Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography:A single-blind,multicenter,randomized controlled trial

Background:Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography(ERCP),the benefits and safety of high-carbohydrate fluid diet(CFD)intake 2 h before ERCP remain unclear.This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’recovery.Methods:This prospective,multicenter,randomized controlled trial involved 15 tertiary ERCP centers.A total of 1330 patients were randomized into CFD group(n=665)and fasting group(n=665).The CFD group received 400 mL of maltodextrin orally 2 h before ERCP,while the control group abstained from food/water overnight(>6 h)before ERCP.All ERCP procedures were performed using deep sedation with intravenous propofol.The investigators were blinded but not the patients.The primary outcomes included postoperative fatigue and abdominal pain score,and the secondary outcomes included complications and changes in metabolic indicators.The outcomes were analyzed according to a modified intention-to-treat principle.Results:The post-ERCP fatigue scores were significantly lower at 4 h(4.1±2.6 vs.4.8±2.8,t=4.23,P<0.001)and 20 h(2.4±2.1 vs.3.4±2.4,t=7.94,P<0.001)in the CFD group,with least-squares mean differences of 0.48(95%confidence interval[CI]:0.26-0.71,P<0.001)and 0.76(95%CI:0.57-0.95,P<0.001),respectively.The 4-h pain scores(2.1±1.7 vs.2.2±1.7,t=2.60,P=0.009,with a least-squares mean difference of 0.21[95%CI:0.05-0.37])and positive urine ketone levels(7.7%[39/509]vs.15.4%[82/533],χ^(2)=15.13,P<0.001)were lower in the CFD group.The CFD group had significantly less cholangitis(2.1%[13/634]vs.4.0%[26/658],χ^(2)=3.99,P=0.046)but not pancreatitis(5.5%[35/634]vs.6.5%[43/658],χ^(2)=0.59,P=0.444).Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla(odds ratio[OR]:0.61,95%CI:0.39-0.95,P=0.028)in the multivariable models.Conclusion:Ingesting 400 mL of CFD 2 h before ERCP is safe,with a reduction in post-ERCP fatigue,abdominal pain,and cholangitis during recovery.Trail Registration:ClinicalTrials.gov,No.NCT03075280.

Feasibility of surgical application of the ligamentum teres hepatis:a review

Ligamentum teres hepatis(LTH),a normal anatomical tissue in the liver,is frequently observed during abdominal surgery.Its unique positional and structural characteristics give it a wide range of potential clinical applications,including but not limited to repairing peptic perforation,preventing hemorrhage,treating hiatal hernia,and strengthening the biliary/pancreatic intestine anastomosis to prevent biliary and pancreatic leak.The current review summarizes kinds of methods of using LTH in abdominal surgery,especially some new clinical applications in recent years,involving various organs and fields.At the same time,domestic and foreign literature and research in the past five years are cited to demonstrate the feasibility of these applications.This review may guide surgeons to think and explore more new applications of LTH in all surgery fields.

中国母婴营养健康研究队列与进展

生命早期1000天(母亲怀孕到幼儿2周岁)是膳食营养影响一生健康的关键窗口期,成年期疾病的预防应从生命早期开始.出生队列研究是探讨多种暴露因素与不良妊娠结局及出生缺陷的关系、生命早期暴露对终身健康影响的优选方法.中国母婴营养健康研究队列(China maternal and infant nutrition health cohort study, MINC)是国家母婴乳品健康工程技术研究中心启动的多地区健康母婴营养研究出生队列,重点研究早期膳食营养、喂养方式、生活习惯等与婴儿肠道菌群和近期、远期健康的相关性,探索成人非感染性疾病的早期营养干预预防措施,指导婴幼儿科学喂养.本文介绍了MINC背景、结构、研究目的及队列已入组人群、生物样本收集、母乳成分、肠道菌群等研究进展.