1.Serum Metabolomics of Simulated Weightless Rats Treated with Taikong Yangxin Pills
Xiaodi LIU ; Xuemei FAN ; Yiming WANG ; Mengjia YAN ; Yongzhi LI ; Jiaping WANG ; Junlian LIU ; Guoan LUO
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(2):147-153
ObjectiveTo study the effect of Taikong Yangxin Pills on the metabolism of simulated weightless rats based on metabolomics and discuss the metabolism mechanism. MethodsIn the simulated space capsule environment on the ground, the rat model of simulated weightlessness was established by the tail suspension method. Rats were randomly grouped as follows: out-of-capsule control, in-capsule control, model, and high (3.0 g·kg-1) and low (1.5 g·kg-1) doses of Taikong Yangxin Pills, and they were administrated with corresponding drugs by gavage for 28 days. The serum levels of endogenous metabolites in rats were determined by ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS). The obtained data were processed by principal component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA) to screen for differential metabolites and potential biomarkers. MetaboAnalyst 5.0 was used for pathway enrichment analysis to explain the metabolic regulation mechanism of the drug. ResultsCompared with the out-of-capsule control group, the in-capsule control group showed elevated levels of thirteen metabolites, including 14-hydroxyhexadecanoic acid, linoleic acid, and α-linolenic acid (P<0.05), which suggested that the space capsule environment mainly affected the metabolism of α-linolenic acid and linoleic acid in the rats. Compared with the in-capsule control group, the model group showed lowered levels of fourteen metabolites, including 4-imidazolone-5-propionic acid, isocitric acid/citric acid, and L-tyrosine (P<0.05), which were recovered after the treatment with Taikong Yangxin pills (P<0.05). The pathway enrichment analysis revealed that weightlessness induced by tail suspension and drug intervention mainly involved the phenylalanine, tyrosine, and tryptophan biosynthesis, tyrosine metabolism, histidine metabolism, and citric acid cycle. ConclusionThe simulated space capsule environment and simulated weightlessness induced by tail suspension can both affect the metabolism level of rats. Taikong Yangxin pills can ameliorate the metabolic abnormality in the rat model of weightlessness by regulating various amino acids and energy metabolism-related pathways.
2.Analysis of Quality Uniformity of Hengzhi Kechuan Capsules Based on HPLC-DAD-CAD
Qian MA ; An LIU ; Qingxia XU ; Cong GUO ; Jun ZHANG ; Maoqing WANG ; Xiaodi KOU ; Yan LIU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(3):168-174
ObjectiveTo establish the fingerprints of 15 batches of Hengzhi Kechuan capsules, to quantitatively analyze 10 index components, and to evaluate the quality uniformity of samples from different batches. MethodsThe fingerprints and quantitative analysis of Hengzhi Kechuan capsules were established by a combination method of high performance liquid chromatography coupled with diode array detector and charged aerosol detector(HPLC-DAD-CAD), adenosine, guanosine, vanillic acid, safflomin A, agarotetrol, naringin, hesperidin, militarine, ginsenoside Rb1, and glycyrrhizic acid were selected as quality attribute indexes. A total of 15 batches of Hengzhi Kechuan capsules from 2022 to 2024(3 boxes per batch) were qualitatively and quantitatively analyzed, and the quality uniformity level of the manufacturers was characterized by parameters of intra-batch consistency(PA) and inter-batch consistency(PB). The homogeneity and difference of quality attribute indexes of samples from different years were analyzed by heatmap clustering analysis. ResultsHPLC fingerprints and quantitative method of Hengzhi Kechuan capsules were established, and the methods could be used for qualitative and quantitative analysis of this preparation, which was found to be stable and reliable by method validation. The similarity of fingerprints of 15 batches of samples was 0.887-0.975, a total of 13 common peaks were calibrated, and 10 common peaks were designated, all of which were quality attribute index components. The results of quantitative analysis showed that the contents of the above 10 ingredients in the samples were 0.038-0.078, 0.115-0.251, 0.007-0.018, 0.291-0.673, 0.122-0.257, 0.887-1.905, 1.841-3.364, 1.412-2.450, 2.207-3.112, 0.650-1.161, respectively. And the contents of ginsenoside Rb1 and glycyrrhizic acid met the limit requirements in the 2020 edition of Chinese Pharmacopoeia. For the samples from 15 batches, the PA values of the 10 index components were all <10%, indicating good intra-batch homogeneity, and the PB values ranged from 33.86% to 92.97%, suggesting that the inter-batch homogeneity was poor. Heatmap clustering analysis showed that the samples from different years were clustered into separate categories, and adenosine, guanosine, safflomin A, naringin, hesperidin and agarotetrol were the main differential components. ConclusionThe intra-annual quality uniformity of Hengzhi Kechuan capsules is good and the inter-annual quality uniformity is insufficient, which may be related to the quality difference of Pinellinae Rhizoma Praeparatum, Carthami Flos, Citri Sarcodactylis Fructus, Citri Reticulatae Pericarpium, Aquilariae Lignum Resinatum, Citri Fructus, etc. In this study, the fingerprint and multi-indicator determination method of Hengzhi Kechuan capsules was established, which can be used for more accurate and efficient quality control and standardization enhancement.
3.Left sided sternocleidomastoid interosseous intravascular papillary endothelial hyperplasia: A case report.
Xiaodi XIAO ; Youchen XIA ; Jianying LIU ; Peng FU
Journal of Peking University(Health Sciences) 2025;57(5):1002-1004
Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson tumor, is a rare vascular benign tumor of blood vessels. It may occur in any part of the body, especially the deep dermis and subcutaneous tissue of the head, neck, fingers and trunk. The imaging and histopathology of IPEH are similar to hemangiosarcoma, especially in the case of active vascular endothelial hyperplasia. IPEH is a reactive proliferative lesion of vascular intima. The etiology is still unclear. After some studies showed that IPEH was a benign lesion, few reports on the etiology of it were reported. IPEH is usually limited to the thrombotic vessels or lumens of vascular malformations, usually accompanied by a clear history of trauma. IPEH usually does not cause any symptoms. It looks like a slow-growing lump. Some cases have been reported with pain and swelling. Although IPEH is relatively rare, its accurate diagnosis is crucial because it may be similar to malignant angiogenic lesions in clinical practice. There were few reports of cases related to intravascular papillary endothelial hyperplasia located in the sternocleidomastoid muscle after reviewing the domestic and foreign literature in recent 10 years. This case reports that a young male, who was admitted to the hospital one month after finding a subcutaneous tumor in the left neck. After admittance, relevant preoperative examinations were completed. After multi-disciplinary discussion and elimination of surgical contraindications, a specific surgical plan was formulated. The tumor was removed under local anesthesia on the second day after admission. During the operation, it was found that the tumor was located between the sternocleidomastoid muscle bundles, and it was sent for pathologic examination. Paraffin section pathology was reported after operation. Histological examination showed that the morphology was consistent with vascular endothelial papillary hyperplasia. There were no related surgical complications and recurrence in the 3-month follow-up. The purpose of this paper is to provide clinicians with a certain understanding of this rare disease through the report of this case of IPEH, and to identify it in later clinical work, and at the same time, to avoid confusion with malignant diseases, such as hemangiosarcoma, leading to unnecessary treatment and increase the cost of treatment.
Humans
;
Male
;
Endothelium, Vascular/pathology*
;
Hemangioendothelioma/surgery*
;
Hyperplasia/pathology*
;
Neck Muscles/surgery*
;
Vascular Neoplasms/pathology*
4.COVID-19 and acute limb ischemia: latest hypotheses of pathophysiology and molecular mechanisms.
Chengjun YAO ; Yanzhao DONG ; Haiying ZHOU ; Xiaodi ZOU ; Ahmad ALHASKAWI ; Sohaib Hasan Abdullah EZZI ; Zewei WANG ; Jingtian LAI ; Vishnu Goutham KOTA ; Mohamed Hasan Abdulla Hasan ABDULLA ; Zhenfeng LIU ; Sahar Ahmed ABDALBARY ; Olga ALENIKOVA ; Hui LU
Journal of Zhejiang University. Science. B 2025;26(4):333-352
Coronavirus disease 2019 (COVID-19) is a multi-system disease that can lead to various severe complications. Acute limb ischemia (ALI) has been increasingly recognized as a COVID-19-associated complication that often predicts a poor prognosis. However, the pathophysiology and molecular mechanisms underlying COVID-19-associated ALI remain poorly understood. Hypercoagulability and thrombosis are considered important mechanisms, but we also emphasize the roles of vasospasm, hypoxia, and acidosis in the pathogenesis of the disease. The angiotensin-converting enzyme 2 (ACE2) pathway, inflammation, and platelet activation may be important molecular mechanisms underlying these pathological changes induced by COVID-19. Furthermore, we discuss the hypotheses of risk factors for COVID-19-associated ALI from genetic, age, and gender perspectives based on our analysis of molecular mechanisms. Additionally, we summarize therapeutic approaches such as use of the interleukin-6 (IL-6) blocker tocilizumab, calcium channel blockers, and angiotensin-converting enzyme inhibitors, providing insights for the future treatment of coronavirus-associated limb ischemic diseases.
Humans
;
COVID-19/physiopathology*
;
Ischemia/etiology*
;
SARS-CoV-2
;
Extremities/blood supply*
;
Risk Factors
;
Interleukin-6/antagonists & inhibitors*
;
Acute Disease
;
Angiotensin-Converting Enzyme 2
5.Schistosoma japonicum cystatin has protective effects against "two-hit" sepsis in mice by regulating the inflammatory microenvironment.
Wenjuan DUO ; Yixiang WANG ; Jiaxing WANG ; Xinlong XU ; Linxian LI ; Dongchen YANG ; Qili SHEN ; Lichun YANG ; Xiaojing LIU ; Qiwang JING ; Liang CHU ; Xiaodi YANG
Journal of Southern Medical University 2025;45(1):110-117
OBJECTIVES:
To evaluate the protective effect of Schistosoma japonicum cystatin (rSj-Cystatin) in a mouse mode of "two-hit" sepsis.
METHODS:
Sixty male C57BL/6 mice randomized equally into sham-operated group, protein group, "two-hit" modeling group, and protein intervention group. In the former two groups, the mice received an intraperitoneal injection of 100 μL PBS followed by exposure of the cecum and then by intraperitoneal injection of 100 μL PBS or 25 μg rSj-Cystatin 30 min later; In the latter two groups, 100 μL PBS containing LPS (5 mg/kg) was injected intraperitoneally 24 h before cecal ligation and puncture (CLP), and 100 μL PBS or 25 μg rSj-Cystatin were injected 30 min after CLP. At 12 h after rSj-Cystatin treatment, 6 mice from each group were sacrificed for detection of TNF-α, IL-6, IL-10, TGF-β, iNOS and Arg-1 in the serum, spleen, liver, lung and kidney tissues using ELISA, for examinations of liver, lung and kidney pathologies with HE staining, and for analysis of CD3+CD4+CD25+Foxp3+ T cell percentage in the spleen using flow cytometry. The remaining mice were observed for general condition and 72-h survival.
RESULTS:
The 72-h survival rates in the 4 groups were 100%, 100%, 0% and 20%, respectively, showing significant differences between the latter two groups. The mouse models of "two-hit" sepsis exhibited obvious tissue pathologies and significant elevations of TNF-α and IL-6 in both the serum and tissue homogenate, which were significantly ameliorated by rSj-Cystatin treatment. Treatment with rSj-Cystatin also increased IL-10 and TGF-β levels and spleen CD3+CD4+CD25+Foxp3+ T cell percentage. The septic mouse models also showed increased iNOS levels in all the detected tissues and a decreased Arg-1 level in the kidney, and these changes were obviously improved by rSj-Cystatin treatment.
CONCLUSIONS
rSj-Cystatin has a protective effect against "two-hit" sepsis in mice by regulating the inflammatory microenvironment.
Animals
;
Mice
;
Sepsis/drug therapy*
;
Male
;
Schistosoma japonicum/chemistry*
;
Mice, Inbred C57BL
;
Cystatins/therapeutic use*
;
Interleukin-10/metabolism*
;
Interleukin-6/blood*
;
Tumor Necrosis Factor-alpha/blood*
;
Disease Models, Animal
;
Transforming Growth Factor beta/metabolism*
6.Preparation and efficacy of a circRNA vaccine with herpes simplex virus type Ⅱ gD as immunogen.
Suixin ZHANG ; Xiaodi ZHENG ; Peng NI ; Zhong WANG ; Biao LIU ; Yang WANG ; Han HU ; Binlei LIU
Chinese Journal of Biotechnology 2025;41(4):1354-1371
This study investigated the specific immune response of BALB/c mice that was induced by a circular RNA (circRNA) vaccine expressing the herpes simplex virus type II (HSV-2) glycoprotein D (gD). The aim was to evaluate the immunological potential of this vaccine and lay a foundation for developing an mRNA vaccine against HSV-2. PCR and homologous recombination were employed to integrate the gD gene obtained from the pT7AMP-gD ectodomain plasmid into pUC57 to generate the recombinant plasmid pUC57-circ-gD, which was then sequenced and characterized. In vitro transcription and cyclization were performed on the template DNA to generate pUC57-circ-gD mRNA. To validate the formation of circular RNA, we cleaved the pUC57-circ-gD mRNA with RNase R and employed RT-PCR to validate the cyclization. The pUC57-circ-gD mRNA was then transfected into 293T cells. After 72 h, the cell supernatant was collected, and Western blotting was employed to measure the protein level of gD. Subsequently, the mRNA was encapsulated in lipid nanoparticles (LNPs) by microfluidic encapsulation. BALB/c mice were administrated with the encapsulated mRNA, and blood was collected from the fundus venous plexus after 21 and 35 days, and from the enucleated eyeballs after 49 days. Enzyme-linked immunosorbent assay was employed to measure the titers of antibodies, including virus-neutralizing antibodies. After 49 days, spleens were harvested and assessed for secretion of interferon-gamma (IFN-γ) by solid-phase enzyme-linked immunospot. The results showed successful construction and sequencing of the recombinant plasmid. RNase R digestion confirmed the presence of circular RNAs. Western blotting of the 293T cells transfected with the mRNA showed clear specific bands. The quality of the vaccine was tested by size exclusion chromatography-high performance liquid chromatography, which showed that the purity of the vaccine was about 90%. The mRNA-LNP showcased the particle size of 82.76 nm and an encapsulation rate of approximately 98%. Following three-dose vaccination, all immunized mice exhibited steady weight gain with 100% survival rate throughout the 28-day observation period, indicating no significant acute toxicity associated with the vaccine formulation. The immunized mice showed dose-dependent increases in serum IgG antibody titer and IFN-γ secretion by splenocytes and they were resistant to virus attacks. These findings indicate good immunogenicity and persistence of the pUC57-circ-gD mRNA vaccine, providing a reference for further studies on circRNA vaccines.
Animals
;
Mice, Inbred BALB C
;
RNA, Circular
;
Mice
;
Humans
;
Herpesvirus 2, Human/genetics*
;
Viral Envelope Proteins/genetics*
;
Antibodies, Viral/blood*
;
HEK293 Cells
;
Female
;
Nanoparticles
;
Plasmids
7.Preparation and antitumor activity characterization of oncolytic nanoparticles encapsulating CVA21.
Yinping WANG ; Qiying CAI ; Jingjing ZHOU ; Xiaodi ZHENG ; Linkang CAI ; Yang WANG ; Binlei LIU
Chinese Journal of Biotechnology 2025;41(4):1395-1414
This study aims to investigate the potential of oncolytic nanoparticles encapsulating Coxsackievirus A21 (CVA21) full-genome mRNA (CVA21@ONP) to resurrect CVA21 and induce apoptosis in host cells, as well as the antitumor immune effects of CVA21@ONP in immunocompetent tumor-bearing BALB/c mice. We used lipid nanoparticles (LNPs) to encapsulate CVA21 full-genome mRNA, thus preparing CVA21@ONP. The killing efficacy of CVA21@ONP was determined by the plaque assay and cell counting kit-8 (CCK-8), and the apoptosis in HT29 and CT26-iRFP cells was evaluated by flow cytometry. Mice were administrated with CVA21@ONP at high and low doses intratumorally, and the growth of tumors expressing infra-red fluorescent protein (iRFP) was monitored. Additionally, the types and changes of immune cells in the spleen were analyzed by flow cytometry. The results demonstrated that CVA21@ONP successfully resurrected CVA21 in both HT29 and U87MG cells. The plaque assay revealed robust killing effects of CVA21@ONP against both human and murine cell lines, and flow cytometry results showed increased early and late apoptotic cells. Notably, intratumoral detection revealed significantly down-regulated expression of iRFP in both high- and low-dose CVA21@ONP groups. Flow cytometry results further indicated that CVA21@ONP treatment effectively reduced the levels of immunosuppressive cells, including myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs), in the spleen, while enhancing T cell-dependent antitumor immune responses. These findings suggest that CVA21@ONP can replicate and survive extensively both in vitro and in vivo, activating the immune system of mice administrated with CVA21@ONP to target cells at the tumor site, thereby remodeling the tumor immune microenvironment and accelerating the suppression or even complete regression of tumors. The oncolytic performance of CVA21@ONP has been verified through intratumoral injection administration in this study, aimed at further exploring its therapeutic potential and promoting the development of the field of tumor treatment.
Animals
;
Nanoparticles/chemistry*
;
Mice
;
Mice, Inbred BALB C
;
Humans
;
Apoptosis
;
Oncolytic Viruses/genetics*
;
Oncolytic Virotherapy/methods*
;
Cell Line, Tumor
;
RNA, Messenger/genetics*
;
HT29 Cells
8.Effect of lateral decubitus hand position pad on tumor micrometastasis and trauma response in patients with non-small cell lung cancer
Chinese Journal of Postgraduates of Medicine 2024;47(10):912-916
Objective:To analyze the effect of lateral decubitus hand position pad on tumor micrometastasis and trauma response in patients with non-small cell lung cancer.Methods:Seventy-eight patients with non-small cell lung cancer (45 patients in stage Ⅰ, and 33 cases in stage Ⅱ) admitted to Zhejiang Jinhua Guangfu Cancer Hospital from January 2020 to January 2022 and performed single-aperture thoracoscopic radical resection of non-small cell lung cancer was retrospectively selected, and they were divided into control group (38 cases, adopted traditional body positioning) and study group (40 cases, adopted lateral decubitus hand position pad). Postural indicators, expression levels of metastatic genes, tumor markers, pain degree and stress response indicators were compared between the two groups.Results:The success rate of one position placement in the study group was higher than that in the control group: 100.00%(40/40) vs. 78.95%(30/38); the incidence of surgical skin compression and limb discomfort were lower than those in the control group: 2.50%(1/40) vs. 26.32%(10/38), 5.00%(2/40) vs. 28.95%(11/38); the position placement time was short than that in the control group: (8.47 ± 1.38) min vs.(12.42 ± 2.03) min, there were statistical differences ( P<0.05). Three months after surgery, the expressions of tumor necrosis factor receptor-associated protein 1(TRAP1), matrix metalloproteinase-9 (MMP-9) in the study group were lower than those in the control group: 0.56 ± 0.07 vs. 0.85 ± 0.10, 0.32 ± 0.04 vs. 0.54 ± 0.06, the expressions of E-cadherin and Kruppel-like factor 4(KLF4) in the study group were higher than those in the control group: 1.69 ± 0.22 vs. 1.36 ± 0.17, 2.25 ± 0.37 vs. 1.98 ± 0.20, there were statistical differences ( P<0.05). Three months after surgery, the levels of carcinoembryonic antigen (CEA), cytokeratin (CYFRA21-1) in the study group were lower than those in the control group: (36.89 ± 4.12) μg/L vs. (41.72 ± 5.34) μg/L, (7.25 ± 0.81) μg/L vs. (8.01 ± 1.34) μg/L, there were statistical differences ( P<0.05). At 1-day after surgery, the levels of prostaglandin E2 (PGE2), cortisol (Cor) and substance P (SP) in the study group were lower than those in the control group: (110.47 ± 10.12) pg/L vs. (138.88 ± 14.42) pg/L, (60.37 ± 7.18) ng/L vs. (71.34 ± 8.01) ng/L, (6.26 ± 0.81) μg/L vs. (8.25 ± 1.17) μg/L, there were statistical differences ( P<0.05). Conclusions:The application of lateral decubitus hand position pad in single-aperture thoracoscopic radical resection of non-small cell lung cancer can improve the patient′s position and improve the surgical effect, thus reducing the trauma reaction and effectively inhibiting tumor micrometastasis.
9.Research progress of myeloid-derived suppressor cells in tumor angiogenesis
Xiaodi LIU ; Jianfei SU ; Jingxian ZHANG ; Xueqin WEI ; Yingjie JIA
Journal of International Oncology 2024;51(1):50-54
As a kind of immunosuppressive cells, myeloid-derived suppressor cells (MDSCs) are an important component of the immune microenvironment. MDSCs play a significant role in promoting tumor immune escape. In addition, non-immunological functions such as promoting angiogenesis can also promote tumor development with the deepening of research. MDSCs can promote tumor angiogenesis directly through vascular endothelial growth factor signaling pathway, or promote tumor growth and angiogenesis by secreting cytokines such as matrix metalloprotein-9, basic fibroblast growth factor, angiogenic peptide Bv8, platelet derived growth factor, exosomes, or interacting with other cells. Exploring the expansion, activation, recruitment and angiogenesis mechanism of MDSCs will provide new ideas for regulating the individualized diagnosis and treatment based on targeted MDSCs.
10.A meta-analysis of prevalent characteristics of injury-related behaviors among adolescents based on Chinese literature
Xiaodi BAI ; Yunlan JIANG ; Ting XU ; Siyu LIN ; Heyao XU ; Shulan LIU ; Xinyao ZHOU
Shanghai Journal of Preventive Medicine 2024;36(10):969-976
ObjectiveTo conduct a meta-analysis of the prevalent characteristics of the injury-related behaviors among adolescents in China based on Chinese literature, so as to inform the prevention and control of injury-related behaviors of this population. MethodsA cross-sectional study on the prevalent characteristics of adolescent injury-related behaviors was conducted with the data collected from CNKI, VIP, Wanfang Data, CBM, PubMed, and Web of Science. The review included publications from the inception of the databases to November 2023. Meta-analysis was performed with Stata 15.1 software. ResultsA total of 40 articles were included in this study, and the meta-analysis results showed that cycling violation rate was 38% (95%CI: 32%‒43%), walking violation rate was 29% (95%CI: 22%‒36%), rate of unsafe swimming was 13% (95%CI: 11%‒14%), suicidal ideation rate was 13% (95%CI: 12%‒15%) and the prevalence of fighting was 19% (95%CI: 17%‒22%). Subgroup analysis showed that the cycling violation rate was (44%) for boys and 34% (95%CI: 28%‒40%) for girls. Adolescents in Northeast, East, and Southwest of China had the highest rate of cycling violation (44%), of which junior high school students had the highest rate of violation [42% (95%CI: 36%‒49%)]. As for the walking violation rate, male students [29% (95%CI: 21%‒37%)] was higher than that of female students [22% (95%CI: 15%‒30%)]. Adolescents in North of China had the highest rate of walking violation [54% (95%CI: 30%‒76%)], of which vocational school students accounted for 38% (95%CI:21%‒56%) of the total violation. In terms of the detection rate of unsafe swimming, male students [18% (95%CI: 14%‒24%)] was higher than that of female students [8% (95%CI: 6%‒10%)]. Adolescents in Central South China had the highest rate of unsafe swimming [15% (95%CI: 12%‒18%)], of which, vocational school students accounted for the highest [15% (95%CI: 10%‒19%)]. When it comes to the prevalence of suicidal ideation, female students [16% (95%CI: 13%‒19%)] was higher than that of male students [13% (95%CI: 11%‒15%)]. Adolescents in Southwest of China had the highest rate of suicidal ideation [17% (95%CI: 10%‒25%)], of which high school students accounted for the highest [15% (95%CI: 12%‒18%)]. Finally, the detection rate of fights was 30% (95%CI: 26%‒34%) for boys and 11% (95%CI: 10%‒14%) for girls. Adolescents from Southwest of China had the highest rate [29% (95%CI: 24%‒34%)] for fights, and junior high school students accounted for the highest [26% (95%CI: 22%‒31%)]. ConclusionThe prevalence of harmful behaviors among adolescents in China is notably high, with statistical differences across gender, region, and school stages. These behaviors pose a risk to adolescent health, underscoring the need for targeted interventions by health and educational authorities.

Result Analysis
Print
Save
E-mail