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Brucella infection combined with Nocardia infection: A case report and literature review

  • Yan Feng , Chun-Lei Zuo and Jia-Xin Shi EMAIL logo
Published/Copyright: February 3, 2024
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Open Life Sciences
From the journal Open Life Sciences Volume 19 Issue 1

Abstract

Human brucellosis is an infectious disease caused by Brucella and is often misdiagnosed for atypical manifestations including fever of unknown origin, headache, weakness, among else. Nocardiosis is a zoonotic disease caused by the genus Nocardia, which usually spreads through the respiratory tract, skin, and digestive tract. Limited research has documented cases of co-infection involving both Brucella and Nocardia pathogens in patients. A 55-year-old male was admitted to our hospital with intermittent high-grade fever. Following sputum and blood cultures, as well as other laboratory examinations, the patient was diagnosed with concurrent brucellosis and nocardiosis. According to recommendations of previous studies and reports, the patient was successively treated with levofloxacin, doxycycline, piperacillin sodium and sulbactam sodium, trimethoprim-sulfamethoxazole, rifampicin, and tigecycline, after which the patient recovered and was discharged. Brucella and Nocardia are both opportunistic pathogens and simultaneous infection of Brucella and Nocardia is relatively rare. If patients continue to experience persistent fever despite receiving empirical antibiotic therapy, it becomes necessary to conduct examinations to identify potential atypical pathogens, including Brucella and Nocardia. Sputum staining, sputum culture, and blood culture are critical auxiliary examinations during clinical practice. The treatment plan should be selected based on guidelines and the individual patient’s condition. Regular reevaluation should be conducted, and antimicrobial agents should be adjusted accordingly.

Keywords: brucellosis; nocardiosis; atypical pathogen; co-infection; pulmonary infection

1 Background

Brucella, a type of gram-negative bacterium, usually causes epidemics in cattle, sheep, and pigs. Humans may be infected when they come in contact with infected animals or ingest their meat or unpasteurized milk. Brucellosis is one of the most common infectious diseases causing fever of unknown origin [1], with a high misdiagnosis rate.

Nocardia lives in the soil and is gram-positive branching rod bacterium, entering the human body through respiratory tract, skin, or digestive tract [2]. The occurrence and transmission of nocardiosis are closely related to the body’s immunity.

Co-infection with both Brucella and Nocardia is not commonly encountered in clinical practice. The aim of this article is to provide some diagnostic and therapeutic strategies for clinicians managing such cases.

2 Case presentation

A 55-year-old male was admitted to our hospital with intermittent fever for the past month. The patient had fever a month ago, with the highest temperature of 40.4°C, accompanied by chills and weakness. He had a small amount of thick sputum, without sore throat, myalgia, or other symptoms. He provided a medical history of previous cerebral infarction and right eye surgery, without lingering residual sequelae. Of note, the patient cleaned a cowshed 4 months ago and was exposed to rain prior to the onset of the illness. He did not have a history of chronic obstructive pulmonary disease or any other chronic lung conditions. He denied any history of using immunosuppressive drugs or any other long-term medications.

On admission, his body temperature was 37.8°C he received ibuprofen suspension before hospitalization), heart rate was 110 bpm, respiration rate was 20 breaths/min, and blood pressure was 96/67 mmHg. We had not observed any signs of arthritis, lymphadenopathy, or hepatosplenomegaly in him. The patient demonstrated normal muscle strength and tone in all extremities, with negative pathological reflexes and no signs of meningeal irritation. There were no other remarkable findings on physical examination. After admission, the patient received routine examinations. His complete blood count showed a white blood cell count of 3.52 × 109/L, red blood cell count of 2.85 × 1012/L, lymphocyte count of 1.1 × 109/L, and a platelet count of 89 × 109/L. Other laboratory examinations showed high erythrocyte sedimentation rate of 69 mm/h, increased level of C-reactive protein of 159.82 mg/L (0.00–5.00 mg/L). Serum biochemical index test revealed 2.65 mmol/L potassium, 26.7 g/L albumin, slightly elevated alanine aminotransferase (84 U/L), and aspartate aminotransferase (84 U/L), with normal creatinine. The examinations for autoimmune antibodies were negative. Immune globulin levels were normal. The human immunodeficiency virus antibody test was negative. Serum galactomannan and (1,3)-β-d-glucan tests were negative. T-SPOT.TB assay was negative. Tuberculosis and fungal infections were not found in the sputum smear. Sputum smear showed gram-positive filamentous bacilli resembling Nocardia or Actinomycetes (Figure 1a and b). All sputum specimens submitted for examination were deep purulent sputum expectorated by patient after thorough mouth rinsing. The sputum culture on day 4 of incubation grew Nocardia otitidiscaviarum (Figure 1c). A positive culture result for Brucella was obtained by blood culture on day 5 (Figure 2a and b), which was later confirmed by Rose Bengal plate agglutination test (RBT) (Figure 2c) and mass spectrometric detection and turned out to be Brucella melitensis. Echocardiogram was performed and revealed no evident anomalies. Chest computed tomography (CT) was performed and showed occupying lesions in the right lower lobe (RLL), multiple nodules in both upper lobes, miliary nodules in both lungs, and bilateral pleural effusion (Figure 3a).

Figure 1 Sputum sample test. (a) Gram staining of the sputum sample. (b) Modified acid-fast staining of the sputum sample. (c) White dry colonies on blood agar plate.
Figure 1

Sputum sample test. (a) Gram staining of the sputum sample. (b) Modified acid-fast staining of the sputum sample. (c) White dry colonies on blood agar plate.

Figure 2 Blood sample test. (a) White dry colonies on blood agar plate. (b) White dry colonies on chocolate agar plate. (c) The patient’s serum sample: RBT showing positive. (d) The control’s serum sample: RBT showing negative.
Figure 2

Blood sample test. (a) White dry colonies on blood agar plate. (b) White dry colonies on chocolate agar plate. (c) The patient’s serum sample: RBT showing positive. (d) The control’s serum sample: RBT showing negative.

Figure 3 Chest CT scan. (a) CT scan on March 15th (day 1) showed occupying lesions in the RLL, multiple nodules in both upper lobes. (b) CT scan on March 23rd (day 9). (c) CT scan on April 1st (day 18) showed that lesions occupying both the RLL and multiple nodules in upper lobes shrank obviously. (d) CT scan on May 12th (day 59). (e) CT scan on Jun 18th (day 96). (f) CT scan on August 27th (day 166) showed almost complete absorption of lesions in both lungs.
Figure 3

Chest CT scan. (a) CT scan on March 15th (day 1) showed occupying lesions in the RLL, multiple nodules in both upper lobes. (b) CT scan on March 23rd (day 9). (c) CT scan on April 1st (day 18) showed that lesions occupying both the RLL and multiple nodules in upper lobes shrank obviously. (d) CT scan on May 12th (day 59). (e) CT scan on Jun 18th (day 96). (f) CT scan on August 27th (day 166) showed almost complete absorption of lesions in both lungs.

During the first 2 days, we empirically gave the patient broad-spectrum antibiotic levofloxacin and symptomatic treatment, after which the patient still had fever. Combined with the patient’s persistent fever, imaging features, and the history of cleaning the cattle pen, on day 3, we adjusted the anti-infection treatment as follows: doxycycline hydrochloride enteric capsule plus piperacillin sodium and sulbactam sodium. When Nocardia infection was confirmed on day 4, oral trimethoprim-sulfamethoxazole (TMP-SMZ) was applied. The piperacillin sodium and sulbactam sodium were discontinued and rifampicin was applied after Brucella infection was confirmed on day 5. After the above treatments, the patient’s body temperature decreased slowly during the initial 4 days but still failed to return to normal and stayed at about 37.6°C in the next 3 days. In addition, the follow-up chest CT on day 9 (Figure 3b) showed no significant differences compared to previous results. Therefore, based on previous studies, we replaced doxycycline with tigecycline, which demonstrated superior antimicrobial efficacy [3,4]. The patient’s body temperature thereafter gradually decreased to normal and cough relieved obviously. On day 18, the chest CT (Figure 3c) showed that lesions occupying both the RLL and multiple nodules in upper lobes shrank obviously, and blood cultures on day 21 and day 25 were both negative. Therefore, the therapeutic regimen was adjusted to doxycycline plus TMP-SMZ. After 24 days of treatment, the sputum and blood cultures of the patient turned negative, and he was subsequently discharged from our hospital. After discharge, the patient continued to take doxycycline and rifampicin for 1 month and TMP-SMZ for 5 months. At the fifth month follow-up, the nodules on chest CT disappeared entirely (Figure 3f).

  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

Brucellosis is widely distributed in Asian countries including China, wherein the northern regions of China were reported facing more epidemics than the southern regions of China [5]. The manifestations of brucellosis mainly include fever, mostly characterized by wavelike fever, sweats, myalgia, fatigue, arthritis, and myocarditis [6,7]. So far, there has been no acknowledged standard of diagnosis for brucellosis. Combined with the epidemiological history, bacterial culture, and serological test results, a relatively high diagnostic rate can be achieved [8]. Patients usually have a history of contact with livestock or livestock products with Brucella infection. Common serological tests include RBT, standard agglutination test, enzyme-linked immunosorbent assay, 2-mercaptoethanol test, of which RBT is the most commonly used in clinical practice due to its high sensitivity, affordability, and rapid detection speed [9]. After further history inquiry, the patient in this case admitted sweeping the cattle pen prior to fever. We conducted sputum culture and blood culture, respectively, and ultimately found Brucella in the blood, following which RBT was carried out and presented a positive result. However, we failed to isolate Brucella from sputum throughout the course of disease. In addition, the patient refused the fiberoptic bronchoscopy as we suggested for bronchoalveolar lavage fluid detection. Combination treatment regimens were reported to prevent brucellosis relapse and avert complications more effectively than monotherapy [10]. There are lots of treatment regimens reported in the study by Skalsky et al. [11], and the recommended treatment duration is 1–3 months [12]. In this case, we chose doxycycline plus rifampicin for treatment initially. The patient’s fever symptom still existed and chest CT showed no obvious change after 7 days of doxycycline treatment. There are literature reports that tigecycline might demonstrate superior therapeutic efficacy in the treatment of brucellosis [3,4]. Therefore, based on the patient’s manifestations, we replaced doxycycline with tigecycline. The patient’s temperature returned to normal, blood culture turned negative as well as lung lesions shrank gradually (Figure 3), thus indicating that the treatment was successful. Therefore, we can conclude that tigecycline could be administered during the initial stage of high pathogen load, and when the condition stabilizes at a later stage, it can be switched to a conventional doxycycline sequential therapy. Regrettably, we did not conduct a follow-up blood culture examination before switching to tigecycline.

Nocardia, an opportunistic bacterium, usually invades immunocompromised hosts [13]. Despite the absence of common risk factors for Nocardia infection, such as HIV infection, chronic lung disease, and immunosuppressive medication use, the patient in this case was vulnerable to infection due to his advanced age and history of rain exposure prior to the onset of illness. Pulmonary nocardiosis is the most common presentation of Nocardia infection clinically, with nonspecific symptoms such as cough, dyspnea fever, and chest pain [14]. Chest imaging findings mainly include single or multiple nodules, pleural effusion, pulmonary infiltrates, and cavitary lesions [15], consistent with the findings on the patient’s chest CT. In addition, the central nervous system (CNS) is another common site of infection, often originating from pulmonary infection and presenting with insidious onset and high mortality rates [16]. Therefore, CNS Nocardiosis should be ruled out in every case of pulmonary nocardiosis especially with delayed response. The patient in this case underwent a cranial magnetic resonance imaging scan at a local hospital about a week before admission, which indicated lacunar cerebral infarction and no other abnormalities were found. The routine laboratory tests include gram staining, modified acid-fast staining, and germiculture [17]. Sputum smear of this patient showed gram-positive filamentous rods (Figure 1a), and modified acid-fast staining showed positive (Figure 1b). The following incubation confirmed the Nocardia otitidiscaviarum. Once antibiotics treatment is initiated, the diagnosis may become more difficult. In this situation, molecular biology methods such as Polymerase Chain Reaction and metagenomics next-generation sequencing should be taken into consideration [18]. Furthermore, we can consider lung biopsy if both of the above examination methods failed to find pathogenic bacteria. The most common treatment in clinical practice for Nocardia treatment is oral TMP-SMZ for 6 months [17]. However, there is variability in the sensitivity of Nocardia otitidiscaviarum to TMP/SMZ [19]. Nevertheless, due to the lack of drug sensitivity testing, we still decided to empirically use TMP/SMZ in this case, and, in the end, we obtained remarkable therapeutic results. Furthermore, tigecycline demonstrates efficacy against Brucella species and possesses certain antibacterial properties towards Nocardia [19].

4 Conclusion

Brucella and Nocardia are both opportunistic pathogens and simultaneous infection of Brucella and Nocardia is relatively rare. If patients continue to experience persistent fever despite receiving empirical antibiotic therapy, it becomes necessary to conduct examinations to identify potential atypical pathogens, including Brucella and Nocardia. Sputum staining, sputum culture, and blood culture are critical auxiliary examinations during clinical practice. The treatment plan should be selected based on guidelines and the individual patient’s condition. Regular reevaluation should be conducted, and antimicrobial agents should be adjusted accordingly.

# Equal contributors.

tel: +86 518 85767009; fax: +86 518 85456700

  1. Funding information: This work was supported by Lianyungang Health Commission Research Foundation (Grant No. 202016), Lianyungang First People’s Hospital Clinical Research Foundation (Grant No. LC10) and Jiangsu Province Senile Health Scientific Research Project (Grant No. LKM2022064).

  2. Author contributions: Y.F. collected and analyzed the data and wrote the manuscript. J.X.S. was the leading doctor and wrote part of the discussion. C.L.Z. performed part of the laboratory examinations and provided pictures. All authors read and approved the final manuscript.

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

  4. Data availability statement: All data generated or analyzed during this study are included in this published article.

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Received: 2023-08-09
Revised: 2023-11-16
Accepted: 2023-11-21
Published Online: 2024-02-03

© 2024 the author(s), published by De Gruyter

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

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  116. Electroacupuncture on GB acupoints improves osteoporosis via the estradiol–PI3K–Akt signaling pathway
  117. Renalase protects against podocyte injury by inhibiting oxidative stress and apoptosis in diabetic nephropathy
  118. Review: Dicranostigma leptopodum: A peculiar plant of Papaveraceae
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  120. Renal microangiopathy and immune complex glomerulonephritis induced by anti-tumour agents: A case report
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  124. Exploring the effects of culture conditions on Yapsin (YPS) gene expression in Nakaseomyces glabratus
  125. Screening of prognostic core genes based on cell–cell interaction in the peripheral blood of patients with sepsis
  126. Coagulation factor II thrombin receptor as a promising biomarker in breast cancer management
  127. Ileocecal mucinous carcinoma misdiagnosed as incarcerated hernia: A case report
  128. Methyltransferase like 13 promotes malignant behaviors of bladder cancer cells through targeting PI3K/ATK signaling pathway
  129. The debate between electricity and heat, efficacy and safety of irreversible electroporation and radiofrequency ablation in the treatment of liver cancer: A meta-analysis
  130. ZAG promotes colorectal cancer cell proliferation and epithelial–mesenchymal transition by promoting lipid synthesis
  131. Baicalein inhibits NLRP3 inflammasome activation and mitigates placental inflammation and oxidative stress in gestational diabetes mellitus
  132. Impact of SWCNT-conjugated senna leaf extract on breast cancer cells: A potential apoptotic therapeutic strategy
  133. MFAP5 inhibits the malignant progression of endometrial cancer cells in vitro
  134. Major ozonated autohemotherapy promoted functional recovery following spinal cord injury in adult rats via the inhibition of oxidative stress and inflammation
  135. Axodendritic targeting of TAU and MAP2 and microtubule polarization in iPSC-derived versus SH-SY5Y-derived human neurons
  136. Differential expression of phosphoinositide 3-kinase/protein kinase B and Toll-like receptor/nuclear factor kappa B signaling pathways in experimental obesity Wistar rat model
  137. The therapeutic potential of targeting Oncostatin M and the interleukin-6 family in retinal diseases: A comprehensive review
  138. BA inhibits LPS-stimulated inflammatory response and apoptosis in human middle ear epithelial cells by regulating the Nf-Kb/Iκbα axis
  139. Role of circRMRP and circRPL27 in chronic obstructive pulmonary disease
  140. Investigating the role of hyperexpressed HCN1 in inducing myocardial infarction through activation of the NF-κB signaling pathway
  141. Characterization of phenolic compounds and evaluation of anti-diabetic potential in Cannabis sativa L. seeds: In vivo, in vitro, and in silico studies
  142. Quantitative immunohistochemistry analysis of breast Ki67 based on artificial intelligence
  143. Ecology and Environmental Science
  144. Screening of different growth conditions of Bacillus subtilis isolated from membrane-less microbial fuel cell toward antimicrobial activity profiling
  145. Degradation of a mixture of 13 polycyclic aromatic hydrocarbons by commercial effective microorganisms
  146. Evaluation of the impact of two citrus plants on the variation of Panonychus citri (Acari: Tetranychidae) and beneficial phytoseiid mites
  147. Prediction of present and future distribution areas of Juniperus drupacea Labill and determination of ethnobotany properties in Antalya Province, Türkiye
  148. Population genetics of Todarodes pacificus (Cephalopoda: Ommastrephidae) in the northwest Pacific Ocean via GBS sequencing
  149. A comparative analysis of dendrometric, macromorphological, and micromorphological characteristics of Pistacia atlantica subsp. atlantica and Pistacia terebinthus in the middle Atlas region of Morocco
  150. Macrofungal sporocarp community in the lichen Scots pine forests
  151. Assessing the proximate compositions of indigenous forage species in Yemen’s pastoral rangelands
  152. Food Science
  153. Gut microbiota changes associated with low-carbohydrate diet intervention for obesity
  154. Reexamination of Aspergillus cristatus phylogeny in dark tea: Characteristics of the mitochondrial genome
  155. Differences in the flavonoid composition of the leaves, fruits, and branches of mulberry are distinguished based on a plant metabolomics approach
  156. Investigating the impact of wet rendering (solventless method) on PUFA-rich oil from catfish (Clarias magur) viscera
  157. Non-linear associations between cardiovascular metabolic indices and metabolic-associated fatty liver disease: A cross-sectional study in the US population (2017–2020)
  158. Knockdown of USP7 alleviates atherosclerosis in ApoE-deficient mice by regulating EZH2 expression
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  169. Development of a detection chip for major pathogenic drug-resistant genes and drug targets in bovine respiratory system diseases
  170. Exploration of the genetic influence of MYOT and MB genes on the plumage coloration of Muscovy ducks
  171. Transcriptome analysis of adipose tissue in grazing cattle: Identifying key regulators of fat metabolism
  172. Comparison of nutritional value of the wild and cultivated spiny loaches at three growth stages
  173. Transcriptomic analysis of liver immune response in Chinese spiny frog (Quasipaa spinosa) infected with Proteus mirabilis
  174. Disruption of BCAA degradation is a critical characteristic of diabetic cardiomyopathy revealed by integrated transcriptome and metabolome analysis
  175. Plant Sciences
  176. Effect of long-term in-row branch covering on soil microorganisms in pear orchards
  177. Photosynthetic physiological characteristics, growth performance, and element concentrations reveal the calcicole–calcifuge behaviors of three Camellia species
  178. Transcriptome analysis reveals the mechanism of NaHCO3 promoting tobacco leaf maturation
  179. Bioinformatics, expression analysis, and functional verification of allene oxide synthase gene HvnAOS1 and HvnAOS2 in qingke
  180. Water, nitrogen, and phosphorus coupling improves gray jujube fruit quality and yield
  181. Improving grape fruit quality through soil conditioner: Insights from RNA-seq analysis of Cabernet Sauvignon roots
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  183. Revealing the effects of amino acid, organic acid, and phytohormones on the germination of tomato seeds under salinity stress
  184. Combined effects of nitrogen fertilizer and biochar on the growth, yield, and quality of pepper
  185. Comprehensive phytochemical and toxicological analysis of Chenopodium ambrosioides (L.) fractions
  186. Impact of “3414” fertilization on the yield and quality of greenhouse tomatoes
  187. Exploring the coupling mode of water and fertilizer for improving growth, fruit quality, and yield of the pear in the arid region
  188. Metagenomic analysis of endophytic bacteria in seed potato (Solanum tuberosum)
  189. Antibacterial, antifungal, and phytochemical properties of Salsola kali ethanolic extract
  190. Exploring the hepatoprotective properties of citronellol: In vitro and in silico studies on ethanol-induced damage in HepG2 cells
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  196. Antioxidant and antimicrobial activities of Salsola imbricata methanolic extract and its phytochemical characterization
  197. Bioengineering and Biotechnology
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  199. New advances in protein engineering for industrial applications: Key takeaways
  200. An overview of the production and use of Bacillus thuringiensis toxin
  201. Research progress of nanoparticles in diagnosis and treatment of hepatocellular carcinoma
  202. Bioelectrochemical biosensors for water quality assessment and wastewater monitoring
  203. PEI/MMNs@LNA-542 nanoparticles alleviate ICU-acquired weakness through targeted autophagy inhibition and mitochondrial protection
  204. Unleashing of cytotoxic effects of thymoquinone-bovine serum albumin nanoparticles on A549 lung cancer cells
  205. Erratum
  206. Erratum to “Investigating the association between dietary patterns and glycemic control among children and adolescents with T1DM”
  207. Erratum to “Activation of hypermethylated P2RY1 mitigates gastric cancer by promoting apoptosis and inhibiting proliferation”
  208. Retraction
  209. Retraction to “MiR-223-3p regulates cell viability, migration, invasion, and apoptosis of non-small cell lung cancer cells by targeting RHOB”
  210. Retraction to “A data mining technique for detecting malignant mesothelioma cancer using multiple regression analysis”
  211. Special Issue on Advances in Neurodegenerative Disease Research and Treatment
  212. Transplantation of human neural stem cell prevents symptomatic motor behavior disability in a rat model of Parkinson’s disease
  213. Special Issue on Multi-omics
  214. Inflammasome complex genes with clinical relevance suggest potential as therapeutic targets for anti-tumor drugs in clear cell renal cell carcinoma
  215. Gastroesophageal varices in primary biliary cholangitis with anti-centromere antibody positivity: Early onset?
https://doi.org/10.1515/biol-2022-0815
Keywords for this article
brucellosis; nocardiosis; atypical pathogen; co-infection; pulmonary infection
Creative Commons
BY 4.0

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  130. ZAG promotes colorectal cancer cell proliferation and epithelial–mesenchymal transition by promoting lipid synthesis
  131. Baicalein inhibits NLRP3 inflammasome activation and mitigates placental inflammation and oxidative stress in gestational diabetes mellitus
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  148. Population genetics of Todarodes pacificus (Cephalopoda: Ommastrephidae) in the northwest Pacific Ocean via GBS sequencing
  149. A comparative analysis of dendrometric, macromorphological, and micromorphological characteristics of Pistacia atlantica subsp. atlantica and Pistacia terebinthus in the middle Atlas region of Morocco
  150. Macrofungal sporocarp community in the lichen Scots pine forests
  151. Assessing the proximate compositions of indigenous forage species in Yemen’s pastoral rangelands
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  155. Differences in the flavonoid composition of the leaves, fruits, and branches of mulberry are distinguished based on a plant metabolomics approach
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  158. Knockdown of USP7 alleviates atherosclerosis in ApoE-deficient mice by regulating EZH2 expression
  159. Utility of dairy microbiome as a tool for authentication and traceability
  160. Agriculture
  161. Enhancing faba bean (Vicia faba L.) productivity through establishing the area-specific fertilizer rate recommendation in southwest Ethiopia
  162. Impact of novel herbicide based on synthetic auxins and ALS inhibitor on weed control
  163. Perspectives of pteridophytes microbiome for bioremediation in agricultural applications
  164. Fertilizer application parameters for drip-irrigated peanut based on the fertilizer effect function established from a “3414” field trial
  165. Improving the productivity and profitability of maize (Zea mays L.) using optimum blended inorganic fertilization
  166. Application of leaf multispectral analyzer in comparison to hyperspectral device to assess the diversity of spectral reflectance indices in wheat genotypes
  167. Animal Sciences
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  169. Development of a detection chip for major pathogenic drug-resistant genes and drug targets in bovine respiratory system diseases
  170. Exploration of the genetic influence of MYOT and MB genes on the plumage coloration of Muscovy ducks
  171. Transcriptome analysis of adipose tissue in grazing cattle: Identifying key regulators of fat metabolism
  172. Comparison of nutritional value of the wild and cultivated spiny loaches at three growth stages
  173. Transcriptomic analysis of liver immune response in Chinese spiny frog (Quasipaa spinosa) infected with Proteus mirabilis
  174. Disruption of BCAA degradation is a critical characteristic of diabetic cardiomyopathy revealed by integrated transcriptome and metabolome analysis
  175. Plant Sciences
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  177. Photosynthetic physiological characteristics, growth performance, and element concentrations reveal the calcicole–calcifuge behaviors of three Camellia species
  178. Transcriptome analysis reveals the mechanism of NaHCO3 promoting tobacco leaf maturation
  179. Bioinformatics, expression analysis, and functional verification of allene oxide synthase gene HvnAOS1 and HvnAOS2 in qingke
  180. Water, nitrogen, and phosphorus coupling improves gray jujube fruit quality and yield
  181. Improving grape fruit quality through soil conditioner: Insights from RNA-seq analysis of Cabernet Sauvignon roots
  182. Role of Embinin in the reabsorption of nucleus pulposus in lumbar disc herniation: Promotion of nucleus pulposus neovascularization and apoptosis of nucleus pulposus cells
  183. Revealing the effects of amino acid, organic acid, and phytohormones on the germination of tomato seeds under salinity stress
  184. Combined effects of nitrogen fertilizer and biochar on the growth, yield, and quality of pepper
  185. Comprehensive phytochemical and toxicological analysis of Chenopodium ambrosioides (L.) fractions
  186. Impact of “3414” fertilization on the yield and quality of greenhouse tomatoes
  187. Exploring the coupling mode of water and fertilizer for improving growth, fruit quality, and yield of the pear in the arid region
  188. Metagenomic analysis of endophytic bacteria in seed potato (Solanum tuberosum)
  189. Antibacterial, antifungal, and phytochemical properties of Salsola kali ethanolic extract
  190. Exploring the hepatoprotective properties of citronellol: In vitro and in silico studies on ethanol-induced damage in HepG2 cells
  191. Enhanced osmotic dehydration of watermelon rind using honey–sucrose solutions: A study on pre-treatment efficacy and mass transfer kinetics
  192. Effects of exogenous 2,4-epibrassinolide on photosynthetic traits of 53 cowpea varieties under NaCl stress
  193. Comparative transcriptome analysis of maize (Zea mays L.) seedlings in response to copper stress
  194. An optimization method for measuring the stomata in cassava (Manihot esculenta Crantz) under multiple abiotic stresses
  195. Fosinopril inhibits Ang II-induced VSMC proliferation, phenotype transformation, migration, and oxidative stress through the TGF-β1/Smad signaling pathway
  196. Antioxidant and antimicrobial activities of Salsola imbricata methanolic extract and its phytochemical characterization
  197. Bioengineering and Biotechnology
  198. Absorbable calcium and phosphorus bioactive membranes promote bone marrow mesenchymal stem cells osteogenic differentiation for bone regeneration
  199. New advances in protein engineering for industrial applications: Key takeaways
  200. An overview of the production and use of Bacillus thuringiensis toxin
  201. Research progress of nanoparticles in diagnosis and treatment of hepatocellular carcinoma
  202. Bioelectrochemical biosensors for water quality assessment and wastewater monitoring
  203. PEI/MMNs@LNA-542 nanoparticles alleviate ICU-acquired weakness through targeted autophagy inhibition and mitochondrial protection
  204. Unleashing of cytotoxic effects of thymoquinone-bovine serum albumin nanoparticles on A549 lung cancer cells
  205. Erratum
  206. Erratum to “Investigating the association between dietary patterns and glycemic control among children and adolescents with T1DM”
  207. Erratum to “Activation of hypermethylated P2RY1 mitigates gastric cancer by promoting apoptosis and inhibiting proliferation”
  208. Retraction
  209. Retraction to “MiR-223-3p regulates cell viability, migration, invasion, and apoptosis of non-small cell lung cancer cells by targeting RHOB”
  210. Retraction to “A data mining technique for detecting malignant mesothelioma cancer using multiple regression analysis”
  211. Special Issue on Advances in Neurodegenerative Disease Research and Treatment
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