There is a growing quantity of evidence on how skin and gut microbiome composition impacts the course of various dermatological diseases. The strategies involving the modulation of bacterial composition are increasingly in the focus of research attention. The aim of the present review was to analyze the literature available in PubMed (MEDLINE) and EMBASE databases on the topic of microbiome modulation in skin diseases. The effects and possible mechanisms of action of probiotics, prebiotics and synbiotics in dermatological conditions including atopic dermatitis (AD), psoriasis, chronic ulcers, seborrheic dermatitis, burns and acne were analyzed. Due to the very limited number of studies available regarding the topic of microbiome modulation in all skin diseases except for AD, the authors decided to also include case reports and original studies concerning oral administration and topical application of the pro-, pre- and synbiotics in the final analysis. The evaluated studies mostly reported significant health benefits to the patients or show promising results in animal or ex vivo studies. However, due to a limited amount of research and unambiguous results, the topic of microbiome modulation as a therapeutic approach in skin diseases still warrants further investigation.

Gastric cancer is a malignant neoplasm of the gastrointestinal tract, with one of the standard treatment methods remaining gastrectomy. The authors conducted a systemic review of the Medline and Embase databases concerning the serum vitamin D level in post-gastrectomy gastric cancer patients, regarding all articles published until 22 May 2022 according to the PRISMA guidelines. 18 studies with a total number of 908 gastric cancer survivors were included in the analysis. The initial rate of vitamin D deficiency in gastric cancer patients undergoing gastrectomy appears to be similar to the global population deficiency. In post-gastrectomy survivors, the level of 25(OH)D may remain stable or decrease, while the level of 1, 25(OH)2D remains normal. Supplementation with vitamin D results in an improvement in its serum concentration and positively affects bone mineral density, which is gradually reduced in post-gastrectomy survivors. Combining vitamin D supplementation with calcium and bisphosphonates enables us to obtain better results than vitamin D and calcium only. The type of surgery influences the level of serum vitamin D and its metabolites, with total or partial gastrectomy and maintenance of the duodenal food passage remaining the most important factors. There is a strong need for randomized, controlled trials that would investigate this matter in the future.

Departmental sources Background:The purpose of our research was to evaluate the relationships between blood viscosity and recanalization of coiled intracranial aneurysms. Material/Methods:The study included consecutives patients treated endovascularly by a team of experienced neurosurgeons and neuroradiologists due to brain aneurysm. A total of 50 patients (the average age was 57.48 years, SD=13.71) were assigned to 2 groups: group A with recanalization (4 male and 8 female patients) and group B without recanalization (10 male and 28 female patients) were examined. All patients underwent a 6-month follow-up of the whole-blood viscosity test with a Brookfield DV III+pro cone-plate viscometer using the Rheocalc program. Differences between groups were assessed using the Statistica 12 computer program (StatSoft Inc., Tulsa, OK, USA). Results:Studies have shown no significant difference in the age range between group A and B (P=0.31). In group A, higher viscosity values were found for whole blood [median: 4.14 dyn×sec/cm 2 (mPa×sec) quartile range 0.42], compared to group B [median: 3.92 dyn×sec/cm 2 (mPa×sec); quartile range 0.40; (P=0.04)]. This difference was significant (P=0.04). Additionally, the level of hematocrit was positively related with recanalization, the higher the hematocrit, the more frequent recanalization. A very strong and statistically significant relationship occurred between the frequency of recanalization and smoking (P<0.001). Conclusions:The occurrence of higher values of whole blood viscosity which increase turbulent flow through the vessels may be a risk for recanalization of the coiled intracranial aneurysm.

[b]Background:[/b] The aim of our study was to present an innovative endovascular technique – the Aptus™ Heli-FX™ EndoAnchor™ system com bined with the Endurant Stent Graft cuff used as a method of choice for the patient in a very poor general condition with symptomatic abdominal aneurysm and a post-EVAR type IA endoleak.[b]Case study: [/b]An 85-year-old male patient, was operated on in March 2016 with endovascular aneurysm repair (EVAR) of a 9.3 cm in diameter ruptured abdominal aneurysm (RAA), accompanied by disturbance to the coagulation profile (prolonged INR of 3.3 because of anticoagulant treatment with Rivaroxaban due to atrial fibrillation). 9 months later, he developed a severe abdominal pain and was urgently referred to the Vascular Surgery Department, at the John Paul II Hospital, Kraków. The Angio-CT xamination revealed the type IA and II endoleaks and a recurrence of the rupture symptoms. He was successfully operated on using an innovative endovascular repair system, the Aptus™ Heli-FX™ ndoAnchor™ system with a combination of other endovascular procedures, such as Endurant Stent Graft cuff implantation. [b]Conclusions:[/b]The innovative endovascular repair system, Aptus™ Heli-FX™ EndoAnchor™ together with the Endurant Stent Graft cuff was successfully used in the treatment of the patient. This technique prevented him from developing serious complications or even death and gave him a much better quality of life in comparison with open surgery repair.

Iatrogenic embolisation of the right ventricle of the heart by a fragment of one of the most basic ICU devices, which has fractured and detached the central vein catheter, is rarely described in subject literature. Removing such an element from the heart is highly risky and requires the use of very modern techniques and equipment. The Atrieve Vascular Snare™ was employed in the described patient. Therefore, it is necessary to present this process and its effectiveness through an evaluation of the health related quality of life (HRQoL) associated with the perception of health status by those patients. This is a requirement in modern medicine. The main aim of this paper was to evaluate the HRQoL after this embolisation. A 67-year-old patient was referred to the Vascular Surgery Department with Endovascular Interventions Ward, John Paul II Hospital in Kraków, after the defragmenting of the central vein catheter and replacement to the right ventricle of the heart. An endovascular approach through the right common femoral vein (RCFV) under local anesthesia of the groin was chosen as the preferred method for removing the broken catheter fragment. The right ventricle of the heart was reached using a 18-30mm Atrieve Vascular Snare™. A structure consisting of three loops facilitated the quick grasp and removal of the catheter fragment at the first attempt through the RCFV. Despite the short time needed for the procedure, the patient experienced periprocedural ventricular fibrillation (VF) with the necessity of defibrillation. After one successful defibrillation attempt, sinus rhythm was restored. The post-operative course showed no complications whatsoever, and the patient was sent to the General Surgery Ward in order for a new Hickman catheter to be implemented and further parenteral nutrition treatment to be carried out. The endovascular technique with the use of Atrieve Vascular Snare™ is an effective method which was used in the case of our patient under local anesthesia. It provides for the fast, safe and convenient removal of a disrupted and dislocated catheter fragment. It allows one to improve the patient’s HRQoL not only in the short term, but also in the longitudinal (6 months after surgery) follow up.

Multilevel atherosclerosis is an inflammatory disease that often occurs in high-risk patients in an ageing population [1,2]. Percutaneous treatment is a challenge for interventional cardiologists but is becoming more frequently recommended in patients with diffuse atherosclerosis [3,4]. A 65-year-old female patient with hypertension, obesity, dyslipidaemia, and stable angina, who was treated with primary percutaneous coronary intervention (PCI) of the left anterior descending artery (LAD) and the right coronary artery (RCA) 18 years ago, was admitted to the our department with stable angina class II/III according to the Canadian Cardiovascular Society classification and left subclavian artery (LSA) steal syndrome. Coronary angiography showed diffuse atherosclerosis with critical stenosis of the RCA, the left main (LM) artery, the LAD, and the left circumflex artery (LCx). The significance of the LM stenosis was confirmed by intravascular ultrasound (IVUS) which revealed a minimal lumen area of 4.6 mm 2 (Fig. 1). According to the Heart Team recommendations, the patient was referred for staged PCI of the RCA and the LM/LAD/LCx. Successful PCI of the RCA with Resolute Integrity™ (Medtronic, Minneapolis, MN, USA) drug eluting stent (DES) implantation was performed during the initial hospitalisation. One month later, the second stage of IVUS-guided revascularisation of the LM/LAD/LCx was performed, with the implantation of two Resolute DESs (3.0 × 18 mm and 3.5 × 18 mm). The "kissing balloon" angioplasty was done and the proximal optimisation technique was used to optimise the bifurcation result. IVUS measurements confirmed the correct stent placement (Fig. 2). The ultrasound revealed a critical lesion in the LSA and significant subclavian steal syndrome with retrograde flow in the left vertebral artery. The patient was admitted again in order to undergo angiography of the subclavian and cerebral circulation. It revealed multiple atherosclerotic plaques in the aortic arch with critical stenosis of the LSA ostium. Percutaneous angioplasty of the ostial LSA lesion, with pre-dilatation using a Sterling 5.0/20 mm balloon (Boston Scientific, Marlborough, MA, USA) and Omnilink 8.0/19 stent (Abbott, Abbott Park, IL, USA) implantation, was performed. We observed normal cephalic flow through the left vertebral artery (Fig. 3). Staged percutaneous interventional procedures in patients with multilevel atherosclerosis are becoming more common and safe. Ultrasound is a very useful tool to diagnose multi-level arterial disease in the aortic arch and the peripheral arteries.