International Neurourology Journal最新文献

Purpose: This study investigated whether the combined application of treadmill exercise and vitamin D injections exerts neuroprotective effects in nonpathological mice by enhancing cognitive function, regulating immune responses, preserving blood-brain barrier (BBB) integrity, and improving mitochondrial efficiency.

Methods: Forty male C57BL/6 mice were randomly assigned to control, exercise (EX), vitamin D (VD), or combined treatment (EXVD) groups. After 20 weeks of intervention, behavioral, molecular, and cellular analyses were performed to assess cognitive function, immune responses, BBB integrity, oxidative stress, and mitochondrial efficiency.

Results: The EXVD group demonstrated superior spatial learning and memory compared to the other groups. Vitamin D treatment significantly increased plasma interleukin-10 and tight junction protein levels, while exercise alone elevated hippocampal tumor necrosis factor-α. Combined treatment reduced astrocyte activation, maintained BBB integrity, and improved mitochondrial respiratory efficiency without increasing oxidative stress. Expression of antioxidant enzymes was decreased in the VD and EXVD groups, indicating improved redox balance.

Conclusion: Treadmill exercise and vitamin D injections confer neuroprotective effects in nonpathological mice by enhancing cognition, reducing neuroinflammation, and improving both BBB integrity and mitochondrial function. These findings highlight the potential of nonpharmacological strategies to support brain health even in the absence of disease.

Purpose: Aging is associated with various physiological changes. These include microvascular dysfunction, which impairs cerebral blood flow and neuronal health, leading to cognitive impairment. Although exercise has demonstrated beneficial effects on aging, its specific impact on age-related microvascular dysfunction and blood-brain barrier (BBB) disruption requires further investigation. This study aimed to evaluate whether an 8-week treadmill exercise regimen in aged mice could improve cognitive impairment by alleviating microvascular and BBB damage and reducing neuroinflammation.

Methods: Twenty-month-old C57BL/6J male mice engaged in a treadmill exercise program for 60 minutes daily over 8 weeks. Cognitive function was assessed using the passive avoidance test. Microvascular integrity was evaluated by measuring microvessel length and fragmentation in the cortex using platelet endothelial cell adhesion molecule-1 as a marker. Activation of microglia and astrocytes was determined by analyzing the expression of ionized calcium-binding adapter molecule 1 and glial fibrillary acidic protein through immunohistochemistry and immunofluorescence. BBB integrity was assessed by examining the expression levels of tight junction proteins, including zonula occludens-1, occludin, claudin-9, and platelet-derived growth factor receptor beta (PDGFRβ), in the cortex via immunostaining and western blotting.

Results: Treadmill exercise significantly improved cognitive function, as indicated by increased latency time in the passive avoidance test. Exercise intervention also increased microvessel length and decreased microvessel fragmentation in the cortex. Additionally, treadmill exercise reduced the activation of microglia and astrocytes, thereby decreasing neuroinflammatory responses. Furthermore, treadmill exercise preserved BBB integrity by maintaining the expression of tight junction proteins and PDGFRβ, counteracting age-related declines.

Conclusion: The findings suggest that regular treadmill exercise mitigates cognitive impairment and vascular dysfunction associated with aging by improving microvascular health and BBB integrity. These results highlight the potential of exercise intervention as a non-pharmacological strategy for treating age-related neurodegenerative diseases by preserving vascular and BBB structures and reducing neuroinflammation.

Purpose: Angiotensin II (Ang II) is widely recognized as a primary factor in the development of hypertension; however, recent research also implicates it in skeletal muscle damage and atrophy. The precise mechanisms by which Ang II impacts muscle morphology and the molecular pathways related to atrophy remain unclear. Moreover, the potential protective effects of aerobic exercise against Ang II-induced muscle alterations have not been fully elucidated. This study aimed to investigate the effects of Ang II on skeletal muscle structure and atrophy-related molecular markers and to assess whether aerobic exercise can confer protective effects against these changes in an Ang II-induced animal model.

Methods: Six-week-old mice (n =48) were divided into 4 groups: (1) control (CON, n =12), (2) Ang II (n =12), (3) Ang II plus low-intensity exercise (Ang II+LIE, n=12), and (4) Ang II plus high-intensity exercise (Ang II+HIE, n=12). Ang II was administered subcutaneously once daily for 4 weeks (1.4 mg/kg/day in phosphate-buffered saline, pH 7.2). The Ang II+LIE and Ang II+HIE groups received daily Ang II injections along with their respective exercise protocols for 4 weeks.

Results: The protein expression of inflammatory factors was significantly reduced in the Ang II+HIE group compared to the Ang II group (P < 0.05). Furthermore, the expression of muscle protein synthesis markers, including insulin-like growth factor 1, AKT, mammalian target of rapamycin, and S6K1, was significantly higher in the exercise groups than in the Ang II group (P<0.05). Notably, the expression of autophagy-related factors was also significantly elevated in the Ang II+HIE group compared to the Ang II group (P < 0.05).

Conclusion: Ang II-induced muscle atrophy was attenuated by aerobic exercise.

Purpose: Perivascular adipose tissue (PVAT) dysfunction contributes to vascular impairment in obesity, primarily through altered lipid accumulation, inflammatory cytokine imbalance, and disrupted endothelial signaling. This study aimed to investigate whether aerobic exercise can ameliorate PVAT-induced vascular dysfunction in mice with obesity induced by a high-fat diet.

Methods: Male C57BL/6J mice were fed either a chow or a high-fat diet for 12 weeks, followed by 8 weeks of aerobic treadmill training or sedentary control. Body weight, PVAT morphology, and levels of inflammatory cytokines (tumor necrosis factor alpha, interleukin 1β, monocyte chemoattractant protein 1, and intercellular adhesion molecule 1), adipokines (leptin and adiponectin), and phosphorylation of endothelial signaling proteins (Akt, AMP-activated protein kinase [AMPK], and endothelial nitric oxide synthase [eNOS]) were evaluated in the thoracic aorta and PVAT. Endothelium-dependent relaxation (EDR) was assessed using acetylcholine-induced vasodilation in aortic rings with or without PVAT.

Results: High-fat diet-induced obesity led to increased adipocyte size in PVAT, while it also impaired vascular relaxation, elevated levels of proinflammatory cytokines, and reduced phosphorylation of Akt, AMPK, and eNOS in both PVAT and the aorta. Aerobic exercise training significantly reduced PVAT adipocyte size, restored EDR, suppressed inflammatory cytokine levels, increased adiponectin expression, and promoted phosphorylation of vascular signaling molecules in both PVAT and the aorta.

Conclusion: Aerobic exercise training restores PVAT homeostasis and endothelial function in obese mice by modulating inflammation, adipokines, and vascular signaling. These findings suggest aerobic exercise as a nonpharmacological approach to improve vascular function in obesity by targeting PVAT dysfunction.

Purpose: Clinical skills training in nursing aims to equip students with the essential knowledge, skills, and attitudes required to successfully overcome challenges encountered in clinical settings and deliver optimal patient care. This study aimed to evaluate the effectiveness of video-based self-assessment as an educational tool for teaching urinary catheterization-a crucial clinical skill-to nursing students.

Methods: This study employed a randomized, single-blind, parallel-group controlled design. A total of 61 undergraduate nursing students participated (30 students in the experimental group and 31 in the control group). Students were randomly allocated to either the experimental or control group. The experimental group received conventional teaching methods supplemented by video-assisted education, while the control group received only conventional teaching methods. Pretests and posttests were administered to both groups.

Results: The experimental group's mean posttest score regarding urinary system knowledge was higher than that of the control group, but the difference was not statistically significant (P>0.05). However, within the experimental group, the difference between pretest and posttest mean scores on urinary system knowledge was statistically significant. Furthermore, the experimental group's mean posttest score for urinary catheterization placement skills was significantly higher than that of the control group (P<0.001).

Conclusion: The video-based self-assessment method effectively enhanced the development of professional skills, such as urinary catheterization, among nursing students.

Purpose: Sacral neuromodulation is widely used for refractory overactive bladder; however, its mechanism of action remains unclear. This study aims to investigate real-time changes in brain activity and functional connectivity (FC) during neuromodulation in an overactive bladder (OAB) rat model using functional magnetic resonance imaging.

Methods: Twelve female Sprague Dawley rats were implanted with fine bipolar electrodes adjacent to the L6 nerve root. Cystometry was performed on normal rats, acetic acid-induced OAB rats, and during spinal nerve stimulation (SNS) to confirm efficacy. Task-based functional magnetic resonance imaging (fMRI) was acquired using a 20-second rest-stimulus cycle, followed by T2-weighted anatomical imaging on a 9.4T MRI scanner. Comparative analyses examined changes in the amplitude of low-frequency fluctuations (ALFF) and FC between normal and OAB rats. Brain activity during SNS was further assessed using the general linear model (GLM) and FC analysis. Statistical significance was defined as P<0.05 (family-wise error-corrected).

Results: Compared with normal rats, OAB rats exhibited increased ALFF in the left prefrontal cortex, periaqueductal gray (PAG), and left primary somatosensory cortex. In addition, FC between the PAG and pons was enhanced (P=0.002). GLM analysis revealed that the left primary somatosensory cortex, left prefrontal cortex, corpus callosum, left secondary motor area, and right brainstem exhibited decreased activity during SNS (P<0.05). Significant FC changes were observed between several regions: the left cerebellum and left caudal zona incerta (P=0.024), right fasciculus retroflexus and left ventral orbital area (P=0.025), and between the pons and PAG (P=0.004). Seed-to-voxel analysis indicated altered FC between clusters identified in the GLM analysis and regions including the PAG, left cingulate area, left prefrontal cortex, left caudate putamen, and right granular insular cortex.

Conclusion: Our fMRI study identified several alterations in brain activity during SNS in rats. Specifically, activity in the left prefrontal cortex decreased during SNS, and FC between the PAG and pons was reduced. These changes may represent central mechanisms underlying sacral neuromodulation in OAB patients.

Purpose: We developed an innovative 2-stage procedure combining transurethral sphincterotomy (TURS) with artificial urinary sphincter (AUS) implantation to restore voiding in patients with refractory bladder emptying disorders. This proof-of-concept study evaluated its safety and efficacy.

Methods: We retrospectively reviewed clinical data from patients who underwent combined TURS and AUS implantation between April 7, 2021, and October 31, 2024. Eligible patients had neurogenic bladder with refractory emptying, irreversible neurogenic disease, and no mechanical obstruction (e.g., urethral strictures). In the TURS stage, the entire inner urethral segment corresponding to the external sphincter was resected to induce intrinsic sphincter deficiency; this was followed by AUS placement. We analyzed patient demographics, preoperative and postoperative daily pad usage, clean intermittent catheterization (CIC) frequency, patient-reported outcomes (Life Quality [LQ], International Consultation on Incontinence Questionnaire [ICIQ], Sandvik Severity Index [SAND]), postvoid residual (PVR) urine volume, estimated glomerular filtration rate (eGFR), abdominopelvic ultrasonography, and postoperative complications.

Results: Four out of 6 patients (66.7%) successfully achieved CIC-free status, with effective self-voiding achieved through AUS activation and abdominal pressure generation. Significant improvements were documented in LQ scores (P=0.042), ICIQ scores (P=0.004), and SAND scores (P=0.039). Median PVR significantly decreased from 237.5 mL (interquartile range [IQR], 112.5-317.5 mL) preoperatively to 1.5 mL (IQR, 0-85.8 mL) postoperatively (P=0.028). No patient demonstrated upper-tract damage or significant eGFR change. One patient developed an AUS infection requiring explantation; another remained CIC-dependent due to insufficient abdominal pressure.

Conclusion: Combining TURS with AUS implantation is a safe and effective surgical option for refractory bladder emptying disorders, yielding significant improvements in voiding autonomy and quality of life while reducing catheter dependence. Future studies with larger cohorts and longer follow-up are warranted to validate safety, long-term durability, and broader applicability. These findings may shift current paradigms in neurogenic bladder management.

Purpose: This study evaluates the efficacy of holmium laser enucleation of the prostate (HoLEP) as a deobstructive surgical intervention for patients with detrusor underactivity (DU) or an acontractile bladder (AcB).

Methods: Between April 2021 and May 2024, patients undergoing HoLEP for benign prostatic obstruction (BPO) were selected based on urodynamic study results indicating DU or AcB. The primary outcome was the change in voiding efficiency (VE) following HoLEP. Secondary outcomes included differences in VE between subgroups, such as the DU and AcB groups. The VE trend over time was visualized using Python's Seaborn library with the locally weighted scatterplot smoothing method, and plots were generated using Matplotlib.

Results: Fourteen patients with DU and 12 patients with AcB underwent HoLEP during the study period. In the DU group, the median age was 76.5 years, with a prostate size of 48.6 mL and 39% of tissue resected. In contrast, the AcB group had a median age of 74.5 years, a prostate size of 68 mL, and 44.5% of tissue resected. The median duration from symptom onset to surgery was 4.3 years in the DU group and 0.8 years in the AcB group. The median preoperative VE was 0% (n=26), which significantly increased to 81.3% postoperatively (P=0.0). VE increased sharply up to one month postoperatively, then plateaued. Additionally, other voiding functions showed statistically significant improvements in maximum urine flow (0 mL/sec vs. 14.4 mL/sec, P=0.0) and postvoid residual (325 mL vs. 45 mL, P=0.0). No significant difference in VE was found between the DU and AcB groups.

Conclusion: HoLEP effectively improves VE and symptoms as a deobstructive surgical intervention for patients with BPO and DU or AcB. There was no significant difference in outcomes between patients with DU and AcB.