Application evaluation of cardiopulmonary exercise test to guide comprehensive pulmonary rehabilitation in patients with pneumoconiosis / 环境与职业医学

Background At present, the practice of pulmonary rehabilitation for pneumoconiosis in China is in a primary stage. The basis for formulating an individualized comprehensive pulmonary rehabilitation plan is still insufficient, which is one of the factors limiting the development of community-level rehabilitation work. Objective To formulate an exercise prescription based on maximum heart rate measured by cardiopulmonary exercise test (CPET), conduct an individualized comprehensive pulmonary rehabilitation program with the exercise prescription for patients with stable pneumoconiosis, and evaluate its role in improving exercise endurance and quality of life, thus provide a basis for the application and promotion of pulmonary rehabilitation. Methods A total of 68 patients were recruited from the Occupational Disease Prevention Hospital of Jinneng Holding Coal Industry Group Co., Ltd. from April to August 2022 , and were divided into an intervention group and a control group by random number table method, with 34 cases in each group. All the pneumoconiosis patients participated in a baseline test. The control group was given routine drug treatment, while the intervention group received multidisciplinary comprehensive pulmonary rehabilitation treatment on the basis of routine drug treatment, including health education, breathing training, exercise training, nutrition guidance, psychological intervention, and sleep management, whose exercise intensity was determined according to the maximum heart rate provided by CPET. The rehabilitation training lasted for 24 weeks. Patients were evaluated at registration and the end of study respectively. CPET was used to measure peak oxygen uptake per kilogram (pVO2/kg), anaerobic threshold (AT), carbon dioxide equivalent of ventilation (EqCO2), maximum metabolic equivalent (METs), and maximum work (Wmax). The modified British Medical Research Council Dyspnea Questionnaire (mMRC), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Chronic Obstructive Pulmonary Disease Assessment Test (CAT), and Short Form of Health Survey (SF-36) were used to evaluate the potential effect of the comprehensive pulmonary rehabilitation program. Results Among the included 68 patients, 63 patients were having complete data, then 31 cases were assigned in the control group and 32 cases in the interventional group. Before the intervention, there was no significant difference in pVO2/kg, AT, EqCO2, METs, or Wmax between the two groups (P>0.05). At the end of the trail, the indicators like pVO2/kg [(19.81±2.38) mL·(min·kg)−1], AT [(14.48±2.33) mL·(min·kg)−1], METs (5.64±0.69), and Wmax [(85.25±14) W] of patients in the intervention group were all higher than those [(13.90±2.37) mL·(min·kg)−1, (11.70±1.94) mL·(min kg)−1, (3.97±0.70), and (61.77±14.72) W, respectively] in the control group (P<0.001); there was no significant difference in EqCO2 between the two groups (P=0.083). Before the trial, there was no significant difference in mMRC, SAS, SDS, PSQI, or CAT scores between the two groups (P>0.05). At the end of the trail, the mMRC score (1.16±0.57), SAS score (27.93±2.12), SDS score (26.48±1.44), PSQI score (1.08±0.88), and CAT score (4.34±3.28) of patients in the intervention group were lower than those [(2.03±0.83), (35.87±6.91), (34.23±6.65), (5.37±3.03), and (13.87±7.53), respectively] in the control group (P<0.001). The SF-36 scores of bodily pain (94.13±10.72), general health (87.50±5.68), vitality (95.31±5.53), mental health (99.88±0.71), and health changes (74.22±4.42) in the intervention group were higher than those [(71.87±32.72), (65.81±15.55), (74.52±16.45), (86.97±16.56), and (29.84±13.50), respectively] in the control group (P<0.001), and no significant difference was found in social functioning and role emotional scores (P>0.05). Conclusion Comprehensive pulmonary rehabilitation can increase the oxygen intake and exercise endurance of pneumoconiosis patients, ameliorate dyspnea symptoms, elevate psychological state and sleep quality, and improve the quality of life.

Interpretation of Consensus of Chinese experts on pneumoconiosis treatment (2024) / 环境与职业医学

The most important revision of the Consensus of Chinese experts on pneumoconiosis treatment (2024) is to attach importance to antifibrotic treatment, and recommend tetrandrine and nintedanib for the treatment of silicosis and coal worker's pneumoconiosis, especially in patients with rapidly progressing silicosis. The second most important revision is a positive attitude towards lung transplantation which is recommended for patients with end-stage pneumoconiosis who do not respond to medically optimized conservative treatment as early as possible. In addition, new updates also include the addition of the application of metagenomic next-generation sequencing (mNGS) in pneumoconiosis with pulmonary infection, the diagnosis and treatment of pneumoconiosis with nontuberculous mycobacteriosis (NTM), and high-flow nasal cannula oxygen therapy (HFNC) in pneumoconiosis with respiratory failure therapies. The evidence and recommendations of the current version are assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

Consensus of Chinese experts on pneumoconiosis treatment (2024) / 环境与职业医学

@#Pneumoconiosis is the most serious occupational disease in China, and the prevention and treatment of pneumoconiosis attracts extensive social concerns. As a pulmonary interstitial fibrotic disease, pneumoconiosis is featured by disrupted lung tissue structure and impaired lung function. With available evidence on tetrandrine and nintedanib demonstrably retarding the progression of pneumoconiosis fibrosis, antifibrotic treatment of pneumoconiosis, especially rapidly progressive silicosis, should be emphasized. Pneumoconiosis patients could maintain an average level of quality of life and capabilities in social activities through comprehensive health management, early initiation of antifibrotic treatment, active prevention and treatment of pulmonary tuberculosis and other complications and comorbidities, as well as regular rehabilitation treatment and training.

Epidemiological characteristics of new pneumoconiosis in Zigong City in 2018 - 2022 / 公共卫生与预防医学

Objective To understand the epidemiological characteristics of new occupational pneumoconiosis in Zigong City from 2018 to 2022, and to provide the basis for further prevention and treatment of local pneumoconiosis. Methods The information of newly diagnosed and reported cases of pneumoconiosis in Zigong City from 2018 to 2022 was collected through the occupational disease and occupational health information monitoring system, and the characteristics of the distribution of pneumoconiosis in three regions, the composition of diseases and the length of service of exposure to dust were analyzed. Results From 2018 to 2022, the top 3 newly diagnosed pneumoconiosis diseases in Zigong City were silicosis, coal workers' pneumoconiosis and asbestosis. Silicosis cases were mainly distributed in small and medium-sized employers, accounting for 81.41%. Coal workers' pneumoconiosis was mainly distributed in large and medium-sized employers, accounting for 97.24%. Asbestosis mainly distributed in large scale employers, accounting for 96.36%. There was significant difference in dust handling age of different scale employers (H=11.453, P<0.05). The median ages of silicosis, coal workers' pneumoconiosis and other pneumoconiosis were 47.0 years, 52.0 years and 48.2 years, respectively. The median age of dust handling was 3.3 years, 22.0 years and 23.2 years, respectively. The age of onset of coal workers' pneumoconiosis was higher than that of silicosis and other pneumoconiosis (H=72.547, P<0.05), and the age of dust exposure of silicosis was shorter than that of coal workers' pneumoconiosis and other pneumoconiosis (H=10.453, P<0.05). Conclusion The current situation of pneumoconiosis in Zigong City is still severe, with obvious clustering in disease types and industries. Prevention and treatment of pneumoconiosis in key industries should be further strengthened to protect the health rights and interests of workers.

Relationship between Body Surface Area and Pulmonary Functions in Patients of Silicosis

Background and objective: Silicosis is one of the oldest occupational lung diseases. However, there are very few studies identifying the anthropometric variables associated with silicosis. The present study aimed at studying the association between body surface area (BSA), pulmonary function indices, and 6-minute walk distance (6MWD) in patients with silicosis. Materials and methods: The study was conducted on 102 male patients of silicosis. Height and weight were measured to calculate BSA. Spirometry and 6 minute-walk tests were performed. Data were analyzed using EPI info V 7 software. Student's t-test of significance (ANOVA) was applied to test the difference between means. Results: There are no significant changes found in the 6-minute walk distance with years of exposure and BSA. Statistically significant lower values of pulmonary function indices were observed in patients with BSA <1.6 sq m. Statistically significant higher values of forced expiratory volume in the first second and forced vital capacity were observed in patients with BSA >1.9 sq m in all categories of exposure. Conclusion: In conclusion, patients of silicosis with >1.9 sq m BSA had higher values of pulmonary function indices. Large body size may be of value in protection from developing occupational lung disease.

Research progress on the predictive role of serum Krebs von den Lungen-6 in pulmonary diseases / 中国职业医学

Early diagnosis of pulmonary diseases is of great significance for their prevention and treatment. Serum Krebs von den Lungen-6 (KL-6) assay can reflect the damage degree of alveolar epithelium and stromal tissue, and is simple, non-invasive and low-cost. Pervious study showed that the serum KL-6 level was higher in patients with various interstitial lung diseases (e.g. idiopathic pulmonary fibrosis and connective tissue disease, primary Sjögren's syndrome, rheumatoid arthritis, idiopathic inflammatory myopathy and systemic sclerosis combined with interstitial lung disease), non-small cell lung cancer, various pneumonias and chronic obstructive pulmonary disease compared to healthy controls. Therefore, serum KL-6 has good sensitivity and specificity for the early diagnosis of these diseases. Occupational pneumoconiosis is an interstitial lung disease with a well-established etiology. Pervious study has shown that serum KL-6 level was higher in patients with occupational silicosis, occupational asbestosis, and dust-exposed workers compared to healthy controls. However, due to the limited sample size and the inconsistent findings on different studies, further research is needed to study the role of serum KL-6 in the early diagnosis of pneumoconiosis. Future studies should increase the sample size, improve the detection methods for serum KL-6, explore its feasibility as an early diagnostic biomarker for occupational pulmonary diseases, and investigate the efficacy andvalue of its combined application with other biomarkers in the early diagnosis of various pulmonary diseases, including occupational lung diseases, to fully exploit its predictive role in pulmonary diseases.

A retrospective analysis of occupational pneumoconiosis in Zibo City from 1949 to 2021 / 中国职业医学

Objective: To analyze the base incidence, distribution characteristics, survival status and social security of occupational pneumoconiosis (hereinafter referred to as "pneumoconiosis") in Zibo City. Methods: The new pneumoconiosis patients in Zibo City from 1949 to 2021 were selected as the research subjects using a cross-sectional survey. Household survey or telephone follow-up were carried out, and the distribution characteristics, living conditions and social security situation were retrospectively analyzed. Results: A total of 8 910 patients with pneumoconiosis were investigated, and 96.0% of them were male. The stage Ⅰ pneumoconiosis patients accounted for 91.3%. From 1949 to 2021, the number of pneumoconiosis patients showed a stepwise upward trend with time. Most of the patients suffered from coal worker pneumoconiosis and silicosis, which accounted for 48.7% and 38.9%, respectively. The average age of onset was (52.7±11.4) years, and the average length of service exposed to dust was (21.1±9.4) years. The patients were concentrated in Zichuan District, Boshan District and Zhangdian District, that accounted for 87.8%. The industry distribution was mostly mining industry and manufacturing industry, accounting for 61.1% and 31.6% respectively. Among the 8 910 cases of pneumoconiosis, 543 cases were lost in follow-up. A total of 8 367 patients were followed-up, with a follow-up rate of 93.9%. The mortality rate of patients who completed follow-up was 50.5%, and the mortality rate decreased with the increase of the stage of pneumoconiosis (P<0.01). The rate of adoring social security in the 4 138 surviving patients was 98.4%. Conclusion: The situation of prevention and treatment of pneumoconiosis in Zibo City is challenging. It is necessary to strengthen the special control of dust hazards in mining and manufacturing industries in key areas such as Zichuan District, Boshan District and Zhangdian District.

Analysis of epidemiological characteristics of newly diagnosed occupational pneumoconiosis in Henan Province from 2006 to 2020 / 中国职业医学

Objective: To analyze the epidemiological distribution of new occupational pneumoconiosis (hereinafter referred as pneumoconiosis) in Henan Province from 2006 to 2020. Methods: Clinical data of newly recruited pneumoconiosis cases from 2006 to 2020 in Henan Province were retrospectively analyzed. Results: A total of 9 624 cases of newly diagnosed pneumoconiosis were reported in Henan Province in the past 15 years, of which 98.6% were males. The number of cases had two peaks, one in 2009-2011 and the other in 2014-2017. There were 12 types of pneumoconiosis of all reported cases except for mica pneumoconiosis, in which coal workers' pneumoconiosis and silicosis accounted for 96.0%. The incidence of phase Ⅰ, Ⅱ and Ⅲ pneumoconiosis was 64.7%, 21.0% and 14.3%, respectively. The incidence of phase Ⅱ and Ⅲ silicosis was higher than that of coal miners' pneumoconiosis (56.3% vs 22.7%, P<0.01). Patients with pneumoconiosis were mainly distributed in Zhengzhou City, Sanmenxia City, Luoyang City, Pingdingshan City and Hebi City, accounting for 85.0%. The enterprises involved were mainly mining industry, large- and medium-sized enterprises, state-owned enterprises and collective enterprises. The top five position of patients were coal miners, rock drillers, excavators, coal mixed workers and pure coal miners, total accounting for 72.0%. There were 196 enterprises reported ≥10 cases, accounting for 17.2% of all enterprises and 80.3% of the total of newly diagnosed pneumoconiosis cases. The median (M) of onset age of new cases was 49 years old, and the M of onset of working age was 16 years. The onset age of silicosis was younger (M: 49 vs 48 years old, P<0.05), while the onset of working age was longer (M: 10 vs 20 years, P<0.05), compared with that of coal workers' pneumoconiosis. Conclusion: The incidence of pneumoconiosis in Henan Province were disease clustering distribution, regional distribution, industry of enterprise, enterprise scale, enterprise type, nature and working position distribution of enterprises. And it showed the characteristics of group incidence. The prevention and control treatment of pneumoconiosis should be strengthened in key areas, key enterprises and key diseases and jobs.

Clinical analysis of 56 cases of occupational pulmonary thesaurosis induced by dust of iron and its compounds / 中国职业医学

Objective: To analyze the clinical characteristics and imaging features of occupational pulmonary thesaurosis induced by dust of iron and its compounds (OPTIDIC). Methods: A total of 230 cases of occupational welder's pneumoconiosis (OWP) patients or observation subjects were selected as the research subjects using the retrospective analysis method. They were diagnosed in four occupational disease diagnosis institutions in Shandong Province from 2010 to 2017. The high kV X-ray chest radiography or chest digital radiograph (hereinafter referred to as X-ray) were re-read to screen OPTIDIC patients. The clinical data of OPTIDIC patients were collected and analyzed. Results: Among the 230 cases, 56 cases were diagnosed as OPTIDIC, accounting for 24.3%. The clinical symptoms of the 56 patients with OPTIDIC were cough, sputum, chest tightness, shortness of breath, and difficulty breathing, while their physical signs were low or coarse breath sounds in lungs and others. Most of the X-ray results showed p shadows or q shadows, accounted for 98.2%, of which p/p shadow and q/q shadow accounted for 62.5%. The result of chest computed tomography (CT) showed diffuse point/round shadow and diffuse glass shadow in OPTIDIC patients. The result of fibro-bronchoscopy showed that a large amount of iron lutein particles was accumulated in macrophages and biopsy of lung showed idiopathic pulmonary hemosiderosis in OPTIDIC patients. Conclusion: The clinical characteristics of OPTIDIC patients showed no different from OWP. However, the result of X-ray of OPTIDIC patients mainly showed small circular shadows, and their CT images mainly showed diffuse point/round shadows or grinding glass shadow, which could be used to the differential diagnosis of OPTIDIC and OWP.

Utilization and influencing factors of whole lung lavage for patients with pneumoconiosis in Chinese mainland from 2018 to 2021 / 中国职业医学

Objective: To evaluate the utilization and influencing factors of whole lung lavage (WLL) for patients with pneumoconiosis. Methods: A total of 10 524 pneumoconiosis patients who sought medical treatment from 2018 to 2021 were selected as the research subjects using a combination of stratified random sampling and non-random sampling methods. The patients were from 27 provincial administrative regions of Chinese mainland (excluding Shanghai City, Tianjin City, Hainan Province and Tibet Autonomous Region). The effects of demographic and sociological characteristics, disease-related factors, and economic and social security status on WLL utilization were analyzed. Results: The WLL rate of pneumoconiosis patients was 17.8% (1 871/10 524). The main reason for promoting WLL in pneumoconiosis patients was “doctor's advice”, accounting for 65.4%； followed by “known-pneumoconiosis-patients had WLL” and “patient's recommendation”, accounting for 24.1% and 18.1%, respectively. Multivariate logistic regression analysis showed that age, body mass index, smoking index, education level, survey area, source of patients, current employment status, nature of dust-exposed unit, stage of pneumoconiosis, type of pneumoconiosis, pneumoconiosis symptoms (coughing up phlegm, chest pain, dyspnea, joint pain), contraindications to WLL (tuberculosis, pulmonary heart disease), family annual income, medical insurance for urban employees, proportion of medical insurance reimbursement, disability benefits, and social assistance were the influencing factors of WLL utilization in pneumoconiosis patients (all P<0.05). Conclusion: A large proportion of pneumoconiosis patients used WLL. The influencing factors of WLL utilization included demographic and sociological characteristics, disease-related factors, economic and social security status, and more. It is necessary to protect the interests of pneumoconiosis patients, strengthen occupational health education and health promotion for pneumoconiosis patients, standardize the use of WLL in medical institutions, and make rational use of WLL.

Epidemiological characteristics of pneumoconiosis deaths in a certain area from 1961 to 2020 / 中华劳动卫生职业病杂志

Objective: To investigate the epidemiological characteristics of pneumoconiosis deaths in Putuo District of Shanghai, and to provide evidence for prevention and management of pneumoconiosis in the future. Methods: In June 2021, the data of 263 patients with pneumoconiosis who died from January 1961 to December 2020 in Putuo District of Shanghai were retrospectively analyzed. Trend χ(2) test, analysis of variance and Spearman rank correlation methods were used to analyze the basic information, age of exposure to dust, promotion period, course of disease and direct cause of death of patients with pneumoconiosis. Results: Among the 263 cases of pneumoconiosis patients who died in Putuo District of Shanghai from 1961 to 2020, 260 cases (98.86%) were male. The main types of pneumoconiosis were foundry worker pneumoconiosis (53.23%, 140/263) and silicosis (43.73%, 115/263). The main types of pneumoconiosis were sand cleaner (36.50%, 96/263). The age of onset was (53.42±10.13) years old, the age of death was (76.14±9.12) years old, and the age of exposure to dust was (20.91±8.99) years. The duration of dust exposure was negatively correlated with the duration of disease (r(s)=-0.24, P<0.001). With the increase of pneumoconiosis stage, the mortality of silicosis and foundry worker pneumoconiosis also showed an increasing trend (χ(2)(trend)=4.22, 3.87, P=0.040, 0.049). 31.94% (84/263) of pneumoconiosis patients died directly from pneumoconiosis, ranking first among the direct causes of death. Conclusion: The death cases of pneumoconiosis in Putuo District of Shanghai are mainly foundry worker pneumoconiosis and silicosis, and pneumoconiosis is the main cause of death.

Analysis of clinical diagnostic characteristics of 26131 patients with pneumoconiosis in Hunan Province / 中华劳动卫生职业病杂志

Objective: To analyze the clinical diagnostic characteristics of pneumoconiosis patients of migrant workers in Hunan Province, and to provide scientific basis for the prevention and treatment of pneumoconiosis. Methods: In February 2022, through the Hunan Provincial Medical Treatment and Assistance Information Platform for Pneumoconiosis Migrant Workers, the cases of irresponsible subjects with pneumoconiosis that were first diagnosed clinically in Hunan Province from January 2017 to December 2021 were collected, and analyzed their gender, age, length of service, types of pneumoconiosis, stages of pneumoconiosis, and comorbidities. Results: From January 2017 to December 2021, there were a total of 26131 cases of irresponsible pneumoconiosis patients diagnosed clinically in Hunan Province, with males accounting for 99.8% (26072 cases) and an average age of (60.66±8.04) years old. Among the 26131 patients, coal workers' pneumoconiosis and silicosis were the main causes, with 16816 and 9078 cases respectively, accounting for 99.1% of the diagnosed cases. There were 8640 cases (33.1%) of stageⅠpneumoconiosis, 6601 cases (25.2%) of stage Ⅱ pneumoconiosis, and 10890 cases (41.7%) of stage Ⅲ pneumoconiosis. 2051 patients experienced complications. The average age of exposure to dust of 26131 patients was (17.81±9.69) years, and the age of exposure to dust in silicosis patients was (14.60±9.62) years. The working age of coal worker's pneumoconiosis was (19.60±9.26) years. Compared with coal workers' pneumoconiosis patients, silicosis patients had a shorter working time exposed to dust, and the difference was statistically significant (P<0.05) . Conclusion: Coal workers' pneumoconiosis and silicosis are mainly diagnosed for the first time in migrant workers' pneumoconiosis patients in Hunan Province. Pneumoconiosis patients should be diagnosed in time, which is conducive to treatment and rehabilitation.

Investigation on medical security and quality of life of migrant workers with pneumoconiosis / 中华劳动卫生职业病杂志

Objective: To investigate and understand the medical security and quality of life of migrant workers with pneumoconiosis, so as to provide scientific basis for the prevention and control countermeasures of migrant workers with pneumoconiosis and targeted poverty alleviation. Methods: Using a stratified random sampling method, 200 migrant workers diagnosed with pneumoconiosis at the Shandong Academy of Occupational Health and Occupational Medicine from January 2016 to December 2021 were selected as the observation group, while 200 non migrant workers diagnosed with pneumoconiosis were selected as the control group. St. George's Respiratory Questionnaire (SGRQ) and Pneumoconiosis Questionnaire were used to collect and compare information on the age, working age of dust exposure, economic sources, employment status, income, medical security and quality of life of two groups of patients. Results: The age of migrant worker pneumoconiosis patients in the observation group was (58.1±8.1) years old, and the working age of dust exposure was (19.3±10.1) years. The main source of income was children support (85.5%, 171/200), employment status was mainly wait for employment or unemployed (69.0%, 138/200), personal monthly income was mainly non income (90.0%, 180/200), and family annual income was mainly less than 10000 yuan (48.0%, 96/200). The average personal annual medical expenditure of 5000-<10000 yuan accounted for 42.0% (84/200). The age of pneumoconiosis patients in the control group was (59.2±8.9) years old, and the working age of dust exposure was (20.2±10.5) years. The main source of income was retirement pension or salary (99.0%, 198/200), with retirement as the main employment status (66.0%, 132/200), the main personal monthly income was 2000-<4000 yuan (61.5%, 123/200), the main family annual income was 20000-<40000 yuan (44.0%, 88/200), and the average personal annual medical expenditure was mostly non-expenditure (92.0%, 184/200). There were statistically significant differences in the distribution of economic sources, employment status, personal monthly income, family annual income and average personal annual medical expenditure between the two groups (P<0.001). The main type of insurance for the observation group was rural cooperative medical care (68.5%, 137/200), and 87.0% (174/200) had no medical reimbursement and a proportion less than 50%. There were statistically significant differences in insurance type and medical reimbursement proportion between the two groups (P<0.001). The respiratory symptoms, activity ability, daily life influence and total quality of life scores of pneumoconiosis patients in the observation group were significantly higher than those in the control group, the differences were statistically significant (P<0.001) . Conclusion: Migrant workers with pneumoconiosis have low income, high medical expenditure, low medical reimbursement proportion and poor quality of life. Therefore, it is necessary to draw high attention from relevant departments and provide timely attention and assistance to improve the quality of life of migrant workers with pneumoconiosis.

Analysis of the disease burden of pneumoconiosis globally and in China from 1990 to 2019 / 中华劳动卫生职业病杂志

Objective: To analyze the disease burden of pneumoconiosis globally and in China from 1990 to 2019 using Global Burden of Disease (GBD) 2019 data, and to provide a theoretical basis for prevention and control of pneumoconiosis. Methods: In September 2022, the data of incidence, prevalence, morality and disability-adjusted life years (DALY) of pneumoconiosis and its subtypes globally and in China from 1990 to 2019 were collected from GBD 2019, including absolute number and age-standardized rate (ASR). Joinpoint linear regression model was used to calculate average annual percent change (AAPC) and analyze the change trends of incidence, prevalence, mortality and DALY of pneumoconiosis and its subtypes. Results: From 1990 to 2019, the incident cases, prevalent cases and DALY value of pneumoconiosis showed upward trends, while the number of death cases showed downward trends. And the ASR of incidence (ASIR), the ASR of prevalence (ASPR), the ASR of mortality (ASMR) and the ASR of DALY (ASDR) showed downward trends globally and in China. China accounted for a large proportion of the global disease burden of penumoconiosis, accounting for more than 67% of the incident cases, more than 80% of the prevalent cases, more than 43% of the deaths cases and more than 60% of the absolute number of DALY in the world every year. Male were the main population of pneumoconiosis disease burden globally and in China, and the age of onset was earlier than that of female. The peak age periods of incidence, prevalence, mortality and DALY of pneumoconiosis globally and in China from 1990 to 2019 have increased. Silicosis was still the type with the highest disease burden of pneumoconiosis globally and in China. The disease burden of coal workers' pneumoconiosis had an overall improvement trend, but asbestosis had an increasing disease burden worldwide. Conclusion: The disease burden of pneumoconiosis is heavy globally and in China, which is necessary to strengthen the supervision and prevention measures according to gender, age and etiological types.

A case of stage Ⅲ pneumoconiosis with large shadow by burr-like changes misdiagnosed as lung cancer / 中华劳动卫生职业病杂志

Pneumoconiosis is characterized by chronic lung inflammation and fibrosis, and inflammation can promote pulmonary fibrosis, which in turn leads to pneumoconiosis. When a large shadow with a long diameter of not less than 2 cm and a short diameter of not less than 1 cm appears in the lung, it can be classified as stage Ⅲ pneumoconiosis. This paper reports a case of stage Ⅲ pneumoconiosis with a large shadow in the upper right lung accompanied by burr-like changes misdiagnosed as lung cancer by CT examination.When the large shadow lesions in patients with pneumoconiosis and lung cancer are difficult to distinguish on CT, an additional MRI examination, particularly T(2)W imaging sequence is useful sequence for identifying the two.

Analysis of disease burden of occupational pneumoconiosis in Gansu Province from 2010 to 2020 / 中华劳动卫生职业病杂志

Objective: Through comparative analysis of the disease burden of occupational pneumoconiosis in Gansu Province from 2010 to 2020, the main influencing factors are screened, and scientific basis is provided for rational allocation of limited health resources, precise management and policy implementation. Methods: In August 2021, survey and collect information on surviving occupational pneumoconiosis patients and dead occupational pneumoconiosis patients diagnosed in Gansu Province from 2010 to 2020, and analyze and calculate indicators such as morbidity, mortality, and disability adjusted of life years (DALY). Analyzing the influencing factors of disease burden usirrg multiple linear regression. Results: From 2010 to 2020, the average annual incidence of occupational pneumoconiosis in Gansu Province was 0.9992/100000, the average annual mortality was 0.897/100000, the cumulative case fatality rate was 25.75%, and the cumulative DALY was 28932.96 person-years. The first stage of occupational pneumoconiosis was the highest among DALY loss (19920.14 person-years), and the DALY loss was positively correlated with the stage of occupational pneumoconiosis. Among occupational pneumoconiosis in Gansu Province, silicosis (13753.66 person-years) and coal worker's pneumoconiosis (13414.73 person-years) caused the highest disease burden, followed by cement pneumoconiosis and asbestos lung. Period, length of service, type of disease, and region are all influencing factors of DALY loss (P<0.05). Conclusion: From 2010 to 2020, the DALY losses caused by occupational pneumoconiosis in Gansu Province showed a fluctuating decrease, with the composition of DALY mainly changing from the loss of life years due to premature death to the loss of years due to injury and disability.

Structural characteristics of lower respiratory tract microflora in patients with pneumoconiosis / 中华劳动卫生职业病杂志

Objective: To explore the composition of bacteria in lower respiratory tract of patients with pneumoconiosis and dust exposure, and to compare and analyze the difference and correlation between them. Methods: From May 2020 to January 2021, a prospective multicenter cross-sectional study was conducted to select patients with pneumoconiosis who underwent bronchoalveolar lavage treatment at the Respiratory and Critical Care Medical Department of the 920th Hospital of the Joint Support Force and the Respiratory Department of Tongren Hospital in Kunming, as well as the population of dust recipients. A total of 24 patients with pneumoconiosis (pneumoconiosis group) were included, and 16 dust exposed individuals (dust exposed group) were used as controls. Two groups of patients' alveolar lavage fluid were collected. The 16SrRNA gene V3-V4 sequencing technology and bioinformatics analysis platform were used to measure and analyze the differences in microbial structure composition and associations between bacterial communities. Results: Compared with the dust exposed group, the top 5 bacterial phyla in the alveolar lavage fluid level of patients with pneumoconiosis were the same, followed by Proteobacteria, Firmicutes, Bacteroidetes, Fusobacteria, and Actinobacteria. Compared with the dust exposure group, the pneumoconiosis group patients belong to the top 5 genera of horizontal flora abundance, which are different. The dust exposure group is respectively: Pseudomonas, Proctor, Streptococcus, Achromobacter, and Neisseria. The pneumoconiosis group is respectively: Pseudomonas, Achromobacter, Streptococcus, Ralstonia, and Proctor. The Alpha diversity analysis results showed that compared with the dust exposed group, the level of bacterial diversity in the pneumoconiosis group was difference (P<0.05), and there was no statistically significant difference in bacterial evenness (P>0.05) ; Beta diversity showed differences in microbial community structure between the two groups (P<0.05 ). Single factor microbial association network analysis showed that there was a high correlation between Firmicutes and Bacteroidetes in the pneumoconiosis and dust exposed groups and other species, showing a positive correlation; The correlation between Proteobacteria and other species is high, showing a negative correlation. Conclusion: The structure and relative abundance of bacteria in lower respiratory tract were different between patients with pneumoconiosis and dust exposure, and the diversity of bacteria in lower respiratory tract increased in patients with pneumoconiosis, which may be related to disease status.

Analysis of the prevalence and social security situation of pneumoconiosis in non-coal mine industry in Jiangsu Province / 中华劳动卫生职业病杂志

Objective: To understand the social security situation of current cases of pneumoconiosis in non-coal mine industries in Jiangsu Province, and to provide reference for the treatment and security work of pneumoconiosis patients. Methods: From January to October 2020, a follow-up survey was conducted on 4038 cases of pneumoconiosis in non-coal mine industries of the province from October 1949 to December 2019. The age, type of pneumoconiosis, industry type, and social security status of the patients were collected. Namely, work-related injury insurance, employer compensation, basic medical insurance for urban and rural residents, major illness insurance, etc. SPSS 19.0 was used for statistical description and analysis. Results: The cases of pneumoconiosis in non-coal mine industries in Jiangsu Province ranged in age from 36 to 105 (70.78±8.43) years old, and had been exposed to dust for 1 to 55 (19.27±9.29) years. Silicosis was the main form (3875 cases, 95.96%), and non-metallic mining and dressing industry was the main form (2618 cases, 64.83%). A total of 3991 cases (98.84%) of pneumoconiosis patients enjoyed social security, most of them were urban and rural residents with basic medical insurance (3624 cases, 89.75%), but there were still 47 patients without any social security. 15 cases (0.37%) enjoyed the subsistence allowance, with the monthly allowance amount ranging from 104 to 3960 yuan, with the average amount of 954.87 yuan/month. Conclusion: In Jiangsu Province, the proportion of pneumoconiosis patients in non-coal mine industries enjoying social security is relatively high, but there are still patients who do not enjoy any social security, and the difference in the amount of subsistence allowance is slightly larger. It is necessary to further improve the medical security of pneumoconiosis patients and improve their quality of life.

Drug clinical comprehensive evaluation of tetrandrine in the treatment of pneumoconiosis / 中华劳动卫生职业病杂志

Objective: To analyze the safety, effectiveness, economics, innovation, suitability and accessibility of tetrandrine in the treatment of pneumoconiosis, and provide evidence-based basis for health policy decision-making and clinical practice. Methods: In July 2022, the system searched PubMed, Embase, the Cochrane Library, CNKI, Wanfang, SinoMed databases (the retrieval time was from the establishment of the database to June 30, 2022), screened the documents that meet the standards, extracted and evaluated the data, and used the "HTA checklist" developed by the International Network of Agencies for Health Technology Assessment (INAHTA) to evaluate the HTA report. AMSTAR-2 Scale was used to evaluate the quality of systematic evaluation/Meta analysis. CHEERS Scale was used to evaluate the quality of pharmacoeconomics research. The included cohort study or case-control study was evaluated with the Newcastle-Ottawa Scale. The included randomized controlled trial (RCT) studies were evaluated using the Cochrane Risk Bias Assessment Tool (Cochrane RCT) quality evaluation criteria. Comprehensive comparison and analysis based on the characteristics of the data included in the study. Results: A total of 882 related literatures were detected from the initial screening. According to relevant standards, 8 RCT studies were finally selected for analysis. Statistical results showed that basic treatment with tetrandrine could better improve FEV(1) (MD=0.13, 95%CI: 0.06-0.20, P<0.001), FEV(1)/FVC (MD=4.48, 95%CI: 0.61-8.35, P=0.02) and clinical treatment efficiency. Tetrandrine had a low incidence of adverse reactions. The affordability coefficient of tetrandrine tablets was 0.295-0.492. Conclusion: Tetrandrine can improve the clinical symptoms and pulmonary ventilation function of pneumoconiosis patients, most of the adverse reactions are mild, and the clinical application is safe.

Application of a light-weighted convolutional neural network for automatic recognition of coal workers' pneumoconiosis in the early stage / 中华劳动卫生职业病杂志

Objective: To construct and verify a light-weighted convolutional neural network (CNN), and explore its application value for screening the early stage (subcategory 0/1 and stage Ⅰ of pneumoconiosis) of coal workers' pneumoconiosis (CWP) from digital chest radiography (DR) . Methods: A total of 1225 DR images of coal workers who were examined at an Occupational Disease Prevention and Control Institute in Anhui Province from October 2018 to March 2021 were retrospectively collected. All DR images were collectively diagnosed by 3 radiologists with diagnostic qualifications and gave diagnostic results. There were 692 DR images with small opacity profusion 0/- or 0/0 and 533 DR images with small opacity profusion 0/1 to stage Ⅲ of pneumoconiosis. The original chest radiographs were preprocessed differently to generate four datasets, namely 16-bit grayscale original image set (Origin16), 8-bit grayscale original image set (Origin 8), 16-bit grayscale histogram equalized image set (HE16) and 8-bit grayscale histogram equalized image set (HE8). The light-weighted CNN, ShuffleNet, was applied to train the generated prediction model on the four datasets separately. The performance of the four models for pneumoconiosis prediction was evaluated on a test set containing 130 DR images using measures such as the receiver operating characteristic (ROC) curve, accuracy, sensitivity, specificity, and Youden index. The Kappa consistency test was used to compare the agreement between the model predictions and the physician diagnosed pneumoconiosis results. Results: Origin16 model achieved the highest ROC area under the curve (AUC=0.958), accuracy (92.3%), specificity (92.9%), and Youden index (0.8452) for predicting pneumoconiosis, with a sensitivity of 91.7%. And the highest consistency between identification and physician diagnosis was observed for Origin16 model (Kappa value was 0.845, 95%CI: 0.753-0.937, P<0.001). HE16 model had the highest sensitivity (98.3%) . Conclusion: The light-weighted CNN ShuffleNet model can efficiently identify the early stages of CWP, and its application in the early screening of CWP can effectively improve physicians' work efficiency.