Association between urinary thallium and nonalcoholic fatty liver disease / 临床肝胆病杂志

ObjectiveTo investigate the association between urinary thallium （TL） and nonalcoholic fatty liver disease （NAFLD）. MethodsRelated data were collected from the registered participants aged ≥18 years in National Health and Nutrition Examination Survey from 2017 to 2020， with th exclusion of the individuals with a lack of liver transient elastography data and urinary TL indicators and those with hepatitis B， hepatitis C or significant alcohol consumption. A total of individuals were divided into NAFLD group and non-NAFLD group. Urinary TL level was quantitatively measured using high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry and online solid-phase extraction combined with isotope dilution. The two groups were compared in terms of age， sex， race， marital status， education， family income poverty impact ratio （FMPIR）， body mass index （BMI）， smoking， alcohol consumption， diabetes mellitus （DM）， hypertension （HTN）， hyperlipidemia （HL）， and urinary TL level. The independent-samples t test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. Descriptive analysis， multivariable Logistic regression， restricted cubic spline regression analysis， subgroup analysis， and interaction analysis were conducted to investigate the risk association between urinary TL and NAFLD. ResultsA total of 2 511 individuals were included， with 1 612 （64.20%） in the NAFLD group and 899 （35.80%） in the non-NAFLD group， and the NAFLD group had a significantly higher urinary TL level than the non-NAFLD group ［0.18 （0.11‍ ‍— ‍0.26）μg/L vs 0.16 （0.09 — ‍0.25）μg/L， Z=-2.76， P=0.01］. After adjustment for the covariates of age， sex， race， education， marital status， FMPIR， BMI， smoking， alcohol consumption， DM， HTN， and HL， the urinary TL Q4 group had a significant increase in the risk of NAFLD （odds ratio ［OR］=1.90， 95% confidence interval ［CI］： 1.48‍ — ‍2.44， P<0.01）. There was a positive dose-response relationship （P<0.01） and a non-linear relationship （P<0.01） between urinary TL and the risk of NAFLD. A significant interaction was observed between urinary TL and smoking/BMI （P<0.05）. For individuals taking ≥100 cigarettes in their lifetime， the risk of NAFLD was increased by 50% for every quartile increase in urinary TL （OR=1.50， 95%CI： 1.24‍ — ‍1.80）， and for individuals taking<100 cigarettes in their lifetime， the risk of NAFLD was increased by 20% for every quartile increase in urinary TL （OR=1.20， 95%CI： 1.03‍ — ‍1.40）； for individuals with a BMI of ≥30 kg/m2， the risk of NAFLD was increased by 30% for every quartile increase in urinary TL （OR=1.30， 95%CI： 1.05‍ — ‍1.70）， with a statistical significance （P<0.05）. ConclusionUrinary TL level is significantly associated with the risk of NAFLD.

Heart rate variability in patients presenting with anginal symptoms in absence of cardiac and other diseases

Objectives: Angina is a symptom of coronary artery disease (CAD). Modulation of cardiac autonomic tone as assessed by heart rate (HR) variability (HRV) is found reduced in patients with CAD; myocardial ischemia, myocardial infarction and some other cardiovascular diseases. Reduced HRV has been found associated with sudden cardiac death in these CAD patients. Several patients present with anginal symptoms clinically in absence of CAD or other diseases. The status of HRV is not much clear in these patients. Thus, we aimed to assess HRV in patients with angina with and without myocardial ischemia and compare it with HRV of healthy subjects of similar age groups and follow-up patients for 1 year for cardiac/health events. Materials and Methods: The study included 61 consecutive male patients clinically presenting with angina and 30 healthy subjects. Based on Thallium-201 myocardial perfusion Single-photon emission computerized tomography (SPECT) imaging, patients were divided into two groups; patients with myocardial perfusion defects (MPD), (n = 33, age 54.91 ± 7.43 years) and patients with no MPD (NMPD), NMPD (n = 28, age 53.04 ± 8.50 years). Short-term HRV was assessed in all patients and subjects in resting supine position following standard protocol. All MPD and 25 NMPD patients could be followed up for 1 year for cardiac/health events. Results: Surprisingly, the NMPD patients showed significantly reduced HRV, Standard deviation of the N-N intervals, The square root of the mean squared differences of successive N-N intervals, Percentage of the number of interval differences of successive N-N intervals greater than >50 ms divided by total number of R-R intervals, low frequency (LF) power, High Frequency (HF) power and total power as compared to both MPD patients and healthy subjects. (Total power [NMPD vs. MPD]: 610.1 [379.9–1072.8] vs. 1508.0 [748.4–2339.4] millisecond squares (ms2 ), P = 0.001), healthy subjects (Total power: 1414.6 [1104.6-2141.5] ms2 , P = 0.001). The markers of sympathetic tone; LF (normalised unit) and LF/HF ratio were higher in NMPD patients as compared to MPD patients resulting in an altered sympathovagal balance. During a 1-year follow-up, sudden death was seen in one MPD patient (3.1%) and two NMPD patients (8%). Conclusion: The NMPD patients showed significantly reduced HRV as compared to both MPD patients and Healthy subjects with an altered sympathovagal balance. Sudden death was also seen in NMPD patients as MPD patients.

Determination of thallium and its soluble compounds in workplace air by inductively coupled plasma mass spectrometry / 中国职业医学

Objective To establish a method for the determination of thallium and its soluble compounds in workplace air using microporous filter membrane sampling and inductively coupled plasma mass spectrometry (ICP-MS). Methods Thallium and its soluble compounds in workplace air were collected using microporous filter membranes, digested with nitric acid, quantified using lutetium internal standard method, and detected by ICP-MS. Results The linear range of thallium was 0.00 to 600.00 μg/L, with the correlation coefficient of 1.000. The detection limit was 0.08 μg/L, and the lower limit of quantification was 0.26 μg/L. The minimum detection concentration and minimum quantitation concentration of thallium of 75.00 L workplace air were 1.0×10-5 and 3.0×10-5 mg/m3, respectively. The minimum detection concentration and minimum quantitation concentration of thallium of 480.00 L workplace air was 2.0×10-6 and 5.0×10-6 mg/m3, respectively. The recovery rate of spiking was 100.82%-103.44%, and the relative standard deviation within- and between-batches was 1.50%-3.32% and 1.32%-3.11%, respectively. The sample could be stored at room temperature for at least 14 days. Conclusion This method can be used for the detection of thallium and its soluble compounds in workplace air.

Assessment of Left Ventricular Ejection Fraction by Thallium-201 Myocardial SPECT-CT in Patients with Angina Pectoris: Comparison with 2D Echocardiography / 대한핵의학회잡지

PURPOSE: Left ventricular (LV) ejection fraction (EF) is an important parameter for assessing cardiac systolic function and predicting prognosis in patients with cardiovascular disease. The aim of this study was to evaluate the feasibility of assessing LVEF by Tl-201 hybrid myocardial single-photon emission computed tomography (SPECT)/CT using two attenuation correction methods in patients with angina pectoris.METHODS: A total of 339 patients with angina pectoris (62.8 ± 12.9 years, male:female = 206:133) were analyzed. All patients underwent Tl-201 myocardial SPECT/CT and transthoracic two-dimensional (2D) echocardiograph. We compared LVEF assessed by SPECT/CT using two attenuation correction methods: CT-based attenuation correction (CTAC) and non-attenuation correction (non-AC) methods and 2D echocardiography.RESULTS: LVEF assessed by either of the two attenuation correction techniques and 2D echocardiography showed moderate correlation in all patients with angina pectoris (r = 0.487 for CTAC and r = 0.473 for non-AC, p < 0.001). Results were similar in the subgroup of patients with perfusion abnormalities on myocardial SPECT/CT images. Overall diagnostic performances were similar for the CTAC and non-AC methods for evaluating normal and decreased LVEF by myocardial SPECT/CT.CONCLUSION: LVEF measured by the CTAC method of Tl-201-gated myocardial SPECT/CT was comparable with the conventional non-AC method in patients with angina pectoris and in the subgroup of patients with perfusion abnormality. Tl-201-gated myocardial hybrid SPECT/CT can be a reliable tool in the assessment of LVEF in clinic.

Evaluación de la recurrencia de tumores musculoesqueléticos mediante gammagrafía complementada con SPECT/CT con talio-201 en población pediátrica / Evaluation of recurrence of musculoskeletal tumors with thallium-201 scintigraphy plus SPECT/CT in pediatric population

Resumen Introducción: Los estudios de imagen, como la tomografía simple y contrastada, son la primera aproximación diagnóstica para detectar la recurrencia de tumores musculoesqueléticos. El objetivo de este estudio retrospectivo fue demostrar la utilidad de la gammagrafía acoplada a tomografía computarizada por emisión de fotón único (SPECT/CT) con talio-201(201Tl) en la valoración de tumores musculoesqueléticos malignos con sospecha de recurrencia o enfermedad metastásica. Métodos: Se realizaron 72 estudios gammagráficos y de SPECT/CT para la valoración de la recurrencia locorregional y a distancia, al menos 8 semanas tras la última terapia, en 42 pacientes con diferentes tipos de tumores musculoesqueléticos malignos, como osteosarcoma, sarcoma de Ewing, rabdomiosarcoma, retinoblastoma, sarcoma sinovial y tumor de Wilms en el Hospital Infantil de México. Se calcularon el valor predictivo positivo (VPP) y el intervalo de confianza del gammagrama y de la SPECT/CT en comparación con el resultado del análisis histopatológico y el seguimiento clínico y radiológico para identificar la recurrencia. Resultados: La gammagrafía fue anormal en 30 (71.4%) de los 42 pacientes. Se detectaron 33 lesiones (30 pacientes) por gammagrafía y 25 (21 pacientes) por telerradiografía de tórax y tomografía de dos regiones. La SPECT/CT se realizó en 30 pacientes y se detectaron 12 lesiones adicionales al rastreo planar. El VPP con la gammagrafía fue del 82%, y con la SPECT/CT, del 100%. Conclusión: La gammagrafía con 201Tl puede considerarse un estudio adecuado para identificar los sitios de viabilidad tumoral, con alto grado de certeza diagnóstica al complementar con SPECT/CT.

Abstract Background: Imaging studies, particularly simple and contrast-enhanced tomography, constitute the first diagnostic approach to detect recurrence of musculoskeletal tumors. The aim of the present retrospective study was to demonstrate the usefulness of scintigraphy plus SPECT/CT (single photon emission computed tomography) with thallium-201 (201Tl) in the evaluation of malignant musculoskeletal tumors with suspicion of recurrence or metastatic disease. Methods: Eight weeks after the last therapy, 72 scintigraphy and SPECT/CT studies were performed to assess regional recurrence and metastatic disease in 42 patients with different types of malignant musculoskeletal tumors, such as osteosarcoma, Ewing's sarcoma, rhabdomyosarcoma, retinoblastoma, synovial sarcoma, and Wilms tumor at the Hospital Infantil de México Federico Gómez. The positive predictive value (PPV) and the confidence interval of the scintigraphy and SPECT/CT were calculated when compared with the results of the histopathological analysis and the clinical and radiological follow-up for the identification of recurrence. Results: Scintigraphy was abnormal in 30 (71.4%) of the 42 patients; 33 lesions (30 patients) were detected by scintigraphy and 25 lesions (21 patients) by chest X-ray and tomography of two regions. The SPECT/CT was performed on 30 patients, where 12 lesions were detected in addition to the planar scintigraphy. Scintigraphy showed a PPV of 82%; SPECT/CT, 100%. Conclusion: 201Tl-scintigraphy can be considered as an adequate study to identify the sites of tumor viability with a high degree of diagnostic certainty combined with the SPECT/CT technique.

Efficacy analysis of prussian blue or its combination with hemoperfusion in the treatment of acute thallium poisoning / 中华危重病急救医学

Objective@#To investigate the efficacy of prussian blue (PB) or its combination with hemoperfusion (HP) in the treatment of acute thallium poisoning.@*Methods@#Forty-seven patients with acute thallium poisoning with complete data hospitalized in the 307th Hospital of PLA from September 2002 to December 2017 were enrolled, and they were divided into mild poisoning group (blood thallium < 150 μg/L, urinary thallium < 1 000 μg/L) and moderate-severe poisoning group (blood thallium ≥ 150 μg/L, urinary thallium ≥ 1 000 μg/L) according to the toxic degrees. All patients were given symptomatic supportive treatments such as potassium supplementation, catharsis, vital organ protections, neurotrophic drugs, and circulation support. The mild poisoning patients were given PB with an oral dose of 250 mg·kg-1·d-1, while moderate-severe poisoning patients were given PB combined HP continued 2-4 hours each time. The PB dose or frequency of HP application was adjusted according to the monitoring results of blood and urine thallium. Data of gender, age, pain grading (numeric rating scale NRS), clinical manifestations, blood and urine thallium before and after treatment, length of hospitalization and prognosis were collected.@*Results@#Of the 47 patients, patients with incomplete blood and urine test results, and used non-single HP treatment such as plasmapheresis and hemodialysis for treatment were excluded, and a total of 29 patients were enrolled in the analysis. ①Among 29 patients, there were 20 males and 9 females, median age of 40.0 (34.0, 49.0) years old; the main clinical manifestations were nervous system and alopecia, some patients had digestive system symptoms. There were 13 patients (44.8%) in the mild poisoning group with painless (grade 0) or mild pain (grade 1-3) with mild clinical symptoms, the length of hospitalization was 17.0 (14.2, 21.5) days. There were 16 patients (55.2%) in the moderate-severe poisoning group with moderate pain (grade 4-6) or severe pain (grade 7-10) with severe clinical symptoms, the length of hospitalization was 24.0 (18.0, 29.0) days. ② After treatment, the thallium concentrations in blood and urine in the mild poisoning group were significantly lower than those before treatment [μg/L: blood thallium was 0.80 (0, 8.83) vs. 60.00 (40.00, 120.00), urine thallium was 11.30 (0, 70.10) vs. 370.00 (168.30, 610.00), both P < 0.01], the thallium concentrations in blood and urine in the moderate-severe poisoning group were also significantly lower than those before treatment [μg/L: blood thallium was 6.95 (0, 50.50) vs. 614.50 (245.00, 922.00), urinary thallium was 20.70 (1.95, 283.00) vs. 5 434.00 (4 077.20, 10 273.00), both P < 0.01]. None of the 29 patients died, and their clinical symptoms were improved significantly. All the 27 patients had good prognosis without sequela in half a year follow-up, and 2 patients with severe acute thallium poisoning suffered from nervous system injury.@*Conclusion@#In the acute thallium poisoning patients, on the basis of general treatment, additional PB in mild poisoning group and PB combined with HP in moderate-severe poisoning group can obtain satisfactory curative effects.

Study on the relationship of thallium exposure and outcomes of births / 中华流行病学杂志

Objective To investigate the relationship of thallium exposure and outcomes of births.Methods A total of 3 236 mothers who had visited in Ma'anshan Maternal and Child Health-Care Hospital between May 2013 and September 2014 were included in this study and their thallium concentrations measured from samples of maternal and umbilical cord blood by inductively coupled plasma mass spectrometry.The results were correlated and evaluated with birth outcomes of the infants,using the multiple linear regression method.Results The median (P25-P75) of thallium levels in first trimester,second trimester and umbilical cord blood were 61.7 (50.8-77.0),60.3 (50.8-75.2) and 38.5 (33.6-44.1) ng/L,respectively.After adjustment for potential confounders,the thallium levels showed an inversely significant association with birth head circumference (unstandardized β coefficient=-0.41,95％ CI:-0.76--0.06) in thc first trimester blood,and associated with reduced birth length (unstandardizedβ coefficient=-0.65,95％ CI:-1.25--0.05) in umbilical cord blood.However,there appeared no significantly associations with birth weight,length and head circumference (P＞0.05) in second trimester.On stratification by sex,in girls but not in boys,the thallium levels were adversely associated with birth head circumference (unstandardized β coefficient=-0.53,95％ CI:-1.05--0.01) in the first trimester and were associated with decreased birth weight (unstandardized β coefficient =-277.08,95％CI:-485.13--69.03) and length (unstandardized β coefficient=-1.39,95％CI:-2.26--0.53) in umbilical cord blood thallium.Conclusions Thallium exposure appeared a gender difference in newborn birth outcomes.In the first trimester,it was negatively associated with the birth head circumference,in the umbilical cord blood,and reduced birth weight and length in girls.

Study on the relationship of thallium exposure and outcomes of births / 中华流行病学杂志

Objective To investigate the relationship of thallium exposure and outcomes of births.Methods A total of 3 236 mothers who had visited in Ma'anshan Maternal and Child Health-Care Hospital between May 2013 and September 2014 were included in this study and their thallium concentrations measured from samples of maternal and umbilical cord blood by inductively coupled plasma mass spectrometry.The results were correlated and evaluated with birth outcomes of the infants,using the multiple linear regression method.Results The median (P25-P75) of thallium levels in first trimester,second trimester and umbilical cord blood were 61.7 (50.8-77.0),60.3 (50.8-75.2) and 38.5 (33.6-44.1) ng/L,respectively.After adjustment for potential confounders,the thallium levels showed an inversely significant association with birth head circumference (unstandardized β coefficient=-0.41,95％ CI:-0.76--0.06) in thc first trimester blood,and associated with reduced birth length (unstandardizedβ coefficient=-0.65,95％ CI:-1.25--0.05) in umbilical cord blood.However,there appeared no significantly associations with birth weight,length and head circumference (P＞0.05) in second trimester.On stratification by sex,in girls but not in boys,the thallium levels were adversely associated with birth head circumference (unstandardized β coefficient=-0.53,95％ CI:-1.05--0.01) in the first trimester and were associated with decreased birth weight (unstandardized β coefficient =-277.08,95％CI:-485.13--69.03) and length (unstandardized β coefficient=-1.39,95％CI:-2.26--0.53) in umbilical cord blood thallium.Conclusions Thallium exposure appeared a gender difference in newborn birth outcomes.In the first trimester,it was negatively associated with the birth head circumference,in the umbilical cord blood,and reduced birth weight and length in girls.

Clinical features, electrophysiological characteristics and treatment of thallium poisoning in twelve patients / 中国神经精神疾病杂志

Objective To investigate the clinical and electrophysiological features and treatments for thallium poisoning. Methods Twelve cases of thallium poisoning patients were from hospital 307 of PLA between June 2012 and October 2017 and their data were retrospectively analyzed. Twelve sex-and age-matched healthy subjects were selected as control group. Result The clinical manifestations of thallium poisoning were mainly symptoms of nervous and gastrointestinal systems as well as hair loss. Thallium poisoning compromised function of motor nerves including the prolonged distal latency of ulnar and common peroneal nerve, the decreased amplitude and slowed nerve conduction velocity of common peroneal nerve and tibial nerve, which were statistically different from control group (P<0.05). Thallium poisoning also impaired function of sensory nerve including the prolonged distal latency and decreased amplitude of median , ulnar and sural nerve, the slowed nerve conduction velocity of median , ulnar, radial and sural nerve which were statistically different from control group (P<0.05 or P<0.01 ). Electroencephalogram (EEG) of 7 cases revealed mild abnormality EEG in 6 cases and moderate abnormality EEG in one case. Patients received potassium supplementation, diuresis, oral Prussian blue, intramuscular injection of sodium dimercaptopropanesulfonate and other treatment. Severe cases had good outcome after hemoperfusion and plasma exchange. Conclusions Thallium poisoning is rare in clinic and typical clinical features and electrophysiological examination are helpful to the diagnosis and differential diagnosis of diseases. Timely increasing thallium excretion and symptomatic support treatment can effectively improve the prognosis of the patients.

Clinical analysis on 2 cases of acute thallium poisoning with combined treatment using blood purification and sodium dimercaptosulfonate / 中国职业医学

OBJECTIVE: To investigate the clinical features,treatment methods and prognosis of acute thallium poisoning.METHODS: The clinical data of 2 cases of acute thallium poisoning were analyzed retrospectively to observe its clinical features,therapeutic effect of blood purification and sodium dimercaptosulfonate,and prognosis.RESULTS: The typical triads of clinical features of the two cases of acute thallium poisoning were gastroenteritis,polyneuropathy and alopecia.Before treatment,the blood thallium level was 200.6 and 712.7 μg/L and the urine thallium level was 5 206.4 and 11050.2 μg/24 h respectively.After the combined treatment using blood purification and sodium dimercaptosulfonate,the blood thallium decreased to 31.6 and 14.6 μg/L and the urine thallium decreased to 175.2 and 265.3 μg/24 h.The two patients had a good prognosis.The result of re-examination showed that blood thallium was 7.9 and 0.6 μg/L and the urine thallium was 31.5 and 5.5 μg/24 h respectively in 2 and 5 months later.CONCLUSION: The combined treatment using blood purification and sodium dimercaptosulfonate is effective for acute thallium poisoning therapy.

Efficiency of hemoperfusion on clearing thallium based on atomic absorption spectrometry / 中华危重病急救医学

ObjectiveTo determine thallium in whole blood by atomic absorption detection method, and to investigate the eliminating effect of hemoperfusion (HP) for thallium in blood.Methods The blood of Beagle dogs which had not exposed to thallium before were obtained for preparation of thallium nitrate (TlNO3)-containing solution in three concentrations according to the conversion formula based on animal weight and volume of blood. HP was performed in the simulated in vivo environment. The content of TlNO3 in blood of the next group was determined on the amount of TlNO3 for the last HP of the former dose group. Thallium quantity in different samples was measured with atomic absorption spectrometer blood samples before and after HP. Finally, the thallium concentration in blood was analyzed statistically.Results Thallium concentrations showed a good linear relationship in the range of 0-200μg/L (r = 0.998 4). The intra-day precision (RSD) was lower than 4.913%, the intra-day recovery rate was 96.2%-111.9%; the inter-day precision (RSD) was lower than 7.502%, the inter-day recovery rate was 89.6%-105.2%. The concentration of thallium in blood was significantly reduced after HP per time in high, middle, and low dose groups [(453.43±27.80) mg/L to (56.09±14.44) mg/L in high dose group,F = 8.820,P = 0.003;(64.51±13.60) mg/L to (3.19±0.23) mg/L in middle dose group,F = 36.312,P = 0.000; (5.40±0.98) mg/L to (0.38±0.25) mg/L in low dose group,F = 46.240,P = 0.000]. The adsorption rate of four times of HP in high, middle and low dose group were (87.63±2.48)%, (95.06±1.54)% and (92.76±4.87)%, respectively, without significant difference (F = 4.231,P = 0.070 ).Conclusions The method for measuring thallium was established, and it shows a very stable, simple, sensitive for determination of thallium. HP can effectively remove thallium from blood. Thallium concentration can be reduced by 90% after four times of HP. HP is also effective even when thallium concentration is not high.

Evaluation of a novel decorporation approach to prevent radioactivity uptake by using acidosis in experimental animals.

With an aim to devise a prophylactic and/or therapeutic approach for preventing internalization of radiothallium (201Tl), and more importantly by implication, its chemical analogue radiocesium (137Cs) during any nuclear emergency, different ex vivo and in vivo animal models were created to determine the role of pH in absorption of 201Tl across jejunum/muscle tissue and whole body retention of 201Tl respectively. Movement of Tl+ under simulated pH conditions proved that pH had direct influence on its absorption. Oral intake of acidified water or parenteral administration of lactic acid was able to reduce the body burden of 201Tl by up to 12 and 50% respectively. The results indicate that acidification of gut, within physiological range may be used as an option for decorporation/inhibition of incorporation of radiothallium and radiocesium, particularly in cases of mass casualty.

Occupational Neurotoxic Diseases in Taiwan

Occupational neurotoxic diseases have become increasingly common in Taiwan due to industrialization. Over the past 40 years, Taiwan has transformed from an agricultural society to an industrial society. The most common neurotoxic diseases also changed from organophosphate poisoning to heavy metal intoxication, and then to organic solvent and semiconductor agent poisoning. The nervous system is particularly vulnerable to toxic agents because of its high metabolic rate. Neurological manifestations may be transient or permanent, and may range from cognitive dysfunction, cerebellar ataxia, Parkinsonism, sensorimotor neuropathy and autonomic dysfunction to neuromuscular junction disorders. This study attempts to provide a review of the major outbreaks of occupational neurotoxins from 1968 to 2012. A total of 16 occupational neurotoxins, including organophosphates, toxic gases, heavy metals, organic solvents, and other toxic chemicals, were reviewed. Peer-reviewed articles related to the electrophysiology, neuroimaging, treatment and long-term follow up of these neurotoxic diseases were also obtained. The heavy metals involved consisted of lead, manganese, organic tin, mercury, arsenic, and thallium. The organic solvents included n-hexane, toluene, mixed solvents and carbon disulfide. Toxic gases such as carbon monoxide, and hydrogen sulfide were also included, along with toxic chemicals including polychlorinated biphenyls, tetramethylammonium hydroxide, organophosphates, and dimethylamine borane. In addition we attempted to correlate these events to the timeline of industrial development in Taiwan. By researching this topic, the hope is that it may help other developing countries to improve industrial hygiene and promote occupational safety and health care during the process of industrialization.

Occupational Neurotoxic Diseases in Taiwan

Occupational neurotoxic diseases have become increasingly common in Taiwan due to industrialization. Over the past 40 years, Taiwan has transformed from an agricultural society to an industrial society. The most common neurotoxic diseases also changed from organophosphate poisoning to heavy metal intoxication, and then to organic solvent and semiconductor agent poisoning. The nervous system is particularly vulnerable to toxic agents because of its high metabolic rate. Neurological manifestations may be transient or permanent, and may range from cognitive dysfunction, cerebellar ataxia, Parkinsonism, sensorimotor neuropathy and autonomic dysfunction to neuromuscular junction disorders. This study attempts to provide a review of the major outbreaks of occupational neurotoxins from 1968 to 2012. A total of 16 occupational neurotoxins, including organophosphates, toxic gases, heavy metals, organic solvents, and other toxic chemicals, were reviewed. Peer-reviewed articles related to the electrophysiology, neuroimaging, treatment and long-term follow up of these neurotoxic diseases were also obtained. The heavy metals involved consisted of lead, manganese, organic tin, mercury, arsenic, and thallium. The organic solvents included n-hexane, toluene, mixed solvents and carbon disulfide. Toxic gases such as carbon monoxide, and hydrogen sulfide were also included, along with toxic chemicals including polychlorinated biphenyls, tetramethylammonium hydroxide, organophosphates, and dimethylamine borane. In addition we attempted to correlate these events to the timeline of industrial development in Taiwan. By researching this topic, the hope is that it may help other developing countries to improve industrial hygiene and promote occupational safety and health care during the process of industrialization.

Transient cell function disruption by low dose acute exposure of ionizing radiation.

Incubation of BMG-1 cells with thallium chloride (201Tl) in the range of diagnostic dose did not show a smooth uptake curve and appeared to have an unsuspected deviation in initial phase. In the present study this unexpected phenomenon was explored, using commonly used radionuclides (viz., 201Tl and 131I). Comparison was made with technetium-99m pertechnetate (99mTcO4-) and technetium-99m labeled methoxyisobutylisonitrile (99mTc-MIBI) that are known to show conventional 2 phase graph representing inflow and outflow segments. Serial in vitro, ex-vivo and in vivo gamma scintigraphy as well as NMR spectroscopy experiments were conducted to corroborate the results. BMG-1 cells demonstrated a four-phase uptake pattern with 201Tl as compared to a conventional biphasic pattern with 99mTc-MIBI. Flow cytometry data however did not reveal any 201Tl induced cell injury. Further, mice tissue extracts injected with 201Tl also showed a transient depression in its uptake. Scintigraphy experiments in rabbits administered with diagnostic dose of 201Tl and 131I confirmed the in vitro and ex vivo findings. Further, proton NMR spectroscopy showed decrease in the level of choline at 3 h and 24 h in 201Tl treated animals as compared to control. Phosphoethanolamine peak firstly decreased at 3 h but reached normal level at 24 h time point. No significant change was observed in the level of betaine. This transient reduction in internalization of 201Tl and 131I may represent a hitherto unknown acute effect of low dose radiation, i.e., transient depression in Na+-K+ ATPase pump activity without any apparent evidence of cell damage, representing a transient cell membrane dysfunction. The phenomenon may present a mechanistical explanation of ‘thyroid stunning’ at cellular level and suggest that it may be more universal in nature than suspected till now.

Dipyridamole 201Tl myocardial SPECT imaging in patients with dilated cardiomyopathy / 中华核医学杂志

Objective To explore the characteristics of dipyridamole 201 Tl myocardial perfusion imaging (MPI) SPECT in patients with dilated cardiomyopathy. Methods Thirty patients with dilated cardiomyopathy underwent pharmacological stress 201Tl MPI SPECT after intravenous infusion of dipyridamole (0. 56 mg/kg) for 4 min. The early and delayed SPECT images were acquired respectively at 10 and 240 min after 201Tl injection. The images were analyzed and reported by two or three experienced nuclear medicine physicians. Results All patients were found to have abnormal perfusion patterns at delay imaging, however 90.00% (27/30) were also abnormal at early images. Six patients had reverse redistribution. Conclusion Dipyridamole 201Tl MPI SPECT imaging may be of some value for the assessment of patients with dilated cardiomyopathy.

Comparison of adenosine and exercise stress 201Tl myocardial perfusion imaging for diagnosing coronary heart disease in women / 中华核医学杂志

Objective To compare the diagnostic value of adenosine and exercise stress myocardial perfusion imaging (MPI) for detecting coronary heart disease (CHD) in women. Methods One hundred and thirty-eight patients with CHD were randomly divided into two groups: adenosine stress group (n = 69)and exercise stress group (n = 69). All patients underwent myocardial SPECT evaluation. Coronary angiography (CAG), referred as "gold standard" , was performed in each patient within 1 week before or after MPI. The diagnostic value of the two stress MPI was compared with χ2 test or Fisher's exact test. Results In adenosine stress group, the sensitivity, negative predictive value and accuracy were 88.2% (45/51),72.7% (16/22), 88.4% (61/69), respectively, which were not significantly different from those of the exercise stress group (91.7% (44/48), 66.7% (8/12), 81.2% (52/64); χ2 =0. 571, 0. 714, 0.249, P >0.05). However, the false positive rate of adenosine stress (11.1%, 2/18) was significantly lower than that of exercise stress (50.0%, 8/16), P = 0.023. Conclusions Adenosine and exercise stress MPI have similar value for CHD diagnosis in women, however, adenosine stress MPI may have an advantage of low false positive rate.

Clinical manifestations and management of thallium poisoning in a single family with 6 cases / 中华神经科杂志

Objective To further investigate clinical manifestations and management for thallium poisoning. Methods Clinical data of 6 patients who were hospitalized in Union Hospital of Tongji Medical College in May 2008 with diagnosis of acute or chronic thallium poisoning,were retrospectively analyzed.Results Six patients (4 male and 2 female) ,aged from 12 to 50,came from one family (two sisters with their husbands and sons). Five of them (3 acute and 2 chronic,for the second time in half a year,thallium poisoning) initiated with peripheral neuritis,represented with severe burning pain,numbness,paresthesia in the lower limbs,accompanied with or without gastrointestinal symptoms. A 12 year-old boy with obviously elevated urinary thallium concentration was asymptomatic. Blood and urinary thallium concentrations of the patients were determined by atomic absorption spectrophotometry and were all significantly elevated.Treatment was initiated using potassium supplementation,diuresis,oral laxatives,Prussian blue and intramuscular injection of dimercaptopropansulfonate sodium.Meanwhile two of them were treated with hemoperfusion. Finally,two of them recovered,another two were transferred to a specialized hospital for continuous treatment,and the rest two deteriorated rapidly with occurrence of unconsciousness and died of multiple organ failure. Conclusions The main clinical manifestations of thallium poisoning are multiple peripheral neuritis,gastrointestinal symptoms and dermatological changes. In order to avoid missed diagnosis and misdiagnosis,a high suspicion should be arose for thallium poisoning when a patient suffering from the above symptoms.Prussian blue was considered traditionally as an effective therapeutic strategy for the condition,and hemoperfusion may be a more effective treatment for acute thallium poisoning.

Reverse 201Tl myocardial redistribution induced by coronary artery spasm / 中华核医学杂志

Objective To investigate the mechanism of reverse redistribution (RR) on dipyridamole 201Tl myocardial perfusion studies in the patients with coronary artery spasm. Methods Twenty-six patients with coronary artery spasm and presented as RR on dipyridamole 201Tl myocardial perfusion studies were enlisted as RR group, while other 16 patients with no coronary artery stenosis nor RR were enlisted as control group. Dipyridamole test was repeated during coronary angiography. Corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) were measured at RR related and non-RR related coronary arteries before and after dipyridamole infusion respectively.All of the data were analyzed by Student's t-test orχ2-test and correlation analysis. Results Coronary artery angiography showed slower blood flow and lower myocardial perfusion in RR related vessels when compared with non-RR related vessels in RR group, but there was no significant difference among the main coronary arteries in control group. The perfusion defects of RR area at rest were positively related to slowerblood velocity at corresponding coronary arteries ( r = 0.79, t = 10.18, P ＜ 0.001 ). In RR related vessels,CTFC were (36 ±6) frames and (26 ±7) frames (t =4.15, P ＜0.01 ), while TMPG were (2.02 ±0.39)grades and (2.92 ± 0.12) grades ( t = 2.25, P ＜ 0.05 ) before and after dipyridamole infusion, respectively.In non-RR related vessels, CTFC were (29 ±7) frames and (25 ±5) frames (t =2.31, P ＜0.05), while TMPG were (2.56 ± 0.31 ) grades and (2.96 ± 0.06) grades ( t = 2.17, P ＜ 0.05 ) before and after dipyridamole infusion, respectively. However, there were no significant changes of CTFC and TMPG before and after dipyridamole infusion in control group ( t = 0.932, 0.867, respectively, both P ＞ 0.05 ). Conclusion RR is related to the decreased blood flow and myocardial perfusion induced by coronary artery spasm at rest,which may be improved by stress test such as intravenous dipyridamole infusion.

Assessment of coronary artery disease with the nitroglycerin augmented ~(99m)Tc-MIBI and ~(201)Tl dual-isotopic myocardial perfusion imaging / 中国医学影像技术

Objective To assess the clinical value of dobutamine 201Tl stress-redistribution/nitroglycerin augmented ~(99m)Tc-metho~(99m)Tc-xyisobutylisonitrile (MIBI) gated myocardial perfusion imaging (MPI) in patients with coronary artery disease (CAD). Methods A total of 132 patients with suspected CAD underwent dobutamine 201Tl stress-redistribution/nitroglycerin augmented MIBI gated MPI and coronary arteriography (CAG) within two weeks after MPI. Percutaneous coronary interventions (PCI) were performed in 23 patients with myocardial infraction. The regional wall movement was assessed with echocardiography before and within three months after PCI. Results Taking stenosis ≥50% as standard of CAD, the sensitivity, specificity and accuracy of dual-isotopic SPECT imaging in diagnosing CAD was 93.41%, 87.80% and 91.67%, respectively. The sensitivity, specificity and accuracy in diagnosing left anterior descending artery (LAD) stenosis was 93.85%, 91.04% and 92.42%, for left circumflex artery (LCX) was 86.79%, 89.87% and 88.64%, while for right coronary artery (RCA) was 81.25%, 82.14% and 81.82%, respectively. Of all 207 myocardium segments in 23 patients with myocardial infarction, radioactivity defect was found in 113 segments on the redistributed ~(201)Tl images, and radiofilling was found in 52 (52/113) segments on the nitroglycerin augmented ~(99m)Tc-MIBI images, whereas 61 segments had no radiofilling. Taking regional wall movement improvement as the criterion of viable myocardium, the sensitivity, specificity and accuracy of identifying viable myocardium with nitroglycerin augmented ~(99m)Tc-MIBI imaging was 87.23%, 83.33% and 84.96%. Conclusion Dobutamine ~(201)Tl stress-redistribution/nitroglycerin augmented ~(99m)Tc-MIBI gated MPI is able to effectively detect CAD and viable myocardium and helpful in diagnosis and treatment of CAD.