Reduced shoulder proprioception due to fatigue after repeated handball throws and evaluation of test-retest reliability of a clinical shoulder joint position test.

Background: Proprioception is vital for motor control and can be disturbed, for example, due to fatigue or injury. Clinical feasible, reliable and valid tests of shoulder proprioception are warranted. The aim was to investigate the effects of local fatigue on shoulder proprioception and the reliability of a feasible joint position sense test using an experimental repeated measures design. Method: Forty participants repeated a shoulder joint position sense test to assess test-retest reliability. The test was then utilized on a subgroup of handball players who were subjected to five bouts of a repeated throwing task with the dominant hand. The effect of local fatigue was investigated by comparing the fatigued with the non-fatigued shoulder. Results: There was a significant interaction for the arm × bout (p = 0.028, ηp2 = 0.20) and a significant effect for the arm (p = 0.034, ηp2 = 0.35) with a significant decrease in joint position sense for the throwing arm compared to the non-throwing arm. The intraclass correlation coefficient was 0.78 (95% CI = [0.57; 0.89]). The standard error of measurement between trials was 0.70° (range: 0.57°-0.90°). Discussion: The results indicate that repeated throwing to fatigue disturbs shoulder joint position sense. Assessment with the modified test showed acceptable reliability and can be a valuable assessment tool in the clinic.

Addressing pollination deficits in orchard crops through habitat management for wild pollinators.

There is increasing evidence that farmers in many areas are achieving below maximum yields due to insufficient pollination. Practical and effective approaches are needed to maintain wild pollinator populations within agroecosystems so they can deliver critical pollination services that underpin crop production. We established nesting and wildflower habitat interventions in 24 UK apple orchards and measured effects on flower-visiting insects and the pollination they provide, exploring how this was affected by landscape context. We quantified the extent of pollination deficits and assessed whether the management of wild pollinators can reduce deficits and deliver improved outcomes for growers over 3 years. Wildflower interventions increased solitary bee numbers visiting apple flowers by over 20%, but there was no effect of nesting interventions. Other pollinator groups were influenced by both local and landscape-scale factors, with bumblebees and hoverflies responding to the relative proportion of semi-natural habitat at larger spatial scales (1000 m), while honeybees and other flies responded at 500 m or less. By improving fruit number and quality, pollinators contributed more than £16 k per hectare. However, deficits (where maximum potential was not being reached due to a lack of pollination) were recorded and the extent of these varied across orchards, and from year to year, with a 22% deficit in output in the worst (equivalent to ~£14 k/ha) compared to less than 3% (equivalent to ~£2 k/ha) in the best year. Although no direct effect of our habitat interventions on deficits in gross output was observed, initial fruit set and seed set deficits were reduced by abundant bumblebees, and orchards with a greater abundance of solitary bees saw lower deficits in fruit size. The abundance of pollinators in apple orchards is influenced by different local and landscape factors that interact and vary between years. Consequently, pollination, and the extent of economic output deficits, also vary between orchards and years. We highlight how approaches, including establishing wildflower areas and optimizing the ratio of cropped and non-cropped habitats can increase the abundance of key apple pollinators and improve outcomes for growers.

Annual estimates of occupancy for bryophytes, lichens and invertebrates in the UK, 1970-2015.

Here, we determine annual estimates of occupancy and species trends for 5,293 UK bryophytes, lichens, and invertebrates, providing national scale information on UK biodiversity change for 31 taxonomic groups for the time period 1970 to 2015. The dataset was produced through the application of a Bayesian occupancy modelling framework to species occurrence records supplied by 29 national recording schemes or societies (n = 24,118,549 records). In the UK, annual measures of species status from fine scale data (e.g. 1 × 1 km) had previously been limited to a few taxa for which structured monitoring data are available, mainly birds, butterflies, bats and a subset of moth species. By using an occupancy modelling framework designed for use with relatively low recording intensity data, we have been able to estimate species trends and generate annual estimates of occupancy for taxa where annual trend estimates and status were previously limited or unknown at this scale. These data broaden our knowledge of UK biodiversity and can be used to investigate variation in and drivers of biodiversity change.

N-Alkyl-α-amino acids in Nature and their biocatalytic preparation.

N-Alkylated-α-amino acids are useful building blocks for the pharmaceutical and fine chemical industries. Enantioselective methods of N-alkylated-α-amino acid synthesis are therefore highly valuable and widely investigated. While there are a variety of chemical methods for their synthesis, they often employ stoichiometric quantities of hazardous reagents such as pyrophoric metal hydrides or genotoxic alkylating agents, whereas biocatalytic routes can provide a greener and cleaner alternative to existing methods. This review highlights the occurrence of the N-alkyl-α-amino acid motif and its role in nature, important applications towards human health and biocatalytic methods of preparation. Several enzyme classes that can be used to access chiral N-alkylated-α-amino acids and their substrate selectivities are detailed.

Both the Observer's Expertise and the Subject's Facial Symmetry Can Affect Anatomical Position of the Head.

PURPOSE: It is easier to judge facial deformity when the patient's head is in anatomic position. The purposes of this study were to determine 1) whether a group of expert observers would agree more than a group of nonexperts on what is the correct anatomic position of the head, 2) whether there would be more variation in the alignment of an asymmetrical face compared with a symmetrical one, and 3) whether the alignments of experts would be more repeatable than those of nonexperts. MATERIALS AND METHODS: Thirty-one orthodontists (experts) and 31 dental students (nonexperts) were recruited for this mixed-model study. They were shown randomly oriented 3-dimensional head photographs of an adult with a symmetrical face and an adolescent with an asymmetrical face. In viewing software, the observers oriented the images into anatomic position. They repeated the orientations 4 weeks later. Data were analyzed using a generalized linear model and Bland-Altman plots. The primary predictor variables were experience and symmetry status. The outcome variable was the anatomic position of the head. The other variables of interest included time and orientation direction. RESULTS: There was a statistically significant difference between measurements completed by experts and nonexperts (F1,60 = 14.83; P < .01). The interaction between expertise and symmetrical status showed a statistically significant difference between symmetrical and asymmetrical faces in the expert and nonexpert groups (F1,60 = 9.93; P = .003). The interaction between expertise and time showed a statistically significant difference in measurement over time in the expert and nonexpert groups (F1,60 = 4.66; P = .03). CONCLUSIONS: The study shows that experts can set a head into anatomic position better than nonexperts. In addition, facial asymmetry has a profound effect on the ability of an observer to align a head in the correct anatomic position. Moreover, observer-guided alignment is not reproducible.

Biocatalytic Synthesis of Chiral N-Functionalized Amino Acids.

N-Functionalized amino acids are important building blocks for the preparation of diverse bioactive molecules, including peptides. The development of sustainable manufacturing routes to chiral N-alkylated amino acids remains a significant challenge in the pharmaceutical and fine-chemical industries. Herein we report the discovery of a structurally diverse panel of biocatalysts which catalyze the asymmetric synthesis of N-alkyl amino acids through the reductive coupling of ketones and amines. Reactions have been performed on a gram scale to yield optically pure N-alkyl-functionalized products in high yields.

The Broad Aryl Acid Specificity of the Amide Bond Synthetase McbA Suggests Potential for the Biocatalytic Synthesis of Amides.

Amide bond formation is one of the most important reactions in pharmaceutical synthetic chemistry. The development of sustainable methods for amide bond formation, including those that are catalyzed by enzymes, is therefore of significant interest. The ATP-dependent amide bond synthetase (ABS) enzyme McbA, from Marinactinospora thermotolerans, catalyzes the formation of amides as part of the biosynthetic pathway towards the marinacarboline secondary metabolites. The reaction proceeds via an adenylate intermediate, with both adenylation and amidation steps catalyzed within one active site. In this study, McbA was applied to the synthesis of pharmaceutical-type amides from a range of aryl carboxylic acids with partner amines provided at 1-5 molar equivalents. The structure of McbA revealed the structural determinants of aryl acid substrate tolerance and differences in conformation associated with the two half reactions catalyzed. The catalytic performance of McbA, coupled with the structure, suggest that this and other ABS enzymes may be engineered for applications in the sustainable synthesis of pharmaceutically relevant (chiral) amides.

An Aminocaprolactam Racemase from Ochrobactrum anthropi with Promiscuous Amino Acid Ester Racemase Activity.

The kinetic resolution of amino acid esters (AAEs) is a useful synthetic strategy for the preparation of single-enantiomer amino acids. The development of an enzymatic dynamic kinetic resolution (DKR) process for AAEs, which would give a theoretical yield of 100 % of the enantiopure product, would require an amino acid ester racemase (AAER); however, no such enzyme has been described. We have identified low AAER activity of 15 U mg-1 in a homologue of a PLP-dependent α-amino ϵ-caprolactam racemase (ACLR) from Ochrobactrum anthropi. We have determined the structure of this enzyme, OaACLR, to a resolution of 1.87 Šand, by using structure-guided saturation mutagenesis, in combination with a colorimetric screen for AAER activity, we have identified a mutant, L293C, in which the promiscuous AAER activity of this enzyme towards l-phenylalanine methyl ester is improved 3.7-fold.

Getting More Power from Your Flowers: Multi-Functional Flower Strips Enhance Pollinators and Pest Control Agents in Apple Orchards.

Flower strips are commonly recommended to boost biodiversity and multiple ecosystem services (e.g., pollination and pest control) on farmland. However, significant knowledge gaps remain regards the extent to which they deliver on these aims. Here, we tested the efficacy of flower strips that targeted different subsets of beneficial arthropods (pollinators and natural enemies) and their ecosystem services in cider apple orchards. Treatments included mixes that specifically targeted: (1) pollinators ('concealed-nectar plants'); (2) natural enemies ('open-nectar plants'); or (3) both groups concurrently (i.e., 'multi-functional' mix). Flower strips were established in alleyways of four orchards and compared to control alleyways (no flowers). Pollinator (e.g., bees) and natural enemy (e.g., parasitoid wasps, predatory flies and beetles) visitation to flower strips, alongside measures of pest control (aphid colony densities, sentinel prey predation), and fruit production, were monitored in orchards over two consecutive growing seasons. Targeted flower strips attracted either pollinators or natural enemies, whereas mixed flower strips attracted both groups in similar abundance to targeted mixes. Natural enemy densities on apple trees were higher in plots containing open-nectar plants compared to other treatments, but effects were stronger for non-aphidophagous taxa. Predation of sentinel prey was enhanced in all flowering plots compared to controls but pest aphid densities and fruit yield were unaffected by flower strips. We conclude that 'multi-functional' flower strips that contain flowering plant species with opposing floral traits can provide nectar and pollen for both pollinators and natural enemies, but further work is required to understand their potential for improving pest control services and yield in cider apple orchards.

Aboriginal mitogenomes reveal 50,000 years of regionalism in Australia.

Aboriginal Australians represent one of the longest continuous cultural complexes known. Archaeological evidence indicates that Australia and New Guinea were initially settled approximately 50 thousand years ago (ka); however, little is known about the processes underlying the enormous linguistic and phenotypic diversity within Australia. Here we report 111 mitochondrial genomes (mitogenomes) from historical Aboriginal Australian hair samples, whose origins enable us to reconstruct Australian phylogeographic history before European settlement. Marked geographic patterns and deep splits across the major mitochondrial haplogroups imply that the settlement of Australia comprised a single, rapid migration along the east and west coasts that reached southern Australia by 49-45 ka. After continent-wide colonization, strong regional patterns developed and these have survived despite substantial climatic and cultural change during the late Pleistocene and Holocene epochs. Remarkably, we find evidence for the continuous presence of populations in discrete geographic areas dating back to around 50 ka, in agreement with the notable Aboriginal Australian cultural attachment to their country.

Glyphosate and aminomethylphosphonic acid chronic risk assessment for soil biota.

Glyphosate is a broad-spectrum herbicide used widely in agriculture, horticulture, private gardens, and public infrastructure, where it is applied to areas such as roadsides, railway tracks, and parks to control the growth of weeds. The exposure risk from glyphosate and the primary soil metabolite aminomethylphosphonic acid (AMPA) on representative species of earthworms, springtails, and predatory soil mites and the effects on nitrogen-transformation processes by soil microorganisms were assessed under laboratory conditions based on internationally recognized guidelines. For earthworms, the reproductive no-observed-effect concentration (NOEC) was 472.8 mg glyphosate acid equivalent (a.e.)/kg dry soil, which was the highest concentration tested, and 198.1 mg/kg dry soil for AMPA. For predatory mites, the reproductive NOEC was 472.8 mg a.e./kg dry soil for glyphosate and 320 mg/kg dry soil for AMPA, the highest concentrations tested. For springtails, the reproductive NOEC was 472.8 mg a.e./kg dry soil for glyphosate and 315 mg/kg dry soil for AMPA, the highest concentrations tested. Soil nitrogen-transformation processes were unaffected by glyphosate and AMPA at 33.1 mg a.e./kg soil and 160 mg/kg soil, respectively. Comparison of these endpoints with worst-case soil concentrations expected for glyphosate (6.62 mg a.e./kg dry soil) and AMPA (6.18 mg/kg dry soil) for annual applications at the highest annual rate of 4.32 kg a.e./ha indicate very low likelihood of adverse effects on soil biota. Environ Toxicol Chem 2016;35:2742-2752. © 2016 The Authors. Environmental Toxicology and Chemistry Published by Wiley Periodicals, Inc. on behalf of SETAC.

Two Species with an Unusual Combination of Traits Dominate Responses of British Grasshoppers and Crickets to Environmental Change.

There are large variations in the responses of species to the environmental changes of recent decades, heightening interest in whether their traits may explain inter-specific differences in range expansions and contractions. Using a long-term distributional dataset, we calculated range changes of grasshoppers and crickets in Britain between the 1980s and the 2000s and assessed whether their traits (resource use, life history, dispersal ability, geographic location) explain relative performance of different species. Our analysis showed large changes in the distributions of some species, and we found a positive relationship between three traits and range change: ranges tended to increase for habitat generalists, species that oviposit in the vegetation above ground, and for those with a southerly distribution. These findings accord well with the nature of environmental changes over this period (climatic warming; reductions in the diversity and increases in the height of vegetation). However, the trait effects applied mainly to just two species, Conocephalus discolor and Metrioptera roeselii, which had shown the greatest range increases. Once they were omitted from the analysis, trait effects were no longer statistically significant. Previous studies on these two species emphasised wing-length dimorphism as the key to their success, resulting in a high phenotypic plasticity of dispersal and evolutionary-ecological feedback at their expanding range margins. This, combined with our results, suggests that an unusual combination of traits have enabled these two species to undertake extremely rapid responses to recent environmental changes. The fact that our results are dominated by two species only became apparent through cautious testing of the results' robustness, not through standard statistical checks. We conclude that trait-based analyses may contribute to the assessment of species responses to environmental change and provide insights into underlying mechanisms, but results need to be interpreted with caution and may have limited predictive power.

Aminomethylphosphonic acid has low chronic toxicity to Daphnia magna and Pimephales promelas.

Aminomethylphosphonic acid (AMPA) is the simplest member of a class of compounds known as aminomethylenephosphonates and the only environmental metabolite measured in significant amounts during the degradation of the herbicide glyphosate in soil. However, there are additional sources of AMPA in the environment, originating from organic phosphonates which are used in water treatment to inhibit scale formation and corrosion. Like glyphosate, AMPA has low acute toxicity to aquatic animals, and the no-observed-adverse effect concentration (NOAEC) obtained from a fish full-life cycle study for glyphosate was determined to be 26 mg/L. However, the chronic toxicity of AMPA to aquatic animals has not been evaluated before. The purpose of the present study was to assess the potential for chronic toxicity of AMPA to fathead minnow (Pimephales promelas) and Daphnia magna. Chronic toxicity to P. promelas was evaluated in a fish early-life stage study. The primary endpoints were larval survival, growth, and development. The NOAEC for P. promelas was determined to be 12 mg/L, the highest concentration tested. The chronic toxicity to D. magna was evaluated in a Daphnia reproduction test. The primary endpoints were survival, growth, and reproduction. The no-observed-effect concentration for D. magna was determined to be 15 mg/L. Conservatively predicted environmental surface water concentrations for AMPA from typical foliar agricultural application rates and values from surface water monitoring programs are 100 to 1000 times less than the NOAEC values from both studies. Consequently, there is a large and highly protective margin of safety between realistic environmental exposures to AMPA and chronic toxicity to aquatic vertebrates and invertebrates.

Evaluating exposure and potential effects on honeybee brood (Apis mellifera) development using glyphosate as an example.

This study aimed to develop an approach to evaluate potential effects of plant protection products on honeybee brood with colonies at realistic worst-case exposure rates. The approach comprised 2 stages. In the first stage, honeybee colonies were exposed to a commercial formulation of glyphosate applied to flowering Phacelia tanacetifolia with glyphosate residues quantified in relevant matrices (pollen and nectar) collected by foraging bees on days 1, 2, 3, 4, and 7 postapplication and glyphosate levels in larvae were measured on days 4 and 7. Glyphosate levels in pollen were approximately 10 times higher than in nectar and glyphosate demonstrated rapid decline in both matrices. Residue data along with foraging rates and food requirements of the colony were then used to set dose rates in the effects study. In the second stage, the toxicity of technical glyphosate to developing honeybee larvae and pupae, and residues in larvae, were then determined by feeding treated sucrose directly to honeybee colonies at dose rates that reflect worst-case exposure scenarios. There were no significant effects from glyphosate observed in brood survival, development, and mean pupal weight. Additionally, there were no biologically significant levels of adult mortality observed in any glyphosate treatment group. Significant effects were observed only in the fenoxycarb toxic reference group and included increased brood mortality and a decline in the numbers of bees and brood. Mean glyphosate residues in larvae were comparable at 4 days after spray application in the exposure study and also following dosing at a level calculated from the mean measured levels in pollen and nectar, showing the applicability and robustness of the approach for dose setting with honeybee brood studies. This study has developed a versatile and predictive approach for use in higher tier honeybee toxicity studies. It can be used to realistically quantify exposure of colonies to pesticides to allow the appropriate dose rates to be determined, based on realistic worst-case residues in pollen and nectar and estimated intake by the colony, as shown by the residue analysis. Previous studies have used the standard methodology developed primarily to identify pesticides with insect-growth disrupting properties of pesticide formulations, which are less reliant on identifying realistic exposure scenarios. However, this adaptation of the method can be used to determine dose-response effects of colony level exposure to pesticides with a wide range of properties. This approach would limit the number of replicated tunnel or field-scale studies that need to be undertaken to assess effects on honeybee brood and may be of particular benefit where residues in pollen and nectar are crop- and/or formulation-specific, such as systemic seed treatments and granular applications.

Enzymatic- and iridium-catalyzed asymmetric synthesis of a benzothiazepinylphosphonate bile acid transporter inhibitor.

A synthesis of the benzothiazepine phosphonic acid 3, employing both enzymatic and transition metal catalysis, is described. The quaternary chiral center of 3 was obtained by resolution of ethyl (2-ethyl)norleucinate (4) with porcine liver esterase (PLE) immobilized on Sepabeads. The resulting (R)-amino acid (5) was converted in two steps to aminosulfate 7, which was used for construction of the benzothiazepine ring. Benzophenone 15, prepared in four steps from trimethylhydroquinone 11, enabled sequential incorporation of phosphorus (Arbuzov chemistry) and sulfur (Pd(0)-catalyzed thiol coupling) leading to mercaptan intermediate 18. S-Alkylation of 18 with aminosulfate 7 followed by cyclodehydration afforded dihydrobenzothiazepine 20. Iridium-catalyzed asymmetric hydrogenation of 20 with the complex of [Ir(COD)2BArF] (26) and Taniaphos ligand P afforded the (3R,5R)-tetrahydrobenzothiazepine 30 following flash chromatography. Oxidation of 30 to sulfone 31 and phosphonate hydrolysis completed the synthesis of 3 in 12 steps and 13% overall yield.

The Association of Abnormal Ventricular Wall Motion and Increased Dispersion of Repolarization in Humans is Independent of the Presence of Myocardial Infarction.

Abnormal ventricular wall motion is a strong clinical predictor of sudden, arrhythmic, cardiac death. Dispersion in repolarization is a prerequisite for the initiation of re-entrant arrhythmia. We hypothesize that regionally decreased wall motion is associated with heterogeneity of repolarization. We measured local activation times, activation-recovery intervals (ARIs, surrogate for action potential duration), and repolarization times using a multielectrode grid at nine segments on the left ventricular epicardium in 23 patients undergoing coronary artery surgery. Regional wall motion was simultaneously assessed using intraoperative transesophageal echocardiography. Three groups were discriminated: (1) Patients with normal wall motion (n = 11), (2) Patients with one or more hypokinetic segments (n = 6), (3) Patients with one or more akinetic or dyskinetic segments (n = 6). The average ARI was similar in all groups (251 ± 3.7 ms, ±SEM). Dispersion of ARIs between the nine segments was significantly increased in the hypokinetic (84 ± 7.4 ms, p < 0.005) and akinetic/dyskinetic group (94 ± 3.5 ms, p < 0.0005) compared with the normal group (49 ± 5.1 ms), independent from the presence of myocardial infarction. Repolarization heterogeneity occurred primarily in the normally contracting regions of the hearts with abnormal wall motion. An almost maximal increased dispersion of repolarization was observed when there was only a single hypokinetic segment. We conclude that inhomogeneous wall motion abnormality of even moderate severity is associated with increased repolarization inhomogeneity, independent from the presence of infarction.

Investigating the phytotoxicity of the graminicide fluazifop-P-butyl against native UK wildflower species.

BACKGROUND: The selective graminicide fluazifop-P-butyl is used for the control of grass weeds in dicotyledonous crops, and commonly applied in amenity areas to reduce grass productivity and promote wildflower establishment. However, evidence suggests that fluazifop-P-butyl might also have phytotoxic effects on some non-target plants. This study investigates the effects of fluazifop-P-butyl on the emergence, phytotoxicity and above-ground biomass of nine perennial wildflower species and two grass species, following pre- and post-emergent applications at half, full and double label rates in a series of glasshouse experiments. RESULTS: While pre- and post-emergent applications of fluazifop-P-butyl caused reductions in seedling emergence and increased phytotoxicity on native wildflower and grass species, these effects were temporary for the majority of wildflower species tested, and generally only occurred at the double application rate. No differences in biomass were observed at any of the rates, suggesting good selectivity and no long-term effects of fluazifop-P-butyl application on the wildflower species from either pre-emergent or post-emergent applications. CONCLUSION: These results have direct relevance to the management of amenity areas for biodiversity, as they confirm the suitability of these wildflower species for inclusion in seed mixtures where fluazifop-P-butyl is to be applied to control grass productivity.

Enhancing habitat to help the plight of the bumblebee.

Modern farming has caused considerable declines in UK bumblebee populations, and, while options exist for farmers to increase the quantity of bee-friendly habitat, uptake has been low. Robin Blake explains how existing habitats on farms could be enhanced for the benefit of bumblebees.

Interaction of activation-repolarization coupling and restitution properties in humans.

BACKGROUND: Dynamic modulation of repolarization is important in arrhythmogenesis. An inverse relation exists in myocardium between activation time (AT) and action potential duration (APD). We hypothesized that resulting gradients of APD and diastolic interval (DI) interact with restitution properties and modulate the timing of repolarization. METHODS AND RESULTS: Activation-recovery intervals (ARI) were acquired from reconstructed noncontact unipolar electrograms from the left ventricular endocardium in 9 patients (7 male) with normal ventricles. At a basic paced cycle length (median, 450 ms), ARIs shortened along the path of activation, with a mandatory reciprocal increase of DIs. In the median patient, this range of DIs started at 230 ms at the site of earliest activation and increased to 279 ms at the site of latest activation at a basic cycle length of 450 ms. Four consecutive standard S1 to S2 restitution curves were performed. At sites with a longer ARI (and therefore shorter DI) close to the site of stimulation, premature stimulation produced more shortening of ARIs; therefore, the time course of restitution was steeper than at more distal sites. At normal heart rate, the decrease in ARIs along the conduction pathway compensated for later activation. Thus, dispersion in repolarization time (RT) is smaller than dispersion in ARI in a heart with a steep negative AT-ARI relationship. This protective effect is lost in hearts without such a relationship. In the patients with a steep AT-ARI relationship at basic cycle length, this relation is lost after premature stimulation and is a function of prematurity. Thus, dispersion in RT is larger after shortly coupled extra stimuli in patients with a steep AT-ARI relationship. CONCLUSIONS: A complex interplay exists between activation-repolarization coupling and restitution properties, largely driven by ARI and DI gradients. This plays a significant role in the dynamics of repolarization in humans.

Repolarization changes induced by mental stress in normal subjects and patients with coronary artery disease: effect of nitroglycerine.

OBJECTIVES: Mental stress can significantly affect ventricular repolarization, which could potentially trigger arrhythmias. We compared the effect of mental stress on repolarization indexed by the amplitude and area of the T wave in patients with coronary artery disease (CAD) and healthy subjects. METHODS: Fourteen healthy controls (11 M, mean age 42 years) and 14 patients with stable CAD (12 M, mean age 64) underwent a mental stress protocol consisting of mental arithmetic followed by a speech (5 minutes each), which was performed on two occasions following either nitroglycerine (NTG) or placebo. Multiple 12-lead electrocardiograms were acquired and repolarization was analyzed using automatically measured T wave amplitude (T(amp)) and area (T(area)). RESULTS: When preceded by placebo the overall effect of mental stress, whether induced by arithmetic or speech, was significantly different in CAD patients compared with controls, with a decrease in T(amp) and T(area) in controls and an increase in patients; e.g., change in T(amp) during arithmetic -20 +/- 3 microV in controls versus 4 +/- 2 microV in patients, p < .001, and during speech -9 +/- 3 microV in controls versus 7 +/- 1 microV in patients, p < .001. Following NTG, the effect of stress on repolarization was similar in the 2 groups, with a reversed effect, i.e., decrease instead of increase in T(amp) and T(area) in CAD patients. CONCLUSIONS: The effect of mental stress on ventricular repolarization is significantly different in CAD patients compared with healthy controls. These differences are considerably reduced by NTG.