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Background Antibiotic-resistant pathogens are challenging treatment of infections worldwide. Urban sewage is potentially a major conduit for dissemination of antibiotic resistance genes into various environmental compartments. However, the diversity and abundance of such genes in wastewater are not well known. Methods Here, seasonal and geographical distributions of antibiotic resistance genes and their host bacterial communities from Chinese urban sewage were characterized, using metagenomic analyses and 16S rRNA gene-based Illumina sequencing, respectively. Results In total, 381 different resistance genes were detected, and these genes were extensively shared across China, with no geographical clustering. Seasonal variation in abundance of resistance genes was observed, with average concentrations of 3.27 × 10 11 and 1.79 × 10 12 copies/L in summer and winter, respectively. Bacterial communities did not exhibit geographical clusters, but did show a significant distance-decay relationship ( P  < 0.01). The core, shared resistome accounted for 57.7% of the total resistance genes, and was significantly associated with the core microbial community ( P  < 0.01). The core human gut microbiota was also strongly associated with the shared resistome, demonstrating the potential contribution of human gut microbiota to the dissemination of resistance elements via sewage disposal. Conclusions This study provides a baseline for investigating environmental dissemination of resistance elements and raises the possibility of using the abundance of resistance genes in sewage as a tool for antibiotic stewardship.

Soil viruses remain understudied when compared to virus found in aquatic ecosystems. Here, we investigate the ecological patterns of soil viral communities across various land use types encompassing forest, agricultural, and urban soil in Xiamen, China. We recovered 59,626 viral operational taxonomic units (vOTUs) via size-fractioned viromic approach with additional mitomycin C treatment to induce virus release from bacterial fraction. Our results show that viral communities are significantly different amongst the land use types considered. A microdiversity analysis indicates that selection act on soil vOTUs, resulting in disparities between land use associated viral communities. Soil pH is one of the major determinants of viral community structure, associated with changes of in-silico predicted host compositions of soil vOTUs. Habitat disturbance and variation of soil moisture potentially contribute to the dynamics of putative lysogenic vOTUs. These findings provide mechanistic understandings of the ecology and evolution of soil viral communities in changing environments. Soil viral communities remain understudied. Here, Liao et al. retrieve a catalogue of around sixty thousand vOTUs through a systematic viromic pipeline, and uncover the response of soil viral communities to anthropogenic land use changes.

BackgroundEarly mobilisation represents a core element of enhanced recovery after surgery (ERAS) and is recommended after minimally invasive spine surgery including unilateral biportal endoscopy (UBE). However, strategies to facilitate early mobilisation after UBE remain limited. Transcutaneous electrical acupoint stimulation (TEAS) may improve postoperative pain and recovery after spine surgery, but available evidence in UBE remains inconclusive.ObjectiveTo investigate whether perioperative TEAS enhances postoperative recovery after UBE.MethodsThis single-centre randomised controlled trial with blinded assessors will enrol 114 patients undergoing elective UBE discectomy. Participants will be randomly allocated (1:1) by simple randomisation to receive stimulation via self-adhesive electrodes, either single-session TEAS at Neiguan, Dazhui, Chengshan and Sanyinjiao initiated 30 min before surgery until the end of the procedure using a disperse–dense waveform (2/100 Hz) with individualised intensity (10–15 mA) or sham stimulation applied at four non-meridian, non-acupoint sites with brief initial stimulation followed by 0 mA output. Standardised general anaesthesia with bispectral index and analgesia nociception index monitoring will be provided following ERAS recommendations. The primary outcome is successful ambulation rate at 6 hour postoperatively; baseline pain, nausea, quality of recovery and functional status will be assessed using the Numerical Rating Scale, Visual Analogue Scale, Quality of Recovery-15 questionnaire, Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) score at baseline before intervention while postoperative pain, nausea and vomiting, opioid consumption and Quality of recovery will be evaluated at 6, 24 and 48 hours after surgery, with ODI and JOA assessed during longer-term follow-up and surgery-related adverse events monitored postoperatively. Continuous outcomes will be analysed using parametric (repeated-measures analysis of variance) or non-parametric (Mann-Whitney U) tests, and categorical variables using χ² or Fisher’s exact tests.Ethical considerations and disseminationThis study was approved by the Ethics Committee of Beijing Friendship Hospital (No: 2024-P2-087-01) and registered with Chinese Clinical Trial Registry. Results will be published in peer-reviewed journals.Trial registration numberChiCTR2400083344.

Antimicrobial resistance (AMR) poses a severe threat to global health. The wide distribution of environmental antibiotic resistance genes (ARGs), which can be transferred between microbiota, especially clinical pathogens and human commensals, contributed significantly to AMR. However, few databases on the spatiotemporal distribution, abundance, and health risk of ARGs from multiple environments have been developed, especially on the absolute level. In this study, we compiled the ARG occurrence data generated by a high-throughput quantitative PCR platform from 1,403 samples in 653 sampling sites across 18 provinces in China. The database possessed 291,870 records from five types of habitats on the abundance of 290 ARGs, as well as 8,057 records on the abundance of 30 mobile genetic elements (MGEs) from 2013 to 2020. These ARGs conferred resistance to major common types of antibiotics (a total of 15 types) and represented five major resistance mechanisms, as well as four risk ranks. The database can provide information for studies on the dynamics of ARGs and is useful for the health risk assessment of AMR.

Imidacloprid is a neonicotinoid insecticide that efficiently controls piercing-sucking mouthparts pests. However, the impact of low lethal concentration of imidacloprid on key demographic parameters of wheat aphids, Schizaphis graminum (R.) and Rhopalosiphum padi (L.) has been scarcely studied. In this study, we used the age stage, two-sex life table approach to investigate the sublethal effects of imidacloprid on the biological traits of S . graminum and R . padi . Bioassays showed that imidacloprid possesses high toxicity to adult S . graminum and R . padi , with LC 50 of 3.59 and 13.78 mg L −1 following 24 h exposure. A low lethal concentration of imidacloprid (LC 25 ) significantly decreased adult longevity and total longevity of progeny generation aphids (F 1 ) of S . graminum . Nevertheless, imidacloprid (LC 25 ) had no significant effects on the fecundity and longevity of directly exposed parental parental S . graminum and R . padi (F 0 ). Our results showed that the low lethal concentration of imidacloprid affected the demographic parameters that ultimately impact on the population of S . graminum . This study provides detailed information about the overall effects of imidacloprid on S . graminum and R . padi that might help to manage these two key pests.

Background Propofol sedation in patients with Obstructive Sleep Apnea (OSA) frequently induces hypoxemia, posing significant clinical risks. Esketamine, an N-Methyl-D-Aspartate (NMDA) receptor antagonist, may reduce propofol requirements while preserving respiratory stability, but its efficacy in OSA patients remains unproven. At the studied dose (0.25 mg/kg), esketamine’s potential side effects (transient hypertension) are expected to be mild and self-limited. Therefore, we aimed to test whether low-dose esketamine (0.25 mg/kg) can reduce the incidence of hypoxemia in moderate-to-high risk OSA patients during propofol-based painless gastroscopy. Methods This single-center, double-blind, randomized controlled superiority trial will enroll 294 patients (STOP-Bang score ≥ 3, 18–90 years, STOP-Bang = Snoring, Tiredness, Observed apnea, Pressure [blood], Body Mass Index [BMI], Age, Neck size, Gender.) undergoing gastroscopy. Participants will be randomized 1:1 to receive either esketamine (0.25 mg/kg) plus propofol or saline placebo plus propofol, stratified by age (18–65 vs. > 65 years) and OSA severity (STOP-Bang 5–6 vs. ≥ 7). The primary outcome is the incidence of hypoxemia (Peripheral Oxygen Saturation [SpO 2 ] < 90% for > 10 s). Secondary outcomes include severe hypoxemia (SpO 2  ≤ 75% or ≤ 90% for ≥ 60 s), duration of hypoxemia, emergency airway management, propofol consumption, hemodynamic stability, involuntary body movements, procedure/recovery times, and clinician satisfaction (measured via 10-cm Visual Analog Scale [VAS]). Discussion This protocol rigorously evaluates esketamine’s potential to improve sedation safety in OSA patients, addressing a critical gap in peri-procedural care. Trial registration Chinese Clinical Trial Registry (ChiCTR2500099420). Registered on March 24, 2025 (Supplementary File 2). Si-Qi Hao is a co-first author with the same contribution as the first author. The corresponding author is Li-Xin An.

Airborne microorganisms, including pathogens, would change with surrounding environments and become issues of global concern due to their threats to human health. Microbial communities typically contain a few abundant but many rare species. However, how the airborne abundant and rare microbial communities respond to environmental changes is still unclear, especially at hour scale. Here, we used a sequencing approach based on bacterial 16S rRNA genes and fungal ITS2 regions to investigate the high time‐resolved dynamics of airborne bacteria and fungi and to explore the responses of abundant and rare microbes to the atmospheric changes. Our results showed that air pollutants and microbial communities were significantly affected by human activities related to the Chinese New Year (CNY). Before CNY, significant hour‐scale changes in both abundant and rare subcommunities were observed, while only abundant bacterial subcommunity changed with hour time series during CNY. Air pollutants and meteorological parameters explained 61.5%−74.2% variations of abundant community but only 13.3%−21.6% variations of rare communities. These results suggested that abundant species were more sensitive to environmental changes than rare taxa. Stochastic processes predominated in the assembly of abundant communities, but deterministic processes determined the assembly of rare communities. Potential bacterial pathogens during CNY were the highest, suggesting an increased health risk of airborne microbes during CNY. Overall, our findings highlighted the “holiday effect” of CNY on airborne microbes and expanded the current understanding of the ecological mechanisms and health risks of microbes in a changing atmosphere. The hour‐scale dynamics of bacteria and fungi in the atmosphere were determined. Human activities during Chinese New Year changed the distribution of air pollutants and subsequently affected communities of airborne bacteria and fungi, distinctly. In addition, our results found that abundant species were more sensitive than rare taxa in response to environmental changes associated with Chinese New Year (CNY). The relative abundance of potential bacterial pathogens in the bacterial community was higher during CNY compared with those before and after CNY, which indicated that human activities during CNY increase the threats of airborne microbes to human beings. Highlights Hour‐scale dynamics of airborne bacteria and fungi were determined. Human activities during Chinese New Year changed the distribution of air pollutants. Environmental changes during Chinese New Year (CNY) affected communities of airborne bacteria and fungi, distinctly. Abundant species were more sensitive than rare taxa in response to changes during CNY. Human activities during CNY increase the threats of airborne microbes to human beings.

Background Propofol deep sedation/anesthesia combined with analgesics is always used in minimally invasive urologic surgeries in elderly patients.Oxygen-desaturation is one of the most frequent respiratory complications susceptible to other life-threatening accidents for elderly patients during propofol sedation. The purpose of this study is to evaluate the efficacy and safety of low-dose esketamine adjunct to propofol sedation on the occurrence of oxygen-desaturation, hypotension, propofol requirements and other related adverse events compared to sufentanil for elderly patients undergoing urologic surgeries. Methods Ninety four elderly male patients undergoing transurethral bladder lesion resection or ureteroscopic ureteral laser lithotripsy were randomly enrolled into esketamine/propofol group (SK group, n  = 47) or sufentanil/propofol group (SF group, n  = 47). The patients in SK group received 0.25 mg/kg esketamine and 1.5 mg/kg propofol for anesthetic induction and SF group received 0.1 μg/kg sufentanil and 1.5 mg/kg propofol. Sedation was Maintained with 4-6 mg/kg/h propofol infusion. The primary outcome was the incidence of oxygen-desaturation during the surgeries. Second outcomes included induction time, hemodynamic changes, intraoperative propofol dosage, operation duration and anesthesia duration, recovery time, other related adverse events and rescue medication. Results The incidence of oxygen-desaturation was 34.0% (16 of 47) in SK group compared to 68.1% (32 of 47) in SF group with a significant difference (risk ratio, 0.50; 95% confidence interval, 0.32–0.78; P  < 0.001). The overall severity of hypoxiemia was mild in SK group (22/9/16 vs 6/9/32, P  = 0.00072). Propofol requirements, induction time were all much lower in SK group than those in SF group ( P  < 0.001). More hemodynamic stability was observed in SK group compared to SF group. The protective factors of oxygen-desaturation were esketamine (OR:0.26, CI: 0.08 to 0.86, P  = 0.027), transurethral bladder lesion resection (OR:0.14, CI: 0.03 to 0.64, P  = 0.011). Weight was a hazard factor of OD (OR:1.07, CI: 1.00 to 1.15, P  = 0.048). Postoperative sedation score, MMSE, VAS score, incidence of nausea and vomiting were similar in both groups ( P  > 0.05). Conclusions Esketamine combined with propofol sedation used in minimal invasive urologic surgeries, could reduce the incidence of oxygen-desaturation, decrease propofol requirements, stabilize hemodynamics and didn’t affect the postoperative recovery and neurological function of elderly patients. Trial registration Chinese Clinical Trial Registry, No: ChiCTR2300077170. Registered on 1 November 2023. Prospective registration. http://www.chictr.org.cn . Graphical abstract

Background Propofol is effective and used as a kind of routine anesthetics in procedure sedative anesthesia (PSA) for ureteroscopy. However, respiratory depression and unconscious physical activity always occur during propofol-based PSA, especially in elderly patients. Esketamine has sedative and analgesic effects but without risk of cardiorespiratory depression. The purpose of this study is to investigate whether esketamine can reduce the propofol median effective dose (ED 50 ) for successful ureteroscope insertion in elderly male patients. Materials and methods 49 elderly male patients undergoing elective rigid ureteroscopy were randomly divided into two groups: SK Group (0.25 mg/kg esketamine+propofol) and SF Group (0.1 µg/kg sufentanil+propofol). Patients in both two groups received propofol with initial bolus dose of 1.5 mg/kg after sufentanil or esketamine was administered intravenously. The effective dose of propofol was assessed by a modified Dixon’s up-and-down method and then was adjusted with 0.1 mg/kg according to the previous patient response. Patients’ response to ureteroscope insertion was classified as “movement” or “no movement”. The primary outcome was the ED 50 of propofol for successful ureteroscope insertion with esketamine or sufentanil. The secondary outcomes were the induction time, adverse events such as hemodynamic changes, hypoxemia and body movement were also measured. Result 49 patients were enrolled and completed this study. The ED 50 of propofol for successful ureteroscope insertion in SK Group was 1.356 ± 0.11 mg/kg, which was decreased compared with that in SF Group, 1.442 ± 0.08 mg/kg ( P  = 0.003). The induction time in SK Group was significantly shorter than in SF Group ( P  = 0.001). In SK Group, more stable hemodynamic variables were observed than in SF Group. The incidence of AEs between the two groups was not significantly different. Conclusion The ED 50 of propofol with esketamine administration for ureteroscope insertion in elderly male patients is 1.356 ± 0.11 mg/kg, significantly decreased in comparsion with sufentanil. Trial registration Chinese Clinical Trial Registry, No: ChiCTR2300077170. Registered on 1 November 2023. Prospective registration. http://www.chictr.org.cn .

Background As a popularly used analgesic adjuvant, intravenous (IV) lidocaine could reduce the consumption of propofol in painless gastrointestinal (GI) endoscopy. However, whether IV lidocaine could affect the incidence of oxygen-desaturation episodes (ODE) during painless GI endoscopy is still unknown. Therefore, we tested the hypothesis that IV lidocaine could decrease the incidence of propofol-induced ODE and involuntary movements in patients during GI endoscopy. Methods Three hundred twenty-two patients scheduled for GI endoscopy were randomly divided into lidocaine group and control group. After midazolam and sufentanil injection, a bolus of 1.5 mg/kg lidocaine was given and followed by continuous infusion of 4 mg/kg/h in lidocaine group, whereas the same volumes of saline solution in control group. Then, propofol was titrated to produce unconsciousness. The primary outcome was the incidence of ODE during the procedure. The secondary outcomes were the incidence of different degree of hypoxia and corresponding treatments and the involuntary body movements. Results A total of 300 patients were finally included in the analysis, 147 patients in lidocaine group and 153 in control group. The incidence of ODE was 22% in lidocaine group and 39% in control group (OR:0.052; 95%CI: 0.284–0.889; P  = 0.018). IV lidocaine also improved the occurrence of different degree of hypoxia ( P  = 0.017) and needed few treatments ( P  = 0.028). The incidence of involuntary body movements (14% vs 26%, P  = 0.013) and adverse circulatory events was decreased by IV lidocaine. Conclusions IV lidocaine adjuvant to propofol-based sedation could reduce the incidence of oxygen-desaturation episodes and involuntary body movements, with fewer adverse circulatory events. Trial registration Chinese Clinical Trial Registry ChiCTR2100053818. Registered on 30 November 2021.