Background: Restricting antibiotic (AB) use with prescriptions and ensuring proper knowledge and attitudes toward AB use is important to reduce antibiotic resistance (ABR). To prevent resistanse problem, several countries have applied prescribing restrictions. Thus, the aim of this work was to re-evaluate the public knowledge and attitudes related to AB use in light of the recent Ministry of Health (MOH) restrictions on AB prescriptions. Methods: A cross-sectional, population-based survey was distributed through various social media platforms. The survey was distributed via email and personal social media. Data were collected and analyzed using appropriate statistical tests. Result: A total of 1333 participants completed the survey. Most participants were female , aged 18–24 years old , and were aware of the AB restrictions implemented by the MOH. In addition, 77% of participants were aware of the MOH Emergency Call Center , but most did not know that it could be used to obtain an AB prescription. Conclusion: Although the knowledge and attitude of the general Saudi population appear better than before, it remains clear that some elements of the population’s knowledge, attitude, and practice need to be strengthened. This could be achieved by utilizing effective channels such as the MOH 937 Service and increased advertising. Staphylococcus aureus isolates had developed resistance to penicillin.Alexander Fleming’s discovery of penicillin in 1928 led to an era of antibiotics (ABs). The discovery allowed humans to fight infections, improve surgery outcomes, undergo chemotherapy, and decrease child mortality [The major cause of ABR, which is considered a global threat that requires immediate action, is the misuse of ABs. The misuse of ABs is possibly driven by the absence of regulation and a lack of patient knowledge regarding the correct use of ABs. Therefore, implementing policies and constantly evaluating the state of knowledge of populations and attitudes toward using AB is important, as it will allow the identification and management of potential knowledge gaps via effective educational programs. The World Health Organization (WHO) published a Global Action Plan on ABR for all countries to participate in, with the aim to increase overall public awareness about appropriate AB use and ABR. Public awareness of the significant impact of ABR is the first step required to curb its progression.The literature discusses ABR prevention from five main perspectives, namely AB prescription and monitoring, assessing the knowledge, attitude, and practice (KAP) of AB use, highlighting the misuse or inappropriate use of ABs, AB self-prescription and encouraging appropriate AB use, and increasing ABR awareness. In Saudi Arabia, over-the-counter AB dispensing was an issue prior to 2015 . As a paPopulation awareness and KAP relating to AB use in Arab countries in general , and Saudi Arabia in particular, have been described previously ,12,13,14Therefore, in this study, we aimed to re-evaluate and measure the public awareness of AB use in Saudi Arabia and assess the public knowledge of the MOH regulations and the 937 Service in prescribing ABs.A cross-sectional survey was designed and conducted among Saudi Arabia’s general population through various social media platforms. This observational study was guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement for cross-sectional studies . A flow A population-based survey was distributed via university emails and social media platforms . The private social media accounts of the authors were used to distribute the survey using the snowball method .All adult participants of Saudi or non-Saudi nationality living in Saudi Arabia and who had agreed to participate voluntarily were recruited between February and April 2021. Participants aged less than 18 years or those living outside Saudi Arabia were excluded. The survey was distributed among the authors’ family, friends, and university email groups via email and WhatsApp, with the participants being asked to forward the survey to as many people as possible. In addition, the Al-Maarefh University administration sent an email to all university students, asking them to participate in the survey. Finally, the research team used their private accounts on Twitter, Instagram, and Snapchat to recruit more participants and request that the survey be forwarded.The survey, which was designed and tailored for this study using Google forms, was composed of several sections, including participant demographics, questions assessing participant attitudes toward AB use, participant knowledge of the new MOH restrictions and regulations, and participant awareness of the proper use of ABs as well as the 937 Service and its role in prescribing ABs. The survey underwent a face validity review by two experts in the field of pharmacology at Al-Maarefa University, and it was piloted with ten students that were not among the recruited participants.t-test. Categorical variables were reported as numbers and percentages and were compared using the chi-square test or Fisher’s exact test, where applicable. Any value that showed a difference was considered significant if it had a p-value of <0.05. Factors possibly affecting participant awareness toward AB restrictions categorized as dependent variables were explored by estimating the odds ratio using binary logistic regression. Binary logistic regression was chosen as the dependent variable, and awareness was binary (yes or no). The 95% confidence interval of the odds was also calculated. The reference value in the regression was the lowest group .Survey response data were collected and analyzed using the Statistical Package for Social Sciences (SPSS) version 27, NY, USA . The meaEthical approval was obtained from the Institutional Review Board of Al-Maarefa University (project number: 06-02032021). Participants were provided with information on the purpose of the study and were asked to provide consent before taking the survey. No participant identifiers were collected during the recruitment process.A total of 1333 surveys were fully completed, and the majority of participants were female  and mostly young . More spp-value < 0.001), with an odds ratio of 1.69  , with an odds ratio of 2.29 (1.81–2.88). Participants with children were significantly more likely to be aware of the MOH AB restriction policy , with an odds ratio of 2.84 (2.23–3.63). Compared to participants with a primary or intermediate school education level, university degree holders  and high school graduates  were significantly less likely to be aware of the MOH AB policy, with odds ratios of 0.45 (0.23–0.91) and 0.37 (0.18–0.76), respectively. When compared to students, participants working in the public  and private sectors , retired participants , housewives , and self-employed participants  were all significantly more likely to be aware of the MOH AB policy, with odds ratios of 3.72 (2.64–5.23), 2.05 (1.49–2.83), 3.58 (1.94–6.59), 1.81 (1.23–2.70), and 2.28 (1.08–4.83), respectively. Participants that were aware of the 937 Service were significantly more likely to be aware of the MOH AB policy , with an odds ratio of 2.75 (2.12–5.58). Regarding the 937 Service and its relation to AB prescriptions, participants that were aware of this relation were significantly more likely to be aware of the MOH AB policy , with an odds ratio of 5.41 (4.24–6.90). Finally, participants that were aware of the penalty for violating the MOH AB policy were significantly more likely to be aware of the MOH AB policy itself , with an odds ratio of 11.87 (9.10–15.47)  . Moreove32–2.16) . Saudi n32–2.16) . Married0–15.47) .With regards to questions related to KAP (misuse), 42% of participants disagreed or strongly disagreed with the statement  . HoweverMost participants  believed that the main reason for banning the sale of ABs without a prescription was the possible development of ABR, while a small percentage of participants  believed that cost was the main reason . The remIn this study, we assessed the KAP of patients taking ABs. In addition, we aimed to evaluate the general Saudi population’s knowledge of current MOH restrictions regarding ABs as well as the purpose of these restrictions. With this in mind, we evaluated factors that may affect the population’s awareness so that these factors can be targeted in future population-specific awareness campaigns. We also assessed the population’s knowledge of the very recent MOH Emergency Call Center . This assessment may help effectively utilize the tool, ultimately facilitating the accomplishment of the goals set by the WHO and the MOH to prevent and combat ABR.Participants who were aware of the MOH restrictions were also more aware of the proper use of AB. In addition, these participants tended to disagree more on statements related to AB misuse. These findings could be explained by the fact that participants with higher awareness were older in age. Indeed, although no previous studies reported their results in the same way as done here, there are similarities between our findings and what is reported in the literature. For example, Alqarni et al.  reportedGiven that communities play a significant role in the emergence and spread of ABR, the findings of this study agree somewhat with previous studies regarding AB misuse. A high percentage i.e., 50.9%) of participants in this survey still expect physicians to prescribe ABs without considering the difference between viral and bacterial infections and how ABs are used in treating infections ,18,19. A% of partThe population studied here generally disagreed with statements of AB misuse, which agrees with some previously published studies. In Saudi Arabia, some studies have revealed that the population had good knowledge and a positive attitude toward AB use. In contrast, a large-scale study investigated the KAP regarding ABs among Hajj pilgrims and reported that the pilgrims had some negative attitudes and poor practices, including acquiring and using ABs without a prescription, sharing ABs, using leftover ABs, and bringing ABs into Saudi Arabia from their country of origin ,22,23,24Assessing the demographic parameters associated with awareness revealed that participants aware of the MOH restrictions were more likely male, of older age , students, or working in the public sector. Interestingly, we found that being aware of the MOH restrictions was inversely related to the level of education, possibly because students made up the majority of the total sample, and students were the reference group in the analysis. Since the participants were mostly students, our findings are similar to a previous study that reported a knowledge gap being evident among pharmacy students, influencing the quality of AB use in Sri Lanka . FactorsThe impact of these findings is expected to be high, given that no previous studies have addressed this issue using our methodology. The MOH provides a service whereby residents of Saudi Arabia have 24/7 access to both emergency and standard healthcare via telephone. Given that the participants in this study knew about this service, it could be utilized to impose greater control over AB prescription. However, the general Saudi population needs to be aware that this service can also be utilized for AB prescriptions. Thus, based on our findings, we recommend that the excellent services provided by the MOH, which improve patient healthcare and well-being, be advertised to a greater extent.This study is not without limitations, as firstly, the sampled population consisted of predominantly young females, thus limiting generalizations. Secondly, the cross-sectional study design may have limited the associations of the explored factors. However, this study involved many participants not limited to a particular region or area, thus representing a diverse population. In addition, the study adds insight into the recent shift in policy related to AB prescription and use.The practice of AB prescribing is a great contributing factor to worldwide ABR. Thus, it needs to be frequently evaluated. Although the knowledge and attitudes of the general Saudi population appear much better than before, it remains clear that some elements of the population’s KAP need to be strengthened. This could be achieved by utilizing effective channels such as the MOH 937 Service and increased advertising.


Toxocara canis, Toxascaris leonina, Trichuris vulpis, and Ancylostoma caninum. For the purpose of reducing their risk of infection by decreasing the survival of helminths’ infective stages in soil, chlamydospores of two parasiticide fungi, Mucor circinelloides (ovicide) and Duddingtonia flagrans (larvicide) were formulated as handmade edible gelatins and given three days per week for 17 months to 18 dogs ; a second group was maintained without fungi . All individuals were dewormed at months 0, 3, 7, 10 and 13, and it was observed that the levels of helminths egg-output were reduced by 96–98% fourteen days after each treatment. Fecal egg counts of STHs were similar in both groups until the 6th–8th months, and then remained significantly lower in DRF than in CD . According to the results, and considering that gelatin treats have always been fully accepted, it is concluded that this new formulation offers an efficient solution to decrease the risk of infection among dogs maintained in shelters, and is therefore recommended.Dogs cared for in a shelter are dewormed every three–four months, but they all become infected one–two months later by the soil-transmitted helminths (STHs)  Canine shelters provide a community service consisting of admitting and caring for lost or abandoned dogs, which are provided appropriate veterinary attention comprising physical examination and deworming. A quarantine period is observed before they are placed into plots with more dogs; females are neutered to avoid overpopulation and facilitate their adoption. Prevalence levels of digestive endoparasites ranging from 17% to 98% have been reported in canine shelters in different countries, mostly caused by protozoa and helminths ,3,4,5. AAscarids or ancylostomatids are potentially zoonotic agents, and their control among pets in shelters is also very important to reduce the risk for keepers who may become infected ,5,6,7,8,Pochonia chlamydosporia and Mucor circinelloides are able to penetrate the eggs of Toxocara canis, Baylisascaris procyonis, and Trichuris vulpis and destroy the inner embryo; Duddingtonia flagrans and Monacrosporium thaumasium elaborate traps in their mycelium for catching larvae developed from eggs of strongyles in the soil [T. canis, T. leonina, and T. vulpis was halved in the feces of puppies given dry feed previously sprayed with a blend of chlamydospores with complementary parasiticide activity, including M. circinelloides (ovicide) and D. flagrans (larvicide) [M. circinelloides and D. flagrans, to limit the survival of STHs’ infective stages in the soil and, therefore, reduce infection among dogs housed in a shelter.For the purpose of reducing the presence of infective stages of certain endoparasites, one interesting procedure relies on the use of certain soil-filamentous saprophytic fungi. More specifically, the soil ,11,12. Tthe soil ; it has rvicide) . The mai“Scooby”   is the largest shelter in Spain, housing more than 600 cats and dogs together with 200 farm animals  . There iDogs are housed in kennels with floors of dirt and cement, wire-fenced, provided with a refuge area (built of concrete and wood) where they can shelter from bad weather . Water i®  chewable tablets composed of febantel (525 mg), pyrantel emboate (504 mg), and praziquantel (175 mg), active against all relevant cestodes and nematodes. Administration is carried out according to the body weight of the dog . This deworming schedule is repeated approximately every 3–4 months.All newly incorporated animals receive an antiparasitic treatment and are then maintained under quarantine for one week before placement in plots with other dogs. Parasiticide treatment consists of a single dose of Helm-exMucor circinelloides  and Duddingtonia flagrans . These species were isolated from soil and fecal samples of livestock and wild captive animals, then deposited in the Spanish Type Culture Collection .In the present investigation, two filamentous fungi with proven parasiticide activity were used: 3 chlamydospores of both M. circinelloides and D. flagrans/mL. Once completely homogenized, the blend was heated under microwave for a brief period and placed into silicone molds (approximately 40 mL/each), quenched at 4–6 °C to enhance gelation and then at −35 °C until frozen. Finally, the products were lyophilized and packed into reusable plastic bags. This formulation ensures a dosage of 2–3 × 105 chlamydospores of each parasiticide fungus is provided to each dog.For the purpose of obtaining chlamydospores of both simultaneously, fungi were cultured in a submerged medium (COPFr) for 1.5–2 months at RT . These c® as previously described) and one gelatin without chlamydospores three times a week  for 17 months.CD (control dogs): dogs receiving anthelmintic treatment periodically (a single dose of Helm-exDRF (dogs receiving fungi): dogs dewormed as in CD. One gelatin containing chlamydospores of the parasiticide fungi was given to each individual, three times a week  for 17 months.The experimental design was approved by the Ethical Committee of the University of Santiago de Compostela  and complied with the Directive 2010/63/EU. A total of six kennels with six adult mix-breed dogs in each were utilized in the current study, and two groups formed by three kennels each (18 dogs) were considered:Faced with the difficulty of taking fecal samples from the rectum of each individual, feces were collected directly from the ground in plastic sample beakers with covers. Every month for a period of 17 months, members of the COPAR Research Group  went to Scooby and collected a total of 18 fecal samples from each kennel. The time elapsed between collection and analysis was ca. 12 h, and in the meantime, samples were kept refrigerated.In order to evaluate the initial status of canine infection by parasites, as well as the efficacy of the measures adopted during the trial , feces were examined in duplicate using the McMaster technique with saturated saline solution (ρ = 1.2 g/dL) . BrieflyThe efficacy of the anthelmintic was estimated fourteen days after each administration, based on the FECR , and efficacy was considered when FECR ≥ 95% .The kinetics of the parasite eggs were evaluated monthly, and the ratios between the values of CD and DRF were estimated. By calculating the FECR values throughout the trial, two comparative risk periods were determined: a non-risky feces period (NRFP) when FECR = 100% (=eggs of STHs were not observed), and low-risk feces period (LRFP) if FECR > 90% and <100% .During the study, the ingestion of gelatin treats by the dogs in the two groups was checked. To confirm the absence of possible adverse effects of fungal spores, all the dogs were examined regularly for weakness, and changes in appetite, thirst, or consistency of feces. Attention was paid also to the respiratory function and to the possibility of emergence of skin damage  or hair loss.p < 0.05). The non-parametric Mann–Whitney U test was performed at a significance level of p < 0.05. All tests were carried out using the statistical package SPSS, version 20 .According to the Kolmogorov–Smirnov test, data were not normally distributed , and the Levene’s test showed the variances were not homogeneous , trichurids (Trichuris vulpis), and ancylostomatids (Ancylostoma caninum). Oocysts of Cystoisospora canis and cysts of Giardia sp. were seldom detected, and these data were not considered in the current research.Eggs of STHs (soil-transmitted helminths) found in the feces of dogs were identified as ascarids , and counts lower than 125 EPG in DRF until the end of study, representing a 42–100% diminution .Numbers of eggs of he study A,B, incrp = 0.002).During the first 8 months of study, the dynamics of eggs of T. vulpis in both groups of dogs were analogous A, with vA. caninum were comparable in the two groups of dogs until the 6th month (p = 0.001).The egg-count values of th month B. ThereaT. canis and T. leonina from the 6th month of study. The ratios for T. vulpis ranged from 0.57 to 0 from the 9th month of study, and ratios between 0.55 and 0 were attained from the 13th month for A. caninum.The ratios between the EPG values of each STHs in DRF and CD were estimated, in order to analyze the effect of the integrated control strategy . At the T. canis, T. leonina, and A. caninum both in CD and DRF , for which a period of one month was observed for  and DRF . The LRFT. vulpis and 72–100% for A. caninum. In the dogs receiving the chlamydospores, it was noted that the prevalence of dogs positive for T. canis decreased from the 5th month of study, and levels around 27–40% were obtained until the end of the study period. Similar results were attained from the 9th month of study for T. leonina, with values about 39–44%. The percentages of dogs taking the chlamydospores and passing eggs of T. vulpis ranged between 21 and 39%, while values lower than 56% were not observed for A. caninum until the 15th month.None of the dogs refused to take the gelatin treats. No problems were observed regarding the appearance of digestive, respiratory, or cutaneous disorders.T. canis, T. leonina, T. vulpis and A. caninum) were identified in the feces of two groups of dogs kept in a shelter, then anthelmintic treatment was successfully administered [M. circinelloides and D. flagrans) [Purpureocilium lilacinus, P. chlamydosporia, Trichoderma sp., or M. circinelloides against eggs of ascarids [Ascaris suum dropped by 50% and 66% when the filamentous fungi Clonostachys rosea or Trichoderma atrobrunneum were sprayed on feces of pigs, while the effect on the eggs of Lemurostrongylus sp. was 25% and 33%, respectively [In the current study, eggs of STHs  , in the ascarids ,19, suppectively . Data obectively , therefoCanine shelters play an essential role in caring for animals abandoned by their owners, or lost, or otherwise unable return home. Regarding the control of their health status, special emphasis is put on certain infections caused by parasites including protozoa or helminths, through the quarantine and deworming of newly arrived animals . It has T. canis fail to eliminate the risk of infection, because of their inability to affect embryogenesis and viability [A. caninum with multiple anthelmintic resistance have been recently reported in the USA, presumably related to deworming in racing greyhound kennels [Bearing in mind that in the current investigation, dogs became infected one–two months after successful deworming, it appears necessary to observe useful strategies complementary to deworming for successful control of STHs in canine shelters, while several points should be considered. Firstly, an interval between two to six weeks is needed for eggs to attain their infective stages, and eggs of ascarids or trichurids present a highly protective eggshell enabling elevated resistance to unfavorable conditions, and thus can remain infective for long periods (months to years), especially in moist and shaded areas ,25,26,27iability . Thirdly kennels .T. canis, T. leonina, and A. caninum, but the LFRP extended two–three times in the group given the fungi, which supports the hypothesis that the viability and evolution of eggs in their feces are strongly limited, therefore reducing the hazard of soil contamination.Contamination of ground by soil-transmitted helminths depends on infected hosts passing eggs in feces, and on the ability of the organisms to attain infective stages and to survive. Another very important factor is the period elapsing between deworming and the reappearance of parasites in feces, when the chance of soil contamination might be significantly increased over short time intervals . For thiThe prevalence of dogs reinfected after deworming appears a very interesting topic due to the possibility of elevated percentages of animals passing low quantities of eggs in their feces also contributing to increased soil contamination levels. In the current investigation, differences according to the prevalence of dogs infected after the administration of anthelmintic were not observed until the 6th month of study, hence it is inferred that the administration of fungal spores did not seem to affect the infective stages that had already developed in the soil. However, the reduction of infection levels in the dogs provided with chlamydospores, together with the values of STH egg-outputs from this point (6th month), was attributable to the diminishing risk of reinfection, because of the decrease of viability and development rates of the eggs passed in their feces .M. circinelloides and D. flagrans as gelatin treats offers a useful solution that is easy to use and without additional work for keepers. The drying of the treats facilitates their easy preservation at room temperature. The treatment provides an effective solution with a sustainable approach to decrease the frequency of deworming in those dogs, and is therefore strongly recommended.To reduce the risk of infection with certain helminths affecting dogs cared for in a shelter, the formulation of chlamydospores of


We aimed to establish nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) of patients with primary urachal carcinoma (UrC).Information on patients diagnosed with UrC from 1975 to 2018 was collected from the Surveillance, Epidemiology, and End Results (SEER) Program Research Data. The independent prognostic factors were determined using univariate and multivariate Cox regression. Backward variable elimination according to the Akaike information criterion (AIC) identified the most accurate and parsimonious model. Nomograms were built based on regression coefficients. The C-index, calibration plot, Brier score, integrated discrimination improvement (IDI), area under the receiver operating curve (AUC), and decision curve analysis (DCA) curve were used to evaluate the efficiency of models.In total, 236 patients obtained from SEER were divided randomly into training and validation cohorts in a 70:30 ratio . In the training cohort, multivariate Cox regression analysis indicated that pTNM/Sheldon/Mayo staging systems (included respectively), age, and tumor grade were independent prognostic factors for OS. A similar result was also found in CSS. While other variables, such as radiotherapy and chemotherapy, did not identify significant correlations. In predicting OS and CSS at 3- and 5- years, the nomograms based on pTNM showed superior discriminative and calibration capabilities in comparison to multiple statistical tools. The C-index values for the training cohort were 0.770 for OS and 0.806 for CSS, and similar outcomes were shown in further internal validation (C-index 0.693 for OS and 0.719 for CSS). We also discovered that the link between age at diagnosis and survival follows a U-shaped curve, indicating that the risk of poor prognosis decreases first and then increases with age.The efficacy of pTNM in predicting the prognosis of patients with UrC was greater than that of the Sheldon and Mayo staging system. Therefore, we recommend pTNM as the preferred system to stage UrC. The novel constructed nomograms based on pTNM, age, and tumor grade showed high accuracy and specificity and could be applied clinically to predict the prognosis of patients with UrC. Urachal carcinoma (UrC) is a rare but highly malignant neoplasm arising from a urachal remnant, which is located between the umbilicus and the dome of the bladder –3. It isUnfortunately, there is no validated staging system for UrC. Different staging approaches have been described, namely, Sheldon, Mayo, and modified TNM staging systems , 10, 11.We are committed to building a user-friendly and meaningful statistical prediction model to determine the prognosis for UrC. A nomogram is a prediction model that can intuitively predict the probability of an event and is currently widely used in the prediction of clinical efficacy of various diseases –17. AccoA retrospective cohort research approach was adopted. The information came from the SEER Program Research Data, which covers approximately 27.8% of the United States population. We used ICD-O-3 site codes C67.7 and histological codes 8140–8147 and 8255–8490 to identify UrC. The inclusion factors included: survival time, survival outcomes, age of diagnosis, gender, race, histologic type, tumor grade, TNM stage, surgical procedures, and lymphadenectomy/radiotherapy/chemotherapy data. Using the obtained TNM system, we re-staged all patients with the Sheldon and Mayo staging systems. Overall survival (OS) was defined as survival until death from any cause, while cancer-specific survival (CSS) was defined as survival until death due to UrC.HRs) estimated from the Cox analysis were mentioned as relative risks (RRs) with corresponding 95% confidence intervals (CIs). For predicting 3/5-year OS and CSS, nomograms based on multivariate models were constructed and verified. In both the training and validation cohorts, the C-index was employed to measure the improved model's discrimination. The optimal risk total points cut-off was calculated using the X-tile software. Accuracy and benefits were evaluated by comparing the nomograms with the area under the receiver operating curve (AUC), integrated discrimination improvement (DCA), and integrated discrimination improvement (IDI)  multivariate Cox proportion analysis was performed. Hazard ratios (nt (IDI) . Brier snt (IDI) . X-tile,Between 1975 and 2018, 501 patients diagnosed with UrC as their initial tumor met the initial inclusion criteria. The remaining 236 individuals were included in the research after 265 patients were eliminated owing to ambiguous data details. In p < 0.001). Given the collinearity among three staging variables, three predictors were fitted into different multivariable models . The variables with p < 0.05 in the univariate analysis were assessed by using the multivariate Cox regression, utilizing a backward elimination procedure to define the independent prognostic indicators and estimate their influence on OS and CSS for patients in the training cohort. After backward stepwise regression analysis (according to the AIC), tumor grade in Sheldon (p = 0.102) and Mayo (p = 0.089) for OS were removed, and all other factors included in the multivariate Cox regression turned out to be essential in their own groups  and model 3  predicted OS with good discrimination, but model 1  predicted it more powerfully. The same conclusion was reached when predicting CSS with model 1 . The 0.199 Brier score of model 1 indicated that the nomogram had higher accuracy, compared with model 2 (0.218) and model 3 (0.210). Among these models, model 1 yielded the highest AUC of 0.801 (95% CI 0.734–0.869) for OS and 0.784 (95% CI 0.712–0.855) for CSS  than patients in the low-risk group (n = 143) and high-risk (n = 23) groups, respectively. Meanwhile, the median CSS times were 159 and 36 months in the low-risk (n = 147) and high-risk (n = 19) groups, respectively. Additionally, the calibration plot for the likelihood of 3- and 5-year OS and CSS was close to the reference line, indicating that predictions and observations were in fair agreement. The C-index values for the training dataset were 0.770 for OS and 0.806 for CSS, and the internal validation cohort's C-index for predicting OS and CSS was 0.693 (95% CI 0.597–0.789) and 0.719 (95% CI 0.618–0.820)  of the total points obtained by the X-tile software and used a Kaplan–Meier survival analysis to estimate their survival. In the training cohort, patients in the high-risk group had clearly shorter OS and CSS (both sk group . The mea820) see , 6.The urachus is a fibrous remnant of the allantois. After birth, it remains throughout life as the medial umbilical ligament running from the apex of the bladder to the umbilicus but without any further physiological role . UrC mosIn the absence of an accepted and accurate grading system, modified TNM and Sheldon and Mayo staging systems are all clinically adopted , 9, 10. In our current study, age at diagnosis, histologic grading, and all three staging systems were shown to be significantly associated with OS and CSS. By applying different model comparison tools, we concluded that the pTNM staging system exhibited higher accuracy compared with the Sheldon and Mayo stages. The nomograms based on pTNM and two other influencing factors also showed good agreement in both the randomly obtained internal validation cohorts. In all the nomograms created, we can observe a risk inflection point at an age of around 60 years. The poor prognosis of elderly patients is to be expected, considering that their general condition is usually poor and they may have underlying diseases, such as hypertension and diabetes mellitus that prevent them from tolerating surgery or other treatment options. In contrast, the bleak prognosis in young people may be related to the biology of UrC, and further studies in the fields of pathology and molecular biology are needed in this group of patients. Meanwhile, our findings may lead clinicians to focus more on the clinical management of young patients. Based on our analysis, we believe that adjuvant treatment modalities such as radiotherapy and chemotherapy have not yet proven to be effective for UrC. The comprehensive treatment of patients with UrC after surgery still needs to be further investigated. Our study is not devoid of limitations. First, although the data we used for our modeling came from a large public dataset, it is important to acknowledge the inherent bias of this retrospective registry-based study. Information on several promising variables, such as underlying disease history, serologic indicators, individualized chemotherapy regimens used, and immunohistochemistry, was not available. Second, the Sheldon and Mayo categories were both re-staged by us because they were not directly available. Then again, the practical application of the model obtained based on the predominantly Caucasian SEER database for other centers, such as China, is unknown due to inevitable ethnic differences across countries and regions. More validations with a wider external sample size are needed to corroborate our findings before they can be used generally. Nonetheless, our research is a significant step toward developing predictive nomograms for predicting the prognosis of patients with UrC.In this study, we developed and validated nomograms and built online calculators for effective prediction of OS and CSS in UrC by comparing three clinically applied staging systems. We suggest using the nomograms based on the TNM staging system because they have better predictive efficacy. Our nomogram-based web calculators have great clinical applicability and can help the clinic individualize clinical assistance to patients.The original contributions presented in the study are included in the article/LD, BX, YZ, and ZL contributed to the idea and design. BX collected and analyzed the data. LD, YZ, and ZL drew the figures and tables. LD and BX wrote the draft. LD, BX, YZ, ZL, and JW contributed to manuscript writing and revision. All authors approved the final manuscript.This study was sponsored by the Second Round of Xuzhou Medical Leading Talents Training Project (No. XWRCHT20210027).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Lactobacillus and Pichia kudriavzevii) of normal BBQ. It suggests that the microbial community has an advantage in utilizing raw materials in premium BBQ, while the community was inclined to form flavors in normal BBQ. The differences between two types of BBQ at the microbial and flavor level have theoretical and practical guiding significance in the application of premium and normal BBQ and in the further improvements of taste and quality of Baijiu.Baobaoqu (BBQ) is a traditional fermenting power, which is widely applied in Nong-flavor Baijiu brewing. There are two different types of BBQ  used in industrial manufacture, but the reasons for the significant differences between two kinds of BBQ have not been clearly illuminated. In this study, the combination of metagenomics and metabolomics was performed to compare the differences in the composition of microbial communities and the components of flavors between premium BBQ and normal BBQ. The results showed that the glycosidase-producing microorganisms are the biomarkers of premium BBQ, contributing a better ability of carbon source utilization than normal BBQ. In addition, several important flavors  were rich in normal BBQ, which have a significant positive correlation with the biomarkers ( Wuliangye Baijiu has a brewing history of more than 4,000 years and is one of the most popular alcoholic beverages in China. With the increasing nutrient, healthy and tasty demand of consumers, the manufacturer of Wuliangye also needs to continuously improve their brewing techniques to increase the quality of Wuliangye in recent years.Baijiu is one of the oldest distilled spirits in the world, which occupies an important position in the development of Chinese alcoholic beverages. In 2020, the annual sales of Baijiu reached $ 91.8 billion in China . According to the characteristics of flavor, Baijiu can be divided into three main types: Nong-flavor (NF), Jiang-flavor (JF), and Qing-flavor QF; . Among tWuliangye Baijiu is fermented by a traditional solid simultaneous saccharification technology dependent on the special fermentation starter  that provides abundant microorganisms, enzymes, and flavor substances  is obtained from pure wheat through solid-state fermentation and is one of the most crucial factors affecting the flavor of Baijiu  through the correlation network analysis. However, based on amplicon sequencing, the depth of research is limited to the analysis of microbial communities, and its correlation analysis with metabolome data is insufficient. As an important supplement to the detailed genetic information of microbial communities, the metagenomic technology not only can simultaneously obtain the composition of microbial communities but also can provide the full sequences of genes. Yang et al. used metagenomic technology to reveal a variety of aroma-producing microorganisms in the manufacturing process of medium-temperature Daqu . DNeasy PowerSoil Pro Kit was purchased from QIAGEN Co. (Germany).NaWuliangye Yibin Co., Ltd. in Sichuan, China. The collected BBQ samples were crushed by a pulverizer , sealed in a sterile bag, and stored at −20°C.The matured samples of PBQ and NBQ were obtained from a traditional BBQ-making garden of 5 g of BBQ sample, 15 ml of PBS buffer and 3 glass beads were added into a 50 ml centrifuge tube and shaken well for 5 min. Then centrifuge at 150 g for 5 min, and take the supernatant in the centrifuge tube. In the following, add 5 ml of PBS buffer to the pellet and repeat the washing twice, centrifuge at 150 g for 5 min, and collect the supernatant. Centrifuge the collected supernatant at 10, 000 g for 10 min, and collect the bacterial pellet. DNA was extracted using DNeasy PowerSoil Pro Kit following the manual. The extracted DNA was tested for quality and concentration by 1% agarose gel electrophoresis and spectrophotometry. The Samples with high quality were stored at −20°C for subsequent experiments.DNA was sheared to 300 bp by the Covaris ultrasonic crusher. To prepare the sequencing library, the fragments were dealt with end repair, a tailing, and were ligated to the Illumina compatible adapters. The libraries of DNA sequencing were sequenced by Illumina Hiseq platform at Allwegene Company (Beijing). After the operation, image analysis, base calling, and error estimation were performed utilizing Illumina Analysis Pipeline Version 2.6.The quality control of raw data was performed by using Trimmomatic , includiHigh-quality sequences were compared with the NR databaseVolatile compounds in BBQ samples were analyzed by headspace solid-phase microextraction coupled with gas chromatography–mass spectrometry (HS-SPME-GC–MS). Briefly, BBQ samples (1 g) mixed with 10 μl 2-octanol (10 mg/l) as an internal standard. The volatile compounds were extracted using an SPME fiber  at 60°C for 30 min. The analyses of GC/MS were performed on the Burker SCIONSQ-456-GC . The separation of compounds was achieved using a DB-Wax column . Helium was used as a carrier gas at a constant flow rate of 0.8 ml/min. The oven temperature was kept at 40°C for 2 min, rose to 100°C at a rate of 6°C/min, then rose to 230°C at a rate of 10°C/min, and held for 6 min. The mass spectrometer was run in electron impact mode with the electron energy set at 70 eV and a scan range of 33–400 m/z. The temperature of the MS source and quadrupole was 200°C and 230°C, respectively. Each compound was identified using the NIST library and Wiley library. The compounds with positive and negative matching degrees greater than 800 were selected. According to the ratio of peak area between internal standard and flavor substances, the relative concentration of volatile flavors of BBQ were calculated. Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA) was performed using SIMCA-14.1 software  to investigate the differences in metabolites between PBQ and NBQ. Metabolites with the VIP (Variable Importance for the Projection) value greater than 1.0 were defined as differential metabolites.p values were calculated to reveal the relationship between potentially functional microorganisms  and differential metabolites , and only the correlations that |ρ| > 0.6 and p < 0.05 were defined as significantly related and were visualized by Cytoscape.The Spearman correlation indices (ρ) and The metagenomic raw data has been deposited in the Genome Sequence Archive in Beijing Institute of Genomics (BIG) Data Center, Chinese Academy of Sciences, under accession number PRJCA008653 which is publicly accessible.de novo. On average, the percentage of Q30  was 93.82%; the percentage of G and C bases in clean data is 43.20. Clean reads were further optimized by being mapped against the complete genome of Triticum aestivum L. to preliminarily remove the host sequences  were calculated to perform differential analysis on the species richness and diversity ,B. The rTaxonomic annotation was performed at the species level and the dominant bacteria and fungi were analyzed. As shown in Lactobacillus, Leuconostoc, and Weissella. Lactobacillus fermentum was the most dominant bacteria of PBQ and NBQ with RA ranging from 12 to 20%, of which RA in NBQ was higher than that in PBQ. The RA of Leuconostoc citreum was between 11 and 20%, which was the second dominant bacteria in the two grades of BBQ, which also had a higher RA in NBQ. According to LEfSe analysis . Besides the above two dominant bacteria L. fermentum and L. citreum, Lactobacillus rossiae, Lactobacillus brevis, and other high-abundance lactic acid bacteria were also biomarkers of NBQ (Weissella and Staphylococcus (LDA > 3), among which Weissella confusa was the most abundant, with the RA ranging from 10 to 13%. The RA of W. confusa in PBQ was greater than that in NBQ . Among these pathways, PBQ has advantages in carbon metabolism, biosynthesis of amino acids, fatty acid metabolism, etc. In contrast, NBQ has advantages in starch and sucrose metabolism, pyrimidine metabolism, amino sugar, nucleotide sugar metabolism, etc.The predicted genes were aligned by KEGG database to obtain information on the metabolic functions of the microbial community, which were categorized into three levels of pathways. Biosynthesis of amino acids, ABC transporters, biosynthesis of aminoacyl-tRNA, and carbon metabolism were the most dominant tertiary metabolic pathway in all samples . There wL. ramosa, Rasamsonia emersonii, and Lactococcus lactis, and Lactobacillus pentosus, while several low-abundance microorganisms also can produce alpha-amylase, including Rhizomucor pusillus, Hyphopichia burtonii, Kutzneria albida, and Thermoactinomyces vulgaris. Among these functional microorganisms, there were no significant differences in the RA of enzyme-producing bacteria between PBQ and NBQ. L. ramosa was the only significantly differential fungi  and one bacterium (Curtobacterium sp. S6) in PBQ were significantly higher than those in NBQ, but only the RA for P. kudriavzevii was significantly higher in NBQ than PBQ. The results demonstrated that the diversity of functional fungi, which was crucial in the degradation of raw materials, was the primary reason for the differences between NBQ and PBQ.The classification of PBQ and NBQ is divided mainly based on the enzyme activity (saccharification enzyme and amylase), and the activities of enzyme are higher in PBQ. Through the previous results of metaproteomics, it can be seen that the RA of glucoamylase of PBQ and amylase was higher than that of NBQ . In this of Daqu  and in t of Daqu  and can  of Daqu . For glup < 0.05 and |ρ| > 0.6 were significantly correlated with the differential flavors , thus providing a large number of precursors and energy for the formation of coke flavor substances. Acetic acid, an important precursor of ethyl acetate, was positively correlated with L. fermentum, P. acidilactici, Rhizopus microsporus, Mucor circineloides, etc. In addition, 2-butenal was positively correlated with L. fermentum.Based on the analysis of Spearman correlation, the microbial factors affecting the metabolic differences between PBQ and NBQ were investigated. The results of visualization  showed t flavors , VIP > 1lethanol . As the Lactobacillus was a key functional genus in BBQ, and its function was mainly reflected in the generation and accumulation of aromatic alcohols and esters with floral and fruity flavor. The difference in RA of Lactobacillus was a remarkable factor causing the differences in aromatic substances between PBQ and NBQ. P. kudriavzevii, L. ramosa, and M. guilliermondii were the dominant functional fungi in BBQ. P. kudriavzevii was an important producer of phenylethanol, while L. ramosa and M. guilliermondii play an important role in the degradation and transformation of starch, which provided an important material basis for the production of pyrogenic substances such as 2,5-dimethyl-pyrazine. Thus, the aroma-producing ability of NBQ was stronger than that of PBQ.In general, Lactobacillus and P. kudriavzevii in NBQ were the key aroma-producing microorganisms. Lactobacillus was beneficial to the generation and accumulation of esters and aromatic alcohols, while P. kudriavzevii was an important producer of phenylethanol. As a whole, although the structure of the microbial community was similar, the differences in the abundance of functional microorganisms led to the deviations in function. The microbial community of PBQ was inclined to the utilization of raw materials, while the microbial community of NBQ take advantage of forming flavors. In practical production of Baijiu, the mixed use of PBQ and NBQ can complement their functions, which can balance the growth of microorganisms and the formation of flavors. This result can provide theoretical guidance for the following improvement of Baijiu quality.Due to the long manufacturing period of BBQ, two different grades of BBQ (PBQ and NBQ) are formed and play different roles during the brewing process of Nong-flavor Baijiu. It is necessary to comprehensively analyze the differences between the two types of BBQ in terms of microorganisms, enzymes, and flavor substances. In the previous study, the characterization and comparison of enzymes in two grades of BBQ have been analyzed, and the RA of glycosidase in PBQ was higher than that in NBQ. In this study, the differences between the two grades of BBQ were analyzed at the microbial and metabolic levels. There were certain differences between the two kinds of BBQ in the functional microbiome. The RA of functional microorganisms producing amylase and glucoamylase was significantly different between the two grades of BBQ, making the utilization of raw material much better in PBQ than in NBQ. There were significant differences in the concentration of 8 flavors in the two types of BBQ, including ethyl hexanoate, hexaldehyde, phenylethanol, ethyl acetate, 2,5-dimethyl-pyrazine, acetic acid, ethyl hexadecanoate, and 2-butenal, except for 2,5-dimethyl-pyrazine. The marker microorganisms The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/JC, JL, GD, and XZ conceived the idea and the design for this work. QZ carried out the experiments and formal analysis. JZ, ZQ, and DZ provided technical support during the experimental phase. QZ drafted the paper. XZ revised the paper. All authors contributed to the article and approved the submitted version.This article was supported by the National Key Research and Development Program of China (2017YFC1600403), the National First-class Discipline Program of Light Industry Technology and Engineering (LITE2018-08), the National Natural Science Foundation of China (31900067), and the National Key Research and Development Program of China (2019YFA0906400).QZ, ZQ, JZ, and DZ were employed by the company Wuliangye Yibin Co., Ltd.The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


This study aims to investigate whether the Dietary Inflammatory Index (DII) is associated with non-alcoholic fatty liver disease (NAFLD) and advanced hepatic fibrosis (AHF) among non-institutionalized adults in the United States.Utilizing data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2016, a total of 10,052 adults aged ≥18 years were included in the analysis. We used multivariable analysis, controlling for demographic variables, to evaluate the association between DII and NAFLD and AHF, a restricted cubic spline (RCS) was used to model the non-linear relationship between DII and NAFLD.p trend <0.0001), and AHF . The association remained statistically significant after stratified by gender in terms of NAFLD, but in case of AHF only in males  was statistically significant. In the RCS models, the relation of DII and NAFLD started increase rapidly until around 1.80 and then started relatively flat afterward.For 10,052 participants, DII ranges from -4.63 to 5.47. Compared with quartile 1, higher DII group were associated with higher levels of female, separated/divorced, lower education level, heavy alcohol use, current smoke status, BMI, poverty income ratio, and waist circumference. DII also showed a significantly positive correlation with ALT, AST. In the fully adjusted multivariable model, DII was positively associated with the presence of NAFLD (OR 1.09, 1.06–1.13 CI, Higher pro-inflammatory level was associated with higher risk of NAFLD in males and females, and with higher risk of AHF in males but not in females. Therefore, strategies to promote an Zhang anti-inflammatory diet should be considered to prevent and ameliorate NAFLD and AHF in adults. Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease among adults in the United States, with a prevalence of 30–40% . The speDietary modification is a significant impact on liver health  and is oTherefore, we aim to assess the cross-sectional relationships between DII and risk of NAFLD and AHF, and the difference between males and females using data from the National Health and Nutrition and Examination Surveys (NHANES). We hypothesized that increased consumption of a pro-inflammatory diet would associate higher NAFLD or AHF risk.The NHANES is a complex, stratified, 4-stage survey design, and probability-cluster designed program conducted by the National Center for Health Statistics (NCHS) , which aData from six cycles of the NHANES that extracted during 2005–2016 were included in this analysis. All participants aged ≥18 years who completed the full 24 h dietary history were included in the cohort. Participants were excluded if they: (1) had unreliable dietary recall status; (2) missed information included fatty liver index (FLI) and NAFLD fibrosis score (NFS), could not define NAFLDa nd AHF; (3) had elevated alcohol intake   was used to model the non-linear relationship between DII and NAFLD, and we used RCS with three knots at the 10th, 50th, 90th centiles to flexibly model the association of DII with NAFLD, however, DII is linearly related to AHF, and we did not execute RCS. Two-tailed p-values <0.05 were considered statistically significant. Statistical analysis software R version 4.1.2. was used for statistical analyses.In the present study, all analyses accounted for the complex survey design of the NHANES and weighting variables. MEC subsample weight (WTMEC2YR for 2005–2016) was used, due to DII was used as major indicators in this study. Chi-squared test was used for comparing categorical variables and presented as numbers (n) and percentage (%). As for continuous variables, weighted A total of 10,052 subjects were invited to participant in the NHANES. These participants represented a weighted population of 72,033,969 non-institutionalized US. p trend <0.0001). After adjustment for potential confounding factors (model III), DII exhibited a significant positive association with AHF risk .p trend <0.001) and in females  after full adjustment in model III. DII levels were associated with higher odds of AHF only in males , and AHF risk was not significantly increased among Q2–Q4 participants compared with Q1.The present study found a pro-inflammatory diet as measured by the DII was associated with a deteriorating NAFLD and AHF risk profile in a nationally representative sample of US adults. In this cohort, the highest quartile of DII, the most pro-inflammatory diet, was positively associated with increased risk of NAFLD and AHF compared to the lowest quartile, the most anti-inflammatory diet. Additionally, in the subgroup analysis by sex basing on multiple logistic regression, DII exhibited a significant positive association with NAFLD, and AHF was not significantly in females.p trend <0.001, Limited studies have investigated the link between the DII and NAFLD and AHF. Mazidi et al.  showed tOur results highlight that anti-inflammatory diets were associated with lower risks of NAFLD and the prevention of its progression to advanced fibrosis. Kenđel et al.  investigThe major highlights of this study are the relatively large and well-designed population-based sample, the results can be extrapolated to the entire population. Due to the strong standardization of the NHANES study procedures, the measurement and information biases are very low . Our finThere were several limitations to this study as follows. First, the cross-sectional nature of NHANES severely constrains causal inferences. Second, in the absence of gold standard techniques to diagnose NAFLD and AHF, we used non-invasive diagnosis indexes . Third, the lack of data on physical activity makes it impossible to predict whether it would be a potential predictor. However, combined with previous study , this prIn conclusion, data from this study suggesting a possible association between NAFLD and AHF risk with the DII. We suggest the anti-inflammatory diet can be a step of NAFLD and AHF management and be considered to prevent NAFLD and AHF in adults. However, further longitudinal studies, larger sample sizes and repeated measures are necessary to validate and verify the current evidence.https://wwwn.cdc.gov/nchs/nhanes/Default.aspx, 2005–2016. Using deidentified data to conduct the secondary analysis was officially classified as exempt by the Albert Einstein College of Medicine Institutional Review Board.We analyzed publicly available datasets in this study. The datasets presented in this study can be found in online repositories. The names of the repositories can be found below: Centers for Disease Control and Prevention (CDC) National Health and Nutrition Examination Survey (NHANES), Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.ZhL and JL were responsible for the conception and design of the study. ZZ, LW, and ZiL wrote the first draft of the manuscript, interpreted the data, and wrote the final version. WeY, JC, XZ, WaY, and JL performed the statistical analysis and interpreted the analysis. ZhL, JL, JC, XZ, and WeY were critically revised the manuscript. ZhL obtained public funding. All authors critically revised the article for important intellectual content and approved the final version.


Water supply to millions of people worldwide is of alarmingly poor quality. Supply sources are depleting, whereas demand is increasing. Health problems associated with water consumption exceeding 1.5 mg/L of fluoride are a severe concern for the World Health Organization (WHO). Therefore, it is urgent to research and develop new technologies and innovative materials to achieve partial fluoride reduction in water intended for human consumption. The new alternative technologies must be environmentally friendly and be able to remove fluoride at the lowest possible costs. So, the use of waste from lignocellulosic biomasses provides a promising alternative to commercially inorganic-based adsorbents—published studies present bioadsorbent materials competing with conventional inorganic-based adsorbents satisfactorily. However, it is still necessary to improve the modification methods to enhance the adsorption capacity and selectivity, as well as the reuse cycles of these bioadsorbents. It is the fundamental reason for its presence at various concentrations in the waters around the world ,2. In aq−) . In huma−) ,4. In ad−) ,2,5.The WHO also recommends fluoride concentrations ranging from 0.5 to 1 mg/L in drinking water as a preventive measure to avoid the incidence of dental caries. However, to prevent damage to the population’s health, it is necessary to remove this element from the water up to harmless concentrations .For developing countries, the WHO reports that drinking water defluoridation technologies are generally applied in batch or batch flow systems, at household or small community scale, using conventional technologies such as precipitation, activated alumina, bone charcoal, clays, and other naturally occurring media. In contrast, for industrialized countries, continuous systems and advanced treatment technologies such as reverse osmosis and electrodialysis are used .Adsorption has been extensively studied and recognized as an efficient and cost-effective alternative for drinking water treatment ,6,7. The−3, SO4−2, CN−, PO4−3, dyes, and even pharmaceuticals, all of them in an aqueous media [Therefore, several investigations document non-carbonized plant materials with competitive removal capacities. These materials have been tested to remove pollutants such as As, Co, Cu, Hg, Cd, Zn, Ni, Cr, Pb, F, NOus media ,28,29,30Different technologies have been studied to remove fluoride excess in drinking water. However, selecting a treatment method will depend on technical and economic feasibility and the water to be treated. Adsorption is the leading technology for the pollutant removal of liquid effluents. It has been widely studied and used due to its simple design, low costs, and simple operation . Among tA biomass-based adsorbent is called a biosorbent. Thus, biosorption is a physicochemical phenomenon that refers to the ability of the biosorbent to capture ions present in an aqueous solution. The biosorbent can be used in a pristine form or modified as a biocomposite ,35. AddiLignocellulosic biomass is the dry matter of plants (biomass) and is the most abundant raw material on Earth. In many countries, lignocellulosic biomass, such as fruit peels, agricultural residues, and garden waste, is part of solid municipal waste . DependiHuang et al. (2022)  stated tIn the last ten years, the literature has reported pollutant ion removal from water by dry and modified lignocellulosic biomasses such as Zr-loaded orange waste gel , apple pIn most studied biomasses, cellulose is the principal active agent, a natural polysaccharide with hydrogen bonds and good stability ,20. TherMany materials of plant sources have been studied for fluoride and other pollutant ion removal from water. This research focused on lignocellulosic biomasses that have not been thermally treated and have not been carbonized. Lignocellulosic biomasses need to be processed before being applied as bioadsorbents. The procedures can be simple, such as drying, grinding, and sieving  to obtain fine powders. However, they can also be more sophisticated and require reagents and laboratory equipment . Using one or more physicochemical treatments is common to improve the fluorine capture capacity and selectivity. However, not only do they help to improve the capacity, but they also sometimes serve to remove interfering or unwanted compounds . These cGenerally, in the final stage of chemical treatment, plant tissues undergo a transformation, which makes it possible to subject them to impregnation or doping with metal cations linked to the pollutant of interest. Physical processes include tap water washing and further washing with distilled, double-distilled, and/or deionized water. This is intended to remove dust, dirt, and other impurities from the biomasses, avoiding interference with the remaining processing ,49,50,58After physical treatments, some authors subject plant tissues to chemical treatments. The purpose of such treatments can be the elimination of pigments, destruction of compounds, and bond formation or destruction, among others. In other cases, these treatments turn the biomass into an element-bearing material (biocomposite). Biocomposite formation is intended to increase the adsorption capacity of biomass.Paudyal et al. (2012a) subjected orange waste to saponification with calcium hydroxide, and then the prepared white material was transformed into a cation-exchange gel containing calcium. Subsequently, this gel was placed in contact with zirconium oxychloride octahydrate, thus completing the preparation and loading Zr into the biomass base .+2 ions in the saponified product undergoes a cation exchange reaction with the charged metal ions [Additionally, Paudyal et al. (2012b), in similar research, used saponified orange peels to impregnate them with different cations. During the loading reaction, the presence of Catal ions . This prSubsequently, Paudyal et al. (2013) studied orange juice residues. Their research described the importance of water-soluble organic acid removal, such as citric acid, as these substances remove the previously charged metal ions .w/v) at 50 ◦C up to 4 h [Yadav et al. (2013) immobilized color and water-soluble substances by treating sawdust and wheat straw with formaldehyde (1%) in a 1:5 ratio  removed tea-colored residues and soluble components by acid treatment with sulphuric acid (1 M). After the acid treatment, the acidified biomass was loaded with Fe and Al 0.4 salt solutions and adjusting the pH with sodium hydroxide (2 M) .Jha et al. (2015) studied fluoride adsorption by Zr-loaded carboxylated orange peel. This study reported that orange waste contains cellulose, hemicelluloses, lignin, and pectin; the latter is estimated to contain 10% of the total orange waste. Pectin is a polysaccharide consisting mainly of hydroxyl and methyl ester groups. Because pectin’s ester and hydroxyl groups do not bind significantly with metals, the authors modified the orange peel by ester group saponification with sodium hydroxide, followed by hydroxyl group carboxylation with chloroacetic acid, thus increasing the number of carboxylate ligands. The Zr-binding capacity of the modified orange peel increased the biomass that can adsorb fluoride from an aqueous solution via a ligand-exchange mechanism .Manna et al. (2015) performed an alkali-steam treatment to treat their lignocellulosic biomasses. Their publication stated that the modified biomass adsorption capacity was better than before the treatment . Later oNaga Babu et al. (2018) performed a combining of the biomass with hydrochloric acid to activate the sorption sites and leaving it in a water bath for 2 h .Mwakabona et al. (2019) impregnated the biomass with Fe(III) by immersing it in Fe(III) chloride. They attributed the Fe charge on the particle surface to the coordination bonds provided by the electrostatic forces between the biomass surface and the Fe(III) complex in the solution. Subsequently, a portion of the impregnated material was soaked in a sodium hydroxide solution  to accomplish the Fe(III) co-precipitation forming Fe(III) hydroxide-coated surfaces. The adsorption experiments showed differences between the two materials. The non-alkalinized material was effective over a wide pH range, while the post-alkalinized material was more chemically stable .Carboxylation is another common technique used to enhance the biomass defluorination capacity, which theoretically increases the fluoride ion removal rate and the pH of the reaction medium . For insA literature review allows us to identify that the main cations used in the biomass impregnation that adsorb fluorides are La, Ca, Fe, Al, Ce, and Zr ,62,64,65Other alternative treatments include cellulose extraction, which increases adsorption capacity, and material pyrolysis, which increases porosity and surface area. However, this involves higher costs due to energy and reagent consumption and eventual waste generation ,36,53,67The characterization of base materials (biomass and reagents), intermediate materials, and final materials (biocomposites and biosorbents used) is a critical stage in understanding the nature of bioadsorbents, as well as the governing mechanisms for capturing the pollutant of interest . MoreoveICP is a practical, versatile and effective technique for the quantification of a large number of elements .Paudyal (2013) determined the Zr, Al, and Ce concentration loaded in orange peel by ICP/AES. Additionally, he used this method to quantify the amount of residual Zr in treated water. The results showed that the Zr leaching is insignificant at pHs between 4 and 10, even when the initial fluoride concentration is up to 120 mg/L .Jha (2015) quantified the concentration of Zr by ICP-OES in his orange peel bioadsorbent. He found that the Zr content in his bioadsorbents was 0.38 g Zr/g ; this vaLikewise, Cai 2015) evaluated the concentration of dissolved Fe and Al in treated water by ICP-MS. The reaction medium pH significantly influenced the material’s stability. Residual amounts of Fe and Al were observed in the treated water. However, Fe and Al quantification showed that the concentration of Fe and Al remained below the permissible limits established by the WHO [ evaluateA thermal analysis (TA) allows relating temperature to the specific physical properties of a material.Jha (2015) determined the amount of organic and inorganic matter in his orange peel bioadsorbent. The weight loss observed between 25 and 185 °C can be attributed to the evaporation of chemically and physically adsorbed water molecules and other volatile chemicals. Moreover, pectin, hemicellulose, and cellulose degradation could be related to weight loss at 185 to 300 °C. Finally, the weight loss in the 300 to 550 °C range is due to lignin degradation. The total weight loss in the bioadsorbent was 97.21% within the temperature range studied, leaving 2.79% of metallic residue due to the Zr impregnation .The microstructure and morphological characteristics of the adsorbent particles can be determined by SEM analysis ,48.Jha (2015) analyzed the surface morphology of his material (orange bioadsorbent) using a SEM with the energy dispersive spectroscopy (EDS) technique. The fluoride adsorption on the bioadsorbent can be associated with the presence of white spots distributed throughout the material, which is confirmed by EDS spectra .Colocasia esculenta) has low porosity, while the activated carbon made from the same biomass has a highly developed porous structure. In both samples, the existence of fluoride was confirmed by EDAX analysis The adherence of fluoride was lowest in the dry biomass [Mukherjee et al. (2016) demonstrated by SEM analysis that the dry biomass of taro  used SEM-EDS analysis to observe Zr-loaded grape debris’s surface morphology and chemical composition before and after processing and contact with fluoride . FurtherSrinivasulu et al. (2021 a) studied tamarind seed husk bioadsorbent morphology by SEM-EDS analysis. They found that the biomass had an opaque appearance, with a non-adhesive nature. The particles had sharp edges and a characteristic irregular structure. In addition, it was determined that the microporous particles possessed voids and provided sites for fluoride capture. After biosorption, the adhesion of fluoride ion particles appeared in EDX analysis, which also showed the presence of O, C, Ca, and Mg in the untreated materials. Finally, the elemental oxygen concentration was reduced after biosorption and fluoride was introduced, suggesting that the fluoride anion can replace the ion-containing oxygen atoms (OH) .Yao et al. (2021) performed SEM analysis on samples of base, intermediate, and final materials before and after fluoride contact. The results allowed them to describe the rough texture and the irregular pore structure of the bioadsorbent material, an ideal characteristic for fluoride adsorption since it provides sufficient surface area and active sites to achieve a high adsorption capacity. Additionally, the sample that adsorbed fluoride showed no significant change compared to the one that did not. This denotes its stability and potential application in water treatment. The mapping of the elements C, O, and Ce on the bioadsorbent surface, before and after fluoride capture, showed homogeneous distribution over the material surface, suggesting a successful preparation. Fluoride was also detected in the EDS analysis .Knowing the surface characteristics is valuable for describing its potential use. One of the fundamental properties is the surface area available for molecule adsorption.2/g, 0.0001 cm3/g, and 2.62 nm, respectively [Jha (2015) determined the surface area of his bioadsorbent by BET using the Quantachrome automated gas sorption system. The bioadsorbent specific surface area, micropore volume, and mean micropore diameter were 20.56 mectively .2/g. In contrast, the bioadsorbent area was 93.38 m2/g. The authors attributed the surface area reduction to the fluoride sorption on the biosorbent surface [The surface area of a tamarind seed-husk was established by Srinivasulu (2021a) using BET at 286.94 m surface .Colocasia esculenta) bioadsorbent surface area and pore volume, and these values were compared with carbonized and steam-activated taro stem samples. The results showed that both pieces are microporous; however, all characteristics were superior in the activated carbon. The results proved why the dry biomass had lower fluoride removal compared with that of the activated carbon from the same biomass. [Mukherjee (2016) measured the taro stem  determined the surface area of the dsorbent .The IR spectrum of functional groups is considered unique and characteristic of the molecule.A given absorption band assigned to a functional group proportionally increases with the number of times that functional group occurs within the molecule. FTIR is often used for qualitative biopolymer characterization ,70,71.−1 shows the presence of -OH groups on the surface. A peak at 496 cm−1 in the same sample indicates the presence of Zr-O bonding. Furthermore, the peak at 3569 cm−1 in the case of the unused bioadsorbent was shifted to 3615 cm−1 in the sample corresponding to the used bioadsorbent. This shows the participation of the hydroxyl anion in the ligand exchange with the fluoride [Jha (2015) obtained the FTIR spectra of Zr-impregnated orange peel before and after contact with fluoride. In the fluoride-captured bioadsorbent spectra, a broad peak at 3569 cmfluoride .−1 shifted to 3424 cm−1 and broadened, due to Al impregnation, leaving evidence of the metal ion interaction with the OH groups. Furthermore, upon adsorption of the fluoride, the 880 cm−1 peak appeared, which was attributed to Al–F stretching vibrations, suggesting adsorption by ion exchange with the OH bonded to Al [Peng et al. (2017) investigated the fluoride adsorption mechanism through the spectra of Al-impregnated tea waste adsorbent. They observed that the band at 3377 cmed to Al .2, COO, and -C=O groups at wavelengths 3423, 2927, 1739, and 1631 cm−1, respectively. However, the latter shifted to 1625 cm−1 after Zr loading. This could be caused by the exchange of Zr ions with the hydrogen present in the base biomass and shows the fundamental role of carbonyl functional groups in the Zr impregnation of the biomass. Subsequently, Zr forms hydrated compounds with high fluoride affinity [Zhang (2019) presented the FTIR spectra of Zr-modified grape pomace. The biomass showed peaks related to stretching vibrations of -OH, -CH−1, the hydroxyl functional group associated with organic acids, alcohols, and phenols was identified. Furthermore, the stretching of the carbonyl group was identified at 1620.36 cm−1. These are more pronounced in the oxidized carbon materials than in the original ones. In addition, broad and long peaks were found on the surface of the bioadsorbent, possibly due to the chemical activation process. That is, the hydrogen ion released by the sulphuric acid could lead to the appearance of the hydroxyl functional group on the surface of the bioadsorbent [Srinivasulu (2021a) described the presence of different functional groups in biomass, which are imputed to the nature of it. For instance, at wavelength 3417.88 cmdsorbent .−1, consistent with Ce–F bonds. The 3325 cm−1 peak, attributed to the stretching of hydroxyl groups, indicated the abundant presence of hydroxyl groups. Upon fluoride adsorption, the band was reduced, as evidence of the critical role of hydroxyl groups. Based on the above, the authors suggest that the mechanism of fluoride ion adsorption is the substitution of species between the fluoride and hydroxyl groups [Yao (2021) confirmed the surface composition of the material as well as the mechanism by which the fluoride is attached by FTIR analysis. The bioadsorbent spectra showed peaks attributable to the vibrations of the C–H, C–O, C–O–C, and Ce–O–Ce bonds. The fluoride retained material spectrum also showed the presence of peaks below 600 cml groups .XRD patterns allow for compound identification. For instance, the literature reports biocomposite and biomass characterization by X-ray diffraction, determining semi-crystalline characteristics due to molecules such as cellulose or lignin.4 and polymerized species. It was indicated that the charged Zr(OH)4 is transformed into an amorphous phase composed of polymerized species by water incorporation [Jha (2015) evaluated Zr-modified orange peel. The XRD analysis revealed the presence of Zr(OH)poration .Colocasia esculenta) stem sample diffraction patterns, showed few sharp peaks before and after adsorption, which shows that the samples are crystalline. Furthermore, after the fluoride ions adsorption, the peaks intensity decreased, indicating the adsorption of fluoride ions on the surfaces of the crystalline structure by physisorption [Mukherjee (2016), through dried and charred taro  extracted cellulose from sugarcane bagasse by ultrasound, which they modified with La. The cellulose and bioadsorbent were analyzed by X-ray diffraction. The analysis showed that the ultrasound treatment weakened the hydrogen bonds between the cellulose layers, thus forming individual layers, which led to increased interaction with the La particles. As a result, La could fill the intermediate layer of the biopolymer matrix during ultrasonication. The 20°–29° peaks indicate La impregnation in the cellulose, and the peaks at 25.86° and 49.56° are due to fluoride adsorption on the bioadsorbent .2 loading on the cellulose membrane used for fluoride adsorption under XRD analysis. He confirmed the cellulose extraction success in the wood residues. The analysis allowed him to identify not only the compound but also its purity [Yao (2021) demonstrated the CeOs purity .XPS analysis is not only helpful in determining the composition of composite materials but has also been shown to be helpful in determining the mechanism by which fluoride is adsorbed on such materials.Manna (2015) demonstrated, by XPS spectra, the binding of fluoride and jute bioadsorbent. In the C1s spectra, the C2 (carbon C–OH), C3 (carbons O–C–O or C=O), and C4 (carbon O–C=O) peaks shifted to higher binding energy ranges, and the atomic percentages of these carbons decreased after exposure to the fluoride solution. This was attributed to hydrogen bonding between fluoride ions and OH groups or OH group substitution by fluoride ions and electrostatic interaction between fluoride ions and protonated carbonyl groups .Peng (2017) determined the fluoride ion-capture mechanism by observing a significant increase in F peak area (0.54–1.22%) after adsorption and associated the change to the surface reaction between the Al–Tea biosorbent and the fluoride. Additionally, changes in Al(2p) peak shapes and binding energy were observed after adsorption, implying that Al participated in the adsorption of fluoride .+3 and Ce+4 oxidation states. The Ce peak was not detected after fluoride adsorption due to fluoride capture. The C1s showed a reduction in the peak area of the C–O and C–C, which is attributable to the presence of fluoride on the surface. The peak shift and significant decrease of the Ce–OH area in the O1s spectrum and the C and Ce spectra give evidence of fluoride capture success in the study material. So, the peak deconvolution, which showed shifts in the peaks and changes in intensities and area, leaves the certainty of fluoride capture by ion exchange between the hydroxyl group and the fluoride [Yao (2021) confirmed the fluoride adsorption mechanism by XPS peak deconvolution for the elements C, O, and Ce present in the bioadsorbent samples before and after contact with fluoride. In the results, it was identified that Ce coexists in the Cefluoride .The quantification of the elements supported in biomasses and the validation of their concentration in treated water  have not been commonly explored, despite their importance. Quantifying elements in water by ICP is a fast and accurate option; this analytical method is also very useful for quantifying elements in a complex matrix, such as bioadsorbents. EDX, EDS, and EDAX analysis can also determine so-transported elements in biomasses.BET is another uncommon method in the adsorbent bio-material characterization. However, describing both surface area and pore size is of utmost importance to explain firstly the viability of the material for capturing the pollutant of interest and the mechanism by which adsorption takes place. Finally, thermogravimetric analyses are another analytical method rarely used to characterize bioadsorbents. Although they do not describe the adsorption capacity or type of adsorption performed by biosorbent materials, these techniques describe the composition and the changes that the base materials undergo in their structure and surface until they become bioadsorbents.The most essential and commonly used analysis techniques to describe bioadsorbent materials are FTIR and SEM. Many authors describe both the composition in functional groups and the presence of cations bonded to the matrix of an organic nature, and some works even describe bond formation with fluoride. By SEM analysis, the authors generally report the texture of the materials, as well as the shape and size. This analysis and BET can be an enriching complement to relate the morphology of adsorbent particles and thus explain the interaction between fluoride anions dissolved in water and the bioadsorbent.Finally, the adsorption mechanism could be explained by XRD and XPS analysis. In them, it is possible to establish the material composition in a detailed matter, thus allowing observing changes in the oxidation states and the formation of bonds and compounds during the modification of the bio-masses until the fluoride is captured.The analysis selection depends on the base material nature, the information needed, and the available resources. However, it is necessary to implement the same analysis for base, intermediate, and final materials. This process will allow the identification and description of all the transformations undergone at each stage.The anion and cation coexistence during fluoride adsorption can reduce the ability of the material to capture fluoride due to precipitation, complex formation, or competition for sorption sites . TherefoWater intended for human consumption has different anion and cation concentrations, depending on the subsoil composition with which it interacts ,5. Howev3−2) and phosphates (PO4−3) mainly affect fluoride adsorption. However, other ions may also interfere with fluoride removal. Specifically, the fluoride adsorption in the presence of anions at different concentrations must be studied to evaluate the bioadsorbent selectivity and the competition between ionic species and fluoride for active sites ,56. The −1, NO3−1, CO3−2, and SO4−2 under a pH range of 2–4 [Paudyal (2012) developed an adsorbent with orange peels. In his study of coexisting ions, he found no significant reduction in fluoride removal in the presence of ions Cle of 2–4 .3−1 and PO4−3 concentrations above 200 mg/L decreased the fluoride removal percentage below 90%, and at 600 mg/L, fluoride adsorption dropped to less than 70%.Jha (2015) reported that for his orange adsorbent, HCO4−2 anions severely negatively affect fluoride bioadsorption by melon peels. Likewise, the effect was associated with a higher negative charge compared with that of Cl− and Br−, whose interference was slight [Kazi et al. (2018) determined that SOs slight .4−2, NO3−, and Cl− ions did not interfere with fluoride biosorption by Zr-modified grape bagasse. However, HPO4−2 and CO3−2 ions show considerable interference in fluoride removal [Zhang (2019) showed that SO removal .The nature of the base material such as the functional group richness and the presence of fluoride-related cations are crucial factors in the biosorbent material selectivity. The anion interference degree on fluoride adsorption also depends on the operating conditions, e.g., pH. This is extremely important when testing biosorbents on real materials. The feasibility of a material can be undermined if the water composition and operating conditions that favor the capture of fluoride anions are not considered. In addition, treatment costs may increase as higher doses of bioadsorbent may be required.Material desorption (elution) is the reverse process of adsorption. The aim is to release or separate, in this particular case, the fluoride from the bioadsorbents ,49,62. TDifferent materials are reported in the literature to have undergone desorption, and in general, this procedure was carried out in a basic medium, using NaOH. Adsorption consists of capturing or retaining an adsorbate present in the aqueous or gas phase on a porous solid material known as an adsorbent. During adsorption, physical or chemical bonds may occur between the adsorbent particles and the adsorbate. The strength of interaction between the two will define whether physisorption or chemisorption occurs .Al-Ghouti et al. (2020) stated that in physisorption, multilayer formation occurs and is attributed to weak electrostatic interactions such as London forces, dipole–dipole forces, and Van der Waals interactions. Conversely, monolayer formation takes place in chemisorption due to the forming of bonds between adsorbate and adsorbent by sharing or transferring electrons. Chemisorption interactions are two orders of magnitude than physisorption .Different adsorbent characterization techniques, before and after adsorption, and equilibrium data modeling (isotherm and kinetic models) has been studied at a constant temperature to describe the interaction mechanisms between adsorbate and adsorbent ,74.Numerous isotherm models have been developed and studied, and each of them involves different parameters and implies various considerations/conditions. However, the Langmuir and Freundlich models are the most widely used. While the first one describes chemisorption, the Freundlich model describes physisorption .Different kinetic models have also been studied to identify the critical mechanism by which the ion capture occurs to understand the mechanisms governing fluoride adsorption and isotherm models.It has been reported that in the adsorption process, the mechanism is regulated by diffusion, and the adsorption rate is controlled by mass transfer .The adsorption mechanism controls the fluoride adsorption capacity, energy, and kinetics .Molecular diffusion, external mass transfer, or fluoride ions transport from the aqueous medium to the external surface.Fluoride ion adsorption on the adsorbent particle surface.Intraparticle diffusion: the adsorbed fluoride ions are transferred to the inner surface of the adsorbent particle ,79,80.Fluoride adsorption has been described as a three-step phenomenon:Generally, the kinetic models described for fluoride adsorption can be classified into reaction-based and diffusion-based models. As with isotherm models, there is a wide variety of models involving different considerations ,81,82,833) was the lowest-cost technology, followed by electrocoagulation (0.230 €/m3). The most expensive treatment method was ion exchange resins, which cost 4675 €/m3. Adsorption using granular activated carbon (the most commonly used adsorbent) was estimated at 3740 €/m3, ranking among the most expensive technologies. The authors also concluded that adsorption is a suitable technique for defluoridation of drinking water sources around 20 mg fluoride/L or less [Lacson et al. (2021) stated that adsorption, precipitation, and membrane-based processes are the most used methods to remove fluoride from water. The authors compared and evaluated these methods of fluoride removal, considering that all have their drawbacks. These include the operation complexity, high chemical consumption, high operating costs, and the large amount of by-products generated . Conceptual estimations of operating costs (OpEx) were then made. The results showed that flocculation coagulation  that pose other risks. Furthermore, bioadsorbent regeneration and reuse studies are shown, and most importantly, the validation of the materials when used in groundwater or other real matrices.The progress and improvement of analytical techniques have made it possible to infer the probable mechanisms and critical steps for fluoride sequestration by bioadsorbents. Understanding how and why such a process occurs allows for refining methodologies, preparation, and anion capture. It also predicts the bioadsorbents’ stability under different operating conditions.Since non-carbonized lignocellulosic-based bioadsorbents are competitive in fluoride capture at different concentrations and conditions, it is essential to explore their application on larger scales and include economic feasibility studies.