Corticospinal-specific Shh overexpression in combination with rehabilitation promotes CST axonal sprouting and skilled motor functional recovery after ischemic stroke.

Ischemic stroke often leads to permanent neurological impairments, largely due to limited neuroplasticity in adult central nervous system. Here, we first showed that the expression of Sonic Hedgehog (Shh) in corticospinal neurons (CSNs) peaked at the 2nd postnatal week, when corticospinal synaptogenesis occurs. Overexpression of Shh in adult CSNs did not affect motor functions and had borderline effects on promoting the recovery of skilled locomotion following ischemic stroke. In contrast, CSNs-specific Shh overexpression significantly enhanced the efficacy of rehabilitative training, resulting in robust axonal sprouting and synaptogenesis of corticospinal axons into the denervated spinal cord, along with significantly improved behavioral outcomes. Mechanistically, combinatory treatment led to additional mTOR activation in CSNs when compared to that evoked by rehabilitative training alone. Taken together, our study unveiled a role of Shh, a morphogen involved in early development, in enhancing neuroplasticity, which significantly improved the outcomes of rehabilitative training. These results thus provide novel insights into the design of combinatory treatment for stroke and traumatic central nervous system injuries.

Transperineal Botulinum Toxin Injection for Chronic Pelvic Pain Syndrome after Transurethral Resection of the Prostate.

PURPOSE: To evaluate the efficacy of botulinum toxin type A (BTX-A) injection in patients with chronic pelvic pain syndrome (CPPS) after transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Six patients after TURP received the injection of BTX-A around the prostate capsule or pelvic floor under ultrasound guidance. The clinical outcomes including overall pain intensity (assessed by visual analog scale, VAS), the Functional Pelvic Pain scale (FPPS), and mental state by anxiety and depression questionnaires, the generalized anxiety disorder (GAD-7) and Hamilton depression rating scale (HAM-D)) were assessed at pre-treatment, and 1, 4, 12 weeks after treatment. RESULTS: Six male patients, aged 65 to 76 years were enrolled. The improvement of VAS pain score, the Functional Pelvic Pain scale, and mental assessment were observed at 1, 4, and 12 weeks after treatment for all six patients. All 6 patients had no safety concerns through 12 weeks visit, except 3 patients complained transient pain at injection site. CONCLUSION: Injection of BTX-A around the prostate under ultrasound guidance may be effective and safe for patients with CPPS after TURP.