L-Citrulline is a non-essential but still important amino acid that is released from enterocytes. Because plasma levels are reduced in case of impaired intestinal function, it has become a biomarker to monitor intestinal integrity. Moreover, oxidative stress induces protein citrullination, and antibodies against anti-citrullinated proteins are useful to monitor rheumatoid diseases. Citrullinated histones, however, may even predict a worse outcome in cancer patients. Supplementation of citrulline is better tolerated compared to arginine and might be useful to slightly improve muscle strength or protein balance. The following article shall provide an overview of L-citrulline properties and functions, as well as the current evidence for its use as a biomarker or as a therapeutic supplement.
Short bowel syndrome (SBS) is a devastating disorder with both short- and long-term implications for patients. Unfortunately, the prevalence of SBS has doubled over the past 40 years. Broadly speaking, the etiology of SBS can be categorized as congenital or secondary, the latter typically due to extensive small bowel resection following diseases of the small intestine, e.g., necrotizing enterocolitis, Hirschsprung’s disease or intestinal atresia. As of yet, no cure exists, thus, conservative treatment, primarily parenteral nutrition (PN), is the first-line therapy. In some cases, weaning from PN is not possible and operative therapy is required. The invention of the longitudinal intestinal lengthening and tailoring (LILT or Bianchi) procedure in 1980 was a major step forward in patient care and spawned further techniques that continue to improve lives for patients with severe SBS (e.g., double barrel enteroplasty, serial transverse enteroplasty, etc.). With this review, we aim to provide an overview of the clinical implications of SBS, common conservative therapies and the development of operative techniques over the past six decades. We also provide a short outlook on the future of operative techniques, specifically with respect to regenerative medicine.
Introduction: Infantile hypertrophic pyloric stenosis is treated by either open pyloromyotomy (OP) or laparoscopic pyloromyotomy (LP). The aim of this meta-analysis was to compare the open versus laparoscopic technique. Methods: A literature search was conducted from 1990 to February 2021 using the electronic databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Primary outcomes were mucosal perforation and incomplete pyloromyotomy.Secondary outcomes consisted of length of hospital stay, time to full feeds, operating time, postoperative wound infection/abscess, incisional hernia, hematoma/seroma formation, and death.Results: Seven randomized controlled trials including 720 patients (357 with OP and 363 with LP) were included. Mucosal perforation rate was not different between groups (relative risk [RR] LP versus OP 1. 60 [0.49-5.26]). LP was associated with nonsignificant higher risk of incomplete pyloromyotomy ). There was no difference in neither postoperative wound infections after LP compared with OP (RR 0.59 [0.24-1.45]) nor in postoperative seroma/hematoma formation ) or occurrence of incisional hernias ). Length of hospital stay (À3.01 h for LP [À8.39 to 2.37 h]) and time to full feeds (À5.86 h for LP [À15.95 to 4.24 h]) were nonsignificantly shorter after LP. Operation time was almost identical between groups (þ0.53 min for LP [À3.53 to min]).Conclusions: On a meta-level, there is no precise effect estimate indicating that LP carries a higher risk for mucosal perforation or incomplete pyloromyotomies compared with the open equivalent. Because of very low certainty of evidence, we do not know about the effect of the laparoscopic approach on postoperative wound infections, postoperative
Background To compare different methods of three-dimensional representations, namely 3D-Print, Virtual Reality (VR)-Glasses and 3D-Display regarding the understanding of the pathology, accuracy of details, quality of the anatomical representation and technical operability and assessment of possible change in treatment in different disciplines and levels of professional experience. Methods Interviews were conducted with twenty physicians from the disciplines of cardiology, oral and maxillofacial surgery, orthopedic surgery, and radiology between 2018 and 2020 at the University Hospital of Basel. They were all presented with three different three-dimensional clinical cases derived from CT data from their area of expertise, one case for each method. During this, the physicians were asked for their feedback written down on a pencil and paper questionnaire. Results Concerning the understanding of the pathology and quality of the anatomical representation, VR-Glasses were rated best in three out of four disciplines and two out of three levels of professional experience. Regarding the accuracy of details, 3D-Display was rated best in three out of four disciplines and all levels of professional experience. As to operability, 3D-Display was consistently rated best in all levels of professional experience and all disciplines. Possible change in treatment was reported using 3D-Print in 33%, VR-Glasses in 44%, and 3D-Display in 33% of participants. Physicians with a professional experience of more than ten years reported no change in treatment using any method. Conclusions 3D-Print, VR-Glasses, and 3D-Displays are very well accepted, and a relevant percentage of participants with less than ten years of professional work experience could imagine a possible change in treatment using any of these three-dimensional methods. Our findings challenge scientists, technicians, and physicians to further develop these methods to improve the three-dimensional understanding of pathologies and to add value to the education of young and inexperienced physicians.
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