Enhanced Recovery After Surgery versus Conventional Care in Cholecystectomy: A Systematic Review and Meta-Analysis.

Objectives: The primary objective of this study was to evaluate the safety and efficacy of the enhanced recovery after surgery (ERAS) protocol in cholecystectomy, comparing it with standard care. Methods: A comprehensive literature search was conducted in December 2023, using globally recognized databases such as PubMed, Embase, and the Cochrane Library. Various parameters were compared using Review Manager software. This study was duly registered with PROSPERO (CRD420223). Results: The meta-analysis included nine studies, encompassing a total of 1920 patients. The findings revealed that the ERAS group, in comparison to traditional care, experienced shorter hospitalization periods (weighted mean difference [WMD]: -1.23, 95% confidence interval [CI]: -1.98 to -0.47; P = .001), lower visual analog scale at 24 hours (WMD: -1.10, 95% CI: -1.30 to -0.90; P < .00001), faster time to first flatus (WMD: -4.48, 95% CI: -4.50 to -4.46; P < .00001), and reduced operative times (WMD: -9.94, 95% CI: -17.88 to -0.96; P = .03). In addition, there was a notable decrease in instances of postoperative nausea and vomiting (odds ratio [OR]: 0.46, 95% CI: 0.28 to 0.74; P = .002). No significant differences were observed in readmission rates, blood loss, postoperative complications, or bile leakage between the two care methods. Conclusions: This study substantiates that the ERAS protocol is an advantageous perioperative care strategy for patients undergoing cholecystectomy. It significantly outperforms traditional care in reducing the length of stay, decreasing the likelihood of postoperative nausea/vomiting, alleviating postoperative pain, and accelerating the time to the first flatus. These findings highlight the effectiveness of ERAS in enhancing patient outcomes in cholecystectomy.

Evaluation of the protein requirement in Chinese young adults using the indicator amino acid oxidation technique.

OBJECTIVE: To accurately calculate the protein requirements in Chinese young adults using the indicator amino acid oxidation technique. METHODS: Nine women and ten men received a restricted daily level of protein intake (0.75, 0.82, 0.89, 0.97, and 1.05 g/kg), along with L-[1-13C]-leucine. Subjects' protein requirement was determined by a biphasic linear regression crossover analysis of F13CO2 data. In doing so, a breakpoint at the minimal rate of appearance of 13CO2 expiration specific to each level of dietary protein was identified. This trial was registered with the Chinese clinical trial registry as ChiCTR-ONC-11001407. RESULTS: The Estimated Average Requirement (EAR) and the Recommended Nutrient Intake (RNI) of protein for healthy Chinese young adults were determined to be 0.87 and 0.98 g/(kg•d), respectively, based on the indicator amino acid oxidation technique. CONCLUSION: The EAR and RNI of mixed protein are 5% and 16% that are lower than the current proposed EAR and RNI (0.92 and 1.16 g/(kg•d), respectively), as determined by the nitrogen balance method. The respective EAR and RNI recommendations of 0.87 and 0.98 g/(kg•d) of mixed protein are estimated to be reasonable and suitable for Chinese young adults.

Total energy expenditure of 16 Chinese young men measured by the doubly labeled water method.

OBJECTIVE: Doubly labeled water (DLW) method is the gold standard for measuring total energy expenditure (TEE). We used this method to measure TEE in Chinese young men. METHODS: Sixteen healthy young men age 23±1 years with body mass index 22.0±1.4 kg/m2 were recruited. TEE was measured by the DLW method, and basal energy expenditure (BEE) was determined by indirect calorimetry. We also conducted 24-h activity, energy balance and factorial approach to estimate energy requirements of the subjects. RESULTS: TEE of subjects by DLW method was 9.45±0.57 MJ/day (2258±180 kcal/day). The 24-h activity was 10.80±0.33 MJ/day (2582±136 kcal/day). The energy requirement, derived from energy balance observations, was 9.93±1.32 MJ/day (2373±315 kcal/day). The BEE of 6.65±0.28 MJ/day (1589±67 kcal/day), calculated by the adjusted Schofield equation, was significantly higher (P<0.001) than that measured by indirect calorimetry, 5.99±0.66 MJ/day (1433±158 kcal/day). The TEE derived from the factorial approach was 10.31±0.43 MJ/day (2463±104 kcal/day). CONCLUSION: The TEE of Chinese young men measured by the DLW method was about 10% lower than the current recommended nutrient intake (RNI), suggesting that the RNI for Chinese men maybe overestimated. Further studies are warranted to determine the value of the estimated energy requirement.

[Study on the roles of the expression of bcl-2 and bax in experimental immunological liver injury in rats].

OBJECTIVE: To elucidate the roles of Bcl-2 and Bax in experimental immunological liver injury in rat and the effect of lowering serum levels on the expression and the injury. METHODS: 48 male Wistar rats were divided into six groups randomly. The animal model of iron low-load was created by intravenation of deferoxamine (DFO) or phlebotomy respectively, and immunological liver damage model was reproduced by injection of BCG (Bacilli Calmette Guein) and lipopolysaccharide (LPS). Then the following parameters were determined such as serum iron (SI) concentration, transferrin (TRF) concentration, total proteins (TP) volume, the serum activity of aspartate aminotransferase (AST), malondialdehyde (MDA) content, iron content (HIC), the expression of Bcl-2 and Bax proteins in liver tissue were assayed; the ratio of Bax to Bcl-2, apoptotic index (AI), and proliferative index (PI) were also calculated. RESULTS: (1) The amount of Bax expression in liver injury group was significantly higher than that of control one, but no change in Bcl-2 expression. The ratio of Bax to Bcl-2 and AI augmented significantly, along with increased serum activities of AST and level of MDA, reduced volume of TP in liver injury animals. (2) The serum activity of AST and TP volume in both of the control groups with DFO and phlebotomy pretreatment remained at control level. Although the expression of Bax and Bcl-2, Bax/Bcl-2 ratio and AI were all higher than those of blank controls, the increased magnitudes of Bax/Bcl-2 ratio and Al were significantly lower than those of the liver injury animals. (3) The expression amounts of Bcl-2 and Bax increased in the injury animals induced after injecting DFO or phlebotomy, thus Bax/Bcl-2 ratio and Al increased. However, Bax/Bcl-2 ratio and AI of them were less than those of the injuries without lowered SI, and the magnitude of increased serum activity of AST was lower than that of the injuries, but no change in TP volume in the rats with lowered SI. The MDA levels in the injuries with lower value of serum iron were lower than those of the animals without lower SI. CONCLUSION: The results show that the apoptotic process of hepatocyte accelerates in immunological liver injury, apoptosis may facilitate hepatocyte damage. Effect of iron on the expression of apoptosis regulating proteins have played an important role in apoptosis of immunological hepatic injury.