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Mucosal blood flow measurements using laser Doppler perfusion monitoring

World Journal of Gastroenterology 2009年第2期15卷 198-203页

作者： Dag Arne Lihaug Hoff Hans Gregersen jan gunnar hatlebakk Institute of Medicine University of Bergen NO-5021 Bergen Norway National Centre for Ultrasound in Gastroenterology Department of Medicine Haukeland University Hospital NO-5021 Bergen Norway Deparment of Medicine Aalesund Hospital Aalesund Norway Mech-Sense Aalborg Hospital 9000 Aalborg Denmark

Perfusion of individual tissues is a basic physiological process that is necessary to sustain oxygenation and nutrition at a cellular level. Ischemia, or the insuff iciency of perfusion, is a common mechanism for tissue death or degeneration, and at a lower threshold, a mechanism for the generation of sensory signalling including pain. It is of considerable interest to study perfusion of pe- ripheral abdominal tissues in a variety of circumstances. Microvascular disease of the abdominal organs has been implicated in the pathogenesis of a variety of disorders, including peptic ulcer disease, inflammatory bowel disease and chest pain. The basic principle of laser Doppler perfusion monitoring (LDPM) is to analyze changes in the spectrum of light reflected from tissues as a response to a beam of monochromatic laser light emitted. It reflects the total local microcirculatory blood perfusion, including perfusion in capillaries, arterioles, venules and shunts. During the last 20-25 years, numerous studies have been performed in different parts of the gastroin-testinal (GI) tract using LDPM. In recent years we have developed a multi-modal catheter device which includes a laser Doppler probe, with the intent primarily to investigate patients suffering from functional chest pain of presumed oesophageal origin. Preliminary studies show the feasibility of incorporating LDPM into such catheters for performing physiological studies in the GI tract. LDPM has emerged as a research and clinical tool in preference to other methods; but, it is important to be aware of its limitations and account for them when reporting results.

关键词： Laser Doppler perfusion monitoring Gastrointestinal tract Mucosal blood flow Perfusion Chest pain

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Reduction in duodenal endocrine cells in irritable bowel syndrome is associated with stem cell abnormalities

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World Journal of Gastroenterology 2015年第32期21卷 9577-9587页

作者： Magdy El-Salhy jan gunnar hatlebakk Trygve Hausken Section for Neuroendocrine Gastroenterology Division of Gastroenterology Department of Clinical Medicine University of Bergen National Centre for Functional Gastrointestinal Disorders Department of Medicine Haukeland University Hospital Section for Gastroenterology Department of Medicine Stord Hospital

AIM: To determine whether the decreased density of duodenal endocrine cells in irritable bowel syndrome(IBS) is associated with abnormalities in stem cell ***: The study sample comprised 203 patients with IBS(180 females and 23 males with a mean age of 36 years) and a control group of 86 healthy subjects without gastrointestinal complaints(77 females and 9 males with a mean age of 38 years). The patients included 80 with mostly diarrhoea(IBS-D), 47 with both diarrhoea and constipation(IBS-M), and 76 with mostly constipation(IBS-C). Both the patients and controls underwent gastroscopy and four biopsy samples were taken from the descending part of the duodenum, proximal to the papilla of Vater. The biopsy samples were sectioned and immunostained for Musashi 1(Msi-1), neurogenin 3(NEUROG3), secretin, cholecystokinin(CCK), gastric inhibitory peptide(GIP), somatostatin and serotonin. Immunostainingwas performed with an ultra View Universal DAB Detection Kit(v1.02.0018, Venata Medical Systems, Basal, Switzerl and) using the Bench Mark Ult ra immunohistochemistry/in situ hybridization staining module(Venata Medical Systems). Endocrine cell densities were quantified by computerized image analysis using the Olympus cell Sens imaging ***: The densities of Msi-1 and NEUROG3 cells were significantly lower in IBS patients, regardless of the subtype, than in the controls(77 ± 17 vs 8 ± 2; P = 0.0001, and 351 ± 33 vs 103 ± 22; P = 0.00002, respectively). Furthermore, the densities of secretin, and CCK cells were significantly lower in patients with diarrhoea as the predominant IBS symptom(IBS-D) than in the controls(161 ± 11 vs 88 ± 8; P = 0.00007, and 325 ± 41 vs 118 ± 10; P = 0.00006, respectively), but not in patients with constipation as the predominant IBS symptom(IBS-C) or those with both diarrhoea and constipation(IBS-M). The GIP cell density was significantly reduced in both IBS-D(152 ± 12 vs 82 ± 7; P = 0.00003), and IBS-C(152 ± 12 vs 107 ±

关键词： Cholecystokinin Irritable bowel syndrome Musashi-1

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High densities of serotonin and peptide YY cells in the colon of patients with lymphocytic colitis

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World Journal of Gastroenterology 2012年第42期18卷 6070-6075页

作者： Magdy El-Salhy Doris Gundersen jan gunnar hatlebakk Trygve Hausken Section for Gastroenterology Department of MedicineStord Helse-Fonna HospitalBox 40005409 StordNorway Department of Research Helse-Fonna5528 HaugesundNorway Section for Gastroenterology Institute of MedicineUniversity of Bergen5029 BergenNorway

AIM： TO investigate colonic endocrine cells in lympho- cytic colitis （LC） patients. METHODS： Fifty-seven patients with LC were in- cluded. These patients were 41 females and 16 males, with an average age of 49 years （range 19-84 years）. Twenty-seven subjects that underwent colonoscopy with biopsies were used as controls. These subjects underwent colonoscopy because of gastrointestinal bleeding or health worries, where the source of bleed- ing was identified as haemorrhoids or angiodysplasia. They were 19 females and 8 males with an average age of 49 years （range 18-67 years）. Biopsies from the right and left colon were obtained from both patients and controls during colonoscopy. Biopsies were fixed in 4% buffered paraformaldehyde, embedded in paraffin and cut into 5 μm-thick sections. The sections immunostained by the avidin-biotin-complex method for se- rotonin, peptide YY （PYY）, pancreatic polypeptide （PP） enteroglucagon and somatostatin cells. The cell densi- ties were quantified by computerised image analysis using Olympus software. RESULTS： The colon of both the patient and the control subjects were macroscopically normal. Histo- pathological examination of colon biopsies from con- trols revealed normal histology. All patients fulfilled the diagnosis criteria required for of LC： an increase in intraepithelial lymphocytes （〉 20 lymphocytes/100 epithelial cells） and surface epithelial damage with increased lamina propria plasma cells and absent or minimal crypt architectural distribution. In the colon of both patients and control subjects, serotonin-, PYY-, PP-, enteroglucagon- and somatostatin-immunoreac- tive cells were primarily located in the upper part of the crypts of Lieberk0hn. These cells were basket- or flask-shaped. There was no statistically significant dif- ference between the right and left colon in controls with regards to the densities of serotonin- and PYY- immunoreactive cells （P = 0.9 and 0.1, respectively）. Serotonin cell density in the right

关键词： Colon Computer image analysis Immuno-histochemistry Lymphocytic colitis Peptide YY Serotonin

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Gastrointestinal neuroendocrine peptides/amines in inflammatory bowel disease

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World Journal of Gastroenterology 2017年第28期23卷 5068-5085页

作者： Magdy El-Salhy Tefera Solomon Trygve Hausken Odd Helge Gilja jan gunnar hatlebakk Division of Gastroenterology Department of MedicineStord Hospital Department of Clinical Medicine University of Bergen National Centre for Functional Gastrointestinal Disorders Department of MedicineHaukeland University Hospital Department of Medicine Haraldsplass Diakonale Hospital National Centre for Ultrasound in Gastro enterology Department of MedicineHaukeland University Hospital

Inflammatory bowel disease(IBD) is a chronic recurrent condition whose etiology is unknown,and it includes ulcerative colitis,Crohn's disease,and microscopic colitis. These three diseases differ in clinical manifestations,courses,and prognoses. IBD reduces the patients' quality of life and is an economic burden to both the patients and society. Interactions between the gastrointestinal(GI) neuroendocrine peptides/amines(NEPA) and the immune system are believed to play an important role in the pathophysiology of IBD. Moreover,the interaction between GI NEPA and intestinal microbiota appears to play also a pivotal role in the pathophysiology of IBD. This review summarizes the available data on GI NEPA in IBD,and speculates on their possible role in the pathophysiology and the potential use of this information when developing treatments. GI NEPA serotonin,the neuropeptide Y family,and substance P are proinflammatory,while the chromogranin/secretogranin family,vasoactive intestinal peptide,somatostatin,and ghrelin are antiinflammatory. Several innate and adaptive immune cells express these NEPA and/or have receptors to them. The GI NEPA are affected in patients with IBD and in animal models of human IBD. The GI NEPA are potentially useful for the diagnosis and follow-up of the activity of IBD,and are candidate targets for treatments of this disease.

关键词： Enteric nervous system Enteroendocrine cells Immune cells Inflammatory bowel disease Musashi-1 Neurogenin 3 Stem cells

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Responses to faecal microbiota transplantation in female and male patients with irritable bowel syndrome

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World Journal of Gastroenterology 2021年第18期27卷 2219-2237页

作者： Magdy El-Salhy Christina Casen Jørgen Valeur Trygve Hausken jan gunnar hatlebakk Department of Medicine Stord Helse-Fonna HospitalStord 5416Norway Department of Clinical Medicine University of BergenBergen 5020Norway National Centre for Functional Gastrointestinal Disorders Department of MedicineHaukeland University HospitalBergen 5020Norway Genetic Analysis AS Oslo 0485Norway Unger-Vetlesen Institute Lovisenberg Diaconal HospitalOslo 0440Norway

BACKGROUND Faecal microbiota transplantation(FMT)seems to be a promising treatment for irritable bowel syndrome(IBS)*** Western countries(United States and Europe),there is a female predominance in IBS.A sex difference in the response to FMT has been reported recently in IBS *** To investigate whether there was a sex difference in the response to FMT in the IBS patients who were included in our previous randomized controlled trial of the efficacy of *** The study included 164 IBS patients who participated in our previous randomized controlled *** patients had moderate-to-severe IBS symptoms belonging to the IBS-D(diarrhoea-predominant),IBS-C(constipation-predominant)and IBSM(mixed)subtypes,and had not responded to the National Institute for Health and Care Excellence(NICE)-modified *** belonged in three groups:placebo(own faeces),and active treated group(30-g or 60-g superdonor faeces).The patients completed the IBS severity scoring system(IBS-SSS),Fatigue Assessment Scale(FAS)and the IBS quality of life scale(IBS-QoL)questionnaires at the baseline and 2 wk,1 mo and 3 mo after *** also provided faecal samples at the baseline and 1 mo after *** faecal bacteria profile and dysbiosis were determined using the 16S rRNA gene polymerase chain reaction DNA amplification covering V3-V9;probe labelling by single nucleotide extension and signal *** levels of short-chain fatty acids(SCFAs)were determined by gas chromatography and flame *** There was no sex difference in the response to FMT either in the placebo group or active treated *** was no difference between females and males in either the placebo group or actively treated groups in the total score on the IBS-SSS,FAS or IBS-QoL,in dysbiosis,or in the faecal bacteria or SCFA ***,the response rate was significantly higher in females with diarrhoea-predominant(IBS-D)than that of males at 1 mo,and 3 mo after ***,IBS-SSS total

关键词： Dysbiosis Fatigue Microbiome Quality of life Short-chain fatty acids Superdonor

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Is irritable bowel syndrome an organic disorder?

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World Journal of Gastroenterology 2014年第2期20卷 384-400页

作者： Magdy El-Salhy Doris Gundersen Odd Helge Gilja jan gunnar hatlebakk Trygve Hausken Section for Gastroenterology Department of MedicineStord Helse-Fonna Hospital5409 StordNorway Section for Gastroenterology Department of Clinical MedicineUniversity of Bergen 5006 BergenNorway Department of Research Helse-Fonna5528 HaugesundNorway

Irritable bowel syndrome(IBS) is a common gastrointestinal disorder that is generally considered to be functional because there appears to be no associated anatomical defect. Stress and psychological factors are thought to play an important role in IBS. The gut neuroendocrine system(NES),which regulates all functions of the gastrointestinal tract,consists of endocrine cells that are scattered among the epithelial cells of the mucosa,and the enteric nervous system. Although it is capable of operating independently from the central nervous system(CNS),the gut NES is connected to and modulated by the CNS. This review presents evidence for the presence of an anatomical defect in IBS patients,namely in the gastrointestinal endocrine cells. These cells have specialized microvilli that project into the lumen and function as sensors for the luminal content and respond to luminal stimuli by releasing hormones into the lamina propria,which starts a chain reaction that progresses throughout the entire NES. The changes in the gastrointestinal endocrine cells observed in IBS patients are highly consistent with the other abnormalities reported in IBS patients,such as visceral hypersensitivity,dysmotility,and abnormal secretion.

关键词： Cholecystokinin Dysmotility Endocrine cells Enteric nervous system Ghrelin Peptide YY Secretion Secretin Serotonin Visceral hypersensitivity

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Endocrine cells in the ileum of patients with irritable bowel syndrome

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World Journal of Gastroenterology 2014年第9期20卷 2383-2391页

作者： Magdy El-Salhy Odd Helge Gilja Doris Gundersen jan gunnar hatlebakk Trygve Hausken Section for Gastroenterology Department of Medicine Stord Helse-Fonna Hospital 54 09 Stord Norway Section for Gastroenterology Department of Clinical Medicine University of Bergen 50 00 Bergen Norway Department of Research Helse-Fonna 55 01 Haugesund Norway

AIM: To study the ileal endocrine cell types in irritable bowel syndrome (IBS) patients.

关键词： Computer image analysis Irritable bowel syndrome Ileum Peptide YY Serotonin

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Advanced imaging and visualization in gastrointestinal disorders

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World Journal of Gastroenterology 2007年第9期13卷 1408-1421页

作者： Odd Helge Gilja jan G hatlebakk Svein φdegaard Arnold Berstad Ivan Viola Christopher Giertsen Trygve Hausken Hans Gregersen National Centre for Ultrasound in Gastroenterology Department of Medicine Haukeland University HospitalNorwayInstitute of Medicine3Institute of Informatics University of Bergen Bergen Norway Institute of Medicine 3Institute of Informatics University of Bergen Bergen Norway National Centre for Ultrasound in Gastroenterology Department of Medicine Haukeland University HospitalNorwayInstitute of Medicine3Institute of Informatics University of Bergen Bergen Norway Institute of Informatics University of BergenBergenNorway Christian michelsen Research AS Bergen Norway National Centre for Ultrasound in Gastroenterology Department of Medicine Haukeland University HospitalNorwayInstitute of Medicine3Institute of Informatics University of Bergen Bergen Norway Institute of Medicine 3Institute of Informatics University of BergenBergen NorwayCenter foe Visceral Biomechanics and PainAalborg Hospital and Center for Sensory-motor InteractionAalborg universityDenmark

Advanced medical imaging and visualization has a strong impact on research and clinical decision making in gastroenterology. The aim of this paper is to show how imaging and visualization can disclose structural and functional abnormalities of the gastrointestinal (GI) tract. Imaging methods such as ultrasonography, magnetic resonance imaging (MRI), endoscopy, endosonography, and elastography will be outlined and visualization with Virtual Reality and haptic methods. Ultrasonography is a versatile method that can be used to evaluate antral contractility, gastric emptying, transpyloric flow, gastric configuration, intragastric distribution of meals, gastric accommodation and strain measurement of the gastric wall. Advanced methods for endoscopic ultrasound, three-dimensional (3D) ultrasound, and tissue Doppler (Strain Rate Imaging) provide detailed information of the GI tract. Food hypersensitivity reactions including gastrointestinal reactions due to food allergy can be visualized by ultrasonography and MRI. Development of multi-parametric and multi-modal imaging may increase diagnostic benefits and facilitate fusion of diagnostic and therapeutic imaging in the future.

关键词： Ultrasonography Medical imaging Functional imaging Elasticity

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Experimental measurements of surgical microenvironments in two operating rooms with laminar airflow and mixing ventilation systems

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Energy and Built Environment 2021年第2期2卷 149-156页

作者： Guangyu Cao Ingeborg Kvammen Thea Amalie Solberg Hatten Yixian Zhang Liv-Inger Stenstad Gabriel Kiss jan gunnar Skogås Department of Energy and Process Engineering Norwegian University of Science and TechnologyKolbjørn Hejes Vei 1B7491 TrondheimNorway Faculty of Urban Construction and Environmental Engineering Chongqing UniversityChongqing 40045China Operating Room of the Future at St.Olavs Hospital St.Olavs HospitalOlav Kyrres Gate 107030 TrondheimNorway

At present,laminar airflow(LAF)systems and mixing ventilation(MV)systems are two commonly used ventila-tion solutions for operating rooms(ORs)to ensure the required indoor air ***,recent studies have shown that there is little difference in the prevalence of surgical site infection(SSI)for the LAF systems and MV *** objective of this study was to compare the performance of an LAF system with an MV system in ORs at *** hospital,*** this study,all the experimental measurements were conducted in real ORs with LAF and MV *** study found that the air velocity above the surgical incision is approximately two times higher in the OR with LAF than that in the OR with *** use of surgical lamps and different airflow patterns may contribute to the different surgical microenvironment of ORs with LAF and MV.

关键词： Operating room Laminar airflow Mixing ventilation Surgical microenvironment Thermal environment

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Imaging for Minimally Invasive Surgery

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Surgical Science 2016年第8期7卷 333-341页

作者： jan gunnar Skogås Hans Olav Myhre Asbjørn Ødegård Gabriel Kiss Operating Rooms of the Future St. Olavs Hospital University Hospital of Trondheim and the Norwegian University of Science and Technology Trondheim Norway Clinic of Radiology and Nuclear Medicine St. Olavs University Hospital Trondheim Norway

The successful outcome of any minimally invasive procedure is highly dependent on the imaging chain, as the medical team has to rely on indirect visualization of the surgical field during the entire procedure. During the last decade, the quality of the images obtainable pre- and intraoperatively has evolved significantly. In addition to the introduction of intra-operative image acquisition techniques such as ultrasound, X-ray, CT or MR, optical imaging technology as well as the corresponding processing units have undergone a rapid development. The article will review the activity related to minimally invasive procedures at the Operating Rooms of the Future (FOR) at St. Olavs Hospital, University Hospital of Trondheim, Norway. The imaging related demands of several surgical fields are introduced and the evolution of the imaging and visualization techniques at FOR will be presented. Subsequently, ongoing research projects in a dedicated visualization laboratory will be discussed and the advantages of updating the imaging equipment continuously in order to keep up with the latest developments in the field will be presented. It will be shown that the quality of the image acquisition and display can be significantly improved when compared to today’s standard. In addition to increasing the surgeon’s confidence, better imaging will lead to increased patient safety as well as more efficient interventions.

关键词： Minimally Invasive Surgery Medical Imaging and Visualization Operating Room of the Future

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