Analysis of mortality in chrysotile asbestos miners in China

In order to investigate the mortality of a cohort of chrysotile asbestos miners in China and evaluate its association with exposure to chrysotile,a fixed cohort of 1932 workers in chrysotile asbes-tos mine was established in 1981 and followed till June 1,2010.Information on vital status,cause of death and smoking habits was collected.The workers were divided into two groups according to their exposure status.The exposed group was composed of frontline workers who worked directly on mining or processing asbestos products.The control group consisted of those who were not directly exposed to asbestos in their work.Standardized mortality ratio (SMR) was calculated according to Chinese national death rates.Cox proportional hazards model was applied to estimate the adjusted relative risks of deaths from major causes in exposed and control groups.The results of this study showed that main causes of mortality were malignant neoplasm,cardiovascular disease,cerebrovascular disease and respiratory disease for chrysotile miners.The mortality rate was 939.20 per 100 000 person-years for workers.The SMR for all causes of death was 1.46 in the cohort.Statistically significant mortality excesses were found for lung cancer (SMR=1.51),pulmonary heart disease (SMR=2.70),respiratory disease (SMR=1.93),asbestosis (SMR=9.62),and accident (SMR=1.59).The mortalities from malignant neo-plasm,lung cancer,cerebrovascular disease and digestive disease in the exposed group were signifi-cantly higher than those in the control group.The findings indicate that chrysotile exposure is a risk factor for lung cancer,respiratory disease,cerebrovascular disease and digestive disease.     

The Incidence of Asbestos Bodies in the Lungs at Random Necropsies in Montreal

The incidence of asbestos bodies in the lungs of adult patients selected at random, who died in four Montreal hospitals, was studied by examining fresh unstained smears of lungs obtained at necropsy. Two techniques were used for preparation of the smears and an arbitrary grading system was developed to estimate the degree of contamination of the lungs by asbestos bodies.

Asbestos bodies were present in 48 out of 100 necropsies; they were found in 32 of 56 men (57%) and in 16 of 44 women (34%). Men were more heavily contaminated. The proportion of positive smears depended on the technique used and the amount of lung sampled. No particular association was noted between asbestos bodies in the lungs and the presence of cancer in the 33 patients in this series with malignant disease. The high incidence in this random series suggests that asbestos is a significant air contaminant in Montreal.

     

Cohort Studies on Cancer Mortality Among Workers Exposed Only to Chrysotile Asbestos： a Meta-analysis

Objective To determine whether there was excessive risk of cancer among workers exposed to chrysotile fiber alone by applying a meta-analysis technique. Methods All data meeting the criteria of cohort studies on cancer mortality among workers exposed only to chrysotile were incorporated into meta-analysis. Pooled standardized mortality ratios (SMRs) and their corresponding 95% confidence intervals (CIs) for main cancer sites were calculated using two approaches of unweighted ratio and random effect model. The heterogeneity and its sources of the results were examined with a Q-statistic and Z-score test. The dose-response effect as reflected in the percentage of all deaths due to mesothelioma served as a proxy measure of chrysotile exposure. Results A cohort of twenty six workers exposed to chrysotile alone was summarized. The significantly elevated meta-SMRs for all deaths (1.27), all cancers (1.28), cancers of respiratory organs (2.51), cancers of lung (2.35) and cancers of stomach (1.24) were observed. The significantly elevated meta-SMRs for lung cancer within occupational strata were observed among textile workers (3.55), asbestos product manufacturers (3.30), miners and millers (2.24), cement product workers (1.22), and for stomach cancer among asbestos product manufacturers (1.49). Meta-SMRs for cancers at other sites were not significant. Meta-SMR for lung cancer showed an increasing trend with an elevated percentage of all deaths from mesothelioma, but no such trend for stomach cancer. Conclusion There are excessiverisks of lung cancer and mesothelioma among workers exposed to chrysotile fiber alone, and likely no convincing indication of an etiological association between chrysotile exposure and cancers at other sites.     

石棉工人的肺癌调查

作者调查了省内两个石棉矿和一个石棉厂共2383例工人的恶性肿瘤,尤其是肺癌的发生率。采用回顾性队列调查法,追踪10年。结果肺癌标化死亡比(SMR)为2.66(P<0.05),相对危险度(RR)10.36(P<0.01),均有显著性差异。肺癌的潜伏期平均23.8年,主要发生在高石棉粉尘浓度的工种,表明肺癌的发生与接触石棉密切相关。     

青石棉环境污染与肺癌的病例对照研究

目的　探索云南省××县肺癌高发的主要危险因素 ,为采取防制措施提供依据。方法　作者对以往进行死因调查时发现的 31例肺癌病例进行调查 ,并按 1∶ 4的比例匹配了与病例性别相同、出生年月相差不超过 2年的对照。调查内容包括一般情况、是否从事过石棉生产、环境石棉污染情况、吸烟、肿瘤家族史等。结果　家庭中使用石棉炉和吸烟与肺癌之间的关联有显著性差异 ,OR分别为 4.2 8(95 %CI,1.39～ 13.2 1)和 6 .0 2 (95 %CI,1.83～ 19.78)。同时还发现 ,随着使用石棉炉的年数和个数增加 ,肺癌的发病危险也有逐渐增加的趋势。结论　该地区肺癌高发可能与家庭环境中石棉污染和吸烟有关 ,其中使用石棉炉可能是一个主要的石棉污染方式。     

Lung cancer cell type and asbestos exposure

It is often claimed that adenocarcinoma is the most frequent type of lung cancer seen in workers exposed to asbestos. Careful review of the published data, however, fails to support this claim. Rather, it seems that all types of lung cancers occur in asbestos workers, and the presence or absence of a specific cell type cannot be used to prove or disprove an association of carcinoma and asbestos exposure.     

Cancer mortality and asbestosis among workers in an asbestos plant in Chongqing, China

Objective To investigate whether asbestosis is a risk factor for mortality of lung cancer. Methods A fixed cohort study was established in an asbestos plant in Chongqing, China, and followed up for 30 years from the beginning of 1972. Basic personal information on life state, cause of death, and diagnosis of asbestosis was collected. Multiple logistic regressions were applied to analyze risk factors. Results During the 30-year follow-up, 584 male workers constituting a total of 14 664 person-years were monitored and data were analyzed. Among them, 203 （34.8%） died and the mortality rate was 13.8 per 1000 person-years, cancer accounting for 37.4%. Excess risks were observed for lung cancer （OR=3.72） and nonmalignant respiratory diseases （OR=2.73） among workers with asbestosis. High-exposure level was another risk factor for lung cancer （OR-3.20）. Workers with category II of asbestosis demonstrated a higher OR of both lung cancer and nonmalignant respiratory diseases than those with category I of asbestosis. Conclusion High asbestos exposure level and asbestosis were the risk factors for death of lung cancer and nonmalignant respiratory diseases. Asbestosis is an independent risk factor for lung cancer among Chinese workers exposed to chrysotile, the risk increases with the increasing profusion of opacities of lung.     

Comparisons of multiple characteristics between young and old lung cancer patients

Background  Risk factors that contribute to younger patients with lung cancer are still relatively unknown. The aim of this study was to compare the clinical characteristics, histological types, stages at diagnosis, treatment modalities and survival rates between young and old patients with lung cancer.

Methods  The study was designed as a retrospective review of all lung cancer patients admitted to the Third Affiliated Hospital of Harbin Medical University from 1998 to 2008. Survival analyses using univariate and multivariate approaches were performed to compare the survival rates between different age groups and to discover potential prognostic factors.

Results  This research included 3320 patients with primary lung cancer, of whom 626 (18.8%) were 45 years old or younger at the time of diagnosis. The percentage of smokers and the male to female ratios between the young and old patient groups were 51.27% vs. 70.6% (P <0.001) and 1.99 vs. 2.13 (P＝0.4801), respectively. The young patient group had a higher incidence of adenocarcinoma and fewer surgeries. The 1-year, 3-year and 5-year survival rates in the young patient group were generally lower than those of the old patient group, with significant differences (P＝0.0232). The clinical stage of the tumor was a prognostic factor for both non-small cell lung cancer patients (P <0.0001) and small cell lung cancer patients (P=0.0002). Symptoms, diagnostic method, histology, smoking, treatment modality and body mass index were shown to have significant relationships with the survival of lung cancer patients (P <0.05).

Conclusions  Patients with lung cancer who are younger than 45 years old might have a significantly poorer prognosis than that of older patients. Symptoms, diagnosis method, histology, smoking, treatment modality and body mass index can be independent prognostic factors for lung cancer.

     

Factors influencing the prevalence of pulmonary nodules in lung cancer screening trials: re-evaluation of a CT study

Numerous false positive findings are a problem in computed tomography based lung cancer screening trials. The potential patient-related variables that could predict the existence of such lung nodules were studied. 526 construction workers (age 38-81 yrs.) previously screened with spiral computed tomography were evaluated. Background features (age, body mass index, stature, sex, C-reactive protein, erythrocyte sedimentation rate, asbestos exposure and smoking history), reported symptoms (general condition, cough, mucous production, dyspnoea, chest pain) and findings in high resolution CT were related to the existence of nodules with logistic regression. There were 107 patients with one or more nodules recorded at least by two of the three observers. Advancing age (OR = 1.042/year, 95% CI = 1.000-1.085, p = 0.048) and dyspnoea symptom (p = 0.014) were positively associated with the existence of nodules, while smoking, asbestos exposure history and other studied parameters were not. Nodules < or = 5 mm (50 patients) were inversely associated with the maximal thickness of pleural plaques (OR = 0.384, 95% CI = 0.169-0.873, p = 0.022). No variables helpful to sample subjects for lung cancer screening studies to reduce the number of false positive findings were found. Poor inspiration or associated pathology such as thick pleura may hamper nodule detection. Further studies should focus especially on the possible effect of computer tomography technology on finding nodules.     

纤维支气管镜对支气管异物漏诊患者的诊治价值

为探讨支气管异物的漏诊原因和总结纤维支气管镜（ Ｆ Ｂ）对该病的诊治经验，作者对曾被误诊为其它疾病并经 Ｆ Ｂ检查确诊的１２例支气管异物患者的诊治经验进行了总结分析。结果发现，该１２例患者均因无明确的异物吸入史，胸片上未能见及异物，仅见及肺不张，肺门阴影增大及阻塞性肺炎，以及临床表现为支气管肺感染或喘息等，而被误诊为肺癌、肺炎、哮喘和肺结核。经 Ｆ Ｂ检查后均获确诊，其中１１例经 Ｆ Ｂ成功地钳出异物而治愈。提示 Ｆ Ｂ对被漏诊的支气管异物患者具有重要的诊治价值。     

未成年近视患者眼前节形态的研究

目的 比较未成年近视患者眼前节形态与正视者的差异。 方法 对121例5～12岁未成年人进行眼前节光学相干断层扫描成像 （OCT）测量,其中正视眼组 (等效球镜度+0.50～－0.25 D) 42例、中低度近视组 （等效球镜度－0.50～－5.75 D）40例、高度近视组 (等效球镜度≤－6.00 D) 39例。比较各组角膜中心厚度 （CCT）、前房深度 （ACD）、房角开放距离 （AOD）、小梁虹膜空间面积 （TISA）及巩膜突角 （SSA）的测量值有无差异。 结果 3组研究对象间CCT值差异无统计学意义。高度近视组ACD、AOD、TISA和SSA值均大于正视眼组 （P<0.01）和中低度近视组 （P <0.05）。中低度近视组和正视组比较ACD、AOD、TISA和SSA各项值差异无统计学意义。 结论 未成年人的中低度近视眼前房形态和正视眼无差异;高度近视眼与正视眼相比,前房更深,房角更宽。     

青石棉污染区恶性肿瘤的影像学调查

目的通过影像学调查以了解1998年以来青石棉污染造成的恶性肿瘤患病情况.方法搜集云南省大姚县人民医院1998年6月1日至2001年12月31日间来我院就诊做CT及X线检查的病例与非污染区同省禄丰县人民医院同期同样病例资料进行对比,重点探讨胸膜间皮瘤及肺癌.结果观察组就诊病人CT检查6 615例,检出恶性肿瘤258例,检出率为3.9%;对照组就诊病人CT检查4 854例,检出恶性肿瘤132例,检出率为2.72%.观察组肺癌66例,检出率为1.00%,胸膜间皮瘤51例,检出率为0.77%;对照组肺癌50例,检出率为1.03%,胸膜间皮瘤1例,检出率为0.02%.观察组就诊病人X线检查14 044例,检出恶性肿瘤57例,检出率为0.41%;对照组就诊病人X线检查16 024例,检查出恶性肿瘤35例,检出率为0.22%.观察组肺癌42例,检出率为0.3%,胸膜间皮瘤6例,检出率为0.04%;对照组肺癌25例,检出率为0.16%,胸膜间皮瘤1例,检出率为0.01%.结论在X线及CT检查中,青石棉污染区恶性肿瘤患病率以肺癌、胸膜间皮瘤最高.     

肺癌患者血浆cofilin蛋白含量的变化及其临床意义

目的探讨非小细胞肺癌患者血浆切丝蛋白（cofilin）含量的变化及其临床意义。方法原发性非小细胞肺癌患者50例,健康对照组50例,采用酶联免疫吸附法测定两组血浆cofilin含量,采用免疫组化SP法检测肺癌组织中的cofilin蛋白。结果肺癌组50例患者癌灶组织中cofilin蛋白阳性表达33例（66.00%）,大部分定位于细胞质内,可见到弥漫性分布的棕黄色颗粒;肺癌组患者血浆cofilin蛋白含量为（0.592±0.387）ng/ml,明显高于对照组的（0.210±0.096）ng/ml（P〈0.05）;肺癌组织中cofilin蛋白阳性表达率、血浆cofilin蛋白含量与患者性别、年龄、组织学分化程度均无关（P〉0.05）,与TNM分期、淋巴结转移状况有关（P〈0.05）;血浆cofilin蛋白含量越高则肺癌组织中cofilin蛋白阳性表达率越高（P〈0.05）。结论肺癌患者血浆cofilin蛋白含量明显升高,并与肺癌分期及淋巴结转移有关,检测血浆cofilin蛋白含量可用于肺癌术前诊断及临床分期、转移程度的评估。     

窄带成像联合自体荧光支气管镜在重度吸烟人群中筛查早期中央型肺癌的研究

目的为了提高中央型肺癌的早期检出率改善预后,寻找一种补充检查方案。方法选取我院2016年1月～2019年12月符合本研究要求的重度吸烟者1821例,使用窄带成像联合自体荧光支气管镜技术与常规低剂量CT检查,比较两者早期中央型肺癌的检出率;同时比较普通白光支气管镜与自体荧光支气管镜(AFB)、窄带成像(NBI)联合自体荧光支气管镜三者间的阳性率与病理学阳性率的差别。结果 (1)共入组患者1821例。入组患者中,胸部CT报告气道可疑结节或占位者共69例,经气管镜检查后68例未发现CT提示部位新生物,1例为气道异物;16例病理阳性的患者,胸部CT检查均为阴性结果。(2)入组患者中发现普通白光支气管镜下黏膜异常9例(0.49%),AFB异常27例(1.48%),AFB、NBI均异常19例(1.04%),病理阳性16例(0.88%)。在27例AFB异常患者中,病理阳性16例,病理阴性11例,阳性率为59.30%;在19例AFB、NBI均异常患者中,病理阳性15例,阴性4例,阳性率为78.95%,因阳性例数少,统计学未得到显著性差异。结论低剂量螺旋CT对于早期中央型肺癌及癌前病变的筛查效能低,自体荧光支气管镜联合窄带成像技术应能弥补CT的不足,提高中央型肺癌的早期诊断率。     

保护性肺通气对电视胸腔镜外科手术患者术后谵妄和恢复的影响*

目的 研究保护性肺通气（PLV）对电视胸腔镜外科手术（VATS）患者术后谵妄（POD）及恢复的影响。方法 将100例择期VATS下肺癌根治术的患者,随机分为保护性肺通气组（PPV组）52例和传统肺通气组（CPV组）48例。PPV组双肺通气设置：潮气量（VT）8?ml/kg+呼吸末正压（PEEP）5?cmH2O,吸入氧浓度（FIO2）0.7;单肺通气（OLV）设置：VT 6 mg/kg+PEEP 5?cmH2O+肺复张[持续肺充气法：3～5?s内将气道峰压（Ppeak）升到30?cmH2O,持续30?s恢复原状,重复3次],FIO2 0.7。CPV组双肺通气设置：VT 10?ml/kg,FIO2 1.0;OLV设置：VT 8?ml/kg,FIO2 1.0。两组吸呼比=1∶2,调整呼吸频率维持呼吸末二氧化碳分压（PETCO2）35～45?mmHg。通过脑氧饱和度（rSO2）监测脑氧合情况,同时监测术中氧分压（PaO2）和氧合指数（OI）;术后每天随访,采用意识错乱评估法（CAM）判定是否发生POD,并记录术后肺部并发症（PPCs）和术后恢复情况。结果 PPV组术中PaO2、OI高于CPV组（P?<0.05）;rSO2发生率低于CPV组（P?<0.05）;POD和PPCs发生率低于CPV组（P?<0.05）;且PPV组术后气管导管拔出时间、下床活动时间及引流管拔出时间缩短（P?<0.05）。结论 PLV提高VATS患者机械通气时血氧饱和度和rSO2,降低POD发生率;并且降低PPCs发生率,加速患者术后恢复。     

Mortality rates among employees potentially exposed to chrysotile asbestos at two automotive parts factories.

A study of the mortality rates among 1657 employees at two Ontario automotive parts factories that manufactured friction materials containing chrysotile asbestos was initiated in response to the workers' concerns about the effects of asbestos on their health. A total of 1194 men and 258 women had had their first potential exposure at least 10 years before the end of the study period; 563 of the men and 138 of the women had had such an exposure at least 20 years before the end of the study period. A significantly increased rate of death from laryngeal cancer and an elevated rate of death from lung cancer were observed in a cohort analysis. One or two deaths might have been due to pleural mesothelioma. There was no increase in the rate of death from gastrointestinal cancer or from nonmalignant respiratory disease. Case-control analysis showed no association between the risk of laryngeal or lung cancer and the total duration of employment (a surrogate for the extent of ambient exposure to asbestos or other workplace toxic substances) or employment in departments where asbestos had been used. An association between risk of death and occupational exposure is uncertain.     

Detection of DNA Aneuploidy in Exfoliated Airway Epithelia Cells of Sputum Specimens by the Automated Image Cytometry and Its Clinical Value in the Identification of Lung Cancer

Lungcanceristhemostcommoncauseofcancerdeathintheworld ,andtheoverallfive yearsurvivalrateforpatientswithlungcancerisbelow 13% [1] .Screeningforhigh riskindividualsanddiagnosisoflungcancerappearalogicalapproachtoreducethedeathrate .Comparedtotheexamination…     

人肺癌组织一氧化氮合酶及总RNA表达水平的梯度改变

目的：探讨一氧化氮合酶（NOS）在肺癌组织中的表达与作用机制。方法：按自身配对原则收集人肺癌癌灶组织、癌灶周围组织及远离癌灶的肺组织各26份,作病理组织学检查并制备肺组织匀浆,分析不同肺组织中总癌周围组织＞远离癌灶肺组织的梯度分布;癌组均显著高于癌周及远癌组织（P＜0．001）,癌组织中总RNA水平与NOS浓度呈显著正相关（P＜0．01）;鳞癌组与腺癌组间总RNA和NOS的表达水平未见明显差异（P＞0．05）;分化程度高的肺癌组NOS表达水平较中分化和低分化肺癌组低;癌灶组织中NO浓度明显高于远癌组织（P＜0．05）。结论：肺癌组织中RNA的高度表达说明肿瘤组织中蛋白质合成旺盛,而NOS的过度表达则可能与加速生成NO以杀伤肿瘤细胞有关。     

早期周围型肺癌的X线平片诊断

目的提高对早期周围型肺癌X线平片征象的认识。方法对30例早期周围型肺癌的X线平片进行回顾性分析。结果本组30例中男女各占一半，发现病变后3个月内未确诊者达70％，均误诊为结核或肺炎，发现病变后3个月内确诊者仅30％。结论早期周围型肺癌的标准应是肿块直径≤20cm，且无局部及远处淋巴转移，并经手术病理证实者。其X线平片特征为密度低、轮廓多不规则、瘤体内小泡征、胸膜凹陷等。     

肺癌术后化疗患者不同营养治疗方式对临床效果的影响*

目的 观察不同营养治疗方式对肺癌术后化疗患者临床效果的影响。方法 采用前瞻性研究,选取2015年7月—2017年12月成都医学院第一附属医院胸外科行肺癌手术且行术后化疗的初筛入组患者754例作为研究对象。观察住院期间肠内营养（EN）、EN+肠外营养（PN） 2种营养治疗方式对肺癌患者术后化疗期间营养状况、免疫功能、并发症的影响。Logistic回归分析2种营养治疗方式及其他因素与营养治疗并发症和肺癌术后并发症的关系。结果 6周最终完成随访患者427例。其中单纯EN治疗（EN组）患者301例（70.5%）,EN+PN治疗（EN+PN组）患者126例（29.5%）。两组的血清总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）、免疫球蛋白（IgG、IgA）水平比较,差异无统计学意义（P?>0.05）;免疫球蛋白（IgM）及淋巴细胞计数（TLC）比较,差异有统计学意义（P?<0.05）。两组共发生营养治疗并发症69例,其中EN组58例,EN+PN组11例,差异有统计学意义（P?<0.05）;共发生肺癌术后并发症43例,其中EN组27例,EN+PN组16例,差异无统计学意义（P?>0.05）。经Logistic回归分析,未发现营养治疗并发症的独立影响因素,但IgG是肺癌术后并发症的保护因素[OlR=0.654（95% CI：0.476,0.898）]。结论 临床应对肺癌术后化疗患者常规予以合理的营养治疗,EN和PN方式各有优势,条件允许时可以优先选择EN+PN的方式实施。