[Interpretation of specification for service of cancer screening for workers]

As the backbone force of China's social and economic construction, the health status of workers is closely related to the nation's productivity and social development. Currently, cancers have become one of the major diseases threatening the health of workers. However, there are still many shortcomings in the cancer screening services for the workers. To standardize cancer screening services for workers, ensure the quality of screening services, and improve the overall screening effectiveness, 19 institutions, including Peking Union Medical College Hospital of the Chinese Academy of Medical Sciences, have jointly formulated the Group Standard "Specification for service of cancer screening for workers (T/CHAA 023-2023)". This standard follows the principles of "legality, scientific rigor, advancement, and feasibility" and combines the frontier scientific advances in cancer screening. It clarifies the relevant requirements for service principles, service design, service delivery, service management, service evaluation, and improving worker cancer screening. Implementing this group standard will help connect the common screening needs of workers, employers, and cancer screening service providers, standardize the screening process, improve screening quality, and ultimately increase the early diagnosis rate and survival rate of cancer patients. Consequently, this group standard will help safeguard workers' health rights and interests, ensure the labor force resources, promote the comprehensive coordinated and sustainable development of society, and contribute to realizing the "Healthy China 2030" strategic policy.

Highly oxidized rearranged derivatives of quinochalcone C-glycosides from Carthamus tinctorius

Safflopentsides A-C (1-3), three highly oxidized rearranged derivatives of quinochalcone C-glycosides, were isolated from the safflower yellow pigments. Their structures were determined based on a detailed spectroscopic analysis (UV, IR, HR-ESI-MS, 1D and 2D NMR), and the absolute configurations were confirmed by the comparison of experimental ECD spectra with calculated ECD spectra. Compounds 1-3 have an unprecedented cyclopentenone or cyclobutenolide ring A containing C-glucosyl group, respectively. The plausible biosynthetic pathways of compounds have been presented. At 10 μM, 2 showed strong inhibitory activity against rat cerebral cortical neurons damage induced by glutamate and oxygen sugar deprivation.

[Intervention effect of apocynin on silicosis induced by silica in rats]

Objective: To investigate the intervention effect and its mechanism of apocynin, an inhibitor of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) on silicosis induced by silica (SiO(2)) in rats. Methods: In October 2021, 24 SPF SD male rats were divided into control group, silicosis model group and apocynin intervention group according to random number table method, with 8 rats in each group. SiO(2) was exposed by one-time intratracheal instillation. The rats in the apocynin intervention group were intraperitoneally injected with apocynin 50 mg/kg, 3 times a week, on the second day after treatment. The rats were sacrificed 28 days later, and lung coefficients were calculated after lung tissues were weighed. Hematoxylin-eosin staining and Masson staining were used to observe the lung histopathological changes in each group, respectively. The levels of NOX, reactive oxygen species (ROS), glutathione peroxidase (GSH-Px) and malondialdehyde (MDA) in lung tissue were detected. The expressions of interleukin-1 beta (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were determined by Enzyme-Linked Immunosorbent Assay (ELISA). The level of hydroxyproline (HYP) was detected by alkaline hydrolysate. The expressions of transforming growth factor beta 1 (TGF-β1), E-cadherin (E-cad) and α-smooth muscle actin (α-SMA) in lung tissue were detected by Western blotting. Results: Compared with the control group, the body weight of silicosis model group was decreased, the lung tissue showed obvious inflammatory infiltration and fibrosis, and the levels of lung coefficient, IL-1β, IL-6, TNF-α and TGF-β1 were significantly increased (P<0.05). Compared with the silicosis model group, the lung tissue injury in the apocynin intervention group was significantly improved, the lung coefficient, NOX, ROS, MDA, IL-1β, IL-6, TNF-α and TGF-β1 levels were decreased, and the activity of GSH-Px was increased (P<0.05). Compared with the silicosis model group, the expressions of HYP and α-SMA were decreased and the level of E-cad was increased in the apocynin intervention group (P<0.05) . Conclusion: Apocynin may alleviate SiO(2)-induced fibrosis in silicosis rats by reducing oxidative stress, the release of inflammatory factors and inhibiting the process of epithelial-mesenchymal transition.

[Analysis of the association between diurnal temperature difference and relative humidity and myocardial infarction in Shantou residents]

Objective: To analyze the effect of meteorological conditions on mortality and population susceptibility of patients with acute myocardial infarction (AMI) in the Shantou area and to provide a scientific basis for the local public health system to prevent AMI. Methods: The AMI mortality data recorded in the resident cause of death surveillance database of Shantou from January 1, 2015, to December 31, 2020, were collected and the distribution lag nonlinear model was used to analyze the diurnal temperature range (DTR) and relative humidity (RH) on AMI mortality and the lag effect. Results: There were 13 932 deaths due to AMI in Shantou during the study period, with a male-to-female sex ratio of 1.3∶1. There was a significant association between high diurnal temperature difference exposure and low RH exposure and AMI deaths, with both single-day lag effects appearing and reaching a maximum at lag 2 day (RR=1.019, 95%CI: 1.000-1.039; RR=1.018, 95%CI: 1.003-1.034); the cumulative lag effect was all maximal at lag 0-14 day (RR=1.199, 95%CI: 1.025-1.401; RR=1.279, 95%CI: 1.117-1.465). The elderly (≥75 years) and female populations were susceptible to high DTR exposure and low RH exposure conditions. Conclusions: There was a significant association between DTR and RH and mortality of AMI in Shantou with a significant lag in their effects. Both female and elderly populations ≥75 years old were susceptible populations under high DTR and low RH exposure conditions.

[Role of blood markers in predicting the failure of prosthesis removal and antibiotic-loaded bone cement spacer implantation for treatment of periprosthetic joint infection]

Objective: To investigate the value of inflammation,coagulation and nutrition markers in predicting the failure of prosthesis removal and antibiotic-loaded bone cement spacer implantation for treatment of periprosthetic joint infection(PJI). Methods: A retrospective study was conducted on 70 patients who undertook prosthesis removal and antibiotic-loaded bone cement spacer implantation due to PJI from June 2016 to October 2020 in the Department of Orthopedics,Henan Provincial People's Hospital. There were 28 males and 42 females,aged (65.5±11.9) years (range: 37 to 88 years). Patients were divided into two groups as the successful group and the failed group depended on whether reinfection occurred after prosthesis removal and antibiotic-loaded bone cement spacer implantation at the last follow up. Patient demographics,laboratory values (C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),ESR and CRP ratio (ESR/CRP),white blood cell count(WBC),platelet count(PLT),hemoglobin(HB),total lymphocyte count(TLC),albumin、fibrinogen(FIB),CRP and albumin ratio (CAR),prognostic nutritional index(PNI)),and reinfection rates were assessed. Comparison between groups was conducted by the independent sample t test or χ2test. Receiver operating characteristic (ROC) curve was plotted,and the area under the curve (AUC),optimal diagnostic threshold,sensitivity,and specificity were analyzed to predict the failure of prosthesis removal and antibiotic-loaded bone cement spacer implantation. Results: All patients were followed up for at least two years,and the follow-up time was (38.4±15.2) months (range: 24 to 66 months). Fifteen patients suffered failure after prosthesis removal and antibiotic-loaded bone cement spacer implantation,while the other 55 patients succeeded. The overall failure rate of prosthesis removal and antibiotic-loaded bone cement spacer implantation in PJI treatment was 21.4%. Level of preoperative CRP ((35.9±16.2)mg/L),PLT ((280.0±104.0)×109/L) and CAR (1.3±0.8) in successful group were lower than CRP ((71.7±47.3)mg/L),PLT ((364.7±119.3)×109/L) and CAR (2.5±2.0) in failed group (all P<0.05).Whereas,level of preoperative ESR/CRP (3.3±3.1), Albumin ((35.3±5.2)g/L) and PNI (43.6±6.2) in successful group were higher than ESR/CRP (1.6±1.4),Albumin ((31.3±4.8)g/L) and PNI (39.2±15.1) in failed group (all P<0.05). AUC of ROC curve,optimal threshold value,sensitivity and specificity of CRP,ESR/CRP, PLT, Albumin,CAR and PNI for the predicting failure of prosthesis removal and antibiotic-loaded bone cement spacer implantation were 0.776(95%CI:0.660 to 0.867),35.4 mg/L,86.7%,67.3%;0.725(95%CI:0.605 to 0.825),1.0,60.0%,78.2%;0.713(95%CI:0.593 to 0.815),253,93.3%,47.3%;0.721(95%CI:0.601 to 0.822),35.7,93.3%,49.1%;0.772(95%CI:0.656 to 0.863),1.1,86.7%,67.3%;0.706(95%CI:0.585 to 0.809),45.7,100%,41.8% respectively. Conclusion: In patients with PJI,CRP>35.4,ESR/CRP≤1.0 and CAR>1.1 could predict the failure of prosthesis removal and antibiotic-loaded bone cement spacer implantation.

[Analysis of management efficacy in patients with heavy menstrual bleeding associated with antithrombotic therapy]

Objective: To evaluate different methods' efficacy of controlling acute bleeding and managing long-term menstruation in patients with heavy menstrual bleeding (HMB) associated with antithrombotic therapy. Methods: The clinical data of 22 cases with HMB associated with antithrombotic therapy admitted to Peking University People's Hospital from January 2010 to August 2022 were analyzed, aged 39 years old (26-46 years). Changes in menstrual volume, hemoglobin (Hb), and quality of life were collected after control of acute bleeding and long-term menstrual management. Menstrual volume was assessed by pictorial blood assessment chart (PBAC), and quality of life was assessed by menorrhagia multi-attribute scale (MMAS). Results: (1) Treatment of acute bleeding: of the 22 cases with HMB associated with antithrombotic therapy, 16 cases were treated in our hospital and 6 in other hospital for emergency bleeding; of the 16 cases treated in our hospital, 3 underwent emergency intrauterine Foley catheter balloon compression due to severe bleeding (Hb decreased by 20 to 40 g/L within 12 hours). Of the 22 cases with antithrombotic therapy-related HMB, 15 (including 2 cases with severe bleeding) underwent emergency aspiration or endometrial resection, and intraoperative placement of levonorgestrel-releasing intrauterine system (LNG-IUS) followed by a significant reduction in bleeding volume; 3 cases had controlled acute bleeding after rivaroxaban dose reduction and continued observation; 2 cases were given gonadotropin-releasing hormone agonists to control acute bleeding in other hospital, of which 1 case was temporarily treated with periodic blood transfusion, and the other one patient underwent total hysterectomy; and 2 cases had temporary amenorrhea with oral mifepristone after intrauterine balloon compression or oral norethindrone. (2) Long-term menstrual management: of the 22 cases with antithrombotic therapy-related HMB, 15 had LNG-IUS placement and 12 had LNG-IUS placement for 6 months, and menstrual volume was significantly reduced [PBAC scores were 365.0 (272.5-460.0) vs 25.0 (12.5-37.5), respectively; Z=4.593, P<0.001], Hb was significantly increased [91.5 g/L (71.8-108.2 g/L) vs 128.5 g/L (121.2-142.5 g/L); Z=4.695, P<0.001], and quality of life was significantly improved [MMAS scores were 415.0 (327.5-472.5) vs 580.0 (570.0-580.0), respectively; Z=-3.062, P=0.002] before placement compared with 6 months after placement. Three rivaroxaban dose reduction patients' PBAC scores decreased by 20 to 35 but remained >100, and perceived quality of life did not change significantly. Two cases with temporary amenorrhea treated with oral mifepristone felt significantly improved quality of life, and the MMAS scores increased by 220 and 180, respectively. Conclusion: Intrauterine Foley catheter balloon compression, aspiration or endometrial ablation could be used to control acute bleeding in patients with antithrombotic therapy-related HMB, and LNG-IUS for long-term management could reduce menstrual volume, increase hemoglobin, and improve the quality of life of patients.

[Surgical treatment of external auricular cholesteatoma involving tympanum and papilloma]

Objective:To explore the operation treatments and their outcomes of external auditory canal cholesteatomas involving the tympanic cavity and mastoid process. Method:Forty-two patients (45 ears) with external auditory canal cholesteatomas were included in this study who were operated. All lesions invaded the tympanic cavity and mastoid process. Excision of cholesteatoma, external auditory canal angioplasty and concha formation were performed. Ossicular chain reconstruction was performed in 3 ears. Mastoidectomy with close technique were performed in 4 ears. Open radical mastoidectomy was performed in 5 ears. Posterior bone-wall of auricular meatus reconstruction was performed in 3 ears. Tympanoplasty was performed in 21 ears. Pure tone audiogram and aural endoscope were carried out after the operation (3 months, 6months, 1 year, 2 years, 3 years…). Result:Stricture of external auditory meatus were occured in 2 ears in 2 and 3 months after surgery respectively. Cholesteatoma recurrence was observed in 2 ears in 1 year after operation. Wet ear was observed in 1 patient and then another operation was performed after 7 months. Besides the patients above, the epitheliums of the cavity were well in all other patients with complete tympanic membranes. Hearing was improved in all patients (hearing by air conduction:5－30 dB HL). Conclusion:According to the range of the external auditory canal cholesteatoma, we took different operation methods including tympanoplasty, open or close radical mastoidectomy and reconstruction of posterior wall of external auditory canal etc. Those methods, including external auditory canal angioplasty, cavity plasty of concha and skin grafting of external auditory canal, could help to prevent scar formation and stricture of external auditory canal, prevent cholesteatoma recurrence and improve hearing.

[Progress of dopamine in obstructive sleep apnea hypopnea syndrome]

The etiology and pathogenesis of sleep obstructive apnea hypopnea syndrome (OSAHS) is not yet definitive, evidence shows that the dysfunction of pharyngeal nerve and the atonia of the muscle innervated by these nerve could play an important role in the progress of OSAHS. Dopamine is a neurotransmitter in the central nervous system which significantly affects the sleep-awake regulation. So far mounting evidence shows that dopamine has a potential role in the modulation of hypoglossal nucleus. The progress of dopamine in obstructive sleep apnea hypopnea syndrome is reviewed in this article.

A novel intronic mutation and a missense mutation of MEN1 identified in two Chinese families with multiple endocrine neoplasia type 1

BACKGROUND

Multiple endocrine neoplasia type 1 (MEN1) caused by MEN1 mutation is widely recognized. To date, 14 novel mutations were reported in Chinese and intronic mutations are getting more attention.

AIM

To explore clinical features and MEN1 mutations in two Chinese families suffering from MEN1.

METHODS

Nineteen individuals (10 males and 9 females) from two unrelated families with MEN1 were studied. Mutations of MEN1 were analyzed by direct sequencing of PCR products. In vitro splicing analysis was also performed with minigenes containing both wildtype and novel mutant fragments. Through the RNAstructure program, we analyzed the secondary structure of the wild type MEN1 pre-mRNA and then introduced T>G mutation at +2 donor splice site of intron 7.

RESULTS

Clinical features of 3 patients in two families were described, and 5 individuals were proven to be carriers of MEN1 mutation without apparent symptoms. A novel splicing site mutation of the intron 7 (IVS7+2 T→G) was identified in the first family. In vitro analysis also verified this mutation caused the aberrant splicing of MEN1 mRNA. With the RNAstructure program, we could figure out that the global secondary structure as well as the number of stems and loops of pre-mRNA greatly changed after this mutation. The mutation c. 1227 C>A (C409X) was identified in another family, which also caused the truncation of menin.

CONCLUSION

We reported a novel intronic mutation and a missense mutations in two Chinese families suffering from MEN1.

Identification of a locus (DSP2) for disseminated superficial porokeratosis at chromosome 12q21.2-24.21

Porokeratosis is a rare disorder of epidermal keratinization that is characterized by the presence of a border called the cornoid lamella. Disseminated superficial porokeratosis (DSP) is a subtype of porokeratosis, which is inherited as an autosomal trait. The first locus for DSP was localized to chromosome 18p11.3, but no causative gene has yet been identified. In this study, we recruited and analysed a large six-generation Chinese family with autosomal dominant DSP. The genome-wide screening identified a maximum two-point LOD score of 3.06 at θ = 0.00 with the microsatellite marker D12S78. Fine mapping and haplotype analysis defined a critical region of 38 Mb between D12S326 and D12S79 on chromosome 12q21.2-24.21, which is a probable second locus identified for DSP (DSP2). We sequenced 50 candidate genes in this region, but no causative mutation was found. This study provides a map location for isolation of a gene causing DSP.

[Determination of serumal soluble interleukin-2 receptor levels in patients with tonsillitis]

OBJECTIVE

To observe serumal soluble interleukin-2 receptor levels in patients with tonsillitis.

METHOD

SIL-2R levels in serum were detected in 68 patients with acute or chronic tonsillitis and 68 normal controls.

RESULT

The SIL-2R concentrations in patients with acute tonsillitis and in patients with chronic tonsillitis within attacking period were (642.2 +/- 87.2) x 10(3) U/L and (762.3 +/- 90.5) x 10(3) U/L, respectively. Both were significantly higher than those of the controls (285.5 +/- 49.6) x 10(3) U/L (P < 0.001). Moreover the latter was higher than the former (P < 0.001). There was no difference between the patients with chronic tonsillitis within non-attacking period and the controls (P > 0.05). After treatment of antibiotics for 3-5 days, the SIL-2R Concentrations in serum in valid cases were obviously becoming lower.

CONCLUSION

Determination of SIL-2R in serum was valuable for the diagnosis and curative effect judgement of tonsillitis.

Individual differences in neural sensitization and the role of context in illness from low-level environmental chemical exposures

This paper summarizes the clinical phenomenology of multiple chemical sensitivity (MCS), outlines the concepts and evidence for the olfactory-limbic, neural sensitization model for MCS, and discusses experimental design implications of the model for exposure-related research. Neural sensitization is the progressive amplification of responsivity by the passage of time between repeated, intermittent exposures. Initiation of sensitization may require single toxic or multiple subtoxic exposures, but subsequent elicitation of sensitized responses can involve low or nontoxic levels. Thus, neural sensitization could account for the ability of low levels of environmental chemicals to elicit clinically severe, adverse reactions in MCS. Different forms of sensitization include limbic kindling of seizures (compare temporal lobe epilepsy and simple partial seizures) and time-dependent sensitization of behavioral, neurochemical, immunological, and endocrinological variables. Sensitized dysfunction of the limbic and mesolimbic systems could account in part for many of the cognitive, affective, and somatic symptoms in MCS. Derealization (an alteration in perception making familiar objects or people seem unfamiliar or unreal) is a common MCS symptom and has been linked with limbic dysfunction in clinical neuroscience research. Sensitization is distinct from, but interactive with, other neurobiological learning and memory processes such as conditioning and habituation (compare adaptation or tolerance). In previous studies, hypotheses for MCS involving sensitization, conditioning, and habituation (adaptation) have often been considered in isolation from one another. To design more appropriate chemical exposure studies, it may be important to integrate the various theoretical models and empirical approaches to MCS with the larger scientific literature on individual differences in these potentially interactive phenomena.

Metabolic fate of Qinghaosu in rats; a new TLC densitometric method for its determination in biological material

Since the sixties, the emergence of malarial parasites resistant to the most potent anti-malarials has posed a serious problem to the therapy of malaria. Qinghaosu, a new sesquiterpene isolated from a Chinese medicinal herb Qing-hao (Artemisia annua Linn) is being used for the treatment of malaria in China with good results even in cases resistant to common anti-malarial agents. In this paper, a sensitive method of high specificity using TLC for the determination of Qinghaosu in biological specimens and in the study of the metabolism of the drug in rats is described. Qinghaosu was shown to be completely and rapidly absorbed after oral administration. However, a very low plasma level was obtained even after a dose of 300 mg/kg. Liver was found to be the chief site of its inactivation. When Qinghaisu was given intramuscularly, significant and more persistent plasma levels were detected. Qinghaosu was shown to pass the blood-brain and blood-placenta barriers after i.v. injection. Very little unchanged Qinghaosu was found in the urine and feces in 48 hours regardless of administration route (i.v., i.m. or p.o.).