[Chinese expert consensus on treatment and management of chronic obstructive pulmonary disease combined with pneumoconiosis].

Chronic obstructive pulmonary disease (COPD) often co-exists with other diseases (comorbidities), of which pneumoconiosis is an important one. The interaction between pneumoconiosis and COPD is manifested in the risk of disease, severity of disease, risk of acute exacerbation and the disease progression, and pharmaceutical and non-pharmaceutical treatment options. At present, there is a general lack of understanding of COPD complications in clinical practice, and there is a lack of clear clinical guidance for diagnosis and management of COPD patients with pneumoconiosis. Based on clinical evidence and experience, and the writing group puts forward five recommendations to improve the recognition and management of COPD patients with pneumoconiosis for medical professionals in hospitals at different levels, particularly in primary medical institutions.

[Analysis of Risk Factors of Chronic Pulmonary Heart Disease in Patients With Pneumoconiosis]. / å°˜è‚ºç— æ‚£è€ å‘ç”Ÿæ ¢æ€§è‚ºå¿ƒç— çš„å±é™©å› ç´ åˆ†æž.

Objective: To explore the risk factors for developing chronic pulmonary heart disease in patients with pneumoconiosis. Methods: The medical records of pneumoconiosis patients admitted to an occupational disease hospital in Sichuan Province between January 2012 and November 2021 were collected. Kaplan-Meier (K-M) method, or product-limit method, was used to plot the incidence curves of pulmonary heart disease in the pneumoconiosis patients. Cox proportional hazard regression model was used to analyze the influencing factors associated with chronic pulmonary heart disease in patients with pneumoconiosis. Results: A total of 885 pneumoconiosis patients were included in this study. The follow-up time was 12 to 115 months and the median follow-up time was 43 months. A total of 138 patients developed chronic pulmonary heart disease and the incidence density of pulmonary heart disease was 38.50/1000 person-years. Multivariate Cox proportional hazard regression analysis showed that the influencing factors of pneumoconiosis inpatients developing chronic pulmonary heart disease included the following, being 50 and older (hazard ratio [HR]=1.85, 95% confidence interval [CI]: 1.25-2.74), stage Ⅲ pneumoconiosis (HR=2.43, 95% CI: 1.48-4.01), resting heart rate≥100 beats/min (HR=2.62, 95% CI: 1.63-4.21), the complication of chronic obstructive pulmonary disease (COPD) (HR=4.52, 95% CI: 2.12-9.63), underweight (HR=2.40, 95% CI: 1.48-3.87), overweight and obesity (HR=0.54, 95% CI: 0.34-0.86), and triacylglycerol (TG) (HR=0.69, 95% CI: 0.49-0.99). Conclusion: Old age, stage Ⅲ pneumoconiosis, high resting heart rate, low BMI, and the complication of COPD are risk factors for chronic pulmonary heart disease in pneumoconiosis patients, while overweight and obesity and TG are protective factors. Early identification of the risk factors and the adoption of the corresponding prevention measures are the key to preventing chronic pulmonary heart disease in patients with pneumoconiosis.

Tetrandrine slows the radiographic progression of progressive massive fibrosis in pneumoconiosis: a retrospective cohort study.

OBJECTIVE: This study aims to explore the clinical effect of Tetrandrine (Tet) on progressive massive fibrosis (PMF) of pneumoconiosis. METHODS: This retrospective study collected 344 pneumoconiosis patients with PMF, and 127 were eligible for the final analysis, including 57 patients in the Tet group and 70 patients in the control group. The progress of imaging and lung function were compared between the two groups. RESULTS: After 13 months (median) of treatment, the size of PMF was smaller in the Tet group than that in the control group (1526 vs. 2306, p=0.001), and the size was stable in the Tet group (1568 vs. 1526, p= 0.381), while progressed significantly in the control group (2055 vs. 2306, p=0.000). The small nodule profusion and emphysema were also milder than that in the control group (6.0 vs. 7.5, p=0.046 and 8.0 vs. 12, p=0.016 respectively). Pulmonary ventilation function parameters FVC and FEV1 improved in the Tet group (3222 vs. 3301, p=0.021; 2202 vs. 2259, p=0.025 respectively) and decreased in the control group (3272 vs. 3185, p= 0.00; 2094 vs. 1981, p=0.00 respectively). FEV1/FVC was also significantly higher in the Tet group than that in the control group (68.45vs. 60.74, p=0.001). However, similar result was failed to observed for DLco%, which showed a significant decrease in both groups. CONCLUSION: Tet has shown great potential in the treatment of PMF by slowing the progression of pulmonary fibrosis and the decline of lung function.

[Blood eosinophils and clinical features of pneumoconiosis complicated with chronic obstructive pulmonary disease: A cross-sectional study].

Objective: To analyze the correlation between peripheral blood eosinophil (EOS) level and clinical characteristics of patients with pneumoconiosis complicated with chronic obstructive pulmonary disease (COPD) . Methods: From January 2007 to November 2020, newly diagnosed patients with pneumoconiosis complicated with COPD in Beijing Chaoyang Hospital, were retrospectively analyzed. These patients were stratified into EOS<100 cells/µl group and EOS≥100 cells/µl group, taking 100 cells/µl as the cut-off value. Demographic characteristics, clinical symptoms, lung function and laboratory indexes were compared between the two groups. Results: The median EOS count of patients with pneumoconiosis complicated with COPD was 100 (40, 180) cells/µl. 50.2% (160/319) had blood eosinophil counts ≥100 cells/µl, and 11.0% (35/319) had blood eosinophil counts ≥300 cells/µl. In comparison with EOS<100 cells/µl group, EOS≥100 cells/µl group were older (P=0.035), had higher body mass index (P=0.008), and had lower forced respiratory volume in the first second (P=0.017), had higher the ratio of residual volume to total lung volume (P=0.010), and had lower diffusing capacity of the lung for carbon monoxide (P=0.008). Arterial partial pressure of oxygen was significantly reduced in EOS≥100 cells/µl group (P=0.039). The peripheral blood EOS count was negatively correlated with forced vital capacity, forced breathing volume in the first second, carbon monoxide diffusion, peak expiratory flow, and maximum mid expiratory flow as a percentage of expected values (r(s)=-0.22, -0.18, -0.19, -0.19, -0.19, P=0.000, 0.001, 0.003, 0.008, 0.002), and positively correlated with the ratio of residual air volume to total lung volume (r(s)=0.17, P=0.002) . Conclusion: There was a correlation between blood EOS count and pulmonary function parameters, can proide reference for the diagnosis and treatment of chnoric obstuctive pulmmory disease in clinical practice.

[Construction and validation of a risk prediction model for pneumoconiosis patients complicated with chronic pulmonary heart disease based on Tei index].

Objective: To conduct a statistical analysis on the condition of patients with pneumoconiosis complicated with chronic pulmonary heart disease based on the Tei index, and to establish a relevant prediction model. Methods: In March 2022, a retrospective analysis of 226 patients diagnosed with pneumoconiosis in the Department of Occupational Disease of Yantai Yantaishan Hospital from January 2016 to January 2022 was conducted. The patients with pneumoconiosis complicated by pulmonary heart disease were included in the pulmonary heart disease group and others were included in the non-pulmonary heart disease group. logistic regression analysis was used to screen out the relevant factors and establish a risk prediction model. Hosmer-Lemeshow test was applied to determine the goodness of fit of the model, and the receiver operating characteristic (ROC) area under the curve (AUC) was used to evaluate the predictive effect of the model. Results: Among the 226 patients with pneumoconiosis, 58 patients had chronic pulmonary heart disease, accounting for 25.7% of the surveyed population. The logistic analysis showed that the course of disease, pneumoconiosis stage and Tei index were influencing factors of pneumoconiosis complicated with pulmonary heart disease (P<0.05). A risk prediction model for pneumoconiosis patients complicated with pulmonary heart disease was developed: Z=6.253X(1)+1.265X(2)+1.423X(3)+9.264, in which X(1) was the stage of pneumoconiosis, X(2) was the course of disease, and X(3) was the Tei index. Hosmer-Lemeshow test was used to evaluate the goodness of fit of the risk prediction model for pneumoconiosis patients complicated with pulmonary heart disease, the results indicated that the prediction model was in good agreement with the actual situation (χ(2)=11.59, P=0.254). The diagnostic ability of the model was evaluated by the ROC curve, and the results showed that its AUC was 0.897, the sensitivity was 0.947, and the specificity was 0.784. Conclusion: The course of disease, pneumoconiosis stage and Tei index are the influencing factors of pneumoconiosis complicated with pulmonary heart disease. The model constructed based on these factors has a good prediction effect, which can provide a basis for the early detection and intervention of pneumoconiosis complicated with pulmonary heart disease.

Standardized incidence ratios of malignant neoplasms among patients with pneumoconiosis.

BACKGROUND: Patients with pneumoconiosis, such as silicosis and asbestosis, have a high risk of lung cancer. However, whether these patients are at high risk for neoplasms other than lung cancer and mesothelioma remains inconclusive. AIMS: To examine whether patients with pneumoconiosis have a higher incidence of malignant neoplasms other than lung cancer. METHODS: We conducted a cohort study using the medical records of patients with pneumoconiosis who visited our two hospitals from 1 January 1991 through 31 December 2017. We identified the occurrence of malignant neoplasms and calculated the incidences and standardized incidence ratios (SIRs) compared with those of the general population. RESULTS: One hundred and seventy patients with pneumoconiosis (163 men, 7 women) including 142 patients with silicosis, 24 with asbestosis and 4 with pneumoconiosis were identified. The mean age was 66.8 years. The proportion of smokers was 79%. Forty-seven malignant neoplasms occurred. Most malignant neoplasms were lung cancer (n = 22), while some were digestive cancers such as gastric cancer (n = 9), oesophageal cancer (n = 3) and colorectal cancer (n = 3). Participants presented increased risks for lung cancer (SIR: 10.86, 95% confidence interval [CI]: 7.15-16.49), gastric cancer (SIR: 2.55, 95% CI: 1.22-5.35) and oesophageal cancer (SIR: 5.78, 95% CI: 1.86-17.92). CONCLUSIONS: Compared with the general population, patients with pneumoconiosis had an increased risk of malignant neoplasms of the digestive system in addition to lung cancer. Clinicians should consider testing for digestive system cancers as well as for lung cancers in these patients.

[Safety Analysis of Perioperative Period in Non-Small Cell Lung Cancer Patients with Comorbid Pneumoconiosis].

Objective: To explore the surgical safety of patients with comorbid non-small cell lung cancer (NSCLC) and pneumoconiosis. Methods: In this study, the clinical data of 165 NSCLC patients treated at West China Fourth Hospital, Sichuan University from August 2019 to May 2021 were collected. Among them, 21 patients with comorbid pneumoconiosis were included in the pneumoconiosis group, and the remaining 144 patients were included in the general group. Radical resection for lung cancer was performed in both groups. The perioperative clinical data, including preoperative, intraoperative and postoperative indicators, of the two groups were compared and analyzed. Results: There was no perioperative death in either group. The proportions of male patients and patients with smoking history in the pneumoconiosis group were significantly higher than those in the general group ( P<0.05). The body mass index (BMI), pulmonary ventilation function and diffusion function in the pneumoconiosis group were significantly lower than those in the general group ( P<0.05). There was no significant difference in the median operative time and the median volume of intraoperative blood loss between the pneumoconiosis group and the general group. In the pneumoconiosis group, the proportion of advanced tumors (stage Ⅱ/Ⅲ), incidence of postoperative complications, median duration of postoperative intubation, and postoperative length of hospital stay were higher/longer than those of the normal group ( P<0.05). Compared with the general group, the incidences of lymph node calcification, dense pleural adhesion and surgical method alteration (switching from thoracoscopic surgery to open surgery or video-assisted thoracoscopy) were also significantly higher in the pneumoconiosis group ( P<0.05). Univariate analysis showed that age, smoking history, pneumoconiosis, pulmonary ventilation dysfunction, lymph node calcification, dense pleural adhesion and the volume of intraoperative blood loss were the risk factors for postoperative complications. Further multivariate regression analysis demonstrated that smoking history ( OR=1.37, P<0.05), lymph node calcification ( OR=2.36, P<0.05) and pulmonary ventilation dysfunction ( OR=5.21, P<0.05) were independent risk factors for postoperative complications. Conclusion: NSCLC patients with comorbid pneumoconiosis face relatively greater risks during the perioperative period when they undergo radical resection for lung cancer. Therefore, the close attention of surgeons and the nursing staff should be raised accordingly.

[Investigation of newly diagnosed pneumoconiosis from artificial quartz stone manufacturers].

Artificial quartz dust exposure may cause associated pneumoconiosis. From November 2019 to July 2020, a total of 27 cases of silicosis associated with artificial quartz stone manufacturers were diagnosed and treated in the Occupational disease Department of Suzhou Fifth People's Hospital. The average age of onset was (46.8±6.6) years, and the average working age of dust exposure was (5.7±1.7) years.The main feature of high KV chest radiography is P/S shadow with strip shadow. CT imaging findings showed diffuse small nodules and ground glass shadows with band shadows. The lesions were mainly distributed in the upper lung, accompanied by pleural thickening, lymphadenopathy and calcification. The pulmonary function impairment was mainly mild restrictive ventilation disorder, and the bronchial mucosa longitudinal plica was the main manifestation under tracheoscopy. The age of silicosis of workers in artificial quartz stone production enterprises is younger, the working age of dust exposure is short, the lung function and bronchial mucosa have a certain degree of damage, and effective preventive measures should be taken in time.

[One case report of pneumoconiosis in porcelain teeth workers].

Porcelain tooth technology is widely used in the treatment of oral diseases, but there are few reports on the possible occupational hazard factors in the process of porcelain tooth production. Porcelain teeth production will produced a large amount of silica dust and metal dust during the grinding process. The technical workers who have been engaged in this work for a long time are very prone to pneumoconiosis due to their poor personal protection awareness. This paper analyzed the clinical data of a pneumoconiosis patient engaged in porcelain tooth making, and analyzed the possible occupational hazard factors in the process of porcelain teeth production, so as to improve the understanding of relevant enterprises, technical workers and medical personnel on the disease and reduce the risk of porcelain teeth production workers suffering from pneumoconiosis.

[Clinical characteristics of coal worker's peneumoconiosis complicated with acute exacerbation of chronic obstractive pulno-mary disease].

Objective: To investigate the clinical characteristics of acute exacerbation of acute lung disease (AECOPD) and to provide reference for clinical diagnosis and treatment. Methods: From January 2018 to December 2018, 127 patients with AECOPD were investigated retrospectively in March 2020, including 65 cases of pneumoconiosis with AECOPD group, 62 cases of AECOPD group, 127 cases of AECOPD group, the clinical characteristics, length of stay, cost difference and the correlation between pulmonary function and blood gas were analyzed in patients with AECOPD. Results: There was no significant difference in age, height, weight, BMI, ethnicity and smoking between the two groups (P>0.05) . The percentage of Neutrophil and hs-crp in pneumoconiosis combined with AECOPD group were significantly higher than those in AECOPD group (P<0.05) . The oxygen partial pressure in pneumoconiosis combined AECOPD group was lower than that in control group (P<0.05) . VC, FVC/Pred%, FEV(1)/Pred% in pneumoconiosis combined with AECOPD group were lower than those in AECOPD group, RV/Pred% and RV/TLC were higher than those in AECOPD group (P<0.05) . The hospitalization time and cost of the patients with AECOPD were significantly higher than that of the patients with AECOPD (P<0.05) . Conclusion: Compared with AECOPD group, the patients with pneumoconiosis combined AECOPD group had higher infection inflammation level, lower pulmonary function, longer hospitalization time and higher hospitalization cost.

[Analysis of influencing factors of pneumoconiosis complicated with pulmonary tuberculosis].

Objective: To investigate the influencing factors of pneumoconiosis complicated with tuberculosis in order to provide the scientific evidence for formulating the preventive strategies. Methods: From July 2019 to January 2020, all occupational pneumoconiosis patients reported in Guangzhou from 1958 to 2018 were investigated retrospectively (n=1155) . The basic data (including gender, diagnosis time, diagnosis age, dust exposure duration, period, pneumoconiosis disease type, work type and industry) were obtained from pneumoconiosis case card and network report database. The data of pulmonary tuberculosis were collected from the occupational disease diagnosis files of Guangzhou Occupational Disease Prevention and Control Hospital, and were supplemented by telephone follow-up. The distribution of pneumoconiosis and tuberculosis in Guangzhou was analyzed. Binary logistic regression analysis model was used to analyze the influencing factors of pneumoconiosis complicated with pulmonary tuberculosis. Results: Among the 1155 new cases of pneumoconiosis, 357 cases were pneumoconiosis tuberculosis, and the complication rate of tuberculosis was 30.9%. Year of diagnosis, age of diagnosis, dust exposure duration, pneumoconiosis caused by mineral dust and construction industry were influencing factors for pneumoconiosis complicated with pulmonary tuberculosis (OR=0.948, 1.048, 0.972, 3.112, 2.815, P<0.05) . After the adjustment of gender, diagnosis year, diagnosis age, dust exposure duration and diagnosis period, the risk of pulmonary tuberculosis in rock drilling workers was 1.462 times higher than that in other types of work (P<0.05) . Conclusion: The complication rate of tuberculosis in patients with pneumoconiosis is relatively high. The main influencing factors are the year of diagnosis, age of diagnosis, dust exposure duration, the type of pneumoconiosis and the industry. The importance of occupational health examination and health education on prevention and treatment of tuberculosis should be emphasized among dust-exposed workers and pneumoconiosis patients. People with susceptibility factors are the top priority.

The clinical value of F-18 FDG PET/CT in differentiating malignant from benign lesions in pneumoconiosis patients.

OBJECTIVES: We reviewed PET/CT findings of pneumoconiosis and determined the ability of PET/CT to differentiate lung cancer from progressive massive fibrosis (PMF), and metastatic lymph nodes (LNs) from underlying reactive LN hyperplasia. METHODS: This was a retrospective study of patients with pneumoconiosis and suspected lung cancer. Maximum standardized uptake value (SUVmax), long- and short-axis diameters (DL and DS), ratio of DL to DS (DL/S), and Hounsfield unit (HU) from the lung mass and mediastinal LNs were measured. The cutoff values of each parameter were obtained by ROC analysis, and we evaluated the diagnostic sensitivity. RESULTS: Forty-nine pneumoconiosis patients were included. Eighty-three lung masses were detected, of which 42 were confirmed as lung cancer (23 squamous cell carcinomas, 12 adenocarcinomas, and 7 small cell carcinomas) and 41 were PMF. There were significant differences between lung cancer and PMF in terms of SUVmax, DS, DL/S, and HU (all p < 0.05). The sensitivity, specificity, and accuracy for diagnosis of lung cancer were 81.0%, 73.2%, and 77.1%, respectively, with an SUVmax cutoff value of 7.4; and 92.8%, 87.8%, and 90.4%, respectively, with a HU cutoff value of 45.5. Among the 40 LNs with available pathological results, 7 were metastatic. Metastatic LNs showed higher SUVmax, larger DS, and lower HU than benign lesions (all p < 0.05). The sensitivity, specificity, and accuracy for predicting metastatic LNs by PET/CT were 85.7%, 93.9%, and 92.5%, respectively. CONCLUSION: By applying PET and CT parameters in combination, the accuracy for differentiating malignant from benign lesions could be increased. PET/CT can play a central role in the discrimination of lung cancer and PMF. KEY POINTS: • Lung cancer showed significantly higher SUVmax than PMF. • Lung cancer showed similar D L but longer D S , resulting in a smaller D L/S than PMF. • SUVmax demonstrated additive value in differentiating lung cancer from PMF, compared with HU alone.

[Study on clinical phenotype of coal workers pneumoconiosis].

Objective: To explore the clinical phenotypic characteristics of coal worker's pneumoconiosis for guiding the individualized treatment of various types of patients with coal worker's pneumoconiosis. Methods: Collect clinical data of 121 cases of coal worker's pneumoconiosis in different stages, and select 16 clinical variables (age, smoking index, years of underground dust exposure, stages of pneumoconiosis, types of work, family history, main symptoms, secondary symptoms, CAT score, imaging manifestations, FVC%, FEV(1)/FVC, FEV(1)%, DLCO%, respiratory failure complications, pulmonary heart disease complications) . Principal Component Factor Analysis (PCA) was used to analyze 16 clinical variables of 121 patients with coal worker's pneumoconiosis. Extracted 2 principal components and 8 related variables from 16 clinical variables, then coal worker's pneumoconiosis patients were divided into three types according to CCC values. Variance analysis or χ(2) test were used to analyze the characteristics of these three types of clinical data, then summarized the clinical phenotype composition ratio and clinical data characteristics. Results: The patients with coal worker's pneumoconiosis were initially divided into three types, including 73 cases (60.3%) in type 1, 18 cases (14.9%) in type 2 and 30 cases (24.8%) in type 3. Patients in type 1 are mainly middle-aged, with little damage to lung function and mild clinical symptoms, the imaging manifestations of type 1 patients are mainly diffuse nodules, and the stages of pneumoconiosis are mostly one-stage and second-stage. Patients in type 2 are mainly in middle-aged and elderly patients.the main pulmonary impairment is diffuse function decline. The clinical symptoms are severe and the imaging manifestations are complex. The stages of pneumoconiosis are one, second and third stages. Patients in type 3 are mainly middle-aged and elderly patients, with more pulmonary function impairment (decreased ventilation and diffusion) , severe clinical symptoms, complex imaging manifestations (micro nodules, emphysema, mass shadow, fibrosis) , and those pneumoconiosis stages are mainly in the second and third stages. Conclusion: According to the clinical characteristics, the patients with coal worker's pneumoconiosis were divided into 3 types by cluster analysis method, the treatment plan has certain guiding value in clinical work according to different classifications.

[Clinical analysis of 350 cases of pneumoconiosis complicated with spontaneous pneumothorax].

Objective: To explore the clinical features of pneumoconiosis complicated with spontaneous pneumothorax to improve the diagnosis and treatment of this disease. Methods: Analyze the clinical characteristics and treatment of 350 cases of pneumoconiosis complicated with spontaneous pneumothorax in Hunan Prevention and Treatment Institute for Occupational Diseases from May 2016 to May 2018. Results: In 350 patients, 22 cases are pneumoconiosis stage I, accounting for 6.3%, 26 cases are pneumoconiosis stage Ⅱ, accounting for 7.4%, 302 cases were pneumoconiosis stage Ⅲ, accounting for 86.3%.168 cases were recurrent pneumothorax, the recurrence rate was as high as 48%.There were 232 cases occurred in winter and spring, accounting for 66.3%. Chronic obstructive pulmonary disease and pulmonary infection were 54.9% and 47.4%, respectively. 233 patients were treated with basic therapy such as high flow oxygen therapy, with an effective rate of 93.1%. 114 cases were treated with thoracic closed drainage, with an effective rate of 86%. Conclusion: Spontaneous pneumothorax is a common complication of pneumoconiosis with high recurrence rate. According to the different conditions to give different treatments in a timely manner can achieve better results.

A case of lung adenocarcinoma complicated by pulmonary talcosis occurring in a patient employed in the confectionery industry.

A 73-year-old Japanese man, who worked at a confectionery company for more than 20 years, was diagnosed with a 28 mm nodular lesion in the superior lobe of the right lung by whole-body computed tomography examination. A biopsy revealed the presence of adenocarcinoma. With a diagnosis of a primary lung cancer, a right upper lobectomy was performed. A nodular lesion, 25 × 23 mm in size, was observed in the upper right lobe lung field, and was diagnosed histopathologically as a papillary adenocarcinoma. In addition, fibrous scars in the central part of the tumor showed numerous Langhans and/or foreign body giant cells, and histiocytic cells that had phagocytized numerous small transparent crystals, together with coal powder deposition. The extracted crystals were observed with a scanning electron microscope, and although plate-like structures were observed, ferruginous bodies suggestive of asbestos were not found. The crystals were demonstrated to be talc by powder X-ray diffraction. Herein, we investigated a case of lung adenocarcinoma in a patient with talcosis, with discussions based on a literature search. This collision of talcosis and lung adenocarcinoma adds to an increasing body of knowledge on an apparent association between talc and cancer cases.

Progressive plasterer's pneumoconiosis complicated by fibrotic interstitial pneumonia: a case report.

BACKGROUND: Although the prevalence of pneumoconiosis has been decreasing due to improvements in working conditions and regular health examinations, occupational hygiene measures are still being established. Plasterers encounter a number of hazardous materials that may be inhaled in the absence of sufficient protection. CASE PRESENTATION: A 64-year-old man who plastered without any dust protection for more than 40 years was referred to our hospital with suspected interstitial pneumonia. Mixed dust pneumoconiosis and an unusual interstitial pneumonia (UIP) pattern with fibroblastic foci were diagnosed by video-assisted thoracoscopic surgery, and an elemental analysis detected elements included in plaster work materials. Despite the cessation of plaster work and administration of nintedanib, the patient developed advanced respiratory failure. CONCLUSION: Plasterers are at an increased risk of pneumoconiosis and may have a poor prognosis when complicated by the UIP pattern. Thorough dust protection and careful monitoring are needed.

[Evaluation of GeneXpert MTB/RIF and BACTEC-MGIT 960 for the detection of tuberculosis among pneumoconiosis-associated tuberculosis patients].

Objective: To evaluate the performence of GeneXpert MTB/RIF and BACTEC-MGIT 960 on detecting Mycobacterium tuberculosis and rifampicin resistance for pneumoconiosis-associated tuberculosis patients. Methods: The recruited 133 suspected active pneumoconiosis-associated tuberculosis hospitalized cases, morning sputum samples were collected to do modified L-J culture, conventional proportion method drug susceptibility test, GeneXpert MTB/RIF and BACTEC-MGIT 960. Analyze the sensitivity and specificity of the 133 sputum from patients, the positive rates of patients with tuberculosis in GeneXpert MTB/RIF test, BACTEC-MGIT 960 and modified L-J culture were 37.59%, 34.59% and 30.08% respectively. There was no significant difference among the three tests respectively (P>0.05) . According to the modified L-J culture, the sensitivity of GeneXpert MTB/RIF and BACTEC-MGIT 960 in detecting tuberculosis were 92.5% and 95.0% respectively, and specificity in rifampicin resistance were 86.0% and 91.4% respectively. There was no significant difference between GeneXpert MTB/RIF and BACTEC-MGIT 960 (P>0.05) . According to conventional proportion method drug susceptibility test, the sensitivity of GeneXpert MTB/RIF and BACTEC-MGIT 960 in detecting rifampicin resistance were 90.0% and 100%, and specificity were 92.6% and 96.4%. There was no significant difference between GeneXpert MTB/RIF and BACTEC-MGIT 960 (P>0.05) . Conclusion: The GeneXpert MTB/RIF has good performence of detecting tuberculosis and rifampicin resistance. It has good application value among pneumoconiosis-associated tuberculosis patients.

[Clinical characteristics of pneumoconiosis complicated with chronic obstructive pulmonary disease].

Objective: To analyze the pulmonary function and clinical features of coal worker's pneumoconiosis complicated with chronic obstructive pulmonary disease (COPD) , coal worker's pneumoconiosis and COPD, in order to improve the diagnosis and treatment of coal worker's pneumoconiosis complicated with chronic obstructive pulmonary disease. Methods: Selected patients in respiratory department of General Hospital of Jincheng Coal Industry Group were classified as pneumoconiosis complicated with COPD group (n=52) , pneumoconiosis group (n=70) and COPD group (n=50) . Clinical data were collected and compared between three groups, including age, history of smoking, BMI, pulmonary function, CAT score and complication with Hypoxemia and respiratory faliure. Results: The mean age, smoking index and BMI of the three groups were not significantly different. The FEV1% pred, FEV(1)/FVC%, DLco-SB%, FVC% pred were significantly lower in pneumoconiosis complicated with COPD group than pneumoconiosis group (P<0.05) ; The FEV(1)% pred, DLco-SB%, FVC% pred were significantly lower in pneumoconiosis complicated with COPD group than COPD group (P<0.05) , but, the FEV(1)/FVC% was no significant different between pneumoconiosis complicated COPD group and COPD group (P>0.05) ; The CAT score for clinical symptoms of pneumoconiosis complicated with COPD group was significantly higher than that of pneumoconiosis group (P<0.05) , but there was no significant difference between pneumoconiosis complicated COPD group and COPD group (P>0.05) . The rate of hypoxemia in coal workers' pneumoconiosis combined with chronic obstructive pulmonary disease was 78.8%, which was higher than that of coal workers' pneumoconiosis group (61.4%) and chronic obstructive pulmonary disease group (72%) ; The respiratory failure rate of coal worker's pneumoconiosis combined with chronic obstructive pulmonary disease group was 44.2%, which was higher than that of coal worker's pneumoconiosis group (4.3%) and chronic obstructive pulmonary disease group (16%) . Conclusion: In pneumoconiosis patients, once complicate with COPD, the pulmonary function indexes are worse, the clinical symptoms are heavier, and the probability of hypoxemia and respiratory failure are higher. Compared with the COPD group, the patients with pneumoconiosis complicated with COPD have more restrictive ventilation dysfunction and diffuse dysfunction, and the clinical symptoms are heavier, and the probability of combined respiratory failure is higher.

[Clinical significance of the N-terminal pro-B-type natriuretic peptide levels in pneumoconiosis patients with chronic pulmonary heart disease].

Objective: To determine the diagnosis value and therapy significance of peripheral blood N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in pneumoconiosis patients with chronic pulmonary heart disease (CPHD) . Methods: A total of 22 pneumoconiosis complicated with CPHD (A group) , 20 pneumoconiosis complicated with coronary heart disease (B group) and 25 pneumoconiosis without heart disease (C group) were selected. The level of blood NT-proBNP was examined and analyzed in the three groups. We observed the difference blood level of NT-proBNP concentration between before and after of therapy in pneumoconiosis patients with CPHD. The optimal cutoff value of blood NT-proBNP was determined according to the principle of maximum Youden's index associated with clinical analysis. Results: Blood NT-proBNP concentrations were 543.19±78.92, 1017.38±731.06, 109.56±57.46 pg/ml in three groups, respectively. Compared with C group, there was a significant increase in the blood levels of NT-proBNP in both A and B groups (P<0.05, P<0.01) , especially for B group. Compared with NT-proBNP 543.19±78.92 pg/ml before therapy, the153.34±58.40 pg/ml was significantly declined after therapy in B group (P<0.05) . The optional threshold for peripheral blood NT-proBNP level as a diagnostic indicator for pneumoconiosis complicated with CPHD was 450 pg/ml. The specificity and sensitivity of NT-proBNP were 95.46% and 54.17%, respectively. Conclusion: Blood NT-proBNP level may be useful as a tool for monitoring the effect of pneumoconiosis patients with CPHD treatment with higher sensitivity in. Blood NT-proBNP cut-off >450 pg/ml should be applied in clinical practice as a valuable diagnostic prediction for pneumoconiosis patients with CPHD.

[Investigation of medication compliance in patients with pneumoconiosis complicated with chronic obstructive pulmonary disease at stable stage].

Objective: To investigate the compliance of inhalation during stable phase of pneumoconiosis complicated with COPD and to explore the factors influencing compliance. Methods: The patients with pneumoconiosis complicated with COPD who were hospitalized in the four Department of occupational disease prevention and treatment in Hunan province from December 2016 to August 2017 were selected as the research subjects. The examination of Chest radiograph, HRCT and lung function was perfected, and CAT score and MRC score were carried out. The age, culture, smoking history, acute aggravation of 1 years, medical insurance and so on were collected, and follow-up was conducted after 6 months. Results: Of the 115 patients who had successfully followed up, 14 cases (12.17%) were persisted in medication, and 101 cases (87.83%) did not adhere to the medication. The smoking index median of the non adherence group was 30 (15, 40) , while that of the adherence group was 16 (6, 31) . The smoking index of the adherence group was lower than that of the non adherence group. The FEV1% in the unadhered group was 44.69+15.48, and the drug group was 37.12+16.98, the FEV(1)/FVC in the unadhered group was 52.43+9.19, and the drug group was 44.43+11.88, and the lung function of the drug group was worse than that of the unadhered group. The adherence rate of group COPD (group D) was higher than that of group A, B and C, and the difference between D group and B group was statistically significant. The adherence rate of pneumoconiosis stage Ⅲ was higher than that of pneumoconiosis stageⅡand pneumoconiosisⅠ. Conclusion: The compliance of long acting bronchodilator inhalation is low in stable phase of pneumoconiosis complicated with COPD. The poorer the lung function, the higher the compliance of inhalation. The compliance of pneumoconiosis patients with Medical insurance for industrial injury is higher than that of pneumoconiosis patients with New rural cooperative medical service.