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Disease Markers 2022To explore the diagnostic value of bulbocavernosus muscle reflex and pudendal somatosensory evoked potentials for diabetic neurogenic bladder.
OBJECTIVE
To explore the diagnostic value of bulbocavernosus muscle reflex and pudendal somatosensory evoked potentials for diabetic neurogenic bladder.
METHODS
From January 2021 to December 2021, 104 patients with type 2 diabetes mellitus admitted to the hospital were recruited, with 57 allocated to the case group and 47 to the control group. Outcome measures included bulbocavernosus muscle response, pudendal somatosensory evoked potentials, and bladder residual urine volume. The connection of bulbocavernosus muscle response and pudendal somatosensory evoked potentials with bladder residual urine volume was investigated using the Pearson analysis.
RESULTS
In both males and females, the latency of the left and right bulbocavernosus muscle reflexes in the case group was longer than in the control group, but the difference was not statistically significant ( > 0.05), and the wave amplitude of the left and right bulbocavernosus muscle reflexes was significantly smaller than that of the control group ( < 0.05). The diabetic neurogenic bladder was associated with a significantly longer latency and a smaller wave amplitude of pudendal somatosensory evoked potentials versus without neurogenic bladder ( < 0.05). Patients with a diabetic neurogenic bladder had more residual bladder urine volume versus those without ( < 0.05). Bladder residual urine volume was significantly positively correlated with bulbocavernosus muscle reflex and pudendal somatosensory evoked potential latency and negatively correlated with wave amplitude ( < 0.05).
CONCLUSION
The bulbocavernosus muscle reflex and pudendal somatosensory evoked potentials demonstrate great potential as adjuncts to diagnose diabetic neurogenic bladder and correlate with ultrasound results in determining bladder function in patients.
Topics: Diabetes Mellitus, Type 2; Evoked Potentials, Somatosensory; Female; Humans; Male; Muscles; Reflex; Urinary Bladder, Neurogenic
PubMed: 36157205
DOI: 10.1155/2022/6096326 -
American Journal of Physiology.... Sep 2021Defined as a structural or functional cardiac abnormality accompanied by symptoms, signs, or biomarkers of altered ventricular pressures or volumes, heart failure also... (Review)
Review
Defined as a structural or functional cardiac abnormality accompanied by symptoms, signs, or biomarkers of altered ventricular pressures or volumes, heart failure also is a state of autonomic disequilibrium. A large body of evidence affirms that autonomic disturbances are intrinsic to heart failure; basal or stimulated sympathetic nerve firing or neural norepinephrine (NE) release more often than not exceed homeostatic need, such that an initially adaptive adrenergic or vagal reflex response becomes maladaptive. The magnitude of such maladaptation predicts prognosis. This Ludwig lecture develops two theses: the elucidation and judiciously targeted amelioration of maladaptive autonomic disturbances offers opportunities to complement contemporary guideline-based heart failure therapy, and serendipitous single-participant insights, acquired in the course of experimental protocols with entirely different intent, can generate novel insight, inform mechanisms, and launch entirely new research directions. I précis six elements of our current synthesis of the causes and consequences of maladaptive sympathetic disequilibrium in heart failure, shaped by patient-inspired epiphanies: arterial baroreceptor reflex modulation, excitation stimulated by increased cardiac filling pressure, paradoxical muscle sympathetic activation as a peripheral neurogenic constraint on exercise capacity, renal sympathetic restraint of natriuresis, coexisting sleep apnea, and augmented chemoreceptor reflex sensitivity and then conclude by envisaging translational therapeutic opportunities.
Topics: Autonomic Nervous System; Exercise; Heart; Heart Failure; Humans; Reflex; Sympathetic Nervous System
PubMed: 34259047
DOI: 10.1152/ajpregu.00143.2021 -
Journal of Neurology, Neurosurgery, and... May 2003Primitive reflexes are typically present in childhood, suppressed during normal development, and may reappear with diseases of the brain, particularly those affecting... (Review)
Review
Primitive reflexes are typically present in childhood, suppressed during normal development, and may reappear with diseases of the brain, particularly those affecting the frontal lobes. In this review we discuss some historical aspects surrounding these reflexes, how they might be elicited and interpreted, and their potential clinical utility in modern neurological practice.
Topics: Brain Diseases; Hand Strength; Humans; Reflex
PubMed: 12700289
DOI: 10.1136/jnnp.74.5.558 -
Annals of Palliative Medicine Dec 2021The blink reflex (BR) can be used as a routine monitoring method during facial nerve microvascular decompression. This study aimed to investigate whether the use of the...
BACKGROUND
The blink reflex (BR) can be used as a routine monitoring method during facial nerve microvascular decompression. This study aimed to investigate whether the use of the BR in hemifacial spasm (HFS) surgery is comparable to that of the lateral spread reflex (LSR), and to explore its significance for guiding intraoperative neurophysiological monitoring (IONM).
METHODS
Patients undergoing facial nerve microvascular decompression from 2016 to 2018 were included in the study. According to the results of IONM, the intraoperative monitoring items of the BR and two conventional facial nerve microvascular decompression procedures, namely the marginal mandibular branch LSR (MAR-LSR) and zygomatic branch LSR (ZYG-LSR), were compared. We mainly compared whether there were differences in the occurrence rate, disappearance rate, waveform, occurrence current, and prognosis of the three monitoring methods.
RESULTS
The occurrence rate of the BR was lower than that of the MAR-LSR and ZYG-LSR, as well as the three combined detection groups. The disappearance rate of the BR was not different to that of the MAR-LSR, but higher than that of the ZYG-LSR group. In addition, the waveform of the BR showed differences from that of the MAR-LSR and ZYG-LSR. The incidence of postoperative residual symptoms in patients with any kind of reflex on the first day after surgery and the day of discharge was significantly higher than that of patients in which all three reflexes disappeared.
CONCLUSIONS
Combined BR and LSR monitoring can reduce the occurrence of postoperative residual symptoms. We suggest that by increasing the use of BR examination during surgery, the integrity of the trigeminal nerve can be protected.
Topics: Blinking; Facial Nerve; Humans; Microvascular Decompression Surgery; Reflex; Retrospective Studies; Treatment Outcome
PubMed: 35016487
DOI: 10.21037/apm-21-3197 -
Scientific Reports Aug 2023Walking on unknown and rough terrain is challenging for (bipedal) robots, while humans naturally cope with perturbations. Therefore, human strategies serve as an...
Walking on unknown and rough terrain is challenging for (bipedal) robots, while humans naturally cope with perturbations. Therefore, human strategies serve as an excellent inspiration to improve the robustness of robotic systems. Neuromusculoskeletal (NMS) models provide the necessary interface for the validation and transfer of human control strategies. Reflexes play a crucial part during normal locomotion and especially in the face of perturbations, and provide a simple, transferable, and bio-inspired control scheme. Current reflex-based NMS models are not robust to unexpected perturbations. Therefore, in this work, we propose a bio-inspired improvement of a widely used NMS walking model. In humans, different muscles show an increase in activation in anticipation of the landing at the end of the swing phase. This preactivation is not integrated in the used reflex-based walking model. We integrate this activation by adding an additional feedback loop and show that the landing is adapted and the robustness to unexpected step-down perturbations is markedly improved (from 3 to 10 cm). Scrutinizing the effect, we find that the stabilizing effect is caused by changed knee kinematics. Preactivation, therefore, acts as an accommodation strategy to cope with unexpected step-down perturbations, not requiring any detection of the perturbation. Our results indicate that such preactivation can potentially enable a bipedal system to react adequately to upcoming unexpected perturbations and is hence an effective adaptation of reflexes to cope with rough terrain. Preactivation can be ported to robots by leveraging the reflex-control scheme and improves the robustness to step-down perturbation without the need to detect the perturbation. Alternatively, the stabilizing mechanism can also be added in an anticipatory fashion by applying an additional knee torque to the contralateral knee.
Topics: Humans; Muscle, Skeletal; Walking; Locomotion; Reflex; Knee; Biomechanical Phenomena; Electromyography; Gait
PubMed: 37580375
DOI: 10.1038/s41598-023-39364-3 -
Reviews in the Neurosciences May 2017Upregulation of defensive reflexes such as the nociceptive flexion reflex (NFR) has been attributed to sensitisation of peripheral and spinal nociceptors and is often... (Meta-Analysis)
Meta-Analysis Review
Upregulation of defensive reflexes such as the nociceptive flexion reflex (NFR) has been attributed to sensitisation of peripheral and spinal nociceptors and is often considered biomarkers of pain. Experimental modulation of defensive reflexes raises the possibility that they might be better conceptualised as markers of descending cognitive control. Despite strongly held views on both sides and several narrative reviews, there has been no attempt to evaluate the evidence in a systematic manner. We undertook a meta-analytical systematic review of the extant English-language literature from inception. Thirty-six studies satisfied our a priori criteria. Seventeen were included in the meta-analysis. Reflexive threshold was lower in people with clinical pain than it was in pain-free controls, but reflex size, latency, and duration were unaffected. The pattern of difference was not consistent with sensitisation of nociceptive neurones, as these changes were not isolated to the affected body part but was more consistent with top-down cognitive control reflective of heightened protection of body tissue. The pattern of modulation is dependent on potentially complex evaluative mechanisms. We offer recommendations for future investigations and suggest that defensive reflex threshold may reflect a biomarker of a broader psychological construct related to bodily protection, rather than sensitisation of primary nociceptors, spinal nociceptors, or pain.
Topics: Central Nervous System Sensitization; Humans; Nociception; Pain; Perceptual Defense; Reflex; Sensory Thresholds
PubMed: 28475100
DOI: 10.1515/revneuro-2016-0057 -
The Japanese Journal of Physiology Feb 2000The upper airway is a vital part of the respiratory tract. Although the upper airway serves several functions, protection of the airway and preservation of airway... (Review)
Review
The upper airway is a vital part of the respiratory tract. Although the upper airway serves several functions, protection of the airway and preservation of airway patency are the most essential functions subserved by upper airway reflexes. Various types of nerve endings have been identified in and under the epithelium of the upper airway, and afferent nerve endings are the natural starting of all reflex activity. The upper airway reflexes consist of many different types of reflex responses such as sneezing, apnea, swallowing, laryngeal closure, coughing, expiration reflex, and negative pressure reflex. Although the activation of upper airway reflexes does not necessarily occur at one particular site of the respiratory tract, individual reflex response is usually considered to be highly specific for the particular respiratory site which has been affected. The upper airway reflexes are modified by many factors such as sleep, anesthesia, and background chemical ventilatory drive. Both depression and exaggeration of upper airway reflexes cause clinical problems. Depression of upper airway reflexes enhances the chance of pulmonary aspiration and compromises the maintenance of the airway, whereas exaggeration of airway reflexes such as laryngospasm and prolonged paroxysm of cough can be harmful and dangerous. In this review, various aspects of upper airway reflexes are discussed focusing on the functions of upper airway reflexes in humans and some pathophysiological problems related to clinical medicine.
Topics: Humans; Laryngeal Nerves; Larynx; Pharynx; Reflex; Respiratory Physiological Phenomena; Respiratory System; Trachea
PubMed: 10866692
DOI: 10.2170/jjphysiol.50.3 -
Clinical Neurophysiology : Official... Mar 2023This retrospective (case-control) collaborative study evaluates tendon reflex recordings combined with transcranial magnetic stimulation motor evoked potentials...
OBJECTIVE
This retrospective (case-control) collaborative study evaluates tendon reflex recordings combined with transcranial magnetic stimulation motor evoked potentials recordings (T-MEPs) at lower limbs in amyotrophic lateral sclerosis (ALS).
METHODS
T-MEPs were recorded in 97 ALS patients distinguished according to their patellar reflex briskness. Patients' electrophysiological data were compared with values measured in 60 control patients matched for age and height. Correlations studies between parameters or with some patients' clinical characteristics were also performed.
RESULTS
The central motor conduction time yields the highest sensitivity (82%) and specificity (93%), allowing twice more upper motor neuron (UMN) dysfunction detection than clinical examination, and being more altered in late stages of the disease. The T response to MEP response amplitude ratio (T/MEP ar) is nearly as sensitive to detect ALS and better identifies abnormal hyperreflexia. It is not correlated with evolutive stage, contrarily to conduction time-related parameters. In addition, T-MEPs detect asymmetries escaping clinical examination.
CONCLUSIONS
The corticospinal conduction to lower limbs is slowed in ALS. The T/MEP ar helps deciding when patellar reflexes are abnormal in a given patient suspected of ALS.
SIGNIFICANCE
The T-MEP technique provide powerful electrophysiological biomarkers of UMN involvement in ALS. This simple and painless procedure introduces the clinically useful concept of electrophysiological hyperreflexia and might be expanded to future exploration of proximal upper limbs and bulbar territories.
Topics: Humans; Amyotrophic Lateral Sclerosis; Evoked Potentials, Motor; Reflex, Stretch; Retrospective Studies; Reflex, Abnormal; Transcranial Magnetic Stimulation
PubMed: 36753809
DOI: 10.1016/j.clinph.2022.12.013 -
Experimental Brain Research Jul 2021The vestibular system facilitates gaze and postural stability via the vestibulo-ocular (VOR) and vestibulo-spinal reflexes, respectively. Cortical and perceptual...
The vestibular system facilitates gaze and postural stability via the vestibulo-ocular (VOR) and vestibulo-spinal reflexes, respectively. Cortical and perceptual mechanisms can modulate long-duration VOR responses, but little is known about whether high-order neural phenomena can modulate short-latency vestibulo-spinal responses. Here, we investigate this by assessing click-evoked cervical vestibular myogenic-evoked potentials (VEMPS) during visual roll motion that elicited an illusionary sensation of self-motion (i.e. vection). We observed that during vection, the amplitude of the VEMPs was enhanced when compared to baseline measures. This modulation in VEMP amplitude was positively correlated with the subjective reports of vection strength. That is, those subjects reporting greater subjective vection scores exhibited a greater increase in VEMP amplitude. Control experiments showed that simple arousal (cold-induced discomfort) also increased VEMP amplitude but that, unlike vection, it did not modulate VEMP amplitude linearly. In agreement, small-field visual roll motion that did not induce vection failed to increase VEMP amplitude. Taken together, our results demonstrate that vection can modify the response of vestibulo-collic reflexes. Even short-latency brainstem vestibulo-spinal reflexes are influenced by high-order mechanisms, illustrating the functional importance of perceptual mechanisms in human postural control. As VEMPs are inhibitory responses, we argue that the findings may represent a mechanism whereby high-order CNS mechanisms reduce activity levels in vestibulo-collic reflexes, necessary for instance when voluntary head movements need to be performed.
Topics: Head; Humans; Postural Balance; Reflex, Vestibulo-Ocular; Vestibular Evoked Myogenic Potentials; Vestibule, Labyrinth
PubMed: 33969437
DOI: 10.1007/s00221-021-06123-7 -
Pneumologie (Stuttgart, Germany) Jun 2013Cough is the number one symptom for patients to visit a physician worldwide. It is an important neuronal reflex which serves to protect the airways from inhaled... (Review)
Review
Cough is the number one symptom for patients to visit a physician worldwide. It is an important neuronal reflex which serves to protect the airways from inhaled exogenous microorganisms, thermal and chemical irritants. Moreover, it prevents the airways from mucus retention.The cough reflex is initiated by activation of different cough receptors. These cough receptors can be divided into three groups according to their electrophysiological properties: into the two Aδ-fiber types "rapid-adapting mechanoreceptor" (RAR) and "slow-adapting mechanoreceptor" (SAR), and the C-fiber receptor.The stimulus is detected by cough receptors which conduct the signal to the cerebral cough centre via vagal-sensory neurons. The cough itself is mediated by efferent motoneurons. Hence the cough reflex consists of 5 functionally sequential parts 1: the cough receptors 2, the primary afferent fibres of the N. vagus 345, N. trigeminus and N. glossopharyngeus 1, the cough centre in the medulla oblongata (N. tractus solitarius) 678, the afferent fibres of the N. phrenicus, spinal nerve and N. laryngeus recurrens, as well as the diaphragm and the abdominal, intercostal and laryngeal muscles. The cough receptors are mainly located in the larynx, trachea and main bronchi 2.The event of coughing can be divided into four subsequent parts: After the first phase of fast inspiration with an opened glottis, there is compression with a closed glottis and increasing tracheal pressure, acceleration and ultimately maximum expiration with an opened glottis 9. According to its characteristics, cough can be split into two distinct types, "aspiration cough", which is loud and involuntary, and "urge-to-cough sensation", which describes an irritant, scratchy, and controlled cough of slowly increasing intensity 10.Acute cough mostly develops because of infection of the respiratory system 111213 and ends spontaneously after 4 weeks. In contrast to this, bacterial infection with pathogens like Adenovirus, Bordetella pertussis and Mycoplasms can last up to 8 weeks 121314. In additional to the division of cough according to its cause, it can also be differentiated according to its manner: dry and mucus-producing cough.With this review we want to give an overview of neuronal processes and mechanisms, as well as diagnostics of and therapy for chronic cough. Thereby the focus is also placed on the efficiency of already established and potential future antitussive agents.
Topics: Antitussive Agents; Chronic Disease; Cough; Humans; Reflex; Respiratory Mechanics
PubMed: 23700135
DOI: 10.1055/s-0033-1343151