High bone mass phenotype in a cohort of patients with Osteogenesis Imperfecta caused due to BMP1 and C-propeptide cleavage variants in COL1A1

OBJECTIVES

Osteogenesis Imperfecta (OI) is a heterogeneous condition mainly characterised by bone fragility; extra-skeletal features in OI include blue sclerae, dentinogenesis imperfecta, skin laxity and joint hyper-extensibility. Most patients with OI are thought to have a low bone mass but contrary to expectations there are certain forms of OI with high bone mass which this study explores in further detail.

METHOD

A cohort of n = 6 individuals with pathogenic variants in BMP1 and the C-propeptide cleavage variants in COL1A1 were included in this study. Detailed clinical and radiological phenotyping was done and correlated with genotype to identify patterns of clinical presentation and fracture history in this cohort of patients. This data was compared to previously reported literature in this group.

RESULTS

2 patients with BMP1 and 4 patients with pathogenic variants in C-propeptide region in COL1A1 were deep-phenotyped as part of this study and 1 patient with C-propeptide variant in COL1A1, showed low bone mineral density. In those with an elevated bone mineral density, this became even more apparent on bisphosphonate therapy. Patients in this cohort had variable clinical presentation ranging from antenatal presentation to more of an insidious course resulting in later confirmation of genetic diagnosis up to 19 years of age.

CONCLUSIONS

Patients with pathogenic variants in the C-propeptide region of COL1A1/A2 and BMP1 appear to have a high bone mass phenotype with increased sensitivity to bisphosphonate therapy. It is important to closely monitor patients with these genotypes to assess their response to therapy and tailor their treatment regime accordingly.

Bright spots as climate-smart marine spatial planning tools for conservation and blue growth

Marine spatial planning that addresses ocean climate-driven change ('climate-smart MSP') is a global aspiration to support economic growth, food security and ecosystem sustainability. Ocean climate change ('CC') modelling may become a key decision-support tool for MSP, but traditional modelling analysis and communication challenges prevent their broad uptake. We employed MSP-specific ocean climate modelling analyses to inform a real-life MSP process; addressing how nature conservation and fisheries could be adapted to CC. We found that the currently planned distribution of these activities may become unsustainable during the policy's implementation due to CC, leading to a shortfall in its sustainability and blue growth targets. Significant, climate-driven ecosystem-level shifts in ocean components underpinning designated sites and fishing activity were estimated, reflecting different magnitudes of shifts in benthic versus pelagic, and inshore versus offshore habitats. Supporting adaptation, we then identified: CC refugia (areas where the ecosystem remains within the boundaries of its present state); CC hotspots (where climate drives the ecosystem towards a new state, inconsistent with each sectors' present use distribution); and for the first time, identified bright spots (areas where oceanographic processes drive range expansion opportunities that may support sustainable growth in the medium term). We thus create the means to: identify where sector-relevant ecosystem change is attributable to CC; incorporate resilient delivery of conservation and sustainable ecosystem management aims into MSP; and to harness opportunities for blue growth where they exist. Capturing CC bright spots alongside refugia within protected areas may present important opportunities to meet sustainability targets while helping support the fishing sector in a changing climate. By capitalizing on the natural distribution of climate resilience within ocean ecosystems, such climate-adaptive spatial management strategies could be seen as nature-based solutions to limit the impact of CC on ocean ecosystems and dependent blue economy sectors, paving the way for climate-smart MSP.

Effects of climate change and management policies on marine fisheries productivity in the north-east coast of India

The study covers two important deltaic systems of the north-east coast of India, viz. the Bengal and Mahanadi delta that support about 1.25 million people. The changes in potential marine fish production and socio-economic conditions were modelled for these two deltas under long-term changes in environmental conditions (sea surface temperature and primary production) to the end of the 21st century. Our results show that an increased temperature (by 4 °C) has a negative impact on fisheries productivity, which was projected to decrease by 5%. At the species level, Bombay duck, Indian mackerel and threadfin bream showed an increasing trend in the biomass of potential catches under the sustainable fishing scenario. However, under the business as usual and overfishing scenarios, our results suggest reduced catch for both states. On the other hand, mackerel tuna, Indian oil sardine, and hilsa fisheries showed a projected reduction in potential catch also for the sustainable fishing scenario. The socio-economic models projected an increase of up to 0.67% (involving 0.8 billion USD) in consumption by 2050 even under the best management scenario. The GDP per capita was projected to face a loss of 1.7 billion USD by 2050. The loss of low-cost fisheries would negatively impact the poorer coastal population since they strongly depend upon these fisheries as a source of protein. Nevertheless, adaptation strategies tend to have a negative correlation with poverty and food insecurity which needs to be addressed separately to make the sector-specific efforts effective. This work can be considered as the baseline model for future researchers and the policymakers to explore potential sustainable management options for the studied regions.

Can we project changes in fish abundance and distribution in response to climate?

Large-scale and long-term changes in fish abundance and distribution in response to climate change have been simulated using both statistical and process-based models. However, national and regional fisheries management requires also shorter term projections on smaller spatial scales, and these need to be validated against fisheries data. A 26-year time series of fish surveys with high spatial resolution in the North-East Atlantic provides a unique opportunity to assess the ability of models to correctly simulate the changes in fish distribution and abundance that occurred in response to climate variability and change. We use a dynamic bioclimate envelope model forced by physical-biogeochemical output from eight ocean models to simulate changes in fish abundance and distribution at scales down to a spatial resolution of 0.5°. When comparing with these simulations with annual fish survey data, we found the largest differences at the 0.5° scale. Differences between fishery model runs driven by different biogeochemical models decrease dramatically when results are aggregated to larger scales (e.g. the whole North Sea), to total catches rather than individual species or when the ensemble mean instead of individual simulations are used. Recent improvements in the fidelity of biogeochemical models translate into lower error rates in the fisheries simulations. However, predictions based on different biogeochemical models are often more similar to each other than they are to the survey data, except for some pelagic species. We conclude that model results can be used to guide fisheries management at larger spatial scales, but more caution is needed at smaller scales.

Biology and fisheries of Hilsa shad in Bay of Bengal

Hilsa (Tenualosa ilisha) or river shad is an anadromous fish species widely distributed in the North Indian Ocean, mainly in the Bay of Bengal (BoB). Hilsa is the national fish of Bangladesh and it contributes 10% of the total fish production of the country, with a market value of $1.74 billion. Hilsa also holds a very important place in the economics of West Bengal of India with 12.5% of the catch and also tops the marine capture in Myanmar. During the last two decades Hilsa production from inland waters has been stable, whereas marine yields in the BoB increased substantially. In order to sustainably manage the trans-boundary stock of Hilsa, the taxonomy, distribution, habitat, migration patterns, population dynamics, fisheries and socio-economics aspects of the fishery have been reviewed here. To achieve a successful trans-boundary management for the Hilsa stock, complete ban on undersize fishing, well-targeted temporal and spatial bans, creation of protected areas in strategic points, incentive for Hilsa fishers and ecological restoration of Hilsa habitats and more work on technological development of Hilsa aquaculture are recommended.

Impacts and responses to environmental change in coastal livelihoods of south-west Bangladesh

Aquatic ecosystems are of global importance for maintaining high levels of biodiversity and ecosystem services, and for the number of livelihoods dependent on them. In Bangladesh, coastal and delta communities rely on these systems for a livelihood, and the sustainability of the productivity is seriously threatened by both climate change and unsustainable management. These multiple drivers of change shape the livelihood dependence and adaptation responses, where a better understanding is needed to achieve sustainable management in these systems, while maintaining and improving dependent livelihoods. This need has been addressed in this study in the region of Satkhira, in the southwest coast of Bangladesh, where livelihoods are highly dependent on aquatic systems for food supply and income. Traditional wild fish harvest in the rivers and aquaculture systems, including ghers, ponds, and crab points have been changing in terms of the uses and intensity of management, and suffering from climate change impacts as well. By means of six focus groups with 50 participants total, and validated by expert consultations, we conduct an analysis to understand the main perceived impacts from climate and human activities; and the adaptation responses from the aquatic system livelihoods. We find that biodiversity has decreased drastically, while farmed species have increased and shrimp gher farming turned more intensive becoming the main source of income. All these changes have important implications for food supply in the region and environmental sustainability. Dramatic responses taken in the communities include exit the fisheries and migration, and more adaptive responses include species diversification, crab fattening and working more on the pond and gher infrastructure. This study evidences the results of the combination of multiple stressors in productive systems and the barriers to adaptation in aquatic ecosystem dependent communities.

Applying the global RCP-SSP-SPA scenario framework at sub-national scale: A multi-scale and participatory scenario approach

To better anticipate potential impacts of climate change, diverse information about the future is required, including climate, society and economy, and adaptation and mitigation. To address this need, a global RCP (Representative Concentration Pathways), SSP (Shared Socio-economic Pathways), and SPA (Shared climate Policy Assumptions) (RCP-SSP-SPA) scenario framework has been developed by the Intergovernmental Panel on Climate Change Fifth Assessment Report (IPCC-AR5). Application of this full global framework at sub-national scales introduces two key challenges: added complexity in capturing the multiple dimensions of change, and issues of scale. Perhaps for this reason, there are few such applications of this new framework. Here, we present an integrated multi-scale hybrid scenario approach that combines both expert-based and participatory methods. The framework has been developed and applied within the DECCMA¹ project with the purpose of exploring migration and adaptation in three deltas across West Africa and South Asia: (i) the Volta delta (Ghana), (ii) the Mahanadi delta (India), and (iii) the Ganges-Brahmaputra-Meghna (GBM) delta (Bangladesh/India). Using a climate scenario that encompasses a wide range of impacts (RCP8.5) combined with three SSP-based socio-economic scenarios (SSP2, SSP3, SSP5), we generate highly divergent and challenging scenario contexts across multiple scales against which robustness of the human and natural systems within the deltas are tested. In addition, we consider four distinct adaptation policy trajectories: Minimum intervention, Economic capacity expansion, System efficiency enhancement, and System restructuring, which describe alternative future bundles of adaptation actions/measures under different socio-economic trajectories. The paper highlights the importance of multi-scale (combined top-down and bottom-up) and participatory (joint expert-stakeholder) scenario methods for addressing uncertainty in adaptation decision-making. The framework facilitates improved integrated assessments of the potential impacts and plausible adaptation policy choices (including migration) under uncertain future changing conditions. The concept, methods, and processes presented are transferable to other sub-national socio-ecological settings with multi-scale challenges.

Fertilization and connectivity in the Garrucha Canyon (SE-Spain) implications for Marine Spatial Planning

Marine Spatial Planning is usually based on benthic georeferenced information or GPS tracked human activities, whereas the pelagic ecosystem is often ignored because of scarce and limited surface information. However, the 3-D pelagic ecosystem plays a key role connecting all the other ecosystems by physical (currents) and biological (migration) processes. According to remote sensing the Garrucha Canyon is oligotrophic, but 3-D sampling reveals subsurface upwelling, and converts it into the richest area around the Cape of Gata. Vertical connectivity by means of zooplankton migration, measured at two sampling stations, is 40 and 220 times faster than microphytoplankton settling and vertical water velocities respectively. Thus coupled physical-biological connectivity models are necessary to estimate the ecosystem connection and the fate of carbon, but also other substances (e.g. radioactivity), that might accumulate throughout the food-web. This is especially important in the Garrucha Canyon and the Coastal Areas Management Programme Levante de Almería where natural heritage and extractive fishery are important for the local economy.

Detecting the presence-absence of bluefin tuna by automated analysis of medium-range sonars on fishing vessels

This study presents a methodology for the automated analysis of commercial medium-range sonar signals for detecting presence/absence of bluefin tuna (Tunnus thynnus) in the Bay of Biscay. The approach uses image processing techniques to analyze sonar screenshots. For each sonar image we extracted measurable regions and analyzed their characteristics. Scientific data was used to classify each region into a class (“tuna” or “no-tuna”) and build a dataset to train and evaluate classification models by using supervised learning. The methodology performed well when validated with commercial sonar screenshots, and has the potential to automatically analyze high volumes of data at a low cost. This represents a first milestone towards the development of acoustic, fishery-independent indices of abundance for bluefin tuna in the Bay of Biscay. Future research lines and additional alternatives to inform stock assessments are also discussed.

Solutions for ecosystem-level protection of ocean systems under climate change

The Paris Conference of Parties (COP21) agreement renewed momentum for action against climate change, creating the space for solutions for conservation of the ocean addressing two of its largest threats: climate change and ocean acidification (CCOA). Recent arguments that ocean policies disregard a mature conservation research field and that protected areas cannot address climate change may be oversimplistic at this time when dynamic solutions for the management of changing oceans are needed. We propose a novel approach, based on spatial meta-analysis of climate impact models, to improve the positioning of marine protected areas to limit CCOA impacts. We do this by estimating the vulnerability of ocean ecosystems to CCOA in a spatially explicit manner and then co-mapping human activities such as the placement of renewable energy developments and the distribution of marine protected areas. We test this approach in the NE Atlantic considering also how CCOA impacts the base of the food web which supports protected species, an aspect often neglected in conservation studies. We found that, in this case, current regional conservation plans protect areas with low ecosystem-level vulnerability to CCOA, but disregard how species may redistribute to new, suitable and productive habitats. Under current plans, these areas remain open to commercial extraction and other uses. Here, and worldwide, ocean conservation strategies under CCOA must recognize the long-term importance of these habitat refuges, and studies such as this one are needed to identify them. Protecting these areas creates adaptive, climate-ready and ecosystem-level policy options for conservation, suitable for changing oceans.

Limb reconstruction in Ollier's disease

We present our experience of lengthening and correction of complex deformities in the management of patients with Ollier’s dysplasia (multiple enchondromatosis) from 1985 and 2002. All patients were under 18 years with a minimum follow-up time of 2 years (mean 9.6 years, range 2–15 years). There were a total of ten patients of which seven were male and three female. The mean age at presentation was 10.7 years (range 5–17 years; SD 3.7 years). The total length gain was 42.3 mm (range 30–110 mm; SD 28.9 mm). The number of days in external fixation was 164.8 days (range 76–244 days; SD 42.9 days). The bone healing index was 32.5 days/cm (18–50 days/cm; SD 10.3 days/cm). Patients with Ollier’s disease have limb length inequality and angular deformities and require multiple reconstructive procedures owing to a high incidence of recurrence. We identified a tendency for the osteotomy to prematurely consolidate and advise the latency period after surgery to be 4–5 days and for distraction to proceed at a faster rate.

Modelling the effects of climate change on the distribution and production of marine fishes: accounting for trophic interactions in a dynamic bioclimate envelope model

Climate change has already altered the distribution of marine fishes. Future predictions of fish distributions and catches based on bioclimate envelope models are available, but to date they have not considered interspecific interactions. We address this by combining the species-based Dynamic Bioclimate Envelope Model (DBEM) with a size-based trophic model. The new approach provides spatially and temporally resolved predictions of changes in species' size, abundance and catch potential that account for the effects of ecological interactions. Predicted latitudinal shifts are, on average, reduced by 20% when species interactions are incorporated, compared to DBEM predictions, with pelagic species showing the greatest reductions. Goodness-of-fit of biomass data from fish stock assessments in the North Atlantic between 1991 and 2003 is improved slightly by including species interactions. The differences between predictions from the two models may be relatively modest because, at the North Atlantic basin scale, (i) predators and competitors may respond to climate change together; (ii) existing parameterization of the DBEM might implicitly incorporate trophic interactions; and/or (iii) trophic interactions might not be the main driver of responses to climate. Future analyses using ecologically explicit models and data will improve understanding of the effects of inter-specific interactions on responses to climate change, and better inform managers about plausible ecological and fishery consequences of a changing environment.

Predicting the impact of climate change on threatened species in UK waters

Global climate change is affecting the distribution of marine species and is thought to represent a threat to biodiversity. Previous studies project expansion of species range for some species and local extinction elsewhere under climate change. Such range shifts raise concern for species whose long-term persistence is already threatened by other human disturbances such as fishing. However, few studies have attempted to assess the effects of future climate change on threatened vertebrate marine species using a multi-model approach. There has also been a recent surge of interest in climate change impacts on protected areas. This study applies three species distribution models and two sets of climate model projections to explore the potential impacts of climate change on marine species by 2050. A set of species in the North Sea, including seven threatened and ten major commercial species were used as a case study. Changes in habitat suitability in selected candidate protected areas around the UK under future climatic scenarios were assessed for these species. Moreover, change in the degree of overlap between commercial and threatened species ranges was calculated as a proxy of the potential threat posed by overfishing through bycatch. The ensemble projections suggest northward shifts in species at an average rate of 27 km per decade, resulting in small average changes in range overlap between threatened and commercially exploited species. Furthermore, the adverse consequences of climate change on the habitat suitability of protected areas were projected to be small. Although the models show large variation in the predicted consequences of climate change, the multi-model approach helps identify the potential risk of increased exposure to human stressors of critically endangered species such as common skate (Dipturus batis) and angelshark (Squatina squatina).

Evaluation of reaching the targets of the water framework directive in the Gulf of Finland

This paper describes the development of the EU Water Framework Directive central water quality elements from 1970 to 2010 in the Gulf of Finland, a eutrophied sub-basin of the Baltic Sea. The likelihood of accomplishing the management objectives simultaneously is assessed using Bayesian networks. The objectives of good ecological status in winter-time total nitrogen and phosphorus, summer-time chlorophyll-a and summer-time Secchi depth have not been met yet. In addition, the results indicate that it is unlikely for them to be achieved in the near future, despite the decreasing trend in nutrient concentrations over the past few years. It was demonstrated that neither phosphorus nor nitrogen alone controls summertime plankton growth. Reaching good ecological status in nutrients does not necessarily lead to good ecological status of chlorophyll-a, even though a dependency between the parameters does exist. In addition, secchi-depth status is strongly related to chlorophyll-a status in three of the four study-areas.

A novel method of applying a split cast

Split plaster casts have been shown to be better than back slabs at accommodating increasing intracompartmental pressure due to swelling. Splitting a wet plaster cast can be time consuming and difficult both for the patient and the medical staff. We describe a novel method of applying a split plaster of Paris cast, which is safe, quick, convenient and inexpensive.

Limb lengthening and correction of deformity in the lower limbs of children with osteogenesis imperfecta

We performed limb lengthening and correction of deformity of nine long bones of the lower limb in six children (mean age, 14.7 years) with osteogenesis imperfecta (OI). All had femoral lengthening and three also had ipsilateral tibial lengthening. Angular deformities were corrected simultaneously. Five limb segments were treated using a monolateral external fixator and four with the Ilizarov frame. In three children, lengthening was done over previously inserted femoral intramedullary rods.

The mean lengthening achieved was 6.26 cm (mean healing index, 33.25 days/cm). Significant complications included one deep infection, one fracture of the femur and one anterior angulation deformity of the tibia. The abnormal bone of OI tolerated the external fixators throughout the period of lengthening without any episodes of migration of wires or pins through the soft bone. The regenerate bone formed within the time which is normally expected in limb-lengthening procedures performed for other conditions.

We conclude that despite the abnormal bone characteristics, distraction osteogenesis to correct limb-length discrepancy and angular deformity can be performed safely in children with OI.

Triplane fractures of the distal tibia requiring open reduction and internal fixation. Pre-operative planning using computed tomography

Computed tomography (CT) of triplane fractures provides useful information not available on conventional radiographs. Knowledge of the size and position of displaced fragments, the location of the intra-articular fracture and any associated articular incongruency is useful when undertaking pre-operative planning.A postal survey of surgeons revealed only 38% always requested CT scans before undertaking open reduction and internal fixation of displaced triplane fractures. Examples of the usefulness of CT scans in pre-operative planning is presented in two cases.

Femoral neck fracture complicating protrusio acetabuli

No Abstract.

The orthopaedic presentation of acute leukaemia in childhood

In children, acute leukaemia can mimic several orthopaedic pathologies and this variable presentation creates difficulties in achieving the correct diagnosis. Four consecutive cases are reported, all of which initially presented via the orthopaedic department, representing 17% of all new cases of leukaemia presenting to our hospital. This series is presented to highlight the need to place acute leukaemia on the list of differential diagnoses of acute joint pathology in children: the associated literature is reviewed.

Treatment of severe actinic rectitis

BACKGROUND

The authors report the treatment of three female patients with severe actinic rectitis, with stenosis or perforation, submitted to anterior proctosigmoidectomy and transanal coloanal anastomosis.

METHODS

In all cases surgery consisted of total proctosigmoidectomy, mucosectomy of the anal canal, lowering of the left colon through the pelvis and transanal anastomosis performed manually at the level of the pectineal line using separate absorbable sutures. A protective intestinal shunt was performed in all cases.

RESULTS

The three patients did not present transoperative or immediate postoperative complications, but the first patient developed deep venous thrombosis of the leg that was submitted to successful clinical treatment. The intestinal shunts were later closed in all three cases. Sphicter function was considered very good in the first case and regular in the remaining two.

CONCLUSION

The surgical technique utilized was considered to be adequate for the cases reported and is the first option for the maintenance of transit in patients with severe actinic rectitis since the anastomosis is performed using non-irradiated colon with the pectineal line, practically outside the pelvis.

Electroencephalogram activity in the anoxic turtle brain

The anoxia-tolerant turtle brain slowly undergoes a complex sequence of changes in electroencephalogram (EEG) activity as the brain systematically downregulates its energy demands. Following N2 respiration, the root mean square voltage rapidly fell, reaching approximately 20% of normoxic levels after approximately 100 min of anoxia. During the first 20- to 40-min transition period, the power of the EEG decreased substantially, particularly in the 12- to 24-Hz band, with low-amplitude slow wave activity predominating (3-12 Hz). Bursts of high voltage rhythmic slow (approximately 3-8 Hz) waves were seen during the 20- to 100-min period of anoxia, accompanied by large sharp waves. During the next 400 min of N2 respiration, two distinct patterns of electrical activity characterized the anoxic turtle brain: 1) a sustained but depressed activity level, with an EEG amplitude approximately 20% of the normoxic control and with total EEG power reduced by one order of magnitude at all frequencies, and 2) short (3-15 s) periodic (0.5-2/min) bursts of mixed-frequency activity that interrupted the depressed activity state. We speculate that the EEG patterns seen during sustained anoxia represent the minimal or basic electrical activities that are compatible with the survival of the anoxic turtle brain as an integrated unit, which allow the brain to return to normal functioning when air respiration resumed.