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As occupational health work enters a new era, the diagnosis and identification of occupational diseases, that are closely related to the protection of workers′ health rights, require higher and newer standards. In 2021, the National Health Commission of the People′s Republic of China revised and issued the Administrative Measures for the Diagnosis and Verification of Occupational Diseases to improve and perfect the original diagnosis and verification system of occupational diseases. These measures clarify the time limit for diagnosis of occupational diseases and shorten the time limit for identification of occupational diseases; and strengthen the main responsibility of the employer. This new system design is more operable. It embodies the management idea of Streamline administration, delegate power, combine decentralization, and optimize services. The language expression is more accurate and standardized. The revision of the Administrative Measures for Diagnosis and Verification of Occupational Disease is conducive to improving the efficiency of occupational disease diagnosis and protecting the rights and interests of workers. It is conducive to strengthening the supervision and management of occupational disease diagnosis institutions and occupational disease verification offices by administrative supervision and management departments. It is conducive to strengthening the responsibilities of employers. However, there are some problems: Article No. 28 sets up obstacles to the realization of legal value, which does not clearly stipulate the concept of new evidence. The effective time of this regulation has caused difficulties for occupational disease diagnosis institutions and occupational disease verification offices. It is recommended that this regulation can be further improved in the future revisions.
ABSTRACT
In the process of occupational disease diagnosis and verification, the rule of inversion of proof is implemented. The purpose of proof is to solve the causal relationship between occupational hazardous factors and occupational diseases in the workplace, and its essence is the responsibility for consequences. However, in the practice of diagnosis and verification of occupational diseases, there are many difficulties in the application of the rule of inversion of burden of proof, which is dare not apply, difficult to apply, and wrong application might occur. Satisfying probability is the premise for the application of the rule of inversion of burden of proof. The relevant judgment of evidence is the basic way to apply the rule. Optimize the article 28 of Administrative Measures for Diagnosis and Verification of Occupational Diseases, delete the precondition “urged by health authorities”, that is an important guarantee for the accurate application of the rule. To clarify the nature of the burden of proof, correctly apply and optimize the rules of proof in the practice of diagnosis and verification occupational diseases, further improve the legislation, and promote the accurate application of the relevant legal system are conducive to protecting the rights and interests of workers in occupational health and implementing the principal responsibility of employers for occupational disease prevention and control.
ABSTRACT
Silica dust is one of the main occupational hazards in various industries. In addition to causing occupational silicosis, silica dust can also stimulate innate and acquired immunity and induce autoimmune diseases(AID) such as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, and antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis. Silica dust exposure can induce changes in the levels of autoantibodies in vivo, such as rheumatoid factor, antinuclear antibody, ANCA, anti-centromere antibody, anti-topoisomerase Ⅰ antibody, anti-desmoglein antibody, anti-centromere antigens-B antibody, anti-carbamylated protein antibody, anti-smooth muscle antibody and anti-glomerular basement membrane antibody. At present, the mechanism of autoimmune disorders induced by silica dust has not yet been fully elucidated. The current research suggests that it is related to cell apoptosis of alveolar macrophages, the disorder of the Fas/Fas ligand system, the imbalance of T cell proportion, and the dysregulation of T helper cell(Th) 1 and Th2 type cytokines homeostasis. Understanding the pathogenesis of autoimmune disorders induced by silica dust and exploring possible therapeutic targets will provide new ideas for the treatment of silicosis.
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The tasks and directions of occupational health works in the new era mainly include three aspects: actions for pneumoconiosis prevention and treatment, risk assessment of occupational health and construction of healthy enterprises. These three aspects exist independently, but they are interrelated, constituting the work support, reflecting the work characteristics, features and direction of different stages of occupational health works. It is necessary to establish a new of ″trinity″ with these three aspects of occupational health works, emphasize the prevention and treatment of pneumoconiosis, promote the occupational health risk assessment and the construction of healthy enterprises. However, as poverty alleviation becomes a past, occupational health risk assessment might be underestimated, and the construction of healthy enterprises might be neglected, the task of occupational health remains laborious. Accelerating the implementation of occupational health protection action is a requirement of the era. It is also the direction of occupational disease prevention and treatment, and the duty of occupational prevention personnel, that must be fully promoted in the right direction.
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OBJECTIVE: To explore the essential conditions and principles of conclusion for suspected occupational disease in order to protect the rights and interests of worker. METHODS: In reference to the legal concept interpretation and the principle of rights remedy,suspected occupational disease was defined,and the related judging organizations,decision criteria and reporting procedures were analyzed. RESULTS: Suspected occupational disease might be defined as the disease state in a specific time period when the preliminary diagnosis of suspected occupational disease was made by the occupational health examination institutions or occupational disease diagnosis organizations,without definite diagnosis by the occupational disease diagnosis organizations and no conclusion of occupational disease diagnosis( identification). We recommended that the conclusion of suspected occupational disease should be made by the occupational health examination institution and occupational disease diagnosis organization according to the criteria of occupational disease diagnosis. The suspected occupational disease should be reported based on the regulation and standard of occupational disease diagnosis.CONCLUSION: The determination of suspected occupational diseases should be strict,and the medical institutions which can make diagnostic conclusion of suspected occupational disease and the relevant requirements should be clear. The diagnostic criteria of suspected occupational disease and reporting procedures should be standardized.
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Objective: To discuss the relationship between defunctionign stoma in low anterior resection for rectal carcinoma and the incidence of anastomotic leakage. Methods: Totally 270 patients who received low anterior resection for rectal carcinoma (with the distance between anastomosis and anal edge being 6 cm or less) from Jan. 2005 to Oct. 2006 were included in the present study. Defunctioning stoma was performed in 113 (41.9%) patients considered with high risk of anastomotic leakage. The clinicopathological data were used to construct database. SPSS 10.0 software was used to analyze the incidences of anastomosis leakage in patients with and without receiving defunctioning stoma. Results: There were 20(7.4%) leakages in the 270 cases. The symptoms included abdominal pain(37%) increase of pulse(53%), fever(47%), leukocytosis(53%), pelvic fluid properties change(68%), anal discharge of bloody fluid (26%) and others (10%). The average age of patients with leakage was 57.8 years. No death was caused by anastomotic leakage. Four(3.5%) leakages happened in defunctioning stoma group, and 16 (10.2%) leakages happened in non-stoma group(P = 0.04). Eighteen(75%) of the 24 patients with preoperative radiotherapy history received defunctioning stoma and none of them had leakage. Two of the 6 cases who had preoperative radiotherapy history receiving no defunctioning stoma had anastornotic leakages; the fisher exact probability test showed P = 0.054. The leakage rate was 4.9% (7 cases) in 142 cases who had received protective measures during low anterior resection and the rate was 10.2% (13 cases) in the rest 1.28 cases who had not received any protective measures (P = 0.10). Leakages subsided with conservative treatment in the 4 patients with stoma, but 8 patients without stoma had severe symptoms and required surgical intervention; one developed peritonitis. The average fasting periods were significantly different between the 2 groups (P<0.01). The postoperative obstruction incidence (P=0.24) and hospitalization stay(P=0.91) were not significantly different between the 2 groups. Conclusion: Anastomotic leakage is still the most important complication of anterior resection for rectal cancer, and a defunctioning stoma can undoubtedly reduce the rate of anastomotic leakage in high-risk patients. It is suggested that all the anterior resection cases with anastomotic height of or less than 6 cm should be considered for defunctioning stoma.
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<p><b>OBJECTIVE</b>To observe the impact of specific short hairpin RNA (shRNA) targeting survivin gene on tumorigenesis and angiogenesis of human brain glioblastoma U251 cells in vivo of nude mice.</p><p><b>METHODS</b>U251 cells, U251-SR cells transfected stably with shRNA eukaryotic expression vector pWH1-SR targeting survivin gene, and U251-P cells transfected stably with blank pWH1 vector, were inoculated respectively into subcutaneous tissue in flank of 15 nude mice (each group 5 mice), and the tumor growth status was observed and measured. Protein expressions of survivin, proliferating cell nuclear antigen (PCNA) and factor VIII related antigen (F VIII RAg) were investigated by immunohistochemistry SABC method, apoptotic cells were screened by TUNEL method, furthermore proliferative index (PI), apoptotic index (AI) and microvessel density (MVD) were measured respectively in each group of tumor specimens.</p><p><b>RESULTS</b>Comparing with those in U251 and U251-P groups, in U251-SR group, the tumorigenesis time delayed, tumor grew slowly, both tumor volume and tumor weight decreased significantly (P < 0.01 for both); Survivin protein expression was down-regulated markedly; PI and MVD decreased significantly, whereas AI increased remarkably (P < 0.01 for all).</p><p><b>CONCLUSIONS</b>The specific shRNA targeting survivin gene can inhibit significantly tumorigenesis and angiogenesis of U251 cells in vivo.</p>
Subject(s)
Animals , Female , Humans , Male , Mice , Apoptosis , Brain Neoplasms , Metabolism , Pathology , Cell Line, Tumor , Glioblastoma , Metabolism , Pathology , Inhibitor of Apoptosis Proteins , Mice, Nude , Microtubule-Associated Proteins , Genetics , Neoplasm Transplantation , Neovascularization, Pathologic , Pathology , RNA Interference , RNA, Small Interfering , Genetics , Repressor Proteins , TransfectionABSTRACT
<p><b>OBJECTIVE</b>To explore the diagnosis and treatment of the cholangiocarcinoma.</p><p><b>METHODS</b>Forty one patients with cholangiocarcinoma who were enrolled in our hospital from January 1970 to January 2005 were retrospectively analyzed.</p><p><b>RESULTS</b>Among these 41 patients, the 1, 3, and 5-year survival rate was 82.3%, 45.8%, 45.8%, respectively, with radical operation, and was 11.0%, 0, 0 with non-radical operation (chi2 = 21.38, P < 0.01). The 1-year and 3-year survival rate was 11.0% and 0 in 9 patients treated with laparatomy, which was not significantly different from those treated with non-radical operation (chi2 = 0.02, P = 0.89). Four patients did not receive operation and all died within one year. Among 25 patients who did not experience lymph node metastasis, the 1, 3, and 5-year survival rate was 58.4%, 27.3%, and 27.3%. Among 16 patients who were found lymph node metastasis, the 1-year and 3-year survival rate was 61.8% and 0 (chi2 = 13.85, P < 0.01).</p><p><b>CONCLUSION</b>Operation is the most effective treatment for cholangiocarcinoma. Radical operation is the only curative treatment.</p>