Abstract

Small nerve fibers regulate local skin blood flow in response to local thermal perturbations. Small nerve fiber function is difficult to assess with classical neurophysiological tests. In this study, a vasomotor response model in combination with a heating protocol was developed to quantitatively characterize the control mechanism of small nerve fibers in regulating skin blood flow in response to local thermal perturbation.The skin of healthy subjects' hand dorsum (n=8) was heated to 42°C with an infrared lamp, and then naturally cooled down. The distance between the lamp and the hand was set to three different levels in order to change the irradiation intensity on the skin and implement three different skin temperature rise rates (0.03°C/s, 0.02°C/s and 0.01°C/s). A laser Doppler imager (LDI) and a thermographic video camera recorded the temporal profile of the skin blood flow and the skin temperature, respectively.The relationship between the skin blood flow and the skin temperature was characterized by a vasomotor response model. The model fitted the skin blood flow response well with a variance accounted for (VAF) between 78% and 99%. The model parameters suggested a similar mechanism for the skin blood flow regulation with the thermal perturbations at 0.03°C/s and 0.02°C/s. But there was an accelerated skin vasoconstriction after a slow heating (0.01°C/s) (p-value<0.05). An attenuation of the skin vasodilation was also observed in four out of the seven subjects during the slow heating (0.01°C/s). Our method provides a promising way to quantitatively assess the function of small nerve fibers non-invasively and non-contact.

Highlights

  • Small nerve fibers carry multiple functions, such as temperature sensation, pain sensation and autonomic functions (Hoitsma et al, 2004)

  • The increase of the skin blood flow lagged behind the increase of the skin temperature, and the skin blood flow reached a peak in the cooling phase when the skin temperature was already declining

  • This study developed a quantitative method to describe the control mechanism of small nerve fibers for regulating skin blood flow in response to an external thermal perturbation

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Summary

Introduction

Small nerve fibers (myelinated Aδ and unmyelinated C nerve fibers) carry multiple functions, such as temperature sensation, pain sensation and autonomic functions (Hoitsma et al, 2004). A complication of diabetes and seen in polyneuropathies of other origin, is a peripheral nerve disease that selectively affects small nerve fibers and their functions (Lacomis, 2002). Diagnosis of small fiber neuropathy and, Abbreviations: AU, arbitrary units; LDI, laser Doppler imager; LTI, linear timeinvariant; ROI, region of interest; RRST, rise rate of the skin temperature; VAF, variance accounted for. Skin biopsy with an assessment of intra-epidermal nerve fiber density, compared with quantitative sensory testing and quantitative sudomotor axonal reflex test, has a higher sensitivity for the diagnosis of small fiber neuropathy (Sommer and Lauria, 2007), but the relation between the loss of intra-epidermal nerve fiber and the pathology of small fiber neuropathy is still unknown.

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