First Report of Root-knot Nematode, Meloidogyne enterolobii on Passiflora edulis in Yulin, China.

Passion fruit (Passiflora edulis), a medicinal plant, was introduced into China in the early 19th century, is mainly cultivated in southern provinces (Liang et al. 2019). During March 2023, a survey was carried out and 167 samples were taken from passion fruit cultivated area in Yulin (22.6570263°E; 110.1765019°N) apart from the planting base appeared yellow leaves, stunted growth, and distinctive galls on the roots. Within the galls, Meloidogyne sp. females and egg masses were observed. From the rhizosphere soil, second-stage juveniles (J2) were extracted, and population density was 105/500 g soil. The species was determined to be Meloidogyne enterolobii based on morphological characteristics, including female perineal pattern, and genetic analyses. Female (n = 10) perineal patterns showed oval shape, with coarse and smooth striae, dorsal arch rounded to square, and lateral lines not distinct. The male head cap was high and rounded, with the head region only slightly set off from the body, knobs large, ovoid to rounded. The measurements of males (n = 10) included body length, 1,230.7 ± 244.94 (997 to 1,569) µm; a, 38.58 ± 7.8 (33.45 to 47.05) µm; c, 113.03 ± 26.22 (80.82 to 144.23) µm; stylet, 15.68 ± 1.1 (14.5 to 17.4) µm; spicules, 31.83 ± 2.84 (28.69 to 36.1) µm; tail, 11.09 ± 1.72 (8.02 to 13.38) µm; and gubernaculum length, 8.34 ± 0.28 (8.11 to 8.98) µm. Measurements of J2 (n = 20) included body length, 455.75 ± 44.94 (381 to 512) µm; a, 26.32 ± 3.89 (18.18 to 32.70) µm; c, 8.56 ± 1.2 (6.36 to 10.80) µm; stylet, 12.44 ± 0.76 (11.2 to 13.8) µm; DGO, 3.65 ± 0.54 (2.84 to 4.68) µm; tail, 53.89 ± 6.36 (39.8 to 62.2) µm; and hyaline tail terminus, 11.77 ± 2.83 (7.14 to 16.2) µm. These morphological characteristics are similar to those reported in the original description of M. enterolobii (Yang and Eisenback 1983). The sequences of the partial ITS region was amplified with V5367 (5'-TTGATTACGTCCCTGCCCTTT-3') and 26S (5'-TTTCACTCGCCGTTACTAAGG-3') primers (Vrain et al. 1992). The region between cytochrome oxidase subunit II (COII) and the 16S rRNA mitochondrial DNA (mtDNA COII) was also amplified with the primers C2F3 (5'-GGTCAATGTTCAGAAATTTGTGG-3') (Powers and Harris 1993) and MRH106 (5'-AATTTCTAAAGACTTTTCTTAGT-3') (Stanton et al. 1997). The ITS region yielded a fragment of 757 bp (OR072957) and mtDNA COII of 706 bp (OR078415). A BLAST search indicated the sequences were 100% identical to several sequences of M. enterolobii (MT406250, MH756127 and AY831967, MN269940, respectively). To confirm pathogenicity, 20 passion fruit (P. edulis Sim. f. flavicarpa) 30-day-old seedlings were transplanted into pots with an autoclaved mixture of sand and field soil (3:1) and maintained in the glasshouse at 25 ± 2°C with 65 ± 5% relative humidity. After eight weeks, fifteen plants were inoculated with 500 J2/pot (nematode culture collected from the original field), and another five uninoculated plants served as a control. Two months later, aboveground symptoms were similar to those observed in the field. Nematode reproduction occurred and root galls were observed. The reproduction factor (nematode final population density/initial population density) was 4.8. The disease caused by M. enterolobii was severe in Yulin city of Guangxi. Guangxi is an important area for passion fruit culture, with about 2000 ha, which is responsible for two-thirds of China production (Xing et al. 2020). This is the first record of P. edulis natural infection with M. enterolobii in the Yulin City of Guangxi, China.

[A case of fungal keratitis caused by Petriella setifera infection].

The patient, a 66-year-old male, suffered from redness, blurred vision, photophobia, and tearing in the right eye after being injured by a wooden board. Anti-inflammatory treatment showed poor effectiveness. A 4 mm × 4 mm infiltrate with white deposits on the surface was observed in the central cornea of the right eye. Microscopic examination of corneal scrapings, fungal culture, and in vivo confocal microscopy all indicated fungal infection. The isolated strain was identified as Scedosporium apiospermum through microscopic morphology and confirmed as Petriella setifera by gene sequencing. The patient received corneal debridement combined with routine anti-inflammatory and antifungal treatment in the outpatient clinic. During the follow-up period, the condition continued to improve. Slit lamp examination at the revisit 40 days after the initial diagnosis revealed thinning of the corneal stroma, basic healing of the epithelium, and an increase in uncorrected visual acuity from 0.3 to 0.6.

[Effects of remimazolam versus propofol on postoperative recovery quality in elderly patients undergoing thoracoscopic laparoscopic radical esophagectomy].

Objective: To investigate the effects of remimazolam versus propofol on postoperative recovery quality in elderly patients undergoing thoracoscopic laparoscopic radical esophagectomy. Methods: A total of 108 elderly patients undergoing thoracoscopic laparoscopic radical esophagectomy under general anesthesia in the Affiliated Cancer Hospital of Zhengzhou University from May to October 2022 were prospectively included. The participants were divided into two groups by the random number table method: remimazolam group (R group, n=54) and propofol group (P group, n=54). There were 54 cases in the R group, with 35males and 19 females, and aged (65.4±3.1) years. Meanwhile, there were 54 cases in the P group, with 33males and 21 females, and aged (64.5±3.0) years. Anesthesia was induced as follows: remimazolam 0.2-0.3 mg/kg and remifentanil 0.5-1.0 µg/kg were intravenously injected in R group, while propofol 1-2 mg/kg and remifentanil 0.5-1.0 µg/kg were intravenously injected in P group. Subsequently, anesthesia was maintained as follows: remimazolam 0.4-1.0 mg·kg-1·h-1 and remifentanil 0.05-0.2 µg·kg-1·min-1 were intravenously infused in group R, while propofol 4-10 mg·kg-1·h-1 and remifentanil 0.05-0.2 µg·kg-1·min-1 were intravenously infused in group P. Bispectral index (BIS) was maintained at 45-60 during operation. The main outcome measures were the 15-item quality of recovery (QoR-15) scores 1 day before surgery, 1 day and 3 days after surgery. Secondary outcome measures included mean arterial pressure (MAP), heart rate and pulse oxygen saturation (SpO2) recorded 5 min before anesthesia induction (T0), 1 min after induction (T1), 1 min after endotracheal intubation (T2), immediately after skin incision (T3) and tracheal extubation (T4). The incidence of bradycardia and hypotension and the frequency of application of vasoactive drugs during anesthesia were recorded. Restlessness score (RS) and Ramsay sedation scale during the awakening period were recorded. Emergence time, tracheal extubation time, duration of postanesthesia care unit (PACU) stay and postoperative length of hospital stay were recorded. The incidence of postoperative pulmonary infection and other complications were also recorded. Results: The QoR-15 scale scores [M (Q1, Q3)] of R group 1 day and 3 days after surgery were 114.0 (109.0, 118.3) and 131.0 (127.8, 133.0), which were higher than those of P group [106.0 (101.0, 112.0) and 127.0 (125.0, 129.3)] (both P<0.001). The incidence of bradycardia, hypotension and the frequency of application of vasoactive drugs of R group during anesthesia were 5.6% (3/54), 35.2% (19/54) and 27.8% (15/54), which were lower than those in P group [33.3% (18/54), 63.0% (34/54) and 55.6% (30/54), respectively] (all P<0.05). RS score during the awakening period in R group was 0.9±0.5, which was lower than that of P group (1.1±0.6) (P=0.046). Emergence time, tracheal extubation time and postoperative length of hospital stay of R group were (15.4±4.9) min, (16.6±4.7) min and (11.6±1.4) d, which were shorter than those of P group [(26.2±6.4) min, (27.8±5.8) min and (12.6±1.3) d] (all P<0.05). There were no statistically significant differences in Ramsay scores during the awakening period, duration of PACU stay and the incidence of postoperative complications (all P>0.05). Conclusions: Both remimazolam and propofol can achieve satisfactory postoperative recovery quality in elderly patients undergoing thoracoscopic laparoscopic radical esophagectomy. Remimazolam has more stable hemodynamics and lower incidence of adverse reactions.

First Report of Root-Knot Nematode Meloidogyne enterolobii on Antirrhinum majus in China.

Antirrhinum majus L. is a medicinal and ornamental herb commonly grown in China. In October 2022, A. majus plants were observed stunted in growth with yellowish leaves and containing a large number of galls on roots in a field in Nanning, Guangxi, China (N22°47'23.35″, E108°23'4.26). Ten samples were collected randomly from rhizosphere soil and roots of A. majus. Second-stage juveniles (J2) were isolated from fresh soil with a Baermann funnel, and a mean of 36 ± 2.9 per 500 cm3 of soil was recorded. Gall roots were dissected using a microscope, where 2+ 0.42 males per sample were recovered. The species was determined to be Meloidogyne enterolobii based on morphological characteristics, including the female perineal pattern, and DNA studies. Female perineal patterns and morphometric data were similar to the original description of M. enterolobii Yang and Eisenback 1983 from Enterolobium contortisilquum (Vell.) Morong in China (Yang and Eisenback 1983). The measurements of males (n = 10) included body length, 1600.7 ± 55.32 (1421.3 to 1924.3) µm; body diameter = 41.3 ± 0.80 (37.8 to 45.4) µm, stylt length = 20.5 ± 0.40 (19.1 to 22.2) µm, spicules length = 30.0 ± 0.47 (28.2 to 32.0) µm and DGO = 4.5 ± 0.3 (3.8 to 5.2) µm. Measurements of J2 (n = 20) included body length, 441.9 ± 5.42 (403.2 to 493.3) µm; body diameter = 16.6 ± 0.30 (14.4 to 8.7) µm, a = 26.8 ± 0.54 (21.9 to 31.2), c = 8.7 ± 0.27 (6.4 to 10.8), stylet length = 12.6 ± 0.17 (11.2 to 14.3) µm, DGO = 3.8 ± 0.10 (2.9 to 4.8) µm, tail length = 51.6 ± 1.27 (42.3 to 63.1) µm and hyaline tail terminus length = 11.7 ± 0.15 (10.2 to 13.1) µm. These morphological characteristics are similar to the original description of M. enterolobii (Yang and Eisenback 1983). Pathogenicity tests were conducted on A. majus 'Taxiti' plants directly germinated from seeds in a 10.5-cm-diameter pot filled with 600 ml of sterilized peat moss/sand (1:1, v/v) soil in the glasshouse. After 1 week, fifteen plants were inoculated with 500 J2/pot (nematode culture collected from the original field) and five uninoculated plants served as a control. After 45 days, aboveground parts of all inoculated plants showed symptoms similar to those observed in the field. No symptoms were observed on control plants. The RF value of the inoculated plants was determined by the method of Belair and Benoit (1996) 60 days after inoculation, and the average was 14.65. J2 were used in this test and sequenced on 28S rRNA-D2/D3, ITS, COII -16SrRNA 3 region and confirmed to be M. enterolobii. Species identification was confirmed by using polymerase chain reaction primers D2A/D3B (De Ley et al. 1999), F194/5368r (Ferris et al. 1993), C2F3/1108 (Powers and Harris, 1993). The sequences obtained GenBank accession numbers OP897743 (COII), OP876758 (rRNA) and OP876759 (ITS) were 100% similar to other M. enterolobii populations from China (MN269947), (MN648519) and (MT406251). M. enterolobii is a highly pathogenic species and has been reported in vegetables, ornamental plants, guava (Psidium guajava L.), and weeds in China, Africa and America (Brito et al. 2004; Xu et al. 2004; Yang and Eisenback 1983). The medicinal plant Gardenia jasminoides J. Ellis was also infected by M. enterolobii in China (Lu et al. 2019). Of concern is its ability to develop on crop genotypes carrying RKN resistance genes in tobacco (Nicotiana tabacum L.), tomato (Solanum lycopersicum L.), soybean (Glycine max (L.) Merr.), potato (Solanum tuberosum L.), cowpea (Vigna unguiculata (L.) Walp.), sweetpotato (Ipomoea batatas (L.) Lam.), and cotton (Gossypium hirsutum L.). Consequently, this species was added to the European and Mediterranean Plant Protection Organization A2 Alert List in 2010. This is the first natural infection report of M. enterolobii in Guangxi, China on the medicinal and ornamental herb A. majus. Acknowledgments This research was funded by the National Natural Science Foundation of China (31860492), Natural Science Foundation of Guangxi (2020GXNSFAA297076), and Guangxi Academy of Agricultural Sciences Fund, China (2021YT062, 2021JM14, 2021ZX24). References: Azevedo de Oliveira, S., et al. 2018. PLoS One 13:e0192397. Belair, G., and Benoit, D. L. 1996. J. Nematol. 28:643. Brito, J. A., et al. 2004. J. Nematol. 36:324. De Ley, P., et al. 1999. Nematol. 1:591-612. Ferris, V. R., et al. 1993. Fundam. Appl. Nematol. 16:177-184. Lu, X. H., et al. 2019. Plant Dis. 103:1434. Powers, T. O. and Harris, T. S. 1993. J. Nematol. 25:1-6 Vrain, T. C., et al. 1992. Fundam. Appl. Nematol. 15:563. Yang, B. and Eisenback, J. D. 1983. J. Nematol. 15:381.

First Report of Root-knot Nematode, Meloidogyne Graminicola on Brassica Juncea in China.

In southern China, the staple food rice (Oryza sativa) field is commonly rotated with brown mustard Brassica juncea. Root-knot nematodes (RKNs) are a major threat to rice production. From 2019 to 2021, B. juncea in 56 fields from 26 counties in Guangxi Province were observed with symptoms of leaf yellowing, stunting, and several hook-shaped galls on the roots. Females and egg masses of Meloidogyne sp. were found within the galls. The females, males, and second-stage juveniles (J2s) were collected, and identified with morphological and molecular characteristics and female perineal patterns. Brassica juncea was transplanted in pots and a pathogenicity test was conducted to confirm the species as Meloidogyne graminicola. In China, this is the first record of a natural infection of mustard with M. graminicola, and this finding has great importance for Chinese mustard production, since this nematode may damage mustard plants and become an additional problem for this crop.

[A case of microsporidial keratitis].

A case of keratitis caused by microsporidia infection was reported. A 57-year-old female patient, without any obvious predisposing cause, presented with eye redness, eye abrasion and vision loss for one year in the left eye. The patient was diagnosed with viral keratitis based on laboratory examinations and clinical symptoms two months ago in our hospital. He was given outpatient treatment for antivirus. Two months later, he was admitted to our hospital with worsened condition that presented with corneal ulcer. After admission, corneal scraping examination was performed for the detection of microsporidia with calcofluor white (CFW) and Ziehl-Neelsen staining, the smear revealed multiple oval spore-like structures, with acid-fast positive and showed blue fluorescence on potassium hydroxide with CFW stain, confirming a diagnosis of microsporidial keratitis in the left eye. Treatment: topical use of ofloxacin eye ointment and voriconazole eye drops was not effective, and then penetrating keratoplasty was performed, and the patient's condition was stable after surgery. At present, they are still in treatment and follow-up.

Protective effect of miR-146 against kidney injury in diabetic nephropathy rats through mediating the NF-κB signaling pathway.

The article "Protective effect of miR-146 against kidney injury in diabetic nephropathy rats through mediating the NF-κB signaling pathway", H.-Y. Yu, L.-F. Meng, X.-H. Lu, L.-H. Liu, X. Ci, Z. Zhuo, published in Eur Rev Med Pharmacol Sci 2020; 24 (6): 3215-3222-DOI: 10.26355/eurrev_202003_20688-PMID: 32271439, has been retracted by the authors due to some inaccuracies (some data cannot be repeated by further research). The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/20688.

[Effects of S(+)-ketamine combined with sufentanil for patient-controlled intravenous analgesia on the early recovery in elderly patients undergoing laparoscopic radical resection of rectal cancer].

Objective: To observe the efficacy and safety of S(+)-ketamine combined with sufentanil for patient-controlled intravenous analgesia (PCIA) in elderly patients undergoing laparoscopic radical resection of rectal cancer and explore its impact on patients' early recovery. Methods: One hundred and ten patients undergoing laparoscopic radical resection of rectal cancer in Affiliated Cancer Hospital of Zhengzhou University from December 2020 to March 2021, were divided into two groups (n=55) using a random number table: group S received PCIA, with continuous infusion of S(+)-ketamine combined with sufentanil, while group C received PCIA, with continuous infusion of sufentanil. PCIA was initiated at the end of the surgery, and the formulations were as follows: group S, S(+)-ketamine (1.44 mg/kg), sufentanil (1.05 µg/kg), ketorolac tromethamine (2.0 mg/kg) and tropisetron (5 mg), in 100 ml of normal saline; group C: sufentanil (1.50 µg/kg), ketorolac tromethamine (2.0 mg/kg) and tropisetron (5 mg), in 100 ml of normal saline. Postoperative visual analogue scale (VAS) and Ramsay sedation scale were recorded at 6, 12, 24, 36, 48 h after the surgery. The incidence of remedial analgesia, the effective compressions number of PCI during 48 h after the operation. Time to first ambulation, time to first anal exhaust, time to resume oral feeding were recorded. The occurrence of adverse effects was compared between the two groups. Results: A total of 10 patients were excluded during the study, including 4 cases of conversion to laparotomy, 3 cases of dropping out of the study, and 3 cases with operation time more than 4 hours. Finally, 50 cases in group S and 50 cases in group C completed the study. There were no significant differences in VAS scores and Ramsay sedation sores at all time points between two groups (all P>0.05). Likewise, there were also no significant differences in the number of remedial analgesia and effective compressions of PCIA during 48 h after the operation between the two groups (both P>0.05). The total dosage of sufentanil consumption in group S [(64±9) µg] was lower than that in group C [(95±12) µg] within 48 h of PCIA, with a statistically significant difference (P<0.001). Time to first ambulation in group S was (1.1±0.2) d, which was shorter than that in group C [(1.6±0.5) d], and the difference was statistically significant (P<0.001). Likewise, time to first anal exhaust in group S [(1.3±0.4) d] was shorter than that in group C [(1.8±0.6) d], with a statistically significant difference (P<0.001). Additionally, time to resume oral feeding in group S was (2.5±0.6) d, which was shorter than that in group C [(3.1±0.7) d], and there was a statistically significant difference (P<0.001). The incidence of nausea, vomiting and pruritus in group S were 4.0%, 2.0% and 0, which were lower than that in group C (16.0%, 10% and 8.0%, respectively), with statistically significant differences (all P<0.05). No case with psychiatric symptoms was found in both groups. Conclusion: When used for postoperative intravenous analgesia in elderly patients undergoing laparoscopic radical resection of rectal cancer, S(+)-ketamine combined with sufentanil can provide satisfactory analgesic effects, decrease total consumption of sufentanil and the incidence of adverse effects, and thus facilitate patients' early recovery.

[Efficacy of two-lung ventilation with different tidal volume assisted by CO2 pneumothorax for airway management in patients undergoing radical resection of esophageal cancer using combined laparoscopic and thoracoscopic approach].

Objective: To evaluate the efficacy of two-lung ventilation with different tidal volume assisted by CO2 pneumothorax for airway management in patients undergoing radical esophagectomy using combined thoracoscopic and laparoscopic approach. Methods: One hundred and eighty patients undergoing radical esophagectomy using combined thoracoscopy and laparoscopy under general anesthesia from the Affiliated Cancer Hospital of Zhengzhou University between February and September 2019 were randomly divided into three groups (group V1, V2, V3, n=60) according to the tidal volume (TV) used. The TVs of group V1-V3 were 4, 5, 7 ml/kg during thoracoscopic surgery, respectively. All the patients were intubated with a single-lumen endotracheal tube and underwent two-lung ventilation assisted by continuous positive pressure CO2 pneumothorax in group V1, V2 and V3, with the CO2 pressure of 10 mmHg (1 mmHg=0.133 kPa) and the frequency of 20 times/min. Mean arterial pressure (MAP) and heart rate (HR) were recorded before thoracoscopic surgery (T1), 30 minutes after thoracoscopic surgery (T2), at the end of thoracoscopic surgery (T3), after thoracoscopic surgery and 30 minutes after two-lung intermittent positive pressure ventilation, respectively. The results of arterial blood gas were collected at T1, T2, T3 and T4. Recovery time from anesthesia, consciousness recovery time, and lung collapse condition were recorded. Results: At T2, the value of MAP in group V1 was (81±10) mmHg, which was higher than those of group V2 [(69±7) mmHg] and group V3 [(71±8) mmHg], with a statistically significant difference (F=9.270, P<0.05). Meanwhile, at T2, the value of HR in group V1 was (83±7) times/min, which was higher than those of group V2 [(68±6) times/min] and group V3 [(71±7) times/min], and there was a statistically significant difference (F=23.460, P<0.05). However, at T2, the values of arterial partial pressure of oxygen (PaO2) in three groups were (262±16), (249±16) and (241±20) mmHg, respectively, with no statistically significant difference (F=1.929, P>0.05). At T3, the value of arterial partial pressure of carbon dioxide (PaCO2) in group V3 was (46±5) mmHg, which was lower than those of group V1 [(63±9) mmHg] and V2 [(62±10) mmHg], with a statistically significant difference (F=20.890, P<0.05). Moreover, at T3, the value of pH in group V3 was (7.35±0.04), which was higher than those of group V1 (7.28±0.04) and V2 (7.32±0.04), and there was a statistically significant difference (F=9.309, P<0.05). Additionally, the satisfaction rates of lung collapse in group V3 was 57.1%, which was lower than those of group V1 (94.7%) and group V2 (96.3%), with a statistically significant difference (χ²=7.601, P<0.05). There was no statistical significance in the time of awakening and consciousness recovery among three groups (F=1.020 and 1.110, both P>0.05). Conclusion: The two-lung ventilation with 5 ml/kg tidal volume assisted by CO2 pneumothorax has advantages in terms of hemodynamics and surgical field exposure, and is more suitable as the appropriate dose for respiratory management in patients undergoing radical resection of esophageal cancer using combined thoracoscopic and laparoscopic approach.

[Analysis of factors affecting live birth outcome of frozen-thawed embryo transfer cycle].

Objective: To analyze the related factors affecting the success of frozen-thawed embryo transfer (FET). Methods: A total of 563 couples treated in the Reproductive Medicine Center of Guangdong Hospital of Traditional Chinese Medicine from January 2017 to March 2020 were selected as subjects. A total of 736 FET cycles were included to analyze the live birth outcomes of FET. Pregnancy outcomes, pregnancy complications and embryo status of patients between the live birth group and the non-live birth group were compared. A multivariate logistic regression model was used to evaluate the association between the 15 candidate factors and live birth outcomes for identifying independent factors associated with the live birth outcomes of the FET. Results: Among the enrolled subjects, the men were (33±5) years old at sperm extraction while the women were (31±4) years old at ovum pick-up (OPU) and (32±4) years old at embryo transfer (ET) and their infertility duration were (3.5±2.6) years. There were 333 (45.2%) live birth cycles and 403 (54.8%) non-live birth cycles in the 736 FET cycles. Pregnancy complications occurred in 49 cases (14.7%) of the live birth group. The age of the women at ET ((31±4) vs (32±4) years), the age of the women at OPU ((30±4) vs (32±4) years) and the age of the men at sperm extraction ((33±4) vs (34±5) years) in the live birth group were all lower than those in the non-live birth group. The infertility duration was shorter ((3.2±2.2) vs (3.6±2.8) years), and the proportion of primary infertility was higher ((63.1%, 210 cases) vs (49.6%, 200 cases)) in the live birth group (P<0.05) than those in the non-live birth group. Multivariate logistic regression analyses showed that the age of woman at ET (OR (95%CI): 0.50 (0.27-0.92), P=0.026), the types of infertility (0.62 (0.43-0.88), P=0.008), the numbers of optimal embryos transferred (1.60(1.11-2.31), P=0.012), and the types of embryos transferred (2.43 (1.46-4.01), P=0.001) were statistically significant related factors for live birth outcome of FET. Conclusion: The age of the woman at ET, the types of infertility, the numbers of optimal embryos transferred and the types of embryos transferred are associated factors for the outcomes of live birth after FET.

[Clinical features and treatment prognoses of Pythium keratitis].

Objective: To analyze the clinical features and evaluate the prognoses of Pythium keratitis. Methods: It was a retrospective study. The clinical characteristics, confocal microscopic image characteristics, treatment and curative effect of 6 cases of Pythium keratitis identified by DNA sequencing from June 2017 to June 2019 were reviewed retrospectively. Results: Among the 6 patients, there were 4 males and 2 females. All cases were monocular. The age was (58.7±11.3) years (range, 52 to 72 years). Keratopathy under a slit lamp was characterized by a dry ulcer surface, burr signs, satellite foci and pseudopodia around the ulcer. An elevated lesion was observed in 2 patients, and no obvious immune ring structure was observed in all patients. Confocal microscopy did not reveal any specific characteristics of Pythium infection. All patients did not respond well to antifungal drugs and received keratoplasty. Three patients had postoperative recurrence. The recurrence time was 4-6 days after the first operation and 2-3 days after the second operation. Two patients underwent two and three corneal transplants, respectively, after recurrence, but evisceration was required finally. Conclusions: Pythium keratitis is rare and can hardly be distinguished from common fungal infections in clinical manifestations and auxiliary examinations. The disease progresses rapidly, the rates of recurrence and evisceration after keratoplasty are both high, and DNA sequencing is the key to identifying the etiology, which should be paid more attention. (Chin J Ophthalmol, 2021, 57: 589-594).

[Application of different kinds of endotracheal intubation in the combined thoracoscopic and laparoscopic esophagectomy].

Objective: To observe the application of three different kinds of endotracheal intubation in the combined thoracoscopic and laparoscopic esophagectomy. Methods: one hundred and eighty patients undergoing combined thoracoscopic and laparoscopic esophagectomy under general anesthesia from the Affiliated Cancer Hospital of Zhengzhou University from February to September 2019 were randomly divided into three groups which include: double-lumen endotracheal intubation group (group S,n=60),single-lumen endotracheal intubation group (group D,n=60) and Coopdech occlusion of bronchial catheter combined with a single-lumen endotracheal intubation group (group C,n=60). The arterial blood samples were collected immediately after endotracheal intubation (T0), 30 min after artificial pneumothorax (single lung ventilation) (T1), 30 min after artificial pneumothorax (double lung ventilation) (T2), and 30 min after extubation (T3) to detect arterial blood gas. Patients' heart rate (HR), blood oxygen partial pressure (PaO2), blood carbon dioxide partial pressure (PaCO2) and airway pressure(Paw) were recorded at T0-T3.Completion time of endotracheal intubation, carbon dioxide intrathoracic inflation pressure, degree of lung collapse and incidence of postoperative 3-day pneumonia in three groups were recorded. The bronchoalveolar lavage fluid (BALF) of patients at T0, T2 and the end of the operation (T4) were collected to detect the levels of tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) in BALF by enzyme-linked immunosorbent assay (ELISA). Results: A total of 14 patients were excluded during the operation, of which 9 cases lasted longer than 6 hours, 3 cases had arrhythmia during the operation and 2 cases lasted less than 1 hour. Finally, 56 cases in group S, 54 cases in group D and 56 cases in group C completed the experiment. The satisfaction rates of lung collapse in group S, group D and group C were 85.7% (48/56), 100.0% (54/54), 89.2% (50/56), respectively, with no statistically significant difference (χ²=1.308, P>0.05). The intrathoracic inflation pressure of carbon dioxide in group D was (10.2±2.2) mmHg (1 mmHg=0.133 kPa), which was higher than (5.1±3.4) mmHg in group S and (5.6±3.1) mmHg in group C, the difference was statistically significant (F=-9.303, P<0.05). The incidence of postoperative 3-day pneumonia in group D was 14.8%, which was lower than 39.3% in group S and 17.8% in group C, the difference was statistically significant (χ²=8.300, P<0.05). At T4, the value of TNF-α in group D was (122.4±4.4) ng/L, which was lower than that in group S and group C, (257.9±6.3) and (185.8±5.6) ng/L, with statistically significant difference (F=69.020, P<0.05). At T4, the value of IL-6 in group D was (175.4±4.9) ng/L, which was lower than that of patients in group S and group C, (289.6±6.8) and (226.2±4.4) ng/L, with statistically significant difference (F=59.750, P<0.05). At T4, the value of IL-8 in group D was (303.1±7.2) ng/L, which was lower than in group S and group C, (595.4±22.1) and (436.8±10.9) ng/L, with statistically significant difference (F=55.359, P<0.05). Conclusion: All the three endotracheal intubations can produce satisfactory ventilation effect in the combined thoracoscopic and laparoscopic esophagectomy, however, single-lumen endotracheal intubation has less effect on lung injury.

LncRNA XIST regulates cell proliferation, migration and invasion of glioblastoma via regulating miR-448 and ROCK1.

Long non-coding ribonucleic acids (lncRNAs) have been recognized as markers in several cancers and play important roles in glioblastoma (GBM). But the role of lncRNA X inactive-specific transcript (XIST) in GBM and its possible mechanisms are rarely studied in depth. This study was conducted to explore the detailed roles of XIST in cell proliferation, migration, and invasion of GBM. Expressions of XIST, miR-448, and ρ associated coiled coil containing protein kinase 1 (ROCK1) were detected by qRT-PCR or Western blot in A172 and U251 cells. The interactions among XIST, miR-448 and ROCK1 were verified through luciferase reporter assay and RNA immunoprecipitation (RIP) assay. Cell Counting Kit-8 (CCK-8) assay and Transwell assay were introduced to detect how XIST knockdown, miR-448 overexpression, or along with ROCK1 overexpression affect cellular malignancy of GBM cells. XIST and ROCK1 were up-regulated while miR-448 expression was decreased in GBM cells. XIST knockdown or miR-448 overexpression could dramatically inhibit GBM cell proliferation, migration, and invasion. Moreover, XIST negatively regulated miR-448 expression through the function as competing endogenous RNA (ceRNA), thus leading to the up-regulation of ROCK1, one miR-448 target gene. Moreover, ROCK1 overexpression could reverse the suppression of XIST knockdown or miR-448 upregulation on cellular malignancy. In brief, the effects of XIST may promote cellular malignancy of GBM through miR-448/ROCK1 axis, which will provide new understanding of GBM pathogenesis and progression.

[Effects of patient-controlled intravenous analgesia with butorphanol versus sufentanil on early postoperative rehabilitation following radical laparoscopic nephrectomy].

Objective: To investigate the effects of patient-controlled intravenous analgesia with butorphanol versus sufentanil on early postoperative rehabilitation following radical laparoscopic nephrectomy. Methods: One hundred patients undergoing radical laparoscopic nephrectomy in Affiliated Cancer Hospital of Zhengzhou University from September 2018 to February 2020 were divided into two groups (n=50) using a random number table: butorphanol patient-controlled intravenous analgesia group (group A) and sufentanil patient-controlled intravenous analgesia group (group B). Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery. The formulation of group A was butorphanol (0.15 mg/kg) and ketorolac tromethamine (180 mg) using the physiological saline at a dilution of 100 ml. The formulation of group B was sufentanil (1.5 µg/kg) and ketorolac tromethamine (180 mg) using the physiological saline at a dilution of 100 ml. At the time points of 4, 8, 24, 48 h after operation (T(1), T(2), T(3), T(4)), VAS scores at rest and cough were recorded. The incidence of remedial analgesia, the number of pressings during 48 h after the operation, the postoperative anal exhaust recovery time of the patients were recorded. Quality of recovery-40(QoR-40) scores were recorded at T(3) and T(4). Adverse reactions were recorded. Results: There was no significant difference in VAS scores at rest and cough at T(1), T(2), T(3) and T(4) between two groups (all P>0.05). There was no significant difference in the incidence of remedial analgesia and the number of pressings during 48 h after the operation between two groups (all P>0.05). The postoperative anal exhaust recovery time of the patients in group A was (32±6) h, which was lower than that in group B with statistically significant difference [(40±5) h, t=7.937, P<0.01]. The QoR-40 total scores in group A were higher than those in group B at T(3) and T(4), which were (185.8±2.5) vs (170.7±2.7), (194.8±1.9) vs (183.6±2.6), and the differences were statistically significant (t=28.878, 25.025, all P<0.01). The incidence of nausea, retching/vomiting, respiratory depression and itch during 48 h after the operation in group A were 10%, 6%, 2%, 2%, which were lower than that in group B (32%, 20%, 14%, 18%), with statistically significant difference (χ(2)=7.294, 4.322, 4.891, 5.983, all P<0.05). Conclusion: PCIA with butorphanol or sufentanil can provide satisfactory analgesia for patients undergoing radical laparoscopic nephrectomy, but butorphanol can promote postoperative rehabilitation with fewer adverse reactions.

[Effects of desflurane and sevoflurane anesthesia on postoperative recovery after long-term tumor surgery].

Objective: To analyze the effects of desflurane and sevoflurane anesthesia on postoperative recovery after long lasting tumor surgery. Methods: One hundred and sixty patients undergoing endoscopic radical esophagectomy and gastrectomy (80 cases of each surgical type) from November 2019 to March 2020 at Henan Cancer Hospital, were randomized into 4 groups(n=40): group CS (esophageal cancer+sevoflurane anesthesia), group DS (esophageal cancer+desflurane anesthesia),group CW (stomach cancer+sevoflurane anesthesia) and group DW (gastric cancer+desflurane anesthesia). General anesthesia was induced by intravenous agents in all four groups, which were maintained by inhaled anesthetic during the operation. The mean arterial pressure (MAP), heart rate (HR), and surplus pulse O(2) (SpO(2)) immediately before induction (T(1)), the moment of operation begin (T(2)), operation end (T(3)) and extubation (T(4)) were recorded. Also, the duration required for inhalation anesthetic alveolar concentration reaching 0.5 minimum alveolar concentration (MAC) during induction, the alveolar anesthetic concentration at the beginning of the operation, the duration required for XMAC (patients specific alveolar concentration) declining to 0.5 MAC on recovery period, and the duration of alveolar concentration of 0.5 MAC declining to 0.2 MAC were determined. Additionally, the durations of spontaneous breathing recovery, eyes opening, extubation and recovery of consciousness were recorded. Finally, restlessness score (RS) during recovery period was used to evaluate postoperative agitation. Results: Compared with group CS and group CW, no significant differences in MAP, HR, SpO(2) in group DS and group DW at T(1) to T(4) were found (all P>0.05). The durations required for inhalation anesthetic alveolar concentration reaching 0.5 MAC were (5.6±1.3), (5.8±2.1), (3.5±1.5) and (3.8±1.0) min in group CS, group CW, group DS and group DW, where the durations in group DS and group DW were significantly shorter than those in group CS and group CW (F=32.538, P<0.05). The durations of alveolar concentration of 0.5 MAC declining to 0.2 MAC were (6.4±2.2), (7.0±1.5), (4.2±2.2) and (4.1±1.5) min in group CS, group CW, group DS and group DW, and the durations in group DS and group DW were significantly shortened as compared with group CS and group CW (F=42.113, P<0.05). Compared with group CS and group CW, group DS and group DW required significantly shorter time for spontaneous breathing recovery, eye opening,extubation, and directional force recovery after operation (all P<0.05). Conclusions: Both desflurane and sevoflurane anesthesia can achieve satisfactory anesthesia depth during long lasting tumor surgery. Desflurane can shorten the recovery time and early extubation, and improve the quality of recovery.

Protective effect of miR-146 against kidney injury in diabetic nephropathy rats through mediating the NF-κB signaling pathway.

OBJECTIVE: To study the protective effect of micro ribonucleic acid (miR)-146 against kidney injury in diabetic nephropathy (DN) rats through the nuclear factor-κB (NF-κB) signaling pathway. MATERIALS AND METHODS: In this experiment, 30 adult Sprague-Dawley rats with 5-6 weeks old and weighing 20-30 g were selected and randomly divided into control group (n=10), model group (n=10), and miR-146 Mimic group (n=10, DN rat model + miR-146 Mimic). The serum levels of creatinine (Cr) and blood urea nitrogen (BUN) in the three groups were detected using the full-automatic biochemical analyzer. The protein expression levels of phosphorylated-inhibitor of NF-κB (p-IκB), p-P65, P65, and Tubulin were detected via Western blotting. The messenger RNA (mRNA) of P65 was determined using quantitative Polymerase Chain Reaction (qPCR). Positive expression of p-IκB in tissues was determined using immunohistochemistry. Moreover, the contents of inflammatory factors tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), and IL-6 were detected using the enzyme-linked immunosorbent assay (ELISA) kits. Finally, the apoptosis was detected through Annexin V-fluorescein isothiocyanate (FITC) and propidium iodide (PI) dual-fluorescence labeling. RESULTS: The serum levels of Cr and BUN were significantly higher in the model group than those in the control group (p<0.01), while they were significantly lower in miR-146 Mimic group than those in the model group (p<0.05). The levels of p-IκB and p-P65/P65 significantly increased in the model group compared with those in the control group (p<0.01), while they remarkably declined in the miR-146 Mimic group compared with those in the model group (p<0.05). The results of qPCR showed that the mRNA level of P65 had no significant difference among the three groups (p>0.05). The immunohistochemical assay showed that the positive expression of p-IκB in tissues was consistent with those of the protein level as Western blotting revealed. The rats in the model group had evidently increased levels of TNF-α, IL-1ß, and IL-6 compared with the control group (p<0.01), while miR-146 Mimic group had evidently decreased levels of them compared with the model group (p<0.01). Finally, apoptosis was enhanced in the model group compared with that in the control group, while it was remarkably inhibited in the miR-146 Mimic group. CONCLUSIONS: MiR-146 can inhibit the NF-κB signaling pathway, lower the levels of TNF-α, IL-1ß, and IL-6, and reduce the apoptosis, thereby exerting a protective effect against kidney injury in DN.

MiRNA-200a-3p suppresses the proliferation, migration and invasion of non-small cell lung cancer through targeting IRS2.

OBJECTIVE: To uncover the biological role of microRNA-200a-3p (miRNA-200a-3p) in the progression of non-small cell lung cancer (NSCLC) and the underlying mechanism. PATIENTS AND METHODS: The expression levels of miRNA-200a-3p and IRS2 in NSCLC tissues and cell lines were examined through quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The correlation between the miRNA-200a-3p level and pathological characteristics of NSCLC patients was analyzed. The prognostic value of miRNA-200a-3p in NSCLC was assessed through the Kaplan-Meier method. The potential interaction between miRNA-200a-3p and IRS2 was explored through Dual-Luciferase Reporter Gene Assay and Spearman correlation test. The regulatory effects of miRNA-200a-3p/IRS2 on the proliferative, migratory, and invasive abilities of NSCLC were evaluated by Cell Counting Kit-8 (CCK-8) and the transwell assay. The protein levels of the epithelial-mesenchymal transition (EMT)-related genes in NSCLC cells influenced by miRNA-200a-3p were detected by Western blot. RESULTS: MiRNA-200a-3p was downregulated in NSCLC tissues and cell lines. The expression level of miRNA-200a-3p was related to tumor size, TNM staging, and lymphatic metastasis of NSCLC. The low level of miRNA-200a-3p predicted worse prognosis in NSCLC patients. The overexpression of miRNA-200a-3p inhibited A549 cells from proliferating, migrating, and invading. The protein levels of E-cadherin were upregulated, while N-cadherin and Vimentin were downregulated in A549 cells overexpressing miRNA-200a-3p. The Dual-Luciferase Reporter Gene Assay verified the binding between miRNA-200a-3p and IRS2. The level of IRS2 was negatively regulated by miRNA-200a-3p. Moreover, the overexpression of IRS2 could reverse the regulatory role of miRNA-200a-3p in the cellular behaviors of A549 cells. CONCLUSIONS: MiRNA-200a-3p suppresses the proliferative, migratory, and invasive abilities of NSCLC by targeting IRS2, thus alleviating the progression of NSCLC.

[The predictive value of serum alkaline phosphatase combined with parathyroid hormone in all-cause and cardiovascular mortality in maintenance hemodialysis patients].

To analyze the predictive value of serum intact parathyroid hormone (iPTH) and alkaline phosphatase (ALP) on all-cause and cardiovascular mortality in maintaining hemodialysis (MHD) patients. A total of 224 MHD patients were prospectively investigated and followed up for 2 years. Serum iPTH levels were not associated with all-cause death and cardiovascular death (HR=1.001, 95%CI 1.000-1.004, P=0.048) . The level of serum ALP was associated with cardiovascular death (HR=1.002, 95%CI 1.000-1.004, P=0.033) . ALP≥106 IU/L was an independent risk factor for cardiovascular death in MHD patients (P<0.05) . The joint variable was correlated with mortality in MHD patients (HR=1.002, 95%CI 1.000~1.004, P=0.033) , that equal or over 37.28 was an independent risk factor for mortality (P<0.05).

Long noncoding RNA GAS5 attenuates cardiac fibroblast proliferation in atrial fibrillation via repressing ALK5.

OBJECTIVE: Recently, long noncoding RNAs (lncRNAs) have caught more attention for their role in the progression of many diseases. Among them, lncRNA GAS5 (Growth Inhibition Specificity 5) was studied in this research to identify how it affects the progression of atrial fibrillation (AF). PATIENTS AND METHODS: In 40 patients with AF and 30 patients with sinus rhythm (SR), the GAS5 expression of the right atrial appendage (RAA) tissues was detected by the quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Moreover, the cell proliferation assay was conducted in AC16 cells transfected with GAS5 inhibitor and mimics, respectively. Furthermore, the qRT-PCR was performed to uncover the mechanism. RESULTS: In the research, the expression of GAS5 in RAA tissues was decreased significantly in AF patients than that in SR ones. Moreover, overexpression of GAS5 inhibited cell growth in AC16 cells, while knockdown of GAS5 promoted cell growth in AC16 cells. In addition, further experiments revealed that ALK5 was a target of GAS5 and its expression in AF tissues negatively correlated to GAS5 expression. CONCLUSIONS: These results indicate that GAS5 could inhibit cell proliferation of AF via suppressing ALK5, which may offer a new vision for interpreting the mechanism of AF development.

[Effect of Dexmedetomidine Combined with Propofol or Sevoflurane General Anesthesia on Stress and Postoperative Quality of Recovery(QoR-40) in Patients Undergoing Laparoscopic Surgery].

Objective: To explore the effects of dexmedetomidine combined with propofol or sevoflurane general anesthesia on stress and postoperative quality of recovery (QoR-40) in patients undergoing laparoscopic surgery. Methods: Two hundreds patients with laparoscopic gastrointestinal tumor resection (100 cases of gastric tumor and 100 cases of colon tumor) from March 2016 to January 2018 at Henan Cancer Hospital,were randomly divided into 4 groups(n=50): group SP (gastric neoplasm + propofol anaesthesia), group SS (gastric tumor + sevoflurane anaesthesia), group CP (colon tumor+ propofol anaesthesia), and group CS (colon tumor + sevoflurane anaesthesia). The four groups were all induced by dexmedetomidine, etomidate, sufentanil and cisatracurium. The patients in group SP and group CP were administered with propofol, and the patients in group SS and group CS were given general anesthesia with sevoflurane. The results of the operation and the quality of recovery were compared. The heart rate, mean arterial pressure change, norepinephrine, epinephrine and cortisol were measured in T0 (before anesthesia started), T1 (30 min after surgery), T2 (10 min after tracheal catheter extraction), T3 (24 h after surgery), T4 (postoperative 48 h), respectively. The postoperative recovery quality after operation was evaluated by QoR-40. Results: There were no significant differences in operation time, bleeding volume and other operation conditions between each group (all P>0.05), and also no significant differences in heart rate and mean arterial pressure from T0 to T4 time points (all P>0.05). There were significant differences in the levels of norepinephrine and cortisol among the four groups at T1 and T2 time points (F=54.135,140.733,12.037, 21.644,all P<0.05). The levels of norepinephrine and cortisol in SP group at T1 and T2 time points were less than SS group (all P<0.05). Similar, those in CP group were less than CS group (P<0.05). However, there was no significant difference among the 4 groups at other time points (all P>0.05). The scores of VAS and RS in SP group were (0.9±0.4) and (0.8±0.4), which were lower than that of SS group(1.4±0.5,1.4±0.5,all P<0.05).At the same time, the time of regain consciousness was (9.3±1.4) min, which was also lower than SS group [(10.1±1.4)min,P<0.05]. The scores of VAS and RS in CP group were (0.8±0.5) and (0.8±0.4), which were lower than that of CS group(1.4±0.5,1.4±0.4,all P<0.05).At the same time, the time of regain consciousness was (9.2±1.2)min,which was also lower than CS group [(10.1±1.2)min,P<0.05]. The recovery quality scores of the SP and CP group were (164±11) and (168±11) after 24 hours, which were greater than that of the SS and CS group(146±10, 143±12, all P<0.05). Conclusion: Dexmedetomidine combined with propofol in laparoscopic surgery can effectively suppress intraoperative stress, reduce postoperative pain and agitation, and improve the quality of postoperative recovery.