Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care

Objectives To measure the effectiveness and cost effectiveness of providing care in a chest pain observation unit compared with routine care for patients with acute, undifferentiated chest pain.Design Cluster randomised controlled trial, with 442 days randomised to the chest pain observation unit or routine care, and cost effectiveness analysis from a health service costing perspective.Setting The emergency department at the Northern General Hospital, Sheffield, United Kingdom.Participants 972 patients with acute, undifferentiated chest pain (479 attending on days when care was delivered in the chest pain observation unit, 493 on days of routine care) followed up until six months after initial attendance.Main outcome measures The proportion of participants admitted to hospital, the proportion with acute coronary syndrome sent home inappropriately, major adverse cardiac events over six months, health utility, hospital reattendance and readmission, and costs per patient to the health service.Results Use of a chest pain observation unit reduced the proportion of patients admitted from 54% to 37% (difference 17%, odds ratio 0.50, 95% confidence interval 0.39 to 0.65, P < 0.001) and the proportion discharged with acute coronary syndrome from 14% to 6% (8%, -7% to 23%, P = 0.264). Rates of cardiac event were unchanged. Care in the chest pain observation unit was associated with improved health utility during follow up (0.0137 quality adjusted life years gained, 95% confidence interval 0.0030 to 0.0254, P = 0.022) and a saving of £78 per patient (-£56 to £210, P = 0.252).Conclusions Care in a chest pain observation unit can improve outcomes and may reduce costs to the health service. It seems to be more effective and more cost effective than routine care.     

Detection of pregnancy by radioimmunoassay of a novel pregnancy-specific protein in serum of cows and a profile of serum concentrations during gestation

The development of a double antibody radioimmunoassay for a bovine pregnancy-specific protein (pregnancy-specific protein B; PSPB) is presented. By means of this assay, PSPB could be measured in serum of pregnant cows. Five dairy cows were bled throughout gestation to measure serum levels of PSPB. Serum concentrations (means +/- SE) exceeded 1 ng/ml by 30 days postbreeding and increased gradually through three months (9 +/- 0.6 ng/ml), six months (35 +/- 6 ng/ml), and nine months (150 +/- 75 ng/ml) of gestation. Maximum levels of PSPB (542 +/- 144 ng/ml) were reached two days before parturition and then steadily declined to less than 78 ng/ml by 21 days postpartum. In 21 cows bled daily from 15 through 30 days postbreeding, PSPB could be measured in a few cows before and in most cows by 24 days after breeding. In a commercial herd of 102 beef cows, the assay could detect pregnancy earlier and more accurately than the routine method of rectal palpation. This radioimmunoassay measures a unique antigen that, for the first time, provides a serological method for detecting pregnancy in cows.     

Circadian adaptation to night-shift work by judicious light and darkness exposure

In this combined field and laboratory investigation, the authors tested the efficacy of an intervention designed to promote circadian adaptation to night-shift work. Fifteen nurses working permanent night schedules (> or = 8 shifts/ 15 days) were recruited from area hospitals. Following avacation period of > or = 10 days on a regular daytime schedule, workers were admitted to the laboratory for the assessment of circadian phase via a 36-h constant routine. They returned to work approximately 12 night shifts on their regular schedules under one of two conditions. Treatment group workers (n = 10, mean age +/- SD = 41.7 +/- 8.8 years) received an intervention including 6 h of intermittent bright-light exposure in the workplace (approximately 3,243 lux) and shielding from bright morning outdoor light with tinted goggles (15% visual light transmission). Control group workers (n = 9, mean age +/- SD = 42.0 +/- 7.2 years) were observed in their habitual work environments. On work days, participants maintained regular sleep/wake schedules including a single 8-h sleep/darkness episode beginning 2 h after the end of the night shift. A second 36-h constant routine was performed following the series of night shifts. In the presence of the intervention, circadian rhythms of core body temperature and salivary melatonin cycles were delayed by an average (+/- SEM) of -9.32 +/- 1.06 h and -11.31 +/- 1.13 h, respectively. These were significantly greater than the phase delays of -4.09 +/- 1.94 h and -5.08 +/- 2.32 h displayed by the control group (p = 0.03 and p = 0.02, respectively). The phase angle between circadian markers and the shifted schedule was reestablished to its baseline position only in the treatment group of workers. These results support the efficacy of a practical intervention for promoting circadian adaptation to night-shift work under field conditions. They also underline the importance of controlling the overall pattern of exposure to light and darkness in circadian adaptation to shifted sleep/wake schedules.     

Changes in germ cell population in young and adult female mice from two inbred strains: CBA/Kw and KE

Female mice from two inbred strains CBA/Kw and KE differ markedly in fertility. The gametes of females from KE strain are of poorer quality than those of CBA/Kw. We analyzed the number of oocytes per ovary in KE and CBA/Kw mice aged 5, 25, 90, 180 and 360 days. The ovaries were dissected and processed according to the routine histological methods. In case of five-day-old females we used a modified distributed point counting method while in order to examine the gonads of older females, the nucleoli counting method was applied. In general, we observed gradual decrease in germ cell number throughout the whole life of females from both strains. The noticeable wave of oocyte loss occurs between 5th and 25th days of life. The mice from KE inbred strain on day 25th (1650 +/- 322 vs. 1140 +/- 210) and 90(th) (1040 +/- 211 vs. 692 +/- 89) days have significantly (p<0.005) more germ cells than the females from CBA/Kw strain. In older females the differences were not statistically significant. Interestingly, CBA/Kw females were found to have more rapid loss of primordial follicles throughout their lives. This can explain their shortened reproductive lifespan which was observed earlier.     

Acute asthma: emergency department management and prospective evaluation of outcome.

To determine the current management of acute asthma in the emergency department and to evaluate outcome we reviewed the charts of 99 patients aged 15 to 55 years who presented to the emergency department of a tertiary referral, university-affiliated hospital and were subsequently discharged with a diagnosis of acute asthma. Outcome was evaluated prospectively, with a structured questionnaire, by telephone. During the visit pulsus paradoxus was documented in four patients. Spirometry was done in 63 patients; postbronchodilator values ranged from 0.9 to 4.1 L. A total of 92 patients received inhaled bronchodilator therapy, most by wet nebulization. Sixteen patients received anticholinergic agents and three received theophylline. Ingested corticosteroids were given to 27 patients. Of the 71 patients contacted, a mean of 12 days after the visit, 26 (37%) had sought further medical attention, 19 at the emergency department; 9 had required admission. Forty-six patients reported that their condition had improved, but over 60% continued to have cough, sputum production, nocturnal waking and early-morning chest tightness. The results indicate that asthma continues to be undertreated in the emergency department and highlight the importance of routine spirometry in all patients and the need for systemic corticosteroid therapy.     

Indications for total parenteral nutrition in the hospitalized patient: a prospective review of evolving practice

The indications for initiating total parenteral nutrition (TPN) were prospectively evaluated in 100 consecutive patients at a tertiary referral hospital with a long-standing Nutritional Support Service to illustrate the reasons why the parenteral route was chosen at this unique institution in terms of patient population. Sixty male and 40 female patients, average age 59 +/- 17 years (range 22-86 years), were classified a priori as to the underlying reasons for initiation of TPN. The study was conducted by a Nutrition Support Service at this hospital without pediatric, trauma, or burn services specializing in the care of patients with diabetes mellitus. Of the 100 patients, 63% were from the surgical service; 24% had diabetes mellitus. Their mean weight (118 +/- 29% of ideal), body mass index (25 +/- 6 kg/m(2)), and serum albumin (2.8 +/- 0.7 g/dL) indicated a reasonable body composition with a moderate systemic inflammatory response. Six patients received preoperative TPN for an average of 5 +/- 3 days with a variety of diagnoses including malignancy, Crohn's disease, bowel obstruction, and gastrointestinal bleeding. The underlying reasons for initiating nutritional support were related to three factors that largely determine the need for involuntary feeding: preexisting protein calorie malnutrition, actual or anticipated semistarvation for a prolonged period, and the presence of a systemic inflammatory response. The choice of TPN was based on anticipated or proven intolerance to full enteral feeding. The duration of time before initiation of TPN postoperatively was 6 +/- 5 days, which reflects our policy that initially well-nourished patients who are experiencing a systemic inflammatory response should not undergo more than 5 to 7 days of inadequate feeding. The duration of TPN overall was 11 +/- 10 days, which primarily illustrates the dramatic reduction in length of hospital stay that has occurred throughout the health care system and the willingness to provide TPN in alternative settings including transitional care units, rehabilitation hospitals, and for short-term care, the patient's home. The most common specific reasons identified for initiating TPN rather than enteral nutrition were ileus (25%), an underlying acid-base or electrolyte/mineral disorder (13%) requiring correction, and the convenience of TPN because a central venous catheter was in place (12%). The usual indication for nutritional support at this tertiary referral and specialty hospital was actual or impending protein calorie malnutrition. TPN was chosen for a variety of reasons related to actual or anticipated tolerance to enteral feeding. This audit demonstrates that our TPN practice has evolved in relation to time of initiation and duration of feeding, which reflect a clearer appreciation of the risks and benefits of TPN.     

Profile of an Accident Flying Squad

An analysis of 184 accident flying squad calls and of 280 patients injured in road accidents and treated by a flying squad based on an accident department inclusive from 1967 to 1971 has shown that such a service can provide an efficient system without disrupting the routine work of the hospital.     

行政干预对Ⅰ类切口围术期预防性使用抗菌药物的影响

目的:探讨行政干预对I类切口围术期预防性使用抗菌药物的影响。方法:2011年4月～6月对全院手术科室进行行政干预,具体做法:卫生行政部门与医院一把手、医院与手术科室主任、科室主任与科室执业医生分别签订目标责任状;医院配合全国抗菌药物临床应用专项整治活动方案进行全员培训,并对医师进行抗菌药物临床应用培训并考核合格后,授予其相应级别的抗菌药物处方权,明确各级医师使用抗菌药物的处方权限;由医务科牵头与院感染科、药剂科、质控科联合对I类切口手术患者预防使用抗菌药物情况进行检查,定期实施目标奖罚,责任到科室主任和临床医生。然后抽取我院2010年7月～12月(行政干预前)和2011年7月～12月(行政干预后)I类切口手术病历各210份,参考《抗菌药物临床应用指导原则》、卫办医政发[2009]38号通知对420例I类切口手术患者预防使用抗菌药物情况进行回顾性分析。结果:行政干预前(2010年7月～12月)I类切口围手术期预防性抗菌药物的使用率达83.81%(176/210),术后抗菌药物使用时间在2～7天者占69.52%,大于7天者占6.67%;行政干预后(2011年7月～12月)210例患者预防使用抗菌药物使用率为30%(63/210),显著低于未使用行政干预的Ⅰ类切口术患者(P<0.05),围术期术后抗菌药物使用时间在2～7天者占16.67%,没有1例患者用药超过7天,抗菌药物的使用时间较未使用行政干预的Ⅰ类切口术患者显著缩短(P<0.05)。结论:有效的行政干预可以强化临床医生合理应用抗菌药物的意识,提高合理用药的水平,明显降低I类切口预防性抗菌药物的使用率,缩短抗菌药物的使用疗程。     

Alterations in carbohydrate metabolism in response to short-term dietary carbohydrate restriction

Dietary carbohydrate restriction (CR) presents a challenge to glucose homeostasis. Despite the popularity of CR diets, little is known regarding the metabolic effects of CR. The purpose of this study was to examine changes in whole body carbohydrate oxidation, glucose availability, endogenous glucose production, and peripheral glucose uptake after dietary CR, without the confounding influence of a negative energy balance. Postabsorptive rates of glucose appearance in plasma (R(a); i.e., endogenous glucose production) and disappearance from plasma (R(d); i.e., glucose uptake) were measured using isotope dilution methods after a conventional diet [60% carbohydrate (CHO), 30% fat, and 10% protein; kcals = 1.3 x resting energy expenditure (REE)] and after 2 days and 7 days of CR (5% CHO, 60% fat, and 35% protein; kcals = 1.3 x REE) in eight subjects (means +/- SE; 29 +/- 4 yr; BMI 24 +/- 1 kg/m(2)) during a 9-day hospital visit. Postabsorptive plasma glucose concentration was reduced (P = 0.01) after 2 days but returned to prediet levels the next day and remained at euglycemic levels throughout the diet (5.1 +/- 0.2, 4.3 +/- 0.3, and 4.8 +/- 0.4 mmol/l for prediet, 2 days and 7 days, respectively). Glucose R(a) and glucose R(d) were reduced to below prediet levels (9.8 +/- 0.6 micromol x kg(-1) x min(-1)) after 2 days of CR (7.9 +/- 0.3 micromol x kg(-1) x min(-1)) and remained suppressed after 7 days (8.3 +/- 0.4 micromol x kg(-1) x min(-1); both P < 0.001). A greater suppression in carbohydrate oxidation, compared with the reduction in glucose R(d), led to an increased (all P 相似文献   

The effect of temperature and fasting period on the viability of free-living females of Rhipicephalus sanguineus (Acari: Ixodidae) under laboratory conditions

Little is known about the effect of temperature on viability of free-living phases of the life cycle of Rhipicephalus sanguineus (Latreille, 1806) despite of its importance as vector of several pathogens. Knowledge of the effect of abiotic factors on the capacity of a given tick species to infest new hosts is important for routine experimental activities under laboratory conditions, and may be relevant to understand the transmission of pathogens. The study evaluates the viability of R. sanguineus females held at 18 +/- 1, 27 +/- 1 and 32 +/- 1 degrees C and 80 +/- 5% RH (saturation deficits of 3.0, 5.3 and 7.2 mmHg, respectively) for three fasting periods (3 and 20 days and the day when female mortality reached approximately 50% after ecdysis), under laboratory conditions. In general, the best result on viability was obtained when rabbits were infested with unfed female ticks after three or 20 fasting days at both 27 +/- 1 and 32 +/- 1 degrees C and 80 +/- 5% RH.     

Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis

BackgroundHealth services across the world increasingly face pressures on the use of expensive hospital services. Better organisation and delivery of primary care has the potential to manage demand and reduce costs for hospital services, but routine primary care services are not open during evenings and weekends.Extended access (evening and weekend opening) is hypothesized to reduce pressure on hospital services from emergency department visits. However, the existing evidence-base is weak, largely focused on emergency out-of-hours services, and analysed using a before-and after-methodology without effective comparators.ConclusionsThe study found that extending access was associated with a reduction in emergency department visits in the first 12 months. The results of the research have already informed the decision by National Health Service England to extend primary care access across Greater Manchester from 2016. However, further evidence is needed to understand whether extending primary care access is cost-effective and sustainable.     

Effect of bifidobacteria and lactobacillus and antibiotics in combination with common gnotobiological isolation on the survival of mice with acute radiation sickness

The influence of the combined use of bacterial preparations (Bifidobacterium and Lactobacillus) and antibiotics (ciprofloxacin, lomefloxacin and amikacin) on the survival rate of irradiated mice placed under the conditions of general gnotobiological isolation was studied. Bacterial strains used in combination with quinolones (ciprofloxacin, lomefloxacin) significantly increased the mean survival time of the animals (p < 0.05) when introduced in a dose of 1.0 x 10(9) microbial cells per mouse on days 1, 3, 5, 7, 9, 11, 13 and 15 after irradiation. At the same time a short course of treatment with bacterial preparations (two injections on days 5 and 7 after irradiation) proved to be insufficient for increasing the survival rate of the animals. The mean survival time of the irradiated mice was higher after the use of bacterial preparations in combination with lomefloxacin or ciprofloxacin than after their use with amikacin.     

Glycopeptides in pus of acute pleurisy patients

Glycopeptides were isolated from tryptic digests of pus from acute pleurisy patients. The hexose, hexosamine, and sialic acid contents rose over the first 2-4 days after admission to the hospital, continued at high levels for 5-8 hospital days, and fell to low levels after 9 hospital days. The course of duration after admission to the hospital was divided into three stages: 1-4 days after admission to the hospital, 5-8 hospital days, and 9-21 hospital days. Materials corresponding to these three stages were then collected for fractionation by DEAE-cellulose column chromatography. Fractionation of glycopeptides by DEAE-cellulose column chromatography yielded three glycopeptide fractions at 0.05 to 0.2 M NaCl. Column chromatography of crude material on DEAE-cellulose showed an increase in the 0.2 M NaCl fraction from the concentrate over a period of 4-8 hospital days due to a large increase in sialic acid-rich glycopeptide fraction.     

Morphologic and functional development of whole human fetal stomachs grafted into nude mice

To study in vivo the cellular differentiation and secretion of human developing fetal stomach, ethically and technically impossible to perform in utero, 256 fetal stomachs were xenografted. Human stomachs from 6- to 10-week-old fetuses were grafted for 1-273 days into nude mice. Biopsies for immunohistochemistry, hybridization and electron microscopy were taken and a catheter introduced into the human stomach. Macroscopic growth was fast and cells in S phase were numerous during the first 9 weeks, then the stomach size was stable and the gastric mucosa, of adult type, remained normal. In situ hybridization detected only a minute mouse mesenchymal chimerism in the graft. Chromogranin A, intrinsic factor and H+/K+ adenosine triphosphatase were immunohistolocally detected in epithelial cells 20 days after grafting, gastrin was detected after 30 days and pepsinogen after 60 days. The pH in gastric juice, which was at 8.0 +/- 0.1 from days 10-25, dropped from 4.39 +/- 1.80 at 30 days to 1.58 +/- 0.29 at 90 days. Intrinsic factor was stable and pepsin ranged from 6.8 +/- 7.8 to 134 +/- 51 units at 90 days. The differentiation of the epithelial cells in xenografts was very accelerated in comparison to that in utero.     

Development of new reconstructive techniques: use of Integra in combination with fibrin glue and negative-pressure therapy for reconstruction of acute and chronic wounds

Large wounds resulting from severe injuries are generally treated with extended reconstructive operations (e.g., free flaps), which are accompanied by long hospitalizations and risks of infection, thrombosis, and flap loss. Integra is a collagen template that can be used for reconstruction of defects. The take rate and the rate of infection are essential for the successful use of Integra (Johnson and Johnson, Hamburg, Germany). Whether the take rate and integration of Integra could be improved with the use of fibrin glue and negative-pressure therapy was assessed. Between January of 2002 and December of 2002, patients with large defects who underwent Integra grafting for reconstruction were randomly divided into groups receiving either a new treatment with fibrin glue-anchored Integra and postoperative negative-pressure therapy or conventional treatment. Demographic features, cause of the wound, location of the wound, take rate, complications of Integra coverage, time from Integra coverage to skin transplantation, and functional and aesthetic results were assessed. Twelve patients (with similar group distributions with respect to sex, age, and location and cause of the injury) were included in the study. The take rate was 78 +/- 8 percent in the conventional treatment group and 98 +/- 2 percent in the fibrin/negative-pressure therapy group (p < 0.003). The mean period from Integra coverage to skin transplantation was 24 +/- 3 days in the conventional treatment group but only 10 +/- 1 days in the fibrin/negative-pressure therapy group (p < 0.002). The decrease in the interval between coverage with Integra and skin transplantation resulted in shorter hospital stays. The use of fibrin glue and negative-pressure therapy in combination with Integra could shorten the period from coverage to integration, which would be beneficial in terms of decreased risks of infection, thrombosis, and catabolism. Therefore, it is suggested that Integra be used in combination with fibrin glue and negative-pressure therapy to improve clinical outcomes and shorten hospital stays, with decreased risks of accompanying complications.     

Feasibility of routine testing for hepatitis B surface antigen in hospital employees and restriction of carriers.

In 1972-73, 48 hospital staff members were tested selectively for hepatitis B surface antigen (HBsAg); 4 (8.3%) were found to be HBsAg-positive. In 1974-75, 1415 staff members were tested routinely before employment and at periodic health examination; 25 (1.8%) were found to be HBsAg-positive. Of the HBsAg-positive staff members 55.2% were Asians, this proportion being significantly (P less than 0.05) greater than that of any other ethnic group, and 31.0% were southern Europeans. Nurses and laboratory technologists were the largest professional groups among the HBsAg-positive staff, each accounting for 20.7%. Our results indicate that it is impractical to carry out routine testing of hospital staff for HBsAg. Selective testing and restriction from work in their units is proposed for staff of the renal and peritoneal dialysis units, the emergency department and the intravenous team and dietary staff who handle food directly.     

Calcitriol plus hydrochlorothiazide prevents transient post-thyroidectomy hypocalcemia.

BACKGROUND: The aim of our double-blinded randomized prospective placebo-controlled study was to test if a week long pre-treatment with hypercalcemic drugs may prevent transient post-thyroidectomy hypocalcemia and reduce hospital stay. METHODS: Forty-two patients undergoing total thyroidectomy were randomized into two groups. Group 1: 22 patients treated with calcitriol 1.5 mcg/die plus hydrochlorothiazide; Group 2: 20 patients only treated with placebo (mineral integrates) as control group. Calcium and PTHi serum levels were assayed baseline and the days before and after thyroidectomy. RESULTS: Baseline calcium and PTHi did not differ between the two groups. Pre-surgery calcemia significantly increased in group 1 (p<0.05) while PTHi significantly decreased (p<0.05). Post-surgery calcemia and PTHi further significantly decreased in both groups, hypocalcemia (<2.10 mmol/l) occurring in 1 out of 22 patients in group 1 without symptoms and in 10 out of 20 in controls (20% developing symptoms) (p<0.01). The hospital stay resulted significantly shorter in group 1 (2.4+/-0.6 days) in respect to the control group (3.6+/-1.4 days, p<0.05). CONCLUSION: The administration of calcitriol plus hydrochlorothiazide is able to prevent transient post-thyroidectomy hypocalcemia and to reduce hospital stay.     

The thoracic sympathetic neurons of the chick: normal development and the effects of nerve growth factor

The generation and degeneration of sympathetic neurons in the third thoracic ganglion (segment 19) of the chick were studied between embryonic days (E) 7-18 using 3H-Thymidine autoradiography and routine cell counts. Cumulative radiolabelling experiments indicated that few sympathetic neurons were generated on E6-7. 10% of the sympathetic neurons were generated on E8 and a further 20% on E9. The final 70% of neurons completed the mitotic cycle between E10-12. Cell counts demonstrated that the neuronal population increased from 10,166 +/- 423 (mean +/- SEM) to 22,291 +/- 767 between E8-10 and remained stable up to E14. The population subsequently declined by 37%, to 14,157 +/- 831, by E18. Pyknotic neurons were found at all stages of development, but were most apparent between E7-15. The effects of Nerve Growth Factor (NGF) on the number of both surviving and pyknotic neurons in the ganglion were also examined. E9 embryos treated with NGF from E5-8 showed a 57% increase in the number of sympathetic neurons. This increase therefore occurred prior to the decline in neuronal number and was not accompanied by a decrease in the number of visibly pyknotic neurons. It is therefore possible that early NGF treatment increases the number of sympathetic neurons through a mechanism other than the attenuation of cell death.     

The effect of prolonged hypobaric hypoxia on growth of fetal sheep

The effect of prolonged hypobaric hypoxia on fetal sheep was studied. Pregnant ewes were subjected to an atmospheric pressure of 429 torr from 30 days to 135 days gestation (long-term study). Average fetal weight for the hypoxaemic group (3.35 +/- 0.53 kg; n = 4; mean +/- SD) was significantly lower than for the controls (4.23 +/- 0.29 kg; n = 7; P less than 0.05). A short-term study was undertaken with fetuses (n = 8) which were catheterized at 110 days gestation and whose dams were subjected to hypobaric hypoxia from 120 to 141 days gestation. The mean carotid PO2 of fetuses in the hypoxic group was 12.7 +/- 0.7 torr compared to 22.7 +/- 0.7 torr for the control group (n = 9; P less than 0.001) throughout the period of treatment. Fetal arterial oxygen content fell from 6.5 +/- 1.7 to 4.9 +/- 0.4 ml/dl (P less than 0.05), but rose to control values after 7 days due to an increase in fetal haemoglobin concentration (9.6 +/- 1.1 to 13.0 +/- 1.9 g/dl, P less than 0.001) and packed cell volume (33 +/- 3 to 45 +/- 4%, P less than 0.001). In the hypoxaemic fetuses, pH fell initially from 7.34 +/- 0.02 to 7.28 +/- 0.03 (P less than 0.05) and then recovered to 7.32 +/- 0.03 within 24 h. Mean fetal weight of the short-term hypoxic group was 3.46 +/- 0.72 kg compared to 4.15 +/- 0.51 for the control group (P less than 0.05). Both long- and short-term hypoxia produced a similar reduction in fetal body weight. The adrenal glands were significantly heavier in the hypoxic fetuses than in controls. Placental weight was not effected by hypoxia, but exposure from 30 days gestation reduced the average size of cotyledons (P less than 0.05). It is concluded that the fetal sheep increases its ability to acquire and transport oxygen in response to chronic hypoxia, but this compensation is not sufficient to prevent growth retardation or changes to the pattern of tissue growth.     

Fetal gender determination in early first trimester pregnancies of rhesus monkeys (Macaca mulatta) by fluorescent PCR analysis of maternal serum

Non-human primate fetal gender determination can be a powerful tool for research study design and colony management purposes. The recent discovery of the presence of fetal DNA in maternal serum has offered a new non-invasive approach for identification of fetal gender. We present a rapid and simple method for the sexing of developing rhesus monkeys in the first trimester by polymerase chain reaction (PCR) analysis of maternal serum. Serum samples were obtained from 72 gravid rhesus monkeys during 20-32 days of gestation (term 165 +/- 10 days). Fetal gender and the quantity of circulating fetal DNA were determined by real-time PCR analysis of the rhesus Y-chromosomal DNA sequences. The sensitivity for identifying a male fetus was 100% by 30 days gestation, and no false-positive results were observed. This study demonstrates that fetal gender can be reliably determined in the early first trimester from maternal serum samples, a non-invasive method for routine gender screening.