Analysis of Health Service Utilization and its Influencing Factors among Patients with Pneumoconiosis in China.

Pneumoconiosis, an interstitial lung disease that occurs from breathing in certain kinds of damaging dust particles, is a major occupational disease in China. Patients diagnosed with occupational pneumoconiosis can avail of free medical treatment, whereas patients without a diagnosis of occupational diseases cannot not claim free medical treatment in most provinces from the government before 2019. This study aimed to analyze the priority of medical facility selection and its influencing factors among patients with pneumoconiosis. A total of 1,037 patients with pneumoconiosis from nine provinces in China were investigated. The health service institutions most frequently selected by the patients were county-level hospitals (37.5%). The main reason for the choice was these hospitals' close distance to the patients' homes (47.3%). The factors for the choice of health care institutions were living in the eastern region ( OR = 2.91), living in rural areas ( OR = 2.10), silicosis diagnosis ( OR = 2.44), employment in private enterprises ( OR = 2.91), smoking ( OR = 2.69), and quit smoking ( OR = 3.98). The diagnosis, treatment, and rehabilitation therapy of pneumoconiosis should be enhanced in primary medical institutions.

Salvage surgery for neck residue or recurrence of nasopharyngeal carcinoma after primary radiotherapy: options of surgical methods and regions.

BACKGROUND: Salvage surgery has been recommended as the approach of choice for neck residue or recurrence of nasopharyngeal carcinoma (NPC) after primary radiotherapy (RT). This study aimed to assess the outcome and prognostic factors, options for different surgical methods, and the extent of neck dissection (ND) for patients. METHODS: NPC patients who had undergone RT and received salvage surgery for neck residue or recurrence from January 2001 to December 2011 were retrospectively analyzed. The overall survival (OS) rate was calculated by Kaplan-Meier method, and prognostic factors were determined by log-rank test and Cox regression analysis. RESULTS: In 153 cases, 96 cases have level I dissections. The metastasis rate was 20/153 (13.07%) for level I metastasis and 7/153 (4.58%) for parotid gland cases. The 3- and 5-year OS rate was 57.2 and 40.6%, respectively, and median survival time was 49 months. By univariate analysis, the age, rN staging, size of lymph nodes (LN), extra-capsular spread (ECS), and surgical procedure were significant prognostic factors. By multivariable analysis, the age, rN staging, and size of LN were significant prognostic factors. CONCLUSIONS: Salvage surgery is effective for neck failure of NPC after primary treatment, but patients with age >50 years, stage rN3, or LN >6 cm have poor prognosis.

Proteome Changes of Human Bone Marrow Mesenchymal Stem Cells Induced by 1,4-Benzoquinone.

Benzene is metabolized to hydroquinone in liver and subsequently transported to bone marrow for further oxidization to 1,4-benzoquinone (1,4-BQ), which may be related to the leukemia and other blood disorders. In the present study, we investigated the proteome profiles of human primary bone marrow mesenchymal stem cells (hBM-MSCs) treated by 1,4-BQ. We identified 32 proteins that were differentially expressed. Two of them, HSP27 and Vimentin, were verified at both mRNA and protein levels and their cellular localization was examined by immunofluorescence. We also found increased mRNA level of RAP1GDS1, a critical factor of metabolism that has been identified as a fusion partner in various hematopoietic malignancies. Therefore, these differentially expressed proteins can play important roles in benzene-mediated hematoxicity.

[Squamous cell carcinoma of cervical lymph nodes from an unknown primary site: a retrospective analysis of treatment strategies and prognosis].

OBJECTIVE: To analyze the treatment strategies and prognosis of squamous cell carcinoma of cervical lymph nodes from an unknown primary site (SCCUP). METHODS: A total of 125 cases with SCCUP was retrospectively analyzed from January 2001 to December 2011. Ninety-seven of the cases were treated with neck dissection (ND), including 24 with classic radical ND, 62 with modified ND and 11 with extended radical ND. Of 125 cases with SCCUP, 72 cases were supplemented with radiotherapy and 52 cases with chemotherapy. Radiotherapy was applied with extensive field in 36 cases, bilateral neck in 15 cases, and ipsilateral neck in 21 cases. The patients were followed up and the Kaplan-Meier method was used to calculate survival curves. Cox's analysis and logistic regression were used to evaluate the prognosis factors for SCCUP. RESULTS: The 5-year overall survival rate and disease free survival rate of the cohort were 66.2% and 60.0%, respectively. The median survival time was 70 months. Cox's analysis showed N-stage, extracapsular spread, bilateral neck metastasis and ND were independent prognostic factors for SCCUP. Logistic regression suggested that N-stage was the main factor for nodal recurrence or uncontrolled. The primary tumor sites emerged in 27 patients (21.6%) within 3 - 96 months after treatment (median time was 15 months), but only 4 patients (11.1%) existed in 36 cases underwent radiotherapy with extensive field. CONCLUSIONS: N-stage and extracapsular spread are two major factors influencing the prognosis of SCCUP. ND may improve the locoregional control and long-term survival.

[Clinical diagnosis and treatment of familial medullary thyroid carcinoma caused by a p.C618Y RET proto-oncogene mutation in a Chinese pedigree].

OBJECTIVE: To explore the clinical characteristics, therapeutic and clinical significance for RET proto-oncogene screening in a pedigree with familial medullary thyroid carcinoma. METHODS: Comprehensive medical history was obtained from 19 members in a 4-generate southern Chinese family. Systemic clinical investigations including biochemical testing, imaging examinations and germline RET screening. RESULTS: RET screening showed heterozygous missense mutations of TGC to TAC at codon 618 on exon 10 in 8 cases (p.C618Y) completely consistent with the clinical manifestations. The clinical data of 7 patients with medullary thyroid carcinoma (MTC) and 2 carriers of asymptomatic RET mutation from were analyzed. Single/bilateral multi-centric MTC with lymph node metastases was confirmed in 6 cases by histopathology and 1 case by clinical examination. There were 1 male and 6 females with an initial mean diagnostic age was 49.6 years (range: 24 - 78). All had palpable neck masses. And the mean maximum diameter of MTC was 2.6 cm (range 1.4 - 4.4). Seven patients underwent thyroidectomy except a 78-year-old female patient: right total and left subtotal thyroidectomy (n = 1), right total thyroidectomy (previous left total thyroidectomy for benign mass) (n = 1) and total thyroidectomy (n = 4) were performed. All procedures were accompanied by at least bilateral level VI lymph node dissection and/or with modified single/bilateral neck dissection. After the first operation, 6 patients still presented a high value of calcitonin: 1 patient died of metastasis 64 months postoperatively; 3 patients underwent reoperation at 6 months after initial operation, the calcitonin levels dropped to normal in 2/3 cases and stayed higher in 1 case; another two cases presented bilateral thyroid gland residua, local lymph node enlargement on imaging examination and elevated levels of calcitonin at 214 and 60 months postoperation respectively. However, 1/2 asymptomatic with elevated pre-operative calcitonin subjects underwent total thyroidectomy and histopathological examination showed bilateral C cell hyperplasia. The other carriers, without surgery, with normal neck images, close monitoring and a 10-month follow-up, still presented undetectable calcitonin. CONCLUSIONS: Based on family survey, integrated RET screening and serum levels of calcitonin facilitate an early diagnosis and normalize surgery to improve the prognosis. For asymptomatic RET mutation carriers, their levels of calcitonin shall guide the individualized regimen of prophylactic thyroidectomy or strict monitoring and follow-ups.

[Primary oncocytic carcinoma of the salivary glands: a clinical and pathologic study of 12 cases].

PURPOSE: To investigate the clinicopathological feature of oncocytic carcinoma of the salivary gland, and discuss diagnosis, treatment and prognosis. METHODS: From March 2001 to September 2010, the clinical data and pathological features of 12 cases of oncocytic carcinoma of the salivary gland in Zhejiang Cancer Hospital were reviewed and analyzed retrospectively. All cases are followed up. The Kaplan-Meier method was used to calculate survival curves by SPSS 16.0 software package. RESULTS: The tumors were found mainly as a painless, irregular-shaped mass or lymphadenectasis in the head and neck firstly. Pathologically, oncocytic carcinoma of salivary gland origin was an extremely rare proliferation of malignant oncocytes with adenocarcinomatous architectural phenotypes, including prominent nucleoli and infiltrative qualities. Surgery was the principal treatment, and postoperative radiotherapy was used as adjuvant treatment. Of the 12 cases with follow-up for 6 to 120 months, 7 cases survived without regional or distant metastases. 1 case survived with regional and distant metastases. 2 cases died of regional recurrences.1 case had lymphatic metastasis and died of distant metastasis finally.1 case had given up therapy and died of tumor progress ultimately. 3 cases had local recurrence within 2 years, and the recurrence rate was 25%; 3 cases died within 2 years, and the mortality rate was 25%. CONCLUSIONS: Oncocytic carcinoma of salivary gland origin is an extremely rare tumor in head and neck, with short course and rapid progress. Radical resection postoperative radiotherapy is the treatment of choice. The prognosis of oncocytic carcinoma may be associated with tumor stage, regional lymph node metastases and complete surgical excision.

[Cyto-genotoxicity induced by cigarette smoke condensates in human peripheral blood lymphocytes in vitro].

OBJECTIVE: To investigate the cyto-genotoxicity of cigarette smoke condensates (CSCs) in human peripheral blood lymphocytes with different assays in vitro. METHODS: Human lymphocytes were exposed to particle matter of cigarette smoke combined with or without S9 mixtures at doses of 25, 50, 75, 100 and 125 microg/ml for 3 h. The cytotoxicity induced by CSCs was detected by CCK-8 assay. The DNA damage, DNA repair (repair time: 30, 60, 90, 120 and 240 min, respectively) and the somatic cell mutations induced by 75 microg/ml CSCs were measured by comet assay, hprt gene and TCR gene mutation tests, respectively. RESULTS: CCK-8 assay indicated that the cell viability decreased with CSCs doses. At the doses of 100, 125 microg/ml, the cell viability of CSCs +S9 group was significantly higher than that of CSCs -S9 group (P < 0.05, P < 0.01). In comet assay, DNA damage significantly increased in a dose-dependent manner, as compared with controls (P < 0.01). Moreover, there was significant difference between -S9 group and +S9 group (P < 0.05, P < 0.01). The Mf-TCR at each dose group was significantly higher than that of controls (P < 0.05, P < 0.01). The Mf-hprt at high-dose groups were significantly higher than that of controls (P < 0.01), and significant difference of Mf-TCR and Mf-hprt at high doses of CSCs between -S9 group and +S9 group (P < 0.05, P < 0.01). The DNA damage induced by CSCs +S9 or CSCs -S9 could be repaired, but DNA repair speed was different between -S9 group and +S9 group (P < 0.05, P < 0.01). CONCLUSION: CSCs may induce cyto-genotoxicity in human peripheral blood lymphocytes in vitro, but S9 mix could reduce the toxicity of CSCs and impact DNA repair speed.

Response of lymphocytes to radiation in untreated breast cancer patients as detected with three different genetic assays.

OBJECTIVE: To detect the response of lymphocytes to radiation in untreated breast cancer patients with three different genetic assays. METHODS: Blood samples were collected from 25 untreated patients and 25 controls. Each blood sample was divided into two parts: one was irradiated by 3-Gy X-ray (irradiated sample), the other was not irradiated (non-irradiated sample). The radiosensitivity of lymphocytes was assessed by comet assay, cytokinesis-block micronucleus (CBMN) assay and 6-TG-resistant cells scored (TG) assay. RESULTS: The baseline values of micronucleated cell frequency (MCF) and micronucleus frequency (MNF) in the patients were significantly higher than those in the controls (P < 0.01), and 3-Gy X-ray induced genetic damage to lymphocytes in the patients increased significantly as compared with that in the controls as detected with the three genetic assays (P < 0.01). The proportion of radiosensitive cases in the patient group was 48% for the mean tail length (MTL), 40% for the mean tail moment (MTM), 40% for MCF, 44% for MNF, and 48% for mutation frequencies of the hprt gene (Mfs-hprt), respectively, whereas the proportion of radiosensitive cases in the control group was only 8% for all the parameters. CONCLUSION: The difference in the lymphocyte radiosensitivity between the breast cancer patients and the controls is significant. Moreover, there are wide individual variations in lymphocyte radiosensitivity of patients with breast cancer. In some cases, the radiosensitivity of the same patient may be different as detected with the different assays. It is suggested that multiple assays should be used to assess the radiosensitivity of patients with breast cancer before therapy.

[Genetic effects of workers occupationally exposed to mercury using three genetic end-points].

OBJECTIVE: To investigating genetic effects of workers occupationally exposed to mercury (Hg). METHODS: The peripheral lymphocytes from 20 workers exposed to mercury and 20 controls were measured with micronucleus test, comet assay, hrpt gene mutation test and TCR gene mutation test. RESULTS: The mean micronuclei rate(MNR) and mean micronucleated cells rate(MCR) in 20 workers were (5.90 +/- 0.91) per thousand and (5.30 +/- 0.81) per thousand, respectively while MNR and MCR in controls were (1.50 +/- 0.47) per thousand and (1.30 +/- 0.31) per thousand respectively, The difference of MNR and MCR between workers and controls was very significant (P < 0.01). The mean tail length (MTL) of workers and controls were (3.16 +/- 0.31) and (0.99 +/- 0.07) microm, respectively. The mean tail moment (MTM) of workers and controls were 1.63 +/- 0.22 and 0.39 +/- 0.03, respectively, There was a significant difference in MTL and MTM between workers and controls(P < 0.01). When the average mutation frequencies (Mfs-hprt) of hprt and (Mfs-TCR) of TCR of workers were compared with those of controls, there were not significant difference (P > 0.05). CONCLUSION: The results of the investigation indicated that the adverse genetic effects in workers occupationally exposed to mercury could be detected.

[Influence of 1.8 GHz microwave on DNA damage induced by 4 chemical mutagens].

OBJECTIVE: To observe the influence of 1.8 GHz microwave (MW) specific absorption rate (SAR, 3 W/kg) on human lymphocytes DNA damage induced by 4 chemical mutagens [mitomycin C (MMC), bleomycin (BLM), methyl methanesulfonate (MMS), and 4-nitroquinoline 1-oxide (4NQO)]. METHODS: Comet assay in vitro was used to detect human lymphocyte DNA damage induced by 1.8 GHz MW, 4 chemical mutagens, and MW plus 4 chemicals 0 h and 21 h respectively after exposure. The time exposed to MW or mutagens was 2 h or 3 h respectively. The results were showed by tail length (TL) and tail moment (TM). RESULTS: The difference of DNA damage between MW group and control group was not statistically significant (P > 0.05). DNA damages in MW plus MMC groups and MW plus 4NQO groups were significantly greater than those in the corresponding concentrations of MMC groups and 4NQO groups (P < 0.01 or P < 0.05). However, MW did not enhance DNA damage induced by MMS and BLM (P > 0.05). CONCLUSION: Exposure to 1.8 GHz (SAR, 3 W/kg) microwave may not induce human lymphocyte DNA damage, but could enhance DNA damage induced by MMC and 4NQO.

Assessment of human DNA repair (NER) capacity with DNA repair rate (DRR) by comet assay.

OBJECTIVE: Alkaline comet assay was used to evaluate DNA repair (nucleotide excision repair, NER) capacity of human fresh lymphocytes from 12 young healthy non-smokers (6 males and 6 females). METHODS: Lymphocytes were exposed to UV-C (254 nm) at the dose rate of 1.5 J/m2/sec. Novobiocin (NOV) and aphidicolin (APC), DNA repair inhibitors, were utilized to imitate the deficiency of DNA repair capacity at the incision and ligation steps of NER. Lymphocytes from each donor were divided into three grougs: UVC group, UVC plus NOV group, and UVC plus APC group. DNA single strand breaks were detected in UVC irradiated cells incubated for 0, 30, 60, 90, 120, 180, and 240 min after UVC irradiation. DNA repair rate (DRR) served as an indicator of DNA repair capacity. RESULTS: The results indicated that the maximum DNA damage (i.e. maximum tail length) in the UVC group mainly appeared at 90 min. The ranges of DRRs in the UVC group were 62.84%-98.71%. Average DRR value was 81.84%. The DRR difference between males and females was not significant (P < 0.05). However, the average DRR value in the UVC plus NOV group and the UVC plus APC group was 52.98% and 39.57% respectively, which were significantly lower than that in the UVC group (P < 0.01). CONCLUSION: The comet assay is a rapid, simple and sensitive screening test to assess individual DNA repair (NER) capacity. It is suggested that the time to detect DNA single strand breaks in comet assay should include 0 (before UV irradiation), 90 and 240 min after exposure to 1.5 J x m(-2) UVC at least. The DRR, as an indicator, can represent the individual DNA repair capacity in comet assay.

[Investigating genetic damage of workers occupationally exposed to methotrexate].

OBJECTIVE: To study genetic damage of workers alone occupationally exposed to methotrexate (MTX) with three end-points. METHODS: The blood samples from 21 workers exposed to MTX and 21 controls were detected with micronucleus test, comet assay, hprt gene mutation test and TCR gene mutation test. RESULTS: The mean micronuclei rate (MNR) and mean micronucleated cells rate (MCR) in 21 workers were 10.10 per thousand +/- 0.95 per thousand and 8.05 per thousand +/- 0.75 per thousand, respectively, which were significantly higher than those (5.48 per thousand +/- 0.82 per thousand and 4.38 per thousand +/- 0.58 per thousand) in control (P < 0.01). The mean tail length (MTL) of 21 workers and 21 controls were (1.30 +/- 0.06) microm and (0.07 +/- 0.01) microm, respectively, there was significant difference between workers and controls (P < 0.01). But the difference between workers and controls for mean tail moment (MTM) was not significant (P > 0.05). The average mutation frequency (Mf-hprt) of hprt and (Mf-TCR) of TCR in workers were 1.00 per thousand +/- 0.02 per thousand and (6.87 +/- 0.52) x 10(-4), respectively, which were significantly higher than those [0.86 per thousand +/- 0.01 per thousand and (1.67 +/- 0.14) x 10(-4)] in control (P < 0.01). CONCLUSION: The genetic damage to some extent appeared in workers occupationally exposed to methotrexate.

[Studies on effect enhancement of the Schistosoma japonicum DNA vaccine pVIV02-IL12-Sj23 by vegetal polysaccharides].

OBJECTIVE: To enhance the immunogenicity of the recombinant pVIVO2-IL12-Sj23 vaccine of Schistosoma japonicum by using mixed vegetal polysaccharides as adjuvant. METHODS: The plasmid pVIVO2-IL12-Sj23 was constructed. 3 groups of BALB/C mice were injected intramuscularly with normal saline (Group A), pVIVO2-IL12-Sj23 plasmid DNA (B), and pVIVO2-IL12-Sj23 plus mixed vegetal polysaccharides (C) respectively, and challenged with S. japonicum cercariae on the 4th week after immunization. Mice were killed to calculate the worm reduction rate and egg reduction rate in liver tissue on the 6th week after infection. Before and 4 weeks after immunization blood samples were collected. RESULTS: The worm reduction rate and egg reduction rate were 64.3% and 79.9%, respectively in group C, 45.5% and 58.4%, respectively in group B, showing a remarkable difference hetween them (P < 0.05). ELISA analysis showed a significantly higher level of IgG specific for Sj23 4 weeks after vaccination in groups B and C (P < 0.05). However, there was no significant difference in IgG level between groups C and B (P > 0.05). CONCLUSION: When mixed vegetal polysaccharides are used as adjuvant, the effect of the vaccine pVIVO2-IL12-Sj23 can he considerably enhanced.

[Detecting DNA repair capacity of human lymphocytes exposed to ultraviolet C with comet assay].

OBJECTIVE: To assess DNA repair capacity of human lymphocytes with comet assay. METHODS: Fresh lymphocytes form twelve 26-year old donors (6 males, 6 females) were exposed to ultraviolet C (UVC, 254 nm) at the dose rate of 1.5 J/m(2). The lymphocytes of each donor were divided into three parts: UVC group, UVC + aphidicolin (APC) group, UVC + novobiocin (NOV) group. DNA single strand breaks were detected with comet assay in UVC-irradiated cells and unirradiated cells incubated for 30, 60, 90, 120, 180 and 240 min. DNA repair rate (DRR) was calculated and served as an indicator of DNA repair capacity. RESULTS: The maximum average comet tail length (MTL) in three groups appeared 90 min after UVC exposure. The DRR range of UVC group was 81.84% (62.84% - 98.71%); There was no significant difference in DRR between males and females (P > 0.05). However, the average DRRs of UVC + NOV group and UVC + APC group (52.98% and 39.57% respectively) were significantly lower than that of UVC group (P < 0.01). CONCLUSION: Comet assay is a rapid and simple screening test to assess DNA repair capacity. DRR, as an indicator, may express the individual DNA repair capacity.