The relationship between the short-term rehabilitation index and the medium-term function of the pelvic nerve in male rectal cancer after laparoscopy / 实用医学杂志

Objective To study of short-term rehabilitation index and its relationship with medium-term function in male rectal cancer after laparoscopic surgery. Methods A retrospective analysis was made of 60 cases with rectal cancer who received laparoscopic radical resection in our hospital. In the observation group,the pelvic autonomic nerves were retained in 30 cases,and 30 cases in the control group were not retained. The levels of se-rum prealbumin(PA),C reactive protein(CRP),white blood cell count(WBC)and blood cortisol(Cor)were compared between the 2 groups. The independent influence factors of erectile and ejaculatory disorder were fol-lowed up at 6 months after operation. Results Postoperative exhaust time,defecation time,postoperative extuba-tion time,ambulation time,postoperative hospitalization time in the observation group were significantly shorter than those in the control group(P < 0.05). The level of serum CRP,WBC and Cor in the observation group was significantly lower than those of the control group at 3 d after operation,and the level of PA was significantly high-er than that of the control group(P < 0.05).The independent influence factors of erectile dysfunction were the level of PA and CRP at 3d after operation(P < 0.05).The independent influence factors of ejaculatory dysfunction were PA level at 3D after operation(P < 0.05). Conclusion Pelvic nerve protection in laparoscopic surgery is helpful to promote the postoperative recovery. High PA at short term after operation may be one of the medium-term protec-tion mechanisms for sexual function.

Effects of pelvic nerves denervation on the expression of transit receptor potential vanilloid 1 in distal colonic mucosa of rats / 中华消化外科杂志

Objective To explore the effects of pelvic nerves denervation (PND) on the expression of transit potential receptor vanilloid 1 (TRPV1) in distal colonic mucosa of rats.Methods The experimental study was conducted.One hundred and eight adult male rats were randomly divided into the control group,sham operation group and PND group:(1) 36 rats in the control group remained untreated and were fed regularly;(2) 36 in the sham operation group received open exclusion for 15 minutes,and then sew up the incision;(3) 36 in the PND group received laparotomy with pelvic nerve transection before abdominal closure.The expression of TRPV1 protein in distal colonic mucosa was respectively detected by Western blot at postoperative day 1,3 and 7.Reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) was used to detect the mRNA level of TRPV1 in the distal colonic mucosa.Measurement data with normal distribution were represented as (x)±s.Repeated measurement data were analyzed by repeated measures ANOVA.Comparisons at the same time intervals among the 3 groups were analyzed using one-way ANOVA.Pairwise comparison was done by the independent samples t test.Results (1) The results of immunohistochemical staining:the average density of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 was respectively 0.180±0.016,0.179±0.015 and 0.183±0.026 in the control group,with no statistically significant difference (F=0.088,P＞0.05).The average density of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 was respectively 0.132±0.017,0.160±0.023 and 0.173±0.020 in the sham operation group,with a statistically significant difference (F=8.699,P＜0.05).The average density of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 was respectively 0.057± 0.009,0.122±0.016 and 0.180± 0.016 in the PND group,with a statistically significant difference (F =113.315,P ＜ 0.05).There were statistically significant differences in the average density of TRPV1 at postoperative day 1 and 3 among the 3 groups (F =108.960,15.218,P＜ 0.05),while significant differences were respectively detected between the control group and the sham operation group or the PND group at postoperative day 1 (t =5.025,15.979,P＜0.05),and a significant difference was also detected between the sham operation group and the PND group (t =9.590,P＜0.05).There was no statistically significant difference in the average density of TRPV1 between the control group and the sham operation group at postoperative day 3 (t =1.670,P＞0.05),while significant differences were respectively detected between the control group and the PND group and between the sham operation group and the PND group (t=6.543,3.361,P＜0.05).There was no statistically significant difference in the average density of TRPV1 at postoperative day 7 among the 3 groups (F=0.518,P＞0.05).(2) The results of Western blot:the relative expressions of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 were respectively 1.02±0.13,1.00±0.15 and 1.00±0.10 in the control group,with no statistically significant difference (F=0.084,P＞0.05).The relative expressions of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 were respectively 0.51±0.13,0.93±0.14 and 1.01±0.16 in the sham operation group,with a statistically significant difference (F =20.930,P＜0.05).The relative expressions of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 were respectively 0.30±0.10,0.70±0.10 and 1.07±0.16 in the PND group,with a statistically significant difference (F=61.441,P＜0.05).There were statistically significant differences in the relative expressions of TRPV1 at postoperative day 1 and 3 among the 3 group (F=58.014,8.841,P＜0.05),while significant differences were respectively detected between the control group and the sham operation group or the PND group at postoperative day 1 (t =6.677,11.145,P＜0.05),and significant difference was also detected between the sham operation group and the PND group (t =3.287,P＜ 0.05).There was no statistically significant difference in the relative expressions of TRPV1 between the control group and the sham operation group at postoperative day 3 (t =0.798,P＞0.05),while significant differences were respectively detected between the control group and the PND group and between the sham operation group and the PND group (t=4.127,3.398,P＜0.05).There was no statistically significant difference in the relative expressions of TRPV1 at postoperative day 7 among the 3 group (F=0.428,P＞0.05).(3) The results of RTqPCR:the mRNA levels of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 were respectively 1.00±0.15,1.10±0.21 and 1.09±0.18 in the control group,with no statistically significant difference (F=0.489,P＞0.05).The mRNA levels of TRPV1 in distal colonic mueosa at postoperative day 1,3 and 7 were respectively 0.58±0.12,0.99±0.19 and 1.13±0.23 in the shan operation group,with a statistically significant difference (F=13.964,P＜0.05).The mRNA levels of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 were respectively 0.31±0.10,0.67±0.12 and 1.09±0.19 in the PND group,with a statistically significant difference (F=44.642,P＜0.05).There were statistically significant differences in the mRNA levels of TRPV1 at postoperative day 1 and 3 among the 3 group (F=44.653,9.700,P＜0.05),while significant differences were respectively detected between the control group and the sham operation group or the PND group at postoperative day 1 (t=5.233,9.264,P＜0.05),and significant difference was also detected between the sham operation group and the PND group (t=4.127,P＜0.05).There was no significant difference in the mRNA levels of TRPV1 between the control group and the sham operation group at postoperative day 3 (t =0.995,P＞0.05),while significant differences were respectively detected between the control group and the PND group and between the sham operation group and the PND group (t =4.411,3.505,P＜0.05).There was no statistically significant difference in the mRNA levels of TRPV1 at postoperative day 7 among the 3 group (F=0.099,P＞0.05).Conclusion The expression of TRPV 1 in distal colonic mucosa of rats is significantly down-regulated after pelvic nerves denervation,however,it is gradually recovered with passage of time,which is consistent with the trend of gradual recovery of colonic transit function after pelvic nerve injury.

Effects of pelvic nerve transection on the colonic motility and the expression of transit receptor potential ankyrin 1 in a rat model / 中华消化外科杂志

Objective To investigate the effects of pelvic nerve transection on the colonic motility and the expression of transit receptor potential ankyrin 1 (TRPA1) in the colon mucosa.Methods Ninety-six Sprague-Dawley rats were divided into 3 groups based on a random number table:(1) 18 rats in the control group remained untreated and were fed regularly;(2) 39 rats in the sham operation group received laparotomy,and the pelvic nerves were stripped;(3) 39 rats in the operation group received laparotomy with pelvic nerve transection before abdominal closure.Colonic transit was assessed respectively at postoperative day 1,3,and 7 by injecting and calculating the geometric center (GC) of the distribution of 51Cr after 3 hours of propagation.The expression of TRPA1 in the colonic mucosa was determined by Western blot at postoperative day 1,3,7.Data with normal distribution were expressed by (x)± s,and were analyzed using the repeated measures ANOVA or LSD test.Results The GC values of the distribution of 51Cr in the sham operation group at postoperative day 1,3,7 were 5.8 ± 0.9,7.5 ± 0.5,7.3 ± 0.5,with a significant difference (F =9.508,P ＜ 0.05).The GC values of the distribution of 51Cr in the operation group at postoperative day 1,3,7 were 4.9 ± 0.4,5.6 ± 0.4,6.4 ± 0.8,with a significant difference (F =11.689,P ＜ 0.05).There were significant differences in the GC values of the distribution of 51 Cr at postoperative day 1 and 3 between the sham operation group and the operation group (t =2.227,7.144,P ＜ 0.05),while no significant difference was detected at postoperative day 7 (t =2.162,P ＞ 0.05).The results of Western blot showed that the relative expressions of TRPA1 in the proximal part of the colon at postoperative day 1,3,7 were 1.00 ± 0.05,1.00 ± 0.07,1.00 ± 0.06 in the control group,with a significant difference (F =0.055,P ＞ 0.05).The relative expressions of TRPA1 in the proximal part of the colon at postoperative day 1,3,7 were 0.78 ± 0.09,0.94 ± 0.08,0.95 ± 0.12 in the sham operation group,with a significant difference (F =5.651,P ＜ 0.05).The relative expressions of TRPA1 in the proximal part of the colon at postoperative day 1,3,7 were 0.37 ± 0.12,0.89 ± 0.10,0.92 ± 0.14 in the operation group,with a significant difference (F =41.005,P ＜0.05).There was significant difference in the relative expressions of TRPA1 in the proximal part of the colon among the 3 groups at postoperative day 1 (F =73.497,P ＜ 0.05),while significant differences were respectively detected between the control group and the sham operation group and the operation group at postoperative day 1 (t =4.224,11.954,P ＜ 0.05),and significant difference between the operation group and the sham operation group was also observed (t =7.730,P ＜ 0.05).There was no significant difference in the relative expression of TRPA1 in the proximal part of the colon among the 3 groups between day 3 and day 7 (F =2.087,0.656,P ＞ 0.05).The relative expressions of TRPA1 in the distal part of the colon at postoperative day 1,3,7 were 1.00 ± 0.05,1.00 ± 0.07,1.00 ± 0.06 in the control group,with no significant difference (F =0.055,P ＞ 0.05).The relative expressions of TRPA1 in the distal part of the colon at postoperative day 1,3,7were 0.68 ±0.11,0.98 ±0.12,1.11 ±0.16 in the sham operation group,with a significant difference (F =16.975,P ＜ 0.05).The relative expressions of TRPA1 in the distal part of the colon at postoperative day 1,3,7 were 0.39 ± 0.12,0.78 ± 0.10,1.06 ± 0.13 in the operation group,with a significant difference (F =50.417,P ＜ 0.05).There were significant differences in the relative expression of TRPA1 in the distal part of the colon among the 3 groups between day 1 and day 3 (F =58.773,8.680,P ＜ 0.05),while significant differences were respectively detected between the control group and the sham operation group and the operation group at postoperative day 1 (t =5.706,10.837,P ＜ 0.05),and significant difference was also detected between the operation group and the sham operation group (t =5.131,P ＜ 0.05).There was no significant difference in the relative expression of TRPA1 in the distal part of the colon between the control group and the sham operation group at postoperative day 3 (t =0.166,P ＞ 0.05),while significant differences were respectively detected between the control group and the operation group and between the sham operation group and the operation group at postoperative day 3 (t =3.694,3.528,P ＜ 0.05).There was no significant difference in the relative expression of the TRPA1 in the distal part of the colon between the 3 groups at postoperative day 7 (F =1.319,P ＞ 0.05).Conclusions Injury to pelvic nerves adversely affects colonic transit and expression of TRPA1 in mucosa.With a compensatory mechanism from the intestinal itself,these alterations in intestinal motility function normalize over time suggesting expression of TRPA1 in mucosa plays a crucial role in the recovery of intestinal motility function.

Various types of total laparoscopic nerve-sparing radical hysterectomies and their effects on bladder function / 부인종양

OBJECTIVE: This study was conducted to ascertain the correlation between preserved pelvic nerve networks and bladder function after laparoscopic nerve-sparing radical hysterectomy. METHODS: Between 2009 and 2011, 53 patients underwent total laparoscopic radical hysterectomies. They were categorized into groups A, B, and C based on the status of preserved pelvic nerve networks: complete preservation of the pelvic nerve plexus (group A, 27 cases); partial preservation (group B, 13 cases); and complete sacrifice (group C, 13 cases). To evaluate bladder function, urodynamic studies were conducted preoperatively and postoperatively at 1, 3, 6, and 12 months after surgery. RESULTS: No significant difference in sensory function was found between groups A and B. However, the sensory function of group C was significantly lower than that of the other groups. Group A had significantly better motor function than groups B and C. No significant difference in motor function was found between groups B and C. Results showed that the sensory nerve is distributed predominantly at the dorsal half of the pelvic nerve networks, but the motor nerve is predominantly distributed at the ventral half. CONCLUSION: Various types of total laparoscopic nerve-sparing radical hysterectomies can be tailored to patients with cervical carcinomas.

Autonomic Nerve Regulation of Colonic Peristalsis in Guinea Pigs

BACKGROUND/AIMS: Colonic peristalsis is mainly regulated via intrinsic neurons in guinea pigs. However, autonomic regulation of colonic motility is poorly understood. We explored a guinea pig model for the study of extrinsic nerve effects on the distal colon. METHODS: Guinea pigs were sacrificed, their distal colons isolated, preserving pelvic nerves (PN) and inferior mesenteric ganglia (IMG), and placed in a tissue bath. Fecal pellet propagation was conducted during PN and IMG stimulation at 10 Hz, 0.5 ms and 5 V. Distal colon was connected to a closed circuit system, and colonic motor responses were measured during PN and IMG stimulation. RESULTS: PN stimulation increased pellet velocity to 24.6 +/- 0.7 mm/sec (n = 20), while IMG stimulation decreased it to 2.0 +/- 0.2 mm/sec (n = 12), compared to controls (13.0 +/- 0.7 mm/sec, P < 0.01). In closed circuit experiments, PN stimulation increased the intraluminal pressure, which was abolished by atropine (10(-6) M) and hexamethonium (10(-4) M). PN stimulation reduced the incidence of non-coordinated contractions induced by NG-nitro-L-arginine methyl ester (L-NAME; 10(-4) M). IMG stimulation attenuated intraluminal pressure increase, which was partially reversed by alpha-2 adrenoceptor antagonist (yohimbine; 10(-6) M). CONCLUSIONS: PN and IMG input determine speed of pellet progression and peristaltic reflex of the guinea pig distal colon. The stimulatory effects of PN involve nicotinic, muscarinic and nitrergic pathways. The inhibitory effects of IMG stimulation involve alpha-2 adrenoceptors.

Nerves and fasciae in and around the paracolpium or paravaginal tissue: an immunohistochemical study using elderly donated cadavers / 대한해부학회지

The paracolpium or paravaginal tissue is surrounded by the vaginal wall, the pubocervical fascia and the rectovaginal septum (Denonvilliers' fascia). To clarify the configuration of nerves and fasciae in and around the paracolpium, we examined histological sections of 10 elderly cadavers. The paracolpium contained the distal part of the pelvic autonomic nerve plexus and its branches: the cavernous nerve, the nerves to the urethra and the nerves to the internal anal sphincter (NIAS). The NIAS ran postero-inferiorly along the superior fascia of the levator ani muscle to reach the longitudinal muscle layer of the rectum. In two nulliparous and one multiparous women, the pubocervical fascia and the rectovaginal septum were distinct and connected with the superior fascia of the levator at the tendinous arch of the pelvic fasciae. In these three cadavers, the pelvic plexus and its distal branches were distributed almost evenly in the paracolpium and sandwiched by the pubocervical and Denonvilliers' fasciae. By contrast, in five multiparous women, these nerves were divided into the anterosuperior group (bladder detrusor nerves) and the postero-inferior group (NIAS, cavernous and urethral nerves) by the well-developed venous plexus in combination with the fragmented or unclear fasciae. Although the small number of specimens was a major limitation of this study, we hypothesized that, in combination with destruction of the basic fascial architecture due to vaginal delivery and aging, the pelvic plexus is likely to change from a sheet-like configuration to several bundles.

Histological modifications of the rat prostate following transection of somatic and autonomic nerves

It is known that hormones influence significantly the prostate tissue. However, we reported that mating induces an increase in androgen receptors, revealing a neural influence on the gland. These data suggested that somatic afferents (scrotal and genitofemoral nerves) and autonomic efferents (pelvic and hypogastric nerves) could regulate the structure of the prostate. Here we assessed the role of these nerves in maintaining the histology of the gland. Hence, afferent or efferent nerves of male rats were transected. Then, the ventral and dorsolateral regions of the prostate were processed for histology. Results showed that afferent transection affects prostate histology. The alveoli area decreased and increased in the ventral and dorsolateral prostate, respectively. The epithelial cell height increased in both regions. Efferent denervation produced dramatic changes in the prostate gland. The tissue lost its configuration, and the epithelium became scattered and almost vanished. Thus, afferent nerves are responsible for spinal processes pertaining to the trophic control of the prostate, activating its autonomic innervation. Hence, our data imply that innervation seems to be synergic with hormones for the healthy maintenance of the prostate. Thus, it is suggested that some prostate pathologies could be due to the failure of the autonomic neural pathways regulating the gland.

Sabe-se que os hormônios influenciam significativamente o tecido prostático. Entretanto, nós demonstramos que o acasalamento induz um aumento nos receptores androgênicos, revelando uma influência neural sobre a glândula. Esses dados sugerem que os aferentes somáticos (nervos escrotal e genito-femural) e os eferentes autonômicos (nervos pélvicos e hipo-gástricos) poderiam regular a estrutura da próstata. Neste trabalho, avaliou-se a função destes nervos na manutenção da histologia da glândula. Dessa forma, os nervos aferentes e eferentes de ratos machos foram seccionados As regiões ventral e dorsolateral da próstata foram processadas para histologia. Os resultados mostraram que a transecção aferente afeta a histologia da próstata. A área alveolar diminuiu e aumentou na próstata dorsal e dorsolateral, respectivamente. A altura da célula epitelial aumentou em ambas as regiões. A desenervação eferente produziu alterações dramáticas na glândula prostática. O tecido perdeu a sua configuração e o epitélio tornou-se difuso e quase desapareceu. Assim, os nervos aferentes são responsáveis por processos espinhais que pertencem ao controle trófico da próstata, ativando sua inervação autonômica. Dessa forma, nossos dados sugerem que a inervação parece ser sinérgica com os hormônios para a manutenção saudável da próstata. Assim, sugere-se que algumas patologias prostáticas poderiam ser ocasionadas devido a falhas nas vias neurais autonômicas que regulam esta glândula.

Hemodynamic Change during Penile Erection Induced by Pelvic Nerve Stimulation in the Dog / 대한비뇨기과학회지

To investigate hemodynamic mechanism of penile erection and to establish animal model which permits hemodynamic study, simultaneous measurement of flow rate, pressure of the internal pudendal artery, and intracorporeal pressure during penile erection was performed using canine electroerection models. The results obtained were summarized as followings: 1. Following pelvic nerve stimulation, the erection phenomenon was grossly observed. The intracorporeal pressure began to increase after a latent period of mean 11.3 sec., and increased to the maximum and then maintained plateau state. When the stimulation was terminated, detumescence with gradual decrease of intracorporeal pressure was observed. 2. With stimulation above threshold level, transient drop of intracorporeal pressure was observed immediately after stimulation. The latent period and time to the maximal intracorporeal pressure were shortened. However, the degree of maximal intracorporeal pressure was not changed. 3. Following electric stimulation of the pelvic nerve, immediate decrease in internal pudendal arterial pressure and increase in flow rate of the internal pudendal artery without change in systemic blood pressure were followed by gradual increase in intracorporeal pressure. These indicate that relaxation of the sinusoidal smooth muscles and the arteries supplying the corpus cavernosum by pelvic nerve stimulation results in an increase in arterial inflow to the corpus cavernosum, which would play an important role in induction of penile erection. And it is suggested that this animal model would contribute to further hemodynamic study and development of therapeutics in erectile impotence.

Hemodynamic Change during Penile Erection Induced by Pelvic Nerve Stimulation in the Dog / 대한비뇨기과학회지

To investigate hemodynamic mechanism of penile erection and to establish animal model which permits hemodynamic study, simultaneous measurement of flow rate, pressure of the internal pudendal artery, and intracorporeal pressure during penile erection was performed using canine electroerection models. The results obtained were summarized as followings: 1. Following pelvic nerve stimulation, the erection phenomenon was grossly observed. The intracorporeal pressure began to increase after a latent period of mean 11.3 sec., and increased to the maximum and then maintained plateau state. When the stimulation was terminated, detumescence with gradual decrease of intracorporeal pressure was observed. 2. With stimulation above threshold level, transient drop of intracorporeal pressure was observed immediately after stimulation. The latent period and time to the maximal intracorporeal pressure were shortened. However, the degree of maximal intracorporeal pressure was not changed. 3. Following electric stimulation of the pelvic nerve, immediate decrease in internal pudendal arterial pressure and increase in flow rate of the internal pudendal artery without change in systemic blood pressure were followed by gradual increase in intracorporeal pressure. These indicate that relaxation of the sinusoidal smooth muscles and the arteries supplying the corpus cavernosum by pelvic nerve stimulation results in an increase in arterial inflow to the corpus cavernosum, which would play an important role in induction of penile erection. And it is suggested that this animal model would contribute to further hemodynamic study and development of therapeutics in erectile impotence.