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The value of an objective exercise test for the assessment of the functional results of aortocoronary bypass was investigated in 19 patients who were studied before and six months after the operation. For positive tests the end point was defined as a net ST segment depression of 0·1 mv 80 ms after the J point of the ECG. For negative tests the end point was 85% of the age-predicted maximal heart rate response. One patient who was not able to attain either of these points after the operation was excluded. In the remaining 18 patients three indices were used in the analysis. First, the heart rate (HR) and the product of heart rate and systolic blood pressure (RPP) were measured at the defined level of ST segment depression during positive exercise tests to yield HR/ST and RPP/ST threshold respectively. Second, the HR and RPP were measured at the end point of the negative tests. Third, the duration of exercise till the end point of the tests was measured. In each patient the duration of the postoperative test was longer than that of the preoperative test. While all the patients had a positive exercise test before the operation, the test was negative in 11 after it. In 10 of these 11 patients the HR and RPP attained at the end point of the postoperative test had increased; the HR and RPP remained unchanged in one patient. Positive tests were still present in seven of the 18 patients. In five of these the HR/ST threshold and RPP/ST threshold were greater after than before operation, and they remained unchanged in two. An improvement in myocardial blood supply after aortocoronary bypass was suggested indirectly by the ability to attain, during exercise, a higher HR and RPP at the end point of the test. The test proved especially valuable in patients who retained a positive exercise test after the operation. [ABSTRACT FROM PUBLISHER]

The effects of a simple physical training programme were investigated in a prospective and randomised trial in patients with stable angina pectoris using a modified exercise test. Twenty-four patients with ischaemic heart disease and an ischaemic response to conventional exercise electrocardiography were randomised into two groups: 12 patients took part in a training programme and 12 patients were allocated to a control group (no training). Exercise testing was performed sequentially at entry to the study and six months afterwards. At both studies we determined the heart rate at the same level of ischaemic ST segment depression (HR/ST threshold), the duration of the test, and relation of heart rate to the exercise load. The HR/ST threshold increased only in patients who underwent the exercise programme, suggesting indirectly that training resulted in the ability to do more work and attain a higher degree of myocardial oxygen consumption at the same level of myocardial ischaemia. In addition, training led to an increase in the duration of the test and to a reduction in heart rate at any level of submaximal exercise load. It is concluded that physical training in anginal patients results in an enhancement of myocardial oxygen availability. [ABSTRACT FROM PUBLISHER]

Purpose: To analyze the effects of positive end-expiratory pressure (PEEP) on Bohr's dead space (VD Bohr /VT) in patients with acute respiratory distress syndrome (ARDS)., Material and Methods: Fourteen ARDS patients under lung protective ventilation settings were submitted to 4 different levels of PEEP (0, 6, 10, 16 cmH 2 O). Respiratory mechanics, hemodynamics and volumetric capnography were recorded at each protocol step., Results: Two groups of patients responded differently to PEEP when comparing baseline with 16-PEEP: those in which driving pressure increased > 15% (∆P ˃15% , n = 7, p = .016) and those in which the change was ≤15% (∆P ≤15% , n = 7, p = .700). VD Bohr /VT was higher in ∆P ≤ 15% than in ∆P ≤15% patients at baseline ventilation [0.58 (0.49-0.60) vs 0.46 (0.43-0.46) p = .018], at 0-PEEP [0.50 (0.47-0.54) vs 0.41 (0.40-0.43) p = .012], at 6-PEEP [0.55 (0.49-0.57) vs 0.44 (0.42-0.45) p = .008], at 10-PEEP [0.59 (0.51-0.59) vs 0.45 (0.44-0.46) p = .006] and at 16-PEEP [0.61 (0.56-0.65) vs 0.47 (0.45-0.48) p = .001]. We found a good correlation between ∆P and VD Bohr /VT only in the ∆P ˃15% group (r = 0.74, p < .001)., Conclusions: Increases in PEEP result in higher VD Bohr /VT only when associated with an increase in driving pressure., (Copyright © 2018. Published by Elsevier Inc.)

Objective: To evaluate whether participation in a statewide enhanced prenatal and postnatal care program, the Maternal Infant Health Program (MIHP), reduced infant mortality risk., Methods: Data included birth and death records, Medicaid claims, and program participation. The study population consisted of Medicaid-insured singleton infants born between January 1, 2009, and December 31, 2012, in Michigan (n = 248 059). The MIHP participants were propensity score-matched with nonparticipants based on demographics, previous pregnancies, socioeconomic status, and chronic disease. Infant mortality, neonatal mortality, and postneonatal mortality analyses were presented by race., Results: Infants with any MIHP participation had reduced odds of death in the first year of life compared with matched nonparticipants (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.63-0.84). Infant death odds were reduced both among black infants (OR 0.71, 95% CI 0.58-0.87) and infants of other races (OR 0.74, 95% CI 0.61-0.91). Neonatal death (OR 0.70, 95% CI 0.57-0.86) and postneonatal death odds (OR 0.78, 95% CI 0.63-0.96) were also reduced. Enrollment and screening in MIHP by the end of the second pregnancy trimester and at least 3 additional prenatal MIHP contacts reduced infant mortality odds further (OR 0.70, 95% CI 0.58-0.85; neonatal: OR 0.67, 95% CI 0.51-0.89; postneonatal: OR 0.74, 95% CI 0.56-0.98)., Conclusions: A state Medicaid-sponsored population-based home-visitation program can be a successful approach to reduce mortality risk in a diverse, disadvantaged population. A likely mechanism is the reduction in the risk of adverse birth outcomes, consistent with previous findings on the effects of the program., (Copyright © 2015 by the American Academy of Pediatrics.)

An analysis of US Food and Drug Administration (FDA)-approved new molecular entities (NMEs) reveals dynamism in terms of new innovation. An assessment of the first patent for each drug shows that the pharmaceutical industry, particularly large, established companies in North America, tend to dominate the field. Over the past 10-15 years, European and Asian organizations have begun to close the gap. A dynamic inventive environment in drug discovery is suggested by the fact that NMEs for biologics or awarded to biotechnology companies often have inventors from the pharmaceutical and academic sectors. Whereas inventors continue to found biotechnology companies at a steady rate, recent trends suggest these inventors more often come from the private sector., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The aim of this clinical trial was to evaluate the effects of application mode on the clinical performance of a two-step etch-and-rinse adhesive in class V cavities over 24 months. Forty patients with at least three similar-sized non-carious cervical lesions participated in this study. A total of 120 restorations with Prime & Bond NT were placed, 40 in each group. The adhesive was applied with no rubbing action, with slight rubbing action, or with vigorous rubbing action. The restorations were placed incrementally using the composite resin Esthet-X. The restorations were evaluated at baseline and after 6, 12, and 24 months following the modified United States Public Health Service criteria. Statistical analysis was conducted using Friedman repeated measures analysis of variance by rank and using the Wilcoxon signed-rank test for significance at each pair (α = 0.05). The 24-month retention rates of Prime & Bond NT were 82.5% for the no rubbing group, 82.5% for the slight rubbing group, and 92.5% for vigorous rubbing group. No significant difference in the retention rates in each recall period was detected among groups (p > 0.05); however, the retention rates in the 24-month recall was statistically lower than the baseline only for no rubbing or slight rubbing groups. The use of a vigorous application mode can be a clinical approach to improve the retention of restorations placed in non-carious cervical lesions.