Oxidized Xanthan Gum Crosslinked NOCC: Hydrogel System and Their Biological Stability from Oxidation Levels of the Polymer.

Dynamic hydrogel systems from N,O-carboxymethyl chitosan (NOCC) are investigated in the past years, which has facilitated their widespread use in many biomedical engineering applications. However, the influence of the polymer's oxidation levels on the hydrogel biological properties is not fully investigated. In this study, chitosan is converted into NOCC and introduced to react spontaneously with oxidized xanthan gum (OXG) to form several injectable hydrogels with controlled degradability. Different oxidation levels of xanthan gum, as well as NOCC/OXG volume ratios, are trialed. The infrared spectroscopy spectra verify chemical modification on OXG and successful crosslinking. With increasing oxidation levels, more dialdehyde groups are introduced into the OXG, resulting in changes in physical properties including gelation, swelling, and self-healing efficiency. Under different volume ratios, the hydrogel shows a stable structure and rigidity with higher mechanical properties, and a slower degradation rate. The shear-thinning and self-healing properties of the hydrogels are confirmed. In vitro assays with L929 cells show the biocompatibility of all formulations although the use of a high amount of OXG15 and OXG25 limited the cell proliferation capacity. Findings in this study suggested a suitable amount of OXG at different oxidation levels in NOCC hydrogel systems for tissue engineering applications.

Primary cesarean section rate among full-term pregnant women with non-previous uterine scar in a hospital of Vietnam.

Aim: This article aims to determine the contributing indications for primary cesarean sections among full-term pregnant women with non-previous uterine scars and suggests several potential solutions to reduce the cesarean section rate. Methods: This is a descriptive study with data being retrospectively collected from electronic medical records (EMRs) at Hanoi Obstetrics & Gynecology Hospital, Vietnam, in 2020. We studied 23,631 women at ≥37 weeks of gestation with non-previous uterine scars. Main ICD-10 categories of diagnosis on the EMRs were used to classify the indications. The proportions of indications for primary cesarean sections were calculated, thereby offering potential solutions to reduce the cesarean section rate. Results: The proportion of cesarean sections among full-term pregnancies with non-previous uterine scars was 40.7%. The most common indications for primary cesarean sections were non-reassuring fetal heart rate tracing (40%), labor arrest (31%), and maternal request (11%). Among the low-risk pregnant women, the cesarean section rate was 35.9%, of which the percentages of labor arrest and non-reassuring fetal heart rate tracings and maternal request were 13.6%, 17.7%, and 4.6%, respectively. Conclusions: The proportion of primary cesarean sections among full-term pregnancies with non-previous uterine scars is high; non-reassuring fetal heart rate tracings, labor arrest, and maternal request were three main indications. It is necessary to build the strategies of health organizations regarding the management of clinical practices and the programs improving the knowledge, attitudes, practices of pregnant women and obstetricians regarding cesarean sections.

Improvement of symptoms after hysteroscopic isthmoplasty in women with abnormal uterine bleeding and expected pregnancy: A prospective study.

BACKGROUND: Cesarean scar myometrial defect as known as niche is associated with postmenstrual spotting, suprapubic pain and secondary infertility. Hysteroscopic isthmoplasty has been proposed in the treatment of niche. This study aims to determine the safety and effectiveness of hysteroscopic isthmoplasty in postmenstrual spotting treatment and improvement of spontaneous conceiving. MATERIALS AND METHOD: A prospective study was performed at Hanoi Obstetrics and Gynecology Hospital, Vietnam. We studied women who developed postmenstrual spotting related to niches and had desired to conceive for more than six months. Women with residual myometrium less than 2.5 mm were excluded. Twenty-three eligible women underwent hysteroscopic isthmoplasty with four main steps, including identification of relevant anatomy, resection of the cephalad edge of fibrosis, resection of the caudal edge of fibrosis, and ablation of the niche base. Participants were followed up at 1, 3, and 6 months postoperatively. RESULTS: The mean surgical duration was 17 min, and no complications took place. The number of women with improved postmenstrual spotting symptoms after 1, 3, and 6 months were 39.1% (9/23), 61.9% (13/21) and 68.8% (11/16), respectively. Suprapubic pain resolved in 94% (15/16) of the women in the first month. The rate of spontaneous pregnancies within 6 months of isthmoplasty was 30.4% (7/23). There were no differences in depth niche and residual myometrium thickness on ultrasound in the period before and after hysteroscopy. CONCLUSION: Our study supports that hysteroscopic isthmoplasty is a safe and effective procedure for women with a niche and postmenstrual spotting and wish to conceive.

Utilization of Response Surface Methodology in Optimization of Polysaccharides Extraction from Vietnamese Red Ganoderma lucidum by Ultrasound-Assisted Enzymatic Method and Examination of Bioactivities of the Extract.

Red Ganoderma lucidum (G. lucidum) is a popular medicinal herb commonly used in Vietnamese traditional remedies due to its potential value for health. In this study, polysaccharides were extracted from G. lucidum using ultrasound-assisted enzymatic extraction method. The response surface methodology and Box-Behnken design were employed to investigate the effects of pH, extraction temperature, extraction time, and ultrasonic power on the content of polysaccharides. Based on ultraviolet-visible spectroscopy analysis, the highest content of polysaccharides in the extract was 32.08 mg/g under optimum experimental parameters including enzyme concentration of 3%, pH of 5.5, extraction temperature of 45°C, extraction time of 30 min, and ultrasonic power of 480 W. The Fourier-transform infrared spectroscopy was also used to identify the functional groups in the extracts. The molecular weights of polysaccharides were determined by gel permeation chromatography. The obtained extract was then evaluated for anticancer activities by using (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, showing the anticancer activities with the half-maximal inhibitory concentration value of more than 512 µg/mL. This result suggested that UAEE could be considered as an appropriate and effective extraction method for bioactive crude polysaccharides from G. lucidum.

Analysis of the neurotoxin ß-N-methylamino-L-alanine (BMAA) and isomers in surface water by FMOC derivatization liquid chromatography high resolution mass spectrometry.

The neurotoxin ß-N-methylamino-L-alanine (BMAA), suspected to trigger neurodegenerative diseases, can be produced during cyanobacterial bloom events and subsequently affect ecosystems and water sources. Some of its isomers including ß-amino-N-methylalanine (BAMA), N-(2-aminoethyl) glycine (AEG), and 2,4-diaminobutyric acid (DAB) may show different toxicities than BMAA. Here, we set out to provide a fast and sensitive method for the monitoring of AEG, BAMA, DAB and BMAA in surface waters. A procedure based on aqueous derivatization with 9-fluorenylmethyl chloroformate (FMOC-Cl) was investigated for this purpose. Under optimized conditions, a small aqueous sample aliquot (5 mL) was spiked with BMAA-d3 internal standard, subjected to FMOC-Cl derivatization, centrifuged, and analyzed. The high-throughput instrumental method (10 min per sample) involved on-line pre-concentration and desalting coupled to ultra-high-performance liquid chromatography high-resolution mass spectrometry (UHPLC-HRMS). Chromatographic gradient and mobile phases were adjusted to obtain suitable separation of the 4 isomers. The method limits of detection were in the range of 2-5 ng L-1. In-matrix validation parameters including linearity range, accuracy, precision, and matrix effects were assessed. The method was applied to surface water samples (n = 82) collected at a large spatial scale in lakes and rivers in Canada. DAB was found in >70% of samples at variable concentrations (<3-1,900 ng L-1), the highest concentrations corresponding to lake samples in cyanobacterial bloom periods. BMAA was only reported (110 ng L-1) at one HAB-impacted location. This is one of the first studies to report on the profiles of AEG, BAMA, DAB, and BMAA in background and impacted surface waters.

Widespread occurrence and spatial distribution of glyphosate, atrazine, and neonicotinoids pesticides in the St. Lawrence and tributary rivers.

The occurrence and spatial distribution of selected pesticides were investigated along a 200-km reach of the St. Lawrence River (SLR) and tributaries in Quebec, Canada. Surface water samples (n = 68) were collected in the summer 2017 and analyzed for glyphosate, atrazine (ATZ), 8 systemic insecticides (acetamiprid, clothianidin, dinotefuran, fipronil, imidacloprid, nitenpyram, thiacloprid, and thiamethoxam) and some metabolites. Overall, 99% of the surface water samples were positive to at least one of the targeted pesticides. The most recurrent compounds were glyphosate (detection frequency: 84%), ATZ (82%), thiamethoxam (59%), desethylatrazine (DEA: 47%), and clothianidin (46%). Glyphosate displayed variable levels (4-3,000 ng L-1), with higher concentrations in south tributaries (e.g., Nicolet and Yamaska). In positive samples, the sum of ATZ and DEA varied between 5 and 860 ng L-1, and the sum of 6 priority neonicotinoids between 1.5 and 115 ng L-1. From Repentigny to the Sorel Islands, the spatial distribution of pesticides within the St. Lawrence River was governed by the different upstream sources (i.e., Great Lakes vs. Ottawa River) due to the limited mixing of the different water masses. Cross-sectional patterns revealed higher concentrations of glyphosate and neonicotinoids in the north portions of transects, while the middle and south portions showed higher levels of atrazine. In Lake St. Pierre and further downstream, cross-sections revealed higher levels of the targeted pesticides near the southern portions of the SLR. This may be due to the higher contributions from south shore tributaries impacted by major agricultural areas, compared to north shore tributaries with forest land and less cropland use. Surface water samples were compliant with guidelines for the protection of aquatic life (chronic effects) for glyphosate and atrazine. However, 31% of the samples were found to surpass the guideline value of 8.3 ng L-1 for the sum of six priority neonicotinoids.

Optimization of extraction methods for comprehensive profiling of perfluoroalkyl and polyfluoroalkyl substances in firefighting foam impacted soils.

The comprehensive analysis of aqueous film forming foam (AFFF) formulations has led in recent years to the discovery of novel classes of perfluoroalkyl and polyfluoroalkyl substances (PFASs). Whether the pre-existing analytical methods for historically monitored PFASs, including perfluorooctane sulfonate (PFOS), could be transferable to a large breadth of newly identified PFASs remains, however, an open question. Data from various lines of evidence indicate that current extraction procedures previously validated with anionic and neutral PFASs may seriously underperform for many cationic and zwitterionic PFASs. The extraction efficiency and instrumental response could be strongly matrix-dependent, which may preclude a robust analysis. The present study sought to investigate a suitable sample preparation procedure for the analysis of anionic, cationic, and zwitterionic PFASs in soil samples. In total, 86 PFASs, representing 24 chemical classes previously discovered in AFFF formulations or at AFFF-impacted sites, were evaluated. The merits and limitations of various extraction media were examined using an AFFF-impacted field-weathered loam soil, as well as a background loam soil amended with AFFFs in-house. Methanol with hydrochloric acid provided excellent recoveries for most cationic and zwitterionic PFASs, including fluorotelomer sulfonamidoalkyl betaines (e.g., 6:2 FTAB) and fluorotelomer betaines (e.g., 9:1:2 FTB), yet performed less satisfactorily for certain anionic PFASs, and may also cause conversion of some PFASs. Sequential extractions using methanol with ammonium acetate exhibited limited matrix effects and suitable recoveries of PFASs from soils of diverse textural classes and organic matter content. The newly-developed extraction method presented the best option for future in-depth characterization of PFASs at AFFF-impacted sites.

Spin splitting in 2D monochalcogenide semiconductors.

We report ab initio calculations of the spin splitting of the uppermost valence band (UVB) and the lowermost conduction band (LCB) in bulk and atomically thin GaS, GaSe, GaTe, and InSe. These layered monochalcogenides appear in four major polytypes depending on the stacking order, except for the monoclinic GaTe. Bulk and few-layer ε-and γ -type, and odd-number ß-type GaS, GaSe, and InSe crystals are noncentrosymmetric. The spin splittings of the UVB and the LCB near the Γ-point in the Brillouin zone are finite, but still smaller than those in a zinc-blende semiconductor such as GaAs. On the other hand, the spin splitting is zero in centrosymmetric bulk and even-number few-layer ß-type GaS, GaSe, and InSe, owing to the constraint of spatial inversion symmetry. By contrast, GaTe exhibits zero spin splitting because it is centrosymmetric down to a single layer. In these monochalcogenide semiconductors, the separation of the non-degenerate conduction and valence bands from adjacent bands results in the suppression of Elliot-Yafet spin relaxation mechanism. Therefore, the electron- and hole-spin relaxation times in these systems with zero or minimal spin splittings are expected to exceed those in GaAs when the D'yakonov-Perel' spin relaxation mechanism is also suppressed.

Crystal growth and characterization of the narrow-band-gap semiconductors OsPn2 (Pn = P, As, Sb).

Using metal fluxes, crystals of the binary osmium dipnictides OsPn2 (Pn = P, As, Sb) have been grown for the first time. Single-crystal X-ray diffraction confirms that these compounds crystallize in the marcasite structure type with orthorhombic space group Pnnm. The structure is a three-dimensional framework of corner- and edge-sharing OsPn6 octahedra, as well as [Pn2(4-)] anions. Raman spectroscopy shows the presence of P-P single bonds, consistent with the presence of [Pn2(-4)] anions and formally Os(4+) cations. Optical-band-gap and high-temperature electrical resistivity measurements indicate that these materials are narrow-band-gap semiconductors. The experimentally determined Seebeck coefficients reveal that nominally undoped OsP2 and OsSb2 are n-type semiconductors, whereas OsAs2 is p-type. Electronic band structure using density functional theory calculations shows that these compounds are indirect narrow-band-gap semiconductors. The bonding p orbitals associated with the Pn2 dimer are below the Fermi energy, and the corresponding antibonding states are above, consistent with a Pn-Pn single bond. Thermopower calculations using Boltzmann transport theory and constant relaxation time approximation show that these materials are potentially good thermoelectrics, in agreement with experiment.

Electronic structure of Zr-Ni-Sn systems: role of clustering and nanostructures in half-Heusler and Heusler limits.

Half-Heusler and Heusler compounds have been of great interest for several decades for thermoelectric, magnetic, half-metallic and many other interesting properties. Among these systems, Zr-Ni-Sn compounds are interesting thermoelectrics which can go from semiconducting half-Heusler (HH) limit, ZrNiSn, to metallic Heusler (FH) limit, ZrNi2Sn. Recently Makongo et al (2011 J. Am. Chem. Soc. 133 18843) found that dramatic improvement in the thermoelectric power factor of HH can be achieved by putting excess Ni into the system. This was attributed to an energy filtering mechanism due to the presence of FH nanostructures in the HH matrix. Using density functional theory we have investigated clustering and nanostructure formation in ZrNi1+xSn (0 â©½ x â©½ 1) systems near the HH (x = 0) and FH (x = 1) ends and have found that excess Ni atoms in HH tend to stay close to each other and form nanoclusters. On the other hand, there is competing interaction between Ni-vacancies occupying different sites in FH which prevents them from forming vacancy nanoclusters. Effects of nano-inclusions on the electronic structure near HH and FH ends are discussed.

Physics of bandgap formation in Cu-Sb-Se based novel thermoelectrics: the role of Sb valency and Cu d levels.

In this paper we discuss the results of ab initio electronic structure calculations for Cu(3)SbSe(4) (Se4) and Cu(3)SbSe(3) (Se3), two narrow bandgap semiconductors of thermoelectric interest. We find that Sb is trivalent in both the compounds, in contrast to a simple nominal valence (ionic) picture which suggests that Sb should be 5 + in Se4. The gap formation in Se4 is quite subtle, with hybridization between Sb 5s and the neighboring Se 4s, 4p orbitals, position of Cu d states, and non-local exchange interaction, each playing significant roles. Thermopower calculations show that Se4 is a better p-type system. Our theoretical results for Se4 agree very well with recent experimental results obtained by Skoug et al (2011 Sci. Adv. Mater. 3 602).

Detection of macrophages in atherosclerotic tissue using magnetic nanoparticles and differential phase optical coherence tomography.

We demonstrate the detection of iron oxide nanoparticles taken up by macrophages in atherosclerotic plaque with differential phase optical coherence tomography (DP-OCT). Magneto mechanical detection of nanoparticles is demonstrated in hyperlipidemic Watanabe and balloon-injured fat-fed New Zealand white rabbits injected with monocrystalline iron oxide nanoparticles (MIONs) of < 40 nm diam. MIONs taken up by macrophages was excited by an oscillating magnetic flux density and resulting nanometer tissue surface displacement was detected by DP-OCT. Frequency response of tissue surface displacement in response to an externally applied magnetic flux density was twice the stimulus frequency as expected from the equations of motion for the nanoparticle cluster.

A comparative evaluation of arterial blood flow and the healing response after femoral artery closure using angio-seal STS Plus and StarClose in a porcine model.

OBJECTIVES: This study prospectively evaluated the acute and chronic arterial blood flow and vascular pathology after vessel closure using two commonly used closure devices controlled by deploying both devices in each animal. BACKGROUND: Several vessel closure systems are approved for clinical use; however, few direct comparisons have ever been performed and no randomized case controlled study has been published using FDA-approved devices. METHODS: Nineteen Sous Scroufulae pigs underwent bilateral percutaneous arteriotomies using ultrasound-guided 6 Fr sheath insertion in both common femoral arteries. The femoral access site was then closed using either an Angio-Seal STS Plus, an absorbable collagen sponge, or StarClose, a self-closing nitinol clip. Angiograms and ultrasound of the site were performed prior to closure and immediately afterwards. At follow-up, ultrasound was performed at the site and the specimens were sent for histopathology. RESULTS: Baseline femoral artery diameters (centimeters) were similar in both groups by U/S (5.2 +/- 0.3, 5.3 +/- 0.3) and quantitative angiography (4.6 +/- 0.7, 4.6 +/- 0.8). Postdeployment angiograms showed a vessel diameter stenosis of 65%+/- 24% with Angio-Seal (n = 18) and 50%+/- 22% with StarClose (n = 18), P = 0.04. 2D U/S performed immediately postdeployment showed vessel diameter stenosis of 59%+/- 33.0 with Angio-Seal (n = 19), and 35%+/- 20 with StarClose (n = 19), P = 0.01. At 7-, 30-, and 60-day follow-up, no appreciable differences in the vessel diameter were observed by U/S. At early follow-up (7 and 30 days), Angio-Seal arteriotomy closure sites were associated with higher inflammatory and hemorrhage scores, but no difference was seen at late (60-day) follow-up. CONCLUSIONS: The StarClose closure device is associated with less short-term vessel injury compared to Angio-Seal STS Plus; however, this difference was not statistically significant after 60 days.

Reactions of Acenaphthenequinone and Aceanthrenequinone with Arenes in Superacid.

The hydroxyalkylation reactions of aceanthrenequinone (6) and acenapthenequinone (7) with a series of arenes have been studied. In reactions with the Brønsted superacid CF(3)SO(3)H (triflic acid), the condensation products are formed in good yields (58-99%, 10 examples) with high regioselectivity. Computational studies were also done to examine the structures and energies of mono- and diprotonated species from 6 and 7. The results from the condensation reactions are consistent with the formation of superelectrophilic species involving protosolvation of carboxonium ion intermediates.

Statin therapy in cardiovascular diseases other than atherosclerosis.

Statins are drugs that inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, thereby blocking the synthesis of cholesterol. Since being discovered in Japan in the mid 1970s, statins have been widely used to lower low-density lipoprotein cholesterol. However, analysis of cardiovascular research has revealed other important effects beyond changes in lipid parameters, referred to as pleiotropic effects. This paper focuses on the effects of statins as anti-ischemic agents with improvement in endothelial function, along with studies on valvular aortic stenosis, atrial fibrillation, heart failure, peripheral arterial disease, and cancer. As the evolution of statin research continues, there appear to be new potential benefits from statins to be found in many facets of cardiovascular disease.

The good fat hormone: adiponectin and cardiovascular disease.

New treatments for heart disease continue to be of paramount importance. The newest pandemic facing us is the rise of obesity and diabetes. One new area of research in the field of metabolism is the hormone adiponectin, which is secreted by fat cells. For the most part, this compound seems more likely to be a part of basic science-oriented research; however, it deserves a much closer look. Many compounds such as high-density lipoprotein and others at first were simply markers of disease but later found to be much more important. During this short review, research from basic science to clinical cardiovascular events is discussed in relation to adiponectin.

Dicationic electrophiles from olefinic amines in superacid.

This paper describes the superacid-catalyzed chemistry of olefinic amines and related compounds. A variety of olefinic amines are found to react with benzene in CF(3)SO(3)H (triflic acid) to give addition products in good yields (75-99%), including the pharmaceutical agents fenpiprane and prozapine. A general mechanism is proposed that invokes the formation of reactive, dicationic electrophiles and the direct observation of a diprotonated species is reported from low-temperature NMR experiments. This chemistry is also used to conveniently prepare functionalized polystyrene beads having pendant amine groups.

What percent luminal stenosis should be used to define angiographic coronary artery disease for noninvasive test evaluation?

BACKGROUND: There has been controversy over what is the best angiographic luminal dimension criterion associated with ischemia for evaluating diagnostic tests. If one assumes that ST-segment depression or scores are indicators of ischemia, then whatever angiographic criteria best discriminates those with ischemic and nonischemic responses would be the best angiographic marker for ischemia. To study this, we calculated the area under the ROC curves for ST depression and scores at different angiographic cut-points in order to determine the best angiographic cut-point for defining ischemia-producing coronary disease. METHODS: Twelve hundred and seventy-six consecutive males without prior MI with a mean age of 59 +/- 11 years who had undergone exercise testing and coronary angiography were analyzed in this study. We calculated the number of patients of this population that would be considered to have coronary artery disease at different cut-points for angiographic luminal stenosis. For example, 59% of the patients had significant CAD when disease was defined as 50% or greater coronary lumen stenosis of any coronary vessel while 49% of the patients had significant CAD when disease was defined as 70% or greater coronary lumen stenosis. Cut-points were considered between 40 to 100% coronary lumen stenosis. ROC analysis was then performed comparing ST depression and treadmill scores at each of these cut-points. RESULTS: The cut-point for coronary lumen stenosis that returned the highest AUC for ST depression and scores was between 70 and 80% coronary luminal stenosis. However, the difference between the 50% and 75% luminal stenosis criteria was minimal. CONCLUSION: It appears that the best cut-point for defining significant angiographic disease when evaluating diagnostic tests of ischemia is 75% or greater coronary luminal stenosis.

The prognostic value of exercise testing in elderly men.

PURPOSE: Our purposes were to compare the responses to exercise testing in elderly (> or =65 years of age) and younger men, and to investigate whether exercise testing has similar prognostic value in the two age groups. METHODS: We included all elderly (n = 1185) and younger (n = 2789) male veterans without established coronary heart disease who underwent routine clinical exercise testing between 1987 and 2000 at two academically affiliated Veteran's Affairs medical center laboratories. Measurements included a standardized medical history, exercise testing, and all-cause mortality. RESULTS: Compared with younger patients, elderly patients achieved a lower workload (a mean [+/- SD] of 7 +/- 3 vs. 10 +/- 4 metabolic equivalents [METs], P <0.001) and were more likely to have abnormal ST depression (27% [n = 324] vs. 16% [n = 436], P <0.001). During the mean follow-up of 6 years, annual mortality was twice as high among elderly patients as among younger patients (4% vs. 2%, P <0.001). The only exercise test variable that was associated significantly with time to death in both age groups was maximal METs achieved: each 1 MET increase in exercise capacity was associated with an 11% reduction in annual mortality. Exercise-induced ST depression was more common in those who subsequently died, but was not an independent predictor of mortality. CONCLUSION: In elderly men, exercise testing provided prognostic information incremental to clinical data. Achieved workload (in METs) was the major exercise testing variable associated with all-cause mortality. Its prognostic importance was the same in elderly as in younger men.

Exercise capacity and mortality among men referred for exercise testing.

BACKGROUND: Exercise capacity is known to be an important prognostic factor in patients with cardiovascular disease, but it is uncertain whether it predicts mortality equally well among healthy persons. There is also uncertainty regarding the predictive power of exercise capacity relative to other clinical and exercise-test variables. METHODS: We studied a total of 6213 consecutive men referred for treadmill exercise testing for clinical reasons during a mean (+/-SD) of 6.2+/-3.7 years of follow-up. Subjects were classified into two groups: 3679 had an abnormal exercise-test result or a history of cardiovascular disease, or both, and 2534 had a normal exercise-test result and no history of cardiovascular disease. Overall mortality was the end point. RESULTS: There were a total of 1256 deaths during the follow-up period, resulting in an average annual mortality of 2.6 percent. Men who died were older than those who survived and had a lower maximal heart rate, lower maximal systolic and diastolic blood pressure, and lower exercise capacity. After adjustment for age, the peak exercise capacity measured in metabolic equivalents (MET) was the strongest predictor of the risk of death among both normal subjects and those with cardiovascular disease. Absolute peak exercise capacity was a stronger predictor of the risk of death than the percentage of the age-predicted value achieved, and there was no interaction between the use or nonuse of beta-blockade and the predictive power of exercise capacity. Each 1-MET increase in exercise capacity conferred a 12 percent improvement in survival. CONCLUSIONS: Exercise capacity is a more powerful predictor of mortality among men than other established risk factors for cardiovascular disease.