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Dariel A, Grynberg L, Auger M, Lefèvre C, Durand T, Aubert P, Le Berre-Scoul C, Venara A, Suply E, Leclair MD, de Vries P, Levard G, Parmentier B, Podevin G, Schmitt F, Couvrat V, Irtan S, Hervieux E, Villemagne T, Lardy H, Capito C, Muller C, Sarnacki S, Mosnier JF, Galmiche L, Derkinderen P, Boudin H, Brochard C, Neunlist M. Analysis of enteric nervous system and intestinal epithelial barrier to predict complications in Hirschsprung's disease. Sci Rep 2020; 10:21725. [PMID: 33303794 PMCID: PMC7729910 DOI: 10.1038/s41598-020-78340-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
In Hirschsprung’s disease (HSCR), postoperative course remains unpredictable. Our aim was to define predictive factors of the main postoperative complications: obstructive symptoms (OS) and Hirschsprung-associated enterocolitis (HAEC). In this prospective multicentre cohort study, samples of resected bowel were collected at time of surgery in 18 neonates with short-segment HSCR in tertiary care hospitals. OS and HAEC were noted during postoperative follow-up. We assessed the enteric nervous system and the intestinal epithelial barrier (IEB) in ganglionic segments by combining immunohistochemical, proteomic and transcriptomic approaches, with functional ex vivo analysis of motility and para/transcellular permeability. Ten HSCR patients presented postoperative complications (median follow-up 23.5 months): 6 OS, 4 HAEC (2 with OS), 2 diarrhoea (without OS/HAEC). Immunohistochemical analysis showed a significant 41% and 60% decrease in median number of nNOS-IR myenteric neurons per ganglion in HSCR with OS as compared to HSCR with HAEC/diarrhoea (without OS) and HSCR without complications (p = 0.0095; p = 0.002, respectively). Paracellular and transcellular permeability was significantly increased in HSCR with HAEC as compared to HSCR with OS/diarrhoea without HAEC (p = 0.016; p = 0.009) and HSCR without complications (p = 0.029; p = 0.017). This pilot study supports the hypothesis that modulating neuronal phenotype and enhancing IEB permeability may treat or prevent postoperative complications in HSCR.
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Affiliation(s)
- Anne Dariel
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France. .,Paediatric Surgery Department, La Timone-Enfants Hospital, Assistance Publique des Hôpitaux de Marseille, 264 rue Saint Pierre, 13385, Marseille, France. .,Paediatric Surgery Department, University Hospital of Nantes, Nantes, France.
| | - Lucie Grynberg
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Marie Auger
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Chloé Lefèvre
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Tony Durand
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Philippe Aubert
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Catherine Le Berre-Scoul
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Aurélien Venara
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Etienne Suply
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Marc-David Leclair
- Paediatric Surgery Department, University Hospital of Nantes, Nantes, France
| | - Philine de Vries
- Paediatric Surgery Department, University Hospital of Brest, Brest, France
| | - Guillaume Levard
- Paediatric Surgery Department, University Hospital of Poitiers, Poitiers, France
| | - Benoit Parmentier
- Paediatric Surgery Department, University Hospital of Poitiers, Poitiers, France
| | - Guillaume Podevin
- Paediatric Surgery Department, University Hospital of Angers, Angers, France
| | - Françoise Schmitt
- Paediatric Surgery Department, University Hospital of Angers, Angers, France
| | | | - Sabine Irtan
- Paediatric Surgery Department, Armand Trousseau Hospital, Paris, France
| | - Erik Hervieux
- Paediatric Surgery Department, Armand Trousseau Hospital, Paris, France
| | - Thierry Villemagne
- Paediatric Surgery Department, University Hospital of Tours, Tours, France
| | - Hubert Lardy
- Paediatric Surgery Department, University Hospital of Tours, Tours, France
| | - Carmen Capito
- Paediatric Surgery Department, Necker Enfants Malades Hospital, Paris, France
| | - Cécile Muller
- Paediatric Surgery Department, Necker Enfants Malades Hospital, Paris, France
| | - Sabine Sarnacki
- Paediatric Surgery Department, Necker Enfants Malades Hospital, Paris, France
| | | | - Louise Galmiche
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France.,Pathology Department, Necker Enfants Malades Hospital, Paris, France
| | - Pascal Derkinderen
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Hélène Boudin
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Charlène Brochard
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Michel Neunlist
- University of Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
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Beardslee LA, Banis GE, Chu S, Liu S, Chapin AA, Stine JM, Pasricha PJ, Ghodssi R. Ingestible Sensors and Sensing Systems for Minimally Invasive Diagnosis and Monitoring: The Next Frontier in Minimally Invasive Screening. ACS Sens 2020; 5:891-910. [PMID: 32157868 DOI: 10.1021/acssensors.9b02263] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ingestible electronic systems that are capable of embedded sensing, particularly within the gastrointestinal (GI) tract and its accessory organs, have the potential to screen for diseases that are difficult if not impossible to detect at an early stage using other means. Furthermore, these devices have the potential to (1) reduce labor and facility costs for a variety of procedures, (2) promote research for discovering new biomarker targets for associated pathologies, (3) promote the development of autonomous or semiautonomous diagnostic aids for consumers, and (4) provide a foundation for epithelially targeted therapeutic interventions. These technological advances have the potential to make disease surveillance and treatment far more effective for a variety of conditions, allowing patients to lead longer and more productive lives. This review will examine the conventional techniques, as well as ingestible sensors and sensing systems that are currently under development for use in disease screening and diagnosis for GI disorders. Design considerations, fabrication, and applications will be discussed.
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Affiliation(s)
- Luke A. Beardslee
- Institute for Systems Research, University of Maryland, College Park, Maryland 20742, United States
| | - George E. Banis
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland 20742, United States
| | - Sangwook Chu
- Institute for Systems Research, University of Maryland, College Park, Maryland 20742, United States
| | - Sanwei Liu
- Institute for Systems Research, University of Maryland, College Park, Maryland 20742, United States
| | - Ashley A. Chapin
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland 20742, United States
| | - Justin M. Stine
- Department of Electrical and Computer Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Pankaj Jay Pasricha
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, United States
| | - Reza Ghodssi
- Institute for Systems Research, University of Maryland, College Park, Maryland 20742, United States
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland 20742, United States
- Department of Electrical and Computer Engineering, University of Maryland, College Park, Maryland 20742, United States
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5
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Li P, Kreikemeier-Bower C, Xie W, Kothari V, Terry BS. Design of a Wireless Medical Capsule for Measuring the Contact Pressure Between a Capsule and the Small Intestine. J Biomech Eng 2017; 139:2612940. [DOI: 10.1115/1.4036260] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Indexed: 12/21/2022]
Abstract
A wireless medical capsule for measuring the contact pressure between a mobile capsule and the small intestine lumen was developed. Two pressure sensors were used to measure and differentiate the contact pressure and the small intestine intraluminal pressure. After in vitro tests of the capsule, it was surgically placed and tested in the proximal small intestine of a pig model. The capsule successfully gathered and transmitted the pressure data to a receiver outside the body. The measured pressure signals in the animal test were analyzed in the time and frequency domains, and a mathematic model was presented to describe the different factors influencing the contact pressure. A novel signal processing method was applied to isolate the contraction information from the contact pressure. The result shows that the measured contact pressure was 1.08 ± 0.08 kPa, and the small intestine contraction pressure's amplitude and rate were 0.29 ± 0.046 kPa and 12 min−1. Moreover, the amplitudes and rates of pressure from respiration and heartbeat were also estimated. The successful preliminary evaluation of this capsule implies that it could be used in further systematic investigation of small intestine contact pressure on a mobile capsule-shaped bolus.
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Affiliation(s)
- Pengbo Li
- Mechanical and Material Engineering, University of Nebraska-Lincoln, W342 Nebraska Hall, Lincoln, NE 68588-0526 e-mail:
| | | | - Wanchuan Xie
- Mechanical and Material Engineering, University of Nebraska-Lincoln, W342 Nebraska Hall, Lincoln, NE 68588-0526
| | - Vishal Kothari
- Department of Surgery, University of Nebraska Medical Center, Nebraska Medicine—Bariatrics Center 4400 Emile Street, Omaha, NE 68198
| | - Benjamin S. Terry
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, 360 Walter Scott Engineering Center, Lincoln, NE 68508
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Terry BS, Lyle AB, Schoen JA, Rentschler ME. Preliminary mechanical characterization of the small bowel for in vivo robotic mobility. J Biomech Eng 2012; 133:091010. [PMID: 22010745 DOI: 10.1115/1.4005168] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In this work we present test methods, devices, and preliminary results for the mechanical characterization of the small bowel for intra luminal robotic mobility. Both active and passive forces that affect mobility are investigated. Four investigative devices and testing methods to characterize the active and passive forces are presented in this work: (1) a novel manometer and a force sensor array that measure force per cm of axial length generated by the migrating motor complex, (2) a biaxial test apparatus and method for characterizing the biomechanical properties of the duodenum, jejunum, and ileum, (3) a novel in vitro device and protocol designed to measure the energy required to overcome the self-adhesivity of the mucosa, and (4) a novel tribometer that measures the in vivo coefficient of friction between the mucus membrane and the robot surface. The four devices are tested on a single porcine model to validate the approach and protocols. Mean force readings per cm of axial length of intestine that occurred over a 15 min interval in vivo were 1.34 ± 0.14 and 1.18 ± 0.22 N cm(-1) in the middle and distal regions, respectively. Based on the biaxial stress/stretch tests, the tissue behaves anisotropically with the circumferential direction being more compliant than the axial direction. The mean work per unit area for mucoseparation of the small bowel is 0.08 ± 0.03 mJ cm(-2). The total energy to overcome mucoadhesion over the entire length of the porcine small bowel is approximately 0.55 J. The mean in vivo coefficient of friction (COF) of a curved 6.97 cm(2) polycarbonate sled on live mucosa traveling at 1 mm s(-1) is 0.016 ± 0.002. This is slightly lower than the COF on excised tissue, given the same input parameters. We have initiated a comprehensive program and suite of test devices and protocols for mechanically characterizing the small bowel for in vivo mobility. Results show that each of the four protocols and associated test devices has successfully gathered preliminary data to confirm the validity of our test approach.
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Affiliation(s)
- Benjamin S Terry
- Department of Mechanical Engineering, University of Colorado at Boulder, Boulder, CO 80309-0427, USA.
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Zhao J, Liao D, Gregersen H. Phasic and tonic stress-strain data obtained in intact intestinal segment in vitro. Dig Dis Sci 2008; 53:3145-51. [PMID: 18461453 DOI: 10.1007/s10620-008-0277-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 04/02/2008] [Indexed: 12/26/2022]
Abstract
The function of the small intestine is to a large degree mechanical, and it has the capability of deforming its shape by generating phasic (short-lasting) and tonic (sustained) contraction of the smooth muscle layers. The aim of this study was to obtain phasic and tonic stress-strain (normalized force-length) curves during distension of isolated rat jejunum and ileum (somewhat similar to the isometric length-tension diagram known from in vitro studies of muscle strips). We hypothesized that the circumferential stress-strain data depend on longitudinal stretch of the intestine. Intestinal segments were isolated from ten Wistar rats and put into an organ bath containing 37 degrees C aerated Krebs solution. Ramp distension was done on active and passive intestinal segments at longitudinal stretch ratios of 0, 10, and 20%. Ramp pressures from 0 to 7.5 cmH(2)O were applied to the intestinal lumen at each longitudinal stretch ratio. Passive conditions were obtained by adding the calcium antagonist papaverine to the solution. Total and passive circumferential stress and strain were computed from the length, diameter and pressure data and from the zero-stress state geometry. The active stress was defined as the total stress minus the passive stress. The total and passive circumferential stresses increased exponentially as a function of the strain. The amplitude of both the total and passive stress was biggest in the jejunum. The total circumferential stress decreased whereas the passive circumferential stress increased when the intestine was stretched longitudinally. Consequently, longitudinal stretching caused the active circumferential stress to decrease. The passive circumferential stress during longitudinal stretching increased more in the jejunum than in the ileum. Therefore, the active circumferential stress decreased most in the jejunum. In conclusion, the circumferential active-passive stress and strain depend on the longitudinal stretch and differs between the jejunum and ileum.
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Affiliation(s)
- Jingbo Zhao
- Center of Excellence in Visceral Biomechanics and Pain, Aalborg Hospital Science and Innovation Center (AHSIC), Sdr. Skovvej 15, 9000, Aalborg, Denmark.
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