1.The prognostic value and immune regulatory role of BRF1 in pan-cancer, and its function in esophageal squamous cell carcinoma
Jianxin XU ; Zihao LI ; Wang LÜ ; ; Zhiyang XU ; Yunfeng YI ; Songlin CHEN ; Jian HU ; Luming WANG
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2026;33(01):122-131
Objective To investigate the expression profile, prognostic value, gene co-expression network, and immunomodulatory role of BRF1 in a pan-cancer context, and to explore its biological functions and molecular regulatory mechanisms in esophageal squamous cell carcinoma (ESCC). Methods The pan-cancer dataset from The Cancer Genome Atlas (TCGA) was utilized to analyze the differential expression of BRF1 in tumor versus normal tissues, its association with patient survival, pathway enrichment for co-expressed genes, and immune features (including immune checkpoints, cytokines, and immune cell infiltration). The expression profile of BRF1 in ESCC was validated using the Gene Expression Omnibus (GEO) database. In vitro, BRF1 was knocked down in ESCC cells using siRNA. Cell proliferation and migration were assessed by MTT and Transwell assays, respectively. The expression levels of proliferation- and migration-related proteins were detected by Western blotting. The correlation between BRF1 and ferroptosis was analyzed using TCGA data. Results BRF1 was significantly upregulated in over 20 types of cancer, and its high expression was associated with poor prognosis in patients with adrenocortical carcinoma and prostate adenocarcinoma. BRF1 was found to positively regulate the T-cell-mediated cell death pathway in esophageal adenocarcinoma and was associated with the circadian rhythm regulation pathway in pancreatic adenocarcinoma. The correlation of BRF1 with immune checkpoints, cytokine networks, and immune cell infiltration was found to be cancer type-specific. In vitro experiments demonstrated that knocking down BRF1 significantly inhibited the proliferation of ESCC cells, accompanied by the downregulation of the proliferation marker PCNA. Cell migration was also significantly impaired, with decreased expression of Vimentin and MMPs and increased expression of E-cadherin. Furthermore, the expression of BRF1 was positively correlated with that of ferroptosis-antagonizing genes, such as GPX4, HSPA5, and SLC7A11. Conclusion BRF1 plays complex roles in pan-cancer, participating in the regulation of tumorigenesis, progression, and immune infiltration. BRF1 promotes the proliferation and migration of ESCC cells, a mechanism potentially associated with the regulation of ferroptosis resistance. These findings suggest that BRF1 could be a potential therapeutic target for ESCC.
2.Profiling and functional characterization of long noncoding RNAs during human tooth development.
Xiuge GU ; Wei WEI ; Chuan WU ; Jing SUN ; Xiaoshan WU ; Zongshan SHEN ; Hanzhang ZHOU ; Chunmei ZHANG ; Jinsong WANG ; Lei HU ; Suwen CHEN ; Yuanyuan ZHANG ; Songlin WANG ; Ran ZHANG
International Journal of Oral Science 2025;17(1):38-38
The regulatory processes in developmental biology research are significantly influenced by long non-coding RNAs (lncRNAs). However, the dynamics of lncRNA expression during human tooth development remain poorly understood. In this research, we examined the lncRNAs present in the dental epithelium (DE) and dental mesenchyme (DM) at the late bud, cap, and early bell stages of human fetal tooth development through bulk RNA sequencing. Developmental regulators co-expressed with neighboring lncRNAs were significantly enriched in odontogenesis. Specific lncRNAs expressed in the DE and DM, such as PANCR, MIR205HG, DLX6-AS1, and DNM3OS, were identified through a combination of bulk RNA sequencing and single-cell analysis. Further subcluster analysis revealed lncRNAs specifically expressed in important regions of the tooth germ, such as the inner enamel epithelium and coronal dental papilla (CDP). Functionally, we demonstrated that CDP-specific DLX6-AS1 enhanced odontoblastic differentiation in human tooth germ mesenchymal cells and dental pulp stem cells. These findings suggest that lncRNAs could serve as valuable cell markers for tooth development and potential therapeutic targets for tooth regeneration.
Humans
;
RNA, Long Noncoding/metabolism*
;
Odontogenesis/genetics*
;
Tooth Germ/embryology*
;
Cell Differentiation
;
Gene Expression Regulation, Developmental
;
Mesoderm/metabolism*
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Tooth/embryology*
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Gene Expression Profiling
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Sequence Analysis, RNA
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Dental Pulp/cytology*
3.A blood supply model for the emergency care of severe trauma
Songlin HU ; Zhiyuan WEI ; Gaoxiang HUANG ; Lijuan LIU ; Mingwei FU ; Junke TAN ; Haozhe LI ; Songtao LI
Chinese Journal of Blood Transfusion 2025;38(10):1327-1333
Objective: To establish and validate a whole blood (WB) supply model, thereby providing practical experience for the clinical application of WB in domestic trauma emergency care and informing the development of a wartime blood supply system for the military. Methods: A “10×24” WB supply model was established by formulating blood collection protocols, storage standards, and transfusion criteria. Multiple WB samples were tested under specific storage conditions to assess key indicators at different time points, including red blood cell (RBC), white blood cell (WBC), and platelet counts, hemoglobin concentration, coagulation parameters (PT, APTT, TT, FIB), coagulation factor activity, thromboelastography (TEG) parameters, and electrolyte levels. Additionally, clinical data from hemorrhagic patients who met the criteria for WB transfusion and were admitted between March and July 2024 were analyzed to evaluate WB transfusion volume. Results: RBC counts and hemoglobin levels remained stable in WB stored at 4℃ for up to 10 days. However, platelet counts and coagulation function (PT, APTT) significantly declined with prolonged storage, while potassium levels increased. From March to July 2024, the model was successfully applied to 23 patients with acute hemorrhage, with a median WB transfusion volume of 543 mL. A detailed case study of a severe traumatic hemorrhagic shock patient was reported, who was successfully treated with 5.5 units of refrigerated WB combined with component blood. Conclusion: The “10×24” WB supply model demonstrated acceptable changes in critical quality parameters under strict management and a 10-day rotation cycle. This model effectively supports the treatment of acute hemorrhage and holds promise for integration into the future wartime blood supply system of the military.
4.Efficacy and Mechanism of Action of Ermiao Situ Decoction in Modulating JAK/STAT Pathway in Rats with Damp-heat Eczema
Kangning HAN ; Junjie HU ; Juan LI ; Min ZHANG ; Xian ZHOU ; Songlin LIU ; Xin CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(9):37-47
ObjectiveUltra performance liquid chromatography-quadrupole-time of flight tandem mass spectrometry (UPLC-Q-TOF-MS/MS) coupled with network pharmacology and molecular docking was utilized to explore the efficacy and mechanism of action of Ermiao Situ decoction on rats with damp-heat eczema. MethodsA rat model of damp-heat eczema was established by artificial climate chamber intervention combined with sensitization induction by dinitrochlorobenzene (DNCB), and it was randomly divided into the normal group, the model group, the medium- and high-dose groups of Ermiao Situ decoction (3.40 g·kg-1 and 6.80 g·kg-1), and the prednisone acetate group (2.51 mg·kg-1), with eight rats in each group, totalling 46 rats, of which six rats were tested with the drug-containing serum. The chemical analysis of drug-containing serum from rats was carried out by UPLC-Q-TOF-MS/MS, combined with network pharmacology for the prediction of key components, core targets, and signaling pathways, and molecular docking experiments were performed by CB-Dock2 online website. The pharmacological effects of Ermiao Situ decoction in the treatment of damp-heat eczema were investigated by epitaxial indexes combined with the pathologic tissue staining method. The serum levels of gastrin (GAS), interleukin-4 (IL-4), and interleukin-13 (IL-13) were measured by enzyme-linked immunosorbent assay (ELISA). Interleukin-6 (IL-6), Janus kinase 1 (JAK1), phosphorylated (p)-JAK1, signal transduction and activation of transcription factor 3 (STAT3), and p-STAT3 protein expression level was determined by Western bolt. ResultsA total of 19 active ingredients were detected in drug-containing serum samples of rats, which were predicted to act on 198 targets for the treatment of damp-heat eczema, among which the key ingredients included rhodopsin, huangpai alkaloids, and quercetin, and the main core targets included STAT3, tumor necrosis factor (TNF), and IL-6, which were mainly involved in the cancer signaling pathway, phosphatidylinositol 3-kinase (PI3K)/protein kinase (Akt) signaling pathway, T helper 17 (Th17) cell differentiation signaling pathway, and JAK/STAT signaling pathway. The molecular docking results suggested that the key components had strong binding activities with the core targets IL-6, JAK1, and STAT3 in the JAK/STAT signaling pathway. The results of animal experiments showed that compared with those in the normal group, rats in the model group were depressed. They had loose hair, loose stools, epidermal oozing, vesiculation, and generation of thick scabs in the form of scales, decreased body weight, increased anus temperature and water intake, and increased indexes of the spleen, thymus gland, and stomach (P<0.05, P<0.01), and the lesion tissue could be seen to be hyperkeratotic, with the aggregation of inflammatory cells and nonsignificant separation of epidermis and dermis. The gastric mucosa was thinned, deficient, and structurally disorganized, and obvious inflammatory cell aggregation was seen. The levels of GAS, IL-4, and IL-13 in serum were significantly reduced (P<0.05, P<0.01), and the protein expression levels of IL-6, JAK1, p-JAK1, and p-STAT3 in the lesion tissue were significantly increased (P<0.05, P<0.01). Compared with those in the model group, rats in each administration group had stable mental states, formed feces, a clean perianal area, and basically normal epidermis. Only a small amount of scaly scabs existed, and the rats had body weight increased, with decreased anal temperature and water intake, as well as decreased spleen, thymus, and gastric indexes (P<0.05, P<0.01). Epidermal thickness was decreased, and epidermal and dermal separation boundaries were obvious, but hyperkeratotic and accumulation of inflammatory cells could still be seen. The thickness of gastric mucosa increased, and the structure was restored to varying degrees. The levels of GAS, IL-4, and IL-13 content in the serum of rats were increased to varying degrees, and the protein expression levels of IL-6, JAK1, p-JAK1, and p-STAT3 in the dermal lesion tissue were significantly decreased (P<0.05, P<0.01). ConclusionErmiao Situ decoction may exert therapeutic effects on rats with damp-heat eczema by modulating the JAK/STAT signaling pathway.
5.Exploration of the antidepressant machanism of Shugan hewei tang based on metabolomics of PFC-NAc-VTA neural circuit
Xinyue QU ; Junjie HU ; Juan LI ; Min ZHANG ; Xian ZHOU ; Songlin LIU ; Xin CHEN
China Pharmacy 2025;36(10):1172-1178
OBJECTIVE To investigate the antidepressant mechanism of Shugan hewei tang (SGHWT) based on the metabolomics of prefrontal cortex (PFC)-nucleus accumbens (NAc)-ventral tegmental area (VTA) neural circuit. METHODS Male SD rats were randomly divided into blank group, model group, SGHWT low-, medium- and high-dose groups [3.67, 7.34, 14.68 g/(kg·d), by raw material], and fluoxetine group [1.58 mg/(kg·d), positive control], with 12 rats in each group. Except for the blank group, the depression model was established by chronic unpredictable mild stress combined with individual cage housing in the remaining groups, and the corresponding drug solution or normal saline was administered via gavage during modeling, once a day, for 6 consecutive weeks. After the last administration, the body weight, sucrose preference rate, total moving distance, frequency into the center and immobility time of rats in each group were detected. Samples of PFC, NAc and VTA areas of rats in the blank group, model group, SGHWT medium-dose group and fluoxetine positive control groups were collected,and their histomorphological features were observed, and non-targeted metabolomics analysis (except for fluoxetine group)were performed and validated. RESULTS Compared with model group, the cytolysis, structural damage and other pathological damages in three brain regions of rats were significantly alleviated in each drug group, while their body weight, sucrose preference rate, total moving distance and frequency into the center were all significantly higher or longer (P<0.05), and immobility time was significantly shorter (P<0.05). The results of non-targeted metabolomics showed that a total of 78 endogenous differential metabolites were identified, with 40, 35 and 24 in the PFC, NAc and VTA regions respectively, mainly involved in amino acid, lipid and sphingolipid metabolism. The results of metabolic pathway enrichment analysis showed that SGHWT affected the neural circuits of depressed rats by regulating sphingolipid metabolism, alanine, aspartic acid and glutamic acid metabolism, saturated fatty acid biosynthesis, among which alanine, aspartic acid and glutamic acid metabolism was predominantly involved. Validation experiments showed that SGHWT significantly increased the phosphorylation levels of protein kinase B (Akt) and mammalian target of rapamycin (mTOR), and decreased the protein expression of N-methyl-D-aspartic acid receptor 1 (NMDAR1) in the NAc region of rats. CONCLUSIONS SGHWT significantly improves the depression-like behavior and attenuates pathological damage of PFC-NAc-VTA neural circuit of model rats, the mechanism of which is associated with inhibiting NMDAR1 expression and activating the Akt/mTOR signaling pathway.
6.Preventive and therapeutic effects of berberine on liver diseases and its mechanism
Huili WANG ; Wenhao QIN ; Dangdang YANG ; Yaqian NING ; Shan LIN ; Songlin DAI ; Bing HU
Journal of Clinical Hepatology 2024;40(11):2326-2331
Berberine is an antipyretic and detoxicating drug commonly used in clinical practice,and it is currently used for the routine treatment of gastrointestinal diseases such as bacterial gastroenteritis and diarrhea.However,several recent studies have shown that berberine can exert a therapeutic effect on the diseases such as autoimmune hepatitis,viral hepatitis,nonalcoholic fatty liver disease,and liver cancer by regulating the AMPK and TGF-β pathways and altering the composition of intestinal flora.This provides new drugs for the treatment of these diseases,expands the potential indications of berberine,and provides clues for the follow-up research and development of similar drugs.This article summarizes the therapeutic effect and mechanism of berberine on various liver diseases,in order to provide a reference for effective clinical application.
7.Comparison of Direct and Extraction Immunoassay Methods With Liquid Chromatography-Tandem Mass Spectrometry Measurement of Urinary Free Cortisol for the Diagnosis of Cushing’s Syndrome
Danni MU ; Jiadan FANG ; Songlin YU ; Yichen MA ; Jin CHENG ; Yingying HU ; Ailing SONG ; Fang ZHAO ; Qi ZHANG ; Zhihong QI ; Kui ZHANG ; Liangyu XIA ; Ling QIU ; Huijuan ZHU ; Xinqi CHENG
Annals of Laboratory Medicine 2024;44(1):29-37
Background:
Twenty-four-hour urinary free cortisol (UFC) measurement is the initial diagnostic test for Cushing’s syndrome (CS). We compared UFC determination by both direct and extraction immunoassays using Abbott Architect, Siemens Atellica Solution, and Beckman DxI800 with liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition, we evaluated the value of 24-hr UFC measured by six methods for diagnosing CS.
Methods:
Residual 24-hr urine samples of 94 CS and 246 non-CS patients were collected.A laboratory-developed LC-MS/MS method was used as reference. UFC was measured by direct assays (D) using Abbott, Siemens, and Beckman platforms and by extraction assays (E) using Siemens and Beckman platforms. Method was compared using Passing–Bablok regression and Bland–Altman plot analyses. Cut-off values for the six assays and corresponding sensitivities and specificities were calculated by ROC analysis.
Results:
Abbott-D, Beckman-E, Siemens-E, and Siemens-D showed strong correlations with LC-MS/MS (Spearman coefficient r = 0.965, 0.922, 0.922, and 0.897, respectively), while Beckman-D showed weaker correlation (r = 0.755). All immunoassays showed proportionally positive bias. The areas under the curve were 0.975 for Abbott-D, 0.972 for LCMS/MS, 0.966 for Siemens-E, 0.948 for Siemens-D, 0.955 for Beckman-E, and 0.877 for Beckman-D. The cut-off values varied significantly (154.8–1,321.5 nmol/24 hrs). Assay sensitivity and specificity ranged from 76.1% to 93.2% and from 93.0% to 97.1%, respectively.
Conclusions
Commercially available immunoassays for measuring UFC show different levels of analytical consistency compared to LC-MS/MS. Abbott-D, Siemens-E, and Beckman-E have high diagnostic accuracy for CS.
8.Preparation and characterization of 3D plant-based scaffold based on decellularization method in liver tissue engineering
Jingjing HU ; Songlin HE ; Daxu ZHANG ; Shuo ZHAO ; Xiaonan SHI ; Weilong LI ; Shujun YE ; Jingyi WANG ; Quanyi GUO ; Li YAN
Chinese Journal of Tissue Engineering Research 2024;28(29):4645-4651
BACKGROUND:Tissue engineering has brought new hope to the clinical challenge of liver failure,and the preparation of plant-derived decellularized fiber scaffolds holds significant importance in liver tissue engineering. OBJECTIVE:To prepare apple tissue decellularized scaffold material by using fresh apple slices and a solution of sodium dodecyl sulfate,and assess its biocompatibility. METHODS:Fresh apples were subjected to decellularization using phosphate buffer saline and sodium dodecyl sulfate solution,separately.Afterwards,the decellularized apple tissues and apple decellularized scaffold materials were decontaminated with phosphate buffer saline.Subsequently,scanning electron microscopy was used to assess the effectiveness of decellularization of the apple materials.Adipose-derived mesenchymal stem cells were extracted from the inguinal fat BALB/C of mice,and their expression of stem cell-related markers(CD45,CD34,CD73,CD90,and CD105)was identified through flow cytometry.The cells were then divided into a scaffold-free control group and a scaffold group.Equal amounts of adipose-derived mesenchymal stem cells were seeded onto both groups.The biocompatibility of the decellularized scaffold with adipose-derived mesenchymal stem cells was evaluated using CCK-8 assay,hematoxylin-eosin staining,and phalloidine staining.Cell adhesion and growth on the scaffold were observed under light microscopy and scanning electron microscopy.Furthermore,the scaffold was subdivided into the non-induced group and the hepatogenic-induced group.Adipose-derived mesenchymal stem cells were cultured on the decellularized apple scaffold,and they were cultured for 14 days in regular culture medium or hepatogenic induction medium for comparison.Immunofluorescent staining using liver cell markers,including albumin,cytokeratin 18,and CYP1A1,was performed.Enzyme-linked immunosorbent assay was used to detect the secretion of alpha fetoprotein and albumin.Additionally,scanning electron microscopy was employed to observe the morphology of the induced cells on the scaffold,verifying the expression of liver cell-related genes on the decellularized scaffold material.Finally,the cobalt-60 irradiated and sterilized decellularized apple scaffolds were transplanted onto the surface of mouse liver and the degradation of the scaffold was observed by gross observation and hematoxylin-eosin staining after 28 days. RESULTS AND CONCLUSION:(1)The scanning electron microscopy results revealed that the decellularized apple scaffold material retained a porous structure of approximately 100 μm in size,with no residual cells observed.(2)Through flow cytometry analysis,the cultured cells were identified as adipose-derived mesenchymal stem cells.(3)CCK-8 assay results demonstrated that the prepared decellularized apple tissue scaffold material exhibited no cytotoxicity.Hematoxylin-eosin staining and phalloidine staining showed that adipose-derived mesenchymal stem cells were capable of adhering and proliferating on the decellularized apple tissue scaffold.(4)The results obtained from immunofluorescence staining and enzyme-linked immunosorbent assay revealed that adipose-derived mesenchymal stem cells cultured on the decellularized apple scaffolds exhibited elevated expression of liver-specific proteins,including albumin,alpha-fetoprotein,cytokeratin 18,and CYP1A1.These results suggested that they were induced differentiation into hepatocyte-like cells possessing functional characteristics of liver cells.(5)The decellularized apple scaffold implanted at 7 days has integrated with the liver,with partial degradation of the scaffold observed.By 28 days,the decellularized apple scaffold has completely degraded and has been replaced by newly-formed tissue.(6)The results indicate that the decellularized scaffold material derived from apple tissue demonstrates favorable biocompatibility,promoting the proliferation,adhesion,and hepatic differentiation of adipose-derived mesenchymal stem cells.
9.Exploring the Mechanism of Shuganheweitang in Antidepressant Action based on the Integrated Strategy of Serum Metabolomics and Network Pharmacology
Qi LI ; Juan LI ; Junjie HU ; Xian ZHOU ; Gouqiang MEI ; Songlin LIU ; Xin CHEN
World Science and Technology-Modernization of Traditional Chinese Medicine 2024;26(10):2580-2599
Objective Serum metabolomics combined with network pharmacology were used to explore the related metabolic pathways and action targets of Shuganheweitang(SGHWT)in the treatment of depression,and to explore the anti-depression mechanism of SGHWT.Methods Ten of the 40 SD male rats were randomly selected as normal control group,and the remaining 30 rats were reproduced as depressed rat model by chronic unpredictable mild stress(CUMS).They were divided into model group,SGHWT group(7.34 g·kg-1·d-1)and fluoxetine group(1.58 mg·kg-1·d-1),with 10 animals in each group and ontinuous modeling and gavage lasted for 6 weeks.The endogenous differential metabolites in rat serum were detected by UPLC-Q-TOF-MS/MS.The core components and key target information of SGHWT were selected by network pharmacology.Finally,combined analysis of differential metabolites and protein targets was carried out by Cytoscape software.Serum contents of arachidonic acid(AA),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and cyclooxygenase(COX-2)in each group were detected according to the analysis results.Results A total of 47 different metabolites were identified from the serum metabolome,18 of which could be recovered by SGHWT.Through pathway enrichment analysis,it was found that it was mainly involved in arachidonic acid metabolism and primary bile acid biosynthesis.71 active ingredients and 47 key target proteins of SGHWT were screened by network pharmacological means,and the proportion of arachidonic acid and related targets was the largest in the combined analysis.The ELISA results showed that compared with the control group,the serum contents of AA(P<0.05),IL-6(P<0.01)and TNF-α(P<0.01)in model group were significantly increased.Compared with model group,the contents of IL-6 and TNF-α in SGHWT group were significantly decreased(P<0.01).Conclusion The effective components of SGHWT have the characteristics of multi-target and multi-pathway in the treatment of depression.Further,the mechanism of action may be related to the fact that SGHWT is involved in regulating the metabolic pathway of arachidonic acid,inhibiting the level of inflammatory factors,and then improving the depression-like symptoms induced by chronic stress.
10.Exploring the Mechanism of Shuganheweitang in Antidepressant Action based on the Integrated Strategy of Serum Metabolomics and Network Pharmacology
Qi LI ; Juan LI ; Junjie HU ; Xian ZHOU ; Gouqiang MEI ; Songlin LIU ; Xin CHEN
World Science and Technology-Modernization of Traditional Chinese Medicine 2024;26(10):2580-2599
Objective Serum metabolomics combined with network pharmacology were used to explore the related metabolic pathways and action targets of Shuganheweitang(SGHWT)in the treatment of depression,and to explore the anti-depression mechanism of SGHWT.Methods Ten of the 40 SD male rats were randomly selected as normal control group,and the remaining 30 rats were reproduced as depressed rat model by chronic unpredictable mild stress(CUMS).They were divided into model group,SGHWT group(7.34 g·kg-1·d-1)and fluoxetine group(1.58 mg·kg-1·d-1),with 10 animals in each group and ontinuous modeling and gavage lasted for 6 weeks.The endogenous differential metabolites in rat serum were detected by UPLC-Q-TOF-MS/MS.The core components and key target information of SGHWT were selected by network pharmacology.Finally,combined analysis of differential metabolites and protein targets was carried out by Cytoscape software.Serum contents of arachidonic acid(AA),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and cyclooxygenase(COX-2)in each group were detected according to the analysis results.Results A total of 47 different metabolites were identified from the serum metabolome,18 of which could be recovered by SGHWT.Through pathway enrichment analysis,it was found that it was mainly involved in arachidonic acid metabolism and primary bile acid biosynthesis.71 active ingredients and 47 key target proteins of SGHWT were screened by network pharmacological means,and the proportion of arachidonic acid and related targets was the largest in the combined analysis.The ELISA results showed that compared with the control group,the serum contents of AA(P<0.05),IL-6(P<0.01)and TNF-α(P<0.01)in model group were significantly increased.Compared with model group,the contents of IL-6 and TNF-α in SGHWT group were significantly decreased(P<0.01).Conclusion The effective components of SGHWT have the characteristics of multi-target and multi-pathway in the treatment of depression.Further,the mechanism of action may be related to the fact that SGHWT is involved in regulating the metabolic pathway of arachidonic acid,inhibiting the level of inflammatory factors,and then improving the depression-like symptoms induced by chronic stress.

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