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Case report of atypical undernutrition of hypoproteinemia type

  • Qun-Ru Wang , Jun Long , Chen-Cheng Wang , Ji-Lei Hu , Ning Lin and Shan-Hong Tang EMAIL logo
Published/Copyright: November 29, 2023
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From the journal Open Life Sciences Volume 18 Issue 1

Abstract

Albumin and prealbumin serve as vital markers reflecting hepatic synthesis activity and overall body nutrient status. Hypoproteinemia can result from various etiological factors, with reduced blood inflow into the liver due to portal vein thrombosis being one such cause. However, literature addressing this specific association remains limited. This report presents an atypical case of malnutrition involving a patient who experienced prolonged hypoproteinemia attributable to a gradual decline in hepatic blood perfusion caused by progressive portal thrombosis and cavernous transformation of the portal vein (CTPV). The case encompasses an in-depth analysis of the factors contributing to undernutrition, the etiology and diagnosis of hypoproteinemia, and its clinical implications. Vigilance for the presence of hypoproteinemia is essential in the management of patients afflicted by progressive portal vein thrombosis complicated by CTPV. Timely and effective interventions aimed at rectifying hypoproteinemia can significantly enhance clinical outcomes. Moreover, reduced hepatic blood flow should be considered a plausible underlying cause in cases of unexplained hypoproteinemia, warranting thorough evaluation. This case underscores the importance of recognizing the intricate interplay between hepatic vascular pathology and protein homeostasis in clinical practice.

Keywords: cavernous transformation of the portal vein; hypoproteinemia; portal thrombosis; undernutrition

1 Introduction

Undernutrition is a deficient energy and nutrient status caused by insufficient dietary intake or malabsorption and can lead to adverse clinical outcomes [1]. Albumin and prealbumin are important markers for hepatic synthesis activity and body nutrient status. Hypoproteinemia is a condition characterized by abnormally low levels of proteins in the blood, particularly serum albumin. Albumin levels below 30 g/L are generally defined as hypoproteinemia, with normal reference values in healthy adults ranging from 35 to 50 g/L. Serum protein levels may drop below normal if the body is in a state of negative nitrogen balance for an extended period. Inadequate nitrogen intake can deplete the body’s protein stores, which include serum proteins like albumin and globulins, leading to hypoproteinemia [2].

The digestive process separates the macro and micronutrients from food into simple sugars, amino acids, fatty acids, vitamins, and other nutrients. These nutrients are then transported to the liver through portal veins. The liver is responsible for the biochemical transformation of these nutrients into substances with useful physiological properties [3].

Hepatic parenchymal cells produce the water-soluble, globular glycoproteins albumin and prealbumin. Prealbumin is so called because it migrates ahead of albumin during protein electrophoresis. Prealbumin is a measure of the health of the liver’s synthesis pathways, its reserve capacity, and its nutritional status. Normal hypoproteinemia is typically treated with albumin infusion, nutritional supplementation, or the elimination of the underlying cause of the condition [4].

Clinicians may also face cases of hypoproteinemia that are particularly difficult to treat. To improve albumin levels actively and symptomatically, clinicians need to first determine the pathological and physiological causes, which necessitates a series of examinations and tests and differentiation through multidisciplinary analyses.

We present a case of atypical-type undernutrition in a patient with progressive portal thrombosis and reduced blood inflow into the liver from portal veins, resulting in prolonged hypoproteinemia. This phenomenon has rarely been reported in the literature. In this article, we have focused on providing a theoretical basis for the diagnosis and treatment of atypical hypoproteinemia caused by progressive portal thrombosis and cavernous transformation of the portal vein (CTPV).

1.1 Case details

A 48-year-old male patient presented at our department of the hospital, with a chief complaint of persistent tachypnea lasting for more than one month. Notably, he had previously been diagnosed with cirrhosis 6 years prior, a condition initially identified during medical care subsequent to a motor vehicle accident in 2016. At that time, the patient exhibited no discernible symptoms of cirrhosis such as abdominal distension, asthenia, aversion to oily foods, anorexia, or any other related discomfort. Furthermore, there was an absence of subsequent medical evaluations or therapeutic interventions specifically targeting cirrhosis.

In the year 2020, the patient experienced a sudden aversion to oily foods without any apparent inciting factors; however, his overall dietary intake remained unaltered, and he did not manifest symptoms such as diarrhea or any associated discomfort. Remarkably, the patient did not seek further medical attention, nor did he pursue a comprehensive diagnostic workup or therapeutic intervention despite this notable change in his dietary preferences.

Over the passage of time, the patient exhibited a progressive state of emaciation, leading to a substantial reduction in body weight, amounting to approximately 15 kg from the year 2020 to the current date when he presented himself for medical evaluation at our facility. In April 2022, the patient reported an episode of tachypnea, which occurred spontaneously without any readily discernible precipitating factors. Remarkably, the patient denied experiencing symptoms such as aversion to cold, fever, recurrent fever, night sweats, cough, expectoration, nausea, vomiting, abdominal pain, abdominal distension, diarrhea, or any other associated discomfort during this period.

The patient had a previously unremarkable medical history, characterized by good health. In 2018, he underwent extracorporeal lithotripsy to address a “left kidney calculus.” Notably, the patient had a history of smoking spanning more than two decades, with a daily consumption of approximately 20 cigarettes. It is pertinent to mention that he successfully ceased smoking over nine months prior to the current medical evaluation. Additionally, the patient reported occasional, modest alcohol consumption, with no other noteworthy clinical features or medical history of significance.

The patient presented to our medical facility seeking further assessment and treatment. Results from auxiliary examinations revealed pertinent findings. Abdominal computed tomography (CT) imaging demonstrated a reduction in parenchymal density within the peripheral regions of both the left and right liver lobes, indicative of potential hepatic impairment or uneven perfusion. Notably, the liver exhibited substantial morphological changes in comparison to imaging conducted in 2016, characterized by diminished density, attenuated enhancement, and the presence of enlarged lesions.

Furthermore, the intrahepatic branches of both the portal vein and hepatic vein displayed a reduction in caliber, with certain branches exhibiting poor visibility. Additionally, there was an enlargement of the main portal vein by 1.5 cm, accompanied by the observation of numerous tortuous vascular shadows within the hepatic portal. These collective radiological findings strongly supported a diagnosis of CTPV, concurrently with the presence of cirrhosis and splenomegaly.

The results of the thoracic CT examination revealed the presence of bilateral pleural effusion, with a depth of 6.0 cm in the right pleural space and 3.7 cm in the left pleural space (as illustrated in Figures 1 and 2). A gastroscopy procedure, conducted on June 7, 2022, unveiled the presence of moderate esophageal varices. It is noteworthy that these varices were classified as moderate in severity, with the absence of a red color sign, signifying an absence of active bleeding. Hepatic vascular ultrasound studies indicated the patency of the portal vein, hepatic vein, and inferior vena cava, suggesting normal vascular flow within the hepatic system. Cardiac color Doppler ultrasound findings revealed evidence of poorly coordinated ventricular wall motion in the heart, alongside mild regurgitation of both the mitral and tricuspid valves. Additionally, and weaker left ventricular diastolic function. The ejection fraction (EF) was 58%. Lastly, thyroid ultrasound investigations yielded unremarkable findings.

Figure 1 Imaging examination: a–c: In 2016, imaging revealed mild stenosis in the main portal vein. There was a conspicuous presence of collateral branches (indicated by the red arrow), facilitating the inflow of blood into the liver during the portal venous phase. Furthermore, the enhancement patterns observed in both the liver and spleen appeared uniform and essentially consistent.
Figure 1

Imaging examination: a–c: In 2016, imaging revealed mild stenosis in the main portal vein. There was a conspicuous presence of collateral branches (indicated by the red arrow), facilitating the inflow of blood into the liver during the portal venous phase. Furthermore, the enhancement patterns observed in both the liver and spleen appeared uniform and essentially consistent.

Figure 2 Imaging examination: (a) During reexamination in 2022: Significant worsening of main portal vein stenosis (indicated by the red arrow) with partial intrahepatic branches essentially having disappeared. In the portal venous phase of CT, significantly lower enhancement in most of the liver than in the spleen (indicated by the red arrow), significantly more aggravated portal hypertension, significantly thicker varices in the esophagus and stomach fundus, and a thicker splenorenal venous shunt. (b) The portal vein area shows thrombosis (indicated by the red arrow). (c) Spongy changes in the portal vein area (indicated by the red arrow). (d and e) Bilateral pleural effusion with no obvious signs of ascites.
Figure 2

Imaging examination: (a) During reexamination in 2022: Significant worsening of main portal vein stenosis (indicated by the red arrow) with partial intrahepatic branches essentially having disappeared. In the portal venous phase of CT, significantly lower enhancement in most of the liver than in the spleen (indicated by the red arrow), significantly more aggravated portal hypertension, significantly thicker varices in the esophagus and stomach fundus, and a thicker splenorenal venous shunt. (b) The portal vein area shows thrombosis (indicated by the red arrow). (c) Spongy changes in the portal vein area (indicated by the red arrow). (d and e) Bilateral pleural effusion with no obvious signs of ascites.

Laboratory investigation results were as follows: White blood cell (WBC): 9.7 × 109/L (the maximum value, 12.79, was on June 7), neutral ratio 78.7%, hemoglobin (Hb) 100 g/L; procalcitonin 0.09 ng/mL, C-reactive protein (CRP) 72.87 mg/L; urine routine: occult blood 3+, urobilinogen 1+, urine protein±. Negative stool occult blood. Hepatic function: albumin 32.3 g/L (June 17 has the minimum value 29.9 g/L), prealbumin 62 mg/L, gamma-glutamyl transferase (GGT) 104.1, alkaline phosphatase (ALP) 519.4, with no remarkable abnormality in other respects in hepatic function; immunoglobulin G (IgG) 29.6 g/L, immunoglobulin A (IgA) 8.82 g/L, total cholesterol 2.16 mmol/L, normal triglyceride (TG). Blood coagulation: prothrombin time (PT) 15.8 s; international normalized ratio (INR) 1.41; D-dimer 0.67 mg/L; B-type natriuretic peptide (BNP) 10.78 pg/mL; renal function and tumor marker cancer antigen 125 (CA-125) 168.8 U/mL. Tests for myocardial markers, 24-h urine protein, anemia three items, thyroid function, hepatitis etiology, complete set of tests for autoimmune antibodies, and hepatitis antibody were all negative. K light chain 26.4 g/L, λ light chain 16.6 g/L. Purified protein derivative (PPD) test results were negative. Routine biochemistry analysis of pleural fluid showed exudate (Table 1).

Table 1

Laboratory investigation results

Investigation Indicator Results
Blood routine
WBC 9.7 × 109/L (the maximum value, 12.79, was on June 7)
Neutral ratio 78.7%
Hb 100 g/L
Procalcitonin 0.09 ng/mL
CRP 72.87 mg/L
Urine routine
Occult blood +++
Urobilinogen +
Urine protein ±
Stool for routine
Stool occult blood −
Hepatic function
Albumin 32.3 g/L (June 17 has the minimum value of 29.9 g/L)
Prealbumin 62 mg/L
GGT 104.1
ALP 519.4
Other respects in hepatic function Negative
Immune globulin
IgG 29.6 g/L
IgA 8.82 g/L
Blood fat
Total cholesterol 2.16 mmol/L
TG Negative
Blood coagulation
PT 15.8 s
INR 1.41
D-dimer 0.67 mg/L
Other investigation
BNP 10.78 pg/mL
CA-125 168.8 U/mL
K Light chain 26.4 g/L
λ Light chain 16.6 g/L
Tests for myocardial marker 26.4 g/L
24-h urine protein 16.6 g/L
Anemia three items Negative
Thyroid function Negative
Hepatitis etiology, complete set of tests for autoimmune antibodies, and hepatitis antibody Negative
PPD Negative

Other tests: Liver biopsy results: Mild chronic liver tissue impairment. Immunolabeling: CD34 (transmembrane phosphoglycoprotein encoded by the CD34 gene in humans) (Focus +). CK19 (cytokeratin fragment 19) (bile ducts +). HBsAg (Hepatitis B surface antigen) (−). Normal liver tissue structure. Turbid and swollen hepatocytes. A small amount of pigment granule deposition in hepatocytes. Scattered punctate necrosis in liver parenchyma. Narrowed sinusoids. Not dilated hepatic centrilobular vein. Normal in shape and number of bile ducts in the portal area. A small amount of chronic inflammatory cell infiltration in the interstitial substance. No visible fibrous septa. No definite changes prompting cirrhosis (Figure 3). Bone marrow (BM) slide test results: Notable proliferation of BM nucleated cells with active BM hyperplasia and prominent erythrocyte proliferation indicated by pathology. Genetic testing results: Results of genetic testing by a third-party-accredited laboratory showed no abnormality in congenital-anemia-relevant hemolysis and paroxysmal nocturnal hemoglobinuria. (These tests were performed by SINO-US Diagnostics Lab, Tianjin, China on June 30, 2022).

Figure 3 Hepatic pathology: Essentially normal liver tissue structure. Turbid and swollen hepatocytes. A small amount of pigment granule deposition in hepatocytes. Scattered punctate necrosis in the liver parenchyma. Narrowed sinusoids. Hepatic centrilobular vein not dilated. Normal shape and number of small bile ducts in the portal area. A small amount of chronic inflammatory cell infiltration in interstitial substance. No visible fibrous septa (hematoxylin and eosin [H&E] staining, ×100-fold).
Figure 3

Hepatic pathology: Essentially normal liver tissue structure. Turbid and swollen hepatocytes. A small amount of pigment granule deposition in hepatocytes. Scattered punctate necrosis in the liver parenchyma. Narrowed sinusoids. Hepatic centrilobular vein not dilated. Normal shape and number of small bile ducts in the portal area. A small amount of chronic inflammatory cell infiltration in interstitial substance. No visible fibrous septa (hematoxylin and eosin [H&E] staining, ×100-fold).

2 Diagnosis and treatment for an integrated nutrition solution

Upon consultation, the patient, with a height of 165 cm and an initial weight of 45 kg, reported a substantial weight loss of 4 kg within a span of 2 weeks, representing a significant 8.16% reduction in body weight. Consequently, the body mass index (BMI) was calculated to be 16.5 kg/m². Clinical examination revealed a conspicuous diminishment of subcutaneous adipose tissue and muscle mass across various anatomical regions of the body. Notably, there was an absence of edema in both lower extremities. A comprehensive dietary assessment conducted by a nutritionist, encompassing a 24-hour observation of the patient’s customary daily food intake, estimated an energy intake of approximately 1,200 kcal and a protein intake of 52 g throughout the course of a typical day.

Nutrition screening: The patient received a score of 4 based on the Nutrition Risk Screening 2002 [5], indicating that he was at risk of malnutrition.

Nutrition assessment: Utilizing the criteria established by the Global Leadership Initiative on Malnutrition (GLIM) [6], the patient exhibited a low BMI of 16.5 kg/m², aligning with the phenotypical criteria. Furthermore, the evaluation of etiological criteria revealed a notable disease burden. Considering these factors in conjunction, the patient’s nutritional status was assessed as severe malnutrition, in accordance with the GLIM guidelines.

Nutrition diagnosis: Severe malnutrition, protein-energy undernutrition.

Nutrition treatment: Target energy was started at 1,500 kcal/day and gradually increased to 1,800 kcal/day if it was tolerated, with a target protein of 60–90 g. Apart from normal oral intake, supplementary nutritional preparations (300–500 kcal/day) were added based on the patient’s oral dietary intake.

Nutrition status follow-up: After nutritional interventions, prealbumin was checked every other day, and liver function and albumin were reviewed two weeks later, with close monitoring of the patient’s gastrointestinal symptoms.

Clinical diagnosis: 1. Severe malnutrition. 2. Non-cirrhotic portal hypertension. 3. Bilateral pleural effusion. 4. Hypoproteinemia. 5. Mild anemia. 6. With nutritional risk.

  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

3.1 Cause analysis of undernutrition

Protein-energy malnutrition and micronutrient malnutrition are common causes of undernutrition. Micronutrient malnutrition manifests as a deficiency of micronutrients, such as vitamins and trace elements, which are required in minute quantities but are essential. Protein energy malnutrition manifests as insufficient energy and protein availability or absorption in the body [7]. In this instance, the patient’s food intake was normal, unchanged from his previous condition, and was devoid of food bias, anorexia, mismatched foods, or wasting disease. It was believed that he was suffering from malnutrition due to a lack of protein.

Causes of hypoproteinemia: Serum prealbumin, a glycoprotein produced in the liver, earns its name from its position in serum protein electrophoresis, where it precedes albumin. Notably, prealbumin boasts an exceptionally brief half-life of approximately 1.9 days. This distinctive characteristic endows prealbumin with the ability to provide a highly accurate reflection of recent overall nutritional status and the liver’s capacity for protein synthesis and secretion. Furthermore, prealbumin serves as a valuable tool for the early detection of liver function impairment, disease-related alterations, and prognosis assessment. Its utility extends to identifying early signs of malnutrition even in patients afflicted by non-malnutritional cirrhosis, making it a versatile marker in clinical contexts [8].

The liver can synthesize about 12–20 g of albumin per day with a half-life of about 21 days [2]. There are two types of albumin decrease: acute and chronic. The most common causes of acute albumin decrease are acute massive bleeding or severe burns that result in plasma loss. The causes of chronic albumin decrease are as follows:

  1. Hepatic synthetic dysfunction. Hepatocyte degeneration and necrosis caused by various types of viral hepatitis or other hepatitis, liver cirrhosis, liver failure, liver cancer, and so on can interfere with hepatic function in albumin synthesis, followed by a rapid drop in albumin in the human body that can reach a significant total drop in about 10 days [9].

  2. Undernutrition. The synthesis of albumin by the liver relies on the absorption of dietary protein and other nutrients. In instances of protein malnutrition or impaired nutrient absorption, hepatic parenchymal cells face a deficit of essential components necessary for albumin synthesis, ultimately resulting in a failure of albumin production. Consequently, serum albumin levels in the human body decline. Several scenarios exemplify this phenomenon: 1. Inadequate dietary intake: Reduced food consumption, as seen in fasting, consumption of low-nutrient foods, dysphagia, anorexia nervosa, selective eating habits, and dietary biases, can all lead to insufficient protein intake. This limitation in nutrient availability hampers the liver’s ability to synthesize albumin. 2. Gastrointestinal disorders: Various gastrointestinal conditions, such as small intestinal mucosal dysplasia, short bowel syndrome, fistulas in the small intestine or colon, gastric cancer, intestinal cancer, liver cancer, and portal hypertension, can impede the intake or absorption of essential proteins and nutrients. In such cases, the liver lacks the necessary raw materials required for albumin production, resulting in a decline in albumin levels within the body [10].

  3. Loss of protein. (1) Nephrogenic hypoproteinemia. In the initial phases of conditions such as nephrotic syndrome and glomerulonephritis, protein loss predominantly involves smaller and finer proteins. However, as these conditions progress, proteinuria may encompass a wider range of protein types. In the later stages, it is possible for albumin levels to drop significantly, potentially falling below 10 g/L. When the concentration of albumin in the bloodstream falls below 20 g/L, it results in reduced colloid osmotic pressure. This decrease in colloid osmotic pressure has significant clinical implications, as it leads to the development of edema in the human body. (2) Low albumin levels can occur in patients with a variety of conditions, including severe burns, acute massive hemorrhage, and others where there is a significant loss of protein. (3) Large amounts of protein can also be lost due to hydrothorax and ascites. This can lead to hypoproteinemia, which in turn aggravates ascites. Later-stage renal impairment can further exacerbate protein loss. (4) Intestine-relevant protein loss: inflammatory intestinal disease, lymphangiectasia, autoimmune intestinal disease (for instance, Ménétrier disease which is associated with autoimmune pancreatitis) [11], protein-losing enteropathy [12], eosinophilic gastroenteritis, and so on.

  4. Hypoproteinemia can also be caused by other chronic and consumptive diseases, such as tuberculosis and hyperthyroidism. Hypoproteinemia can develop as a result of excessive protein consumption or the negative effects on dietary intake caused by local malignant tumors in the lung, liver, kidney, etc., or systemic malignant tumors.

  5. Pregnancy causes a drop in albumin levels, which is most noticeable in the third trimester. Albumin loss can also occur in extremely rare cases such as congenital albumin deficiency (where patients almost completely lack albumin in their blood but do not experience edema). Nutrition is less of a factor in hypoproteinemia than the underlying physiological stress caused by disease or trauma-related inflammation [13].

In addition to disease factors, malnutrition can also be caused by social and environmental factors. Poverty, living conditions, and other socio-economic factors have all been shown to affect the nutritional status of school-age children either directly or indirectly [14]. The most consistent factors associated with child malnutrition are maternal education, household income, maternal nutritional status, age of the child, availability of home health facilities, family size, family birth order, and birth weight of the child [15].

In summary, the concurrent reductions in albumin and prealbumin levels can serve as potential indicators of malnutrition and hepatic synthetic impairment. Through a comprehensive evaluation by a nutritionist, we deduced the possible causes behind the decline in albumin and prealbumin levels in this patient. Notably, malnutrition arising from inadequate dietary intake was ruled out, as the patient exhibited normal food consumption and did not present with symptoms such as dysphagia, dietary aversions, anorexia, or related issues. Malabsorption and protein loss related to intestinal diseases were also eliminated as potential causes for the decline in albumin and prealbumin levels. This exclusion was based on the patient’s favorable gastrointestinal function, which was characterized by the absence of symptoms such as abdominal pain, abdominal distension, diarrhea, and constipation. Furthermore, the patient’s hepatic function, as evidenced by normal bilirubin and transaminase levels, led us to exclude cirrhosis as a contributing factor, a determination further supported by the findings from a liver biopsy. Although the patient did display mildly abnormal blood coagulation parameters, we attributed this anomaly to portal vein thrombosis-induced consumption rather than hepatic synthetic dysfunction.

In 2016, the patient underwent a CT scan that revealed mild stenosis of the main portal vein, liver impairment or inadequate perfusion (the CT showed decreased hepatic blood inflow), a barely perceptible portal vein (likely indicative of thrombosis), and multiple tortuous vascular shadows surrounding the hepatic portal. Based on the CT done in 2016, CTPV was considered likely [16]. In the patient’s 2022 CT scan, a notable deterioration in the condition was observed, particularly in the main portal vein where there was more pronounced stenosis. Furthermore, several intrahepatic branches of the portal vein had virtually disappeared. During the portal venous phase of the CT scan, the majority of liver enhancements were markedly reduced compared to those of the spleen. Concomitantly, there was a significant exacerbation of portal hypertension, as evidenced by thicker varices in the esophagus and stomach fundus, as well as a more prominent splenorenal venous shunt when compared to previous assessments. Additionally, splenomegaly, or enlargement of the spleen, was evident in the imaging findings.

The patient was diagnosed with CTPV, which led to progressive portal thrombosis and progressive aggravation of portal hypertension [17], reducing blood flow and nutrient uptake into the liver, and ultimately leading to hypoproteinemia.

3.2 Diagnosis by exclusion

  1. Exclusion of cardiac organic diseases and heart failure: The patient presented with tachypnea but no other symptoms, such as edema in the lower extremities, asthenia, lung rales, jugular venous regurgitation, etc. The patient’s BNP was normal, and after performing a cardiac ultrasound scan to rule out organic cardiac diseases, we found that his EF was 58%. Consequently, we ruled out heart failure and other organic cardiac conditions.

  2. Exclusion of cirrhosis: There was no fibrosis, pseudolobules, or other pathological evidence of cirrhosis in the patient’s liver biopsy.

  3. Exclusion of malignant tumors of thorax and abdomen: There were no gastrointestinal symptoms present, such as nausea, vomiting, diarrhea, or constipation. His chest and abdomen CT scans came back clear, as did his tumor markers and his gastroscopy, and he was found to have no tumor in his stomach. As a result, there was a lack of supporting evidence for this disease.

  4. Exclusion of tuberculosis: No classic tuberculous symptoms, like persistent fever or night sweats, were present in this patient. The sputum slide test and chest CT both came back negative for tuberculosis.

  5. Exclusion of congenital hemolytic anemia and paroxysmal nocturnal hemoglobinuria: The patient had hypochromic microcytic anemia, a mild form of anemia. There was no evidence of fecal occult blood, ferritin, folic acid, and vitamin B12 levels for anemia, and bilirubin and hepatic function were both within normal ranges. Despite a positive urine occult blood and urobilinogen test, the patient’s urine bilirubin result was negative. Previous lithotripsy for renal calculi was linked to the patient’s urinary occult blood. In addition, genetic testing by an outside, reputable lab showed no indication of a problem with hemolysis or paroxysmal nocturnal hemoglobinuria, both of which are linked to congenital anemia. So, we eliminated paroxysmal nocturnal hemoglobinuria and congenital hemolytic anemia as possible causes.

  6. Exclusion of hyperthyroidism: The patient’s thyroid function and thyroid ultrasound both came back normal.

Figure 4 displays a mind map of the diagnostic procedure.

Figure 4 Mind map of the diagnostic procedure.
Figure 4

Mind map of the diagnostic procedure.

3.3 Treatment with concurrent verification

Following intravenous administration of 20% human albumin and compound amino acids (20AA) within our department, a notable improvement was observed in the patient’s condition. Specifically, there was a significant increase in serum albumin levels, rising from 29.9 g/L on June 17 to 33.9 g/L on June 21. This intervention also led to a reduction in hydrothorax, as well as relief from symptoms of cardiac exhaustion and tachypnea. However, it is worth noting that the patient’s symptoms worsened after discontinuing this intravenous infusion. This observation underscores the effectiveness of parenteral nutrition in rapidly increasing albumin levels and addressing the patient’s clinical presentation when compared to enteral nutrition, suggesting a more immediate and efficacious response to this mode of nutritional support.

3.4 Proposed treatment regimen for this patient

(1) Anticoagulation for early portal vein thrombosis. Unfortunately, the patient missed the optimal window for initiating anticoagulation therapy, as several years had elapsed since his initial diagnosis in 2016. Additionally, the patient was not a candidate for transjugular intrahepatic portosystemic shunt treatment. (2) Intravenous infusion of albumin and amino acids. It is important to note that albumin infusion does not exacerbate portal pressure. Early intravenous administration of albumin in appropriate quantities was shown to provide significant benefits, even in cases where cirrhosis developed subsequently [18]. (3) Adopt a dietary regimen characterized by smaller, more frequent meals, emphasizing a high-protein diet. (4) Wait for gradual compensation of hepatic artery. (5) Liver transplantation.

3.5 Chinese and international literature

Portal vein obstruction is the primary cause of CTPV-induced portal hypertension [17]. CTPV-induced portal hypertension can be divided into congenital and acquired categories. Malformations of the portal vein are the most common cause of portal hypertension due to congenital CTPV. Congenital atresia of the umbilical vein can also result from the involvement of the portal vein. Acquired CTPV-induced portal hypertension is caused by a local inflammatory state, such as portal phlebitis, pancreatitis, peritonitis, cholecystolithiasis, hepatic echinococcosis, and surgical trauma, or it is caused by thrombosis resulting from local tumor infiltration or other causes [19]. Some researchers have hypothesized that thrombophilia is the underlying cause of portal vein thrombosis [20]. In 2016, a CT scan showed signs of possible venous thrombosis in this patient. Over the course of 6 years, CTPV formed in the collateral circulation, blocking portal blood flow. There is currently a gap in the literature concerning the relationship between portal vein thrombosis and CTPV and hypoproteinemia.

The portal system transports nutrients from the digestive tract to the liver, where they are metabolized. This case report describes a patient who developed a progressive aggravated thrombosis in the main portal veins and their intrahepatic branches, causing a reduction in portal blood inflow into the liver, with the majority of this blood directly returning to the systemic circulation via the shunt. In this context, the compromised liver function led to an inability to acquire an adequate supply of essential substrates required for the synthesis of various proteins. Consequently, the nutritional components derived from food became inefficiently utilized, culminating in the development of hypoproteinemia, malnutrition, emaciation, and pleural effusion. It is noteworthy that the existing literature does not currently provide insights into the specific relationship between reduced blood inflow from the portal veins into the liver and the occurrence of hypoproteinemia. As a result, there is a paucity of documented knowledge on this particular aspect of the condition. We will continue to pay close attention to literature in this area, thereby facilitating the development of more effective strategies for addressing hypoproteinemia and malnutrition in patients with similar clinical profiles.

4 Conclusion

Vigilance for the development of hypoproteinemia holds paramount importance in the management of patients with progressive portal vein thrombosis complicated by CTPV. The prompt identification and implementation of effective interventions aimed at rectifying hypoproteinemia can yield substantial improvements in clinical outcomes. Moreover, the possibility of reduced hepatic blood flow should be meticulously considered as a potential underlying factor in instances of unexplained hypoproteinemia.

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Acknowledgments

We would like to acknowledge the hard and dedicated work of all the staff that implemented the intervention and evaluation components of the study.

  1. Funding information: Authors state no funding involved.

  2. Author contributions: Conception and design of the research: Qun-Ru Wang, Shan-Hong Tang; acquisition of data: Chen-Cheng Wang, Jun Long; analysis and interpretation of the data: Jun Long, Ji-Lei Hu; statistical analysis: Chen-Cheng Wang, Ning Lin; obtaining financing: none; writing of the manuscript: Qun-Ru Wang, Ji-Lei Hu; critical revision of the manuscript for intellectual content: Ning Lin, Shan-Hong Tang; all authors read and approved the final draft.

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

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

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Received: 2023-05-15
Revised: 2023-09-18
Accepted: 2023-10-10
Published Online: 2023-11-29

© 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-2022-0766
Keywords for this article
cavernous transformation of the portal vein; hypoproteinemia; portal thrombosis; undernutrition
Creative Commons
BY 4.0

Articles in the same Issue

  1. Biomedical Sciences
  2. Systemic investigation of inetetamab in combination with small molecules to treat HER2-overexpressing breast and gastric cancers
  3. Immunosuppressive treatment for idiopathic membranous nephropathy: An updated network meta-analysis
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  10. Novel CPLANE1 c.8948dupT (p.P2984Tfs*7) variant in a child patient with Joubert syndrome
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  33. Association between the VEGFR-2 -604T/C polymorphism (rs2071559) and type 2 diabetic retinopathy
  34. The role of IL-31 and IL-34 in the diagnosis and treatment of chronic periodontitis
  35. Triple-negative mouse breast cancer initiating cells show high expression of beta1 integrin and increased malignant features
  36. mNGS facilitates the accurate diagnosis and antibiotic treatment of suspicious critical CNS infection in real practice: A retrospective study
  37. The apatinib and pemetrexed combination has antitumor and antiangiogenic effects against NSCLC
  38. Radiotherapy for primary thyroid adenoid cystic carcinoma
  39. Design and functional preliminary investigation of recombinant antigen EgG1Y162–EgG1Y162 against Echinococcus granulosus
  40. Effects of losartan in patients with NAFLD: A meta-analysis of randomized controlled trial
  41. Bibliometric analysis of METTL3: Current perspectives, highlights, and trending topics
  42. Performance comparison of three scaling algorithms in NMR-based metabolomics analysis
  43. PI3K/AKT/mTOR pathway and its related molecules participate in PROK1 silence-induced anti-tumor effects on pancreatic cancer
  44. The altered expression of cytoskeletal and synaptic remodeling proteins during epilepsy
  45. Effects of pegylated recombinant human granulocyte colony-stimulating factor on lymphocytes and white blood cells of patients with malignant tumor
  46. Prostatitis as initial manifestation of Chlamydia psittaci pneumonia diagnosed by metagenome next-generation sequencing: A case report
  47. NUDT21 relieves sevoflurane-induced neurological damage in rats by down-regulating LIMK2
  48. Association of interleukin-10 rs1800896, rs1800872, and interleukin-6 rs1800795 polymorphisms with squamous cell carcinoma risk: A meta-analysis
  49. Exosomal HBV-DNA for diagnosis and treatment monitoring of chronic hepatitis B
  50. Shear stress leads to the dysfunction of endothelial cells through the Cav-1-mediated KLF2/eNOS/ERK signaling pathway under physiological conditions
  51. Interaction between the PI3K/AKT pathway and mitochondrial autophagy in macrophages and the leukocyte count in rats with LPS-induced pulmonary infection
  52. Meta-analysis of the rs231775 locus polymorphism in the CTLA-4 gene and the susceptibility to Graves’ disease in children
  53. Cloning, subcellular localization and expression of phosphate transporter gene HvPT6 of hulless barley
  54. Coptisine mitigates diabetic nephropathy via repressing the NRLP3 inflammasome
  55. Significant elevated CXCL14 and decreased IL-39 levels in patients with tuberculosis
  56. Whole-exome sequencing applications in prenatal diagnosis of fetal bowel dilatation
  57. Gemella morbillorum infective endocarditis: A case report and literature review
  58. An unusual ectopic thymoma clonal evolution analysis: A case report
  59. Severe cumulative skin toxicity during toripalimab combined with vemurafenib following toripalimab alone
  60. Detection of V. vulnificus septic shock with ARDS using mNGS
  61. Novel rare genetic variants of familial and sporadic pulmonary atresia identified by whole-exome sequencing
  62. The influence and mechanistic action of sperm DNA fragmentation index on the outcomes of assisted reproduction technology
  63. Novel compound heterozygous mutations in TELO2 in an infant with You-Hoover-Fong syndrome: A case report and literature review
  64. ctDNA as a prognostic biomarker in resectable CLM: Systematic review and meta-analysis
  65. Diagnosis of primary amoebic meningoencephalitis by metagenomic next-generation sequencing: A case report
  66. Phylogenetic analysis of promoter regions of human Dolichol kinase (DOLK) and orthologous genes using bioinformatics tools
  67. Collagen changes in rabbit conjunctiva after conjunctival crosslinking
  68. Effects of NM23 transfection of human gastric carcinoma cells in mice
  69. Oral nifedipine and phytosterol, intravenous nicardipine, and oral nifedipine only: Three-arm, retrospective, cohort study for management of severe preeclampsia
  70. Case report of hepatic retiform hemangioendothelioma: A rare tumor treated with ultrasound-guided microwave ablation
  71. Curcumin induces apoptosis in human hepatocellular carcinoma cells by decreasing the expression of STAT3/VEGF/HIF-1α signaling
  72. Rare presentation of double-clonal Waldenström macroglobulinemia with pulmonary embolism: A case report
  73. Giant duplication of the transverse colon in an adult: A case report and literature review
  74. Ectopic thyroid tissue in the breast: A case report
  75. SDR16C5 promotes proliferation and migration and inhibits apoptosis in pancreatic cancer
  76. Vaginal metastasis from breast cancer: A case report
  77. Screening of the best time window for MSC transplantation to treat acute myocardial infarction with SDF-1α antibody-loaded targeted ultrasonic microbubbles: An in vivo study in miniswine
  78. Inhibition of TAZ impairs the migration ability of melanoma cells
  79. Molecular complexity analysis of the diagnosis of Gitelman syndrome in China
  80. Effects of maternal calcium and protein intake on the development and bone metabolism of offspring mice
  81. Identification of winter wheat pests and diseases based on improved convolutional neural network
  82. Ultra-multiplex PCR technique to guide treatment of Aspergillus-infected aortic valve prostheses
  83. Virtual high-throughput screening: Potential inhibitors targeting aminopeptidase N (CD13) and PIKfyve for SARS-CoV-2
  84. Immune checkpoint inhibitors in cancer patients with COVID-19
  85. Utility of methylene blue mixed with autologous blood in preoperative localization of pulmonary nodules and masses
  86. Integrated analysis of the microbiome and transcriptome in stomach adenocarcinoma
  87. Berberine suppressed sarcopenia insulin resistance through SIRT1-mediated mitophagy
  88. DUSP2 inhibits the progression of lupus nephritis in mice by regulating the STAT3 pathway
  89. Lung abscess by Fusobacterium nucleatum and Streptococcus spp. co-infection by mNGS: A case series
  90. Genetic alterations of KRAS and TP53 in intrahepatic cholangiocarcinoma associated with poor prognosis
  91. Granulomatous polyangiitis involving the fourth ventricle: Report of a rare case and a literature review
  92. Studying infant mortality: A demographic analysis based on data mining models
  93. Metaplastic breast carcinoma with osseous differentiation: A report of a rare case and literature review
  94. Protein Z modulates the metastasis of lung adenocarcinoma cells
  95. Inhibition of pyroptosis and apoptosis by capsaicin protects against LPS-induced acute kidney injury through TRPV1/UCP2 axis in vitro
  96. TAK-242, a toll-like receptor 4 antagonist, against brain injury by alleviates autophagy and inflammation in rats
  97. Primary mediastinum Ewing’s sarcoma with pleural effusion: A case report and literature review
  98. Association of ADRB2 gene polymorphisms and intestinal microbiota in Chinese Han adolescents
  99. Tanshinone IIA alleviates chondrocyte apoptosis and extracellular matrix degeneration by inhibiting ferroptosis
  100. Study on the cytokines related to SARS-Cov-2 in testicular cells and the interaction network between cells based on scRNA-seq data
  101. Effect of periostin on bone metabolic and autophagy factors during tooth eruption in mice
  102. HP1 induces ferroptosis of renal tubular epithelial cells through NRF2 pathway in diabetic nephropathy
  103. Intravaginal estrogen management in postmenopausal patients with vaginal squamous intraepithelial lesions along with CO2 laser ablation: A retrospective study
  104. Hepatocellular carcinoma cell differentiation trajectory predicts immunotherapy, potential therapeutic drugs, and prognosis of patients
  105. Effects of physical exercise on biomarkers of oxidative stress in healthy subjects: A meta-analysis of randomized controlled trials
  106. Identification of lysosome-related genes in connection with prognosis and immune cell infiltration for drug candidates in head and neck cancer
  107. Development of an instrument-free and low-cost ELISA dot-blot test to detect antibodies against SARS-CoV-2
  108. Research progress on gas signal molecular therapy for Parkinson’s disease
  109. Adiponectin inhibits TGF-β1-induced skin fibroblast proliferation and phenotype transformation via the p38 MAPK signaling pathway
  110. The G protein-coupled receptor-related gene signatures for predicting prognosis and immunotherapy response in bladder urothelial carcinoma
  111. α-Fetoprotein contributes to the malignant biological properties of AFP-producing gastric cancer
  112. CXCL12/CXCR4/CXCR7 axis in placenta tissues of patients with placenta previa
  113. Association between thyroid stimulating hormone levels and papillary thyroid cancer risk: A meta-analysis
  114. Significance of sTREM-1 and sST2 combined diagnosis for sepsis detection and prognosis prediction
  115. Diagnostic value of serum neuroactive substances in the acute exacerbation of chronic obstructive pulmonary disease complicated with depression
  116. Research progress of AMP-activated protein kinase and cardiac aging
  117. TRIM29 knockdown prevented the colon cancer progression through decreasing the ubiquitination levels of KRT5
  118. Cross-talk between gut microbiota and liver steatosis: Complications and therapeutic target
  119. Metastasis from small cell lung cancer to ovary: A case report
  120. The early diagnosis and pathogenic mechanisms of sepsis-related acute kidney injury
  121. The effect of NK cell therapy on sepsis secondary to lung cancer: A case report
  122. Erianin alleviates collagen-induced arthritis in mice by inhibiting Th17 cell differentiation
  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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