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NIH 年底批准了230万美元，由Beaumont医院（美国最大的私立医院之一）)牵头，在美国几个主要医学院多中心推广研究肖氏反射弧（somatic-autonomic reflex arc）肖氏手术。NIH已决定由哈佛大学医学院建立DATA Base，收集处理多中心肖氏反射弧手术资料。
向NIH要求参加该计划的大学太多，在平衡协调上伤透脑筋。我当然希望多多益善，但经费有限。目前基本选定东海岸哥伦比亚大学医学院，哈佛大学医学院，华盛顿大学（WUSTL）/南佛罗里达大学， Emery大学医学院。有些大学已自筹经费开展肖氏手术，但仍要求加入该项目（for academic reputation and credit)
该项目的组织、申请、协调、很像国内的973计划项目，但不像973计划那样在经费预算上花费无穷无尽的精力和时间。
相关NIH链接 http://projectreporter.nih.gov/project_info_description.cfm?aid=7696321
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| Project Number: |
1R01DK084034-01 |
Principal Investigator(s): |
PETERS, KENNETH M |
| Title: |
SAFETY AND EFFICACY OF NERVE REROUTING FOR TREATING NEUROGENIC BLADDER IN SPINA B |
Awardee Organization: |
WILLIAM BEAUMONT HOSPITAL RESEARCH INST |
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| Abstract Text: |
| DESCRIPTION (provided by applicant): Spina Bifida, a congenital defect of the spinal cord, causes nerve damage and a loss of sensation and muscle function below the waist resulting in bowel, bladder and sexual dysfunction. Patients cannot urinate or are constantly wet, and this continues throughout life causing major quality of life and health problems. Clean intermittent catheterization is usually needed to empty the bladder properly. Antimuscarinic medications are commonly required to alleviate high urinary tract pressures that can cause irreversible kidney damage, where dialysis or kidney transplant is the only way to sustain life. Dr. Xiao developed and is performing a novel procedure in China that connects a functioning, healthy lumbar spinal nerve root to the sacral nerve that controls the bladder. The end result is the creation of a new reflex where the bladder can be emptied by scratching or stimulating the skin supplied by that spinal nerve root. He has reported that in 92 SCI patients, 88% regained bladder control within one year after the nerve rerouting surgery and in 110 children with spina bifida, reported success in 87% at one year. However, in China rigorous follow up is challenging, therefore much is still unknown about the neurorecovery post surgery, complications and results occurring in the first year in particular, and the potential role that central nervous system remodeling may play in achieving successful outcomes. At Beaumont, a pilot study is underway on 9 spina bifida subjects, however no other center in the US is currently studying this technique. Our preliminary data are very promising, and with 9 subjects now 12 months post procedure, 7/9 subjects are voiding either voluntarily or by stimulating the new reflex mechanism. This project aims to expand upon our pilot experience to conduct a larger and more rigorous study to establish the safety and effectiveness of the proposed somatic-autonomic reflex pathway procedure in gaining bladder and bowel control in patients with spina bifida. Additionally, we will systemically evaluate and optimize frequency and location for excitation of the new somatic-autonomic reflex arc to a) gain more insight into the neurorecovery associated with nerve rerouting, and b) scientifically and systematically determine the ideal stimulation parameters to achieve best voiding results and make the somatic-autonomic reflex pathway rerouting most useful for the patients. Achieving the aims outlined in this proposal will help firmly establish the procedure as safe and effective, and revolutionize the treatment of bladder and bowel dysfunction in patients with spina bifida. PUBLIC HEALTH RELEVANCE: Spina Bifida, a congenital defect of the spinal cord, causes nerve damage resulting in bowel, bladder and sexual dysfunction. Dr. Xiao, in China, developed a new procedure to rewire the nerves affecting the bladder, and this project aims to scientifically establish the safety and effectiveness of the surgical procedure. |
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| Public Health Relevance Statement: |
| Principal Investigator/Program Director (Last, First, Middle): Peters, Kenneth M. Project Narative: Spina Bifida, a congenital defect of the spinal cord, causes nerve damage resulting in bowel, bladder and sexual dysfunction. Dr. Xiao, in China, developed a new procedure to rewire the nerves affecting the bladder, and this project aims to scientifically establish the safety and effectiveness of the surgical procedure. |
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