Somatic Nerve Research Articles

Small fiber neuropathy associated with COVID‐19 infection and vaccination: A prospective case–control study

AbstractBackgroundSmall fiber neuropathy (SFN) after both COVID‐19 infection or vaccination has been reported in sporadic cases, but a detailed description and comparison are missing. We aimed to screen a large cohort of patients complaining of pain and autonomic symptoms after COVID‐19 natural infection or vaccination to ascertain the presence of SFN and its correlation with autoimmune diseases.MethodsWe prospectively recruited for this case–control study 66 patients: 33 developing sensory and autonomic symptoms after a natural COVID‐19 infection (P‐COVID) and 33 after a mRNA vaccination against COVID‐19 (P‐VAC). We also used 33 matched healthy controls (HC) collected before 2019 when the COVID‐19 virus appeared. Patients underwent neurological examination and clinical scales, an extensive serum screening, and skin biopsy to detect small nerve fiber involvement.ResultsClinical scales showed higher scores for autonomic symptoms in P‐COVID patients than in P‐VAC patients, but the other scales did not differ. P‐COVID and P‐VAC patients showed a significant decrease in somatic small nerve fibers compared with HC, whereas autonomic innervation did not differ. SFN was more frequent in P‐COVID patients (94%) than in P‐VAC patients (79%). Epidermal innervation was correlated with clinical scales for pain and autonomic dysfunctions. Autoimmune abnormalities were frequent in both groups but importantly they were not correlated with SFN.ConclusionsSomatic SFN was frequently found in both P‐COVID and P‐VAC patients, with a higher incidence in the former group. Spared skin autonomic innervation was spared in both groups although a subtle autonomic involvement in P‐COVID patients was suggested by a high COMPASS‐31 scale score. SFN was not correlated with autoimmune dysfunctions, although autoimmune diseases were frequent in both groups.

The Presence of Septin Proteins in the Neuromuscular Junction of Somatic Muscle in the Earthworm Lumbricus terrestris

Using fluorescent confocal microscopy it has been shown that proteins belonging to the septin family such as Septin 2, 3, 5, 7, and 9 are present in the somatic muscle of the earthworm Lumbricus terrestris. Septins 2 and 9 are associated with the lack of their specific concentrations in a cholinergic synapse, while septins 3, 5, and especially 7 levels correlate with quantitatively expressed binding in their localization to the motor end plate. It is assumed that Septins 3, 5 and, mostly, 7 can be involved in the mechanisms of modulation of quantal release of neurotransmitters.

EMC1 Is Required for the Sarcoplasmic Reticulum and Mitochondrial Functions in the Drosophila Muscle

EMC1 is part of the endoplasmic reticulum (ER) membrane protein complex, whose functions include the insertion of transmembrane proteins into the ER membrane, ER–mitochondria contact, and lipid exchange. Here, we show that the Drosophila melanogaster EMC1 gene is expressed in the somatic musculature and the protein localizes to the sarcoplasmic reticulum (SR) network. Muscle-specific EMC1 RNAi led to severe motility defects and partial late pupae/early adulthood lethality, phenotypes that are rescued by co-expression with an EMC1 transgene. Motility impairment in EMC1-depleted flies was associated with aberrations in muscle morphology in embryos, larvae, and adults, including tortuous and misaligned fibers with reduced size and weakness. They were also associated with an altered SR network, cytosolic calcium overload, and mitochondrial dysfunction and dysmorphology that impaired membrane potential and oxidative phosphorylation capacity. Genes coding for ER stress sensors, mitochondrial biogenesis/dynamics, and other EMC components showed altered expression and were mostly rescued by the EMC1 transgene expression. In conclusion, EMC1 is required for the SR network’s mitochondrial integrity and influences underlying programs involved in the regulation of muscle mass and shape. We believe our data can contribute to the biology of human diseases caused by EMC1 mutations.

Single-cell profiling of cellular changes in the somatic peripheral nerves following nerve injury.

Injury to the peripheral nervous system disconnects targets to the central nervous system, disrupts signal transmission, and results in functional disability. Although surgical and therapeutic treatments improve nerve regeneration, it is generally hard to achieve fully functional recovery after severe peripheral nerve injury. A better understanding of pathological changes after peripheral nerve injury helps the development of promising treatments for nerve regeneration. Single-cell analyses of the peripheral nervous system under physiological and injury conditions define the diversity of cells in peripheral nerves and reveal cell-specific injury responses. Herein, we review recent findings on the single-cell transcriptome status in the dorsal root ganglia and peripheral nerves following peripheral nerve injury, identify the cell heterogeneity of peripheral nerves, and delineate changes in injured peripheral nerves, especially molecular changes in neurons, glial cells, and immune cells. Cell-cell interactions in peripheral nerves are also characterized based on ligand-receptor pairs from coordinated gene expressions. The understanding of cellular changes following peripheral nerve injury at a single-cell resolution offers a comprehensive and insightful view for the peripheral nerve repair process, provides an important basis for the exploration of the key regulators of neuronal growth and microenvironment reconstruction, and benefits the development of novel therapeutic drugs for the treatment of peripheral nerve injury.

Psychosomatics: Communication of the Central Nervous System through Connection to Tissues, Organs, and Cells.

This study aimed to scrutinize existing evidence concerning the link between somatic symptoms and nervous system activity. The goal was to pinpoint areas for effective therapeutic interventions. Psychosomatic disorders, an often overlooked field of medicine, bears significance given the multitude of patients experiencing somatic symptoms due to specific emotions and experiences. The literature was explored using the methods of comparative analysis, synthesis and graphical representation. The study introduced pathological neural networks localized in brain regions such as the prefrontal cortex and hippocampus, leading to maladaptive behaviors and heightened negative focus. Activation of the sympathetic nervous system and the hypothalamus-pituitary-adrenal axis, alongside increased cortisol levels, induces chronic distress, inflammation, and disruptions in neurotransmitter metabolism. The gut microbiota significantly influences psychosomatic reactions. Patients with psychosomatic disorders require complex treatment with cognitive-behavioural therapy and hypnosis methods. Within the framework of pathological neural networks, the MindChat technique has yielded effectiveness with the purpose of "dehypnotization" and destruction of aberrant cognitive and emotional patterns. However, it should be noted that this technique requires further empirical support.

Screening tools for diabetic foot ulcers: a narrative review.

The prevalence of diabetic foot ulcers (DFUs) is 4 to 10% among people with diabetes mellitus. DFUs are associated with increased morbidity and mortality as well as reduced quality of life and have a significant impact on overall healthcare expenditure. The main predisposing factors for DFU are diabetic neuropathy, peripheral arterial disease, and trauma. The fact that a range of tests can be used to identify patients at risk for DFU often causes confusion among practitioners regarding which screening tests should be implemented in clinical practice. Herein we sought to determine whether tests of somatic nerve function, such as pinprick sensation, thermal (cold/hot) test, ankle reflexes, vibration perception, 10-g monofilament, Ipswich touch test, neuropathy disability score, and nerve conduction studies, predict the development of DFUs. In addition, we examined whether sudomotor function screening tests, such as Neuropad, sympathetic skin response, and other tests, such as elevated plantar pressure or temperature measurements, can be used for DFU screening. If not treated properly, DFUs can have serious consequences, including amputation, early detection and treatment are vital for patient outcomes.

Muscle degeneration in aging Drosophila flies: the role of mechanical stress

Muscle wasting is a universal hallmark of aging which is displayed by a wide range of organisms, although the causes and mechanisms of this phenomenon are not fully understood. We used Drosophila to characterize the phenomenon of spontaneous muscle fiber degeneration (SMFD) during aging. We found that SMFD occurs across diverse types of somatic muscles, progresses with chronological age, and positively correlates with functional muscle decline. Data from vital dyes and morphological markers imply that degenerative fibers most likely die by necrosis. Mechanistically, SMFD is driven by the damage resulting from muscle contractions, and the nervous system may play a significant role in this process. Our quantitative model of SMFD assessment can be useful in identifying and validating novel genetic factors that influence aging-related muscle wasting.

Genetic Variations in TrkB.T1 Isoform and Their Association With Somatic and Psychological Symptoms in Individuals With IBS

Irritable bowel syndrome (IBS), a disorder of gut-brain interaction, is often comorbid with somatic pain and psychological disorders. Dysregulated signaling of brain-derived neurotrophic factor (BDNF) and its receptor, tropomyosin-related kinase B (TrkB), has been implicated in somatic-psychological symptoms in individuals with IBS. We investigated the association of 10 single-nucleotide polymorphisms (SNPs) in the regulatory 3′ untranslated region of neurotrophic receptor tyrosine kinase-2 (NTRK2) kinase domain-deficient truncated isoform (TrkB.T1) and BDNF Val66Met SNP with somatic and psychological symptoms and quality-of-life (QoL) in a cohort from the United States (IBS, n = 464; healthy controls, n = 156). We found that the homozygous recessive genotype (G/G) of rs2013566 in individuals with IBS is associated with worsened somatic symptoms, including headache, back pain, joint pain, muscle pain, and somatization as well as diminished sleep quality, energy level, and overall QoL. Validation using United Kingdom BioBank data confirmed the association of rs2013566 with an increased likelihood of headache. Several SNPs (rs1627784, rs1624327, and rs1147198) showed significant associations with muscle pain in our U.S. cohort. These 4 SNPs are predominantly located in H3K4Me1-enriched regions, suggesting their enhancer and/or transcription regulation potential. Our findings suggest that genetic variation within the 3′ untranslated region region of the TrkB.T1 isoform may contribute to comorbid conditions in individuals with IBS, resulting in a spectrum of somatic and psychological symptoms impacting their QoL. These findings advance our understanding of the genetic interaction between BDNF/TrkB pathways and somatic-psychological symptoms in IBS, highlighting the importance of further exploring this interaction for potential clinical applications. PerspectiveThis study aims to understand the genetic effects on IBS-related symptoms across somatic, psychological, and quality-of-life (QoL) domains, validated by United Kingdom BioBank data. The rs2013566 homozygous recessive genotype correlates with worsened somatic symptoms and reduced QoL, emphasizing its clinical significance.

Transcutaneous neuromodulation versus oxybutynin for neurogenic detrusor overactivity in persons with spinal cord injury: A randomized, investigator blinded, parallel group, non-inferiority controlled trial

Study design This study is a randomized, investigator-blinded, controlled trial with a non-inferiority design. Objective To investigate the effectiveness of neuromodulation by transcutaneous electrical stimulation of the somatic afferent nerves of the foot in neurogenic detrusor overactivity (NDO) in persons with spinal cord injury (SCI) and compare its effectiveness with oral oxybutynin. Setting The study was conducted in a rehabilitation in-patient ward of a tertiary care hospital. Methods Twenty-nine persons with SCI with NDO, either sex, aged 18 years and above were randomized into two groups, one group receiving oral oxybutynin (5 mg thrice a day for two weeks) and the other transcutaneous electrical stimulation (5 Hz, 200 µs pulse, biphasic, amplitude up to 60 mA, 30 min/day for two weeks). Bladder capacity was evaluated by clinical bladder evaluation (i.e. bladder capacity measured by adding leak volume, voiding volume if any, and post-void residue using a catheter) and cystometric bladder capacity by one-channel cystometry. Maximum cystometric pressure was evaluated by one-channel water cystometry. Data were analyzed with Fisher's Exact, t-test, and Wilcoxon rank sum tests. Results Bladder capacity improved significantly in the oxybutynin and neuromodulation groups as measured by one-channel water cystometry (136 ml vs. 120.57 ml) and clinical evaluation (138.93 ml vs. 112 ml). The increase in the neuromodulation group achieved the pre-decided non-inferiority margin of 30 ml over the oxybutynin group when measured by one-channel water cystometry but not by clinical evaluation. Maximum cystometric pressure did not significantly improve in either group when compared with the baseline. Conclusion Transcutaneous neuromodulation and oxybutynin effectively increased bladder capacity in persons with SCI with NDO. Neuromodulation by once-a-day transcutaneous electrical stimulation was non-inferior to thrice-a-day oxybutynin when evaluated by one-channel water cystometry. Trial registration: Clinical Trials Registry India identifier: CTRI/2018/05/013735.

Somatic and autonomic nerve density and distribution within the clitoris: an immunohistochemical study in adult female cadavers.

Knowledge of clitoral neuroanatomy is critical to vulvar surgery. We sought to characterize the density and distribution of autonomic and somatic nerves supplying the clitoris. Pelvic tissue harvested from female cadavers was sectioned axially at three anatomic levels: the proximal aspect of the clitoral body (CB), the distal CB, and the glans. The CB, glans, and the surrounding connective tissue (dorsal, lateral, and ventral) were outlined microscopically. An area containing large nerve bundles dorsal to the CB, referred to as the dorsal nerve subregion, was analyzed separately. Double-immunofluorescent staining for beta III tubulin (βIIIT), a global axonal marker, and myelin basic protein (MBP), a myelinated nerve marker, was performed. Threshold-based automatic image-segmentation distinguished stained areas. Autonomic and somatic density were calculated as percentage of tissue stained with βIIIT alone, and βIIIT and MBP respectively. Comparisons were made using nonparametric Friedman tests. Seven cadavers, aged 22-81, were examined. Somatic (mean 4.42%, SD ± 1.97) and autonomic (2.14% ± 2.42) nerve density was highest in the dorsal nerve subregion and dorsal region at the distal CB level. Compared with the CB, somatic density was higher in proximal (0.05% ± 0.03 vs 1.27% ± 0.69, p = 0.03) and distal (0.29% ± 0.25 vs 1.09% ± 0.41, p = 0.05) dorsal regions. Somatic density was greater in the glans than in the surrounding lateral (0.78% ± 0.47 vs 0.43% ± 0.23, p = 0.03) and ventral (0.78% ± 0.47 vs 0.52% ± 0.2, p = 0.03) regions. Autonomic density was greater than somatic in all areas, except for the dorsal nerve subregion. Somatic and autonomic nerve density were greatest in a well-defined region dorsal to the CB. Surgical preservation of this region is critical for maintaining nerve supply to the clitoris.

Вплив стресу на стан м’язової системи пацієнтів з ушкодженнями опорно-рухового апарату

The article examines the impact of stress and psychological disorders in the context of military actions in Ukraine on the human muscular system, as well as their effect on the physical condition of patients with injuries and disorders of the musculoskeletal system. It also explores how stress and psychological disorders in wartime conditions contribute to the spread of pathological pain sensations and the occurrence of muscle spasms. A brief historical overview is provided, and scientific publications on the use of various methods in treating different pathologies, including pain syndromes caused by musculoskeletal muscle spasms, are analyzed. The article discusses types of somatic muscle spasms and pain syndromes, as well as mechanisms of local physiological influences and methods of psychological correction for conditions that cause pain and spasms in muscles, fascia, and joints. The positive impact of physiological procedures combined with psychological correction on pain associated with stressful situations and psychological disorders in people who have experienced moral humiliation and physical abuse during wartime and occupation is demonstrated. Various manifestations of stress and their effects on the functioning of muscles, fascia, and joints in individuals who are currently experiencing or have experienced military actions are described. Additionally, the article examines how psychological disorders resulting from military actions in Ukraine affect patients with musculoskeletal injuries. Methods proposed by modern rehabilitation therapy to alleviate and improve the condition of such patients are presented. These methods, such as various types of massage, heat treatments, taping, and psychological correction, are considered techniques for relieving pain that can be used both simultaneously and sequentially, without causing negative side effects during therapy and requiring minimal effort. It is established that the consequences of chronic stress and prolonged experiences of anxiety, nervousness, and panic attacks cause significant harm to the health of adults and children. The accumulated stress over the long period of war causes varying degrees of harm to each individual, with chronic forms of internal organ diseases and inflammatory processes becoming more pronounced. However, the primary target of chronic stress is the muscles. Only a comprehensive approach to this problem is an important factor in overcoming the consequences. Key words: stress, psychological disorders, human muscular system, musculoskeletal system, military actions

Мікрорівнева адаптація окремих органів і тканин стерляді (Acipenser ruthenus Linnaeus, 1758) в умовах теплового стресу

Purpose. To evaluate the variability of the histological parameters of individual organs and tissues of sterlet, to establish the level of effect of heat stress on the physiological status of fish and the degree of their adaptation. To determine the perspective of using histological monitoring data in fish farming practice. Methodology. The primary materials were obtained in aquarium conditions of the Aquatic Bioresources Laboratory of the Kherson State Agrarian and Economic University. The laboratory processing of histological samples was performed according to generally accepted methods and manuals. Histological studies were carried out using the author’s equipment and original methods, specially intended for the diagnostics of fish tissues. The obtained results were processed by methods of variational statistics using a package of appropriate MS Excel applications, with emphasis on the standard error. Findings. Microanatomical studies of sterlet showed that under conditions of heat stress, the most significant changes occur in adipose tissue, somatic and cardiac muscle tissue, thyroid gland and renal tissue, which can conditionally be considered as bioindicative zones. Under the potential influence of the thermal factor, the response of sterlet is expressed in a decrease in the lipid content in the accompanying muscles of adipose tissue. The effect is visualized in the fragmentation and subsequent shredding of lipid vacuoles, which leads to variability in adipocyte shape from stellate to spindle-shaped. The obtained results indicate a decrease in the excretion of thyroid hormones into the bloodstream by the thyroid gland and is expressed in a gradual increase in the diameter of the thyroid follicles (by 16.0 µm and 26.5 µm) and a corresponding decrease in the height of the follicular cells (by 1.1 µm and 2.0 µm), which is statistically significant. Intensive development of “additional” follicles inside existing ones indicates the prevention of thyroid intoxication of the body, which indicates the development of an adaptive reaction of the body. Comparative studies of the ventricular myocardium of fish allowed establishing certain morphological differences in the form of moderate interstitial edema of the tissue and intracellular edema of cardiomyocytes. In the final phase of the experiment, karyopyknosis was locally observed in the ventricular cardiomyocytes of 50% of stressed fish. Somatic muscle tissue is generally resistant to stress, but the rate of its development at elevated temperatures slows down. Characteristic signs of the histological picture of muscle stress are approximately the same ratio of stromal and parenchymal components, the central orientation of the nuclei within a single muscle fiber and insufficient filling of the fibers with the fibrillar component. Antidiuretic hormone is forcedly released in fish under conditions of heat stress, which leads to a decrease in the volume of the primary filtrate. Evidence is a narrow gap in the urinary space between the visceral and parietal layers of the renal corpuscle. Originality. New data are presented and existing data on the histological structure of individual organs and tissues of sterlet under stress loads are significantly expanded. For the first time, a detailed histological analysis of the structure of muscle, adipose tissue, as well as the kidney and thyroid gland of sterlet under heat stress conditions was carried out. The comparative analysis, current and updated information on compensatory changes in tissues demonstrate their adaptive potential, which was developed during the evolution of the species. Practical Value. The information obtained is of value in morphophysiological studies as well as in fish farming practice in connection with the modern problem of a decrease in the life status of fish under stress. The use of the obtained data allows a qualitative assessment of the physiological state and can be used in the process of developing corrective measures in order to consolidate hereditary resistance, which is ultimately aimed at preventing diseases of valuable aquaculture objects. Keywords: sterlet, heat stress, adaptation, muscle tissue, thyroid gland, myocardium, adipose tissue, renal tissue.

Importance of neuro-urological care in patients with spinal cord injuries/diseases

Integrity, control and regulation of the urinary tract are subject to a complex neuronal regulation, in which portions of the sympathetic, parasympathetic and somatic nervous system are involved. The spinal cord plays a central role in regulation and serves as a transmitter for the motor and sensory pathways. Bladder dysfunction followed by renal dysfunction was the most frequent cause of death in patients with spinal cord injuries/diseases (paraplegia) as recently as half a decade ago. Thanks mainly to diagnostic and therapeutic advances made in neuro-urology, urological problems are no longer life-limiting. A vital role is played not only by the actual function of the urinary tract but also by the complex interactions in patients living with paraplegia. Issues such undertreated hyperactivity of the detrusor muscle with autonomous dysregulation, incontinence with secondary skin changes, or insufficient hand function to perform intermittent catheterisation must be evaluated in an interdisciplinary approach. Spinal cord injury/disease implies numerous functional disorders and secondary impairments of the organism. In addition to bladder function, sexual dysfunction also plays a crucial role. Especially in younger patients who sustain paraplegia before or during the family planning phase, this disruption and limitation is an essential reason for reduced quality of life. Neurogenic intestinal function plays an additional crucial role with regard to quality of life and management of everyday life. In recent years, the range of neuro-urological topics has expanded significantly. The focus of our work shifted from being merely on the urinary tract and urodynamics. In particular, the diagnostic investigation and treatment of neurogenic intestinal dysfunction is increasingly in the hands of neuro-urologists. The complex presentation of paraplegia involves an interaction of bladder, intestinal and sexual dysfunction in a way that these influence one another. Therefore, the sustained care and re-integration of these patients essentially includes lifelong and regular neuro-urological care in a paraplegia centre. Last but not least, it is exactly these neuro-urological topics such as urinary tract infections, urinary and intestinal incontinence and faecal impaction, which most commonly lead to re-hospitalisation.

Disturbances in Muscle Energy Metabolism in Patients with Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is a fatal neuromuscular disease type of motor neuron disorder characterized by degeneration of the upper and lower motor neurons resulting in dysfunction of the somatic muscles of the body. The ALS condition is manifested in progressive skeletal muscle atrophy and spasticity. It leads to death, mostly due to respiratory failure. Within the pathophysiology of the disease, muscle energy metabolism seems to be an important part. In our study, we used blood plasma from 25 patients with ALS diagnosed by definitive El Escorial criteria according to ALSFR-R (Revised Amyotrophic Lateral Sclerosis Functional Rating Scale) criteria and 25 age and sex-matched subjects. Aside from standard clinical biochemical parameters, we used the NMR (nuclear magnetic resonance) metabolomics approach to determine relative plasma levels of metabolites. We observed a decrease in total protein level in blood; however, despite accelerated skeletal muscle catabolism characteristic for ALS patients, we did not detect changes in plasma levels of essential amino acids. When focused on alterations in energy metabolism within muscle, compromised creatine uptake was accompanied by decreased plasma creatinine. We did not observe changes in plasma levels of BCAAs (branched chain amino acids; leucine, isoleucine, valine); however, the observed decrease in plasma levels of all three BCKAs (branched chain alpha-keto acids derived from BCAAs) suggests enhanced utilization of BCKAs as energy substrate. Glutamine, found to be increased in blood plasma in ALS patients, besides serving for ammonia detoxification, could also be considered a potential TCA (tricarboxylic acid) cycle contributor in times of decreased pyruvate utilization. When analyzing the data by using a cross-validated Random Forest algorithm, it finished with an AUC of 0.92, oob error of 8%, and an MCC (Matthew's correlation coefficient) of 0.84 when relative plasma levels of metabolites were used as input variables. Although the discriminatory power of the system used was promising, additional features are needed to create a robust discriminatory model.

Concurrent response and action effect representations across the somatomotor cortices during novel task preparation

Instructions allow us to fulfill novel and complex tasks on the first try. This skill has been linked to preparatory brain signals that encode upcoming demands in advance, facilitating novel performance. To deepen insight into these processes, we explored whether instructions pre-activated task-relevant motoric and perceptual neural states. Critically, we addressed whether these representations anticipated activity patterns guiding overt sensorimotor processing, which could reflect that internally simulating novel tasks facilitates the preparation. To do so, we collected functional magnetic resonance imaging data while female and male participants encoded and implemented novel stimulus-response associations. Participants also completed localizer tasks designed to isolate the neural representations of the mappings-relevant motor responses, perceptual consequences, and stimulus categories. Using canonical template tracking, we identified whether and where these sensorimotor representations were pre-activated. We found that response-related templates were encoded in advance in regions linked with action control, entailing not only the instructed responses but also their somatosensory consequences. This result was particularly robust in primary motor and somatosensory cortices. While, following our predictions, we found a systematic decrease in the irrelevant stimulus templates’ representational strength compared to the relevant ones, this difference was due to below-zero estimates linked to the irrelevant category activity patterns. Overall, our findings reflect that instruction processing relies on the sensorimotor cortices to anticipate motoric and kinesthetic representations of prospective action plans, suggesting the engagement of motor imagery during novel task preparation. More generally, they stress that the somatomotor system could participate with higher-level frontoparietal regions during anticipatory task control.

The usefulness of ultrasonography for the early diagnosis of polyneuropathy in patients with type II diabetes mellitus

Background: Diabetic neuropathies, affecting over 50% of diabetes patients, present varied forms of polyneuropathy impacting somatic and autonomic nerves. Clinical assessments, laboratory findings, and nerve conduction studies (NCSs) aid in precise diagnosis, while recent technological advances highlight ultrasonography (US) as a promising, cost-effective diagnostic tool. Aims and Objectives: This study aims to assess the efficacy of US in early polyneuropathy diagnosis in type II diabetes, exploring its potential as an alternative to NCS. Materials and Methods: In this prospective observational study, we enrolled 30 adult patients with type II non-controlled diabetes and 30 age-matched controls, comprising 15 controlled diabetic patients and 15 normal individuals. The comprehensive assessments encompassed history-taking for diabetes duration, hypertension, and diabetic complications, along with clinical examinations and investigations involving nerve electrophysiology and US on one upper limb based on patient complaints. Results: Significant increases in the cross-sectional area (CSA) of the median nerve were observed in diabetic peripheral neuropathy groups compared to controls, with a P<0.001. Similarly, at the level behind the medial epicondyle, the ulnar nerve CSA exhibited a significant increase in the diabetic peripheral neuropathy group (11.7 mm2) compared to controls (6.7 mm2) with a P<0.002. In addition, a significant difference in cross-sectional values was found in the median nerve proximal to the carpal tunnel between the two groups (P<0.05). In contrast, no significant differences were observed at other sites. Regarding the relationship between sonography and NCSs, NCSs showed higher sensitivity, but sonography demonstrated comparable specificity in evaluating diabetic peripheral neuropathy. Conclusion: Peripheral nerve US in the upper limb can be a valuable diagnostic tool for identifying and diagnosing diabetic peripheral neuropathy.

High-Precision Calorimetry-Based Analysis of Pupal-Pharate Adult Development in Drosophila melanogaster.

In holometabolous insects, the larval body is almost completely decomposed and reconstructed into the adult body during the pupal-pharate adult stages. Therefore, the total energetic cost of this process is a key thermodynamic quantity necessary for evaluating the benefit of their life history. Here, we measured whole-body thermal dissipation of single pupae of the fruit fly, Drosophila melanogaster, during the period from puparium formation to adult eclosion as a function of age, using a high-precision isothermal calorimeter at T = 298 K. The mass-specific energy consumption during the period from the onset of larval-pupal apolysis to adult eclosion was determined to be 2.3 kJ/g for an individual of mass (adult) = 1.0 mg, while it was observed to follow Kleiber's law for individuals smaller than mass (adult) = 1.0 mg. During the pupal-pharate adult period, in addition to the U-shaped variation, several characteristic thermal dissipations related to various events, including somatic muscle contractions, ecdyses, pulsatile hormone secretion in a pharate adult, and vaporization of the exuvial fluid, were observed. The periodic bursts in the pharate adult stage grew exponentially, suggesting that the positive feedback in the metabolic system synchronized with the progression of development, making the energy consumption in this stage more efficient. The present study showed that high-precision calorimetry is a powerful and credible method for measuring not only the total energy spent during development but also the energy spent during every specific developmental event in an organism.

Anatomical Location of the Vesical Branches of the Inferior Hypogastric Plexus in Human Cadavers.

We have demonstrated in canines that somatic nerve transfer to vesical branches of the inferior hypogastric plexus (IHP) can be used for bladder reinnervation after spinal root injury. Yet, the complex anatomy of the IHP hinders the clinical application of this repair strategy. Here, using human cadavers, we clarify the spatial relationships of the vesical branches of the IHP and nearby pelvic ganglia, with the ureteral orifice of the bladder. Forty-four pelvic regions were examined in 30 human cadavers. Gross post-mortem and intra-operative approaches (open anterior abdominal, manual laparoscopic, and robot-assisted) were used. Nerve branch distances and diameters were measured after thorough visual inspection and gentle dissection, so as to not distort tissue. The IHP had between 1 to 4 vesical branches (2.33 ± 0.72, mean ± SD) with average diameters of 0.51 ± 0.06 mm. Vesical branches from the IHP arose from a grossly visible pelvic ganglion in 93% of cases (confirmed histologically). The pelvic ganglion was typically located 7.11 ± 6.11 mm posterolateral to the ureteral orifice in 69% of specimens. With this in-depth characterization, vesical branches from the IHP can be safely located both posterolateral to the ureteral orifice and emanating from a more proximal ganglionic enlargement during surgical procedures.

448 Motor Control of Bladder Function by Nerve Transfer

INTRODUCTION: A normal detrusor muscle is activated by parasympathetic efferents that release acetylcholine to muscarinic receptors to contract and expel urine. Through canine work by our group, the scientific underpinning of a somatic nerve transfer to a visceral target (hybrid synapse) was established. We present the scientific basis of this hybrid nerve transfer and report the first-in-human functional outcome. METHODS: Our patient presented with deteriorating bladder function over 1 year and underwent en bloc resection of a sacral chondrosarcoma in December 2020. The sacral roots from S1 caudally were divided – resulting in loss of bowel and bladder function. Urodynamics demonstrated an acontractile bladder (0 cm H20). In May 2021 bilateral obturator nerve transfers to the vesical branches (to bladder) of the inferior hypogastric plexus (6 months after surgery). Patient bladder function and pelvic visceral sensation were followed with serial urodynamic studies. RESULTS: The patient was asked to adduct the thighs and relax the abdomen to initiate a detrusor (bladder) contraction. This provided definitive activation of the nerve transfer in November 2022 (1.5 years after transfer), which was confirmed in January 2023 (∼20 cm H20). Concomitantly, the filling volume at which “full bladder” was perceived appeared at 6 months and progressed until detected within normal range of bladder volumes. CONCLUSIONS: This is a first-in-human nerve transfer that has clear evidence of visceral sensation recovery (need to void) at normal volumes, and functional detrusor contraction. While bladder pressures produced were not within normal range, we expect transfers earlier after loss of function (e.g. within 6 months instead of 18) will result in greater functional gains.

Nerve transfer for restoration of lower motor neuron-lesioned bladder, urethral and anal sphincter function. Part 4: Effectiveness of the motor reinnervation.

In pilot work, we showed that somatic nerve transfers can restore motor function in long-term decentralized dogs. We continue to explore the effectiveness of motor reinnervation in 30 female dogs. After anesthesia, 12 underwent bilateral transection of coccygeal and sacral (S) spinal roots, dorsal roots of lumbar (L)7, and hypogastric nerves. Twelve months postdecentralization, eight underwent transfer of obturator nerve branches to pelvic nerve vesical branches, and sciatic nerve branches to pudendal nerves, followed by 10 mo recovery (ObNT-ScNT Reinn). The remaining four were euthanized 18 mo postdecentralization (Decentralized). Results were compared with 18 Controls. Squat-and-void postures were tracked during awake cystometry. None showed squat-and-void postures during the decentralization phase. Seven of eight ObNT-ScNT Reinn began showing such postures by 6 mo postreinnervation; one showed a return of defecation postures. Retrograde dyes were injected into the bladder and urethra 3 wk before euthanasia, at which point, roots and transferred nerves were electrically stimulated to evaluate motor function. Upon L2-L6 root stimulation, five of eight ObNT-ScNT Reinn showed elevated detrusor pressure and four showed elevated urethral pressure, compared with L7-S3 root stimulation. After stimulation of sciatic-to-pudendal transferred nerves, three of eight ObNT-ScNT Reinn showed elevated urethral pressure; all showed elevated anal sphincter pressure. Retrogradely labeled neurons were observed in L2-L6 ventral horns (in laminae VI, VIII, and IX) of ObNT-ScNT Reinn versus Controls in which labeled neurons were observed in L7-S3 ventral horns (in lamina VII). This data supports the use of nerve transfer techniques for the restoration of bladder function.NEW & NOTEWORTHY This data supports the use of nerve transfer techniques for the restoration of bladder function.