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Neurodevelopment in Early Childhood Affected by Prenatal Lead Exposure and Iron Intake
Shah-Kulkarni, Surabhi,Ha, Mina,Kim, Byung-Mi,Kim, Eunjeong,Hong, Yun-Chul,Park, Hyesook,Kim, Yangho,Kim, Bung-Nyun,Chang, Namsoo,Oh, Se-Young,Kim, Young Ju,Lee, Boeun,Ha, Eun-Hee Wolters Kluwer Health 2016 Medicine Vol.95 No.4
<▼1><P>Supplemental Digital Content is available in the text</P></▼1><▼2><P><B>Abstract</B></P><P>No safe threshold level of lead exposure in children has been recognized. Also, the information on shielding effect of maternal dietary iron intake during pregnancy on the adverse effects of prenatal lead exposure on children's postnatal neurocognitive development is very limited. We examined the association of prenatal lead exposure and neurodevelopment in children at 6, 12, 24, and 36 months and the protective action of maternal dietary iron intake against the impact of lead exposure.</P><P>The study participants comprise 965 pregnant women and their subsequent offspring of the total participants enrolled in the Mothers and Children's environmental health study: a prospective birth cohort study. Generalized linear model and linear mixed model analysis were performed to analyze the effect of prenatal lead exposure and mother's dietary iron intake on children's cognitive development at 6, 12, 24, and 36 months.</P><P>Maternal late pregnancy lead was marginally associated with deficits in mental development index (MDI) of children at 6 months. Mothers having less than 75th percentile of dietary iron intake during pregnancy showed significant increase in the harmful effect of late pregnancy lead exposure on MDI at 6 months. Linear mixed model analyses showed the significant detrimental effect of prenatal lead exposure in late pregnancy on cognitive development up to 36 months in children of mothers having less dietary iron intake during pregnancy.</P><P>Thus, our findings imply importance to reduce prenatal lead exposure and have adequate iron intake for better neurodevelopment in children.</P></▼2>
Prenatal exposure to perfluorinated compounds affects thyroid hormone levels in newborn girls
Shah-Kulkarni, S.,Kim, B.M.,Hong, Y.C.,Kim, H.S.,Kwon, E.J.,Park, H.,Kim, Y.J.,Ha, E.H. Pergamon 2016 Environment international Vol.94 No.-
Perfluorinated compounds (PFCs) are ubiquitous in the environment and have been detected in humans and wildlife. Exposure to PFCs has decreased in the United States recently, while exposure to PFCs continues in Asian countries, which represents a public health concern. Various mechanisms by which PFCs affect fetal growth have been proposed, such as activation of peroxisome proliferators, disruption of thyroid hormones and changes in lipid metabolism. However, the overall evidence for an association with thyroid hormones is not strong. Therefore, we examined the effect of various prenatal PFCs on cord blood thyroid hormones: triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH) levels, and explored the endocrine disrupting effect of these PFCs on thyroid hormone levels in children according to gender. Two hundred and seventy-nine study participants were selected from among the enrolled participants in the Ewha Birth & Growth Retrospective Cohort, a retrospective birth cohort study conducted at Ewha Womans University Hospital, Seoul, Korea between 2006 and 2010. A generalized linear model was constructed to explore the association of PFCs and thyroid hormones. Further, an analysis stratified by gender was conducted. Our study shows that cord blood perfluoro n-pentanoic acid (PFPeA) was positively associated with cord blood T4 (p=0.01) level. Gender-specific analysis showed that prenatal PFCs: PFPeA and Perfluorohexane sulfonic acid (PFHxS) exposure significantly increased T4 (p<0.01) and T3 (p=0.03), respectively, while perfluorononanoic acid (PFNA) decreased TSH (p=0.04) concentration in newborn girls. Thus, prenatal PFC exposure may disrupt thyroid hormone homeostasis. Thyroid hormones play a crucial role in fetal development and may have gender specific action. Hence, these results are of utmost importance in high-risk groups, such as pregnant women and children.
Maternal exposure factors during pregnancy associated with prenatal lead exposure
Surabhi Shah Kulkarni,Byung-Mi Kim(김병미),Eunjeong Kim(김은정),Hye Sook Park(박혜숙),Yun-Chul Hong(홍윤철),Mina Ha(하미나),Yangho Kim(김양호),Boong-Nnyun Kim(김붕년),Namsoo Chang(장남수),Eun-Hee Ha(하은희) 환경독성보건학회 2014 한국독성학회 심포지움 및 학술발표회 Vol.2014 No.5
Rugved Kulkarni,Irfan Kabir,James Hodson,Syed Raza,Tahir Shah,Sanjay Pandanaboyana,Bobby V. M. Dasari 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.1
In patients with neuroendocrine tumors with liver metastases (NETLMs), complete resection of both the primary and liver metastases is a potentially curative option. When complete resection is not possible, debulking of the tumour burden has been proposed to prolong survival. The objective of this systematic review was to evaluate the effect of curative surgery (R0-R1) and debulking surgery (R2) on overall survival (OS) in NETLMs. For the subgroup of R2 resections, outcomes were compared by the degree of hepatic debulking (≥ 90% or ≥ 70%). A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines using PubMed, Medline, CINAHL, Cochrane, and Embase databases. Hazard ratios (HRs) were estimated for each study and pooled using a random-effects inverse-variance meta-analysis model. Of 538 articles retrieved, 11 studies (1,729 patients) reported comparisons between curative and debulking surgeries. After pooling these studies, OS was found to be significantly shorter in debulking resections, with an HR of 3.49 (95% confidence interval, 2.70–4.51; p < 0.001). Five studies (654 patients) compared outcomes between ≥ 90% and ≥ 70% hepatic debulking approaches. Whilst these studies reported a tendency for OS and progression-free survival to be shorter in those with a lower degree of debulking, they did not report sufficient data for this to be assessed in a formal meta-analysis. In patients with NETLM, OS following surgical resection is the best to achieve R0-R1 resection. There is also evidence for a progressive reduction in survival benefit with lesser debulking of tumour load.
임신 초기 임산부의 간접흡연 노출이 영유아의 24개월 시기의 인지발달에 미치는 영향 연구
이명지,( Surabhi Shah-kulkarni ),하미나,홍윤철,박혜숙,김양호,김의정,하은희 한국모자보건학회 2016 한국모자보건학회 학술대회 연제집 Vol.2016 No.2
연구배경 및 목적 간접흡연이 민감군의 건강에 미치는 영향에 대한 연구가 미흡한 실정이다. 이 연구에서는 임산부의 임신 초기의 간접흡연에 노출이 영유아의 생후 24개월의 신경발달에 미치는 영향에 대하여 살펴보고자 하였고, 특히 임산부의 엽산 섭취 여부와 유전적 다형성 및 모유수유 여부가 이 관계에 어떻게 영향을 주는 지에 대해 살펴보았다. 대상 및 방법: 산모ㆍ영유아의 환경 유해인자 노출 및 건강영향 연구 (MOCEH)에 참여한 임산부와 영유아 1,751쌍 중에서 임신 초기 소변 내 코티닌 값이 정의된 임산부 및 그들의 아이들을 대상으로 연구를 진행하였다. 베일리 점수를 활용하여 아이들의 신경발달 (인지발달 및 동작발달) 정도를 24개월 시기에 측정하였다. 로그 변환한 임산부의 소변 내 코티닌 농도와 베일리 점수와의 관계를 다중회귀분석을 이용하여 분석하였고,임산부의 엽산섭취 정도,모유수유 여부와 유전적 다형성에 따른 층화분석을 시행하였다. 연구결과 임신 초 임산부의 소변 내 코티닌 농도가 높은 그룹에서,코티닌 농도가 증가함에 따라 영유아의 생후 24 개월의 인지발달이 유의하게 낮아졌다. (β =-2.56, p=0.01) 이 음의 연관성은 엽산 섭취량이 부족한 군에서 더욱 강해졌고 (β=-3.56, p=0.004),GSTT와 GSTM이 모두 존재하지 않는 경우 음의 연관성이 강해졌다. (β =-5.94, p=0.003) 하지만, 6개월 시기까지 모유수유를 했을 경우 임산부의 간접흡연에 노출과 영유아의 24개월 시기 인지발달 간의 음의 연관성은 유의하지 않았다. 결 론 이번 연구를 통해 임신 초기 임산부의 간접흡연에의 노출이 생애 초기의 영유아의 신경발달을 지연시킬 수 있음을 보여주었다.
Postnatal Growth Following Prenatal Lead Exposure and Calcium Intake
Hong, Yun-Chul,Kulkarni, Surabhi Shah,Lim, Youn-Hee,Kim, Eunjeong,Ha, Mina,Park, Hyesook,Kim, Yangho,Kim, Bung-Nyun,Chang, Namsoo,Oh, Se-Young,Kim, Young-Ju,Park, Chooghee,Ha, Eun-hee American Academy of Pediatrics 2014 Pediatrics Vol.134 No.6
<P><B>BACKGROUND:</B></P><P>The effects on postnatal growth of maternal exposure to low levels of lead during pregnancy have not been well established. In addition, information is limited regarding the protective effect of dietary calcium intake during pregnancy against the effect of lead for fetal and postnatal growth. We investigated the relationship between prenatal exposure to lead and growth at birth and 6, 12, and 24 months postnatal, and evaluated the role of calcium intake against the effect of lead.</P><P><B>METHODS:</B></P><P>A total of 1150 pregnant women, and their subsequent offspring, enrolled in a prospective birth cohort study (Mothers and Children's Environmental Health Study), were evaluated. Multivariable regression analysis was conducted to estimate the effects of prenatal maternal blood lead levels on growth at each follow-up.</P><P><B>RESULTS:</B></P><P>The blood lead levels of participating mothers were <5.0 μg/dL and mean levels were 1.25 μg/dL during the early (before 20 gestational weeks) and late (at delivery) gestational periods. Prenatal exposure to lead, particularly in late pregnancy, was significantly associated with a reduction in infantile growth at 24 months. When pregnant women had dietary calcium intake at mean or upper level, the association was not significant. In contrast, lower than mean level of calcium intake intensified the adverse effect of prenatal lead exposure on growth in children.</P><P><B>CONCLUSIONS:</B></P><P>Prenatal lead exposure <5.0 μg/dL adversely affects postnatal growth and low calcium intake aggravates the effect, indicating more stringent control of lead and sufficient intake of calcium are necessary to help children’s health.</P>