真心希望国内有个好的发展环境，看到国内的一些学术争议演变成双方的黑打，而学术界和法制及公权力似乎都无能为力，很是让人担忧，这与北美成熟而规范的学术环境形成鲜明的对比。

曾经参与州府Medical Board的咨询，电话里谈到对Drug泛滥的控制，说实话我无能为力，如何规范Narcotic的应用是一个学术问题，许多是要证据来说话的，这方面的研究还有很大距离，如果强力以行政法制介入会造成更大的问题，由此对Narcotic的切实体验，在一次年会上，一位Harvard的研究人员拿出一个数据说明某镇痛药对某疾病的症状控制有奇效达到100%，我是极度反感的，Risk要远大于Benefit，在会上提出激烈的反问，一度使其下不了台，我的感觉，他对社会上Narcotic的泛滥没有切肤体验。

在北美通过一个疗法，经常会经历一个反复的研究过程，尤其对于巨大风险的手术疗法，其实验证据和认证推荐程度都有一个规范过程，每次年会由一批顶级专家讨论，达成共识才推广应用，为了不让某一块学术山头主导，每次年会都会换一批人来组织，比如我所参加的年会，就有加州，哈佛，JohnsHopkins 等山头轮流组织，这也避免了某学派或学霸的独裁，自由平等的学术环境绝对是学术发展的一个重要因素。

在出国前，国内神经移植嫁接手术已经很普遍了，这个并不是什么高难手术，但像样的研究不多见，我记得面瘫的神经移植再接效果并不好，神经嫁接再生是个很大问题，所以某手术Somaticto Autonomic Anastomosis在解剖上可以做到手术连接，但神经是否再生嫁接而达到功能上的效应是个很大问题，国内做了上千例竟然没有一个像样的研究，这样产生一些短期的功能改进，而长期并无太大效果，以昂贵的费用和手术风险，绝对是得不偿失的，因为类似的短期效果也可以通过其他疗法来取得的。

北美的学术环境能使得一个复杂的问题明了开来，这对争议的各方都是有益的，最终使得病人和整个社会收益，国内形成关公战秦琼式黑打混战，应该深思。。。媒介的不当掺和可能使得形势更糟糕，像“气功大师”式的品性在当今的学者身上也是常见的。。。

以下是最新的一篇研究文摘，虽然是一例，但很能说明问题，在国内动则上千例的手术前，是否应该做一下小规模类似研究。。。

JNeurosurg Pediatr. 2013 Jul;12(1):80-6. doi:10.3171/2013.4.PEDS12302. Epub 2013 May 10.

Attempted bladderreinnervation and creation of a scratch reflex for bladder emptying through asomatic-to-autonomic intradural anastomosis.

Tuite GF, Storrs BB, Homsy YL, Gaskill SJ, Polsky EG, Reilly MA, Gonzalez-Gomez I, Winesett SP, Rodriguez LF,Carey CM, Perlman SA, Tetreault L.

Source

Pediatric Neuroscience Center;

Abstract

An intraduralsomatic-to-autonomic anastomosis, or Xiao procedure, has been described tocreate a "skin-CNS-bladder" reflex that improves bladder and bowelfunction in patients with neurogenic bladder and bowel dysfunction. The authorspresent their experience with a 10-year-old boy with chronic neurogenic bladderand bowel dysfunction related to spinal cord injury who underwent the Xiaoprocedure. After undergoing a left L-5 ventral root to left S2-3 intraduralanastomosis, the patient reported that his bladder and bowel dysfunctionimproved between 6 and 12 months. Two years after the procedure, however, hereported that there was no change in his bladder or bowel dysfunction ascompared with his condition prior to the procedure. Frequent, systematicmultidisciplinary evaluations produced conflicting data. Electrophysiological andhistological evaluation of the previously performed anastomosis during surgicalreexploration 3 years after the Xiao procedure revealed that the anastomosiswas in anatomical continuity but neuroma formation had prevented reinnervation.Nerve action potentials were not demonstrable across the anastomosis, andstimulation of the nerve above and below the anastomosis created no bladder orperineal contractions. This is the first clinical report on the outcome of theXiao procedure in a child with spinal cord injury outside of China. It isimpossible to draw broad conclusions about the efficacy of the procedure basedon a single patient with no demonstrable benefit. However, future studiesshould carefully interpret transient improvements in bladder function,urodynamic findings, and the patient's ability to void in response toscratching after the Xiao procedure. The authors' experience with the featuredpatient, in whom reinnervation could not be demonstrated, suggests that suchchanges could be related to factors other than the establishment of askin-CNS-bladder reflex as a result of a somatic-to-autonomic anastomosis.

PMID: 23662931