Neurogenic bladder in spinal cord injury

In the past, renal failure was the leading cause of death after spinal cord injury (SCI). Today mortality from SCI has declined dramatically partly owing to the improved management of urologic dysfunction associated with SCI. The goals of bladder management in spinal cord injury patients are intended to (1) ensure social continence for reintegration into community, (2) allow low-pressure storage and efficient bladder emptying at low detrusor pressures, (3) avoid stretch injury from repeated overdistension, (4) prevent upper and lower urinary tracts complications from high intravesical pressures, and (5) prevent recurrent urinary tract infections. This article provides an overview of neurogenic bladder dysfunction associated with SCI and current management options.     

Association of bladder trabeculation and neurogenic bladder with spinal cord injury

ObjectiveTo compare clinical findings and urodynamic parameters according to trabeculation grade and analyze their correlations with trabeculation severity in neurogenic bladder caused by suprasacral spinal cord injury (SCI).MethodsA retrospective chart review was performed of neurogenic bladder caused by SCI. Bladder trabeculation grade was compared with SCI-related clinical parameters and bladder-related urodynamic parameters.ResultsIn SCI patients, factors such as disease duration, bladder capacity, detrusor pressure, peak detrusor pressure values, and compliance were significantly different between different grades of bladder trabeculation, while neurological level of injury, completeness, and detrusor sphincter dyssynergia had no clear relationship with bladder trabeculation grade. In the correlation analysis, vesicoureteral reflux was moderately correlated with trabeculation grade (correlation coefficient 0.433), while the correlation coefficients of disease duration, involuntary detrusor contraction, and bladder filling volume were between 0.3 and 0.4.ConclusionBladder trabeculation with suprasacral-type neurogenic bladder was graded. Although disease duration was positively correlated with bladder trabeculation grade, differences in the neurological level of injury or American Spinal Injury Association Impairment Scale score were not observed. Bladder volume, peak detrusor pressure, compliance, reflex volume, and vesicoureteral reflux also showed significant differences according to trabeculation grade. Vesicoureteral reflux was moderately correlated with trabeculation grade.     

Electrocardiographic findings in patients with chronic spinal cord injury

OBJECTIVE: To demonstrate the prevalence and prognostic value of electrocardiographic abnormalities in patients with chronic spinal cord injury. METHODS: All electrocardiographs obtained in the Palo Alto Veterans Affairs Medical Center since 1987 have been digitally recorded and stored in a computerized database. For this study, only the first electrocardiograph was considered for analysis. The subjects were divided according to age and level of spinal cord injury. The Social Security Death Index was used to ascertain vital status as of December 1999. RESULTS: Annual mortality was similar in those with chronic spinal cord injury and the able-bodied. However, individuals with a higher level of injury had a significantly higher death rate than those with a lower level of injury. The prognostic characteristics of electrocardiographic abnormalities were similar in both the able-bodied and those with spinal cord injury. CONCLUSION: In general, electrocardiographic abnormalities had the same prevalence in the spinal cord injury subjects as in the able-bodied ones. The prognostic value of electrocardiographic abnormalities in subjects with spinal cord injury is similar to that observed in able-bodied subjects.     

按需膀胱冲洗在脊髓损伤致神经源性膀胱患者中的应用效果

目的探讨按需膀胱冲洗在脊髓损伤致神经源性膀胱患者中的应用效果。方法选取2018年9月至2019年3月我院70例脊髓损伤致神经源性膀胱患者作为研究对象,按入院先后顺序等分为对照组和干预组。两组患者均采用间歇导尿术。对照组:膀胱冲洗每周2次,如果肉眼发现尿液中有沉淀物、絮状物或尿液有异味时,则冲洗次数增加为每日1次,直至肉眼观察尿液清亮、无异味为止。干预组:尿液正常情况下无需冲洗,当尿液中有沉淀物、絮状物或尿液有异味时冲洗,冲洗频率为每日1次,直至肉眼观察尿液清亮、无异味为止。比较两组患者尿路感染发生率及人均总医疗费用。结果在治疗12周期间,干预组人均总医疗费用低于对照组(P<0.05),两组患者尿路感染发生率比较差异无统计学意义(P>0.05)。结论在脊髓损伤致神经源性膀胱患者中应用按需膀胱冲洗可获得较好的疗效,减轻患者家庭经济负担,值得临床推广应用。     

5HT1A serotonin receptor agonists inhibit Plasmodium falciparum by blocking a membrane channel

To identify new leads for the treatment of Plasmodium falciparum malaria, we screened a panel of serotonin (5-hydroxytryptamine [5HT]) receptor agonists and antagonists and determined their effects on parasite growth. The 5HT1A receptor agonists 8-hydroxy-N-(di-n-propyl)-aminotetralin (8-OH-DPAT), 2,5-dimethoxy-4-iodoamphetamine, and 2,5-dimethoxy-4-bromophenylethylamine inhibited the growth of P. falciparum in vitro (50% inhibitory concentrations, 0.4, 0.7, and 1.5 microM, respectively). In further characterizing the antiparasitic effects of 8-OH-DPAT, we found that this serotonin receptor agonist did not affect the growth of Leishmania infantum, Trypanosoma cruzi, Trypanosoma brucei brucei, or Trichostrongylus colubriformis in vitro and did not demonstrate cytotoxicity against the human lung fibroblast cell line MRC-5. 8-OH-DPAT had similar levels of growth inhibition against several different P. falciparum isolates having distinct chemotherapeutic resistance phenotypes, and its antimalarial effect was additive when it was used in combination with chloroquine against a chloroquine-resistant isolate. In a patch clamp assay, 8-OH-DPAT blocked a P. falciparum surface membrane channel, suggesting that serotonin receptor agonists are a novel class of antimalarials that target a nutrient transport pathway. Since there may be neurological involvement with the use of 8-OH-DPAT and other serotonin receptor agonists in the treatment of falciparum malaria, new lead compounds derived from 8-OH-DPAT will need to be modified to prevent potential neurological side effects. Nevertheless, these results suggest that 8-OH-DPAT is a new lead compound with which to derive novel antimalarial agents and is a useful tool with which to characterize P. falciparum membrane channels.     

脊髓损伤神经源性膀胱患者的护理体会

神经源性膀胱是康复医学中常见的并发症之一,可由药物、多种神经系统疾病、外伤等原因引起,尤其多见于脊髓损伤,后期可导致肾功能衰竭甚至死亡。我们对13例脊髓损伤患者进行康复护理,取得满意效果。现将护理体会报告如下。     

脊髓损伤后膀胱功能障碍的药物治疗

对影响膀胱尿道功能神经递质及其药理作用 ,从4个方面进行了介绍 :中枢神经系统 ,交感、副交感神经节 ,外周传出纤维和传入神经。对目前常用的神经药物 ,从影响膀胱贮尿和排尿功能两方面进行了讨论 ,并介绍了最新研究进展。     

Effects of 5-hydroxytryptamine and 5-hydroxytryptamine receptor agonists on ion transport across mammalian airway epithelia.

1. 5-Hydroxytryptamine has been suggested as a candidate for an endogenous inhibitor of airway sodium transport. Amiloride, an inhibitor of epithelial sodium channels, has therapeutic potential in disorders of airway ion transport such as cystic fibrosis, but its duration of action in vivo is short. 5-Hydroxytryptamine and related compounds have been studied to investigate whether any might be a useful alternative to amiloride for clinical use, and to further assess the possible physiological role of 5-hydroxytryptamine in the regulation of airway ion transport. 2. Sheep tracheal epithelium was mounted in Ussing chambers under short-circuit conditions. Mucosal application of 5-hydroxytryptamine resulted in an immediate, reversible, concentration-related decrease in the short-circuit current, maximal with 38% inhibition of the short-circuit current at 25 mmol/l. This response was completely inhibited by pretreatment of tissues with mucosal amiloride (100 mumol/l). These features are consistent with a direct effect of 5-hydroxytryptamine on amiloride-sensitive sodium channels. Similar results were obtained in a limited number of studies using human bronchial epithelium. 3. The effects of mucosal addition of a range of 5-hydroxytryptamine agonists were studied to determine if any was a more potent blocker of amiloride-sensitive sodium transport than 5-hydroxytryptamine. The 5-HT3 agonist 2-methyl-5-hydroxytryptamine had no effect on the short-circuit current at concentrations of up to 5 mmol/l. The 5-HT1D agonist sumatriptan had no effect at concentrations below 5 mmol/l and at 5 mmol/l had only a transient effect.(ABSTRACT TRUNCATED AT 250 WORDS)     

Nogo受体和阻断剂与脊髓损伤

目的：总结Nogo受体和阻断剂的性质，与轴突生长的相互关系，探讨Nogo受体阻断剂在促进脊髓损伤修复中的作用。 资料来源：应用计算机检索Medline 1997—01／2006—01关于脊髓损伤与Nogo受体的文章。检索词“spinal cord injury，Nogo，NgR”并限定文章的语种类为English。同时利用计算机检索中国期刊全文数据库1997-01／2006—01的相关文章，限定文章语言种类为中文，检索词“脊髓损伤，Nogo受体”。 资料选择：对资料进行初审，纳入标准：关于脊髓损伤修复与Nogo受体及阻断剂的相互关系。排除标准：重复性研究。 资料提炼：共收集到符合上述要求的文献51篇，排除25篇重复性研究。26篇符合纳入标准。 资料综合：Nogo-66受体1是髓鞘糖蛋白、少突胶质细胞髓鞘糖蛋白以及Nogo的共同受体。通过Nogo-66受体1／P75／LINGO-1的受体复合物激活RhoA，导致神经元轴突溃变，抑制功能恢复。NEP1～40等是Nogo-66受体1的受体阻断剂，能够促进轴突生长。 结论：Nogo-66受体1阻断剂能促进神经再生租功能恢复，很有希望成为治疗脊髓损伤的有效药物。     

脊髓慢性损伤模型的构建

背景:由于缺乏简单、理想的动物实验模型,脊髓病理改变及病理生理机制目前仍不明确.目的:通过对脊髓慢性损伤动物模型综合叙述,为脊髓慢性损伤的动物实验研究提供参考,并进一步探讨脊髓慢性损伤摸型的建立与应用.方法:以spinal cord injury,animal model,Models.Animal为检索词,应用计算机检索Medline等数据库相关文章,排除样本量太少及重复发表的文章,保留34篇文献做进一步分析.结果与结论:脊髓损伤动物模型对于探求脊髓疾病的病因和病理机制,特别是对脊髓再生的神经生物学研究,评价脊髓损伤后有效的干预治疗措施有十分重要的作用.目前脊髓损伤动物模型虽然种类繁多,但各存优缺点,并且存在多种变异因素,如动物间个体差异、手术操作熟练程度及损伤装置的精密程度等,以致现有模型还无法准确控制脊髓损伤的范围和程度.故建立具有较强稳定性,能够反映特定病理变化的脊髓损伤动物模型一直是研究者追求的目标.     

视觉反馈排尿训练在治疗脊髓损伤后神经源性膀胱中的应用

目的：观察视觉反馈排尿训练用于脊髓损伤后神经源性膀胱的疗效。方法：31例脊髓损伤后神经源性膀胱患者，以测压管连通导尿管，使患者可以直视膀胱内压的变化，根据患者排尿障碍的不同进行不同模式的视觉反馈膀胱训练。训练前后记录安全容量、基础膀胱内压、最高膀胱内压、自排尿量、残余尿量、排尿时程等数据。结果：经过2—8周训练，患者的平均最大膀胱内压由30.372±12.957cmH2O增至63.378±19.313cmH2O，尿潴留、无自主排尿者（16例）中有12例可以自主排尿，且残余尿量＜100ml，4例目前尚无自主排尿，但可明确感知膀胱充盈；有自主排尿，但残余尿量≥100ml者（14例）中有12例残余尿量降至100ml以下，2例残余尿量仍在150—200ml；有自主排尿，但排尿时程延长的1例患者控制膀胱内压能力有所提高，但排尿时程仍较伤前长。结论：视觉反馈排尿训练用于脊髓损伤后神经源性膀胱患者的膀胱训练，可以有效提高膀胱内压，为膀胱功能的恢复创造了良好条件。     

Nogo受体和阻断剂与脊髓损伤

目的:总结Nogo受体和阻断剂的性质,与轴突生长的相互关系,探讨Nogo受体阻断剂在促进脊髓损伤修复中的作用。资料来源:应用计算机检索Medline1997-01/2006-01关于脊髓损伤与Nogo受体的文章。检索词“spinalcordinjury,Nogo,NgR”并限定文章的语种类为English。同时利用计算机检索中国期刊全文数据库1997-01/2006-01的相关文章,限定文章语言种类为中文,检索词“脊髓损伤,Nogo受体”。资料选择:对资料进行初审,纳入标准:关于脊髓损伤修复与Nogo受体及阻断剂的相互关系。排除标准:重复性研究。资料提炼:共收集到符合上述要求的文献51篇,排除25篇重复性研究。26篇符合纳入标准。资料综合:Nogo-66受体1是髓鞘糖蛋白、少突胶质细胞髓鞘糖蛋白以及Nogo的共同受体。通过Nogo-66受体1/P75/LINGO-1的受体复合物激活RhoA,导致神经元轴突溃变,抑制功能恢复。NEP1～40等是Nogo-66受体1的受体阻断剂,能够促进轴突生长。结论:Nogo-66受体1阻断剂能促进神经再生和功能恢复,很有希望成为治疗脊髓损伤的有效药物。     

脊髓损伤后膀胱功能的量表评定

本文介绍一种脊髓损伤后膀胱功能的评定量表 ,该量表根据患者不同的膀胱功能状态和不同的膀胱排空方式 ,将膀胱功能分为5个等级 ,能体现脊髓损伤后膀胱功能改善的细微变化 ,内容科学、简便实用 ,有临床应用价值。     

脊髓损伤后神经原性膀胱的功能康复

脊髓损伤后 ,神经原性膀胱的功能康复以非手术治疗为主。间歇导尿感染率低 ,并发症少 ,是目前最常用的尿液引流方法。抗胆碱能药物能提高膀胱顺应性和排尿节制功能。经尿道球囊扩张术和经尿道留置支架外括约肌成形术能有效改善尿道外括约肌痉挛 ,是很有发展前景的新技术。科学的膀胱再训练能促进自主排尿节律的建立。     

Interrater reliability of the international standards for neurological classification of spinal cord injury in youths with chronic spinal cord injury

Mulcahey MJ, Gaughan JP, Chafetz RS, Vogel LC, Samdani AF, Betz RR. Interrater reliability of the International Standards for Neurological Classification of Spinal Cord Injury in youths with chronic spinal cord injury.

Objectives

To evaluate the interrater reliability of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) in children with chronic spinal cord injury (SCI), and to define the lower age limit at which the examinations have clinical utility.

Design

Repeated measures, multicenter reliability study.

Setting

Two U.S. pediatric specialty hospitals with recognized SCI programs.

Participants

Children (N=236) with chronic SCI.

Interventions

Subjects underwent 4 examinations by 2 raters: sensory tests (pin prick [PP] and light touch [LT]), a motor test, and a test of anal sensation (AS) and anal contraction (AC).

Main Outcome Measures

A 2-way general linear model analysis of variance was used for analysis. Intraclass correlation coefficients (ICCs) and 95% confidence intervals were calculated for PP, LT, motor, AS, and AC.

Results

No child younger than 6 years completed the examination. When examined as a function of age, interrater reliability for motor, PP, LT, AS, and AC was moderate (ICC=.89) to high (ICC=.99). There was poor reliability for AS (ICC=.49) in subjects with complete injuries but moderate reliability for all other variables. There was moderate to high reliability for classification of type (tetraplegia/paraplegia) and severity (complete/incomplete) of injury across age groups.

Conclusions

The ISNCSCI does not have utility for children younger than 6 years. For children older than 6 years, interrater reliability of PP, LT, and motor examinations is high.     

坐骨神经分支选择性损伤模型大鼠脊髓背角内5-羟色胺4-7受体亚型mRNAs的表达变化

目的：观察坐骨神经分支选择性损伤模型大鼠脊髓背角内5-羟色胺4—7受体亚型mRNAs的表达变化。 方法：实验于2004—10／2005-06在第四军医大学解剖学教研室进行。①取SD大鼠27只，随机分为正常对照组3只；手术组24只。②手术组大鼠在戍巴比妥钠（40mg／kg）腹腔麻醉下，切开左侧后肢皮肤暴露并钝性分离腓肠肌两头，暴鼹坐骨神经，在邻近坐骨神经分叉处结扎胫神经和腓总神经，于结扎远端0．5cm处切断神经，建立坐骨神经分支选择性损伤大鼠模型，全过程中注意勿伤及腓肠神经；右侧为假手术对照．只暴露不结扎切断坐骨神经，其余过程同手术侧。③分别在术后1，2，3，4，7，14，21，28d，取b～k节段脊髓背角，采用反转录-聚合酶链式反应技术检测脊髓背角内5-羟色胺4—7受体亚型mRNAs的表达变化。 结果：27只大鼠进入结果分析。①正常大鼠脊髓背角检测到5一羟色胺4、5-羟色胺5A、5-羟色胺7受体亚型mRNAs的表达，但未检测到5-羟色胺5B．5-羟色胺6受体亚型mRNAs的表达。②手术组手术侧检测到5-羟色胺4、5-羟色胺5A和5-羟色胺7受体亚型mRNAs的表达上调。其中，5-羟色胺4受体亚型mRNA的表达在术后4d明显升高，21d达高峰后下降，28d趋于正常。5-羟色胺5A受体亚型mRNA的表达在术后3d开始升高，持续升高至28d。5-羟色胺7受体亚型mRNA的表达变化同5-羟色胺5A受体亚型。假手术侧的脊髓背角，各受体亚型mRNAs的表达未出现明显变化。在脊髓背角未检测到5-羟色胺5B和5-羟色胺6受体亚型mRNAs的表达。 结论：5-羟色胺受体亚型mRNA在坐骨神经分支选择性损伤模型脊髓背角中的表达具有不同的时程变化特点，提示它们在坐骨神经分支选择性损伤所致的神经病理性痛中发挥不同作用。     

脊髓损伤后神经原性膀胱的分类及其治疗原则

脊髓损伤后神经原性膀胱的分类及其与治疗的关系近年来有了长足的进展。传统的分类和按膀胱功能及尿流动力学的分类方法与临床治疗不相适应。基于排尿时患者有无尿道外括约肌松弛 ,结合患者全身情况及康复治疗的需要 ,近年提出了新的4型分类法 ,即大脑脊髓束残留型、脊髓协同型、截瘫型和四肢瘫型。本文简要介绍了各种分类方法及其治疗原则 ,尤其是新分类法 ,简明实用。     

坐骨神经分支选择性损伤模型大鼠脊髓背角内5-羟色胺4-7受体亚型mRNAs的表达变化

目的:观察坐骨神经分支选择性损伤模型大鼠脊髓背角内5-羟色胺4-7受体亚型mRNAs的表达变化。方法:实验于2004-10/2005-06在第四军医大学解剖学教研室进行。①取SD大鼠27只,随机分为正常对照组3只;手术组24只。②手术组大鼠在戍巴比妥钠(40mg/kg)腹腔麻醉下,切开左侧后肢皮肤暴露并钝性分离腓肠肌两头,暴露坐骨神经,在邻近坐骨神经分叉处结扎胫神经和腓总神经,于结扎远端0.5cm处切断神经,建立坐骨神经分支选择性损伤大鼠模型,全过程中注意勿伤及腓肠神经;右侧为假手术对照,只暴露不结扎切断坐骨神经,其余过程同手术侧。③分别在术后1,2,3,4,7,14,21,28d,取L3～L6节段脊髓背角,采用反转录-聚合酶链式反应技术检测脊髓背角内5-羟色胺4-7受体亚型mRNAs的表达变化。结果:27只大鼠进入结果分析。①正常大鼠脊髓背角检测到5-羟色胺4、5-羟色胺5A、5-羟色胺7受体亚型mRNAs的表达,但未检测到5-羟色胺5B、5-羟色胺6受体亚型mRNAs的表达。②手术组手术侧检测到5-羟色胺4、5-羟色胺5A和5-羟色胺7受体亚型mRNAs的表达上调。其中,5-羟色胺4受体亚型mRNA的表达在术后4d明显升高,21d达高峰后下降,28d趋于正常。5-羟色胺5A受体亚型mRNA的表达在术后3d开始升高,持续升高至28d。5-羟色胺7受体亚型mRNA的表达变化同5-羟色胺5A受体亚型。假手术侧的脊髓背角,各受体亚型mRNAs的表达未出现明显变化。在脊髓背角未检测到5-羟色胺5B和5-羟色胺6受体亚型mRNAs的表达。结论:5-羟色胺受体亚型mRNA在坐骨神经分支选择性损伤模型脊髓背角中的表达具有不同的时程变化特点,提示它们在坐骨神经分支选择性损伤所致的神经病理性痛中发挥不同作用。     

过氧化物酶体增殖物激活受体γ激动剂对大鼠脊髓损伤后细胞自噬的影响

背景:过氧化物酶体增殖物激活受体γ受体激动剂具有抗炎和抑制神经凋亡保护作用,能在一定程度上保护脊髓神经元,对脊髓损伤后细胞自噬应激调控等产生影响。目的:观察过氧化物酶体增殖物激活受体γ对大鼠脊髓损伤后细胞自噬的影响。方法:将60只SD大鼠分为3组,正常对照组仅做椎板切除,不损伤脊髓,腹腔注射生理盐水;其余大鼠以改良Allen法制作大鼠脊髓损伤模型,过氧化物酶体增殖物激活受体γ组腹腔注射罗格列酮;脊髓损伤组不做处理。损伤后1,3,7,14d为时间点并取材,对脊髓损伤区分别进行免疫组织化学法检测,并以WesternBlot法检测Beclin1/Bcl-2的表达变化,同时采用BBB评分方法观察神经功能恢复情况。结果与结论:大鼠脊髓损伤后第3～14天,过氧化物酶体增殖物激活受体γ组BBB评分显著高于脊髓损伤组(P<0.05)。脊髓损伤组和过氧化物酶体增殖物激活受体γ组均见自噬相关阳性细胞表达,过氧化物酶体增殖物激活受体γ组细胞自噬程度相对降低,Beclin1表达较脊髓损伤组降低(P<0.05),Bcl-2表达较脊髓损伤组明显增加(P<0.05),神经功能增强(P<0.05)。提示过氧化物酶体增殖物激活受体γ激动剂在一定程度上降低大鼠脊髓损伤后细胞自噬,对细胞凋亡产生拮抗作用,并在一定程度上可促进神经功能的恢复。