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Kiss, E., Wessmann, S., Carlson, J. W., Lundberg, E., Stenmarker, M., Bobeck, J. & Lodefalk, M. (2023). Granulosa cell tumors in girls: Preliminary results of a meta-analysis of new and published cases. Paper presented at 61st Annual Meeting of the European Society for Paediatric Endocrinology (ESPE 2023), The Hague, Netherlands, September 21-23, 2023. Hormone Research in Paediatrics, 96(Suppl. 4), 126-127, Article ID T6.
Open this publication in new window or tab >>Granulosa cell tumors in girls: Preliminary results of a meta-analysis of new and published cases
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2023 (English)In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 96, no Suppl. 4, p. 126-127, article id T6Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Granulosa cell tumors (GCT) originate from sex cord/stromal tissue in the gonad. They are typically located in an ovary, but extra-gonadal localisation exists. These tumors are extremely rare in children and no systematic review has been published. The objective of this systematic review is to examine the following questions: What is the clinical picture of girls with a GCT? How are these patients treated and what is their prognosis?

Methods: To be included in the review, the article had to present a new case with GCT fulfilling the following criteria: female human fetus or a girl aged < 19 years with clinical information included a tumor containing granulosa cells.

The databases MEDLINE, Embase, Web of Science, and CINAHL were searched in November 2021. To find new cases, we asked pediatric endocrinologists in Sweden to report patients after informed consent had been secured. We also collected data from a Swedish paediatric reference pathology laboratory.

Results: The search identified 1,894 published references of which 35 were duplicates. We have screened 1,859 abstracts. We are in the process of reading 824 selected articles in full text to check for eligibility. Individual participant data has been extractedfrom 20 of the published reports for preliminary results. Nineteen new Swedish cases with a GCT were identified.

The preliminary analysis of 39 patients’ data shows an average age of 7.3 years at the time of diagnosis (range: antenatal diagnosis up to 18 years of age). Symptoms at presentation were: prepubertal breast enlargement, vaginal discharge/bleeding, abdominal distension or pain, pubic hair growth, fever, constipation, swelling of vulva or cliteromegaly, hyperpigmentation of the skin, primary/secondary amenorrhea, headache, hirsutism and advanced linear growth.

The histopathological diagnosis was juvenile GCT in 76.9%, adult GCT in 12.8%, a mixed type of juvenile and adult GCT in 7.7% and another type of tumor containing granulosa cell component in 2.6% of the cases.

All patients received surgical treatment except one with a post-mortem GCT diagnoses. Adjuvant chemotherapy was administered in two cases.

Three patients (7.7%) died, two of them due to late discovery of the primary tumor and one secondary to local recurrence of the tumor with metastases 4 years after the primary diagnosis.

Conclusion: GCT can present in all pediatric ages and often, but far from always, with endocrine symptoms such as peripheral precautious puberty. Data from this systematic review will hopefully promote early recognition of this malignant disease.

Place, publisher, year, edition, pages
S. Karger, 2023
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-110892 (URN)001091262800201 ()
Conference
61st Annual Meeting of the European Society for Paediatric Endocrinology (ESPE 2023), The Hague, Netherlands, September 21-23, 2023
Available from: 2024-01-24 Created: 2024-01-24 Last updated: 2024-01-24Bibliographically approved
Lodefalk, M., Chelslín, F., Patriksson Karlsson, J. & Hansson, S. R. (2023). Placental Changes and Neuropsychological Development in Children: A Systematic Review. Cells, 12(3), Article ID 435.
Open this publication in new window or tab >>Placental Changes and Neuropsychological Development in Children: A Systematic Review
2023 (English)In: Cells, E-ISSN 2073-4409, Vol. 12, no 3, article id 435Article, review/survey (Refereed) Published
Abstract [en]

Placental dysfunction may increase the offspring's later-life disease risk. The objective of this systematic review was to describe associations between pathological placental changes and neuropsychological outcomes in children after the neonatal period. The inclusion criteria were human studies; original research; direct placental variables; neuropsychological outcomes; and analysis between their associations. The exclusion criterion was the offspring's age-0-28 days or >19 years. The MEDLINE and EMBASE databases were last searched in May 2022. We utilized the ROBINS-I for the risk of bias assessment and performed a narrative synthesis. In total, 3252 studies were identified, out of which 16 were included (i.e., a total of 15,862 participants). Half of the studies were performed on children with neonatal complications, and 75% of the studies reported an association between a placental change and an outcome; however, following the completion of the funnel plots, a risk of publication bias was indicated. The largest study described a small association between placental size and a risk of psychiatric symptoms in boys only. Inconsistency between the studies limited the evidence in this review. In general, no strong evidence was found for an association between pathological placental changes and childhood neuropsychological outcomes after the neonatal period. However, the association between placental size and mental health in boys indicates a placental sexual dimorphism, thereby suggesting an increased vulnerability for male fetuses.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
Autism spectrum disorders, childhood, developmental origins of health and disease, long-term outcome, neuropsychological development, pathological lesion, placenta, sexual dimorphism
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-104163 (URN)10.3390/cells12030435 (DOI)000929378000001 ()36766778 (PubMedID)2-s2.0-85147863423 (Scopus ID)
Available from: 2023-02-14 Created: 2023-02-14 Last updated: 2023-03-15Bibliographically approved
Lennartsson, O., Nilsson, O. & Lodefalk, M. (2023). Sex steroid priming decreases the frequency of divergent results between spontaneous and stimulated GH tests. In: ESPE Abstracts: . Paper presented at 61st Annual ESPE (ESPE 2023),The Hague, Netherlands, 21-23 Sep., 2023.. Bioscentifica, 97, Article ID P1-295.
Open this publication in new window or tab >>Sex steroid priming decreases the frequency of divergent results between spontaneous and stimulated GH tests
2023 (English)In: ESPE Abstracts, Bioscentifica , 2023, Vol. 97, article id P1-295Conference paper, Oral presentation with published abstract (Other academic)
Place, publisher, year, edition, pages
Bioscentifica, 2023
National Category
Pediatrics
Identifiers
urn:nbn:se:oru:diva-109612 (URN)
Conference
61st Annual ESPE (ESPE 2023),The Hague, Netherlands, 21-23 Sep., 2023.
Available from: 2023-11-07 Created: 2023-11-07 Last updated: 2023-11-07Bibliographically approved
Lennartsson, O., Nilsson, O. & Lodefalk, M. (2023). Sex steroid priming decreases the frequency of divergent results between spontaneous and stimulated GH tests. Paper presented at 61st Annual Meeting of the European Society for Paediatric Endocrinology (ESPE 2023), The Hague, Netherlands, September 21-23, 2023. Hormone Research in Paediatrics, 96(Suppl. 4), 287-287, Article ID P1-295.
Open this publication in new window or tab >>Sex steroid priming decreases the frequency of divergent results between spontaneous and stimulated GH tests
2023 (English)In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 96, no Suppl. 4, p. 287-287, article id P1-295Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: The diagnosis of growth hormone (GH) deficiency (GHD) is complicated by the low specificity of GH testing, especially in children before and during early pubertal stages. Sex steroid priming reduces false positive results in pre- and early pubertal children. However, only a small number of studies have assessed its efficacy in improving the diagnostic accuracy of GHD investigations.

Aim: To evaluate the effect of sex steroid priming in GH testing on the prevalence of divergent results of spontaneous nocturnal secretion and arginine-insulin-tolerance test (AITT).

Methods and Materials: This is a retrospective chart review of all 196 children investigated for GHD from January 1, 1993 until February 28, 2023 at the Department of Paediatrics, Örebro University Hospital, Örebro, Sweden. Of them 173 (89%) children had undergone both overnight GH sampling and AITT and 28 of 173 children (16%) had received estrogen priming prior to their tests. A GH peak concentration of ≥ 7.0 μg/L or more was considered normal for both tests.

Results: Children receiving priming (36% girls) had a median age of 12.1 years (6.2–15.0) vs. 8.4 years (1.5 – 15.9) in children not primed (43% girls). Of the 173 children that had undergone both tests, 31 (18%) tested positive (<7.0 μg/L) on both tests, 22 (13%) tested positive on overnight sampling only, and 13 (8%) tested positive on AITT only. Of the 28 children who had received priming ,only one child had divergent results, with a positive result solely from AITT. Amongst non-primed children, 34 of 145 had divergent results with 21 (14.6%) testing positive on AITT, and 13 (9%) exhibiting a positive result on the spontaneous GH test. The frequency of divergent tests was significantly lower (p = 0.016) amongst primed children (3.6%) compared to non-primed children (23.6%).

Conclusion: Our results show that sex steroid priming prio rto GHD testing with overnight sampling and AITT decreases the frequency of divergent results between the two tests and thus suggest that sex steroid priming decreases the risk of false positive results.

Place, publisher, year, edition, pages
S. Karger, 2023
National Category
Pediatrics Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-110870 (URN)001091262801172 ()
Conference
61st Annual Meeting of the European Society for Paediatric Endocrinology (ESPE 2023), The Hague, Netherlands, September 21-23, 2023
Available from: 2024-01-24 Created: 2024-01-24 Last updated: 2024-01-24Bibliographically approved
Chelslín, F., Lodefalk, M. & Kruse, R. (2023). Smoking during pregnancy is associated with the placental proteome. Reproductive Toxicology, 119, Article ID 108409.
Open this publication in new window or tab >>Smoking during pregnancy is associated with the placental proteome
2023 (English)In: Reproductive Toxicology, ISSN 0890-6238, E-ISSN 1873-1708, Vol. 119, article id 108409Article in journal (Refereed) Published
Abstract [en]

Maternal smoking during pregnancy (MSDP) is a significant risk factor for the development of foetal, neonatal, and childhood morbidities. We hypothesized that infants exposed to MSDP have a distinct proteomic expression in their term placentas compared to infants without such an exposure. A total of 39 infants exposed (cord blood cotinine levels of >1ng/ml) and 44 infants not exposed to MSDP were included in the study. Women with chronic disease, body mass index of >30, or a history of uterine surgery were excluded. Total proteome abundance was analysed with quantitative mass spectrometry. For univariate analysis of differences in placental protein levels between groups, ANOVA with multiple testing corrections by the Benjamini-Hochberg method was used. For multivariate analysis, we used principal component analysis, partial least squares, lasso, random forest, and neural networks. The univariate analyses showed four differentially abundant proteins (PXDN, CYP1A1, GPR183, and KRT81) when heavy and moderate smoking groups were compared to non-smokers. With the help of machine learning, we found that an additional six proteins (SEPTIN3, CRAT, NAAA, CD248, CADM3, and ZNF648) were discriminants of MSDP. The placental abundance of these ten proteins together explained 74.1% of the variation in cord blood cotinine levels (p = 0.002). Infants exposed to MSDP showed differential abundance of proteins in term placentas. We report differential placental abundance of several proteins for the first time in the setting of MSDP. We believe that these findings supplement the current understanding of how MSDP affects the placental proteome.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
CYP1A1, PXDN, Placenta, infant, newborn, protein, proteome, smoking
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-105985 (URN)10.1016/j.reprotox.2023.108409 (DOI)001008803600001 ()37209868 (PubMedID)2-s2.0-85161640987 (Scopus ID)
Funder
Nyckelfonden, OLL-886631Region Örebro County, OLL-766591 OLL-878121 OLL-840481
Available from: 2023-05-22 Created: 2023-05-22 Last updated: 2023-07-27Bibliographically approved
Rodanaki, M., Rask, E. & Lodefalk, M. (2022). A Randomized Trial of the Effect of a GnRH Analogue Injection on Ghrelin Levels in Girls. Hormone Research in Paediatrics, 95(5), 442-451
Open this publication in new window or tab >>A Randomized Trial of the Effect of a GnRH Analogue Injection on Ghrelin Levels in Girls
2022 (English)In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 95, no 5, p. 442-451Article in journal (Refereed) Published
Abstract [en]

Introduction: Ghrelin concentrations decline during puberty by an unclear mechanism. Acylated ghrelin (AG) is unstable in sampling tubes, but no standardized sampling protocol exists. We hypothesized that ghrelin levels decrease as a consequence of increased gonadotropin-releasing hormone (GnRH) signalling and that the addition of a protease inhibitor to sampling tubes preserves the AG levels.

Methods: In this randomized, placebo-controlled, cross-over study, 13 girls with suspected central precocious puberty were included. They performed an adjusted GnRH stimulation test twice and were given Relefact LHRH (R)(100 mu g/m(2)) or saline in a randomized order. Blood was sampled repeatedly for 150 min for the analysis of hormone concentrations. Oestradiol levels were only measured at baseline. The protease inhibitor 4-(2-aminoethyl) benzenesulfonyl fluoride hydrochloride (AEBSF) was added to the sampling tubes. Specific ELISA kits were used for the analysis of AG and desacylated ghrelin (DAG) levels.

Results: Neither AG nor DAG levels changed after GnRH analogue injection in comparison to saline. The addition of AEBSF preserved AG levels (650.1 +/- 257.1 vs. 247.6 +/- 123.4 pg/mL, p < 0.001) and decreased DAG levels (51.9 [12.5-115.7] vs. 143.5 [71.4-285.7] pg/mL, p < 0.001). Both AG and DAG levels were inversely associated with insulin levels (r = -0.73, p = 0.005, and r = -0.78, p = 0.002, respectively). AG levels were inversely associated with oestradiol levels (rho = -0.57, p = 0.041).

Conclusion: Ghrelin levels do not decrease following a pharmacological dose of a GnRH analogue in the short term in girls. Addition of a protease inhibitor to the sampling tubes decreases AG degradation, resulting in preserved AG and decreased DAG levels. (C) 2022 The Author(s). Published by S. Karger AG, Basel

Place, publisher, year, edition, pages
S. Karger, 2022
Keywords
Acylated ghrelin, Central precocious puberty, Desacylated ghrelin, GnRH analogue, Protease inhibitor
National Category
Endocrinology and Diabetes Pediatrics
Identifiers
urn:nbn:se:oru:diva-102574 (URN)10.1159/000526147 (DOI)000886610700006 ()35896083 (PubMedID)2-s2.0-85142001007 (Scopus ID)
Note

Funding agencies:

Research Committee and ALF funding, Region Örebro County, Sweden

Regional Research Council Mid Sweden

Available from: 2022-12-07 Created: 2022-12-07 Last updated: 2022-12-07Bibliographically approved
Rodanaki, M., Rask, E. & Lodefalk, M. (2022). Delayed puberty in boys in central Sweden: an observational study on diagnosing and management in clinical practice. BMJ Open, 12(2), Article ID e057088.
Open this publication in new window or tab >>Delayed puberty in boys in central Sweden: an observational study on diagnosing and management in clinical practice
2022 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 2, article id e057088Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To compare the usefulness of the classical definition of delayed puberty (DP) in boys with puberty nomograms and to describe the management of DP in boys in a hospital-based setting.

STUDY DESIGN: Observational retrospective multicentre study with a short-term follow-up.

SETTING AND PARTICIPANTS: Boys diagnosed with DP during 2013-2015 at paediatric departments in four counties in central Sweden. The medical records of 165 boys were reviewed.

PRIMARY AND SECONDARY OUTCOME MEASURES: Number of boys with DP after re-evaluation of the diagnosis according to the classical definition in comparison with puberty nomograms. Description of investigations performed and treatment provided to boys with DP.

RESULTS: In total, 45 and 58 boys were found to have DP according to the classical definition and the nomograms, respectively. Biochemical and/or radiological testing was performed in 91% of the 58 boys, but an underlying disease was only found in 9% of them. Approximately 79% of the boys received testosterone treatment, either as injections of testosterone enanthate or as testosterone undecanoate.

CONCLUSIONS: Puberty nomograms may be helpful instruments when diagnosing pubertal disorders in boys as they are not limited to an age close to 14 years and also identify boys with pubertal arrest. The majority of boys with DP undergo biochemical or radiological examinations, but underlying diseases are unusual emphasising the need for structural clinical practice guidelines for this patient group.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022
Keywords
Community child health, paediatric endocrinology, paediatrics
National Category
Pediatrics
Identifiers
urn:nbn:se:oru:diva-97237 (URN)10.1136/bmjopen-2021-057088 (DOI)000754022100037 ()35115358 (PubMedID)2-s2.0-85123973730 (Scopus ID)
Funder
Region Örebro County
Available from: 2022-02-07 Created: 2022-02-07 Last updated: 2023-08-28Bibliographically approved
Lodefalk, M., Allbrand, M. & Montgomery, S. (2022). Duration of the pushing phase of labor is inversely associated with expression of TNF, IL6, IGF1 and IGF2 in human placenta. The Journal of Maternal-Fetal & Neonatal Medicine, 35(25), 6476-6482
Open this publication in new window or tab >>Duration of the pushing phase of labor is inversely associated with expression of TNF, IL6, IGF1 and IGF2 in human placenta
2022 (English)In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 35, no 25, p. 6476-6482Article in journal (Refereed) Published
Abstract [en]

Objective: Gene expression in placenta differs between vaginal and cesarean deliveries, but the influence of the duration of labor on placental gene expression is incompletely known. Our aim was to investigate associations between duration of labor and expression of some genes involved in growth or inflammation in human placental tissue.

Methods: Placenta samples (n = 126) were collected after an uncomplicated, singleton pregnancy and term vaginal delivery at orebro University Hospital, Sweden. Duration of labor was recorded by the midwife in the delivery room. The expression of the following genes was analyzed by RT-qPCR: tumor necrosis factor (TNF), interleukin-6 (IL6), C-X-C motif chemokine ligand 8, toll-like receptor (TLR) 2, TLR4, insulin receptor, insulin-like growth factor (IGF) 1, IGF2, leptin, hepatocyte growth factor (HGF) and HGF receptor (MET). Multivariable linear regression models were used for the evaluation of associations with labor duration adjusting for potential confounding factors. The Benjamini-Hoschberg method was used to correct for multiple testing.

Results: The expression of TNF, IL6, IGF1 and IGF2 was inversely associated with the duration of the pushing phase of labor (B coefficients (95% confidence interval) = -0.150 (-0.277 to -0.023), -0.159 (-0.289 to -0.029), -0.099 (-0.176 to -0.021), and -0.081 (-0.145 to -0.017), respectively).

Conclusions: Longer duration of pushing is associated with downregulation of the expression of genes in placenta from vaginal deliveries. Future research on gene expression in labored placenta should take into account associations with labor duration and especially the pushing phase. Potential impact of these associations on the mother, the fetus and the new-born infant should also be explored.

Place, publisher, year, edition, pages
Informa Healthcare, 2022
Keywords
Gene expression, insulin-like growth factors, interleukin-6, labor duration, placenta, pushing phase
National Category
Medical Genetics
Identifiers
urn:nbn:se:oru:diva-91667 (URN)10.1080/14767058.2021.1916459 (DOI)000646787600001 ()33910460 (PubMedID)2-s2.0-85105914353 (Scopus ID)
Available from: 2021-05-07 Created: 2021-05-07 Last updated: 2023-12-08Bibliographically approved
Allbrand, M., Eklund, D., Cao, Y., Nilsson, K. & Lodefalk, M. (2022). Gene expression of leptin, leptin receptor isoforms and inflammatory cytokines in placentas of obese women: Associations to birth weight and fetal sex. Placenta, 117, 64-71
Open this publication in new window or tab >>Gene expression of leptin, leptin receptor isoforms and inflammatory cytokines in placentas of obese women: Associations to birth weight and fetal sex
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2022 (English)In: Placenta, ISSN 0143-4004, E-ISSN 1532-3102, Vol. 117, p. 64-71Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Leptin signaling in placentas of obese women may influence fetal growth and may be dependent on fetal sex. The aim of this study was to investigate placental gene expression of leptin, its receptor and inflammatory cytokines in obese mothers in relation to offspring birth weight and sex.

METHODS: In total, 109 placental tissue samples from severely obese women (body mass index in first trimester ≥35 kg/m2) giving birth vaginally at term to a healthy child were included. Quantitative real-time PCR was used for the analysis of leptin (LEP), its receptor LEPR with two splice variants, interleukin (IL)1B, chemokine (C-X-C motif) ligand 8 (CXCL8), tumour necrosis factor (TNF), IL6, IL10, hypoxia-inducible factor 1-alpha (HIF1A) and insulin receptor (INSR). The subjects were divided into three groups based on LEP expression percentiles (<25th percentile; 25-75th percentile and >75th percentile).

RESULTS: A reverse U-shaped association between LEP expression and birth weight z-scores was found (R2 = 0.075, p = 0.005). Placental LEPRb expression was downregulated (p = 0.034) in those with highest LEP expression. Female infants had higher birth weight z-scores than males (0.58 (-1.49-2.88) vs 0.21 (-1.50-2.93), p = 0.020) and their placental LEPRb expression was upregulated (p = 0.047). The associations between expression of different genes differed by sex.

DISCUSSION: A reverse U-shaped relationship between placental LEP expression and offspring birth weight z-scores was found together with sexual dimorphism in LEPRb expression indicating a complex regulation of fetal growth by placental leptin signaling in maternal obesity.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Cytokine, Gene expression, Infant birth weight, Leptin, Obesity, Placenta
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-95430 (URN)10.1016/j.placenta.2021.10.002 (DOI)000742830300010 ()34773742 (PubMedID)2-s2.0-85118757784 (Scopus ID)
Note

Funding agencies:

Research Committee of Region Örebro County

Nyckelfonden, Örebro University Hospital

Available from: 2021-11-15 Created: 2021-11-15 Last updated: 2022-01-28Bibliographically approved
Östling, H., Lodefalk, M., Backman, H. & Kruse, R. (2022). Global microRNA and protein expression in human term placenta. Frontiers in Medicine, 9, Article ID 952827.
Open this publication in new window or tab >>Global microRNA and protein expression in human term placenta
2022 (English)In: Frontiers in Medicine, E-ISSN 2296-858X, Vol. 9, article id 952827Article in journal (Refereed) Published
Abstract [en]

Introduction: Description of the global expression of microRNAs (miRNAs) and proteins in healthy human term placentas may increase our knowledge of molecular biological pathways that are important for normal fetal growth and development in term pregnancy. The aim of this study was to explore the global expression of miRNAs and proteins, and to point out functions of importance in healthy term placentas.

Materials and methods: Placental samples (n = 19) were identified in a local biobank. All samples were from uncomplicated term pregnancies with vaginal births and healthy, normal weight newborns. Next-generation sequencing and nano-scale liquid chromatographic tandem mass spectrometry were used to analyse miRNA and protein expression, respectively.

Results: A total of 895 mature miRNAs and 6,523 proteins were detected in the placentas, of which 123 miRNAs and 346 proteins were highly abundant. The miRNAs were in high degree mapped to chromosomes 19, 14, and X. Analysis of the highly abundant miRNAs and proteins showed several significantly predicted functions in common, including immune and inflammatory response, lipid metabolism and development of the nervous system.

Discussion: The predicted function inflammatory response may reflect normal vaginal delivery, while lipid metabolism and neurodevelopment may be important processes for the term fetus. The data presented in this study, with complete miRNA and protein findings, will enhance the knowledge base for future research in the field of placental function and pathology.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
RNA-sequencing, fetal growth, inflammatory response, microRNA, placenta, proteomics, term pregnancy
National Category
Biochemistry and Molecular Biology
Identifiers
urn:nbn:se:oru:diva-102145 (URN)10.3389/fmed.2022.952827 (DOI)000878519300001 ()36330066 (PubMedID)2-s2.0-85140952815 (Scopus ID)
Funder
Region Örebro County, OLL-935801 OLL-939071 OLL-878121 OLL-550861 OLL-577401 OLL-640561 OLL-812631 OLL-840481
Available from: 2022-11-10 Created: 2022-11-10 Last updated: 2022-11-25Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5292-4913

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