Neuronal Correlation Between Acupoint BL 23 and the Adrenal Gland in Rats / 针刺研究

OBJECTIVE: To explore the neuroanatomical basis of acupoint-visceral correlation by studying the distribution of the neurons associated with acupoint "Shenshu" (BL 23) area and adrenal gland in rats. METHODS: AF 488-CTB and AF 594-CTB were injected into the left side of BL 23 area and adrenal gland in the same rat respectively. Three days after injection, the dorsal root ganglions (DRG), sympathetic chain, and spinal cord were dissected out from the perfused rats. The neuronal labeling with AF 488/594-CTB was directly observed on the sections under a fluorescent microscope or a laser scanning confocal microscope. RESULTS: All neural labeling was observed in the injection side. The sensory neurons associated with both acupoint BL 23 and adrenal gland distributed from thoracic (T) 10 to lumbar (L) 2 DRG with high concentration in T 12-T 13 and T 11-T 12, respectively, in which some of them were simultaneously labeled with both AF 488/594-CTB and located in T 12-L 1 DRG. For the sympathetic innervation, the postganglionic neurons correlated with BL 23 and adrenal gland were labeled with AF 488/594-CTB separately in the sympathetic chain at the lumbar segments, while the labeled preganglionic neurons were only observed at the lateral horn of T 11-T 13 spinal segments in the cases of adrenal gland. In addition, the labeled motor neurons were mainly detected in the spinal ventral horn at cervical (C) 7-C 8 and T 11-L 1 segments. CONCLUSION: These results indicate that there are segmental correlation between BL 23 and adrenal gland on the sensory and sympathetic innervations, and this correlation might be a neural pathway for modulating the function role of adrenal gland through BL 23 needling.

The Therapeutic Effect of Postganglionic Nerve Block for Symptomatic Schmorl Nodule: A Retrospective Case Series

STUDY DESIGN: Retrospective case series. OBJECTIVES: We retrospectively evaluated the clinical efficacy of postganglionic nerve block in symptomatic Schmorl nodules (SNs). SUMMARY OF LITERATURE REVIEW: SNs are common lesions that are often asymptomatic. In certain cases, SNs have been reported to cause severe axial back pain, thereby considerably impacting patients' quality of life. No consensus currently exists on the treatment of symptomatic SNs. MATERIALS AND METHODS: From October 2015 to October 2017, a total of 21 patients with symptomatic SNs diagnosed by magnetic resonance imaging (MRI) that did not respond to conservative treatment after 4 weeks were included in the study. All patients received postganglionic nerve block. We evaluated effective pain relief (improvement of back pain of more than 50% compared with before the intervention) and functional improvements, assessed by visual analogue scale (VAS) and Oswestry Disability Index scores obtained at 4 hours, 4 weeks, 8 weeks, 3 months, and 6 months after the procedure. RESULTS: Symptomatic SNs were more common at the L2-3 level, and the lower end plate was more commonly involved than the upper end plate. Eighteen of the 21 patients (85.7%) showed effective pain relief, and no deterioration was observed within the follow-up period. Throughout the follow-up period, the VAS remained significantly improved compared to before the procedure (p < 0.05). Complications were not reported in any cases. CONCLUSIONS: Postganglionic nerve block for symptomatic SNs that do not respond to conservative treatment is a non-invasive modality for pain relief.

EXPERIMENTAL MORPHOLOGIC STUDY ON THE ARTIFICIAL BLADDER REFLEX ARC ESTABLISHED BY ABDOMINAL REFLEX AFTER SPINAL CORDINJURY / 解放军医学杂志

To study the neural morphological basis of the "abdominal reflex spinal cord center bladder" artificial bladder reflex arc established by abdominal reflex. It is achieved by intradural microanastomosis of the right T 13 ventral root was anastomosed under microscope to S 2 ventral root by autogenous nerve grafting intraduraly, with the right T 13 dorsal root remaining intact and the right L 5 ～S 4 ventral roots severed. three to four months were allowed to achieve axonal regeneration, and new "abdominal reflex spinal cord center bladder" artificial bladder reflex pathway was established. Eight months after the operation, it was seen under light microscopy that regenerative nerve fibers of ventral root of T 12 had grown through the anastomotic site to distal nerve root. Under electron microscopy, nerve endings in the detrusor of the bladder were seen on the experimental side. The basic structure of the junction between parasympathetic nerve endings and bladder detrusor cells on the experimental side was similar to that on the control side. These features were not seen in the control group. The results suggested that the somatic motor axons above the lumbosacral paraplegia level could innervate bladder parasympathetic ganglion cells, and thereby transfersed somatic reflex activity to the bladder detrusor muscle, which was the morphological basis of the artificial bladder reflex arc leading to controllable micturition

Gut Dysmotility in Selective Postganglionic Cholinergic Dysautonomia / 대한소화관운동학회지

Postganglionic cholinergic dysautonomia is a rare disease characterized by impaired secretion of tears and saliva, generalized absence of sweating, lack of cardiac response to carotid massage and atony of the gastrointestinal tract and urinary bladder. Autonomic function tests show the preservation of sympathetic adrenergic functions in contrast to the generalized involvement of postganglionic parasympathetic and sympathetic cholinergic nerves. Recently, we experienced a patient with gut dysmotility in selective postganglionic cholinergic dysautonomia. She is now being treated with bethanechol and milk of magnesia and has experienced minimal symptom improvement.