Hepatic steatosis and skeletal muscle alterations during the COVID-19 lockdown in a cohort of patients with chronic liver disease in Japan.

AIM: Following the coronavirus disease outbreak, a state of public emergency was declared worldwide, which enforced lifestyle changes. This study therefore aimed to investigate the changes in lifestyle, body composition, hepatic steatosis, and fibrosis in patients with chronic liver disease (CLD) under lockdown. METHODS: During the lockdown period, 1344 patients with CLD answered a lifestyle questionnaire. In 298 patients, body composition and liver stiffness measure (LSM)/controlled attenuation parameter (CAP) were analyzed by InBody and FibroScan, respectively, and serial data were obtained in 137 patients. RESULTS: More than half of the CLD patients answered decreases in physical activity and frequency of outings during lockdown, while diet was less affected. Overall, 58% of patients showed elevations in CAP values, which were not different statistically over time. Women, but not men, were more likely to increase CAP values during lockdown. Neither LSM nor serum fibrosis markers were elevated chronologically during lockdown. In men, body mass index (BMI), body fat percentage, and visceral fat area (VFA) were significantly increased, whereas in women, lower-limb muscle mass was significantly decreased. Patients with decreased SMI showed elevations in CAP and VFA values, and patients who exercised less showed increases in BMI. CONCLUSION: In response to lockdown, men tended to increase body fat but the degree of hepatic steatosis was less affected, while women were more likely to exacerbate hepatic steatosis with skeletal muscle loss among CLD patients. Gender-specific approaches need to be established for management of CLD patients to avoid exacerbation or comorbidity of steatotic liver disease.

Benefit of an action camera in endoscopy education for medical students under COVID-19.

BACKGROUND: Endoscopy is an important form of clinical gastroenterology education because it gives students the opportunity to learn about diagnosis procedures and even treatment. During the COVID-19 pandemic, medical students were observed from outside the endoscopy room due to the risk of airborne infection. In this study, we investigated the efficacy of combining endoscopy education with doctor's-eye-view videos of the procedure obtained using live-action cameras (GoPro®). METHODS: From February to May 2021, endoscopists wore GoPro Hero8 cameras on their heads to display a doctor's-eye view video outside the room. The efficacy of the GoPro videos in combination with endoscopic monitoring was evaluated by 15 participating medical students. The participants rated the efficacy on a 5-point scale and commented on the positive and negative points. RESULTS: A total of 78.6% of participants evaluated the GoPro as good; 57.2% answered that it increased their understanding, with 71.4% stating that it increased their understanding of procedures in particular. A total of 85.7% of the students answered that their interest in endoscopy had increased, and 85.7% evaluated the benefit of the GoPro videos as good. In addition, 64.3% answered that the method was effective in preventing COVID-19 infection. Education using GoPro videos enabled students to feel as if they were conducting the endoscopy themselves and enabled them to concentrate on learning. CONCLUSIONS: Practical endoscopic education using a GoPro is an effective educational tool that not only increases understanding of endoscopic practice but also stimulates students' interest and awareness of their future as doctors.

Crystallization of Amorphous Nifedipine Under Isothermal Conditions: Inter-laboratory Reproducibility and Investigation of the Factors Affecting Reproducibility.

High inter-laboratory reproducibility is required for conducting collaborative experiments among several laboratories. The primary aim of our evaluation of the physical stability of amorphous drugs, conducted in co-operation with eight laboratories, was to establish a protocol for isothermal storage tests to obtain data of the same quality from all the participating laboratories. Sharing a protocol that contained the same level of detail as the experimental section of general papers was insufficient for high inter-laboratory reproducibility. We investigated the causes of variations in the data from the various laboratories and restricted the protocol step-by-step to achieve high inter-laboratory reproducibility. The various experimentalists had very different levels of awareness regarding how to control the temperature of a sample as the samples were transferred into and out of thermostatic chambers. Specific instructions on how to conduct this operation, such as regarding the time required for the transfer and thermal protection of the container during the transfer, helped to reduce variation. Improved inter-laboratory reproducibility revealed that the physical stabilities of amorphous drugs differed when samples were prepared in differently shaped aluminum pans designed for various differential scanning calorimeters.

One-year operation of a 20-L submerged anaerobic membrane bioreactor for real domestic wastewater treatment at room temperature: Pursuing the optimal HRT and sustainable flux.

A 20 L hollow-fiber submerged anaerobic membrane bioreactor (SAnMBR) was used to treat real domestic wastewater at 25 °C with hydraulic retention times (HRTs) ranging from 4 to 12 h. The process performance was evaluated by organic removal efficiency, biogas production, sludge yield, and filtration behaviors during one-year's operation. For HRTs ranging between 6 and 12 h, the AnMBR showed good organic removal efficiency with chemical oxygen demand (COD) and biochemical oxygen demand (BOD) removal efficiencies of about 89% and 93%, respectively. The biogas yield was 0.26 L-gas/g-CODfed, with approximately 80% methane content, and the sludge yield was 0.07-0.11 g-VSS/g-CODrem. While at an HRT of 4 h, with the higher wastewater treatment capacity and organic loading rate (OLR), the biogas production was lower (0.17 L-gas/g-CODfed), and the sludge production was higher (0.22 g-VSS/g-CODrem). The organic removal performance (COD 84% and BOD 89%) at HRT of 4 h was acceptable due to the effective separation effect of the membrane filtration process. According to COD balance analysis, the low biogas yield and high sludge yield at HRT of 4 h were due to insufficient biodegradation under an OLR of 2.05 g-COD/L-reactor/d. Theoretical calculations based on Henry's law indicate that the ideal methane content in the biogas should be 82-85% when the operational temperature was 25 °C. To achieve a high flux and sustainable AnMBR operation, the impact of mixed liquor suspended solid (MLSS) and gas sparging velocity (GSV) on the filtration performance was analyzed. The critical flux increased with increase in the GSV from 24.2 to 174.3 m/h, but decreased with increase in the MLSS concentration from 8.2 to 20.2 g/L. Therefore, decreasing fouling rate to 0.8-1.2 kPa/d by efficiently controlling GSV and MLSS, sustainable operation could be achieved at a flux of 0.34 m/d.

Application of two anaerobic membrane bioreactors with different pore size membranes for municipal wastewater treatment.

Pore size is one of the most important properties in the successful operation of membrane-based bioprocesses for the treatment of municipal wastewater. The characteristics of two anaerobic membrane bioreactors (AnMBRs), one with a hollow fiber membrane of 0.4 µm pore size (AnMBR1), and the other with a membrane of 0.05 µm pore size (AnMBR2) were investigated for the treatment of real municipal wastewater at room temperature (25 °C) under varied hydraulic retention times (HRTs). Process performance was evaluated in terms of organic removal efficiency, biogas production and membrane filtration behaviours during a long-term continuous operation. Both AnMBRs showed good organic removal performance with COD and BOD removal efficiencies of around 89% and 93%, respectively. High energy recovery potential was achieved, with the biogas yield ranging between 0.20 and 0.26 L-gas/g-CODrem and a methane content of approximately 75%. The differences in the membrane filtration behaviours in the two AnMBRs included different permeate flux and total filtration resistance (Rt). In the AnMBR with a 0.4 µm pore size membrane, an average Rt of 1.08 × 10^12 m-1 was obtained even when the permeate flux was a high 0.274 m/day, while a higher average Rt of 1.51 × 10^12 m-1 was observed in the AnMBR with 0.05 µm pore size membrane even when the flux was a low 0.148 m/day. The off-line membrane cleaning strategy used for AnMBR1 indicated that the membrane restoration efficiency was 90.2%.

A Strategy for Co-former Selection to Design Stable Co-amorphous Formations Based on Physicochemical Properties of Non-steroidal Inflammatory Drugs.

PURPOSE: This study aimed to investigate the physicochemical factors contributing to stable co-amorphous formations and to design a co-former selection strategy. METHODS: Non-steroidal inflammatory drugs were used as main components and/or co-formers. Physical mixtures of the materials were melted. Co-amorphization was characterized by the inhibition effect of the co-former on crystallization of the main component from the undercooled melt. The contribution of physicochemical factors to the co-amorphous formation was analyzed by multivariate analysis. Co-amorphous samples prepared by melting were subjected to thermal and spectroscopic analyses and the isothermal crystallization test. RESULTS: Naproxen (NAP) was employed as the main component having a rapid crystallization tendency. Some materials used as the co-former inhibited the crystallization of amorphous NAP; decreasing melting temperatures of the components was an indicator of co-amorphization. The contribution of some physicochemical features (e.g., crystallization tendency, glass transition temperature (Tg)/melting temperature and molecular flexibility) of the co-formers to a co-amorphous formation was suggested by multivariate analysis. Deviation of the glass transition temperature from the theoretical value and changes in the infrared spectra of the co-amorphous samples were correlated with intermolecular interaction. The crystallization behaviors of the co-amorphous samples depended on their Tg. CONCLUSIONS: The results showed a relationship between stable co-amorphous formation and the physicochemical features of the components, which should inform efficient co-former selection to design stable co-amorphous formations.