Potent and selective activation of the pancreatic beta-cell type K(ATP) channel by two novel diazoxide analogues

AIMS/HYPOTHESIS

We investigated the pharmacological properties of two novel ATP sensitive potassium (K(ATP)) channel openers, 6-Chloro-3-isopropylamino-4 H-thieno[3,2- e]-1,2,4-thiadiazine 1,1-dioxide (NNC 55-0118) and 6-chloro-3-(1-methylcyclopropyl)amino-4 H-thieno[3,2-e]-1,2,4-thiadiazine 1,1-dioxide (NN414), on the cloned cardiac (Kir6.2/SUR2A), smooth muscle (Kir6.2/SUR2B) and pancreatic beta cell (Kir6.2/SUR1) types of K(ATP) channel.

METHODS

We studied the effects of these compounds on whole-cell currents through cloned K(ATP) channels expressed in Xenopus oocytes or mammalian cells (HEK293). We also used inside-out macropatches excised from Xenopus oocytes.

RESULTS

In HEK 293 cells, NNC 55-0118 and NN414 activated Kir6.2/SUR1 currents with EC(50) values of 0.33 micromol/l and 0.45 micromol/l, respectively, compared with that of 31 micro mol/l for diazoxide. Neither compound activated Kir6.2/SUR2A or Kir6.2/SUR2B channels expressed in oocytes, nor did they activate Kir6.2 expressed in the absence of SUR. Current activation was dependent on the presence of intracellular MgATP, but was not supported by MgADP.

CONCLUSION/INTERPRETATION

Both NNC 55-0118 and NN414 selectively stimulate the pancreatic beta-cell type of K(ATP) channel with a higher potency than diazoxide, by interaction with the SUR1 subunit. The high selectivity and efficacy of the compounds could prove useful for treatment of disease states where inhibition of insulin secretion is beneficial.

The effect of Sterilex Ultra for disinfection of dental unit waterlines

AIM

To evaluate the effect of a disinfectant agent based on hydrogen peroxide (Sterilex Ultra, Sterilex Corporation, Maryland, USA) on the microbiological water quality in dental unit waterlines (DUWL).

SETTING

Six older dental units were disinfected with Sterilex Ultra and another six units with sodium hypochlorite. The results were compared to six non-disinfected units examined during a period without patient treatment.

OUTCOME MEASURE

The number of colony forming units of bacteria (cfu)/ml of water was determined according to European Standards on water quality.

DESIGN

The water quality was initially determined during a six week period, and subsequently in more detail for two weeks. Finally, the effect of prolonged administration of Sterilex Ultra was investigated for six weeks.

RESULTS

Instillation of Sterilex Ultra according to the recommendations of the manufacturer initially reduced the number of bacteria in DUWL to <10(2) cfu/ml. However, following daily, as well as prolonged administration of Sterilex Ultra a gradual recolonisation was observed resulting in bacterial numbers >10(4) cfu/ml in a number of units. Major differences between the number of cfu/ml in individual units were observed.

CONCLUSION

Neither daily nor extended administration of Sterilex Ultra was capable of maintaining an acceptable water quality in these older dental units.

Diurnal variation and the effect of feed restriction on plasma and milk metabolites in TMR-fed dairy cows

The objective was to study the diurnal variation in metabolites in plasma and milk of dairy cows fed total mixed rations (TMR) with a low-energy (LE) or high-energy content (HE) expected to give a minor and a major diurnal variation, respectively. Further, the purpose was to quantify and compare the responses in plasma and milk parameters when cows changed from ad libitum to restrictive feeding. Eight multiparous, early-lactating Danish Holstein cows were used in a cross-over design with two consecutive 14-day periods. Blood and milk samples were collected hourly on day 11 of each period and on days 12-14 of each period, the cows were fed restrictively (65% of ad libitum dry-matter intake). The concentration of beta-hydroxybutyrate (BHB) in plasma was significantly higher in the evening for cows fed the HE TMR, than for cows fed the LE TMR. There was a significant diurnal variation in BHB in milk, with the highest concentrations between milkings and the lowest concentrations at milking. Non-esterified fatty acids (NEFA) in plasma showed significant diurnal variation that was caused by high concentrations in the morning. Plasma glucose did not show any diurnal variation. It has been argued that feeding a TMR removes diurnal changes related to feeding, which is contrary to earlier diurnal studies where concentrates have been fed twice daily. Feed restriction increased (P < 0.001) NEFA and BHB in plasma by 121 and 90%, respectively, while the glucose concentration decreased (P < 0.001) by 19%. Milk concentrations of BHB, citrate and fat increased (P < 0.001) by 163, 11 and 26%, respectively, because of feed restriction, while there were no changes in milk protein and lactose. The relatively high increase in BHB during feed restriction suggests that BHB is more advantageous as a milk indicator of metabolic status in dairy cows than citrate and fat.

Susceptibility of Porphyromonas gingivalis in biofilms to amoxicillin, doxycycline and metronidazole

The susceptibility of Porphyromonas gingivalis to amoxicillin, doxycycline and metronidazole was determined by a standardized method taking into account the biofilm mode of growth of subgingival bacteria. The minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of 48-h biofilms of P. gingivalis established on membrane filters in a Modified Robbins Device were determined by agar dilution. The results were compared to (i) conventional MIC determinations, (ii) the susceptibility of planktonic cultures with cell numbers equal to those of the biofilms, and (iii) results for detached biofilm cells. The MICs of the biofilms of the six reference strains and clinical isolates containing 107-8 cells/filter were much higher than the conventional MIC values. However, the MIC of planktonic cultures of equal cell numbers also increased, indicating that an inoculum effect is part of the explanation of the increased resistance of biofilms. Still, the MBCs of biofilms were 2-8 times, and those for doxycycline up to 64 times, greater than the MBC values for planktonic cultures.

In vitro study of transmission of bacteria from contaminated metal models to stone models via impressions

The purpose of this study was to determine the risk of microbiological transmission into the dental laboratory via impressions and dental stone models. Metal master models were contaminated with Bacillus subtilis and Streptococcus sanguis. Impressions in alginate, polyvinylsiloxane, and polyether were used, and models were cast in two brands of dental stone. Samples were taken from the impression surfaces before and after casting, and sections from the stone models were taken by a technique developed for this study. After incubation, the numbers of colonies were counted and the numbers of colony-forming units per milliliter were calculated. The reductions were statistically significant but considered to be clinically insignificant. The conclusion is that even after severe contamination, the risks to dental laboratory personnel are minimal. "Normal" hygienic procedures are recommended instead of disinfection.

Contamination level of alginate impressions arriving at a dental laboratory

The contamination level of alginate impressions delivered to a large dental laboratory in Sweden was determined. One hundred and seven consecutive alginate impressions were included during 7 days. Samples were taken and transferred into sterile physiological saline and analysed microbiologically for colony-forming units (cfu) as well as nonhemolytic, alpha-hemolytic, and beta-hemolytic colonies. After sampling, the clinics were contacted and asked to fill in simple questionnaires about their routines of disinfecting impressions. The questionnaire study revealed that about half of the clinics had some kind of disinfection routine, while the others rinsed in running water only. Seventy-two percent of the impressions yielded growth of bacteria, with a median number of 1.3x10(2) cfu. Thirteen per cent of the samples yielded >10(3) cfu, with a maximum number of 3.4x10(4) cfu. The majority of isolates were non- and alpha-hemolytic bacteria. Growth was recorded in 61.3% of disinfected impressions, and the numbers of bacteria in disinfected and nondisinfected impressions were similar. These findings raise the question of whether impressions need to be disinfected or if proper handling and hygienic procedures are sufficient to block the possible route of infection.

The effect of drying dental unit waterline biofilms on the bacterial load of dental unit water

AIM

To evaluate drying of the dental unit waterlines (DUWL) as a new method of controlling the bacterial biofilm therein and thereby to reduce the number of living bacteria in dental unit water.

SETTING

18 dental units were incorporated into the study. Six units constituted the experimental units, which were emptied for stagnant water in the DUWL every night; six units were chlorinated every night (positive controls), and six units were left untreated (negative controls).

OUTCOME MEASURE

Water samples from the ultrasonic scaler were examined microbiologically according to the guidelines from the Danish Standard Association and the number of colony forming units (cfu) per ml of water was determined.

RESULT

Drying of DUWL did not reduce the number of cfu per ml in dental unit water below the levels found in DUWL left untreated.

CONCLUSION

The drying of the waterlines for about 16 hours per day during a 19-day period did not result in reduced counts of bacteria in water samples from the experimental units.

The effect of zeolite A supplementation in the dry period on periparturient calcium, phosphorus, and magnesium homeostasis

One potential way of preventing parturient hypocalcemia in the dairy cow is to feed dry cow rations very low in calcium (<20 g/d); but, because it is difficult to formulate rations sufficiently low in calcium, this principle has been almost abandoned. Recent studies have shown, however, that it is possible to prevent milk fever, as well as subclinical hypocalcemia, by supplementing the dry cow ration with sodium aluminium silicate (zeolite A), which has the capacity to bind calcium. The aim of this study was to further evaluate the effect, if any, of such supplementation on other blood constituents, feed intake, and milk production in the subsequent lactation. A total of 31 pregnant dry cows about to enter their third or later lactation were assigned as experimental or control cows according to parity and expected date of calving. The experimental cows received 1.4 kg of zeolite pellets per d (0.7 kg of pure zeolite A) for the last 2 wk of pregnancy. Blood samples were drawn from all cows 1 wk before the expected date of calving, at calving, at d 1 and 2 after calving, and 1 wk after calving. Additionally, a urine sample was drawn 1 wk before the expected date of calving. Zeolite supplementation significantly increased the plasma calcium level on the day of calving, whereas plasma magnesium as well as inorganic phosphate was suppressed. Serum 1,25(OH)2D was significantly increased 1 wk before the expected date of calving among the experimental cows, whereas there was no difference in the urinary excretion of the bone metabolite deoxypyridinoline between the two groups. Feed intake was decreased among the zeolite-treated cows during the last 2 wk of pregnancy. No effect was observed on milk yield, milk fat, and milk protein in the subsequent lactation. The mechanisms and interactions involved in zeolite supplementation are discussed in relation to the observed improvement in parturient calcium homeostasis and to the observed depression in blood magnesium and inorganic phosphate.

Effect of energy density in the diet and milking frequency on hepatic long chain fatty acid oxidation in early lactating dairy cows

The objective of this study was to examine the effects of diet energy density (high versus low) and increased milk yield, induced by increased milking frequency (two versus three times daily), on the hepatic status of triacylglycerol (TAG) and glycogen content and hepatic long chain fatty acid (LCFA) oxidation capacity in early lactation in a 2 x 2 factorial design. Forty multiparous Danish-Holstein dairy cows were used from 8 weeks before to 8 weeks after calving. Liver biopsies and blood samples were taken in weeks -2, 2, and 7 from calving. The cows fed the high energy density diet, compared with the cows fed the low energy density diet, had an 18 and 28% higher milk production and net energy intake, respectively. Milk yield was increased by 10% when the cows were milked three times compared with twice daily. Complete (CO2 production) and incomplete (ketone body production) LCFA oxidation capacity in the liver were 35 and 32% higher, respectively, and liver TAG content was 48% lower for the cows fed the high energy density diet compared with the low energy density diet. Overall there was no effect of milking frequency on liver parameters. However, a significant interaction between diet and milking frequency showed that the cows milked three times daily and fed the low energy density diet had the lowest liver LCFA oxidation (CO2 and ketone body) capacity. Furthermore, these cows had the numerically highest liver TAG content. The results for liver LCFA metabolism are discussed in relation to the plasma concentration of metabolites and insulin. In conclusion, cows in early lactation given a high energy density diet will, in general, have a lower risk of high TAG infiltration in the liver.

Effects of hyperinsulinaemia under euglycaemic condition on liver fat metabolism in dairy cows in early and mid-lactation

The objective was to examine the effects of insulin under euglycaemic conditions on liver long chain fatty acids (LCFA) metabolism with special focus on the aetiology of hepatic lipidosis in early lactation. A 4-day hyperinsulinaemic-euglycaemic clamp (clamp) was conducted on four dairy cows starting in weeks 4 and 17 postpartum. Insulin was infused continuously (1 microg/kg BW per h) and a 50% glucose solution was infused to maintain euglycaemia. Liver biopsies were taken 6 days before, the last day of, and 5 days after the clamp, and blood samples were taken in the same period. In the liver tissue, the relative triglyceride content decreased (P < 0.01) and the glycogen content increased (P < 0.0001) in response to the clamp. Hepatic in vitro palmitate oxidation capacity was lowest during the clamp period and could be explained by a significant decrease in incomplete oxidation (ketogenesis) (P < 0.04) and a tendency to a decreased complete oxidation of palmitate (P < 0.10). Plasma non-esterified fatty acids concentration was decreased during the clamp in early lactation (P < 0.05) but there was no effect on the mid-lactation clamp. The present study shows that increased insulin under euglycaemic conditions seems to depress hepatic LCFA oxidation capacity. However, in terms of preventing hepatic lipidosis, the anti-lipolytic effect of insulin on adipose tissue, which results in decreased mobilization of and hence hepatic load with LCFA, appears more important.

Immobilization in stereotactic radiotherapy: the head and neck localizer frame

Stereotactic radiotherapy refers to multiple daily fractions of radiation, over days or weeks of treatment, with the patient in a relocatable stereotactic frame. The linear accelerator-based, couch-mounted system from Radionics utilizes the Gill-Thomas-Cosman (GTC) frame and the new Tarbell-Loeffler-Cosman (TLC) pediatric frame for accurate positioning reproducibility. Radionics has now made available the Head and Neck Localizer (HNL) frame to be used with its XPlan treatment planning system and the mini multileaf collimator (MMLC). This will extend the overall capability of stereotactic radiotherapy to the treatment of head and neck cancers. However, with no data available on the HNL frame, a study is being undertaken to assess the accuracy in patient position reproducibility using the frame. This report provides the preliminary findings of comparing depth-helmet readings with radiographic data, together with recommended modifications to the frame.

Milk fever and subclinical hypocalcaemia--an evaluation of parameters on incidence risk, diagnosis, risk factors and biological effects as input for a decision support system for disease control

The present review analyses the documentation on incidence, diagnosis, risk factors and effects of milk fever and subclinical hypocalcaemia. It is hereby evaluated whether the existing documentation seems sufficient for further modelling in a decision support system for selection of a control strategy. Several studies have been carried out revealing an incidence of milk fever most often in the level of 5-10%. Few studies indicate that the incidence of subclinical hypocalcaemia is several times higher than milk fever. The diagnosis based on clinical or laboratory methods or based on presence of risk factors is outlined. The clinical symptoms of milk fever are highly specific and the disease level may thus be determined from recording of treatments. Diagnosis of subclinical hypocalcaemia needs to include laboratory examinations or it may be determined by multiplying the incidence of milk fever by a certain factor. From the documentation on risk factors, it is very complex to predict the incidence from the exposure level of the risk factors. Due to uncertainty, sensitivity analyses over a wide range of values for each parameter are needed. The documentation of cow characteristics, nutrition, environment and management as risk factors are described. Among cow characteristics, parity or age, body condition and production level were found to be important. Risk factors associated with nutrition included most importantly dietary cation-anion difference and calcium level whereas the importance of general feeding related factors like type of feed stuff and feeding level were less clear. Environment and management included season, climate, housing, pasturing, exercise, length of dry period and prepartum milking. Several of the parameters on environment and management were confounded among each other and therefore firm conclusions on the importance were difficult. The documentation of the effect of milk fever includes the downer cows, reproductive disorders, occurrence of other diseases and the effect on milk production, body weight and culling. The reproductive disorders included most importantly dystocia, uterine prolapse, retained placenta, metritis and repeat breeding, and occurrence of other diseases included ketosis, displaced abomasum and mastitis. The documentation was substantial and often quantifiable within certain limits. Overall it is concluded that the present documentation on milk fever concerning incidence, diagnosis, risk factors and effects seems sufficient for a systematic inclusion in a decision support system. A model on milk fever should take into consideration the variation in biological data and individual herd characteristics. The inclusion of subclinical hypocalcaemia would be more uncertain and probably should await further documentation on possibilities of determining the herd level incidence and also the effect of this condition on production.

A lethal disease model for hantavirus pulmonary syndrome

Hantaviruses are associated with two human diseases, hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). Development of vaccines and therapies to prevent and treat HFRS and HPS have been hampered by the absence of a practical animal model. Here we report that Andes virus (ANDV), a South American hantavirus, is highly lethal in adult Syrian hamsters. The characteristics of the disease in hamsters, including the incubation period, symptoms of rapidly progressing respiratory distress, and pathologic findings of pulmonary edema and pleural effusion, closely resemble HPS in humans. This is the first report of a lethal disease model for hantaviruses that causes HPS.

Effects of a four-day hyperinsulinemic-euglycemic clamp in early and mid-lactation dairy cows on plasma concentrations of metabolites, hormones, and binding proteins

The effects of insulin, using a 4 d hyperinsulinemic-euglycemic clamp, on plasma concentrations of hormone, metabolites, and binding proteins were evaluated in four Holstein dairy cows during wk 4 and 17 of lactation. Insulin was infused at 1 microg/kg/hr for 96 hr during the clamp period. Compared with the pre-clamp period, plasma insulin concentrations increased 7-fold and 4-fold during the clamp periods in early and mid-lactation, respectively. The total amount of glucose infused was higher (P < 0.05) during the clamp in early lactation. The clamp decreased plasma concentrations of non-esterified fatty acids (P < 0.001) during early lactation while differences in mid-lactation were minor. The clamp also decreased plasma concentration of beta-hydroxybutyrate (P < 0.001), plasma urea nitrogen (P < 0.001), and true protein (P < 0.01) although the patterns of decline differed between early and mid-lactation. Growth hormone (GH) concentrations decreased (P < 0.001) and insulin-like growth factor-1 (IGF-1) increased (P < 0.01) during the clamp period suggesting a direct effect of insulin on the un-coupling of the GH/IGF-1 axis. Levels of IGF binding protein-2 (IGFBP-2) decreased (P < 0.01) during the clamp period. The relative proportion of IGFBP-2 decreased (P < 0.001) and that of IGFBP-3 increased (P < 0.001) during the clamp period. There were no interactions between the clamp period and stage of lactation on GH, IGF-1, or IGFBPs. Overall, most plasma variables measured were affected in the same way during the two clamps, but the pattern of change often varied with stage of lactation.

Sentinel node staging of early breast cancer using lymphoscintigraphy and the intraoperative gamma detecting probe

Lymphoscintigraphy combined with intraoperative gamma-probe detection of sentinel lymph nodes in patients with inoperable early primary breast cancers is effective for staging the disease. The clinical alternative is axillary lymph node dissection, which is a far more invasive procedure and is accompanied by significant morbidity. Accuracy of staging is enhanced by immunohistochemical staining of micrometastases, which pathologists can easily perform for one to three sentinel lymph nodes, but not for 20 to 30 nodes, using axillary dissection procedure. Optimum methodology is presented for performing sentinel lymph node imaging and is important for accurate identification of sentinel node(s).

Evaluation of clinical and clinical chemical parameters in periparturient cows

Certain blood parameters and clinical symptoms have been connected with milk fever and a hypocalcemic condition in the cow. The present study intended to establish a mutual connection between relevant blood parameters and potentially valuable background information about the cow and its observed clinical symptoms at calving. Two veterinarians were summoned within 12 h of parturition of 201 cows, distributed among 41 Danish commercial herds. Cows were at different parity levels (2 to 10) and breeds and management differed broadly among herds. A blood sample was taken from the vena jugularis or the tail vein and was subsequently analyzed in the laboratory. Furthermore, 13 different clinical symptoms were recorded as categorical data. We investigated associations among the data obtained. We assessed an interpretative model for actual blood calcium level with blood parameters and background knowledge of the animals. We established a path analysis using background knowledge, blood parameters, and results of clinical examinations to uncover causal connections among the variables. Twenty-six percent of the animals were diagnosed as having milk fever and subsequent blood analyses revealed a high frequency of hypocalcemia within the general range from 0.69 to 2.73 mmol of Ca per liter. Rectal temperature, inorganic blood phosphate, and potassium were all directly correlated with blood calcium, while glucose, lactate, and magnesium were inversely associated with calcium. Blood osteocalcin was significantly lower in hypocalcemic animals, indicating that de novo synthesis of bone was arrested during hypocalcemia. A mixed effect linear interpretative model explained 75% of the variation in blood calcium. Clinical symptoms like mood, appetite, muscle shivering, rumen motility, and paresis were individually correlated with blood calcium and were thereby predictive of hypocalcemia. The path analysis showed the central role of calcium in affecting the clinical symptoms. However, several other factors contributed to hypocalcemia.

[Three-dimensional ultrasonography of monoamniotic twins]

A case of monoamniotic twins is described. Three-dimensional ultrasound scanning (3DUS) was used to visualise the fetuses lying in a single amniotic cavity. Entanglement of the umbilical cords with several knots was also visualised. The infants were delivered by elective caesarean section at 32 + 2 weeks with an uncomplicated postpartum course. Several knots found between the two umbilical cords, with separate placental insertion, were consistent with the ultrasound scan. We suggest that dedicated software solutions for volumetric ultrasound and knot analysis could contribute to a more precise description of the entanglement, which again would be a useful prognostic tool in the antenatal management and delivery of monoamniotic twins.

[Three-dimensional ultrasonography in obstetrics and gynecology]

Medical ultrasound has during the last decades experienced enormous technological progress, and in obstetrics and gynaecology it has become an integral part of the clinical work. Within the last years several new ultrasound techniques have appeared. Three-dimensional ultrasound scanning (3DUS), in which there has been great interest, is one of them. Especially within obstetrics and gynaecology several papers on that topic describe promising results. Foetal diagnostics relying on morphological signs and accurate distance and volume measurements is one of the areas, believed to benefit from 3DUS. However, until now only few prospective works have been published, most of them counted as preliminary. One of the main reasons might be the huge technological challenge. It is proposed that technological progress over the next few years will allow feasible real-time 3D scanning. Thereby obstetrical and gynaecological ultrasound scanning will undoubtedly take another giant leap forward.

Effect of Norwegian fish powder on risk factors for coronary heart disease among hypercholesterolemic individuals

BACKGROUND AND AIM

Numerous studies suggest an association between high intake of fatty fish and reduced risk of coronary heart disease. Very long-chain omega-3 fatty acids are thought to be responsible for the benefits observed, though other fatty fish components may act in concert with them. Norwegian fish powder is a dry herring product that contains essential amino acids, marine omega-3 fatty acids, vitamins and minerals. The aim of the present study was to determine whether it has beneficial effects on risk factors for coronary heart disease in man.

METHODS AND RESULTS

A single center, randomized, double-blind, parallel-treatment study was carried out for 12 weeks. Subjects with primary hypercholesterolemia were randomly allocated to 10 g fish powder or placebo (20 tablets/day). Participants were instructed to follow National Cholesterol Education Program (NCEP) Step I Diet during a 4-week diet run-in phase and during the study. Concentrations of lipids, lipoproteins, hemostatic variables and endothelial cell markers were determined before and after supplementation. Our data showed that the fish powder supplement was well tolerated. A significant decrease and increase respectively were observed in plasma alpha-linolenic acid (p = 0.03) and docosahexaenoic acid (DHA) (p = 0.03). Concentrations of lipids, lipoproteins, homocysteine, factor VII, fibrinogen, tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI)-1, soluble intercellular adhesion molecule (ICAM)-1, P-selectin and interleukin (IL)-8 were not beneficially affected.

CONCLUSIONS

Fish powder supplementation does not seem an effective approach to improve risk factors for coronary heart disease in hypercholesterolemic subjects following the NCEP Step I Diet.

Serial measurements of serum human placental lactogen (hPL) and serial ultrasound examinations in the evaluation of fetal growth

Serial serum hPL measurements and serial ultrasound fetometry were compared in the evaluation of fetal growth by relating these two parameters to size at birth and to clinical factors known to influence size at birth. The data were from a prospective study of 1000 consecutive pregnant women considered to be at risk for fetal growth retardation with retrospective analysis. Serum hPL was measured by radioimmunoassay and fetal weight estimated by ultrasound every 3 weeks during the last trimester. hPL values were expressed as multiples of the median (MoM) and linear regression analysis of the hPL MoM values was carried out for each pregnancy to find the slope of the line (hPL-slope); at least 3 serum hPL values were required. The estimated fetal weight and weight-for-age at birth was expressed in Z-scores. The individual intrauterine growth velocity was calculated by regression analysis and expressed as change in Z-score for 12 weeks. At least two ultrasound measurements over an interval of at least 42 days were used to estimate the fetal growth velocity. In 588 women the file was complete. The main outcome measures were the individual mean hPL, hPL-slope, fetal growth velocity, birth weight deviation, smoking in pregnancy and diagnosis of preeclampsia. A significant correlation was found between the hPL-slope and the intrauterine fetal growth velocity (r=0.34), and between hPL-slope and birth weight deviation (r=0.32). Mean hPL was correlated to birth weight deviation (r=0.27), but only very weakly to intrauterine growth velocity (r=0.08). hPL-slope and intrauterine growth velocity independently predicted birth weight deviation. Heavy smoking which was stopped before the third trimester was not associated with low intrauterine growth velocity, but with a low hPL-slope. Preeclampsia was associated with a trend towards low and decreasing hPL and with an increasing intrauterine growth velocity and birth weight deviation. In conclusion the rate of change of serial hPL measurements correlated well to intrauterine fetal growth velocity in the third trimester as estimated by ultrasound and to the deviation in birth weight, but hPL seems to have a separate physiological significance, since it did not pick up when smoking was stopped and growth velocity was normalised and it did not at all detect the increased growth associated with preeclampsia.