Functional connectivity within an anxiety network and associations with anxiety symptom severity in middle-aged adults with and without autism

Anxiety is highly prevalent in autism spectrum disorders (ASDs). However, few functional magnetic resonance imaging (fMRI) studies of ASDs have focused on anxiety (and fewer still on anxiety in middle-aged adults). Thus, relationships between atypical connectivity and anxiety in this population are poorly understood. The current study contrasted functional connectivity within anxiety network regions across adults (40-64 years) with and without autism, and tested for group by functional connectivity interactions on anxiety. Twenty-two adults with ASDs (16 males) and 26 typical control (TC) adults (22 males) completed the Beck Anxiety Inventory and a resting-state fMRI scan. An anxiety network consisting of 12 regions of interest was defined, based on a meta-analysis in TC individuals and two studies on anxiety in ASDs. We tested for main effects of group and group by anxiety interactions on connectivity within this anxiety network, controlling for head motion using ANCOVA. Results are reported at an FDR adjusted threshold of q < 0.1 (corrected) and p < 0.05 (uncorrected). Adults with ASDs showed higher anxiety and underconnectivity within the anxiety network, mostly involving bilateral insula. Connectivity within the anxiety network in the ASD group showed distinct relationships with anxiety symptoms that did not relate to ASD symptom severity. Functional connectivity involving the bilateral posterior insula was positively correlated with anxiety in the ASD (but not the TC) group. Increased anxiety in middle-aged adults with ASD is associated with atypical functional connectivity, predominantly involving bilateral insula. Results were not related to ASD symptom severity suggesting independence of anxiety-related effects. LAY SUMMARY: Anxiety is very common in adults with autism but the brain basis of this difference is not well understood. We compared functional connectivity between anxiety-related brain regions in middle-aged adults with and without autism. Adults with autism were more anxious and showed weaker functional connections between these regions. Some relationships between functional connectivity and higher anxiety were specific to the autism group. Results suggest that anxiety functions differently in autism.

Performance of machine learning classification models of autism using resting-state fMRI is contingent on sample heterogeneity

Autism spectrum disorders (ASDs) are heterogeneous neurodevelopmental conditions. In fMRI studies, including most machine learning studies seeking to distinguish ASD from typical developing (TD) samples, cohorts differing in gender and symptom severity composition are often treated statistically as one "ASD group". Using resting-state functional connectivity (FC) data, we implemented random forest to build diagnostic classifiers in 4 ASD samples including a total of 656 participants (N_ASD = 306, N_TD = 350, ages 6-18). Groups were manipulated to titrate heterogeneity of gender and symptom severity and partially overlapped. Each sample differed on inclusionary criteria: (1) all genders, unrestricted severity range; (2) only male participants, unrestricted severity; (3) all genders, higher severity only; (4) only male participants, higher severity. Each set consisted of 200 participants per group (ASD, TD; matched on age and head motion), 160 for training and 40 for validation. FMRI time series from 237 regions of interest (ROIs) were Pearson correlated in a 237×237 FC matrix and classifiers were built using random forest in training samples. Classification accuracies in validation samples were 62.5%, 65%, 70% and 73.75%, respectively for samples 1-4. Connectivity within cingulo-opercular task control (COTC) network, and between COTC ROIs and default mode and dorsal attention network contributed overall most informative features, but features differed across sets. Findings suggest that diagnostic classifiers vary depending on ASD sample composition. Specifically, greater homogeneity of samples regarding gender and symptom severity enhances classifier performance. However, given the true heterogeneity of ASDs, performance metrics alone may not adequately reflect classifier utility.

Distinct Patterns of Atypical Functional Connectivity in Lower-Functioning Autism

BACKGROUND

Functional magnetic resonance imaging research on autism spectrum disorders (ASDs) has been largely limited to individuals with near-average intelligence. Although cognitive impairment is common in ASDs, functional network connectivity in this population remains poorly understood. Specifically, it remains unknown whether lower-functioning individuals exhibit exacerbated connectivity abnormalities similar to those previously detected in higher-functioning samples or specific divergent patterns of connectivity.

METHODS

Resting-state functional magnetic resonance imaging data from 88 children (44 ASD, 44 typically developing; average age: 11 years) were included. Based on IQ, individuals with ASDs were assigned to either a lower-functioning group (mean IQ = 77 ± 6) or a higher-functioning group (mean IQ = 123 ± 8). Two typically developing comparison groups were matched to these groups on head motion, handedness, and age. Seeds in the medial prefrontal cortex, posterior cingulate cortex, posterior superior temporal sulcus, insula, and amygdala were used to contrast whole-brain functional connectivity across groups.

RESULTS

Lower-functioning ASD participants (compared with higher-functioning ASD participants) showed significant underconnectivity within the default mode network and the ventral visual stream. Higher-functioning ASD participants (compared with matched typically developing participants) showed significantly decreased anticorrelations among default mode, salience, and task-positive regions. Effect sizes of detected differences were large (Cohen's d > 1.46).

CONCLUSIONS

Lower- and higher-functioning individuals with ASDs demonstrated distinct patterns of atypical connectivity. Findings suggest a gross pattern of predominantly reduced network integration in lower-functioning ASDs (affecting default mode and visual networks) and predominantly reduced network segregation in higher-functioning ASDs. Results indicate the need for stratification by general functional level in studies of functional connectivity in ASDs.

Pain Catastrophizing and Pain Persistence in Temporomandibular Disorder Patients

AIMS

To describe pain catastrophizing in temporomandibular disorder (TMD) patients in relation to disability and pain persistence.

METHODS

A total of 163 TMD patients underwent a complete TMD evaluation according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), including the Pain Catastrophizing Scale (PCS). Patients were divided into subgroups according to their PCS, Graded Chronic Pain Scale (GCPS), and pain persistence scores. The GCPS and pain persistence subgroups were assigned as dependent variables in a stepwise multiple logistic regression model. The ability of the DC/TMD Axis II parameters and of the PCS to discriminate between patients of low and high disability (according to the GCPS) and low and high pain persistence were examined using area under the receiver operating characteristic (ROC) curve. α < .05 was considered to reflect statistical significance.

RESULTS

Significant differences were found between high and low pain catastrophizing patients as to socioeconomic parameter, Axis I diagnoses, pain persistence, and Axis II evaluation. The parameters with significant discriminant ability for pain persistence were pain catastrophizing, depression, and nonspecific physical symptoms, with no significant differences between them. Depression increased the odds of high disability by 1.2, while pain catastrophizing increased the odds for high pain persistence more than 6-fold. Pain catastrophizing was not significantly associated with pain disability, and depression was not significantly associated with pain persistence.

CONCLUSION

High-pain catastrophizing TMD patients were similar to patients with other chronic pain conditions, but differed from TMD patients as a group. The findings of this study support the addition of an assessment for pain catastrophizing to the DC/TMD for early identification of TMD patients who might be at higher risk for developing chronic pain.

Multimodal approaches to functional connectivity in autism spectrum disorders: An integrative perspective

Atypical functional connectivity has been implicated in autism spectrum disorders (ASDs). However, the literature to date has been largely inconsistent, with mixed and conflicting reports of hypo- and hyper-connectivity. These discrepancies are partly due to differences between various neuroimaging modalities. Functional magnetic resonance imaging (fMRI), electroencephalography (EEG), and magnetoencephalography (MEG) measure distinct indices of functional connectivity (e.g., blood-oxygenation level-dependent [BOLD] signal vs. electrical activity). Furthermore, each method has unique benefits and disadvantages with respect to spatial and temporal resolution, vulnerability to specific artifacts, and practical implementation. Thus far, functional connectivity research on ASDs has remained almost exclusively unimodal; therefore, interpreting findings across modalities remains a challenge. Multimodal integration of fMRI, EEG, and MEG data is critical in resolving discrepancies in the literature, and working toward a unifying framework for interpreting past and future findings. This review aims to provide a theoretical foundation for future multimodal research on ASDs. First, we will discuss the merits and shortcomings of several popular theories in ASD functional connectivity research, using examples from the literature to date. Next, the neurophysiological relationships between imaging modalities, including their relationship with invasive neural recordings, will be reviewed. Finally, methodological approaches to multimodal data integration will be presented, and their future application to ASDs will be discussed. Analyses relating transient patterns of neural activity ("states") are particularly promising. This strategy provides a comparable measure across modalities, captures complex spatiotemporal patterns, and is a natural extension of recent dynamic fMRI research in ASDs. © 2017 Wiley Periodicals, Inc. Develop Neurobiol 78: 456-473, 2018.

Lost in plasmids: next generation sequencing and the complex genome of the tick-borne pathogen Borrelia burgdorferi

Background

Borrelia (B.) burgdorferi sensu lato, including the tick-transmitted agents of human Lyme borreliosis, have particularly complex genomes, consisting of a linear main chromosome and numerous linear and circular plasmids. The number and structure of plasmids is variable even in strains within a single genospecies. Genes on these plasmids are known to play essential roles in virulence and pathogenicity as well as host and vector associations. For this reason, it is essential to explore methods for rapid and reliable characterisation of molecular level changes on plasmids.

In this study we used three strains: a low passage isolate of B. burgdorferi sensu stricto strain B31(−NRZ) and two closely related strains (PAli and PAbe) that were isolated from human patients. Sequences of these strains were compared to the previously sequenced reference strain B31 (available in GenBank) to obtain proof-of-principle information on the suitability of next generation sequencing (NGS) library construction and sequencing methods on the assembly of bacterial plasmids. We tested the effectiveness of different short read assemblers on Illumina sequences, and of long read generation methods on sequence data from Pacific Bioscience single-molecule real-time (SMRT) and nanopore (Oxford Nanopore Technologies) sequencing technology.

Results

Inclusion of mate pair library reads improved the assembly in some plasmids as did prior enrichment of plasmids. While cp32 plasmids remained refractory to assembly using only short reads they were effectively assembled by long read sequencing methods. The long read SMRT and nanopore sequences came, however, at the cost of indels (insertions or deletions) appearing in an unpredictable manner. Using long and short read technologies together allowed us to show that the three B. burgdorferi s.s. strains investigated here, whilst having similar plasmid structures to each other (apart from fusion of cp32 plasmids), differed significantly from the reference strain B31-GB, especially in the case of cp32 plasmids.

Conclusion

Short read methods are sufficient to assemble the main chromosome and many of the plasmids in B. burgdorferi. However, a combination of short and long read sequencing methods is essential for proper assembly of all plasmids including cp32 and thus, for gaining an understanding of host- or vector adaptations. An important conclusion from our work is that the evolution of Borrelia plasmids appears to be dynamic. This has important implications for the development of useful research strategies to monitor the risk of Lyme disease occurrence and how to medically manage it.

Electronic supplementary material

The online version of this article (doi:10.1186/s12864-017-3804-5) contains supplementary material, which is available to authorized users.

Using Make for Reproducible and Parallel Neuroimaging Workflow and Quality-Assurance

The contribution of this paper is to describe how we can program neuroimaging workflow using Make, a software development tool designed for describing how to build executables from source files. A makefile (or a file of instructions for Make) consists of a set of rules that create or update target files if they have not been modified since their dependencies were last modified. These rules are processed to create a directed acyclic dependency graph that allows multiple entry points from which to execute the workflow. We show that using Make we can achieve many of the features of more sophisticated neuroimaging pipeline systems, including reproducibility, parallelization, fault tolerance, and quality assurance reports. We suggest that Make permits a large step toward these features with only a modest increase in programming demands over shell scripts. This approach reduces the technical skill and time required to write, debug, and maintain neuroimaging workflows in a dynamic environment, where pipelines are often modified to accommodate new best practices or to study the effect of alternative preprocessing steps, and where the underlying packages change frequently. This paper has a comprehensive accompanying manual with lab practicals and examples (see Supplemental Materials) and all data, scripts, and makefiles necessary to run the practicals and examples are available in the “makepipelines” project at NITRC.

Subregional differences in intrinsic amygdala hyperconnectivity and hypoconnectivity in autism spectrum disorder

The amygdala is a complex structure with distinct subregions and dissociable functional networks. The laterobasal subregion of the amygdala is hypothesized to mediate the presentation and severity of autism symptoms, although very little data are available regarding amygdala dysfunction at the subregional level. In this study, we investigated the relationship between abnormal amygdalar intrinsic connectivity, autism symptom severity, and anxiety and depressive symptoms. We collected resting state fMRI data on 31 high functioning adolescents and adults with autism spectrum disorder and 38 typically developing (TD) controls aged 14-45. Twenty-five participants with ASD and 28 TD participants were included in the final analyses. ASD participants were administered the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule. Adult participants were administered the Beck Depression Inventory II and the Beck Anxiety Inventory. Functional connectivity analyses were conducted from three amygdalar subregions: centromedial (CM), laterobasal (LB) and superficial (SF). In addition, correlations with the behavioral measures were tested in the adult participants. In general, the ASD group showed significantly decreased connectivity from the LB subregion and increased connectivity from the CM and SF subregions compared to the TD group. We found evidence that social symptoms are primarily associated with under-connectivity from the LB subregion whereas over-connectivity and under-connectivity from the CM, SF and LB subregions are related to co-morbid depression and anxiety in ASD, in brain regions that were distinct from those associated with social dysfunction, and in different patterns than were observed in mildly symptomatic TD participants. Our findings provide new evidence for functional subregional differences in amygdala pathophysiology in ASD. Autism Res 2016, 9: 760-772. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.

The association between higher order abilities, processing speed, and age are variably mediated by white matter integrity during typical aging

Although aging is associated with changes in brain structure and cognition it remains unclear which specific structural changes mediate individual cognitive changes. Several studies have reported that white matter (WM) integrity, as assessed by diffusion tensor imaging (DTI), mediates, in part, age-related differences in processing speed (PS). There is less evidence for WM integrity mediating age-related differences in higher order abilities (e.g., memory and executive functions). In 165 typically aging adults (age range 54-89) we show that WM integrity in select cerebral regions is associated with higher cognitive abilities and accounts variance not accounted for by PS or age. Specifically, voxel-wise analyses using tract-based spatial statistics (TBSS) revealed that WM integrity was associated with reasoning, cognitive flexibility and PS, but not memory or word fluency, after accounting for age and gender. While cerebral fractional anisotropy (FA) was only associated with PS; mean (MD), axial (AD) and radial (RD) diffusivity were associated with reasoning and flexibility. Reasoning was selectively associated with left prefrontal AD, while cognitive flexibility was associated with MD, AD and RD throughout the cerebrum. Average WM metrics within select WM regions of interest accounted for 18% and 29% of the variance in reasoning and flexibility, respectively, similar to the amount of variance accounted for by age. WM metrics mediated ~50% of the age-related variance in reasoning and flexibility and different proportions, 11% for reasoning and 44% for flexibility, of the variance accounted for by PS. In sum, (i) WM integrity is significantly, but variably, related to specific higher cognitive abilities and can account for a similar proportion of variance as age, and (ii) while FA is selectively associated with PS; while MD, AD and RD are associated with reasoning, flexibility and PS. This illustrates both the anatomical and cognitive selectivity of structure-cognition relationships in the aging brain.

[Diagnosis and treatment of overactive bladder, neurourology, urogynaecology and urinary stress incontinence: latest publications from 2009 and 2010]

The current review presents a summary of the most important manuscripts concerning the topics of overactive bladder, neurourology, genital prolapse and male and female urinary stress incontinence published in the year 2009 and the first 4 months of 2010 in peer-reviewed journals. The literature research was focussed on clinically relevant human studies with influence on diagnosis and therapeutic strategies of these diseases.Most of the published manuscripts focussed on the fields of overactive bladder and female urinary stress incontinence during the last 16 months. Some of the studies had very high evidence levels and confirmed new therapeutic strategies. Publications focussing on male urinary stress incontinence were of limited numbers in the year 2009 and did not change the clinical armamentarium significantly.

[Prevention of postoperative urinary stress incontinence]

Postoperative stress incontinence following operative treatment of prostate cancer represents a considerable percentage of overall male incontinence. Postoperative incontinence following radical prostatectomy ranges between 2.9 and 87% depending on author and patient characteristics. Especially patient-related factors such as body mass index, age, size of prostate, preoperative incontinence, and concomitant diseases as well as classification of incontinence and modality of data collection influence postoperative continence rates. However, recent publications demonstrate the important impact of different operative techniques with regard to postoperative continence.The preservation of the muscular urethral sphincter is of particular importance. Nevertheless, the preservation of further anatomical structures contributes to postoperative continence. Preservation of bladder neck, nerve sparing, and reconstruction of the vesicourethral junction are operative techniques to prevent postoperative incontinence. In the last decade different modifications of the operative technique have been investigated regarding specific effects on postoperative continence. The interpretation of these studies investigating these operative techniques showed improvement in early continence with shorter period of time to continence. Long-term follow-up revealed no significant advantages for these modifications with regard to continence compared to the standard procedure. To evaluate the long-term effects of certain modifications to prevent incontinence, randomized and well powered studies are necessary. It seems to be most likely that a combination of these preventive modifications will lead to improved postoperative continence rates.

No relevant difference in quality of life and functional outcome at 12 months' follow-up-a randomised controlled trial comparing robot-assisted versus conventional laparoscopic Nissen fundoplication

PURPOSE

The present randomised pilot trial was designed to compare robot-assisted (RALF) and conventional laparoscopic fundoplication (CLF) focussing on post-operative quality of life (QOL) and functional outcome. Any long-lasting advantages for patients in this regard could be a justification for the use of RALF for the treatment of gastroesophageal reflux disease (GERD).

METHODS

Forty patients with GERD were randomised to either RALF or to CLF. During a follow-up period of 12 months, patients' QOL and functional outcome were investigated using disease-specific questionnaires.

RESULTS

There were no significant differences in the mean QOL (1.3 versus 1.1; P = 0.374) and functional outcome (1.27 versus 1.3; P = 0.913) between both groups. Minor side effects such as bloating and persistent diarrhoea were present in four patients of each group.

CONCLUSION

The present study did not show any benefit for RALF over CLF regarding QOL and functional outcome at 12 months' follow-up.

Success and complication parameters for laparoscopic surgery: a benchmark for natural orifice transluminal endoscopic surgery

BACKGROUND

Natural orifice transluminal endoscopic surgery (NOTES) currently represents an issue of particular interest among surgeons and gastroenterologists. The principle of NOTES is the reduction of the operative trauma by using natural orifices of the human body to access the abdominal cavity. Regarding the tendency to further minimization of the surgical trauma, NOTES may be considered as a logical step in the evolution of minimally invasive surgery. Pioneers of this technique regard NOTES as the successor to laparoscopic surgery in enabling surgeons and gastroenterologists to conduct scarless surgery. This might not only lead to better cosmetic results but also enhance the prospect of decreases in wound infections and incisional hernias, as well as reducing operative stress, postoperative immobility, and pain.

MATERIAL AND METHODS

In this article the authors collect and review the existing literature concerning NOTES and establish a benchmark for the assessment of this new technique by stating results from conventional minimally invasive surgery as the gold standard.

CONCLUSION

It is shown that publications investigating possible advantages or long-term results of NOTES are scarce. However, the investigation and verification of potential advantages and disadvantages represent the most important step in the development of a new technique. Only proven advantages would justify the broad implementation of a new technique in relation to its specific risks. Conventional laparoscopic surgery as the current standard of minimally invasive surgery will be the benchmark for NOTES with regard to most issues. Superiority of NOTES in at least several issues would be the best argument for its further implementation into clinical practice.

Robot-assisted versus conventional laparoscopic fundoplication: short-term outcome of a pilot randomized controlled trial

BACKGROUND

Robotic technology represents the latest development in minimally-invasive surgery. Nevertheless, robotic-assisted surgery seems to have specific disadvantages such as an increase in costs and prolongation of operative time. A general clinical implementation of the technique would only be justified if a relevant improvement in outcome could be demonstrated. This is also true for laparoscopic fundoplication. The present study was designed to compare robotic-assisted (RALF) and conventional laparoscopic fundoplication (CLF) with the focus on operative time, costs und perioperative outcome.

METHODS

Forty patients with gastro-esophageal reflux disease were randomized to either RALF by use of the daVinci Surgical System or CLF. Nissen fundoplication was the standard anti-reflux procedure. Peri-operative data such as length of operative procedure, intra-and postoperative complications, length of hospital stay, overall costs and symptomatic short-term outcome were compared.

RESULTS

The total operative time was shorter for RALF compared to CLF (88 vs. 102 min; p = 0.033) consisting of a longer set-up (23 vs. 20 min; p = 0.050) but a shorter effective operative time (65 vs. 82 min; p = 0.006). Intraoperative complications included one pneumothorax and two technical problems in the RALF group and two bleedings in the CLF group. There were no conversions to an open approach. Mean length of hospital stay (2.8 vs. 3.3 days; p = 0.086) and symptomatic outcome thirty days postoperatively (10% vs. 15% with ongoing PPI therapy; p = 1.0 and 25% vs. 20% with persisting mild dysphagia; p = 1.0) was similar in both groups. Costs were higher for RALF than for CLF (3244 euros vs. 2743 euros, p = 0.003).

CONCLUSION

In comparison with CLF, operative time can be shorter for RALF if performed by an experienced team. However, costs are higher and short-term outcome is similar. Thus, RALF can not be favoured over CLF regarding perioperative outcome.

An automated systems for air sampling with annular denuder systems at a remote site

An automated air sampling system has been designed for use with the annular denuder system (ADS). The automated air sampling system allows for accurate measurements of air volume and day-night sampling while preventing the accumulation of moisture within the ADS caused by condensation or cloud events. The sampling system consists of air flow, monitoring and control subsystems. Calibration of the sampling system against a Hoffer turbine flow meter indicated accurate measurement of air flow volumes. Field testing and preliminary data have shown that the sampling system functions well in a remote mountain forest site, and was relatively unaffected by condensation, fog, or cloud events.

Normal blood pressure and the evaluation of sustained blood pressure elevation in childhood: the Muscatine study

This study describes the seated blood pressure distributions of 6,622 predominantly white schoolchildren in Muscatine, Iowa. Subjects with seated pressures equal to or greater than the 95th percentile for age and sex or 140 mm Hg systolic or 90 mm Hg diastolic were examined on repeated occasions. Approximately 13% of subjects were found to have blood pressures at these levels when first examined, but less than 1% were found to have persistent blood pressure elevations. Of 41 subjects found to have persistent blood pressure elevations, 23 were obese with relative weights in excess of 120%. Of the 18 lean subjects, 5 had secondary hypertension and 13 were considered to have essential hypertension. Mass screening of school-age children identifies many children with transient elevation of blood pressure and few with fixed high blood pressures. Children's blood pressures should be assessed during their continuing care where pressures can be measured over a period of time to identify those with fixed blood pressure elevations.

Blood pressure, salt preference, salt threshold, and relative weight

This study was performed to observe the relationships of salt preference, salt threshold, the relative weight to blood pressure. Three groups were selected from 4,800 school children on the basis of mean blood pressure: less than or equal to fifth percentile, in the area of the 50th percentile, and greater than or equal to 95th percentile. Salt threshold was determined by titrating, on each subject's tongue, solutions ranging from 1 to 60 millimols/liter of sodium chloride. Salt preference was tested by the addition of salt by each subject to unsalted tomato juice and beef broth according to individual taste. The samples were then analyzed for sodium concentration. The coefficient of correlation for the amount of salt added to juice and broth was significant (r=0.63). There was no relationship of salt threshold to preference, nor did threshold or preference relate to blood pressure. Relative weight was related to blood pressure range being the most obese.

Coronary heart disease risk factors in school children: the Muscatine study

The frequency of coronary risk factors was documented in 4,829 school children in Muscatine, Iowa, over a 14-month period of time. Serum cholesterol levels were similar for children at all ages; the mean serum cholesterol level was 182 mg/dl (SD lus or minus 29). Twenty four percent had levels larger than or equal to 200 mg/dl, 9% were larger than or equal to 220 mg/dl, 3 % were larger than or equal to 240 mg/dl, and 1% were larger than or equal to 260 mg/dl. Casual levels of serum triglyceride increased with age: the mean level was 71 mg/dl (SD plus or minus 36) at age 6 years and 108 mg/dl (SD plus or minus 45) at age 18 years. Only 15% of the children had serum triglyceride levels of 140 mg/dl or more. Blood pressure increased strikingly with age. No child between 6 and 9 years of age had blood pressures larger than or equal to 140 mm Hg systolic or larger than or equal to 90 mm Hg diastolic. In the age group 14 to 18 years, 8.9% had systolic blood pressures larger than or equal to 140 mm Hg, 12.2% had diastolic blood pressures larger than or equal to 90 mm Hg, and in 4.4% both pressures were at or above these levels. Obesity also increased through the school years. At ages 6 to 9 years, 20% had weights relative to those of the group as a whole of larger than or equal to 110%, and 5% were larger than or equal to 130%; in the 14 to 18 years age group, 25% had relative weights of larger than or equal to 110%, and 8% were larger than or equal to 130%. These data indicate that a considerable number of school-age children have risk factors which in adults are predictive of coronary heart disease.