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Vocal fold paralysis (VFP) can happen in various conditions due to mediastinal LADs, however no study has proposed anthracosis as an etiology. Here we discussed the chest CT features of anthracosis related LADs causing VFP. Among 41 cases of pulmonary anthracosis, 10 had VFP that all were presented with hoarseness. The paralysis was unilateral (left side) in all cases. Extra-nodal infiltration and conglomeration of lymph nodes were significantly higher in patients with paralysis. Left paratracheal, pre-vascular, and aortopulmonary window lymph nodes were seen in all patients. We propose that mediastinal LADs secondary to anthracosis could be a reason for left side VFP., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Cigarette smoking (CS)-related monocytosis contributes to the development of chronic lung injuries via complex mechanisms. We aim to determine correlations between measures of CS and monocytes, their capacities to predict chronic lung diseases, and their associations with mortality., Methods: A single-center retrospective study of patients undergoing surgical resection for suspected lung nodules/masses was performed. CS was quantified as cigarettes smoked per day (CPD), duration of smoking, composite pack years (CPY), current smoking status, and smoking cessation years. A multivariate logistic regression analysis was performed., Results: Of 382 eligible patients, 88% were ever smokers. In this group, 45% were current smokers with mean CPD of 27.2±40.0. CPY and duration of smoking showed positive linear correlations with percentage monocyte count. Physiologically, CPY was associated with progressive obstruction, hyperinflation, and reduced diffusion capacity (DL CO ). Across the quartiles of smoking, there was an accumulation of radiologic and histologic abnormalities. Anthracosis and emphysema were associated with CPD, while lung cancer, respiratory bronchiolitis (RB), emphysema, and honeycombing were statistically related to duration of smoking. Analysis using consecutive CPY showed associations with lung cancer (≥10 and <30), fibrosis (≥20 and <40), RB (≥50), anthracosis and emphysema (≥10 and onwards). Percentage monocytes correlated with organizing pneumonia (OP), fibrosis, and emphysema. The greater CPY increased mortality across the groups. Significant predictors of mortality included percentage monocyte, anemia, GERD, and reduced DL CO ., Conclusion: Indices of CS and greater monocyte numbers were associated with endpoints of chronic lung disease suggesting a participation in pathogenesis. Application of these easily available metrics may support a chronology of CS-induced chronic lung injuries. While a relative lesser amount of smoking can be associated with lung cancer and fibrosis, greater CPY increases the risk for emphysema. Monocytosis predicted lung fibrosis and mortality. Duration of smoking may serve as a better marker of monocytosis and associated chronic lung diseases., Competing Interests: The authors declare they have no financial or non-financial competing interests in this work., (© 2023 Sangani et al.)

Background: Anthracosis is a disease generally considered to be in the lungs resulting from exposure to industrial dust in the workplace. Esophageal anthracosis is a fairly rare phenomenon and shows a strong correlation with tuberculosis. Moreover, esophageal involvement in tuberculosis is also rare. We here present an extremely rare case in which follow-up gastroesophageal endoscopy revealed a mass with a sunken, black area in the center and raised ring-like pattern in the surrounding mucosa resembling malignant melanoma. Uncovering the patient's tuberculosis history finally avoided a misdiagnosis or overtreatment., Case Presentation: A 67-year-old male patient was admitted to the hospital due to "repeated chest pain for 1 month". Endoscopic ultrasonography and contrast-enhanced CT scans revealed a mass adjacent to the esophageal wall with unclear boundaries. Aspiration biopsy confirmed that esophageal tuberculosis was caused by nearby mediastinal tuberculous lymphadenitis. After a standard anti-tuberculosis treatment regimen, the patient achieved a favorable prognosis. The follow-up gastroesophageal endoscopy showed a sunken black lesion with elevated peripheral mucosa replacing the original tuberculous mass, which was thought to be anthracosis, a disease that rarely occurs in the esophagus., Conclusion: The diagnosis of tuberculosis should be taken into consideration when a submucosal mass appears in the middle part of the esophagus. Endoscopic ultrasonography can effectively contribute to a definite diagnosis. Moreover, this is the first case of esophageal anthracosis observed only 1 year after the treatment of tuberculosis, indicating esophageal anthracosis can be a short-term disease. The traction of the reduction of tubercular mediastinal lymph nodes after anti-tuberculosis treatment may create a circumstance for pigmentation or dust deposition., (© 2023. The Author(s).)

In this work, untargeted lipidomics was employed to analyze the effects of coal dust exposure on serum metabolite profiles. Furthermore, the potential of differential metabolites as novel biomarkers for diagnosis was investigated by binary logistic classification model. Nineteen differential metabolites were found among the three groups. The compounds were enriched in pathways associated with linoleic acid metabolism and pyrimidine metabolism. Fifty-three differential metabolites were found in coal dust-exposed people and CWP patients, and they were mainly enriched in glycerophospholipid metabolism. Three differential metabolites were correlated with lung function values. The diagnostic model, composed of lysoPI (16:0/0:0), bilirubin, and lysoPC (24:1/0:0), showed strong discrimination ability between dust-exposed people and CWP patients. The sensitivity, specificity, and AUC values of the model were 0.869, 0.600, and 0.750, respectively. The results suggest that coal worker's pneumoconiosis causes abnormal lipid metabolism in the body. A diagnostic model may aid current CWP diagnostic methods, and lysoPI (16:0/0:0), bilirubin, and lysoPC (24:1/0:0) can be used as potential CWP biomarkers. Further study is warranted to validate the findings in larger populations., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This review provides an overview of literature addressing progressive massive fibrosis (PMF) from September 2009 to the present. Advances are described in understanding its pathophysiology, epidemiology of the occurrence of PMF and related conditions, the impact of PMF on pulmonary function, advances in imaging of PMF, and factors affecting progression of pneumoconiosis in dust-exposed workers to PMF. Basic advances in understanding the etiology of PMF are impeded by the lack of a well-accepted animal model for human PMF. Recent studies evaluating lung tissue samples and epidemiologic investigations support an important role for the silica component of coal mine dust in causing coal workers' pneumoconiosis and PMF in contemporary coal miners in the United States and for silica in causing silicosis and PMF in artificial stone workers throughout the world. Development of PMF is associated with substantial decline in pulmonary function relative to no disease or small opacity pneumoconiosis. In recent reports, computed tomography has had greater sensitivity for detecting PMF than chest x-ray. Magnetic resonance imaging shows promise in differentiating between PMF and lung cancer. Although PMF develops in dust-exposed workers without previously identified small opacity pneumoconiosis, the presence of small opacity pneumoconiosis increases the risk for progression to PMF, as does heavier dust exposure. Recent literature does not document any effective new treatments for PMF and new therapies to prevent and treat PMF are an important need., Competing Interests: Declaration of Competing Interest The author is a full time employee of the U.S. government and declares that there are no conflicts of interest., (Published by Elsevier Inc.)

Background: Cigarette smoking is a risk factor for interstitial lung abnormalities (ILAs) and interstitial lung diseases (ILDs). Investigation defining the relationships between ILAs/ILDs and clinical, radiographic, and pathologic findings in smokers have been incomplete. Employing a cohort undergoing surgical resection for lung nodules/masses, we (1) define the prevalence of ILAs/ILDs, (2) delineate their clinical, radiographic and pathologic predictors, and (3) determine their associations with mortality., Methods: Patients undergoing resection of lung nodules/masses between 2017 and 2020 at a rural Appalachian, tertiary medical center were retrospectively investigated. Predictors for ILAs/ILDs and mortality were assessed using multivariate logistic regression analysis., Results: In the total study cohort of 352 patients, radiographic ILAs and ILDs were observed in 35.2% and 17.6%, respectively. Among ILA patterns, subpleural reticular changes (14.8%), non-emphysematous cysts, centrilobular (CL) ground glass opacities (GGOs) (8% each), and mixed CL-GGO and subpleural reticular changes (7.4%) were common. ILD patterns included combined pulmonary fibrosis emphysema (CPFE) (3.1%), respiratory bronchiolitis (RB)-ILD (3.1%), organizing pneumonitis (2.8%) and unclassifiable (4.8%). The group with radiographic ILAs/ILDs had a significantly higher proportion of ever smokers (49% vs. 39.9%), pack years of smoking (44.57 ± 36.21 vs. 34.96 ± 26.22), clinical comorbidities of COPD (35% vs. 26.5%) and mildly reduced diffusion capacity (% predicated 66.29 ± 20.55 vs. 71.84 ± 23). Radiographic centrilobular and paraseptal emphysema (40% vs. 22.2% and 17.6% vs. 9.6%, respectively) and isolated traction bronchiectasis (10.2% vs. 4.2%) were associated with ILAs/ILDs. Pathological variables of emphysema (34.9% vs. 18.5%), any fibrosis (15.9% vs. 4.6%), peribronchiolar metaplasia (PBM, 8% vs. 1.1%), RB (10.3% vs. 2.5%), and anthracosis (21.6% vs. 14.5%) were associated with ILAs/ILDs. Histologic emphysema showed positive correlations with any fibrosis, RB, anthracosis and ≥ 30 pack year of smoking. The group with ILAs/ILDs had significantly higher mortality (9.1% vs. 2.2%, OR 4.13, [95% CI of 1.84-9.25])., Conclusions: In a rural cohort undergoing surgical resection, radiographic subclinical ILAs/ILDs patterns were highly prevalent and associated with ever smoking and intensity of smoking. The presence of radiographic ILA/ILD patterns and isolated honeycomb changes were associated with increased mortality. Subclinical ILAs/ILDs and histologic fibrosis correlated with clinical COPD as well as radiographic and pathologic emphysema emphasizing the co-existence of these pulmonary injuries in a heavily smoking population., (© 2022. The Author(s).)

Pneumoconiosis is associated with coal dust particles depositing within the lung causing nodules coalesce to form progressive massive fibrosis (PMF). Cavitary lesions can develop in these PMF areas for concerns of tuberculosis and aspergillosis. We present a 59-year-old patient who had coal workers pneumoconiosis and PMF presenting with chronic dyspnea and hemoptysis with an upper cavitary lesion noted on chest imaging. He notes dyspnea with walking very short distances with associated productive cough. He admits to occasional wheezing, paroxysmal dyspnea, hemoptysis, and orthopnea but denies chest pain. He is an everyday smoker. His physical examination was only remarkable for bronchial breath sounds. On review of his prior imaging, he had a right upper lobe infiltrate as far back as 2012. As the years progressed, a new cavitary lesion developed in the PMF area which progressively got larger with a thick wall and no eccentric region noted inside the cavity. Tuberculosis test was negative. He underwent a transbronchial biopsy with methenamine silver stain which showed acute angle branching and septation suggestive of Aspergillus species. He was diagnosed with pulmonary aspergillosis and treated with voriconazole for 1 year. With pneumoconiosis and evidence confirming aspergillosis, the presence of a new lung infiltration with progression into a cavitary lesion leads to a diagnosis of chronic cavitary pulmonary aspergillosis (CCPA). With follow-up imaging showing extensive lung fibrosis, he had chronic fibrosing pulmonary aspergillosis (CFPA), a late-stage manifestation of CCPA.

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.

Introduction: This study estimated the prevalence of spirometry-defined airflow obstruction and coal workers' pneumoconiosis (CWP) among never-smoking coal miners participating in the National Institute for Occupational Safety and Health (NIOSH) Coal Workers' Health Surveillance Program (CWHSP)., Methods: Data were from working miners screened by a CWHSP mobile unit who had valid spirometry and chest radiography results. Spirometry-defined airflow obstruction was determined when the ratio of forced expiratory volume in the first second to forced vital capacity is less than the lower limit of normal. Chest radiographs were classified according to the International Labour Office system to identify pneumoconiosis, including the most severe form of pneumoconiosis, progressive massive fibrosis (PMF)., Results: Prevalence of airflow obstruction among never-smoking coal miners in this sample was 7.7% overall, 16.4% among miners with CWP and 32.3% among miners with PMF. Airflow obstruction was significantly associated with CWP and PMF., Conclusions: There was a higher prevalence of airflow obstruction among never-smoking coal miners with pneumoconiosis compared with those without pneumoconiosis. These findings support prior research on airflow obstruction and smoking and show pneumoconiosis might present with an obstructive pattern regardless of smoking status., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This investigation assessed the profibrotic role that extracellular histones play in the pathogenesis of coal workers' pneumoconiosis (CWP)., Methods: The correlation of extracellular histones with small opacity profusion (SOP) and transforming growth factor-β (TGF-β) was analyzed. The stimulating effect of extracellular histones on pulmonary fibroblast was assessed in vitro., Results: The levels of extracellular histones in plasma were positively correlated with SOP and TGF-β in the coal miners investigated. Plasma collected from patients with CWP caused apparent lung fibroblast proliferation, while anti-H4 antibody antagonized the stimulating effect of the patient plasma by blocking histone H4. In vitro experiments showed that extracellular histones directly stimulated fibroblast proliferation., Conclusion: Consistent with our hypothesis, the concentrations of extracellular histones were indices of the severity of pulmonary fibrosis in simple CWP, and extracellular histones-targeted intervention could inhibit the proliferation of lung fibroblast.

The aim of this study was to estimate the association between occupational, environmental, behavioral risk factors, and active pulmonary tuberculosis (PTB) among coal workers' pneumoconiosis (CWP) patients. A matched case-control study was conducted in 86 CWP patients with active PTB and 86 CWP controls without TB. A standardized questionnaire was used for risk factors assessment. Conditioned logistic regression analysis was used to identify associations between the risk factors and active PTB among CWP patients. The results showed that the stage of CWP, poor workplace ventilation, family history of TB, and exposure to TB were independent risk factors for active PTB in patients with CWP with which recommendations for improving work environments, and for case finding activities in patients with CWP could be made., (Copyright © 2018 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.)

Introduction: Both fibrosing mediastinitis (FM) and bronchial anthracofibrosis (BAF) are unique diseases. The combined appearance of FM and BAF is extremely rare., Objectives: The aim of this study was to investigate the clinical features of patients with coexisting FM and BAF., Method: Between January 2003 and December 2015, a total of eight patients were diagnosed at the Peking Union Medical College Hospital as having combined FM and BAF. The clinical presentations, radiographic features and bronchoscopic findings of the eight patients were reviewed., Results: The patients were five women and three men with a median age of 64 years (range 56-86 years). Symptoms included dyspnea (eight patients), cough (seven patients), chest pain (two patients), hemoptysis (two patients) and so on. Chest CT of all eight patients showed mediastinal soft-tissue lesions, with multiple narrowed or obliterated lobar or segmental bronchi and arteries. Bronchoscopy showed that all of the patients had multiple stenoses of lobar or segmental bronchi with anthracotic pigmentation on the mucosa. Echocardiography showed that all of the patients had elevated pulmonary arterial systolic pressure (median 81 mm Hg, range 51-107 mm Hg). Each of the eight patients had a history of exposure to, or infection with, tuberculosis, although there was no evidence of active disease. All of the eight patients had long-term exposure to indoor coal or biomass fuel smoke., Conclusions: FM can coexist with BAF, characterized by prominent pulmonary hypertension. The possible etiological factors are tuberculosis and coal or biomass fuel exposure., (© 2017 The Authors. The Clinical Respiratory Journal Published by John Wiley & Sons Ltd.)

Lepidic adenocarcinoma previously known as bronchioloalveolar carcinoma (BAC) is a non-small cell lung cancer with an indolent presentation. Bronchial anthracofibrosis (BAF) is caused by long-standing exposure to biomass fuel smoke often in poorly ventilated kitchen. Middle lobe syndrome (MLS) due to BAF is not uncommon however, lepidic adenocarcinoma then known as BAC, presenting as MLS has been documented only once before in the Polish literature. A 68-year-old never-smoker female with biomass fuel smoke exposure presented with cough and breathlessness. Imaging revealed MLS. Fiberoptic bronchoscopy visualised bluish-black hyperpigmentation with narrowing and distortion of right middle lobe bronchus suggestive of BAF. Transbronchial biopsy confirmed presence of lepidic adenocarcinoma. To our knowledge, this is the first detailed description of lepidic adenocarcinoma and BAF presenting as MLS.

Objective: Several studies have been conducted regarding the effects of coal mining on the respiratory system. However, there is a lack of data concerning potential effects of coal mining on the cardiovascular system. In this study, we aimed to evaluate the potential subclinical right and left ventricular dysfunction in coal miners., Methods: This single-center, prospective study included a total of 102 patients. Patient and control groups consisted of 54 coal miners and 48 healthy men, respectively. All patients underwent 12-lead electrocardiography, transthoracic echocardiography, and pulmonary function test., Results: As compared to control group, coal miners had significantly higher right ventricular myocardial performance index (RVMPI) (0.41 ± 0.03 vs 0.37 ± 0.02, P < .001), lower right ventricular fractional area change (RVFAC) (33.55% ± 6.70% vs 37.04 ± 9.26 P < .05), lower tricuspid annular plane systolic excursion (TAPSE) (1.54 ± 0.17 vs 1.73 ± 0.25, P < .001), lower myocardial isovolumic acceleration (IVA) (2.13 ± 0.16 vs 2.56 ± 0.36 P < .001) and decreased aortic distensibility (AD) (4.14 ± 2.18 vs 6.63 ± 3.91 P < .001). All of the echocardiographic parameters were positively correlated with exposure time to coal mine dust, except IVA., Conclusion: Echocardiographic parameters of both right and left ventricular dysfunction, including RVMPI, RVFAC, TAPSE, IVA, and AD, are impaired in coal miners., (© 2017 The Authors Echocardiography Published by Wiley Periodicals, Inc.)

Introduction: Organizing pneumonia (OP) is an uncommon clinic opathological situation among lung diseases. If no underlying cause can be detected, it is named as cryptogenic OP (COP). In this study, the etiologic and clinical characteristics of patients diagnosed as OP in our hospital in the last ten years were evaluated retrospectively. It was also aimed to make a comparison between COP and secondary OP patients., Materials and Methods: One hundred sixty-five patients diagnosed as OP pathologically in the 10 year period from August 2003 to August 2013 were included into that study. Patients' data were evaluated retrospectively from the medical records., Result: One hundred sixty five patients pathologically diagnosed as OP were included. Diagnostic methods were trans-thoracic fine-needle biopsy (TTFNB) in 89 (53.9%) patients, open lung biopsy (lobectomy, wedge resection, segmentectomy) in 52 (31.5%) patients and transbronchial biyopsy (TBB) in 24 (14.5%) patients. One hundred (60.6%) of the patients were defined as COP and 65 (39.4%) as secondary OP. Cough, fatigue and dyspnea were the most common symptoms on admission. We detected OP cases secondary to anthracosis and cyst hydatic besides other well known etiologies. In 61 patients, the main radiologic manifestation was multiple bilateral patchy consolidation typical for OP. In 76 patients focal lesions (solid mass, cavitating mass lesion) and in 6 patients infiltrative opacities were detected radiologically., Conclusions: There is no difference between properties of OP from clinical, laboratory and radiologic finding sin the criptogenic and seconder form of OP. Although it is not asserted, cyst hidatic and anthracosis could be kept in mind for the list of underlying ethiologies for secondary OP.

BACKGROUND Accumulating evidence shows that functional impairment in subjects with coal workers' pneumoconiosis (CWP) is principally due to emphysema and airflow obstruction, rather than underlying restrictive mechanisms. However, cigarette smoking has remained a major confounder. The aim of this study was to assess whether coal dust exposure was associated with emphysema and/or airflow obstruction in the absence of smoking history. MATERIAL AND METHODS The subjects evaluated for possible pneumoconiosis between 2013 and 2015 were retrospectively enrolled into this study. After excluding those with history of smoking, tuberculosis, or lung cancer, the study population was a total of 57 subjects. The emphysema severity and airflow obstruction were quantified by computed tomographic densitometry analysis and spirometry, respectively. For comparability regarding emphysema, 9 age- and sex-matched nonsmoker (n=9) control subjects without known lung disease were randomly selected from a radiology database. RESULTS Emphysema severity was significantly higher in the CWP group compared with the control group (15% vs. 4%, p<0.001). The median percent emphysema and percentage of those with FEV1/FVC <0.7 was 13% and 37% in subjects with simple CWP and 18% and 67% in subjects with complicated CWP, respectively. Percent emphysema and Perc15 (15th percentile of the attenuation curve) was correlated with FEV1/FVC (r=-0.45, r=-0.47) and FEF25-75 (r=-0.36, r=-0.56), respectively, but not with perfusion score. A linear regression analysis showed that factors associated with emphysema were FEV1/FVC (β=-0.24, p=0.009) and large opacity (β=-3.97, p=0.079), and factors associated with FEV1/FVC were percent emphysema (β=-0.51, p=0.018) and tenure (β=-0.63, p=0.044). CONCLUSIONS Our results support the observation that coal dust exposure is associated with emphysema and airflow obstruction, independent of smoking status., Competing Interests: The authors report no declaration of conflict of interest. The authors alone are responsible for the content and writing of the paper.

Purpose: Coal workers' pneumoconiosis (CWP) is caused by an accumulation of coal particles in the lung parenchyma. Reactive oxygen species (ROS) play an important role in the pathogenesis of CWP. It is well documented that ROS stimulate platelet activation, adhesion, and aggregation. The aim of the present study was to investigate the relationship between platelet indices and CWP., Methods: The demographic features, occupational and medical history, exposure time, and complete blood count of retired coal miners were retrospectively analysed. The control group comprised healthy subjects who had not worked underground. Chest radiographs were evaluated according to the CWP classification of the International Labour Office., Results: The study population was divided into following groups: 50 controls, 97 without CWP, 142 simple pneumoconiosis (SP), 157 progressive massive fibrosis (PMF). The platelet count, mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) were significantly higher in patients with CWP compared to those in patients without CWP and controls. The platelet count, MPV, and PCT were higher in patients with PMF compared to those in the SP group (p < 0.05). The results of multiple logistic regression analyses indicated that the platelet count, MPV, and PCT were independently associated with the development of CWP., Conclusions: Platelet indices may be considered as disease markers for pneumoconiosis in coal miners and as a useful indicator of the progression of pneumoconiosis.

Bronchial anthracofibrosis (BAF), an emerging pulmonary disease due to long-standing exposure to biomass fuel smoke, is predominantly seen in females from developing nations. BAF is known to be associated with tuberculosis, pneumonia, chronic obstructive pulmonary disease and lung cancer, but the association of BAF with interstitial lung disease (ILD) is rare and yet to be highlighted. A 72-year-old woman with a 30-year history of exposure to biomass fuel smoke presented with dry cough and exertional dyspnoea. Imaging demonstrated interlobular, intralobular and peribronchovascular interstitial thickening and honeycombing adjoining the subpleural regions, suggestive of the usual interstitial pneumonia pattern. A restrictive pattern with diffusion defect was noted. Fibrebronchoscopy revealed a bluish-black anthracotic pigmentation with a narrowed and distorted left upper lobe, and apical segment of left lower lobe bronchus, confirming BAF. A diagnosis of BAF with ILD was made. To the best of our knowledge, this is the first detailed description of this association., (2016 BMJ Publishing Group Ltd.)

Background: Endobronchial tuberculosis (EBTB) is a serious form of pulmonary tuberculosis. In EBTB, mycobacterium tuberculosis involves trachea, large airways and bronchial trees Combustion of biomass fuels causes anthracotic bronchitis that is characterized by black pigmentation in bronchial tissue. The majority of anthracotic bronchitis are in aged patients, particularly rural women, that use biomass fuel for cooking or traditional bakery .The aim of this study was to evaluate the endobronchial tuberculosis in anthracotic bronchitis., Material and Methods: In total, 483 EBTB patients who underwent flexible bronchoscopy (FB), for various indications, were included. Tuberculosis was confirmed by microbiological analysis of bronchoalveolar (smear and culture for Koch's bacillus) and histopathological methods. EBTB patients were divided in two groups: subjects with anthracotic bronchitis (group 1) and without anthracosis (group 2). Demographic data and important clinical, radiological and bronchoscopic findings were recorded. Chi-squre test and Spss 11.5 software were used for statistical analysis., Results: 483 out of 1824 patients who underwent FB had EBTB. 73.7% patients had EBTB and anthracotic bronchitis (versus 27.3% EBTB without anthracosis). The mean age was significantly higher in EBTB and anthracotic bronchitis (68.45 ± 16.31 versus 49.08 ± 14.7). Female/male ratio was 1.4:4 in EBTB and anthracotic group versus 1:1 in non anthracotic patients. Dyspnea, cough, hemoptysis and wheezing were higher in group 1. History of biomass fuel was more significant in EBTB and anthracotic bronchitis. Mass, diffuse infiltration in lower lobes were revealed higher in radiography of group 1. Bronchoscopy showed the higher frequency of bronchial stenosis in EBTB with anthracosis (P value < 0.05)., Conclusion: This study suggested significant association between EBTB and anthracotic bronchitis. Unusual findings in radiological and bronchoscopic features were seen in EBTB with anthracosis.

Anthracotic pigmentation in the bronchial mucosa is a bronchoscopic finding of pneumoconiosis, or evidence of heavy atmospheric soot. This pigmentation in the tracheobronchial mucosa is surrounded by calcified or noncalcified lymph nodes. Anthracosis is not a previously known cause of left vocal fold paralysis. We present what we believe to be the first reported case of anthracosis-caused vocal fold paralysis.

Background/aim: Enlarged mediastinal lymph nodes can result from serious etiologies including granulomatous disease, neoplasia, etc., and a rare condition called anthracosis . The aim of this study was to determine the incidence of risk factors and the uptake values within the anthracotic lymph nodes., Materials and Methods: 106 patients who underwent endobronchial ultrasound transbronchial needle aspiration and were diagnosed as having anthracosis were analyzed retrospectively. Patients with positive confirmation by surgical biopsies or a 1-year follow-up period were enrolled., Results: 201 lymph nodes were sampled from 106 patients. Subcarinal and interlobar lymph nodes were the most commonly affected stations (36.8% and 34.3%, respectively). The mean durations of exposure to biomass and cigarette smoke were 35.5 and 33 years, respectively. The mean maximum standardized uptake value (SUVmax) within the lymph nodes was 4.76. The SUVmax of the patients with associated malignancy was 4.19 and the SUVmax of nonmalignant patients was 5.28. This difference was statistically significant (P = 0.009)., Conclusion: These findings suggest that anthracosis also affects the mediastinal and hilar stations; it should be considered in differential diagnosis in patients with mediastinal and hilar lymphadenopathies with intense uptake on positron emission tomography scans, especially when there is a history of exposure to known risk factors.

Objective: To determine the predicative significance of HRV and HRT to premature beat on patients with coal-worker's pneumoconiosis., Methods: 100 coal-worker's pneumoconiosis patients with premature beat (including 44 cases of occasional ventricular premature contraction and 56 cases of frequent ventricular premature contraction) were chosen as CWP group, and 50 healthy coal workers were chosen as control group. 24 h DCG was used to monitor and analyze the change of premature beat and to calculate HRV. Index: SDNN, SDANN, HFLF, HRT: TO, TS, compare HRV of CWP group and control group and the changes of HRT of both occasional and frequent ventricular premature contraction., Results: The incidence of CWP at night (66.1%, 37 cases) is higher than that during daytime (33.9%, 19 cases), and the difference is statistically significant with P < 0.05. HRV (SDNN SDANN HF HL) indexes of CWP group are lower than control group, and the difference is statistically significant with P < 0.05. HRV indexes of control group at night are higher than that during daytime, and the difference is statistically significant with P < 0.05. Comparison of CWP group HRV indexes between day and night is statistically insignificant with P > 0.05. Compared with control group, TO of CWP group is higher while TS is lower, and the difference is statistically significant with P < 0.05. Compared with occasional ventricular premature contraction patients in CWP group, TO of frequent ventricular premature contraction patients is higher while TS is lower, and the difference is statistically significant with P < 0.05., Conclusion: Frequent ventricular premature contraction group in CWP group suffer from severe impaired autonomic nervous function injury, and abnormal HRV and HRT can be prognostic indicator of frequent ventricular premature contraction among coal-worker's pneumoconiosis patients.

Background: Anthracofibrosis is the black discoloration of the bronchial mucosa with deformity and obstruction. Association of this disease with tuberculosis (TB) was approved. The objective of this study was to find the additional benefit of assessment of TB by the polymerase chain reaction (PCR) method., Methods: Bronchoscopy was performed on 103 subjects (54 anthracofibrosis and 49 control subjects) who required bronchoscopy for their pulmonary problems. According to bronchoscopic findings, participants were classified to anthracofibrosis and nonanthracotic groups. They were examined for TB with traditional methods such as direct smear (Ziehl-Neelsen staining), Löwenstein-Jensen culture, and histopathology and the new method "PCR" for Mycobacterium tuberculosis genome (IS6110)., Results: Age, sex, smoking, and clinical findings were not significantly different in the TB and the non-TB groups. Acid-fast bacilli could be detected by a direct smear in 12 (25%) of the anthracofibrosis subjects, and adding the results of culture and histopathology traditional tests indicated TB in 27 (31%) of the cases. Mycobacterium tuberculosis was diagnosed by PCR in 18 (33%) patients, but the difference was not significant. Detection of acid-fast bacilli in control nonanthracosis subjects was significantly lower (3, 6%), but PCR (20, 40%) and accumulation of results from all traditional methods (22, 44%) showed a nonsignificant difference., Conclusions: The PCR method showed a result equal to traditional methods including accumulation of smear, culture, and histopathology.

Introduction: Anthracosis of the lung is the blackening of bronchial tissues which can lead to chronic bronchial obstruction. Many studies have shown association of bronchial anthracosis and tuberculosis. The aim of this study was accumulation of scattered studies and getting the definite conclusion about the association between anthracosis and tuberculosis., Matherials and Methods: We conducted a systematic search that included studies with sufficient information about the frequency of tuberculosis in anthracosis (anthracofibrosis) patients and non-anthracotic control group. Moreover, tuberculosis should be confirmed by microbiologic (smear or culture) or histopathological methods., Results: Twelve studies (eight studies on anthracofibrosis and four studies on anthracosis as a general term) comprising of 6280 patients was entered into our meta-analysis. The frequency of tuberculosis in all anthracosis patients was 22.5 % (32.3 % for anthracofibrosis and 16.6 % for anthracosis), which was significantly higher than the control group. Determination of risk showed that the cumulated odds ratio of tuberculosis in all studies of anthracosis was 3.16 (95 % CI = 2.49 - 6.85), which revealed significantly higher risk than the control group. The analysis of the subgroups showed that the cumulated odds ratio of tuberculosis in subgroups of anthracofibrosis (3.28; 95 % CI = 2.16 - 9.12) was significantly higher than anthracosis as a general term (2.85; 95 % CI = 1.73 - 6.61)., Discussion: The association of tuberculosis with all types of anthracosis of the lung was confirmed and a proper mechanism should be defined.

Objective: To investigate the drug resistance of imipenem-resistant (IR) Gram-negative bacilli (GNB) in coal workers' pneumoconiosis (CWP)-chronic obstructive pulmonary disease (COPD) patients with lower respiratory tract infection (LRTI) and to provide a basis for clinical treatment., Methods: Sixty-six strains of IR-GNB were isolated from the sputum of CWP-COPD patients with LRTI, and the bacterial spectrum was investigated. The drug resistance of bacterial strains was studied by KB disk diffusion method., Results: Among the 66 strains of IR-GNB, 29 (43.9%) were Pseudomonas aeruginosa, 17 (25.8%) were Acinetobacter baumannii, and 11 (16.7%) were Stenotrophomonas maltophilia. The drug sensitivity test showed that all bacteria had high drug resistance; Pseudomonas aeruginosa had a susceptibility rate higher than 50% to ciprofloxacin, polymyxin B, fosfomycin, and amikacin, Acinetobacter baumannii had a susceptibility rate higher than 55% to fosfomycin, polymyxin B, and cefoperazone/sulbactam, Stenotrophomonas maltophilia had a susceptibility rate higher than 50% to cotrimoxazole, ciprofloxacin, piperacillin/tazobactam, levofloxacin, polymyxin B, and cefoperazone/sulbactam, and Pseudomonas cepacia had a susceptibility rate higher than 50% to piperacillin/tazobactam, ciprofloxacin, cefoperazone/sulbactam, and polymyxin B., Conclusion: The main species of IR-GNB are such non-fermentative bacteria as Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia in CWP-COPD patients with LRTI. These bacteria have high drug resistance and are sensitive to only a limited range of antibiotics.

Objective: To investigate the histopathological features, complications, diagnosis, and differential diagnosis of coal workers' pneumoconiosis (CWP)., Methods: The lung tissue sections from 14 autopsy cases of CWP were subjected to HE staining and observed under a light microscope, and a retrospective analysis was performed considering the occupational history and clinical features., Results: The 14 cases were 46-71 years of age (mean, 57.7 years). Two cases were diagnosed as dust reaction, 1 case as simple CWP (stage I anthracosilicosis), and 11 cases as complicated CWP (9 cases of stage II anthracosilicosis, 1 case of stage III anthracosilicosis, and 1 case of stage III silicosis). Twelve cases were complicated by chronic bronchitis and emphysema, 8 cases by pulmonary heart disease, 4 cases by pulmonary tuberculosis, 3 cases by liver cirrhosis and liver cancer with pulmonary metastases, and 2 cases by cerebral hemorrhage., Conclusion: Among patients with CWP, the pathological changes of lung tissue become more complex with increasing years of dust exposure. Coal macule is the common pathological feature of CWP, and dust nodules and massive fibrosis are the necessary indices of pathological diagnosis.

Lipid pneumonia is an unusual, non-infectious, inflammatory lung disease characterized by patchy pneumonic consolidation secondary to accumulation of lipid in macrophages. It can be classified as exogenous or endogenous, depending on whether it is associated with the aspiration of foreign material. Endogenous lipid pneumonia (EnLP) has been reported in many mammal species. In pet birds, EnLP is an incidental and uncommon lesion of unknown pathogenesis. A 35-year-old African grey parrot (Psittacus erithacus erithacus) was presented for depression lasting several months, with marked worsening over the 2 days prior to presentation. The animal died shortly after admission. Necropsy examination showed that the lungs were firm with diffuse grey discolouration. Microscopically, there was EnLP, anthracosis, severe atherosclerosis and hepatic amyloidosis. Although the pathogenesis of EnLP in birds is not clear, it has been associated with concurrent atherosclerosis, hepatic diseases and other lesions of the respiratory tract. This is the first description of EnLP in a bird associated with severe respiratory distress., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

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.)

Background: A probable concordance and association between pulmonary tuberculosis and anthracosis was observed in the published literature. We conducted this study to evaluate the clinical and radiologic characteristics of patients with bronchoscopic evidence of anthracosis as well as the prevalence of pulmonary tuberculosis in patients with anthracosis., Methods: Included in the study were 150 consecutive patients with evidence of anthracosis as evidenced by bronchoscopy. Pulmonary tuberculosis diagnostic work up which included bronchoalveolar lavage, sputum smears and cultures, or histologic examination of lung biopsies was performed on all patients. Patients' clinical, pathological, and radiological findings were also recorded and analyzed., Results: A total of 88 men and 62 women, ranging in age from 42 to 92 years were included in the study. Dyspnea (38.7%) and productive cough (35.3%) were among the most common chief complaints. The abnormal bronchoscopic findings were seen most frequently in the right middle lobe bronchus. In 42 patients pulmonary tuberculosis was confirmed either bacteriologically (n = 32) or histologically (n = 10). CT scans of 26 patients were examined, of which the most frequent findings were consolidation and a reticular pattern. Pleural involvement was observed in 14 patients., Conclusion: Prevalence of pulmonary tuberculosis was higher among those with bronchial stenosis (P < 0.05). These findings have suggested that bronchial anthracosis, especially cases of localized anthracosis, in patients with bronchial stenosis and in those without a history of smoking or occupational exposure may be caused by tuberculosis.

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.)

Objective: To determine the value of terminal force of P wave in V1 lead (Ptf-V1) in the diagnosis of coal-workers' pneumoconiosis with pulmonary heart disease complicated by left ventricular hypertrophy., Methods: Select the coal-worker with pneumoconiosis postmortem examination cases which were pathologically diagnosed as pulmonary heart disease complicated by left ventricular hypertrophy and can measure Ptf-V1. Select 14 cases with ECG left axis deviation, no deviation and right axis deviation. Measure and analyze the Ptf-V1 value, the thickness of left and right ventricular wall., Results: There's obvious discrepancy in ventricular wall thickness mean in ECG left axis deviation, no deviation and right axis deviation groups, the discrepancy have statistical significance (F1 = 32.18, P < 0.01, F2 = 8.02, P < 0.01). The left ventricular wall is thicker in ECG left axis deviation group [(1.81 +/- 0.18) cm] than in no deviation [(1.47 +/- 0.15) cm] and right axis deviation groups [(1.39 +/- 0.10) cm], the discrepancy have statistical significance with (P < 0.01). The right ventricular wall is thicker in ECG left axis deviation group [(0.79 +/- 0.14) cm] than in no deviation group [(0.58 +/- 0.14) cm], the discrepancy have statistical significance with (P < 0.01). The right ventricular wall is thicker in ECG right axis deviation group [(0.71 +/- 0.14) cm] than in no deviation group, the discrepancy have statistical significance with (P < 0.05). ECG left axis deviation Ptf-V1 relevance ratio 85.71% is higher than in no deviation (35.70%) and right axis deviation groups (28.57%), the discrepancy have statistical significance with (P < 0.01). The Ptf-V1 absolute value is positively related with left ventricular wall thickness in ECG left axis deviation and no deviation groups (r1 = 0.92, P < 0.01, r2 = 0.93, P < 0.01)., Conclusion: Pft-V1 absolute value is the criterion index of left ventricular morphosis and function especially left atrium loading change. ECG Ptf-V1 combined with ECG left axis deviation is valuable to the diagnosis of coal-workers with pneumoconiosis complicated by left ventricular hypertrophy.

Objective: To observe simvastatin treatment of pulmonary hypertension in patients with coal workers pneumoconiosis (CWP)., Methods: 96 CWP patients with pulmonary hypertension were randomly divided into treatment and control groups. The control group was treated with 2.5 mg warfarin, once a day for four months; the treatment group was treated with 20 mg simvastatin, taken in evening, for 4 months. 6 min walking distance (6MWD) test and inspection pulmonary artery pressure were measured by echocardiography before and after treatment., Results: In the treatment group, the 6MWD were (258 ± 26) m after treatment and (225 ± 19) m before treatment, respectively. Compared with control group, pulmonary artery pressure was (41 ± 9) mm Hg in the treatment group before treatment, (36 ± 3) mm Hg in the treatment group after treatment, and (39 ± 5) mm Hg in control group, respectively, the difference was statistically significant (P < 0.05)., Conclusions: Simvastatin can improve pulmonary hypertension in coal workers pneumoconiosis, and shows a definite curative effect.

Aims: Anthracosis is the deposition of black dusty material in the pulmonary parenchyma. Previous reports showed anthracosis and p16(ink4a) gene aberrant methylation are closely related to the promotion and progression of small-sized pulmonary adenocarcinoma. In this study, we investigated the influence of anthracosis and p16(ink4a) gene aberrant methylation on clinical samples from patients with small-sized adenocarcinoma., Methods and Results: DNA was bisulfite modified and methylation-specific PCR was performed to detect p16(ink4a) gene aberrant methylation; black dusty material was extracted from lung tissues. Anthracotic index (AI) was defined as the absolute absorbance by densitometry. The histopathological diagnosis was concluded according to Noguchi's classification for small-sized pulmonary adenocarcinoma. The mean AI and the frequency of p16(ink4a) gene aberrant methylation of heavy smokers were significantly higher than that of nonsmokers (Ｐ<0.01 andＰ<0.05, respectively). The frequency of p16(ink4a) gene aberrant methylation of early stage small-sized adenocarcinoma was lower than that of advanced and poorly differentiated, while p16(ink4a) protein expression level of early stage small-sized adenocarcinoma was significantly higher than that of poorly differentiated small-sized adenocarcinoma (P<0.05)., Conclusions: AI and p16(ink4a) gene aberrant methylation may provide a potential universal biomarker for small-sized adenocarcinoma., (Copyright © 2010 Elsevier Inc. All rights reserved.)

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.