Background: Lactulose is recommended as secondary prophylaxis after the initial episode and rifaximin as an add-on to lactulose for preventing recurrent episodes of hepatic encephalopathy (HE) after the second episode. However, the relative merits of rifaximin vs nonabsorbable disaccharides (NADs) on overt and minimal HE (MHE) are debated.Aim: This study aimed to perform a meta-analysis of randomised controlled trials (RCTs) on rifaximin vs NADs in HE.Methods: Electronic and manual searches were performed. The results presented as risk ratios or standardised mean difference with 95% confidence intervals. Sensitivity analyses were performed to evaluate the risk of bias and sources of heterogeneity. Results:In total, 8 RCTs were included, and only 7 RCTs with 386 patients were merged for meta-analysis. Meta-analyses showed that rifaximin appears better at reducing the blood ammonia levels compared with NADs, and that both rifaximin and NADs were well tolerated with few adverse effects. There were however, no significant differences in clinical efficacy or ability to reverse MHE between the two treatments. Most of the included studies were of low quality with a high risk of bias, leading to a low statistical power. Conclusions:Rifaximin had a beneficial effect on blood ammonia levels compared with NADs, and both rifaximin and NADs have good tolerance. However, no difference in the clinical efficacy and MHE reversal was observed between them.

Background Unruptured sinus of valsalva aneurysm (SOVA) are typically asymptomatic, and hence can be easily ignored. Ruptured sinus of valsalva aneurysm (RSOVA) usually protrude into the right atrium or ventricular. However, in this case, the RSOVA protruded into the space between the right atrium and the visceral pericardium leading to compression of the right proximal coronary artery. Very few such cases have been reported till date. Case presentation We describe a case of ruptured right SOVA in a 61-year-old man with syncope and persistent hypotension. At the beginning, considered the markedly elevated troponin, acute myocardial infarction was considered. However, emergency coronary angiography unexpectedly revealed a large external mass compressed right coronary artery (RCA) resulting in severe proximal stenosis. Then, aorta computed tomography angiography (CTA) and urgent surgery confirmed that the ruptured right SOVA led to external compression of the right proximal coronary artery. Finally, ruptured right SOVA repair and RCA reconstruction were successfully performed, and the patient was discharged with no residual symptoms. Conclusions It is very important to be vigilant about the existence of SOVA. RSOVA should be suspected in a patient presenting with acute hemodynamic compromise, and echocardiography should be immediately performed. Moreover, it is very important to achieve dynamic monitoring by using cardiac color ultrasound. Definitive diagnosis often requires cardiac catheterization, and an aortogram should be performed unless endocarditis is suspected.

Background: Hemoptysis after silicone breast prosthesis surgery has not been reported so far, and the mechanism is unclear. Case presentation: A 25-year-old young woman presented hemoptysis after silicone breast prosthesis replacement surgery. CTA revealed diffuse interstitial, alveolar, and terminal bronchial exudate changes in absent of pulmonary embolism. Noninvasive ventilator assisted breathing, combined with atomized inhalation of budesonide 2ml every 8h and intravenous infusion of hydrocortisone 100mg every 12h. Chest CT improved significantly 3 days later, and discharged 10 days later. Conclusions: Diffuse alveolar hemorrhage might be the cause of hemoptysis after silicone breast augmentation, and glucocorticoid treatment is very effective. However, if pulmonary imaging suggested diffuse pulmonary hemorrhage, BAL and lung biopsy should be performed to confirm the clinical diagnosis before treatment.

China is gradually becoming an aging society, and the necessity for prehospital first-aid care is increasing. However, there is a long-term information blind spot in traditional prehospital first-aid care. Fifth-generation (5G) network has the advantages of enhanced broadband, multiple connections, and low latency. Combined with the current prehospital first-aid system, the 5G smart medical prehospital first-aid care model creates a new opportunity for the development of prehospital first-aid care. This paper aimed to describe the 5G smart first-aid care platform and offers practical insights into the construction and application of the 5G smart first-aid care platform in small- and medium-sized cities. We first introduced the working principle of the 5G smart first-aid care platform and then chose patients with prehospital chest pain as an example to describe the whole workflow in detail. The application of the 5G smart emergency-care platform is at the stage of pilot exploration in large- and medium-sized cities. Big data statistical analysis of the completed first-aid care tasks has not been performed yet. The 5G smart first-aid care platform realizes real-time interconnection of information between the ambulance and the hospital, performs remote consultation, shortens the treatment time, and enhances treatment efficiency. Future research should focus on quality control analysis of the 5G smart first-aid care platform.