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Hammoudeh N, Hasan R, Deeb M, Radwan Z, Ayoubi O, Alendary R, Youssef M, Kazan A, Alsahli R, Faiad W, Aldeli N, Hanano A. Exploring transcriptomic databases to identify and experimentally validate tissue-specific consensus reference gene for gene expression normalization in BALB/c mice acutely exposed to 2,3,7,8-Tetrachlorodibenzo- p-dioxin. Curr Res Toxicol 2025; 8:100234. [PMID: 40391131 PMCID: PMC12088766 DOI: 10.1016/j.crtox.2025.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Revised: 04/13/2025] [Accepted: 04/16/2025] [Indexed: 05/21/2025] Open
Abstract
2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a toxic compound affecting organs like the liver, kidney, lung, and reproductive systems in mammals. This study outlines a strategy for choosing appropriate HKGs for tissue-specific gene expression analysis in TCDD toxicity, including four steps: i) identifying candidate HKGs from literature and databases; ii) defining primers from literature or designing new ones; iii) validating primer efficiency and specificity; iv) experimentally assessing candidate HKGs' stability in various tissues of TCDD-exposed mice. Based on this strategy, a total of 40 potential HKGs was selected, further filtered based on their database sources and ranked according to their frequency of use or expression stability. Ultimately, we identified a final set of 15 HKGs (Rps18, Calr, Polr2b, Brms1l, P4hb, Esd, Hdgf, Gapdh, Mlec, Tbp, Rn18s, Sdha, B2m, Actr3 and Actb) with typical efficiencies for further evaluation. Then, the stability of the selected HKGs was determined in the liver, kidney, lung, ovary and testis of TCDD-exposed mouse compared to the control group using the [log (2ΔCt)] and statistically analyzed using Pearson correlation coefficient (r) by BestKeeper algorithm. Our data analysis revealed that Actb, Rps18, and Polr2b were the most stable HKGs for normalizing gene expression in the liver, while Sdha, Actb, and Gapdh were suitable for kidney tissue. In the lung, Tbp, Sdha, and Rps18 showed stability, while Tbp, B2m, and Actb were most stable in ovary. Lastly, Actb, B2m, and Tbp were accurately stable in the testis of TCDD-exposed mice. Our study identifies stable HKGs, improving TCDD toxicity research accuracy and reliability.
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Affiliation(s)
- Nour Hammoudeh
- Department of Animal Biology, Faculty of Sciences, University of Damascus, Damascus, Syria
| | - Reem Hasan
- Distinction and Creativity Agency, Damascus, Syria
| | | | - Zuher Radwan
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, University of Kalamoon, Deir Atiyah, Syria
| | - Omar Ayoubi
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, University of Kalamoon, Deir Atiyah, Syria
| | - Roaa Alendary
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, University of Kalamoon, Deir Atiyah, Syria
| | - Mouayad Youssef
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, University of Kalamoon, Deir Atiyah, Syria
| | - Abdulfattah Kazan
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, University of Kalamoon, Deir Atiyah, Syria
| | - Rasil Alsahli
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, University of Kalamoon, Deir Atiyah, Syria
| | - Walaa Faiad
- Department of Animal Biology, Faculty of Sciences, University of Damascus, Damascus, Syria
| | - Nour Aldeli
- Department of Animal Biology, Faculty of Science, Al Furat University, Deir-ez-Zor, Syria
| | - Abdulsamie Hanano
- Department of Molecular Biology and Biotechnology, Atomic Energy Commission of Syria (AECS), Damascus, Syria
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Cong Y, Wu Y, Liu Y, Ai Y, Wang X, Wei C, Ding H, Xu G, Sun W. TCDD inhibits the proliferation of C17.2 cells through the activation of the c-Cbl/β-catenin signaling pathway. Toxicol In Vitro 2025; 104:106014. [PMID: 39880321 DOI: 10.1016/j.tiv.2025.106014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 12/23/2024] [Accepted: 01/26/2025] [Indexed: 01/31/2025]
Abstract
2,3,7,8-tetrachlordibenzo-p-dioxin (TCDD) belongs to the category of persistent environmental pollutants, and gestational exposure to TCDD can lead to cognitive, memory, and motor deficits, as well as altered neuron development in rodents. However, the molecular mechanisms underlying TCDD's neurotoxicity remain unclear. Neural stem cells (NSCs) possess the capacity for self-renewal and can generate various cell types within the brain, playing fundamental roles in brain development and regeneration. This study investigated the impact of TCDD on the proliferation of mouse NSCs, specifically focusing on the C17.2 cell line. The results demonstrated that TCDD inhibited the proliferation of C17.2 cells in a dose-dependent manner. Even low doses of TCDD (5 nM) significantly reduced C17.2 cell proliferation. Regarding the molecular mechanisms, it was found that TCDD induced the degradation of β-catenin, a key regulator of cell proliferation, through the upregulation of the E3 ubiquitin ligase, casitas B-lineage lymphoma (c-Cbl), which was dependent on the aryl-hydrocarbon Receptor (AhR). Furthermore, knockdown of c-Cbl alleviated the TCDD-induced inhibition of C17.2 proliferation and of the reduction of β-catenin expression. Our research provides foundational data to understand the mechanism of TCDD-induced neurotoxicity through the inhibition of NSCs proliferation, and suggests that the c-cbl/β-catenin pathway may serve as a potential therapeutic target for countering the neurotoxicants of TCDD.
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Affiliation(s)
- Yewen Cong
- School of Public Health, Nantong University, Nantong 226019, Jiangsu, China; Affiliated Matern & Care Hospital, Nantong University, Nantong 226007, Jiangsu, China
| | - Yue Wu
- School of Public Health, Nantong University, Nantong 226019, Jiangsu, China
| | - Yue Liu
- School of Public Health, Nantong University, Nantong 226019, Jiangsu, China
| | - Yongjun Ai
- School of Public Health, Nantong University, Nantong 226019, Jiangsu, China
| | - Xiping Wang
- School of Public Health, Nantong University, Nantong 226019, Jiangsu, China
| | - Chunxi Wei
- School of Public Health, Nantong University, Nantong 226019, Jiangsu, China
| | - Haoyu Ding
- School of Public Health, Nantong University, Nantong 226019, Jiangsu, China
| | - Guangfei Xu
- School of Public Health, Nantong University, Nantong 226019, Jiangsu, China.
| | - Wenxing Sun
- School of Public Health, Nantong University, Nantong 226019, Jiangsu, China.
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Hammoudeh N, Soukkarieh C, Murphy DJ, Hanano A. Female-to-male differential transcription patterns of miRNA-mRNA networks in the livers of dioxin-exposed mice. ENVIRONMENTAL TOXICOLOGY 2023; 38:2310-2331. [PMID: 37318321 DOI: 10.1002/tox.23868] [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: 03/28/2023] [Revised: 05/14/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
Non-coding microRNAs (miRNAs) have important roles in regulating the expression of liver mRNAs in response to xenobiotic-exposure, but their roles concerning dioxins such as TCDD (2,3,7,8-Tetrachlorodibenzo-p-dioxin) are less clear. This report concerns the potential implication of liver (class I) and circulating (class II) miRNAs in hepatotoxicity of female and male mice after acute exposure to TCDD. The data show that, of a total of 38 types of miRNAs, the expression of eight miRNAs were upregulated in both female and male mice exposed to TCDD. Inversely, the expression of nine miRNAs were significantly downregulated in both animal genders. Moreover, certain miRNAs were preferentially induced in either females or males. The potential downstream regulatory effects of miRNAs on their target genes was evaluated by determining the expression of three group of genes that are potentially involved in cancer biogenesis, other diseases and in hepatotoxicity. It was found that certain cancer-related genes were more highly expressed females rather than males after exposure to TCDD. Furthermore, a paradoxical female-to-male transcriptional pattern was found for several disease-related and hepatotoxicity-related genes. These results suggest the possibility of developing of new miRNA-specific interfering molecules to address their dysfunctions as caused by TCDD.
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Affiliation(s)
- Nour Hammoudeh
- Department of Animal Biology, Faculty of Sciences, University of Damascus, Damascus, Syria
| | - Chadi Soukkarieh
- Department of Animal Biology, Faculty of Sciences, University of Damascus, Damascus, Syria
| | - Denis J Murphy
- School of Applied Sciences, University of South Wales, Pontypridd, UK
| | - Abdulsamie Hanano
- Department of Molecular Biology and Biotechnology, Atomic Energy Commission of Syria (AECS), Damascus, Syria
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Lee HA, Kyeong S, Kim DH. Long-term effects of defoliant exposure on brain atrophy progression in humans. Neurotoxicology 2022; 92:25-32. [PMID: 35830900 DOI: 10.1016/j.neuro.2022.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 05/30/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022]
Abstract
As the most toxic dioxin, 2,3,7,8-tetrachlorodibenzo-p-dioxin is classified as a group 1 human carcinogen. We investigated the long-term effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin exposure on the progression of brain atrophy in humans. We retrospectively selected 546 patients exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (exposed group) and 1353 patients not exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (control group). The patients in both groups underwent brain T1-weighted magnetic resonance imaging (MRI) twice. We divided the patients into two propensity score-matched groups, analyzed voxel-wise whole brain atrophy in the MRI images of each patient, and compared the progression of brain atrophy between the two groups. The exposed group showed significant brain atrophy progression in the bilateral frontal and temporal lobes, compared with the control group. The ventrolateral prefrontal area in the frontal lobe and whole temporal lobe were the main atrophic regions in the exposed group, compared with the control group. The neurotoxicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin can damage the brain, even in patients exposed to it over 40 years ago. Humans exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin should thus be evaluated for progression of brain atrophy.
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Affiliation(s)
- Hyun Ah Lee
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Sohyon Kyeong
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Dae Hyun Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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Seralini GE, Jungers G. Endocrine disruptors also function as nervous disruptors and can be renamed endocrine and nervous disruptors (ENDs). Toxicol Rep 2021; 8:1538-1557. [PMID: 34430217 PMCID: PMC8365328 DOI: 10.1016/j.toxrep.2021.07.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 01/14/2023] Open
Abstract
Endocrine disruption (ED) and endocrine disruptors (EDs) emerged as scientific concepts in 1995, after numerous chemical pollutants were found to be responsible for reproductive dysfunction. The World Health Organization established in the United Nations Environment Programme a list of materials, plasticizers, pesticides, and various pollutants synthesized from petrochemistry that impact not only reproduction, but also hormonal functions, directly or indirectly. Cells communicate via either chemical or electrical signals transmitted within the endocrine or nervous systems. To investigate whether hormone disruptors may also interfere directly or indirectly with the development or functioning of the nervous system through either a neuroendocrine or a more general mechanism, we examined the scientific literature to ascertain the effects of EDs on the nervous system, specifically in the categories of neurotoxicity, cognition, and behaviour. To date, we demonstrated that all of the 177 EDs identified internationally by WHO are known to have an impact on the nervous system. Furthermore, the precise mechanisms underlying this neurodisruption have also been established. It was previously believed that EDs primarily function via the thyroid. However, this study presents substantial evidence that approximately 80 % of EDs operate via other mechanisms. It thus outlines a novel concept: EDs are also neurodisruptors (NDs) and can be collectively termed endocrine and nervous disruptors (ENDs). Most of ENDs are derived from petroleum residues, and their various mechanisms of action are similar to those of "spam" in electronic communications technologies. Therefore, ENDs can be considered as an instance of spam in a biological context.
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Affiliation(s)
- Gilles-Eric Seralini
- University of Caen Normandy, Network on Risks, Quality and Sustainable Development, Faculty of Sciences, Esplanade de la Paix, 14032, Caen, France
| | - Gerald Jungers
- University of Caen Normandy, Network on Risks, Quality and Sustainable Development, Faculty of Sciences, Esplanade de la Paix, 14032, Caen, France
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Dai Q, Xu X, Eskenazi B, Asante KA, Chen A, Fobil J, Bergman Å, Brennan L, Sly PD, Nnorom IC, Pascale A, Wang Q, Zeng EY, Zeng Z, Landrigan PJ, Bruné Drisse MN, Huo X. Severe dioxin-like compound (DLC) contamination in e-waste recycling areas: An under-recognized threat to local health. ENVIRONMENT INTERNATIONAL 2020; 139:105731. [PMID: 32315892 DOI: 10.1016/j.envint.2020.105731] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 02/05/2023]
Abstract
Electrical and electronic waste (e-waste) burning and recycling activities have become one of the main emission sources of dioxin-like compounds (DLCs). Workers involved in e-waste recycling operations and residents living near e-waste recycling sites (EWRS) are exposed to high levels of DLCs. Epidemiological and experimental in vivo studies have reported a range of interconnected responses in multiple systems with DLC exposure. However, due to the compositional complexity of DLCs and difficulties in assessing mixture effects of the complex mixture of e-waste-related contaminants, there are few studies concerning human health outcomes related to DLC exposure at informal EWRS. In this paper, we have reviewed the environmental levels and body burdens of DLCs at EWRS and compared them with the levels reported to be associated with observable adverse effects to assess the health risks of DLC exposure at EWRS. In general, DLC concentrations at EWRS of many countries have been decreasing in recent years due to stricter regulations on e-waste recycling activities, but the contamination status is still severe. Comparison with available data from industrial sites and well-known highly DLC contaminated areas shows that high levels of DLCs derived from crude e-waste recycling processes lead to elevated body burdens. The DLC levels in human blood and breast milk at EWRS are higher than those reported in some epidemiological studies that are related to various health impacts. The estimated total daily intakes of DLCs for people in EWRS far exceed the WHO recommended total daily intake limit. It can be inferred that people living in EWRS with high DLC contamination have higher health risks. Therefore, more well-designed epidemiological studies are urgently needed to focus on the health effects of DLC pollution in EWRS. Continuous monitoring of the temporal trends of DLC levels in EWRS after actions is of highest importance.
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Affiliation(s)
- Qingyuan Dai
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, China
| | - Xijin Xu
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, China
| | - Brenda Eskenazi
- School of Public Health, University of California, Berkeley, USA
| | | | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, USA
| | - Julius Fobil
- School of Public Health, University of Ghana, Ghana
| | - Åke Bergman
- Department of Environmental Science, Stockholm University, Sweden; Department of Science and Technology, Örebro University, Sweden; College of Environmental Science and Engineering, Tongji University, China
| | - Lesley Brennan
- Department of Obstetrics and Gynaecology, University of Alberta, Canada
| | - Peter D Sly
- Child Health Research Centre, University of Queensland, Australia
| | | | - Antonio Pascale
- Department of Toxicology, University of the Republic, Uruguay
| | - Qihua Wang
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, China
| | - Eddy Y Zeng
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, China
| | - Zhijun Zeng
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, China
| | | | - Marie-Noel Bruné Drisse
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Xia Huo
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, China.
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Li N, Wu X, Zhuang W, Xia L, Chen Y, Wu C, Rao Z, Du L, Zhao R, Yi M, Wan Q, Zhou Y. Fish consumption and multiple health outcomes: Umbrella review. Trends Food Sci Technol 2020. [DOI: 10.1016/j.tifs.2020.02.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Pelclova D, Talacko P, Navratil T, Zamostna B, Fenclova Z, Vlckova S, Zakharov S. Can proteomics predict the prognosis in chronic dioxin intoxication? MONATSHEFTE FUR CHEMIE 2019. [DOI: 10.1007/s00706-019-02460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zhang HJ, Liu YN, Xian P, Ma J, Sun YW, Chen JS, Chen X, Tang NJ. Maternal exposure to TCDD during gestation advanced sensory-motor development, but induced impairments of spatial learning and memory in adult male rat offspring. CHEMOSPHERE 2018; 212:678-686. [PMID: 30176550 DOI: 10.1016/j.chemosphere.2018.08.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/15/2018] [Accepted: 08/23/2018] [Indexed: 05/19/2023]
Abstract
2,3,7,8-Tetrachlorodibenzo-p-Dioxin (TCDD) is an endocrine disrupting chemical (EDC) with high persistency. Even a low amount can pass the placental barrier during gestational exposure. Exposure to TCDD exposure can impair the development of the nervous system in children, leading to impaired learning ability in later-life. But the changes in neurobehavioral developments in infancy and childhood caused by TCDD are unknown. Pregnant Sprague-Dawley rats were given a consecutive daily dose of TCDD (200 or 800 ng/day/kg) or an equivalent volume of vehicle by gavage on gestational days 8-14 (GD 8-14) as the prenatal TCDD exposure model. In the offspring, early neurobehavioral development was assessed at postnatal day 5 (PND5) and eye-opening was monitored from PND10 onwards. Adult male offspring was tested by Morris Water Maze for spatial memory and learning ability evaluation. Hippocampus Nissl's staining and astrocyte GFAP immunohistochemistry were used to evaluate the activity of astrocytes. The results of the behavioral tests showed that gestational TCDD exposure induced premature motor activity and earlier eyes-opening, but lead to serious deficits of spatial memory and learning ability in the adult male offspring. Morphology and number of neurons in the hippocampus CA1 region was not affected, while the activity of astrocytes in the same region was significantly reduced. These data indicate that perinatal TCDD exposure induced premature neurobehavioral development but impaired the spatial learning and memory in adult male rat offspring. The decreased activity of astrocytes in the hippocampus may play a role in these adverse effects.
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Affiliation(s)
- Hua-Jing Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
| | - Ya-Nan Liu
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
| | - Ping Xian
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
| | - Jing Ma
- Tianjin Cardiovascular Diseases Institute, Tianjin Chest Hospital, Tianjin, 300350, China.
| | - Ya-Wen Sun
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
| | - Jing-Shan Chen
- Department of Technology and Science, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| | - Xi Chen
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
| | - Nai-Jun Tang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
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Pelclova D, Navratil T, Vlckova S, Fenclova Z, Pelcl T, Kacerova T, Kacer P. Exhaled breath condensate biomarkers reflect systemic changes in patients with chronic dioxin intoxication. MONATSHEFTE FUR CHEMIE 2018. [DOI: 10.1007/s00706-018-2211-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pelcl T, Skrha J, Prazny M, Vlckova S, Fenclova Z, Navratil T, Malik J, Diblik P, Zikan V, Pelclova D. Diabetes, Cardiovascular Disorders and 2,3,7,8-Tetrachlorodibenzo-p-Dioxin Body Burden in Czech Patients 50 Years After the Intoxication. Basic Clin Pharmacol Toxicol 2018; 123:356-359. [DOI: 10.1111/bcpt.13013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/12/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Tomas Pelcl
- 3rd Department of Internal Medicine; 1st Faculty of Medicine; Charles University in Prague and General University Hospital in Prague; Prague Czech Republic
| | - Jan Skrha
- 3rd Department of Internal Medicine; 1st Faculty of Medicine; Charles University in Prague and General University Hospital in Prague; Prague Czech Republic
| | - Martin Prazny
- 3rd Department of Internal Medicine; 1st Faculty of Medicine; Charles University in Prague and General University Hospital in Prague; Prague Czech Republic
| | - Stepanka Vlckova
- Department of Occupational Medicine; 1st Faculty of Medicine; Charles University in Prague and General University Hospital in Prague; Prague Czech Republic
| | - Zdenka Fenclova
- Department of Occupational Medicine; 1st Faculty of Medicine; Charles University in Prague and General University Hospital in Prague; Prague Czech Republic
| | - Tomas Navratil
- J. Heyrovsky Institute of Physical Chemistry of the CAS CR, v.v.i.; Prague Czech Republic
| | - Jan Malik
- 3rd Department of Internal Medicine; 1st Faculty of Medicine; Charles University in Prague and General University Hospital in Prague; Prague Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology; 1st Faculty of Medicine; Charles University in Prague and General University Hospital in Prague; Prague Czech Republic
| | - Vit Zikan
- 3rd Department of Internal Medicine; 1st Faculty of Medicine; Charles University in Prague and General University Hospital in Prague; Prague Czech Republic
| | - Daniela Pelclova
- Department of Occupational Medicine; 1st Faculty of Medicine; Charles University in Prague and General University Hospital in Prague; Prague Czech Republic
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