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Prostatitis as initial manifestation of Chlamydia psittaci pneumonia diagnosed by metagenome next-generation sequencing: A case report

  • Mengjie Li , Biao Wang , Peng Liu , Huan Wang und Jian Zhu EMAIL logo
Veröffentlicht/Copyright: 12. April 2023
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Aus der Zeitschrift Open Life Sciences Band 18 Heft 1

Abstract

Chlamydia psittaci (C. psittaci) pneumonia is a zoonotic infectious disease caused by C. psittaci, which is often underdiagnosed. The application of metagenomic next-generation sequencing (mNGS) provides an unbiased method for the detection of unknown pathogens. A 46-year-old man received empirical treatment with piperacillin-tazobactam and moxifloxacin after an initial diagnosis of prostatitis and pneumonia. However, he experienced recurrent symptoms and a cough, and a chest computed tomography (CT) showed aggravated pulmonary inflammation. Upon further questioning, the patient recalled a history of contact with pigeons, and a bronchoscope alveolar lavage fluid analysis with mNGS suggested C. psittaci infection. Following treatment with doxycycline, the patient’s symptoms were rapidly alleviated, and chest CT showed pulmonary lesions absorption. The patient was followed up for 1 month without any discomfort. This case highlights that initial manifestations of C. psittaci pneumonia may present with atypical symptoms such as prostatitis. Furthermore, mNGS can be a useful tool for the detection of rare or unknown pathogens such as C. psittaci.

Keywords: case report; Chlamydia psittaci ; metagenomic next-generation sequencing; pneumonia; prostatitis; initial manifestation

1 Background

Chlamydia psittaci (C. psittaci) is a Gram-negative chlamydia that can infect a wide range of hosts, primarily transmitted via respiratory secretions and feces of birds, including parrots, pigeons, gulls, and other poultry or wild birds [1,2]. Many outbreaks of C. psittaci infection in humans, also known as psittacosis, have been reported worldwide [3,4,5], while sporadic cases have been reported now and then in Asia [6]. Psittacosis in humans is a nationally notifiable disease required by US Centers for Disease Control [7]. Zoonotic transmission of C. psittaci infection can cause various illness, ranging from subtle symptoms to severe systematic diseases, mainly affecting the lungs [8]. C. psittaci pneumonia is a disease resulting from C. psittaci infection, and the proportion of community-acquired pneumonia (CAP) due to C. psittaci is estimated to range from 0 to 6.7% [9]. The onset of C. psittaci pneumonia usually follows an incubation period of 5–14 days, which also can be several weeks, while symptomatic infections usually present with typical symptoms including fever, headache, cough, and chest distress [10].

Case reports of C. psittaci pneumonia have increased in recent years. However, asymptomatic infection or the absence of typical symptoms at onset may lead to undiagnosed infections, resulting in delayed or inadequate treatment. Therefore, it is essential to report and discuss cases with atypical initial manifestations that are eventually diagnosed as C. psittaci pneumonia to raise clinical awareness of atypical CAP and promote disease management. The metagenomic next-generation sequencing (mNGS) shows great favorability in detecting pathogens that are evasive, fastidious, and/or pose a transmission risk using conventional methods. Herein, we reported a case of C. psittaci pneumonia with prostatitis as the initial manifestation for the first time, which was diagnosed using mNGS.

2 Case presentation

A 46-year-old married male farmer was admitted to our hospital on April 20, 2021, due to lower urinary tract symptoms and febrile sickness. He had experienced frequent micturition and urgency, painful urination, dysuria, and discomfort of perineal swelling for about a week before admission, but did not seek medical attention. The patient reported no other symptoms such as nausea, vomiting, cough, sputum expectoration, dyspnea, fever, chills, and other discomforts. As fever occurred with a temperature of 38.5°C and lasted for 1 day without any chills and cough, he presented to the fever clinic and was referred to the urology department. The patient had no history of major diseases or infectious diseases, except for an allergy to sulfonamides. He had a smoking history of 30 cigarettes per day for 25 years and drank alcohol occasionally. On admission, his vital signs included temperature (T) of 38.7°C, pulse (P) of 92 beats/min and respiration (R) of 20 times/min, and blood pressure (Bp) of 150/90 mmHg. Pulmonary auscultation suggested that rough breath sounds in both lungs, while rhonchi and crackles were not heard. The left renal area was tender to percussion, and a digital rectal examination revealed prostate tenderness. Other physical examination results were unremarkable. Chest computed tomography (CT) scan showed double pneumonia and bilateral localized thickening (Figure 1a). Laboratory examinations of blood, urine, and prostatic fluid were performed after admission, and the results are shown in Table 1. B-Scan ultrasonography of the urinary system showed multiple small calculi in both kidneys. Considering the medical history and current examination results, prostatitis, pneumonia, and kidney calculi were tentative diagnoses. The patient was administered piperacillin-tazobactam (4.5 mg, intravenous (IV) injection, quaque 8 hours) for anti-infective treatment and symptomatic treatment for spasmolysis and relaxation of urethral smooth muscle.

Figure 1 Chest CT scan during admission. (a) The chest CT images on April 20, 2021 showed nodules in the upper lobes of the lungs and a little halo sign. (b) The chest CT images on April 28, 2021 showed a range of flocculent high-density shadow increased in the lobes of bilateral pulmonary, peripheral halo sign diffused, and the lesions progressed in contrast to the images on April 20, 2021, especially the whole upper lobe of the left lung showed ground-glass opacity. (c) The chest CT images on May 5, 2021 showed that lesions are mostly absorbed and pneumonia was significantly improved.
Figure 1

Chest CT scan during admission. (a) The chest CT images on April 20, 2021 showed nodules in the upper lobes of the lungs and a little halo sign. (b) The chest CT images on April 28, 2021 showed a range of flocculent high-density shadow increased in the lobes of bilateral pulmonary, peripheral halo sign diffused, and the lesions progressed in contrast to the images on April 20, 2021, especially the whole upper lobe of the left lung showed ground-glass opacity. (c) The chest CT images on May 5, 2021 showed that lesions are mostly absorbed and pneumonia was significantly improved.

Table 1

Laboratory test vital index

Sample Laboratory test Vital index
Apr 20, 2021
Blood Routine blood test WBC 9.77 × 109/L, NEUT 7.45 × 109/L
Myocardial enzymes AST 62.97 U/L, PCT 0.1165 ng/mL
CRP 101.86 mg/L ↑
Blood glucose 6.56 mmol/L
Urine Urine routine WBC (−), WBC 0/μL, occult blood (−), RBC 0/μL
Prostate fluid Prostate fluid test WBC (+++)
April 29, 2021
Blood Routine blood test WBC 8.81 × 109/L, NEUT % 89.9 % ↑
CRP 172.2 mg/L ↑
ALB 28.8 g/L ↓
ESR 102.106 mm/h ↑
BALF Bacterial smear test Few amounts of Gram-positive cocci and Gram-negative bacilli
Fungus smear test Fungi (−)
G test —
GM test —

Abbreviations: ALB, plasma albumin; AST, aspartate aminotransferase; BALF, bronchoalveolar lavage fluid; CRP, C-reaction protein; ESR, erythrocyte sedimentation rate; GM test, galactomannan antigen test; G test, (1,3)-β-d-glucan test; NEUT %, percentage of neutrophils; NEUT, neutrophils; PCT, procalcitonin; RBC, red blood cell; WBC, white blood cell.

After initial treatment, the patient’s fever did not abate. On April 22, 2021, a consultation with the department of Respiratory and Critical Care Medicine confirmed the diagnosis of CAP and considered the possibility of mycoplasma infection. Empirical treatment with antimicrobial moxifloxacin (0.4 g, IV, quaque die) and antiviral agent oseltamivir (75 mg, peros, bis in die) was initiated, which gradually alleviated the patient’s symptoms of painful urination and dysuria, and brought his body temperature back to normal within 2 days. However, on April 28, 2021, the patient developed a fever again (T, 38.5°C) along with cough, mild chest tightness, and breathlessness. Re-examination of chest CT showed double pneumonia with localized thickening of bilateral pleura, with increased range of flocculent high-density shadow in lobes of bilateral pulmonary as compared to the initial examination (Figure 1b). After re-consultation, the patient was transferred to the department of Respiratory and Critical Care Medicine for further treatment.

After a detailed medical history investigation, the patient recalled having killed over 10 pigeons approximately 2 weeks before. Considering the possibility of C. psittaci pneumonia, electronic bronchoscopy was performed for etiological evidence, but no obvious abnormalities were noticed in the trachea and bronchus. Bronchoalveolar lavage (BAL) was performed, and bronchoalveolar lavage fluid (BALF) was collected for examination. Microbiological examination of BALF revealed a small number of Gram-positive cocci and Gram-negative bacilli. No fungi were found in BALF, while (1,3)-β-d-glucan (BDG) test (G test) and galactomannan antigen test (GM test) were negative. Routine blood examination (Table 1) showed that procalcitonin was within normal range; plasma albumin value was below the normal range, but there were no abnormalities in blood potassium, blood sodium, blood chloride, liver function, and renal function. Antibodies of mycoplasma, chlamydia, EB virus, and blood tuberculosis were all negative. Two weeks later, the chlamydia antibody was positive, and its negative may be related to the short time. BALF analysis with mNGS (Simcere Diagnostic, Nanjing, China) reported sequence reads of Burkholderia contaminans complex (3488), Stenotrophomonas maltophilia (145), Pseudomonas aeruginosa (22), Candida albicans (441), Aspergillus flavus (4), and C. psittaci (13) (Figure 2). The number of C. psittaci sequences detected by mNGS in the patient’s prostate fluid was 7. By joint consideration of the patient’s history of close contact with pigeons and C. psittaci infection suggested by mNGS, the diagnosis of C. psittaci pneumonia was confirmed. On May 1, 2021, doxycycline (100 mg, IV, quaque 12 hours) was administered in combination with moxifloxacin, and the fever subsided the next day. After 5 days, a re-examination of chest CT revealed that lesions were mostly absorbed and pneumonia was significantly improved (Figure 1c). After doxycycline combined with moxifloxacin treatment, the fever did not recur, respiratory symptoms subsided, and the urinary system symptoms alleviated significantly. Due to improvement, the patient was discharged on May 10, 2021. Regarding bilateral kidney calculi, he was instructed to drink plenty of water and consulted the department of urology if necessary. With a follow-up for 1 month, the patient did not have any discomfort. The disease progression of the patient and treatment procedure are shown in Figure 3.

Figure 2 Reads count, coverage, and average depth results of Chlamydia psittaci suggested by metagenome next-generation sequencing in this case.
Figure 2

Reads count, coverage, and average depth results of Chlamydia psittaci suggested by metagenome next-generation sequencing in this case.

Figure 3 The disease progression of patient and treatment procedure. Abbreviations: CT, computed tomography; mNGS, metagenome next-generation sequencing; T, temperature.
Figure 3

The disease progression of patient and treatment procedure. Abbreviations: CT, computed tomography; mNGS, metagenome next-generation sequencing; T, temperature.

  1. Informed consent: Informed consent has been obtained from all individuals included in this study.

  2. Ethical approval: The research related to human use has been complied with all the relevant national regulations, institutional policies and in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

3 Discussion

The clinical manifestations of C. psittaci pneumonia vary from asymptomatic in mild cases to multiple organ failure in severe cases [11]. The atypical clinical manifestations of C. psittaci pneumonia may be related to the special infection mode. C. psittaci infection occurs through inhalation of excretion aerosol from birds or other infectious sources, which leads to the pathogen’s proliferation in reticuloendothelial cells of the liver and spleen via blood circulation, eventually affecting the lungs and possibly leading to systemic infection [8]. Previous cases have reported pneumonia with other systemic organ diseases including splenomegaly, myocarditis, keratitis, gastrointestinal symptoms, and even fatal meningitis [10,12]. To our knowledge, this is the first report of prostatitis as the initial manifestation of C. psittaci pneumonia. Although prostatitis is common in male patients under 50 years, its etiology is still unclear, with pathogenic factors typically including infection by a pathogen [13]. In this case, no significant abnormalities were found in routine urine tests, thus excluding urinary tract infection as a possible cause. Based on initial chest CT findings of lung inflammation and increased white blood cell count in prostatic fluid, diagnoses of pneumonia and prostatitis were made. Initially, C. psittaci infection was not suspected due to the lack of relevant evidence, and empirical anti-infective agents were used. However, worsening symptoms of diffuse pulmonary inflammatory lesions shown by chest CT after initial treatment suggested that the pathogen might not be common.

In the initial examination of chest CT examination, nodules were observed in the upper lobes of the lungs, distributed along the pleura, and accompanied by a slight halo sign. However, misdiagnosis as mycoplasma infection resulted in the progression of flocculent high-density shadow increased in the leaves of bilateral pulmonary and diffusion of peripheral halo. Notably, the upper lobe of the left lung showed ground-glass opacity, indicating the development of the disease. There is limited literature available on the imaging changes associated with C. psittaci pneumonia. While a comparative study reports ground-glass opacity as the most common imaging change [14], others have attached importance to lobar consolidation [15]. Some scholars suggest that the halo sign is a typical imaging change of this disease [16], whereas we think that the halo sign is not a specific change and can be observed in a variety of diseases such as pulmonary cryptococcosis [17]. Due to a lack of specificity in imaging, the differential diagnosis requires the identification of a variety of atypical pneumonia, including Coxiella burnetii, Legionella, Chlamydia, and Mycoplasma [18]. Despite considering the possibility of fungal infection, BALF smear, G test, and GM test showed no abnormalities.

Clinical diagnosis of C. psittaci pneumonia can be challenging due to the nonspecific imaging findings and patient symptoms. Traditionally, psittacosis is diagnosed based on clinical presentation, culture, and serological tests, which include complement fixation (CF), microimmunofluorescence (MIF), or enzyme(−linked) immunosorbent assay (ELISA). However, these methods can be ambiguous and deceptive due to cross-reactivity with other species, and culture is often used to confirm the results of serological tests [19]. Molecular tests, such as polymerase chain reaction (PCR), have become more popular due to their sensitivity and specificity for targeted detection [10], replacing serological methods in some cases. However, these methods require a predetermined assumption of pathogen target, which may lead to missing rare pathogens. In this case, the patient did not report a history of contact with pigeons at admission; meanwhile, we neglected the occupational characteristics of the patient as a farmer and did not pay attention to the possibility of Chlamydia infection, resulting in an aggravation of the patient’s condition. C. psittaci infection suggested by mNGS provided guidance for final diagnosis and effective treatment. mNGS can characterize all DNA or RNA existing in the samples and construct the isolated DNA and RNA libraries, so as to analyze the human host genome or transcripts in the whole microbial group and patient samples [20]. The advantage of mNGS is that it can detect any part of the genome unbiasedly to quickly identify potential pathogens, especially rare ones. The patient may not have been clearly diagnosed in this case if we did not perform mNGS. Reports of C. psittaci pneumonia detected by mNGS have increased gradually in recent years [12,21,22]. But it also has drawbacks. In addition to expensive and time-consuming deficiencies, not all genomes suggested by mNGS are available. Other limitations include host genomic predominance of sequence reads in patient samples (reduces sensitivity) and lower clinical utility. In the present case, counting of sequence reads Burkholderia contaminans complex and Candida albicans were much higher than that of C. psittaci, but Burkholderia contaminans had a limited effect on doxycycline and moxifloxacin, and this patient had an excellent effect on doxycycline, confirming the unlikelihood of Burkholderia contaminans infection. The number of C. psittaci sequence detected by mNGS of prostatic fluid was 7, and we finally established the diagnosis of C. psittaci pneumonia based on the patient’s history of pigeon exposure. Overall, mNGS is a novel technique that facilitates the diagnosis of unknown pathogens, but its data still need to be interpreted in conjunction with clinical interpretation and clinical standardization is also necessary.

During the therapy procedure, piperacillin-tazobactam was used for initial treatment, which is a typical antibiotic regimen for acute bacterial prostatitis [23]. However, since the patient’s symptoms did not improve, moxifloxacin was administered. Moxifloxacin, as a fourth-generation fluoroquinolone, has a broad spectrum of efficacy against Gram-positive bacteria and atypical pathogens, such as Mycoplasma and Chlamydia [24]. However, moxifloxacin alone is less effective in treating C. psittaci pneumonia, as demonstrated by the continued disease progression in this case, despite its reported effectiveness [12]. The recommended first-line treatment for C. psittaci pneumonia is tetracycline antimicrobials, such as doxycycline, while macrolide antimicrobials are considered an alternative for patients who are contraindicated with tetracyclines [10]. After C. psittaci infection was detected by mNGS and treatment with doxycycline combined with moxifloxacin, patient’s condition was obviously controlled and the imaging also showed obvious absorption of the lesions in this case. Doxycycline combined with moxifloxacin in the treatment of C. psittaci pneumonia has been reported in some cases [12,21], but it is not clear whether the combination is more effective than the single drug, and further research is needed.

4 Conclusions

C. psittaci pneumonia may present with atypical symptoms such as prostatitis. In cases where the initial empirical anti-infective therapy for atypical CAP is ineffective, mNGS is a promising method for identifying the pathogen and providing guidance for precise clinical treatment.

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  1. Funding information: Authors state no funding is involved.

  2. Author contributions: M.J.L. and J.Z. contributed to the study conception and design. M.J.L. and B.W. contributed to the clinical management of the patient. B.W., P.L., and H.W. were responsible for data collection and literature review. M.J.L. and J.Z. drafted the manuscript. All authors revised, read, and approved the final manuscript.

  3. Conflict of interest: Authors state no conflict of interest.

  4. Data availability statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Received: 2022-10-31
Revised: 2023-03-03
Accepted: 2023-03-15
Published Online: 2023-04-12

© 2023 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  266. Erratum
  267. Erratum to “Protein Z modulates the metastasis of lung adenocarcinoma cells”
  268. Erratum to “BRCA1 subcellular localization regulated by PI3K signaling pathway in triple-negative breast cancer MDA-MB-231 cells and hormone-sensitive T47D cells”
  269. Retraction
  270. Retraction to “Protocatechuic acid attenuates cerebral aneurysm formation and progression by inhibiting TNF-alpha/Nrf-2/NF-kB-mediated inflammatory mechanisms in experimental rats”
https://doi.org/10.1515/biol-2022-0596
Schlagwörter für diesen Artikel
case report; Chlamydia psittaci; metagenomic next-generation sequencing; pneumonia; prostatitis; initial manifestation
Creative Commons
BY 4.0

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  123. Loss of ACOX1 in clear cell renal cell carcinoma and its correlation with clinical features
  124. Signalling pathways in the osteogenic differentiation of periodontal ligament stem cells
  125. Crosstalk between lactic acid and immune regulation and its value in the diagnosis and treatment of liver failure
  126. Clinicopathological features and differential diagnosis of gastric pleomorphic giant cell carcinoma
  127. Traumatic brain injury and rTMS-ERPs: Case report and literature review
  128. Extracellular fibrin promotes non-small cell lung cancer progression through integrin β1/PTEN/AKT signaling
  129. Knockdown of DLK4 inhibits non-small cell lung cancer tumor growth by downregulating CKS2
  130. The co-expression pattern of VEGFR-2 with indicators related to proliferation, apoptosis, and differentiation of anagen hair follicles
  131. Inflammation-related signaling pathways in tendinopathy
  132. CD4+ T cell count in HIV/TB co-infection and co-occurrence with HL: Case report and literature review
  133. Clinical analysis of severe Chlamydia psittaci pneumonia: Case series study
  134. Bioinformatics analysis to identify potential biomarkers for the pulmonary artery hypertension associated with the basement membrane
  135. Influence of MTHFR polymorphism, alone or in combination with smoking and alcohol consumption, on cancer susceptibility
  136. Catharanthus roseus (L.) G. Don counteracts the ampicillin resistance in multiple antibiotic-resistant Staphylococcus aureus by downregulation of PBP2a synthesis
  137. Combination of a bronchogenic cyst in the thoracic spinal canal with chronic myelocytic leukemia
  138. Bacterial lipoprotein plays an important role in the macrophage autophagy and apoptosis induced by Salmonella typhimurium and Staphylococcus aureus
  139. TCL1A+ B cells predict prognosis in triple-negative breast cancer through integrative analysis of single-cell and bulk transcriptomic data
  140. Ezrin promotes esophageal squamous cell carcinoma progression via the Hippo signaling pathway
  141. Ferroptosis: A potential target of macrophages in plaque vulnerability
  142. Predicting pediatric Crohn's disease based on six mRNA-constructed risk signature using comprehensive bioinformatic approaches
  143. Applications of genetic code expansion and photosensitive UAAs in studying membrane proteins
  144. HK2 contributes to the proliferation, migration, and invasion of diffuse large B-cell lymphoma cells by enhancing the ERK1/2 signaling pathway
  145. IL-17 in osteoarthritis: A narrative review
  146. Circadian cycle and neuroinflammation
  147. Probiotic management and inflammatory factors as a novel treatment in cirrhosis: A systematic review and meta-analysis
  148. Hemorrhagic meningioma with pulmonary metastasis: Case report and literature review
  149. SPOP regulates the expression profiles and alternative splicing events in human hepatocytes
  150. Knockdown of SETD5 inhibited glycolysis and tumor growth in gastric cancer cells by down-regulating Akt signaling pathway
  151. PTX3 promotes IVIG resistance-induced endothelial injury in Kawasaki disease by regulating the NF-κB pathway
  152. Pancreatic ectopic thyroid tissue: A case report and analysis of literature
  153. The prognostic impact of body mass index on female breast cancer patients in underdeveloped regions of northern China differs by menopause status and tumor molecular subtype
  154. Report on a case of liver-originating malignant melanoma of unknown primary
  155. Case report: Herbal treatment of neutropenic enterocolitis after chemotherapy for breast cancer
  156. The fibroblast growth factor–Klotho axis at molecular level
  157. Characterization of amiodarone action on currents in hERG-T618 gain-of-function mutations
  158. A case report of diagnosis and dynamic monitoring of Listeria monocytogenes meningitis with NGS
  159. Effect of autologous platelet-rich plasma on new bone formation and viability of a Marburg bone graft
  160. Small breast epithelial mucin as a useful prognostic marker for breast cancer patients
  161. Continuous non-adherent culture promotes transdifferentiation of human adipose-derived stem cells into retinal lineage
  162. Nrf3 alleviates oxidative stress and promotes the survival of colon cancer cells by activating AKT/BCL-2 signal pathway
  163. Favorable response to surufatinib in a patient with necrolytic migratory erythema: A case report
  164. Case report of atypical undernutrition of hypoproteinemia type
  165. Down-regulation of COL1A1 inhibits tumor-associated fibroblast activation and mediates matrix remodeling in the tumor microenvironment of breast cancer
  166. Sarcoma protein kinase inhibition alleviates liver fibrosis by promoting hepatic stellate cells ferroptosis
  167. Research progress of serum eosinophil in chronic obstructive pulmonary disease and asthma
  168. Clinicopathological characteristics of co-existing or mixed colorectal cancer and neuroendocrine tumor: Report of five cases
  169. Role of menopausal hormone therapy in the prevention of postmenopausal osteoporosis
  170. Precisional detection of lymph node metastasis using tFCM in colorectal cancer
  171. Advances in diagnosis and treatment of perimenopausal syndrome
  172. A study of forensic genetics: ITO index distribution and kinship judgment between two individuals
  173. Acute lupus pneumonitis resembling miliary tuberculosis: A case-based review
  174. Plasma levels of CD36 and glutathione as biomarkers for ruptured intracranial aneurysm
  175. Fractalkine modulates pulmonary angiogenesis and tube formation by modulating CX3CR1 and growth factors in PVECs
  176. Novel risk prediction models for deep vein thrombosis after thoracotomy and thoracoscopic lung cancer resections, involving coagulation and immune function
  177. Exploring the diagnostic markers of essential tremor: A study based on machine learning algorithms
  178. Evaluation of effects of small-incision approach treatment on proximal tibia fracture by deep learning algorithm-based magnetic resonance imaging
  179. An online diagnosis method for cancer lesions based on intelligent imaging analysis
  180. Medical imaging in rheumatoid arthritis: A review on deep learning approach
  181. Predictive analytics in smart healthcare for child mortality prediction using a machine learning approach
  182. Utility of neutrophil–lymphocyte ratio and platelet–lymphocyte ratio in predicting acute-on-chronic liver failure survival
  183. A biomedical decision support system for meta-analysis of bilateral upper-limb training in stroke patients with hemiplegia
  184. TNF-α and IL-8 levels are positively correlated with hypobaric hypoxic pulmonary hypertension and pulmonary vascular remodeling in rats
  185. Stochastic gradient descent optimisation for convolutional neural network for medical image segmentation
  186. Comparison of the prognostic value of four different critical illness scores in patients with sepsis-induced coagulopathy
  187. Application and teaching of computer molecular simulation embedded technology and artificial intelligence in drug research and development
  188. Hepatobiliary surgery based on intelligent image segmentation technology
  189. Value of brain injury-related indicators based on neural network in the diagnosis of neonatal hypoxic-ischemic encephalopathy
  190. Analysis of early diagnosis methods for asymmetric dementia in brain MR images based on genetic medical technology
  191. Early diagnosis for the onset of peri-implantitis based on artificial neural network
  192. Clinical significance of the detection of serum IgG4 and IgG4/IgG ratio in patients with thyroid-associated ophthalmopathy
  193. Forecast of pain degree of lumbar disc herniation based on back propagation neural network
  194. SPA-UNet: A liver tumor segmentation network based on fused multi-scale features
  195. Systematic evaluation of clinical efficacy of CYP1B1 gene polymorphism in EGFR mutant non-small cell lung cancer observed by medical image
  196. Rehabilitation effect of intelligent rehabilitation training system on hemiplegic limb spasms after stroke
  197. A novel approach for minimising anti-aliasing effects in EEG data acquisition
  198. ErbB4 promotes M2 activation of macrophages in idiopathic pulmonary fibrosis
  199. Clinical role of CYP1B1 gene polymorphism in prediction of postoperative chemotherapy efficacy in NSCLC based on individualized health model
  200. Lung nodule segmentation via semi-residual multi-resolution neural networks
  201. Evaluation of brain nerve function in ICU patients with Delirium by deep learning algorithm-based resting state MRI
  202. A data mining technique for detecting malignant mesothelioma cancer using multiple regression analysis
  203. Markov model combined with MR diffusion tensor imaging for predicting the onset of Alzheimer’s disease
  204. Effectiveness of the treatment of depression associated with cancer and neuroimaging changes in depression-related brain regions in patients treated with the mediator-deuterium acupuncture method
  205. Molecular mechanism of colorectal cancer and screening of molecular markers based on bioinformatics analysis
  206. Monitoring and evaluation of anesthesia depth status data based on neuroscience
  207. Exploring the conformational dynamics and thermodynamics of EGFR S768I and G719X + S768I mutations in non-small cell lung cancer: An in silico approaches
  208. Optimised feature selection-driven convolutional neural network using gray level co-occurrence matrix for detection of cervical cancer
  209. Incidence of different pressure patterns of spinal cerebellar ataxia and analysis of imaging and genetic diagnosis
  210. Pathogenic bacteria and treatment resistance in older cardiovascular disease patients with lung infection and risk prediction model
  211. Adoption value of support vector machine algorithm-based computed tomography imaging in the diagnosis of secondary pulmonary fungal infections in patients with malignant hematological disorders
  212. From slides to insights: Harnessing deep learning for prognostic survival prediction in human colorectal cancer histology
  213. Ecology and Environmental Science
  214. Monitoring of hourly carbon dioxide concentration under different land use types in arid ecosystem
  215. Comparing the differences of prokaryotic microbial community between pit walls and bottom from Chinese liquor revealed by 16S rRNA gene sequencing
  216. Effects of cadmium stress on fruits germination and growth of two herbage species
  217. Bamboo charcoal affects soil properties and bacterial community in tea plantations
  218. Optimization of biogas potential using kinetic models, response surface methodology, and instrumental evidence for biodegradation of tannery fleshings during anaerobic digestion
  219. Understory vegetation diversity patterns of Platycladus orientalis and Pinus elliottii communities in Central and Southern China
  220. Studies on macrofungi diversity and discovery of new species of Abortiporus from Baotianman World Biosphere Reserve
  221. Food Science
  222. Effect of berrycactus fruit (Myrtillocactus geometrizans) on glutamate, glutamine, and GABA levels in the frontal cortex of rats fed with a high-fat diet
  223. Guesstimate of thymoquinone diversity in Nigella sativa L. genotypes and elite varieties collected from Indian states using HPTLC technique
  224. Analysis of bacterial community structure of Fuzhuan tea with different processing techniques
  225. Untargeted metabolomics reveals sour jujube kernel benefiting the nutritional value and flavor of Morchella esculenta
  226. Mycobiota in Slovak wine grapes: A case study from the small Carpathians wine region
  227. Elemental analysis of Fadogia ancylantha leaves used as a nutraceutical in Mashonaland West Province, Zimbabwe
  228. Microbiological transglutaminase: Biotechnological application in the food industry
  229. Influence of solvent-free extraction of fish oil from catfish (Clarias magur) heads using a Taguchi orthogonal array design: A qualitative and quantitative approach
  230. Chromatographic analysis of the chemical composition and anticancer activities of Curcuma longa extract cultivated in Palestine
  231. The potential for the use of leghemoglobin and plant ferritin as sources of iron
  232. Investigating the association between dietary patterns and glycemic control among children and adolescents with T1DM
  233. Bioengineering and Biotechnology
  234. Biocompatibility and osteointegration capability of β-TCP manufactured by stereolithography 3D printing: In vitro study
  235. Clinical characteristics and the prognosis of diabetic foot in Tibet: A single center, retrospective study
  236. Agriculture
  237. Biofertilizer and NPSB fertilizer application effects on nodulation and productivity of common bean (Phaseolus vulgaris L.) at Sodo Zuria, Southern Ethiopia
  238. On correlation between canopy vegetation and growth indexes of maize varieties with different nitrogen efficiencies
  239. Exopolysaccharides from Pseudomonas tolaasii inhibit the growth of Pleurotus ostreatus mycelia
  240. A transcriptomic evaluation of the mechanism of programmed cell death of the replaceable bud in Chinese chestnut
  241. Melatonin enhances salt tolerance in sorghum by modulating photosynthetic performance, osmoregulation, antioxidant defense, and ion homeostasis
  242. Effects of plant density on alfalfa (Medicago sativa L.) seed yield in western Heilongjiang areas
  243. Identification of rice leaf diseases and deficiency disorders using a novel DeepBatch technique
  244. Artificial intelligence and internet of things oriented sustainable precision farming: Towards modern agriculture
  245. Animal Sciences
  246. Effect of ketogenic diet on exercise tolerance and transcriptome of gastrocnemius in mice
  247. Combined analysis of mRNA–miRNA from testis tissue in Tibetan sheep with different FecB genotypes
  248. Isolation, identification, and drug resistance of a partially isolated bacterium from the gill of Siniperca chuatsi
  249. Tracking behavioral changes of confined sows from the first mating to the third parity
  250. The sequencing of the key genes and end products in the TLR4 signaling pathway from the kidney of Rana dybowskii exposed to Aeromonas hydrophila
  251. Development of a new candidate vaccine against piglet diarrhea caused by Escherichia coli
  252. Plant Sciences
  253. Crown and diameter structure of pure Pinus massoniana Lamb. forest in Hunan province, China
  254. Genetic evaluation and germplasm identification analysis on ITS2, trnL-F, and psbA-trnH of alfalfa varieties germplasm resources
  255. Tissue culture and rapid propagation technology for Gentiana rhodantha
  256. Effects of cadmium on the synthesis of active ingredients in Salvia miltiorrhiza
  257. Cloning and expression analysis of VrNAC13 gene in mung bean
  258. Chlorate-induced molecular floral transition revealed by transcriptomes
  259. Effects of warming and drought on growth and development of soybean in Hailun region
  260. Effects of different light conditions on transient expression and biomass in Nicotiana benthamiana leaves
  261. Comparative analysis of the rhizosphere microbiome and medicinally active ingredients of Atractylodes lancea from different geographical origins
  262. Distinguish Dianthus species or varieties based on chloroplast genomes
  263. Comparative transcriptomes reveal molecular mechanisms of apple blossoms of different tolerance genotypes to chilling injury
  264. Study on fresh processing key technology and quality influence of Cut Ophiopogonis Radix based on multi-index evaluation
  265. An advanced approach for fig leaf disease detection and classification: Leveraging image processing and enhanced support vector machine methodology
  266. Erratum
  267. Erratum to “Protein Z modulates the metastasis of lung adenocarcinoma cells”
  268. Erratum to “BRCA1 subcellular localization regulated by PI3K signaling pathway in triple-negative breast cancer MDA-MB-231 cells and hormone-sensitive T47D cells”
  269. Retraction
  270. Retraction to “Protocatechuic acid attenuates cerebral aneurysm formation and progression by inhibiting TNF-alpha/Nrf-2/NF-kB-mediated inflammatory mechanisms in experimental rats”
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© 2026 De Gruyter Brill
Heruntergeladen am 27.1.2026 von https://www.degruyterbrill.com/document/doi/10.1515/biol-2022-0596/html
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