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Bello JH, Khan MJ, Amir S, Kakakhel HG, Tahir F, Sultan S, Raza SQ, Mamoulakis C, Zachariou A, Tsatsakis A, Sofikitis N, Shah STA. Dysregulation of mitochondrial sirtuin genes is associated with human male infertility. Andrologia 2021; 54:e14274. [PMID: 34664305 DOI: 10.1111/and.14274] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/22/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022] Open
Abstract
Mitochondrial sirtuins (SIRT3, SIRT4, SIRT5) are post-translational modifiers that regulate energy production, body homeostasis and mitochondrial activities via different substrates in response to environmental stressors. The present study aimed at assessing the expression of SIRT3, SIRT4, and SIRT5 in the semen of infertile men. Expression analysis was performed using q-RT PCR. All mitochondrial sirtuin genes were significantly down-regulated in the semen of infertile men compared to fertile men. Mitochondrial sirtuin genes expression levels were correlated with mitochondrial HSP90 expression. HSP90 expression was positively correlated with SIRT3, SIRT4 and SIRT5 expression in the semen of fertile men, while a negative correlation was observed between HSP90 in the semen of infertile men and mitochondrial sirtuin genes in the semen of fertile men. These data suggest that dysregulation of mitochondrial sirtuin genes causes mitochondrial dysfunction due to stress, which appears to be associated with human male infertility by compromising functional and structural sperm integrity.
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Affiliation(s)
- Jaafar Haris Bello
- Department of Biosciences, Functional Genomics and Proteomics Lab, COMSATS University Islamabad, Islamabad, Pakistan
| | - Muhammad Jadoon Khan
- Department of Biosciences, Functional Genomics and Proteomics Lab, COMSATS University Islamabad, Islamabad, Pakistan
| | - Saira Amir
- Department of Biosciences, Functional Genomics and Proteomics Lab, COMSATS University Islamabad, Islamabad, Pakistan
| | - Hoor Gulalai Kakakhel
- Department of Biosciences, Functional Genomics and Proteomics Lab, COMSATS University Islamabad, Islamabad, Pakistan
| | - Faheem Tahir
- Department of Chemical Pathology and Endocrinology, Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan
| | - Sikandar Sultan
- Department of Chemical Pathology and Endocrinology, Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan
| | - Syed Qasim Raza
- Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Charalampos Mamoulakis
- Department of Urology, Medical School, University General Hospital of Heraklion, University of Crete, Heraklion, Greece
| | | | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Nikolaos Sofikitis
- Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
| | - Syed Tahir Abbas Shah
- Department of Biosciences, Functional Genomics and Proteomics Lab, COMSATS University Islamabad, Islamabad, Pakistan
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Sun Y, Yang F, Liu Y, Yu M, Wu F, Wang G. Di-2-ethylhexyl phthalate induces heart looping disorders during zebrafish development. Toxicol Ind Health 2021; 37:391-397. [PMID: 34047658 DOI: 10.1177/07482337211019184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Di-2-ethylhexyl phthalate (DEHP) is a type of plasticizer widely used in industry. It is well-known for its toxic effects to endocrine and reproductive systems and has been detected in amniotic fluid and placenta. In the present study, we explored the effects of DEHP on heart development by using zebrafish as a model organism. DEHP (0.02 pg) was injected into the yolk sac of zebrafish embryos at the one-cell stage. No significant difference was found in embryonic lethality between control and DEHP groups at 1-day postfertilization (dpf), but mortality significantly increased in DEHP groups at 2 and 3 dpf. The average heart rate was significantly reduced in the surviving DEHP-treated zebrafish larvae at 3 and 4 dpf. In addition, massive pericardial edema was found in DEHP-treated zebrafish (12.6 ± 1.5%), which was significantly higher than that of the control group. Serious heart looping disorder was also observed in DEHP-treated larvae, mainly manifested with an elongated atrial-ventricular distance. Moreover, the expression of heart development transcription factors was affected by DEHP injection. Real-time polymerase chain reaction confirmed that five transcription factors (hand2, tp53, mef2c, esr1, and tbx18) were significantly downregulated in the DEHP group at 2 dpf, and three transcription factors (zic3, tcf21, and gata4) were significantly upregulated. Our results emphasize the need for the development of a nontoxic plasticizer to prevent possible deleterious effects on humans and other life-forms.
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Affiliation(s)
- Yangyong Sun
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Fan Yang
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Critical Care Medicine, Naval Medical Center of PLA, Shanghai, China
| | - Manli Yu
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Feng Wu
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Cardiology, the 72th Group Army Hospital of PLA, Zhejiang, China
| | - Guokun Wang
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
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Amir S, Tzatzarakis M, Mamoulakis C, Bello JH, Eqani SAMAS, Vakonaki E, Karavitakis M, Sultan S, Tahir F, Shah STA, Tsatsakis A. Impact of organochlorine pollutants on semen parameters of infertile men in Pakistan. ENVIRONMENTAL RESEARCH 2021; 195:110832. [PMID: 33549619 DOI: 10.1016/j.envres.2021.110832] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 06/12/2023]
Abstract
Male infertility is a major problem with important socioeconomic consequences. It is associated with several pathological factors, including but not limited to endocrine disruption as a result of environmental pollution and the alarming decline in sperm count over the decades is indicative of involvement of many environmental and lifestyle changes around the globe. Organochlorine pollutants such as dichlorodiphenyltrichlorethanes (DDTs), polychlorinated biphenyls (PCBs) and hexachlorobenzene (HCB) disrupt male reproductive system but the exact effect of environmental exposure on semen parameters in human is still not clear. This study was designed to monitor PCBs, DDTs and HCB in hair, urine and serum samples of infertile and healthy fertile men. Solid-phase microextraction gas chromatography-mass spectrometry (SPME/GC-MS) was used to monitor analytes. All tested compounds were detected, indicating recent use/persistent accumulation. Hair samples revealed no significant association with serum/urine concentrations of the analytes, while serum/urine concentrations were significantly correlated positively. Concentrations were higher in serum compared to other samples. The levels of organochlorine pollutants were higher in infertile men compared to controls with few exceptions. Among PCBs, and DDTs, PCB-153 and pp'-DDT were detected in highest concentrations, respectively. op'-DDT and pp'-DDT levels were significantly higher in infertile men compared to controls. HCB was significantly correlated negatively with sperm motility in all samples. Serum concentrations of all compounds were higher in men with defective semen parameters compared to normospermics. Serum was the best biological sample for assessing health outcomes in relation to exposure levels.
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Affiliation(s)
- Saira Amir
- Department of Biosciences, COMSATS University Islamabad, Islamabad, 45550, Pakistan
| | - Manolis Tzatzarakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Jaafar Haris Bello
- Department of Biosciences, COMSATS University Islamabad, Islamabad, 45550, Pakistan
| | | | - Elena Vakonaki
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Sikandar Sultan
- Public Health Laboratories Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Faheem Tahir
- Public Health Laboratories Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Syed Tahir Abbas Shah
- Department of Biosciences, COMSATS University Islamabad, Islamabad, 45550, Pakistan.
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece.
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Amir S, Shah STA, Mamoulakis C, Docea AO, Kalantzi OI, Zachariou A, Calina D, Carvalho F, Sofikitis N, Makrigiannakis A, Tsatsakis A. Endocrine Disruptors Acting on Estrogen and Androgen Pathways Cause Reproductive Disorders through Multiple Mechanisms: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1464. [PMID: 33557243 PMCID: PMC7913912 DOI: 10.3390/ijerph18041464] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
Increasing contamination of the environment by toxic compounds such as endocrine disrupting chemicals (EDCs) is one of the major causes of reproductive defects in both sexes. Estrogen/androgen pathways are of utmost importance in gonadal development, determination of secondary sex characteristics and gametogenesis. Most of the EDCs mediate their action through respective receptors and/or downstream signaling. The purpose of this review is to highlight the mechanism by which EDCs can trigger antagonistic or agonistic response, acting through estrogen/androgen receptors causing reproductive defects that lead to infertility. In vitro, in vivo and in silico studies focusing on the impact of EDCs on estrogen/androgen pathways and related proteins published in the last decade were considered for the review. PUBMED and PUBCHEM were used for literature search. EDCs can bind to estrogen receptors (ERα and ERβ) and androgen receptors or activate alternative receptors such as G protein-coupled receptors (GPCR), GPR30, estrogen-related receptor (ERRγ) to activate estrogen signaling via downstream kinases. Bisphenol A, dichlorodiphenyltrichloroethane, dichlorodiphenyldichloroethylene, polychlorinated biphenyls and phthalates are major toxicants that interfere with the normal estrogen/androgen pathways leading to infertility in both sexes through many ways, including DNA damage in spermatozoids, altered methylation pattern, histone modifications and miRNA expression.
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Affiliation(s)
- Saira Amir
- Department of Biosciences, COMSATS University Islamabad, Islamabad 44000, Pakistan; (S.A.); (S.T.A.S.)
| | - Syed Tahir Abbas Shah
- Department of Biosciences, COMSATS University Islamabad, Islamabad 44000, Pakistan; (S.A.); (S.T.A.S.)
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, Medical School, University of Crete, 700 13 Heraklion, Greece
| | - Anca Oana Docea
- Department of Toxicology, Faculty of Pharmacy, University of Medicine and Pharmacy, Petru Rares, 200349 Craiova, Romania
| | - Olga-Ioanna Kalantzi
- Department of Environment, University of Aegean, University Hill, 81100 Mytilini, Greece;
| | - Athanasios Zachariou
- Department of Urology, Ioannina University School of Medicine, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Felix Carvalho
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal;
| | - Nikolaos Sofikitis
- Department of Urology, Ioannina University School of Medicine, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Antonios Makrigiannakis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, 71003 Heraklion, Greece;
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
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Georgiadis G, Mavridis C, Belantis C, Zisis IE, Skamagkas I, Fragkiadoulaki I, Heretis I, Tzortzis V, Psathakis K, Tsatsakis A, Mamoulakis C. Nephrotoxicity issues of organophosphates. Toxicology 2018; 406-407:129-136. [PMID: 30063941 DOI: 10.1016/j.tox.2018.07.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/15/2018] [Accepted: 07/25/2018] [Indexed: 12/12/2022]
Abstract
Organophosphates are a large class of chemicals, initially invented in 1850 and since then they have been applied in numerous aspects of science to serve our purposes. Their mechanism of action in living organisms involves the irreversible inhibition of acetylcholinesterase, therefore they interfere with neuromuscular signal transmission. Due to the systematic and exaggerated use of these chemicals, there is massive exposure to them, hence there is great concern regarding the ramifications to all mammalian organisms. It has been widely accepted that over-exposure to organophosphates, has a deleterious impact on the renal tissue and subsequently on the renal function. Despite the significance of this global issue, limited knowledge exists, regarding the effect of these substances on our health. Therefore, new and extensive research is required to expand our knowledge and ensure proper guidance regarding the use of organophosphates as well the protection against their detrimental consequences. The aim of this review is to negotiate the effect of organophosphate exposure on renal tissue and kidney function.
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Affiliation(s)
- G Georgiadis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - C Mavridis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - C Belantis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - I E Zisis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - I Skamagkas
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - I Fragkiadoulaki
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece; Department of Forensic Sciences and Toxicology, University of Crete, Medical School, Heraklion, Crete, Greece
| | - I Heretis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - V Tzortzis
- Department of Urology, University of Thessaly, Larissa, Greece
| | - K Psathakis
- Department of Forensic Sciences and Toxicology, University of Crete, Medical School, Heraklion, Crete, Greece
| | - A Tsatsakis
- Department of Forensic Sciences and Toxicology, University of Crete, Medical School, Heraklion, Crete, Greece.
| | - C Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
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Tsiaoussis J, Hatzidaki E, Docea AO, Nikolouzakis TK, Petrakis D, Burykina T, Mamoulakis C, Makrigiannakis A, Tsatsakis A. Molecular and clinical aspects of embryotoxicity induced by acetylcholinesterase inhibitors. Toxicology 2018; 409:137-143. [PMID: 30055296 DOI: 10.1016/j.tox.2018.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 12/20/2022]
Abstract
Acetylcholinesterase inhibitors are widely used for a variety of medical, agricultural and public health purposes. Consequently, exposure is highly possible during lifetime. However, their systematic use raises concerns for the potential impact on the fetus and newborn since these substances may affect angiogenesis, the neonatal and maternal intensive care, neuroimmune function and response, mammary growth/lactation via cholinergic/non-cholinergic central and peripheral neuroendocrine pathways. New methodologies, neuroscientific technologies and research studies are needed to harness existing knowledge along with the proper management, availability for new acetylcholinesterase inhibitors, with stable pharmacodynamics and clinical outcomes.
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Affiliation(s)
- J Tsiaoussis
- Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, Voutes, 71110, Heraklion, Crete, Greece.
| | - E Hatzidaki
- Department of Neonatology, University of Crete, Voutes, 71110, Heraklion, Crete, Greece.
| | - A O Docea
- Department of Toxicology, University of Medicine and Pharmacy, Faculty of Pharmacy, Craiova, 200349, Romania.
| | - T K Nikolouzakis
- Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, Voutes, 71110, Heraklion, Crete, Greece.
| | - D Petrakis
- Department of Forensic Sciences and Toxicology, Medical School, University of Crete, Voutes, 71003, Heraklion, Crete, Greece.
| | - T Burykina
- Department of Analytical and Forensic Medical Chemistry, Sechenov University, 119991, Moscow, Russian Federation
| | - C Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, 71003, Heraklion, Crete, Greece.
| | - A Makrigiannakis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, 71003, Heraklion, Crete, Greece.
| | - A Tsatsakis
- Department of Forensic Sciences and Toxicology, Medical School, University of Crete, Voutes, 71003, Heraklion, Crete, Greece.
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Kalliora C, Mamoulakis C, Vasilopoulos E, Stamatiades GA, Kalafati L, Barouni R, Karakousi T, Abdollahi M, Tsatsakis A. Association of pesticide exposure with human congenital abnormalities. Toxicol Appl Pharmacol 2018; 346:58-75. [PMID: 29596925 PMCID: PMC6029725 DOI: 10.1016/j.taap.2018.03.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/04/2018] [Accepted: 03/22/2018] [Indexed: 01/10/2023]
Abstract
Human pesticide exposure can occur both occupationally and environmentally during manufacture and after the application of indoor and outdoor pesticides, as well as through consumption via residues in food and water. There is evidence from experimental studies that numerous pesticides, either in isolation or in combination, act as endocrine disruptors, neurodevelopmental toxicants, immunotoxicants, and carcinogens. We reviewed the international literature on this subject for the years between 1990 and 2017. The studies were considered in this review through MEDLINE and WHO resources. Out of the n = 1817 studies identified, n = 94 were reviewed because they fulfilled criteria of validity and addressed associations of interest. Epidemiological studies have provided limited evidence linking pre- and post-natal exposure to pesticides with cancers in childhood, neurological deficits, fetal death, intrauterine growth restriction, preterm birth, and congenital abnormalities (CAs). In this review, the potential association between pesticide exposure and the appearance of some human CAs (including among others musculoskeletal abnormalities; neural tube defects; urogenital and cardiovascular abnormalities) was investigated. A trend towards a positive association between environmental or occupational exposure to some pesticides and some CAs was detected, but this association remains to be substantiated. Main limitations of the review include inadequate exposure assessment and limited sample size. Adequately powered studies with precise exposure assessments such as biomonitoring, are warranted to clarify with certainty the potential association between pesticide exposure and human CAs.
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Affiliation(s)
- Charikleia Kalliora
- Medical School, University of Crete, Heraklion, Crete, Greece; Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece.
| | | | - George A Stamatiades
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Roza Barouni
- Department of Biology, University of Athens, Greece
| | | | - Mohammad Abdollahi
- Department of Toxicology & Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran, Iran
| | - Aristidis Tsatsakis
- Department of Toxicology & Forensic Science, Medical School, University of Crete, Voutes Campus, Heraklion 71003, Greece
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Li K, Wang R, Duan R, Liu Y. THE POTENTIAL OF DIETHYLHEXYL-PHTHALATE AND GENISTEIN TO INDUCE TESTICULAR CHANGES IN RAT'S OFFSPRING. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2017; 13:417-424. [PMID: 31149210 PMCID: PMC6516560 DOI: 10.4183/aeb.2017.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study the effect of diethylhexyl phthalate (DEHP) alone or in combination with genistein (GEN) on the reproductive system of offspring rats, focus on the induction of reproductive outcomes. METHOD 180 Wistar rats were divided in 6 groups (30 animals per group): DEHP 250 mg/kg/day group, DEHP 1000 mg/kg/day group, DEHP 2500 mg/kg/day group treated with DEHP 2500 mg/kg/day, DEHP (2500 mg/kg) + GEN (50 mg/kg) group, DEHP (2500 mg/kg) + GEN (500 mg/kg) group and control group treated with the same quantity of corn oil. The differences in sperm quality and reproductive organs were observed. RESULTS After DEHP administration we observed an increase in rat's abestrus, metaestrus and all estrus cycle (P < 0.05), a decrease in rat testicle's organ coefficient and relative energy of testis Sertoli cells and an increase in the early, late and total apoptotic rate of testicular Sertoli cells in a dose dependent manner (P < 0.05). When combine DEHP with GEN the sperm density, sperm quality, the cell activity rate and testis tissue's changes will decrease compared with the group that receive only DEHP in a dose dependent manner. CONCLUSION DEHP exposure induces cryptorchidism in offspring rats and this is aggravated by adding GEN.
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Affiliation(s)
- K. Li
- The Affiliated Hospital of Hebei University of Engineering, Department of Urology, Hebei, China
| | - R. Wang
- The Affiliated Hospital of Hebei University of Engineering, Operation Room, Hebei, China
| | - R. Duan
- The Affiliated Hospital of Hebei University of Engineering, Department of Physiology, Handan, Hebei, China
| | - Y. Liu
- The Affiliated Hospital of Hebei University of Engineering, Department of Physiology, Handan, Hebei, China
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