Long noncoding RNA H19 promotes the apoptosis of corpus cavernsum smooth muscle cells after cavernosal nerve injury via JNK signalling pathway.

JNK/ Bcl-2/ Bax pathway participates in corpus cavernosal smooth muscle cells apoptosis during early period after cavernosal nerve (CN) crush injury (CNCI). Nevertheless, the regulation mechanisms of long noncoding RNA H19 in apoptosis during early stage after CN injury are still poorly understood. The rats in sham group were not direct injury to the CNs. The rats in CNCI group were performed to bilateral CN crush injury. The ICP/MAP rate and smooth muscle content were significantly lower than that in the sham group. Primary CCSMCs were prepared from the tissues samples after completing erectile function detection. Phosphorylated-JNK level was increased significantly, and the expression of Bax and Bcl-2 was elevated and declined in CNCI group respectively. Except for Bcl-2, the mRNA levels of H19, JNK and Bax were significantly increased in CNCI group. After H19 siRNA transfection, for the mRNA and protein levels, JNK and Bax were declined, while Bcl-2 was enhanced. LncRNA H19 might be involved in regulation of Bcl-2, Bax via JNK signalling pathway in CCSMCs apoptosis after CN injury.

Disruption of cardiac cholinergic neurons enhances susceptibility to ventricular arrhythmias.

The parasympathetic nervous system plays an important role in the pathophysiology of atrial fibrillation. Catheter ablation, a minimally invasive procedure deactivating abnormal firing cardiac tissue, is increasingly becoming the therapy of choice for atrial fibrillation. This is inevitably associated with the obliteration of cardiac cholinergic neurons. However, the impact on ventricular electrophysiology is unclear. Here we show that cardiac cholinergic neurons modulate ventricular electrophysiology. Mechanical disruption or pharmacological blockade of parasympathetic innervation shortens ventricular refractory periods, increases the incidence of ventricular arrhythmia and decreases ventricular cAMP levels in murine hearts. Immunohistochemistry confirmed ventricular cholinergic innervation, revealing parasympathetic fibres running from the atria to the ventricles parallel to sympathetic fibres. In humans, catheter ablation of atrial fibrillation, which is accompanied by accidental parasympathetic and concomitant sympathetic denervation, raises the burden of premature ventricular complexes. In summary, our results demonstrate an influence of cardiac cholinergic neurons on the regulation of ventricular function and arrhythmogenesis.

Alterations in Cholinergic Pathways and Therapeutic Strategies Targeting Cholinergic System after Traumatic Brain Injury.

Traumatic brain injury (TBI) results in varying degrees of disability in a significant number of persons annually. The mechanisms of cognitive dysfunction after TBI have been explored in both animal models and human clinical studies for decades. Dopaminergic, serotonergic, and noradrenergic dysfunction has been described in many previous reports. In addition, cholinergic dysfunction has also been a familiar topic among TBI researchers for many years. Although pharmacological agents that modulate cholinergic neurotransmission have been used with varying degrees of success in previous studies, improving their function and maximizing cognitive recovery is an ongoing process. In this article, we review the previous findings on the biological mechanism of cholinergic dysfunction after TBI. In addition, we describe studies that use both older agents and newly developed agents as candidates for targeting cholinergic neurotransmission in future studies.

[Nerve-preserving low anterior rectum resection]. / Nervenschonende offene tiefe anteriore Rektumresektion beim Rektumkarzinom.

AIM: The Performance of an oncological low anterior rectum resection with preservation of the sympathic and parasympathic nerves is illustrated. INDICATION: The total mesorectal excision (TME) by Robert Heald et al. is the gold standard for rectal cancer operations which has lowered drastically the local recurrence rate. As the survival data improve, the new focus is the postoperative quality of life with preserving of the bladder and sexual function. METHOD: We demonstrate an anterior rectal cancer operation with preserving of the sympathetic and parasympathetic nerves step by step. CONCLUSION: The critical parts of preserving the nerves with the N. hypogastricus superior and inferior as well as the neurovascular bundle "erigent pillar" are demonstrated.

Recovery of colonic transit following extrinsic nerve damage in rats.

INTRODUCTION: Injury to pelvic sympathetic and parasympathetic nerves from surgical and obstetrical trauma has long been cited as a cause for abnormal colorectal motility in humans. Using a rat model, acute transaction of these extrinsic nerves has been shown to effect colorectal motility. The aim of this study is to determine in a rat model how transection of these extrinsic nerves affects colonic transit over time. METHODS: Eighty-two Sprague-Dawley rats underwent placement of a tunneled catheter into the proximal colon. Bilateral hypogastric, pelvic nerves (HGN and PN) or both were transected in 66 rats. The remaining 16 rats received a sham operation. Colonic transit was evaluated at postoperative days (PODs) 1, 3, and 7 by injecting and calculating the geometric center (GC) of the distribution of (51)Cr after 3 h of propagation. RESULTS: At POD 1, transection of PNs significantly delayed colonic transit (GC = 4.9, p < 0.05), while transection of HGNs (GC = 8.5, p < 0.05) or transection of both nerves (GC = 7.8, p < 0.05) significantly accelerated colonic transit, when compared with sham operation (GC = 6.0). A significant trend toward recovery was noted in both the HGN and PN transection groups at POD 7. CONCLUSIONS: Damage to the extrinsic sympathetic and/or parasympathetic PNs affects colonic transit acutely. These changes in large bowel motor function normalize over time implicating a compensatory mechanism within the bowel itself.

Nerve-sparing radical hysterectomy for cervical carcinoma.

With the concept of the improvement of quality of life in the field of surgical oncology, recent studies have questioned the place of radical hysterectomy (RH) in the treatment of cervical carcinoma due to a high rate of long-term postoperative complications involving the pelvic autonomic nerve system. It has been demonstrated that RH frequently causes bladder dysfunction, anorectal mobility disorders, and sexual dissatisfaction in cervical cancer survivors due to surgical trauma involving the sympathetic and parasympathetic branches of the autonomous innervation of the pelvic organs. Nerve-sparing RH was first pioneered by Takashi Kobayashi in Japan and then other Japanese gynecologic surgeons introduced and improved this concept to Western countries. However, nerve-sparing RH has only become popular among gynecologic surgeons during the last two decades. Recently, European gynecologic surgeons modified this concept. Herein, a review of the evolution of nerve-sparing RH, a quick overview of long-term pelvic organ dysfunctions associated with RH, and the technical details of different authors and their oncological outcomes are presented. Today, the lack of randomized studies comparing the effectiveness and complications of RH with nerve-sparing RH is an important barrier to the widespread use of this concept. Nonetheless, while nerve-sparing RH still awaits prospective randomized trials in order to prove that its effectiveness is equal to or greater than that of conventional treatment modalities, and that is has fewer long-term complications, this surgical approach remains attractive for the patients and gynecologic oncologists based on the published results.

The dilated pupil: an update.

The dilated pupil can present a significant challenge to the clinician. Although in most cases a complete history and physical examination is sufficient to make an accurate diagnosis, selected patients will require further investigation, including pharmacologic testing and neuroimaging. This review outlines the physiology, clinical features, and diagnostic approach to the most important causes of the dilated pupil. Particular attention is given to recent publications on this topic.

[Peripheral nerve injury and male sexual dysfunction].

The genital organ is innervated by autonomic and somatic nerve. The former is both sympathetic and parasympathetic nerve and the later is comprised by sensory and motor fibers. The symptoms of male sexual dysfunction are sexopathy, erectile dysfunction, disorder of ejaculation and orgasm, and pianism. Not only different symptom but the same symptom can be induced by different injured nerve. The relationship between peripheral nerve injury and male sexual dysfunction should be understood correctly.

The bullet that hit a nerve: the history of Lucja Frey and her syndrome.

Duphenix first described gustatory sweating in 1757. The underlying pathogenesis was not appreciated until 1923, when Lucja Frey, a Polish neurologist, observed the phenomenon in a Polish soldier with an infected bullet wound in the parotid gland and suggested that the auriculo-temporal nerve played a role. Lucja Frey was born in Lwów, Poland, in 1889 and began her medical studies in Lwów before moving to Warsaw to work as a neurologist. She amassed a total of 43 publications on various neurological topics over her career. Unfortunately, during the Second World War she was enlisted into the Lwów ghetto, where she worked until her death in 1943. We present the history of Frey's syndrome, particularly the life of Lucja Frey and the syndrome she described.

Microarray analysis of the rat lacrimal gland following the loss of parasympathetic control of secretion.

Previous studies showed that loss of muscarinic parasympathetic input to the lacrimal gland (LG) leads to a dramatic reduction in tear secretion and profound changes to LG structure. In this study, we used DNA microarrays to examine the regulation of the gene expression of the genes for secretory function and organization of the LG. Long-Evans rats anesthetized with a mixture of ketamine/xylazine (80:10 mg/kg) underwent unilateral sectioning of the greater superficial petrosal nerve, the input to the pterygopalatine ganglion. After 7 days, tear secretion was measured, the animals were killed, and structural changes in the LG were examined by light microscopy. Total RNA from control and experimental LGs (n = 5) was used for DNA microarray analysis employing the U34A GeneChip. Three statistical algorithms (detection, change call, and signal log ratio) were used to determine differential gene expression using the Microarray Suite (5.0) and Data Mining Tools (3.0). Tear secretion was significantly reduced and corneal ulcers developed in all experimental eyes. Light microscopy showed breakdown of the acinar structure of the LG. DNA microarray analysis showed downregulation of genes associated with the endoplasmic reticulum and Golgi, including genes involved in protein folding and processing. Conversely, transcripts for cytoskeleton and extracellular matrix components, inflammation, and apoptosis were upregulated. The number of significantly upregulated genes (116) was substantially greater than the number of downregulated genes (49). Removal of the main secretory input to the rat LG resulted in clinical symptoms associated with severe dry eye. Components of the secretory pathway were negatively affected, and the increase in cell proliferation and inflammation may lead to loss of organization in the parasympathectomized lacrimal gland.

Syndrome auriculotemporal.

Two cases of auriculotemporal syndrome are presented in two male children that began in the first years of life to present reactions of linear erythema itinerary on the cheeks after eating several foods. The allergologic study with these foods was negative, reproducing the clinical picture after their ingestion.

Slow transit constipation: a disorder of pelvic autonomic nerves?

Slow transit constipation (STC) is a severe motility disorder, which in the majority of cases is of unknown etiology. In some, symptoms arise de novo in childhood, but a proportion of patients present in later life, including after pelvic surgery or childbirth. Our aims were: (1) to describe our current knowledge of the anatomy and function of the pelvic autonomic nerves with respect to colonic motility (experimental and observational studies); (2) to discuss evidence for pelvic nerve injury in STC arising after pelvic surgery or childbirth; and (3), on the basis that such patients are clinically indistinguishable from patients with chronic idiopathic STC, to evaluate whether there is evidence that pelvic autonomic neuropathy has an etiologic role in patients with chronic idiopathic STC. The outcome was as follows: (1) The clear importance of the pelvic autonomic nerves in colonic motor function is documented. (2) While there is an association between pelvic surgery and childbirth, and the onset of STC, there is little direct anatomical evidence that pelvic denervation occurs in these patients. However the phenotype of these patients is similar to results of experimental and observational studies. (3) Clinical, physiological, and histological similarities exist between patients whose symptoms arose following pelvic intervention and those whose symptoms arise de novo (idiopathic). We further present evidence for possible pathogenetic mechanisms underlying pelvic autonomic neuropathy in chronic idiopathic STC.

[Neurobiology of postoperative impotence after rectal excision]. / Neurobiología de la impotencia post cirugía de exéresis rectal.

OBJECTIVE: The present study was conducted to determine the changes in the neuro-andrologic profile of patients with impotence following rectal ablative surgery. METHODS/RESULTS: The study comprised 18 patients who had undergone rectal surgery: abdominoperineal resection of the rectum (AP) in 12 cases (67%), anterior resection of the rectum (AR) in 6 cases (33%). The pharmacologic erection test was negative in 60% of the patients (56% of the AP cases and 67% of the RA cases; differences not significant). Sympathetic lesion was demonstrated in 67% of the patients (50% of the AP cases and 100% of the AR cases; significant difference). Parasympathetic lesion was demonstrated in 38% of the patients (56% of the AP and in none of the RA cases; tendency towards statistical significance). Pudendal lesion was demonstrated in 83% of the patients, although no significant differences concerning pudendal involvement were observed between both types of surgery (92% of the AP group and 67% of the RA group). The frequency of the pudendal lesion was significantly greater than the parasympathetic lesion and the sympathetic lesion tended to be significantly greater than the parasympathetic lesion in patients undergoing ablative rectal surgery. No significant differences were observed between the pudendal and the sympathetic lesion in these patients. No relationship was observed between the type of neurologic lesion and the results of the pharmacologic erection test. CONCLUSIONS: The type of neurological lesion appears to be related with the level of the rectal surgery. The sympathetic innervation would be more frequently compromised in anterior resection of the rectum. The parasympathetic innervation would be more frequently compromised in abdominoperineal resection. The pudendal innervation would be affected by both types of surgical techniques.

A case of gustatory rhinorrhoea.

The authors describe a case of gustatory rhinorrhoea that appeared one year after skull trauma with delayed facial palsy. Traumatic interruption and abnormal regrowth of salivary parasympathetic fibers is hypothesized. In order to explain the pathogenesis of this syndrome an anatomical review of the transpetrosal nerves is included. A review of the literature is also presented.

Urinary bladder dysfunction following anterior lumbosacral spine fusion: case report and review of the literature.

A 34-year-old woman suffering from chronic degenerative low back pain involving L5-S1 disc space, refractory to conservative treatment, underwent spinal fusion. A combined instrumented posterolateral, followed by anterior, interbody allograft fusion through a left retroperitoneal approach was performed. Postoperatively, the patient was unable to evacuate her bladder and control her micturition. Anal tone and sensation were intact. A self-catheterisation regime was instituted with a diagnosis of parasympathetic nerve injury during the anterior spinal fusion. After a period of 3 months, the patient regained control of urination. We report this case to highlight the importance of protecting the parasympathetic presacral nerve during L5-S1 anterior interbody fusion, as injury to this nerve affects urinary evacuation.

Effects of hysterectomy on bowel and bladder function.

A case control study compared the bowel habit of 91 post-hysterectomy women with paired controls from the same family doctor practice. More cases had an abnormal bowel frequency, a firmer stool consistency and assessed themselves as having abnormal bowel function, predominantly constipation after hysterectomy, than controls. Significantly more cases than controls had consulted a doctor because of constipation but there was no significant difference in laxative usage. There was a significant short-term association between decreased bowel frequency and increased urinary frequency after hysterectomy. This became highly significant in those patients who developed chronic symptoms. Oophorectomy, unilateral or bilateral, did not significantly affect bowel habit other than to intensify the change in stool consistency. The hypothesis is discussed that the post-hysterectomy effects on bowel and bladder function may have a common aetiology in a degree of autonomic denervation of both viscera.

Pirenzepine, telenzepine, atropine and metacine as agonists for the muscarinic cholinoreceptors in the denervated human parotid gland.

New anti-ulcer preparations, pirenzepine and telenzepine, are structurally dissimilar to the classical cholinomimetics, atropine and hyoscine (scopolamine). However, they are all capable of provoking paradoxical salivation from the chronically parasympathetically denervated human parotid gland. The rates of the secretory responses to the typical and atypical cholinoblockers are found to be the same. This finding is discussed with respect to the general functional mechanism of the traditional and non-traditional antimuscarinic agents.