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Zhang XN, Zhang YJ, Wang L, Hong SJ, Zhang CL, Zhao XL, Zeng T. NLRP3 inflammasome activation triggers severe inflammatory liver injury in N, N-dimethylformamide-exposed mice. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 929:172653. [PMID: 38649053 DOI: 10.1016/j.scitotenv.2024.172653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
N,N-dimethylformamide (DMF) is a widely utilized chemical solvent with various industrial applications. Previous studies have indicated that the liver is the most susceptible target to DMF exposure, whereas the underlying mechanisms remain to be elucidated. This study aimed to investigate the role of NLRP3 inflammasome in DMF-induced liver injury in mice by using two NLRP3 inflammasome inhibitors, Nlrp3-/- mice, Nfe2l2-/- mice, and a macrophage-depleting agent. RNA sequencing revealed that endoplasmic reticulum (ER) stress and NLRP3 inflammasome-associated pathways were activated in the mouse liver after acute DMF exposure, which was validated by Western blotting. Interestingly, DMF-induced liver injury was effectively suppressed by two inflammasome inhibitors, MCC950 and Dapansutrile. In addition, knockout of Nlrp3 markedly attenuated DMF-induced liver injury without affecting the metabolism of DMF. Furthermore, silencing Nfe2l2 aggravated the liver injury and the NLRP3 inflammasome activation in mouse liver. Finally, the depletion of hepatic macrophages by clodronate liposomes significantly reduced the liver damage caused by DMF. These results suggest that NLRP3 inflammasome activation is the upstream molecular event in the development of acute liver injury induced by DMF.
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Affiliation(s)
- Xiu-Ning Zhang
- Institute of Toxicology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Yan-Jing Zhang
- Institute of Toxicology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Lin Wang
- Institute of Toxicology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Shu-Jun Hong
- Institute of Toxicology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Cui-Li Zhang
- Institute of Toxicology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Xiu-Lan Zhao
- Institute of Toxicology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
| | - Tao Zeng
- Institute of Toxicology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
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Hong SJ, Zhang XN, Sun Z, Zeng T. The potential health risks of N,N-dimethylformamide: An updated review. J Appl Toxicol 2024. [PMID: 38339870 DOI: 10.1002/jat.4590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
N,N-dimethylformamide (DMF) is a universally used industrial material with exponential growth in production and consumption worldwide. The frequently reported occupational DMF poisoning cases in some countries and the gradually recognized unavoidable health risks to the general population highlight that DMF should still be a matter of concern. Previous studies have demonstrated that the liver is the primary target organ of DMF exposure and multiple mechanisms have been revealed. However, most of these studies investigate the detrimental effects of acute and subacute DMF exposure, while the effects of chronic DMF exposure are rarely studied. Furthermore, the key mechanism for the acute hepatotoxicity of DMF remains to be elucidated. Future research may focus on the identification of efficient preventive measures against the toxicity of DMF to occupational workers, the investigation of the detrimental effects of DMF at environmentally relevant doses, and the studies on the elimination and recycling of DMF in industrial wastes. Herein, we present an updated review of the metabolism of DMF, the biomarker of DMF exposure, underlying molecular mechanisms of DMF-induced hepatotoxicity, and the toxicity of DMF to both occupational workers and general populations and discuss the possible directions in future studies.
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Affiliation(s)
- Shu-Jun Hong
- Institute of Toxicology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiu-Ning Zhang
- Institute of Toxicology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zhan Sun
- Institute of Physical and Chemical Analysis, Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Tao Zeng
- Institute of Toxicology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Wu H, Shi Y, Yan Y, Zhang J, Zhou X, Mei X, Zheng Z, Li D. Pathological characteristics of liver injury induced by N, N-dimethylformamide: From humans to animal models. Open Med (Wars) 2022; 17:1987-1998. [PMID: 36561849 PMCID: PMC9743195 DOI: 10.1515/med-2022-0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/17/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022] Open
Abstract
N,N-Dimethylformamide (DMF) is widely used in chemical industries because of its excellent solvent properties. Poisoning accidents caused by DMF have been frequently reported, particularly hepatotoxicity; however, the hepatic pathological changes have rarely been described. This study aimed to summarise the pathological characteristics of the hepatotoxicity associated with DMF in clinical cases and to verify in animal models. Liver pathologies of two patients with liver failure due to DMF were retrospectively analysed. Thirty-six rats were categorised into the DMF group (intraperitoneally injected with 4 g/kg DMF once a week), carbon tetrachloride (CCl4) group (intraperitoneally injected with 0.5 g/kg CCl4 twice a week) and control group (intraperitoneally injected with normal saline once a week). The general condition and changes in hepatic pathology at 48 h and 8 weeks were observed. Liver tissues of patients exhibited multiple unevenly distributed inflammatory and fibrotic lesions. The DMF-induced liver injury animal model was successfully established. Inflammation and fibrosis were heterogeneously observed throughout the liver in the DMF group, contrast to entirely homogeneous lesions in the CCl4 group. Specific hepatic pathological findings (heterogeneous lesions) caused by DMF detected for the first time in humans and animal model, may be significant in the clinical diagnosis of DMF poisoning.
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Affiliation(s)
- Haicong Wu
- Department of Hepatobiliary Medicine, 900th Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yixian Shi
- Department of Respiratory, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yongqin Yan
- Department of Pathology, 900th Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Jiaxiang Zhang
- Department of Medical Oncology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Xiaoling Zhou
- Department of Hepatobiliary Medicine, 900th Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Xuan Mei
- Department of Hepatobiliary Medicine, 900th Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Zhiyong Zheng
- Department of Pathology, 900th Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Dongliang Li
- Department of Hepatobiliary Medicine, 900th Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Xu L, Ma W, Jin Y, Sun X, Chen N, Zhu X, Luo J, Li C, Zhao K, Zheng Y, Yu D. N, N-dimethylformamide exposure induced liver abnormal mitophagy by targeting miR-92a-1-5p-BNIP3L pathway in vivo and vitro. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 839:156218. [PMID: 35623527 DOI: 10.1016/j.scitotenv.2022.156218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 06/15/2023]
Abstract
N, N-dimethylformamide (DMF) is a widely existing harmful environmental pollutant from industrial emission which can threat human health for both occupational and general populations. Epidemiological and experimental studies have indicated liver as the primary target organ of DMF. However, the molecular mechanism under DMF-induced hepatoxicity remains unclear. In the present study, we identified that DMF could induce abnormal autophagy flux in cells. We also showed that DMF-induced mitochondrial dysfunction and lethal mitophagy which further leads to autophagic cell death. Next, miRNA microarray analysis identified miR-92a-1-5p as the most down-regulated miRNA upon DMF exposure. Mechanistically, miR-92a-1-5p regulated mitochondrial function and mitophagy by targeting mitochondrial protein BNIP3L. Exogenous miR-92a-1-5p significantly attenuated DMF-induced mitochondrial dysfunction and mitophagy in vitro and in vivo. Our study highlights the mechanistic link between miRNAs and mitophagy under environmental stress, which provided a new clue for the mitochondrial epigenetics mechanism on environmental toxicant-induced hepatoxicity.
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Affiliation(s)
- Lin Xu
- School of Public Health, Qingdao University, Qingdao, China
| | - Wanli Ma
- School of Public Health, Qingdao University, Qingdao, China
| | - Yuan Jin
- School of Public Health, Qingdao University, Qingdao, China
| | - Xueying Sun
- School of Public Health, Qingdao University, Qingdao, China
| | - Ningning Chen
- School of Public Health, Qingdao University, Qingdao, China
| | - Xiaoxiao Zhu
- School of Public Health, Qingdao University, Qingdao, China
| | - Jiao Luo
- School of Public Health, Qingdao University, Qingdao, China
| | - Chuanhai Li
- School of Public Health, Qingdao University, Qingdao, China
| | - Kunming Zhao
- School of Public Health, Qingdao University, Qingdao, China
| | - Yuxin Zheng
- School of Public Health, Qingdao University, Qingdao, China
| | - Dianke Yu
- School of Public Health, Qingdao University, Qingdao, China.
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Gong F, Li X, Zhang H, Wu J, Ma G, Zhang B, Gao J, Ding Y, Huang Y, Xia K, Cheng S, Zhou X, Shi J, Zhao F. MiR-192-5p Alleviated Fibrosis and Inflammatory Responses of Tendon Cells by Targeting NFAT5. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6481846. [PMID: 35836925 PMCID: PMC9276496 DOI: 10.1155/2022/6481846] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the effect of microRNA (miR)-192-5p on the inflammatory and fibrotic responses of tendon cells. Methods Tendon cells were treated with transforming growth factor-β1 (TGF-β1). The expression of miR-192-5p and nuclear factor of activated T cells 5 (NFAT5) in tendon cells were detected by RT-qPCR. The expressions of inflammatory and fibrosis-related factors were detected by RT-qPCR and Western blot. MiR-192-5p binds to NFAT5 targeting by TargetScan and dual-luciferase reporter gene assay. The expression of the NFAT5 gene was detected by RT-qPCR and Western blot. Detection of apoptosis in tendon cells by flow cytometry. Results MiR-192-5p was downregulated in tendon cells, and the expression level gradually decreased with the prolong of TGF-β1 treatment. The expression of NFAT5 increased with the treatment time of TGF-β1. The expression of miR-192-5p decreased collagen III (COLIII), α smooth muscle actin (α-SMA), matrix metalloproteinase- (MMP-) 1, and MMP-8 expression, thereby inhibiting TGF-β1-induced fibrosis in tendon cells. The expression of miR-192-5p decreased the expression of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-1β, thereby alleviating TGF-β1-induced inflammatory response and reduce apoptosis in tendon cells. NFAT5 is a direct target of miR-192-5p in tendon cells. The upregulation of NFAT5 reversed the effect of miR-192-5p on the fibrotic activity and inflammatory response of TGF-β1-stimulated tendon cells. Conclusions MiR-192-5p alleviates fibrosis and inflammatory responses of tendon cells by targeting NFAT5.
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Affiliation(s)
- Fan Gong
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Xiaoliang Li
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Hanling Zhang
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Jianke Wu
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Guoxu Ma
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Bowen Zhang
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Jian Gao
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Yi Ding
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Yonglu Huang
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Kun Xia
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Suoli Cheng
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Xuebing Zhou
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Jiandang Shi
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
| | - Fei Zhao
- Hand & foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan, 750002 Ningxia, China
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Liu Y, Wen C, Zhang Y, Liu Z, He Q, Cui M, Peng H, Wang Y, Zhang X, Li X, Wang Q. Aberrant expression of SNHG12 contributes to N, N-dimethylformamide-induced hepatic apoptosis both in short-term and long-term DMF exposure. Toxicol Res (Camb) 2021; 10:1022-1033. [PMID: 34733487 DOI: 10.1093/toxres/tfab088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/20/2021] [Accepted: 08/08/2021] [Indexed: 12/13/2022] Open
Abstract
N, N-Dimethylformamide (DMF) can cause liver damage in occupationally exposed workers, but the molecular mechanism of DMF-induced liver damage has not been fully elucidated. Researches have proved that lncRNA plays a major function in chemical-induced liver toxicity and can be used as a biomarker and therapeutic target for liver injury. In order to verify that lncRNA also participates in DMF-induced liver damage, we treated HL-7702 cells with 75 or 150 mM DMF, and obtained lncRNA expression profiles through high-throughput sequencing. Among the differentially expressed lncRNAs, lncRNA SNHG12 was proved to be significantly downregulated in DMF-treated HL-7702 cells and participate in DMF-mediated apoptosis, even under long-term low-dose DMF exposure (5-10 mM, 8 weeks). In addition, according to bioinformatics analysis, miR-218-5p is expected to be a potential target of SNHG12, which was verified by the dual luciferase reporter assay in HEK293FT cells. MiR-218-5p mimic can induce apoptosis in HL-7702 cells. Among the predicted targets of miR-218-5p, protein kinase C epsilon (PRKCE) was reported to be involved in apoptosis, and was indeed downregulated by miR-218-5p mimic in our study. Further experiments showed that changes of the expression of SNHG12 can affect the expression of PRKCE. In the epidemiological study of occupational population, we also found that SNHG12 was downregulated in the serum exosomes of workers exposed to DMF. These results indicated that SNHG12 can mediate DMF-induced apoptosis of HL-7702 cells through miR-218-5p/PRKCE pathway.
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Affiliation(s)
- Ye Liu
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Cuiju Wen
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou 510300, China
| | - Yangchun Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ziqi Liu
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Qianmei He
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Mengxing Cui
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Honghao Peng
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yuqing Wang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xueying Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xudong Li
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou 510300, China
| | - Qing Wang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
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Hsa_circ_0005915 promotes N,N-dimethylformamide-induced oxidative stress in HL-7702 cells through NRF2/ARE axis. Toxicology 2021; 458:152838. [PMID: 34153373 DOI: 10.1016/j.tox.2021.152838] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/29/2021] [Accepted: 06/16/2021] [Indexed: 01/02/2023]
Abstract
N,N-dimethylformamide (DMF) is an organic compound widely used in industrial production processes as a solvent with a low evaporation rate. Excessive exposure to DMF may lead to liver damage. Oxidative stress has been reported as one of the main causes of DMF-induced hepatotoxicity. Several doses of DMF (0, 1, 5, and 10 mM) were used to treat HL-7702 cells for a relatively long period to simulate the actual exposure pattern in occupational settings, and oxidative stress was induced. Previous studies illustrated that circular RNA (circRNA) plays a vital role in sustaining hepatocyte physiological function. To explore whether aberrant circRNA expression is involved in DMF-induced excessive ROS generation and hepatotoxicity, high-throughput transcriptional sequencing was performed to identify the altered circRNA expression profiles in HL-7702 liver cells after treatment with 0, 75, or 150 mM DMF for 48 h. We found that levels of induced oxidative stress were similar to those in the long-term exposure model. Among the altered circRNAs, one circRNA (hsa_circ_0005915) was significantly upregulated after DMF exposure, and it affected DMF-mediated oxidative stress in HL-7702 cells. Further experiments revealed that hsa_circ_0005915 downregulated the expression of nuclear factor erythoid-2-related factor 2 (NRF2) at the post-transcriptional level via promoting the ubiquitination and degradation of NRF2, which led to the increase of ROS accumulation. Further investigation demonstrated that the expression levels of NRF2-regulated antioxidative genes-heme oxygenase 1 (HO1) and NAD(P)H quinone dehydrogenase 1 (NQO1)-indeed declined after the overexpression of hsa_circ_0005915. In vivo study also indicated that DMF exposure can upregulate the expression of mmu_circ_0007941 (homologous circRNA of hsa_circ_0005915) and downregulated Nrf2 and Ho1 proteins. In summary, our results revealed that hsa_circ_0005915 plays an important role in promoting DMF-induced oxidative stress by inhibiting the transcriptional activity of the NRF2/ARE axis, which provides a potential molecular mechanism of DMF-mediated hepatotoxicity.
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Ren FJ, Yao Y, Cai XY, Fang GY. Emerging Role of MiR-192-5p in Human Diseases. Front Pharmacol 2021; 12:614068. [PMID: 33708127 PMCID: PMC7940509 DOI: 10.3389/fphar.2021.614068] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
MicroRNAs (miRNAs) are a type of small non-coding RNAs that play an essential role in numerous biological processes by regulating the post-transcriptional expression of target genes. Recent studies have demonstrated that miR-192-5p, a member of the miR-192 family, partakes in several human diseases, especially various cancers, including cancers of the lung, liver, and breast. Importantly, the levels of miR-192-5p are abundant in biofluids, including the serum and urine, and the exosomal levels of miR-192-5p in circulation can aid in the diagnosis and prognosis of various diseases, such as chronic hepatitis B (CHB) infection disease. Notably, recent studies suggest that miR-192-5p is regulated by long noncoding RNAs (lncRNAs) and circular RNAs (circRNAs). However, there are no comprehensive overviews on the role of miR-192-5p in human diseases. This review discusses the significant studies on the role of miR-192-5p in various human diseases, with special emphasis on the diseases of the respiratory and digestive systems.
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Affiliation(s)
- Fu-Jia Ren
- Department of Pharmacy, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, China
| | - Yao Yao
- Department of Pharmacy, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao-Yu Cai
- Department of Pharmacy, Hangzhou First People's Hospital, Hangzhou, China
| | - Guo-Ying Fang
- Department of Pharmacy, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, China
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