Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches
-
Stephan Frosch
,
Gottfried Buchhorn
Abstract
In rotator cuff repair, strong and reliable suturing is necessary to decrease failure rates. The biomechanics of two self-cinching stitches – the single-loop knot stitch (SLKS) and the double-loop knot stitch (DLKS) – and the modified Mason-Allen stitch (mMAS) were compared. Twenty-seven porcine infraspinatus tendons were randomized among the three stitches. Each was cyclically loaded (10–80–200 N for 50 cycles each) while the gap formation was measured. Next, ultimate load to failure was tested. The gap widths after cyclic loading were 8.72 ± 0.93 mm for the DLKS, 8.65 ± 1.33 mm for the mMAS, and 9.14 ± 0.89 mm for the SLKS, without significant differences. The DLKS showed the highest ultimate load (350.52 ± 38.54 N) compared with the mMAS (320.88 ± 53.29 N; p = 0.304) and the SLKS (290.54 ± 60.51 N; p < 0.05). The DLKS showed similar reliability and better strength compared with the mMAS, while the SLKS showed a slight but not significant decrease in performance. In our experience, the DLKS and SLKS have clinical advantages, as they are easy to perform and the self-cinching loop knot allows the surgeon to grasp degenerative tendon tissue. Initial intraoperative tightening of the suture complex (preloading) before locking is important in order to decrease postoperative elongation.
1 Introduction
The rotator cuff tear is one of the most common shoulder injuries causing pain and shoulder dysfunction [1,2,3]. Restoration of full rotator cuff integrity is the aim of surgical repair in order to reduce pain and improve shoulder function [4]. Early failure after rotator cuff repair is the most common complication and rerupture rates of 15–94% of chronic, massive rotator cuff tears are reported [1,3,4,5,6,7]. The risk of a rerupture is multifactorial, depending on tear size and thickness peculiarity, age of the patient, and repair technique [3].
Arthroscopic as well as mini-open procedures are common in rotator cuff repair. Arthroscopic repair techniques have become popular in recent years, with possible advantages in visualization of tears and additional intra-articular lesions, less scar formation, and shorter postoperative recovery [4]. On the other hand, arthroscopic repair can be technically demanding and time-consuming in comparison with mini-open procedures [8]. The modified Mason-Allen stitch (mMAS) technique is common in mini-open procedures and considered to be superior to the simple or mattress stitch with respect to initial fixation strength [9,10]. Furthermore, the mMAS shows similar biomechanical and clinical results when compared with double-row fixation [9,10,11]. Rotator cuff failures often occur during the early postoperative stage, while the integrity of the suture mostly depends on the fixation of the suture–tendon interface [12,13]. Therefore, techniques that create strong and reliable sutures are required. In a previous biomechanical cadaver study, the double-loop knot stitch (DLKS) showed superior ultimate-load-to-failure strength when compared with the mMAS (382.2 vs 309.3 N; p < 0.05) [14]. Especially in mini-open procedures, where space for the use of a round needle under the acromion is limited, the horizontal stitch configuration of the loop in the single-loop knot stitch (SLKS) and DLKS makes repairs relatively easy to perform compared with the bulky vertical stitch of the mMAS. The self-cinching loop knot of the SLKS and DLKS enhances transverse compression of the tendon tissue as axial strain increases. This effect allows a more effective grasping of frayed tendon tissue and enables the surgeon to grab smaller parts of the tendon without losing the slipping resistance of the suture.
Cyclic loading, rather than ultimate-load-to-failure testing, simulates repetitive loading of the tendon in the early postoperative stage. In order to examine the repetitive load resistance of the SLKS and DLKS in comparison with the mMAS, we performed a cyclic loading program using harvested porcine infraspinatus tendons. It was hypothesized that the DLKS and the SLKS would yield better or at least equal results in cyclic loading compared with the mMAS.
2 Materials and methods
2.1 Sample preparation
Twenty-seven porcine shoulders were harvested from corpses of Göttingen minipigs (female adult pigs of similar weight and age) and stored at about −38°C. The animals had been sacrificed for a previous unrelated experiment, and the research related to animals use has been complied with all the relevant national regulations and institutional policies for the care and use of animals. The shoulders were thawed at room temperature 10 h before preparation. The infraspinatus muscle and tendon were exposed with care and dissected from the protruding scapula crista. The tendon was then cut sharply, directly from its bony insertion at the tuberculum of the humerus. The latter was inspected for regular anatomy and discarded. All tendons were roughly 25–30 mm long and had a cross-section of approximately 15 × 6 mm. The preparations were then randomly allocated to three groups of nine samples each. In each group, one of the three suture configurations was tested. The testing began immediately after tendon preparation.
2.2 Suture
A high-strength, multistrand polyethylene suture, Fiber-Wire No. 2 (Arthrex, Karlsfeld/München, Germany), was taken from a reel and combined with a round, sharpened solitary needle. The sutures were placed at a distance of 15 mm from the end of a tendon. Care was taken to always use comparably placed and sized portions of the tendon. The width and thickness of the tendon in the plane of the sutures were measured. To avoid the need for an additional knot to anchor the ends of the threads, a custom-made compensator device was designed. By means of adjustable deflection rollers, the branches of the thread were oriented parallel to the direction of tension. The thread ends were then each clamped to a branch of the axially centred compensator to allow for length compensation in the case of single-sided suture lengthening. This allowed both ends of the suture to be equally loaded.
Three suture techniques were tested as follows:
The mMAS technique [15].
The SLKS, requiring two horizontal passes through the tissue to form a self-cinching sling with a knot that tightens continuously as tension on the thread increases (Figure 1) [14]. Care was taken to not completely penetrate the tendon but rather to only encompass the upper, bursal portion of the cross-section.
Single-loop knot stitch (SLKS). Schematic illustration on the left. The photo on the right shows that only a smaller part of the tendon is grasped with the SLKS.
Double-loop knot stitch (DLKS), made of two consecutive SLKS.
Part of the Zwick UTM test setup. DLKS is shown. The infraspinatus muscle is clamped using two metal brackets of a cryo-jaw (upper part of the picture). The compensator device is mounted on the UTM base (lower part of the picture).
2.3 Biomechanical testing
The specimens were subjected to cyclic loading and ultimate load to failure using a Zwick 1446 universal testing machine (UTM) (Zwick-Roell AG, Ulm, Germany). The fixation protocol described by Baums et al. was used [16]. In short, the infraspinatus muscle was clamped in compression using the two metal brackets of a cryo-jaw (Figure 3). Each bracket had three transverse recesses, 5 mm deep, to be filled with muscle tissue under compression. To achieve reliable fixation and to prevent slippage of the muscle, the metal bags of the brackets were filled with pellets of dry ice to freezing the protuberances and prevent slippage. Care was taken to freeze only the clamped part of the muscle, while the downward-protruding tendon and suture remained unaffected. The cryo-jaw was attached to the load cell and crossbar of the UTM with a cardan joint. The compensator device was mounted on the UTM base in order to load the two threads equally (Figure 3). The data were recorded using testing software (textX-pert V 112.1, Zwick-Roell AG, Ulm, Germany). The elongation (precision = 0.5 mm) and load (precision = 0.1 N) were measured and displayed as a load/elongation curve. The maximum possible error of transverse movement was 0.05%. The calibrated force transducer (maximum load 500 N) had an accuracy of 1% with values above 200 N.
After pre-tension to 40 N, the prepared specimens were cyclically loaded at a displacement rate of 1 mm/s. The cyclic loading started at 10–80 N for 50 cycles and was gradually increased by 20 N every 50 cycles (10–100 N, 10–120 N, etc.) until it reached 10–200 N. After 50 cycles at 10–200 N, the ultimate load to failure was tested. The failure of the ultimate load (F max [N]) testing was defined as 20% loss of the ultimate tensile strength independent of failure mode (suture thread cutting through the tendon or breaking of the suture thread).
2.4 Statistical analysis
The distribution of gap formation (mm) and F max (N) were described by their mean ± standard deviation. The mean was first calculated per animal in order to have just one representative value per animal within each category. Gap formation was visualized separately for each method and force level.
In order to account for the dependencies within the same animal, linear mixed effects models were used with the method, force level, and their interaction as fixed effects for the gap formation and method as fixed effect for the ultimate load. General linear hypothesis testing was carried out for the method comparisons within each force level.
The significance level was set to α = 5% for all statistical tests. All analyses were performed with the statistical programming environment R (version 3.4.0, www.r-project.org).
3 Results
In cyclic loading, the DLKS and mMAS showed comparable gap formation results (8.72 ± 0.93 mm vs 8.65 ± 1.33 mm, p = 1) after 350 cycles (Tables 1 and 2; Figure 4). The gap formation of the SLKS was somewhat higher (9.14 ± 0.89 mm) but not significantly different than the DLKS (p = 0.26) or the mMAS (p = 0.32) (Table 1; Figure 4).
Mean ± standard deviation of gap formation in cyclic loading (10 to 80–200 N) and F max (N) in ultimate load testing within each stitch technique
| Force (N) | DLKS | mMAS | SLKS | |
|---|---|---|---|---|
| Gap formation (mm) | 80 | 1.68 ± 0.62 | 1.15 ± 0.32 | 1.19 ± 0.3 |
| 100 | 2.88 ± 0.62 | 2.45 ± 0.83 | 2.46 ± 0.36 | |
| 120 | 4.19 ± 0.99 | 3.71 ± 1 | 4 ± 0.7 | |
| 140 | 5.73 ± 0.92 | 5.19 ± 1.17 | 5.46 ± 0.79 | |
| 160 | 7.09 ± 0.83 | 6.44 ± 1.03 | 6.96 ± 1.03 | |
| 180 | 7.83 ± 0.91 | 7.56 ± 0.99 | 8.42 ± 0.89 | |
| 200 | 8.72 ± 0.93 | 8.65 ± 1.33 | 9.38 ± 1.14 | |
| F max (N) (ultimate load to failure) | 350.52 ± 38.54 | 320.88 ± 53.29 | 290.54 ± 60.51 |
p value of pairwise comparison of the gap formation in cyclic loading of the DLKS, SLKS, and mMAS
| Comparison (N) | p value |
|---|---|
| DLKS.80 – mMA.80 | 0.9316 |
| DLKS.80 – SLKS.80 | 0.9843 |
| mMA.80 – SLKS.80 | 1 |
| DLKS.100 – mMA.100 | 0.9697 |
| DLKS.100 – SLKS.100 | 0.9884 |
| mMA.100 – SLKS.100 | 1 |
| DLKS.120 – mMA.120 | 0.9575 |
| DLKS.120 – SLKS.120 | 1 |
| mMA.120 – SLKS.120 | 0.9938 |
| DLKS.140 – mMA.140 | 0.961 |
| DLKS.140 – SLKS.140 | 1 |
| mMA.140 – SLKS.140 | 0.9979 |
| DLKS.160 – mMA.160 | 0.7872 |
| DLKS.160 – SLKS.160 | 1 |
| mMA.160 – SLKS.160 | 0.6429 |
| DLKS.180 – mMA.180 | 1 |
| DLKS.180 – SLKS.180 | 0.5395 |
| mMA.180 – SLKS.180 | 0.242 |
| DLKS.200 – mMA.200 | 1 |
| DLKS.200 – SLKS.200 | 0.2644 |
| mMA.200 – SLKS.200 | 0.3225 |
Gap formation in cyclic loading (10 to 80–200 N) of the three types of stitches: DLKS (brown), SLKS (blue), and mMAS (green).
Each DLKS and mMAS suture–tendon complex survived 350 cycles. One SLKS suture–tendon complex did not survive the 10–160 N loading and one did not survive the 10–180 N loading due to suture cutting-out.
The DLKS showed the highest ultimate load with a mean value of 350 N (±38.54), compared with the mMAS (320.88 ± 53.29 N; p = 0.304) and the SLKS (290.54 ± 60.51 N; p < 0.05), while the only significant difference was between the DLKS and SLKS (p < 0.05) (Table 1).
4 Discussion
The most important finding of this study is that the DLKS and to a lesser extent the SLKS showed excellent biomechanical behaviour under cyclic loading conditions when compared with the mMAS as the gold standard in (mini) open rotator cuff repair.
The arthroscopic treatment of chronic, massive rotator cuff tears can be technically demanding, with longer operative times, higher costs, and possible increased rerupture rates compared with open treatment [8,17]. Therefore, open and mini-open procedures are still common and frequently used in rotator cuff repair [8]. Both the SLKS and DLKS are applicable to arthroscopic technique, but less technically demanding in open repair. The advantages of the loop–knot technique are most effective in chronic, massive tears with degenerative and/or frayed tendon tissue. The self-cinching property of the loop knot enhances tissue grip as axial strain increases and enables the surgeon to grasp frayed tendon tissue more effectively. The loop knot enhances transverse compaction of the tendon fibres and thereby increases resistance against axial cutting of the thread through parallel-running fibre sheaths of the tendon.
The findings of Ponce et al. in their biomechanical study support our understanding of the beneficial effect induced by transverse compaction of the tendon [18]. They compared (among other stitch techniques) the biomechanical properties of three self-cinching stitches. The configuration of the lasso-mattress stitch induces considerable transverse compaction of the tendon tissue as axial strain is applied. In contrast, the configuration of the self-cinching lasso-loop and the double-cinch stitch induces more axial compression of the threads, parallel to the fibre sheaths of the tendon, as axial strain increases. Consequently, the lasso-mattress stitch bore superior ultimate loads compared with the lasso-loop stitch (148.1 vs 64.7 N) and double-cinch stitch (148.1 vs 97.1 N). Furthermore, the lasso-loop stitch showed superior results in ultimate loading conditions when compared with the mMAS (148.1 vs 128.3 N) and simple stitches such as the mattress stitch (148.1 vs 67.1 N) and the simple stitch (148.1 vs 47.1 N). The authors concluded that self-cinching stitches lead to superior tissue-holding strength in comparison with other comparable noncinching simple stitches. These findings are consistent with our results, as the DLKS showed superior results compared with the mMAS (345.56 vs 320.88 N in ultimate load), and with a previous study, where the DLKS showed significantly superior values compared with the mMAS (382.2 vs 309.3 N; p = 0.038) [14]. The forces survived by the SLKS in ultimate load testing were insignificantly lower than those survived by the mMAS. However, it is notable that the amount of tendon tissue grasped by the SLKS was considerably less than that grasped by the mMAS, which might explain these findings.
Cyclic loading, rather than ultimate load-to-failure configurations, simulates repetitive loading of the tendon during the early stages of rehabilitation. The results from cyclic loading did not significantly differ among the DLKS, SLKS, and mMAS. All three suture configurations reached 120 N in cyclic loading before gap formation exceeded 5 mm. Notably, gap formation exceeding 5 mm is considered a clinically relevant failure of the suture–tendon complex. Force analysis of the rotator cuff predicts forces acting on the supraspinatus from 60 N during basic elevation of the arm, up to 117 N with maximal isometric abduction, and of 175–353 N with maximal concentric elevation of the arm [19,20,21,22]. However, the results of the present biomechanical study cannot be directly applied to clinical treatment. From our results, we conclude that the DLKS, SLKS, and mMAS are suitable for passive mobilization in the early postoperative phase, but active mobilization could overstrain the suture–tendon complex over time.
Lorbach et al. examined the single-row modified Mason-Allen stitch in a biomechanical laboratory study using porcine infraspinatus tendons [23]. The cyclic loading of the specimens started at 20 N for 50 cycles, increasing stepwise by 20 N until it reached 200 N for 50 cycles. Only the results for 100, 160, and 200 N were reported. The mean elongation of the construct was 6.4 mm after 100 N, 9.7 mm after 160 N, and 12.3 mm after 200 N of 50 cycles at each force level. The reported values are somewhat high compared with our results, but the differences between them and our values of about 3–4 mm are consistent throughout different loadings. This might be due to that study’s different preloading of the suture–tendon construct of 10 N compared with 40 N in our study. In progressive cyclic loading, the cinching loop tightens up to a certain extent, which increases the thread length between knot and anchor, leading to additional elongation. Ponce et al. confirmed additional elongation of self-cinching sutures in loading configurations [18]. Therefore, initial intraoperative tightening of the knot (preloading) before locking the stitch is important to decrease postoperative elongation.
It is possible to place two separate DLKSs at the proximal and distal ends of the rupture and tie the opposing threads on each side of the tendon (two knots). Alternatively, both DLKSs can be placed with one continuous thread and one final locking knot. It should be noted that tightening two consecutive DLKSs with one thread is more difficult because of the self-cinching mechanism.
One limitation of this study is that the results of an in vitro animal study cannot be directly translated to suture techniques for the rotator cuff in human patients. However, the mechanical properties of pig infraspinatus tendons are considered comparable with those of human tendons and are similar to human rotator cuff tendons in size, shape, histological parameters, and mechanical properties [24,25]. Furthermore, the present in vitro animal model is frequently used in the literature and allows for easy comparison of results. The enhanced transverse compression force on the tendon encompassed by the suture raises concerns of local tendon necrosis. Theoretically, larger tendon cross-sections better withstand compression forces of constriction. Gerber et al. demonstrated for the mMAS that these forces do not cause long-term histological changes within the tendon and that they are biologically tolerated [26]. Further histologic investigations regarding self-cinching stitches are necessary.
-
Conflict of interest: Authors state no conflict of interest.
-
Data availability statement: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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© 2021 Stephan Frosch et al., published by De Gruyter
This work is licensed under the Creative Commons Attribution 4.0 International License.
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- miR-377 inhibition enhances the survival of trophoblast cells via upregulation of FNDC5 in gestational diabetes mellitus
- Prognostic significance of TRIM28 expression in patients with breast carcinoma
- Integrative bioinformatics analysis of KPNA2 in six major human cancers
- Exosomal-mediated transfer of OIP5-AS1 enhanced cell chemoresistance to trastuzumab in breast cancer via up-regulating HMGB3 by sponging miR-381-3p
- A four-lncRNA signature for predicting prognosis of recurrence patients with gastric cancer
- Knockdown of circ_0003204 alleviates oxidative low-density lipoprotein-induced human umbilical vein endothelial cells injury: Circulating RNAs could explain atherosclerosis disease progression
- Propofol postpones colorectal cancer development through circ_0026344/miR-645/Akt/mTOR signal pathway
- Knockdown of lncRNA TapSAKI alleviates LPS-induced injury in HK-2 cells through the miR-205/IRF3 pathway
- COVID-19 severity in relation to sociodemographics and vitamin D use
- Clinical analysis of 11 cases of nocardiosis
- Cis-regulatory elements in conserved non-coding sequences of nuclear receptor genes indicate for crosstalk between endocrine systems
- Four long noncoding RNAs act as biomarkers in lung adenocarcinoma
- Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens
- Relation between IL-8 level and obstructive sleep apnea syndrome
- circAGFG1 sponges miR-28-5p to promote non-small-cell lung cancer progression through modulating HIF-1α level
- Nomogram prediction model for renal anaemia in IgA nephropathy patients
- Effect of antibiotic use on the efficacy of nivolumab in the treatment of advanced/metastatic non-small cell lung cancer: A meta-analysis
- NDRG2 inhibition facilitates angiogenesis of hepatocellular carcinoma
- A nomogram for predicting metabolic steatohepatitis: The combination of NAMPT, RALGDS, GADD45B, FOSL2, RTP3, and RASD1
- Clinical and prognostic features of MMP-2 and VEGF in AEG patients
- The value of miR-510 in the prognosis and development of colon cancer
- Functional implications of PABPC1 in the development of ovarian cancer
- Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy
- Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis
- Prediction of improvement after anterior cruciate ligament reconstruction
- Effluent Osteopontin levels reflect the peritoneal solute transport rate
- circ_0038467 promotes PM2.5-induced bronchial epithelial cell dysfunction
- Significance of miR-141 and miR-340 in cervical squamous cell carcinoma
- Association between hair cortisol concentration and metabolic syndrome
- Microvessel density as a prognostic indicator of prostate cancer: A systematic review and meta-analysis
- Characteristics of BCR–ABL gene variants in patients of chronic myeloid leukemia
- Knee alterations in rheumatoid arthritis: Comparison of US and MRI
- Long non-coding RNA TUG1 aggravates cerebral ischemia and reperfusion injury by sponging miR-493-3p/miR-410-3p
- lncRNA MALAT1 regulated ATAD2 to facilitate retinoblastoma progression via miR-655-3p
- Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study
- Analysis of COVID-19 outbreak origin in China in 2019 using differentiation method for unusual epidemiological events
- Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
- Travelers’ vaccines and their adverse events in Nara, Japan
- Association between Tfh and PGA in children with Henoch–Schönlein purpura
- Can exchange transfusion be replaced by double-LED phototherapy?
- circ_0005962 functions as an oncogene to aggravate NSCLC progression
- Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
- Serum intact fibroblast growth factor 23 in healthy paediatric population
- Algorithm of rational approach to reconstruction in Fournier’s disease
- A meta-analysis of exosome in the treatment of spinal cord injury
- Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
- Dexmedetomidine may decrease the bupivacaine toxicity to heart
- Hypoxia stimulates the migration and invasion of osteosarcoma via up-regulating the NUSAP1 expression
- Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
- External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
- miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
- HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
- Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
- Cell population data in identifying active tuberculosis and community-acquired pneumonia
- Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
- Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
- 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
- Association of gene polymorphisms with women urinary incontinence
- Influence of COVID-19 pandemic on stress levels of urologic patients
- miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
- miR-519d downregulates LEP expression to inhibit preeclampsia development
- Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
- Fluorescent light energy modulates healing in skin grafted mouse model
- Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
- Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
- Severe postoperative hyperbilirubinemia in congenital heart disease
- Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
- Clinical factors predicting ureteral stent failure in patients with external ureteral compression
- Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
- Triple-Endobutton and clavicular hook: A propensity score matching analysis
- Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
- Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
- miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
- Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
- The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
- Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
- No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
- circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
- Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
- Educational program for orthopedic surgeons’ influences for osteoporosis
- Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
- GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
- lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
- Anticoagulation is the answer in treating noncritical COVID-19 patients
- Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
- Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
- VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
- Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
- Treatment of osteoporosis with teriparatide: The Slovenian experience
- New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
- Superenhancer–transcription factor regulatory network in malignant tumors
- β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
- Clinical features of atypical tuberculosis mimicking bacterial pneumonia
- Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
- Effect of electromagnetic field on abortion: A systematic review and meta-analysis
- miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
- MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
- Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
- miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
- Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
- MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
- Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
- circATP2A2 promotes osteosarcoma progression by upregulating MYH9
- Prognostic role of oxytocin receptor in colon adenocarcinoma
- Review Articles
- The function of non-coding RNAs in idiopathic pulmonary fibrosis
- Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
- Role of cesarean section in the development of neonatal gut microbiota: A systematic review
- Small cell lung cancer transformation during antitumor therapies: A systematic review
- Research progress of gut microbiota and frailty syndrome
- Recommendations for outpatient activity in COVID-19 pandemic
- Rapid Communication
- Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
- Use of microspheres in embolization for unruptured renal angiomyolipomas
- COVID-19 cases with delayed absorption of lung lesion
- A triple combination of treatments on moderate COVID-19
- Social networks and eating disorders during the Covid-19 pandemic
- Letter
- COVID-19, WHO guidelines, pedagogy, and respite
- Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
- COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
- What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
- Case Report
- Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
- CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
- Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
- Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
- Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
- Pulmonary parenchymal involvement caused by Tropheryma whipplei
- Mediastinal mixed germ cell tumor: A case report and literature review
- Ovarian female adnexal tumor of probable Wolffian origin – Case report
- Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
- Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
- Primary orbital ganglioneuroblastoma: A case report
- Primary aortic intimal sarcoma masquerading as intramural hematoma
- Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
- Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
- Chondroblastoma of mandibular condyle: Case report and literature review
- Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
- Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
- Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
- High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
- Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
- Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
- Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
- Retraction
- Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
- Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
- An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
- Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
Artikel in diesem Heft
- Research Articles
- Identification of ZG16B as a prognostic biomarker in breast cancer
- Behçet’s disease with latent Mycobacterium tuberculosis infection
- Erratum
- Erratum to “Suffering from Cerebral Small Vessel Disease with and without Metabolic Syndrome”
- Research Articles
- GPR37 promotes the malignancy of lung adenocarcinoma via TGF-β/Smad pathway
- Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
- Additional baricitinib loading dose improves clinical outcome in COVID-19
- The co-treatment of rosuvastatin with dapagliflozin synergistically inhibited apoptosis via activating the PI3K/AKt/mTOR signaling pathway in myocardial ischemia/reperfusion injury rats
- SLC12A8 plays a key role in bladder cancer progression and EMT
- LncRNA ATXN8OS enhances tamoxifen resistance in breast cancer
- Case Report
- Serratia marcescens as a cause of unfavorable outcome in the twin pregnancy
- Spleno-adrenal fusion mimicking an adrenal metastasis of a renal cell carcinoma: A case report and embryological background
- Research Articles
- TRIM25 contributes to the malignancy of acute myeloid leukemia and is negatively regulated by microRNA-137
- CircRNA circ_0004370 promotes cell proliferation, migration, and invasion and inhibits cell apoptosis of esophageal cancer via miR-1301-3p/COL1A1 axis
- LncRNA XIST regulates atherosclerosis progression in ox-LDL-induced HUVECs
- Potential role of IFN-γ and IL-5 in sepsis prediction of preterm neonates
- Rapid Communication
- COVID-19 vaccine: Call for employees in international transportation industries and international travelers as the first priority in global distribution
- Case Report
- Rare squamous cell carcinoma of the kidney with concurrent xanthogranulomatous pyelonephritis: A case report and review of the literature
- An infertile female delivered a baby after removal of primary renal carcinoid tumor
- Research Articles
- Hypertension, BMI, and cardiovascular and cerebrovascular diseases
- Case Report
- Coexistence of bilateral macular edema and pale optic disc in the patient with Cohen syndrome
- Research Articles
- Correlation between kinematic sagittal parameters of the cervical lordosis or head posture and disc degeneration in patients with posterior neck pain
- Review Articles
- Hepatoid adenocarcinoma of the lung: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database
- Research Articles
- Thermography in the diagnosis of carpal tunnel syndrome
- Pemetrexed-based first-line chemotherapy had particularly prominent objective response rate for advanced NSCLC: A network meta-analysis
- Comparison of single and double autologous stem cell transplantation in multiple myeloma patients
- The influence of smoking in minimally invasive spinal fusion surgery
- Impact of body mass index on left atrial dimension in HOCM patients
- Expression and clinical significance of CMTM1 in hepatocellular carcinoma
- miR-142-5p promotes cervical cancer progression by targeting LMX1A through Wnt/β-catenin pathway
- Comparison of multiple flatfoot indicators in 5–8-year-old children
- Early MRI imaging and follow-up study in cerebral amyloid angiopathy
- Intestinal fatty acid-binding protein as a biomarker for the diagnosis of strangulated intestinal obstruction: A meta-analysis
- miR-128-3p inhibits apoptosis and inflammation in LPS-induced sepsis by targeting TGFBR2
- Dynamic perfusion CT – A promising tool to diagnose pancreatic ductal adenocarcinoma
- Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches
- Review Articles
- The ambiguous role of mannose-binding lectin (MBL) in human immunity
- Case Report
- Membranous nephropathy with pulmonary cryptococcosis with improved 1-year follow-up results: A case report
- Fertility problems in males carrying an inversion of chromosome 10
- Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature
- Metastatic renal Ewing’s sarcoma in adult woman: Case report and review of the literature
- Burkitt-like lymphoma with 11q aberration in a patient with AIDS and a patient without AIDS: Two cases reports and literature review
- Skull hemophilia pseudotumor: A case report
- Judicious use of low-dosage corticosteroids for non-severe COVID-19: A case report
- Adult-onset citrullinaemia type II with liver cirrhosis: A rare cause of hyperammonaemia
- Clinicopathologic features of Good’s syndrome: Two cases and literature review
- Fatal immune-related hepatitis with intrahepatic cholestasis and pneumonia associated with camrelizumab: A case report and literature review
- Research Articles
- Effects of hydroxyethyl starch and gelatin on the risk of acute kidney injury following orthotopic liver transplantation: A multicenter retrospective comparative clinical study
- Significance of nucleic acid positive anal swab in COVID-19 patients
- circAPLP2 promotes colorectal cancer progression by upregulating HELLS by targeting miR-335-5p
- Ratios between circulating myeloid cells and lymphocytes are associated with mortality in severe COVID-19 patients
- Risk factors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation
- Clinical features of hypertensive patients with COVID-19 compared with a normotensive group: Single-center experience in China
- Surgical myocardial revascularization outcomes in Kawasaki disease: systematic review and meta-analysis
- Decreased chromobox homologue 7 expression is associated with epithelial–mesenchymal transition and poor prognosis in cervical cancer
- FGF16 regulated by miR-520b enhances the cell proliferation of lung cancer
- Platelet-rich fibrin: Basics of biological actions and protocol modifications
- Accurate diagnosis of prostate cancer using logistic regression
- miR-377 inhibition enhances the survival of trophoblast cells via upregulation of FNDC5 in gestational diabetes mellitus
- Prognostic significance of TRIM28 expression in patients with breast carcinoma
- Integrative bioinformatics analysis of KPNA2 in six major human cancers
- Exosomal-mediated transfer of OIP5-AS1 enhanced cell chemoresistance to trastuzumab in breast cancer via up-regulating HMGB3 by sponging miR-381-3p
- A four-lncRNA signature for predicting prognosis of recurrence patients with gastric cancer
- Knockdown of circ_0003204 alleviates oxidative low-density lipoprotein-induced human umbilical vein endothelial cells injury: Circulating RNAs could explain atherosclerosis disease progression
- Propofol postpones colorectal cancer development through circ_0026344/miR-645/Akt/mTOR signal pathway
- Knockdown of lncRNA TapSAKI alleviates LPS-induced injury in HK-2 cells through the miR-205/IRF3 pathway
- COVID-19 severity in relation to sociodemographics and vitamin D use
- Clinical analysis of 11 cases of nocardiosis
- Cis-regulatory elements in conserved non-coding sequences of nuclear receptor genes indicate for crosstalk between endocrine systems
- Four long noncoding RNAs act as biomarkers in lung adenocarcinoma
- Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens
- Relation between IL-8 level and obstructive sleep apnea syndrome
- circAGFG1 sponges miR-28-5p to promote non-small-cell lung cancer progression through modulating HIF-1α level
- Nomogram prediction model for renal anaemia in IgA nephropathy patients
- Effect of antibiotic use on the efficacy of nivolumab in the treatment of advanced/metastatic non-small cell lung cancer: A meta-analysis
- NDRG2 inhibition facilitates angiogenesis of hepatocellular carcinoma
- A nomogram for predicting metabolic steatohepatitis: The combination of NAMPT, RALGDS, GADD45B, FOSL2, RTP3, and RASD1
- Clinical and prognostic features of MMP-2 and VEGF in AEG patients
- The value of miR-510 in the prognosis and development of colon cancer
- Functional implications of PABPC1 in the development of ovarian cancer
- Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy
- Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis
- Prediction of improvement after anterior cruciate ligament reconstruction
- Effluent Osteopontin levels reflect the peritoneal solute transport rate
- circ_0038467 promotes PM2.5-induced bronchial epithelial cell dysfunction
- Significance of miR-141 and miR-340 in cervical squamous cell carcinoma
- Association between hair cortisol concentration and metabolic syndrome
- Microvessel density as a prognostic indicator of prostate cancer: A systematic review and meta-analysis
- Characteristics of BCR–ABL gene variants in patients of chronic myeloid leukemia
- Knee alterations in rheumatoid arthritis: Comparison of US and MRI
- Long non-coding RNA TUG1 aggravates cerebral ischemia and reperfusion injury by sponging miR-493-3p/miR-410-3p
- lncRNA MALAT1 regulated ATAD2 to facilitate retinoblastoma progression via miR-655-3p
- Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study
- Analysis of COVID-19 outbreak origin in China in 2019 using differentiation method for unusual epidemiological events
- Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
- Travelers’ vaccines and their adverse events in Nara, Japan
- Association between Tfh and PGA in children with Henoch–Schönlein purpura
- Can exchange transfusion be replaced by double-LED phototherapy?
- circ_0005962 functions as an oncogene to aggravate NSCLC progression
- Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
- Serum intact fibroblast growth factor 23 in healthy paediatric population
- Algorithm of rational approach to reconstruction in Fournier’s disease
- A meta-analysis of exosome in the treatment of spinal cord injury
- Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
- Dexmedetomidine may decrease the bupivacaine toxicity to heart
- Hypoxia stimulates the migration and invasion of osteosarcoma via up-regulating the NUSAP1 expression
- Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
- External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
- miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
- HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
- Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
- Cell population data in identifying active tuberculosis and community-acquired pneumonia
- Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
- Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
- 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
- Association of gene polymorphisms with women urinary incontinence
- Influence of COVID-19 pandemic on stress levels of urologic patients
- miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
- miR-519d downregulates LEP expression to inhibit preeclampsia development
- Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
- Fluorescent light energy modulates healing in skin grafted mouse model
- Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
- Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
- Severe postoperative hyperbilirubinemia in congenital heart disease
- Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
- Clinical factors predicting ureteral stent failure in patients with external ureteral compression
- Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
- Triple-Endobutton and clavicular hook: A propensity score matching analysis
- Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
- Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
- miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
- Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
- The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
- Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
- No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
- circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
- Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
- Educational program for orthopedic surgeons’ influences for osteoporosis
- Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
- GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
- lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
- Anticoagulation is the answer in treating noncritical COVID-19 patients
- Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
- Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
- VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
- Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
- Treatment of osteoporosis with teriparatide: The Slovenian experience
- New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
- Superenhancer–transcription factor regulatory network in malignant tumors
- β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
- Clinical features of atypical tuberculosis mimicking bacterial pneumonia
- Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
- Effect of electromagnetic field on abortion: A systematic review and meta-analysis
- miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
- MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
- Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
- miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
- Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
- MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
- Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
- circATP2A2 promotes osteosarcoma progression by upregulating MYH9
- Prognostic role of oxytocin receptor in colon adenocarcinoma
- Review Articles
- The function of non-coding RNAs in idiopathic pulmonary fibrosis
- Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
- Role of cesarean section in the development of neonatal gut microbiota: A systematic review
- Small cell lung cancer transformation during antitumor therapies: A systematic review
- Research progress of gut microbiota and frailty syndrome
- Recommendations for outpatient activity in COVID-19 pandemic
- Rapid Communication
- Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
- Use of microspheres in embolization for unruptured renal angiomyolipomas
- COVID-19 cases with delayed absorption of lung lesion
- A triple combination of treatments on moderate COVID-19
- Social networks and eating disorders during the Covid-19 pandemic
- Letter
- COVID-19, WHO guidelines, pedagogy, and respite
- Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
- COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
- What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
- Case Report
- Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
- CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
- Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
- Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
- Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
- Pulmonary parenchymal involvement caused by Tropheryma whipplei
- Mediastinal mixed germ cell tumor: A case report and literature review
- Ovarian female adnexal tumor of probable Wolffian origin – Case report
- Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
- Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
- Primary orbital ganglioneuroblastoma: A case report
- Primary aortic intimal sarcoma masquerading as intramural hematoma
- Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
- Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
- Chondroblastoma of mandibular condyle: Case report and literature review
- Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
- Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
- Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
- High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
- Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
- Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
- Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
- Retraction
- Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
- Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
- An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
- Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
