Notes

Equity-informative strategies to wellness services investigation.
Sarcopenia causes functional disorders and decreases the quality of life. Thus, it has attracted substantial attention in the aging modern world. Dysbiosis of the intestinal microbiota is associated with sarcopenia; however, it remains unclear whether prebiotics change the microbiota composition and result in the subsequent recovery of muscle atrophy in elderly patients with sarcopenia. This study aimed to assess the effects of prebiotics in super-elderly patients with sarcopenia. We analyzed the effects of 1-kestose on the changes in the intestinal microbiota and body composition using a next-generation sequencer and a multi-frequency bioimpedance analysis device. The Bifidobacterium longum population was significantly increased in the intestine after 1-kestose administration. In addition, in all six patients after 12 weeks of 1-kestose administration, the skeletal muscle mass index was greater, and the body fat percentage was lower. This is the first study to show that administration of a prebiotic increased the population of B. longum in the intestinal microbiota and caused recovery of muscle atrophy in super-elderly patients with sarcopenia.Due to the high prevalence of vascular obstructive diseases, discovering potent, safe, and affordable fibrinolytic agents is of importance. There is particular interest concerning the use of functional foods that have a fibrinolytic activity, such as natto, a Japanese fermented soy-based product made with Bacillus subtilis (natto) strain BEST195. We recently isolated another bacterial strain from natto commercialized in Indonesia, B. Epigenetic inhibitor subtilis G8, which has proven to exert fibrinolytic activity. Herein, a further characterization of B. subtilis G8 was assessed through a comparison with commercialized nattokinase, the major fibrinolytic enzyme of B. subtilis, by utilizing various in vitro fibrinolytic assays, namely whole blood clot lysis, euglobulin clot lysis, the fibrin plate method, and zymography. Both nattokinase and B. subtilis G8 were able to dissolve both whole blood and euglobulin clots. Furthermore, both nattokinase and B. subtilis G8 were able to lyse blood clots, presumably due to their ability to directly lyse fibrin. Finally, a crude extract of B. subtilis G8 displayed six zymogram bands of approximately 42.0, 35.5, 30.8, 26.7, 20.0, and 13.7 kDa, with the strongest activity observed at 20.0 kDa. This indicates that B. subtilis G8 contained several fibrinolytic enzymes, which might have comprised nattokinase and other fibrinolytic enzymes. In summary, we demonstrated that a crude extract of B. subtilis G8 has potent fibrinolytic activity and that the activity was mediated by various fibrinolytic enzymes.Construction of a diverting stoma can significantly reduce the onset of severe anastomotic leakage in patients with rectal cancer. High-output stoma is one of the most important potential surgical complications after anal function-preserving surgery with ileostomy. Culture-independent techniques have revealed the interaction of the complex intestinal bacterial ecology with various diseases. Our objective was to evaluate the differences in patient characteristics and gut microbiota distribution features in patients with high-output stomas. The cases of 24 consecutive patients who underwent curative resection for rectal cancer at our hospital between November 2016 and June 2018 were reviewed, and the patients were categorized into high-output and low-output groups. Their microbiota were analyzed using next-generation sequencing of ileostomy stool samples collected on postoperative day 7. There was a significant difference in the percentage of Bacteroidetes between the high-output and low-output groups (14.8% vs 0.5%; p=0.01). The percentage of Clostridium butyricum was increased in the low-output group (p=0.01). After the exclusion of those treated with the probiotic Miya-BM, whose principal component is C. butyricum, analyses revealed no significant differences between the high-output and low-output groups. This pilot study provides the first evidence correlating gut microbiota with the pathogenesis of high- output stoma compared with low-output stoma.During hospitalization, pediatric patients or their parents may feel stressed. If patients need to stay in the hospital with a cast, they are prone to feeling more stressed. Fixation using a cast is an important clinical option, particularly in the case of skin grafts wherein fixation of the foot and ankle is essential to ensure the survival of the graft skin. However, the removal of the cast is also stressful for patients because it needs to be removed with a cast saw. To avoid further stress in pediatric patients, we cut the cast intraoperatively and then fixed the cast again using nylon cable ties. One week after surgery, we separated the patient's cast. Instead of using a cast saw, we used only scissors or nippers. Our cast removal method was easy, safe, and less stressful.Breast surgery is an area of practice where patients value before and after photographs (BAPs). Consensus is needed to develop guidelines to address the deficit in the literature regarding appropriate use of BAPs, as these may ultimately play a significant role in the breast surgery consent process.
Expert breast reconstructive surgeons participated in a modified nominal group technique (NGT) to establish expert consensus on categories and criteria to be used when evaluating appropriate use of BAPs as part of informed consent. Endorsement rate of 75% and coefficients of variance within and between rounds were conducted to determine validity of each criteria item's rank order.

Eight experts participated in the NGT in-person meeting and subsequent online survey. five of seven categories were endorsed for discussion purpose, image type, anatomy, results, and photographic integrity. Overall consensus was obtained for six of 11 criteria. Criteria items found to have consensus were patients considering surgery being the intended photograph audience (100% endorsement, CV1 - CV2 = 0.01), use of photographic images (75% endorsement, CV1 - CV2 = 0.04), defining the standard clinical photograph by having patients in the same body position (100% endorsement, CV1 - CV2 = 0.14), anonymizing images by removing all digital tags (88% endorsement, CV1 - CV2 = 0.03) and patient identifiers (75% endorsement, CV1 - CV2 = 0.00), not limiting the number of photograph sets needed for sufficient representation (100% endorsement, CV1 - CV2 = 0.07), and representing average outcomes (100%, CV1 - CV2 = 0.06).

Early use of this validated and effective technique helps identify potential consensus categories and criteria that surgeons recommend for the use of BAPs in the informed consent process. Further study is required.
Early use of this validated and effective technique helps identify potential consensus categories and criteria that surgeons recommend for the use of BAPs in the informed consent process. Further study is required.
The aim of this study was to evaluate the effect of adjustments to a compression stocking on reductions in leg volume during walking in patients with lymphedema.

Fourteen women and three men suffering from leg lymphedema with ages between 21 and 68 years old (mean 45.68 years) were randomly enrolled in this study. Evaluations were made by volumetry before and after each session of controlled walking. Patients were subjected to three one-hour sessions of walking slowly on the flat ground monitored by a professional. For the first session, the patients used a well-adjusted cotton-polyester compression stocking, for the second they used a badly adjusted compression stocking made of the same fabric, and for the third, no compression garment was used. The Kruskal-Wallis test was used for statistical analysis.

On comparing the volume before and after walking for one hour with the well-adjusted cotton-polyester compression stocking, there was a mean reduction of 46.2 mL ± 66.95 mL (p-value < 0.02) in the vog edema.Background and objective Colon cancer is one of the most common types of cancer globally. The factors that could affect colon cancer survival include age, stage, treatment, and other socioeconomic aspects. Payer status has been shown to be a significant predictor of cancer patient survival in retrospective studies. However, due to the limitations of retrospective studies, patient baseline characteristics between payer statuses are not comparable. Few studies have addressed the effect of payer status on the overall survival (OS) of patients using propensity score matching (PSM). In light of this, we conducted a study to examine the effect of payer status on the survival of colon cancer patients based on PSM. Materials and methods About 66,493 stage II/III colon cancer patients aged 40-90 years and diagnosed between 2004 and 2015 were analyzed from a de-identified National Cancer Database (NCDB) file. All patients had undergone surgery, and patients who had received radiation therapy, hormone therapy, immunothe Medicaid had a MOS of 9.02 years. After PSM, 6,167 paired patients were matched, and patients with private insurance had a MOS of >12.82 years and Medicaid patients had a MOS of 8.88 years. After PSM, patients with Medicaid had a 50% increased risk of death, and payer status proved to be a statistically significant predictor of OS of colon cancer. Conclusion Based on our findings, as per the PSM method, payer status can be a significant predictor of survival among colon cancer patients. Also, chemotherapy, race, age, and other socioeconomic factors were also found to be significant predictors of OS. Further research should be conducted to investigate other covariates not studied here and the mediation effect of payer on the survival of cancer patients.Cerebral sinus venous thrombosis (CSVT) is a rare disorder that presents with highly variable neurological manifestations ranging from headache, confusion, seizures, coma to stroke-like symptoms. It predominantly affects young adults and children, with female predilection. We are presenting a case of 59-year-old female with left-sided transverse and sigmoid sinus thrombosis most likely secondary to dehydration on top of chronically diminutive left transverse sinus and internal jugular vein.Popliteal artery aneurysms (PAAs) are the most common type of peripheral artery aneurysms. Mycotic aneurysms involving the popliteal artery are quite rare and can occur as either a primary de novo infection or a secondary infection from another site. To our knowledge, there are no previous case reports on mycotic PAA in which Staphylococcus epidermidis was the primary etiologic pathogen. We present the case of a 55-year-old male who presented with complaints of lower extremity pain and swelling, malaise, and low-grade temperatures for two weeks and was found to have a PAA. He underwent left femoral-popliteal bypass grafting with expanded polytetrafluoroethylene (ePTFE) graft and ligation of the aneurysm. On postoperative day 10, he experienced acute swelling and pain in his lower extremity with foot drop and was found to have rapid enlargement of his aneurysm sac on imaging. He was returned to the operating room emergently where he underwent aneurysmectomy via a posterior fossa approach. Cultures and gram staining of the aneurysm sac were consistent with Staphylococcus epidermidis.
Homepage: https://www.selleckchem.com/pharmacological_epigenetics.html