Electroacupuncture at Sensitized Acupoints Relieves Somatic Referred Pain in Colitis Rats by Inhibiting Sympathetic-Sensory Coupling to Interfere with 5-HT Signaling Pathway / 中国结合医学杂志

OBJECTIVE@#To investigate whether electroacupuncture (EA) at sensitized acupoints could reduce sympathetic-sensory coupling (SSC) and neurogenic inflammatory response by interfering with 5-hydroxytryptamine (5-HT)ergic neural pathways to relieve colitis and somatic referred pain, and explore the underlying mechanisms.@*METHODS@#Rats were treated with 5% dextran sodium sulfate (DSS) solution for 7 days to establish a colitis model. Twelve rats were randomly divided into the control and model groups according to a random number table (n=6). According to the "Research on Rat Acupoint Atlas", sensitized acupoints and non-sensitized acupoints were determined. Rats were randomly divided into the control, model, Zusanli-EA (ST 36), Dachangshu-EA (BL 25), and Xinshu (BL 15) groups (n=6), as well as the control, model, EA, and EA + GR113808 (a 5-HT inhibitor) groups (n=6). The rats in the control group received no treatment. Acupuncture was administered on 2 days after modeling using the stimulation pavameters: 1 mA, 2 Hz, for 30 min, with sparse and dense waves, for 14 consecutive days. GR113808 was injected into the tail vein at 5 mg/kg before EA for 10 min for 7 consecutive days. Mechanical sensitivity was assessed with von Frey filaments. Body weight and disease activity index (DAI) scores of rats were determined. Hematoxylin and eosin staining was performed to observe colon histopathology. SSC was analyzed by immunofluorescence staining. Immunohistochemical staining was performed to detect 5-HT and substance P (SP) expressions. The calcitonin gene-related peptide (CGRP) in skin tissue and tyrosine hydroxylase (TH) protein levels in DRG were detected by Western blot. The levels of hyaluronic acid (HA), bradykinin (BK), prostaglandin I2 (PGI2) in skin tissue, 5-HT, tryptophan hydroxylase 1 (TPH1), serotonin transporters (SERT), 5-HT 3 receptor (5-HT3R), and 5-HT 4 receptor (5-HT4R) in colon tissue were measured by enzyme-linked immunosorbent assay (ELISA).@*RESULTS@#BL 25 and ST 36 acupoints were determined as sensitized acupoints, and BL 15 acupoint was used as a non-sensitized acupoint. EA at sensitized acupoints improved the DAI score, increased mechanical withdrawal thresholds, and alleviated colonic pathological damage of rats. EA at sensitized acupoints reduced SSC structures and decreased TH and CGRP expression levels (P<0.05). Furthermore, EA at sensitized acupoints reduced BK, PGI2, 5-HT, 5-HT3R and TPH1 levels, and increased HA, 5-HT4R and SERT levels in colitis rats (P<0.05). GR113808 treatment diminished the protective effect of EA at sensitized acupoints in colitis rats (P<0.05).@*CONCLUSION@#EA at sensitized acupoints alleviated DSS-induced somatic referred pain in colitis rats by interfering with 5-HTergic neural pathway, and reducing SSC inflammatory response.

Clinical Study of Modified Shenqi Pill （肾气丸） Plus Tongdu Tiaoshen Acupuncture （通督调神针刺） for Neurogenic Bladder After Spinal Cord Injury of Kidney-Yang Deficiency Syndrome / 中医杂志

ObjectiveTo observe the clinical efficacy of modified Shenqi Pill （肾气丸） plus Tongdu Tiaoshen Acupuncture （通督调神针刺） in the treatment of neurogenic bladder after spinal cord injury of kidney-yang deficiency syndrome. MethodsForty-six patients were randomly divided into 23 cases each in the control group and the treatment group. Both groups were given conventional treatment， i.e. oral methylcobalamin tablets （0.5 mg each time， 3 times a day） and paraplegic conventional acupuncture （once a day， 6 consecutive days a week）. The control group was given simple bladder function rehabilitation training on the basis of the conventional treatment； and the treatment group was given modified Shenqi Pill orally （1 dose a day， 150 ml each time， taken warmly in morning and evening） and Tongdu Tiaoshen Acupuncture （once a day， 6 consecutive days per week） in addition to what were given to the control group. The treatment course lasted for 4 weeks. The 24 h urination frequency， 24 h urine leakage frequency， 24 h single urine volume， bladder residual urine volume， international lower urinary tract symptom （LUTS） score， traditional Chinese medicine （TCM） syndrome score were compared between the two groups， and clinical effectiveness and TCM syndrome effectiveness were compared between the two groups after treatment. ResultsTwenty patients in each group were finally analyzed in this study. The number of 24 h urination， the number of 24 h urine leakage， bladder residual urine volume， LUTS score， and the TCM syndrome scores decreased after treatment in both groups， and the 24 h single urine volume increased （P＜0.01）； and much more improvement was found of each index in the treatment group than in the control group （P＜0.05 or P＜0.01）. The total clinical effectiveness and TCM syndrome effectiveness in the treatment group was 85.00% （17/20） respectively， which were statistically significantly higher than 45.00% （the total clinical effectiveness， 9/20） and 60.00% （TCM syndrome effectiveness， 12/20） in the control group （P＜0.01）. ConclusionModified Shenqi Pill plus Tongdu Tiaoshen Acupuncture can signi-ficantly improve the clinical symptoms of neurogenic bladder patients after spinal cord injury of kidney-yang deficiency syndrome， having better effectiveness than simple bladder function rehabilitation training， and its mechanism may be related to the improvement of the injured nerve function innervating the bladder.

Dynamic and static ultrasound features predictive of vesicoureteral reflux and renal damage in children and adolescents with neurogenic bladder

ABSTRACT Purpose: This study aimed to analyze the diagnostic accuracy of dynamic and static ultrasound (DSUS) in detecting vesicoureteral reflux (VUR) and renal scarring in a cohort of children with neurogenic bladder (NB). Materials and Methods: A retrospective, longitudinal, observational study was conducted using the Reporting Diagnostic Accuracy Studies guideline. The DSUS (index test) data were compared with voiding cystourethrography (VCUG) and renal scintigraphy 99mTc-dimercaptosuccinic (reference tests). Overall performance for predicting VUR and renal scarring was assessed using renal pelvic diameter (RPD)/distal ureteral diameter and renal parenchymal thinning on DSUS, respectively. Results: A total of 107 patients (66 girls, median age 9.6 years) participated. Seventeen patients (15.9%) presented VUR, eight bilateral. For overall reflux grade, the AUC was 0.624 for RPD and 0.630 for distal ureteral diameter. The diagnostic performance for detecting high-grade VUR was slightly better for DSUS parameters. The AUC was 0.666 for RPD and 0.691 for distal ureteral diameter. The cut-offs of 5 mm for RPD and 6.5 mm for distal ureteral diameter presented the best diagnostic odds ratio (DOR) to identify high-grade VUR. The increase of RPD during detrusor contractions showed an accuracy of 89.2%. The thinness of renal parenchyma presented an accuracy of 88% for renal scarring. Conclusion: DSUS predicts VUR and renal scarring in children with NB with fair to good accuracy, and all measurements exhibited a high negative predictive value (NPV). The increase in RPD during voiding or detrusor contractions proved to be the most accurate parameter for indicating the presence of VUR in this study.

Diagnóstico y tratamiento de pacientes con vejiga neurogénica en la Unidad Técnica de Cirugía Pediátrica / Diagnosis and treatment of patients with Neurogenic bladder in the Surgery Technical Unit Pediatric

El presente trabajo toma como base el documento: "Manejo Urológico del Mielomeningocele" de las Guías de Atención Pediátrica, del Hospital De Pediatría "Juan P. Garrahan" de la ciudad de Buenos Aires - Argentina; de los autores: Dra. Carol Burek y Dra. Liliana Campmany. En la Unidad Técnica de Cirugía Pediátrica del Hospital de Especialidades Carlos Andrade Marín, se atienden por mes unos 50 a 70 pacientes afectos de vejiga neurogénica desde el nacimiento hasta la adolescencia. Es una enfermedad crónica que requiere un diagnóstico correcto con estudios de imagen y función de la vía urinaria además de un posterior manejo diario por parte de los padres con la guía del médico especialista.

This work is based on the document: "Urological Management of Myelomeningocele" from the Pediatric Care Guidelines of the Hospital De Pediatría "Juan P. Garrahan" of the city of Buenos Aires - Argentina; by the authors: Dr. Carol Burek and Dr. Liliana Campmany. In the Pediatric Surgery Technical Unit of the Carlos Andrade Marín Specialties Hospital, 50 to 70 patients affected by neurogenic bladder from birth to adolescence are treated every month. It is a chronic disease that requires a correct diagnosis with imaging and urinary tract function studies, as well as subsequent daily management by the parents under the guidance of the specialist.

A rare case of migrainous left bell抯 palsy after migrainous right external ophthalmoplegia - A case report

Migraine increased the risk of Bell palsy in the total population. Among migraine patients, between ?30 and <60 years old are at an increased risk of Bell palsy. A migraine is a primary headache characterized by recurrent headache attacks triggered by various factors. As much as 10% of the global population is thought to experience migraine headaches. It was earlier considered that migraine headaches were triggered by the dilation of cerebral vessels, and the recent evidence supports that migraine attacks can also occur in the absence of vasodilation. According to the researchers, the direct neural effects from the trigeminal nerve to the facial nerve could contribute to the risk of facial palsy among patients with migraine. An alteration of the trigeminovascular function has been suggested to trigger migraines. The neurogenic inflammation of the facial nerve trunk caused by its proximity to the dilated posterior auricular/ stylomastoid/ occipital and superficial temporal arteries during a migraine attack leads to a temporary lower motor neuron type of paresis of the muscles supplied by the facial nerve. We herewith report a rare case of migrainous left Bell抯 palsy after migrainous right external ophthalmoplegia, treated with Sumatriptan.

[Errata] Estudo piloto sobre diâmetro do canal lombar e distância percorrida em pacientes com estenose espinhal lombar: um modelo de predição multivariado / [Erratum] Pilot study on lumbar canal diameter and walking distance in patients with lumbar spinal stenosis: a multivariate prediction model

INTRODUCTION: Neurogenic claudication (NC) is the classic clinical presentation of patients with Lumbar Spinal Stenosis (LSS). These patients may or may not present with symptoms of leg pain and difficulty walking. These symptoms are exacerbated while walking and standing and are eased by sitting or bending forward. METHOD: Patients with LSS, having a lumbar canal diameter of ≤12mm, were recruited from a recognized Tertiary care hospital. Each subject's demographic characteristics and anthropometrics were noted, and the testing procedure was explained. The canal diameter was documented with the help of an MRI report. A self-paced walking test was used to assess the walking distance. STATISTICAL ANALYSIS: Depending on the normality of the data, the Pearson correlation coefficient (r) was used to find the correlation between canal diameter at different lumbar levels and walking distance in patients with LSS. RESULT: Pearson correlation coefficient (r) determined a fair positive correlation (r = 0.29) between lumbar canal diameter and walking distance. Stepwise multiple regression analysis was done, and a prediction equation was found for different levels of canal stenosis. CONCLUSION: Findings of our present study suggest a fair positive correlation between walking distance and canal diameter at L5-S1. This study may also be useful in predicting the approximate canal diameter by estimating the walking distance of the patient with symptoms of LSS and vice-versa.

INTRODUÇÃO: A claudicação neurogênica (CN) é a apresentação clínica clássica de pacientes com Estenose Espinhal Lombar (EEL). Esses pacientes podem ou não apresentar sintomas de dor nas pernas e dificuldade para caminhar. Esses sintomas são exacerbados ao caminhar e ficar em pé e são aliviados ao sentar ou inclinar-se para a frente. MÉTODO: Pacientes com EEL, com diâmetro do canal lombar ≤12mm, foram recrutados em um hospital terciário reconhecido. As características demográficas e antropométricas de cada sujeito foram anotadas e o procedimento do teste foi explicado. O diâmetro do canal foi documentado com a ajuda de um relatório de ressonância magnética. Um teste de caminhada individualizado foi usado para avaliar a distância percorrida. ANÁLISE ESTATÍSTICA: Dependendo da normalidade dos dados, o coeficiente de correlação de Pearson (r) foi usado para encontrar a correlação entre o diâmetro do canal em diferentes níveis lombares e a distância percorrida em pacientes com EEL. RESULTADO: O coeficiente de correlação de Pearson (r) determinou uma correlação positiva razoável (r = 0,29) entre o diâmetro do canal lombar e a distância percorrida. Análise de regressão múltipla stepwise foi feita, e uma equação de predição foi encontrada para diferentes níveis de estenose do canal. CONCLUSÃO: Os achados de nosso estudo sugerem uma correlação positiva razoável entre a distância percorrida e o diâmetro do canal em L5-S1. Este estudo também pode ser útil para prever o diâmetro aproximado do canal, estimando a distância percorrida pelo paciente com sintomas de EEL e vice-versa.

Validation of the Vancouver Symptom Score Questionnaire for bladder and bowel dysfunction for Brazilian children and adolescents

ABSTRACT Objective: This study aimed to translate, and perform a cross-cultural adaptation, and validation of the Vancouver Symptom Score (VSS) for bladder and bowel dysfunction (BBD) for Brazilian children and adolescents Materials and Methods: Six steps were performed for the translation and cross-cultural adaptation: (1) translation, (2) synthesis of translations, (3) back-translation, (4) pre-final version of the translated instrument, (5) pilot test and degree of comprehensibility and (6) elaboration of the Brazilian version of the VSS. For validation, the Brazilian Dysfunctional Voiding Score (DVSS) questionnaire was used. Results: Validation was performed on a sample of 107 children and adolescents with a mean age of 9.2 ± 2.84 years, presenting BBD and 107 without BBD (control group-CG). There was a positive correlation (r = 0.91, 95% CI 0.88 to 0.93, p < 0.0001) between total VSS score and total DVSS score. VSS was higher in patients with BBD (p < 0.0001). The internal consistency estimated by Cronbach's alpha was 0.87 for patients with BBD. The VSS showed excellent diagnostic accuracy in detecting cases, with an area under the ROC curve of 98% (95% CI 0.96 to 0.99, p < 0.001). A cut-off value of >11 points produced a sensitivity of 100% (95% CI 96.4% to 100%) and a specificity of 91.8% (95% CI 85.1% to 95.6%). Conclusion: The translated, cross-culturally adapted, and validated VSS for the Brazilian population is a reliable and valid tool to identify symptoms of BBD in children and adolescents aged five to 16 years, whose first language is Brazilian Portuguese.

Glia function in the endocanabinoid system: narrative review / Função da glia no sistema endocanabinoide: revisão narrativa

ABSTRACT BACKGROUND AND OBJECTIVES: Evidence has highlighted a role of glial cell activation, and their interaction with different neural systems, especially the endocannabinoid system, in the mechanisms involved in the chronicity and maintenance of pain. The aim of this review is to bring an update on published data that demonstrate the interaction between glial cells and the endocannabinoid system in the pathophysiology of chronic pain and its treatment. CONTENTS: A narrative review was performed based on a research in the Medline database, using the Keywords "endocannabinoid", "glial cells", "microglial", "astrocytes", "neuroinflammation". CONCLUSION: Deepening the knowledge about the function of glial cells in the endocannabinoid system will open the possibility of acting on the pathophysiological origin of the pain chronification process, attenuating the mechanisms involved in central sensitization.

RESUMO JUSTIFICATIVA E OBJETIVOS: A evidência científica tem ressaltado um papel da ativação das células da glia e de sua interação com diversos sistemas neurais, com destaque para o sistema endocanabinoide e mecanismos envolvidos na cronificação e manutenção da dor. O objetivo deste estudo foi atualizar os dados publicados que mostrem a interação entre as células da glia com o sistema endocanabinoide na fisiopatologia da dor crônica e seu tratamento. CONTEÚDO: Foi realizada uma revisão narrativa baseada em pesquisa na base de dados Medline, com uso dos unitermos "endocannabinoid", "glial cells", "microglial", "astrocytes", "neuroinflammation". CONCLUSÃO: O aprofundamento do conhecimento acerca da função das células da glia no sistema endocanabinoide abrirá a possibilidade de atuação sobre a origem fisiopatológica do processo de cronificação de dor, atenuando os mecanismos envolvidos na sensibilização central.

Tumor de células granulares de vulva: un raro tumor genital benigno / Granular cell tumor of vulva: a rare benign genital tumor

Resumen ANTECEDENTES: El tumor de células granulares de la vulva es poco común y de origen neurogénico. Afecta, principalmente, a mujeres entre 60 y 70 años y es más frecuente en la raza negra. CASO CLÍNICO: Paciente de 63 años, con una lesión vulvar indolora y no pruriginosa, en crecimiento. En la exploración se observó una lesión excrecente de 2.5 cm en la región superior del labio mayor izquierdo, dura, vascularizada y con infiltración a 2 cm de profundidad. No se palparon adenopatías sospechosas. Luego del reporte de la biopsia, sugerente de tumor de células granulares, se practicó una escisión completa, con márgenes libres. El estudio inmunohistoquímico se reportó positivo para CD68, S100 y TFE3 lo que confirmó el diagnóstico. Puesto que el índice proliferativo (Ki67) fue inferior al 5% y los márgenes quirúrgicos estaban libres, no se requirió tratamiento adyuvante. La paciente permanece en seguimiento y sin signos de recidiva. CONCLUSIÓN: Si bien los tumores de células granulares de la vulva son poco comunes y casi siempre benignos, deben incluirse en el diagnóstico diferencial de una tumoración vulvar. La inmunohistoquímica es la herramienta más útil para el diagnóstico preciso y su tratamiento de elección es la escisión local amplia, por su tendencia a la recurrencia local.

Abstract BACKGROUND: Granular cell tumor of the vulva is rare and neurogenic in origin. It mainly affects women between 60 and 70 years of age and is more frequent in black women. CLINICAL CASE: A 63-year-old woman with a painless, non-pruritic, growing vulvar lesion. Examination revealed a 2.5 cm excrescent lesion in the upper region of the left labium majus, hard, vascularized and infiltrated to a depth of 2 cm. No suspicious lymph nodes were palpated. After the biopsy report, suggestive of granular cell tumor, complete excision was performed, with free margins. The immunohistochemical study was positive for CD68, S100 and TFE3 which confirming the diagnosis. Since the proliferative index (Ki67) was less than 5% and the surgical margins were clear, adjuvant treatment was not required. The patient remains in follow-up with no signs of recurrence. CONCLUSION: Although granular cell tumors of the vulva are rare and almost always benign, they should be included in the differential diagnosis of a vulvar tumor. Immunohistochemistry is the most useful tool for accurate diagnosis and their treatment of choice is wide local excision because of their tendency for local recurrence.

Transanal irrigation to manage neurogenic bowel in the pediatric population with spina bifida: a scoping review

Abstract Objective To map available scientific evidence about the pediatric population with spina bifida submitted to transanal irrigation to manage signs and symptoms of neurogenic bowel. Source of data This research was developed according to recommendations from the Joanna Briggs Institute Reviewers' Manual and the PRISMA Extension for Scoping Reviews. Searches were carried out in the databases: CINAHL, Medline/Pubmed, Scielo, Scopus, Web of Science, Embase, LILACS, Proquest, and the CAPES catalog of theses and dissertations. Quantitative and qualitative studies on the topic were included, as long as they dealt with this population. There was no predetermined time frame. Summary of the findings The authors found 1.020 studies, selected 130 for close reading, and included 23 in the review, all of which had been published from 1989 to 2021. The authors mapped the characteristics of the studies, including their definitions of concepts and use of scales, criteria for the indication of transanal irrigation, training to carry out the procedure, devices and solutions used, number and frequency of transanal irrigations, health care actions, time spent, associated complications, complementary exams, adherence rate, follow-up, and outcomes, focusing on the benefits for bowel management. Conclusions Despite the variability of evaluation parameters and term definitions, evidence suggests that transanal irrigation is a safe and effective method to manage fecal incontinence. Studies in the field are likely to grow, using standardized scales and longitudinal follow-ups. The authors suggest further research on transanal irrigation in the pediatric population with spina bifida in the Latin American context.

Cuidados de enfermagem em programas de reeducação intestinal para pacientes com intestino neurogênico / Nursing care in bowel re-education programs for patients with neurogenic bowel / Cuidados de enfermería en programas de reeducación intestinal para pacientes con intestino neurogénico

RESUMO Objetivo: analisar as evidências disponíveis sobre os cuidados de enfermagem em Programas de Reeducação Intestinal para pacientes com Intestino Neurogênico com constipação. Método: estudo bibliográfico, descritivo, tipo revisão integrativa de artigos publicados entre 2011 e 2021 nas bases de dados LILACS, SciELO, BDENF, SCOPUS e PubMed, utilizando os descritores "Intestino Neurogênico"; "Constipação"; "Enfermagem"; "Neurogenic Bowel"; "Constipation" e "Nursing". A análise foi realizada através da leitura reflexiva e criteriosa acerca da temática do estudo. Resultados: percebeu-se que os cuidados de enfermagem realizados com maior frequência em pacientes com intestino neurogênico incluíam: massagem intestinal, prensa abdominal, treino do vaso, estimulação dígito-anal, irrigação transanal e uso de supositórios, contribuindo positivamente para a instituição de um Programa de Reeducação Intestinal efetivo e seguro. Conclusão: o presente estudo contribui para as ações de cuidados de enfermagem de paciente com IN e para divulgação dos achados sobre os benefícios do Programa de Reeducação Intestinal.

ABSTRACT Objective: to analyze the available evidence on nursing care in Bowel Reeducation Programs for Neurogenic Bowel patients with constipation. Method: bibliographic, descriptive, integrative review type study of articles published between 2011 and 2021 in the LILACS, SciELO, BDENF, SCOPUS, and PubMed databases, using the descriptors "Neurogenic Bowel"; "Constipation"; "Nursing"; "Neurogenic Bowel"; "Constipation" and "Nursing". The analysis was performed through reflective and careful reading about the theme of the study. Results: it was perceived that the most frequently performed nursing care in patients with neurogenic bowel included: bowel massage, abdominal press, vessel training, digit-anal stimulation, transanal irrigation, and use of suppositories, contributing positively to the institution of an effective and safe Bowel Re-education Program. Conclusion: the present study contributes to the nursing care actions of patients with NB and to the dissemination of findings on the benefits of the Bowel Reeducation Program.

RESUMEN Objetivo: analizar las evidencias disponibles sobre los cuidados de enfermería en los Programas de Reeducación Intestinal para pacientes con Intestino Neurogénico y estreñimiento. Método: revisión bibliográfica, descriptiva, integradora de artículos publicados entre 2011 y 2021 en las bases de datos LILACS, SciELO, BDENF, SCOPUS y PubMed, utilizando los descriptores "Neurogenic Bowel"; "Constipation"; "Nursing"; "Neurogenic Bowel"; "Constipation" y "Nursing". El análisis se realizó a través de una lectura reflexiva y cuidadosa sobre el tema del estudio. Resultados: se percibió que los cuidados de enfermería más frecuentemente realizados en pacientes con intestino neurogénico incluían: masaje intestinal, prensa abdominal, entrenamiento de vasos, estimulación digitoanal, irrigación transanal y uso de supositorios, contribuyendo positivamente para la institución de un Programa de Reeducación Intestinal eficaz y seguro. Conclusión: el presente estudio contribuye a las acciones de cuidados de enfermería de los pacientes con IN y a la difusión de los resultados sobre los beneficios del Programa de Reeducación Intestinal.

Adesão ao autocuidado do paciente com disfunção neurogênica do trato urinário inferior: validação de instrumento / Adherence to self-care in patients with neurogenic lower urinary tract dysfunction: instrument validation / Adherencia al autocuidado en pacientes con disfunción neurogénica del tracto urinario inferior: validación de un instrumento

RESUMO Objetivo: construir e validar o conteúdo do instrumento de adesão ao autocuidado de pacientes com Disfunção Neurogênica do Trato Urinário Inferior que realizam o autocateterismo intermitente quanto a aparência e conteúdo. Método: Estudo metodológico de validação de conteúdo de instrumento, composto por três etapas: revisão da literatura, construção do instrumento e validação de instrumento, respectivamente. A análise foi realizada através do modelo de Agree, e pelo cálculo de índice de validação de conteúdo, entre 2020 e 2021. Resultados: O Agree II, apresentou resultado de 85,6% e 84,5% para validação dos domínios escopo e finalidade e partes interessadas. Na validação de conteúdo, o item histórico familiar foi retirado do instrumento com índice de vaidade de conteúdo de 0,77. Conclusão: O instrumento contribuirá para oferecer subsídios para a prática profissional e aos pacientes portadores da disfunção.

ABSTRACT Objective: To build and validate the content of the instrument for adherence to self-care for patients with Neurogenic Lower Urinary Tract Dysfunction who perform intermittent self-catheterization as to appearance and content. Method: Methodological study of instrument content validation, composed of three stages: literature review, instrument construction and instrument validation, respectively. The analysis was performed using the Agree model, and by calculating the content validation index, between 2020 and 2021. Results: Agree II, showed a result of 85.6% and 84.5% for validation of the scope and purpose and stakeholder domains. In content validation, the family history item was removed from the instrument with a content vanity index of 0.77. Conclusion: The instrument will contribute to offering subsidies for professional practice and to patients with the dysfunction.

RESUMEN Objetivo: construir y validar el contenido del instrumento de adición al autocuidado de pacientes con disfunción neurogénica del tracto urinario inferior que realizan el autocateterismo intermitente en cuanto a la apariencia y el contenido. Método: Estudio metodológico de validación de contenido de instrumentos, compuesto por tres etapas: revisión bibliográfica, construcción de instrumentos y validación de instrumentos, respectivamente. El análisis se realizó utilizando el modelo de Agree, y mediante el cálculo del índice de validación de contenido, entre 2020 y 2021. Resultados: El Agree II, mostró un resultado de 85,6% y 84,5% para la validación de los dominios de alcance y propósito y partes interesadas. En la validación de contenido, el ítem histórico familiar fue retirado del instrumento con un índice de vanidad de contenido de 0,77. Conclusión: El instrumento contribuirá a ofrecer subsidios para la práctica profesional y a los pacientes con disfunción.

Development of an educational technology on clean intermittent bladder catheterization in children to instruct family members / Desarrollo de una tecnología educativa sobre cateterismo vesical intermitente limpio en niños para orientar a los familiares / Desenvolvimento de tecnologia educacional sobre cateterismo vesical intermitente limpo em crianças para orientação de familiares

ABSTRACT Objectives: to prepare and validate an illustrated guide to instruct family members on clean intermittent bladder catheterizarion in children. Method: a methodological research study carried out between January 2021 and February 2022 and developed in three stages: Bibliographical review and elaboration of the illustrated guide; Content validation by expert judges (Delphi technique); and Validation of the response process by representatives of the target audience. The study was conducted in the specialties outpatient service of a large-sized university hospital from the municipality of São Paulo, Brazil. The sample consisted of 18 expert judges and 9 mothers of children undergoing clean intermittent bladder catheterization and in outpatient care. Agreement levels equal to or greater than 80% were considered as consensus, and a 0.80 rate was the acceptable minimum for the Content Validity Index. Results: the illustrated guide consists in 18 sessions, from the step-by-step instructions for clean intermittent bladder catheterization to including children in the procedure. In the first and second validation rounds with the evaluators, Content Validity Index values of 0.8 and 1.0 were obtained, respectively. In the validation by the target audience, 100% agreement was reached in the understanding, Appeal, Self-efficacy, Cultural acceptability and Persuasion domains. Conclusion: the illustrated guide proved to be valid in terms of content by the judges and family members, with the potential to mediate the educational practice in care settings for children in need of clean intermittent bladder catheterization.

RESUMEN Objetivos: elaborar y validar una guía ilustrada para orientar a los familiares sobre el cateterismo vesical intermitente limpio en niños. Método: investigación metodológica realizada entre enero de 2021 y febrero de 2022 y desarrollada en tres etapas: Revisión bibliográfica y elaboración de la guía ilustrada; Validación del contenido a cargo de jueces especialistas (técnica Delphi); y Validación del proceso de respuesta por parte de representantes de la población objetivo. El estudio se condujo en el servicio ambulatorio de especialidades de un hospital universitario de gran porte del municipio de San Pablo, Brasil. La muestra estuvo compuesta por 18 jueces especialistas y 9 madres de niños sometidos a cateterismo vesical intermitente limpio y se encontraban en tratamiento ambulatorio. Un nivel de concordancia de al menos el 80% se consideró como consenso, al igual que el índice de 0,80 como concordancia mínima aceptable para el Índice de Validez de Contenido. Resultados: la guía ilustrada consta de 18 sesiones, desde las instrucciones paso a paso para realizar el cateterismo vesical intermitente limpio hasta la inclusión de los niños en el procedimiento. En la primera ronda de validación con los jueces se obtuvo un Índice de Validez de Contenido superior a 0,8 y, en la segunda ronda, dicho índice fue 1,0. En la validación por parte de la población objetivo se obtuvo 100% de concordancia en los dominios de Comprensión, Aspecto atractivo, Autoeficacia, Aceptabilidad cultural y Persuasión. Conclusión: la guía ilustrada demostró ser válida en cuanto al contenido según la evaluación de los jueces y familiares, con potencial para mediar la práctica educativa en situaciones de atención a niños que precisan cateterismo vesical intermitente limpio.

RESUMO Objetivos: elaborar e validar um guia ilustrado para orientações de familiares sobre o cateterismo vesical intermitente limpo em crianças. Método: pesquisa metodológica, realizada entre janeiro de 2021 e fevereiro de 2022, desenvolvida em três etapas: revisão bibliográfica e elaboração do guia ilustrado; validação de conteúdo por juízes especialistas (técnica Delphi) e validação de processo de resposta por representantes do público-alvo. O estudo foi conduzido no ambulatório de especialidades de um hospital universitário de grande porte do município de São Paulo, Brasil. A amostra foi composta por 18 juízes especialistas e 9 mães de crianças que realizavam cateterismo vesical intermitente limpo e estavam em atendimento ambulatorial. Foi considerado consenso concordância igual ou superior a 80%, e taxa de 0,80 como concordância mínima aceitável para o índice de validade de conteúdo. Resultados: o guia ilustrado é composto por 18 sessões, desde o passo a passo do cateterismo vesical intermitente limpo até a inclusão da criança no procedimento. Na primeira rodada de validação com juízes, obteve-se índice de validade de conteúdo maior que 0,8 e, na segunda rodada, de 1,0. Na validação por parte do público-alvo obteve-se 100% de concordância nos domínios compreensão, atratividade, autoeficácia, aceitabilidade cultural e persuasão. Conclusão: o guia ilustrado mostrou-se válido quanto ao conteúdo pelos juízes e familiares com potencial para mediar a prática educativa em cenários de cuidado à criança com necessidade de cateterismo vesical intermitente limpo.

Elderly Neurogenic Orthostatic Hypotension Treated Mainly with Fire Needling on Governor Vessel （督 脉）：A Case Report / 中医杂志

Neurogenic orthostatic hypotension （nOH） is a common neurodegenerative disease， and is usually differentiated as kidney-yang depletion syndrome in traditional Chinese medicine （TCM）. Fire needling on governor vessel （督脉） acupoints as well as Shenshu （BL 23） and Zhishi （BL 52） can dredge the qi and blood of governor vessel， so as to warm yang and unblock the channels， supplement essence and boost marrow. A case of elderly nOH treated by fire needling mainly at governor vessel points， Shenshu （BL 23） and Zhishi （BL 52） was reported. After nearly two months of treatment， the patient's orthostatic blood pressure difference and yang deficiency-related symptoms were significantly improved， and the results of blood pressure monitoring， TCM syndrome scale evaluation and Shenshu （BL 23） area infrared imager detection all showed definite clinical effect.

Changes of bladder morphology and function and effect on upper urinary tract dilatation at different time after lumbosacral nerve transecting in rats / 中华泌尿外科杂志

Objective:To investigate the changes in the morphology, structure and function of the bladders and their effects on the upper urinary tract dilatation(UUTD) after lumbosacral nerve transecting in rats.Methods:A total of 45 female SD rats were included, randomly divided into 3 groups with 15 rats in each group. Two groups were performed bilateral lumbar 6(L6) and cauda equina nerve shearing to establish neurogenic bladder(NB) model, which were nerve transected for 4 weeks(NB-4W) group and nerve transected for 12 weeks(NB-12W) group. Another group was performed bilateral L6 nerves and cauda equine exposing but not transecting, which was sham-operation (Sham) group. Cystometry and renal ultrasound examination were performed and rats in each group were killed to collect the kidney and bladder tissues in NB-4W group at 4 weeks, in Sham group and NB-12W group at 12 weeks after operation. HE, Masson staining, immunohistochemical staining and western blot were used to detect histological changes, expression of transforming growth factor-β1(TGF-β1) and α-smooth muscle actin(α-SMA).Results:All rats in NB-4W and NB-12W group showed acontractile detrusor. In the NB-4W and NB-12W group, the maximum cystometric capacity [(5.84±0.33) ml and (3.13±0.35) ml], the detrusor leak point pressure [(25.41±0.86) cm H 2O and (27.36±2.04) cm H 2O] (1 cm H 2O = 0.098 kPa), were significantly higher than those in the Sham group [(0.98±0.14) ml, (7.13±0.90) cm H 2O, both P<0.05]. Compliance in NB-4W group [(0.28±0.21) ml/cm H 2O] and NB-12W group [(0.17±0.12) ml/cm H 2O] were significantly lower than that of the Sham group [(0.34±0.26) ml/cm H 2O], and the compliance of NB-12W group was lower than that of NB-4W group significantly (all P<0.05). HE staining of the bladder showed that the inflammatory cell infiltration was obvious in the NB-4W and NB-12W group. Bladder collagen volume fractions in NB-4W group [(30.5±1.5) %] and NB-12W group [(45.2±3.8) %] were both higher than that of Sham group [(20.7±2.2) %, both P<0.05]. The expression of TGF-β1 and α-SMA in the bladder tissue of NB-4W group were higher than those of sham group, and that of NB-12W group were higher than NB-4W group. In NB-4W group and NB-12W group, 3 (20.0 %) and 7 (46.7 %) rats were found hydronephrosis, respectively. Additionally, HE staining showed that the degree of renal tubule injury and the number of inflammatory cell infiltration in the NB-4W and NB-12W group were higher than those in the Sham group. Masson staining showed that the volume fraction of collagen in kidneys of NB-4W and NB-12W group were (13.1±1.4) % and (21.6±1.9) %, respectively, which were significantly higher than that in sham operation group [(4.6±0.7) %, both P<0.05]. Conclusions:Bilateral L6 + cauda equina nerve transecting can induce NB with hydronephrosis in parts of rats. The degree of bladder fibrosis gradually increased with the time of nerve transection, and the incidence and severity of UUTD also increased with the time of nerve transection.

Analysis of the effect of one-stage transurethral prostatectomy for benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility / 中华泌尿外科杂志

Objective:To investigate the safety and efficacy of one-stage transurethral prostatectomy for prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility.Methods:The clinical data of 35 patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility admitted to The Second Affiliated Hospital of Zhengzhou University from January 2015 to Octorber 2021 were analyzed.The average age was (74.0±7.9) years old. The average volume of prostate was (77.8±44.5)cm 3. The average total prostate specific antigen(tPSA)was(8.9±8.7)ng/ml. The preoperative international prostate symptom score(IPSS) was (19.1±4.3) and the preoperative quality of life score(QOL)was 5(5, 5). All the patients were treated with one-stage transurethral prostatectomy and suprapubic cystostomy. After removing the cystostomy tube, the post-void resident volume(PVR), the maximum urine flow rate(Q max), IPSS, QOL were recorded, and complications were followed up. Successful treatment is defined as the removal of the cystostomy tube without worsening of upper urinary tract hydronephrosis. Results:All the operations were successfully completed. The success rate of treatment was 85.7%(30/35), and the median time to resume spontaneous urination was 4.0(3.3, 4.5) weeks. The average postoperative Q max was (12.6±2.3)ml/s, and the average PVR was(27.7±9.5)ml. The postoperative IPSS was (5.5±2.4), which was significantly improved compared to preoperative( P<0.001). The postoperative QOL score was 1(1, 2) points, which was significantly lower than preoperative( P<0.001). The patients voiding spontaneously were followed up for 3-69 months, and no complications such as urinary retention, recurrent urinary tract infection and hydronephrosis occurred. Conclusions:One-stage transurethral prostatectomy for patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility has a high success rate and few complications, which greatly improves the quality of life of patients.

Comparison of urodynamic changes in elderly patients with central neurogenic bladder and with peripheral neurogenic bladder / 中华老年医学杂志

Objective:To examine differences in urodynamic changes between central neurogenic bladder(CNB)and peripheral neurogenic bladder(PNB)in elderly patients.Methods:A total of 57 elderly patients over 60 years old with neurogenic bladder(NB)were divided into a CNB group and a PNB group based on the types of nerve injuries.Data on urodynamic parameters recorded for the two groups were compared and analyzed.Results:The rate of detrusor overactivity(DO)in the CNB group was significantly higher than that in the PNB group [66.7%(16/24)vs.36.4%(12/33), χ2=5.105, P=0.024]. There were significant differences between the two groups in maximum bladder capacity(MCC)[(277.8±101.1)in the CNB group vs.(481.4±110.2)ml in the PNB group, t=-7.149, P=0.001]and in safe bladder capacity(SBC)[(283.2±28.8)ml in the CNB group vs.(348.6±33.9)ml in the PNB group, t=-7.636, P=0.000]. There was no significant difference between the two groups in the maximum urine flow rate, residual urine volume, urination volume, leak point pressure, or detrusor pressure at the maximum urine flow rate(all P>0.05). In the CNB group, 8 patients had normal bladder sensation, 4 had disappeared bladder sensation, 10 had decreased sensation, and 2 had increased sensation.In the PNB group, 9 patients had normal bladder sensation, 4 had disappeared bladder sensation, 14 had decreased sensation, and 2 had increased sensation.There was no statistical significance in SBC between different sensation levels within each group( P>0.05). Conclusions:There are differences in urodynamic characteristics between the elderly patients with CNB and those with PNB.Decreases in MCC, SBC and DO are more likely to occur in CNB.

Research advances of sacral neuromodulation in the management of pediatric neurogenic bladder / 现代泌尿外科杂志

Pediatric neurogenic bladder (PNB) is defined as dysfunction of the detrusor and/or urethral sphincter due to myelodysplasia or spinal cord injury, manifesting as impaired urination or defecation, which seriously affects the patients’ quality of life. The main indication for sacral neuromodulation (SNM) is overactive bladder syndrome, which presents as refractory urinary frequency and urgency, urgency incontinence and non-obstructive urinary retention. Age more than 16 years are also recommended for this technique. Previous studies have revealed that SNM could significantly improve the outcome of refractory bladder bowel dysfunction. This paper reviews the advances of the application of SNM in the treatment of pediatric neurogenic bladder so as to provide reference for pediatricians.

Application of three-dimensional printed guiding device for electrode implantation in sacral neuromodulation in children / 现代泌尿外科杂志

【Objective】 To investigate the application value of three-dimensional printed guiding device in sacral neuromodulation in children. 【Methods】 A total of 17 patients admitted during Jan.2017 and Nov.2022 were divided into two groups: control group (n=8), using traditional method to locate sacral foramen for puncture; three-dimensional printed guiding device group (n=5), using three-dimensional printing technology to make individual guiding device for puncture. The clinical indexes of the two groups were evaluated, including puncture time, puncture numbers, intraoperative X-ray exposure times, postoperative evaluation time and second-stage conversion rate. The evaluation indexes of postoperative complications were wound bleeding, wound infection, wound rupture, electrode fracture, displacement or prolapse. 【Results】 In the control group, 1 case was diagnosed as bladder-bowel dysfunction, the remaining 7 were neurogenic bladder; in the three-dimensional printed guiding device group, all 9 cases were diagnosed as neurogenic bladder. The puncture time was shorter in the three-dimensional printed guiding device group than in the control group [85(70-90) min vs.138(133-208) min], the puncture numbers were fewer [15(12-20) vs.22(18-26)], and the X-ray exposure times were fewer [12(12-17) vs.19(16-23)] (all P<0.05). The initial stimulation voltage, postoperative evaluation time and second-stage conversion rate were not statistically significant. 【Conclusion】 Compared with the traditional method, the use of three-dimensional printed guiding device can reduce the puncture numbers and shorten the puncture time in the process of sacral neuromodulation in children.

Important role of urodynamic study in improving the diagnosis and treatment of pediatric neurogenic bladder / 现代泌尿外科杂志

Of the common urinary dysfunctions in children, pediatric neurogenic bladder (PNB) is the most challengeable abnormality. It is well known that PNB is mostly caused by dysplasia of the lumbosacral spinal cord and nerves, which seriously affects the quality of life and the physical and mental health of children. The clinical symptoms are not obvious in minor cases, but severe upper urinary tract damage occurs in severe cases. Urodynamic study (UDS) is the best way to detect and determine the type of dysfunction at an early stage, and can guide the formulation of accurate and individualized treatment protocol. However, UDS in children has not been popularized in China, which seriously affects the level of diagnosis and treatment of PNB. This article reviews the importance of UDS so as to provide reference for the diagnosis and treatment of PNB.