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Ding P, Wang R, He Y. Risk factors for pterygium: Latest research progress on major pathogenesis. Exp Eye Res 2024; 243:109900. [PMID: 38636803 DOI: 10.1016/j.exer.2024.109900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/18/2024] [Accepted: 04/13/2024] [Indexed: 04/20/2024]
Abstract
A pterygium is a wedge-shaped fibrovascular growth of the conjunctiva membrane that extends onto the cornea, which is the outer layer of the eye. It is also known as surfer's eye. Growth of a pterygium can also occur on the either side of the eye, attaching firmly to the sclera. Pterygia are one of the world's most common ocular diseases. However, the pathogenesis remains unsolved to date. As the pathogenesis of pterygium is closely related to finding the ideal treatment, a clear understanding of the pathogenesis will lead to better treatment and lower the recurrence rate, which is notably high and more difficult to treat than a primary pterygium. Massive studies have recently been conducted to determine the exact causes and mechanism of pterygia. We evaluated the pathogenetic factors ultraviolet radiation, viral infection, tumor suppressor genes p53, growth factors, oxidative stress, apoptosis and neuropeptides in the progression of the disease. The heightened expression of TRPV1 suggests its potential contribution in the occurrence of pterygium, promoting its inflammation and modulating sensory responses in ocular tissues. Subsequently, the developmental mechanism of pterygium, along with its correlation with dry eye disease is proposed to facilitate the identification of pathogenetic factors for pterygia, contributing to the advancement of understanding in this area and may lead to improved surgical outcomes.
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Affiliation(s)
- Peiqi Ding
- The Second Clinical Medical College of Jilin University, Changchun, 130012, Jilin Province, China
| | - Ruiqing Wang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China
| | - Yuxi He
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China.
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2
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Ge S, Khachemoune A. Neuroanatomy of the Cutaneous Nervous System Regarding Wound Healing. INT J LOW EXTR WOUND 2024; 23:191-204. [PMID: 34779294 DOI: 10.1177/15347346211054598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Wound healing is an important topic in modern medicine across many disciplines. Healing of all cutaneous wounds, whether accidentally sustained or intentionally created, requires the common yet complex set of interactions between the immune, circulatory, nervous, endocrine, and integumentary systems. Deficits in any of these systems or the molecular factors that mediate their communications can contribute to impaired healing of cutaneous wounds. While the stages of wound repair, angiogenesis, growth factors, and cytokines involved have been extensively studied, the role of the cutaneous nervous system in wound healing has not been well outlined. We have provided a basic overview of cutaneous innervation and wound repair for the dermatologic surgeon by outlining the normal cutaneous nervous anatomy and function and discussing the most important neuropeptides that mediate the wound healing process.
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Affiliation(s)
| | - Amor Khachemoune
- Veterans Affairs Medical Center, Brooklyn, NY, USA
- SUNY Downstate, Brooklyn, NY USA
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3
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Kong L, Ma Y, Wang Q, He T, Xu Z, Lu Z, Zhou N, Hao W, Li Y. Impact of wrist-ankle acupuncture on propofol dosage under the dual monitoring of density spectrum array and anesthesia consciousness index in elderly patients undergoing urologic surgery: a sham-controlled randomized clinical trial. Transl Androl Urol 2023; 12:1686-1696. [PMID: 38106681 PMCID: PMC10719768 DOI: 10.21037/tau-23-301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/10/2023] [Indexed: 12/19/2023] Open
Abstract
Background Propofol is a widely used intravenous anesthetic in clinic. However, it is easy to cause serious circulatory fluctuation in elderly patients, so the dose should be reduced as appropriate. Studies have shown that wrist-ankle acupuncture (WAA) can reduce the dosage of propofol in patients undergoing painless endoscopy. Unfortunately, there is no report on whether WAA will reduce the dosage of propofol when used for anesthesia in elderly patients. The purpose of this study is to observe the effect of WAA on propofol dosage in elderly patients, and to provide a new method for maintaining circulatory stability in elderly patients under general anesthesia. Methods From October 2022 to December 2022, Hebei Provincial Hospital of Traditional Chinese Medicine was selected. Forty-four elderly patients undergoing general anesthesia in urology department were randomly divided into two groups according to the complete random method with WAA group, consisting of 22 individuals, and non-WAA (NWAA) group, also consisting of 22 individuals. Both groups were treated with WAA or false needle acupuncture at the same site before anesthesia, respectively, and the needle was kept until the operation was finished. During the operation, the dosage of propofol was adjusted according to the depth of field monitoring density spectrum array (DSA) and anesthesia consciousness index (Ai) with anesthesia monitor. Results A total of 44 patients participated in this study, and all of them completed the experiment. There were no significant difference in sex, age, height, weight, duration of anesthesia, liver and kidney function, score of Fried frailty scale, activity of daily living (ADL), age-adjusted Charlson comorbidity index (aCCI) and mini-cognitive test (Mini-Cog) between the two groups (P>0.05), but the total dose of propofol (WAA =121.5, NWAA =170.5) mg and maintenance dose (WAA =1.02±0.55, NWAA =1.76±0.67) mg/kg/h, utilization rate of vasoactive drugs during operation, recovery time after anesthesia (WAA =2, NWAA =3) min and surgeon satisfaction (WAA =9, NWAA =8.5) had significant differences (P<0.05). Conclusions Compared with NWAA group, WAA group could reduce the dosage of propofol in anesthesia for elderly patients with exocrine secretion and was beneficial to circulatory stability. Trial Registration Chinese Clinical Trial Registry (ID: ChiCTR2100054132).
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Affiliation(s)
- Lili Kong
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Yuexia Ma
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Qinxian Wang
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Tao He
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Zhe Xu
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Zhixia Lu
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Na Zhou
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Wei Hao
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Yanhong Li
- Rehabilitation Department, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
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Agramunt J, Parke B, Mena S, Ubels V, Jimenez F, Williams G, Rhodes ADY, Limbu S, Hexter M, Knight L, Hashemi P, Kozlov AS, Higgins CA. Mechanical stimulation of human hair follicle outer root sheath cultures activates adjacent sensory neurons. SCIENCE ADVANCES 2023; 9:eadh3273. [PMID: 37889977 PMCID: PMC10610912 DOI: 10.1126/sciadv.adh3273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
Mechanical stimuli, such as stroking or pressing on the skin, activate mechanoreceptors transmitting information to the sensory nervous system and brain. It is well accepted that deflection of the hair fiber that occurs with a light breeze or touch directly activates the sensory neurons surrounding the hair follicle, facilitating transmission of mechanical information. Here, we hypothesized that hair follicle outer root sheath cells act as transducers of mechanical stimuli to sensory neurons surrounding the hair follicle. Using electrochemical analysis on human hair follicle preparations in vitro, we were able to show that outer root sheath cells release ATP and the neurotransmitters serotonin and histamine in response to mechanical stimulation. Using calcium imaging combined with pharmacology in a coculture of outer root sheath cells with sensory neurons, we found that the release of these three molecules from hair follicle cells leads to activation of sensory neurons.
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Affiliation(s)
- Julià Agramunt
- Department of Bioengineering, Imperial College London, London, UK
| | - Brenna Parke
- Department of Bioengineering, Imperial College London, London, UK
| | - Sergio Mena
- Department of Bioengineering, Imperial College London, London, UK
| | - Victor Ubels
- Department of Bioengineering, Imperial College London, London, UK
| | - Francisco Jimenez
- Mediteknia Clinic, Las Palmas, Gran Canaria, Spain
- University Fernando Pessoa Canarias, Gran Canaria, Spain
| | | | - Anna DY Rhodes
- Department of Bioengineering, Imperial College London, London, UK
| | - Summik Limbu
- Department of Bioengineering, Imperial College London, London, UK
| | - Melissa Hexter
- Department of Bioengineering, Imperial College London, London, UK
| | | | - Parastoo Hashemi
- Department of Bioengineering, Imperial College London, London, UK
| | - Andriy S. Kozlov
- Department of Bioengineering, Imperial College London, London, UK
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Martín-Cruces J, Martín-Biedma B, García-Mesa Y, Cuendias P, Gaite JJ, García-Suárez O, Cobo JL, Vega JA. Exploring somatosensory innervation of the human lip: A focus on the vermilion. Ann Anat 2023; 250:152159. [PMID: 37741584 DOI: 10.1016/j.aanat.2023.152159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND The lips are a vital component of the face and are densely innervated to perform various functions. The lip edges are covered with mucocutaneous tissue called vermilion which is particularly receptive to touch and temperature. The aim of this study was to investigate the somatosensory innervation of human lips, focusing on sensory corpuscles and the presence of mechano-gated (ASIC2, PIEZO2, and TRPV4) and thermosensing (TRPV1, TRPM2, and RPM8) ion channels within them. METHODS Twelve intact lips (6 upper and 6 lower) were obtained from non-embalmed frozen cadavers (five females and seven males) with an age range of 60-80 years. The specimens were divided into three zones (medial, lateral, and median). The morphotypes of sensory corpuscles and their immunohistochemical profile was analysed. The occurrence of ion channels involved in mechanosensation and temperature detection was examined using various antibodies. Sensory corpuscle density was quantified in vermilion sections, and statistical analyses were conducted to assess differences between the upper and lower lips, as well as between females and males (p < 0.05). RESULTS Different morphotypes of sensory corpuscles were identified: Ruffini-like associated with hair follicles, Meissner and glomerular corpuscles in the vermilion, and less classifiable sensory corpuscles within the mucosa. The density of sensory corpuscles in the vermilion was higher in the upper lip than in the lower lip; glomerular corpuscles predominated in the medial and median segments, whereas Meissner corpuscles were more abundant in the lateral segment. No sex-related differences were observed in the density or distribution of the two main corpuscular morphotypes. In contrast, the axons of both the glomeruli and Meissner corpuscles regularly displayed ASIC2 and PIEZO2 immunoreactivity, whereas immunoreactivity for TRPV1, TRPV4, TRPM2, and TRPV8 was absent. CONCLUSIONS These results demonstrate that the sensory corpuscles of the vermilion are a mixture of those typical of glabrous skin mucocutaneous tissues. The presence of PIEZO2 and ASIC2 in their axons suggests that these sensory corpuscles function as mechanosensors.
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Affiliation(s)
- José Martín-Cruces
- Departamento de Morfología y Biología Celular - Grupo SINPOs, Universidad de Oviedo, Oviedo, Spain
| | - Benjamín Martín-Biedma
- Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Yolanda García-Mesa
- Departamento de Morfología y Biología Celular - Grupo SINPOs, Universidad de Oviedo, Oviedo, Spain
| | - Patricia Cuendias
- Departamento de Morfología y Biología Celular - Grupo SINPOs, Universidad de Oviedo, Oviedo, Spain
| | - Juan J Gaite
- Unidad Dental, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Olivia García-Suárez
- Departamento de Morfología y Biología Celular - Grupo SINPOs, Universidad de Oviedo, Oviedo, Spain
| | - Juan L Cobo
- Departamento de Morfología y Biología Celular - Grupo SINPOs, Universidad de Oviedo, Oviedo, Spain; Servico de Cirugía Maxillofacial, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José A Vega
- Departamento de Morfología y Biología Celular - Grupo SINPOs, Universidad de Oviedo, Oviedo, Spain; Facutad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago de Chile, Chile.
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Differences between finger and toe Meissner corpuscles: Searching for the optimal place to analyze meissner corpuscles in cutaneous biopsy. TRANSLATIONAL RESEARCH IN ANATOMY 2023. [DOI: 10.1016/j.tria.2023.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
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Liu D, Niu J, Chen G, Xu L. Treatment of Carbapenem-Resistant Multidrug-Resistant Gram-Negative Bacilli with Intracerebroventricular Injection of Polymyxin B: A Retrospective Study. Infect Drug Resist 2022; 15:7653-7666. [PMID: 36579127 PMCID: PMC9791995 DOI: 10.2147/idr.s392818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose We evaluated the efficacy and administration time of intraventricular (IVT) polymyxin B in the treatment of carbapenem-resistant and multidrug-resistant/extensively drug-resistant (MDR/XDR) Gram-negative bacilli in central nervous system (CNS) infections and investigated prognostic factors. Patients and Methods This retrospective analysis comprised 41 post-surgical carbapenem-resistant CNS infections from October 2016 to October 2021. All patients were treated with effective intravenous antibiotics and IVT polymyxin B. Patient characteristics, therapeutic procedure, symptoms, cerebrospinal fluid (CSF) examination, laboratory tests, and complications were recorded. The effectiveness of IVT polymyxin B was evaluated using temperature, Glasgow Coma Scale, CSF contents, bacterial clearance rate, cure rate, and mortality. Mortality between early (7 days) and late administration of IVT polymyxin B was compared. Prognostic factors were evaluated using the pupillary light reflex and multiloculated hydrocephalus. Results The 41 patients acquired carbapenem-resistant MDR/XDR bacteria, including 24 Klebsiella pneumoniae, 15 Acinetobacter baumannii, 3 Pseudomonas aeruginosa, and 1 Enterobacter cloacae. The bacterial clearance rate was 32/41 (78.0%), and 9 patients (22.0%) with uncured bacterial infections died. Adverse events included 1 case of skin pigmentation. Among the 32 cured patients, 31 received a ventriculoperitoneal shunt, and 1 patient had an extraventricular drainage tube removed. Mortality in the late (>7 days) group was higher (39.1% vs 0%, P < 0.05). The group without pupillary light reflex showed a higher death rate (41.2% vs 8.3%; P < 0.05). The multiloculated hydrocephalus group had a higher mortality rate than that of the normal group (34.8% vs 5.6%, P < 0.05). All 32 cured patients were followed up for 9 to 66 months, and all survived without recurrent infections. Conclusion Intraventricular polymyxin B is an effective treatment for carbapenem-resistant MDR/XDR Gram-negative bacilli, with a 78% cure rate and significant mortality reduction if administered within 7 days of bacterial identification. Multiloculated hydrocephalus and the pupillary light reflex may be used as prognostic indicators of mortality.
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Affiliation(s)
- Dongsheng Liu
- Departments of Neurosurgery of Aviation General Hospital, Beijing, 100012, People’s Republic of China
| | - Jianxing Niu
- Departments of Neurosurgery of Aviation General Hospital, Beijing, 100012, People’s Republic of China
| | - Guoqiang Chen
- Departments of Neurosurgery of Aviation General Hospital, Beijing, 100012, People’s Republic of China,Guoqiang Chen, Departments of Neurosurgery of Aviation General Hospital, No. 3, Anwai Beiyuan, Beiyuan Road, Chaoyang District, Beijing, 10001, People’s Republic of China, Tel +86 13311396583, Fax +86 10-59520156, Email
| | - Long Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, 100070, People’s Republic of China,Correspondence: Long Xu, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, National Clinical Research Center for Neurological Diseases (NCRC-ND), No. 119 Nansihuanxilu Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +86 13911129912, Fax +86 10-59976095, Email
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Somatosensory and Gustatory Profiling in the Orofacial Region. Diagnostics (Basel) 2022; 12:diagnostics12123198. [PMID: 36553205 PMCID: PMC9777464 DOI: 10.3390/diagnostics12123198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Quantitative sensory testing (QST) is a standard procedure in medicine to describe sensory patterns in various pathologies. The aim of this prospective clinical study was to define reference values of the trigeminal nerve (V3), including taste qualities, to create a compatibility for sensory loss or gain in pathologies. Fifty-one patients were included, and a standardized testing battery with 11 QST parameters according to the German Research Network on Neuropathic Pain (DFNS) was applied complemented by quantitative gustatory assessments. Significant somatosensory differences were found between the test sites (MDT at the chin, WDT at the lower lip) but no effect was detected for gender, age, and between body types. Taste sensitivity was dependent on concentration, gender (females being more sensitive) and increasing age (for bitter and sour taste). We provide reference values for somatosensory and gustatory testing of the facial area. Our data facilitate the detection of neurosensory abnormalities in the orofacial region. This might also serve as a control setting for COVID-19.
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Changes in TRPV1 Expression as Well as Substance P and Vasoactive Intestinal Peptide Levels Are Associated with Recurrence of Pterygium. Int J Mol Sci 2022; 23:ijms232415692. [PMID: 36555331 PMCID: PMC9779225 DOI: 10.3390/ijms232415692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Pterygium, a disease of the ocular surface, is characterized by the proliferation and invasion of fibrovascular tissue. Chronic inflammation contributes to pterygium occurrence. Sensory neuropeptides of TRPV1-positive nerve fibers are involved in inflammation and corneal wound healing. The possible association between TRPV1 in nerve fibers and neuropeptides such as Substance P (SP) and Vasoactive Intestinal Peptide (VIP) in the recurrence of pterygium has not been examined before. The pterygia from 64 patients were used to determine changes in SP and VIP levels using 10 min acetic-acid extraction that yielded mainly neuronal peptides. There was a sufficient amount of pterygium tissues from the 35 patients for further immunohistochemical analysis of TRPV1 and S100, which is a glial marker to visualize nerve fibers. SP and VIP levels increased markedly in cases with primary and secondary recurrences, and there was a close correlation between SP and VIP levels. TRPV1 expression increased in the epithelium, while stromal expression decreased in recurrences. Nerve fibers were demonstrated mainly in the stroma, and serial sections confirmed the localization of TRPV1 with the nerve fibers. These results together with previous findings demonstrated that the increased epithelial expression of TRPV1 in recurrent pterygia might be involved in the pathogenesis, and the inhibition of epithelial TRPV1 activity may prevent recurrence.
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Villaret A, Lestienne F, Vial F, Aubert A, Maret A, El Marbouh L, Bessou-Touya S, Castex-Rizzi N, Duplan H, Coubetergues H. Clinical evaluation of anaesthetic-like effect of two dermocosmetic formulations containing Aquaphilus dolomiae extract-G3 in subjects with sensitive facial skin. J Eur Acad Dermatol Venereol 2022; 36 Suppl 5:6-12. [PMID: 35315150 DOI: 10.1111/jdv.17902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sensitive skin is a common condition of hyper-reactivity to external stimuli, e.g. heat or abrasion. The symptoms are subjective but can be measured using validated emotional and technical methods. Avène water has several beneficial effects on the skin. In vitro studies indicated that the active component of this natural spring water, Aquaphilus dolomiae extract-G3 (ADE-G3), modulates cutaneous sensitivity via an anaesthetic-like mechanism. OBJECTIVES To assess facial skin reactivity after repeated application of two formulations containing ADE-G3. METHODS In open-label studies, healthy subjects with sensitive facial skin applied cream or balm twice daily for 84 days. The severity of skin sensitivity was measured using the Sensitive Scale (based on quantifying visible or subjective signs). Subjective responses associated with pain or uncomfortable feeling were assessed by measuring electrodermal response (EDR). This involves measuring variations in skin electrical resistance due to non-conscious physiological changes in activity of the sympathetic nervous system. Subjects were also evaluated for beneficial effects according to a quantitative approach using semantic assessment of a question regarding their skin quality. Evaluations were performed before and after the first application, and after 29/30, 56 and 84 days of twice daily use. RESULTS There was a significant decrease in the EDR after stimuli immediately after the application of both ADE-G3 formulations, which continued to decrease over 84 days (40-50% decrease by D85). Likewise, all physical and functional signs of the Sensitive Scale were significantly decreased immediately after the first application and at all time points tested after treatment. Verbatim analysis revealed a semantic shift, from mainly negative terms on D1 to mainly positive terms at D85 for both tested products. CONCLUSIONS These results demonstrated that two formulations containing ADE-G3 reduced skin sensitivity, indicating a decreased activation of the sympathetic nervous system associated with this condition.
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Affiliation(s)
- A Villaret
- R&D Pierre Fabre DermoCosmétique, Toulouse, France
| | - F Lestienne
- R&D Pierre Fabre DermoCosmétique, Toulouse, France
| | - F Vial
- Spincontrol, Tours, France.,Emospin, Tours, France
| | | | - A Maret
- R&D Pierre Fabre DermoCosmétique, Toulouse, France
| | - L El Marbouh
- R&D Pierre Fabre DermoCosmétique, Toulouse, France
| | | | | | - H Duplan
- R&D Pierre Fabre DermoCosmétique, Toulouse, France
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Verdugo RJ, Matamala JM, Inui K, Kakigi R, Valls-Solé J, Hansson P, Bernhard Nilsen K, Lombardi R, Lauria G, Petropoulos IN, Malik RA, Treede RD, Baumgärtner U, Jara PA, Campero M. Review of techniques useful for the assessment of sensory small fiber neuropathies: Report from an IFCN expert group. Clin Neurophysiol 2022; 136:13-38. [DOI: 10.1016/j.clinph.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 02/09/2023]
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12
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Trbovich M, Ford A, Wu Y, Koek W, Wecht J, Kellogg D. Correlation of neurological level and sweating level of injury in persons with spinal cord injury. J Spinal Cord Med 2021; 44:902-909. [PMID: 32315262 PMCID: PMC8725691 DOI: 10.1080/10790268.2020.1751489] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective: Thermoregulatory dysfunction after spinal cord injury (SCI) impairs quality of life and predisposes persons to life-threatening sequela of heat-related illness (HRI) in conditions of high ambient temperature. SCI clinicians currently have no objective way to predict which persons are at greatest risk of HRI. Evaporative cooling via sweating is the body's most efficient mechanism of heat dissipation. The relationship between the neurological level of injury (NLOI) and the degree of sudomotor dysfunction is not well defined. This study examines the relationship between the NLOI and sweating level of injury (SwLOI). This information can assist SCI clinicians in identifying individuals with SCI who have most impaired sudomotor function and thus highest risk of HRI.Design: Observational.Setting: Human physiology laboratory.Participants: 10 persons with tetraplegia (TP), 14 with paraplegia (PP) and 10 able-bodied (AB).Intervention: Passive heat stress (1°C rise in core temperature) with sweat responses (SR) quantified with the starch iodine test.Outcome measures: The most caudal dermatomal level in which sweating was visualized was recorded as the SwLOI, which was compared to the NLOI. Minimum, maximum and median differences between NLOI and SwLOI were calculated.Results: Persons with tetraplegia demonstrated no SR. Persons with paraplegia demonstrated SR at a median of 1 level below NLOI. Able-bodied controls demonstrated sweating on all skin surface areas.Conclusions: Persons with motor complete tetraplegia lack evaporative cooling capacity through SR during passive heat stress predisposing them to HRI. Meanwhile, persons with paraplegia sweat on average 1 dermatomal level below their NLOI.
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Affiliation(s)
- Michelle Trbovich
- Department of Rehabilitation Medicine, University of Texas Health Science Center, San Antonio, Texas, USA,South Texas Veteran’s Health Care System, San Antonio, Texas, USA,Correspondence to: Michelle Trbovich, 7703 Floyd Curl Drive, San Antonio, Texas78229, USA.
| | - Ashley Ford
- Department of Rehabilitation Medicine, University of Texas Health Science Center, San Antonio, Texas, USA,South Texas Veteran’s Health Care System, San Antonio, Texas, USA
| | - Yubo Wu
- South Texas Veteran’s Health Care System, San Antonio, Texas, USA,Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Wouter Koek
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Jill Wecht
- The National Center of Excellence, James J. Peters VA Medical Center, Bronx, New York, USA,Department of Rehabilitation Medicine Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA
| | - Dean Kellogg
- South Texas Veteran’s Health Care System, San Antonio, Texas, USA,Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
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Metzler-Wilson K, Wilson TE, Ausmus SM, Sventeckis AM. Effect of sensory blockade and rate of sensory stimulation on local heating induced axon reflex response in facial skin. Auton Neurosci 2021; 233:102809. [PMID: 33862476 DOI: 10.1016/j.autneu.2021.102809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/12/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
Local neuronal circuits in non-glabrous skin drive the initial increase of the biphasic cutaneous vasodilation response to fast non-noxious heating. Voltage-sensitive Na+ (NaV) channel inhibition blocks the afferent limb of the non-glabrous forearm cutaneous axon reflex. Slow local heating does not engage this response. These mechanisms have not been adequately investigated or extended into areas associated with flushing pathology. We hypothesized that despite regional differences in sensory afferents, both sensory blockade and slowing the heating rate would abate the cutaneous axon reflex-mediated vasodilator responses in facial skin. We measured skin blood flow responses (laser-Doppler flowmetry) of 6 healthy subjects (5 female) to non-noxious forearm, cheek, and forehead local heating, expressed as a percentage of cutaneous vascular conductance at plateau (CVC = flux/mean arterial pressure). We assessed CVC during fast (1 °C/30s) and slow (1 °C/10 min) local heating to 43 °C in both NaV inhibition (topical 2.5% lidocaine/prilocaine) and control conditions. NaV inhibition decreased forearm (control: 84 ± 4, block: 34 ± 9%plateau, p < 0.001) and trended toward decreased forehead (control: 90 ± 3, block: 68 ± 3%plateau, p = 0.057) initial CVC peaks but did not alter cheek responses (control: 90 ± 3, block: 92 ± 13%plateau, p = 0.862) to fast heating. Slow heating eliminated the initial CVC peak incidence for all locations, and we observed similar results with combined slow heating and NaV inhibition. Slower sensory afferent activation rate eliminated the axon reflex response in facial and non-glabrous skin, but topical sensory blockade did not block axon reflex responses in flushing-prone cheek skin. Thus, slower heating protocols are needed to abate facial, particularly cheek, axon reflex responses.
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Affiliation(s)
- Kristen Metzler-Wilson
- Department of Physical Therapy, School of Health & Human Sciences; and (2)Departments of Dermatology and Anatomy, Cell Biology, & Physiology, School of Medicine, Indiana University, Indianapolis, IN, USA; Departments of Dermatology and Anatomy, Cell Biology & Physiology, School of Medicine, Indiana University, Indianapolis, IN, USA.
| | - Thad E Wilson
- Division of Biomedical Sciences, College of Osteopathic Medicine, Marian University, Indianapolis, IN, USA; Department of Physiology and Saha Cardiovascular Research Center, College of Medicine, University of Kentucky, Lexington, KY, USA.
| | - Samantha M Ausmus
- Department of Physical Therapy, School of Health & Human Sciences; and (2)Departments of Dermatology and Anatomy, Cell Biology, & Physiology, School of Medicine, Indiana University, Indianapolis, IN, USA.
| | - Austin M Sventeckis
- Department of Physical Therapy, School of Health & Human Sciences; and (2)Departments of Dermatology and Anatomy, Cell Biology, & Physiology, School of Medicine, Indiana University, Indianapolis, IN, USA.
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14
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Karlsson P, Provitera V, Caporaso G, Stancanelli A, Saltalamacchia AM, Borreca I, Manganelli F, Santoro L, Jensen TS, Nolano M. Increased peptidergic fibers as a potential cutaneous marker of pain in diabetic small fiber neuropathy. Pain 2021; 162:778-786. [PMID: 32833793 DOI: 10.1097/j.pain.0000000000002054] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/12/2020] [Indexed: 12/14/2022]
Abstract
ABSTRACT Diabetic polyneuropathy (DPN) is a common complication of diabetes and is often associated with neuropathic pain. The mechanisms underlying development and maintenance of painful DPN are largely unknown, and quantification of intraepidermal nerve fiber density from skin biopsy, one of the neuropathological gold standard when diagnosing DPN, does not differentiate between patients with and without pain. Identification of possible pain pathophysiological biomarkers in patients with painful DPN may increase our knowledge of mechanisms behind neuropathic pain. Animal models of painful DPN have been shown to have an increased density of peptidergic nerve fibers (substance P and calcitonin gene-related peptide). In this study, we performed a detailed skin biopsy analysis in a well-characterized group of DPN patients with primarily small fiber involvement, with and without pain, and in healthy controls and test for correlation between skin biopsy findings and pain intensity and quantitative sensory testing. We found that although there was no difference in intraepidermal nerve fiber density using protein gene product 9.5 between patients with and without pain, patients with pain had increased density of dermal peptidergic fibers containing substance P and calcitonin gene-related peptide compared with patients with painless DPN and healthy controls. Peptidergic nerve fiber density correlated with pain ratings in patients with pain (R = 0.33; P = 0.019), but not with quantitative sensory testing results. In this article, we show, for the first time in humans, an increased density of dermal peptidergic fibers in painful DPN. These findings provide new insight in the pathophysiological mechanisms of pain in diabetes and open the research towards new therapeutic targets.
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Affiliation(s)
- Pall Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Core Center for Molecular Morphology, Section for Stereology and Microscopy , Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Vincenzo Provitera
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology, Institute of Telese Terme, Italy
| | - Giuseppe Caporaso
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology, Institute of Telese Terme, Italy
| | - Annamaria Stancanelli
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology, Institute of Telese Terme, Italy
| | - Anna Maria Saltalamacchia
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology, Institute of Telese Terme, Italy
| | - Ilaria Borreca
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology, Institute of Telese Terme, Italy
| | - Fiore Manganelli
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Lucio Santoro
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Troels Staehelin Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maria Nolano
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology, Institute of Telese Terme, Italy
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
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15
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Corniani G, Saal HP. Tactile innervation densities across the whole body. J Neurophysiol 2020; 124:1229-1240. [DOI: 10.1152/jn.00313.2020] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The skin is our largest sensory organ and innervated by afferent fibers carrying tactile information to the spinal cord and onto the brain. The density with which different classes of tactile afferents innervate the skin is not constant but varies considerably across different body regions. However, precise estimates of innervation density are only available for some body parts, such as the hands, and estimates of the total number of tactile afferent fibers are inconsistent and incomplete. Here we reconcile different estimates and provide plausible ranges and best estimates for the number of different tactile fiber types innervating different regions of the skin, using evidence from dorsal root fiber counts, microneurography, histology, and psychophysics. We estimate that the skin across the whole body of young adults is innervated by ∼230,000 tactile afferent fibers (plausible range: 200,000–270,000), with a subsequent decrement of 5–8% every decade due to aging. Fifteen percent of fibers innervate the palmar skin of both hands and 19% the region surrounding the face and lips. Slowly and fast-adapting fibers are split roughly evenly, but this breakdown varies with skin region. Innervation density correlates well with psychophysical spatial acuity across different body regions, and, additionally, on hairy skin, with hair follicle density. Innervation density is also weakly correlated with the size of the cortical somatotopic representation but cannot fully account for the magnification of the hands and the face.
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Affiliation(s)
- Giulia Corniani
- Active Touch Laboratory, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
- Sheffield Robotics, University of Sheffield, Sheffield, United Kingdom
| | - Hannes P. Saal
- Active Touch Laboratory, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
- Sheffield Robotics, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
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16
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Nolano M, Provitera V. Vascular bed and nerve vessels in the skin biopsy: Beyond intraepidermal nerve fibers. Muscle Nerve 2020; 62:427-429. [PMID: 32657423 DOI: 10.1002/mus.27019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Maria Nolano
- Scientific Institute for Research and Health Care - IRCCS, Maugeri Scientific Clinical Institutes, Pavia, Italy.,Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenzo Provitera
- Scientific Institute for Research and Health Care - IRCCS, Maugeri Scientific Clinical Institutes, Pavia, Italy
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17
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Van der Cruyssen F, Van Tieghem L, Croonenborghs TM, Baad-Hansen L, Svensson P, Renton T, Jacobs R, Politis C, De Laat A. Orofacial quantitative sensory testing: Current evidence and future perspectives. Eur J Pain 2020; 24:1425-1439. [PMID: 32557971 PMCID: PMC7497080 DOI: 10.1002/ejp.1611] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/07/2020] [Accepted: 05/31/2020] [Indexed: 12/18/2022]
Abstract
Background and objective Orofacial quantitative sensory testing (QST) is an increasingly valuable psychophysical tool for evaluating neurosensory disorders of the orofacial region. Here, we aimed to evaluate the current evidence regarding this testing method and to discuss its future clinical potential. Data treatment We conducted a literature search in Medline, Embase and Scopus for English‐language articles published between 1990 and 2019. The utilized search terms included QST, quantitative, sensory testing and neurosensory, which were combined using the AND operator with the terms facial, orofacial, trigeminal, intraoral and oral. Results Our findings highlighted many methods for conducting QST—including method of levels, method of limits and mapping. Potential stimuli also vary, and can include mechanical or thermal stimulation, vibration or pinprick stimuli. Orofacial QST may be helpful in revealing disease pathways and can be used for patient stratification to validate the use of neurosensory profile‐specific treatment options. QST is reportedly reliable in longitudinal studies and is thus a candidate for measuring changes over time. One disadvantage of QST is the substantial time required; however, further methodological refinements and the combination of partial aspects of the full QST battery with other tests and imaging methods should result in improvement. Conclusions Overall, orofacial QST is a reliable testing method for diagnosing pathological neurosensory conditions and assessing normal neurosensory function. Despite the remaining challenges that hinder the use of QST for everyday clinical decisions and clinical trials, we expect that future improvements will allow its implementation in routine practice.
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Affiliation(s)
- Fréderic Van der Cruyssen
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Loes Van Tieghem
- Department of Oral Health Sciences, KU Leuven and Department of Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Tomas-Marijn Croonenborghs
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Lene Baad-Hansen
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University and Malmö University, Aarhus, Denmark
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University and Malmö University, Aarhus, Denmark
| | - Tara Renton
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Constantinus Politis
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Antoon De Laat
- Department of Oral Health Sciences, KU Leuven and Department of Dentistry, University Hospitals Leuven, Leuven, Belgium
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18
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Zhixia L, Na Z, Chunlei Z, Wei H. Awake craniotomy for patients with difficult airway: a case of anesthetic management using a combination of wrist-ankle acupuncture analgesia and scalp block. Acupunct Med 2020; 38:443-445. [PMID: 32404000 DOI: 10.1177/0964528420920284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lu Zhixia
- Department of Anesthesiology, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Zhou Na
- Department of Anesthesiology, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
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19
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Abstract
Trigeminal spinal subnucleus caudalis (Vc) neurons that project to the ventral posteromedial thalamic nucleus (VPM) and parabrachial nucleus (PBN) are critical for orofacial pain processing. We hypothesized that persistent trigeminal nerve injury differentially alters the proportion of Vc neurons that project to VPM and PBN in a modality-specific manner. Neuroanatomical approaches were used to quantify the number of Vc neurons projecting to VPM or PBN after chronic constriction injury of the infraorbital nerve (ION-CCI) and subsequent upper-lip stimulation. Male rats received injections of retrograde tracer fluorogold into the contralateral VPM or PBN on day 7 after ION-CCI, and at 3 days after that, either capsaicin injection or noxious mechanical stimulation was applied to the upper lip ipsilateral to nerve injury. Infraorbital nerve chronic constriction injury rats displayed greater forelimb wiping to capsaicin injection and mechanical allodynia of the lip than sham rats. Total cell counts for phosphorylated extracellular signal-regulated kinase-immunoreactive (pERK-IR) neurons after capsaicin or mechanical lip stimuli were higher in ION-CCI than sham rats as was the percentage of pERK-IR PBN projection neurons. However, the percentage of pERK-IR VPM projection neurons was also greater in ION-CCI than sham rats after capsaicin but not mechanical lip stimuli. The present findings suggest that persistent trigeminal nerve injury increases the number of Vc neurons activated by capsaicin or mechanical lip stimuli. By contrast, trigeminal nerve injury modifies the proportion of Vc nociceptive neurons projecting to VPM and PBN in a stimulus modality-specific manner and may reflect differential involvement of ascending pain pathways receiving C fiber and mechanosensitive afferents.
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20
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Differential Diagnosis of Chronic Neuropathic Orofacial Pain: Role of Clinical Neurophysiology. J Clin Neurophysiol 2020; 36:422-429. [PMID: 31688325 DOI: 10.1097/wnp.0000000000000583] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Orofacial pain syndromes encompass several clinically defined and classified entities. The focus here is on the role of clinical neurophysiologic and psychophysical tests in the diagnosis, differential diagnosis, and pathophysiological mechanisms of definite trigeminal neuropathic pain and other chronic orofacial pain conditions (excluding headache and temporomandibular disorders). The International Classification of Headache Disorders 2018 classifies these facial pain disorders under the heading Painful cranial neuropathies and other facial pains. In addition to unambiguous painful posttraumatic or postherpetic trigeminal neuropathies, burning mouth syndrome, persistent idiopathic facial and dental pain, and trigeminal neuralgia have also been identified with neurophysiologic and quantitative sensory testing to involve the nervous system. Despite normal clinical examination, these all include clusters of patients with evidence for either peripheral or central nervous system pathology compatible with the subclinical end of a continuum of trigeminal neuropathic pain conditions. Useful tests in the diagnostic process include electroneuromyography with specific needle, neurography techniques for the inferior alveolar and infraorbital nerves, brain stem reflex recordings (blink reflex with stimulation of the supraorbital, infraorbital, mental, and lingual nerves; jaw jerk; masseter silent period), evoked potential recordings, and quantitative sensory testing. Habituation of the blink reflex and evoked potential responses to repeated stimuli evaluate top-down inhibition, and navigated transcranial magnetic stimulation allows the mapping of reorganization within the motor cortex in chronic neuropathic pain. With systematic use of neurophysiologic and quantitative sensory testing, many of the current ambiguities in the diagnosis, classification, and understanding of chronic orofacial syndromes can be clarified for clinical practice and future research.
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21
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Glatte P, Buchmann SJ, Hijazi MM, Illigens BMW, Siepmann T. Architecture of the Cutaneous Autonomic Nervous System. Front Neurol 2019; 10:970. [PMID: 31551921 PMCID: PMC6746903 DOI: 10.3389/fneur.2019.00970] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/23/2019] [Indexed: 12/12/2022] Open
Abstract
The human skin is a highly specialized organ for receiving sensory information but also to preserve the body's homeostasis. These functions are mediated by cutaneous small nerve fibers which display a complex anatomical architecture and are commonly classified into cutaneous A-beta, A-delta and C-fibers based on their diameter, myelinization, and velocity of conduction of action potentials. Knowledge on structure and function of these nerve fibers is relevant as they are selectively targeted by various autonomic neuropathies such as diabetic neuropathy or Parkinson's disease. Functional integrity of autonomic skin nerve fibers can be assessed by quantitative analysis of cutaneous responses to local pharmacological induction of axon reflex responses which result in dilation of cutaneous vessels, sweating, or piloerection depending on the agent used to stimulate this neurogenic response. Sensory fibers can be assessed using quantitative sensory test. Complementing these functional assessments, immunohistochemical staining of superficial skin biopsies allow analysis of structural integrity of cutaneous nerve fibers, a technique which has gained attention due to its capacity of detecting pathogenic depositions of alpha-synuclein in patients with Parkinson's disease. Here, we reviewed the current literature on the anatomy and functional pathways of the cutaneous autonomic nervous system as well as diagnostic techniques to assess its functional and structural integrity.
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Affiliation(s)
- Patrick Glatte
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sylvia J Buchmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mido Max Hijazi
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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22
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de Lucia C, Gambino G, Petraglia L, Elia A, Komici K, Femminella GD, D'Amico ML, Formisano R, Borghetti G, Liccardo D, Nolano M, Houser SR, Leosco D, Ferrara N, Koch WJ, Rengo G. Long-Term Caloric Restriction Improves Cardiac Function, Remodeling, Adrenergic Responsiveness, and Sympathetic Innervation in a Model of Postischemic Heart Failure. Circ Heart Fail 2019. [PMID: 29535114 DOI: 10.1161/circheartfailure.117.004153] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Caloric restriction (CR) has been described to have cardioprotective effects and improve functional outcomes in animal models and humans. Chronic ischemic heart failure (HF) is associated with reduced cardiac sympathetic innervation, dysfunctional β-adrenergic receptor signaling, and decreased cardiac inotropic reserve. We tested the effects of a long-term CR diet, started late after myocardial infarction on cardiac function, sympathetic innervation, and β-adrenergic receptor responsiveness in a rat model of postischemic HF. METHODS AND RESULTS Adult male rats were randomly assigned to myocardial infarction or sham operation and 4 weeks later were further randomized to a 1-year CR or normal diet. One year of CR resulted in a significant reduction in body weight, heart weight, and heart weight/tibia length ratio when compared with normal diet in HF groups. At the end of the study period, echocardiography and histology revealed that HF animals under the CR diet had ameliorated left ventricular remodeling compared with HF rats fed with normal diet. Invasive hemodynamic showed a significant improvement of cardiac inotropic reserve in CR HF rats compared with HF-normal diet animals. Importantly, CR dietary regimen was associated with a significant increase of cardiac sympathetic innervation and with normalized cardiac β-adrenergic receptor levels in HF rats when compared with HF rats on the standard diet. CONCLUSIONS We demonstrate, for the first time, that chronic CR, when started after HF established, can ameliorate cardiac dysfunction and improve inotropic reserve. At the molecular level, we find that chronic CR diet significantly improves sympathetic cardiac innervation and β-adrenergic receptor levels in failing myocardium.
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Affiliation(s)
- Claudio de Lucia
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Giuseppina Gambino
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Laura Petraglia
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Andrea Elia
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Klara Komici
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Grazia Daniela Femminella
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Maria Loreta D'Amico
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Roberto Formisano
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Giulia Borghetti
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Daniela Liccardo
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Maria Nolano
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Steven R Houser
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Dario Leosco
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Nicola Ferrara
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.)
| | - Walter J Koch
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.).
| | - Giuseppe Rengo
- From the Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Italy (C.d.L., G.G., L.P., A.E., K.K., G.D.F., M.L.D., R.F., D. Liccardo, D. Leosco, N.F., G.R.); Center for Translational Medicine (C.d.L., D. Liccardo, W.J.K.), Department of Pharmacology (C.d.L., D. Liccardo, W.J.K.) and Cardiovascular Research Center (G.B., S.R.H.), Lewis Katz School of Medicine, Temple University, Philadelphia, PA; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy (G.G., A.E., M.L.D., M.N., N.F., G.R.); and Neurology Imaging Unit, Imperial College London, United Kingdom (G.D.F.).
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Size-dependent skin penetration of silver nanoparticles: effect of penetration enhancers. APPLIED NANOSCIENCE 2018. [DOI: 10.1007/s13204-018-0886-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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24
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Structural, functional, and symptom relations in painful distal symmetric polyneuropathies: a systematic review. Pain 2018; 160:286-297. [DOI: 10.1097/j.pain.0000000000001381] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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25
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Galosi E, La Cesa S, Di Stefano G, Karlsson P, Fasolino A, Leone C, Biasiotta A, Cruccu G, Truini A. A pain in the skin. Regenerating nerve sprouts are distinctly associated with ongoing burning pain in patients with diabetes. Eur J Pain 2018; 22:1727-1734. [PMID: 29885017 DOI: 10.1002/ejp.1259] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUNDS Patients with diabetic polyneuropathy commonly suffer from ongoing burning pain and dynamic mechanical allodynia. In this clinical and skin biopsy study, we aimed at assessing how intraepidermal regenerating nerve sprouts are associated with these two types of pain. METHODS We consecutively enrolled 85 patients with diabetic polyneuropathy. All patients underwent skin biopsy at the distal leg. Intraepidermal nerve fibres were immunostained with the anti-protein gene product 9.5 (PGP9.5) to quantify all intraepidermal nerve fibres, and the growth-associated protein 43 (GAP43) to quantify regenerating nerve sprouts. RESULTS We found that the GAP43-stained intraepidermal nerve fibre density and the ratio GAP43/PGP9.5 were significantly higher in patients with ongoing burning pain than in those without. The area of receiver operating characteristic (ROC) curve for the ratio GAP43/PGP9.5 was 0.74 and yielded a sensitivity and specificity for identifying ongoing burning pain of 72% and 71%, respectively. Conversely, although the density of PGP9.5 and GAP43 intraepidermal nerve fibre was higher in patients with dynamic mechanical allodynia than in those without, this difference was statistically weak and the ROC curve analysis of skin biopsy variables for this type of pain failed to reach the statistical significance. CONCLUSION Our clinical and skin biopsy study showed that ongoing burning pain was strongly associated with regenerating sprouts, as assessed with GAP43 immunostaining. This finding improves our understanding on the mechanisms underlying neuropathic pain in patients with diabetic polyneuropathy and suggests that the GAP43/PGP 9.5 ratio might be used as an objective marker for ongoing burning pain due to regenerating sprouts. SIGNIFICANCE Our skin biopsy study showing that regenerating sprouts, as assessed with GAP43-staining, were strongly associated with ongoing burning pain, improves our knowledge on the mechanisms underlying neuropathic pain in patients with diabetes.
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Affiliation(s)
- E Galosi
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - S La Cesa
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - G Di Stefano
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - P Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark.,Core Center for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Denmark
| | - A Fasolino
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - C Leone
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - A Biasiotta
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - G Cruccu
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - A Truini
- Department Human Neuroscience, Sapienza University, Rome, Italy
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26
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Alcalde I, Íñigo-Portugués A, González-González O, Almaraz L, Artime E, Morenilla-Palao C, Gallar J, Viana F, Merayo-Lloves J, Belmonte C. Morphological and functional changes in TRPM8-expressing corneal cold thermoreceptor neurons during aging and their impact on tearing in mice. J Comp Neurol 2018; 526:1859-1874. [PMID: 29664111 DOI: 10.1002/cne.24454] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/07/2022]
Abstract
Morphological and functional alterations of peripheral somatosensory neurons during the aging process lead to a decline of somatosensory perception. Here, we analyze the changes occurring with aging in trigeminal ganglion (TG), TRPM8-expressing cold thermoreceptor neurons innervating the mouse cornea, which participate in the regulation of basal tearing and blinking and have been implicated in the pathogenesis of dry eye disease (DED). TG cell bodies and axonal branches were examined in a mouse line (TRPM8BAC -EYFP) expressing a fluorescent reporter. In 3 months old animals, about 50% of TG cold thermoreceptor neurons were intensely fluorescent, likely providing strongly fluorescent axons and complex corneal nerve terminals with ongoing activity at 34°C and low-threshold, robust responses to cooling. The remaining TRPM8+ corneal axons were weakly fluorescent with nonbeaded axons, sparsely ramified nerve terminals, and exhibited a low-firing rate at 34°C, responding moderately to cooling pulses as do weakly fluorescent TG neurons. In aged (24 months) mice, the number of weakly fluorescent TG neurons was strikingly high while the morphology of TRPM8+ corneal axons changed drastically; 89% were weakly fluorescent, unbranched, and often ending in the basal epithelium. Functionally, 72.5% of aged cold terminals responded as those of young animals, but 27.5% exhibited very low-background activity and abnormal responsiveness to cooling pulses. These morpho-functional changes develop in parallel with an enhancement of tear's basal flow and osmolarity, suggesting that the aberrant sensory inflow to the brain from impaired peripheral cold thermoreceptors contributes to age-induced abnormal tearing and to the high incidence of DED in elderly people.
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Affiliation(s)
- Ignacio Alcalde
- Instituto Universitario Fernández-Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
| | - Almudena Íñigo-Portugués
- Instituto Universitario Fernández-Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain.,Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
| | - Omar González-González
- Instituto Universitario Fernández-Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
| | - Laura Almaraz
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
| | - Enol Artime
- Instituto Universitario Fernández-Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
| | - Cruz Morenilla-Palao
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
| | - Juana Gallar
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
| | - Félix Viana
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
| | - Jesús Merayo-Lloves
- Instituto Universitario Fernández-Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
| | - Carlos Belmonte
- Instituto Universitario Fernández-Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain.,Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
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27
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Egan KP, Allen AG, Wigdahl B, Jennings SR. Modeling the pathology, immune responses, and kinetics of HSV-1 replication in the lip scarification model. Virology 2018; 514:124-133. [DOI: 10.1016/j.virol.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/01/2017] [Accepted: 11/13/2017] [Indexed: 12/21/2022]
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28
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Dagsdóttir LK, Bellan V, Skyt I, Vase L, Baad-Hansen L, Castrillon E, Svensson P. Multisensory modulation of experimentally evoked perceptual distortion of the face. J Oral Rehabil 2017; 45:1-8. [PMID: 29054121 DOI: 10.1111/joor.12581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic oro-facial pain patients often perceive the painful face area as "swollen" without clinical signs, that is a perceptual distortion (PD). Local anaesthetic (LA) injections in healthy participants are also associated with PD. OBJECTIVE The aim was to explore whether PD evoked by LA into the infraorbital region could be modulated by adding mechanical stimulation (MS) to the affected area. METHODS Mechanical stimulation was given with a brush and a 128-mN von Frey filament. Firstly, sixty healthy participants were randomly divided into three groups: (i) LA control, (ii) LA with MS, (iii) isotonic solution (ISO) with MS as an additional control condition. To further examine the role of a multisensory modulation, an additional experiment was conducted. Twenty participants received LA with MS (filament) in addition to visual feedback of their distorted face. The results of the two experiments are presented together. RESULTS All three LA groups experienced PD; per contra, PD was not reported in the ISO group. MS alone did not change the magnitude of PD: brush (P = .089), filament (P = .203). However, when the filament stimulation was combined with additional visual information of a distorted face, there was observable decrease in PD (P = .002). CONCLUSION The findings indicate the importance of multisensory integration for PD and represent a significant step forward in the understanding of the factors that may influence this common condition. Future studies are encouraged to investigate further the cortical processing for possible implications for PD in pain management.
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Affiliation(s)
- L K Dagsdóttir
- Section of Orofacial Pain and Jaw Function, Department of Odontology and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center of Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - V Bellan
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - I Skyt
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - L Vase
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - L Baad-Hansen
- Section of Orofacial Pain and Jaw Function, Department of Odontology and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center of Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - E Castrillon
- Section of Orofacial Pain and Jaw Function, Department of Odontology and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center of Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - P Svensson
- Section of Orofacial Pain and Jaw Function, Department of Odontology and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center of Orofacial Neurosciences (SCON), Aarhus, Denmark.,Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
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Mattos KPH, Cintra ML, Gouvêa IR, Ferreira LÁ, Velho PENF, Moriel P. Skin hyperpigmentation following intravenous polymyxin B treatment associated with melanocyte activation and inflammatory process. J Clin Pharm Ther 2017; 42:573-578. [PMID: 28497462 DOI: 10.1111/jcpt.12543] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/03/2017] [Indexed: 11/28/2022]
Abstract
What is known and objective Polymyxins were widely used until the 1960s; however, they fell into disfavour owing to their toxicity. The subsequent growth of infections caused by multidrug-resistant Gram-negative bacteria has led to renewed use of this class of antimicrobials in clinical practice. Acquired skin hyperpigmentation (SH) following intravenous polymyxin B treatment has been previously reported, but little is known about its pathogenesis, clinical course and treatment. To improve understanding of these issues, we conducted a prospective study of adult patients receiving intravenous polymyxin B treatment. Methods Patients receiving intravenous polymyxin B treatment were followed throughout the course of treatment. Clinical, dermatoscopic, histologic and immunohistochemical skin properties of patients who presented with SH were studied. Results and discussion Skin hyperpigmentation was noted in 8% of patients (n=20/249); however, clinical, dermatoscopic, histologic and immunohistochemical examinations were performed only in three patients for whom the consent of relatives was obtained. Histologic and immunohistochemical findings showed an abundant melanocyte-pigmented dendritic network. Langerhans cells' hyperplasia and dermal IL-6 overexpression were also found, presumably for an inflammatory process due to polymyxin B use. As polymyxin B causes the release of histamine, which is known for its melanogenic effect, it is possible that skin darkening is associated with this inflammatory mediator. What is new These clinical and dermatoscopic findings contribute to a better understanding of how the pigmentary reaction manifests following intravenous polymyxin B treatment. Conclusion We concluded that hyperpigmentation due to intravenous polymyxin B treatment is associated with an inflammatory process and subsequent melanocyte activation. Although the pigmentary disorder neither influences the outcome of the therapy nor warrants discontinuation of treatment, it nevertheless considerably affects the patient's quality of life.
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Affiliation(s)
- K P H Mattos
- Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - M L Cintra
- Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - I R Gouvêa
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, SP, Brazil
| | - L Á Ferreira
- Dermatoscopy and melanoma Department of the Clinical Hospital of University of Campinas, Sao Paulo, SP, Brazil
| | - P E N F Velho
- Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.,Dermatoscopy and melanoma Department of the Clinical Hospital of University of Campinas, Sao Paulo, SP, Brazil
| | - P Moriel
- Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.,Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, SP, Brazil
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30
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Sustained attractiveness and natural youthful appearance by upper lip rejuvenation. Wien Med Wochenschr 2017; 168:361-366. [DOI: 10.1007/s10354-017-0560-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
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Saito H, Katagiri A, Okada S, Mikuzuki L, Kubo A, Suzuki T, Ohara K, Lee J, Gionhaku N, Iinuma T, Bereiter DA, Iwata K. Ascending projections of nociceptive neurons from trigeminal subnucleus caudalis: A population approach. Exp Neurol 2017; 293:124-136. [PMID: 28366470 DOI: 10.1016/j.expneurol.2017.03.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/25/2017] [Accepted: 03/29/2017] [Indexed: 12/14/2022]
Abstract
Second-order neurons in trigeminal subnucleus caudalis (Vc) and upper cervical spinal cord (C1) are critical for craniofacial pain processing and project rostrally to terminate in: ventral posteromedial thalamic nucleus (VPM), medial thalamic nuclei (MTN) and parabrachial nuclei (PBN). The contribution of each region to trigeminal nociception was assessed by the number of phosphorylated extracellular signal-regulated kinase-immunoreactive (pERK-IR) neurons co-labeled with fluorogold (FG). The phenotype of pERK-IR neurons was further defined by the expression of neurokinin 1 receptor (NK1). The retrograde tracer FG was injected into VPM, MTN or PBN of the right hemisphere and after seven days, capsaicin was injected into the left upper lip in male rats. Nearly all pERK-IR neurons were found in superficial laminae of Vc-C1 ipsilateral to the capsaicin injection. Nearly all VPM and MTN FG-labeled neurons in Vc-C1 were found contralateral to the injection site, whereas FG-labeled neurons were found bilaterally after PBN injection. The percentage of FG-pERK-NK1-IR neurons was significantly greater (>10%) for PBN projection neurons than for VPM and MTN projection neurons (<3%). pERK-NK1-IR VPM projection neurons were found mainly in the middle-Vc, while pERK-NK1-immunoreactive MTN or PBN projection neurons were found in the middle-Vc and caudal Vc-C1. These results suggest that a significant percentage of capsaicin-responsive neurons in superficial laminae of Vc-C1 project directly to PBN, while neurons that project to VPM and MTN are subject to greater modulation by pERK-IR local interneurons. Furthermore, the rostrocaudal distribution differences of FG-pERK-NK1-IR neurons in Vc-C1 may reflect functional differences between these projection areas regarding craniofacial pain.
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Affiliation(s)
- Hiroto Saito
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan; Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan.
| | - Ayano Katagiri
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan.
| | - Shinji Okada
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan; Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan.
| | - Lou Mikuzuki
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan; Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Asako Kubo
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan.
| | - Tatsuro Suzuki
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan; Department of Periodontology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan.
| | - Kinuyo Ohara
- Department of Endodontics, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan.
| | - Jun Lee
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan.
| | - Nobuhito Gionhaku
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan.
| | - Toshimitsu Iinuma
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan.
| | - David A Bereiter
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA.
| | - Koichi Iwata
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan.
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Abstract
Objective To review the clinical entity of primary burning mouth syndrome (BMS), its pathophysiological mechanisms, accurate new diagnostic methods and evidence-based treatment options, and to describe novel lines for future research regarding aetiology, pathophysiology, and new therapeutic strategies. Description Primary BMS is a chronic neuropathic intraoral pain condition that despite typical symptoms lacks clear clinical signs of neuropathic involvement. With advanced diagnostic methods, such as quantitative sensory testing of small somatosensory and taste afferents, neurophysiological recordings of the trigeminal system, and peripheral nerve blocks, most BMS patients can be classified into the peripheral or central type of neuropathic pain. These two types differ regarding pathophysiological mechanisms, efficacy of available treatments, and psychiatric comorbidity. The two types may overlap in individual patients. BMS is most frequent in postmenopausal women, with general population prevalence of around 1%. Treatment of BMS is difficult; best evidence exists for efficacy of topical and systemic clonazepam. Hormonal substitution, dopaminergic medications, and therapeutic non-invasive neuromodulation may provide efficient mechanism-based treatments for BMS in the future. Conclusion We present a novel comprehensive hypothesis of primary BMS, gathering the hormonal, neuropathic, and genetic factors presumably required in the genesis of the condition. This will aid in future research on pathophysiology and risk factors of BMS, and boost treatment trials taking into account individual mechanism profiles and subgroup-clusters.
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Affiliation(s)
- Satu K Jääskeläinen
- Department of Clinical Neurophysiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Alain Woda
- Université Clermont Auvergne, CROC and University Hospital, Odontology department; Clermont-Ferrand, France
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Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Primers 2017; 3:17002. [PMID: 28205574 PMCID: PMC5371025 DOI: 10.1038/nrdp.2017.2] [Citation(s) in RCA: 1182] [Impact Index Per Article: 168.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neuropathic pain is caused by a lesion or disease of the somatosensory system, including peripheral fibres (Aβ, Aδ and C fibres) and central neurons, and affects 7-10% of the general population. Multiple causes of neuropathic pain have been described and its incidence is likely to increase owing to the ageing global population, increased incidence of diabetes mellitus and improved survival from cancer after chemotherapy. Indeed, imbalances between excitatory and inhibitory somatosensory signalling, alterations in ion channels and variability in the way that pain messages are modulated in the central nervous system all have been implicated in neuropathic pain. The burden of chronic neuropathic pain seems to be related to the complexity of neuropathic symptoms, poor outcomes and difficult treatment decisions. Importantly, quality of life is impaired in patients with neuropathic pain owing to increased drug prescriptions and visits to health care providers, as well as the morbidity from the pain itself and the inciting disease. Despite challenges, progress in the understanding of the pathophysiology of neuropathic pain is spurring the development of new diagnostic procedures and personalized interventions, which emphasize the need for a multidisciplinary approach to the management of neuropathic pain.
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Affiliation(s)
- Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing and Department of Anesthesiology School of Medicine, University of Maryland, 655 West Lombard Street, 21201 Baltimore, Maryland, USA
| | - Taylor Ludman
- Department of Pain and Translational Symptom Science, School of Nursing and Department of Anesthesiology School of Medicine, University of Maryland, 655 West Lombard Street, 21201 Baltimore, Maryland, USA
| | - Didier Bouhassira
- INSERM, Unit 987, Ambroise Paré Hospital, UVSQ, Boulogne Billancourt, France
| | - Ralf Baron
- Department of Neurology, Division of Neurological Pain Research and Therapy, Klinik fur Neurologie Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - Anthony H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - David Yarnitsky
- Department of Neurology, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Truini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Nadine Attal
- Pain Evaluation and Treatment Centre of Hôpital Ambroise Paré, Paris, France
| | - Nanna B Finnerup
- Department of Clinical Medicine - The Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, UK
- Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Eija Kalso
- Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Robert H Dworkin
- Department of Anesthesiology, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Srinivasa N Raja
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Primers 2017; 3:17002. [PMID: 28205574 DOI: 10.1038/nrdp.2017.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Neuropathic pain is caused by a lesion or disease of the somatosensory system, including peripheral fibres (Aβ, Aδ and C fibres) and central neurons, and affects 7-10% of the general population. Multiple causes of neuropathic pain have been described and its incidence is likely to increase owing to the ageing global population, increased incidence of diabetes mellitus and improved survival from cancer after chemotherapy. Indeed, imbalances between excitatory and inhibitory somatosensory signalling, alterations in ion channels and variability in the way that pain messages are modulated in the central nervous system all have been implicated in neuropathic pain. The burden of chronic neuropathic pain seems to be related to the complexity of neuropathic symptoms, poor outcomes and difficult treatment decisions. Importantly, quality of life is impaired in patients with neuropathic pain owing to increased drug prescriptions and visits to health care providers, as well as the morbidity from the pain itself and the inciting disease. Despite challenges, progress in the understanding of the pathophysiology of neuropathic pain is spurring the development of new diagnostic procedures and personalized interventions, which emphasize the need for a multidisciplinary approach to the management of neuropathic pain.
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Affiliation(s)
- Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing and Department of Anesthesiology School of Medicine, University of Maryland, 655 West Lombard Street, 21201 Baltimore, Maryland, USA
| | - Taylor Ludman
- Department of Pain and Translational Symptom Science, School of Nursing and Department of Anesthesiology School of Medicine, University of Maryland, 655 West Lombard Street, 21201 Baltimore, Maryland, USA
| | - Didier Bouhassira
- INSERM, Unit 987, Ambroise Paré Hospital, UVSQ, Boulogne Billancourt, France
| | - Ralf Baron
- Department of Neurology, Division of Neurological Pain Research and Therapy, Klinik fur Neurologie Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - Anthony H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - David Yarnitsky
- Department of Neurology, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Truini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Nadine Attal
- Pain Evaluation and Treatment Centre of Hôpital Ambroise Paré, Paris, France
| | - Nanna B Finnerup
- Department of Clinical Medicine - The Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, UK
- Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Eija Kalso
- Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Robert H Dworkin
- Department of Anesthesiology, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Srinivasa N Raja
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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How diagnostic tests help to disentangle the mechanisms underlying neuropathic pain symptoms in painful neuropathies. Pain 2016; 157 Suppl 1:S53-S59. [PMID: 26785156 DOI: 10.1097/j.pain.0000000000000367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neuropathic pain, ie, pain arising directly from a lesion or disease affecting the somatosensory afferent pathway, manifests with various symptoms, the commonest being ongoing burning pain, electrical shock-like sensations, and dynamic mechanical allodynia. Reliable insights into the mechanisms underlying neuropathic pain symptoms come from diagnostic tests documenting and quantifying somatosensory afferent pathway damage in patients with painful neuropathies. Neurophysiological investigation and skin biopsy studies suggest that ongoing burning pain primarily reflects spontaneous activity in nociceptive-fiber pathways. Electrical shock-like sensations presumably arise from high-frequency ectopic bursts generated in demyelinated, nonnociceptive, Aβ fibers. Although the mechanisms underlying dynamic mechanical allodynia remain debatable, normally innocuous stimuli might cause pain by activating spared and sensitized nociceptive afferents. Extending the mechanistic approach to neuropathic pain symptoms might advance targeted therapy for the individual patient and improve testing for new drugs.
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Bertolini M, Pretzlaff M, Sulk M, Bähr M, Gherardini J, Uchida Y, Reibelt M, Kinori M, Rossi A, Bíró T, Paus R. Vasoactive intestinal peptide, whose receptor-mediated signalling may be defective in alopecia areata, provides protection from hair follicle immune privilege collapse. Br J Dermatol 2016; 175:531-41. [PMID: 27059672 DOI: 10.1111/bjd.14645] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune disorder whose pathogenesis involves the collapse of the relative immune privilege (IP) of the hair follicle (HF). Given that vasoactive intestinal peptide (VIP) is an immunoinhibitory neuropeptide released by perifollicular sensory nerve fibres, which play a role in IP maintenance, it may modulate human HF-IP and thus be therapeutically relevant for AA. OBJECTIVES To answer the following questions: Do human HFs express VIP receptors, and does their stimulation protect from or restore experimentally induced HF-IP collapse? Is VIP signalling defective in AA HFs? METHODS Firstly, VIP and VIP receptor (VPAC1, VPAC2) expression in human scalp HFs and AA skin was assessed. In HF organ culture, we then explored whether VIP treatment can restore and/or protect from interferon-γ-induced HF-IP collapse, assessing the expression of the key IP markers by quantitative (immuno-)histomorphometry. RESULTS Here we provide the first evidence that VIP receptors are expressed in the epithelium of healthy human HFs at the gene and protein level. Furthermore, VIP receptor protein expression, but not VIP(+) nerve fibres, is significantly downregulated in lesional hair bulbs of patients with AA, suggesting defects in VIP receptor-mediated signalling. Moreover, we show that VIP protects the HF from experimentally induced IP collapse in vitro, but does not fully restore it once collapsed. CONCLUSIONS These pilot data suggest that insufficient VIP receptor-mediated signalling may contribute to impairing HF-IP in patients with AA, and that VIP is a promising candidate 'HF-IP guardian' that may be therapeutically exploited to inhibit the progression of AA lesions.
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Affiliation(s)
- M Bertolini
- Department of Dermatology, University of Münster, Münster, Germany.
| | - M Pretzlaff
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - M Sulk
- Department of Dermatology, University of Münster, Münster, Germany
| | - M Bähr
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - J Gherardini
- Department of Dermatology, University of Münster, Münster, Germany
| | - Y Uchida
- Department of Dermatology, University of Münster, Münster, Germany.,Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - M Reibelt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - M Kinori
- Department of Ophthalmology, Sheba Medical Center, Tel Hashomer, Israel
| | - A Rossi
- Department of Internal Medicine and Medical Specialties, University 'La Sapienza', Rome, Italy
| | - T Bíró
- DE-MTA 'Lendület' Cellular Physiology Research Group, Departments of Immunology and Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - R Paus
- Department of Dermatology, University of Münster, Münster, Germany.,Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester, U.K
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Pazzaglia C, Camerota F, Celletti C, Minciotti I, Testani E, Padua L, Valeriani M. Focal Mechanical Vibration Does not Change Laser-Pain Perception and Laser-Evoked Potentials: A Pilot Study. Pain Pract 2016; 17:25-31. [PMID: 26892176 DOI: 10.1111/papr.12417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/13/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nonpainful tactile and electrical stimulation of the large myelinated fibers reduces spontaneous pain and the amplitude of laser-evoked potentials (LEPs), which represent the most reliable technique to assess the nociceptive pathway function. Focal mechanical vibration stimulates the Aβ afferents selectively; thus, it is conceivable its action on nociceptive pathways. AIM The aim of this study was to investigate the effect of vibratory stimuli, activating either both muscle and skin receptors or cutaneous afferents only on the LEPs and subjective laser-pain rating. METHODS Ten healthy volunteers were studied. The subjects were evaluated in two different sessions to test muscle and skin receptors or cutaneous afferents only. In each session, LEPs were recorded to stimulation of the dorsal hand skin in radial and ulnar territory bilaterally, while the vibratory stimulus was delivered on the radial territory of the right forearm. RESULTS The results showed a substantial stability of the potential N1 and N2/P2 after the two protocols, with a declining trend from the initial to the last test of the same session, probably due to habituation. Accordingly, the laser-pain perception did not change during the experimental setting. CONCLUSIONS We conclude that a vibratory stimulus is ineffective in reducing the laser-evoked potentials and laser-pain perception.
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Affiliation(s)
- Costanza Pazzaglia
- Department of Neurorehabilitation, Don Carlo Gnocchi Onlus Foundation, Milan, Italy
| | - Filippo Camerota
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Claudia Celletti
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Ileana Minciotti
- Department of Geriatric, Neuroscience and Orthopaedic, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisa Testani
- Department of Geriatric, Neuroscience and Orthopaedic, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Padua
- Department of Neurorehabilitation, Don Carlo Gnocchi Onlus Foundation, Milan, Italy.,Department of Geriatric, Neuroscience and Orthopaedic, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Valeriani
- Department of Neurology, Pediatric Hospital Bambino Gesù, Rome, Italy.,Center for Sensory-motor Interaction, Aalborg University, Aalborg, Denmark
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Wong R, Geyer S, Weninger W, Guimberteau JC, Wong JK. The dynamic anatomy and patterning of skin. Exp Dermatol 2015; 25:92-8. [PMID: 26284579 DOI: 10.1111/exd.12832] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 12/14/2022]
Abstract
The skin is often viewed as a static barrier that protects the body from the outside world. Emphasis on studying the skin's architecture and biomechanics in the context of restoring skin movement and function is often ignored. It is fundamentally important that if skin is to be modelled or developed, we do not only focus on the biology of skin but also aim to understand its mechanical properties and structure in living dynamic tissue. In this review, we describe the architecture of skin and patterning seen in skin as viewed from a surgical perspective and highlight aspects of the microanatomy that have never fully been realized and provide evidence or concepts that support the importance of studying living skin's dynamic behaviour. We highlight how the structure of the skin has evolved to allow the body dynamic form and function, and how injury, disease or ageing results in a dramatic changes to the microarchitecture and changes physical characteristics of skin. Therefore, appreciating the dynamic microanatomy of skin from the deep fascia through to the skin surface is vitally important from a dermatological and surgical perspective. This focus provides an alternative perspective and approach to addressing skin pathologies and skin ageing.
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Affiliation(s)
- Richard Wong
- Plastic Surgery Research, Centre of Dermatology, University of Manchester, Manchester, UK
| | - Stefan Geyer
- Center for Anatomy & Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Weninger
- Center for Anatomy & Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Jean-Claude Guimberteau
- De la Main et Plastique Reconstructice, Institut Aquitain de la Main Bordeaux, Pessac, France
| | - Jason K Wong
- Plastic Surgery Research, Centre of Dermatology, University of Manchester, Manchester, UK
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Truini A, Haanpaa M, Provitera V, Biasiotta A, Stancanelli A, Caporaso G, Santoro L, Cruccu G, Nolano M. Differential myelinated and unmyelinated sensory and autonomic skin nerve fiber involvement in patients with ophthalmic postherpetic neuralgia. Front Neuroanat 2015; 9:105. [PMID: 26300742 PMCID: PMC4523825 DOI: 10.3389/fnana.2015.00105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/22/2015] [Indexed: 01/03/2023] Open
Abstract
Postherpetic neuralgia (PHN) is a common and exceptionally drug-resistant neuropathic pain condition. In this cross-sectional skin biopsy study, seeking information on the responsible pathophysiological mechanisms we assessed how ophthalmic PHN affects sensory and autonomic skin innervation. We took 2-mm supraorbital punch skin biopsies from the affected and unaffected sides in 10 patients with ophthalmic PHN. Using indirect immunofluorescence and a large panel of antibodies including protein gene product (PGP) 9.5 we quantified epidermal unmyelinated, dermal myelinated and autonomic nerve fibers. Although skin biopsy showed reduced epidermal and dermal myelinated fiber density in specimens from the affected side, the epidermal/dermal myelinated nerve fiber ratio was lower in the affected than in the unaffected side (p < 0.001), thus suggesting a predominant epidermal unmyelinated nerve fiber loss. Conversely, autonomic skin innervation was spared. Our study showing that ophthalmic PHN predominantly affects unmyelinated nerve fiber and spares autonomic nerve fiber might help to understand the pathophysiological mechanisms underlying this difficult-to-treat condition.
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Affiliation(s)
- Andrea Truini
- Department of Neurology and Psychiatry, Sapienza University of Rome Rome, Italy
| | - Maija Haanpaa
- Department of Neurosurgery, Helsinki University Central Hospital Helsinki, Finland
| | - Vincenzo Provitera
- Neurology Division "Salvatore Maugeri" Foundation-Institute of Telese Terme (BN) Italy Telese Terme, Italy
| | - Antonella Biasiotta
- Department of Neurology and Psychiatry, Sapienza University of Rome Rome, Italy
| | - Annamaria Stancanelli
- Neurology Division "Salvatore Maugeri" Foundation-Institute of Telese Terme (BN) Italy Telese Terme, Italy
| | - Giuseppe Caporaso
- Neurology Division "Salvatore Maugeri" Foundation-Institute of Telese Terme (BN) Italy Telese Terme, Italy
| | - Lucio Santoro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples Naples, Italy
| | - Giorgio Cruccu
- Department of Neurology and Psychiatry, Sapienza University of Rome Rome, Italy
| | - Maria Nolano
- Neurology Division "Salvatore Maugeri" Foundation-Institute of Telese Terme (BN) Italy Telese Terme, Italy
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Galluzzo M, Talamonti M, Di Stefani A, Chimenti S. Linear psoriasis following the typical distribution of the sciatic nerve. J Dermatol Case Rep 2015; 9:6-11. [PMID: 25932056 DOI: 10.3315/jdcr.2015.1189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/04/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Some studies suggest that the nervous system plays a role in the onset of psoriasis and psoriasis flares including the symmetry of lesions, sparing of denervated skin and the role of stress in inducing lesions. MAIN OBSERVATIONS We describe an unusual case of psoriasis occurring in the same distribution as sciatic pain from a prolapsed intervertebral disc. The patient, a 45-year-old man with plaque psoriasis was treated with ustekinumab for 104 weeks, at a standard dose. During the eight month of therapy he developed an asymptomatic linear eruption on the left lower extremity along the distribution of the sciatic nerve. On examination, erythematous scaly plaques were noted. Histopathology confirmed the diagnosis of psoriasis. The treatment was continued and clobetasol proprionate 0.05% cream was added. At week 12 after the eruption, the patient reported a pain radiating through the buttock and posterior left leg during jogging. Magnetic resonance imaging showed lumbar disc herniation with compression of the L5-S1 spinal nerve roots. The patient stopped running and the psoriasis spontaneously receded, in a slow but complete fashion, without any local treatment. CONCLUSION There is substantial evidence that nerves play a key role in the pathogenesis of psoriasis. We hypothesized that local TNF-alpha, neuropeptides and nerve growth factor, which are produced by nerve root compression, played a critical role in this case of psoriasis onset in an area of pain from a bulging lumbar intervertebral disc. To our knowledge, a correlation of psoriasis and nerve root compression has not been described previously.
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Affiliation(s)
- Marco Galluzzo
- Department of Dermatology, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Marina Talamonti
- Department of Dermatology, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Alessandro Di Stefani
- Department of Dermatology, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Sergio Chimenti
- Department of Dermatology, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
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42
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Truini A, Provitera V, Biasiotta A, Stancanelli A, Antonini G, Santoro L, Cruccu G, Nolano M. Differential trigeminal myelinated and unmyelinated nerve fiber involvement in FOSMN syndrome. Neurology 2015; 84:540-2. [PMID: 25568294 DOI: 10.1212/wnl.0000000000001216] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Andrea Truini
- From University Sapienza (A.T., A.B., G.A., G.C.), Rome; "Salvatore Maugeri" Foundation (V.P., A.S., M.N.), Institute of Telese Terme (BN), and University Federico II of Naples (L.S.), Naples, Italy
| | - Vincenzo Provitera
- From University Sapienza (A.T., A.B., G.A., G.C.), Rome; "Salvatore Maugeri" Foundation (V.P., A.S., M.N.), Institute of Telese Terme (BN), and University Federico II of Naples (L.S.), Naples, Italy
| | - Antonella Biasiotta
- From University Sapienza (A.T., A.B., G.A., G.C.), Rome; "Salvatore Maugeri" Foundation (V.P., A.S., M.N.), Institute of Telese Terme (BN), and University Federico II of Naples (L.S.), Naples, Italy
| | - Annamaria Stancanelli
- From University Sapienza (A.T., A.B., G.A., G.C.), Rome; "Salvatore Maugeri" Foundation (V.P., A.S., M.N.), Institute of Telese Terme (BN), and University Federico II of Naples (L.S.), Naples, Italy
| | - Giovanni Antonini
- From University Sapienza (A.T., A.B., G.A., G.C.), Rome; "Salvatore Maugeri" Foundation (V.P., A.S., M.N.), Institute of Telese Terme (BN), and University Federico II of Naples (L.S.), Naples, Italy
| | - Lucio Santoro
- From University Sapienza (A.T., A.B., G.A., G.C.), Rome; "Salvatore Maugeri" Foundation (V.P., A.S., M.N.), Institute of Telese Terme (BN), and University Federico II of Naples (L.S.), Naples, Italy
| | - Giorgio Cruccu
- From University Sapienza (A.T., A.B., G.A., G.C.), Rome; "Salvatore Maugeri" Foundation (V.P., A.S., M.N.), Institute of Telese Terme (BN), and University Federico II of Naples (L.S.), Naples, Italy
| | - Maria Nolano
- From University Sapienza (A.T., A.B., G.A., G.C.), Rome; "Salvatore Maugeri" Foundation (V.P., A.S., M.N.), Institute of Telese Terme (BN), and University Federico II of Naples (L.S.), Naples, Italy.
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43
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Johnson JM, Minson CT, Kellogg DL. Cutaneous vasodilator and vasoconstrictor mechanisms in temperature regulation. Compr Physiol 2014; 4:33-89. [PMID: 24692134 DOI: 10.1002/cphy.c130015] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In this review, we focus on significant developments in our understanding of the mechanisms that control the cutaneous vasculature in humans, with emphasis on the literature of the last half-century. To provide a background for subsequent sections, we review methods of measurement and techniques of importance in elucidating control mechanisms for studying skin blood flow. In addition, the anatomy of the skin relevant to its thermoregulatory function is outlined. The mechanisms by which sympathetic nerves mediate cutaneous active vasodilation during whole body heating and cutaneous vasoconstriction during whole body cooling are reviewed, including discussions of mechanisms involving cotransmission, NO, and other effectors. Current concepts for the mechanisms that effect local cutaneous vascular responses to local skin warming and cooling are examined, including the roles of temperature sensitive afferent neurons as well as NO and other mediators. Factors that can modulate control mechanisms of the cutaneous vasculature, such as gender, aging, and clinical conditions, are discussed, as are nonthermoregulatory reflex modifiers of thermoregulatory cutaneous vascular responses.
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Affiliation(s)
- John M Johnson
- Department of Physiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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44
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Abstract
Several diagnoses in the new DSM-5 chapter on 'Obsessive-Compulsive and Related Disorders' directly relate to psychodermatology. The new excoriation (skin-picking) disorder (SPD) and trichotillomania (TTM) both manifest as recurrent body-focused repetitive behaviors that have compulsive and dissociative features, the latter being more prevalent in TTM than SPD. The DSM-5 refers to SPD and TTM occurring without full awareness or preceding tension, however does not specifically mention the possible role of dissociation. This has important treatment implications, as patients with high dissociative symptoms are not likely to respond to the standard treatments for obsessive-compulsive disorder. Body dysmorphic disorder (BDD), which is frequently associated with cutaneous body image (CBI) dissatisfaction, is present in 9%-15% of dermatology patients. Treatment guidelines in dermatology are increasingly considering the psychosocial morbidity related to CBI in their treatment outcome measures. The presence of BDD, if unrecognized, may therefore directly affect the dermatologic treatment regimens offered to the patient.
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Affiliation(s)
- Madhulika A Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, 585 Springbank Drive, Suite 101, London, Ontario, N6J 1H3, Canada,
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45
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Abstract
Every element or cell in the human body produces substances that communicate and respond in an autocrine or paracrine mode, consequently affecting organs and structures that are seemingly far from each other. The same also applies to the skin. In fact, when the integrity of the skin has been altered, or when its healing process is disturbed, it becomes a source of symptoms that are not merely cutaneous. The skin is an organ, and similar to any other structure, it has different functions in addition to connections with the central and peripheral nervous system. This article examines pathological responses produced by scars, analyzing definitions and differences. At the same time, it considers the subcutaneous fascias, as this connective structure is altered when there is a discontinuous cutaneous surface. The consequence is an ample symptomatology, which is not limited to the body area where the scar is located, such as a postural or trigeminal disorder.
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Affiliation(s)
- Bruno Bordoni
- Rehabilitation Cardiology Institute of Hospitalization and Care with Scientific Address, S Maria Nascente Don Carlo Gnocchi Foundation. CRESO Osteopathic Centre for Research and Studies
| | - Emiliano Zanier
- EdiAcademy, Milano, Italy. CRESO Osteopathic Centre for Research and Studies
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Nerve-derived transmitters including peptides influence cutaneous immunology. Brain Behav Immun 2013; 34:1-10. [PMID: 23517710 PMCID: PMC3750093 DOI: 10.1016/j.bbi.2013.03.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/27/2013] [Accepted: 03/10/2013] [Indexed: 01/01/2023] Open
Abstract
Clinical observations suggest that the nervous and immune systems are closely related. For example, inflammatory skin disorders; such as psoriasis, atopic dermatitis, rosacea and acne; are widely believed to be exacerbated by stress. A growing body of research now suggests that neuropeptides and neurotransmitters serve as a link between these two systems. Neuropeptides and neurotransmitters are released by nerves innervating the skin to influence important actors of the immune system, such as Langerhans cells and mast cells, which are located within close anatomic proximity. Catecholamines and other sympathetic transmitters that are released in response to activation of the sympathetic nervous system are also able to reach the skin and affect immune cells. Neuropeptides appear to direct the outcome of Langerhans cell antigen presentation with regard to the subtypes of Th cells generated and neuropeptides induce the degranulation of mast cells, among other effects. Additionally, endothelial cells, which release many inflammatory mediators and express cell surface molecules that allow leukocytes to exit the bloodstream, appear to be regulated by certain neuropeptides and transmitters. This review focuses on the evidence that products of nerves have important regulatory activities on antigen presentation, mast cell function and endothelial cell biology. These activities are highly likely to have clinical and therapeutic relevance.
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Different mechanisms regulate productive herpes simplex virus 1 (HSV-1) and HSV-2 infections in adult trigeminal neurons. J Virol 2013; 87:6512-6. [PMID: 23514893 DOI: 10.1128/jvi.00383-13] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Herpes simplex virus 1 (HSV-1) and HSV-2 establish latency in different neuronal subtypes (A5+ and KH10+) in murine trigeminal ganglia, results which correlate with restricted productive infection in these neurons in vitro. HSV-2 latency-associated transcript (LAT) contains a cis-acting regulatory element near the transcription start site that promotes productive infection in A5+ neurons and a second element in exon 1 that inhibits productive infection in KH10+ neurons. HSV-1 contains no such regulatory sequences, demonstrating different mechanisms for regulating productive HSV infection in neurons.
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