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Hoy RF, Jones C, Newbigin K, Abramson MJ, Barnes H, Dimitriadis C, Ellis S, Glass DC, Gwini SM, Hore-Lacy F, Jimenez-Martin J, Pasricha SS, Pirakalathanan J, Siemienowicz M, Walker-Bone K, Sim MR. Chest x-ray has low sensitivity to detect silicosis in artificial stone benchtop industry workers. Respirology 2024. [PMID: 38802282 DOI: 10.1111/resp.14755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND AND OBJECTIVE Chest x-ray (CXR) remains a core component of health monitoring guidelines for workers at risk of exposure to crystalline silica. There has however been a lack of evidence regarding the sensitivity of CXR to detect silicosis in artificial stone benchtop industry workers. METHODS Paired CXR and high-resolution computed tomography (HRCT) images were acquired from 110 artificial stone benchtop industry workers. Blinded to the clinical diagnosis, each CXR and HRCT was independently read by two thoracic radiologists from a panel of seven, in accordance with International Labour Office (ILO) methodology for CXR and International Classification of HRCT for Occupational and Environmental Respiratory Diseases. Accuracy of screening positive (ILO major category 1, 2 or 3) and negative (ILO major category 0) CXRs were compared with identification of radiological features of silicosis on HRCT. RESULTS CXR was positive for silicosis in 27/110 (24.5%) workers and HRCT in 40/110 (36.4%). Of the 83 with a negative CXR (ILO category 0), 15 (18.1%) had silicosis on HRCT. All 11 workers with ILO category 2 or 3 CXRs had silicosis on HRCT. In 99 workers ILO category 0 or 1 CXRs, the sensitivity of screening positive CXR compared to silicosis identified by HRCT was 48% (95%CI 29-68) and specificity 97% (90-100). CONCLUSION Compared to HRCT, sensitivity of CXR was low but specificity was high. Reliance on CXR for health monitoring would provide false reassurance for many workers, delay management and underestimate the prevalence of silicosis in the artificial stone benchtop industry.
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Affiliation(s)
- Ryan F Hoy
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Catherine Jones
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- I-MED Radiology Network, Victoria, Australia
| | | | - Michael J Abramson
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Hayley Barnes
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christina Dimitriadis
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Samantha Ellis
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Deborah C Glass
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Stella M Gwini
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Fiona Hore-Lacy
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Javier Jimenez-Martin
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | | | | | - Miranda Siemienowicz
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Karen Walker-Bone
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Malcolm R Sim
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Wagner GR, Michaels D. Work Matters: Mainstreaming Worker Health and Safety Is Not Limited to Pandemic Response. Am J Public Health 2024; 114:372-376. [PMID: 38359381 PMCID: PMC10937612 DOI: 10.2105/ajph.2023.307565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Affiliation(s)
- Gregory R Wagner
- Gregory R. Wagner is with the Harvard T. H. Chan School of Public Health, Boston, MA. David Michaels is with the George Washington University Milken Institute School of Public Health, Washington, DC
| | - David Michaels
- Gregory R. Wagner is with the Harvard T. H. Chan School of Public Health, Boston, MA. David Michaels is with the George Washington University Milken Institute School of Public Health, Washington, DC
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Crawford JA, Sanyal S, Burnett BR, Wiesenfeld SL, Abraham JL. Accelerated silicosis in sandblasters: Pathology, mineralogy, and clinical correlates. Am J Ind Med 2024; 67:179-199. [PMID: 38265196 DOI: 10.1002/ajim.23561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND With increasing reports of accelerated and acute silicosis, PMF, and autoimmune disease among coal miners and silica-exposed countertop workers, we present previously incompletely-described pulmonary pathology of accelerated silicosis and correlations with mineralogy, radiography, and disease progression in 46 Texas oilfield pipe sandblasters who were biopsied between 1988 and 1995. METHODS Worker examinations included pulmonary function tests, chest X-ray (CXR), high-resolution computed tomography (HRCT), and Gallium-67 scans. Quantitative mineralogic analysis of pulmonary parenchymal burden of silica, silicates, and metal particles used scanning electron microscopy with energy dispersive x-ray spectroscopy (SEM EDS). RESULTS Workers had clinical deterioration after <10 years exposure in dusty workplaces. Although initial CXR was normal in 54%, Gallium-67 scans were positive in 68% of those with normal CXR, indicating pulmonary inflammation. The histology of accelerated silicosis is diffuse interstitial infiltration of macrophages filled with weakly birefringent particles with or without silicotic nodules or alveolar proteinosis. Lung silica concentrations were among the highest in our database, showing a dose-response relationship with CXR, HRCT, and pathologic changes (macrophages, fibrosis, and silicotic nodules). Radiographic scores and diffusing capacity worsened during observation. Silica exposure was intensified, patients presented younger, with shorter exposure, more severe clinical abnormalities, higher lung particle burdens, and more rapid progression in a subset of patients exposed to recycled blasting sand. CONCLUSIONS Accelerated silicosis may present with a normal CXR despite significant histopathology. Multivariable analyses showed silica, and not other particles, is the driver of observed radiologic, physiologic, and histologic outcomes. Eliminating this preventable disease requires higher physician, public health, and societal awareness.
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Affiliation(s)
- Judith A Crawford
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Soma Sanyal
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York, USA
| | | | - Stephen L Wiesenfeld
- Department of Medicine, Texas Tech University Health Sciences Center, Odessa, Texas, USA
| | - Jerrold L Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York, USA
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Yong J, Shu H, Zhang X, Yang K, Luo G, Yu L, Li J, Huang H. Natural Products-Based Inhaled Formulations for Treating Pulmonary Diseases. Int J Nanomedicine 2024; 19:1723-1748. [PMID: 38414528 PMCID: PMC10898359 DOI: 10.2147/ijn.s451206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024] Open
Abstract
Given the unique physiological and pathological characteristics of the lung, the direct, inhalable route is more conducive to pulmonary drug delivery and disease control than traditional systemic drug delivery, significantly circumventing drug loss, off-target effects, systemic and organ toxicity, etc., and is widely regarded as the preferred regimen for pulmonary drug delivery. However, very few lung diseases are currently treated with the preferred inhaled formulations, such as asthma, chronic obstructive pulmonary disease and pulmonary hypertension. And there is a lack of appropriate inhaled formulations for other critical lung diseases, such as lung cancer and pulmonary fibrosis, due to the fact that the physicochemical properties of the drugs and their pharmacokinetic profiles do not match the physiology of the lung, and conventional inhalation devices are unable to deliver them to the specific parts of the lung. Phytochemicals of natural origin, due to their wide availability and clear safety profile, hold great promise for the preparation of inhalable formulations to improve the current dilemma in the treatment of lung diseases. In particular, the preparation of inhalable formulations based on nano- and microparticulate carriers for drug delivery to deep lung tissues, which overcome the shortcomings of conventional inhalation therapies while targeting the drug activity directly to a specific part of the lung, may be the best approach to change the current dilemma of lung disease treatment. In this review, we discuss recent advances in nano- and micron-carrier-based inhalation formulations for the delivery of natural products for the treatment of pulmonary diseases, which may represent an opportunity for practical clinical translation of natural products.
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Affiliation(s)
- Jiangyan Yong
- Department of Clinical Laboratory, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 610072, People’s Republic of China
| | - Hongli Shu
- Department of Clinical Laboratory, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 610072, People’s Republic of China
| | - Xiao Zhang
- Department of Clinical Laboratory, Chengdu Children Special Hospital, Chengdu, Sichuan, 610031, People’s Republic of China
| | - Kun Yang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People’s Republic of China
| | - Guining Luo
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People’s Republic of China
| | - Lu Yu
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People’s Republic of China
| | - Jiaqi Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People’s Republic of China
| | - Hong Huang
- Department of Clinical Laboratory, the People’s Hospital of Chongqing Liang Jiang New Area, Chongqing, 401121, People’s Republic of China
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Wagner GR, Michaels D. Preventing the Continuing Tragedy of Silicosis. JAMA Intern Med 2024; 184:223-224. [PMID: 38109105 DOI: 10.1001/jamainternmed.2023.6629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Affiliation(s)
- Gregory R Wagner
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - David Michaels
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC
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Hodgson MJ, Smith PA. Workers at Risk of Silicosis-Ongoing Overexposure and Lack of Medical Surveillance. JAMA Intern Med 2024; 184:224-225. [PMID: 38109081 DOI: 10.1001/jamainternmed.2023.6632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Affiliation(s)
- Michael J Hodgson
- Office of Occupational Medicine and Nursing, Washington, DC
- Directorate of Technical Support and Emergency Management, Occupational Safety and Health Administration, Washington, DC
| | - Philip A Smith
- Directorate of Technical Support and Emergency Management, Occupational Safety and Health Administration, Washington, DC
- Salt Lake Technical Center, Sandy, Utah
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Hua JT, Rose CS, Redlich CA. Preventing the Continuing Tragedy of Silicosis-Reply. JAMA Intern Med 2024; 184:224. [PMID: 38109101 DOI: 10.1001/jamainternmed.2023.6635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Affiliation(s)
- Jeremy T Hua
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado
- Department of Environmental & Occupational Health, Colorado School of Public Health, Aurora
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado
- Department of Environmental & Occupational Health, Colorado School of Public Health, Aurora
| | - Carrie A Redlich
- Department of Medicine, Yale Occupational and Environmental Medicine Program, Yale School of Medicine, New Haven, Connecticut
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Fazio JC, Gandhi SA, Harrison RJ. Workers at Risk of Silicosis-Ongoing Overexposure and Lack of Medical Surveillance-Reply. JAMA Intern Med 2024; 184:225-226. [PMID: 38109093 DOI: 10.1001/jamainternmed.2023.6626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Affiliation(s)
- Jane C Fazio
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Occupational Health Branch, California Department of Public Health, Richmond
- Division of Pulmonary, Critical Care, and Sleep Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | - Sheiphali A Gandhi
- Occupational Health Branch, California Department of Public Health, Richmond
- Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco, San Francisco
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco
| | - Robert J Harrison
- Occupational Health Branch, California Department of Public Health, Richmond
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Flattery J, Woolsey C, Epstein-Corbin M, Blackley DJ, Harrison RJ, Cummings KJ. Notes from the Field: Surveillance of Silicosis Using Electronic Case Reporting - California, December 2022-July 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:1275-1276. [PMID: 37971928 PMCID: PMC10684354 DOI: 10.15585/mmwr.mm7246a4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
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