To examine the Down's syndrome screening positive rate among in vitro fertilisation (IVF) pregnancies, we measured second trimester serum marker levels in singleton IVF pregnancies (cases) and in five non-IVF pregnancies (controls) matched to each case for gestational age, age of mother, and duration of storage of the serum sample. There were 15 1 IVF pregnancies in which alpha fetoprotein, unconjugated oestriol (LIE?), free P-human chorionic gonadotrophin (hCG) and total hCG were measured, 104 IVF pregnancies in which free a-hCG was measured, and 39 IVF pregnancies in which inhibin A was measured. Median uE, levels were 6% lower (P = 0.003), median free P-hCG 9% higher (P = 0.024), and median total hCG 14% higher ( P = 0.026) in IVF pregnancies compared with controls. The screen positive rate in the IVF pregnancies (28%) was about twice as high as that in controls (17%). High hCG levels may be explained by progesterone remaining high in IVF pregnancies. The low uE, levels remain unexplained. In Down's syndrome screening in IVF pregnancies hCG and uE, values should be adjusted to avoid the high screen positive rate.

Livers from winter flounder (Pseudopleuronectes americanus) captured near Mount Desert Island, Maine, showed marked variation in hepatic benzo[a]pyrene hydroxylase (AHH; from 0.04 to 8.8 FU∙min−1∙mg protein−1) and 7-ethoxyresorufin deethylase activities (7-ERD; from < 2 to 1165 pmol∙min−1∙mg protein−1), and a dichotomy in the effect of 7,8-benzoflavone (ANF) added in vitro on AHH activity. Based on this ANF effect, the flounder could be divided into two groups. One group had high 7-ERD activity and high AHH activity which was inhibited by ANF; the other group had low 7-ERD activity and low AHH activity which was enhanced by ANF. Sex, weight, length, liver weight, gonad weight/body weight ratio, and liver/body weight ratio explained only a small part of the variability in hepatic AHH activities. Electrophoretograms of hepatic microsomes from flounder treated with 1,2,3,4-dibenzanthracene (DBA) or 5,6-benzoflavone (βNF) showed a novel or enriched polypeptide species present near 57 000 daltons, in the molecular weight (MW) range of known cytochrome P-450 isozymes. A polypeptide of similar MW was only faintly discernable in liver microsomes from untreated flounder whose hepatic AHH activity was much lower than that of the treated flounder, whereas a band of this MW was prominent in hepatic microsomes from untreated flounder with high hepatic AHH activity. These results suggest that many of the winter flounder captured near Mount Desert Island, Maine have induced hepatic monooxygenase activity due to exposure to PAH or PAH-like inducers present in their natural habitat.

Objective To investigate whether risk factor-based screening in pregnancy is failing to identify women with hepatitis C virus (HCV) infection and to assess the cost-effectiveness of universal screening.Design Retrospective study and model-based economic evaluation.Setting Two urban tertiary referral maternity units, currently using risk factor-based screening for HCV infection.Population Pregnant women who had been tested for hepatitis B, HIV but not HCV.Methods Anonymised sera were tested for HCV antibody. Positive sera were tested for HCV antigen. A cost-effectiveness analysis of a change to universal screening was performed using a Markov model to simulate disease progression and Monte Carlo simulations for probabilistic sensitivity analysis. Main outcome measures Presence of HCV antigen and cost per quality-adjusted life year (QALY).Results In all, 4655 samples were analysed. Twenty had HCV antibodies and five HCV antigen. This gives an active infection rate of 5/4655, or 0.11%, compared with a rate of 0.15% in the risk-factor group. This prevalence is 65% lower than a previous study in the same hospitals from 2001 to 2005. The calculated incremental cost-effectiveness ratio (ICER) for universal screening was €3,315 per QALY gained. ConclusionThis study showed that the prevalence of HCV infection in pregnant women in the Dublin region has declined by 65% over the past two decades. Risk factor-based screening misses a significant proportion of infections. A change to universal maternal screening for hepatitis C would be cost-effective in our population.

The infant who is small for gestational age (SGA) is more mature at birth than similar weight infants who are appropriate for gestational age (AGA). Whether the SGA infant behaves as does the larger gestationally equivalent infant, or whether there are specific changes related to intrauterine growth retardation is a matter of some interest in the understanding of the special needs of these infants. The National Institute of Child Health and Human Development (NICHD) phototherapy study provided a large newborn population for whom birth weight, gestational age at birth, and, thereby, intrauterine growth were carefully assessed. Infants who weighed 2,000 g or more at birth were included in the study only when they became jaundiced, whereas infants who weighed less than 2,000 g at birth were routinely entered into the study. Consequently, this report will be limited to the lowbirth-weight population selected by birth weight. Too few SGA babies were present in the groups with greater birth weight to allow meaningful comparisons. PATIENT SELECTIQN All infants whose birth weight was less than 2,000 g were entered into the study at 24 ± 12 hours. Those excluded from the study were: (1) infants who died before 24 hours, (2) infants with serious congenital defects, and (3) infants whose mothers refused consent for study. The study population consisted of 922 infants surviving at 24 hours. Gestational age was calculated from the first day of the last menstrual period obtained from maternal history and also by the evaluation techniques of Dubowitz.25 Intrauterine growth was determined by plotting birth weight and gestational age on the Denver Intrauterine Growth Curves8; infants below the 10th percentile were considered SGA.