Group items tagged

Duke offers a road map for creating a group “decision pod” that can provide us with feedback. Focus on accuracy, accountability, and openness to diverse views. Set clear rules: Court dissent and differing perspectives, and take responsibility even when doing so is painful.

formed to improve viewpoint diversity in academia: Commit to transparency and sharing information; apply consistent standards to claims made by separating information from who is providing it; cultivate disinterestedness; seek “outcome blindness” to the hypothesis being tested; and encourage skepticism and dissent.

Duke explores how we can reduce conflict by shifting perspective among our past, present and futures selves via “mental time travel.” She suggests several techniques, including backcasting, premortems, and Ulysses contracts.

Duke also addresses how we outweigh the present over the future. When we reach for a donut instead of an apple, we’re doing so at the expense of our future self

Some are motivated by potential business revenue, others by national security concerns.

Sometimes, they trade letters, opinion essays or social threads outlining their positions and attacking others’ in public view. More often, they tout their viewpoints without acknowledging alternatives, leaving the impression that their enlightened perspective is the inevitable lens through which to view A.I.

you’ll realize this isn’t really a debate only about A.I. It’s also a contest about control and power, about how resources should be distributed and who should be held accountable.

It is critical that we begin to recognize the ideologies driving what we are being told. Resolving the fracas requires us to see through the specter of A.I. to stay true to the humanity of our values.

Because language itself is part of their battleground, the different A.I. camps tend not to use the same words to describe their positions

One faction describes the dangers posed by A.I. through the framework of safety, another through ethics or integrity, yet another through security and others through economics.

The Doomsayers

These are the A.I. safety people, and their ranks include the “Godfathers of A.I.,” Geoff Hinton and Yoshua Bengio. For many years, these leading lights battled critics who doubted that a computer could ever mimic capabilities of the human mind

Many doomsayers say they are acting rationally, but their hype about hypothetical existential risks amounts to making a misguided bet with our future

Reasonable sounding on their face, these ideas can become dangerous if stretched to their logical extremes. A dogmatic long-termer would willingly sacrifice the well-being of people today to stave off a prophesied extinction event like A.I. enslavement.

The technology historian David C. Brock calls these fears “wishful worries” — that is, “problems that it would be nice to have, in contrast to the actual agonies of the present.”

OpenAI’s Sam Altman and Meta’s Mark Zuckerberg, both of whom lead dominant A.I. companies, are pushing for A.I. regulations that they say will protect us from criminals and terrorists. Such regulations would be expensive to comply with and are likely to preserve the market position of leading A.I. companies while restricting competition from start-ups

the roboticist Rodney Brooks has pointed out that we will see the existential risks coming, the dangers will not be sudden and we will have time to change course.

While we shouldn’t dismiss the Hollywood nightmare scenarios out of hand, we must balance them with the potential benefits of A.I. and, most important, not allow them to strategically distract from more immediate concerns.

The Reformers

While the doomsayer faction focuses on the far-off future, its most prominent opponents are focused on the here and now. We agree with this group that there’s plenty already happening to cause concern: Racist policing and legal systems that disproportionately arrest and punish people of color. Sexist labor systems that rate feminine-coded résumés lower

Superpower nations automating military interventions as tools of imperialism and, someday, killer robots.

Propagators of these A.I. ethics concerns — like Meredith Broussard, Safiya Umoja Noble, Rumman Chowdhury and Cathy O’Neil — have been raising the alarm on inequities coded into A.I. for years. Although we don’t have a census, it’s noticeable that many leaders in this cohort are people of color, women and people who identify as L.G.B.T.Q.

Others frame efforts to reform A.I. in terms of integrity, calling for Big Tech to adhere to an oath to consider the benefit of the broader public alongside — or even above — their self-interest. They point to social media companies’ failure to control hate speech or how online misinformation can undermine democratic elections. Adding urgency for this group is that the very companies driving the A.I. revolution have, at times, been eliminating safeguards

reformers tend to push back hard against the doomsayers’ focus on the distant future. They want to wrestle the attention of regulators and advocates back toward present-day harms that are exacerbated by A.I. misinformation, surveillance and inequity.

Integrity experts call for the development of responsible A.I., for civic education to ensure A.I. literacy and for keeping humans front and center in A.I. systems.

Surely, we are a civilization big enough to tackle more than one problem at a time; even those worried that A.I. might kill us in the future should still demand that it not profile and exploit us in the present.

Other groups of prognosticators cast the rise of A.I. through the language of competitiveness and national security.

Some arguing from this perspective are acting on genuine national security concerns, and others have a simple motivation: money. These perspectives serve the interests of American tech tycoons as well as the government agencies and defense contractors they are intertwined with.

they appear deeply invested in the idea that there is no limit to what their creations will be able to accomplish.

U.S. megacompanies pleaded to exempt their general purpose A.I. from the tightest regulations, and whether and how to apply high-risk compliance expectations on noncorporate open-source models emerged as a key point of debate. All the while, some of the moguls investing in upstart companies are fighting the regulatory tide. The Inflection AI co-founder Reid Hoffman argued, “The answer to our challenges is not to slow down technology but to accelerate it.”

The warriors’ narrative seems to misrepresent that science and engineering are different from what they were during the mid-20th century. A.I. research is fundamentally international; no one country will win a monopoly.

As the science-fiction author Ted Chiang has said, fears about the existential risks of A.I. are really fears about the threat of uncontrolled capitalism

Regulatory solutions do not need to reinvent the wheel. Instead, we need to double down on the rules that we know limit corporate power. We need to get more serious about establishing good and effective governance on all the issues we lost track of while we were becoming obsessed with A.I., China and the fights picked among robber barons.

By analogy to the health care sector, we need an A.I. public option to truly keep A.I. companies in check. A publicly directed A.I. development project would serve to counterbalance for-profit corporate A.I. and help ensure an even playing field for access to the 21st century’s key technology while offering a platform for the ethical development and use of A.I.

Also, we should embrace the humanity behind A.I. We can hold founders and corporations accountable by mandating greater A.I. transparency in the development stage, in addition to applying legal standards for actions associated with A.I. Remarkably, this is something that both the left and the right can agree on.

Most A.I. researchers agree that models trained using R.L.H.F. are better behaved than models without it. But some argue that fine-tuning a language model this way doesn’t actually make the underlying model less weird and inscrutable. In their view, it’s just a flimsy, friendly mask that obscures the mysterious beast underneath.

In a nutshell, the joke was that in order to prevent A.I. language models from behaving in scary and dangerous ways, A.I. companies have had to train them to act polite and harmless. One popular way to do this is called “reinforcement learning from human feedback,” or R.L.H.F., a process that involves asking humans to score chatbot responses, and feeding those scores back into the A.I. model.

Shoggoths are fictional creatures, introduced by the science fiction author H.P. Lovecraft in his 1936 novella “At the Mountains of Madness.” In Lovecraft’s telling, Shoggoths were massive, blob-like monsters made out of iridescent black goo, covered in tentacles and eyes.

@TetraspaceWest said, wasn’t necessarily implying that it was evil or sentient, just that its true nature might be unknowable.

And it reinforces the notion that what’s happening in A.I. today feels, to some of its participants, more like an act of summoning than a software development process. They are creating the blobby, alien Shoggoths, making them bigger and more powerful, and hoping that there are enough smiley faces to cover the scary parts.

“I was also thinking about how Lovecraft’s most powerful entities are dangerous — not because they don’t like humans, but because they’re indifferent and their priorities are totally alien to us and don’t involve humans, which is what I think will be true about possible future powerful A.I.”

when Bing’s chatbot became unhinged and tried to break up my marriage, an A.I. researcher I know congratulated me on “glimpsing the Shoggoth.” A fellow A.I. journalist joked that when it came to fine-tuning Bing, Microsoft had forgotten to put on its smiley-face mask.

@TetraspaceWest, the meme’s creator, told me in a Twitter message that the Shoggoth “represents something that thinks in a way that humans don’t understand and that’s totally different from the way that humans think.”

In any case, the Shoggoth is a potent metaphor that encapsulates one of the most bizarre facts about the A.I. world, which is that many of the people working on this technology are somewhat mystified by their own creations. They don’t fully understand the inner workings of A.I. language models, how they acquire new capabilities or why they behave unpredictably at times. They aren’t totally sure if A.I. is going to be net-good or net-bad for the world.

That some A.I. insiders refer to their creations as Lovecraftian horrors, even as a joke, is unusual by historical standards. (Put it this way: Fifteen years ago, Mark Zuckerberg wasn’t going around comparing Facebook to Cthulhu.)

If it’s an A.I. safety researcher talking about the Shoggoth, maybe that person is passionate about preventing A.I. systems from displaying their true, Shoggoth-like nature.

A great many people are dismissive of suggestions that any of these systems are “really” thinking, because they’re “just” doing something banal (like making statistical predictions about the next word in a sentence). What they fail to appreciate is that there is every reason to suspect that human cognition is “just” doing those exact same things. It matters not that birds flap their wings but airliners don’t. Both fly. And these machines think. And, just as airliners fly faster and higher and farther than birds while carrying far more weight, these machines are already outthinking the majority of humans at the majority of tasks. Further, that machines aren’t perfect thinkers is about as relevant as the fact that air travel isn’t instantaneous. Now consider: we’re well past the Wright flyer level of thinking machine, past the early biplanes, somewhere about the first commercial airline level. Not quite the DC-10, I think. Can you imagine what the AI equivalent of a 777 will be like? Fasten your seatbelts.

@thomas h. You make my point perfectly. You’re observing that the way a plane flies — by using a turbine to generate thrust from combusting kerosene, for example — is nothing like the way that a bird flies, which is by using the energy from eating plant seeds to contract the muscles in its wings to make them flap. You are absolutely correct in that observation, but it’s also almost utterly irrelevant. And it ignores that, to a first approximation, there’s no difference in the physics you would use to describe a hawk riding a thermal and an airliner gliding (essentially) unpowered in its final descent to the runway. Further, you do yourself a grave disservice in being dismissive of the abilities of thinking machines, in exactly the same way that early skeptics have been dismissive of every new technology in all of human history. Writing would make people dumb; automobiles lacked the intelligence of horses; no computer could possibly beat a chess grandmaster because it can’t comprehend strategy; and on and on and on. Humans aren’t nearly as special as we fool ourselves into believing. If you want to have any hope of acting responsibly in the age of intelligent machines, you’ll have to accept that, like it or not, and whether or not it fits with your preconceived notions of what thinking is and how it is or should be done … machines can and do think, many of them better than you in a great many ways. b&

@BLA. You are incorrect. Everything has nature. Its nature is manifested in making humans react. Sure, no humans, no nature, but here we are. The writer and various sources are not attributing nature to AI so much as admitting that they don’t know what this nature might be, and there are reasons to be scared of it. More concerning to me is the idea that this field is resorting to geek culture reference points to explain and comprehend itself. It’s not so much the algorithm has no soul, but that the souls of the humans making it possible are stupendously and tragically underdeveloped.

When even tech companies are saying AI is moving too fast, and the articles land on page 1 of the NYT (there's an old reference), I think the greedy will not think twice about exploiting this technology, with no ethical considerations, at all.

@nome sane? The problem is it isn't data as we understand it. We know what the datasets are -- they were used to train the AI's. But once trained, the AI is thinking for itself, with results that have surprised everybody.

The unique feature of a shoggoth is it can become whatever is needed for a particular job. There's no actual shape so it's not a bad metaphor, if an imperfect image. Shoghoths also turned upon and destroyed their creators, so the cautionary metaphor is in there, too. A shame more Asimov wasn't baked into AI. But then the conflict about how to handle AI in relation to people was key to those stories, too.

The complaint — filed last month with the Securities and Exchange Commission and the Department of Justice, as well as the FTC — says thousands of employees still had wide-ranging and poorly tracked internal access to core company software, a situation that for years had led to embarrassing hacks, including the commandeering of accounts held by such high-profile users as Elon Musk and former presidents Barack Obama and Donald Trump.

the whistleblower document alleges the company prioritized user growth over reducing spam, though unwanted content made the user experience worse. Executives stood to win individual bonuses of as much as $10 million tied to increases in daily users, the complaint asserts, and nothing explicitly for cutting spam.

Chief executive Parag Agrawal was “lying” when he tweeted in May that the company was “strongly incentivized to detect and remove as much spam as we possibly can,” the complaint alleges.

Zatko described his decision to go public as an extension of his previous work exposing flaws in specific pieces of software and broader systemic failings in cybersecurity. He was hired at Twitter by former CEO Jack Dorsey in late 2020 after a major hack of the company’s systems.

“I felt ethically bound. This is not a light step to take,” said Zatko, who was fired by Agrawal in January. He declined to discuss what happened at Twitter, except to stand by the formal complaint. Under SEC whistleblower rules, he is entitled to legal protection against retaliation, as well as potential monetary rewards.

“Security and privacy have long been top companywide priorities at Twitter,” said Twitter spokeswoman Rebecca Hahn. She said that Zatko’s allegations appeared to be “riddled with inaccuracies” and that Zatko “now appears to be opportunistically seeking to inflict harm on Twitter, its customers, and its shareholders.” Hahn said that Twitter fired Zatko after 15 months “for poor performance and leadership.” Attorneys for Zatko confirmed he was fired but denied it was for performance or leadership.

A person familiar with Zatko’s tenure said the company investigated Zatko’s security claims during his time there and concluded they were sensationalistic and without merit. Four people familiar with Twitter’s efforts to fight spam said the company deploys extensive manual and automated tools to both measure the extent of spam across the service and reduce it.

Overall, Zatko wrote in a February analysis for the company attached as an exhibit to the SEC complaint, “Twitter is grossly negligent in several areas of information security. If these problems are not corrected, regulators, media and users of the platform will be shocked when they inevitably learn about Twitter’s severe lack of security basics.”

Zatko’s complaint says strong security should have been much more important to Twitter, which holds vast amounts of sensitive personal data about users. Twitter has the email addresses and phone numbers of many public figures, as well as dissidents who communicate over the service at great personal risk.

This month, an ex-Twitter employee was convicted of using his position at the company to spy on Saudi dissidents and government critics, passing their information to a close aide of Crown Prince Mohammed bin Salman in exchange for cash and gifts.

Zatko’s complaint says he believed the Indian government had forced Twitter to put one of its agents on the payroll, with access to user data at a time of intense protests in the country. The complaint said supporting information for that claim has gone to the National Security Division of the Justice Department and the Senate Select Committee on Intelligence. Another person familiar with the matter agreed that the employee was probably an agent.

“Take a tech platform that collects massive amounts of user data, combine it with what appears to be an incredibly weak security infrastructure and infuse it with foreign state actors with an agenda, and you’ve got a recipe for disaster,” Charles E. Grassley (R-Iowa), the top Republican on the Senate Judiciary Committee,

Many government leaders and other trusted voices use Twitter to spread important messages quickly, so a hijacked account could drive panic or violence. In 2013, a captured Associated Press handle falsely tweeted about explosions at the White House, sending the Dow Jones industrial average briefly plunging more than 140 points.

After a teenager managed to hijack the verified accounts of Obama, then-candidate Joe Biden, Musk and others in 2020, Twitter’s chief executive at the time, Jack Dorsey, asked Zatko to join him, saying that he could help the world by fixing Twitter’s security and improving the public conversation, Zatko asserts in the complaint.

In 1998, Zatko had testified to Congress that the internet was so fragile that he and others could take it down with a half-hour of concentrated effort. He later served as the head of cyber grants at the Defense Advanced Research Projects Agency, the Pentagon innovation unit that had backed the internet’s invention.

But at Twitter Zatko encountered problems more widespread than he realized and leadership that didn’t act on his concerns, according to the complaint.

Twitter’s difficulties with weak security stretches back more than a decade before Zatko’s arrival at the company in November 2020. In a pair of 2009 incidents, hackers gained administrative control of the social network, allowing them to reset passwords and access user data. In the first, beginning around January of that year, hackers sent tweets from the accounts of high-profile users, including Fox News and Obama.

Several months later, a hacker was able to guess an employee’s administrative password after gaining access to similar passwords in their personal email account. That hacker was able to reset at least one user’s password and obtain private information about any Twitter user.

Twitter continued to suffer high-profile hacks and security violations, including in 2017, when a contract worker briefly took over Trump’s account, and in the 2020 hack, in which a Florida teen tricked Twitter employees and won access to verified accounts. Twitter then said it put additional safeguards in place.

This year, the Justice Department accused Twitter of asking users for their phone numbers in the name of increased security, then using the numbers for marketing. Twitter agreed to pay a $150 million fine for allegedly breaking the 2011 order, which barred the company from making misrepresentations about the security of personal data.

After Zatko joined the company, he found it had made little progress since the 2011 settlement, the complaint says. The complaint alleges that he was able to reduce the backlog of safety cases, including harassment and threats, from 1 million to 200,000, add staff and push to measure results.

But Zatko saw major gaps in what the company was doing to satisfy its obligations to the FTC, according to the complaint. In Zatko’s interpretation, according to the complaint, the 2011 order required Twitter to implement a Software Development Life Cycle program, a standard process for making sure new code is free of dangerous bugs. The complaint alleges that other employees had been telling the board and the FTC that they were making progress in rolling out that program to Twitter’s systems. But Zatko alleges that he discovered that it had been sent to only a tenth of the company’s projects, and even then treated as optional.

“If all of that is true, I don’t think there’s any doubt that there are order violations,” Vladeck, who is now a Georgetown Law professor, said in an interview. “It is possible that the kinds of problems that Twitter faced eleven years ago are still running through the company.”

The complaint also alleges that Zatko warned the board early in his tenure that overlapping outages in the company’s data centers could leave it unable to correctly restart its servers. That could have left the service down for months, or even have caused all of its data to be lost. That came close to happening in 2021, when an “impending catastrophic” crisis threatened the platform’s survival before engineers were able to save the day, the complaint says, without providing further details.

One current and one former employee recalled that incident, when failures at two Twitter data centers drove concerns that the service could have collapsed for an extended period. “I wondered if the company would exist in a few days,” one of them said.

The current and former employees also agreed with the complaint’s assertion that past reports to various privacy regulators were “misleading at best.”

For example, they said the company implied that it had destroyed all data on users who asked, but the material had spread so widely inside Twitter’s networks, it was impossible to know for sure

As the head of security, Zatko says he also was in charge of a division that investigated users’ complaints about accounts, which meant that he oversaw the removal of some bots, according to the complaint. Spam bots — computer programs that tweet automatically — have long vexed Twitter. Unlike its social media counterparts, Twitter allows users to program bots to be used on its service: For example, the Twitter account @big_ben_clock is programmed to tweet “Bong Bong Bong” every hour in time with Big Ben in London. Twitter also allows people to create accounts without using their real identities, making it harder for the company to distinguish between authentic, duplicate and automated accounts.

In the complaint, Zatko alleges he could not get a straight answer when he sought what he viewed as an important data point: the prevalence of spam and bots across all of Twitter, not just among monetizable users.

Zatko cites a “sensitive source” who said Twitter was afraid to determine that number because it “would harm the image and valuation of the company.” He says the company’s tools for detecting spam are far less robust than implied in various statements.

“Agrawal’s Tweets and Twitter’s previous blog posts misleadingly imply that Twitter employs proactive, sophisticated systems to measure and block spam bots,” the complaint says. “The reality: mostly outdated, unmonitored, simple scripts plus overworked, inefficient, understaffed, and reactive human teams.”

The four people familiar with Twitter’s spam and bot efforts said the engineering and integrity teams run software that samples thousands of tweets per day, and 100 accounts are sampled manually.

Some employees charged with executing the fight agreed that they had been short of staff. One said top executives showed “apathy” toward the issue.

Zatko’s complaint likewise depicts leadership dysfunction, starting with the CEO. Dorsey was largely absent during the pandemic, which made it hard for Zatko to get rulings on who should be in charge of what in areas of overlap and easier for rival executives to avoid collaborating, three current and former employees said.

For example, Zatko would encounter disinformation as part of his mandate to handle complaints, according to the complaint. To that end, he commissioned an outside report that found one of the disinformation teams had unfilled positions, yawning language deficiencies, and a lack of technical tools or the engineers to craft them. The authors said Twitter had no effective means of dealing with consistent spreaders of falsehoods.

Dorsey made little effort to integrate Zatko at the company, according to the three employees as well as two others familiar with the process who spoke on the condition of anonymity to describe sensitive dynamics. In 12 months, Zatko could manage only six one-on-one calls, all less than 30 minutes, with his direct boss Dorsey, who also served as CEO of payments company Square, now known as Block, according to the complaint. Zatko allegedly did almost all of the talking, and Dorsey said perhaps 50 words in the entire year to him. “A couple dozen text messages” rounded out their electronic communication, the complaint alleges.

Faced with such inertia, Zatko asserts that he was unable to solve some of the most serious issues, according to the complaint.

Some 30 percent of company laptops blocked automatic software updates carrying security fixes, and thousands of laptops had complete copies of Twitter’s source code, making them a rich target for hackers, it alleges.

A successful hacker takeover of one of those machines would have been able to sabotage the product with relative ease, because the engineers pushed out changes without being forced to test them first in a simulated environment, current and former employees said.

“It’s near-incredible that for something of that scale there would not be a development test environment separate from production and there would not be a more controlled source-code management process,” said Tony Sager, former chief operating officer at the cyberdefense wing of the National Security Agency, the Information Assurance divisio

Sager is currently senior vice president at the nonprofit Center for Internet Security, where he leads a consensus effort to establish best security practices.

Zatko stopped the material from being presented at the Dec. 9, 2021 meeting, the complaint said. But over his continued objections, Agrawal let it go to the board’s smaller Risk Committee a week later.

“A best practice is that you should only be authorized to see and access what you need to do your job, and nothing else,” said former U.S. chief information security officer Gregory Touhill. “If half the company has access to and can make configuration changes to the production environment, that exposes the company and its customers to significant risk.”

The complaint says Dorsey never encouraged anyone to mislead the board about the shortcomings, but that others deliberately left out bad news.

The complaint says that about half of Twitter’s roughly 7,000 full-time employees had wide access to the company’s internal software and that access was not closely monitored, giving them the ability to tap into sensitive data and alter how the service worked. Three current and former employees agreed that these were issues.

An unnamed executive had prepared a presentation for the new CEO’s first full board meeting, according to the complaint. Zatko’s complaint calls the presentation deeply misleading.

The presentation showed that 92 percent of employee computers had security software installed — without mentioning that those installations determined that a third of the machines were insecure, according to the complaint.

Another graphic implied a downward trend in the number of people with overly broad access, based on the small subset of people who had access to the highest administrative powers, known internally as “God mode.” That number was in the hundreds. But the number of people with broad access to core systems, which Zatko had called out as a big problem after joining, had actually grown slightly and remained in the thousands.

The presentation included only a subset of serious intrusions or other security incidents, from a total Zatko estimated as one per week, and it said that the uncontrolled internal access to core systems was responsible for just 7 percent of incidents, when Zatko calculated the real proportion as 60 percent.

When Dorsey left in November 2021, a difficult situation worsened under Agrawal, who had been responsible for security decisions as chief technology officer before Zatko’s hiring, the complaint says.

Agrawal didn’t respond to requests for comment. In an email to employees after publication of this article, obtained by The Post, he said that privacy and security continues to be a top priority for the company, and he added that the narrative is “riddled with inconsistences” and “presented without important context.”

On Jan. 4, Zatko reported internally that the Risk Committee meeting might have been fraudulent, which triggered an Audit Committee investigation.

Agarwal fired him two weeks later. But Zatko complied with the company’s request to spell out his concerns in writing, even without access to his work email and documents, according to the complaint.

Since Zatko’s departure, Twitter has plunged further into chaos with Musk’s takeover, which the two parties agreed to in May. The stock price has fallen, many employees have quit, and Agrawal has dismissed executives and frozen big projects.

Zatko said he hoped that by bringing new scrutiny and accountability, he could improve the company from the outside.

“I still believe that this is a tremendous platform, and there is huge value and huge risk, and I hope that looking back at this, the world will be a better place, in part because of this.”

onic constipation, a functional bowel disorder, affects approximately 14% of adults worldwide [1]. Slow transit constipation (STC) is the major cause of chronic constipation which is characterized by markedly prolonged colonic transit time as a result of the colonic motility function disorde

Usually, patients with STC suffer from a common sense of abdominal pain, nausea, depression and sickness, which seriously influence their social ability and health-related quality of life [4–6

Current clinical treatments include cathartics, prokinetics and aggressive surgery which can increase bowel movement frequency to a certain degree.

However, pharmacological interventions is prone to drug dependency and relapse after drug withdrawal [3]

Surgical treatments such as subtotal colectomy and total colectomy in STC patients may adversely affect the quality of life due to the risk of postoperative diarrhea or incontinence, and result in a heavy healthcare burden

The enteric nervous system (ENS), located in the intestinal wall, regulates various functions including contraction of intestine, homeostasis and blood flow [10]. As the ‘second brain’, the ENS contains large amounts of neurons working independently from the central nervous system [11]. Researches have identified that STCs are mostly caused by disorders of the relevant nerves, especially the ENS [12,13].

McCallum et al. [35] found that gastric electrical stimulation in combination with pharmacological treatment could also enhance emptying in patients with gastroparesis. Especially, gastric electrical stimulation has been approved as a clinical therapy method for gastroparesis and obesity in European and American countries [36].

we employed pulse train stimulation and implanted electrodes at the proximal colon in dogs.

After CES treatment, we observed the colonic transit time of the sham treatment group was longer than that of CES treatment and control groups, and electrical stimulation significantly enhanced the colonic electromyogram (EMG) signal.

histopathology and TEM analysis showed increased ganglia and synaptic vesicles existing in the colon myenteric plexus of the CES treatment group as compared with that of the sham CES group

Our results suggested that CES might reduce the degeneration of the myenteric plexus neurons, thereby contributing to the therapeutic effect on STC beagles.

the defecating frequency and the feces characteristics of STC beagles returned to normal after CES treatment. The result indicated that CES could improve the symptoms of STC.

The colonic EMG signal was strongly promoted by CES

Especially, the colonic EMG signal of the beagles with STC was remarkably enhanced by CES (Figure 3), indicating that CES could not only improve the colonic content emptying, but also enhance the EMG signal to promote colonic motility.

Colonic electrical stimulation (CES), a valuable alternative for the treatment of STC, was reported to improve the colon motility by adjusting the bioelectrical activity in animal models or patients with STC [17]. However, little report focuses on the underlying nervous mechanism to normalize the delayed colonic emptying and relieve symptoms. We hypothesized that CES may also repair the disorders of the relevant nerves and then improve the colonic motility.

The first study regarding the CES to modulate colonic motility was performed by Hughes et al. [37]. Since then, many researchers employed short-pulse CES in canine descending colon or pig cecum [20,21,38]. Researchers also applied long-pulse CES to stimulate the colon of human or animals [39]

Recently, studies showed that the prokinetic effect of pulse train CES is better than that of short-pulse CES or long-pulse CES [25]

Our study indicated that CES could enhance the colonic motility, and then accelerate the colonic content emptying. Thereafter, we investigated the underlying mechanism and presumed that CES might improve the STC symptom through the repairment of the ENS.

The neuropathy in ENS is considered to be responsible for various kinds of disordered motility including STC and the related pathophysiologic symptoms [40]. In agreement with this view, our study discovered the decreased number of ganglia in the myenteric plexus, as well as the destruction of the enteric nerve axon terminals and synaptic vesicles in the sham CES group beagles

The present study proves that CES with pulse trains has curative effects on the colonic motility and content emptying in STC beagles. The up-regulation of intestinal nerve related proteins such as SYP, PGP9.5, CAD and S-100B in the colonic myenteric plexus suggests that CES might reduce the degeneration of the myenteric plexus neurons, thereby producing the therapeutic effect on STC beagles. Further investigation for the underlying mechanism of nerve regeneration is necessary to better understand how CES promotes the recovery of delayed colonic motility induced by STC.