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1.
Physiol Meas ; 40(10): 100301, 2019 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-31665126
2.
Clin Rheumatol ; 38(12): 3669-3676, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31482318

RESUMO

INTRODUCTION: Raynaud's phenomenon (RP) is a common condition and causes pain, paraesthesia, ulceration and gangrene. Botulinum toxin A (Btx-A) is effective when injected via a digital palmar approach, in the treatment of severe RP. However, hand weakness resulting from lumbrical malfunction is a recognized complication. This study aimed to determine the effect of Btx-A injected via a dorsal approach. METHOD: Forty patients received 100 units of Btx-A, injected across both hands via a dorsal approach. Each patient had a baseline, 6- and 12-week hand assessment and thermographic image (FLIR E60bx) performed for the study. RESULTS: Eighty-eight percent of patients reported an improvement in symptoms including reduction in pain, improved colour change with reduced swelling and edema at 6 weeks. Of these patients, 80% reported an improvement in cold intolerance with a reduction in the frequency and severity of Raynaud's attacks. There was a significant improvement in both the DASH score (p = 0.001), Kapandji score (p = 0.001) and hand strength (p < 0.05). No patients reported weakness. Improvements in hand function and symptoms of RP were still evident at 12 weeks. CONCLUSIONS: Btx-A injected via a dorsal approach improves symptoms and reduces the number of RP. We have shown an effective non-surgical approach technique to treat RP.Key Points• Raynaud's phenomenon is a common vasospastic disorder of the digital vessels, which can cause severe pain, restrictions to hand function and ulceration.• Dorsal botulinum toxin type A injections can improve the symptoms of secondary Raynaud's phenomenon and hand function for approximately 3 months.

3.
Rheumatology (Oxford) ; 58(2): 284-288, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30247696

RESUMO

Objectives: Nailfold capillaroscopy is being increasingly used by rheumatologists in the diagnosis of SSc. However, assessment of all nailfolds can be time-consuming in a busy outpatient clinic. Our aim was to answer the question as to how many (and which) fingers a clinician should routinely assess to capture accurately the true state. Methods: A total of 2994 assessments (by an international panel of expert observers) of 1600 images from 173 participants (101 with SSc, 22 with primary RP and 50 healthy controls) were included in this analysis. Seven single-finger or finger combinations (derived from the middle and ring fingers) were then tested for sensitivity for the presence of two markers of capillary abnormality [presence of giant capillaries and an SSc grade (early, active or late)] compared with assessment of all eight fingers. Results: For the eight-finger gold standard, sensitivity against the diagnostic criteria was 74.6% (53.0% for the presence of giants alone and 73.1% for image grade alone). Examining only one finger gave low sensitivity (ranging from right middle 31.7% to left ring 46.6%). Examining both ring fingers gave a sensitivity of 59.8%, whereas examining the four-finger combination of both ring and both middle fingers gave a sensitivity of 66.7%. Conclusion: During routine capillaroscopic examination, ideally all eight nailbeds (excluding thumbs) should be examined, otherwise some abnormalities will be missed. Examining only four fingers reduces capillaroscopy sensitivity.


Assuntos
Capilares/anormalidades , Dedos/irrigação sanguínea , Angioscopia Microscópica/métodos , Unhas/irrigação sanguínea , Capilares/diagnóstico por imagem , Estudos de Casos e Controles , Dedos/diagnóstico por imagem , Humanos , Unhas/diagnóstico por imagem , Escleroderma Sistêmico/diagnóstico por imagem , Sensibilidade e Especificidade
5.
Arthritis Rheumatol ; 70(6): 903-911, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29457381

RESUMO

OBJECTIVE: Reliable and objective outcome measures to facilitate clinical trials of novel treatments for systemic sclerosis (SSc)-related Raynaud's phenomenon (RP) are badly needed. Laser speckle contrast imaging (LSCI) and thermography are noninvasive measures of perfusion that have shown excellent potential. This multicenter study was undertaken to determine the reliability and validity of a hand cold challenge protocol using LSCI, standard thermography, and low-cost cell phone/mobile phone thermography (henceforth referred to as mobile thermography) in patients with SSc-related RP. METHODS: Patients with RP secondary to SSc were recruited from 6 UK tertiary care centers. The patients underwent cold challenge on 2 consecutive days. Changes in cutaneous blood flow/skin temperature at each visit were imaged simultaneously using LSCI, standard thermography, and mobile thermography. Measurements included area under the curve (AUC) for reperfusion/rewarming and maximum blood flow rate/skin temperature after rewarming (MAX). Test-retest reliability was assessed using intraclass correlation coefficients (ICCs). Estimated latent correlations (estimated from multilevel models, taking values between -1 and 1; denoted as rho values) were used to assess the convergent validity of LSCI and thermography. RESULTS: In total, 159 patients (77% with limited cutaneous SSc) were recruited (84% female, median age 63.3 years). LSCI and standard thermography both had substantial reliability, with ICCs for the reperfusion/rewarming AUC of 0.67 (95% confidence interval [95% CI] 0.54, 0.76) and 0.68 (95% CI 0.58, 0.80), respectively, and ICCs for the MAX of 0.64 (95% CI 0.52, 0.75) and 0.72 (95% CI 0.64, 0.81), respectively. Very high latent correlations were present for the AUCs of LSCI and thermography (ρ = 0.94; 95% CI 0.87, 1.00) and for the AUCs of standard and mobile thermography (ρ = 0.98; 95% CI 0.94, 1.00). CONCLUSION: This is the first multicenter study to examine the reliability and validity of cold challenge using LSCI and thermography in patients with SSc-related RP. LSCI and thermography both demonstrated good potential as outcome measures. LSCI, standard thermography, and mobile thermography had very high convergent validity.


Assuntos
Técnicas de Diagnóstico Cardiovascular/estatística & dados numéricos , Doença de Raynaud/diagnóstico por imagem , Escleroderma Sistêmico/complicações , Termografia/estatística & dados numéricos , Idoso , Área Sob a Curva , Temperatura Baixa , Meios de Contraste , Estudos de Viabilidade , Feminino , Dedos/irrigação sanguínea , Dedos/diagnóstico por imagem , Mãos/irrigação sanguínea , Mãos/diagnóstico por imagem , Humanos , Lasers , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Doença de Raynaud/etiologia , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Temperatura Cutânea , Estatísticas não Paramétricas , Termografia/métodos
7.
J Therm Biol ; 69: 155-162, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29037377

RESUMO

The importance of using infrared thermography (IRT) to assess skin temperature (tsk) is increasing in clinical settings. Recently, its use has been increasing in sports and exercise medicine; however, no consensus guideline exists to address the methods for collecting data in such situations. The aim of this study was to develop a checklist for the collection of tsk using IRT in sports and exercise medicine. We carried out a Delphi study to set a checklist based on consensus agreement from leading experts in the field. Panelists (n = 24) representing the areas of sport science (n = 8; 33%), physiology (n = 7; 29%), physiotherapy (n = 3; 13%) and medicine (n = 6; 25%), from 13 different countries completed the Delphi process. An initial list of 16 points was proposed which was rated and commented on by panelists in three rounds of anonymous surveys following a standard Delphi procedure. The panel reached consensus on 15 items which encompassed the participants' demographic information, camera/room or environment setup and recording/analysis of tsk using IRT. The results of the Delphi produced the checklist entitled "Thermographic Imaging in Sports and Exercise Medicine (TISEM)" which is a proposal to standardize the collection and analysis of tsk data using IRT. It is intended that the TISEM can also be applied to evaluate bias in thermographic studies and to guide practitioners in the use of this technique.


Assuntos
Temperatura Cutânea , Termografia/métodos , Animais , Regulação da Temperatura Corporal , Técnica Delfos , Exercício , Terapia por Exercício/métodos , Humanos , Medicina Esportiva/métodos
8.
J Therm Biol ; 66: 63-67, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28477911

RESUMO

The aim of the study was to describe the dependence on ambient temperature of distal joint temperature at the forelimbs of racehorses. The study also investigated the influence of differing ambient temperatures on the temperature difference between joints: this was measured ipsilaterally (i.e. between the carpal and fetlock joints along each forelimb) and contralaterally (i.e. between the same joints of the left and right forelimbs). Sixty-four healthy racehorses were monitored over 10 months. At each session, three thermographic images were taken of the dorsal, lateral and medial aspects of the distal forelimbs. Temperature measurements were made from regions of interest (ROIs) covering the carpal and fetlock joints. There was a strong correlation between ambient temperature and absolute joint temperature at all ROIs. The study also observed a moderate correlation between ambient temperature and the ipsilateral temperature differences between joints when measured from the medial and lateral aspects. No significant correlation was noted when measured dorsally. The mean contralateral temperature differences between joints were all close to 0°C. The data support previous reports that the temperature distribution between the forelimbs of the healthy equine is generally symmetric, although some horses differ markedly from the average findings.


Assuntos
Membro Anterior/diagnóstico por imagem , Cavalos , Articulações/diagnóstico por imagem , Temperatura Ambiente , Termografia/veterinária , Animais , Raios Infravermelhos
9.
Microvasc Res ; 113: 56-59, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28495471

RESUMO

BACKGROUND: Nailfold capillaroscopic parameters hold increasing promise as outcome measures for clinical trials in systemic sclerosis (SSc). Their inclusion as outcomes would often naturally require capillaroscopy images to be captured at several time points during any one study. Our objective was to assess repeatability of image acquisition (which has been little studied), as well as of measurement. METHOD: 41 patients (26 with SSc, 15 with primary Raynaud's phenomenon) and 10 healthy controls returned for repeat high-magnification (300×) videocapillaroscopy mosaic imaging of 10 digits one week after initial imaging (as part of a larger study of reliability). Images were assessed in a random order by an expert blinded observer and 4 outcome measures extracted: (1) overall image grade and then (where possible) distal vessel locations were marked, allowing (2) vessel density (across the whole nailfold) to be calculated (3) apex width measurement and (4) giant vessel count. Intra-rater, intra-visit and intra-rater inter-visit (baseline vs. 1week) reliability were examined in 475 and 392 images respectively. A linear, mixed-effects model was used to estimate variance components, from which intra-class correlation coefficients (ICCs) were determined. RESULTS: Intra-visit and inter-visit reliability estimates (ICCs) were (respectively): overall image grade, 0.97 and 0.90; vessel density, 0.92 and 0.65; mean vessel width, 0.91 and 0.79; presence of giant capillary, 0.68 and 0.56. These estimates were conditional on each parameter being measurable. CONCLUSION: Within-operator image analysis and acquisition are reproducible. Quantitative nailfold capillaroscopy, at least with a single observer, provides reliable outcome measures for clinical studies including randomised controlled trials.


Assuntos
Capilares/patologia , Angioscopia Microscópica , Unhas/irrigação sanguínea , Escleroderma Sistêmico/patologia , Doenças Vasculares/patologia , Estudos de Casos e Controles , Humanos , Interpretação de Imagem Assistida por Computador , Modelos Lineares , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
10.
Microvasc Res ; 112: 1-6, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28163035

RESUMO

OBJECTIVES: Our aim was to assess the reliability of nailfold capillary assessment in terms of image evaluability, image severity grade ('normal', 'early', 'active', 'late'), capillary density, capillary (apex) width, and presence of giant capillaries, and also to gain further insight into differences in these parameters between patients with systemic sclerosis (SSc), patients with primary Raynaud's phenomenon (PRP) and healthy control subjects. METHODS: Videocapillaroscopy images (magnification 300×) were acquired from all 10 digits from 173 participants: 101 patients with SSc, 22 with PRP and 50 healthy controls. Ten capillaroscopy experts from 7 European centres evaluated the images. Custom image mark-up software allowed extraction of the following outcome measures: overall grade ('normal', 'early', 'active', 'late', 'non-specific', or 'ungradeable'), capillary density (vessels/mm), mean vessel apical width, and presence of giant capillaries. RESULTS: Observers analysed a median of 129 images each. Evaluability (i.e. the availability of measures) varied across outcome measures (e.g. 73.0% for density and 46.2% for overall grade in patients with SSc). Intra-observer reliability for evaluability was consistently higher than inter- (e.g. for density, intra-class correlation coefficient [ICC] was 0.71 within and 0.14 between observers). Conditional on evaluability, both intra- and inter-observer reliability were high for grade (ICC 0.93 and 0.78 respectively), density (0.91 and 0.64) and width (0.91 and 0.85). CONCLUSIONS: Evaluability is one of the major challenges in assessing nailfold capillaries. However, when images are evaluable, the high intra- and inter-reliabilities suggest that overall image grade, capillary density and apex width have potential as outcome measures in longitudinal studies.


Assuntos
Capilares/patologia , Angioscopia Microscópica , Unhas/irrigação sanguínea , Escleroderma Sistêmico/complicações , Doenças Vasculares/diagnóstico , Adulto , Idoso , Estudos de Casos e Controles , Europa (Continente) , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Escleroderma Sistêmico/diagnóstico , Índice de Gravidade de Doença , Software , Doenças Vasculares/etiologia , Doenças Vasculares/patologia , Adulto Jovem
11.
Anim Sci J ; 88(2): 347-355, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27345632

RESUMO

A previous thermographic study of racehorses identified 13 regions of interest (ROIs) for monitoring the impact of training. However, that investigation did not consider the influence of breed, age, gender or training intensity level on the temperature of ROIs. The present study adopted a multivariate analysis approach to determine whether the aforementioned factors, along with ambient temperature, significantly influenced ROI temperature in the key body regions. Thermography measurements were obtained from 53 racehorses of three breeds. Horses were in regular training for over 10 months, having 13 thermographic examinations in each racing season. Backward stepwise multiple linear regression indicated that ambient temperature and breed contributed significantly to the model for predicting ROI temperature at all 13 ROIs. Training intensity level contributed significantly to the model only at the thoracic vertebrae, the left third metacarpal bone and left fetlock joint. Neither gender nor age contributed to the model significantly at any ROI. Our data suggest that ambient temperature, breed and training level affect racehorse body surface temperature in some areas of the distal parts of the forelimbs and the back. This contributes to a better understanding of the normal range of thermographic findings in racehorses undergoing intensive training.


Assuntos
Envelhecimento/fisiologia , Dorso/fisiologia , Temperatura Corporal/fisiologia , Cruzamento , Membro Anterior/fisiologia , Cavalos/fisiologia , Condicionamento Físico Animal/fisiologia , Caracteres Sexuais , Animais , Superfície Corporal/veterinária , Feminino , Masculino , Análise Multivariada , Temperatura Ambiente , Termografia
12.
Clin Exp Rheumatol ; 35(1): 80-84, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27494156

RESUMO

OBJECTIVES: To review our clinical experience of this rare condition and describe the clinical features and response to therapy in a cohort of patients with erythromelalgia (EM), a rare condition, characterised by paroxysmal hyperthermia of the extremities with erythema, pain and intense burning. METHODS: A review was made of the electronic and paper medical records of patients with the diagnosis of EM, with a telephone interview to verify and complete clinical information relating treatment and outcome. RESULTS: 46 patients (41 females) were included in this study. Mean age was 57 years and mean duration of symptoms was 16 years. Raynaud's phenomenon was present in 36 patients (80%) and 4 patients (9%) had systemic sclerosis. Smoking (current or previous) was identified as a possible risk factor in 26 cases and exposure to chronic vibration in 3 cases. Overall, the effect on quality of life was mild in 15% of cases, moderate in 30% and severe in 48%. The most common symptoms were burning (96%), heat (93%), pain (87%), and redness (83%). Symptoms affected the lower limbs in 98% of cases, upper limbs in 76%, face in 20% and trunk in 11%. Triggers included heat (85%), exercise (78%) and time of day (76%). Various medications were tried, showing poor effect in most cases. Intravenous iloprost was given to 27 patients, with benefit in 17 patients (63%). CONCLUSIONS: Erythromelalgia is a rare chronic debilitating condition. Exercise, heat and night time are common triggers. Current medical therapies are seldom effective and further research is sorely needed.


Assuntos
Eritromelalgia/diagnóstico , Eritromelalgia/tratamento farmacológico , Iloprosta/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Adulto , Eritromelalgia/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Doença de Raynaud/complicações , Fatores de Risco , Fumar , Avaliação de Sintomas , Resultado do Tratamento
13.
Physiol Meas ; 35(7): R91-R141, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24910968

RESUMO

The microvasculature presents a particular challenge in physiological measurement because the vessel structure is spatially inhomogeneous and perfusion can exhibit high variability over time. This review describes, with a clinical focus, the wide variety of methods now available for imaging of the microvasculature and their key applications. Laser Doppler perfusion imaging and laser speckle contrast imaging are established, commercially-available techniques for determining microvascular perfusion, with proven clinical utility for applications such as burn-depth assessment. Nailfold capillaroscopy is also commercially available, with significant published literature that supports its use for detecting microangiopathy secondary to specific connective tissue diseases in patients with Raynaud's phenomenon. Infrared thermography measures skin temperature and not perfusion directly, and it has only gained acceptance for some surgical and peripheral microvascular applications. Other emerging technologies including imaging photoplethysmography, optical coherence tomography, photoacoustic tomography, hyperspectral imaging, and tissue viability imaging are also described to show their potential as techniques that could become established tools for clinical microvascular assessment. Growing interest in the microcirculation has helped drive the rapid development in perfusion imaging of the microvessels, bringing exciting opportunities in microvascular research.


Assuntos
Técnicas de Diagnóstico Cardiovascular , Microcirculação , Microvasos/anatomia & histologia , Microvasos/fisiologia , Humanos , Pele/irrigação sanguínea , Fenômenos Fisiológicos da Pele
14.
Neuromolecular Med ; 15(2): 265-78, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23292638

RESUMO

We identified and clinically investigated two patients with primary erythromelalgia mutations (PEM), which are the first reported to map to the fourth domain of Nav1.7 (DIV). The identified mutations (A1746G and W1538R) were cloned and transfected to cell cultures followed by electrophysiological analysis in whole-cell configuration. The investigated patients presented with PEM, while age of onset was very different (3 vs. 61 years of age). Electrophysiological characterization revealed that the early onset A1746G mutation leads to a marked hyperpolarizing shift in voltage dependence of steady-state activation, larger window currents, faster activation kinetics (time-to-peak current) and recovery from steady-state inactivation compared to wild-type Nav1.7, indicating a pronounced gain-of-function. Furthermore, we found a hyperpolarizing shift in voltage dependence of slow inactivation, which is another feature commonly found in Nav1.7 mutations associated with PEM. In silico neuron simulation revealed reduced firing thresholds and increased repetitive firing, both indicating hyperexcitability. The late-onset W1538R mutation also revealed gain-of-function properties, although to a lesser extent. Our findings demonstrate that mutations encoding for DIV of Nav1.7 can not only be linked to congenital insensitivity to pain or paroxysmal extreme pain disorder but can also be causative of PEM, if voltage dependency of channel activation is affected. This supports the view that the degree of biophysical property changes caused by a mutation may have an impact on age of clinical manifestation of PEM. In summary, these findings extent the genotype-phenotype correlation profile for SCN9A and highlight a new region of Nav1.7 that is implicated in PEM.


Assuntos
Eritromelalgia/genética , Mutação de Sentido Incorreto , Canal de Sódio Disparado por Voltagem NAV1.7/genética , Mutação Puntual , Potenciais de Ação , Idade de Início , Sequência de Aminoácidos , Analgésicos/uso terapêutico , Pré-Escolar , Eritromelalgia/tratamento farmacológico , Eritromelalgia/epidemiologia , Eritromelalgia/fisiopatologia , Feminino , Células HEK293 , Humanos , Transporte de Íons , Pessoa de Meia-Idade , Dados de Sequência Molecular , Mutagênese Sítio-Dirigida , Canal de Sódio Disparado por Voltagem NAV1.7/química , Canal de Sódio Disparado por Voltagem NAV1.7/fisiologia , Técnicas de Patch-Clamp , Fenótipo , Estrutura Terciária de Proteína , Proteínas Recombinantes de Fusão/metabolismo , Transtornos das Sensações/genética , Transtornos das Sensações/fisiopatologia , Alinhamento de Sequência , Homologia de Sequência de Aminoácidos , Sódio/metabolismo , Transfecção
15.
Clin Rev Allergy Immunol ; 43(3): 249-55, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22711501

RESUMO

Raynaud's phenomenon often precedes the diagnosis of systemic sclerosis and is the first symptom of the disease in many cases. Antinuclear antibody positivity can assist in the early identification of cases of isolated Raynaud's phenomenon likely to progress to systemic sclerosis. However, the specific differences between rate of progression for different scleroderma hallmark antibodies is less clear. We review the predictive potential of ANA positivity and nailfold capillaroscopy for identifying cases of Raynaud's phenomenon which may progress to connective tissue diseases. We also have reviewed data from our own large scleroderma cohort to explore the relationship between antibody subtype and time to development of SSc. Duration of pre-existing Raynaud's phenomenon may be an important determinant of the profile of systemic sclerosis cases identified through screening. Ninety-five percent of our patients with isolated Raynaud's phenomenon, negative autoimmune serology on more than one visit and normal capillaroscopy score showed no progression to connective tissue disease. Duration of antecedent Raynaud's phenomenon differs between disease subsets and scleroderma-specific ANA patterns.


Assuntos
Anticorpos Antinucleares/imunologia , Doença de Raynaud/diagnóstico , Doença de Raynaud/imunologia , Esclerodermia Localizada/diagnóstico , Esclerodermia Localizada/imunologia , Progressão da Doença , Diagnóstico Precoce , Humanos
16.
Skin Res Technol ; 15(3): 346-56, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19624432

RESUMO

BACKGROUND/PURPOSE: Localised scleroderma (LS) is the most common form of scleroderma seen in children, and usually presents unilaterally. Infrared thermography (IRT) and laser Doppler (LD) have both been reported to be useful in assessing the active, inflammatory stage of LS. We developed and validated a protocol using these techniques for the assessment of unilateral LS activity in children. METHOD: We investigated the spatial variability and repeatability of LD measurements from adult control forearm skin, and the inter- and intra-operator reproducibility of both LD blood flow trace analysis and IRT skin temperature analysis. Software was developed to produce overlay images of thermograms onto digital photographs of skin sites. In a group of seven adult control subjects, we established the normal range for skin temperature and LD blood flow at six standardised sites (forehead, cheek, abdomen, back, arm and leg), and measured contralateral differences in readings. In a group of 34 children with LS, we investigated the skin temperature and LD blood flow in unaffected skin at the same six sites. RESULTS: In adults, physiological variability in LD blood flow and skin temperature between the two sides of the body was found to be greater than the uncertainty introduced into the measurements by (inter alia) limited intra- or inter-operator reproducibility. The cheek displayed the highest mean asymmetry in both skin temperature (0.5 degrees C) and LD blood flow (40%). CONCLUSION: Our protocol combines IRT, LD and photography for LS assessment in children, and establishes a normal range of readings in line with other authors.


Assuntos
Velocidade do Fluxo Sanguíneo , Diagnóstico por Computador/métodos , Esclerodermia Difusa/diagnóstico , Esclerodermia Difusa/fisiopatologia , Temperatura Cutânea , Pele/fisiopatologia , Termografia/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
17.
Arthritis Rheum ; 56(10): 3489-95, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17907196

RESUMO

OBJECTIVE: Assessment of disease activity is a major challenge in the management of children with localized scleroderma. The aim of this study was to evaluate the role of laser Doppler flowmetry (LDF) in comparison with infrared thermography in the detection of scleroderma disease activity. METHODS: In 41 children with localized scleroderma, 111 lesions were assessed on 2 separate occasions, by clinical examination, LDF, and thermography. Measurements from contralateral areas of unaffected skin served as intrapatient controls, and differences in blood flow and temperature were calculated between the corresponding sites. The sensitivity and specificity to detect clinically active lesions were compared between LDF and thermography. RESULTS: Seventy-five active lesions (34%) and 147 inactive lesions (66%) were identified clinically. The median relative increase in blood flow measured by LDF was +89% (range -69% to +449%) for clinically active lesions and +11% (range -46% to +302%) for clinically inactive lesions (P < 0.001). Thermography showed a median difference in temperature of +0.5 degrees C (range -0.1 degrees C to +4.1 degrees C) and +0.3 degrees C (range -1.9 degrees C to +2.7 degrees C) for clinically active lesions and clinically inactive lesions, respectively (P = 0.024). Using a cutoff level of 39% to indicate increase in blood flow, a sensitivity of 80% and specificity of 77% to detect clinically active lesions were observed; for thermography, no useful cutoff level was identified. The correlation between differences in blood flow and differences in temperature was small, but significant (r2 = 0.120, P < 0.001). CONCLUSION: LDF is a helpful, noninvasive diagnostic technique that can be used to discriminate disease activity in children with localized scleroderma, and is more accurate than thermography for this purpose.


Assuntos
Fluxometria por Laser-Doppler , Esclerodermia Localizada/diagnóstico , Pele/irrigação sanguínea , Termografia , Adolescente , Temperatura Corporal , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Fluxo Sanguíneo Regional , Sensibilidade e Especificidade
19.
Arthritis Res Ther ; 7(5): R1113-23, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16207328

RESUMO

The mechanisms by which microvascular damage leads to dermal fibrosis in diffuse cutaneous systemic sclerosis (dcSSc) are unclear. We hypothesized that microvascular pericytes constitute a cellular link between microvascular damage and fibrosis by transdifferentiating into myofibroblasts. We used a combination of immunohistochemistry and double immunofluorescence labelling of frozen skin biopsies taken from normal and dcSSc patients to determine whether a phenotypic link between pericytes and myofibroblasts exists in dcSSc. Using alpha-smooth muscle actin, the ED-A splice variant of fibronectin (ED-A FN) and Thy-1 to identify myofibroblasts, we demonstrated the presence of myofibroblasts in fibrotic dcSSc skin. Myofibroblasts were totally absent from control skin, atrophic stage dcSSc skin and non-lesional skin. Using double immunofluorescence labelling, both myofibroblasts and pericytes were shown to express ED-A FN and Thy-1 in dcSSc skin but not in control skin. Proliferating cell nuclear antigen was also expressed by myofibroblasts and pericytes in dcSSc skin while being absent in control skin. These observations suggest that the presence of myofibroblasts may represent a transitional phase during the fibrotic stages of dcSSc and that Thy-1+ve pericytes participate in the fibrogenic development of dcSSc by synthesizing ED-A FN, which may be associated with a proliferation and transition of pericytes and fibroblasts to myofibroblasts, thus linking microvascular damage and fibrosis.


Assuntos
Linhagem da Célula , Fibroblastos/patologia , Mioblastos/patologia , Pericitos/patologia , Escleroderma Sistêmico/patologia , Actinas/análise , Adulto , Idoso , Biomarcadores , Colágeno/análise , Feminino , Fibronectinas/análise , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Antígeno Nuclear de Célula em Proliferação/análise , Pele/patologia , Antígenos Thy-1/análise
20.
J Rheumatol ; 30(4): 720-2, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12672189

RESUMO

OBJECTIVE: To assess the value of thermographic measurements of digital skin temperature after cold challenge in classifying Raynaud's phenomenon (RP) in a healthy population. METHODS: One hundred seventy-five patients with RP and 404 controls were subjected to a 15 degrees C, 60 s cold challenge test. All participants were women. Digital temperature measurements were taken at baseline, immediately postimmersion, and 10 min after immersion using a portable radiometer. RESULTS: Baseline skin temperature was a significant predictor of RP; however, the fall in temperature on immersion and the subsequent rewarming rate provided no additional information. CONCLUSION: Baseline skin temperature can help to predict the occurrence of RP in patients drawn from the general population, but has relatively low discriminatory power. The cold challenge test itself is of limited additional value for classification. Although objective temperature measurements show little power overall to discriminate between RP and non-RP patients, detecting low baseline digital temperature may be a useful adjunct to clinical history in classifying the disease.


Assuntos
Doença de Raynaud/diagnóstico , Termografia , Adulto , Temperatura Baixa , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Doença de Raynaud/classificação , Sensibilidade e Especificidade , Temperatura Cutânea
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