Role of C-nociceptive fibers in the nerve axon reflex-related vasodilation in diabetes

Caselli, Antonella; Rich, Jonathan D.; Hanane, Tarik; Uccioli, Luigi; Veves, Aristidis

doi:10.1212/01.wnl.0000040250.31755.f9

Cited by 74 publications

(48 citation statements)

References 21 publications

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“…For our HT measurements, we examined the plantar metatarsal area of the foot and the palm that are covered by glabrous skin that is rich in arteriovenous anastomosis and has increased blood flow. We chose these areas because foot ulcers mainly occur in this type of skin and because previous studies (16,17) have indicated different mechanisms of vasodilation in this area when compared with hairy skin that has considerably less arteriovenous anastomosis. The observed results in glabrous skin areas were similar to HT results we previously observed at the dorsum of the foot and the forearm areas of hairy skin.…”

Section: Discussionmentioning

confidence: 99%

The Use of Medical Hyperspectral Technology to Evaluate Microcirculatory Changes in Diabetic Foot Ulcers and to Predict Clinical Outcomes

et al. 2007

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OBJECTIVE -Foot ulceration is a serious complication of diabetes, and new techniques that can predict wound healing may prove very helpful. We tested the ability of medical hyperspectral technology (HT), a novel diagnostic scanning technique that can quantify tissue oxy-and deoxyhemoglobin to predict diabetic foot ulcer healing.RESEARCH DESIGN AND METHODS -Ten type 1 diabetic patients with 21 foot ulcer sites, 13 type 1 diabetic patients without ulcers, and 14 nondiabetic control subjects were seen up to 4 times over a 6-month period. HT measurements of oxyhemoglobin (HT-oxy) and deoxyhemoglobin (HT-deoxy) were performed at or near the ulcer area and on the upper and lower extremity distant from the ulcer. An HT healing index for each site was calculated from the HT-oxy and -deoxy values.RESULTS -Hyperspectral tissue oxygenation measurements observed changes in tissue immediately surrounding the ulcer when comparing ulcers that heal and ulcers that do not heal (P Ͻ 0.001). The sensitivity, specificity, and positive and negative predictive values of the HT index for predicting healing were 93, 86, 93, and 86%, respectively, when evaluated on images taken at the first visit. Changes in HT-oxy among the three risk groups were noted for the metatarsal area of the foot (P Ͻ 0.05) and the palm (P Ͻ 0.01). Changes in HT-deoxy and the HT healing index were noted for the palm only (P Ͻ 0.05 and P Ͻ 0.01, respectively).CONCLUSIONS -HT has the capability to identify microvascular abnormalities and tissue oxygenation in the diabetic foot and predict ulcer healing. HT can assist in the management of foot ulceration. Diabetes Care 30:903-910, 2007D iabetic foot ulceration (DFU) remains a serious problem, as 15% of all diabetic patients are expected to be affected with the complication during their lifespan (1). Infected and/or ischemic DFU accounts for ϳ25% of all hospital stays among diabetic patients, while foot ulceration precedes 85% of lowerextremity amputations (2). Currently, large multicenter studies (3-5) have reported that the healing rate of DFU over a 12-to 20-week period lies between 30 and 60%. Early identification of patients who will go on to fail to heal an ulcer can be of particular help, as it can allow the physician to make the right choice of treatment between a conservative and aggressive path. Pathways can be developed to streamline patient care and to apply new, expensive therapies only in patients who need them.The evaluation of neuropathy, peripheral vascular disease, presence of infection, and the depth of the ulcer are standard procedures for the management of DFU (6). However, none of the above measurements can predict wound healing. The only method that has previously been shown to predict wound healing is the measurement of changes in the ulcer area over a 4-week period of intensive care (7). However, the positive predictive value of this technique is only 58%, while the negative predictive value is 91%. Additionally, using the measurement-of-change method requires sequential patient examination...

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Section: Discussionmentioning

confidence: 99%

The Use of Medical Hyperspectral Technology to Evaluate Microcirculatory Changes in Diabetic Foot Ulcers and to Predict Clinical Outcomes

et al. 2007

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“…Several recent studies have demonstrated that damage to unmyelinated fibers has a great impact on skin, with disordered blood flow predisposing to foot ulcers (4,38). Some authors have considered small nerve fibers to be the first fibers to be affected in diabetes (39 -41).…”

Section: Discussionmentioning

confidence: 99%

Impaired Pressure-Induced Vasodilation at the Foot in Young Adults With Type 1 Diabetes

et al. 2004

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Vascular and neurological mechanisms are both likely to be involved in foot ulcer. We recently reported a pressure-induced vasodilation (PIV), relying on unmyelinated afferent excitation. We previously found that cutaneous blood flow in response to locally applied pressure might be impaired in diabetic patients because of the combined effects of low cutaneous temperature and alterations in microcirculatory function. Therefore, we aimed to analyze whether, at a relatively high cutaneous temperature, PIV is present in type 1 diabetes and to assess endothelial-dependent vasodilation and endothelium-independent vasodilation. We measured cutaneous blood flow using laser Doppler flowmetry on the head of the first metatarsus in response to applied pressure at 5.0 mmHg/min in warm conditions (29.5 ؎ 0.2°C). Responses to iontophoresis of acetylcholine (endothelium dependent) and sodium nitroprusside (endothelium independent) were measured using laser Doppler flowmetry in the forearm. The data indicate that PIV exists at the foot level in normal subjects, whereas it was not found in diabetic patients. In diabetic patients, the nonendothelial-mediated response to sodium nitroprusside was preserved, whereas the endothelial-mediated response to acetylcholine was impaired. These findings might be relevant to the high prevalence of foot ulcer that occurs in diabetic patients. Diabetes 53: [721][722][723][724][725] 2004

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“…This axon mediated response normally accounts for roughly 1/3 of the endothelium-dependent vasodilation in the foot and forearm (Hamdy et al, 2001). This neurogenic vasodilatory response is impaired in the presence of diabetic peripheral neuropathy and the number of sensory neurons for substance P and CGRP reduced (Levy et al;Caselli et al, 2003).…”

Section: Microvascular Factors and Ulcerationmentioning

confidence: 99%

Diabetic foot ulceration and amputation

Burns¹,

Jan²

2012

Rehabilitation Medicine

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Role of C-nociceptive fibers in the nerve axon reflex-related vasodilation in diabetes

Cited by 74 publications

References 21 publications

The Use of Medical Hyperspectral Technology to Evaluate Microcirculatory Changes in Diabetic Foot Ulcers and to Predict Clinical Outcomes

The Use of Medical Hyperspectral Technology to Evaluate Microcirculatory Changes in Diabetic Foot Ulcers and to Predict Clinical Outcomes

Impaired Pressure-Induced Vasodilation at the Foot in Young Adults With Type 1 Diabetes

Diabetic foot ulceration and amputation

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