Pediatric Inflammatory Bowel Disease: from diagnosis to transition

The inflammatory bowel diseases (IBD) are chronic relapsing inflammatory disorders of the gastrointestinal tract, comprising Crohn’s disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U). CD is characterized by a transmural and often granulomatous inflammation that can involve any part of the gastrointestinal tract in a discontinuous manner, while UC is defined as a chronic inflammatory condition causing continuous mucosal inflammation of the colon, without granulomas on biopsy, affecting the rectum and a variable extent of the colon in continuity. The term IBD-U is used for patients presenting with IBD restricted to the colon without the specific features of either CD or UC.2 Early-onset IBD represents a distinct disease entity with differences in disease type, disease location, disease behavior, gender preponderance, and genetically attributable risk compared with late-onset IBD. As in adults, treatment of early-onset IBD is aimed at inducing and maintaining remission, but special considerations are needed regarding optimal growth, pubertal development, and the transition period to adult care. A better understanding of the differences between early-onset and late-onset IBD will eventually lead to a better understanding of the pathogenesis of the disease. One of the limitations of studying pediatric IBD is however that a relatively small number of patients is available for study at one institution, which requires ongoing collaborations between many institutions. This thesis will present six (inter)national multicenter studies, a single-center pilot study and a review, which all focus on the unique clinical aspects of pediatric IBD, thereby complementing the relatively small body of literature on the diagnosis and treatment of children with IBD

Reliability of patient-specific gait profiles with inertial measurement units during the 2-min walk test in incomplete spinal cord injury

Most established clinical walking tests assess specific aspects of movement function (velocity, endurance, etc.) but are generally unable to determine specific biomechanical or neurological deficits that limit an individual's ability to walk. Recently, inertial measurement units (IMU) have been used to collect objective kinematic data for gait analysis and could be a valuable extension for clinical assessments (e.g., functional walking measures). This study assesses the reliability of an IMU-based overground gait analysis during the 2-min walk test (2mWT) in individuals with spinal cord injury (SCI). Furthermore, the study elaborates on the capability of IMUs to distinguish between different gait characteristics in individuals with SCI. Twenty-six individuals (aged 22-79) with acute or chronic SCI (AIS: C and D) completed the 2mWT with IMUs attached above each ankle on 2 test days, separated by 1 to 7 days. The IMU-based gait analysis showed good to excellent test-retest reliability (ICC: 0.77-0.99) for all gait parameters. Gait profiles remained stable between two measurements. Sensor-based gait profiling was able to reveal patient-specific gait impairments even in individuals with the same walking performance in the 2mWT. IMUs are a valuable add-on to clinical gait assessments and deliver reliable information on detailed gait pathologies in individuals with SCI

Heterochronic maturation of anatomical plugs for protecting the airway in rorqual whales (Balaenopteridae)

Recently, a unique mechanism for protecting the airway during lunge feeding was discovered in rorqual whales (Balaenopteridae). This mechanism is based on an oral plug structure in the soft palate with similarities in musculo-fatty composition to the nasal plugs protecting the respiratory tract of rorquals from water entry and barotrauma during diving. As a follow-up, we present here a developmental series on fetal, prenatal, juvenile and adult specimens across five species of rorquals, showing differential maturation of the nasal and oral respiratory protection plugs. Nasal plugs are fully formed to serve an immediate crucial function at birth. By contrast, the soft palate remains muscular until the onset of solid food intake, where a musculo-fatty oral plug is developed

Computed Tomography as a Method for Age Determination of Carnivora and Odontocetes with Validation from Individuals with Known Age

Traditional methods for age determination of wildlife include either slicing thin sections off or grinding a tooth, both of which are laborious and invasive. Especially when it comes to ancient and valuable museum samples of rare or extinct species, non-invasive methods are preferable. In this study, X-ray micro-computed tomography (µ-CT) was verified as an alternative non-invasive method for age determination of three species within the order of Carnivora and suborders Odontoceti. Teeth from 13 red foxes (Vulpes vulpes), 2 American mink (Neogale vison), and 2 harbor porpoises (Phocoena phocoena) of known age were studied using µ-CT. The number of visible dental growth layers in the µ-CT were highly correlated with true age for all three species (R2 = 96%, p &lt; 0.001). In addition, the Bland–Altman plot showed high agreement between the age of individuals and visible dental layers represented in 2D slices of the 3D µ-CT images. The true age of individuals was on average 0.3 (±0.6 SD) years higher than the age interpreted by the µ-CT image, and there was a 95% agreement between the true age and the age interpreted from visible dental layers in the µ-CT.</p

Gene expression analysis of peripheral cells for subclassification of pediatric inflammatory bowel disease in remission

Objective: In current clinical practice, optimal treatment of inflammatory bowel disease (IBD) aims at the induction and maintenance of clinical remission. Clinical remission is apparent when laboratory markers of inflammation are normal and clinical symptoms are absent. However, sub-clinical inflammation can still be present. A detailed analysis of the immune status during this inactive state of disease may provide a useful tool to categorize patients with clinical remission into subsets with variable states of immune activation. Design: By using Affymetrix GeneChips, we analysed RNA gene expression profiles of peripheral blood leukocytes from pediatric IBD patients in clinical remission and controls. We performed (un)supervised clustering analysis of IBD-associated genes and applied Ingenuity® pathway software to identify specific molecular profiles between patients. Results: Pediatric IBD patients with disease in clinical remission display heterogeneously distributed gene expression profiles that are significantly distinct from controls. We identified three clusters of IBD patients, each displaying specific expression profiles of IBD-associated genes. Conclusion: The expression of immune- and IBD-associated genes in peripheral blood leukocytes from pediatric IBD patients in clinical remission was different from healthy controls, indicating that sub-clinical immune mechanisms are still active during remission. As such, RNA profiling of peripheral blood may allow for non-invasive patient subclassification and new perspectives in treatment regimes of IBD patients in the future

Population genomics of the white beaked dolphin (Lagenorhynchus albirostris)::Implications for conservation amid climate driven range shifts

Climate change is rapidly affecting species distributions across the globe, particularly in the North Atlantic. For highly mobile and elusive cetaceans, the genetic data needed to understand population dynamics are often scarce. Cold-water obligate species such as the white-beaked dolphin (Lagenorhynchus albirostris) face pressures from habitat shifts due to rising sea surface temperatures in addition to other direct anthropogenic threats. Unravelling the genetic connectivity between white-beaked dolphins across their range is needed to understand the extent to which climate change and anthropogenic pressures may impact species-wide genetic diversity and identify ways to protect remaining habitat. We address this by performing a population genomic assessment of white-beaked dolphins using samples from much of their contemporary range. We show that the species displays significant population structure across the North Atlantic at multiple scales. Analysis of contemporary migration rates suggests a remarkably high connectivity between populations in the western North Atlantic, Iceland and the Barents Sea, while two regional populations in the North Sea and adjacent UK and Irish waters are highly differentiated from all other clades. Our results have important implications for the conservation of white-beaked dolphins by providing guidance for the delineation of more appropriate management units and highlighting the risk that local extirpation may have on species-wide genetic diversity. In a broader context, this study highlights the importance of understanding genetic structure of all species threatened with climate change-driven range shifts to assess the risk of loss of species-wide genetic diversity.</p

Spatiotemporal mortality and demographic trends in a small cetacean: Strandings to inform conservation management

With global increases in anthropogenic pressures on wildlife populations comes a responsibility to manage them effectively. The assessment of marine ecosystem health is challenging and often relies on monitoring indicator species, such as cetaceans. Most cetaceans are however highly mobile and spend the majority of their time hidden from direct view, resulting in uncertainty on even the most basic population metrics. Here, we discuss the value of long-term and internationally combined stranding records as a valuable source of information on the demographic and mortality trends of the harbour porpoise (Phocoena phocoena) in the North Sea. We analysed stranding records (n = 16,181) from 1990 to 2017 and demonstrate a strong heterogeneous seasonal pattern of strandings throughout the North Sea, indicative of season-specific distribution or habitat use, and season-specific mortality. The annual incidence of strandings has increased since 1990, with a notable steeper rise particularly in the southern North Sea since 2005. A high density of neonatal strandings occurred specifically in the eastern North Sea, indicative of areas important for calving, and large numbers of juvenile males stranded in the southern parts, indicative of a population sink or reflecting higher male dispersion. These findings highlight the power of stranding records to detect potentially vulnerable population groups in time and space. This knowledge is vital for managers and can guide, for example, conservation measures such as the establishment of time-area-specific limits to potentially harmful human activities, aiming to reduce the number and intensity of human-wildlife conflicts

Distal spinal muscular atrophy featured by predominant calf muscle involvement in VRK1 associated disease - Case series and review

We describe the shared clinical, biochemical, radiological and myopathological characteristics of four patients with distal spinal muscular atrophy (dSMA) caused by vaccinia-related kinase 1 (VRK1) variants and provide a review of the literature on phenotype-genotype correlations in VRK1-related disease. The clinical phenotype was characterized by adult-onset dSMA with predominant calf muscle involvement and mildly elevated serum creatinine kinase (CK) levels. Muscle imaging showed predominant atrophy and fatty replacement of calf muscles. We identified the novel compound heterozygous variants c.607C>T (p.Arg203Trp) and c.858G>T (p.Met286Ile) in two siblings with adult-onset dSMA. Additionally, two unrelated patients both carried the known c.583T>G (p.Leu195Val) VRK1 variant, with either c.197C>G (p.Ala66Gly) or c.701A>G (p.Asn234Ser) as a second variant. We conclude that compound heterozygous VRK1 variants cause distal spinal muscular atrophy with predominant posterior leg muscle involvement