ORCID Profile
0000-0003-4534-8564
Current Organisation
University of Oxford
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Publisher: Informa UK Limited
Date: 27-06-2016
Publisher: American Diabetes Association
Date: 08-2022
DOI: 10.2337/DB21-1147
Abstract: In this cross-sectional study we aimed to quantify the somatosensory dysfunction in the hand in people with diabetes with distal symmetrical polyneuropathy (DSPN) in hands and explore early signs of nerve dysfunction in people with diabetes without DSPN in hands. The clinical diagnosis of DSPN was confirmed with electrodiagnosis and corneal confocal microscopy. Thermal and mechanical nerve function in the hand was assessed with quantitative sensory tests. Measurements were compared between healthy participants (n = 31), in iduals with diabetes without DSPN (n = 35), in iduals with DSPN in feet but not hands (DSPNFEET ONLY) (n = 31), and in iduals with DSPN in hands and feet (DSPNHANDS & FEET) (n = 28) with one-way between-group ANOVA. The somatosensory profile of the hand in people with DSPNHANDS & FEET showed widespread loss of thermal and mechanical detection. This profile in hands is comparable with the profile in the feet of people with DSPN in feet. Remarkably, in iduals with DSPNFEET ONLY already showed a similar profile of widespread loss of nerve function in their hands. People with diabetes without DSPN in feet already had some nerve dysfunction in their hands. These findings suggest that nerve function assessment in hands should become more routine in people with diabetes.
Publisher: Springer Science and Business Media LLC
Date: 10-06-2023
DOI: 10.1007/S00125-023-05945-0
Abstract: Non-invasive in vivo corneal confocal microscopy is gaining ground as an alternative to skin punch biopsy to evaluate small-diameter nerve fibre characteristics. This study aimed to further explore corneal nerve fibre pathology in diabetic neuropathy. This cross-sectional study quantified and compared corneal nerve morphology and microneuromas in participants without diabetes ( n =27), participants with diabetes but without distal symmetrical polyneuropathy (DSPN n =33), participants with non-painful DSPN ( n =25) and participants with painful DSPN ( n =18). Clinical and electrodiagnostic criteria were used to diagnose DSPN. ANCOVA was used to compare nerve fibre morphology in the central cornea and inferior whorl, and the number of corneal sub-epithelial microneuromas between groups. Fisher’s exact tests were used to compare the type and presence of corneal sub-epithelial microneuromas and axonal swelling between groups. Various corneal nerve morphology metrics, such as corneal nerve fibre length and density, showed a progressive decline across the groups ( p .001). In addition, axonal swelling was present more frequently ( p =0.018) and in higher numbers ( p =0.03) in participants with painful compared with non-painful DSPN. The frequency of axonal distension, a type of microneuroma, was increased in participants with painful and non-painful DSPN compared to participants with diabetes but without DSPN and participants without diabetes (all p ≤0.042). The combined presence of all microneuromas and axonal swelling was increased in participants with painful DSPN compared with all other groups ( p ≤0.026). Microneuromas and axonal swelling in the cornea increase in prevalence from participants with diabetes to participants with non-painful DSPN and participants with painful DSPN.
Publisher: Elsevier BV
Date: 09-2013
Publisher: Oxford University Press (OUP)
Date: 25-06-2018
DOI: 10.1093/PM/PNY115
Abstract: To determine the immediate effect of neural tension technique (NTT) on conditioned pain modulation in patients with chronic neck pain. A secondary objective was to determine the immediate effect of neural tensioner technique on pain intensity and cervical range of movement. Randomized clinical trial. University medical center. Fifty-four patients with neck pain (13 males and 41 females mean± SD age = 20.91 ± 2.64 years) were randomly allocated to two groups: NTT or sham technique. Participants received a visual analog scale (VAS) and neck disability index (NDI) after inclusion. Conditioned pain modulation (CPM) and active cervical range of motion were measured before and after the intervention. Each subject received one treatment session. The results of the analysis of variance revealed a significant effect for the group × time interaction only for CPM (F = 11.09, P = 0.002, ηp2 = 0.176). No significant interactions were found for the other measures (VAS [F = 1.719, P = 0.195, ηp2 = 0.031], pressure pain threshold C2 [F = 0.731, P = 0.398, ηp2 = 0.018], flexion [F = 0.176, P = 0.677, ηp2 = 0.003], extension [F = 0.035, P = 0.852, ηp2 = 0.001], lateral flexions [F = 0.422, P = 0.519, ηp2 = 0.008], and rotations [F = 1.307 P = 0.258, ηp2 = 0.024]). Regarding CPM, intergroup interaction differences were found postintervention (P = 0.002) with a high effect size (d = 0.98). This study suggests that neural tension technique enhances immediate conditioned pain modulation in patients with chronic neck pain, but not pain intensity or cervical range of movement.
Publisher: BMJ
Date: 08-2020
DOI: 10.1136/BMJDRC-2020-001566
Abstract: The first signs of diabetic neuropathy typically result from small-diameter nerve fiber dysfunction. This review synthesized the evidence for small-diameter nerve fiber neuropathy measured via quantitative sensory testing (QST) in patients with diabetes with and without painful and non-painful neuropathies. Electronic databases were searched to identify studies in patients with diabetes with at least one QST measure reflecting small-diameter nerve fiber function (thermal or electrical pain detection threshold, contact heat-evoked potentials, temporal summation or conditioned pain modulation). Four groups were compared: patients with diabetes (1) without neuropathy, (2) with non-painful diabetic neuropathy, (3) with painful diabetic neuropathy and (4) healthy in iduals. Recommended methods were used for article identification, selection, risk of bias assessment, data extraction and analysis. For the meta-analyses, data were pooled using random-effect models. Twenty-seven studies with 2422 participants met selection criteria 18 studies were included in the meta-analysis. Patients with diabetes without symptoms of neuropathy already showed loss of nerve function for heat (standardized mean difference (SMD): 0.52, p .001), cold (SMD: −0.71, p=0.01) and electrical pain thresholds (SMD: 1.26, p=0.01). Patients with non-painful neuropathy had greater loss of function in heat pain threshold (SMD: 0.75, p=0.01) and electrical stimuli (SMD: 0.55, p=0.03) compared with patients with diabetes without neuropathy. Patients with painful diabetic neuropathy exhibited a greater loss of function in heat pain threshold (SMD: 0.55, p=0.005) compared with patients with non-painful diabetic neuropathy. Small-diameter nerve fiber function deteriorates progressively in patients with diabetes. Because the dysfunction is already present before symptoms occur, early detection is possible, which may assist in prevention and effective management of diabetic neuropathy.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.MSKSP.2018.06.007
Abstract: Neurodynamic assessment and management are advocated for femoral nerve pathology. Contrary to neurodynamic techniques for other nerves, there is limited research that quantifies femoral nerve biomechanics. To quantify longitudinal and transverse excursion of the femoral nerve during knee and neck movements. Single-group, experimental study, with within-participant comparisons. High-resolution ultrasound recordings of the femoral nerve were made in the proximal thigh/groin region in 30 asymptomatic participants. Scans were made during knee flexion in supine and a semi-seated position, and during neck flexion in side-lying slump (Slump Longitudinal and transverse excursion measurements were reliable (ICC≥0.87). With knee flexion, longitudinal femoral nerve excursion was significant and larger in supine than in sitting (supine (mean (SD)): 3.6 (2.0) mm p < 0.001 sitting: 1.1 (1.6) mm p = 0.001 comparison: p = 0.001). There was also excursion in a medial direction (supine: 1.4 (0.3) mm p < 0.001 sitting: 0.7 (0.6) mm p < 0.001) and anterior direction (supine: 0.2 (0.2) mm p < 0.001 sitting: 0.1 (0.2) mm p = 0.06). Neck flexion in Slump Although the femoral nerve terminates proximal to the knee, femoral nerve excursion in the proximal thigh occurred with knee flexion Neck flexion in Slump
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Eva Sierra Silvestre.