Objective Lactulose is effective in the treatment and prevention of overt hepatic encephalopathy (OHE), but there are limited data on its use on microbiota in relations to minimal hepatic encephalopathy (MHE) recovery. The present study aimed to assess the efficacy of lactulose in recovery of MHE in aspects of cognitive function, quality of life, and impact on intestinal microbiota. Methods This multicenter, open‐label randomized controlled trial was conducted in 11 teaching hospitals in China. Participants were randomly allocated on a 2:1 basis to receive lactulose (Gp‐L) or no therapy as control (Gp‐NL) for 60 days. The primary endpoint was the MHE reversal rate. Gut microbiota were compared between MHE patients and healthy volunteers, as well as lactulose‐responders and non‐responders. Results A total of 98 cirrhotic patients were included in the study, with 31 patients in the Gp‐NL group and 67 patients in the Gp‐L group. At day 60, the MHE reversal rate in Gp‐L (64.18%) was significantly higher than that in Gp‐NL (22.58%) (P = .0002) with a relative risk of 0.46 (95% confidence interval 0.32‐0.67). Number needed to treat was 2.4. Further, there was significantly more improvement in physical functioning in Gp‐L (4.62 ± 6.16) than in Gp‐NL (1.50 ± 5.34) (P = .0212). Proteobacteria was significantly higher in MHE patients compared with healthy volunteers (12.27% vs 4.65%, P < .05). Significant differences were found between lactulose responders and non‐responders in Actinobacteria, Bacteroidetes, Firmicutes, and Proteobacteria. Conclusions Treatment with lactulose significantly improves MHE recovery rate, and gut microbiota change in MHE patients can modulate the effectiveness of this therapy. Chinese Clinical Trial Register (ChiCTR) (ID: ChiCTR‐TRC‐12002342).

BackgroundLimited information is available on the molecular epidemiology of GII.4 Sydney-associated diarrhea in China in the winter of 2012–13 during the global epidemic associated with the emergence of GII.4 Sydney.MethodsFecal specimens collected from 171 diarrhea outpatients (one from each) between late October 2012 and the middle of March 2013 were examined for NoV by reverse transcription-polymerase chain reaction and sequences corresponding to both the NoV partial polymerase and partial capsid regions were analyzed phylogenetically. Clinical characteristics of GII.4 Sydney cases versus other NoV-positive cases detected in a previous study were compared statistically.ResultsTwenty-six (15.2%, 26/171) outpatients with diarrhea were infected with NoV. Twenty-two of the 26 (84.6%) identified NoV strains clustered into GII.4 Sydney. There was a significant difference in symptoms of fever (χ2, P<0.05 ), abdominal pain (χ2, P<0.05 ) and diarrhea frequency (Mann-Whitney U test, P<0.05) between the GII.4 Sydney case group and other NoV-positive case group.ConclusionsThe new NoV variant, GII.4 Sydney, has been circulating in Beijing, China and became the predominant strain in the winter of 2012–13. GII.4 Sydney causes severe fever, abdominal pain and higher diarrhea frequency clinically compared to other NoV infections.

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This paper shows the development of an approximate analytical solution of radial consolidation by prefabricated vertical drains with a threshold gradient. To understand the effect of the threshold gradient on consolidation, a parametric analysis was performed using the present solution. The applicability of the present solution was demonstrated in two cases, wherein the comparisons with Hansbo’s results and observed data were conducted. It was found that (1) the flow with the threshold gradient would not occur instantaneously throughout the whole unit cell. Rather, it gradually occurs from the vertical drain to the outside; (2) the moving boundary would never reach the outer radius of influence ifR+1<n, whereas it will reach the outer radius of influence at some time; (3) the excess pore pressure will not be dissipated completely, but it will maintain a long-term stable value at the end of consolidation; (4) the larger the threshold gradient is, the greater the long-term excess pore pressure will be; and (5) the present solution could predict the consolidation behavior in soft clay better than previous methods.