Objective:To analyze the occurrence and risk factors of moderate-to-severe pain after elective endoscopic variceal ligation (EVL).Methods:This was a single-center case-control study. The research subjects were selected from inpatients with liver cirrhosis who received elective EVL in the Department of Gastroenterology of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2015 to June 2022. Based on the medical records and nursing documents, the general information of the patients, operation records of EVL, laboratory tests and abdominal ultrasound examination results, dose of octreotide and occurrence of very early postoperative gastrointestinal bleeding, pain assessment records, etc. were collected; the preoperative liver function and the severity of gastroesophageal varices (GOV) in the patients were evaluated accordingly. The patients were divided into low (0.3 mg/12 h) and high (0.6 mg/12 h) dose groups according to the octreotide dosage, and the incidence of very early postoperative gastrointestinal bleeding in the 2 groups was compared. The patients were divided into 2 groups based on whether moderate-to-severe pain occurred after the operation. The clinical characteristics in the patients of the 2 groups were compared, and the independent risk factors of moderate-to-severe pain after the operation were analyzed by the multivariate logistic regression model.Results:A total of 252 patients were included in this study, 6 of which developed very early gastrointestinal bleeding after elective EVL with an incidence of 2.4%. There was no statistically significant difference in the incidence of very early bleeding between the low-dose and high-dose octreotide groups [2.5% (3/122) vs. 2.3% (3/130), P=1.000]. Moderate-to-severe pain occurred in 61 patients after elective EVL with an incidence of 24.2%. Compared with patients without moderate-to-severe pain, the proportions of females, and those with severe GOV, undergoing EVL for the first time, and using high-dose octreotide were relatively high in patients with moderate-to-severe pain, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that being female[odds ratio ( OR)=2.603, 95% confidence interval ( CI): 1.377-4.923, P=0.003], with severe GOV ( OR=2.436, 95% CI: 1.098-5.405, P=0.029), using high-dose octreotide ( OR=2.205, 95% CI: 1.162-4.184, P=0.016), and undergoing EVL for the first time ( OR=2.070, 95% CI: 1.072-3.998, P=0.030) were independent risk factors for moderate-to-severe pain after EVL. Conclusions:The efficacy of octreotide at doses 0.3 and 0.6 mg/12 h was similar in preventing very early postoperative gastrointestinal bleeding after elective EVL. Females and patients with severe GOV, using high-dose octreotide, and undergoing EVL for the first time had a higher risk of moderate-to-severe pain after surgery. It is recommended to optimize the octreotide treatment plan to reduce the occurrence of moderate-to-severe pain after elective EVL.

Objective:To analyze the occurrence and risk factors of moderate-to-severe pain after elective endoscopic variceal ligation (EVL).Methods:This was a single-center case-control study. The research subjects were selected from inpatients with liver cirrhosis who received elective EVL in the Department of Gastroenterology of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2015 to June 2022. Based on the medical records and nursing documents, the general information of the patients, operation records of EVL, laboratory tests and abdominal ultrasound examination results, dose of octreotide and occurrence of very early postoperative gastrointestinal bleeding, pain assessment records, etc. were collected; the preoperative liver function and the severity of gastroesophageal varices (GOV) in the patients were evaluated accordingly. The patients were divided into low (0.3 mg/12 h) and high (0.6 mg/12 h) dose groups according to the octreotide dosage, and the incidence of very early postoperative gastrointestinal bleeding in the 2 groups was compared. The patients were divided into 2 groups based on whether moderate-to-severe pain occurred after the operation. The clinical characteristics in the patients of the 2 groups were compared, and the independent risk factors of moderate-to-severe pain after the operation were analyzed by the multivariate logistic regression model.Results:A total of 252 patients were included in this study, 6 of which developed very early gastrointestinal bleeding after elective EVL with an incidence of 2.4%. There was no statistically significant difference in the incidence of very early bleeding between the low-dose and high-dose octreotide groups [2.5% (3/122) vs. 2.3% (3/130), P=1.000]. Moderate-to-severe pain occurred in 61 patients after elective EVL with an incidence of 24.2%. Compared with patients without moderate-to-severe pain, the proportions of females, and those with severe GOV, undergoing EVL for the first time, and using high-dose octreotide were relatively high in patients with moderate-to-severe pain, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that being female[odds ratio ( OR)=2.603, 95% confidence interval ( CI): 1.377-4.923, P=0.003], with severe GOV ( OR=2.436, 95% CI: 1.098-5.405, P=0.029), using high-dose octreotide ( OR=2.205, 95% CI: 1.162-4.184, P=0.016), and undergoing EVL for the first time ( OR=2.070, 95% CI: 1.072-3.998, P=0.030) were independent risk factors for moderate-to-severe pain after EVL. Conclusions:The efficacy of octreotide at doses 0.3 and 0.6 mg/12 h was similar in preventing very early postoperative gastrointestinal bleeding after elective EVL. Females and patients with severe GOV, using high-dose octreotide, and undergoing EVL for the first time had a higher risk of moderate-to-severe pain after surgery. It is recommended to optimize the octreotide treatment plan to reduce the occurrence of moderate-to-severe pain after elective EVL.

Objective:To understand the pre-warnings of contraindicated drugs in medical advices in patients with renal insufficiency by the pre-audit system.Methods:The pre-warnings of contraindicated drugs in medical advices in patients with renal insufficiency by the pre-audit system in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1, 2021 to December 31, 2021 were collected. The drugs involved were analyzed and determined as drugs in the correct pre-warnings and drugs in the audit rules that needed to be corrected. The drugs involved in the correct pre-warnings and the acceptance of pre-warnings by clinicians were analyzed; drugs that can be used off-label according to the evidence-based information were recorded and the proposed suggestions on the revision of the audit rules were provided.Results:A total of 259 medical advices about pre-warnings related to contraindicated drugs in patients with renal insufficiency were included in the analysis, involving 47 drugs. Among the 259 pre-warnings, 169 were correct, with the correct rate of 65.25%, and 107 (63.31%) of them were accepted by clinicians. The rate of acceptance by surgeons was higher than that by physicians, and the difference was statistically significant [76.39% (55/72) vs. 53.61% (52/97), P<0.01]. The audit rules in the 90 pre-warnings that needed to be modified involved 12 drugs. Of them, one drug (dapagliflozin tablets) had updated instruction, thus the rules can be modified directly according to it. The other 11 drugs were recorded for off-label drug use in the system based on evidence-based information, and of them, pre-warning levels were adjusted for 6 drugs, and audit rules were adjusted for 5. Conclusions:The pre-audit system can effectively pre-warning the contraindicated drug prescriptions of CKD patients, and the correct rate of pre-warning and clinician acceptance rate are more than 60%. The audit rules of some pre-warnings need to be adjusted with the update of the instructions and additional evidence-based information for off-label drug use after recording.

Objective:To understand the pre-warnings of contraindicated drugs in medical advices in patients with renal insufficiency by the pre-audit system.Methods:The pre-warnings of contraindicated drugs in medical advices in patients with renal insufficiency by the pre-audit system in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1, 2021 to December 31, 2021 were collected. The drugs involved were analyzed and determined as drugs in the correct pre-warnings and drugs in the audit rules that needed to be corrected. The drugs involved in the correct pre-warnings and the acceptance of pre-warnings by clinicians were analyzed; drugs that can be used off-label according to the evidence-based information were recorded and the proposed suggestions on the revision of the audit rules were provided.Results:A total of 259 medical advices about pre-warnings related to contraindicated drugs in patients with renal insufficiency were included in the analysis, involving 47 drugs. Among the 259 pre-warnings, 169 were correct, with the correct rate of 65.25%, and 107 (63.31%) of them were accepted by clinicians. The rate of acceptance by surgeons was higher than that by physicians, and the difference was statistically significant [76.39% (55/72) vs. 53.61% (52/97), P<0.01]. The audit rules in the 90 pre-warnings that needed to be modified involved 12 drugs. Of them, one drug (dapagliflozin tablets) had updated instruction, thus the rules can be modified directly according to it. The other 11 drugs were recorded for off-label drug use in the system based on evidence-based information, and of them, pre-warning levels were adjusted for 6 drugs, and audit rules were adjusted for 5. Conclusions:The pre-audit system can effectively pre-warning the contraindicated drug prescriptions of CKD patients, and the correct rate of pre-warning and clinician acceptance rate are more than 60%. The audit rules of some pre-warnings need to be adjusted with the update of the instructions and additional evidence-based information for off-label drug use after recording.

Dimethylarginine dimethylaminohydrolase 1 (DDAH1) is an important regulator of plasma asymmetric dimethylarginine (ADMA) levels, which are associated with insulin resistance in patients with nonalcoholic fatty liver disease (NAFLD). To elucidate the role of hepatic DDAH1 in the pathogenesis of NAFLD, we used hepatocyte-specific Ddah1-knockout mice (Ddah1^HKO) to examine the progress of high-fat diet (HFD)-induced NAFLD. Compared to diet-matched flox/flox littermates (Ddah1^f/f), Ddah1^HKO mice exhibited higher serum ADMA levels. After HFD feeding for 16 weeks, Ddah1^HKO mice developed more severe liver steatosis and worse insulin resistance than Ddah1^f/f mice. On the contrary, overexpression of DDAH1 attenuated the NAFLD-like phenotype in HFD-fed mice and ob/ob mice. RNA-seq analysis showed that DDAH1 affects NF-κB signaling, lipid metabolic processes, and immune system processes in fatty livers. Furthermore, DDAH1 reduces S100 calcium-binding protein A11 (S100A11) possibly via NF-κB, JNK and oxidative stress-dependent manner in fatty livers. Knockdown of hepatic S100a11 by an AAV8-shS100a11 vector alleviated hepatic steatosis and insulin resistance in HFD-fed Ddah1^HKO mice. In summary, our results suggested that the liver DDAH1/S100A11 axis has a marked effect on liver lipid metabolism in obese mice. Strategies to increase liver DDAH1 activity or decrease S100A11 expression could be a valuable approach for NAFLD therapy.

Objective:To understand the pre-warnings of drug dosage errors in medical advices in elderly inpatients with renal insufficiency by the prescription review system.Methods:The pre-warnings of drug dosage errors in medical advices in ≥65 years old inpatients with renal insufficiency by the prescription review system in Xinhua Hospital Affiliated to Shanghai Jiao Tong University Medical College from January 1, 2021 to December 31, 2021 were reviewed, and the reasons for the wrong pre-warnings were analyzed. In the correct pre-warnings, the drugs involved in dosage errors related to kidney and the types of errors were evaluated, and the departments related to the occurrence of errors and the acceptance of physicians for pre-warnings were analyzed.Results:A total of 511 medical advices on pre-warnings related to drug dose in ≥65 years old patients with renal insufficiency were included in the analysis. One hundred and eighty-three medical advices (35.8%) were evaluated as wrong pre-warnings, and 328 (64.2%) were correct pre-warnings. The medical advices with correct pre-warnings involved 25 kinds of drugs, of which the most involved drugs was antibacterial drugs [57.62%(189/328)]; the second was cardiovascular system drugs [24.70% (81/328)], among which trimetazidine tablets was the most common. Among the correct pre-warnings, 315 (96.04%) were excessive dose, and 13 (3.96%) were insufficient dose. The most common error content of excessive dose was "excessive single dose and excessive daily dose" (53.33%, 168/315), followed by "high frequency, excessive daily dose" (41.59%, 131/315); the most common errors of insufficient dose was "low frequency, insufficient daily dose" (9/13). A total of 186 (56.7%) medical advices were corrected by physicians after accepting the pre-warnings, and 142 (43.3%) were not. The acceptance rate of surgeons for pre-warning of wrong orders was higher than that of physicians, with a statistically significant difference [73.3%(96/131) vs. 45.7%(90/197), P<0.001]. Conclusions:The effect of pre-warnings from the prescription review system on dosage errors related to kidney is positive. It is necessary to further improve the accuracy of the prescription review system for the dosage errors related to kidney, improve the acceptance of clinicians, and ensure the safety of patients.

Objective:To understand the pre-warnings of drug dosage errors in medical advices in elderly inpatients with renal insufficiency by the prescription review system.Methods:The pre-warnings of drug dosage errors in medical advices in ≥65 years old inpatients with renal insufficiency by the prescription review system in Xinhua Hospital Affiliated to Shanghai Jiao Tong University Medical College from January 1, 2021 to December 31, 2021 were reviewed, and the reasons for the wrong pre-warnings were analyzed. In the correct pre-warnings, the drugs involved in dosage errors related to kidney and the types of errors were evaluated, and the departments related to the occurrence of errors and the acceptance of physicians for pre-warnings were analyzed.Results:A total of 511 medical advices on pre-warnings related to drug dose in ≥65 years old patients with renal insufficiency were included in the analysis. One hundred and eighty-three medical advices (35.8%) were evaluated as wrong pre-warnings, and 328 (64.2%) were correct pre-warnings. The medical advices with correct pre-warnings involved 25 kinds of drugs, of which the most involved drugs was antibacterial drugs [57.62%(189/328)]; the second was cardiovascular system drugs [24.70% (81/328)], among which trimetazidine tablets was the most common. Among the correct pre-warnings, 315 (96.04%) were excessive dose, and 13 (3.96%) were insufficient dose. The most common error content of excessive dose was "excessive single dose and excessive daily dose" (53.33%, 168/315), followed by "high frequency, excessive daily dose" (41.59%, 131/315); the most common errors of insufficient dose was "low frequency, insufficient daily dose" (9/13). A total of 186 (56.7%) medical advices were corrected by physicians after accepting the pre-warnings, and 142 (43.3%) were not. The acceptance rate of surgeons for pre-warning of wrong orders was higher than that of physicians, with a statistically significant difference [73.3%(96/131) vs. 45.7%(90/197), P<0.001]. Conclusions:The effect of pre-warnings from the prescription review system on dosage errors related to kidney is positive. It is necessary to further improve the accuracy of the prescription review system for the dosage errors related to kidney, improve the acceptance of clinicians, and ensure the safety of patients.