Startseite Medizin Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients
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Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients

  • Lang Wang , Baoxin Ma und Jianping Zhang EMAIL logo
Veröffentlicht/Copyright: 22. Mai 2025
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Open Medicine
Aus der Zeitschrift Open Medicine Band 20 Heft 1

Abstract

Objective

This study investigates the effects of subclinical doses of esketamine on serum NLRP3 levels and early cognitive dysfunction in elderly ischemic stroke patients after neurointerventional procedures under general anesthesia.

Methods

A prospective cohort study included 120 elderly ischemic stroke patients undergoing general anesthesia from January 2022 to September 2023. The esketamine group received 0.25 mg/kg of esketamine. Serum levels of NLRP3, C-reactive protein, interleukin-6 (IL-6), IL-1β, and IL-17 were measured before surgery and 24 h postoperatively. Cognitive dysfunction was assessed using the Mini-Mental State Examination (MMSE).

Results

At 24 h postoperatively, the esketamine group had significantly higher MMSE scores (p < 0.05) and lower serum levels of NLRP3, IL-17, and IL-6. Pearson’s correlation showed a link between NLRP3 levels and cognitive outcomes. Logistic regression identified heart rate, mean arterial pressure, preoperative NLRP3, IL-6, IL-17, and esketamine treatment as risk factors for cognitive dysfunction.

Conclusion

Subclinical doses of esketamine might reduce postoperative cognitive dysfunction risk and offer neuroprotection, presenting potential therapeutic options for elderly ischemic stroke patients.

Keywords: esketamine; ischemic stroke; NLRP3; MMSE; cognitive dysfunction

1 Introduction

Stroke remains a leading cause of long-term disability, affecting approximately 13.7 million individuals globally and contributing to 5.5 million deaths annually [1,2,3,4]. Clinically, stroke is categorized as either ischemic or hemorrhagic, with ischemic stroke accounting for nearly 85% of all cases [5]. In recent years, neurointerventional therapies performed under general anesthesia – particularly mechanical thrombectomy – have emerged as cornerstone treatments for ischemic stroke. Mechanical thrombectomy, in particular, is considered a key method for treating ischemic stroke [6]. Despite their benefits, these procedures are frequently associated with postoperative cognitive dysfunction (POCD), which significantly impairs patients’ quality of life and functional recovery, which can have a substantial impact on the quality of life and functional outcomes of the patients [7].

Esketamine, a stereoisomer of ketamine, is a dissociative anesthetic agent that is widely used for analgesia and anesthesia [8]. Emerging evidence suggests that esketamine may possess neuroprotective properties, partly by modulating inflammation-related pathways such as STING/TBK1 and HDAC3/NF-κB/COX1 [9]. There are also reports showing that esketamine improves post-stroke anxiety by modulating the ischemic cortical microglial HDAC3/NF-κB/COX1 inflammatory signaling pathway [10]. Moreover, esketamine appears to regulate microglial activation and inflammatory responses, thus contributing to reduced neuroinflammation. In addition to neuroprotective effects, esketamine has been shown to exert anti-inflammatory, which may be mediated through its modulation of microglial activity and inflammatory signaling pathways [11]. Han et al. found the anti-inflammatory effects of esketamine in orthopedic surgery and protection against postoperative cognitive function and pain control [12].

NLRP3 is a recently discovered key mediator of neuroinflammation closely associated with inflammatory response [13]. Increasing evidence suggested that NLRP3 played a significant physiological and pathological role in the development of ischemic stroke [14]. Activation of autophagy can inhibit the activation of NLRP3 inflammasomes and alleviate sevoflurane-induced cognitive dysfunction in elderly rats [15]. This indicates that NLRP3 plays an important role in post-anesthesia cognitive function. However, currently, there is a relative lack of research on the expression of NLRP3 in patients and clinical studies.

Therefore, the purpose of this study was to investigate the effects of subclinical doses of esketamine on serum NLRP3 levels in elderly patients with ischemic stroke after general anesthesia neurointerventional procedures. Additionally, the study aimed to explore the correlation between NLRP3 levels and early cognitive dysfunction in this patient population and to explore risk factors for POCD in patients. Understanding the impact of esketamine on NLRP3 and its association with cognitive dysfunction could provide valuable insights into potential therapeutic strategies to prevent or mitigate POCD in elderly stroke patients.

2 Methods

2.1 Study population

This prospective observational cohort study included 120 elderly patients with ischemic stroke who underwent general anesthesia for neurointerventional procedures at our hospital from January 2022 to September 2023. The inclusion criteria were as follows: (1) diagnosis with ischemic stroke based on the “2018 Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke” [16] using computed tomography or magnetic resonance imaging; (2) aged ≥60 years, first occurrence of stroke, and admission within 12 h of symptom onset; (3) American Society of Anesthesiologists physical status classification ≤3. The exclusion criteria were as follows: (1) patients who did not require surgical treatment; (2) patients with hemorrhagic stroke; (3) patients unable to undergo scale assessments within 24 h after surgery; (4) patients with severe infection, severe liver or kidney dysfunction, or malignant tumors; (5) patients with epilepsy, Parkinson’s disease, or other neurological or psychiatric disorders; (6) patients who received anticoagulant therapy within 3 months before the study; and (7) patients with an education level of <6 years. All patients maintained spontaneous breathing during the general anesthesia. The anesthesia protocol for the control group included the use of dexmedetomidine (20 µg) and glycopyrrolate (0.2 mg) for induction, maintenance of spontaneous breathing, oxygen flow rate of 2 L/min, placement of a nasopharyngeal airway, monitoring of end-tidal carbon dioxide partial pressure, and maintenance anesthesia with propofol (0.5–1 mg/kg). In the esketamine group, patients received an additional subclinical dose of esketamine (0.25 mg/kg) in addition to the standard anesthesia protocol. Furthermore, all patients received treatments including antiplatelet aggregation, circulation improvement, neuroprotection, free radical scavenging, and statin therapy according to the “2018 Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke.” Written informed consent was obtained from all patients. This study was approved by our hospital’s ethics committee.

2.2 Enzyme-linked immunosorbent assay

The levels of NLRP3, C-reactive protein (CRP), interleukin-6 (IL-6), IL-1β, and IL-17 in serum were measured using ELISA. In brief, fasting venous blood samples (5 mL) were collected from all patients. The collected blood samples were centrifuged at 2,000g for 15 min. After centrifugation, commercially available ELISA kits (NLRP3 MBS9137465 MyBioSource, CRP MBS177184 MyBioSource, IL-6 MBS175877 MyBioSource, IL-1β MBS2021180 MyBioSource, IL-17 MBS2019491 MyBioSource) were used to measure the levels of NLRP3, CRP, IL-6, IL-1β, and IL-17 in strict accordance with the manufacturer’s instructions. The levels of these serum biomarkers were measured before surgery and 24 h after surgery.

2.3 Outcome measures

Demographic baseline parameters of the two groups, including age, sex, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose, and comorbidities (hypertension, diabetes, coronary heart disease), were collected. In addition, surgical duration, anesthesia duration, intraoperative blood loss, heart rate (HR), mean arterial pressure (MAP), and SPO2 at induction (T1), intubation (T2), and extubation (T3) were recorded during the surgery for both groups. Furthermore, cognitive dysfunction was evaluated 24 h after surgery using the Mini-Mental State Examination (MMSE) scale. MMSE scores <27 were defined as the presence of POCD [17].

2.4 Statistical analysis

Data analysis was performed using SPSS 25.0 software (IBM, Armonk, NY, USA). The normality of the data was confirmed using the Kolmogorov–Smirnov test. Normally distributed data are presented as mean ± standard deviation, while non-normally distributed data are presented as median (range). The Mann–Whitney test or Student’s t-test was used for comparisons between the two groups. The chi-square test was used for proportions. Pearson’s and Sparman’s correlation analysis was performed to assess the correlations between serum inflammatory factors and between NLRP3 and clinical characteristics in patients. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic value of serum NLRP3 in predicting POCD. Furthermore, logistic regression analysis was performed to identify the risk factors for POCD in elderly patients with ischemic stroke after general anesthesia. A p-value < 0.05 was considered statistically significant.

3 Results

3.1 Baseline characteristics of all patients

In this prospective observational cohort study, during the study period, a total of 148 patients were initially screened for eligibility. Of these, 120 patients met the inclusion criteria and were enrolled in the study, while 28 patients were excluded based on the following exclusion criteria: patients who did not require surgical treatment (n = 7); patients with hemorrhagic stroke (n = 3); patients unable to undergo scale assessments within 24 h after surgery (n = 8); patients with severe infection, severe liver or kidney dysfunction, or malignant tumors (n = 3); patients with epilepsy, Parkinson’s disease, or other neurological or psychiatric disorders (n = 4); patients who received anticoagulant therapy within 3 months prior to the study (n = 1); and patients with an education level of <6 years (n = 2).

We included two groups of 120 patients, with 63 patients in the control group and 57 patients in the esketamine group. No significant adverse effects were observed in the esketamine group during or after the procedure. After comparing the demographic data, we found no significant differences between the two groups in terms of age, sex, BMI, and comorbidities. In terms of intraoperative clinical data, the HR and MAP of patients in the esketamine group were significantly lower at T3 compared to the control group (p < 0.05). No differences were observed between the two groups in terms of surgical duration, anesthesia duration, HR, MAP, and SPO2 at other time points. Furthermore, we found that the MMSE score at 24 h postoperatively was significantly higher in the esketamine group compared to the control group (Table 1, p < 0.05).

Table 1

Basic characteristics of all patients

Variable Esketamine group, n = 63 Control group, n = 57 p
Age, years 67 (60–77) 66 (67–77) 0.790
Sex, female (%) 27 (42.9) 30 (52.6) 0.170
BMI 22.15 ± 2.11 22.26 ± 2.36 0.788
SBP (mmHg) 122.25 ± 15.93 126.42 ± 18.40 0.186
DBP (mmHg) 90 (62–107) 90 (63–106) 0.737
Hypertension, n (%) 41 (65.1) 35 (61.4) 0.587
Diabetes, n (%) 15 (23.8) 11 (19.3) 0.439
Coronary heart disease, n (%) 6 (9.5) 4 (7.0) 0.521
Intraoperative blood loss (mL) 62.27 ± 12.62 61.48 ± 11.12 0.716
Anesthesia time (min) 120 (85–142) 119 (86–143) 0.642
Operative time (min) 84.79 ± 9.76 87.54 ± 10.14 0.132
MMSE 24 h after surgery 28 (17–30) 27 (17–30) 0.026
T1
HR/min 84.96 ± 4.38 85.31 ± 4.30 0.661
MAP (mm Hg) 93.47 ± 7.76 92.64 ± 7.16 0.544
SPO2 (%) 97.81 ± 0.60 97.81 ± 0.53 0.961
T2
HR/min 67.28 ± 3.87 67.81 ± 4.40 0.479
MAP (mm Hg) 80.33 ± 5.86 78.31 ± 6.57 0.077
SPO2 (%) 98.27 ± 0.55 98.32 ± 0.57 0.663
T3
HR/min 74.85 ± 3.98 77.97 ± 5.38 0.032
MAP (mm Hg) 82.84 ± 6.18 87.11 ± 5.91 <0.001
SPO2 (%) 97.98 ± 0.61 97.95 ± 0.56 0.762

3.2 Differential expression of serum biomarkers in elderly patients with ischemic stroke after surgery

Next, we compared the expression levels of serum NLRP3, IL-6, IL-1β, IL-17, and CRP in the two groups of patients before surgery and 24 h postoperatively. As shown in Figures 1 and 2, there were no significant differences in the levels of serum cytokines between the two groups before surgery. However, after 24 h of surgery, patients in the esketamine group exhibited significantly lower levels of serum NLRP3, IL-17, and IL-6 compared to the control group. Pearson’s correlation analysis revealed a positive correlation between serum NLRP3 levels and IL-17 levels as well as IL-6 levels (Table 2).

Figure 1 Preoperative serum biomarkers in elderly patients with ischemic stroke.
Figure 1

Preoperative serum biomarkers in elderly patients with ischemic stroke.

Figure 2 Serum biomarkers in elderly patients with ischemic stroke 24 h after surgery.
Figure 2

Serum biomarkers in elderly patients with ischemic stroke 24 h after surgery.

Table 2

Correlation analysis among cytokines at 24 h postoperatively

CRP IL-6 IL-1β IL-17 NLRP3
CRP
Pearson’s correlation 1 −0.052 −0.092 0.003 −0.006
p 0.576 0.305 0.970 0.949
IL-6
Pearson’s correlation −0.052 1 −0.033 0.070 0.273
p 0.576 0.722 0.445 0.003
IL-1β
Pearson’s correlation −0.092 −0.033 1 0.102 0.023
p 0.305 0.722 0.268 0.804
IL-17
Pearson’s correlation 0.003 0.070 0.102 1 0.145
p 0.970 0.445 0.268 0.115
NLRP3
Pearson’s correlation −0.006 0.273 0.023 0.145 1
p 0.949 0.003 0.804 0.115

3.3 Correlation between NLRP3 levels and clinical characteristics of patients

We further analyzed the relationship between serum NLRP3 levels at 24 h postoperatively and the clinical characteristics of elderly patients with ischemic stroke. Spearman’s analysis showed a positive correlation between serum NLRP3 levels and MAP at the T3 time point, with Spearman’s coefficients of 0.309 (p < 0.05). In addition, we observed a negative correlation between serum NLRP3 levels and MMSE scores, with Spearman’s coefficients of −0.432 (Table 3, p < 0.05). This indicates that there is an association between serum NLRP3 levels and the clinical characteristics and postoperative cognitive status of patients.

Table 3

Correlation between serum NLRP3 levels and the clinical data of all patients

Variable NLRP3
Spearman’s correlation p
Intraoperative blood loss −0.034 0.709
Anesthesia time −0.055 0.547
Operative time −0.011 0.906
T1HR 0.072 0.437
T2HR −0.066 0.476
T3HR −0.055 0.553
T1MAP −0.040 0.668
T2MAP −0.066 0.474
T3MAP 0.309 0.001
T1SPO2 −0.026 0.774
T2SPO2 0.035 0.708
T3SPO2 −0.107 0.231
MMSE −0.432 <0.001

3.4 Diagnostic value of NLRP3 for POCD in elderly patients with ischemic stroke

Based on the postoperative 24 h MMSE scores, we divided elderly patients with ischemic stroke into a cognitive dysfunction group (MMSE < 27, n = 37) and a non-cognitive dysfunction group (MMSE > 27, n = 83). ROC curve analysis was performed to determine the diagnostic value of serum NLRP3 levels for POCD in patients. The results showed that serum NLRP3 levels had a certain diagnostic value for POCD in elderly patients with ischemic stroke, with an AUC of 0.805, a cutoff value of 7.92 ng/mL, sensitivity of 73.0%, and specificity of 74.7% (Figure 3).

Figure 3 ROC curve of NLRP3 for POCD in elderly patients with ischemic stroke after surgery.
Figure 3

ROC curve of NLRP3 for POCD in elderly patients with ischemic stroke after surgery.

3.5 Logistic regression analysis of risk factors for POCD in elderly patients with ischemic stroke

Finally, we conducted a logistic regression analysis to identify the risk factors for POCD in all elderly patients with ischemic stroke. The results revealed that HR at T3, MAP at T3, preoperative NLRP3, IL-6, IL-17 levels, and esketamine treatment were all risk factors for cognitive dysfunction in elderly patients undergoing general anesthesia for ischemic stroke (Table 4).

Table 4

Logistic regression of risk factors for POCD

Variables Wald Odds ratio 95% CI p
Operative time 2.278 0.953 0.895–1.015 0.131
Anesthesia time 1.175 1.021 0.984–1.059 0.278
Intraoperative blood loss 0.002 1.001 0.952–1.053 0.963
T1HR 1.1.03 1.082 0.928–1.263 0.314
T2HR 0.545 0.941 0.800–1.106 0.460
T3HR 12.968 1.354 1.148–1.597 <0.001
T1MAP 0.573 0.967 0.885–1.055 0.449
T2MAP 0.001 1.001 0.902–1.111 0.984
T3MAP 20.906 1.430 1.227–1.667 <0.001
T1SPO2 0.004 0.963 0.310–2.990 0.948
T2SPO2 1.035 0.560 0.183–1.712 0.309
T3SPO2 3.106 2.554 0.900–7.245 0.078
Preoperative NLRP3 16.901 0.249 0.128–0.483 <0.001
Preoperative IL-6 14.288 0.792 0.702–0.894 <0.001
Preoperative IL-1β 1.608 0.971 0.919–1.027 0.302
Preoperative IL-17 9.827 0.907 0.853–0.964 0.002
Preoperative CRP 0.143 1.003 0.990–1.016 0.705
Esketamine treatment 8.268 0.301 0.133–0.682 0.004

4 Discussion

POCD is a common complication among elderly patients undergoing surgery, often presenting as impairments in memory, attention, and executive function. Additionally, this pathological condition not only leads to a decrease in quality of life but also signifies disease progression [18]. Early detection and intervention are therefore critical for improving neurological and functional outcomes in this population. In this study, we found a significant increase in serum NLRP3 levels at 24 h postoperatively in elderly patients with ischemic stroke who developed POCD. Furthermore, NLRP3 and esketamine were identified as risk factors for cognitive dysfunction in elderly patients undergoing general anesthesia.

Previous studies have extensively reported the use of esketamine alone or in combination with other agents during anesthesia induction, demonstrating improved patient compliance and effective sedation outcomes [19,20]. In recent years, subclinical doses of esketamine have attracted increasing attention due to their potential neuroprotective properties. These doses are defined as being lower than those used for general anesthesia but still capable of exerting therapeutic effects. For example, Li et al. administered 0.2 mg/kg of esketamine during anesthesia induction in elderly patients undergoing unilateral total knee arthroplasty under general anesthesia. The results showed that subclinical doses of esketamine better maintained hemodynamic stability and had no adverse effects on early postoperative recovery quality [21]. Similarly, Zhang et al. found that subanesthetic doses of esketamine relieved pain in the postanesthesia care unit after laparoscopic cholecystectomy, although it may delay aesthetic recovery [22]. Consistent with these findings, no significant adverse events were observed in our esketamine group. This suggested that subclinical doses of esketamine could be safely administered to elderly ischemic stroke patients undergoing neurointerventional procedures. Additionally, Ma et al. used 0.25 mg/kg of esketamine during anesthesia induction in elderly patients undergoing general anesthesia for gastrointestinal tumor surgery, which is consistent with the dose used in our study. In their study, they found that low-dose esketamine reduced the occurrence of delayed neurocognitive recovery in elderly patients undergoing gastrointestinal tumor surgery under general anesthesia [23]. Our study supported this conclusion, suggesting that the use of subclinical doses of esketamine in elderly patients with ischemic stroke might provide neuroprotection and potentially mitigate POCD.

Inflammation following ischemic stroke is considered to be an unavoidable pathological process in post-ischemic brain injury [24,25]. The dynamic release of various pro- and anti-inflammatory cytokines in the brain after stroke may influence the progression of cerebral infarction and contribute to specific cognitive symptoms, including memory impairment, attention deficits, and executive dysfunction. These inflammatory factors are therefore regarded as important biomarkers of stroke pathogenesis and prognosis [26]. Morrison et al. demonstrated that elevated IL-17A levels were associated with poorer executive function and attention in middle-aged individuals, suggesting a direct link between IL-17A and specific cognitive domains [27]. Similarly, Baier et al. found that IL-6 knockout mice exhibited impaired memory in both hippocampus-dependent and independent tasks, indicating that IL-6 plays a critical role in memory processes [28]. Furthermore, Danielski et al. showed that inhibiting the NLRP3 inflammasome reduced neuroinflammation, oxidative stress, and cognitive impairment in a sepsis model, highlighting the importance of NLRP3 in mediating inflammation-related cognitive dysfunction [29]. These studies collectively suggested that specific inflammatory factors were closely associated with distinct cognitive symptoms, underscoring the potential of targeting these pathways to mitigate POCD.

Recent research has indicated that neuroinflammation may be a common precursor to cognitive decline, and inflammatory-related factors, microglial activation, and the interaction between the peripheral immune system and the central nervous system are all involved in cognitive impairment. Therefore, limiting acute neuroinflammation might improve cognitive function and significantly enhance patient prognosis [30]. The NLRP3 inflammasome plays a central role in regulating inflammatory response. Activation of NLRP3-related signaling pathways has been implicated in various neurological disorders, including cognitive dysfunction [31,32]. Elevated NLRP3 levels have been associated with increased inflammation and neuronal damage [33]. Inhibiting NLRP3 signaling has been shown to improve POCD and neuroinflammatory responses in elderly mice [34]. Hence, studying the relationship between NLRP3 and early cognitive dysfunction in elderly patients with ischemic stroke after neurointerventional procedures is of great importance. In this study, we found that serum NLRP3 levels were associated with clinical characteristics and postoperative cognitive outcomes in patients. Furthermore, NLRP3 was identified as an independent risk factor for cognitive dysfunction in elderly patients undergoing general anesthesia. While our findings support the short-term benefits of esketamine, further studies are needed to determine whether its effects on NLRP3 levels and cognitive function are sustained over time. These insights may help establish esketamine as a long-term therapeutic strategy and contribute to the development of targeted interventions for POCD. NLRP3 is not only a key regulator of inflammation but also a critical mediator of pyroptosis, a form of programmed cell death characterized by the activation of caspase-1, cleavage of gasdermin D (GSDMD), and release of pro-inflammatory cytokines such as IL-1β and IL-18. Pyroptosis has been increasingly recognized as a significant contributor to neuroinflammation and cognitive decline, particularly in the context of POCD [35,36]. Recent studies have explored the potential of esketamine, the S-enantiomer of ketamine, in modulating pyroptosis and its associated pathways. Li et al. found that esketamine exerted neuroprotective effects in aged rats with POCD by inhibiting the STING/TBK1 pathway and downregulating pyroptosis-associated proteins such as cleaved caspase-1 and IL-18 [9]. Similarly, Zhou et al. showed that low-dose esketamine downregulated key pyroptosis markers, including NLRP3, cleaved caspase-1, IL-1β, and GSDMD-N, in hippocampal tissues and microglial cells [37]. Despite these promising findings, evidence regarding the role of esketamine in regulating pyroptosis in ischemic stroke and POCD remains limited. Therefore, further studies are needed to explore these mechanisms in elderly patients undergoing neurointerventional procedures, with the aim of identifying new therapeutic targets to mitigate cognitive decline and improve patient outcomes.

Certain limitations to our study should be acknowledged. First, the sample size was relatively small. Second, our analysis only assessed a limited number of serum biomarkers. Additionally, our study did not explore the specific mechanisms by which esketamine might influence NLRP3 levels, such as through NMDA receptor antagonism or modulation of microglial activity. Future mechanistic studies are needed to elucidate these pathways. Finally, while no significant adverse effects were observed in the esketamine group, our study was not specifically designed to evaluate rare or long-term adverse effects of esketamine. Future studies with larger sample sizes and longer follow-up periods are needed to further assess the safety profile of esketamine in this patient population.

5 Conclusion

In conclusion, our study found that the use of subclinical doses of esketamine might provide neuroprotection and potentially reduced the risk of POCD. Furthermore, NLRP3 and the use of esketamine were identified as relevant factors for the development of cognitive dysfunction in elderly patients with ischemic stroke undergoing neurointerventional surgery. This study might provide new therapeutic targets and comprehensive treatment strategies for POCD.

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  1. Funding information: Fujian Provincial Natural Science Foundation for Outstanding Youth (Joint Project), No. 2024J08295. Exploring the effects of different anesthesia methods on postoperative cognitive function in patients undergoing neurointerventional surgery No. 3502Z20224ZD1051.

  2. Author contributions: Conception and design of study: Jianping Zhang; Acquisition of data: Lang Wang, Baoxin Ma; Analysis and interpretation of data: Lang Wang, Baoxin Ma; Drafting the manuscript: Lang Wang; Revising the manuscript critically for important intellectual content: Jianping Zhang. All authors reviewed the manuscript.

  3. Conflict of interest: The authors declare that they have no conflict of interest.

  4. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author.

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Received: 2024-12-13
Revised: 2025-04-08
Accepted: 2025-04-10
Published Online: 2025-05-22

© 2025 the author(s), published by De Gruyter

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

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https://doi.org/10.1515/med-2025-1193
Schlagwörter für diesen Artikel
esketamine; ischemic stroke; NLRP3; MMSE; cognitive dysfunction
Creative Commons
BY 4.0

Artikel in diesem Heft

  1. Research Articles
  2. Network pharmacological analysis and in vitro testing of the rutin effects on triple-negative breast cancer
  3. Impact of diabetes on long-term survival in elderly liver cancer patients: A retrospective study
  4. Knockdown of CCNB1 alleviates high glucose-triggered trophoblast dysfunction during gestational diabetes via Wnt/β-catenin signaling pathway
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  14. Association between statin administration and outcome in patients with sepsis: A retrospective study
  15. Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018
  16. A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
  17. Lysophosphatidic acid 2 alleviates deep vein thrombosis via protective endothelial barrier function
  18. Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
  19. Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
  20. Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
  21. Vitamin D replacement therapy may regulate sleep habits in patients with restless leg syndrome
  22. The first-line antihypertensive nitrendipine potentiated the therapeutic effect of oxaliplatin by downregulating CACNA1D in colorectal cancer
  23. Health literacy and health-related quality of life: The mediating role of irrational happiness
  24. Modulatory effects of Lycium barbarum polysaccharide on bone cell dynamics in osteoporosis
  25. Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
  26. Examination of the causal role of immune cells in non-alcoholic fatty liver disease by a bidirectional Mendelian randomization study
  27. Clinical analysis of ten cases of HIV infection combined with acute leukemia
  28. Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
  29. Clinical observation of probiotics combined with mesalazine and Yiyi Baitouweng Decoction retention enema in treating mild-to-moderate ulcerative colitis
  30. Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection
  31. Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
  32. Core muscle strength and stability-oriented breathing training reduces inter-recti distance in postpartum women
  33. The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial
  34. The serum IL-17A levels in patients with traumatic bowel rupture post-surgery and its predictive value for patient prognosis
  35. Impact of Kolb’s experiential learning theory-based nursing on caregiver burden and psychological state of caregivers of dementia patients
  36. Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
  37. Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
  38. The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
  39. Tetrahydropalmatine improves mitochondrial function in vascular smooth muscle cells of atherosclerosis in vitro by inhibiting Ras homolog gene family A/Rho-associated protein kinase-1 signaling pathway
  40. A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
  41. A comparative analysis of the impact of repeated administration of flavan 3-ol on brown, subcutaneous, and visceral adipose tissue
  42. Identifying early screening factors for depression in middle-aged and older adults: A cohort study
  43. Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
  44. Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
  45. High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
  46. RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
  47. Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
  48. Clinical efficacy of azacitidine in the treatment of middle- and high-risk myelodysplastic syndrome in middle-aged and elderly patients: A retrospective study
  49. The effect of ambulatory blood pressure load on mitral regurgitation in continuous ambulatory peritoneal dialysis patients
  50. Expression and clinical significance of ITGA3 in breast cancer
  51. Single-nucleus RNA sequencing reveals ARHGAP28 expression of podocytes as a biomarker in human diabetic nephropathy
  52. rSIG combined with NLR in the prognostic assessment of patients with multiple injuries
  53. Toxic metals and metalloids in collagen supplements of fish and jellyfish origin: Risk assessment for daily intake
  54. Exploring causal relationship between 41 inflammatory cytokines and marginal zone lymphoma: A bidirectional Mendelian randomization study
  55. Gender beliefs and legitimization of dating violence in adolescents
  56. Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia
  57. Effect of smoking and smoking cessation on hematological parameters in polycythemic patients
  58. Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
  59. Necroptosis of hippocampal neurons in paclitaxel chemotherapy-induced cognitive impairment mediates microglial activation via TLR4/MyD88 signaling pathway
  60. Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
  61. Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
  62. GATA1: A key biomarker for predicting the prognosis of patients with diffuse large B-cell lymphoma
  63. Influencing factors of false lumen thrombosis in type B aortic dissection: A single-center retrospective study
  64. MZB1 regulates the immune microenvironment and inhibits ovarian cancer cell migration
  65. Integrating experimental and network pharmacology to explore the pharmacological mechanisms of Dioscin against glioblastoma
  66. Trends in research on preterm birth in twin pregnancy based on bibliometrics
  67. Four-week IgE/baseline IgE ratio combined with tryptase predicts clinical outcome in omalizumab-treated children with moderate-to-severe asthma
  68. Single-cell transcriptomic analysis identifies a stress response Schwann cell subtype
  69. Acute pancreatitis risk in the diagnosis and management of inflammatory bowel disease: A critical focus
  70. Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients
  71. Interleukin-37 mediates the anti-oral tumor activity in oral cancer through STAT3
  72. CA199 and CEA expression levels, and minimally invasive postoperative prognosis analysis in esophageal squamous carcinoma patients
  73. Efficacy of a novel drainage catheter in the treatment of CSF leak after posterior spine surgery: A retrospective cohort study
  74. Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
  75. Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
  76. Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
  77. Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
  82. Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
  84. The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
  85. Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
  89. Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
  91. Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
  92. Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
  93. Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
  95. Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
  96. Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
  106. Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
  116. Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
  117. Lateral transperitoneal laparoscopic adrenalectomy: A single-centre experience of 21 procedures
  118. Petunidin attenuates lipopolysaccharide-induced retinal microglia inflammatory response in diabetic retinopathy by targeting OGT/NF-κB/LCN2 axis
  119. Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
  120. Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients
  121. Development of a nomogram for predicting cancer-specific survival in patients with renal pelvic cancer following surgery
  122. Inhibition of ATG7 promotes orthodontic tooth movement by regulating the RANKL/OPG ratio under compression force
  123. A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
  124. Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
  125. FAHD1 prevents neuronal ferroptosis by modulating R-loop and the cGAS–STING pathway
  126. Association of placenta weight and morphology with term low birth weight: A case–control study
  127. Investigation of the pathogenic variants induced Sjogren’s syndrome in Turkish population
  128. Nucleotide metabolic abnormalities in post-COVID-19 condition and type 2 diabetes mellitus patients and their association with endocrine dysfunction
  129. TGF-β–Smad2/3 signaling in high-altitude pulmonary hypertension in rats: Role and mechanisms via macrophage M2 polarization
  130. Ultrasound-guided unilateral versus bilateral erector spinae plane block for postoperative analgesia of patients undergoing laparoscopic cholecystectomy
  131. Profiling gut microbiome dynamics in subacute thyroiditis: Implications for pathogenesis, diagnosis, and treatment
  132. Delta neutrophil index, CRP/albumin ratio, procalcitonin, immature granulocytes, and HALP score in acute appendicitis: Best performing biomarker?
  133. Anticancer activity mechanism of novelly synthesized and characterized benzofuran ring-linked 3-nitrophenyl chalcone derivative on colon cancer cells
  134. H2valdien3 arrests the cell cycle and induces apoptosis of gastric cancer
  135. Prognostic relevance of PRSS2 and its immune correlates in papillary thyroid carcinoma
  136. Association of SGLT2 inhibition with psychiatric disorders: A Mendelian randomization study
  137. Motivational interviewing for alcohol use reduction in Thai patients
  138. Luteolin alleviates oxygen-glucose deprivation/reoxygenation-induced neuron injury by regulating NLRP3/IL-1β signaling
  139. Polyphyllin II inhibits thyroid cancer cell growth by simultaneously inhibiting glycolysis and oxidative phosphorylation
  140. Relationship between the expression of copper death promoting factor SLC31A1 in papillary thyroid carcinoma and clinicopathological indicators and prognosis
  141. CSF2 polarized neutrophils and invaded renal cancer cells in vitro influence
  142. Proton pump inhibitors-induced thrombocytopenia: A systematic literature analysis of case reports
  143. The current status and influence factors of research ability among community nurses: A sequential qualitative–quantitative study
  144. OKAIN: A comprehensive oncology knowledge base for the interpretation of clinically actionable alterations
  145. The relationship between serum CA50, CA242, and SAA levels and clinical pathological characteristics and prognosis in patients with pancreatic cancer
  146. Identification and external validation of a prognostic signature based on hypoxia–glycolysis-related genes for kidney renal clear cell carcinoma
  147. Engineered RBC-derived nanovesicles functionalized with tumor-targeting ligands: A comparative study on breast cancer targeting efficiency and biocompatibility
  148. Relationship of resting echocardiography combined with serum micronutrients to the severity of low-gradient severe aortic stenosis
  149. Effect of vibration on pain during subcutaneous heparin injection: A randomized, single-blind, placebo-controlled trial
  150. The diagnostic performance of machine learning-based FFRCT for coronary artery disease: A meta-analysis
  151. Comparing biofeedback device vs diaphragmatic breathing for bloating relief: A randomized controlled trial
  152. Serum uric acid to albumin ratio and C-reactive protein as predictive biomarkers for chronic total occlusion and coronary collateral circulation quality
  153. Multiple organ scoring systems for predicting in-hospital mortality of sepsis patients in the intensive care unit
  154. Single-cell RNA sequencing data analysis of the inner ear in gentamicin-treated mice via intraperitoneal injection
  155. Suppression of cathepsin B attenuates myocardial injury via limiting cardiomyocyte apoptosis
  156. Influence of sevoflurane combined with propofol anesthesia on the anesthesia effect and adverse reactions in children with acute appendicitis
  157. Identification of hub genes related to acute kidney injury caused by sevoflurane anesthesia and endoplasmic reticulum stress
  158. 10.1515/med-2025-1313
  159. 10.1515/med-2025-1316
  160. Health education pathway for individuals with temporary enterostomies using patient journey mapping
  161. 10.1515/med-2025-1321
  162. 10.1515/med-2025-1324
  163. 10.1515/med-2025-1325
  164. 10.1515/med-2025-1327
  165. 10.1515/med-2025-1331
  166. Effect of timing of cholecystectomy on weight loss after sleeve gastrectomy in morbidly obese individuals with cholelithiasis: a retrospective cohort study
  167. 10.1515/med-2025-1337
  168. 10.1515/med-2025-1347
  169. 10.1515/med-2025-1360
  170. Multiple sclerosis and type 1 diabetes: a Mendelian randomization study of European ancestry
  171. Rapid pathogen identification in peritoneal dialysis effluent by MALDI-TOF MS following blood culture enrichment
  172. Comparison of open and percutaneous A1 pulley release in pediatric trigger thumb: a retrospective cohort study
  173. Impact of combined diaphragm-lung ultrasound assessment on postoperative respiratory function in patients under general anesthesia recovery
  174. Review Articles
  175. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  176. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  177. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  178. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  179. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  180. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  181. The application of augmented reality in robotic general surgery: A mini-review
  182. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  183. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  184. Plant polyphenols, terpenes, and terpenoids in oral health
  185. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  186. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  187. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  188. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  189. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  190. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  191. Giant borderline ovarian tumours – review of the literature
  192. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  193. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  194. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  195. Supplement strategies for infertility in overweight women: Evidence and legal insights
  196. Scurvy, a not obsolete disorder: Clinical report in eight young children and literature review
  197. A meta-analysis of the effects of DBS on cognitive function in patients with advanced PD
  198. Protective role of selenium in sepsis: Mechanisms and potential therapeutic strategies
  199. Strategies for hyperkalemia management in dialysis patients: A systematic review
  200. C-reactive protein-to-albumin ratio in peripheral artery disease
  201. 10.1515/med-2025-1251
  202. 10.1515/med-2025-1330
  203. 10.1515/med-2025-1332
  204. Antibiotic prescribing patterns in general dental practice- a scoping review
  205. Clinical and medico-legal reflections on non-invasive prenatal testing
  206. Case Reports
  207. Delayed graft function after renal transplantation
  208. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  209. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  210. Giant right atrial hemangioma presenting with ascites: A case report
  211. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  212. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  213. Molecular hydrogen-rhodiola as an adjuvant therapy for ischemic stroke in internal carotid artery occlusion: A case report
  214. Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
  215. Combined VAT and retroperitoneoscopy for pleural empyema due to nephro-pleuric fistula in xanthogranulomatous pyelonephritis
  216. 10.1515/med-2025-1362
  217. Rapid Communication
  218. Biological properties of valve materials using RGD and EC
  219. A single oral administration of flavanols enhances short-term memory in mice along with increased brain-derived neurotrophic factor
  220. Letter to the Editor
  221. Role of enhanced external counterpulsation in long COVID
  222. Expression of Concern
  223. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  224. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  225. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  226. Corrigendum
  227. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  228. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  229. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  230. Retraction
  231. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  232. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  233. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
  234. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  235. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  236. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  237. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  238. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  239. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  240. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  241. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  242. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  243. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  244. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  245. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  246. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  247. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  248. Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
  249. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  250. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  251. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  252. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  253. A review of brain research on T2DM-related cognitive dysfunction
  254. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  255. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
  256. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
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