Positional cloning is a method to identify genes from their position in the genome without prior knowledge about function. We used this approach to investigate the basis for three distinct genetic disorders; Obesity, Ichthyosis Prematurity Syndrome and Meniere's disease. Obesity appears when energy intake exceeds energy expenditure which leads to an abnormal accumulation of fat in the adipocyte tissue. We have studied a family with a balanced chromosomal translocation t(4;15) segregating with severe obesity. The chromosomal breakpoints create a fusion gene involving the gene for isoform 1 of RAR-related orphan receptor A (RORa1) which is implicated in the regulation of adipogenesis and lipoprotein metabolism. We hypothesize that the obesity in this family is caused by haploinsufficiency of this gene or a gain of function of the fusion gene. Ichthyosis prematurity syndrome (IPS) is a rare skin disorder belonging to a group of autosomal recessive congenital ichthyosis. We have mapped the locus for IPS to chromosome 9q34. Within the IPS locus, we identified a core haplotype with a high carrier frequency among affected, which indicate a possible founder mutation for the disease. The minimal shared region in affected patients contains seven genes which are candidates for IPS. Meniere's disease (MD) is characterised by spontaneous attacks of vertigo, fluctuating sensorineural low frequency hearing loss, aural fullness, and tinnitus. We mapped the MD locus to chromosome 12p13 using three Swedish families. The linked region is 463 kb, containing only one gene, a phosphoinositide-3-kinase (PIK3C2G). Involvement of phosphatidylinositol 3-kinases (PI-3K) in the intra cellular signalling cascades of cells in mammalian balance epithelia makes this gene a good candidate gene for MD.

<p><strong>Inledning:</strong> När en äldre människa har ett stort omvårdnadsbehov finns möjligheten att flytta till ett särskilt boende. Då äldres vardag ser olika ut är det av yttersta vikt att omvårdnadspersonalen kan ge stöd och hjälp så att den äldre skall kunna anpassa sig till den nya situationen. <strong>Syfte:</strong> Syftet med denna studie är att belysa hur anhöriga upplever att deras närstående i särskilt boende får en god omvårdnad. Metod: En kvalitativ ansats med empiriskt inslag användes där anhörigas upplevelser av omvårdnad, delaktighet och bemötande insamlades med hjälp av intervjuer. <strong>Resultat:</strong> Tre olika kategorier Omvårdnad, Delaktighet och Bemötande med nio underkategorier. En betydelsefull del i omvårdnaden är att det skapas en god kontakt mellan anhöriga och omvårdnadspersonalen för att finna ett bra sätt att kommunicera på. Det framkom hur viktigt det är att som vårdtagare känna att de blir sedda för den de är och att de får vara delaktiga i de omvårdnadsåtgärder som beslutas av omvårdnadspersonalen. <strong>Diskussion: </strong>Resultatet kan bidra till en ökad förståelse för anhörigas upplevelser av hur omvårdnaden bedrivs i särskilt boende. När anhöriga göras mer delaktiga i omvårdnaden, kan det leda till en bättre omvårdnad för vårdtagaren i särskilt boende. <strong>Slutsats:</strong> Resultatet som författarna kom fram till skulle kunna användas i utbildningssyfte då omsorgen av äldre människor kräver att omvårdnadspersonalen ständigt förnyar sina kunskaper. Detta kan vara till gagn för sjuksköterskan, de anhöriga och de äldre som bor i särskilt boende.</p> / <p><strong>Introduction:</strong> When a senior person has a large need for special care there is an option to relocate to a nursing home. The seniors every day varies there for it is of outmost importance the nursing care staff can support the senior that he maybe adapt to the new situation. <strong>Purpose:</strong> The purpose with this study is to enlighten how relatives experience their close ones in special nursing home receive good care treatment. Method: A quality approach with empirical elements is used where relatives experiences of care, being part of and recievment was collected with the help of interviews. <strong>Results:</strong> Three categories Care, Involvment and Recievment with nine sub categories. An important part in care is to create good contact between relatives and nursing care staff to evolve good ways for communication. It was revealed how important it is as a health care patient to feel they’re being looked upon for who they are and they be part of treatment measures and decisions made by nursing care staff. <strong>Discussion:</strong> The results can contribute to an increased understanding to how relatives experience care is being conducted in a special accommodation. When relatives are made more involved in care, may lead to a better care for care patient in a nursing home. <strong>Conclusion:</strong> The results which have been concluded could be used in educational purposes when the care of senior people demands that nursing care staff continuously renews their knowledges. This could be of use for the nurse, the relatives and the seniors living in a nursing home.</p>

<p><b>Purpose.</b> The main aim of the present study was to evaluate the effect of a low fat, low lactose diet on acute and late gastrointestinal side effects of pelvic radiotherapy. We also wanted to evaluate if such a treatment would influence the patients health related quality of life (HRQOL) in any way.</p><p><b>Background</b>. Cancer therapies and their side effects may cause nutritional problems and malnutrition. Pelvic radiotherapy, a common treatment modality for patients with carcinoma of the endometrium or cervix, is associated with both acute and late side effects that may affect nutritional status. Acute injury may lead to impaired absorption of nutrients and fluid. The patients experience diarrhoea, weight loss, nausea and vomiting. Bile salt malabsorption may be a factor in the pathogenesis of the diarrhoea. In cases of bile salt malabsorption a low fat diet will cause decreased bile salt excretion and thereby relief of symptoms. This assumption was evaluated in a small, non-randomised study in 1985. The results indicated that a low fat diet may reduce the frequency of diarrhoea and use of anti-diarrhoeal agents during radiotherapy. These findings were regarded as promising and since nutrition management guidelines for radiation enteritis were lacking in the literature, a clinical trial was planned.</p><p><b>Methods</b>. The study was designed as an open randomised clinical trial and conducted at the Norwegian Radium Hospital (NRH). The intervention diet (low fat, low lactose) was to be followed during and six weeks after radiotherapy. Measurements were performed at basement, the 3rd and last week of radiotherapy, six week after and then every 8th week. The entire period was one year. In November 1993 the surviving patients were approached again and asked to complete a questionnaire package similar to the one completed during the clinical trial. The study population was recruited from the department of gynaecology at NRH. The main selection criteria were pelvic radiotherapy (dose above 40 Gy) age = 75 years and a WHO functional status = 2. Patients were consecutive included from May 1988 through May 1990 and 143 women were included. Seventy-one were assigned to the intervention diet and 72 to the control group. In November 1993, 94 women were alive without any known relapse and 79 (84%) accepted participation. The women registered use of Loperamid and the daily number and consistency of bowel movements. The data on bowel movements was categorised and used to evaluate if diarrhoea was present or not. Nutritional status was evaluated by the means of weight development, arm muscle circumference (AMC), serum transferring (STF) and serum albumin (s-Alb). Dietary intake was assessed by 48-hour recall prior to radiotherapy, 4-days unweighed dietary record during radiotherapy and 7-days weighed dietary records during follow-up. 24-hour urinary nitrogen was used to validate the food records. HRQOL was defined as the patients' self-reported subjective physical and psychosocial situation as a consequence of disease and treatment. It was measured with the EORTC Core Quality of Life Questionnaire 36-item version (EORTC QLQ-C36).</p><p><b>Results</b>. During the last week of radiotherapy 14 patients (23%) in the intervention group and 32 (48%) in the control group reported diarrhoea (p< 0.01). The intervention group also used less anti-diarrhoea medication than the control group, 0.6 tablets per day versus 1.1 (p<0.01). Six weeks after end of radiotherapy, no group differences were found with regard to bowel movements or medication. The intervention group had a lower energy intake than the control group during radiotherapy, 5.7 MJ versus 6.5 MJ (p<0.05). The mean daily fat intake was respectively 34.3 g and 60.1 g (p<0.001). The intervention group received a significant lower part of the energy from milk products, meats, fats and sugar than the control group, and consumed more energy from vegetables and fruits, cereals and fish. Weight loss was more pronounced in the intervention group (mean reduction of 2.6 kg versus 1.7 kg) than in the control group (ns) during treatment. Mean values of AMC, s-Alb and STF were within the reference range in both groups during the entire observation period. During the last week of radiotherapy six patients (9%) in the intervention group and 4 (6%) in the control group were mildly depleted (ns). At 12 weeks and after one year none of the patients could be categorised as malnourished. No major differences in HRQOL were found between the two groups during radiotherapy and one-year follow up. Within the control group an association between diarrhoea and deteriorated role functioning, physical functioning and fatigue was found during the last week of radiotherapy that was not found in the intervention group. Regarding late effects of radiotherapy (3-4 years after radiotherapy) both groups had more diarrhoea than in the general population, 23.8 versus 9.5 (p<0.01). There was however a tendency to more pronounced diarrhoea in the control group (29.6 (SD=27.3)) than in the intervention group (19.4 (SD=25.4)) though not statistical significant. Substantial diarrhoea was associated deteriorated SF and fatigue. </p><p><b>Conclusions</b>. The intervention group had less diarrhoea and used less Loperamide during radiotherapy than the control group. This finding did not affect nutritional status since no differences in nutritional status were found between the two groups. Both groups had a reduced energy intake and weight loss during radiotherapy. In the control group diarrhoea increased fatigue and had negative effects on physical functioning and role functioning. The intervention did not lead to differences in late radiation injury and chronic diarrhoea 3-4 years after treatment but diarrhoea was most prominent in the control group. Diarrhoea as a late effect increased fatigue and had a negative influence on social well being.</p>

<p>The onset of cigarette smoking begins primarily in adolescence, and prevalence of smoking among adolescents has been increased during the last ten years. The prevalence of adolescent smoking increases with age and is more common or at least as common in girls as in boys in most western countries.</p><p>Until recently the intensive investigation on health effects of smoking has been mostly conducted among adults. In adolescence the long-term health consequences have been reviewed, but current health problems are probably more important to adolescents and may be more motivating for smoking prevention and cessation. Increased morbidity among adolescent smokers has been reported, but specific current health problems and medication use have received little attention. More</p><p>Control of smoking is a primary health goal. An underlying premise for promotion of physical activity in adolescence is that it may mead to a healthy lifestyle persisting through adulthood. Encouraging participation in sports has been recommended as smoking prevention and as part of smoking cessation programs. Smoking habits within different types of sports has received less attention, and whether physical activity has an impact on lung function is debated.</p><p>Adolescent smokers are often unsuccessful in quitting and difficult to recruit and retain in smoking cessation programs. Occasional smoking may be the strongest risk factor for daily smoking, but occasional smokers could be an important target group for smoking cessation who could be discouraged from moving into daily smoking status. </p><p>The first aim of this thesis was to study associations between smoking and current health status by examining associations between daily smoking and subjective health problems (Paper 1), and gender specific effects on respiratory symptoms and lung function (Paper II). The associations between physical activity and lung function in never smokers and daily smokers were also assessed (Paper III). The second aim was to study factors that might be useful in smoking</p>

<p>Preeclampsia is a complex and variable maternal disturbance that ranges from a dramatic onset at early gestation to slowly developing symptoms towards term. Hypertension and renal involvement with proteinuria are cardinal signs, which are often accompanied by fluid retention, blood-clotting dysfunction, and reduced organ perfusion. HELLP (haemolysis, elevated liver enzymes, and low platelet count) syndrome is regarded as a variant of preeclampsia, and the fulminante disease, eclampsia, includes convulsions. Preeclampsia is the main cause of maternal and fetal morbidity and mortality in western countries (1, 2), and in Nordic countries, 17 percent of maternal deaths have been ascribed to preeclampsia (2). Antenatal care in Norway includes on average 12 doctor/midwife consultations per pregnancy (3), and since blood pressure monitoring and urinary testing are main aims of the consultations, preeclampsia is a pregnancy complication that also generates substantial societal costs.</p> / Paper II, III, IV and V reproduced with permission of Elsevier, sciencedirect.com

<p>Stroke is the third leading cause of death and the major course of long-term disabilities in industrialized countries. Most surviving stroke patients show some degree of spontaneous recovery, but persistent symptoms in sensorimotor and cognitive functions are common. The symptoms can be reproduced in experimental stroke models in rats by occlusion of the middle cerebral artery. Housing rats in an enriched environment (EE), i.e. group housing in a large cage with toys that are changed daily, increases neuronal plasticity in healthy rats and can also improve functional recovery after experimental stroke. </p><p> The present thesis investigates the effect of EE on the recovery of sensorimotor and cognitive functions one month after focal cerebral ischemia in rats, with emphasis on the underlying molecular mechanisms. Furthermore, EE-induced effect on gene expression in healthy rats was investigated after different periods of EE-housing and at different time points of the day. </p><p> We show an improved recovery of both sensorimotor and cognitive functions in rats housed in EE for one month after focal cerebral ischemia. The recovery of sensorimotor function correlated significantly to mRNA expression of the plasticity associated transcription factors NGFI-A and NGFI-B in hippocampus and cortical regions outside the infarct. Social interaction seems to be an important component for the beneficial effects of EE after focal cerebral ischemia. Microarray analysis of hippocampal gene expression after one month of postischemic environmental enrichment revealed no confirmable EE-induced changes that could explain the improved recovery in spatial memory. Interestingly, healthy rats housed in EE showed increased mRNA expression of NGFI-A and Krox-20 exclusively during the dark period of the day compared to rats housed in isolation. In addition, EE housed rats had a substantial diurnal variation in NGFI-A, Krox-20 and NGFI-B mRNA expression; this was absent in single-housed rats. EE-induced changes in gene expression are more evident during the dark period of the day, when rats are more active and can benefit from the stimulating environment. This is important to consider in future investigation of putative mediators of the EE-induced neuronal plasticity. </p><p> In summary, these findings may contribute to an increased understanding of the underlying molecular mechanisms behind improved functional recovery in rats housed in enriched environment after focal cerebral ischemia.</p>

<p>In multicellular organisms all cells in one individual have an identical genotype, and yet their bodies consist of many and very different tissues and thus many different cell types. Somehow there must be a difference in how genes are interpreted. So, there must be signals that tell the genes when and where to be active and inactive, respectively. In some instances a specific an expression pattern (active or inactive) is epigenetic; it is established and maintained throughout multiple rounds of cell divisions. In the developing <i>Drosophila</i> embryo, the proper expression pattern of e.g. the homeotic genes <i>Abd-B</i> and <i>Ubx</i> is to be kept active in the posterior part and silenced in the anterior. Properly silenced homeotic genes are crucial for the correct segmentation pattern of the fly and the Polycomb group (Pc-G) proteins are vital for maintaining this type of stable repression.</p><p>As part of this thesis, <i>Suppressor of zeste 12 (Su(z)12)</i> is characterized as a <i>Drosophila</i> Pc-G gene. Mutations in the gene cause widespread misexpression of several homeotic genes in embryos and larvae. Results show that the silencing of the homeotic genes <i>Abd-B</i> and <i>Ubx</i>, probably is mediated via physical binding of SU(Z)12 to Polycomb Response Elements in the BX-C. <i>Su(z)12</i> mutations are strong suppressors of position-effect-variegation and the SU(Z)12 protein binds weakly to the heterochromatic centromeric region. These results indicate that SU(Z)12 has a function in heterochromatin-mediated repression, which is an unusual feature for a Pc-G protein. The structure of the <i>Su(z)12</i> gene was determined and the deduced protein contains a C2-H2 zinc finger domain, several nuclear localization signals, and a region, the VEFS box, with high homology to mammalian and plant homologues. <i>Su(z)12 </i>was originally isolated in a screen for modifiers of the zeste-white interaction and I present results that suggests that this effect is mediated through an interaction between <i>Su(z)12 </i>and <i>zeste</i>. I also show that <i>Su(z)12</i> interact genetically with other Pc-G mutants and that the SU(Z)12 protein binds more than 100 euchromatic bands on polytene chromosomes. I also present results showing that SU(Z)12 is a subunit of two different E(Z)/ESC embryonic silencing complexes, one 1MDa and one 600 kDa complex, where the larger complex also contains PCL and RPD3. </p><p>In conclusion, results presented in this thesis show that the recently identified Pc-G gene, <i>Su(z)12</i>, is of vital importance for correct maintenance of silencing of the developmentally important homeotic genes.</p>

<p>Predisposition to autoimmune diseases such as, rheumatoid arthritis, diabetes, and multiple sclerosis, is caused by the effect of multiple genes and a strong influence from the environment. </p><p>In this study, I have investigated genetic factors that confer susceptibility to rheumatoid arthritis in a rat model. This work has led to the identification of several chromosomal regions, containing uncharacterized genes that directly or indirectly are associated to the arthritis development in these rats. We have observed that timing, gender, and genetic interactions are features that play a part in the effect that these genetic factors exert. </p><p>Unarguably, animal models for human disorders display differences to the human form of disease. An important fact is however that the same chromosomal regions are identified in both rodent and human studies, which suggests that there are genetic factors that we have in common, which are involved directly or indirectly with an autoimmune response. </p><p>Focusing the interest on these similarities, and on the possibility to apply a wide set of genetic tools, make animal models an invaluable, and probably necessary, instrument to dissect the genetic component of complex disorders. To fully comprehend the genetic basis for a complex disorder like this, will require understanding of how multiple genes interact with each other to cause disease. </p><p>We have been able to demonstrate that chronic arthritis, in a rat model for rheumatoid arthritis, is regulated by several genes and that these act during different temporal phases of the disease. These findings will hopefully contribute to our understanding of the etiology and progression of rheumatoid arthritis.</p>

<p>A previous model of morphological pathogenesis assumed that cervical carcinoma is of monoclonal origin and progresses through multiple steps from normal epithelium via CINS into invasive carcinomas. The aim of this study was to investigate the molecular mechanism of pathogenesis of cervical neoplasia. </p><p>In the clonality study, we found that 75% (6/8) of informative cases of cervical carcinoma had identical patterns of loss of heterozygosity (LOH) in the multiple synchronous lesions, while the remaining cases had different LOU patterns. In an extensively studied "golden case", the multiple carcinoma and cervical intraepithelial neoplasia (CIN) lesions could be divided into several different clonal groups by the X-chromosome inactivation patterns, HPV 16 mutations and LOH patterns. The biggest clonal family included one CIN II, one CIN III and four carcinoma samples, while four other monoclonal families of carcinoma did not include CIN lesions. These results suggested that cervical carcinoma can be either monoclonal or polygonal and contains clones developing either directly or via multiple steps. In the study of HPV types and HPV16 variations, the results confirmed that specific HPV types are the cause of cervical carcinoma but failed to support the previous opinion that HPV16 E6 variants are more malignant than the prototype. We established a novel classification called oncogene lineage of HPV16, and found that additional variations of HPV 16 oncogenes might be a weak further risk factor for cervical carcinoma. In the study of LOH, we found that interstitial deletion of two common regions of chromosome 3p, i.e., 3p2l.1-3p2l.3, and 3p22, was an early event in the development of cervical carcinoma. The results showed that the hMLH1 gene, located in 3p22 and showing LOH in 43% of the studied cases, was not involved in the development of cervical carcinoma because neither the expression level of protein nor the gene sequence was altered in these cases. </p><p>In summary, a suggested model of molecular pathogenesis of cervical carcinoma is as follows. Specific types of HPV infect one or more committed stem cells in the basal layer of the epithelium. Fully efficient LOH events turn one (monoclonal origin) or more (polyclonal origin) HPV-infected stem cells into carcinoma cells without CIN steps. Less efficient LOH events would lead to CIN steps where some other unknown factors require to be added to facilitate the formation of carcinoma. In the absence of LOH events no carcinoma develops from the HPV-infected stem cells.</p>

<p>Mast cells are essential effector cells in the immune system as they release several inflammatory mediators. An accumulation of mast cells has been described in inflammatory conditions such as asthma and allergic rhinitis. Increased mast cell number, in the skin and other organs, is also a characteristic in mastocytosis, a disease without an effective treatment. One explanation for the increase in mast cell number is migration of mast cells in the tissue. In our studies we utilised mast cell lines, including HMC-1; cell lines transfected with the <i>c-kit</i> gene; and <i>in vitro</i> developed mast cells.</p><p>Our aim was to characterise, two variants of the HMC-1 cell line; the signalling pathways essential for mast cell migration towards TGF-β and SCF; and the mechanism regulating mast cell accumulation in mastocytosis.</p><p>Our results help to explain inconsistent findings regarding mast cell biology when HMC-1 cells have been used as a model system. The two variants, which we name HMC-1⁵⁶⁰ and HMC-1^{560, 816}, are used in different laboratories around the world. HMC-1⁵⁶⁰ and HMC-1^{560, 816} exhibited different characteristics regarding their karyotype, phenotype as well as their set of activating point mutations in the Kit receptor. Furthermore, divergent signalling pathways are of importance for mast cell migration towards TGF-β and SCF. The classical MAP kinase-signalling cascade was found to be of major relevance for TGF-β-induced migration. In contrast, this pathway had a modest impact on SCF-induced migration, which instead was highly dependent on p38 MAP kinase signalling. Finally, one mechanism for mast cell accumulation in mastocytosis appeared to be an activating point mutation in the gene for the Kit receptor. This mutation appeared to prone transfected cells and mast cell progenitors to a higher rate of migration towards SCF if compared with cells expressing wt Kit receptor.</p><p>In conclusion, our results show the importance of two different MAP kinase signalling pathways and mutations in the Kit receptor for mast cell migration induced by various types of stimuli. This knowledge helps us to understand the mechanism </p>