Home Primary mediastinum Ewing’s sarcoma with pleural effusion: A case report and literature review
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Primary mediastinum Ewing’s sarcoma with pleural effusion: A case report and literature review

  • Xuhong Li , Shan Qi , Taiwen Zhu , Ying Jiang and Wei Wang EMAIL logo
Published/Copyright: August 1, 2023
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Open Life Sciences
From the journal Open Life Sciences Volume 18 Issue 1

Abstract

Ewing’s sarcoma (ES) is an aggressive cancer in young adults. Primary ES occurring in the chest with pleural effusion is even rarer. We report the case of a 15-year-old girl who presented with intermittent chest pain occurring for more than 2 months and cough and wheezing for 10 days. Radiological imaging showed a large soft tissue mass with multiple small vessel shadows near the left mediastinum and bloody pleural effusion in the left thorax. ES was diagnosed by positive immunostaining for CD99, FLI-1, and NKX2 combined with fluorescence in situ hybridization detection of the EWSR1 gene arrangement. With chemotherapy, lung computed tomography revealed that the tumor had become much smaller, and the fluid was absorbed. We report a case of extraskeletal Ewing’s sarcoma (EES) in the mediastinum with pleural effusion, which is unusual and challenging. EES is a highly malignant tumor with a poor prognosis. Early diagnosis and treatment can improve the survival rate of patients.

Graphic abstract the timeline of the treatment

Keywords: extraskeletal Ewing’s sarcoma; mediastinum Ewing’s sarcoma; pleural effusion

1 Background

Ewing’s sarcoma (ES) is a malignant tumor thought to originate from mesenchymal stem cells [1]. The tumor mainly occurs in children and adults, with a slight preference in males. It has an incidence rate of 4.5 per million per year in the population [2]. ES commonly occurs in the bones, especially the pelvis and limbs; however, it can also occur in many extraskeletal sites [3].

Extraskeletal Ewing’s sarcoma (EES) accounts for approximately 20% of ES cases and shows a bimodal age distribution among children and adults [4]. The incidence of EES is 0.4 per million individuals, and it has a high degree of malignancy and poor prognosis [5]. EES can occur in any soft tissue and is often misdiagnosed as other diseases. However, the most common sites are the upper thigh, buttocks, upper arm, and shoulders [4]. EES has also been reported to occur in the ribs, abdomen, and seminal vesicles [3,6,7]. However, EES originating from the mediastinum with massive pleural effusion has rarely been reported. Here, we report a case of EES with pleural effusion and review previous case reports to provide a better understanding of EES.

2 Case presentation

A 15-year-old girl was admitted to our hospital due to intermittent chest pain occurring for more than 2 months and cough and wheezing for 10 days. The patient was a student, and her family denied a history of malignancy. Chest examination revealed solid sounds obtained during percussion and low breath sounds over the left thorax.

The laboratory tests showed increased procalcitonin (26.59 ng/ml), elevated interleukin-6 (15.2 pg/ml), and a slightly high erythrocyte sedimentation rate of 28 mm/h. The patient underwent transcatheter thoracic drainage to determine the features of the pleural effusion, and a routine examination showed bloody turbid pleural effusion without tumor cells (Figure 1). However, the levels of carcinoembryonic antigen and lactic dehydrogenase in the pleural effusion were more than three times the normal upper limit. Acid-fast staining and tuberculosis gene sequencing of the pleural effusion were normal, helping us rule out the possibility of tuberculous pleural effusion.

Figure 1 Examination of the pleural effusion showed massive lymphocytes, and no obvious heterotypic epithelial cells were detected.
Figure 1

Examination of the pleural effusion showed massive lymphocytes, and no obvious heterotypic epithelial cells were detected.

A chest computed tomography (CT) scan showed a large soft tissue mass (15.7 × 11.7 × 10.5 cm) near the left mediastinum with multiple nodules and masses in the left pleura, and the fluid could be seen on the same side of the thorax (Figure 2a and b). Moderately heterogeneous enhancement with multiple small vessel shadows could be seen in the aforementioned mass and nodules after the injection of a contrast agent (Figure 2a and b). A radiological examination of the abdomen and brain revealed no other lesions.

Figure 2 CT scan of the thorax. (a and b) A mass with multiple small vessel shadows was observed near the mediastinum. A pleural effusion was found in the left thorax. (c and d) Chest CT after one cycle of chemotherapy showed that the mass and fluid decreased. (e and f) After six treatment cycles, the tumor was hard to observe, and no pleural effusion could be observed. CT: computed tomography.
Figure 2

CT scan of the thorax. (a and b) A mass with multiple small vessel shadows was observed near the mediastinum. A pleural effusion was found in the left thorax. (c and d) Chest CT after one cycle of chemotherapy showed that the mass and fluid decreased. (e and f) After six treatment cycles, the tumor was hard to observe, and no pleural effusion could be observed. CT: computed tomography.

A percutaneous puncture biopsy was performed to clarify the properties of this mass. Pathological examination showed a population of small, round, deeply stained tumor cells. The tumor cells formed clusters. Immunohistochemical results demonstrated strong positivity for CD99, FLI-1, and NKX2, which are the markers of EES. The cells were also positive for Ki‐67 (approximately 30%). The tumor cells were negative for MPO, GFAP, CD30, EMA, CgA, desmin, and WT-1 (Figure 3). The negativity for these markers excluded lymphoma and glioma. After discussion by a multidisciplinary treatment (MDT) team, the mass was initially identified as ES derived from the mediastinum. Fluorescence in situ hybridization (FISH) suggested EWSR1 gene breakage and rearrangement (Figure 4). Based on the aforementioned results, the patient was diagnosed with left mediastinum ES with pleural effusion.

Figure 3 Pathological examination of the tumor. (a) Hematoxylin and eosin staining of the mass showed small and deeply stained cells with less extracellular matrix. (b–d) Immunohistochemistry of sections showed positivity for CD99, FLI-1, and NKX2. Scale bar = 20 μm.
Figure 3

Pathological examination of the tumor. (a) Hematoxylin and eosin staining of the mass showed small and deeply stained cells with less extracellular matrix. (b–d) Immunohistochemistry of sections showed positivity for CD99, FLI-1, and NKX2. Scale bar = 20 μm.

Figure 4 Molecular pathology of the tumor was detected by FISH. (a and b) Molecular pathology indicated EWSR1 rearrangement. The percentage of cells with EWSR1 breakage (red and green signal points separated) in the visual field was approximately 71%.
Figure 4

Molecular pathology of the tumor was detected by FISH. (a and b) Molecular pathology indicated EWSR1 rearrangement. The percentage of cells with EWSR1 breakage (red and green signal points separated) in the visual field was approximately 71%.

Considering the age, tumor size and properties, and the consensus from the MDT meeting, the patient received treatment with cyclophosphamide (1.8 g), adriamycin (doxorubicin) (75 mg), and vincristine (2 mg) (VDC) for the first cycle. After finishing one cycle of chemotherapy, a CT scan of the chest revealed that the tumor was approximately half its size before treatment, and the pleural effusion had decreased (Figure 2c and d). After approximately 3 weeks, the patient received cyclophosphamide (1.6 g), adriamycin (doxorubicin) (67.5 mg), and vincristine (1.8 mg) for the second cycle. After six cycles of treatment, the tumor was hard to observe, and no pleural effusion was observed (Figure 2e and f). The patient felt no chest pain and did not cough or wheeze. For the ongoing treatment plan, a regular chemotherapy will be continued, and the patient is advised to follow up.

  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 authors’ institutional review board or equivalent committee.

3 Discussion

EES and ES both belong to the ES family of tumors, which has a common histology and genetic mechanism. ES is the second most common bone cancer in children, and EES only occurs in 20% of ES cases [8]. However, EES has a high degree of malignancy and a poor prognosis. Patients with EES often suffer from localized pain and present with nonspecific symptoms [8]. Thus, it may be mistaken for other diseases. Therefore, differential diagnosis is particularly important.

ES and EES are characterized by monomorphic, small, round blue cells. Small round cell sarcomas (SRCSs) share histological similarities with ES. Capicua transcriptional repressor (CIC)-rearranged sarcoma (CIC sarcoma) and BCOR-rearranged sarcoma (BCOR sarcoma) are two typical SRCSs [9]. CIC sarcoma is composed of slightly pleomorphic round cells [10]. However, BCOR sarcoma is composed of a mixed proliferation of round and spindle cells [11]. Immunohistochemically, CIC sarcoma and BCOR sarcoma are positive for CD99, which is an important marker of ES. CIC sarcoma can express patchy CD99, whereas CD99 is diffusely expressed in ES [11]. The biggest difference between SRCSs and ES is the gene mutation. CIC sarcoma often shows CIC–DUX4 fusion [12]. BCOR sarcoma often presents as BCOR–CCNB3 fusion [11]. However, ES is defined by fusions between FET and ETS, with approximately 85% of tumors expressing the EWSR1–FLI1 fusion [13].

Early diagnosis and treatment of EES can improve the survival rate of patients. The diagnosis is mainly based on imaging and histopathology. Imaging plays an important role in the evaluation and treatment management of EES [14]. CT findings of EES include a large mass with a similar intensity to that of the soft tissue. Calcification occurs in 10% of cases [4]. Although the imaging findings of CT are nonspecific, chest CT is important to assess the tumor size, shape, and boundary. Contrast-enhanced CT helps to assess the blood supply of the EES. Immunohistochemically, ES cells are positive for CD99, NKX2, and FLI-1 [15]. S-100 protein, CD57, neurofilaments, cytokeratin, and desmin are nonspecific markers of ES [11]. Additionally, the detection of EWSR1–FLI1 fusion is helpful in diagnosis. In our case, the patient exhibited cough and wheezing because of pleural effusion. Pleural effusion in patients, especially children or adolescents, is often mistaken for tuberculous hydrothorax, as tuberculosis is one of the main reasons for pleural effusion in our country. However, after further extraction of the pleural effusion, we found a large mediastinal mass by CT and performed a puncture biopsy. Immunohistochemistry of the mass showed positivity for CD99, FLI-1, and NKX2. Finally, the mass was diagnosed as EES after a discussion at the MDT meeting.

Treatment for EES is similar to that for ES. The current management of primary ES is a combination of cytotoxic drugs and local management, which includes surgery and radiotherapy [8]. Multiagent chemotherapy is critical to the treatment of ES. Vincristine, adriamycin (doxorubicin), and cyclophosphamide alternating with ifosfamide and etoposide (VDC/IE) are the standard treatments for ES in North America [16]. In Europe, vincristine, ifosfamide, doxorubicin, and etoposide are used for induction therapy. After induction therapy, high-dose chemotherapy with subsequent stem cell rescue can be used as consolidation treatment [16]. Definitive local therapy is recommended after induction chemotherapy [17]. For local control, surgery is performed in cases where complete resection is possible. Although ES is radiosensitive, the long-term outcome of radiotherapy alone for local control is less effective [4]. Radiotherapy could be used for local control when the mass is unresectable. In our case, the patient received chemotherapy and had an excellent outcome; therefore, she did not receive surgery and radiotherapy temporarily.

Although pulmonary EES has been reported in previous case reports, primary EES in the mediastinum with massive pleural effusion is rare [18]. We used “Sarcoma, Ewing’s, Ewing’s Sarcoma, Ewing’s Tumor” and “Effusion, Pleural, Pleural Effusions” as the keywords for a literature search and excluded publications regarding tumors originating from the chest wall. Here, we have summarized six cases from 2011 to 2023 [19,20,21,22,23,24] (Table 1). Of these six patients, four were female and two were male, exhibiting cough, dyspnea, chest pain, and tightness as the main clinical presentation. Among these patients, the oldest was 66 years of age, which is very rare. In addition, old age also contributes to poor outcomes. Of these cases, only one patient had gene examinations performed [20]. We consider gene examination combined with pathology to be more accurate. Three cases exhibited positivity for Ki-67, and we believe that this marker may be inversely correlated with the survival rate [19,21,24]. Primary EES in the mediastinum is easily mistaken for other tumors. Aldo Caltavituro et al. reported a 30-year-old female with recurrent EES in the mediastinum, which was mistaken for thymic carcinoma [24]. Because of the recurrent EES, they treated the patient with nine cycles of VDC/IE and two courses of high-dose chemotherapy followed by autologous transplantation. Our patient received different treatments and, similar to that 30-year-old female, has had an excellent outcome thus far. However, our patient still needs further long-term follow-up. Additionally, surgery was performed to relieve the symptoms in four cases [19,21,22,24]. This highlights the importance of local management.

Table 1

Primary EES with massive pleural effusion

First author Publication date Age (y) Gender Primary site Clinical manifestation Diagnosis method Ki-67 Therapy outcome
Aldo Caltavituro 2023 30 Female Mediastinum Cough, dyspnea Pathology 40% Surgery Follow-up
Chemotherapy (VDC/IEa, HDCT/ASCT)
Manman Cui 2023 66 Male Mediastinum Chest tightness Pathology 90% Surgery Death
Xuefeng Ling 2021 15 Female Lobe Chest pain, cough, dyspnea Pathology >70% Surgery Follow-up
Chemotherapy (VDC/IEa)
Xuexue Zou 2021 14 Male Pleura Fever, dyspnea Pathology FISH NSb Chemotherapy Death
(VDC/IEa)
Radiotherapy
Abhijith Bhaskaran 2021 34 Female Pleura Fever, cough, dyspnea Pathology NSb Chemotherapy, surgery, radiotherapy NSb
C Karatziou 2011 21 Female Visceral pleura Fever, cough, chest pain Pathology NSb Chemotherapy NSb

Abbreviations: VDC: vincristine, adriamycin (doxorubicin), cyclophosphamide; IE: ifosfamide, etoposide; HDCT/ASCT: high-dose chemotherapy followed by autologous stem cell transplantation. aVDC/IE: vincristine, adriamycin, and cyclophosphamide alternating with ifosfamide and etoposide. bNS: not stated.

In summary, EES is a highly aggressive tumor with a poor prognosis that can occur in many parts of the body. The diagnosis should involve a combination of clinical manifestations, CT imaging, and multidisciplinary discussion. Image-guided needle biopsies are especially important because they can provide early diagnosis. To improve the long-term survival rate of patients, chemotherapy should be adopted in a timely manner in combination with surgery or radiotherapy.

4 Conclusion

In this study, we report a rare case of primary mediastinum EES with massive pleural effusion. EES is a highly malignant tumor with a poor prognosis. Reports of this disease are rare, and there is little experience in treatment. The diagnosis and treatment of this disease require the joint discussion and analysis of experts from multiple disciplines (including respiratory, radiology, pathology, thoracic surgery, and oncology). Therefore, we must summarize the characteristics of more cases to provide evidence for further early diagnosis and improve the survival rate of patients.

# These authors contributed equally to this work.

Acknowledgments

We would like to acknowledge the hard and dedicated work of all the staff. We also appreciate the selfless dedication of our patient.

  1. Funding information: This work was supported by Zhongnan Hospital of Wuhan University Science, Technology and Innovation Cultivation Fund (Grant Number CXPY2022084, XKJS202011).

  2. Author contributions: W.W. conceived the original idea of the work. X.H.L. and S.Q. performed and drafted the manuscript. T.W.Z. and Y.J. reviewed the manuscript. All authors approved 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 this study are available from the corresponding author on a reasonable request.

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Received: 2023-03-06
Revised: 2023-06-11
Accepted: 2023-07-06
Published Online: 2023-08-01

© 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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  96. TAK-242, a toll-like receptor 4 antagonist, against brain injury by alleviates autophagy and inflammation in rats
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  103. Intravaginal estrogen management in postmenopausal patients with vaginal squamous intraepithelial lesions along with CO2 laser ablation: A retrospective study
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  115. Diagnostic value of serum neuroactive substances in the acute exacerbation of chronic obstructive pulmonary disease complicated with depression
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  117. TRIM29 knockdown prevented the colon cancer progression through decreasing the ubiquitination levels of KRT5
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  121. The effect of NK cell therapy on sepsis secondary to lung cancer: A case report
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  129. Knockdown of DLK4 inhibits non-small cell lung cancer tumor growth by downregulating CKS2
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  132. CD4+ T cell count in HIV/TB co-infection and co-occurrence with HL: Case report and literature review
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  134. Bioinformatics analysis to identify potential biomarkers for the pulmonary artery hypertension associated with the basement membrane
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  171. Advances in diagnosis and treatment of perimenopausal syndrome
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  176. Novel risk prediction models for deep vein thrombosis after thoracotomy and thoracoscopic lung cancer resections, involving coagulation and immune function
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  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
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  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
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  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
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  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
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  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
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  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”
https://doi.org/10.1515/biol-2022-0669
Keywords for this article
extraskeletal Ewing’s sarcoma; mediastinum Ewing’s sarcoma; pleural effusion
Creative Commons
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  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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