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1.
J Hazard Mater ; 416: 125715, 2021 08 15.
Artículo en Inglés | MEDLINE | ID: mdl-33838513

RESUMEN

The release of soil arsenic (As) in an unsaturated zone under oxidative conditions and at two temperatures simulating the seasonal effect (15 °C and 23 °C) was studied in four cultivated soils from the Elbe River catchment (Czech Republic, Central Europe). The soils with a low geogenic As background contained from 10 to 50 µg.g-1 of As, mostly originating from atmospheric deposition in the past. The temperature effect on the stability of As in soils was studied in connection with the stability of hydrated iron (Fe) oxides and dissolved organic carbon (DOC), as essential binding partners of As in soils. The temperature impact on As release was related to the actual As binding in soil determined by the sequential leaching. With predominant As binding to amorphous and poorly crystalline Fe phases the higher temperature (23 °C) increased As release up to twice compare to 15 °C. In the soils with a low total Fe and the preferential As binding to well-crystallised Fe phases the temperature effect on As release was negligible. Unlike Fe, the release of DOC is strongly temperature dependent, therefore As mobilisation was controlled by the DOC concentration. A higher experimental temperature (23 °C) supported the formation of DOC and the consequent release of As and Fe into the soil solution.


Asunto(s)
Arsénico , Contaminantes del Suelo , Arsénico/análisis , República Checa , Hierro , Suelo , Contaminantes del Suelo/análisis
2.
Toxicol Lett ; 199(1): 60-8, 2010 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-20723587

RESUMEN

DNA integrity was investigated in the lymphocytes of 50 bus drivers, 20 garagemen and 50 controls using the comet assay with excision repair enzymes. In parallel, 8-oxo-7,8-dihydro-2'-deoxyguanosine and 15-F(2t)-isoprostane levels in the urine and protein carbonyl levels in the plasma were assessed as markers of oxidative damage to DNA, lipids and proteins. Exposure to carcinogenic polycyclic aromatic hydrocarbons (cPAHs) and volatile compounds was measured by personal samplers for 48 and 24h, respectively, before the collection of biological specimens. Both exposed groups exhibited a higher levels of DNA instability and oxidative damage to biological macromolecules than the controls. The incidence of oxidized lesions in lymphocyte DNA, but not the urinary levels of 8-oxodG, correlated with exposure to benzene and triglycerides increased this damage. Oxidative damage to lipids and proteins was associated with exposure to cPAHs and the lipid peroxidation levels positively correlated with age and LDL cholesterol, and negatively with vitamin C. The carriers of at least one variant hOGG1 (Cys) allele tended to higher oxidative damage to lymphocyte DNA than those with the wild genotype, while XPD23 (Gln/Gln) homozygotes were more susceptible to the induction of DNA strand breaks. In contrast, GSTM1 null variant seemed to protect DNA integrity.


Asunto(s)
Contaminantes Ocupacionales del Aire/toxicidad , Contaminación del Aire , ADN/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Polimorfismo Genético , Emisiones de Vehículos/toxicidad , 8-Hidroxi-2'-Desoxicoguanosina/análogos & derivados , Ensayo Cometa , Daño del ADN , ADN Glicosilasas/genética , ADN Glicosilasas/metabolismo , Dinoprost/análogos & derivados , Dinoprost/orina , Predisposición Genética a la Enfermedad , Glutatión Transferasa/genética , Guanina/análogos & derivados , Guanina/orina , Humanos , Peroxidación de Lípido/efectos de los fármacos , Linfocitos/química , Linfocitos/efectos de los fármacos , Masculino , Hidrocarburos Policíclicos Aromáticos/análisis , Hidrocarburos Policíclicos Aromáticos/toxicidad , Carbonilación Proteica/efectos de los fármacos , Vasoconstrictores/orina , Compuestos Orgánicos Volátiles/análisis , Compuestos Orgánicos Volátiles/toxicidad , Proteína de la Xerodermia Pigmentosa del Grupo D/genética
3.
Mutat Res ; 642(1-2): 21-7, 2008 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-18436262

RESUMEN

The aim of the present study was to investigate the seasonal variability of markers of oxidative damage to lipids (15-F2t-isoprostane, 15-F2t-IsoP) and proteins (protein carbonyl levels) in 50 bus drivers and 50 controls from Prague, Czech Republic, and to identify factors affecting oxidative stress markers. The samples were collected in three seasons with different levels of air pollution. The exposure to environmental pollutants (carcinogenic polycyclic aromatic hydrocarbons, c-PAHs, particulate matter, PM2.5 and PM10, and volatile organic compounds, VOC) was monitored by personal and/or stationary monitors. For the analysis of both markers, ELISA techniques were used. The median levels of individual markers in bus drivers versus controls were as follows: 15-F2t-IsoP (nmol/mmol creatinine): winter 2005, 0.81 versus 0.68 (p<0.01); summer 2006, 0.62 versus 0.60 (p=0.90); winter 2006, 0.76 versus 0.51 (p<0.001); carbonyl levels (nmol/ml plasma): winter 2005, 14.1 versus 12.9 (p=0.001); summer 2006, 17.5 versus 16.6 (p=0.26); winter 2006, 13.5 versus 11.7 (p<0.001). Multivariate logistic regression identified PM levels measured by stationary monitors over a period 25-27 days before urine collection as a factor positively associated with lipid peroxidation, while protein oxidation levels correlated negatively with both c-PAHs and PM levels. In conclusion, markers of oxidative damage to lipids and proteins were increased in bus drivers in winter seasons, but not in summer. Lipid peroxidation was positively correlated with c-PAHs and PM exposure; protein oxidation correlated negatively and was highest in summer suggesting another factor(s) affecting protein carbonyl levels.


Asunto(s)
Daño del ADN , Peroxidación de Lípido , Carbonilación Proteica , Estaciones del Año , Contaminantes Ocupacionales del Aire/efectos adversos , Biomarcadores/análisis , Monitoreo del Ambiente , Contaminantes Ambientales , F2-Isoprostanos/análisis , Humanos , Vehículos a Motor , Exposición Profesional , Estrés Oxidativo , Material Particulado/efectos adversos , Hidrocarburos Policíclicos Aromáticos/efectos adversos
4.
Mutat Res ; 642(1-2): 14-20, 2008 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-18436263

RESUMEN

We investigated the seasonal variability of 8-oxodeoxyguanosine (8-oxodG), a marker of oxidative damage to DNA, in urine of 50 bus drivers and 50 controls in Prague, Czech Republic, in three seasons with different levels of air pollution: winter 2005, summer 2006 and winter 2006. The exposure to environmental pollutants (carcinogenic polycyclic aromatic hydrocarbons, c-PAHs, particulate matter (PM), and volatile organic compounds (VOC)) was monitored by personal and/or stationary monitors. For the analysis of 8-oxodG levels, the ELISA technique was used. Bus drivers were exposed to significantly higher levels of c-PAHs in winter 2006, while in the other two seasons the exposure of controls was unexpectedly higher than that of bus drivers. We did not see any difference in VOC exposure between both groups in summer 2006 and in winter 2006; VOC were not monitored in winter 2005. 8-OxodG levels were higher in bus drivers than in controls in all seasons. The median levels of 8-oxodG (nmol/mmol creatinine) in bus drivers vs. controls were as follows: winter 2005: 7.79 vs. 6.12 (p=0.01); summer 2006: 6.91 vs. 5.11 (p<0.01); winter 2006: 5.73 vs. 3.94 (p<0.001). Multivariate logistic regression analysis identified PM2.5 and PM10 levels, measured by stationary monitors during a 3-day period before urine collection, as the only factors significantly affecting 8-oxodG levels, while the levels of c-PAHs had no significant influence.


Asunto(s)
Daño del ADN , Desoxiguanosina/análogos & derivados , Estrés Oxidativo , Estaciones del Año , 8-Hidroxi-2'-Desoxicoguanosina , Contaminantes Ocupacionales del Aire , Biomarcadores/orina , Carcinógenos Ambientales , Desoxiguanosina/orina , Monitoreo del Ambiente , Contaminantes Ambientales , Humanos , Vehículos a Motor , Exposición Profesional , Material Particulado/efectos adversos , Hidrocarburos Policíclicos Aromáticos/efectos adversos
5.
Toxicol Lett ; 172(1-2): 12-20, 2007 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-17604575

RESUMEN

The capital city of Prague is one of the most polluted localities of the Czech Republic. The effect of exposure to carcinogenic polycyclic aromatic hydrocarbons (c-PAHs) adsorbed onto respirable air particles (<2.5 microm) on chromosomal aberrations was studied in a group of city policemen (street patrol, aged 34+/-8 years) working in the downtown area of Prague and spending daily >8h outdoors (N=61) in months of January and March 2004. Ambient air particles (PM10, PM2.5) and c-PAHs were monitored using Versatile Air Pollution Sampler (VAPS), and personal exposure was evaluated using personal samplers during working shift. Chromosomal aberrations were analyzed by fluorescent in situ hybridization (FISH) and conventional cytogenetic analysis. Urinary cotinine, plasma levels of vitamins A, E and C, folate, total cholesterol, HDL, LDL cholesterols and triglycerides were also analyzed as possible effect modifiers. During the sampling period the particulate air pollution monitored by VAPS was in January versus March as follows: PM10 55.6 microg/m3 versus 36.4 microg/m3, PM2.5 44.4 microg/m3 versus 24.8 microg/m3, c-PAHs 19.7 ng/m3 versus 3.6 ng/m3, and B[a]P 4.3 ng/m3 versus 0.8 ng/m3. Significant differences were observed for all FISH endpoints studied for the sampling in January and March (%AB.C.=0.27+/-0.18 versus 0.16+/-0.17, p<0.001, F(G)/100=1.32+/-1.07 versus 0.85+/-0.95, p<0.01, AB/1000 (aberrations/1000 cells)=4.27+/-3.09 versus 2.59+/-2.79, p<0.001) while conventional cytogenetic analysis did not reveal any differences in the frequency of chromosomal aberrations. Factors associated with an increased level of translocations by FISH indicated the effect of age, cholesterol, LDL-cholesterol and vitamin C. We may conclude that FISH indicates that the city policemen in Prague represent a group of increased genotoxic risk. This is the first study reporting that translocations induced by c-PAHs in peripheral lymphocytes last only several weeks.


Asunto(s)
Carcinógenos Ambientales/efectos adversos , Aberraciones Cromosómicas/inducido químicamente , Pintura Cromosómica , Análisis Citogenético , Monitoreo del Ambiente/métodos , Exposición Profesional , Material Particulado/efectos adversos , Hidrocarburos Policíclicos Aromáticos/efectos adversos , Adulto , Factores de Edad , Biomarcadores/sangre , Biomarcadores/orina , Carcinógenos Ambientales/análisis , Cotinina/orina , República Checa , Humanos , Modelos Lineales , Lípidos/sangre , Linfocitos/efectos de los fármacos , Masculino , Material Particulado/análisis , Policia , Hidrocarburos Policíclicos Aromáticos/análisis , Medición de Riesgo , Factores de Riesgo , Estaciones del Año , Factores de Tiempo , Translocación Genética/efectos de los fármacos , Salud Urbana , Vitaminas/sangre
6.
Toxicol Lett ; 172(1-2): 37-47, 2007 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-17590289

RESUMEN

DNA integrity was analyzed in the lymphocytes of 65 non-smoking city policemen during January and September 2004 using the comet assay combined with excision repair enzymes. Information about inhalation exposure was obtained by (1) stationary monitoring of PM2.5 and carcinogenic polycyclic aromatic hydrocarbons (cPAHs) during the sampling periods and (2) personal exposure monitoring of cPAHs 48h before blood sampling. The data were completed by a lifestyle questionnaire. Regardless of the season of the year, policemen working outdoors (exposed group) exhibited higher levels of DNA damage than those working indoors (controls). Within the exposed group, the levels of both unspecified and oxidative DNA damage detected in January significantly exceeded those found in September. The controls did not show analogous inter-seasonal variability. The winter levels of oxidative DNA damage positively correlated with exposure to cPAHs, probably reflecting increased oxidative stress as a result of high concentrations of PM2.5. In comparison with the wild type genotype, the carriers of at least one mutated allele, CYP1A1*2C (Ile/Val), MTHFR 2656 or MS 2656, and the EPHX1-medium phenotype appeared to be more susceptible specifically to the induction of oxidative DNA damage, while the p53 MspI mutation predisposed the carrier to a higher incidence of both breaks and oxidative lesions in DNA. In contrast, GSTM1-null and vitamin C tended rather to protect DNA integrity.


Asunto(s)
Carcinógenos Ambientales/efectos adversos , Daño del ADN , Genotipo , Linfocitos/efectos de los fármacos , Exposición Profesional , Material Particulado/efectos adversos , Policia , Hidrocarburos Policíclicos Aromáticos/efectos adversos , Adulto , Carcinógenos Ambientales/análisis , Estudios de Casos y Controles , Ensayo Cometa , Citocromo P-450 CYP1A1/genética , República Checa , Monitoreo del Ambiente/métodos , Epóxido Hidrolasas/genética , Humanos , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Estrés Oxidativo/efectos de los fármacos , Material Particulado/análisis , Hidrocarburos Policíclicos Aromáticos/análisis , Polimorfismo Genético , Estaciones del Año , Encuestas y Cuestionarios
7.
Mutat Res ; 620(1-2): 22-33, 2007 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-17418242

RESUMEN

The capital city of Prague is one of the most polluted localities of the Czech Republic. Therefore, the effect of exposure to carcinogenic polycyclic aromatic hydrocarbons (c-PAHs) adsorbed onto respirable air particles (<2.5mum) on chromosomal aberrations was studied in a group of policemen (males, aged 22-50 years) working in the downtown area of Prague and spending daily >8h outdoors (N=53). Age- and sex-matched healthy volunteers spending >90% daily time indoors were chosen as controls (N=52). Ambient air particles (PM10, PM2.5) and c-PAHs were monitored using versatile air pollution sampler (VAPS), and personal exposure was evaluated using personal samplers during working shift. Chromosomal aberrations were analyzed by conventional cytogenetic analysis and fluorescent in situ hybridization (FISH). Urinary cotinine plasma levels of vitamins A, E and C, folate, total cholesterol, HDL, LDL cholesterols and triglycerides were also analyzed as possible effect modifiers. Genotypes CYP1A1*2A, CYP1A1*2C, GSTM1, GSTP1, GSTT1, EPHX1, NAT2, hOGG1, XRCC1, XPD, p53 BstI, p53 MspI, MTHFR677, and MS2656 were determined by PCR-based RFLP assays. The following levels of air pollution were recorded during the study period (mean from HiVol sampling): PM10 62.6microg/m(3), c-PAHs 24.7ng/m(3), B[a]P 3.50ng/m(3). The conventional cytogenetic analysis did not reveal any differences between the group of policemen exposed to the ambient air pollution and the control group. The cytogenetic analysis by FISH analysis used the whole chromosome painting probes for chromosomes #1 and #4 (Cambio, UK). It detected a significant increase in all studied endpoints in the policemen compared to controls (% AB.C.=0.33+/-0.25 versus 0.24+/-0.18, p<0.05, F(G)/100=1.72+/-1.57 versus 1.25+/-1.11, p<0.05, AB/1000 (aberrations/1000 cells)=5.58+/-4.62 versus 3.90+/-3.06, p<0.05). CYP1A1*2C (Ile/Ile), XPD 23 (Lys/Lys), and XPD 6 (CC) genotypes were associated with an increase of aberrant cells by conventional method. Factors associated with an increased level of translocations by FISH included age, smoking, B[a]P-like DNA adducts (corresponding to the exposure of c-PAHs), folate, polymorphisms of CYP1A1*2C, GSTP1, EPHX1, p53 MspI and MTHFR. Ambient air exposure to c-PAHs significantly increased FISH cytogenetic parameters in nonsmoking policemen. We may conclude that FISH indicates that the city policemen in Prague represent a group of increased genotoxic risk. This is the first study that has reported a relationship between DNA adducts (biomarker of exposure) and chromosomal aberrations by FISH (biomarker of effect).


Asunto(s)
Contaminantes Atmosféricos/toxicidad , Carcinógenos Ambientales/toxicidad , Aberraciones Cromosómicas , Reparación del ADN , Exposición Profesional , Hidrocarburos Policíclicos Aromáticos/toxicidad , Polimorfismo Genético , Adulto , Pintura Cromosómica , Citocromo P-450 CYP1A1/genética , Genotipo , Glutatión Transferasa/genética , Humanos , Hibridación Fluorescente in Situ , Masculino , Persona de Mediana Edad , Policia
8.
Mutat Res ; 620(1-2): 49-61, 2007 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-17412371

RESUMEN

Epidemiologic studies indicate that prolonged exposure to particulate air pollution may be associated with increased risk of cardiovascular diseases and cancer in general population. These effects may be attributable to polycyclic aromatic hydrocarbons (PAHs) adsorbed to respirable air particles. It is expected that metabolic and DNA repair gene polymorphisms may modulate individual susceptibility to PAH exposure. This study investigates relationships between exposure to PAHs, polymorphisms of these genes and DNA adducts in group of occupationally exposed policemen (EXP, N=53, males, aged 22-50 years) working outdoors in the downtown area of Prague and in matched "unexposed" controls (CON, N=52). Personal exposure to eight carcinogenic PAHs (c-PAHs) was evaluated by personal samplers during working shift prior to collection of biological samples. Bulky-aromatic DNA adducts were analyzed in lymphocytes by (32)P-postlabeling assay. Polymorphisms of metabolizing (GSTM1, GSTP1, GSTT1, EPHX1, CYP1A1-MspI) and DNA repair (XRCC1, XPD) genes were determined by PCR-based RFLP assays. As potential modifiers and/or cofounders, urinary cotinine levels were analyzed by radioimmunoassay, plasma levels of vitamins A, C, E and folates by HPLC, cholesterol and triglycerides using commercial kits. During the sampling period ambient particulate air pollution was as follows: PM10 32-55microg/m(3), PM2.5 27-38microg/m(3), c-PAHs 18-22ng/m(3); personal exposure to c-PAHs: 9.7ng/m(3) versus 5.8ng/m(3) (P<0.01) for EXP and CON groups, respectively. The total DNA adduct levels did not significantly differ between EXP and CON groups (0.92+/-0.28adducts/10(8) nucleotides versus 0.82+/-0.23adducts/10(8) nucleotides, P=0.065), whereas the level of the B[a]P-"like" adduct was significantly higher in exposed group (0.122+/-0.036adducts/10(8) nucleotides versus 0.099+/-0.035adducts/10(8) nucleotides, P=0.003). A significant difference in both the total (P<0.05) and the B[a]P-"like" DNA adducts (P<0.01) between smokers and nonsmokers within both groups was observed. A significant positive association between DNA adduct and cotinine levels (r=0.368, P<0.001) and negative association between DNA adduct and vitamin C levels (r=-0.290, P=0.004) was found. The results of multivariate regression analysis showed smoking, vitamin C, polymorphisms of XPD repair gene in exon 23 and GSTM1 gene as significant predictors for total DNA adduct levels. Exposure to ambient air pollution, smoking, and polymorphisms of XPD repair gene in exon 6 were significant predictors for B[a]P-"like" DNA adduct. To sum up, this study suggests that polymorphisms of DNA repair genes involved in nucleotide excision repair may modify aromatic DNA adduct levels and may be useful biomarkers to identify individuals susceptible to DNA damage resulting from c-PAHs exposure.


Asunto(s)
Contaminantes Atmosféricos/toxicidad , Carcinógenos Ambientales/toxicidad , Aductos de ADN/análisis , Reparación del ADN , Hidrocarburos Policíclicos Aromáticos/toxicidad , Polimorfismo Genético , Adulto , Ácido Ascórbico/sangre , Glutatión Transferasa/genética , Humanos , Lípidos/sangre , Masculino , Exposición Profesional , Policia , Hidrocarburos Policíclicos Aromáticos/metabolismo
9.
Mutat Res ; 617(1-2): 23-32, 2007 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-17328930

RESUMEN

Exposure to ambient air pollution is associated with many diseases. Oxidative and nitrosative stress are believed to be two of the major sources of particulate matter (PM)-mediated adverse health effects. PM in ambient air arises from industry, local heating, and vehicle emissions and poses a serious problem mainly in large cities. In the present study we analyzed the level of oxidative and nitrosative stress among 50 bus drivers from Prague, Czech Republic, and 50 matching controls. We assessed simultaneously the levels of 15-F(2t)-isoprostane (15-F(2t)-IsoP) and 8-oxodeoxyguanosine (8-oxodG) in urine and protein carbonyl groups and 3-nitrotyrosine (NT) in blood plasma. For the analysis of all four markers we used ELISA techniques. We observed significantly increased levels of oxidative and nitrosative stress markers in bus drivers. The median levels (min, max) of individual markers in bus drivers versus controls were as follows: 8-oxodG: 7.79 (2.64-12.34)nmol/mmol versus 6.12 (0.70-11.38)nmol/mmol creatinine (p<0.01); 15-F(2t)-IsoP: 0.81 (0.38-1.55)nmol/mmol versus 0.68 (0.39-1.79)nmol/mmol creatinine (p<0.01); carbonyl levels: 14.1 (11.8-19.0)nmol/ml versus 12.9 (9.8-16.6)nmol/ml plasma (p<0.001); NT: 694 (471-3228)nmol/l versus 537 (268-13833)nmol/l plasma (p<0.001). 15-F(2t)-IsoP levels correlated with vitamin E (R=0.23, p<0.05), vitamin C (R=-0.33, p<0.01) and cotinine (R=0.47, p<0.001) levels. Vitamin E levels also positively correlated with 8-oxodG (R=0.27, p=0.01) and protein carbonyl levels (R=0.32, p<0.001). Both oxidative and nitrosative stress markers positively correlated with PM2.5 and PM10 exposure. In conclusion, our study indicates that exposure to PM2.5 and PM10 results in increased oxidative and nitrosative stress.


Asunto(s)
Contaminación del Aire , Conducción de Automóvil , Biomarcadores/metabolismo , Desoxiguanosina/análogos & derivados , F2-Isoprostanos/orina , Estrés Oxidativo , Tirosina/análogos & derivados , 8-Hidroxi-2'-Desoxicoguanosina , Estudios de Casos y Controles , República Checa , Desoxiguanosina/orina , Ensayo de Inmunoadsorción Enzimática , Humanos , Masculino , Persona de Mediana Edad , Oxidación-Reducción , Material Particulado , Tirosina/sangre
10.
Mutat Res ; 591(1-2): 302-10, 2005 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-16099478

RESUMEN

Folate plays an important role in the genomic stability of human cells. In our studies of the impact of environmental pollution on human health, we have found that air pollution can affect pregnancy outcome. As it may be also affected by nutrition, we examined the effect of plasma folate levels of mothers and newborns on intrauterine growth retardation (IUGR) and birth weight (BW) in cohorts from Prague (N=319) and Teplice (N=444). The lower plasma levels (<6.1 nmol/L) were observed in 7.1% of mothers in Prague, and in 9.6% of mothers in Teplice. The higher plasma levels (>36.5 nmol/L) were observed in 28.4% of mothers in Prague, and in 15.7% of mothers in Teplice. The higher plasma levels were observed in 75.4% of newborns in Prague, and 73.2% of newborns in Teplice. When comparing maternal high versus low folate plasma levels and IUGR by logistic regression, the risk of IUGR was significantly decreased for European cohort (according to ethnicity) with gestation age >36 weeks [N=536, OR=0.44, P=0.026], and even more pronounced in the group of European smokers [N=157, OR=0.14, P=0.015]. Using multiple regression analysis, plasma folate levels of mothers and newborns significantly affected the birth weight of newborns of smoking mothers (P<0.05). The obtained results seem to indicate a positive effect of folate on pregnancy outcome, especially its potential to decrease the risk of IUGR in European population and lower birth weight in smoking European mothers. It would be warranted to study the effect of folate levels on pregnancy outcomes in the relationship to different environmental pollution and life styles of mothers.


Asunto(s)
Peso al Nacer , Retardo del Crecimiento Fetal , Ácido Fólico/sangre , Etnicidad , Femenino , Edad Gestacional , Humanos , Recién Nacido , Embarazo , Resultado del Embarazo , Estadística como Asunto
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