Searching for Heavy Dark Matter near the Planck Mass with XENON1T.

Multiple viable theoretical models predict heavy dark matter particles with a mass close to the Planck mass, a range relatively unexplored by current experimental measurements. We use 219.4 days of data collected with the XENON1T experiment to conduct a blind search for signals from multiply interacting massive particles (MIMPs). Their unique track signature allows a targeted analysis with only 0.05 expected background events from muons. Following unblinding, we observe no signal candidate events. This Letter places strong constraints on spin-independent interactions of dark matter particles with a mass between 1×10^{12} and 2×10^{17} GeV/c^{2}. In addition, we present the first exclusion limits on spin-dependent MIMP-neutron and MIMP-proton cross sections for dark matter particles with masses close to the Planck scale.

First Dark Matter Search with Nuclear Recoils from the XENONnT Experiment.

We report on the first search for nuclear recoils from dark matter in the form of weakly interacting massive particles (WIMPs) with the XENONnT experiment, which is based on a two-phase time projection chamber with a sensitive liquid xenon mass of 5.9 ton. During the (1.09±0.03) ton yr exposure used for this search, the intrinsic ^{85}Kr and ^{222}Rn concentrations in the liquid target are reduced to unprecedentedly low levels, giving an electronic recoil background rate of (15.8±1.3) events/ton yr keV in the region of interest. A blind analysis of nuclear recoil events with energies between 3.3 and 60.5 keV finds no significant excess. This leads to a minimum upper limit on the spin-independent WIMP-nucleon cross section of 2.58×10^{-47} cm^{2} for a WIMP mass of 28 GeV/c^{2} at 90% confidence level. Limits for spin-dependent interactions are also provided. Both the limit and the sensitivity for the full range of WIMP masses analyzed here improve on previous results obtained with the XENON1T experiment for the same exposure.

First Leptophobic Dark Matter Search from the Coherent-CAPTAIN-Mills Liquid Argon Detector.

We report the first results of a search for leptophobic dark matter (DM) from the Coherent-CAPTAIN-Mills (CCM) liquid argon (LAr) detector. An engineering run with 120 photomultiplier tubes (PMTs) and 17.9×10^{20} protons on target (POT) was performed in fall 2019 to study the characteristics of the CCM detector. The operation of this 10-ton detector was strictly light based with a threshold of 50 keV and used coherent elastic scattering off argon nuclei to detect DM. Despite only 1.5 months of accumulated luminosity, contaminated LAr, and nonoptimized shielding, CCM's first engineering run has already achieved sensitivity to previously unexplored parameter space of light dark matter models with a baryonic vector portal. With an expected background of 115 005 events, we observe 115 005+16.5 events which is compatible with background expectations. For a benchmark mediator-to-DM mass ratio of m_{V_{B}}/m_{χ}=2.1, DM masses within the range 9 MeV≲m_{χ}≲50 MeV are excluded at 90% C. L. in the leptophobic model after applying the Feldman-Cousins test statistic. CCM's upgraded run with 200 PMTs, filtered LAr, improved shielding, and 10 times more POT will be able to exclude the remaining thermal relic density parameter space of this model, as well as probe new parameter space of other leptophobic DM models.

Genetic transformation of mosquitoes by microparticle bombardment.

Mosquitoes constitute the major living beings causing human deaths in the world. They are vectors of malaria, yellow fever, dengue, zika, filariases, chikungunya, among other diseases. New strategies to control/eradicate mosquito populations are based on newly developed genetic manipulation techniques. However, genetic transformation of mosquitoes is a major technical bottleneck due to low efficiency, the need of sophisticated equipment, and highly trained personnel. The present report shows the transgenerational genetic transformation of Aedes aegypti, using the particle inflow gun (PIG), by integrating the ecfp gene in the AAEL000582 mosquito gene with the CRISPR-Cas9 technique, achieving a mean efficiency of 44.5% of bombarded individuals (G0) that showed ECFP expression in their tissues, and a mean of 28.5% transformation efficiency measured on G1 individuals. The same transformation technique was used to integrate the egfp/scorpine genes cloned in the Minos transposon pMinHygeGFP into the Anopheles albimanus genome, achieving a mean efficiency of 43.25% of bombarded individuals (G0) that showed EGFP expression in their tissues. Once the technique was standardized, transformation of Ae. aegypti neonate larvae and An. albimanus eggs was achieved when exposed to gold microparticle bombardment. Integration of genes and heterologous protein expression were confirmed by PCR, sequencing, fluorescent microscopy, mass spectrometry, Western blot and dot blot analyses. Transgenerational inheritance of the transgenes was observed only on Ae. aegypti, as all transformed An. albimanus individuals died at the pupal stage of the G0 generation.

The key components of a successful model of midwifery-led continuity of carer, without continuity at birth: findings from a qualitative implementation evaluation.

BACKGROUND: Recent UK maternity policy changes recommend that a named midwife supports women throughout their pregnancy, birth and postnatal care. Whilst many studies report high levels of satisfaction amongst women receiving, and midwives providing, this level of continuity of carer, there are concerns some midwives may experience burnout and stress. In this study, we present a qualitative evaluation of the implementation of a midwife-led continuity of carer model that excluded continuity of carer at the birth. METHODS: Underpinned by the Conceptual Model for Implementation Fidelity, our evaluation explored the implementation, fidelity, reach and satisfaction of the continuity of carer model. Semi-structured interviews were undertaken with midwives (n = 7) and women (n = 15) from continuity of carer team. To enable comparisons between care approaches, midwives (n = 7) and women (n = 10) from standard approach teams were also interviewed. Interviews were recorded, transcribed and analysed using thematic analysis. RESULTS: For continuity of carer team midwives, manageable caseloads, extended appointment times, increased team stability, and flexible working patterns facilitated both care provided and midwives' job satisfaction. Both continuity of carer and standard approach midwives reported challenges in providing postnatal continuity given the unpredictable timing of labour and birth. Time constraints, inadequate staffing and lack of administrative support were reported as additional barriers to implementing continuity of carer within standard approach teams. Women reported continuity was integral to building trust with midwives, encouraged them to disclose mental health issues and increased their confidence in making birth choices. CONCLUSIONS: Our evaluation highlighted the successful implementation of a continuity of carer model for ante and postnatal care. Despite exclusion of the birth element in the model, both women and midwives expressed high levels of satisfaction in comparison to women and midwives within the standard approach. Implementation successes were largely due to structural and resource factors, particularly the combination of additional time and smaller caseloads of women. However, these resources are not widely available within the resources of maternity unit budgets. Future research should further explore whether a continuity of carer model focusing on antenatal and postnatal care delivery is a feasible and sustainable model of care for all women.

International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary-Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology.

Food protein-induced enterocolitis (FPIES) is a non-IgE cell- mediated food allergy that can be severe and lead to shock. Despite the potential seriousness of reactions, awareness of FPIES is low; high-quality studies providing insight into the pathophysiology, diagnosis, and management are lacking; and clinical outcomes are poorly established. This consensus document is the result of work done by an international workgroup convened through the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology and the International FPIES Association advocacy group. These are the first international evidence-based guidelines to improve the diagnosis and management of patients with FPIES. Research on prevalence, pathophysiology, diagnostic markers, and future treatments is necessary to improve the care of patients with FPIES. These guidelines will be updated periodically as more evidence becomes available.

Concentrations of Mercury and Other Inorganic Ions in Wet Precipitation Collected from a Mountain Mining Zone and an Urban Area in Central Mexico.

We measured and compared mercury (Hg) and other ions in rainwater collected in San Joaquin (mining zone) and Juriquilla (urban area), central Mexico, from 2009 to 2012. A total of 274 rainwater samples were collected and analyzed for pH, electrical conductivity, [Formula: see text] Cl-, [Formula: see text] Na+, K+, Ca2+, Mg2+ and Hg. Mercury concentrations in rainwater varied from 24.21 to 248.89 (x-bar = 86.97 ± 10.77) µg L- 1 in San Joaquin (mining zone) and 11.26 to 176.91 (x-bar = 81.51 ± 10.24) µg L- 1 in Juriquilla (urban area). Rainwater sample were collected over periods 1-3 days, depending upon precipitation frequency. Significant correlations (p < 0.05) were found between [Formula: see text] Cl-, [Formula: see text] Na+, K+, Ca2+, Mg2+ and Hg at the San Joaquin site. Significant correlations were obtained between [Formula: see text] Na+, K+, Ca2+, Mg2+ and Hg at the Juriquilla site. In order to determine if there were significant differences among each measured parameter in rainwater collected in San Joaquin and Juriquilla, Kruskal-Wallis test was applied to data. We emphasized that the distribution and concentrations of Hg and the studied ions in rainwater samples were affected by atmospheric dust and local meteorological conditions of wind-speed and direction.

Binary information propagation in circular magnetic nanodot arrays using strain induced magnetic anisotropy.

Nanomagnetic logic has emerged as a potential replacement for traditional Complementary Metal Oxide Semiconductor (CMOS) based logic because of superior energy-efficiency (Salahuddin and Datta 2007 Appl. Phys. Lett. 90 093503, Cowburn and Welland 2000 Science 287 1466-68). One implementation of nanomagnetic logic employs shape-anisotropic (e.g. elliptical) ferromagnets (with two stable magnetization orientations) as binary switches that rely on dipole-dipole interaction to communicate binary information (Cowburn and Welland 2000 Science 287 1466-8, Csaba et al 2002 IEEE Trans. Nanotechnol. 1 209-13, Carlton et al 2008 Nano Lett. 8 4173-8, Atulasimha and Bandyopadhyay 2010 Appl. Phys. Lett. 97 173105, Roy et al 2011 Appl. Phys. Lett. 99 063108, Fashami et al 2011 Nanotechnology 22 155201, Tiercelin et al 2011 Appl. Phys. Lett. 99 , Alam et al 2010 IEEE Trans. Nanotechnol. 9 348-51 and Bhowmik et al 2013 Nat. Nanotechnol. 9 59-63). Normally, circular nanomagnets are incompatible with this approach since they lack distinct stable in-plane magnetization orientations to encode bits. However, circular magnetoelastic nanomagnets can be made bi-stable with a voltage induced anisotropic strain, which provides two significant advantages for nanomagnetic logic applications. First, the shape-anisotropy energy barrier is eliminated which reduces the amount of energy required to reorient the magnetization. Second, the in-plane size can be reduced (∼20 nm) which was previously not possible due to thermal stability issues. In circular magnetoelastic nanomagnets, a voltage induced strain stabilizes the magnetization even at this size overcoming the thermal stability issue. In this paper, we analytically demonstrate the feasibility of a binary 'logic wire' implemented with an array of circular nanomagnets that are clocked with voltage-induced strain applied by an underlying piezoelectric substrate. This leads to an energy-efficient logic paradigm orders of magnitude superior to existing CMOS-based logic that is scalable to dimensions substantially smaller than those for existing nanomagnetic logic approaches. The analytical approach is validated with experimental measurements conducted on dipole coupled Nickel (Ni) nanodots fabricated on a PMN-PT (Lead Magnesium Niobate-Lead Titanate) sample.

[Paresis of an upper extremity. Action observation and motor imagery in recovery of patients with chronic stroke]. / Paresia de una extremidad superior. Recuperación mediante observación de la acción más imaginería motora en pacientes con ictus crónico.

INTRODUCTION: Action observation (AO) and motor imagery (MI) are considered functionally equivalent forms of motor representation related to movement execution (ME). Because of their characteristics, AO and MI have been proposed as techniques to facilitate the recovery of post-stroke hemiparesis in the upper extremities. PATIENTS AND METHODS: An experimental, longitudinal, prospective, single-blinded design was undertaken. Eleven patients participated, and were randomly assigned to each study group. Both groups received 10 to 12 sessions of physical therapy. Five patients were assigned to the control treatment group, and six patients to the experimental treatment group (AO + MI). All were assessed before and after treatment for function, strength (newtons) and mobility (percentage) in the affected limb, as well as alpha desynchronisation (8-13 Hz) in the supplementary motor area, the premotor cortex and primary motor cortex while performing AO + MI tasks and action observation plus motor execution (AO + ME). RESULTS: The experimental group presented improvement in function and strength. A negative correlation was found between desynchronisation in the supplementary motor area and function, as well as a post-treatment increase in desynchronisation in the premotor cortex of the injured hemisphere in the experimental group only. CONCLUSIONS: An AO + MI-based intervention positively impacts recovery of the paretic upper extremity by stimulating the supplementary motor area, a cortex involved in movement preparation and learning. AO + MI therapy can be used as adjunctive treatment in patients with upper extremity paresis following chronic stroke.

TITLE: Paresia de una extremidad superior. Recuperación mediante observación de la acción más imaginería motora en pacientes con ictus crónico.Introducción. La observación de la acción (OA) y la imaginería motora (IM) se consideran formas de representación motora funcionalmente equivalentes, relacionadas con la ejecución del movimiento (EM). Debido a sus características, la OA y la IM se han propuesto como técnicas para facilitar la recuperación de las hemiparesias de la extremidad superior posterior a ictus. Pacientes y métodos. Se realizó un diseño experimental, longitudinal y prospectivo simple ciego. Participaron 11 pacientes, quienes fueron asignados aleatoriamente a cada grupo de estudio. Ambos grupos recibieron de 10 a 12 sesiones de terapia física. Cinco pacientes fueron asignados al grupo de tratamiento control y seis pacientes al grupo de tratamiento experimental (OA + IM). A todos se les evaluó antes y después del tratamiento para determinar la función, la fuerza (newtons) y la movilidad (porcentaje) de la extremidad afectada, así como la desincronización de alfa (8-13 Hz) en el área motora suplementaria, la corteza premotora y la corteza motora primaria durante tareas de OA + IM y observación de la acción más ejecución motora (OA + EM). Resultados. El grupo experimental presentó mejoría en la función y la fuerza. Se encontró correlación negativa entre la desincronización en el área motora suplementaria y la función, así como incremento postratamiento de la desincronización en la corteza premotora del hemisferio lesionado únicamente para el grupo experimental. Conclusiones. Una intervención basada en OA + IM impacta positivamente en la recuperación de la extremidad superior parética mediante la estimulación del área motora suplementaria, corteza involucrada en la preparación y aprendizaje del movimiento. La terapia OA + IM puede usarse como tratamiento complementario en pacientes con paresia de una extremidad superior posterior a un ictus crónico.

The consensus of the Asociación Mexicana de Gastroenterología on the diagnosis and treatment of gastroesophageal reflux and gastroesophageal reflux disease in infants.

Gastroesophageal reflux (GER) is a frequent normal phenomenon in children of any age. It is more common in infants, in whom the majority of episodes are short-lived and cause no other symptoms or complications, differentiating it from gastroesophageal reflux disease (GERD). The diagnosis and management of GER and GERD continue to be a challenge for the physician. Therefore, the aim of the Asociación Mexicana de Gastroenterología was to adapt international documents to facilitate their adoption by primary care physicians, with the goal of standardizing quality of care and reducing the number of diagnostic tests performed and inappropriate medication use. The ADAPTE methodology was followed, and the recommendations were approved utilizing the Delphi strategy. The executive committee carried out the review of the guidelines, position papers, and international reviews that met the a priori quality criteria and possible applicability in a local context. The recommendations were taken from those sources and adapted, after which they were approved by the working group. The consensus consists of 25 statements and their supporting information on the diagnosis and treatment of GER and GERD in infants. The adapted document is the first systematic effort to provide an adequate consensus for use in Mexico, proposing a practical approach to and management of GER and GERD for healthcare providers.

Good clinical practice recommendations for the diagnosis and treatment of gastroesophageal reflux disease. An expert review from the Asociación Mexicana de Gastroenterología.

INTRODUCTION: Gastroesophageal reflux disease (GERD) is very prevalent in the general population, with a broad spectrum of clinical manifestations, requiring accurate diagnosis and treatment. AIM: The aim of this expert review is to establish good clinical practice recommendations for the diagnosis and personalized treatment of GERD. METHODS: The good clinical practice recommendations were produced by a group of experts in GERD, members of the Asociación Mexicana de Gastroenterología (AMG), after carrying out an extensive review of the published literature and discussing each recommendation at a face-to-face meeting. This document does not aim to be a clinical practice guideline with the methodology such a document requires. RESULTS: Fifteen experts on GERD formulated 27 good clinical practice recommendations for recognizing the symptoms and complications of GERD, the rational use of diagnostic tests and medical treatment, the identification and management of refractory GERD, the overlap with functional disorders, endoscopic and surgical treatment, and GERD in the pregnant woman, older adult, and the obese patient. CONCLUSIONS: An accurate diagnosis of GERD is currently possible, enabling the prescription of a personalized treatment in patients with this condition. The goal of the good clinical practice recommendations by the group of experts from the AMG presented in this document is to aid both the general practitioner and specialist in the process of accurate diagnosis and treatment, in the patient with GERD.

From targets to targeted therapies and molecular profiling in non-small cell lung carcinoma.

Although tumor molecular-profile-directed therapy appears promising in early clinical studies, there are many practical challenges to its successful clinical application in non-small-cell lung cancer (NSCLC). These challenges may be broadly classified as those relating to tumor (heterogeneity), tissue (acquisition and processing), testing (assays for molecular profiling) and trials (clinical evaluation of molecular markers and drugs). Strategies to overcome these challenges include (i) understanding the biological basis of tumor heterogeneity and of carcinogenesis in the large subset of patients with no currently evident driver events; (ii) technological advances in minimally invasive acquisition of tumor and next-generation sequencing (NGS) which would enable single-platform analysis of molecular alterations in limited tissue at a reasonable turnaround time (TAT); (iii) deliberation in early stages of drug development as well as clinical trial design to identify, validate and assess the clinical utility of biomarkers in conjunction with drugs and (iv) collaboration to improve understanding of and accrual to trials enrolling patients with rare molecular alterations.

A phase I/II study of sepantronium bromide (YM155, survivin suppressor) with paclitaxel and carboplatin in patients with advanced non-small-cell lung cancer.

BACKGROUND: This phase I/II study examined the safety and efficacy of Sepantronium Bromide (S), a small-molecule selective survivin suppressant, administered in combination with carboplatin (C) and paclitaxel (P). PATIENTS AND METHODS: Forty-one patients were treated on study. Twenty-two patients received escalating doses of S (3.6-12 mg/m(2)) and 19 with untreated stage IV non-small-cell lung cancer (NSCLC) were treated with the maximum tolerated dose of 10 mg/m(2) in combination with standard doses of C (AUC6) and P (200 mg/m(2)) for six cycles. S was administered as a continuous intravenous infusion (CIVI) over 72 h in 21-day treatment cycles. Study end points included safety and toxic effect, response rate, progression-free and overall survival (PFS and OS), as well as exploratory pharmacodynamic correlates. RESULTS: Treatment with S was well tolerated, and toxic effects were mostly hematological in the phase II study. Two (11%) partial responses were observed with a median PFS of 5.7 months and median OS 16.1 months. Pharmacodynamic analysis did not demonstrate an association with response. CONCLUSION: The combination of S (10 mg/m(2)/day 72-h CIVI) administered with C and P every 3 weeks exhibited a favorable safety profile but failed to demonstrate an improvement in response rate in advanced NSCLC. CLINICAL TRIAL NUMBER: NCT01100931.

Serum IL-12 is increased in Mexican obese subjects and associated with low-grade inflammation and obesity-related parameters.

Interleukin-(IL-) 12 has been recently suggested to participate during development of insulin resistance in obese mice. Nevertheless, serum IL-12 levels have not been accurately determined in overweight and obese humans. We thus studied serum concentrations of IL-12 in Mexican adult individuals, examining their relationship with low-grade inflammation and obesity-related parameters. A total of 147 healthy individuals, 43 normal weight, 61 overweight, and 43 obese subjects participated in the study. Circulating levels of IL-12, tumor necrosis factor-alpha (TNF- α ), leptin, insulin, glucose, total cholesterol, and triglyceride were measured after overnight fasting in all of the study subjects. Waist circumference and body fat percentage were recorded for all the participants. Serum IL-12 was significantly higher in overweight and obese individuals than in normal weight controls. Besides being strongly related with body mass index (r = 0.5154), serum IL-12 exhibited a significant relationship with abdominal obesity (r = 0.4481), body fat percentage (r = 0.5625), serum glucose (r = 0.3158), triglyceride (r = 0.3714), and TNF- α (r = 0.4717). Thus, serum levels of IL-12 are increased in overweight and obese individuals and show a strong relationship with markers of low-grade inflammation and obesity in the Mexican adult population. Further research is needed to understand the role of IL-12 in developing obesity-associated alterations in humans.

Performic acid for advanced wastewater disinfection.

The disinfection efficiency of performic acid (PFA) against various microbial contaminants has been studied in municipal secondary effluent. The study demonstrated that PFA provides rapid, efficient and safe disinfection, degrading both bacteria and viruses even at low doses. The resistance order starting from the most resistant microorganism is as follows: MS2-coliphages > DNA-coliphages > enterococci and Escherichia coli. PFA is also efficient in the elimination of Salmonella spp., Clostridium perfringens spores and Giardia cysts. The results showed that a PFA dose as low as 0.5-1 mg L(-1) with contact time of 10 min was efficient in achieving and maintaining for 72 h the disinfection level required for unrestricted agricultural water reuse (≤3 log units for faecal coliforms). However, the optimal dose will depend on the quality of wastewater. Regarding the formation of by-products during disinfection with PFA, very low amounts of hydrogen peroxide and organic per-acids were observed; active oxygen was not detected. The amounts of adsorbable organically bound halogens (AOX) compounds formed were significantly lower compared to the amounts generated during chlorine disinfection. This chlorine-free solution enables compliance with microbiological criteria for various water reuse applications and is already on the market for advanced disinfection.

Supercooling of the A phase of 3He.

Because of the extreme purity, lack of disorder, and complex order parameter, the first-order superfluid 3He A-B transition is the leading model system for first order transitions in the early universe. Here we report on the path dependence of the supercooling of the A phase over a wide range of pressures below 29.3 bar at nearly zero magnetic field. The A phase can be cooled significantly below the thermodynamic A-B transition temperature. While the extent of supercooling is highly reproducible, it depends strongly upon the cooling trajectory: The metastability of the A phase is enhanced by transiting through regions where the A phase is more stable. We provide evidence that some of the additional supercooling is due to the elimination of B phase nucleation precursors formed upon passage through the superfluid transition. A greater understanding of the physics is essential before 3He can be exploited to model transitions in the early universe.

Electron transport measurements in liquid xenon with Xenoscope, a large-scale DARWIN demonstrator.

The DARWIN observatory is a proposed next-generation experiment with 40 tonnes of liquid xenon as an active target in a time projection chamber. To study challenges related to the construction and operation of a multi-tonne scale detector, we have designed and constructed a vertical, full-scale demonstrator for the DARWIN experiment at the University of Zurich. Here, we present the first results from a several-months run with 343kg of xenon and electron drift lifetime and transport measurements with a 53cm tall purity monitor immersed in the cryogenic liquid. After 88days of continuous purification, the electron lifetime reached a value of (664±23)µs. We measured the drift velocity of electrons for electric fields in the range (25-75) V/cm, and found values consistent with previous measurements. We also calculated the longitudinal diffusion constant of the electron cloud in the same field range, and compared with previous data, as well as with predictions from an empirical model.

Bi2Te3 Thin Films Deposited by the Combination of Bi and Te Plasmas in a PLD Process.

Bismuth telluride thin films were grown by pulsed laser deposition by implementing a novel method that combines both Te and Bi plasmas resulting from the laser ablation of individual Bi and Te targets. Furthermore, the mean kinetic ion energy and density of the plasmas, as estimated by TOF curves obtained from Langmuir probe measurements, were used as control parameters for the deposition process. The obtained thin films exhibit a metallic mirror-like appearance and present good adhesion to the substrate. Morphology of the thin films was observed by SEM, yielding smooth surfaces where particulates were also observed (splashing). Chemical composition analysis obtained by EDS showed that apparently the films have a Te-rich composition (ratio of Te/Bi of 3); however, Te excess arises from the splashing as revealed by the structural characterization (XRD and Raman spectroscopy). The XRD pattern indicated that depositions have the rhombohedral (D3d5 (R3¯m)) structure of Bi2Te3. Likewise, Raman spectra exhibited the presence of signals that correspond to Eg2, A1u2 and A1g2(LO) vibrational modes of the same rhombohedral phase of Bi2Te3. Additionally, oxidation states, analyzed by XPS, resulted in signals associated to Bi3+ and Te2- that correspond to the Bi2Te3 compound. Finally, surface topology and thickness profiles were obtained from AFM measurements, confirming a combination of a smooth surface with particulates on top of it and a film thickness of 400 nm.

The Mexican consensus on fecal incontinence.

Fecal incontinence is the involuntary passage or the incapacity to control the release of fecal matter through the anus. It is a condition that significantly impairs quality of life in those that suffer from it, given that it affects body image, self-esteem, and interferes with everyday activities, in turn, favoring social isolation. There are no guidelines or consensus in Mexico on the topic, and so the Asociación Mexicana de Gastroenterología brought together a multidisciplinary group (gastroenterologists, neurogastroenterologists, and surgeons) to carry out the «Mexican consensus on fecal incontinence¼ and establish useful recommendations for the medical community. The present document presents the formulated recommendations in 35 statements. Fecal incontinence is known to be a frequent entity whose incidence increases as individuals age, but one that is under-recognized. The pathophysiology of incontinence is complex and multifactorial, and in most cases, there is more than one associated risk factor. Even though there is no diagnostic gold standard, the combination of tests that evaluate structure (endoanal ultrasound) and function (anorectal manometry) should be recommended in all cases. Treatment should also be multidisciplinary and general measures and drugs (lidamidine, loperamide) are recommended, as well as non-pharmacologic interventions, such as biofeedback therapy, in selected cases. Likewise, surgical treatment should be offered to selected patients and performed by experts.