Soft tissue tumors in the hand have a broad differential diagnosis. Included in the list of differential diagnoses for these tumors are Schwannomas, which are benign tumors within the peripheral nervous system [1]. Sc...Soft tissue tumors in the hand have a broad differential diagnosis. Included in the list of differential diagnoses for these tumors are Schwannomas, which are benign tumors within the peripheral nervous system [1]. Schwannomas are uncommon within the upper extremity, and they are exceedingly rare within the hand and wrist [1]. We describe a case of an 80-year-old female presented with a soft tissue mass within her right thumb. She underwent excisional biopsy of the mass, and pathology showed features consistent with schwannoma. She had resolution of her symptoms thereafter. We discuss the differential diagnosis for soft-tissue tumors in this location. When assessing patients with soft tissue tumors of the hand and wrist, it is important for the treating provider to maintain a broad differential diagnosis in order to facilitate appropriate management of these lesions.展开更多
BACKGROUND Beinaglutide,a short-acting glucagon-like polypeptide-1 receptor agonist,has shown variable efficacy in weight reduction and metabolic control in randomized controlled trials(RCTs).AIM To summarize the ther...BACKGROUND Beinaglutide,a short-acting glucagon-like polypeptide-1 receptor agonist,has shown variable efficacy in weight reduction and metabolic control in randomized controlled trials(RCTs).AIM To summarize the therapeutic effects of beinaglutide in patients with overweight/obesity with/without type 2 diabetes.METHODS RCTs involving patients receiving beinaglutide in the intervention arm and placebo or active comparator in the control arm were searched through multiple electronic databases.The change from baseline in body weight was the primary outcome;secondary outcomes included changes in body mass index(BMI),waist circumference(WC),blood pressure,glycemic parameters,lipids,and adverse events(AEs).RevMan web was used to conduct meta-analysis using random-effects models.Outcomes were presented as mean differences(MDs),odds ratios(ORs),or risk ratios(RRs)with 95%confidence intervals(95%CIs).RESULTS Six RCTs(n=800)with mostly some concerns about the risk of bias were included.Over 12-24 weeks,beinaglutide 0.1-0.2 mg thrice daily was superior to the control group in reducing total(MD=-3.25 kg,95%CI:-4.52 to-1.98,I^(2)=84%,P<0.00001)and percent(MD=-4.13%,95%CI:-4.87 to-3.39,I^(2)=54%,P<0.00001)body weight reduction.Beinaglutide also outperformed the control group in achieving weight loss by 5%(OR 4.61)and 10%(OR=5.34).The superiority of beinaglutide vs the control group was also found in reducing BMI(MD=-1.22 kg/m^(2),95%CI:-1.67 to-0.77)and WC(MD=-2.47 cm,95%CI:-3.74 to-1.19]).Beinaglutide and the control group had comparable impacts on blood pressure,glycemic parameters,insulin resistance,hepatic transaminases,and lipid profile.Beinaglutide posed higher risks of treatment discontinuation due to AEs(RR=3.15),nausea(RR=4.51),vomiting(RR=8.19),palpitation(RR=3.95),headache(RR=2.87),and dizziness(RR=6.07)than the control.However,the two groups had identical risks of total and serious AEs,diarrhea,fatigue,and hypoglycemia.CONCLUSION Short-term data from RCTs suggested that beinaglutide causes modest benefits in reducing body weight,BMI,and WC,with no significant difference in glycemic and other metabolic endpoints compared to the control arm.Safety data were consistent with those of the other drugs in the glucagon-like polypeptide-1 receptor agonist class.Larger RCTs are warranted to prove the longer-term metabolic benefits of beinaglutide.展开更多
BACKGROUND Data on the use of glucagon-like peptide-1 receptor agonists(GLP-1RAs)in individuals with type 2 diabetes mellitus(T2DM)during Ramadan fasting is limited.No meta-analysis has summarized the safety and effec...BACKGROUND Data on the use of glucagon-like peptide-1 receptor agonists(GLP-1RAs)in individuals with type 2 diabetes mellitus(T2DM)during Ramadan fasting is limited.No meta-analysis has summarized the safety and effectiveness of GLP-1RAs in these situations.AIM To evaluate the safety and efficacy of GLP-1RA in patients with T2DM fasting during Ramadan.METHODS Electronic databases were systematically searched for relevant studies that featured GLP-1RA in the intervention arm and other glucose-lowering medications in the control arm.The primary outcome was adverse events(AEs)during Ramadan for both groups;other outcomes included changes in glycemic and anthropometric measures during the peri-Ramadan period.RESULTS Four studies[three randomized-controlled trials with low risk of bias(RoB)and one prospective observational study with serious RoB]involving 754 subjects were analyzed.GLP-1RA group achieved greater glycated hemoglobin reduction than the non-GLP-1RA group[mean difference(MD):-0.31%,95%CI:-0.61 to-0.01,P=0.04,I2=77%]with a lower risk of documented symptomatic hypoglycemia(risk ratio=0.38,95%CI:0.16 to 0.88,P=0.02).Any AEs,serious AEs,or AEs that led to treatment discontinuation were comparable between the two groups.The GLP-1RA group experienced greater weight loss compared to the non-GLP-1RA group(MD:-2.0 kg,95%CI:-3.37 to-0.63,P=0.004,I2=95%).There were comparable changes in blood pressure and lipid profile between the two groups.GLP-1RA users experienced higher risks of gastrointestinal AEs,nausea,and vomiting;however,the risks of heartburn,abdominal pain,and diarrhea were similar in both groups.CONCLUSION Limited evidence suggests that GLP-1RAs are safe for T2DM management during Ramadan,offering modest benefits in blood sugar control and weight loss.Large multicenter trials are needed to confirm their safety and efficacy in at-risk populations,improving clinical practice decision-making.展开更多
BACKGROUND Despite therapeutic benefits,discontinuation of tirzepatide is common in randomized controlled trials(RCTs)due to adverse events(AEs)and other causes.No previous systematic reviews have explored the reasons...BACKGROUND Despite therapeutic benefits,discontinuation of tirzepatide is common in randomized controlled trials(RCTs)due to adverse events(AEs)and other causes.No previous systematic reviews have explored the reasons for discontinuing tirzepatide in the RCTs.AIM To explore the reasons for permanent discontinuation of tirzepatide vs controls[placebo,insulin,and glucagon-like peptide-1 receptor agonists(GLP-1Ras)]in RCTs.METHODS Relevant RCTs were systematically searched using related terms through multiple databases such as MEDLINE(via PubMed),Scopus,Cochrane Central Register,and ClinicalTrials.gov from their inception until June 20,2024.RevMan web was used to conduct meta-analysis using random-effects models.Outcomes were presented as risk ratios(RR)with 95%confidence intervals(CI).RESULTS Seventeen RCTs(n=14645),mostly having low risks of bias,were analyzed.Compared to placebo,the risk of permanent discontinuation of the study drug was substantially lower with tirzepatide 10 mg(RR:0.69,95%CI:0.51-0.93,P=0.02)and similar with tirzepatide 5 mg(RR:0.74,95%CI:0.47-1.17,P=0.20)and 15 mg(RR:0.94,95%CI:0.68-1.31,P=0.71).Tirzepatide had identical discontinuation risks when compared to insulin at 5 mg(RR:0.96,95%CI:0.75-1.24,P=0.77)and 10 mg(RR:1.19,95%CI:0.77-1.82,P=0.44)doses,whereas such risk was higher with tirzepatide 15 mg than insulin(RR:1.31,95%CI:1.03-1.67,P=0.03).Compared to GLP-1RA,the permanent discontinuation risk was similar with tirzepatide 5 mg(RR:0.98,95%CI:0.70-1.37,P=0.90)but was higher with tirzepatide 10 mg(RR:1.40,95%CI:1.03-1.90,P=0.03)and 15 mg(RR:1.70,95%CI:1.27-2.27,P=0.0004).Tirzepatide,at all doses,had higher risks of AE-related discontinuation than insulin;such risks were only greater with higher doses of tirzepatide than with placebo or GLP-1RA.Discontinuation risk due to withdrawal by the study subjects was lower with tirzepatide than with placebo or insulin.Compared to the placebo,tirzepatide(all doses)conferred a lower risk of study drug discontinuation due to other causes not specifically mentioned.CONCLUSION The discontinuation risk is not higher in tirzepatide group than in the placebo arm.Many factors other than AEs led to drug discontinuation in the included RCTs.展开更多
BACKGROUND Efruxifermin(EFX),a fibroblast growth factor 21 analogue,has demonstrated the potential to improve liver fat and markers of liver injury,fibrosis,and key metabolic biomarkers in individuals with metabolic d...BACKGROUND Efruxifermin(EFX),a fibroblast growth factor 21 analogue,has demonstrated the potential to improve liver fat and markers of liver injury,fibrosis,and key metabolic biomarkers in individuals with metabolic dysfunction-associated steatohepatitis(MASH)in phase 2 clinical trials.AIM To summarize the safety and effectiveness of EFX in managing MASH.METHODS Electronic databases and registries were systematically searched from their inception to May 15,2025,for randomized-controlled trials(RCTs)that included EFX in the intervention arm and placebo in the control arm in individuals with MASH.The primary outcome was the safety of EFX,while additional outcomes included its efficacy in altering hepatic and metabolic parameters.Meta-analyses were conducted using the RevMan web computer program with the random-effects model.RESULTS Four phase 2 RCTs(five reports),mostly with low risk of bias,involving 450 subjects,were analyzed.Compared to the placebo,EFX 50 mg was associated with higher risks of treatment-emergent adverse events(TEAEs)[risk ratio(RR)=1.05],TEAEs leading to discontinuation(RR=3.05),nausea(RR=1.78),and diarrhea(RR=1.9).EFX 28 mg increased risks of vomiting(RR=2.17)and frequent bowel movements(RR=8.98).Both doses of EFX were associated with higher risks of drug-related TEAEs(28 mg:RR=1.45;50 mg:RR=1.67)and increased appetite(28 mg:RR=3.16;50 mg:RR=5.66).EFX(28 and 50 mg)and placebo exhibited identical risks for severe TEAEs,serious AEs,abdominal pain,fatigue,headache,injection site erythema,and injection site reactions.EFX(28 and 50 mg)was associated with improvements in hepatic safety outcomes,including liver enzymes and urate levels.EFX outperformed the placebo in both relative and absolute reductions in hepatic fat fraction.Reductions in enhanced liver fibrosis score,Pro-C3,and liver stiffness were also more robust with EFX.EFX was superior in terms of MASH resolution and improvement in fibrosis stage,MASH resolution and no worsening of the fibrosis stage,and fibrosis regression by≥1 stage and no worsening in steatohepatitis.Furthermore,EFX also improved metabolic parameters,including reductions in HbA1c and insulin resistance,as well as improvements in adiponectin and lipid parameters.CONCLUSION EFX demonstrates promising dual efficacy on liver histology and metabolic markers in MASH.However,gastrointestinal side effects and the need for parenteral administration require caution.Long-term data are still necessary to fully evaluate safety and long-term effectiveness.展开更多
BACKGROUND Type 2 diabetes(T2D),as well as obesity,are risk factors for chronic kidney disease(CKD)and end-stage renal disease.The renal impacts of glucose-lowering and weight-lowering drugs and their potential benefi...BACKGROUND Type 2 diabetes(T2D),as well as obesity,are risk factors for chronic kidney disease(CKD)and end-stage renal disease.The renal impacts of glucose-lowering and weight-lowering drugs and their potential benefits in preventing CKD often guide clinicians in choosing them appropriately.Only limited data based on randomized controlled trials(RCTs)is currently available on the renal effects and safety profile of tirzepatide.AIM To explore the renal benefits and safety of tirzepatide vs controls.METHODS RCTs involving patients receiving tirzepatide for any indication in the intervention arm and placebo or active comparator in the control arm were searched through multiple electronic databases.The co-primary outcomes were percent change from baseline(CFB)in urine albumin-to-creatinine ratio(UACR)and absolute CFB in estimated glomerular filtration rate(eGFR;in mL/min/1.73 m^(2));the secondary outcome was tirzepatide’s renal safety profile.RevMan web was used to conduct meta-analysis using random-effects models.Outcomes were presented as mean differences(MD)or risk ratios with 95%confidence intervals.RESULTS Fifteen RCTs(n=14471)with mostly low risk of bias(RoB)were included.Over 26-72 weeks,tirzepatide 10 mg[MD-26.95%(-40.13,-13.76),P<0.0001]and 15 mg[MD-18.03%(-28.58,-7.47),P=0.0008]were superior to placebo in percent reductions of UACR.Tirzepatide,at all doses,outperformed insulin in percent reductions of UACR.Compared to the placebo,the percent UACR reduction was greater in subjects with T2D than those with obesity but without T2D(MD-33.25%vs-7.93%;P=0.001).The CFB in eGFR with all doses of tirzepatide was comparable[5 mg:MD 0.36(-1.41,2.14);10 mg:MD 1.17(-0.22,2.56);15 mg:MD 1.42(-0.04,2.88)];P>0.05 for all vs insulin.Tirzepatide(pooled and separate doses)did not increase the risks of adverse renal events,urinary tract infection,nephrolithiasis,acute kidney injury,and renal cancer compared to the placebo,insulin,and glucagon-like peptide-1 receptor agonists.CONCLUSION Short-term data from RCTs with low RoB suggests that tirzepatide positively impacts UACR without detrimental effects on eGFR in subjects with T2D and obesity without T2D,with a reassuring renal safety profile.Larger RCTs are warranted to prove the longer-term renal benefits of tirzepatide,which might also prevent eGFR decline and worsening of CKD.展开更多
BACKGROUND Diabetes distress(DD),an emotional problem arising from the challenges of living with diabetes and the relentless burden of daily self-management,is common among patients with type 2 diabetes(T2D).South Asi...BACKGROUND Diabetes distress(DD),an emotional problem arising from the challenges of living with diabetes and the relentless burden of daily self-management,is common among patients with type 2 diabetes(T2D).South Asia has a high T2D burden,and many studies have reported varying prevalence rates of DD in this area.AIM To estimate the pooled prevalence of DD among patients with T2D in South Asia,as it is crucial for developing effective therapeutic strategies.METHODS This systematic review and meta-analysis included cross-sectional studies conducted in South Asian countries involving adults with T2D and reported the prevalence of DD.The studies were identified by searching multiple electronic databases and registries from the inception of each database to January 30,2025,using prespecified search terms.Four authors screened and extracted data independently.Meta-analyses were conducted using RStudio software with a random-effects model.The primary outcome was the pooled prevalence of DD.RESULTS Thirty-seven cross-sectional studies(28 from India,five from Bangladesh,and two each from Pakistan and Sri Lanka)with mostly high methodological quality involving 11500 subjects were included.The pooled prevalence of DD was 44%(95%confidence interval:35-53,I2=97.4%).The prevalence of DD was highest in Pakistan(85%),followed by India and Bangladesh(42%each),and Sri Lanka(25%).Emotional burden was the most prevalent form of DD(60%),followed by treatment regimen-related distress(51%),interpersonal distress(31%),and physician-related distress(17%).Meta-regression analysis revealed no significant associations between the prevalence of DD and publication year,sample size,proportion of females,age,duration of diabetes,insulin usage,glycated hemoglobin levels,or diabetic complications.CONCLUSION South Asians with T2D seem to experience a relatively high burden of DD,and the emotional burden is the most common form of DD in this area.Larger studies utilizing unique tools and involving a broader participant base from the region would provide better epidemiological data for effectively planning high-quality diabetes care in South Asian countries.展开更多
The S-scheme heterojunction has garnered increasing attention due to its remarkable oxidation capacity and efficient separation of photogenerated carriers.In this study,a one-pot glycerol-assisted hydrothermal process...The S-scheme heterojunction has garnered increasing attention due to its remarkable oxidation capacity and efficient separation of photogenerated carriers.In this study,a one-pot glycerol-assisted hydrothermal process was utilized to successfully synthesize S-scheme heterojunction photocatalysts comprising basic bismuth nitrate(BBN)and bismuth tungstate(BWO).Interestingly,the BBN/BWO heterogeneous photo-catalysts exhibited the highest photocatalytic properties.The optimized product achieved the degradation of sulfamethazine(SMZ)within 1 h,with a kinetic constant(k)value of 0.05818 min^(−1).The degradation process was influenced significantly by·O^(2)−and h^(+)species.To determine the degradation pathway of SMZ in the presence of BBN/BWO-0.6,liquid chromatography-mass spectrometry(LC-MS)analysis was performed,which revealed a decrease in the toxicity of intermediates and products.The enhanced pho-tocatalytic activity can be attributed to the internal electric field(IEF)of the S-scheme heterojunction between BBN and BWO,effectively promoting the separation of photogenerated carriers.This research presents a viable approach for developing S-scheme heterojunctions in SMZ photodegradation and other environmental applications.展开更多
Background Subacute ruminal acidosis(SARA)is a common metabolic disorder of high yielding dairy cows,and it is associated with dysbiosis of the rumen and gut microbiome and host inflammation.This study evaluated the i...Background Subacute ruminal acidosis(SARA)is a common metabolic disorder of high yielding dairy cows,and it is associated with dysbiosis of the rumen and gut microbiome and host inflammation.This study evaluated the impact of two postbiotics from Saccharomyces cerevisiae fermentation products(SCFP)on rumen liquid associated microbiota of lactating dairy cows subjected to repeated grain-based SARA challenges.A total of 32 rumen cannulated cows were randomly assigned to 4 treatments from 4 weeks before until 12 weeks after parturition.Treatment groups included a Control diet or diets supplemented with postbiotics(SCFPa,14 g/d Original XPC;SCFPb-1X,19 g/d Nutri Tek;SCFPb-2X,38 g/d Nutri Tek,Diamond V,Cedar Rapids,IA,USA).Grain-based SARA challenges were conducted during week 5(SARA1)and week 8(SARA2)after parturition by replacing 20%DM of the base total mixed ration(TMR)with pellets containing 50%ground barley and 50%ground wheat.Total DNA from rumen liquid samples was subjected to V3–V416S r RNA gene amplicon sequencing.Characteristics of rumen microbiota were compared among treatments and SARA stages.Results Both SARA challenges reduced the diversity and richness of rumen liquid microbiota,altered the overall composition(β-diversity),and its predicted functionality including carbohydrates and amino acids metabolic pathways.The SARA challenges also reduced the number of significant associations among different taxa,number of hub taxa and their composition in the microbial co-occurrence networks.Supplementation with SCFP postbiotics,in particular SCFPb-2X,enhanced the robustness of the rumen microbiota.The SCFP supplemented cows had less fluctuation in relative abundances of community members when exposed to SARA challenges.The SCFP supplementation promoted the populations of lactate utilizing and fibrolytic bacteria,including members of Ruminococcaceae and Lachnospiraceae,and also increased the numbers of hub taxa during non-SARA and SARA stages.Supplementation with SCFPb-2X prevented the fluctuations in the abundances of hub taxa that were positively correlated with the acetate concentration,andα-andβ-diversity metrics in rumen liquid digesta.Conclusions Induction of SARA challenges reduced microbiota richness and diversity and caused fluctuations in major bacterial phyla in rumen liquid microbiota in lactating dairy cows.Supplementation of SCFP postbiotics could attenuate adverse effects of SARA on rumen liquid microbiota.展开更多
Spine biomechanical testing methods in the past few decades have not evolved beyond employing either cadaveric studies or finite element modeling techniques.However,both these approaches may have inherent cost and tim...Spine biomechanical testing methods in the past few decades have not evolved beyond employing either cadaveric studies or finite element modeling techniques.However,both these approaches may have inherent cost and time limitations.Cadaveric studies are the present gold standard for spinal implant design and regulatory approval,but they introduce significant variability in measurements across patients,often requiring large sample sizes.Finite element modeling demands considerable expertise and can be computationally expensive when complex geometry and material nonlinearity are introduced.Validated analogue spine models could complement these traditional methods as a low-cost and high-fidelity alternative.A fully 3D printable L-S1 analogue spine model with ligaments is developed and validated in this research.Rotational stiffness of the model under pure bending loading in flexion-extension,Lateral Bending(LB)and Axial Rotation(AR)is evaluated and compared against historical ex vivo and in silico models.Additionally,the effect of interspinous,intertransverse ligaments and the Thoracolumbar Fascia(TLF)on spinal stiffness is evaluated by systematic construction of the model.In flexion,model Range of Motion(ROM)was 12.92±0.11°(ex vivo:16.58°,in silico:12.96°)at 7.5Nm.In LB,average ROM was 13.67±0.12°at 7.5 Nm(ex vivo:15.21±1.89°,in silico:15.49±0.23°).Similarly,in AR,average ROM was 17.69±2.12°at 7.5Nm(ex vivo:14.12±0.31°,in silico:15.91±0.28°).The addition of interspinous and intertransverse ligaments increased both flexion and LB stiffnesses by approximately 5%.Addition of TLF showed increase in flexion and AR stiffnesses by 29%and 24%,respectively.This novel model can reproduce physiological ROMs with high repeatability and could be a useful open-source tool in spine biomechanics.展开更多
Metal clusters or even single-atoms dispersed and anchored on the photocatalysts'surface can enhance photocatalytic performances on organic pollutant oxidation.Here,a simple photoreduction method was used to creat...Metal clusters or even single-atoms dispersed and anchored on the photocatalysts'surface can enhance photocatalytic performances on organic pollutant oxidation.Here,a simple photoreduction method was used to create atomically dispersed metal single-atoms/clusters(MSCs,M=Cu,Pd,Au and Ag)on P-modulated tubular carbon nitride(TCN).The obtained MSCs@TCN demonstrated excellent photocatalytic performances for the degradation of sulfamethazine(SMZ).In particular,the photocatalyst with 2 wt%Cu loading showed ultrahigh SMZ oxidation efficiency(k=0.06110 min^(-1)),almost three times that of TCN(k=0.02066 min^(-1)).It also shows excellent stability in the 5th-cycle measurements.The improved photocatalytic activity of the CuSCs@TCN is ascribed to the synergistic promotion of photogenerated charge separation by Cu single-atoms/clusters as active sites,accelerated charge transfer from bulk TCN to Cu sites through Cu-N_(x)interaction.Meanwhile,the active sites of Cu single-atoms/clusters could promote the production of·O_(2)^(-),which participates in organic oxidation with strong oxidizing holes(h^(+)).This strategy paves a new avenue for designing high-performance photocatalysts decorated with metal single-atoms and clusters.展开更多
The rapid expansion of the Internet of Things (IoT) has driven the need for advanced computational frameworks capable of handling the complex data processing and security challenges that modern IoT applications demand...The rapid expansion of the Internet of Things (IoT) has driven the need for advanced computational frameworks capable of handling the complex data processing and security challenges that modern IoT applications demand. However, traditional cloud computing frameworks face significant latency, scalability, and security issues. Quantum-Edge Cloud Computing (QECC) offers an innovative solution by integrating the computational power of quantum computing with the low-latency advantages of edge computing and the scalability of cloud computing resources. This study is grounded in an extensive literature review, performance improvements, and metrics data from Bangladesh, focusing on smart city infrastructure, healthcare monitoring, and the industrial IoT sector. The discussion covers vital elements, including integrating quantum cryptography to enhance data security, the critical role of edge computing in reducing response times, and cloud computing’s ability to support large-scale IoT networks with its extensive resources. Through case studies such as the application of quantum sensors in autonomous vehicles, the practical impact of QECC is demonstrated. Additionally, the paper outlines future research opportunities, including developing quantum-resistant encryption techniques and optimizing quantum algorithms for edge computing. The convergence of these technologies in QECC has the potential to overcome the current limitations of IoT frameworks, setting a new standard for future IoT applications.展开更多
Integrating hydrothermal treatment processes and anaerobic digestion(AD)is promising for maximizing resource recovery from biomass and organic waste.The process water generated during hydrothermal treatment contains h...Integrating hydrothermal treatment processes and anaerobic digestion(AD)is promising for maximizing resource recovery from biomass and organic waste.The process water generated during hydrothermal treatment contains high concentrations of organic matter,which can be converted into biogas using AD.However,process water also contains various compounds that inhibit the AD process.Fingerprinting these inhibitors and identifying suitable mitigation strategies and detoxification methods is necessary to optimize the integration of these two technologies.By examining the existing literature,we were able to:(1)compare the methane yields and organics removal efficiency during AD of various hydrothermal treatment process water;(2)catalog the main AD inhibitors found in hydrothermal treatment process water;(3)identify recalcitrant components limiting AD performance;and(4)evaluate approaches to detoxify specific inhibitors and degrade recalcitrant components.Common inhibitors in process water are organic acids(at high concentrations),total ammonia nitrogen(TAN),oxygenated organics,and N-heterocyclic compounds.Feedstock composition is the primary determinant of organic acid and TAN formation(carbohydrates-rich and protein-rich feedstocks,respectively).In contrast,processing conditions(e.g.,temperature,pressure,reaction duration)influence the formation extent of oxygenated organics and N-heterocyclic compounds.Struvite precipitation and zeolite adsorption are the most widely used approaches to eliminate TAN inhibition.In contrast,powdered and granular activated carbon and ozonation are the preferred methods to remove toxic substances before AD treatment.Currently,ozonation is the most effective approach to reduce the toxicity and recalcitrance of N and O-heterocyclic compounds during AD.Microaeration methods,which disrupt the AD microbiome less than ozone,might be more practical for nitrifying TAN and degrading recalcitrant compounds,but further research in this area is necessary.展开更多
文摘Soft tissue tumors in the hand have a broad differential diagnosis. Included in the list of differential diagnoses for these tumors are Schwannomas, which are benign tumors within the peripheral nervous system [1]. Schwannomas are uncommon within the upper extremity, and they are exceedingly rare within the hand and wrist [1]. We describe a case of an 80-year-old female presented with a soft tissue mass within her right thumb. She underwent excisional biopsy of the mass, and pathology showed features consistent with schwannoma. She had resolution of her symptoms thereafter. We discuss the differential diagnosis for soft-tissue tumors in this location. When assessing patients with soft tissue tumors of the hand and wrist, it is important for the treating provider to maintain a broad differential diagnosis in order to facilitate appropriate management of these lesions.
文摘BACKGROUND Beinaglutide,a short-acting glucagon-like polypeptide-1 receptor agonist,has shown variable efficacy in weight reduction and metabolic control in randomized controlled trials(RCTs).AIM To summarize the therapeutic effects of beinaglutide in patients with overweight/obesity with/without type 2 diabetes.METHODS RCTs involving patients receiving beinaglutide in the intervention arm and placebo or active comparator in the control arm were searched through multiple electronic databases.The change from baseline in body weight was the primary outcome;secondary outcomes included changes in body mass index(BMI),waist circumference(WC),blood pressure,glycemic parameters,lipids,and adverse events(AEs).RevMan web was used to conduct meta-analysis using random-effects models.Outcomes were presented as mean differences(MDs),odds ratios(ORs),or risk ratios(RRs)with 95%confidence intervals(95%CIs).RESULTS Six RCTs(n=800)with mostly some concerns about the risk of bias were included.Over 12-24 weeks,beinaglutide 0.1-0.2 mg thrice daily was superior to the control group in reducing total(MD=-3.25 kg,95%CI:-4.52 to-1.98,I^(2)=84%,P<0.00001)and percent(MD=-4.13%,95%CI:-4.87 to-3.39,I^(2)=54%,P<0.00001)body weight reduction.Beinaglutide also outperformed the control group in achieving weight loss by 5%(OR 4.61)and 10%(OR=5.34).The superiority of beinaglutide vs the control group was also found in reducing BMI(MD=-1.22 kg/m^(2),95%CI:-1.67 to-0.77)and WC(MD=-2.47 cm,95%CI:-3.74 to-1.19]).Beinaglutide and the control group had comparable impacts on blood pressure,glycemic parameters,insulin resistance,hepatic transaminases,and lipid profile.Beinaglutide posed higher risks of treatment discontinuation due to AEs(RR=3.15),nausea(RR=4.51),vomiting(RR=8.19),palpitation(RR=3.95),headache(RR=2.87),and dizziness(RR=6.07)than the control.However,the two groups had identical risks of total and serious AEs,diarrhea,fatigue,and hypoglycemia.CONCLUSION Short-term data from RCTs suggested that beinaglutide causes modest benefits in reducing body weight,BMI,and WC,with no significant difference in glycemic and other metabolic endpoints compared to the control arm.Safety data were consistent with those of the other drugs in the glucagon-like polypeptide-1 receptor agonist class.Larger RCTs are warranted to prove the longer-term metabolic benefits of beinaglutide.
基金thankful to Dr.Marina George Kudiyirickal MSc,MJDF-RCS,PhD for providing us the audio core tip of this article.
文摘BACKGROUND Data on the use of glucagon-like peptide-1 receptor agonists(GLP-1RAs)in individuals with type 2 diabetes mellitus(T2DM)during Ramadan fasting is limited.No meta-analysis has summarized the safety and effectiveness of GLP-1RAs in these situations.AIM To evaluate the safety and efficacy of GLP-1RA in patients with T2DM fasting during Ramadan.METHODS Electronic databases were systematically searched for relevant studies that featured GLP-1RA in the intervention arm and other glucose-lowering medications in the control arm.The primary outcome was adverse events(AEs)during Ramadan for both groups;other outcomes included changes in glycemic and anthropometric measures during the peri-Ramadan period.RESULTS Four studies[three randomized-controlled trials with low risk of bias(RoB)and one prospective observational study with serious RoB]involving 754 subjects were analyzed.GLP-1RA group achieved greater glycated hemoglobin reduction than the non-GLP-1RA group[mean difference(MD):-0.31%,95%CI:-0.61 to-0.01,P=0.04,I2=77%]with a lower risk of documented symptomatic hypoglycemia(risk ratio=0.38,95%CI:0.16 to 0.88,P=0.02).Any AEs,serious AEs,or AEs that led to treatment discontinuation were comparable between the two groups.The GLP-1RA group experienced greater weight loss compared to the non-GLP-1RA group(MD:-2.0 kg,95%CI:-3.37 to-0.63,P=0.004,I2=95%).There were comparable changes in blood pressure and lipid profile between the two groups.GLP-1RA users experienced higher risks of gastrointestinal AEs,nausea,and vomiting;however,the risks of heartburn,abdominal pain,and diarrhea were similar in both groups.CONCLUSION Limited evidence suggests that GLP-1RAs are safe for T2DM management during Ramadan,offering modest benefits in blood sugar control and weight loss.Large multicenter trials are needed to confirm their safety and efficacy in at-risk populations,improving clinical practice decision-making.
文摘BACKGROUND Despite therapeutic benefits,discontinuation of tirzepatide is common in randomized controlled trials(RCTs)due to adverse events(AEs)and other causes.No previous systematic reviews have explored the reasons for discontinuing tirzepatide in the RCTs.AIM To explore the reasons for permanent discontinuation of tirzepatide vs controls[placebo,insulin,and glucagon-like peptide-1 receptor agonists(GLP-1Ras)]in RCTs.METHODS Relevant RCTs were systematically searched using related terms through multiple databases such as MEDLINE(via PubMed),Scopus,Cochrane Central Register,and ClinicalTrials.gov from their inception until June 20,2024.RevMan web was used to conduct meta-analysis using random-effects models.Outcomes were presented as risk ratios(RR)with 95%confidence intervals(CI).RESULTS Seventeen RCTs(n=14645),mostly having low risks of bias,were analyzed.Compared to placebo,the risk of permanent discontinuation of the study drug was substantially lower with tirzepatide 10 mg(RR:0.69,95%CI:0.51-0.93,P=0.02)and similar with tirzepatide 5 mg(RR:0.74,95%CI:0.47-1.17,P=0.20)and 15 mg(RR:0.94,95%CI:0.68-1.31,P=0.71).Tirzepatide had identical discontinuation risks when compared to insulin at 5 mg(RR:0.96,95%CI:0.75-1.24,P=0.77)and 10 mg(RR:1.19,95%CI:0.77-1.82,P=0.44)doses,whereas such risk was higher with tirzepatide 15 mg than insulin(RR:1.31,95%CI:1.03-1.67,P=0.03).Compared to GLP-1RA,the permanent discontinuation risk was similar with tirzepatide 5 mg(RR:0.98,95%CI:0.70-1.37,P=0.90)but was higher with tirzepatide 10 mg(RR:1.40,95%CI:1.03-1.90,P=0.03)and 15 mg(RR:1.70,95%CI:1.27-2.27,P=0.0004).Tirzepatide,at all doses,had higher risks of AE-related discontinuation than insulin;such risks were only greater with higher doses of tirzepatide than with placebo or GLP-1RA.Discontinuation risk due to withdrawal by the study subjects was lower with tirzepatide than with placebo or insulin.Compared to the placebo,tirzepatide(all doses)conferred a lower risk of study drug discontinuation due to other causes not specifically mentioned.CONCLUSION The discontinuation risk is not higher in tirzepatide group than in the placebo arm.Many factors other than AEs led to drug discontinuation in the included RCTs.
文摘BACKGROUND Efruxifermin(EFX),a fibroblast growth factor 21 analogue,has demonstrated the potential to improve liver fat and markers of liver injury,fibrosis,and key metabolic biomarkers in individuals with metabolic dysfunction-associated steatohepatitis(MASH)in phase 2 clinical trials.AIM To summarize the safety and effectiveness of EFX in managing MASH.METHODS Electronic databases and registries were systematically searched from their inception to May 15,2025,for randomized-controlled trials(RCTs)that included EFX in the intervention arm and placebo in the control arm in individuals with MASH.The primary outcome was the safety of EFX,while additional outcomes included its efficacy in altering hepatic and metabolic parameters.Meta-analyses were conducted using the RevMan web computer program with the random-effects model.RESULTS Four phase 2 RCTs(five reports),mostly with low risk of bias,involving 450 subjects,were analyzed.Compared to the placebo,EFX 50 mg was associated with higher risks of treatment-emergent adverse events(TEAEs)[risk ratio(RR)=1.05],TEAEs leading to discontinuation(RR=3.05),nausea(RR=1.78),and diarrhea(RR=1.9).EFX 28 mg increased risks of vomiting(RR=2.17)and frequent bowel movements(RR=8.98).Both doses of EFX were associated with higher risks of drug-related TEAEs(28 mg:RR=1.45;50 mg:RR=1.67)and increased appetite(28 mg:RR=3.16;50 mg:RR=5.66).EFX(28 and 50 mg)and placebo exhibited identical risks for severe TEAEs,serious AEs,abdominal pain,fatigue,headache,injection site erythema,and injection site reactions.EFX(28 and 50 mg)was associated with improvements in hepatic safety outcomes,including liver enzymes and urate levels.EFX outperformed the placebo in both relative and absolute reductions in hepatic fat fraction.Reductions in enhanced liver fibrosis score,Pro-C3,and liver stiffness were also more robust with EFX.EFX was superior in terms of MASH resolution and improvement in fibrosis stage,MASH resolution and no worsening of the fibrosis stage,and fibrosis regression by≥1 stage and no worsening in steatohepatitis.Furthermore,EFX also improved metabolic parameters,including reductions in HbA1c and insulin resistance,as well as improvements in adiponectin and lipid parameters.CONCLUSION EFX demonstrates promising dual efficacy on liver histology and metabolic markers in MASH.However,gastrointestinal side effects and the need for parenteral administration require caution.Long-term data are still necessary to fully evaluate safety and long-term effectiveness.
文摘BACKGROUND Type 2 diabetes(T2D),as well as obesity,are risk factors for chronic kidney disease(CKD)and end-stage renal disease.The renal impacts of glucose-lowering and weight-lowering drugs and their potential benefits in preventing CKD often guide clinicians in choosing them appropriately.Only limited data based on randomized controlled trials(RCTs)is currently available on the renal effects and safety profile of tirzepatide.AIM To explore the renal benefits and safety of tirzepatide vs controls.METHODS RCTs involving patients receiving tirzepatide for any indication in the intervention arm and placebo or active comparator in the control arm were searched through multiple electronic databases.The co-primary outcomes were percent change from baseline(CFB)in urine albumin-to-creatinine ratio(UACR)and absolute CFB in estimated glomerular filtration rate(eGFR;in mL/min/1.73 m^(2));the secondary outcome was tirzepatide’s renal safety profile.RevMan web was used to conduct meta-analysis using random-effects models.Outcomes were presented as mean differences(MD)or risk ratios with 95%confidence intervals.RESULTS Fifteen RCTs(n=14471)with mostly low risk of bias(RoB)were included.Over 26-72 weeks,tirzepatide 10 mg[MD-26.95%(-40.13,-13.76),P<0.0001]and 15 mg[MD-18.03%(-28.58,-7.47),P=0.0008]were superior to placebo in percent reductions of UACR.Tirzepatide,at all doses,outperformed insulin in percent reductions of UACR.Compared to the placebo,the percent UACR reduction was greater in subjects with T2D than those with obesity but without T2D(MD-33.25%vs-7.93%;P=0.001).The CFB in eGFR with all doses of tirzepatide was comparable[5 mg:MD 0.36(-1.41,2.14);10 mg:MD 1.17(-0.22,2.56);15 mg:MD 1.42(-0.04,2.88)];P>0.05 for all vs insulin.Tirzepatide(pooled and separate doses)did not increase the risks of adverse renal events,urinary tract infection,nephrolithiasis,acute kidney injury,and renal cancer compared to the placebo,insulin,and glucagon-like peptide-1 receptor agonists.CONCLUSION Short-term data from RCTs with low RoB suggests that tirzepatide positively impacts UACR without detrimental effects on eGFR in subjects with T2D and obesity without T2D,with a reassuring renal safety profile.Larger RCTs are warranted to prove the longer-term renal benefits of tirzepatide,which might also prevent eGFR decline and worsening of CKD.
文摘BACKGROUND Diabetes distress(DD),an emotional problem arising from the challenges of living with diabetes and the relentless burden of daily self-management,is common among patients with type 2 diabetes(T2D).South Asia has a high T2D burden,and many studies have reported varying prevalence rates of DD in this area.AIM To estimate the pooled prevalence of DD among patients with T2D in South Asia,as it is crucial for developing effective therapeutic strategies.METHODS This systematic review and meta-analysis included cross-sectional studies conducted in South Asian countries involving adults with T2D and reported the prevalence of DD.The studies were identified by searching multiple electronic databases and registries from the inception of each database to January 30,2025,using prespecified search terms.Four authors screened and extracted data independently.Meta-analyses were conducted using RStudio software with a random-effects model.The primary outcome was the pooled prevalence of DD.RESULTS Thirty-seven cross-sectional studies(28 from India,five from Bangladesh,and two each from Pakistan and Sri Lanka)with mostly high methodological quality involving 11500 subjects were included.The pooled prevalence of DD was 44%(95%confidence interval:35-53,I2=97.4%).The prevalence of DD was highest in Pakistan(85%),followed by India and Bangladesh(42%each),and Sri Lanka(25%).Emotional burden was the most prevalent form of DD(60%),followed by treatment regimen-related distress(51%),interpersonal distress(31%),and physician-related distress(17%).Meta-regression analysis revealed no significant associations between the prevalence of DD and publication year,sample size,proportion of females,age,duration of diabetes,insulin usage,glycated hemoglobin levels,or diabetic complications.CONCLUSION South Asians with T2D seem to experience a relatively high burden of DD,and the emotional burden is the most common form of DD in this area.Larger studies utilizing unique tools and involving a broader participant base from the region would provide better epidemiological data for effectively planning high-quality diabetes care in South Asian countries.
基金supported by the National Natural Science Foundation of China(No.22278245)the Young Taishan Scholars Program of Shandong Province(No.tsqn.201909026)+1 种基金the Youth Interdisciplinary Science and Innovative Research Groups of Shandong University supported by the Fundamental Research Funds for the Central Universities(No.2020QNQT014)the Shandong University Future Youth Grant Program(No.61440089964189).
文摘The S-scheme heterojunction has garnered increasing attention due to its remarkable oxidation capacity and efficient separation of photogenerated carriers.In this study,a one-pot glycerol-assisted hydrothermal process was utilized to successfully synthesize S-scheme heterojunction photocatalysts comprising basic bismuth nitrate(BBN)and bismuth tungstate(BWO).Interestingly,the BBN/BWO heterogeneous photo-catalysts exhibited the highest photocatalytic properties.The optimized product achieved the degradation of sulfamethazine(SMZ)within 1 h,with a kinetic constant(k)value of 0.05818 min^(−1).The degradation process was influenced significantly by·O^(2)−and h^(+)species.To determine the degradation pathway of SMZ in the presence of BBN/BWO-0.6,liquid chromatography-mass spectrometry(LC-MS)analysis was performed,which revealed a decrease in the toxicity of intermediates and products.The enhanced pho-tocatalytic activity can be attributed to the internal electric field(IEF)of the S-scheme heterojunction between BBN and BWO,effectively promoting the separation of photogenerated carriers.This research presents a viable approach for developing S-scheme heterojunctions in SMZ photodegradation and other environmental applications.
基金supported by grants from Natural Science and Engineering Research Council(NSERC)of Canada Collaborative Research and Development(CRD)programNSERC Discovery program,Dairy Farmers of Manitoba,and Diamond V,USA,to EK and JCP。
文摘Background Subacute ruminal acidosis(SARA)is a common metabolic disorder of high yielding dairy cows,and it is associated with dysbiosis of the rumen and gut microbiome and host inflammation.This study evaluated the impact of two postbiotics from Saccharomyces cerevisiae fermentation products(SCFP)on rumen liquid associated microbiota of lactating dairy cows subjected to repeated grain-based SARA challenges.A total of 32 rumen cannulated cows were randomly assigned to 4 treatments from 4 weeks before until 12 weeks after parturition.Treatment groups included a Control diet or diets supplemented with postbiotics(SCFPa,14 g/d Original XPC;SCFPb-1X,19 g/d Nutri Tek;SCFPb-2X,38 g/d Nutri Tek,Diamond V,Cedar Rapids,IA,USA).Grain-based SARA challenges were conducted during week 5(SARA1)and week 8(SARA2)after parturition by replacing 20%DM of the base total mixed ration(TMR)with pellets containing 50%ground barley and 50%ground wheat.Total DNA from rumen liquid samples was subjected to V3–V416S r RNA gene amplicon sequencing.Characteristics of rumen microbiota were compared among treatments and SARA stages.Results Both SARA challenges reduced the diversity and richness of rumen liquid microbiota,altered the overall composition(β-diversity),and its predicted functionality including carbohydrates and amino acids metabolic pathways.The SARA challenges also reduced the number of significant associations among different taxa,number of hub taxa and their composition in the microbial co-occurrence networks.Supplementation with SCFP postbiotics,in particular SCFPb-2X,enhanced the robustness of the rumen microbiota.The SCFP supplemented cows had less fluctuation in relative abundances of community members when exposed to SARA challenges.The SCFP supplementation promoted the populations of lactate utilizing and fibrolytic bacteria,including members of Ruminococcaceae and Lachnospiraceae,and also increased the numbers of hub taxa during non-SARA and SARA stages.Supplementation with SCFPb-2X prevented the fluctuations in the abundances of hub taxa that were positively correlated with the acetate concentration,andα-andβ-diversity metrics in rumen liquid digesta.Conclusions Induction of SARA challenges reduced microbiota richness and diversity and caused fluctuations in major bacterial phyla in rumen liquid microbiota in lactating dairy cows.Supplementation of SCFP postbiotics could attenuate adverse effects of SARA on rumen liquid microbiota.
基金the Natural Science and Engineering Research Council of Canada(NSERC,grant no.NSERC 250992 and 245375)Fonds de recherche du Québec(FRQNT,grant no.315108 and 332139)。
文摘Spine biomechanical testing methods in the past few decades have not evolved beyond employing either cadaveric studies or finite element modeling techniques.However,both these approaches may have inherent cost and time limitations.Cadaveric studies are the present gold standard for spinal implant design and regulatory approval,but they introduce significant variability in measurements across patients,often requiring large sample sizes.Finite element modeling demands considerable expertise and can be computationally expensive when complex geometry and material nonlinearity are introduced.Validated analogue spine models could complement these traditional methods as a low-cost and high-fidelity alternative.A fully 3D printable L-S1 analogue spine model with ligaments is developed and validated in this research.Rotational stiffness of the model under pure bending loading in flexion-extension,Lateral Bending(LB)and Axial Rotation(AR)is evaluated and compared against historical ex vivo and in silico models.Additionally,the effect of interspinous,intertransverse ligaments and the Thoracolumbar Fascia(TLF)on spinal stiffness is evaluated by systematic construction of the model.In flexion,model Range of Motion(ROM)was 12.92±0.11°(ex vivo:16.58°,in silico:12.96°)at 7.5Nm.In LB,average ROM was 13.67±0.12°at 7.5 Nm(ex vivo:15.21±1.89°,in silico:15.49±0.23°).Similarly,in AR,average ROM was 17.69±2.12°at 7.5Nm(ex vivo:14.12±0.31°,in silico:15.91±0.28°).The addition of interspinous and intertransverse ligaments increased both flexion and LB stiffnesses by approximately 5%.Addition of TLF showed increase in flexion and AR stiffnesses by 29%and 24%,respectively.This novel model can reproduce physiological ROMs with high repeatability and could be a useful open-source tool in spine biomechanics.
基金financially supported by the National Natural Science Foundation of China(No.U22B20102)Shandong Provincial Natural Science Foundation(No.ZR2023QE218)+3 种基金the Young Taishan Scholars Program of Shandong Province(No.tsqn201909026)Taishan Scholars Project of Shandong Province(No.tstp20230604)the Future Young Scholars Program of Shandong University(No.61440089964189)the Key Laboratory of Organic Compound Pollution Control Engineering(MOE)Foundation(No.20190202)。
文摘Metal clusters or even single-atoms dispersed and anchored on the photocatalysts'surface can enhance photocatalytic performances on organic pollutant oxidation.Here,a simple photoreduction method was used to create atomically dispersed metal single-atoms/clusters(MSCs,M=Cu,Pd,Au and Ag)on P-modulated tubular carbon nitride(TCN).The obtained MSCs@TCN demonstrated excellent photocatalytic performances for the degradation of sulfamethazine(SMZ).In particular,the photocatalyst with 2 wt%Cu loading showed ultrahigh SMZ oxidation efficiency(k=0.06110 min^(-1)),almost three times that of TCN(k=0.02066 min^(-1)).It also shows excellent stability in the 5th-cycle measurements.The improved photocatalytic activity of the CuSCs@TCN is ascribed to the synergistic promotion of photogenerated charge separation by Cu single-atoms/clusters as active sites,accelerated charge transfer from bulk TCN to Cu sites through Cu-N_(x)interaction.Meanwhile,the active sites of Cu single-atoms/clusters could promote the production of·O_(2)^(-),which participates in organic oxidation with strong oxidizing holes(h^(+)).This strategy paves a new avenue for designing high-performance photocatalysts decorated with metal single-atoms and clusters.
文摘The rapid expansion of the Internet of Things (IoT) has driven the need for advanced computational frameworks capable of handling the complex data processing and security challenges that modern IoT applications demand. However, traditional cloud computing frameworks face significant latency, scalability, and security issues. Quantum-Edge Cloud Computing (QECC) offers an innovative solution by integrating the computational power of quantum computing with the low-latency advantages of edge computing and the scalability of cloud computing resources. This study is grounded in an extensive literature review, performance improvements, and metrics data from Bangladesh, focusing on smart city infrastructure, healthcare monitoring, and the industrial IoT sector. The discussion covers vital elements, including integrating quantum cryptography to enhance data security, the critical role of edge computing in reducing response times, and cloud computing’s ability to support large-scale IoT networks with its extensive resources. Through case studies such as the application of quantum sensors in autonomous vehicles, the practical impact of QECC is demonstrated. Additionally, the paper outlines future research opportunities, including developing quantum-resistant encryption techniques and optimizing quantum algorithms for edge computing. The convergence of these technologies in QECC has the potential to overcome the current limitations of IoT frameworks, setting a new standard for future IoT applications.
基金supported,in part,by a grant from the German-Israeli Foundation for Scientific Research and Development(GIF)(grant number I-1547-500.15/2021)funding from the Agricultural Experiment Station at the University of GeorgiaL.T.A.was supported,in part,by the Alexander von Humboldt Foundation in the framework of the Alexander von Humboldt Professorship.
文摘Integrating hydrothermal treatment processes and anaerobic digestion(AD)is promising for maximizing resource recovery from biomass and organic waste.The process water generated during hydrothermal treatment contains high concentrations of organic matter,which can be converted into biogas using AD.However,process water also contains various compounds that inhibit the AD process.Fingerprinting these inhibitors and identifying suitable mitigation strategies and detoxification methods is necessary to optimize the integration of these two technologies.By examining the existing literature,we were able to:(1)compare the methane yields and organics removal efficiency during AD of various hydrothermal treatment process water;(2)catalog the main AD inhibitors found in hydrothermal treatment process water;(3)identify recalcitrant components limiting AD performance;and(4)evaluate approaches to detoxify specific inhibitors and degrade recalcitrant components.Common inhibitors in process water are organic acids(at high concentrations),total ammonia nitrogen(TAN),oxygenated organics,and N-heterocyclic compounds.Feedstock composition is the primary determinant of organic acid and TAN formation(carbohydrates-rich and protein-rich feedstocks,respectively).In contrast,processing conditions(e.g.,temperature,pressure,reaction duration)influence the formation extent of oxygenated organics and N-heterocyclic compounds.Struvite precipitation and zeolite adsorption are the most widely used approaches to eliminate TAN inhibition.In contrast,powdered and granular activated carbon and ozonation are the preferred methods to remove toxic substances before AD treatment.Currently,ozonation is the most effective approach to reduce the toxicity and recalcitrance of N and O-heterocyclic compounds during AD.Microaeration methods,which disrupt the AD microbiome less than ozone,might be more practical for nitrifying TAN and degrading recalcitrant compounds,but further research in this area is necessary.
