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1.  PA01.34. Catagorical interpretation in Microsoft excel of jangam dravya database from Bruhat-Trayi & Laghu-Trayi 
Ancient Science of Life  2012;32(Suppl 1):S84.
Purpose:
Not a single drug in Ayurveda has been termed as non-medicinal. This means every Dravya has medicinal value in this world. Jangam dravya is an animal sourced medicine. In samhita Jangam Dravya are described first. So as per Krama Varnan Vichar, Jangam Dravyas are significant in this type. In Ayurvedic literature there is more literature on Audbhid & Parthiva Dravyas. I Total available nighantu: more than 25. Total available Rasa Grantha: about 145. There is no one Grantha on Jangam Dravya which describes their whole information. Jangam Dravyas are described in Ayurvedic literature in different views and in different branches. Gross description is available in Samhitas. But they aren’t in format. They are not compiled according to their Guna Karma, Upayogitwa, Vyadhiharatwa, and Kalpa etc. Their use in Chikitsa is minimal as their ready references are not available, though very much effective. So due to sheer need of compilation of these references this topic was selected for study. The basic need for study of Jangam Dravya is to prepare its whole DATABASE. So through this study Database of Jangam Dravya can be available like Jangam Dravya.
Method:
Selection of topic this is a fundamental & literary study, Selection of material, Selection of Database software & font, Collection of data & preparation of Master Chart, Preparation of Database, Interpretation & summarization of data.
Result:
So in this paper, we are going to focus on literature availability of jangam dravya with the help of modern technique like Microsoft Excel. And also how we can prepare and use the categorical interpretation of jangam dravya with help of database
Conclusion:
Jangam Dravyas are described in Ayurvedic literature in different views and in different branches. Importances of these dravyas are the main key point of this study.
PMCID: PMC3800966
2.  PA02.11. An insight on ayurvedic drug discovery 
Ancient Science of Life  2013;32(Suppl 2):S56.
Purpose:
Every dravya have its own medicinal importance in the universe. Hence, we have to study each and every drug which is available around us. The locally available drugs are considered as best. Only few drugs are mentioned in ayurvedic textbooks but many have to be explained for their quality & applications. The research on new drugs is the need of hour in Ayurveda and we have to assess all dravyas viz. herbs, metals, minerals & animal products which are available in universe.
Method:
Drug research methodology is well explained in Ayurveda along with ethno & medico botanical survey. There are certain steps of research viz. the nature of dravyas, morphological characters of dravyas, place & time of collection, preservation etc and doctrine of signature or elaborate in new drug discovery. Further taste and taste threshold examination, exothermic and endothermic reactions, experimental model for assessment of vipaka and other methods of research on new drug will be discussed. This paper will discuss in detail about the ancient research method for new drugs.
Result:
Methodical research for new drug gives not only importance of pharmecological and clinical study but also importance to seasonal derivation, collection time and different application methods. Ancient ayurvedic drug research methodology includes from survey, pharmacognostic to clinical research.
Conclusion:
The oldest drug research methodology suits now also for all new drug research.
doi:10.4103/0257-7941.123873
PMCID: PMC4147528
3.  Conceptual and applied study of Snigdha and Ruksa Guna with special reference to Rasa-raktagata Sneha (hyperlipidemia) 
Ayu  2011;32(2):200-206.
Ayurveda as well as Philosophy accepted the Guna as the basic entity of the Sristi. The Maha Gunas, i.e., Sattva, Raja, and Tama are the prime energy, from where the universe evolves, along with human beings. Dravya and Guna both have a Samavayi relationship in which Gunas reside in Dravya and have a secondary place to it. Guna has multifold meanings according to its use, in social, cultural, philosophical, and literary fields. The concepts of Ayurveda are expressed with Gunas. Samanya and Visesa are usually expressed in terms of Gunas; the classification, description, and function of Dravyas depends upon Guna; Karmas are manifested forms of Guna and Samavaya is the eternal, intimate relation of Dravya and Guna. The principles like Triskandha (Hetu, linga, ousadhi) of Ayurveda also narrated by Gunas, Hetus are narrated in the terms of Guna; the Laksanas are the reflections in the status of Gunas of bodily elements, and Cikitsa is in the form of administration of Viparita Gunas. The increased elements are treated by opposite Guna. So if Ruksa Guna is increased then it is to be managed by Snigdha Guna and vice-versa. So diseases can be treated by applying the Gunas, and drugs for the required patient can be selected by applying these Gunas. In support of the above concept, a study on the persons of Rasa-raktagata Sneha (hyperlipidemia) has been carried out assuming that the condition is an increased state of Snigdha Guna and treatment is done using Ruksa property drugs. Patients were divided into two groups, i.e., treatment group (Ruksa Guna drugs) and control group (placebo). The results were assessed after 45 days with the help of a specially prepared pro forma. All the important hematological, biochemical, and urine investigations were done. According to subjective and objective criteria, significant results were found for Group A as compared to Group B.
doi:10.4103/0974-8520.92586
PMCID: PMC3296341  PMID: 22408303
Ayurveda; Guna; hyperlipidemia; Rasa-raktagata Sneha; Ruksa Guna
4.  Clinical evaluation of Apamarga-Ksharataila Uttarabasti in the management of urethral stricture 
Ayu  2013;34(2):180-183.
Stricture urethra, though a rare condition, still is a rational and troublesome problem in the international society. Major complications caused by this disease are obstructed urine flow, urine stasis leading to urinary tract infection, calculi formation, etc. This condition can be correlated with Mutramarga Sankocha in Ayurveda. Modern medical science suggests urethral dilatation, which may cause bleeding, false passage and fistula formation in few cases. Surgical procedures have their own complications and limitations. Uttarabasti, a para-surgical procedure is the most effective available treatment in Ayurveda for the diseases of Mutravaha Strotas. In the present study, total 60 patients of urethral stricture were divided into two groups and treated with Uttarabasti (Group A) and urethral dilatation (Group B). The symptoms like obstructed urine flow, straining, dribbling and prolongation of micturation were assessed before and after treatment. The results of the study were significant on all the parameters.
doi:10.4103/0974-8520.119674
PMCID: PMC3821247  PMID: 24250127
Mutramarga Sankocha; stricture urethra; urethral dilatation; Uttarabasti
5.  OA02.17. Medicinal plant tissue culture and its ayurvedic perspective. 
Ancient Science of Life  2013;32(Suppl 2):S23.
Purpose:
Introduction of Plant tissue culture (PTC) concept to the Ayurveda realm.
Method:
1. Analysis of principles the plant tissue culture based on the literature review and real wet lab images of tissue culture 2. Analysis of ayurvedic principles which are relevant in the context 3. Logical concept development.
Result:
Plant tissue culture is based on the natural ability of plant cells to grow in to fullfledged organism, called as totipotency. Plant cell can exhibit totipotency only when it is placed in a suitable micro condition where it is supplied with all essential nutrients such as minerals, water, light source, carbon source and air. Two branches of tissue culture a. micropropagation b. in vitro adventitious root development (Sivakumar 2006), are relevant for ayurvedic industry in purview of increasing demand for good quality raw materials and decreasing wild sources of medicinal plants. Ayurvedic concept of Anukta dravya grahana (Reddy 2008; Kusuma and Joshi 2010) describes the need for understanding the properties of an undocumented drug or medicinal plant experimentally before considering it as an ayurvedic drug. Ayurvedic system dravya guna vijnana is for understanding and classification of medicinal plants based on their seven fold properties (Valiathan 2003). The concept of ‘Abhava prathinidhi dravya’ (Padma et al. 2010) explains the situations where original drugs are substituted with substances of similar qualities, which were prescribed in case of several unavailable or rare drugs. The efficacy of medicinal plants or plant part produced through tissue culture has to be determined even though those are botanically and genetically the same. Rasanirdharana method (Dhyani 2008) can be combined efficiently with phytochemical screening for this purpose.
Conclusion:
Plant materials produced through PTC can be ideologically acceptable for ayurvedic industry when principles of plant tissue culture is analysed in detail in the light of certain ayurvedic principles.
doi:10.4103/0257-7941.123837
PMCID: PMC4147492
6.  Detection of Intracellular Bacterial Communities in Human Urinary Tract Infection 
PLoS Medicine  2007;4(12):e329.
Background
Urinary tract infections (UTIs) are one of the most common bacterial infections and are predominantly caused by uropathogenic Escherichia coli (UPEC). While UTIs are typically considered extracellular infections, it has been recently demonstrated that UPEC bind to, invade, and replicate within the murine bladder urothelium to form intracellular bacterial communities (IBCs). These IBCs dissociate and bacteria flux out of bladder facet cells, some with filamentous morphology, and ultimately establish quiescent intracellular reservoirs that can seed recurrent infection. This IBC pathogenic cycle has not yet been investigated in humans. In this study we sought to determine whether evidence of an IBC pathway could be found in urine specimens from women with acute UTI.
Methods and Findings
We collected midstream, clean-catch urine specimens from 80 young healthy women with acute uncomplicated cystitis and 20 asymptomatic women with a history of UTI. Investigators were blinded to culture results and clinical history. Samples were analyzed by light microscopy, immunofluorescence, and electron microscopy for evidence of exfoliated IBCs and filamentous bacteria. Evidence of IBCs was found in 14 of 80 (18%) urines from women with UTI. Filamentous bacteria were found in 33 of 80 (41%) urines from women with UTI. None of the 20 urines from the asymptomatic comparative group showed evidence of IBCs or filaments. Filamentous bacteria were present in all 14 of the urines with IBCs compared to 19 (29%) of 66 samples with no evidence of IBCs (p < 0.001). Of 65 urines from patients with E. coli infections, 14 (22%) had evidence of IBCs and 29 (45%) had filamentous bacteria, while none of the gram-positive infections had IBCs or filamentous bacteria.
Conclusions
The presence of exfoliated IBCs and filamentous bacteria in the urines of women with acute cystitis suggests that the IBC pathogenic pathway characterized in the murine model may occur in humans. The findings support the occurrence of an intracellular bacterial niche in some women with cystitis that may have important implications for UTI recurrence and treatment.
Analyzing urine specimens from women with bladder infections, Scott Hultgren and colleagues find evidence for intracellular bacterial communities, which have been associated with recurrent urinary tract infections in mice.
Editors' Summary
Background.
Every year, nearly 10 million people in the United States—mainly women—consult their doctors because of a urinary tract infection (UTI). UTIs occur when bacteria living in the gut—usually Escherichia coli—get transferred to the opening of the urethra (the tube through which urine leaves the body), as may occur during sexual intercourse. From here, the bacteria can move into the bladder (the muscular sac that stores urine until it is excreted) where they can multiply and cause cystitis (inflammation of the bladder). If cystitis is untreated, the bacteria can move further up the urinary tract and infect the kidneys (which make urine). Symptoms of UTIs include pain when urinating, frequent and intense urges to urinate, and cloudy urine. UTIs are diagnosed by looking for bacteria and white blood cells (that fight infection) in the urine; the usual treatment is a short course of antibiotics.
Why Was This Study Done?
Half the women who get a UTI will have another attack within a year, often caused by the same bacterial strain. It is generally thought that these strains persist in the gut and reinfect the urinary tract, but recent animal studies suggest an additional explanation. In mice, E. coli strains that cause UTIs can invade the cells lining the bladder. Here, they replicate and form so-called intracellular bacterial communities (IBCs). Many of the infected cells fall off the bladder's surface into the urine, but IBCs also release bacteria, many of which have a long, slender filamentous appearance (E. coli usually have a simple rod-like shape). Immune system cells normally kill bacteria in the urine but cannot deal with filamentous bacteria. In mice, these bacteria can then reinfect the lining of the bladder and establish long-lasting intracellular reservoirs of bacteria that are protected from antibiotics and probably from the host immune system. If this IBC cycle occurs in people, it might explain why some UTIs recur and might suggest ways to manage these recurrences. In this study, therefore, the researchers have investigated whether there is an IBC cycle in women.
What Did the Researchers Do and Find?
The researchers collected urine from 80 young women with cystitis and from 20 women with no symptoms who had had cystitis previously. They identified the type of bacteria in each sample and looked for IBCs and filamentous bacteria using light microscopy, electron microscopy, and a technique called immunofluorescence. None of the women without cystitis had IBCs or filamentous bacteria in their urine, but IBCs were found in nearly 1 in 5, and filamentous bacteria were in nearly half, of urine samples from the women with cystitis. All the urine samples that contained IBCs also contained filamentous bacteria. All of the women with IBCs and most of them with filamentous bacteria had E coli infections. Finally, the women with IBCs and filamentous bacteria in their urine had higher bacterial counts in their urine and had symptoms of cystitis for slightly longer than those without.
What Do These Findings Mean?
These findings suggest that the IBC cycle identified in mice occurs in at least some women with UTIs and may be associated with infections caused by E. coli. Because only one urine sample was collected from each woman, the cycle may be more common than these findings suggest. That is, in some cases the sample may have been taken at a time when there were no IBCs or filamentous bacteria in the urine. Also, because samples were taken at only one point in time, this study does not show whether intracellular bacteria persist and contribute to recurrent UTIs in women, as they appear to do in mice. To provide more information about the IBC cycle in people and its clinical relevance, additional studies are needed to examine whether there are any associations between the presence of IBCs and filamentous bacteria and treatment responses and recurrence, and to examine what is actually happening in the bladder during UTI. Until such studies are done, the clinical implications of the current findings remain uncertain. However, one possibility is that the presence of IBCs and filamentous bacteria in urine might identify people who would benefit from longer treatment with antibiotics or treatment with antibiotics that kill bacteria inside human cells.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040329.
The MedlinePlus encyclopedia contains pages on urinary tract infection, on cystitis, and on recurrent cystitis (in English and Spanish)
Information is available from the UK National Health Service Direct health encyclopedia on urinary tract infections and on cystitis
The US National Kidney and Urologic Diseases Information Clearinghouse provides information on urinary tract infections (in English and Spanish)
Information is available from the American Urological Association on urinary tract infections in adults
doi:10.1371/journal.pmed.0040329
PMCID: PMC2140087  PMID: 18092884
7.  Optimum Methadone Compliance Testing 
Executive Summary
Objective
The objective of this analysis was to determine the diagnostic utility of oral fluid testing collected with the Intercept oral fluid collection device.
Clinical Need: Target Population and Condition
Opioids (opiates or narcotics) are a class of drugs derived from the opium poppy plant that typically relieve pain and produce a euphoric feeling. Methadone is a long-acting synthetic opioid used to treat opioid dependence and chronic pain. It prevents symptoms of opioid withdrawal, reduces opioid cravings and blocks the euphoric effects of short-acting opioids such as heroin and morphine. Opioid dependence is associated with harms including an increased risk of exposure to Human Immunodeficiency Virus and Hepatitis C as well as other health, social and psychological crises. The goal of methadone treatment is harm reduction. Treatment with methadone for opioid dependence is often a long-term therapy. The Ontario College of Physicians and Surgeons estimates that there are currently 250 physicians qualified to prescribe methadone, and 15,500 people in methadone maintenance programs across Ontario.
Drug testing is a clinical tool whose purpose is to provide objective meaningful information, which will reinforce positive behavioral changes in patients and guide further treatment needs. Such information includes knowledge of whether the patient is taking their methadone as prescribed and reducing or abstaining from using opioid and other drugs of abuse use. The results of drug testing can be used with behavior modification techniques (contingency management techniques) where positive reinforcements such as increased methadone take-home privileges, sustained employment or parole are granted for drug screens negative for opioid use, and negative reinforcement including loss of these privileges for drug screens positive for opioid used.
Body fluids including blood, oral fluid, often referred to as saliva, and urine may contain metabolites and the parent drug of both methadone and drugs of abuse and provide a means for drug testing. Compared with blood which has a widow of detection of several hours, urine has a wider window of detection, approximately 1 to 3 days, and is therefore considered more useful than blood for drug testing. Because of this, and the fact that obtaining a urine specimen is relatively easy, urine drug screening is considered the criterion measure (gold standard) for methadone maintenance monitoring. However, 2 main concerns exist with urine specimens: the possibility of sample tampering by the patient and the necessity for observed urine collection. Urine specimens may be tampered with in 3 ways: dilution, adulteration (contamination) with chemicals, and substitution (patient submits another persons urine specimen). To circumvent sample tampering the supervised collection of urine specimens is a common and recommended practice. However, it has been suggested that this practice may have negative effects including humiliation experienced by patient and staff, and may discourage patients from staying in treatment. Supervised urine specimen collection may also present an operational problem as staff must be available to provide same-sex supervision. Oral fluid testing has been proposed as a replacement for urine because it can be collected easily under direct supervision without infringement of privacy and reduces the likelihood of sample tampering. Generally, the results of oral fluid drug testing are similar to urine drug testing but there are some differences, such as lower concentrations of substances in oral fluid than urine, and some drugs remain detectable for longer periods of time in urine than oral fluid.
The Technology Being Reviewed
The Intercept Oral Specimen Collection Device (Ora-Sure Technologies, Bethlehem, PA) consists of an absorbent pad mounted on a plastic stick. The pad is coated with common salts. The absorbent pad is inserted into the mouth and placed between the cheek and gums for 3 minutes on average. The pad absorbs the oral fluid. After 3 minutes (range 2min-5 min) the collection device is removed from the mouth and the absorbent pad is placed in a small vial which contains 0.8mL of pH-balanced preservative, for transportation to a laboratory for analysis. It is recommended that the person undergoing oral fluid drug testing have nothing to eat or drink for a 10- minute period before the oral fluid specimen is collected. This will remove opportunity for adulteration. Likewise, it is recommended that the person be observed for the duration of the collection period to prevent adulteration of the specimen. An average of 0.4 mL of saliva can be collected. The specimen may be stored at 4C to 37C and tested within 21 days of collection (or within 6 weeks if frozen).
The oral fluid specimen must be analyzed in a laboratory setting. There is no point-of-care (POC) oral fluid test kit for drugs of abuse (other than for alcohol). In the laboratory the oral fluid is extracted from the vial after centrifugation and a screening test is completed to eliminate negative specimens. Similar to urinalysis, oral fluid specimens are analyzed first by enzyme immunoassay with positive specimens sent for confirmatory testing. Comparable cut-off values to urinalysis by enzyme immunoassay have been developed for oral fluids
Review Strategy
 
Research Question
What is the diagnostic utility of the Intercept oral specimen device?
Inclusion criteria:
Studies evaluating paired urine and oral fluid specimens from the same individual with the Intercept oral fluid collection device.
The population studied includes drug users.
Exclusion criteria:
Studies testing for marijuana (THC) only.
Outcomes:
Sensitivity and Specificity of oral fluid testing compared to urinalysis for methadone (methadone metabolite), opiates, cocaine, benzodiazepines, and alcohol.
Quality of the Body of Evidence
The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the overall quality of the body of evidence (defined as 1 or more studies) supporting the research questions explored in this systematic review. A description of the GRADE system is reported in Appendix 1.
Summary of Findings
A total of 854 potential citations were retrieved. After reviewing titles and abstracts, 2 met the inclusion and exclusion criteria. Two other relevant studies were found after corresponding with the author of the 2 studies retrieved from the literature search. Therefore a total of 4 published studies are included in this analysis. All 4 studies carried out by the same investigator meet the definition of Medical Advisory Secretariat level III (not a-randomized controlled trial with contemporaneous controls) study design. In each of the studies, paired urine and oral fluid specimens where obtained from drug users. Urine collection was not observed in the studies however, laboratory tests for pH and creatinine were used to determine the reliability of the specimen. Urine specimens thought to be diluted and unreliable were removed from the evaluation. Urinalysis was used as the criterion measurement for which to determine the sensitivity and specificity of oral fluid testing by the Intercept oral fluid device for opiates, benzodiazepines, cocaine and marijuana. Alcohol was not tested in any of the 4 studies. From these 4 studies, the following conclusions were drawn:
The evidence indicates that oral fluid testing with the Intercept oral fluid device has better specificity than sensitivity for opiates, benzodiazepines, cocaine and marijuana.
The sensitivity of oral fluids testing with the Intercept oral fluid device seems to be from best to worst: cocaine > benzodiazepines >opiates> marijuana.
The sensitivity and specificity for opiates of the Intercept oral fluid device ranges from 75 to 90% and 97- 100% respectively.
The consequences of opiate false-negatives by oral fluid testing with the Intercept oral fluid device need to be weighed against the disadvantages of urine testing, including invasion of privacy issues and adulteration and substitution of the urine specimen.
The window of detection is narrower for oral fluid drug testing than urinalysis and because of this oral fluid testing may best be applied in situations where there is suspected frequent drug use. When drug use is thought to be less frequent or remote, urinalysis may offer a wider (24-48 hours more than oral fluids) window of detection.
The narrow window of detection for oral fluid testing may mean more frequent testing is needed compared to urinalysis. This may increase the expense for drug testing in general.
POC oral fluid testing is not yet available and may limit the practical utility of this drug testing methodology. POC urinalysis by immunoassay is available.
The possible applications of oral fluid testing may include:
Because of its narrow window of detection compared to urinalysis oral fluid testing may best be used during periods of suspected frequent or recent drug use (within 24 hours of drug testing). This is not to say that oral fluid testing is superior to urinalysis during these time periods.
In situations where an observed urine specimen is difficult to obtain. This may include persons with “shy bladder syndrome” or with other urinary conditions limiting their ability to provide an observed urine specimen.
When the health of the patient would make urine testing unreliable (e,g., renal disease)
As an alternative drug testing method when urine specimen tampering practices are suspected to be affecting the reliability of the urinalysis test.
Possible limiting Factors to Diffusion of Oral Fluid Technology
No oral fluid POC test equivalent to onsite urine dips or POC analyzer reducing immediacy of results for patient care.
Currently, physicians get reimbursed directly for POC urinalysis. Oral fluid must be analyzed in a lab setting removing physician reimbursement, which is a source of program funding for many methadone clinics.
Small amount of oral fluid specimen obtained; repeat testing on same sample will be difficult.
Reliability of positive oral fluid methadone (parent drug) results may decrease because of possible contamination of oral cavity after ingestion of dose. Therefore high methadone levels may not be indicative of compliance with treatment. Oral fluid does not as yet test for methadone metabolite.
There currently is no licensed provincial laboratory that analyses oral fluid specimens.
Abbreviations
2-ethylidene- 1,5-dimethyl-3,3-diphenylpyrrolidine
enzyme immunoassay
Enzyme Linked Immunosorbent Assay (ELISA),
Enzyme Multiplied Immunoassay Test (EMIT)
Gas chromatography
gas chromatography/mass spectrometry
High-performance liquid chromatography
Limit of Detection
Mass spectrometry
Methadone Maintenance Treatment
Oral fluid testing
Phencyclidine
Point of Care Testing
tetrahydrocannabinol
11-nor-delta-9-tetrhydrocannabinol-9-carboxylic acid
urine drug testing
PMCID: PMC3379523  PMID: 23074492
8.  PA01.17. A clinical study to evaluate the effect of extract based herbal formulation on hypertension- a single blinded standard controlled randomized study 
Ancient Science of Life  2012;32(Suppl 1):S66-S67.
Purpose:
In Ayurveda although there is no such terminology like hypertension but still this work is an approach to establish relationship between Hypertension & vitiated functioning of three governing forces of our body i.e. Tridosha and to treat Hypertension on Ayurvedic principles. The logic behind such correlation is based on the fact that, like other physiological processes, B.P. too is normal phenomenon of our body which is governed by Tridosha. After going through modern pathogenesis of primary hypertension and its symptomology, in present study it has been correlated with Vata Kaphaja Vikara with Rasavaha, Raktavaha and Manovahi Srotas as the seat of disease. Looking at its pathogenesis, the term Uccha Vyan Bala (exaggerated physiological functioning of Vyan Vayu leading to increase contractility of heart & blood vessels) can be coined for hypertension.
Method:
Subjective criteria Headache, Palpitation, Vertigo, Dyspnoea on walks and Fatigue. Objective criteria BP value recorded by sphygmomanometer in supine position. Final assessment of results; Subjective assessment 75 to 100% disappearance of symptoms effectively cured. 50 to 74% disappearance of symptoms well cured. 25 to 49% disappearance of symptoms fairly cured. 0 to 24% disappearance of symptoms poorly cured. Objective assessment Patient showing reduction in BP by 10mmHg Poorly cured; Patient showing reduction in BP between 11 to 20mmHg Fairly cured; Patient showing reduction in BP between 21 to 30 mmHg Well cured; Patient showing reduction in BP by more than 30 mmHg Effectively cured. Research methodology Type of study-Single blinded comparative study. Study site IPD and OPD department of Shubhdeep ayurved medical college, Indore (MP). Sample size 50 patients divided randomly into two equal groups. Group A given trial drug whereas Group B given control drug. Drug dosage and vehicle 1 capsule twice daily with lukewarm water after meals. Duration of treatment one month (examined at weekly intervals.) Dietary advice to strictly restrict the daily intake of Amla, Lavana, Guru & Vidahi diet.
Result:
70% Patients found to be hypertensive were above 40 years of age. 60% Patients were fond of salty & spicy diet. Out of 50 patients 30 patients (60%) belongs to service class. Out of 50 patients 35 patients (70%) were male. Regarding prevalence of symptoms, Dyspnoea on routine work was found in 82%, Headache & palpitation in 80%, Vertigo in 78% & Fatigue in 66% patients.
Conclusion:
As per classical texts, Vata predominant diseases are caused due to vitiation of Vata due to emaciation (Dhatu Kshaya) & obstruction (Marg avarodha). Hypertension seems to be Vata predominant disease due to obstruction. Reason being that, Lavana is Vata Shamak, & should therefore decrease Blood pressure but on contrary it increases B.P. Similarly increase in weight leads to greater chances of High Blood pressure. Above discussion favours that Hypertension can be considered Vata predominant disease due to Marg avarodha by Kapha Dosha and Pitta Dosha in Anubandh. Finally it can be concluded that the drug under study has shown enthusiastic results in reducing the overall value of blood pressure. 64% patients got effectively cured, 24% got well cured and 12% got fairly cured. Regarding symptomatic relief, out of 25 patients 8 showed more than 75% relief, 9 showed more than 50% relief, 7 showed more than 25% relief and only 1 patient showed less than 25% relief in overall symptoms. No significant side effects have been reported in any subject.
PMCID: PMC3800947
9.  Abhava pratinidhi dravya: A comparative phytochemistry of Ativisha, Musta and related species 
Authentic Ativisha (Aconitum heterophyllum) is a rare, endangered Himalayan species. Ayurveda classical texts of c. 15th–16th century, introduced “abhava-pratinidhi dravya” concept, wherein Ativisha was categorized as an abhava dravya (unavailable drug) and Musta (Cyperus rotundus) was suggested as a pratinidhi dravya (substitute) for it. C. rotundus is a weed, abundantly available pan-India. Cryptocoryne spiralis (Naattu Athividayam) and Cyperus scariosus (Nagarmotha) are also traded as Ativisha and Musta, respectively. Yet, there are no scientific studies to validate the use of substitutes. A. heterophyllum bears no similarity in terms of botanical classification with the other candidates. This article reviews published literature with an emphasis to look for similar phytochemicals or groups of phytochemicals in the species that could contribute to similar pharmacological activities, thereby supporting the drug substitution from a bio-medical perspective. Alkaloids like atisine were found to be the main focus of studies on A. heterophyllum, whereas for the Cyperus spp., it was terpenoids like cyperene. Although alkaloids and terpenoids were reported from both species, alkaloids in C. rotundus and terpenoids in A. heterophyllum were minor constituents. Reports on phytochemicals on Cryptocoryne spiralis and C. scariosus were very limited. Despite no significant similarities in chemical profiles reported, the dravyaguna (Ayurvedic drug classification) of Ativisha and Musta was quite similar warranting further exploration into the bio-functional aspects of the drug materials.
doi:10.4103/0975-9476.146550
PMCID: PMC4395931  PMID: 25878466
Aconitum; Ativisha; Ayurveda; Cryptocoryne; Cyperus; Musta; phytochemistry
10.  Critical appraisal of Doshavaha Srotas 
Ayu  2012;33(3):337-342.
Tridoshas viz Vata, Pitta, and Kapha are responsible for health and disease depending on their normalcy and disequilibrium state. Improper usage of foods and drinks along with abnormal activities manifests diseases of respective Doshik predominance. Sira (vein) is the synonym of Srotas, keeping this in mind, Vatavaha Sira is correlated with Vatavaha Srotas, Pittavaha Sira with Pittavaha Srotas, Kaphavaha Sira with Kaphavaha Srotas, and Sarvavaha Sira with Sarvavaha Srotas. The purpose of detail understanding of Doshavaha Srotas is essential to understand the role of Doshas in the manifestation of diseases. One can easily predict by observing the color changes in particular area to be able to predict the predominance of Doshas in that area. Manifestation of a disease occurs in the body as a result of the defective Srotas favoring the Dosha–Dushya conglomeration. Hence, any defect in the Srotas must be corrected quickly for the restoration of normal health. Present article emphasis on the proper understanding of Doshavaha Srotas in a systematic manner to understand its root, causative factors, signs and symptoms, and diseases produced due to their vitiation.
doi:10.4103/0974-8520.108819
PMCID: PMC3665105  PMID: 23723638
Kapha; nanatmaja vikara; pitta; Sarvavaha Srotas; sira; vata
11.  Neurotrophins in the Lower Urinary Tract: Becoming of Age 
Current Neuropharmacology  2011;9(4):553-558.
The lower urinary tract (LUT) comprises a storage unit, the urinary bladder, and an outlet, the urethra. The coordination between the two structures is tightly controlled by the nervous system and, therefore, LUT function is highly susceptible to injuries to the neuronal pathways involved in micturition control. These injuries may include lesions to the spinal cord or to nerve fibres and result in micturition dysfunction. A common trait of micturition pathologies, irrespective of its origin, is an upregulation in synthesis and secretion of neurotrophins, most notably Nerve Growth Factor (NGF) and Brain Derived Neurotrophic Factor (BDNF). These neurotrophins are produced by neuronal and non-neuronal cells and exert their effects upon binding to their high-affinity receptors abundantly expressed in the neuronal circuits regulating LUT function. In addition, NGF and BDNF are present in detectable amounts in the urine of patients suffering from various LUT pathologies, suggesting that analysis of urinary NGF and BDNF may serve as likely biomarkers to be studied in tandem with other factors when diagnosing patients. Studies with experimental models of bladder dysfunction using antagonists of NGF and BDNF receptors as well as scavenging agents suggest that those NTs may be key elements in the pathophysiology of bladder dysfunctions. In addition, available data indicates that NGF and BDNF might constitute future targets for designing new drugs for better treatment of bladder dysfunction.
doi:10.2174/157015911798376253
PMCID: PMC3263451  PMID: 22654715
NGF; BDNF; Trk receptors; bladder; LUT.
12.  Neural Control of the Lower Urinary Tract 
Comprehensive Physiology  2015;5(1):327-396.
This article summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract. The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. The neural control of micturition is organized as a hierarchical system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brain stem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brain stem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary micturition, leading to urinary incontinence. Neuroplasticity underlying these developmental and pathological changes in voiding function is discussed.
doi:10.1002/cphy.c130056
PMCID: PMC4480926  PMID: 25589273
13.  Rasa Nirdhāraṇa (assessment of taste) of Leonotis nepetifolia (L.) R. Br.: A preliminary study in healthy volunteers 
Ancient Science of Life  2014;33(3):186-191.
Background:
Rasa (a concept corresponding to taste) is the only perceivable parameter for drug identification in Ayurveda. The Ayurvedic pharmacological principles such as guṇa (quality), vīrya (potency) and vipāka (effect of biotransformation) are inferred based on the identified Rasa of a drug. All these principles together predict the probable spectrum of drug action in Ayurveda. It is mandatory to screen a drug in the Ayurvedic pharmacological perspective to incorporate it into Ayurvedic materia medica.
Aim:
To assess the rasa of a non classical herb, Leonotis nepetifolia (L.).R.Br. based on the lakṣaṇas (characteristics) described in Ayurvedic texts for the identification of individual rasa.
Settings and Design:
The study was conducted at the Department of Dravyaguna, Institute for Post Graduate Teaching and Reaseach in Ayurveda, Gujarat Ayurved University, Jamnagar.
Materials and Methods:
The whole plant powder (3g) of Leonotisnepetifolia was administered to 50 participants (trained Ayurvedic physicians) and their responses after intake of the drug were elicited using a structured questionnaire.
Results and Conclusion:
On analyzing the data it was found that Leonotis nepetifolia possess predominantly tikta rasa (bitter taste) followed by Kaṣāya rasa (astringent taste). Recent researches and ethnomedicinal claims on Leonotis nepetifolia stand comparable with the pharmacological activities attributed to tikta and Kaṣāya rasa in Ayurvedic classics. Rasa nirdhāraṇa can be one of the preliminary steps to initiate the process of screening of an unknown drug along the lines of Ayurvedic pharmacology specially because rasa is the only perceivable parameter. According to Ayurveda, rasa of a dravya has a bearing on its karma (pharmacological action) and the identification of rasa could be one of the subjective means for inferring pāñcabhautika constitution of a substance which in turn could help in tentatively inferring guṇa, vīrya and vipāka of the dravya. This paper demonstrates how a simple method can be used without any instruments to do a preliminary assessment of the rasa or taste of a plant.
doi:10.4103/0257-7941.144625
PMCID: PMC4264309  PMID: 25538356
Ayurveda; Assessment of Taste; ethnomedicinal; Leonotisnepetifolia (L.) R.Br; Rasa nirdharana; structured questionnaire; Tikta rasa
14.  Micturitional disturbance in herpetic brainstem encephalitis; contribution of the pontine micturition centre 
Micturitional disturbance is rarely mentioned in human herpetic brainstem encephalitis although the pontine tegmentum, called the pontine micturition centre, seems to regulate the lower urinary tract in experimental animals. The case of a 45 year old man, who developed subacute coma and hiccup-like dysrhythmic breathing, and needed assisted ventilation is reported. Examination of CSF showed mononuclear pleocytosis and antibody against herpes simplex virus type 1, but the opening pressure was 90 cm H2O. Brain CT showed brain swelling, predominantly in the posterior fossa, and bilateral subdural effusion. Herpetic brainstem encephalitis was diagnosed, and he received 900 mg/day vidarabine. On regaining consciousness, he had left trochlear nerve palsy, left corectopia, ageusia, and urinary retention. Brain MRI showed right side dominant, bilateral pontine segmental lesions extending slightly to the midbrain and medulla. After two weeks he was able to urinate but showed nocturnal urinary frequency, urinary incontinence, and voiding difficulty. Urodynamic studies showed a residual urine volume of 350 ml and detrusor hyporeflexia on voiding. Micturitional disturbance gradually disappeared together with the neurological signs. The bilateral pontine tegmental lesions in this patient are similar to those in previous findings on brainstem strokes, evidence of the presence of a pontine micturition centre in humans.


PMCID: PMC2169952  PMID: 9489547
15.  Neural Mechanisms Underlying Lower Urinary Tract Dysfunction 
Korean Journal of Urology  2014;55(2):81-90.
This article summarizes anatomical, neurophysiological, and pharmacological studies in humans and animals to provide insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract and alterations in these mechanisms in lower urinary tract dysfunction. The functions of the lower urinary tract, to store and periodically release urine, are dependent on the activity of smooth and striated muscles in the bladder, urethra, and external urethral sphincter. During urine storage, the outlet is closed and the bladder smooth muscle is quiescent. When bladder volume reaches the micturition threshold, activation of a micturition center in the dorsolateral pons (the pontine micturition center) induces a bladder contraction and a reciprocal relaxation of the urethra, leading to bladder emptying. During voiding, sacral parasympathetic (pelvic) nerves provide an excitatory input (cholinergic and purinergic) to the bladder and inhibitory input (nitrergic) to the urethra. These peripheral systems are integrated by excitatory and inhibitory regulation at the levels of the spinal cord and the brain. Therefore, injury or diseases of the nervous system, as well as disorders of the peripheral organs, can produce lower urinary tract dysfunction, leading to lower urinary tract symptoms, including both storage and voiding symptoms, and pelvic pain. Neuroplasticity underlying pathological changes in lower urinary tract function is discussed.
doi:10.4111/kju.2014.55.2.81
PMCID: PMC3935075  PMID: 24578802
Detrusor overactivity; Lower urinary tract; Nerve growth factor; Overactive urinary bladder
16.  PA02.07. Rational scientific analysis of modern lifestyle as a nidana w.s.r to viruddha ahara 
Ancient Science of Life  2013;32(Suppl 2):S52.
Purpose:
To understand the concept of viruddha ahara as a nidana in causation of diseases and to know its relavance in the present era. In the classics hitabhuk, mitabhuk, kshutabhuk, rhutubhuk are mentioned for maintaing the health of a person. Ahara that which vitiates dosha and which is antagonist to the dhatu in the body is known as viruddha ahara.
Method:
Classical literatures like bruhat trayi, laghu trayi, other texts and contemporary books are reviewed. The datas collected are analyzed scientifically with the help of contemporary science.
Result:
The eighteen types of viruddha ahara mentioned in the classics like desha, kala, agni, matra, etc. are understood with the help of examples like Agni viruddha In mandagni condition consuming guru snigdha ahara. In condition like dyspepsia where impairement in gastric, bile, pancreatic secretions are present, due to increased intake of mamsala ahara which are rich in amino acids and lipids impaires metabolism. Satmya viruddha Person satmya with katu ushna dravya sevana consuming increased swadu sheeta dravya. Persons habituated with rich spicy diet like pepper which causes irritation of gastric mucosa leading to increased gastric juice secretion, if increased intake of chilled soft drinks in such persons causes constriction of gastric mucosa leading to less gastric juice secretion. Avastha viruddha after nidra consuming kaphavardhka ahara like curd. After sleep basal metabolic rate of the body is reduced, curd which is rich in fats and carbohydrates requires more time for digestion. The rest types of viruddha ahara are analyzed and understood scientifically in the same manner as explained above.
Conclusion:
Ayurveda emphazises on nidana parivarjanameva chikitsa, understanding the nidana is prime important. Viruddha ahara affects the body metabolism and hence the concept of viruddha ahara is relevant to present era.
doi:10.4103/0257-7941.123868
PMCID: PMC4147524
17.  PA01.25. Clinical evaluation of chitrakadi churna and kshar basti in the management of amavata with special reference to rheumatoid arthritis 
Ancient Science of Life  2012;32(Suppl 1):S75.
Purpose:
The disease Amavata can be presented as very similar to Rheumatoid Arthritis. Rheumatoid Arthritis is chronic in nature and affects mostly middle aged people. For this disease there is no satisfactory medicine is available till date. But in Ayurveda there are many drugs described for Amavata which are cost effective and easily available with no side effects. The present clinical study evaluated the effect of Chitrakadi Churna and Kshar Basti in the management of Amavata.
Method:
30 clinically diagnosed patient of Amavata were registered and completed the trial. In this 15 patients (Group A) administered Chitrakadi Churna 4gm twice daily with lukewarm water after meal. Another 15 patients (Group B) administered Chitrakadi Churna 4gm twice daily with lukewarm water after meal and Kshar Basti as per Kalbasti krama i.e 16days followed by local Snehan Swedan.
Result:
Results of this trial were encouraging as there is improvement in each symptom of patient like pain, stiffness, swelling, and tenderness. Group A in which only Chitrakadi Churna was administered there was no significant improvement seen statistically. But Group B in which Chitrakadi Churna as well as Kshar Basti was administered highly significant improvement seen statistically. Details of the Statistical test and other important will be discussed at the time of paper presentation.
Conclusion:
From present clinical trial it is concluded that this therapy is very useful for pain, swelling, tenderness and stiffness, which were chief complaint of the patient. Chronicity more than 3 years did not show marked improvement. And also this drug is supposed to be very good combination of Vedanashamaka, Shothaghna, Amapachaka Dravyas. No untoward effects were seen except mild loss of weight.
PMCID: PMC3800956
18.  An overview of the causes of current practices in Pratinidhi Dravyas (substitution of drugs) in Ayurveda including newer techniques for their evaluation 
Ayu  2012;33(4):481-485.
Many Pratinidhi Dravyas in Ayurvedic classics are mentioned and certainly are based on a methodical approach, which involves many aspects. These principles on which Pratinidhis were decided are quoted nowhere; so both to understand the established Pratinidhis and to find new ones a rational approach is the need of the hour. This article is an effort in the direction to study this concept meticulously in light of modern techniques for its better understanding and application. As there are very few established parameters, which help for selection and evaluation of Pratinidhi Dravyas. A rational technique like Fourier transform infrared spectroscopy may be incorporated to set a new dimension. As most of the routine analytical techniques are separation based, overall component load cannot be predicted. Thus, it is prime necessity to compare the drugs with a whole aspect, which goes in hand by hand with a holistic approach of Ayurveda “Treat the man as Whole – Take the drug as whole.”
doi:10.4103/0974-8520.110518
PMCID: PMC3665206  PMID: 23723663
Ayurveda; Fourier transform infrared spectroscopy; Pratinidhi Dravya
19.  Objective non-intrusive markers of sperm production and sexual activity 
Asian Journal of Andrology  2012;14(3):476-480.
Objective studies of men's reproductive function are hindered by their reliance on: (i) self-reporting to quantify sexual activity and (ii) masturbation to quantify sperm output rendering both types of estimate vulnerable to unverifiable subjective factors. We therefore examined whether detection of spermatozoa and measurement of prostate-specific antigen (PSA) in urine could provide objective semiquantitative estimates of sperm output and recent ejaculation, respectively, using widely available laboratory techniques. Of 11 healthy volunteers who provided urine samples before and at intervals for 5 days after ejaculation, sperm was present in 2/11 men before, and in all 11/11 samples immediately after ejaculation, but by the second and subsequent void, spermatozoa were present in ∼10%. PSA was detectable at high levels in all urine samples, peaking at the first post-ejaculatory sample but returning to baseline levels by the second post-ejaculatory void. We conclude that urinary spermatozoa and PSA are objective biomarkers for sperm production and sexual activity, but only for a short-time window until the first post-ejaculatory urine void. Hence, for a single urine specimen, the presence of spermatozoa and PSA are valid biomarkers, reflecting sperm production and recent ejaculation only until the next micturition, so their measurement should be restricted to the first morning urine void.
doi:10.1038/aja.2012.2
PMCID: PMC3720168  PMID: 22522506
ejaculation; PSA; sexual activity; sperm output; spermatozoa; urine
20.  Autoimmunity to Uroplakin II Causes Cystitis in Mice: A Novel Model of Interstitial Cystitis 
European urology  2011;61(1):193-200.
Background
The pathophysiology of interstitial cystitis (IC) is unknown. Deficits in urothelial cell layers and autoimmune mechanisms may play a role.
Objective
To examine whether immunization of mice with recombinant mouse uroplakin II (rmUPK2), a bladder-specific protein, would provoke an autoimmune response sufficient to create an IC phenotype.
Design, setting, and participants
RmUPK2 complementary DNA was generated, transferred into a bacterial expression vector, and the generated protein was purified. Eight-week-old SWXJ female mice were immunized with rmUPK2 protein via subcutaneous injection of 200 µg of rmUPK2 protein in 200 µl of an emulsion.
Measurements
Mice were euthanized 5 wk after immunization. Axillary and inguinal lymph node cells were tested for antigen-specific responsiveness and cytokine production, serum isotype antibody titers against rmUPK2 were determined, and gene expression of inflammatory mediators was measured in the bladder and other organs. For functional analysis, mice were placed in urodynamic chambers for 24-h micturition frequency and total voided urine measurements.
Results and limitations
Immunization with rmUPK2 resulted in T-cell infiltration of the bladder urothelium and increased rmUPK2-specific serum antibody responses in the experimental autoimmune cystitis (EAC) mice models compared with controls. The ratio of bladder to body weight was increased in EAC mice. Quantitative reverse transcriptase polymerase chain reaction analysis showed elevated gene expression of tumor necrosis factor α, interferon γ, interleukin (IL)-17A, and IL-1β in bladder urothelium but not in other organs. Evaluation of 24-h micturition habits of EAC mice showed significantly increased urinary frequency (p < 0.02) and significantly decreased urine output per void (p < 0.021) when compared with control mice.
Conclusions
Our study showed that a bladder-specific autoimmune response sufficient to induce inflammation and EAC occurs in mice following immunization with rmUPK2. EAC mice displayed significant evidence of urinary frequency and decreased urine output per void. Further phenotype characterization of EAC mice should include evidence for pain and/or afferent hypersensitivity, and evidence of urothelial cell layer damage.
doi:10.1016/j.eururo.2011.06.028
PMCID: PMC3226908  PMID: 21719190
Autoimmune; Animal model; Bladder; Cystitis; T cell
21.  Study of the response of the penile corporal tissue and cavernosus muscles to micturition 
BMC Urology  2008;8:4.
Background
The reaction of the corpora cavernosa (CC), the corpus spongiosum (CS), the bulbocavernosus (BCM) and ischiocavernosus (ICM) muscles to passage of urine through the urethra during micturition is not known. We investigated the hypothesis that the passage of urine through the urethra stimulates the corporal tissue and cavernosus muscles.
Methods
In 30 healthy men (mean age 42.8 ± 11.7 years), the electromyographic activity (EMG) of the CC, CS, BCM, and ICM were recorded before and during micturition, and on interruption of and straining during micturition. These tests were repeated after individual anesthetization of urethra, corporal tissue, and cavernosus muscles.
Results
During micturition, the slow wave variables (frequency, amplitude, conduction velocity) of the CC and CS decreased while the motor unit action potentials of the BCM and ICM increased; these EMG changes were mild and returned to the basal values on interruption or termination of micturition. Micturition after individual anesthetization of urethra, corporal tissue and cavernosal muscles did not effect significant EMG changes in these structures, while saline administration produced changes similar to those occurring before saline administration.
Conclusion
The decrease of sinusoidal and increase of cavernosus muscles' EMG activity during micturition apparently denotes sinusoidal relaxation and cavernosus muscles contraction. Sinusoidal muscle relaxation and cavernosus muscles contraction upon micturition are suggested to be mediated through a 'urethro-corporocavernosal reflex'. These sinusoidal and cavernosus muscle changes appear to produce a mild degree of penile tumescence and stretch which might assist in urinary flow during micturition.
doi:10.1186/1471-2490-8-4
PMCID: PMC2270861  PMID: 18312692
22.  Cyperus rotundus, a substitute for Aconitum heterophyllum: Studies on the Ayurvedic concept of Abhava Pratinidhi Dravya (drug substitution) 
In the absence of a desired first choice medicinal herb, classical Ayurveda recommends use of a functionally similar substitute. Post 16th century Ayurvedic texts and lexicons give specific examples of possible substitutes. Here we report a preliminary study of one such Ayurvedic substitution pair: Musta (Cyperus rotundus L., Cyperaceae), a common weed, for the rare Himalayan species, Ativisha (Aconitum heterophyllum Wall. ex Royle; Ranunculaceae). The study's strategy was to use modern phytochemical and pharmacological methods to test the two herbs for biochemical and metabolic similarities and differences, and literary studies to compare their Ayurvedic properties, a novel trans-disciplinary approach. No previous scientific paper has compared the two herbs’ bioactivities or chemical profiles. Despite being taxonomically unrelated, the first choice, but relatively unavailable (Abhava) plant, A. heterophyllum, and its substitute (Pratinidhi) C. rotundus, are not only similar in Ayurvedic pharmacology (Dravyaguna) profile, but also in phytochemical and anti-diarrheal properties. These observations indicate that Ayurveda may attach more importance to pharmacological properties of raw drugs than to their botanical classification. Further research into the nature of raw drugs named could open up new areas of medicinal plant classification, linking chemistry and bioactivity. Understanding the logic behind the Ayurvedic concept of Abhava Pratinidhi Dravya (drug substitution) could lead to new methods of identifying legitimate drug alternatives, and help solve industry's problems of crude drug shortage.
doi:10.4103/0975-9476.59825
PMCID: PMC3149390  PMID: 21829299
Abhava Pratinidhi Dravya; Ayurveda; anti-diarrheal; drug substitution
23.  Organization of the neural switching circuitry underlying reflex micturition 
The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain and spinal cord that coordinates the activity of the bladder and urethral outlet. Experimental studies in animals indicate that urine storage is modulated by reflex mechanisms in the spinal cord, whereas voiding is mediated by a spinobulbospinal pathway passing through a coordination centre in the rostral brain stem. Many of the neural circuits controlling micturition exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. This study summarizes the anatomy and physiology of the spinal and supraspinal micturition switching circuitry and describes a computer model of these circuits that mimics the switching functions of the bladder and urethra at the onset of micturition.
doi:10.1111/apha.12014
PMCID: PMC3718009  PMID: 23033877
brain stem; spinal cord; switching circuit
24.  Plasticity in reflex pathways to the lower urinary tract following spinal cord injury 
Experimental neurology  2011;235(1):123-132.
The lower urinary tract has two main functions, storage and periodic expulsion of urine, that are regulated by a complex neural control system in the brain and lumbosacral spinal cord. This neural system coordinates the activity of two functional units in the lower urinary tract: (1) a reservoir (the urinary bladder) and (2) an outlet (consisting of bladder neck, urethra and striated muscles of the external urethra sphincter). During urine storage the outlet is closed and the bladder is quiescent to maintain a low intravesical pressure. During micturition the outlet relaxes and the bladder contracts to promote efficient release of urine. This reciprocal relationship between bladder and outlet is generated by reflex circuits some of which are under voluntary control. Experimental studies in animals indicate that the micturition reflex is mediated by a spinobulbospinal pathway passing through a coordination center (the pontine micturition center) located in the rostral brainstem. This reflex pathway is in turn modulated by higher centers in the cerebral cortex that are involved in the voluntary control of micturition. Spinal cord injury at cervical or thoracic levels disrupts voluntary control of voiding as well as the normal reflex pathways that coordinate bladder and sphincter function. Following spinal cord injury the bladder is initially areflexic but then becomes hyperreflexic due to the emergence of a spinal micturition reflex pathway. However the bladder does not empty efficiently because coordination between the bladder and urethral outlet is lost. Studies in animals indicate that dysfunction of the lower urinary tract after spinal cord injury is dependent in part on plasticity of bladder afferent pathways as well as reorganization of synaptic connections in the spinal cord. Reflex plasticity is associated with changes in the properties of ion channels and electrical excitability of afferent neurons and appears to be mediated in part by neurotrophic factors released in the spinal cord and/or the peripheral target organs.
doi:10.1016/j.expneurol.2011.05.003
PMCID: PMC3580860  PMID: 21596038
Micturition; Urinary bladder; Nerve growth factor; Urethra sphincter; Neurogenic detrusor overactivity; Detrusor-sphincter-dyssynergia; Afferent nerves; Synaptic remodeling; Neuropeptides; Urothelium
25.  Do Rotational Shifts Affect Micturition Patterns in Real Practice? A Pilot Study in Healthy, Young Female Nurses 
Purpose
Healthy, young individuals are known to exhibit circadian variation in urinary functions. However, the effects of chronic circadian disturbance on voiding functions are largely unknown. The present work compared the effects of rotational shifts on the micturition patterns of female nurses to that in female nurses with routine daytime shifts.
Methods
A total of 19 nurses without lower urinary tract symptoms who worked rotational shifts for an average duration of 2 years were recruited. A voiding diary was kept for 9 consecutive days, and the overactive bladder symptom score (OABSS) questionnaire was completed three times, starting 3 days before their night duties until 3 days after completion of their night duties. For comparison, seven nurses with regular shifts completed a 3-day voiding diary and the OABSS questionnaire.
Results
Female nurses working rotational shifts had lower overall urine production and had decreased urination frequency and nocturia than female nurses working regular shifts, even when the nurses who worked rotational shifts had a regular night's sleep for at least 7 days. Upon reinitiation of night duty, overall urine production increased significantly, with no significant changes in urgency and frequency. When these nurses returned to daytime duty, the volume of urine decreased but nocturnal urine production remained high, and the incidence of nocturia also increased significantly. However, the effects on OABSS score were not significant under the study design used.
Conclusions
Long-term rotational shifts resulted in adaptive changes such as decreased urine production and frequency in healthy, young female nurses. In addition, their micturition patterns were significantly affected by abrupt changes in their work schedules. Although working in shifts did not increase urgency or frequency of urination in healthy, young female nurses working rotational shifts for an average 2 years, large-scale studies are needed to systematically analyze the influence of shift work timings on micturition in humans.
doi:10.5213/inj.2014.18.4.206
PMCID: PMC4280440  PMID: 25558418
Circadian Rhythm; Work; Rotation; Urination

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