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1.
Int J Mol Sci ; 24(24)2023 Dec 06.
Article in English | MEDLINE | ID: mdl-38139020

ABSTRACT

Organic phosphorus (OP) is an essential component of the soil P cycle, which contributes to barley nutrition after its mineralization into inorganic phosphorus (Pi). However, the dynamics of OP utilization in the barley rhizosphere remain unclear. In this study, phytin was screened out from six OP carriers, which could reflect the difference in OP utilization between a P-inefficient genotype Baudin and a P-efficient genotype CN4027. The phosphorus utilization efficiency (PUE), root morphological traits, and expression of genes associated with P utilization were assessed under P deficiency or phytin treatments. P deficiency resulted in a greater root surface area and thicker roots. In barley fed with phytin as a P carrier, the APase activities of CN4027 were 2-3-fold lower than those of Baudin, while the phytase activities of CN4027 were 2-3-fold higher than those of Baudin. The PUE in CN4027 was mainly enhanced by activating phytase to improve the root absorption and utilization of Pi resulting from OP mineralization, while the PUE in Baudin was mainly enhanced by activating APase to improve the shoot reuse capacity. A phosphate transporter gene HvPHT1;8 regulated P transport from the roots to the shoots, while a purple acid phosphatase (PAP) family gene HvPAPhy_b contributed to the reuse of P in barley.


Subject(s)
6-Phytase , Hordeum , Phosphorus/metabolism , Hordeum/genetics , Hordeum/metabolism , 6-Phytase/metabolism , Phytic Acid/metabolism , Genotype , Plant Roots/genetics , Plant Roots/metabolism
2.
Math Biosci Eng ; 20(4): 6498-6516, 2023 Feb 02.
Article in English | MEDLINE | ID: mdl-37161116

ABSTRACT

Digital economy is regarded as the main economic form following agricultural economy and industrial economy. And the digital transformation has given enterprises new development momentum. Can it reduce the equity capital cost? This paper uses text analysis obtained by crawling the annual reports from 2010 to 2021 and investigates the impact of digital transformation on the corporate equity capital cost. The results show that: 1) Digital transformation will reduce the equity capital cost; 2) The digital transformation has a heterogeneous impact on the equity capital cost of enterprises with different scales, natures and levels of leverage, which is more significant for large-scale enterprises, state-owned enterprises and highly leveraged enterprises; 3) Digital transformation mainly affects the equity capital cost by improving enterprise value, rather than by increasing analysts' attention and influencing the level of corporate risk bearing.

3.
Chin Med J (Engl) ; 136(23): 2857-2866, 2023 Dec 05.
Article in English | MEDLINE | ID: mdl-37052133

ABSTRACT

BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01597232.


Subject(s)
Erythrocyte Transfusion , Postoperative Complications , Humans , Adult , Erythrocyte Transfusion/adverse effects , Blood Transfusion , Hospitals , Hemoglobins/analysis
4.
PLoS One ; 16(12): e0261589, 2021.
Article in English | MEDLINE | ID: mdl-34936690

ABSTRACT

Firm's effort on Green technology innovation (hereafter, called G-innovation) is affected by financing constraints, and firm will make a discretionary choice according to its own situation, to achieve the maximization of self-interests. Based on the data of Chinese micro enterprises, firstly, we empirically analyze firms' decision-making towards G-innovation when faced with financing constraints. It supports the view that financing constraints can hinder enterprise technological innovation. And we also make an explanation that the social benefits of green technology innovation are greater than personal benefits, which makes enterprises tend to reduce green technology innovation when facing financing constraints. Then we examine firms' heterogonous behaviors under different internal attributes and external environments. The results reveal that: First, firms are reluctant to pay more efforts to G-innovation when faced with increased financing constraints. Second, firms with different attributes exhibit heterogeneous G-innovation. Political connections will change firms' willingness to innovate, while the structure of property rights and the pollution degree will not. Third, firms under different external environment also exhibit heterogeneous G-innovation. When economic policy uncertainty increases, firms' willingness to innovate weakens. The development of shadow banks fail to improve firm's willingness to innovate.


Subject(s)
Inventions , China , Conservation of Natural Resources/economics , Environmental Pollution/economics , Inventions/economics , Research/economics , Technology/economics
5.
Clin Neuropharmacol ; 44(5): 157-168, 2021.
Article in English | MEDLINE | ID: mdl-34347636

ABSTRACT

BACKGROUND: Intranasal drip of dexmedetomidine in children with sevoflurane anesthesia can reduce anesthesia and restlessness. However, there is still some controversy. We conducted a meta-analysis to explore the effect of intranasal infusion of dexmedetomidine on the quality of recovery during the recovery period, to provide certain guidance for clinical application. METHODS: Web of Science, PubMed, Embase, and the Cochrane Library were used for literature search. Systematic reviews were based on PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analysis). RESULTS: A total of 14 articles and 1123 patients were included. The results of the meta-analysis showed that the incidence of emergence agitation [risk ratio (RR), 0.32; 95% confidence interval (CI), 0.20-0.50; P < 0.0001], satisfactory sedation at parent separation (RR, 1.41; 95% CI, 1.031-93; P = 0.034), incidence of nausea and vomiting (RR, 0.41; 95% CI, 0.21-0.78; P = 0.007), and incidence of laryngospasm (RR, 0.23; 95% CI, 0.08-0.65; P = 0.006) of the intranasal dexmedetomidine group were different compared with the control group. However, the satisfactory sedation at mask induction in the intranasal dexmedetomidine group (RR, 1.16; 95% CI, 0.87-1.54; P = 0.319), postanesthesia care unit (PACU) stay time (standardized mean deviation, 0.51; 95% CI, -0.11 to 1.12; P = 0.107), and extubation time (standardized mean deviation, 1.64; 95% CI, -1.07 to 4.35; P = 0.235) were not statistically significant compared with those of the control group. CONCLUSION: Intranasal dexmedetomidine anesthesia with sevoflurane in children can reduce the incidence of emergence agitation, provide more satisfactory sedation when the parents are separated, reduce the incidence of nausea and vomiting, and reduce the incidence of laryngospasm. In addition, the 2 µg/kg dose of dexmedetomidine may be the best dose for clinical application.


Subject(s)
Dexmedetomidine , Anesthesia, General , Child , Dexmedetomidine/adverse effects , Humans , Hypnotics and Sedatives/adverse effects , Psychomotor Agitation , Sevoflurane
6.
BMC Anesthesiol ; 20(1): 103, 2020 05 04.
Article in English | MEDLINE | ID: mdl-32366275

ABSTRACT

BACKGROUND: Trunk block technique has been used in postoperative analgesia for patients undergoing surgery, specifically, transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) have been proved effective. The purpose of this meta-analysis is to evaluate the effects of TAPB and QLB in postoperative analgesia. METHODS: Online databases, including MEDLINE, EMBASE, Cochrane Library (&Trail), Web of Science, CNKI, Wanfang and QVIP were applied to collect the randomized controlled trials (RCTs) from inception to Dec. 9th, 2019. Twenty-two studies were finally included containing 777 patients in the TAPB group and 783 cases in QLB group. RCTs comparing TAPB and QLB in postoperative analgesia were included in this meta-analysis. The indicators including total analgesia consumption postoperatively, operative time, duration of anesthesia, visual analogue scale (VAS) score at 24 h postoperatively, duration of postoperative analgesia, the number of patients requiring analgesia postoperatively and adverse reactions were analyzed. RESULTS: our findings showed that morphine consumption (mg) (WMD = 3.893, 95%CI: 2.053 to 5.733, P < 0.001), fentanyl consumption (µg) (WMD = 23.815, 95%CI: 15.521 to 32.109, P < 0.001), VAS score at 24 h postoperatively (WMD = 0.459, 95%CI: 0.118 to 0.801, P = 0.008), the number of patients requiring analgesia postoperatively (WMD = 3.893, 95%CI: 2.053 to 5.733, P < 0.001), and the incidence of dizziness (WMD = 2.691, 95%CI: 1.653 to 4.382, P < 0.001) in TAPB group were higher than in QLB group. CONCLUSIONS: QLB is superior to TAPB in reducing morphine consumption, fentanyl consumption, VAS score at 24 h postoperatively, the number of patients requiring analgesia postoperatively, and the incidence of dizziness.


Subject(s)
Nerve Block/methods , Pain, Postoperative/prevention & control , Abdominal Muscles/innervation , Abdominal Oblique Muscles , Fentanyl/administration & dosage , Humans , Morphine/administration & dosage , Nerve Block/adverse effects , Publication Bias , Randomized Controlled Trials as Topic
7.
BMC Anesthesiol ; 20(1): 128, 2020 May 27.
Article in English | MEDLINE | ID: mdl-32460772

ABSTRACT

An amendment to this paper has been published and can be accessed via the original article.

8.
Medicine (Baltimore) ; 99(5): e18939, 2020 Jan.
Article in English | MEDLINE | ID: mdl-32000411

ABSTRACT

RATIONALE: Diagnosing and treating refractory cancer pain have become standardized and effective procedures with guidance from the Expert Consensus on Refractory Cancer Pain released in 2017 by the Committee of Rehabilitation and Palliative Care of China. Doxorubicin has been used for perineural injection in the treatment of chronic non-cancer pain owing to its retrograde sensory ganglion resection effect. Our study reports a new fourth-ladder treatment for cancer pain: CT-guided paravertebral doxorubicin injection for patients with refractory cancer pain caused by paraspinal metastasis. PATIENT CONCERNS: A 48-year-old female and a 47-year-old male patients suffered from refractory cancer pain over the past months. They had both undergone surgical tumor resection, chemotherapy, and precision radiotherapy but result in limited analgesic effect. The daily oral morphine dosage was around 60 to 100 mg and rescue analgesic methods had been used at the time. DIAGNOSES: Refractory cancer pain in 2 patients with renal cancer and hepatobiliary adenocarcinoma. INTERVENTIONS: The patients both received computed tomography (CT)-guided 1 mL of 0.5% doxorubicin paravertebral injection at each affected nerve root segments. OUTCOMES: The Visual Analog Scale and Douleur Neuropathique four Questions were used for 6-month follow-up, and the analgesic requirement was also recorded. The patients enjoyed satisfactory analgesia for up to 6 months without adverse reaction. In addition, the oral opioid analgesic doses were significantly reduced after the neurolytic block. LESSONS: The CT-guided paravertebral doxorubicin injection was an effective fourth-step analgesic interventional technology that allowed our 2 patients with refractory cancer pain to maintain satisfactory analgesia. This analgesia method taken at an appropriate stage, according to the latest analgesic concept, results in good analgesia and opioid use reduction. Also, with the imaging guidance, only a small amount of neurolytic agent is needed to achieve analgesia in a precise and safe way.


Subject(s)
Analgesics/administration & dosage , Cancer Pain/drug therapy , Doxorubicin/administration & dosage , Pain, Intractable/drug therapy , Spinal Neoplasms/secondary , Tomography, X-Ray Computed , Cancer Pain/diagnostic imaging , Female , Humans , Male , Middle Aged , Pain Management/methods , Pain, Intractable/diagnostic imaging , Spinal Neoplasms/complications , Spinal Neoplasms/diagnostic imaging , Spinal Neoplasms/drug therapy
9.
Medicine (Baltimore) ; 98(48): e18168, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31770265

ABSTRACT

RATIONALE: Recent years have witnessed a marked improvement in the safety and accuracy of nerve blocks with the help of ultrasound and other visualization technologies. This study reports a challenging case of a severe complication during the ultrasound-guided stellate ganglion block. PATIENT CONCERNS: A 28-year-old male patient with refractory migraine complained episodic pulsatile pain with photophobia, haphalgesia of the scalp for 3 years. INTERVENTIONS: Ultrasound-guided stellate ganglion block with 4 ml of 1% lidocaine was administrated. OUTCOMES: A sudden loss of consciousness and tonic-clonic seizure was occurred after negative aspiration and test dose. Further sonographic examination revealed a variation in the left vertebral artery, which remained unrecognized during the needle insertion because of its sliding ability under the differential pressure applied by the probe. LESSONS: Inadvertent intra-arterial injection of a local anesthetic agent could be minimized under the ultrasound guidance with various protective strategies, including the determination of any prior variation, optimizing the block route, maintaining a constant probe pressure, and using saline for the test dosage. This case resulted in the implementation of new protocols of the ultrasound-guided stellate ganglion block in our department.


Subject(s)
Autonomic Nerve Block , Intraoperative Complications , Lidocaine , Seizures , Stellate Ganglion , Unconsciousness , Vertebral Artery , Adult , Anesthetics, Local/administration & dosage , Anesthetics, Local/adverse effects , Autonomic Nerve Block/adverse effects , Autonomic Nerve Block/methods , Humans , Intraoperative Complications/diagnosis , Intraoperative Complications/etiology , Intraoperative Complications/therapy , Lidocaine/administration & dosage , Lidocaine/adverse effects , Male , Medical Errors/prevention & control , Migraine Disorders/surgery , Patient Care/methods , Seizures/etiology , Seizures/therapy , Stellate Ganglion/diagnostic imaging , Stellate Ganglion/surgery , Treatment Outcome , Ultrasonography, Interventional/methods , Unconsciousness/etiology , Unconsciousness/therapy , Vertebral Artery/anatomy & histology , Vertebral Artery/injuries
10.
Biomed Pharmacother ; 118: 109215, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31545245

ABSTRACT

Currently, no reliable prognostic biomarkers have been identified for adult IDH wild-type (WT) diffuse low grade glioma (LGG). With data from The Cancer Genome Atlas (TCGA)-LGG, we examined the prognostic value of GABAA receptor subunits in adult IDH WT LGG. Using 2016 WHO CNS tumor classification, we re-classified the TCGA-LGG and identified 95 IDH WT patients. Among 16 GABAA receptor subunit genes with RNA-seq data, eight genes showed significantly different expression in IDH WT LGG compared with IDH mutant (MT) cases. Among these genes, only GABRD expression was related to overall survival (OS) status. Preserved GABRD expression was independently associated with longer OS (HR: 0.799, 95%CI: 0.691-0.925, p = 0.003) in IDH WT LGG. GABRD expression showed a moderately negative correlation with tumor infiltration macrophage (TIM) and CSF1 expression. The methylation status of 34 CpG sites across GABRD gene was checked and only cg13916816 showed a moderately negative correlation with GABRD expression. In conclusion, GABRD expression might serve as a potential independent prognostic marker in patients with IDH WT LGG. Meanwhile, its expression was negatively correlated with the extent of TIM, which might help to explain the favorable survival outcome. Cg13916816 might be a critical CpG site influencing GABRD expression in IDH WT LGG.


Subject(s)
Biomarkers, Tumor/genetics , Brain Neoplasms/genetics , Glioma/genetics , Isocitrate Dehydrogenase/genetics , Receptors, GABA-A/genetics , Brain Neoplasms/classification , Brain Neoplasms/mortality , CpG Islands , Databases, Genetic , Glioma/classification , Glioma/mortality , Humans , Kaplan-Meier Estimate , Mutation , Prognosis
11.
Medicine (Baltimore) ; 98(7): e14445, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30762755

ABSTRACT

The aim of this study was to investigate the association between purinergic receptor P2X7 (P2RX7) gene rs1718125 polymorphism and analgesic effect of fentanyl after surgery among patients with lung cancer in a Chinese Han population.A total of 238 patients with lung cancer who received resection were enrolled in our study. The genotype distributions of P2RX7 rs1718125 polymorphism were detected by polymerase chain reaction and direct sequencing. Postoperative analgesia was performed by patient-controlled intravenous analgesia, and the consumption of fentanyl was recorded. The postoperative pain was measured by visual analog scale (VAS). Differences in postoperative VAS score and postoperative fentanyl consumption for analgesia in different genotype groups were analyzed by analysis of variance assay.The frequencies of GG, GA, and AA genotypes were 46.22%, 44.96%, and 8.82%, respectively. After surgery, the postoperative VAS score of GA group was significantly high in the period of analepsia after general anesthesia and at 6 hours after surgery (P = .041 and P = .030, respectively), while AA group exhibited obviously high in the period of analepsia after general anesthesia (P < .001), at postoperative 6 hours (P = .006) and 24 hours (P = .016). Moreover, the patients carrying GA and AA genotypes needed more fentanyl to control pain within 48 hours after surgery (P < .05 for all).P2RX7 gene rs1718125 polymorphism is significantly associated with postoperative pain and fentanyl consumption in patients with lung cancer.


Subject(s)
Analgesics, Opioid/therapeutic use , Fentanyl/therapeutic use , Lung Neoplasms/genetics , Pain, Postoperative/genetics , Receptors, Purinergic P2X7/genetics , Aged , Analgesia, Patient-Controlled/statistics & numerical data , Asian People/genetics , China , Female , Genotype , Humans , Lung Neoplasms/surgery , Male , Middle Aged , Pain Measurement , Pain, Postoperative/drug therapy , Polymorphism, Single Nucleotide/genetics , Time Factors
12.
J Clin Monit Comput ; 33(6): 1061-1064, 2019 Dec.
Article in English | MEDLINE | ID: mdl-30656506

ABSTRACT

Capnography is an effective and non-invasive method for monitoring patients during general anesthesia and can reflect the changes in both the respiratory function as well as the circulatory function. In this paper, we present four cases of lobectomy in which we observed a "chair-like" waveform on performing capnography after the surgery. In all the cases, the appearance of this "chair-like" waveform led to the suspicion of a blockage in the pulmonary artery perfusion, which was then confirmed to be an obstruction in the pulmonary artery on further investigation. This suggests that during lobectomy, capnography can help confirm that the pulmonary circulation is unobstructed. We believe that it is very important to observe the changes of end-tidal carbon dioxide pressure and capnogram during one-lung ventilation, particularly in cases of pulmonary artery anastomosis.


Subject(s)
Anesthesia, General/methods , Capnography/methods , Lung/surgery , Aged , Carbon Dioxide/chemistry , Female , Humans , Lung/physiology , Male , Middle Aged , Monitoring, Intraoperative/methods , Perfusion , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/pathology , Pulmonary Circulation , Pulmonary Ventilation , Respiration
13.
Am J Cancer Res ; 8(5): 810-823, 2018.
Article in English | MEDLINE | ID: mdl-29888104

ABSTRACT

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third leading cause of cancer death in both men and women. NudC domain containing 1 (NUDCD1) was identified as an oncoprotein which was activated or over-expressed in various human cancers. We aimed to investigate the effects and mechanisms of NUDCD1 in human CRC. The expression of NUDCD1 in CRC and pericarcinous tissues from 70 CRC patients were determined by real-time PCR, western blotting, and immunohistochemistry. The correlation between the expression of NUDCD1 and clinical characteristics was analyzed. The expression of NUDCD1 in five CRC cell lines and normal colon mucosal epithelial cell line was measured by real-time PCR. Then we knock down NUDCD1 in HCT116 and HT 29 cells. The cell viability assay, scratch assay, migration and invasion assay and flow cytometry were used to analyze NUDCD1's effects on the proliferation, migration, invasion, cell cycle and apoptosis of CRC cells. NUDCD1's effects on CRC xenografts of nude mice was also determined. Results showed that the expression of NUDCD1 was much higher in CRC tissues than that in pericarcinous tissues. Over-expression of NUDCD1 in human CRC tissues was significantly associated with lymph node metastasis, distant metastasis, and advanced stages. The expression of NUDCD1 was higher in all of the CRC cell lines than that in normal colon epithelial mucosal cells. To knockdown NUDCD1 resulted in significant decreases in cell viability and proliferation, decreased protein expression of N-cadherin and increased protein expression of E-cadherin which were biomarkers of EMT, arrested the cell cycle and increased apoptosis via down-regulated cyclin D1, Bcl2, and up-regulated cleaved-caspase3. Furthermore, to knockdown NUDCD1 inactivated IGF1R-ERK1/2 signaling pathway in vitro and in vivo, and suppressed the xenografts of CRC. In conclusion, NUDCD1 promotes the carcinogenesis and metastasis of CRC through inducing EMT and inhibiting apoptosis, which suggests NUDCD1 be a potential biomarker for CRC.

14.
J Int Med Res ; 46(4): 1404-1413, 2018 Apr.
Article in English | MEDLINE | ID: mdl-29458276

ABSTRACT

Objective Postoperative cognitive dysfunction (POCD) is common after surgery in elderly patients and is associated with high morbidity. The molecular mechanisms responsible for POCD are unknown. Minocycline, an inhibitor of microglial activation, may be useful in treating and preventing POCD. We explored whether minocycline can inhibit microglial activation and prevent POCD in aged rats as a surgery model. Methods Rats aged 18 to 20 months were randomly allocated to the following groups: naïve, abdominal surgery alone, or minocycline injection before abdominal surgery. Hippocampal cytokine mRNA levels were measured at 3 hours, 1 day, 3 days, and 7 days after surgery, and microglial activation was measured at 3 hours and 7 days after surgery. Memory was assessed using the Morris water maze test. Results Surgery resulted in severe cognitive impairment in aged rats and induced a significant neuroinflammatory response and microglial activation. The use of minocycline can prevent microglial activation after surgery, but delayed microglial activation may occur. The use of minocycline may further impair memory after surgery. Conclusion Minocycline can restrain microglial activation and restrict the inflammatory response in the hippocampus early after surgery, but it may induce delayed microglial activation and cannot prevent POCD in aged rats.


Subject(s)
Aging/pathology , Cognitive Dysfunction/etiology , Cognitive Dysfunction/prevention & control , Microglia/pathology , Minocycline/adverse effects , Postoperative Complications/prevention & control , Animals , Cognitive Dysfunction/physiopathology , Dose-Response Relationship, Drug , Hippocampus/metabolism , Hippocampus/pathology , Hippocampus/physiopathology , Interleukin-1beta/genetics , Interleukin-1beta/metabolism , Memory, Short-Term , Microglia/metabolism , Postoperative Complications/physiopathology , RNA, Messenger/genetics , RNA, Messenger/metabolism , Rats, Sprague-Dawley , Tumor Necrosis Factor-alpha/genetics , Tumor Necrosis Factor-alpha/metabolism
15.
Support Care Cancer ; 26(2): 353-359, 2018 02.
Article in English | MEDLINE | ID: mdl-28956176

ABSTRACT

CONTEXT: Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) by bilateral or unilateral approach is widely used in palliative abdominal pain management in pancreatic cancer patients, but the analgesic effect and relative risks of the two different puncture routes remain controversial. OBJECTIVES: The aim of this systematic review was to evaluate the analgesic efficacy and safety of bilateral EUS-CPN compared with unilateral EUS-CPN. METHODS: An electronic database search was performed for randomized controlled trials comparing bilateral and unilateral approaches of EUS-CPN using the Pubmed, Cochrane Library, Web of Science, Google Scholar, and CNKI databases. Meta-analysis was performed using RevMan 5.3 after screening and methodological evaluation of the selected studies. Outcomes included pain relief, treatment response, analgesic reduction, complications, and quality of life (QOL). RESULTS: Six eligible studies involving 437 patients were included. No significant difference was found in short-term pain relief [SMD = 0.31, 95% CI (- 0.20, 0.81), P = 0.23] and response to treatment [RR = 0.99, 95% CI (0.77, 1.41), P = 0.97] between the bilateral and unilateral neurolysis groups. However, only the bilateral approach was associated with a statistically significant reduction in the postoperative use of analgesics [RR = 0.66, 95% CI (0.47, 0.94), P = 0.02] compared to the unilateral approach. A descriptive analysis was performed for complications and QOL. CONCLUSION: The short-term analgesic effect and general risk of bilateral EUS-CPN are comparable with those of unilateral EUS-CPN, but our evidence supports the conclusion that the bilateral approach significantly reduces postoperative analgesic use.


Subject(s)
Abdominal Pain/therapy , Endosonography/methods , Nerve Block/methods , Pain Management/methods , Pancreatic Neoplasms/therapy , Ultrasonography, Interventional/methods , Abdominal Pain/etiology , Analgesics/administration & dosage , Analgesics/adverse effects , Celiac Plexus/diagnostic imaging , Celiac Plexus/drug effects , Celiac Plexus/pathology , Humans , Nerve Block/adverse effects , Pain Management/adverse effects , Pancreatic Neoplasms/complications , Quality of Life
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