To evaluate if glutamine (GLN) supplementation may affect primary outcomes in patients undergoing major elective abdominal operations, we performed a systematic literature review of randomized clinical trials (RCTs) published from 1983 to 2013 and comparing intravenous glutamine dipeptide supplementation to no supplementation in elective surgical abdominal procedures. A meta-analysis for each outcome (overall and infectious morbidity and length of stay) of interest was carried out. The effect size was estimated by the risk ratio (RR) or by the weighted mean difference (WMD). Nineteen RCTs were identified with a total of 1243 patients (640 receiving GLN and 603 controls). In general, the studies were underpowered and of medium or low quality. GLN supplementation did not affect overall morbidity (RR = 0.84, 95% CI 0.51 to 1.36; p = 0.473) and infectious morbidity (RR = 0.64; 95% CI = 0.38 to 1.07; p = 0.087). Patients treated with glutamine had a significant reduction in length of hospital stay (WMD = −2.67; 95% CI = −3.83 to −1.50; p < 0.0001). In conclusion, GLN supplementation appears to reduce hospital stay without affecting the rate of complications. The positive effect of GLN on time of hospitalization is difficult to interpret due to the lack of significant effects on surgery-related morbidity.

In cancer microenvironment, aberrant glycosylation events of ECM proteins and cell surface receptors occur. We developed a protocol to generate 3D bioprinted models of colorectal cancer (CRC) crosslinking hyaluronic acid and gelatin functionalized with three signalling glycans characterized in CRC, 3'-Sialylgalactose, 6'-Sialylgalactose and 2'-Fucosylgalactose. The crosslinking, performed exploiting azide functionalized gelatin and hyaluronic acid and 4arm-PEG-dibenzocyclooctyne, resulted in biocompatible hydrogels that were 3D bioprinted with commercial CRC cells HT-29 and patient derived CRC tumoroids. The glycosylated hydrogels showed good 3D printability, biocompatibility and stability over the time. SEM and synchrotron radiation SAXS/WAXS analysis revealed the influence of glycosylation in the construct morphology, whereas MALDI-MS imaging showed that protein profiles of tumoroid cells vary with glycosylation, indicating that sialylation and fucosylation of ECM proteins induce diverse alterations to the proteome of the tumoroid and surrounding cells.

Appendectomy is amongst the most common general surgical procedures and the laparoscopic approach is recognized and recommended by international guidelines as a valid option. The different closure techniques of the appendicular stump constitute a matter of debate since their possible implication in determining postoperative infectious complications. The aim of the present meta-analysis is to compare endostapler versus endoscopic loop ties for stump closure during laparoscopic appendectomy. This is a systematic review with meta-analysis of randomized trials and cohort studies comparing endostapler with endoscopic loop ties for the closure of appendicular sump in laparoscopy appendectomy. Subgroup analysis of pediatric patients and patients with complicated appendicitis were performed when data were available. Complicated acute appendicitis was defined as in case of gangrenous/necrotic appendix or perforated appendix. Main outcomes were wound infection rate, intra-abdominal infection rate, length of stay, readmission and reoperation rates. a total of 5934 patients from 14 studies were included in the analysis. Endostapler was associated with a similar intra-abdominal abscess rate (RR 0.88, 95%C.I. 0.54-1.43) but a lower incidence of wound infection (RR 0.54, 95%C.I. 0.22-0.97) Length of stay, readmission and reoperation rates were similar. In subgroups analysis endostapler reduces significantly the wound infection rate in pediatric patients; no differences in main outcomes were observed in patients with complicated acute appendicitis. In complicated acute appendicitis the stump closure technique did not affect outcomes; the use of endostapler seems to be associated to a reduction of wound infection rate in pediatric patients with non-complicated acute appendicitis.

Hepatic resection of liver metastases of non-colorectal, non-neuroendocrine, and non-sarcoma (NCNNNS) primary malignancies seems to improve survival in selected patients. The aims of the current review were to describe long-term results of surgery and to evaluate prognostic factors for survival in patients who underwent resection of NCNNNS liver metastases. We identified 30 full texts (25 single-center and 5 multicenter studies) published after year 1995 and published in English with a total of 3849 patients. For NCNNNS liver metastases, 83.4 % of these subjects were resected. No prior systematic reviews or meta-analyses on this topic were identified. All studies were case series without matching control groups. The most common primary sites were breast (23.8 %), genito-urinary (21.8 %), and gastrointestinal tract (19.8 %). The median 5- and 10-year overall survival were 32.3 % (range 19–42 %) and 24 % (indicated only in two studies, range 23–25 %), respectively, with 71 % of R0 resections. There is evidence suggesting that surgery of NCNNNS metastases is safe, feasible, and effective if treatment is part of a multidisciplinary approach and if indication is based on the prognostic factors underlined in literature analysis.

The pathogenesis of diverticular disease and acute diverticulitis is still unclear and many different hypotheses have been formulated. Seemingly, there are several related factors such as chronic inflammation, gut microbiome, obesity and the immunogenic properties of fat tissue and diet. Inflammation plays a pivotal role in diverticular disease and acute diverticulitis. The aim of the present review is to investigate the role of inflammation in diverticular disease as well as in mild and complicated acute diverticulitis with a focus on current research and treatment perspectives.