Polymorphism of the ovine beta3-adrenergic receptor gene (ADRB3) and its association with wool mean staple strength and yield

We investigated the possibility that variation in ovine ADRB3 is associated with various wool traits, in particular mean staple strength (MSS). Polymerase chain reaction-single strand conformational polymorphism analysis of part of the ADRB3 intron was used to genotype 695 Merino lambs born on three farms in the South Island of New Zealand and which were shorn as 2-tooths. For each fleece, MSS, mean fibre diameter, mean staple length and yield were measured. The results from mixed-effects models and half-sib analyses suggest that ADRB3 alleles A and D have a negative impact on some wool traits, whereas ADRB3 alleles C and E appear to have a positive impact, with allele C potentially having a greater impact than allele E on MSS. This variation in the ADRB3 may assist in the genetic selection for increased MSS and yield in Merino sheep.

A copper(II)-selective chelator ameliorates left-ventricular hypertrophy in type 2 diabetic patients: a randomised placebo-controlled study

AIMS/HYPOTHESIS

Cu(II)-selective chelation with trientine ameliorates cardiovascular and renal disease in a model of diabetes in rats. Here, we tested the hypothesis that Cu(II)-selective chelation might improve left ventricular hypertrophy (LVH) in type 2 diabetic patients.

METHODS

We performed a 12 month randomised placebo-controlled study of the effects of treatment with the Cu(II)-selective chelator trientine (triethylenetetramine dihydrochloride, 600 mg given orally twice daily) on LVH in diabetic patients (n = 15/group at baseline) in an outpatient setting wherein participants, caregivers and those assessing outcomes were blinded to group assignment. Using MRI, we measured left ventricular variables at baseline, and at months 6 and 12. The change from baseline in left ventricular mass indexed to body surface area (LVM(bsa)) was the primary endpoint variable.

RESULTS

Diabetic patients had LVH with preserved ejection fraction at baseline. Trientine treatment decreased LVM(bsa) by 5.0 +/- 7.2 g/m(2) (mean +/- SD) at month 6 (when 14 trientine-treated and 14 placebo-treated participants were analysed; p = 0.0056 compared with placebo) and by 10.6 +/- 7.6 g/m(2) at month 12 (when nine trientine-treated and 13 placebo-treated participants were analysed; p = 0.0088), whereas LVM(bsa) was unchanged by placebo treatment. In a multiple-regression model that explained ~75% of variation (R (2) = 0.748, p = 0.001), cumulative urinary Cu excretion over 12 months was positively associated with trientine-evoked decreases in LVM(bsa).

CONCLUSIONS/INTERPRETATION

Cu(II)-selective chelation merits further exploration as a potential pharmacotherapy for diabetic heart disease.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN 12609000053224 FUNDING: The Endocore Research Trust; Lottery Health New Zealand; the Maurice and Phyllis Paykel Trust; the Foundation of Research, Science and Technology (New Zealand); the Health Research Council of New Zealand; the Ministry of Education (New Zealand) through the Maurice Wilkins Centre for Molecular Biodiscovery; and the Protemix Corporation.

Plasma levels of sex hormone-binding globulin, corticosteroid-binding globulin and cortisol in overweight subjects who develop impaired fasting glucose: a 3-year prospective study

Circulating sex hormone-binding globulin (SHBG), corticosteroid-binding globulin (CBG), and total and calculated free cortisol were measured in 206 overweight subjects to investigate whether or not they were markers of insulin resistance. Measurements were carried out on two occasions 36 months apart and subjects were grouped according to fasting plasma glucose. Fifty-one subjects, with a normal basal fasting glucose (<5.6 mmol/l) developed impaired fasting glucose 3 years later (> or = 5.6 mmol/l). Analysis either in toto or based on gender showed a highly significant increase in fasting insulin and insulin resistance, a modest increase in body mass index (BMI), but importantly no change in plasma SHBG, CBG, or cortisol concentrations. Subjects (n=101) with a normal fasting glucose both at baseline (<5.6 mmol/l) and at 36 months showed no significant change in fasting insulin, insulin resistance, SHBG, CBG, cortisol, or BMI. Cross-sectional analysis of the study population showed that plasma SHBG correlated negatively with insulin resistance both in men and women. Overall SHBG at baseline was not predictive of changes in fasting glucose. In females, plasma CBG correlated negatively with BMI. The major finding is that overweight subjects who developed impaired fasting glucose showed no significant change in plasma SHBG, CBG or cortisol, and therefore these indices are probably not early markers of insulin resistance in overweight subjects.

Harris-Galante II acetabular cup: a survival analysis

PURPOSE

To determine the survival rate of the Harris-Galante (HG) II cup and identify factors contributing to failure.

METHODS

271 primary total hip arthroplasties (THAs) performed between 1992 and 1999 in our hospitals using the HG II acetabular cup were retrospectively reviewed due to a high incidence of liner dissociation.

RESULTS

48 THAs were revised, 32 (67%) of which were due to liner dissociation. The Kaplan-Meier 10-year survival rate was 73%. Dislocation (p<0.001) and acetabular size (p=0.042) were independent predictors of acetabular component failure in the Cox's regression model.

CONCLUSION

The long-term outcome of the HG II cup is unsatisfactory. Although the HG II cup is no longer produced, numerous patients have this prosthesis in situ and should be reviewed regularly, as liner dissociation and retroacetabular osteolysis may occur.

Polymorphism at the ovine β3-adrenergic receptor locus (ADRB3) and its association with lamb mortality1

The beta3-adrenergic receptors (ADRB3) are guanine nucleotide-binding protein (G-protein)-coupled receptors predominantly found on the surface of adipocytes. They are major mediators of the lipolytic and thermogenic effects of high catecholamine concentrations, in particular norepinephrine. Recently, variation in the ovine beta3-adrenergic receptor gene (ADRB3) has been associated with lamb survival in Merino sheep. In this study, PCR-single strand conformational polymorphism analysis of part of the ADRB3 intron was used to genotype 13,420 lambs (Borderdale, n = 351; Corriedale, n = 4,260; Coopworth, n = 1,225; Dorset Down, n = 663; Dorset Down x Coopworth, n = 264; Hampshire, n = 230; Merino, n = 4,488; Merino x Coopworth, n = 329; Merino x Polwarth, n = 226; Polwarth, n = 928; Poll Dorset, n = 241; and Suffolk, n = 215) born on 22 farms throughout the South Island of New Zealand. Univariate and multivariate odds ratios calculated for each of the 8 alleles revealed weak to moderate associations of the A and E alleles with cold survival and alleles C and F with cold-related mortality, and a strong association of the D allele with cold-related mortality and total mortality. This variation at the ADRB3 locus can possibly be exploited as a gene marker to increase selection accuracy when breeding for more cold-tolerant lambs.

B-type natriuretic peptide infusions in acute myocardial infarction

BACKGROUND

Natriuretic peptides have actions likely to ameliorate cardiac dysfunction. B-type natriuretic peptide (BNP) is indicated as treatment for decompensated cardiac failure.

OBJECTIVE

To determine the utility of BNP in acute myocardial infarction (MI).

DESIGN

Double-blind randomised placebo-controlled trial.

SETTING

Tertiary hospital coronary care unit.

PATIENTS

28 patients with acute MI with delayed or failed reperfusion and moderate left ventricular dysfunction.

INTERVENTIONS

Infusion of BNP or placebo for 60 hours after MI.

MAIN OUTCOME MEASURES

Neurohormonal activation and renal function in response to BNP infusion, secondary end points of echocardiographic measures of left ventricular function and dimension.

RESULTS

BNP infusion resulted in a significant rise in BNP (276 pg/l vs 86 pg/l, p = 0.001). NT-proBNP levels were suppressed by BNP infusion (p = 0.002). Atrial natriuretic peptide (ANP) and NT-proANP levels fell with a significant difference in the pattern between BNP infusion and placebo during the first 5 days (p<0.005). C-type natriuretic peptide (CNP) and NT-proCNP levels rose during the infusion with higher levels than placebo at all measurements during the first 3 days (p<0.01). Cyclic guanosine monophosphate (cGMP) was raised during the infusion period showing a peak of 23 pmol/l on day 2 (placebo 8.9 pmol/l, p = 0.002), with a correlation between BNP and cGMP levels (p<0.001). Glomerular filtration rate (GFR) fell with BNP infusion but was not significantly lower than with placebo (71.0 (5.6) vs 75.8 (5.4) ml/min/1.73 m2, p = 0.62). Patients receiving nesiritide exhibited favourable trends in left ventricular remodelling.

CONCLUSIONS

Nesiritide, given soon after MI, induced increments in plasma cGMP and CNP and decrements in other endogenous cardiac peptides with a neutral effect on renal function and a trend towards favourable ventricular remodelling.

Cardiac sympathetic nerve activity and ventricular fibrillation during acute myocardial infarction in a conscious sheep model

The association between cardiac sympathetic nerve activity (CSNA) and ventricular fibrillation (VF) during acute myocardial infarction (MI) has not been assessed in conscious animal models. During the first 60 min post-MI, mean blood pressure (MBP), heart rate (HR), and CSNA were recorded continuously in 20 conscious sheep. Resistant sheep ( group A, n = 10) were compared with susceptible sheep ( group B, n = 10) who developed fatal VF ( n = 7) or sustained ventricular tachycardia (VT, n = 3). The mean time to VF/VT was 28.1 ± 3.3 min. In group B, MBP, HR, and CSNA were averaged at each consecutive minute from baseline at 14 min before the onset of VF/VT and compared with time-matched values in group A. When compared with those of group A, indexes of CSNA burst size increased before the onset of VF/VT: burst area/minute (F13,208 = 2.17, P = 0.01) and burst area/100 beats (F13,208 = 1.86, P = 0.04). By contrast, burst frequency indexes were not significantly different: burst frequency (F13,208 = 1.6, P = 0.09) and burst incidence (F13,208 = 1.48, P = 0.13). In group A, CSNA burst area/min and burst area/100 beats did not change across this time period (F13,117 = 0.97, P = 0.5, F13,117 = 0.96, P = 0.7) but increased with time in group B (F13,91 = 2.3, P = 0.01; and F13,91 = 2.25, P = 0.01). Between-group comparisons demonstrated no differences in time of onset of ventricular ectopic beats: 18.5 (range 12–24) in group A versus 15.0 min (range 7–22) in group B (Mann-Whitney U-test, P = 0.09). Pre-MI baroreflex slopes were similar: R-R slopes were 11.8 ± 2 and 15.6 ± 1.1 ms/mmHg ( t18 = −1.6, P = 0.14). CSNA slopes were −1.8 ± 0.3 and −2.3 ± 0.2%/mmHg ( t18 = −1.4, P = 0.2). An early increase in CSNA burst size indexes (before 60 min post-MI), mediated by an excitatory sympathetic reflex, is important in the genesis of VF/VT.

Alendronate prevents bone loss in patients with acute spinal cord injury: a randomized, double-blind, placebo-controlled study

CONTEXT

Patients who sustain an acute spinal cord injury (SCI) experience rapid dramatic reductions in bone mineral density (BMD), especially marked in sublesional areas and sometimes leading to hypercalcemia and hypercalciuria, as well as increased fracture risk.

OBJECTIVE

In this prospective, double-blind, randomized, placebo-controlled study, we evaluated the hypothesis that oral alendronate administration would preserve BMD when administered soon after acute SCI.

PATIENTS AND INTERVENTION

Thirty-one patients with acute SCI were randomly allocated to receive oral alendronate 70 mg/wk or placebo, within 10 d of acute SCI, for 12 months.

MAIN OUTCOME MEASUREMENTS

At entry and at 3, 6, 12, and 18 months, total body bone density, lumbar and hip BMD, ultrasound of the calcaneus, 24-h urinary calcium, and serum C-telopeptide (betaCTX) were measured.

RESULTS

At study entry, patients in the two groups were well matched for age, gender, severity of neurological deficit, BMD, urinary calcium, and betaCTX. BMD indices declined steadily in the placebo group, and this effect was attenuated significantly by alendronate. After 12 months, there was a 5.3% difference (P<0.001) in total body BMD and a 17.6% difference (P<0.001) in the total hip BMD between the two groups. Alendronate compared with placebo induced significant (P<0.001) reductions in urinary calcium excretion and serum betaCTX. No treatment-related side effects were noted.

CONCLUSIONS

We conclude that alendronate therapy, 70 mg/wk, initiated soon after acute SCI, prevents bone loss and is not associated with side effects.

The effect of streptozotocin-induced diabetes on the rat seminal vesicle: A possible pathophysiological basis for disorders of ejaculation

In the streptozotocin (STZ)-diabetic rat major increases in noradrenaline concentration and content of the seminal vesicles were evident as early as 7 weeks following induction of hyperglycemia and returned toward normal after 34 weeks of hyperglycemia. There were significant reductions in the concentration and content of dopamine at 19-42 weeks of diabetes, and small occasionally significant reductions in the content of serotonin and adrenaline, particularly around 19-26 weeks after STZ treatment. The uptake of tritiated noradrenaline in the diabetics was increased at 12 weeks compared to the controls, and decreased to control levels with increasing age. Release of tritiated noradrenline was increased in response to electrical field stimulation and high potassium solutions, and raising calcium concentration caused increased release at rest and during electrical stimulation. Immunohistochemical demonstration of tyrosine hydroxylase was increased during the period when the noradrenaline concentration and content were elevated. It is concluded that there are significant changes in the sympathetic innervation of the seminal vesicle during the course of STZ diabetes, and that alterations in the reuptake, release, and synthesis of the neurotransmitter noradrenaline may contribute to changes in the concentration of the amine in the tissue. It is possible that the changes observed are related to the remodeling and regrowth of sympathetic nerve endings damaged in the early stages of hyperglycemia. These changes may also contribute to disorders of ejaculation in diabetes.

Short-term statin treatment improves endothelial function and neurohormonal imbalance in normocholesterolaemic patients with non-ischaemic heart failure

OBJECTIVES

To investigate the effect of short-term statin treatment on impaired endothelium-dependent vasodilatation and haemodynamic abnormalities typically occurring in chronic heart failure (CHF).

METHODS

In a double-blind, crossover study endothelium-dependent vasodilatation was measured in conduit and resistance vessels of 23 patients with non-ischaemic CHF after 6 weeks of placebo and 40 mg atorvastatin. The haemodynamic impact was assessed by cardioendocrine hormones, echocardiography and clinical indicators of CHF.

RESULTS

Cholesterol concentrations were population average (low density lipoprotein 3.56 (SEM 0.16) mmol/l, triglycerides 1.70 (0.20) mmol/l and high density lipoprotein 1.17 (0.07) mmol/l). In resistance vessels, the area under the curve ratio during acetylcholine infusion increased from 9.2 (1.9) with placebo to 12.2 (2.1) with statin (p < 0.01). This improvement was reversed during co-infusion with the nitric oxide antagonist N(G)-monomethyl-L-arginine. In conduit arteries, flow-mediated dilatation increased from 5.64 (SEM 0.88)% with placebo to 6.83 (0.97)% with statin (p < 0.05). Endothelium-independent vasodilatation did not change (p = 0.68 for conduit and p = 0.45 for resistance vessels). Endothelin 1 and atrial natriuretic peptide (ANP) decreased from 1.57 (0.08) and 51.3 (1.0) with placebo to 1.42 (0.09) pg/ml (p < 0.05) and 42.1 (7.5) pmol/l (p < 0.05), respectively, with statin.

CONCLUSIONS

In patients with non-ischaemic CHF and population-average cholesterol concentrations, short-term statin treatment improves endothelial function in conduit and resistance vessels and lowers plasma endothelin 1 and ANP concentrations.

Plasma variation of corticosteroid-binding globulin and sex hormone-binding globulin

Sex hormone-binding globulin (SHBG) and corticosteroid-binding globulin (CBG) circulate in plasma and bind their cognate ligands with high affinity, offering a steroid delivery system to target tissues by a variety of mechanisms. Analysis of these steroid-binding proteins is gaining importance in the clinical setting, although more information is warranted on their diurnal and biological variation. This study shows that plasma SHBG (in normal subjects) exhibits little diurnal or biological variation over the 30 day period studied, in contrast to CBG, where plasma levels peak in the early afternoon. This leads to attenuation of the diurnal free cortisol level rhythm compared to total cortisol. We also show that plasma CBG is significantly lower in male subjects with the metabolic syndrome compared to age-matched lean counterparts, and may therefore act as a surrogate marker of insulin resistance. The consequence of lower levels of CBG in these obese male subjects is reflected by higher levels of circulating free cortisol, potentially offering a more favourable environment for adipogenesis.

Natriuretic peptide and adrenomedullin levels in chronic renal failure and effects of peritoneal dialysis

Plasma levels of B-type natriuretic peptide (BNP) and its N-terminal propeptide (NT-BNP) are elevated in renal impairment and provide a robust prognostic index. The effect of peritoneal dialysis on plasma NT-BNP, however, is unknown. Furthermore, no information exists regarding levels of the N-terminal propeptide for C-type natriuretic peptide (NT-CNP) in renal failure and the effects of peritoneal dialysis. Accordingly, we documented venous levels of these peptides, and adrenomedullin, across peritoneal dialysis. We measured venous BNP, NT-BNP, NT-CNP, adrenomedullin, blood urea nitrogen (BUN) and creatinine before, during and after completion of overnight peritoneal dialysis in 11 patients, and identical sampling was carried out in eight patients (controls) but between peritoneal dialysis treatments. Peptide levels were measured using well-validated, published methods. Baseline levels of NT-CNP (212, 150-303 pmol/l, median and 25th and 75th percentiles) were much higher than recorded previously in healthy volunteers or in heart failure, and correlated with plasma creatinine (rs=0.53, P<0.05). Peritoneal dialysis had no effect on plasma NT-CNP, nor on NT-BNP, BNP or adrenomedullin (all elevated above normal), whereas both BUN and creatinine levels, as expected, declined (P<0.001). We conclude that plasma levels of NT-CNP are grossly elevated in chronic renal failure and correlated with plasma creatinine, but are not altered by peritoneal dialysis. Likewise, BNP, NT-BNP and adrenomedullin are elevated but are not altered by peritoneal dialysis. This information is needed if levels of these hormones are to be used as prognostic indicators or as a guide to the management of patients with chronic renal failure.

Increased cardiac sympathetic nerve activity following acute myocardial infarction in a sheep model

The time course of cardiac sympathetic nerve activity (CSNA) following acute myocardial infarction (MI) is unknown. We therefore undertook serial direct recordings of CSNA, arterial blood pressure (MAP) and heart rate (HR) in 11 conscious sheep before and after MI, and compared them with 10 controls. Conscious CSNA recordings were taken daily from electrodes glued into the thoracic cardiac nerves. Infarction was induced under pethidine and diazepam analgesia by applying tension to a coronary suture. MI size was assessed by left ventricular planimetry (%) at postmortem, peak troponin T and brain natriuretic peptide levels (BNP). Baroreflex slopes were assessed daily using phenylephrine-nitroprusside ramps. The mean infarcted area was 14.4 +/- 2.9%, troponin T 1.88 +/- 0.39 microg l(-1) and BNP 8.4 +/- 1.3 pmol l(-1). There were no differences in haemodynamic parameters or CSNA between groups at baseline. MAP and HR remained constant following MI. CSNA burst frequency increased from baseline levels of 55.8 +/- 7.1 bursts min(-1) to levels of 77.5 +/- 8.7 bursts min(-1) at 2 h post-MI, and remained elevated for 2 days (P < 0.001). CSNA burst area also increased and was sustained for 7 days following MI (P= 0.016). Baroreflex slopes for pulse interval and CSNA did not change. CSNA increases within 1 h of the onset of MI and is sustained for at least 7 days. The duration of this response may be longer because the recording fields decrease with time. This result is consistent with a sustained cardiac excitatory sympathetic reflex.

The effect of Helicobacter pylori infection and dietary iron deficiency on host iron homeostasis: a study in mice

BACKGROUND

Helicobacter pylori, which requires iron to survive, may cause host iron deficiency by directly competing with the host for available iron or by impairing iron uptake as a consequence of atrophy-associated gastric hypochlorhydria. The aim of this study was to examine the effect of H. pylori infection and dietary iron deficiency on host iron homeostasis in a mouse model.

MATERIALS AND METHODS

H. pylori SS1-infected and uninfected C57BL/6 mice, fed either a normal diet or an iron-deficient diet, were assessed for iron status and infection-associated gastritis over a 30-week period.

RESULTS

After 10 weeks, serum ferritin values were higher in H. pylori-infected mice than in uninfected controls, irrespective of dietary iron intake (p = .04). The infection-related increase in body iron stores persisted in the iron-replete mice but diminished over time in mice with restricted dietary iron intake (p < .0001). At 30 weeks serum ferritin levels were lower in these animals (p = .063). No significant difference in bacterial numbers was detected at the 30-week time point (p > .05) and the histological changes observed were consistently associated with infection (p < .01) and not with the iron status of the mice (p = .771).

CONCLUSIONS

Infection with H. pylori did not cause iron deficiency in iron-replete mice. However, diminished iron stores in mice as a result of limited dietary iron intake were further lowered by concurrent infection, thus indicating that H. pylori competes successfully with the host for available iron.

Prospective audit of conversion from regular to lispro insulin during routine clinical care

BACKGROUND

Randomized controlled trials show that lispro insulin has the potential to improve glycaemic control. Observational, practice-based studies provide information that is complementary to that obtained from randomized controlled trials and results of both types of studies are of relevance when advising patients of likely outcomes during routine clinical care.

AIMS

This prospective audit aimed to determine whether conversion from regular (short-acting, soluble) preprandial insulin to lispro during routine clinical care improved glycated haemoglobin.

METHODS

Eligible patients were those using regular insulin before main meals and a basal neutral protamine Hagedorn (NPH) insulin. Study group patients were those who chose to convert to lispro insulin. Patients who elected not to change their regimen were used as a comparison group. Follow up was for a minimum of 1 year.

RESULTS

Glycated haemoglobin (HbA(1c)) and body mass index showed no change in either the study or comparison groups. Post-hoc analysis revealed that the patients most likely to improve their HbA(1c) on lispro were those with a higher baseline HbA(1c). Patients using lispro reported a decreased frequency of hypoglycaemia and improved convenience of use.

CONCLUSIONS

Administration of lispro insulin was perceived by patients as convenient to use and was also associated with less hypoglycaemia when compared with the use of regular insulin. There was, however, no improvement in HbA(1c). This finding may be informative when advising patients during routine clinical care of the likely metabolic outcome of changing their insulin regimen.

Effect of changes in body posture on vasoactive hormones in pre-eclamptic women

The aim of this study was to determine the normality or otherwise of neurohormone indices, particularly the sympathetic nervous system, in pre-eclamptic patients and document whether changes in body posture magnify any differences between pre-eclamptic and normal women. We studied 11 women with pre-eclampsia and compared them with 17 matched normotensive pregnant women and eight nonpregnant women. Measurements of arterial pressure, heart rate and neurohormones were carried out with subjects in the left lateral position, then supine, left lateral, with upright posture and finally with assumption of the left lateral position again. Main outcome measures were arterial pressure, heart rate and hormones (plasma norepinephrine, renin activity, natriuretic peptides and endothelin-1). We observed that plasma norepinephrine levels were higher in pre-eclamptic than normotensive pregnant women and this was most obvious in the upright position. Plasma renin activity was likewise higher in pre-eclamptic than normotensive pregnant women, again most obvious with upright posture. Plasma natriuretic peptides and endothelin-1 levels were similar in pre-eclamptics and normotensive pregnant women. These data strengthen the premise that pre-eclampsia is associated with sympathetic overactivity as reflected by plasma norepinephrine levels, most obviously observed in the upright position.

Decrease in cardiac output and muscle sympathetic activity during vasovagal syncope

The importance of cardiac output (CO) to blood pressure level during vasovagal syncope is unknown. We measured thermodilution CO, mean blood pressure (MBP), and leg muscle mean sympathetic nerve activity (MSNA) each minute during 60 degrees head-up tilt in 26 patients with recurrent syncope. Eight patients tolerated tilt (TT) for 45 min (mean age 60 +/- 5 yr) and 15 patients developed syncope during tilt (TS) (mean age 58 +/- 4 yr, mean tilt time 15.4 +/- 2 min). In TT patients, CO decreased during the first minute of tilt (from 3.2 +/- 0.2 to 2.5 +/- 0.3 l x min(-1) x m(-2), P = 0.001) and thereafter remained stable between 2.5 +/- 0.3 (P = 0.001) and 2.4 +/- 0.2 l x min(-1) x m(-2) (P = 0.004) at 5 and 45 min, respectively. In TS patients, CO decreased during the first minute (from 3.3 +/- 0.2 to 2.7 +/- 0.1 l x min(-1) x m(-2), P = 0.02) and was stable until 7 min before syncope, falling to 2.0 +/- 0.2 at syncope (P = 0.001). Regression slopes for CO versus time during tilt were -0.01 min(-1) in TT versus -0.1 l x min(-1) x m(-2) x min(-1) in TS (P = 0.001). However, MBP was more closely correlated to total peripheral resistance (R = 0.56, P = 0.001) and MSNA (R = 0.58, P = 0.001) than CO (R = 0.32, P = 0.001). In vasovagal reactions, a progressive decline in CO may contribute to hypotension some minutes before syncope occurs.

A fast method for monitoring foliage density in single lower-canopy trees

A subjective visual assessment of foliage density is the most widely used rapid method of determining forest health. For these assessments to be ecologically meaningful they must be reliable (have low inter- and intra-observer variability) and readily relate to a measure of physiological or physical stress. A simple rapid method for assessing percent foliage density in lower stature trees is described. This method has low inter-observer variability (standard deviation between observers=8.6%) and therefore, minimizes the risk of confounding the effects of different observers with genuine changes in density. The percentage changes in this measure of foliage density correlate well with percentage changes in biomass, allowing a ready interpretation of observed changes. The technique does not specifically identify the cause of the measured changes, however, with appropriate additional measures this problem may be overcome.

Standard setting in an objective structured clinical examination: use of global ratings of borderline performance to determine the passing score

BACKGROUND

Objective structured clinical examination (OSCE) standard-setting procedures are not well developed and are often time-consuming and complex. We report an evaluation of a simple 'contrasting groups' method, applied to an OSCE conducted simultaneously in three separate schools.

SUBJECTS

Medical students undertaking an end-of-fifth year multidisciplinary OSCE.

METHODS

Using structured marking sheets, pairs of examiners independently scored student performance at each OSCE station. Examiners also provided a global rating of overall performance. The actual scores of any borderline candidates at each station were averaged to provide a passing score for each station. The passing scores for all stations were combined to become the passing score for the whole exam. Validity was determined by making comparisons with performance on other fifth-year assessments. Reliability measures comprised interschool agreement, interexaminer agreement and interstation variability.

RESULTS

The approach was simple and had face validity. There was a stronger association between the performance of borderline candidates on the OSCE and their in-course assessments than with their performance on the written exam, giving a weak measure of construct validity in the absence of a better 'gold standard'. There was good agreement between examiners in identifying borderline candidates. There were significant differences between schools in the borderline score for some stations, which disappeared when more than three stations were aggregated.

CONCLUSION

This practical method provided a valid and reliable competence-based pass mark. Combining marks from all stations before determining the pass mark was more reliable than making decisions based on individual stations.

Differing thresholds for modulatory effects of adrenomedullin infusion on haemodynamic and hormone responses to angiotensin II and adrenocorticotrophic hormone in healthy volunteers

Experimental data indicate that adrenomedullin (AM) interacts at various levels with the renin-angiotensin-aldosterone system and the hypothalamic-pituitary-adrenal axis, but data from humans are scant. We examined the effects of intermediate-dose, short-term AM infusion on angiotensin II- and adrenocorticotrophic hormone (ACTH)-mediated hormone and haemodynamic responses in healthy subjects. Seven normal volunteers (age 18-25 years) completed a placebo-controlled crossover study. Each subject was studied on day 4 of two periods of a low-salt diet (40 mmol of sodium and 80 mmol of potassium daily), receiving incremental infusions of angiotensin II in the morning and ACTH in the afternoon of each study day, on a background infusion of AM (4 pmol.min(-1).kg(-1)) or vehicle (hemaccel). Achieved plasma AM levels (23+/-6 pmol/l) and peak angiotensin II levels (160 pmol/l) were similar on the two experimental days. While the pressor action of angiotensin II was attenuated by AM (P<0.01) and noradrenaline levels rose (P<0.05), the aldosterone response was unaltered. During ACTH infusion, AM increased heart rate (P<0.01), plasma adrenaline (P<0.01) and plasma noradrenaline (P<0.05), and augmented the cortisol response (P<0.01), but was without effect on aldosterone levels and blood pressure. We conclude that the threshold for the effects of AM on aldosterone secretion in humans is set higher than for other biological responses to this hormone, namely blood pressure, heart rate, sympathetic activity and cortisol secretion, under these experimental conditions.