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Idiopathic pulmonary fibrosis telemedicine management during COVID-19 outbreak

  • Anna Agnese Stanziola EMAIL logo , Andrea Salzano , Rossella D’Angelo , Alberto Maria Marra , Lorena Gallotti , Roberta D’Assante , Danilo Pentangelo , Brigida Ranieri , Eduardo Bossone and Antonio Cittadini
Published/Copyright: April 7, 2022
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Open Medicine
From the journal Open Medicine Volume 17 Issue 1

Abstract

The present report investigates the impact of a Telemedicine Service (TMS) on the management of Idiopathic Pulmonary Fibrosis (IPF) during coronavirus disease of 2019 (COVID-19) outbreak in Italy. The TMS comprised 3 phone numbers, active 12 h per day, and an email address, monitored every 4 h by trained physicians; chat- and videoconference-services were also offered. At the end of the study period, our staff contacted all patients, to get information about the final outcome (i.e. composite hospitalisations/all causes of death). Outcomes were compared with a cohort of patients who attended our unit in the same period of the previous year (when no TMS was available). 189 patients participated in the present study. From 11th March to 4th May 2020, 61% of patients made at least one TMS access, mostly by emails (53%), followed by phone calls (33%). With regard to the primary outcome, TMS patients experienced a significant lower rate of events of the 182 patients of the no-TMS cohort (p < 0.001). Specifically, a significant difference was observed for IPF hospitalisation (p < 0.001) whereas no differences were observed with regard to deaths (p = 0.64). TMS permits patients to be followed up even during COVID-19 lockdown, with an encouraging impact on outcomes.

Keywords: Telemedicine; idiopathic pulmonary fibrosis; COVID-19; outcomes; SARS-CoV-2; prognosis

1 Introduction

A few weeks after the first case of person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) was confirmed in a small town in the Northern Italy [1], a governmental Decree-Law imposed a global lockdown in Italy, with the aim of reducing the spread of coronavirus disease of 2019 (COVID-19). As a result, national healthcare system has been affected by several restrictions, with outpatient clinics and day-services suspended and inward access allowed only for urgent events. Despite leading to a reduction in the risk of in-hospital COVID-19 spread, as a downside, a huge decrease in the clinic assistance of chronic diseases – e.g. Idiopathic Pulmonary Fibrosis (IPF) – was expected. Therefore, our IPF university tertiary referral centre [2,3] set up a Telemedicine Service (TMS) to guarantee clinical assistance to patients affected by this chronic disease during the COVID-19 pandemic.

Aims of the present report were to investigate the impact of TMS on the management of IPF during COVID-19 outbreak, and to compare outcomes (i.e. composite of hospitalisation/death) with the identical period (11th March–4th May) of the previous year, when TMS was not available.

2 Materials and methods

Our TMS comprised 3 phone numbers, active 12 h per day, and an email address, monitored every 4 h by trained physicians; chat- and videoconference-services were also offered, using most popular smartphone applications. On purpose, the TMS was based mostly on phone calls, to avoid possible social disparities (e.g. accessibility of service only to people with available technologies and/or capacities to use the service) [4]; indeed, as minimum hardware requirements, patients were asked to have free access to a phone, available at their need. All accesses were on voluntary basis by the patients, who were encouraged to use the TMS for all clinical needs. General measures to prevent COVID-19 diffusion (e.g. frequent handwashing, use of face masks in public places, social distancing, and self-isolating) were prescribed. Patients were encouraged to assess parameters such as blood pressure and oxygen saturation (SpO2) at least three times per week. With regard to IPF specific treatment, we recommended the prosecution of all drugs as per medical standard [5]. At the end of the study period, our staff contacted all patients, to get information about the final outcome.

Data are expressed as mean value ± SD or median (interquartile range [IQR]) wherever appropriate. Statistical analysis was performed using SPSS version 26 (IBM, New York, NY, USA) running on a MAC OSX 10.15.5 (Apple, Cupertino, CA, USA). Pearson’s chi-squared and Fisher’s exact tests were used to compare the primary outcomes (defined as a composite of hospitalisation/death, all-cause hospitalisations, or all-cause mortality). A p value <0.05 was considered significant.

The need for the patient’s informed consent was waived due to the observational design of the study, and because patients’ information have been anonymised before data analysis.

3 Results

One hundred and eighty-nine patients participated in the present study; outcomes were compared with data from 182 IPF patients who attended our unit in the same period of 2019 (Table 1). From 11th March to 4th May 2020, 61% of patients made at least one TMS access, mostly by emails (53%), followed by phone calls (33%). Overall, 56% of contacts led to a clinical decision (adjustment of corticosteroids/antibiotics/antifibrotic doses, oxygen management, and others), based on clinical data reported by patients during the contact (e.g. blood pressure and SpO2) (Figure 1). No differences were found with regard to education and social status of patients who accessed the TMS compared to patients who did not (data not shown). With regard to the primary outcome, nine patients experienced the primary endpoint. Specifically, four patients deceased (all of them were at advanced stage of IPF before the lockdown), whereas five patients were hospitalised (one for stroke, two for exacerbation of the IPF, and one for non IPF-related surgery); notably, only 1 of our IPF patients got COVID-19, with an unexpected positive outcome after hospitalisation. Pearson’s chi-squared and Fisher’s exact tests showed that patients in 2020 cohort (when TMS was available) were less likely to experience the primary outcome (X 2 [degree of freedom 1, cases = 371] 21.8, p < 0.001) than the 2019 cohort (i.e. TMS not offered). Specifically, a significant difference was observed for IPF hospitalisation (p < 0.001), whereas no differences were observed with regard to deaths (p = 0.64).

Table 1

Demographic characteristics at baseline, telemedicine data, and outcomes

Variables Cohort 2020 (n = 189) Cohort 2019 (n = 182) p
Demographics
Age (year) 71.8 ± 7.4 70 ± 8.1 ns
Sex (male/female) 114/80 115/64 ns
Systolic blood pressure (mm Hg) 126 ± 5.7 125 ± 4.3 ns
Diastolic blood pressure (mm Hg) 80.2 ± 7.4 79.3 ± 6.7 ns
Heart rate (bpm) 78.9 ± 8.6 78.3 ± 7.3
BMI (kg/m2) 31.9 ± 6.3 29.7 ± 5.2 ns
Smokers (%) 59 (31) 60 (33) ns
FVC (% predicted) 75.9 ± 23.3 76.5 ± 22.4 ns
SpO2 (%) 91.28 ± 5.21 90.71 ± 4.87 ns
Medication
O2 therapy (%) 52 (27) 51 (28) ns
Corticosteroids (%) 60 (32) 58 (31) ns
Antifibrotics (pirfenidone/nintedanib/none) 79/105/5 72/107/3 ns
Telemedicine
Total number of accesses 215 — —
Patients with at least 1 access (%) 116 (61%) — —
Type of access
Phone calls (%) 71 (33) — —
Chat (%) 26 (12%) — —
Video (%) 0 (%) — —
Emails (%) 115 (53%) — —
Patients needing at least one clinical intervention 110 (58%) — —
Number of clinical interventions 122 (56%) — —
Type of clinical intervention
Monitoring for treatment confirmation 70 — —
Corticosteroids management 11 — —
Oxygen therapy management 10 — —
Antibiotics management 8 — —
Antifibrotics management 3 — —
Others# 20 — —
Outcome
2020 lockdown Same period in 2019 p
Composite hospitalisation/death 9 38 0.001*
Hospitalisations 5 33 0.001*
Deaths 4 5 ns

BMI: body mass index; FVC: forced vital capacity; SpO2: blood oxygen saturation level. Period of observation: 11th March–4th May 2020 for COVID-19 lockdown cohort, and 11th March–4th May 2019 for control cohort; * p < 0.01; # other interventions: diuretics prescription, arterial hypertension management, blood analyses monitoring, general advice. Data expressed as mean value ± standard deviation or percentages.

4 Discussion

The present investigation represents the first study designed to investigate the utility of telemedicine in the management of IPF during the lockdown due to Covid-19 outbreak. Telemedicine represents one of the most promising methods to improve quality and healthcare availability during period of limited direct contact between patients and healthcare professionals. Using worldwide available technologies (analogic phones, emails, smartphones, apps), our large cohort of IPF patients has been followed up even during the COVID-19 outbreak, with a positive impact on the general IPF management, as shown in other diseases (e.g. heart failure) [6]. About half of the patients needed at least one TMS access, and about 50% of these accesses led to a clinical decision, confirming the usefulness of our TMS. Intriguingly, even if our TMS was based mostly on phone calls to avoid possible social inequality, in our cohort, the most frequent way to access was by email; this was the opposite of the findings we observed when a similar TMS has been applied in another chronic disease (i.e. heart failure), with patients preferring phone calls [6]. A possible explanation is the different nature of the patients’ request between these two cohorts (confirmation of treatment vs changes in symptoms relief drugs dosage, IPF vs heart failure cohort), leading to the hypothesis that the urgency of the need was the most impacting factor on the means of access to the TMS. A recent randomised controlled trial showed that an IPF home monitoring program did not improve the quality of life but psychological well-being, with great appreciation by patients [7]; in this regard, our patients expressed a great appreciation about our TMS. Further, home monitoring program allowed individually tailored medication adjustments and early detection of intercurrent events [7], in line with the results of the present report and with a similar experience in a different chronic disease [6]. In addition, our TMS allowed to anticipate hospitalisation of the patient affected only by COVID-19 in our cohort, who was referred to the closer COVID-19 hospital after a TMS access. Altogether, these findings further support the idea that a TMS can help in addressing the challenges that physical isolation is creating in patients with chronic diseases during the COVID-19 outbreak [8,9]. Notably, recently the development of telemedicine has been pointed out as one of the key priorities in the agenda for COVID-19 research in respiratory disease, and being an instrument able to improve patient management, allowing effective isolation and disease monitoring [10]. Finally, the use of telephone or video appointments has been described as a useful strategy to reduce potential exposure to COVID-19 for patients with fibrotic interstitial lung disease [11].

4.1 Study limitations

As study limitations, our report shows data from a single centre experience. Further, some variables (e.g. age of patients, availability of modern technologies, and socio-cultural barriers) could impact the capacity of the patients to access the TMS service, representing a limitation of TMS method itself. However, we included a direct phone number in our TMS, available to all patients and their caregivers, trying to minimise this possible bias. Further, the team provided support and training to the caregivers when patients were not able to access TMS by their own.

5 Conclusion

In conclusion, our TMS permits our large cohort of IPF patients to be followed up even during COVID-19 lockdown, with an encouraging impact on IPF outcome. With the aim of reducing possible socio-cultural limits, it is important that TMS comprises simple phone based service too, and not only high-technologies methods.

The present report confirms telemedicine as a valuable tool in IPF management and shows its feasibility in IPF management during COVID-19 outbreak.

Figure 1 (a) Patients who accessed TMS and access modality. (b) Outcome of the accesses performed and medical decisions.
Figure 1

(a) Patients who accessed TMS and access modality. (b) Outcome of the accesses performed and medical decisions.

Contributed equally to this manuscript.

tel: +39-0817461111, fax: +39-0817461111

Acknowledgments

Dr Salzano received research grant support from CardioPath, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy, and UniNA and Compagnia di San Paolo in the frame of the STAR (Sostegno Teritoriale alla Attività di Ricerca) programme.

  1. Funding information: No funding was received.

  2. Author contributions: A.A.S., A.S., and A.C; had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: A.S., A.S.S., and A.C.; acquisition, analysis, or interpretation of data: All authors; drafting of the manuscript: A.S., A.S.S., and A.C.; critical revision of the manuscript for important intellectual content: All authors; statistical analysis: A.S.; supervision: A.S.S., E.B., and A.C.

  3. Conflict of interest: Andrea Salzano serve as Editor for Open Medicine, but it did not affected the peer-review process.

  4. Data availability statement: The datasets used or analysed during this study are available from the corresponding author on reasonable request.

References

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Received: 2021-04-02
Revised: 2022-02-21
Accepted: 2022-03-09
Published Online: 2022-04-07

© 2022 Anna Agnese Stanziola et al., published by De Gruyter

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

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  153. Long non-coding RNAs LINC00689 inhibits the apoptosis of human nucleus pulposus cells via miR-3127-5p/ATG7 axis-mediated autophagy
  154. The relationship between oxygen therapy, drug therapy, and COVID-19 mortality
  155. Monitoring hypertensive disorders in pregnancy to prevent preeclampsia in pregnant women of advanced maternal age: Trial mimicking with retrospective data
  156. SETD1A promotes the proliferation and glycolysis of nasopharyngeal carcinoma cells by activating the PI3K/Akt pathway
  157. The role of Shunaoxin pills in the treatment of chronic cerebral hypoperfusion and its main pharmacodynamic components
  158. TET3 governs malignant behaviors and unfavorable prognosis of esophageal squamous cell carcinoma by activating the PI3K/AKT/GSK3β/β-catenin pathway
  159. Associations between morphokinetic parameters of temporary-arrest embryos and the clinical prognosis in FET cycles
  160. Long noncoding RNA WT1-AS regulates trophoblast proliferation, migration, and invasion via the microRNA-186-5p/CADM2 axis
  161. The incidence of bronchiectasis in chronic obstructive pulmonary disease
  162. Integrated bioinformatics analysis shows integrin alpha 3 is a prognostic biomarker for pancreatic cancer
  163. Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway
  164. Comparison of hospitalized patients with severe pneumonia caused by COVID-19 and influenza A (H7N9 and H1N1): A retrospective study from a designated hospital
  165. lncRNA ZFAS1 promotes intervertebral disc degeneration by upregulating AAK1
  166. Pathological characteristics of liver injury induced by N,N-dimethylformamide: From humans to animal models
  167. lncRNA ELFN1-AS1 enhances the progression of colon cancer by targeting miR-4270 to upregulate AURKB
  168. DARS-AS1 modulates cell proliferation and migration of gastric cancer cells by regulating miR-330-3p/NAT10 axis
  169. Dezocine inhibits cell proliferation, migration, and invasion by targeting CRABP2 in ovarian cancer
  170. MGST1 alleviates the oxidative stress of trophoblast cells induced by hypoxia/reoxygenation and promotes cell proliferation, migration, and invasion by activating the PI3K/AKT/mTOR pathway
  171. Bifidobacterium lactis Probio-M8 ameliorated the symptoms of type 2 diabetes mellitus mice by changing ileum FXR-CYP7A1
  172. circRNA DENND1B inhibits tumorigenicity of clear cell renal cell carcinoma via miR-122-5p/TIMP2 axis
  173. EphA3 targeted by miR-3666 contributes to melanoma malignancy via activating ERK1/2 and p38 MAPK pathways
  174. Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block
  175. miRNA-130a-3p targets sphingosine-1-phosphate receptor 1 to activate the microglial and astrocytes and to promote neural injury under the high glucose condition
  176. Review Articles
  177. Current management of cancer pain in Italy: Expert opinion paper
  178. Hearing loss and brain disorders: A review of multiple pathologies
  179. The rationale for using low-molecular weight heparin in the therapy of symptomatic COVID-19 patients
  180. Amyotrophic lateral sclerosis and delayed onset muscle soreness in light of the impaired blink and stretch reflexes – watch out for Piezo2
  181. Interleukin-35 in autoimmune dermatoses: Current concepts
  182. Recent discoveries in microbiota dysbiosis, cholangiocytic factors, and models for studying the pathogenesis of primary sclerosing cholangitis
  183. Advantages of ketamine in pediatric anesthesia
  184. Congenital adrenal hyperplasia. Role of dentist in early diagnosis
  185. Migraine management: Non-pharmacological points for patients and health care professionals
  186. Atherogenic index of plasma and coronary artery disease: A systematic review
  187. Physiological and modulatory role of thioredoxins in the cellular function
  188. Case Reports
  189. Intrauterine Bakri balloon tamponade plus cervical cerclage for the prevention and treatment of postpartum haemorrhage in late pregnancy complicated with acute aortic dissection: Case series
  190. A case of successful pembrolizumab monotherapy in a patient with advanced lung adenocarcinoma: Use of multiple biomarkers in combination for clinical practice
  191. Unusual neurological manifestations of bilateral medial medullary infarction: A case report
  192. Atypical symptoms of malignant hyperthermia: A rare causative mutation in the RYR1 gene
  193. A case report of dermatomyositis with the missed diagnosis of non-small cell lung cancer and concurrence of pulmonary tuberculosis
  194. A rare case of endometrial polyp complicated with uterine inversion: A case report and clinical management
  195. Spontaneous rupturing of splenic artery aneurysm: Another reason for fatal syncope and shock (Case report and literature review)
  196. Fungal infection mimicking COVID-19 infection – A case report
  197. Concurrent aspergillosis and cystic pulmonary metastases in a patient with tongue squamous cell carcinoma
  198. Paraganglioma-induced inverted takotsubo-like cardiomyopathy leading to cardiogenic shock successfully treated with extracorporeal membrane oxygenation
  199. Lineage switch from lymphoma to myeloid neoplasms: First case series from a single institution
  200. Trismus during tracheal extubation as a complication of general anaesthesia – A case report
  201. Simultaneous treatment of a pubovesical fistula and lymph node metastasis secondary to multimodal treatment for prostate cancer: Case report and review of the literature
  202. Two case reports of skin vasculitis following the COVID-19 immunization
  203. Ureteroiliac fistula after oncological surgery: Case report and review of the literature
  204. Synchronous triple primary malignant tumours in the bladder, prostate, and lung harbouring TP53 and MEK1 mutations accompanied with severe cardiovascular diseases: A case report
  205. Huge mucinous cystic neoplasms with adhesion to the left colon: A case report and literature review
  206. Commentary
  207. Commentary on “Clinicopathological features of programmed cell death-ligand 1 expression in patients with oral squamous cell carcinoma”
  208. Rapid Communication
  209. COVID-19 fear, post-traumatic stress, growth, and the role of resilience
  210. Erratum
  211. Erratum to “Tollip promotes hepatocellular carcinoma progression via PI3K/AKT pathway”
  212. Erratum to “Effect of femoral head necrosis cystic area on femoral head collapse and stress distribution in femoral head: A clinical and finite element study”
  213. Erratum to “lncRNA NORAD promotes lung cancer progression by competitively binding to miR-28-3p with E2F2”
  214. Retraction
  215. Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
  216. Retraction to “miR-519d downregulates LEP expression to inhibit preeclampsia development”
  217. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part II
  218. Usefulness of close surveillance for rectal cancer patients after neoadjuvant chemoradiotherapy
https://doi.org/10.1515/med-2022-0466
Keywords for this article
Telemedicine; idiopathic pulmonary fibrosis; COVID-19; outcomes; SARS-CoV-2; prognosis
Creative Commons
BY 4.0

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  153. Long non-coding RNAs LINC00689 inhibits the apoptosis of human nucleus pulposus cells via miR-3127-5p/ATG7 axis-mediated autophagy
  154. The relationship between oxygen therapy, drug therapy, and COVID-19 mortality
  155. Monitoring hypertensive disorders in pregnancy to prevent preeclampsia in pregnant women of advanced maternal age: Trial mimicking with retrospective data
  156. SETD1A promotes the proliferation and glycolysis of nasopharyngeal carcinoma cells by activating the PI3K/Akt pathway
  157. The role of Shunaoxin pills in the treatment of chronic cerebral hypoperfusion and its main pharmacodynamic components
  158. TET3 governs malignant behaviors and unfavorable prognosis of esophageal squamous cell carcinoma by activating the PI3K/AKT/GSK3β/β-catenin pathway
  159. Associations between morphokinetic parameters of temporary-arrest embryos and the clinical prognosis in FET cycles
  160. Long noncoding RNA WT1-AS regulates trophoblast proliferation, migration, and invasion via the microRNA-186-5p/CADM2 axis
  161. The incidence of bronchiectasis in chronic obstructive pulmonary disease
  162. Integrated bioinformatics analysis shows integrin alpha 3 is a prognostic biomarker for pancreatic cancer
  163. Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway
  164. Comparison of hospitalized patients with severe pneumonia caused by COVID-19 and influenza A (H7N9 and H1N1): A retrospective study from a designated hospital
  165. lncRNA ZFAS1 promotes intervertebral disc degeneration by upregulating AAK1
  166. Pathological characteristics of liver injury induced by N,N-dimethylformamide: From humans to animal models
  167. lncRNA ELFN1-AS1 enhances the progression of colon cancer by targeting miR-4270 to upregulate AURKB
  168. DARS-AS1 modulates cell proliferation and migration of gastric cancer cells by regulating miR-330-3p/NAT10 axis
  169. Dezocine inhibits cell proliferation, migration, and invasion by targeting CRABP2 in ovarian cancer
  170. MGST1 alleviates the oxidative stress of trophoblast cells induced by hypoxia/reoxygenation and promotes cell proliferation, migration, and invasion by activating the PI3K/AKT/mTOR pathway
  171. Bifidobacterium lactis Probio-M8 ameliorated the symptoms of type 2 diabetes mellitus mice by changing ileum FXR-CYP7A1
  172. circRNA DENND1B inhibits tumorigenicity of clear cell renal cell carcinoma via miR-122-5p/TIMP2 axis
  173. EphA3 targeted by miR-3666 contributes to melanoma malignancy via activating ERK1/2 and p38 MAPK pathways
  174. Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block
  175. miRNA-130a-3p targets sphingosine-1-phosphate receptor 1 to activate the microglial and astrocytes and to promote neural injury under the high glucose condition
  176. Review Articles
  177. Current management of cancer pain in Italy: Expert opinion paper
  178. Hearing loss and brain disorders: A review of multiple pathologies
  179. The rationale for using low-molecular weight heparin in the therapy of symptomatic COVID-19 patients
  180. Amyotrophic lateral sclerosis and delayed onset muscle soreness in light of the impaired blink and stretch reflexes – watch out for Piezo2
  181. Interleukin-35 in autoimmune dermatoses: Current concepts
  182. Recent discoveries in microbiota dysbiosis, cholangiocytic factors, and models for studying the pathogenesis of primary sclerosing cholangitis
  183. Advantages of ketamine in pediatric anesthesia
  184. Congenital adrenal hyperplasia. Role of dentist in early diagnosis
  185. Migraine management: Non-pharmacological points for patients and health care professionals
  186. Atherogenic index of plasma and coronary artery disease: A systematic review
  187. Physiological and modulatory role of thioredoxins in the cellular function
  188. Case Reports
  189. Intrauterine Bakri balloon tamponade plus cervical cerclage for the prevention and treatment of postpartum haemorrhage in late pregnancy complicated with acute aortic dissection: Case series
  190. A case of successful pembrolizumab monotherapy in a patient with advanced lung adenocarcinoma: Use of multiple biomarkers in combination for clinical practice
  191. Unusual neurological manifestations of bilateral medial medullary infarction: A case report
  192. Atypical symptoms of malignant hyperthermia: A rare causative mutation in the RYR1 gene
  193. A case report of dermatomyositis with the missed diagnosis of non-small cell lung cancer and concurrence of pulmonary tuberculosis
  194. A rare case of endometrial polyp complicated with uterine inversion: A case report and clinical management
  195. Spontaneous rupturing of splenic artery aneurysm: Another reason for fatal syncope and shock (Case report and literature review)
  196. Fungal infection mimicking COVID-19 infection – A case report
  197. Concurrent aspergillosis and cystic pulmonary metastases in a patient with tongue squamous cell carcinoma
  198. Paraganglioma-induced inverted takotsubo-like cardiomyopathy leading to cardiogenic shock successfully treated with extracorporeal membrane oxygenation
  199. Lineage switch from lymphoma to myeloid neoplasms: First case series from a single institution
  200. Trismus during tracheal extubation as a complication of general anaesthesia – A case report
  201. Simultaneous treatment of a pubovesical fistula and lymph node metastasis secondary to multimodal treatment for prostate cancer: Case report and review of the literature
  202. Two case reports of skin vasculitis following the COVID-19 immunization
  203. Ureteroiliac fistula after oncological surgery: Case report and review of the literature
  204. Synchronous triple primary malignant tumours in the bladder, prostate, and lung harbouring TP53 and MEK1 mutations accompanied with severe cardiovascular diseases: A case report
  205. Huge mucinous cystic neoplasms with adhesion to the left colon: A case report and literature review
  206. Commentary
  207. Commentary on “Clinicopathological features of programmed cell death-ligand 1 expression in patients with oral squamous cell carcinoma”
  208. Rapid Communication
  209. COVID-19 fear, post-traumatic stress, growth, and the role of resilience
  210. Erratum
  211. Erratum to “Tollip promotes hepatocellular carcinoma progression via PI3K/AKT pathway”
  212. Erratum to “Effect of femoral head necrosis cystic area on femoral head collapse and stress distribution in femoral head: A clinical and finite element study”
  213. Erratum to “lncRNA NORAD promotes lung cancer progression by competitively binding to miR-28-3p with E2F2”
  214. Retraction
  215. Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
  216. Retraction to “miR-519d downregulates LEP expression to inhibit preeclampsia development”
  217. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part II
  218. Usefulness of close surveillance for rectal cancer patients after neoadjuvant chemoradiotherapy
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