P-490 Recurrent pregnancy loss acts as a posttraumatic stress event in both women and men

Study question

What are the psychological impacts of recurrent pregnancy loss (RPL) on men and women and their interdependencies?

Summary answer

Women show higher psychological risks than men, except for lack of social support. Avoidance behaviour of men correlates with higher posttraumatic stress of their partner.

What is known already

About 1-3% of all couples trying to conceive are affected by RPL. The loss of the unborn child can be the most traumatic experience in a woman’s life and is associated with significant psychological distress besides the instant grief. RPL can also be stressful for the partner, even though being at a lower risk for psychiatric morbidities. The man’s gender role expects him to support and not to show weakness which may result in a suppression of his feelings and a disenfranchised grief.

Study design, size, duration

Cross-sectional study. All women and men referred to the special unit for RPL between March 2019 and October 2020 were asked to participate voluntarily with a total sample size of 105 couples and 17 women. Exclusion criteria were less than two pregnancy losses, inadequate knowledge of the German language and incomplete data.

Participants/materials, setting, methods

Couples were invited to fill out a questionnaire package estimating their psychological risks (e.g. posttraumatic stress disorder, anxiety, depression, perceived social support) and coping strategies with established instruments. Clinical history was obtained from medical records. Couple data were analysed with the Actor Partner Interdependence Model, taking the couple as the unit of analysis.

Main results and the role of chance

The response rate was 82.3%. The following psychological risks were measured among women versus men: posttraumatic stress disorder (PTSD): 13.7% versus 3.9% (p = 0.017); anxiety: 50.4% versus 17.3% (p < 0.001), depression: 48.1% versus 14.4% (p < 0.001), lack of social support: 32.5% versus 32.7% (N.S.). A risk in at least one category showed 68.9% of women versus 44.8% of men (p < 0.001), with those at higher risk indicating a lower satisfaction with their partnership (p < 0.001) and higher impairment of their sexual life (p < 0.001). Neither total number of pregnancy losses nor time gap since last pregnancy loss showed relevant correlations with psychological risks. For women, number of curettages, controlled for the number of pregnancy losses, correlates with the severity of posttraumatic stress (p < 0.05). Higher levels of anxiety, depression and a lack of social support in women correlated positively with posttraumatic stress in their partners. The coping strategy “trivialization and wishful thinking” as well as the subscale “avoidance” of the Impact-of-Event-Scale (self-report questionnaire measuring posttraumatic stress) of men was correlated with more severe posttraumatic stress in their female partners (both p < 0.05).

Limitations, reasons for caution

The data show only correlations between the measured variables, as cross-sectional studies are not suitable to analyse causal relationships. The sample was obtained in a special unit for RPL at a university hospital, so the findings may not be generalizable to all couples with RPL.

Wider implications of the findings

Screening psychological risks in couples with RPL may be reasonable considering the high risks in both sexes and the extent of PTSD diagnoses in women, their interdependencies and the potential risk of chronification. Professionals should encourage affected couples to support each other and provide targeted information on mental health services.

Trial registration number

DRKS 00014965

P–490 Recurrent pregnancy loss acts as a posttraumatic stress event in both women and men

Study question

What are the psychological impacts of recurrent pregnancy loss (RPL) on men and women and their interdependencies?

Summary answer

Women show higher psychological risks than men, except for lack of social support. Avoidance behaviour of men correlates with higher posttraumatic stress of their partner.

What is known already

About 1–3% of all couples trying to conceive are affected by RPL. The loss of the unborn child can be the most traumatic experience in a woman’s life and is associated with significant psychological distress besides the instant grief. RPL can also be stressful for the partner, even though being at a lower risk for psychiatric morbidities. The man’s gender role expects him to support and not to show weakness which may result in a suppression of his feelings and a disenfranchised grief.

Study design, size, duration

Cross-sectional study. All women and men referred to the special unit for RPL between March 2019 and October 2020 were asked to participate voluntarily with a total sample size of 105 couples and 17 women. Exclusion criteria were less than two pregnancy losses, inadequate knowledge of the German language and incomplete data.

Participants/materials, setting, methods

Couples were invited to fill out a questionnaire package estimating their psychological risks (e.g. posttraumatic stress disorder, anxiety, depression, perceived social support) and coping strategies with established instruments. Clinical history was obtained from medical records. Couple data were analysed with the Actor Partner Interdependence Model, taking the couple as the unit of analysis.

Main results and the role of chance

The response rate was 82.3%. The following psychological risks were measured among women versus men: posttraumatic stress disorder (PTSD): 13.7% versus 3.9% (p = 0.017); anxiety: 50.4% versus 17.3% (p < 0.001), depression: 48.1% versus 14.4% (p < 0.001), lack of social support: 32.5% versus 32.7% (N.S.). A risk in at least one category showed 68.9% of women versus 44.8% of men (p < 0.001), with those at higher risk indicating a lower satisfaction with their partnership (p < 0.001) and higher impairment of their sexual life (p < 0.001). Neither total number of pregnancy losses nor time gap since last pregnancy loss showed relevant correlations with psychological risks. For women, number of curettages, controlled for the number of pregnancy losses, correlates with the severity of posttraumatic stress (p < 0.05). Higher levels of anxiety, depression and a lack of social support in women correlated positively with posttraumatic stress in their partners. The coping strategy “trivialization and wishful thinking” as well as the subscale “avoidance” of the Impact-of-Event-Scale (self-report questionnaire measuring posttraumatic stress) of men was correlated with more severe posttraumatic stress in their female partners (both p < 0.05).

Limitations, reasons for caution

The data show only correlations between the measured variables, as cross-sectional studies are not suitable to analyse causal relationships. The sample was obtained in a special unit for RPL at a university hospital, so the findings may not be generalizable to all couples with RPL.

Wider implications of the findings: Screening psychological risks in couples with RPL may be reasonable considering the high risks in both sexes and the extent of PTSD diagnoses in women, their interdependencies and the potential risk of chronification. Professionals should encourage affected couples to support each other and provide targeted information on mental health services.

Trial registration number

DRKS 00014965

Publisher's Note: Direct Lifetime Measurements of the Excited States in ^{72}Ni [Phys. Rev. Lett. 116, 122502 (2016)]

This corrects the article DOI: 10.1103/PhysRevLett.116.122502.

Improving cognitive training for schizophrenia using neuroplasticity enhancers: Lessons from decades of basic and clinical research

Mounting evidence indicates that schizophrenia is a disorder that stems from maladaptive plasticity within neural circuits and produces broad cognitive deficits leading to loss of autonomy. A large number of studies have identified abnormalities spanning many neurotransmitter systems in schizophrenia, and as a result, a variety of drugs have been developed to attempt to treat these abnormalities and enhance cognition. Unfortunately, positive results have been limited so far. This may be in part because the scope of abnormalities in the schizophrenic brain requires a treatment capable of engaging many different neurotransmitter systems. One approach to achieving this kind of treatment has been to use neuroplasticity-based computerized cognitive training programs to stimulate the formation of more adaptive circuits. Although the number of studies implementing this approach has increased exponentially in recent years, effect sizes for cognitive gains have been modest and adherence to treatment remains an important challenge in many studies, as patients are often required to train for 40 h or more. In the present paper, we argue that cognitive training protocols will benefit from the addition of cognitive enhancers to produce more robust and longer lasting targeted neuroplasticity. Indeed, recent data from animal studies have provided support for combining plasticity-enhancing drugs with tailored behavioral training paradigms to restore normal function within dysfunctioning neural circuits. The advantages and challenges of applying this approach to patients with schizophrenia will be discussed.

New low-spin states of 122Xe observed via high-statistics β-decay of 122Cs

Excited states of 122Xe were studied via the β+/EC decay of 122Cs with the 8π γ-ray spectrometer at the TRIUMF-ISAC facility. Compton-suppressed HPGe detectors were used for measurements of γ-ray intensities, γγ coincidences, and γ-γ angular correlations. Two sets of data were collected to optimize the decays of the ground (21.2 s) and isomeric (3.7 min) states of 122Cs. The data collected have enabled the observation of about 505 new transitions and about 250 new levels, including 51 new low-spin states. Spin assignments have been made for 58 low-spin states based on the deduced β-decay feeding and γ-γ angular correlation analyses.

NEUTRON GENERATOR FACILITY AT SFU: GEANT4 DOSE RATE PREDICTION AND VERIFICATION

Detailed dose rate maps for a neutron generator facility at Simon Fraser University were produced via the GEANT4 Monte Carlo framework. Predicted neutron dose rates throughout the facility were compared with radiation survey measurements made during the facility commissioning process. When accounting for thermal neutrons, the prediction and measurement agree within a factor of 2 or better in most survey locations, and within 10 % inside the vault housing the neutron generator.

Direct Lifetime Measurements of the Excited States in (72)Ni

The lifetimes of the first excited 2^{+} and 4^{+} states in ^{72}Ni were measured at the National Superconducting Cyclotron Laboratory with the recoil-distance Doppler-shift method, a model-independent probe to obtain the reduced transition probability. Excited states in ^{72}Ni were populated by the one-proton knockout reaction of an intermediate energy ^{73}Cu beam. γ-ray-recoil coincidences were detected with the γ-ray tracking array GRETINA and the S800 spectrograph. Our results provide evidence of enhanced transition probability B(E2;2^{+}→0^{+}) as compared to ^{68}Ni, but do not confirm the trend of large B(E2) values reported in the neighboring isotope ^{70}Ni obtained from Coulomb excitation measurement. The results are compared to shell model calculations. The lifetime obtained for the excited 4_{1}^{+} state is consistent with models showing decay of a seniority ν=4, 4^{+} state, which is consistent with the disappearance of the 8^{+} isomer in ^{72}Ni.

Evidence of soft dipole resonance in ^{11}li with isoscalar character

The first conclusive evidence of a dipole resonance in ^{11}Li having isoscalar character observed from inelastic scattering with a novel solid deuteron target is reported. The experiment was performed at the newly commissioned IRIS facility at TRIUMF. The results show a resonance peak at an excitation energy of 1.03±0.03 MeV with a width of 0.51±0.11 MeV (FWHM). The angular distribution is consistent with a dipole excitation in the distorted-wave Born approximation framework. The observed resonance energy together with shell model calculations show the first signature that the monopole tensor interaction is important in ^{11}Li. The first ab initio calculations in the coupled cluster framework are also presented.

Monitoring rainwater and seaweed reveals the presence of (131)I in southwest and central British Columbia, Canada following the Fukushima nuclear accident in Japan

Detailed analysis of (131)I levels in rainwater and in three species of seaweed (Fucus distichus Linnaeus, Macrocystis pyrifera, and Pyropia fallax) collected in southwest British Columbia and Bella Bella, B.C., Canada was performed using gamma-ray spectroscopy following the Fukushima nuclear power plant accident on March 11, 2011. Maximum (131)I activity was found to be 5.8(7) Bq/L in rainwater collected at the campus of Simon Fraser University in Burnaby, B.C. nine days after the accident. Concomitantly, maximum observed activity in the brown seaweed F. distichus Linnaeus was observed to be 130(7) Bq/kg dry weight in samples collected in North Vancouver 11 days following the accident and 67(6) Bq/kg dry weight in samples collected from the Bamfield Marine Sciences Centre on Vancouver Island 17 days following the accident. The (131)I activity in seaweed samples collected in southwest B.C. following the Fukushima accident was an order of magnitude less than what was observed following Chernobyl. Iodine-131 activity in F. distichus Linnaeus remained detectable for 60 days following the accident and was detectable in each seaweed species collected. The Germanium Detector for Elemental Analysis and Radioactivity Studies (GEARS) was modeled using the Geant4 software package and developed as an analytical tool by the Nuclear Science group in the Simon Fraser University Department of Chemistry for the purpose of these measurements.

Probing configuration mixing in 12Be with Gamow-Teller transition strengths

We present a novel technique for studying the quenching of shell gaps in exotic isotopes. The method is based on extracting Gamow-Teller (ΔL=0, ΔS=1) transition strengths [B(GT)] to low-lying states from charge-exchange reactions at intermediate beam energies. These Gamow-Teller strengths are very sensitive to configuration mixing between cross-shell orbitals, and this technique thus provides an important complement to other tools currently used to study cross-shell mixing. This work focuses on the N=8 shell gap. We populated the ground and 2.24 MeV 0+ states in 12Be using the 12B(1+) (7Li, 7Be) reaction at 80  MeV/u in inverse kinematics. Using the ground-state B(GT) value from β-decay measurements (0.184±0.007) as a calibration, the B(GT) for the transition to the second 0+ state was determined to be 0.214±0.051. Comparing the extracted Gamow-Teller strengths with shell-model calculations, it was determined that the wave functions of the first and second 0+ states in 12Be are composed of 25±5% and 60±5% (0s)4(0p)8 configurations, respectively.

Community-level HIV risk behaviors and HIV prevalence among women and men in Zimbabwe

Most studies on HIV risk in sub-Saharan Africa focus on individual-level sociodemographic and behavioral correlates of risk. Only recently have researchers and programmers considered the context within which individuals live. This study uses the 2005-6 Zimbabwe Demographic and Health Survey to examine the correlation between the prevalence of HIV at the community level and the prevalence of HIV risk-taking behaviors. Results show that women and men living in communities with higher HIV prevalence in the opposite sex are at increased risk of HIV. In addition, rural women and men living in communities with greater premarital and nonmarital sex are at greater risk of HIV. Finally, HIV prevalence is higher among women and men living in urban areas with higher intimate partner violence. Programs should address community-level social norms that make high-risk behaviors acceptable and thus increase all women and men's risk of HIV, not just those engaged in high-risk behaviors.

Lifetime measurement of the 2(1)+ state in 20C

Establishing how and when large N/Z values require modified or new theoretical tools is a major quest in nuclear physics. Here we report the first measurement of the lifetime of the 2(1)+ state in the near-dripline nucleus 20C. The deduced value of τ(2(1)+)=9.8±2.8(stat)(-1.1)(+0.5)(syst)  ps gives a reduced transition probability of B(E2; 2(1)+→0(g.s.)+)=7.5(-1.7)(+3.0)(stat)(-0.4)(+1.0)(syst)  e2  fm4 in good agreement with a shell model calculation using isospin-dependent effective charges.

Enhanced quadrupole collectivity at N = 40: the case of neutron-rich Fe isotopes

The transition rates for the 2(1)+ states in (62,64,66)Fe were studied using the recoil distance Doppler-shift technique applied to projectile Coulomb excitation reactions. The deduced E2 strengths illustrate the enhanced collectivity of the neutron-rich Fe isotopes up to N = 40. The results are interpreted using the generalized concept of valence proton symmetry which describes the evolution of nuclear structure around N = 40 as governed by the number of valence protons with respect to Z ≈ 30. The trend of collectivity suggested by the experimental data is described by state-of-the-art shell-model calculations with a new effective interaction developed for the fpgd valence space.

Delayed matching-to-sample performance: Effects of relative reinforcer frequency and of signaled versus unsignaled reinforcer magnitudes

Six pigeons were trained on a delayed red-green matching-to-sample task that arranged four delays within sessions. Matching responses intermittently produced either 1.5-s access to food or 4.5-s access to food, and nonmatching responses produced either 1.5-s or 4.5-s blackout. Two phases were conducted: a signaled phase in which the reinforcer magnitudes (small and large) were signaled by houselights (positioned either on the left or right of the chamber), and an unsignaled phase in which there was no correlation between reinforcer magnitude and houselight position. In both phases, the relative frequency with which red and green matching responses produced food was varied across five values. Both matching accuracy and the sensitivity of performance to the distribution of reinforcers for matching responses decreased with increasing delays in both phases. In addition, accuracy and reinforcer sensitivity were significantly lower on signaled small-reinforcer trials compared with accuracy and sensitivity values on signaled large-reinforcer trials and on both types of unsignaled trials. These results are discussed in the context of research on both nonhuman animal and human memory.

Stimulus control and response bias in an analogue prey-detection procedure

The present study compared the performance of 6 pigeons trained to detect luminance differences in two different signal-detection procedures. Exposed to a three-key array, the pigeons were trained to peck the left key when the brighter of two light intensities had been presented on the center key and to peck the right key when the dimmer of two light intensities had been presented on the center key. Procedure A was a standard signal-detection procedure in which left/bright and right/dim responses produced food reinforcement and left/dim and right/bright responses produced periods of timeout. Procedure B was designed to simulate some of the contingencies operating in a prey-detection situation. Left-key responses produced reinforcement following the brighter center-key stimulus and a period of timeout following the dimmer center-key stimulus. Right-key responses always produced a short period of timeout irrespective of the stimulus. Within each procedure, the duration of timeout arranged for false alarms (left/dim responses) was varied between 3 s and 120 s. Measures of accuracy and response bias were compared between the two procedures. The timeout manipulation produced systematic, but relatively small, changes in these measures when right/dim responses (i.e., correct rejections) produced reinforcement (Procedure A). Arranging timeout for right/dim responses in Procedure B produced greater variability in accuracy and response bias than did arranging reinforcement, but this variability was not related to timeout duration. Overall, discrimination accuracy was considerably higher when right/dim responses produced timeout than when they resulted in reinforcement, and accuracy was accompanied by a large bias toward the response associated with reinforcement. These results are consistent with a recently proposed model of signal detection.

34P(7Li,7Be+γ) reaction at 100A MeV in inverse kinematics

We report on the first successful extraction of a β+ Gamow-Teller strength distribution from a radioactive isotope in an intermediate-energy charge-exchange experiment in inverse kinematics. The (7Li,7Be+γ(429  keV)) reaction at 100A  MeV was used to measure Gamow-Teller transition strengths from 34P to states in 34Si. The results show that little mixing occurs between sd and pf shell configurations for the low-lying 0+ and 2+ states even though 34Si neighbors the island of inversion and low-lying 2ℏω intruder states exist. Shell-model calculations in the sdpf model space are consistent with these findings.

Protection from annual flooding is correlated with increased cholera prevalence in Bangladesh: a zero-inflated regression analysis

BACKGROUND

Alteration of natural or historical aquatic flows can have unintended consequences for regions where waterborne diseases are endemic and where the epidemiologic implications of such change are poorly understood. The implementation of flood protection measures for a portion of an intensely monitored population in Matlab, Bangladesh, allows us to examine whether cholera outcomes respond positively or negatively to measures designed to control river flooding.

METHODS

Using a zero inflated negative binomial model, we examine how selected covariates can simultaneously account for household clusters reporting no cholera from those with positive counts as well as distinguishing residential areas with low counts from areas with high cholera counts. Our goal is to examine how residence within or outside a flood protected area interacts with the probability of cholera presence and the effect of flood protection on the magnitude of cholera prevalence.

RESULTS

In Matlab, living in a household that is protected from annual monsoon flooding appears to have no significant effect on whether the household experiences cholera, net of other covariates. However, counter-intuitively, among households where cholera is reported, living within the flood protected region significantly increases the number of cholera cases.

CONCLUSIONS

The construction of dams or other water impoundment strategies for economic or social motives can have profound and unanticipated consequences for waterborne disease. Our results indicate that the construction of a flood control structure in rural Bangladesh is correlated with an increase in cholera cases for residents protected from annual monsoon flooding. Such a finding requires attention from both the health community and from governments and non-governmental organizations involved in ongoing water management schemes.

Shape and structure of N=Z 64Ge: electromagnetic transition rates from the application of the recoil distance method to a knockout reaction

Transition rate measurements are reported for the 2(1)+ and 2(2)+ states in N=Z 64Ge. The experimental results are in excellent agreement with large-scale shell-model calculations applying the recently developed GXPF1A interactions. The measurement was done using the recoil distance method (RDM) and a unique combination of state-of-the-art instruments at the National Superconducting Cyclotron Laboratory (NSCL). States of interest were populated via an intermediate-energy single-neutron knockout reaction. RDM studies of knockout and fragmentation reaction products hold the promise of reaching far from stability and providing lifetime information for excited states in a wide range of nuclei.

The nuclear proteasome and the degradation of oxidatively damaged proteins

The accumulation of oxidized proteins is known to be linked to some severe neurodegenerative diseases like Alzheimer's, Parkinson's and Huntington's disease. Furthermore, the aging process is also accompanied by an ongoing aggregation of misfolded and damaged proteins. Therefore, mammalian cells have developed potent degradation systems, which selectively degrade damaged and misfolded proteins. The proteasomal system is largely responsible for the removal of oxidatively damaged proteins form the cellular environment. Not only cytosolic proteins are prone to oxidative stress, also nuclear proteins are readily oxidized. The nuclear proteasomal system is responsible for the degradation of these proteins. This review is focused on the specific degradation of oxidized nuclear proteins, the role of the proteasome in this process and the regulation of the nuclear proteasomal system under oxidative conditions.

Measurement of co- and cross-polarized Raman spectra in silica fiber for small detunings: erratum

We present corrected versions of Fig. 5(a) and Fig. 6(b) below with the original captions.

Measurement of co- and cross-polarized Raman spectra in silica fiber for small detunings

We report measurement of co- and cross-polarized Raman gain spectra at the zero-dispersion wavelength of standard dispersion-shifted fiber for detunings down to 0.17 THz (5.7cm-1) on both Stokes and anti-Stokes sides by using a photon-counting technique. This technique separates the Raman scattering from the four-photon scattering. In addition, the use of a pulsed pump eliminates Brillouin scattering and the use of a Sagnac loop rejects the pump photons that spectrally spread into the detection band due to self-phase-modulation.

All-fiber photon-pair source for quantum communications: Improved generation of correlated photons

We demonstrate greatly improved results for the production of correlated photon-pairs using the four-photon scattering process in silica fiber. We achieve a true-coincidence-count to accidental-coincidence-count ratio greater than 10, when the photon-pair production rate is about 0.04 /pulse. This represents a four-fold improvement over our previous results. The contribution of spontaneous Raman scattering, the primary cause of uncorrelated photons that degrades the fidelity of this source, is reduced by decreasing the wavelength detuning between the correlated photons and the pump photons and by using polarizers to remove the cross-polarized Raman-scattered photons. Excess Raman scattering could be further suppressed by cooling the silica fiber. Even without cooling the fiber, the achieved 10 to 1 ratio of true-coincidence to accidental-coincidence makes the fiber source of correlated photon-pairs a useful tool for realizing various quantum-communication protocols.

[Comparison between age-dependent (Wald alpha program) and age-independent (Ulm index) analysis program for prenatal detection of Down's syndrome with serum markers]

An age-dependent analytic program (Alpha-Software from Wald) was compared to an age-independent Index (Ulm-Index) in order to determine effectivity of detection in prenatal screening for Down's Syndrome in 7060 pregnant women. The rate of accuracy was similar in both analytic programs (6 from 7), but, the rate of false-positive results was twice as high using the Ulm-Index (14.7 versus 7.7%). The higher rate of amniocentesis necessary using the age-independent Ulm-Index apparently does not justify this method for prenatal screening of Down's Syndrome.

Leaving patches: Effects of travel requirements

Five pigeons were trained in an analogue foraging procedure in which, by completing a travel requirement, they entered a "patch" in which a reinforcer might be available after an unpredictable time. They also had the opportunity, by emitting a defined response, to exit the patch and travel to another patch. Prey availability in a patch was not signaled. Data were collected on the length of time that subjects stayed in patches before exiting (residence times) as a function of various travel requirements: travel for a fixed time in blackout, fixed-interval schedule traveling, fixed-time traveling with an added response required to terminate traveling, and fixed-ratio traveling. For each of these conditions, the required amount of travel (time or responses) was varied over a wide range. As previously reported, residence times increased with increases in fixed-time traveling, as they did with increasing fixed-interval or fixed-ratio traveling. There was no evidence that adding response or work requirements systematically affected residence time except via increased travel time, although 3 of the 5 birds stayed longer in a patch under higher fixed-ratio values. A "threshold-maximization" model described the data well with a single parameter that was consistent across subjects, procedures, and experiments.

[Noninvasive serum test for prenatal detection of Down syndrome, other chromosome abnormalities and open neural tube defects--a prospective study]

Between September 1st 1990 and Juli 31st 1993, 5071 pregnant women were screened prospectively by the "triple-test", including maternal serum alpha-fetoprotein, human chorionic gonadotropin and unconjugated oestriol in order to detect chromosomal anomalies and open neural tube defects. The serum samples were collected in collaboration with the obstetricians of the region of West-Mecklenburg and North-West-Brandenburg. Laboratory testing using radioimmunoassays was performed between weeks 15 and 20 of gestation, all serum specimens being investigated in only one institution. The original alpha-software from Wald et al. was the basis for calculating the statistical risk for Down's syndrome. Pregnant women with a high risk for Down's syndrome (cutoff > or = 1:250) were taken care of in a special outpatient clinic including procedures like amniocentesis and fetal blood sampling. Amongst 5071 pregnant women, 21 fetal anomalies were seen. Five cases of Down's syndrome, three of trisomy 18, one trisomy 13, two cases of triploidy and four cases of open neural tube defects, one 46 xy/45 x mosaic karyotype and one case of gastroschisis could be diagnosed correctly. One case of trisomy 21, one case of trisomy 18 and two open neural tube defects showed false negative results. Using the cutoff of 1:250 for prenatal detection of Down's syndrome and performing ultrasound routinely to determine gestational age, the sensitivity of the "triple-test" was 83.33% having a specificity of 92.68%. The predictive value of a positive test for prenatal diagnosis of Down's syndrome was 1.33%.(ABSTRACT TRUNCATED AT 250 WORDS)

Cold response of digital arteries in chain saw operators

ABSTRACT In a study of vibration-induced white finger (VWF) 39 chain saw operators, being representative of 365 lumberjacks according to a completed questionnaire, underwent clinical investigation. In a medical interview 13 of the 39 had VWF and 26 were without finger symptoms. In the subjects with VWF both hands were equally affected, the third and fourth finger most frequently; the thumbs were always normal. A cold provocation test, measuring the finger systolic blood pressure with a cuff technique during combined body cooling and finger cooling to 30, 15, and 6°C, was applied to the 39 chain saw operators and to 20 age-matched outdoor workers who had not used vibrating hand tools. The finger most often showing Raynaud's phenomenon was cold provoked, and a non-affected finger was used as a reference. The systolic pressure gradient measured at 30°C from the upper arm to the cooled finger was increased in the chain sawyers most severely affected by VWF compared with the control group and with the chain sawyers without VWF (p <0·02). Raynaud's phenomenon was verified by digital arterial closure (zero pressure in the finger) at 15 or 6°C in 12 of 13 chain sawyers having anamnestic and clinical evidence of VWF. Chain sawyers without VWF had an increased digital arterial response to cold at 15 and 6°C compared with the control group (p <0·05) and had a decreased cold response compared with chain sawyers with VWF (p <0·05). In chain sawyers without VWF 13 subjects with an exposure period of 10-23 years had an increased cold response at 6°C compared with 13 subjects with an exposure period of one to three years (p <0·05). Only one of 38 chain saws did not exceed the exposure limit proposed by the International Standardisation Organisation. The results of the present study indicate that vibrations induce hyperresponsiveness to cold in the exposed arteries, even in chain sawyers without finger symptoms. The exposure to vibration therefore should be reduced to eliminate this damage. The presented cold provocation test may be used to diagnose Raynaud's phenomenon and to disclose an abnormal digital arterial cold response before subjective symptoms have appeared.