1
|
Zhang WZ, Jiang BY, Ye C, Xue HZ, Yang YM, Zhang H, Wang GL, Luo WX, Xiao YH, Mi BH. Preliminary study of finger temperature recovery in patients with diabetes mellitus following cold stimulation. Diabetes Metab Res Rev 2024; 40:e3706. [PMID: 37545385 DOI: 10.1002/dmrr.3706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/09/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To explore the difference in temperature recovery following cold stimulation between participants with and without diabetes mellitus (DM). MATERIALS AND METHODS The participants without (control group; n = 25) and with (DM group; n = 26) DM were subjected to local cold stimulation (10º C for 90 s). The thermal images of their hands were continuously captured using a thermal camera within 7 min following cold stimulation, and the highest temperature of each fingertip was calculated. According to the temperature values at different timepoints, the temperature recovery curves were drawn, and the baseline temperature (T-base), initial temperature after cooling (T0), temperature decline amplitude (T-range), and area under the temperature recovery curve > T0 (S) were calculated. Finally, symmetry differences between the two groups were analysed. RESULTS No statistical differences in the T-base, T0, and T-range were observed between the DM and control groups. After drawing the rewarming curve according to the temperature of the fingertips of the patients following cold stimulation, the S in the DM group was significantly lower than that in the control group (p < 0.05). Furthermore, the asymmetry of the base temperature of the hand was observed in the DM group. CONCLUSIONS Following cold stimulation, the patients with DM exhibited a different rewarming pattern than those without DM. Thus, cold stimulation tests under infrared thermography may contribute to the early screening of diabetic peripheral neuropathy in future.
Collapse
Affiliation(s)
- Wen-Zheng Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Bi-Yao Jiang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Ye
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hui-Zhong Xue
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yi-Meng Yang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hua Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Guang-Lei Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wen-Xuan Luo
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yong-Hua Xiao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Bao-Hong Mi
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
2
|
Tapia-Haro RM, García-Ríos MC, Castro-Sánchez AM, Toledano-Moreno S, Casas-Barragán A, Aguilar-Ferrándiz ME. Analysis of Hand Function, Upper Limb Disability, and Its Relationship with Peripheral Vascular Alterations in Raynaud's Phenomenon. Diagnostics (Basel) 2023; 14:93. [PMID: 38201402 PMCID: PMC10795737 DOI: 10.3390/diagnostics14010093] [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: 11/16/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
This study aimed to compare vascular involvement, hand functionality, and upper limb disability between Raynaud's phenomenon participants and controls. Also, we analyzed the relationships between vascular impairment, mobility, and strength with disability in this Raynaud population. We conducted a case-control study with fifty-seven participants. We registered sociodemographic and clinical data; vascular variables (temperature, cold test, blood flow, and oxygen saturation); functional variables (pinch strength, range of motion), and disability (Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire) (Q-DASH). Raynaud participants present more disability in all Q-DASH subscales, lower hands' temperature pre and post cold test, decreased blood flow on radial artery, decreased ranges of motions at passive extension of index finger, and active flexion and extension of thumb than the healthy controls. The multivariate regression analysis showed that extension of the index finger, lateral pinch strength, and oxygen saturation were significantly associated with disability in RP, almost the 55% of the total variance on the upper limb, 27% at sports/arts, and 42% at work. Our findings suggest that RP has a disabling effect on the upper extremities and a practice of activities in people who suffer it. Also, disability in Raynaud seems to be more related with hand mobility and strength impairment than vascular injury.
Collapse
Affiliation(s)
- Rosa Mª Tapia-Haro
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), 18071 Granada, Spain; (R.M.T.-H.); (M.C.G.-R.); (A.C.-B.)
- ibs.GRANADA Instituto de Investigación Biosanitaria, 18012 Granada, Spain;
| | - Mª Carmen García-Ríos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), 18071 Granada, Spain; (R.M.T.-H.); (M.C.G.-R.); (A.C.-B.)
- ibs.GRANADA Instituto de Investigación Biosanitaria, 18012 Granada, Spain;
| | | | - Sonia Toledano-Moreno
- ibs.GRANADA Instituto de Investigación Biosanitaria, 18012 Granada, Spain;
- Biomedicine Program, Department of Physical Therapy, Faculty of Health Science, University of Granada (UGR), 18071 Granada, Spain
| | - Antonio Casas-Barragán
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), 18071 Granada, Spain; (R.M.T.-H.); (M.C.G.-R.); (A.C.-B.)
- ibs.GRANADA Instituto de Investigación Biosanitaria, 18012 Granada, Spain;
| | - Mª Encarnación Aguilar-Ferrándiz
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), 18071 Granada, Spain; (R.M.T.-H.); (M.C.G.-R.); (A.C.-B.)
- ibs.GRANADA Instituto de Investigación Biosanitaria, 18012 Granada, Spain;
| |
Collapse
|
3
|
Shams S, Prokopiou P, Esmaelbeigi A, Mitsis GD, Chen JJ. Modeling the dynamics of cerebrovascular reactivity to carbon dioxide in fMRI under task and resting-state conditions. Neuroimage 2023; 265:119758. [PMID: 36442732 DOI: 10.1016/j.neuroimage.2022.119758] [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: 07/06/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022] Open
Abstract
Conventionally, cerebrovascular reactivity (CVR) is estimated as the amplitude of the hemodynamic response to vascular stimuli, most commonly carbon dioxide (CO2). While the CVR amplitude has established clinical utility, the temporal characteristics of CVR (dCVR) have been increasingly explored and may yield even more pathology-sensitive parameters. This work is motivated by the current need to evaluate the feasibility of dCVR modeling in various experimental conditions. In this work, we present a comparison of several recently published/utilized model-based deconvolution (response estimation) approaches for estimating the CO2 response function h(t), including maximum a posteriori likelihood (MAP), inverse logit (IL), canonical correlation analysis (CCA), and basis expansion (using Gamma and Laguerre basis sets). To aid the comparison, we devised a novel simulation framework that incorporates a wide range of SNRs, ranging from 10 to -7 dB, representative of both task and resting-state CO2 changes. In addition, we built ground-truth h(t) into our simulation framework, overcoming the conventional limitation that the true h(t) is unknown. Moreover, to best represent realistic noise found in fMRI scans, we extracted noise from in-vivo resting-state scans. Furthermore, we introduce a simple optimization of the CCA method (CCAopt) and compare its performance to these existing methods. Our findings suggest that model-based methods can accurately estimate dCVR even amidst high noise (i.e. resting-state), and in a manner that is largely independent of the underlying model assumptions for each method. We also provide a quantitative basis for making methodological choices, based on the desired dCVR parameters, the estimation accuracy and computation time. The BEL method provided the highest accuracy and robustness, followed by the CCAopt and IL methods. Of the three, the CCAopt method has the lowest computational requirements. These findings lay the foundation for wider adoption of dCVR estimation in CVR mapping.
Collapse
Affiliation(s)
- Seyedmohammad Shams
- Rotman Research Institute, Baycrest Health Sciences, Canada; Department of Neurology, Henry Ford Health, USA
| | - Prokopis Prokopiou
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - J Jean Chen
- Rotman Research Institute, Baycrest Health Sciences, Canada; Department of Bioengineering, McGill University, Canada; Department of Medical Biophysics, University of Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Canada.
| |
Collapse
|
4
|
Thapa D, Valente JDS, Barrett B, Smith MJ, Argunhan F, Lee SY, Nikitochkina S, Kodji X, Brain SD. Dysfunctional TRPM8 signalling in the vascular response to environmental cold in ageing. eLife 2021; 10:70153. [PMID: 34726597 PMCID: PMC8592571 DOI: 10.7554/elife.70153] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/02/2021] [Indexed: 12/16/2022] Open
Abstract
Ageing is associated with increased vulnerability to environmental cold exposure. Previously, we identified the role of the cold-sensitive transient receptor potential (TRP) A1, M8 receptors as vascular cold sensors in mouse skin. We hypothesised that this dynamic cold-sensor system may become dysfunctional in ageing. We show that behavioural and vascular responses to skin local environmental cooling are impaired with even moderate ageing, with reduced TRPM8 gene/protein expression especially. Pharmacological blockade of the residual TRPA1/TRPM8 component substantially diminished the response in aged, compared with young mice. This implies the reliance of the already reduced cold-induced vascular response in ageing mice on remaining TRP receptor activity. Moreover, sympathetic-induced vasoconstriction was reduced with downregulation of the α2c adrenoceptor expression in ageing. The cold-induced vascular response is important for sensing cold and retaining body heat and health. These findings reveal that cold sensors, essential for this neurovascular pathway, decline as ageing onsets.
Collapse
Affiliation(s)
- Dibesh Thapa
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| | - Joäo de Sousa Valente
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| | - Brentton Barrett
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| | - Matthew John Smith
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| | - Fulye Argunhan
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| | - Sheng Y Lee
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom.,Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Sofya Nikitochkina
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| | - Xenia Kodji
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom.,Skin Research Institute, Agency of Science, Technology, and Research (A*STAR), Singapore, Singapore
| | - Susan D Brain
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| |
Collapse
|
5
|
|
6
|
Flavahan S, Flavahan NA. Cooling-induced dilatation of cutaneous arteries is mediated by increased myoendothelial communication. Am J Physiol Heart Circ Physiol 2020; 319:H123-H132. [PMID: 32469638 DOI: 10.1152/ajpheart.00159.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cold exposure causes cutaneous vasoconstriction via a reflex increase in sympathetic activity and a local effect to augment adrenergic constriction. Local cooling also initiates cutaneous dilatation, which may function to restrain cold-induced constriction. However, the underlying mechanisms and physiological role of cold-induced dilatation have not been defined. Experiments were performed to assess the role of endothelial-derived mediators in this response. In isolated pressurized cutaneous mouse tail arteries, cooling (28°C) did not affect the magnitude of dilatation to acetylcholine in preconstricted arteries. However, inhibition of nitric oxide (NO) [NG-nitro-l-arginine methyl ester (l-NAME)] and prostacyclin (PGI2) (indomethacin) reduced acetylcholine-induced dilatation at 37°C but not at 28°C, suggesting that cooling increased NO/PGI2-independent dilatation. This NO/PGI2-independent dilatation was reduced by inhibition of endothelial SK (UCL1684) and IK (TRAM34) Ca2+-activated K+-channels (KCa), consistent with endothelium-derived hyperpolarization (EDH). Cooling also increased dilatation to direct activation of KCa channels (SKA31, CyPPA) but did not affect dilatation to exogenous NO (DEA-NONOate). This cooling-induced increase in EDH-type dilatations was associated with divergent effects on potential downstream EDH mechanisms: cooling reduced dilatation to K+, which mimics an intercellular K+ cloud, but increased direct communication between endothelial and smooth muscle cells (myoendothelial coupling), assessed by cellular transfer of biocytin. Indeed, inhibition of gap junctions (carbenoxolone) abolished the EDH-type component of dilatation to acetylcholine during cooling but did affect NO-dominated dilatation at 37°C. Cooling also inhibited U46619 constriction that was prevented by inhibition of IK and SK KCa channels or inhibition of gap junctions. The results suggest that cooling dilates cutaneous arteries by increasing myoendothelial communication and amplifying EDH-type dilatation.NEW & NOTEWORTHY Cold causes cutaneous vasoconstriction to restrict heat loss. Although cold also initiates cutaneous dilatation, the mechanisms and role of this dilatation have not been clearly defined. This study demonstrates that cooling increases myoendothelial coupling between smooth muscle and endothelial cells in cutaneous arteries, which is associated with increased endothelium-derived hyperpolarization (EDH)-type dilatation. Dysfunction in this process may contribute to excessive cold-induced constriction and tissue injury.
Collapse
Affiliation(s)
- Sheila Flavahan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nicholas A Flavahan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
7
|
Bergersen TK, Walløe L. Acral coldness - severely reduced blood flow to fingers and toes. HANDBOOK OF CLINICAL NEUROLOGY 2018; 157:677-685. [PMID: 30459032 DOI: 10.1016/b978-0-444-64074-1.00040-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The term acral coldness is used to describe physiologic or pathologic situations in humans where the fingers and toes are exceptionally cold in spite of normal central body temperature. In the thermoneutral zone, the blood flow to acral skin normally shows large fluctuations between high and low values, with a frequency of about 3 cycles per minute. At an acral skin temperature of about 21°C, finger blood flow is constantly low. At lower temperatures the fingers and toes become painful. This is a normal physiologic reaction, probably because of ischemia. The characteristics of the most frequent acral vascular syndromes, Raynaud phenomenon, acrocyanosis, and chilblains, are discussed. Common to all three is pathologically low blood flow and disappearance of physiologic fluctuations even in the thermoneutral zone. Ischemic vascular diseases in acral skin are usually diagnosed from clinical observations. Measurements of fluctuating blood flow by laser or ultrasound Doppler could be useful, but should be carried out at a room temperature of 24-25°C.
Collapse
Affiliation(s)
- Tone Kristin Bergersen
- Department of Dermatology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Walløe
- Department of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| |
Collapse
|
8
|
Roustit M, Giai J, Gaget O, Khouri C, Mouhib M, Lotito A, Blaise S, Seinturier C, Subtil F, Paris A, Cracowski C, Imbert B, Carpentier P, Vohra S, Cracowski JL. On-Demand Sildenafil as a Treatment for Raynaud Phenomenon: A Series of n-of-1 Trials. Ann Intern Med 2018; 169:694-703. [PMID: 30383134 DOI: 10.7326/m18-0517] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Treatment of Raynaud phenomenon (RP) with phosphodiesterase-5 inhibitors has shown moderate efficacy. Adverse effects decrease the risk-benefit profile of these drugs, and patients may not be willing to receive long-term treatment. On-demand single doses before or during exposure to cold may be a good alternative. OBJECTIVE To assess the efficacy and safety of on-demand sildenafil in RP. DESIGN Series of randomized, double-blind, n-of-1 trials. (ClinicalTrials.gov: NCT02050360). SETTING Outpatients at a French university hospital. PARTICIPANTS Patients with primary or secondary RP. INTERVENTION Each trial consisted of a multiple crossover study in a single patient. Repeated blocks of 3 periods of on-demand treatment were evaluated: 1 week of placebo, 1 week of sildenafil at 40 mg per dose, and 1 week of sildenafil at 80 mg per dose, with a maximum of 2 doses daily. MEASUREMENTS Raynaud Condition Score (RCS) and frequency and daily duration of attacks. Skin blood flow in response to cooling also was assessed with laser speckle contrast imaging. Mixed-effects models were used and parameters were estimated in a Bayesian framework to determine individual and aggregated efficacy. RESULTS 38 patients completed 2 to 5 treatment blocks. On the basis of aggregated data, the probability that sildenafil at 40 mg or 80 mg was more effective than placebo was greater than 90% for all outcomes (except for RCS with sildenafil, 80 mg). However, the aggregated effect size was not clinically relevant. Yet, substantial heterogeneity in sildenafil's efficacy was observed among participants, with clinically relevant efficacy in some patients. LIMITATION The response to sildenafil was substantially heterogeneous among patients. CONCLUSION Despite a high probability that sildenafil is superior to placebo, substantial heterogeneity was observed in patient response and aggregated results did not show that on-demand sildenafil has clinically relevant efficacy. In this context, the use of n-of-1 trials may be an original and relevant approach in RP. PRIMARY FUNDING SOURCE GIRCI (Groupement Interrégional de Recherche Clinique et d'Innovation) Auvergne Rhône-Alpes (academic funding) and Pfizer.
Collapse
Affiliation(s)
- Matthieu Roustit
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Joris Giai
- Université de Lyon and Hospices Civils de Lyon, Lyon, France (J.G., F.S.)
| | - Olivier Gaget
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Charles Khouri
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Myriam Mouhib
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Adrien Lotito
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Sophie Blaise
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Christophe Seinturier
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Fabien Subtil
- Université de Lyon and Hospices Civils de Lyon, Lyon, France (J.G., F.S.)
| | - Adeline Paris
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Claire Cracowski
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Bernard Imbert
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Patrick Carpentier
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Sunita Vohra
- University of Alberta, Edmonton, Alberta, Canada (S.V.)
| | - Jean-Luc Cracowski
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| |
Collapse
|
9
|
Mosdósi B, Bölcskei K, Helyes Z. Impairment of microcirculation and vascular responsiveness in adolescents with primary Raynaud phenomenon. Pediatr Rheumatol Online J 2018; 16:20. [PMID: 29566759 PMCID: PMC5865297 DOI: 10.1186/s12969-018-0237-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Raynaud's phenomenon (RP) is a functional vascular disease, presenting with recurrent episodes of ischemia of extremities in response to cold and emotional stress. Investigating cutaneous microcirculation is an important tool in understanding the complex neuro-immuno-vascular interactions in its pathophysiological mechanisms. Since there is no available data on vascular responsiveness in RP in the paediatric population, we investigated skin perfusion and heat-induced hyperaemia in comparison with clinical severity and laboratory parameters of the disease. METHODS Fifty two adolescents (27 patients with primary RP and 25 age-matched healthy controls) were investigated in the study. Patients were divided into two groups according to the symptoms existing within the previous 2 months. Following baseline microcirculation measurement with Laser Doppler flowmetry (Periflux 5000 system), all subjects underwent local heating test at 42 °C and 44 °C. Besides routine laboratory parameters, immune-serological tests and the vasoactive sensory neuropeptides somatostatin and pituitary adenylate-cyclase activating polypeptide (PACAP) were measured. RESULTS Baseline perfusion measured in perfusion units (PU) at 32 °C was significantly lower in symptomatic RP patients (97.6 ± 22.4 PU) compared with both healthy volunteers (248.3 ± 23.5 PU, p < 0.001) and RP patients without symptoms (187.4 ± 24.9 PU, p < 0.05). After local heating to 42 °C maximum blood flow was significantly reduced in primary RP participants with current symptoms (358.6 ± 43.9 PU, p < 0.001), but not in asymptomatic ones (482.3 ± 28.7 PU, p > 0.05) when compared with healthy subjects (555.9 ± 28.2 PU). Both the area under the response curve and the latency to reach the maximum flow were significantly increased in both RP groups (symptomatic 164.6 ± 7.4 s, p < 0.001, asymptomatic 236.4 ± 17.4 s, p < 0.001) when compared with the control group (101.9 ± 4.7 s). The heat-induced percentage increase from baseline to maximal blood flow was significantly greater in symptomatic RP adolescents in comparison with healthy ones. Laboratory parameters and neuropeptide plasma levels were not altered in any groups. CONCLUSION To our knowledge this is the first study in paediatric population to show altered heat-induced cutaneous hyperaemia responses in relation with the clinical severity and symptomatology.
Collapse
Affiliation(s)
- Bernadett Mosdósi
- Clinical Center, Department of Pediatrics, University of Pécs, József Attila u. 7, Pécs, H-7623, Hungary.
| | - Kata Bölcskei
- 0000 0001 0663 9479grid.9679.1János Szentágothai Research Centre & Centre for Neuroscience, University of Pécs, Ifjúság útja 20, Pécs, H-7624 Hungary ,0000 0001 0663 9479grid.9679.1Medical School, Department of Pharmacology and Pharmacotherapy, University of Pécs, Szigeti út 12, Pécs, H-7624 Hungary
| | - Zsuzsanna Helyes
- 0000 0001 0663 9479grid.9679.1János Szentágothai Research Centre & Centre for Neuroscience, University of Pécs, Ifjúság útja 20, Pécs, H-7624 Hungary ,0000 0001 0663 9479grid.9679.1Medical School, Department of Pharmacology and Pharmacotherapy, University of Pécs, Szigeti út 12, Pécs, H-7624 Hungary
| |
Collapse
|
10
|
Zeng S, Chen Q, Wang XW, Hong K, Li JX, Li P, Cheng XS, Su H. Longer rewarming time in finger cooling test in association with HbA1c level in diabetics. Microvasc Res 2016; 107:72-5. [PMID: 27211911 DOI: 10.1016/j.mvr.2016.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess if rewarming time in finger cooling test (FCT) as an indicator of microvascular dysfunction is abnormal in patients with type 2 diabetes mellitus (T2DM). METHODS Forty-three T2DM patients and 48 healthy controls with similarly distributed baseline demographic, clinical and laboratory parameters were subjected to FCT involving 60-second index finger immersion into water at 4°C. Finger temperature was measured before FCT (baseline-T), immediately after cooling stimulus (T0), and at one-minute intervals until baseline-T recovery. Temperature decline amplitude was calculated as the difference between T0 and baseline-T, and rewarming time as time elapsed from T0 to baseline-T recovery. RESULTS T2DM patients compared with healthy controls had statistically similar baseline-T, significantly larger temperature decline amplitude, significantly lower T0, and significantly longer rewarming time. In T2DM patients, rewarming time positively correlated with T2DM duration (r=0.513, p<0.001) and glycated hemoglobin (HbA1c) level (r=0.446, p=0.003), which also were its independent predictors in multivariate regression analysis. CONCLUSIONS Patients with T2DM display abnormal FCT results suggestive of microvascular dysfunction, with T2DM duration and HbA1c level independently predicting rewarming time.
Collapse
Affiliation(s)
- Shan Zeng
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Qi Chen
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Xiang-Wen Wang
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Kui Hong
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Key Laboratory of Molecular Medicine, Jiangxi 330006, China
| | - Ju-Xiang Li
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Ping Li
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Xiao-Shu Cheng
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Hai Su
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.
| |
Collapse
|
11
|
Mahe G, Liedl DA, McCarter C, Shepherd R, Gloviczki P, McPhail IR, Rooke TW, Wennberg PW. Digital obstructive arterial disease can be detected by laser Doppler measurements with high sensitivity and specificity. J Vasc Surg 2014; 59:1051-1057.e1. [DOI: 10.1016/j.jvs.2013.10.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 10/25/2022]
|
12
|
Roustit M, Khouri C, Blaise S, Villier C, Carpentier P, Cracowski JL. Pharmacologie du phénomène de Raynaud. Therapie 2014; 69:115-28. [DOI: 10.2515/therapie/2013068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/19/2013] [Indexed: 11/20/2022]
|
13
|
Roustit M, Cracowski JL. Assessment of endothelial and neurovascular function in human skin microcirculation. Trends Pharmacol Sci 2013; 34:373-84. [DOI: 10.1016/j.tips.2013.05.007] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 05/03/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
|
14
|
Current world literature. Curr Opin Rheumatol 2012; 24:694-702. [PMID: 23018859 DOI: 10.1097/bor.0b013e328359ee5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Bricq S, Mahé G, Rousseau D, Humeau-Heurtier A, Chapeau-Blondeau F, Rojas Varela J, Abraham P. Assessing spatial resolution versus sensitivity from laser speckle contrast imaging: application to frequency analysis. Med Biol Eng Comput 2012; 50:1017-23. [DOI: 10.1007/s11517-012-0919-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 05/13/2012] [Indexed: 10/28/2022]
|
16
|
Heitmar R, Summers RJ. Assessing vascular function using dynamic retinal diameter measurements: a new insight on the endothelium. Thromb Haemost 2012; 107:1019-26. [PMID: 22534674 DOI: 10.1160/th11-11-0810] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 03/18/2012] [Indexed: 11/05/2022]
Affiliation(s)
- Rebekka Heitmar
- School of Life and Health Sciences, Aston University, Aston Triangle, B4 7ET, Birmingham, UK.
| | | |
Collapse
|
17
|
Sildenafil increases digital skin blood flow during all phases of local cooling in primary Raynaud's phenomenon. Clin Pharmacol Ther 2012; 91:813-9. [PMID: 22453196 DOI: 10.1038/clpt.2011.302] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Digital skin vasoconstriction on local cooling is exaggerated in primary Raynaud's phenomenon (RP) as compared with controls. A significant part of such vasoconstriction relies on the inhibition of the nitric oxide (NO) pathway. We tested the effect of the phosphodiesterase 5 (PDE5) inhibitor sildenafil, which potentiates the effect of NO, on skin blood flow. We recruited 15 patients with primary RP, performing local cooling without sildenafil (day 1), after a single oral dose of 50 mg (day 2), and after a dose of 100 mg (day 3). Skin blood flow, skin temperature, and arterial pressure were recorded, and data were expressed as cutaneous vascular conductance (CVC). Sildenafil at 100 mg, but not 50 mg, significantly lessened the cooling-induced decrease in CVC. It also increased resting CVC and skin temperature. These data suggest that 100 mg sildenafil improves digital skin perfusion during local cooling in primary RP. The benefit of sildenafil "as required" should be confirmed in a randomized, controlled trial.
Collapse
|
18
|
ROUSTIT MATTHIEU, CRACOWSKI JEANLUC. Non-invasive Assessment of Skin Microvascular Function in Humans: An Insight Into Methods. Microcirculation 2011; 19:47-64. [DOI: 10.1111/j.1549-8719.2011.00129.x] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|