ABSTRACT
PURPOSE: Fabry disease frequently includes pain as an early disease feature, which was characterized as a dysfunctional processing of somatosensory information in various studies. The pathomechanism involves the mutation in the x-chromosomal GLA-gene and a consequent reduction of the α-galactosidase. This results in an insufficient reduction of globotriaosylceramide (GL3). Interestingly, an accumulation of GL3 was shown in both vascular endothelial cells and nerve tissue. This implicates that both an endothelial and nerve-dependent dysfunction may be considered as prominent mechanisms in pain pathogeneses. PATIENTS AND METHODS: The exploration of endothelial and C-fiber-dependent microcirculatory changes was conducted in a healthy cohort (n = 22) and in patients with polyneuropathy (n = 21) and Fabry disease (n = 15). Microcirculatory measurements were conducted using a laser speckle contrast analysis (LASCA) in combination with a thermoprobe controlling system, which applied a constant heat stimulus (42°C). Additionally, nerve fiber function was assessed via Quantitative Sensory Testing and heart rate variability (HRV). RESULTS: The results indicated a characteristic perfusion profile in the control group as well as both patient groups. Fabry patients had the smallest increase of endothelial-dependent perfusion as compared to the others [% increase as compared to Fabry: control + 129% (p = 0.002), PNP + 126% (p = 0.019)]. The sensory testing indicated a dysfunctional processing of A-delta fibers in Fabry disease as compared to healthy controls [cold detection threshold (CDT): p = 0.004, mechanical pain threshold (MPT): p = 0.007] and PNP patients (MPT: p = 0.001). CONCLUSION: Our results point to both an endothelial and a nerve-dependent dysfunction in Fabry disease. Therefore, not only direct changes in nerve fiber tissue may contribute to an altered sensory processing. Indeed, evidence of a perfusion change in vasa nervorum could also contribute to the dysfunctional processing of sensory information, which likely occurs under physical stress.
ABSTRACT
PURPOSE: Fabry disease belongs to lysosomal storage disorders and can be successfully treated today. On the contrary, the correct diagnostic classification of its symptoms can be challenging and most patients suffer from pain for years, until they are diagnosed correctly. The aim of this project was to characterize patients with unclassified extremity pain and to present a simple algorithm for a retrospective stratification approach. PATIENTS AND METHODS: The FabryScan includes a bedside-test and a questionnaire, consisting of 10 symptom-orientated and anamnestic questions. For the stratification of patients according to the likelihood for Fabry disease two different approaches were conducted. First, a prospective subgrouping based on the previously invented FabryScan evaluation system was conducted. The second retrospective approach consisted of a factor analysis and a subsequent two-way cluster analysis. Further on, 4 patients diagnosed with Fabry disease were stratified according to both approaches. RESULTS: In total, 183 completed datasets were included in the statistical analysis. The first approach prospectively classified patients into 3 subgroups (n=40 [likely], n=96 [possible], n=47 [unlikely]) according to the FabryScan evaluation system. The second approach retrospectively stratified patients into 3 subgroups (n=47 [cluster 1], n=95 [cluster 2], n=41 [cluster 3]). Finally, the Fabry patients were sorted to the subgroups, indicative for the highest possibility of Fabry disease in both stratification approaches A and B. CONCLUSION: Both stratification approaches sorted patients with confirmed Fabry disease to the subgroups, indicative for the highest likelihood for Fabry. These results indicate validity of the initially selected FabryScan outcome parameters.
ABSTRACT
Sirepo, a browser-based GUI for X-ray source and optics simulations, is presented. Such calculations can be performed using SRW (Synchrotron Radiation Workshop), which is a physical optics computer code, allowing simulation of entire experimental beamlines using the concept of a `virtual beamline' with accurate treatment of synchrotron radiation generation and propagation through the X-ray optical system. SRW is interfaced with Sirepo by means of a Python application programming interface. Sirepo supports most of the optical elements currently used at beamlines, including recent developments in SRW. In particular, support is provided for the simulation of state-of-the-art X-ray beamlines, exploiting the high coherence and brightness of modern light source facilities. New scientific visualization and reporting capabilities have been recently implemented within Sirepo, as well as automatic determination of electron beam and undulator parameters. Publicly available community databases can be dynamically queried for error-free access to material characteristics. These computational tools can be used for the development and commissioning of new X-ray beamlines and for testing feasibility and optimization of experiments. The same interface can guide simulation on a local computer, a remote server or a high-performance cluster. Sirepo is available online and also within the NSLS-II firewall, with a growing number of users at other light source facilities. Our open source code is available on GitHub.
