At 8 a.m. on October 30, 2023, on Xingbin Road, Jimei District, Xiamen City, the huge conference hall was full. Witnessed by more than 800 experts and scholars including Lin Shengcai, academician of the Chinese Academy of Sciences, Chen Jiabin, vice president of the Guangdong Provincial Institute of Occupational Disease Prevention and Control (hereinafter referred to as the "Provincial Institute of Occupational Prevention") and former director of the Provincial Key Laboratory of Occupational Disease Prevention and Control, held up a heavy honorary certificate - the 2023 China Toxicology Outstanding Contribution Award.
As one of the top honors in the industry, the China Toxicology Outstanding Contribution Award is selected every two years, and this time there are only 2 winners, Chen Jiabin is one of them.
The special significance doesn't stop there. The award requires candidates to have made an important breakthrough, made outstanding contributions or solved a major toxicological problem in the field of toxicology, and most of the previous winners were well-known experts with great academic influence. Chen Jiabin has been engaged in occupational poisoning treatment and emergency toxicology research for a long time, and the results are more often written in hospital wards, factory workshops, and mountains and fields.
Since graduating from Sun Yat-sen Medical University in 1987 with a 6-year bachelor's degree and joining the Provincial Institute of Occupational Prevention, Chen Jiabin has been ordered to run in the starry night countless times, responsible for or participated in the investigation and treatment of hundreds of major occupational poisoning and unexplained poisoning accidents inside and outside the province, and led the establishment of a key technical system for the treatment of patients with organic solvent poisoning, created a complete poisoning prevention and control model covering "on-site-clinical-experimental-management", and built a three-dimensional, wide-coverage, and medical-prevention health emergency network for sudden poisoning incidents in Guangdong Province.
"It is not important for me to win the award, the important thing is that this award is an affirmation of the toxicology research and occupational disease prevention and control work of poisoning first aid in Guangdong Province. Chen Jiabin said with a smile that he was just one of the people who had been working in the Provincial Occupational Defense Institute for decades. Before him, countless predecessors left valuable achievements and experiences, and behind him, more young people are devoting themselves to this important cause, continuing to protect the health and happiness of hundreds of millions of working people.
01
36 years of searching for drugs and chasing the murderer
Ah Xiu couldn't understand why her good husband became "mentally ill" overnight?
A few days ago, while eating, Zhang Sheng suddenly rushed out the door and plunged into the river beside the road. Ah Xiu was startled and hurriedly sent her husband to the hospital. When he arrived at the emergency department, Zhang Sheng never cooperated with the examination, not only scolded everyone, but even injured a doctor. After several rounds, Zhang Sheng was sent to the brain hospital. But soon, the psychiatrist also felt that something was wrong, Zhang Sheng was sometimes sober, sometimes insane, and the abnormal behavior did not match the performance of patients with mental illness, and the relevant treatment was ineffective. Once again, diagnosis and treatment are at an impasse.
At this time, the director of the department with rich clinical experience proposed to invite Chen Jiabin to come for consultation. After understanding the situation, Chen Jiabin considered that it might be poisoning, and suggested that blood and urine samples should be collected as soon as possible and sent to the Provincial Occupational Defense Institute for laboratory analysis.
"After a check, it turned out to be acute organotin poisoning. Chen Jiabin recalled that he immediately arranged for Zhang Sheng to be transferred to the Provincial Occupational Defense Institute for targeted treatment, and led a team to Zhang Sheng's factory and residence to sample and test all the items that may be in contact with the process and life trajectory, and found out the "murderer" - trimethyltin chloride.
This is a unique chemical that can cause mental confusion and low blood potassium, often existing as impurities in inferior plastics, which can be volatilized when stirred and heated, and enter the human body through the respiratory tract, digestive tract, skin and mucous membranes, causing poisoning, and even cerebral edema and death in severe cases. Because the incubation period varies from person to person and the early symptoms are not specific, treatment may be delayed. Zhang Sheng was fortunate that due to timely diagnosis and treatment, he recovered and was discharged from the hospital soon after.
When all kinds of unexplained poisoning incidents occur, Chen Jiabin can make quick and accurate judgments, relying on years of accumulated practical experience.
In order to find out the process of poisoning, he guided the patients to recall the fatal details that they had never noticed in their work and life, and found the key nodes; in order to improve the chain of clues, he organized a simulation of the factory operation process and restored the poisoning scene, just to measure the accurate concentration of poison; in order to treat more poisoned people, he led a team to travel thousands of miles, covering Guizhou, Sichuan, Hubei, Jiangsu, Zhejiang, Guangxi, Shanghai and other provinces and cities.
Once, there was a collective poisoning incident in Heyuan, and the patients all had symptoms such as abnormal liver function and changes in coagulation time, which were somewhat similar to rat poison poisoning. Chen Jiabin dealt with many rat poisoning accidents and immediately found that something was wrong, "Sodium rat poisoning often occurs first, and then liver function abnormalities, which is inconsistent with the clinical manifestations of patients. ”
Under his guidance, the local re-investigation found that the real cause was that the patient had consumed rice flour containing rice fermented acid. Bacillic acid is a highly toxic substance absorbed through the mucosa of the digestive tract, which can cause vomiting and diarrhea, fatigue and irritability, shock, multi-organ failure, and even death. "This poison is rare, but it is highly fatal. He said that the local government immediately investigated the relevant manufacturers, and the Provincial Occupational Prevention Institute also issued an early warning signal to the whole province to avoid more poisoning accidents.
When encountering more cunning poisons, it is very difficult to catch and detect. But Chen Jiabin is not alone - the strength of "Chasing Poison Detective" is not only because of its wisdom, but also because there are enough "Watson".
In the spring of 2009, Yang Yan, a female worker in a shoe factory, suddenly fell into a coma in the middle of the night and was rushed to Huizhou Hospital for rescue, but the cause could not be found. The condition continued to worsen, and a week later, the hospital had to issue a critical illness notice. Just as the family was about to give up, Chen Jiabin, who received the consultation notice, arrived overnight and preliminarily judged that it was acute dichloroethane poisoning.
In 1992, he opened the investigation into the first unexplained poisoning death in his career, acute dichloroethane poisoning, in which patients had almost identical symptoms. "Whether the patient was an occupational poisoning or not was controversial at first. Chen Jiabin recalled. Unlike general occupational poisoning, dichloroethane poisoning patients develop the disease several hours after leaving their posts, and they appear sporadically, and the chemicals reported by the factory show low toxicity, and no specific poison concentration is found in the production environment.
When the two sides were at a stalemate, the Toxicology Laboratory of the Provincial Institute of Occupational Prevention, which has long provided technical support for the occupational health work of Guangdong Province and even the whole country, made a final decision through animal experiments.
"We simulated the workshop environment using the chemicals provided by the factory and found a strange phenomenon. Liu Lili, director of the Toxicology Laboratory, said, "Although it is a low-toxicity substance, if the low concentration continues to be poisoned for 4 hours, the animal will have symptoms such as malaise and reduced activity." The symptoms disappeared after the poisoning stopped, but after a few hours, the animals began to die one after another, and pathological examination revealed delayed cerebral edema. This is largely consistent with the symptoms of poisoned workers. ”
With these foundations, another narrow encounter with dichloroethane, Chen Jiabin outperformed the Grim Reaper. He judged that Yang Yan still had a chance to be rescued, and transferred him to the Provincial Occupational Defense Institute for examination overnight, and confirmed that it was dichloroethane poisoning and then carried out targeted treatment. Two days later, the 19-year-old girl woke up.
▲Chen Jiabin (middle) investigates the dichloroethane poisoning incident
"Whether you are a clinician or a researcher, you can't be a real expert if you haven't seen poisons or poisoned patients. He said. In the past 36 years of work, he has never stopped fighting against all kinds of poisons, handled more than 200 major poisoning incidents, consulted and guided more than 100 occupational poisoning accidents across provinces, successfully rescued more than 3,000 cases of severe poisoning, and allowed countless poisoned patients to regain their health.
For his outstanding contributions, he has been rated as an advanced worker in the national health system, an advanced individual in national health emergency response of the Ministry of Health, etc., and his related scientific research projects have won the third prize of the Science and Technology Award of the Chinese Preventive Medicine Association, the first prize of the Science and Technology Award of the China Occupational Safety and Health Association, and the third prize of the Science and Technology Achievement Award of the State Administration of Work Safety.
02
Put the beast in a cage
"Guangdong Province is at the forefront of reform and opening up, and the use of foreign chemicals accounts for most of the country, and some chemicals with unknown toxicity and no standards in the mainland have also entered the country from here. Chen Jiabin said. They are a catalyst for socio-economic development, but they can also sometimes become a beast that harms workers – the front line of occupational disease prevention needs to be constantly moved forward to keep the beast in a cage in the shortest possible time.
Different from the speed of life and death in clinical treatment, prevention at the source is a protracted and tough battle.
At the end of July 1996, A-Ying, who was working in an electronics factory, suddenly collapsed to the ground with weak legs, and could no longer walk independently. The strange illness first appeared 1 month ago - every time she walked out of the irrigation workshop, her legs always seemed to be heavy as lead, and she often fell inexplicably, and she needed to hold on to the railing when she went up and down the stairs.
What's even more bizarre is that in the same workshop, more and more female workers are falling. When I went to the local clinic for examination, most of them were attributed to a cold and heavy dampness, and I did not get better after taking medicine and resting. The general hospital diagnosed "peripheral neuritis" and could not find an effective treatment.
When the bus sent 38 sick female workers to the Provincial Occupational Health Hospital, most of them were unable to stand on their own, and it was Chen Jiabin who took more than 10 medical staff to carry them to the inpatient department on the fourth floor one by one. Looking at the group of female workers with muscle atrophy and withering, combined with clinical symptoms and laboratory test results, he judged that this might be another poisoning accident caused by n-hexane.
Sure enough, the provincial and municipal occupational disease treatment teams established immediately monitored and found that the n-hexane concentration in the cleaning workshop exceeded the health toxicological indicators by several times. "We conducted an on-site physical examination of all the workers in the workshop and found that all 76 people were poisoned. Chen Jiabin felt very sad.
N-hexane, commonly known as white oil, is a highly effective industrial cleaner and adhesive used in many industries. Although its acute toxicity classification is a low-toxicity substance, it is highly volatile and highly fat-soluble, and can be absorbed by the body when inhaled or touched by the skin, and will accumulate in the body, and long-term exposure can cause nervous system damage. However, at that time, the relevant research in the domestic medical community was still in its infancy, and there was a lack of workshop hygiene standards and occupational poisoning diagnostic standards.
The alarm bell sounded by this n-hexane occupational poisoning accident was deafening, and the Provincial Occupational Defense Institute was deeply aware that it was urgent to pay attention to occupational n-hexane poisoning. As a result, with the help of almost the whole hospital, the first systematic, comprehensive and scientific research on the prevention and control of chronic n-hexane poisoning in China began.
- In 1997, with the support of the then Guangdong Provincial Department of Health, the Chinese Academy of Preventive Medicine, and the Chinese Center for Disease Control and Prevention, the Provincial Institute of Occupational Prevention and Control launched a research project on the prevention and treatment of chronic n-hexane poisoning.
- In 1998, the research group was formally established and organized a large number of field and laboratory investigations.
- Since 2002, three national standards, including the recommended values of the health standard for n-hexane in the air, the detection method, and the diagnostic standard for occupational chronic n-hexane poisoning, have been proposed and formulated.
- In 2017, the "Diagnosis of Occupational Chronic N-Hexane Poisoning" was formulated and improved, and the diagnostic principles and treatment principles were revised and adjusted to further protect the rights and interests of patients with occupational diseases......
During this period, the Provincial Occupational Defense Institute also explored and formulated a set of comprehensive therapy, and admitted hundreds of patients with n-hexane poisoning, including 76 poisoned workers in the above-mentioned electronics factory, with a cure rate of 100%, which refreshed the international perception that severe chronic n-hexane poisoning patients could not be cured.
After more than ten years of in-depth research and a series of standard releases, the number of occupational poisoning incidents of n-hexane in Guangdong has gradually decreased. Not only that, in the "poisoned apple" and other incidents in Suzhou, Chen Jiabin and others were also invited to fly to the local area to provide assistance for the clinical treatment and investigation of n-hexane poisoning incidents in brother provinces and cities.
▲In 2018, Chen Jiabin went to Dublin, Ireland to participate in the 32nd International Conference on Occupational Health
In the Guangdong Provincial Institute of Occupational Defense, it is not uncommon for such research projects with a large time span and high technical difficulty, and they are often carried out in parallel and synchronously. In particular, the hospital discovered 27 new occupational diseases for the first time in China, and many poison prevention and control research were led and promoted from scratch:
- In order to solve the problem of 1,2-dichloroethane poisoning, a special group was established in 1994 to tackle the poisoning mechanism and prevention and control research, and the institute as the main drafting unit formulated, released, improved and revised a series of national standards, and the relevant research lasted for more than 20 years;
- In order to prevent and treat occupational trichloroethylene drug eruption-like dermatitis with high mortality, the hospital has conducted systematic research for more than 20 years to reduce the mortality rate from more than 50% to less than 5%;
- Since the first discovery of trimethyltin chloride occupational poisoning in Guangdong in 1998, the research has continued until 2022 to complete the development of exposure limits and detection methods, making a significant contribution to the prevention and control of organotin poisoning in China......
03
Protecting the health of workers is the best cause
Completing a systematic study often requires ten years of patience and perseverance, and Chen Jiabin and his colleagues have long been prepared for this, but at the same time, they are also Xi to using "faster, faster" as a mantra - time waits for no one, they need to produce results in the shortest time, and use the fastest speed to transform into a powerful weapon for clinical treatment.
In 1997, with the approval of the then Provincial Department of Health, the Guangdong Poison Emergency Center was officially established to provide technical support for poison first aid in comprehensive medical and health institutions. It is the first provincial emergency center in the country.
Five years later, relying on the advantages of the national chemical poisoning treatment base and the provincial poisoning emergency center, the Provincial Occupational Prevention Institute built an ICU for poisoning treatment, specializing in the treatment of occupational and daily chemical poisoning, including acute mass rat poisoning, fluoroacetamide poisoning, chloroform poisoning, organotin poisoning and other related patients.
"At the beginning, we were equipped with advanced flexible bronchoscope, temperature raising and lowering equipment, blood purification devices, hemodynamic monitoring, oxygen metabolism monitoring and other equipment, which were constantly updated with clinical needs. Chen Jiabin recalled that later, hyperbaric oxygen chambers and blood purification centers were built one after another, and the treatment capacity was continuously improved.
Since 2014, under the co-ordination of the Provincial Occupational Prevention Institute, Chen Jiabin coordinated seven cities such as Chaozhou, Foshan, and Huizhou, and each selected a tertiary general hospital to build a poisoning emergency sub-center, and radiated to the surrounding areas, forming a treatment alliance in the city and its surroundings, and building a health emergency network covering the Pearl River Delta, eastern Guangdong, western Guangdong and other areas with high incidence of poisoning.
"Today, most of the hospitals affiliated to each sub-center have developed into high-level hospital construction units in Guangdong Province. Chen Jiabin said. Under the dispatch of the Provincial Occupational Defense Institute, all sub-centers and testing sub-bases cooperate closely to jointly complete the disposal of poisoning incidents with points and lines.
It is worth mentioning that in every battle, Chen Jiabin will emphasize the importance of toxicology research. The toxicology analysis technology and data accumulated over the years have also made the Toxicology Laboratory of the Provincial Institute of Occupational Prevention and Control a key gentleman many times.
"Based on years of data accumulation, we have built a toxicity database containing nearly 8,000 common poisons, and the next step is to establish a risk prediction model with universities and scientific research institutions to explore the construction of a rapid screening and evaluation system. Liu Lili introduced that this open database will continue to be updated to help improve the province's occupational health event risk monitoring, prediction and early warning efficiency and emergency response capabilities.
As one of the earliest units to carry out toxicology research in China, the Provincial Institute of Toxicology is one of the main units of toxicity evaluation of pesticides, chemicals, cosmetics, disinfection products, medical materials and medical devices in China, in 2003, it won the first place in the total score of the Ministry of Health Chemical Toxicity Identification Agency Class A Qualification, and has undertaken more than 7,000 toxicological safety evaluation tests in 1~4 stages, presided over 11 projects of the National Natural Science Foundation of China, and participated in Sino-Japanese, Sino-US international cooperation and provincial, There are more than 40 department-level scientific research projects.
Today, the provincial chemical toxicity assessment center undertaken by the hospital has been included in the "14th Five-Year Plan for the Prevention and Control of Occupational Diseases in Guangdong Province", and the construction project of the medical emergency rescue center for sudden occupational and environmental diseases (chemical poisoning and nuclear radiation) in Guangdong Province has been successfully included in the key projects of the "14th Five-Year Plan" for national economic and social development of the province.
▲In 2015, the Provincial Institute of Occupational Defense took over the flag of the National Nuclear Emergency Medical Rescue Team. On the left is Chen Jiabin
Plan ahead because new challenges are still coming.
"With the continuous development of science and technology and industry, new materials, new processes, and new forms of business continue to enter the public life, not only to strictly guard against traditional poisons, but also to take into account the prevention of new poison hazards, quickly and accurately identify new potential risks, and the scope of research needs to be expanded. Chen Jiabin said that the concept of "health-centered" also requires the prevention and treatment of occupational diseases to continue to expand the scope of attention, and gradually cover the whole occupational population and the whole life cycle.
At present, the Provincial Institute of Occupational Defense is making a comprehensive layout, from discipline construction to talent construction. In particular, in June 2023, the institute and Anhui University of Science and Technology took the lead in launching the training program for talents in short supply of occupational health projects in the country, injecting fresh water into the prevention and control problems of new and old occupational diseases.
Looking at the growing team of occupational disease prevention and control, Chen Jiabin was very pleased. Sometimes he remembers the first time he walked into the gate of the Provincial Occupational Defense Institute. At that time, he had many choices with excellent grades, and when he was hesitant, a sentence from Professor Zhou Jiongliang, a famous toxicologist and mentor in the mainland, changed his life.
The teacher said that protecting the health of frontline workers is the best cause. Chen Jiabin sighed with emotion, half a life, he fully realized the power of this sentence - the battle against all kinds of poisons is full of unknowns and challenges, but every victory saves not only the patients in front of them, but also countless people who have been saved from harm. "I hope more people will join this cause and feel this happiness. ”
(Names have been changed.)
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Author | Song Bingjun
Reporter | Chen Xiangting
编辑 | 程橙 苏海宁 责编 | 张秀丽
This article was first published in the magazine "The Beginning of Man", and may not be reprinted without authorization, and infringement must be investigated.
Produced by the Guangdong Health Online all-media team