Analgesic Effect of Esketamine Combined with Tramadol for Patient-Controlled Intravenous Analgesia After Cesarean Section: A Randomized Controlled Trial.

Purpose: High rate of cesarean section (CS) bring challenges to analgesic management after CS. Previous studies state that adjuvant treatment with a low dose of esketamine intraoperatively could reduce postoperative pain and opioid consumption, and even prevent postpartum depression. However, few researches involve in patient-controlled intravenous analgesia (PCIA) with esketamine after CS. In this trial, we explored a new combination of esketamine with tramadol for PCIA after CS with the aim to provide a better analgesic regimen for use in the clinic. Patients and Methods: 170 puerperae undergoing CS were recruited for this trial and randomly assigned into 2 groups (1:1): The control group received a formula of PCIA with butorphanol 0.1mg/kg and tramadol 400mg postoperatively, while the intervention group received a formula of PCIA with esketamine 1mg/kg and tramadol 400mg. The primary outcome was the mean numerical rating scale (NRS) scores at rest, sitting, and uterine contraction at 6 hours postoperatively. The second outcomes included the mean NRS scores at rest, sitting, and uterine contraction at 12, 24, and 48 hours postoperatively. The incidence of adverse events, postoperative sedation, postoperative sleep quality, maternal satisfaction regarding postoperative analgesia and the Edinburgh postnatal depression scale (EPDS) score were also be evaluated. Results: The mean (SD) of the mean NRS scores at rest, sitting, and during uterine contraction at 6 hours postoperatively were 4.8 (0.7) points in the intervention group and 5.3 (0.5) points in the control group. The estimated mean difference between the two groups at 6 hours postoperatively was -0.5 points (95% confidence interval [CI], -0.7 to -0.3; P < 0.001). Compared with the control group, the patients in the intervention group had a significantly lower mean pain intensity at 12 and 24 hours postoperatively (-0.5 points [95% CI, -0.6 to -0.3]; P < 0.001 and -0.2 points [95% CI, -0.4 to 0]; P = 0.019 respectively). Otherwise, differences at 48 hours after surgery between the two groups were nonsignificant (0 points [95% CI, -0.2 to 0.2]; P = 0.802). The incidence of adverse events in the intervention group (11.8%) was significantly lower than in the control group (24.7%) (ratio difference -12.9, [95% CI, -24.3 to -1.5]; P = 0.029). No difference was found in postoperative sleep quality (P = 0.765), analgesic satisfaction (P= 0.818) and EPDS scores (P = 0.154) between the two groups. Conclusion: In this trial, among patients undergoing CS, esketamine combined with tramadol by PCIA improved pain intensity 6 hours postoperatively compared with butorphanol combined with tramadol.

Bacterial seed endophyte and abiotic factors influence cadmium accumulation in rice (Oryza sativa) along the Yangtze River area.

Cadmium (Cd) contamination in rice (Oryza sativa) is particularly problematic due to its high risk to human health. Investigating the hidden roles of seed endophytes of rice in influencing Cd accumulation is essential to comprehensively understand the effects of biotic and abiotic factors to food security. Here, the content of Cd in soils and rice (Huanghuazhan) seeds from 19 sites along the Yangtze River exhibited considerable differences. From a biotic perspective, we observed the dominant endophytic bacteria, Stenotrophomonas (7.25 %), contribute to Cd control of rice (below 0.2 mg kg-1). Partial Least Squares (PLS) analysis further suggested that Enterobacteriaceae (15.48 %), altitude and pH were found to be the strong variables that might reduce the Cd uptake of rice. In contrast, Cytophagaceae (0.58 %), latitude and mean annual air pressure had the opposite effect. In pot experiments, after respectively inoculating the isolated endophytic bacteria Stenotrophomonas T4 and Enterobacter R1, N1 (f_Enterobacteriaceae), the Cd contents in shoot decreased by 47.6 %, 21.9 % and 33.0 % compared to controls. The distribution of Cd resistant genes (e.g., czcABC, nccAB, cznA) of Stenotrophomonas, Enterobacteriaceaea and Cytophagaceae further suggested their distinct manners in influencing the Cd uptake of rice. Overall, this study provides new insights into the food security threatened by globally widespread Cd pollution.

Community-based mechanisms underlying the root cadmium uptake regulated by Cd-tolerant strains in rice (Oryza sativa. L).

In recent years, the problem of Cd pollution in paddy fields has become more and more serious, which seriously threatens the safe production of food crops and human health. Using microorganisms to reduce cadmium pollution in rice fields is a green, safe and efficient method, the complicated interactions between the microbes in rice roots throughout the process of cadmium absorption by rice roots are poorly understood. In this investigation, a hydroponic pot experiment was used to examine the effects of bacteria R3 (Herbaspirillum sp) and T4 (Bacillus cereus) on cadmium uptake and the endophytic bacterial community in rice roots. The results showed that compared with CK (Uninoculated bacterial liquid), the two strains had significant inhibitory or promotive effects on cadmium uptake in rice plant, respectively. Among them, the decrease of cadmium content in rice plants by R3 strain reached 78.57-79.39%, and the increase of cadmium content in rice plants by T4 strain reached 140.49-158.19%. Further investigation showed that the cadmium content and root cadmium enrichment coefficient of rice plants were significantly negatively correlated with the relative abundances of Burkholderia and Acidovorax, and significantly positively correlated with the relative abundances of Achromobacter, Agromyces and Acidocella. Moreover, a more complex network of microbes in rice roots inhibited rice plants from absorbing cadmium. These results suggest that cadmium uptake by rice plants is closely related to the endophytic bacterial community of roots. This study provides a reference scheme for the safe production of crops in cadmium contaminated paddies and lays a solid theoretical foundation for subsequent field applications.

Renal­rotation techniques in retroperitoneoscopic adrenalectomy for giant pheochromocytomas: a clinical intervention study with historical controls.

BACKGROUND: Dealing with the giant pheochromocytomas (maximum diameter ≥ 6 cm) has long been a tough challenge for urologists. We introduced a new retroperitoneoscopic adrenalectomy method modified with renal-rotation techniques to treat giant pheochromocytomas. METHODS: 28 diagnosed patients were prospectively recruited as the intervention group. Meanwhile, by referring to the historical records in our database, matched patients who had undergone routine retroperitoneoscopic adrenalectomy (RA), transperitoneal laparoscopic adrenalectomy (TA), or open adrenalectomy (OA) for giant pheochromocytomas were selected as controls. Perioperative and follow-up data were collected for comparative assessment. RESULTS: Among all the groups, the intervention group had the minimal bleeding volume (28.93 ± 25.94 ml, p < 0.05), the least intraoperative blood pressure variation (59.11 ± 25.68 mmHg, p < 0.05), the shortest operation time (115.32 ± 30.69 min, p < 0.05), the lowest postoperative ICU admission rates (7.14%, p < 0.05), and shortest drainage time length (2.57 ± 0.50 days, p < 0.05). Besides, compared with TA and OA groups, intervention group was also characterized by lower pain scores (3.21 ± 0.63, p < 0.05), less postoperative complications (p < 0.05), earlier diet initiation time (1.32 ± 0.48 postoperative days, p < 0.05) and ambulation time (2.68 ± 0.48 postoperative days, p < 0.05). Follow-up blood pressure and metanephrine and normetanephrine levels in all intervention group patients remained normal. CONCLUSION: Compared with RA, TA, and OA, retroperitoneoscopic adrenalectomy with renal-rotation techniques is a more feasible, efficient, and secure surgical treatment for giant pheochromocytomas. TRIAL REGISTRATION: This study has been prospectively registered on the Chinese Clinical Trial Registry website (ChiCTR2200059953, date of first registration: 14/05/2022).

Developing a predictive model for clinically significant prostate cancer by combining age, PSA density, and mpMRI.

PURPOSE: The study aimed to construct a predictive model for clinically significant prostate cancer (csPCa) and investigate its clinical efficacy to reduce unnecessary prostate biopsies. METHODS: A total of 847 patients from institute 1 were included in cohort 1 for model development. Cohort 2 included a total of 208 patients from institute 2 for external validation of the model. The data obtained were used for retrospective analysis. The results of magnetic resonance imaging were obtained using Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1). Univariate and multivariate analyses were performed to determine significant predictors of csPCa. The diagnostic performances were compared using the receiver operating characteristic (ROC) curve and decision curve analyses. RESULTS: Age, prostate-specific antigen density (PSAD), and PI-RADS v2.1 scores were used as predictors of the model. In the development cohort, the areas under the ROC curve (AUC) for csPCa about age, PSAD, PI-RADS v2.1 scores, and the model were 0.675, 0.823, 0.875, and 0.938, respectively. In the external validation cohort, the AUC values predicted by the four were 0.619, 0.811, 0.863, and 0.914, respectively. Decision curve analysis revealed that the clear net benefit of the model was higher than PI-RADS v2.1 scores and PSAD. The model significantly reduced unnecessary prostate biopsies within the risk threshold of > 10%. CONCLUSIONS: In both internal and external validation, the model constructed by combining age, PSAD, and PI-RADS v2.1 scores exhibited excellent clinical efficacy and can be utilized to reduce unnecessary prostate biopsies.

Integrated network analysis reveals that exogenous cadmium-tolerant endophytic bacteria inhibit cadmium uptake in rice.

Most previous studies have focused on the diversity and species richness of microbial communities, however, understanding the interactions between species and detecting key functional members of the community can help us better understand how microorganisms perform their functions. In this study, the response of the rice plant microbial community to the inoculation of cadmium-resistant endophytic bacterium R5 (Stenotrophomonas) was investigated for the first time using a microbial phylogenetic molecular ecological network. The results showed that inoculation of R5 changed the topological characteristics of the microbial network in rice plants, with the resulting network displaying stronger complexity and interaction in roots and aboveground parts, indicating that inoculation of R5 provided favorable conditions for microbial interactions. In addition, these interactions may be related to the absorption and transportation of cadmium by rice. Under the exogenous addition of R5, the network interactions of the rice plant microbial community were more inclined to cooperation. Both in the roots and aboveground parts of rice, the plant Cd content showed a decrease as the complexity and connectivity of the network increased, suggesting that complex microbial networks may be more beneficial to rice than simple microbial networks because as they were more adaptive and resistant to unfavorable environments. After inoculation with the R5 strain, the negative interaction with Cd content in rice plants increased significantly, and there might be more synergy between the microbial community and plants to jointly inhibit the absorption and transportation of Cd.

Deep tillage reduces the dependence of tobacco (Nicotiana tabacum L.) on arbuscular mycorrhizal fungi and promotes the growth of tobacco in dryland farming.

The traditional shallow tillage method reduces soil quality and affects the efficiency of agricultural production. Using conventional rotary tillage (12 cm) as the control, Yunyan 87 as the test variety, and paddy soil as the test site, we studied the effects of deep tillage (subsoiling 30 cm) on soil nutrients, arbuscular mycorrhizal fungi (AMF), and tobacco (Nicotiana tabacum L.) growth. The results showed that deep tillage increased the content of organic carbon, available phosphorus (AP), and available potassium (AK) in the 20-40 cm soil layer. The AMF community was also affected by deep tillage. Glomus, the dominant genus in both groups, increased significantly in soil after deep tillage. The AMF colonization rate was lower than that of conventional rotary tillage. Deep tillage was beneficial for tobacco growth in the middle and late stages. The root growth and nutrient content of the tobacco plants increased. Deep tillage significantly improved the output value of tobacco plants. Deep tillage is conducive to improving soil fertility, promoting the vigorous growth of roots, reducing the dependence of tobacco on AMF, and promoting the high quality and yield of tobacco in the drylands of Hunan.

Soil Bacterial Community in the Multiple Cropping System Increased Grain Yield Within 40 Cultivation Years.

The shortage of land resources restricts the sustainable development of agricultural production. Multiple cropping has been widely used in Southern China, but whether the continuous planting will cause a decline in soil quality and crop yield is unclear. To test whether multiple cropping could increase grain yield, we investigated the farmlands with different cultivation years (10-20 years, 20-40 years, and >40 years). Results showed that tobacco-rice multiple cropping rotation significantly increased soil pH, nitrogen nutrient content, and grain yield, and it increased the richness of the bacterial community. The farmland with 20-40 years of cultivation has the highest soil organic carbon (SOC), ammonium nitrogen, and grain yield, but there is no significant difference in the diversity and structure of the bacterial community in farmlands with different cultivation years. The molecular ecological network indicated that the stability of the bacterial community decreased across the cultivation years, which may result in a decline of farmland yields in multiple cropping system> 40 years. The Acidobacteria members as the keystone taxa (Zi ≥ 2.5 or Pi ≥ 0.62) appeared in the tobacco-rice multiple cropping rotation farmlands, and the highest abundance of Acidobacteria was found in the farmland with the highest SOC and ammonium nitrogen content, suggesting Acidobacteria Gp4, GP7, GP12, and GP17 are important taxa involved in the soil carbon and nitrogen cycle. Therefore, in this study, the multiple cropping systems for 20 years will not reduce the crop production potential, but they cannot last for more than 40 years. This study provides insights for ensuring soil quality and enhancing sustainable agricultural production capacity.