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Endovascular management of post-pancreatectomy hemorrhage caused by a hepatic artery pseudoaneurysm: Case report and review of the literature

  • Ariadni Fouza , Ioakeim Giagtzidis , Maria Sidiropoulou , Elissavet Symeonidou , Anna Maria Kouskoumvekaki , Maria Daoudaki EMAIL logo , Panagiotis Petras and Konstantinos Mpallas
Published/Copyright: August 5, 2025
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Open Life Sciences
From the journal Open Life Sciences Volume 20 Issue 1

Abstract

Pancreaticoduodenectomy is the standard surgical treatment for a range of malignant and some benign diseases. The mortality rate associated with this procedure has decreased to less than 3% in recent years, although the morbidity remains high at 6–40%. Common complications may include delayed gastric emptying, pancreatic fistula, intra-abdominal abscess, and gastrointestinal or intra-abdominal bleeding, among others. Bleeding and pseudoaneurysm formation are likely to be the most significant complications. This is a case report about gastrointestinal bleeding following a Whipple procedure from an aberrant hepatic artery originating from the superior mesenteric artery (SMA), treated by endovascular means. The SMA was cannulated under local anesthesia and direct puncture of the common femoral artery. Catheterization and angiogram of the aberrant right hepatic artery identified the pseudoaneurysm and bleeding site at its bifurcation. Coil embolization resulted in pseudoaneurysm occlusion and bleeding management. Hepatic perfusion was not affected as the main vasculature of the liver, namely the common hepatic artery, remained intact. The management of hemorrhage following pancreatectomy represents a significant challenge, particularly given the vulnerability of the patient cohort and the necessity for re-operation in an anatomically challenging environment. Endovascular intervention is the preferred method of treatment when applicable, as it can be performed under local anesthesia and is associated with less morbidity.

Keywords: hepatic artery pseudoaneurysm; post-pancreatectomy hemorrhage; endovascular management

1 Introduction

Pancreaticoduodenectomy (PD, also known as the Whipple procedure) is the standard surgical intervention for a range of malignant diseases, including carcinoma of the head of the pancreas, duodenal carcinoma, terminal bile duct malignancies, as well as certain benign conditions such as pancreatitis. The mortality rate of this procedure has decreased to less than 3% in recent years; however, the morbidity rate remains high, at 6–40% [1,2,3].

Complications may include delayed gastric emptying, pancreatic fistula, intra-abdominal abscess, and gastrointestinal or intra-abdominal bleeding [4,5]. Bleeding is considered to be the most serious complication, occurring in 6–10% of cases and accounting for 11–38% of all-cause mortality [4]. Pseudoaneurysms can be formed in 28% of those cases requiring urgent treatment [4].

This study is a case report of endovascular management of a hepatic artery pseudoaneurysm and gastrointestinal bleeding following Whipple’s procedure and literature review.

2 Case report

A 72-year-old male patient underwent a PD and right hemicolectomy for a pancreatic head carcinoma that had invaded the transverse mesocolon. On the 13th postoperative day, the patient experienced an episode of gastrointestinal bleeding, which was attributed to the ileo-transverse anastomosis. A reoperation was performed, during which the ileo-transverse anastomosis was resected, and a terminal ileostomy was created. Eight days following the second operation, the patient once again presented in the emergency department with acute gastrointestinal bleeding and hemorrhagic shock. A CT angiography (CTA) was conducted, which demonstrated the presence of hyperdense material within the gastrointestinal tract, suggestive of blood, yet no evidence of contrast extravasation was observed. The patient was treated conservatively with the transfusion of 11 units of packed red blood cells and 8 units of fresh frozen plasma.

However, 2 days later, a more severe episode of gastrointestinal hemorrhage occurred. An urgent CTA was performed, which identified an aberrant right hepatic artery arising from the SMA and a pseudoaneurysm at its bifurcation (Figure 1) in close proximity to the hepaticojejunal anastomosis with a maximum diameter of 8 mm, without evidence of contrast extravasation (Figure 2).

Figure 1 Anatomy explanation from the 3D reconstructed image.
Figure 1

Anatomy explanation from the 3D reconstructed image.

Figure 2 CTA. Arrows show hepatic artery pseudoaneurysm: (a) axial view, (b) axial MPR, (c) coronal MPR, (d) 3d reconstruction.
Figure 2

CTA. Arrows show hepatic artery pseudoaneurysm: (a) axial view, (b) axial MPR, (c) coronal MPR, (d) 3d reconstruction.

An endovascular approach was deemed the optimal strategy. The SMA was cannulated with the use of a “Simmons” catheter under local anesthesia and direct puncture of the common femoral artery. A 6Fr-45cm sheath was advanced, and an angiogram revealed the aberrant right hepatic artery, as well as the pseudoaneurysm at the bifurcation of the hepatic artery (Figure 3). The original 0.035-in. stiff wire was replaced with a 0.035-in. “Rosen” wire, and a 5Fr “Vertebral” catheter was advanced distally beyond the pseudoaneurysm. In order to seal the pseudoaneurysm and the right hepatic artery, six detachable coils were deployed (Interlock-18 Fibered IDC occlusion system, Boston Scientific, Marlborough USA) of various sizes (8 × 100 n = 2, 6 × 100 n = 1, 4 × 100 n = 2, 4 × 60 n = 1). Stent graft deployment was not considered, since the location of the pseudoaneurysm at the bifurcation of the aberrant hepatic artery did not provide an adequate landing zone and diameter mismatch between the hepatic artery and its branches. Final angiography demonstrated successful occlusion of the pseudoaneurysm, without compromise of liver blood supply from the coeliac artery (Figure 4).

Figure 3 Intra-op angiography. The arrow shows the contrast extravagation.
Figure 3

Intra-op angiography. The arrow shows the contrast extravagation.

Figure 4 Final angiography with coils in place. No hemorrhage identified. Arrow indicates the previous site of extravagation.
Figure 4

Final angiography with coils in place. No hemorrhage identified. Arrow indicates the previous site of extravagation.

The postoperative period was uneventful, with no further instances of bleeding, and the patient was discharged on the fourth postoperative day. The patient’s hepatic function was not affected postoperatively, as the maximum values of hepatic enzymes were SGOT 58U/L and SGPT 68U/L. In fact, hepatic enzymes reached the highest measurement 2 days before the operation (SGOT 298U/L, SGPT 156U/L, ALP 1007U/L, γGT 320U/L). The deterioration of hepatic function preoperatively was attributed to ischemia due to hemorrhagic shock. The patient developed no further bleeding episodes 6 months postoperatively.

  1. Informed consent: Informed consent has been obtained from the patient’s caregivers.

  2. Ethical approval: The research related to human use has been complied with all the relevant national regulations, institutional policies and in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors' institutional review board or equivalent committee.

3 Discussion

Post-pancreatectomy hemorrhage (PPH) is a common complication of the postoperative period in patients, with a mortality rate of 20–50% [6]. There is currently no consensus on the optimal management of PPH. A consensus statement on the definition and further categorization of the condition has been published by the International Study Group of Pancreatic Surgery (ISGPS) [4].

In accordance with the ISGPS classification system, PPH is initially categorized as either early or late. Early hemorrhage refers to incidences occurring within the first 24 h postoperatively and are typically attributable to erroneous surgical technique or underlying coagulopathies. The most common sites for bleeding are the retroperitoneum or omental branches, and such patients are predominantly managed with re-laparotomy [5,7]. Late hemorrhage occurs after the first 24 h and is associated with elevated mortality, particularly when it occurs after the fifth postoperative day.

PPH is additionally classified as either mild or severe. A mild hemorrhage is defined as a medium blood loss, with a drop in hemoglobin of less than 3 g/dL, hemodynamic stability, and recommended conservative treatment. Severe hemorrhage is characterized by a drop in hemoglobin of more than 3 g/dL, clinical signs of hemodynamic instability, and strong recommendation for active bleeding control. It is important to make a specific reference to the term “sentinel bleeding,” which refers to a limited amount of blood loss in the peritoneal cavity or the gastrointestinal tract. This type of bleeding is not clinically significant, it is characterized by a drop in hemoglobin of less than 1.5 g/dL, and it is typically resolved spontaneously [5].

Additionally, post-pancreatectomy bleeding may occur within the lumen or extraluminally. Intraluminal bleeding is evidenced by the presence of blood within the nasogastric tube, hematemesis or melena. During the initial three postoperative days, the source of bleeding is predominantly the gastroenteric or enteroenteric anastomoses, which are managed endoscopically with the use of epinephrine or clipping [1]. After the third day, intraluminal bleeding is derived primarily from the pancreaticojejunostomy and is initially managed with interventional angiography [8]. The term “false” extraluminal bleeding, as defined by Yekebas and Wolfram, describes intraluminal bleeding from the pancreaticoenteric anastomosis that results in its secondary disruption and subsequent bleeding into the peritoneal cavity [5]. Secondary leakage of pancreatic enzymes can result in vascular erosion and the formation of arterial pseudoaneurysms. It has been demonstrated that extensive dissection during lymphadenectomy can render vessels more vulnerable to pancreatic enzymes [9]. It is important to note that bleeding from pseudoaneurysms can manifest as intraluminal hemorrhage, whereby blood can enter the lumen of the bowel through a disruption in the pancreaticoenteric or hepaticoenteric anastomosis [30]. This was also the case in our patient [1].

Special reference should also be made to the anatomy of our patient, as the presence of the aberrant hepatic artery, which derived from the SMA allowed us to safely embolize this vessel, without completely disrupting the arterial blood supply of the liver, as the common hepatic artery (CHA) and its branches were left intact. Complete occlusion of the hepatic arterial blood supply could lead to biliary necrosis or hepatic abscesses. Miura et al. mention that the dual blood supply of the liver along with its extensive collateral pathways protect the organ from ischemic infarction and that occlusion of the hepatic artery is often tolerated. However, 5 out of 15 patients analyzed in their study suffered from infarction [6]. Yoon et al. revealed a 30% incidence of abscesses after hepatic artery occlusion [31], and Kim et al. found that six out of seven patients of their series developed hepatic abscesses [32]. Hassold et al. report a 29–70% liver ischemia in their study [13].

4 Endovascular management as first-line therapy

CTA is a mandatory procedure that plays an important role in the diagnosis and identification of PPH origin. The endovascular approach appears to be a promising and viable alternative to open repair, offering a minimally invasive procedure that can be conducted under local anesthesia [10,30].

Vascular access is typically obtained through the common femoral artery or the left brachial artery, and visceral angiography of the abdomen is conducted to identify instances of extravasation or the formation of pseudoaneurysms [11,12]. The most common sources of bleeding are branches of the SMA, the gastroduodenal artery stump, and the CHA and its branches [6]. The management of bleeding is achieved through embolization and/or the placement of a covered stent [11,13]. The choice of embolization agent is dependent on the specific circumstances. Coils, as well as other liquid embolization agents such as NBCA (N-butyl-2-cyanocrylate) glue, gelfoam, or zein ethiodized coil, may be utilized in this process [14,15,20]. There is no randomized prospective study or meta-analysis that compares different coiling embolization techniques and materials for arterial trauma or pseudoaneurysms. A comparative study from 2021 for partial splenic embolization came under the conclusion that permanent embolic materials achieved better laboratory and radiological outcomes than gelatin sponge particles in cirrhotic hypersplenism patients [33].

A literature review was conducted on a series of patients with PPH who had been treated by endovascular means using the PubMed database. The data collected included the location of the bleeding (intra or extraluminal), whether angiography was applied, and the responsible vessels (Table 1). Additionally, the use of embolization agents or stents, technical success, recurrent bleeding, and re-intervention, as well as overall mortality, were documented (Table 1). Case reports and patient series that did not include the aforementioned information were excluded.

Table 1

Literature review of studies with PPH

Author, year Patient with PPH Intraluminal Extraluminal Angio graphy Source of bleeding Pseudo aneurysm Embolization/coil/stent (n = number) Success
Yekebas et al. (2007) [5] 87 36 51 43 (49%) HA (4) 4 Coil (n = 25) 20 (80 %)
GDA/SPDA (12)
SMA branches (14)
SA branches (4)
Xu et al. (2020) [10] 17 17 14 17 (100%) GDA (15) 18 Coil (n = 18) 16 (94.1%)
HA (1)
SA (1)
Miura et al. (2007) [6] 15 NA NA 12 (80%) SMA (4) 5 Coil (n = 13) 6 (40 %)
SMA + CHA (1)
HA (5)
GDA (6)
Correa-Gallego et al. (2012) [7] 33 18 15 10 (30%) HA (2) 2 Coil (n = 8) 8 (100%)
GDA (4)
SA (1)
Pole branch of left renal artery (1)
Unknown (2)
Khalsa et al. (2015) [1] 10 7 7 9 (90%) GDA (4) NA Coil (n = 6), Stent (n = 3) 8 (89%)
HA (2)
Jejunal branches of the SMA (1)
PDA (1)
Inferior phrenic (1)
Izumi et al. (2023) [11] 6 2 4 6 (100%) GDA (3) 3 Coil (n = 3), Stent (n = 3) 5 (83%)
DPA (1)
PHA (1)
RHA (1)
Pottier et al. (2015) [12] 69 9 60 69 (100%) SA (14) 25 Coil (n = 47), Stent (n = 6) 51 (74%)
GDA (13)
HA (8)
LGA (4)
Other (8)
No target artery (22)
Hassold et al. (2016) [13] 27 27 (100%) CHA (11) 6 Coil n = 11, Stent (n = 16) 24 (89%)
GDA (5)
PHA (4)
SA (5)
SMA (3)
Right gastroepiploic (1)
Ching et al. (2016) [14] 28 8 30 GDA (15) 26 Coil (n = 9), Stent (n = 25) 37 (97.4%)
SMA (8)
HA (7)
38 Interventions- SA (3)
PDA (3)
RHA (2)
Asari et al. (2016) [15] 25 2 23 20 (80%) CHA (5) Unknown Embolization (n = 25), Stent (n = 1) 16 (80%)
PHA (3)
GDA (4)
SA (5)
SMA (4)
Unknown (5)
Other (11)
Beyer et al. (2009) [16] 10 9 (90%) GDA (5) Unknown Embolization (n = 8), Stent (n = 4) 9 (100%)
Jejunal art. (2)
SA (1)
RGA (1)
Darnis et al. (2013) [17] 46 26 20 (2 of parietal origin) 14 (30.4%) SA (8) Unknown Embolization (n = 14) 7 (50%)
GDA (3)
Other (4)
Unknown (3)
Feng et al. (2014) [18] 73 40 45 19 (35.2%) GDA (7) 9 Embolization (n = 11), Stent (n = 1) 9 (69.2%)
PHA (4)
SMA (2)
CT (2)
CHA (1)
SA (1)
Other (2)
Sanjay et al. (2012) [19] 11 2 9 8 (73%) CHA (3) 6 Embolization (n = 5), stent (n = 3) 5 (62.5%)
GDA (2)
SMA branches (2)
SA (1)
Huo et al. (2015) [20] 21 15 11 18 (86%) SMA (1) Unknown Embolization (n = 10), Stent (n = 8) 15 (71.4%)
PHA (1)
GDA (11)
CHA (7)
IPDA (1)
SA (1)
You et al. (2018) [21] 66 24 17 62 (94%) GDA (26) 62 Embolization (n = 30), Stent (n = 19) 57 (92%)
PHA (16)
CHA (14)
SMA (9)
Other (8)
Choi et al. (2004) [22] 22 10 12 16 (73%) GDA (5) 9 Embolization (n = 14) 8 (57%)
CHA (3)
SMA (3)
PHA (1)
Other (2)
Schäfer et al. (2010) [23] 18 7 4 12 (67%) SA (4) Unknown Embolization (n = 12), Stent (n = 3) 10 (83%)
SMA (1)
CHA (6)
RHA (3)
PHA (1)
GDA (2)
jejunal (1)
Lee et al. (2010) [24] 27 10 13 23 (85%) GDA (11) 23 Embolization (n = 18), Stent (n = 2) 18 (78.2%)
HA (8)
Other (6)
Makowiec et al. (2005) [25] 12 7 5 10 (83%) CHA (5) Unknown Embolization (n = 4), Coil (n = 2) 6 (60%)
GDA (5)
SA (1)
PDA (1)
Ansari et al. (2016) [26] 19 12 11 10 (53%) PHA (2) Unknown Embolization (n = 8), Coil (n = 2) 8 (80%)
GDA (2)
RHA (1)
CHA (1)
Other (2)
Zhang et al. (2011) [27] 14 4 10 11 (78.5%) CHA (3) Unknown Embolization (n = 9) 12 (85.7%)
RHA (1)
LHA (2)
CT (1)
SA (2)
GDA (4)
Unknown (1)
Asai et al. (2014) [28] 32 28 18 32 (100%) CHA/GDA (18) Unknown Embolization (n = 27), stent (n = 14) 25 (78%)
SMA/IPDA (14)
Stampfl et al. (2012) [29] 25 7 18 25 (100%) IPDA (1) 8 Embolization (n = 23) 19 (83%)
SMA branches (3)
GDA (7)
Other (3)
RHA (1)
PHA (4)
SA (4)
Unknown (2)

CHA: common hepatic artery, CT: celiac trunk, DPA: dorsal pancreatic artery, GDA: gastroduodenal artery, HA: hepatic artery, IPDA: inferior pancreaticoduodenal artery, LGA: left gastric artery, LHA: left hepatic artery, PDA: pancreaticoduodenal artery, PHA: proper hepatic artery, RHA: right hepatic artery, SA: splenic artery, SMA: superior mesenteric artery, SPDA: superior pancreaticoduodenal artery. “Embolization” is referred to usage of coiling and other embolization agents.

The review included 24 studies conducted between 2007 and 2023 involving 713 patients with PPH. Angiography was performed in 510 cases (80.2%), resulting in 483 interventional procedures (67.7%) with a success rate of 75.7% (range 40–100%). The remaining procedures were conducted for diagnostic purposes only. The most common source of bleeding was the gastroduodenal artery (38.9%), followed by the hepatic artery and its branches (32.9%). The majority of PPH cases were managed with embolization (n = 370, 76.6%), while 125 (25.8%) patients had been treated with a covered stent, either as a primary intervention or in conjunction with embolization. The overall incidence of recurrent bleeding and the necessity for re-intervention was, on average, 19% (range 0–50%), while the mortality rate was 15.1%. A recent systematic review and meta-analysis on PPH came up with similar findings from our review [30]. Specifically, the success rate of an endovascular approach was 61%, with a mortality rate of 16%, while with an open surgical procedure, the success rate dropped to 56%, and the mortality rate increased to 37% [30].

It is evident from the existing literature that an endovascular approach is preferable in PPH cases [21,28] as it allows for minimally invasive treatment of frail and unstable patients with satisfactory technical success and outcomes. In the event of recurrent bleeding, which is a common occurrence, the benefit of embolization and/or stenting is that it can be performed again without the need for access to a hostile abdomen, which in turn lowers mortality rates. However, the surgical approach offers simultaneous control of septic sources, such as intraabdominal collections arising from pancreatic fistulas, and hemostasis with sutures allows control of arterial bleeding without completely blocking the vessels [6].

Endovascular techniques include embolization as well as covered stents, as mentioned above. Stents offer an advantage, as they maintain the blood flow of the vessels. However, it can be challenging to choose the correct size of the stent, as undersizing can lead to endoleaks, and oversizing can lead to vessel rupture [13].

5 Conclusion

The management of hemorrhage following pancreatectomy represents a significant challenge, particularly given the vulnerable nature of the patient cohort and the necessity for re-operation in an anatomically challenging environment. Advancements in CT technology can identify potential pathologies with great accuracy, while the broader accessibility of endovascular treatment has improved morbidity and mortality rates. Endovascular intervention appears to be the preferred method of treatment when applicable, as it can be performed under local anesthesia and is associated with less morbidity. This case report presents a “how to guide” for similar cases, with the use of available and low-cost materials, that can be performed in most vascular units with quite a steep learning curve.

A systematic review and a meta-analysis would clarify the best treatment option, the ideal embolization agent, and postoperative management for this complex and lethal complication.

# These two authors contributed equally to this paper and share first authorship.

  1. Funding information: Authors state no funding involved.

  2. Author contributions: AF and IG conceptualized and designed the study, drafted the manuscript. MS contributed to data collection and analysis. ES, MK, and PP reviewed and edited the manuscript equally. MD, KM involved in study supervision, validation, and completion of all the required revisions.

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

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

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Received: 2024-12-12
Revised: 2025-05-03
Accepted: 2025-05-15
Published Online: 2025-08-05

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

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

Articles in the same Issue

  1. Biomedical Sciences
  2. Mechanism of triptolide regulating proliferation and apoptosis of hepatoma cells by inhibiting JAK/STAT pathway
  3. Maslinic acid improves mitochondrial function and inhibits oxidative stress and autophagy in human gastric smooth muscle cells
  4. Comparative analysis of inflammatory biomarkers for the diagnosis of neonatal sepsis: IL-6, IL-8, SAA, CRP, and PCT
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  12. Impact of fracture fixation surgery on cognitive function and the gut microbiota in mice with a history of stroke
  13. COLEC10: A potential tumor suppressor and prognostic biomarker in hepatocellular carcinoma through modulation of EMT and PI3K-AKT pathways
  14. High-temperature requirement serine protease A2 inhibitor UCF-101 ameliorates damaged neurons in traumatic brain-injured rats by the AMPK/NF-κB pathway
  15. SIK1 inhibits IL-1β-stimulated cartilage apoptosis and inflammation in vitro through the CRTC2/CREB1 signaling
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https://doi.org/10.1515/biol-2025-1127
Keywords for this article
hepatic artery pseudoaneurysm; post-pancreatectomy hemorrhage; endovascular management
Creative Commons
BY 4.0

Articles in the same Issue

  1. Biomedical Sciences
  2. Mechanism of triptolide regulating proliferation and apoptosis of hepatoma cells by inhibiting JAK/STAT pathway
  3. Maslinic acid improves mitochondrial function and inhibits oxidative stress and autophagy in human gastric smooth muscle cells
  4. Comparative analysis of inflammatory biomarkers for the diagnosis of neonatal sepsis: IL-6, IL-8, SAA, CRP, and PCT
  5. Post-pandemic insights on COVID-19 and premature ovarian insufficiency
  6. Proteome differences of dental stem cells between permanent and deciduous teeth by data-independent acquisition proteomics
  7. Optimizing a modified cetyltrimethylammonium bromide protocol for fungal DNA extraction: Insights from multilocus gene amplification
  8. Preliminary analysis of the role of small hepatitis B surface proteins mutations in the pathogenesis of occult hepatitis B infection via the endoplasmic reticulum stress-induced UPR-ERAD pathway
  9. Efficacy of alginate-coated gold nanoparticles against antibiotics-resistant Staphylococcus and Streptococcus pathogens of acne origins
  10. Battling COVID-19 leveraging nanobiotechnology: Gold and silver nanoparticle–B-escin conjugates as SARS-CoV-2 inhibitors
  11. Neurodegenerative diseases and neuroinflammation-induced apoptosis
  12. Impact of fracture fixation surgery on cognitive function and the gut microbiota in mice with a history of stroke
  13. COLEC10: A potential tumor suppressor and prognostic biomarker in hepatocellular carcinoma through modulation of EMT and PI3K-AKT pathways
  14. High-temperature requirement serine protease A2 inhibitor UCF-101 ameliorates damaged neurons in traumatic brain-injured rats by the AMPK/NF-κB pathway
  15. SIK1 inhibits IL-1β-stimulated cartilage apoptosis and inflammation in vitro through the CRTC2/CREB1 signaling
  16. Rutin–chitooligosaccharide complex: Comprehensive evaluation of its anti-inflammatory and analgesic properties in vitro and in vivo
  17. Knockdown of Aurora kinase B alleviates high glucose-triggered trophoblast cells damage and inflammation during gestational diabetes
  18. Calcium-sensing receptors promoted Homer1 expression and osteogenic differentiation in bone marrow mesenchymal stem cells
  19. ABI3BP can inhibit the proliferation, invasion, and epithelial–mesenchymal transition of non-small-cell lung cancer cells
  20. Changes in blood glucose and metabolism in hyperuricemia mice
  21. Rapid detection of the GJB2 c.235delC mutation based on CRISPR-Cas13a combined with lateral flow dipstick
  22. IL-11 promotes Ang II-induced autophagy inhibition and mitochondrial dysfunction in atrial fibroblasts
  23. Short-chain fatty acid attenuates intestinal inflammation by regulation of gut microbial composition in antibiotic-associated diarrhea
  24. Application of metagenomic next-generation sequencing in the diagnosis of pathogens in patients with diabetes complicated by community-acquired pneumonia
  25. NAT10 promotes radiotherapy resistance in non-small cell lung cancer by regulating KPNB1-mediated PD-L1 nuclear translocation
  26. Phytol-mixed micelles alleviate dexamethasone-induced osteoporosis in zebrafish: Activation of the MMP3–OPN–MAPK pathway-mediating bone remodeling
  27. Association between TGF-β1 and β-catenin expression in the vaginal wall of patients with pelvic organ prolapse
  28. Primary pleomorphic liposarcoma involving bilateral ovaries: Case report and literature review
  29. Effects of de novo donor-specific Class I and II antibodies on graft outcomes after liver transplantation: A pilot cohort study
  30. Sleep architecture in Alzheimer’s disease continuum: The deep sleep question
  31. Ephedra fragilis plant extract: A groundbreaking corrosion inhibitor for mild steel in acidic environments – electrochemical, EDX, DFT, and Monte Carlo studies
  32. Langerhans cell histiocytosis in an adult patient with upper jaw and pulmonary involvement: A case report
  33. Inhibition of mast cell activation by Jaranol-targeted Pirin ameliorates allergic responses in mouse allergic rhinitis
  34. Aeromonas veronii-induced septic arthritis of the hip in a child with acute lymphoblastic leukemia
  35. Clusterin activates the heat shock response via the PI3K/Akt pathway to protect cardiomyocytes from high-temperature-induced apoptosis
  36. Research progress on fecal microbiota transplantation in tumor prevention and treatment
  37. Low-pressure exposure influences the development of HAPE
  38. Stigmasterol alleviates endplate chondrocyte degeneration through inducing mitophagy by enhancing PINK1 mRNA acetylation via the ESR1/NAT10 axis
  39. AKAP12, mediated by transcription factor 21, inhibits cell proliferation, metastasis, and glycolysis in lung squamous cell carcinoma
  40. Association between PAX9 or MSX1 gene polymorphism and tooth agenesis risk: A meta-analysis
  41. A case of bloodstream infection caused by Neisseria gonorrhoeae
  42. Case of nasopharyngeal tuberculosis complicated with cervical lymph node and pulmonary tuberculosis
  43. p-Cymene inhibits pro-fibrotic and inflammatory mediators to prevent hepatic dysfunction
  44. GFPT2 promotes paclitaxel resistance in epithelial ovarian cancer cells via activating NF-κB signaling pathway
  45. Transfer RNA-derived fragment tRF-36 modulates varicose vein progression via human vascular smooth muscle cell Notch signaling
  46. RTA-408 attenuates the hepatic ischemia reperfusion injury in mice possibly by activating the Nrf2/HO-1 signaling pathway
  47. Decreased serum TIMP4 levels in patients with rheumatoid arthritis
  48. Sirt1 protects lupus nephritis by inhibiting the NLRP3 signaling pathway in human glomerular mesangial cells
  49. Sodium butyrate aids brain injury repair in neonatal rats
  50. Interaction of MTHFR polymorphism with PAX1 methylation in cervical cancer
  51. Convallatoxin inhibits proliferation and angiogenesis of glioma cells via regulating JAK/STAT3 pathway
  52. The effect of the PKR inhibitor, 2-aminopurine, on the replication of influenza A virus, and segment 8 mRNA splicing
  53. Effects of Ire1 gene on virulence and pathogenicity of Candida albicans
  54. Small cell lung cancer with small intestinal metastasis: Case report and literature review
  55. GRB14: A prognostic biomarker driving tumor progression in gastric cancer through the PI3K/AKT signaling pathway by interacting with COBLL1
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  57. FTO alleviated the diabetic nephropathy progression by regulating the N6-methyladenosine levels of DACT1
  58. Clinical relevance of inflammatory markers in the evaluation of severity of ulcerative colitis: A retrospective study
  59. Zinc valproic acid complex promotes osteoblast differentiation and exhibits anti-osteoporotic potential
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  81. Haplo-hematopoietic stem cell transplantation and immunoradiotherapy for severe aplastic anemia complicated with nasopharyngeal carcinoma: A case report
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  93. Efficacy and safety of anti-PD-1/PD-L1 antibodies in patients with relapsed refractory diffuse large B-cell lymphoma: A meta-analysis
  94. SATB2 promotes humeral fracture healing in rats by activating the PI3K/AKT pathway
  95. Overexpression of the ferroptosis-related gene, NFS1, corresponds to gastric cancer growth and tumor immune infiltration
  96. Understanding risk factors and prognosis in diabetic foot ulcers
  97. Atractylenolide I alleviates the experimental allergic response in mice by suppressing TLR4/NF-kB/NLRP3 signalling
  98. FBXO31 inhibits the stemness characteristics of CD147 (+) melanoma stem cells
  99. Immune molecule diagnostics in colorectal cancer: CCL2 and CXCL11
  100. Inhibiting CXCR6 promotes senescence of activated hepatic stellate cells with limited proinflammatory SASP to attenuate hepatic fibrosis
  101. Cadmium toxicity, health risk and its remediation using low-cost biochar adsorbents
  102. Pulmonary cryptococcosis with headache as the first presentation: A case report
  103. Solitary pulmonary metastasis with cystic airspaces in colon cancer: A rare case report
  104. RUNX1 promotes denervation-induced muscle atrophy by activating the JUNB/NF-κB pathway and driving M1 macrophage polarization
  105. Morphometric analysis and immunobiological investigation of Indigofera oblongifolia on the infected lung with Plasmodium chabaudi
  106. The NuA4/TIP60 histone-modifying complex and Hr78 modulate the Lobe2 mutant eye phenotype
  107. Experimental study on salmon demineralized bone matrix loaded with recombinant human bone morphogenetic protein-2: In vitro and in vivo study
  108. A case of IgA nephropathy treated with a combination of telitacicept and half-dose glucocorticoids
  109. Analgesic and toxicological evaluation of cannabidiol-rich Moroccan Cannabis sativa L. (Khardala variety) extract: Evidence from an in vivo and in silico study
  110. Wound healing and signaling pathways
  111. Combination of immunotherapy and whole-brain radiotherapy on prognosis of patients with multiple brain metastases: A retrospective cohort study
  112. To explore the relationship between endometrial hyperemia and polycystic ovary syndrome
  113. Research progress on the impact of curcumin on immune responses in breast cancer
  114. Biogenic Cu/Ni nanotherapeutics from Descurainia sophia (L.) Webb ex Prantl seeds for the treatment of lung cancer
  115. Dapagliflozin attenuates atrial fibrosis via the HMGB1/RAGE pathway in atrial fibrillation rats
  116. Glycitein alleviates inflammation and apoptosis in keratinocytes via ROS-associated PI3K–Akt signalling pathway
  117. ADH5 inhibits proliferation but promotes EMT in non-small cell lung cancer cell through activating Smad2/Smad3
  118. Apoptotic efficacies of AgNPs formulated by Syzygium aromaticum leaf extract on 32D-FLT3-ITD human leukemia cell line with PI3K/AKT/mTOR signaling pathway
  119. Novel cuproptosis-related genes C1QBP and PFKP identified as prognostic and therapeutic targets in lung adenocarcinoma
  120. Bee venom promotes exosome secretion and alters miRNA cargo in T cells
  121. Treatment of pure red cell aplasia in a chronic kidney disease patient with roxadustat: A case report
  122. Comparative bioinformatics analysis of the Wnt pathway in breast cancer: Selection of novel biomarker panels associated with ER status
  123. Kynurenine facilitates renal cell carcinoma progression by suppressing M2 macrophage pyroptosis through inhibition of CASP1 cleavage
  124. RFX5 promotes the growth, motility, and inhibits apoptosis of gastric adenocarcinoma cells through the SIRT1/AMPK axis
  125. ALKBH5 exacerbates early cardiac damage after radiotherapy for breast cancer via m6A demethylation of TLR4
  126. Phytochemicals of Roman chamomile: Antioxidant, anti-aging, and whitening activities of distillation residues
  127. Circadian gene Cry1 inhibits the tumorigenicity of hepatocellular carcinoma by the BAX/BCL2-mediated apoptosis pathway
  128. The TNFR-RIPK1/RIPK3 signalling pathway mediates the effect of lanthanum on necroptosis of nerve cells
  129. Longitudinal monitoring of autoantibody dynamics in patients with early-stage non-small-cell lung cancer undergoing surgery
  130. The potential role of rutin, a flavonoid, in the management of cancer through modulation of cell signaling pathways
  131. Construction of pectinase gene engineering microbe and its application in tobacco sheets
  132. Construction of a microbial abundance prognostic scoring model based on intratumoral microbial data for predicting the prognosis of lung squamous cell carcinoma
  133. Sepsis complicated by haemophagocytic lymphohistiocytosis triggered by methicillin-resistant Staphylococcus aureus and human herpesvirus 8 in an immunocompromised elderly patient: A case report
  134. Sarcopenia in liver transplantation: A comprehensive bibliometric study of current research trends and future directions
  135. Advances in cancer immunotherapy and future directions in personalized medicine
  136. Can coronavirus disease 2019 affect male fertility or cause spontaneous abortion? A two-sample Mendelian randomization analysis
  137. Heat stroke associated with novel leukaemia inhibitory factor receptor gene variant in a Chinese infant
  138. PSME2 exacerbates ulcerative colitis by disrupting intestinal barrier function and promoting autophagy-dependent inflammation
  139. Hyperosmolar hyperglycemic state with severe hypernatremia coexisting with central diabetes insipidus: A case report and literature review
  140. Efficacy and mechanism of escin in improving the tissue microenvironment of blood vessel walls via anti-inflammatory and anticoagulant effects: Implications for clinical practice
  141. 10.1515/biol-2025-1168
  142. Ecology and Environmental Science
  143. Optimization and comparative study of Bacillus consortia for cellulolytic potential and cellulase enzyme activity
  144. The complete mitochondrial genome analysis of Haemaphysalis hystricis Supino, 1897 (Ixodida: Ixodidae) and its phylogenetic implications
  145. Epidemiological characteristics and risk factors analysis of multidrug-resistant tuberculosis among tuberculosis population in Huzhou City, Eastern China
  146. Indices of human impacts on landscapes: How do they reflect the proportions of natural habitats?
  147. Genetic analysis of the Siberian flying squirrel population in the northern Changbai Mountains, Northeast China: Insights into population status and conservation
  148. Diversity and environmental drivers of Suillus communities in Pinus sylvestris var. mongolica forests of Inner Mongolia
  149. Global assessment of the fate of nitrogen deposition in forest ecosystems: Insights from 15N tracer studies
  150. Fungal and bacterial pathogenic co-infections mainly lead to the assembly of microbial community in tobacco stems
  151. Influencing of coal industry related airborne particulate matter on ocular surface tear film injury and inflammatory factor expression in Sprague-Dawley rats
  152. Temperature-dependent development, predation, and life table of Sphaerophoria macrogaster (Thomson) (Diptera: Syrphidae) feeding on Myzus persicae (Sulzer) (Homoptera: Aphididae)
  153. Eleonora’s falcon trophic interactions with insects within its breeding range: A systematic review
  154. Agriculture
  155. Integrated analysis of transcriptome, sRNAome, and degradome involved in the drought-response of maize Zhengdan958
  156. Variation in flower frost tolerance among seven apple cultivars and transcriptome response patterns in two contrastingly frost-tolerant selected cultivars
  157. Heritability of durable resistance to stripe rust in bread wheat (Triticum aestivum L.)
  158. Molecular mechanism of follicular development in laying hens based on the regulation of water metabolism
  159. Animal Science
  160. Effect of sex ratio on the life history traits of an important invasive species, Spodoptera frugiperda
  161. Plant Sciences
  162. Hairpin in a haystack: In silico identification and characterization of plant-conserved microRNA in Rafflesiaceae
  163. Widely targeted metabolomics of different tissues in Rubus corchorifolius
  164. The complete chloroplast genome of Gerbera piloselloides (L.) Cass., 1820 (Carduoideae, Asteraceae) and its phylogenetic analysis
  165. Field trial to correlate mineral solubilization activity of Pseudomonas aeruginosa and biochemical content of groundnut plants
  166. Correlation analysis between semen routine parameters and sperm DNA fragmentation index in patients with semen non-liquefaction: A retrospective study
  167. Plasticity of the anatomical traits of Rhododendron L. (Ericaceae) leaves and its implications in adaptation to the plateau environment
  168. Effects of Piriformospora indica and arbuscular mycorrhizal fungus on growth and physiology of Moringa oleifera under low-temperature stress
  169. Effects of different sources of potassium fertiliser on yield, fruit quality and nutrient absorption in “Harward” kiwifruit (Actinidia deliciosa)
  170. Comparative efficiency and residue levels of spraying programs against powdery mildew in grape varieties
  171. The DREB7 transcription factor enhances salt tolerance in soybean plants under salt stress
  172. Using plant electrical signals of water hyacinth (Eichhornia crassipes) for water pollution monitoring
  173. Food Science
  174. Phytochemical analysis of Stachys iva: Discovering the optimal extract conditions and its bioactive compounds
  175. Review on role of honey in disease prevention and treatment through modulation of biological activities
  176. Computational analysis of polymorphic residues in maltose and maltotriose transporters of a wild Saccharomyces cerevisiae strain
  177. Optimization of phenolic compound extraction from Tunisian squash by-products: A sustainable approach for antioxidant and antibacterial applications
  178. Liupao tea aqueous extract alleviates dextran sulfate sodium-induced ulcerative colitis in rats by modulating the gut microbiota
  179. Toxicological qualities and detoxification trends of fruit by-products for valorization: A review
  180. Polyphenolic spectrum of cornelian cherry fruits and their health-promoting effect
  181. Optimizing the encapsulation of the refined extract of squash peels for functional food applications: A sustainable approach to reduce food waste
  182. Advancements in curcuminoid formulations: An update on bioavailability enhancement strategies curcuminoid bioavailability and formulations
  183. Impact of saline sprouting on antioxidant properties and bioactive compounds in chia seeds
  184. The dilemma of food genetics and improvement
  185. Bioengineering and Biotechnology
  186. Impact of hyaluronic acid-modified hafnium metalorganic frameworks containing rhynchophylline on Alzheimer’s disease
  187. Emerging patterns in nanoparticle-based therapeutic approaches for rheumatoid arthritis: A comprehensive bibliometric and visual analysis spanning two decades
  188. Application of CRISPR/Cas gene editing for infectious disease control in poultry
  189. Preparation of hafnium nitride-coated titanium implants by magnetron sputtering technology and evaluation of their antibacterial properties and biocompatibility
  190. Preparation and characterization of lemongrass oil nanoemulsion: Antimicrobial, antibiofilm, antioxidant, and anticancer activities
  191. Corrigendum
  192. Corrigendum to “Utilization of convolutional neural networks to analyze microscopic images for high-throughput screening of mesenchymal stem cells”
  193. Corrigendum to “Effects of Ire1 gene on virulence and pathogenicity of Candida albicans”
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