Optimal interval for delayed retrieval surgery with reciprocating morcellators after enucleation of giant prostatic hyperplasia in holmium laser enucleation of the prostate

Objective:The aim of this research was to evaluate the efficiency of reciprocating morcellation for removing giant benign prostatic hyperplasia during holmium laser enucleation of the prostate,investigate whether performing morcellation as a two-stage procedure improves tissue retrieval efficiency,and seek to determine the optimal interval between the two surgeries.Methods:This study included nine cases of holmium laser enucleation of the prostate with an enucleated prostate weight exceeding 200 g,indicative of substantial prostate enlargement.Morcellation was performed on Day 0(n=4),Day 4(n=1),Day 6(n=1),and Day 7(n=3).The intervals were compared regarding the morcellation efficiency,beach ball presence,and pathology.Results:The mean estimated prostate volume was 383(range 330e528)mL;the median enucleation weight was 252(interquartile range[IQR]222,342)g;and the median enucleation time was 83(IQR 62,100)min.The mean morcellation efficiency was 1.44(SD 0.55)g/min on Day 0 and 13.69(SD 2.46)g/min on day 7.The morcellation efficiency was 4.15 g/min and 10.50 g/min on Day 4 and Day 6,respectively,with significantly higher in the two-stage group compared to one-stage group(11.0 g/min vs.1.5 g/min;p=0.014).Efficiency was strongly correlated with intervals(p<0.001);the incidences of beach balls were 100%(4/4)and 60%(3/5)in the immediate and two-stage surgery groups,respectively.Conclusion:The efficiency of two-stage morcellation with reciprocating morcellators was highly related to the postoperative interval,with the maximum efficiency reached on Day 7.

Effects of the 23-Valent Pneumococcal Polysaccharide Vaccine on the Mortality of Pneumonia among Elderly over 70 Years Old after the Great East Japan Earthquake—PPV Vaccination Program in Iwate Prefecture, Japan

Objective: To estimate the efficacy of 23-valent pneumococcal polysaccharide vaccine (PPSV23) among the elderly, we analyzed the relationship between the mortality of the elderly for pneumonia and the vaccination rate of PPSV23 from 2008 to 2016 in Iwate Prefecture, Japan. Study Design: The present study was a retrospective, observational, database study adopting an ecological design. The mortality for pneumonia among the elderly over 70 years old from 2006 to 2016 in Iwate Prefecture was calculated based on the data from the Japanese Vital Statistics. We compared the mortality rate (MR) of pneumonia among the elderly over 70 years old between the low-vaccinated period (LVP) (2006-2010) and high-vaccinated period (HVP) (2012-2016) using a Poisson regression model. Results: While the vaccination rate of PPSV23 among the elderly over 65 years old was 3.3% in 2010, it increased rapidly up to 40.7% in 2012 and reached 66.4% in 2016. The MR ratio of the total population during HVP to the average MR during LVP was 0.749. The MR of the total population during HVP was significantly lower than that during LVP (p Conclusion: The increase in vaccination rate of PPSV23 during HVP (2012-2016) may contribute to the decrease in mortality for pneumonia among the elderly over 70 years old in Iwate Prefecture.

Tumor size discrepancy between endoscopic and pathological evaluations in colorectal endoscopic submucosal dissection

BACKGROUND Tumor size impacts the technical difficulty and histological curability of colorectal endoscopic submucosal dissection(ESD);however,the preoperative evaluation of tumor size is often different from histological assessment.Analyzing influential factors on failure to obtain an accurate tumor size evaluation could help prepare optimal conditions for safer and more reliable ESD.METHODS This was a retrospective study conducted at a single institution.A total of 377 lesions removed by colorectal ESD at our hospital between April 2018 and March 2022 were collected.We first assessed the difference in size with an absolute per-centage of the scaling discrepancy.Subsequently,we compared the clinicopatho-logical characteristics of the correct scaling group(>-33%and<33%)with that of the incorrect scaling group(<-33%or>33%),which was further subdivided into the underscaling group(-33%or less of the discrepancy)and overscaling group(33%or more of the discrepancy),respectively.As secondary outcome measures,parameters on size estimation were compared between the underscaling and correct scaling groups,as well as between the overscaling and correct scaling groups.Finally,multivariate analysis was performed in terms of the following relevant parameters on size estimation:Pathological size,location,and possible influential factors(P<0.1)in the univariate analysis.RESULTS The mean of absolute percentage in the scaling discordance was 21%,and 91 lesions were considered to be incorrectly estimated in size.The incorrect scaling was significantly remarkable in larger lesions(40 mm vs 28 mm;P<0.001)and less experience(P<0.001),and these two factors were influential on the underscaling(75 lesions;P<0.001).Conversely,compared with the correct scaling group,16 lesions in the overscaling group were significantly small(20 mm vs 28 mm;P<0.001),and the small lesion size was influential on the overscaling(P=0.002).CONCLUSION Lesions indicated for colorectal ESD tended to be underestimated in large tumors,but overestimated in small ones.This discrepancy appears worth understanding for optimal procedural preparation.

Determination of Taurine in Biological Samples by High-Performance Liquid Chromatography Using 4-Fluoro-7-Nitrobenzofurazan as a Derivatizing Agent

Objective A highly sensitive and rapid high‐performance liquid chromatography method with pre‐column derivatization with 4‐fluoro‐7‐nitrobenzofurazan was developed for determination of taurine in biological samples,including plasma,brain,and liver.Methods The optimum derivatization reaction temperature was 70℃,and at this temperature the reaction was complete within 3 min.The derivatized taurine was separated using phosphate buffer （0.02 mol/L,pH 6.0）：acetonitrile （84：16,v/v） as the mobile phase at a flow rate of 1.0 mL/min,and a column temperature of 25℃.The taurine derivatives were separated within 20 min （tR：14.5 min） and fluorometrically detected at 530 nm with excitation at 470 nm.Results The intra‐ and the inter‐day coefficients of variation for the method were 5.3% and 7.7%,respectively.The calibration curve was linear from 0.1 μmol/L to 30.0 μmol/L with a correlation coefficient of 0.9995.Conclusion This method can be used to determine the taurine contents in plasma,brain,and liver from normal rats and human plasma.

Molecular basis of the irritable bowel syndrome

Irritable bowel syndrome(IBS)is a functional disorder characterized by abdominal pain,discomfort and bloating.The pathophysiology of IBS is poorly understood,but the presence of psychosocial basis is now known.There is an increasing number of publications supporting the role of genetics in IBS.Most of the variations are found in genes associated with the brain-gut axis,revealing the strong correlation of brain-gut axis and IBS.miRNAs,which play critical roles in physiological processes,are not well studied in IBS.However,so far there is found an involvement of alterations in miRNA expression or sequence,in IBS symptoms.IBS phenotype is affected by epigenetic alteration and environment.Changes in DNA and histone methylation are observed in patients who suffered childhood trauma or abuse,resulting in altered gene expression,such as the glucocorticoid receptor gene.Finally,diet is another factor associated with IBS,which may contribute to symptom onset.Certain foods may affect on bacterial metabolism and epigenetic modifications,predisposing to IBS.

Multiplex RT-PCR-based detections of CEA, CK20 and EGFR in colorectal cancer patients

AIM: To develop a multiplex reverse transcription polymerase chain reaction (RT-PCR) method detecting cir-culating tumor cells in the peripheral blood of colorectal cancer (CRC) patients. METHODS: Peripheral blood samples were collected from 88 CRC patients and 40 healthy individuals from the blood donors' clinic and subsequently analyzed by multiplex RT-RCR for the expression of carcinoembryonic antigen (CEA), cytokeratin 20 (CK20) and epidermal growth factor receptor (EGFR) mRNA. The analysis involved determining the detection rates of CEA, CK20 and EGFR transcripts vs disease stage and overall survival. Median follow-up period was 19 mo (range 8-28 mo). RESULTS: Rates of CEA, CK20 and EGFR detection in CRC patients were 95.5%, 78.4% and 19.3%, respectively. CEA transcripts were detected in 3 healthy volunteer samples (7.5%), whereas all control samples were tested negative for CK20 and EGFR transcripts. The increasing number of positive detections for CEA, CK20 and EGFR transcripts in each blood sample was positively correlated with Astler-Coller disease stage (P< 0.001) and preoperative serum levels of CEA (P=0.029) in CRC patients. Data analysis using Kaplan-Meier estimator documented signif icant differences in the overall survival of the different CRC patient groups as formed according to the increasing number of positivity for CEA, CK20 and EGFR transcripts. CONCLUSION: These data suggest that multiplex RTPCR assay can provide useful information concerning disease stage and overall survival of CRC patients.

Effects of laparoscopic cholecystectomy on lung function:A systematic review

AIM: To present and integrate findings of studies investigating the effects of laparoscopic cholecystectomy on various aspects of lung function.

Short-term effects of di-（2-ethylhexyl） phthalate on testes,liver, kidneys and pancreas in mice

Aim： To determine the biochemical effect of di-（2-ethylhexyl） phthalate （DEHP） on testes, liver, kidneys and pancreas on day 10 in the process of degeneration of the seminiferous epithelium. Methods： Diets containing 2% DEHP were given to male Crlj：CDI（ICR） mice for 10 days. The dose of DEHP was 0.90±0.52 mg/mouse/day. Their testes, livers, kidneys and pancreata were examined for detection of mono-（2-ethylhexyl） phthalate （MEHP）, nitrogen oxides （NOx） produced by peroxidation of nitric oxide （NO） with free radicals, and lipid peroxidation induced by the chain reaction of free radicals. Results： Histological observation and serum analysis showed the presence of severe sperrnatogenic disturbance, Leydig cell dysfunction, liver dysfunction and dehydration. Unexpectedly, the concentration of MEHP in the testes was extremely low compared with that in the liver. However, the concentration of the NOx in the testes was as high as the hepatic concentration. Furthermore, free radical-induced lipid peroxidation was histochemically detected in the testes but not in the liver. Conclusion： The results indicate that DEHP-induced aspermatogenesis is caused by the high sensitivity of the testicular tissues to MEHP rather than the specific accumulation or uptake of circulating MEHP into the testes.

Insulin-like growth factor-1, IGF binding protein-3, and the risk of esophageal cancer in a nested case-control study

To assess the relationship between serum levels of insulin-like growth factor-1 (IGF1)/IGF-binding protein-3 (IGFBP3) and the risk of esophageal carcinoma.METHODSWe assessed the relationship between the serum levels of these molecules and the risk of esophageal cancer in a prospective, nested case-control study of participants from the Japan Collaborative Cohort Study. A baseline survey was conducted from 1988 to 1990. Of the 110585 enrolled participants, 35% donated blood samples. Those who had been diagnosed with esophageal cancer were considered cases for nested case-control studies. A conditional logistic model was used to estimate odds ratios for the incidence of esophageal cancer associated with serum IGF1 and IGFBP3 levels.RESULTSThirty-one cases and 86 controls were eligible for the present assessment. The molar ratio of IGF1/IGFBP3, which represents the free and active form of IGF1, was not correlated with the risk of esophageal carcinoma. A higher molar difference between IGFBP3 and IGF1, which estimates the free form of IGFBP3, was associated with a decreased risk of esophageal carcinoma (P = 0.0146), and people in the highest tertile had the lowest risk (OR = 0.107, 95%CI: 0.017-0.669). After adjustment for body mass index, tobacco use, and alcohol intake, the molar difference of IGFBP3-IGF1 was inversely correlated with the risk of esophageal carcinoma (P = 0.0150).CONCLUSIONThe free form of IGFBP3, which is estimated by this molar difference, may be inversely associated with esophageal cancer incidence.

Simple hematological predictors of AF recurrence in patients undergoing atrial fibrillation ablation

Backgound Red cell distribution width(RDW) and neutrophil-to-lymphocyte ratio(NLR) are simple hematologic indices that have been used to predict adverse outcomes in different clinical settings. The aim of our study is to determine whether RDW and NLR can predict atrial fibrillation(AF) recurrence in patients undergoing AF ablation. Methods Consecutive patients, without known hematological disorders, who underwent AF catheter ablation between January 2014 and April 2017 were enrolled into this study. Blood samples were taken one day before and five hours after the ablation procedure. Results A total of 346 patients(224 males(65%), mean age: 59 ± 11 years old) were included. After a mean follow up of 26.2 ± 12.1 months, 80(23.1%) patients experienced late AF recurrence(defined as any recurrence after the blanking period of three months), while 97(28%) patients experienced early AF recurrence during the blanking period. Univariate analysis showed that early arrhythmia recurrence, type of AF and NLR after the procedure were significantly associated with late AF recurrence, while early arrhythmia recurrence and NLR remained significant in multivariate analysis. RDW was not associated with late AF recurrence. None of the parameters above predicted early arrhythmia recurrence. Conclusions Simple and inexpensive hematological indices such as NLR should be evaluated for their ability to predict AF recurrence in patients undergoing catheter ablation in larger prospective studies.

Impact of parietal cell autoantibodies and non-organ-specific autoantibodies on the treatment outcome of patients with hepatitis C virus infection: A pilot study

AIM: Various side effects have been reported in patients infected with hepatitis C virus (HCV) who were treated with interferon-alpha (IFN-α), including the appearance or exacerbation of underlying autoimmune diseases and the development of a variety of organ and non-organ specific autoantibodies (NOSA). However, very few studies in adults have been strictly designed to address: whether the prevalence and the titre of organ and NOSA in serial samples of HCV-treated patients were affected by IFN-α, and the impact of these autoantibodies on the treatment outcome of HCV patients. METHODS: We investigated whether parietal cell autoantibodies (PCA) and/or NOSA were related with treatment-outcome in 57 HCV-treated patients (19 sustained-responders, 16 relapsers, 22 non-responders). Serum samples from patients were studied blindly at three time-points (entry, end of treatment and end of followup). For the detection of autoantibodies we used indirect immunofluorescence, commercial and in-house ELISAs. RESULTS: Sustained biochemical response was associated with ANA-negativity at the entry or end of follow up. Sustained virological response was associated with the absence of PCA at the entry. Combined virological and biochemical sustained response (CVBSR) was associated with the absence of antinuclear antibodies (ANA) at the end of follow up and PCA-negativity at the entry. Sustained virological and CVBSR were associated with a reduction of ANA and SMA titers during therapy. CONCLUSION: Although PCA and/or NOSA seropositivity should not affect the decision to treat HCV patients, the presence of some of them such as ANA, PCA and SMA before treatment or their increase during therapy with IFN- a may predict a worse response, indicating the need for a closer monitoring during treatment of HCV patients positive for these autoantibodies.

TYMS/KRAS/BRAF molecular profiling predicts survival following adjuvant chemotherapy in colorectal cancer

BACKGROUND Patients with stage II-III colorectal cancer (CRC) treated with adjuvant chemotherapy, gain a 25% survival benefit. In the context of personalized medicine, there is a need to identify patients with CRC who may benefit from adjuvant chemotherapy. Molecular profiling could guide treatment decisions in these patients. Thymidylate synthase (TYMS) gene polymorphisms, KRAS and BRAF could be included in the molecular profile under consideration. AIM To investigate the association of TYMS gene polymorphisms, KRAS and BRAF mutations with survival of CRC patients treated with chemotherapy.METHODS A retrospective study studied formalin-fixed paraffin-embedded tissues (FFPEs) of consecutive patients treated with adjuvant chemotherapy during January/2005-January/2007. FFPEs were analysed with PCR for the detection of TYMS polymorphisms, mutated KRAS (mKRAS) and BRAF (mBRAF). Patients were classified into three groups (high, medium and low risk) according to 5’UTR TYMS polymorphisms Similarly, based on 3’UTR polymorphism ins/loss of heterozygosity (LOH) patients were allocated into two groups (high and low risk of relapse, respectively). Cox regression models examined the associated 5- year survival outcomes. RESULTS One hundred and thirty patients with early stage CRC (stage I-II: 55 patients;stage III 75 patients;colon: 70 patients;rectal: 60 patients) were treated with surgery and chemotherapy. The 5-year disease free survival and overall survival rate was 61.6% and 73.9% respectively. 5’UTR polymorphisms of intermediate TYMS polymorphisms (2RG/3RG, 2RG/LOH, 3RC/LOH) were associated with lower risk for relapse [hazard ratio (HR) 0.320, P = 0.02 and HR 0.343, P = 0.013 respectively] and death (HR 0.368, P = 0.031 and HR 0.394, P = 0.029 respectively). The 3’UTR polymorphism ins/LOH was independently associated with increased risk for disease recurrence (P = 0.001) and death (P = 0.005). mBRAF (3.8% of patients) was associated with increased risk of death (HR 4.500, P = 0.022) whereas mKRAS (39% of patients) not. CONCLUSION Prospective validating studies are required to confirm whether 2RG/3RG, 2RG/LOH, 3RC/LOH, absence of ins/LOH and wild type BRAF may indicate patients at lower risk of relapse following adjuvant chemotherapy.

Economic evaluation of the hepatitis C elimination strategy in Greece in the era of affordable direct-acting antivirals

BACKGROUND Hepatitis C virus(HCV) is a leading cause of worldwide liver-related morbidity and mortality. The World Health Organization released an integrated strategy targeting HCV-elimination by 2030. This study aims to estimate the required interventions to achieve elimination using updated information for direct-acting antiviral(DAA) treatment coverage, to compute the total costs(including indirect/societal costs) of the strategy and to identify whether the elimination strategy is cost-effective/cost-saving in Greece.AIM To estimate the required interventions and subsequent costs to achieve HCV elimination in Greece.METHODS A previously validated mathematical model was adapted to the Greek HCVinfected population to compare the outcomes of DAA treatment without the additional implementation of awareness or screening campaigns versus an HCV elimination strategy, which includes a sufficient number of treated patients. We estimated the total costs(direct and indirect costs), the disability-adjusted life years and the incremental cost-effectiveness ratio using two different price scenarios.RESULTS Without the implementation of awareness or screening campaigns,approximately 20000 patients would be diagnosed and treated with DAAs by2030. This strategy would result in a 19.6% increase in HCV-related mortality in2030 compared to 2015. To achieve the elimination goal, 90000 patients need to be treated by 2030. Under the elimination scenario, viremic cases would decrease by78.8% in 2030 compared to 2015. The cumulative direct costs to eliminate the disease would range from 2.1-2.3 billion euros(€) by 2030, while the indirect costs would be €1.1 billion. The total elimination cost in Greece would range from €3.2-3.4 billion by 2030. The cost per averted disability-adjusted life year is estimated between €10100 and €13380, indicating that the elimination strategy is very costeffective. Furthermore, HCV elimination strategy would save €560-895 million by2035.CONCLUSION Without large screening programs, elimination of HCV cannot be achieved. The HCV elimination strategy is feasible and cost-saving despite the uncertainty of the future cost of DAAs in Greece.

Seroprevalence of Cryptosporidium and risks of cryptosporidiosis in residents of Sothern Egypt: A cross-sectional study

Objective: To identify the serological epidemiology of Cryptosporidium infections and to follow up on the changes in the infection profile in Southern Egypt in order to establish a suitable scheme for control and prevention of cryptosporidiosis.Methods: A total of 1 912(960 from human and 952 from animals) stool specimens and sera were screened for Cryptosporidium species using modified Ziehl Neelsen technique and a newly-developed enzyme-linked immunosorbent assay(ELISA).Environmental risk factors and socioeconomic data were surveyed by questionnaire between September 2016 and December 2017.Results: Totally, 20.83% of the human subjects were positive for Cryptosporidium infection tested by ELISA.The seropositivity was positively correlated with age.The prevalence of Cryptosporidium infections in females was significantly higher than in males(P<0.05).The sensitivity and specificity of ELISA for Cryptosporidium were 99.06% and 88.88%, respectively.Furthermore, a high prevalence of Cryptosporidium in domestic animals(42.20%).Conclusions: The study observed that Cryptosporidium infections are common in the study area, with water sanitation, socioeconomic level; eating habits and hygienic status are considered the main risk factors for cryptosporidiosis.Therefore, environmental sanitation and health education will be useful in reducing the prevalence of infection.

Crohn’s disease incidence evolution in North-western Greece is not associated with alteration of NOD2/CARD15 variants

AIM: To assess the trends in the incidence of inflammatory bowel disease (IBD) over 23 years in the same area and to identify genetic factors related to incidence evolution. METHODS: Patients with IBD arising from North- western Greece were systematically recorded through the 1983-2005 period. Trends in disease incidence and genetic patterns related to CARD15 variants were documented and correlated. RESULTS: A total of 447 patients with IBD were recorded (23.5% Crohn’s disease, 72.7% Ulcerative colitis and 3.8% indeterminate colitis). Mean annual incidence rates of CD and UC were 0.9/100 000 (95% CI 0.1-1.7) and 2.7/100 000 (95% CI 1.7-4.1) inhabitants, respectively. There was a statistically significant increase of CD incidence (P < 0.01) during the study period, in contrast to the UC incidence. There were no statistical differences in CARD15 variants over the study period. CONCLUSION: The incidence of CD in North-western Greece has risen disproportionately to that of UC in the 21st century. This is not related to alterations of genetic background though.

Evaluation of whole body reaction time and one leg with eye closed balance in elderly Japanese

We evaluated whole body reaction time and one leg with eye closed balance in elderly Japanese. A total of 2059 elderly Japanese (730 men and 1329 women), aged 60 - 79 years, were enrolled in the cross-sectional investigation study. Anthropometric parameters, whole body reaction time and one leg with eye closed balance were measured. Whole body reaction time was significantly higher and one leg with eye closed balance was significantly lower in 70’s than those in 60’s in both sexes. Two hundred twenty seven men (31.1%) and 533 women (40.1%) were having no medications. In men, whole body reaction time was significantly higher and one leg with eye closed balance was significantly lower in subjects with medications than those in subjects without in 60’s. However, significant differences of whole body reaction time and one leg with eye closed balance between subjects with and without medications in men with 70’s and women with 60’s and 70’s were not noted. This standard mean value may provide a useful reference database for evaluating whole body reaction time and one leg with eye closed balance in Japanese elderly subjects.

Effects of carob-bean gum thickened formulas on infants' reflux and tolerance indices

AIM: To examine the effect of carob-bean gum(CBG) thickened-formulas on reflux and tolerance indices in infants with gastro-esophageal reflux(GER). METHODS: Fifty-six eligible infants(1-6 mo old) were randomly allocated to receive for two weeks a formula with either 0.33 g/100 m L(Formula A) or 0.45 g/100 m L(Formula B) of cold soluble CBG galactomannans respectively, or a formula with 0.45 g/100 m L of hot soluble CBG galactomannans(Formula C). No control group receiving standard formula was included in the study. Data on the following indices were obtained both at baseline and follow-up from all study participants: 24 h esophageal p H monitoring indices, anthropometrical indices(i.e., body weight and length) and tolerance indices(i.e., frequency of colics; type and frequency ofdefecations). From the eligible infants, forty seven were included in an intention-to-treat analysis to examine the effects of the two-week trial on esophageal 24 h p H monitoring, growth and tolerance indices. Repeated Measures ANOVA was used to examine the research hypothesis.RESULTS: Regarding changes in 24 h p H monitoring indices, significant decreases from baseline to followup were observed in the "Boix Ochoa Score"(i.e., an index of esophageal acid exposure), in the total number of visible refluxes and in all symptoms related indices due to acid reflux only for infants provided with Formula A, while no significant changes were observed for infants provided with Formulas B and C. In addition, the significant decreases observed in two symptoms related p H monitoring indices(i.e., "Symptom index for reflux" and "Percentage of all reflux") for infants provided with Formula A were also found to differentiate significantly compared to the changes observed in the other two groups(P = 0.048 and P = 0.014 respectively). Concerning changes in anthropometric indices, body weight significantly increased among infants provided with Formulas A and C, but not for infants provided with Formula B. As far as tolerance indices were concerned, the numbers of total and diarrheic defecations increased significantly only in infants provided with Formula B and these changes were significantly higher compared to the decreases observed in infants fed with Formulas A and C(P = 0.003 and P = 0.015 respectively. Lastly the number of colics significantly decreased in all infants, irrespective of the tested formula. CONCLUSION: Formula A(i.e., 0.33 g/100 m L of cold galactomannans) was effective in reducing certain p Hmonitoring indices of uncomplicated GER, increased body weight and was well-tolerated by infants.

Comparison of ventilatory threshold between subjects with and without proteinuria in Japanese

We compared the levels of ventilatory threshold (VT) between subjects with and without pro-teinuria. We used data of 402 men and 413 women who were not taking any medications, aged 20 - 77 years, in this cross-sectional in-vestigation study. Aerobic Parameters at VT i.e. oxygen uptake, work rate and heart rate, and exercise habits were evaluated, which are con-sidered to be cardio respiratory fitness. Pro-teinuria was measured by using urine strip de-vices. Forty three men (10.7%) and 29 women (7.0%) were diagnosed as having the proteinuria (± ≦). There were no significant relationships between proteinuria and exercise habits in both sexes after adjusting for age. Oxygen uptake at VT in subjects with proteinuria was significantly lower than that in subjects without proteinuria after adjusting for age in men. However, such link was not noted in women after adjusting for age (p = 0.9964). Finally, associations were at-tenuated after adjusting for age and exercise habits in both sexes. Among Japanese not tak-ing medications, proteinuria might be a modifi-able factor of VT, especially in Japanese men.

High fecal calprotectin levels are associated with SARS-CoV-2 intestinal shedding in COVID-19 patients:A proof-of-concept study

BACKGROUND One third of coronavirus disease 2019(COVID-19)patients have gastrointestinal symptoms.Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)RNA has been detected in stool samples of approximately 50%of COVID-19 individuals.Fecal calprotectin is a marker of gastrointestinal inflammation in the general population.AIM To investigate if fecal calprotectin correlates with SARS-CoV-2 intestinal shedding in COVID-19 patients with pneumonia.METHODS Patients with SARS-CoV-2 pneumonia admitted to the Infectious Disease Unit(University Hospital of Trieste,Italy)from September to November 2020 were consecutively enrolled in the study.Fecal samples were collected and analyzed for quantification of fecal calprotectin(normal value<50 mg/kg)and SARS-CoV-2 RNA presence by polymerase chain reaction(PCR).Inter-group differences were determined between patients with and without diarrhea and patients with and without detection of fecal SARS-CoV-2.RESULTS We enrolled 51 adults(40 males)with SARS-CoV-2 pneumonia.Ten patients(20%)presented with diarrhea.Real-time-PCR of SARS-CoV-2 in stools was positive in 39 patients(76%),in all patients with diarrhea(100%)and in more than two thirds(29/41,71%)of patients without diarrhea.Obesity was one of the most common comorbidities(13 patients,25%);all obese patients(100%)(P=0.021)tested positive for fecal SARS-CoV-2.Median fecal calprotectin levels were 60 mg/kg[interquartile range(IQR)21;108];higher fecal calprotectin levels were found in the group with SARS-CoV-2 in stools(74 mg/kg,IQR 29;132.5)compared to the group without SARS-CoV-2(39 mg/kg,IQR 14;71)(P<0.001).CONCLUSION High fecal calprotectin levels among COVID-19 patients correlate with SARSCoV-2 detection in stools supporting the hypothesis that this virus can lead to bowel inflammation and potentially to the‘leaky gut’syndrome.

Urban-Rural Comparison of HBV and HCV Infection Prevalence in Eastern China

The present study was initiated to make an urban rural comparison of the prevalence of cases positive to hepatitis B and C virus (HBV and HCV, respectively) infection markers in densely populated eastern half of China. For this purpose, 10 survey sites were selected, i.e., six sites in urban areas (the city group; Beijing, Shanghai and four provincial capitals) and four sites in rural areas (the village group ; one village each in Jilin and Shandong Provinces, and two villages in Shaanxi Province). About 50 adult women per site volunteered to participate, from whom 494 valid blood samples were collected. Positivities to HBsAg (HBsAg +), anti HBs (anti HBs +) and anti HBc (anti HBc +) were examined by RIA methods, and that to anti HCV (anti HCV +) by either EIA or RIA. Those positive to any one of the three HBV infection markers were taken as HBV infection positive (HBV +). The prevalence of HBsAg +, HBV + and anti HBc + was 8%, 70% and 2.7% in the city group, and 8%, 65% and 2.0% in the village group, and no significant difference was found between the two groups. The overall prevalence was 8% for HBsAg +, 68% for HBV +, and 2.4% for anti HCV +. The results were discussed in reference to some 20 papers each on HBV + and anti HCV + prevalence in China published since 1991. The reviewing of these papers confirmed that the prevalence of HBV was high (i.e., in excess of 50%), whereas the prevalence of anti HCV was low (well below 5%), and that no substantial difference was found between the rural and urban populations.