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If fasting guidelines are instead meant to minimize aspiration events without respect to residual gastric contents, then I think we need to start questioning what amount of residual gastric contents (and what type) are clinically significant.2 Oprea and colleagues published a correspondence this month addressing some of the criticisms of their article

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In patients with endogenous Cushing's syndrome, significant gut microbiota dysbiosis has been observed, characterized by an increased abundance of Proteobacteria and a decreased abundance of Lachnospiraceae and Faecalibacterium (Zhang et al., 2023c)

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