Parental factors predicting social deviance and psychological outcomes in offspring: Evidence from the Avon Longitudinal Study of Parents and Children (ALSPAC)

Objective: The objective of the present study was to examine whether exposure to prenatal psychoactive substances is associated with psychological outcomes and deviant behaviour. Methods: This was a secondary analysis of 7,769 mother-child dyads in the Avon Longitudinal Study of Parents and Children (ALSPAC) who were followed until the children were aged approximately 12 years. Parental characteristics and maternal use of various substances were collected in pregnancy and entered as predictors of psychological outcomes in childhood and deviant behaviours in early adolescence. The psychological outcomes were IQ, social cognition, working memory and inhibition, while the deviant behaviours were threatening others, truancy and cruelty to animals. Weighted logistic regression models were used to predict deviant behaviours and weighted linear regression for the psychological outcomes. Results: High prenatal alcohol exposure predicted truancy and cruelty to animals. Tobacco exposure predicted lower IQ, a greater social communication deficit, lower working memory, truancy and threatening others. Illicit drugs predicted a higher social communication deficit and truancy. All prenatal substance exposures remained significant after adjustment for peer influences and covariate imbalance. Conclusion: Alcohol, tobacco and illicit drugs were associated with deviant behaviours in early adolescence and these behaviours were preceded by psychological deficits in childhood. The present study supports the guideline that no amount of alcohol is safe to consume in pregnancy and that tobacco and illicit drugs should be avoided.

Berberine alleviates monosodium glutamate induced postnatal metabolic disorders associated vascular endothelial dysfunction in newborn rats: possible role of matrix metalloproteinase-1

Excessive food additives Monosodium glutamate (MSG) results in metabolic disorders with increased Cardiovascular diseases CVD. We aimed to emphasise berberine (BBR) effect on MSG induced metabolic syndrome (MetS) and its associated endothelial dysfunction. Newborn rats were divided into control group, MSG group (4 mg/g) each other day for the first 14 days of life and MSG + BBR group that was given MSG then BBR in dose 150 mg/kg/day for 6 weeks. Body weight, food intake, systolic blood pressure, biochemical metabolic and oxidative stress markers were evaluated. Aortic tissue homogenate Endothelin -1 (ET-1) and matrix metalloproteinase -1 (MMP-1) assessment, in addition to histological and EM examination were done. Newborn rats MSG exposure results in typical adult life MetS and oxidative stress with significant increase in ET-1 and MMP-1with aortic vasculopathy. BBR significantly improved all the disturbed parameters; suppress increased body weight (BW), food intake (FI) and partly improved the aortic vasculopathy lesions, holding a promise for BBR as a defending agent against MSG metabolic and vascular disorders.HIGH LIGHT MSGMSG is frequently consumed as a flavour enhancer especially between children and adolescentExcessive utilisation MSG is associated MS with vascular endothelial dysfunctionMMP-1 may be involved in atherosclerotic plaque formationBBR has beneficial outcome for metabolic disorders induced by MSG among newly born ratsBBR has a role in management vascular inflammation and remodelling.

Epidemiological study of Middle East respiratory syndrome coronavirus infection in dromedary camels in Saudi Arabia, April-May 2015

A cross-sectional study was conducted in five regions in Saudi Arabia to investigate the epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in dromedary camels (Camelus dromedarius) during April and May2015. Serum and nasal swab samples were tested for MERS-CoV antibodies andribonucleic acid (RNA) using a recombinant enzyme-linked immunosorbent assay (rELISA) and real-time reverse-transcription polymerase chain reaction (rRT-PCR), respectively. The overall MERS-CoV antibody seroprevalence was 80.5%, whereas the overall viral RNA prevalence was 2.4%. The associations of risk factors with each prevalence were quantified using univariate and multivariate analyses. The multivariate models identified region, age, grazing system, exposure to wild animals and dung removal as factors significantly associated with seroprevalence (p ??0.05). A higher seroprevalence was more likely to occur in camels from the Riyadh, Eastern, Northern and Makkah regions than those from the Jazan region; camels ??4 and 1-3 years of age (marginally significant) than calves < 1 year; and camels raised in zero grazing and semi-open grazing systems than those raised in an open grazing system. However, the presence of wild animals and daily dung removal were negatively associated with seroprevalence. On the other hand, region and sex were significantly associated with MERS-CoV RNA prevalence(p ??0.05). A higher viral RNA prevalence was more likely to occur in camels from the Riyadh region and Eastern region (marginally significant) than in those from the Makkah region, and in male camels than female camels. In conclusion, the risk factors identified in this study can be considered to be predictors of MERS-CoV infection in camels and should be taken into account when developing an efficient and cost-effective control strategy.

Dysfunctional anger and sexual violence

Sexual offenses with or without aggression attract attention from the popular media and the scientific community. Empirical research suggests a relationship between anger and sexual violence. This article describes the key themes of dysfunctional anger and sexual violence, and how dysfunctional anger relates to sexual fantasies, sexual offending, and sexual recidivism. The implications of the findings for clinical practice and future research are discussed.

Treatment and management of child pornography use

Advances in Internet and other digital technologies have created ready and affordable access to pornography involving real children or computer-generated images of children. To better understand and manage child pornography users, clinicians must acquaint themselves with the characteristics and behaviors of these offenders. This article distinguishes motivations to use child pornography and different types of child pornography offenders and provides a brief overview of the assessment, diagnosis, and management options available. The authors conclude with recommendations on future directions in the assessment, diagnosis, and management of child pornography offenders.

Ethics and the treatment of sexual offenders

Clinicians in sex offender treatment programs always encounter the need to balance the best interests of sex offenders and the safety needs of the community. The protection of the community often takes primacy, resulting in violation of traditional mental health codes of ethics. These ethical dilemmas have generated debates in the academic community. To minimize ethical dilemmas, clinicians in sex offender treatment programs need to acknowledge the conflicts, adhere to safeguards, and thoughtfully address the challenges with profession-specific ethical values and codes. This article reviews ethical principles in relation to conceptualization of sex offenders and their assessment and treatment and research involving sex offenders.

Commentary: sildenafil in phallometric testing--an evidence-based assessment of sexual offenders

The field of medicine has moved toward best practices based on evidence. There is pressure on all medical disciplines, including forensic psychiatry, to adopt this approach. Some areas of forensic psychiatry have a stronger scientific basis that clearly fits the definition of evidence-based medicine than do other areas. One of these areas is the assessment and treatment of sexual offenders, which has a strong scientific basis and meets the definition of evidence-based medicine, as defined by Sackett et al. in 2007. Phallometric testing is an objective, physiological indicator of deviant sexual preferences that support the diagnosis of paraphilias and the assessment of sexual offenders. The current article by Kolla et al. is an effort to improve the reliability of phallometric testing related to diagnosis by pharmacologic stimulation.

Pharmacological treatments for psychosis-related polydipsia

BACKGROUND

Polydipsia is the intake of more than three litres of fluids per day. Primary polydipsia occurs when excessive drinking cannot be explained by an identified medical condition, and is not secondary to polyuria. The prevalence of this problem in psychiatric inpatients has been estimated at between 6 and 17%. It can hinder standard care and be a highly disabling, even life-threatening condition.

OBJECTIVES

To review the effect of pharmacological interventions for the treatment of psychosis-related polydipsia.

SEARCH STRATEGY

We searched the Cochrane Schizophrenia Group's Register (January 2002 and February 2005) which is compiled by up-to-date methodical searches of BIOSIS, The Cochrane Library, CINAHL, Dissertation abstracts, EMBASE, LILACS, MEDLINE, PSYNDEX, PsycINFO, RUSSMED and Sociofile and is supplemented with hand searching of relevant journals and numerous conference proceedings. References of all identified studies were also searched for further trials.

SELECTION CRITERIA

We included all randomised controlled trials involving people with a psychotic illness and secondary polydipsia, which evaluated drug treatments, and measured clinically meaningful outcomes.

DATA COLLECTION AND ANALYSIS

Working independently, we inspected citations, ordered papers, and then re-inspected and quality assessed the studies and extracted data. For homogeneous dichotomous data, we calculated the relative risk (RR), 95% confidence interval (CI), and, where appropriate, the number needed to treat (NNT) and the number needed to harm (NNH), on an intention-to-treat basis. We assumed that people who left the study early or who were lost to follow-up had no improvement. We calculated weighted mean differences (WMD) for continuous data. We excluded data if loss to follow-up was greater than 50%.

MAIN RESULTS

We identified two small trials (Alexander 1991 and Nishikawa 1996) which fulfilled the inclusion criteria, (total n=17, duration 3-6 weeks). Few data were reported and, because of inappropriate use of crossover methodology, we could not include all of the data in this review. For the few chronically ill people in these trials, neither the 'active' tetracycline bacteriostatic agent, oral demeclocycline, nor the opiate antagonist naloxone, nor placebo, gave any suggestion of serious adverse effects for a period of up to six weeks. The studies did not report any useful data on measures of polydipsia, physical symptoms secondary to increased fluid intake, mental state, general functioning or economic outcomes.

AUTHORS' CONCLUSIONS

The trials offer little useful data to the clinician hoping to treat psychosis-related polydipsia with drugs, except that further evaluative studies need to be conducted in this area. Treatment of any sort for psychosis related polydipsia might only be informative within a well designed, conducted and reported randomised study. The two pioneering studies suggest that larger trials, though difficult, would not be impossible with adequate support and co-ordination.

Homicide in the Canadian Prairies: elderly and nonelderly killings

OBJECTIVE

To examine the psychosocial and clinical characteristics of male perpetrators of elderly and nonelderly homicides in the Canadian Prairies.

METHOD

We examined data drawn from a study of 901 adult homicide offenders who were incarcerated or on parole between 1988 and 1992 in Alberta, Saskatchewan, and Manitoba.

RESULTS

Of those studied, 67 men were convicted of homicide involving 79 elderly victims, and 671 were convicted of homicide involving 675 nonelderly victims. Most perpetrators were single and engaged in irregular patterns of employment at the time of their index offence. Fourteen (20.8%) offenders with elderly victims had a history of psychiatric treatment, compared with 98 (14.6%) offenders with nonelderly victims; however, this difference was not statistically significant. Approximately 30% of both groups were diagnosed with personality disorders. A comparison of the index- offence characteristics showed no significant differences between the 2 groups.

CONCLUSION

Our findings suggest that elderly individuals are more likely to be killed in their own homes by strangers. Social isolation appears to be a significant risk factor in cases of elderly homicide.

Pharmacological treatments for psychosis-related polydipsia

BACKGROUND

Polydipsia is the intake of more than three litres of fluids per day. Primary polydipsia occurs when excessive drinking cannot be explained by an identified medical condition, and is not secondary to polyuria. The prevalence of this problem in psychiatric inpatients has been estimated at between 6 and 17%. It can hinder standard care and be a highly disabling, even life-threatening condition.

OBJECTIVES

To review the effect of pharmacological interventions for the treatment of psychosis-related polydipsia.

SEARCH STRATEGY

The reviewers searched the Cochrane Schizophrenia Group's Register (January 2002) which is compiled by up-to-date methodical searches of BIOSIS, The Cochrane Library, CINAHL, Dissertation abstracts, EMBASE, LILACS, MEDLINE, PSYNDEX, PsycINFO, RUSSMED and Sociofile and is supplemented with hand searching of relevant journals and numerous conference proceedings. References of all identified studies were also searched for further trials.

SELECTION CRITERIA

All randomised controlled trials involving people with a psychotic illness and secondary polydipsia, which evaluated drug treatments, and measured clinically meaningful outcomes.

DATA COLLECTION AND ANALYSIS

Reviewers, working independently, inspected citations, ordered papers, and then re-inspected and quality assessed the studies. They also worked independently to extract data. For homogeneous dichotomous data, the relative risk (RR), 95% confidence interval (CI), and, where appropriate, the number needed to treat (NNT) and the number needed to harm (NNH), were calculated on an intention-to-treat basis. Reviewers assumed that people who left the study early or were lost to follow-up had no improvement. Weighted mean differences (WMD) were calculated for continuous data. Data was excluded if loss to follow-up was greater than 50%.

MAIN RESULTS

The reviewers identified two trials which fulfilled the inclusion criteria, (total n=17, duration 3-6 weeks). Few data were reported and, because of inappropriate use of crossover methodology, it could not all be used in this review. For the few chronically ill people in these trials, neither the 'active' tetracycline bacteriostatic agent, oral demeclocycline, nor the opiate antagonist naloxone, nor placebo, gave any suggestion of serious adverse effects for a period of up to six weeks. The two small studies did not report any useful data on measures of polydipsia, physical symptoms secondary to increased fluid intake, mental state, general functioning or economic outcomes.

REVIEWER'S CONCLUSIONS

The trials offer little to the clinician hoping to treat psychosis-related polydipsia with drugs, except that further evaluative studies need to be conducted in this area. Treatment of any sort for psychosis related polydipsia might only be informative within a well designed, conducted and reported randomised study. The two pioneering studies suggest that larger trials, though difficult, would not be impossible with adequate support and co-ordination.

Polydipsia, psychosis, and familial psychopathology

OBJECTIVE

To compare the demographic and clinical factors and familial psychopathology of chronic psychiatric inpatients with, and without, polydipsia.

METHOD

We undertook a case-control study of chronic psychiatric inpatients both with, and without, polydipsia. Clinical and demographic data were gathered using a predesigned questionnaire, the Positive and Negative Syndrome Scale (PANSS), the Abnormal Involuntary Movement Scale (AIMS), the Mini-Mental State Examination Scale (MMSE), and the Family History-Research Diagnostic Criteria (FH-RDC).

RESULTS

The prevalence rate of polydipsia was 20.2%. The group with polydipsia was significantly younger, both at the time of their first-ever psychiatric and current psychiatric admissions, compared with the group without polydipsia. The 2 groups were similar in terms of their illness characteristics and psychiatric diagnoses. In the group with polydipsia, alcohol abuse predated the psychotic illness by a mean of 10.5 (SD 4.4) years, compared with 4.8 (SD 1.6) years for the same period in the unaffected group. The 2 groups did not differ significantly regarding the antipsychotic medication dosage, the proportion on concomitant anticholinergic medication, the documented previous response to antipsychotic medication, or past treatment with electroconvulsive therapy (ECT). First-degree relatives of patients with polydipsia were found to have significantly higher rates of alcohol dependence.

CONCLUSION

This study provides further evidence for the higher rate of polydipsia among chronic psychiatric patient populations and for high rates of alcohol-related problems among their first-degree relatives.

Seclusion practice in a Canadian forensic psychiatric hospital

In this study, seclusion practice was examined in a multilevel, secure psychiatric hospital, serving federally sentenced individuals in the Prairie Region, as defined by the Correctional Service of Canada. Between August 1996 and February 1999, 183 patients (27.7% of total admissions) were secluded on 306 occasions. The mean duration of seclusion was 90.3 hours (minimum I hour; maximum 908 hours). A higher proportion of female patients (60%) was secluded than of male patients (25%). Sixty-five percent of the patients were secluded once, 29.5 percent two to four times, and 5.5 percent more than four times. Suicidal threats and self-harm gestures were the reasons for initiating seclusion in 27.4 percent of cases. Patients with diagnosed substance-related disorders accounted for 40.8 percent of all seclusion episodes, whereas those with schizophrenia and related psychoses accounted for 28.1 percent. These findings suggest that seclusion remains a relatively common intervention in some disturbed patients in a forensic setting.

Psychiatric disorders in first-degree relatives of patients with opiate dependence

High rates of psychiatric disorders, particularly major depression, alcoholism, drug-use disorder and antisocial personality disorder in the relatives of opiate-dependent patients compared with normal controls, have been reported in some previous studies. This study was designed to evaluate the prevalence rates of drug-use and other psychiatric disorders in the first-degree relatives of opiate-dependent patients and compare these with rates in the first-degree relatives of surgical and psychiatric patients. A case-control study was conducted to compare the prevalence of psychiatric and drug-use disorders (which were estimated by the Family History Method) in 241 biological first-degree relatives of 50 opiate-dependent patients to that in 235 and 222 first-degree relatives of 50 surgical and 50 psychiatric patients respectively. The main outcome measure was the relative risk (expressed as odds ratio) of psychiatric and drug-use disorders. First-degree relatives of opiate-dependent patients were found to have significantly higher rates of drug-use and antisocial personality disorders, compared with relatives of surgical and psychiatric probands. The odds ratio for alcoholism appeared significantly higher only in first-degree female relatives of opiate users, suggesting effect modification by sex. The study provides further evidence for the higher rate of drug-use disorder in the first-degree relatives of opiate-dependent patients. These findings suggest that familial drug-use disorder contributes to a vulnerability to opiate misuse. Implications of these findings for the classification and treatment of opiate dependence are discussed.

Practice of seclusion: a five-year retrospective review in north Cheshire

This study examines, retrospectively, the trends and factors associated with the use of seclusion over a five-year period in a regional secure unit located within a large psychiatric hospital that serves the population of North Cheshire. Ninety-four patients (15.3% of total admissions to the unit) spent some time in seclusion on 186 occasions. The average time spent in seclusion was 85 minutes (minimum 15 minutes and maximum 10 hours). Sixty-seven per cent of patients were secluded once, 20% secluded twice, and 13% more than three times. Patients with a clinical diagnosis of personality disorder (11.4%) accounted for 44.2% of seclusions whereas those with a defined mental disorder (55%) accounted for 35% of all seclusions. The rate of seclusion, characteristics of secluded patients, reasons, and average duration spent in seclusion, did not vary significantly over the study period, despite the significant reduction of the unit's admission rate from 150 to 63 per year. The consistent and regular occurrence of the practice over a five-year period may suggest that seclusion of some disturbed patients will inevitably continue to be used as an effective intervention and, probably at times, the only acceptable method that may ensure the safety of patients and staff.

The khat users: a study of khat chewing in Liverpool's Somali men

This study reports the demographic and social characteristics and level of psychological dysfunction in regular khat users compared with matched non-users. The results indicate that khat users resemble non-users on a number of psychosocial variables and GHQ scores, with no evidence to suggest higher morbidity amongst users. The two groups appear to differ only in the level of their use of nicotine and also in their perception of the harmful effects associated with khat use.

An outbreak of dracunculiasis in central Sudan

This paper describes an outbreak of dracunculiasis in Mazmum, a town in central Sudan. The study included collection of clinical and epidemiological data from 319 patients treated in hospital, a review of the hospital records, a house survey covering a sample of 757 subjects, a school survey covering 1390 schoolchildren, and examination of water sources. The overall incidence of the disease was 23.4%, with most cases appearing in the agricultural season (July-October). Incidence was highest in young females but most severe disability occurred in male patients aged > or = 20 years, of whom more than 60% were unable to work for more than 4 weeks. The disease is transmitted in shallow natural pools, artificial ponds and trenches in rocky hills that hold rain water. All these sources were found to be infested with Cyclops. The outbreak is attributed to deterioration in the structure and management of the water sources, together with a massive population influx from other endemic areas. These observations underscore the importance of co-ordinating efforts to eradicate the disease from African countries.

Sonographic assessment of ovarian and endometrial changes during long-term Norplant use and their correlation with hormonal levels

OBJECTIVE

To study the probability of ovulation and subclinical abortion during long-term use of Norplant and to assess the concomitant endometrial development.

DESIGN

This was a prospective nonrandomized comparative study. The ovaries and endometrium were assessed daily by ultrasonography during 59 menstrual cycles in 50 women who were using Norplant for > 1 year. Serum concentrations of E2, P, FSH, LH, pregnancy specific beta 1 glycoprotein (Sp1), and hCG were also daily measured. The findings were compared with those in 35 ovulatory cycles in normal fertile women not using contraception.

SETTING

Clients of the Family Planning Clinic of Assiut University Hospital (Norplant users) and the hospital women staff (controls).

RESULTS

Sonographic and hormonal evidence of ovulation were observed in one third of Norplant users; two of them resulted in conception. However, the majority of these ovulatory cycles showed low midcycle peaks of E2, FSH, and LH and evidence of luteal phase defect (LPD). Excessive follicular enlargement was observed in 46% of the cycles. Norplant users had significantly thinner endometrium that did not exhibit the normal phasic changes in sonographic texture. Apart from conceptive cycles, no rise in Sp1 or hCG was observed.

CONCLUSIONS

Norplant acts mainly by inhibiting ovulation, but when this occurs, it is associated with LPD and subnormal endometrial development. Subclinical abortion does not contribute to the contraceptive effect.

Five-year experience with Norplant implants in Assiut, Egypt

This report describes the five-year experience of the first 250 acceptors of NORPLANT implants in Assiut, Egypt. The five-year net continuation rate was 58.6 per 100 women. The five-year net cumulative pregnancy rate was 1.6 per 100 women. About three-fourths of those who continued use of this contraceptive through the fifth year reported having regular cycles. There was definite improvement in the bleeding pattern with time. The five-year net termination rate because of bleeding problems was 17.7 per 100 women. After 5 years of NORPLANT use there was a slight, statistically insignificant increase in weight, systolic and diastolic blood pressures. Of those who used contraceptives after the end of the five-year term of NORPLANT, about one-third opted to have reinsertion of the implants for a second term. About 96% of those who used NORPLANT through the fifth year reported that their experience with the contraceptive had been satisfactory.

Estimation of gestational age by last menstrual period, by ultrasound scan and by SP1 concentration: comparisons with date of delivery

The date of delivery in 62 normal pregnant women was predicted by last menstrual period, by ultrasound scan and by the serum concentration of Schwangerschaftsprotein 1 (SP1). It was found that SP1 concentration in the first trimester gave as reliable an indication of when labour would occur as did the last menstrual period or ultrasound scan.

Observations on the dating of pregnancy

The relationship between the concentrations of placental proteins and the stage of gestation has been examined. Human chorionic gonadotrophin and Schwangerschaftsprotein 1 were measured in two groups of patients: one a group of 13 women studied daily from conception to 21 days after ovulation and the other 43 normal pregnancies studied from 5 to 16 wk gestation. The results of assessment of the stage of gestation as determined by placental protein assay were compared with the dating obtained from last menstrual period and ultrasonic scan. The measurement of placental proteins was at least as accurate as the last menstrual period or ultrasonic scan in determining the stage of gestation.

Concomitant secretion of Schwangerschaftsprotein 1 and human chorionic gonadotrophin following conception

Daily measurements of serum oestradiol, progesterone, Schwangerschaftsprotein 1 (SP1) and hCG were made in 13 menstrual cycles during which conception occurred. The assays were continued until 21 d after ovulation. SP1 was detected in maternal blood 8-14 d after ovulation and hCG 9-13 d after ovulation. We conclude that these two proteins are secreted simultaneously but independently by the syncytiotrophoblast.

Postpartum decline in serum concentration of placental proteins in an abdominal pregnancy

The alpha and the beta forms of Schwangerschaftsprotein 1 (SP1) and chorionic gonadotrophin (hCG) were measured after delivery in an abdominal pregnancy with the placenta left in situ. All three proteins declined more slowly than after normal delivery; the half-lives ranging from 6.2-6.5 days. Traces of the proteins could still be detected in the maternal circulation 9 weeks after delivery. These findings are construed as further support for the belief that the placenta plays a major role in the synthesis of these proteins.

Serum concentration of placental proteins in non-pregnant and pregnant subjects

Chorionic gonadotrophin (hCG) and Schwangerschaftsprotein 1 (SP1) were measured in 35 menstrual cycles in 20 women. During the follicular phase, 3 samples were positive for hCG and two of these were also positive for SP1. All these positives occurred on the day of ovulation or immediately before. In the luteal phase 25 specimens showed both hCG and SP1 and two showed only SP1, the positive results occurring 3-15 days after ovulation. The placental proteins were also measured in a further eight women who became pregnant. The pattern in these was quite different. The first positives were detected 8 days after ovulation and by 12 days all the subjects were positive for both proteins. Thereafter both proteins increased sharply in concentration. A group of 139 subjects who, on biological grounds, could not have conceived, showed no positive results.

Placental proteins in male serum

Placental proteins such as human chorionic gonadotrophin (hCG), Schwangerschaftsprotein 1 (SP1) and pregnancy-associated plasma protein A (PAPP-A) are found in the blood of pregnant women and in subjects suffering from cancer. They can also be found in the blood of healthy non-pregnant women and in the seminal fluid of males. Surprisingly, hCG and SP1 could not be found in male serum, although PAPP-A occasionally occurs there.

Determination of the stage of gestation by the assay of chorionic gonadotrophin and Schwangerschaftsprotein 1

Serial assays of Schwangerschaftsprotein 1 (SP1), SP1 alpha, SP1 beta and human chorionic gonadotrophin were performed in 12 subjects from ovulation until the pregnancies had reached 16 weeks. From these data formulae were devised for deducing the stage of gestation from the concentration of the placental protein. These formulae were then tested by assays on 34 women not included in the original study. Assays of hCG do not give reliable indications of the stage of gestation when this has progressed beyond 9-10 weeks but SP1 assays give predictions of gestation corresponding closely to that derived from the last menstrual period up to 16 weeks gestation.

Placental proteins in the normal menstrual cycle, in occult pregnancy and in early normal pregnancy in the same subject

Assays of SP1 and of hCG were done in three successive menstrual cycles in a woman undergoing artificial insemination from a donor. The day of ovulation was determined by basal body temperature, and by assays of oestradiol and progesterone. In the first cycle no placental proteins were detected, in the second cycle there was a transient peak of SP1 and hCG 4 days after ovulation. In the third cycle both proteins were first detected 12 days after ovulation, then increased rapidly in concentration and the patient went on to a normal pregnancy.

Studies on the half-life of Schwangerschaftsprotein 1 (SP1)

Schwangerschaftsprotein 1 (SP1) was measured in 10 women at intervals after delivery of the placenta. SP1 alpha decreased more sharply than SP1 beta and showed evidence of a two-compartmental distribution in the mother. Trace amounts of both proteins could still be detected 5 weeks after delivery. It is concluded that the findings support the view that the two proteins are separate biological entities and that there is a possibility that SP1 beta is generated from SP1 alpha in the maternal compartment.

The concentrations of SP1 beta and SP1 alpha in retroplacental and peripheral blood at term

The concentrations of the two components of Schwangerschaftsprotein 1 (SP1 beta and SP1 alpha), human chorionic gonadotrophin (hCG) and human placental lactogen (hPL), were measured in peripheral venous blood and in retroplacental blood at term delivery in 22 women. Like hCG and hPL, the values of SP1 alpha were higher in the retroplacental than in the peripheral blood, as might be expected with placental secretory products. On the other hand, the concentration of SP1 beta showed a reverse gradient, being higher in the peripheral than in retroplacental blood.

Diagnosis of early pregnancy by assay of placental proteins

The plasma concentrations of Schwangerschaftsprotein 1 (SP1) and human chorionic gonadotrophin (hCG) were measured in 22 women before and after conception. In these pregnancies ovulation occurred spontaneously in seven subjects, or followed treatment with either clomiphene citrate (6 subjects), or human menopausal gonadotrophin (hMG) and hCG (6 subjects). The remaining three patients became pregnant after artificial insemination with donor semen. Seventeen of these pregnancies were normal and five were abnormal (3 abortions, 1 ectopic and 1 twin). SP1 could be detected 6-14 days after ovulation in all these patients. In contrast 40 non-pregnant women gave a negative test for SP1.

Complex formation of pregnancy-specific alpha 2-glycoprotein (SP1 alpha) and heparin

The Schwangerschaftsprotein 1 (SP1)alpha values in blood measured by rocket immunoelectrophoresis are affected by the addition of anticoagulants. When compared with values in serum, those in heparin plasma were much higher, while those in sequestrene ethylenediamine-tetra-acetic acid), sodium citrate and fluoride oxalate were lower. On the other hand, SP1 and SP1 beta concentrations were not significantly affected in heparin or sequestrene and were only slightly depressed in sodium citrate and fluoride oxalate. The effect of heparin on SP1 alpha in serum was dose-dependent. We surmise that SP1 alpha forms a complex with heparin and that it may be involved in the coagulation system in pregnancy.

Measurement of SP1 in samples with varying SP1 alpha: SP1 beta ratios

Mixtures containing a fixed amount of SP1 alpha, increasing amounts of SP1 beta and vice versa have been measured by rocket immunoelectrophoresis, by enzyme immunoassay and by radioimmunoassay. Both proteins have immunological determinants which react with standard antisera to SP1 and the value obtained for any particular mixture is dependent on the ratio of the proteins. The effect of the ratio on measurement by immunoelectrophoresis is different from that on measurement by enzyme immunoassay or radioimmunoassay. As these two proteins exist together in the blood of pregnant women, Results obtained by the two types of assay cannot be compared. Even with the same method the results will depend on the ratio which varies from subject to subject. It is concluded that until specific measurements for SP1 alpha and SP1 beta are designed, clinical application studies must be viewed with reserve.

Immunological observations on the relationship of SP 1 alpha to SP 1 beta

SP 1 alpha and SP 1 beta in pregnancy sera were separated by gel chromatography. When these proteins were subjected to crossed immunoelectrophoresis with an antiserum to non-pregnant human serum in the first dimension gel, SP 1 alpha was absorbed but SP 1 beta was unaffected. Similarly incubation with such an antiserum caused the precipitation of SP 1 alpha but not SP 1 beta. When SP 1 antiserum was absorbed with either SP 1 alpha or SP 1 beta it resulted in the removal of all antibodies to either SP 1 alpha or SP 1 beta.

An immunochemical study of proteins with SP1 determinants in native and acidified pregnancy serum

The alpha and beta forms of the pregnancy-associated protein, SP1, have been studied in late pregnancy serum and in similar serum after acidification. In both sera only two forms of the protein, SP1 alpha and SP1 beta, could be found; both reacting with antisera against SP1. On gel chromatography these two forms could be separated, with the intermediate effluent containing a varying mixture of both proteins. Immunoelectrophoresis of the effluent fractions from gel chromatography showed rocket shaped immunoprecipitates whose morphology depended on the mixture of SP1 alpha and SP1 beta. Crossed immunoelectrophoresis confirmed that only two proteins could be defined with SP1 antisera; the front running protein having an alpha 2 electrophoretic mobility and a molecular weight of 430,000, while the slower moving component had the electrophoretic mobility of a beta 1 globulin and a molecular weight of 90,000.

Observations on the separation of SP1 alpha and SP1 beta by affinity chromatography

SP1 antigens in late pregnancy blood, in placental extracts and in acidified plasma have been purified on positive affinity chromatography columns with immobilized SP1 antiserum and on negative affinity columns with immobilized antihuman non-pregnancy serum. Both SP1 alpha and SP1 beta are bound by the positive column but only SP1 alpha is bound by the negative column. This is adduced as further support for the view that SP1 alpha is formed by the combination of SP1 beta with a protein present in non-pregnancy serum.

Separation of two pregnancy-associated proteins with SP1 determinants and the conversion of SP1 beta to SP1 alpha

The alpha and beta forms of the pregnancy-associated protein, SP1 which have been previously identified in late pregnancy serum were found to be also present in the placenta. The alpha form was somewhat more difficult to extract, requiring the use of detergents in the extracting buffer. The two variants can be separated by ion exchange chromatography or by gel filtration and distinguished by the different shapes of the precipitation rockets on immunoelectrophoresis. The alpha variant appears to be the larger molecule on gel filtration. When solutions of SP1 are acidified to pH 2.5 the beta form is rapidly converted to the alpha form and the latter is slowly destroyed. It is suggested that SP1 alpha represents the combination of SP1 beta with some other protein present in the placenta and in the serum.