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评为最重要的， 脊髓损伤（SCI）患者。重要的是，膀胱和肠道扩张都有 被确定为颈椎病患者自主神经反射异常（AD）的主要触发因素， 上胸水平病变（大多数SCI人群），收缩压经常升高 超过20 mmHg，并保持在这些值，出现无法忍受的症状（冲击 例如头痛和/或寒战）。我们最近记录了当前R 01的一部分 这种巨大的未经调节的交感神经反射会引起广泛的血管收缩 （表现为严重高血压）在许多研究中作为膀胱容量的限制 参与者有趣的是，许多使用清洁间歇导尿术的膀胱 管理报告使用AD症状每天作为膀胱充盈的信号， 清空，这是一种需要解决的不安全做法。此外，我们和其他 在问卷中记录了肠道计划期间AD症状的定期发生， 在正在进行的基于实验室的研究中，已经有许多AD的实例， 直肠探头，用于膀胱测压（用于记录腹压）或肛门直肠手术期间 测压法目前的多学科研究的目标，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， 使用移动的在家监测AD的程度、严重程度和发生频率， 关于日常膀胱和肠功能，结合识别潜在的潜在的 通过检查几种特定血管活性激素的尿生物标志物的机制，和2） 作为膀胱和肠的一部分，在治疗上调节心血管（CV）功能 使用脊髓硬膜外刺激进行管理，我们的CV团队已经证明， 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.