Wellness professionals ideas of maggot debridement therapy

One of the problems of modern cardiology in Ukraine and the world is acute coronary syndrome (ACS), which results in high mortality and invalidation of patients. Recently, much attention is drawn to the growth differentiation factor 15 (GDF-15). A lot of studies provided, in which the role of GDF-15 in cardiovascular pathology proved.
The aim of the study was to determine the predictive possibility of the GDF-15 marker in the stratification of the ACS complications risk within 5 years after the event.
70 patients with ACS were involved. The mean age was (61.8 +/- 1.3) years, the following diagnosis was established in the patients 76 patients had acute myocardial infarction with Q (AMI with Q), 28 - acute myocardial infarction without Q (AMI without Q) and 36 patients were diagnosed unstable angina (UA). During the follow-up period the endpoint was reached by 28 patients.
A statistical relationship between the elevated level of GDF - 15 and the 5-year survival of these patients (χ2 = 4.75, p = 0.03) has been found. It was established that the level of the GDF-15 biomarker > 2350 pg/ml independently predicted the onset of adverse events with the sensitivity of 80% and the specificity of 60% (p = 0.006). To investigate the influence of the GDF-15 levels on mortality in the remote period, the Cox regression analysis was performed. It was revealed that the level of GDF-15 significantly predicted the onset of the primary endpoint within 5 years after ACS (p = 0.004).
The increased level of GDF-15, determined in the first 24 hours after development of ACS, is highly associated with the adverse outcome within 5 years after the event.
The increased level of GDF-15, determined in the first 24 hours after development of ACS, is highly associated with the adverse outcome within 5 years after the event.Esophageal reconstruction using intestine is often performed for esophageal cancer patients in cases where the stomach cannot be used. We have previously performed reconstruction using ileocolon with supercharge and drainage as our 1st choice in those cases. However, a less invasive, simpler, and safer reconstructive technique using pedicled jejunal flap has recently become popular at our facility. When making the pedicled jejunal flap, the 1st jejunal vascular arcade was preserved, which in many cases allowed it to be pulled up to the cervical region by processing and transection up to the 2nd jejunal vascular branch. But supercharge and superdrainage may be required for pedicled jejunal flap reconstruction when blood flow of jejunal flap is not good condition. And free jejunal reconstruction is performed to reconstruction after cervical esophagectomy. Vascular anastomosis is essential for free jejunal reconstruction. This article describes the surgical technique and perioperative management of esophageal reconstruction with vascular anastomosis.Definitive chemo-radiotherapy (CRT) in locally advanced esophageal cancer is associated with a high rate of loco-regional recurrence. In this condition, salvage esophagectomy may be considered as a therapeutic option. Despite the survival benefits of this combined approach, salvage esophagectomy remains a highly invasive procedure that confers a significant rate of morbidity and mortality and can adversely affect long-term quality of life. So careful evaluation is needed before the decision of the indication for salvage surgery. In order to prevent postoperative morbidity or mortality in patients underwent salvage esophagectomy, modifications in the surgical procedures, including minification of lymph node dissection and conversion to 2-stage surgery, are needed. Especially, it was necessary to pay attention to preserve blood flow of trachea. As aspiration pneumonia is sometimes fatal in patients after salvage esophagectomy, care to avoid aspiration is needed. selleckchem Respiratory care is also essential during the follow-up period as well as perioperative period in patients who underwent salvage esophagectomy. Although salvage esophagectomy is considered a high-risk surgery, if indication for surgery was appropriate, that could be the only way which could prolong survival of locally advanced esophageal cancer patients after CRT.The incidence of postoperative morbidity and mortality are higher in patients with preoperative malnutrition in esophageal cancer patients. Oral intake tends to decrease during preoperative chemotherapy, and nutritional status is likely to worsen. When nutrition intake decreases, catabolism increases and muscle mass can decrease. It has been reported that related to preoperative sarcopenia and the onset and prognosis of postoperative complications. It has been reported to be associated with preoperative sarcopenia and the incident of postoperative complications and prognosis. Early nutritional assessment and interventions should improve nutritional status before surgery. Amino acid intake and exercise therapy improve exercise capacity such as walking. It is expected that a synergistic effect on the improvement of long-term prognosis by nutrition therapy and exercise therapy. Our hospital has introduced a enhanced preoperative nutrition rehabilitation program for undernourished patients. Immuno-nutrition therapy, exercise therapy, and postexercise branched-chain amino acid preparations are administered. During surgery for such malnourished patient, it is necessary to minimize the surgical invasion and to avoid complications. It is important to have continuous nutritional evaluation, intervention and rehabilitation by various occupations from the initial diagnosis to the perioperative period as well as during outpatient follow-up after discharge.According to the aging of society, elderly patients with esophageal cancer have been increasing in Japan. A multimodality treatment strategy is required to achieve long-term survival in patients with advanced-stage esophageal cancer. However, in elderly patients with impaired organ functions, the highly invasive treatment strategy is often difficult to be indicated. Esophagectomy remains the mainstay of treatment even in the elderly. Indication for esophagectomy in the elderly should be determined comprehensively, based on the physical status, life expectancy, tumor staging, and patients' desires. To predict the risk of postoperative complications, some scoring systems, such as estimation of physiology ability and surgical stress( E-PASS) and controlling nutritional status(CONUT), and the risk calculator provided by the National Clinical Database in Japan should be appropriately used. For patients with impaired organ functions, surgical procedures to reduce the surgical invasiveness, such as 2-stage operation, transhiatal esophagectomy, and mediastinoscopic esophagectomy, should be considered as an alternative to conventional transthoracic esophagectomy and reconstruction.