Human spinal ejaculation generator
Human spinal ejaculation generator
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DOI：
10.1002/ana.24819
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发表时间：
2017-01-01
影响因子：
11.2
通讯作者：
Giuliano, Francois
中科院分区：
文献类型：
--
作者：
Chehensse, Clement;Facchinetti, Patricia;Giuliano, Francois
目的脊髓射精发生器(SEG)已在大鼠体内被发现，其中腰部甘丙胺能中间神经元起着关键作用(Science 2002；297：1566-1569)。方法对6例男性身体脊髓节段甘丙氨酸能神经元的空间分布进行了研究，并与6例女性标本进行了比较。根据已知的甘氨酸能神经元节段性分布，对384例临床完全性脊髓损伤(SCI)并随后射精的患者进行了阴茎振动刺激(PVS)相关脊髓节段损伤时诱发射精的能力的研究。这类患者代表了一种独特的模型来研究明确的脊髓节段在控制射精中的作用。结果Galanine能神经元主要位于第VII内侧椎板的L2至L5节段之间，在L4内密度最大。三维重建显示，这些神经元在中央管两侧呈单列分布。此外，男性L3和L4节段的甘氨酸能神经元密度高于女性，支持性别二型性。在患者队列中，L3-L5节段损伤是PVS诱导射精失败的唯一独立预测因素。虽然临床观察的证据是间接的，但与神经解剖学数据有密切的对应关系。人脊髓甘氨酸能神经元的组织和性别二型性与大鼠的SEG相似。神经组织学数据和临床结果证实人类L3-L5节段存在SEG。这种发生器可能被用于治疗神经源性和非神经源性射精障碍。Ann Neurol 2017；81：35-45
ObjectiveA spinal ejaculation generator (SEG) has been identified in the rat with lumbar galaninergic interneurons playing a pivotal role (Science 2002;297:1566-1569). The aim was to evidence a SEG in humans.MethodsSpatial distribution of galaninergic neurons was studied in postmortem spinal cord segments of 6 men and compared with that of 6 women for evidencing sexual dimorphism. Based on the identified segmental distribution of galaninergic neurons, the ability for penile vibratory stimulation (PVS) to elicit ejaculation when the concerned spinal segments were injured was studied in 384 patients with clinically complete spinal cord injury (SCI) and consequent anejaculation. Such patients represent a unique model to investigate the role of defined spinal segments in the control of ejaculation.ResultsGalaninergic neurons were mostly located between L2 and L5 segments in medial lamina VII, with a maximal density within L4. Three-dimensional 3D reconstruction showed that these neurons were grouped into single columns bilaterally to the central canal. In addition, galaninergic neuron density was found higher in L3 and L4 segments in men as compared to women supporting sexual dimorphism. In the patients' cohort, injury of L3-L5 segments was the sole independent predictor for failure of PVS to induce ejaculation. Although evidence from clinical observations was indirect, there is close correspondence to neuroanatomical data.InterpretationOrganization and sexual dimorphism of human spinal galaninergic neurons were similar to the rat's SEG. Neurohistological data, together with clinical results, corroborate the existence of an SEG in humans in L3-L5 segments. Such a generator could be targeted to treat neurogenic and non-neurogenic ejaculatory disorders. ANN NEUROL 2017;81:35-45