I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
13
,
No
.
4
,
Dec
em
b
er
2
0
2
4
,
p
p
.
1
82
6
~
1
83
3
I
SS
N:
2
2
5
2
-
8
8
0
6
,
DOI
: 1
0
.
1
1
5
9
1
/ijp
h
s
.
v
1
3
i4
.
2
4
1
4
6
1826
J
o
ur
na
l ho
m
ep
a
g
e
:
h
ttp
:
//
ijp
h
s
.
ia
esco
r
e.
co
m
M
a
ternal ha
ir lea
d and
cyto
kine
pr
o
-
inflam
ma
tory
e
ff
ec
ts in
preter
m
bir
th
Q
o
nita
Nur
Q
o
lby
1
,
J
uli
a
n D
ewa
ntining
rum
2
,
B
esa
ri
Adi
P
ra
m
o
no
2
,
Na
ni M
a
ha
ra
ni
3
,
E
k
a
Dj
a
t
nik
a
Nug
ra
ha
4
,
M
ufliha
t
ul M
u
niro
h
5
1
M
a
s
t
e
r
P
r
o
g
r
a
m
o
f
B
i
o
me
d
i
c
a
l
S
c
i
e
n
c
e
,
F
a
c
u
l
t
y
o
f
M
e
d
i
c
i
n
e
,
U
n
i
v
e
r
si
t
a
s
D
i
p
o
n
e
g
o
r
o
,
S
e
mara
n
g
,
I
n
d
o
n
e
s
i
a
2
D
e
p
a
r
t
me
n
t
o
f
O
b
s
t
e
t
r
i
c
s
a
n
d
G
y
n
e
c
o
l
o
g
y
,
F
a
c
u
l
t
y
o
f
M
e
d
i
c
i
n
e
,
U
n
i
v
e
r
si
t
a
s Di
p
o
n
e
g
o
r
o
,
S
e
m
a
r
a
n
g
,
I
n
d
o
n
e
si
a
3
D
e
p
a
r
t
me
n
t
o
f
P
h
a
r
mac
o
l
o
g
y
a
n
d
T
h
e
r
a
p
y
,
U
n
i
v
e
r
si
t
a
s D
i
p
o
n
e
g
o
r
o
,
S
e
ma
r
a
n
g
,
I
n
d
o
n
e
s
i
a
4
R
e
s
e
a
r
c
h
C
e
n
t
e
r
f
o
r
S
a
f
e
t
y
,
M
e
t
r
o
l
o
g
y
,
a
n
d
N
u
c
l
e
a
r
Te
c
h
n
o
l
o
g
y
,
T
h
e
N
a
t
i
o
n
a
l
R
e
sea
r
c
h
a
n
d
I
n
n
o
v
a
t
i
o
n
A
g
e
n
c
y
o
f
I
n
d
o
n
e
s
i
a
(
B
R
I
N
)
,
S
o
u
t
h
Ta
n
g
e
r
a
n
g
,
I
n
d
o
n
e
s
i
a
5
D
e
p
a
r
t
me
n
t
o
f
P
h
y
si
o
l
o
g
y
,
F
a
c
u
l
t
y
o
f
M
e
d
i
c
i
n
e
,
U
n
i
v
e
r
si
t
a
s
D
i
p
o
n
e
g
o
r
o
,
S
e
mara
n
g
,
I
n
d
o
n
e
si
a
Art
icle
I
nfo
AB
S
T
RAC
T
A
r
ticle
his
to
r
y:
R
ec
eiv
ed
No
v
3
,
2
0
2
3
R
ev
is
ed
Mar
13
,
2
0
2
4
Acc
ep
ted
Ap
r
2
4
,
2
0
2
4
Th
is
c
a
se
-
c
o
n
tro
l
st
u
d
y
a
n
a
ly
z
e
d
th
e
lea
d
(P
b
),
i
n
terle
u
k
i
n
6
(
IL
-
6
),
a
n
d
tu
m
o
r
n
e
c
ro
sis
fa
c
to
r
a
lp
h
a
(TNF
-
α
)
lev
e
ls
in
p
re
g
n
a
n
t
wo
m
e
n
wit
h
p
re
term
b
irt
h
(P
TB)
i
n
Ce
n
tral
Ja
v
a
,
In
d
o
n
e
sia
.
Ha
ir
sa
m
p
les
fro
m
7
2
p
re
g
n
a
n
t
wo
m
e
n
we
re
c
o
ll
e
c
ted
n
o
n
-
in
v
a
siv
e
ly
.
T
h
e
p
re
n
a
tal
e
x
p
o
su
re
t
o
P
b
wa
s
d
e
term
in
e
d
wit
h
th
e
to
tal
re
flec
ti
o
n
X
-
ra
y
fl
u
o
re
sc
e
n
c
e
(TXRF
)
m
e
th
o
d
.
S
e
ru
m
IL
-
6
a
n
d
TNF
-
α
we
re
e
x
a
m
in
e
d
u
si
n
g
e
n
z
y
m
e
-
li
n
k
e
d
imm
u
n
o
s
o
rb
e
n
t
a
ss
a
y
s
(EL
IS
A).
Th
e
P
b
c
o
n
c
e
n
tr
a
ti
o
n
i
n
h
a
ir
wa
s
slig
h
tl
y
h
i
g
h
e
r
i
n
wo
m
e
n
with
P
TB
th
a
n
th
o
se
with
o
u
t
P
TB;
h
o
we
v
e
r,
t
h
is
d
iffere
n
c
e
wa
s
n
o
t
sta
ti
stica
ll
y
sig
n
ifi
c
a
n
t.
An
e
lev
a
ted
h
a
ir
P
b
lev
e
l
wa
s
n
o
t
a
ss
o
c
i
a
ted
with
in
c
re
a
se
d
P
TB
risk
(OR
2
4
.
6
9
,
9
5
%
CI
0
.
9
3
–
6
5
3
.
8
2
,
p
>
0
.
0
5
).
A
se
ru
m
TNF
-
α
lev
e
l
≥2
7
p
g
/ml,
a
se
ru
m
IL
-
6
lev
e
l
≥9
p
g
/ml,
a
n
d
th
e
sp
o
u
se
’s
sm
o
k
in
g
fre
q
u
e
n
c
y
we
re
sig
n
ifi
c
a
n
tl
y
a
ss
o
c
iate
d
with
in
c
re
a
se
d
P
TB
risk
(TNF
-
α
OR
4
2
.
2
5
,
9
5
%
CI
5
.
2
6
–
3
3
9
.
6
1
;
I
L
-
6
OR
2
2
.
3
3
,
9
5
%
CI
3
.
1
2
–
1
5
8
.
5
4
;
sp
o
u
se
’s
sm
o
k
in
g
fre
q
u
e
n
c
y
OR
1
.
2
8
,
9
5
%
CI
1
.
0
9
–
1
.
5
),
wh
il
e
th
e
m
a
tern
a
l
h
e
m
o
g
lo
b
in
c
o
n
c
e
n
trati
o
n
si
g
n
ifi
c
a
n
t
ly
d
e
c
re
a
se
d
P
TB
risk
(OR
0
.
4
3
,
9
5
%
CI
0
.
2
–
0
.
9
2
7
).
Th
is
stu
d
y
d
e
m
o
n
stra
tes
th
a
t
m
a
tern
a
l
h
a
ir
P
b
c
o
n
c
e
n
tratio
n
h
a
s
n
o
si
g
n
ifi
c
a
n
t
r
e
latio
n
sh
i
p
with
P
TB
.
S
e
ru
m
TNF
-
α
,
IL
-
6
,
a
n
d
th
e
sp
o
u
se
’s
sm
o
k
in
g
fre
q
u
e
n
c
y
p
o
ten
ti
a
ll
y
in
c
re
a
se
d
P
TB
risk
,
wh
il
e
th
e
m
a
tern
a
l
h
e
m
o
g
lo
b
in
lev
e
l
is
a
p
ro
tec
ti
v
e
fa
c
to
r
.
K
ey
w
o
r
d
s
:
IL
-
6
s
er
u
m
I
n
f
lam
m
atio
n
L
ea
d
ex
p
o
s
u
r
e
Pre
ter
m
b
ir
th
T
NF
-
α
se
ru
m
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Mu
f
lih
atu
l M
u
n
ir
o
h
Dep
ar
tm
en
t o
f
Ph
y
s
io
lo
g
y
,
Facu
lty
o
f
Me
d
icin
e,
Un
iv
er
s
itas
Dip
o
n
eg
o
r
o
T
em
b
alan
g
,
Sem
a
r
an
g
,
C
en
tr
al
J
av
a,
I
n
d
o
n
esia
E
m
a
il:
m
u
f
lih
atu
l.m
u
n
ir
o
h
@
f
k
.
u
n
d
i
p
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
L
ea
d
(
Pb
)
is
a
to
x
ic
m
etal
u
s
ed
in
i
n
d
u
s
tr
ial
wo
r
k
as
a
b
atter
y
,
p
ain
t,
ca
b
le
co
atin
g
,
weld
in
g
m
ater
ial,
b
u
llet
am
m
u
n
itio
n
,
a
n
d
s
o
ld
er
.
Hu
m
a
n
ac
tiv
ities
s
p
r
ea
d
Pb
p
o
llu
tio
n
in
th
e
air
,
wate
r
,
an
d
s
o
il
[
1
]
,
[
2
]
.
Pb
en
ter
s
th
e
b
o
d
y
b
y
in
g
esti
o
n
an
d
in
h
alatio
n
.
I
t
is
ex
c
r
eted
in
th
e
f
ec
es,
u
r
in
e,
s
wea
t
,
s
aliv
a,
h
air
,
n
ails
,
an
d
b
r
ea
s
t
m
ilk
[
3
]
.
Nu
m
er
o
u
s
to
x
ic
e
f
f
ec
ts
o
f
Pb
h
av
e
b
ee
n
r
ep
o
r
te
d
,
i
n
clu
d
in
g
m
is
ca
r
r
iag
e,
s
till
b
ir
th
,
p
r
eter
m
b
ir
th
(
PTB),
lo
w
b
i
r
th
weig
h
t,
an
d
o
th
er
f
eto
m
ater
n
al
o
u
tco
m
es.
M
o
r
eo
v
e
r
,
ch
ild
r
e
n
ar
e
m
o
r
e
v
u
ln
er
ab
le
to
Pb
e
x
p
o
s
u
r
e:
T
h
is
g
r
o
u
p
s
h
o
ws
4
–
5
tim
es
h
i
g
h
er
Pb
a
b
s
o
r
p
tio
n
th
a
n
a
d
u
lt
s
an
d
th
ey
ar
e
also
ex
p
o
s
ed
to
lead
in
-
u
ter
o
,
r
e
s
u
ltin
g
in
ad
v
er
s
e
n
eu
r
o
b
e
h
av
io
r
al
d
ev
elo
p
m
en
tal
ef
f
ec
ts
[
4
]
.
B
ec
au
s
e
Pb
p
o
llu
tio
n
is
s
till
a
co
n
ce
r
n
i
n
g
p
r
o
b
lem
,
Pb
u
s
e
h
as b
ee
n
p
r
o
h
ib
ited
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Ma
tern
a
l h
a
ir
lea
d
a
n
d
cy
to
ki
n
e
p
r
o
-
in
fla
mma
to
r
y
effec
ts
in
p
r
eterm
b
ir
th
(
Qo
n
ita
N
u
r
Qo
lb
y
)
1827
PTB
co
n
tr
ib
u
tes
to
two
-
th
ir
d
s
o
f
p
er
i
n
atal
m
o
r
tality
.
I
t
h
as
m
u
ltip
le
f
ac
to
r
s
,
in
clu
d
in
g
in
f
lam
m
atio
n
[
5
]
–
[
7
]
.
An
in
v
iv
o
s
tu
d
y
s
h
o
wed
th
at
Pb
ex
p
o
s
u
r
e
co
u
ld
alter
in
f
lam
m
atio
n
b
y
in
cr
ea
s
in
g
th
e
r
elea
s
e
o
f
p
r
o
in
f
lam
m
ato
r
y
c
y
to
k
in
es
s
u
ch
as
in
ter
leu
k
in
6
(
I
L
-
6
)
an
d
tu
m
o
r
n
ec
r
o
s
is
f
ac
to
r
-
alp
h
a
(
T
NF
-
α
)
[
8
]
.
C
y
to
k
in
es
ar
e
p
y
r
o
g
en
ic
m
o
l
ec
u
les
th
at
in
d
u
ce
th
e
s
y
n
th
esis
o
f
p
r
o
s
tag
lan
d
in
,
w
h
ich
is
ess
en
tial
in
th
e
d
eliv
er
y
p
r
o
ce
s
s
[
9
]
,
[
1
0
]
.
L
a
b
o
r
in
d
u
ctio
n
b
ef
o
r
e
3
7
wee
k
s
o
f
g
estatio
n
al
ag
e
co
u
ld
tr
ig
g
er
PTB
[
1
1
]
.
B
ased
o
n
e
x
is
tin
g
th
eo
r
etica
l
f
in
d
in
g
s
,
we
wan
ted
to
k
n
o
w
wh
eth
er
m
ater
n
al
Pb
lev
els
a
n
d
m
ater
n
al
s
er
u
m
cy
to
k
in
e
lev
els ar
e
in
ter
r
elate
d
an
d
af
f
e
ct
PTB.
I
n
p
r
ev
i
o
u
s
s
tu
d
ies,
th
er
e
h
a
v
e
b
ee
n
v
a
r
iab
le
r
esu
lts
r
eg
ar
d
in
g
th
e
ef
f
ec
t
o
f
Pb
ex
p
o
s
u
r
e
o
n
PTB
[
1
2
]
–
[
1
6
]
.
Mo
s
t
o
f
th
ese
s
tu
d
ies
u
s
ed
in
v
asiv
e
m
eth
o
d
s
to
ex
am
in
e
h
ea
v
y
m
etal
lev
els,
b
u
t
m
o
th
er
s
an
d
th
eir
in
f
an
ts
r
eq
u
i
r
e
a
n
o
n
-
i
n
v
asiv
e
m
eth
o
d
to
av
o
id
in
d
u
cin
g
p
ai
n
d
u
r
in
g
t
h
e
s
am
p
lin
g
p
r
o
ce
d
u
r
es.
Hair
s
am
p
lin
g
is
p
ain
less
,
an
d
to
tal
X
-
r
ay
f
lu
o
r
escen
ce
(
T
XR
F)
ca
n
m
ea
s
u
r
e
h
air
elem
en
ts
,
in
clu
d
in
g
Pb
,
with
h
ig
h
s
en
s
itiv
ity
an
d
lo
w
lim
it
o
f
d
etec
tio
n
[
1
7
]
,
[
1
8
]
.
T
h
is
s
tu
d
y
p
r
esen
ts
a
n
o
n
-
in
v
asiv
e
m
e
th
o
d
to
ass
ess
th
e
ass
o
ciatio
n
b
etwe
en
PTB an
d
Pb
ex
p
o
s
u
r
e
a
n
d
p
r
o
in
f
lam
m
a
to
r
y
cy
to
k
in
es.
2.
M
E
T
H
O
D
2
.
1
.
Resea
rc
h su
bje
ct
T
h
is
s
tu
d
y
was
co
n
d
u
cted
f
r
o
m
Ma
y
to
Dec
em
b
e
r
2
0
2
2
.
I
t
in
v
o
lv
ed
7
2
m
o
th
er
s
wh
o
u
n
d
er
wen
t
lab
o
r
in
th
r
ee
cities
in
C
en
tr
al
J
av
a
I
n
d
o
n
esia:
Sem
ar
an
g
,
Salatig
a,
an
d
J
ep
ar
a
.
T
h
e
ca
s
e
g
r
o
u
p
co
m
p
r
is
es
m
o
th
er
s
with
PTB,
wh
ile
th
e
co
n
tr
o
l
g
r
o
u
p
c
o
m
p
r
is
es
m
o
t
h
er
s
with
ter
m
lab
o
r
.
T
h
e
in
c
lu
s
io
n
cr
iter
ia
wer
e
m
o
th
er
s
ag
ed
2
0
–
3
5
y
ea
r
s
in
l
ab
o
r
,
a
r
esid
en
t
o
f
C
en
tr
al
J
av
a
d
u
r
in
g
p
r
eg
n
a
n
cy
,
a
m
e
n
s
tr
u
al
cy
cle
o
f
2
4
–
3
8
d
ay
s
,
an
d
a
b
o
d
y
m
ass
in
d
ex
(
B
MI
)
o
f
1
8
.
5
–
2
5
.
T
h
e
ex
cl
u
s
io
n
cr
iter
ia
in
clu
d
ed
twin
p
r
eg
n
an
cy
,
a
h
is
to
r
y
o
f
d
iab
etes m
ellitu
s
,
ch
r
o
n
ic
h
y
p
er
ten
s
io
n
,
h
o
r
m
o
n
al
co
n
tr
ac
e
p
tio
n
u
s
ag
e
with
in
th
r
ee
m
o
n
th
s
b
ef
o
r
e
p
r
eg
n
a
n
cy
,
in
f
er
tili
ty
,
p
r
e
g
n
an
t
with
th
e
h
elp
o
f
in
vitr
o
f
er
tili
za
tio
n
(
I
VF)
,
s
till
b
ir
th
o
r
f
etal
ab
n
o
r
m
ality
,
h
is
to
r
y
o
f
a
p
ath
o
lo
g
ical
co
n
d
itio
n
o
f
t
h
e
u
ter
u
s
a
n
d
p
r
e
v
io
u
s
PTB,
p
o
ly
h
y
d
r
am
n
io
s
,
a
h
is
to
r
y
o
f
in
f
ec
tio
n
d
u
r
i
n
g
p
r
eg
n
a
n
cy
(
HI
V,
h
ep
atitis
B
,
an
d
s
y
p
h
ilis
)
,
an
d
in
ab
ilit
y
to
c
o
llect
a
h
air
s
am
p
le.
2
.
2
.
M
ea
s
urem
ent
o
f
P
b in m
a
t
er
na
l ha
ir
Hair
s
am
p
les
wer
e
cu
t
3
cm
f
r
o
m
th
e
s
ca
lp
with
s
ter
ilized
s
ciss
o
r
s
an
d
k
ep
t
in
a
s
ter
ile
cl
ip
p
last
ic.
T
h
e
co
llected
h
air
s
am
p
le
was
wash
ed
b
y
s
o
ak
in
g
i
n
ac
e
to
n
e
s
o
lu
tio
n
an
d
p
u
t
in
a
B
r
an
s
o
n
ic
Ultr
aso
n
ic
C
lean
er
with
in
5
m
in
u
tes.
Af
ter
b
ein
g
in
c
u
b
ated
f
o
r
ar
o
u
n
d
3
0
m
i
n
u
tes,
th
e
s
am
p
les
wer
e
d
r
ied
at
r
o
o
m
tem
p
er
atu
r
e
f
o
r
eig
h
t
h
o
u
r
s
.
T
h
e
s
am
p
les
wer
e
cu
t
in
to
5
-
mm
-
lo
n
g
s
eg
m
en
ts
an
d
m
ea
s
u
r
ed
u
s
in
g
T
ef
l
o
n
g
lass
.
T
h
e
s
am
p
les
u
n
d
er
wen
t
d
ig
esti
o
n
b
y
a
d
d
in
g
a
5
m
l
m
ix
tu
r
e
o
f
HNO
3
/H
2
O
2
(
3
:1
,
v
/v
)
.
T
h
e
n
,
1
0
μ
l
o
f
g
alliu
m
,
5
μ
l
o
f
p
alla
d
iu
m
,
a
n
d
1
0
0
μ
l
o
f
p
o
ly
v
in
y
l
alco
h
o
l
(
PVA)
wer
e
ad
d
ed
to
t
h
e
s
am
p
le.
T
h
e
m
i
x
tu
r
e
was
b
o
iled
at
1
1
0
°C
f
o
r
3
0
m
i
n
u
tes.
Af
ter
th
at,
2
0
μ
l
o
f
th
e
s
am
p
le
was
d
r
o
p
p
e
d
o
n
to
a
t
o
tal
r
ef
lectio
n
X
-
r
a
y
f
lu
o
r
escen
ce
(
T
XR
F)
q
u
ar
tz
d
is
k
.
T
h
e
d
is
k
was d
r
ied
o
n
a
h
o
t p
late
at
8
0
°C
an
d
th
en
ex
a
m
in
ed
with
T
XR
F to
d
eter
m
in
e
th
e
Pb
co
n
ten
t.
T
h
e
to
o
ls
,
m
ater
ials
,
an
d
wo
r
k
ar
ea
s
f
o
r
h
air
s
am
p
le
p
r
ep
ar
a
tio
n
wer
e
m
ad
e
o
f
p
last
ic,
T
ef
lo
n
,
o
r
s
ilico
n
,
an
d
wer
e
f
r
ee
f
r
o
m
co
n
tam
in
atio
n
with
o
th
e
r
m
etals.
T
h
e
p
r
o
c
ed
u
r
e
was
b
ased
o
n
I
SO/TS 1
8
5
0
7
:2
0
1
5
.
2
.
3
.
M
ea
s
urem
ent
o
f
I
L
-
6
a
nd
T
NF
-
α
i
n m
a
t
er
na
l serum
Ven
o
u
s
b
lo
o
d
was
tak
en
with
in
4
8
h
o
u
r
s
af
ter
d
eliv
er
y
in
an
E
DT
A
tu
b
e.
T
h
e
s
a
m
p
le
was
ce
n
tr
if
u
g
e
d
at
3
,
0
0
0
r
p
m
f
o
r
1
5
m
in
u
tes.
T
h
e
s
er
u
m
was
r
em
o
v
ed
a
n
d
s
to
r
ed
in
a
f
r
e
ez
er
at
-
2
0
°C
u
n
til
an
aly
s
is
.
I
L
-
6
an
d
T
NF
-
α
le
v
e
ls
in
m
ater
n
al
s
er
u
m
wer
e
m
e
asu
r
ed
with
e
n
zy
m
e
-
lin
k
ed
im
m
u
n
o
s
o
r
b
en
t
ass
ay
(
E
L
I
SA)
m
eth
o
d
.
2
.
4
.
Da
t
a
a
na
ly
s
is
SP
SS
S
tatis
t
ics
v
er
s
io
n
2
1
was
u
s
ed
f
o
r
s
tatis
tical
an
aly
s
is
.
T
h
e
Ko
lm
o
g
o
r
o
v
–
Sm
ir
n
o
v
test
was
u
s
ed
to
d
eter
m
in
e
wh
eth
e
r
th
e
d
ata
f
o
llo
wed
a
n
o
r
m
al
d
is
tr
ib
u
tio
n
.
Su
b
s
eq
u
en
tly
,
c
o
r
r
el
atio
n
an
aly
s
is
was
p
er
f
o
r
m
ed
.
A
b
iv
ar
iate
c
o
m
p
ar
ativ
e
test
was
p
er
f
o
r
m
ed
,
f
o
llo
wed
b
y
m
u
ltiv
ar
iate
an
al
y
s
is
f
o
r
Ho
s
m
er
–
L
em
esh
o
w
-
co
m
p
lian
t
v
ar
iab
le
s
.
2
.
5
.
E
t
hica
l c
o
ns
idera
t
io
n
T
h
e
s
tu
d
y
was
p
er
f
o
r
m
ed
b
y
f
o
llo
win
g
th
e
C
o
d
e
o
f
E
th
ics
o
f
th
e
W
o
r
ld
Me
d
ical
Ass
o
ciatio
n
(
Dec
lar
atio
n
o
f
Helsin
k
i)
.
I
n
f
o
r
m
ed
co
n
s
en
t
was
o
b
tain
e
d
f
r
o
m
all
p
ar
ticip
an
ts
.
T
h
e
Hea
lth
R
esear
ch
E
th
ics
C
o
m
m
ittee,
Facu
lty
o
f
Me
d
icin
e
Un
iv
er
s
itas
Dip
o
n
eg
o
r
o
,
p
r
o
v
id
ed
eth
ical
clea
r
an
ce
(
s
tu
d
y
r
ef
er
en
ce
n
u
m
b
e
r
1
2
5
/EC/KEPK/FK
-
UNDI
P/V/
2
0
2
2
)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
13
,
No
.
4
,
Dec
em
b
er
20
24
:
1
8
2
6
-
1
8
3
3
1828
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Cha
ra
c
t
er
is
t
ics o
f
t
he
Study
Su
bje
ct
T
ab
le
1
s
h
o
ws
th
e
s
u
b
ject
ch
a
r
ac
ter
is
tics
,
in
clu
d
in
g
p
o
s
s
ib
le
Pb
ex
p
o
s
u
r
e
an
d
b
ir
th
o
u
tc
o
m
e.
T
h
er
e
wer
e
n
o
s
ig
n
if
ican
t
d
i
f
f
er
en
ce
s
in
m
ater
n
al
p
ar
ity
,
ed
u
ca
tio
n
,
o
cc
u
p
atio
n
,
in
co
m
e,
ag
e
,
h
eig
h
t,
weig
h
t,
b
o
d
y
m
ass
in
d
ex
(
B
MI
)
,
u
p
p
e
r
ar
m
cir
cu
m
f
er
en
ce
,
a
n
d
h
em
o
g
lo
b
i
n
lev
el.
I
n
th
e
ca
s
e
g
r
o
u
p
,
t
h
e
m
ed
ian
g
estatio
n
al
ag
e
was
3
3
.
5
(
2
5
–
3
6
)
wee
k
s
,
an
d
3
5
.
7
%
o
f
th
e
s
u
b
jects
h
ad
p
r
em
atu
r
e
m
em
b
r
an
e
r
u
p
t
u
r
e
(
PR
OM
)
.
I
n
th
e
ca
s
e
g
r
o
u
p
,
5
7
.
1
%
o
f
th
e
i
n
f
an
ts
wer
e
m
ale
a
n
d
th
e
m
ea
n
±
s
tan
d
a
r
d
d
ev
iatio
n
b
ir
th
weig
h
t
was
1
8
8
7
.
6
8
±
4
9
7
.
8
g
.
T
ab
le
1
.
Su
b
ject’
s
ch
a
r
ac
ter
is
tics
V
a
r
i
a
b
l
e
s
N
(
%) o
r
mea
n
±
s
t
a
n
d
a
r
d
d
e
v
i
a
t
i
o
n
;
med
i
a
n
(
m
i
n
–
ma
x
)
p
-
v
a
l
u
e
C
a
se
(
n
=
2
8
)
C
o
n
t
r
o
l
(
n
=
4
4
)
P
a
r
i
t
y
N
u
l
l
i
p
a
r
a
1
2
(
4
2
.
9
%)
1
0
(
2
2
.
7
%)
0
.
0
7
1
a
M
u
l
t
i
p
a
r
a
1
6
(
5
7
.
1
%)
3
4
(
7
7
.
3
%)
Ed
u
c
a
t
i
o
n
<
1
2
y
e
a
r
s o
l
d
9
(
3
2
.
1
%)
1
0
(
2
2
.
7
%)
0
.
3
7
7
a
≥
1
2
y
e
a
r
s o
l
d
1
9
(
6
7
.
9
%)
3
4
(
7
7
.
3
%)
O
c
c
u
p
a
t
i
o
n
Emp
l
o
y
e
e
1
1
(
3
9
.
3
%)
2
2
(
5
0
%)
0
.
3
7
4
a
H
o
u
s
e
w
i
f
e
1
7
(
6
0
.
7
%)
2
2
(
5
0
%)
I
n
c
o
me
<
D
M
W
2
2
(
7
8
.
6
%)
2
7
(
6
1
.
4
%)
0
.
1
2
7
a
≥
D
M
W
6
(
2
1
.
4
%)
1
7
(
3
8
.
6
%S)
M
a
t
e
r
n
a
l
a
g
e
2
7
±
5
.
0
8
;
2
6
.
5
(
2
0
–
3
5
)
2
8
.
0
5
±
4
.
7
9
;
2
7
.
5
(
2
0
–
40)
0
.
3
8
1
c
H
e
i
g
h
t
(
c
m)
1
5
5
.
3
6
±
5
.
4
0
;
1
5
5
(
1
4
6
–
1
6
7
)
1
5
5
.
2
2
±
5
.
1
9
;
1
5
5
(
1
3
6
–
1
6
8
)
0
.
8
8
0
d
W
e
i
g
h
t
(
k
g
)
5
3
.
4
±
6
.
8
8
;
5
4
(
4
0
–
6
6
)
5
2
.
7
1
±
6
.
9
8
;
5
2
(
4
1
–
68)
0
.
6
8
0
c
B
o
d
y
mas
s i
n
d
e
x
(
k
g
/
m
2
)
2
2
.
1
2
±
2
.
5
9
;
2
2
.
1
3
(
1
7
.
5
4
–
2
6
.
6
7
)
2
1
.
8
8
±
2
.
6
9
;
2
2
.
6
9
(
1
7
.
2
9
–
2
7
.
0
6
)
0
.
9
0
3
d
U
p
p
e
r
a
r
m
c
i
r
c
u
mf
e
r
e
n
c
e
(
c
m)
2
6
.
6
1
±
3
.
4
1
;
2
6
(
2
1
–
35)
2
5
.
6
±
2
.
5
4
;
2
5
.
5
(
2
0
–
3
5
)
0
.
2
9
2
d
G
e
st
a
t
i
o
n
a
l
a
g
e
(
w
e
e
k
s)
3
2
.
2
1
±
3
.
3
2
;
3
3
.
5
(
2
5
–
36)
3
8
.
9
5
±
1
.
2
;
3
9
(
3
7
–
42
0
.
0
0
d
*
H
e
mo
g
l
o
b
i
n
1
1
.
4
5
±
1
.
1
3
;
1
1
.
5
(9
–
1
3
.
1
)
1
1
.
8
2
±
1
.
2
1
;
1
1
.
8
5
(
7
.
1
–
1
4
.
9
)
0
.
2
1
8
d
P
r
e
mat
u
r
e
m
e
m
b
r
a
n
e
r
u
p
t
u
r
e
Y
e
s
10
(
3
5
.
7
%)
0
0
.
0
0
b
*
No
18
(
6
4
.
3
%)
4
4
(
1
0
0
%)
No
19
(
6
7
.
9
%)
2
4
(
5
4
.
5
%)
H
i
st
o
r
y
o
f
h
o
u
s
e
r
e
n
o
v
a
t
i
o
n
i
n
t
h
e
p
a
st
1
0
y
e
a
r
s
Y
e
s
1
1
(
3
9
.
3
%)
2
7
(
6
1
.
4
%)
0
.
0
6
7
a
No
1
7
(
6
0
.
7
%)
1
7
(
3
8
.
6
%)
Li
v
i
n
g
i
n
a
h
i
g
h
-
t
r
a
f
f
i
c
a
r
e
a
s
Y
e
s
8
(
2
8
.
6
%)
7
(
1
5
.
9
%)
0
.
1
6
1
a
N
o
2
0
(
7
1
.
4
%)
3
7
(
8
4
.
1
%)
F
a
mi
l
y
h
i
st
o
r
y
o
f
c
i
g
a
r
e
t
t
e
smo
k
i
n
g
Y
e
s
2
3
(
8
2
.
1
%)
3
2
(
7
2
.
7
%)
0
.
2
6
6
a
No
5
(
1
7
.
9
%)
1
2
(
2
7
.
3
%)
S
p
o
u
se’s
smo
k
i
n
g
f
r
e
q
u
e
n
c
y
(
c
i
g
a
r
e
t
t
e
s
/
d
a
y
)
8
.
0
4
±
6
.
5
7
;
6
(
0
–
24)
5
.
4
±
4
.
8
4
;
6
(
0
–
1
8
)
0
.
1
1
0
c
I
n
f
a
n
t
’
s se
x
F
e
mal
e
1
2
(
4
2
.
9
%)
1
7
(
3
8
.
6
%)
0
.
7
2
2
a
M
a
l
e
1
6
(
5
7
.
1
%)
2
7
(
6
1
.
4
%)
I
n
f
a
n
t
’
s
b
i
r
t
h
w
e
i
g
h
t
(
g
)
1
8
8
7
.
6
8
±
4
9
7
.
8
;
1
8
5
0
(
9
0
0
–
3
0
0
0
)
3
1
1
0
.
2
5
±
3
9
8
.
3
6
;
3
1
0
0
(
2
5
0
0
–
4
4
0
0
)
0
.
0
0
c
*
N
o
t
e
:
a
=
C
h
i
-
s
q
u
a
r
e
t
e
s
t
;
b
=
F
i
s
h
e
r
’
s
e
x
a
c
t
t
e
st
;
c
=
i
n
d
e
p
e
n
d
e
n
t
sa
mp
l
e
s
T
-
t
e
st
;
d
=
M
a
n
n
–
W
h
i
t
n
e
y
t
e
s
t
;
e
=
b
a
s
e
d
o
n
P
ER
D
A
N
o
3
o
f
2
0
1
4
c
o
n
c
e
r
n
i
n
g
1
2
y
e
a
r
s o
f
c
o
mp
u
l
s
o
r
y
e
d
u
c
a
t
i
o
n
;
f
=
b
a
se
d
o
n
t
h
e
d
i
s
t
r
i
c
t
m
i
n
i
m
u
m w
a
g
e
(
D
M
W
)
o
f
C
e
n
t
r
a
l
J
a
v
a
(
G
o
v
e
r
n
o
r
D
e
c
r
e
e
N
u
m
b
e
r
5
6
1
/
5
4
o
f
2
0
2
2
se
t
t
h
e
mi
n
i
mu
m
w
a
g
e
a
t
I
D
R
2
,
2
7
2
,
0
2
5
)
;
g
=
t
r
a
f
f
i
c
a
r
e
a
i
s
b
a
s
e
d
o
n
a
5
-
p
o
i
n
t
Li
k
e
r
t
sc
a
l
e
c
o
mp
l
e
t
e
d
b
y
t
h
e
s
u
b
j
e
c
t
(
a
sco
r
e
o
f
4
–
5
i
n
d
i
c
a
t
e
s
a
h
i
g
h
-
t
r
a
f
f
i
c
a
r
e
a
)
;
*
p
<
0
.
0
5
3
.
2
.
Ana
ly
s
is
o
f
P
b lev
els in
ha
ir
f
ro
m
m
o
t
hers wit
h P
T
B
T
h
e
m
ed
ian
Pb
m
ater
n
al
h
air
lev
el
in
all
s
u
b
jects
was
1
.
5
(
1
.
1
–
2
)
p
p
m
,
s
ee
T
ab
le
2
.
T
h
e
ca
s
e
g
r
o
u
p
h
ad
a
s
lig
h
tly
h
ig
h
e
r
m
ed
ian
Pb
h
air
lev
el
th
an
th
e
co
n
t
r
o
l
g
r
o
u
p
,
1
.
5
(
1
.
1
2
–
2
)
v
er
s
u
s
1
.
4
(
1
.
1
–
1
.
9
)
p
p
m
,
b
u
t
th
e
d
if
f
e
r
en
ce
was
n
o
t
s
ig
n
if
ic
an
t
,
s
ee
Fig
u
r
e
1
.
T
h
e
r
e
was
a
n
o
n
s
ig
n
if
ican
t
n
eg
ativ
e
co
r
r
e
latio
n
b
etwe
en
th
e
m
ater
n
al
h
air
Pb
lev
el
an
d
g
e
s
tatio
n
al
ag
e
(
r
=
-
0
.
0
1
9
5
%
co
n
f
id
en
ce
in
ter
v
al
[
C
I
]
-
0
.
2
5
9
to
0
.
2
1
8
,
p
>
0
.
0
5
)
,
s
ee
T
ab
le
3
.
W
e
ca
teg
o
r
ized
th
e
h
air
Pb
lev
el
b
y
a
cu
to
f
f
o
f
1
.
4
5
p
p
m
.
Fo
r
th
e
g
r
o
u
p
with
Pb
≥
1
.
4
5
p
p
m
,
th
e
cr
u
d
e
o
d
d
s
r
atio
(
OR
)
o
f
1
.
4
6
(
9
5
%
C
I
0
.
5
6
–
3
.
7
9
)
f
o
r
PTB,
b
u
t
th
e
r
esu
lt
was
n
o
t
s
ig
n
if
ican
t
,
s
ee
T
ab
le
4
.
Mu
ltiv
ar
iate
an
aly
s
is
s
h
o
wed
th
at
Pb
co
u
ld
be
a
r
is
k
f
ac
t
o
r
f
o
r
PTB,
alth
o
u
g
h
th
e
ad
j
u
s
ted
OR
wa
s
n
o
t
s
ig
n
if
ican
t (
2
4
.
6
9
,
9
5
% C
I
0
.
9
3
–
6
5
3
.
8
2
,
p
>0
.
0
5
)
,
s
ee
T
ab
le
5
.
T
ab
le
2
.
Pb
,
T
NF
-
α
an
d
I
L
-
6
m
ea
s
u
r
em
en
t in
all
s
u
b
jects
V
a
r
i
a
b
l
e
s
M
e
a
n
±
st
a
n
d
a
r
d
d
e
v
i
a
t
i
o
n
;
me
d
i
a
n
(
mi
n
-
ma
x
)
p
-
v
a
l
u
e
a
M
a
t
e
r
n
a
l
ser
u
m I
L
-
6
(
p
g
/
ml
)
1
8
.
2
8
±
1
9
.
6
;
1
0
.
7
7
(
0
.
6
4
–
9
5
.
0
5
)
0
.
0
0
M
a
t
e
r
n
a
l
ser
u
m TNF
-
α (
p
g
/
m
l
)
2
3
.
0
2
±
2
7
.
8
2
;
1
0
.
0
2
(
1
.
4
8
–
1
3
1
.
4
6
)
0
.
0
0
M
a
t
e
r
n
a
l
h
a
i
r
P
b
l
e
v
e
l
(
p
p
m)
1
.
4
9
±
0
.
2
1
;
1
.
5
(
1
.
1
–
2)
0
.
0
1
N
o
t
e
:
a
K
o
l
mo
g
o
r
o
v
–
S
m
i
r
n
o
v
t
e
st
.
I
L
-
6
a
n
d
TN
F
-
α
mea
s
u
r
e
d
w
i
t
h
ELI
S
A
;
ma
t
e
r
n
a
l
h
a
i
r
P
b
w
a
s
m
e
a
s
u
r
e
d
w
i
t
h
t
o
t
a
l
r
e
f
l
e
c
t
i
o
n
X
-
r
a
y
f
l
u
o
r
e
sc
e
n
c
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Ma
tern
a
l h
a
ir
lea
d
a
n
d
cy
to
ki
n
e
p
r
o
-
in
fla
mma
to
r
y
effec
ts
in
p
r
eterm
b
ir
th
(
Qo
n
ita
N
u
r
Qo
lb
y
)
1829
(
a)
(
b
)
(
c)
Fig
u
r
e
1
.
C
o
m
p
a
r
is
o
n
o
f
(
a)
t
u
m
o
r
n
ec
r
o
s
is
f
ac
to
r
-
alp
h
a
(
T
N
F
-
α
)
,
(
b
)
in
ter
leu
k
in
6
(
I
L
-
6
)
,
an
d
(
c)
lead
(
Pb
)
lev
els b
etwe
en
th
e
ca
s
e
an
d
c
o
n
tr
o
l g
r
o
u
p
s
.
T
h
e
Ma
n
n
–
W
h
itn
ey
test
r
ev
ea
led
s
ig
n
if
ica
n
tly
h
ig
h
er
I
L
-
6
a
n
d
T
NF
-
α
le
v
el
s
,
an
d
a
s
lig
h
tly
h
i
g
h
er
m
ater
n
al
h
air
Pb
le
v
el
in
th
e
ca
s
e
co
m
p
ar
e
d
with
th
e
co
n
tr
o
l g
r
o
u
p
T
ab
le
3
.
C
o
r
r
elatio
n
o
f
Pb
,
T
NF
-
α
,
I
L
-
6
,
an
d
g
estatio
n
al
ag
e
V
a
r
i
a
b
l
e
IL
-
6
TN
F
-
α
G
e
st
a
t
i
o
n
a
l
a
g
e
Pb
r=
-
0
.
0
1
5
a
;
p
=
0
.
8
9
7
r=
-
0
.
0
2
a
;
p
=
0
.
8
9
3
r=
-
0
.
0
1
0
a
;
p
=
0
.
9
3
6
IL
-
6
r=
-
0
.
0
3
1
a
;
p
=
0
.
7
9
6
r=
-
0
.
1
5
7
a
;
p
=
0
.
1
8
6
TN
F
-
α
r=
-
0
.
2
3
3
a
;
p
=
0
.
0
4
9
*
N
o
t
e
:
r
=
c
o
e
f
f
i
c
i
e
n
t
c
o
r
r
e
l
a
t
i
o
n
;
a
=
S
p
e
a
r
man
t
e
st
;
*
p
<
0
.
0
5
T
ab
le
4
.
Ass
ess
in
g
Pb
,
I
L
-
6
,
a
n
d
T
NF
-
α
lev
els as r
is
k
f
ac
to
r
s
f
o
r
PTB
V
a
r
i
a
b
l
e
s
N
(
%)
p
-
v
a
l
u
e
C
r
u
d
e
o
d
d
s
r
a
t
i
o
(
9
5
%
c
o
n
f
i
d
e
n
c
e
i
n
t
e
r
v
a
l
)
C
a
se
(
N
=
2
8
)
C
o
n
t
r
o
l
(
N
=
4
4
)
M
a
t
e
r
n
a
l
h
a
i
r
P
b
P
b
<
1
.
4
5
p
p
m
1
2
(
4
2
.
9
%)
2
3
(
5
2
.
3
%)
0
.
4
3
6
a
1
.
4
6
(
0
.
5
6
–
3
.
7
9
)
P
b
≥
1
.
4
5
p
p
m
1
6
(
5
7
.
1
%)
2
1
(
4
7
.
7
%)
M
a
t
e
r
n
a
l
ser
u
m I
L
-
6
IL
-
6
<
9
p
g
/
ml
6
(
2
1
.
4
%)
2
4
(
5
4
.
5
%)
0
.
0
0
5
a
4
.
4
(
1
.
4
9
–
1
2
.
9
6
)
*
IL
-
6
≥
9
p
g
/
ml
2
2
(
7
8
.
6
%)
2
0
(
4
5
.
5
%)
M
a
t
e
r
n
a
l
ser
u
m TNF
-
α
TN
F
-
α<2
7
p
g
/
ml
1
2
(
4
2
.
9
%)
4
0
(
9
0
.
9
%)
0
.
0
0
b
1
3
.
3
3
(
3
.
7
4
–
4
7
.
5
5
)
*
TN
F
-
α≥2
7
p
g
/
ml
1
6
(
5
7
.
1
%)
4
(
9
.
1
%)
N
o
t
e
:
a
C
h
i
-
s
q
u
a
r
e
t
e
s
t
;
b
F
i
s
h
e
r
’
s
e
x
a
c
t
t
e
s
t
;
*
p
<
0
.
0
5
;
Th
e
c
u
t
-
o
f
f
o
f
P
b
,
I
L
-
6
,
a
n
d
TN
F
-
α w
e
r
e
d
e
t
e
r
mi
n
e
d
b
y
R
O
C
a
n
a
l
y
si
s
T
ab
le
5
.
PTB r
is
k
f
ac
to
r
V
a
r
i
a
b
l
e
s
C
o
e
f
f
i
c
i
e
n
t
S
t
a
n
d
a
r
d
e
r
r
o
r
p
-
v
a
l
u
e
O
d
d
s
r
a
t
i
o
9
5
%
c
o
n
f
i
d
e
n
c
e
i
n
t
e
r
v
a
l
M
i
n
M
a
x
I
n
t
e
r
l
e
u
k
i
n
6
≥
9
p
g
/
ml
3
.
1
0
6
1
.
0
0
0
0
.
0
0
2
2
2
.
3
3
*
3
.
1
4
4
1
5
8
.
5
3
4
Tu
m
o
r
n
e
c
r
o
si
s
f
a
c
t
o
r
-
a
l
p
h
a
≥
2
7
p
g
/
ml
3
.
7
4
4
1
.
0
6
3
0
.
0
0
0
4
2
.
2
5
*
5
.
2
5
6
3
3
9
.
6
0
7
H
e
mo
g
l
o
b
i
n
-
0
.
8
4
2
0
.
3
9
1
0
.
0
3
1
0
.
4
3
*
0
.
2
0
0
0
.
9
2
7
S
p
o
u
se’s
smo
k
i
n
g
f
r
e
q
u
e
n
c
y
0
.
2
4
3
0
.
0
8
2
0
.
0
0
3
1
.
2
8
*
1
.
0
8
7
1
.
4
9
6
M
a
t
e
r
n
a
l
l
e
a
d
l
e
v
e
l
3
.
2
0
6
1
.
6
7
2
0
.
0
5
5
2
4
.
6
9
0
.
9
3
2
6
5
3
.
8
1
9
N
o
t
e
:
*
V
a
r
i
a
b
l
e
s
h
a
d
si
g
n
i
f
i
c
a
n
t
r
e
s
u
l
t
s
b
a
se
d
o
n
m
u
l
t
i
v
a
r
i
a
t
e
l
o
g
i
st
i
c
r
e
g
r
e
ssi
o
n
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
13
,
No
.
4
,
Dec
em
b
er
20
24
:
1
8
2
6
-
1
8
3
3
1830
Pb
is
a
h
ea
v
y
m
etal
th
at
ca
n
tr
ig
g
er
to
x
ic
ef
f
ec
ts
in
o
r
g
an
i
s
m
s
an
d
af
f
ec
t
im
m
u
n
o
m
o
d
u
lato
r
s
[
1
9
]
.
Pb
ex
p
o
s
u
r
e
in
h
u
m
an
s
in
c
r
ea
s
es
p
r
o
in
f
lam
m
ato
r
y
c
y
to
k
in
es,
s
u
g
g
esti
n
g
p
o
s
s
ib
le
Pb
in
ter
f
er
en
ce
in
in
f
lam
m
atio
n
[
2
0
]
.
An
i
n
vitr
o
s
tu
d
y
with
m
o
n
o
n
u
clea
r
ce
ll
s
f
r
o
m
h
u
m
an
p
er
ip
h
er
al
b
lo
o
d
s
h
o
wed
in
cr
ea
s
ed
s
tim
u
latio
n
o
f
T
NF
-
α
a
n
d
I
L
-
6
at
a
h
ig
h
Pb
d
o
s
e
o
f
1
5
0
p
p
m
[
2
1
]
.
B
ased
o
n
a
s
tu
d
y
t
h
at
ad
d
ed
4
–
4
0
p
p
m
Pb
io
n
s
to
p
er
ito
n
ea
l
a
d
h
er
e
n
t
c
ells
an
d
ly
m
p
h
ce
lls
,
Pb
in
t
er
f
er
es
with
th
e
p
r
o
d
u
ctio
n
o
f
p
r
o
in
f
lam
m
ato
r
y
cy
to
k
in
e
r
eg
u
latio
n
.
I
n
th
at
s
t
u
d
y
,
I
L
-
6
an
d
T
NF
-
α
lev
els
wer
e
s
ig
n
if
ican
tly
lo
wer
co
m
p
ar
ed
with
u
n
tr
ea
ted
cu
ltu
r
ed
ce
lls
[
2
2
]
.
Pb
ex
p
o
s
u
r
e
in
wo
r
k
er
s
f
o
r
4
0
d
ay
s
s
ig
n
if
ican
tly
in
cr
ea
s
es
Pb
b
lo
o
d
lev
els
with
a
p
o
s
itiv
e
co
r
r
elatio
n
with
IL
-
6
lev
els
[
2
3
]
.
T
h
o
s
e
f
in
d
i
n
g
s
d
em
o
n
s
tr
ate
h
o
w
th
e
e
x
p
o
s
u
r
e
d
o
s
e
an
d
d
u
r
atio
n
im
p
ac
t
th
e
im
m
u
n
o
m
o
d
u
latin
g
ef
f
ec
t.
Data
an
aly
s
is
o
f
th
e
ass
o
ciatio
n
b
etwe
en
Pb
ex
p
o
s
u
r
e
an
d
PTB
r
ev
ea
led
an
in
cr
ea
s
ed
r
is
k
f
r
o
m
b
o
th
b
iv
ar
iate
an
d
m
u
ltiv
ar
iate
te
s
ts
,
alth
o
u
g
h
th
e
f
i
n
d
in
g
s
w
er
e
n
o
t
s
ig
n
if
ican
t.
Similar
ly
,
th
er
e
was
n
o
t
a
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
b
etwe
en
th
e
Pb
lev
el
an
d
th
e
I
L
-
6
o
r
T
NF
-
α
lev
el.
T
h
e
m
ed
ia
n
h
air
Pb
lev
el
in
th
e
p
r
esen
t
s
tu
d
y
was
1
.
5
p
p
m
,
s
u
b
s
tan
tially
lo
wer
th
an
th
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
(
W
HO)
th
r
esh
o
ld
o
f
<1
2
p
p
m
.
T
h
is
lev
el
is
lo
wer
th
an
ea
r
lier
s
tu
d
ies
in
I
n
d
o
n
e
s
ia,
s
u
g
g
esti
n
g
th
at
th
e
Pb
lev
el
m
ay
n
ee
d
t
o
b
e
h
ig
h
er
to
d
em
o
n
s
tr
ate
th
e
h
ar
m
f
u
l
ef
f
ec
ts
o
f
Pb
e
x
p
o
s
u
r
e
[
2
1
]
,
[
2
4
]
,
[
2
5
]
.
Pre
v
io
u
s
s
tu
d
ies
in
th
e
C
h
in
ese
an
d
J
ap
an
ese
p
o
p
u
latio
n
s
s
im
ilar
ly
d
em
o
n
s
tr
ated
a
s
lig
h
tly
h
ig
h
er
tr
en
d
r
eg
ar
d
in
g
th
e
Pb
i
n
wo
m
en
with
PTB,
alth
o
u
g
h
th
e
lo
w
Pb
lev
els
d
id
n
o
t
s
h
o
w
a
to
x
ic
ass
o
ciatio
n
with
PTB
[
2
6
]
,
[
2
7
]
.
T
h
e
tr
ac
e
elem
en
ts
an
d
m
icr
o
n
u
tr
ie
n
ts
th
at
ar
e
k
n
o
wn
as
p
r
o
tectiv
e
f
ac
to
r
s
in
p
r
eg
n
an
cy
co
u
l
d
in
f
lu
e
n
ce
th
e
h
ea
v
y
m
etals
p
ath
o
lo
g
y
in
PTB
[
2
6
]
,
[
2
8
]
,
[
2
9
]
.
3.
3
.
Ana
ly
s
is
o
f
Serum
I
L
-
6
a
nd
T
NF
-
α
L
ev
els in
M
o
t
hers wit
h P
T
B
T
h
e
m
ed
ian
I
L
-
6
s
er
u
m
lev
el
in
all
s
u
b
jects
was
1
0
.
7
7
(
0
.
6
4
–
9
5
.
0
5
)
p
g
/m
l.
T
h
er
e
was
a
s
ig
n
if
ican
t
d
if
f
er
en
ce
b
etwe
en
th
e
ca
s
e
a
n
d
c
o
n
tr
o
l
g
r
o
u
p
s
,
in
w
h
ich
t
h
e
ca
s
e
h
a
d
a
h
ig
h
er
m
ed
ian
,
1
3
.
1
1
(
2
.
6
–
9
5
.
0
5
)
v
er
s
u
s
7
.
2
3
(
0
.
6
4
–
7
0
.
7
6
)
p
<0
.
0
5
,
s
ee
Fig
u
r
e
1
.
T
h
er
e
was
a
n
o
n
s
ig
n
if
ican
t
n
eg
ativ
e
co
r
r
e
latio
n
b
etwe
en
th
e
s
er
u
m
I
L
-
6
lev
el
an
d
g
estatio
n
al
ag
e
(
r
=
-
0
.
1
5
7
;
p
>0
.
0
5
)
.
A
s
er
u
m
I
L
-
6
lev
el
≥
9
p
g
/m
l
c
o
u
ld
b
e
a
r
is
k
f
ac
to
r
f
o
r
PTB,
with
a
c
r
u
d
e
OR
o
f
4
.
4
(
9
5
%
C
I
1
.
4
9
–
1
2
.
9
6
,
p
<0
.
0
5
)
a
n
d
an
ad
ju
s
ted
OR
o
f
2
2
.
3
3
(
9
5
%
C
I
3
.
1
4
–
1
5
8
.
5
3
)
.
T
h
e
m
ed
ian
s
er
u
m
T
NF
-
α
lev
el
in
all
s
u
b
jects
was
1
0
.
0
2
(
1
.
4
8
–
1
3
1
.
4
6
)
p
g
/m
l.
T
h
e
T
NF
-
α
lev
el
was
s
ig
n
if
ican
tly
h
ig
h
er
in
th
e
ca
s
e
g
r
o
u
p
,
wh
ic
h
h
ad
a
m
ed
ian
o
f
3
2
.
2
(
1
.
4
8
–
1
3
1
.
4
6
)
v
er
s
u
s
9
.
2
2
(
1
.
4
8
–
6
2
.
2
9
)
p
<0
.
0
5
,
s
ee
Fig
u
r
e
1
.
T
h
e
r
e
was
a
s
ig
n
if
ican
t
n
eg
ativ
e
co
r
r
elatio
n
b
etwe
en
T
NF
-
α
an
d
g
estatio
n
al
ag
e
(r=
-
0
.
2
3
3
,
p
<0
.
0
5
)
.
A
T
NF
-
α
lev
el
≥
2
7
p
g
/
m
l
co
u
l
d
b
e
a
r
is
k
f
ac
to
r
f
o
r
PTB,
with
a
cr
u
d
e
OR
o
f
1
3
.
3
3
(
9
5
%
C
I
3
.
7
4
–
4
7
.
5
5
,
p
<
0
.
0
5
)
an
d
a
n
ad
ju
s
ted
OR
o
f
4
2
.
2
5
(
9
5
% C
I
5
.
2
6
–
3
3
9
.
6
1
)
.
T
NF
-
α
is
p
ar
t
o
f
ce
llu
lar
im
m
u
n
ity
an
d
co
n
tr
ib
u
tes
to
PTB
[
3
0
]
.
I
L
-
6
p
lay
s
a
r
o
le
i
n
h
u
m
o
r
al
im
m
u
n
ity
an
d
is
in
v
o
lv
ed
i
n
lab
o
r
an
d
p
r
eter
m
p
h
y
s
io
l
o
g
y
[
3
1
]
,
[
3
2
]
.
It
is
p
r
o
d
u
c
ed
b
y
f
ib
r
o
b
last
s
,
k
er
atin
o
cy
tes,
m
o
n
o
cy
tes,
m
a
cr
o
p
h
a
g
es,
T
ce
lls
,
en
d
o
m
etr
i
al
s
tr
o
m
al
ce
lls
,
d
ec
id
u
al
ce
lls
,
th
e
am
n
io
n
,
a
n
d
th
e
ch
o
r
io
n
,
an
d
o
n
e
o
f
its
tr
ig
g
er
in
g
f
ac
to
r
s
is
T
NF
-
α
[
3
1
]
,
[
3
2
]
.
I
n
vivo
an
d
in
vitr
o
s
tu
d
ie
s
s
u
g
g
est
th
at
I
L
-
6
an
d
T
NF
-
α
p
r
o
m
o
te
PTB
an
d
p
r
em
atu
r
e
m
em
b
r
a
n
e
r
u
p
tu
r
e
th
r
o
u
g
h
th
e
p
r
o
d
u
ctio
n
o
f
a
d
is
in
teg
r
in
an
d
m
etallo
p
r
o
tein
ase
with
th
r
o
m
b
o
s
p
o
n
d
in
m
o
tifs
9
(
ADAM
T
S9
)
[
3
3
]
.
IL
-
6
an
d
T
NF
-
α
also
d
is
r
u
p
t
tr
o
p
h
o
b
last
in
v
asio
n
an
d
alter
p
lace
n
tal
f
u
n
ctio
n
s
wh
ich
in
d
u
ce
p
r
ee
clam
p
s
ia
an
d
r
elate
to
PTB
[
3
4
]
.
Pro
in
f
lam
m
ato
r
y
cy
to
k
in
es
i
n
d
u
ce
th
e
lab
o
r
p
r
o
ce
s
s
.
Uter
in
e
ac
tiv
atio
n
o
cc
u
r
s
d
u
r
in
g
lab
o
r
,
f
o
llo
wed
b
y
m
y
o
m
etr
ial
co
n
tr
ac
tio
n
s
th
at
r
ip
en
a
n
d
s
o
f
te
n
t
h
e
ce
r
v
ix
u
n
til
th
e
m
em
b
r
a
n
e
s
ar
e
to
r
n
[
3
5
]
.
T
h
e
u
ter
in
e
ac
tiv
atio
n
p
r
o
tein
(
U
AP)
,
leu
k
o
c
y
te
in
v
asio
n
,
an
d
a
s
ter
ile,
in
f
lam
m
ato
r
y
-
lik
e
p
r
o
ce
s
s
th
at
lead
s
t
o
p
ar
tu
r
itio
n
(
i
n
clu
d
in
g
d
am
a
g
e
-
ass
o
ciate
d
m
o
lecu
lar
p
atter
n
s
)
ar
e
all
ac
tiv
ated
in
r
esp
o
n
s
e
to
p
r
o
in
f
lam
m
ato
r
y
s
ig
n
als
[
3
5
]
.
T
h
e
in
f
lu
x
o
f
leu
k
o
cy
tes
to
th
e
ce
r
v
ix
r
elea
s
e
s
p
r
o
teo
ly
tic
en
zy
m
es
th
at
aid
in
r
em
o
d
elin
g
th
e
ce
r
v
ix
u
n
til
d
ilatatio
n
o
cc
u
r
s
[
3
6
]
.
Pro
in
f
lam
m
ato
r
y
cy
to
k
in
es
s
tim
u
late
th
e
s
y
n
th
esis
o
f
p
r
o
s
tag
lan
d
in
s
an
d
m
etallo
p
r
o
tein
ases
th
at
lead
t
o
ea
r
ly
lab
o
r
b
y
in
d
u
ci
n
g
m
em
b
r
an
e
r
u
p
tu
r
e,
ce
r
v
i
x
m
at
u
r
atio
n
,
a
n
d
u
ter
i
n
e
co
n
tr
ac
tio
n
s
[
3
0
]
.
3.
4
.
Ana
ly
s
is
o
f
o
t
her
v
a
ria
b
les t
ha
t
a
f
f
ec
t
P
T
B
Mu
ltiv
ar
iate
lo
g
is
tic
r
eg
r
ess
io
n
s
h
o
wed
th
at
th
e
s
p
o
u
s
e’
s
s
m
o
k
in
g
f
r
eq
u
en
cy
an
d
m
ater
n
al
h
em
o
g
lo
b
in
m
ay
i
n
f
lu
en
ce
P
T
B
.
T
h
e
s
p
o
u
s
e’
s
s
m
o
k
in
g
f
r
eq
u
en
cy
co
u
ld
in
c
r
ea
s
e
th
e
r
is
k
o
f
PTB
(
OR
1
.
2
8
,
9
5
%
C
I
1
.
1
–
1
.
5
)
,
wh
ile
m
ate
r
n
al
h
em
o
g
lo
b
in
c
o
u
ld
b
e
a
p
r
o
tectiv
e
f
ac
to
r
ag
ai
n
s
t
PTB
(
OR
0
.
4
3
,
9
5
%
C
I
0
.
2
–
0
.
9
3
)
.
Sm
o
k
in
g
is
k
n
o
wn
to
h
av
e
n
eg
ativ
e
h
ea
lth
im
p
ac
ts
,
p
ar
ticu
lar
ly
d
u
r
in
g
p
r
eg
n
an
cy
[
3
7
]
.
Pas
s
iv
e
s
m
o
k
in
g
—
b
r
ea
th
i
n
g
in
cig
ar
et
te
s
m
o
k
e
—
m
ay
lead
to
s
ev
er
e
ad
v
er
s
e
ef
f
ec
ts
[
3
8
]
.
A
lo
w
h
em
o
g
lo
b
i
n
lev
el,
a
co
n
d
itio
n
k
n
o
wn
as
an
em
ia,
is
ass
o
ciate
d
with
an
in
cr
ea
s
ed
r
is
k
o
f
s
till
b
ir
th
,
PTB,
an
d
lo
w
b
ir
th
weig
h
t
[
3
9
]
,
[
4
0
]
.
T
h
e
f
r
e
q
u
en
c
y
o
f
s
m
o
k
in
g
s
ig
n
if
ican
tly
in
cr
ea
s
ed
th
e
r
is
k
o
f
PTB
in
th
e
f
in
al
m
u
ltiv
ar
iate
an
aly
tic
m
o
d
el.
T
h
e
h
em
o
g
lo
b
in
lev
el
h
as th
e
p
o
ten
tial to
b
e
a
s
u
b
s
ta
n
tial p
r
o
tectiv
e
f
ac
to
r
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Ma
tern
a
l h
a
ir
lea
d
a
n
d
cy
to
ki
n
e
p
r
o
-
in
fla
mma
to
r
y
effec
ts
in
p
r
eterm
b
ir
th
(
Qo
n
ita
N
u
r
Qo
lb
y
)
1831
4.
CO
NCLU
SI
O
N
Ma
ter
n
al
h
air
Pb
lev
els,
m
ater
n
al
s
er
u
m
I
L
-
6
an
d
T
NF
-
α
lev
els,
an
d
th
e
s
p
o
u
s
e’
s
s
m
o
k
in
g
f
r
eq
u
e
n
cy
in
cr
ea
s
e
th
e
r
is
k
o
f
PTB.
Ho
wev
er
,
m
ater
n
al
h
em
o
g
lo
b
i
n
s
er
v
es
as
a
p
r
o
tectiv
e
f
ac
t
o
r
.
T
h
e
lo
w
m
ater
n
al
h
ai
r
Pb
lev
el
in
th
e
s
tu
d
y
p
o
p
u
lati
o
n
m
ig
h
t
h
av
e
p
r
e
v
en
ted
t
h
e
ab
ilit
y
to
o
b
s
er
v
e
th
e
to
x
ic
ef
f
ec
t
o
f
Pb
.
Fu
tu
r
e
in
v
esti
g
atio
n
s
s
h
o
u
ld
f
o
cu
s
o
n
o
th
er
h
ea
v
y
m
etals
an
d
tr
ac
e
elem
en
ts
th
at
co
u
ld
ac
t
as
co
n
f
o
u
n
d
in
g
f
ac
to
r
s
in
at
-
r
is
k
s
u
b
jects to
d
eter
m
in
e
t
h
e
to
x
ic
ef
f
ec
ts
o
f
Pb
o
n
f
etal
an
d
m
ater
n
al
h
ea
lth
.
ACK
NO
WL
E
DG
E
M
E
NT
S
T
h
is
s
tu
d
y
was
s
u
p
p
o
r
ted
b
y
t
h
e
f
u
n
d
in
g
o
f
th
e
Mi
n
is
tr
y
o
f
R
esear
ch
an
d
T
ec
h
n
o
lo
g
y
,
R
ep
u
b
lic
o
f
I
n
d
o
n
esia
(
R
esear
ch
Gr
an
t
No
5
6
9
-
4
6
/UN7
.
D
2
/PP
/VI
I
/2
0
2
2
)
.
T
h
e
au
th
o
r
s
d
ec
la
r
e
n
o
c
o
n
f
lict
o
f
in
ter
est.
T
h
e
f
u
n
d
er
s
h
ad
n
o
r
o
le
in
th
e
s
tu
d
y
’
s
d
esig
n
;
in
th
e
co
llectio
n
,
an
aly
s
es,
o
r
in
ter
p
r
etatio
n
o
f
d
ata;
in
th
e
wr
itin
g
o
f
th
e
m
a
n
u
s
cr
ip
t; o
r
in
th
e
d
e
cisi
o
n
to
p
u
b
lis
h
th
e
r
esu
lt.
RE
F
E
R
E
NC
E
S
[
1
]
UN
E
n
v
i
r
o
n
me
n
t
P
r
o
g
r
a
mm
e
,
T
h
e
L
e
a
d
C
a
m
p
a
i
g
n
.
2
0
1
9
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s:
/
/
w
w
w
.
u
n
e
n
v
i
r
o
n
men
t
.
o
r
g
/
e
x
p
l
o
r
e
-
t
o
p
i
c
s/
t
r
a
n
sp
o
r
t
/
w
h
a
t
-
we
-
d
o
/
p
a
r
t
n
e
r
s
h
i
p
-
c
l
e
a
n
-
f
u
e
l
s
-
a
n
d
-
v
e
h
i
c
l
e
s
/
l
e
a
d
-
c
a
mp
a
i
g
n
(
a
c
c
e
sse
d
S
e
p
t
e
mb
e
r
1
0
,
2
0
2
3
)
.
[
2
]
T.
M
o
h
s
i
n
,
“
Ef
f
e
c
t
s
o
f
Le
a
d
o
n
H
u
m
a
n
H
e
a
l
t
h
:
A
R
e
v
i
e
w
,
”
J
o
u
rn
a
l
o
f
E
n
v
i
r
o
n
m
e
n
t
a
l
a
n
d
A
n
a
l
y
t
i
c
a
l
T
o
x
i
c
o
l
o
g
y
,
v
o
l
.
1
2
,
n
o
.
6
,
p
.
6
6
5
,
2
0
2
2
,
d
o
i
:
1
0
.
3
7
4
2
1
/
2
1
6
1
-
0
5
2
5
.
2
0
2
2
.
1
2
.
6
6
5
.
[
3
]
A
.
E.
C
h
a
r
k
i
e
w
i
c
z
a
n
d
J.
R
.
B
a
c
k
s
t
r
a
n
d
,
“
Le
a
d
t
o
x
i
c
i
t
y
a
n
d
p
o
l
l
u
t
i
o
n
i
n
P
o
l
a
n
d
,
”
I
n
t
e
rn
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
En
v
i
ro
n
m
e
n
t
a
l
Re
se
a
rc
h
a
n
d
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
1
7
,
n
o
.
1
2
,
p
p
.
1
–
1
6
,
2
0
2
0
,
d
o
i
:
1
0
.
3
3
9
0
/
i
j
e
r
p
h
1
7
1
2
4
3
8
5
.
[
4
]
U
N
I
C
EF
a
n
d
P
u
r
e
Ea
r
t
h
,
“
T
h
e
t
o
x
i
c
t
r
u
t
h
:
c
h
i
l
d
r
e
n
’
s
e
x
p
o
s
u
r
e
t
o
l
e
a
d
p
o
l
l
u
t
i
o
n
u
n
d
e
r
mi
n
e
s
a
g
e
n
e
r
a
t
i
o
n
o
f
f
u
t
u
r
e
p
o
t
e
n
t
i
a
l
,
”
U
N
I
C
EF,
2
0
2
0
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s:
/
/
w
w
w
.
u
n
i
c
e
f
.
o
r
g
/
r
e
p
o
r
t
s
/
t
o
x
i
c
-
t
r
u
t
h
-
c
h
i
l
d
r
e
n
s
-
e
x
p
o
su
r
e
-
to
-
l
e
a
d
-
p
o
l
l
u
t
i
o
n
-
2
0
2
0
(
a
c
c
e
s
se
d
S
e
p
t
e
m
b
e
r
1
0
,
2
0
2
3
)
.
[
5
]
J.
S
t
o
n
e
,
P
.
S
u
t
r
a
v
e
,
E
.
G
a
sc
o
i
g
n
e
,
M
.
B
.
G
i
v
e
n
s
,
R
.
C
.
F
r
y
,
a
n
d
T.
A
.
M
a
n
u
c
k
,
“
E
x
p
e
r
t
r
e
v
i
e
w
e
x
p
o
su
r
e
t
o
t
o
x
i
c
me
t
a
l
s
a
n
d
p
e
r
-
a
n
d
p
o
l
y
f
l
u
o
r
o
a
l
k
y
l
su
b
s
t
a
n
c
e
s
a
n
d
t
h
e
r
i
sk
o
f
p
r
e
e
c
l
a
m
p
si
a
a
n
d
p
r
e
t
e
r
m
b
i
r
t
h
i
n
t
h
e
U
n
i
t
e
d
S
t
a
t
e
s
:
a
r
e
v
i
e
w
,
”
A
m
e
ri
c
a
n
J
o
u
r
n
a
l
o
f
O
b
s
t
e
t
r
i
c
s
& G
y
n
e
c
o
l
o
g
y
MF
M
,
v
o
l
.
3
,
n
o
.
3
,
p
.
1
0
0
3
0
8
,
2
0
2
1
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
a
j
o
g
mf
.
2
0
2
1
.
1
0
0
3
0
8
.
[
6
]
M
.
A
.
A
r
f
a
n
d
i
,
A
.
A
n
sari
a
d
i
,
R
.
A
m
i
r
u
d
d
i
n
,
W
.
W
a
h
i
d
u
d
d
i
n
,
A
.
U
.
S
a
l
m
a
h
,
a
n
d
A
.
S
a
l
a
m,
“
P
r
e
t
e
r
m
b
i
r
t
h
r
i
s
k
i
n
m
o
t
h
e
r
w
i
t
h
h
y
p
e
r
t
e
n
si
v
e
d
i
s
o
r
d
e
r
s
o
f
p
r
e
g
n
a
n
c
y
,”
I
n
t
e
rn
a
t
i
o
n
a
l
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
P
u
b
l
i
c
H
e
a
l
t
h
S
c
i
e
n
c
e
(
I
J
PH
S
)
,
v
o
l
.
1
2
,
n
o
.
2
,
p
p
.
5
9
0
–
5
9
7
,
2
0
2
3
,
d
o
i
:
1
0
.
1
1
5
9
1
/
i
j
p
h
s.
v
1
2
i
2
.
2
2
5
9
9
.
[
7
]
H
.
A
.
D
.
S
u
k
ma
a
n
d
S
.
Ti
w
a
r
i
,
“
R
i
sk
f
a
c
t
o
r
s
f
o
r
p
r
e
ma
t
u
r
e
b
i
r
t
h
i
n
I
n
d
o
n
e
s
i
a
,
”
J
u
rn
a
l
Bi
o
m
e
t
ri
k
a
d
a
n
K
e
p
e
n
d
u
d
u
k
a
n
(
J
o
u
r
n
a
l
o
f
Bi
o
m
e
t
r
i
c
s
a
n
d
P
o
p
u
l
a
t
i
o
n
)
,
v
o
l
.
9
,
n
o
.
1
,
p
p
.
7
7
–
9
0
,
2
0
2
1
,
d
o
i
:
1
0
.
2
3
8
8
8
/
h
mj
2
0
2
1
9
1
7
7
-
9
0
.
[
8
]
C
.
F
e
n
g
a
,
S
.
G
a
n
g
e
mi
,
V
.
D
i
S
a
l
v
a
t
o
r
e
,
L
.
F
a
l
z
o
n
e
,
a
n
d
M
.
L
i
b
r
a
,
“
I
mm
u
n
o
l
o
g
i
c
a
l
e
f
f
e
c
t
s
o
f
o
c
c
u
p
a
t
i
o
n
a
l
e
x
p
o
s
u
r
e
t
o
l
e
a
d
,
”
Mo
l
e
c
u
l
a
r
Me
d
i
c
i
n
e
R
e
p
o
rt
s
,
v
o
l
.
1
5
,
n
o
.
5
,
p
p
.
3
3
5
5
–
3
3
6
0
,
2
0
1
7
,
d
o
i
:
1
0
.
3
8
9
2
/
mm
r
.
2
0
1
7
.
6
3
8
1
.
[
9
]
S
.
K
.
M
u
n
r
o
,
B
.
B
a
l
a
k
r
i
s
h
n
a
n
,
A
.
C
.
L
i
ssam
a
n
,
P
.
G
u
j
r
a
l
,
a
n
d
A
.
P
.
P
o
n
n
a
m
p
a
l
a
m,
“
C
y
t
o
k
i
n
e
s
a
n
d
p
r
e
g
n
a
n
c
y
:
p
o
t
e
n
t
i
a
l
r
e
g
u
l
a
t
i
o
n
b
y
h
i
s
t
o
n
e
d
e
a
c
e
t
y
l
a
ses
,
”
M
o
l
e
c
u
l
a
r
Re
p
r
o
d
u
c
t
i
o
n
&
D
e
v
e
l
o
p
m
e
n
t
,
v
o
l
.
8
8
,
n
o
.
5
,
p
p
.
3
2
1
–
3
3
7
,
2
0
2
1
,
d
o
i
:
1
0
.
1
0
0
2
/
mr
d
.
2
3
4
3
0
.
[
1
0
]
J.
L
.
W
a
u
t
i
e
r
a
n
d
M
.
P
.
W
a
u
t
i
e
r
,
“
P
r
o
-
a
n
d
a
n
t
i
-
i
n
f
l
a
mm
a
t
o
r
y
p
r
o
s
t
a
g
l
a
n
d
i
n
s
a
n
d
c
y
t
o
k
i
n
e
s
i
n
h
u
m
a
n
s
:
a
mi
n
i
-
r
e
v
i
e
w
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
M
o
l
e
c
u
l
a
r
S
c
i
e
n
c
e
s
i
s
a
n
i
n
t
e
r
n
a
t
i
o
n
a
l
,
v
o
l
.
2
4
,
n
o
.
1
1
,
2
0
2
3
,
d
o
i
:
1
0
.
3
3
9
0
/
i
j
ms
2
4
1
1
9
6
4
7
.
[
1
1
]
E.
S
.
G
r
e
e
n
a
n
d
P
.
C
.
A
r
c
k
,
“
P
a
t
h
o
g
e
n
e
si
s
o
f
p
r
e
t
e
r
m
b
i
r
t
h
:
b
i
d
i
r
e
c
t
i
o
n
a
l
i
n
f
l
a
mm
a
t
i
o
n
i
n
m
o
t
h
e
r
a
n
d
f
e
t
u
s,”
S
e
m
i
n
a
rs
i
n
I
m
m
u
n
o
p
a
t
h
o
l
o
g
y
,
v
o
l
.
4
2
,
n
o
.
4
,
p
p
.
4
1
3
–
4
2
9
,
2
0
2
0
,
d
o
i
:
1
0
.
1
0
0
7
/
s
0
0
2
8
1
-
0
2
0
-
0
0
8
0
7
-
y.
[
1
2
]
P
.
A
s
h
r
a
p
e
t
a
l
.
,
“
M
a
t
e
r
n
a
l
b
l
o
o
d
me
t
a
l
a
n
d
m
e
t
a
l
l
o
i
d
c
o
n
c
e
n
t
r
a
t
i
o
n
s
i
n
a
ss
o
c
i
a
t
i
o
n
w
i
t
h
b
i
r
t
h
o
u
t
c
o
mes
i
n
N
o
r
t
h
e
r
n
P
u
e
r
t
o
R
i
c
o
,
”
En
v
i
r
o
n
m
e
n
t
I
n
t
e
r
n
a
t
i
o
n
a
l
,
v
o
l
.
1
3
8
,
n
o
.
D
e
c
e
m
b
e
r
2
0
1
9
,
p
.
1
0
5
6
0
6
,
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
e
n
v
i
n
t
.
2
0
2
0
.
1
0
5
6
0
6
.
[
1
3
]
Y
ı
l
d
ı
r
ı
m
e
t
a
l
.
,
“
I
s
t
h
e
c
o
n
c
e
n
t
r
a
t
i
o
n
o
f
c
a
d
m
i
u
m,
l
e
a
d
,
m
e
r
c
u
r
y
,
a
n
d
s
e
l
e
n
i
u
m
r
e
l
a
t
e
d
t
o
p
r
e
t
e
r
m
b
i
r
t
h
?
,
”
Bi
o
l
o
g
i
c
a
l
T
ra
c
e
El
e
m
e
n
t
R
e
se
a
rc
h
,
v
o
l
.
1
9
1
,
p
p
.
3
0
6
–
3
1
2
,
2
0
1
9
,
d
o
i
:
1
0
.
1
0
0
7
/
s
1
2
0
1
1
-
018
-
1
6
2
5
-
2
I
s.
[
1
4
]
J.
L
i
e
t
a
l
.
,
“
M
a
t
e
r
n
a
l
ser
u
m
l
e
a
d
l
e
v
e
l
d
u
r
i
n
g
p
r
e
g
n
a
n
c
y
i
s
p
o
s
i
t
i
v
e
l
y
c
o
r
r
e
l
a
t
e
d
w
i
t
h
r
i
s
k
o
f
p
r
e
t
e
r
m
b
i
r
t
h
i
n
a
C
h
i
n
e
s
e
p
o
p
u
l
a
t
i
o
n
,
”
E
n
v
i
ro
n
m
e
n
t
a
l
P
o
l
l
u
t
i
o
n
,
v
o
l
.
2
2
7
,
p
p
.
4
8
4
–
4
8
9
,
2
0
1
7
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
e
n
v
p
o
l
.
2
0
1
7
.
0
5
.
0
0
9
.
[
1
5
]
L.
C
h
e
n
g
e
t
a
l
.
,
“
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
H
y
g
i
e
n
e
a
n
d
F
e
t
a
l
e
x
p
o
s
u
r
e
t
o
l
e
a
d
d
u
r
i
n
g
p
r
e
g
n
a
n
c
y
a
n
d
t
h
e
r
i
s
k
o
f
p
r
e
t
e
r
m
a
n
d
e
a
r
l
y
-
t
e
r
m
d
e
l
i
v
e
r
i
e
s,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
H
y
g
i
e
n
e
a
n
d
En
v
i
r
o
n
m
e
n
t
a
l
H
e
a
l
t
h
,
v
o
l
.
2
2
0
,
n
o
.
6
,
p
p
.
9
8
4
–
9
8
9
,
2
0
1
7
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
i
j
h
e
h
.
2
0
1
7
.
0
5
.
0
0
6
.
[
1
6
]
Z.
S
a
l
e
h
i
,
T
.
Ja
h
e
d
,
S
.
S
a
e
d
i
,
a
n
d
Z.
N
a
i
i
j
i
,
“
T
h
e
a
ss
o
c
i
a
t
i
o
n
o
f
ser
u
m
l
e
a
d
c
o
n
c
e
n
t
r
a
t
i
o
n
i
n
p
r
e
g
n
a
n
t
w
o
me
n
a
n
d
r
i
s
k
f
o
r
p
r
e
t
e
r
m
d
e
l
i
v
e
r
y
,
”
J
o
u
r
n
a
l
o
f
G
y
n
e
c
o
l
o
g
y
a
n
d
W
o
m
e
n
'
s
H
e
a
l
t
h
,
v
o
l
.
2
2
,
n
o
.
4
,
p
.
5
5
6
0
9
3
,
2
0
2
1
,
d
o
i
:
D
O
I
:
1
0
.
1
9
0
8
0
/
JG
W
H
.
2
0
2
1
.
2
2
.
5
5
6
0
9
3
.
[
1
7
]
C
.
J
.
F
r
e
d
e
r
i
c
k
s
o
n
e
t
a
l
.
,
“
S
i
n
g
l
e
h
a
i
r
a
n
a
l
y
s
i
s
b
y
X
-
r
a
y
f
l
u
o
r
e
s
c
e
n
c
e
s
p
e
c
t
r
o
m
e
t
r
y
d
e
t
e
c
t
s
s
m
a
l
l
c
h
a
n
g
e
s
i
n
d
i
e
t
a
r
y
z
i
n
c
i
n
t
a
k
e
:
a
n
e
s
t
e
d
r
a
n
d
o
m
i
z
e
d
c
o
n
t
r
o
l
l
e
d
t
r
i
a
l
,”
F
r
o
n
t
i
e
r
s
i
n
N
u
t
r
i
t
i
o
n
,
v
o
l
.
1
0
,
p
.
1
1
3
9
0
1
7
,
2
0
2
3
,
d
o
i
:
1
0
.
3
3
8
9
/
f
n
u
t
.
2
0
2
3
.
1
1
3
9
0
1
7
.
[
1
8
]
T.
Y
a
n
g
,
X
.
F
a
n
,
a
n
d
J
.
Zh
o
u
,
“
T
o
t
a
l
r
e
f
l
e
c
t
i
o
n
X
-
R
a
y
f
l
u
o
r
e
s
c
e
n
c
e
s
p
e
c
t
r
o
sc
o
p
y
,
”
O
p
e
n
A
c
c
e
ss
L
i
b
r
a
r
y
J
o
u
r
n
a
l
,
v
o
l
.
0
7
,
n
o
.
0
8
,
p
p
.
1
–
1
2
,
2
0
2
0
,
d
o
i
:
1
0
.
4
2
3
6
/
o
a
l
i
b
.
1
1
0
6
6
7
1
.
[
1
9
]
E.
M
e
t
r
y
k
a
e
t
a
l
.
,
“
Le
a
d
(
P
b
)
e
x
p
o
s
u
r
e
e
n
h
a
n
c
e
s
e
x
p
r
e
ss
i
o
n
o
f
f
a
c
t
o
r
s
a
ss
o
c
i
a
t
e
d
w
i
t
h
i
n
f
l
a
mm
a
t
i
o
n
,
”
I
n
t
e
rn
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
Mo
l
e
c
u
l
a
r
S
c
i
e
n
c
e
s
,
v
o
l
.
1
9
,
n
o
.
6
,
p
.
1
8
1
3
,
2
0
1
8
.
[
2
0
]
T.
G
o
y
a
l
,
P
.
M
i
t
r
a
,
P
.
S
i
n
g
h
,
S
.
S
h
a
r
ma,
P
.
P
u
r
o
h
i
t
,
a
n
d
P
.
S
h
a
r
ma
,
“
Ef
f
e
c
t
o
f
o
c
c
u
p
a
t
i
o
n
a
l
c
o
-
e
x
p
o
s
u
r
e
t
o
l
e
a
d
a
n
d
c
a
d
mi
u
m
o
n
sel
e
c
t
e
d
i
mm
u
n
o
mo
d
u
l
a
t
o
r
y
c
y
t
o
k
i
n
e
s,
”
T
o
x
i
c
o
l
o
g
y
a
n
d
I
n
d
u
s
t
ri
a
l
H
e
a
l
t
h
,
v
o
l
.
3
8
,
n
o
.
1
,
p
p
.
1
–
1
0
,
2
0
2
2
,
d
o
i
:
1
0
.
1
1
7
7
/
0
7
4
8
2
3
3
7
2
1
1
0
1
9
1
7
2
.
[
2
1
]
N
.
Y
.
A
.
H
e
m
d
a
n
e
t
a
l
.
,
“
D
o
s
e
-
d
e
p
e
n
d
e
n
t
m
o
d
u
l
a
t
i
o
n
o
f
t
h
e
i
n
v
i
t
r
o
c
y
t
o
k
i
n
e
p
r
o
d
u
c
t
i
o
n
o
f
h
u
ma
n
i
mm
u
n
e
c
o
mp
e
t
e
n
t
c
e
l
l
s
by
Le
a
d
S
a
l
t
s
,
”
T
o
x
i
c
o
l
o
g
i
c
a
l
S
c
i
e
n
c
e
s
,
v
o
l
.
8
6
,
n
o
.
1
,
p
p
.
7
5
–
8
3
,
2
0
0
5
,
d
o
i
:
1
0
.
1
0
9
3
/
t
o
x
sc
i
/
k
f
i
1
7
7
.
[
2
2
]
Z.
K
r
o
c
o
v
a
,
A
.
M
a
c
e
l
a
,
M
.
K
r
o
c
a
,
a
n
d
L.
H
e
r
n
y
c
h
o
v
a
,
“
T
h
e
i
mm
u
n
o
mo
d
u
l
a
t
o
r
y
e
f
f
e
c
t
(
s)
o
f
l
e
a
d
a
n
d
c
a
d
m
i
u
m
o
n
t
h
e
c
e
l
l
s
o
f
i
mm
u
n
e
s
y
st
e
m i
n
v
i
t
r
o
,
”
T
o
x
i
c
o
l
o
g
y
i
n
Vi
t
ro
,
v
o
l
.
1
4
,
p
p
.
3
3
–
4
0
,
2
0
0
0
,
d
o
i
:
1
0
.
1
0
1
6
/
s0
8
8
7
-
2
3
3
3
(
9
9
)
0
0
0
8
9
-
2.
[
2
3
]
A
.
M
a
c
h
o
ń
-
G
r
e
c
k
a
,
M
.
D
o
b
r
a
k
o
w
sk
i
,
A
.
K
a
s
p
e
r
c
z
y
k
,
E.
B
i
r
k
n
e
r
,
T.
P
r
y
z
w
a
n
,
a
n
d
S
.
K
a
s
p
e
r
c
z
y
k
,
“
T
h
e
e
f
f
e
c
t
o
f
s
u
b
a
c
u
t
e
l
e
a
d
e
x
p
o
s
u
r
e
o
n
se
l
e
c
t
e
d
b
l
o
o
d
i
n
f
l
a
mm
a
t
o
r
y
b
i
o
mar
k
e
r
s
a
n
d
a
n
g
i
o
g
e
n
e
t
i
c
f
a
c
t
o
r
s
,
”
J
o
u
r
n
a
l
o
f
O
c
c
u
p
a
t
i
o
n
a
l
H
e
a
l
t
h
,
v
o
l
.
6
0
,
n
o
.
5
,
p
p
.
3
6
9
–
3
7
5
,
2
0
1
8
,
d
o
i
:
1
0
.
1
5
3
9
/
j
o
h
.
2
0
1
7
-
0
3
0
7
-
OA.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
13
,
No
.
4
,
Dec
em
b
er
20
24
:
1
8
2
6
-
1
8
3
3
1832
[
2
4
]
T.
A
.
M
u
l
y
a
t
i
a
n
d
F
.
E.
P
u
j
i
o
n
o
,
“
Th
e
e
x
p
o
s
u
r
e
o
f
P
b
t
o
h
a
i
r
a
n
d
n
a
i
l
s
i
n
c
h
i
l
d
r
e
n
a
r
o
u
n
d
“
X
”
c
o
a
l
m
i
n
e
s u
s
i
n
g
a
t
o
mi
c
a
b
s
o
r
p
t
i
o
n
sp
e
c
t
o
sc
o
p
y
(AAS)
m
e
t
h
o
d
,
”
J
u
r
n
a
l
K
e
se
h
a
t
a
n
L
i
n
g
k
u
n
g
a
n
(
J
o
u
r
n
a
l
o
f
En
v
i
r
o
n
m
e
n
t
a
l
H
e
a
l
t
h
)
,
v
o
l
.
1
3
,
n
o
.
3
,
p
p
.
1
7
4
–
1
7
9
,
2
0
2
1
,
d
o
i
:
1
0
.
2
0
4
7
3
/
j
k
l
.
v
1
3
i
3
.
2
0
2
1
.
1
7
4
-
1
7
9
.
[
2
5
]
S
.
S
.
M
a
r
i
sa,
“
D
e
scri
p
t
i
o
n
o
f
l
e
v
e
l
s
o
f
l
e
a
d
(
P
b
)
i
n
h
a
i
r
o
f
m
o
t
o
r
c
y
c
l
e
w
o
r
k
s
h
o
p
w
o
r
k
e
r
s
(
M
e
c
h
a
n
i
c
a
l
)
i
n
P
a
d
a
n
g
C
i
t
y
,
”
S
a
i
n
s
t
e
k
:
J
u
r
n
a
l
S
a
i
n
s
d
a
n
T
e
k
n
o
l
o
g
i
,
v
o
l
.
1
4
,
n
o
.
2
,
p
p
.
8
9
–
9
3
,
2
0
2
2
,
d
o
i
:
1
0
.
3
1
9
5
8
/
j
s.v
1
4
i
2
.
4
9
7
8
.
[
2
6
]
M
.
R
e
n
e
t
a
l
.
,
“
A
ss
o
c
i
a
t
i
o
n
s
b
e
t
w
e
e
n
h
a
i
r
l
e
v
e
l
s
o
f
t
r
a
c
e
e
l
e
me
n
t
s
a
n
d
t
h
e
r
i
sk
o
f
p
r
e
t
e
r
m
b
i
r
t
h
a
mo
n
g
p
r
e
g
n
a
n
t
w
o
me
n
:
A
p
r
o
s
p
e
c
t
i
v
e
n
e
s
t
e
d
c
a
s
e
-
c
o
n
t
r
o
l
s
t
u
d
y
i
n
B
e
i
j
i
n
g
B
i
r
t
h
C
o
h
o
r
t
(
B
B
C
)
,
C
h
i
n
a
,
”
En
v
i
r
o
n
m
e
n
t
I
n
t
e
r
n
a
t
i
o
n
a
l
,
v
o
l
.
1
5
8
,
2
0
2
2
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
e
n
v
i
n
t
.
2
0
2
1
.
1
0
6
9
6
5
R
e
c
e
i
v
e
d
.
[
2
7
]
M
.
T
su
j
i
,
E.
S
h
i
b
a
t
a
,
S
.
M
o
r
o
k
u
ma,
R
.
T
a
n
a
k
a
,
A
.
S
e
n
j
u
,
a
n
d
S
.
A
r
a
k
i
,
“
Th
e
a
ss
o
c
i
a
t
i
o
n
b
e
t
w
e
e
n
w
h
o
l
e
b
l
o
o
d
c
o
n
c
e
n
t
r
a
t
i
o
n
s
o
f
h
e
a
v
y
m
e
t
a
l
s
i
n
p
r
e
g
n
a
n
t
w
o
me
n
a
n
d
p
r
e
ma
t
u
r
e
b
i
r
t
h
s
:
T
h
e
Ja
p
a
n
e
n
v
i
r
o
n
m
e
n
t
a
n
d
c
h
i
l
d
r
e
n
’
s
s
t
u
d
y
(
JE
C
S
)
,
”
E
n
v
i
ro
n
m
e
n
t
a
l
Re
se
a
rc
h
,
v
o
l
.
1
6
6
,
n
o
.
M
a
y
,
p
p
.
5
6
2
–
5
6
9
,
2
0
1
8
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
e
n
v
r
e
s
.
2
0
1
8
.
0
6
.
0
2
5
.
[
2
8
]
S
.
S
.
K
i
m
e
t
a
l
.
,
“
U
r
i
n
a
r
y
t
r
a
c
e
me
t
a
l
s
i
n
d
i
v
i
d
u
a
l
l
y
a
n
d
i
n
m
i
x
t
u
r
e
s
i
n
a
sso
c
i
a
t
i
o
n
w
i
t
h
p
r
e
t
e
r
m
b
i
r
t
h
,
”
E
n
v
i
ro
n
m
e
n
t
I
n
t
e
r
n
a
t
i
o
n
a
,
v
o
l
.
1
2
1
,
n
o
.
O
c
t
o
b
e
r
,
p
p
.
5
8
2
–
5
9
0
,
2
0
1
8
.
[
2
9
]
R
.
I
r
w
i
n
d
a
,
N
.
W
i
b
o
w
o
,
a
n
d
A
.
S
.
P
u
t
r
i
,
“
T
h
e
c
o
n
c
e
n
t
r
a
t
i
o
n
o
f
m
i
c
r
o
n
u
t
r
i
e
n
t
s
a
n
d
h
e
a
v
y
m
e
t
a
l
s
i
n
ma
t
e
r
n
a
l
ser
u
m,
p
l
a
c
e
n
t
a
,
a
n
d
c
o
r
d
b
l
o
o
d
:
a
c
r
o
ss
-
se
c
t
i
o
n
a
l
s
t
u
d
y
i
n
p
r
e
t
e
r
m
b
i
r
t
h
,
”
J
o
u
r
n
a
l
o
f
Pr
e
g
n
a
n
c
y
,
v
o
l
.
2
0
1
9
,
2
0
1
9
,
d
o
i
:
1
0
.
1
1
5
5
/
2
0
1
9
/
5
0
6
2
3
6
5
.
[
3
0
]
M
.
P
a
n
d
e
y
,
M
.
C
h
a
u
h
a
n
,
a
n
d
S
.
A
w
a
st
h
i
,
“
I
n
t
e
r
p
l
a
y
o
f
C
y
t
o
k
i
n
e
s
i
n
P
r
e
t
e
r
m
B
i
r
t
h
,
”
I
n
d
i
a
n
J
o
u
r
n
a
l
o
f
Me
d
i
c
a
l
R
e
se
a
rc
h
,
v
o
l
.
1
4
6
,
n
o
.
1
1
,
p
p
.
3
1
6
–
3
2
7
,
2
0
1
7
,
d
o
i
:
1
0
.
4
1
0
3
/
i
j
mr
.
I
JM
R
.
[
3
1
]
E.
P
r
a
i
r
i
e
e
t
a
l
.
,
“
T
h
e
d
e
t
e
r
m
i
n
a
n
t
r
o
l
e
o
f
I
L
-
6
i
n
t
h
e
e
st
a
b
l
i
s
h
me
n
t
o
f
i
n
f
l
a
mm
a
t
i
o
n
l
e
a
d
i
n
g
t
o
s
p
o
n
t
a
n
e
o
u
s
p
r
e
t
e
r
m
b
i
r
t
h
,
”
C
y
t
o
k
i
n
e
& G
ro
w
t
h
Fa
c
t
o
r
Re
v
i
e
w
s
,
v
o
l
.
5
9
,
n
o
.
N
o
v
e
m
b
e
r
2
0
2
0
,
p
p
.
1
1
8
–
1
3
0
,
2
0
2
1
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
c
y
t
o
g
f
r
.
2
0
2
0
.
1
2
.
0
0
4
.
[
3
2
]
M
.
M
u
r
a
k
a
mi
,
D
.
K
a
mi
m
u
r
a
,
a
n
d
T.
H
i
r
a
n
o
,
“
P
l
e
i
o
t
r
o
p
y
a
n
d
S
p
e
c
i
f
i
c
i
t
y
:
I
n
si
g
h
t
s
f
r
o
m
t
h
e
I
n
t
e
r
l
e
u
k
i
n
6
F
a
m
i
l
y
o
f
C
y
t
o
k
i
n
e
s,
”
I
m
m
u
n
i
t
y
,
v
o
l
.
5
0
,
n
o
.
4
,
p
p
.
8
1
2
–
8
3
1
,
2
0
1
9
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
i
m
mu
n
i
.
2
0
1
9
.
0
3
.
0
2
7
.
[
3
3
]
W
.
Li
,
X
.
Zh
a
o
,
S
.
Li
,
X
.
C
h
e
n
,
H
.
C
u
i
,
a
n
d
Y
.
C
h
a
n
g
,
“
U
p
r
e
g
u
l
a
t
i
o
n
o
f
TN
F
-
α
a
n
d
I
L
-
6
i
n
d
u
c
e
s
p
r
e
t
e
r
m
p
r
e
mat
u
r
e
r
u
p
t
u
r
e
o
f
memb
r
a
n
e
s
b
y
a
c
t
i
v
a
t
i
o
n
o
f
A
D
A
M
T
S
-
9
i
n
e
m
b
r
y
o
n
i
c
m
e
m
b
r
a
n
e
c
e
l
l
s,”
L
i
f
e
S
c
i
e
n
c
e
s
,
v
o
l
.
2
6
0
,
n
o
.
2
8
0
,
p
.
1
1
8
2
3
7
,
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
l
f
s.
2
0
2
0
.
1
1
8
2
3
7
.
[
3
4
]
A
.
N
.
F
a
d
h
i
l
a
,
B
.
A
.
P
r
a
m
o
n
o
,
a
n
d
M
.
M
u
n
i
r
o
h
,
“
M
e
r
c
u
r
y
a
n
d
c
a
d
m
i
u
m
-
i
n
d
u
c
e
d
i
n
f
l
a
m
ma
t
o
r
y
c
y
t
o
k
i
n
e
s
a
c
t
i
v
a
t
i
o
n
a
n
d
i
t
s
e
f
f
e
c
t
o
n
t
h
e
r
i
s
k
o
f
p
r
e
e
c
l
a
m
p
s
i
a
:
a
r
e
v
i
e
w
,
”
Re
v
i
e
w
s
o
n
E
n
v
i
ro
n
m
e
n
t
a
l
H
e
a
l
t
h
,
v
o
l
.
N
o
v
e
mb
e
r
,
p
p
.
1
–
1
0
,
2
0
2
3
,
d
o
i
:
d
o
i
:
1
0
.
1
5
1
5
/
r
e
v
e
h
-
2
0
2
3
-
0
0
8
3
.
[
3
5
]
K
.
B
.
L
e
i
m
e
r
t
,
W
.
X
u
,
M
.
M
.
P
r
i
n
c
,
S
.
C
h
e
m
t
o
b
,
a
n
d
D
.
M
.
O
l
s
o
n
,
“
I
n
f
l
a
mm
a
t
o
r
y
a
m
p
l
i
f
i
c
a
t
i
o
n
:
a
c
e
n
t
r
a
l
t
e
n
e
t
o
f
u
t
e
r
i
n
e
t
r
a
n
s
i
t
i
o
n
f
o
r
l
a
b
o
r
,
”
Fr
o
n
t
i
e
rs
i
n
C
e
l
l
u
l
a
r
a
n
d
I
n
f
e
c
t
i
o
n
M
i
c
r
o
b
i
o
l
o
g
y
,
v
o
l
.
1
1
,
n
o
.
A
u
g
u
s
t
,
p
p
.
1
–
1
9
,
2
0
2
1
,
d
o
i
:
1
0
.
3
3
8
9
/
f
c
i
mb
.
2
0
2
1
.
6
6
0
9
8
3
.
[
3
6
]
M
.
W
.
S
o
c
h
a
,
W
.
F
l
i
s
,
M
.
P
i
e
t
r
u
s,
M
.
W
a
r
t
e
g
a
,
a
n
d
M
.
S
t
a
n
k
i
e
w
i
c
z
,
“
S
i
g
n
a
l
i
n
g
p
a
t
h
w
a
y
s
r
e
g
u
l
a
t
i
n
g
h
u
m
a
n
c
e
r
v
i
c
a
l
r
i
p
e
n
i
n
g
i
n
p
r
e
t
e
r
m a
n
d
t
e
r
m
d
e
l
i
v
e
r
y
,
”
C
e
l
l
s
,
v
o
l
.
1
1
,
n
o
.
3
9
6
0
,
p
p
.
1
–
2
5
,
2
0
2
2
,
d
o
i
:
1
0
.
3
3
9
0
/
c
e
l
l
s
1
1
2
2
3
6
9
0
.
[
3
7
]
B
.
T
a
r
a
si
,
J.
C
o
r
n
u
z
,
C
.
C
l
a
i
r
,
a
n
d
D
.
B
a
u
d
,
“
C
i
g
a
r
e
t
t
e
sm
o
k
i
n
g
d
u
r
i
n
g
p
r
e
g
n
a
n
c
y
a
n
d
a
d
v
e
r
s
e
p
e
r
i
n
a
t
a
l
o
u
t
c
o
mes
:
a
c
r
o
ss
-
sec
t
i
o
n
a
l
s
t
u
d
y
o
v
e
r
1
0
y
e
a
r
s,
”
B
MC
Pu
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
2
2
,
n
o
.
1
,
p
p
.
1
–
8
,
2
0
2
2
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
2
8
8
9
-
0
2
2
-
1
4
8
8
1
-
4.
[
3
8
]
N
.
N
.
R
a
n
g
,
T.
Q
.
H
i
e
n
,
T
.
Q
.
C
h
a
n
h
,
a
n
d
T
.
K
.
T
h
u
y
e
n
,
“
P
r
e
t
e
r
m
b
i
r
t
h
a
n
d
se
c
o
n
d
h
a
n
d
sm
o
k
i
n
g
d
u
r
i
n
g
p
r
e
g
n
a
n
c
y
:
a
c
a
se
-
c
o
n
t
r
o
l
st
u
d
y
f
r
o
m V
i
e
t
n
a
m
,
”
PLo
S
O
n
e
,
v
o
l
.
1
5
,
n
o
.
O
c
t
o
b
e
r
,
p
p
.
1
–
8
,
2
0
2
0
,
d
o
i
:
1
0
.
1
3
7
1
/
j
o
u
r
n
a
l
.
p
o
n
e
.
0
2
4
0
2
8
9
.
[
3
9
]
L.
Li
n
e
t
a
l
.
,
“
P
r
e
v
a
l
e
n
c
e
,
r
i
s
k
f
a
c
t
o
r
s
a
n
d
a
sso
c
i
a
t
e
d
a
d
v
e
r
se
p
r
e
g
n
a
n
c
y
o
u
t
c
o
mes
o
f
a
n
a
e
m
i
a
i
n
c
h
i
n
e
se
p
r
e
g
n
a
n
t
w
o
m
e
n
:
a
mu
l
t
i
c
e
n
t
r
e
r
e
t
r
o
s
p
e
c
t
i
v
e
st
u
d
y
,”
BM
C
Pr
e
g
n
a
n
c
y
C
h
i
l
d
b
i
r
t
h
,
v
o
l
.
1
1
1
,
p
p
.
1
–
8
,
2
0
1
8
,
d
o
i
:
1
0
.
1
1
8
6
/
s1
2
8
8
4
-
0
1
8
-
1
7
3
9
-
8.
[
4
0
]
H
.
S
h
i
e
t
a
l
.
,
“
S
e
v
e
r
i
t
y
o
f
a
n
e
m
i
a
d
u
r
i
n
g
p
r
e
g
n
a
n
c
y
a
n
d
a
d
v
e
r
s
e
ma
t
e
r
n
a
l
a
n
d
f
e
t
a
l
o
u
t
c
o
mes
,”
J
AM
A
N
e
t
w
o
r
k
O
p
e
n
,
v
o
l
.
5
,
n
o
.
2
,
p
p
.
1
–
1
3
,
2
0
2
2
,
d
o
i
:
1
0
.
1
0
0
1
/
j
a
ma
n
e
t
w
o
r
k
o
p
e
n
.
2
0
2
1
.
4
7
0
4
6
.
B
I
O
G
RAP
H
I
E
S O
F
AUTH
O
RS
Q
o
n
ita
Nur
Q
o
lb
y
is
a
g
e
n
e
ra
l
p
ra
c
ti
ti
o
n
e
r
m
e
d
ica
l
d
o
c
to
r.
S
h
e
is
a
stu
d
e
n
t
in
M
a
ste
r
P
ro
g
ra
m
o
f
Bio
m
e
d
ica
l
S
c
ien
c
e
,
F
a
c
u
lt
y
o
f
M
e
d
ici
n
e
,
Un
iv
e
rsitas
Dip
o
n
e
g
o
r
o
,
In
d
o
n
e
sia
.
He
r
re
se
a
rc
h
in
tere
st
s
a
re
p
a
th
o
b
io
lo
g
y
,
to
x
ico
l
o
g
y
,
m
a
tern
a
l
h
e
a
lt
h
,
p
h
y
si
o
l
o
g
y
,
a
n
d
sp
o
rt
m
e
d
ici
n
e
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
q
o
n
it
a
n
u
r
q
o
l
b
y
@g
m
a
il
.
c
o
m
.
J
u
li
a
n
De
wa
n
ti
n
in
g
r
u
m
i
s
a
n
o
b
ste
tri
c
ian
a
n
d
g
y
n
e
c
o
lo
g
ist,
M
a
tern
a
l
F
e
tal
M
e
d
icin
e
.
S
h
e
is
a
lec
tu
re
r
i
n
M
e
d
ica
l
Do
c
t
o
r,
F
a
c
u
lt
y
o
f
M
e
d
icin
e
,
U
n
iv
e
rsitas
Dip
o
n
e
g
o
r
o
,
I
n
d
o
n
e
sia
.
S
h
e
h
a
s
c
o
m
p
lete
d
D
o
c
to
ra
l
P
ro
g
ra
m
o
f
Bio
m
e
d
ica
l
S
c
ien
c
e
,
F
a
c
u
lt
y
of
M
e
d
icin
e
,
Un
i
v
e
rsitas
Dip
o
n
e
g
o
ro
.
He
r
re
se
a
rc
h
in
tere
st
s
a
re
m
icro
n
u
tri
ti
o
n
i
n
p
re
g
n
a
n
c
y
a
n
d
fe
tal
g
r
o
wth
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
jd
e
wa
n
ti
n
i
n
g
r
u
m
@fk
.
u
n
d
ip
.
a
c
.
id
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Ma
tern
a
l h
a
ir
lea
d
a
n
d
cy
to
ki
n
e
p
r
o
-
in
fla
mma
to
r
y
effec
ts
in
p
r
eterm
b
ir
th
(
Qo
n
ita
N
u
r
Qo
lb
y
)
1833
Be
sa
r
i
Adi
Pra
m
o
n
o
is
a
n
o
b
ste
tri
c
ian
a
n
d
g
y
n
e
c
o
l
o
g
ist
,
m
a
tern
a
l
fe
tal
m
e
d
icin
e
.
He
a
d
o
f
th
e
Ob
ste
tri
c
s
a
n
d
G
y
n
e
c
o
lo
g
y
S
tu
d
y
P
r
o
g
ra
m
,
F
a
c
u
lt
y
o
f
M
e
d
icin
e
,
Un
iv
e
rsitas
Dip
o
n
e
g
o
r
o
,
In
d
o
n
e
sia
.
His
re
s
e
a
rc
h
in
tere
st
in
to
x
ico
l
o
g
y
n
u
tri
ti
o
n
i
n
p
re
g
n
a
n
c
y
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
b
e
sa
riad
i@fk
.
u
n
d
ip
.
a
c
.
id
.
Na
n
i
Ma
h
a
r
a
n
i
is
a
m
e
d
ica
l
d
o
c
to
r
a
n
d
As
sista
n
t
P
r
o
fe
ss
o
r
i
n
De
p
a
rtem
e
n
t
o
f
P
h
a
rm
a
c
o
lo
g
y
a
n
d
Th
e
ra
p
y
,
F
a
c
u
lt
y
o
f
M
e
d
icin
e
,
Un
i
v
e
rsitas
Di
p
o
n
e
g
o
r
o
,
In
d
o
n
e
sia
.
He
r
re
se
a
rc
h
in
tere
sts
a
re
c
a
rd
io
v
a
sc
u
lar,
p
h
a
rm
a
c
lo
g
y
,
g
e
n
e
ti
c
s,
a
n
d
m
o
lec
u
lar
b
io
l
o
g
y
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
m
a
h
a
ra
n
i.
n
a
n
i@fk
.
u
n
d
i
p
.
a
c
.
id
.
Ek
a
Dja
tn
i
k
a
Nu
g
r
a
h
a
is
a
S
e
n
io
r
Re
se
a
rc
h
e
r
a
t
th
e
Re
s
e
a
rc
h
Ce
n
ter
fo
r
S
a
fe
ty
,
M
e
tr
o
l
o
g
y
,
a
n
d
N
u
c
lea
r
Tec
h
n
o
lo
g
y
,
T
h
e
Na
ti
o
n
a
l
R
e
se
a
rc
h
a
n
d
In
n
o
v
a
ti
o
n
Ag
e
n
c
y
o
f
I
n
d
o
n
e
sia
(BRIN),
In
d
o
n
e
sia
.
Do
c
t
o
r
o
f
Ra
d
iat
io
n
S
c
ien
c
e
.
His
re
se
a
rc
h
in
tere
sts
in
Ra
d
io
e
c
o
l
o
g
y
,
Ra
d
o
n
/
Th
o
r
o
n
,
En
v
ir
o
n
m
e
n
tal
Ra
d
io
a
c
ti
v
it
y
,
Do
se
As
se
ss
m
e
n
ts,
Ra
d
iatio
n
P
r
o
tec
ti
o
n
,
a
n
d
Ra
d
io
c
h
e
m
istry
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
e
k
a
d
0
0
1
@b
r
in
.
g
o
.
id
.
Mu
fli
h
a
tu
l
Mu
n
iro
h
is
a
m
e
d
ica
l
d
o
c
to
r
a
n
d
As
so
c
iat
e
P
ro
fe
ss
o
r
i
n
De
p
a
rtme
n
t
o
f
P
h
y
si
o
l
o
g
y
,
F
a
c
u
lt
y
o
f
M
e
d
icin
e
,
U
n
iv
e
rsitas
Di
p
o
n
e
g
o
r
o
I
n
d
o
n
e
sia
.
He
r
re
se
a
rc
h
in
tere
sts
in
To
x
ico
l
o
g
y
,
M
o
lec
u
lar
&
G
e
n
e
ti
c
Ep
id
e
m
io
lo
g
y
,
Ca
n
c
e
r
G
e
n
e
ti
c
s,
a
n
d
P
h
y
si
o
lo
g
y
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
m
u
fli
h
a
t
u
l.
m
u
n
iro
h
@fk
.
u
n
d
ip
.
a
c
.
id
.
Evaluation Warning : The document was created with Spire.PDF for Python.