Home Utility of methylene blue mixed with autologous blood in preoperative localization of pulmonary nodules and masses
Article Open Access

Utility of methylene blue mixed with autologous blood in preoperative localization of pulmonary nodules and masses

  • Zhi Feng , Qiu-Xia Liao , Jin-Bao Xie , Jian-Feng Chen , Ming-Lian Qiu and Xu Li EMAIL logo
Published/Copyright: July 9, 2023

Abstract

The value of CT-guided puncture with methylene blue mixed with autologous blood in preoperative localization of pulmonary nodules and masses was explored. A total of 113 patients with 146 nodules and masses were treated with methylene blue mixed with autologous blood for preoperative localization and thoracoscopic surgery in the Department of Thoracic Surgery, the First Affiliated Hospital of Fujian Medical University between October 2021 and October 2022. The localization effect, complications, and pathological conditions were observed. The localization success rate was 98.63% (144/146). The localization failed nodules and masses could still be located by looking for needle eyes and reading films. The whole group successfully completed thoracoscopic surgery. The average interval of operation after puncture was 22.16 ± 6.22 h. There was a small amount of suspicious hemothorax after puncture. There was no pneumothorax after puncture in the whole group. There were no hemoptysis, irritating dry cough, and other reactions. The overall complication rate was 2.65%, and no special treatment was given. It is safe and effective to use methylene blue mixed with autologous blood for CT-guided preoperative puncture and localization of small pulmonary nodules and masses.

1 Introduction

With the emphasis on lung cancer screening and the widespread application of low-dose spiral CT in physical examination, the number of patients with small pulmonary nodules and masses has been increasing in recent years. Ground-glass nodules have a high probability of malignancy confirmed by pathology, and early surgical intervention has an ideal effect. However, small pulmonary nodules are often insufficient under thoracoscopy and difficult to palpate [1]. Without preoperative localization, it may lead to conversion to thoracotomy or even surgical failure [2].

At present, CT-guided percutaneous lung localization has become a common method of preoperative localization, and a variety of positioning materials have reported good positioning effects, for example, hookwire, microcoil, dye, medical surgical adhesive, or radionuclide. the mean success rate for all techniques of positioning methods in the included relevant studies was 98.1% (94.9–100%), but almost every positioning material has its corresponding advantages and disadvantages [3].

Since October 2021, we have tried to use methylene blue mixed with autologous blood for preoperative CT-guided percutaneous lung localization of small pulmonary nodules and masses in our department, and good results have been achieved.

2 Methods and materials

2.1 Subjects

A total of 113 patients with pulmonary nodules and masses diagnosed by chest CT in the Department of Thoracic Surgery, the First Affiliated Hospital of Fujian Medical University from October 2021 to October 2022 were collected, including 39 males and 74 females, and the median age of 51.91 ± 11.64 years. Inclusion criteria were as follows: the lesion had no pleural traction sign and no pleural involvement. Exclusion criteria were as follows: pulmonary vascular lesions or lesions close to the pulmonary great vessels and patients with severe cardiopulmonary insufficiency or bleeding tendency. The data of nodules and masses characteristics, diameter, location, localization time, localization complications, the interval between localization and operation, surgical methods, and postoperative pathology were collected. This study was approved by the Ethics Committee of the First Affiliated Hospital of Fujian Medical University (MTCAECFAH of FMU 2015]084-1), and all patients signed “informed consent form.”

  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 Ethics Committee of the First Affiliated Hospital of Fujian Medical University (MTCAECFAH of FMU 2015]084-1).

2.2 Method of positioning

Methylene blue mixed with autologous blood was used for preoperative localization of small pulmonary nodules and masses and thoracoscopic surgery. One day before or on the day of surgery, 5–10 ml of peripheral venous blood was drawn and mixed with 1 ml of methylene blue before puncture. After the patient entered the CT room, the appropriate position was determined according to the location of the nodule by reading the film. The 18-G PTC needle (Hakko Co., Ltd, Japan) was gradually inserted 1 cm away from the lesion and then withdrawn to confirm that it did not enter the bronchus or blood vessels. About 3 ml of methylene blue-autologous blood mixture was injected, and the needle was removed at the end of the operation. Postoperative scanning was performed by 64-slice spiral CT scanner (Siemens SOMATOM Definition AS, Germany), to confirm whether the distribution of markers was satisfactory and whether pneumothorax or hemothorax occurred after puncture.

2.3 Surgical procedure

Patients were generally brought to the operating room 1 day or the same day after localization. All patients underwent single-utility port thoracoscopic surgery with double-lumen endotracheal intubation under general anesthesia and one-lung ventilation. The thoracoscopic hole was made at the midaxillary line of the seventh intercostal space, and the main operation hole was made at the anterior axillary line of the fourth intercostal space. Thoracoscopic exploration was performed, and a dark purple ecchymosis sign was found on the pleural surface of the lung layer (Figure 1), with a clear boundary with the surrounding tissues. For the nodules and masses close to the lung surface, a wedge resection was performed, and a linear cutting closed suture device was used to perform a wedge resection. The specimen was carefully searched according to the puncture path, and the frozen section was sent during the operation to confirm the posterior line. For the deep nodules and masses, segmentectomy was performed, and the segmental arteries and bronchi were treated. The inflation-collapse method was used to confirm the boundary, and the linear cutting closed suture device was used to remove the specimen. After confirming the location of the nodules and masses, the frozen section was sent to determine whether to perform lymph node dissection and lobectomy.

Figure 1 
                  Representative images before and after operation. (a) The markers appeared bule-purple on thoracoscopy (as the white arrow points); (b) after dissection, the gray-white nodules were marked with a line (as the white arrow points).
Figure 1

Representative images before and after operation. (a) The markers appeared bule-purple on thoracoscopy (as the white arrow points); (b) after dissection, the gray-white nodules were marked with a line (as the white arrow points).

2.4 Statistical analysis

Data were analyzed by SPSS 22.0. Data were shown as mean ± standard deviation (SD). Fisher’s precision probability test was used to compare the difference in the probability of pneumothorax and hemothorax after puncture between the groups. A P-value of less than 0.05 was considered statistically significant.

3 Results

3.1 Positioning and analysis of nodules and masses

The clinical characteristics of the patients are shown in Table 1. Single nodule/mass was located in 85 cases, 2 nodules/masses in 23 cases, and 3 nodules/masses in 5 cases. The average diameter of nodules and masses was (8.39 ± 4.00) mm (range 3–31 mm), and the average vertical distance between nodules/masses and pleura was 11.11 ± 8.07 mm (range 0–31.5 mm).

Table 1

Clinical data of all patients

Characteristic Results
Age, years (mean ± SD) 51.91 ± 11.64
Sex (male/female) 39/74
Number of localized nodules and masses
 1 85
 2 23
 3 5
Characteristics of nodules and masses
 pGGO 113
 mGGO 17
Solid 16
Diameter of nodules and masses
 ≤1.0 cm 120
 >1.0 cm 26
Location of nodules and masses
 Upper/middle/lower lobes of the right lung 59/6/26
 Upper/lower lobes of the left lung 39/18
Time from positioning to surgery, h (mean ± SD) 22.16 ± 6.22

SD, standard deviation; pGGO: pure ground-glass opacity; mGGO: mixed ground glass opacity.

Among 146 nodules and masses, 144 nodules and masses were successfully identified and 2 nodules and masses were failed, with a success rate of 98.63% (144/146). As for the two nodules and masses that failed to be identified, one showed only a small amount of haze formation in the lung tissue after localization, which was not clearly displayed during the operation. The location of the other one was too deep, and the lung itself was seriously pigmented, and no obvious pleural hematoma and purple markers were found by thoracoscopy during operation. It was necessary to confirm the position of the needle eye of the chest wall after lung inflation and to comprehensively determine the location of the nodules and masses.

The remaining 144 localized nodules and masses were identified as typical purplish red pleural hematoma under thoracoscopy. The average time from the detection of nodules and masses to localization was 13.63 ± 5.14 min. The average time from puncture to surgery in 113 patients was about 22.16 ± 6.22 h. After positioning, the stained area of pleura marked with purple red was explored under thoracoscopy during the operation (Figure 1).

3.2 Complications

One case had a small amount of suspected hemothorax after puncture, but no progress was found after observation. Intraoperative exploration showed that pleural hemorrhage did not exceed 80 ml. Two cases had a small amount of pneumothorax after puncture, and the compression did not exceed 90%, and no special treatment was given. No hemoptysis, irritating dry cough, thrombosis, and other reactions occurred in the whole group, and the overall complication rate was 2.65%. In addition to the cost of puncture operation, only an additional cost of 12.25 yuan/methylene blue was incurred.

3.3 Postoperative pathological diagnosis of nodules and masses

The postoperative pathological diagnosis of 146 nodules and masses was as follows: malignant nodules and masses accounted for 80.82% (118/146), including 5 atypical adenomatous hyperplasia, 58 adenocarcinoma in situ, 42 minimally invasive adenocarcinoma, and 13 invasive adenocarcinoma, and benign nodules/masses accounted for 19.18% (28/146).

3.4 Comparison of probability of pneumothorax and hemothorax

The 113 patients were divided into 1 nodule/mass localization group, 2 nodules/masses localization group, and 3 nodules/masses localization group. There was no significant difference in the probability of pneumothorax and hemothorax after puncture between the groups (P > 0.05) (Table 2).

Table 2

Comparison for incidence of complications between different positioning arrays

Group with 1 nodule and mass Group with 2 nodules and masses Group with 3 nodules and masses P
N 85 23 5
Pneumothorax 1 1 0 0.436
Hemothorax 0 1 0 0.248

4 Discussion

CT-guided percutaneous lung localization is an important auxiliary method for the surgical treatment of small pulmonary nodules and masses. At present, several methods are commonly used: (1) a Hookwire localization method, which is the most common puncture technique [4], is CT-guided percutaneous puncture with a hook wire; the metal wire can be lifted to make the lesion located at the top of the lung tissue, which is easy to grasp the resection margin. VATS surgery should be performed within 1–2 h after puncture. The disadvantage is that the wire is easily displaced and leads to positioning failure, which produces the risk of complications such as pneumothorax, hemoptysis, and pleural reaction, and in addition, the positioning needle will be difficult to handle if the operation is suspended for various reasons. Patients with conditions can choose to perform surgery immediately after puncture in a hybrid operating room, which can effectively reduce the occurrence of complications [5]. (2) The positioning method of percutaneous puncture coil [6], which is a platinum microcoil commonly used for interventional embolization, has no barbed design, and the tip of the microcoil is released around the nodule and the tail is released on the lung surface under the guidance of CT. The localization of the nodules and masses can be accomplished by inspection, palpation, and lifting the tail. Compared with a Hookwire system, the small nodules can be fixed in place by the friction between the spring coil and the lung tissue [7,8]. (3) Percutaneous puncture liquid material injection positioning method, liquid material including lipiodol, methylene blue, indocyanine green, etc. [9,10]. All kinds of positioning materials have their own advantages and disadvantages, and all of them have certain value, but they also have the risk of allergy, pneumothorax, bleeding, and pleural reaction [3,11]. In addition, there are other methods such as intraoperative ultrasound localization, virtual reality technology-assisted localization, and intraoperative electromagnetic navigation bronchial localization. However, due to the complicated steps and high cost, their clinical promotion is limited.

When methylene blue is used for localization alone, the operation should be performed within 2 h after puncture because of the rapid diffusion speed, otherwise the localization will fail due to the diffusion of the marker [12]. Over-injection of methylene blue may also cause diffuse staining and lead to localization failure. The success rate of localization is about 85%, which is lower than that of methods such as Hookwire localization [13]. It has the advantage of less complications and lower cost [14]. In clinical practice, if the operation cannot be performed immediately after puncture, this method is not suitable, so the application of methylene blue in puncture localization is limited. Mixing with other liquid positioning materials is also a scheme to improve the positioning effect of methylene blue puncture. If it is mixed with medical tissue glue for positioning, its diffusion can be avoided and better positioning effect can be achieved. However, tissue glue is a foreign body, which may cause irritating cough. In addition, the glue and methylene blue may coagulation during the mixing process so as to affect the use. It is necessary to explore the ratio of glue produced by different manufacturers and methylene blue that may be applicable [15,16].

When using autologous blood alone, the hematoma formed by autologous blood puncture also has the problem of diffusion. Generally, it is recommended to complete the operation within 12 h, otherwise the hematoma may disappear [17]. In addition, there is the problem of insufficient color development, especially for patients with severe pigmentation on the surface of the lung itself; it may be unclear and lead to localization failure. However, this method also has many advantages, because autologous blood injection through the needle tract itself can reduce the incidence of pneumothorax during lung puncture [18], and there are also reports that autologous blood is used as a patch to treat refractory pneumothorax [19]. The probability of pneumothorax and hemothorax is lower than other puncture methods, and it also has the advantages of convenient sampling, small rejection reaction, and self-absorption of hematoma even if the operation cannot be performed. If improved, it is expected to become a safer and more reliable new localization method.

The use of methylene blue combined with autologous blood for preoperative puncture localization overcomes the shortcomings of insufficient diffusion absorption and color development of the above two materials, which not only improves the lack of color development but also prolongs the diffusion absorption time. The localization success rate was 98.63% (144/146), which was comparable with other methods (successful targeting rates [95% confidence interval] for hookwire, microcoil, and lipiodol localization were 0.98 (0.97, 0.99), 0.98 (0.96, 0.99), and 0.99 (0.98, 1.00), respectively) [20]. In this study, the average interval between puncture localization and operation was 22.16 ± 6.22 h, and the operation was performed almost 1 day after the completion of localization. The overall satisfactory positioning effect was still maintained. This method is more flexible than using methylene blue or autologous blood alone, and it can be used to locate the tumor 1 day before the operation. When methylene blue mixed with autologous blood is used for localization, the formation of subpleural blue-purple hematoma can be seen during the operation, which is easier to identify than autologous blood alone, and plays a good role in identifying the location.

This method has few complications (2.65%), no serious complications were found in this study, and no special treatment was given after puncture positioning to the operation. There was no obvious pneumothorax in the whole group, and the major complications rate of our method was also lower than hookwire, microcoil, medical dye, medical surgical adhesive, and contrast agent location [3]. The incidence of pneumothorax was lower than using autologous blood puncture positioning [17], which was related to the use of thinner PTC needle (18G).

The advantage of a liquid-based locator is that it allows the use of a finer needle than a metallic locator. Although a thinner puncture needle may reduce the risk of puncture trauma and pneumothorax, the finer the puncture needle is not the better. If the location is not obvious, a smaller puncture point is more likely to lead to difficulty in finding the puncture point, which may increase the risk of surgical failure.

Both methylene blue and autologous blood have great advantages in terms of the availability and economy of the required materials. Methylene blue as a simple routine preparation is in sufficient supply, and the acquisition of autologous blood is not affected by the supply chain of drug consumables. In addition, under the background of the gradual promotion of DRG payment mode of medical insurance, the more economical puncture positioning scheme also makes the total hospitalization cost of patients not easy to exceed the standard.

In summary, the use of methylene blue mixed with autologous blood for CT-guided lung puncture positioning has the advantages of high accuracy, low incidence of complications, relatively simple positioning operation, low cost, and easy-to-obtain required consumables. However, there are still disadvantages, such as poor identification of cases with severe lung surface pigmentation, and unclear display when puncture is deep from the pleura. The overall effect of this method is satisfactory and can be carried out in most hospitals, which is worthy of further clinical promotion.

Acknowledgments

This study was supported by the staff of the Department of Thoracic Surgery at the First Affiliated Hospital of Fujian Medical University.

  1. Funding information: This study was funded by the National Key R&D Program of China (grant no. 2022YFC2407303).

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

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

References

[1] Wang LL, He BF, Cui JH, Gao XL, Sun JY. Electromagnetic navigational bronchoscopy-directed dye marking for locating pulmonary nodules. Postgrad Med J. 2020 Nov;96(1141):674–9.10.1136/postgradmedj-2019-137083Search in Google Scholar PubMed

[2] Liu B, Gu C. Expert consensus workshop report: Guidelines for preoperative assisted localization of small pulmonary nodules. J Cancer Res Ther. 2020 Sep;16(5):967–73.10.4103/jcrt.JCRT_449_20Search in Google Scholar PubMed

[3] Wang L, Sun D, Gao M, Li C. Computed tomography-guided localization of pulmonary nodules prior to thoracoscopic surgery. Thoracic Cancer. 2023 Jan;14(2):119–26.10.1111/1759-7714.14754Search in Google Scholar PubMed PubMed Central

[4] Jin X, Wang T, Chen L, Xing P, Wu X, Shao C, et al. Single-stage pulmonary resection via a combination of single hookwire localization and video-assisted thoracoscopic surgery for synchronous multiple pulmonary nodules. Technol Cancer Res T. 2021 Jan-Dec;20(1):259–65.10.1177/15330338211042511Search in Google Scholar PubMed PubMed Central

[5] Zhao ZLR, Ng C. Hybrid theatre and alternative localization techniques in conventional and single-port video-assisted thoracoscopic surgery. J Thorac Dis. 2016 Mar;8(Suppl 3):S319–27.Search in Google Scholar

[6] McGuire AL, Vieira A, Grant K, Mayo J, Sedlic T, Choi J, et al. Computed tomography-guided platinum microcoil lung surgery: A cross-sectional study. J Thorac Cardiovasc Surg. 2019 Aug;158(2):594–600.10.1016/j.jtcvs.2019.03.096Search in Google Scholar PubMed

[7] Zhang WH, Bai YY, Guo W, Li M, Chang GX, Liu W, et al. Application of intrapulmonary wire combined with intrapleural fibrin glue in preoperative localization of small pulmonary nodules. Medicine (Baltimore). 2019 Jan;98(4):e14029.10.1097/MD.0000000000014029Search in Google Scholar PubMed PubMed Central

[8] Hu L, Gao J, Chen C, Zhi X, Liu H, Hong N. Comparison between the application of microcoil and hookwire for localizing pulmonary nodules. Eur Radiol. 2019 Aug;29(8):4036–43.10.1007/s00330-018-5939-4Search in Google Scholar PubMed

[9] Zhang CY, Yu HL, Liu SH, Jiang G, Wang YJ. Effect of lipiodol and methylene blue on the thoracoscopic preoperative positioning. Int J Clin Exp Med. 2015 May 15;8(5):7569–76.Search in Google Scholar

[10] Kreklau A, Benitez RL, Fornaro J, Meili G, Günthert A. Computer tomography-guided percutaneous indocyanine green injection for intraoperative mapping of metastatic suspected lesions. Front Med. 2018 Jul 10;5:191.10.3389/fmed.2018.00191Search in Google Scholar PubMed PubMed Central

[11] Wang B, Zeng Y, Zhao Z, Wang T, Ma Z, Yu G. A safe and novel method for video-assisted thoracic surgery preoperative localization of small pulmonary nodules by using ZT medical glue (2-octyl cyanoacrylate). Surg Oncol. 2020 Jun;33:164–9.10.1016/j.suronc.2020.02.001Search in Google Scholar PubMed

[12] Bi S. The application of methyltllioIliIliullI cMoride injection during resection of pulmonary nodule with video-assitstant thoracic surgery. J Yanan Univ. 2020;18(1):30–3 (Chinese).Search in Google Scholar

[13] Liao M, He Z, Xu E, Wu D. Value of preoperative localization techniques for solitary pulmonary nodules in singleport thoracoscopic surgery. Nan fang yi ke da xue xue bao = J Southern Med Univ. 2020;40(5):718–22 (Chinese).Search in Google Scholar

[14] Kleedehn M, Kim DH, Lee FT, Lubner MG, Robbins JB, Ziemlewicz TJ, et al. Preoperative pulmonary nodule localization: A comparison of methylene blue and hookwire techniques. AJR Am J Roentgenol. 2016 Dec;207(6):1334–9.10.2214/AJR.16.16272Search in Google Scholar PubMed

[15] Qian K, Zhi X, Yi Z, et al. Application of CT-guided localization with medical glue injection in treatment of ground-glass opacity and pulmonary nodules with video-assisted thoracoscope surgery. J Capital Med Univ. 2015;36(4):4 (Chinese).Search in Google Scholar

[16] Kong J, Guo J, Zhang H, Li Y, Wang G, Zhang Y. CT-guided localization techniques of small pulmonary nodules: a prospective non-randomized controlled study on pulmonary nodule localization needle and methylene blue staining with surgical glue. J Thorac Dis. 2020 Nov;12(11):6826–35.10.21037/jtd-20-3147Search in Google Scholar PubMed PubMed Central

[17] Wu GJX, Lu D. Preoperative localization of small peripheral pulmonary nodules by autologous blood marking under computed tomography guidance. Chin J Inter Rad (Electron Ed). 2011 Jul;13(1):25–8.10.1510/icvts.2011.266932Search in Google Scholar PubMed

[18] Liu GZX, Su Q. Evaluation of autologous blood injection through catheter sheath in reducing the incidence of pneumothorax after CT-guided percuataneous lung biopsy:a clinical study. J Intervent Rodiol. 2020;29(01):79–82.Search in Google Scholar

[19] Hasan IS, Allen MS, Cassivi SD, Harmsen WS, Mahajan N, Nichols FC, et al. Autologous blood patch pleurodesis for prolonged postoperative air leaks. J Thorac Dis. 2021 Jun;13(6):3347–58.10.21037/jtd-20-1761Search in Google Scholar PubMed PubMed Central

[20] Vollmer I, Páez-Carpio A, Sánchez-Lorente D, Boada M, Martínez D, Sánchez M, et al. Preoperative localization of lung nodules: a comparative analysis of hookwire and radio-guided procedures. J Thorac Dis. 2022 Nov;14(11):4329–40.10.21037/jtd-22-552Search in Google Scholar PubMed PubMed Central

Received: 2023-02-28
Revised: 2023-04-27
Accepted: 2023-05-31
Published Online: 2023-07-09

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

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

Articles in the same Issue

  1. Biomedical Sciences
  2. Systemic investigation of inetetamab in combination with small molecules to treat HER2-overexpressing breast and gastric cancers
  3. Immunosuppressive treatment for idiopathic membranous nephropathy: An updated network meta-analysis
  4. Identifying two pathogenic variants in a patient with pigmented paravenous retinochoroidal atrophy
  5. Effects of phytoestrogens combined with cold stress on sperm parameters and testicular proteomics in rats
  6. A case of pulmonary embolism with bad warfarin anticoagulant effects caused by E. coli infection
  7. Neutrophilia with subclinical Cushing’s disease: A case report and literature review
  8. Isoimperatorin alleviates lipopolysaccharide-induced periodontitis by downregulating ERK1/2 and NF-κB pathways
  9. Immunoregulation of synovial macrophages for the treatment of osteoarthritis
  10. Novel CPLANE1 c.8948dupT (p.P2984Tfs*7) variant in a child patient with Joubert syndrome
  11. Antiphospholipid antibodies and the risk of thrombosis in myeloproliferative neoplasms
  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”
Downloaded on 6.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/biol-2022-0645/html
Scroll to top button