Nerve Reflex Research Articles

Excess Dietary Vitamin B-6 Alters Startle Behavior of Rats

Excessive intakes of vitamin B-6 can produce peripheral nervous system abnormalities, but few reports of central nervous system effects exist. We measured startle response, a central nervous system reflex, in rats fed excess pyridoxine to determine if subtle effects on central nervous system function could be detected. Female Long-Evans rats (218 g; n = 12) were fed either 1, 10, 100, 200 or 300 times the requirement of pyridoxine HCl (7 mg/kg) for 7 wk. Startle behavior was assessed weekly in chambers that allowed quantification of movement in response to stimuli. Food intake and body weights did not differ among groups (P > 0.1), and urinary vitamin B-6 excretion reflected intake (P < 0.001). Overt toxicity was not observed. There was a marginally significant effect of pyridoxine intake over time (P = 0.053) on the amplitude of response to a startling acoustic stimulus (117 dB, 40 ms) administered alone; the response appeared attenuated at the three highest pyridoxine concentrations. When the same stimulus was preceded by either a 70- or 75-dB prepulse (40 ms), responses of groups fed the two highest pyridoxine concentrations were significantly reduced relative to those fed the two lowest concentrations (P < 0.05). No effect of diet was seen with a startling tactile stimulus. Changes in central nervous system function were detected in rats fed excess vitamin B-6 using techniques of startle behavior measurement.

Toxicological testing of Fuganlin Oral Liquid on young Sprague Dawley rats

Purpose: To further evaluate the safety of Fuganlin Oral Liquid (FGLOL) for clinical application by conducting toxicological tests in young rats.&#x0D; Methods: Based on the clinical dose for infants aged less than 1 year, 4-day-old Sprague-Dawley (SD) rats were orally administered FGLOL3.88, 11.64 and 38.75 g crude drug/kg for 18 days, followed by a 3-week withdrawal. This was followed by evaluating the effect of FGLOL on various growth and development indicators, nerve reflex function and spontaneous behavior of the rats. Based on the clinical dose for children aged 1 - 6 years, 15-day-old rats were orally administered FGLOL3.88, 11.64 and 38.75 g crude drug/kg for 31 days, followed by a 3-week withdrawal in order to evaluate the impact of the FGLOL on the development of reproductive organs and nervous systems in young rats. The effects of FGLOL on the safety of young rats were judged based on ophthalmic examination, physical examination, spontaneous behavior and other developmental effects.&#x0D; Results: FGLOL did not cause animal death, and no significant toxicological changes were observed in the body weight, growth and development, and behavior of the young rats (p &lt; 0.05). No observed adverse effect level (NOAEL) even after administering the higher dose at each stage. However, the results at each stage showed that oral administration of a large amount of FGLOL had a greater effect on normal food consumption of the rats (p &lt; 0.05).&#x0D; Conclusion: The findings indicate that Fuganlin Oral Liquid, a traditional Chinese medicine formulation, is safe in rats. However, clinical trials are required to acertain its safety in humans.

Application of Self-Adaptive Medical Ultrasonic Imaging Algorithm-Based Obturator Nerve Block in Transurethral Resection of Bladder Tumor

The application values of ultrasound-guided obturator nerve block (ONB) optimized by self-adaptive algorithm in transurethral resection of bladder tumor (TURBT) are investigated. For this purpose, total of 50 patients receiving TURBT areselected and randomly rolled into a control group (Ctrl group, ONB under traditional resectoscope) and an experimental group (Exp group, self-adaptive algorithm-based ultrasound-guided ONB (algorithm+ultrasound ONB)). Each group contains 25 cases. The results of the comprehensive assessment of each index showed that the self-adaptive algorithm enhanced the solution of ultrasonoscopy, which was morebeneficial for the intraoperative guidance on block. The success rate of the block in the Exp group reached 100%, higher than that in the Ctrl group (92%). The block time was 6.53±1.28 minutes, which was obviously shorter than that in the Ctrl group (10.34±1.76 minutes). The incidence of complications (IoC) (16%) was significantly lower than that in the Ctrl group (36%). Besides, postoperative visual analogue scale/score (VAS) (2.01±0.84 points) was remarkably lower based on the score in theCtrl group (4.73±1.15 points). The above differences all show statistical significance (P &lt;0.05). To sum up, self-adaptive algorithm could enhance the quality of surgical ultrasound-guided ONB, which showed significant values in the prevention of obturator nerve reflex, postoperative analgesia for patients, and the recovery.

Principles of diagnosis and non-surgical treatment of lumbar and sacral radiculopathy

Jūratė Kazlauskaitė1, Paulius Meškauskas1, Miglė Puodžiūnaitė2 1 Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicin, Kaunas, Lithuania 2 Lithuanian University of Health Sciences, Department of Family Medicine, Kaunas, Lithuania Abstract Background. Lumbosacral radiculopathy is a condition, when the lumbar and sacral spinal nerve roots are irritated, compressed or otherwise damaged for various etiological reasons. Depending on the location and extent of damage to the spinal nerve roots, sensory and reflex disorders of the lower extremities may also occur. The increasing incidence of this disease especially in developed countries leads that lumbosacral radiculopathy is one of the most common cause of disability. Aim. Tol review the main principles of diagnosis and non-surgical treatment of lumbosacral radiculopathy. Results: It is important to collect a medical history, perform a consistent physical examination to differentiate the causes of radiculopathy, and rule out the symptoms of the red flag, which could signal an acute and special attention requiring disorder. Imaging techniques like magnetic resonance imaging, computed tomography, and myelography can also be used to confirm a diagnosis:. In cases of unclear radiological image, electromyography and electroneurography might be performed. Treatment of lumbosacral radiculopathy is a complex process that includes physiotherapy, manual therapy, kinesitherapy, and pharmacological treatment. If neurological symptoms progress, or there is no response to conservative treatment, surgical treatment may be appointed. Conclusions. In order to prevent the progression of neurological symptoms and deterioration of the patient’s quality of life, the most important thing is timely and accurate diagnosis of lumbar and sacral radiculopathy. Neurodynamic tests are used during the physical examination. If necessary, neuroradiological or electroneurographic tests are performed. In the absence of contraindications, it is recommended to start the treatment with conservative measures. Keywords: lumbosacral radiculopathy, neurodynamic test, radiculopathy pain syndrome, radiofrequency therapy, epidural steroid injection.

Organ Crosstalk in Acute Kidney Injury: Evidence and Mechanisms.

Acute kidney injury (AKI) is becoming a public health problem worldwide. AKI is usually considered a complication of lung, heart, liver, gut, and brain disease, but recent findings have supported that injured kidney can also cause dysfunction of other organs, suggesting organ crosstalk existence in AKI. However, the organ crosstalk in AKI and the underlying mechanisms have not been broadly reviewed or fully investigated. In this review, we summarize recent clinical and laboratory findings of organ crosstalk in AKI and highlight the related molecular mechanisms. Moreover, their crosstalk involves inflammatory and immune responses, hemodynamic change, fluid homeostasis, hormone secretion, nerve reflex regulation, uremic toxin, and oxidative stress. Our review provides important clues for the intervention for AKI and investigates important therapeutic potential from a new perspective.

Comparison of different methods of obturator nerve block in transurethral resection of bladder tumors: A systematic review and network meta-analysis.

Bladder cancer is the most common malignancy of the urinary system, and accounts for 3% of newly diagnosed tumors. Transurethral resection of bladder tumor plays a key role in treating bladder cancer, among which one of the most serious complications is bladder perforation caused by obturator nerve reflex. Obturator nerve reflex can be prevented by inducing obturator nerve block after lumbar anesthesia. However, No study so far has compared the inhibitory effect of different obturator nerve block approaches on intraoperative obturator nerve reflex and bladder perforation. In this study, we conducted a network meta-analysis (NMA) of studies comparing the efficacy of different obturator nerve block approaches performed after lumbar anesthesia in operation. The distal obturator nerve block guided by peripheral nerve stimulator is the best approach for preventing obturator reflex. The proximal obturator nerve block guided by ultrasound is the best approach for preventing bladder perforation. Spinal anesthesia combined with the distal obturator nerve block guided by peripheral nerve stimulator is the most optimal approach to prevent the obturator nerve reflex. But the doctor should choose the appropriate anesthesia method according to the patient's general condition, tumor location, and doctor's proficiency in puncture techniques.

Insulin increases sensory nerve density and reflex bronchoconstriction in obese mice.

Obesity-induced asthma responds poorly to all current pharmacological interventions, including steroids, suggesting that classic, eosinophilic inflammation is not a mechanism. Since insulin resistance and hyperinsulinemia are common in obese individuals and associated with increased risk of asthma, we used diet-induced obese mice to study how insulin induces airway hyperreactivity. Inhaled 5-HT or methacholine induced dose-dependent bronchoconstriction that was significantly potentiated in obese mice. Cutting the vagus nerves eliminated bronchoconstriction in both obese and nonobese animals, indicating that it was mediated by a neural reflex. There was significantly greater density of airway sensory nerves in obese compared with nonobese mice. Deleting insulin receptors on sensory nerves prevented the increase in sensory nerve density and prevented airway hyperreactivity in obese mice with hyperinsulinemia. Our data demonstrate that high levels of insulin drives obesity-induced airway hyperreactivity by increasing sensory innervation of the airways. Therefore, pharmacological interventions to control metabolic syndrome and limit reflex-mediated bronchoconstriction may be a more effective approach to reduce asthma exacerbations in obese and patients with asthma.

The 980 nm diode laser treatment for non-muscle-invasive bladder tumor with en bloc technique: single-center experience

BackgroundTransurethral resection of the bladder tumor (TURBT) is one of the most established urological procedures for the treatment of the primary non-muscle-invasive bladder cancer (NMIBC). The aim of the study is to evaluate the efficacy and safety of 980 nm diode laser as a treatment for primary NMIBC.MethodsEighty-eight patients with NMIBC were treated by en bloc transurethral resection with 980 nm diode laser, and 76 patients were treated by plasmakinetic transurethral resection from May 2016 to July 2019 at the Department of Urology, Tangdu Hospital, Air Force Medical University. The clinical data were collected and compared between the two groups.ResultsThe bladder irrigation time was shortened in 980 nm diode laser group compared to that of plasmakinetic transurethral resection group (4.1 ± 0.6 vs 13.1 ± 3.1 h, p < 0.001). A total of 13.2% (10/76) patients experienced obturator nerve reflex, and 5.3% (4/76) experienced delayed bleeding in plasmakinetic transurethral resection group, while no obturator nerve reflex and delayed bleeding cases were observed in 980 nm diode laser group (p < 0.05). The postoperative catheterization and hospitalization time showed no significant difference between the two groups. The median follow-up time was 27 months (13–38 months). No significant difference in the recurrence rate was observed between the two groups.ConclusionsThe 980 nm diode laser is an effective and safe tool in transurethral resection of NMIBC using en bloc technique. It has less perioperative complications and shortened bladder irrigation time.

Patterns of facial and blink reflex abnormalities in type 2 diabetes mellitus patients with short disease duration: a clue to subclinical cranial neuropathy

Abstract Background Cranial neuropathies occur in 3 to 14% of diabetic patients. Motor conduction study of the facial nerve and blink reflex study are electrophysiologic techniques used to assess the facio-trigeminal pathway in diabetic patients. The patterns of facial and blink reflex abnormalities are inconsistent among studies. This study aimed to assess the subclinical facial nerve and blink reflex abnormalities patterns in short-duration type 2 diabetes mellitus patients. This cross-sectional study included 30 type 2 diabetic patients with disease duration ≤ 5 years. We included only patients with the Toronto clinical neuropathy score ≤ 5. We enrolled 30 age- and sex-matched healthy subjects as a control group. We performed facial nerve motor conduction and blink reflex studies. Patients with prior history of cranial nerve lesions, stroke, or any other disease-causing polyneuropathy or drug-induced neuropathy were excluded from the study. Results Thirty diabetic patients were included, 20 females (66.7%) and ten males (33.3%). Their mean age was 52.63 ± 8.94 years. None of the patients had clinical evidence of neuropathy. There were significant differences between patients and controls in the distal latencies and amplitudes of facial nerve compound muscle action potentials and contralateral R2 late response latencies of the blink reflex. We detected subclinical cranial abnormalities in 6 diabetic patients (20%). One of them (3.3%) had facial nerve conduction abnormalities, four of them (13.4%) had blink reflex abnormalities, and one of them (3.3%) had both facial nerve and blink reflex abnormalities. Conclusion Subclinical cranial neuropathy can occur in short-duration type 2 diabetes mellitus patients. We detected different blink reflex patterns and facial conduction study abnormalities. We recommend blink reflex and facial nerve conduction studies as simple tests for the early evaluation of neurological subclinical affection in patients with short disease duration of T2DM as they may appear in the absence of peripheral neuropathy.

Resección transuretral en bloque vs. resección transuretral convencional para el cáncer de vejiga primario no músculo-infiltrante: metaanálisis

IntroductionWe performed a meta-analysis to evaluate the effect of en-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer. MethodsA systematic literature search up to January 2022 was done and 28 studies included 3714 primary non-muscle invasive bladder cancer subjects at the start of the study; 1870 of them were en-bloc transurethral resection, and 1844 were conventional transurethral resection for primary non-muscle invasive bladder cancer. We calculated the odds-ratio (OR) and mean-difference (MD) with 95% confidence-intervals (CIs) to evaluate the effect of en-bloc transurethral resection compared with conventional transurethral resection for primary non-muscle invasive bladder cancer by the dichotomous or continuous methods with random or fixed-effects models. ResultsEn-bloc transurethral resection had significantly lower twenty-four-month recurrence (OR: 0.63; 95%CI: 0.50-0.78; P<0.001), catheterization-time (MD: –0.66; 95%CI: –1.02-[–0.29]; P<0.001), length of hospital stay (MD: –0.95; 95%CI: –1.55-[–0.34]; P=0.002), postoperative bladder irrigation duration (MD: –6.06; 95%CI: –9.45-[–2.67]; P<0.001), obturator nerve reflex (OR: 0.08; 95%CI: 0.02-0.34; P=0.03), and bladder perforation (OR: 0.14; 95%CI: 0.06-0.36: P<0.001) and no significant difference in the 12-month-recurrence (OR: 0.79; 95%CI: 0.61-1.04; P=0.09), the operation time (MD: 0.67; 95%CI: –1.92-3.25; P=0.61), and urethral stricture (OR: 0.46; 95%CI: 0.14-1.47; P=0.19) compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. ConclusionsEn-bloc transurethral resection had a significantly lower twenty-four-month recurrence, catheterization time, length of hospital stay, postoperative bladder irrigation duration, obturator nerve reflex, bladder perforation, and no significant difference in the twelve-month recurrence, operation time, and urethral stricture compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. Further studies are required.

En-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer: A meta-analysis

IntroductionWe performed a meta-analysis to evaluate the effect of en-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer. MethodsA systematic literature search up to January 2022 was done and 28 studies included 3714 primary non-muscle invasive bladder cancer subjects at the start of the study; 1870 of them were en-bloc transurethral resection, and 1844 were conventional transurethral resection for primary non-muscle invasive bladder cancer. We calculated the odds-ratio (OR) and mean-difference (MD) with 95% confidence-intervals (CIs) to evaluate the effect of en-bloc transurethral resection compared with conventional transurethral resection for primary non-muscle invasive bladder cancer by the dichotomous or continuous methods with random or fixed-effects models. ResultsEn-bloc transurethral resection had significantly lower twenty-four-month recurrence (OR: 0.63; 95%CI: 0.50–0.78; p < 0.001), catheterization-time (MD: –0.66; 95%CI: –1.02–[–0.29]; p < 0.001), length of hospital stay (MD: –0.95; 95%CI: –1.55–[–0.34]; p = 0.002), postoperative bladder irrigation duration (MD: –6.06; 95%CI: –9.45–[–2.67]; p < 0.001), obturator nerve reflex (OR: 0.08; 95%CI: 0.02–0.34; p = 0.03), and bladder perforation (OR: 0.14; 95%CI: 0.06–0.36: p < 0.001) and no significant difference in the 12-month-recurrence (OR: 0.79; 95%CI: 0.61–1.04; p = 0.09), the operation time (MD: 0.67; 95%CI: –1.92 to 3.25; p = 0.61), and urethral stricture (OR: 0.46; 95%CI: 0.14–1.47; p = 0.0.19) compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. ConclusionsEn-bloc transurethral resection had a significantly lower twenty-four-month recurrence, catheterization time, length of hospital stay, postoperative bladder irrigation duration, obturator nerve reflex, bladder perforation, and no significant difference in the twelve-month recurrence, operation time, and urethral stricture compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. Further studies are required.

A Systematic Review and Meta-Analysis Comparing the Safety and Efficacy of Spinal Anesthesia and Spinal Anesthesia Combined with Obturator Nerve Block in Transurethral Resection of Bladder Tumors.

Background Transurethral resection of bladder tumors (TURBT) is the main surgical treatment for bladder cancer, but during TURBT, it is easy to stimulate the obturator nerve passing close to the lateral side of the bladder wall and induce involuntary contraction of the adductor muscle group of the thigh innervated by it, which will affect the surgical process and lead to adverse reactions. Obturator nerve block (ONB) helps to prevent the obturator nerve reflex. This study systematically evaluated and meta-analyzed the reports on the co-application of ONB and spinal anesthesia (SA) in TURBT in recent years to provide evidence for clinical diagnosis and treatment. Methods The clinical randomized controlled literature studies of ONB combined with SA in TURBT published in PubMed, EMBASE, the Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang databases from January 2000 to December 2021 were searched. After screening the qualified literature studies, the literature quality was assessed by the Jadad scale. The incidence of obturator nerve reflex, the incidence of bladder perforation, length of hospital stay, and tumor recurrence rate were used as outcome indicators. The meta-analysis was performed with the R language toolkit. Results A total of 444 articles were initially retrieved, and after the screening, a total of 8 articles were included in the selection, and a total of 635 patients with ureterovesical tumor resection were included. The meta-analysis showed that the use of SA + ONB anesthesia during TURBT was associated with a smaller incidence of bladder perforation (RR = 0.24, 95% CI (0.11, 0.53), Z = −3.48, P=0.0005), a smaller incidence of obturator nerve reflex (RR = 0.22, 95% CI (0.13, 0.36), Z = −6.11, P=0.0001), a significantly shorter length of hospital stay (MD = −1.81, 95% CI (−2.65, −0.97), Z = −4.24, P=0.0001), and a significantly lower tumor recurrence rate (RR = 0.46, 95% CI (0.29, 0.73), Z = −3.30, P=0.001) compared with SA alone. Conclusion The application of SA combined with ONB in TURBT can effectively reduce the incidence of obturator nerve reflex, reduce the incidence of bladder perforation, shorten the hospital stay and reduce the tumor recurrence rate.

Accuracy of the Hammersmith infant neurological examination for the early detection of neurological changes in infants exposed to Zika virus: A case-cohort study.

The Hammersmith infant neurological examination (HINE) is a highly predictive tool for the easy and low-cost detection of cerebral palsy. Between 2015 and 2016, the rapid spread of the Zika virus (ZIKV) in Brazil was responsible for an increase in microcephaly cases. This study aimed to verify the accuracy of the HINE for the early detection of neurological problems in Brazilian babies exposed to ZIKV.This was a cross sectional case-control study of children exposed to ZIKV. This study was part of the Jundiaí ZIKV Cohort. Of a total sample of 782 children, 98 were evaluated (26 in the exposed group and 63 in the control group). We included late preterm infants and term infants who were exposed to the ZIKV and were participants in the ZIKV Cohort study. Student's t-test and stepwise multivariate logistic regression were used to compare groups.Of the 26 items evaluated in the five scored categories of the HINE (cranial nerve function, posture, movements, tone, reflexes, and reactions), only the difference in ankle dorsiflexion between the exposed and the control groups was statistically significant. However, some items showed a significant trend in relation to the control group.Our results demonstrated the importance of early neurological assessment of infants exposed to ZIKV, even in those without a microcephaly diagnosis.

High resolution retrograde tracing, morphological analysis, RNA sequencing and differential expression analysis of identified vagal afferent neurons innervating the muscle or mucosa in 3 different stomach regions in the rat

The functions of the stomach are powerfully influenced by the vagus nerve and vago‐vagal reflexes. The vagal afferent neurons that innervate the stomach and monitor its functional state have clearly demonstrated roles in appetite regulation, gastric accommodation and gastric emptying. In mammals with single compartment stomachs, including humans, the stomach can be divided into functional regions and the muscle and mucosal layers show region‐specific specializations. Electrophysiological and morphological studies suggest that the vagal sensory axons innervating the different regions and layers of the stomach wall have distinct properties and participate in different types of reflex controls. We therefore hypothesized that these functional and structural differences would be reflected in distinct gene expression profiles of afferent neurons, depending on the stomach region and tissue innervated. We developed methods to selectively retrogradely label afferent neurons innervating the muscle or mucosa in the corpus and antrum and the muscle in the fundus in the rat, using local microinjections of fluorescent nanospheres that diffuse minimally. Up to 30 microinjections of 30‐100nL of tracer beads were made into either the muscle or the mucosa in one stomach region in each rat under anesthesia. The animal was allowed to recover and kept for 1‐2 weeks before being humanely killed and tissues harvested. Labelled neurons were studied in situ in the nodose ganglion using confocal microscopy, immunohistochemistry and fluorescence in situ hybridization, and individual neurons collected after dissociation for RNAseq analysis. RNA sequencing was performed using pooled samples of 5‐12 neurons labelled from each region and deep sequencing (30‐50 million reads per sample), and then analyzed using minimal filtering to allow detection of genes expressed at low copy number.Nodose neurons labelled from the mucosa were significantly larger than those labelled from the muscle in both the corpus and antrum, whether quantified in situ or after dissociation, confirming that microinjections into the different stomach wall layers labelled different populations of neurons. Pairwise differential expression analyses of RNAseq data showed distinct mRNA expression profiles depending on the region innervated, and between muscle and mucosal innervating neurons in each region, based on Benjamini/Hochberg adjusted P values (Limma analysis tool). Some genes displayed region specific expression patterns while others showed tissue specific patterns (eg muscle vs mucosa) and some showed both. Among differentially expressed genes were some previously identified to specifically label gastric mucosal and muscle afferent neurons, such as somatostatin, CCKB receptor and GRP65. In addition, many other genes were differentially expressed and mRNA for genes known to be functional in vagal afferent neurons, such as ghrelin, leptin and galanin receptors, were detected. Differential expression patterns for various genes were confirmed in labelled neurons in situ using immunohistochemistry and/or in situhybridization. The data provide a rich resource for further studies of the visceral sensation in the different stomach regions and how region‐specific signaling might regulate appetite and gastric function in both normal and disease states.

MP59-13 BLADDER TUMOR ACCURATE RADIOFREQUENCY RESECTION: 38 CASES REPORTS

You have accessJournal of UrologyCME1 May 2022MP59-13 BLADDER TUMOR ACCURATE RADIOFREQUENCY RESECTION: 38 CASES REPORTS Shengkun Sun, Guangfu Chen, Weijun Fu, and Xu Zhang Shengkun SunShengkun Sun More articles by this author , Guangfu ChenGuangfu Chen More articles by this author , Weijun FuWeijun Fu More articles by this author , and Xu ZhangXu Zhang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002642.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder cancer is the fourth most frequently diagnosed malignancy in males and the 12th most common malignancy in females. Transurethral resection of bladder tumor (TURBT) remains the mainstay of diagnosis and initial treatment of bladder neoplasms. TURBT is performed conventionally with an electrocautery loop. The piecemeal resection specimens are inappropriate for tumor pathological evaluation because of poor anatomic orientation and evaluation of the pathological depth is not necessarily accurate. Also, tumor cells are scattered as the tumor is fragmented so that the possibility of implantation cannot be excluded. The objective of this study is to optimize the surgical method of transurethral bladder tumor resection. METHODS: 38 patients with non-muscle invasive bladder cancer received transurethral accurate resection of the tumor with a novel β electrode with a radiofrequency energy platform. Normal bladder mucosa 0.5 to 1 cm from the tumor base was marked with the tip of β electrode with an electrocautery energy. The needle of the β electrode was insert into the submucosa, and tissue of the bladder wall was pulled towards the midline of the bladder, followed by electro-cutting. Tumor blood vessels were cauterized with the needle tip. After en bloc resection of the tumor bulk, a novel β basket, which could be opened and trapped the tumor in bladder, was introduced into the bladder to retrieve the tumor en bloc or sub-en bloc. RESULTS: Tumors exceeded T2 stage or tumors with a maximum diameter of less than 1 cm were excluded. 38 patients underwent accurate transurethral radiofrequency resection of bladder tumors, and a total of 47 tumors were removed. The maximum diameter of the tumor is 2.4cm (range from 1 to 5cm). Tumors less than 3cm could be retrieved through the resection sheath or be taken out with the β basket. 12 tumors with a maximum diameter of >3cm were divided into 2-3 large pieces by the β basket and then taken out. During the operation, there was no obturator nerve reflex, no bladder perforation or urine extravasation. The intraoperative bleeding was less than 2ml in every patient. The bladder was flushed with normal saline for 24 hours post operation. Postoperative pathology showed Ta in 27cases and T1 in 11 cases. No second TURBT was performed in this group. No operative complications occurred. All patients received intravesical irrigation of BCG or chemotherapy agent periodically. 2 patients had tumor recurrence in the bladder during the mean follow-up of 8.7 months (range from 3 to 11 months). CONCLUSIONS: A novel β electrode was used to remove the tumor during accurate transurethral radiofrequency resection of bladder tumors. There are several advantages of this novel method. First, the blood supply of the tumor was occluded to avoid bleeding. Second, the obturator nerve reflex could be prevented completely and local nerve blockage was not necessary. Third, accurate radiofrequency resection of bladder tumor improved the resection quality and the en bloc resection helped make accurate TNM stage which was significant for postoperative treatment strategy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1007 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shengkun Sun More articles by this author Guangfu Chen More articles by this author Weijun Fu More articles by this author Xu Zhang More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD26-01 EN-BLOC VERSUS CONVENTIONAL TRANSURETHRAL RESECTION OF BLADDER TUMORS: SINGLE-CENTER PROSPECTIVE RANDOMIZED TRIAL

You have accessJournal of UrologyCME1 May 2022PD26-01 EN-BLOC VERSUS CONVENTIONAL TRANSURETHRAL RESECTION OF BLADDER TUMORS: SINGLE-CENTER PROSPECTIVE RANDOMIZED TRIAL Andrea Gallioli, Pietro Diana, Matteo Fontana, Angelo Territo, Alberto Piana, Ferran Algaba, Óscar Rodriguez-Faba, Asier Marcadé, Alejandra Bravo, Antonio Rosales, Josep Maria Gaya, Joan Palou, and Alberto Breda Andrea GallioliAndrea Gallioli More articles by this author , Pietro DianaPietro Diana More articles by this author , Matteo FontanaMatteo Fontana More articles by this author , Angelo TerritoAngelo Territo More articles by this author , Alberto PianaAlberto Piana More articles by this author , Ferran AlgabaFerran Algaba More articles by this author , Óscar Rodriguez-FabaÓscar Rodriguez-Faba More articles by this author , Asier MarcadéAsier Marcadé More articles by this author , Alejandra BravoAlejandra Bravo More articles by this author , Antonio RosalesAntonio Rosales More articles by this author , Josep Maria GayaJosep Maria Gaya More articles by this author , Joan PalouJoan Palou More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002574.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transurethral resection of bladder tumor (TURBT) is considered the gold standard in the diagnosis and risk stratification bladder cancer (BC). En-bloc resection of bladder tumor (ERBT) has been proposed to improve resection quality. Recently, the International Collaborative Consensus Statement on ERBT underlined the lack of high-quality prospective studies precluding the achievement of solid conclusion on ERBT. The aim of our study is to compare TURBT and ERBT in pathological diagnosis, surgical, and oncological outcomes. METHODS: This study is a prospective, randomized trial enrolling patients diagnosed with BC and undergoing endoscopic intervention. Inclusion criteria were: tumor size of ≤3 cm, and ≤3 lesions, and no sign of muscle invasion and/or ureteral involvement. The primary outcome is the staging of BC. Secondary outcomes included T1 substaging (microstaging systems T1a/b/c), intraoperative complications, rate of adjuvant treatment, postoperative complications, oncologic outcomes. With an α and β risk of 2.5% and 20% with a non-inferior difference of 5% en the rate of detrusor muscle presence, a total of 300 subjects were included in the study with 1:1.5 treatment allocation for ERBT. The trial (NCT04712201) was approved by the Institutional Review Board (2017/09c). RESULTS: From 03/2018 to 06/2021, 300 patients met inclusion criteria and 248 (82.7%) of these were underwent the assigned intervention. 108 (43.5%) and 140 (56.5%) patients were submitted to TURBT and ERBT. Pre-operatively, the populations were comparable. Table 1 shows the pathological results per patient. The rate of Tx was comparable (2.8% TURBT vs 4.3% ERBT). T1 substaging was feasible in 80% TURBT vs 100% ERBT (p=0.02). The rate of obturator nerve reflex and perforation were comparable (both p=0.2). In patients candidate to adjuvant treatment, the instillation was performed in 86% and 94% in TURBT and ERBT (p=0.1). Clavien-Dindo >2 complications were 2.8% vs 4.3% for TURBT and ERBT. Surgical, irrigation, and catheterization time were all comparable (all p>0.05). Recurrence rate at a median follow-up of 12 months (7-25) was 17.6% vs 12.9% in TURBT and ERBT (p>0.1). CONCLUSIONS: ERBT is non-inferior to TURBT in pathological, surgical, and short term oncological outcomes. ERBT reported a higher rate of T1 substaging feasibility compared to TURBT. This is the largest randomized study in this setting. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e487 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea Gallioli More articles by this author Pietro Diana More articles by this author Matteo Fontana More articles by this author Angelo Territo More articles by this author Alberto Piana More articles by this author Ferran Algaba More articles by this author Óscar Rodriguez-Faba More articles by this author Asier Marcadé More articles by this author Alejandra Bravo More articles by this author Antonio Rosales More articles by this author Josep Maria Gaya More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF DownloadLoading ...

Recent advances in transurethral resection of bladder tumors

Transurethral resection of the bladder tumor (TURBT) is a standard procedure in bladder cancer management. TURBT has two main goals: to resect completely all the tumor lesions in healthy tissues and to provide high-quality specimen to facilitate accurate diagnosis. To achieve these goals, urologists make use of several options to maximize the efficiency of the procedure. To make tumor detection as effective as possible, the European Association of Urology guidelines recommend using enhanced visualization methods such as photodynamic diagnostics (PDD) and narrow-band imaging (NBI). Novel en bloc technique enables one to provide specimens of a higher quality and to increase recurrence-free survival. Also, the use of new energy sources such as lasers helps to decrease bleeding and prevent several complications after TURBT, e.g., obturator nerve reflex and bladder perforation. This article summarizes the options available to enhance the TURBT procedure and reports on the latest data on their feasibility for clinical practice.

A new cell death program regulated by toll-like receptor 9 through p38 mitogen-activated protein kinase signaling pathway in a neonatal rat model with sepsis associated encephalopathy.

Background:Sepsis, a serious condition with high mortality, usually causes sepsis associated encephalopathy (SAE) that involves neuronal cell death. However, the cell death programs involved and their underlying mechanisms are not clear. This study aimed to explore the regulatory mechanisms of different cell death programs in SAE.Methods:A neonatal rat model of SAE was established by cecal ligation and perforation. Survival rate and vital signs (mean arterial pressure and heart rate) were monitored, nerve reflexes were evaluated, and cortical pathological changes were observed by hematoxylin and eosin staining. The expression of pyroptosis, apoptosis, and necroptosis (PANoptosis)-related proteins, mitogen- activated protein kinase (MAPK), and its upstream regulator toll-like receptor 9 (TLR9) were detected. The expression of TLR9 in neurons was observed by immunofluorescence staining. The ultrastructure of neurons was observed by transmission electron microscope.Results:First, PANoptosis was found in cortical nerve cells of the SAE rats. Meanwhile, the subunits of MAPKs, p38 MAPK, Jun N- terminal kinase, and extracellular signal-regulated kinase (ERK) were activated. After pharmacologically inhibiting each of the subunits, only p38 MAPK was found to be associated with PANoptosis. Furthermore, blocking the p38 MAPK signaling pathway activated necroptosis but inhibited apoptosis and pyroptosis. When necroptosis was pharmacologically inhibited, apoptosis and pyroptosis were reactivated. Finally, we found that the expression of TLR9, a regulator of MAPKs, was significantly increased in this model. After down-regulation of TLR9, p38 MAPK, and ERK signaling pathways were inhibited, which led to the inhibition of PANoptosis. Further analysis found that down-regulation of TLR9 improved the survival rate and reduced the pathological changes in SAE rats.Conclusions:Our study showed that the programs comprising PANoptosis are activated simultaneously in SAE rats. TLR9 activated PANoptosis through the p38 MAPK signaling pathway. TLR9 may work as a potential target for SAE treatment.

Autonomic Disorders in Trigeminal Autonomic Cephalalgias: An Update

The term trigeminal autonomic cephalalgias (TACs) was introduced in the 2nd edition of the International Classification of Headache Disorders, and has been retained in the 3rd edition. TACs include cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, hemicrania continua, and probable trigeminal autonomic cephalalgia. Headaches classified as TACs share clinical features with unilateral headache and usually present with prominent lateralized and ipsilateral cranial parasympathetic autonomic features, including the following: (1) conjunctival injection and/or lacrimation, (2) nasal congestion and/or rhinorrhea, (3) eyelid edema, (4) forehead and facial sweating, (5) miosis and/or ptosis. "Clinical Practice Guideline for Headache 2021 (Japanese version)" will serve as a useful aid for diagnosis and treatment of TACs. Currently, hypothalamic activation, activation of the trigeminal-autonomic nerve reflex, internal carotid artery dilatation, and the action of some neuropeptides are implicated as pathophysiological mechanisms underlying TACs; however, it is not unequivocal. Further studies are warranted to gain deeper insight into several unclear aspects associated with TACs.

Comparison of various types of lasers and transurethral resection in the treatment of bladder tumors: a systematic review and meta-analysis.

Bladder cancer is one of the most common cancers of the urinary tract. The two available treatments for this malignancy are laser and Transurethral Resection of the Bladder Tumor (TURBT). The aim of this study was to compare the different parameters of these two methods. A systematic search was performed on PubMed, Scopus and Google Scholar between 2000 and 2021. All articles related to non-muscle invasive bladder cancer (NMIBC) were extracted. All analyses were performed using R-studio statistical software version 1.0.136. In total, 11 studies that reported tumor recurrence in two methods were evaluated. A total of 626 and 742 patients were treated with laser and TURBT, respectively. Tumor recurrence, duration of operation, hospitalization and catheterization in laser therapy were significantly lower than TURBT. In addition, the incidence of complications was lower in patients treated with laser. The incidence of obturator nerve reflex, bladder perforation and postoperative bladder irrigation was significantly higher in patients treated with TURBT. Only in relation to postoperative urethral stricture, no significant difference was observed between the two treatment methods. Laser therapy compared to TURBT in patients with NMIBC has fewer complications and faster recovery. Also, the risk of tumor recurrence in laser therapy is less than TURBT.