Introduction: Surgical fear is common and has a negative impact on surgery and its outcome. Recent research has identified individual religiousness as an important factor among patients with associations to mental health, particularly anxiety.Objective: This study aimed to examine associations between religiousness and surgical fear in a representative sample of adult surgical patients in Croatia.Design: Cross-sectional study among elective surgery patients at different departments of a single hospital.Setting: University Hospital Sveti Duh, a tertiary health care facility in Croatia.Measurements: Religiousness and surgical fear were the variables of interest and assessed through self-report instruments. The Croatian version of the Duke Religiosity Index questionnaire (DUREL) assessed organizational religious activity (ORA), non-organizational religious activity (NORA), and intrinsic religiousness (IR). The Croatian version of the Surgical Fear Questionnaire (SFQ) measured surgical fear and its subscales the fear of the short-term and long-term consequences of surgery. Additionally, sociodemographic characteristics and medical history were assessed. Analyses were carried out using descriptive and linear regression analyses.Results: 178 subjects were included for data analysis. Univariate linear regression found two dimensions of religiousness (non-organizational religious activity, intrinsic religiousness) to be weak, but significant predictors of greater surgical fear (adj. R²= 0.02 and 0.03 respectively). In the multiple linear regression model together with age, gender, education and type of surgery, all three dimensions of religiousness were found to be significant independent predictors of greater surgical fear.Limitations: The study was single-center and cross-sectional and did not assess patients’ specific religious identity.Conclusions: This study demonstrated significant positive associations between dimensions of religiousness and surgical fear, potentially suggesting that surgical patients experience increased religiousness to cope with heightened anxiety. Assessment and intervention to address patient religiousness is warranted in the context of surgical fear among religious patients, and the importance of religiousness in the context of surgical fear needs to be further addressed in research.

Background: Since the gut microbiota is important for athlete health and performance, its optimization is increasingly gaining attention in sports nutrition, for example, with whole fermented foods. Sauerkraut is a traditional fermented food rich in pro-, pre-, and postbiotics, which has not yet been investigated in the field of sports nutrition. Methods: To determine whether sauerkraut could be used for gut microbiota optimization in sports nutrition, a proof-of-concept study was conducted. The microbiota composition of organic pasteurized sauerkraut was analyzed, and then healthy active athletes were provided with the same sauerkraut for 10 days as an intervention. The effects of sauerkraut on the athlete’s gut microbiota, laboratory parameters, and bowel function were assessed. Results: Significant changes in the gut microbiota composition were seen on taxonomic and functional levels, independent of baseline microbiota composition, even after short-term supplementation. Most notably, there was an increase in several health-promoting genera of the family Lachnospiraceae, as well as significant alterations in metabolic pathways regarding cell wall synthesis and the metabolism of nucleotide bases. An increase in the proportion of lymphocytes and a decrease in B12 vitamin levels was observed, as well as a risk of indigestion in certain athletes, which significantly resolved after seven days of supplementation in all athletes. It is unclear whether the observed effects are attributable to the sauerkraut’s own microbiome or its pre- and postbiotics since it is a whole food. Conclusions: Our study has demonstrated that the concept of whole fermented foods, such as sauerkraut, could potentially be feasible and effective in sports nutrition for gut microbiota optimization.

Objectives: The application of whole fermented foods in sports nutrition for gut microbiota personalization is a promising area of investigation. Sauerkraut, a traditional fermented food, has not been extensively studied in this context. This study aimed to replicate earlier findings of a proof-of-concept study on the potential of sauerkraut for gut microbiota personalization in active athletes. Methods: A pilot follow-up study was conducted on active recreational athletes who consumed 250 g of organic pasteurized sauerkraut daily for 10 days. Changes in gut microbiota composition and functionality were assessed using 16S rRNA sequencing and metabolic pathway analysis across three time points: pre-intervention, postintervention, and one-month postintervention. Laboratory parameters, bowel function, and side effects were monitored throughout the study. Results: In total, 11 male participants with an average age of 30 years completed the study. The pilot follow-up study did not replicate the original study’s findings on sauerkraut’s short-term effects on β-diversity and taxonomic and functional groups. However, long-term effects of sauerkraut supplementation were demonstrated, including a significant reduction in α-diversity variance and increased gut microbiota composition similarity (β-diversity) as well as several significant changes in bacterial taxa and metabolic pathways after a washout period. The intervention also induced a transient decrease in B12 vitamin levels and a short- and long-term increase in leukocyte concentrations. The probability for physiological types of stools increased after one week of sauerkraut supplementation as well as the incidence of gastrointestinal side effects, such as bloating, diarrhea, pain, nausea, and constipation. Conclusions: This study suggests that the short-term effects on the gut microbiota of sauerkraut supplementation depend on its baseline status, but it can induce long-term effects. Sauerkraut supplementation requires a seven-day adaptation period. Further research is needed to explore the mechanisms behind the short- and long-term effects of sauerkraut supplementation.

Objective: The carnivore diet is a ketogenic diet based exclusively on the consumption of food of animal origin. While the impact of various diets on the gut microbiome is extensively documented, the effects of a carnivore diet remain unclear. To address this gap, we conducted a pilot study on the gut microbiome of an individual following a carnivore diet and compared it with that of a subgroup of healthy individuals. Methods: A stool sample was collected from a healthy 32-year-old male adhering to a carnivore diet and was sequenced using 16S DNA Amplicon Sequencing. The results were then compared to those from three control groups possessing similar anthropometric characteristics and differing in their frequency of meat consumption. Results: The gut microbiome of the carnivore was dominated by the phylum Firmicutes and the genera Faecalibacterium, Blautia, unspecific Lachnospiraceae, Bacteroides, and Roseburia—bacteria known for fiber degradation. Furthermore, neither alpha- nor beta-diversity, nor the functional capacity of the gut microbiome, showed differences when compared to the control groups. Additionally, the gut microbiome of the carnivore showed the least similarities with the microbiome of the cohort consuming meat on a daily basis. Conclusion: In our study, we showcase the compositional and functional characteristics of the gut microbiome in an individual on a carnivorous diet, finding no differences in comparison to a control cohort. Further research is needed to investigate the short- and long-term impacts of a carnivorous diet on gut health through cross-sectional and longitudinal studies. Significance statement: To the best of our knowledge, this is the first study to report on the composition of the gut microbiome of a person adhering long-term to the carnivore diet.

Background. Endoscopic retrograde cholangiopancreatography (ERCP) can lead to several complications such as duodenal or bile duct perforation. The incidence of pneumoperitoneum post-ERCP is rarely seen (<1) and is associated with perforations of the duodenum or common bile duct in therapeutic ERCP after sphincterotomy. In this case, we disclose a novel cause of biliary peritonitis after ERCP. Case Presentation. A 65-year-old man presented with abdominal pain and distended abdomen after uneventful ERCP with sphincterotomy. An abdominal computed tomography (CT) was performed whose finding indicated duodenal perforation. The patient was rushed to an emergency laparotomy where only a rupture of an otherwise normal subcapsular intrahepatic bile duct was found. The surrounding liver parenchyma was healthy. The cause of this condition was probably post-ERCP pneumobilia and the increase of pressure in the biliary tract. Conclusions. This is the first case in literature describing the rupture of a subcapsular healthy bile duct as cause of biliary peritonitis after ERCP. This case also suggests that in the management of post-ERCP complications, the cooperation of radiologists and surgeons is vital for the patients wellbeing.

The management of infected nonunion associated with bone loss in long bones is both a time-consuming and challenging procedure for the orthopedic and trauma surgeon. In this paper, we present the case of a 75-year-old woman with infected nonunion of the distal femur associated with bone loss after plate osteosynthesis for a distal femur fracture. The patient was referred for nonunion of the distal femur after plate fixation (nonlocking classic plate) and was treated with a locking compression plate (LCP) and autologous cancellous bone transplant. During the follow-up, the patient was ambulatory without pain; however, the nonunion failed to heal, therefore, the induced membrane technique (Masquelet procedure) was performed in two stages, tissue samples were taken and revealed a bacterial infection (S. epidermidis), and antibiotic treatment was started. Due to infection, fracture healing was slowed, but did commence. Unfortunately, the LC plate failed before union occurred, the nonunion was treated with a femoral nail and blocking (Poller) screws, and the bony defect was filled with Ca-P cement. The patient was operated one last time for cement dislocation when not only the dislocated cement was removed but also the femoral nail dynamized. After one year after treatment completion, the fracture healed, and leg length discrepancy was 1.5cm shorter on the left side. The patient experienced significant pain relief and can walk with the help of crutches. Our paper demonstrates the application of different techniques in fracture surgery as they are required can result in fracture healing even in very adverse circumstances.