Junfa Wu

Objectives: To characterize urodynamic findings after lower-level spinal cord injury (LSCI) and to evaluate a new pressure-based classification framework—the bladder–sphincter dyscoordination syndrome (BSDS)—for describing voiding patterns. We also introduce a descriptive “neurogenic bladder outlet obstruction” (NBOO) phenotype for straining-dependent voiding difficulty. Methods: We retrospectively analyzed the first urodynamic studies (December 2020–August 2024) in 81 men with LSCI (injury at T10 or below). Key urodynamic measures included detrusor and intravesical pressures during filling and voiding, bladder volumes (first desire to void and capacity), compliance, maximum flow rate (Q_max), post-void residual (PVR), voiding efficiency, and the ratio of detrusor to abdominal pressure rise (ΔPdet/ΔPabd). We compared cases with detrusor overactivity (DO) versus those without DO. Among those with voiding discoordination, we distinguished classical detrusor–sphincter dyssynergia (DSD) from a proposed NBOO phenotype (characterized by abdominal straining pressure ≥ 40 cmH₂O, detrusor pressure < 20 cmH₂O, incomplete emptying, and no anatomic obstruction). We further classified discoordination cases using the BSDS framework into four subtypes—dual high-pressure (DHP), detrusor-muscle predominant (DMP), dual low-pressure (DLP), and abdominal-pressure predominant (APP)—based on reference pressure thresholds (detrusor 20 cmH₂O; abdominal 40 cmH₂O). Results: Patients with DO (43.2%) showed significantly higher detrusor pressures during filling (at first desire to void and at capacity) and a lower first desire volume than non-DO patients, while maximum capacity was similar (p = 0.105). During voiding, DO cases had lower PVR and higher emptying rates, although the detrusor-vs-abdominal pressure contribution (ΔPdet/ΔPabd) was comparable between groups. Among 63 patients with voiding discoordination, 32 (50.8%) met NBOO criteria; these NBOO cases exhibited lower detrusor and intravesical voiding pressures but worse emptying (higher PVR) compared to classical DSD cases. Overall, 76 of 81 patients (93.8%) fit within the BSDS classification—distributed as 22 DHP, 13 DMP, 15 DLP, and 26 APP patterns. Conclusions: The BSDS framework (and the NBOO descriptor when conventional indices cannot be applied) offers a novel way to describe voiding patterns after LSCI. It links urodynamic observations to potential management strategies (by identifying whether the bladder or outlet is the primary issue). Prospective studies are needed to validate this framework against outcomes such as upper tract integrity, continence, and dependence on catheterization.

Although environmental enrichment (EE) promotes post‐stroke motor recovery, the mechanisms underlying its regulation of cerebellar dentate nucleus (DN) plasticity remain unclear; this study therefore investigated how EE coordinates autophagy, mitochondrial homeostasis, and synaptic remodeling in the contralateral DN to facilitate functional restoration. Using a permanent middle cerebral artery occlusion (pMCAO) mouse model, we combined behavioral tests (rotarod and ladder rung) with electron microscopy, Western blotting (LC3B, p62, mTOR/p‐mTOR), and ELISA (TNF‐α, IL‐1β, IL‐6) to assess motor function, ultrastructural changes, autophagy, and neuroinflammation. Results demonstrated that EE significantly improved cerebellar‐mediated motor coordination, reduced neuronal degeneration, and preserved mitochondrial integrity, while enhancing autophagic activity via increased LC3B expression and decreased p62 accumulation. Ultrastructural analysis revealed elevated synaptic density and a shift toward mitochondrial rejuvenation, paralleled by attenuated neuroinflammatory responses and suppressed pro‐inflammatory cytokine levels, consistent with mTOR pathway inhibition. These findings indicate that EE promotes motor recovery by activating a self‐reinforcing repair loop in the DN, wherein autophagy‐mediated mitochondrial clearance and neuroinflammation suppression create a permissive microenvironment for synaptic remodeling, thereby establishing the DN as a pivotal hub for EE's therapeutic effects and supporting combinatory strategies targeting autophagy–mitochondrial pathways to optimize rehabilitation.

To investigate the characteristics of pharyngeal and laryngeal structure in patients with acquired brain injury (ABI), who were long time wearing nasogastric tube (NGT) with or without tracheostomy. 103 ABI patients with NGT indwelled for more than 1 month were retrospectively studied and divided into two groups by whether or not undergoing tracheostomy. Age, gender, types of brain injury, course of the disease, disorders of consciousness, activities of daily living (ADL) and fiberoptic endoscopic examination of swallowing (FEES) were evaluated. The structure and function of pharyngeal and laryngeal were assessed by FEES, focusing on the morphology of the arytenoid cartilage, epiglottis, vocal folds, tongue base, and pharyngeal cavity. Prolonged indwelling nasogastric tubes and tracheostomy tubes might lead to abnormal alterations of the structure and function in the arytenoid cartilage, epiglottis, tongue base, and pharyngeal cavity. Epiglottis shape abnormality, glossoptosis and pharyngeal stenosis were present in a larger proportion of the NGT–TRACH (nasogastric tube with tracheostomy) group than the NGT group (p < 0.05). This study highlights potential physiological changes associated with prolonged placement of nasogastric tubes and tracheostomy tubes, which could impede the recovery of swallowing function and decannulation. We hope to provide valuable evidence to develop effective management strategies for ABI patients with NGT or tracheostomy.

A modified enriched environment (mEE) with 12 h per night was recently proposed and exhibited cognitive improvement. The present study aimed to evaluate the effects of different courses of mEE on different deficits in ischemic mice. Mice were subjected to photothrombotic stroke at the left sensorimotor cortex and then randomly assigned to standard environment or mEE for 7 d (St-PE) or 28 d (Ct-PE) on the third day post-stroke. Neurological deficits and sensorimotor, emotional, and cognitive performances were assessed at the 10th, 17th, and 31st days post-stroke. Our results demonstrated that Ct-PE ameliorated neurological deficits, forelimb using asymmetry, and reduced slip rates of the affected limbs at all time points, while this effect of St-PE was observed only on the 10th day. Similarly, Ct-PE for 28 d promoted spatial learning and working memory, but St-PE did not. Differently, ischemic mice in both St-PE and Ct-PE groups exhibited increased exploration behavior in the open field, light–dark box and elevated plus maze, and less immobile behavior during the tail suspension at all the time points. Our findings indicated that Ct-PE improved sensorimotor and cognitive dysfunctions after cortical ischemia in a time-dependent manner, but St-PE appeared to have greater therapeutic potential on anxiety and depression.

Article: Theta-burst transcranial magnetic stimulation for dysphagia patients during recovery stage of stroke: a randomized controlled trial - European Journal of Physical and Rehabilitation Medicine 2023 Sep 22 - Minerva Medica - Journals

Stroke seriously affects human health. Many studies have shown that enriched environment (EE) can promote functional recovery after stroke, but the intrinsic mechanisms remain unclear. In order to study the internal mechanisms of EE involved in functional recovery after ischemic stroke and which mechanism plays a leading role in the recovery of limb function after cerebral infarction, key proteins potentially involved in neuronal protection and synaptic remodeling in the ischemic penumbra have been investigated. In this study, adult C57BL/6 mice after permanent middle cerebral artery occlusion (pMCAO) were assigned to the EE and standard housing (SH) groups 3 days after operation. The EE house was spacious that contained a large variety of small toys; the SH was a normal sized cage. Sham‐operated mice without artery occlusion were housed under standard conditions and were fed a normal diet. On days 3, 7, 14, and 21, postoperative motor functional recovery was tested using the modified neurological severity score (mNSS) and the Rotarod test. The expression of B‐cell lymphoma‐2 (Bcl‐2), Bcl‐2‐associated X protein (Bax), growth‐associated protein‐43 (GAP‐43), and synaptophysin (SYN) was examined by western blotting and immunofluorescence staining. The motor functional recovery (based on the mNSS and Rotarod test 3, 7, 14, and 21 days post operation) of mice in the EE group improved significantly compared to the SH group. The expression of GAP‐43 and SYN and the ratio of Bcl‐2/Bax were all upregulated in the EE group compared to the SH group. In addition, we also explored the relationship between neuronal protection and synaptic remodeling in the EE‐mediated recovery of limb function after cerebral infarction by correlation analysis. Correlation analysis showed that compared with the increase of Bcl‐2/Bax ratio, the increased expression of GAP‐43 and SYN was more closely related to the recovery of limb function in ischemic mice. These data support the hypothesis that EE can promote the process of improvement of limb dysfunction induced by ischemic stroke, and this behavior restoration may, via promoting neuroprotection in the ischemic penumbra, be dependent on the regulation of the expression of GAP‐43, SYN, Bcl‐2, and Bax. A limitation of the study was that we only observed several representative key indicators of synaptic remodeling and neuronal apoptosis, without an in‐depth study of the potential mechanisms involved.

Understanding the patterns of brain glucose metabolism and connectivity in hypoxic-ischemic encephalopathy (HIE) patients with prolonged disorders of consciousness (DOC) may be of positive significance to the accurate assessment of consciousness and the optimization of neuromodulation strategy. We retrospectively analyzed the brain glucose metabolism pattern and its correlation with clinical Coma Recovery Scale-Revised (CRS-R) score in six HIE patients with prolonged DOC who had undergone ¹⁸F-deoxyglucose brain positron emission tomography scanning (FDG-PET). We also compared the differences in global metabolic connectivity patterns and the characteristics of several brain networks between HIE patients and healthy controls (HC). The metabolism of multiple brain regions decreased significantly in HIE patients, and the degree of local metabolic preservation was correlated with CRS-R score. The internal metabolic connectivity of occipital lobe and limbic system in HIE patients decreased, and their metabolic connectivity with frontal lobe, parietal lobe and temporal lobe also decreased. The metabolic connectivity patterns of default mode network, dorsal attention network, salience network, executive control network and subcortex network of HIE also changed compared with HC. The present study suggested that pattern of cerebral glucose metabolism and network connectivity of HIE patients with prolonged DOC were significantly different from those of healthy people.

Objectives: The aims of the study were to investigate the effect of tongue-pressure resistance training in poststroke dysphagia patients with oral motor dysfunction and to examine the therapeutic value of tongue-pressure resistance training in the oral and pharyngeal phases. Design: Patients were divided into an experimental and a control group. Both groups received 30 mins of traditional swallowing rehabilitation treatment every day for 4 wks. In addition, the experimental group received tongue-pressure resistance training for an extra 20 mins/d. Maximum tongue pressure and fiberoptic endoscopic examination of swallowing were assessed before and after treatments. Results: Compared with the control group, the experimental group showed significant improvement in Functional Communication Measure for swallowing, Oral Motor Function Scale, maximum tongue pressure, Murray Secretion Scale, Rosenbek Penetration–Aspiration Scale, and food residue in pyriform sinuses (P < 0.05). There was no significant difference in food residue in epiglottic vallecula between both groups (P > 0.05). Conclusions: This study demonstrated that tongue-pressure resistance training is an effective approach to improve the overall swallowing function in patients with oral motor dysfunction. The improvement of oral motor function could facilitate the recovery of pharyngeal motor function. Tongue-pressure resistance training seems to have more clearance of residue in piriform sinus than epiglottic vallecula.