Engaging multisector stakeholders to identify priorities for global health innovation, change and research: an engagement methodology and application to prosthetics service delivery in Cambodia

PURPOSE

While innovation is known to catalyse solutions to global sustainable development challenges, lack of engagement from stakeholders during conceptualisation and development may influence the degree of success of implementation.

METHODS AND MATERIALS

This paper presents a complete and novel engagement methodology, developed from value led business modelling approaches, for working with multi-sector stakeholders. The methodology can be used to determine barriers and facilitators to clinical practice innovations or translational research, within a country-specific context. The approach has then been applied in the Cambodian prosthetics and orthotics sector to provide a practice-based exemplar application of the framework.

RESULTS

This approach seeks to ensure the suitability and sustainability of clinical practice and research programmes being implemented within a complex ecosystem. A theoretical basis, drawn from academic and business innovation sectors, has been consolidated and adapted for practical application to design, direct, and inform initiatives in low resource settings.

CONCLUSIONS

The methods presented provide a way to both develop and articulate the mission, vision, and goals of any proposed change, and to effectively communicate these with stakeholders in a way that engages the personal and professional values that exist in their ecosystem. It provides a structured process through which meaningful conversations can happen, and a basis for relationship management with key stakeholders; intrinsic to enable a sustained legacy from research and development.

Enterohormonal disturbances in colorectal cancer patients

Gastrointestinal (GI) hormonal peptides play a role in the development of gastrointestinal malignancies, and their abnormal levels may contribute to dysmotility. The aim of this study was to analyze plasma concentrations of enterohormones (motilin, ghrelin, gastrin and pancreatic polypeptide) and to verify if their abnormal levels may contribute to the severity of dyspeptic symptoms in colorectal cancer patients. The study included 60 patients with colorectal malignancies (22 men and 38 women), among them 30 individuals with colon cancers (group A) and 30 subjects with rectal tumors (group B). Fasting plasma levels of pancreatic polypeptide (PP), motilin, gastrin and ghrelin were determined by means of ELISA. The results were compared with the respective parameters of healthy volunteers. Colon cancer patients presented with significantly lower concentrations of ghrelin than the subjects with rectal tumors and healthy controls (156.8±86.7 vs. 260.2±87.6 vs. 258.4±94.2 pg/ml, p=0.02), as well as with significantly higher levels of PP (265.5±66.3 vs. 154.1±54.6 vs. 148.3±64.3 pg/ml, p=0.005). Also the levels of motilin turned out to be lower in colon cancer patients than in the subjects with rectal malignancies and healthy controls. No statistically significant intergroups differences were found in plasma levels of gastrin (388.2±98.6 vs. 475.6±88.7 vs. 428.2±91.2 pg/ml, p>0.05). Epigastric bloating was the most frequent dyspeptic symptom, reported by 63.3% and 40% of patients with colon and rectal tumors, respectively. Our findings imply that colon cancer patients may present with abnormal plasma levels of enterohormones significantly more often than individuals with rectal malignancies. Dysmotility observed in colon cancer patients may result not only from anticancer surgery, but also from abnormal release of enterohormones, induced either by neoplastic process or by changes within the autonomic nervous system.

Changes in U937 cell viability induced by stress factors - possible role of calmodulin

Current studies were aimed to elucidate influence of magnetic field (MF) stimulation on cell viability and its effect on expression of calmodulin (CaM) and Hsp70 protein which plays a role of cell stress indicator and is a Ca²⁺-dependent CaM-binding protein. For the experimental model we have chosen U937 cell line exposed to chemical- and/or physical stress factors. Puromycin (PMC) was used as a chemical apoptosis inducer. Alternating (AC) (6.5_rms mT, 35 Hz) magnetic field combined with 6 mT static (DC) component, or pulsed electromagnetic field (45 ± 5)mT, 50 Hz (PEMF) acted as physical stressors. Cell viability was assessed by flow cytometry, and the Western blot analysis was carried out for CaM and Hsp70 levels in cytosolic extracts of U937 cells. Cell viability in samples exposed to MF alone did not differ from sham sample, for both types of MF exposure systems. Simultaneous action of MF and PMC influenced cell viability in type of MF stimulation-dependent manner. In contrast to PEMF + PMC stimulated samples, combination of ACDCMF with PMC enhanced cell death compared to PMC control. The observed changes in cell viability were correlated with changes in level of CaM and Hsp70 proteins. Immunoblots have shown, that cytosolic content of both CaM and Hsp70 proteins was enhanced in PMC-treated sample, and further elevated for ACDCMF + PMC. For PEMF + PMC stimulated samples, level of CaM was reduced compared to PMC-treated sample. The results suggest that the changes in expression of CaM and CaM-dependent proteins might modulate effectiveness of cell death under stimulation with MF and/or cytotoxic agents.

Effect of the different doses of acrylamide on acetylocholinoesterase activity, thiol groups, malondialdehyde concentrations in hypothalamus and selected muscles of mice

Acrylamide is a chemical compound that typically forms in starchy food products during high-temperature cooking, including frying, baking and roasting. Acrylamide is a known lethal neurotoxin. Its discovery in some cooked starchy foods in 2002 prompted concerns about the carcinogenicity of those foods. Little is known about acrylamide's influence on the peripheral nerves. In our research we measured acrylamide's influence on the acetylcholinesterase activity in hypothalamus, heart muscle, skeletal muscles of the thigh and smooth muscle of the small intestine (males, Swiss strain) in relation to the thiol groups and malondialdehyde concentration. Acrylamide was injected intraperitoneally (20 and 40 mg/kg, i.e. 0.52 and 1.04 mg per animal). The hypothalamus and muscles were taken 24, 48, and 192 h after the injection. Acetylcholinesterase activity was significantly lower (P < 0.001 to P < 0.05) in all structures. It was accompanied by the statistically significant (P < 0.001 to P < 0.05) increase in malondialdehyde concentrations in most of the studied structures time periods and ACR doses. -SH groups concentrations were significantly depleted in selected structures (P < 0.001 to P < 0.05). The AChE activity evaluation in mice muscles and hypothalamus was very important because there are many evidences that acrylamide affects directly on the peripheral nerves. Thus, it causes structural damages and physiological changes. The results obtained in the present study provide evidence for the occurrence of oxidative stress after intraperitoneal injection of acrylamide to hypothalamus, heart muscle, skeletal muscles of the thigh and smooth muscle of the small intestine.

Prostaglandin-targeting agents and spectral heart rate variability in experimental partial bladder outlet obstruction in rats

The purpose of this study was to determine the activity of the autonomic nervous system (ANS), using spectral analysis of the heart rate variability (HRV) in the model of partial bladder outlet obstruction (PBOO) in rats treated with selected non-steroidal anti-inflammatory drugs (NSAID): piroxicam (PRX) or meloxicam (MLX), and following administration of PGF2a prostaglandin analogue (Enzaprost F5). Neither the use of PGF2a analogue nor of MLX, caused significant changes in the HRV spectrum (except for HRV spectrum total power reduction with MLX). The use of PRX caused reduction of the total power and powers of all components of the HRV spectrum (except for VLF). Moreover, increased nLF and reduced nHF were observed. The obtained results suggest that the total prostaglandin synthesis block with a non-selective cyclooxygenase inhibitor (PRX) results in reduced ANS total activity, with decreased parasympathetic activity and a relative sympathetic predominance. The preferential cyclooxygenase-2 block (MLX) caused reduction of the total ANS activity as well, however with no clear disproportion of any part of the ANS. Therefore, prostaglandin synthesis inhibition and associated decrease of parasympathetic activity may constitute an additional and favourable feature of NSAID pharmacodynamics in the treatment of BPH.

Disturbances of autonomic nervous system activity and diminished response to stress in patients with celiac disease

Celiac disease (CED) is immune-mediated enteropathy caused by gluten intolerance affecting genetically predisposed individuals. CED may exert a number of various symptoms, including extra intestinal manifestations. Neurological symptoms can be the first sign of gluten intolerance. However, affected autonomic nervous system (ANS) activity may be linked to other symptoms. We evaluated the frequency of ANS impairment and resting ANS response to several stimuli in CED patients without neurological manifestations. Twenty five neurologically asymptomatic patients with CED were studied. The medical history was taken and ANS activity was determined. ANS tests included heart rate variability (HRV) at rest and after stimulation (sympathetic - stress, and parasympathetic - deep breathing). The results were compared with those of the control group comprising of 30 healthy asymptomatic volunteers. Both the resting HRV parameters and the HRV indices recorded after deep breathing (parasympathetic stimulation) were significantly lower in patients with CED than in the controls (P<0.05). Also the stress-induced increase in normalized low frequency parameter (LFnu) was significantly lower in the CED group than in the control group (P<0.05). Overall, about 20% of CED patients presented with parasympathetic dominancy but 36% with sympathetic dominancy, and 44% of patients did not show changes in sympathetic-vagal balance of the autonomic nervous system. We conclude that sympathetic-parasympathetic imbalance, in favour of more often sympathetic than parasympathetic overactivity occurs among neurologically asymptomatic CED patients. The ANS impairment observed in the course of CED may result from prolonged intestinal inflammation. Therefore, routine ANS testing might be considered in patients presenting with this condition.

Electrical vagus nerve stimulation decreases food consumption and weight gain in rats fed a high-fat diet

There is growing evidence that vagus nerve stimulation (VNS) has a suppressive effect on both short- and long-term feeding in animal models. We previously showed that long-term VNS (102 days) with low-frequency electrical impulses (0.05 Hz) decreased food intake and body weight in rats. In the present study, we investigated the effect of high frequency (10 Hz) VNS on feeding behavior and appetite in rats fed a high-fat diet; peptide secretion and other parameters were assessed as well. Adult male Wistar rats were each implanted subcutaneously with a microstimulator (MS) and fed a high-fat diet throughout the entire study period (42 days). The left vagus nerve was stimulated by rectangular electrical pulses (10 ms, 200 mV, 10 Hz, 12 h a day) generated by the MS. Body weight and food intake were measured each morning. At the end of the experimental period, animals were euthanized and blood samples were taken. Serum levels of ghrelin, leptin and nesfatin-1 were assessed using radioimmunoassays. Adipose tissue content was evaluated by weighing epididymal fat pads, which were incised at the time of sacrifice. To determine whether VNS activated the food-related areas of the brain, neuronal c-Fos induction in the nuclei of the solitary tract (NTS) was assessed. Chronic vagus nerve stimulation significantly decreased food intake, body weight gain and epididymal fat pad weight in animals that received VNS compared with control animals. Significant neuronal responses in the NTS were observed following VNS. Finally, serum concentrations of ghrelin were increased, while serum levels of leptin were decreased. Although not significant, serum nesfatin-1 levels were also elevated. These results support the theory that VNS leads to reductions in food intake, body weight gain and adipose tissue by increasing brain satiety signals conducted through the vagal afferents. VNS also evoked a feed-related hormonal response, including elevated blood concentrations of nesfatin-1.

Pulsating electromagnetic field stimulation prevents cell death of puromycin treated U937 cell line

Aim of study was to verify whether pulsating electromagnetic field (PEMF) can affect cancer cells proliferation and death. U937 human lymphoid cell line at densities starting from 1 x 10(6) cells/ml to 0.0625 x 10(6) cells/ml, were exposed to a pulsating magnetic field 50 Hz, 45+/-5 mT three times for 3 h per each stimulation with 24 h intervals. Proliferation has been studied by counting number of cells stimulated and non-stimulated by PEMF during four days of cultivation. Viability of cells was analyzed by APC labeled Annexin V and 7-AAD (7-amino-actinomycin D) dye binding and flow cytometry. Growing densities of cells increase cell death in cultures of U937 cells. PEMF exposition decreased amount of cells only in higher densities. Measurement of Annexin V binding and 7-AAD dye incorporation has shown that density-induced cell death corresponds with decrease of proliferation activity. PEMF potentiated density-induced death both apoptosis and necrosis. The strongest influence of PEMF has been found for 1 x 10(6)cells/ml and 0.5 x 10(6) cells/ml density. To eliminate density effect on cell death, for further studies density 0.25 x 10(6) cells/ml was chosen. Puromycin, a telomerase inhibitor, was used as a cell death inducer at concentration 100 microg/ml. Combined interaction of three doses of puromycin and three fold PEMF interaction resulted in a reduced of apoptosis by 24,7% and necrosis by 13%. PEMF protects U937 cells against puromycin- induced cell death. PEMF effects on the human lymphoid cell line depends upon cell density. Increased density induced cells death and on the other hand prevented cells death induced by puromycin.

Physiological and morphological effects of long-term vagal stimulation in diet induced obesity in rats

Some previous studies have shown suppressive effect of the vagal nerve stimulation (VNS) on long - term feeding regulation in rats. We assessed body weight, interstitial cells of Cajal (ICC), myenteric plexus neurons, mast cells in the stomach, duodenum and colon and c-Fos expression in nodose vagal ganglia in the rats with VNS. Male Wistar rats were implanted with microchip (MC) and kept during the whole study (100 days) on high calorie diet. Left vagal nerve was stimulated by electrical pulses (10ms, 200mV, 0.05Hz) generated by MC. After finishing the experiments tissue samples (stomach, duodenum, colon and nodosal vagal ganglia) were taken. Mast cells were toluidine blue stained and counted in mucosa, muscularis externa and serosa. For immunostaining, antibodies for ICC (CD117), myenteric plexus neurons (PGP9.5) and c-Fos were used. Positive cells were assessed by image analysis. Chronic microchip vagal stimulation significantly decreased epididymal fat pad weight, meal size with effect on decreased weight gain in VNS rat. VNS significantly increased mast cells number in all examined parts of the gastrointestinal wall, mainly in the muscularis. There were no significant differences in ICC and myenteric plexus neurons between VNS and control. Expression of c-Fos in nodosal ganglia was higher in VNS group. The effects observed during long-term VNS concern predominantly mast cells. These data support the theory that VNS can increase vagal afferent satiety signals leading to reduced food intake and body weight gain and mast cells are involved in this process.

Magnetically induced vagus nerve stimulation and feeding behavior in rats

Vagus nerve (VN) contribute to the bidirectional communication between the gastrointestinal tract and the central nervous system. Stimulation of the VN by a magnetically-driven solenoid with parameters similar to those during food-induced stomach distension has been thought to mimic short-term signaling of satiety and suppress food intake. In this study, the determination of optimal parameters of vagal neuro-modulation to achieve decreased food intake with a resulting reduction in body mass of rats is explored as therapy to treat obesity. The experimental design consisted of three groups of obese adult male Wistar rats: Group 1: VEMF - with solenoid's electrodes placed on the left VN in the magnetic field exposure (MFE); Group 2: EMF - without solenoid's electrodes on the VN in MFE; Group 3: CON - without solenoid's electrodes on the VN outside the MFE. This study suggests that the rats with solenoid's electrodes placed on the left VN significantly decreased their food intake, weight gain and serum leptin concentrations when compared to that of the CON group. PP levels were found to be higher in the VEMF group when compared to the controls groups. It was found that the most effective parameters of vagal stimulation on eating behavior were 3631, 7861, 14523 A(2) x h/m(2). The magnetic field by unknown mechanisms also influences feeding behavior. This study suggests that vago-vagal reflexes are involved in the feeding homeostasis and that neuromodulation might be an effective method for managing obesity. Further studies are required to confirm these effects in humans.

Magnetic field anti-inflammatory effects in Crohn's disease depends upon viability and cytokine profile of the immune competent cells

AIM

We investigated effects of pulsating electromagnetic field (PEMF-50 Hz, 45 +/- 5 mT) on viability and cytokine production by human peripheral blood mononuclear cells (PBMC) from healthy donors and from Crohn's disease patients (CD).

METHODS

The study was performed after activation of cells with phytohaemaglutinin (PHA) and lipopolisaccharide (LPS). Exposure of PBMC cultures to PEMF from both CD patients and from healthy donors decreased cell's viability of about 10% and 5% (p>0.05) respectively. PEMF influence was most effective after threefold application. Susceptibility of PBMCs to magnetic field exposure differs among the stimulated (PHA, LPS) and not stimulated (NS) cells. Mitogen activated cells during cell division are most susceptible to induction of the cell death as a result of magnetic interaction, contrary PEMF exposure has minimal effect on non-diving PBMCs from CD patients and from controls. Decreased viability of the Crohn derived cells upon magnetic stimulation was accompanied by altered cytokines profile. Exposed and stimulated PBMCs from Crohn patients decreased IFN-gamma proinflammatory and increased IL-10 anti-inflammatory cytokine production. The electromagnetically induced cell death could be an important step for non-invasive PEMF treatment in chronic inflammatory diseases.

Effect of subdiaphragmatic vagotomy and cholinergic agents in the hypothalamic-pituitary-adrenal axis activity

In the present study, we examined whether the vagus nerve is involved in mediating the stimulation of hypothalamic-pituitary-adrenal (HPA) axis by cholinergic muscarinic and nicotinic agonists, carbachol and nicotine. The site of HPA axis muscarinic stimulation was determined using peripheral (i.p.) and intracerebroventricular (i.c.v.) administration of carbachol, atropine sulphate (AtrS) and atropine hydrobromide (AtrBr). The i.p. carbachol-(0.5 mg/kg)-induced corticosterone response was significantly reduced by i.p. pretreatment with AtrBr (0.1 mg/kg), but was not diminished by i.c.v. AtrS (0.1 mug). The increase in corticosterone secretion induced by i.c.v. carbachol (2 microg) was totally abolished by i.c.v. pretreatment with AtrS (0.1 microg) but was not altered by i.p. AtrBr. Subdiaphragmatic vagotomy performed 2 weeks earlier substantially decreased the i.p. carbachol (0.2 mg/kg)-induced ACTH response and markedly augmented ACTH and corticosterone response to a higher dose of carbachol (0.5 mg/kg) in comparison with the responses in sham operated rats. Vagotomy abolished the stimulatory effect of i.p. nicotine in a low dose (1 mg/kg) on ACTH and corticosterone secretion; the ACTH response to higher dose (2.5 mg/kg) was considerably reduced, while corticosterone response remained unaffected. These results suggest that carbachol given i.c.v. evokes considerable corticosterone response by stimulation of central cholinergic muscarinic receptors. A major part of the i.p. carbachol-induced corticosterone secretion results from peripheral cholinergic muscarinic receptor stimulation. Subdiaphragmatic vagotomy moderately intensified the carbachol-induced ACTH and corticosterone secretion. Vagotomy significantly reduced the nicotine-induced ACTH secretion, possibly by the involvement of vagal afferents. The nicotine-induced corticosterone secretion is not exclusively regulated by circulating ACTH but by various intra-adrenal regulatory components.

Influence of cyclooxygenase inhibitors on the central histaminergic stimulations of hypothalamic - pituitary - adrenal axis

Brain histamine participates in central regulation of the hypothalamic-pituitary-adrenal (HPA) axis. Endogenous prostaglandins modulate signal transduction of different neurotransmitters involved in activation of HPA axis. In the present experiment we investigated whether endogenous prostaglandins are involved in the stimulation of ACTH and corticosterone secretion by histaminergic systems in the rat brain. Histamine (50 microg), histamine-trifluoromethyl-toluidine derivative (HTMT, 75microg) a selective and potent H(1)-receptor agonist, and amthamine (50 microg) a H(2)-receptor agonist given intracerebroventricularly (i.c.v.) to non-anesthetized rats considerably increased ACTH and corticosterone secretion 1h after administration. A non-selective cyclooxygenase inhibitor indomethacin (2 mg/kg i.p. or 10 microg i.c.v.), piroxicam (0.02 and 0.2 microg i.c.v.) a more potent antagonist of constitutive cyclooxygenase (COX-1) and compound NS-398 (0.1 and 1.0 microg i.c.v.), a selective inhibitor of inducible cyclooxygenase (COX-2) were given 15 min before histamine and histamine receptor agonists. One hour after the last injection trunk blood from decapitated rats was collected for hormones determination. The histamine-induced ACTH and corticosterone secretion was significantly diminished by piroxicam and was not markedly altered by indomethacin and compound NS-398. The HTMT-elicited increase in ACTH and corticosterone secretion was significantly prevented by indomethacin and was not affected by piroxicam or compound NS-398. The amthamine-evoked increase in ACTH and corticosterone secretion was not markedly influenced by any cyclooxygenase blocker applied in the present experiment. These results indicate that the histamine H(1)-receptor transmitted central stimulation of the HPA axis is considerably mediated by prostaglandins generated by consititutive cyclooxygenase, whereas stimulation transmitted via H(2)-receptor does not significantly depend on endogenous prostaglandins mediation.

Effect of different cycling frequencies during incremental exercise on the venous plasma potassium concentration in humans

The effect of different muscle shortening velocity was studied during cycling at a pedalling rate of 60 and 120 rev.min(-1) on the [K+]v in humans. Twenty-one healthy young men aged 22.5+/-2.2 years, body mass 72.7+/-6.4 kg, VO2 max 3.720+/-0.426 l. min(-1), performed an incremental exercise test until exhaustion. The power output increased by 30 W every 3 min, using an electrically controlled ergometer Ergoline 800 S (see Zoladz et al. J. Physiol. 488: 211-217, 1995). The test was performed twice: once at a cycling frequency of 60 rev.min(-1) (test A) and a few days later at a frequency of 120 rev. min(-1) (test B). At rest and at the end of each step (i.e. the last 15 s) antecubital venous blood samples for [K+]p were taken. Gas exchange variables were measured continuously (breath-by-breath) using Oxycon Champion Jaeger. The pre-exercise [K+]v in both tests was not significantly different amounting to 4.24+/-0.36 mmol.l(-1) in test A, and 4.37+/-0.45 mmol.l(-1) in test B. However, the [K+]p during cycling at 120 rev. min(-1) was significantly higher (p<0.001, ANOVA for repeated measurements) at each power output when compared to cycling at 60 rev.min(-1). The maximal power output reached 293+/-31 W in test A which was significantly higher (p<0.001) than in test B, which amounted to 223+/-40 W. The VO2max values in both tests reached 3.720+/-0.426 l. min(-1) vs 3.777+/-0.514 l. min(-1). These values were not significantly different. When the [K+]v was measured during incremental cycling exercise, a linear increase in [K+]v was observed in both tests. However, a significant (p<0.05) upward shift in the [K+]v and a % VO2max relationship was detected during cycling at 120 rev.min(-1). The [K+]v measured at the VO2max level in tests A and B amounted to 6.00+/-0.47 mmol.l-1 vs 6.04+/-0.41 mmol.l-1, respectively. This difference was not significant. It may thus be concluded that: a) generation of the same external mechanical power output during cycling at a pedalling rate of 120 rev.min(-1) causes significantly higher [K+]v changes than when cycling at 60 rev.min(-1), b) the increase of venous plasma potassium concentration during dynamic incremental exercise is linearly related to the metabolic cost of work expressed by the percentage of VO2max (increase as reported previously by Vollestad et al. J. Physiol. 475: 359-368, 1994), c) there is a tendency towards upward up shift in the [K+]v and % VO2max relation during cycling at 120 rev.min(-1) when compared to cycling at 60 rev.min(-1).

The influence of cholecystokinin on gastric myoelectrical activity in duodenal ulcer following Helicobacter pylori eradication--an electrogastrographic study

Cholecystokinin (CCK) plays an important role in the regulation of postprandial gastric motor activity which was found to be abnormal in duodenal ulcer patients. This study was designed to compare the influence of CCK on gastric myoelectrical function in duodenal ulcer patients and healthy controls. Fifteen patients with active duodenal ulcer and Helicobacterpylori (H. pylori) infection and 15 healthy controls were included into this study. Electrogastrography (EGG) was performed before and 4 weeks after the eradication of H. pylori in ulcer patients and in healthy controls. We compared EGG parameters in the fasting and postprandial period and during intravenous infusion of caerulein, an analog of CCK with or without addition of loxiglumide, a specific CCK-1 receptor antagonist. The amplitude of fasting EGG in duodenal ulcer patients was similar to that in control subjects and was not affected by H. pylori eradication. In contrast, the amplitude of postprandial EGG was markedly increased in duodenal ulcer patients when compared to that in healthy controls and it was significantly reduced following the eradication of H. pylori. The blockade of CCK-1 receptors with loxiglumide in healthy controls or H. pylori eradicated ulcer patients significantly enhanced postprandial EGG amplitude almost to the level observed in the infected duodenal ulcer patients, but failed to affect this amplitude in ulcer patients. Exogenous caerulein, an analog of CCK, failed to affect EGG amplitude in duodenal ulcer patients with H. pylori infection, but it reduced significantly EGG amplitude in these patients after H. pylori eradication and in control subjects. This inhibitory effect of caerulein in H. pylori negative ulcer patients and healthy controls was abolished by the addition of loxiglumide. Ulcer patients showed significant dysrhythmia with tachygastria up to 20% of the recording time both under basal conditions and postprandially and H. pylori eradication was followed by a significant decrease in tachygastria to about 5%, the value being similar to that in healthy controls. We conclude that the amplitude and frequency of gastric myoelectrical activity are enhanced in duodenal ulcer patients and impaired in response to CCK but these changes can be normalized by successful H. pylori eradication.

The cybergut. An experimental study on permanent microchip neuromodulation for control of gut function

Acute electrical stimulation of vagal nerve changes gut motility, secretion as well as absorption, and it may have effect on food intake and satiety regulation. The aim of the study was to evaluate the effect of permanent microchip mediated neuromodulation (McNm) of vagal afferent activity on GI function and body mass in the experimental model.

MATERIAL AND METHODS

Two-steps study was performed. In the first step (evaluation of food intake) 16 rabbits were divided in two groups, 8 animals each. Group A was subjected to microchip mediated neuromodulation (McNm), and control group B was sham operated. In both groups laparotomy and vagal exploration were performed. In the second step pathomechanism of Mc action was analysed in fourteen Wistar rats divided in two groups (C and D), 7 animals each. Group C was subjected to Mc implantation and gastrostomy placement and group D (controls) to gastrostomy placement alone.

RESULTS

Food intake and body mass significantly decreased in group A after Mc implantation compared with the preoperative period and control group B. No differences were found in the frequency of gastric contractions between groups C and D, however, their amplitude was significantly stronger in group C. Neuromodulation had significant effect on BAO without changes in MAO levels.

CONCLUSIONS

Low frequency permanent vagal neuromodulation affects gastric function and influences food intake in the experimental model.

Reversible autonomic dysfunction in hyperthyroid patients affects gastric myoelectrical activity and emptying

The autonomic nervous system (ANS) function in hyperthyroidism has been so far investigated mainly from the cardiovascular point of view. The aim of this study is to show that the ANS dysfunction in hyperthyroidism is also expressed in gastric myoelectrical activity disturbances and gastric emptying disorders and to search for a correlation between the severity of clinical manifestation and free thyroid hormone levels and the degree of the ANS dysfunction. The analyzed group included 50 recently diagnosed patients with hyperthyroidism who were examined twice: before and after 3 months of thyrostatic treatment. Results were compared with those of a sex-, age- and BMI-matched control group of 50 healthy volunteers. The study included: heart rate variability analysis in time and frequency domain, at rest and during a deep-breathing test, surface electrogastrography in preprandial and postprandial periods measured simultaneously with the ultrasound assessment of gastric emptying time by Bolondi method. In patients with hyperthyroidism in comparison with the control group, the following significant differences were observed: a sharp reduction of the high-frequency component and a decrease of heart rate variability, a high incidence of dysrhythmia with dominant bradyarrhythmia, and a delay of gastric emptying. The degree of disorders related to the degree of clinical manifestation of hyperthyroidism's symptoms and free triiodothyronine serum concentration both. All the disorders were functional and disappeared in a stable euthyroidism. To conclude, the ANS dysfunction in hyperthyroidism results not only in withdrawal of vagal inhibitory effect on sinoatrial node, but in impaired mutual neuro-hormonal regulation (decrease of vagal influence) of gastric myoelectrical activity followed by delay of gastric emptying.

Involvement of nitric oxide in central histaminergic stimulation of the hypothalamic-pituitary-adrenal axis

Brain histamine participates in central regulation of the hypothalamic-pituitary-adrenal (HPA) axis. Endogenous nitric oxide (NO) modulates signal transduction of some neurotransmitters involved in activation of the HPA axis. In the present study we investigated whether endogenous NO and histaminergic systems in the rat brain interact in their regulation of ACTH and corticosterone secretion. Histamine (50 microg), histamine-trifluoromethyl-toluidide derivative (HTMT, 75 microg) a selective and potent H1-receptor agonist, and amthamine (75 microg) a H2-receptor agonist given intracerebroventricularly (i.c.v.) considerably increased ACTH and corticosterone secretion 1 h after administration. A potent and competitive inhibitor of rat brain neuronal NO synthase, (NOS), 7-nitroindazole (7-NI), given i.p. 15 min before histamine moderately increased the histamine-induced ACTH secretion and did not substantially alter the histamine-induced corticosterone secretion. Pretreatment with 7-NI totally abolished the HTMT-induced increase in ACTH and corticosterone secretion. The amthamine-evoked rise in ACTH secretion was moderately diminished and the amthamine-induced corticosterone secretion was not substantially altered by preatreatment with 7-NI. These results suggest that the histamine H -receptor transmited central stimulation of the HPA axis is considerably mediated by endogenous NO, whereas stimulation by histamine and via H2-receptor does not significantly depend on endogenous NO mediation.

[Circadian rhythm of autonomic heart activity in patients with primary essential hypertension treated with angiotensin converting enzyme inhibitor]

Although the immediate effects of angiotensin converting enzyme inhibitors (ACEI) on cardiac autonomic innervation have been extensively studied, little is known about circadian rhythm of heart rate variability (HRV) in these patients. The purpose of the present study was to investigate circadian changes of the autonomic activity in patients with essential hypertension treated with ACEI, which may play some role in the pathogenesis of hypertension. We studied 10 middle age patients with essential hypertension (treated with ACEI--enarenal at least 1 yr.) and 10 age, gender matched control subjects. Heart rate variability (HRV) was calculated from the 24-hr ambulatory electrocardiograms by the Fourier transformation. Power spectra were quantified at 0.003-0.04 Hz--very low frequency power (VLF), 0.04-0.15 Hz--low frequency power (LF) and 0.15-0.40 Hz--high frequency power (HF). The HF component and the ratio LF to HF were used as indices of the parasympathetic activity and balance between sympathetic and parasympathetic activities.

RESULTS

The circadian rhythms of the LF, HF and LF/HF ratio differed significantly. In control group, LF, HF increased but LF/HF decreased (p < 0.05) at night, in hypertensive patients LF, HF increase was attenuated at night but LF/HF increased (p < 0.05). In control subjects when compared to hypertensive patients power spectrum HF was doubled at night.

CONCLUSION

These findings suggest that in hypertension primary cardiac autonomic dysfunction might contribute to altered circadian rhythm leading to the development of cardiovascular diseases despite long term normalisation of high blood pressure.

Relationship between specific dynamic action and protein deposition in calanoid copepods

The link between specific dynamic action (SDA) and protein deposition was investigated in copepodites stage V of two calanoid copepod species, the neritic Acartia tonsa and the oceanic Calanus finmarchicus. This was done by measuring respiration before, during, and after a specific feeding period and measuring the incorporation of carbon into proteins. These were also measured on individuals incubated with cycloheximide, an antibiotic that inhibits protein synthesis. The cycloheximide treatment significantly diminished the magnitude of SDA in both A. tonsa and C. finmarchicus, and inhibited carbon incorporation into protein in both species. This provides evidence that the rate at which protein deposition takes place greatly affects the magnitude of SDA. The specific respiration rates of both starving and feeding copepods were generally higher in A. tonsa than in C. finmarchicus. This influenced SDA, the magnitude of SDA normalised to an 8 h feeding period being threefold higher in A. tonsa (78.7+/-25.7 nlO(2) µgC(-1)) than in C. finmarchicus (27.5+/-11.6 nlO(2) µgC(-1)). This difference may arise due to differences in energy allocation in the organisms of the copepodite V stage of the two species. In this stage C. finmarchicus deposits large quantities of storage lipids, predominately wax esters, whereas A. tonsa deposits proteins during somatic growth.

Gastric electromechanical dysfunction in Parkinson's disease

This study was designed to evaluate gastric myoelectrical and mechanical activities in idiopathic Parkinson's disease (IPD) patients. Twenty patients with IPD (14 male and 6 female, mean age 42 +/- 9 years) were studied. Patients were divided into two groups: group A--early stage of disease (no. = 6) and group B--advanced IPD (no. = 14). Electrogastrography (EGG) was performed in fasting and postprandial conditions (Synectics system). The cross-sectional area of the gastric antrum was measured by sonography (Hitachi EUB-240). The antral area in fasting conditions was 2.1 +/- 0.4 and 4.2 +/- 1.2 cm2 and gastric emptying was 75 +/- 5 and 125 +/- 12 min in groups A and B respectively. EGG showed dysrhythmias (range 1-6 cycles per minute) in about 75% of both groups of IPD patients without increase in signal amplitude after a meal. Our results suggest that gastric motility is particularly impaired in patients with advanced IPD. It may be caused by the primary degenerative process in the autonomic nervous system of the gut.

[Mechanism of action of neurotensin on microcirculation, metabolism and motility of the small intestine]

The aim of this study was to investigate the influence of neurotensin on total microcirculatory blood flow, oxygen consumption, myoelectric activity and motility of the small bowel. The attempts were made to evaluate the role of L-Arginine, NO-system in the mechanism of action of this peptide on microcirculation, metabolism and motor-activity of the intestine. The experiments were performed in two experimental models--dogs and rats. In Vetbutal anesthetised animals the systemic arterial pressure, superior mesenteric artery blood flow, microcirculatory blood flow and myoelectric activity of the small bowel were continuously monitored. In experiments with dogs effective capillary index, arterio-venous oxygen difference and oxygen consumption were analysed. Neurotensin administered intraarterially caused a dose depended increase in total and microcirculatory blood flow in the small bowel in both groups of animals. The experiment with dogs showed the rise of effective capillary index and intestinal oxygen consumption. Administration of neurotensin changed the profile of myoelectric activity of the small bowel similar to that of postprandial hyperaemia. Inhibition of NO-synthase by the intravenous administration of L-NNA reduced significantly the amplitude of neurotensin hyperaemia. Pretreatment with L-Arginine, the substrate of NO-synthase reversed the hemodynamic, but not motility effects of neurotensin. The results presented proved the role of the L-Arginine-NO in circulatory mechanism, but not motility effects of neurotensin.

[Autonomic nervous system dysfunction in Parkinson's disease evaluated by the heart rhythm variability test]

It is well recognized that autonomic dysfunction are common in Parkinson's disease (PD). Fourteen patients with early PD and 8 patients with advanced PD aged from 38-71 were investigated. Heart rate variability at rest differ significantly between patients with advanced PD and age-matched controls. Cardiovascular autonomic dysfunction in PD mainly affects parasympathetic but also sympathetic system, and occurs only in advanced cases. Heart rate variability is a useful non-invasive test to assess autonomic dysfunction in PD.

[Evaluation of autonomic nervous system function with heart rate variability analysis in patients with hyperthyroidism and during euthyroidism after pharmacologic and surgical treatment]

The aim of the present study was both to estimate autonomic nervous system (ANS) function in patients with hyperthyroidism by the heart rate variability (HRV) analysis and to evaluate the impact of pharmacological and surgical treatment on the ANS function. Analysis of the HRV underwent 10 female patients in course of thyreotoxicosis and after reaching full clinical and biochemical euthyroidism, after pharmacological therapy and in month after surgical treatment. The 10 minutes records at rest, in horizontal position were evaluated. The HRV parameters like mean of the heart rate, mean of RR intervals, standard deviation of all normal RR intervals (SDNN), range of the heart rate variability, low frequency (LF), high frequency (HF) components of the heart rate power spectral density and LF/HF ratio were assessed. The results were compared to those obtained from 10 age-, sex-, and body mass index-matched control subjects. The statistical significance (p < 0.05) was found in reduction of range of RR intervals, in increase of LF/HF ratio and in decrease of SDNN in hyperthyroidism in comparison to the control group (151.6/346.8 ms; 2.4/0.74; 24.4/57.2 ms2). In course of pharmacological euthyroidism there were statistically significant (p < 0.05) increase of range of RR intervals, reduction of LF/HF ratio and increase of SDNN in comparison to hyperthyroidism (270/151.6 ms; 0.995/2.4; 39/24.4 ms2). In euthyroidism after surgical treatment all the above parameters kept the similar levels as in pharmacological euthyroidism (no statistical significance for p < 0.05). On the base of the outcomes it was considered that in hyperthyroid patients there is advantage of sympathetic part of ANS over parasympathetic one which is due to sharp reduction of parasympathetic system activity. Pharmacological therapy with thyreostatics normalises balance of ANS to the level of the control group and after surgical treatment the balance keeps the same. Moreover, in the estimation of ANS as important as LF/HF ratio is the mean range of RR intervals.

Myoelectric bowel activity in ischemia/reperfusion damage. Role of sensory neurons

The present knowledge indicates that afferent sensory neurons (C-fibres) play an important role in the relationship between intestinal myoelectric activity (IMA) and blood flow (LDBF). The aim of this study was to evaluate the role of C-fibers in myoelectric activity of small intestine during its ischemia and reperfusion. A neurotoxin-capsaicin (CAP) was used to induce functional ablation of afferent sensory neurons. Experiments were performed on 6 groups of anesthetized rats. In the I, II, III group of rats IMA and LDBF were recorded during 100% ischemia induced by AMA 15, 30 and 60 min total occlusion and during 60 min reperfusion period. In group V and VI, IMA and LDBF were registered after intrajejunal placement of 1% CAP. In group IV we measured effects of intraluminal instillation of CAP alone. Intraluminal placement of CAP induced an early increase in slow wave amplitude SWA and slow wave frequency SWF by 35+/-11% and 19+/-10% (p<0.05) with the subsequent decrease in both by 25+/-6 and 24+/-8% (p<0.05) respectively. Short 15 min lasting ischemia induced by 100% occlusion of AMA evoked only a slight increase of SWA. During reperfusion period SWA and SWF returned to the baseline values after 15 min. Total 30 min occlusion decreased SWA and SWF by 25+/-9 and 24+/-6% (p<0.05) respectively. During reperfusion period recovery of IMA parameters to preocclusion values were slower. Intestinal hyperemia was smaller than in previous group. After 60 min lasting intestinal ischemia SWA and SWF were decreased by 58+/-7 and 40+/-6% (p<0.01) respectively. There was no return of IMA parameters to control values. These data demonstrated that intestinal ischemia induces typical changes in the bowel myoelectric activity. These changes possess their own electrical characteristics which can be used in clinical practice for evaluation of the degree ischemically-induced intestinal injury. Capsaicin pretreatment significantly decreased SWA and SWF and LDBF in comparison with those observed in group II and III during 30 and 60 min occlusion and reperfusion period. We conclude that afferent neurons C activated during mesenteric ischemia/reperfusion play an important role in protecting ischemic bowel viability.

[Electromyographic and histologic evaluation of intestinal viability]

Myoelectrical small bowel activity was measured intraoperatively with two serosal electrodes in two groups of patients. 16 patients operated electively for other indications than bowel ischaemia and 10 with small bowel ileus with symptoms of ischaemia. In later cases necrotic bowel was resected. Resected ischaemic bowel was submitted to histological examination and changes in intramural neurones were assessed. Areas of mild, moderate and severe ischaemia were compared to unchanged bowel. Both amplitude and frequency of slow waves in ischaemic bowel was markedly diminished corresponding well with changes in bowel histology. Intraoperative measurements of intestine myoelectrical activity might help a surgeon to estimate a bowel viability.

Endogenous nitric oxide in the control of esophageal motility in humans

Recent animal studies have suggested that nitric oxide (NO) plays an important role in the regulation of esophageal motility, being partly responsible for latency period and latency gradient between the onset of a swallow and contractions of esophageal circular smooth muscles. The aim of this study was to evaluate whether endogenous NO is responsible for physiological timing of forthcoming contractions in the human esophageal body after swallowing. Eight male volunteers (age 21-25 years, weight 67-82 kg) were involved in this placebo controlled study on the effects of increasing doses of the NO synthase blocker, NG-monomethyl-L-arginine (L-NMMA 1.0-4.0 mumol/min i.v.), and/or L-arginine (L-arg) (30 mumol/kg-min i.v.) on the peristalsis of esophageal body in response to wet swallows (5 ml of water) and lower esophageal sphincter (LES) resting pressure. The esophageal motor activity was determined manometrically using 3-channel electronic catheter. Additionally, during all examinations arterial blood pressure (BP) was measured every 5 min. L-NMMA resulted in a significant and dose-dependent reduction in the latency period between swallows and the onset of contractions which was most pronounced in the distal esophagus (control: 7.07 +/- 0.74 s vs. L-NMMA 4.0 mumol/min: 5.87 +/- 0.57 s), and this effect was partially reversed after addition of L-arg to the L-NMMA infusion (6.91 +/- 0.62 s). L-NMMA infusion significantly reduced the duration of contractions and increased the velocity of onset propagation but did not change the amplitude of contractions and again, these effects were reversed during simultaneous infusion of L-arg. The resting tone of LES increased significantly during infusion of L-NMMA and these effects were reversed by addition of L-arg. The mean BP significantly increased during infusion of L-NMMA (control 97.0 +/- 5.7 vs. L-NMMA 4.0 mumol/min: 116.4 +/- 3.1 mm Hg) and this was also reversed by L-arg. We conclude that in humans endogenous NO is involved, at least in part, in the physiological regulation of motility patterns of the distal esophageal body and LES.

Dysfunction in gastric myoelectric and motor activity in Helicobacter pylori positive gastritis patients with non-ulcer dyspesia

Helicobacter pylori (Hp) infection has been shown to affect gastric acid secretion and the somatostatin-gastrin ratio but its effects on gastric motility have not been evaluated. This study was carried out in 12 patients (10 males and 2 females, mean age 33 +/- 6 yrs) who underwent endoscopy and Campylobacter-like Organism (CLO)-test. All patients were found initially to be Hp positive according to CLO-test. Gastric emptying was evaluated by measuring antral diameter with ultrasonography (Hitachi EUB 240) in fasted and fed patients. Electrogastrography (EGG) with antral manometry were done 5 h before and 4 h after a meal before the therapy and one month after the eradication with triple therapy (lanzoprazole 30 mg daily- 2 x 250 mg clarithromycin 500 mg t.i.d.-3 x 500 mg and metronidazole 500 mg b.i.d.-2 x 500 mg). In Hp positive patients before the triple therapy the mean fasted antral diameter was 4.3 cm2, initial EGG showed significant dysrhythmia of electrical control activity (ECA) with tachygastria up to 25% of recording time in 9 of 12 Hp positive patients without normal increase of the power of signal in any of tested subjects. In 7 Hp positive fasted antral manometry failed to exhibit gastric phases III of the migrating motor complex (MMC). Hp eradication was accomplished in 10 of 12 examined patients and this was followed by a decrease in tachygastria to 3 cpm rhythm with an increase of the ECA power after meal. Phase III of MMC was observed again in 7 Hp negative patients with a decrease of fasted antral diameter (p < 0.05). Fasted and fed antral motility pattern increased after eradication. Two patients remained Hp positive after standard therapy. We conclude that most symptomatic non ulcer dyspeptic Hp positive patients show changes in ECA and antral hypomotility that are associated with Hp infections.

Effects of nitric oxide on antral motility and gastric emptying in humans

OBJECTIVE

It has been suggested that nitric oxide is a nonadrenergic-noncholinergic (NANC) inhibitory neurotransmitter released by the nerves in the gastrointestinal tract. We studied the influence of nitric oxide on gastric emptying and antral motility using glyceryl trinitrate (GTN), a donor of nitric oxide and L-arginine as the substrate of nitric oxide synthase.

DESIGN

Six male volunteers (aged 21-24 years) participated in this placebo-controlled, double-blind study.

METHODS

We investigated the effects of 0.8 mg sublingual GTN, 300 mg/kg/h intravenous L-arginine or placebo on meal-stimulated antral motility and gastric emptying on four separate occasions. After an overnight fast, a 500 ml standard liquid meal was ingested and the gastric emptying rate assessed by ultrasound. The changes in antral cross-sectional areas were measured by ultrasonography and the antral motor activity was determined simultaneously using a multilumen perfused catheter. Blood samples were taken from fasted and fed patients before and after the administration of GTN, L-arginine or placebo to determine plasma glucagon and somatostatin levels.

RESULTS

GTN at a sublingual dose of 0.8 mg and 300 mg/kg/h intravenous L-arginine significantly (P < 0.01) prolonged gastric emptying half-time, averaging 56 +/- 12 and 38 +/- 8 min, respectively, compared with the placebo control value (28 +/- 7 min). The antral motor activity, calculated as the motility index (number of contractions x mmHg/min) significantly decreased in both test series, i.e., after GTN from 375.5 +/- 185.1 (control) to 104.4 +/- 55.7 (P < 0.01) and after L-arginine from 401 +/- 76 (control) to 285 +/- 57 (P < 0.05). L-arginine given intravenously at a dose of 300 mg/kg/h significantly increased plasma glucagon and somatostatin in fasted patients and increased postprandially released glucagon without affecting postprandial plasma somatostatin levels. GTN did not affect plasma hormone levels.

CONCLUSIONS

Our results indicate that (1) exogenous nitric oxide inhibits gastric emptying and antral motor activity, which could be useful in the treatment of patients with functional disturbances of gastric motility and emptying; and (2) the reduction in gastric emptying and antral motility observed after the administration of L-arginine results from changes in plasma enterohormone release rather than from the enhanced formation of endogenous nitric oxide.

Role of cholecystokinin in the control of gastric emptying and secretory response to a fatty meal in normal subjects and duodenal ulcer patients

BACKGROUND

Exogenous cholecystokinin (CCK) is known to affect gastric motor and secretory activities, but its physiologic role in the control of gastric functions is unknown.

METHODS

In this study involving 10 young healthy subjects and 10 duodenal ulcer (DU) patients, 500 ml of a standard meal without or with addition of 15% soybean oil was given, and the gastric emptying rate and the pH profile and plasma levels of gastrin, CCK, pancreatic polypeptide (PP), and somatostatin were determined in separate tests with placebo or with antagonism of type-A CCK receptors (loxiglumide, 1200 mg orally).

RESULTS

In healthy controls and DU patients the emptying half-time was 44 and 34 min, respectively, and the addition of oil prolonged the emptying by about 50%. Pretreatment with loxiglumide significantly reduced fat-induced retardation of gastric emptying in both healthy controls and DU patients. A standard meal in healthy subjects resulted in an immediate rise in median gastric pH to about 6.0, and this was followed by gradual decrease within about 3 h to premeal values of about 2.0. After the meal, plasma gastrin rose by 57%, CCK by 177%, PP by 100%, and somatostatin by 39%. Addition of fat significantly attenuated and prolonged the pH decrease after the meal while reducing the increment in plasma gastrin and enhancing plasma CCK and PP levels. Loxiglumide significantly reduced the median postprandial pH (from control 4.8 to 2.5) and reversed the changes in the pH profile caused by the addition of fat. The increments in plasma gastrin and CCK were markedly augmented, whereas those of somatostatin and PP were significantly attenuated. DU patients showed lower postprandial pH (3.0) in tests with or without fat and higher increments in plasma gastrin. CCK antagonism failed to affect significantly the pH profile or the increments in plasma gastrin in DU patients.

CONCLUSIONS

These results indicate that endogenous CCK released by a fatty meal delays gastric emptying and inhibits gastric acid and plasma gastrin responses in healthy subjects, but in DU patients the inhibitory effect of CCK is less pronounced, suggesting a defect in the action of this hormone on gastrin release and gastric acid secretion.

Nitric oxide and the interrelation between intestinal motility and pancreatic secretion in fasted and fed dogs

Intestinal motility and pancreatic secretion show synchronous cyclic changes (MMC) that are interrupted by feeding. The aim of this study was to determine the possible implication of nitric oxide (NO) (that was proposed as nonadrenergic noncholinergic neurotransmitter) in the motor and secretory components of MMC in 5 conscious dogs equipped with monopolar electrodes implanted along the small bowel and pancreatic fistulas. In fasted dogs with typical MMCs, L-NNA (an inhibitor of NO synthase) (5 mg/kg-h i.v.) decreased the MMC interval from control value of 80 +/- 7 to 60 +/- 4 min while increasing significantly the slow waves with spikes and suppressing the phase III-related increase in pancreatic secretion. Infusion of L-arginine (L-Arg) (a substrate of NO synthase) (10 mg/kg-h i.v.) increased the MMC interval from control 79 +/- 7 to 96 +/- 8 min and reduced the slow waves spikes by about 25%. Pancreatic secretion showed significant increase to about 20%. CCK maximum. Similar but transient effects were observed when glyceryl trinitrate (GTN) (a donor of NO) (1 mg/kg-h) was administered. After ingestion of meal, the MMC cycles were replaced by irregular spike activity with an average of about 35% slow waves with spikes and pancreatic secretion rose to about 70% of CCK maximum. Infusion of L-Arg (10 mg/kg-h) reduced by about 90% the postprandial spike activity but failed to affect significantly the pancreatic secretion. Also, injection of GTN (1 mg/kg-h) reduced the spike activity but did not influence pancreatic secretion. L-NNA in fed dogs caused an initial increase in spike activity followed by phase III and about 60% inhibition of pancreatic secretion. L-NNA added to L-Arg infusion reversed in part both intestinal motility and pancreatic secretory effects of L-Arg infusion. We conclude that NO system exerts a tonic inhibitory influence on intestinal myoelectric activity by reducing the frequency of MMC pacesetter and by suppressing the postprandial activity but stimulates pancreatic secretion.

Microcirculatory and motor effects of endogenous nitric oxide in the rat gut

The aim of the study was to determine the role of endogenous nitric oxide (NO) as the mediator of intestinal blood flow and motility. Experiments were performed on anesthetized rats. Blood flow in the jejunum was determined by Laser-Doppler flowmeter. Motility was monitored on the basis of changes in intrajejunal pressure. Systemic arterial pressure was also recorded. To investigate the potential role of nitric oxide in the regulation of basal intestinal blood flow and motility the NO synthase inhibitor NG-nitro-L-arginine (L-NNA) was given systemically. Intravenous bolus of L-NNA (15 mg/kg) reduced basal intestinal blood flow and increased both intestinal motility and arterial pressure in the dose-dependent manner. To test the specificity of the NO synthase blockade we administered L-arginine alone or in combination with L-NNA. Pretreatment with L-arginine (100.0 mg/kg i.v.) alone had no major influence but when combined with L-NNA it reversed the intestinal circulatory and motor effects of L-NNA. The results of these studies suggest that endogenous NO exerts a tonic relaxatory influence on the smooth muscle of the intestinal vessels and intestinal wall.

Nitric oxide inhibits the myoelectric activity of the small intestine in dogs

Intestinal motility in fasted animals shows cyclic changes (MMC) that are interrupted by feeding. The aim of this study was to determine the possible implication of nitric oxide (NO) (that was proposed as nonadrenergic noncholinergic neurotransmitter) in the motor components of MMC in 5 conscious dogs equipped with monopolar electrodes implanted along the small bowel. In fasted dogs with typical MMCs, L-NNA (an inhibitor of NO synthase) (5 mg/kg-h i.v.) decreased the MMC interval from control 80 +/- 7 to 60 +/- 4 min and increased significantly the spike activity. Infusion of L-arginine (L-Arg) (a substrate of NO synthase) (10 mg/kg-h i.v.) increased the MMC interval from control 79 +/- 7 to 96 +/- 8 min and reduced the slow waves with spikes by about 25%. Similar but transient effects were observed when glycerin trinitrate (GTN) (a donor of NO) (1 mg/kg-h) was administered. After ingestion of meal, the MMC cycles were replaced by irregular spike activity with an average of about 35% slow waves with spikes. Infusion of L-Arg (10 mg/kg-h) reduced by about 90% the postprandial spike activity. Also, infusion of GTN (1 mg/kg-h) strongly reduced the postprandial spike activity. L-NNA in fed dogs caused an initial increase in spike activity followed by phase III-like activity. Similar effects were obtained when L-NNA was infused in dogs with fed-like motility patterns induced by i.v. infusion of caerulein (75 pmol/kg-h). L-NNA added to L-Arg infusion reversed in part the changes of intestinal motility patterns induced by L-Arg. We conclude that NO system exerts a tonic inhibitory influence on intestinal myoelectric activity by reducing the frequency of MMC pacesetter and by suppressing the postprandial spike activity.

Role of cholecystokinin in postprandial and vagally stimulated duodenal and gallbladder motility in dogs

This study was designed to determine the role of cholecystokinin (CCK) in postprandial motility pattern of the duodenum and gallbladder (GB) in conscious dogs provided with chronic duodenal electrodes for recording of myoelectric activity and GB fistulas for measurement of intraluminal pressure and volume of GB and to calculate the GB motility index (MI) and GB emptying rate. During naturally occurring activity front (phase III MMC) in the duodenum there was significant increase in the MI of GB accompanied by about 20-30% reduction in the GB volume. These changes in duodenal and GB motility pattern could be duplicated by i.v. motilin. Feeding abolished the appearance of spontaneous activity front in the duodenum and greatly increased motility of GB while reducing its volume. Administration of CCK receptor antagonists in fed dogs failed to affect the motility changes induced by meal in the duodenum but abolished these of the GB. Vagal cholinergic stimulation with insulin, 2DG or urecholine caused similar effects to that induced by food i.e. increased duodenal spike activity, abolished phase III of the MMC, decreased GB volume and increased GB motility. Pretreatment with CCK antagonists did not affect significantly duodenal spike activity or GB motility but significantly increased the GB volume. Atropine 125 micrograms/kg) blocked almost completely spontaneous activity front in the duodenum and accompanying alterations in the motility and volume of GB. We conclude that CCK contributes to the MMC related alterations in the GB motor activity and is essential in cholinergic stimulation induced of the GB emptying but not in vagally induced duodenal and GB motility.

Cholecystokinin in the regulation of intestinal motility and pancreatic secretion in dogs

Peptidal (CR-1409) and nonpeptidal (L-364,718) cholecystokinin (CCK) receptor antagonists were used to determine the possible involvement of CCK in the fasted and fed intestinal motility patterns and the related alterations in pancreatic secretion. Dogs were implanted with electrodes along the small bowel and with chronic pancreatic fistulas. In fasted dogs, the typical migrating motor complex (MMC) cycles and accompanying fluctuations in pancreatic secretion were recorded. Neither of the CCK antagonists affected these motor and secretory components of the MMC. Feeding interrupted the MMC and increased spike activity at all levels of the small bowel, and this was accompanied by a significant increase in pancreatic secretion and in plasma hormone [gastrin, CCK, and pancreatic polypeptide (PP)] levels. Both CCK antagonists significantly reduced the postprandial spike activity but failed to restore the fasted pattern. Exogenous gastrin and CCK, as well as bombesin, induced fedlike motility patterns accompanied by marked pancreatic protein secretion. These effects were completely reversed to the fasted patterns during intravenous infusion of CCK antagonists. In contrast, cholinergic stimulation (bethanechol) induced a fedlike pattern that was more resistant to CCK antagonists. We conclude that CCK does not play a major role in the fasted motility pattern and related fluctuations in pancreatic secretion but may be partly involved (by itself and by released PP) in the induction of the fed motility pattern and the postprandial stimulation of the exocrine pancreas.

Vagal cholinergic control of gastric alkaline secretion in normal subjects and duodenal ulcer patients

Gastric alkaline secretion was determined in ranitidine treated healthy subjects and duodenal ulcer (DU) patients using gastric perfusion aspiration system and back titration of gastric perfusate to original pH 6.0. Basal alkaline secretion showed periodic fluctuations reaching peaks at phase III of the migrating motor complex (MMC) in the stomach. Mean basal alkaline secretion in healthy normals and DU patients averaged 1120 +/- 124 and 880 +/- 72 mumol/h, respectively and no correlation was found between basal and maximally stimulated gastric acid and alkaline secretion. Modified sham feeding in normal subjects and in DU patients increased this secretion to the peaks of about 28 and 36% of the maximal alkaline response to intragastric application of 16,16 dimethyl-PGE2 in these subjects. Vagotomy did not affect significantly basal alkaline secretion but prevented the rise in alkaline secretion induced by modified sham feeding. Atropine (5-20 micrograms/kg) decreased dose dependently basal, and prevented the modified sham feeding induced alkaline secretion, while pirenzepine (5-20 micrograms/kg) had little influence on basal, and did not affect the modified sham feeding induced, alkaline secretion. This study shows that basal gastric alkaline secretion fluctuates in phase with gastric motor activity, and is similar in normal and DU patients. Vagal stimulation strongly increases alkaline secretion, the effect being abolished by vagotomy and atropine, but not by pirenzepine, suggesting the involvement of M2 rather than M1 subtypes of muscarinic receptors in this stimulation.

Cephalic phase of gastroduodenal alkaline secretion

Alkaline secretion measured under basal conditions in the intact stomach of conscious dogs averaged 47 mumol/30 min and was about twice lower than that recorded in the proximal (approximately 7 cm long) portion of the duodenum. Vagal excitation elicited by sham feeding and insulin resulted in a marked stimulation of alkaline secretion both from the stomach and the duodenum. Atropine significantly reduced gastric and duodenal alkaline secretion under basal state. It abolished gastric and diminished duodenal alkaline response to sham feeding and insulin hypoglycemia, while propranolol was without significant influence. Indomethacin reduced by approximately 75% basal duodenal alkaline secretion but did not prevent the increment in alkaline response to vagal stimulation. We postulate the existence of the cephalic phase of gastroduodenal alkaline secretion, which seems to be cholinergically dependent in the stomach and partly of noncholinergic and nonadrenergic character but prostaglandin dependent in the duodenum.

Role of GIP and insulin in glucose-induced changes in intestinal motility patterns

This study was designed to correlate the intestinal motility patterns with duodenal glucose loads and the increments in plasma gastric inhibitory peptide (GIP) and insulin levels after these loads or after the administration of exogenous hormones in conscious dogs. Isotonic glucose instilled intraduodenally at lower loads (5.2-42.4 mmol/h) only caused a moderate increase in spike activity, but at higher loads (84.8 mmol/h) it disrupted migrating myoelectric complexes (MMC), being accompanied by marked increases in plasma GIP and insulin levels. Duodenal loads of isotonic mannitol resulted in similar motility changes but without alteration in plasma GIP or insulin. Hypertonic glucose (20%) in the duodenum also caused an increase in spike activity, and at higher loads (72 mmol/h or higher) it disrupted MMCs and resulted in significant increments in plasma GIP and insulin levels. Physiological doses of exogenous GIP (25-400 pmol X kg-1 X h-1) or insulin (12-24 mU X kg-1 X h-1) did not affect the motility pattern, but at higher doses, raising plasma hormone over the levels occurring after a mixed meal, GIP (400 pmol X kg-1 X h-1) increased significantly the MMC interval, whereas insulin (48-96 pmol X kg-1 X h-1) induced a fed-like motility pattern. Intravenous 20% glucose (72 mmol/h) caused a marked rise in plasma insulin (but not GIP) levels but failed to affect the intestinal motility as did 20% mannitol infused intravenously in the same dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Relation between duodenal alkaline secretion and motility in fasted and sham-fed dogs

A relation between duodenal myoelectric and motor activity and alkaline secretion has been investigated in conscious dogs under basal conditions and following vagal excitation with and without pretreatment with atropine or indomethacin. It was found that duodenal alkaline secretion shows typical periodicity in phase with the myoelectric or motor activity of the duodenum, reaching a peak during phase III and a nadir during phase I of the migrating motor complex (MMC). Sham feeding interrupted the motor and secretory MMC cycle and caused a prolonged increase in duodenal myoelectric or motor activity as well as a sudden and marked rise in duodenal alkaline secretion accompanied by a significant elevation in plasma gastrin and pancreatic polypeptide. Atropine and indomethacin abolished the motor and secretory duodenal cycles and reduced basal alkaline secretion significantly. Atropine abolished, whereas indomethacin increased duodenal myoelectric or motor activity during basal conditions and after vagal stimulation. Neither atropine nor indomethacin abolished sham feeding-induced duodenal alkaline secretion. We conclude that duodenal alkaline secretion fluctuates cyclically in phase with duodenal motility, vagal excitation results in a potent stimulation of duodenal motor and secretory activity, and the mechanism of vagally induced duodenal alkaline secretion is only partly cholinergic and does not involve endogenous generation of prostaglandins.

Cephalic phase of gastroduodenal alkaline secretion

This study was designed to determine gastric alkaline secretion (GAS) and duodenal alkaline secretion (DAS) and their relation to the duodenal motility pattern in conscious dogs under basal conditions and after vagal stimulation by sham-feeding and insulin hypoglycaemia. GAS was measured in the gastric perfusate and DAS was determined in the perfusate of the upper duodenum (7 cm in length between occluding balloons). Resting GAS and DAS showed typical periodicity in phase with myoelectric and motor activity, reaching peaks during phases II and III, respectively, and nadir during phase I of the migrating motor cycle (MMC). Vagal excitation by sham-feeding or insulin hypoglycaemia resulted in an immediate rise in GAS and DAS, accompanied by a suppression of MMC. Atropine (25 micrograms/kg) reduced basal GAS and DAS by about 50% and abolished GAS but not DAS in response to vagal stimulation, being accompanied by complete suppression of MMC for several hours. Following injection of indomethacin (2.5 mg/kg) to suppress the generation of endogenous prostaglandins, a prolonged reduction in basal GAS and DAS and an increase in the myoelectric activity and the disruption of the MMC occurred. Neither GAS nor DAS responses to vagal stimulation were affected by indomethacin. We conclude that resting GAS and DAS fluctuate cyclically in phase with gastroduodenal motor activity, and that vagal excitation results in a potent stimulation of alkaline secretion and myoelectric activity which are, in part, cholinergic and do not depend upon the generation of endogenous prostaglandins.

Gastrointestinal secretory, motor and circulatory effects of corticotropin releasing factor (CRF)

This study was designed to determine the effects of CRF on the gastrointestinal functions such as secretion, motility and circulation in dogs. CRF was found to inhibit dose-dependently gastric acid response to pentagastrin but not to histamine. CRF stimulated pancreatic bicarbonate and protein secretion under basal conditions and in response to secretin or cholecystokinin (CCK). This stimulation was accompanied by an increase in plasma levels of pancreatic polypeptide (PP), but not of secretin or gastrin. CRF caused a partial inhibition of the migrating motor complexes in fasted dogs and increased spike activity of the small bowel. These motor effects of CRF probably resulted from the action of the released PP on the intestinal smooth muscle. CRF is also a potent and selective stimulant of the mesenteric blood flow. This effect may be secondary to the stimulation of intestinal motility and metabolism.

Role of prostaglandins in control of intestinal motility

Intestinal myoelectric activity was measured in four conscious dogs with implanted monopolar electrodes after administration of prostaglandins (PG) and indomethacin (Indo), a potent inhibitor of PG biosynthesis. PGE2 and PGI2 given intravenously caused a dose-dependent decrease in the frequency of the migrating myoelectric complex (MMC) in fasted dogs and in postprandial spike activity in fed animals. In contrast, PGF2 alpha interrupted the MMC and caused a fedlike pattern in fasted dogs and did not affect the postprandial spike activity. Similar effects were observed after intra-arterial infusion of PGs. PGE2 and PGI2 infused into the superior mesenteric artery caused a dose-dependent inhibition of the fasted and postprandial pattern of myoelectric activity of the small bowel, whereas PGF2 alpha blocked the MMC and increased spike activity. Indo injected in a single intravenous dose caused a significant reduction in the MMC interval, and Indo infused intravenously in a constant dose induced fedlike motility pattern in fasted dogs but had little effect on the postprandial activity in these animals. This study demonstrates that exogenous PGs of E and I series administered intravenously or intra-arterially inhibit intestinal motility, whereas PGF2 alpha has opposite effects. The finding that Indo increases intestinal motility indicates that endogenous PGs are important in the physiological control of intestinal motility.

Influence of methionine-enkephalin and morphine on myoelectric activity of small bowel

Enkephalins, naturally occurring peptides with powerful opiatelike effects, have recently been detected throughout the tissues of the alimentary tract, but their role is unknown. This study was designed to compare the effects of methionine-enkephalin (met-enkephalin) and morphine on the myoelectrical pattern of the small bowel. Five conscious dogs were prepared with electrodes spaced 25 cm apart along the entire small intestine. Spike activity and slow waves were recorded with a Beckman Dynograph. Records were obtained in fasted conditions and following a meat meal or intravenous infusion of caerulein while animals received intravenous infusion of either met-enkephalin or morphine in various doses (range 10-160 microgram/kg . h). Met-enkephalin at a dose of 40 microgram/kg . h caused a significant decrease in spike activity and in the frequency of bursts of the interdigestive myoelectric complexes (IMC), whereas morphine almost doubled the frequency of the IMC. Met-enkephalin in dogs given food or infused with caerulein significantly decreased the fed-type spike activity of the small bowel, whereas morphine did not affect it. The effects of met-enkephalin and morphine on the intestinal myoelectrical pattern can be reversed by naloxone, an opioid antagonist, suggesting that they are mediated by separate opioid receptors.