Stepwise Treatment Research Articles

Indication of Phages and Their Role in the Regulation of the Purification Process at the Govsany Aeration Station in Baku

Due to the epidemic situation and the emergence of enteroviral diseases, we set ourselves the task of conducting comprehensive virological and bacteriological studies of the wastewater, its sludge and contaminated soil from the Govsany aeration station. The fact of constant detection of enteroviruses in samples of wastewater and soil in combination with bacteriophages is considered by us as a possibility of detection of bacteriophages at WWTP sites. The 26 wastewater samples contain enteroviruses at various stages of treatment, 18 of which were characterised by high levels of faecal contamination (thermoletarian coliforms), C. perfringens and Enterococcus faecalis. In samples with high contamination (TCB up to 106 per 100 ml of wastewater), which are potentially dangerous in terms of the content of infectious disease pathogens, both bacterial and viral, the number of coliphages was below the norm. Consequently, coliphages cannot be used as a sanitary indicator of microorganisms of viral contamination. Intestinal phages are common where humans and animals live and therefore intestinal bacteria are present. Coliphages (bacteriophages) can be formed from lysogenic enterobacteria during the process of stepwise wastewater treatment at the Govsany WWTP.

Proposed treatment strategy for reactive hypoglycaemia.

Managing reactive hypoglycaemia (RH) poses challenges due to limited and often ineffective treatment options. We report a case series and draw on this to propose a stepwise treatment approach consisting of lifestyle modifications, metformin, GLP-1 analogues, and the use of flash glucose monitoring technology. A retrospective review was conducted to analyse the management of 11 cases presenting with recurrent RH symptoms. Two patients experienced successful resolution of symptoms through lifestyle modifications. Metformin alone was effective in treating seven out of nine patients who received pharmacological treatment. Two patients with previous upper gastrointestinal surgery showed a partial response to metformin and benefited further from additional long-acting GLP-1 analogue. Pharmacological intervention led to significant reductions in insulin and C-peptide levels in repeat mixed meal tolerance tests (P-values 0.043 for insulin and 0.006 for C-peptide). Finally, flash glucose monitoring technology was useful in early detection and preventing episodes of hypoglycaemia in one of these patients with persistent symptoms. These findings highlight the potential efficacy of escalated treatment strategies for RH, including the use of metformin, GLP-1 analogues, and flash glucose monitoring technology.

Effects of stepwise administration of osteoprotegerin and parathyroid hormone-related peptide DNA vectors on bone formation in ovariectomized rat model

Osteoporosis is a metabolic bone disease that impairs bone mineral density, microarchitecture, and strength. It requires continuous management, and further research into new treatment options is necessary. Osteoprotegerin (OPG) inhibits bone resorption and osteoclast activity. The objective of this study was to investigate the effects of stepwise administration of OPG-encoded minicircles (mcOPG) and a bone formation regulator, parathyroid hormone-related peptide (PTHrP)-encoded minicircles (mcPTHrP) in osteoporosis. The combined treatment with mcOPG and mcPTHrP significantly increased osteogenic marker expression in osteoblast differentiation compared with the single treatment groups. A model of postmenopausal osteoporosis was established in 12-week-old female rats through ovariectomy (OVX). After 8 weeks of OVX, mcOPG (80 µg/kg) was administered via intravenous injection. After 16 weeks of OVX, mcPTHrP (80 µg/kg) was injected once a week for 3 weeks. The bone microstructure in the femur was evaluated 24 weeks after OVX using micro-CT. In a proof-of-concept study, stepwise treatment with mcOPG and mcPTHrP on an OVX rat model significantly improved bone microstructure compared to treatment with mcOPG or mcPTHrP alone. These results suggest that stepwise treatment with mcOPG and mcPTHrP may be a potential treatment for osteoporosis.

Resourcization of Argillaceous Limestone with Mn3O4 Modification for Efficient Adsorption of Lead, Copper, and Nickel.

Argillaceous limestone (AL) is comprised of carbonate minerals and clay minerals and is widely distributed throughout the Earth's crust. However, owing to its low surface area and poorly active sites, AL has been largely neglected. Herein, manganic manganous oxide (Mn3O4) was used to modify AL by an in-situ deposition strategy through manganese chloride and alkali stepwise treatment to improve the surface area of AL and enable its utilization as an efficient adsorbent for heavy metals removal. The surface area and cation exchange capacity (CEC) were enhanced from 3.49 to 24.5 m2/g and 5.87 to 31.5 cmoL(+)/kg with modification, respectively. The maximum adsorption capacities of lead (Pb2+), copper (Cu2+), and nickel (Ni2+) ions on Mn3O4-modified argillaceous limestone (Mn3O4-AL) in mono-metal systems were 148.73, 41.30, and 60.87 mg/g, respectively. In addition, the adsorption selectivity in multi-metal systems was Pb2+ > Cu2+ > Ni2+ in order. The adsorption process conforms to the pseudo-second-order model. In the multi-metal system, the adsorption reaches equilibrium at about 360 min. The adsorption mechanisms may involve ion exchange, precipitation, electrostatic interaction, and complexation by hydroxyl groups. These results demonstrate that Mn3O4 modification realized argillaceous limestone resourcization as an ideal adsorbent. Mn3O4-modified argillaceous limestone was promising for heavy metal-polluted water and soil treatment.

Selective removal of zinc and lead from electric arc furnace dust by chlorination–evaporation reactions

Re-melting of scrap in an electric arc furnace (EAF) results in the accumulation of filter dust from off-gas treatment that predominantly consists of iron and zinc oxides. Filter dust is classified as hazardous waste due to its high contents of potentially toxic or ecotoxic elements such as Pb, Cr, Cd, and As. A promising processing route for this waste is selective chlorination, in which the non-ferrous metal oxides are chlorinated and selectively evaporated in form of their respective chlorides from the remaining solids via the process gas flow. Here, we investigate stepwise thermochemical treatment of EAF dust with either waste iron(II) chloride solution or hydrochloric acid at 650, 800, and 1100 °C. The Zn and Pb contents of the thermochemically processed EAF dust could be lowered from 29.9% and 1.63% to 0.09% and 0.004%, respectively. Stepwise heating allowed high separation between zinc chloride at the 650 °C step and sodium-, potassium-, and lead-containing chlorides at higher temperatures. Furthermore, the lab-scale results were transferred to the use of an experimental rotary kiln highlighting the possibilities of upscaling the presented process. Selective chlorination of EAF dust with liquid chlorine donors is, therefore, suggested as a potential recycling method for Zn-enriched steelworks dusts.

Clinical Benefits of Targeting Treatable Traits in Asthma and Chronic Obstructive Pulmonary Disease.

Asthma and chronic obstructive pulmonary disease (COPD) have long been debated regarding their similarities and differences in clinical presentation and pathology. There has also been a discussion about how common therapeutics should be used differently for each disease. Traditionally, a "one size fits all" stepwise treatment has been chosen based on the severity of each case after categorizing the diseases, such as asthma or COPD. However, recently, the need for a precise approach for the treatment of individual patients beyond the disease category has been emphasized, especially in severe cases. To achieve precise personalized therapy, it has become necessary to focus on the individual phenotypes and underlying causal molecular mechanisms (endotypes) and to identify key therapeutic targets, which are called treatable traits. This review discusses the evidence for the importance of identifying treatable traits and therapeutic strategies based on the broader perspective of chronic obstructive airway disease rather than on individual diseases such as asthma or COPD.

Mastalgia - The Burden Beneath.

Mastalgia is the most common breast-related complaint. A multitude of hormonal changes and lifestyle associated factors have been implicated in its causation. A long list of treatment modalities have been tried with varying success rates. To identify the most common risk factors and the most effective management strategies for mastalgia in our clinic population. A total of 100 women between 18-65 years of age presenting to the breast clinic with mastalgia were followed throughout their course of diagnosis and management. Stepwise treatment was provided, starting with reassurance and breast support and progressing to include pharmacological measures, when necessary. The risk factors and outcomes of treatment were analysed. The majority (66%) were aged 25-47 years and the left breast was found to be most frequently involved. Involvement of the upper outer quadrant was significantly more common. Lump/nodularity was the most prevalent risk factor. Most patients showed a positive response to non-steroid anti-inflammatories (NSAIDs) in addition to reassurance, breast support and dietary changes. A detailed history and clinical examination helps to identify the risk factors and the best approach for the management of mastalgia. Educating women regarding breast self-examination at regular intervals helps in early presentation and diagnosis of the underlying condition. Reassurance, breast support and lifestyle changes are the first line treatment and have good results in a significant number of patients. In our practice topical and oral NSAIDs, evening primrose oil and vitamin E were frequently used as additional treatments to non-pharmacological methods.

IN VITRO PRODUCTION OF VIRUS-FREE CARNATION (DIANTHUS CARIOPHYLLUS L.) PLANTING MATERIAL

The methods of culture of apical meristems and direct and indirect morphogenesis in vitro were used for production of virus-free planting material of carnation. A scheme for obtaining aseptic material has been developed, which consists of stepwise treatment of explants: Thimerosal - 2 min, 70% ethyl alcohol - 0.5 min and 0.08% AgNO 3 - 1 min, which reduces the level of contamination by fungal infection. Expounded the results of studies of callusogenesis and direct and indirect morphogenesis in the culture of in vitro explants of Dutch carnation, their dependence on the content of growth regulators in the nutrient medium. It was established that there were almost no significant differences in the course of callusogenesis processes within carnation varieties . At the same time, the frequency of callusogenesis was 100%. Under the conditions of indirect morphogenesis realization, it is necessary to take into account the age of callus tissues. The growth and intensive shoot formation of carnations was noted on the Murashige-Skoog nutrient medium supplemented with BAP at a concentration of 0.5 mg/l. The best medium for rooting was the MS medium with half the concentration of macro- and microsalts with the addition of 0.5 mg/l of NAA, which is recommended by us for rooting regenerating carnation plants of various varieties. Peat : perlite in a 1:1 ratio was used as a substrate for the adaptation of regenerating plants . Survival of carnation plants to conditions in vivo for the variety "Raffino Linde" was 90%, while for the variety "Tiya" - 83%, respectively.

Development of Durable Pt/CoWO4 Nanofiber Catalyst-Support Hybrid Material Using Ex-Solution for Zn-Air Batteries

The zinc-air batteries (ZABs) has been regarded as a next-generation energy storage device due to its high energy density, cost competitiveness, and excellent safety [1]. However, several challenges must still be overcome to commercialize the ZABs, including poor cycle properties and low coulombic efficiency. These problems are due to oxygen-base reaction which has sluggish kinetics and a high overpotential. Generally, noble metals (Pt) and metal oxides (IrO2, RuO2) have been employed as oxygen-based electrocatalysts for oxygen reduction reaction and oxygen evolution reaction respectively. However, these materials suffer from poor durability during the reaction and high material costs. Therefore more durable and economical catalyst materials designed for ZABs should be developed.In this study, we developed Pt/CoWO4 nanofiber hybrid material with excellent stability to overcome the limitations of the commercial catalyst. First, the ceramic nanofibers with a high specific surface area were fabricated by the electrospinning method. Pt and Co catalysts were strongly bonded to a WO3 support using an Ex-solution technique in which metal ions within the solid solution were exposed as metal nanoparticles on the surface [2]. We have modulated a stepwise thermal treatment that controls the crystallinity and oxygen deficiency of support material, and the exposure behavior of Pt, and Co nanoparticles such as particle size and alloy formation. Finally, the optimized hybrid material exhibited high catalytic activity, reaction stability, and material durability in the half-cell tests in alkaline media. Furthermore, a container-type zinc-air cell was fabricated and the Pt/CoWO4 catalyst successfully operated for over 240 h at 2mA∙cm-2. We believe this study guides a strategy for the development of more efficient catalyst materials for feasible not only the ZABs but also various metal catalyst–ceramic supports[1] J. Fu, R. Liang, G. Liu, A. Yu, Z. Bai, L. Yang, and Z. Chen, "Recent Progress in Electrically Rechargeable Zinc – Air Batteries," Adv. Mater., vol. 31, no. 31, p. 1805230, 2019[2] Js Jang, BJ Kim, JW HAN, WC Jung and Id Kim, “Dopant-Driven Positive Reinforcement in Ex-Solution Process: New Strategy to Develop Highly Capable and Durable Catalytic Materials,” Adv. Mater. Vol. 32, issue 46, p. 2003983, 2020 Figure 1

Standardized treatment protocols for hypertension: global availability, characteristics, and alignment with the hypertension guideline recommendations.

Hypertension control is suboptimal globally. Implementing evidence-based, simple, standardized treatment protocols (STPs) has been instrumental in effectively and efficiently improving treatment and control of hypertension. We aimed to identify, characterize, and critically appraise hypertension STPs. We defined STP as a series of steps for the pharmacological treatment of primary hypertension, with information on target population, BP threshold for treatment initiation, target BP, specific drugs/classes/doses, and follow-up frequency. STPs for adult patients were identified from the websites of relevant health organizations, Google search, and through expert consultations (until July 2023). STPs for secondary, gestational, or malignant hypertension or those that were templates/samples were excluded. Included STPs were critically appraised using HEARTS in the Americas Checklist for hypertension management in primary care and compared with the 2021 WHO hypertension management guideline recommendations. Fifty STPs were identified. All STPs had a stepwise treatment approach, involved guideline-recommended first-line drugs, and 98% consisted of at least four steps. Majority (54%) recommended monotherapy with calcium channel blockers as first-line treatment. Only 44% STPs recommended treatment initiation with combination therapy, and 16% recommended single-pill combinations. Most (62%) had dose-intensification as the second step. Most (74%) STPs did not provide complete dosing information. Only one STP mentioned a target time for achieving BP control. On average, STPs scored a performance of 68% on the HEARTS Checklist. Several STPs are available globally; however, most of them have enormous scope for improvement through interventions aimed at alignment with the latest evidence-based guidelines and multistakeholder engagement.

Forefoot reconstruction in brachymetatarsia

Background. Brachymetatarsia is a rare disease characterized by abnormal shortening of one or more metatarsal bones. The clinical picture is most often dominated by complaints of aesthetic dissatisfaction, as well as pain in the forefoot caused by mechanical dysfunction. A radical way to solve the problem is surgical treatment. The aim. To demonstrate a rare clinical observation of a patient with bilateral brachymetatarsia of both feet. Materials and methods. The article presents a case of stepwise treatment of a patient with bilateral brachymetatarsia with shortening of the III and IV metatarsal bones in combination with hallux valgus. Results and discussion. According to the protocol, the patient underwent stepwise reconstruction of the forefoot of both feet with intervention on all five metatarsal bones. After all the rehabilitation measures, there was a complete restoration of all functions of both lower limbs after the surgery, and the patient was satisfied with the aesthetic result of the surgical treatment. Conclusions. The obtained result of treatment of a patient with bilateral brachymetatarsia allows us to conclude that the use of this group of techniques is acceptable with the obligatory preoperative calculation of the necessary shortening and lengthening of the metatarsal bones, focusing on the parameters of the metatarsal formula of the forefoot, even in combination with other deformities.

Hong Kong-Macau Severe Hives and Angioedema Referral Pathway.

Urticaria (defined as the presence of hives, angioedema, or both) can be caused by a variety of etiologies ranging from more common conditions such as chronic spontaneous urticaria (CSU) to rarer conditions such as hereditary angioedema (HAE). Specialist referral may be necessary in cases of severe urticaria or HAE, but access to specialist services remains limited in certain regions, such as the Greater Bay Area (GBA) of China. To address this, the Hong Kong-Macau Severe Hives and Angioedema Referral Pathway (SHARP) was initiated by the Hong Kong Institute of Allergy and Macau Society of Dermatology to promote multidisciplinary collaboration and regional exchange of expertise in the diagnosis and management of severe urticaria. A nominated task force of dermatologists and immunologists who manage patients with severe urticaria formulated the consensus statements (CS) using the Delphi method. The consensus was defined a priori as an agreement of ≥80%. A total of 24 CS were formulated, including four statements on classifications and definitions, seven statements on diagnosis, and 13 statements on management and referral. The definitions for acute/chronic urticaria and severe CSU were stated. Unnecessary investigations and inappropriate medications were discouraged. The characteristics and recommended approach to suspected bradykinergic angioedema were specified. Stepwise treatment options using second-generation antihistamines, omalizumab, or cyclosporin for patients with CSU were addressed, and the importance of access to HAE-specific medications was emphasized. Furthermore, an integrated referral pathway for patients with severe hives and angioedema was constructed. The SHARP provides guidance for the management and specialist referral of patients with severe hives and angioedema in Hong Kong and Macau.

Synthesis and characterization of Eu3+-doped glass ceramics from the system CaO-GeO2-Li2O-B2O3

Three Eu3+ doped glass compositions from the system CaO-GeO2-Li2O-B2O3 were thermally treated for obtaining of the nano glass-ceramics. A series of glass ceramics were obtained under different heat treatment conditions for each glass composition. The main crystallizing phases in the three investigated compositions were Ca2GeO4, Ca5Ge3O11 or Li2CaGeO4. Research was aimed at finding the optimal thermal treatment conditions of parent glasses for preparing of glass-ceramics with optimal particle size, degree of crystallization and transparency determining high emission intensity. For this, a stepwise heat treatment was applied to obtain a series of glass-ceramic samples from the same starting glass composition. Under such treatment, the kinetics of nucleation and growth of the crystallizing phase were tracked. DTA, XRD, TEM, UV–vis analyses were used for characterization of the obtained series of glass-ceramics. Based on the results, it was concluded that the main factors determining the behavior of the crystallizing nanophase (predominant new nucleation or predominant growth of already appeared seeds) are the thermal treatment conditions and the composition and structure of the parent glass, and not so much the composition and structure of the crystallizing phase.

Phenotype-guided targeted therapy based on functional signal transduction pathway activity in recurrent ovarian cancer patients: The STAPOVER study protocol

ObjectiveOvarian cancer is the fifth cause of cancer-related death among women. The benefit of targeted therapy for ovarian cancer patients is limited even if treatment is stratified by molecular signature. There remains a high unmet need for alternative diagnostics that better predict targeted therapy, as current diagnostics are generally inaccurate predictors. Quantitative assessment of functional signal transduction pathway (STP) activity from mRNA measurements of target genes is an alternative approach. Therefore, we aim to identify aberrantly activated STPs in tumour tissue of patients with recurrent ovarian cancer and start phenotype-guided targeted therapy to improve survival without compromising quality of life. Study designPatients with recurrent ovarian cancer and either 1) have platinum-resistant disease, 2) refrain from standard therapy or 3) are asymptomatic and not yet eligible for standard therapy will be included in this multi-centre prospective cohort study with multiple stepwise executed treatment arms. Targeted therapy will be available for patients with aberrantly high functional activity of the oestrogen receptor, androgen receptor, phosphoinositide 3-kinase or Hedgehog STP. The primary endpoint of this study is the progression-free survival (PFS) ratio (PFS2/PFS1 ratio) according to RECIST 1.1 determined by the PFS on matched targeted therapy (PFS2) compared to PFS on prior therapy (PFS1). Secondary endpoints include among others best overall response, overall survival, side effects, health-related quality of life and cost-effectiveness. ConclusionThe results of this study will show the clinical applicability of STP activity in selecting recurrent ovarian cancer patients for effective therapies.

Aesthetic rehabilitation on fractured and altered passive eruption anterior teeth: A case report

Objective: This case report aims to present the management of crown fractures with pulpal exposure caused by traumatic injury and a condition called gummy smile or altered passive eruption (APE), through a multidisciplinary approach.
 Case Report: A 24-year-old male patient came to the Dental Conservation Clinic RSGM Prof Soedomo FKG UGM, complained of broken teeth and pain in the upper front tooth due to an accident. #12 and #21 experienced horizontal discontinuity to the dentine surface and some lines on the labial surface and #11 underwent a fracture with exposure of the pulpal tissue. The patient wants to take care of broken teeth and improve his smiles.
 Results: A treatment plan was formulated, which consisted of a stepwise treatment including endodontic treatment, crown lengthening, prefabricated glass-fiber post followed by a core build-up, and finally, direct composite to achieve patient satisfaction.
 Conclusion: The careful planning of a multidisciplinary approach such as endodontics, periodontics, and direct restorations can treat patients with complex aesthetic complaints relating to problems with the tooth and its soft tissues, and immediate restoration for providing a fast, predictable, economical, yet satisfactory result to improves patient self-confidence.

Cough in Severe Asthma

Asthma is a heterogeneous clinical syndrome that presents with variable symptoms, including cough, breathlessness, chest discomfort, and wheezing. Cough, a primary symptom of asthma, has distinct regulatory mechanisms and was associated with asthma severity, poor asthma control, diminished quality of life, and an increased risk of frequent future exacerbations. However, current tools for measuring asthma control do not include separate items for cough or other specific symptoms, and the true impact and clinical relevance of cough in asthma remains poorly understood. Consequently, current stepwise treatment algorithms based on asthma control may be overly simplistic and might not adequately address the heterogeneity of asthma or the mechanisms underlying its symptoms. Furthermore, this approach carries the risk of overestimating asthma severity and subsequent overtreatment. The concept of treatable traits is fundamental to precision medicine, wherein each symptom, especially cough, may serve as a treatable trait in its own right. In this paper, we aim to present evidence supporting the concept of cough as a treatable trait in asthma, addressing its three major components, which are clinical relevance, measurability, and treatability.

Transvenous Embolization of Cerebrospinal Fluid-Venous Fistulas: Pearls, Pitfalls, and Lessons Learned

Cerebrospinal fluid-venous fistulas (CSFVFs) are increasingly recognized as a cause of spontaneous intracranial hypotension (SIH), a debilitating neurologic condition that may present with postural headaches, hearing loss, and/or cognitive impairment. Curative treatment is available for patients whose fistulas are localized with myelography. Transvenous endovascular embolization has emerged in recent years as a safe, effective, and durable treatment option for patients with CSFVF. Here, we briefly review the clinical presentation of SIH, present diagnostic algorithm by which CSFVFs are identified, and discuss a stepwise treatment paradigm. We then detail endovascular treatment strategies of CSFVF with particular emphasis on direct versus indirect approaches to the fistula, embolization principles, and techniques to minimize complications. With increasing awareness of SIH and enhanced detection of CSFVF, it is important for endovascular neurosurgeons and neurointerventionalists to be familiar with transvenous CSFVF embolization strategies to meet the needs of this patient population.

Percutaneous Intra-arterial Hyaluronidase Injection for Hyaluronic Acid Filler Embolism Threatening Skin Barrier Integrity: Implementation of a Stepwise Treatment Protocol.

Hyaluronic acid (HA) filler-induced vascular embolism that threatens skin integrity is an urgent situation. There is increasing evidence that percutaneous intra-arterial hyaluronidase injection is an effective therapeutic technique for it. However, until now, there is a lack of a unifying protocol about the technique. This study aims to provide a conclusion of percutaneous intra-arterial hyaluronidase injection along with adjunctive measures on the treatment of occlusions precipitated by HA-based filler and develop a stepwise treatment protocol. We searched PubMed for peer-reviewed studies, consensus statements, case series, and case reports using a variety of keywords. High-dose, pulsed hyaluronidase is the mainstay for the treatment of HA filler-induced embolism, but percutaneous intra-arterial hyaluronidase injection is a more effective technique. Until now, hyaluronidase is injected into three arteries percutaneously, including facial artery, supratrochlear artery, and superficial temporal artery. Furthermore, the adjunctive measures that may optimize clearance of an occlusion and/or skin barrier repair such as the use of image guidance and CGF should be considered. Vascular occlusions that threaten skin integrity are an urgent matter which requires accurate diagnosis and effective intervention. Percutaneous intra-arterial hyaluronidase injection along with adjunctive measures performed in a stepwise manner is key to an optimal outcome. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Dual-path Fe migration in the bulk phase reconstructing high quality Ni-O-Fe units for high efficient oxygen evolution reaction

In the oxygen evolution reaction (OER), the non-reversible destruction of surface electronic structure caused by the irregular element migration in complex surface/interface reaction limits the improvement of catalyst’s activity and stability. Herein, we successfully realize the control of ‘dual-path migration of metallic elements in OER’ to stepwise reconstruct the O-coordinated bi-metal heterodimer (M1-O-M2) for electron density redistribution. By designing Fe@FeNi3 @NiO-Fe3O4 (F-FN-NFO) model electrode with stepwise surface treatment in OER process, the directional migration (from core to shell, path 1) and adjacent-surface migration of Fe atoms (path 2) are both controlled to reduce the formation energy of Ni-O-Fe units, realizing strengthened electron transfer between heterogeneous metal centers. After the surface reconstruction, the OER activity of F-FN-NFO increases for 8.6 times at 1.7 V (30.5–263 mA cm−2). Based on this strategy, the designed three-dimension NiFe@NiFexO is positive activated compared to traditional NiFe-oxidation with the overpotential reduced to 299 mV at 10 mA cm−2.

Idiopathic Granulomatous Lobular Mastitis: A Mimicker of Inflammatory Breast Cancer.

Idiopathic granulomatous lobular mastitis (IGLM) is a rare, chronic inflammatory breast disease without a known etiology. Even though the current literature proposes several treatment strategies, there is no universal consensus for long-term management. A 43-year-old White woman (gravida 5, para 4) presented with a 2-week history of right lower outer quadrant breast tenderness, heaviness, warmth, and redness. Mammography and ultrasound were concerning for inflammatory breast cancer. Biopsies returned as granulomatous mastitis without malignancy. After 8 months of unsuccessful therapy with prednisone and methotrexate, surgeons excised the breast tissue. Cultures and special stains were negative for other organisms. At the 7-month follow-up, no evidence of recurrence was seen. As there remains no consensus behind the etiology or management of IGLM, our case demonstrates a reasonable and successful stepwise treatment beginning with medical therapy before proceeding to surgical cure. Because of possible malignancy risk with chronic IGLM, patients should not delay surgical excision if their condition remains refractory to medical therapy alone.