OBJECTIVE: To explore the rules of acupoint selection in the treatment of neurogenic bladder (NB) with acupuncture and moxibustion by using data mining.
METHODS: The clinical research literatures on acupuncture treatment of NB were collected from PubMed, Embase, Cochrane Library, CNKI, Wanfang Database, VIP Database and China Biology Medicine from retrieved to January 1, 2023. The acupoint prescription database was established using Excel 2019. SPSS Modeler 18.0 and SPSS Statistics 26.0 softwares were used to conduct the frequency, meri-dians, locations, specific acupoints analysis and association rules analysis, factor analysis, cluster analysis, etc., to explore the characteristics and rules of acupoint selection in acupuncture and moxibustion treatment of NB.
RESULTS: Totally 313 papers were included, including 110 acupoints with a total frequency of 1 995. The high-frequency acupoints are Zhongji (CV3), Guanyuan (CV4), Sanyinjiao (SP6), etc. The commonly used meridians are the Bladder Meridian of Foot Taiyang and Conception Vessel. The involved acupoints are mostly located in the lumbosacral region and abdomen, and intersection acupoints, mu-front acupoints and back-shu acupoints are the majority in the specific acupoints. The core acupoints group was analyzed, and 17 groups of association rules, 7 factors and 6 effective cluster groups were obtained.
CONCLUSIONS: Acupuncture and moxibustion treatment of NB follows the therapeutic principles of toni-fying the kidney, invigorating the spleen, and soothing the liver. The core acupoints group is CV3-CV4-SP6.
目的: 通过数据挖掘技术，探讨针灸治疗神经源性膀胱（NB）的选穴规律。方法: 检索PubMed、Embase、Cochrane Library、中国知网、万方数据库、维普数据库、中国生物医学文献数据库建库至2023年1月1日收录的有关针灸治疗NB的临床研究类文献，利用Excel 2019建立其腧穴处方数据库，采用SPSS Modeler 18.0、SPSS Statistics 26.0软件对腧穴进行使用频次、归经、部位、特定穴分析及关联规则分析、因子分析、聚类分析等，分析针灸治疗NB的选穴特点及规律。结果: 共纳入313篇文献，包含110个腧穴，腧穴使用的总频次为1 995次。高频腧穴为中极、关元、三阴交等，常用经脉为足太阳膀胱经与任脉，涉及的腧穴多位于腰骶部和腹部，特定穴中以交会穴、募穴和背俞穴居多。分析得出核心穴组，并得到17组关联规则、7个因子和6个有效聚类群。结论: 针灸治疗NB的选穴遵循补肾、健脾、疏肝的治疗原则，核心穴组为中极-关元-三阴交。.

UNASSIGNED: To investigate the occurrence rate of urinary tract infections (UTIs) in the early phase after performing intermittent catheterization (IC) and to explore the possible factors associated with UTIs after performing IC among people with spinal cord injury (SCI).
UNASSIGNED: An inpatient rehabilitation department of a teaching hospital in China.
UNASSIGNED: Retrospective chart review.
UNASSIGNED: A retrospective chart review was carried out for traumatic and non-traumatic SCI patients after performing IC during their inpatient stay. Demographic information, comorbidity of diabetes, urine analysis results before IC, method of IC (sterile or clean), use of bladder irrigation, cessation of IC and its reasons, and UTI events were collected.
UNASSIGNED: A total of 183 adult individuals were included, of which 60 (32.8%) of them were women. The median age was 49.0 years. The median time post-injury was 2 months. The overall occurrence rate of UTI after performing IC was 1.31 (95% confidence intervals: 0.96-1.77) events per 100 days. Sixty-nine (37.7%) patients discontinued IC during hospitalization, and UTIs were the leading reason for cessation (50.7%). Female sex, use of antibiotics for infections other than UTI, and use of bladder irrigation were found to be associated with a lower occurrence rate of UTI in the early phase after performing IC, with an odds ratio of 0.38 (p = 0.019), 0.20 (p = 0.022), and 0.24 (p < 0.001), respectively.
UNASSIGNED: UTI after performing IC is prevalent among people with SCI. The study indicated that antibiotic prophylaxis and routine bladder irrigation might be associated with the reduction in UTI in the early phase after performing IC. Further research is needed to provide more evidence.

OBJECTIVE: To observe the clinical efficacy of timing umbilical therapy for neurogenic bladder after spinal cord injury based on the midnight-noon and ebb-flow doctrine.
METHODS: Sixty patients with neurogenic bladder after spinal cord injury were randomly divided into a trial group and a control group, with 30 patients in each group. In the trial group, based on the midnight-noon and ebb-flow doctrine, umbilical therapy was given at the time zone, 15:00 to 17:00. In the control group, umbilical therapy was delivered at any time zones except the period 15:00 to 17:00. The herbal plaster was remained on the umbilicus for 4 h each time, once daily. One course of treatment was composed of 2 weeks and the treatment lasted 4 weeks. Before and after treatment, the urodynamic indexes (maximum urinary flow rate [Qmax], maximum detrusor pressure [Pdet-max], residual urine volume [RUV]), voiding diary (average daily number of voiding, average daily number of leakage, average daily voided volume), neurogenic bladder symptom score (NBSS), the score of urinary symptom distress scale (USDS) and the score of World Health Organization quality of life assessment-BREF (WHOQOL-BREF) were compared between the two groups; and the clinical efficacy of the two groups was assessed.
RESULTS: After treatment, Qmax, Pdet-max, the average daily voided volume and the scores of WHOQOL-BREF were increased (P<0.05); and RUV, the average daily number of voiding, the average daily number of leakage, NBSS and the scores of USDS were all reduced (P<0.05) in comparison with those before treatment in the two groups. When compared with those in the control group, Qmax, Pdet-max, the average daily voided volume and the score of WHOQOL-BREF were all higher (P<0.05); and RUV, the average daily number of voiding, the average daily number of leakage, NBSS and the score of USDS were lower (P<0.05) in the trial group. The total effective rate was 96.7% (29/30) in the trial group, higher than that (76.7%, 23/30) in the control group (P<0.05).
CONCLUSIONS: Timing umbilical therapy, based on the midnight-noon and ebb-flow doctrine, effectively relieves the symptoms of dysuria and improves the quality of life in patients with neurogenic bladder after spinal cord injury.
目的: 观察基于子午流注理论择时脐疗治疗脊髓损伤后神经源性膀胱的临床疗效。方法: 将60例脊髓损伤后神经源性膀胱患者随机分为子午流注脐疗组和其他时间脐疗组，每组30例。子午流注脐疗组根据子午流注纳子法于申时（15：00-17：00）行脐疗，其他时间脐疗组避开申时，于其他时间行脐疗，均每次贴敷4 h，每日1次，2周为一疗程，连续治疗4周。比较两组患者治疗前后尿流动力学指标［最大尿流率（Qmax）、最大逼尿肌压力（Pdet-max）、残余尿量（RUV）］、排尿情况（日均排尿次数、日均漏尿次数、日均单次排尿量）、神经源性膀胱症状评分（NBSS）、泌尿症状困扰量表（USDS）评分、世界卫生组织生存质量评估简表（WHOQOL-BREF）评分，并评定临床疗效。结果: 治疗后，两组患者Qmax、Pdet-max、日均单次排尿量、WHOQOL-BREF评分较治疗前增加（P<0.05），RUV、日均排尿次数、日均漏尿次数、NBSS及USDS评分均较治疗前减少（P<0.05）；子午流注脐疗组患者Qmax、Pdet-max、日均单次排尿量、WHOQOL-BREF评分均高于其他时间脐疗组（P<0.05），RUV、日均排尿次数、日均漏尿次数、NBSS及USDS评分均低于其他时间脐疗组（P<0.05）。子午流注脐疗组总有效率为96.7%（29/30），高于其他时间脐疗组的76.7%（23/30，P<0.05）。结论: 基于子午流注理论择时脐疗可有效改善脊髓损伤后神经源性膀胱患者排尿困难症状，提高其生活质量。.

OBJECTIVE: To assess the effect of an injection of botulinum toxin A (BoNT/A) at the epicenter of the spinal cord injury (SCI) site on the recovery of lower urinary tract function in female rats with thoracic SCI.
METHODS: Twenty-four female Wistar rats with Sham (laminectomy at T8/T9 level) or SCI (at T8/T9; 30 g compression for 5 s) were assigned into Sham-SS (injected with 5 µL of saline solution), Sham-BoNT/A (injected with 15 pg/rat, equivalent to 7.5 Units/kg of BoNT/A in 5 µL volume), SCI-SS (injured and injected with saline), SCI-BoNT/A (injured and injected with BoNT/A), N = 6 per group. Weekly evaluation of stereotyped micturition behavior, hind-limb nociception, and locomotor activity was performed 1 week before and during 6 weeks after surgery. Subsequently, all groups underwent simultaneous electromyography of the external urethral sphincter (EUS-EMG) and cystometric (CMG) studies.
RESULTS: A compression SCI at the T8/T9 thoracic level significantly impairs sensory and locomotive functions, as well as stereotyped micturition behavior. However, these impairments were improved by BoNT/A injection after SCI. Neither injections of saline solution nor BoNT/A had an appreciable effect on the same parameters evaluated in the Sham groups. The combined EUS-EMG and CMG evaluations revealed important improvements of lower urinary tract physiology, particularly a reduction in the frequency of non-voiding contractions and the properties of EUS bursting activity indicated as the amplitude of the EUS-EMG signal and duration of burst electrical activity during effective voiding.
CONCLUSIONS: The severe impairments on sensory and locomotive functions as well stereotyped micturition caused by an SCI could be potentially attenuated by an injection of a small amount of BoNT/A directly into the epicenter of the SCI region. A reduction in the release of neurotoxic neurotransmitters requiring the SNARE complex may be the mechanism triggered by BoNT/A to reduce neurotoxicity and hyperexcitability created in the SCI area to improve the survival of spinal cord cells involved in micturition.

UNASSIGNED: Neurogenic bladder (NB) is a form of neurological bladder dysfunction characterized by excessive contraction of the bladder detrusor. Protein kinase A (PKA) signaling is involved in the contraction of the detrusor muscle.
UNASSIGNED: To investigate whether PKA signaling mediates the effect of electroacupuncture (EA) on the excessive contraction of the bladder detrusor in NB.
UNASSIGNED: Sixty rats were randomly divided into control, sham, NB, NB + EA, and NB + EA + H89 (a PKA receptor antagonist) groups. The modified Hassan Shaker spinal cord transection method was used to generate a NB model. After EA intervention for one week, urodynamic tests were used to evaluate bladder function, hematoxylin and eosin staining was conducted to assess morphological changes, enzyme-linked immunosorbent assay (ELISA) was performed to measure the concentration of PKA, and Western blotting was conducted to measure the protein levels of phosphorylated myosin light chain kinase (p-MLCK)/p-MLC.
UNASSIGNED: The results showed that NB resulted in morphological disruption, impairment of urodynamics, and decreases in the concentration of PKA and the protein levels of p-MLCK/p-MLC. EA reversed the changes induced by NB dysfunction. However, the improvement in urodynamics and the increases in the concentration of PKA and the protein levels of p-MLCK/p-MLC were inhibited by H89.
UNASSIGNED: Our findings indicate that the PKA signaling pathway mediates the beneficial effect of EA on excessive contraction of the bladder detrusor in a rat model of NB.

OBJECTIVE: To observe the effect of electroacupuncture (EA) on urodynamics and Raf/MEK/ERK signaling pathway in spine cord tissue of rats after suprasacral spinal cord injury (SSCI), so as to explore its possible mechanism in improving bladder function in rats with detrusor hyperreflexia after SSCI.
METHODS: Female SD rats were randomly divided into blank, sham operation, model, EA and EA+PD98059 groups, with 12 rats in each group. Thorax (T) 10 spinal cord transection was performed by surgery. Rats in the EA group were given EA (10 Hz/50 Hz, 20 min) at \"Ciliao\" (BL32), \"Zhongji\" (CV3), \"Sanyinjiao\" (SP6) and \"Dazhui\" (GV14) once daily for 7 d. Rats of the EA+PD98059 group received intraperitoneal injection of PD98059 (5 mg/kg) 2 h before EA intervention. The urodyna-mics was used to measure the base pressure, leak point pressure, maximum pressure, maximum capacity and comp-liance of bladder, and the morphology of bladder detrusor tissue was observed with HE staining. The TUNEL staining was used to detect the cell apoptosis of the spinal cord tissue. The expression levels of exchange protein directly activated by cAMP 2 (Epac2), Rap, phosphorylated rapidly accelerated fibrosarcoma (p-Raf), phosphorylated mitogen-activated extracellular signal-regulated kinase (p-MEK), phosphorylated extracellular signal regulated kinase 1 and 2 (p-ERK1/2), B-cell lymphoma-2 (Bcl-2), and Bcl-2 associated X protein (Bax) were determined by Western blot.
RESULTS: Compared with the sham operation group, the base pressure, leak point pressure and maximum pressure of bladder were significantly increased (P<0.01), the maximum bladder capacity and bladder compliance were decreased (P<0.01), the cell apoptosis rate of spinal cord tissue was increased (P<0.01), and the expression levels of Epac2, Rap, p-Raf, p-MEK, p-ERK1/2, and Bcl-2 protein in spinal cord tissue were decreased (P<0.01), while the expression level of Bax protein was increased (P<0.01) in the model group. After the treatment and compared with the model group, the base pressure, leak point pressure and maximum pressure of bladder, the cell apoptosis rate of spinal cord tissue, the expression level of Bax protein were decreased (P<0.05) in the EA group, while the maximum bladder capacity and bladder compliance, the expression levels of Epac2, Rap, p-Raf, p-MEK, p-ERK1/2, and Bcl-2 protein in spinal cord tissue were all increased (P<0.05, P<0.01). In comparison with the EA group, the base pressure, leak point pressure and maximum pressure of bladder, the cell apoptosis rate, the expression level of Bax protein were significantly increased (P<0.05), whereas the maximum bladder capacity, bladder compliance, and the expression levels of p-MEK, p-ERK1/2, and Bcl-2 protein were decreased (P<0.05) in the EA+PD98059 group. Results of HE staining showed disordered transitional epithelial cells and destroyed lamina propria in bladder detrusor tissue, with the infiltration of monocytes in the model group, which was obviously milder in both EA and EA+PD98059 groups, especially in the EA group.
CONCLUSIONS: EA can improve the bladder function in detrusor hyperreflexia rats after SSCI, which may be related to its effect in up-regulating Epac2 and Rap, activating the Raf-MEK-ERK pathway, and reducing the cell apoptosis of spinal cord tissue.
目的: 观察电针对骶上脊髓损伤（SSCI）后逼尿肌反射亢进型大鼠尿流动力学及脊髓组织中丝氨酸/苏氨酸蛋白激酶（Raf）与丝裂原活化的细胞外信号调节激酶（MEK）及细胞外信号调节激酶1/2（ERK1/2）信号通路的影响，探讨电针改善SSCI后逼尿肌反射亢进型大鼠膀胱功能的可能机制。方法: 72只SD大鼠随机分为空白组和假手术组各12只，其余48只大鼠采用脊髓横断法造模，在符合模型标准的大鼠中随机抽取36只分为模型组、电针组和电针+PD98059组各12只。电针组大鼠于“次髎”“中极”“三阴交”“大椎”给予电针治疗，20 min/次，1次/d，连续7 d；电针+PD98059组大鼠在同样电针干预前2 h给予腹腔注射PD98059（5 mg/kg）。采用尿流动力学检测大鼠膀胱基础压、漏尿点压、最大压力、最大容量及顺应性，HE染色观察大鼠膀胱逼尿肌组织形态，用TUNEL法测定脊髓组织细胞凋亡情况，用Western blot法检测脊髓组织中环磷酸腺苷直接激活交换蛋白2（Epac2）、小分子G蛋白Rap、磷酸化（p）-Raf、p-MEK、p-ERK 1/2、B淋巴细胞瘤-2（Bcl-2）、Bcl-2相关蛋白X（Bax）的表达。结果: 与假手术组比较，模型组大鼠膀胱基础压、漏尿点压、最大压力均升高（P<0.01），而膀胱最大容量减少（P<0.01），膀胱顺应性降低（P<0.01），脊髓组织细胞凋亡率升高（P<0.01），脊髓组织Epac2、Rap、p-Raf、p-MEK、p-ERK1/2及Bcl-2蛋白表达水平降低（P<0.01），Bax蛋白表达水平升高（P<0.01）。与模型组比较，电针组大鼠膀胱基础压、漏尿点压、最大压力均降低（P<0.05），膀胱最大容量增加（P<0.05），膀胱顺应性升高（P<0.05），脊髓组织细胞凋亡率降低（P<0.05），脊髓组织Epac2、Rap、p-Raf、p-MEK、p-ERK1/2及Bcl-2蛋白表达水平升高（P<0.05，P<0.01），Bax蛋白表达水平降低（P<0.05）。与电针组比较，电针＋PD98059组大鼠膀胱基础压、漏尿点压、最大压力均升高（P<0.05），膀胱最大容量减少（P<0.05），膀胱顺应性降低（P<0.05），脊髓组织细胞凋亡率升高（P<0.05），脊髓组织p-MEK、p-ERK1/2及Bcl-2蛋白表达水平均降低（P<0.05），Bax蛋白表达水平升高（P<0.05）。HE染色结果显示，空白组和假手术组大鼠膀胱逼尿肌组织细胞排列紧密整齐，细胞形态完整；模型组大鼠膀胱逼尿肌移行上皮细胞排列紊乱，固有膜被破坏，伴单核细胞浸润；与模型组比较，电针组膀胱逼尿肌组织弹性纤维增生程度减轻，肌纤维排列层次较清晰，可观察到更多形态饱满的完整细胞；与电针组比较，电针＋PD98059组逼尿肌组织肌纤维排列层次欠清晰，细胞间隙大。结论: 电针可改善SSCI后逼尿肌反射亢进型大鼠的膀胱功能，其机制可能与电针上调脊髓Epac2、Rap，启动Raf-MEK-ERK级联反应，减少细胞凋亡，改善膀胱神经支配有关。.

OBJECTIVE: To observe the effect of Yiyuan moxibustion on urodynamics and the expressions of transient receptor potential vanilloid 4 (TRPV4), adenosine triphosphate (ATP), tyrosine protein kinase KIT (C-Kit) and adenosine triphosphate receptor P2X5 in bladder tissue of rats with detrusor reflex-free neurogenic bladder (NB) after sacral cord injury (SCI), so as to explore its mechanism in promoting the recovery of urination function of NB rats.
METHODS: Female SD rats were randomly divided into sham operation, model, Yiyuan moxibustion, Yiyuan moxibustion+inhibitor (combination) and inhibitor groups, with 12 rats in each group. The model of detruser reflex-free NB after sacral SCI was established by modified Hassan Shaker spinal cord transection method. The behavioral score of Basso Beasttie Bresnahan (BBB) and urodynamic indexes were used to evaluate the model of rats after operation. Fifteen days after modeling, Yiyuan moxibustion was applied to \"Shenque\" (CV8) and \"Guanyuan\" (CV4) for 20 min, once daily for 14 days. Rats of the inhibitor and combination groups were given intravesical instillation of HC067047 (1 mL, 1 μmol/L, 30 min). After the interventions, urodynamics was used to evaluate the bladder function of rats. HE staining was used to observe the morphology of bladder tissue. ATP content in bladder tissue was detected by colorimetric method. The positive expression rates of C-Kit and their receptor P2X5 in bladder tissue were observed by immunofluorescence double labeling method, and TRPV4, C-Kit, and P2X5 protein expression levels in bladder tissue were detected by Western blot.
RESULTS: Compared with the sham operation group, the maximum bladder capacity and bladder compliance of rats in the model group were increased (P<0.01), the leak point pressure, ATP content, the possitive expression rates of C-Kit and P2X5, and the protein expression levels of TRPV4, C-Kit, P2X5 in bladder tissue were decreased (P<0.01). In comparison with the model and combination groups, the Yiyuan moxibustion group showed a decrease in maximum bladder capacity and bladder compliance (P<0.01), an increase in leakage point pressure, ATP content, the possitive expression rates of C-Kit and P2X5, and TRPV4, C-Kit, and P2X5 protein expression levels (P<0.01, P<0.05)；However, these indicators showed opposite trends in the inhibitor group (P<0.01, P<0.05).
CONCLUSIONS: Yiyuan moxibustion can improve the urodynamics and bladder function in rats with bladder detrusor nonreflective after SCI, which may be related to its effect in activating the TRPV4 channel in bladder tissue, promoting the release of ATP from bladder epithelium, thus increasing the expression of bladder Cajal interstitial cells and their purinergic P2X5 receptors.
目的: 观察益元灸对骶髓损伤后逼尿肌无反射型神经源性膀胱（NB）大鼠尿流动力学的作用，探讨益元灸调控膀胱组织中瞬时受体电位香草酸4（TRPV4）、三磷酸腺苷（ATP）、酪氨酸蛋白激酶KIT（C-Kit）和ATP受体P2X5的表达以促进NB大鼠排尿功能恢复的机制。方法: 80只雌性SD大鼠，随机选取12只作为假手术组，其余大鼠用骶髓横断法制备膀胱逼尿肌无反射型NB模型，造模成功的大鼠随机分为模型组、益元灸组、益元灸+抑制剂组、抑制剂组，每组12只。术后第15天开始治疗，益元灸组在手法排尿基础上给予益元灸“神阙”“关元”治疗，抑制剂组在手法排尿基础上给予HC067047膀胱灌注（1 mL，1 μmol/L，30 min），益元灸+抑制剂组在手法排尿基础上给予益元灸+HC067047膀胱灌注，模型组除手法排尿外不予其他治疗。末次干预结束后采用尿流动力学评价大鼠膀胱功能，HE染色法观察膀胱组织形态，比色法检测膀胱组织中ATP含量，免疫荧光法观察膀胱组织中C-Kit及P2X5的阳性表达率，Western blot法检测膀胱组织中TRPV4、C-Kit和P2X5蛋白表达水平。结果: 与假手术组比较，模型组大鼠最大膀胱容量、膀胱顺应性均升高（P<0.01），漏尿点压力、膀胱组织中ATP含量、C-Kit和P2X5的阳性表达率及TRPV4、C-Kit、P2X5蛋白表达水平均降低（P<0.01）。与模型组比较，益元灸组大鼠最大膀胱容量、膀胱顺应性均降低（P<0.01），漏尿点压力、膀胱组织中ATP含量、C-Kit和P2X5的阳性表达率及TRPV4、C-Kit、P2X5蛋白表达水平均升高（P<0.01，P<0.05）；抑制剂组大鼠最大膀胱容量、膀胱顺应性均升高（P<0.01），漏尿点压力、膀胱组织中ATP含量、C-Kit和P2X5的阳性表达率及TRPV4、C-Kit、P2X5蛋白表达水平均降低（P<0.05，P<0.01）。与益元灸+抑制剂组比较，益元灸组大鼠最大膀胱容量、膀胱顺应性均降低（P<0.01），漏尿点压力、膀胱组织中ATP含量、C-Kit和P2X5的阳性表达率及TRPV4、C-Kit、P2X5蛋白表达水平均升高（P<0.01，P<0.05）；抑制剂组大鼠最大膀胱容量、膀胱顺应性均升高（P<0.01），漏尿点压力、膀胱组织中ATP含量、C-Kit和P2X5的阳性表达率及TRPV4、C-Kit、P2X5蛋白表达水平均降低（P<0.01，P<0.05）。结论: 益元灸对膀胱逼尿肌无反射型NB大鼠尿流动力学有明显改善作用，其作用机制可能是激活膀胱组织中的TRPV4通道，促进膀胱上皮细胞释放ATP，从而增加膀胱Cajal间质细胞数量及其嘌呤能受体P2X5表达，提高逼尿肌收缩能力，改善膀胱功能。.

Neurogenic bladder (NB) following suprasacral spinal cord injury (SSCI) is an interstitial disease with the structural remodeling of bladder tissue and matrix over-deposition. Circular RNAs (circRNAs) are involved in fibrotic disease development through their post-transcriptional regulatory functions. This study aimed to use transcriptome high-throughput sequencing to investigate the process of NB and bladder fibrosis after SSCI.
Spinal cord transection at the T10-T11 level was used to construct the SSCI model in rats (10-week-old female Wistar rats, weighing 200 ± 20 g). The bladders were collected without (sham group) and with (SSCI 1-3 groups) NB status. Morphological examination was conducted to assess the extent of bladder fibrosis. Additionally, RNA sequencing was utilized to determine mRNAs and circRNAs expression patterns. The dynamic changes of differentially expressed mRNAs (DEMs) and circRNAs (DECs) in different periods of SSCI were further analyzed.
Bladder weight, smooth muscle cell hypertrophy, and extracellular matrix gradually increased after SSCI. Compared with the sham group, 3,255 DEMs and 1,339 DECs, 3,449 DEMs and 1,324 DECs, 884 DEMs, and 1,151 DECs were detected in the SSCI 1-3 groups, respectively. Specifically, circRNA3621, circRNA0617, circRNA0586, and circRNA4426 were significant DECs common to SSCI 1-3 groups compared with the sham group. Moreover, Gene Ontology (GO) enrichment suggested that inflammatory and chronic inflammatory responses were the key events in NB progression following SSCI. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enrichment associated with the \"Chemokine signaling pathway\", the \"IL-17 signaling pathway\", and the \"TGF-beta signaling pathway\" suggests their potential involvement in regulating biological processes. The circRNA-miRNA-mRNA interaction networks of DECs revealed rno-circ-2239 (micu2) as the largest node, indicating that the rno-circ-2239-miRNA-mRNA-mediated network may play a critical role in the pathogenesis of SSCI-induced NB.
This study offers a comprehensive outlook on the possible roles of DEMs and DECs in bladder fibrosis and NB progression following SSCI. These findings have the potential to serve as novel biomarkers and therapeutic targets.

OBJECTIVE: To compare the clinical efficacy between electroacupuncture(EA) and moxibustion for neurogenic bladder (NB) after spinal cord injury (SCI).
METHODS: One hundred and twenty patients with NB after SCI were randomly divided into an EA group, a moxibustion group, and an intermittent catheterization group, with 40 patients in each group. The patients in the intermittent catheterization group were treated with routine treatment and intermittent catheterization, while the patients in the EA group and the moxibustion group were treated with additional treatments of EA (discontinuous wave, with a frequency of 1.3-1.6 Hz, and intensity based on patient tolerance) and moxibustion, respectively. The acupoints used in both groups were Zhongji (CV 3) and Guanyuan (CV 4), bilateral Zusanli (ST 36), Yinlingquan (SP 9), and Baliao points. Each session lasted for 30 min, once daily, six times a week, for a total of six weeks.The maximum bladder capacity (MBC), residual urine vdume (RUV), detrusor pressure (Pdet) during the filling phase, bladder compliance (BC), maximum renal pelvis separation width of both kidneys, urine white blood cell count, TCM syndrome score, and World Health Organization quality of life assessment-BREF (WHOQOL-BREF) score were compared before and after treatment in the 3 groups. The number of patients in each group who achieved bladder functional balance was recorded, and the clinical efficacy was assessed after treatment.
RESULTS: After treatment, the MBC, Pdet, BC, and WHOQOL-BREF scores in the EA group and the moxibustion group were increased (P<0.05), while the RUV, maximum renal pelvis separation width of both kidneys, urine white blood cell count, and TCM syndrome scores were decreased (P<0.05, P<0.01). In the intermittent catheterization group, MBC, RUV, maximum renal pelvis separation width of both kidneys, and urine white blood cell count were decreased (P<0.05), while BC and WHOQOL-BREF score were increased (P<0.05) after treatment. After treatment, the MBC, Pdet, BC, and WHOQOL-BREF scores in the EA group and the moxibustion group were higher than those in the intermittent catheterization group (P<0.05), while the RUV and TCM syndrome scores were lower than those in the intermittent catheterization group (P<0.05). Moreover, after treatment, the MBC and Pdet in the moxibustion group were higher than those in the EA group (P<0.05), while the RUV, maximum renal pelvis separation width of both kidneys, and TCM syndrome score in the EA group were lower than those in the moxibustion group (P<0.05). The number of patients who achieved bladder functional balance after treatment in the EA group and the moxibustion group was higher than that in the intermittent catheterization group (P<0.05). The cured and effective rate was 85.0% (34/40) in the EA group and 82.5% (33/40) in the moxibustion group, which were both higher than 65.0% (26/40) in the intermittent catheterization group (P<0.05), there was no significant difference between the EA group and the moxibustion group (P>0.05).
CONCLUSIONS: EA and moxibustion could effectively improve the functional state of bladder in patients with NB after SCI. EA is more effective in reducing residual urine volume and excessive activity of the urethral sphincter, and relieving TCM syndromes, while moxibustion is more effective in increasing the pressure of the detrusor during the filling period and establishing the detrusor reflex.
目的：比较电针和艾灸治疗脊髓损伤（SCI）后神经源性膀胱（NB）的临床疗效。方法：将120例SCI后NB患者随机分为电针组、艾灸组和间歇导尿组，每组40例。间歇导尿组给予常规治疗及间歇导尿，电针组和艾灸组在间歇导尿组基础上分别给予电针（断续波，频率1.3~1.6 Hz，强度以患者能耐受为度）和艾灸治疗，均穴取中极、关元，双侧足三里、阴陵泉、八髎穴，每次30 min，每日1次，每周6次，共治疗6周。比较治疗前后各组患者最大膀胱容积（MBC）、残余尿量（RUV）、充盈期逼尿肌压力（Pdet）、膀胱顺应性（BC）、双肾最大肾盂分离宽度、尿白细胞数、中医证候积分、世界卫生组织生存质量测定量表简表（WHOQOL-BREF）评分，记录治疗后各组达到膀胱功能平衡状态患者例数，评定各组临床疗效。结果：治疗后，电针组和艾灸组MBC、Pdet、BC、WHOQOL-BREF评分较治疗前增加（P<0.05），RUV、双肾最大肾盂分离宽度、尿白细胞数、中医证候积分较治疗前减少（P<0.05，P<0.01）；间歇导尿组MBC、RUV、双肾最大肾盂分离宽度、尿白细胞数较治疗前减少（P<0.05），BC、WHOQOL-BREF评分较治疗前增加（P<0.05）。治疗后，电针组和艾灸组MBC、Pdet、BC、WHOQOL-BREF评分高于间歇导尿组（P<0.05），RUV、中医证候积分低于间歇导尿组（P<0.05）；艾灸组MBC、Pdet高于电针组（P<0.05），电针组RUV、双肾最大肾盂分离宽度、中医证候积分低于艾灸组（P<0.05）。电针组和艾灸组治疗后达到膀胱功能平衡状态患者例数多于间歇导尿组（P<0.05）。电针组愈显率为85.0%（34/40），艾灸组愈显率为82.5%（33/40），均高于间歇导尿组的65.0%（26/40，P<0.05），电针组和艾灸组比较差异无统计学意义（P>0.05）。结论：电针、艾灸均能有效改善SCI后NB患者膀胱功能状态，电针在减少残余尿量、减轻尿道括约肌过度活动、缓解中医证候方面疗效更佳，艾灸则在增加充盈期逼尿肌压力、建立逼尿肌反射方面疗效更佳。.

Bladder dysfunction has been linked to the progression of renal failure in children with neurogenic bladder (NB) dysfunction. The purpose of this study was to determine whether bladder injuries in fetal rats with myelomeningocele (MMC) may be treated with folic acid.
Pregnant Sprague-Dawley rats were randomly divided into three groups. On the 10th day of gestation, pregnant rats were intragastrically injected with all-trans retinoic acid (ATRA) (60 mg/kg) to induce MMC fetal rats. The same amount of olive oil was put into the control group to create normal fetal rats. The rats in the rescue group were given folic acid (40 mg/kg) by gavage 0.5 and 12 hr after ATRA therapy. Bladders were obtained via cesarean section on embryonic day E20.5 and examined for MMC. The histology of the fetuses was examined using hematoxylin and eosin staining, and immunohistochemistry (IHC) was utilized to determine the expression of α-smooth muscle actin (α-SMA) and neuron-specific nuclear-binding protein (NeuN). Furthermore, the levels of neuromuscular development-related and apoptotic proteins were determined by western blotting.
The incidence of MMC in the model group was 60.6% (20/33) while it was much lower in the rescue group (21.4%). In comparison to the model group, the weight and crown-rump length of the fetal rats in the rescue group were significantly improved. IHC revealed that there was no significant difference in the expression of α-SMA and NeuN between the control and ATRA groups, while the expression levels decreased significantly in the MMC group. Western blot analysis showed that there was no significant difference between the model and ATRA groups, but the expression of the α-SMA protein and the β3-tubulin was much lower in the MMC group than in the control group. After the administration of folic acid, the α-SMA and β3-tubulin proteins considerably increased in the folic acid-rescued MMC group and folic acid-rescued ATRA group. Meanwhile, in the control group, the expression of cleaved caspase-3 in the bladder tissue was significantly higher, and the expression of poly (ADP-ribose) polymerase (PARP) protein was significantly lower compared to the control group. Folic acid therapy reduced cleaved caspase-3 expression while increasing PARP expression in comparison to the MMC group.
NB in MMC fetal rats is associated with the reduction of bladder nerve and smooth muscle-related protein synthesis. However, folic acid therapy can help improve these functional deficiencies. Folic acid also exhibits strong anti-apoptotic properties against NB in MMC fetal rats.