Bone Health in Children and Adolescents with Juvenile Idiopathic Arthritis and Solid Organ Transplant

Osteoporosis is a skeletal disorder characterized by compromised bone strength that predisposes to increased fracture risk. Childhood and adolescence are critical periods for bone mass gain. Peak bone mass is mostly acquired by the age of 18 years and is an important determinant of adult bone health and lifetime risk for fractures. Medications, especially glucocorticoids (GCs), chronic inflammation, decreased physical activity, hormonal deficiencies, delayed puberty, and poor nutrition may predispose children and adolescents with a chronic disease to impaired bone health. In this work, we studied overall bone health, the incidence and prevalence of fractures in children and adolescents who were treated for juvenile idiopathic arthritis (JIA) or had undergone solid organ transplantation. The first study cohort included 62 patients diagnosed with JIA and treated with GCs. The epidemiology of fractures after transplantation was investigated in 196 patients and a more detailed analysis of bone health determinants was performed on 40 liver (LTx) and 106 renal (RTx) transplantation patients. Bone mineral density (BMD) and vertebral morphology were assessed by dual-energy x-ray absorptiometry. Standard radiographs were obtained to detect vertebral fractures and to determine bone age; BMD values were adjusted for skeletal maturity. Our study showed that median BMD values were subnormal in all patient cohorts. The values were highest in patients with JIA and lowest in patients with LTx. Age at transplantation influenced BMD values in LTx but not RTx patients; BMD values were higher in patients who had LTx before the age of two years. BMD was lowest during the immediate posttransplantation years and increased subnormally during puberty. Delayed skeletal maturation was common in all patient groups. The prevalence of vertebral fractures ranged from 10% to 19% in the cohorts. Most of the fractures were asymptomatic and diagnosed only at screening. Vertebral fractures were most common in LTx patients. Vitamin D deficiency was common in all patient groups, and only 3% of patients with JIA and 25% of transplantation patients were considered to have adequate serum vitamin D levels. The total cumulative weight-adjusted dose of GC was not associated with BMD values in JIA or LTx patients. The combination of female gender and age over 15 years, parathyroid hormone concentration over 100 ng/L, and cumulative weight-adjusted methylprednisolone dose over 150 mg/kg during the three preceding years were found to be important predictors for low lumbar spine BMD in RTx patients. Based on the high prevalence of osteoporosis in the study cohorts more efforts should be put to prevention and early diagnosis of osteoporosis in these pediatric patients.

Anti-TNF treatment in juvenile idiopathic arthritis and associated uveitis : Clinical perspectives on growth, uveitis, and drug survival

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of childhood chronic arthritides, associated with chronic uveitis in 20% of cases. For JIA patients responding inadequately to conventional disease-modifying anti-rheumatic drugs (DMARDs), biologic therapies, anti-tumor necrosis factor (anti-TNF) agents are available. In this retrospective multicenter study, 258 JIA-patients refractory to DMARDs and receiving biologic agents during 1999-2007 were included. Prior to initiation of anti-TNFs, growth velocity of 71 patients was delayed in 75% and normal in 25%. Those with delayed growth demonstrated a significant increase in growth velocity after initiation of anti-TNFs. Increase in growth rate was unrelated to pubertal growth spurt. No change was observed in skeletal maturation before and after anti-TNFs. The strongest predictor of change in growth velocity was growth rate prior to anti-TNFs. Change in inflammatory activity remained a significant predictor even after decrease in glucocorticoids was taken into account. In JIA-associated uveitis, impact of two first-line biologic agents, etanercept and infliximab, and second-line or third-line anti-TNF agent, adalimumab, was evaluated. In 108 refractory JIA patients receiving etanercept or infliximab, uveitis occurred in 45 (42%). Uveitis improved in 14 (31%), no change was observed in 14 (31%), and in 17 (38%) uveitis worsened. Uveitis improved more frequently (p=0.047) and frequency of annual uveitis flares was lower (p=0.015) in those on infliximab than in those on etanercept. In 20 patients taking adalimumab, 19 (95%) had previously failed etanercept and/or infliximab. In 7 patients (35%) uveitis improved, in one (5%) worsened, and in 12 (60%) no change occurred. Those with improved uveitis were younger and had shorter disease duration. Serious adverse events (AEs) or side-effects were not observed. Adalimumab was effective also in arthritis. Long-term drug survival (i.e. continuation rate on drug) with etanercept (n=105) vs. infliximab (n=104) was at 24 months 68% vs. 68%, and at 48 months 61% vs. 48% (p=0.194 in log-rank analysis). First-line anti-TNF agent was discontinued either due to inefficacy (etanercept 28% vs. infliximab 20%, p=0.445), AEs (7% vs. 22%, p=0.002), or inactive disease (10% vs. 16%, p=0.068). Females, patients with systemic JIA (sJIA), and those taking infliximab as the first therapy were at higher risk for treatment discontinuation. One-third switched to the second anti-TNF agent, which was discontinued less often than the first. In conclusion, in refractory JIA anti-TNFs induced enhanced growth velocity. Four-year treatment survival was comparable between etanercept and infliximab, and switching from first-line to second-line agent a reasonable therapeutic option. During anti-TNF treatment, one-third with JIA-associated anterior uveitis improved.

Affected sibling pairs with juvenile idiopathic arthritis : An immunogenetic study of the disease in multicase families

Genetic susceptibility to juvenile idiopathic arthritis (JIA) was studied in the genetically homogeneous Finnish population by collecting families with two or three patients affected by this disease from cases seen in the Rheumatism Foundation Hospital. The number of families ranged in different studies from 37 to 45 and the total number of patients with JIA, from among whom these cases were derived, was 2 000 to 2 300. Characteristics of the disease in affected siblings in Finland were compared with a population-based series and with a sibling series from the United States. A thorough clinical and ophthalmological examination was made of all affected patients belonging to sibpair series. Information on the occurrence of chronic rheumatic diseases in parents was collected by questionnaire and diagnoses were confirmed from hospital records. All patients, their parents and most of the healthy sibs were typed for human leukocyte antigen (HLA) alleles in loci A, C, B, DR and DQ. The HLA allele distribution of the cases was compared with corresponding data from Finnish bone marrow donors. The genetic component in JIA was found to be more significant than previously believed. A concordance rate of 25% for a disease with a population prevalence of 1 per 1000 implied a relative risk of 250 for a monozygotic (MZ) twin. An estimate for the sibling risk of an affected individual was about 15- to 20-fold. The disease was basically similar in familial and sporadic cases; the mean age at disease onset was however lower in familial cases, (4.8 years vs 7.4 years). Three sibpairs (3.4 expected) were concordant for the presence of asymptomatic uveitis. Uveitis would thus not appear to have any genetic component of its own, separate from the genetic basis of JIA. Four of the parents had JIA (0.2 cases expected), four had a type of rheumatoid factor-negative arthritis similar to that seen in juvenile patients but commencing in adulthood, and one had spondyloarthropathy (SPA). These findings provide additional support for the conception of a genetic predisposition to JIA and suggest the existence of a new disease entity, JIA of adult onset. Both the linkage analysis of the affected sibpairs and the association analysis of nuclear families provided overwhelming evidence of a major contribution of HLA to the genetic susceptibility to JIA. The association analysis in the Finnish population confirmed that the most significant associations prevailed for DRB1*0801, DQB1*0402, as expected from previous observations, and indicated the independent role of Cw*0401.

The United Nations and juvenile justice: An overview

The purpose of this article is to provide an overview of the various United Nations instruments relevant to juvenile justice and to examine how knowledge of these can assist those interested in the protection and enhancement of young people's rights in the justice system. It is argued that whilst these instruments are variable they are valuable tools for unmasking the discriminatory and unjust treatment of young people who come into contact with the justice system.

Juvenile diversity of tree species in Theobroma cacao L. agroforestry and primary forest – Central Sulawesi, Indonesia

This thesis studies the tree species’ juvenile diversity in cacao (Theobroma cacao L.) based agroforestry and in primary forest in a natural conservation forest environment of Lore Lindu National Park, Sulawesi, Indonesia. Species’ adult composition in Lore Lindu National Park is relatively well studied, less is known about tree species’ diversity in seedling communities particularly in frequently disturbed cacao agroforestry field environment. Cacao production forms a potentially serious thread for maintaining the conservation areas pristine and forested in Sulawesi. The impacts of cacao production on natural environment are directly linked to the diversity and abundance of shade tree usage. The study aims at comparing differences between cacao agroforestry and natural forest in the surrounding area in their species composition in seedling and sapling size categories. The study was carried out in two parts. Biodiversity inventory of seedlings and saplings was combined with social survey with farmer interviews. Aim of the survey was to gain knowledge of the cacao fields, and farmers’ observations and choices regarding tree species associated with cacao. Data was collected in summer 2008. The assessment of the impact of environmental factors of solar radiation, weeding frequency, cacao tree planting density, distance to forest and distance to main park road, and type of habitat on seedling and sapling compositions was done with Non-metric Multidimensional Scaling (NMS). Outlier analysis was used to assess distorting variables for NMS, and Multi-Response Permutation Procedures (MRPP) analysis to differentiate the impact of categorical variables. Sampling success was estimated with rarefaction curves and jackknife estimate of species richness. In the inventory 135 species of trees and shrubs were found. Only some agroforestry related species were dominating. The most species rich were sapling communities in forest habitat. NMS was showing generally low linear correlation between variation of species composition and environmental variables. Solar radiation was having most significance as explaining variable. The most clearly separated in ordination were cacao and forest habitats. The results of seedling and sapling inventory were only partly coinciding with farmers’ knowledge of the tree species occurring on their fields. More research with frequent assessment of seedling cohorts is needed due to natural variability of cohorts and high mortality rate of seedlings.

Role of juvenile hormone in the synthesis and sequestration of vitellogenins in the red cotton stainer, Dysdercus koenigii (Heteroptera : Pyrrhocoridae)

Investigations were carried out to determine the role of juvenile hormone (JH) and 20-hydroxy ecdysone in the synthesis and uptake of vitellogenins, which were earlier identified, purified and characterised, in Dysdercus koenigii. The concentration(s) of vitellogenin(s) in fat body, haemolymph and that of vitellin(s) in ovary were significantly lower after chemical allatectomy at eclosion. In addition, at 70 h after emergence, chemical allatectomy reduced ovarian vitellin concentration, but vitellogenin levels remained normal in the fat body and haemolymph. The haemolymph vitellogenins were not incorporated into oocytes in such insects. Administration of JH-III at 20 h after allatectomy restored vitellogenin levels in the fat body and haemolymph, but the ovary failed to incorporate the available vitellogenins from haemolymph in such insects. However, when JH-III was administered twice, one at 20 h and then at 70 h after allatectomy, vitellogenin concentrations in fat body and haemolymph and also vitellin concentrations in ovary approached control levels. It is suggested that JH has two separate roles, one in vitellogenin synthesis and the other in uptake. 20-hydroxy ecdysone had no apparent role in either vitellogenin synthesis or uptake in D. koenigii. (C) 2000 Elsevier Science Inc. All rights reserved.

Regeneration of Juvenile Woody Plants after Fire in a Seasonally Dry Tropical Forest of Southern India

Woody tree species in seasonally dry tropical forests are known to have traits that help them to recover from recurring disturbances such as fire. Two such traits are resprouting and rapid post-fire growth. We compared survival and growth rates of regenerating small-sized individuals (juveniles) of woody tree species after dry season fire (February-March) at eight adjacent pairs of burnt and unburnt transects in a seasonally dry tropical forest in southern India. Juveniles were monitored at 3-mo intervals between August 2009 and August 2010. High juvenile survivorship (>95%) was observed in both burnt and unburnt areas. Growth rates of juveniles, analyzed at the community level as well as for a few species individually (especially fast-growing ones), were distinctly higher in burnt areas compared to unburnt areas after a fire event, particularly during the pre-monsoon season immediately after a fire. Rapid growth by juveniles soon after a fire may be due to lowered competition from other vegetative forms such as grasses, possibly aided by the availability of resources stored belowground. Such an adaptation would allow a juvenile bank to be retained in the understory of a dry forest, from where individuals can grow to a possible fire-tolerant size during favorable conditions.

Relationships between Larval and Juvenile Abundance of Winter-Spawned Fishes in North Carolina, USA

We analyzed the relationships between the larval and juvenile abundances of selected estuarine-dependent fishes that spawn during the winter in continental shelf waters of the U.S. Atlantic coast. Six species were included in the analysis based on their ecological and economic importance and relative abundance in available surveys: spot Leiostomus xanthurus, pinfish Lagodon rhomboides, southern flounder Paralichthys lethostigma, summer flounder Paralichthys dentatus, Atlantic croaker Micropogonias undulatus, and Atlantic menhaden Brevoortia tyrannus. Cross-correlation analysis was used to examine the relationships between the larval and juvenile abundances within species. Tests of synchrony across species were used to find similarities in recruitment dynamics for species with similar winter shelf-spawning life-history strategies. Positive correlations were found between the larval and juvenile abundances for three of the six selected species (spot, pinfish, and southern flounder). These three species have similar geographic ranges that primarily lie south of Cape Hatteras. There were no significant correlations between the larval and juvenile abundances for the other three species (summer flounder, Atlantic croaker, and Atlantic menhaden); we suggest several factors that could account for the lack of a relationship. Synchrony was found among the three southern species within both the larval and juvenile abundance time series. These results provide support for using larval ingress measures as indices of abundance for these and other species with similar geographic ranges and winter shelf-spawning life-history strategies.

Influence of seagrass landscape structure on the juvenile blue crab habitat-survival function

Organismal survival in marine habitats is often positively correlated with habitat structural complexity at local (within-patch) spatial scales. Far less is known, however, about how marine habitat structure at the landscape scale influences predation and other ecological processes, and in particular, how these processes are dictated by the interactive effect of habitat structure at local and landscape scales. The relationship between survival and habitat structure can be modeled with the habitat-survival function (HSF), which often takes on linear, hyperbolic, or sigmoid forms. We used tethering experiments to determine how seagrass landscape structure influenced the HSF for juvenile blue crabs Callinectes sapidus Rathbun in Back Sound, North Carolina, USA. Crabs were tethered in artificial seagrass plots of 7 different shoot densities embedded within small (1 – 3 m2) or large (>100 m2) seagrass patches (October 1999), and within 10 × 10 m landscapes containing patchy (<50% cover) or continuous (>90% cover) seagrass (July 2000). Overall, crab survival was higher in small than in large patches, and was higher in patchy than in continuous seagrass. The HSF was hyperbolic in large patches and in continuous seagrass, indicating that at low levels of habitat structure, relatively small increases in structure resulted in substantial increases in juvenile blue crab survival. However, the HSF was linear in small seagrass patches in 1999 and was parabolic in patchy seagrass in 2000. A sigmoid HSF, in which a threshold level of seagrass structure is required for crab survival, was never observed. Patchy seagrass landscapes are valuable refuges for juvenile blue crabs, and the effects of seagrass structural complexity on crab survival can only be fully understood when habitat structure at larger scales is considered.

Juvenile fish assemblages collected on unconsolidated sediments of the southeast United States continental shelf

Patterns were investigated in juvenile fish use of unconsolidated sediments on the southeast United States continental shelf off Georgia. Juvenile fish and environmental data were sampled at ten stations along a 110-km cross-shelf transect, including four stations surrounding Gray’s Reef National Marine Sanctuary (Gray’s Reef NMFS). Cross-shelf stations were sampled approximately quarterly from spring 2000 to winter 2002. Additional stations were sampled on three transects inshore of Gray’s Reef NMS and four transects offshore of the Sanctuary during three cruises to investigate along-shelf patterns in the juvenile fish assemblages. Samples were collected in beam trawls, and 121 juvenile taxa, of which 33 were reef-associated species, were identified. Correspondence analysis on untransformed juvenile fish abundance indicated a cross-shelf gradient in assemblages, and the station groupings and assemblages varied seasonally. During the spring, fall, and winter, three cross-shelf regions were identified: inner-shelf, mid-shelf, and outer-shelf regions. In the summer, the shelf consisted of a single juvenile fish assemblage. Water depth was the primary environmental variable correlated with cross-shelf assemblages. However, salinity, density, and water column stratification also correlated with the distribution of assemblages during the spring, fall, and winter, and along with temperature likely influenced the distribution of juvenile fish. No along-shelf spatial patterns were found in the juvenile fish assemblages, but the along-shelf dimension sampled was small (~60 km). Our results revealed that a number of commercially and recreationally important species used unconsolidated sediments on the shelf off Georgia as juvenile habitat. We conclude that management efforts would be improved through a greater recognition of the importance of these habitats to fish production and the interconnectedness of multiple habitats in the southeast U.S. continental shelf ecosystem.

Power analysis for detecting trends in juvenile spotted seatrout abundance in Florida Bay

The spotted seatrout (Cynoscion nebulosus) is considered a key species relative to the implementation of the Comprehensive Everglades Restoration Plan (CERP). One of the goals of the CERP is to increase freshwater flows to Florida Bay. Increased freshwater flows can have potential positive and negative impacts on spotted seatrout populations. At low salinities, the planktonic eggs of spotted seatrout sink to the bottom and are not viable (Alshuth and Gilmore, 1994; Holt and Holt, 2002). On the other hand, increased freshwater flows can alleviate hypersaline conditions that could result in an expansion of the distribution of the early life stages of spotted seatrout (Thayer et al., 1999; Florida Department of Environmental Protection1). Thus it would be useful to develop a monitoring program that can detect changes in seatrout abundance on time scales short enough to be useful to resource managers. The NOAA Center for Coastal Fisheries and Habitat Research (NOAA) has made sporadic collections of juvenile seatrout using otter trawls since 1984 (see Powell et al, 2004). The results suggest that it might be useful to sample for seatrout in as many as eight different areas or basins (Figure 1): Bradley Key, Sandy Key, Johnson Key, Palm Key, Snake Bight, Central, Whipray and Crocodile Dragover. Unfortunately, logistical constraints are likely to limit the number of tows to about 40 per month over a period of six months each year. Inasmuch as few seatrout are caught in any given tow and the proportion of tows with zero seatrout is often high, it is important to determine how best to allocate this limited sampling effort among the various basins so that any trends in abundance may be detected with sufficient statistical confidence. (PDF contains 16 pages)

An evaluation of Northern Florida Bay as a nursery area for red drum, Sciaenops ocellatus, and other juvenile and small resident fishes.

Red drum is one ofthe most popular species sought by anglers in Florida Bay, yet juveniles are rarely encountered. We evaluated Florida Bay as a nursery area for red drum by sampling for recently-settled late larvae in basin areas within the bay with an epi-benthic sled at six stations in November 2000, and at seven stations during December 2000 through February 2001. In November 2000 we surveyed potential sampling sites in quiet backwaters adjacent to mangroves for juvenile red drum. A total of 202 sites were sampled mainly in northern Florida Bay and adjacent waters with a cast net. We collected only one recently-settled red drum larvae and no juveniles. Obviously the sites that we sampled in Florida Bay and adjacent waters are not nursery habitat for this valuable species. Sled collections were dominated by bay anchovy, Anchoa mitchilli, but densities were biased by one collection. Five small resident species were among the dominant species: rainwater killifish, Lucania parva; dusky pipefish, Syngnathus floridae; dwarf seahorse, Hippocampus zosterae; and clown goby, Microgobius gulosus. Three species that spawn outside Florida Bay in the GulfofMexico were common: pinfish, Lagodon rhomboides; pigfish, Orthopristis chrysoptera; and silver perch, Bairdiella chrysoura. Twenty-seven species were collected with the cast net. Hardhead silversides (Atherinomorus stipes), bay anchovy, tidewater mojarra (Eucinostomus harengulus), silver jenny (Eucinostomus gula), and goldspotted killifish (Floridichthys carpio) were the most common in cast net collections. Although only one red drum was collected, we were able to: (1) identify mesohaline waters from our cast net sites to test our preliminary assessment that mesohaline habitat might be limited in Florida Bay, (2) document the distribution and abundance of fishes collected by cast net that should enhance our understanding of ichthyofauna in the Northern Subdivision ofFlorida Bay and adjacent waters, and (3) from epibenthic sled collections, describe the habitats, abundance and distribution of recently settled larvae/small juveniles/small resident fishes during late fall and winter. This information should be useful to managers and future research. (PDF contains 34 pages)

Genetic and morphological identification of pelagic juvenile rockfish collected from the Gulf of Alaska

Pelagic juvenile rockfish (Sebastes spp.) collected in surveys designed to assess juvenile salmonids and other species in the Gulf of Alaska in 1998 and 2000–2003 provide an opportunity to document the occurrence of the pelagic juveniles of several species of rockfish. Often, species identification of rockfish is difficult or impossible at this stage of development (~20 to 60 mm), and few species indigenous to Alaska waters have been described. Use of mitochondrial DNA markers for rockfish species allowed unequivocal identification of ten species (S. aleutianus, S. alutus, S. borealis, S. entomelas, S. flavidus, S. melanops, S. pinniger, S. proriger, S. reedi, and S. ruberrimus) in subsamples from the collections. Other specimens were genetically assignable to groups of two or three species. Sebastes borealis, S. crameri, and S. reedi were identified using morphological data. Combining genetic and morphological data allowed successful resolution of the other species as S. emphaeus, probably S. ciliatus (although S. polyspinis cannot be totally ruled out), and S. polyspinis. Many specimens were initially morphologically indistinguishable from S. alutus, and several morphological groups included fish genetically identified as S. alutus. This paper details the characteristics of these pelagic juveniles to facilitate morphological identification of these species in future collections. (PDF file contains 32 pages.)

Juvenile and small resident fishes of Florida Bay, a critical habitat in the Everglades National Park, Florida

This compendium presents information on the life history, diet, and abundance and distribution of 46 of the more abundant juvenile and small resident fish species, and data on three species of seagrasses in Florida Bay, Everglades National Park. Abundance and distribution of fish data were derived from three sampling schemes: (1) an otter trawl in basins (1984–1985, 1994–2001), (2) a surface trawl in basins (1984–1985), and (3) a surface trawl in channels (1984–1985). Results from surface trawling only included pelagic species. Collections made with an otter trawl in basins on a bi-monthly basis were emphasized. Nonparametric statistics were used to test spatial and temporal differences in the abundance of species and seagrasses. Fish species accounts were presented in four sections – Life history, Diet, Abundance and distribution, and Length-frequency distributions. Although Florida Bay is a subtropical estuary, the majority of fish species (76%) had warm-temperate affinities; i.e., only 24% were solely tropical species. The five most abundant species collected, in descending order, by (1) otter trawl in basins were: Eucinostomus gula, Lucania parva, Anchoa mitchilli, Lagodon rhomboides, and Syngnathus scovelli; (2) surface trawl in basins were: Hyporhamphus unifasciatus, Strongylura notata, Chriodorus atherinoides, Anchoa hepsetus, and Atherinomorus stipes; (3) surface trawl in channels were: Hypoatherina harringtonensis, A. stipes, A. mitchelli, H. unifasciatus, and C. atherinoides. (PDF file contains 219 pages.)