Assessing fertility preservation strategies: A scoping review

Objective:To describe the various options available for preserving female and/or male fertility,taking into account both social and medical aspects,and to identify the effects of different natural products on male infertility extracted from plants.Methods:We reviewed the literature and included full-text publications in English provided by international biomedical databases,including Sciences Direct,Google Scholar,OVID,PubMed,and MEDLINE between 2016 and 2023.Search terms,such as fertility preservation,in vitro maturation,cryopreservation,plants for the treatment of male infertility,were taken from Medical Subject Headings(MeSH)and Boolean operators were used to improve sensitivity.Results:112 papers were identified in the initial search,of which 18 were excluded due to duplication.After reviewing titles and abstracts,70 papers were finally included.The main findings of this study are presented under three key themes:gametogenesis,fertility preservation techniques,and plant-based alternatives.Regarding gametogenesis,significant progress has been made in understanding oocyte and sperm maturation,with optimized conditions improving maturation rates and motility.For fertility preservation,techniques such as rescue in vitro maturation and cryopreservation have shown the enhanced outcomes,particularly in maintaining gamete quality.Lastly,plant-based alternatives,including extracts and essential oils,have demonstrated potential in reducing oxidative stress,improving sperm motility,and supporting oocyte development,thus providing a promising complementary approach to conventional methods.Conclusions:Fertility preservation is achieved in a variety of ways,including oocyte and embryo vitrification and sperm cryopreservation,and the use of plant-based treatment of male infertility.

Retrospective study evaluating association of colorectal tumors and hepatitis C virus

BACKGROUND Chronic hepatitis C virus(HCV)has been associated with hepatic and extrahe-patic malignancies.Limited studies have shown an association between colorectal adenomas and HCV populations.AIM To study the prevalence of colorectal adenomas in patients with HCV compared to the general population and to evaluate if it is an independent risk factor for colorectal adenomas.METHODS Patients were divided into HCV and non-HCV based on their HCV RNA titers.Patients with alcoholic liver disease,hepatitis B infection,and inflammatory bowel disease were excluded.Continuous variables were analyzed using the Mann-Whitney U test,and categorical variables usingχ^(2) with P<0.05 were considered statistically significant.The significant covariates(independent variables)were matched in both groups by propensity score matching,followed by multivariate regression analysis.RESULTS Of the 415 patients screened,109 HCV patients and 97 non-HCV patients with colonoscopy results were included in the study.HCV patients were older,had a smoking history,had less frequent aspirin use,and had a lower body mass index(BMI)(P<0.05).The HCV cohort had a significantly increased number of patients with adenomas(adenoma detection rate of 53.2%vs 34%.P=0.006).We performed a propensity-matched multivariate analysis where HCV infection was significantly associated with colorectal adenoma(OR:2.070,P=0.019).CONCLUSION Our study shows a significantly higher rate of adenomas in HCV patients compared to the general population.Prospective studies would help determine if the increase in adenoma detection lowers the risk for colorectal cancer.

Capacity-Power Consumption and Energy-Efficiency Evaluation of Green Wireless Networks

In this paper,we discuss in detail the basic issue of green design and consider an energy efficiency function as the metric to evaluate green cellular networks.Specifically,we investigate the transmit power required for an expected transmission capacity and propose a capacity-power formula based on the energy conservation and the Shannon capacity theorem.Two novel definitions of cell interference depth and handoff dynamic model are introduced and the corresponding expression of energy efficiency function is derived.Numerical results show that the energy efficiency function is closely correlated with the transmitted/received power required and the cell radius.Our work provides a useful basis for research and evaluation on green design and technology of cellular networks.

Antimycobacterial natural products from Moroccan medicinal plants: Chemical composition, bacteriostatic and bactericidal profile of Thymus satureioides and Mentha pulegium essential oils

Objective: To evaluate the susceptibility of Mycobacterium aurum and Mycobacterium smegmatis in vitro to the essential oils obtained from two medicinal plants: Thymus satureioides(T. satureioides) and Mentha pulegium(M. pulegium), and to study their chemical composition.Methods: The aerial parts of T. satureioides and M. pulegium(leaves and stems) were hydro-distillated using a Clevenger-type apparatus and essential oils were analyzed and identified by gas chromatography-mass spectrometry. Antimycobacterial screening of essential oils was performed on the basis of the inhibition zone diameter by disc diffusion method against two mycobacterial strains whereas the minimal inhibitory concentration and minimal bactericidal concentration were determined by using the micro-dilution method.Results: Chemical analysis of their aerial part's essential oils gave as major compounds,borneol(34.26%), carvacrol(31.21%) and thymol(3.71%) for T. satureioides and R(+)-pulegone(75.48%), carvone(6.66%) and dihydrocarvone(4.64%) for M. pulegium.Thereafter their antimycobacterial effect evaluation, using the micro-dilution method,indicated that minimal inhibitory concentration values of T. satureioides essential oil ranged from 0.062% to 0.015%(v/v) and from 0.125% to 0.031%(v/v) for M. pulegium respectively against Mycobacterium aurum and Mycobacterium smegmatis.Conclusions: It is clearly evident from the results obtained that the Moroccan medicinal plants have great potential to be used as anti-tuberculosis agents. These findings may help scientists to undertake several research projects to discover useful natural product as new anti-tuberculosis drug.

Aripiprazole augmentation in treating comorbid bipolar disorder and obsessive-compulsive disorder

Obsessive-compulsive disorder(OCD) is one of the most difficult additional diagnoses to manage in patients with bipolar disorder(BD) since the gold standard treatment for one disease(antidepressants for OCD) can worsen the other. This case report describes the efficacy of aripiprazole augmentation as maintenance therapy in a young patient with comorbid BD-OCD. Our patient presented complete remission of affective and obsessivecompulsive symptoms with remarkable improvement in social and occupational functioning for 24 months.Adverse drug reactions were not severe enough to result in drug discontinuation. In consideration of the important nosological, clinical and therapeutic implications, future research efforts may lead to more grounded guidelines,which are greatly needed in patients with comorbid BDOCD.

Comparison of perioperative parameters in one-handed rotational phacoemulsification versus conventional phacoemulsification and femtosecond laser-assisted cataract surgery

AIM:To compare perioperative parameters of one-handed rotational phacoemulsification technique(one-handed phaco-roll)with each of other two techniques,“Divide et Conquer”and femtosecond laser-assisted cataract surgery(FLACS)METHODS:In this retrospective and comparative cohort study,eyes with uncomplicated cataract(nuclear density grade 2 to 3)treated routinely with one-handed phacoroll(n=23;Group 1)or“Divide et Conquer”(n=23;Group 2)or FLACS(n=23;Group 3)were enrolled.Intraoperative parameters including effective phaco-time(EPt),ultrasound time(USt),aspiration time,surgical time,phacoemulsification(phaco)-power,balanced salt solution(BSS)use,cumulative dissipated energy(CDE)were recorded and compared.Clinical outcomes including best corrected visual acuity(BCVA),corneal endothelial cell density(ECD),endothelial cell loss(ECL),central corneal thickness(CCT)and central macular thickness(CMT),were assessed and compared pre-operatively and at 1mo after surgery.RESULTS:Aspiration and surgical time,and BSS used were lower in Group 1(P<0.01)than other groups.EPt,phaco-power and CDE were lower in Group 1(P<0.05)than Group 2 but not significantly different from Group 3.In Group 1,USt was lower(P<0.05)than Group 2 but higher(P<0.05)than Group 3.BCVA improved in all groups without significant difference between Group 1 and the other ones.No significant differences regarding all post-operative morphologic outcomes(ECD,ECL,CCT,CMT)were reported.No clinical complications occurred.CONCLUSION:One-handed phaco-roll seems to be less time-consuming than“Divide et Conquer”and FLACS and less energy-consuming than“Divide et Conquer”.Furthermore,one-handed phaco-roll seems to have an equal safety profile compared to the other two techniques.

Wingless/It/β-catenin signaling in liver metastasis from colorectal cancer:A focus on biological mechanisms and therapeutic opportunities

The liver is the most common site of metastases in patients with colorectal cancer.Colorectal liver metastases(CRLMs)are the result of molecular mechanisms that involve different cells of the liver microenvironment.The aberrant activation of Wingless/It(Wnt)/β-catenin signals downstream of Wnt ligands initially drives the oncogenic transformation of the colon epithelium,but also the progression of metastatization through the epithelial-mesenchymal transition/mesenchymalepithelial transition interactions.In liver microenvironment,metastatic cells can also survive and adapt through dormancy,which makes them less susceptible to pro-apoptotic signals and therapies.Treatment of CRLMs is challenging due to its variability and heterogeneity.Advances in surgery and oncology have been made in the last decade and a pivotal role for Wnt/β-catenin pathway has been recognized in chemoresistance.At the state of art,there is a lack of clear understanding of why and how this occurs and thus where exactly the opportunities for developing anti-CRLMs therapies may lie.In this review,current knowledge on the involvement of Wnt signaling in the development of CRLMs was considered.In addition,an overview of useful biomarkers with a revision of surgical and non-surgical therapies currently accepted in the clinical practice for colorectal liver metastasis patients were provided.

DESIGN OF LDPC-CODED BICM USING A SEMI-GAUSSIAN APPROXIMATION

This paper investigates analysis and design of Low-Density Parity-Check （LDPC） coded Bit Interleaved Coded Modulation （BICM） over Additive White Gaussian Noise （AWGN） channel. It focuses on Gray-labeled 8-ary Phase-Shift-Keying （8PSK） modulation and employs a Maximum A Posteriori （MAP） symbol-to-bit metric calculator at the receiver. An equivalent model of a BICM communication channel with ideal interleaving is presented. The probability distribution function of log-likelihood ratio messages from the MAP receiver can be approximated by a mixture of symmetric Gaussian densities. As a result semi-Gaussian approximation can be used to analyze the decoder. Extrinsic information transfer charts are employed to describe the convergence behavior of LDPC decoder. The design of irregular LDPC codes reduces to a linear programming problem on two-dimensional variable edge-degree distribution. This method allows irregular code design in a wider range of rates without any limit on the maximum node degree and can be used to design irregular codes having rates varying from 0.5275 to 0.9099. The designed convergence thresholds are only a few tenths, even a few hundredths of a decibel from the capacity limits. It is shown by Monte Carlo simulations that, when the block length is 30,000, these codes operate about 0.62-0.75 dB from the capacity limit at a bit error rate of 10s.

Terrain Details Effect on Connectivity in Ad hoc Wireless Networks

In this work, we conduct a research on the effects of the details of the terrain on the path establishment in wireless networks. We discuss how the terrain induced variations, that are unavoidably caused by the obstructions and irregularities in the surroundings of the transmitting and the receiving antennas, have two distinct effects on the network. Firstly, they reduce the amount of links in the network connectivity graph causing it to behave more randomly, while decreasing the coverage and capacity of the network. Secondly, they increase the length of the established paths between the nodes. The presented results show how the terrain oblique influences the layout of the network connectivity graph, in terms of different network metrics, and gives insight to the appropriate level of details needed to describe the terrain in order to obtain results that will be satisfyingly accurate.

Data Timed Sending (DTS) Energy Efficient Protocol for Wireless Sensor Networks: Simulation and Testbed Verification

The Data Timed Sending (DTS) protocol contributes to the energy savings in Wireless Sensor Networks (WSNs) and prolongs the sensor nodes’ battery lifetime. DTS saves energy by transmitting short packets, without data payload, from the sensor nodes to the base station or the cluster head according to the Time Division Multiple Access (TDMA) scheduling. Placing the short packets into appropriate slots and subslots in the TDMA frames transfers the information about the measured values and node identity. This paper presents the proof of concept of the proposed DTS protocol and provides verification of the energy savings using the QualNet&reg;communication simulation platform (QualNet) and the SunTM Small Programmable Object Technology (Sun SPOT) testbed platform (for single hop and multi hop scenarios). The simulations and the testbed measurements confirm that the DTS protocol can provide energy savings up to 30% when compared with the IEEE 802.15.4 standard in unslotted Carrier Sense Multiple Access with Collision Avoidance (CSMA-CA) mode at 2.4 GHz frequency band.

Incidental right atrial mass in a patient with secondary pancreatic cancer: A case report and review of literature

BACKGROUND The incidental detection of a right atrial mass during routine cardioncological workup is a rare condition. The correct differential diagnosis between cancer and thrombi is challenging. A biopsy may not be feasible while diagnostic techniques and tools may not be available.CASE SUMMARY We report the case of a 59-year-old female patient with a history of breast cancer and current secondary metastatic pancreatic cancer. She developed deep vein thrombosis and pulmonary embolism and was admitted to the Outpatient Clinic of our Cardio-Oncology Unit for follow-up. Transthoracic echocardiogram incidentally found a right atrial mass. Clinical management was difficult due to the abrupt worsening of the patient’s clinical condition and the progressive severe thrombocytopenia. We suspected a thrombus, according to its echocardiographic appearance, the patient’s cancer history and recent venous thromboembolism. The patient was unable to adhere to low molecular weight heparin treatment. Due to worsening prognosis, palliative care was recommended. We also highlighted the distinguishing features between thrombi and tumors. We proposed a diagnostic flowchart to aid diagnostic decision making in the case of an incidental atrial mass.CONCLUSION This case report highlights the importance of cardioncological surveillance during anticancer treatments to detect cardiac masses.

The Islamic Religion in Course Curriculums of High School History Textbooks in the Republic of Macedonia

History textbooks can and primarily should contribute to the strengthening of students’awareness of universal human values.However,history textbooks can also deepen the divisions,prejudices,and uncritical attitudes,contrary to the goals of education.The youth population,which is still building and creating their point of view towards the world is the main group in the education process.The learning period,in the elementary,as well as in the secondary education is of utmost importance for the development of every human.To that end,history,through the contents of the past largely shapes our perceptions of every individual,ourselves,and the others.Since we are living in a multiethnic and multi-confessional society,I have decided to conduct an analysis of the teaching contents of high school textbooks related to religion.Another reason for the analysis is the role of religion in the formation of Balkan nations,which have made it one of the key elements of their national identities.It is often given the role of raising and strengthening the national awareness,patriotism,as well as the country homogeneity,which most often leads to forming prejudices,divisions,and discrimination towards people of minority religions.The large volume of content related to the religion,and also the mere fact that Muslims are the second largest religion group in the population,I have decided to analyze the contents which are related only to the Islamic religion.The goal is to look for both the positive and negative sides of those contents in history textbooks in secondary schools,which are backed by state institutions that are supposed to take care of the development of competitive,creative,progressive,and ethically formed human potential.The critical review will give an additional impulse to the efforts of eliminating those parts of the teaching contents that create divisions and prejudices,especially in history textbooks,so that its studying can become the key factor in the building of trust between people of different religions.

Facile Surface Engineering of NiCo_(2)O_(4) to Boost Propane Oxidation Activity

Spinel oxide(NiCo_(2)O_(4))has demonstrated great potential to replace noble metal catalysts for the oxidation reaction of air pollutants.To further boost the oxidation ability of such catalysts,in this study,a facile surface-engineering strategy wherein NiCo_(2)O_(4) was treated with different alkali solvents was developed.The obtained catalyst(NiCo_(2)O_(4)-OH)showed a higher surface alkalinity and more surface defects compared to the pristine spinel oxide,including enhanced structural distortion as well as promoted oxygen vacancies.The propane oxidation ability of NiCo_(2)O_(4)-OH was greatly enhanced,with a propane conversion rate that was approximately 6.4 times higher than that of pristine NiCo_(2)O_(4) at a reaction temperature 193℃.This work sets a valuable paradigm for the surface modulation of spinel oxide via alkali treatment to ensure a high-performance oxidation catalyst.

COVID-19 in the endoscopy unit:How likely is transmission of infection?Results from an international,multicenter study

BACKGROUND Coronavirus disease 2019(COVID-19)significantly affected endoscopy practice,as gastrointestinal endoscopy is considered a risky procedure for transmission of infection to patients and personnel of endoscopy units(PEU).AIM To assess the impact of COVID-19 on endoscopy during the first European lockdown(March-May 2020).METHODS Patients undergoing endoscopy in nine endoscopy units across six European countries during the period of the first European lockdown for COVID-19(March-May 2020)were included.Prior to the endoscopy procedure,participants were stratified as low-or high-risk for potential COVID-19 infection according to the European Society of Gastrointestinal Endoscopy(ESGE)and the European Society of Gastroenterology and Endoscopy Nurses and Associates(ESGENA)joint statement,and contacted 7-14 d later to assess COVID-19 infection status.PEU were questioned regarding COVID-19 symptoms and/or infection via questionnaire,while information regarding hospitalizations,intensive care unitadmissions and COVID-19-related deaths were collected.The number of weekly endoscopies at each center during the lockdown period was also recorded.RESULTS A total of 1267 endoscopies were performed in 1222 individuals across nine European endoscopy departments in six countries.Eighty-seven(7%)were excluded because of initial positive testing.Of the 1135 pre-endoscopy low risk or polymerase chain reaction negative for COVID-19,254(22.4%)were tested post endoscopy and 8 were eventually found positive,resulting in an infection rate of 0.7%[95%CI:0.2-0.12].The majority(6 of the 8 patients,75%)had undergone esophagogastroduodenoscopy.Of the 163 PEU,5[3%;(95%CI:0.4-5.7)]tested positive during the study period.A decrease of 68.7%(95%CI:64.8-72.7)in the number of weekly endoscopies was recorded in all centers after March 2020.All centers implemented appropriate personal protective measures(PPM)from the initial phases of the lockdown.CONCLUSION COVID-19 transmission in endoscopy units is highly unlikely in a lockdown setting,provided endoscopies are restricted to emergency cases and PPM are implemented.

Practical approach to linear endoscopic ultrasound examination of the gallbladder

The gallbladder(GB)is a susceptible organ,prone to various pathologies that can be identified using different imaging techniques.Transabdominal ultrasound(TUS)is typically the initial diagnostic method due to its numerous well-established advantages.However,in cases of uncertainty or when a definitive diagnosis cannot be established,computed tomography(CT)or magnetic resonance imaging may be employed to provide more detailed information.Nevertheless,CT scans may sometimes offer inadequate spatial resolution,which can limit the differentiation of GB lesions,particularly when smaller yet clinically relevant abnormalities are involved.Conversely,endoscopic ultrasound(EUS)provides higher frequency compared to TUS,superior spatial resolution,and the option for contrast-enhanced harmonic imaging,enabling a more comprehensive examination.Thus,EUS can serve as a supplementary tool when conventional imaging methods are insufficient.This review will describe the standard EUS examination of the GB,focusing on its endosonographic characteristics in various GB path-ologies.

Cognitive impairment in heart failure patients

Cognitive damage in heart failure （HF） involves different domains thus interfering with the ability for single patient to self-care and to cope with treatment regimens, modifying symptoms and health behaviours. Many cerebral and functional changes were detected in brain imaging, involving areas of both grey and white matter deputed to cognition. Although various instruments are available to explore cognition, no consensus was obtained on better tools to be used in HF population. Reduction in cerebral blood flow, decreased cardiac output, altera-tions of cerebrovascular reactivity and modification of blood pressure levels are the main features involved in the etiopathogenetic mecha-nisms of cognitive deficit. Several cardiac variables, laboratory parameters, demographic and clinical elements were studied for their possible relation with cognition and should be properly evaluated to define patients at increased risk of impairment. The present review gathers avail-able data pointing out assured information and discussing possible areas of research development.

Androgen receptors are expressed in a variety of human fetal extragenital tissues： an immunohistochemical study

Aim： To investigate the expression of androgen receptors in the extragenital tissues of developing human embryo. Methods： Using immunohistochemistry, we investigated the distribution of androgen receptor （AR） in the extragenital tissues of paraffin-embedded tissue sections of first trimester （8-12 weeks gestation） human embryos. Gender was determined by polymerized chain reaction. Results： There were no differences in the expression and distribution of AR in male and female embryos at any stage of gestation. AR expression was seen in the thymus gland. The bronchial epithelium of the lungs showed intense positive staining with surrounding stroma negative. Furthermore, positive staining for androgen receptor was exhibited in the spinal cord with a few positive cells in the surrounding tissues. Cardiac valves also showed strong positive staining but with faint reactivity of the surrounding cardiac muscle. There was no staining in kidney, adrenal, liver or bowel. Conclusion： This study demonstrates that immunoreactive AR protein is present in a wide variety of human first trimester fetal tissues and shows the potential for androgen affecting tissues, which are mostly not considered to be androgen dependent. Moreover, it implies that androgen might act as atrophic factor and affect the early development of these organs rather than simply sexual differentiation.

Cenozoic topography,monsoons and biodiversity conservation within the Tibetan Region:An evolving story

The biodiversity of the Himalaya,Hengduan Mountains and Tibet,here collectively termed the Tibetan Region,is exceptional in a global context.To contextualize and understand the origins of this biotic richness,and its conservation value,we examine recent fossil finds and review progress in understanding the orogeny of the Tibetan Region.We examine the deep-time origins of monsoons affecting Asia,climate variation over different timescales,and the establishment of environmental niche heterogeneity linked to topographic development.The origins of the modern biodiversity were established in the Eocene,concurrent with the formation of pronounced topographic relief across the Tibetan Region.High(>4 km)mountains to the north and south of what is now the Tibetan Plateau bounded a Paleogene central lowland(<2.5 km)hosting moist subtropical vegetation influenced by an intensifying monsoon.In mid Miocene times,before the Himalaya reached their current elevation,sediment infilling and compressional tectonics raised the floor of the central valley to above 3000 m,but central Tibet was still moist enough,and low enough,to host a warm temperate angiosperm-dominated woodland.After 15 Ma,global cooling,the further rise of central Tibet,and the rain shadow cast by the growing Himalaya,progressively led to more open,herb-rich vegetation as the modern high plateau formed with its cool,dry climate.In the moist monsoonal Hengduan Mountains,high and spatially extensive since the Eocene but subsequently deeply dissected by river incision,Neogene cooling depressed the tree line,compressed altitudinal zonation,and created strong environmental heterogeneity.This served as a cradle for the then newly-evolving alpine biota and favoured diversity within more thermophilic vegetation at lower elevations.This diversity has survived through a combination of minimal Quaternary glaciation,and complex relief-related environmental niche heterogeneity.The great antiquity and diversity of the Tibetan Region biota argues for its conservation,and the importance of that biota is demonstrated through our insights into its long temporal gestation provided by fossil archives and information written in surviving genomes.These data sources are worthy of conservation in their own right,but for the living biotic inventory we need to ask what it is we want to conserve.Is it 1)individual taxa for their intrinsic properties,2)their services in functioning ecosystems,or 3)their capacity to generate future new biodiversity?If 2 or 3 are our goal then landscape conservation at scale is required,and not just seed banks or botanical/zoological gardens.

Low complexity power control approach based on MMSE detection for V-BLAST

A low complexity Per-Antenna Power Control （PAPC） approach based on Minimum Mean Squared Error （MMSE） detection for V-BLAST is proposed in this paper. The PAPC approach is developed for minimizing the Bit Error Rate （BER） averaged over all substreams when the data throughput and the total transmit power keep constant over time. Simulation results show that the Power-controlled V-BLAST （P-BLAST） outperforms the conventional V-BLAST in terms of BER performance with MMSE detector, especially in presence of high spatial correlation between antennas. However, the additional complexity for P-BLAST is not high. When MMSE detector is adopted, the P-BLAST can achieve a comparable BER performance to that of conventional V-BLAST with Maximum Likelihood （ML） detector but with low complexity.

Human cytomegalovirus and Epstein-Barr virus infection in inflammatory bowel disease:Need for mucosal viral load measurement

AIM:To evaluate the best diagnostic technique and risk factors of the human Cytomegalovirus(HCMV)and Epstein-Barr virus(EBV)infection in inflammatory bowel disease(IBD).METHODS:A cohort of 40 IBD patients(17 refractory)and 40 controls underwent peripheral blood and endoscopic colonic mucosal sample harvest.Viral infection was assessed by quantitative real-time polymerase chain reaction and immunohistochemistry,and correlations with clinical and endoscopic indexes of activity,and risk factors were investigated.RESULTS:All refractory patients carried detectable levels of HCMV and/or EBV mucosal load as comparedto 13/23(56.5%)non-refractory and 13/40(32.5%)controls.The median DNA value was significantly higher in refractory(HCMV 286 and EBV 5.440 copies/105cells)than in non-refractory(HCMV 0 and EBV 6copies/105 cells;P<0.05 and<0.001)IBD patients and controls(HCMV and EBV 0 copies/105 cells;P<0.001 for both).Refractory patients showed DNA peak values≥103 copies/105 cells in diseased mucosa in comparison to non-diseased mucosa(P<0.0121 for HCMV and<0.0004 for EBV),while non-refractory patients and controls invariably displayed levels below this threshold,thus allowing us to differentiate viral colitis from mucosal infection.Moreover,the mucosal load positively correlated with the values found in the peripheral blood,whilst no correlation with the number of positive cells at immunohistochemistry was found.Steroid use was identified as a significant risk factor for both HCMV(P=0.018)and EBV(P=0.002)colitis.Finally,a course of specific antiviral therapy with ganciclovir was successful in all refractory patients with HCMV colitis,whilst refractory patients with EBV colitis did not show any improvement despite steroid tapering and discontinuation of the other medications.CONCLUSION:Viral colitis appeared to contribute to mucosal lesions in refractory IBD,and its correct diagnosis and management require quantitative real-time polymerase chain reaction assay of mucosal specimens.