Professor LIU Zhishun\'s clinical experience of electroacupuncture (EA) for pediatric neurogenic bladder of lower motor neuron type in children is summarized. Considering the unique physiological and pathological characteristics of children, with the strategy of combining \"disease-symptom-location\" in the selection of acupoints, professor LIU Zhishun proposes that the main disease location is the bladder and kidney, with the involvement of the conception vessel, governor vessel, kidney meridian of foot-shaoyin and the bladder meridian of foot-taiyang. The primary acupoint prescription-1 (bilateral Zhongliao [BL 33], Ciliao [BL 32] and Huiyang [BL 35]) and primary acupoint prescription-2 (Guanyuan [CV 4], Zhongji [CV 3] and bilateral Sanyinjiao [SP 6]) are selected to promote the yang of the governor vessel, stimulate the yin of the conception vessel, and invigorate the bladder\'s qi transformation. Before acupuncture, the four-step method is applied to precisely locate Ciliao (BL 32) and Zhongliao (BL 33). During acupuncture, the importance of achieving deqi is emphasized, with deep insertion in the sacral area to reach the disease location. Based on the tolerance characteristics of children, low-frequency EA and gentle moxibustion treatment are applied.
总结刘志顺教授电针治疗小儿下运动神经元型神经源性膀胱的临证经验。结合小儿独特的生理病理特点，运用“病-症-位”结合组方选穴思想，认为本病病位主要在膀胱和肾，经脉涉及任、督二脉和足少阴肾经、足太阳膀胱经。选取主穴方1（双侧中髎、次髎、会阳）和主穴方2（关元、中极、双侧三阴交），以宣通督脉之阳，刺激任脉之阴，激发膀胱气化。针刺前四步法精准定位次髎、中髎，针刺时重视得气，骶部深刺至病所；基于小儿耐受特点予低频电针刺激和温和灸治疗。.

To identify different patterns of neurogenic lower urinary tract dysfunction management among Chinese community-dwelling individuals with spinal cord injury and explore the factors associated with latent classes. This was a cross-sectional study conducted in communities throughout China Mainland. Participants were recruited through the China Association of Persons with Physical Disability and a total of 2582 participants was included in the analysis. The data were collected by a questionnaire consisting of socio-demographic factors, disease-related factors, and a list of 8 bladder management methods. Latent class analysis was used to identify different latent classes of neurogenic lower urinary tract dysfunction management. Then the multinomial logistic regression was applied to analyze the relationship between neurogenic lower urinary tract dysfunction management patterns and socio-demographic and disease-related factors. Neurogenic lower urinary tract dysfunction management pattern among community-dwelling individuals with spinal cord injury was divided into four latent classes: \"urinal collecting apparatus dominated pattern\" (40.3%), \"bladder compression dominated pattern\" (30.7%), \"intermittent catheterization dominated pattern\" (19.3%) and \"urethral indwelling catheterization dominated pattern\" (9.6%). Multinomial logistic regression analysis found that the employment status, residential region, nursing need, payment method for catheterization products, hand function, time since spinal cord injury, urinary incontinence and concerns about social interaction affected by urination problems were significantly associated with latent classes. Only 19.3% of people used the intermittent catheterization as their main neurogenic lower urinary tract dysfunction management method. More attention needs to be paid to the promotion of the standardization process of intermittent catheterization in community-dwelling individuals with spinal cord injury. The associated factors of the four classes can be used for tailored and targeted interventions to increase the use of intermittent catheterization.

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。.

BACKGROUND: The Short Form Qualiveen (SF-Qualiveen) questionnaire assesses the effect of bladder and urinary symptoms on patients\' quality of life (QoL) with urological impairment caused by neurological diseases. There is no validated SF-Qualiveen questionnaire in Arabic, so this study aims to provide a translated and validated version of the SF-Qualiveen questionnaire among Arabic-speaking patients with multiple sclerosis (MS).
METHODS: The English version of the SF-Qualiveen was translated into Arabic using an algorithm for linguistic and cultural adaptation. MS patients completed the SF-Qualiveen, and the Neurogenic Bladder Symptom Score(NBSS) questionnaire. Psychometric features such as content and construct validity, test-retest reliability, and internal consistency were analyzed. Construct validity was evaluated by contrasting the SF-Qualiveen with the NBSS questionnaire. Internal consistency was measured using Cronbach\'s alpha, whereas the intraclass correlation coefficient (ICC) was employed to assess the test-retest reliability.
RESULTS: One hundred and two patients with MS were included in this study. The internal consistency of the total SF-Qualiveen, and the domains \"Bother with limitations,\" \"Fear,\" \"Feeling,\" and \"Frequency of limitations\" showed good internal consistency (Cronbach\'s alpha of > 0.7). ICC was 0.91 for the total score 0.85 for the Bother with limitations, 0.81 for Fears, 0.86 for Feeling, and 0.81 for Frequency of limitations. The correlation analysis revealed a positive association between the total scores on the NBSS and the domains of the SF-Qualiveen, comprising bother with limitations (r = 0.473, p = 0.027), fears (r = 0.611, p = 0.031), feelings (r = 0.572, p = 0.04), and frequency of limitations (r = 0.514, p = 0.013).
CONCLUSIONS: The findings of this validation study revealed that the SF-Qualiveen is a reliable and valid instrument appropriate for Arabic-speaking patients with MS in both research and clinical practice.

BACKGROUND: The Short-Form Qualiveen (SF-Qualiveen) questionnaire assesses the effect of bladder and urinary symptoms on patients\' quality of life (QoL) with urological impairment caused by neurological diseases. There is no validated SF-Qualiveen questionnaire in Arabic, so this study aims to provide a translated and validated version of the SF-Qualiveen questionnaire among Arabic patients experiencing spinal cord injury (SCI).
METHODS: Psychometric features such as content and construct validity, test-retest reliability, and internal consistency were analyzed. Construct validity was evaluated by contrasting the SF-Qualiveen with the Neurogenic Bladder Symptom Score Short-Form (NBSS-SF) questionnaire. Internal consistency was measured using Cronbach\'s alpha, whereas the intraclass correlation coefficient (ICC) was employed to assess the test-retest reliability. Factorial validity was established by principal component analysis (PCA).
RESULTS: The internal consistency of the total SF-Qualiveen and the domains \"Bother with limitations,\" \"Fear,\" \"Feeling,\" and \"Frequency of limitations\" showed good internal consistency (Cronbach\'s alpha of > 0.7). ICC was 0.90 for the total score, 0.83 for the bother with limitations, 0.80 for fears, 0.84 for feeling, and 0.81 for frequency of limitations. The correlation analysis revealed a positive association between the total scores on the NBSS-SF and the domains of the SF-Qualiveen, comprising bother with limitations (r = 0.53, p = 0.02), fears (r = 0.44, p = 0.03), feelings (r = 0.49, p = 0.04), and frequency of limitations (r = 0.46, p = 0.02). The best-fit four-factor model for confirming overall item communalities ranged from 0.552 to 0.814, which indicates moderate to high communalities, and confirms the homogeneity of the SF-Qualiveen using PCA.
CONCLUSIONS: The findings of this validation study revealed that the SF-Qualiveen is a reliable and valid instrument appropriate for Arabic-speaking patients with SCI in both research and clinical practices.

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。.

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 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。.

We conducted a cross-sectional study using an online questionnaire to investigate the current status of urinary tract infections (UTIs) and the use of clean intermittent catheterization (CIC) in Chinese community-based SCI patients and to explore the risk factors for UTIs in patients using CIC. Our findings suggest that the prevalence of UTIS is higher in Chinese community-based SCI patients compared with patients in medically developed countries. In addition, we found that CIC had the lower incidence of UTIs than urinary indwelling catheter (UIC) and suprapubic catheter (SPC), and that SCI patients with CIC had low rates of use and poor compliance. Further analysis indicated that most of the risk factors for UTIs in CIC patients were associated with irregular use of CIC. Therefore, we call for not only the need to provide stronger caregiver support and financial assistance to improve CIC adherence in Chinese community SCI patients, but also the establishment of a database of Chinese SCI patients in order to enhance the management of bladder emptying methods and further standardize the CIC operation in such patients, thus reducing the risk of UTIs in Chinese community SCI patients.

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.