BACKGROUND: The pathogenesis of hepatic encephalopathy is still not completely clear at present, and the theory of ammonia poisoning may be the most powerful, the mechanism for lactulose in decreasing ammonia is clearer, and there are many studies on hepatic encephalopathy treated by lactulose at home and aboard, but the comparative studies on the long-term and short-term treatment of lactulose and placebo control treatment are still in lack. OBJECTIVE: To given long-term and short-term treatment of lactulose to patients with minimal hepatic encephalopathy, and compare the effect on the quality of life (QOL) of the patients with minimal hepatic encephalopa thy. DESIGN: A case-control observation. SETTING: Department of Geriatrics, Guangzhou First People's Hospital. PARTICIPANTS: Sixty patients with minimal hepatic encephalopathy, who were abnormal in the number connection test (NCT), digital symbol test (DST) and/or evoked potential examination and cooperated with the treatment, were selected from the patients with cirrhosis treated in the De partment of Geriatrics of Guangzhou First People's Hospital between June 1998 and March 2002, and they were randomly divided into control group (n=20), short-term lactulose group (n=20) and long-term lactulose group (n=20). METHODS: All the patients were given vitamin B for 24 weeks, two tablets for each time, three times a day; besides, the patients in the short term lactulose group and long-term lactulose group were orally adminis tered with lactulose (15-90 mL per day) for 8 and 24 weeks respectively. They were assessed with WHOQOL-BREF at the end of 0, 8, 16 and 24 weeks respectively, the incidence rate of hepatic encephalopathy was observed, and the ammonia conc entration in blood was detected at the same period.MAIN OUTCOME MEASURES: The changes of QOL and ammonia concentration in blood during the treatment were observed.RESULTS: During the treatment, one case in the control group lost to the follow-up, one case in the short-term lactulose group died from traffic accident, and two cases in the long -term group quitted because they could not endure the side effect of diarrhea, and totally 56 cases finished the treatment and entered the analysis of results. ① The incidence rate of hepatic encephalopathy at 6 months was 40%(8/20), 30%(6/20), 5%(1/20) in the control group, short-term lactulose group and long-term lactulose group respectively, and it was significantly lower in the long-term lactulose group than in the control group and short-term lactulose group (P ＜ 0.05), but there was no significant difference between the short-term lactulose group and control group (P ＞ 0.05). ② At 8, 16 and 24 weeks after treatment,the score of environment in QOL had no significant difference among the control group, short-term lactulose group and long-term lactulose group (P ＞ 0.05), but there were significant differences in the scores of physiology,psychology and social relationship (P ＜ 0.05); At 8 weeks, there were more obvious differences in the long-term lactulose group and short-term lactulose group than in the control group, but no significant difference between the long and short-term lactulose groups; At 16 weeks, there were more obvious differences in the long-term lactulose group than in the short-term lactulose group and control group, but no significant difference between the short-term lactulose group and control group; At 24 weeks, the long-term lactulose group had more improvements than in the control group and short-term lactulose group. ③ At 16 and 24 weeks after treatment, the ammonia concentrations in blood were significantly decreased in the long-term lactulose group as compared with the control group and short-term lactulose group.CONCLUSION: The long-term treatment of lactulose can improve the QOL of patients with minimal hepatic encephalopathy, eventually reduce the incidence of hepatic encephalopathy and decrease the ammonia concentration in blood; However, the short-term treatment of lactulose could not.

Every year more than 10 million people newly infected with Mycobacterium tuberculosis (MTB) worldwide, which seriously threats human health and life. The anti-MTB infection drugs are constantly developed and updated. Vitamin D3 is a drug which can regulate the immune system, its effect on MTB infection has attracted more and more attention. This article reviews the clinical efficacy of vitamin D3 in adjuvant therapy for MTB infection, and its mechanism in regulating the innate and adaptive immune system, to provide insight for treatment of MTB infection.

BACKGROUND:The shoulder joint,as a non-weight-bearing joint of the human upper limb,is considered a perfect compromise between flexibility and stability.The traditional experimental mechanics research of shoulder joints has some limitations due to the complexity of internal structure,measurement techniques and ethical issues.The finite element analysis method is applied to the research of shoulder joints,which provides valuable reference conclusions for the discussion of shoulder joint diseases and the decision of surgical methods. OBJECTIVE:To review the status of finite element research in the field of the shoulder joint,and to put forward the prospect of future research. METHODS:The finite element analysis method was used to search the literature on shoulder joint complex-related diseases in PubMed,Web of Science,WanFang and CNKI databases by computer.Chinese search terms were"shoulder joint,finite element analysis,rotator cuff injury,glenoid labrum,shoulder joint replacement".English search terms were"FE,should joint,glenohumeral joint,rotator cuff tears,glenoid labrum,shoulder arthroplasty".The search period was mainly from January 2010 to January 2023.Some important documents were also tracked,retrieved and read. RESULTS AND CONCLUSION:(1)With the open network of model data and the establishment of relevant model databases,finite element research has become more and more standardized and reproducible.(2)The widely validated finite element model of the shoulder joint deepens our understanding of the shoulder field to enable more efficient clinical decision-making.(3)With the continuous development of computer technology and software development,future finite element research is bound to become an indispensable practical tool for clinical scientific research.

Objective    To evaluate the efficacy of hybrid ablation through compared with thoracoscopic epicardial ablation. Methods    In this study, 108 patients with all long-standing persistent atrial fibrillation (LSPAF) received thoracoscopic epicardial ablation (TEA) after enrollment. There were 82 males and 26 females at age of 56.5±9.4 years. After blanking-period, patients off antiarrhythmic therapy with sinus rhythm were divided into a hybrid ablation (HA) group (50 patients) and a TEA group (58 patients). Only patients in the HA group received catheter ablation after randomization subsequently. In at least two-year observation period, cardiovascular risk factors were observed in all groups’ patients. Results    The mean follow-up duration was 17.3-41.8 (26.9±6.1) months and there was no significant difference between two groups [8.2-40.6 (27.5±5.7) months in the HA group and 17.3-41.8 (26.4±6.7) months in the TEA group]. The off antiarrhythmic agents (AADs) sinus rhythm rate was significantly higher in the HA group than that in the TEA group at the time of postoperative 6, 12, 24 and 36 months ［96.0%, 90.0%, 83.7%, 83.7% versus 79.3%, 75.9%, 67.3%, 63.1%, HR=0.415 (95%CI 0.206-0.923)]. Conclusion    We can conclude that the efficacy of two-staged hybrid ablation for LSPAF is superior to thoracoscopic epicardial ablation alone. Patients can obtain benefit from a supplemental radiofrequency catheter ablation after blanking-period of surgical ablation, instead of those without a supplemental ablation.