Noninvasive Neuromonitoring of Hypothermic Circulatory Arrest in Aortic Surgery

BACKGROUND AND AIMS

Circulatory arrest carries a high risk of neurological damage, but modern monitoring methods lack reliability, and is susceptible to the generalized effects of both anesthesia and hypothermia. The objective of this prospective, explorative study was to research promising, reliable, and noninvasive methods of neuromonitoring, capable of predicting neurological outcome after hypothermic circulatory arrest.

MATERIALS AND METHODS

Thirty patients undergoing hypothermic circulatory arrest during surgery of the thoracic aorta were recruited in a single center and over the course of 4 years. Neuromonitoring was performed with a four-channel electroencephalogram montage and a near-infrared spectroscopy monitor. All data were tested off-line against primary neurological outcome, which was poor if the patient suffered a significant neurological complication (stroke, operative death).

RESULTS

A poor primary neurological outcome seen in 10 (33%) patients. A majority (63%) of the cases were emergency surgery, and thus, no neurological baseline evaluation was possible. The frontal hemispheric asymmetry of electroencephalogram, as measured by the brain symmetry index, predicted primary neurological outcome with a sensitivity of 79 (interquartile range; 62%-88%) and specificity of 71 (interquartile range; 61%-84%) during the first 6 h after end of circulatory arrest.

CONCLUSION

The hemispheric asymmetry of frontal electroencephalogram is inherently resistant to generalized dampening effects and is predictive of primary neurological outcome. The brain symmetry index provides an easy-to-use, noninvasive neuromonitoring method for surgery of the thoracic aorta and postoperative intensive care.

Sickness Absence Among Female Employees With Migraine and Co-Existing Conditions

This prospective cohort study examined the risk of sickness absence among 27 127 female public-sector employees by status of migraine and co-existing conditions. A baseline survey was used to assess chronic disorders and demographic factors. Information on sickness absence in the 3 years following the survey was obtained from employers' registers. Migraine was related to 5.4 extra sickness absence days per person-year, with the corresponding figures being 14.6 and 6.1 for depression and respiratory disorders, respectively. After adjusting for age, marital status, socioeconomic status and presence of depression or respiratory disorders, employees with migraine had a 1.21 (95± confidence interval 1.18, 1.24) times higher risk of self-certified sickness absence episodes (≤ 3 days) than did those without migraine. The corresponding excess risk for medically certified absence episodes (≤ 3 days) was 1.15 (1.12, 1.19). Among employees with depression or respiratory disorders, secondary migraine was associated with an increased risk of sickness absence episode of 1.15 to 1.23. These findings suggest that migraine is associated with increased risk of recorded sickness absence independent of depression and respiratory disorders.

Work Stress and New-Onset Migraine in a Female Employee Population

This prospective cohort study examined whether work stress, as indicated by the job strain model and the effort-reward imbalance model, predicts new-onset migraine among 19 469 female employees with no history of migraine at study entry. A baseline survey between 2000 and 2002 assessed work stress and demographic factors. Self-reported newly diagnosed migraine was measured at follow-up between 2004 and 2005 and 1281 new cases of migraine were detected. In logistic regression analysis adjusted for age, socioeconomic position and depression at baseline, no association between job strain and migraine was found. In contrast, high effort-reward imbalance was associated with slightly increased risk of migraine at follow-up, odds ratio 1.23 (95± confidence interval 1.04, 1.45). The proportion of new migraine cases attributable to high effort-reward imbalance was 6.2±. If the observed association is causal, our findings suggest that high effort-reward imbalance might function as a modifiable risk factor for new-onset migraine.

An indication of major genes affecting hip and elbow dysplasia in four Finnish dog populations

The aim of the study was to assess the possible existence of major genes influencing hip and elbow dysplasia in four dog populations. A Bayesian segregation analysis was performed separately on each population. In total, 34 140 dogs were included in the data set. Data were analysed with both a polygenic and a mixed inheritance model. Polygenic models included fixed and random environmental effects and additive genetic effects. To apply mixed inheritance models, the effect of a major gene was added to the polygenic models. The major gene was modelled as an autosomal biallelic locus with Mendelian transmission probabilities. Gibbs sampling and a Monte Carlo Markov Chain algorithm were used. The goodness-of-fit of the different models were compared using the residual sum-of-squares. The existence of a major gene was considered likely for hip dysplasia in all the breeds and for elbow dysplasia in one breed. Several procedures were followed to exclude the possible false detection of major genes based on non-normality of data: permuted datasets were analysed, data-transformations were applied, and residuals were judged for normality. Allelic effects at the major gene locus showed nearly to complete dominance, with a recessive, unfavourable allele in both traits. Relatively high estimates of the frequencies of unfavourable alleles in each breed suggest that considerable genetic progress would be possible by selection against major genes. However, the major genes that are possibly affecting hip and elbow dysplasia in these populations will require further study.

Results of ophthalmologic screening examinations of German Pinschers in Finland--a retrospective study

OBJECTIVE

To retrospectively review ophthalmologic findings in German Pinschers in Finland.

ANIMALS STUDIED

One hundred and twenty-two German Pinschers that had ophthalmologic examination performed according to the Finnish Kennel Club's Eye Scheme before June 15, 1999.

PROCEDURES

A total of 154 eye examination reports of 122 dogs were analysed and all described findings were reported.

RESULTS

Persistent hyperplastic tunica vasculosa lentis (PHTVL) was diagnosed in 8.4% of all cases, and hereditary cataract (HC) in 6.5%. Even higher numbers of similar changes were reported by ophthalmologists; some of the dogs, however, were officially diagnosed as "free of symptoms" of inherited ocular diseases. A relatively high number (4.5%) of dogs had reported changes in Y sutures. A pedigree analysis suggests recessive inheritance for both diseases. Because of missing information about many dogs in the pedigree, an autosomal incomplete inheritance pattern cannot be ruled out in either case.

CONCLUSIONS

Both HC and PHTVL are inherited diseases in German Pinschers. Further studies are needed to determine the importance of the changes found in Y sutures. Discrepancies between the official diagnosis and described changes are probably partially due to the lack of familiarity with the published literature concerning this breed. Further studies are needed to ascertain the inheritance pattern for both diseases. So far breeding with affected animals should be avoided.

Estimates of genetic parameters for hip and elbow dysplasia in Finnish Rottweilers

Data from 2,764 Rottweiler dogs born from 1987 to 1996 were analyzed with a Restricted Maximum Likelihood procedure using a mixed linear animal model to obtain variance component estimates for hip and elbow dysplasia. The data included 2,764 hip dysplasia and 2,278 elbow dysplasia records. Hip joints were scored as normal (0), borderline (1), slight (2), moderate (3), and severe (4, 4.5, and 5) hip dysplasia. Elbow joints were graded normal or borderline (0), slight (1), moderate (2), and severe (3) elbow dysplasia. The mean for the hip scores was 1.07 and for the elbow scores .60. Environmental effects influencing hip dysplasia were age, birth year, birth year x season interaction, and experience of the veterinarian responsible for x-raying the dog. For elbow dysplasia, statistically significant effects were age, birth year, sex of the dog, and panelist responsible for each screening. Estimates of heritability for hip and elbow dysplasia were .58 +/- .04 and .31 +/- .04, respectively, with a genetic correlation of .37 +/- .08 between the traits. Genetic improvement of almost one genetic standard deviation was observed in both traits during the 10 yr covered by the data.

Factors affecting hip dysplasia in German shepherd dogs in Finland: efficacy of the current improvement programme

Hip dysplasia records from 10,335 German shepherd dogs were used to estimate environmental effects and predict breeding values and genetic change achieved with the Finnish Kennel Club's breeding programme. The best linear unbiased prediction (BLUP) procedure was used for the analysis. No clear genetic improvement could be found during the study period (1985 to 1997). This might be due to ineffective selection for good hips. Significant environmental effects included year and month of birth, panellist, screening age and the effect of the genetic group of offspring from imported versus non-imported sires. In order to make the breeding programme more effective, BLUP breeding values should be used instead of phenotypic selection.