Human intestinal gas measurement systems: in vitro fermentation and gas capsules

Miniaturized Capsule System Toward Real-Time Electrochemical Detection of H2 S in the Gastrointestinal Tract

Hydrogen sulfide (H2 S) is a gaseous inflammatory mediator and important signaling molecule for maintaining gastrointestinal (GI) homeostasis. Excess intraluminal H2 S in the GI tract has been implicated in inflammatory bowel disease and neurodegenerative disorders; however, the role of H2 S in disease pathogenesis and progression is unclear. Herein, an electrochemical gas-sensing ingestible capsule is developed to enable real-time, wireless amperometric measurement of H2 S in GI conditions. A gold (Au) three-electrode sensor is modified with a Nafion solid-polymer electrolyte (Nafion-Au) to enhance selectivity toward H2 S in humid environments. The Nafion-Au sensor-integrated capsule shows a linear current response in H2 S concentration ranging from 0.21 to 4.5 ppm (R2 = 0.954) with a normalized sensitivity of 12.4% ppm-1 when evaluated in a benchtop setting. The sensor proves highly selective toward H2 S in the presence of known interferent gases, such as hydrogen (H2 ), with a selectivity ratio of H2 S:H2 = 1340, as well as toward methane (CH4 ) and carbon dioxide (CO2 ). The packaged capsule demonstrates reliable wireless communication through abdominal tissue analogues, comparable to GI dielectric properties. Also, an assessment of sensor drift and threshold-based notification is investigated, showing potential for in vivo application. Thus, the developed H2 S capsule platform provides an analytical tool to uncover the complex biology-modulating effects of intraluminal H2 S.

Review article: Current status and future directions of ingestible electronic devices in gastroenterology

BACKGROUND

Advances in microelectronics have greatly expanded the capabilities and clinical potential of ingestible electronic devices.

AIM

To provide an overview of the structure and potential impact of ingestible devices in development that are relevant to the gastrointestinal tract.

METHODS

We performed a detailed literature search to inform this narrative review.

RESULTS

Technical success of ingestible electronic devices relies on the ability to miniaturise the microelectronic circuits, sensors and components for interventional functions while being sufficiently powered to fulfil the intended function. These devices offer the advantages of being convenient and minimally invasive, with real-time assessment often possible and with minimal interference to normal physiology. Safety has not been a limitation, but defining and controlling device location in the gastrointestinal tract remains challenging. The success of capsule endoscopy has buoyed enthusiasm for the concepts, but few ingestible devices have reached clinical practice to date, partly due to the novelty of the information they provide and also due to the challenges of adding this novel technology to established clinical paradigms. Nonetheless, with ongoing technological advancement and as understanding of their potential impact emerges, acceptance of such technology will grow. These devices have the capacity to provide unique insight into gastrointestinal physiology and pathophysiology. Interventional functions, such as sampling of tissue or luminal contents and delivery of therapies, may further enhance their ability to sharpen gastroenterological diagnoses, monitoring and treatment.

CONCLUSIONS

The development of miniaturised ingestible microelectronic-based devices offers exciting prospects for enhancing gastroenterological research and the delivery of personalised, point-of-care medicine.

In vitro gastrointestinal gas monitoring with carbon nanotube sensors

In vitro simulators of the human gastrointestinal (GI) tract are remarkable technological platforms for studying the impact of food on the gut microbiota, enabling continuous and real-time monitoring of key biomarkers. However, comprehensive real-time monitoring of gaseous biomarkers in these systems is required with a cost-effective approach, which has been challenging to perform experimentally to date. In this work, we demonstrate the integration and in-line use of carbon nanotube (CNT)-based chemiresitive gas sensors coated with a thin polydimethylsiloxane (PDMS) membrane for the continuous monitoring of gases within the Simulator of the Human Microbial Ecosystem (SHIME). The findings demonstrate the ability of the gas sensor to continuously monitor the different phases of gas production in this harsh, anaerobic, highly humid, and acidic environment for a long exposure time (16 h) without saturation. This establishes our sensor platform as an effective tool for real-time monitoring of gaseous biomarkers in in vitro systems like SHIME.

Effects of in vitro fermentation of Atractylodes chinensis (DC.) Koidz. polysaccharide on fecal microbiota and metabolites in patients with type 2 diabetes mellitus

Atractylodes chinensis (DC.) Koidz. polysaccharide (AKP) has been shown to have hypoglycemic activity. In this study, the effects of AKP on fecal microbiota and metabolites in healthy subjects and patients with type 2 diabetes mellitus (T2DM) were investigated using an in vitro simulated digestive fermentation model. AKP were isolated and purified from Atractylodes chinensis (DC.) Koidz. Its main component AKP1 (AKP-0 M, about 78 % of AKP) has an average molecular weight of 3.25 kDa with monosaccharide composition of rhamnose, arabinose, and galactosamine in a molar ratio of 1: 1.25: 2.88. Notably, AKP fermentation might improve the intestinal microbiota of T2DM patients by the enrichment of some specific bacteria rather than the increase of microbial diversity. The addition of AKP specifically enriched Bifidobacteriaceae and weakened the proportion of Escherichia-Shigella. Moreover, AKP also increased the levels of short-chain fatty acids without affecting total gut gas production, suggesting that AKP could have beneficial effects while avoiding flatulence. Metabolomic analysis revealed that ARP fermentation caused changes in some metabolites, which were mainly related to energy metabolism and amino acid metabolism. Importantly, ARP fermentation significantly increased the level of myo-inositol, an insulin sensitizer. In addition, a significant correlation was observed between specific microbiota and differential metabolites. This study has laid a theoretical foundation for AKP application in functional foods.

Smart capsules for sensing and sampling the gut: status, challenges and prospects

Smart capsules are developing at a tremendous pace with a promise to become effective clinical tools for the diagnosis and monitoring of gut health. This field emerged in the early 2000s with a successful translation of an endoscopic capsule from laboratory prototype to a commercially viable clinical device. Recently, this field has accelerated and expanded into various domains beyond imaging, including the measurement of gut physiological parameters such as temperature, pH, pressure and gas sensing, and the development of sampling devices for better insight into gut health. In this review, the status of smart capsules for sensing gut parameters is presented to provide a broad picture of these state-of-the-art devices while focusing on the technical and clinical challenges the devices need to overcome to realise their value in clinical settings. Smart capsules are developed to perform sensing operations throughout the length of the gut to better understand the body's response under various conditions. Furthermore, the prospects of such sensing devices are discussed that might help readers, especially health practitioners, to adapt to this inevitable transformation in healthcare. As a compliment to gut sensing smart capsules, significant amount of effort has been put into the development of robotic capsules to collect tissue biopsy and gut microbiota samples to perform in-depth analysis after capsule retrieval which will be a game changer for gut health diagnosis, and this advancement is also covered in this review. The expansion of smart capsules to robotic capsules for gut microbiota collection has opened new avenues for research with a great promise to revolutionise human health diagnosis, monitoring and intervention.

Chemically Driven Oscillating Soft Pneumatic Actuation

Pneumatic actuators are widely studied in soft robotics as they are facile, low cost, scalable, and robust and exhibit compliance similar to many systems found in nature. The challenge is to harness high energy density chemical and biochemical reactions that can generate sufficient pneumatic pressure to actuate soft systems in a controlled and ecologically compatible manner. This investigation evaluates the potential of chemical reactions as both positive and negative pressure sources for use in soft robotic pneumatic actuators. Considering the pneumatic actuation demands, the chemical mechanisms of the pressure sources, and the safety of the system, several gas evolution/consumption reactions are evaluated and compared. Furthermore, the novel coupling of both gas evolution and gas consumption reactions is discussed and evaluated for the design of oscillating systems, driven by the complementary evolution and consumption of carbon dioxide. Control over the speed of gas generation and consumption is achieved by adjusting the initial ratios of feed materials. Coupling the appropriate reactions with pneumatic soft-matter actuators has delivered autonomous cyclic actuation. The reversibility of these systems is demonstrated in a range of displacement experiments, and practical application is shown through a soft gripper that can move, pick up, and let go of objects. Our approach presents a significant step toward more autonomous, versatile soft robots driven by chemo-pneumatic actuators.

Ultrahigh-acetone-sensitivity sensor based on Pt-loaded TiO2porous nanoparticles synthesized via a facile hydrothermal method

A simple hydrothermal method based on an orthogonal experimental design was used to synthesis Pt-loaded TiO2mesoporous nanoparticles in one step. The successful synthesis of Pt-loaded TiO2nanoparticles was demonstrated by various characterization methods. The effects of the modification of Pt and its explanation are described in detail by means of the test results. Through systematic gas-sensing tests, we found that the Pt-loaded TiO2nanoparticles outperform pure TiO2nanoparticles, with a high response value (S= 42.5) to 200 ppm acetone at 260 °C and with a film thickness of 0.45 mm, far superior to that of pure TiO2. The response time (8 s) and recovery time (11 s) of the material are also relatively good with excellent selectivity and long-term stability (30 days). The frequent use of acetone as an organic solution in factories and laboratories, as well as the possibility of making a preliminary diagnosis of diabetes by detecting acetone levels in exhaled gas, make this work promising for environmental monitoring and medical diagnosis.

In vitro digestion and fermentation combined with microbiomics and metabolomics reveal the mechanism of superfine yak bone powder regulating lipid metabolism by altering human gut microbiota

The effects of superfine yak bone powder (YBP) on human gut microbiota (HGM) were investigated by in vitro digestion and fermentation combined with microbiomics and metabolomics. Results showed that size reduction and protein structural degradation during digestion allowed superfine YBP to release more Ca²⁺ than CaCO₃ powders with similar particle size. Moreover, the indigestible YBP further influenced HGM and was associated with increased occurrence of beneficial bacteria such as Megasphaera spp., Megamonas spp., Acidaminococcus spp., and Prevotella spp. The altered HGM was associated with greater production of short-chain fatty acids with 4-6 carbon atoms. Furthermore, the indigestible YBP was associated with up-regulation of many lipid-related metabolites, including taurine, secondary bile acids, saturated long-chain fatty acids, and ω-3/ω-6 polyunsaturated fatty acids, which modulated favorably lipid metabolic pathways. These findings implied the potential activity of superfine YBP as a food fortifier in favorably altering HGM community structure and regulating lipid metabolism.

Structural, in vitro digestion, and fermentation characteristics of lotus leaf flavonoids

Bioaccessibility and bioactivity of flavonoids in lotus leaves are related to their characteristics in gastrointestinal digestion and colonic fermentation. The aim of this study is to investigate the stability of lotus leaf flavonoids (LLF) in simulated gastrointestinal digestion, and its modulation on gut microbiota in vitro fermentation. Results showed that LLF mainly consisted of quercetin-3-O-galactoside, quercetin-3-O-glucuronide, quercetin-3-O-glucoside, and kaempferol-3-O-glucoside. These flavonoids kept stability with only a small fraction degraded in simulated gastric and intestinal fluids. In vitro fermentation, LLF stimulated the growth of Actinobacteria and Firmicutes, inhibited the growth of Proteobacteria, and induced the production of fermentation gases and short-chain fatty acids. Interestingly, supplementation of soluble starch significantly improved the utilization of LLF by the intestinal flora. These results revealed that LLF shaped a unique biological web with Lactobacillus and Bifidobacterium spp. as the core of the biological network, which would be more beneficial to gut health.

Understanding Our Tests: Hydrogen-Methane Breath Testing to Diagnose Small Intestinal Bacterial Overgrowth

There is increasing appreciation that small intestinal bacterial overgrowth (SIBO) drives many common gastrointestinal symptoms, including diarrhea, bloating, and abdominal pain. Breath testing via measurement of exhaled hydrogen and methane gases following ingestion of a readily metabolized carbohydrate has become an important noninvasive testing paradigm to help diagnose SIBO. However, because of a number of physiological and technical considerations, how and when to use breath testing in the diagnosis of SIBO remains a nuanced clinical decision. This narrative review provides a comprehensive overview of breath testing paradigms including the indications for testing, how to administer the test, and how patient factors influence breath testing results. We also explore the performance characteristics of breath testing (sensitivity, specificity, positive and negative predictive values, likelihood ratios, and diagnostic odds ratio). Additionally, we describe complementary and alternative tests for diagnosing SIBO. We discuss applications of breath testing for research. Current estimates of SIBO prevalence among commonly encountered high-risk populations are reviewed to provide pretest probability estimates under a variety of clinical situations. Finally, we discuss how to integrate breath test performance characteristics into clinical care decisions using clinical predictors and the Fagan nomogram.

Physicochemical characteristics of Ganoderma lucidum oligosaccharide and its regulatory effect on intestinal flora in vitro fermentation

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G. lucidum oligosaccharide was obtained by ultrasonic enzymatic hydrolysis and Sephadex G25.

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GLO was a chain-like homogeneous oligosaccharide with a molecular weight of 1280 Da.

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GLO could not be easily degraded by digestion in the mouth, gastric and small intestine.

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GLO could be utilized and had good regulatory effects on intestinal flora.

This study explored the structure characteristics of an oligosaccharide from Ganoderma lucidum (GLO) and its regulatory functions on intestinal flora fermentation in vitro. GLO was extracted by ultrasonic-assisted enzymatic hydrolysis, and purified with a dextran gel column. Digestion properties and intestinal flora regulation effects of GLO were investigated by both simulation models. Results showed that GLO was a chain-like homogeneous oligosaccharide, composed of → 6)-β-d-Glcp-(1→, →4)-α-d-Glcp-(1→, β-d-Glcp-(1→, α-d-Manp-(1 →. Its structure could not be easily degraded by digestion in the mouth, gastric and small intestine. Accordingly, they can be utilized by the intestinal flora in large intestine. By evaluating the gas, short chain fatty acids, pH and flora abundance in vitro fermentation, it indicated that GLO had good regulatory effects on intestinal flora. Accordingly, GLO might be a potential prebiotic applied in functional foods.

Positive effects of dietary fiber from sweet potato [Ipomoea batatas (L.) Lam.] peels by different extraction methods on human fecal microbiota in vitro fermentation

The purpose of this study was to compare the effects of sweet potato peels dietary fiber obtained by different extraction methods on intestinal health. Specifically, four different dietary fibers were extracted by hot water, microwave, ultrasonic and subcritical water methods. And the prebiotics effects of sweet potato peels dietary fibers were explored in an in vitro fermentation model, by determining intestinal gas content, short-chain fatty acid content, pH, ammonia content and the gut microbiota composition. The results showed that dietary fiber obtained by four different extraction methods could be utilized by GM and improve human health by increasing the abundance of beneficial bacteria (e.g., Bifidobacterium, Faecalibacterium, and Prevotella) and reducing the abundance of harmful bacteria (e.g., Proteobacteria, Romboutsia and Dorea), enhancing the relative abundance of SCFA-producing bacteria, promoting the production of short-chain fatty acids, reducing intestinal pH from 6.89 to 4.63 and ammonia. Among them, dietary fiber extracted by ultrasound is better than the other three extraction methods. This study suggests that all the four different extraction methods are available for sweet potato peels dietary fiber, and the extracted dietary fiber could be served as potential functional foods with great development value. In addition, it is beneficial to reduce the environmental pollution of sweet potato peels and improve the high-value processing and utilization of sweet potato by-products.

In Vitro Infant Fecal Fermentation Characteristics of Human Milk Oligosaccharides Were Controlled by Initial Microbiota Composition More than Chemical Structure

SCOPE

Human milk oligosaccharides (HMOs), multifunctional glycans naturally present in human milk, are known to contribute to the infant's microbiota and immune system development. However, the molecular specificity of HMOs on microbiota and associated fermentation is not yet fully understood, and is important for the development of infant formula optimum functionality.

METHODS AND RESULTS

In vitro fermentation is carried out on structurally different HMOs with infant fecal inocula dominated by Bifidobacterium longum, Bifidobacterium breve, and Bacteroides. The gas, metabolite (SCFA, lactate, and succinate) profiles, and microbiota responses differ between individual microbiota inocula patterns regardless of HMO structure. In terms of HMO pairs with same sugar composition but different glycosidic bonds, gas and metabolite profiles are similar with the B. longum- and B. breve-dominated inocula. However, large individual variations are observed with the Bacteroides-dominated inocula. The microbial communities at the end of fermentation are closely related to the initial microbiota composition.

CONCLUSION

The findings demonstrate that short-term in vitro fermentation outcomes largely depend on the initial gut microbiota composition more than the impact of HMO molecular specificity. These results advance the current understanding for the design of personalized infant nutritional solutions and therapies in future.

State of the Art in Smart Portable, Wearable, Ingestible and Implantable Devices for Health Status Monitoring and Disease Management

Several illnesses that are chronic and acute are becoming more relevant as the world's aging population expands, and the medical sector is transforming rapidly, as a consequence of which the need for "point-of-care" (POC), identification/detection, and real time management of health issues that have been required for a long time are increasing. Biomarkers are biological markers that help to detect status of health or disease. Biosensors' applications are for screening for early detection, chronic disease treatment, health management, and well-being surveillance. Smart devices that allow continual monitoring of vital biomarkers for physiological health monitoring, medical diagnosis, and assessment are becoming increasingly widespread in a variety of applications, ranging from biomedical to healthcare systems of surveillance and monitoring. The term "smart" is used due to the ability of these devices to extract data with intelligence and in real time. Wearable, implantable, ingestible, and portable devices can all be considered smart devices; this is due to their ability of smart interpretation of data, through their smart sensors or biosensors and indicators. Wearable and portable devices have progressed more and more in the shape of various accessories, integrated clothes, and body attachments and inserts. Moreover, implantable and ingestible devices allow for the medical diagnosis and treatment of patients using tiny sensors and biomedical gadgets or devices have become available, thus increasing the quality and efficacy of medical treatments by a significant margin. This article summarizes the state of the art in portable, wearable, ingestible, and implantable devices for health status monitoring and disease management and their possible applications. It also identifies some new technologies that have the potential to contribute to the development of personalized care. Further, these devices are non-invasive in nature, providing information with accuracy and in given time, thus making these devices important for the future use of humanity.

Sub-ppb-Level Detection of Nitrogen Dioxide Based on High-Quality Black Phosphorus

The development of gas sensors based on two-dimensional (2D) layered materials has received lots of focus attributing to their excellent gas sensitivity. Here, a black phosphorus (BP) gas sensor device is fabricated based on high-quality few-layered BP microribbons using a facile route. Although BP is well known to oxidize in ambient conditions, energy dispersive spectroscopy (EDS) mapping manifests that the few-layered BP microribbons undergo slight oxidation and contamination during the grinding process. It is interesting that the surface and side of BP microribbons have nanoscale thin films and step-like nanoscale thin films, respectively, owing to the in-plane slip of the few-layered BP microribbons in the process of grinding, which are different from the conventional BP bulk crystals. The layered BP microribbon gas sensor demonstrated a high response to low-concentration NO₂ and a very low limit of detection (LOD) of 0.4 ppb of NO₂ under N₂ and air conditions, which is the lowest LOD for NO₂ detection reported so far. The mechanisms for excellently sensitive detection of NO₂ for the BP microribbons have been investigated by first-principles calculations combined with experiment results, revealing that the sensitization mechanisms of the BP microribbon sensor are abundant nanoscale thin films, an optimum bandgap range with optimal carrier concentration, a hierarchical homojunction structure, and strong adsorption energy to NO₂. In addition, the BP microribbon sensor demonstrated high selectivity to NO₂, a low LOD under a high relative humidity, and good repeatability. The reported results of the BP sensor may provide great promise for improving the performance of other 2D material-based gas sensors and may expand sensing applications.

Quantitative GC-TCD Measurements of Major Flatus Components: A Preliminary Analysis of the Diet Effect

The impact of diet and digestive disorders in flatus composition remains largely unexplored. This is partially due to the lack of standardized sampling collection methods, and the easy atmospheric contamination. This paper describes a method to quantitatively determine the major gases in flatus and their application in a nutritional intervention. We describe how to direct sample flatus into Tedlar bags, and simultaneous analysis by gas chromatography–thermal conductivity detection (GC–TCD). Results are analyzed by univariate hypothesis testing and by multilevel principal component analysis. The reported methodology allows simultaneous determination of the five major gases with root mean measurement errors of 0.8% for oxygen (O₂), 0.9% for nitrogen (N₂), 0.14% for carbon dioxide (CO₂), 0.11% for methane (CH₄), and 0.26% for hydrogen (H₂). The atmospheric contamination was limited to 0.86 (95% CI: [0.7–1.0])% for oxygen and 3.4 (95% CI: [1.4–5.3])% for nitrogen. As an illustration, the method has been successfully applied to measure the response to a nutritional intervention in a reduced crossover study in healthy subjects.

Encapsulation of Gas Sensors to Operate in the Gastrointestinal Tract for Continuous Monitoring

Recent advances in ingestible sensors have enabled in situ detection of gastrointestinal (GI) biomarkers which shows great potential in shifting the paradigm of diagnosing GI and systemic diseases. However, the humid, acidic gastric environment is extremely harsh to electrically powered sensors, which limits their capacity for long term, continuous monitoring. Here, we propose an encapsulation approach for a gas sensor integrated into a nasogastric (NG) tube that overcomes chemical corrosion, electrical short, and mechanical collision in a gastric environment to enable continuous gaseous biomarkers monitoring. The coating effects on the sensitivity, signal latency, and repeatability are investigated. Our long-term continuous monitoring in vitro results show that the proposed coating method enables the gas sensors to function reliably and consistently in the simulated GI environment for more than 1 week. The encapsulation is composed of Polycaprolactone (PCL) to protect against mechanical scratching and Parylene C to prevent a sensor from chemical corrosion and electrical short. The average life-time of the sensor with 10 micrometers Parylene coating is about 3.6 days. Increasing the coating thickness to 20 micrometers results in 10.0 days. In terms of repeatability, 10 micrometers and 20 micrometers Parylene C coated sensors have a standard deviation of 1.30% and 2.10% for its within sensor response, and 5.19% and 3.06% between sensors respectively.

Dynamic Monitoring of Systemic Biomarkers with Gastric Sensors

Continuous monitoring in the intensive care setting has transformed the capacity to rapidly respond with interventions for patients in extremis. Noninvasive monitoring has generally been limited to transdermal or intravascular systems coupled to transducers including oxygen saturation or pressure. Here it is hypothesized that gastric fluid (GF) and gases, accessible through nasogastric (NG) tubes, commonly found in intensive care settings, can provide continuous access to a broad range of biomarkers. A broad characterization of biomarkers in swine GF coupled to time-matched serum is conducted . The relationship and kinetics of GF-derived analyte level dynamics is established by correlating these to serum levels in an acute renal failure and an inducible stress model performed in swine. The ability to monitor ketone levels and an inhaled anaesthetic agent (isoflurane) in vivo is demonstrated with novel NG-compatible sensor systems in swine. Gastric access remains a main stay in the care of the critically ill patient, and here the potential is established to harness this establishes route for analyte evaluation for clinical management.

Connected healthcare: Improving patient care using digital health technologies

Now more than ever, traditional healthcare models are being overhauled with digital technologies of Healthcare 4.0 increasingly adopted. Worldwide, digital devices are improving every stage of the patient care pathway. For one, sensors are being used to monitor patient metrics 24/7, permitting swift diagnosis and interventions. At the treatment stage, 3D printers are under investigation for the concept of personalised medicine by allowing patients access to on-demand, customisable therapeutics. Robots are also being explored for treatment, by empowering precision surgery, rehabilitation, or targeted drug delivery. Within medical logistics, drones are being leveraged to deliver critical treatments to remote areas, collect samples, and even provide emergency aid. To enable seamless integration within healthcare, the Internet of Things technology is being exploited to form closed-loop systems that remotely communicate with one another. This review outlines the most promising healthcare technologies and devices, their strengths, drawbacks, and opportunities for clinical adoption.

Liquid Metal-Based Epidermal Flexible Sensor for Wireless Breath Monitoring and Diagnosis Enabled by Highly Sensitive SnS2 Nanosheets

Real-time wireless respiratory monitoring and biomarker analysis provide an attractive vision for noninvasive telemedicine such as the timely prevention of respiratory arrest or for early diagnoses of chronic diseases. Lightweight, wearable respiratory sensors are in high demand as they meet the requirement of portability in digital healthcare management. Meanwhile, high-performance sensing material plays a crucial role for the precise sensing of specific markers in exhaled air, which represents a complex and rather humid environment. Here, we present a liquid metal-based flexible electrode coupled with SnS2 nanomaterials as a wearable gas-sensing device, with added Bluetooth capabilities for remote respiratory monitoring and diagnoses. The flexible epidermal device exhibits superior skin compatibility and high responsiveness (1092%/ppm), ultralow detection limits (1.32 ppb), and a good selectivity of NO gas at ppb-level concentrations. Taking advantage of the fast recovery kinetics of SnS2 responding to H2O molecules, it is possible to accurately distinguish between different respiratory patterns based on the amount of water vapor in the exhaled air. Furthermore, based on the different redox types of H2O and NO molecules, the electric signal is reversed once the exhaled NO concentration exceeds a certain threshold that may indicate the onset of conditions like asthma, thus providing an early warning system for potential lung diseases. Finally, by integrating the wearable device into a wireless cloud-based multichannel interface, we provide a proof-of-concept that our device could be used for the simultaneous remote monitoring of several patients with respiratory diseases, a crucial field in future digital healthcare management.

Understanding the role of the gut in undernutrition: what can technology tell us?

Gut function remains largely underinvestigated in undernutrition, despite its critical role in essential nutrient digestion, absorption and assimilation. In areas of high enteropathogen burden, alterations in gut barrier function and subsequent inflammatory effects are observable but remain poorly characterised. Environmental enteropathy (EE)-a condition that affects both gut morphology and function and is characterised by blunted villi, inflammation and increased permeability-is thought to play a role in impaired linear growth (stunting) and severe acute malnutrition. However, the lack of tools to quantitatively characterise gut functional capacity has hampered both our understanding of gut pathogenesis in undernutrition and evaluation of gut-targeted therapies to accelerate nutritional recovery. Here we survey the technology landscape for potential solutions to improve assessment of gut function, focussing on devices that could be deployed at point-of-care in low-income and middle-income countries (LMICs). We assess the potential for technological innovation to assess gut morphology, function, barrier integrity and immune response in undernutrition, and highlight the approaches that are currently most suitable for deployment and development. This article focuses on EE and undernutrition in LMICs, but many of these technologies may also become useful in monitoring of other gut pathologies.

AuPt Bimetal-Functionalized SnSe2 Microflower-Based Sensors for Detecting Sub-ppm NO2 at Low Temperatures

A novel chemiresistive-type sensor for detecting sub-ppm NO₂ has been fabricated using AuPt bimetal-decorated SnSe₂ microflowers, which was synthesized by the hydrothermal treatment followed by in situ chemical reduction of the bimetal precursors on the surface of the petals of the microflowers. The as-prepared sensor registers a superior performance in detection of sub-ppm concentration of NO₂. Functionalized by the AuPt bimetal, the SnSe₂ microflower-based sensor shows a response of approximately 4.62 to 8 ppm NO₂ at 130 °C. It is significantly higher than those of the sensors using the pristine SnSe₂ (∼2.29) and the modified SnSe₂ samples by a single metal, either Au (∼3.03) or Pt (∼3.97). The sensor demonstrates excellent long-term stability, signal repeatability, and selectivity to some typical interfering gaseous species including ammonia, acetone, formaldehyde, ethanol, methanol, benzene, CO₂, SO₂, and CO. The remarkable improvement of the sensitive characteristics could be induced by the electronic and chemical sensitization and the synergistic effect of the AuPt bimetal. Density functional theory (DFT) is implemented to calculate the adsorption states of NO₂ on the sensing materials and thus to possibly reveal the sensing mechanism. The significantly enhanced response of the SnSe₂-based sensor decorated with AuPt bimetallic nanoparticles has been found to be possibly caused by the orbital hybridization of O, Au, and Pt atoms leading to the redistribution of electrons, which is beneficial for NO₂ molecules to obtain more electrons from the composite material.

Evolution of Intestinal Gases and Fecal Short-Chain Fatty Acids Produced in vitro by Preterm Infant Gut Microbiota During the First 4 Weeks of Life

Background: The production of intestinal gases and fecal short-chain fatty acids (SCFAs) by infant gut microbiota may have a significant impact on their health, but information about the composition and volume of intestinal gases and SCFA profiles in preterm infants is scarce. Objective: This study examined the change of the composition and volume of intestinal gases and SCFA profiles produced by preterm infant gut microbiota in vitro during the first 4 weeks of life. Methods: Fecal samples were obtained at five time points (within 3 days, 1 week, 2 weeks, 3 weeks, and 4 weeks) from 19 preterm infants hospitalized in the neonatal intensive care unit (NICU) of Shanghai Children's Hospital, Shanghai Jiao Tong University between May and July 2020. These samples were initially inoculated into four different media containing lactose (LAT), fructooligosaccharide (FOS), 2'-fucosyllactose (FL-2), and galactooligosaccharide (GOS) and thereafter fermented for 24 h under conditions mimicking those of the large intestine at 37.8°C under anaerobic conditions. The volume of total intestinal gases and the concentrations of individual carbon dioxide (CO₂), hydrogen (H₂), methane (CH₄), and hydrogen sulfide (H₂S) were measured by a gas analyzer. The concentrations of total SCFAs, individual acetic acid, propanoic acid, butyric acid, isobutyric acid, pentanoic acid, and valeric acid were measured by gas chromatography (GC). Results: The total volume of intestinal gases (ranging from 0.01 to 1.64 ml in medium with LAT; 0-1.42 ml with GOS; 0-0.91 ml with FOS; and 0-0.44 ml with FL-2) and the concentrations of CO₂, H₂, H₂S, and all six fecal SCFAs increased with age (p-trends < 0.05). Among them, CO₂ was usually the predominant intestinal gas, and acetic acid was usually the predominant SCFA. When stratified by birth weight (<1,500 and ≥1,500 g), gender, and delivery mode, the concentration of CO₂ was more pronounced among infants whose weight was ≥1,500 g than among those whose weight was <1,500 g (p-trends < 0.05). Conclusions: Our findings suggested that the intestinal gases and SCFAs produced by preterm infant gut microbiota in vitro increased with age during the first 4 weeks of life.

Design of hierarchical SnSe2 for efficient detection of trace NO2 at room temperature

Nanosheet-assembled hierarchical SnSe2 could serve as a new suitable candidate for high-performance room-temperature NO2 gas sensing.

Adjustment of oxygen vacancy states in ZnO and its application in ppb-level NO2 gas sensor

Oxygen vacancy (V_O) is long believed as a key factor influencing the gas sensing properties. However, the concentration of V_O is generally focused while the V_O state is neglected, which masks the inherent mechanism of gas sensor. Using a post annealing process, the influence of V_O states on the response of ZnO nanofilm to NO₂ gas is investigated in this study. The systematical analysis of the results obtained by different methods indicates a transformation of V_O from the neutral to the doubly ionized state during post annealing treatment. The results also imply that the gas sensing properties is not directly correlated with the V_O concentration. And due to the competitive adsorption of ambient O₂, the neutral V_O is majorly occupied by the adsorbed O₂ while the V_O in doubly ionized state can promote the adsorption of NO₂. Consequently, the transition of V_O from the neutral to the doubly ionized state can lead to a dramatic increase of the response to NO₂, from 733 to 3.34 × 10⁴ for 100 ppm NO₂. Guided by this mechanism, NO₂ gas sensing in ppb-level is also achieved: the response reaches 165% to 25 ppb (0.025 ppm) NO₂ with a good repeatability.

Factors That Affect Prevalence of Small Intestinal Bacterial Overgrowth in Chronic Pancreatitis: A Systematic Review, Meta-Analysis, and Meta-Regression

OBJECTIVES

Small intestinal bacterial overgrowth (SIBO) can complicate chronic pancreatitis (CP) and interfere with management. Its predisposing factors in CP and treatment response are unknown. In this review, we evaluated factors affecting disease burden.

METHODS

A computerized search of PubMed and EMBASE databases from inception through May 2019 was done for studies correlating SIBO with CP. Studies were screened, and relevant data were extracted and analyzed. Pooled prevalence, odds ratio (OR), and meta-regression were performed using the random effects model as classically described by Borenstein et al. (2009). SIBO's relation to diabetes mellitus (DM), pancreatic exocrine insufficiency (PEI), narcotic use, and proton-pump inhibitor use was investigated. Treatment response was pooled across studies. P value < 0.05 was considered significant.

RESULTS

In 13 studies containing 518 patients with CP, SIBO prevalence was 38.6% (95% confidence interval [CI] 25.5-53.5). OR for SIBO in CP vs controls was 5.58 (95% CI 2.26-13.75). Meta-regression showed that PEI and the diagnostic test used were able to explain 54% and 43% of the variance in SIBO prevalence across studies, respectively. DM and PEI were associated with increased SIBO in CP with OR (2.1, 95% CI 1.2-3.5) and OR (2.5, 95% CI 1.3-4.8), respectively. Symptomatic improvement was reported in 76% of patients after SIBO treatment.

DISCUSSION

SIBO complicates 38% of CP with OR of 5.58 indicating a predisposition for this condition. PEI correlates with SIBO in CP and might play a role in pathophysiology. DM and PEI are associated with increased SIBO in CP. Treatment of SIBO may lead to symptomatic improvement.

Small Intestinal Bacterial Overgrowth: How to Diagnose and Treat (and Then Treat Again)

Small intestinal bacterial overgrowth (SIBO) is a condition with presentation that can vary from asymptomatic to steatorrhea and malnutrition. Small bowel aspiration and culture is the current gold standard of diagnosis; however, this is invasive and is not without risk to the patient. Breath testing is a noninvasive and less expensive alternative method; however, it lacks diagnostic sensitivity and specificity. Novel diagnostic methods being studied include gas-sensing capsules. The mainstay of treatment is antibiotics; alternative therapies include herbal medications, dietary modifications, and prokinetic agents. Further investigation into less invasive and less harmful diagnostic methods and treatment options is warranted.

2D/2D heterojunction of g-C3N4/SnS2: room-temperature sensing material for ultrasensitive and rapid-recoverable NO2 detection

Heterojunction engineering plays an indispensable role in improving gas-sensing performance. However, rational heterojunction engineering to achieve room-temperature NO2 sensing with both high response and rapid recovery is still a challenge. Herein, a 2D/2D heterojunction of g-C3N4/SnS2 is designed to improve the sensing performance of SnS2 and used for ultrasensitive and rapid-recoverable NO2 detection at room temperature. The pristine SnS2 fails to work at room temperature because of its high resistivity and weak adsorption to NO2. After combination with g-C3N4 nanosheets, the g-C3N4/SnS2-based sensor exhibits an extremely high response (503%) and short recovery time (166 s) towards 1 ppm NO2 at room temperature. The improved sensing performance is primarily attributed to the increased adsorption sites and enhanced charge transfer induced by the 2D/2D heterojunctions with large interface contact area. This achievement of g-C3N4/SnS2 2D/2D heterostructures demonstrates a promising pathway for the design of sensitive gas-sensing material based on a 2D/2D heterojunction strategy.

Capacitive sensing of triglyceride film reactions: a proof-of-concept demonstration for sensing in simulated duodenal contents with gastrointestinal targeting capsule system

Ingestible capsule systems continue to evolve to overcome drawbacks associated with traditional gastrointestinal (GI) diagnostic and therapeutic processes, such as limitations on which sections of the GI tract can be accessed or the inability to measure local biomarker concentrations. We report an integrated capsule sensing system, utilizing a hybrid packaging scheme coupled with triglyceride film-coated capacitive sensors, for measuring biochemical species present in the duodenum, such as pancreatic lipase and bile acids. The system uses microfabricated capacitive sensors interfaced with a Bluetooth low-energy (BLE)-microcontroller, allowing wireless connectivity to a mobile app. The triglyceride films insulate the sensor surface and react either with 0.01-1 mM lipase via hydrolysis or 0.07-7% w/v bile acids via emulsification in simulated fluids, leading to measurable changes in capacitance. Cross reactivity of the triglyceride films is evaluated in both phosphate buffered saline (PBS) as well as pancreatic trypsin solutions. The film morphology is observed after exposure to each stimulus to better understand how these changes alter the sensor capacitance. The capsule utilizes a 3D-printed package coated with polymers that remain intact in acid solution (mimicking gastric conditions), then dissolve at a duodenum-mimicking neutral pH for triggered opening of the sensing chamber from which we can subsequently detect the presence of pancreatic lipase. This device strategy represents a significant step towards using embedded packaging and triglyceride-based materials to target specific regions of the GI tract and sensing biochemical contents for evaluating gastrointestinal health.

Solution-Processed p-SnSe/n-SnSe2 Hetero-Structure Layers for Ultrasensitive NO2 Detection

The formation of semiconductor heterostructures is an effective approach to achieve high performance in electrical gas sensing. However, such heterostructures are usually prepared via multi-step procedures. In this contribution, by taking advantage of the crystal phase-dependent electronic property of SnSe_x based materials, we report a one-step colloid method for the preparation of SnSe(x%)/SnSe₂ (100-x%) p-n heterostructures, with x ≈30, 50, and 70. The obtained materials with solution processability were successfully fabricated into NO₂ sensors. Among them, the SnSe(50 %)/SnSe₂ (50 %) based sensor with an active layer thickness of 2 μm exhibited the highest sensitivity to NO₂ (30 % at 0.1 ppm) with a limit of detection (LOD) down to 69 ppb at room temperature (25 °C). This was mainly attributed to the formation of p-n junctions that allowed for gas-induced modification of the junction barriers. Under 405 nm laser illumination, the sensor performance was further enhanced, exhibiting a 3.5 times increased response toward 0.1 ppm NO₂ , along with a recovery time of 4.6 min.

Two-Dimensional, Few-Layer MnPS3 for Selective NO2 Gas Sensing under Ambient Conditions

In this study, two-dimensional few-layer MnPS₃ is introduced as a selective and reversible NO₂ gas sensor in dry nitrogen (N₂) under ambient conditions. The solvent exfoliation technique is utilized to exfoliate bulk MnPS₃ into a few layers, which are further assembled as thin films by the vacuum filtration method. The films are subsequently transferred onto a sensing device and used for NO₂ sensing. Exfoliated MnPS₃ shows excellent sensitivity toward NO₂ gas with a low detection limit of a few tens of ppb at 25 °C. A sensitivity of 9530% is obtained at 35 ppm concentration of NO₂ with the theoretical limit of detection calculated to be ∼9.5 ppb. The sensor is highly selective toward NO₂ gas (with respect to interferents NO, NH₃, H₂, CO, CO₂, C₂H₂, and O₂) and is fully reversible under ambient conditions. The time constant is determined to be in the range of 30-160 s for adsorption and desorption processes. Raman spectroscopy reveals that the mechanism of sensing is based on charge transfer interactions between the sensor and analyte. This study opens up ways to fabricate gas sensors using few-layer metal phosphochalcogenides (MPX₃).

Hydrogenotrophic methanogens of the mammalian gut: Functionally similar, thermodynamically different-A modelling approach

Methanogenic archaea occupy a functionally important niche in the gut microbial ecosystem of mammals. Our purpose was to quantitatively characterize the dynamics of methanogenesis by integrating microbiology, thermodynamics and mathematical modelling. For that, in vitro growth experiments were performed with pure cultures of key methanogens from the human and ruminant gut, namely Methanobrevibacter smithii, Methanobrevibacter ruminantium and Methanobacterium formicium. Microcalorimetric experiments were performed to quantify the methanogenesis heat flux. We constructed an energetic-based mathematical model of methanogenesis. Our model captured efficiently the dynamics of methanogenesis with average concordance correlation coefficients of 0.95 for CO₂, 0.98 for H₂ and 0.97 for CH₄. Together, experimental data and model enabled us to quantify metabolism kinetics and energetic patterns that were specific and distinct for each species despite their use of analogous methane-producing pathways. Then, we tested in silico the interactions between these methanogens under an in vivo simulation scenario using a theoretical modelling exercise. In silico simulations suggest that the classical competitive exclusion principle is inapplicable to gut ecosystems and that kinetic information alone cannot explain gut ecological aspects such as microbial coexistence. We suggest that ecological models of gut ecosystems require the integration of microbial kinetics with nonlinear behaviours related to spatial and temporal variations taking place in mammalian guts. Our work provides novel information on the thermodynamics and dynamics of methanogens. This understanding will be useful to construct new gut models with enhanced prediction capabilities and could have practical applications for promoting gut health in mammals and mitigating ruminant methane emissions.

Intestinal gases: influence on gut disorders and the role of dietary manipulations

The inner workings of the intestines, in which the body and microbiome intersect to influence gut function and systemic health, remain elusive. Carbon dioxide, hydrogen, methane and hydrogen sulfide, as well as a variety of trace gases, are generated by the chemical interactions and microbiota within the gut. Profiling of these intestinal gases and their responses to dietary changes can reveal the products and functions of the gut microbiota and their influence on human health. Indeed, different tools for measuring these intestinal gases have been developed, including newly developed gas-sensing capsule technology. Gases can, according to their type, concentration and volume, induce or relieve abdominal symptoms, and might also have physiological, pathogenic and therapeutic effects. Thus, profiling and modulating intestinal gases could be powerful tools for disease prevention and/or therapy. As the interactions between the microbiota, chemical constituents and fermentative substrates of the gut are principally influenced by dietary intake, altering the diet, which, in turn, changes gas profiles, is the main therapeutic approach for gastrointestinal disorders. An improved understanding of the complex interactions within the intestines that generate gases will enhance our ability to prevent, diagnose, treat and monitor many gastrointestinal disorders.

SnS2/SnS p-n heterojunctions with an accumulation layer for ultrasensitive room-temperature NO2 detection

The unique features of SnS₂ make it a sensitive material ideal for preparing high-performance nitrogen dioxide (NO₂) gas sensors. However, sensors based on pristine tin disulfide (SnS₂) fail to work at room temperature (RT) owing to their poor intrinsic conductivity and weak adsorptivity toward the target gas, thereby impeding their wide application. Herein, an ultrasensitive and fully recoverable room-temperature NO₂ gas sensor based on SnS₂/SnS p-n heterojunctions with an accumulation layer was fabricated. The amounts of SnS₂/SnS heterojunctions can be effectively controlled by tuning the ratios of tin and sulfur precursors in the easy one-step solvothermal synthesis. Compared with pristine SnS₂, the conductivity of SnS₂/SnS heterostructures improved considerably. Such improvement was caused by the electron transfer from p-type SnS to n-type SnS₂ because the Fermi level of SnS was higher than that of SnS₂. The sensing response of optimized SnS₂/SnS toward 4 ppm NO₂ was 660% at room temperature, which was higher than most reported sensitivity values of other two-dimensional (2D) materials at room temperature. The superior sensing response of SnS₂/SnS heterostructures was attributed to the enhanced electron transport and the increased adsorption sites caused by the SnS₂/SnS p-n heterojunctions. Moreover, the SnS₂/SnS sensor showed good selectivity and long-term stability. These achievements of SnS₂/SnS heterostructured sensors make them highly desirable for practical applications.

Metabolism, bioenergetics and thermal physiology: influences of the human intestinal microbiota

The micro-organisms which inhabit the human gut (i.e. the intestinal microbiota) influence numerous human biochemical pathways and physiological functions. The present review focuses on two questions, 'Are intestinal microbiota effects measurable and meaningful?' and 'What research methods and variables are influenced by intestinal microbiota effects?'. These questions are considered with respect to doubly labelled water measurements of energy expenditure, heat balance calculations and models, measurements of RMR via indirect calorimetry, and diet-induced energy expenditure. Several lines of evidence suggest that the intestinal microbiota introduces measurement variability and measurement errors which have been overlooked in research studies involving nutrition, bioenergetics, physiology and temperature regulation. Therefore, we recommend that present conceptual models and research techniques be updated via future experiments, to account for the metabolic processes and regulatory influences of the intestinal microbiota.

Extremely Deformable, Transparent, and High-Performance Gas Sensor Based on Ionic Conductive Hydrogel

Fabrication of stretchable chemical sensors becomes increasingly attractive for emerging wearable applications in environmental monitoring and health care. Here, for the first time, chemically derived ionic conductive polyacrylamide/carrageenan double-network (DN) hydrogels are exploited to fabricate ultrastretchable and transparent NO₂ and NH₃ sensors with high sensitivity (78.5 ppm^-1) and low theoretical limit of detection (1.2 ppb) in NO₂ detection. The hydrogels can withstand various rigorous mechanical deformations, including up to 1200% strain, large-range flexion, and twist. The drastic mechanical deformations do not degrade the gas-sensing performance. A facile solvent replacement strategy is devised to partially replace water with glycerol (Gly) molecules in the solvent of hydrogel, generating the water-Gly binary hydrogel with 1.68 times boosted sensitivity to NO₂ and significantly enhanced stability. The DN-Gly NO₂ sensor can maintain its sensitivity for as long as 9 months. The high sensitivity is attributed to the abundant oxygenated functional groups in the well-designed polymer chains and solvent. A gas-blocking mechanism is proposed to understand the positive resistance shift of the gas sensors. This work sheds light on utilizing ionic conductive hydrogels as novel channel materials to design highly deformable and sensitive gas sensors.

The diagnosis of small intestinal bacterial overgrowth: Two steps forward, one step backwards?

Small intestinal bacterial overgrowth (SIBO) was originally described decades ago as a cause of malabsorption among individuals with abnormal intestinal anatomy and/or impaired gastric acid secretion and intestinal motor functions. More recently, the concept of SIBO has been expanded to explain symptoms among a much broader patient population-a move that brings the definition of SIBO into much sharper focus. For largely logistical reasons, breath tests and, especially, those based on the excretion of hydrogen consequent on the fermentation of unabsorbed carbohydrate substrates, have almost entirely replaced jejunal aspirates in the diagnosis of SIBO. Ever bedeviled by concerns regarding their reliability, hydrogen breath tests have now come under even more critical scrutiny with the study from Sundin and colleagues in this issue suggesting that their sole function is to detect carbohydrate malabsorption and that they are incapable of defining SIBO.

Advances in Materials and Structures for Ingestible Electromechanical Medical Devices

Ingestible biomedical devices that diagnose, prevent, or treat diseases has been a dream of engineers and clinicians for decades. The increasing apparent importance of gut health on overall well-being and the prevalence of many gastrointestinal diseases have renewed focus on this emerging class of medical devices. Several prominent examples of commercially successful ingestible medical devices exist. However, many technical challenges remain before ingestible medical devices can achieve their full clinical potential. This Minireview summarizes recent discoveries in this interdisciplinary topic including novel materials, advanced materials processing techniques, and select examples of integrated ingestible electromechanical systems. After a brief historical perspective, these topics will be reviewed with a dedicated focus on advanced functional materials and fabrication strategies in the context of clinical translation and potential regulatory considerations. Future perspectives, challenges, and opportunities related to ingestible medical devices will also be summarized.

Ultrasensitive and Fully Reversible NO2 Gas Sensing Based on p-Type MoTe2 under Ultraviolet Illumination

The unique properties of two-dimensional (2D) materials make them promising candidates for chemical and biological sensing applications. However, most 2D material sensors suffer from extremely long recovery time due to the slow molecular desorption at room temperature. Here, we report an ultrasensitive p-type molybdenum ditelluride (MoTe₂) gas sensor for NO₂ detection with greatly enhanced sensitivity and recovery rate under ultraviolet (UV) illumination. Specifically, the sensitivity of the sensor to NO₂ is dramatically enhanced by 1 order of magnitude under 254 nm UV illumination as compared to that in the dark condition, leading to a remarkable low detection limit of 252 ppt. More importantly, the p-type MoTe₂ sensor can achieve full recovery after each sensing cycle well within 160 s at room temperature. Finally, the p-type MoTe₂ sensor also exhibits excellent sensing performance to NO₂ in ambient air and negligible response to H₂O, indicating its great potential in practical applications, such as breath analysis and ambient NO₂ detection. Such impressive features originate from the activated interface interaction between the gas molecules and p-type MoTe₂ surface under UV illumination. This work provides a promising and easily applicable strategy to improve the performance of the gas sensors based on 2D materials.

The safety and sensitivity of a telemetric capsule to monitor gastrointestinal hydrogen production in vivo in healthy subjects: a pilot trial comparison to concurrent breath analysis

BACKGROUND

Intestinal gases are currently used for the diagnosis of disorders including small intestinal bacterial overgrowth and carbohydrate malabsorption.

AIM

To compare the performance of measuring hydrogen production within the gut directly with the telemetric gas-sensing capsule with that of indirect measurement through breath testing.

METHODS

Using standard breath testing protocols, the capsules and breath tests were simultaneously evaluated in a single-blinded trial in 12 healthy subjects. Eight received a single dose of 1.25-40 g inulin and four 20 or 40 g glucose. Safety and reliability of the capsules were also assessed.

RESULTS

There were no reported adverse events. All capsules were retrieved and operated without failure. Capsule measurements were in agreement with breath test measurements in magnitude but not in timing; minimal hydrogen production was observed after glucose ingestion and capsule measurements correlated with breath hydrogen after ingestion of 40 g inulin. A dose-dependent increase in concentration of hydrogen was observed from the capsule following ingestion of inulin as low as 1.25 g compared with >10 g for breath measurements. Specifically, the capsule measured >3000 times higher concentrations of hydrogen compared to breath tests, resulting in a signal-to-noise ratio of 23.4 for the capsule compared to 4.2 for the breath test.

CONCLUSIONS

The capsule showed high sensitivity and signal-to-noise ratio in measuring luminal hydrogen concentrations, provided information on the site of intestinal gas production, and demonstrated safety and reliability. The capsule has potential for improving diagnostic precision for disorders such as small intestinal bacterial overgrowth.

Hierarchical SnS2/SnO2 nanoheterojunctions with increased active-sites and charge transfer for ultrasensitive NO2 detection

SnS2 nanosheets with unique properties are excellent candidate materials for fabricating high-performance NO2 gas sensors. However, serious restacking and aggregation during sensor fabrication have greatly impacted the sensing response. In this study, flower-like hierarchical SnS2 was prepared by a simple microwave method and partially thermally oxidized to form hierarchical SnS2/SnO2 nanocomposites to further improve the sensing performance at low operating temperature. The fabricated SnS2/SnO2 sensor exhibited ultrahigh response (resistance ratio = 51.1) toward 1 ppm NO2 at 100 °C, roughly 10.2 times higher than that of pure SnS2 nanoflowers. The excellent and enhanced NO2 sensing performances of hierarchical SnS2/SnO2 nanocomposites were attributed to the novel hierarchical structure of SnS2 and the nanoheterojunction between SnS2 and the ultrafine SnO2 nanoparticles. The SnS2/SnO2 sensors also exhibited excellent selectivity and reliable repeatability. The simple fabrication of high performance sensing materials may facilitate the large-scale production of NO2 gas sensors.

Breath Hydrogen Testing in East and Southeast Asia

Breath hydrogen tests are popular, noninvasive tests for the assessment of carbohydrate fermentation in patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD). There is limited information regarding the utility of breath hydrogen and methane tests in IBS and FD patients in East and Southeast Asia. This review aims to summarize current literature about common indications of breath testing in this region, the genesis of functional gastrointestinal symptoms by provocative breath testing and provide suggestions for correct use. The most common testing indication is the assessment of lactose intolerance, followed by small intestinal bacterial overgrowth (SIBO) and differentiation of intestinal gas profiles in research setting. Studies in this region not only documented a high prevalence of lactose malabsorption but a population, both healthy and IBS, that is highly symptomatic to typical lactose intakes. Breath hydrogen assessment of other fermentable carbohydrates (FODMAPs) are fairly uncommon, whereas methane breath testing is almost nonexistent. Cumulative hydrogen production following lactulose was also not excessive in IBS patients compared with controls. The evidence however, for the detection of SIBO suggests limited reliability in the use of lactulose or glucose breath testing alone and inconclusive data on its correlation with symptoms. Conversely, little has been carried out in FD. In conclusion, breath testing should be limited in the predicting patients with SIBO for directing clinical management but can be considered in the objective assessment of lactose malabsorption within a low FODMAP diet. Recommendations to improve the interpretation of breath testing in research were also provided.

Luminally expressed gastrointestinal biomarkers

A biomarker is a measurable indicator of normal biologic processes, pathogenic processes or pharmacological responses. The identification of a useful biomarker is challenging, with several hurdles to overcome before clinical adoption. This review gives a general overview of a range of biomarkers associated with inflammatory bowel disease or colorectal cancer along the gastrointestinal tract. Areas covered: These markers include those that are already clinically accepted, such as inflammatory markers such as faecal calprotectin, S100A12 (Calgranulin C), Fatty Acid Binding Proteins (FABP), malignancy markers such as Faecal Occult Blood, Mucins, Stool DNA, Faecal microRNA (miRNA), other markers such as Faecal Elastase, Faecal alpha-1-antitrypsin, Alpha2-macroglobulin and possible future markers such as microbiota, volatile organic compounds and pH. Expert commentary: There are currently a few biomarkers that have been sufficiently validated for routine clinical use at present such as FC. However, many of these biomarkers continue to be limited in sensitivity and specificity for various GI diseases. Emerging biomarkers have the potential to improve diagnosis and monitoring but further study is required to determine efficacy and validate clinical utility.