Knowledge is power: Issues of measuring training and performance in cycling

Mobile power meters provide a valid means of measuring cyclists' power output in the field. These field measurements can be performed with very good accuracy and reliability making the power meter a useful tool for monitoring and evaluating training and race demands. This review presents power meter data from a Grand Tour cyclist's training and racing and explores the inherent complications created by its stochastic nature. Simple summary methods cannot reflect a session's variable distribution of power output or indicate its likely metabolic stress. Binning power output data, into training zones for example, provides information on the detail but not the length of efforts within a session. An alternative approach is to track changes in cyclists' modelled training and racing performances. Both critical power and record power profiles have been used for monitoring training-induced changes in this manner. Due to the inadequacy of current methods, the review highlights the need for new methods to be established which quantify the effects of training loads and models their implications for performance.

Sex and Age Differences in Choice Behaviour: The Object–Person Dimension

There is a popular belief that females are more socially oriented than males, while males are more nonsocially or object oriented than females. A 2 × 2 factorial design was employed to examine this, with independent variables of sex and age (young and older adults). The subjects were presented with six pairs of pictures, each consisting of an object and a person. Each presentation lasted 30 s; the time spent looking at each stimulus was taken as a measure of interest. The hypothesis that in this choice situation males and females would differ in their preference for object and person stimuli was confirmed. However, the sex difference was confined to young adults; older subjects of both sexes showed more (and equal) interest in the social stimuli than in the object stimuli. Masculinity and femininity scores on the Bem Sex Role Inventory showed some relationship with object–person preferences but failed to throw much light on the absence of a sex difference in older adults.

Ethnic variability in human leukocyte antigen-E haplotypes

Human leukocyte antigen-E (HLA-E) is an important nonclassical major histocompatibility complex (MHC) class I (Ib) molecule that acts as the ligand for NKG2A/B/C receptors expressed on natural killer (NK) cells and T cells. Unlike the classical class I molecules, HLA-E is highly conserved in evolution and the biological significance of polymorphism is therefore unclear. Our aim was to investigate the polymorphism in HLA-E gene in three ethnic groups in the UK and to obtain population data relating to any variations observed at this locus. We developed a polymerase chain reaction-sequence-specific primer (PCR-SSP) method for identifying HLA-E single nucleotide polymorphisms (SNPs) in genomic DNA. This was used to investigate the genotype distribution and allele frequency of nine published SNPs in the coding region of HLA-E in 223 Euro-Caucasoid, 60 Afro-Caribbean and 52 Asian healthy individuals. Genotype frequencies were in Hardy-Weinberg equilibrium. No polymorphism was observed for seven previously reported SNPs and these should not be considered polymorphic. However, positions 1114 and 1446 were confirmed as polymorphic and different genotype frequencies were identified at nucleotide position 1114 between the three studied ethnic groups. We present these data together with the intragene haplotype frequencies in these populations. To our knowledge, this is the first description of population frequencies of nine different SNPs in HLA-E in three main large ethnic groups. The data generated from this study will be of importance in the context of describing the effect of HLA-E polymorphism in clinical settings such as transplantation and autoimmune diseases.

HA-1 Mismatch Has Significant Effect in Chronic Allograft Nephropathy in Clinical Renal Transplantation

BACKGROUND

The minor histocompatibility antigen HA-1 occurs in two allelic forms: H and R. The HA-1(H) form presented in the context of HLA A2 can elicit specific cytotoxic lymphocyte (CTL) responses and can cause graft-versus-host disease in marrow transplants. However, its significance in solid organ transplants is unknown. We determined whether incompatibility of the HA-1 resulted in enhanced rejection and whether HA-1 specific CTLs were generated.

MATERIALS AND METHODS

HLA A2-matched donor/recipient pairs were selected and typed for HA-1 antigens by polymerase chain reaction. Nineteen of 81 pairs were mismatched for HA-1. Peripheral blood mononuclear leucocytes from five recipients, HLA A2 DR-matched with donors, were stimulated for 3 days with third-party donor, matched for HLA A2 DR but mismatched for HA-1. Cells were stained for surface markers, HA-1(H)-specific tetramer reagent, and analyzed by flow cytometry. Controls were unstimulated cells; PBML from two patients never exposed to HA-1(H); immunoglobulin G isotype-matched controls. For all patients, acute rejection rates posttransplant was ascertained. Long-term data was available for 36 patients.

RESULTS AND CONCLUSIONS

There was no difference in acute rejection rates between the HA-1-matched and -mismatched groups, but there was a significant difference in chronic rejection rates, evidenced by increased graft failures during the follow-up period (P = .0024). Lymphocytes from five HA-1-mismatched recipients were stimulated in vitro with cells from HLA-A2 and DR-matched but HA-1-mismatched surrogate donor. Though there seemed to be an excess of tetramer-positive cells, anti-HA-1-specific CTL responses were not conclusively elicited in vitro.

Immune responses to native beta(2)-glycoprotein I in patients with systemic lupus erythematosus and the antiphospholipid syndrome

OBJECTIVE

To identify HLA class II associations with anti beta(2)-glycoprotein I (beta2GPI) antibodies in a cohort of Caucasian patients with systemic lupus erythematosus (SLE) and to determine whether these HLA genotypes act as restriction elements for lymphocyte proliferation to native human beta2GPI in vitro.

METHODS

Anti-beta2GPI antibodies were detected in patient sera using enzyme-linked immunosorbent assays (ELISAs). HLA class II alleles (DRB1, DQB1) were determined by polymerase chain reaction-based DNA genotyping. In vitro peripheral blood mononuclear cell (PBMC) responses to native human beta2GPI were measured in a 7-day proliferation assay.

RESULTS

We identified three groups of Caucasian SLE patients using these ELISAs. In group 1, 16 out of 18 SLE patients (89%) with anti-beta2GPI antibodies were positive for HLA-DRB1*0401/4/8, DR11 or DRB1*1302 (P=0.001 vs controls) compared with 23 out of 53 patients (43%) in group 2 with anti-cardiolipin antibodies only, 57 out of 151 patients (38%) in group 3 (SLE patients without anticardiolipin antibodies) and 109 out of 225 controls (48%). Fourteen patients with anti-beta2GPI antibodies had greater median stimulation indices to beta2GPI in vitro compared with the 15 controls studied (P=0.04).

CONCLUSION

The HLA class II and PBMC proliferation data suggest that beta2GPI may be both a T- and B-cell autoantigen in SLE.

The natural history of fetomaternal alloimmunization to the platelet-specific antigen HPA-1a (PlA1, Zwa) as determined by antenatal screening

Immunization against the human platelet antigen (HPA)-1 alloantigen is the most common cause of severe fetal and neonatal thrombocytopenia. Fetal therapy has substantial risks and its indications need better definition. Of 24,417 consecutive pregnant women, 618 (2.5%) were HPA-1a negative of whom 385 entered an observational study. All were HLA-DRB3*0101 genotyped and screened for anti-HPA-1a. Their partners and neonates were HPA-1 genotyped and the latter were assessed by cord blood platelet counts and cerebral ultrasound scans. Anti-HPA-1a was detected in 46 of 387 pregnancies (12.0%; 95% CI 8.7%-15.2%). All but one were HLA-DRB3*0101 positive (odds ratio 140; 95% CI 19-1035; P< .00001). One baby died in utero, and of 26 HPA-1a-positive babies born to women with persistent antenatal antibodies, 9 were severely thrombocytopenic (8 with a count <10 x 10(9)/L, 1 with a large porencephalic cyst), 10 were mildly thrombocytopenic, whereas 7 had normal platelet counts. Severe thrombocytopenia was significantly associated with a third trimester anti-HPA-1a titer >/= 1:32 (P = . 004), but was not observed in babies of women with either transient or postnatal-only antibodies. HPA-1a alloimmunization complicates 1 in 350 unselected pregnancies, resulting in severe thrombocytopenia in 1:1,200. HPA-1a and HLA-DRB3*0101 typing combined with anti-HPA-1a titration allows selection of the majority of pregnancies at risk of severe thrombocytopenia.

Childhood immunisation advisory service for general practitioners

A study of 270 general practitioners associated with the University of Sydney, Division of Family Medicine, was conducted to examine the need for a childhood immunisation advisory service. Forty-three per cent of respondents had deferred immunisation or altered the schedule of immunisation of children attending them over the previous month. The majority stated that an immunisation advisory service would be beneficial. The preferred option was a telephone service operating from 9 am to 5 pm.

Mixed lymphocyte reactions do not predict severity of graft versus host disease (GVHD) in HLA-DR compatible, sibling bone marrow transplants

Mixed lymphocyte reactions (MLRs) were measured in 25 HLA-A, B and DR compatible sibling bone marrow transplants. Only four of 25 MLRs were positive and in these the low reactivity was of doubtful clinical importance. There was no correlation between MLR and the subsequent development or severity of graft versus host disease (GVHD). A survey of bone marrow transplant units in the United Kingdom showed that most centres perform HLA-DR typing as well as an assessment of the MLR. Factors other than histocompatibility are important in the pathogenesis of GVHD and the data from this study suggest that conventional MLRs can be omitted in HLA-A, B and DR compatible sibling bone marrow transplants.

HLA and C4 polymorphism in diabetic microangiopathy

We have reported an increased frequency of the rare B3 allotype of the fourth component of complement (C4B3) in insulin-dependent diabetics, especially in those with microangiopathy. This study has now been expanded--20 of 106 subjects with microangiopathy and 9 of 116 without possessed the C4B3 allotype (p less than 0.02). C4B3 is said to be in linkage disequilibrium with HLA-DR4. HLA typing was performed on 94 of these patients, 52 with and 42 without microangiopathy. There was no significant difference in the frequency of DR4 (62 vs 50%), DR3 (65 vs 52%), B8 (40 vs 40%) or B15 (32 vs 19%) respectively between these 2 groups. These results confirm an HLA-linked predisposition to microangiopathy, but do not determine whether the primary association is with C4B3, DR4 or another gene with which they are in linkage disequilibrium.

Human lymphocyte antigens in hypertrophic cardiomyopathy

An increasing number of genetic studies in hypertrophic cardiomyopathy challenge conventional views on inheritance and suggest genetic heterogeneity or non-genetic disease. We have found changes in relative risk for some antigens with significantly increased frequency of HLA antigen DR4 in this condition. These findings are consistent with there being a genetic component in susceptibility to hypertrophic cardiomyopathy. No evidence was found for HLA linkage using either sib pair analysis or lod scores. This suggests that hypertrophic cardiomyopathy does not have a disease susceptibility gene related to the HLA region on the short arm of chromosome number six. Population HLA associations with hypertrophic cardiomyopathy must thus be explained by other influences of the genetic background on disease susceptibility.

Penicillamine-induced myasthenia in rheumatoid arthritis: its clinical and genetic features

The clinical features and genetic background of 18 patients with rheumatoid arthritis were investigated following the development of penicillamine-induced myasthenia (PIM). The initial myasthenia symptoms in all patients consisted of variable diplopia and/or ptosis with progression to a more generalized involvement in 7 of them. No clinical, humoral, or genetic factor was determined which would allow identification of individuals developing generalized as opposed to ocular myasthenia. Withdrawal of penicillamine was associated over 4-60 weeks with a slow resolution of symptoms, facilitated in 12 patients by the use of anticholinesterase agents. In 2 patients a persistent partial unilateral ptosis remains after 15 and 25 months, while in a further patient diplopia is present 42 months after resolution of the other myasthenic symptoms. The patients with PIM when compared with a healthy 'control' population had a significant increase in HLA Dr1 (p corr less than 0.005) and an absence of HLA Dr 3. A genetic susceptibility to the development of PIM, distinct from that observed in myasthenia gravis of spontaneous onset, is suggested by this abnormal distribution of HLA Dr antigens.

Immunocytochemical localization of water-soluble glycoproteins, including group 1 allergen, in pollen of ryegrass, Lolium perenne, using ferritin-labelled antibody

The cellular sites of the glycoproteins Group 1 allergen (glycoprotein 1) and Antigen A (glycoprotein 2) in mature ryegrass pollen have been investigated by immunoelectron microscopy. Radioimmunoassays confirm previous findings of cross-reactivity between the purified glycoprotein antigens at the high immunoglobulin G (IgG) concentrations used for localization. Freeze-drying of anthers followed by anhydrous processing has been employed because of the water solubility and mobility of the glycoproteins. A double-embedding technique has been developed. This involves, first, embedding anthers in the water-soluble plastic resin JB-4, sectioning and incubating in ferritin-labelled antisera by the indirect method. The sections are then embedded in Spurr's resin for ultra-thin sectioning. Both glycoproteins are found in the following sites: (1) exine and intine wall layers; (2) pollen cytoplasm; (3) the orbicules and anther loculus; and (4) the anther cuticle. In the exine arcades and surface and in the anther loculus, the ferritin label is bound to pollenkitt. The finding that the glycoproteins are in similar sites is predictable in view of the cross-specificity of the antisera. The extent of antibody penetration of the plastic sections has been examined; labelling is confined to cut grains and absent from intact grains.

Familial cheiroarthropathy without juvenile onset diabetes mellitus

Cheiroarthropathy is a recently recognised complication of juvenile onset diabetes mellitus. It comprises inability to extend fully the fingers, contracted tendons, and waxy thickening of the skin overlying the fingers and to a lesser extent the hands. We report two families in which one parent and a number of siblings had the typical features of cheiroarthropathy without juvenile onset diabetes mellitus. The changes developed gradually during childhood and did not progress after adolescence. There were no other abnormal clinical findings, no persistently abnormal laboratory tests, and no association with a specific HLA phenotype. There are some similarities with scleroderma and its recognition is important to prevent unnecessary treatment and to reassure patients.