The aims of this study were to quantify the effects of factors such as mode of exercise, body composition and training on the relationship between heart rate and physical activity energy expenditure (measured in kJ · min⁻¹) and to develop prediction equations for energy expenditure from heart rate. Regularly exercising individuals (n = 115; age 18 – 45 years, body mass 47 – 120 kg) underwent a test for maximal oxygen uptake ([Vdot]O_2max test), using incremental protocols on either a cycle ergometer or treadmill; [Vdot]O_2max ranged from 27 to 81 ml · kg⁻¹ · min⁻¹. The participants then completed three steady-state exercise stages on either the treadmill (10 min) or the cycle ergometer (15 min) at 35%, 62% and 80% of [Vdot]O_2max, corresponding to 57%, 77% and 90% of maximal heart rate. Heart rate and respiratory exchange ratio data were collected during each stage. A mixed-model analysis identified gender, heart rate, weight, [Vdot]_2max and age as factors that best predicted the relationship between heart rate and energy expenditure. The model (with the highest likelihood ratio) was used to estimate energy expenditure. The correlation coefficient (r) between the measured and estimated energy expenditure was 0.913. The model therefore accounted for 83.3% (R ²) of the variance in energy expenditure in this sample. Because a measure of fitness, such as [Vdot]O_2max, is not always available, a model without [Vdot]O_2max included was also fitted. The correlation coefficient between the measured energy expenditure and estimates from the mixed model without [Vdot]O_2max was 0.857. It follows that the model without a fitness measure accounted for 73.4% of the variance in energy expenditure in this sample. Based on these results, we conclude that it is possible to estimate physical activity energy expenditure from heart rate in a group of individuals with a great deal of accuracy, after adjusting for age, gender, body mass and fitness.

Objectives: A COL5A1 gene variant was shown to be associated with chronic Achilles tendinopathy in a South African population. The aim of this case–control genetic association study was to investigate the BstUI and DpnII restriction fragment length polymorphisms (RFLP) in a second population from Australia and to identify a predisposing haplotype for Achilles tendinopathy in both populations. Methods: 85 Australian and 93 South African patients with tendinopathy, as well as 210 Australian and 132 white South African control subjects were genotyped for the BstUI (rs12722) and DpnII (rs13946) RFLP, as well as markers rs10858286, rs3196378, rs11103544, rs4504708 and rs3128575. Results: The BstUI RFLP (p<0.001) and marker rs3196378 (p = 0.016) were associated with chronic Achilles tendinopathy in Australian subjects. Individuals within both populations with a CC genotype for the BstUI RFLP had a significantly decreased risk of developing tendinopathy versus any other genotypes (Australian odds ratio 0.42, 95% CI 0.20 to 0.86, p = 0.017). The TC inferred haplotype (rs12722, rs3196378) was found to be overrepresented (global p = 0.008) in the South African tendinopathy group compared with all other haplotypes. Conclusion: The BstUI RFLP is associated with chronic Achilles tendinopathy in a second population and a region within the COL5A1 3′ untranslated region may predispose individuals to an increased risk of developing chronic Achilles tendinopathy.

Objectives: Sequence variation within theCOL5A1andTNCgenes are known to associate with Achilles tendinopathy. The primary aim of this case-control genetic association study was to investigate whether variants within the matrix metalloproteinase 3 (MMP3) gene also contributed to both Achilles tendinopathy and Achilles tendon rupture in a Caucasian population. A secondary aim was to establish whether variants within theMMP3gene interacted with theCOL5A1rs12722 variant to raise risk of these pathologies.Methods: 114 subjects with symptoms of Achilles tendon pathology and 98 healthy controls were genotyped forMMP3variants rs679620, rs591058 and rs650108.Results: As single markers, significant associations were found between the GG genotype of rs679620 (OR = 2.5, 95% CI 1.2 to 4.90, p = 0.010), the CC genotype of rs591058 (OR = 2.3, 95% CI 1.1 to 4.50, p = 0.023) and the AA genotype of rs650108 (OR = 4.9, 95% CI 1.0 to 24.1, p = 0.043) and risk of Achilles tendinopathy. The ATG haplotype (rs679620, rs591058, and rs650108) was under-represented in the tendinopathy group when compared to the control group (41% vs 53%, p = 0.038). Finally, the G allele of rs679620 and the T allele ofCOL5A1rs12722 significantly interacted to raise risk of AT (p = 0.006). No associations were found between any of theMMP3markers and Achilles tendon rupture.Conclusion: Variants within theMMP3gene are associated with Achilles tendinopathy. Furthermore, theMMP3gene variant rs679620 and theCOL5A1marker rs12722 interact to modify the risk of tendinopathy. These data further support a genetic contribution to a common sports related injury.

Objective: To estimate the diagnostic accuracy of chest radiography in the detection of chest lymphadenopathy in children with clinically suspected pulmonary tuberculosis. Methods: Design: Prospective cross sectional study. Setting: A short stay ward in a children’s hospital in South Africa. Patients: Consecutive children under 14 years of age admitted with suspected pulmonary tuberculosis. Diagnostic test: Antero-posterior and/or lateral chest x rays interpreted independently and blind to the reference standard by three primary care clinicians and three paediatricians, all with a special interest in tuberculosis. Reference standard: Spiral chest computed tomography (CT) with contrast injection. Results: One hundred children (median age 21.5 months) were enrolled. Lymphadenopathy was present in 46 of 100 reference CT scans and judged to be present in 47.1% of x ray assessments. Overall sensitivity was 67% and specificity 59%. Primary care clinicians were more sensitive (71.5% v 63.3%, p = 0.047) and less specific (49.8% v 68.9%, p<0.001) than paediatricians. Overall accuracy was higher for the paediatricians (diagnostic odds ratio 3.83 v 2.49, p = 0.008). The addition of a lateral to an antero-posterior view did not significantly increase accuracy (diagnostic odds ratio 3.09 v 3.73, p = 0.16). Chance adjusted inter-observer agreement (κ) varied widely between viewer pairs, but was around 30%. Conclusions: Detection of mediastinal lymphadenopathy on chest x ray to diagnose pulmonary tuberculosis in children must be interpreted with caution. Diagnostic accuracy might be improved by refining radiological criteria for lymphadenopathy.