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Misawa T, Kagawa T, Ohgami N, Tazaki A, Ohnuma S, Naito H, Chen D, Gu Y, Tamura T, Wakai K, Nishiwaki K, Kato M. Elevated level of urinary tellurium is a potential risk for increase of blood pressure in humans and mice. ENVIRONMENT INTERNATIONAL 2024; 188:108735. [PMID: 38761428 DOI: 10.1016/j.envint.2024.108735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/12/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND People worldwide are routinely exposed to tellurium mainly via dietary ingestion. There has been no study to clarify the contribution of tellurium to blood pressure in humans or animals. METHODS In this cross-sectional study conducted in a general population of 2592 residents in Japan, the associations of urinary tellurium levels with blood pressure and prevalence of hypertension were investigated. The potential sources of tellurium were also investigated. An interventional study in mice confirmed the effect of tellurium exposure on blood pressure. RESULTS Linear and logistic regression analyses with consideration of confounders including urinary sodium-potassium ratio showed significant positive associations of urinary tellurium level with prevalence of hypertension and blood pressure. Cereals/beans and vegetables/fruits were determined to be potential dietary sources of tellurium exposure. Intermediary analysis suggested that increased intake of cereals/beans, but not that of vegetables/fruits, is positively associated with the tellurium-mediated risk of hypertension. Correspondingly, the mouse study showed that exposure to a putative human-equivalent dose of tellurium via drinking water increased blood pressure with an elevated level of urinary tellurium. The temporally increased blood pressure was decreased to the normal level by a break of tellurium exposure with a reduced level of urinary tellurium. CONCLUSIONS The interdisciplinary approach provided the first evidence that tellurium exposure is a potential risk for increase of blood pressure. Since the human urinary tellurium level in this study is comparable with the levels in general populations in other Asian and European countries in previous studies, exposure to tellurium may be a latent universal risk for hypertension.
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Affiliation(s)
- Tomoko Misawa
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takumi Kagawa
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Voluntary Body for International Health Care in Universities, Nagoya, Aichi, Japan
| | - Nobutaka Ohgami
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Voluntary Body for International Health Care in Universities, Nagoya, Aichi, Japan; Department of Hygiene, Fujita Heath University School of Medicine, Toyoake, Aichi, Japan
| | - Akira Tazaki
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Voluntary Body for International Health Care in Universities, Nagoya, Aichi, Japan
| | - Shoko Ohnuma
- Department of Voluntary Body for International Health Care in Universities, Nagoya, Aichi, Japan
| | - Hisao Naito
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Dijie Chen
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Voluntary Body for International Health Care in Universities, Nagoya, Aichi, Japan
| | - Yishuo Gu
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Voluntary Body for International Health Care in Universities, Nagoya, Aichi, Japan
| | - Takashi Tamura
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kimitoshi Nishiwaki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masashi Kato
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Voluntary Body for International Health Care in Universities, Nagoya, Aichi, Japan.
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Gu Y, Ohgami N, Al Hossain MMA, Tazaki A, Tsuchiyama T, He T, Aoki M, Ahsan N, Akhand AA, Kato M. Decreased hearing levels at frequencies for understanding speech in tannery workers exposed to a high level of trivalent chromium in Bangladesh. CHEMOSPHERE 2022; 306:135571. [PMID: 35798151 DOI: 10.1016/j.chemosphere.2022.135571] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
Hexavalent chromium [Cr(VI)], which has a strong corrosive effect, has been reported to cause perforation of the eardrum. Trivalent chromium [Cr(III)] also has a weak corrosive effect. However, there has been no study on the effects of exposure to Cr, either Cr(VI) or Cr(III), on hearing levels in animals or humans. In this study, the effect of Cr(III) exposure on hearing levels was determined in a human study. Then the reproducibility of the results obtained in the human study and the etiology were investigated in an animal study. The mean levels of total chromium (t-Cr) in hair and toenails from 100 Bangladeshi tannery workers were >20-fold and >360-fold higher, respectively, than those in hair and toenails from 49 Bangladeshi non-tannery workers (office workers). Multivariate analysis revealed decreases of hearing levels (DHLs) at 1 k and 4 k Hz, frequencies that are crucial for understanding language, but not at 8 k and 12 k Hz, in the tannery workers. Since >99.99% of t-Cr in the wastewater that the workers were in direct contact with in the tanneries was Cr(III), the epidemiological results suggest Cr(III)-mediated DHLs in the tannery workers. The results of animal experiments in this study further showed that treatment with eardrops but not intraperitoneal injection with the same amount of Cr(III) that tannery workers might be exposed to resulted in DHL with a damaged eardrum in mice. Previous studies suggested that Cr(III) can directly reach the eardrums of tannery workers via droplets in the air. Cr(III) could also reach the eardrum via picking an ear canal with a finger contaminated with tannery wastewater including Cr(III). Taken together, the results of both human and animal studies suggest the risk of DHLs caused by damage of the eardrum through external exposure to Cr(III) via the ear canal.
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Affiliation(s)
- Yishuo Gu
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Voluntary Body for International Healthcare in Universities, Nagoya, Aichi, Japan.
| | - Nobutaka Ohgami
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Voluntary Body for International Healthcare in Universities, Nagoya, Aichi, Japan; Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, Kasugai, Aichi, Japan.
| | - M M Aeorangajeb Al Hossain
- Voluntary Body for International Healthcare in Universities, Nagoya, Aichi, Japan; Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Akira Tazaki
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Voluntary Body for International Healthcare in Universities, Nagoya, Aichi, Japan.
| | - Tomoyuki Tsuchiyama
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Voluntary Body for International Healthcare in Universities, Nagoya, Aichi, Japan.
| | - Tingchao He
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Voluntary Body for International Healthcare in Universities, Nagoya, Aichi, Japan.
| | - Masayo Aoki
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Voluntary Body for International Healthcare in Universities, Nagoya, Aichi, Japan.
| | - Nazmul Ahsan
- Voluntary Body for International Healthcare in Universities, Nagoya, Aichi, Japan; Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Anwarul Azim Akhand
- Voluntary Body for International Healthcare in Universities, Nagoya, Aichi, Japan; Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Masashi Kato
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Voluntary Body for International Healthcare in Universities, Nagoya, Aichi, Japan; Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, Kasugai, Aichi, Japan.
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Pakzad D, Akbari V, Sepand MR, Aliomrani M. Risk of neurodegenerative disease due to tau phosphorylation changes and arsenic exposure via drinking water. Toxicol Res (Camb) 2021; 10:325-333. [PMID: 33884182 PMCID: PMC8045564 DOI: 10.1093/toxres/tfab011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/28/2020] [Accepted: 01/24/2021] [Indexed: 12/12/2022] Open
Abstract
It is estimated that around 140 million people are drinking highly contaminated water with arsenic (As) as a natural earth's crust component. On the other hand, the prevalence of neurodegenerative disorders, especially Alzheimer's disease, is constantly increasing. The aim of the present study was to investigate the correlation between oral arsenic trioxide exposure and its impact on tau protein phosphorylation at Ser262. Fifty-four male mice were randomly divided into three groups and were freely accessed to food and contaminated water of 1 and 10 ppm arsenic trioxide for 3 months, except for control subjects. At the end of each month, As concentration and tau phosphorylation were checked with graphite furnace atomic absorption spectrometer and western blot analysis, respectively. Surprisingly, it was observed that the amount of measured brain arsenic in 10 ppm-exposed subjects was significantly increased after 3 months (P-value ˂ 0.0001). The significant changes in tau phosphorylation were not seen in the 1 ppm-exposed subjects, and it was observed that Ser262 phosphorylation significantly increased after 2 and 3 months in the 10 ppm group (P-value < 0.05). Our results demonstrated that arsenic accumulated in the brain time-dependently and increased Ser262 tau phosphorylation, which is very important in several tauopathies. In conclusion, it could be inferred that environmental arsenic exposure even at very low concentrations could be considered as a reason for increasing the risk of developing neurodegenerative disease.
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Affiliation(s)
- Davoud Pakzad
- Isfahan University of Medical Sciences and Health Services, Isfahan 81746-73461, Iran
| | - Vajihe Akbari
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Isfahan University of Medical Sciences and Health Services, Isfahan 81746-73461, Iran
| | - Mohammad Reza Sepand
- Department of Toxicology and Pharmacology, School of Pharmacy and Pharmaceutical Sciences, Tehran University of Medical Sciences and Health Services, Tehran 81746-73461, Iran
| | - Mehdi Aliomrani
- Department of Toxicology and Pharmacology, Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences and Health Services, Isfahan 81746-73461, Iran
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Sudo M, Hashimoto K, Yoshinaga M, Azimi MD, Fayaz SH, Hamajima N, Kondo-Ida L, Yanagisawa K, Kato M. Lithium promotes malignant transformation of nontumorigenic cells in vitro. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 744:140830. [PMID: 32721671 DOI: 10.1016/j.scitotenv.2020.140830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/11/2020] [Accepted: 07/07/2020] [Indexed: 06/11/2023]
Abstract
Because of the deficiency of water caused by the regional disparities of rainfall due to global warming, attention has been given to the use of well water as drinking water in developing countries. Our fieldwork study in Afghanistan showed that there was a maximum value of 3371 μg/L and an average value of 233 μg/L of lithium in well drinking water. Since the level of lithium in well water is higher than the levels in other countries, we investigated the health risk of lithium. After confirming no influence of ≤1000 μM lithium on cell viability, we found that lithium at concentrations of 100 and 500 μM promoted anchorage-independent growth of human immortalized keratinocytes (HaCaT) and lung epithelial cells (BEAS-2B) but not that of human keratinocytic carcinoma cells (HSC-5) or lung epithelial carcinoma cells (A549). The same concentrations of lithium also promoted phosphorylation of c-SRC and MEK/ERK but not that of AKT in the keratinocytes. Inhibitors of c-SRC (PP2) and MEK (PD98059) suppressed the lithium-induced increase in anchorage-independent growth of the keratinocytes. Our results suggested that lithium promoted transformation of nontumorigenic cells rather than progression of tumorigenic cells with preferential activation of the c-SRC/MEK/ERK pathway. Since previous pharmacokinetics studies indicated that it is possible for the serum level of lithium to reach 100 μM by drinking 2.5 L of water containing 3371 μg/L of lithium per day, the high level of lithium contamination in well drinking water in Kabul might be a potential oncogenic risk in humans.
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Affiliation(s)
- Makoto Sudo
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazunori Hashimoto
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Voluntary Body, International Health Care in Universities, Nagoya, Japan
| | - Masafumi Yoshinaga
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mohammad Daud Azimi
- Department of Human Resources, Ministry of Public Health, Kabul, Afghanistan
| | - Said Hafizullah Fayaz
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Administrative Office of the President, Deputy Public Relations and Outreach, Kabul, Afghanistan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Lisa Kondo-Ida
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Molecular and Cancer Medicine, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Kiyoshi Yanagisawa
- Department of Molecular and Cancer Medicine, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Masashi Kato
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Voluntary Body, International Health Care in Universities, Nagoya, Japan; Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, Kasugai, Aichi, Japan.
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Xu H, Hashimoto K, Maeda M, Azimi MD, Fayaz SH, Chen W, Hamajima N, Kato M. High levels of boron promote anchorage-independent growth of nontumorigenic cells. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 266:115094. [PMID: 32659568 DOI: 10.1016/j.envpol.2020.115094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 05/14/2023]
Abstract
WHO has presented a health-based guideline value for boron in drinking water. That fact indicates that a high level of boron is toxic for humans. However, there is no direct evidence of boron-mediated malignant transformation. In this study, human lung epithelial nontumorigenic BEAS-2B cells and tumorigenic A549 cells were used to investigate the tumorigenic toxicity of boron in vitro. Anchorage-independent growth, a hallmark of malignant transformation, was increased by boron at concentrations of 50, 250 and 500 μM in BEAS-2B cells, though the same concentrations of boron had no influence on anchorage-independent growth of A549 cells. Moreover, boron at concentrations of 250 and 500 μM activated the c-SRC/PI3K/AKT pathway of BEAS-2B cells. The results of our in vitro study suggest that exposure to high levels of boron promotes transforming activity of nontumorigenic cells.
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Affiliation(s)
- Huadong Xu
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan; Voluntary Body for International Health Care in Universities, Nagoya, Japan
| | - Kazunori Hashimoto
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan; Voluntary Body for International Health Care in Universities, Nagoya, Japan
| | - Masao Maeda
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | | | - Said Hafizullah Fayaz
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan; Administrative Office of the President, Deputy Public Relations and Outreach, Kabul, Afghanistan
| | - Wei Chen
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan; Voluntary Body for International Health Care in Universities, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masashi Kato
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan; Voluntary Body for International Health Care in Universities, Nagoya, Japan; Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, Matsumoto-cho, Kasugai-shi, Aichi, Japan.
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Kato M, Ohgami N, Ohnuma S, Hashimoto K, Tazaki A, Xu H, Kondo-Ida L, Yuan T, Tsuchiyama T, He T, Kurniasari F, Gu Y, Chen W, Deng Y, Komuro K, Tong K, Yajima I. Multidisciplinary approach to assess the toxicities of arsenic and barium in drinking water. Environ Health Prev Med 2020; 25:16. [PMID: 32460744 PMCID: PMC7254659 DOI: 10.1186/s12199-020-00855-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/17/2020] [Indexed: 12/17/2022] Open
Abstract
Well water could be a stable source of drinking water. Recently, the use of well water as drinking water has been encouraged in developing countries. However, many kinds of disorders caused by toxic elements in well drinking water have been reported. It is our urgent task to resolve the global issue of element-originating diseases. In this review article, our multidisciplinary approaches focusing on oncogenic toxicities and disturbances of sensory organs (skin and ear) induced by arsenic and barium are introduced. First, our environmental monitoring in developing countries in Asia showed elevated concentrations of arsenic and barium in well drinking water. Then our experimental studies in mice and our epidemiological studies in humans showed arsenic-mediated increased risks of hyperpigmented skin and hearing loss with partial elucidation of their mechanisms. Our experimental studies using cultured cells with focus on the expression and activity levels of intracellular signal transduction molecules such as c-SRC, c-RET, and oncogenic RET showed risks for malignant transformation and/or progression arose from arsenic and barium. Finally, our original hydrotalcite-like compound was proposed as a novel remediation system to effectively remove arsenic and barium from well drinking water. Hopefully, comprehensive studies consisting of (1) environmental monitoring, (2) health risk assessments, and (3) remediation will be expanded in the field of environmental health to prevent various disorders caused by environmental factors including toxic elements in drinking water.
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Affiliation(s)
- Masashi Kato
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan. .,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Nobutaka Ohgami
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shoko Ohnuma
- Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kazunori Hashimoto
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Akira Tazaki
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Huadong Xu
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Lisa Kondo-Ida
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Tian Yuan
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Tomoyuki Tsuchiyama
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Tingchao He
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Fitri Kurniasari
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yishuo Gu
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Wei Chen
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yuqi Deng
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kanako Komuro
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Keming Tong
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Ichiro Yajima
- Departments of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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