Lower C-reactive protein and IL-6 associated with vegetarian diets are mediated by BMI

BACKGROUND AND AIMS

The mechanism by which vegetarian diets are associated with less inflammation is not clear. We investigated the role of BMI as a mediator in the relationship between vegetarian diet and concentrations of C-reactive protein (CRP), and the cytokines IL-6, IL-10 and TNF-α.

METHODS AND RESULTS

We used data from participants of the Adventist Health Study 2 (AHS-2) Calibration (n = 893) and Biological Manifestations of Religion (n = 478) sub-studies. Vegetarian diet variations were determined based on reported intake of animal products assessed by FFQ. Combining all participants, the proportion of non-vegetarians (NVs), partial vegetarians (PVs), lacto-ovo vegetarians (LOVs), and strict vegetarians (SVs) was 44%, 16%, 31%, and 9%, respectively. NV and PV participants were older than other dietary groups, and non-vegetarians had the highest BMI. Mediation analyses supported the mediating effect of BMI in associations of vegetarian diet with CRP (p < 0.001 each for PV, LOV and SV), and with IL-6 (p < 0.05 each for PV, LOV and SV). Mediation by BMI was not evident between vegetarian diet and the biomarkers IL-10 and TNF-α. A direct pathway was significant only in the association between strict vegetarians and CRP (p = 0.017).

CONCLUSION

The lower CRP and IL-6 concentrations among vegetarians may be mediated by BMI.

New Algorithms for Global Optimization and Reaction Path Determination

We present new schemes to improve the convergence of an important global optimization problem and to determine reaction pathways (RPs) between identified minima. Those methods have been implemented into the CAST program (Conformational Analysis and Search Tool). The first part of this chapter shows how to improve convergence of the Monte Carlo with minimization (MCM, also known as Basin Hopping) method when applied to optimize water clusters or aqueous solvation shells using a simple model. Since the random movement on the potential energy surface (PES) is an integral part of MCM, we propose to employ a hydrogen bonding-based algorithm for its improvement. We show comparisons of the results obtained for random dihedral and for the proposed random, rigid-body water molecule movement, giving evidence that a specific adaption of the distortion process greatly improves the convergence of the method. The second part is about the determination of RPs in clusters between conformational arrangements and for reactions. Besides standard approaches like the nudged elastic band method, we want to focus on a new algorithm developed especially for global reaction path search called Pathopt. We started with argon clusters, a typical benchmark system, which possess a flat PES, then stepwise increase the magnitude and directionality of interactions. Therefore, we calculated pathways for a water cluster and characterize them by frequency calculations. Within our calculations, we were able to show that beneath local pathways also additional pathways can be found which possess additional features.

A Cumulative Risk Factor Model for Early Identification of Academic Difficulties in Premature and Low Birth Weight Infants

OBJECTIVES

Premature and low birth weight children have a high prevalence of academic difficulties. This study examines a model comprised of cumulative risk factors that allows early identification of these difficulties.

METHODS

This is a secondary analysis of data from a large cohort of premature (<37 weeks gestation) and LBW (<2500 g) children. The study subjects were 8 years of age and 494 had data available for reading achievement and 469 for mathematics. Potential predictor variables were categorized into 4 domains: sociodemographic, neonatal, maternal mental health and early childhood (ages 3 and 5). Regression analysis was used to create a model to predict reading and mathematics scores.

RESULTS

Variables from all domains were significant in the model, predicting low achievement scores in reading (R (2) of 0.49, model p-value < .0001) and mathematics (R (2) of 0.44, model p-value < .0001). Significant risk factors for lower reading scores, were: lower maternal education and income, and Black or Hispanic race (sociodemographic); lower birth weight and male gender (neonatal); lower maternal responsivity (maternal mental health); lower intelligence, visual-motor skill and higher behavioral disturbance scores (early childhood). Lower mathematics scores were predicted by lower maternal education, income and age and Black or Hispanic race (sociodemographic); lower birth weight and higher head circumference (neonatal); lower maternal responsivity (maternal mental health); lower intelligence, visual-motor skill and higher behavioral disturbance scores (early childhood).

CONCLUSIONS

Sequential early childhood risk factors in premature and LBW children lead to a cumulative risk for academic difficulties and can be used for early identification.

Delta-aminolevulinic acid dehydratase polymorphism and the relation between low level lead exposure and the Mini-Mental Status Examination in older men: the Normative Aging Study

OBJECTIVE

To determine whether a polymorphism the in delta-aminolevulinic acid dehydratase (ALAD) gene modifies the neurotoxicity of lead in older adults.

METHODS

The authors studied men participating in the Department of Veterans Affairs' Normative Aging Study, assessing their recent exposure to lead by measuring blood lead (n = 915) at each triennial clinic visit, and, beginning in 1991, assessing their cumulative exposure by measuring lead levels in tibia (n = 722) and patella (n = 720), using K-shell x ray fluorescence. Starting in 1993 and again at each triennial visit, the authors administered the Mini-Mental State Examination (MMSE) to assess their cognitive functioning. The relation of the lead biomarkers to MMSE score was evaluated and this association was compared among men who carried the variant allele, ALAD-2, versus men without the allele.

RESULTS

Sixteen per cent of men carried the ALAD-2 allele. Median tibia and patella lead levels (first-third quartile) were 19 (13-28) and 27 (18-39) microg/g. Blood lead levels were consistent with non-occupational exposure: only 6% of men had levels > or =10 microg/dl. In multivariable adjusted analyses, higher levels of blood lead were associated with poorer performance on the MMSE. This association was most pronounced among ALAD-2 carriers, among whom a 3 microg/dl increment in blood lead (the interquartile range) was associated with a 0.26 point lower mean MMSE score (95% CI -0.54 to 0.01), compared with a 0.04 point lower score (95% CI -0.16 to 0.07) among non-carriers. The modest 0.22 point difference in these associations did not attain statistical significance, however (p(interaction) = 0.13). The associations between bone lead levels and MMSE score did not vary by ALAD-2 status.

CONCLUSIONS

Although not statistically significant, these findings suggest that ALAD genotype may modify blood lead's adverse association with cognition among older men who had community exposures to lead. However, despite a relatively large sample size and the use of sensitive methods for measuring lead burden, the evidence overall was fairly weak.

Children with adequate academic achievement scores referred for evaluation of school difficulties: information processing deficiencies

Children (7-11 years old) with standardized academic achievement test scores in the normal range referred for evaluation of learning problems were compared to low-achieving children matched for age, sex, and nonverbal cognitive ability, and to children with no known history of learning difficulty matched for age, sex, and reading (all N = 65) on a battery of computerized tasks of nonverbal information processing. The normally achieving referred children performed similarly to the low-achieving group but worse than reading-matched nonreferred counterparts. These findings suggest that children who struggle in school yet perform adequately on standardized achievement measures can have heightened neurodevelopmental vulnerability. Implications are discussed with respect to the underlying substrate of learning disabilities, as well as their diagnosis, classification, and remediation.

Studies of lead exposure and the developing central nervous system: a reply to Kaufman

Kaufman's critique of the lead-cognition hypothesis is a reiteration of well worn and weary claims raised many times in the past, primarily by spokespersons for the lead industry. They have been fully rebutted in the literature. The essence of these claims is that those studies showing an association between lead and IQ are flawed by uncontrolled confounding, multiple comparisons, and errors in measurement. Any effect of lead, Kaufman asserts, if present, is small. This response examines each of these issues and shows that they lack substance. Lead's negative impact on IQ persists in most modern studies after confounding has been controlled in many different statistical models. At least three metaanalyses have confirmed an effect of lead at low dose. Animal studies in which lead is given systematically, and the issue of confounding thereby avoided, demonstrate an unequivocal lead effect at similar doses to the human studies. The criticism of multiple comparisons similarly does not withstand examination. Measurement errors are nonsystematic and nondifferential. They are, therefore, null biasing. The actual size of the lead effect has been shown to be substantial, and to be found most prominently at the ends of the distribution. Kaufman says that lead requires study of diverse dimensions of intellect, but he restricts his scope to a sample of studies of lead and IQ, ignoring recent high quality studies that show a clear lead effect, and in those studies that he critiques he ignores data that contradict his position. His article adds nothing to the dialogue on lead neurotoxicity.

Processing of rapid auditory stimuli in school-age children referred for evaluation of learning disorders

Tallal hypothesized that reading disabled children have a domain-general deficit in processing rapidly occurring auditory stimuli that degrades speech perception, thereby limiting phonologic awareness and thus reading acquisition. She predicted they would be disproportionately affected by rapidly presented auditory stimuli. In this study, one hundred 7- to 11-year-old children with learning impairment (LI) and 243 non-learning impaired (NLI) children were evaluated on a two-tone auditory discrimination paradigm. LI committed more errors, but effects of timing were comparable. The same result was obtained for a subsample of good and poor readers. Task performance predicted reading, spelling, and calculation. Neural processes underlying perception of speech and other auditory stimuli may be less effective in poor readers; however, contrary to Tallal's hypothesis, rate may not be specifically affected.

Cognitive tests: interpretation for neurotoxicity? (Workshop summary)

The appropriate use and interpretation of cognitive tests presents important challenges to the toxicologist and to the risk assessor. For example, intelligence cannot be measured directly; rather intelligence is quantified indirectly by scoring responses (i.e., behaviors) to specific situations (problems). This workshop, "Cognitive Tests: Interpretation for Neurotoxicity?" provided an overview on the types of cognitive tests available and described approaches by which the validity of such tests can be assessed. Unlike many tools available to the toxicologist, cognitive tests have a particular advantage. Being noninvasive and species-neutral, the same test can be performed in different mammalian species. This enhances one's ability to assess the validity of test results. Criteria for test validity include comparable responses across species as well as similar disruption by the same neurotoxicant across species. Test batteries, such as the Operant Test Battery, have indicated remarkable similarity between monkeys and children with respect to performance of certain tasks involving, for example, short-term memory. Still, there is a need for caution in interpretation of such tests. In particular, cognitive tests, especially when performed in humans, are subject to confounding by a range of factors, including age, gender, and, in particular, education. Moreover, the ability of such tests to reflect intelligence must be considered. Certain aspects of intelligence, such as the ability to plan or carry out specific tasks, are not well reflected by many of the standard tests of cognition. Nonetheless, although still under development, cognitive tests do hold promise for reliably predicting neurotoxicity in humans.

Speed of information processing in children referred for learning problems: performance on a visual filtering test

Children referred for evaluation of learning impairment (LI, N =100) and a comparison group of nonreferred (NLI, N = 243) children were evaluated on a visual filtering task. The task was designed hierarchically to provide for evaluation of component operations-serial search, parallel search, decision, and response. With each additional processing demand, response times increased disproportionately for the LI group relative to the NLI group. Overall response time reliably predicted academic skills and cognitive ability, but was more strongly related to group membership. Thus, this nonverbal visual task is sensitive to a characteristic of children with learning problems over and above discrete academic and cognitive skills. Children with problems adapting to the demands of schooling may be distinguished by a disproportionate vulnerability to processing load.

Persistent expression of canine factor IX in hemophilia B canines

We previously demonstrated that direct intramuscular injection of recombinant adeno-associated virus (rAAV) carrying the human FIX (hFIX) cDNA can safely be administered to hemophilic B canines and express human factor IX protein; however, the functional activity of the hFIX protein could not be assessed due to anti-human FIX antibody (inhibitor) formation. To test the therapeutic efficacy of rAAV in hemophilic dogs, rAAV type 2 (rAAV2) carrying canine FIX (cFIX) cDNA was injected into the skeletal muscle of two dogs at doses of 1012-13particles. Circulating cFIX protein levels were maintained for 1 year at levels of 1-2% of normal. Hemostatic correction (WBCT and APTT) paralleled plasma FIX antigen levels. Both dogs still required plasma infusion for spontaneous and traumatic bleeding events. Inhibitors to cFIX protein were not detected in either animal by Bethesda assay. Neutralizing antibodies directed against AAV-2 capsid were pronounced and persistent. Vector DNA and mRNA transcripts were detected only at the injected skeletal muscle tissue. Analysis of both high and low molecular weight DNA identified both replicative episomal and integrated AAV species. These results demonstrate that persistent secretion of the FIX transgene protein, necessary for successful gene therapy of hemophilia B, can be achieved using the parvovirus-based rAAV vector

Mother and teacher reports of ADHD symptoms: DSM-IV Questionnaire data

OBJECTIVE

Diagnosis of attention-deficit/hyperactivity disorder (ADHD) is thought to be best accomplished by a multimodal approach. In many research and clinical settings, such extensive procedures may not be feasible. A screening instrument that could identify children meeting necessary (but not sufficient) criteria would permit selection of subgroups for more resource-intensive diagnostic procedures.

METHOD

The Diagnostic Rating Scale (DRS) was completed by the mothers and teachers of 124 children referred to hospital-based clinics and 225 nonreferred children. The authors performed principal components analysis (PCA) on the questionnaire, compared the scores obtained by children from the 2 samples, and examined age and gender effects. Diagnoses derived from the DRS were not validated against structured diagnostic interviews.

RESULTS

PCAs replicated the DSM-IV symptom combinations. Children from the referred sample exhibited more symptoms (p < .001) than children from the community sample. Boys were overrepresented among the children who received DRS-derived ADHD diagnoses. Girls were more likely (92%) to receive a diagnosis of ADHD, predominantly inattentive subtype, than other ADHD diagnoses.

CONCLUSIONS

The results of this study provide preliminary support for the validity of the parent and teacher DRS as time- and resource-efficient screening instruments for examining symptoms associated with ADHD.

Investigation of the possible associations between fluorosis, fluoride exposure, and childhood behavior problems

PURPOSE

This study investigated the potential association between fluoride exposure and behavior problems in children, as well as the prevalence of and risk factors for fluorosis.

METHODS

Children between the ages of 7 and 1 years (N = 197) were included in the study and were examined for dental fluorosis using the Modified Dean's Index. Parents of subjects completed and returned three questionnaires which investigated their children's history of exposures to fluoride, social and medical backgrounds, and behavior using the Child Behavior Checklist (CBCL).

RESULTS

Sixty-nine percent of the study participants demonstrated fluorosis with very mild fluorosis being the most common (39%), while 13% demonstrated moderate to severe fluorosis. Using a summation of the Modified Dean's index (Sum of 8), we divided the children into high fluorosis (HF) and low fluorosis (LF) groups. These groups were compared to each other with respect to fluoride exposures and behavior.

CONCLUSION

Although there was no association between the fluoride exposures in aggregate and fluorosis, there was a significant association between supplemental fluoride exposure from ages 0-3 years and fluorosis. There was no association between behavior problems and dental fluorosis in this population.

Residential lead-based-paint hazard remediation and soil lead abatement: their impact among children with mildly elevated blood lead levels

OBJECTIVES

This prospective study describes the impact of residential lead-based-paint hazard remediations on children with mildly elevated blood lead levels.

METHODS

Changes in blood lead levels were observed following paint hazard remediation alone and in combination with soil abatement.

RESULTS

After adjustment for the confounding variables paint hazard remediation alone was associated with a blood lead increase of 6.5 micrograms/dL (P = 0.5), and paint hazard remediation combined with soil abatement was associated with an increase of 0.9 microgram/dL (P = 36).

CONCLUSIONS

Lead-based-paint hazard remediation as performed in this study, is not an effective secondary prevention strategy among children with mildly elevated blood lead levels.

Norepinephrine content in primary and secondary lymphoid organs is altered in rats with adjuvant-induced arthritis

Chemical sympathectomy of secondary lymphoid organs with sparing of the hind limbs exacerbates adjuvant-induced arthritis (AA) in Lewis rats supporting a role for noradrenergic (NA) innervation of the immune system in AA pathology. The present study examines sympathetic innervation of lymphoid organs from Lewis rats 32 days after treatment with complete Freund's adjuvant (CFA) or vehicle using fluorescence histochemistry for localization of catecholamines (CA) and high-performance liquid chromatography with electrochemical detection (LCEC) for measurement for norepinephrine. The thymus from AA rats was significantly reduced in size, while secondary lymphoid organs, i.e., spleen and draining lymph nodes (DLN), were significantly enlarged compared with that seen in vehicle-treated controls. Fluorescence histochemistry revealed no apparent differences in the density of NA innervation, or the intensity of staining in sympathetic nerves in any of the secondary lymphoid organs from AA rats compared with that observed in control animals. However, there was an apparent increase in the density of NA nerve fibers in the thymus of AA rats. Norepinephrine (NE) concentration (pmol NE per g or mg wet weight), in the thymus from AA rats was significantly increased. Conversely, a significant decrease in splenic and lymph node NE concentration was measured in adjuvant-treated animals compared with that seen in vehicle-treated rats. Total NE content (pmol NE per whole organ weight) in lymphoid organs was not altered, except in popliteal lymph nodes (PLN), where it was increased. Collectively, our findings suggest that changes in NA innervation of lymphoid organs from AA rats result largely from increases or decreases in organ mass. Since NE released from NA nerves acts in a paracrine fashion, changes in lymphoid tissue volume that result from enhanced proliferation, migration, or cell death can make a significant difference in the availability of NE for interaction with immune target cells in these organs, even in the absence of a change in NE metabolism. Decreased thymic weight and increased spleen and lymph node weight should increase and decrease NE availability for interaction with target cells, respectively. Additionally, in PLN (a site where the highest concentration of antigen is encountered) an increase in total NE content suggests compensatory changes in NE metabolism.

Longitudinal relationship between dentin lead levels in childhood and bone lead levels in young adulthood

A retrospective cohort study was conducted to examine the relationship between tooth lead in children and bone lead levels in young adults. Members of a cohort of young adults were reassessed 13 y after initial examination at an ambulatory clinical research center. Dentin lead levels were measured by anodic stripping voltammetry during the years 1975-1978, and bone lead levels of the tibia and patella were measured by K-x-ray fluorescence technique during 1989 and 1990. A total of 63 subjects who had no history of chelation or had no missing information on potential confounders were studied. The median follow-up interval was 13.2 y. Dentin lead levels averaged 13.4 micrograms/g (standard deviation [SD] = 10.7 micrograms/g, range = 2.9-51.8 micrograms/g), and bone lead levels averaged 1.3 micrograms/g (SD = 4.4 micrograms/g, range = -9-13 micrograms/g) for tibia and 5.4 micrograms/g (SD = 8.4 micrograms/g, range = -10-25 micrograms/g) for patella. The authors controlled for age, sex, race, and mother's socioeconomic status, and dentin lead levels were predictive of higher tibia, patella, and mean bone lead levels in 32 subjects (follow-up interval of 11.8-13.2 y). A correction for measurement errors in dentin lead measurements was made, and it was determined that a 10-micrograms/g increase in dentin lead levels in childhood was predictive of a 1-microgram/g increase in tibia lead levels, a 5-micrograms/g increase in patella lead levels, and a 3-micrograms/g increase in mean bone lead levels among the young adults. It was concluded, therefore, that lead exposure in early life may be used to predict elevated body burden up to 13 y later.

Application of 6-hydroxydopamine into the fatpads surrounding the draining lymph nodes exacerbates adjuvant-induced arthritis

Adjuvant-induced arthritis (AA) was examined in Lewis rats following local injection of 6-hydroxydopamine (6-OHDA) into the fatpads of the popliteal and inguinal lymph nodes which drain the hindlimbs (DLN). This method of 6-OHDA treatment resulted in noradrenergic (NA) denervation of DLN, spleen, and other organs in the peritoneal cavity, while sparing NA nerve fibers in the hindlimbs. Sympathectomy exacerbated the inflammation and osteopathic destruction of arthritic joints. Significant increases in dorsoplantar width in arthritic rats following denervation were observed by day 27 following immunization compared to nondenervated arthritic animals. Radiographic evaluation on day 27 after immunization confirmed the inflammation of soft tissue and revealed deterioration of bones of the ankle joint in both AA groups compared with the control groups; more extensive joint damage was apparent in arthritic rats following denervation compared to nondenervated arthritic rats. These findings suggest that the NA innervation of DLN and spleen (and possibly other organs of the peritoneal cavity) plays a regulatory role in the expression of AA. These data supports the hypothesis that absence of NA innervation in lymphoid organs during initiation, onset, and progression of the disease results in exacerbation of AA.

Biologically based, quantitative risk assessment of neurotoxicants

The need for biologically based, quantitative risk assessment procedures for noncancer endpoints such as neurotoxicity has been discussed in reports by the United States Congress (Office of Technology Assessment, OTA), National Research Council (NRC), and a federal coordinating council. According to OTA, current attention and resources allocated to health risk assessment research are inadequate and not commensurate with its impact on public health and the economy. Methods to include continuous rather than dichotomous data for neurotoxicity endpoints, biomarkers of exposure and effects, and pharmacokinetic and mechanistic data have been proposed for neurotoxicity risk assessment but require further review and validation before acceptance. The purpose of this symposium was to examine procedures to enhance the risk assessment process for neurotoxicants and to discuss techniques to make the process more quantitative. Accordingly, a review of the currently used safety factor risk assessment approach for neurotoxicants is provided along with specific examples of how this process may be enhanced with the use of the benchmark dose approach. The importance of including physiologically based pharmacokinetic data in the risk assessment process and specific examples of this approach is presented for neurotoxicants. The role of biomarkers of exposure and effect and mechanistic information in the risk assessment process are also addressed. Finally, quantitative approaches with the use of continuous neurotoxicity data are demonstrated and the outcomes compared to those generated by currently used risk assessment procedures.

A longitudinal study of chronic lead exposure and physical growth in Boston children

We investigated the cross-sectional and longitudinal relationships between chronic exposure to lead and physical growth among a cohort of children reassessed 13 years after initial examination. We measured weight, height, and dentin lead levels of 270 children in 1975-78. In 1989-1990 we reexamined 79 of these children for measurement of weight, height, and bone lead levels by means of in vivo K X-ray fluorescence. To avoid potential confounding by race and chelation history, analysis was restricted to white subjects without a history of lead chelation therapy. A total of 236 subjects provided complete information for the study of cross-sectional relationship between dentin lead levels and changes in physical growth: 58 subjects for the study of longitudinal relationship between dentin lead levels and changes in physical growth and 54 subjects for the study of longitudinal relationship between bone lead levels and changes in physical growth. Dentin lead levels averaged 14.9 micrograms/g; tibia and patella lead levels averaged 1.2 and 5.0 micrograms/g, respectively. With control for potential confounders including age, sex, baseline body size, and mother's socioeconomic status, log10 dentin lead level was positively associated with body mass index as of 1975-1978 (beta = 1.02, p = 0.03) and increase in body mass index between 1975-78 and 1989-90 (beta = 2.65, p = 0.03). Bone lead levels were not significantly associated with physical growth. This is the first study relating chronic lead exposure to body mass index. The results suggest that chronic lead exposure in childhood may result in obesity that persists into adulthood.

Models of delayed recovery

After a biologic insult has impaired function of the developing central nervous system, recovery may not become apparent for years. Probability models adopted from the carcinogenesis, developmental neurobiology, learning decay, and stochastic process literatures are presented so that assumptions about apparent delays in the recovery process can be tested with data from longitudinal studies after a temporally circumscribed adverse event/exposure. This process of evaluating multiple models is exemplified with one data set. Nonlinear models of recovery are important because some children with early deficits first show improvement months to years later.

von Willebrand factor in plasma, platelets, and selected tissues of ferrets

By standard laboratory methods the presence and activity of von Willebrand factor (vWF) was detected and characterized in the ferret (Mustela putorius furo); vWF in plasma, platelets, and selected tissues (thoracic aorta, cranial vena cava, thoracic portion of caudal vena cava, and lung) was documented. Activity, antigenic concentration, plasma multimeric distribution, and localization within tissues were similar to those features in other species. Two differences were apparent: multimeric distribution of platelet vWF was skewed toward the smaller molecular weight multimers, and mucous goblet, but not ciliated, cells of the bronchial epithelium stained positive for vWF. Larger molecular weight multimers were not released subsequent to administration of 1-deamino-8-D-arginine-vasopressin. The ferret may be a useful animal model in studying the role of vWF in hemostasis, thrombosis, and atherosclerosis. In particular, the role of small molecular weight multimers found in ferret platelets may provide further insight into the roles of platelet vWF multimeric distribution, platelet adhesion, and thrombosis.

The impact of soil lead abatement on urban children's blood lead levels: phase II results from the Boston Lead-In-Soil Demonstration Project

The Boston Lead-In-Soil Demonstration Project was a randomized environmental intervention study of the impact of urban soil lead abatement on children's blood lead levels. Lead-contaminated soil abatement was associated with a modest reduction in children's blood lead levels in both phases of the project; however, the reduction in Phase II was somewhat greater than that in Phase I. The combined results from both phases suggest that a soil lead reduction of 2060 ppm is associated with a 2.25 to 2.70 micrograms/dl decline in blood lead levels. Low levels of soil recontamination 1 to 2 years following abatement indicate that the intervention is persistent, at least over the short-term. Furthermore, the intervention appears to benefit most children since no measurable differences in efficacy were observed for starting blood and soil lead level, race, neighborhood, gender, and many other characteristics. However, soil abatement did appear to be more beneficial to children in the higher socioeconomic classes, with low baseline ferritin levels, and who spent time away from home on a regular basis and lived in nonowner occupied housing, and with adults who had lead-related hobbies and almost always washed their hands before meals. Children who lived in apartments with consistently elevated floor dust lead loading levels derived almost no benefit from the soil abatement. It was not possible to separate the effects of the variables that had a beneficial impact on efficacy because they were closely correlated and the number of subjects was small. We recommend that further research be conducted to identify subgroups of children to whom soil lead abatement might be targeted.

Pre- and postnatal lead exposure and behavior problems in school-aged children

The association between early lead exposure and later problem behaviors was evaluated prospectively in a cohort of 8-year-old children born during a 12-month period at one hospital. Lead levels in umbilical cord blood (means = 6.8 micrograms/dl, SD = 3.1) and the dentin of a shed deciduous tooth (means = 3.4 micrograms/g, SD = 2.4) provided measures of prenatal and postnatal exposure, respectively. Ratings on the Teacher Report Form of the Child Behavior Profile provided information about children's problem behaviors. Cord blood lead level was not associated with the overall prevalence or nature of problem behaviors. In both crude and adjusted analyses, tooth lead level was significantly associated with total problem behavior scores (approximately 2 points in T score per log unit increase in tooth lead). Significant tooth lead-associated increases in both internalizing and externalizing scores were also observed (approximately 1.5 points in T score per log unit increase). Weaker associations were noted between tooth lead level and the prevalence of "extreme" problem behavior scores. The extent to which these associations reflect residual confounding is uncertain. These data suggest, however, that social and emotional dysfunctions are correlates and may be expressions of increased lead exposure.

In vivo hepatic gene therapy: complete albeit transient correction of factor IX deficiency in hemophilia B dogs

Hemophilia B is a bleeding disorder caused by mutations in the factor IX gene. The disorder is X-linked recessive with a prevalence of about 1 in 30,000 Caucasian males. Factor IX is naturally synthesized in the liver and secreted into blood. Here we report the construction of recombinant adenoviral vectors containing the canine factor IX cDNA that are capable of transducing hepatocytes in mice at high efficiencies in vivo without partial hepatectomy. The recombinant viral vector was used to treat hemophilia B dogs by direct vector infusion into the portal vasculature of deficient animals. Plasma factor IX concentrations in the treated hemophilia B dogs increased from 0 to 300% of the level present in normal dogs, resulting in complete amelioration of the disease as demonstrated by normal blood coagulation and hemostatic measurements. Although plasma factor IX concentration started to decline after a few days, therapeutic levels of factor IX persisted for 1-2 months in the treated animals. The results validate the principle of in vivo hepatic gene delivery to reconstitute the genetic deficiency in a large animal model and suggest that gene therapy is achievable when long-acting vectors are developed.

Attentional correlates of dentin and bone lead levels in adolescents

In an effort to determine whether specific aspects of attention are impaired by lead, the performance of 79 subjects (aged 19 and 20 y) on a neuropsychologically based battery of tests of attention was examined in relation to lead levels in deciduous teeth (dentin), current blood, and tibia and patella bones measured by K-X-ray fluorescence. Dentin lead levels averaged 14 micrograms/g. Most bone lead levels were less than 10 micrograms/g. Dentin lead levels were related inversely to scores on two of four attention factors: focus-execute (ability to select and respond to critical information) and shift (ability to shift focus adaptively). Few significant associations were observed between bone lead levels and performance. Five individuals with the ALA-D 1-2 isozyme phenotype tended to achieve more optimal scores. Executive and self-regulation functions may be among the cognitive skills targeted by lead.

Children with hypoplastic enamel defects of primary incisors are not at increased risk of learning-problem syndromes

Developmental enamel defects of primary teeth have been associated in earlier reports with motor, hearing and psychological disturbances. The relationship between hypoplastic enamel defects and learning problems had not been evaluated previously. For a total of 149 girls and 196 boys we collected a primary tooth shortly after shedding and approximately 2 years later a teacher-completed questionnaire about function in school. Children with a hypoplastic enamel defect of one of their primary incisors were no more likely than their peers without an enamel defect to have any of 7 different learning problem syndromes. In the absence of reason to suspect selection bias, confounding, or misclassification of hypoplastic defects or school problems, we conclude that hypoplastic enamel defects are not associated with teacher-identified learning problems.

Relationships between serial blood lead levels and exfoliated tooth dentin lead levels: models of tooth lead kinetics

Because bones and permanent teeth accumulate lead, exfoliated deciduous teeth have been utilized as retrospective markers of cumulative exposure in epidemiological surveys. In this paper we describe four models of lead uptake by the coronal dentin of shed primary teeth, each with different assumptions and ramifications. Each model is characterized by different relationships between blood lead at several ages and tooth lead. Values observed in our cohort of normal Boston children are most compatible with models positing the largest lead contribution coming at older ages (i.e., closer to age at exfoliation). Characteristics of models incompatible with our data include (1) lead deposition only during initial calcification and (2) no loss or resorption of lead.

The Boston Teacher Questionnaire. 3. A reassessment

The prevalence of different types of dysfunction in school was assessed with the Boston Teacher Questionnaire, completed for 1923 children born 8 years earlier in a university-affiliated maternity hospital. Cluster analyses of 15 items on the questionnaire resulted in six two-item clusters and one three-item cluster that were identical for girls and boys. We identified children as having a syndrome if they possessed all features of the cluster-defined syndrome. The most prevalent syndrome, consisting of both daydreaming and distractibility items, occurred in 18.5% of boys and 11.5% of girls. Boys were also more likely than girls to be identified as having the reading syndrome (11.6% and 7.7%, respectively), the hyperactivity/impulsivity syndrome (6.1% and 1.5%), and the syndrome characterized by frustration intolerance and peer problems (9.5% and 4.0%). The prevalences of the remaining three syndromes were similar in both sexes (arithmetic, 11.3% and 10.3%; difficulty following instructions, 5.1% and 4.7%; and the tasks syndrome [characterized by impersistence/dependence/inflexibility], 5.5% and 5.4%). More than 40% of boys and girls with one syndrome also had another. The lower prevalences in this sample than in an earlier-born sample assessed with the same instrument were confined to boys. Reasons for this temporal decrease in one sex only remain obscure. Girls with the reading syndrome were 10 times more likely, and boys with the reading syndrome were five times more likely, than their peers to receive special services and to have repeated a grade.

Pre- and postnatal low-level lead exposure and children's dysfunction in school

The contributions of pre- and postnatal low-level lead exposures to the risk of learning problems were evaluated among 1923 children who were born in one Boston hospital in 1979-1980 and followed to age 8 years. In this relatively privileged group, more than 20% of the children had a mother with some formal postgraduate education. Prenatal lead exposure was estimated with a measurement of umbilical cord blood lead content, and postnatal lead exposure was approximated with measurement of lead in the dentin of an exfoliated deciduous tooth. Information about potential confounders and effect modifiers was obtained from maternal interview shortly after delivery and from a mailed questionnaire completed and returned when the child was approximately 6 years old. An assessment of each child's function in school was provided by the teacher, who completed a questionnaire near the end of the school year in which the child reached the age of 8 years. We considered a learning problem to be related to lead exposure if its adjusted prevalence increased with each loge increase in lead, and if the adjusted prevalence was elevated among children with high levels (i.e., approximating the highest decile) of umbilical cord blood lead (i.e., > or = 10 micrograms/dl) or dentin lead (i.e., > or = 5 micrograms/g). Girls with elevated umbilical cord blood lead levels were more likely than their peers to be dependent and inpersistent and to display an inflexible and inappropriate approach to tasks (defined as the "tasks" cluster). Boys with elevated umbilical cord blood lead levels were more likely than others to have difficulty with both simple directions and sequences of directions. Among girls, elevated deciduous tooth dentin lead content was associated with reading and spelling difficulties, the tasks cluster, and with "not functioning as well as peers." Elevated dentin lead levels were not overrepresented among boys with any of the assessed learning clusters. These findings are consistent with the inference that lead levels still prevalent among children (i.e., blood < 15 micrograms/dl) are associated with some learning problems in girls.

Cell proliferation in breast carcinoma assessed by a PCNA grading system and its relation to other prognostic variables

This study was undertaken to relate the expression of the proliferating cell nuclear antigen (PCNA), a proliferation marker of putative prognostic significance, to some more established prognostic factors in a series of 60 consecutive breast cancer surgical specimens. PCNA was detected by the PC10 monoclonal antibody (MAb) using an immunohistochemical method and PCNA immunostaining was estimated on a semiquantitative basis, a cut-off value of 50% of positively stained tumour cells discriminating between the high (> 50%) and low (< 50%) PCNA grade. The PCNA grade did not correlate with tumour size and axillary node status. However, a high PCNA grade tended to be associated with a poor histological grade and there was an inverse relationship with oestrogen-receptor status, as determined by means of the immuno-histochemical staining for the oestrogen-induced pS2 protein. These conflicting results suggest that the possible prognostic usefulness of PCNA immunostaining, as a measure of cell proliferation rate, in breast cancer is yet to be demonstrated and can be validated only by direct relation to survival data.

Antecedents and correlates of hypoplastic enamel defects of primary incisors

Four hundred and fifty-five exfoliated primary incisors were obtained from children whose mothers provided information about a wide range of pre-, peri-, and postnatal characteristics of both the mother and child. These teeth then were examined for the presence of hypoplastic enamel defects (HED). The basic form of the null hypothesis tested was that children who had HED of a primary incisor did not differ from those who did not have such a defect. Of the primary incisors examined, 18.5% had HED (25.0% maxillary and 10.1% mandibular). The following items were found to be associated most strongly (P less than 0.003) with an increase in a child's risk of developing HED; 1) maternal antenatal history of smoking, higher prepregnancy weight, and failure to obtain prenatal care during the first trimester; 2) prematurity, low birth-weight and their associated correlates; and 3) postnatal measles infection. Left-handedness, maternal tea and Tylenol (McNeil Consumer Products Co., Fort Washington, PA) consumption, and failure to screen for undue lead burden were associated less prominently (P less than 0.05) with HED prevalence. Season of birth and serum and dentin lead levels were not related to the prevalence of HED. Many of these risk factors are also covariates of low socioeconomic status such as suboptimal nutrition and increased risk of infection. Additional investigation is needed to delineate the associations between specific pre- and perinatal nutritional and infectious factors, socioeconomic status, and HED development.

Pre-natal blood lead levels and learning difficulties in children: an analysis of non-randomly missing categorical data

This paper presents an analysis of categorical variables subject to non-response. We incorporate the incomplete data into the analysis by modelling the distribution of the variables of interest and the non-response mechanism. We discuss issues of model selection and interpretation and the effect of discarding incomplete observations. In addition, we describe how to perform all of the computations with standard statistical software. We discuss the problem of incomplete categorical data within the context of a study of the effect of lead exposure on learning difficulties in children. In this study, many of the children are not observed on some of the variables of interest. It is particularly important in this study to incorporate the incomplete data, since there is evidence that non-response is related to the variables of interest. We reach different conclusions when we incorporate the incomplete data into the analysis than we reach when we discard the incomplete data. We also examine the sensitivity of our conclusions to the choice of a model for the non-response mechanism.

Low-level lead exposure and children's cognitive function in the preschool years

In a cohort of 170 middle and upper-middle class children participating in a prospective study of child development and low-level lead exposure, higher blood lead levels at age 24 months were associated with lower scores at age 57 months on the McCarthy Scales of Children's Abilities. The mean blood lead level at age 24 months was 6.8 micrograms/dL (SD = 6.3; 75th, 90th, and 99th percentiles: 8.8, 13.7, 23.6, respectively) and for all but 1 child was less than 25 micrograms/dL, the current definition of an "elevated" level. After adjustment for confounding, scores on the General Cognitive Index decreased approximately 3 points (SE = 1.4) for each natural log unit increase in 24-month blood lead level. The inverse association between lead level and performance was especially prominent for visual-spatial and visual-motor integration skills. Higher prenatal exposures were not associated with lower scores at 57 months except in the subgroup of children with "high" concurrent blood lead levels (ie, greater than or equal to 10 micrograms/dL). The concentration of lead in the dentine of shed deciduous teeth was not significantly associated with children's performance after adjustment for confounding.

Antecedents and correlates of improved cognitive performance in children exposed in utero to low levels of lead

Up to 2 years of age, children with umbilical cord blood lead levels of 10 to 25 micrograms/dL achieve significantly lower scores on tests of cognitive development than do children with lower prenatal exposures. By age 5 years, however, they appear to have recovered from, or at least compensated for, this early insult. Change in performance between 24 and 57 months of age was examined in relation to level of postnatal lead exposure and various sociodemographic factors. Among children with high prenatal lead exposure, greater recovery of function was associated with lower blood level at 57 months, higher socioeconomic status, higher Home Observation for Measurement of the Environment scores, higher maternal IQ, and female gender. The difference between the scores at 57 months of children with optimal and less optimal values on these variables generally exceed 1/2 standard deviation. Higher prenatal lead exposure is associated with an increased risk of early cognitive deficit. Furthermore, the risk that a deficit will persist through the preschool years is increased among children with high prenatal exposure and either high postnatal exposure or less optimal sociodemographic characteristics.

Coronary atherosclerosis in the pig. Induced plaque injury and platelet response

The thrombogenic potential of atherosclerotic diet-induced coronary atherosclerotic plaques was investigated in normal swine and in bleeder swine with homozygous von Willebrand disease. Fourteen paired normal and bleeder swine were placed on a 1% cholesterol diet for 1 to 16 weeks. Serum cholesterol was elevated in all animals at sacrifice. Foam cell deposits developed in all major epicardial coronary arteries, and lesions progressed over time from small subendothelial foam cell deposits to fibrous cap lesions that contained foam cells, elastic fibers, collagen, degenerative material, and smooth muscle cells. Balloon catheter injury resulted in platelet deposition, largely in a monolayer or as small platelet clumps devoid of fibrin. Lipid debris was present in injured areas of the subendothelium but did not induce thrombus formation. When the injury involved the media, platelet-fibrin thrombi were formed. Lipid was not present in these thrombi. Morphometric analysis of platelet deposition on ballooned atherosclerotic vessels showed similar numbers of platelets in both phenotypes. However, the attached platelets in bleeder pigs showed significantly less spreading than did those in the normal animals. The results show that injury to intimal foam cell and mixed cellular lesions in coronary arteries of cholesterol-fed swine does not promote the development of platelet-fibrin thrombus formation. In contrast, when the injury extended to the media, mixed thrombi were formed.

The long-term effects of exposure to low doses of lead in childhood. An 11-year follow-up report

To determine whether the effects of low-level lead exposure persist, we reexamined 132 of 270 young adults who had initially been studied as primary school-children in 1975 through 1978. In the earlier study, neurobehavioral functioning was found to be inversely related to dentin lead levels. As compared with those we restudied, the other 138 subjects had had somewhat higher lead levels on earlier analysis, as well as significantly lower IQ scores and poorer teachers' ratings of classroom behavior. When the 132 subjects were reexamined in 1988, impairment in neurobehavioral function was still found to be related to the lead content of teeth shed at the ages of six and seven. The young people with dentin lead levels greater than 20 ppm had a markedly higher risk of dropping out of high school (adjusted odds ratio, 7.4; 95 percent confidence interval, 1.4 to 40.7) and of having a reading disability (odds ratio, 5.8; 95 percent confidence interval, 1.7 to 19.7) as compared with those with dentin lead levels less than 10 ppm. Higher lead levels in childhood were also significantly associated with lower class standing in high school, increased absenteeism, lower vocabulary and grammatical-reasoning scores, poorer hand-eye coordination, longer reaction times, and slower finger tapping. No significant associations were found with the results of 10 other tests of neurobehavioral functioning. Lead levels were inversely related to self-reports of minor delinquent activity. We conclude that exposure to lead in childhood is associated with deficits in central nervous system functioning that persist into young adulthood.

Lead, IQ and social class

Social class (SC) conveys information about a child's potential lead exposure (PB) as well as other, independent determinants of cognition (IQ). Thus, depending on the way in which SC is handled in statistical analyses, the PB-IQ association may be either 'overadjusted' or 'underadjusted' for SC. Two assumptions that underlie the inclusion of SC in correlation/regression analyses of the PB-IQ relationship are: 1) SC is an interval scale and 2) the PB-IQ relationship is homogeneous in all social strata. Simulation analyses are presented to illustrate the impact that different values of the bivariate correlations PB-SC, IQ-SC, and PB-IQ have on the estimate of the PB-IQ adjusted for SC. Alternative approaches to addressing these issues are discussed.