Next-generation sequencing testing in children with epilepsy reveals novel clinical, diagnostic and therapeutic implications

Introduction: Epilepsy is one of the commonest diseases in children, characterized by extensive phenotypic and genetic heterogeneity. This study was conducted to determine the diagnostic utility and to identify novel clinical and therapeutic implications of genetic testing in pediatric patients with epilepsy. Methods: Large multigene panel and/or exome sequencing was performed in 127 unrelated Polish and Ukrainian patients with suspected monogenic epilepsy. Diagnostic yields were presented for five phenotypic subgroups, distinguished by seizure type, electroencephalographic abnormalities, anti-seizure treatment response, and neurodevelopmental deficits. Results: A definite molecular diagnosis was established in 46 out of 127 cases (36%). Alterations in six genes were detected in more than one patient: SCN1A, MECP2, KCNT1, KCNA2, PCDH19, SLC6A1, STXBP1, and TPP1, accounting for 48% of positive cases. 4/46 cases (8.7%) were mosaic for the variant. Although the highest rates of positive diagnoses were identified in children with developmental delay and generalized seizures (17/41, 41%) and in developmental end epileptic encephalopathies (16/40, 40%), a monogenic etiology was also frequently detected in patients with solely focal seizures (10/28, 36%). Molecular diagnosis directly influenced anti-seizure management in 15/46 cases. Conclusion: This study demonstrates the high diagnostic and therapeutic utility of large panel testing in childhood epilepsies irrespective of seizure types. Copy number variations and somatic mosaic variants are important disease-causing factors, pointing the need for comprehensive genetic testing in all unexplained cases. Pleiotropy is a common phenomenon contributing to the growing phenotypic complexity of single-gene epilepsies.

Comparison of knowledge and awareness of epilepsy between medical students of two universities in Poland

BACKGROUND

Epilepsy is one of the most common neurological disorders. As a chronic disease, associated with long-term treatment with antiseizure medication, it can have a negative impact on patients' quality of life. Moreover, patients are faced with a significant psychosocial burden associated with the stigma surrounding epilepsy. Medical professionals should be well educated and free of prejudices in order to provide adequate care for patients with epilepsy. The aim of the study was to evaluate the knowledge and awareness of epilepsy among medical students of years 1-6 in Poland and examine if certain personality traits influence students' view of epilepsy.

METHODS

The study was conducted using snowball sampling of 166 Polish medical students from Medical University of Gdansk and Medical University of Warsaw. Participants completed a survey which consisted of their subjective assessment of knowledge of epileptology, actual knowledge of epileptology, and their view of stereotypes about epilepsy. In addition, students completed the IPIP-BFM-20 personality questionnaire.

RESULTS

Polish medical students have sufficient basic knowledge about epilepsy (mean scores of students from both universities is 14 out of 25 points). There is still room for improvement, especially in the field of epidemiology, semiology, factors provoking seizures, antiseizure medications, and most importantly about first aid during seizure (e.g., 7% of respondents believed it is necessary to put something between teeth of a patient during seizure). Age and the year of study were well correlated with knowledge score (p = 0.008) and level of awareness of the stereotypes. We found that most personality traits do not have a strong impact on the level of knowledge about epilepsy.

CONCLUSIONS

Most students have a satisfying level of knowledge about epilepsy. Academic teachers should put more emphasis on first aid during seizures and awareness of psychosocial challenges associated with the disease. It is crucial for future physicians to not only possess sufficient theoretical knowledge, but also establish an empathetic doctor-patient relationship in order to provide better care for patients with epilepsy and other chronic diseases.

Wild Mammals in the Economy of Wrocław (Poland) as an Example of a Medieval and Modern Era City in the Light of Interdisciplinary Research

The purpose of this article was to determine the role of wild animals in the economy of a historical city on the basis of archaeological and cultural layers of medieval and early modern Wrocław from the 11th to the 17th century. Archaeozoological analyses were applied, mainly encompassing the percentage share of particular animal species and the research of material culture, i.e., items manufactured from bones, antlers and hides of wild animals. The collected data were compared with written sources. As a result of the following analysis, a low but stable frequency of bone remains in urban layers and is evidence for occasional breaching of the medieval hunting laws by burghers, possibly driven by the opportunity to sell meat and other wild animal products on the markets. Moreover, the relatively low amounts of items made from bones, antlers and wild animal leather may indicate low availability or seasonality (shed antler) of the materials, which might have indirectly raised the product price. Additionally, the area around Wrocław did not feature large forest complexes, which are habitats of wild game, thus explaining the low frequency of wild animal remains in the archaeozoological material.

Time evolution of the action potential in plant cells

In this paper we extend and reconsider a solitonic model of the actionpotential in biological membranes for the case of plant cells. Aiming togive at least a qualitative description of the K(+),Cl(-) and Ca(2+) driven process of propagation ofthe action potential along plant cells we put forward the hypothesis ofthree scalar fields φ(i) (X), i = 1, 2, 3 which representK(+), Cl(-) and Ca(2+) ions,respectively. The modulus squared of these fields carries the usualquantum-mechanical (probabilistic) interpretation of the wave function. Onthe other hand, the fields are described themselves by the Lagrangiandensities ℒ[Formula: see text]. Moreover, the interaction and self-interaction term ℒ[Formula: see text] between thefields is considered. The Lagrangian densities ℒ[Formula: see text]include a double-well potential (which is proportional toσ(4) (i)) that leads to spontaneous symmetrybreaking which may produce structures with non-zero topological charge, e.g.longitudinal solitons. In order to describe the transversal motion of theions of concern we need to assume only non-uniform solutions of the system of equation of motion. Hence we seek for solutions (travelling waves) whichpreserve the shape and which move without dissipation and in this way wereconstruct the main dynamical features of the action potential in plants.

Effect of temperature on plant elongation and cell wall extensibility

Lockhart equation was derived for explaining plant cell expansion where both cell wall extension and water uptake must occur concomitantly. Its fundamental contribution was to express turgor pressure explicitly in terms of osmosis and wall mechanics. Here we present a new equation in which pressure is determined by temperature. It also accounts for the role of osmosis and consequently the role of water uptake in growing cell. By adopting literature data, we also attempt to report theoretically the close relation between plant elongation and cell wall extensibility. This is accomplished by the modified equation of growth solved for various temperatures in case of two different species. The results enable to interpret empirical data in terms of our model and fully confirm its applicability to the investigation of the problem of plant cell extensibility in function of environmental temperature. Moreover, by separating elastic effects from growth process we specified the characteristic temperature common for both processes which corresponds to the resonance energy of biochemical reactions as well as to the rapid softening of the elastic modes toward the high temperature end where we encountered viscoelastic and/or plastic behavior as dominating. By introducing analytical formulae connected with growth and elastic properties of the cell wall, we conclude with the statement how these both processes contribute quantitatively to the resonance-like shape of the elongation curve. In addition, the tension versus temperature "phase diagram" for a living plant cell is presented.

Anisotropic plant cell elongation due to ortho-gravitropism

In this article we elucidate the well-known biological phenomenon (geotropism) as governed by physical mechanisms, resulting from internal biochemical reactions, in terms of mathematics. Gravitropism causes vertical orientation of plant's axis and in its special cases of positive (root) and negative (stem) geotropism together is called ortho-geotropism. It represents one of the most rapid and visually obvious response of plants to the influence of gravitational field. Seeking for approximate description for this phenomenon we confine to a single cell approach and we begin with the Lockhart equation considering a plant cell as a homogeneous one. In principle, the latter should also account for the existing anisotropies due to mechanical stresses (auxin redistribution). Hence, all global quantities like internal pressure or turgor threshold become direction dependent and consequently acquire tensor representation. Moreover, by involving explicitly time dependence the tensor differential equation becomes a dynamic one. In the context of ortho-geotropism, where gravitational field causes movement of phytohormones and mobile particles following gravity (statolith theory) a basic solution of our tensor equation is found and detailed step by step derivations are presented. By considering only positive (root) geotropism we may, however, extend our solution to the stem bending even though the biological mechanisms differ. Both solutions represent two possible empirical situations which have been probed and verified worldwide ever since.

Anisotropic plant growth due to phototropism

Phototropism--the directional curvature of organs in response to lateral differences in light intensity and/or quality--represents one of the most rapid and visually obvious reaction of plants to changes in their light environment. It is a topic of fundamental interest to understand the mechanics of plants during growth. We propose a generalization of the scalar Lockhart model (1965) to three dimensional deformation, solve the new equation in two particular cases and compare results with empirical data. We believe that carefully designed experiments linked to our model will provide (by determining the active transport coefficient) a new method for qualitative description of auxin redistribution during phototropism. The proposed method supplements very recent investigations concerning specific auxin-influx and -efflux carriers (LAX and PIN proteins).

Theoretical search for the growth-temperature relationship in plants

In this article we deal with the definition of a new phenomenological model with physical bases for the response of short-term cell expansion growth to temperature. Although the interest on both the biomechanical bases of elongation growth and on temperature responses has a long lasting development in plant biology and biophysics, yet the question of the mode of actions of temperature is a very relevant and still open one. The purpose of our paper was not to deal with all the complexity of the possible effects of temperature on a growing cell but to concentrate on two more focused questions: i) whether it is possible to specify an optimal temperature for growth responses all along development by defining some phenomenological equations for temperature response, ii) can we learn something from that on the temperature dependence of the cell wall expansion process using a minimal analytical modelling? To answer both questions we introduce (by extending Lockhart approach) the notion of temperature by simple thermodynamical reasoning. Assuming incompressibility of water (by the constant molar density n/V ) we also accounted for the role of osmosis and consequently - the role of water uptake in growing cell. This approach allowed us (by comparing theoretical solutions and experimental results) not only to determine the specific (resonance) temperature (or corresponding absorption energy kBT*) of the optimal growth but also draw conclusions about the cell wall extensibility dependence on temperature and its evolution in time. A straightforward application of our method to determine optimum growth temperature for different plant species in a greenhouse practice (as its simple implication) can also be recommended.

The effect of lead on the photoelectric reaction of Zea mays L. plants

We investigate the correlation between the concentrations of lead (10(-6)-10(-2) mol dm(-3) PbCl2) in the external medium and photoelectric reaction of Zea mays L. plants. The experiments were carried out on 8-10-day-old maize plants (Zea mays L. var. K33 x F2) with the use of conventional electrophysiological technique. The results suggest that in plants treated with lead ions the photoelectric reaction is significantly reduced. The pH variation of the incubation medium including the green fragments of leaves showed that lead ions caused inhibition of light-induced external acidification.

Abnormality of spontaneous lymphokine synthesis by lymphocytes of patients with connective tissue disorders

Forty-seven patients with various connective tissue disorders were studied to evaluate the spontaneous release of lymphocyte factors affecting the in vitro migration of guinea pig macrophages. In the assay used the lymphocytes from 8 patients produced an excessive amount of factors inhibiting macrophage migration while the lymphocytes from 12 patients produced an enhancement of migration. There were no differences in the delayed hypersensitivity skin test responses between the 2 groups of patients. The data are consistent with either an abnormality of suppressor lymphocyte function or an altered lymphocyte subpopulation relationship as a factor in this in vitro abnormality.

Rhabdomyosarcoma arising within a cystosarcoma phyllodes. Case report and review of the literature

Rhabdomyosarcoma of the breast is a rare tumor that is characterized by its rapid growth, large size, and poor prognosis. It most often presents as a pure neoplasm and infrequently as the stromal component of a cystosarcoma phyllodes. The clinical and pathological features of a cystosarcoma with a rhabdomyosarcomatous stroma occurring in a 45-year-old woman are presented, and the results are discussed in reference to the 24 published cases of mammary rhabdomyosarcoma. The patient was treated by radical mastectomy and died 2.5 years later with pulmonary and cerebral metastases. Though two long-term survivors have been reported, cures are infrequent and no form of therapy has been uniformly successful.

Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases

A retrospective clinicopathologic evaluation of 42 patients with cystosarcoma phyllodes was undertaken to determine if tumor size, contour, degree of stromal atypia and mitotic activity were reliable indicators of clinical behavior. Excluding size, the latter three determinants showed a positive correlation with prognosis and served as the basis of a classification in which 18 benign, 5 borderline and 19 malignant cystosarcomas were diagnosed. The tumors occurred in women averaging 44.3 years of age who most often presented with a palpable occasionally painful mass with a median diameter of 5 cm. Excision or simple mastectomy were the more frequent forms of therapy. Local recurrences were experienced by 6 patients and occurred in all 3 categories of tumor. Only malignant neoplasms developed systemic metastases which was observed in 4 patients 3 of which have died. On borderline tumor recurred 14 times and eventually proved fatal as a result of contiguous pulmonary involvement. A plea is made to label the stroma of malignant cystosarcomas as to the cell(s) of origin so future investigators may evaluate the effect of various soft tissue patterns on prognosis.

Malignant meningioma: ultrastructure and observations on histogenesis

A malignant meningioma was studied by light and electron microscopy. Histologically, the tumour was composed predominantly of spindle shaped cells arranged in interlacing bundles with numerous mitoses and much nuclear atypia. There were many necrotic foci as well as invasion of the cerebral cortex, dura mater and blood vessels. Ultrastructurally, the main findings included moderate plasma membrane interdigitation, many intracytoplasmic filaments, and junctional attachments of three kinds: desmosomes, hemidesmosomes, and zonulae adhaerentes. These subcellular features are suggestive of arachnoidal cell origin.

Sarcomas of the breast: a clinicopathologic analysis of ten cases

The clinical and pathologic features of ten mammary sarcomas are discussed. Tumor size, contour, degree of cellular atypia, and mitotic activity were specifically evaluated to determine if they are important indiced of clinical behavior. Results indicate that infiltrating margins, 2-3+ stromal atypia, and eight or more mitoses per 10 HPF are characteristics of neoplasms associated with a poor prognosis. Tumor size was an unreliable criterion. A classification of breast sarcomas is presented with an appeal to avoid use of the term "stromal sarcoma" as a specific pathologic diagnosis. Since a diagnosis based upon cell of origin and correlated with the above morphologic features is fundamental to an intelligent therapeutic approach to this rare group of neoplasms, future reports dealing with this subject should include these details.

Sarcomas of the breast: a clinicopathologic analysis of ten cases

The clinical and pathologic features of ten mammary sarcomas are discussed. Tumor size, contour, degree of cellular atypia, and mitotic activity were specifically evaluated to determine if they are important indiced of clinical behavior. Results indicate that infiltrating margins, 2-3+ stromal atypia, and eight or more mitoses per 10 HPF are characteristics of neoplasms associated with a poor prognosis. Tumor size was an unreliable criterion. A classification of breast sarcomas is presented with an appeal to avoid use of the term "stromal sarcoma" as a specific pathologic diagnosis. Since a diagnosis based upon cell of origin and correlated with the above morphologic features is fundamental to an intelligent therapeutic approach to this rare group of neoplasms, future reports dealing with this subject should include these details.