-
Experimental Neurology Nov 2016Detrusor underactivity (DU) is defined as a contraction of reduced strength and/or duration during bladder emptying and results in incomplete and prolonged bladder... (Review)
Review
Detrusor underactivity (DU) is defined as a contraction of reduced strength and/or duration during bladder emptying and results in incomplete and prolonged bladder emptying. The clinical diagnosis of DU is challenging when present alone or in association with other bladder conditions such as detrusor overactivity, urinary retention, detrusor hyperactivity with impaired contractility, aging, and neurological injuries. Several etiologies may be responsible for DU or the development of an underactive bladder (UAB), but the pathobiology of DU or UAB is not well understood. Therefore, new clinically relevant and interpretable models for studies of UAB are much needed in order to make progress towards new treatments and preventative strategies. Here, we review a neuropathic cause of DU in the form of traumatic injuries to the cauda equina (CE) and conus medullaris (CM) portions of the spinal cord. Lumbosacral ventral root avulsion (VRA) injury models in rats mimic the clinical phenotype of CM/CE injuries. Bilateral VRA injuries result in bladder areflexia, whereas a unilateral lesion results in partial impairment of lower urinary tract and visceromotor reflexes. Surgical re-implantation of avulsed ventral roots into the spinal cord and pharmacological strategies can augment micturition reflexes. The translational research need for the development of a large animal model for UAB studies is also presented, and early studies of lumbosacral VRA injuries in rhesus macaques are discussed.
Topics: Animals; Disease Models, Animal; Humans; Spinal Diseases; Spinal Nerve Roots; Urinary Bladder Diseases
PubMed: 27222131
DOI: 10.1016/j.expneurol.2016.05.026 -
Pediatric Reports May 2022Most preterm infants exhibit atypical and immature feeding skills. Even though preterm infants have fulfilled the oral feeding readiness criteria, they still do not have...
Most preterm infants exhibit atypical and immature feeding skills. Even though preterm infants have fulfilled the oral feeding readiness criteria, they still do not have optimal oral feeding ability. This study aimed to determine various factors affecting oral feeding ability in Indonesian preterm infants who have fulfilled oral feeding readiness criteria but still have not been able to feed orally. A cross-sectional study included 120 preterm infants admitted to five tertiary hospitals in Jakarta, Indonesia. Participants were preterm infants born at 28-34 weeks gestational age who had fulfilled the oral feeding readiness as the inclusion criteria: (1) stable cardiorespiratory status, (2) have achieved full enteral feeding via orogastric tube (OGT) 120 mL/kg/day without vomiting or bloating, and (3) strong and rhythmic non-nutritive sucking (NNS) through objective measurement. Infants' oral feeding ability and various factors that were assumed to affect oral feeding ability, including physiological flexion postural tone, physiological stability, rooting reflex, self-regulation, behavioral state, and level of morbidity were evaluated. Chi-square and multivariate analysis with Poisson regression were performed. Results indicated that postural tone, rooting reflex, physiological stability, self-regulation, behavioral state, and level of morbidity were significantly related to oral feeding ability in preterm infants. The most influencing factors were self-regulation with a prevalence ratio (PR) of 1.96 (1.16-3.34; CI 95%) and = 0.012, followed by postural tone, high morbidity, and behavioral state (PR 1.91; 1.59; 1.56; CI 95%, respectively). In conclusion, despite meeting the oral feeding readiness criteria, most preterm infants were still not able to feed orally. There are other factors affecting oral feeding ability in Indonesian preterm infants.
PubMed: 35645368
DOI: 10.3390/pediatric14020031 -
Annals of Neurosciences Jul 2011It is now clear that a peripheral nerve lesion affects contralateral non-lesioned structures, and thus such a lesion can result in mirror image pain. The pathogenesis is... (Review)
Review
It is now clear that a peripheral nerve lesion affects contralateral non-lesioned structures, and thus such a lesion can result in mirror image pain. The pathogenesis is still not exactly known, but there are some possible signaling pathways in the contralateral reaction of the nerve tissue after unilateral nerve injury. Potential signaling pathways of contralateral changes can be generally divided into humoral and neuronal mechanisms. Damage to peripheral nerves or spinal roots produces a number of breakdown products with development of an aseptic inflammatory reaction. Released immunomodulatory cytokines are believed to be transported via blood or cerebrospinal fluid into the contralateral part of the body affecting spinal roots, dorsal root ganglia or peripheral nerves. Because neurons are elements of a highly organized network, injury to the peripheral neuron results in signals that travel transneuronally into the central nervous system and affects the contralateral homonymous neurons. There is also evidence that spinal glia creates and maintain pathological pain. Additionally, there may be compensatory changes in behavior of animals with an impact on contralateral neurons, such as altered stance and motor performance or autonomic reflex changes. Although the transneuronal signaling pathway appears to be plausible, the humoral signaling pathway or other communication systems cannot be excluded at this time. Knowledge about these processes has clinical implications for the understanding of chronic neuropathic pain states, and, therefore, further studies will be necessary. Understanding signaling mechanisms in mirror image pain pathogenesis may provide novel therapeutic targets for the management of neuropathic pain.
PubMed: 25205938
DOI: 10.5214/ans.0972-7531.11183010 -
Progress in Neurobiology Jun 2011This commentary on ideas about neural mechanisms underlying pain is aimed at providing perspective for a reader who does not work in the field of mammalian somatic... (Review)
Review
This commentary on ideas about neural mechanisms underlying pain is aimed at providing perspective for a reader who does not work in the field of mammalian somatic sensation. It is not a comprehensive review of the literature. The organization is historical to chronicle the evolution of ideas. The aim is to call attention to source of concepts and how various ideas have fared over time. One difficulty in relating concepts about pain is that the term is used to refer to human and animal reactions ranging from protective spinal reflexes to complex affective behaviors. As a result, the spectrum of "pain"-related neural organization extends to operation of multiple neuronal arrangements. Thinking about pain has shadowed progress in understanding biological mechanisms, in particular the manner of function of nervous systems. This essay concentrates on the evolution of information and concepts from the early 19th century to the present. Topics include the assumptions underlying currently active theories about pain mechanisms. At the end, brief consideration is given to present-day issues, e.g., chronic pain, central pain, and the view of pain as an emotion rather than a sensation. The conceptual progression shows that current controversies have old roots and that failed percepts often resurface after seemingly having been put to rest by argument and evidence.
Topics: Afferent Pathways; Animals; Disease Models, Animal; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Models, Biological; Nociceptors; Pain; Sensation
PubMed: 21419824
DOI: 10.1016/j.pneurobio.2011.03.001 -
Asian Spine Journal Dec 2020Cervical radiculopathy is characterized by neurological dysfunction caused by compression and inflammation of the spinal nerves or nerve roots of the cervical spine. It...
Cervical radiculopathy is characterized by neurological dysfunction caused by compression and inflammation of the spinal nerves or nerve roots of the cervical spine. It mainly presents with neck and arm pain, sensory loss, motor dysfunction, and reflex changes according to the dermatomal distribution. The most common causes of cervical radiculopathy are cervical disc herniation and cervical spondylosis. It is important to find the exact symptomatic segment and distinguish between conditions that may mimic certain cervical radicular compression syndromes through meticulous physical examinations and precise reading of radiographs. Non-surgical treatments are recommended as an initial management. Surgery is applicable to patients with intractable or persistent pain despite sufficient conservative management or with severe or progressive neurological deficits. Cervical radiculopathy is treated surgically by anterior and/or posterior approaches. The appropriate choice of surgical treatment should be individualized, considering the patient's main pathophysiology, specific clinical symptoms and radiographic findings thoroughly.
PubMed: 33373515
DOI: 10.31616/asj.2020.0647 -
Journal of Neurophysiology Mar 2000The hindlimb wiping reflex of the frog is an example of a targeted trajectory that is organized at the spinal level. In this paper, we examine this reflex in 45 spinal...
The hindlimb wiping reflex of the frog is an example of a targeted trajectory that is organized at the spinal level. In this paper, we examine this reflex in 45 spinal frogs to test the importance of proprioceptive afferents in trajectory formation at the spinal level. We tested hindlimb to hindlimb wiping, in which the wiping or effector limb and the target limb move together. Loss of afferent feedback from the wiping limb was produced by cutting dorsal roots 7-9. This caused altered initial trajectory direction, increased ankle path curvature, knee-joint velocity reversals, and overshooting misses of the target limb. We established that these kinematic and motor-pattern changes were due mainly to the loss of ipsilateral muscular and joint afferents. Loss of cutaneous afferents alone did not alter the initial trajectory up to target limb contact. However, there were cutaneous effects in later motor-pattern phases after the wiping and target limb had made contact: The knee extension or whisk phase of wiping was often lost. Finally, there was a minor and nonspecific excitatory effect of phasic contralateral feedback in the motor-pattern changes after deafferentation. Specific muscle groups were altered as a result of proprioceptive loss. These muscles also showed configuration-based regulation during wiping. Biceps, semitendinosus, and sartorius (all contributing knee flexor torques) all were regulated in amplitude based on the initial position of the limb. These muscles contributed to an initial electromyographic (EMG) burst in the motor pattern. Rectus internus and semimembranosus (contributing hip extensor torques) were regulated in onset but not in the time of peak EMG or in termination of EMG based on initial position. These two muscles contributed to a second EMG burst in the motor pattern. After deafferentation the initial burst was reduced and more synchronous with the second burst, and the second burst often was broadened in duration. Ankle path curvature and its degree of change after loss of proprioception depended on the degree of joint staggering used by the frog (i.e., the relative phasing between knee and hip motion) and on the degree of motor-pattern change. We examined these variations in 31 frogs. Twenty percent (6/31) of frogs showed largely synchronous joint coordination and little effect of deafferentation on joint coordination, end-point path, or the underlying synchronous motor pattern. Eighty percent of frogs (25/31) showed some degree of staggered joint coordination and also strong effects of loss of afferents. Loss of afferents caused two major joint level changes in these frogs: collapse of joint phasing into synchronous joint motion and increased hip velocity. Fifty percent of frogs (16/31) showed joint-coordination changes of type (1) without type (2). This change was associated with reduction, loss, or collapse of phasing of the sartorius, semitendinosus and biceps (iliofibularis) in the initial EMG burst in the motor pattern. The remaining 30% (9/31) of frogs showed both joint-coordination changes 1 and 2. These changes were associated with both the knee flexor EMG changes seen in the other frogs and with additional increased activity of rectus internus and semimembranosus muscles. Our data show that multiple ipsilateral modalities all play some role in regulating muscle activity patterns in the wiping limb. Our data support a strong role of ipsilateral proprioception in the process of trajectory formation and specifically in the control of limb segment interactions during wiping by way of the regulation and coordination of muscle groups based on initial limb configuration.
Topics: Algorithms; Animals; Biomechanical Phenomena; Electrodes, Implanted; Electromyography; Hindlimb; Joints; Movement; Muscle, Skeletal; Neurons, Afferent; Proprioception; Rana catesbeiana; Skin; Spinal Cord; Videotape Recording
PubMed: 10712474
DOI: 10.1152/jn.2000.83.3.1480 -
Archives of Iranian Medicine Aug 2021Pain control methods after cesarean section may interfere with infant breast-feeding. The aim of this study was to evaluate the effect of pethidine on breast feeding of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Pain control methods after cesarean section may interfere with infant breast-feeding. The aim of this study was to evaluate the effect of pethidine on breast feeding of infants born via cesarean section with spinal anesthesia.
METHODS
In this randomized double-blind clinical trial, we evaluated 116 infants born via cesarean section in Gerash Amiralmomenin hospital (Southern Iran) in 2017. The subjects were selected through purposive sampling and randomly by permuted block randomization and assigned to intervention and control groups. The test group received 100 mg of pethidine as intravenous infusion and the control group received only routine cares. Infants' breast feeding behavior in both groups was recorded within 48 hours of hospitalization, using the standard tool for rapid assessment of infant feeding behavior, which consists of 4 main components of breastfeeding, including readiness to feed, rooting, latching, and sucking with a score range of 0 to 3 for each component evaluated at 1, 6, 12, 24, 36, and 48 hours postnatally. Data were analyzed using independent t tests and chi-square test.
RESULTS
The highest score of breast-feeding behavior pertained to sucking reflexes in the control group and the lowest score to breast feeding readiness in the pethidine group. Readiness for feeding in the control group (2.09±0.53) was significantly higher than the pethidine group (1.81±0.61) (95% CI: 0.0552, 0.5092 and =0.015). Sucking reflex (95% CI: -0.1461, 0.2208 and =0.687), latching (95% CI: -0.3012, 0.0345 and =0.118) and rooting reflexes (95% CI: -0.1685, 0.2342 and =0.747) were almost equal in the control group (2.54±0.49, 2.52±0.38, 2.5±0.48, respectively) and pethidine groups (2.51±0.43, 2.65±0.45, 2.46±0.53, respectively). The total score of feeding behavior in the control group (9.66±1.04) was higher than that of the pethidine group (9.44 ±.69) (95% CI: -0.2032, 0.6412 and =0.306). There was no significant difference between the infants' feeding frequency (95% CI: -0.269, 1.930 and =0.137) and duration of feeding (95% CI: -3.2067, 0.4597 and =0.14).
CONCLUSION
Evaluation of infants in the first 48 hours after birth showed that those babies whose mothers received pethidine were less willing to start breast-feeding. However, other components of breast-feeding behaviors were similar.
Topics: Anesthesia, Spinal; Breast Feeding; Cesarean Section; Female; Humans; Infant; Meperidine; Mothers; Pregnancy
PubMed: 34488326
DOI: 10.34172/aim.2021.84 -
Emerging clinical applications of electrical stimulation: opportunities for restoration of function.Journal of Rehabilitation Research and... 2001Emerging clinical application of electrical stimulation in three systems is reviewed. In the bladder, stimulation of sacral posterior roots reduces reflex incontinence... (Review)
Review
Emerging clinical application of electrical stimulation in three systems is reviewed. In the bladder, stimulation of sacral posterior roots reduces reflex incontinence and significantly improves bladder capacity. With the combination of anterior and posterior root stimulation, bladder control can be achieved without the need for rhizotomy. Preliminary research demonstrates that bladder contractions may also be generated by stimulation of the urethral sensory branch of the pudendal nerve, even after acute spinal cord transection, while inhibition of the bladder and control of urge incontinence can be achieved by stimulation of the whole pudendal nerve. Spinal cord stimulation can modulate the activity of the intrinsic cardiac nervous system involved in the regulation of regional cardiac function and significantly reduce the pain associated with angina pectoris. Finally in the area of upper airway disorders, functional electrical stimulation has great potential for increasing life support as well as for quality of life in chronic ailments, particularly obstructive sleep apnea and dysphagia.
Topics: Angina Pectoris; Electric Stimulation Therapy; Humans; Muscle Contraction; Muscle, Smooth; Prostheses and Implants; Respiration Disorders; Spinal Cord Injuries; Urinary Bladder; Urinary Bladder Diseases; Urinary Incontinence
PubMed: 11767972
DOI: No ID Found -
Neurotherapeutics : the Journal of the... Apr 2016Epidural spinal cord stimulation has a long history of application for improving motor control in spinal cord injury. This review focuses on its resurgence following the... (Review)
Review
Epidural spinal cord stimulation has a long history of application for improving motor control in spinal cord injury. This review focuses on its resurgence following the progress made in understanding the underlying neurophysiological mechanisms and on recent reports of its augmentative effects upon otherwise subfunctional volitional motor control. Early work revealed that the spinal circuitry involved in lower-limb motor control can be accessed by stimulating through electrodes placed epidurally over the posterior aspect of the lumbar spinal cord below a paralyzing injury. Current understanding is that such stimulation activates large-to-medium-diameter sensory fibers within the posterior roots. Those fibers then trans-synaptically activate various spinal reflex circuits and plurisegmentally organized interneuronal networks that control more complex contraction and relaxation patterns involving multiple muscles. The induced change in responsiveness of this spinal motor circuitry to any residual supraspinal input via clinically silent translesional neural connections that have survived the injury may be a likely explanation for rudimentary volitional control enabled by epidural stimulation in otherwise paralyzed muscles. Technological developments that allow dynamic control of stimulation parameters and the potential for activity-dependent beneficial plasticity may further unveil the remarkable capacity of spinal motor processing that remains even after severe spinal cord injuries.
Topics: Humans; Lumbar Vertebrae; Movement; Nerve Net; Spinal Cord; Spinal Cord Injuries; Spinal Cord Stimulation
PubMed: 26843089
DOI: 10.1007/s13311-016-0421-y