Unlike other therapeutic endoscopic procedure, sedation is generally not used in a cirrhotic patient for fear of hepatic encephalopathy (HE). However, a successful procedure might not be guaranteed due to poor cooperation and/or delirious behavior. In this study, we evaluated safety and effectiveness of midazolam in a cirrhotic
patient undergoing Ipatasertib cell line EVL. Methods: The medical records of 320 cirrhotic patients who underwent EVL between October 2005 and December 2012 were reviewed retrospectively. The main outcomes were treatment success and adverse drug reaction (ADR) that might be related with sedation. Also, risk factors for development of HE were pursued. Results: Midazolam was used in 151 patients and not in 161 and baseline characteristics were similar. The rates of treatment success were not differ in both groups (95.8% vs. 96.2%, p = 0.999). Although the incidence of ADR didn’t differ (46.2% vs. 55.0%, p = 0.115), development of HE (6.6% and 0%, p = 0.001) and desaturation (23.2% vs. 7.7%, p = 0.001) were more common in the midazolam group. A patient from
the midazolam group died due to uncontrolled bleeding. There were a total of 10 cases of HE. With logistic regression, MK-8669 cell line ECOG score ≥ 2 turned out to be associated with ADR (OR = 2.69, 95% CI 1.68–4.29, p ≤ 0.001). However, age, body mass index, Child-Pugh classification and variceal grade were not related. Conclusion: Because midazolam was associated with ADR including HE in a cirrhotic patient undergoing EVL, it should be used with extreme caution including appropriate intra- and post-procedural monitoring, especially when the ECOG score of a patient is not less than 2. Key Word(s): 1. endoscopic variceal ligation; 2. midazolam; 3. liver cirrhosis; 4. sedation Presenting Author: TAO LI Additional Authors: XIANYI LIN, TAO JIN Corresponding Author: TAO LI Affiliations: The Third Affiliated
Hospital of Sun Yat-Sen University; Sinomenine Third Affiliated Hospital, Sun Yat-Sen University Objective: To investigate endoplasmic reticulum (ER) stress in the development of acute liver injury induced by carbon tetrachloride (CCl4) in mice. Methods: Mice were randomly allocated to establish acute liver injury models by the administration of 20% CCl4 intraperitoneally. The expressions of ER stress-related proteins and apoptotic proteins in the liver of CCl4-treated mice were determined by pathological staining. The trends of ER stress-related proteins and apoptotic proteins were also analyzed by western blot. Results: It was shown by pathological analysis that administration of 20% CCl4 to mice caused a marked hepatic damage, characterized by significant expressions of ER stress-related proteins and apoptotic proteins combined with a remarkable reduction of proliferative proteins, PCNA. TUNEL staining and PCNA staining showed that significant increasing apoptotic cells and decreasing proliferative cells, respectively, when compared with the control group (P < 0.01).