Startseite The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
Artikel Open Access

The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis

  • Hanxu Guo , Yuhang Wang , Zhicheng Wang , Zishu Wang EMAIL logo und Sheng Xue EMAIL logo
Veröffentlicht/Copyright: 16. September 2021

Abstract

Background

miR-92a is believed to have a significant role in the diagnosis and prognosis of different types of tumors, but the potential impact of its expression is still controversial due to the sample size. We conducted the meta-analysis to figure out whether miR-92a could be used as a detecting tool for assessing the prognosis of gastric cancer.

Method

A literature search was conducted by retrieving the Web of Science, PubMed, EMBASE, Chinese National Knowledge Infrastructure, VIP (Technology of Chongqing databases), and Wanfang databases (last updated by February 2020). The sensitivity (SEN), specificity (SPE), positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratio (DOR), and area under the ROC curve (AUC) were pooled to explore the diagnostic performance of miR-92a. The pooled hazard ratios (HRs) and 95% CIs of miR-92a for overall survival (OS) were calculated to explore the prognostic performance of miR-92a.

Results

Nine articles containing 11 studies were included. The pooled SEN and SPE were 0.76 and 0.79. Besides, the pooled PLR and NLR were 3.7 and 0.30, and the pooled DOR was 12. AUC was 0.84, indicating a significant value of miR-92a in gastric cancer detection. For the prognostic analysis of miR-92a in gastric cancer, the univariate and multivariate data’s poor OS were 1.37 and 2.01.

Conclusion

The present meta-analysis demonstrated that miR-92a could be a potential biomarker for the detection of gastric cancer. miR-92a could also be used as a valuable indicator for predicting the prognosis of gastric cancer patients.

1 Introduction

Gastric cancer still represents the third common leading cause of cancer death with more than 1,000,000 cases in 2018 and an estimated 783,000 deaths (equating to 1 in every 12 deaths worldwide) [1]. Even now there are reports that conversion surgery following chemotherapy can improve survival [2]. The clinical outcome of prognosis of gastric cancer patients is still poor. Due to the advanced stage when people are diagnosed with gastric cancer, a reliable biomarker is needed to diagnose gastric cancer and to indicate the survival time of patients, especially in the early stages.

MicroRNAs (miRNAs) refer to small and non-coding, which are actually involved at the post transcriptional level and bind to the 3′-UTR of their target messenger RNA (mRNA) to inhibit expression. A large number of miRNAs have been downregulated or upregulated in human cancer and are regarded as oncomiRs or oncosuppressor miRs [3]. More and more evidence show that miRNAs are involved in many biological processes including cell proliferation, apoptosis, differentiation, invasion, and metastasis [4]. In addition, a host of miRNAs in serum/plasma have been demonstrated to be biomarkers to identify gastric cancer at an early stage [5]. miR-92a is a member of miR-17-5p and is associated with the development of several cancers, including gastric cancer. Besides, miR-92a has been reported to be an important diagnostic and prognostic tool of other cancers, such as colorectal cancer [6], non-small cell lung cancer [7], and breast cancer [8]. However, the clinical and prognostic roles of miR-92a in tumors still need to be identified more precisely. The objective of this systematic review and meta-analysis is to summarize the current knowledge regarding miR-92a and to evaluate its diagnostic and prognostic impact in patients with gastric cancer.

2 Materials and methods

2.1 Search strategy

To identify the relevant studies, we searched the databases PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure, Technology of Chongqing (VIP), and Wan Fang databases (up to 10 February 2020). In each of the databases, the keywords “miRNA-92”or “MicroRNA-92” or “miR-92” or “hsa-mir-92” or “microRNA-92” were used as search terms together with “gastric cancer” or “stomach neoplasm” or “stomach cancer” or “stomach carcinoma” or “Stomach Neoplasms (Mesh).” In addition, we also sifted through the reference lists of original articles and manually searched relevant reviews for additional literature. Before the manuscript was published, we found that there are no more articles covering this topic in other languages except English and Chinese.

2.2 Inclusion and exclusion criteria

To screen out eligible studies, the following specific criteria were used: (1) gastric cancer was diagnosed via histopathology; (2) the study evaluated the diagnostic or prognostic value of miR-92a in gastric cancer; and (3) sufficient data were provided to calculate the sensitivity and specificity (for diagnostic value), and to calculate the hazard ratio (HR) and corresponding 95% CI (for prognostic value).

The exclusion criteria were as follows: laboratory studies, review articles, case reports, animal studies, or studies that did not provide sufficient data to calculate the diagnostic or prognostic value of miR-92a. If the same patient population was reported in several publications, the most recent study was selected for analysis.

2.3 Data extraction

Two independent researchers (G.H.X. and W.Y.H.) extracted data from all the included studies. The uncertain results were assessed by another investigator (W.Y.H.). For determining the diagnostic value of miR-92a, the following data were extracted: (1) first author’s name, country, year of publication, and ethnicity of the population studied; (2) number of patients and controls; (3) assay type for evaluating miR-92a; (4) stage of gastric cancer; and (5) diagnostic results of SEN, SPE, TP, FP, FN, and TN. For the prognostic value of miR-92a, the following data were extracted: (1) first author’s name, country, year of publication, and ethnicity of the population studied; (2) number of patients and controls; (3) assay type for evaluating miR-92a; (4) stage of gastric cancer; and (5) prognostic outcomes including HRs of elevated miR-92a expression for overall survival (OS)/disease-free survival (DFS).

2.4 Quality assessment

For diagnostic meta-analysis, we used QUADAS-2 as a tool to assess the quality of the diagnostic value [9]. This tool includes four domains to evaluate: patient selection, index test, reference standard, and flow and timing through the study and timing of the index test and reference standard. The methodological quality graph and methodological quality summary were conducted by Review Manager (version 5.2. Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration, 2012) (Figure 2). For prognostic meta-analysis, the quality of involved studies was evaluated with the Newcastle–Ottawa Scale (NOS) [10,11]. In addition, it can evaluate the quality of the experiment by answering eight questions. Each answer was ranged across the score from 0 to 9. Two independent researchers (G.H.X. and W.Y.H.) extracted the data and assessed whether each of the included literature met quality standards separately.

2.5 Statistical analysis

For diagnostic accuracy studies, the summary diagnostic index, including SEN and SPE, PLR, NLR, and DOR with the corresponding 95% CIs, were calculated. The heterogeneity between studies was determined using Cochran’s Q value and I 2 statistics. I 2 values <25%, 25–50%, and >50% were set to indicate mild, moderate, and significant heterogeneity. If I 2 > 50%, the random-effects model would be adopted. Otherwise, a fixed-effect model would be utilized for further analysis [12]. The summary receiver operating characteristic (SROC) curve was applied to assess the overall diagnostic accuracy, and the area under the SROC curve (AUC) were constructed for diagnostic usefulness. Subgroup analysis was carried out by dividing the studies according to the different sample size, assay type, and sample type.

For the prognostic meta-analyses, the pooled HR and its 95% CI were calculated to elucidate the link between high expression of miR-92a and corresponding OS of gastric cancer patients. Similarly, Cochran’s Q test and I 2 statistics were applied to evaluate the heterogeneity of the pooled results [13]. The statistical analyses were conducted by using Stata SE12.0 (StataCorp, College Station, TX, USA) and RevMan5.3 software.

3 Results

3.1 Literature search results

The initial literature search elucidated a total of 181 articles. The identification and selection trial are briefly illustrated in Figure 1. Of course, 172 articles were excluded because they did not meet our inclusion criteria. Eventually, this meta-analysis included 9 articles covering 12 cohort studies [14,15,16,17,18,19,20,21,22].

Figure 1 
                  Flow chart of study selection.
Figure 1

Flow chart of study selection.

3.2 Characteristics and quality assessment

For the diagnostic analysis, we included eight studies of 577 cases and 801 controls (Table 1). Besides, the studies were divided by the sample size. Gastric cancer was diagnosed using serum and plasma samples. In addition, all included studies detected miR-92a expression through quantitative Real-Time PCR (qRT-PCR) using different assay types (Taqman or SYBR). The quality of the included studies, evaluated by the QUADAS-2 assessment tool, is shown in Figure 2a and b, which is suitable for quantitative synthesis.

Table 1

Characteristics of the studies that related to the diagnosis of gastric cancer

Study Country/year Design Sample type Tumor/control Stage Cutoff Test method Sensitivity (%) Specificity (%)
Zhang X China/2011 R Blood 80/40 I–IV NA RT-qPCR 85.7 70.8
Dong QG China/2014 R Blood 100/100 I–IV NA RT-qPCR 64.0 82.0
Liu CF China/2019 R Blood 45/89 I–II NA RT-qPCR 39.9 97.8
R Blood 125/89 III–IV NA RT-qPCR 39.3 84.0
Niu WW China/2017 R Blood 60/303 I–IV NA RT-qPCR 85.7 70.8
Li H China/2014 R Blood 79/38 I–IV 0.028 RT-qPCR 53.0 84.0
Zhu C China/2014 R Blood 40/40 I–IV 0.095 RT-qPCR 97.5 85.0
R Blood 48/102 I–IV 0.095 RT-qPCR 72.9 73.5

R, retrospective; QUADAS, quality assessment of diagnostic accuracy studies; RT-qPCR, reverse transcription-quantitative polymerase chain reaction; NA, not available.

Figure 2 
                  QUADAS-2 quality assessment. Investigators’ assessment regarding each domain for included studies: (a) graph and (b) summary.
Figure 2

QUADAS-2 quality assessment. Investigators’ assessment regarding each domain for included studies: (a) graph and (b) summary.

In four of the eligible prognostic studies, 688 participants were included in the univariate analysis and 608 were included in the multivariate (Table 2). All the studies were identified for assessing for OS. NOS was used for evaluating the detailed quality of these studies (Table 3). The NOS score ranged from 0 to 8.

Table 2

Characteristics of the studies related to the prognosis of gastric cancer

Study Country/year Design Sample type Number Stage Cut-off Test method Outcome HR (95%CI)
Peng W China/2018 R Blood 333 I–III NA RT-qPCR OS (U) 1.406 (1.041–1.898)
(M) 1.353 (0.972–1.885)
DFS (U) 1.406 (0.983–2.013)
(M) 1.309 (0.882–1.944)
Ren C China/2015 R Tissue 180 I–IV NA Microarray OS (U) 2.940 (2.010–4.310)
(M) 3.340 (1.670–6.700)
Song W China/2017 R Blood 80 I–III NA RT-qPCR OS (U) 0.930 (0.320–2.720)

R, retrospective; QUADAS-2, quality assessment of diagnostic accuracy studies; RT-qPCR, reverse transcription-quantitative polymerase chain reaction; NA, not available; OS, overall survival; DFS, disease-free survival; HR, hazard ratio; CI, confidence interval.

Table 3

Newcastle–Ottawa quality assessment scale

First author Year Quality indicators from Newcastle–Ottawa scale Score
1 2 3 4 5 6 7 8
Wu Q 2013 7
Ren C 2015 7
Peng W 2018 ★★ 8

1. Representativeness of the exposed cohort; 2. Selection of the nonexposed cohort; 3. Ascertainment of exposure; 4. Demonstration that outcome of interest was not present at start of study; 5. Comparability of cohorts on the basis of the design or analysis; 6. Assessment of outcome; 7. Was follow-up long enough for outcomes to occur; 8. Adequacy of follow up of cohorts.

Note: ★ and ★★ means the studies are satisfied one or two criterion below the tables.

The indicator “5” is the special one, because if there are ★★, meaning that the experiment of “Peng W” is conducted by comparability of cohorts on the basis of the design AND analysis.

4 Diagnosis meta-analysis

4.1 Diagnostic value of miR-92a in gastric cancer

The summary results of the diagnostic indexes for miR-92a in gastric cancer are presented in Figure 3 by using the random effect model. The pooled SEN and SPE were 0.76 (95% CI 0.64–0.85) and 0.79 (95% CI 0.63–0.90), and the pooled PLR and NLR were 3.7 (95% CI 1.8–7.5) and 0.30 (95% CI 0.18–0.50), respectively. Meanwhile, the pooled DOR was 12 (95% CI 4–38). AUC was 0.84 (95% CI: 0.81–0.87) (Figure 4). The results had significant heterogeneity (P < 0 01).

Figure 3 
                  Forest plots of sensitivity (a), specificity (b) for miR-92a in the diagnosis of gastric cancer.
Figure 3

Forest plots of sensitivity (a), specificity (b) for miR-92a in the diagnosis of gastric cancer.

Figure 4 
                  SROC curve plotted graph for the diagnostic value of miR-92a in gastric cancer.
Figure 4

SROC curve plotted graph for the diagnostic value of miR-92a in gastric cancer.

4.2 Gastric cancer

In order to analyze the heterogeneity between studies, a subgroup was performed according to the assay type, type of the sample, and sample size. As the results shown in Table 4 indicate that there are not any significant differences in the summary of sensitivity and specificity according to assay type, type of the sample, and sample size.

Table 4

Subgroup analysis of the diagnostic value of miR-92a in gastric cancer

Subgroup Sensitivity P1 Specificity P2
Sample size >500 0.70 [0.54–0.86] 0.07 0.78 [0.59–0.98] 0.70
<500 0.82 [0.70–0.94] 0.81 [0.62–0.99]
Assay type SYBR 0.77 [0.65–0.89] 0.79 0.73 [0.57–0.90] 0.08
Taqman 0.74 [0.51–0.97] 0.93 [0.82–1.00]
Sample type Serum 0.74 [0.60–0.88] 0.24 0.73 [0.54–0.92] 0.16
Plasma 0.80 [0.64–0.95] 0.88 [0.74–1.00]

5 Prognosis meta-analysis

5.1 Prognostic value of miR-92a in gastric cancer

The univariate (I 2 = 91.6%) and multivariate data (I 2 = 86.4%) were analyzed separately using the random effect model due to the high heterogeneity in the data. The 43 studies included for univariate analysis showed that there was no significant correction between overexpression of miRNA-92a and poor OS (HR 1.37, 95% CI: 0.92–3.24) (Figure 5). The two studies included for multivariate analysis showed that there is no significant association between the high expression of miR-92a and OS (HR 2.01, 95% CI: 0.98–4.15) (Figure 6).

Figure 5 
                  Forest plots of the studies that evaluated the HRs of high miR-92a expression on univariate study.
Figure 5

Forest plots of the studies that evaluated the HRs of high miR-92a expression on univariate study.

Figure 6 
                  Forest plots of the studies that evaluated the HRs of high miR-155 expression on multivariate study.
Figure 6

Forest plots of the studies that evaluated the HRs of high miR-155 expression on multivariate study.

5.2 Sensitivity analysis of the prognostic value of miR-92a expression in gastric cancer

In univariate analysis, only one study [21] used blood sample to investigate the association of miR-92a with OS. This study was omitted, and we found that the result remained similar to the overall results (HR 1.456, 95% CI: 0.620–3.416). In multivariate analysis, the study [21] in which only one used plasma was excluded found that the sensitivity result was in line with the overall results (HR 1.735, 95% CI: 0.54–5.63).

6 Discussion

Currently, qualifying the up- and downregulated miRNAs for the assessment of gastric precancerous lesions has also been proposed but not implemented routinely. Studies have evaluated the diagnostic and prognostic value of miRNAs in human gastric cancer with the method of meta-analysis or in systematic reviews [23]. Several miRNAs, such as miR-21 and miR-17-5p, have been proved to be potential biomarks for gastric cancers. In this study, we have evaluated the diagnostic and prognostic value of miR-92a in gastric cancer through meta-analysis. The results of the study showed that the different assay types, type of sample, and sample size did not have a significant effect on overall diagnostic accuracy. Besides, more moderate specificity and sensitivity have been found in the diagnosis of gastric cancer. We expanded the number of articles for diagnostic value compared with Wei et al.’s and Liu et al.’s studies [23,24]. In prognostic value, patients who have a high expression of miR-92a have more longer OS compared to low expression. On par with the study of Ren et al. [25], which included only two studies that investigated the prognostic value of miR-92a in gastric cancer, the present study included more articles, thus greatly enhancing the reliability of results.

The significant role of miR-92a has been found in several cancers. One study indicated that the overexpression of miR-92a is associated with osteosarcoma, colorectal cancer, and non-small cell lung cancer or hepatocellular carcinoma [26]. However, in gastric cancer, a few scholars still have definite statements on the specific role of miR-92a. The study of Liu et al. [24] of combined multi-miRNAs showed that the expression of miR-92a was increased in the serum sample of gastric cancer. Patients with high miR-92a expression have only a short survival time [26]. But one study [27] indicated that the levels of miR-92a may not be related to gastric cancer, which found contrasting results. Recently, studies by Ohzawa et al. [28] and Naruyoshi et al. [29] provided a new method for the prediction of gastric cancer, which regard the exosome miR-92a as a biomarker for the diagnosis of gastric cancer. They revealed the same results that gastric cancer patients with a high expression of miR-92a had a shorter OS time. Collectively, these conflicting results indicate the need for further studies on the role of miR-92a.

The diagnostic value of miR-92a has been demonstrated in several studies. With a sensitivity and specificity of 76 and 75%, Peng et al. [30] found that expression varied between patients with colorectal cancer and healthy controls. Moreover, their experiment indicated that the miR-92a-related combination markers achieved a higher level of diagnostic power. miR-92a also presented a high accuracy in the diagnosis of cervical cancer, with a sensitivity and specificity of 70 and 80%, respectively [31]. For gastric cancer, the diagnostic accuracy of miR-92a varied significantly, with a sensitivity ranging from 39.3 to 97.5% and a specificity ranging from 70.8 to 97.8%. In addition, there are differences among these studies, such as assay type for qRT-PCR, type of the sample, and sample size. We found that miR-92as have high accuracy in diagnosis regardless of these differences. The results indicate that miR-92a can be used as a diagnostic indicator for gastric cancer.

For the prognostic value of miR-92a, we found that the high expression of miR-92a may not be associated with poor clinical outcomes in gastric cancer patients, which had a 1.46-fold higher risk for poor OS in both univariate and multivariate studies. However, until we have finished extracting the articles, we have not found any data of DFS and progression-free survival for miR-92a in gastric cancer. Currently, non-invasive biomarkers are more and more popular for assessing survival prognosis at any time before or after treatment. In our study, we have not noticed any obvious prognostic effect on gastric cancer, which is inconsistent with the previous results of some previous prognostic studies, while our study may be the first one to report that there is a negative association between the high expression of miR-92a and patient survival. However, our sample size was larger than the previous meta-analysis. To clarify the results, more research with sufficient data is needed in future.

7 Limitations

This study has several limitations. (1) The sample size was still relatively small, including only 12 studies. Therefore, more well-designed studies for diagnostic and prognostic value of miR-92a are needed to obtain more reliable results. (2) The ethnicities of patients with gastric cancer varied. For example, the diagnostic meta-analysis and the prognostic meta-analysis focused only on Asians. Therefore, researchers should pay attention to the impact of the race factor in future studies. (3) We included only articles published in English and Chinese, but did not include articles in other languages. (4) Some other risk factors for the development and progression of gastric cancer need to be considered, such as Helicobacter pylori infection, unhealthy diet, etc., which will influence the reliability of the study. (5) The detection of miR-92a is based on qRT-PCR, which having used the different types of assays will affect the results of the study. Future studies should address these limitations to accurately validate the diagnostic and prognostic value of miR-92a in gastric cancer.

8 Conclusion

To sum up, we demonstrated for the first time that miR-92a is promising to be a novel indicator for the diagnosis of gastric cancer. And it can also be a valuable indicator for predicting the prognosis of gastric cancer. Together, these findings provide important evidence for further development of future non-invasive methods for diagnosing gastric cancer.

Acknowledgement

None.

  1. Funding information: This work was supported by grants from The Natural Science Research Key Project of the Education Office of Anhui Province (KJ2019A0329), the Research and Innovation Team of Bengbu Medical College (No. BYKC201908), and the National University Student Innovation Experimental Project (No. 202010367035).

  2. Author contributions: G.H.X. and W.Y.H. drafted the work and assessed the included studies. The data were extracted from the included studies by two reviewers (Z.S.W. and X.S.). All authors participated in the final approval of the version to be published and agreed to be accountable for all aspects of the work.

  3. Conflict of interest: None declared.

  4. Data availability statements: The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Received: 2021-03-06
Revised: 2021-08-23
Accepted: 2021-08-23
Published Online: 2021-09-16

© 2021 Hanxu Guo et al., published by De Gruyter

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

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  11. SLC12A8 plays a key role in bladder cancer progression and EMT
  12. LncRNA ATXN8OS enhances tamoxifen resistance in breast cancer
  13. Case Report
  14. Serratia marcescens as a cause of unfavorable outcome in the twin pregnancy
  15. Spleno-adrenal fusion mimicking an adrenal metastasis of a renal cell carcinoma: A case report and embryological background
  16. Research Articles
  17. TRIM25 contributes to the malignancy of acute myeloid leukemia and is negatively regulated by microRNA-137
  18. CircRNA circ_0004370 promotes cell proliferation, migration, and invasion and inhibits cell apoptosis of esophageal cancer via miR-1301-3p/COL1A1 axis
  19. LncRNA XIST regulates atherosclerosis progression in ox-LDL-induced HUVECs
  20. Potential role of IFN-γ and IL-5 in sepsis prediction of preterm neonates
  21. Rapid Communication
  22. COVID-19 vaccine: Call for employees in international transportation industries and international travelers as the first priority in global distribution
  23. Case Report
  24. Rare squamous cell carcinoma of the kidney with concurrent xanthogranulomatous pyelonephritis: A case report and review of the literature
  25. An infertile female delivered a baby after removal of primary renal carcinoid tumor
  26. Research Articles
  27. Hypertension, BMI, and cardiovascular and cerebrovascular diseases
  28. Case Report
  29. Coexistence of bilateral macular edema and pale optic disc in the patient with Cohen syndrome
  30. Research Articles
  31. Correlation between kinematic sagittal parameters of the cervical lordosis or head posture and disc degeneration in patients with posterior neck pain
  32. Review Articles
  33. Hepatoid adenocarcinoma of the lung: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database
  34. Research Articles
  35. Thermography in the diagnosis of carpal tunnel syndrome
  36. Pemetrexed-based first-line chemotherapy had particularly prominent objective response rate for advanced NSCLC: A network meta-analysis
  37. Comparison of single and double autologous stem cell transplantation in multiple myeloma patients
  38. The influence of smoking in minimally invasive spinal fusion surgery
  39. Impact of body mass index on left atrial dimension in HOCM patients
  40. Expression and clinical significance of CMTM1 in hepatocellular carcinoma
  41. miR-142-5p promotes cervical cancer progression by targeting LMX1A through Wnt/β-catenin pathway
  42. Comparison of multiple flatfoot indicators in 5–8-year-old children
  43. Early MRI imaging and follow-up study in cerebral amyloid angiopathy
  44. Intestinal fatty acid-binding protein as a biomarker for the diagnosis of strangulated intestinal obstruction: A meta-analysis
  45. miR-128-3p inhibits apoptosis and inflammation in LPS-induced sepsis by targeting TGFBR2
  46. Dynamic perfusion CT – A promising tool to diagnose pancreatic ductal adenocarcinoma
  47. Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches
  48. Review Articles
  49. The ambiguous role of mannose-binding lectin (MBL) in human immunity
  50. Case Report
  51. Membranous nephropathy with pulmonary cryptococcosis with improved 1-year follow-up results: A case report
  52. Fertility problems in males carrying an inversion of chromosome 10
  53. Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature
  54. Metastatic renal Ewing’s sarcoma in adult woman: Case report and review of the literature
  55. Burkitt-like lymphoma with 11q aberration in a patient with AIDS and a patient without AIDS: Two cases reports and literature review
  56. Skull hemophilia pseudotumor: A case report
  57. Judicious use of low-dosage corticosteroids for non-severe COVID-19: A case report
  58. Adult-onset citrullinaemia type II with liver cirrhosis: A rare cause of hyperammonaemia
  59. Clinicopathologic features of Good’s syndrome: Two cases and literature review
  60. Fatal immune-related hepatitis with intrahepatic cholestasis and pneumonia associated with camrelizumab: A case report and literature review
  61. Research Articles
  62. Effects of hydroxyethyl starch and gelatin on the risk of acute kidney injury following orthotopic liver transplantation: A multicenter retrospective comparative clinical study
  63. Significance of nucleic acid positive anal swab in COVID-19 patients
  64. circAPLP2 promotes colorectal cancer progression by upregulating HELLS by targeting miR-335-5p
  65. Ratios between circulating myeloid cells and lymphocytes are associated with mortality in severe COVID-19 patients
  66. Risk factors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation
  67. Clinical features of hypertensive patients with COVID-19 compared with a normotensive group: Single-center experience in China
  68. Surgical myocardial revascularization outcomes in Kawasaki disease: systematic review and meta-analysis
  69. Decreased chromobox homologue 7 expression is associated with epithelial–mesenchymal transition and poor prognosis in cervical cancer
  70. FGF16 regulated by miR-520b enhances the cell proliferation of lung cancer
  71. Platelet-rich fibrin: Basics of biological actions and protocol modifications
  72. Accurate diagnosis of prostate cancer using logistic regression
  73. miR-377 inhibition enhances the survival of trophoblast cells via upregulation of FNDC5 in gestational diabetes mellitus
  74. Prognostic significance of TRIM28 expression in patients with breast carcinoma
  75. Integrative bioinformatics analysis of KPNA2 in six major human cancers
  76. Exosomal-mediated transfer of OIP5-AS1 enhanced cell chemoresistance to trastuzumab in breast cancer via up-regulating HMGB3 by sponging miR-381-3p
  77. A four-lncRNA signature for predicting prognosis of recurrence patients with gastric cancer
  78. Knockdown of circ_0003204 alleviates oxidative low-density lipoprotein-induced human umbilical vein endothelial cells injury: Circulating RNAs could explain atherosclerosis disease progression
  79. Propofol postpones colorectal cancer development through circ_0026344/miR-645/Akt/mTOR signal pathway
  80. Knockdown of lncRNA TapSAKI alleviates LPS-induced injury in HK-2 cells through the miR-205/IRF3 pathway
  81. COVID-19 severity in relation to sociodemographics and vitamin D use
  82. Clinical analysis of 11 cases of nocardiosis
  83. Cis-regulatory elements in conserved non-coding sequences of nuclear receptor genes indicate for crosstalk between endocrine systems
  84. Four long noncoding RNAs act as biomarkers in lung adenocarcinoma
  85. Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens
  86. Relation between IL-8 level and obstructive sleep apnea syndrome
  87. circAGFG1 sponges miR-28-5p to promote non-small-cell lung cancer progression through modulating HIF-1α level
  88. Nomogram prediction model for renal anaemia in IgA nephropathy patients
  89. Effect of antibiotic use on the efficacy of nivolumab in the treatment of advanced/metastatic non-small cell lung cancer: A meta-analysis
  90. NDRG2 inhibition facilitates angiogenesis of hepatocellular carcinoma
  91. A nomogram for predicting metabolic steatohepatitis: The combination of NAMPT, RALGDS, GADD45B, FOSL2, RTP3, and RASD1
  92. Clinical and prognostic features of MMP-2 and VEGF in AEG patients
  93. The value of miR-510 in the prognosis and development of colon cancer
  94. Functional implications of PABPC1 in the development of ovarian cancer
  95. Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy
  96. Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis
  97. Prediction of improvement after anterior cruciate ligament reconstruction
  98. Effluent Osteopontin levels reflect the peritoneal solute transport rate
  99. circ_0038467 promotes PM2.5-induced bronchial epithelial cell dysfunction
  100. Significance of miR-141 and miR-340 in cervical squamous cell carcinoma
  101. Association between hair cortisol concentration and metabolic syndrome
  102. Microvessel density as a prognostic indicator of prostate cancer: A systematic review and meta-analysis
  103. Characteristics of BCR–ABL gene variants in patients of chronic myeloid leukemia
  104. Knee alterations in rheumatoid arthritis: Comparison of US and MRI
  105. Long non-coding RNA TUG1 aggravates cerebral ischemia and reperfusion injury by sponging miR-493-3p/miR-410-3p
  106. lncRNA MALAT1 regulated ATAD2 to facilitate retinoblastoma progression via miR-655-3p
  107. Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study
  108. Analysis of COVID-19 outbreak origin in China in 2019 using differentiation method for unusual epidemiological events
  109. Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
  110. Travelers’ vaccines and their adverse events in Nara, Japan
  111. Association between Tfh and PGA in children with Henoch–Schönlein purpura
  112. Can exchange transfusion be replaced by double-LED phototherapy?
  113. circ_0005962 functions as an oncogene to aggravate NSCLC progression
  114. Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
  115. Serum intact fibroblast growth factor 23 in healthy paediatric population
  116. Algorithm of rational approach to reconstruction in Fournier’s disease
  117. A meta-analysis of exosome in the treatment of spinal cord injury
  118. Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
  119. Dexmedetomidine may decrease the bupivacaine toxicity to heart
  120. Hypoxia stimulates the migration and invasion of osteosarcoma via up-regulating the NUSAP1 expression
  121. Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
  122. External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
  123. miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
  124. HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
  125. Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
  126. Cell population data in identifying active tuberculosis and community-acquired pneumonia
  127. Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
  128. Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
  129. 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
  130. Association of gene polymorphisms with women urinary incontinence
  131. Influence of COVID-19 pandemic on stress levels of urologic patients
  132. miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
  133. miR-519d downregulates LEP expression to inhibit preeclampsia development
  134. Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
  135. Fluorescent light energy modulates healing in skin grafted mouse model
  136. Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
  137. Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
  138. Severe postoperative hyperbilirubinemia in congenital heart disease
  139. Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
  140. Clinical factors predicting ureteral stent failure in patients with external ureteral compression
  141. Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
  142. Triple-Endobutton and clavicular hook: A propensity score matching analysis
  143. 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
  144. Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
  145. miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
  146. Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
  147. The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
  148. Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
  149. No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
  150. circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
  151. Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
  152. Educational program for orthopedic surgeons’ influences for osteoporosis
  153. Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
  154. GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
  155. lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
  156. Anticoagulation is the answer in treating noncritical COVID-19 patients
  157. Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
  158. Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
  159. VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
  160. Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
  161. Treatment of osteoporosis with teriparatide: The Slovenian experience
  162. New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
  163. Superenhancer–transcription factor regulatory network in malignant tumors
  164. β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
  165. Clinical features of atypical tuberculosis mimicking bacterial pneumonia
  166. Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
  167. Effect of electromagnetic field on abortion: A systematic review and meta-analysis
  168. miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
  169. MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
  170. Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
  171. miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
  172. Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
  173. MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
  174. Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
  175. circATP2A2 promotes osteosarcoma progression by upregulating MYH9
  176. Prognostic role of oxytocin receptor in colon adenocarcinoma
  177. Review Articles
  178. The function of non-coding RNAs in idiopathic pulmonary fibrosis
  179. Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
  180. Role of cesarean section in the development of neonatal gut microbiota: A systematic review
  181. Small cell lung cancer transformation during antitumor therapies: A systematic review
  182. Research progress of gut microbiota and frailty syndrome
  183. Recommendations for outpatient activity in COVID-19 pandemic
  184. Rapid Communication
  185. Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
  186. Use of microspheres in embolization for unruptured renal angiomyolipomas
  187. COVID-19 cases with delayed absorption of lung lesion
  188. A triple combination of treatments on moderate COVID-19
  189. Social networks and eating disorders during the Covid-19 pandemic
  190. Letter
  191. COVID-19, WHO guidelines, pedagogy, and respite
  192. Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
  193. COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
  194. What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
  195. Case Report
  196. Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
  197. CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
  198. Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
  199. Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
  200. Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
  201. Pulmonary parenchymal involvement caused by Tropheryma whipplei
  202. Mediastinal mixed germ cell tumor: A case report and literature review
  203. Ovarian female adnexal tumor of probable Wolffian origin – Case report
  204. Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
  205. Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
  206. Primary orbital ganglioneuroblastoma: A case report
  207. Primary aortic intimal sarcoma masquerading as intramural hematoma
  208. Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
  209. Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
  210. Chondroblastoma of mandibular condyle: Case report and literature review
  211. Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
  212. Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
  213. Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
  214. High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
  215. Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
  216. Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
  217. Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
  218. Retraction
  219. Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
  220. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
  221. An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
  222. Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
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