Search

Objective: To test the hypothesis that the type 2 diabetes mellitus (T2DM) phenotype in an indigenous population is characterized by proportionally short legs and obesity. Methods: Anthropometric characteristics were compared in females and males with T2DM (n = 20, n = 8, respectively) and without T2DM (n = 117, n = 93, respectively). Factor analysis derived dimensions were regressed on T2DM in logistic regression. Results: Weight, sitting height ratio and hip circumference were significantly lower (p

Alzheimer’s disease (AD) is an untreatable cause of dementia, and new therapeutic approaches are urgently needed. AD pathology is defined by extracellular amyloid plaques and intracellular neurofibrillary tangles. Research of the past decades has suggested that neuroinflammation plays a critical role in the pathophysiology of AD. This has led to the idea that anti-inflammatory treatments might be beneficial. Early studies investigated non-steroidal anti-inflammatory drugs (NSAIDS) such as indomethacin, celecoxib, ibuprofen, and naproxen, which had no benefit. More recently, protective effects of diclofenac and NSAIDs in the fenamate group have been reported. Diclofenac decreased the frequency of AD significantly compared to other NSAIDs in a large retrospective cohort study. Diclofenac and fenamates share similar chemical structures, and evidence from cell and mouse models suggests that they inhibit the release of pro-inflammatory mediators from microglia with leads to the reduction of AD pathology. Here, we review the potential role of diclofenac and NSAIDs in the fenamate group for targeting AD pathology with a focus on its potential effects on microglia.

Antiplatelet drugs are effective in preventing recurrence of atherosclerosis in type 2 diabetes (T2D) patients. However, the efficacy and usefulness of antiplatelet drugs on the progression of carotid intima-media thickness (IMT), a marker for evaluating early atherosclerotic vascular disease, has not been analyzed. We conducted a prospective, randomized, open, 36-month trial comparing cilostazol vs. aspirin. A total of 415 T2D patients (age range 38–83 years; 206 females) without macrovascular complications were randomized to either an aspirin (100 mg/day) or cilostazol (200 mg/day) treatment. Patients underwent B-mode ultrasonography annually to assess the IMT and serum levels of inflammatory markers were measured before and after each treatment. Potential confounders were statistically adjusted, and included lipid profiles, HbA1c, body mass index, waist circumference, anti-hypertensive and statin medications. The decrease in mean left, maximum left, mean right and maximum right IMT were significantly greater with cilostazol compared with aspirin (− 0.094 ± 0.186 mm vs. 0.006 ± 0.220 mm, p

OBJECTIVE The goal of the present investigation is to analyze thymus, brain, heart, liver, and kidney weights in SIDS victims compared to controls. BACKGROUND Epidemiologic risk factors for SIDS (eg, male gender, genetic, obstetric, environmental, smoke exposure, nonbreastfeeding, etc.) are consistent with an infectious process underlying many of these deaths. METHODS Data from autopsy reports on 585 SIDS victims and comparison deaths (n = 294 control, n = 291 SIDS) were analyzed. Cases were obtained from Australia (n = 184 controls, n = 98 SIDS) and Russia (n = 122 controls, n = 181 SIDS). Log10 transform of thymus and other organ weights was computed because variables were skewed. Multivariate analysis of variance (MANOVA) of standardized log values were age-adjusted by multivariate analysis of covariance (MANCOVA). The standardized log10 thymus residual adjusted for age, brain and liver weights was computed for the final analysis. RESULTS After controlling for age by MANCOVA, thymus, body, brain and liver weights were significantly higher among SIDS compared to non-SIDS victims. The largest difference as between covariate-adjusted log10 non-SIDS thymus weight differed (mean = 1.423, 95% CI: 1.393-1.452) and log10 non-SIDS thymus weight (mean = 1.269, 95% CI: 1.243-1.294) were significantly different (P

Background The coronavirus disease 2019 pandemic is expected to affect operations and lifestyles of interventional cardiologists around the world in unprecedented ways. Timely gathering of information on this topic can provide valuable insight and improve the handling of the ongoing and future pandemic outbreaks. Methods and Results A survey instrument developed by the authors was disseminated via e‐mail, text messaging, WhatsApp, and social media to interventional cardiologists between April 6, 2020, and April 11, 2020. A total of 509 responses were collected from 18 countries, mainly from the United States (51%) and Italy (36%). Operators reported significant decline in coronary, structural heart, and endovascular procedure volumes. Personal protective equipment was available to 95% of respondents; however FIT‐tested N95 or equivalent masks were available to only 70%, and 74% indicated absence of coronavirus disease 2019 pretesting. Most (83%) operators expressed concern when asked to perform cardiac catheterization on a suspected or confirmed coronavirus disease 2019 patient, primarily because of fear of viral transmission (88%). Although the survey demonstrated significant compliance with social distancing, high use of telemedicine (69%), and online education platforms (80%), there was concern over impending financial loss. Conclusions Our survey indicates significant reduction in invasive procedure volumes and concern for viral transmission. There is near universal adoption of personal protective equipment; however, coronavirus disease 2019 pretesting and access to FIT‐tested N95 masks is suboptimal. Although there is concern over impending financial loss, substantial engagement in telemedicine and online education is reported.

OBJECTIVE To analyze variation in the growth status of indigenous children and youth attending bilingual schools, escuelas albergues, for the indigenous population in Mexico. MATERIALS AND METHODS The children and youth attended escuelas albergues in 1,009 localities in 21 Mexican states in 2012. Heights and weights of 31,448 boys and 27,306 girls 6-18 years of age were measured by trained staff at each school; the BMI was calculated. The students were divided into five geographic regions for analysis: North, Central, South-Gulf, South-Pacific, and South-Southeast. Growth status was compared to United States reference percentiles (P). RESULTS Mean heights of children and youth from the five regions varied between P10 and P5 of the reference until about 13 years (girls) and 14 years (boys); subsequently, heights were ≤P5. Mean weights in both sexes were at P25 of the reference between 6 and 12 years, and then varied between P25 and P10 in boys and were ≥P25 in girls. Given the elevated weights relative to heights compared to the reference, mean BMIs of indigenous boys and girls were at or above the reference medians. Children and youth in the North and Central regions were, on average, taller than those in the South-Pacific and South-Southeast regions, while heights of those in the South-Gulf region were generally intermediate. In contrast, mean weights and BMIs differed negligibly among the regions. CONCLUSIONS The geographic gradient in heights of indigenous children and youth was consistent with a north-to-south pattern noted among indigenous adults in studies spanning 1898 through 2013. Variation in height among children and youth likely reflected ethnic-specific and geographic variation interacting with economic and nutritional factors.

Background: Our aim was to determine whether specific nonsteroidal anti-inflammatory (NSAID) agents are associated with a decreased frequency of Alzheimer’s disease (AD). Materials and methods: Days of drug exposure were determined for diclofenac, etodolac, and naproxen using US Department of Veterans Affairs (VA) pharmacy transaction records, combined from two separate VA sites. AD diagnosis was established by the International Classification of Diseases, ninth revision (ICD-9)/ICD-10 diagnostic codes and the use of AD medications. Cox regression survival analysis was used to evaluate the association between AD frequency and NSAID exposure over time. Age at the end of the study and the medication-based disease burden index (a comorbidity index) were used as covariates. Results: Frequency of AD was significantly lower in the diclofenac group (4/1431, 0.28%) compared with etodolac (328/14,646, 2.24%), and naproxen (202/12,203, 1.66%). For regression analyses, naproxen was chosen as the comparator drug, since it has been shown to have no effect on the development of AD. Compared with naproxen, etodolac had no effect on the development of AD, hazard ratio (HR) 1.00 [95% confidence interval (CI): 0.84–1.20, p = 0.95]. In contrast, diclofenac had a significantly lower HR of AD compared with naproxen, HR 0.25 (95% CI: 0.09–0.68, p Conclusion: Diclofenac, which has been shown to have active transport into the central nervous system, and which has been shown to lower amyloid beta and interleukin 1 beta, is associated with a significantly lower frequency of AD compared with etodolac and naproxen. These results are compelling, and parallel animal studies of the closely related fenamate NSAID drug class.

New advances in satellite data acquisition and processing offer promise for monitoring agricultural lands globally. Using these data to estimate crop yields for individual fields would benefit both crop management and scientific research, especially for areas where reliable ground-based estimates are not currently made. Here we introduce a generalized approach for mapping crop yields with satellite data and test its predictions for yields across more than 17,000 maize fields and 11,000 soybean fields spanning multiple states and years in the Midwestern United States. The method, termed SCYM (a scalable satellite-based crop yield mapper), uses crop model simulations to train statistical models for different combinations of possible image acquisition dates, and these are then applied to Landsat and gridded weather data within the Google Earth Engine platform, where the Landsat is composited to find the “best” dates of observations on a pixel-by-pixel basis. SCYM estimates successfully captured a significant fraction of maize yield variation in all state-years, with a range of 14–58% and an average of 35% for this particular study region and crop. Similar results were observed for soybean, with an average of 32% of yield variation captured. The multi-year yield estimates were also used to examine the temporal persistence of yield advantages for the top yielding fields in different counties, which is one measure of how important factors such as farmer skill are in explaining yield gaps. The strength of the SCYM approach lies in its ability to leverage physiological knowledge embedded in crop models to interpret satellite observations in a scalable way, as it can be readily applied to new crops, regions, and types and timing of remote sensing observations without the need for ground calibration.

OBJECTIVE To test the hypothesis that secular changes in body size and age at menarche are related to the demographic and epidemiologic transitions in an indigenous community in Oaxaca, southern Mexico. METHODS Data were derived from surveys of a Zapotec-speaking community conducted between 1968 and 2000. Segmented linear regressions of height, weight, BMI and recalled age at menarche on year of birth in cohorts of adults born before and after the demographic transition were used to evaluate secular changes. Corresponding comparisons of body size (MANCOVA controlling for age) and age at menarche (status quo, probit analysis) were done for samples of children and adolescents born before and after the epidemiological transition. RESULTS Height and weight increased in adults born after the demographic transition (mid-1950s), and especially in children and adolescents born after the epidemiological transition (mid-1980s). Age at menarche also decreased significantly in women born after the demographic transition, but at a more rapid estimated rate in adolescents born after the epidemiological transition. Secular gains in body weight were proportional to those for height among children and adolescents, but adults, males more so than females, gained proportionally more weight. CONCLUSIONS The secular trend in height in adults of both sexes was associated with the decade of the demographic transition in the mid-1950s. Significant secular gains in size attained and age at menarche occurred in children and youth born after the epidemiologic transition which likely reflected improved health and nutritional conditions since the mid-1980s.

The effect of altitude of residence on the growth status of 11,454 indigenous school children 6–14 years of age in Oaxaca, southern Mexico, was examined. Indicators of living conditions (human development index [HDI], index of community nutritional risk [INR], index of marginalization [IM], index of relative isolation [II]) were regressed on z-scores for height, weight and BMI, and the residuals were regressed on altitude of residence (km). Independent of other environmental conditions, altitude negatively affected height by approximately −0.07 z-scores per kilometer altitude above sea level. The estimated average decrease in stature was 0.92 cm per kilometer elevation. BMI was significantly increased, 1.2 units per kilometer elevation, consistent with earlier studies of growth status and altitude. In contrast, weight was not affected by altitude of residence. Approximately 36% of the reduction in height and 54% of the increase in BMI were due to altitude effects; the remaining changes in height and BMI were associated with environmental factors reflected in the indices of community well-being considered. Am J Phys Anthropol 152:1–10, 2013. © 2013 Wiley Periodicals, Inc.

This paper analyses a large dataset based on empirical non-market valuation study results reported in the USA. The dataset is used to estimate a meta-regression model that is applied to predict the corresponding recreation activity values in China. The convergent validity of the meta-analytical international benefit transfer is tested against observed recreation activity values in China. In the process, a relative percentage error indicator, paired t-test and the Wilcoxon signed-rank test are used. The mean benefit transfer error is 18.74%, an acceptable value for international transfer.

Context: Evidence indicates higher prevalence of obesity in rural American youth. The present study evaluates the growth status and estimates the prevalence of overweight and obesity among rural school children in Texas. Methods: Heights and weights were measured in a sample of 1,084 school youth (545 males, 539 females) 5–19 years of age, in rural north central Texas in 2010. body mass index (BMI) was calculated. Growth status was plotted relative to US reference data. Weight status (underweight/thin, overweight, and obesity) was classified relative to age- and sex-specific Centers for Disease Control (CDC) and International Obesity Task Force (IOTF) criteria. Concordance of classifications was evaluated. Results: Mean heights of the rural children approximated reference medians, while median weights exceeded reference medians and approximated 75th percentiles with increasing age. Median BMIs of boys and girls were below the 75th percentiles except among late adolescent girls. Prevalence of underweight/thinness was low (

Objective This study tests the hypothesis that natural selection is associated with type 2 diabetes (T2D)-associated mortality and fertility in a rural isolated Zapotec community in the Valley of Oaxaca, southern Mexico. Participants and Methods Mortality data and related demographic and genealogic information were linked with data for fertility, prereproductive mortality and family history of mortality attributed to T2D. Physician verified T2D mortality (n = 27) between 1980 and 2009 and imputed T2D (n = 70) from cardiovascular mortality (68% random sample) and renal failure (44% random sample). Bootstrapping was used to obtain a robust variance estimate in survival analysis and multivariate analysis of variance. Results Estimated maximum natural selection by Crow's Index occurred circa 1930 and was relaxed after this time in the study population. Cox-regression survival analysis of T2D mortality with covariates (family history of T2D, cardiovascular disease, renal failure) indicated a significant hazard ratio (HR = 5.95, 95% CI: 1.38–25.67, p < .008) for the increase in T2D in 2000 to 2009. Survival analysis of imputed T2D resulted in a significant HR of 2.03 (95% CI: 1.08–3.85, p = .01) for the increase in T2D in the 2000 to 2009 cohort (reference group: 1980–1989). Mean number of live born offspring was lower among T2D (n = 27, 4.04 ± 3.85 SD) compared to non-T2D (n = 199, 5.30 ± 3.48) groups (p < .08). Mean number of live born offspring was lower (p = .003) among imputed T2D compared to non-T2D groups (4.10 ± 3.44 vs. 5.62 + 3.50). Discussion T2D-associated mortality increased in frequency as natural selection decreased, and favored offspring survival of non-T2D descedants. The results indicated statistically significant directional selection against T2D and imputed T2D to this population isolate.

Objectives The purpose of this study is to compare post-dilation strategies of nitinol self-expanding stents implanted in the superficial femoral artery of diabetic patients with peripheral arterial disease. Background Endovascular treatment of superficial femoral artery disease with nitinol self-expanding stents is associated with high rates of in-stent restenosis in patients with diabetes mellitus. Methods We conducted a prospective, multicenter, randomized, controlled clinical trial of diabetic patients to investigate whether post-dilation of superficial femoral artery nitinol self-expanding stents using a cryoplasty balloon reduces restenosis compared to a conventional balloon. Inclusion criteria included diabetes mellitus, symptomatic peripheral arterial disease, and superficial femoral artery lesions requiring implantation of stents >5 mm in diameter and >60 mm in length. Primary endpoint was binary restenosis at 12 months, defined as ≥2.5-fold increase in peak systolic velocity by duplex ultrasonography. Results Seventy-four patients, with 90 stented superficial femoral artery lesions, were randomly assigned to post-dilation using cryoplasty (n = 45 lesions) or conventional balloons (n = 45 lesions). Mean lesion length was 148 ± 98 mm, mean stented length was 190 ± 116 mm, mean stent diameter was 6.1 ± 0.4 mm, and 50% of the lesions were total occlusions. Post-dilation balloon diameters were 5.23 ± 0.51 mm versus 5.51 ± 0.72 mm in the cryoplasty and conventional balloon angioplasty groups, respectively (p = 0.02). At 12 months, binary restenosis was significantly lower in the cryoplasty group (29.3% vs. 55.8%, p = 0.01; odds ratio: 0.36, 95% confidence interval: 0.15 to 0.89). Conclusions Among diabetic patients undergoing implantation of nitinol self-expanding stents in the superficial femoral artery, post-dilation with cryoplasty balloon reduced binary restenosis compared to conventional balloon angioplasty. (Study Comparing Two Methods of Expanding Stents Placed in Legs of Diabetics With Peripheral Vascular Disease [COBRA]; NCT00827853 )

Many factors in the natural, man-made and social environments can influence the physical growth and maturation and behavioral development of children and adolescents. Improved environmental conditions over the past century or so have contributed to positive secular changes in growth and maturation. More recently, however, technological advances have increased opportunities for sedentary behaviors and contributed to reductions in physical activity, both of which have potentially negative implications for the health of youth. Pollutants associa-ted with some industries also have implications for health. Children with elevated lead levels are at increased risk for impaired growth and maturation and for impairments in fine motor coordination. The impact of elevated lead on gross motor coordination in several tests of physical fitness is mediated through the influence of lead on growth in body size. Similarly, emissions from coal-fired power plants and other industries are associated with asthma, which has implications for the physical activity and fitness of youth.

Objectives: To evaluate short-term secular change in menarche and associations with blood lead level in Polish girls between 1995 and 2007. Methods: Menarcheal status of school girls 7–16 years from villages in southwestern Poland was surveyed in 1995, 2001, 2004, and 2007. Blood lead was sampled in 1995 and 2007. Median ages and variance statistics for menarche were estimated with probit analysis. Associations between blood lead level and menarcheal status in 1995 and 2007 were analyzed with logistic regression using blood lead level as an independent binary variable: 2.00–5.00 and ≥5.10 μg/dl. Results: Median ages at menarche declined slightly from 1995 (13.36 ± 0.06 years) to 2001 (13.20 ± 0.04 years), was stable in 2004 (13.20 ± 0.05 years), and declined to 2007 (12.81 ± 0.05 years). Blood lead levels declined from 6.57 ± 0.13 μg/dl in 1995 to 4.24 ± 0.14 μg/dl in 2007. With age, height, and BMI controlled, probability of attaining menarche was not associated with blood lead in 1995, but was decreased with increased blood lead in 2007 (OR 0.31, 95% CI 0.09–1.06, P = 0.057). Conclusion: Ages at menarche and blood lead levels declined between 1995 and 2007. Higher blood lead levels were not associated with menarche in 1995, suggesting that nutritional and health conditions and perhaps somewhat unstable social and economic conditions in the 1980s and early 1990s may have masked the influence of lead on sexual maturation. Elevated blood lead was associated with the probability of later menarche in 2007, although the association was of borderline (P = 0.06). Am. J. Hum. Biol., 2012. © 2012 Wiley Periodicals, Inc.

The objective of this study is to compare the growth and physical fitness of normal, stunted and overweight/obese (owt/ob) Oaxaca children 6-13 years.This study was a cross-sectional, included 688 school children (grades 1-3, 4-6), aged 6-13 years, from an indigenous rural community (n=361) and colonia popular (n=327) in Oaxaca, southern Mexico.Anthropometry-weight, height, sitting height, limb circumferences, skinfolds. Derived-body mass index, sitting height/height ratio, leg and step lengths, limb muscle areas, sum of skinfolds. Physical fitness-sit and reach, sit-ups, distance run, grip strength, standing long jump, 35 yard dash. Physical activity-steps to and from school, household chores, sports participation.Normal-not stunted, not owt/ob; stunted-not owt/ob; and owt/ob-not stunted were compared with multivariate analysis of covariance controlling for age. Two children were stunted and owt/ob, and were excluded.Age-adjusted means for body size, muscularity, adiposity and grip strength showed a gradient, owt/obnormalstunted in both sexes and grade levels (P0.001). Relative position of stunted and owt/ob children was reversed for strength per unit mass. Stunted and normal children ran a greater distance than owt/ob children (P0.05). Normal, stunted and owt/ob children did not differ consistently in other fitness items and indicators of activity and inactivity.Size, muscularity, fatness and strength differed significantly, owt/obnormalstunted, but owt/ob children had less strength per unit mass and poorer endurance. Normal and stunted children did not differ consistently in fitness. Physical activity and television time did not differ among the three groups.

Differential investment in offspring by parental and progeny gender has been discussed and periodically analyzed for the past 80 years as an evolutionary adaptive strategy. Parental investment theory suggests that parents in poor condition have offspring in poor condition. Conversely, parents in good condition give rise to offspring in good condition. As formalized in the Trivers-Willard hypothesis (TWH), investment in daughters will be greater under poor conditions while sons receive greater parental investment under good conditions. Condition is ultimately equated to offspring reproductive fitness, with parents apparently using a strategy to maximize their genetic contribution to future generations. Analyses of sex ratio have been used to support parental investment theory and in many instances, though not all, results provide support for TWH. In the present investigation, economic strategies were analyzed in the context of offspring sex ratio and survival to reproductive age in a Zapotec-speaking community in the Valley of Oaxaca, southern Mexico. Growth status of children, adult stature, and agricultural resources were analyzed as proxies for parental and progeny condition in present and prior generations. Traditional marriage practice in Mesoamerican peasant communities is patrilocal postnuptial residence with investments largely favoring sons. The alternative, practiced by ∼25% of parents, is matrilocal postnuptial residence which is an investment favoring daughters. Results indicated that sex ratio of offspring survival to reproductive age was related to economic strategy and differed significantly between the patrilocal and matrilocal strategies. Variance in sex ratio was affected by condition of parents and significant differences in survival to reproductive age were strongly associated with economic strategy. While the results strongly support TWH, further studies in traditional anthropological populations are needed. Am J Phys Anthropol 143:501–511, 2010. © 2010 Wiley-Liss, Inc.

Objective To evaluate the relationship between community well-being based on an index of marginalization and growth status of indigenous rural school children in Oaxaca. Methods Heights and weights of a cross-sectional sample of 11,454 children, 6–14 years, from schools for indigenous rural children ( escuelas albergue ) in 158 municipios in Oaxaca were measured in 2007. Tertiles of an index of marginalization were used to classify the 158 municipios into three categories of community well-being: lowest (highest marginalization), low, and moderate (lowest marginalization). Multivariate analysis of covariance, controlling for age, relative isolation and population size, was used to compare body size of children by category of community well-being. Contributions of marginalization, isolation and population size to variation in body size were estimated with sex-specific linear regression. Results Children from municipios lowest in well-being were shorter and lighter than children from municipios low and moderate in well-being. Marginalization and relative isolation accounted for 23% (boys) and 21% (girls) of the variance in height and for 21% of the variance in weight of girls. Marginalization was the predictor of weight in boys (23%). Conclusion Community well-being was reflected in the growth status of rural indigenous school children. Compromised growth status was consistent with poor health and nutritional conditions that were and are characteristic of rural areas in the state of Oaxaca.

There are emerging reports supporting the fact that proton-pump inhibitors competitively inhibit the metabolism of clopidogrel to its active metabolite and diminish its clinical efficacy, especially in patients on long-term dual antiplatelet therapy. In this article, we examine the current evidence and provide interpretation of the results along with practical recommendations for healthcare providers.

The study compared the grip strength of indigenous school youth 6-17 years of age in Oaxaca, southern Mexico, who were surveyed in 1968, 1978 and 2000.Grip strength (Smedley/Stoelting) was measured to 0.5 kg in 1280 children and adolescent, 621 males and 659 females, in the three surveys. Height and weight were also measured. Strength of the right and left hands was summed to provide a general estimate of muscular strength. Summed grip strength was also expressed per unit body mass (kg/kg) and height (kg/m). Subjects were classified into four age groups: 6-8 years (childhood), 9-11 years (transition in adolescence), 12-14 years (early adolescence) and 15-17 years (later adolescence). Children 6-14 years were surveyed in 1968, 1978 and 2000 while adolescents 15-17 years were surveyed in 1978 and 2000. Sex-specific MANCOVAs were used for comparisons among years within age groups.Changes in grip strength between 1968 and 1978 among children 6-14 years were small and significant only in girls. Grip strength increased, on average, between 1978 and 2000 in boys 6-17 years but only in girls 6-14 years; adolescent girls 15-17 years in 1978 were stronger than those in 2000. Secular gains in muscular strength were generally proportional to secular gains in body weight and height.The data demonstrate secular changes in muscular strength in indigenous rural youth in a community in the process of transition from subsistence level agriculture to an economy less dependent upon agriculture.

Survival Analysis method has been commonly used in biology, medical science, and human life insurance studies but it is rarely applied in agricultural insurance research. The main objective of this study is to explore the appropriateness of the Survival Analysis model for the crop insurance program design. Our analysis was mainly focused on the catastrophic risk premium rate estimates under the condition of 70% yield coverage for rice, corn and sorghum in Panjin of Liaoning province, China. The results indicate that the estimated premium rates for each crop are consistent with the currently prevailed crop insurance premium rate in Panjin.

Secular change in adult height of resi- dents in a rural indigenous community in the Valley of Oaxaca was evaluated. Subjects were measured in 1971 (49 males, 26 females 19-70 years), 1978 (128 males, 124 females 19-82 years) and 2000 (155 males, 255 females 19-89 years). Heights were adjusted for esti- mated loss with age using two protocols; height at 21 years of age was also estimated. The effects of age and secular factors on measured and adjusted heights were evaluated through segmented linear regressions for three birth periods

Using the travel cost method, the authors measure the recreational trip value of Xinghai Park in Dalian, China. They compare non-linear, truncated Poisson and truncated negative-binomial count data models to estimate recreational trip demand. The economic values of recreational trips in terms of consumer surplus (CS) are derived from each model. They estimate the CS values at between RMB ¥493 (US$64) to RMB ¥562 (US$73) per trip, resulting in a total social welfare estimate in the range from RMB ¥1.08 billion to RMB ¥1.23 billion (US$140 million to US$160 million in 2007).

The purpose of this investigation is to analyze childhood blood lead levels and growth status (ages 2-12) in Dallas, Texas lead smelter communities in the 1980s and 2002, where smelters operated from 1936 to 1990.A sample of convenience study design was used in two cohorts (n=360): 1980-1989 (n=191) and 2002 (n=169). Multivariate analysis of variance and covariance and tandem multiple regressions were used to evaluate the association between stature and blood lead level in two time periods.In 2002 average child blood lead level (1.6 microg/dL+/-0.2 SE) was significantly (p0.001) lower compared to the 1980 cohort mean level (23.6 microg/dL+/-1.3 SE). Average height and weight in 2002 were 4.5 cm and 4.0 kg greater, respectively, than in 1980. Lowered blood lead level was associated with 3.9 cm, 3.5 kg and 1.1 units greater height, weight and body mass index (BMI), respectively. Cohort effect was associated with greater height (0.6 cm), weight (0.5 kg) and BMI (0.1).This investigation reports on child growth in a community before and after the transition from high to low blood lead levels over several decades. Using child growth as a proxy, health status of Dallas's lead smelter communities increased markedly over the past two decades, primarily because of lower blood lead levels, while the poverty rate was only marginally lower.

The optimal duration of clopidogrel administration after percutaneous coronary intervention (PCI) remains unknown. Clopidogrel is currently recommended for minimums of 1 and 12 months after bare-metal stent and drug-eluting stent implantation, respectively. To determine the impact of clopidogrel discontinuation 1 year after PCI, the outcomes of 530 consecutive patients who underwent PCI from January 2004 to July 2006, were free of cardiovascular events for 6 months after PCI, and had follow-up available for12 months were examined. The outcomes of patients who received clopidogrel foror =1 year were compared with those of patients who received it for1 year. The mean age was 65 +/- 9 years. Patients often presented with acute coronary syndromes (57%), and 85% received drug-eluting stents. Clopidogrel was used foror =1 year and for1 year in 341 and 189 patients, respectively. During a mean follow-up period of 2.4 +/- 0.8 years, 40 patients (8%) died, 21 (4%) had acute myocardial infarctions, and 89 (17%) underwent repeat coronary revascularization. Compared with patients with clopidogrel administration for1 year after PCI, those who received clopidogrel foror =1 year had lower mortality (14.8% vs 3.5%, p0.001). On multivariate analysis, clopidogrel use foror =1 year was associated with lower mortality (hazard ratio 0.28, 95% confidence interval 0.14 to 0.59), independent of traditional cardiovascular risk factors, clinical presentation, and the use of drug-eluting stents. In conclusion, the use of clopidogrel foror =1 year after PCI was associated with lower mortality.

Observations of activities of contemporary subsistence agricultural communities may provide insights into the lifestyle of youth of 2 to 3 generations ago. The purpose of this study was to document age- and sex-associated variation in household activities and daily steps walking to school of youth 9-17 years in an indigenous subsistence agricultural community in Oaxaca, southern Mexico. Activities during leisure were also considered. A cross-sectional survey of a rural Zapotec-speaking community was undertaken, and respondents included 118 boys and 152 girls, aged 8.7-17.9 years. Household and leisure activities were documented by questionnaire and subsequent interview. Household activities were classified by estimated intensity for before and after school and on the weekend, and an estimate of METS per day accumulated while doing chores was derived. Number of steps from home to school was estimated. Contingency table analysis and MANCOVA controlling for age was used to evaluate results. Household activities tended to cluster at light and moderate intensities in girls and at moderate to moderate-to-vigorous intensities in boys. Estimated METS per day in approximately 2 h of chores differed significantly by sex. Secondary school girls expended significantly more METS per day in chores than primary school girls, but there was no difference by school level in boys. The daily round trip from home to school was approximately 2400 steps for primary students and approximately 2700 and approximately 3100 steps for secondary boys and girls, respectively. Television viewing and participation in sports were major leisure activities for boys and girls. Daily household chores, walking, and leisure activities suggest moderately active and moderately-to-vigorously active lifestyles in girls and boys, respectively, in this indigenous subsistence agricultural community.

In the broad sense, modern humans have lived in an environment in which physical activity and associated movement skills were central, especially in the context of physical competition with other animals. The physically active lifestyle of earlier human populations has been emphasized, especially the cardiovascular endurance component and energy expenditure, but less attention has been devoted to the gross and fine motor skills that are essential components of this lifestyle. Motor skills developed through practice are important determinants of success and survival in preindustrial societies. In industrial and postindustrial societies, on the other hand, the role of physical activity is different, with prowess in certain areas of physical expertise (e.g., accuracy with projectiles, muscular strength, among others) and prolonged exertion (i.e., cardiovascular endurance) less important for survival. The combined effects of the transition to a sedentary lifestyle and attendant dietary changes have resulted first an epidemic of coronary heart disease and more recently an epidemic of overweight/obesity in postindustrial societies. Although mortality associated with coronary heart disease has declined, due largely to biomedical advances, overweight and obesity have increased concomitantly with population reduction in physical activity (energy expenditure) and increased calorie (energy) consumption. The current scenario begs several questions which have implications for contemporary human biology related to sustaining the pace of cultural change on a biological base that is increasingly being compromised by physical inactivity, overweight, and obesity. Am. J. Hum. Biol., 2008. © 2008 Wiley-Liss, Inc.

Aim The aim of this study was to seek an association between the control of type 2 diabetes mellitus (T2DM), as determined by hemoglobin A1c (HbA1c) levels, and the outcome of colorectal cancer (CRC). Methods We performed a retrospective review of patients with T2DM who had CRC diagnosed between 1997 and 2001. We defined well-controlled T2DM as HbA1c

Populations in the state of Oaxaca in southern Mexico are at high risk for malnutrition and marginalization.The study compared secular changes in the growth status of urban and rural schoolchildren in the Valley of Oaxaca between the 1970s and 2000.Cross-sectional surveys of boys and girls aged 6-13 years (n = 1472) were carried out in an urban colonia populares in 1972 and 2000 and a rural indigenous community in 1978 and 2000. Height, sitting height and weight were measured; leg length, sitting height ratio, BMI, and prevalence of stunting, underweight, overweight and obesity were calculated. Sex-specific ANCOVA controlling for age was used.Both urban and rural children experienced significant secular gains in linear dimensions, body weight and the BMI between the 1970s and 2000. Estimated rates of secular gain overlapped considerably between urban and rural children. Secular gains in the BMI are significantly greater in urban than rural boys and girls. Urban-rural differences in linear dimensions and body weight in 2000 compared to the 1970s do not differ in either sex, but urban-rural differences in the BMI are greater in boys and girls in 2000 compared to the 1970s. The prevalence of stunting declined while that of overweight and obesity increased.Significant secular increases in body size occurred between the 1970s and 2000, but there was considerable overlap between urban and rural children. Only secular gains in the BMI were significantly greater in urban than rural boys and girls and the magnitudes of urban-rural differences in the BMI were greater in 2000 than in the 1970s.

The present study was set in the context of two questions. First, does blood lead level exert a direct effect on measures of physical fitness? And second, might blood lead influence physical fitness indirectly through growth stunting?Blood lead level is negatively associated with performances on a variety of fine motor tasks. Corresponding information on associations with measures of physical fitness and gross motor coordination are limited.Schoolchildren 7-15 years of age (463 males, 436 females) living in the vicinity of copper smelters and refineries were tested for blood lead. In addition to body size and blood lead, physical fitness was measured: right and left grip strength, timed sit-ups, flexed arm hang, plate tapping, shuttle run, standing long jump and medicine ball throw. Simple reaction time was also measured.The effect of blood lead level on physical fitness was indirect and small, and operated through anthropometric dimensions that more directly influenced the measures of fitness.Direct effects of blood lead level on indicators of physical fitness in school age youth are not evident. Blood lead level adversely affects physical fitness indirectly through growth stunting.

The study analyzed the relationship between skeletal age (SA) and the difference between skeletal and chronological ages (SA-CA) and body size among growth-stunted and well-nourished children.Tanner-Whitehouse 2 (TW2) 20 bone, radius-ulna-short (RUS) bone, and carpal SAs were analyzed in three cross-sectional samples of school children aged 6-13 years: Mestizo children (n = 396) from the city of Oaxaca, southern Mexico, and American Black (n = 570) and White (n = 432) from Philadelphia. The Oaxaca children were mild-to-moderately undernourished while the Philadelphia children were well nourished. The total sample included 1398 radiographs assessed with the Tanner-Whitehouse protocol by a single, experienced rater. Maturity scores were converted to TW2 20 bone, RUS and carpal SAs.Correlations of SA and SA-CA differences with body dimensions (height, sitting height, leg length, weight, triceps skinfold, arm and estimated midarm muscle circumferences) were consistent and approximately equal in magnitude for the well-nourished samples but were different among Oaxaca children. SAs of Philadelphia children were significantly more highly correlated with body dimensions than were SA-CA differences compared to Oaxaca Mestizo children. Patterns of RUS and carpal SA correlations with body size (height, sitting height, and leg length) in Oaxaca children were different from the Philadelphia samples. Oaxaca children tended to have advanced RUS SA and delayed carpal SA.Long bone complexes mature earlier than round bone complexes in Oaxaca children compared to Philadelphia Black and White children, resulting in short stature in Oaxaca children. Results suggest a gene-environment interaction effect on the program for skeletal growth and maturation in undernourished Oaxaca children compared to well-nourished Black and White children from Philadelphia.

There are limited data regarding contemporary use of stent and non-stent based treatment strategies of infrainguinal peripheral artery disease (PAD).We analyzed data from the ongoing multicenter XLPAD registry between July 2005 and October 2013 to report on the use of non-stent (atherectomy ± balloon angioplasty) and stent-based treatment of superficial femoral artery (SFA), popliteal, and below-the-knee (BTK) vessels in contemporary clinical practice.A total of 584 interventions (SFA, 82.5%; popliteal, 7.2%; BTK, 9.9%) were performed in 372 patients (mean age, 63.2 years; diabetes mellitus, 57.7%; Rutherford category 1-3, 73.5%; Rutherford category 4-6, 20.1%). Stents were deployed in 389 lesions (66.6%; SFA, 90.5%; popliteal, 5.1%; BTK, 4.1%) and non-stent strategy (atherectomy, 49%) in 195 lesions (33.4%; SFA, 66.7%; popliteal, 11.3%; BTK, 21.5%). In the stent and non-stent groups, mean lesion lengths were 133.9 mm and 86.0 mm (P.001), chronic total occlusions (CTOs) constituted 63.0% and 49.7% (P.01), and restenotic lesions were 12.6% and 32.3% (P.001), respectively. At a mean follow-up of 260 ± 130 days, in the stent and non-stent treated patients, all-cause mortality was 4.3% and 3.5% (P=.65), clinically indicated repeat revascularization was 17.5% and 14.9% (P=.42), and amputation was 4.6% and 9.2% (P.01), respectively. SFA lesion location, long lesion length, and CTO were associated with the use of stents. Advanced Rutherford class was associated with a non-stent treatment strategy.The majority of endovascular peripheral arterial interventions are performed in the SFA; most include a CTO and in patients with diabetes mellitus. Operators use stents to primarily treat complex SFA lesions with overall similar outcomes, except for fewer amputations compared to a non-stent strategy.

This study implements a recently proposed score test that could help guide insurance fraud researchers in deciding whether to use a logit or a probit model in predicting insurance fraud probabilities, especially when the occurrence of ones in the dependent variable is much less than zeros. The test is easily implemented in a crop insurance fraud context and seems to be a promising method that could be applicable to analysing and detecting potentially fraudulent claims in various lines of insurance.

The study assessed the national prevalence of obesity among schoolchildren in the United Arab Emirates (UAE).A stratified 10% random sample of 16,391 children was drawn from 145,492 pupils in the UAE.Height and weight were measured by physicians and trained nurses, and the body mass index (BMI; weight (kg)/height (m)2) was computed. BMIs for UAE were compared to recently published international standards.Comparison of BMIs to international reference data revealed that UAE children are at increased risk for overweight (25 kg m-2 and =30 kg m-2) and obesity (=30 kg m-2). For example, 10-year-old male UAE children had 1.7 times the rate of overweight compared to international standards and 1.9 times at 18 years. Similarly, female UAE children have 1.8 times the rate of overweight compared to international standards at 10 and 18 years of age. Obesity was 2.3-fold higher among UAE males at 14 years compared to international standards, and increased to 3.6 times at 18 years of age. Among UAE female children, obesity was same as males at 14 years, 2.3 times than the international standards. At 18 years of age, UAE female obesity was 1.9-fold higher than the international standard, nearly one-half the rate of obesity among UAE males at the same age.The frequency of obesity among UAE youth is two to three times greater than the recently published international standard. Profound public health implications of childhood obesity for UAE children and young adults are seriously increased because of adult chronic disease processes (e.g. cardiovascular disease, diabetes) normally attendant to increased obesity rates.

We analyzed inbreeding using surname isonymy in an indigenous genetic isolate. The subjects were residents of a rural Zapotec-speaking community in the valley of Oaxaca, southern Mexico. The community can be classified as a genetic isolate with an average gene flow of < or = 3% per generation. Surnames were collected for individuals in each household in pedigree form using the culturally traditional patronym-matronym naming. Estimation of inbreeding from surname isonymy is facilitated by the traditional patronym-matronym name assignment among indigenous Mexican populations. A total of 2,149 individuals had valid surname patronym-matronym pairings, including 484 deceased ancestors. Surname isonymy analysis methods were used to estimate total inbreeding and to segregate it into random and nonrandom components. The surname isonymy coefficient computed from 119 isonymous surname pairings (119/2,149) was 0.0554. The estimated inbreeding coefficient from surname isonymy was 0.0138 (0.0554/4). The random and nonrandom components of inbreeding were F(r) = 0.0221 and F(n) = -0.0091, respectively. The results suggest that consanguinity is culturally avoided. Nonrandom inbreeding decreased total inbreeding by about 41%. Total estimated inbreeding by surname isonymy was 0.0138, which is similar to inbreeding estimated from a sample of pedigrees, 0.01. Socially prescribed inbreeding avoidance substantially lowered total F through negative nonrandom inbreeding. Even in the situation of genetic isolation and small effective population size (N(e)), estimated inbreeding is lower than may have otherwise occurred if inbreeding were only random. However, among the poorest individuals, socially prescribed jural rules for inbreeding avoidance failed to operate. Thus the preponderance of inbreeding appears to occur among the poor, economically disadvantaged in the community.

Defines data mining as the extraction of potentially useful information from large databases. Shows how data mining can be applied to detecting anomalous behaviour in American agriculture and thus support the Risk Protection Agency in its compliance mission to detect fraud in crop insurance, using corn as the crop studied and percentage of acres harvested as the key indicator for “proof of concept”. Indicates potential areas of improvement, such as the development of a single data warehouse, and the role of social scientists with knowledge of data analysis and agricultural management. Concludes that data mining could be more effective than the current technique of random selection for investigation of individual entities.

To evaluate secular changes in height, sitting height and estimated leg length between 1968 and 2000 in residents in a rural Zapotec-speaking community in Oaxaca, southern Mexico.Height and sitting height were measured in school children 6-13 years (1968; 1978, 2000), in adolescents 13-17 years (1978, 2002) and adults 19-29 years (1978, 2000). Leg length was estimated as height minus sitting height. The sitting height/ height ratio was calculated. Subjects were grouped by sex into four age categories: 6-9, 10-13, 13-17 and 19-29 years for analysis. The Preece-Baines Model I growth curve was fitted to cross-sectional means for 1978 and 2000.There were no differences between children 6-9 and 10-13 years in 1968 and 1978 with the exception of the sitting height ratio in girls 6-9 years. Children of both sexes 6-13 years and adolescent boys 13-17 years were significantly larger in the three dimensions in 2000 compared to 1978; adolescent girls differed only in height and sitting height. Adult males in 2000 were significantly taller with longer legs than those in 1978, but the samples did not differ in sitting height and the ratio. Adult females in 1978 and 2000 did not differ significantly in the three dimensions. Rates of secular change in height and sitting height between 1978 and 2000 were reasonably similar in the three age groups of male children and adolescents, but the rate for estimated leg length was highest in 10-13-year-old boys. Secular gains were smaller in adult males, but were proportionally greater in estimated leg length. Girls 6-9 and 10-13 years experienced greater secular gains in height, sitting height and estimated leg length than adolescent and young adult females, while secular gains and rates decreased from adolescent girls to young adult women. Ages of peak velocity for height, sitting height and estimated leg length declined in boys, while only ages of peak velocity for height and estimated leg length declined in girls.There are major secular increases in height, sitting height and estimated leg length of children and adolescents of both sexes since 1978. Secular gains in height are of similar magnitude in boys and girls 6-13 years, but are greater in adolescent and young adult males than females. The secular increase in height of young adults of both sexes is smaller than that among adolescents. Estimated leg length accounts for about 60% of the secular increase in height in children of both sexes. Estimated leg length and sitting height contribute equally to the secular increase in height in adolescent boys, whereas estimated leg length accounts for about 70% of the secular increase in height in young adult males. Sitting height contributes about two-thirds of the secular increase in height in adolescent and young adult females.

Predicting Responses to Drought The U.S. Corn Belt accounts for a sizeable portion of the world's maize growth. Various influences have increased yields over the years. Lobell et al. (p. 516 ; see the Perspective by Ort and Long ) now show that sensitivity to drought has been increasing as well. It seems that as plants have been bred for increased yield under ideal conditions, the plants become more sensitive to non-ideal conditions. A key factor may be the planting density. Although today's maize varieties are more robust to crowding and the farmer can get more plants in per field, this same crowding takes a toll when water resources are limited.

An abnormal ankle-brachial index (ABI) is associated with higher risk for future cardiovascular (CV) events; however, it is unknown whether this association is true in patients with established coronary artery disease (CAD) and associated diabetes mellitus (DM). We evaluated 679 patients with stable CAD enrolled in the Excellence in Peripheral Arterial Disease and Veterans Affairs North Texas Healthcare System peripheral arterial disease databases. ABI and 12-month major adverse CV events (MACEs, a composite of all-cause death, nonfatal myocardial infarction, need for repeat coronary revascularization, and ischemic stroke) were assessed. Cox proportional hazard models were used to assess the association of ABI and DM with subsequent CV events. An abnormal ABI (0.9 or1.4) was present in 72% of patients with stable CAD and 68% had DM. Using patients without DM and normal ABI as reference, the adjusted hazard ratio for 12-month MACE was 1.7 (95% confidence interval [CI] 0.71 to 4.06) for patients with DM and normal ABI; 2.03 (95% CI 0.83 to 4.9) for patients without DM with abnormal ABI; and 4.85 (95% CI 2.22 to 10.61) for patients with DM and abnormal ABI. In conclusion, in patients with stable CAD, an abnormal ABI confers an incremental risk of MACE in addition to DM and traditional CV risk factors.

Studies on the long-term developmental effects of in utero cocaine exposure are few and the small number of studies published do not consider the postnatal environment. The present investigation was con- ducted to quantify the role that postnatal environment played compared to prenatal exposure. Four groups of 25 infants, each assessed at 12 months of age, were included in the study design: 1) noncocaine-exposed children re- siding with their biological parents in low socioeconomic environments, 2) cocaine-exposed children living with their biological parents in low socioeco- nomic environments, 3) noncocaine-exposed children adopted at birth in middle to upper-middle socioeconomic environments, and 4) cocaine-exposed children adopted at birth. Infants were assessed by the Uzgiris-Hunt Ordinal Scales of Infant Psychological Development, the Fagan Test of Infant Intel- ligence, and the Infant Monitoring Questionnaire. Height and head circum- ference were measured. Gender and ethnicity were controlled statistically. Significant differences were found in cognitive functioning, in fine motor development, and in physical growth between control and prenatally cocaine- exposed children. Adoption enhanced cognitive functioning and fine motor skills among infants not exposed to cocaine prenatally, but had no apparent effect on infants prenatally exposed to cocaine. Am. J. Hum. Biol. 12:417-428, 2000. © 2000 Wiley-Liss, Inc.

Lithium is used as a primary treatment or augmentation therapy for several psychiatric conditions, such as bipolar depression, mania and unipolar depression. For many patients with bipolar disorder, it is the most effective mood stabiliser.More than half of the patients maintained on lithium are women, and many are of reproductive age. An unknown proportion of women who are receiving lithium maintenance therapy become pregnant, posing numerous clinical issues for the obstetrician, psychiatrist and patient. The specific problems associated with lithium exposure vary during different stages of gestation. The risk of the serious heart defect, Ebstein's anomaly, exists if the drug is taken during weeks 2 to 6 post-conception; risks of fetal/neonatal complications occur if lithium is taken during the second and third trimesters.Given the effects of lithium on the conceptus, potentially safer alternatives may be required. The best case scenario is to counsel fecund women who require lithium to plan pregnancy, allowing for a temporary change in treatment regimen during the period of embryogenesis. If lithium therapy is reinstituted during the second and third trimesters, fetal monitoring for altered renal and endocrine function is important. Lithium requirements usually increase in the third trimester, but should be decreased in the peripartum period to avoid drug toxicity in the neonate and mother. Ultimately, the risk/benefit considerations must guide clinicians and patients in the decision to use lithium during pregnancy.

Objective. To evaluate change in body mass index (BMI) and weight status of indigenous youth in Oaxaca between the 1970s and 2007. Materials and methods. Heights and weights were measured in cross-sectional samples of school children 6-14 years in the 1970s (2 897) and 2007 (4 305); BMI was calculated. International Obesity Task Force cutoffs for weight status were used. BMI and prevalence of severe and moderate thinness, overweight and obesity were compared by year. Results. BMI increased significantly across time. Primary change in weight status occurred in overweight, 1970s

To compare the prevalence of thinness, overweight and obesity with IOTF and WHO criteria among indigenous school youth from the state of Oaxaca, southern Mexico.The sample included 11 454 indigenous youth (6216 boys, 5238 girls) 6-14 years of age. Heights and weights were measured in 2007 by trained staff. BMIs were calculated and classified as severely thin, moderately thin, normal, overweight or obese using age- and sex-specific IOTF and WHO cut-offs. Prevalence, percentage agreement between classifications, Spearman rank order correlations and Kappa coefficients were calculated.Prevalence of overweight and obesity was higher with WHO than IOTF criteria, while prevalence of severe and moderate thinness did not appreciably differ between criteria. Weight status with the two criteria was discordant in 839 boys (13.5%) and 383 girls (7.3%) and more often for overweight and obesity than thinness. Percentage agreement, correlations and Kappa coefficients were moderate-to-high and were higher in girls than boys.Prevalence of overweight and obesity among indigenous youth in Oaxaca was higher with WHO than IOTF criteria, whereas prevalence of severe and moderate thinness was similar. Differences in estimates for overweight and obesity have implications for surveillance.

It was suggested that a "fetal cocaine syndrome" exists. The objective of this study was to systematically investigate whether or not a "cocaine syndrome" exists. The setting was Parkland Memorial Hospital, a large urban public hospital in Dallas, TX, where approximately 15,000 infants are delivered annually. Infants who tested positive by urinalysis for cocaine (n = 25) were included in this study. Controls negative for cocaine (n = 25) were matched to cocaine-exposed infants for estimated gestational age, sex, and race. A standardized dysmorphology examination (135 features) and a series of anthropometric measures (n = 22) were done for each cocaine-exposed and control infant by an observer blinded to drug-exposure status. Fetal growth retardation characterized cocaine-exposed infants. No characteristic pattern of minor dysmorphic or anthropometric features of the face, limbs, or torso was observed among cocaine-exposed infants. Cocaine-exposed infants lack a facial gestalt or torso/limb features that would characterize a syndrome. If a "cocaine syndrome" that can be characterized dysmorphologically and/or anthropometrically exists, its occurrence seems infrequent.

Background: Presence of epicardial coronary artery chronic total occlusion (CTO) predicts higher referral rates for coronary bypass graft surgery (CABG). However, the impact of coronary artery CTO on CABG outcomes has never been systematically studied. Method: We examined one-year outcomes in 605 consecutive Veterans, discharged post-CABG between June 2005 and December 2008. Results: A coronary CTO was present in 256 patients (42%), predominantly (48.3%) in the right coronary artery distribution. Baseline clinical characteristics and medical therapy were similar in patients with and without a coronary CTO. A single CTO was present in 73.8%, and 26.2% patients had multiple CTO. All left anterior descending coronary artery CTO were successfully bypassed, as were >92% in left circumflex and right coronary arteries and 85% CTO in multiple coronary artery distributions. During the mean follow-up of 348.9 ± 4.5 days, incidence of all-cause death and myocardial infarction were similar in both groups (7.1% in CTO group and 7.4% in non-CTO group; p = 0.97). CTO >20 mm in length constituted 74.9% and >40 mm 37.8%. One-year survival post-CABG was significantly lower in patients with CTO lengths >40 mm compared to ≤20 mm (p = 0.04). CTO >40 mm was an independent predictor of post-CABG mortality controlling for age, number of CTO, comorbid diseases, clopidogrel use, severity of coronary artery disease, renal failure, and left ventricular ejection fraction. Conclusion: CABG achieves high success in grafting epicardial coronary vessels with CTO; however, presence of long coronary CTO (>40 mm) is an independent predictor of post-CABG survival. (J Card Surg 2012;27:662-667)

Objective. To determine whether the incidence of neurosonographic and neurologic abnormalities is higher in cocaine-exposed infants at birth. Methods. In utero exposure to cocaine was investigated in 39 term and near-term infants with positive urine screens for cocaine only and 39 matched control infants without drug exposure admitted to the regular term newborn nursery. Serial evaluations were performed on each infant on postnatal days 1 and 2 and included a cranial sonogram, a neurologic and behavioral assessment for drug withdrawal, and Doppler interrogation of the anterior and middle cerebral arteries. Results. There were no differences between groups in neurosonographic abnormalities. Grade I or II intraventricular hemorrhage occurred in 11% of cocaine-exposed and 11% of control infants. There were no cases of grade III intraventricular hemorrhage, cystic periventricular leukomalacia, or neonatal stroke. Head size was smaller in cocaine-exposed infants, ie, 32.7 ± 0.1 cm versus 33.8 ± 0.1 cm. The neurologic examination was similar between groups with regard to tone, reflexes, and cranial nerves. Behavioral scores were higher on both days, in cocaine-exposed versus control infants, ie, 4.4 ± 0.5 versus 2.7 ± 0.3 on day 1 and 5.0 ± 0.5 versus 1.71 ± 0.31 on day 2. Cerebral blood flow velocity measurements in the anterior cerebral artery were similar between groups on both days of examination. However, cocaine-exposed infants demonstrated a significant increase in flow velocity from day 1 to day 2, ie, 0.48 ± 0.03 to 0.57 ± 0.04. There was a concomitant decrease in the pulsatility index from day 1 to day 2 in the cocaine-exposed, ie, 0.74 ± 0.02 to 0.69 ± 0.02, but not in the control infants. No differences were noted in the flow velocities in the middle cerebral arteries between groups. Conclusions. Term and near-term infants admitted to a regular nursery who are exposed to cocaine in utero: (1) do not exhibit an increased incidence of neurosonographic abnormalities; (2) do exhibit altered behavior consistent with drug withdrawal; and (3) do demonstrate changes in flow velocity in the anterior cerebral artery consistent with the vasoconstrictive effects of the drug. However, these changes were not accompanied by changes in the neurologic examination or altered care. The long-term neurodevelopmental implications of these subtle abnormalities in the neonatal period remain to be determined.