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Objective: To investigate the effect of combined exposure to four heavy metals (lead, cadmium, arsenic, mercury) on early kidney injury in occupational population. Methods: A total of 384 workers exposed to combined heavy metals in a non-ferrous metal smelting plant in Guangdong Province were selected as the research subjects using judgment sampling method. The levels of blood lead, urinary cadmium and urinary arsenic were detacted by inductively coupled plasma mass spectrometry, while urinary mercury levels were measured using cold atomic absorption spectroscopy (acidic tin chloride reduction method). The levels of biomarkers such as urinary β2-microglobulin (β2-MG), kidney injury molecule-1 (Kim-1) and neutrophil gelatinase-associated lipocalin (NGAL) were detected by enzyme-linked immunosorbent assay. Spearman correlation analysis, linear regression, weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR) models were used to analyze the association between the exposure to the four heavy metals and early kidney injury biomarkers. Results: The median of blood lead, urinary cadmium, urinary arsenic and urinary mercury were 0.47 μmol/L and 4.450, 27.790 and 0.520 μg/gCr, respectively. The median of urinary β2-MG, Kim-1 and NGAL were 62.960, 1.130 and 18.150 μg/gCr, respectively. Spearman correlation analysis showed that urinary levels of β2-MG, Kim-1, and NGAL were weakly correlated with blood lead and urinary mercury levels (all P<0.01), but not correlated with urinary cadmium and urinary arsenic (all P>0.05). The results of multiple linear regression analysis showed that urinary mercury was positively correlated with urinary β2-MG, Kim-1 and NGAL (all P<0.01), urinary arsenic was positively correlated with urinary β2-MG level (P<0.01), and blood lead was negatively correlated with urinary β2-MG and Kim-1 (all P<0.05). The WQS regression analysis showed that the combined effect of the four heavy metals was positively correlated with urinary β2-MG, Kim-1 and NGAL (all P<0.01), with mercury having the highest impact and lead the lowest. BKMR model analysis showed the increasing trend in urinary β2-MG, Kim-1 and NGAL with the increasing levels of the combined exposure to the four heavy metals. Urinary β2-MG, Kim-1 and NGAL decreased when urinary mercury level increased from the 25th percentile to the 75th percentile and the other metals were correspondingly fixed at a certain level. When the blood exposure levels of other metals remained at the corresponding median levels, urinary β2-MG, Kim-1 and NGAL levels were positively correlated with urinary arsenic level, but no significant linear dose-response relationship was observed with the other three heavy metals. Conclusion: sLead, arsenic, and mercury are independently associated with early kidney injury biomarkers in occupational population from non-ferrous metal smelting. The four heavy metals had positive combined effects on urinary β2-MG, Kim-1 and NGAL, with mercury having the greatest impact.
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Background Occupational exposure to lead, cadmium, or arsenic is a potential risk factor for blood pressure elevation. Current studies mainly focus on the relationship between a single metal and blood pressure. However, mixed metal exposure often exists in the actual working environment, and the interactive effects of polymetallic interactions on blood pressure and the dose-effect relationship remain unclear yet. Objective To explore the influence proportion of occupational exposure to lead, cadmium, or arsenic on blood pressure and their interactive effects. Methods From January to December 2021, workers from a smelter in southern China were selected. Demographic characteristics, height, weight, and blood pressure of workers were collected through questionnaire and physical examination. At the same time, their urine samples were collected and the levels of urinary lead, urinary cadmium, and urinary arsenic were detected by inductively coupled plasma mass spectrometry, and corrected by urinary creatinine (Cr). Linear regression and logistic regression were used to analyze the relationship between urinary lead, cadmium, and arsenic and blood pressure. Weighted quantile sum (WQS) regression was applied to evaluate the dose-effect relationship between urinary lead, cadmium, and arsenic exposures and blood pressure and the effect weight of each metal on blood pressure. Generalized linear regression and additive/multiplicative scaling were used to identify interactive effects of the three metals on blood pressure. Results A total of 1075 workers were included in this study, with a mean age of (44.68±5.11) years and mean working seniority of (24.66±5.23) years. There were 891 males (88.9%) and 184 were females (17.1%); 24.7% workers were drinkers and 45.7% workers were smokers; 302 workers (28.1%) reported hypertension and 37 of them were taking antihypertensive drugs. The P50 (P25, P75) levels of urinary lead, urinary cadmium, and urinary arsenic were 6.11 (3.71, 11.08), 3.88 (2.68, 5.44), and 26.04 (19.99, 35.11) μg·g−1, respectively. After adjusting for gender, age, working seniority, body mass index, smoking, drinking, and the usage of antihypertensive drugs, systolic and diastolic blood pressure increased by 0.772 and 0.418 mmHg respectively for 10% increase in lead, cadmium, and arsenic mixed exposure. Urinary cadmium, among the three single exposures, had the greatest effect on systolic and diastolic blood pressure, weight (w)=0.523 and 0.551 respectively. The interaction of urinary lead and urinary cadmium was positively correlated with the occurrence of hypertension, multiplicative interaction OR (ORint)=1.88 (95%CI: 1.09, 3.63), attributable proportion due to interaction (AP)=1.19 (95%CI: 0.40, 8.18). Conclusion This study shows that mixed exposure to lead, cadmium, and arsenic has a positive relationship with blood pressure, in which cadmium plays a major role. Co-exposure to lead and cadmium has a positive interactive effect on hypertension development and systolic blood pressure elevation.
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Objective To compare the dose difference of intensity-modulated radiotherapy (IMRT) with different gantry angle between target volumes and surrounding normal tissues in lumbar spinal metastases therapy. Methods Ten patients with lumbar spinal metastases were enrolled in the study. Three plans with the same prescription dose of 3000 cGy/10f were designed by seven-equal beams (plan-A), five-back beams (plan-B) and seven-back beams (plan-C). All the plans were designed with the same objective function and dose limiting condition. The difference of dosimetric parameters of planning target volume (PTV), organ at risk (OAR), normal tissues, and treatment parameters in all the plans were compared with SPSS 21.0 statistical software. Results All the plans satisfied the clinical requirement. There was no significant difference in the Dmean, D2%, D98%, CI and HI of PTV between plan-A and plan-C (P >0.05), and these parameters of plan-A and plan-C were better than plan-B (P < 0.05). Compared with the other two plans, plan-B reduced the dosimetric parameters of bilateral kidney (P < 0.05), whereas plan-B increased the Dmax of spinal cord (P < 0.05). The V5 and V10 of normal tissue of plan-B were lower than the other two plans while the V15, V20 and V25 showed inverse relationship (P < 0.05). plan-B had certain advantages in shortening the monitor units and treatment time (P < 0.05).. Conclusions The seven-equal beams (plan-A) and seven-back beams (plan-C) IMRT plans can provide better target dose distribution, and reduce the Dmax of spinal cord. Five-back beams (plan-B) IMRT plan had certain advantages in protecting bilateral kidney and shortening treatment time.
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Objective:To analyze the mental health status of men who have sex with men (MSM) population among acquired immunodeficiency syndrome (AIDS) patients.Methods:A face-to-face questionnaire survey was conducted to investigate the general information, symptom check list-90 (SCL-90) questionnaire and scale of 269 MSM patients with AIDS in the Eighth Hospital of Xi'an city from November 2015 to May 2016.Results:Among the 269 cases of MSM with human immunodeficiency virus (HIV)/AIDS, the majority were 20-40 years old, with higher education level, mostly unmarried and nonsingleton. The scores of each factor of SCL-90 were significantly higher than that of the norm, among which diet and sleep, interpersonal relationship, anxiety and depression were the most prominent; regression analysis showed that the main reason affecting the scores of each factor among AIDS patients was the low quality of life, and the patients with high education were more likely to have depression and anxiety.Conclusions:MSM has its own special characteristics among AIDS patients, and there are many psychological problems. Necessary psychological intervention measures should be given.
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Objective@#To compare the short-term effects of FOLFOXIRI and SOX chemotherapy regimens in treatment of advanced colorectal cancer.@*Methods@#A retrospective study was conducted. The clinical data of 71 patients with advanced colorectal cancer admitted from January 2013 to January 2015 in Jingmen Second People's Hospital were analyzed. According to the different chemotherapy regimens, the patients were divided into two groups. The SOX group was treated with SOX chemotherapy regimen (oxaliplatin+S-1), and the FOLFOXIRI group was treated with FOLFOXIRI chemotherapy regimen (oxaliplatin + irinotecan + 5-fluorouracil). After 4 courses of treatment, the clinical efficacy and adverse reactions were compared between the two groups. The patients were followed up for 6-24 months, and the survival of the two groups was compared by using Kaplan-Meier method.@*Results@#After 4 courses of treatment, in the FOLFOXIRI group, 16 cases were partial remission, 11 cases were stable disease, 10 cases were disease progression; in the SOX group, 15 cases were partial remission, 10 cases were stable disease, 9 cases were disease progression; there was no significant difference in the clinical efficacy between the two groups (Z = 0.069, P > 0.05). In the FOLFOXIRI group, the objective response rate was 43.24% (16/37), the clinical control rate was 72.97% (27/37); in the SOX group, the objective response rate was 44.12% (15/34), the clinical control rate was 73.53% (25/34); there were no significant differences between the two groups (χ 2 values were 0.005 and 0.003, both P > 0.05). In the FOLFOXIRI group, the 1-, 2-year survival rates were 83.78% (31/37) and 29.73% (11/37); in the SOX group, the 1-, 2-year survival rates were 85.29% (29/34) and 38.24% (13/34); there were no significant differences between the two groups (χ 2 values were 0.031 and 0.573, both P > 0.05). In the FOLFOXIRI group, the median progression free survival time was 9.4 months, and the median overall survival time was 19.2 months; in the SOX group, the median progression free survival time was 11.6 months, and the median overall survival time was 20.3 months; there were no significant differences between the two groups(χ 2 values were 0.85 and 0.573, both P > 0.05). The incidence rates of leukocyte depletion and diarrhea of FOLFOXIRI group were significantly higher than those of SOX group (Z values were 2.252 and 2.214, both P < 0.05).@*Conclusion@#FOLFOXIRI regimen has similar efficacy with SOX regimen in treatment of advanced colorectal cancer, but SOX regimen is more tolerant.