CORRELATION OF QUANTITATIVE SUDOMOTOR AXON REFLEX TESTING

我们建议研究QSART与穿孔皮肤活检所确定的小纤维神经病的病理证实的相关性。我们建议研究10名非糖尿病小纤维神经病变患者，10名糖尿病神经病变患者(活检部位QSART异常)，以及10名其他主要是大纤维神经病变的患者，如慢性炎症性消化障碍神经病变(其中QSART可能正常)，作为自主神经反射筛查的一部分，在自主神经反射实验室进行QSART测试。我们还建议研究10名正常对照，作为实验方案的一部分，他们将接受QSART测试。患者和对照组将在QSART测试的部位(小腿近端在腓骨头下方5厘米，远端在脚踝内踝上方5厘米)进行两次直径4 mm的穿孔皮肤活组织检查。手术将在无菌的情况下进行。皮肤将用无菌胶条和敷料封闭。皮肤活检将放置在固定剂中，并进行组织病理学和免疫细胞化学检查。后者将包括将活组织检查材料送到约翰霍普金斯医院的周围神经实验室进行专门的染色和神经纤维密度的定量。组织水平去甲肾上腺素的含量，使用微孔高效液相色谱法，将在刘特佐博士的实验室进行。将使用通用预防措施对标本进行活组织检查和处理，以将任何污染风险降至最低。

We propose to study the correlation between QSART and pathological confirmation of small fiber neuropathy as determined by punch skin biopsy. We propose to study 10 patients with non diabetic small fiber neuropathy, 10 patients with diabetic neuropathy (with abnormal QSART over the biopsy site), and 10 patients with other, predominantly large fiber neuropathies such as chronic inflammatory dymelinating neuropathy (in whom QSART is likely to be normal) referred for QSART testing as part of an Autonomic Reflex Screen in the Autonomic Reflex Laboratory. We also propose to study 10 normal controls on whom QSART testing will be performed as part of the experimental protocol. Patients and controls will have two 4 mm diameter punch skin biopsies performed at sites of QSART testing (proximal leg 5 cms below the fibular head and distal leg 5 cm above the medial malleolus of the ankle). The procedure will be performed in a sterile fashion. The skin will be closed with a sterile adhesive strip and a dressing applied. The skin biopsy will be placed in fixative and processed for histopathological and immunocytochemical examination. The latter will involve sending biopsy material to the peripheral nerve laboratory at Johns Hopkins Hospital for specialized staining and quantitation of nerve fiber density. Tissue levels of norepinephrine content, using microbore HPLC, will be performed in Dr. Low's laboratory. Biopsy and handling of the specimen will be carried out using universal precautions to minimize any contamination risk.