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Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis

  • Ingrida Poškienė EMAIL logo , Giedrius Vanagas , Asta Kirkilytė and Rūta Jolanta Nadišauskienė
Published/Copyright: October 15, 2021
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Open Medicine
From the journal Open Medicine Volume 16 Issue 1

Abstract

Background

Experts in many countries are recommending a scaling up midwifery-led care as a model to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, realise cost savings, and facilitate normal spontaneous vaginal birth.

Objective

The aim of this study was to compare midwifery-led and obstetrician-gynaecologist-led care-related vaginal birth outcomes.

Participants

Pregnant women in Kaunas city maternity care facilities.

Methods

A propensity score-matched case–control study of midwifery-led versus physician-led low-risk birth outcomes. Patient characteristics and outcomes were compared between the groups. Continuous variables are presented as mean ± standard deviation and analysed using the Mann–Whitney U test. Categorical and binary variables are presented as frequency (percentage), and differences were analysed using the chi-square test. Analyses were conducted separately for the unmatched (before propensity score matched [PSM]) and matched (after PSM) groups.

Results

After adjusting groups for propensity score, postpartum haemorrhage differences between physician-led and midwifery-led labours were significantly different (169.5 and 152.6 mL; p = 0.026), same for hospital stay duration (3.3 and 3.1 days, p = 0.042). Also, in matched population, significant differences were seen for episiotomy rates (chi2 = 4.8; p = 0.029), newborn Apgar 5 min score (9.58 and 9.76; p = 0.002), and pain relief (chi2 = 14.9; p = 0.002). Significant differences were seen in unmatched but not confirmed in matched population for obstetrical procedures used during labour, breastfeeding, birth induction, newborn Apgar 1 min scores, and successful vaginal birth as an overall spontaneous vaginal birth success measure.

Conclusion

The midwifery-led care model showed significant differences from the physician-led care model in episiotomy rates, hospital stay duration and postpartum haemorrhage, and newborn Apgar 5 min scores. Midwifery-led care is as safe as physician-led care and does not influence the rate of successful spontaneous vaginal births.

Keywords: midwifery-led care; physician-led care; birth outcomes; vaginal birth

1 Introduction

In the most general sense, physician-led care can be associated with the biomedical model of care, which aims to reduce the risk of maternal/foetal/infant morbidity and mortality by screening, diagnosis, and treatment of potential complications as they develop [1]. In contrast to the biomedical physician-led model, midwifery practice focuses on the normal biological processes of pregnancy, birth, and transition to parenthood [2]. It is well documented that midwifery-led care can be important to improve quality of care, outcomes, and be more efficient in the use of health care resources by reducing maternal and neonatal mortality and morbidity, reducing stillbirth and preterm birth, decreasing the number of unnecessary interventions, and improving psychosocial and public health outcomes [3]. Global health experts in many countries are recommending a scaling up midwifery-led care as a model to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, realise cost savings, and facilitate normal spontaneous vaginal birth [4,5,6].

For almost half of the century, Lithuania had an obstetrician-gynaecologist-led maternity care system, in which midwives were a part of the system without autonomy in their practice. As in all antenatal and postnatal maternity care in the Soviet system, the role of midwives was diminished to the position of a doctor’s assistant. Midwives had very limited responsibilities and without possibilities to make individual clinical decisions. However, since gained independence from Soviet, there have been promising changes towards enhancing autonomy of midwifery during the last decades. In 1996 World Health Organisation (WHO) has stated: “The midwife appears to be the most appropriate and cost-effective type of health care provider to be assigned to the care of normal pregnancy and normal birth, including risk assessment and the recognition of complications” [7]. Recently, in settings with well-functioning midwifery programmes, WHO has recommended a midwifery-led continuity-of-care model, in which a known midwife or a small group of known midwives support a woman throughout the antenatal, intrapartum, and postnatal continuum [8,9].

Since 1992 Lithuania has introduced the perinatology programme and allocated midwifery services to all three levels of care. Since then, the Lithuanian Union of Midwives was active in the preparation of the legislative documentation, standardised operating procedures and regulations, and organisation of postgraduate education programmes and courses [10]. Subsequent changes from 2010 in maternity care organisation led to a new midwives’ practice, with higher midwife’s independence to provide antenatal care independently for low-risk women. And accordingly, midwifery-led care had to become essential for all low-risk births.

Currently, in Lithuania, there are two main models of care: midwiferys-led and physician-led care for the perinatal period. The first model – midwifery-led care model – is based on a normal physiological process of birth, focusing on personalised care and avoiding unnecessary medical interventions. The second model – physician-led model – is focused on safety aspects of birth. The qualification and competence of physicians permit to use more medical interventions, and also they take care of high-risk births. Accordingly, low-risk pregnant women can choose either midwiferys-led care or physician-led care. However, in some cases, low-risk pregnant women during pregnancy period can become as a high risk, and it can increase the need and use of medical interventions, changing the normal process of birth. In such cases, the obstetrician-gynaecologist will also be involved in the care process (when necessary) and medical staff will work in a team.

Obstetric interventions and procedures are the responsibilities of the obstetrician-gynaecologist. However, in Lithuania, it is regulated that some interventions can also be performed by a midwife. The midwife can perform an amniotomy, stimulate the activity by oxytocin, provide pain control, perform an episiotomy, suture the episiotomy, and provide active placental period. In the event of any complications until the arrival of the physician, midwife on her own may perform the following procedures: initiate the woman’s resuscitation; provide assistance in cases of breach presentation, umbilical cord prolapse, and foetal shoulder dystocia; if necessary, use a vacuum extractor; examine the uterus by hand and remove the placenta; and stop the bleeding from uterus by applying bimanual uterine pressure and squeezing the aorta, if necessary.

The aim of this study was to compare midwifery-led and obstetrician-gynaecologist-led care-related vaginal birth outcomes.

2 Methods

2.1 Study design

A propensity score-matched case–control study of midwifery-led versus physician-led birth outcomes. The use of propensity score allows us to compare midwifery-led and physician-led birth by matching the birth risk and other clinical characteristics between groups and minimise the potential for selection bias.

2.2 Setting

This study was conducted in Kaunas city maternity care units with obstetric care. We studied low-risk women with singleton pregnancies who were supervised and gave vaginal birth beyond 37 weeks of gestation.

Kaunas city has all three levels of health care facilities: two small maternities serving for low-risk births and one multiprofile regional hospital for low-risk births and births from 34 weeks for women with risk factors, and one Perinatology Center was available with all levels of care, including neonatology and intensive care units.

2.3 Study participants

Pregnant women in Kaunas city maternity care facilities.

2.4 Case definition

A study group was composed according to low-risk pregnancy attendant: midwifery-led versus physician-led low-risk pregnancies.

A low-risk pregnancy is considered for a healthy woman before pregnancy, who did not develop any diseases during pregnancy, pregnancy without complications, foetus developed without complications, and no premature birth. At first visit, the birth risk is assessed. For a low-risk birth, the midwifery-led care is proposed first, but if the pregnant woman did not agree, physician-led care option is also available. If the risk of birth changes during the antenatal period and becomes high, the obstetrician-gynaecologist will also be involved in the care process and medical staff will work in a team.

2.5 Selection of controls

Controls were women who were supervised and had childbirth led by physician. Selection of controls was based on the propensity score matching from a pool of physician-led births.

2.6 Study size

Total unmatched population was 1,848 singleton births, 1,664 led by physicians, and 184 led by midwives, and the matched population came to 174 births in each group (1:1 matching).

2.7 Variables

Sociodemographic variables such as age, weight, living place, pregnancy, birth number, and newborn weight were obtained from medical records.

Data on outcome variables such as postpartum haemorrhage, hospital stay duration, obstetrical procedures as uterine revision, instrumental termination of labour, perineal tears, birth induction, pain relief methods, newborn Apgar 1 and 5 min scores, and breastfeeding initiation were collected from medical records.

Successful spontaneous vaginal birth (i.e. normal birth) was assessed as birth in which labour starts spontaneously, progresses spontaneously, and gives childbirth spontaneously without any intervention [11,12].

2.8 Data analysis and statistical methods

We used propensity score-matched (PSM) pairs analysis to optimise the balance of baseline covariates between groups and minimise a potential bias and confounding arising from a selection of study participants. We used a one-to-one genetic matching algorithm (Rgenoud and Matching libraries in R software V.3.5.3 – Free Software Foundation s GNU General Public License, developed at Bell Laboratories (formerly AT&T, now Lucent Technologies) by John Chambers and colleagues.) without replacement with a caliper of 0.25 to get the best balance of the groups for potentially confounding variables showing significant differences in unmatched population. Matching was performed on following potentially confounding variables: maternal age, body mass index (BMI), pregnancy number, birth number, and birth-risk evaluation. We used effect size and significance testing to assess the balance of the covariates after matching.

Patient characteristics and outcomes were compared between the groups. Continuous variables are presented as mean ± standard deviation (SD) and analysed using the Mann–Whitney U test. Categorical and binary variables are presented as frequency (percentage), and differences were analysed using the chi-square test. Analyses were conducted separately for the unmatched (before PSM) and matched (after PSM) groups. Statistical data analysis was two tailed and performed using the JASP V.0.10.2. The statistical difference between the groups was considered significant when p < 0.05.

2.9 Ethical and data protection considerations

The study protocol was reviewed and approved by the Biomedical Research Ethics Committee of Kaunas region (No. BE-2-33). There was no direct contact with births and neonates during data collection and analysis. No maternal and neonatal personally identifiable information was included in the research data; therefore, the Biomedical Research Ethics Committee of Kaunas region exempted the informed consent form usage.

3 Results

The study data were available for 1,848 singleton low-risk births from Kaunas city maternity care units with obstetric care. Of all number of births, there were 184 births led by midwives and 1,664 births led by obstetrician-gynaecologists. Of all total 1,848 births, 348 were matched 1:1 by making each group of 174 led by midwives and births led by obstetrician-gynaecologists. Tables 1 and 2 summarise sociodemographic and systemic disorders characteristics of study participants in matched and unmatched cohorts. The matched data also indicated an overall lower difference on potential confounding variables and almost perfect match on controlled variables during the matching. The matching process improved balance of systemic disorders and sociodemographic characteristics between these groups.

Table 1

Sociodemographic characteristics of study participants in the unmatched and matched study populations

Unmatched population (N = 1,848) Matched population (N = 348)
Physician (N = 1,664) Midwife (N = 184) p value Physician (N = 174) Midwife (N = 174) p value
Maternal age (years) 28.6 ± 4.1 28.9 ± 0.5 0.466 28.8 ± 3.9 28.8 ± 3.9 0.980
Maternal BMI 27.8 ± 4.1 27.0 ± 3.5 0.035 27.2 ± 3.8 27.0 ± 3.6 0.721
Maternal weight (kg) 78.4 ± 12.3 76.4 ± 10.9 0.075 76.6 ± 11.3 76.3 ± 10.8 0.922
Newborn weight (kg) 3.54 ± 0.30 3.48 ± 0.35 0.081 3.49 ± 0.35 3.47 ± 0.35 0.321
Primiparas 704 (42.3) 46 (25.0) <0.001 44 (25.3) 44 (25.3) 1.000
Birth no. 1.6 ± 0.6 1.8 ± 0.6 <0.001 1.8 ± 0.5 1.8 ± 0.5 1.000
Pregnancy no. 1.9 ± 0.9 2.1 ± 0.8 <0.001 2.0 ± 0.7 2.0 ± 0.7 1.000
Pregnancy duration (days) 39.4 ± 1.0 39.2 ± 1.1 0.105 39.4 ± 0.9 39.2 ± 1.0 0.223
Previous pregnancies
  None 610 (36.7) 44 (23.9) <0.001 42 (24.2) 44 (25.3) 0.968
  Normal 613 (36.8) 92 (50.0) 90 (51.7) 89 (51.1)
  Complicated 441 (26.5) 48 (26.1) 42 (24.1) 41 (23.6)
  Living place = city 1,166 (70.1) 133 (72.3) 0.534 122 (70.1) 125 (71.8) 0.723

Note. Continuous variables were reported as mean ± SD, and categorical variables were reported as counts and percentages. P-value was determined by the Mann–Whitney U test for continuous variables and chi2 test for categorical and binary variables.

Table 2

Systemic disorders of study participants in the unmatched and matched study populations

Unmatched population (N = 1,848) Matched population (N = 348)
Physician (N = 1,664) Midwife (N = 184) p value Physician (N = 174) Midwife (N = 174) p value
Hypertension 666 (40.0) 67 (36.4) 0.342 67 (38.5) 65 (37.4) 0.825
Allergy 240 (14.4) 27 (14.7) 0.927 24 (13.8) 26 (14.9) 0.760
Heart disease 84 (5.0) 7 (3.8) 0.459 5 (2.9) 7 (4.0) 0.557
Endocrinological diseases 90 (5.4) 12 (6.5) 0.530 10 (5.7) 11 (6.3) 0.822
Tuberculosis 47 (2.8) 3 (1.6) 0.343 4 (2.3) 3 (1.7) 0.703
Urinary tract diseases 252 (15.1) 26 (14.1) 0.715 24 (13.8) 23 (13.2) 0.875
Preeclampsia 17 (1.0) 0 (0.0) 0.168 1 (0.6) 0 (0.0) 0.317
Viral infection 117 (7.0) 7(3.8) 0.097 11 (6.3) 6 (3.5) 0.214
Epilepsy 11 (0.7) 0 (0.0) 0.269 1 (0.6) 0 (0.0) 0.317
Infection in the mouth 55 (3.3) 11 (5.9) 0.064 7 (4.0) 10 (5.7) 0.456

Note. Continuous variables were reported as mean ± SD, and categorical variables were reported as counts and percentages. P-value was determined by the Mann–Whitney U test for continuous variables and chi2 test for categorical and binary variables.

Table 3 shows comparison for each of investigated birth outcome in the unmatched and matched study populations. Postpartum haemorrhage differences between physician-led and midwifery-led labour were significant in both unmatched and matched populations (p = 0.007 and 0.026), same for hospital stay duration (p = 0.001 and 0.042), episiotomy (p = <0.001 and 0.029), newborn Apgar 5 (p = 0.001 and 0.002) and pain relief (p < 0.001 and p = 0.002).

Table 3

Comparison of birth outcomes and services in the unmatched and matched study populations

Outcomes Unmatched population (N = 1,848) Matched population (N = 348)
Physician (N = 1,664) Midwife (N = 184) p value Physician (N = 174) Midwife (N = 174) p value
Postpartum haemorrhage (mL) 169.9 ± 99.6 152.4 ± 70.4 0.007 169.5 ± 90.1 152.6 ± 71.4 0.026
Hospital stay duration (days) 3.4 ± 1.4 3.1 ± 0.9 0.001 3.3 ± 1.4 3.1 ± 0.9 0.042
Obstetrical procedures
  None 1,589 (95.5) 183 (99.5) 0.036 167 (96.0) 173 (99.4) 0.086
  Revision 55 (3.3) 1 (0.5) 4 (2.3) 1 (0.6)
  Instrumental 20 (1.2) 0 (0) 3 (1.7) 0 (0.0)
Perineal tears
  First- and second-degree tears 316 (19.0) 45 (24.5) 0.926 45 (25.9) 42 (24.1) 0.079
  Third- and fourth-degree tears 1 (0.1) 0 (0.0) 0 (0.0) 0 (0.0)
  Genital tears 109 (5.4) 15 (8.2) 6 (3.4) 14 (8.0)
Episiotomy 402 (24.2) 17 (9.2) <0.001 31 (17.8) 16 (9.2) 0.029
Intact perineum 836 (50.2) 107 (58.2) 0.01 92 (52.9) 102 (58.6) 0.473
Birth induction
  None 837 (50.3) 115 (62.5) <0.001 101 (58.0) 108 (62.1) 0.199
  Rupture the amniotic fluid 237 (14.2) 39 (21.2) 27 (15.5) 37 (21.3)
  Oxytocinum 380 (22.8) 22 (12.0) 33 (19.0) 22 (12.6)
  Misoprostolum 29 (1.7) 1 (0.5) 1 (0.6) 1 (0.6)
  Other 181 (10.9) 7 (3.8) 12 (6.9) 6 (3.4)
Apgar 1 min. score 9.07 (0.7) 9.22 (0.5) 0.017 9.08 (0.8) 9.23 (0.5) 0.152
Apgar 5 min. score 9.61 (0.6) 9.76 (0.5) 0.001 9.58 (0.6) 9.76 (0.5) 0.002
Pain relief
  None 987 (59.3) 130 (70.7) <0.001 121 (69.5) 122 (70.1) 0.002
  NO2 76 (4.6) 21 (11.4) 4 (2.3) 20 (11.5)
  Spinal-epidural 581 (34.9) 33 (17.9) 48 (27.6) 32 (18.4)
  Other 20 (1.2) 0 (0.0) 1 (0.6) 0 (0.0)
Breastfeeding 1,233 (89.7) 174 (95.1) 0.02 126 (92.0) 164 (94.8) 0.314
Successful vaginal birth 325 (19.5) 57 (31.0) <0.001 46 (26.4) 54 (31.0) 0.343

Note: Continuous variables were reported as mean ± SD, and categorical variables were reported as counts and percentages. P-value was determined by Mann–Whitney U test for continuous variables and chi2 test for categorical and binary variables.

Significant differences were seen in unmatched but not confirmed in matched population for obstetrical procedures used during labour, breastfeeding, birth induction, newborn Apgar 1 and successful vaginal birth as overall spontaneous vaginal birth success measure.

4 Discussion

Midwifery-led care was associated with several benefits for mothers and babies and have almost no identified adverse effects in randomized controlled trials [13]. The main benefits of midwifery-led care are a reduction in the use of regional analgesia, with fewer episiotomies or instrumental births. Studies also reported that midwifery-led care can increase the woman’s chance of being individually cared and the chance of feeling in control during labour, having a spontaneous vaginal birth and initiating breastfeeding after birth. However, there was no difference in caesarean birth rates [13]. In this retrospective study, we analysed midwifery-led and obstetrician-gynaecologist-led care low-risk spontaneous vaginal birth outcomes.

4.1 Key results and its interpretation

Our findings are partially in line with other studies in this field although the designs of these studies were different. Our study showed significantly lower postpartum haemorrhage (p = 0.007 and 0.026) and shorter hospital stay duration (p = 0.001 and 0.042) in both unmatched and matched populations were seen for births led by midwife. A review of clinical trials was also concluded that midwifery-led care was superior to other forms of care and was more likely to have a shorter length of hospital stay [13]. However, there is no agreement on postpartum haemorrhage. Recent retrospective cohort study concluded that women in midwifery-led care had increased the odds of postpartum haemorrhage; however, it did not remain significant in the propensity score analysis [14]. Some other study reported lower rates of postpartum haemorrhage [15]. The studies reported that incidence and severity of postpartum bleeding are related to more frequent use of obstetric interventions [16,17,18,19], and postpartum haemorrhage can be increased by twin births (OR 6.8), retained placenta (OR 3.9) and inductions of labour (OR 2.2), birthweight >4,000 g (OR 2.0), and sphincter rupture (OR 1.6) [13]. Our data show that the midwifery-led births were less medicalised by pain-relief methods, birth induction, and obstetric interventions. It is possible that midwifery-led care provides more personalised and individual needs and preferences-focused care, which leads to a lower rate of clinical interventions. Previous studies did not demonstrate significant differences in Apgar scores between midwifery-led care and other models [15,20,21]; however, our study results demonstrated higher Apgar 5 (p = 0.001 and 0.002) scores were recorded for midwifery-led births; however, Apgar 1 score differences were not significant.

The prospective birthplace in England study group was analysed for a composite poor neonatal outcome among low-risk women and found that the proportion of women with a successful spontaneous vaginal birth as “normal birth” (birth without induction of labour, epidural or spinal analgesia, general anaesthesia, forceps or ventouse birth, caesarean section or episiotomy) varied from 58% of births in physician-led units to 76% in alongside midwifery units; the adjusted odds of having a “normal birth” were significantly higher in non-obstetric unit setting. Other maternal outcomes (third- or fourth-degree perineal trauma, maternal blood transfusion, and maternal admission to higher level care) were generally lower for planned births in midwifery units [11,22]. Our study did not confirm higher rates of “normal birth” as composite outcome of successful spontaneous vaginal birth in midwifery-led care by PSM analysis, and the differences were significant only in unmatched population. Similar results were for breastfeeding initiation after birth, despite some studies argued better outcomes for midwifery-led care births.

4.2 Strengths and weaknesses

The main weakness of the study is that due to low sample size in matched analysis, we did not examine the inter-relationships between different predictors of outcomes across physician-led and midwifery-led care models. Although we identified certain outcomes were different across settings, we did not examine why these changes occur. Alternatively, there are sufficient number of previous studies explaining such inter-relationships between outcomes and potential factors.

Usually with case–control studies, there are concerns about the problem of selection bias when comparing different practices and potential that, in settings like ours, there is a possibility to choose both models of care in the same unit, the women who were selected or allocated to midwifery-led care might be healthier and at lower risk. Thus, the main strength of our study is the fact that we created comparable groups through group matching, thereby attempting to reduce bias due to confounding variables such as maternal age, BMI, pregnancy number, birth number, and birth risk evaluation score. Due to the use of genetic matching algorithm, we improved balance of clinical and sociodemographic characteristics between the groups not only on matched variables.

4.3 Generalisability

Our study showed promising results for enhancing autonomy of midwifery-led care and autonomous work at labour wards for low-risk women in Lithuanian maternity health care system. The clinical practice should be more focused on the normal biological processes of pregnancy, birth, and transition to parenthood and further reduction of unnecessary medicalisation of birth.

5 Conclusion

Midwifery-led care showed significant differences from physician-led care model in episiotomy rates, hospital stay duration, postpartum haemorrhage, and newborn Apgar 5 min scores. Midwifery-led care is as safe as physician-led care and care model selection does not influence rate of successful spontaneous vaginal births.

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The author of the manuscript would like to thank Prof. Giedrius Vanagas and Prof. Ruta Jolanta Nadisauskiene for his assistance in writing this article.

  1. Funding information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  2. Author contributions: I.P., G.V., and R.J.N. were involved in study design, acquisition, analysis and interpretation of data, and drafting of the article. G.V., A.K., and R.J.N. were involved in conception and study design, interpretation of data, and critical revision of the article. All authors approved the final version for publication.

  3. Conflict of interest: The authors declare that they have no conflict of interest.

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

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Received: 2021-01-06
Revised: 2021-07-21
Accepted: 2021-09-20
Published Online: 2021-10-15

© 2021 Ingrida Poškienė et al., published by De Gruyter

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

Articles in the same Issue

  1. Research Articles
  2. Identification of ZG16B as a prognostic biomarker in breast cancer
  3. Behçet’s disease with latent Mycobacterium tuberculosis infection
  4. Erratum
  5. Erratum to “Suffering from Cerebral Small Vessel Disease with and without Metabolic Syndrome”
  6. Research Articles
  7. GPR37 promotes the malignancy of lung adenocarcinoma via TGF-β/Smad pathway
  8. Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
  9. Additional baricitinib loading dose improves clinical outcome in COVID-19
  10. The co-treatment of rosuvastatin with dapagliflozin synergistically inhibited apoptosis via activating the PI3K/AKt/mTOR signaling pathway in myocardial ischemia/reperfusion injury rats
  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
https://doi.org/10.1515/med-2021-0373
Keywords for this article
midwifery-led care; physician-led care; birth outcomes; vaginal birth
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. Identification of ZG16B as a prognostic biomarker in breast cancer
  3. Behçet’s disease with latent Mycobacterium tuberculosis infection
  4. Erratum
  5. Erratum to “Suffering from Cerebral Small Vessel Disease with and without Metabolic Syndrome”
  6. Research Articles
  7. GPR37 promotes the malignancy of lung adenocarcinoma via TGF-β/Smad pathway
  8. Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
  9. Additional baricitinib loading dose improves clinical outcome in COVID-19
  10. The co-treatment of rosuvastatin with dapagliflozin synergistically inhibited apoptosis via activating the PI3K/AKt/mTOR signaling pathway in myocardial ischemia/reperfusion injury rats
  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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