INITIAL SCREENING FOR BEDWETTING: THE USE OF QUESTIONNAIRES AND VOIDING DIARIES First results from a National Belgian study

Title Initial screening for bedwetting: the use of questionnaires and voiding diaries. First results from a National Belgian study Authors S. Karamaria2, N. Ranguelov3, P. Hansen4, V. De Boe5, P. Verleyen6, J. Vande Walle1,2, L. Dossche2, A. Bael7,8 1Department of Pediatric Nephrology, UZ Gent, Ghent, 2Ghent University, 3Department of Pediatrics, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, 4Department of Pediatrics, CHU Tivoli, La Louvière, 5Department of Urology, UZ Brussel, Brussels, 6Department of Urology, AZ Groeninge, Kortrijk, 7Department of Pediatrics, Pediatric Nephrology, ZNA Koningin Paola Kinderziekenhuis, Antwerp; 8Faculty of Medicine, University of Antwerp, Antwerp Background International guidelines have a consensus that stratification of nocturnal enuresis (NE) into non-monosymptomatic (NMNE) and monosymptomatic (MNE) is mandatory at intake to optimize therapeutic approach. This stratification is based on clinical parameters (presence or absence of Lower Urinary Tract Symptoms (LUTS) respectively). To identify clinical parameters a checklist (Clinical Management Tool (CMT)) and/or voiding diaries based on home recordings can be used. However, these recordings can be time consuming and difficult for the family. Moreover, the added value to the CMT, especially in treatment naïve patients, is rather expert opinion than evidence based. Methods The aim of this study run in 7 Belgian Hospitals, was to document in treatment naïve NE patients >5 years: 1) The prevalence of MNE vs NMNE 2) the added value and correlation of CMT and/or diary in differentiating NE. Two study visits were scheduled: At visit 1 CMT was obtained, after a thorough medical history and basic assessments. If daytime incontinence and/or LUTS were identified, the diagnosis was NMNE. After the 1st study visit, a 2day voiding diary (fluid intake, voiding volumes, incontinence) was registered at home. During the second study visit, this diary was evaluated; if the micturition frequency was >8 or <3 and/or there was daytime incontinence, the diagnosis was NMNE. Results In total 109 children were included, of which19 were lost in follow up. Mean age was 7,7 (±2); 62 were boys (68,9%) and 27 were girls (30%). 68 (75, 6%) were included at a non-University center. Based on the CMT 13 children were diagnosed as MNE (16,7%) and 75 children as NMNE (83,3%). Based on the diary 16 children were diagnosed as MNE (17,8%) and 74 children as NMNE (82,2%). 25 children (27,8%) had the same diagnosis with both methods Regarding the presence or not of LUTS we observed significant inconsistencies between the CMT and the diary. Specifically there was fair agreement between the two modalities for urge (κ=0,219), moderate agreement for daytime incontinence (κ=0,432) and no agreement for abnormal voiding frequency (8 voidings/day) between what the parents answered on the CMT and what they registered in the diary (κ=-0,057). Conclusion NMNE is more frequent than MNE in treatment naïve patients. CMT alone versus CMT + diary had a different sensitivity and specificity of identifying LUTS : in absence of validation of the importance by a therapeutic trial outcome, we state that we can only consider patients as MNE when and CMT and diary do not demonstrate LUTS

New physiological activities of myosuppressin, sulfakinin and NVP-like peptide in Zophobas atratus beetle

Three neuropeptides Zopat-MS-2 (pEDVDHVFLRFa), Zopat-SK-1 (pETSDDYGHLRFa) and Zopat-NVPL-4trunc. (GRWGGFA), recently isolated from the neuroendocrine system of the Zophobas atratus beetle, were tested for their myotropic and hyperglycaemic activities in this species. These peptides exerted differentiated dose-dependent and tissue specific physiological effects. Zopat-MS-2 inhibited contractions of the isolated heart, ejaculatory duct, oviduct and hindgut of adult beetles and induced bimodal effects in the heart contractile activity of pupae in vivo. It also increased the haemolymph free sugar level in larvae of this species, apart from myotropic activity. Zopat-SK-1 showed myostimulatory action on the isolated hindgut of the adult beetles, but it decreased contractions of the heart, ejaculatory duct and oviduct. Injections of this peptide at a dose of 2 μg also caused delayed cardioinhibitory effects on the heartbeat of the pupae. Together with the ability to increase free sugar level in the haemolymph of larvae these were new physiological activities of sulfakinins in insects. Zopat-NVPL-4trunc. inhibited the muscle contractions of the two organs: hindgut and ejaculatory duct but it was inactive on the oviduct and the heart of the adult beetles. This peptide also increased free sugar level concentration in the haemolymph of Z. atratus larvae. These physiological actions are the first biological activities discovered for this group of the insect peptides. The present work showed pleiotropic activity of three neuropeptides and indicates that the visceral muscle contractions and the haemolymph sugar homeostasis in Z. atratus are regulated by complex mechanisms

Antarctic temperature changes during the last millennium: evaluation of simulations and reconstructions

Temperature changes in Antarctica over the last millennium are investigated using proxy records, a set of simulations driven by natural and anthropogenic forcings and one simulation with data assimilation. Over Antarctica, a long term cooling trend in annual mean is simulated during the period 1000–1850. The main contributor to this cooling trend is the volcanic forcing, astronomical forcing playing a dominant role at seasonal timescale. Since 1850, all the models produce an Antarctic warming in response to the increase in greenhouse gas concentrations. We present a composite of Antarctic temperature, calculated by averaging seven temperature records derived from isotope measurements in ice cores. This simple approach is supported by the coherency displayed between model results at these data grid points and Antarctic mean temperature. The composite shows a weak multi-centennial cooling trend during the pre-industrial period and a warming after 1850 that is broadly consistent with model results. In both data and simulations, large regional variations are superimposed on this common signal, at decadal to centennial timescales. The model results appear spatially more consistent than ice core records. We conclude that more records are needed to resolve the complex spatial distribution of Antarctic temperature variations during the last millennium

The Central Clock Neurons Regulate Lipid Storage in Drosophila

A proper balance of lipid breakdown and synthesis is essential for achieving energy homeostasis as alterations in either of these processes can lead to pathological states such as obesity. The regulation of lipid metabolism is quite complex with multiple signals integrated to control overall triglyceride levels in metabolic tissues. Based upon studies demonstrating effects of the circadian clock on metabolism, we sought to determine if the central clock cells in the Drosophila brain contribute to lipid levels in the fat body, the main nutrient storage organ of the fly. Here, we show that altering the function of the Drosophila central clock neurons leads to an increase in fat body triglycerides. We also show that although triglyceride levels are not affected by age, they are increased by expression of the amyloid-beta protein in central clock neurons. The effect on lipid storage seems to be independent of circadian clock output as changes in triglycerides are not always observed in genetic manipulations that result in altered locomotor rhythms. These data demonstrate that the activity of the central clock neurons is necessary for proper lipid storage

Cross-Disciplinarity in the Advance of Antarctic Ecosystem Research

The biodiversity, ecosystem services and climate variability of the Antarctic continent, and the Southern Ocean are major components of the whole Earth system. Antarctic ecosystems are driven more strongly by the physical environment than many other marine and terrestrial ecosystems. As a consequence, to understand ecological functioning, cross-disciplinary studies are especially important in Antarctic research. The conceptual study presented here is based on a workshop initiated by the Research Programme Antarctic Thresholds - Ecosystem Resilience and Adaption of the Scientific Committee on Antarctic Research, which focused on challenges in identifying and applying cross-disciplinary approaches in the Antarctic. Novel ideas, and first steps in their implementation, were clustered into eight themes, ranging from scale problems, risk maps, organism and ecosystem responses to multiple environmental changes, to evolutionary processes. Scaling models and data across different spatial and temporal scales were identified as an overarching challenge. Approaches to bridge gaps in the research programmes included multi-disciplinary monitoring, linking biomolecular findings and simulated physical environments, as well as integrative ecological modelling. New strategies in academic education are proposed. The results of advanced cross-disciplinary approaches can contribute significantly to our knowledge of ecosystem functioning, the consequences of climate change, and to global assessments that ultimately benefit humankind

Five decades of terrestrial and freshwater research at Ny-Ålesund, Svalbard

For more than five decades, research has been conducted at Ny-Alesund, in Svalbard, Norway, to understand the structure and functioning of High Arctic ecosystems and the profound impacts on them of environmental change. Terrestrial, freshwater, glacial and marine ecosystems are accessible year-round from Ny-Alesund, providing unique opportunities for interdisciplinary observational and experimental studies along physical, chemical, hydrological and climatic gradients. Here, we synthesize terrestrial and freshwater research at Ny-Alesund and review current knowledge of biodiversity patterns, species population dynamics and interactions, ecosystem processes, biogeochemical cycles and anthropogenic impacts. There is now strong evidence of past and ongoing biotic changes caused by climate change, including negative effects on populations of many taxa and impacts of rain-on-snow events across multiple trophic levels. While species-level characteristics and responses are well understood for macro-organisms, major knowledge gaps exist for microbes, invertebrates and ecosystem-level processes. In order to fill current knowledge gaps, we recommend (1) maintaining monitoring efforts, while establishing a longterm ecosystem-based monitoring programme; (2) gaining a mechanistic understanding of environmental change impacts on processes and linkages in food webs; (3) identifying trophic interactions and cascades across ecosystems; and (4) integrating long-term data on microbial, invertebrate and freshwater communities, along with measurements of carbon and nutrient fluxes among soils, atmosphere, freshwaters and the marine environment. The synthesis here shows that the Ny-Alesund study system has the characteristics needed to fill these gaps in knowledge, thereby enhancing our understanding of High-Arctic ecosystems and their responses to environmental variability and change

Five decades of terrestrial and freshwater research at Ny-Ålesund, Svalbard

For more than five decades, research has been conducted at Ny-Ålesund, in Svalbard, Norway, to understand the structure and functioning of High-Arctic ecosystems and the profound impacts on them of environmental change. Terrestrial, freshwater, glacial and marine ecosystems are accessible year-round from Ny-Ålesund, providing unique opportunities for interdisciplinary observational and experimental studies along physical, chemical, hydrological and climatic gradients. Here, we synthesize terrestrial and freshwater research at Ny-Ålesund and review current knowledge of biodiversity patterns, species population dynamics and interactions, ecosystem processes, biogeochemical cycles and anthropogenic impacts. There is now strong evidence of past and ongoing biotic changes caused by climate change, including negative effects on populations of many taxa and impacts of rain-on-snow events across multiple trophic levels. While species-level characteristics and responses are well understood for macro-organisms, major knowledge gaps exist for microbes, invertebrates and ecosystem-level processes. In order to fill current knowledge gaps, we recommend (1) maintaining monitoring efforts, while establishing a long-term ecosystem-based monitoring programme; (2) gaining a mechanistic understanding of environmental change impacts on processes and linkages in food webs; (3) identifying trophic interactions and cascades across ecosystems; and (4) integrating long-term data on microbial, invertebrate and freshwater communities, along with measurements of carbon and nutrient fluxes among soils, atmosphere, freshwaters and the marine environment. The synthesis here shows that the Ny-Ålesund study system has the characteristics needed to fill these gaps in knowledge, thereby enhancing our understanding of High-Arctic ecosystems and their responses to environmental variability and change