Neurophysiologic assessment of esophageal sensory processing in noncardiac chest pain

Background & Aims: Esophageal hypersensitivity is thought to be important in the generation and maintenance of symptoms in noncardiac chest pain (NCCP). In this study, we explored the neurophysiologic basis of esophageal hypersensitivity in a cohort of NCCP patients. Methods: We studied 12 healthy controls (9 women; mean age, 37.1 ± 8.7 y) and 32 NCCP patients (23 women; mean age, 47.2 ± 10 y). All had esophageal manometry, esophageal evoked potentials to electrical stimulation, and NCCP patients had 24-hour ambulatory pH testing. Results: The NCCP patients had reduced pain thresholds (PT) (72.1 ± 19.4 vs 54.2 ± 23.6, P = .02) and increased P1 latencies (P1 = 105.5 ± 11.1 vs 118.1 ± 23.4, P = .02). Subanalysis showed that the NCCP group could be divided into 3 distinct phenotypic classifications. Group 1 had reduced pain thresholds in conjunction with normal/reduced latency P1 latencies (n = 9). Group 2 had reduced pain thresholds in conjunction with increased (>2.5 SD) P1 latencies (n = 7), and group 3 had normal pain thresholds in conjunction with either normal (n = 10) or increased (>2.5 SD, n = 3) P1 latencies. Conclusions: Normal esophageal evoked potential latencies with reduced PT, as seen in group 1 patients, is indicative of enhanced afferent transmission and therefore increased esophageal afferent pathway sensitivity. Increased esophageal evoked potential latencies with reduced PT in group 2 patients implies normal afferent transmission to the cortex but heightened secondary cortical processing of this information, most likely owing to psychologic factors such as hypervigilance. This study shows that NCCP patients with esophageal hypersensitivity may be subclassified into distinct phenotypic subclasses based on sensory responsiveness and objective neurophysiologic profiles. © 2006 by the American Gastroenterological Association.

Real-time imaging of human cortical activity evoked by painful esophageal stimulation

Background & Aims: Current models of visceral pain processing derived from metabolic brain imaging techniques fail to differentiate between exogenous (stimulus-dependent) and endogenous (non-stimulus-specific) neural activity. The aim of this study was to determine the spatiotemporal correlates of exogenous neural activity evoked by painful esophageal stimulation. Methods: In 16 healthy subjects (8 men; mean age, 30.2 ± 2.2 years), we recorded magnetoencephalographic responses to 2 runs of 50 painful esophageal electrical stimuli originating from 8 brain subregions. Subsequently, 11 subjects (6 men; mean age, 31.2 ± 1.8 years) had esophageal cortical evoked potentials recorded on a separate occasion by using similar experimental parameters. Results: Earliest cortical activity (P1) was recorded in parallel in the primary/secondary somatosensory cortex and posterior insula (∼85 ms). Significantly later activity was seen in the anterior insula (∼103 ms) and cingulate cortex (∼106 ms; P = .0001). There was no difference between the P1 latency for magnetoencephalography and cortical evoked potential (P = .16); however, neural activity recorded with cortical evoked potential was longer than with magnetoencephalography (P = .001). No sex differences were seen for psychophysical or neurophysiological measures. Conclusions: This study shows that exogenous cortical neural activity evoked by experimental esophageal pain is processed simultaneously in somatosensory and posterior insula regions. Activity in the anterior insula and cingulate - brain regions that process the affective aspects of esophageal pain - occurs significantly later than in the somatosensory regions, and no sex differences were observed with this experimental paradigm. Cortical evoked potential reflects the summation of cortical activity from these brain regions and has sufficient temporal resolution to separate exogenous and endogenous neural activity. © 2005 by the American Gastroenterological Association.

Development of esophageal hypersensitivity following experimental duodenal acidification

OBJECTIVES: As visceral afferents from different regions of the gastrointestinal tract converge at the level of the spinal cord, we hypothesized that sensitization of one gut organ would induce visceral hypersensitivity in another gut organ, remote to the sensitizing stimulus. METHODS: Protocol 1: Eight healthy male volunteers, age 30 +/- 8.2 yr, underwent three studies on different days. Esophageal pain thresholds (PT) were recorded at 10-min intervals prior to and for 2 h following a 30-min duodenal infusion of either 0.15 M hydrochloric acid (HCl), saline, or no infusion. Five subjects repeated the study to demonstrate reproducibility. Protocol 2: Esophageal evoked potentials (EEP) were studied in six subjects on two occasions prior to and 1 h after a 30-min duodenal infusion of 0.15 M HCl or saline. RESULTS: Protocol 1: After acid infusion, there were reproducible reductions in esophageal PT (ICC = 0.88), which were maximal at 110 min (15.05 +/- 2.25 mA) (p < 0.002). Following saline infusion there was an increase in esophageal PT (ICC = 0.71), which was similar to the no-infusion condition (6.21 +/- 1.54 mA vs 8.5 + 7.6 mA; p > 0.05). Protocol 2: Esophageal sensation scores increased (p= 0.02) after acid, but not after saline infusion (p= 0.1). A comparison of the latencies of EEP components prior to and following acid and saline infusion revealed a reduction in the N1 (p= 0.02) and P2 components (p= 0.04). CONCLUSION: This study provides the first objective evidence that duodenal acidification can induce esophageal hypersensitivity associated with changes in sensitivity of the central visceral pain pathway. As the esophagus was remote from the sensitizing stimulus, central sensitization of spinal dorsal horn neurons is likely to have contributed to these changes.

A circular Malmquist-type index for measuring productivity

This paper develops two new indices for measuring productivity in multi-input multi-output situations. One index enables the measure of productivity change of a unit over time while the second index makes it possible to compare two units on productivity at the same or different points in time. Productivity in a single input single output context is defined as the ratio of output to input. In multi-input multi-output contexts this ratio is not defined. Instead, one of the methods traditionally used is the Malmquist Index of productivity change over time. This is computed by reference to the distances of the input-output bundles of a production unit at two different points in time from the efficient boundaries corresponding to those two points in time. The indices developed in this paper depart form the use of two different reference boundaries and instead they use a single reference boundary which in a sense is the most efficient boundary observed over two or more successive time periods. We discuss the assumptions which make possible the definition of such a single reference boundary and proceed to develop the two Malmquist-type indices for measuring productivity. One key advantage of using a single reference boundary is that the resulting index values are circular. That is it is possible to use the index values of successive time periods to derive an index value of productivity change over a time period of any length covered by successive index values or vice versa. Further, the use of a single reference boundary makes it possible to construct an index for comparing the productivities of two units either at the same or at two different points in time. This was not possible with the traditional Malmquist Index. We decompose both new indices into components which isolate production unit from industry or comparator unit effects. The components themselves like the indices developed are also circular. The components of the indices drill down to reveal more clearly the performance of each unit over time relative either to itself or to other units. The indices developed and their components are aimed at managers of production units to enable them to diagnose the performance of their units with a view to guiding them to improved performance.

Resistance heating of steel conductors of circular cross-section

The object of this thesis is to develop a method for calculating the losses developed in steel conductors of circular cross-section and at temperatures below 100oC, by the direct passage of a sinusoidally alternating current. Three cases are considered. 1. Isolated solid or tubular conductor. 2. Concentric arrangement of tube and solid return conductor. 3. Concentric arrangement of two tubes. These cases find applications in process temperature maintenance of pipelines, resistance heating of bars and design of bus-bars. The problems associated with the non-linearity of steel are examined. Resistance heating of bars and methods of surface heating of pipelines are briefly described. Magnetic-linear solutions based on Maxwell's equations are critically examined and conditions under which various formulae apply investigated. The conditions under which a tube is electrically equivalent to a solid conductor and to a semi-infinite plate are derived. Existing solutions for the calculation of losses in isolated steel conductors of circular cross-section are reviewed, evaluated and compared. Two methods of solution are developed for the three cases considered. The first is based on the magnetic-linear solutions and offers an alternative to the available methods which are not universal. The second solution extends the existing B/H step-function approximation method to small diameter conductors and to tubes in isolation or in a concentric arrangement. A comprehensive experimental investigation is presented for cases 1 and 2 above which confirms the validity of the proposed methods of solution. These are further supported by experimental results reported in the literature. Good agreement is obtained between measured and calculated loss values for surface field strengths beyond the linear part of the d.c. magnetisation characteristic. It is also shown that there is a difference in the electrical behaviour of a small diameter conductor or thin tube under resistance or induction heating conditions.

Embedded multiplexed polymer optical fiber sensor for esophageal manometry

There is a growing interest for esophageal measurements which can provide important and reliable data when diagnosing the motor function of the sphincters and the esophageal body. Biocompatibility, sensing resolution and the comfort of the patient are key parameters for manometric sensing systems. A new sensing approach which could fulfill all these needs is presented in this paper consisting of an embedded polymer fiber sensor, based on multiplexed fiber Bragg gratings. A response to a radial pressure almost 6 times that of a comparable silica fiber based sensor is obtained.

Effects of electric charge on osmotic flow across periodically arranged circular cylinders

An electrostatic model is developed for osmotic flow across a layer consisting of identical circular cylinders with a fixed surface charge, aligned parallel to each other so as to form an ordered hexagonal arrangement. The expression of the osmotic reflection coefficient is derived for spherical solutes with a fixed surface charge suspended in an electrolyte, based on low-Reynolds-number hydrodynamics and a continuum, point-charge description of the electric double layers. The repulsive electrostatic interaction between the surface charges with the same sign on the solute and the cylinders is shown to increase the exclusion region of solute from the cylinder surface, which enhances the osmotic flow. Applying the present model to the study of osmotic flow across the endothelial surface glycocalyx of capillary walls has revealed that this electrostatic model could account well for the reflection coefficients measured for charged macromolecules, such as albumin, in the physiological range of charge density and ion concentration.

A semi- analytic finite element approach to the stress analysis of circular plate

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Embedded multiplexed polymer optical fiber sensor for esophageal manometry

There is a growing interest for esophageal measurements which can provide important and reliable data when diagnosing the motor function of the sphincters and the esophageal body. Biocompatibility, sensing resolution and the comfort of the patient are key parameters for manometric sensing systems. A new sensing approach which could fulfill all these needs is presented in this paper consisting of an embedded polymer fiber sensor, based on multiplexed fiber Bragg gratings. A response to a radial pressure almost 6 times that of a comparable silica fiber based sensor is obtained.

Linear stability of flow past two circular cylinders in a side-by-side arrangement

The linear stability of flow past two circular cylinders in a side-by-side arrangement is investigated theoretically, numerically and experimentally under the assumption of a two-dimensional flow field, in order to explore the origin of in-phase and antiphase oscillatory flows. Steady symmetric flow is realized at a small Reynolds number, but becomes unstable above a critical Reynolds number though the solution corresponding to the flow still satisfies the basic equations irrespective of the magnitude of the Reynolds number. We obtained the solution numerically and investigated its linear stability. We found that there are two kinds of unstable modes, i.e., antisymmetric and symmetric modes, which lead to in-phase and antiphase oscillatory flows, respectively. We determined the critical Reynolds numbers for the two modes and evaluated the critical distance at which the most unstable disturbance changes from the antisymmetric to the symmetric mode, or vice versa. ©2005 The Physical Society of Japan.

The development of a wax layer on the interior wall of a circular pipe transporting heated oil

In this article we develop a simple model to describe the evolution of a depositional wax layer on the inner surface of a circular pipe transporting heated oil, which contains dissolved wax. When the outer pipe surface is cooled sufficiently, the growth of a wax layer is initiated on the inner pipe wall, and this evolves to a saturated steady state thickness. The model proposed is based on fundamental balances of heat flow from the oil, into the wax layer, and across the pipe wall. We present an analysis of the model, examine a relevant asymptotic limit in which the full details of the solution to the model are available and develop an efficient numerical method (based on the method of fundamental solutions) for producing approximations of the model solution. The mathematical structure of the model is that of a free boundary evolution problem of generalised Stefan type. © The Author, 2014.

The development of a wax layer on the interior wall of a circular pipe transporting heated oil

In this article we develop a simple model to describe the evolution of a depositional wax layer on the inner surface of a circular pipe transporting heated oil, which contains dissolved wax. When the outer pipe surface is cooled sufficiently, the growth of a wax layer is initiated on the inner pipe wall, and this evolves to a saturated steady state thickness. The model proposed is based on fundamental balances of heat flow from the oil, into the wax layer, and across the pipe wall. We present an analysis of the model, examine a relevant asymptotic limit in which the full details of the solution to the model are available and develop an efficient numerical method (based on the method of fundamental solutions) for producing approximations of the model solution. The mathematical structure of the model is that of a free boundary evolution problem of generalised Stefan type. © The Author, 2014.

Psychological traits influence autonomic nervous system recovery following esophageal intubation in health and functional chest pain

Background: Esophageal intubation is a widely utilized technique for a diverse array of physiological studies, activating a complex physiological response mediated, in part, by the autonomic nervous system (ANS). In order to determine the optimal time period after intubation when physiological observations should be recorded, it is important to know the duration of, and factors that influence, this ANS response, in both health and disease. Methods: Fifty healthy subjects (27 males, median age 31.9 years, range 20-53 years) and 20 patients with Rome III defined functional chest pain (nine male, median age of 38.7 years, range 28-59 years) had personality traits and anxiety measured. Subjects had heart rate (HR), blood pressure (BP), sympathetic (cardiac sympathetic index, CSI), and parasympathetic nervous system (cardiac vagal tone, CVT) parameters measured at baseline and in response to per nasum intubation with an esophageal catheter. CSI/CVT recovery was measured following esophageal intubation. Key Results: In all subjects, esophageal intubation caused an elevation in HR, BP, CSI, and skin conductance response (SCR; all p < 0.0001) but concomitant CVT and cardiac sensitivity to the baroreflex (CSB) withdrawal (all p < 0.04). Multiple linear regression analysis demonstrated that longer CVT recovery times were independently associated with higher neuroticism (p < 0.001). Patients had prolonged CSI and CVT recovery times in comparison to healthy subjects (112.5 s vs 46.5 s, p = 0.0001 and 549 s vs 223.5 s, p = 0.0001, respectively). Conclusions & Inferences: Esophageal intubation activates a flight/flight ANS response. Future studies should allow for at least 10 min of recovery time. Consideration should be given to psychological traits and disease status as these can influence recovery. The psychological trait of neuroticism retards autonomic recovery following esophageal intubation in health and functional chest pain. © 2013 John Wiley & Sons Ltd.

Phase noise tolerance study in coherent optical circular QAM transmissions with Viterbi- Viterbi carrier phase estimation

We present a performance evaluation of a non-conventional approach to implement phase noise tolerant optical systems with multilevel modulation formats. The performance of normalized Viterbi-Viterbi carrier phase estimation (V-V CPE) is investigated in detail for circular m-level quadrature amplitude modulation (C-mQAM) signals. The intrinsic property of C-mQAM constellation points with a uniform phase separation allows a straightforward employment of V-V CPE without the need to adapt constellation. Compared with conventional feed-forward CPE for square QAM signals, the simulated results show an enhanced tolerance of linewidth symbol duration product (ΔvTs) at a low sensitivity penalty by using feed-forward CPE structure with C-mQAM. This scheme can be easily upgraded to higher order modulations without inducing considerable complexity.

Aspirin and aspirin analogs on esophageal cancer

Background: Esophageal cancer is the eighth most common cancer seen worldwide and is the sixth most common cause of death from cancer. The UK alone has over 8,000 new cases of esophageal cancer every year. Epidemiological studies have shown that low-dose daily intake of aspirin can decrease the incidence of esophageal cancer. However, its use as an anti-cancer drug has been restrained because of its side effects exerted through inhibition of cyclooxygenase (COX) enzymes. In our study, we have investigated the effects of a number of novel aspirin analogs on esophageal cancer cell lines. Methods: The effects of aspirin and its analogs on the viability of esophageal cancer cell lines were tested using the MTT assay. ApoSense and flow cytometric analysis were performed to examine whether aspirin analog-mediated tumor cell death is due to apoptosis or necrosis. Colorimetric assays measuring peroxidase component of cyclooxygenases were employed to screen aspirin analogs for COX inhibition. Results: Our data suggests that the anti-proliferative property of certain aspirin analogs is greater than that of aspirin itself. Benzoylsalicylates and fumaroyl diaspirin were more effective than aspirin against the oe21 squamous cell carcinoma cells and oe33 esophageal adenocarcinoma cells. Flo-1 esophageal adenocarcinoma cells showed resistance to aspirin and most of the aspirin analogs other than the benzoylsalicylates. Both diaspirin and benzoylsalicylates inhibited metabolic activity in all these esophageal cells. However, apoptosis was induced in only a small proportion. We have also shown that these aspirin analogs do not appear to inhibit COX enzymes. Conclusion: We have synthesized and characterized a number of novel aspirin analogs that are more effective against esophageal cancer cell lines than aspirin. These compounds do not exert their anti-proliferative effect through induction of apoptosis. Moreover, these analogs inability to inhibit COX enzymes suggests that they may cause fewer or no side effects compared to aspirin.