Abstract:Microbial mineralization is widespread in nature， and can generate natural microbial minerals with diverse structures，different compositions，and superior performance， such as biological apatite，calcium magnesium carbonate，magnetite，silica minerals，etc. The main mechanism is divided into microbial induced mineralization and microbial controlled mineralization. In the process of microbial mineralization，the organization and metabolic functions of microorganisms play an important role，providing a theoretical basis for the preparation of biomimetic mineral materials with specific components and functions. Compared with mineral materials synthesized by traditional physical or chemical methods， biomimetic synthesis of mineralized materials by simulating the formation process of microbial mineralization not only has a highly controllable structure， but also has higher biocompatibility，which has potential applications in the field of biomedicine. However，it is still a challenge to accurately simulate the mineralization process of microorganisms. This article introduces the process of microbial mineralization and its regulatory factors，and further reviews the research progress of biomimetic synthesis of functional materials inspired by microbial mineralization in recent years.

Abstract:Acute respiratory distress syndrome（ARDS） is a common critical disease in intensive care unit. Due to insufficient understanding of the disease，its diagnosis and treatment are still challenging，and the mortality remains high. More and more scholars believe that ARDS has considerable heterogeneity in clinical and biological aspects，which has aroused the interest of many scholars. This article aims to summarize the research progress of the subphenotype of ARDS，so as to provide reference for better understanding of its pathogenesis，formulate individual treatment for patients， and promote the treatment of ARDS towards precision medicine as soon as possible.

Abstract:Recent studies have shown that ferroptosis plays an important role in the occurrence and development of Alzheimer's disease. This article summarizes relevant domestic and foreign literature in recent years，and categorizes and reviews the relationship between the three main mechanisms of ferroptosis，namely iron metabolism disorder，glutathione（GSH） depletion，and lipid peroxidation，and AD. This finding suggests that ferroptosis may become a new therapeutic strategy to treat and prevent AD in the future.

Abstract:PIK3CA-related overgrowth spectrum（PROS） is a genetic disease caused by PIK3CA gene activation mutations in the embryonic stage，which belongs to mosaic mutations and is one of the common causes of segmental overgrowth. Due to the heterogeneity of PROS，the morbidity is severely underestimated，and the clinical manifestations，diagnosis，and management of the disease are particularly difficult. This paper summarizes the latest research progress in the early recognition and diagnosis of PROS，and the pathogenesis of abnormal PI3K/AKT pathway and the treatment methods around this signal pathway，thus providing reference for clinical diagnosis and treatment of PROS patients.

Abstract:Triplet pregnancies can be divided into various types based on chorionic and amniotic character. Among them， dichorionic triamniotic（DCTA） triplet and monochorionic triamniotic（MCTA） pregnancies have the risk of multiple pregnancies and complications of monochorionic twins due to its monochorionic part. Multifetal pregnancy reduction can improve pregnancy outcomes effectively，and radiofrequency ablation（RFA） is the most commonly performed method. At present，there are few clinical reports on RFA for monochorionic triplet pregnancies and dichorionic triplet pregnancies. This study，through the review of previous studies，has summarized the safety and effectiveness of RFA for triplet pregnancy reduction of DCTA and MCTA，as well as the influence of the timing and indication of reduction on pregnancy outcomes， so as to provide guidance for clinical consultation.

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Abstract:Objective Although both education and apolipoprotein E（ApoE） gene affect the risk of cognitive impairment，whether there is an interaction between them is still unclear. This study aimed to explore the effects and interaction of education level and ApoE genotype on cognitive function and default mode network（DMN） in patients with mild cognitive impairment（MCI）.Methods The study was based on the Alzheimer's Disease Neuroimaging Initiative dataset. According to the level of education and the carrier status of ApoE ε4（ApoE4） allele，MCI subjects were divided into four groups. The effects of education level and ApoE genotype on cognitive function and the DMN were analyzed by using the covariance model.Results There was a significant interaction between education and ApoE genotype on the global cognitive function of MCI patients（P<0.05）. Specifically，in subjects with low education level，the global function of non-ApoE4 carriers was better than that of carriers［23.00（22.50，25.50） vs. 22（21，24）］，while in subjects with high education level，it was opposite［23.00（22.00，26.00） vs. 25.00（22.75，26.25）］. On the other hand，education level and ApoE genotype also had a significant interaction on the functional connectivity（FC） of the left middle temporal gyrus of DMN（P<0.05）. Among subjects with low education level，the FC of ApoE4 carriers was significantly higher than that of non-carriers（0.35±0.32 vs. 0.15±0.28），while it was opposite in subjects with high education level（0.09±0.26 vs. 0.25±0.23）. Behavioral correlation analysis showed that the FC of the left middle temporal gyrus was negatively correlated with the global function（r=-0.560，P=0.030）.Conclusion High education level can significantly reduce the damage effect of ApoE4 allele on cognitive function of MCI patients，which may be related to the reduction of abnormal DMN FC of ApoE4 carriers by high education level. These results support that the interaction between genes and the environment plays an important role in regulating the occurrence of cognitive impairment.

Abstract:Objective To investigate the protective effect of glucagon-like peptide-1 receptor（GLP-1R） agonist（NLY01） on synaptic plasticity in neonatal hypoxia ischemia（HI） model mice.Methods In experiment 1，P7 mice were assigned to one of the following four groups，n=16/group：control group （Con group）， HI group， NLY01 group and HI+NLY01 group. In experiment 2， P7 mice were assigned to four groups（n=8/group）：HI group， HI+NLY01 group， HI+Ex9-39 group and HI+NLY01+Ex9-39 group. Among them， Ex9-39 was used to block GLP-1R. Behavioral tests were performed to measure learning ability. Golgi staining was used to measure dentate gyrus synaptic plasticity. Expression of synaptic and neuroinflammation-related proteins was assessed by Western blotting and immunofluorescence.Results Activation of GLP-1R by NLY01 prevented the emotional and cognitive deficits caused by HI. NLY01 prevented HI-induced reduction in GLP-1R levels. Activation of GLP-1R significantly ameliorated the impairment of synaptic plasticity，prevented the upregulation of inflammatory factors，and suppressed nuclear factor-κB（NF-κB） phosphorylation and microglial M1 polarization. In the HI model，the protective effect of NLY01 on HI-induced neonatal mice was blocked by Ex9-39.Conclusion GLP-1R may be a functional target regulating inflammatory pathways in acute brain injury in neonatal mice，supporting a potential therapeutic role of GLP-1R agonists in HI-induced neonatal mice.

Abstract:Objective To investigate the expression，clinical significance and functional mechanism of nucleolar and spindle-associated protein 1（NUSAP1）in esophageal carcinoma（ESCA），and to provide new ideas for the early diagnosis and treatment of ESCA.Methods ESCA samples and paracancerous samples were downloaded from GEPIA2 and TIMER databases to analyze the expression of NUSAP1，STRING and Cytoscape software were used to construct the PPI network of NUSAP1 related genes，and GO，KEGG and GSEA enrichment analysis were performed. The TIMER database was used to analyze the correlation between NUSAP1 and immune cells. Finally，the expression of NUSAP1 in ESCA tissues and cells was verified by RT-PCR，Western blot and immunohistochemistry，and ESCA cells were transfected with lentivirus-coated small interfering RNA to knock down the expression of NUSAP1. The effect of NUSAP1 on ESCA cell proliferation was evaluated by CKK-8 and Ki67 immunofluorescence.Results NUSAP1 was highly expressed in ESCA tissues and cells. The expression of NUSAP1 was positively correlated with the infiltration of CDK1，B cells and macrophages，but negatively correlated with the infiltration of CD4⁺ T cells，CD8⁺ T cells，neutrophils and dendritic cells. GSEA analysis found that the high expression group of NUSAP1 was mainly enriched in Wnt/β-catenin signaling pathway，peroxidase pathway，PI3K/Akt/mTOR signaling pathway. In vitro，knockdown of NUSAP1 inhibited the proliferation of ESCA cells.Conclusion NUSAP1 is highly expressed in ESCA and closely related to ESCA cell proliferation and immune cell infiltration. Therefore，NUSAP1 may help the diagnosis and treatment of ESCA.

Abstract:Objective To study the effect of solid pulmonary nodules volume measurement by 3D-Slicer software on the interobserver consistency of lung CT screening reporting and data system（Lung-RADS） categories.Methods Seventy-six solid nodules from 76 patients were included in this study. The diameter and volume of nodules were obtained by three radiologists using manual and 3D-Slicer software semi-automatic volume measurement methods，respectively，and the raw data was converted to the corresponding Lung-RADS score，of which 2 points was negative and 3 points or above was positive. Intraclass correlation coefficient（ICC） and Bland-Altman index were used to evaluate the interobserver consistency of diameter and volume measurements. Kappa analysis was used to evaluate the interobserver consistency of Lung-RADS score and the intergroup consistency of positive/negative.Results ICC analysis showed that the consistency of manual diameter measurement（0.994-0.996） was significantly lower than that of semi-automatic volume measurement（0.997-0.998），and Bland-Altman index analysis showed that the bias of manual diameter measurement was higher than that of semi-automatic volume measurement. Compared with manual diameter measurement，the use of semi-automatic volume measurement can significantly improve the consistency of Lung-RADS score and positive/negative classifications（0.963-0.975 and 0.957-0.977 vs. 0.833-0.866 and 0.863-0.892）.Conclusion 3D-Slicer semi-automatic volume measurement can improve the interobserver consistency of the size measurement of solid pulmonary nodules， as well as the corresponding Lung-RADS categories.

Abstract:Objective To evaluate the potential long-term prognostic impact of peritumoral imaging features in patients with colorectal liver metastases（CRLM） after non-anatomic resection（NAR）.Methods Thirty-six patients who had abdominal gadoxetic acid-enhanced magnetic resonance imaging（MRI） before CRLM surgery were included in this retrospective research. Peritumoral early enhancement，peritumoral hypointensity on hepatobiliary phase（HBP），and biliary dilatation to the CRLM at MRI were evaluated. Survival estimates were calculated using the Kaplan-Meier method，and multivariate analysis was conducted to identify independent predictors of liver recurrence-free survival（LRFS）， recurrence-free survival（RFS） and overall survival（OS）.Results Overall， 36 patients with 58 CRLM were evaluated. There was a significant difference in 3-year LRFS and RFS rates between patients with and without peritumoral early enhancement（LRFS：14.3% vs. 43.9%，P=0.005； RFS：14.3% vs. 40.3%，P=0.006）. Peritumoral early enhancement was associated with poor LRFS［P=0.002， hazard ratio（HR）=5.541，95%CI=1.853-15.975］ and poor RFS（P=0.002，HR=5.392，95%CI=1.887-15.412） in patients with CRLM after NAR. However， bile duct dilatation and peritumoral hypointensity on HBP were not independent predictors of LRFS， RFS and OS.Conclusion In patients with CRLM after NAR， peritumoral early enhancement was predictor of LRFS and RFS.

Abstract:Objective To investigate the effects of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery.Methods Sixty-nine elderly patients，scheduled for elective foot surgery，were randomized into 3 groups：subarachnoid block combined with thigh tourniquet group（group C），subarachnoid block combined with ankle tourniquet group（group SA），adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet group（group NA）. The peak changes of mean arterial pressure（MAP） and heart rate（HR） during 30 min after anesthesia，and changes of MAP and HR at 1 min，3 min，5 min，10 min and 15 min after tourniquet deflation；postoperative micturition and flatus passage time，quality of recovery-15（QoR-15） score 24 h after operation；effects of anesthesia and surgical field hemostasis，dose of metaraminol，time of patient-controlled analgesia（PCA） initiation and consumption of sufentanil within 48 h after operation and adverse reactions were compared among the three groups.Results Sixty-nine patients were enrolled in the study，and sixty-four completed the study. Compared with group C and group SA，the peak changes of MAP and HR during 30 min after anesthesia of group NA were significantly lower. In addition， the postoperative micturition and flatus passage time were shortened，and QoR-15 score 24 h after operation was higher. The onset of anesthesia was slower，region of blockade was smaller，less metaraminol was used，time of PCA initiation was longer，and cumulative consumptions of sufentanil were less at 12 h，24 h and 48 h after operation in group NA. All the differences were statistically significant（P<0.05）. Compared with group C，the amplitudes of MAP and HR changes in group SA and group NA after tourniquet deflation were significantly smaller with less metaraminol. Moreover，the incidences of skin blisters and pain in tourniquet area were significantly lower after operation（P<0.05）. There were no significant differences in other indexes among the three groups（P>0.05）.Conclusion Applications of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery could bring stable hemodynamics，enhanced recovery， favorable effects and few adverse reactions.

Abstract:Objective To explore the benefit findings of patients with bipolar disorder（BD） from the perspective of BD patients.Methods Using the phenomenological research method of qualitative research，12 BD patients visited in the Outpatient Department of the Mental Health Center of West China Hospital of Sichuan University were interviewed by objective sampling method from May to July 2022，and the data were collated and analyzed by Colaizzi 7-step content analysis method.Results The benefit findings of BD patients included the enhancement of feeling happiness，acceptance of disease and self-acceptance，enhancement of disease self-management ability，improvement of family relationship，emphasis on self-feeling and spiritual life，self-understanding，tolerance and empathy，and improvement of living habits.Conclusion The benefit findings of BD patients are mainly manifested in the acceptance of the disease and self-acceptance，the enhancement of the sense of control over the disease and life， and the reduction of the influence of adverse psychosocial factors. Medical staff can promote patients to obtain the benefit findings of the disease and promote rehabilitation through corresponding interventions.

Abstract:Objective To investigate the risk factors of acute kidney injury（AKI） after heart valve surgery in elderly patients ≥ 65 years old and their effects on prognosis.Methods A retrospective analysis was performed on elderly patients aged 65 years and above who underwent heart valve surgery in Guangdong Provincial People's Hospital from January 2013 to May 2014. The patients who received renal replacement therapy before surgery and whose serum creatinine value was missing were excluded，and the selected cases were recorded. The preoperative，intraoperative，and postoperative clinical data were collected，and regular telephone follow-up was conducted. The primary endpoint was the incidence of AKI，and the secondary endpoint was follow-up mortality. Patients were divided into AKI group and control group according to whether they complicated with stage ≥ 2 AKI. Univariate analysis and logistic regression multivariate analysis were used to explore the risk factors of postoperative AKI，Kaplan-Meier survival analysis was used to show the effect of AKI on follow-up death，and multivariate Cox regression model was used to analyze the risk factors of postoperative follow-up death.Results A total of 225 patients were included in this study，including 110 women（58.89%），and the incidence of AKI was 26.22%（n=59）. The in-hospital mortality in the AKI group was significantly higher than that in the control group（13.6% and 0.0%，P<0.001）. The longest follow-up time was 9 years，and the follow-up mortality in the AKI group was significantly higher than that in the control group（42.4% and 9.6%，P<0.001）. Kaplan-Meier survival analysis showed that the follow-up mortality in the AKI group was significantly higher than that in the control group（P<0.001）. Univariate and logistic regression multivariate analysis showed that the independent risk factors for postoperative AKI were lower preoperative platelet count（OR=0.99，P=0.011） and larger amount of perioperative red blood cell transfusion（OR=1.11，P<0.001）. Univariate and multivariate Cox regression model analysis showed that the risk factors for follow-up death were lower preoperative albumin level（HR=0.90，P=0.028），use of intra-aortic balloon pump（HR=7.38，P=0.003） and postoperative AKI（HR=2.88，P=0.006）.Conclusion Lower preoperative platelet count and larger amount of perioperative red blood cell transfusion might increase the risk of AKI after heart valve surgery in elderly patients ≥ 65 years old，and postoperative AKI could increase in-hospital mortality and follow-up mortality.

Abstract:Objective To study the clinical characteristics and influencing factors of obstructive sleep apnea hypopnea syndrome （OSAHS） and chronic obstructive pulmonary disease（COPD） with the emphysematous phenotype，namely COPD-OSAHS overlap syndrome，so as to provide understanding and guidance for clinical practice.Methods A retrospective case-control study was conducted on 301 patients with OSAHS admitted to The Second Affiliated Hospital of Kunming Medical University from March 2015 to June 2022. The COPD-OSAHS overlap syndrome group was divided into two groups：COPD patients with the emphysematous phenotype and non-emphysematous phenotype according to Goddard's classification criteria. The demographic data，pulmonary function，night polysomnography monitoring indexes，chest imaging parameters，complications，and other characteristics were compared separately. Partial correlation analysis and logistic regression were used to analyze the influencing factors of OSAHS with COPD with the emphysematous phenotype.Results There were statistically significant differences in sex，smoking，dyspnea，BMI，apnea hypopnea index（AHI），Infiltrated% and Collapsed% in the COPD-OSAHS overlap syndrome with emphysematous phenotype patients compared with the simple OSAHS group and non-emphysematous phenotype group（all P<0.05）. And pulmonary artery pressure，TS₈₅ and oxygen desaturation index（ODI） between COPD-OSAHS overlap syndrome patients with emphysematous phenotype and non-emphysematous phenotype were statistically significant（all P<0.05）. The incidence of pulmonary heart disease，atrial fibrillation and lower limb edema was higher in COPD-OSAHS overlap syndrome patients with non-emphysematous phenotype group. The results of correlation analysis showed that BMI，smoking index，AHI，TS₈₅，ODI，Infiltrated%，Collapsed% were negatively correlated with LAA%（r =-0.434，-0.254，-0.439，-0.327，-0.336，-0.756，-0.609），with statistical significance（all P<0.05）. In the logistic regression analysis of the related factors of COPD patients with emphysematous phenotype and OSAHS patients，BMI（OR=0.891，95%CI=0.807-0.984），AHI（OR=0.948，95%CI=0.918-0.979），Collapsed%（OR=0.406，95%CI=0.265-0.623） were the main influencing factors（all P<0.05）.Conclusion Compared with the simple OSAHS group and non-emphysematous phenotype group，COPD-OSAHS overlap syndrome with emphysematous phenotype patients have a larger proportion of males，smoking，dyspnea，lower index of BMI and AHI，less collapse% in both lungs，and higher pulmonary artery pressure，more cough and expectoration，more complicated with pulmonary heart disease，atrial fibrillation，lower limb edema and longer hypoxia time in COPD-OSAHS overlap syndrome with non-emphysematous phenotype compared with simple OSAHS. And BMI，AHI and Collapsed% are the main influencing factors in patients with COPD with the emphysematous phenotype and OSAHS.

Abstract:Objective To establish a risk prediction model of anal incontinence after complex anal fistula surgery and evaluate its effect.Methods The data of 195 patients with complex anal fistula admitted to the Anorectal Department of The People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from January 2020 to May 2021 were analyzed retrospectively. According to the symptoms of postoperative anal incontinence，the patients with CCFIS score ≥ 2 points were divided into anal incontinence group （42 cases），and the patients with CCFIS score<2 points were divided into normal function group（153 cases）. Univariate and logistic regression analysis was carried out in combination with the general situation of patients， fistula nature， anorectal manometry measurement results，surgical methods and other variables.Results The incidence of postoperative anal incontinence was 21.54%，and the average score of CCFIS was 3.40±1.170. Logistic regression analysis showed that the fistula type was supra-sphincter fistula（OR=1.024，95%CI=0.405–2.585，P=0.025），previous anal fistula surgery > 1 time in the past（OR=16.224，95%CI=3.291–29.977，P=0.001），low resting pressure（OR=0.909，95%CI=0.869–0.952，P=0.000），and the operation method was cutting seton（OR=1.389，95%CI=1.044–1.848，P=0.024），which were independent risk factors of the anal incontinence after complex anal fistula surgery（P<0.05）. According to the screened independent risk factors，the prediction model was constructed and the ROC curve was drawn. The area under the curve（AUC） was 0.879（95%CI=0.818-0.939，P<0.001），suggesting a good prediction value of the model.Conclusion The prediction model established by independent risk factors has high accuracy， and provides a good reference for the formulation of clinical treatment plan for complex anal fistula.

Abstract:Objective To investigate the pregnancy outcomes and ultrasonic changes of cervical length in patients with cervical incompetence（CI） after laparoscopic cervical cerclage（LAC） and transvaginal cervical cerclage（TVC） during pregnancy，and to further explore the indications of laparoscopic cerclage.Methods We retrospective analyzed the data of 115 patients who underwent cervical cerclage in our hospital due to CI during pregnancy from June 2016 to February 2022. Among them，there were 65 patients who underwent LAC（LAC group），35 patients with previous TVC failure，and 30 patients with previous cervical conization；there were 50 patients who underwent TVC（TVC group），none of which had previous TVC failure， and 20 patients had previous cervical conization. Pregnancy outcomes，intraoperative conditions，postoperative complications and cervical length measured by ultrasound during pregnancy were compared between the two groups.Results The previous TVC failure rate in LAC group was significantly higher than that in TVC group （53.8% vs. 0.0%，P<0.05），and there were no statistically significant differences in the rate of previous cervical conization between the two groups（46.1% vs. 40.0%，P>0.05）. The full-term delivery rate， neonatal survival rate，gestational weeks of delivery and postoperative prolongation of gestational weeks［83.0%，100.0%，（36.5±4.0） weeks，（17.0±4.2） weeks］ in LAC group were significantly higher than those in TVC group［44.0%，76.2%，（32.0±5.2） weeks，（13.2±4.3）weeks］（P<0.05）. The rates of premature birth and inevitable abortion in TVC group（40.0%，16.0%） were significantly higher than those in LAC group（12.3%，4.6%）（P<0.05）. There were no postoperative complications in the LAC group，but 8 cases （16.0%） in the TVC group，including 1 case of cervical laceration and 7 cases of postoperative infection. The incidence of postoperative complications in the TVC group was higher than that in the LAC group（P<0.05）. The cervix length prior to surgery was similar in both groups. After cervical cerclage placement，there was a statistical difference in the distance between the tape and the external cervical orifice between the two groups［LAC group：（28.7±4.6） mm vs. （12.3±4.2） mm，P<0.05］. During pregnancy，the cervical length was significantly shortened in the TVC group［from （25.0±2.0） mm before surgery to （12.0±4.5） mm at delivery，P<0.05］，while in the LAC group，the cervical length remained unchanged.Conclusion In patients with CI during pregnancy，LAC is safe and effective，and its pregnancy outcomes are better than those of TVC，possibly because LAC can better preserve the length of the cervix throughout pregnancy as compared to TVC. LAC is recommended as the first choice for patients with previous TVC failure and a short cervix after previous cervical conization.

Abstract:Objective To assess the repeatability of shear wave elastography（SWE） in the measurement of cervical Young's modulus in healthy childless women of childbearing age.Methods SWE was performed twice on the cervix of 100 healthy childless women of childbearing age on the same day and at different time points by the same senior physician who had received SWE testing training. The cervical Young's modulus value in healthy childless women of childbearing age was obtained by measuring the following four sites of cervix：anterior lip of the inner mouth（IA），posterior lip of the inner mouth（IP），anterior lip of the outer mouth（EA） and posterior lip of the outer mouth（EP）. Interclass correlation coefficient（ICC） was used to evaluate the intra-group repeatability，and Bland-Altman scatter plot was performed to assess the consistency of the measurement.Results There were no statistical significances between the two measurements of the four sites of cervix（P>0.05）. The intra -group correlation coefficients of Young's modulus at IA，EA and EP were 0.828，0.785 and 0.768 respectively，indicating quite satisfactory repeatability. The intra-group correlation coefficient of Young's modulus at IP was 0.632，indicating satisfactory repeatability. And Bland-Altman scatter plot indicated preferable intra-group consistency of Young's modulus measured by SWE at four sites of cervix.Conclusion SWE can be used to measure cervical hardness，and has good repeatability and consistency at different sites of cervix.

Abstract:Objective To compare whether intermittent use of rifaximin in clinical practice is no less effective than regular dosing in preventing recurrence of hepatic encephalopathy（HE） and whether rifaximin treatment before and after reduces the number of patients hospitalized for HE and all-cause illness.Methods The study was a single-center prospective case-control study in which enrolled HE patients were divided into 2 groups according to different dosing regimens，with a minimum duration of 4 weeks，including intermittent dosing group（rifaximin 400 mg tid， 2 days a week），with 30 patients，18 of whom were treated for 3 months；regular dosing group （rifaximin 400 mg tid， daily），with 25 patients，24 of whom were treated for 3 months. The differences in HE and all-cause hospitalization between the two groups were compared at different dosing times and before and after dosing.Results There was no statistically significant difference in the probability of hospitalization for HE and all-cause hospitalization in the intermittent dosing group compared to the regular dosing group at 4 weeks of dosing（P>0.05）， and there was either no statistically significant difference in the number of hospitalizations for HE and all-cause hospitalization at 3 months of dosing（P>0.05）. The mean times of hospitalizations for HE ［（0.52±0.86） vs. （1.12±1.04），P=0.000］ and all-cause hospitalizations［（0.90±0.98） vs. （1.60±1.08），P=0.000］ were reduced in the 3 months following rifaximin administration compared to the 3 months prior to administration. Subgroup analysis revealed a statistically significant difference in the number of hospitalizations for he and all-cause hospitalizations in both the intermittent and regular dosing groups at 3 months after dosing compared to 3 months before dosing（P<0.05）. Patients in the regular dosing group had a higher proportion of stools containing fungi（4/7 vs. 1/10），but the difference was not statistically significant（P=0.101）.Conclusion Intermittent use of rifaximin for the prevention of HE is non-inferior to regular use. Both intermittent and regular use of rifaximin can reduce the number of patients hospitalized for HE and all-cause hospitalization after dosing. Long-term use in the clinic requires caution about the risk of fungal infection.

Abstract:Objective To compare and analyze the hemodynamics and cardiac ultrasound indexes before and after operation in patients with patent ductus arteriosus（PDA） complicated with severe pulmonary artery hypertension（PAH） who have undergone interventional treatment，so as to explore the correlation of pulmonary to systemic flow ratio（Qp/Qs） with pulmonary artery pressure change and cardiac structure recovery and predictive value of Qp/Qs after interventional treatment of such patients.Methods A total of 33 PDA patients complicated with PAH who had undergone interventional occlusion were divided into group A（Qp/Qs≥2.5） and group B（Qp/Qs<2.5） according to the preoperative Qp/Qs. The hemodynamic parameters obtained by cardiac catheterization before and after the operation were collected， and the results of transthoracic echocardiography（TTE） before and after the operation were recorded. The two groups were compared and analyzed.Results ①There was no difference in systolic pressure of pulmonary artery（sPAP） and mean pressure of pulmonary artery（mPAP） between the two groups before operation. Immediately after operation，the sPAP and mPAP in group A were lower than those in group B. ②The left ventricular end diastolic diameter index（LVEDDI），left atrial diameter index（LAI） and pulmonary artery diameter index（PAI） in group A were lower than those before operation at 48 hours，1 month and 3 months after operation，while only PAI and LVEDDI in group B were lower than those before operation at 3 months after operation. There was no difference in right ventricular end diastolic diameter index（RVEDDI） between the two groups before operation， and group A was lower than group B 3 months after operation. ③Five patients with immediate residual severe PAH occurred in group B. Among them，targeted drug therapy was significantly effective in 1 patient.Conclusion ①For PDA patients with severe PAH，the greater the Qp/Qs ratio，the more obvious the recovery of pulmonary artery pressure and cardiac structure after operation. ②Qp/Qs has a certain predictive value for the immediate residual severe PAH in these patients.

Abstract:Objective Caudal block，characterized by simple operation，small injury，rapid onset and definite anesthetic effect，is a common anesthesia method for children and adults undergoing lower extremity，urinary system or anorectal surgery. Intravenous dexmedetomidine（IV-DEX） is a commonly used sedative method during regional anesthesia，but it also shows synergistic effect on local anesthetics. This study aims to examine whether IV-DEX reduces the median effective concentration（EC₅₀） of local anesthetics for caudal block.Methods Sixty patients scheduled for elective hemorrhoidectomy were enrolled in the study and divided into intravenous-normal saline（IV-NS） group and IV-DEX group. In IV-NS group and IV-DEX group，20 mL saline and 1 μg/kg dexmedetomidine （diluted to 20 mL） were intravenously infused 15 min before caudal block， respectively. The EC₅₀ of ropivacaine for caudal block was determined by Dixon-Massey “up and down” sequential assignment method. Vital signs，hypotension， bradycardia，and other intraoperative adverse events requiring medical treatment were recorded.Results The EC₅₀ of ropivacaine for caudal block in IV-NS group was 0.280%，and that in IV-DEX group was 0.233%（P<0.05）. Compared with the IV-NS group，the EC₅₀ of ropivacaine in the IV-DEX group was decreased by 16.8%（P=0.000），and the difference was statistically significant. The incidence of hypotension，bradycardia，and other adverse events requiring medical treatment had no difference between the two groups.Conclusion IV-DEX can reduce the EC₅₀ of ropivacaine for caudal block，but it may lead to an increase in the incidence of hypotension and bradycardia. Therefore，the optimal synergistic dose of IV-DEX with local anesthetics still needs to be further explored.