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Marcinkevics Z, Rubins U, Aglinska A, Logina I, Glazunovs D, Grabovskis A. Contactless photoplethysmography for assessment of small fiber neuropathy. Front Physiol 2023; 14:1180288. [PMID: 37727661 PMCID: PMC10505793 DOI: 10.3389/fphys.2023.1180288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023] Open
Abstract
Chronic pain is a prevalent condition affecting approximately one-fifth of the global population, with significant impacts on quality of life and work productivity. Small fiber neuropathies are a common cause of chronic pain, and current diagnostic methods rely on subjective self-assessment or invasive skin biopsies, highlighting the need for objective noninvasive assessment methods. The study aims to develop a modular prototype of a contactless photoplethysmography system with three spectral bands (420, 540, and 800 nm) and evaluate its potential for assessing peripheral neuropathy patients via a skin topical heating test and spectral analyses of cutaneous flowmotions. The foot topical skin heating test was conducted on thirty volunteers, including fifteen healthy subjects and fifteen neuropathic patients. Four cutaneous nerve fiber characterizing parameters were evaluated at different wavelengths, including vasomotor response trend, flare area, flare intensity index, and the spectral power of cutaneous flowmotions. The results show that neuropathic patients had significantly lower vasomotor response (50%), flare area (63%), flare intensity index (19%), and neurogenic component (54%) of cutaneous flowmotions compared to the control group, independent of photoplethysmography spectral band. An absolute value of perfusion was 20%-30% higher in the 420 nm band. Imaging photoplethysmography shows potential as a cost-effective alternative for objective and non-invasive assessment of neuropathic patients, but further research is needed to enhance photoplethysmography signal quality and establish diagnostic criteria.
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Affiliation(s)
- Zbignevs Marcinkevics
- Department of Human and Animal Physiology, Faculty of Biology, University of Latvia, Riga, Latvia
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Riga, Latvia
| | - Uldis Rubins
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Riga, Latvia
| | - Alise Aglinska
- Department of Human and Animal Physiology, Faculty of Biology, University of Latvia, Riga, Latvia
| | - Inara Logina
- Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia
| | - Dmitrijs Glazunovs
- Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia
| | - Andris Grabovskis
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Riga, Latvia
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Marcinkevics Z, Aglinska A, Rubins U, Grabovskis A. Remote Photoplethysmography for Evaluation of Cutaneous Sensory Nerve Fiber Function. SENSORS 2021; 21:s21041272. [PMID: 33670087 PMCID: PMC7916836 DOI: 10.3390/s21041272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
About 2% of the world’s population suffers from small nerve fiber dysfunction, neuropathy, which can result in severe pain. This condition is caused by damage to the small nerve fibers and its assessment is challenging, due to the lack of simple and objective diagnostic techniques. The present study aimed to develop a contactless photoplethysmography system using simple instrumentation, for objective and non-invasive assessment of small cutaneous sensory nerve fiber function. The approach is based on the use of contactless photoplethysmography for the characterization of skin flowmotions and topical heating evoked vasomotor responses. The feasibility of the technique was evaluated on volunteers (n = 14) using skin topical anesthesia, which is able to produce temporary alterations of cutaneous nerve fibers function. In the treated skin region in comparison to intact skin: neurogenic and endothelial component of flowmotions decreased by ~61% and 41%, the local heating evoked flare area decreased by ~44%, vasomotor response trend peak and nadir were substantially reduced. The results indicate for the potential of the remote photoplethysmography in the assessment of the cutaneous nerve fiber function. It is believed that in the future this technique could be used in the clinics as an affordable alternative to laser Doppler imaging technique.
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Affiliation(s)
- Zbignevs Marcinkevics
- Department of Human and Animal Physiology, Faculty of Biology, University of Latvia, Jelgavas St.1, LV-1004 Riga, Latvia
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Jelgavas St. 3, LV-1004 Riga, Latvia; (A.A.); (U.R.); (A.G.)
- Correspondence:
| | - Alise Aglinska
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Jelgavas St. 3, LV-1004 Riga, Latvia; (A.A.); (U.R.); (A.G.)
| | - Uldis Rubins
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Jelgavas St. 3, LV-1004 Riga, Latvia; (A.A.); (U.R.); (A.G.)
| | - Andris Grabovskis
- Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Jelgavas St. 3, LV-1004 Riga, Latvia; (A.A.); (U.R.); (A.G.)
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Strömberg T, Sjöberg F, Bergstrand S. Temporal and spatiotemporal variability in comprehensive forearm skin microcirculation assessment during occlusion protocols. Microvasc Res 2017; 113:50-55. [PMID: 28455225 DOI: 10.1016/j.mvr.2017.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
Forearm skin hyperemia during release after brachial occlusion has been proposed for evaluating peripheral arterial disease and endothelial dysfunction. We used a novel fiberoptic system integrating Laser Doppler Flowmetry and Diffuse Reflectance Spectroscopy for a comprehensive pointwise model based microcirculation characterization. The aim was to evaluate and compare the temporal and the spatiotemporal variabilities in forearm skin microcirculation parameters (speed resolved perfusion; low speed <1mm/s, PerfSR, <1; mid-speed 1-10mm/s, high speed >10mm/s, and total perfusion (PerfSR, tot); the concentration and oxygenation of red blood cells, CRBC and SO2). Ten healthy subjects underwent arterial and venous forearm occlusions (AO, VO), repeated within one week. The repeatability was calculated as the coefficient of variation (CV) and the agreement as the intra-class correlation coefficient (ICC). The temporal CVs for conventional perfusion, Perfconv, PerfSR, tot, CRBC and SO2 were 14%, 12%, 9% and 9%, respectively, while the ICC were >0.75 (excellent). The perfusion measures generally had a higher spatiotemporal than temporal variability, which was not the case for SO2 and CRBC. The corresponding spatiotemporal CVs were 33%, 32%, 18% and 15%, respectively. During VO, CRBC had a CV<35% and ICC>0.40 (fair-good), and after release this was the case for CRBC (AO and VO), SO2 (VO) and PerfSR, <1 (VO). In conclusion, the skin microcirculation parameters showed excellent temporal repeatability, while the spatiotemporal repeatability especially for perfusion was poorer. The parameters with acceptable repeatability and fair-good agreement were: CRBC during and after release of VO, the PerfSR, <1 after release of VO, the SO2 and the CRBC after release of AO. However, the value of these parameters in discriminating endothelial function remains to be studied.
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Affiliation(s)
- Tomas Strömberg
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden.
| | - Folke Sjöberg
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sara Bergstrand
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Abraham A, Alabdali M, Alsulaiman A, Breiner A, Barnett C, Katzberg HD, Lovblom LE, Perkins BA, Bril V. Laser Doppler Flare Imaging and Quantitative Thermal Thresholds Testing Performance in Small and Mixed Fiber Neuropathies. PLoS One 2016; 11:e0165731. [PMID: 27824912 PMCID: PMC5100917 DOI: 10.1371/journal.pone.0165731] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/17/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction Small fiber neuropathy might be a part of typical mixed small and large fiber neuropathy, or a distinct entity, affecting exclusively small nerve fibers. Objectives Explore the utility of small nerve fiber testing in patients with clinical presentation suggesting small fiber neuropathy, with and without evidence for concomitant large fiber neuropathy. Methods Patients attending the neuromuscular clinic from 2012 to 2015 with a clinical presentation suggesting small nerve fiber impairment, who had Laser Doppler flare imaging (LDIFlare) and quantitative thermal testing (QTT) were evaluated for this study. Patients with clinical or electrophysiological evidence for concomitant large fiber neuropathy were not excluded. Results The sensitivities of LDIFlare, cooling and heat threshold testing were 64%, 36%, and 0% respectively for clinically highly suggestive small fiber neuropathy, 64%, 56%, and 19% respectively for mixed fiber neuropathy, and 86%, 79%, and 29% respectively for diabetic mixed fiber neuropathy. Discussion LDIFlare and cooling thresholds testing are non-invasive small nerve fiber testing modalities, with moderate performance in patients with small and mixed fiber neuropathy, and excellent performance in diabetic mixed fiber neuropathy.
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Affiliation(s)
- Alon Abraham
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Majed Alabdali
- Department of Neurology, King Fahad Hospital of the University, University of Dammam, Dammam, Saudi Arabia
| | - Abdulla Alsulaiman
- Department of Neurology, King Fahad Hospital of the University, University of Dammam, Dammam, Saudi Arabia
| | - Ari Breiner
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Carolina Barnett
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Hans D. Katzberg
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Leif E. Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Bruce A. Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
- * E-mail:
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Amirova LE, Navasiolava NM, Bareille MP, Beck A, Tomilovskaya ES, Kozlovzkaya IB, Gauquelin-Koch G, Gharib C, Custaud MA. Effects of plantar stimulation on cardiovascular response to orthostatism. Eur J Appl Physiol 2016; 116:2257-2266. [PMID: 27688160 DOI: 10.1007/s00421-016-3479-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/22/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Walking is a complex locomotor process that involves both spinal cord reflexes and cortical integration of peripheral nerve input. Maintaining an upright body position requires not only neuromuscular activity but also cardiovascular regulation. We postulated that plantar mechanical stimulation might modulate autonomic nervous system activity and, thereby, impact blood pressure adaptation during standing. METHODS Twelve healthy subjects underwent three randomly ordered 45-min 70°-saddle tilt tests while the plantar surfaces of the feet were stimulated using specially engineered Korvit boots in the following modes: (1) no stimulation, (2) disrupted stimulation, and (3) walking mode. Orthostatic tolerance time was measured for each trial. During testing, we obtained an electrocardiogram and measured blood pressure, skin blood flow, and popliteal vein cross-sectional area. We estimated central hemodynamics, baroreflex sensitivity and heart rate variability. RESULTS Orthostatic tolerance time was not found to differ significantly between test conditions (37.2 ± 10.4, 40.9 ± 7.6, and 41.8 ± 8.2 min, for no stimulation, disrupted stimulation, and walking mode, respectively). No significant differences between treatment groups were observed for stroke volume or cardiac baroreflex sensitivity, both of which decreased significantly from baseline during tilt testing in all groups. Cardiac sympathetic index and popliteal vein cross-sectional area increased at the end of the tilt period in all groups, without significant differences between treatments. CONCLUSIONS Plantar mechanical stimulation is insufficient for immediate modulation of cardiac sympathetic and parasympathetic activity under orthostatic stress.
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Affiliation(s)
- Liubov E Amirova
- Laboratoire BNMI, Faculté de Médecine, UMR CNRS 6214, INSERM 1083, 49045, Angers Cedex, France
- Institute for Biomedical Problems, Moscow, Russia
| | | | | | - Arnaud Beck
- Institute for Space Medicine and Physiology (MEDES), Toulouse, France
| | | | | | | | - Claude Gharib
- Claude Bernard University, Lyon, France
- CIDO, Saint Etienne, France
| | - Marc-Antoine Custaud
- Laboratoire BNMI, Faculté de Médecine, UMR CNRS 6214, INSERM 1083, 49045, Angers Cedex, France.
- CRC, Clinical Research Center, Angers University Hospital, Angers, France.
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Nieuwenhoff MD, Wu Y, Huygen FJPM, Schouten AC, van der Helm FCT, Niehof SP. Reproducibility of axon reflex-related vasodilation assessed by dynamic thermal imaging in healthy subjects. Microvasc Res 2016; 106:1-7. [PMID: 26956622 DOI: 10.1016/j.mvr.2016.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Small nerve fiber dysfunction is an early feature of diabetic neuropathy. There is a strong clinical need for a non-invasive method to assess small nerve fiber function. Small nerve fibers mediate axon reflex-related vasodilation and play an important role in thermoregulation. Assessing the reflex vasodilation after local heating might elucidate some aspects of small fiber functioning. In this study, we determined the reproducibility of the reflex vasodilation after short local heating in healthy subjects, assessed with thermal imaging and laser Doppler imaging. METHODS Healthy subjects underwent six heating rounds in one session (protocol I, N=10) or spread over two visits (protocol II, N=20). Reflex vasodilation was elicited by heating the skin to 42°C with an infrared lamp. Skin temperature and skin blood flow were recorded during heating and recovery with a thermal imaging camera and a laser Doppler imager. Skin temperature curves were fitted with a mathematical model to describe the heating and recovery phase with time constant tau (tauHeat and tauCool1). RESULTS The reproducibility of tau within a session was moderate to excellent (intra-class correlation coefficient 0.42-0.86) and good (0.71-0.72) between different sessions. Within one session the differences in tauHeat were small (bias±SD -1.3±18.9s); the bias between two visits was -1.2±12.2s. For tauCool1 the differences were also small, 1.4±6.6s within a session and between visits -1.4±11.6s. CONCLUSIONS The heat induced axon reflex-related vasodilation, assessed with thermal imaging and laser Doppler imaging, was reproducible both within a session and between different sessions. Tau describes the temporal profile in one parameter and represents the effects of all changes including blood flow and as such, is an indicator of the vasodilator function. TauHeat and tauCool1 can accurately describe the dynamics of the axon reflex-related vasodilator response in the heating and recovery phase respectively.
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Affiliation(s)
- M D Nieuwenhoff
- Department of Anesthesiology and Pain Medicine, Erasmus MC University Medical Center, Room Ba-430, P.O. box 2040, 3000CA Rotterdam, The Netherlands.
| | - Y Wu
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlands.
| | - F J P M Huygen
- Department of Anesthesiology and Pain Medicine, Erasmus MC University Medical Center, Room Ba-430, P.O. box 2040, 3000CA Rotterdam, The Netherlands.
| | - A C Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlands; Department of Biomechanical Engineering, MIRA Institute, University of Twente, Building Zuidhorst, P.O. box 217, 7500AE Enschede, The Netherlands.
| | - F C T van der Helm
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlands.
| | - S P Niehof
- Department of Anesthesiology and Pain Medicine, Erasmus MC University Medical Center, Room Ba-430, P.O. box 2040, 3000CA Rotterdam, The Netherlands.
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Charlot K, Romana M, Moeckesch B, Jumet S, Waltz X, Divialle-Doumdo L, Hardy-Dessources MD, Petras M, Tressières B, Tarer V, Hue O, Etienne-Julan M, Antoine-Jonville S, Connes P. Which side of the balance determines the frequency of vaso-occlusive crises in children with sickle cell anemia: Blood viscosity or microvascular dysfunction? Blood Cells Mol Dis 2016; 56:41-5. [DOI: 10.1016/j.bcmd.2015.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 10/26/2015] [Indexed: 02/08/2023]
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Dawson EA, Low DA, Meeuwis IH, Kerstens FG, Atkinson CL, Cable NT, Green DJ, Thijssen DH. Reproducibility of Cutaneous Vascular Conductance Responses to Slow Local Heating Assessed Using seven-Laser Array Probes. Microcirculation 2015; 22:276-84. [DOI: 10.1111/micc.12196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/18/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ellen A. Dawson
- Research Institute for Sport and Exercise Science; Liverpool John Moores University; Liverpool UK
| | - David A. Low
- Research Institute for Sport and Exercise Science; Liverpool John Moores University; Liverpool UK
| | - Iris H.M. Meeuwis
- Research Institute for Sport and Exercise Science; Liverpool John Moores University; Liverpool UK
| | - Floor G. Kerstens
- Research Institute for Sport and Exercise Science; Liverpool John Moores University; Liverpool UK
| | - Ceri L. Atkinson
- School of Sport Science, Exercise and Health; The University of Western Australia; Crawley Western Australia Australia
| | - Nigel Timothy Cable
- Research Institute for Sport and Exercise Science; Liverpool John Moores University; Liverpool UK
| | - Daniel J. Green
- Research Institute for Sport and Exercise Science; Liverpool John Moores University; Liverpool UK
- School of Sport Science, Exercise and Health; The University of Western Australia; Crawley Western Australia Australia
| | - Dick H.J. Thijssen
- Research Institute for Sport and Exercise Science; Liverpool John Moores University; Liverpool UK
- Department of Physiology; Radboud University Nijmegen Medical Centre; Nijmegen the Netherlands
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Increasing acclimation period improves the reproducibility of short-heating local thermal hyperemia. Microvasc Res 2013; 85:93-8. [DOI: 10.1016/j.mvr.2012.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 10/24/2012] [Accepted: 11/05/2012] [Indexed: 01/05/2023]
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Medow MS, Aggarwal A, Baugham I, Messer Z, Stewart JM. Modulation of the axon-reflex response to local heat by reactive oxygen species in subjects with chronic fatigue syndrome. J Appl Physiol (1985) 2012; 114:45-51. [PMID: 23139367 DOI: 10.1152/japplphysiol.00821.2012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Local cutaneous heating causes vasodilation as an initial first peak, a nadir, and increase to plateau. Reactive oxygen species (ROS) modulate the heat plateau in healthy controls. The initial peak, due to C-fiber nociceptor-mediated axon reflexes, is blunted with local anesthetics and may serve as a surrogate for the cutaneous response to peripheral heat. Chronic fatigue syndrome (CFS) subjects report increased perception of pain. To determine the role of ROS in this neurally mediated response, we evaluated changes in cutaneous blood flow from local heat in nine CFS subjects (16-22 yr) compared with eight healthy controls (18-26 yr). We heated skin to 42°C and measured local blood flow as a percentage of maximum cutaneous vascular conductance (%CVC(max)). Although CFS subjects had significantly lower baseline flow [8.75 ± 0.56 vs. 12.27 ± 1.07 (%CVC(max), CFS vs. control)], there were no differences between groups to local heat. We then remeasured this with apocynin to inhibit NADPH oxidase, allopurinol to inhibit xanthine oxidase, tempol to inhibit superoxide, and ebselen to reduce H(2)O(2). Apocynin significantly increased baseline blood flow (before heat, 14.91 ± 2.21 vs. 8.75 ± 1.66) and the first heat peak (69.33 ± 3.36 vs. 59.75 ± 2.75). Allopurinol and ebselen only enhanced the first heat peaks (71.55 ± 2.48 vs. 61.72 ± 2.01 and 76.55 ± 5.21 vs. 58.56 ± 3.66, respectively). Tempol had no effect on local heating. None of these agents changed the response to local heat in control subjects. Thus the response to heat may be altered by local levels of ROS, particularly H(2)O(2) in CFS subjects, and may be related to their hyperesthesia/hyperalgesia.
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Affiliation(s)
- Marvin S Medow
- Department of Pediatrics, New York Medical College and The Center for Pediatric Hypotension, Hawthorne, New York 10532, USA.
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