Facile one-pot synthesis of lithium metal nanoparticles for superior lithium-ion anode applications.

A capable one-step method, femtosecond laser ablation of solids in liquids, was successfully applied to prepare lithium metal nanoparticles to mitigate the initial capacity loss and improve the electrochemical performance of a graphite-based electrode as a Li-host anode. Remarkably, according to the physicochemical characterization, this advanced optical method allowed to obtain uniform spheroidal and crystalline Li nanoparticles with an average particle size <20 nm. These novel ultrafine Li nanoparticles significantly decrease the initial capacity loss of a graphite-based anode, leading to reach high coulombic efficiency (>99 %), good specific charge capacity (322 mAh/g), and superior capacity retention (96 %) at an applied current density of 100 mA g-1 after 200 cycles.

Sexual dysfunction worsens both the general and specific quality of life of women with irritable bowel syndrome. A cross-sectional study.

BACKGROUND: Irritable bowel syndrome (IBS) and sexual dysfunction (SxD) lowers quality of life (QOL) separately, but the effect of their overlap in unselected populations has not been studied. OBJECTIVE: To evaluate the QOL of IBS women with and without SxD and compare it with controls. METHODS: In this cross-sectional assessment, we studied 51 IBS women (Rome IV criteria) and 54 controls. SxD was determined using the female sexual function index questionnaire. QOL was evaluated by the Short Form 36 (SF-36) and IBS-QOL questionnaires. RESULTS: SxD prevalence was similar between IBS women (39.22%) and controls (38.89%). Compared with other groups, IBS patients with SxD showed lower scores in all domains as well as in the physical, mental summaries of the SF-36 and almost all domains (except for body image, food avoidance, and social reaction compared with IBS patients without SxD) and the total score of IBS-QOL. CONCLUSIONS: These findings show that SxD worsens both general and specific QOL of women with IBS. The consideration of SxD in patients with IBS will allow us to make a more effective diagnostic and therapeutic approach. Clinical trial registry in Mexico City General Hospital: DI/19/107/03/080. CLINICAL TRIALS REGISTRATION: NCT04716738.

Cardiovascular Autonomic Regulation, ETCO2 and the Heart Rate Response to the Tilt Table Test in Patients with Orthostatic Intolerance.

Chronic orthostatic intolerance (COI) is defined by changes in heart rate (HR), blood pressure (BP), respiration, symptoms of cerebral hypoperfusion and sympathetic overactivation. Postural tachycardia syndrome (POTS) is the most common form of COI in young adults and is defined by an orthostatic increase in heart rate (HR) of ≥ 30 bpm in the absence of orthostatic hypotension. However, some patients referred for evaluation of COI symptoms do not meet the orthostatic HR response criterion of POTS despite debilitating symptoms. Such patients are ill defined, posing diagnostic and therapeutic challenges. This study explored the relationship among cardiovascular autonomic control, the orthostatic HR response, EtCO2 and the severity of orthostatic symptoms and fatigue in patients referred for evaluation of COI. Patients (N = 108) performed standardized testing protocol of the Autonomic Reflex Screen and completed the Composite Autonomic Symptom Score (COMPASS-31) and the Fatigue Severity Scale (FSS). Greater severity of COI was associated with younger age, larger phase IV amplitude in the Valsalva maneuver and lower adrenal baroreflex sensitivity. Greater fatigue severity was associated with a larger reduction in ETCO2 during 10 min of head-up tilt (HUT) and reduced low-frequency (LF) power of heart rate variability. This study suggests that hemodynamic changes associated with the baroreflex response and changes in EtCO2 show a stronger association with the severity of orthostatic symptoms and fatigue than the overall orthostatic HR response in patients with COI.

The Age-AST-D Dimer (AAD) Regression Model Predicts Severe COVID-19 Disease.

AIM: Coronavirus disease (COVID-19) ranges from mild clinical phenotypes to life-threatening conditions like severe acute respiratory syndrome (SARS). It has been suggested that early liver injury in these patients could be a risk factor for poor outcome. We aimed to identify early biochemical predictive factors related to severe disease development with intensive care requirements in patients with COVID-19. METHODS: Data from COVID-19 patients were collected at admission time to our hospital. Differential biochemical factors were identified between seriously ill patients requiring intensive care unit (ICU) admission (ICU patients) versus stable patients without the need for ICU admission (non-ICU patients). Multiple linear regression was applied, then a predictive model of severity called Age-AST-D dimer (AAD) was constructed (n = 166) and validated (n = 170). RESULTS: Derivation cohort: from 166 patients included, there were 27 (16.3%) ICU patients that showed higher levels of liver injury markers (P < 0.01) compared with non-ICU patients: alanine aminotrasnferase (ALT) 225.4 ± 341.2 vs. 41.3 ± 41.1, aspartate aminotransferase (AST) 325.3 ± 382.4 vs. 52.8 ± 47.1, lactic dehydrogenase (LDH) 764.6 ± 401.9 vs. 461.0 ± 185.6, D-dimer (DD) 7765 ± 9109 vs. 1871 ± 4146, and age 58.6 ± 12.7 vs. 49.1 ± 12.8. With these finding, a model called Age-AST-DD (AAD), with a cut-point of <2.75 (sensitivity = 0.797 and specificity = 0.391, c - statistic = 0.74; 95%IC: 0.62-0.86, P < 0.001), to predict the risk of need admission to ICU (OR = 5.8; 95% CI: 2.2-15.4, P = 0.001), was constructed. Validation cohort: in 170 different patients, the AAD model < 2.75 (c - statistic = 0.80 (95% CI: 0.70-0.91, P < 0.001) adequately predicted the risk (OR = 8.8, 95% CI: 3.4-22.6, P < 0.001) to be admitted in the ICU (27 patients, 15.95%). CONCLUSIONS: The elevation of AST (a possible marker of early liver injury) along with DD and age efficiently predict early (at admission time) probability of ICU admission during the clinical course of COVID-19. The AAD model can improve the comprehensive management of COVID-19 patients, and it could be useful as a triage tool to early classify patients with a high risk of developing a severe clinical course of the disease.

A short telephone-call reminder improves bowel preparation, quality indicators and patient satisfaction with first colonoscopy.

BACKGROUND AND STUDY AIMS: Addition of a reminder program to conventional indications improves colonoscopy. The aim of this study was to evaluate the effectiveness of a short telephone call reminder (STCR) on a patient's first colonoscopy. PATIENTS AND METHODS: One day before colonoscopy, we made a STCR of < 10 minutes to 141 randomly selected patients of 258 recruited. The STCRs informed patients about the procedure date, indications for taking laxatives, and dietetic requirements. Questions were clarified only when patients asked directly. We evaluated bowel preparation, quality indicators, and patient satisfaction. Data were expressed as mean ±â€ŠSD and percentages. Statistical differences were evaluated by Student's t and Chi squared tests; alpha = 0.05. All authors had access to the study data and reviewed and approved the final manuscript. RESULTS: The STCR group had better bowel preparation which was demonstrated by higher completion frequency (97.16 % vs. 82.05 %), in less time (4.52 ±â€Š3.06 vs. 5.38 ±â€Š3.03 hours) intake of laxative, and higher Boston's scale (7.66 ±â€Š2.42 vs. 5.2 ±â€Š1.65). Quality indicators of colonoscopy were better in patients that received a STCR [cecal intubation rate: 100.00 % vs. 87.18 %; polyp detection: 42.55 % vs. 9.4 %; and cecal arrival time (min): 12.09 ±â€Š3.62 vs. 15.09 ±â€Š5.02]. STCR patients were more satisfied (97.87 % vs. 55.56 %) and would repeat colonoscopy (21.99 % vs. 11.11 %). CONCLUSIONS: A simple additional step such as a STCR improves quality of bowel preparation, quality indicators, and satisfaction of patients undergoing their first colonoscopy. Clinical trial registry in Mexico City General Hospital: DI/16/107/3/108.

Erratum: A short telephone-call reminder improves bowel preparation, quality indicators and patient satisfaction with first colonoscopy.

[This corrects the article DOI: 10.1055/s-0043-117954.].

Rectal tone and compliance affected in patients with fecal incontinence after fistulotomy.

AIM: To investigate the anal sphincter and rectal factors that may be involved in fecal incontinence that develops following fistulotomy (FIAF). METHODS: Eleven patients with FIAF were compared with 11 patients with idiopathic fecal incontinence and with 11 asymptomatic healthy subjects (HS). All of the study participants underwent anorectal manometry and a barostat study (rectal sensitivity, tone, compliance and capacity). The mean time since surgery was 28 ± 26 mo. The postoperative continence score was 14 ± 2.5 (95%CI: 12.4-15.5, St Mark's fecal incontinence grading system). RESULTS: Compared with the HS, the FIAF patients showed increased rectal tone (42.63 ± 27.69 vs 103.5 ± 51.13, P = 0.002) and less rectal compliance (4.95 ± 3.43 vs 11.77 ± 6.9, P = 0.009). No significant differences were found between the FIAF patients and the HS with respect to the rectal capacity; thresholds for the non-noxious stimuli of first sensation, gas sensation and urge-to-defecate sensation or the noxious stimulus of pain; anal resting pressure or squeeze pressure; or the frequency or percentage of relaxation of the rectoanal inhibitory reflex. No significant differences were found between the FIAF patients and the patients with idiopathic fecal incontinence. CONCLUSION: In patients with FIAF, normal motor anal sphincter function and rectal sensitivity are preserved, but rectal tone and compliance are impaired. The results suggest that FIAF is not due to alterations in rectal sensitivity and that the rectum is more involved than the anal sphincters in the genesis of FIAF.

Endoscopic and symptoms analysis in Mexican patients with irritable Bowel syndrome, dyspepsia, and gastroesophageal reflux disease.

The aim of this study was to analyze the data of endoscopy and symptoms in 118 Mexican patients with irritable bowel syndrome (IBS), dyspepsia, non-erosive reflux disease (NERD) and erosive esophagitis (EE). IBS criteria were fulfilling for dyspepsia patients in 47%, for NERD in 48%, and for EE patients in 48% of cases. Esophagitis was present in 42% of patients with IBS and in 45% of patients with dyspepsia. A higher prevalence of hiatus hernia was found in EE vs. NERD. Heartburn and acid eructation were associated with the presence of esophagitis; acid eructation, regurgitation and nocturnal pain with duodenitis; and heartburn and regurgitation with hiatus hernia. Males more frequently reported: mucus in feces, abdominal distension, nausea and gastritis; and women more frequently reported esophagitis and duodenitis. Patients with NERD (OR 2.54, 95% CI 1.08 to 5.99, p=0.04), tenesmus and early satiety, and men had an increase risk for reporting hard or lumpy stools. In conclusion, nearly half of the Mexican patients with NERD, EE and dyspepsia fulfill criteria for IBS. A large number of symptoms were correlated with endoscopy, which can be used to improve the indication of the endoscopy and its implementation in clinical studies.

Endoscopic and symptoms analysis in Mexican patients with irritable Bowel syndrome, dyspepsia, and gastroesophageal reflux disease

The aim of this study was to analyze the data of endoscopy and symptoms in 118 Mexican patients with irritable bowel syndrome (IBS), dyspepsia, non-erosive reflux disease (NERD) and erosive esophagitis (EE). IBS criteria were fulfilling for dyspepsia patients in 47 percent, for NERD in 48 percent, and for EE patients in 48 percent of cases. Esophagitis was present in 42 percent of patients with IBS and in 45 percent of patients with dyspepsia. A higher prevalence of hiatus hernia was found in EE vs. NERD. Heartburn and acid eructation were associated with the presence of esophagitis; acid eructation, regurgitation and nocturnal pain with duodenitis; and heartburn and regurgitation with hiatus hernia. Males more frequently reported: ucus in feces, abdoinal distension, nausea and gastritis; and oen ore frequently reported esophagitis and duodenitis. Patients with NERD (OR 2.54, 95 percent CI 1.08 to 5.99, p=0.04), tenesmus and early satiety, and men had an increase risk for reporting hard or lumpy stools. In conclusion, nearly half of the Mexican patients with NERD, EE and dyspepsia fulfill criteria for IBS. A large number of symptoms were correlated with endoscopy, which can be used to improve the indication of the endoscopy and its implementation in clinical studies.

O objetivo deste estudo foi analisar os dados de endoscopia e sintomas de 118 pacientes mexicanos com síndrome do intestino irritável (IBS), dispepsia, doença do refluxo não-erosiva (NERD) e esofagite erosiva (EE). Os pacientes com IBS preencheram os critérios para dispepsia em 47 por cento, para NERD em 48 por cento, e para pacientes EE em 48 por cento dos casos. Esofagite estava presente em 42 por cento dos pacientes com IBS e em 45 por cento dos pacientes com dispepsia. A maior prevalência de hérnia de hiato foi encontrada na EE em comparação com NERD. Azia e eructação ácida foram associadas à presença de esofagite; eructação ácida, regurgitação e dor noturna, com duodenite; e azia e regurgitação com hérnia de hiato. Os homens relataram mais frequentemente sintomas como muco nas fezes, distensão abdominal, náuseas e gastrite, enquanto que as mulheres mais frequentemente relataram esofagite e duodenite. Os pacientes com NERD (OR 2,54, IC 95 por cento 1,08-5,99, p = 0,04), apresentaram tenesmo e saciedade precoce, e os homens tiveram um risco aumentado relacionado a fezes endurecidas ou fragmentadas. Em conclusão, quase metade dos pacientes mexicanos com NERD, EE e dispepsia preenchem os critérios para a IBS. Um grande número de sintomas foi correlacionado com a endoscopia, esta correlação pode ser utilizada para aumentar a indicação da endoscopia e sua aplicação em estudos clínicos.

Reference values for stationary and 24-hour ambulatory esophageal manometry and pH data in Hispanic population.

BACKGROUND: It has not yet been determined whether values obtained with stationary esophageal motility test are similar to those obtained with the 24-h procedure. Furthermore, there are no normal values established for esophageal pH and motility parameters in a Hispanic population. METHODS: Reflux symptoms, endoscopy, Helicobacter pylori, stationary esophageal manometry, and combined 24-h pH-manometry were evaluated in 12 healthy volunteers. Three subjects also underwent 24-h esophageal bilirubin monitoring. RESULTS: Mean lower esophageal sphincter pressure measured stationary was lower (p<0.05) compared with 24-h ambulatory procedure. Mean duration of contraction waves was greater with stationary method (p<0.05). Esophageal contraction mean amplitude was not different between both procedures. Total percent of time with pH<4 was 0.16+/-0.21. Total 24-h acid reflux episodes were 5.5+/-6.6, with no episodes >5 min. No high bilirubin reflux episodes were recorded. CONCLUSIONS: These results suggested that physiologic motility parameters differed depending on the method employed for its evaluation. Values obtained with stationary and 24-h ambulatory esophageal manometry are identical when evaluating amplitude of contractions but differ in duration of contractions and lower esophageal sphincter pressure. In addition, these results provide for the first time reference values for stationary and 24-h ambulatory esophageal manometry and pH data in a Hispanic population.

Helicobacter pylori infection and hiatal hernia do not affect acid reflux and esophageal motility in patients with gastro-esophageal reflux.

BACKGROUND: The association of H. pylori and hiatal hernia in patients with gastroesophageal reflux disease, in terms of acidity and esophageal motility, is not well defined. The purpose of this work was to assess whether, in patients with gastroesophageal reflux, the presence of H. pylori and hiatal hernia affects the severity of esophagitis. METHODS: Reflux symptoms, endoscopy, H. pylori, esophageal manometry, and 24-h pH monitoring were evaluated in 37 patients with esophageal reflux and 14 healthy volunteers. RESULTS: A total of 75.6% of patients with esophageal reflux was positive for H. pylori; 81% had hiatal hernia, and only 43.2% showed an acid score by 24-h pHmetry. Esophageal reflux patients with H. pylori, hiatal hernia, and an acid score demonstrated higher acid parameters compared with those in healthy volunteers. Patients with an acid score who were negative for H. pylori tended toward more acid reflux events than patients with an acid score who were positive for H. pylori, a difference that did not reach significance. The same situation existed with patients with an acid score and hiatal hernia who were negative for H. pylori, but the tendency did not achieve significance. Independent analysis of patients with Savary-Miller stage II and III esophagitis showed results that were not different from the combined analysis of stage II and III patients. Amplitude and contraction-duration parameters of the esophageal wave, and the number of high-pressure and prolonged contractions were not different among the reflux groups. Wave amplitude in the lower third of the esophagus was significantly lower in esophagitis stage III patients with hiatal hernia and in esophagitis stage II and III patients, combined, with H. pylori, compared with findings in the healthy volunteers. CONCLUSIONS: These results suggest that H. pylori and hiatal hernia in patients with esophageal reflux do not constitute risk factors that affect the severity of esophagitis.

Retroalimentación biológica y su aplicación clínica / Clinical applications of biofeedback

Antecedentes: La incontinencia fecal constituye un serio problema social que afecta a todos los grupos de edad. Su tratamiento es tan complejo como desconocido. Métodos: Efectuamos un estudio longitudinal, prospectivo, experimental, entre 47 pacientes consecutivos que presentaban incontinencia total por un periodo de 55.4 ñ 7.6 meses (intervalo: seis meses a 21 años), con 2.4 ñ 0.2 episodios de incontinencia (intervalo: 1-7 por día). A todos se les efectuó cuestionario para validar el diagnóstico de incontinencia, historia clínica completa, laboratorio, colon por enema, rectosigmoidoscopia, sensibilidad rectal, manometría rectoanal, y retroalimentación biológica sin instrumentación electrónica. Veintiún sujetos normales sirvieron como grupo control. Resultados: Los pacientes con incontinencia fecal presentaron disminución de la sensibilidad rectal (p<0.01) y alteraciones en el reflejo recto anal inhibitorio espontáneo. Todos obtuvieron curación completa en un periodo de 4 ñ 0.5 meses (intervalo: 15 días a 15 meses) y fueron seguidos por uno a ocho años. Conclusiones: La nueva modalidad de retroalimentación biológica aquí descrita no utiliza ningún instrumento electrónico. La curación y el tiempo de curación de los pacientes no solamente es comparable, sino superior a lo hasta ahora informados. Puede ser reproducido, con el entrenamiento adecuado, por mayor número de médicos en cualquier centro y condicionar, por tanto, un beneficio significativo en la calidad de vida de un mayor número de pacientes