A case-control study of thallium exposure with the risk of premature ovarian insufficiency in women

Thallium exposure has been associated with female reproductive health, but little is known about its potential association with premature ovarian insufficiency (POI). In this study, a total of 169 patients with POI and 209 healthy women were recruited from Zhejiang province, China. Urinary thallium concentrations were significantly positively associated with the risk of POI [adjusted odds ratio (OR) = 1.63, 95% CI: 1.25-2.13, p < 0.001], geometric mean values of which were significantly higher in POI cases (0.213 μg/L, 0.302 μg/g for creatinine adjustment) than those of controls (0.153 μg/L, 0.233 μg/g for creatinine adjustment). Furthermore, the serum levels of follicle-stimulating hormone and luteinizing hormone were positively associated with urinary thallium concentrations, whereas anti-Mullerian hormone and estradiol were negatively correlated with thallium. To the best of our knowledge, this is the first study to provide evidence that thallium exposure at currently environmental levels is the potential risk factor for POI in women.

Thallium exposure at low concentration leads to early damage on multiple organs in children: A case study followed-up for four years

Thallium (TI) is one of the most toxic heavy metals and priority pollutant metals. The emerging TI environmental pollution worldwide has posed a great threat to human health. However, based on the World Health Organization (WHO), the risk and severity of adverse health effects of TI in the range of 5-500 μg/L are uncertain. Moreover, evidence regarding the adverse impacts of TI on children's health is still insufficient. Herein, we aim to investigate the early adverse effects of TI on children's health and provide references for the WHO to establish stricter safety limits of TI. From 2015 to 2019, urinary TI and many clinical laboratory parameters related to blood routine, hepatic, renal, myocardial, coagulation function and serum electrolyte were measured in six children aged 1-9 years. The urinary TI concentration ranged from 13.4 μg/L to 60.1 μg/L with a mean of 36.1 μg/L and a median of 34.8 μg/L in six children in 2015. Although only four children felt a little poor appetite, several laboratory abnormalities indicated early damage in liver, renal, and myocardial functions in all children in 2015. After treatment and following up for four years, although the children's TI concentration decreased below 5 μg/L, their liver and renal functions did not completely recover, and their myocardial function worsened. Results indicated that impaired liver, renal, and myocardial functions were closely associated with elevated urinary TI concentration in children. Considering the increasing use of TI in high-technology industries and emerging TI environmental-contamination zones worldwide, establishing stricter safety limits of TI and paying more attention to the adverse health effects of TI on children are urgently required. SUMMARY: We found that a relatively low concentration of thallium (13.4 μg/L to 60.1 μg/L) impaired liver, renal, and myocardial function in six children. After treatment and following up these children for four years, although their urinary TI concentration decreased below 5 μg/L, their liver and renal functions did not completely recover, and their myocardial function worsened.

Toxicity of Thallium at Low Doses: A Review

A mini review of the toxicity of Thallium (Tl) at low doses is herein presented. Thallium has severe toxicity. Although its acute biological effects have been widely investigated and are well known, its biological effects on human health and in cell cultures at low doses (<100 μg/L) due, for example, to Tl chronic exposure via consumption of contaminated water or foods, have often been overlooked or underestimated. Relatively few papers have been published on this topic and are herein reviewed to provide a focused scientific opinion in the light of current worldwide regulatory issues.

Metal concentrations in surface water and sediments from Pardo River, Brazil: human health risks

Pardo River (Brazil) is suffering from an important anthropogenic impact due to the pressure of highly populated areas and the influence of sugarcane cultivation. The objective of the present study was to determine the levels of 13 trace elements (As, Be, Cd, Cr, Cu, Pb, Mn, Hg, Ni, Tl, Sn, V and Zn) in samples of surface water and sediments from the Pardo River. Furthermore, the human health risks associated with exposure to those metals through oral intake and dermal absorption were also evaluated. Spatial and seasonal trends of the data were closely analyzed from a probabilistic approach. Manganese showed the highest mean concentrations in both water and sediments, remarking the incidence of the agricultural activity and the geological characteristics within the basin. Thallium and arsenic were identified as two priority pollutants, being the most important contributors to the Hazard Index (HI). Since non-carcinogenic risks due to thallium exposure slightly exceeded international guidelines (HI>1), a special effort should be made on this trace element. However, the current concentrations of arsenic, a carcinogenic element, were in accordance to acceptable lifetime risks. Nowadays, there is a clear increasing growth in human population and economic activities in the Pardo River, whose waters have become a serious strategic alternative for the potential supply of drinking water. Therefore, environmental monitoring studies are required not only to assure that the current state of pollution of Pardo River does not mean a risk for the riverside population, but also to assess the potential trends in the environmental levels of those elements.

Toxic neuropathies associated with pharmaceutic and industrial agents

Neuropathies associated with industrial, environmental, and pharmacologic toxicants are uncommon. Nevertheless, it is important to consider toxic etiologies in the differential diagnosis of neuropathies, because they are among the most treatable forms of peripheral nervous system dysfunction. The purpose of this article is to discuss the clinical investigation of a suspected toxic neuropathy, to review some of the more common or representative neurotoxicants, and to identify the methods for establishing causation.

[Sustainability of medical imaging in cardiology]

Every year, 5 billion imaging testing are performed worldwide, and about 1 out of 2 are cardiovascular examinations. According to recent estimates, 30 to 50% of all examinations are partially or totally inappropriate. This represents a potential damage for patient undergoing imaging (who takes the acute risks of a stress procedure and/or a contrast study without a commensurable benefit), an exorbitant cost for the society and an excessive delay in the waiting lists for other patients needing the examination. Economic induction, medico-legal concern, and specialist guidelines, which do not quantitate the potential benefits against the risks of a given procedure, boost inappropriateness of all imaging techniques. In case of ionizing tests, the reduction of useless imaging testing would improve the quality of care also through abatement of long-term risks, which are linked to the dose employed. The radiation dose equivalent of common cardiological imaging examinations corresponds to more than 1000 chest x rays for a thallium scan and to more than 500 chest x-rays for a multislice computed tomography. Although a direct evaluation of incidence of cancer in patients submitted to these procedures is not available, the estimated risk (often ignored by cardiologists) of cancer according to the latest 2005 Biological Effects of Ionizing Radiation Committee VII is about one in 500 exposed patients for a Thallium scintigraphy scan, and one in 750 for a CT scan. Such a risk is probably not acceptable when a scintigraphic or radiological procedure is applied for mass screening (when the risk side of the risk-benefit balance is not considered) or when a similar information can be obtained by other means. By contrast, it is fully acceptable in appropriately selected groups as a filter to more invasive, risky and costly procedures (for instance, coronary angiography and anatomy-driven revascularization). At this point, the cardiological community, that faces the reality of limited resources, should do every effort in order to minimize inappropriate testing, since they induce an exorbitant increase in health care costs with no improvement, and possibly with a reduction in care quality.

Sodium bicarbonate-augmented stress thallium myocardial scintigraphy

It is well known that sodium bicarbonate in pharmacological doses induces transient alkalosis, causing intracellular transport of serum potassium. The aims of this study were (a) to investigate whether, in humans, myocardial thallium-201 uptake can be augmented by pretreatment with a single bolus of sodium bicarbonate at a pharmacological dose, (b) to verify general safety aspects of the intervention and (c) to evaluate the clinical implications of augmentation of (201)Tl uptake, if any. Routine exercise myocardial scintigraphy was performed twice in eight adult volunteers (five normal and three abnormal), once without intervention and the second time (within a week) following intravenous administration of sodium bicarbonate (88 mEq in 50 ml) as a slow bolus 1 h prior to the injection of (201)Tl. Conventional myocardial thallium study was compared with sodium bicarbonate interventional myocardial scintigraphy with respect to myocardial uptake (counts per minute per mCi injected dose), washout patterns in normal and abnormal myocardial segments, and overall clinical interpretation based on planar and single-photon emission tomographic (SPET) images. All patients remained asymptomatic after the intervention. A mean increase of 53% in myocardial uptake of thallium was noted in post-exercise acquisitions after the intervention, confirming uptake of the tracer via the potassium-hydrogen pump and its augmentation by transient alkalosis. The washout pattern remained unchanged. The visual quality of planar and SPET images improved significantly after the intervention. Out of the five abnormal myocardial segments identified in three cases, four showed significant filling-in after the intervention, causing the diagnosis to be upgraded from "partial scar" to "ischaemia", or from "ischaemia" to "normal". The overall scan impression changed in two out of three such cases. Sodium bicarbonate augmentation may have significant implications for stress-thallium scintigraphy and may be a new parameter for defining myocardial viability.

Evaluation of diabetic patients for renal and pancreas transplantation: noninvasive screening for coronary artery disease using radionuclide methods

Pharmacologic stress thallium scintigraphy is commonly performed in the risk assessment of diabetic patients with nephropathy before kidney and/or pancreas transplantation; however, controversy exists regarding the test's accuracy in detecting coronary artery disease. Our purpose was to compare pharmacologic stress thallium scintigraphy and also exercise radionuclide ventriculography with coronary angiography in diabetic patients undergoing evaluation for transplantation. In addition, we also determined the association of the test results with outcome after transplantation. The medical records of 47 patients (mean age, 37+/-9 years) without clinical evidence of coronary artery disease were reviewed. Forty-one patients had pharmacologic stress thallium scintigraphy performed during their evaluation. Sensitivity was 62% and specificity was 76% for detecting > or = 75% coronary artery stenosis (sensitivity was 53% and specificity was 73% for > or = 50% stenosis). Thirty-five patients had exercise radionuclide ventriculography performed. Sensitivity was 50% and specificity was 67% for detecting > or = 75% coronary artery stenosis (sensitivity was 44% and specificity was 63% for > or = 50% stenosis). Thirty patients had both pharmacologic stress thallium scintigraphy and exercise radionuclide ventriculography performed; when either test was abnormal, sensitivity in the detection of > or = 50% or > or = 75% stenosis tended to increase compared with pharmacologic stress thallium scintigraphy alone (0.05<P<0.10), whereas specificity decreased (P<0.01). The incidence of adverse cardiac outcomes was identical for patients with abnormal thallium scintigrams and undergoing transplantation (2/11) compared with patients with normal scintigrams and undergoing transplantation (4/22). We conclude that: (1) pharmacologic stress thallium scintigraphy and exercise radionuclide ventriculography are suboptimal screening tests for coronary artery disease in diabetic patients awaiting kidney and/or pancreas transplantation; (2) using the two radionuclide tests in combination results in a decrease in specificity; and (3) patients with abnormal thallium scintigrams can receive transplants with outcomes similar to those for patients with normal thallium scintigrams.

Chronic administration of malonic acid produces selective neural degeneration and transient changes in calbindin immunoreactivity in rat striatum

Adult rats received chronic dialytic delivery devices that exposed the striatum to a 100 mM, 400 mM, or 4 M solution of the reversible succinate dehydrogenase inhibitor malonic acid (MA). Three weeks of exposure to 100 or 400 mM MA produced no significant reduction in striatal cytochrome oxidase staining, whereas striata chronically exposed to 1 and 4 M MA showed a significant and dose-related reduction in cytochrome oxidase staining. In striata exposed to 1 M MA, analysis of regions radial to the necrotic core revealed significant reduction of nissl cell staining with relative sparing of NADPH-diaphorase-containing neurons. Although 100 and 400 mM MA failed to produce lesions, both of these concentrations significantly decreased the number of striatal calbindin (CALB) immunoreactive perikarya. The reduction in CALB immunoreactivity was partly reversed in animals allowed to survive 4 weeks after cessation of exposure to 400 mM MA. These results indicate that, like striatal lesions produced by quinolinic acid, lesions produced by chronic exposure to MA possess a Huntington's disease-like pattern of selective neurodegeneration. In addition, exposure to subthreshold MA concentrations (100 and 400 mM) produce widespread transient changes in striatal CALB that may be associated with a premorbid state of neuronal dysfunction.

Radiotoxicity of thallium-201 in mouse testes: inadequacy of conventional dosimetry

When TI-201 is concentrated in mouse testes, the low-energy Auger electrons following its electron-capture decay are found to be much more effective in causing loss of testicular weight and reduction of sperm heads than the energetic beta particles from similarly distributed TI-204. These results are contrary to expectations based on conventional dosimetry of tissue-incorporated radionuclides, and point to possible underestimation of risks by the currently adopted dosimetric procedures, especially in the case of radionuclides decaying by electron capture and internal conversion.

[Imaging of the myocardium with thallium-201]

Myocardial imaging after the intravenous injection of radionuclides offers a non-invasive, highly sensitive and reliable method for the detection of myocardial infarction and regional myocardial ischaemia. Considerable attention has been given to various isotopes as a means of independent assessment of regional blood flow distribution in the normal, ischaemic or infarcted myocardium. The clinical use of cationic tracers such as potassium-43 and rubidium-81 is based upon the principle that tracer uptake is proportional to regional myocardial blood flow. A region of absent tracer uptake suggests the presence of previous infarction or fibrosis, while a new perfusion defect appearing after stress suggests transient ischaemia. These isotopes, however, have significant physical limitations as imaging agents. The physical and biological properties of thallium-201, however, make it ideally suited for imaging of the myocardium with currently available imaging equipment.

The toxicity of thallium(I) to cardiac and skeletal muscle

The effects of (a) partial or complete replacement of K+ by Tl+ in saline perfusing isolated rat heart and diaphragm preparations and (b) pulse injections of high concentrations of Tl+ or K+, have been studied. The immediate effect of Tl+ resembles that of higher concentrations of K+ and may reflect its more rapid penetration into the tissue. Tl+ appears to replace K+ on a 1:1 basis to an extent dependent upon the relative abundance of the two cations in the perfusion solution. However, analysis of diaphragm preparations after perfusion with salines containing increasing Tl+ but constant [K+ + Tl+] showed a related and progressive increase in total cation content. This effect, which was not seen in the presence of constant high (normal) K+ concentrations, may reflect an increase of the intracellular space brought about by the thallium. Functional effects of Tl+ were (a) preferential block of the phrenic nerve or neuromuscular junction over the muscle fibre and (b) transient but marked acceleration of cardiac frequency following pulse injections, which may be of value in analysing the pacemaker mechanism of the heart. In both tissues Tl+ is eventually toxic and probably irreversibly so.