体外冲击波治疗在男性慢性骨盆疼痛综合征中的应用进展

Ⅲ型前列腺炎又称为慢性骨盆疼痛综合征(CPPS),约占慢性前列腺炎的90%,20～83岁男性均可发病,发病率为4%～16%。临床表现为长期、反复的骨盆区域疼痛或不适,持续时间超过3个月,可伴有不同程度的排尿症状和性功能障碍,严重影响患者的生活质量。目前,CPPS的发病机制和病因尚不明确,尚没有标准的治疗方法。临床运用体外冲击波治疗男性CPPS,收到良好的临床效果。     

Gastric slow waves, gastrointestinal symptoms and peptides in systemic sclerosis patients

Abstract  Impaired gastric slow waves, frequent gastrointestinal (GI) symptoms and altered GI peptides have been reported in Scleroderma (SSc) patients. The aim of this study was to investigate the associations among these three important components in GI dysmotility. Seventeen fasted SSc patients underwent four channel surface electrogastrography, measuring % of normal gastric slow waves or dysrhythmia. Patients completed a questionnaire designed by us to assess demographics, upper and lower GI symptoms (symptom presence, frequency and impact on quality of life, QOL), by YES/NO, Likert Scales and Visual Analogue Scales 1–100 mm (called GI Dysmotility Questionnaire, GIDQ) and health-related QOL by SF-36. Fasting plasma vasoactive intestinal peptide (VIP) and motilin levels were measured by peptide immunoassays. There were significant correlations between percentages of gastric dysrhythmias (bradygastria or arrhythmia) and a number of major GI symptoms such as nausea, abdominal bloating and pain. The plasma level of VIP was correlated positively with % dysrhythmia but negatively with % normal slow waves. Motilin was positively correlated with slow wave coupling (coordination). No major differences were noted in the measured peptides or gastric slow waves between limited SSc and diffuse SSc. Correlations were noted between SF-36 domain scores and our GIDQ scores. In SSc patients, gastric dysrhythmias are correlated with certain GI symptoms. Correlations are also noted between plasma VIP/Motilin levels and gastric slow waves. Thus in SSc, gastric dysrhythmias may be predictive of development of certain dyspeptic symptoms. Plasma VIP may be involved in the development of dysrhythmias.     

High risk of reading disability and speech sound disorder in rolandic epilepsy families: case-control study

PURPOSE: Associations between rolandic epilepsy (RE) with reading disability (RD) and speech sound disorder (SSD) have not been tested in a controlled study. We conducted a case-control study to determine whether (1) RD and SSD odds are higher in RE probands than controls and (2) an RE proband predicts a family member with RD or SSD, hence suggesting a shared genetic etiology for RE, RD, and SSD. METHODS: Unmatched case-control study with 55 stringently defined RE cases, 150 controls in the same age range lacking a primary brain disorder diagnosis, and their siblings and parents. Odds ratios (OR) were calculated by multiple logistic regression, adjusted for sex and age, and for relatives, also adjusted for comorbidity of RD and SSD in the proband. RESULTS: RD was strongly associated with RE after adjustment for sex and age: OR 5.78 (95% CI: 2.86-11.69). An RE proband predicts RD in family members: OR 2.84 (95% CI: 1.38-5.84), but not independently of the RE proband's RD status: OR 1.30 (95% CI: 0.55-12.79). SSD was also comorbid with RE: adjusted OR 2.47 (95%CI: 1.22-4.97). An RE proband predicts SSD in relatives, even after controlling for sex, age and proband SSD comorbidity: OR 4.44 (95% CI: 1.93-10.22). CONCLUSIONS: RE is strongly comorbid with RD and SSD. Both RD and SSD are likely to be genetically influenced and may contribute to the complex genetic etiology of the RE syndrome. Siblings of RE patients are at high risk of RD and SSD and both RE patients and their younger siblings should be screened early.     

Auditory Inhibition of Rapid Eye Movements and Dream Recall from REM Sleep

Study Objectives:

There is debate in dream research as to whether ponto-geniculo-occipital (PGO) waves or cortical arousal during sleep underlie the biological mechanisms of dreaming. This study comprised 2 experiments. As eye movements (EMs) are currently considered the best noninvasive indicator of PGO burst activity in humans, the aim of the first experiment was to investigate the effect of low-intensity repeated auditory stimulation on EMs (and inferred PGO burst activity) during REM sleep. It was predicted that such auditory stimuli during REM sleep would have a suppressive effect on EMs. The aim of the second experiment was to examine the effects of this auditory stimulation on subsequent dream reporting on awakening.

Design:

Repeated measures design with counterbalanced order of experimental and control conditions across participants.

Setting:

Sleep laboratory based polysomnography (PSG)

Participants:

Experiment 1: 5 males and 10 females aged 18-35 years (M = 20.8, SD = 5.4). Experiment 2: 7 males and 13 females aged 18-35 years (M = 23.3, SD = 5.5).

Interventions:

Below-waking threshold tone presentations during REM sleep compared to control REM sleep conditions without tone presentations.

Measurements and Results:

PSG records were manually scored for sleep stages, EEG arousals, and EMs. Auditory stimulation during REM sleep was related to: (a) an increase in EEG arousal, (b) a decrease in the amplitude and frequency of EMs, and (c) a decrease in the frequency of visual imagery reports on awakening.

Conclusions:

The results of this study provide phenomenological support for PGO-based theories of dream reporting on awakening from sleep in humans.

Citation:

Stuart K; Conduit R. Auditory inhibition of rapid eye movements and dream recall from REM sleep. SLEEP 2009;32(3):399–408.     

Mechanism of asynchronous Ca2+ waves underlying agonist-induced contraction in the rat basilar artery

Background and purpose:

Uridine 5''-triphosphate (UTP) is a potent vasoconstrictor of cerebral arteries and induces Ca²⁺ waves in vascular smooth muscle cells (VSMCs). This study aimed to determine the mechanisms underlying UTP-induced Ca²⁺ waves in VSMCs of the rat basilar artery.

Experimental approach:

Isometric force and intracellular Ca²⁺ ([Ca²⁺]_i) were measured in endothelium-denuded rat basilar artery using wire myography and confocal microscopy respectively.

Key results:

Uridine 5''-triphosphate (0.1–1000 µmol·L⁻¹) concentration-dependently induced tonic contraction (pEC₅₀ = 4.34 ± 0.13), associated with sustained repetitive oscillations in [Ca²⁺]_i propagating along the length of the VSMCs as asynchronized Ca²⁺ waves. Inhibition of Ca²⁺ reuptake in sarcoplasmic reticulum (SR) by cyclopiazonic acid abolished the Ca²⁺ waves and resulted in a dramatic drop in tonic contraction. Nifedipine reduced the frequency of Ca²⁺ waves by 40% and tonic contraction by 52%, and the nifedipine-insensitive component was abolished by SKF-96365, an inhibitor of receptor- and store-operated channels, and KB-R7943, an inhibitor of reverse-mode Na⁺/Ca²⁺ exchange. Ongoing Ca²⁺ waves and tonic contraction were also abolished after blockade of inositol-1,4,5-triphosphate-sensitive receptors by 2-aminoethoxydiphenylborate, but not by high concentrations of ryanodine or tetracaine. However, depletion of ryanodine-sensitive SR Ca²⁺ stores prior to UTP stimulation prevented Ca²⁺ waves.

Conclusions and implications:

Uridine 5''-triphosphate-induced Ca²⁺ waves may underlie tonic contraction and appear to be produced by repetitive cycles of regenerative Ca²⁺ release from the SR through inositol-1,4,5-triphosphate-sensitive receptors. Maintenance of Ca²⁺ waves requires SR Ca²⁺ reuptake from Ca²⁺ entry across the plasma membrane via L-type Ca²⁺ channels, receptor- and store-operated channels, and reverse-mode Na⁺/Ca²⁺ exchange.     

Shock waves activate in vitro cultured progenitors and precursors of cardiac cell lineages from the human heart

Postischemic cardiomyopathy remains one of the disorders in urgent need of effective noninvasive therapy. It is currently accepted that the isolation, expansion and application of resident cardiac stem cells may hold therapeutic promise for the future. Recently, it has been demonstrated that shock waves (SW) could enhance the expression of vascular endothelial growth factor (VEGF) and its receptor, Flt-1. As the development of angiogenic noninvasive therapy is very important for future therapeutic strategies in cardiovascular diseases, we examined in vitro, the effects of SW treatment on adult resident cardiac primitive cells isolated from bioptic fragments of normal human hearts and from explanted pathologic hearts with postischemic cardiomyopathy. This study demonstrates that SW have positive influence on both the proliferation and the differentiation of cardiomyocytes, smooth muscle and endothelial cells precursors, with a more obvious effect being evident in the cells from normal heart than in those taken from pathologic hearts. Our results suggest that SW treatment could inhibit or retard the pathologic remodeling and functional degradation of the heart if applied during the early stages of heart failure.     

The electrifying stomach

The stomach is electrified and subject to eurhythmic and dysrhythmic electrical events – much like the heart. The normal human slow wave ranges from 2.5 to 3.75 cycles per min (cpm), tachygastrias range from 3.75 cpm to 10.0 cpm and bradygastrias from .5 to 2.5 cpm, the gastric dysrhythmias of men and women. In this issue of Neurogastroenterology & Motility, O’Grady, et al. describe the gastric dysrhythmias of pigs in electrocardiology terms. Printed circuit boards (PCB) with multi‐electrode arrays (160–192 electrodes) were attached to the stomach serosa. Gastric dysrhythmias occurred in eight of the 16 anesthetized pigs and were analysed by manually and by computer. The patterns of dysrhythmias were reminiscent of cardiac dysrhythmias: conduction blocks, ectopic foci, re‐entrant wave fronts, premature and aberrant slow waves and regular and irregular tachygastrias. The authors suggest gastric dysrhythmias recorded in pigs may be relevant to human gastric dysrhythmias and electricity‐based therapies. The categories of porcine gastric dysrhythmias may help to understand the spectrum of gastric dysrhythmias of men and women recorded over the past 25 years. Analogies between gastric and cardiac neuromuscular disorders are explored because Neurogastroenterology is evolving as a clinical and therapeutic field utilizing knowledge of gastric rhythmicity and electro‐contractile events. Interstitial cells of Cajal are the pacemaker cells of the stomach and loss of cells or faulty circuitry appear to be key pathways to gastric dysrhythmias. Gastric electrophysiology (EP) labs, human and animal, are needed to test hypotheses and advance understanding of human gastric dysrhythmias and upper GI symptoms.     

Incidence of F waves in single human thenar motor units.

F-wave generation, axon conduction velocities, and contractile properties were compared in 44 healthy individual human thenar motor units. Force and muscle action potentials were recorded when single motor axons were stimulated intraneurally about 10 cm proximal to the elbow. Each stimulus usually evoked only one electromyographic (EMG) potential. However, in seven units (16%), a single stimulus elicited an F wave in response to 1.7 +/- 1.6% (mean +/- SD) of the stimuli applied. Axon conduction velocity proximal to the site of stimulation was faster than distal conduction velocity (72.7 +/- 8.0 m/s versus 64.2 +/- 10.5 m/s). Distal conduction velocities, twitch forces, and contraction times were similar for units that did and did not generate F waves. Thus, no obvious subset of thenar motor units generated F waves. These results provide valuable baseline information on F waves that can be used to assess changes in axon conduction, motor unit contractile properties, and motoneuron excitability in disease.     

The role of early neural activity in the maturation of turtle retinal function

In the developing vertebrate retina, ganglion cells fire spontaneous bursts of action potentials long before the eye becomes exposed to sensory experience at birth. These early bursts are synchronised between neighbouring retinal ganglion cells (RGCs), yielding unique spatiotemporal patterns: ‘waves’ of activity sweep across large retinal areas every few minutes. Both at retinal and extraretinal levels, these embryonic retinal waves are believed to guide the wiring of the visual system using hebbian mechanisms of synaptic strengthening. In the first part of this review, we recapitulate the evidence for a role of these embryonic spontaneous bursts of activity in shaping developing complex receptive field properties of RGCs in the turtle embryonic retina. We also discuss the role of visual experience in establishing RGC visual functions, and how spontaneous activity and visual experience interact to bring developing receptive fields to maturation. We have hypothesised that the physiological changes associated with development reflect modifications in the dendritic arbours of RGCs, the anatomical substrate of their receptive fields. We demonstrate that there is a temporal correlation between the period of receptive field expansion and that of dendritic growth. Moreover, the immature spontaneous activity contributes to dendritic growth in developing RGCs. Intracellular staining of RGCs reveals, however, that immature receptive fields only rarely show direct correlation with the layout of the corresponding dendritic tree. To investigate the possibility that not only the presence of the spontaneous activity, but even the precise spatiotemporal patterns encoded in retinal waves might contribute to the refinement of retinal neural circuitry, first we must clarify the mechanisms mediating the generation and propagation of these waves across development. In the second part of this review, we present evidence that turtle retinal waves, visualised using calcium imaging, exhibit profound changes in their spatiotemporal patterns during development. From fast waves sweeping across large retinal areas and recruiting many cells on their trajectory at early stages, waves become slower and eventually stop propagating towards hatching, when they become stationary patches of neighbouring coactive RGCs. A developmental switch from excitatory to inhibitory GABA_A responses appears to mediate the modification in spontaneous activity patterns while the retina develops. Future chronic studies using specific spatiotemporal alterations of the waves will shed a new light on how the wave dynamics help in sculpting retinal receptive fields.     

Interstitial cells of Cajal: are they major players in control of gastrointestinal motility?

This review examines recent evidence from structural and functional studies that interstitial cells of Cajal (ICC) play a major role in control of gastrointestinal function. These cells, identified to date only by their structural and somewhat selective staining characteristics, form networks in the region of the myentehc plexus and in or adjacent to circular muscle. Those in circular muscle are often coupled to one another and to smooth muscle cells by gap junctions and are closely innervated by a high proportion of enteric nerves, especially those containing vasoactive intestinal polypeptide (VIP). ICC in the myenteric plexus often have no visible connections by gap junctions to smooth muscle. There is a growing body of evidence from study of small intestine and colon that these cells are either the pacemakers or provide clocks for the pacemaking function of the gut (vahously known as slow waves, pacesetter potentials or control potentials). Additional evidence suggests that they may play a role in neurotransmission of non-adrenergic, non-cholinergic inhibitory activity. This review summarizes our current understanding and attempts to point the way for future research.