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Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program

  • Keun-Ok An and Kwang-Jin Lee EMAIL logo
Published/Copyright: August 13, 2024
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Open Medicine
From the journal Open Medicine Volume 19 Issue 1

Abstract

There is limited evidence regarding the effect of circuit-type low-intensity resistance exercise on physical fitness and blood parameters in breast cancer survivors (BCSs). Therefore, this study aimed to investigate the effect of low-intensity circuit resistance exercise on changes in physical fitness and blood parameters in BCSs. A total of 16 BCSs participated in a low-intensity circuit resistance exercise group (LCREG). The exercise program in the LCREG consisted of 50–60% of one repetition maximum, two to three times weekly, for 24 weeks. The control group (CG) did not receive any interventions. All participants were measured for physical fitness and blood parameters before and after the exercise intervention. The results showed that LCREG significantly improved body mass index (BMI) (p = 0.012), grip strength (p = 0.017), back strength (p = 0.042), plank (p = 0.036), balance (p = 0.030), low-density lipoproteins (LDL) (p = 0.050), total cholesterol (p = 0.017), and natural killer cell activity (NKCA) (p = 0.035) after exercise compared to before exercise. The LCREG also significantly improved BMI (p = 0.001), grip strength (p = 0.014), plank (p = 0.018), balance (p = 0.012), LDL (p = 0.024), total cholesterol (p = 0.012), and NKCA (p = 0.036) compared to the CG. These findings suggest that low-intensity circuit resistance exercise can increase physical fitness levels and improve the blood index in BCSs.

Keywords: physical fitness; circuit resistance training; natural killer cell activation; insulin-like growth factor binding protein 3; breast cancer survivors

1 Introduction

Physical activity decreases after a breast cancer diagnosis, and low physical function is observed for more than 5 years after breast cancer treatment [1,2]. Irwin et al. [3] reported a decrease in physical activity levels in 25% of patients with breast cancer, and 35% reported no change in physical activity levels during a 6-year follow-up period. A decrease in physical function leads to fatigue, sleep disturbances, pain, depression, and anxiety, contributing to a decline in the quality of life of breast cancer survivors (BCS) [4,5]. Additionally, in breast cancer patients, the treatment process may have negative effects on sexual function, such as vulvo-vaginal atrophy, potentially leading to outcomes related to reduced quality of life [6,7]. Therefore, effective intervention methods should be applied to improve the BCS’s physical and psychological conditions. Exercise is one of the most effective strategies for improving physical and psychological problems associated with BCS [8,9,10,11]. In a prior study, Schwartz et al. [12] classified 66 BCSs into an aerobic exercise group, a resistance exercise group, and a control group (CG), and observed their progress over 24 weeks. This analysis showed that cardiorespiratory function and muscle strength improved in both the aerobic exercise and resistance exercise groups. Burnham and Wilcox [13] reported that 10 weeks of aerobic exercise improved physical functions, such as cardiorespiratory function, and psychological problems in breast and rectal cancer survivors. In addition, Serra et al. [14] reported that resistance exercise positively affected muscle strength and blood parameters in BCS. As a result, exercise is a key factor in improving physical and psychological problems and recovering, maintaining, and improving the physical function of BCS.

In previous studies related to BCS, various exercise methods and strengths have been applied. Short-term moderate- and high-intensity exercise [10,15,16,17], and long-term low- and medium-intensity exercise [18,19,20,21] have been applied. In particular, high-intensity resistance exercise has been shown to bring greater health benefits [10,17]. However, because high-intensity exercise requires extreme energy consumption, a high level of motivation is required, which can lead to giving up or making it difficult to continue [22,23]. In addition, exercise should focus on restoring, maintaining, and enhancing BCS’s bodily functions safely and efficiently from a mid-to-long-term perspective rather than a short-term perspective. This suggests that it is necessary for BCS to increase resistance exercise adaptation by performing low rather than high-intensity resistance exercise. This is because the survival period and rate of BCS are increasing, and strategies to sustain a healthy life are required. Therefore, it is necessary to comprehensively review exercise type, intensity, duration, and interest to induce continuous participation and interest.

Circuit resistance exercise is effective in arousing interest and increasing the participation rate compared to other exercises because the program can be configured in various ways and is an exercise method that attracts attention from women with low physical fitness levels [24,25]. The dropout rate has been reported to be relatively low [22,26], so it is judged to be the most suitable form of exercise for BCS to participate continuously.

We hypothesized that low-intensity circuit resistance training increases physical fitness in BCSs. Further, we proposed that low-intensity circuit resistance exercise improves blood parameters in BCSs. Therefore, this study aimed to examine the effects of long-term low-intensity circuit resistance exercise on physical fitness and blood parameters in BCS.

2 Methods

2.1 Participants

Sixteen BCS participated in this study. The criteria for participation in the study were as follows: (a) Diagnosis of breast cancer stage: I–Ⅲ A, (b) 50–65 years of age, (c) menopause diagnosis (≥50 years of age), (d) no resistance exercise for 1 year, (e) completely cured breast cancer, ≥2 years, and (f) no musculoskeletal symptoms and ≥6 months. Subjects who agreed to participate in exercises were assigned to low-intensity circuit resistance exercise group (LCREG), and subjects who did not agree to participate in exercises were assigned to CG. All participants were assigned to either an LCREG; (n = 8, age: 55.1 ± 4.6, weight: 66.5 ± 6.4, and height: 1.58 ± 0.0) or a CG; (n = 8, age: 57.8 ± 2.9, weight: 63.5 ± 7.0, and height: 1.56 ± 0.0). All participants signed a consent form identical to the content approved by the Institutional Review Board (U1IRB2021-08). Our study was registered with the Clinical Research Information Service (https://cris.nih.go.kr; registration number: KCT0008261). The criteria for selecting subjects are shown in Figure 1.

Figure 1 Flow diagram explaining criteria for participant selection.
Figure 1

Flow diagram explaining criteria for participant selection.

2.2 study design

This study was a non-randomized clinical trial. Measurements were ongoing at Center A in Region C, starting at 8:00 AM and ending at 12:00 PM. The participants were measured for 2 days. On the first day of measurement, body composition, muscle strength, muscle endurance, and balance were measured. Light jogging and stretching for 10 min were performed before the measurements. All participants were prohibited from eating for 2 h, and exercise was prohibited for 24 h before measurement. Blood was collected on the second measurement day, and fasting was performed 12 h before blood collection. After 24 weeks of exercise intervention, post-measurement was conducted simultaneously by the same measurer and measurement method.

2.3 Measurement of physical fitness

The participants’ body composition (height, weight, body mass index [BMI]) was measured using Bioelectrical Impedance Analysis (InBody-770, InBody Co., Ltd., Seoul, South Korea). Muscle strength was measured using a grip strength machine (TKK-5401, Takei, Niigata, Japan) and a back muscle strength machine (TKK-5402, Takei, Niigata, Japan) [27]. This was measured twice, and the best value was used. Muscular endurance was measured using sit-ups [28] and plank tests [29]. The participants lie on a sit-up board, spread both feet by 30 cm, and bend the knees vertically. With both hands intertwined behind their head, he raises his upper body with the ‘start’ signal. As you lift your upper body, your back touches the ground again after your elbows touch your knee. This motion was repeated for 30 s. The plank position was performed in a push-up position with the elbow bent at 90° and the floor supported with the forearm. The pelvis and lumbar spine were maintained in a neutral posture, and the body was made in a straight line from the ankles to the knees, hips, pelvis, spine, and head. Balance was measured using the one-legged standing method with eyes closed. All measurements were conducted after one practice session before the measurements. During the measurement, the measurement was stopped and recorded if the hand fell on the pelvis or the lower extremity was not kept in a 90° posture. The measurements were performed twice, and the best record was used.

2.4 Measurement of blood sample measurement of physical fitness

Blood samples were collected before and after exercise. Ten milliliters blood samples were collected from a vein in the participants’s arm. All samples were collected between 8:00 am and 10:00 am. After blood collection, 1 ml of blood was stored in a dedicated tube (NK Vue; ATGen Co., Seongnam-si, Korea) for natural killer cell activation (NKCA) analysis. The remaining 9 ml blood samples were transported in a vacuum tube for high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and IGFBP-3 (Insulin-like growth factor binding protein 3) analysis and then used for analysis. Immediately after blood collection, blood was centrifuged at 3,000 rpm for 5 min at room temperature to separate it from serum and stored frozen at −70°C. HDL, LDL, and total cholesterol were subjected to enzymatic colorimetric analysis using a Cobas 8000 C702 (Roche Diagnostics System, Basel, Switzerland). IGFBP-3 was subjected to chemiluminescent immunoassay using an IM MULITE 2000XPI (Siemens Healthineers, Forchheim, Germany). NKCA was subjected to immunoassays using an ELx808 reader (BioTek Instruments).

2.5 Exercise program

The low-intensity circuit resistance exercise (LCRE) consisted of eight upper and lower extremity exercises (leg press, seated row, leg extension, shoulder press, back extension, arm extension, hip adduction, and hip abduction). The LCRE for BCS was constructed by modifying and supplementing the circuit resistance exercise program used in the studies by Lee & An, Gauche et al., [25] and Hashemi et al. [30]. The 1 RM for each exercise was calculated using the Brzycki formula [31]. The participants performed at an exercise intensity of 40% based on 1 RM and set different exercise sets for each week (1–4 weeks; 3 sets, 5–8 weeks; 4 sets, 9–12 weeks; 5 sets). After the 12 weeks of exercise, it was performed at 50% intensity based on 1 RM, and the weekly exercise set (13–16 weeks, 3 sets; 17–20 weeks, 4 sets; 21–24 weeks, 5 sets) was set differently. The rest period between the sets was 3 min. All participants set the exercise intensity by remeasuring 1 RM once every 4 weeks. LCREG was conducted in the afternoon, and 60 min of exercise was performed 2–3 times a week. The LCRE program is presented in Table 1.

Table 1

Low-intensity circuit resistance training program

Weeks Type Set (rep) Set rest Intensity Concentric and eccentric ratio Time
1–4

  1. Leg press

  2. Seated row

  3. Leg extension

  4. Shoulder press

  5. Back extension

  6. Arm extension

  7. Hip adduction

 3 (16) 3 min 40% (1 RM) 1:1

  1. Warm up: 10 min

  2. Main exercise: 30–40 min

  3. Cool down: 10 min
5–8 4 (16)
9–12 5 (16)
13–16 4 (14) 50% (1 RM)
17–20 5 (15)
20–24 6 (16)

1 RM: one repetition maximum; rep: repetitions.

2.6 Statistical analysis

Data were analyzed using SPSS 23.0 (IBM Corp, Armonk, NY, USA). An independent samples t-test was performed to verify homogeneity between groups, and the results showed no differences between groups (p < 0.05). Nonparametric tests based on Shapiro–Wilk and Kolmogorov–Smirnov were performed. The two-tailed Mann–Whitney U test was used to examine differences between the groups. The two-tailed Wilcoxon test was used to determine the differences within the group. All significance levels were set at 0.05.

  1. Informed consent: Informed consent was obtained from all individuals included in this study

  2. Ethical approval: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of U1 University (U1IRB2021-08).

3 Results

3.1 Changes in physical fitness

Changes in physical fitness before and after the intervention are shown in Table 2. BMI (z = 2.521, p = 0.012), grip strength (z = 2.380, p = 0.017), back strength (z = 2.033, p = 0.042), plank (z = 2.100, p = 0.036), and balance (z = 2.173, p = 0.030) of the LCREG showed significant within-group differences after the intervention compared with pre-intervention. The BMI (z = 2.546, p = 0.011) of the CG group showed significant differences after the intervention compared to pre-intervention. In the differences between the groups, there were significant differences in BMI (z = 3.361, p = 0.001), grip strength (z = 2.470, p = 0.014), plank (z = 2.365, p = 0.018), and balance (z = 2.522, p = 0.012).

Table 2

Changes in physical fitness

Variables Within-group analysis Between-group analysis (pre–post differences)
Pre Post Z p-value Z p-value
Mean (SD) Mean (SD)
BMI (kg/m2) CG 20.30 (1.70) 20.60 (1.62) 2.546 0.011* 3.361 0.001**
LCREG 21.03 (2.05) 20.15 (1.88) 2.521 0.012*
Grip strength (kg) CG 23.91 (4.70) 23.02 (3.64) 1.260 0.208 2.470 0.014*
LCREG 24.80 (2.35) 27.22 (2.04) 2.380 0.017*
Back strength (kg) CG 49.26 (13.23) 48.70 (15.58) 0.420 0.674 1.524 0.128
LCREG 52.71 (11.51) 54.72 (10.74) 2.033 0.042*
Sit-up (rep) CG 7.12 (4.38) 7.37 (5.47) 0.283 0.777 1.377 0.168
LCREG 6.50 (5.09) 8.75 (4.97) 1.897 0.058
Plank (s) CG 28.18 (8.69) 27.01 (6.84) 1.014 0.310 2.365 0.018*
LCREG 26.35 (7.36) 35.02 (8.51) 2.100 0.036*
Balance (s) CG 8.28 (4.41) 7.91 (3.21) 0.841 0.400 2.522 0.012*
LCREG 7.28 (5.59) 11.55 (3.66) 2.173 0.030*

Means ± SD: means and standard deviation; BMI: body mass index; LCREG: low-intensity circuit resistance exercise; group; CG: control group; *p ≤ 0.05, **p ≤ 0.01; rep: repetitions.

3.2 Changes in blood parameters

Changes in blood parameters before and after the intervention are shown in Table 3. LDL (z = 1.960, p = 0.050), total cholesterol (z = 2.380, p = 0.017), and NKCA (z = 2.103, p = 0.035) of the LCREG showed significant within-group differences after the intervention compared to pre-intervention. CG showed no significant differences after the intervention compared to pre-intervention. In the differences between the groups, there were significant differences in LDL (z = 2.263, p = 0.024), total cholesterol (z = 2.521, p = 0.012), and NKCA (z = 2.102, p = 0.036).

Table 3

Changes in blood parameters

Variable Pre Post Within-group analysis Between-group analysis (pre–post differences)
Z p-value Z p-value
HDL (mg/dl) CG 66.93 (18.61) 62.20 (16.87) 1.260 0.208 1.155 0.248
LCREG 60.92 (21.52) 65.56 (17.52) 0.980 0.327
LDL (mg/dl) CG 126.25 (49.31) 132.50 (42.60) 1.825 0.050* 2.263 0.024*
LCREG 118.75 (46.21) 98.37 (23.61) 1.960 0.050*
Total cholesterol (mg/dl) CG 214.87 (62.91) 226.75 (62.38) 1.332 0.183 2.521 0.012*
LCREG 207.62 (58.22) 189.37 (47.88) 2.380 0.017*
NKCA (pg/ml) CG 641.87 (529.44) 630.75 (508.22) 0.560 0.575 2.102 0.036*
LCREG 727.50 (876.31) 850.50 (837.26) 2.103 0.035*
IGFBP-3 (μg/ml) CG 3.73 (0.62) 3.74 (0.65) 0.700 0.484 1.575 0.115
LCREG 4.29 (0.82) 4.17 (0.81) 1.521 0.128

Means ± SD: means and standard deviation; HDL: high-density lipoprotein; LDL: low-density lipoprotein; NKCA: natural killer cell activation; IGFBP-3: insulin-like growth factor binding protein 3; LCRTG: low-intensity circuit resistance training group; CG: control group. *p ≤ 0.05.

4 Discussion

This study is the first to identify the effects of long-term LCRE on BCS. We hypothesized that LCREG would improve physical fitness and blood parameters compared with the CG. The results of applying LCRE twice a week for 24 weeks confirm our hypothesis that it improves fitness and blood parameters in BCS.

Cancer survivors are more likely to stop exercising after treatment and very rarely resume exercise after treatment [31]. Muscle strength loss frequently occurs during breast cancer treatment. Therefore, restoring or maintaining muscle strength is one of the most important activities for BCS [32]. Resistance exercise significantly improves body function, including body composition, physical fitness, and strength in BCS. Vizza et al. [6] reported that using Replen to treat dyspareunia during resistance training such as pelvic floor exercises can improve the quality of life of cancer patients by improving physical strength and sexual function. Cormi et al. [33] reported that high-intensity resistance exercise (1 RM 75–85%) for 12 weeks improved muscle strength in breast cancer patients with lymphedema. Lee and An also reported that eight weeks of high-intensity circuit resistance exercise applied to BCS positively improved muscle strength and body composition. In addition, moderate-intensity resistance exercise (1 RM 60–70%) was also found to positively affect muscle strength and body composition in BCS [34]. Despite these benefits, many BCS avoid upper-body activities, including resistance exercise [35]. Low fitness levels, fatigue, and upper body injuries have been cited as the causes. Considering these points, we identified for the first time the effect of LCRE that BCS can easily access. The results showed that LCREG positively significant differences in BMI, grip strength, back muscle strength, plank, and balance of BCS after the exercise intervention. In addition, LCREG was positively correlated with BMI, grip strength, plank, and balance to CG. Watanabe et al. [36] argued that low-intensity exercise with a long muscle contraction period effectively increased muscle strength without hypertrophy. Linero and Choi [37] reported that 12 weeks of low-intensity resistance exercise was a safe and effective way to improve strength and balance in postmenopausal women with osteopenia.

Breast cancer treatment increases body fat [38], blood lipids [38], IGFBP-3 [39], negative impact on sexual functioning such as vulvo-vaginal atrophy [6,7], and decreases the activation of natural killer cells. This symptom is persistent among BCS and contributes to reduced quality of life and mortality from breast cancer recurrence and complications [40]. High-intensity resistance exercise reduces IGFBP-1 and IGFBP-3, which are involved in cancer cell growth [41], reduces cholesterol [42], and enhances NKCA [17], which kills cancer cells. However, long-term high-intensity resistance exercise affects BCS reduced motivation to participate, physical and psychological burden, and occurrence of orthopedic problems [43]. Therefore, alternative methods of participating in resistance exercises while reducing these problems are needed. As an alternative method, we applied LCRE to BCS over a long period. LDL, total cholesterol, and NKCA levels in the LCREG showed positive changes after 24 weeks of exercise intervention. In addition, LCREG positively improved LDL, total cholesterol, and NKCA compared to CG. Although we did not confirm any studies that analyzed the effect of LCRE on blood markers in BCS, other studies have shown the effect of resistance training on these variables. Okamoto et al. [44] reported that low-intensity resistance exercise effectively reduced LDL and total cholesterol levels in healthy women, and home-based low-intensity resistance exercise positively improved NKCA in esophageal cancer survivors [45]. In particular, Hashemi et al. [30] reported that low-intensity (1 RM 40%) circuit resistance exercise effectively increased HDL, decreased LDL, and reduced triglycerides in postmenopausal women. It was found that 35% of circuit resistance exercises based on 1 RM positively affected the improvement of plasma retinol-binding protein-4 and tumor necrosis factor-α in postmenopausal women. The physiological mechanisms underlying the effects of LCRE on changes in blood markers can be explained by several factors. It should be noted that LCRE is effective in improving cholesterol levels, similar to aerobic exercise [30]. In addition, the production of mytokines induced by continuous muscle contraction may have positively improved blood marker levels [46]. Finally, it is possible that the set variables positively improved as exercise volume gradually increased [36]. Our findings are meaningful in promoting the health status of BCS and applying them as a method of exercise prescription. Of course, the evidence to claim that it is superior to high-intensity resistance exercise is very weak, but it is a viable alternative for BCS who are weak or hesitant to do high-intensity exercise. In particular, engaging in low-intensity circular exercise can increase adaptability to resistance exercise and increase health benefits. This may open up the possibility of applying high-intensity forms of resistance exercise in the future, and may provide more essential health benefits for BCS. However, the limitations of this study are as follows: (a) The small sample size. (b) The lack of comparison or comment on the benefit of low-intensity endurance exercise in breast cancer patients. (c) Different breast cancer treatment methods, diagnosis stages, and fitness levels. (d) Physical fitness, BMI, medication, and dietary interventions were not considered when recruiting participants. (e) This study was conducted as a pilot study.

5 Conclusion

Current research shows that long-term LCRE can promote physical activity and improve health-related parameters in BCS. Based on these findings, it would be practical to apply different exercise intensities, including low-intensity circuit resistance exercise, to more BCSs and conduct larger community-based trials to evaluate their health-related benefits. Future studies should use randomized methods to classify study participants and consider the combined effects of other lifestyle interventions, including exercise and dietary modifications.

  1. Funding information: This research received no external funding.

  2. Author contributions: Conceptualization, K.-O.A. and K.-J.L.; methodology, K.-O.A. and K.-J.L.; software, K.-O.A. and K.-J.L.; validation, K.-O.A. and K.-J.L.; investigation, K.-O.A. and K.-J.L.; resources, K.-O.A. and K.-J.L.; data curation, K.-O.A. and K.-J.L.; writing – original draft preparation, K.-J.L.; writing – review and editing, K.-J.L.; visualization, K.-O.A. and K.-J.L.; supervision, K.-O.A. and K.-J.L.; project administration, K.-O.A. and K.-J.L.; funding acquisition, K.-O.A. and K.-J.L.; all authors have read and agreed to the published version of the manuscript.

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

  4. Data availability statement: The data presented in this study are available upon request from the corresponding author.

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Received: 2023-07-04
Revised: 2024-05-29
Accepted: 2024-07-06
Published Online: 2024-08-13

© 2024 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-2024-1010
Keywords for this article
physical fitness; circuit resistance training; natural killer cell activation; insulin-like growth factor binding protein 3; breast cancer survivors
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. EDNRB inhibits the growth and migration of prostate cancer cells by activating the cGMP-PKG pathway
  3. STK11 (LKB1) mutation suppresses ferroptosis in lung adenocarcinoma by facilitating monounsaturated fatty acid synthesis
  4. Association of SOX6 gene polymorphisms with Kashin-Beck disease risk in the Chinese Han population
  5. The pyroptosis-related signature predicts prognosis and influences the tumor immune microenvironment in dedifferentiated liposarcoma
  6. METTL3 attenuates ferroptosis sensitivity in lung cancer via modulating TFRC
  7. Identification and validation of molecular subtypes and prognostic signature for stage I and stage II gastric cancer based on neutrophil extracellular traps
  8. Novel lumbar plexus block versus femoral nerve block for analgesia and motor recovery after total knee arthroplasty
  9. Correlation between ABCB1 and OLIG2 polymorphisms and the severity and prognosis of patients with cerebral infarction
  10. Study on the radiotherapy effect and serum neutral granulocyte lymphocyte ratio and inflammatory factor expression of nasopharyngeal carcinoma
  11. Transcriptome analysis of effects of Tecrl deficiency on cardiometabolic and calcium regulation in cardiac tissue
  12. Aflatoxin B1 induces infertility, fetal deformities, and potential therapies
  13. Serum levels of HMW adiponectin and its receptors are associated with cytokine levels and clinical characteristics in chronic obstructive pulmonary disease
  14. METTL3-mediated methylation of CYP2C19 mRNA may aggravate clopidogrel resistance in ischemic stroke patients
  15. Understand how machine learning impact lung cancer research from 2010 to 2021: A bibliometric analysis
  16. Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay
  17. Metformin plus L-carnitine enhances brown/beige adipose tissue activity via Nrf2/HO-1 signaling to reduce lipid accumulation and inflammation in murine obesity
  18. Downregulation of carbonic anhydrase IX expression in mouse xenograft nasopharyngeal carcinoma model via doxorubicin nanobubble combined with ultrasound
  19. Feasibility of 3-dimensional printed models in simulated training and teaching of transcatheter aortic valve replacement
  20. miR-335-3p improves type II diabetes mellitus by IGF-1 regulating macrophage polarization
  21. The analyses of human MCPH1 DNA repair machinery and genetic variations
  22. Activation of Piezo1 increases the sensitivity of breast cancer to hyperthermia therapy
  23. Comprehensive analysis based on the disulfidptosis-related genes identifies hub genes and immune infiltration for pancreatic adenocarcinoma
  24. Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis
  25. The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis
  26. Development and validation of a novel model to predict pulmonary embolism in cardiology suspected patients: A 10-year retrospective analysis
  27. Downregulation of lncRNA XLOC_032768 in diabetic patients predicts the occurrence of diabetic nephropathy
  28. Circ_0051428 targeting miR-885-3p/MMP2 axis enhances the malignancy of cervical cancer
  29. Effectiveness of ginkgo diterpene lactone meglumine on cognitive function in patients with acute ischemic stroke
  30. The construction of a novel prognostic prediction model for glioma based on GWAS-identified prognostic-related risk loci
  31. Evaluating the impact of childhood BMI on the risk of coronavirus disease 2019: A Mendelian randomization study
  32. Lactate dehydrogenase to albumin ratio is associated with in-hospital mortality in patients with acute heart failure: Data from the MIMIC-III database
  33. CD36-mediated podocyte lipotoxicity promotes foot process effacement
  34. Efficacy of etonogestrel subcutaneous implants versus the levonorgestrel-releasing intrauterine system in the conservative treatment of adenomyosis
  35. FLRT2 mediates chondrogenesis of nasal septal cartilage and mandibular condyle cartilage
  36. Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study
  37. Let-7 family regulates HaCaT cell proliferation and apoptosis via the ΔNp63/PI3K/AKT pathway
  38. Phospholipid transfer protein ameliorates sepsis-induced cardiac dysfunction through NLRP3 inflammasome inhibition
  39. Postoperative cognitive dysfunction in elderly patients with colorectal cancer: A randomized controlled study comparing goal-directed and conventional fluid therapy
  40. Long-pulsed ultrasound-mediated microbubble thrombolysis in a rat model of microvascular obstruction
  41. High SEC61A1 expression predicts poor outcome of acute myeloid leukemia
  42. Comparison of polymerase chain reaction and next-generation sequencing with conventional urine culture for the diagnosis of urinary tract infections: A meta-analysis
  43. Secreted frizzled-related protein 5 protects against renal fibrosis by inhibiting Wnt/β-catenin pathway
  44. Pan-cancer and single-cell analysis of actin cytoskeleton genes related to disulfidptosis
  45. Overexpression of miR-532-5p restrains oxidative stress response of chondrocytes in nontraumatic osteonecrosis of the femoral head by inhibiting ABL1
  46. Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model
  47. Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section
  48. Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study
  49. No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study
  50. Identification and validation of autophagy-related genes in SSc
  51. Long non-coding RNA SRA1 suppresses radiotherapy resistance in esophageal squamous cell carcinoma by modulating glycolytic reprogramming
  52. Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study
  53. The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis
  54. Compilation of a self-management assessment scale for postoperative patients with aortic dissection
  55. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation
  56. Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study
  57. Clinical characteristics and assessment of risk factors in patients with influenza A-induced severe pneumonia after the prevalence of SARS-CoV-2
  58. Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli
  59. High STAT4 expression correlates with poor prognosis in acute myeloid leukemia and facilitates disease progression by upregulating VEGFA expression
  60. Factors influencing cardiovascular system-related post-COVID-19 sequelae: A single-center cohort study
  61. HOXD10 regulates intestinal permeability and inhibits inflammation of dextran sulfate sodium-induced ulcerative colitis through the inactivation of the Rho/ROCK/MMPs axis
  62. Mesenchymal stem cell-derived exosomal miR-26a induces ferroptosis, suppresses hepatic stellate cell activation, and ameliorates liver fibrosis by modulating SLC7A11
  63. Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke
  64. ANO6 (TMEM16F) inhibits gastrointestinal stromal tumor growth and induces ferroptosis
  65. Prognostic value of EIF5A2 in solid tumors: A meta-analysis and bioinformatics analysis
  66. The role of enhanced expression of Cx43 in patients with ulcerative colitis
  67. Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance
  68. Role of ICAM-1 in triple-negative breast cancer
  69. Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2
  70. HLA-DRB5 promotes immune thrombocytopenia via activating CD8+ T cells
  71. Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome
  72. Efficacy of tacrolimus monotherapy in primary membranous nephropathy
  73. Mechanisms of Tripterygium wilfordii Hook F on treating rheumatoid arthritis explored by network pharmacology analysis and molecular docking
  74. FBXO45 levels regulated ferroptosis renal tubular epithelial cells in a model of diabetic nephropathy by PLK1
  75. Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns
  76. Alpha-lipoic acid upregulates the PPARγ/NRF2/GPX4 signal pathway to inhibit ferroptosis in the pathogenesis of unexplained recurrent pregnancy loss
  77. Correlation between fat-soluble vitamin levels and inflammatory factors in paediatric community-acquired pneumonia: A prospective study
  78. CD1d affects the proliferation, migration, and apoptosis of human papillary thyroid carcinoma TPC-1 cells via regulating MAPK/NF-κB signaling pathway
  79. miR-let-7a inhibits sympathetic nerve remodeling after myocardial infarction by downregulating the expression of nerve growth factor
  80. Immune response analysis of solid organ transplantation recipients inoculated with inactivated COVID-19 vaccine: A retrospective analysis
  81. The H2Valdien derivatives regulate the epithelial–mesenchymal transition of hepatoma carcinoma cells through the Hedgehog signaling pathway
  82. Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets
  83. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis
  84. Lycopene inhibits pyroptosis of endothelial progenitor cells induced by ox-LDL through the AMPK/mTOR/NLRP3 pathway
  85. Methylation regulation for FUNDC1 stability in childhood leukemia was up-regulated and facilitates metastasis and reduces ferroptosis of leukemia through mitochondrial damage by FBXL2
  86. Correlation of single-fiber electromyography studies and functional status in patients with amyotrophic lateral sclerosis
  87. Risk factors of postoperative airway obstruction complications in children with oral floor mass
  88. Expression levels and clinical significance of serum miR-19a/CCL20 in patients with acute cerebral infarction
  89. Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022
  90. Evaluating anemia in HIV-infected patients using chest CT
  91. Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court
  92. Causal association of circulating immune cells and lymphoma: A Mendelian randomization study
  93. Assessment of the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals on treating renal fibrosis: A systematic review and meta-analysis
  94. Comprehensive landscape of integrator complex subunits and their association with prognosis and tumor microenvironment in gastric cancer
  95. New target-HMGCR inhibitors for the treatment of primary sclerosing cholangitis: A drug Mendelian randomization study
  96. Population pharmacokinetics of meropenem in critically ill patients
  97. Comparison of the ability of newly inflammatory markers to predict complicated appendicitis
  98. Comparative morphology of the cruciate ligaments: A radiological study
  99. Immune landscape of hepatocellular carcinoma: The central role of TP53-inducible glycolysis and apoptosis regulator
  100. Serum SIRT3 levels in epilepsy patients and its association with clinical outcomes and severity: A prospective observational study
  101. SHP-1 mediates cigarette smoke extract-induced epithelial–mesenchymal transformation and inflammation in 16HBE cells
  102. Acute hyper-hypoxia accelerates the development of depression in mice via the IL-6/PGC1α/MFN2 signaling pathway
  103. The GJB3 correlates with the prognosis, immune cell infiltration, and therapeutic responses in lung adenocarcinoma
  104. Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program
  105. Exploring anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-coronary artery bypass graft surgery
  106. Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism
  107. Analysis of the risk factors of the radiation-induced encephalopathy in nasopharyngeal carcinoma: A retrospective cohort study
  108. Reproductive outcomes in women with BRCA 1/2 germline mutations: A retrospective observational study and literature review
  109. Evaluation of upper airway ultrasonographic measurements in predicting difficult intubation: A cross-section of the Turkish population
  110. Prognostic and diagnostic value of circulating IGFBP2 in pancreatic cancer
  111. Postural stability after operative reconstruction of the AFTL in chronic ankle instability comparing three different surgical techniques
  112. Research trends related to emergence agitation in the post-anaesthesia care unit from 2001 to 2023: A bibliometric analysis
  113. Frequency and clinicopathological correlation of gastrointestinal polyps: A six-year single center experience
  114. ACSL4 mediates inflammatory bowel disease and contributes to LPS-induced intestinal epithelial cell dysfunction by activating ferroptosis and inflammation
  115. Affibody-based molecular probe 99mTc-(HE)3ZHER2:V2 for non-invasive HER2 detection in ovarian and breast cancer xenografts
  116. Effectiveness of nutritional support for clinical outcomes in gastric cancer patients: A meta-analysis of randomized controlled trials
  117. The relationship between IFN-γ, IL-10, IL-6 cytokines, and severity of the condition with serum zinc and Fe in children infected with Mycoplasma pneumoniae
  118. Paraquat disrupts the blood–brain barrier by increasing IL-6 expression and oxidative stress through the activation of PI3K/AKT signaling pathway
  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
  120. Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway
  121. Association of polymorphisms in FBN1, MYH11, and TGF-β signaling-related genes with susceptibility of sporadic thoracic aortic aneurysm and dissection in the Zhejiang Han population
  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
  130. Role of FOXM1 and AURKB in regulating keratinocyte function in psoriasis
  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
  136. The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study
  137. The unusual location of primary hydatid cyst: A case series study
  138. Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
  139. Obesity and risk of placenta accreta spectrum: A meta-analysis
  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
  228. Single-cell analysis identified key macrophage subpopulations associated with atherosclerosis
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