Establishing the blood reference interval of pancreatic elastase-1: A prospective study.

BACKGROUND AND AIM: Pancreatic elastase-1 (PE-1) has been investigated in pancreatic disorders. However, the reference interval (RI) of PE-1 in blood remains unconfirmed. We aimed to establish the blood RI of PE-1 in an adult population. METHODS: In this prospective cross-sectional study, we enrolled 400 adults who had received the whole-body physical check-up program between May 1, 2019 and November 20, 2019. The serum and plasma PE-1 levels were measured by latex turbidimetric immunoassay in different storage conditions (fresh, refrigerated, and frozen). The 95% and 99% RI of PE-1 were calculated according to the Clinical & Laboratory Standards Institute guidelines. The correlations between PE-1 and other parameters were analyzed using multivariable regression models. Ultimately, 38 patients with acute pancreatitis were prospectively recruited as the validation cohort. RESULTS: The PE-1 levels in fresh serum were highly correlated with those in refrigerated (R2  = 0.998) or frozen (R2  = 0.942) samples; however, plasma should not be suggested in frozen conditions (plasma vs serum: R2  = 0.185). In the RI study population (202 male & 198 female participants), the median age was 52.6 (25-75% interquartile range: 43.1-61.0). The 95% and 99% RIs of PE-1 were 30.0-221.0 and 22.0-359.0 ng/dL, respectively. Triglycerides (ß = 0.106, P = 0.033), lipase (ß = 0.154, P = 0.007), and CA19-9 (ß = 0.130, P = 0.008) were independent factors associated with PE-1. In the pancreatitis validation cohort, with a cut-off value of 359.0 ng/dL, the sensitivity and specificity were 100% and 99.8%, respectively. CONCLUSION: The RI of PE-1 established in this study can be used for further applications. Serum is the suggested form for frozen sample storage.

Residents had an increasing risk of norovirus gastroenteritis infection than health care workers during an outbreak in a nursing home.

OBJECTIVES: To study norovirus gastroenteritis infection among residents and health care workers (HCWs) during an outbreak in a nursing home by investigating the attack rate and positive diagnostic rate for norovirus by reverse transcription-polymerase chain reaction (RT-PCR). METHODS: All members in a Chang Gung Memorial Hospital-affiliated nursing home from November 17, 2006, to November 25, 2006, including 236 residents and 125 HCWs, whose available medical records were available were consecutively included in the retrospective analysis. Fecal specimens of symptomatic residents and HCWs were tested for norovirus by RT-PCR. In addition, routine stool analysis and a stool culture study were conducted to identify the bacterial and parasitic agents. The fecal specimens of asymptomatic residents and HCWs were tested only for norovirus by RT-PCR. RESULTS: The outbreak was controlled within 9 days during the outbreak period. There were 51 symptomatic cases, 41 residents and 10 HCWs, during the norovirus outbreak. The odds ratio (OR) of the attack rate in the residents was approximately 2.4 times higher than that in the HCWs (OR: 2.4; 95% confidence interval [CI]: 1.2-5.0; P = .015). Norovirus was detected in 59 (30.6%) of 193 residents and in 11 (10.5%) of 105 HCWs who provided stool specimens for the study by RT-PCR. The OR of the positive diagnostic rate for norovirus by RT-PCR in the residents was approximately 3.8 times higher than that in the HCWs (OR: 3.8; 95% CI: 1.9-7.5; P < .001). CONCLUSIONS: During an outbreak of norovirus gastroenteritis in a nursing home, the infection can be easily transmitted from person to person and affects both residents and HCWs. In addition, residents had a higher risk of norovirus gastroenteritis infection than HCWs.