36 research outputs found

    A Device to Quantify Sweat in Single Sweat Glands to Diagnose Neuropathy

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    We devised an objective "Sensitive Sweat Test" (SST) that detects and quantifies early changes in the function of sudomotor nerves that activate sweat glands (SGs). The SST is designed to diagnose peripheral neuropathy early, when the probability for reversal is greatest. Chemotherapy induced and diabetic neuropathy are very common causes of neuropathy in the USA. Both result in peripheral numbness, pain, decreased sweating, abnormal circulation, and eventual weakness. Early recognition can provide a better opportunity to treat and halt neuropathy than discovery after the onset of nerve degeneration. We contend that early diagnosis can be achieved by sensitive monitoring of sweating. Unfortunately, the changes that first signal impending sweat deficiency escape detection by conventional clinical examination and current tests We contracted with several MN small business concerns (SBCs) to construct the SST miniature camera device Methods Skin sites on the medial calf and foot dorsum, each measuring 2 cm 2 were stimulated to sweat maximally by iontophoresis of 1% pilocarpine (2 ma, 5 min; Transparent tape thinly coated with starch was attached over the lens of the SST miniature camera. The skin test sites were prepped with a 1% iodine solution. The skin was wiped dry and immediately the camera was pressed against the skin, activating a switch to begin image collection and storage. As sweat water exited from each sweat pore it contacted iodine and starch and formed a tiny dark spot. The tape prevented formation of a drop. Instead, sweat was forced to flow centrifugally to form a flat expanding dark spot. The SST device imaged spots from >200 SGs at 1 frame/sec (area of 2 cm 2 ) for 60 to 90 seconds, until adjacent spots coalesced. The process was performed twice. Image analysis was done in the Mathworks Software, MATLAB version R2012a. Each individual sweat spot was identified and followed from frame to fram

    Contribution of Skin Biopsy in Peripheral Neuropathies

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    In the last three decades the study of cutaneous innervation through 3 mm-punch-biopsy has provided an important contribution to the knowledge of small fiber somatic and autonomic neuropathies but also of large fiber neuropathies. Skin biopsy is a minimally invasive technique with the advantage, compared to sural nerve biopsy, of being suitable to be applied to any site in our body, of being repeatable over time, of allowing the identification of each population of nerve fiber through its target. In patients with symptoms and signs of small fiber neuropathy the assessment of IntraEpidermal Nerve Fiber density is the gold standard to confirm the diagnosis while the quantification of sudomotor, pilomotor, and vasomotor nerve fibers allows to evaluate and characterize the autonomic involvement. All these parameters can be re-evaluated over time to monitor the disease process and to evaluate the effectiveness of the treatments. Myelinated fibers and their receptors can also be evaluated to detect a “dying back” neuropathy early when nerve conduction study is still normal. Furthermore, the morphometry of dermal myelinated fibers has provided new insight into pathophysiological mechanisms of different types of inherited and acquired large fibers neuropathies. In genetic neuropathies skin biopsy has become a surrogate for sural nerve biopsy, no longer necessary in the diagnostic process, to study genotype–phenotype correlations

    Acetylcholinesterase inhibition and orthostatic hypotension

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    Positive impact of short-term gait rehabilitation in Parkinson patients: a combined approach based on statistics and machine learning

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    Parkinson's disease is the second most common neurodegenerative disorder in the world. Assumed that gait dysfunctions represent a major motor symptom for the pathology, gait analysis can provide clinicians quantitative information about the rehabilitation outcome of patients. In this scenario, wearable inertial systems for gait analysis can be a valid tool to assess the functional recovery of patients in an automatic and quantitative way, helping clinicians in decision making. Aim of the study is to evaluate the impact of the short-term rehabilitation on gait and balance of patients with Parkinson's disease. A cohort of 12 patients with Idiopathic Parkinson's disease performed a gait analysis session instrumented by a wearable inertial system for gait analysis: Opal System, by APDM Inc., with spatial and temporal parameters being analyzed through a statistic and machine learning approach. Six out of fourteen motion parameters exhibited a statistically significant difference between the measurements at admission and at discharge of the patients, while the machine learning analysis confirmed the separability of the two phases in terms of Accuracy and Area under the Receiving Operating Characteristic Curve. The rehabilitation treatment especially improved the motion parameters related to the gait. The study shows the positive impact on the gait of a short-term rehabilitation in patients with Parkinson's disease and the feasibility of the wearable inertial devices, that are increasingly spreading in clinical practice, to quantitatively assess the gait improvement

    Cutaneous sensory and autonomic denervation in CADASIL

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    OBJECTIVE: To assess the involvement of the peripheral nervous system in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) by means of immunofluorescence and confocal analysis of punch skin biopsies. METHODS: We recruited 14 unrelated patients with CADASIL (M/F = 9/5; age 53.9 ± 10.5 years) and 52 healthy controls (M/F = 31/21; age 53.8 ± 9.8). Patients underwent clinical and neuroradiologic assessment. Three-millimeter punch skin biopsies were taken from the fingertip, the thigh, and the distal leg and processed using indirect immunofluorescence and a panel of primary antibodies to mark vessels and sensory and autonomic nerve fibers. Intraepidermal nerve fibers (IENF), Meissner corpuscles (MC), and sudomotor, vasomotor, and pilomotor nerves were assessed using confocal microscopy. RESULTS: In patients, compared to controls, we found a severe loss of IENF at the distal leg (p < 0.01), at the thigh (p < 0.01), and at the fingertip (p < 0.01) with a non-length-dependent pattern and a loss of MC (p < 0.01). A severe sudomotor, vasomotor, and pilomotor nerve fiber loss was found by semiquantitative evaluation. Along with nerve loss, a severe derangement of the vascular bed was observed. In our patient population, sensory and autonomic denervation did not correlate with age, sex, type of mutation, or MRI involvement. CONCLUSIONS: We found an involvement of the peripheral nervous system in patients with CADASIL through the assessment of cutaneous somatic and autonomic nerves. The neurovascular derangement observed in the skin may reflect, although to a lesser extent, what happens in the CNS
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