NIH 年底批准了230万美元，由Beaumont医院（美国最大的私立医院之一）)牵头，在美国几个主要医学院多中心推广研究肖氏反射弧（somatic-autonomic reflex arc）肖氏手术。NIH已决定由哈佛大学医学院建立DATA Base，收集处理多中心肖氏反射弧手术资料。

相关NIH链接 http://projectreporter.nih.gov/project_info_description.cfm?aid=7696321

	Home > RePORTER > Project Information   Font Size:       Project Information Project Number: 1R01DK084034-01 Principal Investigator(s): PETERS, KENNETH M Title: SAFETY AND EFFICACY OF NERVE REROUTING FOR TREATING NEUROGENIC BLADDER IN SPINA B Awardee Organization: WILLIAM BEAUMONT HOSPITAL RESEARCH INST Abstract Text: DESCRIPTION (provided by applicant): Spina Bifida, a congenital defect of the spinal cord, causes nerve damage and a loss of sensation and muscle function below the waist resulting in bowel, bladder and sexual dysfunction. Patients cannot urinate or are constantly wet, and this continues throughout life causing major quality of life and health problems. Clean intermittent catheterization is usually needed to empty the bladder properly. Antimuscarinic medications are commonly required to alleviate high urinary tract pressures that can cause irreversible kidney damage, where dialysis or kidney transplant is the only way to sustain life. Dr. Xiao developed and is performing a novel procedure in China that connects a functioning, healthy lumbar spinal nerve root to the sacral nerve that controls the bladder. The end result is the creation of a new reflex where the bladder can be emptied by scratching or stimulating the skin supplied by that spinal nerve root. He has reported that in 92 SCI patients, 88% regained bladder control within one year after the nerve rerouting surgery and in 110 children with spina bifida, reported success in 87% at one year. However, in China rigorous follow up is challenging, therefore much is still unknown about the neurorecovery post surgery, complications and results occurring in the first year in particular, and the potential role that central nervous system remodeling may play in achieving successful outcomes. At Beaumont, a pilot study is underway on 9 spina bifida subjects, however no other center in the US is currently studying this technique. Our preliminary data are very promising, and with 9 subjects now 12 months post procedure, 7/9 subjects are voiding either voluntarily or by stimulating the new reflex mechanism. This project aims to expand upon our pilot experience to conduct a larger and more rigorous study to establish the safety and effectiveness of the proposed somatic-autonomic reflex pathway procedure in gaining bladder and bowel control in patients with spina bifida. Additionally, we will systemically evaluate and optimize frequency and location for excitation of the new somatic-autonomic reflex arc to a) gain more insight into the neurorecovery associated with nerve rerouting, and b) scientifically and systematically determine the ideal stimulation parameters to achieve best voiding results and make the somatic-autonomic reflex pathway rerouting most useful for the patients. Achieving the aims outlined in this proposal will help firmly establish the procedure as safe and effective, and revolutionize the treatment of bladder and bowel dysfunction in patients with spina bifida. PUBLIC HEALTH RELEVANCE: Spina Bifida, a congenital defect of the spinal cord, causes nerve damage resulting in bowel, bladder and sexual dysfunction. Dr. Xiao, in China, developed a new procedure to rewire the nerves affecting the bladder, and this project aims to scientifically establish the safety and effectiveness of the surgical procedure. Public Health Relevance Statement: Principal Investigator/Program Director (Last, First, Middle): Peters, Kenneth M. Project Narative: Spina Bifida, a congenital defect of the spinal cord, causes nerve damage resulting in bowel, bladder and sexual dysfunction. Dr. Xiao, in China, developed a new procedure to rewire the nerves affecting the bladder, and this project aims to scientifically establish the safety and effectiveness of the surgical procedure. NIH Spending Category: Clinical Research; Neurosciences; Pediatric; Spina Bifida; Urologic Diseases Project Terms: 0-11 years old; Active Follow-up; Administration of enema; Adverse Experience; Adverse effects; Adverse event; Affect; Analgesic Cutaneous Electrostimulation; Anatomic; Anatomical Sciences; Anatomy; Applications Grants; Area; Axon; Benefits and Risks; Birth Defects; Bladder; Bladder Control; Bladder Disorder, Neurogenic; Bladder Dysfunction; Bladder, Neurogenic; Bp50; Brain; CD40; CDW40; Cathetergram; Catheterization; Catheters; Central Nervous System; Child; Child Youth; Children (0-21); China; Clinical; Clinical Trials; Clinical Trials, Unspecified; Comment; Comment (PT); Comment [Publication Type]; Commentary; Commentary (PT); Common Rat Strains; Complement; Complement Proteins; Congenital Abnormality; Congenital Anatomic Abnormality; Congenital Anatomical Abnormality; Congenital Defects; Congenital Deformity; Congenital Malformation; Crossing Over; Crossing Over, Genetic; Cutaneous; Data; Dependency; Dependency (Psychology); Devices; Dialysis; Dialysis procedure; Dorsal Root of the Spinal Nerve; Drugs; Dysfunction; Editorial Comment; Editorial Comment (PT); Effectiveness; Electric Stimulation; Electric Stimulation, Transcutaneous; Electrical Stimulation; Electrical Stimulation, Transcutaneous; Electrodes; Encephalon; Encephalons; Enema; Foundations; Frequencies (time pattern); Frequency; Functional Magnetic Resonance Imaging; Functional disorder; Future; Ganglia, Parasympathetic; Genetic Crossing Over; Grafting, Kidney; Grant Proposals; Grants, Applications; HRP; Health; Horseradish Peroxidase; Human, Child; Individual; Institution; Intestinal; Intestines; Kidney; Kidney Transplantation; Kidney Transplants; Left; Life; Location; Loss of Sensation; Lower Extremity; Lower Limb; Lumbar Spinal Nerve Root; Lumbar spinal nerve root structure; MGC9013; MRI, Functional; Magnetic Resonance Imaging, Functional; Mainland China; Mammals, Rats; Manuals; Mechanical Stimulation; Mechanics; Medical; Medication; Medulla Spinalis; Membrum inferius; Methods and Techniques; Methods, Other; Micturition Reflex; Mission; Molecular Genetic Abnormality; Motor; Motor Cell; Motor Neurons; Muscle function; Muscle, Involuntary; Muscle, Smooth; Myelopathy, Traumatic; Natural regeneration; Nerve; Nervous; Nervous System, Brain; Nervous System, CNS; Neuraxis; Neurogenic Bladder; Neuropathic Bladder; Numbness; Operation; Operative Procedures; Operative Surgical Procedures; Organ; Outcome; Participant; Pathway interactions; Patients; Pelvic; Pelvic Region; Pelvis; Percutaneous Electric Nerve Stimulation; Percutaneous Electrical Nerve Stimulation; Pharmaceutic Preparations; Pharmaceutical Preparations; Physiopathology; Pilot Projects; Play; Posterior root of spinal nerve; Pressure; Pressure- physical agent; Principal Investigator; Procedures; Programs (PT); Programs [Publication Type]; Published Comment; QOL; Quality of life; Rat; Rattus; Reflex; Reflex action; Regeneration; Renal Transplantation; Renal Transplants; Reporting; Research; Research Design; Role; Roots, Dorsal; Sacral nerve; Safety; Schistorrhachis; Science of Anatomy; Sex Disorders; Sex Functioning; Sexual Dysfunction; Site; Skin; Smooth muscle (tissue); Solutions; Spina Bifida; Spinal Cord; Spinal Cord Trauma; Spinal Dysraphia; Spinal Dysraphias; Spinal Dysraphism; Spinal Dysraphisms; Spinal Nerve Roots; Spinal Roots; Spinal Trauma; Spinal cord injured; Spinal cord injuries; Spinal cord injury; Spinal nerve root structure; Structure of parasympathetic ganglion; Study Subject; Study Type; Surgical; Surgical Interventions; Surgical Procedure; TENS; TNFRSF5; TNFRSF5 gene; Techniques; Testing; Transcutaneous Electric Nerve Stimulation; Transcutaneous Electrical Nerve Stimulation; Transcutaneous Nerve Stimulation; Transdermal Electrostimulation; Translational Research; Translational Research Enterprise; Translational Science; Treatment Side Effects; Tumor Necrosis Factor Receptor Superfamily Member 5 Gene; Urethral sphincter; Urinary Bladder Disorder, Neurogenic; Urinary Bladder Neurogenic Dysfunction; Urinary System, Bladder; Urinary System, Kidney; Urination; Urology; Ventral Nerve Root; Ventral Roots; Viewpoint; Viewpoint (PT); Visceral; Waiting Lists; Work; anatomy; autonomic reflex; base; bladder continence; bowel; children; cleft spine; clinical investigation; dialysis therapy; drug/agent; emotional dependency; enema administration; experience; fMRI; follow-up; gangliocyte; ganglion cell; hydrocele spinalis; improved; improved functioning; insight; interest; micturition; micturition control; motoneuron; neural; nonsister chromatid exchange; novel; p50; pathophysiology; pathway; pilot study; pilot trial; pressure; programs; public health relevance; rachischisis posterior; regenerate; relating to nervous system; renal; response; sexual functioning; side effect; social; social role; somatic reflex; spinal nerve posterior root; study design; success; surgery; therapy adverse effect; translation research enterprise; treatment adverse effect; uRNA; urinary bladder; urinary continence; urinary control; urinary tract pressure; urination control; voiding; voiding reflex; youngster     Download Readers:
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