sis of fFN performance in which the ratios showed narrow confidence intervals (4 ).The major goal of this study was to determine the effect of implementing the fFN test on hospital admission rates. We hypothesized that if clinicians were using a negative fFN result to rule out preterm labor, test implementation would lead to a decrease in admissions for preterm labor. One previous study showed reduced hospital admissions for preterm labor as a result of fFN testing by comparing admission rates before and after test introduction (5 ). Because of changes in our hospital's referral base in early 2002, we did not believe we could accurately assess the impact of fFN testing by comparing admission rates before and after test introduction. We therefore assessed the effect of implementing the fFN test as follows. We first compared the rate of hospital admission for Ͼ12 h for fFN-negative patients to the admission rate for fFNpositive patients. We found that fFN-negative patients were less likely to be admitted than fFN-positive patients (2% of fFN-negative patients vs 19% of fFN-positive patients were admitted; see Table 1C). This difference in admission rates was statistically significant (P ϭ 0.002). For the smaller subset of patients with survey results (n ϭ 58), the trend was similar although not statistically significant (2% vs 14%; P ϭ 0.14). These data suggest that clinicians are incorporating the fFN result in their decision-making process. However, it is also possible that the differential admission rates reflect differences in the pretest characteristics of fFN-negative and -positive patients, rather than the impact of test results on clinical management.To help distinguish between these possibilities, we examined the results of the pretest survey that accompanied each test requisition. We determined which patients had a high pretest probability of admission by noting whether the clinician circled "admit to observation" as a possibility on the pretest survey. If this option was circled, we counted the patient as "admission considered" (Table 1D). Although we cannot know the frequency with which these patients would have been admitted without the fFN result, we reasoned that clinicians' responses to this survey question should reflect any pretest differences between the fFN-positive and -negative patient populations. Overall, 57% of patients were considered for admission. Interestingly, the proportions of fFN-positive and -negative patients considered for admission were very similar (64% and 55%, respectively; P ϭ 0.56). This finding suggests that the fFN result itself, rather than a pretest characteristic of the two patient populations, was the major reason for the differential admission rates in fFNnegative vs fFN-positive patients.A secondary point regarding test utilization should be emphasized as well. When a test with a low positive predictive value is introduced, there is always a concern that clinicians will overinterpret a positive test result. For the fFN test, a positive test result does not indicat...

D-Serine, an endogenous modulator of NMDA receptors has been shown to play a vital role in many neuropsychiatric functions such as learning, memory, nociception and implicated in pathological conditions like schizophrenia and Alzheimer's disease. We propose possible therapeutic approaches for some CNS diseases and chronic pain, targeting the D-serine levels by manipulating its uptake, biosynthesis and metabolism.

This study analyzes the relationship between amino acids and pain perception during active labor. Cerebrospinal fluid (CSF) levels of the excitatory amino acids (EAAs)-glutamate, aspartate and their amide forms, inhibitory amino acids (IAAs)-glycine, gamma-amino butyric acid (GABA) and taurine and nitric oxide (NO) related compounds-arginine and citrulline (by-product of NO synthesis) were compared between pregnant women at term pregnancy with labor pain (n = 38) and without labor pain (Caesarian section; n = 30). The levels of aspartate, glycine, GABA and citrulline were significantly higher; whilst taurine was significantly lower in the labor pain group. These findings suggest that aspartate and NO are associated with labor pain. An inhibitory role for the IAA taurine and a pronociceptive role for glycine in labor pain are proposed.

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