Strain-energy function and three-dimensional stress distribution in esophageal biomechanics

Knowledge of the transmural stress and stretch fields in esophageal wall is necessary to quantify growth and remodeling, and the response to mechanically based clinical interventions or traumatic injury, but there are currently conflicting reports on this issue and the mechanical properties of intact esophagus have not been rigorously addressed. This paper offers multiaxial data on rabbit esophagus, warranted for proper identification of the 3D mechanical properties. The Fung-type strain-energy function was adopted to model our data for esophagus, taken as a thick-walled (1 or 2-layer) tubular structure subjected to inflation and longitudinal extension. Accurate predictions of the pressure–radius–force data were obtained using the 1-layer model, covering a broad range of extensions; the calculated material parameters indicated that intact wall was equally stiff as mucosa–submucosa, but stiffer than muscle in both principal axes, and tissue was stiffer longitudinally, concurring our histological findings (Stavropoulou et al., Journal of Biomechanics. 42 (2009) 2654–2663). Employing the material parameters of individual layers, with reference to their zero-stress state, a reasonable fit was obtained to the data for intact wall, modeled as a 2-layer tissue. Different from the stress distributions presented hitherto in the esophagus literature, consideration of residual stresses led to less dramatic homogenization of stresses under loading. Comparison of the 1- and 2-layer models of esophagus demonstrated that heterogeneity induced a more uniform distribution of residual stresses in each layer, a discontinuity in circumferential and longitudinal stresses at the interface among layers, and a considerable rise of stresses in mucosa, with a reduction in muscle.     

Multiscale, structure-based modeling for the elastic mechanical behavior of arterial walls

Passive elastic behavior of arterial wall remains difficult to model. Although phenomenological and structural models exist, the question of how the three-dimensional network structure of the collagen in the artery determines its mechanical properties is still open. A model is presented that incorporates a collagen network as well as the noncollagenous material that comprise the artery. The collagen architecture is represented as a network of interconnected fibers, and a neo-Hookean constitutive equation is used to describe the contribution of the noncollagenous matrix. The model is multiscale in that volume-averaging theory is applied to the collagen network, and it is structural in that parameters of the microstructure of the collagen network were considered instead of a macroscopic constitutive law. The computational results provided a good fit to published experimental data for decellularized porcine carotid arteries. The model predicted increased circumferential compliance for increased axial stretch, consistent with previously published reports, and a relatively small sensitivity to open angle. Even at large extensions, the model predicted that the noncollagenous matrix would be in compression, preventing collapse of the collagen network. The incorporation of fiber-fiber interactions led to an accurate model of artery wall behavior with relatively few parameters. The counterintuitive result that the noncollagenous component is in compression during extension and inflation of the tissue suggests that the collagen is important even at small strains, with the noncollagenous components supporting the network, but not resisting the load directly. More accurate representation of the microstructure of the artery wall is needed to explore this issue further.     

Experimentally validated microstructural 3D constitutive model of coronary arterial media

Accurate modeling of arterial response to physiological or pathological loads may shed light on the processes leading to initiation and progression of a number of vascular diseases and may serve as a tool for prediction and diagnosis. In this study, a microstructure based hyperelastic constitutive model is developed for passive media of porcine coronary arteries. The most general model contains 12 independent parameters representing the three-dimensional inner fibrous structure of the media and includes the effects of residual stresses and osmotic swelling. Parameter estimation and model validation were based on mechanical data of porcine left anterior descending (LAD) media under radial inflation, axial extension, and twist tests. The results show that a reduced four parameter model is sufficient to reliably predict the passive mechanical properties. These parameters represent the stiffness and the helical orientation of each lamellae fiber and the stiffness of the interlamellar struts interconnecting these lamellae. Other structural features, such as orientational distribution of helical fibers and anisotropy of the interlamellar network, as well as possible transmural distribution of structural features, were found to have little effect on the global media mechanical response. It is shown that the model provides good predictions of the LAD media twist response based on parameters estimated from only biaxial tests of inflation and extension. In addition, good predictive capabilities are demonstrated for the model behavior at high axial stretch ratio based on data of law stretches.     

Biomechanical and histological characteristics of passive esophagus: Experimental investigation and comparative constitutive modeling

Information on the passive biomechanical properties of two-layered esophagus is still limited, although this would enhance our understanding of its physiology/pathophysiology and help to address problems in surgery, medical-device applications, and for the optimal design of prostheses. In this study, rabbit esophagi were excised and dissected into mucosa–submucosa and muscle layers that were submitted to histological quantification of elastin and collagen content and orientation, as well as to inflation-extension testing and geometrical analysis, i.e. delineation of the zero-stress state serving as a reference configuration for biomechanical analysis. The pressure–radius data of both layers displayed a monotonically rising slope with inflating pressure, unlike the sigma shape characterizing elastin-rich tissues, for which biphasic constitutive models were initially postulated. Three phenomenological expressions of strain-energy function (SEF), commonly appearing in soft-tissue biomechanics literature, were used in an attempt to model the pseudoelastic response of esophageal tissue, namely the exponential Fung-type SEF, and the combined neo-Hookean (isotropic) or quadratic (anisotropic) and exponential Fung-type SEF. Accurate fits were attained for the pressure–radius–force data, spanning a wide range of longitudinal stretch ratios, when using the exponential form; the biphasic SEFs failed to generate improved fits, being also over-parameterized. According to the calculated material parameters, mucosa–submucosa was stiffer than muscle in both directions, justified by our histological observation of increased collagen content in that layer, and tissue was stiffer longitudinally, substantiated by the increased elastin and collagen contents and their preferential alignment towards that direction. Our results demonstrate that the passive response of esophagus is best modeled with an exponential Fung-type SEF.     

Simulation studies of the role of esophageal mucosa in bolus transport

Based on a fully coupled computational model for esophageal transport, we analyzed the role of the mucosa (including the submucosa) in esophageal bolus transport and how bolus transport is affected by mucosal stiffness. Two groups of studies were conducted using a computational model. In the first group, a base case that represents normal esophageal transport and two hypothetical cases were simulated: (1) esophageal mucosa replaced by muscle and (2) esophagus without mucosa. For the base case, the geometric configuration of the esophageal wall was examined and the mechanical role of mucosa was analyzed. For the hypothetical cases, the pressure field and transport features were examined. In the second group of studies, cases with mucosa of varying stiffness were simulated. Overall transport characteristics were examined, and both pressure and geometry were analyzed. Results show that a compliant mucosa helped accommodate the incoming bolus and lubricate the moving bolus. Bolus transport was marginally achieved without mucosa or with mucosa replaced by muscle. A stiff mucosa greatly impaired bolus transport due to the lowered esophageal distensibility and increased luminal pressure. We conclude that mucosa is essential for normal esophageal transport function. Mechanically stiffened mucosa reduces the distensibility of the esophagus by obstructing luminal opening and bolus transport. Mucosal stiffening may be relevant in diseases characterized by reduced esophageal distensibility, elevated intrabolus pressure, and/or hypertensive muscle contraction such as eosinophilic esophagitis and jackhammer esophagus.     

Axial prestretch and circumferential distensibility in biomechanics of abdominal aorta

Elastic arteries are significantly prestretched in an axial direction. This property minimises axial deformations during pressure cycle. Ageing-induced changes in arterial biomechanics, among others, are manifested via a marked decrease in the prestretch. Although this fact is well known, little attention has been paid to the effect of decreased prestretch on mechanical response. Our study presents the results of an analytical simulation of the inflation–extension behaviour of the human abdominal aorta treated as nonlinear, anisotropic, prestrained thin-walled as well as thick-walled tube with closed ends. The constitutive parameters and geometries for 17 aortas adopted from the literature were supplemented with initial axial prestretches obtained from the statistics of 365 autopsy measurements. For each aorta, the inflation–extension response was calculated three times, with the expected value of the initial prestretch and with the upper and lower confidence limit of the initial prestretch derived from the statistics. This approach enabled age-related trends to be evaluated bearing in mind the uncertainty in the prestretch. Despite significantly decreased longitudinal prestretch with age, the biomechanical response of human abdominal aorta changes substantially depending on the initial axial stretch was used. In particular, substituting the upper limit of initial prestretch gave mechanical responses which can be characterised by (1) low variation in axial stretch and (2) high circumferential distensibility during pressurisation, in contrast to the responses obtained for their weakly prestretched counterparts. The simulation also suggested the significant effect of the axial prestretch on the variation of axial stress in the pressure cycle. Finally, the obtained results are in accordance with the hypothesis that circumferential-to-axial stiffness ratio is the quantity relatively constant within this cycle.     

Inflation of an artery leading to aneurysm formation and rupture

Formation and rupture of aneurysms due to the inflation of an artery with collagen fibers distributed in two preferred directions, subjected to internal pressure and axial stretch are examined within the framework of nonlinear elasticity. A two layer tube model with a fiber-reinforced composite based incompressible anisotropic hyperelastic constitutive material is employed to model the stress-strain behavior of the artery wall with distributed collagen fibers. The artery wall takes up a uniform inflation deformation, and there are no aneurysms in the artery under the normal condition. But an aneurysm may be formed in arteries when the stiffness of the fibers is decreased to a certain value or the direction of the fibers is changed to a certain degree towards the circumferential direction. The aneurysm may expand to much large extent and become complex in shape. One portion of the aneurysm becomes highly distended as a bubble while the rest remains lightly inflated. The rupture of the aneurysm is discussed along with the distribution of stresses. Critical pressures and the rupture pressures are given for different collagen fiber orientations or stiffness. Furthermore, the stability of the solutions is discussed to explain the formation of aneurysm.     

A piece-wise non-linear elastic stress expression of human and pig coronary arteries tested in vitro.

Eight human and nineteen pig unembalmed proximal left anterior descending and circumflex coronary arteries were subjected to linear volume changes (2 s ramp time) at three fixed axial extensions while immersed in a physiological saline bath at body temperature. Measured parameters included: lumen pressure, outside diameter, axial force, and axial extension. The deformations were measured using a video dimensional analyzer. The arteries were inflated to pressures well above the physiological range at each axial extension. A latex inner tube was placed inside of each specimen to prevent leakage, and its effects upon the measured stresses were corrected analytically. With this method, the average circumferential and axial stresses could be computed directly from the experimental data. In both directions the average stresses measured displayed two distinct regions: stresses occurring for small diameter changes (physiological pressures) and stresses occurring for large diameter changes (high pressures). The resulting average small strain and large strain stress components were curve-fit separately and, when reassembled, provided a piece-wise model of the stress response of coronary arteries over a wide range of inflation pressures and axial extensions.     

Determination of homeostatic elastic moduli in two layers of the esophagus

The function of the esophagus is mechanical. To understand the function, it is necessary to know how the stress and strain in the esophagus can be computed, and how to determine the stress-strain relationship of the wall materials. The present article is devoted to the issue of determining the incremental elastic moduli in the layers of the esophagus under homeostatic conditions. The esophagus is treated as a two-layered structure consisting of an inner collagen-rich submucosa layer and an outer muscle layer. We adopt a theory based on small perturbation experiments at homeostatic conditions for determination of incremental moduli in circumferential, axial, and cross directions in the two layers. The experiments are inflation, axial stretching, circumferential bending, and axial bending. The analysis takes advantage of knowing the esophageal zero-stress state (an open sector with an opening angle of 59.4 +/- 13.2 deg). The neutral axis was located 27% +/- 1.9%away from the mucosal surface. It is demonstrated that under homeostatic conditions, the incremental moduli are layer and direction dependent. The incremental modulus is the highest in the axial direction. Furthermore, the axial moduli for the two layers are similar, whereas in the circumferential direction, the incremental modulus is a factor of 6 higher in the mucosa-submucosa layer compared to the muscle layer. Hence, the esophagus has to be treated as a composite, anisotropic body. With this additional information, we can then look forward to a vision of truly understanding the mechanical events of the esophagus.     

Effect of different doses of GLP-2 (Teduglutide) on acute esophageal lesion due to acid-pepsin perfusion in male rats

Gastro-esophageal reflux currently is widespread disorders with dangerous complications. GLP-2 is a peptide that has trophic and anti-inflammatory effects on gastrointestinal mucosa. The aim of this study was to evaluate the protective role of GLP-2 in esophageal mucosa lesion due to perfusion acid-pepsin. Thirty-six male rats were used in this study and divided into six groups. They were control, acid-pepsin, GLP-2 20 μg, GLP-2 30 μg, GLP-2 40 μg and GLP-2 50 μg/kg groups. Esophageal blood flow, plasma NO metabolite, esophageal tissue NO metabolites and histological study of esophagus were performed as indicators of esophageal damage following acid-pepsin perfusion. Results showed that GLP-2 significantly increased plasma and tissue NO metabolites in comparison to acid-pepsin group. Also histological study showed significantly fewer lesions in the most effective dose GLP-2 30 μg in comparison to acid-pepsin group, our results show that GLP-2 could be useful for the treatment of esophageal in animal model.     

A theoretical and non-destructive experimental approach for direct inclusion of measured collagen orientation and recruitment into mechanical models of the artery wall

Gradual collagen recruitment has been hypothesized as the underlying mechanism for the mechanical stiffening with increasing stress in arteries. In this work, we investigated this hypothesis in eight rabbit carotid arteries by directly measuring the distribution of collagen recruitment stretch under increasing circumferential loading using a custom uniaxial (UA) extension device combined with a multi-photon microscope (MPM). This approach allowed simultaneous mechanical testing and imaging of collagen fibers without traditional destructive fixation methods. Fiber recruitment was quantified from 3D rendered MPM images, and fiber orientation was measured in projected stacks of images. Collagen recruitment was observed to initiate at a finite strain, corresponding to a sharp increase in the measured mechanical stiffness, confirming the previous hypothesis and motivating the development of a new constitutive model to capture this response. Previous constitutive equations for the arterial wall have modeled the collagen contribution with either abrupt recruitment at zero strain, abrupt recruitment at finite strain or as gradual recruitment beginning at infinitesimal strain. Based on our experimental data, a new combined constitutive model was presented in which fiber recruitment begins at a finite strain with activation stretch represented by a probability distribution function. By directly including this recruitment data, the collagen contribution was modeled using a simple Neo-Hookean equation. As a result, only two phenomenological material constants were required from the fit to the stress stretch data. Three other models for the arterial wall were then compared with these results. The approach taken here was successful in combining stress-strain analysis with simultaneous microstructural imaging of collagen recruitment and orientation, providing a new approach by which underlying fiber architecture may be quantified and included in constitutive equations.     

食管腺癌、Barrett 食管活检粘膜中TGF-β1 的表达

目的:研究食管腺癌、Barret食管(Barrett esophagus,BE)和正常食管粘膜中转化生长因子β1(transforming growth factor-betal,TGF-β1)的表达。方法:采用免疫组化方法检测35例食管腺癌患者、40例BE患者及30例健康对照组食管组织中TGF-β1的表达水平。结果:未在健康对照组食管粘膜中发现TGF-β1的表达,食管腺癌组TGF-β1的表达水平>BE组>健康对照组(P<0.05)。食管腺癌组中,TGF-β1在中-高分化腺癌及低分化腺癌患者食管粘膜中的表达无明显差异(Z=1.07,P>0.05)。结论:食管腺癌、BE食管粘膜中TGF-β1表达水平升高,在食管腺癌中的表达与细胞分化程度无关。     

Mechanical identification of layer-specific properties of mouse carotid arteries using 3D-DIC and a hyperelastic anisotropic constitutive model

The role of mechanics is known to be of primary order in many arterial diseases; however, determining mechanical properties of arteries remains a challenge. This paper discusses the identifiability of the passive mechanical properties of a mouse carotid artery, taking into account the orientation of collagen fibres in the medial and adventitial layers. On the basis of 3D digital image correlation measurements of the surface strain during an inflation/extension test, an inverse identification method is set up. It involves a 3D finite element mechanical model of the mechanical test and an optimisation algorithm. A two-layer constitutive model derived from the Holzapfel model is used, with five and then seven parameters. The five-parameter model is successfully identified providing layer-specific fibre angles. The seven-parameter model is over parameterised, yet it is shown that additional data from a simple tension test make the identification of refined layer-specific data reliable.     

New method for quantitative evaluation of esophageal sensibility

A method for quantitating esophagus sensibility by an electric stimulation test is described. Square stimulus waveform at different voltages and durations were transmitted to the esophagus, three series of electric stimuli being used in successive durations (0.5, 1, 2, 4, 8 and 16 ms); in each series the voltage discharge was increased progressively from 0 mV, until the subject noted the first sensation. This procedure was carried out at all esophageal levels. The following parameters were analyzed: sensitive threshold along the esophagus; the relation of threshold sensibility (mV) duration of stimulus (ms), and reobase and cronaxia for each esophageal level. At all esophageal levels, the sensitive threshold was regular and coherent; in the middle esophagus a zone was found having higher sensitive threshold than the proximal and distal esophageal zones. The relationship between sensitive threshold and inverse of the stimulus duration indicated that esophageal sensibility follows the basic law of excitation of WEISS, at least with this type of stimulus, reobase and cronaxia being representative of the sensibility threshold along the esophagus. Quantitative esophageal sensibility, therefore is concluded to be particularly suited to evaluation by electric stimulation.     

Novel device to sample the esophageal microbiome-the esophageal string test

A growing number of studies implicate the microbiome in the pathogenesis of intestinal inflammation. Previous work has shown that adults with esophagitis related to gastroesophageal reflux disease have altered esophageal microbiota compared to those who do not have esophagitis. In these studies, sampling of the esophageal microbiome was accomplished by isolating DNA from esophageal biopsies obtained at the time of upper endoscopy. The aim of the current study was to identify the esophageal microbiome in pediatric individuals with normal esophageal mucosa using a minimally invasive, capsule-based string technology, the Enterotest?. We used the proximal segment of the Enterotest string to sample the esophagus, and term this the "Esophageal String Test" (EST). We hypothesized that the less invasive EST would capture mucosal adherent bacteria present in the esophagus in a similar fashion as mucosal biopsy. EST samples and mucosal biopsies were collected from children with no esophageal inflammation (n?=?15) and their microbiome composition determined by 16S rRNA gene sequencing. Microbiota from esophageal biopsies and ESTs produced nearly identical profiles of bacterial genera and were different from the bacterial contents of samples collected from the nasal and oral cavity. We conclude that the minimally invasive EST can serve as a useful device for study of the esophageal microbiome.     

The influence of fiber dispersion on the mechanical response of aortic tissues in health and disease: a computational study

Changes in the structural components of aortic tissues have been shown to play a significant role in the pathogenesis of aortic degeneration. Therefore, reliable stress analyses require a suitable and meaningful constitutive model that captures micro-structural changes. As recent data show, in-plane and out-of-plane collagen fiber dispersions vary significantly between healthy and aneurysmatic aortic walls. The aim of this study is to computationally investigate the influence of fiber dispersion on the mechanical response of aortic tissues in health and disease. In particular, the influence of three different fiber dispersions is studied: (i) non-rotationally symmetric dispersion, the most realistic assumption for aortic tissues; (ii) transversely isotropic dispersion, a special case; (iii) perfectly aligned fibers (no dispersion in either plane), another special case. Explicit expressions for the stress and elasticity tensors as needed for the implementation in a finite element code are provided. Three representative numerical examples are studied: planar biaxial extension, inflation of residually stressed and pre-stretched aortic segments and inflation of an idealized abdominal aortic aneurysm (AAA) geometry. For the AAA geometry the case of isotropic dispersion is additionally analyzed. Documented structural and mechanical parameters are taken from human aortas (healthy media/adventitia and AAA). The influence of fiber dispersions upon magnitudes and distributions of stresses and deformations are presented and analyzed. Stresses vary significantly, especially in the AAA case, where material stiffening is significantly influenced by fiber dispersion. The results highlight the need to incorporate the structural differences into finite element simulations to obtain more accurate stress predictions. Additionally, results show the capability of one constitutive model to represent different scenarios of aortic micro-structures allowing future studies of collagen reorientation during disease progression.     

p53--prognostic factor of malignant transformation of Barrett's esophagus

The most significant precancerosis in the esophageal cancer is Barrett's esophagus. The risk of malignant transformation is determined primarily in accordance with the degree of dysplastic alterations of the mucosa. Indication of "preventive" extirpation of the esophagus should be supported by other factors, for example by detection of p53 mutation or expression. The study reports on the evaluation of a group of 20 patients with Barrett's esophagus treated at the 1st Department of Surgery, the p53 level and its correlation with histological findings evaluated in these patients. A good correlation was found between the grade of Barrett's esophagus dysplasia and high p53 positivity. This correlation was also confirmed by detection of early carcinoma in patients with "preventive" extirpation of the esophagus due to a high-grade dysplasia. Preliminary results show that examination of p53 level in specimens taken from the esophageal mucosa may be helpful for the estimation of malignant potential of the dysplastic mucosa.     

Heterogeneous Vesicles in Mucous Epithelial Cells of Posterior Esophagus of Chinese Giant Salamander (Andrias Davidianus)

The Chinese giant salamander belongs to an old lineage of salamanders and endangered species. Many studies of breeding and disease regarding this amphibian had been implemented. However, the studies on the ultrastructure of this amphibian are rare. In this work, we provide a histological and ultra-structural investigation on posterior esophagus of Chinese giant salamander. The sections of amphibian esophagus were stained by hematoxylin & eosin (H&E). Moreover, the esophageal epithelium was observed by transmission electron microscopy (TEM). The results showed that esophageal epithelium was a single layer epithelium, which consisted of mucous cells and columnar cells. The esophageal glands were present in submucosa. The columnar cells were ciliated. According to the diverging ultrastructure of mucous vesicles, three types of mucous cells could be identified in the esophageal mucosa: i) electron-lucent vesicles mucous cell (ELV-MC); ii) electron-dense vesicles mucous cell (EDV-MC); and iii) mixed vesicles mucous cell (MV-MC).Key words: Amphibian, esophagus, ultrastructure, mucous cells, heterogeneous vesicles     

Introducing mesoscopic information into constitutive equations for arterial walls

We propose a new elastic constitutive law for arterial tissue in which the limiting polymeric chain extensibility of both collagen and elastin fibres is accounted for. The elastic strain-energy function is separated additively into two parts: an isotropic contribution associated with the matrix (incorporating the elastin fibre network) and an anisotropic one associated with the collagen fibres. Information on the limiting extensibility in each case provides some mesoscopic input into the model. The (logarithm-based) model is compared with the Fung-Demiray exponential model and certain other recently proposed models. Some aspects of the elastic response under extension and inflation of a thin-walled circular cylindrical tube (the artery) are then examined and compared with the corresponding response of a rubber-like tube. We point out that our model, when both isotropic and anisotropic terms are included, can be developed to accommodate changing mechanical properties associated with degradation of the elastin and collagen by considering the material constants that define the limit of chain extensibility to evolve in time.