Influence of operational conditions and wastewater properties on the removal of organic micropollutants through ozonation.

The objective of this study was to evaluate the influence of operational conditions and wastewater properties on the removal of pharmaceuticals, contrast media and antibiotics through ozonation, in order to facilitate the optimization of treatment and its implementation on a full scale. Pilot-scale ozone oxidation trials were performed on treated wastewater, before and after post-precipitation, over a seven-month period, including summer and winter months. Hydraulic retention times as short as 7 min were found to be sufficient for organic micropollutant removal. A short hydraulic retention time reduces both investment costs and land use. Neither the choice of ozone dispersion method, a static mixer or a Venturi injector, nor the wastewater temperature had any significant effect on the removal efficiency of organic micropollutants, however, higher removal was achieved after on-site post-precipitation with aluminum chloride.

Is dissolved COD a suitable design parameter for ozone oxidation of organic micropollutants in wastewater?

Ozone oxidation of organic micropollutants in biologically treated wastewater was investigated in pilot-scale after a high- and a low loaded activated sludge process. Higher ozone doses were required to remove organic micropollutants in the effluent wastewater from the high loaded activated sludge process. Further comparison of the micropollutant removal was based on normalized ozone doses, expressed as g O3/g DOC and g O3/g soluble COD (sCOD). A clear difference was noted for the two effluents when the micropollutant removal was normalized by DOC. This difference disappeared almost completely when the removal was linked to ozone doses normalized by sCOD. The dose-response curves for the organic micropollutants were practically linear in the removal range up to 95%. A linear prediction model was developed and compared with literature values to test the transferability of the obtained results. Results from this comparison indicated that the slope of the dose-response functions could be used to predict the removal efficiency of organic micropollutants at a third plant with an average uncertainty of 10%. The modeled ozone requirements were then set in relation to the COD concentrations in the discharged water from approximately 90 Swedish activated sludge treatment plants with and without nitrogen removal. This comparison highlighted the need for a well-functioning biological treatment for an effective ozone oxidation of organic micropollutants. The results in this study suggest that soluble COD should be further explored for design and modeling of ozone oxidation of organic micropollutants in biologically treated wastewater.

Effect of lifelong football training on the expression of muscle molecular markers involved in healthy longevity.

PURPOSE: We investigated whether lifelong football training affects the expression of healthy longevity-related muscle molecular markers. METHODS: Biopsies were collected from the vastus lateralis muscle of 10 lifelong football-trained men (68.2 ± 3.0 years) and of 10 active untrained healthy men (66.7 ± 1.3 years). Gene and protein expression was measured by RTqPCR on RNA and by western blotting on protein extracts from muscle biopsies, respectively. RESULTS: The expression of AMPKα1/α2, NAMPT, TFAM and PGC1α, which are markers of oxidative metabolism, and MyHC ß isoform expression was higher in the muscle of football-trained men vs untrained men. Also citrate synthase activity was higher in trained than in untrained men (109.3 ± 9.2 vs 75.1 ± 9.2 mU/mg). These findings were associated with a healthier body composition in trained than in untrained men [body weight: 78.2 ± 6.5 vs 91.2 ± 11.2 kg; body mass index BMI: 24.4 ± 1.6 vs 28.8 ± 4.0 kg m-2; fat%: 22.6 ± 8.0 vs 31.4 ± 5.0%)] and with a higher maximal oxygen uptake (VO2max: 34.7 ± 3.8 vs 27.3 ± 4.0 ml/min/kg). Also the expression of proteins involved in DNA repair and in senescence suppression (Erk1/2, Akt and FoxM1) was higher in trained than in untrained men. At BMI- and age-adjusted multiple linear regression analysis, fat percentage was independently associated with Akt protein expression, and VO2max was independently associated with TFAM mRNA and with Erk1/2 protein expression. CONCLUSIONS: Lifelong football training increases the expression of key markers involved in muscle oxidative metabolism, and in the DNA repair and senescence suppression pathways, thus providing the molecular basis for healthy longevity.

Repeated evolution of exaggerated dewlaps and other throat morphology in lizards.

The existence of elaborate ornamental structures in males is often assumed to reflect the outcome of female mate choice for showy males. However, female mate choice appears weak in many iguanian lizards, but males still exhibit an array of ornament-like structures around the throat. We performed a phylogenetic comparative study to assess whether these structures have originated in response to male-male competition or the need for improved signal efficiency in visually difficult environments. We found little evidence for the influence of male-male competition. Instead, forest species were more likely to exhibit colourful throat appendages than species living in open habitats, suggesting selection for signal efficiency. On at least three independent occasions, throat ornamentation has become further elaborated into a large, conspicuously coloured moving dewlap. Although the function of the dewlap is convergent, the underlying hyoid apparatus has evolved very differently, revealing the same adaptive outcome has been achieved through multiple evolutionary trajectories. More generally, our findings highlight that extravagant, ornament-like morphology can evolve in males without the direct influence of female mate choice and that failure to consider alternative hypotheses for the evolution of these structures can obscure the true origins of signal diversity among closely related taxa.

Investigation of different cell types and gel carriers for cell-based intervertebral disc therapy, in vitro and in vivo studies.

Biological treatment options for the repair of intervertebral disc damage have been suggested for patients with chronic low back pain. The aim of this study was to investigate possible cell types and gel carriers for use in the regenerative treatment of degenerative intervertebral discs (IVD). In vitro: human mesenchymal cells (hMSCs), IVD cells (hDCs), and chondrocytes (hCs) were cultivated in three gel types: hyaluronan gel (Durolane®), hydrogel (Puramatrix®), and tissue-glue gel (TISSEEL®) in chondrogenic differentiation media for 9 days. Cell proliferation and proteoglycan accumulation were evaluated with microscopy and histology. In vivo: hMSCs or hCs and hyaluronan gel were co-injected into injured IVDs of six minipigs. Animals were sacrificed at 3 or 6 months. Transplanted cells were traced with anti-human antibodies. IVD appearance was visualized by MRI, immunohistochemistry, and histology. Hyaluronan gel induced the highest cell proliferation in vitro for all cell types. Xenotransplanted hMSCs and hCs survived in porcine IVDs for 6 months and produced collagen II in all six animals. Six months after transplantation of cell/gel, pronounced endplate changes indicating severe IVD degeneration were observed at MRI in 1/3 hC/gel, 1/3 hMSCs/gel and 1/3 gel only injected IVDs at MRI and 1/3 hMSC/gel, 3/3 hC/gel, 2/3 gel and 1/3 injured IVDs showed positive staining for bone mineralization. In 1 of 3 discs receiving hC/gel, in 1 of 3 receiving hMSCs/gel, and in 1 of 3 discs receiving gel alone. Injected IVDs on MRI results in 1 of 3 hMSC/gel, in 3 of 3 hC/gel, in 2 of 3 gel, and in 1 of 3 injured IVDs animals showed positive staining for bone mineralization. The investigated hyaluronan gel carrier is not suitable for use in cell therapy of injured/degenerated IVDs. The high cell proliferation observed in vitro in the hyaluronan could have been a negative factor in vivo, since most cell/gel transplanted IVDs showed degenerative changes at MRI and positive bone mineralization staining. However, this xenotransplantation model is valuable for evaluating possible cell therapy strategies for human degenerated IVDs.

Fitness disadvantages to disrupted embryogenesis impose selection against suboptimal nest-site choice by female grass snakes, Natrix natrix (Colubridae).

Phenotypic traits of hatchling reptiles are strongly influenced by incubation regimes (e.g. of temperature and moisture), suggesting that maternal choice of suitable nest-sites should be under intense selection. Our laboratory incubation of 209 eggs (17 clutches) from wild-caught Swedish grass snakes (Natrix natrix) showed that scale abnormalities (half-scales on one side of the body, often reflecting lateral asymmetry in the number of ribs) occurred more frequently if eggs were incubated under cooler conditions. Especially at low incubation temperatures, individuals with scale asymmetries took longer to hatch than did symmetric conspecifics, were smaller in body length at hatching and were slower in trials of locomotor speed. Anti-predator tactics also covaried with scale asymmetry. These patterns suggest that individuals with asymmetric scales should have lower fitness and hence should rarely survive to adulthood in the wild. We tested this prediction by examining 201 field-collected snakes from museum collections. As predicted, scale asymmetries were seen primarily in small snakes, and rarely in larger animals. We interpret these data to suggest that scale asymmetries in this species offer an index of developmental instability and that fitness disadvantages to disrupted embryogenesis impose selection against suboptimal nest-site choice by females.

Human disk cells from degenerated disks and mesenchymal stem cells in co-culture result in increased matrix production.

Transplantation of mesenchymal stem cells (MSCs) has been suggested for disk degeneration, which is characterized by dysfunctional cells and low proteoglycan production. The aim of this study was to examine the effects of a 3D co-culture system using human disk cells (DCs) and MSCs on collagen and proteoglycan production. DCs and MSCs were expanded in monolayer and grown in pellet cultures for 7, 14 and 28 days and analyzed for hydroxyproline (HP), reflecting total collagen production, and glycosaminoglycan (GAG) accumulation. DCs and MSCs co-cultured at different ratios (25/75, 50/50 and 75%/25%) were examined for GAG accumulation. Collagen type II expression was analyzed immunohistochemically. In a second series, conditioned media were added to pellet cultures of degenerated DCs or MSCs. DCs from degenerated disks and MSCs demonstrated lower total collagen production than non-degenerated DC pellets. GAG production was comparable in DCs and MSCs, except in the youngest donor, with MSC producing about 10 times higher GAG/DNA. Co-cultures resulted in approximately 1.5 times higher GAG/DNA production than DCs. Increased collagen type II expression was seen in co-cultures compared to DC or MSC culture alone, except in the case with highly active MSCs. No positive effect of conditioned media was seen. In conclusion, co-culture of MSCs with degenerated DCs increased proteoglycan and collagen-type ceII production, indicating that in future clinical therapy MSCs can be transplanted without pre-differentiation in vitro. The lack of effect of conditioned media suggests that the positive effect of co-culture on matrix production is not due to soluble factors.

Work status, work hours and health in women with and without children.

OBJECTIVES: The authors studied self-reported health in women with and without children in relation to their work status (employed, student, job seeker or homemaker), work hours and having an employed partner. METHODS: The study group comprised of 6515 women born in 1960-1979 who were interviewed in one of the Swedish Surveys of Living Conditions in 1994-2003. Self-rated health, fatigue and symptoms of anxiety were analysed. RESULTS: Having children increased the odds of poor self-rated health and fatigue in employed women, female students and job seekers. The presence of a working partner marginally buffered the effects. In dual-earner couples, mothers reported anxiety symptoms less often than women without children. Few women were homemakers (5.8%). The odds of poor self-rated health and fatigue increased with increasing number of children in employed women, and in women working 40 h or more. Poor self-rated health was also associated with the number of children in students. Many mothers wished to reduce their working hours, suggesting time stress was a factor in their impaired health. The associations between having children and health symptoms were not exclusively attributed to having young children. CONCLUSIONS: Having children may contribute to fatigue and poor self-rated health particularly in women working 40 h or more per week. Student mothers and job seeking mothers were also at increased risk of poor self-rated health. The results should be noted by Swedish policy-makers. Also countries aiming for economic and gender equality should consider factors that may facilitate successful merging of work and family life.

Advanced oxidation of refractory organics in leachate--potential methods and evaluation of biodegradability of the remaining substrate.

An assessment of potential methods suitable for degradation and/or reduction of refractory organics was performed on landfill leachate from SYSAV AB, Malmö, Sweden. Pretreatment of the leachate was performed in a sequence batch reactor designed for nitrification in activated sludge. Oxidation of the leachate was then O3, O3/pH adjustment (pH 9 and 10), H2O2, O3/H2O2 and performic acid in lab-scale reactors. The degradation of organic material was followed with chemical oxygen demand (COD) measurements for all experiments except for the performic acid treatment for which total organic carbon (TOC) measurements were used. The potential degradation of refractory organics into biodegradable organic material was analysed by subsequent oxygen uptake rate (OUR) measurements in laboratory batch reactors. Ozonation of biologically pre-treated leachate increased reduction of the organic material. The most biodegradable organic material was produced after oxidation with only ozone and ozonation at pH 9. Performic acid did not reduce the content of organic material in the leachate. However, a combination of biological pretreatment, chemical oxidation with O3/H2O2 and a subsequent biological process resulted in the most efficient oxidation method for the tested leachate.

Mixed carbon sources for nitrate reduction in activated sludge-identification of bacteria and process activity studies.

Mixtures of methanol and acetate as carbon source were investigated in order to determine their capacity to enhance denitrification and for analysis of the microbial composition and carbon degradation activity in activated sludge from wastewater treatment plants. Laboratory batch reactors at 20 degrees C were used for nitrate uptake rate (NUR) measurements in order to investigate the anoxic activity, while single and mixed carbon substrates were added to activated sludge. Microautoradiography (MAR) in combination with fluorescence in situ hybridisation (FISH) were applied for microbial analysis during exposure to different carbon sources. The NUR increased with additions of a mixture of acetate and methanol compared with additions of a single carbon source. MAR-FISH measurements demonstrated that the probe-defined group of Azoarcus was the main group of bacteria utilising acetate and the only active group utilising methanol under anoxic conditions. The present study indicated an improved denitrification potential by additions of a mixed carbon source compared with commonly used single-carbon additions. It is also established that Azoarcus bacteria are involved in the degradation of both acetate and methanol in the anoxic activated sludge.

Oxygen uptake rate measurements for evaluation of ozonation of municipal wastewater.

Ozonation has become more frequently used as oxidant to reduce chemical oxygen demand (COD) and toxic substances in wastewater originating from different industrial processes. An ozonation pilot plant followed by two parallel biological filters are used to investigate the possibility to reduce the high concentration of refractory COD in the effluent from a municipal wastewater treatment plant, partly loaded with biologically treated wastewater from a large pharmaceutical industry. COD measurements are used to evaluate the overall reduction of organic matter, oxygen uptake rate (OUR) and volatile fatty acids measurements are used for evaluation of the biodegradability of the remaining COD after ozonation. The impact of the ozone dose on the overall COD degradation and degradability of the remaining COD has been estimated. Biochemical oxygen demand (BOD) measurements confirm that parts of the COD are converted into biodegradable organic matter by ozonation. Biofilters following the ozonation plant secure that any degradable organic matter produced by ozonation is removed, which is confirmed from OUR-measurements.

Biological detoxification of tar-water.

Gasification is an important option for the swift implementation of biomass combined heat and power processes in the Danish energy supply system. Tar-water produced by the gas-cleaning system of gasifiers may contain substances toxic to nitrifying bacteria. As the gasification plants are small and often located in the catchment area of small wastewater treatment plants, discharge of the tar-water may be critical for wastewater treatment plants operated with nitrogen removal. Tar-water from a full-scale updraft gasifier has been thoroughly examined with respect to inhibition of nitrification and the toxicity for nitrifying bacteria has been evaluated for the dominating constituents in the tar-water. Simple organic substances make up the dominating part of the organic matter but phenol and phenolic compounds are also present in significant concentrations. The identified substances are biologically degradable and it has been demonstrated that most of the organic matter together with the toxicity can be eliminated in an aerobic activated sludge process.

Effects on the nervous system in different groups of workers exposed to aluminium.

OBJECTIVE: To investigate possible neurotoxic effects in groups of aluminium pot room and foundry workers, aluminium welders, and a small group of workers exposed to aluminium in the production of flake powder. METHODS: Exposure to aluminium was evaluated with aluminium concentrations in blood and urine as well as a questionnaire. The groups exposed to aluminium were compared with a group of mild steel welders. Neurotoxic effects were studied with mood and symptom questionnaires and several psychological and neurophysiological tests. RESULTS: The pot room and foundry workers showed very low aluminium uptake as their aluminium concentrations in blood and urine were close to normal, and no effects on the nervous system were detected. The group of workers exposed to flake powder had high concentrations of aluminium in blood and urine, even higher than those of the aluminium welders. However, aluminium could not be shown to affect the functioning of the nervous system in flake powder producers. Although significant effects could not be shown in the present analysis of the data on welders, the performance of the welders exposed to high concentrations of aluminium was affected according to the analyses in the original paper from this group. CONCLUSIONS: For the pot room and foundry workers no effects related to the exposure to aluminium could be found. For the group of flake powder producers exposed for a short term no effects on the nervous systems were evident despite high levels of exposure. Due to the high concentrations of aluminium in the biological samples of this group, measures to reduce the exposure to aluminium are recommended, as effects on the central nervous system might develop after protracted exposures. However, this assumption needs to be verified in further studies.

Age and angina as predictors of quality of life after myocardial infarction: a prospective comparative study.

OBJECTIVES: The objectives were to compare quality of life (QoL) after first myocardial infarction with an age- and sex-adjusted normative population and to test whether the 1-month QoL had predictive properties. DESIGN: QoL was assessed by self-administered questionnaires (SF-36 and Cardiac Health Profile) 1, 3 and 6 months after index-event. Participants were 60 consecutive patients (20% women) with a mean age of 58 +/- 7.4 years. RESULTS: Patients > or =59 years improved in Physical (PCS) and Mental Component Summary (MCS), scoring comparable to community norms at 6 months. However, patients <59 years improved in PCS but not in MCS. and scored significantly below community norms in both PCS (x = 44.7, CI 40.6-48.7 vs x = 50.3, CI 49.3-51.4) and MCS (x = 45.9, Cl 41.8-49.9 vs. x = 51.3, CI 50.3-52.4) at 6 months. Predictors for MCS were age (p = 0.025) and Vitality (p = 0.020) both positively related to QoL. Predictors for PCS were Physical Function (p = 0.003) and CCS score (p < 0.001) where angina grade was negatively related to QoL. CONCLUSION: Because of impaired mental recovery in younger post-infarction patients, their need of special attention in the rehabilitation process must not be overlooked.

[Prognosis is often poor in chest pain not interpreted as angina pectoris. Simultaneous occurrence of cardiovascular risk factors increases the risk of premature death]. / Prognosen ofta dålig vid bröstsmärta som inte tolkas som angina pectoris. Samtidig förekomst av kardiovaskulära riskfaktorer ökar risken för förtidig död.

BACKGROUND: Typical angina pectoris is easy to recognize, but coronary insufficiency may present with nonspecific chest discomfort. AIMS OF STUDY: We wanted to investigate long-term prognosis in men with different types of chest pain. METHODS: A random population sample comprising 5,773 men aged 51-57 years at baseline were followed for 16 years. RESULTS: Mortality due to coronary heart disease was 8.0% among men without chest pain, 19.5% (total mortality 44%) among those with non-specific chest pain, 24.8% (total mortality 45%) among those with typical angina and 48.5% among those with a history of myocardial infarction at baseline. CONCLUSION: Non-specific chest pain is associated with poor prognosis, and coronary risk factors have strong predictive value.

Subchronic toluene exposure in low concentrations produces signs of reduced dysfunction in the 6-hydroxydopamine lesioned nigrostriatal dopaminergic system of the rat.

The effect of a subchronic (4-week) exposure to low concentrations of toluene (40 or 80 parts per million, ppm) on the brain dopaminergic system has been examined in a rat model of Parkinson's disease. A unilateral lesion of the substantia nigra (SN) dopamine (DA) nerve cells was performed by injection of a low dose of 6-hydroxydopamine (6-OH DA). The peak activity of contralateral rotational behavior induced by apomorphine was significantly decreased after exposure to 80 ppm toluene. Analysis of the neostriatum and SN ipsilateral to the lesion revealed that toluene (80 ppm, but not 40 ppm) counteracted the 6-OH DA-induced reductions of DA tissue levels both within the SN and the neostriatum. Also the lesion-induced reduction of immunoreactivity for tyrosine hydroxylase (TH IR) in the neostriatum was partly counteracted by the toluene exposure (80 ppm). In conclusion, a subchronic exposure to low doses of toluene (80 ppm) leads to signs of reduced dysfunction of the nigrostriatal dopaminergic system after the neurotoxic treatment.

Comparison of adherence to and penetration of a human laryngeal epithelial cell line by group A streptococci of various M protein types.

Clinically isolated group A streptococci (GAS) of different M protein types were studied using aminoglycoside exclusion and [2,8-3H]adenine radiolabeled GAS assays to compare the abilities of different strains to adhere to and internalize within human laryngeal epithelial (HEp-2) cells. GAS isolated from patients with pharyngitis and GAS isolated from patients with more severe disease, such as necrotizing fasciitis, adhered to and penetrated HEp-2 cells equally well. M3, M4, M6, and M12 strains adhered to and were internalized within HEp-2 cells more than M1 strains. M18 GAS producing hyaluronic acid capsules were less adherent and less invasive than the M3, M4, M6, and M12 strains. An M3-producing GAS strain and its M protein-deficient isogenic strain adhered similarly to HEp-2 cells, but the M protein-deficient strain exhibited greater penetration. Preincubation of HEp-2 cells with an N-terminal synthetic M3 peptide did not alter the adherence or penetration by an M3 strain. In summary, this study demonstrates that GAS from invasive and non-invasive disease adhere to and penetrate HEp-2 cells equally well and that multiple strains of GAS with various M protein types have the ability to adhere to and penetrate HEp-2 cells.

"Nonspecific" chest pain associated with high long-term mortality: results from the primary prevention study in Göteborg, Sweden.

BACKGROUND: The syndrome angina pectoris with effort-related chest pain or discomfort is usually easy to recognize. However, vague and nonspecific symptoms may cause little reason for extensive evaluation. The prognosis of such patients in the general population has so far not been well described. HYPOTHESIS: The study was undertaken to investigate long-term prognosis in men with chest pain considered to be nonspecific in comparison with men with typical angina pectoris (AP) or prior myocardial infarction (MI), and men without chest pain. METHODS: At the second screening of the Göteborg Primary Prevention Study in 1974-1977, 6,488 men aged 51 to 59 years at baseline were available for the present analysis. Men who had responded positively to a postal questionnaire about chest pain during exercise or at rest were interviewed by a physician according to a Rose questionnaire at the screening examination. Those with typical or probable AP were further examined by single experienced physician. The following four groups were formed: Group 1: men who did not complain of chest pain (n = 5,545). Group 2: men who had not consulted any doctor because of chest pain, but who had chest pain according to a questionnaire (n = 441); these men were not considered to have AP according to a three-step examination by experienced physicians. Group 3: typical AP (n = 232). Group 4: men who had suffered an MI (n = 134). RESULTS: During 16 years of follow-up, coronary heart disease (CHD) mortality for Groups 1-4 was 8.0, 19.5, 24.8, and 48.5%, respectively. Mortality from all cardiovascular diseases was 11.5, 24.5, 31.2, and 59.0%, respectively. Noncardiovascular disease mortality was 14.1, 17.7, 14.3, and 8.7%, respectively. Thus, the relative risk (RR) for CHD mortality among men with nonspecific chest pain (Group 2) was 2.77 [95% confidence interval (CI) 2.20, 3.50], for all cardiovascular disease mortality 2.46 (95% CI 2.00, 3.02), and for noncardiovascular disease mortality 1.60 (95% CI 1.28, 2.00). Total mortality in this group was as high (44%) as among those with typical AP (45%), but the highest mortality was found among men with a previous MI (68%). In men without chest pain it was 26%. Patients of Groups 2-4 had higher levels of cardiovascular risk factors than those in Group 1. Neither any specific questions in the Rose questionnaire, nor electrocardiographic changes at rest (uncommon) were of prognostic significance. Serum cholesterol, systolic blood pressure, diabetes, and smoking were significant predictors of outcome, both with respect to fatal CHD and to total mortality during the 16-year follow-up. CONCLUSION: We found a high cardiovascular as well as noncardiovascular mortality among patients with chest pain who had not been considered to have AP at a three-step examination procedure. It is important to be suspicious of early CHD symptoms in men (and women?) with "nonspecific" chest symptoms and to analyze their cardiovascular risk factor pattern further because they are at considerably higher risk for future events than those in whom CHD is not suspected.

Echocardiography allows early detection and long-term survival after infarct free wall rupture.

Approximately one third of free wall infarct ruptures are subacute and theoretically accessible for surgery. Two-dimensional echocardiography is an important tool in the early diagnosis of cardiac rupture. We report the successful treatment of a 74-year-old woman with subacute free wall rupture, who is still alive 3 years after surgery.

Natural history of myocardial infarction and angina pectoris in a general population sample of middle-aged men: a 16-year follow-up of the Primary Prevention Study, Göteborg, Sweden.

OBJECTIVES: Although many studies have described prognosis in patients with coronary heart disease (CHD), few have compared outcome in men with clinical evidence of CHD with healthy men from the general population over an extended follow-up. This study aimed to compare long-term prognosis in men with a history of myocardial infarction (MI) and in men with angina pectoris (AP) without MI, with men without clinical signs of CHD. DESIGN: Longitudinal general population study. SETTING: City of Göteborg, Sweden. SUBJECTS: From a general population sample, 195 men who had survived an MI for 0-19 years (median 3 years) and 314 men with AP but no MI (uncomplicated AP) at baseline in 1974-77 were identified and compared with 6591 men without clinical coronary disease. All were aged 51-59 years. Incident non-fatal and fatal cases occurring until the beginning of 1983 were also followed (n = 317). MAIN OUTCOME MEASURES: Death from CHD, from other causes and from all causes during a follow-up of at least 16 years. RESULTS: Overall survival was 72% amongst men without coronary disease, 53% amongst men with uncomplicated AP and 34% amongst men with past MI at baseline. In survivors of MI the risk-factor-adjusted relative risk (RR) of coronary death during follow-up was 6.67 (95% confidence interval (CI) 5.29-8.39), of dying from non-cardiovascular causes 1.35 (0.96-1.91), and of dying from any cause 3.20 (2.67-3.83). During the first 4 years after the baseline examination, the adjusted RR of CHD death was 15.96 (10. 29-24.74), and of dying from any cause 5.22 (3.68-7.41). During the last 4 years of follow-up, relative risk was still 5.87 (3.44-10.01) for CHD death and 2.93 (2.05-4.18) for death from any cause. In men with uncomplicated AP, the adjusted relative risk of CHD death during the first 4 years was 4.05 (2.27-7.22) and 3.23 (2.10-4.96) during the last 4-year period. After the first year, the incident MI cases had the same average annual mortality (about 5%) as the prevalent cases. CONCLUSIONS: In survivors of MI, mortality risk remained high even after an extended follow-up. Men with angina had a better prognosis, but still a compromised survival compared with the general population.