Small fibre neuropathy in Fabry disease: a human-derived neuronal in vitro disease model and pilot data

Acral burning pain triggered by fever, thermal hyposensitivity and skin denervation are hallmarks of small fibre neuropathy in Fabry disease, a life-threatening X-linked lysosomal storage disorder. Variants in the gene encoding alpha-galactosidase A may lead to impaired enzyme activity with cellular accumulation of globotriaosylceramide. To study the underlying pathomechanism of Fabry-associated small fibre neuropathy, we generated a neuronal in vitro disease model using patient-derived induced pluripotent stem cells from three Fabry patients and one healthy control. We further generated an isogenic control line via gene editing. We subjected induced pluripotent stem cells to targeted peripheral neuronal differentiation and observed intra-lysosomal globotriaosylceramide accumulations in somas and neurites of Fabry sensory neurons using super-resolution microscopy. At functional level, patch-clamp analysis revealed a hyperpolarizing shift of voltage-gated sodium channel steady-state inactivation kinetics in isogenic control neurons compared with healthy control neurons (P < 0.001). Moreover, we demonstrate a drastic increase in Fabry sensory neuron calcium levels at 39°C mimicking clinical fever (P < 0.001). This pathophysiological phenotype was accompanied by thinning of neurite calibres in sensory neurons differentiated from induced pluripotent stem cells derived from Fabry patients compared with healthy control cells (P < 0.001). Linear-nonlinear cascade models fit to spiking responses revealed that Fabry cell lines exhibit altered single neuron encoding properties relative to control. We further observed mitochondrial aggregation at sphingolipid accumulations within Fabry sensory neurites utilizing a click chemistry approach together with mitochondrial dysmorphism compared with healthy control cells. We pioneer pilot insights into the cellular mechanisms contributing to pain, thermal hyposensitivity and denervation in Fabry small fibre neuropathy and pave the way for further mechanistic in vitro studies in Fabry disease and the development of novel treatment approaches.

In vitro characterization of cells derived from a patient with the GLA variant c.376A>G (p.S126G) highlights a non-pathogenic role in Fabry disease

Fabry disease (FD) is a life-limiting disorder characterized by intracellular globotriaosylceramide (Gb3) accumulations. The underlying α-galactosidase A (α-GAL A) deficiency is caused by variants in the gene GLA. Variants of unknown significance (VUS) are frequently found in GLA and challenge clinical management. Here, we investigated a 49-year old man with cryptogenic lacunar cerebral stroke and the chance finding of the VUS S126G, who was sent to our center for diagnosis and initiation of a costly and life-long FD-specific treatment. We combined clinical examination with in vitro investigations of dermal fibroblasts (HDF), induced pluripotent stem cells (iPSC), and iPSC-derived sensory neurons. We analyzed α-GAL A activity in iPSC, Gb3 accumulation in all three cell types, and action potential firing in sensory neurons. Neurological examination and small nerve fiber assessment was normal except for reduced distal skin innervation. S126G iPSC showed normal α-GAL A activity compared to controls and no Gb3 deposits were found in all three cell types. Baseline electrophysiological characteristics of S126G neurons showed no difference compared to healthy controls as investigated by patch-clamp recordings. We pioneer multi-level cellular characterization of the VUS S126G using three cell types derived from a patient and provide further evidence for the benign nature of S126G in GLA, which is of great importance in the management of such cases in clinical practice.

Amplification of satellite DNA at 16q11.2 in the germ-line of a patient with breast-cancer

Cytogenetic analyses of peripheral blood cells of breast cancer patients unveiled in one case a grossly enlarged G-band in one copy of chromosome 16 (16qh+), which scored also strongly positive in C-banding. Fluorescence in situ hybridization with both a total chromosome 16 library and with probe pHuR195 detecting locus D16Z3 further documented the increase of the copy number of the corresponding satellite DNA at 16q-11.2. Slot-blot analyses with pHuR195 revealed an approximately 10-fold amplification compared to a random selection of normal chromosomes 16. The chromosome 16 carrying amplified DNA is passed on to one of 3 children, who shows no obvious anomaly. Previous studies (Kokalj-Vokac N, Alemeida A, Gerbault-Seureau M, Malfoy B, Dutrillaux B: Gene Chromosome Cancer 7: 8-14, 1993) had revealed that satellite DNA in chromosome 16 often participates in interchromosomal recombinations, preferentially with chromosome 1, in breast cancer cells. Although the increased copy number of satellite DNA could represent a polymorphism, it might provide an enlarged target for recombination events and therefore could be a determinant for cancer predisposition.

[Epigenetic markers in migrating population burial sites of the Mid-Elbe-Saale area]

The distribution of 122 epigenetic traits of the cranium and the postcranial skeleton (180 skeletal individuals) of six sites of the period of the Middleelbe-Saale-Region was analyzed. Based on these frequencies and using the method of biodistance analysis (MMD after Sjøvold 1973) the relationships of these population groups were investigated which are different concerning their geographical origin. The results did not show distinct differences between these groups, but suggested a possible homogeneity of our populations.

Alcohol and drug use of inter-city versus rural school age children

The purpose of this study of seventy-nine children was to determine: 1) the prevalence and type of substance use in inter-city and rural eight to twelve-year-old children; and 2) the relationships between child substance use, self-esteem, peer substance use, and family climate. The conceptual framework for the study was a modification of Kumpfer and Turner's Social Ecology Model (1991). Nineteen percent of the children had used alcohol or drugs. Thirty-three percent of the children acknowledged having friends who used substances. Inter-city children reported more alcohol and marijuana use, while the rural children reported more use of inhalants. The responses of both inter-city and rural children also indicated that there were problems with substance use and family violence in the home. Self-esteem and affiliation with drug using peers were significantly correlated with substance use of the child.

[Is head size modified by environmental factors?]

In the article the development of skull measurements and head measurements (length and breadth) and of the cephalic index, calculated from these measurements, since the Neolithic period are presented. The results obtained from the historical material are compared with those of living persons. The measurements as well of the skull as of the head show secular changes. The following general trend was found: an increase of body height is connected with a debrachycephalisation and a decrease of body height is connected with a brachycephalisation. It can be emphasized that brachycephalisation/debrachycephalisation are part of the secular trend. Therefore environmental factors are responsible for the described changes of measurements of the skull and the head in a broadest sense.

[Secular trend in body height since the Neolithic period]

The body height of children and adults is estimated on the basis of skeleton material from the middle Elbe-Saale region since the Neolithic period. The men's body height was calculated according to Breitinger (1938), the women's body height according to Bach (1965), and the children's body height according to Telkkä et al. (1962). These estimates are compared with the mean body height of living persons from the adult population and of Jena schoolchildren, respectively. These are the following essential results: 1. Since 7000 years ago changes of body height can be observed. There was an increase of the mean body height from the Neolithic period until the Bronce age. In the A.D. era no clear changes of the average values can be found until about the 12th century, after which there occurred decreases seen until the 19th century. 2. The greatest secular trends in children and adults arise in our century. 3. The influence of different environmental factors on the body height in past and present is discussed and the sex-specific reactions to changes of these environmental factors are described. 4. It is pointed out that social, and/or geographic influences can cause changes of the body height calculated from skeleton material.

An interstitial tandem duplication of 9p23-24 coexists with a mutation in the BRCA2 gene in the germ line of three brothers with breast cancer

Germ-line mutations of the BRCA2 gene account for the majority of families with both male and female breast cancer. However, among independently ascertained families with the same mutation, cases of male breast cancer often appear to cluster in a single family or in a particular branch of one family. This suggests that the risk of male breast cancer conferred by BRCA2 mutations may be modified by other genetic or environmental factors. We report a family in which three brothers with breast cancer carry in their germ line two genetic abnormalities: an insertion A at nucleotide 2041 in exon 10 of BRCA2, which leads to premature termination of the encoded protein at codon 615, and a tandem interstitial duplication involving chromosome bands 9p23-24. We propose that the coexistence of this rare chromosomal abnormality with BRCA2 mutation may be augmenting the risk of male breast cancer conferred by the BRCA2 mutation.

Nurses referred to a peer assistance program for alcohol and drug problems

Investigation into nurses referred to peer assistance programs for substance abuse is essential to program development and the development of primary prevention strategies. The purpose of this study was to (1) describe the characteristics, substance use, and program participation of 221 nurses referred to a state nursing organization peer assistance program, and (2) identify factors associated with program participation. The highest percentage of nurses (63%) used narcotics; 36% had diverted drugs from patients for their own use. Sixty-four percent of the referred nurses successfully completed the program. This model was found to be effective in addressing substance abuse in nursing.

Drug and alcohol use of school-age children in a rural community

Drug abuse affects the physical and psychological well-being of the user as well as creating heavy societal costs--which are amplified if the user is a child. This study examined the relationship between drug and alcohol use and self-esteem, school climate, peer effects, and family climate among a small sample of fourth graders in a rural community.

Are CD44 variant isoforms involved in human tumour progression?

The transmembrane glycoprotein CD44 exists in a variety of isoforms generated by alternative splicing of the pre-mRNA. In a rat metastasis model, certain variant isoforms (containing exon 6v) are causally involved in lung metastasis formation. We have summarized the data obtained to date on the expression of CD44 variant isoforms in human tumour progression. In non-Hodgkin lymphomas, expression of exon 6v containing isoforms is an independent prognostic factor indicating an adverse prognosis. Upregulation of exon 9v containing isoforms in gastric and renal cell carcinomas relates to a poor prognosis of patients. In colorectal carcinomas, CD44-9v isoforms are strongly expressed already in early adenomas; CD44-6v isoforms are upregulated in late adenomas along with ras and TP53 mutations. No expression of variant isoforms has been detectable in neuroblastomas, but significant downregulation of CD44s correlates inversely with tumour progression and N-myc amplification. Only in breast carcinoma has no correlation of CD44 expression with survival or any other prognostic marker been established. Evaluation of CD44 isoform expression by immunohistochemistry in cases of non-Hodgkin lymphoma, gastric, colon and renal cell carcinomas, as well as neuroblastomas, may be a useful diagnostic parameter indicating invasive processes.

Faculty perceptions of teaching on television: one school's experience

Videoteleconferencing (or teaching on television) represents a means of growing importance for distant learners to gain greater access to nursing education. Research has identified a number of key issues for nurse educators to consider related to videoteleconferencing: teaching/evaluation strategies, faculty workload, rewards and incentives, and support structures. The authors conducted an evaluation survey using a case study approach aimed at describing the perceptions of a convenience sample of faculty members (n = 17) regarding their recent television experiences. The survey, conducted by means of a mailed questionnaire, examined perceptions centering on sources of support, reception site logistics, rewards teaching strategies, and future directions. Key findings included: overall, respondents perceived television teaching positively; reception site, administrative support, and peer support were important to faculty; additional preparation time was required for television teaching; teaching on television required changes in style and pedagogical strategies; and student-teacher interactions were affected by the medium. Findings have implications for the implementation of videoteleconferencing operations, recruitment of faculty for television teaching, and evaluation of videoteleconferencing operations.

Collaboration in distance education between nursing schools and hospitals

Interactive television (ITV) is being used by increasing numbers of nursing schools and hospitals to provide educational access to geographically diverse learners and nurse employees. ITV-related research suggests that learner outcomes and satisfaction with such distance education courses are similar to those associated with the traditional classroom. The authors conducted an evaluation of a major nursing school's nursing telecourse program (NTP) to assess collaborative efforts with hospitals and regional campuses. The respondents, 15 site coordinators, were generally satisfied with the operational aspects of the NTP. Concerns raised by respondents included classroom space availability, operational costs, library resources, and communication equipment and processes. These stakeholders' perspectives were viewed as valuable in identifying problems and making improvements in the school's NTP.