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The objective of this article is to examine the association between agricultural subsidies and dairy farm technical efficiency in the European Union, and in so doing we make novel contributions to the literature.We include in the analysis nine diverse western European Union (EU) countries over an 18-year period (1990–2007) encompassing the various Common Agricultural Policy (CAP) reforms enacted since the inception of the EU. Further, we account for input endogeneity using an original method of moments estimator. Our results show that the effect of subsidies on technical efficiency may be positive, null, or negative, depending on the country. The analysis reveals that the introduction of decoupling with the 2003 CAP reform weakens the effect that subsidies have on technical efficiency.

The development of artificial hearts in patients with end-stage heart disease have been confronted with the major issues of thromboembolism or haemorrhage. Since valvular bioprostheses are associated with a low incidence of these complications, we decided to use bioprosthetic materials in the construction of a novel artificial heart (C-TAH). We report here the device characteristics and its first clinical applications in two patients with end-stage dilated cardiomyopathy. The aim of the study was to evaluate safety and feasibility of the CARMAT TAH for patients at imminent risk of death from biventricular heart failure and not eligible for transplant. The C-TAH is an implantable electro-hydraulically actuated pulsatile biventricular pump. All components, batteries excepted, are embodied in a single device positioned in the pericardial sac after excision of the native ventricles. We selected patients admitted to hospital who were at imminent risk of death, having irreversible biventricular failure, and not eligible for heart transplantation, from three cardiac surgery centres in France. The C-TAH was implanted in two male patients. Patient 1, aged 76 years, had the C-TAH implantation on Dec 18, 2013; patient 2, aged 68 years, had the implantation on Aug 5, 2014. The cardiopulmonary bypass times for C-TAH implantation were 170 min for patient 1 and 157 min for patient 2. Both patients were extubated within the first 12 postoperative hours and had a rapid recovery of their respiratory and circulatory functions as well as a normal mental status. Patient 1 presented with a tamponade on day 23 requiring re-intervention. Postoperative bleeding disorders prompted anticoagulant discontinuation. The C-TAH functioned well with a cardiac output of 4·8–5·8 L/min. On day 74, the patient died due to a device failure. Autopsy did not detect any relevant thrombus formation within the bioprosthesis nor the different organs, despite a 50-day anticoagulant-free period. Patient 2 experienced a transient period of renal failure and a pericardial effusion requiring drainage, but otherwise uneventful postoperative course. He was discharged from the hospital on day 150 after surgery with a wearable system without technical assistance. After 4 months at home, the patient suffered low cardiac output. A change of C-TAH was attempted but the patient died of multiorgan failure. This preliminary experience could represent an important contribution to the development of total artificial hearts using bioprosthetic materials. CARMAT SA.

Prosthetic aortic valves are often required for patients with aortic stenosis. The optimal choice of valve in middle-aged patients is not clear and the available options all have drawbacks. Patient choice is the most important factor in deciding which valve to use, with biological valves increasingly favored over mechanical valves. The authors of this Review present the various prosthetic aortic valves currently in use and discuss the implications of prosthesis selection in this group of patients. Choosing the optimal aortic valve prosthesis for middle-aged patients (late 40s to early 60s) with aortic stenosis presents a challenge. The available options all have substantial drawbacks that must be considered in the decision-making process. Current data indicate that there is little or no difference in survival between mechanical and bioprosthetic aortic valve replacement in middle-aged patients at 10–15 years after surgery. Patients who receive a mechanical valve replacement have an annual risk of major hemorrhagic or embolic events of 2–4% per year for life compared with about 1% per year for patients who have a bioprosthetic valve. However, bioprostheses are associated with an increasing risk of structural valve degeneration from 10 years postimplantation, and most patients will require reoperation if they survive much longer than a decade. The mortality risk associated with reoperation is similar to that of primary surgery for most patients, and does not seem to impact on the 15-year survival in this patient group. The Ross procedure, in which the aortic valve is replaced with a pulmonary autograft, can provide improved freedom from morbidity, but operative mortality is probably double that of isolated aortic valve replacement and most patients will require reoperation. Informed patient choice is the most important factor in deciding which valve to use, with biological valves increasingly favored over mechanical valves in middle-aged patients. Key Points Valve replacement for aortic stenosis can be performed using a mechanical or bioprosthetic valve, or a pulmonary autograft Current data indicate that there is little or no difference in patient survival between mechanical and bioprosthetic aortic valve replacement in middle-aged patients at 10–15 years after surgery Informed patient choice is the most important factor in deciding which valve to use; biological valves are increasingly favored over mechanical valves in middle-aged patients Patients with a mechanical valve replacement have a higher risk of major hemorrhagic or embolic events than with a bioprosthesis, but biological valves often suffer from structural degeneration, requiring reoperation The mortality risk associated with reoperation is about the same as for primary surgery in most patients, and does not seem to impact on the 15-year survival of middle-aged patients The Ross procedure, in which the aortic valve is replaced with a pulmonary autograft, could provide greater freedom from morbidity; however, operative mortality is increased, and most patients require reoperation

To assess the impact of metabolic stress on blood lactate, muscle damage, inflammatory and hormonal responses following a high-load (70% maximum) strength training session, we compared two methods with a similar number of repetitions but that differed by their metabolic demand: the 3/7 method consisting in two series of five sets of an increasing number of repetitions (3 to 7) with a short inter-set interval (15 s) and the 8 × 6 method that comprises eight sets of six repetitions with a longer inter-set interval (2.5 min). Blood concentrations in lactate, creatine kinase (CK), myoglobin (MB), interleukine-6 (IL-6), leukocytes, growth hormone (GH), insulin-like growth factor-1 (IGF-1) and cortisol were determined before and after each session. Lactate concentration increased more (11.9 vs. 3.1 mmol/L; p < 0.001) for the 3/7 method whereas CK and MB concentrations were augmented similarly (p > 0.05) for both methods. Inflammatory markers (leukocytes and IL-6) increased (p < 0.01) more after the 3/7 method. GH and cortisol concentrations also increased more (p < 0.001) after the 3/7 method with no difference in IGF-1 concentrations between methods. Positive associations were found between the change in lactate and changes in IL-6 (r2 = 0.47; p < 0.01), GH (r2 = 0.58; p < 0.001) and cortisol (r2 = 0.61; p < 0.001) concentrations. In conclusion, the greater lactate accumulation induced by short inter-set intervals during a high-load training session is associated with enhanced inflammatory and hormonal responses, suggesting that metabolic stress might contribute to the greater adaptative response previously observed with this method.

We recently reported that the nonclassical HLA class I molecule HLA-G was expressed in the endomyocardial biopsies and sera of 16% of heart transplant patients studied. The aim of the present report is to identify cells that may be responsible for HLA-G protein expression during the allogeneic reaction. Carrying out mixed lymphocyte cultures in which the responder cell population was depleted either in CD4+or CD8+T cells, we found that soluble HLA-G5 protein but not the membrane-bound HLA-G isoform was secreted by allo-specific CD4+T cells from the responder population, which suppressed the allogeneic proliferative T cell response. This inhibition may be reversed by adding the anti-HLA-G 87G antibody to a mixed lymphocyte culture. That may indicate a previously uncharacterized regulatory mechanism of CD4+T cell proliferative response.

The life expectancy of patients with Duchenne muscular dystrophy (DMD) has increased. A cross-sectional study of DMD patients showed that 54 % of 13-year-old patients are obese and that 54 % of 18-year-old patients are underweight. We aimed to describe the natural evolution of weight status in DMD. This retrospective multi-centre audit collected body-weight measurements for seventy DMD patients born before 1992. The body-weight:age ratio (W:A) was used to evaluate weight status in reference to the Griffiths and Edwards chart. At the age of 13 years, 73 % were obese and 4 % were underweight. At maximal follow-up (age 15–26 years, mean 18·3 (sd 2·3) years), 47 % were obese and 34 % were underweight. Obesity at the age of 13 years was associated with later obesity, whereas normal weight status and underweight in 13-year-old patients predicted later underweight. A W:A ≥ 151 % in 13-year-old patients predicted later obesity, and a W:A ≤ 126·5 % predicted later underweight. Our audit provides the first longitudinal information about the spontaneous outcome of weight status in DMD. Patients (13 years old) with a W:A ≥ 151 % were more likely to become obese in late adolescence, but obesity prevented later underweight. These data suggest that mild obesity in 13-year-old DMD patients (W:A between 120 and 150 %) should not be discouraged because it prevents later underweight.

Increase in myofibrillar protein accretion can occur in the very early post-exercise period and can be potentiated by ingestion of essential amino acid (EAA). Furthermore, strength exercise induces important disturbances in protein turnover, especially in novice athletes. The purpose of this investigation was to evaluate the effects of an EAA supplementation on muscle mass, architecture and strength in the early stages of a heavy-load training programme. 29 young males trained during 12 weeks. They were divided into a placebo (PLA) ( n  = 14) group and an EAA group ( n  = 15). At baseline, daily food intake and nitrogenous balance were assessed with a food questionnaire over 7 days and two 24-h urine collections. The effect of training on muscle mass was assessed by anthropometric techniques. Muscle thickness and pennation angle were recorded by ultrasonography of the gastrocnemius medialis (GM). Maximal strength during squat and bench press exercises were tested on an isokinetic ergometer. Training resulted in significant increase in muscle mass and strength in both PLA and EAA groups. Positive linear regressions were found between nitrogen balance and increase in muscle mass in the PLA group ( P  < 0.01, r ² = 0.63) and between the initial strength and the increase in muscle strength in the EAA group ( P  < 0.05, r ² = 0.29). EAA ingestion resulted in greater changes in GM muscle architecture. These data indicate that EAA supplementation has a positive effect on muscle hypertrophy and architecture and that such a nutritional intervention seems to be more effective in subject having lower nitrogen balance and/or lower initial strength.

SummaryMission: to urge all relevant entities within the international cardiac surgery, industry and government sectors to commit to develop and implement an effective strategy to address the scourge of rheumatic heart disease in the developing world through increased access to life-saving cardiac surgery.

HLA-G found in five of 31 heart-transplant recipients was associated with a decrease of acute and chronic rejection episodes.HLA-G found in five of 31 heart-transplant recipients was associated with a decrease of acute and chronic rejection episodes.

Cardiovascular research is the main shaper of clinical evidence underpinning decision making, with its cyclic progression of junior researchers to mature faculty members. Despite efforts at improving cardiovascular research training, several unmet needs persist. We aimed to appraise current perceptions on cardiovascular research training with an international survey. We administered a 20-closed-question survey to mentors and mentees belonging to different international institutions. A total of 247 (12%) surveys were available (out of 2,000 invitations). Overall, mentees and mentors were reasonably satisfied with the educational and research resources. Significant differences were found analyzing results according to gender, geographic area, training and full-time researcher status. Specifically, women proved significantly less satisfied than men, disclosed access to fewer resources and less support from mentors (all P<0.05). People working in institutions not located in North America or Northern/Central Europe were significantly less satisfied and disclosed much less support (both P<0.05). Those in training reported limited opportunities for collaboration (P = 0.009), and non-full-time researchers disclosed more limited access to tutors and formal grant writing training (both P<0.05). Several potential biases appear to be present in the way training in cardiovascular research is provided worldwide, including one against women. If confirmed, these data require proactive measures to decrease discriminations and improve the cardiovascular research training quality.