IQGAP1 promotes anoikis resistance and metastasis through Rac1-dependent ROS accumulation and activation of Src/FAK signalling in hepatocellular carcinoma.

BACKGROUND: Hepatitis B virus (HBV) has a crucial role in the progression of hepatocellular carcinoma (HCC). Tumour cells must develop anoikis resistance in order to survive before metastasis. This study aimed to investigate the mechanism of IQGAP1 in HBV-mediated anoikis evasion and metastasis in HCC cells. METHODS: IQGAP1 expression was detected by immunohistochemistry, real-time PCR and immunoblot analysis. Lentiviral-mediated stable upregulation or knockdown of IGAQP1, immunoprecipitation, etc. were used in function and mechanism study. RESULTS: IQGAP1 was markedly upregulated in HBV-positive compared with HBV-negative HCC cells and tissues. IQGAP1 was positively correlated to poor prognosis of HBV-associated HCC patients. IQGAP1 overexpression significantly enhanced the anchorage-independent growth and metastasis, whereas IQGAP1-deficient HCC cells are more sensitive to anoikis. Mechanistically, we found that HBV-induced ROS enhanced the association of IQGAP1 and Rac1 that activated Rac1, leading to phosphorylation of Src/FAK pathway. Antioxidants efficiently inhibited IQGAP1-mediated anoikis resistance and metastasis. CONCLUSIONS: Our study indicated an important mechanism by which upregulated IQGAP1 by HBV promoted anoikis resistance, migration and invasion of HCC cells through Rac1-dependent ROS accumulation and activation of Src/FAK signalling, suggesting IQGAP1 as a prognostic indicator and a novel therapeutic target in HCC patients with HBV infection.

A benzoxazole derivative PO-296 inhibits T lymphocyte proliferation by the JAK3/STAT5 signal pathway.

Immunosuppressants have shown striking achievements in treating autoimmune diseases in recent years. It is urgent to develop more immunosuppressants to provide more options for patients. PO-296 [2-(6-chlorobenzo[d]oxazol-2-yl)-4,5,6,7-tetrahydro-2H-indazol-3-ol] was identified as a novel benzoxazole derivative. We observed that it exhibits an obvious immunosuppressive activity to T lymphocytes. PO-296 significantly inhibited the proliferation of activated human T lymphocyte without cytotoxicity. Moreover, PO-296 did not affect the expression of cluster of differentiation (CD)-25 or CD69 but induced T lymphocyte cycle arrest in the G0/G1 phase. Furthermore, PO-296 inhibited interleukin (IL)-6, IL-17, and interferon gamma expression but had no effect on IL-2, IL-4, or IL-10. Yet, importantly, PO-296 inhibited the phosphorylation of signal transducer and activator of transcription 5 (STAT5), increased the phosphorylation of p70S6K, but did not affect the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt)/mitogen-activated protein kinase pathway. In conclusion, these findings indicate that PO-296 inhibits human activated T-lymphocyte proliferation by affecting the janus kinase 3 (JAK3)/STAT5 pathway. PO-296 possesses a potential lead compound for the design and development of new immunosuppressants for the treatment of autoimmune diseases.

K313, a novel benzoxazole derivative, exhibits anti-inflammatory properties via inhibiting GSK3ß activity in LPS-induced RAW264.7 macrophages.

Benzoxazole and its derivatives have been widely studied in recent years due to their various biological properties. A previous study has demonstrated that K313 (1H-indole-2,3-dione 3-(1,3-benzoxazol-2-ylhydrazone)), a novel benzoxazole derivative, inhibits T cell proliferation to yield immunosuppressive effects. However, there are no related reports about its anti-inflammatory effects. In the present study, we investigated the anti-inflammatory properties and the underlying molecular mechanism of K313 in lipopolysaccharide (LPS)-induced RAW264.7 macrophages. K313 dose-dependently (5, 10, and 20 µM) inhibited LPS-stimulated nitric oxide (NO), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and 3-nitrotyrosine (3-NT) production and significantly decreased the gene transcription levels of inducible nitric oxide (iNOS), IL-6, and TNF-α. In addition, the results showed that the inflammatory cytokines suppressed by K313 were not regulated by p65 NF-κB, ERK1/2, AKT, or p38 MAPK. Instead, K313 increased phosphorylation of glycogen synthase kinase-3 beta (GSK-3ß) (Ser9) resulting in GSK-3ß deactivation. Moreover, in LPS-stimulated RAW264.7 macrophages, K313 and lithium chloride (LiCl) had a synergistic effect on the anti-inflammatory response. These results indicated that K313 exhibited anti-inflammatory properties and revealed the potential mechanism. K313 can increase GSK-3ß (Ser9) phosphorylation to decrease GSK-3ß activation in LPS-induced RAW264.7 macrophages.

Monoterpenoid Indole Alkaloids from Kopsia officinalis and the Immunosuppressive Activity of Rhazinilam.

Six new monoterpenoid indole alkaloids, kopsinidines C-E (1-3), 11,12-methylenedioxychanofruticosinic acid (4), 12-methoxychanofruticosinic acid (5), and N(4)-methylkopsininate (7), as well as chanofruticosinic acid (6, as a natural product) and 23 known alkaloids, were obtained from the twigs and leaves of Kopsia officinalis. Their structures were characterized by physical data analysis. All isolated compounds were evaluated for their immunosuppressive activity on human T cell proliferation. Rhazinilam (29) significantly inhibited human T cell proliferation activated by anti-CD3/anti-CD28 antibodies (IC50 = 1.0 µM) and alloantigen stimulation (IC50 = 1.1 µM) without obvious cytotoxicity for naïve human T cells and peripheral blood mononuclear cells (0-320 µM). Although it did not affect T cell activation, it induced T cell cycle arrest in the G2/M phase and inhibited proinflammatory cytokine production in activated T cells.

Hemorrhagic Fever with Renal Syndrome, Zibo City, China, 2006-2014.

Analysis of hemorrhagic fever with renal syndrome cases in Zibo City, China, during 2006-2014 showed that it occurred year-round. Peaks in spring and fall/winter were caused by Hantaan and Seoul viruses, respectively. Rodent hosts were the striped field mouse for Hantaan virus and the brown rat and house mouse for Seoul virus.

[Retrospective analysis for clinical and histopathological characteristics of basal cell carcinoma in 418 patients].

OBJECTIVE: To investigate the clinical and histopathological characteristics of basal cell carcinoma (BCC) in Chinese patients. METHODS: Clinical and pathological data of BCC confirmed by histology from 2010 to 2012 in Peking University First Hospital were retrospectively analyzed. RESULTS: Among 418 patients enrolled, the male/female ratio was 0.77:1. The average age was (65.39±13.51) years. Among the patients younger than 60 years who occupied 29% of all the cases, the male/female ratio was 1.16:1. In terms of the histology subtypes of the BCCs, 81.8% were nodular, followed by superficial (9.8%), and the others were in very small proportion. The head and face were the most common sites of BCC (86.6%). All morpheaform subtypes, and the majority of the nodular subtypes were located on the head and face, whereas the trunk and extremities were the most common locations for the others. Clinically, 86.6% of the BCC were pigmented and 80.4% were not ulcerated. The diagnostic accordance rates of BCC on the head and face (84.7%) and on the trunk (79.1%) were higher than those on the extremities (46.2%, P<0.05). CONCLUSION: The most clinical and histopathological characteristics of our cases were similar to those of Caucasian. This study displays some unique characteristics. The young and middle aged patients occupied relative higher proportion, and their gender ration was different from that of the aged group. Tumor with hyperpigmentation was popular and few cases were ulcerated. In this study, multiple BCC cases were seldom, and the BCC patients with nevus sebaceous were older than those in other reports. The research of the diagnostic accordance rates of BCC revealed that both doctors and patients should pay more attention to BCC.

Activation of Toll-Like Receptor 3 Induces Interleukin-1 Receptor Antagonist Expression by Activating the Interferon Regulatory Factor 3.

Toll-like receptor 3 (TLR3) is a sensor of endogenous cell necrosis during the process of acute inflammation. Interleukin (IL)-1 receptor antagonist (IL-1Ra) is an anti-inflammatory cytokine and can negatively regulate the pathogenesis of inflammation. However, whether and how activation of TLR3 can regulate IL-1Ra expression has not been clarified. Here, we show that poly(I:C) induces IL-1Ra expression in primarily cultured human fibroblast-like synoviocytes and other types of cells. Induction of IL-1Ra by poly(I:C) was dependent on TLR3, but was independent of melanoma differentiation--associated protein 5 or retinoic acid-inducible gene I. Interferon regulatory factor 3 (IRF3) directly binds to the IL-1Ra promoter and promotes IL-1Ra expression in response to poly(I:C) stimulation. Induction of IL-1Ra by poly(I:C) was abolished by the inhibition of the NF-κB signaling, attenuated by the inhibition of the PI3K-Akt signaling, enhanced by inhibition of the ERK1/2 or MSK1/2 activation, but was independent of the p38 MAPK signaling. Treatment with poly(I:C) or Sendai virus elevated the levels of serum IL-1Ra in wild-type, but not in TLR3-/- or IRF3-/- mice. Our findings may provide new insights into the intrinsic anti-inflammatory function of TLR3 and double-stranded RNA-induced IL-Ra expression by TLR3 and its regulation.

PO-322 exerts potent immunosuppressive effects in vitro and in vivo by selectively inhibiting SGK1 activity.

BACKGROUND AND PURPOSE: Immunosuppressive drugs have shown great promise in treating autoimmune diseases in recent years. A series of novel oxazole derivatives were screened for their immunosuppressive activity. PO-322 [1H-indole-2,3-dione 3-(1,3-benzoxazol-2-ylhydrazone)] was identified as the most effective of these compounds. Here, we have investigated the mechanism(s) underlying the inhibition of T-cell proliferation in vitro by PO-322, as well as its effects on the delayed-type hypersensitivity (DTH) response and imiquimod-induced dermatitis in vivo. EXPERIMENTAL APPROACH: T-cell proliferation and apoptosis were analysed with flow cytometry. Cell viability was assessed with a CCK-8 assay. Protein kinase activity was assessed by SelectScreen Kinase Profiling Services. The phosphorylation of signal-regulated molecules was measured by Western blot. Cytokine levels were determined by elisa. The effect of PO-322 on DTH and imiquimod-induced dermatitis was evaluated in BALB/c mice. KEY RESULTS: PO-322 inhibited human T-cell proliferation with anti-CD3/anti-CD28 mAbs or alloantigen without significant cytotoxicity. Importantly, PO-322 was a selective inhibitor of the serum- and glucocorticoid-regulated kinase 1 (SGK1) and decreased NDRG1 phosphorylation but not p70S6K, STAT5, Akt, or ERK1/2 phosphorylation. Furthermore, PO-322 inhibited IFN-γ, IL-6, and IL-17 expression but not IL-10 expression. Finally, treatment with PO-322 was safe and effective for ameliorating the DTH response and imiquimod-induced dermatitis in mice. CONCLUSIONS AND IMPLICATIONS: PO-322 exerted immunosuppressive activity in vitro and in vivo by selectively inhibiting SGK1 activity. PO-322 represents a potential lead compound for the design and development of new drugs for the treatment of autoimmune diseases.

Clinical and dermoscopic features of surgically treated melanocytic nevi: a retrospective study of 1046 cases.

BACKGROUND: Compared with Caucasians, unique demographic and clinical features have been reported in Chinese patients with malignant melanoma, but similar comparative studies of melanocytic nevi (MN) are lacking. This study examined the clinical and dermoscopic features of MN in surgically treated Chinese cases. METHODS: Clinical data and dermoscopic findings from 1046 cases of MN were collected and analyzed. Cases were treated from January 1 to December 31, 2014 at the Department of Dermatology and Venerology, Peking University First Hospital. The association between nevi location and histologic subtypes was examined with Chi-squared test and univariate logistic regression. Chi-squared test was also used to analyze the proportion of globular patterns across different body sites, and proportion of parallel furrow patterns across different histologic subtypes. RESULTS: The majority of the nevi were from female patients, irrespective of location. The range of age at the time of nevi onset was from 0 (birth) to 79 years. There were 381 (36.4%, 381/1046) congenital nevi; of these 81.6% (311/381) were present at birth. Nevi appeared before 30 years of age in 83.2% (870/1046) of the cases. Median values of length growth rate in congenital and acquired MN were 2.0 and 1.6, respectively. Median values of length growth rates in four age groups (0-9, 10-19, 20-29, and ≥30 years) of congenital nevi were 2.2, 2.0, 2.4, and 2.0, respectively. In acral nevi, which often need to be differentiated from acral lentiginous melanoma, 50.2% (109/217) were junctional (odds ratio [OR]; 95% confidence interval [CI]: 91.572 [52.210-160.959], P < 0.05). Acral location was also associated with a higher likelihood of compound nevi subtype (OR [95% CI]: 14.468 [8.981-23.306], P < 0.05). The globular (59.4%, 354/596) and pseudonetwork (48.8%, 291/596) dermoscopic patterns were often seen in the head and neck region. In areas other than head and neck and acral regions, the globular pattern was the commonest pattern (34.8%, 71/204) regardless of age. Parallel furrow pattern occurred in 46.0% (87/189) of acral MN, followed by fibrillar pattern (21.7%, 41/189). CONCLUSION: Unique clinical and dermoscopic features exist in Chinese patients with MN compared with observations reported in other population.

[Morphological research on brain development and expression of vital cytokines in brain of human 6-8 week old embryo aborted for unexpected cause].

OBJECTIVE: To clarify the changes in cell proliferation, differentiation, apoptosis and in the expression of vital cytokines during development of 6-8 week old embryo, and hence provide the evidence for identifying the mechanisms of cell proliferation, differentiation, apoptosis during early developing human embryonic brain. METHODS: Human aborted embryos were obtained with the consents signed by the pregnant women with unexpected abortions in gestation of 6-8 weeks. The histochemical SABC method and TUNEL Staining were employed to this research project. RESULTS: At 6 weeks, two telencephalons, diencephalon, mesencephalon, metencephalon, and myelencephalon have been formed, and from week 6 to 8, every cerebral vesicle has had three layer cells including germinal layer (GL), intermediate layer ( IL ), and marginal zone (MZ). At 6-7 weeks, TUNEL-labeled cells and PCNA-, Bcl-2-, Bax-, Fas-, Fas-L-, Rb- and P53-positive cells were all observed in the GL and IL of the five brain regions, positive deposition appeared in nuclei. At week 8, Fas- and Rb-positive cells were observed in the IL of the five brain regions, positive deposition appeared in cytoplasm and cell processes, and no changes in the distributions of TUNEL-labeled cells and positive cells regarding the other five factors. The expressions of the cytokines were in agreement with the occurrence of the neuronal proliferation and apoptosis temporally and in space. CONCLUSION: During development in early embryo brain, neural precursor cell proliferation and apoptosis occur simultaneously. Fas, FasL and Bax may be involved in the induction of cell apoptosis. Bcl-2 probably prevents the cell apoptosis and provides a survival signal for cells. Rb and P53 may play a critical role in monitoring and maintaining the normal neural precursor cell to proliferation and differentiation.

[Study on cases of nasal tumors treated by dermatologic surgery: analysis of 63 cases].

OBJECTIVE: To study 63 cases of nasal tumors treated by dermatologic surgery, and analyze their generality and characters. METHODS: The cases were analyzed with SPSS 10.0 and SAS6.12. RESULTS: The average age of the patients was 46.92 +/- 18.63. The number of man was about equal to that of women. Most cases were basal cell carcinoma (42.9%). Nevus came second (38.1%). The other cases were benign tumors. The distribution of operational locations showed the character of nasal surgery. Operations of Alar occupied 52.4%, 22.2% were on the dorsal and 15.9% on the tip. Other locations occupied 9.5%. Cases of primary close occupied 69.8%. Cases applying complex close were 30.2%. Statistic analysis illustrated that primary close was different from complex close with distribution of operational locations. The area of defects between primary close and complex close was also different. At the same time, the differentiation of applying complex close was obvious between malignant tumors and benign tumors. CONCLUSION: Skin cancers and benign tumors usually occur on the nose, so it is very important to master the techniques of plastic surgery to repair the defects of nose, besides removing tumors perfectly by the classical way of dermatologic surgery, Mohs Micrographic Surgery.

A novel water-soluble benzothiazole derivative BD926 triggers ROS-mediated B lymphoma cell apoptosis via mitochondrial and endoplasmic reticulum signaling pathways.

Benzothiazole derivatives are known for various biological activities, and their potency in cancer therapy have received considerable attention in recent years. However, the poor water solubility of most benzothiazole derivatives has limited their clinical application. We developed BD926, a novel water-soluble benzothiazole derivative and showed here that it could inhibit the proliferation and induce apoptosis of human Ramos B-lymphoma cells. We further showed that BD926 triggered apoptosis through both mitochondria and endoplasmic reticulum pathways. Moreover, BD926 caused cell cycle arrest at G0/G1 stage. Furthermore, accumulation of reactive oxygen species (ROS) were observed after BD926 treatment and ROS inhibitor was able to attenuate BD926-induced apoptosis, which suggested that BD926-induced apoptosis may be due to over-producing ROS. These results demonstrate the anticancer effects of BD926 in cell models and raise the possibility for the application of BD926 in cancer therapy.

[Expression of HNF4alpha and HNF6 mRNA during the process of mouse liver development].

OBJECTIVE: To investigate the function of HNF4a and HNF6 during liver development. METHODS: The expression levels of HNF4alpha and HNF6 at E8, 9, 13, 15, 17, P1 and in adult mouse liver were detected by RT-PCR and in situ hybridization. RESULTS: RT-PCR results showed that HNF4alpha first expressed at E9, the time of liver bud formation, and lasted through all gestation and existed in adult liver. In situ hybridization showed that the expression of HNF4alpha was detected at the cells of liver cords during various stages of mouse liver development, and there were still a few HNF4alpha positive hepatocytes in adult liver. The cells of bile duct plate and biliary epithelial cells, endothelial cells, hematopoietic cells of liver were negative for HNF4alpha. The expression of HNF6 mRNA was detected in the liver at E9, the time of liver formation onset. Then, HNF6 mRNA disappeared transiently at E13, but it appeared again at E15. Its expression lasted until adult. In situ hybridization studies showed that most liver cord cells were positive for HNF6 at E9 and E15. At E17 and P1, the expression levels of liver cord cells declined, and HNF6 strongly expressed in the cells of bile duct plate and biliary epithelial cells. CONCLUSION: HNF4alpha could modulate the formation of liver bud, trigger the differentiation of hepatic stem cell towards hepatocytes, and keep the shape of hepatocytes. HNF6 might play a role at the onset of liver development, in the differentiation of hepatic stem cell towards biliary epithelial cells, and in maintaining the morphological characteristic of biliary epithelial cells.

A novel water-soluble benzothiazole derivative BD926 inhibits human activated T cell proliferation by down-regulating the STAT5 activation.

Immunosuppressants are widely used for treatment of T cell-mediated autoimmune diseases and allogeneic graft rejection. However, because of the toxicity and tolerance of these drugs, novel immunosuppressants are urgently needed. We synthesized a series of novel water-soluble benzothiazole derivatives and found that BD926 [sodium 2-(benzo[d]thiazol-2-yl)-4,5,6,7-tetrahydro-2H-indazol-3-olate] had potent immunosuppressive activity. Treatment with BD926 significantly inhibited anti-CD3/anti-CD28 and alloantigen-induced human T cell proliferation as well as IL2-stimulated activated T cell proliferation in a dose-dependent manner in vitro. BD926 had no obvious cytotoxicity against human resting T cells, IL-4 treated activated T cells and fibroblast-like synoviocytes in our experimental conditions. Furthermore, BD926 induced cell cycle arrest at G0/G1 phase and inhibited the cyclin D3 and CDK 6 expression in activated T cells. BD926 inhibited the STAT5, but not Akt and p70S6K, phosphorylation in a dose-dependent manner in the IL-2-treated activated T cells. Interestingly, BD926 inhibited IFN-γ, IL-6 and IL-17, but not IL-2, IL-4 and IL-10, production in activated T cells. Finally, treatment with BD926 reduced delayed-type hypersensitivity in mice in a dose-dependent manner. Collectively, these data suggest that BD926 may be a lead compound for the design and development of new immunosuppressants for the intervention of allograft rejection and autoimmune diseases.

Expression of parathyroid hormone (PTH)/PTH-related peptide receptor messenger ribonucleic acid in mice hair cycle.

There is increasing evidence that parathyroid hormone (PTH) and PTH-related peptide (PTHrP) are involved in normal skin cell growth, influence the proliferation and differentiation of the epidermis and hair follicle. PTHrP and PTH/PTHrP receptor show prominent cutaneous expression, may exert important paracrine and/or autocrine functions. The expression of PTH/PTHrP receptor in different stages of hair cycle is unknown. Therefore, we examined the amount of PTH/PTHrP mRNA in C57BL/6 mice skin at different stages of hair cycle by relatively quantitative reverse transcription-polymerase chain reaction (RT-PCR), and investigated the localization of this receptor in mice skin by in situ hybridization. The expression of PTH/PTHrP receptor mRNA were higher in anagen, but significantly lower in catagen and telogen. Then, the PTH/PTHrP receptor mRNA was located in the inner root sheath (IRS) in anagen and catagen, but was not detected in telogen hair follicles, although it was expressed weakly in dermis. The variety of the PTH/PTHrP receptor mRNA expression during hair cycling suggest that PTH, PTHrP and their receptors might participate in the regulation of hair cycle in mice skin.

Calophyline A, a new rearranged monoterpenoid indole alkaloid from Winchia calophylla.

Calophyline A (1), a novel unprecedented rearranged monoterpenoid indole alkaloid, along with a new natural product N-methyl aspidodasycarpine (2) and six known analogues, was isolated from the trunk barks of Winchia calophylla. The structure of compound 1 was elucidated on the basis of spectroscopic data and then confirmed by a single-crystal X-ray crystallographic analysis. A hypothetical biogenetic pathway for compound 1 was proposed. All isolated compounds were evaluated for their in vitro cytotoxicity against a small panel of human cancer cell lines.

[Expression of CD34, CD14, CD10, CD31 and factor VIII on hematopoietic cells of yolk sac blood island, AGM region and liver of human embryo and fetus].

OBJECTIVES: To study the expression of CD34, CD31, CD14, CD10 and factor VIII on blood island of yolk sac (YS), PAS/aorta-germen-mesonephros (AGM) region and hepatic hematopoietic foci. METHODS: Thirty-two cases of 3rd-12th weeks human embryo were obtained by drug abortion. Paraffin embedded sections with H.E staining and immunohistochemistry reaction (SABC) were performed. RESULTS: YS blood island of 3rd-4th weeks of gestation was consisted of two types of cells. One was vascular endothelial cells located outside and the other hematopoietic cells inside the blood island. Both the two types of cells were CD10, CD14, CD31 and factor VIII positive. Hematopoietic cells were CD34 negative, and vascular endothelial cells were CD34 positive. On 32nd days of gestation, the hematopoietic cells migrated out of YS. On 4th week of gestation, CD34, CD14, CD10, CD31 and factor VIII positive cells appeared in the aorta, mesonephros and hepatic hematopoietic foci. By the 7th week, the number of positive hematopoietic cells reached the peak. In 11th-12th weeks, most cells in these regions were matured red blood cells and were negative for all the antibodies mentioned above excepting for CD34. During 4th-12th weeks, all endothelial cells in embryo were CD34 positive. CONCLUSIONS: The hematopoietic cells and endothelial cells of YS blood island co-expressed CD10, CD14, CD31 and factor VIII. Endothelial cells were CD34 positive but hematopoietic cells were negative in YS blood island. The hematopoietic cells of aorta, mesonephros and hepatic hematopoietic foci expressed CD34, CD10, CD14 and factor VIII from 4th week to 7th week. Anti-CD34 antibody could label endothelial cells of every kinds vessels of embryo from 3rd to 12th weeks.

[A case control study on the risk factors of male infertility].

OBJECTIVE: To study the risk factors of male infertility. METHOD: Case control study including 94 cases and control group with a ratio of 1 to 1. RESULTS: The risk factors of male infertility were long time heavy smoking habit (OR = 3.45, 95% CI: 1.95 - 6.10), illegal sexual intercourse (OR = 7.29, 95% CI: 2.54 - 20.89), growing vegetable under plastic in higher temperature (OR = 6.73, 95% CI: 1.91 - 23.69), contact with benzene chemicals (OR = 20.53, 95% CI: 4.67 - 90.25) and having Ureaplasma urealyticum (Uu) infection (OR = 5.55, 95% CI: 2.28 - 13.53). CONCLUSION: Male infertility was resulted from many factors repeatedly acting on men for long time. In order to prevent male infertility, issues as environmental pollution, occupational protection need to be improved while bad working condition and risky behavior should be changed.