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Azuma T, Usui M, Hayashi T. Inactivation of antibiotic-resistant bacteria in hospital wastewater by ozone-based advanced water treatment processes. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 906:167432. [PMID: 37777130 DOI: 10.1016/j.scitotenv.2023.167432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/02/2023]
Abstract
The emergence and spread of antimicrobial resistance (AMR) continue on a global scale. The impacts of wastewater on the environment and human health have been identified, and understanding the environmental impacts of hospital wastewater and exploring appropriate forms of treatment are major societal challenges. In the present research, we evaluated the efficacy of ozone (O3)-based advanced wastewater treatment systems (O3, O3/H2O2, O3/UV, and O3/UV/H2O2) for the treatment of antimicrobials, antimicrobial-resistant bacteria (AMRB), and antimicrobial resistance genes (AMRGs) in wastewater from medical facilities. Our results indicated that the O3-based advanced wastewater treatment inactivated multiple antimicrobials (>99.9%) and AMRB after 10-30 min of treatment. Additionally, AMRGs were effectively removed (1.4-6.6 log10) during hospital wastewater treatment. The inactivation and/or removal performances of these pollutants through the O3/UV and O3/UV/H2O2 treatments were significantly (P < 0.05) better than those in the O3 and O3/H2O2 treatments. Altered taxonomic diversity of microorganisms based on 16S rRNA gene sequencing following the O3-based treatment showed that advanced wastewater treatments not only removed viable bacteria but also removed genes constituting microorganisms in the wastewater. Consequently, the objective of this study was to apply advanced wastewater treatments to treat wastewater, mitigate environmental pollution, and alleviate potential threats to environmental and human health associated with AMR. Our findings will contribute to enhancing the effectiveness of advanced wastewater treatment systems through on-site application, not only in wastewater treatment plants (WWTPs) but also in medical facilities. Moreover, our results will help reduce the discharge of AMRB and AMRGs into rivers and maintain the safety of aquatic environments.
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Affiliation(s)
- Takashi Azuma
- Department of Pharmacy, Osaka Medical and Pharmaceutical University, 4-20-1 Nasahara, Takatsuki, Osaka 569-1094, Japan.
| | - Masaru Usui
- Food Microbiology and Food Safety, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, 582 Midorimachi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
| | - Tetsuya Hayashi
- Department of Pharmacy, Osaka Medical and Pharmaceutical University, 4-20-1 Nasahara, Takatsuki, Osaka 569-1094, Japan; Faculty of Human Development, Department of Food and Nutrition Management Studies, Soai University, 4-4-1 Nankonaka, Osaka Suminoeku, Osaka 559-0033, Japan
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Shitada C, Sekizuka T, Yamamoto A, Sakamoto C, Hashino M, Kuroda M, Takahashi M. Comparative pathogenomic analysis reveals a highly tetanus toxin-producing clade of Clostridium tetani isolates in Japan. mSphere 2023; 8:e0036923. [PMID: 38009947 PMCID: PMC10732020 DOI: 10.1128/msphere.00369-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023] Open
Abstract
IMPORTANCE C. tetani is a spore-forming, anaerobic bacterium that produces a toxin causing muscle stiffness and paralysis. Tetanus is preventable with the toxoid vaccine, but it remains a significant public health threat in regions with low vaccine coverage. However, there are relatively few isolates and limited genomic information available worldwide. In Japan, about 100 cases are reported each year, but there have been no nationwide surveys of isolates, and no genomic information from Japanese isolates has been published. In our study, we analyzed the genomes of 151 strains from a limited survey of soil in Kumamoto, Japan. Our findings revealed a high degree of genetic diversity, and we also identified a subset of strains that produced significantly more toxin, which provides new insights into the pathogenesis of tetanus. Our findings lay the foundation for future studies to investigate the distribution and evolution of C. tetani in Japan and neighboring countries.
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Affiliation(s)
- Chie Shitada
- Toxin and Biologicals Research Laboratory, Kumamoto Health Science University, Kumamoto, Japan
- The Chemo-Sero-Therapeutic Research Institute, Kumamoto, Japan
| | - Tsuyoshi Sekizuka
- Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Akihiko Yamamoto
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Chiyomi Sakamoto
- Toxin and Biologicals Research Laboratory, Kumamoto Health Science University, Kumamoto, Japan
- The Chemo-Sero-Therapeutic Research Institute, Kumamoto, Japan
| | - Masanori Hashino
- Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Makoto Kuroda
- Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Motohide Takahashi
- Toxin and Biologicals Research Laboratory, Kumamoto Health Science University, Kumamoto, Japan
- The Chemo-Sero-Therapeutic Research Institute, Kumamoto, Japan
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Leoni F, Sacchini L, Pieralisi S, Angelico G, Magistrali CF, Cucco L, Massacci FR, Albini E, Duranti A, Cammà C, Secondini B, Rinaldi A, Barchiesi F. Occurrence and temporal distribution of extended-spectrum β-lactamase-producing Escherichia coli in clams from the Central Adriatic, Italy. Front Microbiol 2023; 14:1219008. [PMID: 38029166 PMCID: PMC10657901 DOI: 10.3389/fmicb.2023.1219008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
The spread of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is a major public health issue. Bivalves are filter-feeder animals capable of bioaccumulating the microorganisms present in water. This physiological characteristic makes them both good indicators of environmental contamination and possible carriers of pathogenic bacteria, including those resistant to antimicrobials. The aim of this study was to investigate the occurrence of ESBL-producing E. coli in clams (n = 308) collected from harvesting areas of the Central Adriatic Sea between 2018 and 2019. ESBL- /class C β-lactamase (AmpC)- producing E. coli and Escherichia spp. were isolated by streaking over the surface of MacConkey agar plates supplemented with cefotaxime enriched broths of the initial shellfish suspension. E. coli and Escherichia spp. resistant to cefotaxime were screened for ESBL production by using the double disk synergy test. Susceptibility to different antimicrobials and confirmation of ESBL-production were determined by the minimum inhibitory concentration (MIC) test. Isolates were further characterized by whole genome sequencing (WGS) and bioinformatic analysis of genomes with different tools. Overall, ESBL-producing E. coli were isolated from 3% of the samples. Of 13 ESBL- and ESBL-/AmpC-producing Escherichia spp. (n = 11 E. coli, n = 1 E. marmotae, n = 1 E. ruysiae) isolates, 13 were resistant to ampicillin and cefotaxime, 9 to sulfamethoxazole, 6 to tetracycline and nalidixic acid, 4 to trimethoprim, and 3 to ceftazidime, cefoxitin, ciprofloxacin, and chloramphenicol. Moreover, the majority (8/11) of the ESBL-producing E. coli isolates were multidrug-resistant. WGS showed that the isolates predominantly carried the blaCTX-M-15 gene (3/11) and blaCTX-M-14 and blaCTX-M-1 (2/11 each). The AmpC β-lactamase CMY-2 was found in two isolates. Phylogroup A was the most prevalent (5/11), followed by phylogroups D (4/11), F (1/11), and B2 (1/11). Ten different sequence types (STs) were identified. Occurrence at sampling sites ranged between 0 and 27%. To identify associations between the occurrence of ESBL-producing E. coli and E. coli levels, samples were divided into two groups, with E. coli at >230 MPN/100 g and E. coli at ≤230 MPN/100 g. ESBL-producing E. coli isolates were significantly more commonly recovered in samples with higher E. coli levels (14%) than in those with lower levels of E. coli (2%). Moreover, the majority (3/4) of the potentially pathogenic strains were isolated in samples with higher E. coli levels. These findings provided evidence for the bacterial indicator of fecal contamination, E. coli, as an index organism for ESBL-producing E. coli isolates in bivalves.
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Affiliation(s)
- Francesca Leoni
- Laboratorio Nazionale di Riferimento per il Controllo Delle Contaminazioni Batteriche dei Molluschi Bivalvi, Istituto Zooprofilattico Sperimentale Dell’Umbria e Delle Marche “Togo Rosati”, Ancona, Italy
| | - Luca Sacchini
- Laboratorio Nazionale di Riferimento per il Controllo Delle Contaminazioni Batteriche dei Molluschi Bivalvi, Istituto Zooprofilattico Sperimentale Dell’Umbria e Delle Marche “Togo Rosati”, Ancona, Italy
| | - Silvia Pieralisi
- Laboratorio Nazionale di Riferimento per il Controllo Delle Contaminazioni Batteriche dei Molluschi Bivalvi, Istituto Zooprofilattico Sperimentale Dell’Umbria e Delle Marche “Togo Rosati”, Ancona, Italy
| | - Gabriele Angelico
- Laboratorio Nazionale di Riferimento per il Controllo Delle Contaminazioni Batteriche dei Molluschi Bivalvi, Istituto Zooprofilattico Sperimentale Dell’Umbria e Delle Marche “Togo Rosati”, Ancona, Italy
| | | | - Lucilla Cucco
- Istituto Zooprofilattico Sperimentale Dell’Umbria e Delle Marche “Togo Rosati”, Perugia, Italy
| | | | - Elisa Albini
- Istituto Zooprofilattico Sperimentale Dell’Umbria e Delle Marche “Togo Rosati”, Perugia, Italy
| | - Anna Duranti
- Istituto Zooprofilattico Sperimentale Dell’Umbria e Delle Marche “Togo Rosati”, Perugia, Italy
| | - Cesare Cammà
- National Reference Centre for Whole Genome Sequencing of Microbial Pathogens: Data-Base and Bioinformatics Analysis (GENPAT), Istituto Zooprofilattico Sperimentale Dell’Abruzzo e del Molise “G. Caporale”, Teramo, Italy
| | - Barbara Secondini
- National Reference Centre for Whole Genome Sequencing of Microbial Pathogens: Data-Base and Bioinformatics Analysis (GENPAT), Istituto Zooprofilattico Sperimentale Dell’Abruzzo e del Molise “G. Caporale”, Teramo, Italy
| | - Antonio Rinaldi
- National Reference Centre for Whole Genome Sequencing of Microbial Pathogens: Data-Base and Bioinformatics Analysis (GENPAT), Istituto Zooprofilattico Sperimentale Dell’Abruzzo e del Molise “G. Caporale”, Teramo, Italy
| | - Francesca Barchiesi
- Centro di Referenza per il Controllo Microbiologico e Chimico dei Molluschi Bivalvi Vivi, Istituto Zooprofilattico Sperimentale Dell’Umbria e Delle Marche “Togo Rosati”, Ancona, Italy
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Kawata S, Morimoto S, Kosai K, Kawamoto Y, Nakashima Y, Morinaga Y, Yanagihara K, Yoshida LM, Moriuchi H. The fecal carriage rate of extended-spectrum β-lactamase-producing or carbapenem-resistant Enterobacterales among Japanese infants in the community at the 4-month health examination in a rural city. Front Cell Infect Microbiol 2023; 13:1168451. [PMID: 37389210 PMCID: PMC10305779 DOI: 10.3389/fcimb.2023.1168451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
Background Extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) is a great public health concern globally not only in hospitals but also in the community. To our knowledge, there have been few studies on the prevalence of ESBL-E and much less about carbapenem-resistant Enterobacterales (CRE) among children in the community, and there is no such study in Japan despite such situations. This study aimed to clarify their carriage status among Japanese infants in the community by taking the opportunity of the 4-month health checkup. Methods This prospective analysis was conducted from April 2020 to March 2021 in Shimabara City, Nagasaki Prefecture, Japan. The research-related items were mailed to all subjects with official documents for the checkup. The fecal samples were obtained from the diaper by guardians beforehand and were collected with the questionnaire and then screened for ESBL-E and CRE by a clinical laboratory company with selective agars followed by identification and confirmation. Only the positive samples were analyzed about resistant genotypes. Results One hundred fifty infants aged 4-5 months, over half of the subjects, participated in this study. The overall ESBL-E carriage rate was 19.3% (n = 29), and no CRE carrier was detected among them. All identified ESBL-E were E. coli except for one K. pneumoniae. A significantly higher carriage rate was recorded among the infants born at "Hospital A" (25.0%) than the others (11.3%). Enterobacterales producing CTX-M-9 ± TEM were broadly distributed among the positive samples (65.5%), whereas the CTX-M-1 group was exclusively detected among those from "Hospital A". Recursive partitioning analysis suggested that delivery facilities might be an important factor for ESBL-E colonization, although the effect could be decreased as they grow. In contrast, no significant effect was observed for other factors such as parent(s) as healthcare worker(s), having a sibling(s), and the mode of delivery. Conclusion This study revealed the ESBL-E and CRE carriage status of Japanese infants in the community for the first time, although the setting is somewhat limited. Our findings indicated that environmental factors, especially delivery facilities, influenced ESBL-E colonization among infants aged 4-5 months, implying the need for strengthening countermeasures against antimicrobial resistance at delivery facilities and communities outside the hospitals.
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Affiliation(s)
- Soichiro Kawata
- Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Tropical Pediatric Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shimpei Morimoto
- Innovation Platform & Office for Precision Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kosuke Kosai
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Yasuhide Kawamoto
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Yumiko Nakashima
- Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan
| | - Yoshitomo Morinaga
- Department of Microbiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Azuma T, Katagiri M, Sasaki N, Kuroda M, Watanabe M. Performance of a Pilot-Scale Continuous Flow Ozone-Based Hospital Wastewater Treatment System. Antibiotics (Basel) 2023; 12:antibiotics12050932. [PMID: 37237835 DOI: 10.3390/antibiotics12050932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Antimicrobial resistance (AMR) is becoming a global concern. Recently, research has emerged to evaluate the human and environmental health implications of wastewater from medical facilities and to identify acceptable wastewater treatment methods. In this study, a disinfection wastewater treatment system using an ozone-based continuous flow system was installed in a general hospital located in Japan. The effectiveness of antimicrobial-resistant bacteria (ARB) and antimicrobials in mitigating the environmental impact of hospital wastewater was evaluated. Metagenomic analysis was conducted to characterize the microorganisms in the wastewater before and after treatment. The results demonstrated that ozone treatment enables effective inactivation of general gut bacteria, including Bacteroides, Prevotella, Escherichia coli, Klebsiella, DNA molecules, and ARGs, as well as antimicrobials. Azithromycin and doxycycline removal rates were >99% immediately after treatment, and levofloxacin and vancomycin removal rates remained between 90% and 97% for approximately one month. Clarithromycin was more readily removed than the other antimicrobials (81-91%), and no clear removal trend was observed for ampicillin. Our findings provide a better understanding of the environmental management of hospital wastewater and enhance the effectiveness of disinfection wastewater treatment systems at medical facilities for mitigating the discharge of pollutants into aquatic environments.
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Affiliation(s)
- Takashi Azuma
- Department of Pharmaceutical Sciences, Osaka Medical and Pharmaceutical University, Takatsuki 569-1094, Japan
| | - Miwa Katagiri
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
| | - Naobumi Sasaki
- Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo 162-8640, Japan
| | - Makoto Kuroda
- Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo 162-8640, Japan
| | - Manabu Watanabe
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
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Garcillán-Barcia MP, Redondo-Salvo S, de la Cruz F. Plasmid classifications. Plasmid 2023; 126:102684. [PMID: 37116631 DOI: 10.1016/j.plasmid.2023.102684] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/09/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
Plasmids are universally present in bacteria and play key roles in the dissemination of genes such as antibiotic resistance determinants. Major concepts in Plasmid Biology derive from the efforts to classify plasmids. Here, we review the main plasmid classification systems, starting by phenotype-based methods, such as fertility inhibition and incompatibility, followed by schemes based on a single gene (replicon type and MOB class), and finishing with recently developed approaches that use genetic distances between whole plasmid sequences. A comparison of the latter highlights significant differences between them. We further discuss the need for an operational definition of plasmid species that reveals their biological features, akin to plasmid taxonomic units (PTUs).
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Affiliation(s)
- M Pilar Garcillán-Barcia
- Instituto de Biomedicina y Biotecnología de Cantabria (Consejo Superior de Investigaciones Científicas - Universidad de Cantabria), Cantabria, Spain.
| | - Santiago Redondo-Salvo
- Instituto de Biomedicina y Biotecnología de Cantabria (Consejo Superior de Investigaciones Científicas - Universidad de Cantabria), Cantabria, Spain; Biomar Microbial Technologies, León, Spain
| | - Fernando de la Cruz
- Instituto de Biomedicina y Biotecnología de Cantabria (Consejo Superior de Investigaciones Científicas - Universidad de Cantabria), Cantabria, Spain.
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Azuma T, Murakami M, Sonoda Y, Ozaki A, Hayashi T. Occurrence and Quantitative Microbial Risk Assessment of Methicillin-Resistant Staphylococcus aureus (MRSA) in a Sub-Catchment of the Yodo River Basin, Japan. Antibiotics (Basel) 2022; 11:antibiotics11101355. [PMID: 36290013 PMCID: PMC9598951 DOI: 10.3390/antibiotics11101355] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
The occurrence of Staphylococcus aureus (S. aureus) and methicillin-resistant S. aureus (MRSA) in a sub-catchment of the Yodo River Basin, a representative water system of a drinking water source in Japan, was investigated. The chromogenic enzyme-substrate medium method was used for the detection of S. aureus and MRSA by the presence or absence of antimicrobials in the medium for viable bacteria in a culture-based setting. The contributions of S. aureus and MRSA from wastewater to the rivers were estimated based on mass flux-based analysis, and quantitative microbial risk assessment (QMRA) was further conducted for S. aureus and MRSA in river environments. The mean abundance of S. aureus and MRSA was 31 and 29 CFU/mL in hospital effluent, 124 and 117 CFU/mL in sewage treatment plant (STP) influent, 16 and 13 CFU/mL in STP effluent, and 8 and 9 CFU/mL in river water, respectively. Contribution of the pollution load derived from the target STP effluent to river water ranged from 2% to 25%. The QMRA showed that to achieve the established health benchmarks, the drinking water treatment process would need to yield 1.7 log10 and 2.9 log10 inactivation in terms of infection risk and disability-adjusted life year (DALY) indexes, respectively. These findings highlight the link between medical environment and the importance of environmental risk management for antimicrobial-resistant bacteria in aquatic environments.
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Affiliation(s)
- Takashi Azuma
- Department of Pharmacy, Osaka Medical and Pharmaceutical University, 4-20-1 Nasahara, Takatsuki 569-1094, Japan
- Correspondence: ; Tel./Fax: +81-72-690-1055
| | - Michio Murakami
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Techno Alliance C209, 2-8 Yamadaoka, Suita 565-0871, Japan
| | - Yuki Sonoda
- Nursing Unit, Jyoban Hospital of Tokiwa Foundation, 57 Kaminodai, Jyoban-Kamiyunaga-Yamachi, Iwaki 972-8322, Japan
| | - Akihiko Ozaki
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, 57 Kaminodai, Jyoban-Kamiyunaga-Yamachi, Iwaki 972-8322, Japan
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikariga-oka, Fukushima 960-1295, Japan
| | - Tetsuya Hayashi
- Department of Pharmacy, Osaka Medical and Pharmaceutical University, 4-20-1 Nasahara, Takatsuki 569-1094, Japan
- Department of Food and Nutrition Management Studies, Faculty of Human Development, Soai University, 4-4-1 Nankonaka, Osaka 559-0033, Japan
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