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Biomedical subjects

H Choi

Publications and source records attributed to H Choi.

At least 91 records · Page 5Linked to original sources
PubMed2000

Telepathology networking in VISN-12 of the Veterans Health Administration.

The Veterans Integrated Service Network (VISN)-12, headquartered in Chicago, has implemented a telepathology network between the eight VISN-12 hospital laboratories and Loyola University Medical School linked by an economical, high-speed wide-area network (WAN). Implementation of the WAN has reduced monthly telecommunications costs in VISN-12 by approximately 67%. In addition to telepathology, the WAN enables real-time teleradiology (general, computer tomography, and ultrasound), telefluoroscopy, telenuclear medicine imaging, telepsychiatry, and other forms of teleconsultation. Current applications of telepathology in VISN-12 include: primary diagnosis and consultation in surgical pathology, interpretation of serum protein electrophoresis and immunofixation gels, provision of support for consolidated microbiology laboratories, review of problematic peripheral blood smears, and distance learning. We have learned a variety of lessons from telepathology. The enthusiasm and technical skill of providers are essential for success. As well, frequent communication and rapid technical support are necessary. Finally, in a supportive environment, telepathology is a tool that can help bring together clinical laboratories with shared missions and goals.

Computer Communication Networks↗
PubMed2000

Muscle forces and spinal loads at C4/5 level during isometric voluntary efforts.

PURPOSE: The goal of this study was to determine neck muscle forces and spinal loads that result from isometric muscle contractions. METHODS: Electromyographic (EMG) activity of the neck musculature and a three-dimensional biomechanical model of the neck were used. The model was EMG-based and estimated muscle forces and spinal loads at the C4/5 level. EMG signals were collected from eight sites at the C4/5 level of the neck using Ag-AgCl surface electrodes from 10 adult male subjects. The subjects performed isometric contractions gradually developing to maximum efforts in flexion, extension, left lateral bending, and right lateral bending. RESULTS: During maximum voluntary contraction (MVC) trials most muscles generated high levels of EMG signal during cervical rotation. The posterior surface of the neck (trapezius) was the only electrode site at which maximum activity EMG consistently occurred by the same method (rotation) in all subjects. Variations in the EMG patterns were observed in different experiments that produced overall neck moments of equal magnitudes. With these data the model computed variations in load distribution among the agonist muscles. Consistent also with EMG distributions, the model also computed co-contractions of antagonist muscles. The average (+/- SD) magnitudes of peak moments were 28.3 (+/- 3.3) Nm in extension, 17.7 (+/- 3.1) Nm in flexion, 16.9 (+/- 2.8) Nm in left lateral bending, and 17.0 (+/- 2.9) Nm in right lateral bending. The model predicted C4/5 joint compressive forces during peak moments were 1372 (+/- 140) N in extension, 1654 (+/- 308) N in flexion, 956 (+/- 169) N in left lateral bending, and 1065 (+/- 207) N in right lateral bending. CONCLUSIONS: Results suggest that higher C4/5 joint loads than previously reported are possible during maximum isometric muscle contractions.

Adult↗
PubMed2000

Modulation of liver microsomal monooxygenase system by dietary n-6/n-3 ratios in rat hepatocarcinogenesis.

This study was designed to determine the effects of dietary n-3/n-6 fatty acid ratios on preneoplastic foci and the microsomal monooxygenase system in rat hepatocarcinogenesis. Male Sprague-Dawley rats were fed four kinds of diets containing 15% (wt/wt) fat with different n-6/n-3 ratios: low ratio (> or = 1.0) with tuna oil, low ratio (> or = 1.0) with perilla oil, moderate ratio (< or = 4.0), and high ratio (< or = 10.0). Hepatocarcinogenesis was induced by diethylnitrosamine and partial hepatectomy. The moderate ratio diet decreased significantly the area and number of placental glutathione S-transferase-positive foci compared with the high ratio diet and low ratio diet with perilla oil. The fatty acid composition of microsomal membrane varied extensively, reflecting the dietary n-6/n-3 ratios. Liver microsomal lipid peroxidation was significantly decreased in the group fed the low ratio diet with tuna oil compared with the moderate and high ratio groups. Glucose-6-phosphatase activity, which reflects membrane stability, was significantly higher in the low ratio groups than in the high ratio group. The monooxygenase activities were increased significantly in the moderate ratio group compared with the high ratio group. These results suggest that a moderate n-6/n-3 ratio (< or = 4.0) may be the most effective in decreasing preneoplastic foci by elevating the monooxygenase activities and n-3 fatty acids in fish oil may have a protective effect by lowering the lipid peroxidation and stabilizing the microsomal membrane during rat hepatocarcinogenesis.

Animals↗
PubMed2000

Changes in gallbladder motility in gastrectomized patients.

OBJECTIVES: Gastric resection may predispose gallstone formation. However, the mechanism has not been clearly understood. To evaluate the relationship between gastric resection and gallstone formation, we compared gallbladder(GB) motility in gastrectomized patients and control subjects. METHODS: We compared the GB volume and ejection fraction of the 46 gastrectomized patients with 37 healthy controls using real time ultrasonography. RESULTS: GB volume increased significantly in the gastrectomized group in fasting (30.2 +/- 13.9 ml). The GB volume after a fatty meal was greater in the gastrectomized group (12.6 +/- 6.4 ml) than in the control group (4.3 +/- 3.3 ml) (p < 0.01). A significant reduction of ejection fraction was found in gastrectomized patients (56.9 +/- 13.0%) in comparison with the control group (75.5 +/- 16.1%) (p < 0.01). The GB ejection fraction had a poor correlation to the postoperative period (r = 0.232). CONCLUSION: A gastrectomy appears to be a risk factor of GB dysmotility, which may play a major role in gallstone formation in gastrectomized patients.

Adult↗
PubMed2000

Collagen-to-smooth muscle ratio helps prediction of prognosis after pyeloplasty.

PURPOSE: We quantitatively evaluated the collagen-to-smooth muscle tissue matrix ratio in ureteropelvic junction obstruction, and compared the ratio with the degree of obstruction, patient age and postoperative renal recovery. MATERIALS AND METHODS: We analyzed histological sections from 65 patients with ureteropelvic junction obstruction and 6 normal controls. Morphological and functional grading systems were adapted to determine the degree of renal obstruction. To examine smooth muscle and collagen tissue, sections were stained using Masson's trichrome. Two distinct populations of collagen versus smooth muscle were identified and the tissue matrix ratio was calculated by color image analysis. RESULTS: The mean tissue matrix ratio plus or minus standard deviation was 1.32+/-0.79 in all patients with ureteropelvic junction obstruction but only 0.30+/-0.10 in normal controls (p <0.0001). It appeared that the lower the tissue matrix ratio, the better the improvement in postoperative hydronephrosis (r = -0.50, p = 0.0001). Better recovery of renal function after pyeloplasty was observed with a decrease in the tissue matrix ratio (r = -0.43, p = 0.0004). We divided patients according to the tissue matrix ratio into groups 1--ratio 1 or less, 2--greater than 1 to 1.5 and 3--greater than 1.5 to determine a more detailed and clinically applicable correlation of tissue matrix ratio with postoperative renal functional changes. Better improvement in postoperative renal function was observed in group 1 than in group 3 (p = 0.002). Also, the tissue matrix ratio increased with patient age (r = 0.33, p = 0.007). CONCLUSIONS: Since our data represent an objective and quantitative parameter associated with ureteropelvic junction obstruction, we believe that our findings may help to predict the prognosis after pyeloplasty.

Child↗
PubMed1999

Effect of additives on the physicochemical properties of liquid suppository bases.

To investigate the effects of additives on the physicochemical properties of in situ gelling and mucoadhesive liquid suppository base, gelation temperature, gel strength and bioadhesive force of liquid suppository base, poloxamer 407 (P 407) and poloxamer 188 (P 188) (15/15%) were evaluated in the presence of following additives: solvent (ethanol, propylene glycol, glycerin), ionic strength-controlling agent (sodium chloride) and pH-controlling agent (hydrochloric acid, sodium monohydrogen phosphate, sodium dihydrogen phosphate). Among the additives studied, sodium chloride, sodium monohydrogen phosphate and sodium dihydrogen phosphate increased to a great extent the gel strength and the bioadhesive force of P 407/P 188 (15/15%) with a decrease in gelation temperature. Glycerin slightly decreased the gelation temperature and slightly increased the gel strength and bioadhesive force. However, the addition of 1% of sodium chloride, sodium monohydrogen phosphate or sodium dihydrogen phosphate caused a greater than 60-fold increase in gel strength and over a tenfold increase in bioadhesive force with 2-4 degrees C decrease of gelation temperature within optimal range, compared with P 407/P 188 (15/15%) alone. On the other hand, ethanol, propylene glycol and hydrochloric acid increased the gelation temperature and slightly decreased the gel strength and the bioadhesive force. Taken together, these findings indicate that the effect of additives on the physicochemical properties of liquid suppository bases depends on their bonding capacities, in that additives such as sodium chloride, sodium monohydrogen phosphate and sodium dihydrogen phosphate having strong cross-linking bonds with the components of liquid suppository base increase the strength and bioadhesive force of a gel compared to liquid suppository base alone, while additives such as ethanol, propylene glycol and hydrochloric acid having weaker hydrogen bonding result in a weaker response. Thus, sodium chloride and sodium phosphates appear to be promising additives for in situ gelling and mucoadhesive liquid suppository base, if used in adequate amounts.

Adhesiveness↗
PubMed1999

Development of a thermo-reversible insulin liquid suppository with bioavailability enhancement.

The purpose of this work is to develop a thermo-reversible insulin liquid suppository, which undergoes a phase transition to bioadhesive gels at body temperature and enhances the bioavailability of insulin. The effects of insulin and sodium salicylate on the physicochemical properties of a liquid suppository composed of poloxamer P 407, P 188 and polycarbophil were investigated. The pharmacodynamic study and quantitative histological assessment of the rectal mucosa of rats were carried out after the dose of insulin-loaded liquid suppositories with different amounts of sodium salicylate into streptozotocin-treated rats. Only thermo-reversible insulin liquid suppository [insulin/P407/P188/polycarbophil/sodium salicylate (100 (IU/g)/15/20/0.2/10%)] showed the optimal physicochemical properties and good safety in rats. It gave significantly lower plasma glucose levels, AUC(0-->4h) (the area below basal glucose level) and C(nadir) (the plasma glucose levels at the nadir) than did the solid and liquid suppositories without sodium salicylate in rats, indicating that the insulin from liquid suppository with sodium salicylate could be well absorbed in rats due to the absorption enhancing effect of sodium salicylate. It is concluded that thermo-reversible insulin liquid suppository [insulin/P 407/P 188/polycarbophil/sodium salicylate (100 (IU/g)/15/20/0.2/10%)], which was easy to administer without any pain during insertion and remained at the administered sites, could have a potential to be developed as a more convenient, safe and effective rectal delivery system of insulin.

Administration, Rectal↗
PubMed1999

Isolation and characterization of a thermophilic lipase from bacillus thermoleovorans ID-1.

A thermophilic microorganism, Bacillus thermoleovorans ID-1, isolated from hot springs in Indonesia, showed extracellular lipase activity and high growth rates on lipid substrates at elevated temperatures. On olive oil (1.5%, w/v) as the sole carbon source, the isolate ID-1 grew very rapidly at 65 degrees C with its specific growth rate (2.50 h(-1)) and its lipase activity reached the maximum value of 520 U l(-1) during the late exponential phase and then decreased. In addition to this, isolate ID-1 could grow on a variety of lipid substrates such as oils (olive oil, soybean oil and mineral oil), triglycerides (triolein, tributyrin) and emulsifiers (Tween 20, 40). The excreted lipase of ID-1 was purified 223-fold to homogeneity by ammonium sulfate precipitation, DEAE-Sephacel ion-exchange chromatography and Sephacryl S-200 gel filtration chromatography. As a result, the relative molecular mass of the lipase was determined to be 34 kDa on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The enzyme showed optimal activity at 70-75 degrees C and pH 7.5 and exhibited 50% of its original activity after 1 h incubation at 60 degrees C and 30 min at 70 degrees C and its catalytic function was activated in the presence of Ca(2+) or Zn(2+).

Bacillus↗
PubMed1999

Correlation of deformability at a tRNA recognition site and aminoacylation specificity.

The fidelity of protein synthesis depends on specific tRNA aminoacylation by aminoacyl-tRNA synthetase enzymes, which in turn depends on the recognition of the identity of particular nucleotides and structural features in the substrate tRNA. These features generally reside within the acceptor helix, the anticodon stem-loop, and in some systems the variable pocket of the tRNA. In the alanine system, fidelity is ensured by a G.U wobble base pair located at the third position within the acceptor helix of alanine tRNA. We have investigated the activity of mutant alanine tRNAs to explore the mechanism of enzyme recognition. Here we show that the mismatched pair C-C is an excellent substitute for G.U in alanine-tRNA-knockout cells. A structural investigation by NMR spectroscopy of the C-C RNA acceptor end reveals that the two cytosines are intercalated into the helix, and that C-C exists in multiple conformations. Structural heterogeneity also is present in the wild-type G.U RNA, whereas inactive Watson-Crick helices are structurally rigid. The correlation between functional and structural data suggests that the G.U pair provides a distinctive structure and a point of deformability that allow the tRNA acceptor end to fit into the active site of the alanyl-tRNA synthetase. Fidelity is ensured because noncognate and inactive mutant tRNAs are bound in the active site in an incorrect conformation that reduces enzymatic activity.

Acylation↗
PubMed1999

Aspergillus fumigatus antigen exposure results in pulmonary airway resistance in wild-type but not in IL-4 knockout mice.

Inhalation of Aspergillus fumigatus, a ubiquitous fungus, results in the development of allergic bronchopulmonary aspergillosis, a disabling allergic lung disease. For better patient management early diagnosis is essential, and understanding of the immune mechanism is important in achieving this goal. Although animal model studies have contributed to the understanding of the disease mechanism, details on the immunopathogenesis are still lacking. In the present study, we have developed an allergic aspergillosis model in wild-type and IL-4 knockout mice and studied the immune and airway responses. The results indicate that the immune response, pulmonary pathology, and airway reactivity comparable to allergic bronchopulmonary aspergillosis are reproducible in wild mice. IL-4 knockout mice showed similar pulmonary pathology, but no increase in airway resistance, suggesting that IgE and hence IL-4 may be important in eliciting the airway response, while other factors may be involved in the inflammatory process.

Airway Resistance↗
PubMed1999

No further development of renal scarring after antireflux surgery in children with primary vesicoureteral reflux: review of the results of 99mtechnetium dimercapto-succinic acid renal scan.

PURPOSE: Reports of previous studies using excretory urography indicate that significant numbers of new scars developed in 5 to 31% of cases and scarring progressed in 11 to 16% after antireflux surgery. We evaluated renal scarring after surgery using a more accurate method, that is dimercapto-succinic acid renal scintigraphy. MATERIALS AND METHODS: Between 1985 and 1997 antireflux surgery was performed for primary vesicoureteral reflux in 223 children at our hospital. Of these patients 45 boys and 29 girls with a median age of 74 months at surgery in whom preoperative and postoperative renal scans were available form the basis of our retrospective study. Renal scan was performed 0.3 to 58 months (median 2) preoperatively and 5.3 to 44 months (median 18.7) postoperatively. A total of 24 children (39 renal units) were followed further by additional scanning for as long as 25 to 120 months (median 43.2) postoperatively. Each scan was blindly reviewed for the size, number and zone location of cortical defects based on morphology. Interval changes were grouped into categories as improved, no change, progressed and new scar formation. RESULTS: Postoperatively there was no ureteral obstruction. Pyelonephritis developed in 2 patients (2.7%) and asymptomatic bacteriuria was noted in 35 (47.3%) postoperatively. Of the renal units 110 (86.6%) showed no change, while 15 (11.8%) were improved and 2 (1.6%) had progression. In no case was new renal scar formation observed. CONCLUSIONS: Contrary to most previous reports involving excretory urography, our results indicate no significant progression of renal scarring after antireflux surgery. In most cases postoperative followup renal scans demonstrated no significant morphological change. When there was change, it mostly involved the disappearance or decrease of renal scars.

Child↗
PubMed1999

Carbachol-induced sustained tonic contraction of rat detrusor muscle.

OBJECTIVE: To investigate the underlying contractile mechanism of the sustained tonic contraction (SuTC) induced by repetitive carbachol application in rat detrusor muscles. MATERIALS AND METHODS: Longitudinal muscle strips with no mucosa were obtained from the anterior wall of the urinary bladder in 12-week-old Sprague-Dawley rats. Carbachol (5 micromol/L) was applied repetitively to induce SuTC. The carbachol-induced SuTC was assessed in the presence of various Ca2+-channel blockers and drugs affecting intracellular Ca2+ concentration. RESULTS: The first application of carbachol elicited a large phasic contraction followed by a tonic contraction (TC); the carbachol-induced contraction was completely reversed by washing out the solution. However, the initial phasic contraction was not reproduced after a second or further application of carbachol. There was consistently only a SuTC with no phasic contraction. The amplitude of the SuTC was 85% of the TC induced by the first carbachol application. The application of atropine (1 micromol/L) to the bath completely blocked SuTC. The carbachol-induced SuTC was insensitive to nicardipine (5 micromol/L) and extracellular polyvalent cations (1 mmol/L, La3+, Co2+, Cd2+, Ni2+ ). Moreover, a similar SuTC was induced even after the complete elimination of extracellular Ca2+ by adding 2 mmol/L EGTA to the Ca2+-free Tyrode solution. To exclude intracellular Ca2+ sources related to the sarcoplasmic reticulum (SR), the effects of SR Ca2+ pump inhibitors, cyclopiazonic acid (CPA, 10 micromol/L) and thapsigargin (0.5 micromol/L) were tested. The carbachol-induced SuTC was insensitive to pretreatment with CPA and/or thapsigargin. To deplete the ryanodine-sensitive Ca2+ pool, muscle strips were repetitively stimulated with caffeine (10 mmol/L) in the presence of 10 micromol/L ryanodine, which did not affect the carbachol-induced SuTC. CONCLUSIONS: Although the characteristics of the carbachol-induced SuTC have not been defined, these results show that a significant proportion of the carbachol-induced contraction in rats is contributed by the SuTC, which is present even in the complete absence of external Ca2+. The SuTC was not affected by limiting the contributions of internal Ca2+ sources. This suggests that the SuTC in rat bladders is unrelated to known Ca2+ mobilization mechanisms.

Animals↗
PubMed1999

Routine surgical telepathology in the Department of Veterans Affairs: experience-related improvements in pathologist performance in 2200 cases.

OBJECTIVE: To determine whether diagnostic concordance, case deferral rate, and/or time required to review slides changed significantly as telepathologists gained additional experience using a hybrid dynamic/store-and-forward (HDSF) telepathology (TP) system on the 2000 cases following an initial 200 consecutive surgical cases, previously reported. MATERIALS AND METHODS: Gross surgical pathology specimens were prepared by specially trained personnel in Iron Mountain, Michigan. For TP, glass slides were placed on the stage of a robotic microscope at the Iron Mountain VAMC (remote site); control of the motorized microscope was then transferred to a pathologist located 220 miles away at the Milwaukee, Wisconsin, VAMC (host site). For each case, a telepathologist had the option of either rendering a diagnosis or deferring the case for later analysis by conventional light microscopy (LM). After the slides were read by TP and a surgical pathology report had been generated (for nondeferred cases), the slides were transported to Milwaukee, where they were reexamined by the same pathologist, now using LM. When there was disagreement between the TP and LM diagnosis, a supplemental or revised report was issued, and the referring physician was notified by telephone immediately. All supplemental and revised reports were reviewed by a third pathologist in the group. The slides were then reviewed by the pathology group practice or, when there was no consensus, by the Armed Forces Institute of Pathology to establish a "truth" diagnosis. To determine changes in telepathologist performance with experience after the initial start-up of the service, their performance in handling 10 consecutive sets of 200 surgical pathology cases was analyzed. RESULTS: Concordance rates for clinically significant TP and LM diagnoses were high for all 10 sets, ranging from 99% to 100%. Comparing the first set (Cases 201-400) with the last set (Cases 2001-2200), viewing times per case were reduced from 10.26 min to 3. 58 min. Viewing times per slide were reduced from 3.44 min to 1.13 min per slide, comparing the first and last sets. Case turnaround times (TAT) decreased from 2.46 days to < or =1.5 days. CONCLUSION: Thes results demonstrate that improvements in TP services occur over time as the result of additional experience using the TP system. The high diagnostic concordance and low rate of case deferral lend additional support to the proposal that a host-site pathologist using HDSF TP can substitute effectively for an on-site pathologist as a service provider.

Clinical Competence↗
PubMed1999

Oligogalacturonic acid and chitosan reduce stomatal aperture by inducing the evolution of reactive oxygen species from guard cells of tomato and Commelina communis.

Stomatal opening provides access to inner leaf tissues for many plant pathogens, so narrowing stomatal apertures may be advantageous for plant defense. We investigated how guard cells respond to elicitors that can be generated from cell walls of plants or pathogens during pathogen infection. The effect of oligogalacturonic acid (OGA), a degradation product of the plant cell wall, and chitosan (beta-1,4-linked glucosamine), a component of the fungal cell wall, on stomatal movements were examined in leaf epidermis of tomato (Lycopersicon esculentum L.) and Commelina communis L. These elicitors reduced the size of the stomatal aperture. OGA not only inhibited light-induced stomatal opening, but also accelerated stomatal closing in both species; chitosan inhibited light-induced stomatal opening in tomato epidermis. The effects of OGA and chitosan were suppressed when EGTA, catalase, or ascorbic acid was present in the medium, suggesting that Ca(2+) and H(2)O(2) mediate the elicitor-induced decrease of stomatal apertures. We show that the H(2)O(2) that is involved in this process is produced by guard cells in response to elicitors. Our results suggest that guard cells infected by pathogens may close their stomata via a pathway involving H(2)O(2) production, thus interfering with the continuous invasion of pathogens through the stomatal pores.

Ascorbic Acid↗
PubMed1999

Immune response and airway reactivity in wild and IL-4 knockout mice exposed to latex allergens.

BACKGROUND: Natural rubber latex has been reported as a major cause of allergy and asthma in a number of individuals. One of the occupational groups most affected by latex allergy are the health care workers who are frequently exposed to natural rubber latex products in their patient care activities. The immunopathogenesis of latex allergy is not well understood. In order to understand the immune mechanism in latex allergy, we have developed a mouse model of latex allergy. METHODS: Both wild-type and IL-4 knockout BALB/c mice were challenged intranasally with latex proteins and their immune responses, lung pathology, and airway reactivity were evaluated. RESULTS: The total serum IgE and latex specific IgE, IgG1, and peripheral blood and lung eosinophil levels in wild type BALB/c mice were enhanced by the latex exposure, while no IgE or eosinophil were detected in IL-4 knockout mice. Latex-specific IgG1 levels in the sera were lower in IL-4 knockout animals compared to wild mice. However, latex-specific IgG2a antibody was higher in all the IL-4 knockout mice compared to wild type mice. Both the wild type and IL-4 knockout animals developed increased airway resistance after antigen challenge when compared to control animals, although the airway resistance response of IL-4 knockout animals was attenuated compared to the wild-type animals. The histology of the lungs of these two groups of animals was similar. CONCLUSION: In spite of the differences in the immune responses in the two groups of mice, there were comparable lung inflammatory responses, suggesting a multifactorial pathogenetic mechanism.

Animals↗
PubMed1999

Social environment and year of birth influence type 1 diabetes risk for African-American and Latino children.

OBJECTIVE: Credible epidemiological data, primarily from European-origin populations, indicate that environmental factors play an important role in the incidence of type 1 diabetes. RESEARCH DESIGN AND METHODS: A population-based registry of incident cases of type 1 diabetes among African-American and Latino children in Chicago was used to explore the influence of individual and neighborhood characteristics on diabetes risk. New cases of insulin-treated diabetes in African-American and Latino Chicagoans aged 0-17 years for 1985-1990 (n = 400) were assigned to one of 77 community areas based on street address. Census tables provided denominators, median household income, percentage of adults > or = 25 years old who had completed high school and college, and a crowding variable for each community area individual-level data were birth cohort, sex, and ethnicity. Outcomes in Poisson regression were sex-, ethnic-, and birth cohort-specific incidence rates. RESULTS: Significant univariate associations between diabetes risk and ethnicity, birth cohort, crowding, and the percentage of adults in each community area who had completed high school and college were observed. African-Americans had a relative risk (RR) of 1.42 (95% CI, 1.14-1.76) compared with Latinos. Risk varied significantly by birth cohort in both ethnic groups. For every 10% increase in the proportion of adults who completed college, the RR for diabetes increased by 25% (RR, 1.25 [95% CI, 1.09-1.44]). Social class variables were significant determinants of risk for African Americans, but not for Latinos. CONCLUSIONS: The strong birth cohort and social class associations observed in this study implicate an infectious exposure linked with age.

Adolescent↗