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There has been a resurgence of progressive massive fibrosis (PMF) in the United States, particularly among central Appalachian miners. We characterized the proportion of PMF among former U.S. coal miners applying for Federal Black Lung Program benefits, 1970-2016. Data from the U.S. Department of Labor were used to characterize trends in proportion of PMF cases, defined as an approved black lung claim with a determination of PMF, among all miners who filed for federal benefits between January 1, 1970, and December 31, 2016. Joinpoint, logistic, and linear regression models were used to identify changes in the proportion of claimants with PMF over time. There were 4,679 unique PMF cases among claimants for federal black lung benefits between 1970 and 2016, with 2,474 miners determined to have PMF since 1996. The number of PMF cases among Federal Black Lung Program claimants fell from 404 (0.5% of claimants) in 1978 to a low of 18 cases (0.6%) in 1988, and then increased to 353 cases (8.3%) in 2014. The proportion of federal black lung benefits claimants with PMF has been increasing since 1978 (0.06% annual percent change [APC]; 95% confidence interval [CI], 0.05-0.07%; P < 0.0001), and began increasing at a significantly increased rate after 1996 (0.26% APC; 95% CI, 0.25-0.28%; P < 0.0001). Most miners with PMF (84%) last mined in West Virginia, Kentucky, Pennsylvania, or Virginia. Since 1970, the proportion of claimants with PMF has increased significantly among miners who last worked in Kentucky (16.6% APC; 95% CI, 16.5-16.7%), Pennsylvania (4.7% APC; 95% CI, 4.6-4.8%), Tennessee (16.1% APC; 95% CI, 15.7-16.4%), West Virginia (16.8% APC; 95% CI, 16.6-16.9%), and most sharply among miners last working in Virginia (31.5% APC; 95% CI, 31.2-31.7%), where in 2009, more than 17% of claimants received a PMF determination. The proportion of PMF determinations for the rest of the United States has not exceeded 4%. There has been a resurgence of PMF, particularly in central Appalachian miners. The resurgence of this preventable disease points to the need for improved primary and secondary prevention of dust-related lung disease in U.S. coal miners.

ObjectivesThe natural history of coal workers’ pneumoconiosis (CWP) after cessation of exposure remains poorly understood.MethodsWe characterised the development of and progression to radiographic progressive massive fibrosis (PMF) among former US coal miners who applied for US federal benefits at least two times between 1 January 2000 and 31 December 2013. International Labour Office classifications of chest radiographs (CXRs) were used to determine initial and subsequent disease severity. Multivariable logistic regression models were used to identify major predictors of disease progression.ResultsA total of 3351 former miners applying for benefits without evidence of PMF at the time of their initial evaluation had subsequent CXRs. On average, these miners were 59.7 years of age and had 22 years of coal mine employment. At the time of their first CXR, 46.7% of miners had evidence of simple CWP. At the time of their last CXR, 111 miners (3.3%) had radiographic evidence of PMF. Nearly half of all miners who progressed to PMF did so in 5 years or less. Main predictors of progression included younger age and severity of simple CWP at the time of initial CXR.ConclusionsThis study provides further evidence that radiographic CWP may develop and/or progress absent further exposure, even among miners with no evidence of radiographic pneumoconiosis after leaving the industry. Former miners should undergo regular medical surveillance because of the risk for disease progression.

Objective This study aims to explore the clinical effect of Tetrandrine (Tet) on progressive massive fibrosis (PMF) of pneumoconiosis. Methods This retrospective study collected 344 pneumoconiosis patients with PMF, and 127 were eligible for the final analysis, including 57 patients in the Tet group and 70 patients in the control group. The progress of imaging and lung function were compared between the two groups. Results After 13 months (median) of treatment, the size of PMF was smaller in the Tet group than that in the control group (1526 vs. 2306, p =0.001), and the size was stable in the Tet group (1568 vs. 1526, p = 0.381), while progressed significantly in the control group (2055 vs. 2306, p =0.000). The small nodule profusion and emphysema were also milder than that in the control group (6.0 vs. 7.5, p =0.046 and 8.0 vs. 12, p =0.016 respectively). Pulmonary ventilation function parameters FVC and FEV 1 improved in the Tet group (3222 vs. 3301, p =0.021; 2202 vs. 2259, p =0.025 respectively) and decreased in the control group (3272 vs. 3185, p = 0.00; 2094 vs. 1981, p =0.00 respectively). FEV 1 /FVC was also significantly higher in the Tet group than that in the control group (68.45vs. 60.74, p =0.001). However, similar result was failed to observed for DLco%, which showed a significant decrease in both groups. Conclusion Tet has shown great potential in the treatment of PMF by slowing the progression of pulmonary fibrosis and the decline of lung function.

OBJECTIVE:The aim of this study was to characterize workplace practices and respiratory health among coal miners with large opacities consistent with progressive massive fibrosis (PMF) who received care at a federally funded black lung clinic network in Virginia. METHODS:Participants were interviewed about their workplace practices and respiratory health. Medical records were reviewed. RESULTS:Nineteen former coal miners were included. Miners reported cutting rock, working downwind of dust-generating equipment, nonadherence to mine ventilation plans (including dust controls), improper sampling of respirable coal mine dust exposures, working after developing respiratory illness, and suffering from debilitating respiratory symptoms. CONCLUSION:Consistent themes of suboptimal workplace practices contributing to development of PMF emerged during the interviews. Some of the practices reported were unsafe and unacceptable. Further research is needed to determine the prevalence of these factors and how best to address them.

Background: The purpose of this study is to see if exfoliative pulmonary airway pathology in cancer-free coal workers’ pneumoconiosis (CWP) can be used as a biomarker for predicting pulmonary morbidity. Methods: We investigated persistent metaplastic changes in bronchoscopic washing cytology and differential cell counts in bronchoalveolar lavages (BAL) in 97 miners with CWP and 80 miners without CWP as the control. Clinicopathological parameters were examined including pulmonary function tests and the presence of progressive massive fibrosis. Results: When compared to the control group, severe alveolitis, severe goblet cell hyperplasia (GCH), severe hyperplastic epithelial change, and severe squamous metaplasia were the distinguishing biomarkers in CWP. Multivariate analysis revealed that severe alveolitis and severe GCH, along with miner duration and current smoker, were independent predictors of pulmonary mortality. The survival analysis revealed a significantly different survival rate between the three groups: no evidence of severe alveolitis and severe GCH, presence of severe alveolitis or severe GCH but not both, and both severe alveolitis and severe GCH. Conclusions: The severities of alveolitis and goblet cell hyperplasia in the bronchoscopic study are independent prognostic factors for CWP. A pathologic grading system based on these two parameters could be used in the stratification and clinical management of CWP patients.

ObjectivesEpidemiological reports since 2000 have documented increased prevalence and rapid progression of pneumoconiosis among underground coal miners in the United States. To investigate a possible role of silica exposure in the increase, we examined chest x-rays (CXRs) for specific abnormalities (r-type small opacities) known to be associated with silicosis lung pathology.MethodsUnderground coal miners are offered CXRs every 5 years. Abnormalities consistent with pneumoconiosis are recorded by National Institute for Occupational Safety and Health (NIOSH) B Readers using the International Labour Organization Classification of Radiographs of Pneumoconioses. CXRs from 1980 to 2008 of 90 973 participating miners were studied, focussing on reporting of r-type opacities (small rounded opacities 3–10 mm in diameter). Log binomial regression was used to calculate prevalence ratios adjusted for miner age and profusion category.ResultsAmong miners from Kentucky, Virginia and West Virginia, the proportion of radiographs showing r-type opacities increased during the 1990s (prevalence ratio (PR) 2.5; 95% CI 1.7 to 3.7) and after 1999 (PR 4.1; 95% CI 3.0 to 5.6), compared to the 1980s (adjusted for profusion category and miner age). The prevalence of progressive massive fibrosis in 2000–2008 was also elevated compared to the 1980s (PR 4.4; 95% CI 3.1 to 6.3) and 1990s (PR 3.8; 95% CI 2.1 to 6.8) in miners from Kentucky, Virginia and West Virginia.ConclusionsThe increasing prevalence of pneumoconiosis over the past decade and the change in the epidemiology and disease profile documented in this and other recent studies imply that US coal miners are being exposed to excessive amounts of respirable crystalline silica.

Background/Objectives: Silicosis, a fibrotic lung disease, is re-emerging globally, driven by an aggressive form linked to engineered stone processing that rapidly progresses to progressive massive fibrosis (PMF). The standard diagnostic approach, chest X-ray (CXR), is subject to considerable inter-observer variability, making the distinction between simple silicosis (SS) and PMF particularly challenging. The purpose of this study was to develop and validate an automated multimodal framework for silicosis staging by integrating artificial intelligence (AI), CXR images, and routine blood biomarkers. Methods: We developed three fusion architectures, early, late, and hybrid, connecting blood biomarker analysis with CXR analysis. Deep learning and conventional (shallow) machine learning models were combined. The models were trained and validated on a cohort of 94 patients with engineered stone silicosis, providing 341 paired CXR and biomarker samples. A patient-aware 5-fold cross-validation was used to ensure the model’s generalizability and prevent patient data leakage between folds. Results: The hybrid and late fusion models achieved the best performance for disease staging, yielding an area under the receiver operating characteristic (ROC) curve (AUC) of 0.85. This multimodal approach outperformed both the unimodal CXR-based model (AUC = 0.83) and the biomarker-based model (AUC = 0.70). Conclusions: This study reveals that AI-based techniques that utilize a multimodal fusion approach have the potential to outperform single-modality methods have the potential to serve as an objective decision support tool for clinicians, leading to more consistent staging and improved patient management.

Pneumoconiosis, caused by inhaling mineral dust, remains a significant occupational disease, despite a declining incidence. Coal workers' pneumoconiosis (CWP), a common subtype, varies in presentation from simple to complicated forms. Differential diagnosis is crucial, especially when CWP manifests as lung masses mimicking malignancy. We present a case of CWP in a 75‐year‐old female with a history of breast cancer, initially suspected of lung cancer due to an incidental mass on chest radiography. Clinical examination, laboratory tests, chest tomography, and biopsy were conducted. The patient, with a history of biomass fuel exposure, presented with a left upper lung mass, initially thought to be lung cancer. Biopsy‐induced hemopneumothorax led to intensive care admission. Histopathology confirmed CWP and conservative management resulted in recovery. Imaging revealed a solid mass in the left upper lung with lymphadenopathy. Histopathology showed carbon‐laden macrophages and anthracosis, consistent with CWP. Imaging modalities, including MRI and FDG‐PET/CT, aid in differentiating CWP from cancer. CWP, mimicking lung cancer, underscores the importance of accurate diagnosis. Imaging features, including nodules with calcifications, guide diagnosis. MRI and FDG‐PET/CT offer valuable insights, albeit with limitations, emphasizing the need for judicious use based on clinical suspicion.

Mycobacterium kansasii is a slow-growing mycobacterium commonly affecting the lungs, usually in a structurally deformed lung. We discuss a case of 67-year-old male with a medical history of complicated coal workers pneumoconiosis or coal mine dust lung disease presented to the pulmonary clinic with worsening dyspnea and hemoptysis with imaging findings revealing cavitary lung lesions in the right upper lobe and progressive massive fibrosis (PMF) bilaterally. Patient sputum gram stain showed acid-fast bacilli, and the cultures grew M. kansasii. He was started on rifampin, ethambutol, and azithromycin. This case highlights the importance of thorough workup of cavitary lung lesion, reinforcing the association of mycobacterium species in a patient with PMF and associated cavities.

Silicosis is a major occupational lung disease with a relatively fatal and irreversible outcome. Early diagnosis for shifting the potential candidates to safe modes of workplace as well as for prevention of further progression is the cornerstone of management. Here, we present a complicated case of silicosis in the form of progressive massive fibrosis, which was initially interpreted as tuberculosis; radiological images had resemblance with tuberculosis and cryptogenic organizing pneumonia. Radiology-guided trucut biopsy was imperative to confirm the diagnosis.