Introduction Nightshift work is prevalent in developed and developing countries in which female nightshift workers are more vulnerable, particularly for mental health. Objective This study aims to investigate if the prevalence of negative emotion differ among male and female nightshift workers and explore the contributing factors using the baseline information of a prospective nightshift worker cohort in Shenzhen, China. Methods We recruited 5329 workers and collected their blood/urine samples from 5 industries at the baseline, but only included 834 workers from 2 companies into this report because other 3 companies mainly composed of male workers. We adopted a standardized questionnaire to collect information on lifetime nightshift work, lifestyle factors, housework demands and socio-demographic data. Results Overall, 510 workers were males (61.2%) and 324 were females (38.8%). More female than male workers were nightshift workers (90.1% vs. 82.7%), aged≥40 years (20.4% vs. 12.9%) and married (74.4% vs. 58.2%) but less females attained college or above (8.6% vs. 23.5%) and leisure-time exercises (32.7% vs. 50.0%). Significantly more female workers did different housework including cooking (12.7% vs. 9.6%), washing (50.6% vs. 31.4%) and taking care of children/elderly (20.4% vs. 12.2%), and the sex difference in housework demands was particularly prominent among nightshift workers. Female nightshift workers were more prone to negative emotion because of ‘feel exhaust or insufficient energy (40.1% vs. 32.2%)’, ‘worry of significant change of body weight (18.5% vs. 12.6%)’, ‘insomnia/poor sleep (31.5% vs. 21.3%)’, and ‘hard to concentration or forgetful (30.1% vs. 20.4%)’; however, there was no significant sex difference of negative emotion among daytime workers. Conclusion This study reveals that female nightshift workers were more vulnerable to negative emotion, and nightshift work schedule and high housework burden are the contributing factors.

This study aims to develop an artificial intelligence (AI)-based model to assist radiologists in pneumoconiosis screening and staging using chest radiographs. The model, based on chest radiographs, was developed using a training cohort and validated using an independent test cohort. Every image in the training and test datasets were labeled by experienced radiologists in a double-blinded fashion. The computational model started by segmenting the lung field into six subregions. Then, convolutional neural network classification model was used to predict the opacity level for each subregion respectively. Finally, the diagnosis for each subject (normal, stage I, II, or III pneumoconiosis) was determined by summarizing the subregion-based prediction results. For the independent test cohort, pneumoconiosis screening accuracy was 0.973, with both sensitivity and specificity greater than 0.97. The accuracy for pneumoconiosis staging was 0.927, better than that achieved by two groups of radiologists (0.87 and 0.84, respectively). This study develops a deep learning-based model for screening and staging of pneumoconiosis using man-annotated chest radiographs. The model outperformed two groups of radiologists in the accuracy of pneumoconiosis staging. This pioneer work demonstrates the feasibility and efficiency of AI-assisted radiography screening and diagnosis in occupational lung diseases.

职业性慢性正己烷中毒是由于长期接触正己烷后出现的以多发性周围神经损害为主要临床表现的职业病[1]。2016年至2019年, 深圳市职业病防治院诊断并收治职业性慢性正己烷中毒患者21例, 经营养神经、改善循环、康复理疗等综合治疗后, 其中5例在临床症状及神经肌电图均明显好转后, 出现发作性频繁肌肉颤动抽搐、疼痛, 伴有手足多汗、乏力、失眠等自主神经症状, 严重影响患者生活和工作, 现报告如下。一、临

Objectives Experimental studies suggested that bisphenol A (BPA) exposure increased the risk of metabolic syndrome (MetS) through the mechanism of insulin resistance. All previous epidemiological studies of BPA and MetS were cross-sectional studies, and their findings were mixed. This study aims to provide further evidence on the association between urinary BPA and risk of MetS using a prospective cohort study in China. Methods The study population was from the Shenzhen Night shift workers’ cohort. A total of 1227 male workers were recruited from the baseline survey in 2013 and then followed until 2017. Modified Adult Treatment Panel III criteria were used to identify the cases of MetS. Urinary BPA concentration was assessed using high-performance liquid chromatography–tandem mass spectrometry, and it was categorised into three subgroups by tertiles to obtain the adjusted HR (aHR) and 95% CI using Cox proportional hazard model. Results During 4 years of follow-up, 200 subjects developed MetS. Compared with the lowest urinary BPA subgroup, a weakly increased risk of MetS was suggested among those with the middle (aHR=1.19, 95% CI 0.87 to 1.63) and high level of urinary BPA (aHR=1.16, 95% CI 0.84 to 1.59); however, the significant association with MetS was restricted primarily to the smokers, showing a positive gradient with urinary BPA (middle level: aHR=2.40, 95% CI 1.13 to 5.08; high level: aHR=2.87, 95% CI 1.38 to 5.98; p trend= 0.010). Conclusion This prospective cohort study provided further evidence that exposure to BPA may increase the risk of MetS, and this association was further positively modified by cigarette smoking.

[目的]系统分析尘肺病诊断中读片差异情况及其产生的原因,为制定干预措施,提高尘肺病诊断准确性提供依据.[方法]检索1990年1月1日-2018年12月31日我国关于尘肺病诊断读片相关研究的中文文献,确定评价指标,遴选相关文献并进行系统分析.[结果]共检索出331篇中文文献,其中有16篇文献符合遴选要求,发表时间为1991-2014年.研究内容大多是上级诊断机构专家对被抽取的诊断机构已诊断为尘肺病的胸片进行读片,部分是诊断专业人员个人自身复读,对两组或两次读片结果进行对比分析,指标包括尘肺病分期、总体密集度,各肺区小阴影密集度和形态,是否存在小阴影聚集、大阴影、胸膜病变等;评价指标以符合率为主.前后两次读片时,集体两次读片符合率(85.9％～94.0％)高于个人两次读片符合率(15％～64％);不同集体读片符合率大多在60％以上,最高84.2％,最低40.0％.读片者的职称和专业、小阴影特征(包括形态和密集度)、胸片质量等均会对读片结果产生影响.[结论]无论是集体诊断还是个人阅片,读片差异都是普遍存在的,应采取必要的干预措施,保证尘肺病诊断更加科学、准确和权威.

Objective: To explore the effect of the umbilical cord mesenchymal stem cells(UC-MSCs) on the pulmonary fibrosis in silicosis rats. Methods: SPF male Sprague Dawley rats were randomly divided into control group, silica model group and UC-MSCs treatment group with 12 rats each group. SiO(2) intra-tracheal injection(0.5 ml of 50 mg/ml/rat) were applied to silica model group and UC-MSCs treatment groups. After that UC-MSCs treatment group received 1 ml UC-MSCs suspension (3×10(6) cells/ml) by tail vein injection on the 29th, 36th, 43th and 50th day after exposure to the first silica suspension. On the 60th and 75th day after exposure to silica suspension, all animals were examed for pulmonary CT. Then the rats were euthanized on 75th day after the first exposure to silica.Lung's histopathological examination of the rats from all the groups were carried out. The content of hydroxyproline in lungs, TGF-β1 and IL-6 in serum were examined. Results: The lung's histopathological examination showed no obvious inflammatory cell and no fibrosis in the lung tissue of the control group, there were a lot of inflammatory cell aggregation and collagen fiber deposition in silica model group, while in the UC-MSCs intervention group and treatment group, there were less inflammatory cells and collagen fiber. The rats from silica model groups had higher HYP, TGF-β1 and IL-6 than the rats from UC-MSCs treatment group and control group. Lung fields of rats in the control group were clear and no obvious high-density shadow. Different-sized granular high-density shadows or reticular fibrous shadows were found diffusely distributed in the lungs of the rats in silica model group. Lung field of rats in UC-MSCs intervention group and treatment group were less high density shadows, and more clear. Conclusion: UC-MSCs can alleviate the pulmonary fibrosis in silica model rats through regulating the secretion of some fibrosis related cytokines.

我国是世界上尘肺病发病率最高的国家,庞大的尘肺病人群给个人、家庭和社会均带来了沉重的负担.但是,由于尘肺病病情的不可逆性,目前对其治疗的效果均不理想.近年来,从传统中医方面寻求治疗尘肺病的方法取得了一定的进展,基于此,从体质分布与辨证、传统中药治疗、特色中药治疗和中西医结合治疗等方面,对尘肺病的中医治疗方法、研究进展进行了综述,认为尘肺病的治疗在以上多个方面均取得了进展,但这些探索相对零散和单一,没有充分发挥中药多途径、多靶点的优势,今后还需继续加强这方面的研究.

[目的]通过读片统计尘肺病诊断结果,并对其差异性进行分析,为提高诊断的准确性提供依据.[方法]邀请尘肺病诊断专家分A、B两组对163张已确诊为尘肺病病人的胸片进行双盲读片,对两组诊断结果不一致的胸片,从A、B组各抽取2名医生,并另邀请2名国家级专家进行最终集体读片,记录读片结果,进行数据处理与统计学分析.[结果]A、B两组专家对小阴影形态大小的判断一致性最低(Kappa值=0.422,P＜0.01);小阴影密集度和小阴影聚集判断一致性稍好(Kappa值=0.518、0.469,P＜ 0.01);大阴影判断一致性最好(Kappa值=0.716,P＜0.01).在胸片的6个分区中,两肺中区是一致性最低的区域(Kappa值=0.362、0.411,P＜0.01),两肺上区一致性最高(Kappa值=0.567、0.525,P＜0.01);两组专家对期别的判断和把握较好,两组间符合率为75.46％,Kappa值为0.708(P＜0.01).对结果不一致的胸片,A、B两组医生与专家组最终集体读片的诊断分期结果符合率分别为53.65％、41.46％,Kappa值分别为0.393、0.221(P＜0.01),A组专家与专家组集体读片结果更为接近.[结论]尘肺病诊断读片客观上存在一定差异,小阴影总体密集度和各肺区的分布是关键判断依据,正确判断局部的细节是做出精确诊断的基础,资历深的专家在总体的把握上比较稳健,能根据丰富的读片经验,综合各种小阴影的性质给出正确的尘肺病分期结论.

[目的]探讨采用多层螺旋CT(multi-slice spiral CT,MSCT)观察大鼠矽肺模型疗效的可行性.[方法]将60只无特定病原级SD大鼠随机分为对照组、模型组和治疗组3组,每组各20只,分别进行MSCT检查及病理检查.根据各个肺窗的小阴影密集度拟定大鼠矽肺模型MSCT分级,统计所有大鼠矽肺模型MSCT级别的例数.通过观察肺组织病理学改变,进行大鼠矽肺病理分级.不同组别大鼠矽肺模型MSCT分级、病理分级统计均采用非参数检验(Kruskal-Wallis检验);大鼠矽肺模型MSCT分级与病理分级的一致性采用加权Kappa一致性检验.[结果]不同组别大鼠矽肺模型MSCT分级(H=26.27,P＜0.01)及病理分级(H=38.86,P＜0.01)的分布差异均有统计学意义.大鼠矽肺模型MSCT分级与病理分级的一致性检验的加权Kappa值=0.706(P＜ 0.05),提示各组大鼠的矽肺模型MSCT分级与病理分级具有较高的一致性.[结论]MSCT可观察大鼠矽肺模型的疾病状态发展,作为评估大鼠矽肺模型疗效的检查方法,具有一定的可行性.

对我国尘肺病防治的发展历程进行了系统总结,重点回顾了我国建立的尘肺病防治法规体系、尘肺病以预防为主的策略和措施,以及开展的尘肺病治疗科技攻关实践,对我国在尘肺病防治方面开展的卓有成效的工作进行了展示.同时通过对客观数据的分析,反映我国目前尘肺病防治形势依然非常严峻,任重而道远.结合国家发布的《尘肺病防治攻坚行动方案》,展望我国尘肺病防治今后的工作和前景,认为通过全国统一行动,以及全社会的共同努力,一定会从根本上预防和减少新发尘肺病病人,实现全面建成小康社会的宏伟目标.

ObjectiveTo examine the relationship between night shift work and elevated level of alanine transaminase (e-ALT) of workers, stratified by status of non-alcohol fatty liver.MethodsWe established a prospective cohort of night shift workers in Shenzhen, China. All 4740 male workers who had liver function data from the baseline survey of this night shift workers’ cohort were included in the current analysis. We collected information on demographics, lifestyles, and lifetime working schedule from standardized questionnaire. We examined workers’ NAFL status using liver sonography and their serum ALT levels using the automatic biochemical analyzer. Unconditional logistic regression models were used to evaluate odds ratios (ORs) and 95% confidence interval (95% CI).ResultsThis cohort contained 39.5% night shift workers. Compared with the day workers, night shift workers had higher odds of e-ALT (OR: 1.18; 95% CI 1.00–1.40). Stratified analysis showed that a positive gradient between night shift years and elevated e-ALT was only restricted to the night shift workers without NAFL. No similar trend was observed among those with NAFL.ConclusionsNight shift work is positively associated with the abnormal liver function in workers without NAFL, which indicates that shift work involving circadian disruption is likely to affect abnormal liver function.[National Natural Science Foundation of China (Project number 81273172 and 81372964), Shelly@cuhk.edu.hk (Lap Ah Tse)]

目的:探究影响医院患者安全文化的因素.方法:使用分层线性模型分析三级公立医院患者安全文化问卷调查数据;采用美国AHRQ患者安全文化调查问卷(HSOPSC)对深圳市11所三级医院进行随机调查,共回收1 621份有效问卷;使用SPSS v22和HML v7软件对数据进行统计分析.结果:问卷整体Cronbach's α为0.873,信度良好;KMO取样适切性量数为0.929,Bartlett球形度检验显著性P＜0.05,变量间偏相关性非常强;分层线性模型数据分析显示,影响患者安全文化的变量按重要性排序依次为科室间合作、科室内合作、不良事件报告频率、是否为主管;主管身份与患者安全文化呈负相关.结论:分层线性模型在分析较大样本且具有嵌套结构特征的患者安全文化数据时更加精准;研究结果为医院患者安全管理提供了参考依据.

Introduction Previous studies in Asia developed areas showed inconsistent findings on the association between nightshift work and obesity occurrence, and there has been no study in Chinese. This study aims to examine the association between nightshift work, body weight gain and obesity occurrence in a Chinese night shift cohort after 3 years of follow-up. Methods We recruited 5256 male workers from 6 companies in China in 2013. We used standardised questionnaire to collect participants' information on occupational history of shift work. Night shift work was defined as ever worked in a working schedule during 00–5 am at least once per month for no less than one year. Anthropometric parameters were measured using standard medical protocols. All participants were followed up till the end of 2017. Multiple logistic regression analysis was conducted to evaluate the association between night shift work and overweight (BMI ≥25), obesity (BMI ≥30) and BMI gain status. Results We only included 492 male workers in this report, as the data of other participants have not been input whilst the overall results from entire cohort will be presented in ICOH 2018. The mean age of night shift work and daytime workers is comparable (30 vs 29 years). Compared with the daytime workers, slightly more night shift workers were current smokers (25.1% vs 23.7%) and alcohol drinkers (28.1% vs 22.2%), but fewer had vigorous physical activity (29.9% vs 59.4%). More nightshift workers than daytime workers slept less than 8 hours per night (60.5% vs 34.8%) but the proportion of working longer than 55 hours per week was substantially higher (6.6% vs 3.7%). After three years of follow-up, night shift workers showed more BMI gain than the daytime workers (1.45±1.10 vs 1.32±1.09). More night shift workers with large body mass index at baseline tended to retaining in the same category of overweight (BMI ≥24 kg/m2) status with odds ratios of 1.49 (95% CI: 0.95 to 2.33), and stayed in the same category of abdominal obesity with OR of 1.34 (95% CI: 0.86 to 2.11). More night shift workers developed abdominal obesity from normal body size during 3 year period of follow-up and the risk of abdominal obesity was 1.43 (95% CI: 0.75 to 2.73), but there was no statistical significance. Conclusions This study provided preliminary evidence to on a possible link between nightshift work and obesity occurrence or body weight gain in Chinese male workers; however, these findings would be verified in a larger dataset of all 5256 workers. Funding This work was supported by National Natural Science Foundation of China (Project number 81273172 and 81372964).

[目的]研究穿戴定制国际生物力学学院(International College of Biomechanics,ICB)矫形鞋垫结合医学运动康复训练的治疗方式对低足弓相关性足底筋膜炎患者的中短期疗效,探讨该康复治疗手段的价值.[方法]选取诊断为低足弓相关性足底筋膜炎的60例患者,随机分为观察组(30例)和对照组(30例),两组均接受常规医学运动康复训练治疗,观察组在此基础上穿戴定制的矫形鞋垫进行介入治疗.对两组患者治疗前、治疗后1个月、6个月、12个月进行疼痛视觉模拟量表(visual analogue scale,VAS)和足踝功能量表(foot and ankle ability measure,FAAM)评分进行测量,FAAM评分由日常生活活动(activities of daily living,ADL)分量表评分和运动功能(motor ability)分量表评分组成.[结果]两组患者治疗前的VAS及FAAM各项评分(包括ADL分量表评分和运动功能分量表评分)差异均无统计学意义(P＞0.05).两组患者治疗后1个月、6个月、12个月的VAS评分及FAAM各项评分(包括ADL分量表评分和运动功能分量表评分)与治疗前比较均有改善,差异有统计学意义(P＜0.01).治疗后6个月、12个月,观察组的疼痛视觉模拟评分(VAS)优于同时间点的对照组(P＜0.01);治疗后1个月、6个月、12个月,观察组FAAM各项评分(包括ADL分量表评分和运动功能分量表评分)均优于同时间点的对照组(P＜0.01).[结论]ICB矫形鞋垫能纠正下肢足底压力改变,调整足弓生物力学;在医学运动康复训练的基础上运用该疗法,相比传统医学运动康复训练,对低足弓相关性足底筋膜炎有更佳的中短期疗效.

[目的]利用蒙特利尔认知评估量表研究职业性慢性苯中毒患者认知功能的特点.[方法]收集职业性慢性苯中毒患者39例作为观察组,与观察组性别、年龄、学历相匹配的健康人群39例作为对照组.两组分别使用蒙特利尔认知评估(Montreal cognitive assessment,MoCA)量表来探讨苯中毒患者的认知功能特点.[结果]观察组MoCA量表评分平均总得分(24.10±3.82)分,对照组平均总得分(25.36±2.34)分;两组总得分比较,差异均无统计学意义(P＞0.05).同对照组相比,观察组视空间与执行能力、命名、注意力与计算力3个因子分值降低,差异有统计学意义(P＜ 0.05).[结论]职业性慢性苯中毒可能对患者在视空间与执行能力、命名、注意力与计算力方面有一定影响.

对矽肺发病概况及机制、矽肺治疗现状做了回顾,对干细胞治疗在矽肺中的应用做了分析和展望.认为,鉴于缺乏有效的治疗干预措施,干细胞疗法成为矽肺治疗中一个有前途的方法.干细胞是一类能够自我复制的多潜能细胞,具有较强分化功能,由于干细胞的潜能区分,它可替换目标组织中的受损细胞.这种疗法的关键作用包括减少有害的促炎症和促纤维化过程,减少细胞凋亡,以及增强肺损伤后的修复.细胞治疗方案的优化和临床试验的进步可以带来矽肺治疗的重要突破.

[目的]通过二次气管切开灌注二氧化硅建立硅肺动物模型,为探讨硅肺病发病机制、寻找更有效的治疗方法提供模型支持.[方法]将40只SD雄性大鼠随机分为对照组和模型组各20只.模型组采用二次(间隔7d)气管切开灌注0.5 mLSiO2混悬液(50 mg/mL)建立硅肺大鼠模型,对照组通过气管滴注注入生理盐水.两组均在第一次染尘90 d后行CT检查,并于处死后进行HE和Masson染色观察肺组织病理学变化;用酶联免疫法检测大鼠血清白介素-6(IL-6)和转化生长因子β1(TGF-β1)的水平,酸解法检测肺组织羟脯胺酸(HYP)水平的变化.[结果]模型组大鼠肺组织双肺表面可见散在的灰白色斑点,部分融合成不规则形斑块;CT摄影可见肺部呈弥漫性云雾状片状高密度影;病理检查结果显示肺组织出现细胞性硅结节(肉芽肿)等病理改变;模型组以上影像学、大体外观、组织学病理改变各有16例、20例、20例,而对照组均未发生改变.模型组IL-6、HYP、TGF-β1水平较对照组均明显升高,组间差异均有统计学意义(P＜ 0.01).[结论]采用二次染尘法气管内二次注入二氧化硅(SiO2)建立硅肺大鼠模型,能够达到满意效果.

Objectives Accumulated evidence implies that night shift work may trigger liver dysfunction. Non-alcoholic fatty liver (NAFL) is suggested to be a necessary mediator in this process. This study aimed to examine the relationship between night shift work and elevated level of alanine transaminase (e-ALT) of workers and investigate the potential mediation effect of NAFL. Methods This study included all male workers from the baseline survey of a cohort of night shift workers. Information on demographics, lifestyle and lifetime working schedule was collected by face-to-face interview. Liver sonography was used to identify NAFL cases. Serum ALT level was detected by an automatic biochemical analyser. e-ALT was defined as ALT >40 U/L. Logistic regression models were used to evaluate ORs, and mediation analysis was employed to examine the mediation effect. Results Among 4740 male workers, 39.5% were night shift workers. Night shift workers had an increased risk of e-ALT (OR, 1.19, 95% CI 1.00 to 1.42). With the increase in night shift years, the OR of e-ALT increased from 1.03 (95% CI 0.77 to 1.36) to 1.60 (95% CI 1.08 to 2.39) among workers without NAFL. A similar trend was not found among workers with NAFL. In addition, no significant mediation effect of NAFL in the association between night shift work and e-ALT was found. Conclusions Night shift work is positively associated with abnormal liver function, in particular among workers without NAFL. Shift work involving circadian disruption is likely to exert a direct effect on liver dysfunction rather than rely on the mediation effect of NAFL.

动物模型是一个强大的科学研究工具.通过尘肺病动物模型的建立和应用,不仅能为尘肺病的发病机制研究提供良好的基础,而且能为尘肺病的临床治疗提供实验依据.通过对尘肺病文献的梳理,总结了目前常用的建立尘肺病动物模型的方法,包括非暴露式气管内注入法、暴露式气管内注入法、动静式口鼻吸人染尘(毒)法等.在分析各种动物模型优劣点的基础上,为未来探寻更理想的尘肺病动物模型提供文献基础和实验依据.

AIMS:This study aimed to evaluate the associations between types of night shift work and different indices of obesity using the baseline information from a prospective cohort study of night shift workers in China. METHODS:A total of 3,871 workers from five companies were recruited from the baseline survey. A structured self-administered questionnaire was employed to collect the participants' demographic information, lifetime working history, and lifestyle habits. Participants were grouped into rotating, permanent and irregular night shift work groups. Anthropometric parameters were assessed by healthcare professionals. Multiple logistic regression models were used to evaluate the associations between night shift work and different indices of obesity. RESULTS:Night shift workers had increased risk of overweight and obesity, and odds ratios (ORs) were 1.17 (95% CI, 0.97-1.41) and 1.27 (95% CI, 0.74-2.18), respectively. Abdominal obesity had a significant but marginal association with night shift work (OR = 1.20, 95% CI, 1.01-1.43). A positive gradient between the number of years of night shift work and overweight or abdominal obesity was observed. Permanent night shift work showed the highest odds of being overweight (OR = 3.94, 95% CI, 1.40-11.03) and having increased abdominal obesity (OR = 3.34, 95% CI, 1.19-9.37). Irregular night shift work was also significantly associated with overweight (OR = 1.56, 95% CI, 1.13-2.14), but its association with abdominal obesity was borderline (OR = 1.26, 95% CI, 0.94-1.69). By contrast, the association between rotating night shift work and these parameters was not significant. CONCLUSION:Permanent and irregular night shift work were more likely to be associated with overweight or abdominal obesity than rotating night shift work. These associations need to be verified in prospective cohort studies.