Comparison of clinical picture between Yusho/Yucheng cases and occupational PCB poisoning cases

Cancer- and noncancer-specific cumulative incidence of death after exposure to polychlorinated biphenyls and dioxins: A competing risk analysis among Yusho patients

BACKGROUND

In competing risks settings, the cause-specific cumulative incidence function is of great interest since it quantifies cumulative risk in the presence of other causes. To date, however, long-term cancer- and noncancer-specific mortality in Yusho patients exposed to polychlorinated biphenyls (PCBs) and dioxin-related compounds has not been estimated.

METHODS

We identified vital status and cause of death for Yusho patients between 1968 and 2017. Risk of cancer- and noncancer-specific mortality was estimated using a flexible hazards-based regression model, with accounting for competing events.

RESULTS

In total, 1664 Yusho patients with 63,566 person-years of follow-up were included in the analysis. 50-year cumulative incidence of cancer mortality was 12.4% (95% confidence interval [CI], 10.5-14.7) in males and 4.7% (95% CI, 3.5-6.4) in females (difference, 7.7 percentage points [95% CI, 5.2-10.2]; adjusted hazard ratio for males, 2.61 [95% CI, 1.93-3.52]). For noncancer, the 50-year cumulative incidence of mortality was 35.4% (95% CI, 32.8-38.3) in males and 35.6% (95% CI, 33.3-38.1) in females (difference, -0.2 percentage points [95% CI, -3.5 to 3.1]; adjusted hazard ratio for males, 1.51 [95% CI, 1.26-1.82]).

CONCLUSIONS

These findings confirm that male Yusho patients have a significantly higher risk of cumulative incidence of cancer-specific mortality than female Yusho patients. Our findings might be useful in providing Yusho patients with more accurate information on cancer prognosis and survivorship and help determine more appropriate disease management.

Mortality in Yusho patients exposed to polychlorinated biphenyls and polychlorinated dibenzofurans: a 50-year retrospective cohort study

BACKGROUND

In 1968, the Yusho incident resulted in accidental exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related compounds in Japan. This study updated the risk of mortality in Yusho patients.

METHODS

We obtained updated cohort data for all Yusho patients for the period 1968-2017. We calculated standardized mortality ratios (SMRs) for all-cause and cause-specific mortality over a 50-year follow-up period compared with the general population in Japan.

RESULTS

A total of 1664 Yusho patients with 63,566 person-years of follow up were included in the analysis. Among males, excess mortality was observed for all cancers (SMR: 1.22, 95% confidence interval [CI]: 1.02 to 1.45) and lung cancer (SMR: 1.59, 95% CI: 1.12 to 2.19). Among females, increased mortality was observed for liver cancer (SMR: 2.05, 95% CI: 1.02 to 3.67). No significant increase was seen in non-cancer-related mortality compared with the general population.

CONCLUSIONS

Carcinogenic risk in humans after exposure to PCBs and PCDFs remains higher among Yusho patients. Our findings suggest the importance of care engagement and optimum management to deal with the burden of Yusho disease.

Net survival after exposure to polychlorinated biphenyls and dioxins: the Yusho study

BACKGROUND

Net survival is an important measure of the overall outcome of disease management. This net survival is the most appropriate for international comparisons of disease impact between countries or time periods with different patterns of all-cause mortality because it is not influenced by other causes of death. However, little information is available on net survival among Yusho patients, who were accidentally exposed to PCBs and other dioxin-related compounds.

METHODS

We estimated the net survival of 1664 Yusho patients (860 males, 804 females) as Yusho cohort subjects using the unbiased Pohar-Perme method.

RESULTS

Among males, 1-, 5-, 10-, and 15-year net survival were 99.5% (95% confidence interval (CI): 97.9, 99.9), 99.1% (CI: 95.0, 99.9), 97.4% (CI: 86.5, 99.5), and 97.4% (CI: 84.2, 99.6), respectively. Among females, net survival remained almost constant. 1-, 5-, 10-, and 15-year net survival were generally higher in females than in males.

CONCLUSIONS

This study provides the first unbiased estimations of net survival among Yusho patients. We confirmed that older male Yusho patients have experienced a significant decrease in net survival. Our results suggest that the excess hazard of PCBs and dioxins must be taken into account when evaluating unbiased estimates of net survival.

Blood levels of PCDDs, PCDFs, and coplanar PCBs in Yusho mothers and their descendants: association with fetal Yusho disease

Maternal exposure to polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and polychlorinated biphenyls (PCBs) may result in adverse health effects in their children. In Japan in 1968, an accidental human exposure to rice oil contaminated with PCDDs, PCDFs, and PCBs, led to the development of Yusho disease. Yusho mothers delivered descendants with low birth weights and hyperpigmented skin and mucosa, which are characteristic of fetal Yusho disease (FYD). The Yusho cohort was used to evaluate the effect of maternal exposure to PCDDs, PCDFs, and PCBs on the development of FYD. Blood samples, obtained from 64 Yusho mothers (117 descendants: 10 with FYD and 107 without FYD), were analyzed for congeners of seven PCDDs, 10 PCDFs, and four coplanar PCBs. We investigated the association between the maternal estimated blood levels of dioxins at delivery and the risk of fetal Yusho disease. We also studied the differences in dioxin blood levels in 24 mother-descendant pairs (5 with FYD and 19 without FYD). The estimated levels of total PCDD TEQ, total PCDF TEQ, total coplanar PCB TEQ, and total TEQ in the maternal blood at delivery were associated with significantly increased risk of FYD. The odds ratios, which present the risk of FYD for a 10-fold increase in blood dioxin, were largest for 1,2,3,6,7,8-HexaCDD (odds ratio=28.6, 95% confidence interval=1.67-489.9, p=0.02). The levels of 1,2,3,6,7,8-HexaCDD in both the Yusho mothers and their descendants with FYD were higher than the levels in those without FYD. These findings suggest that 1,2,3,6,7,8-HexaCDD is the most important causative congener for the development of FYD.

Relative survival after exposure to polychlorinated biphenyls and dioxins: a follow-up of Japanese patients affected in the Yusho incident

OBJECTIVES

Little information is available on conditional survival among Yusho patients, who were accidentally exposed to PCBs and other dioxin-related compounds. In this study, we estimated relative survival among Yusho patients to quantify time trends in excess mortality compared to the general population.

METHODS

A total of 1664 Yusho patients (860 males, and 804 females) were analyzed as Yusho cohort subjects. Relative survival ratio (RSR) was calculated as a measure of patient survival.

RESULTS

Overall, 1-, 5-, 10-, and 15-year RSRs were 1.00 (95% confidence interval (CI): 0.99, 1.00), 1.00 (95% CI: 0.99, 1.01), 0.99 (95% CI: 0.98, 1.00), and 0.99 (95% CI: 0.98, 1.01), respectively. We did not observe meaningful increases or decreases in RSRs in either sex, which remained the same in all age groups for 1-, 5-, 10-, and 15-year RSRs.

CONCLUSIONS

This study provides quantitative evidence that Yusho patients have no significant difference in relative survival compared with the general Japanese population. Our results suggest that PCBs and dioxin exposure confers no excess mortality. This information may be important for both the clinical management of and patient coping with Yusho disease.

Long-term effects of polychlorinated biphenyls and dioxins on pregnancy outcomes in women affected by the Yusho incident

BACKGROUND

Maternal exposure to polychlorinated biphenyls (PCBs) is associated with increased proportions of spontaneous abortion and stillbirth in animal studies. In Japan in 1968, accidental human exposure to rice oil contaminated with PCBs and other dioxin-related compounds, such as polychlorinated dibenzofurans (PCDFs), led to the development of what was later referred to as Yusho oil disease.

OBJECTIVE

The aim of this study was to investigate the association of maternal PCB and dioxin exposure with adverse pregnancy outcomes in Yusho women.

METHODS

In 2004, we interviewed 214 Yusho women (512 pregnancies) about their pregnancy outcomes over the past 36 years. Pregnancy outcomes included induced abortion, spontaneous abortion, preterm delivery, and pregnancy loss.

RESULTS

In pregnancy years 1968-1977 (within the first 10 years after exposure), the proportions of induced abortion [odds ratio adjusted for age at delivery (ORadj) = 5.93; 95% confidence interval (CI), 2.21-15.91; two-tailed p < 0.001) and preterm delivery (ORadj = 5.70; 95% CI, 1.17-27.79; p = 0.03) were significantly increased compared with the proportions in pregnancy years 1958-1967 (10 years before the incident). Spontaneous abortion (ORadj = 2.09; 95% CI, 0.84-5.18), and pregnancy loss (ORadj = 2.11; 95% CI, 0.92-4.87) were more frequent (OR = 2.18; 95% CI, 1.02-4.66), but these were not significant (p = 0.11 and p = 0.08, respectively) in pregnancy years 1968-1977. We found no significant increases in the proportions of these adverse pregnancy outcomes in pregnancies occurring during 1978-1987 or 1988-2003 compared with those in pregnancies before 1968.

CONCLUSION

High levels of PCB/PCDF exposure had some adverse effects on pregnancy outcome in Yusho women.

Subjective complaints in persons under chronic low-dose exposure to lower polychlorinated biphenyls (PCBs)

Polychlorinated biphenyls (PCBs) have been in widespread industrial use in the 1960s and 1970s. Despite a worldwide reduction, environmental exposure remains an issue especially in contaminated buildings. Due to the ubiquitous presence and poor degradation of PCBs, public health concerns continue to exist; however, evidence on the actual health effects of chronic low-dose exposure is scanty. The objective of the present study is an assessment of subjective complaints of exposed subjects in comparison to a non-exposed control group and their inter-relation to plasma levels of PCB congeners. The plasma concentrations of PCB congeners were measured in 583 subjects who had worked for an average of 14.7+/-9.6 years in a contaminated building in Germany, and 205 control subjects working in a non-contaminated building. Subjective complaints were assessed with the 24-item 'Giessen Subjective Complaints List' (GSCL-24). The subjects under chronic low-dose exposure scored significantly higher values on all the GSCL subscales except 'stomach complaints' in comparison to the non-exposed subjects and a 'normal' sample derived from the literature. However, thorough statistical analysis revealed no correlation of symptoms and PCB congener plasma concentration; the scores on the subscale 'exhaustion were even higher in subjects with low PCB concentration. Subjects working in a PCB-contaminated building report more subjective complaints in comparison to non-exposed subjects, but the complaints are not related to current PCB plasma concentrations.

Development and verification of a toxicokinetic model of polychlorinated biphenyl elimination in persons working in a contaminated building

BACKGROUND

Polychlorinated biphenyls are toxic and slowly degrading substances that have been in widespread industrial use in the 1960s and 1970s. Despite a worldwide reduction, environmental exposure remains an issue; the assessment of an individual's level of exposure at a given time in retrospect requires valid toxicokinetic modeling of the different PCB congeners.

OBJECTIVES

To develop and verify a toxicokinetic model of the in vivo-degradation of PCB 28 and 52 in adult humans.

METHODS

The plasma concentrations of PCB congeners were measured in 583 persons working in a contaminated building for an average of 14.7+/-9.6 years. The values were adapted to a simple pharmacokinetic model (yt = y0 x (1 - e(-kt))); the steady state concentration y0 was estimated based on the median values of persons working exposed more than 10 years.

RESULTS

The steady state concentration of PCB 28 was 0.10 microg/l, that of PCB 52 0.02 microg/l. The half-life of the congeners was estimated based on a logarithmic regression analysis according to the model mentioned above; it was 2.18 (95% CI: 1.91-2.54) years for PCB 28 and 3.95 (95% CI: 3.55-4.45) years for PCB 52, respectively. Stepwise elimination of persons with very long employment duration did not reduce the estimated half-life.

CONCLUSIONS

The estimated half-life is higher than previously published data especially for PCB 52. Possible reasons and implications of this finding are discussed.

Relationship between clinical features and blood levels of pentachlorodibenzofuran in patients with Yusho

BACKGROUND

Yusho is a form of food poisoning that occurred in 1968, as a result of consuming rice bran oil contaminated with polychlorinated biphenyls (PCBs) and various dioxins such as polychlorinated dibenzofurans (PCDFs). The victims of Yusho suffered from various dermatological, ophthalmological, and mucosal symptoms in addition to general fatigue, weight loss, anorexia, headache, paresthesia of the extremities, abdominal pain, cough and sputa, dysmenorrhea, and growth retardation in infants and children. We measured the blood levels of dioxins in the annual medical check-up of Yusho patients from 2001 to 2003.

PURPOSE

To analyze the relationship between the concentrations of PCDFs/PCBs and the subjective/objective/laboratory findings of patients with Yusho. We also compared the present clinical findings with those collected in 1988.

RESULTS AND DISCUSSION

The mean blood level of 2,3,4,7,8-pentachlorodibenzofuran (PeCDF) in 359 patients with Yusho was 177.50 pg/g lipids, which was much higher than that of normal controls (15.2 +/- 8.9 pg/g lipids). The blood levels of PeCDF were significantly correlated with total PCB levels, hexachlorobiphenyl levels, urinary sugar, 2-h erythrocyte sedimentation rate, thymol turbidity test, and sodium levels. A significant correlation was also noted with dermatological findings (acneform eruption and comedones), mucosal findings (oral pigmentation), constipation, numbness in the extremities, body weight loss, and abnormal abdominal ultrasonography. The incidence and severity of most of the dermatological and ophthalmological symptoms decreased from 1988 to 2001-2003. In conclusion, high amounts of PCBs and PeCDF are still present in a number of patients with Yusho. The patients still suffer from various mucocutaneous and subjective symptoms.

Concentrations of polychlorinated biphenyl congeners in cultivated oysters (Crassostrea gigas) in western Taiwan

Spatial and temporal variations of polychlorinated biphenyl (PCB) concentrations in cultivated oysters from five aquaculture areas along the western coast of Taiwan were investigated. Poor correlations between total PCB concentrations (ng/g dry weight [dw]) and physiologic parameters of oysters (shell length, width, thickness, and lipid content) were found. Total PCB concentrations ranged from 3.4 to 94 cng/g dw. The highest value was found in oysters from the Lu'ermen aquaculture area, which receives wastewater from a sodium hydroxide and pentachlorophenol factory. Furthermore, principal component analysis confirmed that the PCB congener pattern in this area was distinct from others and that two additional pollution sources might exist in the Tainan and Hsinchu areas. Oysters with PCB concentrations > 1 SD above the geometric mean were found mainly in Tainan (stations TN5 to TN9) with only one increased concentration in the Yunlin (station YL2) and Hsinchu (station HC4) aquaculture areas. Except for four confined stations, TN3 to TN6, where total PCB concentrations were higher (p = 0.028) in the warmer (May and July) than in the colder season (November and March), seasonal variation of total PCB concentrations in oysters was not significant. Geometric mean and geometric mean plus 1 SD of total PCB concentrations in this study are lower than those in South Korea and the United States (Mussel Watch).

Developmental dental aberrations after the dioxin accident in Seveso

Children's developing teeth may be sensitive to environmental dioxins, and in animal studies developing teeth are one of the most sensitive targets of toxicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Twenty-five years after the dioxin accident in Seveso, Italy, 48 subjects from the contaminated areas (zones A and B) and in patches lightly contaminated (zone R) were recruited for the examination of dental and oral aberrations. Subjects were randomly invited from those exposed in their childhood and for whom frozen serum samples were available. The subjects were frequency matched with 65 subjects from the surrounding non-ABR zone for age, sex, and education. Concentrations of TCDD in previously analyzed plasma samples (zone ABR subjects only) ranged from 23 to 26,000 ng/kg in serum lipid. Ninety-three percent (25 of 27) of the subjects who had developmental enamel defects had been < 5 years of age at the time of the accident. The prevalence of defects in this age group was 42% (15 of 36) in zone ABR subjects and 26% (10 of 39) in zone non-ABR subjects, correlating with serum TCDD levels (p = 0.016). Hypodontia was seen in 12.5% (6 of 48) and 4.6% (3 of 65) of the zone ABR and non-ABR subjects, respectively, also correlating with serum TCDD level (p = 0.05). In conclusion, developmental dental aberrations were associated with childhood exposure to TCDD. In contrast, dental caries and periodontal disease, both infectious in nature, and oral pigmentation and salivary flow rate were not related to the exposure. The results support our hypothesis that dioxins can interfere with human organogenesis.