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.

OBJECTIVETo investigate the effects of exogenous hydrogen sulfide (H2S) on β-site APP cleaving enzyme 1 (BACE-1) and β-amyloid peptide (Aβ) metabolism in primary culture of neurons under high-glucose condition.

METHODSThe cortical neurons in primary culture under normal and high glucose (60 mmol/L) conditions for 24 h were exposed to 25, 50 and 100 µmol/L NaHS. Aβ1-42 concentration in the cell culture was measured by ELISA, and BACE-1 mRNA and protein levels were detected by fluorescent quantitative real-time PCR and Western blotting, respectively.

RESULTSCompared with the neurons cultured in normal glucose, the neurons exposed to high glucose showed significantly increased Aβ1-42 concentration and BACE-1 mRNA and protein expressions (P<0.05). Exposure to 25, 50 and 100 µmol/L NaHS significantly decreased Aβ1-42 concentration and BACE-1 mRNA and protein expressions in the high-glucose cell culture (P<0.05).

CONCLUSIONNeurons exposed to high glucose exhibit increased Aβ1-42 levels and BACE-1 mRNA and protein expressions, which can be concentration-dependently decreased by NaHS.

Amyloid Precursor Protein Secretases ; metabolism ; Amyloid beta-Peptides ; metabolism ; Animals ; Aspartic Acid Endopeptidases ; metabolism ; Cells, Cultured ; Culture Media ; chemistry ; Glucose ; chemistry ; Hydrogen Sulfide ; pharmacology ; Neurons ; drug effects ; metabolism ; Peptide Fragments ; metabolism ; Rats ; Rats, Sprague-Dawley

Objective To investigate the effects of exogenous hydrogen sulfide (H2S) onβ-site APP cleaving enzyme 1 (BACE-1) and β-amyloid peptide (Aβ) metabolism in primary culture of neurons under high-glucose condition. Methods The cortical neurons in primary culture under normal and high glucose (60 mmol/L) conditions for 24 h were exposed to 25, 50 and 100μmol/L NaHS. Aβ1-42 concentration in the cell culture was measured by ELISA, and BACE-1 mRNA and protein levels were detectedby fluorescent quantitative real-time PCR and Western blotting, respectively. Results Compared with the neurons cultured in normal glucose, the neurons exposed to high glucose showed significantly increased Aβ1-42 concentration and BACE-1 mRNA and protein expressions (P<0.05). Exposure to 25, 50 and 100 μmol/L NaHS significantly decreased Aβ1-42 concentration and BACE-1 mRNA and protein expressions in the high-glucose cell culture (P<0.05). Conclusion Neurons exposed to high glucose exhibit increased Aβ1-42 levels and BACE-1 mRNA and protein expressions, which can be concentration-dependently decreased by NaHS.

Objective To investigate the effects of exogenous hydrogen sulfide (H2S) onβ-site APP cleaving enzyme 1 (BACE-1) and β-amyloid peptide (Aβ) metabolism in primary culture of neurons under high-glucose condition. Methods The cortical neurons in primary culture under normal and high glucose (60 mmol/L) conditions for 24 h were exposed to 25, 50 and 100μmol/L NaHS. Aβ1-42 concentration in the cell culture was measured by ELISA, and BACE-1 mRNA and protein levels were detectedby fluorescent quantitative real-time PCR and Western blotting, respectively. Results Compared with the neurons cultured in normal glucose, the neurons exposed to high glucose showed significantly increased Aβ1-42 concentration and BACE-1 mRNA and protein expressions (P<0.05). Exposure to 25, 50 and 100 μmol/L NaHS significantly decreased Aβ1-42 concentration and BACE-1 mRNA and protein expressions in the high-glucose cell culture (P<0.05). Conclusion Neurons exposed to high glucose exhibit increased Aβ1-42 levels and BACE-1 mRNA and protein expressions, which can be concentration-dependently decreased by NaHS.

Objective To retrospectively evaluate and analyze the clinical effect of posterior pedicle subtraction osteotomy in treating chronic, posttraumatic thoracolumbar kyphosis. Methods Nineteen patients (11 males and 8 females) with chronic, posttraumatic thoracolumbar kyphosis were corrected surgically. The patients were at age range of 29-61 years (mean 42 years). Preoperative kyphosis Cobb angle ranged from 31° to 63° (mean 47°) and trauma history ranged from 8 months to 63 months (mean 29 months). All patients were treated with pedicle subtraction osteotomy according to the size of Cobb angle, extent of spinal stenosis and source of compression. Results Sagittal alignment was improved to average 40.2°, with a correction rate of 85.8%. Two patients developed postoperative leakage of cerebrospinal fluid. Among them, one was combined with encephalic infection and cured with active treatment, and the other developed postoperative wound infection, which were treated conservatively with antibiotics and local wound care. There were no other severe complications. The average follow-up period was 15 months (range 6-41 months). At the last follow-up, clinical symptoms and neurological function were improved significantly. Neither loss of correction nor failure of internal fixators was observed. X-ray and dynamic X-ray films showed a 100% fusion in all patients. Conclusions The single-stage posterior pedicle subtraction osteotomy is a safe and effective procedure for correction of posttraumatic thoracolumbar kyphosis. It is possible and safe to obtain a correction within 55° on single segment by this technique.