A combination therapy for Kawasaki disease with severe complications: a case report
-
Yuriko Abe
Abstract
Kawasaki disease (KD) is a form of acute multisystem vasculitis that presents with various complications, including coronary artery aneurysm. Heart failure and brain damage are rare, but life-threatening complications are associated with KD. Here, we describe a 4-year-old girl who developed intravenous immunoglobulin-resistant KD with both left ventricular failure and acute encephalopathy. On day 8 of the illness, the low left ventricular ejection fraction, mitral regurgitation, and low blood pressure, which required continuous administration of dobutamine, were observed during the treatments for KD, including intravenous immunoglobulin. She also appeared unconscious, where the electroencephalogram showed slow waves of activity in all regions of the brain. The cardiac performance improved after she received plasma exchange for three days. However, her unconsciousness with slow waves of activity on electroencephalogram and fever continued after the plasma exchange. Therefore, she was treated with methylprednisolone pulse, followed by prednisolone, as well as intravenous immunoglobulin. Finally, she recovered without any cardiac or neurological sequelae not only at the time she was discharged, but also throughout the follow-up period. The combination therapy using plasma exchange and methylprednisolone pulse may be a treatment option for severe KD with left ventricular failure and acute encephalopathy complications.
1 Introduction
Kawasaki disease (KD) is a form of acute febrile multisystem vasculitis of unknown etiology, which most often affects children younger than 5 years of age [1, 2, 3, 4, 5]. It is known that there are various complications associated with KD, including coronary artery aneurysm, and some complications are life-threatening, such as heart failure [6] and encephalopathy [7, 8].
The use of intravenous immunoglobulin (IVIG, a single dosage of 2 g/kg) and oral aspirin (a dosage of 30 mg/kg/day) are established as first-line therapy for KD with efficacy and safety [9]. However, some are IVIG-resistant. Recently, various treatments have been tested for IVIG-resistant KD [10]. However, the treatments for IVIG-resistant KD, especially life-threatening KD, have not yet been established. Here, we report on a rare case of a girl who developed IVIG-resistant KD with left ventricular failure and acute encephalopathy, who was successfully treated with plasma exchange (PE), methylprednisolone pulse (MP), and additional IVIG. Importantly, our patient recovered without any cardiac or neurological sequelae. Written informed consent was obtained from the parents of the patient for the publication of the data.
2 Case Report
A 4-year-old girl admitted to our hospital with a highgrade fever, that lasted for seven days, with conjunctival injection, erythema of the lips, cervical lymphadenopathy, and erythema of the palms and soles. The results of her laboratory examinations revealed an increase in white blood cells, in C-reactive protein, in N-terminal pro-brain natriuretic peptide, in interleukin (IL)-6, and in tumor necrosis factor-α (TNF-α) levels (Table 1). Echocardiography showed that the left ventricular ejection fraction was 45% without coronary artery aneurysm. A clinical diagnosis of KD was made, and then the patient was treated with IVIG (a dosage of 2 g/kg), aspirin (a dosage of 30 mg/kg/day), ulinastatin (5000 units/kg/dose, four times a day), and furosemide (1 mg/kg/dose, three times a day) on day 7 of the illness. Despite these treatments, her fever maintained. We found congestion on the chest X-ray scans that were taken on day 8 of the illness (Fig. 1A). In her echocardiography, on day 8 of the illness, the left ventricular ejection fraction was 39% and mild mitral regurgitation was detected, indicating left heart failure (Fig. 1B). Her blood pressure decreased to 80/40 mmHg, which thus required the continuous administration of dobutamine (2 μg/kg/min). The electrocardiogram showed low voltage in the limb leads. In addition, at the same time, unconscious (Glasgow coma scale: 8 [Eye opening: 2, Verbal response: 2, Motor response: 4]) appeared. The electroencephalogram (EEG) showed slow waves of activity in all regions of the brain, especially in the occipital lobe (Fig. 2A), although magnetic resonance imaging (MRI) scans of the brain were normal. Based on these findings, she was diagnosed with acute encephalopathy. As the progression of KD was getting worse, PE was started on day 8 of the illness and was repeated for three days (Fig. 3). The exchange volume was about 1- to 1.5-fold of the circulating plasma volume, which was calculated using the following formula: circulating plasma volume (ml) = body weight (g)/13 × [1-hematocrit (%)/100]. The replacement solution contained 5% albumin. During PE, she was sedated and her breathing was regulated by a respiratory assist device. Her fever went down and the left ventricular function got better during the treatment. However, the fever reoccurred soon after the PE ended. The EEG still showed slow waves of activity at the occipital lobe and parietal lobe. She was treated with MP (30 mg/kg/day) for three days followed by prednisolone administration, as well as IVIG (2 g/kg) to manage the encephalopathy and refractory fever. On day 13 of the illness, her body temperature normalized, and she regained consciousness after discontinuing the sedation and artificial respiratory support. On day 18 of the illness, the EEG showed improvement of slow waves (Fig. 2B), and on day 19, she was able to walk. She was discharged without any cardiac or neurological sequelae. She remained healthy without cardiac or neurological abnormalities during the one year of her follow-up appointments.
Image examinations on day 8 of illness
A: Chest X-ray
The cardio-thoracic ratio was 0.53 and congestion was observed in the hilum of both lungs.
B and C: Echocardiograms
The left ventricular ejection function was 39%, percent fractional shortening was 20.9%, and the left ventricular end-diastolic dimension was 33.9 mm (104% larger than in a normal case).
Electroencephalograms
A: Slow waves of activity in all brain regions, especially in the occipital lobe, were observed on day 8 of illness
B: Abnormal waves were recovered on day 18 of illness.
Clinical course
Treatments with IVIG (2 g/kg), aspirin (30 mg/kg/day), ulinastatin (5000 units/kg/dose, four times a day), and furosemide (1 mg/kg/dose, three times a day) were started on day 7 of illness. A continuous administration of dobutamine (2 μg/kg/min) was required, because of her low blood pressure. PE therapy was started on day 8 of illness because of left ventricular failure and acute encephalopathy. Due to the recurrence of the fever and EEG abnormalities, MP and IVIG were administered from day 11 of illness. Due to the combination therapy of IVIG, PE, and MP the symptoms of the patient improved.
BT: body temperature, CK: creatine kinase, CRP: C-reactive protein,
EEG: electroencephalogram, IVIG: intravenous immunoglobulin, KD:
Kawasaki disease, MP: methylpredonine pulse therapy, NT-proBNP:
N-terminal pro-brain natriuretic peptide, PE: plasma exchange,
WBC: white blood cell.
Laboratory tests on 7 days of illness
| WBC | 35,400 | /μl | CRP | 35.0 | mg/dl |
| Neutrophil | 93.5 | % | Na | 134 | mEq/l |
| Lymphocytes | 3.0 | % | T-bil | 0.28 | mg/dl |
| Erythrocyte | 436×104 | /μl | AST | 42 | U/l |
| Hemoglobin | 12.4 | g/dl | ALT | 53 | U/l |
| Hematocrit | 37.7 | % | CK | 75 | U/l |
| Platelet | 39.2×104 | /μl | CK-MB | 4 | U/l |
| BUN | 16.7 | mg/dl | |||
| Cr | 0.3 | mg/dl | |||
| HDL-C | 14 | mg/dl | |||
| TP | 5.9 | g/dl | |||
| Alb | 1.9 | g/dl | |||
| NTproBNP | 15,317 | pg/ml | |||
| Troponin I | 0.04 | ng/ml | |||
| IL-6 | 354 (normal level: <8) | pg/ml | |||
| IL-10 | >8 (normal level: <8) | pg/ml | |||
| TNF-α | 3.9 (normal level: <2.8) | pg/ml |
ALT: alanine transaminase, Alb: albumin, AST: aspartate transaminase, BUN: blood urinary nitrogen, CRP: C-reactive protein, CK: creatine kinase, Cr: creatinine, HDL-C: high density lipoprotein cholesterol, IL-6: interleukin-6, IL-10: interleukin-10, NTproBNP: N-terminal pro brain natriuretic peptide, Na: sodium, T-Bil: Total bilirubin, TNF-α: tumor necrosis factor-α, TP: total protein, WBC: white blood cell.
The research related to human use has been complied with all the relevant national regulations, institutional policies and in accordance the tenets of the Helsinki Declaration, and has been approved by the authors' institutional review board or equivalent committee.
3 Discussion
This is a rare case with severe complications that include both left ventricular failure and acute encephalopathy, which was treated with the combination therapy of IVIG, PE, and MP. Myocarditis frequently occurs in the acute phase of KD, which is usually transient; however, there are a few cases of severe myocarditis, which can result in death [11, 12]. In our rare case, the left ventricular failure was serious as there was a need for emergency PE. In regards to neurological complications, the central nervous system is also affected in 0.4% of KD cases. Complications of the central nervous system include seizures, ataxia, cerebral infarction, and subdual effusion [13, 14]. Also, clinical mild encephalitis/encephalopathy with a reversible splenial lesion diagnosed by MRI scans has been reported [15]. However, the finding was not documented on MRI scans in our case. KD with both heart failure and encephalopathy is extremely rare [16], but they are life-threatening complications.
Many previous studies have already reported the efficacy of IVIG in the acute phase of KD to reduce coronary artery abnormalities [9, 10, 17]. However, IVIG-resistant KD is still a serious condition. A recent study has shown that IVIG plus MP prevented coronary artery abnormalities in patients with IVIG-resistant KD [18]. MP might be a good treatment option to prevent coronary artery lesions in KD patients who are unresponsive to additional IVIG [18, 19]. On the other hand, a report has documented that PE was useful to prevent coronary artery abnormalities in patients with severe KD [20]. The removal of inflammatory cytokines might be effective in refractory KD [21]. PE has been used in Japan for over 15 years to prevent coronary artery aneurysm in IVIG-resistant KD patients. However, the efficacy of the combination therapy of PE and MP for severe IVIG-resistant KD patients still does not give any conclusive results. In our case, we initiated PE soon after IVIG treatment, because PE would be more effective in the early disease stage. As expected, PE led a positive effect on our patients’ heart failure. However, unconsciousness and fever were sustained unexpectedly. We, therefore, tried to the following MP for the encephalopathy. Some reports have shown that infliximab, an anti- TNF-α monoclonal antibody, or infliximab plus PE was effective for IVIG-resistant KD [10, 22]. The infliximab was not used in our case, because it is not recommended when the patient has severe heart failure. We speculate that the combination therapy of PE and MP might be safe and prevent cardiac or neurological sequelae in our IVIG-resistant KD.
KD with encephalitis or encephalopathy is also rare. An effective treatment has not been established yet. Some studies have shown that serum IL-6, IL-10, and TNF-α levels were elevated in KD, and these cytokines could cause brain damage in acute encephalopathy following prolonged febrile seizures [23]. Another study has highlighted that the central nervous system complications associated with KD might be due to focal impairment of blood flow caused by cerebral vasculitis [15]. In our case, high levels of serum IL-6 and TNF-α were considered to be the cause of the encephalopathy; regrettably however, the blood flow was not examined.
Another point of discussion is whether MP-alone treatment immediately after initial IVIG treatment followed by aspirin plus prednisolone was sufficiently effective. Suga et al. have reported that the MP combined with IVIG treatments for a KD patient with myocarditis and encephalopathy might inhibit the formation of aneurysms in coronary arteries [16]. However, our patient was a more severe case compared to the subjects of Suga et al. study, as the Glasgow coma scale and blood C-reactive protein levels of our patient were extremely high. Matsui et al. have reported a case of KD that was resistant to PE, but finally, the patient responded to simultaneous MP and PE [24]. Unfortunately, they did not describe the conscious state or the cardiac function of the patient [24]. As the number of reports on this subject matter is limited, it cannot draw the conclusion that MP-alone treatment is best for heart failure as well as encephalopathy. At least, PE would be a reliable treatment to prevent coronary artery complications.
The combination therapy of PE followed by MP cannot be applied for all severe KD patients, because our report is a case study. However, it may be a treatment option to improve IVIG-resistant KD complicated with left ventricular failure and acute encephalopathy.
Lists of abbreviations
- EEG
electroencephalogram
- IL
interleukin
- IVIG
intravenous immunoglobulin
- KD
Kawasaki disease
- MP
methylprednisolone pulse
- MRI
magnetic resonance imaging
- PE
plasma exchange
- TNF-α
tumor necrosis factor-α
Acknowledgement
This report was partially supported by the Japan Agency for Medical Research and Development (Grant number: 18fk0108047h0002).
Conflict of interest: Authors state no conflict of interest in this report.
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© 2020 Yuriko Abe et al., published by De Gruyter
This work is licensed under the Creative Commons Attribution 4.0 International License.
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- Diagnosis of complication in lung transplantation by TBLB + ROSE + mNGS
- Case Report
- Endometrial cancer in a renal transplant recipient: A case report
- Research Article
- Downregulation of lncRNA FGF12-AS2 suppresses the tumorigenesis of NSCLC via sponging miR-188-3p
- Case Report
- Splenic abscess caused by Streptococcus anginosus bacteremia secondary to urinary tract infection: a case report and literature review
- Research Article
- Advances in the role of miRNAs in the occurrence and development of osteosarcoma
- Rheumatoid arthritis increases the risk of pleural empyema
- Effect of miRNA-200b on the proliferation and apoptosis of cervical cancer cells by targeting RhoA
- LncRNA NEAT1 promotes gastric cancer progression via miR-1294/AKT1 axis
- Key pathways in prostate cancer with SPOP mutation identified by bioinformatic analysis
- Comparison of low-molecular-weight heparins in thromboprophylaxis of major orthopaedic surgery – randomized, prospective pilot study
- Case Report
- A case of SLE with COVID-19 and multiple infections
- Research Article
- Circular RNA hsa_circ_0007121 regulates proliferation, migration, invasion, and epithelial–mesenchymal transition of trophoblast cells by miR-182-5p/PGF axis in preeclampsia
- SRPX2 boosts pancreatic cancer chemoresistance by activating PI3K/AKT axis
- Case Report
- A case report of cervical pregnancy after in vitro fertilization complicated by tuberculosis and a literature review
- Review Article
- Serrated lesions of the colon and rectum: Emergent epidemiological data and molecular pathways
- Research Article
- Biological properties and therapeutic effects of plant-derived nanovesicles
- Case Report
- Clinical characterization of chromosome 5q21.1–21.3 microduplication: A case report
- Research Article
- Serum calcium levels correlates with coronary artery disease outcomes
- Rapunzel syndrome with cholangitis and pancreatitis – A rare case report
- Review Article
- A review of current progress in triple-negative breast cancer therapy
- Case Report
- Peritoneal-cutaneous fistula successfully treated at home: A case report and literature review
- Research Article
- Trim24 prompts tumor progression via inducing EMT in renal cell carcinoma
- Degradation of connexin 50 protein causes waterclefts in human lens
- GABRD promotes progression and predicts poor prognosis in colorectal cancer
- The lncRNA UBE2R2-AS1 suppresses cervical cancer cell growth in vitro
- LncRNA FOXD3-AS1/miR-135a-5p function in nasopharyngeal carcinoma cells
- MicroRNA-182-5p relieves murine allergic rhinitis via TLR4/NF-κB pathway
Articles in the same Issue
- Research Article
- MicroRNA-451b participates in coronary heart disease by targeting VEGFA
- Case Report
- A combination therapy for Kawasaki disease with severe complications: a case report
- Vitamin E for prevention of biofilm-caused Healthcare-associated infections
- Research Article
- Differential diagnosis: retroperitoneal fibrosis and oncological diseases
- Optimization of the Convolutional Neural Networks for Automatic Detection of Skin Cancer
- NEAT1 promotes LPS-induced inflammatory injury in macrophages by regulating miR-17-5p/TLR4
- Plasma matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 as prognostic biomarkers in critically ill patients
- Effects of extracorporeal magnetic stimulation in fecal incontinence
- Case Report
- Mixed germ cell tumor of the endometrium: a case report and literature review
- Bowel perforation after ventriculoperitoneal-shunt placement: case report and review of the literature
- Research Article
- Prognostic value of lncRNA HOTAIR in colorectal cancer : a meta-analysis
- Case Report
- Treatment of insulinomas by laparoscopic radiofrequency ablation: case reports and literature review
- Research Article
- The characteristics and nomogram for primary lung papillary adenocarcinoma
- Undiagnosed pheochromocytoma presenting as a pancreatic tumor: A case report
- Bioinformatics Analysis of the Expression of ATP binding cassette subfamily C member 3 (ABCC3) in Human Glioma
- Diagnostic value of recombinant heparin-binding hemagglutinin adhesin protein in spinal tuberculosis
- Primary cutaneous DLBCL non-GCB type: challenges of a rare case
- LINC00152 knock-down suppresses esophageal cancer by EGFR signaling pathway
- Case Report
- Life-threatening anaemia in patient with hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber syndrome)
- Research Article
- QTc interval predicts disturbed circadian blood pressure variation
- Shoulder ultrasound in the diagnosis of the suprascapular neuropathy in athletes
- The number of negative lymph nodes is positively associated with survival in esophageal squamous cell carcinoma patients in China
- Differentiation of pontine infarction by size
- RAF1 expression is correlated with HAF, a parameter of liver computed tomographic perfusion, and may predict the early therapeutic response to sorafenib in advanced hepatocellular carcinoma patients
- LncRNA ZEB1-AS1 regulates colorectal cancer cells by miR-205/YAP1 axis
- Tissue coagulation in laser hemorrhoidoplasty – an experimental study
- Classification of pathological types of lung cancer from CT images by deep residual neural networks with transfer learning strategy
- Enhanced Recovery after Surgery for Lung Cancer Patients
- Case Report
- Streptococcus pneumoniae-associated thrombotic microangiopathy in an immunosuppressed adult
- Research Article
- The characterization of Enterococcus genus: resistance mechanisms and inflammatory bowel disease
- Case Report
- Inflammatory fibroid polyp: an unusual cause of abdominal pain in the upper gastrointestinal tract A case report
- Research Article
- microRNA-204-5p participates in atherosclerosis via targeting MMP-9
- LncRNA LINC00152 promotes laryngeal cancer progression by sponging miR-613
- Can keratin scaffolds be used for creating three-dimensional cell cultures?
- miRNA-186 improves sepsis induced renal injury via PTEN/PI3K/AKT/P53 pathway
- Case Report
- Delayed bowel perforation after routine distal loopogram prior to ileostomy closure
- Research Article
- Diagnostic accuracy of MALDI-TOF mass spectrometry for the direct identification of clinical pathogens from urine
- The R219K polymorphism of the ATP binding cassette subfamily A member 1 gene and susceptibility to ischemic stroke in Chinese population
- miR-92 regulates the proliferation, migration, invasion and apoptosis of glioma cells by targeting neogenin
- Clinicopathological features of programmed cell death-ligand 1 expression in patients with oral squamous cell carcinoma
- NF2 inhibits proliferation and cancer stemness in breast cancer
- Body composition indices and cardiovascular risk in type 2 diabetes. CV biomarkers are not related to body composition
- S100A6 promotes proliferation and migration of HepG2 cells via increased ubiquitin-dependent degradation of p53
- Review Article
- Focus on localized laryngeal amyloidosis: management of five cases
- Research Article
- NEAT1 aggravates sepsis-induced acute kidney injury by sponging miR-22-3p
- Pericentric inversion in chromosome 1 and male infertility
- Increased atherogenic index in the general hearing loss population
- Prognostic role of SIRT6 in gastrointestinal cancers: a meta-analysis
- The complexity of molecular processes in osteoarthritis of the knee joint
- Interleukin-6 gene −572 G > C polymorphism and myocardial infarction risk
- Case Report
- Severe anaphylactic reaction to cisatracurium during anesthesia with cross-reactivity to atracurium
- Research Article
- Rehabilitation training improves nerve injuries by affecting Notch1 and SYN
- Case Report
- Myocardial amyloidosis following multiple myeloma in a 38-year-old female patient: A case report
- Research Article
- Identification of the hub genes RUNX2 and FN1 in gastric cancer
- miR-101-3p sensitizes non-small cell lung cancer cells to irradiation
- Distinct functions and prognostic values of RORs in gastric cancer
- Clinical impact of post-mortem genetic testing in cardiac death and cardiomyopathy
- Efficacy of pembrolizumab for advanced/metastatic melanoma: a meta-analysis
- Review Article
- The role of osteoprotegerin in the development, progression and management of abdominal aortic aneurysms
- Research Article
- Identification of key microRNAs of plasma extracellular vesicles and their diagnostic and prognostic significance in melanoma
- miR-30a-3p participates in the development of asthma by targeting CCR3
- microRNA-491-5p protects against atherosclerosis by targeting matrix metallopeptidase-9
- Bladder-embedded ectopic intrauterine device with calculus
- Case Report
- Mycobacterial identification on homogenised biopsy facilitates the early diagnosis and treatment of laryngeal tuberculosis
- Research Article
- The will of young minors in the terminal stage of sickness: A case report
- Extended perfusion protocol for MS lesion quantification
- Identification of four genes associated with cutaneous metastatic melanoma
- Case Report
- Thalidomide-induced serious RR interval prolongation (longest interval >5.0 s) in multiple myeloma patient with rectal cancer: A case report
- Research Article
- Voluntary exercise and cardiac remodeling in a myocardial infarction model
- Electromyography as an intraoperative test to assess the quality of nerve anastomosis – experimental study on rats
- Case Report
- CT findings of severe novel coronavirus disease (COVID-19): A case report of Heilongjiang Province, China
- Commentary
- Directed differentiation into insulin-producing cells using microRNA manipulation
- Research Article
- Culture-negative infective endocarditis (CNIE): impact on postoperative mortality
- Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome
- Plasma microRNAs in human left ventricular reverse remodelling
- Bevacizumab for non-small cell lung cancer patients with brain metastasis: A meta-analysis
- Risk factors for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage
- Problems and solutions of personal protective equipment doffing in COVID-19
- Evaluation of COVID-19 based on ACE2 expression in normal and cancer patients
- Review Article
- Gastroenterological complications in kidney transplant patients
- Research Article
- CXCL13 concentration in latent syphilis patients with treatment failure
- A novel age-biomarker-clinical history prognostic index for heart failure with reduced left ventricular ejection fraction
- Case Report
- Clinicopathological analysis of composite lymphoma: A two-case report and literature review
- Trastuzumab-induced thrombocytopenia after eight cycles of trastuzumab treatment
- Research Article
- Inhibition of vitamin D analog eldecalcitol on hepatoma in vitro and in vivo
- CCTs as new biomarkers for the prognosis of head and neck squamous cancer
- Effect of glucagon-like peptide-1 receptor agonists on adipokine level of nonalcoholic fatty liver disease in rats fed high-fat diet
- 72 hour Holter monitoring, 7 day Holter monitoring, and 30 day intermittent patient-activated heart rhythm recording in detecting arrhythmias in cryptogenic stroke patients free from arrhythmia in a screening 24 h Holter
- FOXK2 downregulation suppresses EMT in hepatocellular carcinoma
- Case Report
- Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
- Research Article
- Clinical prediction for outcomes of patients with acute-on-chronic liver failure associated with HBV infection: A new model establishment
- Case Report
- Combination of chest CT and clinical features for diagnosis of 2019 novel coronavirus pneumonia
- Research Article
- Clinical significance and potential mechanisms of miR-223-3p and miR-204-5p in squamous cell carcinoma of head and neck: a study based on TCGA and GEO
- Review Article
- Hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma in noncirrhotic liver. A case report and systematic review
- Research Article
- Voltage-dependent anion channels mediated apoptosis in refractory epilepsy
- Prognostic factors in stage I gastric cancer: A retrospective analysis
- Circulating irisin is linked to bone mineral density in geriatric Chinese men
- Case Report
- A family study of congenital dysfibrinogenemia caused by a novel mutation in the FGA gene: A case report
- Research Article
- CBCT for estimation of the cemento-enamel junction and crestal bone of anterior teeth
- Case Report
- Successful de-escalation antibiotic therapy using cephamycins for sepsis caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia: A sequential 25-case series
- Research Article
- Influence factors of extra-articular manifestations in rheumatoid arthritis
- Assessment of knowledge of use of electronic cigarette and its harmful effects among young adults
- Predictive factors of progression to severe COVID-19
- Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different concepts
- Acute chemoradiotherapy toxicity in cervical cancer patients
- IGF-1 regulates the growth of fibroblasts and extracellular matrix deposition in pelvic organ prolapse
- NANOG regulates the proliferation of PCSCs via the TGF-β1/SMAD pathway
- An immune-relevant signature of nine genes as a prognostic biomarker in patients with gastric carcinoma
- Computer-aided diagnosis of skin cancer based on soft computing techniques
- MiR-1225-5p acts as tumor suppressor in glioblastoma via targeting FNDC3B
- miR-300/FA2H affects gastric cancer cell proliferation and apoptosis
- Hybrid treatment of fibroadipose vascular anomaly: A case report
- Surgical treatment for common hepatic aneurysm. Original one-step technique
- Neuropsychiatric symptoms, quality of life and caregivers’ burden in dementia
- Predictor of postoperative dyspnea for Pierre Robin Sequence infants
- Long non-coding RNA FOXD2-AS1 promotes cell proliferation, metastasis and EMT in glioma by sponging miR-506-5p
- Analysis of expression and prognosis of KLK7 in ovarian cancer
- Circular RNA circ_SETD2 represses breast cancer progression via modulating the miR-155-5p/SCUBE2 axis
- Glial cell induced neural differentiation of bone marrow stromal cells
- Case Report
- Moraxella lacunata infection accompanied by acute glomerulonephritis
- Research Article
- Diagnosis of complication in lung transplantation by TBLB + ROSE + mNGS
- Case Report
- Endometrial cancer in a renal transplant recipient: A case report
- Research Article
- Downregulation of lncRNA FGF12-AS2 suppresses the tumorigenesis of NSCLC via sponging miR-188-3p
- Case Report
- Splenic abscess caused by Streptococcus anginosus bacteremia secondary to urinary tract infection: a case report and literature review
- Research Article
- Advances in the role of miRNAs in the occurrence and development of osteosarcoma
- Rheumatoid arthritis increases the risk of pleural empyema
- Effect of miRNA-200b on the proliferation and apoptosis of cervical cancer cells by targeting RhoA
- LncRNA NEAT1 promotes gastric cancer progression via miR-1294/AKT1 axis
- Key pathways in prostate cancer with SPOP mutation identified by bioinformatic analysis
- Comparison of low-molecular-weight heparins in thromboprophylaxis of major orthopaedic surgery – randomized, prospective pilot study
- Case Report
- A case of SLE with COVID-19 and multiple infections
- Research Article
- Circular RNA hsa_circ_0007121 regulates proliferation, migration, invasion, and epithelial–mesenchymal transition of trophoblast cells by miR-182-5p/PGF axis in preeclampsia
- SRPX2 boosts pancreatic cancer chemoresistance by activating PI3K/AKT axis
- Case Report
- A case report of cervical pregnancy after in vitro fertilization complicated by tuberculosis and a literature review
- Review Article
- Serrated lesions of the colon and rectum: Emergent epidemiological data and molecular pathways
- Research Article
- Biological properties and therapeutic effects of plant-derived nanovesicles
- Case Report
- Clinical characterization of chromosome 5q21.1–21.3 microduplication: A case report
- Research Article
- Serum calcium levels correlates with coronary artery disease outcomes
- Rapunzel syndrome with cholangitis and pancreatitis – A rare case report
- Review Article
- A review of current progress in triple-negative breast cancer therapy
- Case Report
- Peritoneal-cutaneous fistula successfully treated at home: A case report and literature review
- Research Article
- Trim24 prompts tumor progression via inducing EMT in renal cell carcinoma
- Degradation of connexin 50 protein causes waterclefts in human lens
- GABRD promotes progression and predicts poor prognosis in colorectal cancer
- The lncRNA UBE2R2-AS1 suppresses cervical cancer cell growth in vitro
- LncRNA FOXD3-AS1/miR-135a-5p function in nasopharyngeal carcinoma cells
- MicroRNA-182-5p relieves murine allergic rhinitis via TLR4/NF-κB pathway
