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PubMed1999

The independent contribution of bone and erythrocyte lead to urinary lead among middle-aged and elderly men: the normative aging study.

Plasma is the component of blood from which lead is free to cross cell membranes and cause organ toxicity. Plasma lead levels, however, are extremely low and difficult to measure. Urinary lead originates from plasma lead that has been filtered at the glomerular level; thus, urinary lead adjusted for glomerular filtration rate serves as a proxy for plasma lead levels. In this investigation we examined the interrelationships of lead levels in whole blood corrected by hematocrit [i.e., erythrocyte lead (EPb)], trabecular bone (TBoPb), cortical bone (CBoPb), and urine excreted over 24 hr (UPb); all samples were obtained from 71 middle-aged and elderly men with no known occupational lead exposures. Lead was measured by graphite furnace atomic absorption spectroscopy (blood), K-X-ray fluorescence (bone), and inductively coupled plasma mass spectroscopy (urine). Lead levels were generally low, with mean EPb, TBoPb, and CBoPb values of 13.8, 31.1, and 21.7 microg/g, respectively, and a median UPb value of 6.15 microg/day. In generalized additive models adjusted for body weight and creatinine clearance rate, both EPb and bone lead variables remained independently and significantly associated with UPb. This finding suggests that bone influences plasma lead in a manner that is independent of the influence of erythrocytic lead on plasma lead. Thus, the superiority of bone lead over blood lead in predicting some chronic forms of toxicity may be mediated through bone's influence on plasma lead. In addition, this study suggests that measurement of urinary lead might be useful as a proxy for plasma lead levels in studies of lead toxicity.

Aged↗
PubMed2000

Minimal lead sets for reconstruction of 12-lead electrocardiograms.

It may not always be possible to record all precordial leads of the standard 12-lead electrocardiogram (ECG). Especially in monitoring situations, a minimal lead set from which the 12-lead ECG can be reconstructed, would be valuable. This article assesses how well missing precordial leads could be synthesized from the remaining leads of the 12-lead ECG. A total of 2,372 diagnostic 12-lead ECG recordings were obtained from subjects with chest pain suggestive for acute myocardial infarction. Representative average beats were computed from the digital 12-lead ECG recordings with our Modular ECG Analysis System. The recordings were divided into a learning set and a test set. We considered all lead sets with one or more precordial leads removed, but always including limb leads I and II. By using the learning set, general reconstruction coefficients were computed to synthesize the missing precordial leads to each lead set. Performance of the synthesis was assessed by cross correlation between the original and the reconstructed leads. Also, patient-specific reconstruction coefficients were derived for each ECG in the test set and correlations were determined. High correlation coefficients were found with both reconstruction techniques. For different sizes of lead sets, the best patient-specific reconstructions had higher correlation values than the general reconstructions. For example, when 2 precordial leads were excluded, the best patient-specific median correlation was 0.994 compared to 0.963 for the best general reconstruction correlation. General reconstruction allows synthesis of 2 or 3 excluded precordial leads in good approximation. When patient-specific reconstruction can be applied, a minimal lead set including the limb leads and only 2 precordial leads suffices.

Electrocardiography↗
PubMed1998

Lead consumption of 18- to 36-month-old children as determined from duplicate diet collections: nutrient intakes, blood lead levels, and effects on growth.

OBJECTIVE: To determine the amount of lead ingested in food by means of duplicate diet collections, nutrient intakes, and anthropometric measurements of young children. DESIGN: Once a month for a year, data were collected from 24-hour duplicate diets, hand wipes, a dust index, and anthropometric measurements. Quarterly, venous blood samples were obtained. Thermal ionization spectrometry by means of a lead-205 tracer was used to determine lead present in food, blood, and the hand wipes. A dust index was determined on the basis of observation of dust on surfaces in the home. Anthropometric measurements obtained were height, weight, head circumference, and mid-upper arm circumference. SUBJECTS/SETTING: Subjects were 21 children, aged 18 to 36 months, who resided in homes located in an urban area with potentially high lead levels. MAIN OUTCOMES MEASURED: Lead contamination in food and on hands, and blood lead values, were determined. STATISTICAL ANALYSIS PERFORMED: Pearson correlation coefficients were used to determine relationships between lead content in food, blood, and hand wipes and growth. Multiple regression analyses examined the effect of food types and dust lead on lead levels in food, and the effect of these variables on head circumference. RESULTS: Mean blood levels were 0.3089 +/- 0.1496 micromol/L; 12 samples contained more than 0.4826 micromol/L. Total intake of lead from food was 4.95 microg/day and ranged from 1.10 to -22.10 microg/day. More than a fourth of the diets collected exceeded 6.00 microg/day. Foods considered home prepared were moderately related to blood lead level, and the dust index and hand wipe lead levels were related to total food lead. Home-handled foods, canned foods, and hand-wipe lead were significant predictors of the lead content in food. A negative relationship was found between head circumference and blood lead level. APPLICATIONS: Level of lead in food was directly related to hand-wipe lead. This finding underscores the need for dietitians and other health professionals to stress the importance of cleanliness in environments that are potentially lead contaminated. Appropriate hand washing and surface cleaning should be emphasized when preparing and consuming food. The inverse relationship between head circumference and blood lead levels points to the need for additional studies to validate this finding while controlling for other extraneous variables.

Anthropometry↗
PubMed2004

[Parental education to reduce blood lead levels in children with mild and moderate lead poisoning: a randomized controlled study].

OBJECTIVE: To evaluate the effectiveness of parental education on reducing lead exposure of children by examining the changes in blood lead levels of children whose parents receiving or not receiving educational intervention. METHODS: Two hundred children with confirmed blood lead levels beyond 100 microg/L were selected. They were randomized into two groups, 107 children in study group and 93 in control. At the beginning of the study, parents of both study and control groups were called for interview to complete KABP questionnaire and lead study questionnaire. The study group was provided with interventional measures while control group was not contacted until the end of study. Intervention of parental education was undertaken by means of a TV program, a set of slides and a brochure, and focused on the questions regarding harmful effects of lead poisoning, the sources of environmental lead and prevention of this preventable disease. Tests for blood lead level were repeated for both study and control groups 3 months after the determination of the initial blood lead level. RESULTS: All the relevant knowledge of health effect, lead sources and prevention of childhood lead poisoning of participating parents of study group were improved significantly (chi(2) = 14.06, 13.07, 10.08, 28.26, P < 0.01) after educational intervention while parents control group also were significantly improved in the sub-catalogs of concept and prevention (chi(2) = 7.69, 8.64, P < 0.01), but not the health effect and sources of childhood lead poisoning. Children and parents' behavior in study group was improved accordingly and significantly. Less children ate popcorn (chi(2) = 4.08, P < 0.05), less children drank tap-water in the morning (chi(2) = 23.04, P < 0.01), more kids washed their hands before eating (chi(2) = 5.82, P < 0.05), less kids played on road side (chi(2) = 9.60, P < 0.01), and more parents changed their coat or took shower or washed hands before going home after work (chi(2) = 4.00, P < 0.05). But in the control group only the number of kids playing on road side was decreased significantly (chi(2) = 9.60, P < 0.01). A general decline in blood lead levels was detected in both groups with statistical significance at P < 0.01. However, the decrease in blood lead levels was more remarkable in the study group. There was average reduction of 55 microg/L (35%) in blood lead levels for study group (t = 4.979, P < 0.01) and an almost 33 microg/L (20%) for control (t = 3.398, P < 0.01). The reduction in blood lead level was 22 microg/L greater in study group (t = 3.531, P < 0.01). The study also showed that the effectiveness of the educational interventions depended upon various aspects. Fourteen variables were included in the stepwise multiple regression equation of blood lead level changes. Such as parents' occupational exposure to lead, the improvement of knowledge about prevention of childhood lead poisoning, the chang of habit of snacks intake, parents' education levels, the change of attitude of parents for the childhood lead poisoning, etc. CONCLUSION: Educating parents is proved to be an effective approach for children with mild and moderate lead poisoning.

Child↗
PubMed2000

Maternal bone lead contribution to blood lead during and after pregnancy.

We examined bone lead contribution to blood lead in a group of 311 immigrant women, 99% from Latin America, during the third trimester of pregnancy and 1 to 2 months after delivery. We measured in vivo tibia and calcaneus (heel) bone lead concentration in the postdelivery period with K shell X-ray fluorescence. Prenatal and postnatal geometric mean (range) blood lead level was 2.2 microg/dL (0.4 to 38.7) and 2.8 microg/dL (0.4 to 25.4), reflecting low current exposure. Postnatal blood lead level was significantly higher than prenatal (P<0.0001). Mean (range) tibia and calcaneus lead concentration was 6.7 microg/g (-33.7 to 62.2) and 8.4 microg/g (- 30.1 to 66.4), reflecting varying but elevated past lead exposure. Mean calcaneus lead concentration was significantly higher than mean tibia lead concentration (P = 0.055). Variance-weighted multiple regression and structural equation models showed that both calcaneus and tibia lead were directly associated with prenatal blood lead but only calcaneus lead was associated with postnatal blood lead. Increasing natural log years in the United States independently predicted decreasing calcaneus and third-trimester blood lead. The data suggest that while some exogenous lead sources and modulators of blood lead level, such as use of lead-glazed pottery and calcium in the diet, control lead exposure during and after pregnancy, endogenous lead sources from past exposure before immigration continue to influence blood lead levels in this sample.

Adolescent↗
PubMed2005

Blood lead levels in children after phase-out of leaded gasoline in Bombay, India.

The objective of this study was to test for reduction in pediatric blood lead levels (BLLs) in Bombay, India, by comparing BLLs collected in 2002 (after use of leaded gasoline was phased out in Bombay) to those collected in a study conducted by the George Foundation in 1997 (when leaded gasoline was still used in Bombay). We analyzed BLL in a total of 754 children under 12 years of age in two separate sampling campaigns (276 from December 2002 to January 2003 [non-monsoon season]; 478 in June to August 2003 [monsoon season]). BLL was measured using an ESA Lead Care Portable Analyzer. We also measured lead in PM10 samples collected in the study region. These data were compared with a study done by the George Foundation in 1997 before the phase out of leaded gasoline. The George Foundation study reported that 61.8% of the 291 children tested in Bombay had elevated blood lead levels (BLL>or=10 microg/dL). In the present study, 33.2% of the 754 tested children had elevated blood lead levels. The average BLL for the current study population (Geometric Mean=8.36 microg/dL, SD=5.23 microg/dL) was lower than the CDC level of concern (10 microg/dL), with one child diagnosed with lead poisoning (BLL>65 microg/dL). A seasonal trend of BLLs was suggested, with BLL in monsoon season (Geometric Mean=9.1 microg/dL, SD=5.7 microg/dL) higher than that in the non-monsoon season (Geometric Mean=7.3 microg/dL, SD=4.0 microg/dL). A seasonal periodicity of lead in PM10 was found, with lead in monsoon season (Geometric Mean=0.04 microg/m3, SEM=0.000667 microg/m3) lower than that in the non-monsoon season (Geometric Mean=0.38 microg/m3, SEM=0.10 microg/m3). The overall level of airborne dust (PM10) in monsoon season (56.2 microg/m3) was lower than in the non-monsoon season (273.0 microg/m3), presumably due to precipitation. The comparatively higher BLLs in the monsoon season, in the presence of lower air lead levels, suggest ingestion of water or food, with greater lead contamination in the monsoon season, as a possible pathway contributing to elevated BLLs in these children in the monsoon season. These results demonstrate a significant success of the public health system in Bombay, India-achieved by the removal of lead from gasoline. The emphasis should shift in the study region towards sources of lead exposure other than leaded gasoline (lead in paints, lead in Herbal medicines and lead in Kohl).

Adolescent↗
PubMed1974

New information on lead in dirt and dust as related to the childhood lead problem.

It has been known for many years that the eating of leaded paint is the prime cause of lead poisoning and elevated blood leads of children living in deteriorated housing. Recently, there has been speculation that children may eat dirt and dust contaminated with lead exhausted from cars and that this amount of ingested lead is sufficient to contribute significantly to the childhood lead problem. This paper reports on a twopart study conducted to evaluate the validity of the dirt-and-dust hypotheses. The first part of the study was made to determine the source of lead in dirt to which children are normally exposed. Dirt samples were taken in old urban areas around 18 painted frame houses and 18 houses of brick construction. Samples also were taken around seven old frame farmhouses remote from traffic. Based on the fact that lead concentrations in the dirt were similar in city and rural yards at corresponding distances from the houses, it is clear that nearly all of the lead in dirt around these houses is due to paint from the houses. Lead antiknock additives are therefore not a significant contributor to the lead content of dirt around houses where children usually play. The second part of the study used a naturally occurring radioactive tracer (210)Pb to determine the relative amounts of dust and other lead-containing materials (e.g., paint) eaten by young children. This tracer is present in very low concentrations in paint and in significantly higher concentrations in fallout dust. Stable lead and (210)Pb were analyzed in fecal material from eight children suspected of having elevated body burdens of lead and ten children living in good housing where lead poisoning is not a problem. The normal children averaged 4 mug Pb/g dry feces, with a range of 2 to 7. Of the eight children suspected of having elevated lead body burdens, two had fecal lead values within the normal range. However, the remaining six were 4 to 400 times as high. Despite these differences in fecal lead between the two groups, the groups were essentially identified in the (210)Pb content of their feces. The "elevated" children averaged 0.040 pCi of (210)Pb dry feces, while the normal group averaged 0.044 pCi/g. The results provide sound evidence that these children suspected of elevated lead body burden were not ingesting dust or air-suspended particulate.

Air Pollution↗
PubMed1997

Lead exposure at an early age substantially increases lead retention in the rat.

It has been hypothesized that the high rate of bone remodeling during childhood and the consequent high calcium and lead turnover result in a substantial reduction in bone lead stores so that much of the lead incorporated in bone during childhood does not persist into adulthood. We studied the effect of age at lead exposure on blood and organ concentrations of lead, calcium, and zinc 1-5 months after termination of lead ingestion. Blood and organ lead concentrations and contents 4 weeks after lead exposure ceased were significantly higher in the rats exposed beginning at 5 weeks of age than in those exposed beginning at 10 or 15 weeks old. Bone lead declined as the time since exposure increased. Despite this trend, the rats exposed when youngest had bone lead concentrations at 20 weeks after the termination of lead exposure that were higher than those of the other rats only 4 weeks after cessation of lead ingestion. Multiple regression analysis demonstrated that age at lead exposure remained a significant predictor of blood and organ lead concentrations and contents even after the inclusion of total lead consumed, body weight, and age at organ harvesting in the regression analysis. There were only small differences in organ calcium and zinc concentrations among treatment groups except for kidney calcium. The results do not support the hypothesis of rapid depletion of bone lead stores in young animals, but rather suggest that younger age at lead exposure is associated with greater lead retention and toxicity even in the absence of continued lead exposure.

Age Factors↗
PubMed1998

Effect of the delta-aminolevulinate dehydratase polymorphism on the accumulation of lead in bone and blood in lead smelter workers.

Lead inhibition of the zinc metalloenzyme delta-aminolevulinate dehydratase (ALAD) is one of the most sensitive indicators of blood lead levels. ALAD is polymorphic, with about 20% of Caucasians expressing the rarer ALAD2 allele. Previous studies indicated that this polymorphism may be a genetic factor in lead transport, metabolism, and/or distribution. Whole blood lead, serum lead, and ALAD genotype were determined for 381 lead smelter workers, including 70 workers expressing the ALAD2 allele, whose blood lead elevations were observed for more than 20 years of employment. The same employees demonstrated higher serum lead levels. Using a cumulative blood lead index (CBLI) for each worker, based on individual blood lead histories, and in vivo X-ray fluorescence measurements of bone lead to estimate total lead body burden, the slopes of linear relations of bone lead to CBLI were greater for workers homoallelic for ALAD1, indicating more efficient uptake of lead from blood into bone. This effect was most significant in calcaneus bone and for workers hired since 1977 [ALAD1-1: 0.0528 +/- 0.0028 and ALAD1-2 or 2-2: 0.0355 +/- 0.0031 (P < 0.001)]. Decreased transfer of blood lead into bone in individuals expressing the ALAD2 allele contrasted with increased blood lead. Thus the ALAD genotype affected lead metabolism and potentially modified lead delivery to target organs including the brain; however, the ALAD genotype did not significantly affect the net accumulation of lead in bone.

Amino Acid Sequence↗
PubMed1990

Modelling of environmental lead contributors to blood lead in human.

The Second National Health and Nutrition Examination Survey (NHANES II) is the only representative national study of body burden of lead where detailed concurrent information is available on a number of geographic and socio-economic factors. To date, however, reliable information on concurrent local environmental lead exposure for the sample has been lacking. In this study, we have identified and utilized previously unused concurrent lead exposure data. Our exposure data include time and region specific information on sales of lead from gasoline and ambient air-lead measurements from the United States Environmental Protection Agency (EPA). In addition, we have included information on lead consumed in food from the United States Food and Drug Administration (FDA). Our results indicate weak but significant associations between state sales of lead from gasoline and blood lead. In addition, we found a significant association between ambient air lead measurements and blood-lead concentrations. Socio-economic factors and life-style factors were significantly related to blood lead, controlling for other possible confounders. Overall, our model explained 34% of the variance in blood-lead levels, which is a significant improvement compared to the maximum of 25% from other studies using the NHANES II data. The study substantiates prior findings that the majority of the variance in overall blood lead is significantly related to lead sources other than gasoline. From a public health perspective, it is therefore imperative that lead screening programs be continued and focused on multiple sources of lead, including lead in gasoline. The study supports prior findings of a continuous decrease in blood lead, independent of decreases of lead from gasoline.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2003

Risks to children from exposure to lead in air during remedial or removal activities at Superfund sites: a case study of the RSR lead smelter Superfund site.

Superfund sites that are contaminated with lead and undergoing remedial action generate lead-enriched dust that can be released into the air. Activities that can emit lead-enriched dust include demolition of lead smelter buildings, stacks, and baghouses; on-site traffic of heavy construction vehicles; and excavation of soil. Typically, air monitoring stations are placed around the perimeter of a site of an ongoing remediation to monitor air lead concentrations that might result from site emissions. The National Ambient Air Quality (NAAQ) standard, established in 1978 to be a quarterly average of 1.5 microg/m(3), is often used as a trigger level for corrective action to reduce emissions. This study explored modeling approaches for assessing potential risks to children from air lead emissions from the RSR Superfund site in West Dallas, TX, during demolition and removal of a smelter facility. The EPA Integrated Exposure Uptake Biokinetic (IEUBK) model and the International Commission of Radiologic Protection (ICRP) lead model were used to simulate blood lead concentrations in children, based on monitored air lead concentrations. Although air lead concentrations at monitoring stations located in the downwind community intermittently exceeded the NAAQ standard, both models indicated that exposures to children in the community areas did not pose a significant long-term or acute risk. Long-term risk was defined as greater than 5% probability of a child having a long-term blood lead concentration that exceeded 10 microg/dl, which is the CDC and the EPA blood lead concern level. Short-term or acute risk was defined as greater than 5% probability of a child having a blood lead concentration on any given day that exceeded 20 microg/dl, which is the CDC trigger level for medical evaluation (this is not intended to imply that 20 microg/dl is a threshold for health effects in children exposed acutely to airborne lead). The estimated potential long-term and short-term exposures at the downwind West Dallas community did not result in more than 5% of children exceeding the target blood lead levels. The models were also used to estimate air lead levels for short-term and long-term exposures that would not exceed specified levels of risk (risk-based concentrations, RBCs). RBCs were derived for various daily exposure durations (3 or 8 h/day) and frequencies (1-7 days/week). RBCs based on the ICRP model ranged from 0.3 (7 days/week, 8 h/day) to 4.4 microg/m(3) (1 day/week, 3 h/day) for long-term exposures and were lower than those based on the IEUBK model. For short-term exposures, the RBCs ranged from 3.5 to 29.0 microg/m(3). Recontamination of remediated residential yards from deposition of air lead emitted during remedial activities at the RSR Superfund site was also examined. The predicted increase in soil concentration due to lead deposition at the monitoring station, which represented the community at large, was 3.0 mg/kg. This potential increase in soil lead concentration was insignificant, less than 1% increase, when compared to the clean-up level of 500 mg/kg developed for residential yards at the site.

Air Movements↗
PubMed2003

Elevated blood lead resulting from maxillofacial gunshot injuries with lead ingestion.

PURPOSE: The purpose of this study was to identify the contribution of ingested lead particles to elevated blood lead concentrations in victims of gunshot injury to the maxillofacial region. PATIENTS AND METHODS: As part of a larger study of the effects of retained lead bullets on blood lead, a retrospective review of study findings was completed on 5 of 8 patients who sustained injuries to the maxillofacial region. These 5 patients were recruited into the larger study within 11 days of injury and showed a penetration path for the projectile that engaged the upper aerodigestive tract. All subjects were recruited from patients presenting for care of their gunshot injuries to a large inner-city trauma center with a retained bullet resulting from a gunshot injury. An initial blood lead level was measured for all recruited patients and repeated 1 to 17 weeks later. Medical history was taken along with a screening and risk factor questionnaire to determine other potential or actual sources (occupational/recreational) of lead exposure. (109)Cd K-shell x-ray fluorescence determinations of bone lead were completed to determine past lead exposure not revealed by medical history and risk factor questionnaire. Radiographs taken of the abdomen and chest, required as a part of the patient's hospital care, were retrospectively reviewed for signs of metallic fragments along the aerodigestive tract. RESULTS: All 5 patients retained multiple lead pellets or fragments at the site of injury, sustained fractures of the facial bones, and showed increases in blood lead. Three of the 5 study subjects who sustained maxillofacial gunshot injuries involving the mouth, nose, or throat region showed metallic densities along the gastrointestinal tract indicative of ingested bullet fragments. Each patient with ingested bullet fragments showed rapid elevation of blood lead exceeding 25 microg/dL and sustained increases well beyond the time when all ingested fragments were eliminated. A 3-year follow-up on these 3 patients showed significantly sustained elevation of blood lead but less than that observed during the initial 6 months after injury. None of the 5 study subjects showed any evidence of metallic foreign bodies within the tracheobronchial regions indicative of aspiration. CONCLUSION: Ingestion of lead fragments can result from gunshot injuries to the maxillofacial region and may substantially contribute to a rapid increase in blood lead level. Prompt diagnosis and elimination of ingested lead fragments are essential steps necessary to prevent lead being absorbed from the gastrointestinal tract. Increased blood lead in victims after gunshot injuries must be fully evaluated for all potential sources, including recent environmental exposure, absorption of lead from any remaining bullets in body tissues, and the possibility of mobilization of lead from long-term body stores such as bone.

Adult↗
PubMed1998

Lead exposure in the lead-acid storage battery manufacturing and PVC compounding industries.

This study was conducted as part of the Human Exposure Assessment Location (HEAL) Project which comes under the United Nations Environment Programme/World Health Organisation (UNEP/WHO) Global environmental Monitoring System (GEMS). The objective of the study was to evaluate workers' exposure to lead in industries with the highest exposure. All subjects were interviewed about their occupational and smoking histories, the use of personal protective equipment and personal hygiene. The contribution of a dietary source of lead intake from specified foods known to contain lead locally and personal air sampling for lead were assessed. A total of 61 workers from two PVC compounding and 50 workers from two lead acid battery manufacturing plants were studied together with 111 matched controls. In the PVC compounding plants the mean lead-in-air level was 0.0357 mg/m3, with the highest levels occurring during the pouring and mixing operations. This was lower than the mean lead-in-air level of 0.0886 mg/m3 in the lead battery manufacturing plants where the highest exposure was in the loading of lead ingots into milling machines. Workers in lead battery manufacturing had significantly higher mean blood lead than the PVC workers (means, 32.51 and 23.91 mcg/100 ml respectively), but there was poor correlation with lead-in-air levels. Among the lead workers, the Malays had significantly higher blood lead levels than the Chinese (mean blood levels were 33.03 and 25.35 mcg/100 ml respectively) although there was no significant difference between the two ethnic groups in the control group. There were no significant differences between the exposed and control group in terms of dietary intake of specified local foods known to contain lead. However, Malays consumed significantly more fish than the Chinese did. There were no ethnic differences in the hours of overtime work, number of years of exposure, usage of gloves and respirators and smoking habits. Among the Malays, 94.3% eat with their hands compared with 9.2% of the Chinese. Workers who ate with bare hands at least once a week had higher blood lead levels after adjusting for lead-in-air levels (mean blood lead was 30.2 and 26.4 mcg/100 ml respectively). The study indicated that the higher blood lead levels observed in the Malay workers might have been due to their higher exposure and eating with bare hands.

Adult↗
PubMed1994

Long-term trends in blood lead levels among children in Chicago: relationship to air lead levels.

OBJECTIVES: To evaluate trends in blood lead levels among children in Chicago from 1968 through 1988, and to determine the impact of the changes in the Centers for Disease Control and Prevention (CDC) blood lead level of concern. METHODS: We reviewed a systematic sample of blood lead screening records of the Chicago Department of Health Laboratory for high-risk children aged 6 months to 5 years. Median blood lead levels for each quarter of the years 1974 through 1988 were determined and regressed against mean air lead levels recorded at air-monitoring stations in Chicago during the same period. RESULTS: Median blood lead levels declined from 30 micrograms/dL in 1968 to 12 micrograms/dL in 1988, and were strongly associated with declining average air lead levels (r = .8, P < .001) from 1974 through 1988. A regression model using log-transformed data predicted a decline of 0.56 microgram/dL in the median blood lead level with each 0.1 microgram/m3 decline in the mean air lead level when the air lead level was near 1.0 microgram/m3; the predicted slope was steeper at lower air lead levels. Despite the nearly 20-fold reduction in air lead levels, the median blood lead level of 12 micrograms/dL in 1988 indicates substantial continuing lead exposure. The CDC blood lead level of concern was lowered twice from 1968 to 1988, but due to the decline in blood lead levels, fewer than 30% of the children were above the level of concern throughout most of the study. CONCLUSION: Although substantial lead exposure persists in Chicago, reductions in airborne lead emissions seem to have contributed to a long-term decline in the median blood lead level of high-risk Chicago children.

Age Factors↗
PubMed2004

Reconstruction of the 12-lead electrocardiogram from reduced lead sets.

In clinical practice, continuous recording of all leads of the 12-lead electrocardiogram (ECG) is often not possible. We wanted to assess how well absent, noisy, or defective leads can be reconstructed from different lead subsets and how well lead reconstruction performs over time. A data set of 234 24-hour ECG recordings was divided into an equally sized training and test set. Precordial leads were systematically removed, and for all lead subsets including both limb leads and at least one precordial lead, the absent leads were reconstructed using general and patient-specific reconstruction templates. Reconstruction performance was measured by correlation between the original and reconstructed leads over the QRS and T waves, by average and maximum absolute ST differences, and by agreement when a clinical decision rule was applied. Reconstruction performance over time was evaluated at baseline, at 20 minutes, and 1, 6, 12 and 24 hours after the start of each recording. Reconstruction accuracy was high (correlation > or =0.932, average ST difference < or =30 microV, agreement > or =94.9%) with general reconstruction for lead sets with 1 or 2 precordial leads removed but was less satisfactory when more leads were missing. Patient-specific reconstruction performed well when up to 4 precordial leads were removed (correlation > or =0.967, average ST difference < or =26 microV, agreement > or =95.7%). Patient-specific reconstruction performance initially slightly decreased and then stabilized over time but remained much better than general reconstruction after 24 hours. Accurate reconstruction of the 12-lead ECG from lead subsets is possible over time. General reconstruction allows reconstruction of 1 or 2 precordial leads, whereas up to 4 leads can be reconstructed well using patient-specific reconstruction.

Angina, Unstable↗
PubMed2003

Durability of repaired sensing leads equivalent to that of new leads in implantable cardioverter defibrillator patients with sensing abnormalities.

Breaks in the insulation portions of implantable cardioverter defibrillator (ICD) leads may cause nonphysiological sensing and subsequent inappropriate ICD therapy, and may also interfere with the sensing and pacing functions of the ICD. Previously, leads with insulation breaks have been replaced with new sensing leads. However, repair of leads, utilizing a commercially available patch kit may reduce the morbidity, hospital stay, and cost of lead replacement. The long-term durability of these repairs has not previously been reported and is the subject of this study. Patients undergoing ICD sensing lead repair or replacement constituted the study population. Patients were followed at 3 month intervals with an endpoint of new lead abnormalities necessitating repeat lead repair or replacement. Twenty-five patients underwent lead repair and 27 individuals underwent lead replacement for either preoperative nonphysiological sensing (n = 25) or intraoperative evidence of insulation break (n = 27). There was no significant difference between the individuals undergoing lead repair or replacement in age (59 +/- 9 vs 60 +/- 12 years), mean left ventricular ejection fraction (40%+/- 18% vs 33%+/- 17%) or age of the lead being repaired or replaced (4.5 +/- 2.0 years vs 5.0 +/- 2.0 years). During follow-up of 44 +/- 23 months, 4 of the repaired leads and 4 of the replaced leads developed new insulation breaks requiring surgical intervention (P = 0.43). In conclusion, in nearly 4 years of follow-up of patients with sensing lead insulation breaks, there was no difference is subsequent lead survival in those with lead repair compared to those with new sensing leads inserted. The strategy of lead repair, when technically feasible, should thus be considered in all patients with sensing abnormalities secondary to insulation breaks.

Defibrillators, Implantable↗
PubMed2000

Sensing lead failure in implantable defibrillators: a comparison of two commonly used leads.

INTRODUCTION: Despite major technological advances, structural problems in implantable cardioverter defibrillator (ICD) endocardial sensing leads remain a significant problem. There are two types of ICD sensing leads: (1) dedicated bipolar leads and (2) integrated lead systems that include defibrillation coils. The long-term performance of these two lead systems has not been directly compared. METHODS AND RESULTS: We prospectively examined the incidence of lead failure manifested by inappropriate arrhythmia detection in 247 consecutive patients undergoing abdominal ICD implant at a single center between 1991 and 1995. A total of 107 patients received BT-10 (dedicated bipolar) leads and 140 patients received Endotak (integrated bipolar) leads. Over a mean follow-up of 860 +/- 442 days, there were 19 (17.8%) lead failures with the BT-10 lead (261 to 1,505 days postimplant) compared with only 6 (4.3%; P < 0.01) with the Endotak lead (410 to 1,211 days postimplant). Lead failure was due to an insulation defect in all cases, with the problem occurring in the proximal lead (within the pulse generator pocket) in all but one case. Lead survival was significantly better with the Endotak lead (P = 0.015, risk ratio = 3.0, 95% confidence intervals 1.2 to 7.6). CONCLUSION: Late lead failure due to insulation defects in BT-10 sensing leads (causing inappropriate ICD activation) is a relatively common and progressive phenomenon, with difficulties becoming apparent as long as 4 years after implant. This problem is a likely cause of inappropriate shocks in patients with BT-10 leads. Implantation of a new sensing lead should be considered at the time of elective pulse generator replacement, even in the absence of demonstrable oversensing.

Aged↗