Stepwise events involved in stress induced localized inflammation and barrier dysfunction. ➊ Stress induced autonomic nerve stimulation, release of peripheral corticotropin-releasing factor (CRF) and muscularis macrophages receptors activation, further strengthened by damage associated molecular patterns (DAMPs) mediated immune cells activation. ➋ Nuclear activation and release of pro-inflammatory chemokines and cytokines. ➌ Upregulation of intercellular adhesion molecules-1 (ICAM-1) in the endothelial cells of blood vessels. ➍ Influx of leukocytes in the muscularis. ➎ Increase synthesis of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) enzymes in the muscularis resident macrophages, release of inflammatory substances (prostaglandins [PGs] and nitric oxide [NO]) in the muscularis to cause localized inflammation. ➏ Mast cell and cortisol mediated barrier disruption cause translocation of luminal antigens (lipopolysaccharide [LPS]). ➐ LPS induce pathogen associated molecular patterns (PAMPs) mediated activation of mucosal immune cells to further exacerbate inflammation. ➑ The luminal antigen drainage through lymphatics and activation of dendritic cells along activation of inhibitory sympathetic and vagal nerve cause generalized inflammation through gastrointestinal tract to induce post-operative ileus. Th, T helper cells; MM, muscularis macrophages; MCP-1, monocyte chemoattractant protein-1; MIP-1α, macrophage inflammatory protein-1α; SM, smooth muscle; LM, longitudinal muscle.
Metrics from esophageal high-resolution manometry used in the evaluation of contraction reserve. (A) The vigor of esophageal body contraction is assessed using the distal contractile integral (DCI). (B) The vigor of esophageal body contraction following inhibition of peristalsis during the repetitive swallows by multiple rapid swallows (MRS) provocative test. The DCI of contraction following MRS is higher than the mean DCI from test swallows (post-MRS: wet swallow DCI ratio > 1) indicates contraction reserve.
Probability for esophagogastric junction (EGJ) obstruction using functional lumen imaging probe (FLIP) panometry metrics. Four patients (A-D) from the study cohort are plotted based on the EGJ-distensibility index (DI) and maximum EGJ-diameter from FLIP panometry as described in the text. Figure used with permission from the Esophageal Center of Northwestern (available from URL: https://www.wklytics.com/nmgi/prob_flip.html).
Four categories of integrated pressurized volumes (IPVs) from the rectum to the anal canal. (A) Categorization of the pressure signals during simulated evacuation from the rectum to the anus into 5 regions. (B-E) IPVs from the lower portion (blue), upper portion (red), and the IPV ratio.
Biomarker identification of responders to probiotic treatment. The potential biomarkers identified by the linear discriminant analysis (LDA) effect size algorithm are shown with heatmaps of the log-scaled relative abundance. Each plot represents biomarkers of the responders and non-responders in the (A) pre-treatment samples and (B) post-treatment samples and (C) biomarkers of the pre- and post-treatment samples in the responder group.
Simultaneous bioelectrical and video mapping method. (A) Arrangement of the cross-polarized camera setup and the electrode array on the intestine. Camera exposure is recorded along with the bioelectrical signals by the BioSemi ActiveTwo system for synchronization. (B) Flexible electrode array used for high-resolution (HR) bioelectrical mapping (16 × 8 configuration; 4 mm spacing). (C) Intestine as visible from the camera, placed over the flexible electrode array. LED, light emitting diode.
J Neurogastroenterol Motil 2022; 28(4): 509~710 
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