Effects of activity dependent plasticity on recovery of bladder and sexual function after human spinal cord injury

摘要 膀胱和肠道并发症一直被认为是最重要的 脊髓损伤(SCI)人群。重要的是，膀胱和肠胀都有 已被确定为颈椎病患者自主神经反射障碍(AD)的主要触发因素 上胸椎水平病变(大多数脊髓损伤患者)，收缩压经常升高 超过20毫米汞柱，并保持在这些值，并伴有无法忍受的症状(敲击 例如，头痛和/或寒战)。我们最近将其记录为当前R01的一部分 这种巨大的未调节的交感反射会引起广泛的血管收缩 (表现为严重高血压)是众多研究中对膀胱容量的限制 参与者。据传闻，许多使用清洁间歇性导尿管的人 每天使用AD症状作为膀胱充盈和时间信号的管理报告 清空，这是一种需要解决的不安全做法。此外，我们和其他人有 在问卷中记录的AD症状在肠道程序和 在正在进行的以实验室为基础的研究中，有许多AD的例子是由于插入 直肠探头，用于膀胱测压(用于记录腹压)或在肛门直肠 测压技术。目前这项多学科研究的目标包括关键的交叉内脏- 内脏系统间的相互作用是1)在受控的实验室环境中进行研究，然后 通过移动居家监控AD的程度、严重程度和发生频率 注意日常的排尿和排便功能，同时识别潜在的潜在潜在因素 通过检测尿液中几种特定血管活性激素的生物标志物的作用机制，以及2) 作为膀胱和肠道的一部分，以治疗性方式调节心血管(CV)功能 使用脊髓硬膜外刺激进行治疗，我们的CV团队已经证明 使血压正常化。

Abstract Bladder and bowel complications have consistently been rated as of the upmost importance by the spinal cord injury (SCI) population. Importantly, both bladder and bowel distention have been identified as primary triggers of autonomic dysreflexia (AD) in individuals with cervical and upper thoracic level lesions (majority of SCI population), a systolic blood pressure rising often more than 20 mmHg and remaining at these values with intolerable symptoms (pounding headache and/or chills, for example). We have recently documented as part of our current R01 this massive unmodulated sympathetic reflex which causes widespread vasoconstriction (presenting as severe hypertension) as a limitation for bladder capacity in numerous research participants. Anecdotally, many who use clean intermittent catheterization for bladder management report using AD symptoms daily as a signal of bladder fullness and time for emptying, an unsafe practice that needs addressing. Additionally, we and others have documented in questionnaires regular occurrences of AD symptoms during bowel programs and in ongoing lab-based studies there have been numerous instances of AD upon insertion of a rectal probe either for bladder cystometry (for recording abdominal pressure) or during anorectal manometry. The goals of the current multi-disciplinary study incorporating critical cross viscero- visceral intersystem interactions are 1) to investigate in a controlled laboratory setting and then with mobile at-home monitoring the extent, severity and frequency of occurrence of AD with respect to daily bladder and bowel function, in conjunction with identifying potential underlying mechanisms by examining urinary biomarkers for several specific vasoactive hormones, and 2) to regulate cardiovascular (CV) function therapeutically as part of bladder and bowel management using spinal cord epidural stimulation, which our CV team have shown can normalize blood pressure.