Home Effects of pegylated recombinant human granulocyte colony-stimulating factor on lymphocytes and white blood cells of patients with malignant tumor
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Effects of pegylated recombinant human granulocyte colony-stimulating factor on lymphocytes and white blood cells of patients with malignant tumor

  • Tong Zhao , Yuejun Wang , Deqing Zhou and Weike Zhang EMAIL logo
Published/Copyright: April 12, 2023

Abstract

We investigated the effect of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) on lymphocytes and white blood cells of patients with malignant tumors. After PEG-rhG-CSF treatment, the count of lymphocytes increased in 66 cases, remained unchanged in 2 cases, and decreased in 20 cases. The difference in lymphocyte count before and after treatment was statistically significant (P < 0.001). White blood cell changes were positively correlated with lymphocyte changes (r = 0.36, P = 0.001). In the subgroup with increased white blood cells (n = 80), there were 62 cases with increased lymphocytes, 1 case with unchanged lymphocytes, and 17 cases with decreased lymphocytes after PEG-rhG-CSF treatment. There was significant difference in the count of lymphocytes and white blood cells (P < 0.001). In the subgroup with 6 mg of PEG-rhG-CSF (n = 66) and the subgroup with 3 mg of PEG-rhG-CSF (n = 22), the changes of white blood cell and lymphocyte counts before and after treatment were statistically significant (P < 0.001). The two were positively correlated in the 6 mg PEG-rhG-CSF subgroup, with correlation coefficient r = 0.34 (P = 0.002). PEG-rhG-CSF can increase the count of lymphocytes and white blood cells in patients with malignant tumors, and the increase of lymphocytes is positively correlated with the increase of white blood cells.

1 Introduction

Chemotherapy and radiotherapy are still important modes of comprehensive treatment for malignant tumors [1], and neutropenia is the most common hematological toxicity during chemotherapy and radiotherapy. It often induces fever during neutropenia (FN), septic shock, and even death, which seriously affects the clinical treatment and survival of tumor patients and increases medical expenses [2,3]. Pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) is a glycoprotein that can bind to specific receptors on the surface of granulocyte progenitor cells or mature neutrophils. It can promote the proliferation and differentiation of granulocyte progenitor cells and enhance the phagocytosis and killing ability of neutrophils [4]. PEG-rhG-CSF is a long-acting, self-regulating stimulator with a plasma half-life of 47 h and only needs to be applied once after each chemotherapy cycle. The standardized management guidelines for chemotherapy-related neutropenia have been issued [5,6], which recommends the prophylactic application of PEG-rhG-CSF at 24–72 h after chemotherapy. PEG-rhG-CSF can effectively reduce the incidence and severity of neutropenia caused by chemotherapy and shorten the duration of neutropenia [7,8]. However, the effects of PEG-rhG-CSF on lymphocytes and white blood cells remain unclear.

Herein, this study analyzed the effect of PEG-rhG-CSF on lymphocyte and white blood cell count during chemotherapy in patients with malignant tumors.

2 Materials and methods

2.1 Participants

This is a retrospective observational study. Initially, 183 patients who received PEG-rhG-CSF in the Department of Oncology of the Eighth People’s Hospital of Jinan from January 2021 to June 2022 were screened. Finally, 88 patients with nonhematologic malignant tumors were enrolled in this study. The inclusion criteria were as follows: 1) patients with histopathologically or cytologically confirmed nonhematologic malignant tumors; 2) patients with age equal to or greater than 18 years; 3) patients with Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score less than or equal to 2; 4) before chemotherapy, white blood cells ≥4.0 × 109/L, absolute neutrophil count ≥2.0 × 109/L, hemoglobin ≥9.0 g/dL, and platelets ≥80 × 109/L; 5) patients with normal coagulation function; and 6) patients with normal heart, liver, and kidney function. The exclusion criteria were: 1) patients with repeated myelosuppression in previous chemotherapy; 2) patients with uncontrollable infection; 3) patients with previous hematopoietic stem-cell transplantation or organ transplantation; 4) patients with previous radiotherapy treatment; 5) patients with bone marrow invasion; 6) patients with kidney metastasis, adrenal metastasis, or abnormal renal function, such as abnormal creatinine clearance rate and blood urea nitrogen; 7) patients with other serious complications; and 8) patients with hematologic system disease.

2.1.1 Sample size calculation

The sample size was calculated using the following formula:

n = ( Z α + Z β ) 2 × ρ ¯ ( 1 ρ ¯ ) ( ρ 1 ρ 0 ) 2 ,

where α = 0.05, 1 – β = 0.90, Z α = 1.64, Z β = 1.28, ρ ¯ = ρ 1 + ρ 0 2 , and ρ 1 = ρ 0 OR 1 + ρ 0 ( OR 1 ) . According to the pilot experiment, ρ 0 was determined as 0.2 and OR was determined as 3.079. The calculated sample size was 82. Finally, 88 cases were enrolled in this study.

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

  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 Ethics Committee of the Eighth People s Hospital of Jinan (No. 2020053). This study has been registered at Chinese Clinical Trial Register (ChiCTR2200063211).

2.2 Medication

For primary or secondary prevention of chemotherapy-related neutropenia, patients were subcutaneously injected with PEG-rhG-CSF (6 or 3 mg; Qilu Pharmaceutical Co., Ltd, Jinan, China; specification: 3 mg × 1 mL/piece, s20150013) on day 3 after chemotherapy.

2.3 Blood routine test

According to the pharmacokinetic parameters of PEG-rhG-CSF [9], we chose 4–7 days after injection of PEG-rhG-CSF as the observation time point. All patients received blood routine tests on days 3 and 7–10 after chemotherapy to evaluate the changes of lymphocytes. Blood routine test was performed using BC-5180 Automatic Blood Cell Analyzer (Mindray Biomedical Electronics Co., Ltd., Shenzhen, China).

2.4 Data collection

Clinical data were collected including 1) demographics (sex and age), 2) pathological diagnosis, 3) ECOG PS score, and 4) blood routine results.

2.5 Statistical analysis

SPSS 19.0 statistical software was used. The measurement data were expressed as mean ± standard deviation, and compared with paired sample t-test. Pearson regression analysis was used for correlation analysis. P < 0.05 was considered as statistically significant.

3 Results

3.1 Baseline characteristics of patients

The baseline characteristics of patients are shown in Table 1. Of 88 patients, 66 cases received 6 mg of PEG-rhG-CSF and 22 cases received 3 mg of PEG-rhG-CSF after chemotherapy. There were 41 cases of nonsmall cell lung cancer, 11 cases of small cell lung cancer, 14 cases of breast cancer, 6 cases of esophageal cancer, 11 cases of colon cancer, and 5 cases of gastric cancer. Their mean age was 49.37 ± 9.53 years. There were 47 male and 41 female patients. Additionally, 84 cases had an ECOG PS score of 0–1 and 4 cases had an ECOG PS score of 2.

Table 1

Baseline characteristics of patients

Characteristics All patients (N = 88) PEG-rhG-CSF 6 mg group (N = 66) PEG-rhG-CSF 3 mg group (N = 22)
Median age – years old 49.37 ± 9.53 49.23 ± 6.23 49.44 ± 5.48
Sex – No. (%)
Male 47 (53.41) 35 (53.03) 12 (54.55)
Female 41 (46.59) 31 (46.97) 10 (45.45)
Tumor type – No. (%)
Nonsmall cell lung cancer 41 (46.59) 32 (48.48) 9 (40.90)
Small cell lung cancer 11 (12.50) 8 (12.12) 3 (13.64)
Breast cancer 14 (15.91) 10 (15.15) 4 (18.18)
Esophageal cancer 6 (6.82) 5 (7.58) 1 (4.55)
Colon cancer 11 (12.50) 9 (13.64) 2 (9.09)
Gastric cancer 5 (5.68) 2 (3.03) 3 (13.64)
ECOG PS score: 0, 1 No. (%) 84 (95.45) 63 (95.45) 21 (95.45)
ECOG PS score: 2 No. (%) 4 (4.55) 3 (4.55) 1 (4.55)

3.2 Comparison of white blood cell and lymphocyte counts before and after treatment with PEG-rhG-CSF

In the 88 patients, there were 80 cases with increased white blood cells and 8 cases with decreased white blood cells after treatment with PEG-rhG-CSF. There were 66 cases with increased lymphocytes, 2 cases with no significant change in lymphocytes, and 20 cases with decreased lymphocytes. Statistically, the white blood cell and lymphocyte counts after treatment with PEG-rhG-CSF were significantly higher than those of before treatment (P < 0.001) (Table 2).

Table 2

Comparison of white blood cell count and lymphocyte count before and after PEG-rhG-CSF treatment

Variable (×109/L) Mean ± standard deviation t P Difference 95% CI
White blood cell count before PEG-rhG-CSF treatment 5.69 ± 2.84 −10.91 <0.001 −19.20 to −13.28
White blood cell count after PEG-rhG-CSF treatment 21.93 ± 14.02
Lymphocyte count before PEG-rhG-CSF treatment 1.22 ± 0.45 −6.37 <0.001 −0.70 to −0.37
Lymphocyte count after PEG-rhG-CSF treatment 1.75 ± 0.90

3.3 Correlation between the white blood cell count change and lymphocyte change before and after treatment with PEG-rhG-CSF

Pearson regression analysis was conducted with lymphocyte change (x) as the explained variable and white blood cell change (y) as the explanatory variable: y = 0.0202*x + 0.2043 (Figure 1). The results showed that white blood cell change was positively correlated with lymphocyte change in all 88 patients, with a correlation coefficient of 0.36 (P = 0.001). The regression coefficient was highly significant (1% significance level), which indicates that lymphocyte change showed a significant linear relationship with white blood cell change. On average, for every 1 × 109/L increase in white blood cells, lymphocytes would increase by 0.02 × 109/L.

Figure 1 
                  Scatter plot of correlation analysis between lymphocyte change and white blood cell change in all patients (n = 88).
Figure 1

Scatter plot of correlation analysis between lymphocyte change and white blood cell change in all patients (n = 88).

3.4 Changes in lymphocyte count in the subgroup with increased white blood cells after treatment with PEG-rhG-CSF

Among the 80 cases with increased white blood cells after treatment with PEG-rhG-CSF, 62 cases had increased lymphocytes, 1 case had no significant change in lymphocytes, and 17 cases had decreased lymphocytes. The difference in lymphocyte count was statistically significant before and after PEG-rhG-CSF in the subgroup with increased white blood cells after treatment (P < 0.001), as shown in Table 3.

Table 3

Comparison of lymphocyte counts before and after PEG-rhG-CSF treatment in the subgroup with increased white blood cells

Variable (×109/L) Mean ± standard deviation t P Difference 95% CI
Lymphocyte count before PEG-rhG-CSF treatment 1.22 ± 0.44 −6.47 <0.001 −0.75 to −0.40
Lymphocyte count after PEG-rhG-CSF treatment 1.79 ± 0.92

3.5 Correlation between changes in lymphocyte count and white blood cell count in the subgroup with increased white blood cells after application of PEG-rhG-CSF treatment

In the subgroup with increased white blood cells after PEG-rhG-CSF treatment, Pearson regression analysis was performed with lymphocyte change (x) as the explained variable and white blood cell change (y) as the explanatory variable: y = 0.0344*x + 1.1674 (Figure 2). The results found that white blood cell change was positively correlated with lymphocyte change with a correlation coefficient of r = 0.34, P = 0.002. The regression coefficient was highly significant (1% significance level), which suggests a significant linear relationship between lymphocyte change and white blood cell change. For every 1 × 109/L rise in white blood cells, lymphocytes will increase by 0.03 × 109/L.

Figure 2 
                  Scatter plot of correlation analysis between lymphocyte change and white blood cell change in the subgroup with increased white blood cells (n = 80).
Figure 2

Scatter plot of correlation analysis between lymphocyte change and white blood cell change in the subgroup with increased white blood cells (n = 80).

3.6 Analysis of subgroup that received 6 mg of PEG-rhG-CSF

A total of 66 patients were treated with 6 mg of PEG-rhG-CSF. As shown in Table 4, there were statistically significant changes in white blood cell count and lymphocyte count before and after treatment (P < 0.001). Similarly, in the subgroup with 6 mg of PEG-rhG-CSF, white blood cell count and lymphocyte count were positively correlated, with a correlation coefficient of r = 0.34 and P = 0.002.

Table 4

Comparison of white blood cell count and lymphocyte count before and after treatment in the 6 mg PEG-rhG-CSF subgroup

Variable (×109/L) Mean ± standard deviation t P Difference 95% CI
White blood cell count before PEG-rhG-CSF treatment 5.95 ± 2.89 −10.46 <0.001 −22.59 to −15.35
White blood cell count after PEG-rhG-CSF treatment 24.92 ± 14.41
Lymphocyte count before PEG-rhG-CSF treatment 1.26 ± 0.48 −5.74 <0.001 −0.77 to −0.37
Lymphocyte count after PEG-rhG-CSF treatment 1.83 ± 0.95

3.7 Analysis of subgroup with 3 mg of PEG-rhG-CSF

A total of 22 patients were treated with 3 mg of PEG-rhG-CSF. There were also statistically significant changes in white blood cell count (P < 0.001) and lymphocytes (P = 0.012) before and after treatment, as shown in Table 5. However, there was no significant correlation between white blood cell count and lymphocyte count (P > 0.05).

Table 5

Comparison of white blood cell count and lymphocyte count before and after treatment in the 3 mg PEG-rhG-CSF subgroup

Variable (×109/L) Mean ± standard deviation t P Difference 95% CI
White blood cell count before PEG-rhG-CSF treatment 4.92 ± 2.57 −5.81 <0.001 −10.93 to −5.17
White blood cell count after PEG-rhG-CSF treatment 12.97 ± 7.70
Lymphocyte count before PEG-rhG-CSF treatment 1.09 ± 0.34 −2.76 0.012 −0.72 to −0.10
Lymphocyte count after PEG-rhG-CSF treatment 1.51 ± 0.67

4 Discussion

Neutropenia occurs in 25–40% of patients treated initially with chemotherapy, and neutropenia results in delayed chemotherapy and dose reduction in more than 60% of patients. Human granulocyte CSF (hG-CSF) is often used to treat neutropenia in clinic. PEG-rhG-CSF has been confirmed to be as effective as hG-CSF in preventing and treating chemotherapy-related myelosuppression and FN [10]. However, hG-CSF is a short-acting drug and should be applied three to seven times per chemotherapy cycle. Meanwhile, PEG-rhG-CSF is a long-acting drug and needs to be applied only once at 24 h after each chemotherapy cycle, which is more convenient. In addition, Huang et al. showed that PEG-rhG-CSF had a stronger immune cell-modulating effect compared to rhG-CSF in breast cancer patients [11]. Therefore, we focused on PEG-rhG-CSF in this study.

PEG-rhG-CSF has a definite effect on granulocytes. However, there are limited studies on the effects of PEG-rhG-CSF on immune cells (especially lymphocytes), immune microenvironment, and immune status in patients with malignant tumors. This study investigated the effect of PEG-rhG-CSF on lymphocytes and white blood cells in patients with malignant tumors. Our results found that lymphocyte counts were significantly increased in 66 cases after PEG-rhG-CSF treatment. The white blood cell increase was positively correlated with lymphocyte increase (correlation coefficient r = 0.36, P = 0.001). Pearson regression analysis showed a highly significant regression coefficient (1% significance level). On average, for every 1 × 109/L increase in white blood cells, lymphocytes will increase by 0.02 × 109/L. This indicates that PEG-rhG-CSF can increase lymphocyte counts in patients with malignant tumors. Single-cell analysis by Franzke et al. showed that CD4 + T cells and CD8 + T cells also expressed G-CSF receptors after stimulation with short-acting G-CSF, and that G-CSF could regulate T cells directly through these receptors [12]. We speculate that it may be possible that treatment with long-acting PEG-rhG-CSF can also cause CD4 + T cells and CD8 + T cells in patients with malignancies to express G-CSF receptors, which in turn can regulate T cells and elevate lymphocyte counts through these receptors. More in-depth studies are needed to confirm this speculation.

In this study, we further analyzed the subgroup with increased white blood cells after PEG-rhG-CSF treatment. The changes in lymphocytes and white blood cells were also significantly different in this subgroup, and there was a positive correlation between increased white blood cells and increased lymphocytes, with a correlation coefficient of 0.34. A mean increase of 1 × 109/L in white blood cells indicates a mean increase of 0.03 × 109/L in lymphocytes.

In the subgroup with increased white blood cells after PEG-rhG-CSF treatment, the increase in lymphocytes was more significant along with the increase in white blood cells than in the all-case group. It is hypothesized that this may be because patients with increased white blood cells after PEG-rhG-CSF treatment may have higher expression of G-CSF receptors by lymphocyte CD4 + T cells and CD8 + T cells, which in turn may exert stronger effects on regulating T cells and elevating lymphocytes through G-CSF receptors.

Clinically, the commonly used dose of PEG-rhG-CSF for subcutaneous injection is 6 mg per cycle. If the body weight of patients is less than 45 kg or if the patients have a “white blood cell-like reaction” (white blood cells > 50 × 109/L and neutrophils > 20 × 109/L), the dose of PEG-rhG-CSF for subcutaneous injection can be adjusted to 3 mg per cycle [13]. In primary-care hospitals, PEG-rhG-CSF at 3 mg per cycle can also be used because of high cost of the drug. Therefore, this study analyzed the 6 mg group and the 3 mg group separately. The results showed that the 66 patients in the PEG-rhG-CSF 6 mg subgroup showed statistically significant changes in white blood cell count and lymphocyte count before and after treatment, and the two were positively correlated with a correlation coefficient of r = 0.34, P = 0.002. The 22 patients in the PEG-rhG-CSF 3 mg subgroup showed statistically significant changes in lymphocyte count and white blood cell count before and after treatment. However, there was no correlation between the changes in white blood cell count and lymphocyte count before and after treatment in the 3 mg subgroup. This may be caused by the small number of samples in the 3 mg subgroup. It should be further clarified in future studies by increasing the sample size.

In recent years, immunotherapy using programmed death factor-1 (PD-1) antibodies and chimeric receptor lymphocytes, for example, have been widely used as first-line class IA and recommended drugs for advanced lung cancer, esophageal cancer, and other solid tumors [14,15,16]. Despite longer overall survival, the overall response rate of immunotherapy is still low, only 10–20%, and the problem of primary and secondary drug resistance has been difficult to be solved [17,18].

There are many theories on the mechanism of poor efficacy and drug resistance of immunotherapy. Some scholars consider that the internal factors of tumor cells (such as activation of driver genes and inactivation of oncogenes) and external factors may lead to drug resistance [19]. In addition, there are other factors that affect the efficacy of immunotherapy, including the decrease of tumor-infiltrating lymphocytes, the low expression of PD-L1, and the decrease in absolute value of lymphocytes [20].

Long-term stimulation by tumor antigens can cause T cells to gradually lose their original ability to recognize antigens, activate and proliferate, or secrete interleukin-2, leading to T cell depletion [21]. The immune microenvironment and the distribution of immune cells in peripheral blood are important markers of immune status. A study has found that there were more CD3+, CD4+, CD8+, and PD-1+ T cells in the peripheral blood of lung adenocarcinoma patients with long-term survival, indicating that the infiltration degree of immune cells in the tumor immune microenvironment is closely related to long-term survival [22]. The distribution of peripheral blood lymphocyte subpopulations can be used as a prognostic indicator for tumor patients [23]. Understanding and improving the immune status of patients with malignant tumors, increasing the number of lymphocytes, reversing the depletion of lymphocytes, and changing the immune microenvironment are of great significance for improving the effect of immunotherapy.

In order to improve the efficacy of immunotherapy, some new combination immunotherapy models have been proposed, including immunotherapy combined with radiotherapy and double immunotherapy [24,25,26]. Our study confirmed that PEG-rhG-CSF could increase the number of lymphocytes in patients with malignant tumors. Immunotherapy combined with PEG-rhG-CSF may serve as a new mode of combined immunotherapy. On the one hand, PEG-rhG-CSF, as the primary or secondary prevention of agranulocytosis, can prevent agranulocytosis and FN and ensure smooth treatment. On the other hand, by increasing the number of lymphocytes, we may reverse the depletion of lymphocytes, improve the efficacy of immunotherapy, and reduce the occurrence of drug resistance.

The following were the limitations of this study: 1) although the sample size was large, the selective bias and recall bias of data selection were high; 2) the disease types of the study population were heterogeneous; 3) this study did not perform further detailed analysis of lymphocyte subgroups and did not conduct a T-cell antigen receptor group library study; and 4) follow-up study was not performed. Further prospective studies with specific tumor type and detailed analysis of lymphocyte subgroups (such as CD3+, CD4+, CD8+, NK cells, B cells, etc.) are needed.

5 Conclusion

In summary, PEG-rhG-CSF at both 3 and 6 mg per cycle can increase the count of lymphocytes and white blood cells in patients with malignant tumors. Immunotherapy combined with PEG-rhG-CSF may serve as a new combined immunotherapy mode to prevent granulocytopenia and FN, increase the number of lymphocytes in patients with malignant tumors, reverse lymphocyte depletion, and then improve the efficiency of immunotherapy.


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  1. Funding information: This study was supported by Shandong Medical Association Clinical Research Fund–Qilu Special Project (YXH2022ZX02046) and Shandong Medical and Health Science and Technology Development Plan Project (202103100315).

  2. Author contributions: Z.T. collected the cases, performed the experiments, collected and analyzed the data, and drafted the manuscript. W.Y.J. and Z.D.Q. participated in data collection and analysis. Z.W.K. conceived the idea, designed the study, and revised the manuscript. The authors applied the sequence-determines-credit approach for the sequence of authors. All authors approve the final version of the manuscript.

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

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

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Received: 2022-10-25
Revised: 2023-01-26
Accepted: 2023-03-12
Published Online: 2023-04-12

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

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

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