A Dutch guideline for the treatment of scoliosis in neuromuscular disorders

Background

Children with neuromuscular disorders with a progressive muscle weakness such as Duchenne Muscular Dystrophy and Spinal Muscular Atrophy frequently develop a progressive scoliosis. A severe scoliosis compromises respiratory function and makes sitting more difficult. Spinal surgery is considered the primary treatment option for correcting severe scoliosis in neuromuscular disorders. Surgery in this population requires a multidisciplinary approach, careful planning, dedicated surgical procedures, and specialized after care.

Methods

The guideline is based on scientific evidence and expert opinions. A multidisciplinary working group representing experts from all relevant specialties performed the research. A literature search was conducted to collect scientific evidence in answer to specific questions posed by the working group. Literature was classified according to the level of evidence.

Results

For most aspects of the treatment scientific evidence is scarce and only low level cohort studies were found. Nevertheless, a high degree of consensus was reached about the management of patients with scoliosis in neuromuscular disorders. This was translated into a set of recommendations, which are now officially accepted as a general guideline in the Netherlands.

Conclusion

In order to optimize the treatment for scoliosis in neuromuscular disorders a Dutch guideline has been composed. This evidence-based, multidisciplinary guideline addresses conservative treatment, the preoperative, perioperative, and postoperative care of scoliosis in neuromuscular disorders.     

A new metazoan from the Vendian of the White Sea,Russia, with possible affinities to the ascidians

Two specimens recovered from late Neoproterozoic shallow marine sediments of northern Russia may be the oldest known ascidians. Dated at around 555 Ma, these, together with the younger Ausia from the Nama Group in southwestern Africa, are probably relatives of these invertebrate chordates, which have a deep time origin predicted by molecular studies.     

The Changing Face of Natural Resources Students,Education, and the Profession

ABSTRACT There are many challenges facing natural resources programs in North American higher education today. Pressures exerted by a new generation of students, changing workplace requirements (including undergraduate core-knowledge requirements), and an increasingly specialized professoriate are great but not insurmountable. We discuss each of these issues and pose potential solutions to address each including adopting new pedagogical techniques for content delivery (e.g., adapting courses to be inclusive of new technologies), revising curriculum to meet the needs of a new suite of learners (e.g., developing curricula that allow structured flexibility of choices, designing a core curriculum that is a mix of single-discipline courses and courses that integrate across disciplines), and new strategies for faculty engagement in discipline-specific survey courses. By remaining deliberate and effective in our pursuit of quality higher education we have the opportunity to ensure we are delivering the best possible education to the future professionals of our disciplines.     

Developmental significance of a cortical cytoskeletal domain in Chaetopterus eggs

The cortex of Chaetopterus eggs contains a cytoskeletal domain (CD) which includes a specific class of dense granular organelles and a large proportion of the maternal mRNA. This CD, along with its constituent dense granular organelles and mRNA, can be displaced to atypical locations in the egg by centrifugation. To investigate the developmental significance of the CD, we have examined the early development of egg and zygote fragments, prepared by centrifugation, which contained the CD, the nucleus, or both. Specifically, we prepared nucleate egg and zygote fragments depleted in the CD, and two-cell embryos in which the CD was present in only one cell. Nucleate centripetal egg fragments were both unable to develop after fertilization and were depleted in the CD, as shown by electron microscopy, acridine orange staining of cortical organelles, and hybridization with poly(U) and cloned DNA probes. In contrast, about 20-35% of the nucleate centripetal fragments derived from one-cell zygotes developed into swimming larva. Correlated with this improved success of development, we found that these zygotic centripetal fragments contained significant levels of the CD, using the same methods listed above. More effective removal of the CD from zygotic centripetal fragments by stratification prior to fragmentation virtually eliminated their ability to develop. The CD and associated components could be displaced into only one of the first two blastomeres by centrifugation of zygotes immediately prior to the first cleavage. Embryos containing the CD in only one blastomere continued to cleave, but formed defective larva. The results suggest that the cortical CD is necessary for normal embryonic development.     

The independence of myogenesis and chondrogenesis in micromass cultures of chick wing buds

Micromass cultures prepared from stage 23, 24, or 25 chick wing buds and cultured under identical conditions produce similar numbers of myoblasts. After treatment with the DNA synthesis inhibitor cytosine-1-beta-D-arabinofuranoside, [3H]thymidine labeling and autoradiography of the cultures show that the increase in myoblast number during the first 48 hr of culture is due primarily to cell division. Micromass cultures prepared from proximal and distal portions of stage 23 or 24 wing buds have very different chondrogenic potentials in vitro (B.J. Swalla, E.M. Owens, T.F. Linsenmayer, and M. Solursh (1983). Dev. Biol. 97, 59-69) but a similar myogenic potential under these culture conditions. Medium supplements that significantly enhance chondrogenesis by proximal cell cultures, such as low serum or 1 mM db cyclic AMP, do not affect the number of myoblasts per unit area of culture during the first 3 days. Muscle cells are eventually reduced in number in whole limb micromass cultures, yet persist as long as 6 days in proximal and distal cultures. These results suggest that myogenic cells are already committed in the early limbs but are inhibited from differentiation in situ until a later time. Myogenesis and chondrogenesis occur independently in culture, consistent with the idea that these two differentiated cells are derived from two separate cell populations. Furthermore, treatments which enhance chondrogenesis do not act indirectly by killing the myoblast population in these cultures.     

Inhibition of limb chondrogenesis by fibronectin

Abstract. This study compares the chondrogenic capacity of high density cultures prepared from either the develop-mentally younger, distal region or more advanced proximal region of stage 23/24 limb mesenchyme in high density cultures. Distal cultures undergo extensive chondrogenesis whether in F₁₂ medium supplemented with 10% fetal calf serum, 5% fetal calf serum, or fibronectin. On the other hand, proximal cultures fail to undergo chondrogenesis in medium containing 10% fetal calf serum or fibronectin, but do form cartilage in medium containing a decreased serum concentration or no serum. Furthermore, if the cells are cultured at low densities in native type I collagen gels, proximal cells have a reduced chondrogenic capacity in the presence of fibronectin, while chondrogenesis by distal cells is unaffected by the addition of fibronectin. The results demonstrate that proximal and distal cells respond differentially to serum and to fibronectin, and they suggest that the response of the cell to prevalent components of the extracellular matrix might change with development.     

Effects of Hunting on Response Behaviors of Wild Reindeer

ABSTRACT Because wild reindeer (Rangifer tarandus) are hunted in southern Norway, reindeer may perceive all recreationists as threats. Potential adverse effects of hunting on reindeer behavior may be exacerbated by other forms of recreation because the number of skiers and hikers in areas inhabited by reindeer has also increased. The Norefjell-Reinsjøfjell wild reindeer area is used extensively for recreation and tourism. Reindeer hunting was introduced in the area in 1992, and harvest rate has been stable at about 38% of winter herd size. We recorded behavioral responses of reindeer to a person approaching directly on foot or skis during 1992 and again in 2002–2006. Compared to 1992, flight-initiation distance increased and fewer groups assessed the observer before taking flight during 2002–2006. In winter, when reindeer are usually comparably more vigilant than in other seasons, flight-initiation distance increased from only 60 m to 115 m and escape distance decreased from 400 m to 210 m. Neither alert distance, calf carcass weights (23.6 ± 0.7 [SE] kg to 22.4 ± 0.2 kg), nor reindeer herd size (661 ± 73 to 579 ± 15) changed during the 15 years of our study. Reindeer appeared to habituate to the observer because they initiated flight at shorter distances as the number of approaches on the same day increased. In Norefjell-Reinsjøfjell, encounters with a person on foot or skis did not result in behavioral responses likely to entail substantial energy costs for reindeer; therefore, hunting at current levels appears compatible with other recreational activities.