1.Effect of type 2 diabetes mellitus on orthodontic tooth movement and bone microstructure parameters on the tension side in rats
Chengbo YAN ; Qiuchi LUO ; Jiabing FAN ; Yeting GU ; Qian DENG ; Junmei ZHANG
Chinese Journal of Tissue Engineering Research 2026;30(4):824-831
BACKGROUND:Bone remodeling is the biological basis of orthodontic tooth movement.Type 2 diabetes mellitus leads to metabolic changes in the jaw and alveolar bone,so it is hypothesized that tooth mobility characteristics may be altered in a high-sugar environment.OBJECTIVE:To explore the impact of type 2 diabetes mellitus on orthodontic tooth movement in rats within one tooth movement cycle.METHODS:Seventy-two Sprague-Dawley rats were selected.Forty rats were randomly chosen and fed with a high-fat diet to construct a type 2 diabetes mellitus model.Thirty-two rats that were successfully modeled were randomly divided into a type 2 diabetes mellitus group(n=16)and a diabetic orthodontic group(n=16).The remaining 32 rats were randomly divided into a control group(n=16)and an orthodontic group(n=16).The rats in the orthodontic group and the diabetic orthodontic group were equipped with nickel-titanium coil spring orthodontic force application devices to move the unilateral maxillary first molars mesially with a force of 50 g.The rats were anesthetized and sacrificed on the 3rd,7th,14th,and 21st days after orthodontic treatment,and Micro-CT was used to measure the mesial displacement of the first molars and detect the changes in the bone microstructure parameters on the tension side.RESULTS AND CONCLUSION:There were significant differences in the tooth movement distances among the four groups of rats on the 3rd,7th,14th,and 21st days of orthodontic treatment(P<0.05).There were significant differences in bone mineral density,bone volume fraction and trabecular bone separation on the tension side among the four groups on the 7th,14th,and 21st days of orthodontic treatment(P<0.05).There were differences in the trabecular thickness among the four groups on the 3rd and 14th days of orthodontic treatment(P<0.05).The diabetic orthodontic group had the smallest tension-side alveolar bone mineral density,bone volume fraction,and trabecular thickness,and the largest tooth movement distance and trabecular separation on the 21st day of orthodontic treatment.The above results indicate that type 2 diabetes mellitus adversely affects bone microstructural parameters on the tension side in orthodontic tooth movement in rats,suggesting the occurrence of an osteoporotic state.
2.Effect of type 2 diabetes mellitus on orthodontic tooth movement and bone microstructure parameters on the tension side in rats
Chengbo YAN ; Qiuchi LUO ; Jiabing FAN ; Yeting GU ; Qian DENG ; Junmei ZHANG
Chinese Journal of Tissue Engineering Research 2026;30(4):824-831
BACKGROUND:Bone remodeling is the biological basis of orthodontic tooth movement.Type 2 diabetes mellitus leads to metabolic changes in the jaw and alveolar bone,so it is hypothesized that tooth mobility characteristics may be altered in a high-sugar environment.OBJECTIVE:To explore the impact of type 2 diabetes mellitus on orthodontic tooth movement in rats within one tooth movement cycle.METHODS:Seventy-two Sprague-Dawley rats were selected.Forty rats were randomly chosen and fed with a high-fat diet to construct a type 2 diabetes mellitus model.Thirty-two rats that were successfully modeled were randomly divided into a type 2 diabetes mellitus group(n=16)and a diabetic orthodontic group(n=16).The remaining 32 rats were randomly divided into a control group(n=16)and an orthodontic group(n=16).The rats in the orthodontic group and the diabetic orthodontic group were equipped with nickel-titanium coil spring orthodontic force application devices to move the unilateral maxillary first molars mesially with a force of 50 g.The rats were anesthetized and sacrificed on the 3rd,7th,14th,and 21st days after orthodontic treatment,and Micro-CT was used to measure the mesial displacement of the first molars and detect the changes in the bone microstructure parameters on the tension side.RESULTS AND CONCLUSION:There were significant differences in the tooth movement distances among the four groups of rats on the 3rd,7th,14th,and 21st days of orthodontic treatment(P<0.05).There were significant differences in bone mineral density,bone volume fraction and trabecular bone separation on the tension side among the four groups on the 7th,14th,and 21st days of orthodontic treatment(P<0.05).There were differences in the trabecular thickness among the four groups on the 3rd and 14th days of orthodontic treatment(P<0.05).The diabetic orthodontic group had the smallest tension-side alveolar bone mineral density,bone volume fraction,and trabecular thickness,and the largest tooth movement distance and trabecular separation on the 21st day of orthodontic treatment.The above results indicate that type 2 diabetes mellitus adversely affects bone microstructural parameters on the tension side in orthodontic tooth movement in rats,suggesting the occurrence of an osteoporotic state.
3.Intervention Mechanism of Guizhi Fulingwan in Delaying Colitis-associated Colon Cancer via Modulating and Restoring MDSCs and Reshaping Immune Microenvironment
Yanwei HAO ; Chunrun LI ; Zhengwu QU ; Junmei TANG ; Jing GUO ; Yi ZHANG ; Fengming YOU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(14):185-194
ObjectiveThis paper aims to investigate the efficacy and related actions of Guizhi Fulingwan in intervening in the mice with colitis-associated colon cancer (CAC) based on the immunosuppressive microenvironment associated with myeloid-derived suppressor cells (MDSCs). MethodsSixty male C57BL/6 mice were randomly assigned to a blank group, a model group, an aspirin group (0.04 g·kg-1), and low-, medium-, and high-dose Guizhi Fulingwan groups (4.87, 9.75, and 19.50 g·kg-1), with ten mice per group. The CAC mouse model was established via combined induction of azoxymethane (AOM)/dextran sulphate sodium (DSS). Drug intervention commenced in week five, with continuous intragastric administration for nine weeks. The food intake, body weight, fecal characteristics, and haematochezia were observed and recorded, and disease activity index (DAI) scores were calculated according to scoring criteria. Hematoxylin and eosin (HE) staining was used to observe the histopathological changes in the colon tissues of the mice. Immunohistochemistry was used to determine proliferating cell nuclear antigen-67 (Ki67) expression in the colon tissues, and enzyme-linked immunosorbent assay (ELISA) was used to detect the contents of interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α) in the serum of the mice. Flow cytometry was employed to determine the proportion levels of MDSCs, CD4+ T cells, and CD8+ T cells in the spleen tissues of the mice. The mRNA expressions of MDSC-associated effector molecules, including arginase 1 (Arg1) and inducible nitric oxide synthase (iNOS), were detected by real-time quantitative polymerase chain reaction (Real-time PCR). After that, an in vitro co-culture model of MDSCs and CD8+ T cells was established, and drug-containing serum of Guizhi Fulingwan was used for intervention. The Flow cytometry was employed to assess the effects of drug-containing serum of Guizhi Fulingwan with different concentrations on the levels of reactive oxygen species (ROS) and iNOS in MDSCs and the proliferation of CD8+ T cells. The levels of granzyme B (GZMB) and interferon-γ (IFN-γ) in cell supernatant were detected by ELISA. ResultsCompared with those in the control group, the mice in the model group exhibited significantly reduced body weight, elevated DAI scores, shortened colon length (P<0.01), increased number of tumors and Ki67 expression (P<0.01), and significantly elevated contents of IL-6, IL-1β, and TNF-α in the serum (P<0.01). Significant increases in the number of MDSCs were observed in mouse spleens, alongside marked reductions in the levels of CD4+ T and CD8+ T cells (P<0.01). Furthermore, the mRNA expressions of MDSC function-associated effector molecules Arg1 and iNOS were significantly upregulated (P<0.01). Compared with those in the model group, the mice in the middle-dose Guizhi Fulingwan group exhibited increased body weight and significantly decreased DAI scores (P<0.05, P<0.01). The mice in the middle- and high-dose Guizhi Fulingwan groups exhibited significantly improved colon shortening, significantly decreased number of tumors and Ki67 expression (P<0.05, P<0.01), and significantly decreased contents of IL-6, IL-1β, and TNF-α in the serum (P<0.05, P<0.01). Furthermore, administration of Guizhi Fulingwan markedly reduced MDSC infiltration in the spleen of the mice, with different degrees of increase in the levels of both CD4+ T and CD8+ T cells (P<0.05, P<0.01), alongside significant decreases in the mRNA expressions of Arg1 and iNOS (P<0.05, P<0.01). In vitro cell co-culture shows that administration of drug-containing serum of Guizhi Fulingwan significantly decreases the activity levels of ROS and iNOS in MDSCs and promotes the proliferation of CD8+ T cells and the secretion of GZMB and IFN-γ (P<0.05, P<0.01). ConclusionGuizhi Fulingwan can reduce pro-inflammatory cytokine secretion and inhibit tumor proliferation in the colon tissues of CAC mice. Its potential mechanism may involve reducing MDSC infiltration, enhancing effector T cells, particularly CD8+ T cell response, and improving the tumor immunosuppressive microenvironment.
4.Mechanism of Qifu Lizhong Decoction in Repairing Intestinal Mucosal Barrier and Improving Ulcerative Colitis via Myosin Light Chain Kinase (MLCK)/ Phosphorylated Myosin Light Chain (p-MLC) Signaling Pathway
Junmei TANG ; Zhengwu QU ; Chunrun LI ; Lingling YUAN ; Xuli YANG ; Yanwei HAO ; Yi ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(19):174-184
ObjectiveTo explore the mechanism by which Qifu Lizhong decoction restores intestinal mucosal barrier function in ulcerative colitis (UC) by regulating the myosin light chain kinase (MLCK)/phosphorylated myosin light chain (p-MLC) signaling pathway. MethodsA rat model of UC with spleen-kidney Yang deficiency syndrome and an in vitro intestinal barrier injury model were established. In vivo experiments were conducted to evaluate the body weight, disease activity index (DAI) scores, and changes in colonic pathological morphology in each group of rats. Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and myeloperoxidase (MPO). Transmission electron microscopy (TEM) was employed to observe the morphology and structure of tight junctions (TJ) in rat colonic epithelium. In vitro experiments were conducted to observe the morphology of F-actin in human colon adenocarcinoma cell line-2(Caco-2) cells by phalloidin staining. Combining both in vivo and in vitro approaches, immunohistochemistry (IHC), immunofluorescence (IF), and Western blot were applied to detect the expression and phosphorylation levels of TJ proteins [zonula occludens-1 (ZO-1), Occludin, Claudin-1] as well as key proteins in the MLCK/p-MLC signaling pathway. ResultsIn vivo experiments demonstrated that, compared with the normal group, the model group exhibited significant body weight loss, elevated DAI scores and histopathological scores (P<0.01), increased colonic TNF-α, IL-1β, and MPO levels (P<0.01). TJ structures were disrupted, and the expression of ZO-1, Occludin, and Claudin-1 was significantly reduced (P<0.05, P<0.01). The protein expression levels of myosin light chain (MLC), MLCK, phosphorylated (p)-MLC, and p-MLCK significantly increased (P<0.01). Compared with the model group, all Qifu Lizhong decoction dose groups exhibited increased body weight, as well as significantly decreased DAI scores and histopathological scores (P<0.05, P<0.01). The colonic levels of MPO, TNF-α, and IL-1β were significantly reduced (P<0.05, P<0.01). In the Qifu Lizhong decoction + inhibitor group, the expression of TJ proteins ZO-1, Occludin, and Claudin-1 significantly increased (P<0.01), while the protein expression levels of MLC, MLCK, p-MLC, and p-MLCK were significantly reduced (P<0.01). In vitro experiment results showed that, compared with the normal group, the TNF-α group exhibited disordered cytoskeletal architecture, weakened fluorescence signals of ZO-1, Occludin, and Claudin-1, and significantly elevated protein expression levels of MLC, MLCK, p-MLC, and p-MLCK (P<0.01). Compared with the TNF-α group, the Qifu Lizhong decoction + inhibitor group restored the ordered arrangement of the F-actin cytoskeleton, normalized the expression and localization of TJ proteins ZO-1, Occludin, and Claudin-1, and significantly decreased the protein expression levels of MLC, MLCK, p-MLC, and p-MLCK (P<0.01). ConclusionQifu Lizhong decoction may exert its therapeutic effects on UC by inhibiting the MLCK/p-MLC signaling pathway, thereby stabilizing TJ structure and repairing intestinal barrier integrity.
5.Application progress of digital health technology in nutrition management of gestational diabetes mellitus patients
Keying SUN ; Fangyuan HE ; Rou ZHANG ; Meisu LU ; Jing ZHAO ; Junmei KONG ; Xiaoli GUO
Chinese Journal of Nursing 2025;60(14):1694-1699
In recent years,using digital health technology can improve the quality and effect of nutrition management for patients with gestational diabetes mellitus(GDM).This article provides an overview of digital health technology,reviews the application form and effect of digital health technology in nutrition manage-ment of pregnant women with GDM,puts forward suggestions,in order to provide references and bases for promoting the more scientific,effective and standardized application of digital health technology in nutrition management of GDM patients.
6.Clinical and genetic analysis of a child with Lamb-Shaffer syndrome due to a de novo variant of SOX5 gene
Liming ZHANG ; Liye SHI ; Linfei LI ; Jianwei YANG ; Hongqi SUN ; Junmei YANG ; Yongxing CHEN
Chinese Journal of Medical Genetics 2025;42(1):89-93
Objective:To explore the clinical features of a child with Lamb-Shaffer syndrome (LAMSHF) due to a variant of SOX5 gene. Methods:A child who was admitted to Children′s Hospital Affiliated to Zhengzhou University in July 2022 was selected as the study subject. Clinical data of the child was collected. Whole exome sequencing (WES) was carried out on peripheral blood samples from the child and his parents, and candidate variant was verified by Sanger sequencing and bioinformatic analysis. The study has been approved by the Medical Ethics Committee of the Children′s Hospital Affiliated to Zhengzhou University (Ethics No. 2024-K-100).Results:The child, an one-year-and-seven-month-old male, has manifested delayed development in speech and language, intelligence and movement, in addition with mild facial deformities and eye signs. Whole exome sequencing revealed that he has harbored a heterozygous c. 1828_1829insGACT (p.Y610fs*1) frameshifting variant of the SOX5 gene. Sanger sequencing confirmed the variant to be de novo in origin. The variant was also unreported previously. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was rated as pathogenic (PVS1+ PS2+ PM2_supporting). Conclusion:The c. 1828_1829insGACT (p.Y610fs*1) variant of the SOX5 gene probably underlay the pathogenesis of LAMSHF in this child. For children with delayed mental, language, intellectual, and motor development, genetic testing should be conducted to facilitate early diagnosis. Above finding has enriched the mutational spectrum of the SOX5 gene.
7.Genetic analysis of a case of Miller-McKusick-Malvaux syndrome type 1 caused by CUL7 gene variant and a literature review
Liming ZHANG ; Xue WU ; Jianwei YANG ; Hongqi SUN ; Junmei YANG ; Yongxing CHEN
Chinese Journal of Medical Genetics 2025;42(3):343-348
Objective:To explore the clinical features, genetic characteristics in a child with Miller-McKusick-Malvaux syndrome (3MS) type 1 caused by CUL7 gene variant. Methods:A child diagnosed with 3MS type 1 at the Children′s Hospital Affiliated to Zhengzhou University in February 2021 was selected as the subject of this study. Peripheral blood samples were collected from the child and her parents for genomic DNA extraction. Whole exome sequencing (WES) was performed on the child, and Sanger sequencing was used to validate the candidate variants and analyze their pathogenicity. A literature search was conducted using the keywords "3M syndrome" in the China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and PubMed databases from inception to December 2024. The clinical data of Chinese children with 3MS reported in the literature were summarized. This study was approved by the Medical Ethics Committee of the Children′s Hospital Affiliated to Zhengzhou University (Ethics No. 2024-K-020).Results:①The child was a 6-year-old and 2-month-old female with facial dysmorphism, skeletal abnormalities, and growth and developmental delay. ②WES revealed compound heterozygous variants in the CUL7 gene: c. 2686G>T (p.E896*) and c. 1200delT (p.R401Gfs66). Sanger sequencing confirmed that these two variants were inherited from the child′s father and mother, respectively. According to the American College of Medical Genetics and Genomics (ACMG) Standards and Guidelines for the Interpretation of Sequence Variants, c. 2686G>T (p.E896) was classified as a pathogenic (PVS1+ PM2_Supporting+ PM3), and c. 1200delT (p.R401Gfs*66) was classified as a likely pathogenic (PVS1+ PM2_Supporting). ③ Based on the literature search strategy, 18 relevant articles were identified, including a total of 32 Chinese cases of 3MS, of which 8 were fetuses. A total of 32 Chinese 3MS cases were included in the literature review, of which 8 were fetuses. The majority of these cases carried variants in the CUL7 gene (20/32, 62.5%) and OBSL1 gene (12/32, 37.5%). The main clinical manifestations included intrauterine or postnatal growth and developmental delay (32/32, 100.0%), triangular facies (27/32, 84.3%), and skeletal abnormalities (21/32, 65.6%). Conclusion:The compound heterozygous variants c.2686G>T (p.E896*) and c. 1200delT (p.R401Gfs*66) in the CUL7 gene are likely the genetic cause of 3MS type 1 in the child. For children presenting with facial dysmorphism, skeletal abnormalities, and intrauterine or postnatal growth and developmental delay, 3MS should be considered as a differential diagnosis.
8.Analysis of factors associated with recurrence of macular edema secondary to branch retinal vein occlusion after anti-vascular endothelial growth factor treatment
Junmei WANG ; Shuna WANG ; Xuemin ZHANG ; Jianliang LIU ; Zhenhua FENG
International Eye Science 2025;25(9):1500-1504
AIM: To investigate the risk factors associated with the recurrence of macular edema secondary to branch retinal vein occlusion(BRVO-ME)after anti-vascular endothelial growth factor(anti-VEGF)therapy.METHODS:A total of 32 patients(32 eyes)with BRVO-ME who were treated at the ophthalmology department of the Affiliated Hospital of Shandong Second Medical University from February 2021 to June 2022 were selected. They were treated with a 3+pro re nata (PRN)anti-VEGF regimen and followed up for 6 mo. Following 3 consecutive anti-VEGF injections, patients were categorized into a non-recurrence group and a recurrence group based on central macular thickness(CMT)measured by optical coherence tomography(OCT)at 6 mo post-treatment. Aqueous humor levels of various cytokines levels were quantified using suspension assay method. Demographic characteristics, CMT, and cytokine levels were compared between the two groups, and their correlations with the recurrence of BRVO-ME after anti-VEGF treatment were analyzed.RESULTS:At 6 months post-treatment, ME resolved in 19 eyes(no recurrence group), while 13 eyes showed persistent or recurrent ME(recurrence group). Compared to baseline, the CMT significantly improved in both groups at 1 d, 1, and 6 mo post-treatment(all P<0.05). However, the recurrence group exhibited significantly higher baseline, 1 d and 6 mo post-treatment CMT values than the non-recurrence group(all P<0.05). The aqueous humor levels of VEGF and monocyte chemoattractant protein-1(MCP-1)at baseline were significantly higher in the recurrence group than the non-recurrence group(all P<0.05). Spearman correlation analysis revealed positive associations between baseline CMT and interlukin IL-1β, IL-5, IL-12, MCP-1 and IP-10 levels(all P<0.05). Multivariable Logistic regression analysis identified baseline CMT and MCP-1 levels as independent risk factors for BRVO-ME recurrence(OR>1, P<0.05).CONCLUSION: Elevated baseline CMT and aqueous humor MCP-1 levels were identified as independent risk factors for BRVO-ME recurrence after anti-VEGF therapy. Patients exhibiting higher baseline CMT and MCP-1 levels demonstrated significantly increased susceptibility to recurrence.
9.Clinical and genetic analysis of a child with Lamb-Shaffer syndrome due to a de novo variant of SOX5 gene.
Liming ZHANG ; Liye SHI ; Linfei LI ; Jianwei YANG ; Hongqi SUN ; Junmei YANG ; Yongxing CHEN
Chinese Journal of Medical Genetics 2025;42(1):89-93
OBJECTIVE:
To explore the clinical features of a child with Lamb-Shaffer syndrome (LAMSHF) due to a variant of SOX5 gene.
METHODS:
A child who was admitted to Children's Hospital Affiliated to Zhengzhou University in July 2022 was selected as the study subject. Clinical data of the child was collected. Whole exome sequencing (WES) was carried out on peripheral blood samples from the child and his parents, and candidate variant was verified by Sanger sequencing and bioinformatic analysis. The study has been approved by the Medical Ethics Committee of the Children's Hospital Affiliated to Zhengzhou University (Ethics No. 2024-K-100).
RESULTS:
The child, an one-year-and-seven-month-old male, has manifested delayed development in speech and language, intelligence and movement, in addition with mild facial deformities and eye signs. Whole exome sequencing revealed that he has harbored a heterozygous c.1828_1829insGACT (p.Y610fs*1) frameshifting variant of the SOX5 gene. Sanger sequencing confirmed the variant to be de novo in origin. The variant was also unreported previously. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was rated as pathogenic (PVS1+PS2+PM2_supporting).
CONCLUSION
The c.1828_1829insGACT (p.Y610fs*1) variant of the SOX5 gene probably underlay the pathogenesis of LAMSHF in this child. For children with delayed mental, language, intellectual, and motor development, genetic testing should be conducted to facilitate early diagnosis. Above finding has enriched the mutational spectrum of the SOX5 gene.
Humans
;
SOXD Transcription Factors/genetics*
;
Male
;
Infant
;
Exome Sequencing
;
Genetic Testing
;
Mutation
10.Genetic analysis of a case of Miller-McKusick-Malvaux syndrome type 1 caused by CUL7 gene variant and a literature review.
Liming ZHANG ; Xue WU ; Jianwei YANG ; Hongqi SUN ; Junmei YANG ; Yongxing CHEN
Chinese Journal of Medical Genetics 2025;42(3):343-348
OBJECTIVE:
To explore the clinical features, genetic characteristics in a child with Miller-McKusick-Malvaux syndrome (3MS) type 1 caused by CUL7 gene variant.
METHODS:
A child diagnosed with 3MS type 1 at the Children's Hospital Affiliated to Zhengzhou University in February 2021 was selected as the subject of this study. Peripheral blood samples were collected from the child and her parents for genomic DNA extraction. Whole exome sequencing (WES) was performed on the child, and Sanger sequencing was used to validate the candidate variants and analyze their pathogenicity. A literature search was conducted using the keywords "3M syndrome" in the China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and PubMed databases from inception to December 2024. The clinical data of Chinese children with 3MS reported in the literature were summarized. This study was approved by the Medical Ethics Committee of the Children's Hospital Affiliated to Zhengzhou University (Ethics No. 2024-K-020).
RESULTS:
The child was a 6-year-old and 2-month-old female with facial dysmorphism, skeletal abnormalities, and growth and developmental delay. WES revealed compound heterozygous variants in the CUL7 gene: c.2686G>T (p.E896*) and c.1200delT (p.R401Gfs66). Sanger sequencing confirmed that these two variants were inherited from the child's father and mother, respectively. According to the American College of Medical Genetics and Genomics (ACMG) Standards and Guidelines for the Interpretation of Sequence Variants, c.2686G>T (p.E896) was classified as a pathogenic (PVS1+PM2_Supporting+PM3), and c.1200delT (p.R401Gfs*66) was classified as a likely pathogenic (PVS1+PM2_Supporting). Based on the literature search strategy, 18 relevant articles were identified, including a total of 32 Chinese cases of 3MS, of which 8 were fetuses. A total of 32 Chinese 3MS cases were included in the literature review, of which 8 were fetuses. The majority of these cases carried variants in the CUL7 gene (20/32, 62.5%) and OBSL1 gene (12/32, 37.5%). The main clinical manifestations included intrauterine or postnatal growth and developmental delay (32/32, 100.0%), triangular facies (27/32, 84.3%), and skeletal abnormalities (21/32, 65.6%).
CONCLUSION
The compound heterozygous variants c.2686G>T (p.E896*) and c.1200delT (p.R401Gfs*66) in the CUL7 gene are likely the genetic cause of 3MS type 1 in the child. For children presenting with facial dysmorphism, skeletal abnormalities, and intrauterine or postnatal growth and developmental delay, 3MS should be considered as a differential diagnosis.
Humans
;
Cullin Proteins/genetics*
;
Female
;
Child
;
Limb Deformities, Congenital/genetics*
;
Exome Sequencing
;
Mutation
;
Child, Preschool
;
Dwarfism
;
Muscle Hypotonia
;
Spine/abnormalities*

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