Assessment of acute stroke cerebral CT examinations by anaesthesiologists.

BACKGROUND AND PURPOSE: It is essential to diagnose ischaemic stroke as soon as possible after symptom onset, so that thrombolytic treatment can be initiated as quickly as possible. This might be greatly facilitated if cerebral CT could be carried out in a pre-hospital setting. The aim of this study was to evaluate if anaesthesiologists, who in Norway provide pre-hospital medical care, could be trained to assess cerebral CT scans to exclude radiological contraindications for thrombolytic stroke treatment. METHODS: Thirteen anaesthesiologists attended an 8-h course in acute stroke assessment, including a 2-h introduction to the neuroradiology of acute stroke. Each participant then assessed 12 non-contrast cerebral CT examinations of acute stroke patients with specific regard to radiological contraindications for thrombolytic therapy. Test results were compared with those of three experienced neuroradiologists. Inter-rater agreement between anaesthesiologists and neuroradiologists was calculated using Cohen's Kappa statistics. Robustness of the results was assessed using the non-parametric bootstrap. RESULTS: Among the neuroradiologists, Kappa was 1 for detecting radiological contraindications for thrombolytic therapy. Twelve of the 13 anaesthesiologists showed good or excellent agreement (Kappa > 0.60) with the neuroradiologists. The anaesthesiologists spent a median time of 2 min and 18 s on each CT scan. CONCLUSIONS: This study suggests that anaesthesiologists who are experienced in pre-hospital care may be quickly trained to assess cerebral CT examinations in acute stroke patients with regard to radiological contraindications for thrombolytic therapy.

Genome-wide association mapping in Norwegian Red cattle identifies quantitative trait loci for fertility and milk production on BTA12.

Reproductive performance is a critical trait in dairy cattle. Poor reproductive performance leads to prolonged calving intervals, higher culling rates and extra expenses related to multiple inseminations, veterinary treatments and replacements. Genetic gain for improved reproduction through traditional selection is often slow because of low heritability and negative correlations with production traits. Detection of DNA markers associated with improved reproductive performance through genome-wide association studies could lead to genetic gain that is more balanced between fertility and production. Norwegian Red cattle are well suited for such studies, as very large numbers of detailed reproduction records are available. We conducted a genome-wide association study for non-return rate, fertility treatments and retained placenta using almost 1 million records on these traits and 17 343 genome-wide single-nucleotide polymorphisms. Genotyping costs were minimized by genotyping the sires of the cows recorded and by using daughter averages as phenotypes. The genotyped sires were assigned to either a discovery or a validation population. Associations were only considered to be validated if they were significant in both groups. Strong associations were found and validated on chromosomes 1, 5, 8, 9, 11 and 12. Several of these were highly supported by findings in other studies. The most important result was an association for non-return rate in heifers in a region of BTA12 where several associations for milk production traits have previously been found. Subsequent fine-mapping verified the presence of a quantitative trait loci (QTL) having opposing effects on non-return rate and milk production at 18 Mb. The other reproduction QTL did not have pleiotropic effects on milk production, and these are therefore of considerable interest for use in marker-assisted selection.

A genome wide association study for QTL affecting direct and maternal effects of stillbirth and dystocia in cattle.

Dystocia and stillbirth are significant causes of female and neonatal death in many species and there is evidence for a genetic component to both traits. Identifying causal mutations affecting these traits through genome wide association studies could reveal the genetic pathways involved and will be a step towards targeted interventions. Norwegian Red cattle are an ideal model breed for such studies as very large numbers of records are available. We conducted a genome wide association study for direct and maternal effects of dystocia and stillbirth using almost 1 million records of these traits. Genotyping costs were minimized by genotyping the sires of the recorded cows, and using daughter averages as phenotypes. A dense marker map containing 17,343 single nucleotide polymorphisms covering all autosomal chromosomes was utilized. The genotyped sires were assigned to one of two groups in an attempt to ensure independence between the groups. Associations were only considered validated if they occurred in both groups. Strong associations were found and validated on chromosomes 4, 5, 6, 9, 12, 20, 22 and 28. The QTL region on chromosome 6 was refined using LDLA analysis. The results showed that this chromosome most probably contains two QTL for direct effect on dystocia and one for direct effect on stillbirth. Several candidate genes may be identified close to these QTL. Of these, a cluster of genes expected to affect bone and cartilage formation (i.e. SPP1, IBSP and MEPE) are of particular interest and we suggest that these genes are screened in candidate gene studies for dystocia and stillbirth in cattle as well as other species.

Characterization of a QTL region affecting clinical mastitis and protein yield on BTA6.

Quantitative trait loci affecting clinical mastitis were detected and fine mapped to a narrow region on bovine chromosome 6 in the Norwegian Red cattle population. The region includes the casein gene cluster and several candidate genes thought to influence clinical mastitis. The most significant results were found for SNPs within the Mucin 7 gene. This gene encodes an antimicrobial peptide and constitutes part of the first line of defence for the mucosal immune system. Detection of long haplotypes extending several Mb may indicate that artificial selection has influenced the haplotype structures in the region. A search for selection sweeps supports this observation and coincides with association results found both by single SNP and haplotype analyses. Our analyses identified haplotypes carrying quantitative trait loci alleles associated with high protein yield and simultaneously fewer incidences of clinical mastitis. The fact that such haplotypes are found in relative high frequencies in Norwegian Red may reflect the combined breeding goal that is characterized by selection for both milk production and disease resistance. The identification of these haplotypes raises the possibility of overcoming the unfavourable genetic correlation between these traits through haplotype-assisted selection.

Shear stress activation of platelets with subsequent refractoriness.

Platelet rich plasma was prepared with soybean trypsin inhibitor (SBTI) as anticoagulant, to preserve normal Ca++-concentration, and subsequently tested in an aggregometer. Shear stress alone, induced by stirring, resulted in platelet aggregation and disaggregation. Such platelets showed only minor aggregational response on the addition of ADP, indicating that the platelets had been partly desensitized towards ADP-stimulation. When the stirrer was started at the same time as the addition of 1.6 microM ADP, the aggregation velocity was related to the speed of the stirrer. Disaggregation always started 1.5 min after the stimulus. Platelet shape change was apparently not influenced by the stirring. Since platelets from SBTI-anticoagulated blood could be aggregated by stirring alone, we examined the effect of centrifugation of whole blood at 50 xg for 3 and 10 min. Signs of transient aggregation and release of alpha-granule content were respectively observed.

Decompression sickness from saturation diving: a case control study of some diving exposure characteristics.

A comprehensive computerized database of diving activity for a Norwegian offshore diving contractor [Stolt-Nielsen Seaway (SNS)] covering the years 1983-1990 has been established. The database contains detailed dive information about 12,087 surface-oriented and 2,622 saturation dives. During this period a majority of the divers were permanently employed. Preliminary analysis had suggested that decompression sickness (DCS) might be the result of exposure to factors causing pathophysiologic effects which accumulate over the course of a single dive or a series of dives. This concept evolved into the HADES (Highest Accumulated Decompression Score) theory which assumes that DCS is predictable once the underlying exposure factors are understood. The incidence of DCS among the SNS divers from saturation diving in the North Sea was studied by use of a "nested" case-control design. Twenty-one case dives (i.e., dives where DCS occurred) were compared with 41 randomly selected control dives. For these dives, several saturation dive characteristics were established. The relative pressure change between maximum and minimum storage depths was significantly greater among the cases. For each 1% increase in the relative pressure change there was a 5% increase in the probability of a saturation dive resulting in DCS. Significantly more cases than controls performed a saturation dive with more than one storage depth, and the data suggested that there were more and greater ascending and descending changes in storage depth conditions among the affected divers.

Revealing genetic relationships between compounds affecting boar taint and reproduction in pigs.

Boar taint is characterized by an unpleasant taste or odor in intact male pigs and is primarily attributed to increased concentrations of androstenone and skatole and to a lesser extent by increased indole. The boar taint compounds skatole and indole are produced by gut bacteria, metabolized in the liver, and stored in the fat tissue. Androstenone, on the other hand, is synthesized in the testis along with testosterone and estrogens, which are known to be important factors affecting fertility. The main goal of this study was to investigate the relationship between genetic factors involved in the primary boar taint compounds in an attempt to discover ways to reduce boar taint without decreasing fertility-related compounds. Heritabilities and genetic correlations between traits were estimated for compounds related to boar taint (androstenone, skatole, indole) and reproduction (testosterone, 17ß-estradiol, and estrone sulfate). Heritabilities in the range of 0.47 to 0.67 were detected for androstenone concentrations in both fat and plasma, whereas those for skatole and indole were slightly less (0.27 to 0.41). The genetic correlations between androstenone in plasma and fat were extremely high (0.91 to 0.98) in Duroc and Landrace. In addition, genetic correlations between androstenone (both plasma and fat) and the other sex steroids (estrone sulfate, 17ß-estradiol, and testosterone) were very high, in the range of 0.80 to 0.95. Furthermore, a genome-wide association study (GWA) and a combined linkage disequilibrium and linkage analysis (LDLA) were conducted on 1,533 purebred Landrace and 1,027 purebred Duroc to find genome regions involved in genetic control of the boar taint compounds androstenone, skatole, and indole, and sex hormones related to fertility traits. Up to 3,297 informative SNP markers were included for both breeds, including SNP from several boar taint candidate genes. From the GWA study, we found that altogether 27 regions were significant at a genome-wide level (P < 0.05) and an additional 7 regions were significant at a chromosomal level. From the LDLA study, 7 regions were significant on a genome-wide level and an additional 7 regions were significant at a chromosomal level. The most convincing associations were obtained in 6 regions affecting skatole and indole in fat on chromosomes 1, 2, 3, 7, 13, and 14, 1 region on chromosome 6 affecting androstenone in plasma only, and 5 regions on chromosomes 3, 4, 13, and 15 affecting androstenone, testosterone, and estrogens.

Histogram analysis of MR imaging-derived cerebral blood volume maps: combined glioma grading and identification of low-grade oligodendroglial subtypes.

BACKGROUND AND PURPOSE: Inclusion of oligodendroglial tumors may confound the utility of MR based glioma grading. Our aim was, first, to assess retrospectively whether a histogram-analysis method of MR perfusion images may both grade gliomas and differentiate between low-grade oligodendroglial tumors with or without loss of heterozygosity (LOH) on 1p/19q and, second, to assess retrospectively whether low-grade oligodendroglial subtypes can be identified in a population of patients with high-grade and low-grade astrocytic and oligodendroglial tumors. MATERIALS AND METHODS: Fifty-two patients (23 women, 29 men; mean age, 52 years; range, 19-78 years) with histologically confirmed gliomas were imaged by using dynamic susceptibility contrast MR imaging at 1.5T. Relative cerebral blood volume (rCBV) maps were created, and 4 neuroradiologists defined the glioma volumes independently. Averaged over the 4 observers, a histogram-analysis method was used to assess the normalized histogram peak height of the glioma rCBV distributions. RESULTS: Of the 52 patients, 22 had oligodendroglial tumors. The histogram method was able to differentiate high-grade gliomas (HGGs) from low-grade gliomas (LGGs) (Mann-Whitney U test, P < .001) and to identify low-grade oligodendroglial subtypes (P = .009). The corresponding intraclass correlation coefficients were 0.902 and 0.801, respectively. The sensitivity and specificity in terms of differentiating low-grade oligodendroglial tumors without LOH on 1p/19q from the other tumors was 100% (6/6) and 91% (42/46), respectively. CONCLUSION: With histology as a reference, our results suggest that histogram analysis of MR imaging-derived rCBV maps can differentiate HGGs from LGGs as well as low-grade oligodendroglial subtypes with high interobserver agreement. Also, the method was able to identify low-grade oligodendroglial tumors without LOH on 1p/19q in a population of patients with astrocytic and oligodendroglial tumors.

[Normal pressure hydrocephalus--evaluation of investigation procedures]. / Normaltrykkshydrocephalus--vurdering av utredningsprosedyrer.

58 patients were investigated with a lumbar infusion test for normal pressure hydrocephalus in the department of neurology of the National Hospital between January 1991 and December 1996. We present a retrospective evaluation of the investigation protocol for these patients with suspected normal pressure hydrocephalus. The aim of the study was to find out whether specific prognostic factors could be identified by routine investigations. 20 patients had been referred to the department of neurosurgery and were subsequently shunted. A critical review of the criteria leading to surgical treatment (clinical symptoms, cerebral CT scan, infusion test, cisternography) is presented. There was no single variable which alone could discriminate normal pressure hydrocephalus from other types of hydrocephalus, or predict the outcome of shunting. A more systematic referral and clinical assessment of the patients together with a more precise evaluation of the findings and improved follow-up procedures are necessary for optimal selection of patients for surgery. The study also shows the importance of diagnosing these patients early, as delay in treatment appeared to worsen prognosis after shunting.

[Prescription of psychopharmaceuticals. A survey of drug treatment at 10 psychiatric hospitals]. / Forskrivning av psykofarmaka. En oversikt over medikamentell behandling i ti psykiatriske sykehus.

This study describes a survey of the drugs prescribed to long-term psychiatric patients and psychogeriatric patients in ten Norwegian psychiatric hospitals. Of 1,124 patients, 12% received no psychotropic drugs and 14% were given a combination of more than three psychotropic drugs. Of 872 patients given neuroleptics, 81% received antipsychotic medication with low-dose neuroleptics and 27% received depot-neuroleptics. Hypnotics and minor tranquillizers were commonly prescribed together with neuroleptics and antidepressants. Anti-parkinsonian drugs were prescribed for 37% of those receiving neuroleptics. Neuroleptics, minor tranquillizers and anti-parkinsonian drugs were commonly given three times a day. The prescription pattern differed between the hospitals. Guidelines are suggested for more rational use of psychotropic drugs.