Stool specimens were handled according to the GEMS protocol (16 (link)). DNA was isolated from frozen stool specimens by using a bead beater with 3-mm diameter solid glass beads (Sigma-Aldrich, St. Louis, MO, USA) and, subsequently, with 0.1-mm zirconium beads (BioSpec Products, Inc., Bartlesville, OK, USA) to disrupt cells. The cell slurry was then centrifuged at 16,000 × g for 1 min, and the supernatant was processed by using QIAamp DNA Stool Extraction Kit (QIAGEN, Valencia, CA, USA). Extracted DNA was precipitated with ethanol and shipped to the United States.
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