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Occupational lung diseases are caused or made worse by exposure to harmful substances in the work-place. "Pneumoconiosis" is the term used for the diseases associated with inhalation of mineral dusts. While many of these broad-spectrum substances may be encountered in the general environment, many occur in the work-place for greater amounts as a result of industrial processes; therefore, a range of lung reactions may occur as a result of work-place exposure. Physicians in metropolitan cities are likely to encounter pneumoconiosis for two reasons: (i) patients coming to seek medical help from geographic areas where pneumoconiosis is common, and (ii) pneumoconiosis caused by unregulated small-scale industries that are housed in poorly ventilated sheds within the city. A sound knowledge about the various pneumoconioses and a high index of suspicion are necessary in order to make a diagnosis. Identifying the disease is important not only for treatment of the individual case but also to recognise and prevent similar disease in co-workers.

The purpose of this study was to explore the accuracy of (18)F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) in the assessment of mediastinal lymph node in coal workers who had non-small cell lung cancer. We retrospectively reviewed 42 retired coal workers who had lung cancer without distant metastasis, between May 2007 and May 2010. Regarding the mediastinal lymph nodes, when the standard uptake value was greater than 2.5, it was considered "malignancy positive." After histological examination of the mediastinal lymph nodes, anthracotic and metastatic ones were detected. The results of PET/CT were analyzed to determine its accuracy. Of these 42 patients, PET/CT detected 47 positive mediastinal lymph nodes in 24 patients with a mean SUV maximum of 6.2 (2.6-13.8). One hundred and thirty-one mediastinal lymph node foci were dissected. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT in detecting nodal metastases were 84% (16/19), 65% (15/23), 66% (16/24), 83% (15/18), and 74% (31/42) on a per-patient basis, respectively. Mediastinal node staging with FDG-PET/CT in coal workers is insufficient due to the high false-positive rates due to the presence of pneumoconiosis. In these patients, an invasive technique such as mediastinoscopy seems mandatory for confirmation of ipsilateral or contralateral mediastinal lymph node metastasis.

Anthracofibrosis is a bronchial stenosis due to local mucosal fibrosis that also presents anthracotic pigment in the mucosa. The cause has not been well clarified, although there is a frequent association with tuberculosis and the exposure to smoke from biofuel or biomass combustion. It is an entity that has not been reported in Spain, although the influx of people from rural areas of developing countries or rural areas of our own country should make us contemplate this entity in the differential diagnosis of our patients. We present 3 cases detected in Spain (2 of them natives) diagnosed by bronchoscopy and bronchial biopsy, which are techniques necessary to confirm the diagnosis. There is no specific treatment, except for tuberculostatic treatment in cases with coexisting tuberculosis., (Copyright © 2011 SEPAR. Published by Elsevier Espana. All rights reserved.)

Introduction: Hemoptysis is observed frequently in patients, although chest computed tomography (CT) shows no explainable lesion as the cause of hemoptysis. However, the clinical course of these patients has not been reported fully., Methods: This study included patients who visited Seoul National University Hospital and Seoul National University Bundang Hospital to be treated for hemoptysis from January 2003 through October 2009 and who had no lesion causing hemoptysis in chest CT. We retrospectively analyzed their bronchoscopic and clinical findings., Results: A total of 228 patients were included, and the mean follow-up duration was 781 days. All patients underwent bronchoscopy. The bronchoscopic findings of 191 patients (83.8%) were negative for hemoptysis and showed the possible causes of bleeding in 37 patients (16.2%). Forty-three of the 191 patients with negative bronchoscopic findings had oronasopharyngeal problems or were using anticoagulants. After excluding these 43 patients, hemoptysis recurred in 29 (19.6%) of the remaining patients. Thirteen of the patients whose bronchoscopic findings identified the possible causes of bleeding (35.1%) experienced recurrence. Only one patient (0.4%) was diagnosed with lung cancer by the initial bronchoscopy, and no patient developed malignancy during the follow-up period., Conclusion: The recurrence rate was higher in the patients with positive findings than in the patients with negative findings on bronchoscopy. Although about 20% of patients with negative bronchoscopy findings experienced recurrence, the clinical course of those in whom recurrent bleeding occurred was usually benign., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Previous studies have demonstrated that alterations in certain circulating biomarkers may be correlated with Coal workers' pneumoconiosis (CWP). This study investigated the relationship between changes of serum biomarkers and pulmonary function during the development of CWP., Methods: Lung function parameters and specific serum indices were measured in 69 non-smoking coal workers, including 34 miners with CWP, 24 asymptomatic miners and 11 miners with minimal symptoms. The associations between changes in pulmonary function and serum indices were tested with Pearson's correlation coefficients. Multivariable analysis was used to estimate the predictive power of potential determinant variables for lung function., Results: Compared to healthy miners, lung function (FVC, FEV1, FEF50, FEF75, FEF25-75 % of predicted values) was decreased in miners with CWP (p < 0.05). Increased serum matrix metalloproteinase-9 (MMP-9) was associated with decreased FVC% of predicted values in the asymptomatic miners (r = -0.503, p = 0.014)., Conclusions: In coal mine workers, alterations of lung function parameters are associated with the development of CWP and with changes in circulating MMP-9, TIMP-9, IL-13 and IL-18R. These serum biomarkers may likely reflect the pathogenesis and progression of CWP in coal workers, and may provide for the importance of serum indicators in the early diagnosis of lung function injury in coal miners.

Objective: To study the significance of oxidative injury in the screening of coal workers' pneumoconiosis (CWP)., Methods: With the method of nitrate reductase, TBA, et al, the content of NO, MDA and other indexes of peroxidation in plasma lipid were detected in 112 patients suffering from coal workers' pneumoconiosis and 114 healthy coal workers as controls., Results: There were statistical significant between two groups (P < 0.05) with the content or density of MDA, CuZn-SOD, GSH-Px, T-AOC, UA, NO and iNOS except CP. As screening index of pneumoconiosis, there were statistical significant in area under the curve (AUC) of MDA, T-AOC, NO and iNOS between the two groups by ROC. As screening index of pneumoconiosis, MDA, T-AOC, NO and iNOS can be selected as early screening index. Especially, T-AOC was the best index of four indexes (sensitivity is 70.5%, specificity is 68.1%)., Conclusion: Joint screening of MDA, T-AOC and iNOS is better than single index or series of T-AOC and MDA to the screening of CWP.

Objectives: 1) To document current knowledge of bronchial anthracofibrosis (BAF), an emerging pulmonary disease recognised just over a decade ago; 2) to highlight the demographic profile, and clinical, radiological and bronchoscopic features peculiar to BAF; and 3) to discuss the postulated causes and clinical conditions associated with BAF, emphasising the need to characterise and recognise it as a distinct clinical disorder., Data Sources: An extensive search of the literature was performed in Medline/PubMed and other databases with key terms 'anthracosis', 'biomass fuels', 'bronchial anthracofibrosis' and 'pulmonary tuberculosis'. The bibliographies of papers identified were searched for further relevant articles., Results: A total of 17 studies and six case series/reports describing 1320 patients with bronchoscopically confirmed BAF were documented. BAF was predominantly observed in elderly housewives in rural areas with prolonged exposure to biomass fuel, and was associated with respiratory diseases such as tuberculosis (TB), chronic obstructive pulmonary disease, pneumonia and malignancy. Exposure to biomass fuel smoke emerged as the main causative factor, but the possibility of an occupational lung disorder was also raised. Characteristic clinical, thorax computed tomography and bronchoscopic features of BAF were identified and its differentiation from endobronchial TB and bronchogenic carcinoma was described., Conclusion: As a pulmonary disease, BAF is yet to be highlighted in both developing and industrialised countries. BAF is currently diagnosed only on bronchoscopy, whereas a suitable non-invasive diagnostic modality would enable rapid diagnosis and increased recognition. Approaches for patients with BAF need to be developed and the serious hazards of biomass fuel use should be emphasised.

We reported a case with bronchial anthracofibrosis and endobronchial tuberculosis. Our case demonstrated this possible correlation between anthracofibrosis and endobronchial tuberculosis. We showed this correlation visually and microbiologically.

Objective: Fas/APO-1 (CD95) and Fas Ligand (FasL) is a major mediator system that activates programmed cell death (apoptosis) and is most important for pulmonary cellular homeostasis. Another form of Fas, circulating soluble Fas (sCD95), produced by alternative mRNA splicing antagonizes the cell-surface Fas function. It was the aim of the study to test the hypothesis that the Fas/FasL system is implicated in the development of silica-induced pulmonary nodular lesions., Material and Methods: We investigated the serum levels of sCD95 in 55 former hard coal miners. Coal workers' pneumoconiosis (CWP) was assumed when the profusion of small round opacities according to the ILO 2000 classification system was 1/1 or greater. Analyses of sCD95 were performed by a sandwich ELISA., Results: Radiologic CWP was found in 34 of the 55 individuals. The age of subjects with and without CWP was similar (73.5 (SD 7.2) years vs. 73.5 (7.1) years; P = 0.924). sCD95 could be quantified in all samples; significantly higher levels were observed in subjects with radiologic signs of CWP (914 (752-1251) pg/ml vs. 632 (509-804) pg/ml, P < 0.001). However, there was no relationship between sCD95 serum concentrations and the quantity of profusion according to ILO., Conclusions: The hypothesis of elevated sCD95 concentrations in CWP was corroborated. The usefulness of sCD95 for prevention and diagnosis of CWP and other forms of silica-induced fibrosis needs to be established by epidemiological studies.

In Turkey, bituminous coal mining is performed only in Zonguldak coal basin since 1940. Pneumoconiosis surveillance programs and dust control measures are in effect, but published pneumoconiosis data from this area is lacking. In this study, we aimed to evaluate the change in prevalence and case detection between 1985 and 2004 and assess the correlation between the dust concentration in workplaces and the prevalence of pneumoconiosis. Data on respirable dust concentrations and number of workers diagnosed as pneumoconiosis between 1985 and 2004 were obtained from Turkish Coal Enterprises authorities. Mean respirable dust concentrations in workplaces underground and on the ground were 1.66 mg/m(3) and 0.73 mg/m(3) respectively. Total number of workers decreased from 38.231 in 1985 to 12.261 in 2004 including 8932 underground workers. In this period, pneumoconiosis has not been reported in the ground workers. Incidence of pneumoconiosis ranged between 0.17-2.8 percent and prevalence ranged between 1.23-6.23 percent between 1985 and 2004. Radiologic opacities compatible with pneumoconiosis were predominantly small opacities. This is the first report about the incidence and prevalence rate of coal worker's pneumoconiosis in the main coal mining area of Turkey. Dust measurement and screening standards should be improved and adapted to international standards and we conclude that surveillance data should be closely monitored in this region and further epidemiologic studies in this area are warranted.

Traditional latent class modeling has been widely applied to assess the accuracy of dichotomous diagnostic tests. These models, however, assume that the tests are independent conditional on the true disease status, which is rarely valid in practice. Alternative models using probit analysis have been proposed to incorporate dependence among tests, but these models consider restricted correlation structures. In this article, we propose a probit latent class model that allows a general correlation structure. When combined with some helpful diagnostics, this model provides a more flexible framework from which to evaluate the correlation structure and model fit. Our model encompasses several other PLC models but uses a parameter-expanded Monte Carlo EM algorithm to obtain the maximum-likelihood estimates. The parameter-expanded EM algorithm was designed to accelerate the convergence rate of the EM algorithm by expanding the complete-data model to include a larger set of parameters and it ensures a simple solution in fitting the PLC model. We demonstrate our estimation and model selection methods using a simulation study and two published medical studies.

Bronchial anthracostenosis describes a disease entity consisting of bronchial destruction, deformity and stenosis related to dark pigmentation on bronchoscopy in patients with a history of coal workers' pneumoconiosis or chronic exposure to biomass smoke. The combined occurrence of bronchial anthracostenosis and mediastinal fibrosis in association with wood-smoke exposure has not been previously reported. This case report describes a non-cigarette smoking elderly woman who developed bronchial anthracostenosis and mediastinal fibrosis after long-term exposure to wood smoke. Clinical and radiological improvements were achieved after treatment with corticosteroid and tamoxifen. Awareness of this unusual entity will help to avoid misdiagnosis of malignancy or unnecessary thoracotomy.

Objective: To define the clinical, radiographic, and bronchoscopic features, and to describe the occupations of the largest group of patients with anthracosis., Methods: All patients who underwent flexible bronchoscopy at 2 Iranian hospitals (Imam Hospital [Tehran], and Tohid Hospital [Sanandaj]), Iran, between April 1982 and June 2006 were considered for inclusion in the study. The demographic data, clinical, and radiographic findings of anthracotic and anthracofibrotic patients were recorded., Results: Of the 14,300 patients, 487 cases of simple anthracosis, and 291 of anthracofibrosis were found. A total of 98.4% female patients were housewives, and 86.4% lived in rural areas. Of the male patients, 40.6% were farmers, 29.6% were manual workers, and 7.5% were miners. Of these, 96% of patients had abnormal chest radiography. On bronchoscopic examination, bilateral bronchial involvement was found in 62.5% of the patients. The condition was confined to the trachea in 0.38% of patients, the bronchi involved were the main bronchus in 37%, the lobar bronchi in 83.2%, and segmental bronchi in 35%. Bronchial narrowing and obstruction was observed in 37.4% of the patients., Conclusion: Anthracosis and anthracofibrosis are neglected conditions that are a common finding on routine bronchoscopic examination. Given the demographic findings, and a review of other reports from developing countries, exposure to combustion of biomass fuel in rural areas is a possible risk factor.

Anthracofibrosis, which was recently defined as bronchial stenosis with overlying anthracotic mucosa, has been infrequently reported in Asia as a complication of tuberculosis (TB). It has not been reported in the United Kingdom or the United States, or, to our knowledge, in non-Asian patients. We have identified seven cases of patients presenting to a single teaching hospital in the northwest of England over a 13-year period. Only one patient had a history of TB, but six of the seven patients had a history of occupational dust exposure, including one patient with pneumoconiosis. It is possible that anthracofibrosis is an exaggerated endobronchial form of the much more common condition of anthracosis in coal miners and other workers who have been exposed to mineral dusts. Our study suggests that this is essentially a benign condition, although it may progress very slowly, leading to gradually progressive bronchial stenosis. The diagnosis is important because most patients have clinical, radiologic, and bronchoscopic changes that are highly suspicious of malignancy.