Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study

AIM

To quantify the association between behaviour change and weight loss after diagnosis of Type 2 diabetes, and the likelihood of remission of diabetes at 5-year follow-up.

METHOD

We conducted a prospective cohort study in 867 people with newly diagnosed diabetes aged 40-69 years from the ADDITION-Cambridge trial. Participants were identified via stepwise screening between 2002 and 2006, and underwent assessment of weight change, physical activity (EPAQ2 questionnaire), diet (plasma vitamin C and self-report), and alcohol consumption (self-report) at baseline and 1 year after diagnosis. Remission was examined at 5 years after diabetes diagnosis via HbA1c level. We constructed log binomial regression models to quantify the association between change in behaviour and weight over both the first year after diagnosis and the subsequent 1-5 years, as well as remission at 5-year follow-up.

RESULTS

Diabetes remission was achieved in 257 participants (30%) at 5-year follow-up. Compared with people who maintained the same weight, those who achieved ≥ 10% weight loss in the first year after diagnosis had a significantly higher likelihood of remission [risk ratio 1.77 (95% CI 1.32 to 2.38; p<0.01)]. In the subsequent 1-5 years, achieving ≥10% weight loss was also associated with remission [risk ratio 2.43 (95% CI 1.78 to 3.31); p<0.01].

CONCLUSION

In a population-based sample of adults with screen-detected Type 2 diabetes, weight loss of ≥10% early in the disease trajectory was associated with a doubling of the likelihood of remission at 5 years. This was achieved without intensive lifestyle interventions or extreme calorie restrictions. Greater attention should be paid to enabling people to achieve weight loss following diagnosis of Type 2 diabetes.

Anti-platelet therapy does not influence the outcome of patients undergoing hepatic resection for colorectal liver metastases, an observational study

AIM

To evaluate the impact of anti-platelet therapy on the outcomes of patients undergoing liver resection for CRLM. Secondary aim was to determine whether anti-platelet therapy influenced histo-pathological changes in CRLM.

METHODS

Patients treated with liver resection for CRLM were identified from a prospectively maintained hepatobiliary database during an 11-year period. Collated data included demographics, primary tumour treatment, surgical data, histopathology analysis and clinical outcome.

RESULTS

454 patients that underwent primary hepatic resections for CRLM were included. 60 patients were on anti-platelet therapy. 241 patients developed recurrent disease and 131 patients have died. Multi-variate analysis identified 4 independent predictors of disease-free survival: tumour number; tumour size; peri-neural invasion; and resection margin. The presence of peri-neural invasion and multiple hepatic metastases were independent predictors of poorer overall survival on multi-variate analysis. Uni-variate analysis showed that the use of anti-platelet therapy was associated with larger tumour size (p=0.031) and vascular invasion (p=0.023).

CONCLUSION

Anti-platelet therapy does not affect the survival outcome in patients with CRLM following liver resection. Anti-platelet therapy is associated with larger liver metastases and vascular invasion on histo-pathological analysis.

SYNOPSIS

A large retrospective study looking at outcomes of patients taking pre operative anti platelet therapy who have undergone liver resection for colorectal liver metastases.

Comparative safety and tolerability of duloxetine vs. pregabalin vs. duloxetine plus gabapentin in patients with diabetic peripheral neuropathic pain

OBJECTIVE

The safety and tolerability of three treatments for diabetic peripheral neuropathic pain (DPNP) were compared.

METHODS

A 12-week, randomized, open-label study confirming the non-inferiority of duloxetine (N = 138) vs. pregabalin (N = 134) and the combination of duloxetine plus gabapentin (N = 135) as the primary outcome was previously published. Patients had an inadequate pain response to a stable dose of gabapentin (≥ 900 mg/day) for ≥ 5 weeks prior to study enrolment. Data from that study were assessed in this current analysis for a detailed report of safety and tolerability.

RESULTS

Completion rates did not differ significantly between the groups. Discontinuation because of adverse events was significantly greater in the duloxetine (19.6%) vs. pregabalin group (10.4%; p = 0.04); no differences emerged between the duloxetine vs. duloxetine plus gabapentin (13.3%) groups (p = 0.19) or pregabalin vs. duloxetine plus gabapentin groups (p = 0.57). Adverse event rates varied: nausea, insomnia, hyperhidrosis and decreased appetite were reported significantly more often in patients treated with duloxetine vs. patients treated with pregabalin (each p ≤ 0.01); insomnia significantly more in patients treated with duloxetine vs. duloxetine plus gabapentin (p = 0.01); peripheral oedema significantly more in patients treated with pregabalin vs. duloxetine and duloxetine plus gabapentin (p ≤ 0.001 each) and nausea, hyperhidrosis, decreased appetite and vomiting significantly more in patients treated with duloxetine plus gabapentin vs. pregabalin (each p ≤ 0.05). At end-point, weight change differed significantly among treatment groups: patients in the pregabalin group on average gained weight (1.0 ± 0.04 kg); while, patients in the duloxetine and duloxetine plus gabapentin groups on average lost weight (-2.39 ± 0.04 and -1.06 ± 0.04 kg, respectively) (pregabalin vs. duloxetine, p ≤ 0.001; pregabalin vs. duloxetine plus gabapentin, p ≤ 0.001; duloxetine vs. duloxetine plus gabapentin, p = 0.01).

CONCLUSION

Duloxetine, pregabalin and duloxetine plus gabapentin were generally safe and tolerable for the treatment of DPNP.

Chronic heart failure guidelines: do they adequately address patient need at the end-of-life?

INTRODUCTION

A number of international guidelines have been developed to support primary care clinicians improve the quality of care for patients with chronic heart failure at the end of life. The objective of this study was to undertake a systematic evaluation of such guidelines in relation to end-of-life care.

METHODS

A systematic literature search of research databases and guideline clearing houses was undertaken. The selected guidelines were independently assessed by two researchers using the AGREE II quality criteria. A data-extraction framework was devised based on the holistic needs assessment tool of the Gold Standards Framework. The content of each guideline was then analysed using an approach similar to that used for thematic analysis.

RESULTS

A total of 19 guidelines were included. Those guidelines with lower overall AGREE II scores covered fewer domains on the holistic needs assessment. Across all guidelines the lowest scoring domain was applicability and stakeholder involvement. Qualitative assessment showed that some guidelines adopt an unwavering disease orientated approach to assessing patient need. Guidance around continuity of care, out of hours care and after care was particularly poor in several guidelines. There was considerable heterogeneity in the evidence presented even amongst those guidelines that achieved high AGREE II scores.

CONCLUSION

Combined quantitative and qualitative assessment demonstrates the importance of rigorous guideline development. Whilst the variation in evidence presented could be a result of methodological heterogeneity in the development of guidelines, it raises important questions about the processes by which evidence, information and knowledge become transformed into clinical guidelines.

Painless electrodiagnostic current perception threshold and pain tolerance threshold values in CRPS subjects and healthy controls: a multicenter study

The purpose of this study is to evaluate both painless and painful sensory transmission in patients with Complex Regional Pain Syndrome (CRPS) using the automated electrodiagnostic sensory Nerve Conduction Threshold (sNCT) test. This test generates reliable, painless Current Perception Threshold (CPT) and atraumatic Pain Tolerance Threshold (PTT) measures. Standardized CPT and PTT measures using constant alternating current sinusoid waveform stimulus at 3 different frequencies 5 Hz, 250 Hz, and 2 kHz (Neurometer CPT/C Neurotron, Inc. Baltimore, MD) were obtained from CRPS subjects at a distal phalange of the affected extremity and at an ipsilateral asymptomatic control site. Matched sites were tested on healthy subjects. Detection sensitivities for an abnormal PTT and CPT test were calculated based on specificity of 90% as determined from data obtained from healthy controls. A Spearman rank correlation was used to test for a significant association between presence of allodynia and an abnormal PTT or CPT at any frequency tested. Thirty-six CRPS subjects and 57 healthy controls were tested. The highest detection sensitivity of the PTT test from symptomatic test sites was 63% for the finger and 71% for the toe. PTT abnormalities were also detected, to a lesser degree, at the asymptomatic control site (41% finger control site, 16% toe control site). The highest CPT detection sensitivity at the symptomatic site was 37% for the finger site and 53% for the toe site. CPT abnormalities were also detected at the asymptomatic control site (29% finger control site, 37% toe control site). Eighty-six percent of the CRPS subjects had either a PTT or CPT abnormality at any frequency at the symptomatic site. There was a significant correlation between presence of allodynia and presence of an abnormal CPT and PTT, respectively (P < .01). The correlation coefficient was lower for CPT than for PTT, ie, 0.34 versus 0.6 for the finger and 0.48 versus 0.67 for the toe, respectively. In studied CRPS patients an abnormal PTT was detected with higher sensitivity than an abnormal CPT. Assessing PTT may become a useful electrodiagnostic quantitative sensory test for diagnosing and following the course of neuropathic pain conditions.

A national study examining the effect of making emergency hormonal contraception available without prescription

BACKGROUND

In January 2001, emergency hormonal contraception was made available for women over the age of 16 years directly from a pharmacist without prescription. It is of interest whether this change in the UK has led to any improvements or deterioration in the service provided for the women who need it.

METHODS

Self- completed, anonymous questionnaires were distributed to women requesting emergency hormonal contraception through a single group of pharmacies located throughout England, Wales and Scotland.

RESULTS

A total 419 women returned completed questionnaires. A greater proportion of women were able to take emergency contraception within 24 h when they obtained their tablets directly from a pharmacy without a prescription (64% versus 46%, P = 0.029). Women who obtained their drugs directly from the pharmacist were just as well informed, just as likely to arrange regular follow-up and generally preferred this system, although they disliked having to pay.

CONCLUSION

Making emergency hormonal contraception available without prescription has improved services to women who need them, but these improvements are quantitatively minimal, preventing only five additional pregnancies per 10,000 users.

Psychological factors associated with recurrent vaginal candidiasis: a preliminary study

OBJECTIVE

To identify psychological factors associated with chronic recurrent vaginal candidiasis.

DESIGN

A cross sectional exploratory study of women with chronic, recurrent vaginal candidiasis.

PATIENTS

28 women found culture positive and treated for vaginal candidiasis by a clinic physician at least twice within the past 6 months. All women reported that they had experienced vaginal thrush six or more times within 1 year. A comparison group comprised 16 women with no history of recurrent vaginal candidiasis, of similar age range, and recruited from a women's family planning service.

METHODS

Both groups were compared on demographic criteria, sexual health histories, mental health, and psychological health characteristics. A purpose designed structured interview was administered alongside a battery of standardised psychometric instruments measuring mood, satisfaction with life, self esteem, and perceived stress.

RESULTS

The two groups showed considerable similarities, with no significant differences in demographic characteristics and most sexual health issues. However, women with recurrent vaginal candidiasis were significantly more likely to suffer clinical depression, to be less satisfied with life, to have poorer self esteem, and to perceive their lives as more stressful. Additionally, women with recurrent vaginal candidiasis reported that their candidiasis seriously interfered with their sexual and emotional relationships.

CONCLUSIONS

Overall, this study identified many areas of psychological morbidity associated with chronic vaginal candidiasis, and indicates that development of appropriate psychological treatment initiatives in this area is long overdue.

Quantitative assessment of differential sensory blockade after lumbar epidural lidocaine

A cutaneous current perception threshold (CPT) sensory testing device measures both large and small diameter sensory nerve fiber function and may be useful in evaluating differential neural blockade. Eight subjects received both lumbar epidural saline and lumbar epidural lidocaine. Five milliliters of normal saline was administered and the CPTs were measured. After the saline, 10 mL of 2% plain lidocaine was administered. CPTs, and sensation to touch, pinprick, and cold were subsequently measured. Saline had no effect on any measurements. Lidocaine caused an increase in all CPTs at the umbilicus and the knee reaching a statistical significance at 5 Hz for the umbilicus only. The great toe showed a slight increase of the 5 Hz stimulus and no increase of the 2000 or 250 Hz stimulus. There was a significant decrease in touch, pinprick, and cold sensation at the umbilicus and knee and a significant decrease in the cold sensation at the great toe. There was no effect on any measurements made at the mastoid. Epidural lidocaine resulted in a differential neural blockade as measured by a CPT monitor but not with crude sensory measurements.

Prospective associations between lateralised brain function and immune status in HIV infection: analysis of EEG, cognition and mood over 30 months

Prospective relations between individual differences in both lateralised neuro-psychophysiological functions and mood ratings with immune status (CD4 and CD8 counts) were examined in asymptomatic HIV-positive men (n = 27) over thirty months. They participated in a controlled study of zidovudine versus placebo (results published elsewhere). Measures included EEG spectra, neuropsychological tests and mood ratings. A model of reciprocal lateralised influences on the immune system was tested whereby patients with left superior to right hemispheric functions were predicted to show a less deleterious outcome than those with the opposite asymmetry pattern. Prospective relations with immune status were found in the EEG with lateralised theta, alpha and beta activity; among cognitive measures with word fluency, semantic processing, and lateralised motor and recognition memory (word/face) processes; with mood ratings including depression, confusion and the total mood score. The nature of the effects supported the laterality predictions. These unique data, showing that neuro-psychophysiological factors in HIV+ but otherwise healthy subjects predict immune competence and compromise present 2-3 years later, warrant replication in a larger cohort.

Psychological distress among gay men supporting a lover or partner with AIDS: a pilot study

To date, there has been little research to examine how much psychological distress is caused to people providing care and support to a lover or partner with AIDS. This study aimed to determine the level of psychological distress experienced by a sample of gay men providing care and support to a lover or partner with AIDS. It was conducted as a cross-sectional questionnaire survey. A control group was not enlisted, thus the study was descriptive in nature. The experimental hypothesis proposed that providing care and support would result in a high level of psychological distress. Thirty-eight gay men, some of whom themselves were infected with HIV, who were the primary carer of a lover or partner with an AIDS diagnosis were assessed using a self-report questionnaire. The 28-item General Health Questionnaire was used as a measure of global psychological distress. In addition, Martin's (1988) Traumatic Stress Response Scale was used as a measure of psychological distress arising specifically from AIDS. The sample reported high levels of global and AIDS-specific psychological distress. The levels of distress reported were of such a degree to indicate that the majority of the sample were probably suffering from significant psychiatric problems. The results strongly suggest that providing care and support to a lover or partner with AIDS may have an adverse affect on the carer's own psychological health: however, because of the design of the study it is impossible to state this conclusively.

Preoperative HIV antibody testing: the views of surgeons and patients

Fifty surgeons and 72 preoperative patients in 2 central London hospitals were asked their views on preoperative HIV antibody testing, who is at risk of HIV infection and HIV test counseling. A substantial proportion of both surgeons and preoperative patients, 48% and 54% respectively, supported compulsory HIV antibody testing without patient consent. They believed this should occur as a routine practice prior to surgery. However, surgeons and patients differed in the preoperative patients to be considered for such testing. All surgeons advocating compulsory testing believed that it was only necessary for those patients belonging to high risk groups whilst preoperative patients believed that all patients should be HIV tested prior to surgery. Surgeons and patients also differed in their views on who was at risk of HIV infection. Surgeons believed those at risk to be members of identifiable risk groups whilst patients believed everyone was at risk, especially those engaging in high risk behaviours. Finally, when asked which health professionals they thought should be involved in HIV test counselling, both surgeons and patients agreed that hospital doctors, including surgeons themselves, should take on the responsibility of test counselling. The implications of this and routine HIV antibody testing are discussed.

Neurophysiological evaluation of zidovudine in asymptomatic HIV-1 infection: a longitudinal placebo-controlled study

The effect of early antiretroviral medication with zidovudine on neurophysiological functions was evaluated in subjects with asymptomatic HIV-1 infection. Patients were recruited participants of a larger double-blind randomised placebo-controlled treatment trial with zidovudine (Concorde). The main outcome measures included: quantitative electroencephalography (QEEG), auditory event-related potentials (AEP) and pattern-reversal visual evoked potentials (PRVEP), as well as standard clinical, virological and immunological markers. No significant impairment and no difference between treatment groups was found in visual P100 latency and auditory long-latency P3 responses which is in agreement with the absence of neurological and neuropsychological impairment over the study period. Significant treatment effects were revealed by quantitative electroencephalography (QEEG). While the placebo group showed a significant increase in delta and theta slow frequency QEEG activity over the study period, slow wave amplitude remained unchanged in the zidovudine group after a mean follow-up period of 28 months. In summary, the data provide evidence for a low level neuropathological process in asymptomatic HIV-1 infection which can be effectively suppressed by antiretroviral medication.

Patterns of cognitive asymmetry and syndromes of schizotypal personality

The Schizotypal Personality Questionnaire, modeled on the nine components of DSM-III-R schizotypy, was administered to 122 medical students along with the Thayer Activation-Deactivation Adjective Checklist and the Warrington Recognition Memory Test for words and faces. Close affinities were found between a three-factor schizotypal personality structure and a three-syndrome model of schizophrenia. Different patterns of cognitive asymmetry (word-face discrepancy scores) were related to Active and Withdrawn syndromes as in schizophrenia, and were related to high activation and general deactivation differences as predicted. A prospective single case study showed that a face-word discrepancy before a first episode of schizophrenia accurately predicted a Withdrawn presenting syndrome. The consistency between syndromes of schizophrenia and schizotypal personality in a normal population suggests possible etiological links between the two, and it supports a dimensional view of psychosis and subclinical predispositions.

The reliability and validity of a symptom checklist for use in HIV infection: a preliminary analysis

The aim of the study was to determine the reliability and validity of a self-report symptom checklist designed for use in HIV infection. One hundred and seventy-one gay men completed a 28-item symptom checklist which produces 3 dimensions: physical, cognitive and psychological. The validity of each dimension was examined by comparing scores on the checklist with indices of disease progression and previously validated psychological scales. People with more advanced HIV disease had higher scores on the physical and cognitive checklists, though the psychological scale was not related to disease stage. All the scales showed moderate correlations with measures of psychological health. Examination of individual item responses suggested that patients over-reported the presence of some symptoms. Although individual items should be interpreted with caution, the overall scores of the RSC are reliable and valid as measures of subjective health status in HIV infection. The importance of psychological factors in the reporting of symptoms suggests that symptom checklists should be interpreted in the light of adequate measures of psychological state.

Auditory and visual event-related potentials in a controlled investigation of HIV infection

Auditory and visual event-related brain potentials (ERPs) were used to complement neuropsychological and medical assessment in neurologically healthy subjects with asymptomatic and symptomatic human immunodeficiency virus type 1 (HIV-1) infection. Auditory and visual ERPs, recorded using standard oddball paradigms, disclosed delays in late waves (N2 and P3) in symptomatic subjects (CDC stage IV) when compared with matched controls. Abnormally delayed P3 waves in at least one modality were recorded in 41% of symptomatics and this was associated with deficits in neuropsychological performance, particularly psychomotor slowing. However, no differences in late wave latencies between asymptomatic and control subjects were found, though asymptomatics showed delays in auditory N1 and P2 latencies. The number of morphological abnormalities, such as indiscernible late waves as well as topographical variability of the P3 wave, was increased in both HIV seropositive groups and possibly indicates a distinct mechanism of impairment, different from latency delay. Whilst P3 delay in symptomatics was not associated with changes in immune function (T4 cells) there was, however, a link with anaemia and subclinical hepatic dysfunction.

A survey of the use of blood and blood components among South African anaesthetists working in teaching hospitals

A survey of the peri-operative policies for blood and blood component therapy was carried out among anaesthetists in the nine South African teaching hospitals. All anaesthetists completed the questionnaire, without recourse to books or discussion. The survey revealed a possible over-utilisation of blood and blood components in the peri-operative period. There were significant deficiencies in the pre-operative assessment of blood and platelet requirements and the specific indications for platelet, fresh frozen plasma and blood transfusions. A significant number of respondents exhibited poor knowledge of the potential dangers and expense that the use of blood and blood components entails. Educational effort was perceived to be the main method of rationalising the anaesthetist's usage of blood and blood components.

Skin photoplethysmography--a review

The photoplethysmograph has been used for over 50 years but there are still misconceptions in how and what is the information obtained. A photoplethysmograph signal from any site on the skin can be separated into an oscillating (a.c.) and a steady-state (d.c.) component, their amplitudes dependent upon the structure and flow in the vascular bed. Many simple applications are available: pulse counters, using the a.c. component, skin colour and haemoglobin saturation meters, using the d.c. component. The d.c. component of the photoplethysmograph signal is a function of the blood flux beneath the device. A good emitter for use in a photoplethysmograph of skin blood flow is one in the frequency range 600-700 nm and the best signal for a.c. analysis is obtained from the finger pulp. The frequency range of the electronic circuitry should be from 0.01 to 15 Hz, then all the information in the signal can be extracted about the autonomic nervous system control of the cardiovascular system, particularly between 0.01 and 2 Hz. Comparative studies may be drawn between similar skin sites on a subject or between subjects if the afferent inputs to the brain stem are controlled or driven at a known frequency. These afferents, inputs, will modulate the efferents, outputs, which generate variations in the a.c. component of the detected photoplethysmograph signal.

Beta-adrenergic blockade restores glucose's antiketogenic activity after exercise in carbohydrate-depleted athletes

1. The development of post-exercise ketosis is not abolished by the ingestion of glucose immediately after exercise, despite inducing high insulin/glucagon ratios in the peripheral (and therefore by implication in the portal) blood. 2. To investigate the possibility of autonomic control of the liver influencing its sensitivity to the major counter-regulatory hormones, we administered 50 g glucose, either on its own, or together with 0.5 mg prazosine, 40 mg propranolol, or 15 mg propantheline, to forty-seven 48 h carbohydrate-starved athletes who had just run 25 km. 3. The blood 3-hydroxybutyrate concentration rose from 0.30 +/- 0.05 (mean +/- S.E. of mean) to 0.52 +/- 0.08 mmol/l with exercise, and then to 1.32 +/- 0.40 mmol/l at 6 h after exercise in subjects who had ingested only glucose after exercise. 4. The effects of prazosine and propantheline on the blood ketone body concentration at 2 h after exercise was not statistically significant. Propranolol, on the other hand, significantly lowered the blood 3-hydroxybutyrate concentration (compared with controls) to 0.09 +/- 0.03 mmol/l at 3 h (P less than 0.01), and 0.35 +/- 0.08 mmol/l at 6 h (P less than 0.01) after exercise. 5. The plasma insulin, glucagon, glucose and free fatty acid concentrations were unaffected by propranolol, indicating that the antiketogenesis was the result of a direct effect on ketone body metabolism. 6. Since beta-adrenergic blockade has not previously been shown to have antiketogenic activity, except in somatostatin-induced hyperketonaemia, it is concluded that its effectiveness in post-exercise ketosis can probably be ascribed to a functional hepatic insulin and glucagon deficiency.

Runner's Knee: What Is It and How Effective Is Conservative Management?

In brief: Forty-eight trained runners with runner's knee were examined, treated, and followed for eight months to identify the causes of this injury and its response to a particular regimen of conservative management. The subjects (41 men, 7 women), ranged in age from 20 to 40. Most trained from 40 to 80 km per week and had been running for four years or less; half had recently altered their training routine, the most common change being an increase in distance. Treatment consisted of prescribing appropriate running shoes alone (34%), orthoses alone (28%), shoes and orthoses (15%), appropriate running shoes plus ice application (19%), or icing alone (4%). Sixty-five percent of the subjects were symptom free within four weeks of starting treatment, a result at least equal to results cited in other reports.

Personality characteristics of physiotherapy students

Seventy-nine first year physiotherapy students from Lincoln Institute were matched for age and sex with a sample of fifty-two trainee teachers from Melbourne State College. The two samples were compared on personality dimensions as measured by Cattell's Sixteen Personality Factor Inventory. Statistical analysis revealed significant differences on five dimensions; Factors I, M, N, O and Q1. Compared to the teaching students the physiotherapy undergraduates were less tender-minded, more practical and conventional, more forthright, more self-assured and more conservative. These results were reasonably consistent with other findings and had implications for professional behaviour and future training of physiotherapists.

Progesterone concentration in the peripheral plasma of pregnant goats

Plasma progesterone concentration was measured by a competitive protein-binding method in serial samples of jugular venous blood from 21 pregnant goats, 11 with twin and 10 with single foetuses.

Progesterone levels in twin pregnancies were significantly greater than in singletons. The mean progesterone concentration (ng/ml plasma) in the twin pregnancies was greatest during the 3rd month of gestation (10·7 ± 0·4 (s.e.m.)) and in the singletons during the 4th month (7·8 ± 0·2 (s.e.m.)). There was a significant decrease in mean progesterone concentration in the last month of pregnancy due to a steady decline in the last 7 days before parturition.

The mean progesterone concentrations at parturition in five twin and eight single pregnancies were 2·2 ± 0·4 and 1·5 ± 0·2 (s.e.m.) ng/ml plasma respectively; there was no significant difference between these values. In cord blood from nine kids immediately after delivery the progesterone concentration was 0·9 ± 0·1 ng/ml.