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.

Analysis of incidence characteristics and trend of pneumoconiosis in Ningbo City from 1967 to 2019 / 中华劳动卫生职业病杂志

Objective: To understand the incidence of pneumoconiosis in Ningbo city from 1967 to 2019, and to analyze the distribution characteristics and change trend of pneumoconiosis. Methods: In February 2021, the data of pneumoconiosis patients in Ningbo city from 1967 to 2019 were sorted out. The data from 1967 to 1987 were from historical case files of Zhejiang Center for Disease Control and Prevention, the data from 1988 to 2005 were from the historical case files of Ningbo Center for Disease Control and Prevention, and the data from 2006 to 2019 were from the pneumoconiosis report card in China Disease Prevention and Control Information System; Followed up and supplement relevant information, including basic information, basic information of employers and information related to pneumoconiosis diagnosis, and comprehensively analyze the composition and development trend, population characteristics and industry characteristics of pneumoconiosis. Results: From 1967 to 2019, a total of 1715 cases of pneumoconiosis were reported in Ningbo City, including 1254 cases of stageⅠpneumoconiosis, 258 cases of stageⅡpneumoconiosis, 172 cases of stage Ⅲpneumoconiosis. 1202 cases of silicosis (70.09%) , 296 cases of asbestosis (17.26%) , 40 cases of welder's pneumoconiosis (2.33%) , 32 cases of graphite pneumoconiosis (1.87%) were reported. There were 1296 male cases (75.57%) and 419 female cases (24.43%) were reported. Silicosis (91.15%, 1102/1209) and welder's pneumoconiosis (100.00%, 40/40) were the most common pneumoconiosis in males, while asbestosis (90.24%, 268/297) and graphite pneumoconiosis (87.50%, 28/32) were the most common pneumoconiosis in females. The average age was (49.71±10.90) years old and the average length of service was (10.98±6.96) years. The top three reported pneumoconiosis cases were construction industry (336 cases, 19.59%) , ferrous metal smelting and rolling industry (317 cases, 18.48%) and non-metallic mineral products industry (315 cases, 18.37%) . The top three reported pneumoconiosis cases were 414 cases (24.14%) in Ninghai County, 294 cases (17.14%) in Yuyao City and 272 cases (15.86%) in Yinzhou District. Conclusion: With the development of industries in Ningbo City, government departments should strengthen supervision and management of enterprises involving silica dust and welding fume to curb the high incidence of pneumoconiosis.

Chest high-resolution CT features analysis in predicting the progression of asbestosis / 中华劳动卫生职业病杂志

Objective: To analyze the radiological characteristics of chest high-resolution computed tomography (HRCT) of patients with asbestosis, and to investigate the signs of predicting the disease progression of asbestosis. Methods: A prospective method was used to enroll 68 patients with asbestosis who were regularly followed up from 2013 to 2016. The radiological characteristics of patients with asbestosis were described by the International Classification of HRCT for Occupational and Environmental Respiratory Diseases (ICOERD) , and the differences between patients with and without progression were compared during the observation period. The Cox proportional hazards regression model was used to analyze the chest HRCT radiological signs predicting the progression of asbestosis. Results: The study included 68 patients with asbestosis aged (65.5±7.8) years old, of which 64.7% (44/68) were female, 29.4% (20/68) had a history of smoking. There was no significant difference in age, sex, smoking and asbestos exposure between patients with progressive asbestosis (20.6%, 14/68) and patients without progressive asbestosis (79.4%, 54/68) (P>0.05) . Chest HRCT of patients with asbestosis showed irregular and/or linear opacities, of which 5.9% (4/68) were accompanied by honeycombing. Irregular and/or linear opacities were mainly lower lung preponderant, often accompanied with ground glass opacity and mosaic perfusion. 98.5% (67/68) had pleural abnormalities, of which 39.7% (27/68) had diffuse pleural thickening with parenchymal bands and/or rounded atelectasis. The analysis of multivariable Cox proportional hazard regression showed that the risk of the progression of asbestosis was increased with higher irregular and/or linears opacities cores (HR=1.184, 95%CI: 1.012-1.384, P=0.034) and the appearance of honeycombing (HR=6.488, 95%CI: 1.447-29.097, P=0.015) . Conclusion: The irregular and/or linear opacities scores and honeycombing on chest HRCT are independent influencing factors for predicting the disease progression of asbestosis.

Mesotelioma en paciente colombiano con sobrevida mayor a tres años: presentación de caso / Mesothelioma in a Colombian Patient over three years: Case Presentation / Mesotelioma em paciente colombiano com sobrevivência superior a três anos: apresentação de caso

Resumen Introducción: el mesotelioma epitelioide es un tumor que se desarrolla en las capas embrionarias mesoteliales; es de etiología desconocida, pero se relaciona con la exposición al asbesto, con una presentación clínica inespecífica y con un pronóstico de sobrevida corto después del diagnóstico. Presentación del caso: hombre de profesión mecánico automotor, con tos sin expectoración, disnea, hipertermia y emaciación posterior a la extracción quirúrgica de lipomas que afectaban el tórax, quien posteriormente fue diagnosticado con mesotelioma epitelioide maligno con ubicación en la pleura del hemitórax derecho y fue tratado con toracotomía, quimioterapia con los medicamentos pemetrexed y cisplatino y sesiones de radioterapia, que mostraron un aumento en la sobrevida 3 tres años. Conclusión: este caso permitió identificar que el uso de la pleurodesis química con quimioterapia como tratamiento podría ser responsable del aumento de la esperanza de vida y la calidad de esta en los pacientes que padecen este tipo de tumor.

Abstract Introduction: Epithelioid mesothelioma is a tumor that develops in the mesothelial embryonic layers; it is of an unknown etiology, but it is related to asbestos exposure with a nonspecific clinical presentation and a short survival prognosis after diagnosis. Case presentation: An automotive mechanic patient presents with cough without expectoration, dyspnea, hyperthermia, and emaciation following surgical removal of lipomas. This affected the chest and the patient was subsequently diagnosed with malignant epithelioid mesothelioma located in the pleura of the right hemithorax. The patient was treated with thoracotomy, chemotherapy with the drugs pemetrexed and cisplatin, and radiation therapy sessions which resulted in an increased survival rate at 4 years. Conclusion: This case report identifies the use of chemical pleurodesis in combination with chemotherapy as an effective treatment for increasing the life expectancy and quality of life in patients suffering from this type of tumor.

Resumo Introdução: o mesotelioma epitelióide é um tumor que se desenvolve nas camadas embrionárias mesote-liais; é de causa desconhecida, mas está relacionado com a exposição ao amianto e possui uma manifestação clínica inespecífica e com prognóstico de sobrevivência curto após o diagnóstico. Apresentação do caso: o paciente é um mecânico automotivo, que apresentou tosse seca, dispneia, hipertermia e emagrecimento posterior a extração cirúrgica de lipomas que afetavam o tórax sendo posteriormente diagnosticado com mesotelioma epitelióide maligno localizado na pleura do hemitórax direito e foi tratado com toracotomia, quimioterapia com os medicamentos pemetrexed e cisplatino além de sessões de radioterapia, mostrando um aumento de expectativa de vida para 4 anos. Conclusão: este estudo de caso permite identificar que o uso da pleurodese química com quimioterapia como tratamento poderia ser a responsável pelo aumento da expectativa e qualidade de vida em pacientes acometidos por este tipo de tumor.

Câncer de pulmão no Brasil: relação com fatores sociais e exposição ao asbesto / Lung cancer in Brazil: relationship between social factors and exposure to asbestos

INTRODUÇÃO: O conhecimento científico sobre causas de morte em trabalhadores potencialmente expostos ao asbesto em países de baixa ou média renda, como o Brasil, é escasso, mas importante para reforçar informações que levem à implementação de políticas públicas que protejam a população da exposição a esse cancerígeno. São várias as doenças reconhecidas como causalmente associadas ao asbesto pela IARC, entre elas o câncer de pulmão. OBJETIVOS: Explorar a desigualdade socioeconômica nas tendências de mortalidade por câncer de pulmão no Brasil. Estudar a mortalidade geral e específica por causa de morte, com ênfase em câncer de pulmão, em populações expostas ao asbesto no Brasil. MÉTODOS: Esta tese está dividida em três manuscritos. MANUSCRITO 1: Foram recuperados registros de óbito por câncer de pulmão de 2000 a 2015 em adultos com 30 anos ou mais. As análises utilizaram regressão linear generalizada de Prais-Winsten e correlação de Pearson. A correlação entre as taxas de mortalidade por câncer de pulmão e o IDH diminuiu quando comparada às taxas do primeiro e do último ano da série histórica em ambos os sexos. Entretanto, a correlação entre as tendências nas taxas de mortalidade por câncer de pulmão e o IDH foi negativa em homens (r = -0,76) e em mulheres (r = -0,58), indicando maiores reduções (ou menores acréscimos) entre as Unidades Federativas com o IDH mais alto. Os resultados apontam para uma relevante desigualdade na tendência de mortalidade por câncer de pulmão no Brasil. MANUSCRITO 2: Foram recuperados registros de óbito por câncer de pulmão de 1980 a 2016 em adultos com 60 anos ou mais e estimadas a mudança percentual anual média (AAPC) e o efeito idade-período-coorte. Entre os homens, houve uma tendência crescente na mortalidade por câncer de pulmão em Osasco de 0,7% (IC: 0,1; 1,3), em contraste com uma redução anual média para Sorocaba de -1,5% (IC: -2,4; -0,6) e uma tendência média estável para o estado de São Paulo de -0,1 (IC: -0,3; 0,1). O modelo idade-período-coorte mostrou um aumento no risco de morte a partir de 1996 em Osasco e uma redução para Sorocaba e São Paulo no mesmo período. Um monitoramento especial é necessário em relação à incidência e mortalidade por câncer de pulmão em áreas com maior exposição ao asbesto. MANUSCRITO 3: Foi realizado um estudo de coorte com 988 ex-trabalhadores homens, que contribuíram com um total de 12.217 pessoas-ano de observação. A razão de mortalidade padronizada (RMP) por idade, empregando o método indireto, foi calculada para homens com 30 anos e mais. Foram observadas RMP aumentados para mortalidade geral (RMP 1,1, IC 95% 0,98-1.23), câncer de pleura (RMP 69,4, IC 95% 22,55 a 162,1), câncer de peritônio (RMP 5,0, IC 95% 0,13 a 27,78), câncer de laringe (RMP 1,4, IC 95% 0,30 a 4,20), câncer de pulmão (RMP 1,5, IC 95% 0,82 a 2,64) e asbestose (RMP 975,7, IC 95% 396,4 a 2031). Os resultados do presente estudo são consistentes com estudos de mortalidade em trabalhadores expostos ao asbesto realizados em diferentes países.

INTRODUCTION: Scientific knowledge about causes of death in workers potentially exposed to asbestos in low-or middle-income countries, such as Brazil, is scarce but important to strengthen information leading to the implementation of public policies that protect the population from the exposure to this carcinogen. Several diseases are recognized by the International Agency for Research on Cancer as causally associated with asbestos, such as lung cancer. OBJECTIVE: To explore socioeconomic inequality in lung cancer mortality trends in Brazil. To study general and specific mortality, especially caused by lung cancer in populations exposed to asbestos in Brazil. METHODS: This study is divided into three manuscripts. MANUSCRIPT 1: The death records of lung cancer cases from 2000 to 2015 in adults aged 30 years and older were retrieved. The Prais-Winsten estimation and Pearson's correlation were applied. The correlation between lung cancer mortality rates and the Human Development Index (HDI) decreased when the rates for the first and last years of the historical series were compared, for both sexes. However, the correlation between the trends in lung cancer mortality rates and the HDI was negative in men (r = - 0.76) and women (r = - 0.58), indicating greater reductions of lung cancer mortality (or smaller additions) among the Brazilian Federative Units with the highest HDI. The results suggest a relevant inequality in lung cancer mortality trends in Brazil. MANUSCRIPT 2: The death records of lung cancer cases from 1980 to 2016 in adults aged 60 years and older were retrieved. Joinpoint regression and Age-Period-Cohort models were fitted to the data. Among men, there was an increasing trend in lung cancer mortality in Osasco of 0.7% (CI: 0.1; 1.3) in contrast to a mean annual decrease for Sorocaba of -1.5% (CI: -2.4; -0.6) and a stable average trend for São Paulo of -0.1 (CI: -0.3; 0.1). Similar increasing trends were found for women. The Age-Period-Cohort model showed an increase in the risk of death from 1996 in Osasco and a reduction for Sorocaba and the state of São Paulo during the same period. The results show a need for special monitoring regarding lung cancer incidence and mortality in areas with higher exposure to asbestos. MANUSCRIPT 3: A cohort study was conducted with 988 former male workers, who contributed a total of 12,217 person-years of observation. The Standardized Mortality Ratio (SMR) by age was estimated for men aged 30 and over using the indirect method. Increased SMR was observed for overall mortality (SMR 1.1, 95%CI 0.98-1.23), pleural cancer (SMR 69.4, 95%CI 22.55 to 162.1), peritoneal cancer (SMR 5.0, 95%CI 0.13 to 27.78), laryngeal cancer (SMR 1.4, 95%CI 0.30 to 4.20), lung cancer (SMR 1.5, 95%CI 0.82 to 2.64), and asbestosis (SMR 975.7, 95%CI 396.4 to 2031). The results of this study corroborate the studies on mortality in workers exposed to asbestos performed in different countries.

Asbestosis: un problema del siglo XX que persiste en el siglo XXI / Asbestosis: A Problem of the XX Century that Persists in the XXI Century

El Asbesto ha sido conocido y utilizado desde la antigüedad por ser un excelente material aislante, ignífugo y por poseer resistencia a los ácidos. Los griegos lo utilizaban en las lámparas votivas para sus deidades y Alejandro el Grande, agasajaba a sus invitados con comidas servidas sobre un mantel confeccionado con dicho material. El toque de hechizo lo efectuaba al culminar el banquete, cuando lo arrojaba al fuego para que se consumiese lo orgánico, rescatando el mantel sin sufrir alteraciones, al ser incombustible. El Asbesto se clasifica en dos grandes grupos: las SERPENTINAS (entre las que más del 90% de la explotación industrial lo compone el crisotilo) y las ANFÍBOLAS (crocidolita o "amianto azul" y la amosita o "amianto marrón)

Occupational Burden of Asbestos-Related Diseases in Korea, 1998–2013: Asbestosis, Mesothelioma, Lung Cancer, Laryngeal Cancer, and Ovarian Cancer

BACKGROUND: Asbestos exposure causes asbestos-related diseases (ARDs) including asbestosis, malignant mesothelioma, lung cancer, laryngeal cancer, and ovarian cancer. Although Korea used substantial amounts of asbestos in the past, no study has focused on its occupational burden of disease (OBD). Therefore, this study aimed to determine the OBDs of ARDs in Korea. METHODS: The CARcinogen Exposure (CAREX) database was used to determine the proportion of exposed population. Relative risks for lung cancer, laryngeal cancer, and ovarian cancer were used to determine the population-attributable fraction. Data for deaths caused by ARDs during 1998–2013 were obtained from the World Health Organization mortality database. The potential years of life lost (PYLL) and annual average PYLL (APYLL) indicated OBDs. RESULTS: In Korea, the number of ARD-attributable deaths and PYLL due to all ARDs during 1998–2013 were 4,492 and 71,763.7, respectively. The number of attributable deaths and PYLL due to asbestosis, malignant mesothelioma, lung cancer, laryngeal cancer, and ovarian cancer were 37 and 554.2, 808 and 15,877.0, 3,256 and 47,375.9, 120 and 1,605.5, and 271 and 6,331.1, respectively; additionally, the APYLL were 15.0, 19.7, 14.6, 13.4, and 23.4, respectively, and the average age at death was 70.4, 62.6, 69.1, 69.9, and 61.8, respectively. Our study showed that although the use of asbestos has ceased in Korea, the incidence of ARDs tends to increase. CONCLUSION: Therefore, efforts to reduce future OBDs of ARDs, including early detection and proper management of ARDs, are needed in Korea.

Cancer Incidence in Asbestos-Exposed Workers: An Update on Four Finnish Cohorts

BACKGROUND: We assessed the cancer risks of four different Finnish asbestos-exposed cohorts. We also explored if the cohorts with varying profiles of asbestos exposure exhibited varying relative risks of cancer. METHODS: The incident cancer cases for the asbestos-exposed worker cohorts were updated to the end of 2012 using the files of the Finnish Cancer Registry. The previously formed cohorts consisted of asbestos mine workers, asbestosis patients, asbestos sprayers, and workers who had taken part in a screening study based on asbestos exposure at work. RESULTS: The standardized incidence ratio (SIR) for mesothelioma varied from about threefold to > 100-fold in the different cohorts. In the screening cohort the SIR for mesothelioma was highest in 2003–2007, In other cohorts it was more constant in 5-year period inspection. The SIR for lung cancer was about twofold to tenfold in all except the screening cohort. Asbestos sprayers were at the highest risk of mesothelioma and lung cancer. CONCLUSION: The SIR for mesothelioma is high in all of the cohorts that represent different kinds of asbestos exposure. The smaller SIR for mesothelioma in the screening cohort with lowest level of asbestos exposure might suggest dose-responsiveness between asbestos exposure and mesothelioma. It does seem that the highest risk of lung cancer in these cohorts except in the youngest of the cohorts, the screening cohort, is over. The highest SIR for lung cancer of the asbestosis patient and sprayers cohort is explained by their heavy asbestos exposure.

Polyvinylidene Fluoride Alters Inflammatory Responses by Activation-induced Cell Death in Macrophages

Carbon nanotubes (CNTs) are nanomaterials that have been employed in generating diverse materials. We previously reported that CNTs induce cell death in macrophages, possibly via asbestosis. Therefore, we generated CNT-attached polyvinylidene fluoride (PVDF), which is an established polymer in membrane technology, and then examined whether CNT-attached PVDF is immunologically safe for medical purposes compared to CNT alone. To test this, we treated RAW 264.7 murine macrophages (RAW cells) with CNT-attached PVDF and analyzed the production of nitric oxide (NO), a potent proinflammatory mediator, in these cells. RAW cells treated with CNT-attached PVDF showed reduced NO production in response to lipopolysaccharide. However, the same treatment also decreased the cell number suggesting that this treatment can alter the homeostasis of RAW cells. Although cell cycle of RAW cells was increased by PVDF treatment with or without CNTs, apoptosis was enhanced in these cells. Taken together, these results indicate that PVDF with or without CNTs modulates inflammatory responses possibly due to activation-induced cell death in macrophages.

Hallazgos imagenológicos en la enfermedad pleuropulmonar asociada al asbesto / Imaging findings in pleuropulmonary disease associated with asbestos

Abestos-related pleuropulmonary disease involves a number of pathologic conditions that share inhalation exposure to asbestos fibers as a common factor. Dose and time of exposure have a role in the clinical manifestations of it, the main ones being benign pleural disease, asbestosis, malignant mesothelioma and bronchogenic carcinoma. Despite the ban on asbestos material usage in Chile, there is a long latency between exposure and clinical manifestations, which lead to it being still a relevant public health issue to this day. We present a series of representative images of abestos-related pleuropulmonary disease diagnosed at our centre. The pathogeny and radiologic manifestations are discussed, with an emphasis on the latter.

Radiologic Diagnosis of Asbestosis in Korea

Asbestosis is the most important change noted in the lung parenchyma after environmental and occupational exposure to asbestos fibers. It is characterized by diffuse interstitial pulmonary fibrosis. In Korea, the incidence of asbestosis will continue to increase for many years to come and the government enacted the Asbestos Damage Relief Law in 2011 to provide compensation to those suffering from asbestos-related diseases. Radiologic evaluation is necessary for diagnosis of asbestosis, and radiologists play a key role in this process. Therefore, it is important for radiologists to be aware of the various imaging features of asbestosis.

Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea

OBJECTIVE: To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD). MATERIALS AND METHODS: The authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque. RESULTS: Pleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD. CONCLUSION: Awareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD.

Enfermedades respiratorias ocupacionales / Occupational pulmonary diseases

Las enfermedades ocupacionales son aquellas producidas directamente por el ejercicio de la profesión. Estas se encuentran reguladas por la Ley 16.744 y son de cargo de prestadores de servicios denominados habitualmente mutuales. En este artículo se describen los principales aspectos epidemiológicos, fisiopatológicos, clínicos, de criterios diagnósticos y principios terapéuticos, de cuatro enfermedades respiratorias, las más relevantes en el medio nacional: Silicosis, asma, enfermedades por asbesto y enfermedades por hipobaria.

Occupational diseases are those produced directly by work activities. In Chile, occupational diseases are regulated by the law 16.744 and the service providers are called, mutualidades. In this paper is described epidemiology, physiopathology, clinical aspects, diagnostic criteria and therapeutic principles of the four most important occupational respiratory diseases in Chile: Silicosis, occupational asthma, asbestos diseases and altitude sickness.

Las enfermedades pulmonares intersticiales difusas en el ámbito laboral / Diffuse interstitial lung diseasesin the workplace

La enfermedad pulmonar intersticial difusa (EPID) se refiere a un grupo heterogéneo de condiciones pulmonares caracterizadas clínicamente por disnea y empeoramiento de la función pulmonar y radiológicamente por una infiltración intersticial evidente que afecta predominantemente las bases pulmonares. No existe una clasificación estándar o internacional sobre la misma, pero muchos autores tienden a clasificarla en uno de los dos siguientes grupos: los de causa conocida, secundarios a enfermedades de causa desconocida y los idiopáticos (que son 7 identidades clínicas claramente descritas). Como se ha visto, una de las causas dilucidadas de esta condición se asocia directamente con materiales irritantes como agentes y sustancias químicas tales como: el asbesto, silicón, y carbón utilizadas comúnmente en distintos ámbitos laborales, por lo que aquellas personas que se vieran continuamente expuestas a estos tienen un riesgo aumentado de desarrollar dicha patología. Las EPID son alteraciones que, a pesar de medidas, precauciones y regulaciones impuestas en distintas organizaciones de la promoción de la salud continúan siendo una de las principales enfermedades adquiridas en ámbitos laborales y además es de suma importancia clínica dado que estos pacientes pueden tener un rápido deterioro de función pulmonar. Este factor, sumado al hecho que su fisiopatología, incidencia e historia natural no han logrado ser suficientemente esclarecidos, constituyen la base que soporta la revisión que se ha propuesto realizar. Finalmente, es importante destacar que puede existir un largo tiempo entre la exposición a los agentes causales de la enfermedad y el inicio de las manifestaciones clínicas, por lo que se han documentado pacientes con estos diagnósticos aún años o hasta décadas después de que ocurrió la exposición, por lo que una adecuada regulación (por ejemplo, vacaciones profilácticas) y prevención a la misma podría evitar las consecuencias...

Diffuse interstitial lung disease (ILD) refers to a heterogeneous group of lung conditions characterized clinically by dyspnea, worsening of lung function and radiologically by an evident interstitial infiltration predominantly affecting the lung bases. There is no standard classification on it, but many authors tend to separate it into one of two groups: those with known cause, secondary to diseases of unknown cause and those idiopathic (with 7 clinical identities described). It is known that the condition is also directly associated with irritating materials, agents and chemicals such as asbestos, silicon, and carbon commonly used in industrial fields, so that people continouslly working with these have an increased risk of developing this disease. Despite measures, precautions and regulations imposed by various organizations of health promotion, ILD remains one of the major diseases acquired in work environments and it is of great clinical importance since these patients may have a rapid impaired lung function. This factor, besides the fact that its pathophysiology , incidence and natural history have failed to be sufficiently understood , constitute the base supporting the following review. Finally, we must know that there may be a long time between exposure to the causative agents of disease and the onset of clinical manifestations so that patients could present the diagnoses years or even decades after exposure. Hence derives the importance of proper regulations (eg, prophylactic holidays) and prevention to avoid the possible consequences...

Analysis of the clinical diagnosis of asbestosis complicated with malignant mesothelioma / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To discuss the clinical characteristics, diagnosis and treatment of the clinical characteristics and prognosis of asbestosis complicated with malignant mesothelioma patients.</p><p><b>METHODS</b>In 3 cases of asbestosis complicated with malignant mesothelioma were retrospectively analyzed.</p><p><b>RESULTS</b>In the 3 patients, 2 cases of pleural mesothelioma, with chest tightness, chest and back pain as initial symptom; 1 case of peritoneal mesothelioma, with abdominal distention, abdominal pain, dysuria as initial symptom. One case of the pleural mesothelioma misdiagnosed as tuberculous pleurisy. 3 patients were in CT or B ultrasound guided biopsy pathology confirmed to be malignant mesothelioma. 2 patients received systemic chemotherapy, another received symptomatic and supportive treatment. Up till now, 3 patients have died.</p><p><b>CONCLUSION</b>The disease is a high degree of malignant, the early clinical manifestations are not specific, easily missed diagnosis and misdiagnosis. The treatment effect is not ideal, the prognosis is poor. Biopsy is a reliable method for diagnosis of MM.</p>

Case fatality rate in patients with pneumoconiosis in China: a meta-analysis / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To evaluate the fatality rate of pneumoconiosis as well as the contributory factors in China in order to provide a foundation for prolonging the patients' lives.</p><p><b>METHODS</b>China National Knowledge Infrastructure (CNKI) and Wanfang Databases were searched to collect observational studies published between Jan, 2000 and Oct, 2013 on pneumoconiosis case fatality rate. Articles meeting the inclusion criteria were reviewed systematically, and analyzed by using Stata/SE 12.0, according to stage and type of pneumoconiosis and whether complicated with tuberculosis.</p><p><b>RESULTS</b>41 papers were included for meta-analysis. The pooled total case fatality rate of pneumoconiosis was 31.2%. The pooled case fatality rate of pneumoconiosis patients of stage 1, 2 and 3 were 25.4%, 39.8%and 57.5%, respectively. The pooled case fatality rate of patients with silicosis, coal worker's pneumoconiosis, foundry worker's pneumoconiosis, asbestosis and cement pneumoconiosis were 35.8%, 32.4%, 24.7%, 35.1%and 5.5%, respectively. The complication with tuberculosis was a risk factor for the death of pneumoconiosis patients and the pooled RR was 1.82 (95%CI: 1.59∼2.08).</p><p><b>CONCLUSION</b>There are significant differences in the case fatality rate of pneumoconiosis among different stages and different types of pneumoconiosis and whether complicated with tuberculosis.</p>

Risk assessment of gastric cancer associated with asbestosis: a case report

BACKGROUND: The International Agency for Research on Cancer classifies asbestos as belonging to Carcinogen Group 2A for gastric cancer. We herein report a case of gastric cancer associated with asbestosis and describe the work-related and risk assessments of asbestos exposure for gastric cancer. CASE PRESENTATION: The 66-year-old male patient in our case worked in asbestos spinning factories. His level of cumulated asbestos fiber exposure was estimated to be 38.0-71.0 f-yr/cc. Thus, the Excess Life Cancer Risk for lung cancer associated with asbestos exposure was 9,648x10-5, almost 9,600 times the value recommended by the United States of America Environmental Protection Agency (1 x 10-5). The relative risk of developing lung cancer for this patient was more than 25 f-yr/cc, a well-known criterion for doubling the risk of lung cancer. CONCLUSION: The patient's exposure to high-dose asbestos was sufficient to increase his risk of gastric cancer because as the risk of lung cancer increased, the risk of gastric cancer was due to increase as well. Therefore, occupational asbestos fiber exposure might be associated with gastric cancer in this case.

CT Characteristics of Pleural Plaques Related to Occupational or Environmental Asbestos Exposure from South Korean Asbestos Mines

OBJECTIVE: This study evaluated the CT characteristics of pleural plaques in asbestos-exposed individuals and compared occupational versus environmental exposure groups. MATERIALS AND METHODS: This study enrolled 181 subjects with occupational exposure and 98 with environmental exposure from chrysotile asbestos mines, who had pleural plaques confirmed by a chest CT. The CT scans were analyzed for morphological characteristics, the number and distribution of pleural plaques and combined pulmonary fibrosis. Furthermore, the CT findings were compared between the occupational and environmental exposure groups. RESULTS: Concerning the 279 subjects, the pleural plaques were single in 2.2% and unilateral in 3.6%, and showed variable widths (range, 1-20 mm; mean, 5.4 +/- 2.7 mm) and lengths (5-310 mm; 72.6 +/- 54.8 mm). The chest wall was the most commonly involved (98.6%), with an upper predominance on the ventral side (upper, 77.8% vs. lower, 55.9%, p < 0.001) and a lower predominance on the dorsal side (upper, 74.9% vs. lower, 91.8%, p = 0.02). Diaphragmatic involvement (78.1%) showed a right-side predominance (right, 73.8% vs. left, 55.6%, p < 0.001), whereas mediastinal plaques (42.7%) were more frequent on the left (right, 17.6% vs. left, 39.4%, p < 0.001). The extent and maximum length of plaques, and presence and severity of combined asbestosis, were significantly higher in the occupational exposure group (p < 0.05). CONCLUSION: Pleural plaques in asbestos-exposed individuals are variable in number and size; and show a predominant distribution in the upper ventral and lower dorsal chest walls, right diaphragm, and left mediastinum. Asbestos mine workers have a higher extent of plaques and pulmonary fibrosis versus environmentally exposed individuals.

Review of carcinogenicity of asbestos and proposal of approval standards of an occupational cancer caused by asbestos in Korea

Carcinogenicity of asbestos has been well established for decades and it has similar approval standards in most advanced countries based on a number of studies and international meetings. However, Korea has been lagging behind such international standards. In this study, we proposed the approval standards of an occupational cancer due to asbestos through intensive review on the Helsinki Criteria, post-Helsinki studies, job exposure matrix (JEM) based on the analysis of domestic reports and recognized occupational lung cancer cases in Korea. The main contents of proposed approval standards are as follows; (1) In recognizing an asbestos-induced lung cancer, diagnosis of asbestosis should be based on CT. In addition, initial findings of asbestosis on CT should be considered. (2) High Exposure industries and occupations to asbestos should be also taken into account in Korea (3) An expert's determination is warranted in case of a worker who has been concurrently exposed to other carcinogens, even if the asbestos exposure duration is less than 10 years. (4) Determination of a larynx cancer due to asbestos exposure has the same approval standards with an asbestos-induced lung cancer. However, for an ovarian cancer, an expert's judgment is necessary even if asbestosis, pleural plaque or pleural thickening and high concentration asbestos exposure are confirmed. (5) Cigarette smoking status or the extent should not affect determination of an occupational cancer caused by asbestos as smoking and asbestos have a synergistic effect in causing a lung cancer and they are involved in carcinogenesis in a complicated manner.

CT Findings in People Who Were Environmentally Exposed to Asbestos in Korea

Asbestos related pleuropulmonary disease has been emerging health problem for recent years. It can cause variable clinical symptoms and radiological abnormalities. However, there has been no report for their characteristics in subjects who were environmentally exposed to asbestos. We reviewed the CT images of 35 people who were environmentally exposed to asbestos in Chungnam province, Korea. The study result showed high incidence of pleural plaque and pulmonary fibrosis on chest CT (94% and 77%, respectively). The common CT findings of lung parenchymal lesions were as follows: centrilobular opacities (94%), subpleural dot-like or branching opacities (80%), interlobular septal thickening (57%), intralobular interstitial thickening (46%), parenchymal bands (43%) and subpleural curvilinear line (29%). There were no significant differences in the prevalence of pulmonary fibrosis and pleural plaques according to sex, age and duration of exposure. In conclusion, pleural plaque and pulmonary fibrosis are common asbestos-related CT finding in the exposed people. Asbestos related lung parenchymal CT findings in the participants with environmental exposure show similar to those observed in the occupational exposure.