1.Preliminary study on botulinum toxin type A bladder injection for the treatment of autonomic dysreflexia related to bladder dysfunction
Maping HUANG ; Hui CHEN ; Conghui HAN ; Tianhai HUANG ; Heyi ZHEN ; Xiaoyi YANG ; Qiuling LIU ; Mengxia GUO ; Hongge PAN ; Jing LIU ; Shuqing WU ; Keji XIE
Chinese Journal of Urology 2025;46(10):759-763
Objective:To investigate the clinical efficacy of botulinum toxin type A(BTX-A)bladder injection in the treatment of neurogenic detrusor overactivity(NDO)with autonomic dysreflexia(AD).Methods:The patients with spinal cord injury at or above T6,who were treated at Guangdong Provincial Work Injury Rehabilitation Hospital from January 2018 to December 2022,were included in this study prospectively. Inclusion criteria:①chronic spinal cord injury patients over 18 years old(with no progression of neurological symptoms within 3 months);② presence of NDO and AD;③ inadequate response or intolerance to oral antimuscarinic agent(M-receptor antagonists or β 3-receptor agonists)④ perform clean intermittent catheterization to empty the bladder. Exclusion criteria:① primary disease in the acute or progressive phase;② previous surgeries that would affect lower urinary tract function,such as transurethral sphincterotomy,bladder neck resection,prostatectomy,or bladder surgery;③ allergy to BTX-A or its adjuvants,or those with allergic predisposition ④ patients who were pregnant,breastfeeding,or planning for pregnancy in the near future;⑤ patients did not accept or were unable to perform intermittent catheterization. Before treatment,all patients were required to maintain 3-5 day urine diary,along with urodynamic studies(UDS),incontinence specific quality of life instrument(I-QOL)and AD symptom severity assessment,and blood pressure monitored. Key UDS parameters recorded included maximum bladder capacity,maximum detrusor pressure during filling phase,changes in maximum systolic blood pressure(SBP)relative to baseline(ΔSBP)during UDS examination,and the frequency of 24-hour blood pressure exceeding baseline by 20 mmHg. After general anesthesia or epidural anesthesia,BTX-A(200 U)was injected into the bladder at 30 points(including the triangle)under the cystoscope using a special injection needle,6.7 U per injection,and then the catheter was kept for 3-5 days after treatment. Three months later,relevant indicators were collected and compared with pre-treatment data. Results:A total of 43 patients were included in this study,including 34 males and 9 females. The age was(39.23±13.17)years old and the disease course was(2.69±3.27)years old. There were 33 cervical and 10 thoracic cases. The American Spinal Injury Association Injury Scale score distribution was as follows:26(60%)A,4(9%)B,9(21%)C,and 4(9%)D. The presence of AD was confirmed in all patients during urodynamic examination(UDS),that was the systolic blood pressure(SBP)suddenly increased and exceeded 20 mmHg(1 mmHg = 0.133 kPa). Before treatment,The AD symptoms severity score(consist of headache,sweating,goose bumps,anxiety and palpitation)were(14.53±2.51),Bladder-related AD frequency was 10.67 episodes/day. Baseline SBP was(103.51±9.64)mmHg,the maximum SBP was(150.40±22.75)mmHg,and the change in SBP(ΔSBP)from maximum to baseline SBP during UDS examination was(43.83±21.01)mmHg. The UDS indicated that the maximum detrusor pressure during storage phase was(54.95±24.68)cmH 2O,and the bladder capacity was(131.70±75.29)ml. Bladder diary showed the volume of catheterization each time from was(181.16±49.86)ml,and The I-QOL score was(44.07±8.60). Three months after treatment,the AD symptoms severity score(consist of headache,sweating,goose bumps,anxiety and palpitation)were(11.37±2.39). The frequency of bladder-related AD episodes was(7.51±2.37)episodes/day,showing statistically significant differences compared to pre-treatment( P<0.05).The SBP before UDS examination was(102.12±10.28)mmHg,with no statistically significant difference from baseline( P = 0.518). The maximum SBP in perfusion phase and the ΔSBP were(132.84±16.30)mmHg and(28.72 ± 14.02)mmHg,respectively,both demonstrating statistically significant differences( P < 0.05). The UDS examination revealed that the maximum detrusor pressure during the storage phase was(29.77±13.72)cmH 2O,showed a significant decrease,and the bladder capacity was(272.63±79.75)ml,which were both statistically different before and after surgery. Bladder diary showed the volume of catheterization each time was(326.74±63.71)ml;I-QOL score was(71.86±11.45),both were significant different after treatment( P < 0.01). Conclusion:BTX-A intravesical injection in the treatment of NDO can also alleviate the severity and frequency of bladder related AD.
2.Comparative efficacy of navigation system and orthopedic robot-assisted nail placement in the treatment of lower cervical fracture and dislocation
Xinnan CHENG ; Shuai LI ; Jiaojiao BAI ; Qingda LI ; Yukuan LEI ; Lei ZHU ; Zhen CHANG ; Zhigang ZHAO ; Yunfei HUANG ; Mingzhe FENG ; Liang YAN ; Hua HUI ; Lingbo KONG ; Baorong HE
Chinese Journal of Trauma 2025;41(2):148-156
Objective:To compare the clinical efficacy of navigation system and orthopedic robot-assisted nail placement in the treatment of lower cervical fracture and dislocation.Methods:A retrospective cohort study was conducted to analyze the clinical data of 49 patients with fracture and dislocation of the lower cervical spine who were admitted to Honghui Hospital, Xi′an Jiaotong University School of Medicine from May 2021 to October 2022, including 38 males and 11 females, aged 29-61 years [(39.3±7.3)years]. Injury segments involved C 3 in 12 patients, C 4 in 11, C 5 in 8, C 6 in 9 and C 7 in 9. Twenty-one patients were treated with S8 navigation system (navigation group, 84 screws), and 28 with TINAVI orthopedic robot (robot group, 112 screws). The two groups were compared in terms of the total surgical duration, single screw placement time, total screw placement time, distance between the screw and the anterior cortex, incision length, intraoperative radiation dose, intraoperative blood loss and length of hospital stay. The height of intervertebral space, Cobb angle, sliding distance between vertebral bodies and American Spinal Injury Association (ASIA) grade were assessed before surgery and at 3 days after surgery. Visual analogue scale (VAS), Japanese Orthopedic Association (JOA) score and neck dysfunction index (NDI) before surgery, at 3 days, 3 months after surgery and at the last follow-up were compared. The accuracy of screw placement, intraoperative invasion rate of adjacent facet joints and rate of postoperative complications (infection, screw loosening, etc.) were evaluated. Results:All the patients were followed up for 12-16 months [(13.6±1.9)months]. In the navigation group, the total surgical duration, distance from the screw to the anterior cortex and the intraoperative radiation dose were (236.2±30.6)minutes, (2.0±0.2)mm and (374.3±90.3)mGy respectively, which were significantly shorter or less than those in the robot group [(278.4±20.7)minutes, (10.6±2.9)mm and (448.4±77.9)mGy] ( P<0.01). The single screw placement time, total screw placement time, incision length and intraoperative blood loss were (3.5±0.4)minutes, (23.9±0.5)minutes, (9.1±2.4)cm and (422.2±30.4)ml respectively, which were significantly longer or more than those in the robot group [(2.6±0.2)minutes, (17.9±0.7)minutes, (6.6±2.6)cm and (360.3±56.3)ml] ( P<0.01). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). No significant differences were observed in the height of the intervertebral space, Cobb angle, sliding distance between the vertebral bodies and ASIA grade between the two groups ( P>0.05). At 3 days after surgery, the height of intervertebral space, Cobb angle, sliding distance between vertebral bodies and ASIA grade in both groups were significantly improved when compared with those before surgery ( P<0.05 or 0.01). There were no significant differences in VAS, JOA scores or NDI between the two groups before surgery, at 3 days, 3 months after surgery and at the last follow-up ( P>0.05). The VAS, JOA scores and NDI in both groups were gradually improved at 3 days, 3 months and at the last follow-up after surgery when compared with those before surgery ( P<0.05). There was no significant difference in the accuracy of screw placement of levels 0 and 0+1 between the two groups ( P>0.05). No significant difference in the intraoperative invasion rate of adjacent facet joints between the two groups was found ( P>0.05). There were no serious complications such as infection or screw loosening after surgery in both groups. Conclusions:For lower cervical fracture and dislocation, although there are more advantages in total surgical duration, screw holding force and radiation control regarding the navigation system, and more outstanding performance in screw placement efficiency, incision length and intraoperative blood loss regarding the orthopedic robot, both of them can effectively rebuild the cervical structure, improve neurological function, relieve postoperative pain, improve screw placement accuracy and reduce facet joint injury and serious complications. Selection of the best auxiliary screw placement system should comprehensively consider patients′ conditions and the experience of the surgical team.
3.Pharmacological Mechanism of Chinese Medicine in Systemic Lupus Erythematosus: A Narrative Review.
Bo-Yu ZHU ; Zhi-Chao LIU ; Zhen-Xi ZHAO ; Hui-Ping HUANG ; Na ZHANG ; Jia XIA ; Wei-Wei CHEN
Chinese journal of integrative medicine 2025;31(2):157-169
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder affecting multiple systems, characterized by the development of harmful autoantibodies and immune complexes that lead to damage in organs and tissues. Chinese medicine (CM) plays a role in mitigating complications, enhancing treatment effectiveness, and reducing toxicity of concurrent medications, and ensuring a safe pregnancy. However, CM mainly solves the disease comprehensively through multi-target and multi-channel regulation process, therefore, its treatment mechanism is often complicated, involving many molecular links. This review introduces the research progress of pathogenesis of SLE from the aspects of genetics, epigenetics, innate immunity and acquired immunity, and then discusses the molecular mechanism and target of single Chinese herbal medicine and prescription that are commonly used and effective in clinic to treat SLE.
Lupus Erythematosus, Systemic/immunology*
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Humans
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Medicine, Chinese Traditional
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Drugs, Chinese Herbal/pharmacology*
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Animals
4.Genotypic and clinical phenotypic analysis of children with incontinentia pigmenti accompanied by ocular lesions
Zhen LI ; Xiaoyu HUANG ; Xunlun SHENG ; Weining RONG
International Eye Science 2025;25(9):1511-1516
AIM:To analyze the clinical phenotypes and genotypes of children with incontinentia pigmenti(IP)and enhance clinicians' understanding of the condition.METHODS: A family with IP diagnosed in February 2020 at the ophthalmology department of People's Hospital of Ningxia Hui Autonomous Region was enrolled. The proband and family members underwent comprehensive systemic and ocular examinations. Peripheral venous blood was collected for DNA extraction, followed by whole-exome sequencing and MLPA assay to identify pathogenic variants. Corresponding treatments were administered based on the severity of fundus lesions, and ocular clinical features and therapeutic outcomes were monitored during follow-up.RESULTS: The child in this study was a female, aged 8 years, with typical skin changes and scarring alopecia and dental abnormalities at the time of initial consultation. The results of genetic testing suggested that the child carried a heterozygous deletion of exons 4-10 of the IKBKG gene chrX:153440010-153446570del. The child had asymmetric lesions in both eyes, with severe lesions in the left eye, atrophy of the eyeballs, and ocular B-ultrasound suggesting structural disturbances in the eye, and neovascularization was seen in the peripheral retina of the right eye, and the patient was given laser photocoagulation treatment for the right eye, and no progression of retinopathy was detected during follow-up.CONCLUSION:Children with IP have different ocular clinical phenotypes, and retinal vasculopathy is the main change. Early screening and timely and standardized treatment are crucial for children diagnosed with IP.
5.Biomarkers of hepatotoxicity in rats induced by aqueous extract of Dictamni Cortex based on urine metabolomics.
Hui-Juan SUN ; Rui GAO ; Meng-Meng ZHANG ; Ge-Yu DENG ; Lin HUANG ; Zhen-Dong ZHANG ; Yu WANG ; Fang LU ; Shu-Min LIU
China Journal of Chinese Materia Medica 2025;50(9):2526-2538
This paper aimed to use non-targeted urine metabolomics to reveal the potential biomarkers of toxicity in rats with hepatic injury induced by aqueous extracts of Dictamni Cortex(ADC). Forty-eight SD rats were randomly assigned to a blank group and high-dose, medium-dose, and low-dose ADC groups, with 12 rats in each group(half male and half female), and they were administered orally for four weeks. The hepatic injury in SD rats was assessed by body weight, liver weight/index, biochemical index, L-glutathione(GSH), malondialdehyde(MDA), and pathological alterations. The qPCR was utilized to determine the expression of metabolic enzymes in the liver and inflammatory factors. Differential metabolites were screened using principal component analysis(PCA) and partial least squares-discriminant analysis(PLS-DA), followed by a metabolic pathway analysis. The Mantel test was performed to assess differential metabolites and abnormally expressed biochemical indexes, obtaining potential biomarkers. The high-dose ADC group showed a decrease in body weight and an increase in liver weight and index, resulting in hepatic inflammatory cell infiltration and hepatic steatosis. In addition, this group showed elevated levels of MDA, cytochrome P450(CYP) 3A1, interleukin-1β(IL-1β), and tumor necrosis factor-α(TNF-α), as well as lower levels of alanine transaminase(ALT) and GSH. A total of 76 differential metabolites were screened from the blank and high-dose ADC groups, which were mainly involved in the pentose phosphate pathway, tryptophan metabolism, purine metabolism, pentose and glucuronic acid interconversion, galactose metabolism, glutathione metabolism, and other pathways. The Mantel test identified biomarkers of hepatotoxicity induced by ADC in SD rats, including glycineamideribotide, dIDP, and galactosylglycerol. In summary, ADC induced hepatotoxicity by disrupting glucose metabolism, ferroptosis, purine metabolism, and other pathways in rats, and glycineamideribotide, dIDP, and galactosylglycerol could be employed as the biomarkers of its toxicity.
Animals
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Male
;
Rats, Sprague-Dawley
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Rats
;
Metabolomics
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Biomarkers/metabolism*
;
Liver/metabolism*
;
Drugs, Chinese Herbal/adverse effects*
;
Female
;
Chemical and Drug Induced Liver Injury/metabolism*
;
Glutathione/metabolism*
;
Humans
6.Post-transplant parvovirus B19 infection and diagnostic research progress
Ya′nan ZHAO ; Zhen SONG ; Yuze ZHU ; Qingtian LI ; Hui LI ; Beiwen WEI ; Jiewen HUANG ; Juanxiu QIN ; Min LI
Chinese Journal of Laboratory Medicine 2025;48(3):412-418
Organ transplantation is an effective treatment for end-stage organ failure, but postoperative infections and rejection reactions are key factors affecting the survival of the patients. Recently, the incidence of human parvovirus B19 (B19V) infection following transplantation has increased. B19V is a non-enveloped virus that primarily infects the upper respiratory tract and exhibits significant tropism for erythroid progenitor cells in the bone marrow, leading to the lysis of erythrocytes and hematological abnormalities. After B19V viremia, it may further infect other cells, triggering inflammatory responses and tissue damage. B19V infection may lead to chronic anemia in organ transplant patients, thereby affecting the success of the transplant and the survival of the patients. Therefore, it is essential to diagnose and monitor B19V infection post-transplantation. Due to the immunosuppressive therapy following transplantation, traditional serological detection methods, such as IgM and IgG antibody tests, are often unreliable. In contrast, molecular biological detection, especially real-time fluorescent quantitative PCR technology, provides more accurate results. However, the diversity of B19V genotypes may lead to the missed detection of some genotypes. Thus, it is necessary to use different detection techniques to improve the diagnostic accuracy of B19 virus infections. Additionally, there is a need to explore more precise diagnostic methods to enhance the early identification and management of B19V infection, further improving the survival and life quality of the patients.
7.Inhibitory effect of gallic acid on HCC1806 triple-negative breast cancer xenograft growth in nude mice
Chun-juan JIANG ; Si LIN ; Hui-zhen QIN ; Jie HUANG
Chinese Traditional Patent Medicine 2025;47(6):1853-1860
AIM To investigate the inhibitory effect of gallic acid on HCC1806 triple-negative breast cancer xenograft growth in nude mice.METHODS The nude mouse models of HCC1806 triple-negative breast cancer xenograft growth were established and randomly divided into the model group,the gallic acid group(200 mg/kg)and the adriamycin group(5 mg/kg),with 6 mice in each group.After 21 days of respective drug administration,the nude mice were killed and had their xenografts procured and measured.The nude mice had their serum levels of IL-6 and TNF-α detected by ELISA;their morphological changes of xenografts observed with HE staining;their protein expressions of p53,PCNA and Ki67 in xenograft detected by immunohistochemistry;their mRNA expressions of PCNA,Ki67,Bcl-2,Bax,Caspase-3,PI3K,Akt,JNK and p38 detected by RT-qPCR;and their protein expressions of Bcl-2,Bax,Caspase-3,cleaved-Caspase-3,PI3K,p-PI3K,Akt,p-Akt,JNK,p-JNK,p38 MAPK and p-p38 MAPK in xenografts detected by Western blot.RESULTS Compared with the model group,the groups intervened with either gallic acid or adriamycin shared decreased tumor weight(P<0.05);increased serum levels of IL-6 and TNF-α(P<0.05,P<0.01);condensed or irregular nuclei of xenograft,and increased number of cell necrosis;increased protein expressions of p53 and Bax and the ratios of cleaved-Caspase-3/Caspase-3,p-JNK/JNK and p-p38/p38 in xenograft(P<0.01);decreased protein expressions of PCNA,Ki67 and Bcl-2 and the ratios of p-PI3K/PI3K and p-Akt/Akt(P<0.01);decreased mRNA expressions of PCNA,Ki67,Bcl-2,PI3K and Akt(P<0.05,P<0.01);and increased mRNA expressions of Caspase-3,Bax,JNK and p38(P<0.05,P<0.01).CONCLUSION Gallic acid can inhibit HCC1806 triple-negative breast cancer xenograft growth in nude mice,and the underlying mechanism may involve suppression of pro-cell proliferation proteins,activation of pro-apoptotic proteins,and modulation of the PI3K/Akt and JNK/p38 signaling pathways.
8.Inhibitory effect of gallic acid on HCC1806 triple-negative breast cancer xenograft growth in nude mice
Chun-juan JIANG ; Si LIN ; Hui-zhen QIN ; Jie HUANG
Chinese Traditional Patent Medicine 2025;47(6):1853-1860
AIM To investigate the inhibitory effect of gallic acid on HCC1806 triple-negative breast cancer xenograft growth in nude mice.METHODS The nude mouse models of HCC1806 triple-negative breast cancer xenograft growth were established and randomly divided into the model group,the gallic acid group(200 mg/kg)and the adriamycin group(5 mg/kg),with 6 mice in each group.After 21 days of respective drug administration,the nude mice were killed and had their xenografts procured and measured.The nude mice had their serum levels of IL-6 and TNF-α detected by ELISA;their morphological changes of xenografts observed with HE staining;their protein expressions of p53,PCNA and Ki67 in xenograft detected by immunohistochemistry;their mRNA expressions of PCNA,Ki67,Bcl-2,Bax,Caspase-3,PI3K,Akt,JNK and p38 detected by RT-qPCR;and their protein expressions of Bcl-2,Bax,Caspase-3,cleaved-Caspase-3,PI3K,p-PI3K,Akt,p-Akt,JNK,p-JNK,p38 MAPK and p-p38 MAPK in xenografts detected by Western blot.RESULTS Compared with the model group,the groups intervened with either gallic acid or adriamycin shared decreased tumor weight(P<0.05);increased serum levels of IL-6 and TNF-α(P<0.05,P<0.01);condensed or irregular nuclei of xenograft,and increased number of cell necrosis;increased protein expressions of p53 and Bax and the ratios of cleaved-Caspase-3/Caspase-3,p-JNK/JNK and p-p38/p38 in xenograft(P<0.01);decreased protein expressions of PCNA,Ki67 and Bcl-2 and the ratios of p-PI3K/PI3K and p-Akt/Akt(P<0.01);decreased mRNA expressions of PCNA,Ki67,Bcl-2,PI3K and Akt(P<0.05,P<0.01);and increased mRNA expressions of Caspase-3,Bax,JNK and p38(P<0.05,P<0.01).CONCLUSION Gallic acid can inhibit HCC1806 triple-negative breast cancer xenograft growth in nude mice,and the underlying mechanism may involve suppression of pro-cell proliferation proteins,activation of pro-apoptotic proteins,and modulation of the PI3K/Akt and JNK/p38 signaling pathways.
9.Comparative efficacy of navigation system and orthopedic robot-assisted nail placement in the treatment of lower cervical fracture and dislocation
Xinnan CHENG ; Shuai LI ; Jiaojiao BAI ; Qingda LI ; Yukuan LEI ; Lei ZHU ; Zhen CHANG ; Zhigang ZHAO ; Yunfei HUANG ; Mingzhe FENG ; Liang YAN ; Hua HUI ; Lingbo KONG ; Baorong HE
Chinese Journal of Trauma 2025;41(2):148-156
Objective:To compare the clinical efficacy of navigation system and orthopedic robot-assisted nail placement in the treatment of lower cervical fracture and dislocation.Methods:A retrospective cohort study was conducted to analyze the clinical data of 49 patients with fracture and dislocation of the lower cervical spine who were admitted to Honghui Hospital, Xi′an Jiaotong University School of Medicine from May 2021 to October 2022, including 38 males and 11 females, aged 29-61 years [(39.3±7.3)years]. Injury segments involved C 3 in 12 patients, C 4 in 11, C 5 in 8, C 6 in 9 and C 7 in 9. Twenty-one patients were treated with S8 navigation system (navigation group, 84 screws), and 28 with TINAVI orthopedic robot (robot group, 112 screws). The two groups were compared in terms of the total surgical duration, single screw placement time, total screw placement time, distance between the screw and the anterior cortex, incision length, intraoperative radiation dose, intraoperative blood loss and length of hospital stay. The height of intervertebral space, Cobb angle, sliding distance between vertebral bodies and American Spinal Injury Association (ASIA) grade were assessed before surgery and at 3 days after surgery. Visual analogue scale (VAS), Japanese Orthopedic Association (JOA) score and neck dysfunction index (NDI) before surgery, at 3 days, 3 months after surgery and at the last follow-up were compared. The accuracy of screw placement, intraoperative invasion rate of adjacent facet joints and rate of postoperative complications (infection, screw loosening, etc.) were evaluated. Results:All the patients were followed up for 12-16 months [(13.6±1.9)months]. In the navigation group, the total surgical duration, distance from the screw to the anterior cortex and the intraoperative radiation dose were (236.2±30.6)minutes, (2.0±0.2)mm and (374.3±90.3)mGy respectively, which were significantly shorter or less than those in the robot group [(278.4±20.7)minutes, (10.6±2.9)mm and (448.4±77.9)mGy] ( P<0.01). The single screw placement time, total screw placement time, incision length and intraoperative blood loss were (3.5±0.4)minutes, (23.9±0.5)minutes, (9.1±2.4)cm and (422.2±30.4)ml respectively, which were significantly longer or more than those in the robot group [(2.6±0.2)minutes, (17.9±0.7)minutes, (6.6±2.6)cm and (360.3±56.3)ml] ( P<0.01). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). No significant differences were observed in the height of the intervertebral space, Cobb angle, sliding distance between the vertebral bodies and ASIA grade between the two groups ( P>0.05). At 3 days after surgery, the height of intervertebral space, Cobb angle, sliding distance between vertebral bodies and ASIA grade in both groups were significantly improved when compared with those before surgery ( P<0.05 or 0.01). There were no significant differences in VAS, JOA scores or NDI between the two groups before surgery, at 3 days, 3 months after surgery and at the last follow-up ( P>0.05). The VAS, JOA scores and NDI in both groups were gradually improved at 3 days, 3 months and at the last follow-up after surgery when compared with those before surgery ( P<0.05). There was no significant difference in the accuracy of screw placement of levels 0 and 0+1 between the two groups ( P>0.05). No significant difference in the intraoperative invasion rate of adjacent facet joints between the two groups was found ( P>0.05). There were no serious complications such as infection or screw loosening after surgery in both groups. Conclusions:For lower cervical fracture and dislocation, although there are more advantages in total surgical duration, screw holding force and radiation control regarding the navigation system, and more outstanding performance in screw placement efficiency, incision length and intraoperative blood loss regarding the orthopedic robot, both of them can effectively rebuild the cervical structure, improve neurological function, relieve postoperative pain, improve screw placement accuracy and reduce facet joint injury and serious complications. Selection of the best auxiliary screw placement system should comprehensively consider patients′ conditions and the experience of the surgical team.
10.Preliminary study on botulinum toxin type A bladder injection for the treatment of autonomic dysreflexia related to bladder dysfunction
Maping HUANG ; Hui CHEN ; Conghui HAN ; Tianhai HUANG ; Heyi ZHEN ; Xiaoyi YANG ; Qiuling LIU ; Mengxia GUO ; Hongge PAN ; Jing LIU ; Shuqing WU ; Keji XIE
Chinese Journal of Urology 2025;46(10):759-763
Objective:To investigate the clinical efficacy of botulinum toxin type A(BTX-A)bladder injection in the treatment of neurogenic detrusor overactivity(NDO)with autonomic dysreflexia(AD).Methods:The patients with spinal cord injury at or above T6,who were treated at Guangdong Provincial Work Injury Rehabilitation Hospital from January 2018 to December 2022,were included in this study prospectively. Inclusion criteria:①chronic spinal cord injury patients over 18 years old(with no progression of neurological symptoms within 3 months);② presence of NDO and AD;③ inadequate response or intolerance to oral antimuscarinic agent(M-receptor antagonists or β 3-receptor agonists)④ perform clean intermittent catheterization to empty the bladder. Exclusion criteria:① primary disease in the acute or progressive phase;② previous surgeries that would affect lower urinary tract function,such as transurethral sphincterotomy,bladder neck resection,prostatectomy,or bladder surgery;③ allergy to BTX-A or its adjuvants,or those with allergic predisposition ④ patients who were pregnant,breastfeeding,or planning for pregnancy in the near future;⑤ patients did not accept or were unable to perform intermittent catheterization. Before treatment,all patients were required to maintain 3-5 day urine diary,along with urodynamic studies(UDS),incontinence specific quality of life instrument(I-QOL)and AD symptom severity assessment,and blood pressure monitored. Key UDS parameters recorded included maximum bladder capacity,maximum detrusor pressure during filling phase,changes in maximum systolic blood pressure(SBP)relative to baseline(ΔSBP)during UDS examination,and the frequency of 24-hour blood pressure exceeding baseline by 20 mmHg. After general anesthesia or epidural anesthesia,BTX-A(200 U)was injected into the bladder at 30 points(including the triangle)under the cystoscope using a special injection needle,6.7 U per injection,and then the catheter was kept for 3-5 days after treatment. Three months later,relevant indicators were collected and compared with pre-treatment data. Results:A total of 43 patients were included in this study,including 34 males and 9 females. The age was(39.23±13.17)years old and the disease course was(2.69±3.27)years old. There were 33 cervical and 10 thoracic cases. The American Spinal Injury Association Injury Scale score distribution was as follows:26(60%)A,4(9%)B,9(21%)C,and 4(9%)D. The presence of AD was confirmed in all patients during urodynamic examination(UDS),that was the systolic blood pressure(SBP)suddenly increased and exceeded 20 mmHg(1 mmHg = 0.133 kPa). Before treatment,The AD symptoms severity score(consist of headache,sweating,goose bumps,anxiety and palpitation)were(14.53±2.51),Bladder-related AD frequency was 10.67 episodes/day. Baseline SBP was(103.51±9.64)mmHg,the maximum SBP was(150.40±22.75)mmHg,and the change in SBP(ΔSBP)from maximum to baseline SBP during UDS examination was(43.83±21.01)mmHg. The UDS indicated that the maximum detrusor pressure during storage phase was(54.95±24.68)cmH 2O,and the bladder capacity was(131.70±75.29)ml. Bladder diary showed the volume of catheterization each time from was(181.16±49.86)ml,and The I-QOL score was(44.07±8.60). Three months after treatment,the AD symptoms severity score(consist of headache,sweating,goose bumps,anxiety and palpitation)were(11.37±2.39). The frequency of bladder-related AD episodes was(7.51±2.37)episodes/day,showing statistically significant differences compared to pre-treatment( P<0.05).The SBP before UDS examination was(102.12±10.28)mmHg,with no statistically significant difference from baseline( P = 0.518). The maximum SBP in perfusion phase and the ΔSBP were(132.84±16.30)mmHg and(28.72 ± 14.02)mmHg,respectively,both demonstrating statistically significant differences( P < 0.05). The UDS examination revealed that the maximum detrusor pressure during the storage phase was(29.77±13.72)cmH 2O,showed a significant decrease,and the bladder capacity was(272.63±79.75)ml,which were both statistically different before and after surgery. Bladder diary showed the volume of catheterization each time was(326.74±63.71)ml;I-QOL score was(71.86±11.45),both were significant different after treatment( P < 0.01). Conclusion:BTX-A intravesical injection in the treatment of NDO can also alleviate the severity and frequency of bladder related AD.

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