OBJECTIVE: To screen the allergens of trichloroethylene-induced occupational medicamentosa-like dermatitis( OMDT) by patch test,and explore methods for OMDT auxiliary diagnosis and trichloroethylene( TCE) allergic population screening. METHODS: A total of 20 subjects diagnosed with OMDT were selected as case group,and 22 nonOMDT healthy workers exposed to TCE≥12 weeks were selected as control group. Different concentrations of TCE and its main metabolites such as chloral hydrate( CH),trichloroethanol( TCOH) and trichloroacetic acid( TCA) were used as allergens in a skin patch test in workers of these two groups. Another 20 new workers exposed to TCE < 12 weeks without OMDT were tested as validation group. They were tested with a patch test at a mass fraction of 15. 00% CH and follow-up observations were performed until 12 weeks of TCE exposure. RESULTS: The patch test of TCE,CH,TCOH and TCA were negative in the control group. In the case group,the patch test positive rate for 50. 00% TCE was 10. 00%,the patch tests were negative in 25. 00%,10. 00% and 5. 00% TCE. The CH patch test positive rate was 100. 00% with the CH mass concentrations of 15. 00%,10. 00% and 5. 00%. The TCOH patch test positive rates were 90. 00%,75. 00% and50. 00%,with the corresponding concentration of 5. 00%,0. 50% and 0. 05%. The TCA patch test positive rates were50. 00% and 0. 00% with the TCA concentrations of 5. 00% and 0. 50% respectively. When the mass concentration was5. 00%,the patch test positive rates in case group from high to low were CH,TCOH,TCA and TCE( P < 0. 01). And the patch test positive rates of CH and TCOH showed no statistical significant difference( P > 0. 05). The patch test positive rate of TCOH increased with increase of TCOH mass concentrations( P < 0. 01). The patch test positive rates for 5. 00%TCA was higher than that of 0. 50% TCA( P < 0. 01). The patch test positive rate in 0. 50% TCOH was higher than that of 0. 50% TCA( P < 0. 01). In the validation group,the patch test of 15. 00% CH was negative,and there was no OMDT case found during the follow-up 12 weeks of TCE exposure. CONCLUSION: The metabolites CH and TCOH of TCE may be the main allergens of OMDT after exposure to TCE. The CH and TCOH patch test can be an auxiliary diagnosis method for OMDT. The CH patch test could be used as a method for screening population allergic to TCE.

OBJECTIVE: To investigate the levels of cortisol and inflammatory factors and their influencing factors in patients with occupational noise-induced hearing loss(ONID). METHODS: A total of 106 ONID patients were selected as the ONID group, and 50 healthy participants without noise exposure were selected as the control group by judge sampling method. The levels of salivary cortisol in the two groups were detected by enzyme-linked immunosorbent assay.The serum levels of cortisol, tumor necrosis factor alpha(TNF-α), interleukin-6(IL-6) and C-reactive protein(CRP) in the peripheral blood were detected by electrochemiluminescence assay. Tinnitus Handicap Inventory was used to evaluate the disability levels of tinnitus in ONID patients. RESULTS: The level of salivary cortisol in the morning and in the nighttime, and cortisol, TNF-α, IL-6 in the serum were higher in the ONID group compared with that in the control group(P<0.05). There was no significant difference in the serum level of CRP between these two groups(P>0.05). Spearman correlation analysis results showed that the level of cortisol in the saliva and in the serum was not correlated with TNF-α and IL-6(P>0.05). Analysis of multiple linear regression showed that the levels of serum cortisol and salivary cortisol in the morning in the ONID patients were positively correlated with noise exposure level(P<0.05). The level of TNF-α in the serum was positively correlated with tinnitus score(P<0.05). CONCLUSION: Hyperactivity of hypothalamus-pituitary-adrenal axis and inflammation activation may exist in patients with ONID. The cortisol can be used as a biomarker for the effect of noise-stress.

OBJECTIVE: To investigate the changes of hemorheology and blood lipid index in patients with occupational hand-arm vibration disease(OHAVD). METHODS: A total of 78 patients with OHAVD were selected as the OHAVD group, and 78 workers without hand transmitted vibration exposure were selected as control group by judgment sampling method. The hemorrheology and blood lipid indexes of the two groups were detected. RESULTS: The whole blood viscosities(low-, medium-and high-shear), hematocrit, erythrocyte aggregation index, and abnormal rate of whole blood viscosities(mid-and high-shear) in the OHAVD group were higher in the OHAVD group than that in the control group(P<0.05). The erythrocyte deformability index and erythrocyte electrophoresis index were lower in the OHAVD group than that of the control group(P<0.05). In the vibration-induced white finger(VWF) subgroup of the OHAVD group, the whole blood viscosity(low-, medium-and high-shear), hematocrit were increased(P<0.05), and the abnormal rate of whole blood viscosity(high-shear) was higher(P<0.017) than that of the control group.The whole blood viscosity(medium shear), hematocrit and erythrocyte aggregation index were increased in the non-VWF subgroup than that of the control group(P<0.017). The concentration of low density lipoprotein cholesterol in the OHAVD group and non-VWF subgroup was higher than that in the control group(P<0.05). The whole blood viscosity(low-, medium-and high-shear), hematocrit, erythrocyte deformability index, erythrocyte aggregation index and erythrocyte electrophoresis index were not correlated with the length of service and age in the OHAVD group(P>0.05). CONCLUSION: The changes of hemorheological properties and blood lipids in OHAVD patients may be associated with vibration vascular injury.

OBJECTIVE: To investigate the asthma control status of occupational sensitizer-induced asthma(OSIA) and explore the influencing factors. METHODS: A total of 50 OSIA patients were selected as study subjects by judgment sampling method. Asthma Control Test(ACT) and Asthma Quality of Life Questionnaire were used to investigate the asthma control status and the quality of life of patients. The fractional exhaled nitric oxide(FeNO) level, pulmonary function, peripheral blood eosinophil ratio(EOS%)and serum total immunoglobulin E(IgE) level of the patients were measured. RESULTS: Among the 50 cases of OSIA patients, 27(54.0%) cases were well controlled, and 23(46.0%) cases were non-fully controlled. The patients with allergic rhinitis, with no inhaled corticosteroids treatment and with poor compliance were risk factors of the non-fully controlled OSIA(all P<0.05). The scores of ACT and the quality of life, and the percentage of the first second forced expiratory volume(FEV_1%) decreased(all P<0.05), while the level of FeNO increased(P<0.05) in the non-fully controlled group compare with the well-controlled group. There was no statistical significance in EOS% and serum total IgE level between the two groups(both P>0.05).CONCLUSION: Allergic rhinitis, lack of inhaled corticosteroids treatment and poor compliance are the influencing factors that affect the control of OSIA. The combinational scores of ACT and quality of life, FeNO, FEV_1% and other indicators can reflect the status of OSIA and assess the level of asthma control, and help guiding OSIA diagnosis and treatment plans.

OBJECTIVE: To establish the clinical pathway of occupational medicamentosa-like dermatitis due to trichloroethylene(OMDT).METHODS: OMDT was selected as the clinical disease category.The diagnosis and treatment schemes of OMDT were determined and the clinical pathway was developed on the basis of evidence-based medicine,clinical data analysis,and the expert opinion as well as GBZ 185—2006 Diagnostic Criteria of Occupational Medicamentosa-like Dermatitis due to Trichloroethylene.The initial clinical validation was performed.RESULTS: We formulated the clinical pathway of OMDT for medical staffs,including standard hospitalization procedures(including normative use of glucocorticoids),Clinical Path Form,and Informed Consent for Glucocorticoid Therapy.The Clinical Pathway Notification of OMDT for patients or their family members was established.Based on the initial clinical verifications,the clinical pathway was conducive to optimize the medical process,none of the patients suffered from rebounds and complications,and the awareness of OMDT and satisfaction with treatments were improved.CONCLUSION: The clinical pathway for OMDT is scientific and reasonable,which is suitable for use to regulate medical behaviors.