The incidence, angiographic characteristics, and natural history of coronary artery fistulas in patients undergoing diagnostic cardiac catheterization have not been well defined. Of 33,600 patients who had diagnostic cardiac catheterization, 34 (0.1%) had coronary artery fistula. Nineteen fistulas originated from the right, 11 from the left anterior descending, and 4 from the circumflex coronary arteries, respectively. The mean ratio of pulmonary to systemic flow was 1.19 +/- 0.33. Only one patient with coexistent atrial septal defect had a pulmonic to systemic flow ratio > 1.5. Right and left heart pressures, with the exception of three patients in whom left ventricular end-diastolic pressures was > 12 mm Hg, were within normal limits. During a mean follow-up period of 6.3 years (range 2-14 years), there were no complications related to coronary artery fistula. It was concluded that the incidence of coronary artery fistulas detected during diagnostic coronary angiography is very low. Coronary artery fistulas originate predominantly from the right coronary artery and are not associated with hemodynamic abnormalities or other congenital heart diseases. The prognosis of coronary artery fistulas in adults is good.

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The age of sand dunes in the Nebraska Sand Hills has been controversial, with some investigators suggesting a full-glacial age and others suggesting that they were last active in the late Holocene. New accelerator mass spectrometry radiocarbon ages of unaltered bison bones and organic-rich sediments suggest that eolian sand deposition occurred at least twice in the past 3000 14C yr B.P. in three widely separated localities and as many as three times in the past 800 14C yr at three other localities. These late Holocene episodes of eolian activity are probably the result of droughts more intense than the 1930s “Dust Bowl” period, based on independent Great Plains climate records from lake sediments and tree rings. However, new geochemical data indicate that the Nebraska Sand Hills are mineralogically mature. Eolian sands in Nebraska have lower K-feldspar (and K2O, Rb, and Ba) contents than most possible source sediments and lower K-feldspar contents than dunes of similar age in Colorado. The most likely explanation for mineralogical maturity is reduction of sand-sized K-feldspar to silt-sized particles via ballistic impacts due to strong winds over many cycles of eolian activity. Therefore, dunes of the Nebraska Sand Hills must have had a long history, probably extending over more than one glacial–interglacial cycle, and the potential for reactivation is high, with or without a future greenhouse warming.

Most previous workers have regarded the insoluble residues of high-purity Quaternary limestones (coral reefs and oolites) as the most important parent material for well-developed, clay-rich soils on Caribbean and western Atlantic islands, but this genetic mechanism requires unreasonable amounts of limestone solution in Quaternary time. Other possible parent materials from external sources are volcanic ash from the Lesser Antilles island arc and Saharan dust carried across the Atlantic Ocean on the northeast trade winds. Soils on Quaternary coral terraces and carbonate eolianites on Barbados, Jamaica, the Florida Keys (United States), and New Providence Island (Bahamas) were studied to determine which, if either, external source was important. Caribbean volcanic ashes and Saharan dust can be clearly distinguished using ratios of relatively immobile elements (Al2O3/TiO2, Ti/Y, Ti/Zr, and Ti/Th). Comparison of these ratios in 25 soils, where estimated ages range from 125,000 to about 870,000 yr, shows that Saharan dust is the most important parent material for soils on all islands. These results indicate that the northeast trade winds have been an important component of the regional climatology for much of the Quaterary. Saharan dust may also be an important parent material for Caribbean island bauxites of much greater age.

Lower estimated insulin sensitivity was associated with risk for hyperfiltration over time, whereas increased albumin excretion was associated with hyperglycemia in youth-onset T2DM.

of dobutamine on regional myocardial blood flow and ventricular performance during acute and chronic myocardial ischemia in dogs.

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