On postoperative reflex cardiac disorders of mechanical origin Sauerbruch (Zentr. F. Chir . 1925, no. 16)

According to Sauerbruch (Zentr. F. Chir . 1925, No. 16) during operations in the thoracic cavity, the operator must be accurately aware of the reflex pathways coming from the chest cavity, and of reflex disorders that sometimes accompany intrathoracic interventions.

Congenital ocular counter-roll: a review of cases treated exclusively by ophthalmologists

AIM: To review the demographics, clinical manifestations, and surgical experiences of patients with congenital ocular counter-roll, whose treatments were performed exclusively by ophthalmologists. METHODS: A retrospective review was conducted consisting of patients who received strabismus surgery between 2017 to 2019. Patients with obvious ocular counter-roll were included. RESULTS: A total of 7008 patients who received strabismus surgery, 28 (12 males, 16 females) were diagnosed as congenital ocular counter-roll, accounting for 0.40%. All patients were initially misdiagnosed: 21 patients were misdiagnosed as superior oblique palsy (SOP), 3 as inferior oblique overaction, 2 as dissociated vertical deviation (DVD), 1 as superior oblique overaction with A-pattern exotropia, and 1 as medial rectus palsy. The mean±SD age was 12.4±9.4y (range 2.5-36y). The most common clinical findings included ocular counter-roll, vertical deviation or vertical deviation combined with outward deviation and head tilt. At follow-up, an excellent surgical result was achieved in 20 patients. Preoperative horizontal deviation of 26±24 prism diopter (PD) and vertical deviation of 18±12 PD were reduced to 0±12 PD (P=0.0001) and 3±4 PD (P=0.001), respectively. CONCLUSION: Congenital ocular counter-roll is a rare supranuclear vertical strabismus caused by congenital abnormalities involving vestibule-ocular reflex pathways. In addition to ocular counter-roll, the most salient clinical features included, but are not limited to, hyperdeviation, outward deviation, overelevation in adduction and head tilt.

Understanding mechanoreflex and metaboreflex interactions – a great challenge

The exercise pressor reflex (EPR) plays an essential role in cardiovascular and ventilatory responses to physical activity. Despite immense meaning and increasing validation of the EPR, there is no agreement on the character of interactions between its components and other reflexes in health and disease. The data addressing this issue remain incomplete and incoherent, partially due to various challenges in testing these pathways. The mounting evidence of EPR malfunction contribution to sympathetic over-activation in heart failure and other cardiovascular diseases shows clinical importance of comprehensive understanding of these mechanisms. In this review, we briefly summarize experiments focused on the issue of interactions between mechano-, metabo, chemo-, and baroreflex during exercise. We also address potential reasons of discrepancies in the results, identify gaps in this particular scientific area and propose notional pathways for future research. This article highlights the clinical importance of the EPR deterioration in heart failure pathophysiology and discusses potential therapies focused on restoring the reflex pathways. In addition, consideration is given to the latest sophisticated experiments in this area, underlining the need of changing the paradigm in EPR interactions studying – from teleological to mechanistic approach.

Vibrations and spasticity

This experimental study aims to evaluate and validate the effectiveness of the proposed application method in the use of "focused mechanical vibrations" for the treatment of muscle spasticity. The basic concept of this study is that in spasticity, by specifically stimulating some clearly identifiable trigger points of the body, better results are obtained; in fact, with the localized mechanical-sound vibrations, by positioning the handpiece for the treatment on those specific points, immediate generalized relaxation of the entire spastic muscle is obtained through reflex pathways. To evaluate this operative reality we treated 5 subjects affected by neurological pathology with spasticity and at T0 time (before treatment) and at T1 time (immediately after treatment), they were assessed with Ashworth Scale, Passive joint evaluation, Evaluation of active motility, Test of Bahkta (for non-functioning hand), surface electromyography The subjects were treated with a 120Hz vibratory therapy handpiece for a total time of 15 minutes The data showed us a clear improvement of the parameters lost in the exam, in the less serious patients and a good improvement also in the most serious subjects.

High-density spinal cord stimulation selectively activates lower urinary tract afferents

Epidural spinal cord stimulation (SCS) has recently been reported as a potential intervention to improve limb and autonomic functions, with lumbar stimulation improving locomotion and thoracic stimulation regulating blood pressure. We asked whether sacral SCS could be used to target the lower urinary tract. Here we show that high-density epidural SCS over the sacral spinal cord and cauda equina of anesthetized cats evokes responses in nerves innervating the bladder and urethra and that these nerves can be activated selectively. Sacral epidural SCS always recruited the pelvic and pudendal nerves and selectively recruited these nerves in all but one animal. Individual branches of the pudendal nerve were always recruited as well. Electrodes that selectively recruited specific peripheral nerves were spatially clustered on the arrays, suggesting anatomically organized sensory pathways. This selective recruitment demonstrates a mechanism to directly modulate bladder and urethral function through known reflex pathways, which could be used to restore bladder and urethral function after injury or disease.

An objective approach to assess colonic pain in mice using colonometry

The present study presents a non-surgical approach to assess colonic mechanical sensitivity in mice using colonometry, a technique in which colonic stretch-reflex contractions are measured by recording intracolonic pressures during saline infusion into the distal colon in a constant rate. Colonometrical recording has been used to assess colonic function in healthy individuals and patients with neurological disorders. Here we found that colonometry can also be implemented in mice, with an optimal saline infusion rate of 1.2 mL/h. Colonometrograms showed intermittent pressure rises that was caused by periodical colonic contractions. In the sceneries of colonic hypersensitivity that was generated post 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colonic inflammation, following chemogenetic activation of primary afferent neurons, or immediately after noxious stimulation of the colon by colorectal distension (CRD), the amplitude of intracolonic pressure (AICP) was markedly elevated which was accompanied by a faster pressure rising (ΔP/Δt). Colonic hypersensitivity-associated AICP elevation was a result of the enhanced strength of colonic stretch-reflex contraction which reflected the heightened activity of the colonic sensory reflex pathways. The increased value of ΔP/Δt in colonic hypersensitivity indicated a lower threshold of colonic mechanical sensation by which colonic stretch-reflex contraction was elicited by a smaller saline infusion volume during a shorter period of infusion time. Chemogenetic inhibition of primary afferent pathway that was governed by Nav1.8-expressing cells attenuated TNBS-induced up-regulations of AICP, ΔP/Δt, and colonic pain behavior in response to CRD. These findings support that colonometrograms can be used for analysis of colonic pain in mice.

An objective approach to assess colonic pain in mice using colonometry

ABSTRACTThe present study presents a non-surgical approach to assess colonic mechanical sensitivity in mice using colonometry, a technique in which colonic stretch-reflex contractions are measured by recording intracolonic pressures during saline infusion into the distal colon in a constant rate. Colonometrical recording has been used to assess colonic function in healthy individuals and patients with neurological disorders. Here we found that colonometry can also be implemented in mice, with an optimal saline infusion rate of 1.2 mL/h. Colonometrograms showed intermittent pressure rises that was caused by periodical colonic contractions. In the sceneries of colonic hypersensitivity that was generated post 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colonic inflammation, following chemogenetic activation of primary afferent neurons, or immediately after noxious stimulation of the colon by colorectal distension (CRD), the amplitude of intracolonic pressure (AICP) was markedly elevated which was accompanied by a faster pressure rising (ΔP/Δt). Colonic hypersensitivity-associated AICP elevation was a result of the enhanced strength of colonic stretch-reflex contraction which reflected the heightened activity of the colonic sensory reflex pathways. The increased value of ΔP/Δt in colonic hypersensitivity indicated a lower threshold of colonic mechanical sensation by which colonic stretch-reflex contraction was elicited by a smaller saline infusion volume during a shorter period of infusion time. Chemogenetic inhibition of primary afferent pathway that was governed by Nav1.8-expressing cells attenuated TNBS-induced up-regulations of AICP, ΔP/Δt, and colonic pain behavior in response to CRD. These findings support that colonometrograms can be used for analysis of colonic pain in mice.

The execution of movement - a spinal affair

In this tribute to Reggie Edgerton, I briefly review the spinal mechanisms that coordinate locomotion and the interaction between the different sensory mechanisms that help coordinate the locomotor movements and the central locomotor network. The step cycle has four distinct parts, the support phase, the lift off, the flexion phase and the most complex, the touch down, when the limb makes a smooth contact with ground again. Each of these phases is affected by different sensory mechanisms, which interact with the central network (CPG) generating the basic movements with its four components. Conversely, the CPG also gates the sensory reflex pathways, so that they are active only in a given phase of the step cycle, or even produces opposite effects in different parts of the step cycle. These different examples from mammals are most likely important also to consider for human locomotion, and in particular in patients with spinal cord injury, partial or complete.

Integration of Convergent Sensorimotor Inputs Within Spinal Reflex Circuits in Healthy Adults

The output from motor neuron pools is influenced by the integration of synaptic inputs originating from descending corticomotor and spinal reflex pathways. In this study, using paired non-invasive brain and peripheral nerve stimulation, we investigated how descending corticomotor pathways influence the physiologic recruitment order of the soleus Hoffmann (H-) reflex. Eleven neurologically unimpaired adults (9 females; mean age 25 ± 3 years) completed an assessment of transcranial magnetic stimulation (TMS)-conditioning of the soleus H-reflex over a range of peripheral nerve stimulation (PNS) intensities. Unconditioned H-reflex recruitment curves were obtained by delivering PNS pulses to the posterior tibial nerve. Subsequently, TMS-conditioned H-reflex recruitment curves were obtained by pairing PNS with subthreshold TMS at short (−1.5 ms) and long (+10 ms) intervals. We evaluated unconditioned and TMS-conditioned H-reflex amplitudes along the ascending limb, peak, and descending limb of the H-reflex recruitment curve. Our results revealed that, for long-interval facilitation, TMS-conditioned H-reflex amplitudes were significantly larger than unconditioned H-reflex amplitudes along the ascending limb and peak of the H-reflex recruitment curve. Additionally, significantly lower PNS intensities were needed to elicit peak H-reflex amplitude (Hmax) for long-interval facilitation compared to unconditioned. These findings suggest that the influence of descending corticomotor pathways, particularly those mediating long-interval facilitation, contribute to changing the recruitment gain of the motor neuron pool, and can inform future methodological protocols for TMS-conditioning of H-reflexes. By characterizing and inducing short-term plasticity in circuitry mediating short- and long-interval TMS-conditioning of H-reflex amplitudes, future studies can investigate supraspinal and spinal circuit contributions to abnormal motor control, as well as develop novel therapeutic targets for neuromodulation.