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Dupre N, Riou MC, Isaac J, Ferre F, Cormier-Daire V, Kerner S, de La Dure-Molla M, Nowwarote N, Acevedo AC, Fournier BPJ. Root resorptions induced by genetic disorders: A systematic review. Oral Dis 2024. [PMID: 38566363 DOI: 10.1111/odi.14942] [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: 12/22/2023] [Revised: 03/08/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Root resorption in permanent teeth is a common pathological process that often follows dental trauma or orthodontic treatment. More rarely, root resorption is a feature of genetic disorders and can help with diagnosis. Thus, the present review aims to determine which genetic disorders could induce pathological root resorptions and thus which mutated genes could be associated with them. METHODS We conducted a systematic review following the PRISMA guidelines. Articles describing root resorptions in patients with genetic disorders were included from PubMed, Embase, Web of Science, and Google Scholar. We synthesized the genetic disorder, the type, severity, and extent of the resorptions, as well as the other systemic and oral symptoms and histological features. RESULTS The synthetic analysis included 25 studies among 937 identified records. We analyzed 21 case reports, three case series, and one cohort study. Overall, we highlighted 14 different pathologies with described root resorptions. Depending on the pathology, the sites of resorption, their extent, and their severity showed differences. CONCLUSION With 14 genetic pathologies suspected to induce root resorptions, our findings are significant and enrich a previous classification. Among them, three metabolic disorders, three calcium-phosphorus metabolism disorders, and osteolysis disorders were identified.
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Affiliation(s)
- Nicolas Dupre
- Reference Center for Oral and Dental Rare Diseases, APHP, ORARES, Rothschild Hospital, Paris, France
- Centre de Recherche Des Cordeliers, Laboratory of Molecular Oral Pathophysiology, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
- Department of Periodontology, Oral Biology, Pediatric Dentistry, and Oral Surgery, Faculty of Odontology, Université Paris Cité, Paris, France
| | - Margot C Riou
- Reference Center for Oral and Dental Rare Diseases, APHP, ORARES, Rothschild Hospital, Paris, France
- Centre de Recherche Des Cordeliers, Laboratory of Molecular Oral Pathophysiology, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
- Department of Periodontology, Oral Biology, Pediatric Dentistry, and Oral Surgery, Faculty of Odontology, Université Paris Cité, Paris, France
| | - Juliane Isaac
- Centre de Recherche Des Cordeliers, Laboratory of Molecular Oral Pathophysiology, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
- Department of Periodontology, Oral Biology, Pediatric Dentistry, and Oral Surgery, Faculty of Odontology, Université Paris Cité, Paris, France
| | - François Ferre
- Centre de Recherche Des Cordeliers, Laboratory of Molecular Oral Pathophysiology, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
- Department of Periodontology, Oral Biology, Pediatric Dentistry, and Oral Surgery, Faculty of Odontology, Université Paris Cité, Paris, France
| | - Valérie Cormier-Daire
- Reference Center for Skeletal Dysplasia, INSERM UMR1163, Institut Imagine, Necker Hospital, Université Paris Cité, Paris, France
| | - Stéphane Kerner
- Reference Center for Oral and Dental Rare Diseases, APHP, ORARES, Rothschild Hospital, Paris, France
- Centre de Recherche Des Cordeliers, Laboratory of Molecular Oral Pathophysiology, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
- Department of Periodontology, Oral Biology, Pediatric Dentistry, and Oral Surgery, Faculty of Odontology, Université Paris Cité, Paris, France
- Department of Periodontics, School of Dentistry, Loma Linda University, Loma Linda, California, USA
- Post-Graduate Program in Periodontology and Implant Dentistry, EFP, Université Paris Cité, Paris, France
| | - Muriel de La Dure-Molla
- Reference Center for Oral and Dental Rare Diseases, APHP, ORARES, Rothschild Hospital, Paris, France
- Department of Periodontology, Oral Biology, Pediatric Dentistry, and Oral Surgery, Faculty of Odontology, Université Paris Cité, Paris, France
- Reference Center for Skeletal Dysplasia, INSERM UMR1163, Institut Imagine, Necker Hospital, Université Paris Cité, Paris, France
| | - Nunthawan Nowwarote
- Centre de Recherche Des Cordeliers, Laboratory of Molecular Oral Pathophysiology, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
- Department of Periodontology, Oral Biology, Pediatric Dentistry, and Oral Surgery, Faculty of Odontology, Université Paris Cité, Paris, France
| | - Ana Carolina Acevedo
- Centre de Recherche Des Cordeliers, Laboratory of Molecular Oral Pathophysiology, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
- Department of Periodontology, Oral Biology, Pediatric Dentistry, and Oral Surgery, Faculty of Odontology, Université Paris Cité, Paris, France
- Laboratory of Oral Histopathology, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
- Oral Care Center for Inherited Diseases, University Hospital of Brasilia, Brasilia, Brazil
| | - Benjamin P J Fournier
- Reference Center for Oral and Dental Rare Diseases, APHP, ORARES, Rothschild Hospital, Paris, France
- Centre de Recherche Des Cordeliers, Laboratory of Molecular Oral Pathophysiology, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
- Department of Periodontology, Oral Biology, Pediatric Dentistry, and Oral Surgery, Faculty of Odontology, Université Paris Cité, Paris, France
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Saji S, Devi K P, Morankar R, Tewari N, Mathur VP, Bansal K. Orofacial characteristics in a child with Hajdu-Cheney syndrome. SPECIAL CARE IN DENTISTRY 2024; 44:428-433. [PMID: 37227705 DOI: 10.1111/scd.12878] [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: 11/16/2022] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/26/2023]
Abstract
Hajdu-Cheney syndrome (HCS) also known as Cranio-skeletal dysplasia is a rare genetic disorder of bone metabolism. It is mainly characterized by acro-osteolysis and generalized osteoporosis. The other distinctive features include a dysmorphic face, short stature, aplasia of facial sinuses, and persistent cranial sutures. Although the condition begins to manifest since birth, the characteristic features become more prominent with age. This syndrome is usually recognized by dentists due to these craniofacial abnormalities. This case report aims to highlight a case of 6-year-old girl HCS who presented with aberrant facial features, premature exfoliation of teeth, unusual mobility of teeth and atypical root resorption in primary dentition.
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Affiliation(s)
- Seba Saji
- Department of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Pavithra Devi K
- Department of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Morankar
- Department of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Nitesh Tewari
- Department of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Prakash Mathur
- Department of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Bansal
- Department of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Hajdu-Cheney Syndrome: A Novel NOTCH2 Mutation in a Spanish Child in Treatment with Vibrotherapy: A Case Report. J Clin Med 2022; 11:jcm11175205. [PMID: 36079132 PMCID: PMC9457082 DOI: 10.3390/jcm11175205] [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: 08/19/2022] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
A case report of an 11-year-old boy with a de novo variant in NOTCH2 and clinical features characteristic of Hajdu-Cheney syndrome is reported, with acroosteolysis of the distal phalanges of the feet and hands, generalized osteoporosis, musculoskeletal and craniofacial alterations, short stature, bowing of long bones, vertebral anomalies, genu recurvatum, hypertrichosis, joint and skin hyperlaxity, atopic dermatitis, megalocorneas, micrognathia and frequent respiratory infections, among others. Treatment is with bisphosphonates in the framework of bone density improvement and with focal vibration therapy for rehabilitation of the musculoskeletal system and gait improvement. The three generalities of this pathology-phenotypic variability, degenerative character and the presence of generalized osteoporosis and acroosteolysis of the distal phalanges-are seen in this case, whose diagnostic confirmation was made by genetic study.
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Cortés-Martín J, Díaz-Rodríguez L, Piqueras-Sola B, Sánchez-García JC, Menor-Rodríguez MJ, Rodríguez-Blanque R. Nursing Care Plan for Patients with Hajdu-Cheney Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7489. [PMID: 35742738 PMCID: PMC9223558 DOI: 10.3390/ijerph19127489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 02/01/2023]
Abstract
Hajdu-Cheney syndrome is a rare genetic disease. Its main features include phenotypic variability, age-dependent progression and the presence of acroosteolysis of the distal phalanges and generalized osteoporosis, which have significant disabling potential. Currently, there is no effective curative treatment, so nursing care is essential to ensure the maintenance of the quality of life of these patients. The main objective of this study was to establish a specific standardized nursing care plan using the NANDA-NIC-NOC taxonomy. The application of a care plan as such would improve the quality of life of patients affected by this rare disease, will contribute to increasing healthcare professionals' knowledge on this matter and will support future studies on this disease.
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Affiliation(s)
- Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (L.D.-R.); (B.P.-S.); (R.R.-B.)
- Faculty of Health Sciences, School of Nursing, University of Granada, 18071 Granada, Spain
| | - Lourdes Díaz-Rodríguez
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (L.D.-R.); (B.P.-S.); (R.R.-B.)
- Faculty of Health Sciences, School of Nursing, University of Granada, 18071 Granada, Spain
| | - Beatriz Piqueras-Sola
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (L.D.-R.); (B.P.-S.); (R.R.-B.)
- Hospital University Virgen de las Nieves, 18014 Granada, Spain
| | - Juan Carlos Sánchez-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (L.D.-R.); (B.P.-S.); (R.R.-B.)
- Faculty of Health Sciences, School of Nursing, University of Granada, 18071 Granada, Spain
| | - María José Menor-Rodríguez
- Subdirectora de Humanización y Atención al Ciudadano, Área Sanitaria Santiago-Barbanza, 15706 Santiago de Compostela, Spain;
| | - Raquel Rodríguez-Blanque
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (L.D.-R.); (B.P.-S.); (R.R.-B.)
- Faculty of Health Sciences, School of Nursing, University of Granada, 18071 Granada, Spain
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Spodzieja K, Olczak-Kowalczyk D. Premature Loss of Deciduous Teeth as a Symptom of Systemic Disease: A Narrative Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063386. [PMID: 35329073 PMCID: PMC8953685 DOI: 10.3390/ijerph19063386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 12/22/2022]
Abstract
Background: Premature loss of primary teeth can occur as a consequence of dental trauma, neonatal tooth extraction, early childhood caries, or periodontal problems, or it can be a manifestation of systemic disease. This review aims to present systemic disorders that can lead to premature loss of deciduous teeth in children and to provide a comprehensive resource for clinical practice for both physicians and dentists. Methods: This study is a narrative review of original studies and case reports published in English and Polish between 1957 and 2021 that was conducted by searching electronic scientific resources: PubMed, Google Scholar, Web of Science, and Science Direct. The schema of the qualification process is represented by a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). In total, 196 articles were identified; after provisional assessment of the titles and abstracts by two reviewers, 46 were found to be relevant to the topic, including 1 review, 16 original papers, and 27 case reports regarding systemic disease resulting in premature tooth loss. Results: In this study, 16 systemic diseases were linked to premature primary tooth loss in children: Papillon–Lefèvre syndrome, mucocutaneous dyskeratosis, Coffin–Lowry syndrome, congenital adrenal hyperplasia, Langerhans cell histiocytosis, cherubism, hypophosphatasia, acatalasia, Chediak–Higashi syndrome, cyclic neutropenia, erythromelalgia, Down syndrome, Hajdu–Cheney syndrome, short bowel syndrome, leukocyte adhesion deficiency type 1 (LAD-1), and Wiedemann–Steiner syndrome (WSS).
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Hajdu-Cheney Syndrome: Report of a Case in Spain. Diagnostics (Basel) 2022; 12:diagnostics12030566. [PMID: 35328119 PMCID: PMC8947164 DOI: 10.3390/diagnostics12030566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023] Open
Abstract
This paper describes the case of a 54-year-old woman diagnosed with Hajdu–Cheney syndrome, who presents with characteristic craniofacial dysmorphia, short stature, premature loss of teeth, developmental skeletal disorders, fibrocystic mastopathy, bilateral hearing loss and an intermittent mild neutropenia. The patient received treatment with bisphosphonates and was awaiting evaluation for surgical arthroplasty of both hips when she suffered a motor vehicle accident, which led to a rapid progression in her disease by increasing her degree of dependence for most activities of daily living. The clinical presentation and radiologic findings seen in this case confirm the three main features of the syndrome: phenotypic variability, an age-dependent progression and the presence of generalized osteoporosis and acroosteolysis of distal phalanges. The main objective of the manuscript is to describe a new case of a patient diagnosed with Hajdu–Cheney syndrome. Due to the low prevalence of the syndrome and the small number of cases reported in the scientific literature, obtaining a complete description and a global perspective of the disease is complex.
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Oral Surgery Procedures in a Patient with Hajdu-Cheney Syndrome Treated with Denosumab-A Rare Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179099. [PMID: 34501688 PMCID: PMC8431733 DOI: 10.3390/ijerph18179099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 12/20/2022]
Abstract
Background: Hajdu-Cheney syndrome (HCS) is a very rare autosomal-dominant congenital disease associated with mutations in the NOTCH2 gene. This disorder affects the connective tissue and is characterized by severe bone resorption. Hajdu-Cheney syndrome most frequently affects the head and feet bones (acroosteolysis). Case report: We present an extremely rare case of a 34-year-old male with Hajdu-Cheney syndrome. The patient was admitted to the Department of Oral Surgery, Medical University of Gdańsk, in order to perform the extraction of three teeth. These teeth were not eligible for conservative treatment and prosthetic reconstruction. The patient was treated with denosumab (angiogenesis and receptor activator of nuclear factor-κB RANK ligand inhibitor, RANKL). Discussion: Denosumab is a monoclonal antibody against RANKL. This drug works through a suppression of osteoclast activity. In cases of patients in which the pathway of the RANK/RANKL/osteoprotegerin is dysregulated, denosumab has been approved for the treatment off-label. In patients receiving denosumab, a delayed wound healing in the oral cavity and osteonecrosis may occur. Dental procedures involving the alveolar bone process (tooth extractions and bone alveoloplasty) may be a risk factor for medication-related osteonecrosis of the jaw (MRONJ). Spontaneous osteonecrosis is rarely observed. MRONJ consists of the destruction of exposed bone, with the exposure persisting for a minimum of 6–8 weeks. This is the first article about an HCS patient treated with denosumab who underwent invasive oral surgery procedures. This case report highlights the difficulties for professionals occurring during the oral surgery procedures in such patients.
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Ahmed S, Arif A, Abbas S, Khan MO, Kirmani S, Khan AH. Hajdu Cheney Syndrome due to NOTCH2 defect - First case report from Pakistan and review of literature. Ann Med Surg (Lond) 2021; 62:154-159. [PMID: 33520214 PMCID: PMC7820303 DOI: 10.1016/j.amsu.2021.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Hajdu Cheney Syndrome (HCS) is a rare skeletal disease characterized by severe, progressive focal bone loss with osteoporosis, variable craniofacial, vertebral anomalies and distinctive facial features. It is inherited as an autosomal dominant disease although sporadic cases have been described in literature. Identifying these cases in clinical practice is important for proper diagnosis and management. CASE PRESENTATION We report a case of a 36-year-old male patient presented at metabolic bone disease clinic at the Aga Khan University Hospital with history of multiple fragility fractures and juvenile osteoporosis since childhood. DNA sequence analysis of the NOTCH2 coding sequence revealed a pathogenic variant in NOTCH 2, Exon 34, c.6426_6427insTT (p.Glu2143Leufs*5), consistent with a NOTCH2 related conditions including HCS. CLINICAL DISCUSSION The multitude of presentations associated with HCS are linked to the NOTCH2 gene, as Notch signaling is one of the core signaling pathways that control embryonic development. Hence, mutations in the Notch signaling pathway cause developmental phenotypes that affect various organs including the liver, skeleton, heart, eye, face, kidney, and vasculature. CONCLUSION To the best of our knowledge, nucleotide mutations of c.6933delT, c.6854delA, c.6787C.T, and c.6424-6427delTCTG were all determined to be novel, with c.6428T > C being the most common mutation found in literature. The c.6426_6427insTT mutation our patient was found to have via gene sequencing too appears to be a novel mutation, which has not previously been reported in literature.
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Affiliation(s)
- Sibtain Ahmed
- Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Aahan Arif
- Medical College, Aga Khan University. Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Saadia Abbas
- Medical College, Aga Khan University. Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Muhammad Osama Khan
- Medical College, Aga Khan University. Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Salman Kirmani
- Department of Paediatrics & Child Health, Aga Khan University. Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Aysha Habib Khan
- Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
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Zeng C, Lin Y, Lu Z, Chen Z, Jiang X, Mao X, Liu Z, Lu X, Zhang K, Yu Q, Wang X, Huang Y, Liu L. Distinct severity of phenotype in Hajdu-Cheney syndrome: a case report and literature review. BMC Musculoskelet Disord 2020; 21:154. [PMID: 32143606 PMCID: PMC7060511 DOI: 10.1186/s12891-020-3181-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Hajdu-Cheney syndrome (HCS) is a rare inherited skeletal disorder caused by pathogenic mutations in exon 34 of NOTCH2. Its highly variable phenotypes make early diagnosis challenging. In this paper, we report a case of early-onset HCS with severe phenotypic manifestations but delayed diagnosis. Case presentation The patient was born to non-consanguineous, healthy parents of Chinese origin. She presented facial anomalies, micrognathia and skull malformations at birth, and was found hearing impairment, congenital heart disease and developmental delay during her first year of life. Her first visit to our center was at 1 year of age due to cardiovascular repair surgery for patent ductus arteriosus (PDA) and ventricular septal defect (VSD). Skull X-ray showed wormian bones. She returned at 7 years old after she developed progressive skeletal anomalies with fractures. She presented with multiple wormian bones, acro-osteolysis, severe osteoporosis, bowed fibulae and a renal cyst. Positive genetic test of a de novo heterozygous frameshift mutation in exon 34 of NOTCH2 (c.6426dupT) supported the clinical diagnosis of HCS. Conclusion This is the second reported HCS case caused by the mutation c.6426dupT in NOTCH2, but presenting much earlier and severer clinical expression. Physicians should be aware of variable phenotypes so that early diagnosis and management may be achieved.
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Affiliation(s)
- Chunhua Zeng
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Yunting Lin
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Zhikun Lu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Zhen Chen
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Xiaoling Jiang
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Xiaojian Mao
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Zongcai Liu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Xinshuo Lu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Kangdi Zhang
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Qiaoli Yu
- Department of Dentistry, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Xiaoya Wang
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Yonglan Huang
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Li Liu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China.
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