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Biomedical subjects

T L Kuo

Publications and source records attributed to T L Kuo.

At least 19 recordsLinked to original sources

Spectra interference between diquat and paraquat by second derivative spectrophotometry.

A rapid and accurate method, combining solid-phase extraction and second-order derivative spectrophotomety approaches, is developed for the simultaneous determination of diquat (DQ) and paraquat (PQ) in blood, tissue and urine samples. Supernatant resulting from the precipitation of protein (with trichloroacetic acid) in plasma and tissue or Amberlite IRA-401 resin treated urine are passed through a mini-column packed with Wakogel gel (Silica gel). Analytes are then eluted with a non-organic solvent, 0.2mol/l HCl solution containing 2mol/l NH(4)Cl. UV spectrum of the eluent in 220-350nm range provides effective screen to detect the presence of DQ and/or PQ. In the presence of DQ or PQ alone, the analyte present is quantitated by conventional zero- or second-order derivative spectrophotometry. The calibration curve in the 0.1-5.0mg/l range for either analyte obeys Beer's law. When both DQ and PQ are present, their concentrations are determined by the peak amplitudes of their respective second-derivative spectra after the addition of alkaline dithionite reagent. Interference is negligible when the DQ/PQ concentration ratio is within the 5.0-0.2 range. Using a 2-ml of sample size, the detection limits for DQ and PQ in plasma are 0.02 and 0.005mg/l. The corresponding detection limits for urine samples (10ml sample size) are 0.004 and 0.001mg/l. Recoveries of DQ and PQ in triplicate plasma and urine samples spiked with 0.5mg/l of analytes are 93 and 85%. The precision of the proposed method resulting from triplicate study of spiked urine samples varies from 3.2 to 4.6% at 0.5mg/l of DQ and PQ, respectively.

Diquat↗

Effects of methionine-induced hyperhomocysteinemia on endothelium-dependent vasodilation and oxidative status in healthy adults.

BACKGROUND: Homocysteine-mediated endothelial dysfunction has been proposed to occur via oxidative stress mechanisms in humans. However, there is controversy regarding the effects of homocysteine on endothelial function and oxidative status, which may in part result from age discrepancy across the studies. The present study was designed to investigate the aging effect on the relationship between endothelium-dependent vasodilation and oxidative status in methionine-induced hyperhomocysteinemia. METHODS AND RESULTS: Plasma homocysteine, phosphatidylcholine hydroperoxide (PCOOH), P-selectin levels, and brachial artery flow-mediated vasodilation were measured at baseline and 4 hours after an oral methionine load (0.1 g/kg) in 15 younger (21 to 40 years) and 15 older (55 to 70 years) healthy adults. Homocysteine increased from 7.3+/-1.3 micromol/L at baseline to 22.7+/-5.2 micromol/L at 4 hours in younger (P<0.001) and from 7. 4+/-1.4 to 24.3+/-4.5 micromol/L in older adults (P<0.001). PCOOH levels were not significantly different between baseline and 4 hours in both groups (P=0.10 in young; P=0.14 in old). P-selectin, which is expected to increase during oxidative stress, was not changed in older (P=0.08) but decreased in younger adults (P=0.037) at 4 hours. Flow-mediated vasodilation was preserved from 13.1+/-2.1% at baseline to 13.5+/-2.8% at 4 hours in younger (P=0.49) and decreased from 12.8+/-2.4% to 8.5+/-2.8% in older adults (P<0.001). CONCLUSIONS: The present study demonstrates that endothelial dysfunction caused by methionine-induced hyperhomocysteinemia is age-related and is mediated through impaired nitric oxide activity without change of oxidative status. Our data do not support previous hypotheses that endothelial damage by homocysteine is via oxidative stress mechanism in humans.

Adult↗

Risk of internal cancers from arsenic in drinking water.

The U.S. Environmental Protection Agency is under a congressional mandate to revise its current standard for arsenic in drinking water. We present a risk assessment for cancers of the bladder, liver, and lung from exposure to arsenic in water, based on data from 42 villages in an arseniasis-endemic region of Taiwan. We calculate excess lifetime risk estimates for several variations of the generalized linear model and for the multistage-Weibull model. Risk estimates are sensitive to the model choice, to whether or not a comparison population is used to define the unexposed disease mortality rates, and to whether the comparison population is all of Taiwan or just the southwestern region. Some factors that may affect risk could not be evaluated quantitatively: the ecologic nature of the data, the nutritional status of the study population, and the dietary intake of arsenic. Despite all of these sources of uncertainty, however, our analysis suggests that the current standard of 50 microg/L is associated with a substantial increased risk of cancer and is not sufficiently protective of public health.

Adult↗

Acute and chronic arsenic poisoning associated with treatment of acute promyelocytic leukaemia.

Seven relapsed and/or refractory acute promyelocytic leukaemia patients were treated by arsenic trioxide (As2O3). Four patients (4/7, 57%) achieved complete remission after one to three cycles of treatment and the most common acute side-effect was fluid retention (in six patients, 86%), including weight gains and pleuro-pericardial effusions. Evident polyneuropathy compatible with chronic arsenic toxicity was noted in two of the three patients who received As2O3 maintenance therapy and one of them had marked distal muscular atrophy. We suggest that As2O3 may be a useful salvage therapy for relapsed and refractory APL patients, but the acute or chronic arsenic toxicity should be carefully monitored.

Acute Disease↗

Skin cancer and inorganic arsenic: uncertainty-status of risk.

The current U.S. EPA standard for inorganic arsenic in drinking water is 50 ppb (microgram/L), dating to the National Interim Primary Drinking Water Regulation of 1976. The current EPA risk analysis predicts an increased lifetime skin cancer risk on the order of 3 or 4 per 1000 from chronic exposure at that concentration. Revision of the standard to only a few ppb, perhaps even less than 1 ppb, may be indicated by the EPA analysis to reduce the lifetime risk to an acceptable level. The cost to water utilities, and ultimately to their consumers, to conform to such a large reduction in the standard could easily reach several billion dollars, so it is particularly important to assess accurately the current risk and the risk reduction that would be achieved by a lower standard. This article addresses the major sources of uncertainty in the EPA analysis with respect to this objective. Specifically, it focuses on uncertainty and variability in the exposure estimates for the landmark study of Tseng and colleagues in Taiwan, analyzed using a reconstruction of the their exposure data. It is concluded that while the available dataset is suitable to establish the hazard of skin cancer, it is too highly summarized for reliable dose-response assessment. A new epidemiologic study is needed, designed for the requirements of dose-response assessment.

Arsenic↗

Multiple risk factors associated with arsenic-induced skin cancer: effects of chronic liver disease and malnutritional status.

In order to evaluate the prevalence and multiple risk factors of arsenic-induced skin cancer among residents in Taiwanese villages in which chronic arseniasis is hyperendemic, a total of 1571 subjects aged 30 or more years were recruited between September 1988 and March 1989. All of them were interviewed personally by a public health nurse using a structured questionnaire, and 1081 interviewed study subjects, including 468 men and 613 women, participated in physical examination, giving a participation rate of 68.8%. The overall prevalence of skin cancer was as high as 6.1%, showing an increase with age in both men and women. There was a significant dose-response relation between skin cancer prevalence and chronic arsenic exposure as indexed by duration of residence in the endemic area, duration of consumption of high-arsenic artesian well water, average arsenic exposure in parts per million (p.p.m.) and cumulative arsenic exposure in p.p.m.-years. Chronic carriers of hepatitis B surface antigen with liver dysfunction had an increased prevalence of skin cancer. Undernourishment, indexed by a high consumption of dried sweet potato as a staple food, was also significantly associated with an increased prevalence of arsenic-induced skin cancer. All these risk factors remained statistically significant in the multiple logistic regression analysis. Consistent with animal experiments, the findings imply that liver function and nutritional status may affect the metabolism of inorganic arsenic and the development of subsequent skin cancers.

Adult↗

Determination of paraquat in biologic materials by a simplified solid phase extraction and spectrophotometry.

A rapid measurement of low paraquat levels in body fluids is important for diagnosis and prognosis of paraquat intoxication. A simple and sensitive method for the determination of submicrogram levels of paraquat by solid phase extraction in conjunction with spectrophotometry has been developed. Serum, urine and formalin from fixed tissue were passed through this column and paraquat was eluted with 2 mL 2N NaOH. The eluent was reduced with dithionite and spectrophotometrically quantified with the zero- or second-order derivative. The detection limits of paraquat by this method are 0.05 mg/L and 0.01 mg/L with the zero-order and 0.005 mg/L and 0.001 mg/L with the second-order derivative, using 2 mL of serum and 10 mL of urine or formalin. The proposed method prevents the interference of biologic specimens as well as providing high extraction efficiency and good precision. The entire procedure can be completed within 30 minutes without special skills, reagents or equipment. These results show that this method is suitable for clinical and forensic toxicologic purposes.

Chromatography, Gel↗

Increased prevalence of hypertension and long-term arsenic exposure.

To examine the association between long-term exposure to inorganic arsenic and the prevalence of hypertension, we studied a total of 382 men and 516 women residing in villages where arseniasis was hyperendemic. Hypertension was defined as a systolic blood pressure of 160 mm Hg or greater, a diastolic blood pressure of 95 mm Hg or greater, or a history of hypertension treated regularly with antihypertensive drugs. The long-term arsenic exposure was calculated from the history of artesian well water consumption obtained through standardized interviews based on a structured questionnaire and the measured arsenic concentration in well water. Residents in villages where long-term arseniasis was hyperendemic had a 1.5-fold increase in age- and sex-adjusted prevalence of hypertension compared with residents in nonendemic areas. Duration of artesian well water consumption, average arsenic concentration in drinking water, and cumulative arsenic exposure were all significantly associated with hypertension prevalence. The higher the cumulative arsenic exposure, the higher the prevalence of hypertension. This dose-response relation remained significant after adjustment for age, sex, diabetes mellitus, proteinuria, body mass index, and serum triglyceride level. The results suggest that long-term arsenic exposure may induce hypertension in humans.

Adult↗

Ingested inorganic arsenic and prevalence of diabetes mellitus.

To examine the association between ingested inorganic arsenic and prevalence of diabetes mellitus, in 1988, the authors studied 891 adults residing in villages in southern Taiwan where arseniasis is hyperendemic. The status of diabetes mellitus was determined by an oral glucose tolerance test and a history of diabetes regularly treated with sulfonylurea or insulin. The cumulative arsenic exposure in parts per million-years was calculated from the detailed history of residential addresses and duration of drinking artesian well water obtained through standardized interviews based on a structured questionnaire and the arsenic concentration in well water. The body mass index was derived from body height and weight measured according to a standard protocol, while the physical activity at work was also obtained by questionnaire interviews. Residents in villages where the chronic arseniasis was hyperendemic had a twofold increase in age- and sex-adjusted prevalence of diabetes mellitus compared with residents in Taipei City and the Taiwan area. There was a dose-response relation between cumulative arsenic exposure and prevalence of diabetes mellitus. The relation remained significant after adjustment for age, sex, body mass index, and activity level at work by a multiple logistic regression analysis giving a multivariate-adjusted odds ratio of 6.61 and 10.05, respectively, for those who had a cumulative arsenic exposure of 0.1-15.0 and greater than 15.0 ppm-year compared with those who were unexposed. These results suggest the chronic arsenic exposure may induce diabetes mellitus in humans.

Adult↗

Effects of ethanol on pharmacokinetics and intestinal absorption of paraquat in animals.

The effect of ethanol on pharmacokinetics of paraquat was studied in rabbits by intravenous (i.v.) bolus injection of ethanol 0.5 g/kg (or normal saline, in the control group) followed by an i.v. dose of paraquat 20 mg/kg. A greater apparent volume of distribution (Vd), faster distribution rate constants and lower peak plasma concentration (P < 0.01) of paraquat were observed in the ethanol-treated than that in the control rabbits. The total clearance of paraquat was not significantly different between the two groups. The effect of ethanol on the intestinal absorption of paraquat was estimated by in situ intestinal perfusion technique in rats. The perfusate contained paraquat 50 micrograms/ml alone or with 1% or 2% ethanol. Inulin 320 micrograms/ml was added to the perfusate for the measurement of water net flux. The absorption clearance of paraquat as well as the absorption of water increased (P < 0.01) about two-fold in the presence of ethanol. The results of this study suggest that ethanol may potentiate paraquat toxicity by increasing intestinal absorption and tissue distribution. The critical lethal plasma concentration of paraquat is supposed to be lower in the presence of ethanol owing to increased volume of distribution.

Animals↗

Cancer potential in liver, lung, bladder and kidney due to ingested inorganic arsenic in drinking water.

In order to compare risk of various internal organ cancers induced by ingested inorganic arsenic and to assess the differences in risk between males and females, cancer potency indices were calculated using mortality rates among residents in an endemic area of chronic arsenicism on the southwest coast of Taiwan, and the Armitage-Doll multistage model. Based on a total of 898,806 person-years as well as 202 liver cancer, 304 lung cancer, 202 bladder cancer and 64 kidney cancer deaths, a significant dose-response relationship was observed between arsenic level in drinking water and mortality of the cancers. The potency index of developing cancer of the liver, lung, bladder and kidney due to an intake of 10 micrograms kg day of arsenic was estimated as 4.3 x 10(-3), 1.2 x 10(-2), 1.2 x 10(-2), and 4.2 x 10(-3), respectively, for males; as well as 3.6 x 10(-3), 1.3 x 10(-2), 1.7 x 10(-2), and 4.8 x 10(-3), respectively, for females in the study area. The multiplicity of inorganic arsenic-induced carcinogenicity without showing any organotropism deserves further investigation.

Adult↗

Effect of ethanol on the disposition of paraquat.

Rabbits that received paraquat (200 mg/kg) and ethanol (1.0-3.8 g/kg) by gavage resulted in shorter median survival times and higher mortality rates than those dosed with paraquat alone. Plasma paraquat levels in rabbits dosed with ethanol before, after and concurrently with ingestion of paraquat were significantly higher when compared with animals without ethanol intake. Furthermore, substantial differences in paraquat kinetics, higher AUC, lower total clearance (CL/F) and volume of distribution (V/F) were seen in the ethanol-paraquat group. The effect of ethanol on acute paraquat toxicity is, at least in part, associated with the increase in paraquat absorption and/or the decrease in paraquat excretion.

Alcoholic Intoxication↗

Serum copper and zinc levels in patients with cervical cancer.

The serum copper (SCL) and zinc (SZL) levels were measured in 99 patients with cervical cancer and 50 patients with uterine myoma as controls. The mean SCL in the control group was 109.4 +/- 17.4 micrograms/ml as compared to 117.1 +/- 14.6 micrograms/dl and was not significant (NS) in 17 carcinoma in situ (CIS) patients, 142.3 +/- 14.2 micrograms/dl in 30 stage I patients (p less than 0.001), 159.0 +/- 16.6 micrograms/dl in 22 stage II patients (p less than 0.001), 171.6 +/- 25.7 micrograms/dl in 10 stage III or IV patients (p less than 0.001), and 166.2 +/- 32.2 micrograms/dl in 20 recurrent patients (p less than 0.001). The SCL returned to control level 2 weeks after surgical treatment for the stage I and II patients (mean 110.6 +/- 19.6 and 108.7 +/- 20.4 micrograms/dl, respectively, p less than 0.001). The SZL was 97.2 +/- 15.8 micrograms/dl in control patients and only showed a significant decrease in stage III or IV and recurrent patients (67.2 +/- 16.6 and 70.4 +/- 17.2 micrograms/dl, respectively). Concerning the copper/zinc ratio, the control group was 1.13 +/- 0.07 as compared to 1.17 +/- 0.07 in CIS (p = 0.06), 1.51 +/- 0.24 in stage I (p less than 0.001), 1.85 +/- 0.37 in stage II (p less than 0.001), 2.66 +/- 0.61 in stage III or IV (p less than 0.001), and 2.50 +/- 0.75 in recurrent patients (p less than 0.001). Taking mean +/- 2.5 SD of the control values as cut off points, the percentages of the recurrent patients with abnormal SCL, SZL, and a Cu/Zn ratio were 65, 30 and 90%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Release of tissue paraquat into formalin solution during fixation.

Formalin-fixed tissues and formalin solutions are among the most frequently found materials in pathology and forensic science laboratories. However, these materials are seldom used for the identification of poisons for forensic toxicology purposes. In this study, the possibility that paraquat may be released from formalin-fixed tissues during the fixation process was investigated. However, because of the interference of formaldehyde on the reduction of paraquat with dithionite reagent, paraquat in formalin solutions was treated with ion-pair column chromatography and then determined by measuring the derivative spectrum of reduced paraquat. The results show that the interference of formalin on paraquat determination has been eliminated by the proposed method. Furthermore, a study on the formalin solutions of fixed organs in cases with suspected paraquat intoxication revealed that portions of tissue paraquat had been released into formalin during the fixation process. Moreover, the paraquat levels in formalin increased with increased storage time. Therefore, these data suggest that the combined concentrations of paraquat in the formalin-fixed tissues and formalin solutions might reflect more reliably the total paraquat in the postmortem tissues. This investigation could be of value to the forensic toxicologist, especially in cases in which no fresh tissue samples are available for analysis.

Adult↗

Effect of ethanol on acute paraquat toxicity in rabbits.

The effects of simultaneous administration of ethanol and paraquat on the blood paraquat levels and fatality in rabbits were investigated to evaluate the role of alcohol ingestion in inducing susceptibility to paraquat intoxication. Paraquat alone and with the combination of ethanol were administered orally to rabbits. Rabbit mortality rates for the 24 h period following the ingestion of paraquat alone and paraquat combined with 2.0 and 3.8 g/kg of ethanol, were 0/8, 4/8 and 8/8 subjects, respectively. Animals which ingested paraquat and ethanol at 2.0 and 3.8 g/kg showed significant elevation of blood paraquat levels. Furthermore, an animal dosed with ethanol 2 h following the ingestion of paraquat, consequently, exhibited a marked increase in paraquat levels in the blood 0.5 h after the administration of the ethanol. On the other hand, the average values of Tmax, Cmax, and AUC 8-8 h of paraquat in rabbits dosed simultaneously with paraquat (200 mg/kg) and ethanol, at 2 g/kg, were 1.38 +/- 0.52 h, 28.11 +/- 14.08 micrograms/ml, and 108.97 +/- 39.54 micrograms/ml.h, and at 3.8 g/kg of ethanol, were 2.20 +/- 1.10 h, 47.61 +/- 19.15 micrograms/ml, and 194.43 +/- 53.82 micrograms/ml.h, respectively. These values were significantly higher than those for the rabbits dosed with 200 mg/kg of paraquat alone (Tmax, Cmax, and AUC 0-8 h were 0.94 +/- 0.18 h, 13.81 +/- 2.71 micrograms/ml, and 44.1 +/- 8.6 micrograms/ml.h, respectively). These results show a close correlation between blood paraquat levels in rabbits dosed simultaneously with ethanol and mortality rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗

Dose-response relation between arsenic concentration in well water and mortality from cancers and vascular diseases.

Age-adjusted mortality rates were analyzed to examine the dose-response relation between ingested arsenic levels and risk of cancers and vascular diseases among residents in the endemic area of blackfoot disease, a unique peripheral vascular disease associated with long-term exposure to high-arsenic artesian well water and confined to the southwestern coast of Taiwan. The arsenic levels in well water determined in 1964-1966 were available in 42 villages of the study area, while mortality and population data during 1973-1986 were obtained from the local household registration offices and Taiwan Provincial Department of Health. Age-adjusted mortality rates from various cancers and vascular diseases by sex were calculated using the 1976 world population as the standard population. A significant dose-response relation was observed between arsenic levels in well water and cancers of the bladder, kidney, skin, and lung in both males and females, and cancers of the prostate and liver in males. However, there was no association for cancers of the nasopharynx, esophagus, stomach, colon, and uterine cervix, and for leukemia. Arsenic levels in well water were also associated with peripheral vascular diseases and cardiovascular diseases in a dose-response pattern, but not with cerebrovascular accidents. The dual effect of arsenic on carcinogenesis and arteriosclerosis and the interrelation between these two pathogenic mechanisms deserve more intensive study.

Adolescent↗