论文标题

压力 - 基于区域环的表型分类和食管胃结构生理的力学

Pressure -- area loop based phenotypic classification and mechanics of esophagogastric junction physiology

论文作者

Elisha, Guy, Halder, Sourav, Acharya, Shashank, Carlson, Dustin A., Kou, Wenjun, Kahrilas, Peter J., Pandolfino, John E., Patankar, Neelesh A.

论文摘要

食管胃结(EGJ)位于食道的远端,充当阀门,允许吞咽材料进入胃并防止酸反流。 EGJ肌肉的不规则弱化或僵硬导致其开口和闭合模式的变化,可以发展为食管疾病。因此,了解EGJ的开放和闭合周期背后的物理学提供了对其功能的机械洞察力,并可以帮助识别导致其降解的潜在条件。使用临床翻转数据,我们在EGJ位置绘制了压力区域滞后,并区分了两种主要环类型,即压力显性环(PDL)和一个音调主导环(TDL)。在这项研究中,我们旨在确定定义每种循环类型的关键特征,并找到导致从一个循环到另一个循环的反转的原因。为此,使用位于食管中的翻转装置内的流动装置中的一维流进行了临床观察结果,并计算了EGJ壁完成的工作。这项工作分解为主动和被动组件,揭示了决定循环类型的竞争机制。这些机制是食道刚度,流体粘度和EGJ松弛模式。在PDL中,周期中的主要能源来自蠕动收缩波的流体压力增加,而在TDL中,周期中的主要能源来自EGJ音调的收缩和放松。

The esophagogastric junction (EGJ) is located at the distal end of the esophagus and acts as a valve allowing swallowed materials to enter the stomach and preventing acid reflux. Irregular weakening or stiffening of the EGJ muscles result in changes to its opening and closing patterns which can progress into esophageal disorders. Therefore, understanding the physics behind the opening and closing cycle of the EGJ provides a mechanistic insight into its function and can help identify the underlying conditions that cause its degradation. Using clinical FLIP data, we plotted the pressure-area hysteresis at the EGJ location and distinguished two major loop types, a pressure dominant loop (PDL) and a tone dominant loop (TDL). In this study, we aimed to identify the key characteristics that define each loop type and find what causes the inversion from one loop to another. To do so, the clinical observations were reproduced using 1D simulations of flow inside a FLIP device located in the esophagus, and the work done by the EGJ wall over time was calculated. This work was decomposed into active and passive components, which revealed the competing mechanisms that dictate the loop type. These mechanisms are esophagus stiffness, fluid viscosity, and the EGJ relaxation pattern. In PDL, the leading source of energy in the cycle is coming from the fluid pressure increase from the peristaltic contraction wave, and in TDL the leading source of energy in the cycle is coming from the contraction and relaxation of the EGJ tone.

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