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Biomedical subjects

Ying Zhou

Publications and source records attributed to Ying Zhou.

At least 37 records · Page 2Linked to original sources

[Childhood upper respiratory infection caused by Mycoplasma pneumoniae].

OBJECTIVE: This study was designed to investigate the prevalence, clinical characteristics and outcome of upper respiratory infection (URI) caused by Mycoplasma pneumoniae (MP) in children. METHODS: Pharyngeal cultures for MP antibody were performed in 960 children with acute URI. The samples were randomly collected from the outpatient room or emergency room (Observed group). Of the Observed group, there were 232 cases under 1 year of age, and the remainder, were between 1-12 years old. The samples from 100 healthy children aged from 6 months to 12 years were used as the Control group. The prevalence of MP infection between the two groups was compared. The clinical manifestations and the outcome between the patients with MP positive and negative were compared. RESULTS: MP antibody was positive in 31.7% (304/960) of the Observed group but only 9.0% (9/100) in the Control group (P < 0.05). The URI patients under 1 year of age had a lower positive rate of MP than those over 1 year old (P < 0.05). Coughs and tonsillitis were more common (P < 0.05), but catarrh, gastroenteritic symptoms, herpes, and tetter were rare (P < 0.01) in URI patients with MP positive compared with those with MP negative. Pneumonia developed in 14.8% of the patients with MP positive but only 7.0% in those with MP negative (P < 0.01). CONCLUSIONS: MP is one of the main pathogens of acute URI in children. Acute pharyngotonsillitis symptoms are predominately presented in children with MP infection. MP infection was commonly seen in children over 1 year old and they are prone to develop pneumonia.

Child↗

[Effects of pesticides metolachlor and S-metolachlor on soil microorganisms in aquisols. II. Soil respiration].

An incubation test on the soil microbial respiration as affected by 0, 5, 20, and 100 mg x kg(-1) of metolachlor and S-metolachlor (Dual Gold) showed that at the early period of incubation, 5 mg x kg(-1) of metolachlor had a stronger stimulation effect on the respiration than 5 mg x kg(-1) of Dual Gold, but after then, metolachlor presented an inhibition effect while Dual Gold had the effects of stimulation or recovery. 20 mg x kg(-1) of Dual Gold had little effect on the respiration, while metolachlor with the same concentration stimulated it. 100 mg x kg(-1) of metolachlor had a stronger stimulation effect on the respiration than 100 mg x kg(-1) of Dual Gold, but both of them had the same inhibition effect during the later period. The higher the concentration of metolachlor or Dual Gold, the greater the stimulation effect was. There was a significant difference in soil microbial respiration between treated and blank soil at the beginning of incubation, while no significant difference was observed during the later period. With the same concentration of 20 or 100 mg x kg(-1), metolachlor had more harm than Dual Gold. It was suggested that metolachlor and Dual Gold belonged to lower poisonous pesticides, and had less harm on soil microbes.

Acetamides↗

[Application of NIR quantitative analysis to nondestructive detection of loquat soluble solid content].

The objective of the present research was to evaluate the potential of NIR diffuse reflectance spectroscopy as a way for nondestructive measurement of loquat soluble solid content of three varieties harvested from two orchards. According to the analysis, it was shown that the correlation coefficient of curves was relatively high in the two regions of 1400-1500 nm and 1900- 2000 nm. Statistical models were developed using partial least square regression (PLSR), stepwise multiple linear regression (SMLR) and principal component regression (PCR) methods in the full spectral region from 800 to 2500 nm and in the combined region of 1400-1500 nm and 1900-2000 nm. The results of PLSR model in the full spectral region were better than those of other models. The modeling results based on derivative spectra were not as good as those based on original spectra. Finally, a model was established based on the original spectra with 17 points smoothing for all the three varieties in the full spectral region by PLSR method. The correlation coefficients of calibration and validation were 0.96 and 0.95, respectively. The results indicate that it is feasible to use NIR spectroscopy technique for quantitative analysis of loquat soluble solid content.

Algorithms↗

[Roadside observation on the use of safety belt in Guangzhou and Nanning cites of China].

OBJECTIVE: To determine the rates of correct use of safety belt (CUSB) among drivers and front seat passengers in Guangzhou and Nanning through roadside observation and to provide scientific evidence for the development of intervention plan and to strengthen road safety law enforcement. METHODS: Observational sites were randomly selected from three road types (Highway, Main Street and Subordinate Street). Targeted automobiles were observed at each site at four different times and uniformed checklists were used to record safety belt use during observations. Within each vehicle, belt use by drivers of different sex, road type, workday/weekend, day/night and seating position were calculated. Data was analyzed, using Chi-square tests to compare the statistic significance. RESULTS: (1)The rate of CUSB and non-use rate among drivers were higher in Nanning than in Guangzhou (P= 0.00) but the rate of incorrect use was on the contrarary. (2) The rate of CUSB by front seat passengers in Guangzhou was higher than that in Nanning (P = 0.04); as well as the rate of (P = 0.00) incorrect use while the non-use rate was on the contrarary. (3)In general, the rate of CUSB was higher on highways than on local streets (P = 0.00). (4) The CUSB rate of drivers and front seat passengers was higher at daytime than at night (P = 0.00), and the rate of incorrect use was higher at working days than weekends (P = 0.00). (5) The CUSB rate was higher for female drivers than for males in Guangzhou (P = 0.00), but there no statistical significance was found in Nanning (P = 0.21). CONCLUSION: Results suggested that intervention actions should be undertaken to raise the awareness of the importance of safety belt use. Effective public information and education programs, law enforcement and mandatory safety belt use, prioritizing programs on people neglegent to the importance are necessary to increase the safety belt use and to decrease the mortality and injuries caused by traffic accidents.

Automobile Driving↗

Self-assembled thermoresponsive micelles of poly(N-isopropylacrylamide-b-methyl methacrylate).

To achieve a combination of spatial specificity in a passive manner with a stimuli-response targeting mechanism, a temperature-responsive polymeric micelle was prepared using block copolymers of poly(N-isopropylacrylamide-b-methyl methacrylate) (PNIPAAm-b-PMMA). The critical micelle concentration of amphiphilic block copolymers in aqueous solution was determined by fluorescence spectroscopy using pyrene as a fluorescence probe. Transmission electron microscopy images showed that these nanoparticles were regularly spherical in shape. Micelle size determined by size analysis was around 190 nm. The micelles showed reversible dispersion/aggregation in response to temperature cycles through an outer polymer shell lower critical solution temperature (LCST) for PNIPAAm at around 33 degrees C, observed by optical absorbance measurements and dynamic light scattering (DLS). The anti-inflammation drug prednisone acetate was loaded as the model drug in the polymeric nanoparticles. In vitro release behavior of prednisone acetate was investigated, which showed a dramatic thermoresponsive fast/slow switching behavior according to the temperature-responsive structural changes of a micellar shell structure. The reversible and sensitive thermoresponse of this micelle might provide opportunities to construct a novel drug delivery system in conjunction with localized hyperthermia.

Acrylamides↗

The influence of geographic location on population exposure to emissions from power plants throughout China.

This analysis seeks to evaluate the influence of emission source location on population exposure in China to fine particles and sulfur dioxide. We use the concept of intake fraction, defined as the fraction of material or its precursor released from a source that is eventually inhaled or ingested by a population. We select 29 power-plant sites throughout China and estimate annual average intake fractions at each site, using identical source characteristics to isolate the influence of geographic location. In addition, we develop regression models to interpret the intake fraction values and allow for extrapolation to other sites. To model the concentration increase due to emissions from selected power plants, we used a detailed long-range atmospheric dispersion model, CALPUFF. Primary fine particles have the highest average intake fraction (1 x 0(-5)), followed by sulfur dioxide (5 x 10(-6)), sulfate from sulfur dioxide (4 x 10(-6)), and nitrate from nitrogen oxides (4 x 10(-6)). For all pollutants, the intake fractions span approximately an order of magnitude across sites. In the regression analysis, the independent variables are meteorological proxies (such as climate region and precipitation) and population at various distances from the source. We find that population terms can explain a substantial percentage of variability in the intake fraction for all pollutants (R(2) between 0.86 and 0.95 across pollutants), with a significant modifying influence of meteorological regime. Near-source population is more important for primary coarse particles while population at medium to long distance is more important for primary fine particles and secondary particles. A significant portion of intake fraction (especially for secondary particles and primary fine particles) occurs beyond 500 km of the source, emphasizing the need for detailed long-range dispersion modeling. These findings demonstrate that intake fractions for power plants in China can be estimated with reasonable precision and summarized using simple regression models. The results should be useful for informing future decisions about power-plant locations and controls.

Air Pollutants↗

Primary cutaneous T-cell lymphomas show a deletion or translocation affecting NAV3, the human UNC-53 homologue.

Multicolor fluorescent in situ hybridization (FISH) was used to identify acquired chromosomal aberrations in 12 patients with mycosis fungoides or Sézary syndrome, the most common forms of primary cutaneous T-cell lymphoma (CTCL). The most frequently affected chromosome was 12, which showed clonal deletions or translocations with a break point in 12q21 or 12q22 in five of seven consecutive Sézary syndrome patients and a clonal monosomy in the sixth patient. The break point of a balanced translocation t(12;18)(q21;q21.2), mapped in the minimal common region of two deletions, fine mapped to 12q2. By locus-specific FISH, the translocation disrupted one gene, NAV3 (POMFIL1), a human homologue of unc-53 in Caenorhabditis elegans. A missense mutation in the remaining NAV3 allele was found in one of six cases with a deletion or translocation. With locus-specific FISH, NAV3 deletions were found in the skin lesions of four of eight (50%) patients with early mycosis fungoides (stages IA-IIA) and in the skin or lymph node of 11 of 13 (85%) patients with advanced mycosis fungoides or Sézary syndrome. Preliminary functional studies with lentiviral small interfering RNA-based NAV3 silencing in Jurkat cells and in primary lymphocytes showed enhanced interleukin 2 expression (but not CD25 expression). Thus, NAV3 may contribute to the growth, differentiation, and apoptosis of CTCL cells as well as to the skewing from Th1-type to Th2-type phenotype during disease progression. NAV3, a novel putative haploinsufficient tumor suppressor gene, is disrupted in most cases of the commonest types of CTCL and may thus provide a new diagnostic tool.

Alleles↗

Nicotine stimulates adhesion molecular expression via calcium influx and mitogen-activated protein kinases in human endothelial cells.

To evaluate the effect of nicotine on endothelium dysfunction and development of vascular diseases, we investigated the influence on adhesion molecular expression mediated by nicotine and the mechanism of this effect in human umbilical vein endothelial cells (HUVECs). The result showed that nicotine could induce surface/soluble vascular cell adhesion molecule (VCAM-1) and endothelial selectin (E-selectin) expression in a time-response decline manner and the peak appeared at 15 min. This action could be mediated by mitogen-activated protein kinase/extracellular signal regulated kinase 1/2 (MAPK/ERK1/2) and MAPK/p38 because their activation could be distinctly blocked by MAPK inhibitors, PD098059 or SB203580. Mecamylamine (non-selective nicotinic receptor inhibitor), alpha-bungarotoxin (alpha7 nicotinic receptor inhibitor) could block Ca2+ accumulation, and then, prevented the phosphorylation on ERK1/2 and p38. They also inhibited the surface/soluble VCAM-1, E-selectin production of HUVECs modulated by nicotine. Therefore, we concluded that: (i) nicotine obviously up-regulates VCAM-1 and E-selectin expression at 15 min in HUVECs, (ii) nicotine activates HUVECs triggered by the ERK1/2 and p38 phosphorylation with an involvement of intracellular calcium mobilization chiefly mediated by alpha7 nicotinic receptor, (iii) intracellular Ca2+ activates a sequential pathway from alpha7 nicotinic receptor to the phosphorylation of ERK1/2, p38. These elucidate that nicotine activates HUVECs through fast signal transduction pathway and arguments their capacity of adhesion molecular production. Further more nicotine may contribute its influence to the progression of vascular disease such as atherosclerotic lesion.

Animals↗

Population pharmacokinetics of cyclosporine in clinical renal transplant patients.

Population pharmacokinetics of cyclosporine (CsA) in clinical renal transplant patients has been reported in the present study. A total of 2,548 retrospective drug monitoring data points were collected from 120 renal transplant patients receiving CsA. Population modeling was performed using the NONMEM (nonlinear mixed-effect modeling) program, using a one-compartment model with first-order absorption and elimination. The final regression model for CsA clearance (CL/F) with the influence of six significant covariates, comprising postoperative days (POD), total bilirubin level (TBIL, micromolar concentration), current body weight (CBW, kilograms), age (years), concurrent metabolic inhibitors of cyclosporine (INHI), and hematocrit (HCT, percentage), has been established and expressed as CL/F=28.5 -- 1.24 . POD -- 0.252 . (TBIL -- 11)+0.188 . (CBW -- 58) --0.191 . (Age -- 42) -- 2.45 . INHI -- 0.212 . (HCT-- 28) (liters per hour). The values in parentheses represent the median level for each of the corresponding covariates. The population estimates for CL/F (28.5 l/h), V/F (volume of distribution, 133 l), and interpatient variability (CV%=19.7%) for CL/F were achieved, respectively. The population model was further validated by internal and external approaches, and was demonstrated to be effective and stable. Moreover, simulation was conducted to facilitate the individualized treatment based on patient information and the final model.

Adolescent↗

Differential effects of angiotensin II on atherogenesis at the aortic sinus and descending aorta of apolipoprotein-E-deficient mice.

Angiotensin (Ang) II infusion increases atherosclerosis and leads to the formation of abdominal aortic aneurysms in apolipoprotein E-deficient (ApoE-/-) mice. Conversely, blockade of the renin-angiotensin system (RAS) decreases atherosclerosis in this model. However, there are conflicting data in the literature concerning responses to both Ang II infusion and RAS blockade which may depend on age, sex, dose, duration of treatment, and the site at which lesion area was measured. In the present study we examined the effects of Ang II infusion on lesion formation in male ApoE-/- mice both at the aortic sinus and in the descending aorta, starting at different ages, and varying in duration. We also tested the effects of the Ang II receptor antagonist losartan at different doses in both males and females. Blood pressure and plasma renin concentration (PRC) were measured as indicators of the hemodynamic and neurohormonal effects of these treatments. Administration of Ang II increased lesion area much more in the descending aorta than at the aortic sinus. However, spontaneous lesion development at the aortic sinus was much greater than in more distal regions of the aorta. Aneurysms were observed in all treatment groups but were less severe in animals treated from 4 weeks age, possibly because of protective remodeling. Losartan treatment reduced lesion area at the aortic sinus, although differences were only significant in female mice. These findings demonstrate regional and temporal differences in the sensitivity of the aorta to the effects of RAS stimulation and blockade, and may help to explain some of the discrepancies between previous reports from other laboratories.

Angiotensin II↗

Putative exposed aromatic and hydroxyl residues on the surface of the N-terminal domains of Chi1 from Aeromonas caviae CB101 are essential for chitin binding and hydrolysis.

Chitinase Chi1 of Aeromonas caviae CB101 possesses chitin binding sites at both its N and C termini. Four putative exposed residues aligned in a line on the surface of the N-terminal domains of Chi1 were found to contribute to the enzyme-chitin binding and hydrolysis via site-directed mutagenesis. Also, it was found that Chi1 requires the cooperation of the N- and C-terminal domains to bind fully with crystalline and colloidal chitin.

Aeromonas↗

[Rapid analysis of genetically modified soybean by a duplex PCR-capillary electrophoresis system with laser-induced fluorescence detection].

OBJECTIVE: To develop a rapid detection method for genetically modified soybean resistant to glyphosate. METHODS: A duplex PCR was performed with primers designed in this study to simultaneously amplify heterogenous genes in transgenic soybean: CaMV-35S promoter, NOS terminator and CP4-EPSPS gene. And a simple capillary electrophoresis with laser-induced fluorescence detection (CE-LIF) was developed and applied to the rapid analysis of the above PCR products by using a 50 cm length x 100 microm i.d. capillary coated with linear polyacrylamide and an 8 g/L HPMC-4000 sieving buffer under 200 V/cm electric field strength. RESULTS: The proposed method was able to simultaneously detect the three heterogenous genes existing in genetically modified soybean under the optimization conditions of PCR and capillary electrophoresis. The measured sequences of the duplex PCR products were identical with the original genes' sequences. Moreover, the sample volumes required were not more than 5 nl and the detection could be completed in less than 24 min. The relative standard deviations (R. S. D.) of the migration times for the PCR products were < or = 3.2%. CONCLUSION: In comparison with agarose gels electrophoresis, the duplex PCR-based capillary electrophoretic method with laser-induced fluorescence detection is rapid, sensitive and accurate, and it is suitable for detection of genetically modified soybean.

DNA, Plant↗

[Restriction enzyme pattern analysis of mycobacteria DNA by capillary electrophoresis with laser induced fluorescence detection].

A new method for rapidly detecting restriction enzyme pattern of mycobacterium deoxyribonucleic acid (DNA) by capillary electrophoresis with laser induced fluorescence detection (CE-LIFD) was developed. Polymerase chain reaction was used to amplify a 439 bp fragment of 65,000 (Mr) heat shock protein gene (hsp65) of mycobacterium. After digesting the amplification products by BstE II and Hae III respectively, the patterns of enzyme cleavaged products were detected by both CE-LIFD and agarose gel electrophoresis (AGE). The experimental parameters of CE were optimized. The restriction enzyme patterns of mycobacterium DNA can be detected under the optimum electrophoresis conditions: a coated capillary column with the length of 50 cm and 100 microm i. d., electrophoresis buffer of 45 mmol/L TBE (trihydroxymethyl aminomethane (Tris)-boric acid-ethylenediaminetetraacetic acid (EDTA)) and 11 kV running voltage. The restriction enzyme patterns for eight species of mycobacteria were studied. Relative standard deviations of the relative migration times of the DNA segments were less than 3.6%. Compared with AGE, CE is more outstanding in resolution and detection time, and it can be applied as a more effective means for DNA restriction enzyme pattern analysis.

Animals↗

[Effects of pesticides metolachlor and S-metolachlor on soil microorganisms in aquisols of Southern China. I. Catalase activity].

This paper studied the effects of different concentrations (0, 5, 20, and 100 mg.kg(-1)) metolachlor and its enantiomer S-metolachlor (Dual Gold) on soil catalase activity. The results showed that 20 mg.kg(-1) metolachlor had the most successive stimulating effect, 5 mg.kg(-1) metolachlor had an inhibitory effect in the early period, while 100 mg.kg(-1) metolachlor had a stimulating effect in the late period. Different concentrations Dual Gold displayed a tendency stimulation-inhibition-stimulation. 5 and 100 mg.kg(-1) metolachlor might have more damage on soil ecosystem than different concentrations Dual Gold.

Acetamides↗

Characterization of Ceap-11 and Ceap-16, two novel splicing-variant-proteins, associated with centrosome, microtubule aggregation and cell proliferation.

A novel human gene, encoding two polypeptide-isoforms, has been identified from human fetal liver cDNA library. These two alternatively spliced polypeptide-variants are associated with centrosomes, and are designated Ceap-11 and Ceap-16, respectively, according to the acronym Ceap for centrosomal-associated protein and the approximate relative molecular mass. The high degree of sequence similarity between Ceap proteins of divergent species indicates that the Ceap homologous genes are significantly conserved in evolution and constitute a new gene family without any functional information until now. Human Ceap gene is mapped on 10q24.2. These two Ceap cDNA isoforms are generated by RNA alternative splicing on the 5' terminus of the Ceap gene, and are composed of four and five exons, respectively. Ceap-11 and Ceap-16 are co-immunoprecipitated and co-located with gamma-tubulin; ectopic overexpression of these two proteins in NIH3T3 cells induces microtubule aggregation and cell proliferation; the protein level of Ceap in certain tumors is significantly higher than that in corresponding normal tissues. Taken together, our data provide the first evidence for the function of Ceap-11 and Ceap-16, the two novel human proteins, namely, association with centrosome, microtubule aggregation and cell proliferation.

Alternative Splicing↗

Nitric oxide synthase inhibition accelerates the pressor response to low-dose angiotensin II, exacerbates target organ damage, and induces renin escape.

Because nitric oxide may attenuate both the pressor and cytotoxic effects of angiotensin II (Ang II), we investigated whether nitric oxide synthase (NOS) inhibition might accelerate the slow pressor effect of Ang II, and augment target organ damage. Using conscious, chronically catheterized rats, we previously observed that low-dose Ang II (10 ng/kg/min) rapidly increased mean arterial pressure (MAP) by approximately 25 mm Hg. The MAP then remained at this level for 2 to 4 days, and then increased again during the next 5 days by a further 25 mm Hg to a second plateau. In the present study, 7 days of N(omega)-nitro-l-arginine methyl ester (L-NAME; 10 microg/kg/min) alone increased MAP by 16 mm Hg. When Ang II was added to L-NAME, MAP increased as much as with Ang II alone, but then continued to increase until day 4, reaching a plateau as high as that reached only on day 9 of Ang II alone. In approximately half the rats infused with L-NAME + Ang II, plasma renin escaped from Ang II-induced suppression after day 4 of Ang II, and continued to increase for the duration of the study. On the first day that Ang II was added to L-NAME, urinary protein excretion and plasma cardiac troponin T increased, indicating early target organ damage. By the end of the study, all rats treated with L-NAME + Ang II developed tubulointerstitial and glomerular injuries, fibrosis of the renal and cardiac arteries, and cardiac interstitial fibrosis. Target organ damage was greater in rats that developed renin escape than in those in which plasma renin remained suppressed, but was minimal in rats infused with Ang II or L-NAME alone. Taken together, these findings suggest that endogenous NO normally attenuates the pressor response to low-dose Ang II for several days, and protects from Ang II-induced target organ damage. Under conditions of reduced NO bioavailability, which may result from endothelial insufficiency, relatively small changes in circulating Ang II levels may damage target organs. Moreover, renal damage leading to renin escape may initiate a vicious cycle of elevated Ang II production, leading to higher blood pressure and greater target organ damage.

Angiotensin II↗

[Study on a sensitive setup of capillary electrophoresis with laser induced fluorescence detector and its application].

OBJECTIVE: To develop a setup of capillary electrophoresis with laser induced fluorescence detector for separating and detecting DNA fragments and protein. METHODS: The setup is assembled of He-Ne Laser with 543.5 nm as the excitation light, filter, monochromator, photomultiplier tube and a computer for controlling the system and collecting the electropherograms. RESULTS: The design of the setup and the analytical parameters were optimized. The electropherograms with high Signal-to-Noise were obtained by the laser induced fluorescence detector-capillary electrophoretic setup. For Sulforhdamine B, the detection limit was 10(-9) mol/L, and the linear range from 1 x 10(-6) mol/L to 1 x 10(-9) mol/L. The PCR products, the digested products by Hae III and BstE of mycobacterium DNA, and the human serum albumin were determined by the successful application of this setup. CONCLUSION: The setup is characterized by simple structure, low cost and high sensitivity. Compared with traditional agarose gel electrophoresis, capillary electrophoresis with laser induced fluorescence detector is more remarkable in resolution and detection time. It can be applied as a more effective means for analysis of DNA fragments and protein.

DNA↗

[Analysis of pregnancy outcomes after in vitro fertilization-embryo transfer and intracytoplasmic sperm injection].

OBJECTIVE: To compare pregnancy and perinatal outcomes between in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI). METHODS: A retrospective study was carried out to measure pre-clinical and clinical abortion, ectopic pregnancies, multiple gestations, birth weight, gestational age, congenital malformation and perinatal mortality in patients receiving either IVF-ET (n = 143, group 1) or ICSI (n = 173, group 2) from January 1999 to June 2001. The outcomes of singleton and twin were compared separately. RESULTS: The maternal age, infertility duration, parity and the number of transferred embryo were comparable between the two groups. There were no significant differences in abortion rate (16.1% vs 13.3%), birth rate (65.7% vs 74.6%) between IVF-ET and ICSI groups (P > 0.05). In singleton, the rates of low birth weight, small for gestational age and pre-term birth were 1.8%, 7.3%, 5.5% respectively in IVF-ET group and 6.8%, 8.1%, 14.9% respectively in ICSI group. In twin, the rates of low birth weight, small for gestational age and pre-term birth were 34.2%, 30.3%, 42.1% respectively in IVF-ET group and 42.6%, 38.0%, 46.3% respectively in ICSI group. There were no significant differences between the two groups (P > 0.05). But the rates of low birth weight, small for gestational age and pre-term birth were higher in twin than in singleton (P < 0.01). The incidence of congenital malformation was 2.2% and 1.6% in IVF-ET and ICSI group respectively (P > 0.05). CONCLUSIONS: The pregnancy and perinatal outcomes are similar between IVF-ET and ICSI groups. Twin is the main cause of low birth weight, small for gestational age and pre-term birth.

Adult↗