealed a good fit and interactions between NK and antioxidant enzymes. Thus, the current study demonstrated that NK is a potential new food additive for the prevention or treatment of ML-induced toxicity.
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Affiliation(s)
- Ola A. Habotta
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Abdeen
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, Benha University, Toukh 13736, Egypt
| | - Ali B. Roomi
- Department of Quality Assurance, University of Thi-Qar, Thi-Qar, Nasiriyah 64001, Iraq
- Department of Medical Laboratory, College of Health and Medical Technology, National University of Science and Technology, Thi-Qar, Nasiriyah 64001, Iraq
| | - Afnan I. Elgndy
- Department of Physiology, Faculty of Medicine, Benha University, Benha 13518, Egypt
| | - Safwa M. Sorour
- Department of Pharmacology, Faculty of Medicine, Benha University, Benha 13518, Egypt
| | - Maha H. Morsi
- Department of Clinical and Chemical Pathology, Faculty of Applied Health Sciences Technology, Misr University for Science and Technology, Giza 3236101, Egypt
| | - Kamal M. Kamal
- Department of Anatomy and Embryology, Faculty of Medicine, Benha University, Benha 13518, Egypt
| | - Samah F. Ibrahim
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Doaa Abdelrahaman
- Department of Basic Sciences, Faculty of Medicine, Al-Azhar University, Cairo 11751, Egypt
| | - Liana Fericean
- Department of Biology and Plant Protection, Faculty of Agriculture, University of Life Sciences “King Michael I” from Timișoara, Calea Aradului 119, CUI 3487181, 300645 Timisoara, Romania
| | - Ioan Banatean-Dunea
- Department of Biology and Plant Protection, Faculty of Agriculture, University of Life Sciences “King Michael I” from Timișoara, Calea Aradului 119, CUI 3487181, 300645 Timisoara, Romania
| | - Heba I. Ghamry
- Nutrition and Food Sciences, Department of Home Economics, Faculty of Home Economics, King Khalid University, P.O. Box 960, Abha 61421, Saudi Arabia
| | - Mohammad El-Nablaway
- Department of Medical Biochemistry, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
- Department of Basic Medical Sciences, College of Medicine, AlMaarefa University, P.O. Box 71666, Riyadh 11597, Saudi Arabia
| | - Reem T. Atawia
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo 11566, Egypt
- Department of Pharmaceutical Sciences, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK 73096, USA
| | - Dania Abdelhady
- Department of Physiology, Faculty of Medicine, Benha University, Benha 13518, Egypt
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Habotta OA, Abdeen A, El-Hanafy AA, Yassin N, Elgameel D, Ibrahim SF, Abdelrahaman D, Hasan T, Imbrea F, Ghamry HI, Fericean L, Behairy A, Atwa AM, Abdelkader A, Mahdi MR, El-Mosallamy SA. Sesquiterpene nootkatone counteracted the melamine-induced neurotoxicity via repressing of oxidative stress, inflammatory, and apoptotic trajectories. Biomed Pharmacother 2023; 165:115133. [PMID: 37454594 DOI: 10.1016/j.biopha.2023.115133] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
Melamine (ML), a chemical substance of high nitrogen content, is used as a food adulterant. Former evidences implied that ML could induce a variety of toxic effects including neurotoxicity and cognitive impairment. Therefore, the aim of this study was to delineate the protective effect of the nootkatone (NK) against ML-induced neural adverse effects. Rats were orally pretreated with NK (5 and 10 mg/kg) prior to the oral administration of ML (700 mg/kg) for a period of 28 days. Our findings unveiled remarkable alleviating effect of NK on MK-induced neurobehavioral disturbance in open field test. Furthermore, NK lessened ML-caused increases in the acetylcholine esterase level in the brain tissue of exposed rats. NK also decreased the neural oxidative stress as represented by elevated levels of SOD, CAT, and GSH along with decreased MDA and NO levels. Upregulated mRNA expression levels of neural NRF-2 and HO-1 were noticed after NK administration. Remarkable anti-inflammatory impact was prominent by decreased neural IL-1β, and TNF-α along with downregulated NF-κB and TLR-4 gene expression levels in NK-treated rats. Noteworthily, pre-treatment with NK decreased the immune reaction of RAGE and HMGB-1 induced by oral ML exposure. Brain histological examination validated the obtained biochemical and molecular results. To sum up, these outcomes reveal that NK successfully alleviated the neural damage induced by ML via blocking of oxidative stress, and inflammatory signaling pathways. Consequently, our study may suggest NK as a new effective therapeutic supplement for treatment of ML-mediated neurotoxicity in rats via inhibition of HMGB-1-RAGE/TLR-4/NF-κB.
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Affiliation(s)
- Ola A Habotta
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, 35516, Egypt.
| | - Ahmed Abdeen
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, Benha University, Toukh 13736, Egypt.
| | - Aya A El-Hanafy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt; Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, New Mansoura University, New Mansoura, 35516, Egypt.
| | - Neimet Yassin
- Department of Pharmacology, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt.
| | - Dina Elgameel
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta 31111, Egypt.
| | - Samah F Ibrahim
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia.
| | - Doaa Abdelrahaman
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia.
| | - Tabinda Hasan
- Department of Basic Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia.
| | - Florin Imbrea
- Department of Crop Science, Faculty of Agriculture, University of Life Sciences "King Mihai I" from Timisoara, 119, Calea Aradului, 300645 Timisoara, Romania.
| | - Heba I Ghamry
- Nutrition and Food Sciences, Department of Home Economics, Faculty of Home Economics, King Khalid University, P.O. Box 960, Abha 61421, Saudi Arabia.
| | - Liana Fericean
- Department of Biology and Plant protection, Faculty of Agriculture. University of Life Sciences "King Michael I" from Timișoara, Calea Aradului 119, CUI 3487181, Romania.
| | - Ali Behairy
- Department of Pharmacology, Faculty of Medicine, Benha University, Benha 13518, Egypt.
| | - Ahmed M Atwa
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Egyptian Russian University, Cairo 11829, Egypt.
| | - Afaf Abdelkader
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Benha University, Benha 13518, Egypt.
| | - Mohamed R Mahdi
- Department of Human Anatomy and Embryology, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt; Department of Basic Medical Sciences, Faculty of Medicine, Galala University, Suez, Egypt.
| | - Shaaban A El-Mosallamy
- Department of Forensic Medicine and Clinical toxicology, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt.
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Kim WI, Pak SW, Lee SJ, Moon C, Shin IS, Lee IC, Kim JC. Effects of melamine and cyanuric acid on placental and fetal development in rats. Food Chem Toxicol 2023:113862. [PMID: 37247804 DOI: 10.1016/j.fct.2023.113862] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023]
Abstract
Melamine or cyanuric acid alone has low toxicity, but combined exposure to melamine and cyanuric acid was reported to cause unexpected toxicological effects. This study investigated the potential effects and toxic mechanism of combined exposure to melamine and cyanuric acid on placental and fetal development in rats. Exposure to melamine and cyanuric acid caused maternal toxicity manifested by increased abnormal symptoms and decreased body weight gain. Developmental toxic effects included a decrease in placental and fetal weights with increased fetal deaths and post-implantation loss. Melamine and cyanuric acid induced oxidative stress in the developing placenta and fetus. The placentas from rats treated with melamine and cyanuric acid showed shortening of the placental layers with histological changes, decreased cell proliferation, increased apoptotic changes, and decreased insulin-like growth factor (IGF)/IGF-binding proteins (IGFBPs) and placental lactogen (PL) expression levels. Fetuses from melamine- and cyanuric acid-treated dams showed increased apoptotic changes and suppressed cellular proliferation in their livers and vertebrae. Consequently, combined exposure to melamine and cyanuric acid resulted in high levels of oxidative stress and impaired placental development associated with impairment of the IGF/IGFBP and PL systems, resulting in increased apoptotic changes and reduced fetal cell proliferation.
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Affiliation(s)
- Woong-Il Kim
- College of Veterinary Medicine and BK21 FOUR Program, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - So-Won Pak
- College of Veterinary Medicine and BK21 FOUR Program, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Se-Jin Lee
- College of Veterinary Medicine and BK21 FOUR Program, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Changjong Moon
- College of Veterinary Medicine and BK21 FOUR Program, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - In-Sik Shin
- College of Veterinary Medicine and BK21 FOUR Program, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - In-Chul Lee
- Functional Biomaterial Research Center, Korea Research Institute of Bioscience and Biotechnology, Jeongeup, 56212, Republic of Korea.
| | - Jong-Choon Kim
- College of Veterinary Medicine and BK21 FOUR Program, Chonnam National University, Gwangju, 61186, Republic of Korea.
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Sun W, Zhao X, Wan Y, Yang Y, Li X, Chen X, Mei Y, An L. Prenatal cyanuric acid exposure induced spatial learning impairments associated with alteration of acetylcholine-mediated neural information flow at the hippocampal CA3-CA1 synapses of male rats. Hum Exp Toxicol 2023; 42:9603271231163477. [PMID: 36890733 DOI: 10.1177/09603271231163477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Cyanuric acid (CA) is reported to induce nephrotoxicity but its toxic effect is not fully known. Prenatal CA exposure causes neurodevelopmental deficits and abnormal behavior in spatial learning ability. Dysfunction of the acetyl-cholinergic system in neural information processing is correlated with spatial learning impairment and was found in the previous reports of CA structural analogue melamine. To further investigate the neurotoxic effects and the potential mechanism, the acetylcholine (ACh) level was detected in the rats which were exposed to CA during the whole of gestation. Local field potentials (LFPs) were recorded when rats infused with ACh or cholinergic receptor agonist into hippocampal CA3 or CA1 region were trained in the Y-maze task. We found the expression of ACh in the hippocampus was significantly reduced in dose-dependent manners. Intra-hippocampal infusion of ACh into the CA1 but not the CA3 region could effectively mitigate learning deficits induced by CA exposure. However, activation of cholinergic receptors did not rescue the learning impairments. In the LFP recording, we found that the hippocampal ACh infusions could enhance the values of phase synchronization between CA3 and CA1 regions in theta and alpha oscillations. Meanwhile, the reduction in the coupling directional index and the strength of CA3 driving CA1 in the CA-treated groups was also reversed by the ACh infusions. Our findings are consistent with the hypothesis and provide the first evidence that prenatal CA exposure induced spatial learning defect is attributed to the weakened ACh-mediated neuronal coupling and NIF in the CA3-CA1 pathway.
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Affiliation(s)
- Wei Sun
- Department of Obstetrics, 326770The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China.,Department of Geriatrics, 326770The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China.,Department of Pediatric, 326770The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Xuanyin Zhao
- Department of Obstetrics, 326770The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Yiwen Wan
- Department of Neurology, Jinan Geriatric/Rehabilitation Hospital, China.,Department of Rehabilitation Medicine, 70570Shenzhen Bao'an Hospital Affiliated of Southern Medical University, Shenzhen, China
| | - Yang Yang
- Department of Pediatric, 326770The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Xiaoliang Li
- Department of Neurology, Jinan Geriatric/Rehabilitation Hospital, China
| | - Xiao Chen
- Department of Neurology, Jinan Geriatric/Rehabilitation Hospital, China
| | - Yazi Mei
- 47879Graduate School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lei An
- Department of Geriatrics, 326770The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China.,Department of Pediatric, 326770The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China.,Department of Neurology, Jinan Geriatric/Rehabilitation Hospital, China.,47879Graduate School of Guangzhou University of Chinese Medicine, Guangzhou, China
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