Cost analysis of Down syndrome screening in advanced maternal age.

OBJECTIVE: To analyze the potential cost and efficacy of Down syndrome screening in the population with advanced maternal age. METHODS: Three screening methods defining Down syndrome risk for women with advanced maternal age were analyzed: advanced maternal age; advanced maternal age and maternal serum triple screen; and advanced maternal age, maternal serum triple screen and genetic sonogram. Costs for all tests and procedures were estimated. Procedure-related loss for amniocentesis was assumed to be 1:200. Efficacy was defined as: number of amniocenteses performed, number of Down syndrome cases detected, procedure-related losses, Down syndrome cases detected per fetal loss, cost per Down syndrome case detected and total cost of screening. RESULTS: In 1999 in the USA, there were 530,610 women with advanced maternal age at 16 weeks' gestation carrying an estimated 4,043 fetuses with Down syndrome. Screening by maternal age alone would result in the 100% detection of Down syndrome cases, but would require over 530,000 amniocenteses and result in 2,653 procedure-related losses. Combining age with serum screen and genetic sonogram would detect 97.6% of Down syndrome cases, but would require only 119,791 amniocenteses and result in 599 procedure-related losses. The projected cost per Down syndrome case detected using age screening is 219,109 dollars versus 155,992 dollars using serum screen and genetic sonogram. CONCLUSIONS: The combination of advanced maternal age, maternal serum screen and genetic sonogram would result in the fewest procedure-related losses and lowest cost per Down syndrome case detected.

Glutamate synthase in Medicago sativa L. Occurrence and properties of FD-dependent enzyme in plant cell fraction during root nodule development.

In the plant cell fraction of Medicago sativa (L. cv Europe) nodules, glutamate synthase is active with reduced Fd, MV, NADH and NADPH as an electron donor. Up to 25 to 30 days after inoculation, the activities of Fd-dependent glutamate synthase (EC 1.4.1.7), the most active form of the enzyme, NADH-dependent (EC 1.4.1.14) and NADPH-dependent (EC 1.4.1.13) glutamate synthases increase about 2-fold followed by a relatively constant level per gram fresh weight of nodules. The activities of glutamate synthases with different electron carriers increase constantly about 30-fold after 46 days of inoculation by total fresh weight of nodules per plant. These nodule glutamate synthase activities with Fd, NADH or NADPH represent 30% relative to those of root glutamate synthases per plant with the respective electron donor. Fd-glutamate synthase in nodule plant fraction is a protein molecule immunochemically distinct from pyridine nucleotide-glutamate synthases. MV-linked enzyme activity is associated with Fd-glutamate synthase. The Fd-glutamate synthase has a subunit molecular mass of 68.2 kDa, and it exhibits a high affinity for spinach Fd as an electron carrier. The increase in Fd-glutamate synthase activity during nodule development is accompanied by a rise in the enzyme protein content. The total activity of different forms of glutamate synthase in vitro ensures a higher level than the rate of ammonia production during N2 fixation in bacteroids of Medicago sativa nodules.