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. (1) Among 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. CONCLUSIONS 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.
Adult ; Female ; Ferrocyanides ; Heavy Metal Poisoning ; Hemoperfusion ; Humans ; Male ; Middle Aged ; Thallium/poisoning*

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 (P(25)-P(75)) 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 the first trimester blood, and associated with reduced birth length (unstandardized β 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.
Adult ; Birth Weight ; Environmental Pollutants/blood* ; Female ; Fetal Blood/metabolism* ; Fetus/metabolism* ; Humans ; Infant, Newborn ; Male ; Maternal Exposure ; Parturition ; Pregnancy ; Pregnancy Outcome/epidemiology* ; Thallium/blood*

BACKGROUND: Coronary microcirculation impairment with sequential decrease in cardiac function is reflected by abnormal left ventricular ejection fraction reserve (LVEFR),which precedes diagnostic evidence of myocardial insult. However, prognostic utility of LVEFR is less, if not least explored. The aim of this study was to evaluate the clinical utility of LVEFR in predicting major cardiac events (MACE) among patients with and suspected coronary artery disease (CAD).
MATERIALS AND METHODS: A retrospective cohort study of 245 patients who underwent stress thallium-201 myocardial perfusion scan (MPS) was conducted. The patients were categorized as having normal or abnormal perfusion scan. Each group was subdivided into normal and abnormal LVEFR groups. All subjects were followed up for any major adverse cardiac events 36 months after MPS through review of hospital records.
RESULTS: There was an overall increase in the likelihood of cardiac events with abnormal LVEFR (i.e., odds ratio of 2.99,p=<0.01). Majority of subjects with abnormal MPS also had abnormal LVEFR showing a significantly lower mean LVEFR (1.17± 7.30 vs. 3.02 ± 7.36p =<0.01).
CONCLUSION: Abnormal LVEFR can be used as an independent predictor of cardiac events which can be observed in subjects with normal and abnormal perfusion scans alike.

Human ; Male ; Female ; Middle Aged ; Adult ; Coronary Artery Disease ; Thallium ; Omega-chloroacetophenone ; Microcirculation ; Stroke Volume ; Heart ; Thallium Radioisotopes ; Myocardium ; Perfusion Imaging

BACKGROUND: Coronary microcirculation impairment with sequential decrease in cardiac function is reflected by abnormal left ventricular ejection fraction reserve (LVEFR),which precedes diagnostic evidence of myocardial insult. However, prognostic utility of LVEFR is less, if not least explored. The aim of this study was to evaluate the clinical utility of LVEFR in predicting major cardiac events (MACE) among patients with and suspected coronary artery disease (CAD).
MATERIALS AND METHODS: A retrospective cohort study of 245 patients who underwent stress thallium-201 myocardial perfusion scan (MPS) was conducted. The patients were categorized as having normal or abnormal perfusion scan. Each group was subdivided into normal and abnormal LVEFR groups. All subjects were followed up for any major adverse cardiac events 36 months after MPS through review of hospital records.
RESULTS: There was an overall increase in the likelihood of cardiac events with abnormal LVEFR (i.e., odds ratio of 2.99,p=<0.01). Majority of subjects with abnormal MPS also had abnormal LVEFR showing a significantly lower mean LVEFR (1.17± 7.30 vs. 3.02 ± 7.36p =<0.01).
CONCLUSION: Abnormal LVEFR can be used as an independent predictor of cardiac events which can be observed in subjects with normal and abnormal perfusion scans alike.

Human ; Male ; Female ; Middle Aged ; Adult ; Coronary Artery Disease ; Thallium ; Omega-chloroacetophenone ; Microcirculation ; Stroke Volume ; Heart ; Thallium Radioisotopes ; Myocardium ; Perfusion Imaging

BACKGROUND: Serum thyroglobulin assays and I-131 imaging and routinely employed for the detection of remaining functioning thyroid tissue after surgery and radioiodine therapy. However, the sensitivity of I-131 is suboptimal resulting in cases of positive thyroglobulin test but negative I-131 imaging, potentially creating a dilemma in subsequent therapeutic management. Other radiopharmaceuticals, such as TI-201 may offer better sensitivity, although it is not clear whether this contributes to the decision-making for subsequent I-131therapy. This prospective cohort study aimed to determine if Tl-201 imaging identified thyroid tissues that will take up therapeutic I-131, and to help define its clinical utility.
METHODS: Fourteen consecutive patients who underwent surgery for well-differentiated thyroid cancer, had I-131 therapy at least eight months previously, and with elevated thyroglobulin (>10 ng/mL) but negative pre-therapy (111 MBq) I-131 whole body scan (WBS), were enrolled in the study. WBS was done using 56.74 MBq of Tl-201. All patients had repeat I-131 ablation (3.7-7.4GBq) one to two months after Tl-201 imaging. Post-therapy WBS was done four to seven days after.
RESULTS: All 14 patients had papillary thyroid carcinoma. Ten patients had a positive Tl-201 scan. Of the 14 subjects, only two had a positive post-therapy I-131 WBS, both whom had a positive Tl-201 scan. Thallium-201 scanning showed a fairly high sensitivity (71%) in demonstrating thyroid remnants or metastases using a thyroglobulin level of >10 ng/mL as standard. However, a positivel Tl-201 scan only has a predictive value of 20% for subsequent uptake of therapeutic I-131 as shown in the post-therapy scan.
CONCLUSION: Thallium-201 uptake correlates poorly with therapeutic I-131 uptake in thyroglobulin-positive, but I-131 scan-negative, differentiated thyroid cancer patients. Results of this study suggest that the presence of thyroid remnants and metastases on Tl-201 imaging is inappropriate as a basis for subsequent I-131 therapy.

Human ; Male ; Female ; Middle Aged ; Adult ; Thyroglobulin ; Thyroid Cancer, Papillary ; Radiopharmaceuticals ; Iodine Radioisotopes ; Thallium ; Thyroid Neoplasms ; Carcinoma ; Neoplasms, Second Primary ; Thallium Radioisotopes

BACKGROUND: Serum thyroglobulin assays and I-131 imaging and routinely employed for the detection of remaining functioning thyroid tissue after surgery and radioiodine therapy. However, the sensitivity of I-131 is suboptimal resulting in cases of positive thyroglobulin test but negative I-131 imaging, potentially creating a dilemma in subsequent therapeutic management. Other radiopharmaceuticals, such as TI-201 may offer better sensitivity, although it is not clear whether this contributes to the decision-making for subsequent I-131therapy. This prospective cohort study aimed to determine if Tl-201 imaging identified thyroid tissues that will take up therapeutic I-131, and to help define its clinical utility.
METHODS: Fourteen consecutive patients who underwent surgery for well-differentiated thyroid cancer, had I-131 therapy at least eight months previously, and with elevated thyroglobulin (>10 ng/mL) but negative pre-therapy (111 MBq) I-131 whole body scan (WBS), were enrolled in the study. WBS was done using 56.74 MBq of Tl-201. All patients had repeat I-131 ablation (3.7-7.4GBq) one to two months after Tl-201 imaging. Post-therapy WBS was done four to seven days after.
RESULTS: All 14 patients had papillary thyroid carcinoma. Ten patients had a positive Tl-201 scan. Of the 14 subjects, only two had a positive post-therapy I-131 WBS, both whom had a positive Tl-201 scan. Thallium-201 scanning showed a fairly high sensitivity (71%) in demonstrating thyroid remnants or metastases using a thyroglobulin level of >10 ng/mL as standard. However, a positivel Tl-201 scan only has a predictive value of 20% for subsequent uptake of therapeutic I-131 as shown in the post-therapy scan.
CONCLUSION: Thallium-201 uptake correlates poorly with therapeutic I-131 uptake in thyroglobulin-positive, but I-131 scan-negative, differentiated thyroid cancer patients. Results of this study suggest that the presence of thyroid remnants and metastases on Tl-201 imaging is inappropriate as a basis for subsequent I-131 therapy.

Human ; Male ; Female ; Middle Aged ; Adult ; Thyroglobulin ; Thyroid Cancer, Papillary ; Radiopharmaceuticals ; Iodine Radioisotopes ; Thallium ; Thyroid Neoplasms ; Carcinoma ; Neoplasms, Second Primary ; Thallium Radioisotopes

Poisoning ; drug therapy ; Thallium ; toxicity

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.
Arsenic ; Ataxia ; Carbon Disulfide ; Carbon Monoxide ; Cerebellar Diseases ; Delivery of Health Care ; Developing Countries ; Dimethylamines ; Disease Outbreaks ; Electrophysiology ; Gases ; Hexanes ; Hydrogen Sulfide ; Manganese ; Metals, Heavy ; Nervous System ; Neuroimaging ; Neurologic Manifestations ; Neuromuscular Junction Diseases ; Neurotoxins ; Occupational Diseases ; Occupational Health ; Organophosphate Poisoning ; Organophosphates ; Parkinsonian Disorders ; Polychlorinated Biphenyls ; Quaternary Ammonium Compounds ; Semiconductors ; Sodium Fluoride ; Solvents ; Taiwan ; Thallium ; Tin ; Toluene ; Urethane

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.
Arsenic ; Ataxia ; Carbon Disulfide ; Carbon Monoxide ; Cerebellar Diseases ; Delivery of Health Care ; Developing Countries ; Dimethylamines ; Disease Outbreaks ; Electrophysiology ; Gases ; Hexanes ; Hydrogen Sulfide ; Manganese ; Metals, Heavy ; Nervous System ; Neuroimaging ; Neurologic Manifestations ; Neuromuscular Junction Diseases ; Neurotoxins ; Occupational Diseases ; Occupational Health ; Organophosphate Poisoning ; Organophosphates ; Parkinsonian Disorders ; Polychlorinated Biphenyls ; Quaternary Ammonium Compounds ; Semiconductors ; Sodium Fluoride ; Solvents ; Taiwan ; Thallium ; Tin ; Toluene ; Urethane

Adult ; Autopsy ; Female ; Hair ; metabolism ; Humans ; Liver ; pathology ; Thallium ; poisoning