Startseite Association between thyroid stimulating hormone levels and papillary thyroid cancer risk: A meta-analysis
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Association between thyroid stimulating hormone levels and papillary thyroid cancer risk: A meta-analysis

  • Bin Xu EMAIL logo , Shu-Yan Gu , Ning-Ming Zhou EMAIL logo und Jun-Jie Jiang
Veröffentlicht/Copyright: 11. August 2023
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Open Life Sciences
Aus der Zeitschrift Open Life Sciences Band 18 Heft 1

Abstract

High thyroid stimulating hormone (TSH) levels may stimulate papillary thyroid cancer (PTC) cell proliferation; however, the relationship between TSH levels and PTC risk remains controversial. We aim to ascertain the association through a meta-analysis. Literature searches were conducted in PubMed, Embase, and Web of Science databases. After literature screening, the methodological quality was assessed using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality methods. Cochran’s Q and I 2 tests were used to evaluate heterogeneity in the meta-analysis. Egger’s test was applied to assess publication bias. A total of 12 eligible studies were included in this meta-analysis; all were of moderate and high methodological quality. The pooled results suggested that increased TSH levels were significantly associated with PTC risk; however, the included studies were significantly heterogeneous. Stratification analysis indicated that the heterogeneity might be from the area or type of control. Although significant publication bias existed among the studies, the trim-and-fill method and sensitivity analysis revealed that the combined results were stable and robust. TSH levels are significantly associated with the PTC risk; however, more high-quality studies in large sample sizes are recommended to verify the extrapolation of these findings.

Graphical abstract

Keywords: thyroid stimulating hormone; papillary thyroid cancer; meta-analysis

1 Introduction

Thyroid cancer is the most prevalent of all endocrine malignancies worldwide, and its rapid increase in incidence can be attributed to papillary thyroid cancer (PTC) [1,2]. As the most widespread histological subtype of thyroid cancer, PTC accounts for 80–90%, but with a superior prognosis than other subtypes [3,4]. The 10-year survival rate of PTC is estimated to be approximately 93%; however, 25–35% of patients still exhibit tumor heterogeneity as well as aggressive variants with unique clinical, pathological, and molecular characteristics [5,6]. The current recommendation is to use ultrasound (US) and fine-needle aspiration cytology (FNAC) to diagnose malignancy, along with surgical treatment as first-line therapy [7]. Although FNAC is the gold standard for assessing thyroid nodules, it still carries the risk of trauma and of causing the spread of tumor cells and has approximately 10% diagnostic uncertainty [8]. Clinical guidelines also suggest incorporating specific clinicopathological features, such as age, sex, tumor size, and BRAF mutations, to reduce overdiagnosis and indicate the probability of recurrence [9,10]. Therefore, there is a need to discover new molecular markers and apply them to the diagnosis and treatment of PTC to better predict the malignancy and aggressiveness of the lesions.

Thyroid stimulating hormone (TSH) is a pituitary hormone whose serum or plasma levels are a sensitive marker for assessing hyper- or hypothyroidism [11]. TSH is regulated by the negative feedback from triiodothyronine and thyroxine and is influenced by stress hormones and cytokines during homeostasis [12]. In addition to genetic factors, demographic factors (such as sex and age), intrinsic factors (such as microbial community and stress response), drug use, and environmental factors, all contribute to inter-individual variation in TSH levels [13]. TSH suppression is now considered to significantly reduce the postoperative recurrence risk of low-risk differentiated thyroid cancer [14]. A higher TSH level may also activate cell proliferation and thyroglobulin production in PTC [15]. However, there is still controversy about the relationship between TSH levels and the risk of developing PTC. It has been suggested that a significant positive correlation exists between the risk of PTC and TSH levels, particularly in cases of PTC with tumor sizes less than 1.0 cm [16]. However, another case–control study found a negative correlation between PTC risk and TSH levels within the normal range [17].

Therefore, this meta-analysis aimed to summarize observational studies on TSH levels and PTC risks and comprehensively assess and explore their association. This study’s findings will provide evidence for prediagnostic risk assessment of PTC to reduce invasive testing and overdiagnosis among patients.

2 Methods

2.1 Literature retrieval

Literature retrieval was carried out through PubMed, Embase, and Web of Science databases. Search keywords included “thyrotropin,” “thyrotropic hormone,” “thyroid stimulating hormone,” and “papillary thyroid cancer.” Keywords in the same category were joined together with “OR,” while keywords in different categories were joined together with “AND.” The search process combined subject terms with free terms, and the search strategy was adapted to the characteristics of the database. Detailed retrieval procedures of each database are displayed in Tables S1–S3. The search was available until January 12, 2023, without language restrictions. This study also screened relevant reviews and their included literature to expand the search scope of this meta-analysis.

2.2 Inclusion and exclusion criteria of literature screening

Inclusion criteria: (1) the study reports TSH and PTC incidence risk, (2) the study type is cross-sectional, case–control, or cohort, and (3) the odds ratio (OR) and 95% confidence interval (CI) with univariate or multivariable adjustment are reported, or can be calculated by converting data based on frequency, sample size, etc.

Exclusion criteria: (1) reviews, conference abstracts, and comments, (2) studies with participants under 18 years of age, and (3) for duplicate publications or multiple papers with the same batch of data, only the study with the most comprehensive data was kept, and the rest were excluded.

2.3 Data extraction and quality evaluation

Two independent researchers conducted literature screening and data extraction based on the above criteria. Information to be extracted includes first author, publication year, region where the study was conducted, type of study, basic characteristics of the study population (sample size, gender, and age), TSH grouping, study outcomes, and correction factors. Any inconsistency in data extraction will be solved after discussion. The methodological quality of the case–control and cohort studies was appraised according to the Newcastle-Ottawa Scale (NOS) [18], which included three aspects of selection, comparability, and exposure, with a total of eight scoring items and each of which is scored out of nine. Of these, scores of 7–9, 4–5, and 0–3 were assessed as high-, moderate-, and low-quality studies, respectively. The methodological quality of the cross-sectional study was evaluated by the Agency for Healthcare Research and Quality (AHRQ) [19]. A total of 11 entries were assessed using “yes,” “no,” and “unclear,” with “yes” scoring 1 while “no” and “unclear” scoring 0. For these, scores of 8–11, 4–7, and 0–3 were considered as high-, moderate-, and low-quality studies, respectively.

2.4 Statistical analysis

To assess the relationship between TSH and the risk of PTC, the OR and 95% CI were adopted as effect size indicators. If the included studies classified TSH into multiple categories, such as <0.40, 0.40–1.35, 1.36–2.12, 2.13–4.20, and >4.20 μIU/mL, then TSH <0.40 μIU/mL was used as the control group, and the OR (95% CI) of the remaining subgroups was combined in a random-effects model to calculate OR (95% CI) of ≥0.4 vs <0.40 μU/mL (high vs low) for the following meta-analysis. If the included studies used TSH as a continuous variable to calculate the risk of PTC occurrence, then this study used an increase of 1 μIU/mL as the dose change value for TSH and calculated its corresponding OR (95% CI) for the following meta-analysis.

Cochran’s Q test and I 2 test [20] were then performed to estimate the heterogeneity among the studies. The significant heterogeneity was defined at P < 0.05 or I 2 > 50%, and the random-effects model was therefore applied for the meta-analysis. Otherwise, the fixed effect model was adopted instead. Subgroup analysis was performed according to geographical location, study type, type of control, TSH grouping type, confounding factors adjusted or not, and methodological quality. A one-by-one elimination test [21] was used to determine whether the effect of the individual included study on the results of the meta-analysis was significant. Egger’s test [22] was used to evaluate publication bias. When significant publication bias existed, the trim-and-fill method [23] was employed to evaluate the stability of the combined results. The above statistical analyses were generated using Stata 12.0 software.

3 Results

3.1 Literature search and screening

The detailed retrieval process and results are shown in Figure 1. Based on three databases, 3,799 records were obtained. After excluding 1,009 duplicates, 2,790 records remained. Subsequently, 2,772 articles that did not meet the inclusion criteria were excluded after browsing the titles and abstracts. Furthermore, six articles were eliminated after full-text assessment and the remaining eligible 12 studies [16,17,24–33] were finally included in this meta-analysis.

Figure 1 Detailed literature retrieval process and results in this meta-analysis.
Figure 1

Detailed literature retrieval process and results in this meta-analysis.

3.2 Characteristics and methodological quality evaluation of the included studies

As shown in Table 1, the 12 included studies were published between 2010 and 2022 and were conducted in China, Korea, Poland, the USA, Spain, and other regions. Of these, eight were cross-sectional [24–27,29,31–33], and four were case–control studies [16,17,28,30]. The sample size for inclusion in the study ranged from 233 to 27,914, with 7,774 patients with PTC and 33,909 controls enrolled in this meta-analysis. Other detailed information, such as the study participants’ age, study outcomes, and correction factors, are exhibited in Table 1.

Table 1

Characteristics of 12 included studies in this meta-analysis

Study Location Design n, M/F Case/control Age (years) Type of control Categories of TSH (μU/mL) OR (95% CI) Adjusted factors
Fiore et al. [25] Italy CSS 27,914, 5,249/22,665 1,275/26,639 40.0 ± 12.9 TBP ≥0.4 vs <0.4 3.862 (2.476, 6.024) None
Guo et al. [26] China CSS 258, 62/196 153/105 45.7 ± 11.6/48.4 ± 11.9# TBP Per 1 μIU/mL 1.054 (0.972, 1.142) Fasting insulin, HOMA-IR, TPOAb
Hu et al. [16] China CCS 649, 208/441 320/329 47.5 ± 15.0 TBP, HC ≥1.32 vs <1.32 1.021 (0.693, 1.503) Sex, age, income, BMI, physical activity, history of CT scan or thyroid diseases, diabetes, fasting serum glucose, and urinary iodine/creatinine ratio
Huang et al. [17] USA CCS 1,482, 800/682 741/741 NR TBP, HC >1.93 vs 1.20–1.93 1.060 (0.512, 2.196) BMI and branch of military service
Lee et al. [27] Taiwan CSS 368, 58/310 127/241 47.7 ± 12.7/46.1 ± 14.7# TBP 0.14–4.52 vs <0.14 8.113 (4.886, 13.472) None
Lun et al. [28] China CCS 2,478, 524/1,954 676/1,802 44.2 ± 13.2/49.4 ± 11.3# TBP Per 1 μIU/mL 1.28 (1.19, 1.38) HT, sex, age, T3, T4, TGAB, and TPOAB
Sohn et al. [29] Korea CSS 3,791, 597/3,194 2,881/910 46.8 ± 11.8/44.1 ± 13.0# TBP ≥0.4 vs <0.40 2.802 (1.954, 4.016) Sex, age, solitary nodule, HT
Wang et al. [30] China CCS 460, 111/349 103/357 50.5 ± 10.3/49.5 ± 11.2# TBP, HC Per 1 μIU/mL 1.53 (1.27, 1.70) FT3, FT4, TgAb, TPOAb, age, sex, urine iodine, and thyroid nodule size
Wang et al. [24] China CSS 233, 58/175 81/152 44 (37, 54) TBP, HC Per 1 μIU/mL 1.145 (0.928, 1.413) T3, T4, TGAb, TPOAb, NDRG3
Wu et al. [31] China CSS 2,132, 482/1,650 537/1,595 45.0 ± 11.6/49.3 ± 13.4# TBP ≥0.35 vs <0.35 1.972 (1.251, 3.108) FT3, FT4, TAb, TgAb, TPOAb, age, sex, thyroid nodules
Zafon et al. [32] Spain CSS 346, NR 36/310 52.1 ± 14.7/54.4 ± 14.2# TBP >4.0 vs <0.40 1.670 (0.742, 3.759) None
Zhao et al. [33] China CSS 1,572, 0/1,572 844/728 45.1 ± 10.6/49.7 ± 11.8# TBP >1.697 vs <1.697 1.46 (1.13, 1.90) Age, TPOAb, TGAb, urinary iodine, nodule size and number

TBP, thyroid benign patients; HC, healthy control; CSS, cross-sectional study; CCS, case–control study; T3, triiodothyronine; T4, tetraiodothyronine; TAb, thyroid autoantibodies; TGAb, thyroglobulin antibody; TPOAb, thyroidperoxidase antibody; TSH, thyrotropin; HOMA-IR, homeostasis model assessment of insulin resistance; HT, Hashimoto’s thyroiditis; BMI, body mass index; NR, not reported; M, male; F, female. #, case/control.

The results of the quality assessment suggested AHRQ scores of 6–8 for cross-sectional studies and NOS scores of 5–9 for case–control studies (Tables S4 and S5). Thus, six of the 12 included articles are high-quality studies [16,28–31,33], and the remaining six [17,24–27,32] are of medium methodological quality, with the main types of bias being recall and confounding bias.

3.3 Meta-analysis

These 12 studies were incorporated in the meta-analysis to appraise the relationship between TSH and the onset risk of PTC. The results indicated a significant heterogeneity between studies at I 2 = 91.4% and P < 0.001, and the random-effects model was used in this meta-analysis. The pooled results estimated a significant association between elevated TSH levels and an increased risk of PTC, with OR (95% CI) = 1.70 (1.39, 2.09) and P < 0.001 (Figure 2).

Figure 2 Forest plot depicts the combined results of 12 included studies on the association between TSH levels and PTC risk.
Figure 2

Forest plot depicts the combined results of 12 included studies on the association between TSH levels and PTC risk.

3.4 Subgroup analysis

The subgroup analysis was conducted to identify sources of heterogeneity further (Table 2). After stratifying the included studies according to geographical location, study type, control type, TSH variable type, confounders adjusted or not, and methodological quality, all subgroups still suggested significant heterogeneities (I 2 > 50%), indicating that none of the grouping factors mentioned above contributed to the heterogeneity of combined results. In addition, except for the Western area and the control type of thyroid benign patients (TBP) or healthy control (HC), the results for all subgroups were consistent with the combined results, suggesting that elevated TSH levels may increase the risk of PTC (OR > 1, P < 0.01).

Table 2

Subgroup analyses of the relationship between TSH and PTC risk

Outcomes No. of study OR (95%CI) P value Heterogeneity test
I 2 (%) P H
Overall 12 1.70 (1.39, 2.09) <0.001 91.4 <0.001
Area
 Asian 9 1.61 (1.31, 1.99) <0.001 92.3 <0.001
 Western 3 1.98 (0.85, 4.59) 0.111 79.9 0.007
Design
 CSS 8 2.12 (1.42, 3.17) <0.001 94.1 <0.001
 CCS 4 1.32 (1.14, 1.53) <0.001 54.8 0.085
Type of control
 TBP 8 2.08 (1.56, 2.77) <0.001 94.1 <0.001
 TBP or HC 4 1.25 (1.00, 1.56) 0.055 60.6 0.055
Comparison
 High vs Low 8 2.17 (1.37, 3.44) 0.001 88.6 <0.001
 Increase 1 μIU/mL 4 1.24 (1.06, 1.45) 0.007 87.3 <0.001
Adjusted
 No 3 3.95 (1.81, 8.61) 0.001 82.4 0.003
 Yes 9 1.37 (1.17, 1.60) <0.001 84.4 <0.001
Quality
 High 6 1.54 (1.26, 1.88) <0.001 80.4 <0.001
 Moderate 6 2.00 (1.18, 3.39) 0.010 94.5 <0.001

TSH, thyrotropin; PTC, papillary thyroid cancer; OR, odds ratio; CI, confidence interval; CSS, cross-sectional study; CCS, case–control study; TBP, thyroid benign patients; HC, healthy control.

3.5 Sensitivity analysis and publication bias test

Sensitivity analysis showed a change in OR (95% CI) from 1.50 (1.26, 1.78) to 1.83 (1.43, 2.33) for the combined results after eliminating articles one by one (Figure 3). Meanwhile, after excluding any single study, the combined results of the remaining studies maintained statistical significance at P < 0.05, suggesting that the original pooled result was stable and not significantly altered by individual studies.

Figure 3 Sensitivity analysis displays the change in the combined results after removing individual studies one by one.
Figure 3

Sensitivity analysis displays the change in the combined results after removing individual studies one by one.

Furthermore, Egger’s test was conducted to ascertain publication bias, and the result suggested a significant publication bias at P = 0.039 among the included studies. However, with the trim-and-fill method, the procedure did not fill in the dummy negative results to enhance the symmetry of the funnel plot, indicating that the meta-analysis results were stable.

4 Discussion

A recent study found that sensitivity to thyroid hormone indices was an indicator for predicting PTC [34]. TSH is the thyroid gland’s main regulator and growth factor, and its level is somewhat indicative of thyroid function. TSH inhibition is reported to inhibit the cell proliferation of thyroid cancer and reduce disease progression and recurrence, thereby improving the survival status of patients with PTC [35]. However, studies are inconsistent on the relationship between TSH levels and PTC risk. We integrated data from 12 moderate- and high-quality observational studies and performed this meta-analysis. The combined results suggested that there may be an observable association between elevated TSH levels and an increased risk of developing PTC. A relevant meta-analysis confirmed our results and suggested a prominent relation between higher TSH levels and the risk of differentiated thyroid cancer [36]. In addition, each 1 mU/L increase in serum TSH was correlated with a 14% increase in the risk of all histological types of thyroid cancer and a 22% increase in the risk of PTC [37]. Therefore, depending on the US features and size, we recommend that FNAC be carried out on nodules in patients with high TSH levels to avoid invasive testing and overdiagnosis. Finally, preoperative assessment in patients can affect cancer postoperative outcomes and overall survival [38]. TSH levels also demonstrated the ability to risk of extrathyroidal spread and central lymph node metastasis [39].

Although the above evidence suggests that the increased serum TSH level is correlated with cancer risk in thyroid nodules, the basis of this view is that TSH affects the proliferation of malignant transformed cells of differentiated thyroid cancers and thyroid cells [39]. The stratified results of this study suggested that the association between TSH levels and PTC risks was not significant in the subgroup where the controls contained the healthy population. These findings indicated that changes in TSH levels might only be of significance in the progression of benign nodules to thyroid cancer. The possible reason is that TSH receptor expression is increased in benign adenomas and thyroid cancers compared to normal thyroid tissues, and TSH binding to its receptor promotes cell development and proliferation, as well as PTC progression [40]. Therefore, we recommend using TSH level to predict the PTC onset risk among patients with benign thyroid nodules. In addition, the subgroup analysis in this study also revealed that the correlation between TSH levels and PTC risk is significant in Asian countries but not in Western countries. Although TSH is a sensitive and specific biomarker of thyroid status, age, sex, ethnicity, iodine status, body mass index (BMI), smoking, and other factors can all affect TSH levels [41]. For example, TSH levels increase with body weight and are positively correlated with BMI levels [42,43]. However, obesity rates in high-income countries in Western regions such as North America, Oceania, and Europe exceed those in Asia [44]. BMI also varies significantly across ethnic groups, with Chinese, Koreans, and Vietnamese having lower BMIs than Whites [45]. Furthermore, cigarette smoking causes a decrease in TSH levels, possibly due to elevated serum FT4 and FT3 levels caused by sympathetic nervous system activation [46]. The current data support that European smokers have more tobacco consumption per day and therefore have higher cumulative pack-years than South Asians [47]. Meanwhile, excess iodine can lead to excessive TSH synthesis and release, as well as decreased thyroid hormone levels [48]. The global data suggest that excess iodine intake in school-age children is more prevalent in non-Asian regions [49]. Combined with the results of this study, it is suggested that additional attention needs to be paid to variables and factors such as BMI, smoking status, and iodine intake that significantly affect TSH levels when assessing the correlation between TSH levels and PTC risk in Western populations.

The highlights of this study are as follows: (1) The effect values of this meta-analysis results were relatively large, suggesting a high strength of association between TSH levels and PTC risk. (2) The combined results do not alter significantly under the influence of any individual study, and the results are therefore robust. (3) Although the included studies exhibited significant publication bias, the trim-and-fill method suggested that the pooled results were stable. However, this study has some limitations: (1) The included studies were significantly heterogeneous, and subgroup analysis did not clarify the source of heterogeneity. (2) All included studies are observational studies with numerous confounding factors. Although most studies have conducted multi-factor correction, the corrected factors are not uniform, which may exaggerate the correlation strength between TSH and PTC. (3) The inconsistent grouping criteria of TSH levels may lead to clinical and statistical heterogeneity. It is hoped that follow-up studies can determine the uniform grouping criteria.

5 Conclusion

The combined results of this meta-analysis suggested a significant association between high levels of TSH and elevated risk of PTC. However, this relationship still needs to be supported by more evidence in the Western subgroup, as well as in the subgroup of controls containing healthy populations. Furthermore, more high-quality studies with larger sample sizes are recommended to validate the extrapolation of these findings.

# Co-first authors: Bin Xu and Shu-Yan Gu.

tel: +86-021-24289359

  1. Funding information: This study was supported by the Health Profession Clinical Research Funds of Shanghai Municipal Health Commission (No. 202040388).

  2. Author contributions: B.X. and S.Y.G. designed the research, did a statistical analysis of the data, and drafted the manuscript. N.M.Z. and J.J.J. acquired and analyzed the data and revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

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

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

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Received: 2023-04-14
Revised: 2023-06-15
Accepted: 2023-07-06
Published Online: 2023-08-11

© 2023 the author(s), published by De Gruyter

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

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  264. Study on fresh processing key technology and quality influence of Cut Ophiopogonis Radix based on multi-index evaluation
  265. An advanced approach for fig leaf disease detection and classification: Leveraging image processing and enhanced support vector machine methodology
  266. Erratum
  267. Erratum to “Protein Z modulates the metastasis of lung adenocarcinoma cells”
  268. Erratum to “BRCA1 subcellular localization regulated by PI3K signaling pathway in triple-negative breast cancer MDA-MB-231 cells and hormone-sensitive T47D cells”
  269. Retraction
  270. Retraction to “Protocatechuic acid attenuates cerebral aneurysm formation and progression by inhibiting TNF-alpha/Nrf-2/NF-kB-mediated inflammatory mechanisms in experimental rats”
https://doi.org/10.1515/biol-2022-0671
Schlagwörter für diesen Artikel
thyroid stimulating hormone; papillary thyroid cancer; meta-analysis
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Artikel in diesem Heft

  1. Biomedical Sciences
  2. Systemic investigation of inetetamab in combination with small molecules to treat HER2-overexpressing breast and gastric cancers
  3. Immunosuppressive treatment for idiopathic membranous nephropathy: An updated network meta-analysis
  4. Identifying two pathogenic variants in a patient with pigmented paravenous retinochoroidal atrophy
  5. Effects of phytoestrogens combined with cold stress on sperm parameters and testicular proteomics in rats
  6. A case of pulmonary embolism with bad warfarin anticoagulant effects caused by E. coli infection
  7. Neutrophilia with subclinical Cushing’s disease: A case report and literature review
  8. Isoimperatorin alleviates lipopolysaccharide-induced periodontitis by downregulating ERK1/2 and NF-κB pathways
  9. Immunoregulation of synovial macrophages for the treatment of osteoarthritis
  10. Novel CPLANE1 c.8948dupT (p.P2984Tfs*7) variant in a child patient with Joubert syndrome
  11. Antiphospholipid antibodies and the risk of thrombosis in myeloproliferative neoplasms
  12. Immunological responses of septic rats to combination therapy with thymosin α1 and vitamin C
  13. High glucose and high lipid induced mitochondrial dysfunction in JEG-3 cells through oxidative stress
  14. Pharmacological inhibition of the ubiquitin-specific protease 8 effectively suppresses glioblastoma cell growth
  15. Levocarnitine regulates the growth of angiotensin II-induced myocardial fibrosis cells via TIMP-1
  16. Age-related changes in peripheral T-cell subpopulations in elderly individuals: An observational study
  17. Single-cell transcription analysis reveals the tumor origin and heterogeneity of human bilateral renal clear cell carcinoma
  18. Identification of iron metabolism-related genes as diagnostic signatures in sepsis by blood transcriptomic analysis
  19. Long noncoding RNA ACART knockdown decreases 3T3-L1 preadipocyte proliferation and differentiation
  20. Surgery, adjuvant immunotherapy plus chemotherapy and radiotherapy for primary malignant melanoma of the parotid gland (PGMM): A case report
  21. Dosimetry comparison with helical tomotherapy, volumetric modulated arc therapy, and intensity-modulated radiotherapy for grade II gliomas: A single‑institution case series
  22. Soy isoflavone reduces LPS-induced acute lung injury via increasing aquaporin 1 and aquaporin 5 in rats
  23. Refractory hypokalemia with sexual dysplasia and infertility caused by 17α-hydroxylase deficiency and triple X syndrome: A case report
  24. Meta-analysis of cancer risk among end stage renal disease undergoing maintenance dialysis
  25. 6-Phosphogluconate dehydrogenase inhibition arrests growth and induces apoptosis in gastric cancer via AMPK activation and oxidative stress
  26. Experimental study on the optimization of ANM33 release in foam cells
  27. Primary retroperitoneal angiosarcoma: A case report
  28. Metabolomic analysis-identified 2-hydroxybutyric acid might be a key metabolite of severe preeclampsia
  29. Malignant pleural effusion diagnosis and therapy
  30. Effect of spaceflight on the phenotype and proteome of Escherichia coli
  31. Comparison of immunotherapy combined with stereotactic radiotherapy and targeted therapy for patients with brain metastases: A systemic review and meta-analysis
  32. Activation of hypermethylated P2RY1 mitigates gastric cancer by promoting apoptosis and inhibiting proliferation
  33. Association between the VEGFR-2 -604T/C polymorphism (rs2071559) and type 2 diabetic retinopathy
  34. The role of IL-31 and IL-34 in the diagnosis and treatment of chronic periodontitis
  35. Triple-negative mouse breast cancer initiating cells show high expression of beta1 integrin and increased malignant features
  36. mNGS facilitates the accurate diagnosis and antibiotic treatment of suspicious critical CNS infection in real practice: A retrospective study
  37. The apatinib and pemetrexed combination has antitumor and antiangiogenic effects against NSCLC
  38. Radiotherapy for primary thyroid adenoid cystic carcinoma
  39. Design and functional preliminary investigation of recombinant antigen EgG1Y162–EgG1Y162 against Echinococcus granulosus
  40. Effects of losartan in patients with NAFLD: A meta-analysis of randomized controlled trial
  41. Bibliometric analysis of METTL3: Current perspectives, highlights, and trending topics
  42. Performance comparison of three scaling algorithms in NMR-based metabolomics analysis
  43. PI3K/AKT/mTOR pathway and its related molecules participate in PROK1 silence-induced anti-tumor effects on pancreatic cancer
  44. The altered expression of cytoskeletal and synaptic remodeling proteins during epilepsy
  45. Effects of pegylated recombinant human granulocyte colony-stimulating factor on lymphocytes and white blood cells of patients with malignant tumor
  46. Prostatitis as initial manifestation of Chlamydia psittaci pneumonia diagnosed by metagenome next-generation sequencing: A case report
  47. NUDT21 relieves sevoflurane-induced neurological damage in rats by down-regulating LIMK2
  48. Association of interleukin-10 rs1800896, rs1800872, and interleukin-6 rs1800795 polymorphisms with squamous cell carcinoma risk: A meta-analysis
  49. Exosomal HBV-DNA for diagnosis and treatment monitoring of chronic hepatitis B
  50. Shear stress leads to the dysfunction of endothelial cells through the Cav-1-mediated KLF2/eNOS/ERK signaling pathway under physiological conditions
  51. Interaction between the PI3K/AKT pathway and mitochondrial autophagy in macrophages and the leukocyte count in rats with LPS-induced pulmonary infection
  52. Meta-analysis of the rs231775 locus polymorphism in the CTLA-4 gene and the susceptibility to Graves’ disease in children
  53. Cloning, subcellular localization and expression of phosphate transporter gene HvPT6 of hulless barley
  54. Coptisine mitigates diabetic nephropathy via repressing the NRLP3 inflammasome
  55. Significant elevated CXCL14 and decreased IL-39 levels in patients with tuberculosis
  56. Whole-exome sequencing applications in prenatal diagnosis of fetal bowel dilatation
  57. Gemella morbillorum infective endocarditis: A case report and literature review
  58. An unusual ectopic thymoma clonal evolution analysis: A case report
  59. Severe cumulative skin toxicity during toripalimab combined with vemurafenib following toripalimab alone
  60. Detection of V. vulnificus septic shock with ARDS using mNGS
  61. Novel rare genetic variants of familial and sporadic pulmonary atresia identified by whole-exome sequencing
  62. The influence and mechanistic action of sperm DNA fragmentation index on the outcomes of assisted reproduction technology
  63. Novel compound heterozygous mutations in TELO2 in an infant with You-Hoover-Fong syndrome: A case report and literature review
  64. ctDNA as a prognostic biomarker in resectable CLM: Systematic review and meta-analysis
  65. Diagnosis of primary amoebic meningoencephalitis by metagenomic next-generation sequencing: A case report
  66. Phylogenetic analysis of promoter regions of human Dolichol kinase (DOLK) and orthologous genes using bioinformatics tools
  67. Collagen changes in rabbit conjunctiva after conjunctival crosslinking
  68. Effects of NM23 transfection of human gastric carcinoma cells in mice
  69. Oral nifedipine and phytosterol, intravenous nicardipine, and oral nifedipine only: Three-arm, retrospective, cohort study for management of severe preeclampsia
  70. Case report of hepatic retiform hemangioendothelioma: A rare tumor treated with ultrasound-guided microwave ablation
  71. Curcumin induces apoptosis in human hepatocellular carcinoma cells by decreasing the expression of STAT3/VEGF/HIF-1α signaling
  72. Rare presentation of double-clonal Waldenström macroglobulinemia with pulmonary embolism: A case report
  73. Giant duplication of the transverse colon in an adult: A case report and literature review
  74. Ectopic thyroid tissue in the breast: A case report
  75. SDR16C5 promotes proliferation and migration and inhibits apoptosis in pancreatic cancer
  76. Vaginal metastasis from breast cancer: A case report
  77. Screening of the best time window for MSC transplantation to treat acute myocardial infarction with SDF-1α antibody-loaded targeted ultrasonic microbubbles: An in vivo study in miniswine
  78. Inhibition of TAZ impairs the migration ability of melanoma cells
  79. Molecular complexity analysis of the diagnosis of Gitelman syndrome in China
  80. Effects of maternal calcium and protein intake on the development and bone metabolism of offspring mice
  81. Identification of winter wheat pests and diseases based on improved convolutional neural network
  82. Ultra-multiplex PCR technique to guide treatment of Aspergillus-infected aortic valve prostheses
  83. Virtual high-throughput screening: Potential inhibitors targeting aminopeptidase N (CD13) and PIKfyve for SARS-CoV-2
  84. Immune checkpoint inhibitors in cancer patients with COVID-19
  85. Utility of methylene blue mixed with autologous blood in preoperative localization of pulmonary nodules and masses
  86. Integrated analysis of the microbiome and transcriptome in stomach adenocarcinoma
  87. Berberine suppressed sarcopenia insulin resistance through SIRT1-mediated mitophagy
  88. DUSP2 inhibits the progression of lupus nephritis in mice by regulating the STAT3 pathway
  89. Lung abscess by Fusobacterium nucleatum and Streptococcus spp. co-infection by mNGS: A case series
  90. Genetic alterations of KRAS and TP53 in intrahepatic cholangiocarcinoma associated with poor prognosis
  91. Granulomatous polyangiitis involving the fourth ventricle: Report of a rare case and a literature review
  92. Studying infant mortality: A demographic analysis based on data mining models
  93. Metaplastic breast carcinoma with osseous differentiation: A report of a rare case and literature review
  94. Protein Z modulates the metastasis of lung adenocarcinoma cells
  95. Inhibition of pyroptosis and apoptosis by capsaicin protects against LPS-induced acute kidney injury through TRPV1/UCP2 axis in vitro
  96. TAK-242, a toll-like receptor 4 antagonist, against brain injury by alleviates autophagy and inflammation in rats
  97. Primary mediastinum Ewing’s sarcoma with pleural effusion: A case report and literature review
  98. Association of ADRB2 gene polymorphisms and intestinal microbiota in Chinese Han adolescents
  99. Tanshinone IIA alleviates chondrocyte apoptosis and extracellular matrix degeneration by inhibiting ferroptosis
  100. Study on the cytokines related to SARS-Cov-2 in testicular cells and the interaction network between cells based on scRNA-seq data
  101. Effect of periostin on bone metabolic and autophagy factors during tooth eruption in mice
  102. HP1 induces ferroptosis of renal tubular epithelial cells through NRF2 pathway in diabetic nephropathy
  103. Intravaginal estrogen management in postmenopausal patients with vaginal squamous intraepithelial lesions along with CO2 laser ablation: A retrospective study
  104. Hepatocellular carcinoma cell differentiation trajectory predicts immunotherapy, potential therapeutic drugs, and prognosis of patients
  105. Effects of physical exercise on biomarkers of oxidative stress in healthy subjects: A meta-analysis of randomized controlled trials
  106. Identification of lysosome-related genes in connection with prognosis and immune cell infiltration for drug candidates in head and neck cancer
  107. Development of an instrument-free and low-cost ELISA dot-blot test to detect antibodies against SARS-CoV-2
  108. Research progress on gas signal molecular therapy for Parkinson’s disease
  109. Adiponectin inhibits TGF-β1-induced skin fibroblast proliferation and phenotype transformation via the p38 MAPK signaling pathway
  110. The G protein-coupled receptor-related gene signatures for predicting prognosis and immunotherapy response in bladder urothelial carcinoma
  111. α-Fetoprotein contributes to the malignant biological properties of AFP-producing gastric cancer
  112. CXCL12/CXCR4/CXCR7 axis in placenta tissues of patients with placenta previa
  113. Association between thyroid stimulating hormone levels and papillary thyroid cancer risk: A meta-analysis
  114. Significance of sTREM-1 and sST2 combined diagnosis for sepsis detection and prognosis prediction
  115. Diagnostic value of serum neuroactive substances in the acute exacerbation of chronic obstructive pulmonary disease complicated with depression
  116. Research progress of AMP-activated protein kinase and cardiac aging
  117. TRIM29 knockdown prevented the colon cancer progression through decreasing the ubiquitination levels of KRT5
  118. Cross-talk between gut microbiota and liver steatosis: Complications and therapeutic target
  119. Metastasis from small cell lung cancer to ovary: A case report
  120. The early diagnosis and pathogenic mechanisms of sepsis-related acute kidney injury
  121. The effect of NK cell therapy on sepsis secondary to lung cancer: A case report
  122. Erianin alleviates collagen-induced arthritis in mice by inhibiting Th17 cell differentiation
  123. Loss of ACOX1 in clear cell renal cell carcinoma and its correlation with clinical features
  124. Signalling pathways in the osteogenic differentiation of periodontal ligament stem cells
  125. Crosstalk between lactic acid and immune regulation and its value in the diagnosis and treatment of liver failure
  126. Clinicopathological features and differential diagnosis of gastric pleomorphic giant cell carcinoma
  127. Traumatic brain injury and rTMS-ERPs: Case report and literature review
  128. Extracellular fibrin promotes non-small cell lung cancer progression through integrin β1/PTEN/AKT signaling
  129. Knockdown of DLK4 inhibits non-small cell lung cancer tumor growth by downregulating CKS2
  130. The co-expression pattern of VEGFR-2 with indicators related to proliferation, apoptosis, and differentiation of anagen hair follicles
  131. Inflammation-related signaling pathways in tendinopathy
  132. CD4+ T cell count in HIV/TB co-infection and co-occurrence with HL: Case report and literature review
  133. Clinical analysis of severe Chlamydia psittaci pneumonia: Case series study
  134. Bioinformatics analysis to identify potential biomarkers for the pulmonary artery hypertension associated with the basement membrane
  135. Influence of MTHFR polymorphism, alone or in combination with smoking and alcohol consumption, on cancer susceptibility
  136. Catharanthus roseus (L.) G. Don counteracts the ampicillin resistance in multiple antibiotic-resistant Staphylococcus aureus by downregulation of PBP2a synthesis
  137. Combination of a bronchogenic cyst in the thoracic spinal canal with chronic myelocytic leukemia
  138. Bacterial lipoprotein plays an important role in the macrophage autophagy and apoptosis induced by Salmonella typhimurium and Staphylococcus aureus
  139. TCL1A+ B cells predict prognosis in triple-negative breast cancer through integrative analysis of single-cell and bulk transcriptomic data
  140. Ezrin promotes esophageal squamous cell carcinoma progression via the Hippo signaling pathway
  141. Ferroptosis: A potential target of macrophages in plaque vulnerability
  142. Predicting pediatric Crohn's disease based on six mRNA-constructed risk signature using comprehensive bioinformatic approaches
  143. Applications of genetic code expansion and photosensitive UAAs in studying membrane proteins
  144. HK2 contributes to the proliferation, migration, and invasion of diffuse large B-cell lymphoma cells by enhancing the ERK1/2 signaling pathway
  145. IL-17 in osteoarthritis: A narrative review
  146. Circadian cycle and neuroinflammation
  147. Probiotic management and inflammatory factors as a novel treatment in cirrhosis: A systematic review and meta-analysis
  148. Hemorrhagic meningioma with pulmonary metastasis: Case report and literature review
  149. SPOP regulates the expression profiles and alternative splicing events in human hepatocytes
  150. Knockdown of SETD5 inhibited glycolysis and tumor growth in gastric cancer cells by down-regulating Akt signaling pathway
  151. PTX3 promotes IVIG resistance-induced endothelial injury in Kawasaki disease by regulating the NF-κB pathway
  152. Pancreatic ectopic thyroid tissue: A case report and analysis of literature
  153. The prognostic impact of body mass index on female breast cancer patients in underdeveloped regions of northern China differs by menopause status and tumor molecular subtype
  154. Report on a case of liver-originating malignant melanoma of unknown primary
  155. Case report: Herbal treatment of neutropenic enterocolitis after chemotherapy for breast cancer
  156. The fibroblast growth factor–Klotho axis at molecular level
  157. Characterization of amiodarone action on currents in hERG-T618 gain-of-function mutations
  158. A case report of diagnosis and dynamic monitoring of Listeria monocytogenes meningitis with NGS
  159. Effect of autologous platelet-rich plasma on new bone formation and viability of a Marburg bone graft
  160. Small breast epithelial mucin as a useful prognostic marker for breast cancer patients
  161. Continuous non-adherent culture promotes transdifferentiation of human adipose-derived stem cells into retinal lineage
  162. Nrf3 alleviates oxidative stress and promotes the survival of colon cancer cells by activating AKT/BCL-2 signal pathway
  163. Favorable response to surufatinib in a patient with necrolytic migratory erythema: A case report
  164. Case report of atypical undernutrition of hypoproteinemia type
  165. Down-regulation of COL1A1 inhibits tumor-associated fibroblast activation and mediates matrix remodeling in the tumor microenvironment of breast cancer
  166. Sarcoma protein kinase inhibition alleviates liver fibrosis by promoting hepatic stellate cells ferroptosis
  167. Research progress of serum eosinophil in chronic obstructive pulmonary disease and asthma
  168. Clinicopathological characteristics of co-existing or mixed colorectal cancer and neuroendocrine tumor: Report of five cases
  169. Role of menopausal hormone therapy in the prevention of postmenopausal osteoporosis
  170. Precisional detection of lymph node metastasis using tFCM in colorectal cancer
  171. Advances in diagnosis and treatment of perimenopausal syndrome
  172. A study of forensic genetics: ITO index distribution and kinship judgment between two individuals
  173. Acute lupus pneumonitis resembling miliary tuberculosis: A case-based review
  174. Plasma levels of CD36 and glutathione as biomarkers for ruptured intracranial aneurysm
  175. Fractalkine modulates pulmonary angiogenesis and tube formation by modulating CX3CR1 and growth factors in PVECs
  176. Novel risk prediction models for deep vein thrombosis after thoracotomy and thoracoscopic lung cancer resections, involving coagulation and immune function
  177. Exploring the diagnostic markers of essential tremor: A study based on machine learning algorithms
  178. Evaluation of effects of small-incision approach treatment on proximal tibia fracture by deep learning algorithm-based magnetic resonance imaging
  179. An online diagnosis method for cancer lesions based on intelligent imaging analysis
  180. Medical imaging in rheumatoid arthritis: A review on deep learning approach
  181. Predictive analytics in smart healthcare for child mortality prediction using a machine learning approach
  182. Utility of neutrophil–lymphocyte ratio and platelet–lymphocyte ratio in predicting acute-on-chronic liver failure survival
  183. A biomedical decision support system for meta-analysis of bilateral upper-limb training in stroke patients with hemiplegia
  184. TNF-α and IL-8 levels are positively correlated with hypobaric hypoxic pulmonary hypertension and pulmonary vascular remodeling in rats
  185. Stochastic gradient descent optimisation for convolutional neural network for medical image segmentation
  186. Comparison of the prognostic value of four different critical illness scores in patients with sepsis-induced coagulopathy
  187. Application and teaching of computer molecular simulation embedded technology and artificial intelligence in drug research and development
  188. Hepatobiliary surgery based on intelligent image segmentation technology
  189. Value of brain injury-related indicators based on neural network in the diagnosis of neonatal hypoxic-ischemic encephalopathy
  190. Analysis of early diagnosis methods for asymmetric dementia in brain MR images based on genetic medical technology
  191. Early diagnosis for the onset of peri-implantitis based on artificial neural network
  192. Clinical significance of the detection of serum IgG4 and IgG4/IgG ratio in patients with thyroid-associated ophthalmopathy
  193. Forecast of pain degree of lumbar disc herniation based on back propagation neural network
  194. SPA-UNet: A liver tumor segmentation network based on fused multi-scale features
  195. Systematic evaluation of clinical efficacy of CYP1B1 gene polymorphism in EGFR mutant non-small cell lung cancer observed by medical image
  196. Rehabilitation effect of intelligent rehabilitation training system on hemiplegic limb spasms after stroke
  197. A novel approach for minimising anti-aliasing effects in EEG data acquisition
  198. ErbB4 promotes M2 activation of macrophages in idiopathic pulmonary fibrosis
  199. Clinical role of CYP1B1 gene polymorphism in prediction of postoperative chemotherapy efficacy in NSCLC based on individualized health model
  200. Lung nodule segmentation via semi-residual multi-resolution neural networks
  201. Evaluation of brain nerve function in ICU patients with Delirium by deep learning algorithm-based resting state MRI
  202. A data mining technique for detecting malignant mesothelioma cancer using multiple regression analysis
  203. Markov model combined with MR diffusion tensor imaging for predicting the onset of Alzheimer’s disease
  204. Effectiveness of the treatment of depression associated with cancer and neuroimaging changes in depression-related brain regions in patients treated with the mediator-deuterium acupuncture method
  205. Molecular mechanism of colorectal cancer and screening of molecular markers based on bioinformatics analysis
  206. Monitoring and evaluation of anesthesia depth status data based on neuroscience
  207. Exploring the conformational dynamics and thermodynamics of EGFR S768I and G719X + S768I mutations in non-small cell lung cancer: An in silico approaches
  208. Optimised feature selection-driven convolutional neural network using gray level co-occurrence matrix for detection of cervical cancer
  209. Incidence of different pressure patterns of spinal cerebellar ataxia and analysis of imaging and genetic diagnosis
  210. Pathogenic bacteria and treatment resistance in older cardiovascular disease patients with lung infection and risk prediction model
  211. Adoption value of support vector machine algorithm-based computed tomography imaging in the diagnosis of secondary pulmonary fungal infections in patients with malignant hematological disorders
  212. From slides to insights: Harnessing deep learning for prognostic survival prediction in human colorectal cancer histology
  213. Ecology and Environmental Science
  214. Monitoring of hourly carbon dioxide concentration under different land use types in arid ecosystem
  215. Comparing the differences of prokaryotic microbial community between pit walls and bottom from Chinese liquor revealed by 16S rRNA gene sequencing
  216. Effects of cadmium stress on fruits germination and growth of two herbage species
  217. Bamboo charcoal affects soil properties and bacterial community in tea plantations
  218. Optimization of biogas potential using kinetic models, response surface methodology, and instrumental evidence for biodegradation of tannery fleshings during anaerobic digestion
  219. Understory vegetation diversity patterns of Platycladus orientalis and Pinus elliottii communities in Central and Southern China
  220. Studies on macrofungi diversity and discovery of new species of Abortiporus from Baotianman World Biosphere Reserve
  221. Food Science
  222. Effect of berrycactus fruit (Myrtillocactus geometrizans) on glutamate, glutamine, and GABA levels in the frontal cortex of rats fed with a high-fat diet
  223. Guesstimate of thymoquinone diversity in Nigella sativa L. genotypes and elite varieties collected from Indian states using HPTLC technique
  224. Analysis of bacterial community structure of Fuzhuan tea with different processing techniques
  225. Untargeted metabolomics reveals sour jujube kernel benefiting the nutritional value and flavor of Morchella esculenta
  226. Mycobiota in Slovak wine grapes: A case study from the small Carpathians wine region
  227. Elemental analysis of Fadogia ancylantha leaves used as a nutraceutical in Mashonaland West Province, Zimbabwe
  228. Microbiological transglutaminase: Biotechnological application in the food industry
  229. Influence of solvent-free extraction of fish oil from catfish (Clarias magur) heads using a Taguchi orthogonal array design: A qualitative and quantitative approach
  230. Chromatographic analysis of the chemical composition and anticancer activities of Curcuma longa extract cultivated in Palestine
  231. The potential for the use of leghemoglobin and plant ferritin as sources of iron
  232. Investigating the association between dietary patterns and glycemic control among children and adolescents with T1DM
  233. Bioengineering and Biotechnology
  234. Biocompatibility and osteointegration capability of β-TCP manufactured by stereolithography 3D printing: In vitro study
  235. Clinical characteristics and the prognosis of diabetic foot in Tibet: A single center, retrospective study
  236. Agriculture
  237. Biofertilizer and NPSB fertilizer application effects on nodulation and productivity of common bean (Phaseolus vulgaris L.) at Sodo Zuria, Southern Ethiopia
  238. On correlation between canopy vegetation and growth indexes of maize varieties with different nitrogen efficiencies
  239. Exopolysaccharides from Pseudomonas tolaasii inhibit the growth of Pleurotus ostreatus mycelia
  240. A transcriptomic evaluation of the mechanism of programmed cell death of the replaceable bud in Chinese chestnut
  241. Melatonin enhances salt tolerance in sorghum by modulating photosynthetic performance, osmoregulation, antioxidant defense, and ion homeostasis
  242. Effects of plant density on alfalfa (Medicago sativa L.) seed yield in western Heilongjiang areas
  243. Identification of rice leaf diseases and deficiency disorders using a novel DeepBatch technique
  244. Artificial intelligence and internet of things oriented sustainable precision farming: Towards modern agriculture
  245. Animal Sciences
  246. Effect of ketogenic diet on exercise tolerance and transcriptome of gastrocnemius in mice
  247. Combined analysis of mRNA–miRNA from testis tissue in Tibetan sheep with different FecB genotypes
  248. Isolation, identification, and drug resistance of a partially isolated bacterium from the gill of Siniperca chuatsi
  249. Tracking behavioral changes of confined sows from the first mating to the third parity
  250. The sequencing of the key genes and end products in the TLR4 signaling pathway from the kidney of Rana dybowskii exposed to Aeromonas hydrophila
  251. Development of a new candidate vaccine against piglet diarrhea caused by Escherichia coli
  252. Plant Sciences
  253. Crown and diameter structure of pure Pinus massoniana Lamb. forest in Hunan province, China
  254. Genetic evaluation and germplasm identification analysis on ITS2, trnL-F, and psbA-trnH of alfalfa varieties germplasm resources
  255. Tissue culture and rapid propagation technology for Gentiana rhodantha
  256. Effects of cadmium on the synthesis of active ingredients in Salvia miltiorrhiza
  257. Cloning and expression analysis of VrNAC13 gene in mung bean
  258. Chlorate-induced molecular floral transition revealed by transcriptomes
  259. Effects of warming and drought on growth and development of soybean in Hailun region
  260. Effects of different light conditions on transient expression and biomass in Nicotiana benthamiana leaves
  261. Comparative analysis of the rhizosphere microbiome and medicinally active ingredients of Atractylodes lancea from different geographical origins
  262. Distinguish Dianthus species or varieties based on chloroplast genomes
  263. Comparative transcriptomes reveal molecular mechanisms of apple blossoms of different tolerance genotypes to chilling injury
  264. Study on fresh processing key technology and quality influence of Cut Ophiopogonis Radix based on multi-index evaluation
  265. An advanced approach for fig leaf disease detection and classification: Leveraging image processing and enhanced support vector machine methodology
  266. Erratum
  267. Erratum to “Protein Z modulates the metastasis of lung adenocarcinoma cells”
  268. Erratum to “BRCA1 subcellular localization regulated by PI3K signaling pathway in triple-negative breast cancer MDA-MB-231 cells and hormone-sensitive T47D cells”
  269. Retraction
  270. Retraction to “Protocatechuic acid attenuates cerebral aneurysm formation and progression by inhibiting TNF-alpha/Nrf-2/NF-kB-mediated inflammatory mechanisms in experimental rats”
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Heruntergeladen am 2.12.2025 von https://www.degruyterbrill.com/document/doi/10.1515/biol-2022-0671/html
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