Solid Pseudopapillary Neoplasms of the Pancreas Across Races Demonstrate Disparities with Comparably Good Prognosis.

BACKGROUND: Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare with low-grade malignancy and unclarified clinicopathological features. This study aimed to examine their characteristics and re-evaluate current treatments. METHODS: Databases from three sources were screened for patients with SPNs. We compared the perioperative variables, clinical data, overall survival (OS), and prognostic factors for recurrence among the three corresponding cohorts. RESULTS: We identified 286 patients diagnosed with SPNs between 1988 and 2020. Patients were mostly women (81%; median age: 38 years), and peak incidence was observed in women of 20-29 years of age. SPNs had a peak incidence in Asian men at 50-59 years of age (p = 0.002) and a delayed peak incidence in Asian women at 30-39 years of age (p < 0.001). Treatment strategies differed significantly across the institutions and included variations in the number of harvested lymph nodes and rates of vascular resection. Lymph node positivity was the only predictor of postoperative recurrence (odds ratio, 2.2; 95% confidence interval, 1.38-2.99; p = 0.007). Higher rates of lymphovascular invasion (p = 0.02), perineural invasion (p < 0.001), and R1 margin involvement (p < 0.001), as seen in one institution, did not result in poorer long-term survival in terms of the overall (p = 0.43), SPN-specific (p = 0.69), and recurrence-free survivals (p = 0.067). CONCLUSIONS: In contrast to previous findings that SPNs are prevalent in young women, a racial predilection for middle-aged Asian men and a delayed female peak incidence were noted. Parenchyma-preserving pancreatectomy may be an acceptable treatment. Non-radical surgery may be appropriate in patients with multiple comorbidities.

Inappropriate manipulation and drainage exacerbate post-operative pain and prolong the hospital stay after laparoscopic appendectomy for pediatric complicated appendicitis.

BACKGROUND: This study examined whether drain placement or not is associated with the postoperative outcomes of pediatric patients following trans-umbilical single-port laparoscopic appendectomy (TUSPLA) for complicated appendicitis. METHODS: The medical records of pediatric patients undergoing TUSPLA for acute complicated appendicitis from January 2012 to September 2018 in Kaohsiung Chang Gung Memorial Hospital were reviewed retrospectively. They were classified according to whether they received passive drainage with a Penrose drain (Penrose group) (19), active drainage with a Jackson-Pratt drain with a vacuum bulb (JP group) (16), or no drain (non-drain group) (86). The postoperative outcomes of the three groups were compared. RESULTS: Postoperative visual analog scale pain score was significantly higher in the non-drain group than in either the JP group or Penrose group. Patients in the Penrose group had a significantly longer postoperative hospital stay than those in the non-drain group and a higher rate of intra-abdominal abscess, while patients in the JP group had a significantly shorter postoperative hospital stay; moreover, no patient in JP group developed a postoperative intra-abdominal abscess. CONCLUSIONS: Compared to passive drainage with a Penrose drain or no drain, active drainage with a JP drain shorter the postoperative hospital stay and decreased the risk of postoperative intra-abdominal abscess.

Rebound thymic hyperplasia after liver transplantation for a child with biliary atresia; a case report.

The thymus gland possesses the ability to regrow in children leading to a newly developed anterior mediastinal mass. This condition may represent a rebound phenomenon during recovery from a stressful event such as post-chemotherapy and hence was described as RTH. RTH after LT has not been well documented. We are reporting an infant with BA who underwent LT and presented with a symptomless anterior mediastinal mass, detected on follow-up imaging 6 months thereafter. Surgical partial excision was performed to rule out other differential diagnoses of a solid mass in the anterior mediastinum of an infant particularly lymphoma-that may arise as post-transplant lymphoproliferative disorder-and teratoma, as well as the other aggressive lesions such as thymoma and thymic carcinoma. The final pathological analysis revealed true thymic hyperplasia, consistent with RTH. The diagnosis of RTH should be considered for a child presenting by anterior mediastinal mass after LT.

Development of in situ forming thermosensitive hydrogel for radiotherapy combined with chemotherapy in a mouse model of hepatocellular carcinoma.

This study evaluated a system for local cancer radiotherapy combined with chemotherapy. The delivery system is a thermosensitive hydrogel containing a therapeutic radionuclide ((188)Re-Tin colloid) and a chemotherapeutic drug (liposomal doxorubicin). The thermosensitive PCL-PEG-PCL copolymer was designed to spontaneously undergo a sol-gel phase transition in response to temperature, remaining liquid at room temperature and rapidly forming a gel at body temperature. A scanning electron microscope was used to observe the microstructure of the fully loaded hydrogel. Release of radionuclide and doxorubicin from the hydrogel was slow, and the system tended to remain stable for at least 10 days. After the intratumoral administration of Lipo-Dox/(188)Re-Tin hydrogel in mice with hepatocellular carcinoma (HCC), its retention by the tumor, spatiotemporal distribution, and therapeutic effect were evaluated. The residence time in the tumor was significantly longer for (188)Re-Tin loaded hydrogel than for Na (188)Re perrhenate (Na (188)ReO4). The hydrogel after thermal transition kept the radionuclide inside the tumor, whereas free (188)Re perrhenate ((188)ReO4) diffused quickly from the tumor. The tumor growth was more profoundly inhibited by treatment with Lipo-Dox/(188)Re-Tin hydrogel (with up to 80% regression of well-established tumors on day 32) than treatment with either (188)Re-Tin hydrogel or Lipo-Dox hydrogel. Therefore, this injectable and biodegradable hydrogel may offer the advantage of focusing radiotherapy and chemotherapy locally to maximize their effects on hepatocellular carcinoma.

Dislodgement of port-A catheters in pediatric oncology patients: 11 years of experience.

BACKGROUND: Port-A catheters are frequently used in pediatric cancer patients. Their dislodgement is potentially seriously risky although the incidence is not high. We analyzed our 11 years of data to address this important problem. METHODS: From January 2001 to December 2011, 330 port-A catheters of different brands were implanted in pediatric cancer patients. In total, eight children suffered a dislodgement of their catheter. Their ages ranged from four to thirteen years, with a median age of ten. Five patients presented with catheter dysfunction, two presented with a cough and one was identified incidentally during surgery to remove his port. RESULTS: The downstream ends of the dislodged catheters were located in the right atrium (three patients), left pulmonary artery (three) and inferior vena cava (two). Six of the eight catheters were broken at the site of anastomosis to the port and the other two were broken halfway in between. All episodes of dislodgement happened after the chemotherapy regimen was completed. The dislodged catheters were successfully retrieved without complications by transcatheter retrieval using a gooseneck snare. CONCLUSIONS: The dislodgment rate of port-A catheter in our series was 2.4%. Chest X-rays can rapidly detect the problem. Most of the catheters were broken at the site of anastomosis. Earlier explantation of port-A catheters after completing chemotherapy may be considered to avoid the dislodgement of catheters, but this needs to be weighed against the possibility of underlying disease recurrence. However, we should re-examine how long port-A catheters need to be retained after chemotherapy considering the improved cure rate of pediatric cancer.

Laparoscopic management for non-traumatic colon perforation in children.

PURPOSE: Although recent reports have seen an increase in acceptance of laparoscopic surgery as treatment for traumatic colon injury, its role in the management of non-traumatic colon perforation in children has not been reported. In this study, we review our experience in laparoscopic non-resectional management for children who presented with non-traumatic colonic perforation. METHODS: Between October 2003 and May 2011, 15 children who had been diagnosed with colonic perforation and underwent laparoscopic surgery were included in the study. Their medical records were reviewed for analysis. RESULTS: The clinical manifestation of non-traumatic colon perforation in children was non-specific. The most likely aetiology was infective colitis. Solitary perforation at the caecum was the most common finding. The exact perforation site could not be identified in 3 patients. Nine patients had primary closure while 3 patients underwent wedge resection. The single trocar laparoscopic surgery was successful in 12 patients. The mean postoperative hospital stay was 7.3 days. CONCLUSION: For children presenting with suspected non-traumatic colon perforation, laparoscopic management is the desirable approach. The peritoneal lavage, wedge excision and primary repair can be performed with single trocar techniques and is associated with minimal morbidity. Future prospective studies are needed to compare this minimally invasive approach with conventional open surgery.

Low-Level Laser Therapy Induces Melanoma Tumor Growth by Promoting Angiogenesis.

The effects of low-level laser therapy (LLLT) on tumor growth are inconsistent. In this study, we investigated the effects of LLLT on melanoma tumor growth and angiogenesis. C57/BL6 mice were challenged with B16F10 melanoma cells and treated with LLLT for 5 consecutive days; untreated mice were used as controls. Tumor weight, angiogenesis, immunohistochemistry, and protein levels were compared between the treated and untreated mice. In an in vitro experiment, B16F10 cells were treated with LLLT. Proteins were extracted and subjected to Western blot analysis for analyzing signaling pathways. Compared with the findings in the untreated mice, tumor weight substantially increased in the treated mice. Both immunohistochemical and Western blot analyses revealed markedly increased levels of CD31, a biomarker of vascular differentiation, in the LLLT group. In B16F10 cells, LLLT considerably induced the phosphorylation of extracellular signal-regulated kinase (ERK), which, in turn, phosphorylated p38 mitogen-activated protein kinase (MAPK). Furthermore, LLLT induced the expression of vascular endothelial growth factor, but not hypoxia-inducible factor-1α, through the ERK/p38 MAKP signaling pathways. Our findings indicate that LLLT induces melanoma tumor growth by promoting angiogenesis. Therefore, it should be avoided in patients with melanoma.

Action Research on Applying Compound Stimulus Approach to Improve Empathetic Communication: The Case of Physical Therapy Students.

(1) Background: Empathetic communicative skills are the first step in establishing a good therapeutic relationship. The purpose of this study is to understand the effectiveness of improving the empathetic communicative skills applied to obtain accurate and precise information from patients via compound stimulus-drama in education. (2) Methods: A cross-sectional, one-group, pre- and post-test design was used for this study. In the two-day workshop, four clinical physiotherapists acted as tutors for the "Compound Stimulus-Drama in Education" module and assessed students' performances. The Standard Patient Rating Scale (SPRS), Objective Structured Clinical Examination Scale (OSCES), Professional and Communication Self-Assessment Scale (PCSS), Patients' Information (PI), and the Jefferson Scale of Empathy (JSE) were used to assess the students' empathy scores and communication skills, before and after the course. (3) Results: Fifty-seven students participated in this study. The results showed that there were significant improvements in the SPRS, OSCES, PCSS, PI, and JSE (p < 0.05). Both the quantitative data and the participants' reflection feedback suggest that this novel module was more helpful than traditional clinical practice courses for improving clinical empathy communication skills. (4) Conclusions: This study provided an innovative teaching model and assessment tools for learning clinic empathetic communicative skills in future education training.

Voice and emotion processing in the human neonatal brain.

Although the voice-sensitive neural system emerges very early in development, it has yet to be demonstrated whether the neonatal brain is sensitive to voice perception. We measured the EEG mismatch response (MMR) elicited by emotionally spoken syllables "dada" along with correspondingly synthesized nonvocal sounds, whose fundamental frequency contours were matched, in 98 full-term newborns aged 1-5 days. In Experiment 1, happy syllables relative to nonvocal sounds elicited an MMR lateralized to the right hemisphere. In Experiment 2, fearful syllables elicited stronger amplitudes than happy or neutral syllables, and this response had no sex differences. In Experiment 3, angry versus happy syllables elicited an MMR, although their corresponding nonvocal sounds did not. Here, we show that affective discrimination is selectively driven by voice processing per se rather than low-level acoustical features and that the cerebral specialization for human voice and emotion processing emerges over the right hemisphere during the first days of life.

Reappraise the effect of redo-Kasai for recurrent jaundice following Kasai operation for biliary atresia in the era of liver transplantation.

PURPOSE: This study was conducted to reappraise the efficacy of redo-Kasai (or revision) in the era of liver transplantation as a treatment option in those patients with recurrent jaundice after initially successful Kasai procedure. METHODS: We studied ten patients that received redo-Kasai, among a total of 102 patients diagnosed with biliary atresia after receiving Kasai operation from 1986 to 2011. RESULTS: Kasai operation was done at a median age of 55 days and redo-Kasai at 150 days. The bilirubin levels returned to normal in six patients after the procedure. Four of six enjoyed jaundice-free survival with native liver till the time of last follow-up. Three patients died and three received liver transplantation (LT). Only one out of seven patients with three or more episodes of cholangitis survived with native liver, while all the three patients with 1 or 0 episode survived with native liver. The difference was significant (P = 0.033). Re-do Kasai did not result in more blood loss or operative time during LT. CONCLUSION: Redo-Kasai is still valuable in the era of LT and the episodes of cholangitis are the decisive factors affecting the outcome of the procedure.

Transumbilical laparoscopic appendectomy for acute appendicitis: a reliable one-port procedure.

BACKGROUND: Emergency surgical procedures frequently must be performed at times when availability of adequately trained personnel is problematic yet the requirements for maintaining surgical quality and patient safety remain unchanged. This report aims to describe a safe, effective, transumbilical, one-port laparoscopic technique for appendectomy that can be performed by one surgeon. METHODS: Between January 2006 and December 2008, transumbilical one-port laparoscopic appendectomy (TOPLA) was used by two pediatric surgeons in the authors' department to treat 152 consecutive patients presenting with simple and complicated appendicitis. With the patient placed in the Trendelenburg position and rotated to the left, a single surgeon was easily able to perform the procedure using a 10-mm 0° operative laparoscope (Karl Storz) with a 5-mm working channel. The appendix was lifted with transabdominal suspensory sutures to facilitate its removal. The results were compared with those for 112 patients receiving open appendectomy (OA) during the same period. RESULTS: The operative time was significantly shortened using TOPLA (mean, 61.5 min) compared with using OA (mean, 118.3 min) (p = 0.000). Despite significantly higher numbers of patients with complicated appendicitis enrolled in the TOPLA arm of the study, the rate of wound infection was significantly lower after TOPLA (0%, 0/152) than after OA (9.8%, 11/112) (p = 0.000). The number of patients requesting intramuscular or intravenous analgesics for pain relief was significantly lower after TOPLA than after OA. The overall results for TOPLA were comparable with those for the more common three-port laparoscopic procedure, but it offers the alternative of having an inconspicuous scar hidden within the umbilicus. CONCLUSION: This report describes a simple and safe laparoscopic procedure that offers an effective way for one surgeon to treat simple and complicated appendicitis through a single port with satisfactory cosmetic outcomes.

Late-presenting congenital diaphragmatic hernia in childhood.

AIM: To characterize the clinical manifestations of late-presenting diaphragmatic hernia and its associated anomalies, diagnostic methods and outcomes. METHODS: The records of patients aged 1 month-18 years old diagnosed with Bochdalek diaphragmatic hernia from February 1987-June 2008 were reviewed. RESULTS: Fifteen children (nine boys, six girls) met inclusion criteria. Median age was 1.5 years (range, 38 days-9.9 years). Eleven (73%) had left-sided and four (27%) had right-sided diaphragmatic hernias. Six (40%) patients presented with respiratory symptoms, six (40%) with gastrointestinal symptoms and three (20%) with both. Five (33%) patients had failure to thrive. Six (40%) were diagnosed by chest radiography alone. The others required gastrointestinal contrast series, or chest computed tomography to confirm the diagnosis. One referred patient had been misdiagnosed as having left pneumothorax. Cases of bowel malrotation and gastric volvulus associated with the hernia were found in one patient each. One patient required mechanical ventilation because of respiratory failure before surgery. Primary repair without patch was performed in all patients. The overall survival in this series was 100%. CONCLUSION: Late-presenting diaphragmatic hernia should be suspected in cases of unexplained acute or chronic respiratory or gastrointestinal symptoms, and abnormal chest radiographic findings. The prognosis is favourable with correct diagnosis and prompt surgical repair.

Photobiomodulation Therapy to Promote Angiogenesis in Diabetic Mice with Hindlimb Ischemia.

Objective: To assess whether photobiomodulation therapy (PBMT) induces angiogenesis in diabetic mice with hindlimb ischemia (HLI). Background: Patients with diabetes mellitus (DM) are at high risk of developing peripheral arterial disease (PAD) in the lower extremities. PBMT has been shown to promote angiogenesis both in vitro and in vivo and could be a treatment for DM patients with PAD. Methods: Femoral artery ligation/excision in mice was performed to induce HLI as an animal model of PAD. PBMT at a dose of 660 nm and 1.91 J/cm2 was delivered for 10 min on 5 consecutive days after the HLI surgery. Control mice received HLI only. Mice in the DM group were injected with streptozocin to induce diabetes before HLI surgery. Mice in the laser and DM+ laser groups received both HLI and PBMT, and the latter group had induced DM. After the laser treatment, lower limb blood flow was evaluated by laser Doppler. The capillary density and CD31 were analyzed by immunofluorescence staining, and protein levels of vascular endothelial growth factor (VEGF)-A, hypoxia-inducible factor-1α (HIF-1α), inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS), and extracellular signal-regulated kinases (ERK) were measured by Western blotting of tissue samples. Results: Compared with the control and DM mice, the laser and DM+ laser groups had more than double the capillary density and blood perfusion rate. Levels of CD31 and VEGF-A proteins in groups that received laser were increased by 1.9- to 3.2-fold compared with groups that did not undergo laser treatment. Animals treated with PBMT exhibited significantly increased HIF-1α expression and ERK phosphorylation compared with animals that did not receive this treatment, and the amount of phospho-eNOS and iNOS increased and decreased, respectively. Conclusions: PBMT can induce therapeutic angiogenesis, indicating that low intensity laser could be a novel treatment for PAD patients.

Isoorientin Decreases Cell Migration via Decreasing Functional Activity and Molecular Expression of Proton-Linked Monocarboxylate Transporters in Human Lung Cancer Cells.

Aggressive tumor cells mainly rely on glycolysis, and further release vast amounts of lactate and protons by monocarboxylate transporter (MCT), which causes a higher intracellular pH (pHi) and acidic extracellular pH. Isoorientin, a principle flavonoid compound extracted from several plant species, shows various pharmacological activities. However, effects of isoorientin on anticancer and MCT await to explore in human lung cancer cells. Human lung cancer tissues were obtained from cancer patients undergoing surgery, while the human lung adenocarcinoma cells (A549) were bought commercially. Change of pHi was detected by microspectrofluorometry method with a pH-sensitive fluorescent dye, BCECF. MTT and wound-healing assay were used to detect the cell viability and migration, respectively. Western blot techniques and immunocytochemistry staining were used to detect the protein expression. Our results indicated that the expression of MCTs1/4 and CD147 were upregulated significantly in human lung tissues. In experiments of A549 cells, under HEPES-buffer, the resting pHi was 7.47, and isoorientin (1-300µM) inhibited functional activity of MCT concentration-dependently (up to -42%). Pretreatment with isoorientin (3-100µM) for 24h, MCT activity and cell migration were significantly inhibited (-25% and -40%, respectively), while the cell viability was not affected. Moreover, the expression of MCTs1/4, CD147, and matrix metalloproteinase (MMP) 2/9 were significantly down regulated. In summary, MCTs1/4 and CD147 are significantly upregulated in human lung adenocarcinoma tissues, and isoorientin inhibits cells-migration by inhibiting activity/expression of MCTs1/4 and MMPs2/9 in human lung cancer cells. These novel findings suggest that isoorientin could be a promising pharmacological agent for lung cancer.

Atypical manifestations of acute retrocecal appendicitis in a child.

We report a child of elongated retrocecal appendicitis who presented with abdominal pain over the right upper quadrant and circular skin erythema over the right flank. Sonography showed an elongated tubular structure over the right abdomen. By the location, relationship to adjacent tissue and origin of tubular structure, the sonographic findings were differentiated from those of other similar diseases, such as colonic duplication or Meckel's diverticulum. This case illustrates retrocecal appendicitis should be considered as one of the differential diagnoses for earlier surgical intervention if a patient exhibits such atypical clinical manifestations accompanied with an elongated tubule structure of the right abdomen by sonography.

Differences in the distribution and presentation of bronchogenic cysts between adults and children.

BACKGROUND: Bronchogenic cysts are rare congenital malformations that occur in adults and children, with differences in distribution and presentation. METHODS: The study population comprised 16 infants and children (aged 7 days to 18 years) and 23 adults (aged 20-78 years) who received pathological diagnoses of bronchogenic cysts over a 14-year period (1999-2012). Cyst distribution and presentation were reviewed. RESULTS: Half (8/16) of the infants and children presented with palpable masses in the neck (n=6) or on the skin (n=2), and only one (12.5%) presented with symptoms of mild stridor. Another eight pediatric patients had mediastinal (n=7) or pulmonary (n=1) bronchogenic cysts, and respiratory symptoms were present in six (75%) patients. Thirteen of 23 (56.5%) adult patients had asymptomatic cysts (neck, n=1; mediastinum, n=11; lung, n=1). Symptomatic presentations occurred in 10/23 (43.5%) patients, including 2 with palpable mass in the neck, 3 in the mediastinum, 4 in the lung, and 1 in the retroperitoneum. Among the 13 asymptomatic patients, 6 were identified during regular health screening, 5 during routine chest computed tomographic surveys for cancer, and 2 incidentally found during thyroid and parathyroid surgery. Bronchogenic cysts tended to be larger in symptomatic than in asymptomatic adults. CONCLUSION: The clinical spectra of bronchogenic cysts differ between adults and children and are closely related to cyst location and, probably, size.

Laparoscopy diagnosis and treatment excision of bleeding Meckel's diverticulum in a child: report of one case.

Meckel's diverticulum is a common cause of low gastrointestinal bleeding in childhood. Conventional diagnostic methods including plain abdominal radiographs, abdominal ultrasound, technectium 99m pertechnetate scintigraphy, angiography, and exploratory laparotomy have several limitations. Here, we report that a case of Meckel's diverticulum in a 1-year-7-month-old boy presenting with intermittent episodes of painless low gastrointestinal bleeding for about one year. Despite the traditional studies, including plain abdominal films, abdominal ultrasound, rectosigmoidoscopy and repeated Tc-99m Meckel's scan, all showed negative finding, it was successfully diagnosed along with excision of Meckel's diverticulum by laparoscopy. The patient made a rapid recovery and discharged at 48 hours after the procedure. We emphasize that laparoscopy should be an alternative diagnostic and therapeutic modality of choice in patients suspected of Meckel's diverticulum, especially in pediatric patients who had negative results of all other work-ups.

A new simplified one-port laparoscopic technique for peritoneal dialysis catheter placement.

BACKGROUND: Various techniques for laparoscopic insertion of a peritoneal dialysis catheter have been described. Usually 2 - 3 ports are required, and complications related to the port sites (such as abdominal wall hernia, leakage, and hemorrhage) cannot be avoided. To minimize the potential complications, we designed a simplified 1-port laparoscopic technique for peritoneal dialysis catheter placement. ♢ METHODS: We conducted a retrospective data review of 44 patients who underwent 1-port laparoscopic insertion of a Tenckhoff catheter from June 2009 to February 2011. All patient data, including postoperative complications, were analyzed. ♢ RESULTS: The mean follow-up period was 11.52 months. All catheters were working properly, except in 1 patient who developed peritonitis 3 months after catheter placement. (The catheter was removed.) No postoperative abdominal wall hemorrhage, early leaks, hernias, or catheter migration occurred. No exit-site or tunnel infections were observed. ♢ CONCLUSIONS: Our 1-port laparoscopic technique provides excellent catheter fixation, avoids excessive port sites, and yields good cosmesis. The low complication rate and the simplicity of the method justify its standard use for Tenckhoff catheter placement.

Daily intake of probiotics with high IFN-γ/IL-10 ratio increases the cytotoxicity of human natural killer cells: a personalized probiotic approach.

A personalized probiotic microfluidic chip system has been established and used to screen the probiotics which had the highest value of IFN-γ/IL-10 or IL-10/IFN-γ among six probiotics, including L. paracasei BRAP01, L. acidophilus AD300, B. longum BA100, E. faecium BR0085, L. rhamnosus AD500, and L. reuteri BR101. One hundred volunteers were included and their PBMCs were collected and stimulated by the six probiotics. People who belonged to the IFN-γ group took the probiotics that exerted the highest ratio of IFN-γ/IL-10 and vice versa in IL-10 group. A significant increase in NK cytotoxicity of 69 volunteers in the IFN-γ group was observed compared to the IL-10 group (n = 21) and control group (n = 10). The result also showed that L. paracasei BRAP01 and L. acidophilus AD300 were the two dominant inducers in IFN-γ group which yielded higher value of IFN-γ/IL-10 than the other 4 probiotics, while L. reuteri BR101 was the most effective agent on the ratio of IL-10/IFN-γ in the IL-10 group. Our finding highlighted the concept of personalized probiotics and also provided a good foundation to investigate the probiotics with NK activity.