Neurogenic bladder in patients with traumatic spinal cord injury: Treatment and follow-up

Study design:Multi-center, cross-sectional study.Objectives:Our aim was to evaluate the treatment methods and follow-up of neurogenic bladder in patients with traumatic spinal cord injury retrospectively using a questionnaire.Setting: Turkey.Methods:Three hundred and thirty-seven patients who had spinal cord injury for at least 2 years were enrolled from six centers in the neurogenic bladder study group. They were asked to fill-out a questionnaire about treatments they received and techniques they used for bladder management.Results:The study included 246 male and 91 female patients with a mean age of 42±14 years. Intermittent catheterization ( IC) was performed in 77.9% of the patients, 3.8% had indwelling catheters, 13.8% had normal spontaneous micturition, 2.6% performed voiding maneuvers, 1.3% used diapers and 0.6% used condom catheters. No gender difference was found regarding the techniques used in bladder rehabilitation ( P>0.05). Overall, 63.2% of patients used anticholinergic drugs; anticholinergic drug use was similar between genders ( P>0.05). The most common anticholinergic drug used was oxybutynin ( 40.3%), followed by trospium ( 32.6%), tolterodine ( 19.3%) darifenacin ( 3.3%), propiverine ( 3.3%) and solifenacin ( 1.1%). The specialties of the physicians who first prescribed the anticholinergic drug were physiatrists ( 76.2%), urologists ( 22.1%) and neurologists ( 1.7%). Only four patients had previously received injections of botulinum-toxin-A into the detrusor muscle and three of them stated that their symptoms showed improvement. Most of the patients ( 77%) had regular follow-up examinations, including urine cultures, urinary system ultrasound and urodynamic tests, when necessary; the reasons for not having regular control visits were living distant from hospital ( 15.3%) and monetary problems ( 7.7%). Of the patients, 42.7% did not experience urinary tract infections ( UTI), 36.4% had bacteriuria but no UTI episodes with fever, 15.9% had 1-2 clinical UTI episodes per year and 5% had ≥3 clinical UTIs. The clinical characteristics of patients with and without UTI ( at least one symptomatic UTI during 1 year) were similar ( P>0.05). The frequency of symptomatic UTI was similar in patients using different bladder management techniques ( P>0.05).Conclusion:The most frequently used technique for bladder rehabilitation in patients with SCI was IC ( 77.9%). In all, 63.2% of patients used anticholinergic drugs, oxybutynin being the most commonly used drug. Also, 77% of patients had regular control visits for neurogenic bladder; 42.7% did not experience any UTIs. © 2014 International Spinal Cord Society

Possible directions of human cord blood mononuclear cells differentiation in the regenerating rat liver

It is known that human cord blood hematopoietic stem cells (HSC) are able to differentiate into hepatocytes. This ability can be widely used in treatment of various liver diseases. However, there are some genetic diseases of liver, when the application of autologous stem cells is not possible. So it could be very helpful to develop methods of genetic modification of stem/progenitor cells. However, it should be proved that genetic modification does not change the properties of HSC. We performed partial hepatectomy for the white mongrel male rats and injected human umbilical cord blood mononuclear cells transfected by gene of green fluorescent protein (GFP) into the spleen. Paraffin sections of the liver were stained with antibodies to stem cell factor receptor, human leukocyte antigen, α-smooth muscle actin, enhanced GFP, cytokeratin 19, hepatocyte specific antigen, human α-fetoprotein. Also we used a double-immunohistochemical staining to detect expression of stem cell factor receptor and desmin, enhanced GFP and cytokeratin 19. Our study showed that human cord blood mononuclear cells transfected by gfp transplanted into the spleen of rats after partial hepatectomy migrated to the liver and acquired the phenotype of hepatocytes, cholangiocytes and sinusoidal cells. At the same time the differentiation of such transplanted cells into myofibroblasts, as it was previously shown, does not occur. Hepatoblasts and hepatocytes found in the liver of rats after transplantation of genetically modified and native cells express human hepatocyte specific antigen and α-fetoprotein that means they are functionally active. © Human stem cells institute, 2013

Possible directions of human cord blood mononuclear cells differentiation in the regenerating rat liver

It is known that human cord blood hematopoietic stem cells (HSC) are able to differentiate into hepatocytes. This ability can be widely used in treatment of various liver diseases. However, there are some genetic diseases of liver, when the application of autologous stem cells is not possible. So it could be very helpful to develop methods of genetic modification of stem/progenitor cells. However, it should be proved that genetic modification does not change the properties of HSC. We performed partial hepatectomy for the white mongrel male rats and injected human umbilical cord blood mononuclear cells transfected by gene of green fluorescent protein (GFP) into the spleen. Paraffin sections of the liver were stained with antibodies to stem cell factor receptor, human leukocyte antigen, α-smooth muscle actin, enhanced GFP, cytokeratin 19, hepatocyte specific antigen, human α-fetoprotein. Also we used a double-immunohistochemical staining to detect expression of stem cell factor receptor and desmin, enhanced GFP and cytokeratin 19. Our study showed that human cord blood mononuclear cells transfected by gfp transplanted into the spleen of rats after partial hepatectomy migrated to the liver and acquired the phenotype of hepatocytes, cholangiocytes and sinusoidal cells. At the same time the differentiation of such transplanted cells into myofibroblasts, as it was previously shown, does not occur. Hepatoblasts and hepatocytes found in the liver of rats after transplantation of genetically modified and native cells express human hepatocyte specific antigen and α-fetoprotein that means they are functionally active. © Human stem cells institute, 2013