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1.
Nat Chem Biol ; 15(10): 1017-1024, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31527836

RESUMEN

Small-scale production of biologics has great potential for enhancing the accessibility of biomanufacturing. By exploiting cell-material feedback, we have designed a concise platform to achieve versatile production, analysis and purification of diverse proteins and protein complexes. The core of our technology is a microbial swarmbot, which consists of a stimulus-sensitive polymeric microcapsule encapsulating engineered bacteria. By sensing the confinement, the bacteria undergo programmed partial lysis at a high local density. Conversely, the encapsulating material shrinks responding to the changing chemical environment caused by cell growth, squeezing out the protein products released by bacterial lysis. This platform is then integrated with downstream modules to enable quantification of enzymatic kinetics, purification of diverse proteins, quantitative control of protein interactions and assembly of functional protein complexes and multienzyme metabolic pathways. Our work demonstrates the use of the cell-material feedback to engineer a modular and flexible platform with sophisticated yet well-defined programmed functions.


Asunto(s)
Proteínas Bacterianas/metabolismo , Bioingeniería , Escherichia coli/metabolismo , Proteínas Bacterianas/genética , Reactores Biológicos , Regulación de la Expresión Génica , Ingeniería Genética , Plásmidos
2.
Proc Natl Acad Sci U S A ; 115(16): 4069-4074, 2018 04 17.
Artículo en Inglés | MEDLINE | ID: mdl-29610312

RESUMEN

It is widely acknowledged that faster-growing bacteria are killed faster by ß-lactam antibiotics. This notion serves as the foundation for the concept of bacterial persistence: dormant bacterial cells that do not grow are phenotypically tolerant against ß-lactam treatment. Such correlation has often been invoked in the mathematical modeling of bacterial responses to antibiotics. Due to the lack of thorough quantification, however, it is unclear whether and to what extent the bacterial growth rate can predict the lysis rate upon ß-lactam treatment under diverse conditions. Enabled by experimental automation, here we measured >1,000 growth/killing curves for eight combinations of antibiotics and bacterial species and strains, including clinical isolates of bacterial pathogens. We found that the lysis rate of a bacterial population linearly depends on the instantaneous growth rate of the population, regardless of how the latter is modulated. We further demonstrate that this predictive power at the population level can be explained by accounting for bacterial responses to the antibiotic treatment by single cells. This linear dependence of the lysis rate on the growth rate represents a dynamic signature associated with each bacterium-antibiotic pair and serves as the quantitative foundation for designing combination antibiotic therapy and predicting the population-structure change in a population with mixed phenotypes.


Asunto(s)
Antibacterianos/farmacología , Bacteriólisis/efectos de los fármacos , Carbenicilina/farmacología , Escherichia coli/efectos de los fármacos , Carga Bacteriana , Biomasa , Medios de Cultivo/farmacología , Escherichia coli/crecimiento & desarrollo , Ensayos Analíticos de Alto Rendimiento/instrumentación , Cinética , Nefelometría y Turbidimetría , Robótica , Temperatura
3.
Nat Chem Biol ; 11(3): 182-8, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25689336

RESUMEN

Bacteria have developed resistance against every antibiotic at a rate that is alarming considering the timescale at which new antibiotics are developed. Thus, there is a critical need to use antibiotics more effectively, extend the shelf life of existing antibiotics and minimize their side effects. This requires understanding the mechanisms underlying bacterial drug responses. Past studies have focused on survival in the presence of antibiotics by individual cells, as genetic mutants or persisters. Also important, however, is the fact that a population of bacterial cells can collectively survive antibiotic treatments lethal to individual cells. This tolerance can arise by diverse mechanisms, including resistance-conferring enzyme production, titration-mediated bistable growth inhibition, swarming and interpopulation interactions. These strategies can enable rapid population recovery after antibiotic treatment and provide a time window during which otherwise susceptible bacteria can acquire inheritable genetic resistance. Here, we emphasize the potential for targeting collective antibiotic tolerance behaviors as an antibacterial treatment strategy.


Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana/fisiología , Animales , Antibacterianos/uso terapéutico , Bacterias/efectos de los fármacos , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Farmacorresistencia Bacteriana/efectos de los fármacos , Humanos
4.
Exp Cell Res ; 319(6): 850-9, 2013 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-23237990

RESUMEN

BACKGROUND: Esophageal fibrosis is a complication of eosinophilic esophagitis (EoE) which has been attributed to both subepithelial fibrosis and to epithelial to mesenchymal transition (EMT), a process by which epithelial cells acquire mesenchymal features. Common to both causes of EoE-fibrosis is the notion that granulocyte-derived TGF-ß, induces myofibroblast differentiation of the target cell. To date, the role of esophageal epithelial cells as effector cells in esophageal fibrosis has never been explored. Herein, we investigated consequences of cross-talk between esophageal epithelial cells and fibroblasts, and identified profibrotic cytokines which influence the development of EMT in vitro. METHODS AND RESULTS: Stimulation of primary fetal esophageal fibroblasts (FEF3) with conditioned media (CEM) from esophageal epithelial cells (EPC2-hTERT), primed FEF3 cells to secrete IL-1ß and TNFα, but not TGFß. To determine whether these cytokines signaled in a paracrine fashion to esophageal epithelial cells, FEF3 cells were stimulated with CEM, followed by transfer of this fibroblast conditioned media (FCM) to EPC2-hTERT cells. Epithelial FCM stimulation increased expression of mesenchymal markers and reduced E-cadherin expression, features of EMT which were TNFα and IL-1ß-dependent. Using organotypic culture models, primary EoE epithelial cells exhibited features of EMT compared to non-EoE cells, corresponding to patterns of EMT in native biopsies. CONCLUSIONS: Esophageal epithelial cell and fibroblast cross-talk contributes to esophageal fibrosis. Our results suggest that features of EMT can develop independent of TGF-ß and granulocytes, which may have important implications in treatment of EoE.


Asunto(s)
Comunicación Celular , Esofagitis Eosinofílica/patología , Células Epiteliales/citología , Transición Epitelial-Mesenquimal , Esófago/citología , Adolescente , Biopsia , Cadherinas/metabolismo , Diferenciación Celular , Células Cultivadas , Niño , Medios de Cultivo Condicionados/metabolismo , Medios de Cultivo Condicionados/farmacología , Esofagitis Eosinofílica/metabolismo , Células Epiteliales/efectos de los fármacos , Células Epiteliales/metabolismo , Esófago/efectos de los fármacos , Esófago/metabolismo , Femenino , Fibroblastos/efectos de los fármacos , Fibroblastos/metabolismo , Granulocitos/metabolismo , Humanos , Interleucina-1beta/metabolismo , Interleucina-1beta/farmacología , Masculino , Proteínas Recombinantes/metabolismo , Proteínas Recombinantes/farmacología , Factor de Crecimiento Transformador beta/metabolismo , Factor de Crecimiento Transformador beta/farmacología , Factor de Necrosis Tumoral alfa/metabolismo , Factor de Necrosis Tumoral alfa/farmacología
5.
J Ultrasound Med ; 31(2): 213-8, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22298864

RESUMEN

OBJECTIVES: We sought to determine the normal sonographically measured placental thickness in millimeters at the second-trimester scan (18 weeks to 22 weeks 6 days) and determine whether the measurement should be adjusted for gestational age and the placental site. METHODS: We conducted a cross-sectional observational pilot study involving 114 consecutive patients with singleton pregnancies presenting for routine second-trimester sonography between 18 weeks and 22 weeks 6 days. RESULTS: The unadjusted overall mean placental thickness was 24.6 (SD, 7.29) mm. The placental thickness was normally distributed. On multivariable analysis, the predicted mean thickness was 6.6 mm (95% confidence interval, 4.4 to 8.8 mm; P < .001) less in anterior compared to posterior or fundal placentas and increased by 0.6 mm (95% confidence interval, -0.5 to 1.7 mm; P = .27) for each week increase in gestation after 18 weeks CONCLUSIONS: The placental position and possibly gestational age need to be considered when determining placental thickness. Anterior placentas are approximately 7 mm thinner than posterior or fundal placentas. Anterior placentas of greater than 33 mm and posterior placentas of greater than 40 mm should be considered abnormally thick.


Asunto(s)
Placenta/diagnóstico por imagen , Segundo Trimestre del Embarazo , Ultrasonografía Prenatal/métodos , Adolescente , Adulto , Estudios Transversales , Femenino , Edad Gestacional , Humanos , Proyectos Piloto , Embarazo , Valores de Referencia
6.
Ecology ; 103(12): e3829, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-35869828

RESUMEN

Teleost fishes account for 96% of all fish species and exhibit a spectacular variety of body forms. Teleost lineages range from deep bodied to elongate (e.g., eels, needlefish), laterally compressed (e.g., ribbonfish) to globular (e.g., pufferfish), and include uniquely shaped lineages such as seahorses, flatfishes, and ocean sunfishes. Adaptive body shape convergence within fishes has long been hypothesized but the nature of the relationships between fish form and ecological and environmental variables remain largely unknown at the macroevolutionary scale. To facilitate the investigation of the interacting factors influencing teleost body shape evolution we measured eight functionally relevant linear traits on adult-sized specimens along with specimen mass. Linear measurements of standard length, maximum body depth, maximum fish width, lower jaw length, mouth width, head depth, minimum caudal peduncle depth, and minimum caudal peduncle width were taken in millimeters with calipers, or tape measures for oversized specimens. We measured these traits on a total of 16,523 specimens (1-3 specimens per species) at the Smithsonian National Museum of Natural History and took approximately 7000 person hours of data collection to complete. The data went through a three-step error-checking process to clean and validate the data and then species averages were calculated. We present the complete specimen data set, which encompasses approximately one-fifth of extant teleost species diversity, spanning ~90% of teleost families and ~96% of orders. The species and family names are compatible with the taxonomy used by FishBase and the order information with the phylogenetically informed taxonomy of Betancur-R and colleagues published in 2014. This dataset is licensed under Creative Commons CC0 1.0 Universal (CC0 1.0) but please cite this paper when using the data or a subset of it.


Asunto(s)
Peces , Animales , Fenotipo
8.
Sci Adv ; 4(12): eaau1873, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30525104

RESUMEN

An essential property of microbial communities is the ability to survive a disturbance. Survival can be achieved through resistance, the ability to absorb effects of a disturbance without a notable change, or resilience, the ability to recover after being perturbed by a disturbance. These concepts have long been applied to the analysis of ecological systems, although their interpretations are often subject to debate. Here, we show that this framework readily lends itself to the dissection of the bacterial response to antibiotic treatment, where both terms can be unambiguously defined. The ability to tolerate the antibiotic treatment in the short term corresponds to resistance, which primarily depends on traits associated with individual cells. In contrast, the ability to recover after being perturbed by an antibiotic corresponds to resilience, which primarily depends on traits associated with the population. This framework effectively reveals the phenotypic signatures of bacterial pathogens expressing extended-spectrum ß-lactamases (ESBLs) when treated by a ß-lactam antibiotic. Our analysis has implications for optimizing treatment of these pathogens using a combination of a ß-lactam and a ß-lactamase (Bla) inhibitor. In particular, our results underscore the need to dynamically optimize combination treatments based on the quantitative features of the bacterial response to the antibiotic or the Bla inhibitor.


Asunto(s)
Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Fenómenos Fisiológicos Bacterianos , Farmacorresistencia Bacteriana , Bacterias/genética , Humanos , Viabilidad Microbiana/efectos de los fármacos , Modelos Biológicos , Fenotipo , beta-Lactamasas/genética , beta-Lactamasas/metabolismo
9.
PLoS One ; 11(3): e0150968, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26992000

RESUMEN

Eosinophilic esophagitis (EoE) is a chronic Th2 and food antigen-mediated disease characterized by esophageal eosinophilic infiltration. Thymic stromal lymphopoetin (TSLP), an epithelial derived cytokine which bridges innate and Th2-type adaptive immune responses in other allergic conditions, is overexpressed in esophageal biopsies of EoE subjects. However, the triggers of TSLP expression in the esophageal epithelium are unknown. The objective of the current study was to characterize TSLP expression in human esophageal epithelium in EoE in vivo and to determine the role of food antigens upon epithelial TSLP expression in vitro. Using immunohistochemistry (IHC), we localized TSLP in esophageal biopsies of active EoE (≥15 eos/hpf), inactive EoE (<15 eos/hpf) and non-EoE control subjects, and found that TSLP expression was restricted to the differentiated suprabasal layer of the epithelium in actively inflamed EoE biopsies. Consistent with these results in vivo, inducible TSLP protein secretion was higher in CaCl2 differentiated telomerase-immortalized esophageal epithelial cells (EPC2-hTERT) compared to undifferentiated cells of the basal phenotype, following stimulation with the TLR3 ligand poly(I:C). To determine whether food antigens could directly induce epithelial TSLP secretion, differentiated and undifferentiated primary esophageal epithelial cells from EoE and non-EoE subjects were challenged with food antigens clinically relevant to EoE: Chicken egg ovalbumin (OVA), wheat, and milk proteins beta-lactoglobulin (blg) and beta-casein. Food antigens failed to induce TSLP secretion by undifferentiated cells; in contrast, only OVA induced TSLP secretion in differentiated epithelial cells from both EoE and control cell lines, an effect abolished by budesonide and NF-κb inhibition. Together, our study shows that specific food antigens can trigger innate immune mediated esophageal TSLP secretion, suggesting that esophageal epithelial cells at the barrier surface may play a significant role in the pathogenesis of EoE by regulating TSLP expression.


Asunto(s)
Diferenciación Celular , Citocinas/metabolismo , Esofagitis Eosinofílica/metabolismo , Células Epiteliales/metabolismo , Esófago/metabolismo , Antígenos/farmacología , Budesonida/farmacología , Línea Celular Transformada , Citocinas/inmunología , Esofagitis Eosinofílica/inmunología , Esofagitis Eosinofílica/patología , Células Epiteliales/inmunología , Células Epiteliales/patología , Esófago/inmunología , Esófago/patología , Regulación de la Expresión Génica/efectos de los fármacos , Regulación de la Expresión Génica/inmunología , Humanos , FN-kappa B/antagonistas & inhibidores , FN-kappa B/inmunología , FN-kappa B/metabolismo , Poli I-C/farmacología , Receptor Toll-Like 3/agonistas , Receptor Toll-Like 3/inmunología , Receptor Toll-Like 3/metabolismo , Linfopoyetina del Estroma Tímico
10.
Biomaterials ; 61: 239-45, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26005763

RESUMEN

Culturing and measuring bacterial population dynamics are critical to develop insights into gene regulation or bacterial physiology. Traditional methods, based on bulk culture to obtain such quantification, have the limitations of higher cost/volume of reagents, non-amendable to small size of population and more laborious manipulation. To this end, droplet-based microfluidics represents a promising alternative that is cost-effective and high-throughput. However, difficulties in manipulating the droplet environment and monitoring encapsulated bacterial population for long-term experiments limit its utilization. To overcome these limitations, we used an electrode-free injection technology to modulate the chemical environment in droplets. This ability is critical for precise control of bacterial dynamics in droplets. Moreover, we developed a trapping device for long-term monitoring of population dynamics in individual droplets for at least 240 h. We demonstrated the utility of this new microfluidic system by quantifying population dynamics of natural and engineered bacteria. Our approach can further improve the analysis for systems and synthetic biology in terms of manipulability and high temporal resolution.


Asunto(s)
Bacterias/citología , Bacterias/aislamiento & purificación , Técnicas de Cultivo Celular por Lotes/instrumentación , Separación Celular/instrumentación , Análisis de Inyección de Flujo/instrumentación , Dispositivos Laboratorio en un Chip , Reactores Biológicos/microbiología , Diseño de Equipo , Análisis de Falla de Equipo , Micromanipulación/instrumentación
11.
PLoS One ; 10(2): e0114831, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25723478

RESUMEN

Eosinophilic Esophagitis (EoE) is a chronic allergic disorder, whose pathobiology is incompletely understood. Histamine-producing cells including mast cells and basophils have been implicated in EoE. However, very little is currently known about the role of histamine and histamine receptor (HR) expression and signaling in the esophageal epithelium. Herein, we characterized HR (H1R, H2R, H3R, and H4R) expression in human esophageal biopsies and investigate the role of histamine signaling in inducible cytokine expression in human esophageal epithelial cells in vitro. HR expression was quantified in esophageal biopsies from non-EoE control (N = 23), inactive EoE (<15 eos/hpf, N = 26) and active EoE (>15 eos/hpf, N = 22) subjects using qRT-PCR and immunofluorescent localization. HR expression and histamine-mediated cytokine secretion were evaluated in human primary and telomerase-immortalized esophageal epithelial cells. H1R, H2R, and H4R expression were increased in active EoE biopsies compared to inactive EoE and controls. H2R was the most abundantly expressed receptor, and H3R expression was negligible in all 3 cohorts. Infiltrating eosinophils expressed H1R, H2R, and H4R, which contributed to the observed increase in HR in active subjects. H1R and H2R, but not H3R or H4R, were constitutively expressed by primary and immortalized cells, and epithelial histamine stimulation induced GM-CSF, TNFα, and IL-8, but not TSLP or eotaxin-3 secretion. Epithelial priming with the TLR3 ligand poly (I:C) induced H1R and H2R expression, and enhanced histamine-induced GM-CSF, TNFα, and IL-8 secretion. These effects were primarily suppressed by H1R antagonists, but unaffected by H2R antagonism. Histamine directly activates esophageal epithelial cytokine secretion in vitro in an H1R dependent fashion. However, H1R, H2R and H4R are induced in active inflammation in EoE in vivo. While systemic antihistamine (anti-H1R) therapy may not induce clinical remission in EoE, our study suggests that further study of histamine receptor signaling in EoE is warranted and that targeting of additional histamine receptors may lead to novel treatment strategies for this important disease.


Asunto(s)
Esofagitis Eosinofílica/genética , Expresión Génica , Receptores Histamínicos/genética , Adolescente , Biopsia , Recuento de Células , Línea Celular , Niño , Preescolar , Esofagitis Eosinofílica/etiología , Esofagitis Eosinofílica/metabolismo , Esofagitis Eosinofílica/patología , Eosinófilos/patología , Células Epiteliales/metabolismo , Femenino , Estudios de Asociación Genética , Factor Estimulante de Colonias de Granulocitos y Macrófagos/metabolismo , Histamina/metabolismo , Humanos , Lactante , Interleucina-8/metabolismo , Masculino , Membrana Mucosa/metabolismo , Membrana Mucosa/patología , Receptores Histamínicos/metabolismo , Receptores Histamínicos H1/genética , Receptores Histamínicos H1/metabolismo , Receptores Histamínicos H2/genética , Receptores Histamínicos H2/metabolismo , Receptores Histamínicos H3/genética , Receptores Histamínicos H3/metabolismo , Receptor Toll-Like 3/agonistas , Receptor Toll-Like 3/metabolismo , Factor de Necrosis Tumoral alfa/metabolismo
12.
Stem Cells Transl Med ; 1(11): 843-54, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23197696

RESUMEN

Controlled differentiation of mesenchymal stem cells (MSCs) into the chondrogenic lineage is crucial for in vitro generation of neocartilage, yet achieving it remains challenging. Traditional protocols for MSC differentiation using exogenous inductive molecules, such as transforming growth factor-ß, fall short in meeting the needs of clinical applications because they yield differentiated cells that exhibit hypertrophic characteristics and subsequently facilitate endochondral bone formation. The objective of the current study was to deliver endogenous inductive factors from juvenile articular chondrocytes to bone marrow-derived MSCs to drive MSC chondrogenic differentiation through cocultivation of the two cell types in the absence of direct physical contact and exogenous stimulators. An initial chondrocyte/MSC ratio of 63:1 was identified as the appropriate proportion of the two cell populations to ensure that coculture-driven MSC-differentiated (CDMD) cells replicated the cellular morphology, behavior, and phenotype of articular chondrocytes. In a three-dimensional agarose system, CDMD cells were further shown to develop into robust neocartilage structurally and mechanically stronger than chondrocyte-laden constructs and with reduced hypertrophic potential. Although MSCs tended to lose the ability to express CD44, an important regulator in cartilage biology, during the coculture induction, CDMD cells regained this function in the three-dimensional tissue cultivation. The present work establishes a chondrocyte/MSC coculture model that serves as a template to better understand chondrocyte-driven MSC differentiation and provides insights for improved strategies to develop clinically relevant cartilage tissue replacements.


Asunto(s)
Cartílago Articular/crecimiento & desarrollo , Condrocitos/fisiología , Condrogénesis , Células Madre Mesenquimatosas/metabolismo , Molécula de Adhesión Celular del Leucocito Activado/metabolismo , Fosfatasa Alcalina/metabolismo , Animales , Bovinos , Diferenciación Celular/fisiología , Células Cultivadas , Técnicas de Cocultivo , Receptores de Hialuranos/metabolismo , Regeneración , Técnicas de Cultivo de Tejidos
13.
ACS Synth Biol ; 1(9): 389-402, 2012 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-23411668

RESUMEN

The survival of cells and organisms requires proper responses to environmental signals. These responses are governed by cellular networks, which serve to process diverse environmental cues. Biological networks often contain recurring network topologies called "motifs". It has been recognized that the study of such motifs allows one to predict the response of a biological network and thus cellular behavior. However, studying a single motif in complete isolation of all other network motifs in a natural setting is difficult. Synthetic biology has emerged as a powerful approach to understanding the dynamic properties of network motifs. In addition to testing existing theoretical predictions, construction and analysis of synthetic gene circuits has led to the discovery of novel motif dynamics, such as how the combination of simple motifs can lead to autonomous dynamics or how noise in transcription and translation can affect the dynamics of a motif. Here, we review developments in synthetic biology as they pertain to increasing our understanding of cellular information processing. We highlight several types of dynamic behaviors that diverse motifs can generate, including the control of input/output responses, the generation of autonomous spatial and temporal dynamics, as well as the influence of noise in motif dynamics and cellular behavior.


Asunto(s)
Fenómenos Fisiológicos Celulares , Biología Sintética/métodos , Ambiente , Redes Reguladoras de Genes , Transducción de Señal
14.
Diabetes Care ; 30(4): 878-83, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17392549

RESUMEN

OBJECTIVE: We sought to determine the long-term risk of type 2 diabetes following a pregnancy complicated by gestational diabetes mellitus (GDM) and assess what maternal antepartum, postpartum, and neonatal factors are predictive of later development of type 2 diabetes. RESEARCH DESIGN AND METHODS: This was a retrospective cohort study using survival analysis on 5,470 GDM patients and 783 control subjects who presented for postnatal follow-up at the Mercy Hospital for Women between 1971 and 2003. RESULTS: Risk of developing diabetes increased with time of follow-up for both groups and was 9.6 times greater for patients with GDM. The cumulative risk of developing type 2 diabetes for the GDM patients was 25.8% at 15 years postdiagnosis. Predictive factors for the development of type 2 diabetes were use of insulin (hazard ratio 3.5), Asian origin compared with Caucasian (2.1), and 1-h blood glucose (1.3 for every 1 mmol increase above 10.1 mmol). BMI was associated with an increased risk of developing type 2 diabetes but did not meet the assumption of proportional hazards required for valid inference when using Cox proportional hazards. CONCLUSIONS: While specific predictive factors for the later development of type 2 diabetes can be identified in the index pregnancy, women with a history of GDM, as a group, are worthy of long-term follow-up to ameliorate their excess cardiovascular risk.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Diabetes Gestacional/sangre , Índice de Masa Corporal , Estudios de Cohortes , Diabetes Mellitus Tipo 2/mortalidad , Femenino , Estudios de Seguimiento , Prueba de Tolerancia a la Glucosa , Humanos , Recién Nacido , Paridad , Embarazo , Grupos Raciales , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia
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