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Ud-Din S, Bayat A. Noninvasive Objective Tools for Quantitative Assessment of Skin Scarring. Adv Wound Care (New Rochelle) 2022; 11:132-149. [PMID: 33966482 DOI: 10.1089/wound.2020.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Significance: Many treatments are utilized in the management of skin scarring; however, difficulties arise due to the high rates of recurrence and the identification of treatment efficacy in each patient, in particular, in the case of raised dermal scarring. Therefore, evaluation of treatments and the provision of objective scar assessment pre-therapy and post-therapy is of paramount importance to identify changes in scar characteristics using noninvasive devices. Recent Advances: There have been a number of emerging noninvasive objective quantitative devices, which assess specific scar parameters such as pliability, volume, color, perfusion, and depth. These can include three-dimensional imaging, optical coherence tomography, in vivo confocal microscopy, full-field laser perfusion imaging, and spectrophotometric intracutaneous analysis. Critical Issues: Clinical assessment and grading scales are most commonly used to assess scarring; however, there is a need for more objective quantitative measures to monitor their maturation and response to therapy. Currently, there is no consensus as to which objective measuring device is most optimal when assessing skin scarring. There is a need for a predictor tool that allows early implementation of treatment and addresses diagnosis, therapy, and prognosis. Future Directions: Validation of noninvasive objective scar assessment tools is essential as well as further development of technologies. There are currently more modalities that assess physical scar characteristics and only few that measure the physiological parameters. Therefore, the development of a technology that quantifies the metabolic and cellular activity in skin scars is necessary to allow for bespoke strategies for each patient.
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Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, England, United Kingdom
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, England, United Kingdom
- MRC-SA Wound Healing Unit, Division of Dermatology, University of Cape Town, Cape Town, South Africa
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Khadka N, Bikson M. Role of skin tissue layers and ultra-structure in transcutaneous electrical stimulation including tDCS. Phys Med Biol 2020; 65:225018. [PMID: 32916670 DOI: 10.1088/1361-6560/abb7c1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND During transcranial electrical stimulation (tES), including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS), current density concentration around the electrode edges that is predicted by simplistic skin models does not match experimental observations of erythema, heating, or other adverse events. We hypothesized that enhancing models to include skin anatomical details, would alter predicted current patterns to align with experimental observations. METHOD We develop a high-resolution multi-layer skin model (epidermis, dermis, and fat), with or without additional ultra-structures (hair follicles, sweat glands, and blood vessels). Current flow patterns across each layer and within ultra-structures were predicted using finite element methods considering a broad range of modeled tissue parameters including 78 combinations of skin layer conductivities (S m-1): epidermis (standard: 1.05 × 10-5; range: 1.05 × 10-6 to 0.465); dermis (standard: 0.23; range: 0.0023 to 23), fat (standard: 2 × 10-4; range: 0.02 to 2 × 10-5). The impact of each ultra-structures in isolation and combination was evaluated with varied basic geometries. An integrated final model is then developed. RESULTS Consistent with prior models, current flow through homogenous skin was annular (concentrated at the electrode edges). In multi-layer skin, reducing epidermis conductivity and/or increasing dermis conductivity decreased current near electrode edges, however no realistic tissue layer parameters produced non-annular current flow at both epidermis and dermis. Addition of just hair follicles, sweat glands, or blood vessels resulted in current peaks around each ultrastructure, irrespective of proximity to electrode edges. Addition of only sweat glands was the most effective approach in reducing overall current concentration near electrode edges. Representation of blood vessels resulted in a uniform current flow across the vascular network. Finally, we ran the first realistic model of current flow across the skin. CONCLUSION We confirm prior models exhibiting current concentration near hair follicles or sweat glands, but also exhibit that an overall annular pattern of current flow remains for realistic tissue parameters. We model skin blood vessels for the first time and show that this robustly distributes current across the vascular network, consistent with experimental erythema patterns. Only a state-of-the-art precise model of skin current flow predicts lack of current concentration near electrode edges across all skin layers.
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Affiliation(s)
- Niranjan Khadka
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY 10031, United States of America
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A test-retest reliability study of assessing small cutaneous fibers by measuring current perception threshold with pin electrodes. PLoS One 2020; 15:e0242490. [PMID: 33201884 PMCID: PMC7671533 DOI: 10.1371/journal.pone.0242490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022] Open
Abstract
Background The quantitative measurement of current perception threshold (CPT) has been used as a method to assess the function of nerve fibers in neuropathy diseases. The aim of this study was to assess the test-retest reliability measuring CPT using the circular pin electrodes for assessing the function of cutaneous thin nerve fibers. Methods CPT measurement was repeated on two separate days with at least one-week interval in 55 volunteers. Superficial blood flow (SBF) and skin temperature (ST) were measured on the skin in an around area concentric to the circular pin electrodes after the process of finding CPTs. The coefficient of variation (CV) and intra-class correlation coefficient (ICC) were calculated. The correlation between each two of CPT, SBF increment and ST increment was analyzed. Results No significant differences were found for CPT, SBF and ST between two sessions. SBF was found to be significantly increased after the process of finding CPT. CPT values of males were found to be higher than females. SBF increment was found to be positively correlated with ST increment. The ICC values for CPT, SBF and ST were 0.595, 0.852 and 0.728, respectively. The CV values for CPT, SBF and ST were 25.53%, 12.59% and 1.94%, respectively. Conclusions The reliability of CPT measurement using circular pin electrodes is fair, and need consistence of measurements in longitudinal studies.
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Lötsch J, Walter C, Zunftmeister M, Zinn S, Wolters M, Ferreiros N, Rossmanith T, Oertel BG, Geisslinger G. A data science approach to the selection of most informative readouts of the human intradermal capsaicin pain model to assess pregabalin effects. Basic Clin Pharmacol Toxicol 2019; 126:318-331. [PMID: 31608551 DOI: 10.1111/bcpt.13337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/01/2019] [Indexed: 12/29/2022]
Abstract
Persistent and, in particular, neuropathic pain is a major healthcare problem with still insufficient pharmacological treatment options. This triggered research activities aimed at finding analgesics with a novel mechanism of action. Results of these efforts will need to pass through the phases of drug development, in which experimental human pain models are established components e.g. implemented as chemical hyperalgesia induced by capsaicin. We aimed at ranking the various readouts of a human capsaicin-based pain model with respect to the most relevant information about the effects of a potential reference analgesic. In a placebo-controlled, randomized cross-over study, seven different pain-related readouts were acquired in 16 healthy individuals before and after oral administration of 300 mg pregabalin. The sizes of the effect on pain induced by intradermal injection of capsaicin were quantified by calculating Cohen's d. While in four of the seven pain-related parameters, pregabalin provided a small effect judged by values of Cohen's d exceeding 0.2, an item categorization technique implemented as computed ABC analysis identified the pain intensities in the area of secondary hyperalgesia and of allodynia as the most suitable parameters to quantify the analgesic effects of pregabalin. Results of this study provide further support for the ability of the intradermal capsaicin pain model to show analgesic effects of pregabalin. Results can serve as a basis for the designs of studies where the inclusion of this particular pain model and pregabalin is planned.
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Affiliation(s)
- Jörn Lötsch
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany.,Fraunhofer Institute of Molecular Biology and Applied Ecology-Project Group Translational Medicine and Pharmacology, IME-TMP), Frankfurt am Main, Germany
| | - Carmen Walter
- Fraunhofer Institute of Molecular Biology and Applied Ecology-Project Group Translational Medicine and Pharmacology, IME-TMP), Frankfurt am Main, Germany
| | - Martin Zunftmeister
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Sebastian Zinn
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Miriam Wolters
- Fraunhofer Institute of Molecular Biology and Applied Ecology-Project Group Translational Medicine and Pharmacology, IME-TMP), Frankfurt am Main, Germany
| | - Nerea Ferreiros
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Tanja Rossmanith
- Fraunhofer Institute of Molecular Biology and Applied Ecology-Project Group Translational Medicine and Pharmacology, IME-TMP), Frankfurt am Main, Germany
| | - Bruno G Oertel
- Fraunhofer Institute of Molecular Biology and Applied Ecology-Project Group Translational Medicine and Pharmacology, IME-TMP), Frankfurt am Main, Germany
| | - Gerd Geisslinger
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany.,Fraunhofer Institute of Molecular Biology and Applied Ecology-Project Group Translational Medicine and Pharmacology, IME-TMP), Frankfurt am Main, Germany
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Jonas R, Namer B, Schnakenberg M, Soares S, Pakalniskis J, Carr R, Schmelz M, Rukwied R. Sympathetic efferent neurons are less sensitive than nociceptors to 4 Hz sinusoidal stimulation. Eur J Pain 2019; 24:122-133. [DOI: 10.1002/ejp.1467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 08/01/2019] [Accepted: 08/03/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Robin Jonas
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Barbara Namer
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
- Department Physiology I Friedrich‐Alexander‐University Erlangen‐Nuremberg Erlangen Germany
| | - Mark Schnakenberg
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Sabrina Soares
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Julius Pakalniskis
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Richard Carr
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Martin Schmelz
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Roman Rukwied
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
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Sauerstein K, Liebelt J, Namer B, Schmidt R, Rukwied R, Schmelz M. Low-Frequency Stimulation of Silent Nociceptors Induces Secondary Mechanical Hyperalgesia in Human Skin. Neuroscience 2018; 387:4-12. [DOI: 10.1016/j.neuroscience.2018.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 01/25/2018] [Accepted: 03/06/2018] [Indexed: 01/29/2023]
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Strupf M, Fraunberger B, Messlinger K, Namer B. Cyclic changes in sensations to painful stimuli in migraine patients. Cephalalgia 2018; 39:585-596. [DOI: 10.1177/0333102418793641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Migraine is characterized by cycling phases (interictal, preictal, ictal and postictal) with differing symptoms, while in chronic tension type headache pain phases are fluctuating. The question we asked is whether these phases are associated with changes in parameters of somatosensation and axon-reflex erythema. Methods Patients with episodic migraine and chronic tension type headache were examined psychophysically in the interictal, preictal and ictal phase and healthy subjects on five different test days. Thresholds and suprathreshold ratings of pressure and electrical pain were assessed on three different regions of the head. In migraine patients and in healthy controls, electrically induced axon-reflex erythema was measured in the area of the first trigeminal branch. All migraine patients filled out questionnaires about prodromal symptoms at every visit. Results The axon-reflex erythema was always larger in patients with migraine in contrast to healthy subjects. The pressure pain threshold was lower in migraine patients and chronic tension type headache in comparison to healthy subjects. Electrical pain thresholds did not differ between headache patients and healthy subjects and showed no changes between the phases. However, suprathreshold pain ratings showed less habituation solely in the preictal phase of migraine. The number of prodromal symptoms in migraine patients was increased in the preictal and ictal phase. Discussion Reduced habituation was the unique sign of the preictal phase in migraine patients, independently of prodromal symptoms, whereas a larger axon-reflex erythema and higher pressure pain sensitivity are constitutional and non-phase dependent properties of migraine. Reduced inhibitory mechanisms in the preictal phase may contribute to trigger headache attacks in migraine.
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Affiliation(s)
- Marion Strupf
- Institute of Physiology and Experimental Pathophysiology, University of Erlangen/Nürnberg, Germany
| | - Britta Fraunberger
- Pain Center, Medical Faculty Erlangen, University of Erlangen/Nürnberg, Germany
| | - Karl Messlinger
- Institute of Physiology and Experimental Pathophysiology, University of Erlangen/Nürnberg, Germany
| | - Barbara Namer
- Institute of Physiology and Experimental Pathophysiology, University of Erlangen/Nürnberg, Germany
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Khadka N, Zannou AL, Zunara F, Truong DQ, Dmochowski J, Bikson M. Minimal Heating at the Skin Surface During Transcranial Direct Current Stimulation. Neuromodulation 2017; 21:334-339. [PMID: 28111832 DOI: 10.1111/ner.12554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/11/2016] [Accepted: 10/28/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess if transcranial direct current stimulation (tDCS) produces a temperature change at the skin surface, if any change is stimulation polarity (anode or cathode) specific, and the contribution of passive heating (joule heat) or blood flow on such change. MATERIAL AND METHODS Temperature differences (ΔTs) in an agar phantom study and an in vivo study (forearm stimulation) including 20 volunteers with both experimental measures and finite element method (FEM) multiphysics prediction (current flow and bioheat) models of skin comprising three tissue layers (epidermis, dermis, and subcutaneous layer with blood perfusion) or of the phantom for active stimulation and control cases were compared. Temperature was measured during pre, post, and stimulation phases for both phantom and subject's forearms using thermocouples. RESULTS In the phantom, ΔT under both anode and cathode, compared to control, was not significantly different and less than 0.1°C. Stimulation of subjects resulted in a gradual increase in temperature under both anode and cathode electrodes, compared to control (at t = 20 min: ΔTanode = 0.9°C, ΔTcathode = 1.1°C, ΔTcontrol = 0.05°C). The FEM phantom model predicted comparable maximum ΔT of 0.27°C and 0.28°C (at t = 20 min) for the control and anode/cathode cases, respectively. The FEM skin model predicted a maximum ΔT at t = 20 min of 0.98°C for control and 1.36°C under anode/cathode electrodes. CONCLUSIONS Taken together, our results indicate a moderate and nonhazardous increase in temperature at the skin surface during 2 mA tDCS that is independent of polarity, and results from stimulation induced blood flow rather than joule heat.
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Affiliation(s)
- Niranjan Khadka
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Adantchede L Zannou
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Fatima Zunara
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Dennis Q Truong
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Jacek Dmochowski
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
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Hoeck EA, Marker JB, Gazerani P, H. Andersen H, Arendt-Nielsen L. Preclinical and human surrogate models of itch. Exp Dermatol 2016; 25:750-7. [DOI: 10.1111/exd.13078] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Emil A. Hoeck
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg E Denmark
| | - Jens B. Marker
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg E Denmark
| | - Parisa Gazerani
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg E Denmark
| | - Hjalte H. Andersen
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg E Denmark
| | - Lars Arendt-Nielsen
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg E Denmark
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Xia W, Mørch CD, Andersen OK. Test-Retest Reliability of 10 Hz Conditioning Electrical Stimulation Inducing Long-Term Potentiation (LTP)-Like Pain Amplification in Humans. PLoS One 2016; 11:e0161117. [PMID: 27529175 PMCID: PMC4986952 DOI: 10.1371/journal.pone.0161117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 07/29/2016] [Indexed: 11/19/2022] Open
Abstract
Background 10 Hz conditioning electrical stimulation (CES) has been shown to induce long-term potentiation (LTP)-like pain amplification similar to traditional 100 Hz CES in healthy humans. The aim of this study was to assess the test-retest reliability and to estimate sample sizes required for future crossover and parallel study designs. Methods The 10 Hz paradigm (500 rectangular pulses lasting 50 s) was repeated on two separate days with one week interval in twenty volunteers. Perceptual intensities to single electrical stimulation (SES) at the conditioned skin site and to mechanical stimuli (pinprick and light stroking) in immediate vicinity to the conditioned skin site were recorded. Superficial blood flow (SBF) was assessed as indicator of neurogenic inflammation. All outcome measures were assessed with 10 min interval three times before and six times after the CES. The coefficient of variation and intra-class correlation coefficient were calculated within session and between sessions. Sample sizes were estimated for future crossover (Ncr) and parallel (Np) drug testing studies expected to detect a 30% decrease for the individual outcome measure following 10 Hz CES. Results Perceptual intensity ratings to light stroking (Ncr = 2, Np = 33) and pinprick stimulation (491 mN) (Ncr = 6, Np = 54) increased after CES and showed better reliability in crossover than parallel design. The SBF increased after CES, and then declined until reaching a plateau 20 minutes postCES. SBF showed acceptable reliability both in crossover and parallel designs (Ncr = 3, Np = 13). Pain ratings to SES were reliable, but with large estimated sample sizes (Ncr = 634, Np = 11310) due to the minor pain amplification. Conclusions The reliability of 10 Hz CES was acceptable in inducing LTP-like effects in the assessments of superficial blood flow, heterotopic mechanical hyperalgesia, and dysesthesia in terms of sample sizes for future crossover study designs.
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Affiliation(s)
- Weiwei Xia
- Center for Neuroplasticity and Pain (CNAP), SMI ®, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
- * E-mail:
| | - Carsten Dahl Mørch
- Center for Neuroplasticity and Pain (CNAP), SMI ®, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ole Kæseler Andersen
- Center for Neuroplasticity and Pain (CNAP), SMI ®, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Ud-Din S, Bayat A. Non-invasive objective devices for monitoring the inflammatory, proliferative and remodelling phases of cutaneous wound healing and skin scarring. Exp Dermatol 2016; 25:579-85. [DOI: 10.1111/exd.13027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research; Institute of Inflammation and Repair; University of Manchester; Manchester UK
- University Hospital of South Manchester NHS Foundation Trust; Faculty of Medical and Human Sciences; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research; Institute of Inflammation and Repair; University of Manchester; Manchester UK
- University Hospital of South Manchester NHS Foundation Trust; Faculty of Medical and Human Sciences; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
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Xia W, Mørch CD, Andersen OK. Exploration of the conditioning electrical stimulation frequencies for induction of long-term potentiation-like pain amplification in humans. Exp Brain Res 2016; 234:2479-89. [DOI: 10.1007/s00221-016-4653-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/13/2016] [Indexed: 01/07/2023]
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Dei A, Miyamoto JJ, Takada JI, Ono T, Moriyama K. Evaluation of blood flow and electromyographic activity in the perioral muscles. Eur J Orthod 2015; 38:525-31. [PMID: 26584843 DOI: 10.1093/ejo/cjv079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND/OBJECTIVES Although the electromyographic (EMG) activity of the perioral muscles, including the orbicularis oris and mentalis muscles, has been described in individuals with lip incompetence during lip sealing, blood flow through these muscles remains to be elucidated. The purpose of this study was to examine the blood flow associated with EMG activity in the perioral muscles using laser speckle imaging in individuals with lip incompetence. SUBJECTS/METHODS Blood flow and EMG activity of the superior and inferior orbicularis oris and mentalis muscles were measured with the lips in contact (C condition) and apart (O condition) in lip incompetence (experimental) and control subjects (n = 15 in each group; mean age: 29.5 years). The change ratios of blood flow and EMG activity in the C condition versus O condition (C/O ratios) were calculated and plotted in a scattergram. The Mann-Whitney U-test, Wilcoxon signed-rank test, discriminant analysis using the Mahalanobis generalized distance, and Spearman correlation were used for statistical analysis. RESULTS In the experimental group, blood flow and EMG activity in all muscles were significantly greater in the C condition than in the O condition. The plots of C/O ratios in the experimental group showed a distinct and wide distribution and were significantly different than those in the control group. In both groups, a significant positive correlation was observed between blood flow and EMG activity in the mentalis muscle. CONCLUSIONS/IMPLICATIONS The present findings suggest that observing blood flow in the mentalis muscle is an effective and easily performed method of evaluating lip incompetence.
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Affiliation(s)
- Ayano Dei
- *Department of Maxillofacial Orthognathics
| | | | | | - Takashi Ono
- **Department of Orthodontic Science,Tokyo Medical and Dental University (TMDU), Japan
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Takeshima Y, Miyake H, Nakagawa I, Motoyama Y, Park YS, Nakase H. Visualization of Regional Cerebral Blood Flow Dynamics during Cortical Venous Occlusion using Laser Speckle Contrast Imaging in a Rat Model. J Stroke Cerebrovasc Dis 2015. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Landmann G, Stockinger L, Lustenberger C, Schmelz M, Rukwied R. Effects of Current Density on Nociceptor Activation Upon Electrical Stimulation in Humans. Pain Pract 2015; 16:273-81. [DOI: 10.1111/papr.12339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 06/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Gunther Landmann
- Centre for Pain Medicine; Swiss Paraplegic Centre; Nottwil Switzerland
| | - Lenka Stockinger
- Centre for Pain Medicine; Swiss Paraplegic Centre; Nottwil Switzerland
| | | | - Martin Schmelz
- Medical Faculty Mannheim; Department of Anaesthesiology and Intensive Care Medicine; University of Heidelberg; Mannheim Germany
| | - Roman Rukwied
- Medical Faculty Mannheim; Department of Anaesthesiology and Intensive Care Medicine; University of Heidelberg; Mannheim Germany
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Qian CY, Yuan C, Tan YM, Liu XP, Dong YQ, Yang LJ, Wu PL, Wang XM. Comparing performance of Chromameter®, Mexameter®and full-field laser perfusion imaging for measurement of ultraviolet B light-induced erythema. Clin Exp Dermatol 2015; 40:438-40. [PMID: 25683325 DOI: 10.1111/ced.12589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 11/25/2022]
Affiliation(s)
- C. Y. Qian
- Department of Skin and Cosmetic Research; Shanghai Skin Disease Hospital; Shanghai China
| | - C. Yuan
- Department of Skin and Cosmetic Research; Shanghai Skin Disease Hospital; Shanghai China
| | - Y. M. Tan
- Department of Skin and Cosmetic Research; Shanghai Skin Disease Hospital; Shanghai China
| | - X. P. Liu
- Department of Skin and Cosmetic Research; Shanghai Skin Disease Hospital; Shanghai China
| | - Y. Q. Dong
- Department of Skin and Cosmetic Research; Shanghai Skin Disease Hospital; Shanghai China
| | - L. J. Yang
- Department of Skin and Cosmetic Research; Shanghai Skin Disease Hospital; Shanghai China
| | - P. L. Wu
- Department of Skin and Cosmetic Research; Shanghai Skin Disease Hospital; Shanghai China
| | - X. M. Wang
- Department of Skin and Cosmetic Research; Shanghai Skin Disease Hospital; Shanghai China
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Abstract
This article presents an overview of the literature regarding treatments for keloid disease, hypertrophic scars, and striae distensae in dark pigmented skin. Striae, keloid, and hypertrophic scarring present a challenging problem for both the clinician and patient. No single therapy is advocated for hypertrophic scars, keloid scars, or striae distensae. New therapies have shown promise in the treatment of hypertrophic and keloid scars, and in patients with dark pigmented skin. This article provides guidance on the assessment and determination of patients' suitability for certain treatment options, as well as advice on the follow-up of patients affected with problematic scarring and striae.
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Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester M1 7DN, UK; Plastic and Reconstructive Surgery Research, Faculty of Medical and Human Sciences, Institute of Inflammation and Repair, University Hospital of South Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester M1 7DN, UK; Plastic and Reconstructive Surgery Research, Faculty of Medical and Human Sciences, Institute of Inflammation and Repair, University Hospital of South Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
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Sensitized pain response to bradykinin after sunburn - a human model for ongoing inflammatory pain? Pain 2013; 154:769-770. [DOI: 10.1016/j.pain.2013.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 03/12/2013] [Indexed: 01/26/2023]
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Klijn E, Hulscher HC, Balvers RK, Holland WPJ, Bakker J, Vincent AJPE, Dirven CMF, Ince C. Laser speckle imaging identification of increases in cortical microcirculatory blood flow induced by motor activity during awake craniotomy. J Neurosurg 2012; 118:280-6. [PMID: 23176333 DOI: 10.3171/2012.10.jns1219] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The goal of awake neurosurgery is to maximize resection of brain lesions with minimal injury to functional brain areas. Laser speckle imaging (LSI) is a noninvasive macroscopic technique with high spatial and temporal resolution used to monitor changes in capillary perfusion. In this study, the authors hypothesized that LSI can be useful as a noncontact method of functional brain mapping during awake craniotomy for tumor removal. Such a modality would be an advance in this type of neurosurgery since current practice involves the application of invasive intraoperative single-point electrocortical (electrode) stimulation and measurements. METHODS After opening the dura mater, patients were woken up, and LSI was set up to image the exposed brain area. Patients were instructed to follow a rest-activation-rest protocol in which activation consisted of the hand-clenching motor task. Subsequently, exposed brain areas were mapped for functional motor areas by using standard electrocortical stimulation (ECS). Changes in the LSI signal were analyzed offline and compared with the results of ECS. RESULTS In functional motor areas of the hand mapped with ECS, cortical blood flow measured using LSI significantly increased from 2052 ± 818 AU to 2471 ± 675 AU during hand clenching, whereas capillary blood flow did not change in the control regions (areas mapped using ECS with no functional activity). CONCLUSIONS The main finding of this study was that changes in laser speckle perfusion as a measure of cortical microvascular blood flow when performing a motor task with the hand relate well to the ECS map. The authors have shown the feasibility of using LSI for direct visualization of cortical microcirculatory blood flow changes during neurosurgery.
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Affiliation(s)
- Eva Klijn
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Ud-Din S, Perry D, Giddings P, Colthurst J, Zaman K, Cotton S, Whiteside S, Morris J, Bayat A. Electrical stimulation increases blood flow and haemoglobin levels in acute cutaneous wounds without affecting wound closure time: evidenced by non-invasive assessment of temporal biopsy wounds in human volunteers. Exp Dermatol 2012; 21:758-64. [DOI: 10.1111/exd.12005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Sara Ud-Din
- Plastic & Reconstructive Surgery Research, Manchester Institute of Biotechnology; University of Manchester; Manchester UK
- Faculty of Medical and Human Sciences; University Hospital of South Manchester NHS Foundation Trust; Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre; Manchester UK
| | - Donna Perry
- Plastic & Reconstructive Surgery Research, Manchester Institute of Biotechnology; University of Manchester; Manchester UK
- Faculty of Medical and Human Sciences; University Hospital of South Manchester NHS Foundation Trust; Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre; Manchester UK
| | | | | | - Karen Zaman
- Plastic & Reconstructive Surgery Research, Manchester Institute of Biotechnology; University of Manchester; Manchester UK
- Faculty of Medical and Human Sciences; University Hospital of South Manchester NHS Foundation Trust; Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre; Manchester UK
| | | | - Sigrid Whiteside
- Faculty of Medical and Human Sciences; University Hospital of South Manchester NHS Foundation Trust; Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre; Manchester UK
- Medical Statistics; University Hospital South Manchester NHS Foundation Trust; Manchester UK
| | - Julie Morris
- Faculty of Medical and Human Sciences; University Hospital of South Manchester NHS Foundation Trust; Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre; Manchester UK
- Medical Statistics; University Hospital South Manchester NHS Foundation Trust; Manchester UK
| | - Ardeshir Bayat
- Plastic & Reconstructive Surgery Research, Manchester Institute of Biotechnology; University of Manchester; Manchester UK
- Faculty of Medical and Human Sciences; University Hospital of South Manchester NHS Foundation Trust; Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre; Manchester UK
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Weigel R, Capelle HH, Schmelz M, Krauss JK. Selective thoracic ganglionectomy for the treatment of segmental neuropathic pain. Eur J Pain 2012; 16:1398-402. [PMID: 22461422 DOI: 10.1002/j.1532-2149.2012.00141.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2012] [Indexed: 01/27/2023]
Abstract
Segmental thoracic neuropathic pain (NeuP) remains particularly difficult to treat. Sensory ganglionectomy was reported to alleviate NeuP. The experience with thoracic ganglionectomy, however, is very limited. Here, we report the results of a prospective pilot study in patients with incapacitating segmental thoracic NeuP treated by selective ganglionectomy. Seven patients were included suffering from refractory NeuP scoring 8 or more on a visual analogue scale (VAS). Every patient had test anaesthesia prior to surgery yielding more than 50% pain relief. The spinal ganglion was excised completely via an extraforaminal approach. Mean preoperative VAS scores were 9.1 (maximum pain); 5.4 (minimum pain); 7.9 (pain on average); 6.9 (pain at the time of presentation); and 7.4 (allodynia). Early post-operatively, there was a marked improvement of mean scores: 1.7; 0.7; 1.2; 1.0; and 0.7, respectively. One patient developed a mild transient hemihypaesthesia. In three patients, substantial pain occurred in a formerly unaffected dermatome within 1 year. Two of these patients had significant pain relief by a second operation. At the time of last follow-up at a mean of 24 months after the first procedure, mean VAS scores were 6.3; 2.1; 4.3; 4.0; and 1.3. Overall, medication was reduced. The patients rated their outcome as excellent (1), good (2), fair (2) and nil (2) with best improvement for allodynia. Selective thoracic ganglionectomy is a safe and partially effective procedure in selected patients albeit there may be partial recurrence of pain. Recurrent pain may affect dermatomes that were not involved initially.
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Affiliation(s)
- R Weigel
- Department of Neurosurgery, Medical School Hannover, Germany
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22
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Manresa JAB, Mørch CD, Andersen OK. Long-term facilitation of nociceptive withdrawal reflexes following low-frequency conditioning electrical stimulation: A new model for central sensitization in humans. Eur J Pain 2012; 14:822-31. [DOI: 10.1016/j.ejpain.2009.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 11/24/2009] [Accepted: 12/21/2009] [Indexed: 01/21/2023]
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Obreja O, Kluschina O, Mayer A, Hirth M, Schley M, Schmelz M, Rukwied R. NGF enhances electrically induced pain, but not axon reflex sweating. Pain 2011; 152:1856-1863. [DOI: 10.1016/j.pain.2011.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 03/23/2011] [Accepted: 04/01/2011] [Indexed: 01/16/2023]
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Takeshima Y, Nakamura M, Miyake H, Tamaki R, Inui T, Horiuchi K, Wajima D, Nakase H. Neuroprotection With Intraventricular Brain-Derived Neurotrophic Factor in Rat Venous Occlusion Model. Neurosurgery 2011; 68:1334-41. [DOI: 10.1227/neu.0b013e31820c048e] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Schmidt R, Weidner C, Schmelz M. Time course of acetylcholine-induced activation of sympathetic efferents matches axon reflex sweating in humans. J Peripher Nerv Syst 2011; 16:30-6. [DOI: 10.1111/j.1529-8027.2011.00320.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bezemer R, Klijn E, Khalilzada M, Lima A, Heger M, van Bommel J, Ince C. Validation of near-infrared laser speckle imaging for assessing microvascular (re)perfusion. Microvasc Res 2010; 79:139-43. [PMID: 20079750 DOI: 10.1016/j.mvr.2010.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 01/04/2010] [Accepted: 01/06/2010] [Indexed: 10/19/2022]
Abstract
The present study was conducted to compare laser speckle imaging (LSI) with sidestream dark field (SDF) imaging (i.e., capillary microscopy) so as to validate the use of LSI for assessing microvascular (re)perfusion. For this purpose, LSI and SDF measurements were performed on the human nail fold during gradual occlusion of the upperarm circulation to modify nail fold perfusion under controlled circumstances. Additionally, a vascular occlusion test was performed to test the ability of LSI to detect rapid changes in tissue perfusion during reactive hyperemia and a hyperthermic challenge was performed to measure LSI perfusion at maximum functional capillary density. Normalized LSI measurements (i.e., normalized to baseline is 100%) were shown to correlate positively with normalized SDF measurements (Pearson's r=0.92). This was supported by linear regression analysis (slope of 1.01, R(2)=0.85, p<0.001). During the vascular occlusion test, LSI perfusion decreased from 307+/-90 AU (baseline) to 42+/-8 AU (ischemia). Peak perfusion during reperfusion was 651+/-93 AU (212% of baseline), which had returned to baseline after 2 min. Hyperthermia increased LSI perfusion from 332+/-90 AU to 1067+/-256 AU (321% of baseline). The main finding was that changes in perfusion as measured by LSI correlated well with changes in capillary red blood cell velocities as measured by SDF imaging during controlled reduction of the (micro)vascular perfusion. It was further shown that LSI is capable of measuring tissue perfusion at high temporal and spatial resolution. In conclusion, LSI can be employed to accurately quantitate microvascular reactivity following ischemic and hyperthermic challenges.
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Affiliation(s)
- Rick Bezemer
- Department of Intensive Care, Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands.
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Dusch M, Schley M, Obreja O, Forsch E, Schmelz M, Rukwied R. Comparison of electrically induced flare response patterns in human and pig skin. Inflamm Res 2009; 58:639-48. [DOI: 10.1007/s00011-009-0029-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 03/04/2009] [Accepted: 03/04/2009] [Indexed: 10/21/2022] Open
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29
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De R, Maihöfner C. Centrally mediated sensory decline induced by differential C-fiber stimulation. Pain 2008; 138:556-564. [DOI: 10.1016/j.pain.2008.02.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 01/21/2008] [Accepted: 02/04/2008] [Indexed: 11/24/2022]
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