著者

Hiroshi TANAKA Yoshikazu NISHIKAWA Kotaro KURE Kinsuke TSUDA Masaya HOSOKAWA

出版者

Center for Academic Publications Japan

雑誌

Journal of Nutritional Science and Vitaminology (ISSN:03014800)

巻号頁・発行日

vol.64, no.4, pp.284-286, 2018 (Released:2018-08-31)

参考文献数

17

被引用文献数

6

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The semi-solidified nutrition supplemented with soluble dietary fiber, xanthan gum (XG), inhibited postprandial glycemia in rats. The purpose of the present study is to examine whether XG exerts the same effects in humans. Subjects fasted for 12 h and then ingested the enteral nutrient, Meibalance with or without XG at 9 AM. Blood glucose levels were measured 0, 20, 40, 60, and 120 min after its ingestion. Postprandial blood glucose levels were lower in the XG group than in the control group. At 20 min, postprandial blood glucose levels were significantly lower in the XG group (84±5.3 mg/dL) than in the control group (107±7.8 mg/dL) (p<0.05). A significant difference was also observed in ΔAUC between the two groups. These results demonstrate that XG exerts inhibitory effects on glucose excursion in humans.

著者

菅原 準二 木村 和男 曽矢 猛美 三谷 英夫 川村 仁 茂木 克俊 junji Sugawara Kazuo Kimura Takemi Soya Hideo Mitani Hiroshi Kawamura Katsutoshi Motegi

出版者

東北大学歯学会

雑誌

東北大学歯学雑誌 = Tohoku University dental journal (ISSN:02873915)

巻号頁・発行日

vol.9, no.1, pp.7-22, 1990-07-10

被引用文献数

5

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上顎骨にまで変形が及び咬合平面の左右傾斜をきたしている重度の顔面非対称症に対しては, Le Fort I型骨切り術と下顎枝骨切り術を併用した上下顎同時移動術(Two-Jaw Surgery)が有効かつ確実な治療法である。本稿においては, 我々が日常的に行っている顔面非対称症の臨床的評価方法と, Two-Jaw Surgeryの適応症について述べるとともに, 具体例としてTwo-Jaw Surgeryを適用した3治験例についてそれらの診断および治療内容を報告する。第1症例は, 15歳11ヵ月の女子で, 咬合平面の左下がり傾斜と軽度のClassIII顎関係を有する顔面非対称症例である。第2症例は, 23歳3ヵ月の女性で, 咬合平面の右上がり傾斜と軽度のClassIII顎関係を有する顔面非対称症例である。第3症例は, 16歳6ヵ月の女子で, 咬合平面の左上がり傾斜と過大な下顎骨によるClassIII顎関係を有する顔面非対称症例である。顔面非対称の臨床的評価方法においては, 1)顔面正中線の設定, 2)歯列正中線の偏位, 3)根尖歯槽部正中線の偏位, 4)オトガイ正中線の偏位, 5)上顎咬合平面の左右傾斜度, 6)Smiling Lineにおける歯冠露出度などが重要な検討項目である。我々は, このような評価結果に基づいて, Two-Jaw Surgeryの適応症を3つのカテゴリーに大別しているが, 今回報告する3症例は, いずれも上顎咬合平面の左右傾斜が著しく, 矯正治療単独による修正が極めて困難な部類に属する患者である。

著者

Yoshikazu Matsuoka Hiroshi Morimatsu

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.83, no.2, pp.432-440, 2019-01-25 (Released:2019-01-25)

参考文献数

29

被引用文献数

2

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Background: Pulmonary embolism (PE) is a serious complication during the perioperative period. However, because most previous studies on the incidence of postoperative PE are based on symptoms, asymptomatic occurrences of PE have been overlooked, and the absolute incidence of postoperative PE remains unknown. The aim of this study was to investigate the incidence of perioperative PE, regardless of its symptoms, by reviewing the clinical interpretations of the diagnostic images obtained during the postoperative period. Methods and Results: This study included all patients aged at least 18 years who underwent operations under general and/or neuraxial anesthesia in our institution from 2013 to 2016. We reviewed all interpretations of the diagnostic imaging performed in the postoperative period. We analyzed the 90-day cumulative incidence of postoperative PE and the characteristics, risk factors, and symptoms of patients with and without postoperative PE. Among 21,763 operations, postoperative diagnostic imaging was performed in 1,168 patients, which found PE in 217 patients. Symptoms appeared in 11.1% (24/217) of the PE patients, and 66.7% of these symptoms were decreased levels of SpO2alone. Mortality from PE was 0.5% (1/217). Conclusions: Diagnostic imaging found a number of postoperative PE cases, regardless of the presence of symptoms. Although symptomatic PE was not a frequent occurrence, these findings suggest that clinicians should be aware of postoperative PE even under current prophylaxis.

著者

Takahiro Yoshizaki Junko Ishihara Ayaka Kotemori Junpei Yamamoto Yoshihiro Kokubo Isao Saito Hiroshi Yatsuya Kazumasa Yamagishi Norie Sawada Motoki Iwasaki Hiroyasu Iso Shoichiro Tsugane the JPHC Study Group

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20180130, (Released:2019-01-12)

参考文献数

27

被引用文献数

9

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Background: Few studies have investigated the effects of Okinawan vegetable consumption on the risk of incident stroke and coronary heart disease. This study aimed to examine associations of vegetable, fruit, and Okinawan vegetable consumption with risk of incident stroke and coronary heart disease in the Japanese population of Okinawa.Methods: Study design was a prospective cohort study. During 1995-1998, a validated food frequency questionnaire was administered in two study areas to 16,498 participants aged 45-74 years. In 217,467 person-years of follow-up until the end of 2012, a total of 839 stroke cases and 197 coronary heart disease cases were identified.Results: No statistically significant association between total Okinawan vegetable consumption and risk of stroke and coronary heart disease was obtained: the multivariable adjusted hazard ratios for the highest versus lowest tertile of consumption were 1.09 (95% confidence interval, 0.93-1.29; p for trend = 0.289) in model 2. Total vegetable and fruit and specific Okinawan vegetable consumption were also not statistically significantly associated with risk of cardiovascular outcomes.Conclusions: This study demonstrated that consumption of total vegetable and fruit, total Okinawan vegetables, and specific Okinawan vegetables in Japanese residents of Okinawa was not associated with risk of incident stroke and coronary heart disease.

著者

Mayumi Tsuji Chihaya Koriyama Yasuhiro Ishihara Megumi Yamamoto Kiwako Yamamoto-Hanada Kumiko Kanatani Yu Ait Bamai Kazunari Onishi Ayako Senju Shunsuke Araki Eiji Shibata Seiichi Morokuma Masafumi Sanefuji Hiroshi Kitazawa Mayako Saito Masakazu Umezawa Atsuto Onoda Koichi Kusuhara Rie Tanaka Toshihiro Kawamoto the Japan Environment & Children’s Study Group

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20180098, (Released:2019-01-12)

参考文献数

54

被引用文献数

7

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Background: Metal exposures could possibly affect allergic responses in pregnant women, although no studies have yet shown a clear relationship between the two, and such exposures might also affect the development of allergic diseases in children.Methods: We investigated the relationship between metal concentrations in whole blood and immunoglobulin E (IgE; total and specific) in 14,408 pregnant women who participated in the Japan Environment and Children’s Study. The subjects submitted self-administered questionnaires, and blood samples were collected from them twice, specifically, during the first trimester and again during the second/third trimester. Concentrations of the metals Cd, Pb, Hg, Se, and Mn, as well as serum total and allergen-specific IgEs for egg white, house dust-mites (HDM), Japanese cedar pollen (JCP), animal dander, and moth, were measured. Allergen-specific IgE(s) were divided based on concentrations <0.35 or ≥0.35 UA/mL, and the metal levels were divided into quartiles.Results: Multivariable logistic regression analysis showed that there was a significant negative correlation between HDM- and animal dander-specific IgEs and Hg and Mn concentrations. Conversely, there was a significant positive relationship between JCP-specific IgE and Hg and Se concentrations.Conclusions: Metal exposures may be related to both increases and decreases in allergen-specific IgEs in pregnant women.

著者

鈴木 宏 Suzuki Hiroshi

出版者

新潟医学会

雑誌

新潟医学会雑誌 (ISSN:00290440)

巻号頁・発行日

vol.124, no.4, pp.181-186, 2010-04

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10年前からパンデミック発生が危惧されてきたが, 2009年春に豚インフルエンザH1N1からのパンデミックとなった. 発生後既に1年を経過しようとしているが, 今回の流行は, これまでの想定とはまったく異なり, 多くの点でシナリオの変更を余儀なくされる程の混乱を招いた. 今回の混乱を来たした最大の点は, パンデミック対策の基本とすべき罹患率と致死率などのよる重症度分類が今でも提示されないことにある. 今回のパンデミックは, 季節性インフルエンザの規模と近いくらいであり, 対応としてやり過ぎの面はあるが, 第二波や将来の次のパンデミックに備える一つの試練ととらえ, 各部署での今回の総括を早期に行うべきと思われる.

著者

Tomiyo Nakamura Yasuyuki Nakamura Shigeyuki Saitoh Tomonori Okamura Masahiko Yanagita Katsushi Yoshita Yoshikuni Kita Yoshitaka Murakami Hiroshi Yokomichi Nobuo Nishi Nagako Okuda Aya Kadota Takayoshi Ohkubo Hirotsugu Ueshima Akira Okayama Katsuyuki Miura

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.28, no.Supplement_III, pp.S10-S16, 2018-03-05 (Released:2018-03-05)

参考文献数

20

被引用文献数

23

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Background: Socioeconomic status (SES) imbalances in developed and developing countries may result in individuals being overweight and obese. However, few studies have investigated this issue in Japan. We herein examined the relationship between SES and being underweight, overweight or obese according to sex and age groups (20–64 or ≥65 years) in Japan.Methods: In 2010, we established a cohort of participants in the National Health and Nutrition Survey of Japan. We divided 2,491 participants (1,081 men and 1,410 women) according to the WHO definitions of underweight, overweight or obesity and performed multinomial logistic analyses using BMI <18.5 kg/m2 (underweight), BMI 25.0–29.9 kg/m2 (overweight), and BMI ≥30.0 kg/m2 (obese) versus BMI 18.5–24.9 kg/m2 (normal) as the outcome, with SES groups as the main explanatory variables.Results: In adult men, a lower education level relative to a higher education level was inversely associated with obesity after adjustments for other SESs (odds ratio [OR] 0.41; 95% confidence interval [CI], 0.18–0.96). However, in adult women, lower education level was positively associated with being overweight and obese (OR 1.67; 95% CI, 1.07–2.49 for overweight and OR 2.66; 95% CI, 1.01–7.01 for obese). In adult women, a lower household income was positively associated with being overweight and obese (obese: OR 4.84; 95% CI, 1.36–17.18 for those with a household income <2 million JPY relative to those with ≥6 million JPY).Conclusions: In adult women, a lower education level and lower household income were positively associated with being overweight or obese. In contrast, in adult men, a lower education level was inversely associated with obesity. Gender and age differences in SESs affect the prevalence of being overweight or obese.

著者

津田 博司 Tsuda Hiroshi

出版者

大阪大学西洋史学会

雑誌

パブリック・ヒストリー (ISSN:1348852X)

巻号頁・発行日

vol.1, pp.74-91, 2004-02

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特集:イギリス帝国と戦争の記憶

著者

Yuka Kobara Hiroshi Hasegawa Masanori Hirose Hiroyuki Takano Yoshio Kobayashi

出版者

International Heart Journal Association

雑誌

International Heart Journal (ISSN:13492365)

巻号頁・発行日

pp.17-547, (Released:2018-10-25)

参考文献数

52

被引用文献数

2

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Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used as antidiabetic drugs. We recently reported that DPP-4 inhibition has beneficial effects on heart failure (HF) mice model. Furthermore, we confirmed that myocardial DPP-4 activity was significantly increased in HF mice compared with non-HF mice. The aim of this study was to investigate the level of myocardial CD26 (DPP-4) expression and its association to clinical parameters in HF patients.Endomyocardial biopsy (EMB) specimens (n = 33) were obtained from HF patients who were admitted to Chiba University Hospital from June 2006 to July 2012. EMB specimens were fixed in formaldehyde and stained with Masson's trichrome staining or with anti-CD26 antibody. Patients were divided into the high CD26 density (CD26-H) or low CD26 density groups (CD26-L). DPP-4 density was compared with blood brain natriuretic peptide (BNP) level and echocardiographic parameters at one year after EMB. Although there were no significant differences in echocardiographic parameters between the CD26-H group and CD26-L group, blood BNP levels were higher in the CD26-H group than in the CD26-L group at one year after EMB. Multivariate regression analysis showed that CD26 density was also an independent determinant of blood BNP levels at one year after EMB.The level of myocardial CD26 expression might be a predictive marker of prognosis in patients with HF.

著者

Hiroshi Yoshikura

出版者

National Institute of Infectious Diseases, Japanese Journal of Infectious Diseases Editorial Committee

雑誌

Japanese Journal of Infectious Diseases (ISSN:13446304)

巻号頁・発行日

pp.JJID.2018.228, (Released:2018-09-28)

参考文献数

4

被引用文献数

2

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The frequency of the ages of the HIV/AIDS deaths and that of the patients detected before or after the development of AIDS followed normal distribution. The median of HIV/AIDS deaths was 40-44 years in 1995-1998 and 50-54 years in 2014-2016, while the median of detection of the infection as “HIV” or as “AIDS” was constantly 25-29 years; it implied that the survival time of the HIV/AIDS patients became longer by 10 years in the past twenty odd years. The lengthening of the survival time could have been attributable to introduction of HIV/AIDS therapy, such as HAART. Importantly, however, during the same period, the life span of Japanese population was lengthened by near 10 years. Under the assumption that HIV/AIDS patients died 20 years after detection of the infection, the total number of the deaths was 1,446 in 1990-2016, which was close to the total number in Vital Statistics during the same period 1,532.

著者

服部 寛 Hiroshi Hattori 松山大学法学部 Matsuyama University Faculty of Law

出版者

松山大学総合研究所

雑誌

松山大学論集 = Matsuyama University review (ISSN:09163298)

巻号頁・発行日

vol.23, no.6, pp.179-226, 2012-02-01

著者

Yuki Wakasugi Hiroshi Azuma (Present Name: Suzuki) Akiyo Naiki Sachiko Nishida

出版者

The Japanese Society for Plant Systematics

雑誌

Acta Phytotaxonomica et Geobotanica (ISSN:13467565)

巻号頁・発行日

vol.68, no.3, pp.129-144, 2017 (Released:2017-11-24)

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Geranium yesoense (Geraniaceae) includes several varieties that are mainly discriminated by two morphological features, namely, the degree of leaf incision and the density of spreading hairs on the sepals, but these features have never been objectively quantified. To clarify whether these features can truly discriminate varieties, we analyzed leaf shape and sepal pubescence, and conducted a molecular phylogenetic analysis using nuclear and chloroplast DNA. Our morphological analyses showed some trends in leaf morphology and density of hairs, but failed to identify any groupings that could be clearly distinguished on the basis of these features. Our molecular analysis recognized G. yesoense as a distinct taxon, but did not support the existence of subgroups within the species. We conclude that G. yesoense must be treated as a single taxon with some tendency toward morphological variation depending on locality and habitat.

著者

渡邉 博吏 ワタナベ ヒロシ Hiroshi WATANABE

雑誌

九州保健福祉大学博物館学年報

巻号頁・発行日

no.2, pp.16-29, 2013-02-28

著者

Hiroshi Inoue Eitaro Kodani Hirotsugu Atarashi Ken Okumura Takeshi Yamashita Hideki Origasa on behalf of the J-RHYTHM Registry Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-18-0242, (Released:2018-07-06)

参考文献数

33

被引用文献数

5

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Background:It is unclear whether renal dysfunction affects warfarin control in patients with non-valvular atrial fibrillation (NVAF).Methods and Results:Using a dataset from the J-RHYTHM Registry, time in therapeutic range (TTR) of the international normalized ratio (INR) of prothrombin time, and creatinine clearance (CrCl) were determined in elderly patients aged ≥70 years. Target INR values were 1.6–2.6 following Japanese guidelines. Incidences of thromboembolism, major hemorrhage, and all-cause death were determined over 2 years. Of 7,406 NVAF patients enrolled in the registry, 2,782 elderly patients (mean age, 75 years) had data for CrCl measured at baseline and TTR. TTR values were lower in the lower CrCl groups (P<0.001 for trend). CrCl <30 mL/min was independently associated with TTR <65% (odds ratio, 1.49; 95% confidence interval, 1.13–1.95; P=0.004). In the multivariate analysis, TTR <65% was independently associated with thromboembolism (hazard ratio, 2.26; 95% confidence interval, 1.37–3.72; P=0.001), but CrCl was not (CrCl <30 mL/min, 1.68, 0.41–6.85, P=0.473). However, CrCl <30 mL/min and TTR <65% were independently associated with all-cause death (5.32, 1.56–18.18, P=0.008 and 1.60, 1.07–2.38, P=0.022, respectively) and the composite event (thromboembolism, major hemorrhage and all-cause death) (2.03, 1.10–3.76, P=0.024 and 1.58, 1.22–2.04, P=0.001, respectively).Conclusions:Elderly NVAF patients with renal dysfunction had poor warfarin control, which was associated with higher risk of thromboembolism and all-cause death.

著者

Bando Hiroshi Ebe Koji Bando Masahiro

出版者

OMICS International

雑誌

Molecular Biology : Open Access (ISSN:21689547)

巻号頁・発行日

vol.7, no.1, 2018-01-24

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Discussion concerning Calorie Restriction (CR) and low carbohydrate diet (LCD) has continued for years. Authors have developed research of LCD using super LCD with 12% of carbohydrate. The biology of human aging includes study between human and mammalian such as mice, rhesus monkeys. Moderate CR reduced age-related mortality, incidence of diabetes, cancer, cardiovascular disease. By very low calorie diet (VLCD), body weight can be reduced, but the diabetic pathological state remains. Besides CR and LCD, Zone, Ornish, LEARN Diets and Mediterranean style can be applicable. There are very low-carbohydrate ketogenic diet (VLCKD), Moderate-LCD, High- Carbohydrate Diet, as related with the definition of LCD. Morbus (M) value was investigated for clinical practice of LCD, in which M value was remarkably improved by LCD treatment.

著者

Maki Yamashita Naoki Tamasawa Kota Matsuki Jutaro Tanabe Hiroshi Murakami Jun Matsui Toshihiro Suda

出版者

Japan Atherosclerosis Society

雑誌

Journal of Atherosclerosis and Thrombosis (ISSN:13403478)

巻号頁・発行日

vol.17, no.11, pp.1183-1189, 2010 (Released:2010-11-27)

参考文献数

37

被引用文献数

8 19

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Aims: We studied the effect of insulin on HDL-mediated cholesterol efflux from macrophages. The potential involvement of cholesteryl ester hydrolysis and membrane cholesterol transport was also addressed.Methods: Human monocyte-derived THP-1 cells were developed into macrophages. Cholesterol efflux was measured by incubating macrophages, labeled with [3H]-cholesterol, with HDL for 24 h. The cells were treated with insulin (0-500 nM) for 30 min prior to the addition of HDL. To investigate the molecular mechanisms of the effect of insulin, the expressions of neutral cholesteryl ester hydrolase (nCEH) and ATP-binding cassette transporter (ABC) G1 were analyzed.Results: Insulin inhibited, in a concentration-dependent manner, HDL-mediated cholesterol efflux from macrophages. Insulin also inhibited the enzyme activity of nCEH and its mRNA and protein expression in cells. Insulin also suppressed the expressions of mRNA and protein for ABCG1.Conclusions: Insulin inhibits HDL-mediated cholesterol efflux from macrophages, which may result from the suppression of nCEH and ABCG1 expressions. Our findings show part of the potential molecular mechanism of atherogenesis in type 2 diabetes with hyperinsulinemia.

著者

Kazutaka Aonuma Tsuyoshi Shiga Hirotsugu Atarashi Kosuke Doki Hirotoshi Echizen Nobuhisa Hagiwara Junichi Hasegawa Hideharu Hayashi Kenzo Hirao Fukiko Ichida Takanori Ikeda Yorinobu Maeda Naoki Matsumoto Toshiyuki Sakaeda Wataru Shimizu Mitsuru Sugawara Kyoichi Totsuka Yoshimasa Tsuchishita Kazuyuki Ueno Eiichi Watanabe Masayuki Hashiguchi Sumio Hirata Hidefumi Kasai Yoshiaki Matsumoto Akihiko Nogami Yukio Sekiguchi Tokuko Shinohara Atsushi Sugiyama Naokata Sumitomo Atsushi Suzuki Naohiko Takahashi Eiji Yukawa Masato Homma Minoru Horie Hiroshi Inoue Hiroshi Ito Takanori Miura Tohru Ohe Kimikazu Shinozaki Kazuhiko Tanaka on behalf of the Japanese Circulation Society and the Japanese Society of Therapeutic Drug Monitoring Joint Working Group

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.81, no.4, pp.581-612, 2017-03-24 (Released:2017-03-24)

参考文献数

185

被引用文献数

33

著者

Keisuke OGUMA Megumi OHNO Mayuko YOSHIDA Hiroshi SENTSUI

出版者

JAPANESE SOCIETY OF VETERINARY SCIENCE

雑誌

Journal of Veterinary Medical Science (ISSN:09167250)

巻号頁・発行日

pp.17-0704, (Released:2018-05-17)

被引用文献数

7

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Feline coronavirus (FCoV) is classified into two biotypes based on its pathogenicity in cats: a feline enteric coronavirus of low pathogenicity and a highly virulent feline infectious peritonitis virus. It has been suspected that FCoV alters its biotype via mutations in the viral genome. The S and 3c genes of FCoV have been considered the candidates for viral pathogenicity conversion. In the present study, FCoVs were analyzed for the frequency and location of mutations in the S and 3c genes from faecal samples of cats in an animal shelter and the faeces, effusions, and tissues of cats that were referred to veterinary hospitals. Our results indicated that approximately 95% FCoVs in faeces did not carry mutations in the two genes. However, 80% FCoVs in effusion samples exhibited mutations in the S and 3c genes with remainder displaying a mutation in the S or 3c gene. It was also suggested that mutational analysis of the 3c gene could be useful for studying the horizontal transmission of FCoVs in multi-cat environments.

著者

栗林 千聡 中村 菜々子 佐藤 寛 Chisato Kuribayashi Nanako Nakamura-Taira Hiroshi Sato

雑誌

関西学院大学心理科学研究 = Kwansei Gakuin University Bulletin of Psychological Science Research (ISSN:21876355)

巻号頁・発行日

vol.44, pp.1-7, 2018-03-25

著者

Fuminari Miura Ryota Matsuyama Hiroshi Nishiura

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20170040, (Released:2018-03-31)

参考文献数

34

被引用文献数

36

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Background: Foodborne norovirus outbreak data in Japan from 2005–2006, involving virological surveillance of all symptomatic and asymptomatic individuals, were reanalyzed to estimate the asymptomatic ratio of norovirus infection along with the risk of infection and the probability of virus shedding.Methods: Employing a statistical model that is considered to capture the data-generating process of the outbreak and virus surveillance, maximum likelihood estimation of the asymptomatic ratio was implemented.Results: Assuming that all norovirus outbreaks (n = 55) were the result of random sampling from an identical distribution and ignoring genogroup and genotype specificities, the asymptomatic ratio was estimated at 32.1% (95% confidence interval [CI], 27.7–36.7). Although not significant, separate estimation of the asymptomatic ratio of the GII.4 genotype appeared to be greater than other genotypes and was estimated at 40.7% (95% CI, 32.8–49.0).Conclusion: The present study offered the first explicit empirical estimates of the asymptomatic ratio of norovirus infection in natural infection settings. The estimate of about 30% was consistent with those derived from volunteer challenge studies. Practical difficulty in controlling GII.4 outbreaks was supported by the data, considering that a large estimate of the asymptomatic ratio was obtained for the GII.4 genotype.