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Wang Y, Wang PM, Larauche M, Mulugeta M, Liu W. Bio-impedance method to monitor colon motility response to direct distal colon stimulation in anesthetized pigs. Sci Rep 2022; 12:13761. [PMID: 35961998 PMCID: PMC9374686 DOI: 10.1038/s41598-022-17549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/27/2022] [Indexed: 11/09/2022] Open
Abstract
Electrical stimulation has been demonstrated as an alternative approach to alleviate intractable colonic motor disorders, whose effectiveness can be evaluated through colonic motility assessment. Various methods have been proposed to monitor the colonic motility and while each has contributed towards better understanding of colon motility, a significant limitation has been the spatial and temporal low-resolution colon motility data acquisition and analysis. This paper presents the study of employing bio-impedance characterization to monitor colonic motor activity. Direct distal colon stimulation was undertaken in anesthetized pigs to validate the bio-impedance scheme simultaneous with luminal manometry monitoring. The results indicated that the significant decreases of bio-impedance corresponded to strong colonic contraction in response to the electrical stimulation in the distal colon. The magnitude/power of the dominant frequencies of phasic colonic contractions identified at baseline (in the range 2-3 cycles per minute (cpm)) were increased after the stimulation. In addition, positive correlations have been found between bio-impedance and manometry. The proposed bio-impedance-based method can be a viable candidate for monitoring colonic motor pattern with high spatial and temporal resolution. The presented technique can be integrated into a closed-loop therapeutic device in order to optimize its stimulation protocol in real-time.
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Affiliation(s)
- Yushan Wang
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Po-Min Wang
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Muriel Larauche
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, CURE: Digestive Diseases Research Core Center (DDRCC), Center for Neurobiology of Stress and Resilience (CNSR), University of California, Los Angeles, Los Angeles, CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Million Mulugeta
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, CURE: Digestive Diseases Research Core Center (DDRCC), Center for Neurobiology of Stress and Resilience (CNSR), University of California, Los Angeles, Los Angeles, CA, USA. .,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Wentai Liu
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, USA. .,Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA. .,California NanoSystems Institute, University of California, Los Angeles, Los Angeles, CA, USA. .,Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, USA.
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2
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Larauche M, Wang Y, Wang PM, Dubrovsky G, Lo YK, Hsiang EL, Dunn JC, Taché Y, Liu W, Million M. The effect of colonic tissue electrical stimulation and celiac branch of the abdominal vagus nerve neuromodulation on colonic motility in anesthetized pigs. Neurogastroenterol Motil 2020; 32:e13925. [PMID: 32578346 PMCID: PMC7606494 DOI: 10.1111/nmo.13925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/20/2020] [Accepted: 05/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Knowledge on optimal electrical stimulation (ES) modalities and region-specific functional effects of colonic neuromodulation is lacking. We aimed to map the regional colonic motility in response to ES of (a) the colonic tissue and (b) celiac branch of the abdominal vagus nerve (CBVN) in an anesthetized porcine model. METHODS In male Yucatan pigs, direct ES (10 Hz, 2 ms, 15 mA) of proximal (pC), transverse (tC), or distal (dC) colon was done using planar flexible multi-electrode array panels and CBVN ES (2 Hz, 0.3-4 ms, 5 mA) using pulse train (PT), continuous (10 min), or square-wave (SW) modalities, with or without afferent nerve block (200 Hz, 0.1 ms, 2 mA). The regional luminal manometric changes were quantified as area under the curve of contractions (AUC) and luminal pressure maps generated. Contractions frequency power spectral analysis was performed. Contraction propagation was assessed using video animation of motility changes. KEY RESULTS Direct colon ES caused visible local circular (pC, tC) or longitudinal (dC) muscle contractions and increased luminal pressure AUC in pC, tC, and dC (143.0 ± 40.7%, 135.8 ± 59.7%, and 142.0 ± 62%, respectively). The colon displayed prominent phasic pressure frequencies ranging from 1 to 12 cpm. Direct pC and tC ES increased the dominant contraction frequency band (1-6 cpm) power locally. Pulse train CBVN ES (2 Hz, 4 ms, 5 mA) triggered pancolonic contractions, reduced by concurrent afferent block. Colon contractions propagated both orally and aborally in short distances. CONCLUSION AND INFERENCES In anesthetized pigs, the dominant contraction frequency band is 1-6 cpm. Direct colonic ES causes primarily local contractions. The CBVN ES-induced pancolonic contractions involve central neural network.
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Affiliation(s)
- Muriel Larauche
- CURE: Digestive Diseases Research Center (DDRCC), Center for Neurobiology of Stress and Resilience (CNSR), Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Yushan Wang
- Department of Bioengineering, California NanoSystems Institute, UCLA, Los Angeles, CA, USA
| | - Po-Min Wang
- Department of Bioengineering, California NanoSystems Institute, UCLA, Los Angeles, CA, USA
| | | | - Yi-Kai Lo
- Department of Bioengineering, California NanoSystems Institute, UCLA, Los Angeles, CA, USA
| | - En-Lin Hsiang
- Department of Bioengineering, California NanoSystems Institute, UCLA, Los Angeles, CA, USA
| | - James C.Y. Dunn
- Departments of Surgery and Bioengineering, Stanford University, Stanford, CA, USA
| | - Yvette Taché
- CURE: Digestive Diseases Research Center (DDRCC), Center for Neurobiology of Stress and Resilience (CNSR), Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Wentai Liu
- Department of Bioengineering, California NanoSystems Institute, UCLA, Los Angeles, CA, USA
| | - Mulugeta Million
- CURE: Digestive Diseases Research Center (DDRCC), Center for Neurobiology of Stress and Resilience (CNSR), Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Schiemer JF, Stumm K, Somerlik-Fuchs KH, Hoffmann KP, Baumgart J, Kneist W. Robotic Setup Promises Consistent Effects of Multilocular Gastrointestinal Electrical Stimulation: First Results of a Porcine Study. Eur Surg Res 2020; 61:14-22. [PMID: 32772020 DOI: 10.1159/000506799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Electrical stimulation (ES) of several gastrointestinal (GI) segments is a promising therapeutic option for multilocular GI dysmotility, but conventional surgical access by laparotomy involves a high degree of tissue trauma. We evaluated a minimally invasive surgical approach using a robotic surgical system to perform electromyographic (EMG) recordings and ES of several porcine GI segments, comparing these data to an open surgical approach by laparotomy. MATERIALS AND METHODS In 5 acute porcine experiments, we placed multiple electrodes on the stomach, duodenum, jejunum, ileum, and colon. Three experiments were performed with a median laparotomy and 2 others using a robotic platform. Multichannel EMGs were recorded, and ES was sequentially delivered with 4 ES parameters to the 5 target segments. We calculated pre- and poststimulatory spikes per minute (Spm) and performed a statistical Poisson analysis. RESULTS Electrode placement was achieved in all cases without complications. Increased technical and implantation time were required to achieve the robotic electrode placement, but invasiveness was markedly reduced in comparison to the conventional approach. The highest calculated (c)Spm values were found in the poststimulatory period of the small bowel with both the conventional and robotic approaches. Six of the 20 Poisson test results in the open setup reached statistical significance and 12 were significant in the robotic experiments. CONCLUSIONS The robotic setup was less invasive, revealed more consistent effects of multilocular ES in several GI segments, and is a promising option for future preclinical and clinical studies of GI motility disorders.
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Affiliation(s)
- Jonas F Schiemer
- Department of General, Visceral, and Transplant Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karen Stumm
- Translational Animal Research Center, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karin H Somerlik-Fuchs
- Department of Research and Development, inomed Medizintechnik GmbH, Emmendingen, Germany
| | - Klaus-Peter Hoffmann
- Department of Biomedical Engineering, Fraunhofer Institute for Biomedical Engineering, St. Ingbert, Germany
| | - Jan Baumgart
- Translational Animal Research Center, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Werner Kneist
- Department of General, Visceral, and Transplant Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, .,Department of General and Visceral Surgery, St. Georg Hospital Eisenach gGmbH, Eisenach, Germany,
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Schiemer JF, Heimann A, Somerlik-Fuchs KH, Ruff R, Hoffmann KP, Baumgart J, Berres M, Lang H, Kneist W. Five-fold Gastrointestinal Electrical Stimulation With Electromyography-based Activity Analysis: Towards Multilocular Theranostic Intestinal Implants. J Neurogastroenterol Motil 2019; 25:461-470. [PMID: 31177652 PMCID: PMC6657931 DOI: 10.5056/jnm19045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/30/2019] [Accepted: 05/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background/Aims Motility disorders are common and may affect the entire gastrointestinal (GI) tract but current treatment is limited. Multilocular sensing of GI electrical activity and variable electrical stimulation (ES) is a promising option. The aim of our study is to investigate the effects of adjustable ES on poststimulatory spike activities in 5 GI segments. Methods Six acute porcine experiments were performed with direct ES by 4 ES parameter sets (30 seconds, 25 mA, 500 microseconds or 1000 microseconds, 30 Hz or 130 Hz) applied through subserosal electrodes in the stomach, duodenum, ileum, jejunum, and colon. Multi-channel electromyography of baseline and post-stimulatory GI electrical activity were recorded for 3 minutes with hook needle and hook-wire electrodes. Spike activities were algorithmically calculated, visualized in a heat map, and tested for significance by Poisson analysis. Results Post-stimulatory spike activities were markedly increased in the stomach (7 of 24 test results), duodenum (8 of 24), jejunum (23 of 24), ileum (18 of 24), and colon (5 of 24). ES parameter analysis revealed that 80.0% of the GI parts (all but duodenum) required a pulse width of 1000 microseconds, and 60.0% (all but jejunum and colon) required 130 Hz frequency for maximum spike activity. Five reaction patterns were distinguished, with 30.0% earlier responses (type I), 42.5% later or mixed type responses (type II, III, and X), and 27.5% non-significant responses (type 0). Conclusions Multilocular ES with variable ES parameters is feasible and may significantly modulate GI electrical activity. Automated electromyography analysis revealed complex reaction patterns in the 5 examined GI segments.
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Affiliation(s)
- Jonas F Schiemer
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Axel Heimann
- Institute for Neurosurgical Pathophysiology, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Karin H Somerlik-Fuchs
- Department of Research and Development at inomed Medizintechnik GmbH, Emmendingen, Germany
| | - Roman Ruff
- Department of Biomedical Engineering, Fraunhofer Institute for Biomedical Engineering, St. Ingbert, Germany
| | - Klaus-Peter Hoffmann
- Department of Biomedical Engineering, Fraunhofer Institute for Biomedical Engineering, St. Ingbert, Germany
| | - Jan Baumgart
- Translational Animal Research Center, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Manfred Berres
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz and RheinAhrCampus of the University of Applied Sciences K
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Werner Kneist
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Wang Y, Wang Q, Kuerban K, Dong M, Qi F, Li G, Ling J, Qiu W, Zhang W, Ye L. Colonic electrical stimulation promotes colonic motility through regeneration of myenteric plexus neurons in slow transit constipation beagles. Biosci Rep 2019; 39:BSR20182405. [PMID: 31064818 PMCID: PMC6522827 DOI: 10.1042/bsr20182405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/24/2019] [Accepted: 05/02/2019] [Indexed: 12/29/2022] Open
Abstract
Slow transit constipation (STC) is a common disease characterized by markedly delayed colonic transit time as a result of colonic motility dysfunction. It is well established that STC is mostly caused by disorders of relevant nerves, especially the enteric nervous system (ENS). Colonic electrical stimulation (CES) has been regarded as a valuable alternative for the treatment of STC. However, little report focuses on the underlying nervous mechanism to normalize the delayed colonic emptying and relieve symptoms. In the present study, the therapeutic effect and the influence on ENS triggered by CES were investigated in STC beagles. The STC beagle model was established by oral administration of diphenoxylate/atropine and alosetron. Histopathology, electron microscopy, immunohistochemistry, Western blot analysis and immunofluorescence were used to evaluate the influence of pulse train CES on myenteric plexus neurons. After 5 weeks of treatment, CES could enhance the colonic electromyogram (EMG) signal to promote colonic motility, thereby improving the colonic content emptying of STC beagles. HE staining and transmission electron microscopy confirmed that CES could regenerate ganglia and synaptic vesicles in the myenteric plexus. Immunohistochemical staining showed that synaptophysin (SYP), protein gene product 9.5 (PGP9.5), cathepsin D (CAD) and S-100B in the colonic intramuscular layer were up-regulated by CES. Western blot analysis and immunofluorescence further proved that CES induced the protein expression of SYP and PGP9.5. Taken together, pulse train CES could induce the regeneration of myenteric plexus neurons, thereby promoting the colonic motility in STC beagles.
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Affiliation(s)
- Yongbin Wang
- Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, China
| | - Qian Wang
- Department of Microbiological and Biochemical Pharmacy, School of Pharmacy, Fudan University, Shanghai 201203, China
- Department of Pathology, Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Kudelaidi Kuerban
- Department of Microbiological and Biochemical Pharmacy, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Mengxue Dong
- Department of Microbiological and Biochemical Pharmacy, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Feilong Qi
- Department of Microbiological and Biochemical Pharmacy, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Gang Li
- Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, China
| | - Jie Ling
- Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, China
| | - Wei Qiu
- Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, China
| | - Wenzhong Zhang
- Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, China
| | - Li Ye
- Department of Microbiological and Biochemical Pharmacy, School of Pharmacy, Fudan University, Shanghai 201203, China
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6
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de Camp NV, Heimann A, Kempski O, Bergeler J. Accelerometer-Based Assessment of Intestinal Peristalsis: Toward Miniaturized Low-Power Solutions for Intestinal Implants. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:2700507. [PMID: 30245946 PMCID: PMC6147734 DOI: 10.1109/jtehm.2018.2864975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 05/13/2018] [Accepted: 08/02/2018] [Indexed: 12/28/2022]
Abstract
Intestinal electrical stimulation via implants is already used to treat several disorders like constipation or incontinence. Stimulation parameters are most often empiric and not based on systematic studies. One prerequisite to evaluate effects of intestinal electrical stimulation is a direct assessment of intestinal motility. Some common methods are strain gauge transducers or manometry. With both the methods, it is not possible to record the exact 3-D movement. Therefore, we established a new method to record gastrointestinal motility with ultraminiaturized accelerometers, directly glued to the outer surface of the stomach, small intestine, and colon. With this technique, we were able to record precise local motility changes after electrical stimulation. Due to the low energy demand and the small size of the system, it is potentially useful for chronic measurements at multiple sites of the intestinal tract. We will present our first results regarding stimulation-dependent motility changes using up to eight implanted accelerometers in an acute pig model.
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Affiliation(s)
- Nora Vanessa de Camp
- Medical CenterJohannes Gutenberg University Mainz55122MainzGermany.,Department of Behavioral PhysiologyHumboldt University of Berlin10099BerlinGermany.,Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Free University of Berlin14195BerlinGermany
| | - Axel Heimann
- Medical CenterJohannes Gutenberg University Mainz55122MainzGermany
| | - Oliver Kempski
- Medical CenterJohannes Gutenberg University Mainz55122MainzGermany
| | - Juergen Bergeler
- Medical CenterJohannes Gutenberg University Mainz55122MainzGermany.,Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Free University of Berlin14195BerlinGermany
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Tan AY, Sourial M, Hutson JM, Southwell BR. Short-Term Interferential Transabdominal Electrical Stimulation Did Not Change Oral-Rectal Transit Time in Piglets. Neuromodulation 2018; 21:669-675. [DOI: 10.1111/ner.12761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/10/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Andre Y.F. Tan
- Surgical Research Group, Murdoch Children's Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Melbourne VIC Australia
| | - Magdy Sourial
- Surgical Research Group, Murdoch Children's Research Institute; Parkville VIC Australia
- Large Animal House Facility, Royal Children's Hospital; Melbourne VIC Australia
| | - John M. Hutson
- Surgical Research Group, Murdoch Children's Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Melbourne VIC Australia
- Department of Urology; Royal Children's Hospital; Melbourne VIC Australia
| | - Bridget R. Southwell
- Surgical Research Group, Murdoch Children's Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Melbourne VIC Australia
- Department of Urology; Royal Children's Hospital; Melbourne VIC Australia
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8
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Zhang L, Zhao W, Zhao C, Jin H, Wang B, Wang B. Study on effects of electrical stimulation on rabbit esophageal body motility in vivo. Physiol Res 2018; 67:275-282. [PMID: 29303604 DOI: 10.33549/physiolres.933652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Electric stimulation (ES) could induce contraction of intestinal smooth muscle. The aim of this study was to analyze the effects of ES on esophageal motility and the underlying mechanism in vivo. Twenty-eight rabbits were equipped with a pair of subserosa electrodes (connected to an electrical stimulator) in the lower segment of the esophagus. The ES signal consisted of bipolar rectangular pulse trains, lasting for 3 s, with different amplitudes (1 mA, 3 mA, 5 mA and 10 mA), and frequencies (10 Hz, 20 Hz and 50 Hz). The amplitude of the contraction was recognized by high-resolution manometry. The effect of ES was tested under anesthesia and following administration of atropine, phentolamine or L-NAME. ES induced esophageal contraction at the stimulated site. A statistically significant increase in esophageal pressure was observed when the stimulation amplitude was above 3 mA. The increase in esophageal pressure was associated with the amplitude of stimulus as well as the frequency. During stimulation, atropine, phentolamine and L-NAME had no effect on the increase of esophageal pressure induced by ES. These findings implied that ES induced esophageal contraction were not mediated via the NANC, adrenergic or cholinergic pathway. The amplitude of esophageal contraction was current and frequency dependent.
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Affiliation(s)
- Lili Zhang
- Department of Digestive Diseases, General Hospital, Tianjin Medical University, Tianjin, China.
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9
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Yao S, Li Y, Chen S. Colonic Electrical Stimulation for Constipation. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00120-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Ghiselli R, Lucarini G, Orlando F, Ortenzi M, Cardinali L, Provinciali M, Di Primio R, Guerrieri M. Increase of n-NOS and i-NOS in Rat Colon After Sacral Neuromodulation. Neuromodulation 2017; 20:761-766. [PMID: 28837238 DOI: 10.1111/ner.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/30/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sacral neuromodulation (SNM) is proposed to treat different anorectal dysfunctions but its mechanism of action is not yet known. Our previous study demonstrated how SNM can significantly increase neuronal nitric oxide synthase NOS (n-NOS) and inducible NOS (i-NOS) expression in the anus and rectum of rats. There are no reports regarding the relation between SNM and NOS in colonic cells: our aim was to assess NOS expression in colonic rat model after SNM. MATERIALS AND METHODS Twenty-six female Sprangue-Dawley rats were considered: group I, normal control rats; group II, sham treatment rats, in whom electrodes for electrical stimulation were placed in S1 foramen bilaterally and left in place, without performing neuromodulation; group III, rats in whom SNM was performed. After 14 days, the rats were sacrificed and we evaluated n-NOS and i-NOS in colonic specimens by immunohistochemistry and Western Blot analysis. RESULTS Western Blot analysis showed that levels of n-NOS and i-NOS were higher in colon of the III group rats respect to the others; in particular, immunohistochemistry revealed that, after neuromodulation, n-NOS expression in the muscle cells and i-NOS expression in glandular epithelium and nervous cells were highly represented (p < 0.05). CONCLUSION Our study showed that in colon, SNM is able to influence NO synthesis, activating n-NOS expression in muscle cells and i-NOS expression in glandular epithelium and nervous cells. Our study showed a complex colonic response to SNM. This experimental model could be applied to better understand the mechanism of action of SNM in bowel dysfunction.
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Affiliation(s)
- Roberto Ghiselli
- Clinical Surgery, Università Politecnica delle Marche - Ospedali Riuniti, Ancona, Italy
| | - Guendalina Lucarini
- Department of Clinic and Molecular Sciences, Histology, Università Politecnica delle Marche, Ancona, Italy
| | - Fiorenza Orlando
- Experimental Animal Models for Aging Units, Research Department, I.N.R.C.A. I.R.R.C.S., Ancona, Italy
| | - Monica Ortenzi
- Clinical Surgery, Università Politecnica delle Marche - Ospedali Riuniti, Ancona, Italy
| | - Luca Cardinali
- Clinical Surgery, Università Politecnica delle Marche - Ospedali Riuniti, Ancona, Italy
| | - Mauro Provinciali
- Experimental Animal Models for Aging Units, Research Department, I.N.R.C.A. I.R.R.C.S., Ancona, Italy
| | - Roberto Di Primio
- Department of Clinic and Molecular Sciences, Histology, Università Politecnica delle Marche, Ancona, Italy
| | - Mario Guerrieri
- Clinical Surgery, Università Politecnica delle Marche - Ospedali Riuniti, Ancona, Italy
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11
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Chen S, Liu L, Guo X, Yao S, Li Y, Chen S, Zhang Y, Chen W, Du Y. Effects of colonic electrical stimulation using different individual parameter patterns and stimulation sites on gastrointestinal transit time, defecation, and food intake. Int J Colorectal Dis 2016; 31:429-37. [PMID: 26607906 DOI: 10.1007/s00384-015-2457-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE This study aimed to compare the effects of colonic electrical stimulation (CES) on gastrointestinal transit time (GITT), energy consumption, stool frequency, stool consistency, and food intake using different individual parameter patterns and stimulation sites. METHODS Eight beagle dogs underwent surgery and CES. First, CES was conducted to determine the individual parameters with different pulse configurations, based on symptoms. Second, influences on energy consumption and GITT were compared between CES sessions with different pulse configurations. Third, GITT, stool frequency, stool consistency, and food intake were compared to assess the effects of CES at different stimulation sites. RESULTS The individual parameters varied greatly among the dogs. In proximal colon electrical stimulation (PCES) and rectosigmoid colon electrical stimulation (RCES), energy consumption was lower with the constant pulse width mode than with the constant pulse amplitude mode (p = 0.012 and p = 0.018, respectively). There was no statistical difference between the two pulse configurations in GITT assessment. The PCES, RCES, and sequential CES sessions significantly accelerated GITT compared to sham stimulation. There was no statistical difference in GITT between PCES, RCES, and sequential CES sessions. Compared to sham CES session, RCES and sequential CES sessions exhibited significant higher stool frequency (p < 0.001 and p = 0.001, respectively), and PCES and RCES sessions inhibited food intake (p = 0.003 and p = 0.002, respectively). CONCLUSIONS Constant pulse width mode is an appropriate pulse configuration for individual CES. At different stimulation sites, CES may exert different effects on stool frequency and food intake. This study provides an experimental basis for the clinical application of CES.
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Affiliation(s)
- Shuo Chen
- Department of Gastroenterology, China-Japan Friendship Hospital, 2nd Yinghua East Road, Chaoyang District, Beijing, 100029, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, 9th Dong Dan San Tiao, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Liang Liu
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong University, 105th Jiefang Road, Lixia District, Jinan, 250013, People's Republic of China
| | - Xiaojuan Guo
- Department of Gastroenterology, Beijing Tsinghua Chang Gung Hospital, 168th Litang Road, Changping District, Beijing, 102218, People's Republic of China
| | - Shukun Yao
- Department of Gastroenterology, China-Japan Friendship Hospital, 2nd Yinghua East Road, Chaoyang District, Beijing, 100029, People's Republic of China. .,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, 9th Dong Dan San Tiao, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Yanmei Li
- Department of Gastroenterology, China-Japan Friendship Hospital, 2nd Yinghua East Road, Chaoyang District, Beijing, 100029, People's Republic of China.
| | - Shaoxuan Chen
- Department of Gastroenterology, China-Japan Friendship Hospital, 2nd Yinghua East Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Yanli Zhang
- Department of Gastroenterology, China-Japan Friendship Hospital, 2nd Yinghua East Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Wang Chen
- Institute of Clinical Medicine, China-Japan Friendship Hospital, 2nd Yinghua East Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Yuhui Du
- Rishena Technology Development Co. Ltd., 26th Huashan Middle Road, Xinbei District, Changzhou, 213000, People's Republic of China
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Chen S, Li Y, Yao S, Zhang Y, Liu L, Guo X, Chen W, Chen Y, Du Y. Implantable Colonic Electrical Stimulation Improves Gastrointestinal Transit and Defecation in a Canine Constipation Model. Neuromodulation 2015; 19:108-15. [PMID: 26573699 DOI: 10.1111/ner.12369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 09/08/2015] [Accepted: 10/01/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Shuo Chen
- Department of Gastroenterology; China-Japan Friendship Hospital; Beijing China
- Graduate School; Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing China
| | - Yanmei Li
- Department of Gastroenterology; China-Japan Friendship Hospital; Beijing China
| | - Shukun Yao
- Department of Gastroenterology; China-Japan Friendship Hospital; Beijing China
- Graduate School; Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing China
| | - Yanli Zhang
- Department of Gastroenterology; China-Japan Friendship Hospital; Beijing China
| | - Liang Liu
- Department of Gastroenterology; Jinan Central Hospital Affiliated to Shandong University; Jinan China
| | - Xiaojuan Guo
- Department of Gastroenterology; Beijing Tsinghua Chang Gung Hospital; Beijing China
| | - Wang Chen
- Institute of Clinical Medicine; China-Japan Friendship Hospital; Beijing China
| | - Yan Chen
- Department of Radiology; China-Japan Friendship Hospital; Beijing China
| | - Yuhui Du
- Rishena Technology Development Co. Ltd.; Changzhou China
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Sobocki J, Nowakowski M, Herman RM, Wałęga P, Frączek M, Tuz R, Schwartz T, Murawski M. Laparoscopically Implanted System for Stimulation of the Hypogastric Plexus Induces Colonic Motility, Defecation, and Micturition. Surg Innov 2014; 22:70-6. [DOI: 10.1177/1553350614530190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Modulation of the enteric nervous system seems to be promising in several functional colorectal disorders for which targeted, causal treatment methods do not exist. However, sacral nerve stimulation can induce undesirable muscle contraction or paresthesia. Therefore, we have developed a laparoscopic technique for implanting a neural electrode, placed directly over the pelvic autonomic nerve plexus. The aim of this experimental study was to evaluate the effect of stimulating the hypogastric plexus and pelvic nerves on inducing distal colon contraction, defecation, and micturition. Method. A total of 10 white, male healthy pigs (25-30 kg) were subjected to the laparoscopic implantation of the electrode and the stimulator. In the third and fourth weeks postimplantation, the efficacy of the acute and chronic stimulation to induce defecation was evaluated. Results. The average operative time was 105 minutes (85-150 minutes). In all pigs, acute stimulation activated induced defecation, every second day, every time on demand, with an average delay of 139.7 s. Micturition was induced incidentally. Acute or chronic stimulation did not cause any harm, pain, or suffering to the animals. No adverse effects of the stimulation were observed, and no septic complications or macroscopic fibrosis around the electrodes were found on autopsy. Conclusion. Hypogastric plexus stimulation can be a useful and safe option of distal colon contraction, defecation, and micturition. However, the efficacy of the stimulation was observed for a relatively short period of time, and it is not known if it will be sustained for a longer duration.
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14
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Guo XJ, Yao SK. Advances in research of colonic electrical stimulation. Shijie Huaren Xiaohua Zazhi 2014; 22:795-800. [DOI: 10.11569/wcjd.v22.i6.795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In recent years great attention has been paid to the study of colonic electrical stimulation. Colonic electrical stimulation is expected to become a valuable option for treatment of gastrointestinal dysfunction. This article reviews the classification, mechanisms and clinical applications of colonic electrical stimulation.
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Martellucci J, Valeri A. Colonic electrical stimulation for the treatment of slow-transit constipation: a preliminary pilot study. Surg Endosc 2013; 28:691-7. [PMID: 24048815 DOI: 10.1007/s00464-013-3192-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 08/12/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Electrical stimulation of the gastrointestinal tract is an attractive concept. In this article we report on a procedure for electrical colonic pacing due to intramuscular electrode placement for slow-transit constipation and some preliminary results. METHODS From January 2011 to December 2012, all consecutive patients affected by constipation and evaluated in our Pelvic Floor Center were prospectively assessed. Patients who underwent colonic electrical stimulation were evaluated for the present study. RESULTS In the study period, 256 patients were evaluated for constipation; 58% were identified as having obstructed defecation syndrome, 27.3% with irritable bowel syndrome or mixed forms, 4% with pelvic floor dyssynergia, and 10.5% (27 patients) as having slow-transit constipation. After failure of all the maximal conventional therapies, two patients, candidates for colectomy, agreed to undergo colonic electrical stimulation before a resective treatment. Both patients were females, aged 34 and 29 years, and were suffering from severe constipation since childhood. The follow-up was 19 and 6 months. The number of bowel movements per week increased from 0.3 to 3.5 in the first patient and from 0.5 to 2.5 in the second patient. Both patients no longer needed laxatives, enemas, or any other treatment. The hospital stay was 4 days, the mean operative time was 120 min, and no complications were reported. CONCLUSIONS Colonic pacing seems to be feasible and shows positive results. Further studies are required with a larger number of patients and a longer follow-up period to confirm the role of this promising treatment for slow-transit constipation.
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Affiliation(s)
- Jacopo Martellucci
- General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy,
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Abstract
Obesity is one of the most prevalent health problems in the United States. Current therapeutic strategies for the treatment of obesity are unsatisfactory. We hypothesized the use of colon electrical stimulation (CES) to treat obesity by inhibiting upper gastrointestinal motility. In this preliminary study, we aimed at studying the effects of CES on gastric emptying of solid, intestinal motility, and food intake in dogs. Six dogs, equipped with serosal colon electrodes and a jejunal cannula, were randomly assigned to receive sham-CES or CES during the assessment of: (i) gastric emptying of solids, (ii) postprandial intestinal motility, (iii) autonomic functions, and (iv) food intake. We found that (i) CES delayed gastric emptying of solids by 77%. Guanethidine partially blocked the inhibitory effect of CES on solid gastric emptying; (ii) CES significantly reduced intestinal contractility and the effect lasted throughout the recovery period; (iii) CES decreased vagal activity in both fasting and fed states, increased the sympathovagal balance and marginally increased sympathetic activity in the fasting state; (iv) CES resulted in a reduction of 61% in food intake. CES reduces food intake in healthy dogs and the anorexigenic effect may be attributed to its inhibitory effects on gastric emptying and intestinal motility, mediated via the autonomic mechanisms. Further studies are warranted to investigate the therapeutic potential of CES for obesity.
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Affiliation(s)
- Hanaa S Sallam
- Department of Internal Medicine, Division of Gastroenterology, University of Texas Medical Branch, Galveston, Texas, USA
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Bertschi M, Schlageter V, Vesin JM, Aellen S, Peloponissios N, D'Ambrogio A, Wiesel PH, Givel JC, Kucera P, Virag N. Direct electrical stimulation using a battery-operated device for induction and modulation of colonic contractions in pigs. Ann Biomed Eng 2010; 38:2398-405. [PMID: 20300849 DOI: 10.1007/s10439-010-9985-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 02/23/2010] [Indexed: 11/27/2022]
Abstract
Direct electrical stimulation of the colon offers a promising approach for the induction of propulsive colonic contractions by using an implantable device. The objective of this study was to assess the feasibility to induce colonic contractions using a commercially available battery-operated stimulator (maximum pulse width of 1 ms and maximum amplitude of 10 V). Three pairs of pacing electrodes were inserted into the cecal seromuscular layer of anesthetized pigs. During a first set of in vivo experiments conducted on six animals, a pacing protocol leading to cecum contractions was determined: stimulation bursts with 1 ms pulse width, 10 V amplitude (7-15 mA), 120 Hz frequency, and 30-s burst duration, repeated every 2-5 min. In a second testing phase, an evaluation of the pacing protocol was performed in four animals (120 stimulation bursts in total). By using the battery-operated stimulator, contractions of the cecum and movement of contents could be induced in 92% of all stimulations. A cecal shortening of about 30% and an average intraluminal pressure increase of 10.0 +/- 6.0 mmHg were observed.
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Affiliation(s)
- Mattia Bertschi
- Signal Processing Institute, Swiss Federal Institute of Technology, Lausanne, Switzerland
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Vaucher J, Cerantola Y, Gie O, Letovanec I, Virag N, Demartines N, Gardaz JP, Givel JCR. Electrical colonic stimulation reduces mean transit time in a porcine model. Neurogastroenterol Motil 2010; 22:88-92, e31. [PMID: 19594689 DOI: 10.1111/j.1365-2982.2009.01359.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Electrical stimulation is a new way to treat digestive disorders such as constipation. Colonic propulsive activity can be triggered by battery operated devices. This study aimed to demonstrate the effect of direct electrical colonic stimulation on mean transit time in a chronic porcine model. The impact of stimulation and implanted material on the colonic wall was also assessed. Three pairs of electrodes were implanted into the caecal wall of 12 anaesthetized pigs. Reference colonic transit time was determined by radiopaque markers for each pig before implantation. It was repeated 4 weeks after implantation with sham stimulation and 5 weeks after implantation with electrical stimulation. Aboral sequential trains of 1-ms pulse width (10 V; 120 Hz) were applied twice daily for 6 days, using an external battery operated stimulator. For each course of markers, a mean value was computed from transit times obtained from individual pig. Microscopic examination of the caecum was routinely performed after animal sacrifice. A reduction of mean transit time was observed after electrical stimulation (19 +/- 13 h; mean +/- SD) when compared to reference (34 +/- 7 h; P = 0.045) and mean transit time after sham stimulation (36 +/- 9 h; P = 0.035). Histological examination revealed minimal chronic inflammation around the electrodes. Colonic transit time measured in a chronic porcine model is reduced by direct sequential electrical stimulation. Minimal tissue lesion is elicited by stimulation or implanted material. Electrical colonic stimulation could be a promising approach to treat specific disorders of the large bowel.
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Affiliation(s)
- J Vaucher
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.
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