Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
-
Wenyuan Li
Abstract
In recent months, the novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health crisis with takeover more than 1 million lives worldwide. The long-lasting existence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not yet been reported. Herein, we report a case of SARS-CoV-2 infection with intermittent viral polymerase chain reaction (PCR)-positive for >4 months after clinical rehabilitation. A 35-year-old male was diagnosed with COVID-19 pneumonia with fever but without other specific symptoms. The treatment with lopinavir-ritonavir, oxygen inhalation, and other symptomatic supportive treatment facilitated recovery, and the patient was discharged. However, his viral PCR test was continually positive in oropharyngeal swabs for >4 months after that. At the end of June 2020, he was still under quarantine and observation. The contribution of current antivirus therapy might be limited. The prognosis of COVID-19 patients might be irrelevant to the virus status. Thus, further investigation to evaluate the contagiousness of convalescent patients and the mechanism underlying the persistent existence of SARS-CoV-2 after recovery is essential. A new strategy of disease control, especially extending the follow-up period for recovered COVID-19 patients, is necessary to adapt to the current situation of pandemic.
1 Introduction
The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first reported in Wuhan, China, is causing serious public health problems globally [1]. Millions of cases have already been reported and more than 2 million deaths occurred worldwide [2]. Thus, COVID-19 has become a great threat to humanity and a challenge to disease control for all the countries owing to its transmission capacity. There have already been a lot of researches about the mechanism of COVID-19. Generally, it has been universally acknowledged that the virus spike protein contains a receptor-binding domain (RBD), which can recognize the angiotensin-converting enzyme 2 while invading into human respiratory tract and alveoli, which is quite similar to SARS-CoV [3]. Herein, we present a COVID-19 patient with intermittent viral polymerase chain reaction (PCR) test positive for >4 months after his clinical rehabilitation. Informed consent was obtained from the patient for publication of the case.
2 Case report
A 35-year-old male Chinese businessman, who was once an asymptomatic HBV carrier, was presented with fever but without other specific symptoms on February 1, 2020. The highest body temperature was 38.4°C. He visited the local hospital, and computed tomography (CT) scan revealed pneumonia (data not shown). Then, he was sent to the fever outpatient department of the first affiliated hospital of USTC. Considering his epidemiology history, he was transferred to the Department of Infectious Diseases for quarantine as a COVID-19 suspected patient on the same day. Informed consent was obtained from the patient for publication of the case study. Before all the symptoms occurred, the patient had dinner with a friend on January 19, 2020, who visited Hubei province but did not show any symptoms.
The patient has HBsAg-positive history for 2 years without treatment. He denied other medical or medication, as well as smoking and alcoholism, history.
No specific signs were observed on physical examination. However, the oropharyngeal swabs were SARS-CoV-2 PCR-positive, as assessed by Hefei city center for disease control and prevention (CDC) on February 4, 2020 and confirmed by Anhui provincial CDC on the following day. The chest CT on February 6 showed multiple nodular and patchy high-density shadows in the bilateral lung areas (Figure 1a).
Chest CT images of the patient. (a) Multiple nodular and patchy high-density shadows on February 6; (b) Partial absorption of multiple nodular and patchy high-density shadows with ground-glass opacity on February 13; (c) Most absorbed with few parts of ground-glass opacity on March 5; (d) Normal CT image on April 29.
The patient was treated with lopinavir-ritonavir 500 mg po. bid, oxygen inhalation, N-acetylcysteine (NAC) 4.0 ivgtt. qd., and other symptomatic supportive treatment according to the COVID-19 guidelines[2,4]. The symptoms recovered satisfactorily, and the temperature dropped back to normal since day 3. Nonetheless, a chest CT scan on February 13 showed multiple nodular and patchy high-density shadows and ground-glass opacity, which was partially absorbed (Figure 1b).
After a temporary negative result on February 3, his SARS-CoV-2 PCR test was continually positive from February 4–13. Finally, he got two negative results on February 16 and 18, and hence, was discharged on February 19, according to the Chinese guidelines[5]. Interestingly, his liver function was normal during this whole period. The patient had a slight abnormal liver function on the discharge day with serum alanine transaminase (ALT) 133 IU/L. The HBV viral load was evaluated by qPCR, and diammonium glycyrrhizinate 150 mg tid was administered orally after discharge. The level of HBV-DNA on the discharge day was 3.17 × 106 IU/mL, which returned back to normal later on February 21.
When the patient revisited the hepatology outpatient on March 5 after quarantine, the CT scan showed only a few ground-glass opacity, while the ALT level was elevated to 1,029 IU/L, following which he was admitted again to our department for chronic hepatitis B (CHB) (Figure 1c). Subsequently, he underwent the SARS-CoV-2 PCR screening that was reported positive on March 7. Thus, he was sent to the quarantine department, and the glutathione dose was reduced to 1.8 ivgtt. qd., while magnesium isoglycyrrhizinate 150 mg ivgtt. qd. and polyene phosphatidylcholine 15 mL ivgtt. qd. were administered along with tenofovir 300 mg qd. Daily, SARS-CoV-2 virus PCR test was performed from March 9–12 with negative results. He was then discharged on March 13 for the second time, while his ALT level was dropped back to 342 IU/L. Oral diammonium glycyrrhizinate and tenofovir were also given, and the ALT returned to the normal level on April 1.
During the months of March, April, and May, his SARS-CoV-2 virus PCR test was lingering between positive and negative, and the patient was isolated either at the quarantine outpost or at home. Chinese CDC was confused about his COVID-19 test result, and hence, he was sent to our fever outpatient on April 29 to validate the test results. Chest CT and SARS-CoV-2 PCR did not show any specific abnormality (Figure 1d). On June 3, the patient was assessed at the local hospital. With supportive treatment, the virus PCR test was negative three times on June 4, 5, and 6, respectively, following which, he was discharged on June 8. As of June 15, the patient was still under observation at home anxiously awaiting future test results (Figure 2).
Timeline of this case after exposure.
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Informed consent: Informed consent was obtained from the patient for this manuscript to be published.
3 Discussion
This patient presented atypical symptoms with an indirect epidemiological history of Hubei Province and was confirmed by the SARS-CoV-2 PCR-positive test. However, his SARS-CoV-2 persisted for >120 days; the symptoms and chest CT manifestation recovered adequately. As the clinical recovery of the patient is not synchronous with the existence of SARS-CoV-2 in the oropharynx, the contribution of the current antivirus therapy may be overestimated, especially for mild and moderate COVID-19 patients.
Notably, this patient was once an HBV asymptomatic carrier before COVID-19, and his transaminase level was raised markedly soon after recovery. This phenomenon indicated that SARS-CoV-2 infection might activate the virus and break the immune tolerance state, progressing the patient from HBV carrier to CHB. We also found that after Tenofovir treatment, the liver function and HBV DNA level returned to normal, but the effects on SARS-CoV-2 were not as significant as those of HBV, as deduced from the positive PCR.
As the epidemic has now been endured for over a year, many countries have faced COVID-19. Several studies have reported that recovered patients turned positive again and some of them even endured the infection for >14 days [6,7,8,9,10,11]. Some studies reported a long endurance; in one case, it was >90 days [12,13,14,15]. Although the mechanism is not yet understood, some studies indicated that immune evasion might play a significant role in the disease [9]. In addition, the RBD of SARS-CoV-2 remained dormant compared to SARS-CoV, which was beneficial for immune evasion [3]. Some other studies found that SARS-CoV-2 RNA fragments may integrate into the human genome, which may explain the situation of persistent positive of RT-PCT results in some patients [16]. Fortunately, as the SARS-CoV-2 RNA integrated into the human genome were not fully functional viral sequences, it cannot reproduce virus from human body in this way [16,17]. In addition, many studies reported that no subsequent infections were detected by these long-lasting virus-positive patients [12,15]. However, the pandemic has lasted for a year, and yet, there is no report of a case wherein PCR results are positive during the whole duration of the disease, thereby supporting the gene integration theory. Nonetheless, the underlying mechanism needs further investigation.
In the current case, the patient’s virus test was continually positive for >4 months, which is much longer than most of the cases reported previously. Thus, this could be the first case of COVID-19 lasting over 120 days. Although the virus PCR test was persistently positive, in this case, his father, who took care of him during the 14-day home quarantine, was not infected and tested negative in the PCR test. Thus, the virological status of the patient seems to be irrelevant to both the prognosis and the contagiousness. Nonetheless, the contagiousness of the recovered patients needs further investigation.
Since the viral load in the asymptomatic and symptomatic patients is similar [18], an early discharge might be problematic for both disease tracing and patient quarantine [19]. Thus, the local quarantine outpost needs three times negative results for virus tests conducted independently for discharge. If the long-lasting virus status in recovered patients is not just a rare case, disease control is challenging. A prolonged shedding time after negative coronavirus tests and multiple reexamination should also be considered. Currently, the SARS-CoV-2 virus test has been included in the routine return visit test with chest CT, blood test, and other relevant tests. The screening of coronavirus should be enforced as a regular test of admission in the hospital, as is the norm in most of the Chinese hospitals. Virus screening in the whole community or even the whole city may be carried out for asymptomatic patients, if necessary.
As the duration of the virus staying in the body is longer than expected, and a small proportion of the SARS-CoV-2 virus carrier population may become the norm, further investigation of the contagiousness of SARS-CoV-2 and new strategy of disease control are essential.
In conclusion, the contribution of antivirus therapy may be limited to mild and moderate COVID-19 patients. The prognosis of COVID-19 patients might be irrelevant to the virus status. The evaluated contagiousness of recovered patients and understanding the persistent existence of SARS-CoV-2 after recovery need to be investigated. Thus, a novel approach of disease control is necessary; extending the follow-up period for recovered COVID-19 patients could be feasible in the wake of the pandemic.
Abbreviations
- COVID-19
-
coronavirus disease 2019
- HBV
-
hepatitis B virus
- PCR
-
polymerase chain reaction
- SARS-CoV-2
-
severe acute respiratory syndrome coronavirus 2
-
Funding information: Natural Science Foundation of Anhui Province of China (1908085QH331), “USTC New Medicine” Joint Fund Cultivation Project (WK9110000023).
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Author contributions: Wenyuan Li followed up the patient, summarized all data, and completed the manuscript. Beibei Huang communicated with the patient and collected data during the time out of the hospital. Qiang Shen, Shouwei Jiang, and Kun Jin communicated with the patient and collected data during admission. Ling Ning and Lei Liu provided technical support during the follow-up. Lei Li communicated with the patient, guided me through the manuscript, and supervised overall progress.
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Conflict of interest: The authors have no conflict of interest to disclose.
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Data availability statement: Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
References
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© 2021 Wenyuan Li et al., published by De Gruyter
This work is licensed under the Creative Commons Attribution 4.0 International License.
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- Research progress of gut microbiota and frailty syndrome
- Recommendations for outpatient activity in COVID-19 pandemic
- Rapid Communication
- Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
- Use of microspheres in embolization for unruptured renal angiomyolipomas
- COVID-19 cases with delayed absorption of lung lesion
- A triple combination of treatments on moderate COVID-19
- Social networks and eating disorders during the Covid-19 pandemic
- Letter
- COVID-19, WHO guidelines, pedagogy, and respite
- Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
- COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
- What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
- Case Report
- Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
- CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
- Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
- Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
- Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
- Pulmonary parenchymal involvement caused by Tropheryma whipplei
- Mediastinal mixed germ cell tumor: A case report and literature review
- Ovarian female adnexal tumor of probable Wolffian origin – Case report
- Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
- Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
- Primary orbital ganglioneuroblastoma: A case report
- Primary aortic intimal sarcoma masquerading as intramural hematoma
- Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
- Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
- Chondroblastoma of mandibular condyle: Case report and literature review
- Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
- Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
- Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
- High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
- Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
- Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
- Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
- Retraction
- Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
- Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
- An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
- Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
Artikel in diesem Heft
- Research Articles
- Identification of ZG16B as a prognostic biomarker in breast cancer
- Behçet’s disease with latent Mycobacterium tuberculosis infection
- Erratum
- Erratum to “Suffering from Cerebral Small Vessel Disease with and without Metabolic Syndrome”
- Research Articles
- GPR37 promotes the malignancy of lung adenocarcinoma via TGF-β/Smad pathway
- Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
- Additional baricitinib loading dose improves clinical outcome in COVID-19
- The co-treatment of rosuvastatin with dapagliflozin synergistically inhibited apoptosis via activating the PI3K/AKt/mTOR signaling pathway in myocardial ischemia/reperfusion injury rats
- SLC12A8 plays a key role in bladder cancer progression and EMT
- LncRNA ATXN8OS enhances tamoxifen resistance in breast cancer
- Case Report
- Serratia marcescens as a cause of unfavorable outcome in the twin pregnancy
- Spleno-adrenal fusion mimicking an adrenal metastasis of a renal cell carcinoma: A case report and embryological background
- Research Articles
- TRIM25 contributes to the malignancy of acute myeloid leukemia and is negatively regulated by microRNA-137
- CircRNA circ_0004370 promotes cell proliferation, migration, and invasion and inhibits cell apoptosis of esophageal cancer via miR-1301-3p/COL1A1 axis
- LncRNA XIST regulates atherosclerosis progression in ox-LDL-induced HUVECs
- Potential role of IFN-γ and IL-5 in sepsis prediction of preterm neonates
- Rapid Communication
- COVID-19 vaccine: Call for employees in international transportation industries and international travelers as the first priority in global distribution
- Case Report
- Rare squamous cell carcinoma of the kidney with concurrent xanthogranulomatous pyelonephritis: A case report and review of the literature
- An infertile female delivered a baby after removal of primary renal carcinoid tumor
- Research Articles
- Hypertension, BMI, and cardiovascular and cerebrovascular diseases
- Case Report
- Coexistence of bilateral macular edema and pale optic disc in the patient with Cohen syndrome
- Research Articles
- Correlation between kinematic sagittal parameters of the cervical lordosis or head posture and disc degeneration in patients with posterior neck pain
- Review Articles
- Hepatoid adenocarcinoma of the lung: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database
- Research Articles
- Thermography in the diagnosis of carpal tunnel syndrome
- Pemetrexed-based first-line chemotherapy had particularly prominent objective response rate for advanced NSCLC: A network meta-analysis
- Comparison of single and double autologous stem cell transplantation in multiple myeloma patients
- The influence of smoking in minimally invasive spinal fusion surgery
- Impact of body mass index on left atrial dimension in HOCM patients
- Expression and clinical significance of CMTM1 in hepatocellular carcinoma
- miR-142-5p promotes cervical cancer progression by targeting LMX1A through Wnt/β-catenin pathway
- Comparison of multiple flatfoot indicators in 5–8-year-old children
- Early MRI imaging and follow-up study in cerebral amyloid angiopathy
- Intestinal fatty acid-binding protein as a biomarker for the diagnosis of strangulated intestinal obstruction: A meta-analysis
- miR-128-3p inhibits apoptosis and inflammation in LPS-induced sepsis by targeting TGFBR2
- Dynamic perfusion CT – A promising tool to diagnose pancreatic ductal adenocarcinoma
- Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches
- Review Articles
- The ambiguous role of mannose-binding lectin (MBL) in human immunity
- Case Report
- Membranous nephropathy with pulmonary cryptococcosis with improved 1-year follow-up results: A case report
- Fertility problems in males carrying an inversion of chromosome 10
- Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature
- Metastatic renal Ewing’s sarcoma in adult woman: Case report and review of the literature
- Burkitt-like lymphoma with 11q aberration in a patient with AIDS and a patient without AIDS: Two cases reports and literature review
- Skull hemophilia pseudotumor: A case report
- Judicious use of low-dosage corticosteroids for non-severe COVID-19: A case report
- Adult-onset citrullinaemia type II with liver cirrhosis: A rare cause of hyperammonaemia
- Clinicopathologic features of Good’s syndrome: Two cases and literature review
- Fatal immune-related hepatitis with intrahepatic cholestasis and pneumonia associated with camrelizumab: A case report and literature review
- Research Articles
- Effects of hydroxyethyl starch and gelatin on the risk of acute kidney injury following orthotopic liver transplantation: A multicenter retrospective comparative clinical study
- Significance of nucleic acid positive anal swab in COVID-19 patients
- circAPLP2 promotes colorectal cancer progression by upregulating HELLS by targeting miR-335-5p
- Ratios between circulating myeloid cells and lymphocytes are associated with mortality in severe COVID-19 patients
- Risk factors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation
- Clinical features of hypertensive patients with COVID-19 compared with a normotensive group: Single-center experience in China
- Surgical myocardial revascularization outcomes in Kawasaki disease: systematic review and meta-analysis
- Decreased chromobox homologue 7 expression is associated with epithelial–mesenchymal transition and poor prognosis in cervical cancer
- FGF16 regulated by miR-520b enhances the cell proliferation of lung cancer
- Platelet-rich fibrin: Basics of biological actions and protocol modifications
- Accurate diagnosis of prostate cancer using logistic regression
- miR-377 inhibition enhances the survival of trophoblast cells via upregulation of FNDC5 in gestational diabetes mellitus
- Prognostic significance of TRIM28 expression in patients with breast carcinoma
- Integrative bioinformatics analysis of KPNA2 in six major human cancers
- Exosomal-mediated transfer of OIP5-AS1 enhanced cell chemoresistance to trastuzumab in breast cancer via up-regulating HMGB3 by sponging miR-381-3p
- A four-lncRNA signature for predicting prognosis of recurrence patients with gastric cancer
- Knockdown of circ_0003204 alleviates oxidative low-density lipoprotein-induced human umbilical vein endothelial cells injury: Circulating RNAs could explain atherosclerosis disease progression
- Propofol postpones colorectal cancer development through circ_0026344/miR-645/Akt/mTOR signal pathway
- Knockdown of lncRNA TapSAKI alleviates LPS-induced injury in HK-2 cells through the miR-205/IRF3 pathway
- COVID-19 severity in relation to sociodemographics and vitamin D use
- Clinical analysis of 11 cases of nocardiosis
- Cis-regulatory elements in conserved non-coding sequences of nuclear receptor genes indicate for crosstalk between endocrine systems
- Four long noncoding RNAs act as biomarkers in lung adenocarcinoma
- Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens
- Relation between IL-8 level and obstructive sleep apnea syndrome
- circAGFG1 sponges miR-28-5p to promote non-small-cell lung cancer progression through modulating HIF-1α level
- Nomogram prediction model for renal anaemia in IgA nephropathy patients
- Effect of antibiotic use on the efficacy of nivolumab in the treatment of advanced/metastatic non-small cell lung cancer: A meta-analysis
- NDRG2 inhibition facilitates angiogenesis of hepatocellular carcinoma
- A nomogram for predicting metabolic steatohepatitis: The combination of NAMPT, RALGDS, GADD45B, FOSL2, RTP3, and RASD1
- Clinical and prognostic features of MMP-2 and VEGF in AEG patients
- The value of miR-510 in the prognosis and development of colon cancer
- Functional implications of PABPC1 in the development of ovarian cancer
- Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy
- Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis
- Prediction of improvement after anterior cruciate ligament reconstruction
- Effluent Osteopontin levels reflect the peritoneal solute transport rate
- circ_0038467 promotes PM2.5-induced bronchial epithelial cell dysfunction
- Significance of miR-141 and miR-340 in cervical squamous cell carcinoma
- Association between hair cortisol concentration and metabolic syndrome
- Microvessel density as a prognostic indicator of prostate cancer: A systematic review and meta-analysis
- Characteristics of BCR–ABL gene variants in patients of chronic myeloid leukemia
- Knee alterations in rheumatoid arthritis: Comparison of US and MRI
- Long non-coding RNA TUG1 aggravates cerebral ischemia and reperfusion injury by sponging miR-493-3p/miR-410-3p
- lncRNA MALAT1 regulated ATAD2 to facilitate retinoblastoma progression via miR-655-3p
- Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study
- Analysis of COVID-19 outbreak origin in China in 2019 using differentiation method for unusual epidemiological events
- Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
- Travelers’ vaccines and their adverse events in Nara, Japan
- Association between Tfh and PGA in children with Henoch–Schönlein purpura
- Can exchange transfusion be replaced by double-LED phototherapy?
- circ_0005962 functions as an oncogene to aggravate NSCLC progression
- Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
- Serum intact fibroblast growth factor 23 in healthy paediatric population
- Algorithm of rational approach to reconstruction in Fournier’s disease
- A meta-analysis of exosome in the treatment of spinal cord injury
- Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
- Dexmedetomidine may decrease the bupivacaine toxicity to heart
- Hypoxia stimulates the migration and invasion of osteosarcoma via up-regulating the NUSAP1 expression
- Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
- External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
- miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
- HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
- Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
- Cell population data in identifying active tuberculosis and community-acquired pneumonia
- Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
- Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
- 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
- Association of gene polymorphisms with women urinary incontinence
- Influence of COVID-19 pandemic on stress levels of urologic patients
- miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
- miR-519d downregulates LEP expression to inhibit preeclampsia development
- Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
- Fluorescent light energy modulates healing in skin grafted mouse model
- Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
- Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
- Severe postoperative hyperbilirubinemia in congenital heart disease
- Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
- Clinical factors predicting ureteral stent failure in patients with external ureteral compression
- Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
- Triple-Endobutton and clavicular hook: A propensity score matching analysis
- Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
- Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
- miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
- Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
- The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
- Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
- No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
- circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
- Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
- Educational program for orthopedic surgeons’ influences for osteoporosis
- Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
- GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
- lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
- Anticoagulation is the answer in treating noncritical COVID-19 patients
- Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
- Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
- VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
- Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
- Treatment of osteoporosis with teriparatide: The Slovenian experience
- New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
- Superenhancer–transcription factor regulatory network in malignant tumors
- β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
- Clinical features of atypical tuberculosis mimicking bacterial pneumonia
- Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
- Effect of electromagnetic field on abortion: A systematic review and meta-analysis
- miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
- MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
- Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
- miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
- Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
- MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
- Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
- circATP2A2 promotes osteosarcoma progression by upregulating MYH9
- Prognostic role of oxytocin receptor in colon adenocarcinoma
- Review Articles
- The function of non-coding RNAs in idiopathic pulmonary fibrosis
- Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
- Role of cesarean section in the development of neonatal gut microbiota: A systematic review
- Small cell lung cancer transformation during antitumor therapies: A systematic review
- Research progress of gut microbiota and frailty syndrome
- Recommendations for outpatient activity in COVID-19 pandemic
- Rapid Communication
- Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
- Use of microspheres in embolization for unruptured renal angiomyolipomas
- COVID-19 cases with delayed absorption of lung lesion
- A triple combination of treatments on moderate COVID-19
- Social networks and eating disorders during the Covid-19 pandemic
- Letter
- COVID-19, WHO guidelines, pedagogy, and respite
- Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
- COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
- What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
- Case Report
- Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
- CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
- Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
- Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
- Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
- Pulmonary parenchymal involvement caused by Tropheryma whipplei
- Mediastinal mixed germ cell tumor: A case report and literature review
- Ovarian female adnexal tumor of probable Wolffian origin – Case report
- Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
- Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
- Primary orbital ganglioneuroblastoma: A case report
- Primary aortic intimal sarcoma masquerading as intramural hematoma
- Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
- Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
- Chondroblastoma of mandibular condyle: Case report and literature review
- Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
- Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
- Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
- High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
- Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
- Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
- Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
- Retraction
- Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
- Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
- An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
- Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
