Comparison of the effects of esketamine, sufentanil, or lidocaine combined with propofol on tussis reflection during upper gastrointestinal endoscopy: study protocol for a randomised, two centre, three-blind, controlled trial.

BACKGROUND: Tussis, which increases the incidence of airway spasm, aspiration, nausea, and vomiting, is a common complication faced during upper gastrointestinal (GI) endoscopy. However, sedatives and analgesics exhibit inhibitory actions against airway reflexes to different degrees. Our assumption is a combination of propofol and small doses of sufentanil, esketamine, or lidocaine, especially the combination of propofol and esketamine, might reduce tussis incidence. METHOD: The study will be performed as a randomised controlled three-blind, two-centre trial. Patients undergoing upper GI endoscopy, ≥ 18 years old, with American Society of Anesthesiologists (ASA) classification I-III will be randomised to four groups: P group (single administration of propofol), P + S group (administration of propofol and sufentanil in combination), P + K group (administration of propofol and esketamine in combination), and P + L group (administration of propofol and lidocaine in combination) (N = 100 per group). The primary endpoints include the frequency of tussis, nausea and vomiting, and/or body movements observed at the insertion of the endoscope into the pharyngeal cavity or within 5 min of endoscope insertion. Secondary outcomes are recovery assessment, patients' and endoscopists' satisfaction with the procedure, MMSE scores, MET scores, sleep condition, and the number of sedation-related events. Data on sedation-related events are collected by recording of vital signs. Satisfaction parameters and mental states are collected by means of questionnaires and evaluation scales before and after the procedure and on different following days. DISCUSSION: Esketamine can reduce tussis occurrence with good tolerability and relax the bronchus and also provides high clearance rates and low possibility of adverse reactions. We aim to demonstrate that the combination of esketamine with propofol for sedation in patients subjected to upper GI procedure is nevertheless superior to only administration of propofol or a combination of propofol with other anaesthetics, such as opioids or lidocaine. TRIAL REGISTRATION: ClinicalTrials.gov. NCT05497492 , Registered 09 August 2022.

[Necessity of prophylactic contralateral nephroureterectomy in the renal transplantation patients with transitional cell carcinoma of unilateral upper urinary tract].

OBJECTIVE: To discuss the necessity of prophylactic contralateral nephroureterectomy in renal transplantation patients with upper urinary tract transitional cell carcinoma (TCC). METHODS: In our study 15 renal transplantation patients with upper urinary tract TCC were involved from Dec.2006 to May 2013. All the patients received prophylactic contralateral nephroureterectomy 3 months after their last nephroureterectomy. A retrospective analysis was performed. RESULTS: TCC of upper urinary tract was confirmed by postoperative pathology in all the 15 cases .Similarly, TCC of contralateral upper urinary tract was detected in 7 of these cases (46.7%), and 13 survived after 36 months' follow-up (86.7%). CONCLUSION: In the renal transplantation patient with unilateral upper urinary tract TCC, the possibility of contralateral upper urinary tract TCC is high, thus the necessity of prophylactic contratateral nephroureterectomy is certain.

[Differential Responses of Rhizospheric nirK- and nirS-type Denitrifier Communities to Different Phosphorus Levels in Paddy Soil].

Phosphorus is an essential life element, which can affect the activities and functions of denitrifiers. Both nirK and nirS genes can code nitrite reductase; however, it remains unclear whether nirK- and nirS-containing denitrifers respond differentially to changes in the availability of phosphorus in paddy soil. In this study, P-deficient paddy soil was used to grow rice plants. Three phosphorus levels established by applying P fertilizer at a rate of 0 mg·kg-1 (CK), 15 mg·kg-1 (P1), and 30 mg·kg-1(P2), respectively. The abundance and community structure of nirK- and nirS- containing denitrifers were determined using quantitative PCR and high-throughput sequencing techniques. Results indicated that nirK- and nirS-containing communities responded differentially to changes in the P levels. The nirS-containing communities are more sensitive to the changes in P in both rhizosphere and bulk soil samples. In addition, the abundance of nirS genes was 2-3 times higher in the P2 treatment than in the CK treatment. Furthermore, the nirS community structure is also clearly differed from the CK treatment. However, P addition only induced partial modification of the community structure and abundance of nirK-containing denitrifiers. Moreover, compared to the bulk soil with each phosphorus level, the nirS community structure in the rhizosphere soil changed significantly; however, only the P2 treatment induced significant increases in the abundance of the nirS gene. In contrast, no significant differences in the abundance and composition of nirK-containing denitrifers were detected between rhizosphere and bulk soils under different phosphorus levels. Collectively, application of phosphate fertilizer in P-deficient paddy soil could significantly increase the abundance of nirK- and nirS-containing denitrifiers, changing their community structures, with nirS-type showing a greater sensitivity than nirK-type denitrifiers. In comparison, the denitrifying communities in the rhizosphere were more sensitive to variable P levels than that in the bulk soil. Compared to bulk soils, rice growth shifted the community structure of nirS- and nirK-containing denitrifiers in rhizosphere soils at each level of P, but failed to induce significant changes in their abundance (except for P2) that could cause a significant increase in nirS abundance. These results could provide a theoretical basis for exploring the effects of fertilization on soil denitrification.

Effects of rice straw mulching on N2O emissions and maize productivity in a rain-fed upland.

In the hilly areas of southern China, uplands and paddies are located adjacent to each other. Using rice straw as mulch for upland soil may improve crop production and partially replace chemical fertilizers, which may mitigate N2O emissions. A field experiment was conducted to investigate the potential of rice straw mulching for mitigating N2O emissions and increasing crop production. The treatments included no mulching (CK), 5000 kg ha-1 of straw mulching (SM5), and 10,000 kg ha-1 of straw mulching (SM10). Moreover, all the treatments received equivalent amounts of nitrogen, phosphorus, and potassium from chemical fertilizers plus rice straw. Relative to CK, cumulative N2O emissions decreased by 23.1 and 33.5% with SM5 and SM10, respectively. Significant positive correlations were observed between N2O fluxes and soil water-filled pore space (WPFS) (r 2 = 0.495, P < 0.05) and between seasonal cumulative N2O fluxes and the chemical N fertilization rate (r 2 = 0.814, P < 0.05). These findings indicate that soil WPFS was the key environmental factor in N2O emissions and that the substitution of chemical nitrogen fertilizer with rice straw was the main driver of N2O mitigation. Relative to CK, the maize yield increased by 16.5 and 29.6% with SM5 and SM10, respectively, which can be attributed primarily to the increases in soil moisture. The chemical fertilizer input could be decreased and N2O emissions could be mitigated through straw mulching, while achieving improved crop yield. This management strategy has great potential, and this study provides an important reference for low-carbon agriculture.

Comparison of two supplement oxygen methods during gastroscopy with intravenous propofol anesthesia in obese patients: study protocol for a randomized controlled trial.

BACKGROUND: Hypoxemia is a major complication in obese patients undergoing gastrointestinal endoscopy under intravenous anesthesia or sedation due to altered airway anatomy. We design this randomized controlled trial (RCT) to compare efficacy and safety of the Wei nasal jet tube (WNJT) and nasal prongs for supplement oxygen during gastroscopy with intravenous propofol anesthesia in obese patients. METHODS: The study will be a single-center, prospective RCT. A total of 308 obese patients will be recruited and randomly assigned to receive either the WNJT (group A) or nasal prongs (group B). During gastroscopy with intravenous propofol anesthesia, 5 L/min of oxygen will be delivered through the jet port of the WNJT in the group A and via the nasal prongs in the group B. The primary outcome is the incidence of hypoxemia and severe hypoxemia. The secondary outcomes are adverse events during the gastroscopy, postoperative complications, and satisfaction of the anesthetist, physician, and patient. DISCUSSION: This RCT aims to clarify whether the WNJT can result in reduced incidences of hypoxemia and complications and provide improved satisfaction to the anesthetist, physician, and patient. Thus, it can be determined if the WNJT is a useful tool for supplement oxygen in obese patients undergoing gastroscopy with intravenous propofol anesthesia. The results will provide the evidence for anesthesiologists to make a decision regarding the choice of supplementary oxygen methods in this condition. TRIAL REGISTRATION: Chinese Clinical Trial, ChiCTR-IOR-17013089 . Registered on 23 October 2017.

Water consumption, grain yield, and water productivity in response to field water management in double rice systems in China.

Rice cultivation has been challenged by increasing food demand and water scarcity. We examined the responses of water use, grain yield, and water productivity to various modes of field water managements in Chinese double rice systems. Four treatments were studied in a long-term field experiment (1998-2015): continuous flooding (CF), flooding-midseason drying-flooding (F-D-F), flooding-midseason drying-intermittent irrigation without obvious standing water (F-D-S), and flooding-rain-fed (F-RF). The average precipitation was 483 mm in early-rice season and 397 mm in late-rice season. The irrigated water for CF, F-D-F, F-D-S, and F-RF, respectively, was 263, 340, 279, and 170 mm in early-rice season, and 484, 528, 422, and 206 mm in late-rice season. Grain yield for CF, F-D-F, F-D-S, and F-RF, respectively, was 4,722, 4,597, 4,479, and 4,232 kgha-1 in early-rice season, and 5,420, 5,402, 5,366, and 4,498 kgha-1 in late-rice season. Compared with CF, F-D-F consumed more irrigated water, which still decreased grain yield, leading to a decrease in water productivity by 25% in early-rice season and by 8% in late-rice season. Compared with F-D-F, F-D-S saved much irrigated water with a small yield reduction, leading to an increase in water productivity by 22% in early-rice season and by 26% in late-rice season. The results indicate that CF is best for early-rice and FDS is best for late-rice in terms of grain yield and water productivity.