Home Life Sciences Acute lupus pneumonitis resembling miliary tuberculosis: A case-based review
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Acute lupus pneumonitis resembling miliary tuberculosis: A case-based review

  • Xin Li , Yuan Wang , Baoyu Zhang , Xiaoxia Jia , Lin Mu and Jing Ke EMAIL logo
Published/Copyright: December 31, 2023
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Open Life Sciences
From the journal Open Life Sciences Volume 18 Issue 1

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple systems and organs, with pulmonary involvement known to be associated with disease prognosis and mortality. Acute lupus pneumonitis (ALP) resembling miliary tuberculosis (TB) is rare. Here, we present a case of ALP mimicking miliary TB and review the literature. A 19-year-old male student was referred to our hospital with fever. Although the patient met the diagnostic criteria for SLE, diffuse miliary nodules in both lungs were observed on a chest computed tomography scan. A series of tests, including pathological testing of bronchoscopy brushes, T-lymphocyte culture + interferon assay (A + B), tuberculin test, detection of mycobacterium TB DNA, and acid-fast bacilli smear in bronchoalveolar lavage fluid, were unable to confirm the presence of TB infection. We considered the patient to have ALP. After beginning ALP therapy, his symptoms disappeared, and the imaging and hematological results returned to normal. Miliary TB and ALP have similar clinical manifestations and imaging changes, which make diagnosis difficult. This case highlights the need to ensure accurate diagnosis and treatment to improve prognosis.

Keywords: systemic lupus erythematosus; acute lupus pneumonitis; miliary tuberculosis

1 Introduction

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of multiple autoantibodies and involves multiple systems and organs [1]. The incidence of pulmonary involvement in SLE is more common than some connective tissue diseases [2]. Pulmonary involvement is more common in men, particularly in the later stages of the disease, where it is associated with disease prognosis and can increase mortality [3,4]. Pulmonary involvement in SLE can be manifested by chronic interstitial pneumonia, pulmonary fibrosis, pleurisy, diffuse alveolar hemorrhage, pulmonary vascular embolism, and pulmonary hypertension, among others [5]. Even so, acute lupus pneumonitis (ALP), particularly ALP that resembles miliary tuberculosis (TB), is rare.

Miliary TB, an infectious disease caused by the spread of TB through blood, is common in people with low immunity due to long-term use of hormones and immunosuppressants [6,7]. The clinical manifestations of miliary TB and ALP are similar, including fever, cough, night sweats, and shortness of breath. Imaging features show diffuse alveolar infiltration, which lacked specificity [8,9,10]. Clinically, miliary TB and ALP are easily confused and largely indistinguishable.

Here, we present a rare case of ALP mimicking miliary TB that occurred in a 19-year-old male student, which manifested as fever, cough, muscle aches, and joint pain. At the early stage of the disease, uniform miliary nodules were observed on chest computed tomography (CT) image. We further explain the difference between ALP and miliary TB in terms of imaging, clinical manifestations, and laboratory examination results.

2 Case presentation

A 19-year-old male student was referred to the Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, for fever that had persisted for 26 days (highest temperature: 39.5℃). The patient had gradually developed symptoms of cough, fatigue, muscle aches, pain in both knee and toe joints, and rashes on the face and scalp, with no evidence of night sweats, hemoptysis, hair loss, dental ulcers, or Raynaud’s phenomenon. He had suffered from hypertension for 3 years. He also had a history of leukopenia for 1.5 years, with the presence of antinuclear antibodies (ANA) 1:160 and anti-β2GP1 IgM (+). However, he did not seek further treatment. He had no notable medical, family, or psycho-social history. On physical examination, swollen, soft, non-tender lymph nodes were felt on both sides of the submandibular, together with thick breathing sounds in both lungs, but no rales. Laboratory examination revealed a white blood cell (WBC) count of 1.64 × 109/L, hemoglobin (Hb) level of 99 g/L, platelet (PLT) level of 56 × 109/L, complement C3 level of 0.206 g/L, and complement C4 level of 0.077 g/L were decreased. The erythrocyte sedimentation rate (ESR) was 90 mm/h, and the C-reactive protein (CRP) level was 10.67 mg/L. Blood gas analysis revealed a pH of 7.480, as well as PaCO2 of 32 mmHg, and PaO2 of 70 mmHg. The results of tumor marker tests, common virus-related tests, procalcitonin, 1,3-β-d-glucan test (G test), and galactomannan test (GM test) were generally normal. However, we noted positive indicators for autoantibodies, including ANA 1:640 (reference range: <1:40), anti-dsDNA 1:40 (reference range: <1:5), and lupus anticoagulant (LA) 1.76 (reference range: ≦1.2). Additionally, the 24-h urinary protein quantity (24 h-UPro) was 1.34 g/24 h. Color Doppler ultrasound showed that the lymph nodes in the neck, supraclavicular fossa, axilla, and groin area were swollen and well-defined. Bone marrow and peripheral blood smears were conducted to screen for blood system abnormalities, but both results were normal and not indicative of hematological diseases. Based on clinical manifestations and examination results, we considered a diagnosis of SLE.

However, the results of the patient’s chest CT scan were confusing. Diffuse miliary nodules in both lungs were observed on chest CT after 14 days of fever (Figures 1 and 2a). This led us to consider that the patient had miliary TB. Before being hospitalized at our center, the patient visited many hospitals, but it was unclear whether he had been infected with TB. We completed a series of tests to confirm the presence of mycobacterium TB infection. The pathological results of bronchoscopy brushes of the right lower basal segment identified epithelial cells and lymphocytes, but acid-fast bacillus was not observed. In parallel, the results of T lymphocyte culture + interferon assay (A + B), tuberculin test (PPD), detection of mycobacterium TB DNA, and acid-fast bacilli smear in bronchoalveolar lavage fluid were negative. The results of the pulmonary function test showed moderate mixed ventilation dysfunction and small airway dysfunction. The residual gas volume increased, the total lung volume decreased, and the total residual gas ratio increased. Additionally, both the amount of dispersion and the coefficient of dispersion decreased. Two days after admission, a chest X-ray was completed, which showed multiple plaques in both lungs (Figure 3a). Considering the rapid progression of the patient’s disease in a short period of time, empirical intravenous immunoglobulin (IVIG) and methylprednisolone (MP) therapy were temporarily given. Three days after empirical treatment (31 days after the onset of fever), the patient underwent a repeat chest CT, at which point, patchy shadows were observed in the lower and middle fields of both lungs (Figure 2b).

Figure 1 Diffuse miliary nodules in both lungs were observed on chest CT.
Figure 1

Diffuse miliary nodules in both lungs were observed on chest CT.

Figure 2 (a) Diffuse miliary nodules were observed in both lungs 14 days after the onset of fever; (b) Patchy shadows in the lower and middle fields of both lungs 31 days after the onset of fever (3 days after empirical treatment; 5 days after admission). (c) After 46 days of treatment, no nodules or shadows were observed in either lung.
Figure 2

(a) Diffuse miliary nodules were observed in both lungs 14 days after the onset of fever; (b) Patchy shadows in the lower and middle fields of both lungs 31 days after the onset of fever (3 days after empirical treatment; 5 days after admission). (c) After 46 days of treatment, no nodules or shadows were observed in either lung.

Figure 3 (a) Two days after admission, chest X-ray showed multiple plaques in both lungs. (b) After 5 months of treatment, no high-density shadows were observed on chest X-ray.
Figure 3

(a) Two days after admission, chest X-ray showed multiple plaques in both lungs. (b) After 5 months of treatment, no high-density shadows were observed on chest X-ray.

At present, there is no evidence to support the diagnosis of miliary TB. Therefore, we believe that the miliary changes in both lungs represent a rare imaging manifestation of ALP. The patient continued to receive intravenous MP. After 7 days of treatment, the patient’s temperature returned to normal, and there was no discomfort such as cough and joint pain. In the meantime, the WBC count (5.86 × 109/L) and PLT (154 × 109/L) and ESR 45 mm/h levels recovered. Out of hospital, the patient was given prednisone, hydroxychloroquine, and mycophenolate mofetil (Figure 4). After 46 days of treatment, the miliary nodules and patchy shadows disappeared in chest CT (Figure 2c). After 5 months of treatment, chest X-ray showed no discernible high-density shadows (Figure 3b). Meanwhile, the blood routine examination results, and levels of CRP, ESR, complement C3, and complement C4 returned to normal.

Figure 4 Diagnosis and treatment of a case of acute lupus pneumonia. The first day of fever was recorded as D0. WBC: white blood cells, Hb: hemoglobin, PLT: platelet, C3: complement C3, C4: complement C4, T-SPOT: T-lymphocyte culture + interferon assay (A + B), PPD: tuberculin test, ANA: antinuclear antibodies, LA: lupus anticoagulant, anti-ACL: anti-cardiolipin antibodies, ANCA: neutrophil cytoplasmic antibodies, 24-h-Upro: 24-h urinary protein quantity, SLE: systemic lupus erythematosus, ALP: acute lupus pneumonitis, LN: lupus nephritis, IVIG: intravenous immunoglobulin, MP: methylprednisolone, HCQ: hydroxychloroquine, MMF: mycophenolate mofetil, i.v.: intravenous injection, po: orally, qd: once a day, bid: twice a day.
Figure 4

Diagnosis and treatment of a case of acute lupus pneumonia. The first day of fever was recorded as D0. WBC: white blood cells, Hb: hemoglobin, PLT: platelet, C3: complement C3, C4: complement C4, T-SPOT: T-lymphocyte culture + interferon assay (A + B), PPD: tuberculin test, ANA: antinuclear antibodies, LA: lupus anticoagulant, anti-ACL: anti-cardiolipin antibodies, ANCA: neutrophil cytoplasmic antibodies, 24-h-Upro: 24-h urinary protein quantity, SLE: systemic lupus erythematosus, ALP: acute lupus pneumonitis, LN: lupus nephritis, IVIG: intravenous immunoglobulin, MP: methylprednisolone, HCQ: hydroxychloroquine, MMF: mycophenolate mofetil, i.v.: intravenous injection, po: orally, qd: once a day, bid: twice a day.

  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

SLE is an autoimmune disease, which presents with vasculitis as the main pathological change. Pulmonary involvement can occur at any stage of SLE and is consistently reported in approximately 50–70% of SLE cases [11]. Pleural involvement is the most common lung manifestation of SLE, with an incidence of 20–90% [3,12]. ALP, a sudden non-infectious pneumonia in patients with SLE, has a low incidence rate of only 1–4% [13,14]. ALP is characterized by fever, cough, dyspnea, hypoxemia, chest pain, and hemoptysis, among others. Bilateral or unilateral patchy consolidation, focal atelectasis, diaphragmatic elevation, or pleural effusion can be seen on ALP imaging [15]. The mortality of ALP is very high (up to 50%); therefore, early diagnosis and treatment are crucial.

TB, caused by the bacillus mycobacterium TB, is one of the top 10 causes of disease-related death worldwide. The World Health Organization’s global TB reports 2019 reported that approximately 10.0 million people were infected with TB globally in 2018, with people in China accounting for 9%. Unfortunately, China is the country with the second largest share of the global TB burden due to the emergence of drug-resistant TB [16,17]. The incidence of TB among patients with SLE is 1.16 per 100 person-years [18]. In patients with SLE, TB infection has not only a high incidence but also a more severe degree of disease, with a fatality rate of 15.6% [19]. Clinical observations show that the clinical manifestations of patients with SLE with TB infection are almost identical to those of simple TB infection and SLE, which makes diagnosis difficult. Several Chinese studies have shown that the incidence of miliary TB in patients with SLE is 35.0%, which represents an important reason for the high fatality rate of SLE [19]. Therefore, clinicians should promptly identify the presence of TB to improve prognosis in this patient population.

In this case, a 19-year-old young boy, who suffered from hyperpyrexia, rashes, leukopenia, thrombocytopenia, urinary protein >0.5 g/24 h, and several types of positive autoantibodies, was definitive diagnosed with SLE, based on 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for SLE [20]. However, he also exhibited symptoms of fever, cough, fatigue, and hypoxemia, as well as demonstrating miliary nodules of both lungs that were uniform in size, density, and distribution on chest CT. Therefore, we considered whether the pulmonary manifestation was a component of ALP or SLE with miliary TB. The positive rate of sputum smear, TB antibody test, and PPD test is only 14.3–41.8% in patients with SLE with TB [21]. Therefore, obtaining histopathology and tissue culture results as soon as possible is of great significance to this case. Moreover, the clinical manifestations of patients with SLE with TB infection are non-specific and are often difficult to distinguish from those of SLE itself. The diagnosis of SLE combined with TB is more challenging. In this case, despite attempting to improve the TB test, we found no evidence of TB infection. We have not completely ruled out the possibility of TB infection at this time. We administered the patient IVIG (20 g daily) and MP (40 mg daily). Three days later, the temperature of the patient was normal and the WBC count (2.14 × 109/L) and Hb (101 g/L) and PLT (134 × 109/L) levels were increased. Meanwhile, patchy shadows instead of miliary nodules were been seen in the latest chest radiograph and chest CT. At this time, we considered that the miliary changes in the pre-chest CT may be early imaging manifestations of ALP, rather than miliary TB, and the follow-up results of the patient without anti-TB treatment further verified the correctness of our diagnosis.

The lessons from this rare case of ALP mimicking miliary TB can be summarized as follows. The clinical presentation of ALP is nonspecific. ALP was caused by acute injury of alveoli and capillaries. Patients often develop hypoxemia and hypocapnia. Imaging changes in early ALP with diffuse miliary nodules in both lungs are very rare. At this time, patients may not have serious respiratory tract symptoms, such as dyspnea, cyanosis, and hemoptysis, and may only show discomfort such as cough, fever, and fatigue. it is important to conduct thorough viral, fungal, and bacterial (especially TB) testing. In regard to the identification of ALP with miliary TB, besides perfecting PPD, T-spot, TB antibody, and sputum smear, it is important to actively improve the TB-related pathology and culture inspection. If there is no evidence of TB infection, we can also re-take the chest X-ray or chest CT in a short period of time. The imaging performance of a patient with ALP will change greatly, and scattered patchy shadows may appear gradually, especially in the lower lung field. However, the imaging performance of miliary TB does not change significantly in a short time. In the meantime, if we consider a diagnosis of ALP, we can give 40–80 mg glucocorticoid treatment empirically, while also paying close attention to the changes in clinical manifestations, blood routine, ESR, CRP, blood gas analysis, and chest CT.

We also analyzed two similar published case reports (Table 1) and found that ALP, similar to miliary TB, is most common in adolescents, with fever and cough being notable at the beginning of the disease. Some patients may also present with myalgia and arthralgia. Laboratory tests show that the three systems are reduced, and anti-dsDNA antibodies are positive. Glucocorticoids and immunosuppressants are the standard treatment for ALP, although plasma exchange and gamma globulin may also be used. Unlike this patient, in the other two cases, it was proven that the miliary nodules on chest CT were not miliary TB given the failure of anti-TB treatment. In the cases reported by YP Zhang and YC Huang, TB examinations were not completed, especially the detection of mycobacterium TB by respiratory histopathology and tissue TB DNA. Additionally, the changes in chest X-ray or CT were not observed before treatment with MP or IVIG in the two previously reported cases given that it was not advantageous to describe the changes in the chest imaging of ALP. In this case report, for the first time, we describe the entire process for the development of ALP chest CT. The process occurs in a short time, so it is crucial to observe the changes in chest imaging in time to distinguish ALP from miliary TB.

Table 1

Clinical features of ALP

Clinical features Case 1 Case 2 Case 3
Age 19 15 19
Gender Female Female Male
Fever Positive Positive Positive
Cough Positive Positive Positive
Oral ulcer Positive Negative Negative
Rash Negative Negative Positive
Myodynia Negative Positive Positive
Neck pain Positive Negative Negative
Joint pain Positive Negative Positive
Alopecia Positive Negative Negative
Serous effusion Positive Positive Negative
Proteinuria Negative Positive Positive
Decreased trilineage Positive Positive Positive
Anti-dsDNA antibodies (+) Positive Positive Positive
Anti-Sm antibodies (+) Positive Positive Negative
Complement reduction Positive Negative Positive
IVIG — Negative Positive
Corticosteroids Positive Positive Positive
Immunosuppressor — Positive Positive
Reference [22] [10] —

IVIG: intravenous immunoglobulin.

To sum up, when patients with SLE present with miliary nodules in the lungs, clinicians should take care during the identification process, especially in young patients, and should actively improve the examination of TB, tumor biomarker testing, and other tests for infection with other pathogens, as well as consider the possibility of the disease being complicated with ALP.

4 Conclusion

Here, we present a rare case of ALP mimicking miliary TB that occurred in a 19-year-old male student. SLE with miliary TB and ALP have similar clinical manifestations and imaging changes, which often makes them clinically indistinguishable. Every effort should be made to ensure accurate diagnosis and treatment to improve patient prognosis.

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Acknowledgments

All authors would like to show sincere thanks to the editor and reviewers for critical comments on this manuscript. We would also like to thank International Science Editing (http://www.internationalscienceediting.com) for editing this article.

  1. Funding information: Authors state no funding involved.

  2. Author contributions: The paper was co-authored by Xin Li, Yuan Wang, Baoyu Zhang, Xiaoxia Jia, Lin Mu, and Jing Ke. Conceptualization: Xin Li. Data collection: Xin Li, Xiaoxia Jia, Lin Mu, and Baoyu Zhang. Manuscript revision: Xin Li and Yuan Wang. Writing – original draft: Xin Li. Responsible for all aspects of the work and final approval of the version to be published: Jing Ke.

  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: 2023-04-03
Revised: 2023-08-19
Accepted: 2023-09-11
Published Online: 2023-12-31

© 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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  235. Clinical characteristics and the prognosis of diabetic foot in Tibet: A single center, retrospective study
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  245. Animal Sciences
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  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
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  261. Comparative analysis of the rhizosphere microbiome and medicinally active ingredients of Atractylodes lancea from different geographical origins
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  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”
https://doi.org/10.1515/biol-2022-0751
Keywords for this article
systemic lupus erythematosus; acute lupus pneumonitis; miliary tuberculosis
Creative Commons
BY 4.0

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  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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