Startseite Medizin Association of ST-T changes with all-cause mortality among patients with peripheral T-cell lymphomas
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Association of ST-T changes with all-cause mortality among patients with peripheral T-cell lymphomas

  • Hanzhi Du , Lihong Yang , Bin Yan , Juan Zhao EMAIL logo und Mengchang Wang EMAIL logo
Veröffentlicht/Copyright: 12. Juli 2022

Abstract

Research has suggested a significant prognostic value of ST-T changes in various cardiovascular diseases and malignant tumors. However, their role in predicting prognosis in patients with peripheral T-cell lymphomas (PTCLs) remains unknown. Here, we investigated the prognostic potential of ST-T changes in all-cause mortality of PTCLs patients. In total, 131 patients with PTCLs between January 2015 and April 2020 were enrolled. Univariable and multivariable COX proportional hazards regression models were used to find the relationship between ST-T changes and all-cause mortality in these patients. A significant difference in all-cause mortality was found between patients with ST-T abnormalities and those without definite abnormalities in the ST-T segments (P = 0.027). Multivariable Cox risk regression analysis indicated that patients with ST-T changes had greater all-cause mortality than patients with normal ST-T segments in the intermediate-high/high-risk groups (P < 0.001). In addition, ST-T changes were markedly distinction in patients with hypoproteinemia than in those with no definite abnormalities in the ST-T segments (P = 0.021). ST-T changes may serve as potential, simple, and effective prognostic factors for all-cause mortality in PTCLs patients, especially in the intermediate-high/high-risk and hypoproteinemia groups. Therefore, regular ECG monitoring is recommended to guide the clinical treatment of patients with PTCLs.

1 Introduction

Peripheral T-cell lymphomas (PTCLs) are a nonuniform group of diseases that originate in mature postthymic T lymphocytes. They represent about 10–15% of non-Hodgkin’s lymphomas in European and American countries, and approximately 21.4% in China [1,2]. PTCLs are more frequent in men and older adults. Although clinical manifestations may vary greatly depending on the various subtypes and stages, the prognosis is usually poor. In some PTCL subtypes, the 5-year survival rate may be as low as 7%. Patients with intermediate-high/high-risk are often at a greater risk for poor prognosis [3,4,5].

Anthracycline-based regimens remain the cornerstone of treatment for PTCLs [6,7,8,9]. Other second-line anticancer chemotherapeutics are recommended for relapsed and refractory patients, including antimetabolites 5-fluoropyrimidine, cytarabine, alkylating agents, platinums, monoclonal antibodies, and antimicrotubule drugs. The overall response rates are 50–60%, and the complete remission rates are 20–30% [10]. However, there is an increased risk of cardiovascular adverse events in patients receiving treatment. These drugs can directly or indirectly cause certain cardiotoxicity, mainly manifested as arrhythmia, dilated cardiomyopathy, ventricular dysfunction, heart failure, myocardial infarction, pericarditis, and pericardial effusion [6,11,12]. Consequently, it is important to evaluate the cardiac burden and optimize appropriate treatment strategies to improve outcomes and patient survival.

The 12-lead electrocardiogram (ECG) is a simple, noninvasive, and inexpensive tool in clinical practice. ST-T represents the electrical activity from ventricular contraction to ventricular relaxation. The manifestation of the ST segment and T wave on ECG beyond the normal range is called ST-T changes. Recently, ST-T changes were demonstrated as strong prognostic indicators of coronary artery disease, acute myocarditis, systemic sclerosis (scleroderma), and various types of malignant tumors, including gastrointestinal tumors and breast cancer [13,14,15,16,17,18]. Nevertheless, there is no evidence indicating an exact relationship between ST-T changes and PTCLs prognosis. During this study, we explored the potential predictive role of ST-T changes in mortality from all-cause among PTCL patients.

2 Patients and methods

2.1 Patients

From January 2015 and April 2020, 131 patients diagnosed with PTCLs in the First Affiliated Hospital of Xi’an JiaoTong University were incorporated into this study. Diagnosis, subtypes, and treatment were assigned according to the 2016 National Comprehensive Cancer Network Peripheral T-cell Lymphoma Clinical Practice Guidelines [19]. Patients with congenital heart disease, acute coronary syndrome, atrial fibrillation, and other arrhythmias, and lack of follow-up information were excluded. The present study obtained the approval by the Medical Ethics Review Committee of the First Affiliated Hospital of Xi’an JiaoTong University (NO. XJTU1AF2020LSK-179).

2.2 Clinical characteristics

Clinical baseline characteristics and demographics of PTCL patients were extracted from the patient’s electronic medical records based on the inclusion and exclusion criteria. Clinical staging referred to the Ann Arbor classification revised by 2014 Lugano evaluation standard [20]. Eastern Cooperative Oncology Group (ECOG) scoring criteria were defined as an indicator of the general health status and tolerance to treatment from physical activity in patients, and the scores ranged from 0 to 5. The International Prognostic Index (IPI) score system, which is the most widely accepted and used clinical prognostic scoring system [21], was utilized for non-Hodgkin’s lymphoma and included five prognostic indicators: age, serum lactate dehydrogenase (LDH), ECOG score, clinical stage, and the number of involved extranodal invasion sites. Furthermore, the IPI was calculated for patient risk stratification into the following categories: IPI score 0–1 as low-risk, 2 as low-intermediate risk, 3 as intermediate-high risk, and 4–5 as high-risk. Given the relatively small sample size and other factors, we divided the groups into two categories (low/low-intermediate risk and intermediate-high/high-risk). Moreover, patients were categorized into the normal (≥3.5 g/dL) and hypoproteinemia (<3.5 g/dL) groups. All-cause mortality was defined as the endpoint, and the last follow-up was July 31, 2020. Follow-up was conducted by telephone or outpatient visits. ST-T changes in PTCL patients were evaluated. ECG reports were analyzed by two professional technicians in the ECG room of the First Affiliated Hospital of Xi ‘an Jiaotong University independently, and any disagreement was discussed till an unanimous decision was made.

2.3 Statistical analysis

Continuous data are presented as mean ± SD or median (interquartile range), and categorical data are presented as percentage (n%). The normality and homogeneity of the variable distributions were determined using the Shapiro Wilks test and Levene’s test, respectively. Survival curves were built by the Kaplan–Meier method, and survival differences were tested by the log-rank test. The association between ST-T changes and mortality from all-cause was performed using univariable and multivariable Cox proportional hazard models. Covariates for the multivariable Cox proportional hazard regression models were selected as potential confounders based on P < 0.05 or their biological relevance in univariable analyses. Assumptions for Cox proportional hazards regression were tested and met with the Schoenfeld residuals. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression, adjusting for potential confounders and covariates. Statistical significance was set at P < 0.05. All statistical analyses were conducted using SPSS version 26.0 (IBM Corp., Armonk, NY).

3 Results

3.1 Patient characteristics

In total, 131 patients with PTCLs, and complete electronic medical records were analyzed retrospectively. The clinical baseline characteristics of PTCLs patients are listed in Table 1. In this study, 84 (64.1%) men and 47 (35.9%) women with the average age of 50.6 ± 18.3 years were comprised. The mean duration of follow-up was 18.1 months for the 131 patients (range, 0.4−75 months). In all cases, 70 (53.4%) and 61 (46.6%) patients were stratified into low/low-intermediate risk and intermediate-high/high-risk, respectively, according to the IPI score. A total of 27 (38.6%) and 47 (77.0%) patients in the low/low-intermediate risk and intermediate-high/high-risk groups, respectively, had died.

Table 1

Clinical baseline characteristics of all PTCLs patients

Patient demographics N = 131
Age, year 50.6 ± 18.3
Gender, n (%)
 Male 84 (64.1)
 Female 47 (35.9)
Ann Arbor classification, n (%)
 I 16 (12.2)
 II 9 (6.9)
 III 39 (29.8)
 IV 67 (51.1)
Stratification, n (%)
 Low/low-medium risk 70 (53.4)
 High-medium/high risk 61 (46.6)
IPI score, n (%)
 0 16 (12.2)
 1 24 (18.3)
 2 30 (22.9)
 3 35 (26.7)
 4 22 (16.8)
 5 4 (3.1)
B symptom, n (%) 51 (38.9)
Anthracycline regimen, n (%) 95 (72.5)
Biochemical test
 Hemoglobin, g/L 95.8 ± 24.0
 White blood cell, 109/L 3.8 (2.1, 6.4)
 Platelets, 109/L 131 (58, 191)
 ESR, mm/h 29 (16, 61.5)
 ALT, U/L 25 (12, 40)
 AST, U/L 20 (14, 34)
 Albumin, g/L 27.4 ± 5.8
 ALP, U/L 87.5 (60.3, 131)
 Creatine kinase, U/L 35.5 (23, 62)
 Creatine kinase isoenzyme, U/L 11 (7.3, 16)
 Blood urea nitrogen, mmol/L 7.5 ± 6.0
 Blood creatinine, umol/L 77.6 ± 37.8
 LDH, U/L 313 (234, 475)
 EB virus, copies 50 (50, 892)
 NT-pro BNP, pg/mL 539.4 (114.2, 3634)
d-Dimer, mg/L 3.3 (1.5, 9.5)
 Troponin T, ng/mL 0.006 (0.003, 0.013)
ST-T changes, n (%) 17 (13.0)
Death, n (%) 74 (56.5)
Follow-up time, months 18.1 ± 15.7

Data are expressed as mean ± SD or median (interquartile range). Ann Arbor classification: clinical staging of malignant lymphoma. Stratification: low/low-medium risk (IPI/PIT 0–2), high-medium/high risk (IPI/PIT 3–5). IPI/PIT score system: IPI. B symptom: fever, night sweat, weight loss. ESR: erythrocyte sedimentation rate, ALT: alanine aminotransferase, AST: aspartate transaminase, ALP: alkaline phosphatase, NT-proBNP: N-terminal pro-brain natriuretic peptide.

3.2 Prognostic values of ST-T changes

ST-T changes in ECG parameters were observed in 17 (13.0%) patients, and we found that all these patients had low or inverted T waves, among which 10 (7.6%) patients are accompanied by ST segment depression. ST-T changes are significantly associated with all-cause mortality (Figure 1a). The all-cause mortality was 70.6% (12/17) in patients with ST-T segment abnormalities and 54.4% (62/114) in patients with no definite abnormalities of the ST-T wave segments. Further, these ST-T changes remained independently correlated with all-cause mortality, irrespective of the stratification subtype, Ann Arbor classification, and serum albumin (HR = 2.042, 95% CI = 1.083−3.848, P = 0.027; Table 2).

Figure 1 
                  Survival curve analysis. (a) Kaplan–Meier survival curves according to the presence of ST-T normal and ST-T abnormalities, ST-T changes had worse cumulative survival ratio (P = 0.027). (b) Kaplan–Meier survival curves according to presence of ST-T normal and ST-T abnormalities and in the low/low-intermediate risk and intermediate-high/high risk groups, patients with ST-T segment abnormalities had a higher all-cause mortality than the patients with no definite abnormalities in both groups (P = 0.013; P < 0.001). (c) Kaplan–Meier survival curves according to the presence of ST-T normal and ST-T abnormalities in the normal serum albumin and hypoproteinemia group, and patients with ST-T changes in the hypoproteinemia group showed a poor cumulative survival ratio (P = 0.021).
Figure 1

Survival curve analysis. (a) Kaplan–Meier survival curves according to the presence of ST-T normal and ST-T abnormalities, ST-T changes had worse cumulative survival ratio (P = 0.027). (b) Kaplan–Meier survival curves according to presence of ST-T normal and ST-T abnormalities and in the low/low-intermediate risk and intermediate-high/high risk groups, patients with ST-T segment abnormalities had a higher all-cause mortality than the patients with no definite abnormalities in both groups (P = 0.013; P < 0.001). (c) Kaplan–Meier survival curves according to the presence of ST-T normal and ST-T abnormalities in the normal serum albumin and hypoproteinemia group, and patients with ST-T changes in the hypoproteinemia group showed a poor cumulative survival ratio (P = 0.021).

Table 2

Univariable and multivariable analyses for overall mortality

Univariable analysis Multivariable analysis
HR 95% CI P value HR 95% CI P value
Age 1.011 0.997–1.024 0.116
Gender (female) 0.711 0.447–1.133 0.151
Hemoglobin 0.983 0.974–0.992 <0.001 0.995 0.983–1.007 0.375
ESR 1.002 0.995–1.009 0.528
EB virus 1.000 1.000 0.262
Albumin 0.899 0.856–0.945 <0.001 0.919 0.872–0.969 0.002
LDH 1.000 1.000 0.002
Creatine kinase 1.000 0.999–1.000 0.810
Creatine kinase isoenzyme 0.996 0.976–1.016 0.679
Blood urea nitrogen 1.049 1.015–1.084 0.005 1.007 0.996–1.049 0.756
Creatinine 1.006 1.001–1.012 0.029
NT-pro BNP 1.000 1.000 0.046
d-Dimer 1.013 1.007–1.019 <0.001
Troponin T 7.275 0.143–369.648 0.322
Ann Arbor classification
I 1
II 0.423 0.152–1.174 0.099
III 0.431 0.204–0.912 0.028
IV 0.392 0.191–0.806 0.011
Stratification subtype
Low/low-medium risk 1 1
High-medium/high risk 3.507 2.159–5.697 <0.001 2.957 1.802–4.851 <0.001
IPI/PIT score system
0 1
1 1.174 0.353–3.902 0.793
2 2.114 0.693–6.453 0.189
3 4.978 1.734–14.293 0.003
4 5.780 1.934–17.275 0.002
5 5.265 1.165–23.786 0.031
ST-T changes 1.989 1.060–3.734 0.032 2.042 1.083–3.848 0.027

Ann Arbor Classification: Clinical staging of malignant lymphoma. Stratification: low/low-medium risk (IPI/PIT 0–2), high-medium/high risk (IPI/PIT 3–5). IPI/PIT score system: IPI. B symptom: fever, night sweat, weight loss. ESR: erythrocyte sedimentation rate, NT-proBNP: N-terminal pro-brain natriuretic peptide.

3.3 Prognostic values of ST-T changes in risk stratification

The average ages of patients in the low/low-intermediate risk and intermediate-high/high-risk groups were 46.7 ± 16.7 and 55.1 ± 19.1 years, respectively. Moreover, patients in the two groups accounted for 53.4% (70/131) and 46.6% (61/131) of all patients in this study. All-cause mortality was 38.6% (27/70) and 77.0% (47/61) for the two different risk stratification groups. In both groups, all-cause mortality was higher in the ST-T segment abnormalities group than that in the no definite abnormalities of the ST-T wave segments group (HR = 3.235, 95% CI = 1.283–8.159, P = 0.013; HR = 6.118, 95% CI = 2.410–15.534, P < 0.001; Figure 1b).

3.4 Prognostic values of ST-T changes in PTCLs with hypoproteinemia

We further explored the interactions between the ST-T changes in PTCLs patients with hypoproteinemia and all-cause mortality in multivariable Cox proportional hazard regression models. The mean albumin level was 27.4 ± 5.8 g/dL. Among 131 patients, 117 patients (89.3%) patients presented hypoproteinemia, while 14 (10.7%) patients had normal serum albumin levels. ST-T changes were observed in 1 patient among 14 patients with normal serum levels (7.1%) and in 16 patients out of 117 patients with hypoproteinemia (13.7%). Significantly, patients with ST-T changes and hypoproteinemia showed a poor cumulative survival ratio (HR = 5.930, 95% CI = 1.310–26.836, P = 0.021). However, no significant prognostic potential of ST-T changes was found between patients with normal ST-T segments and ST-T abnormalities in the normal serum albumin group (HR = 3.927, 95% CI = 0.355–43.434, P = 0.265; Figure 1c).

4 Discussion

ST-T changes are useful predictors of survival in various malignancies such as gastrointestinal tumors and breast cancer [16,17]. However, there is little evidence regarding the connection between ST-T changes and PTCLs. In this study, we explored the relationship between ST-T changes and all-cause mortality in PTCLs patients and identified ST-T changes as independent predictors for all-cause mortality in PTCL patients.

PTCLs often have poor clinical outcomes due to their heterogeneity and aggressive nature. Anthracycline-based chemotherapy remains the most commonly used frontline regimen for PTCLs. It is estimated that the 2-year mortality rate of cancer patients diagnosed with anthracycline-induced cardiotoxicity is approximately 50% [22]. The underlying mechanism is believed to be related to excessive reactive oxygen species production, intracellular calcium dysregulation, cytokine release mediated by activation of the innate immune system, high affinity for myocardial phospholipids, and mitochondrial functional disturbances [9,23]. Most antitumor agents can induce cardiotoxicity and affect patient prognosis. The current prognostic factors of PTCLs commonly rely on age, clinical stage, classification, Epstein–Barr (EB) virus quantitative, serum LDH, and specific cytogenetic abnormalities. Although there are many factors affecting prognosis, the overall survival (OS) rate of PTCLs in 10–15 years is 10% [4]. Therefore, early and prompt recognition of abnormal electrical activities and timely diagnostic evaluation of cardiac burden are essential when choosing suitable therapies and improving patient prognosis.

ECG can be used to measure the electrical activity of the heart. Further, ECG can be utilized to reflect changes in heart physiological activity and correctly identify different cardiac events, including ST-T changes that may indicate a potential risk of arrhythmias and sudden cardiac death. Studies have shown that ST-T changes are closely affiliated with unfavorable prognosis [24,25]. In our study, the two specific ST-T changes of ischemic T-wave level or inversion and ischemic ST-segment depression all indicate endocardial myocardial injury, and ST-T changes were found to be independently related to all-cause mortality in PTCLs. Except for other secondary inflammations, ST-T changes are reliable prognostic indicators of myocardial ischemia [26,27]. Interestingly, we found that all-cause mortality was higher in patients with ST-T abnormalities than in those patients with no definite abnormalities of the ST-T wave segments in all risk stratifications (P < 0.05). The results indicate that a progressive delay in cardiac repolarization and myocardial ischemia develop in PTCLs and ST-T changes are useful factors for analyzing the prognostic outcomes in PTCLs patients.

Albumin is a significant predictor of survival in patients with diffuse large B-cell lymphoma [28]. Moreover, it is an independent prognostic agent of OS in PTCL patients [29]. We evaluated several related prognostic factors in both groups that may affect survival in this research, and albumin was considered an independent risk factor based on the multivariable Cox regression analysis. Further, significant differences in all-cause mortality could be found between patients with ST-T changes and normal ST-T segments within the hypoproteinemia group (P = 0.021). The suspected reasons for hypoproteinemia are impaired liver function, malnutrition, and high globulin levels [28]. Therefore, ST-T changes are suggested to have a statistically significant impact on all-cause mortality in PTCL patients with hypoproteinemia.

The atypical ST-T segment in ECG parameters represents myocardial repolarization abnormalities. The most frequently used anthracycline chemotherapeutic drugs that influence ventricular repolarization in PTCL patients can elicit ST-T changes in the surface ECG. As it may enable early detection of cardiotoxicity, clinical ambulatory electrocardiogram monitoring is warranted during PTCL treatment. Twelve-lead ECGs are easily available and relatively inexpensive for prognostic use in patients with PTCLs.

The present study had several strengths and limitations. This is the first study focusing on the potential prognostic role of ST-T changes on all-cause mortality in PTCL patients. As our data are based on a large general hospital in Northwest China, our findings can be generalized to a certain extent. However, this was a single-center retrospective study, and data on echocardiography are lacking. In addition, the sample size was relatively small in the stratified analysis. Moreover, we have not further analyzed and compared different types of ST-T changes and the differences between anthracycline- and nonanthracycline-induced ST-T changes due to the relatively small sample size and the low proportion of ST-T changes.

5 Conclusion

We explored the clinical and prognostic value of ST-T changes in PTCL patients and found that ST-T changes led to higher all-cause mortality, especially in the intermediate-high/high-risk and hypoproteinemia groups. Thus, ST-T changes may be markers of all-cause mortality to provide prognostic information for PTCLs.

Abbreviations

CI

confidence interval

ECG

electrocardiogram

ECOG

Eastern Cooperative Oncology Group

HR

hazard ratio

IPI

International Prognostic Index

LDH

lactate dehydrogenase

NCCN

National Comprehensive Cancer Network

OS

overall survival

PTCLs

peripheral T-cell lymphomas

ROS

reactive oxygen species


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Acknowledgments

Not applicable.

  1. Funding information: This work was supported by the Key Research and Development Program of Shaanxi Province of China [Grant number 2020SF-169].

  2. Author contributions: Hanzhi Du drafted the manuscript. Hanzhi Du and Lihong Yang illustrated and captioned all figures. Hanzhi Du, Bin Yan, Juan Zhao and Mengchang Wang provided critical review and revision of the manuscript. All authors approved the final draft for publication.

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

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

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Received: 2022-01-28
Revised: 2022-05-31
Accepted: 2022-06-06
Published Online: 2022-07-12

© 2022 Hanzhi Du et al., published by De Gruyter

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

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  7. Promising novel biomarkers and candidate small-molecule drugs for lung adenocarcinoma: Evidence from bioinformatics analysis of high-throughput data
  8. Plasmapheresis: Is it a potential alternative treatment for chronic urticaria?
  9. The biomarkers of key miRNAs and gene targets associated with extranodal NK/T-cell lymphoma
  10. Gene signature to predict prognostic survival of hepatocellular carcinoma
  11. Effects of miRNA-199a-5p on cell proliferation and apoptosis of uterine leiomyoma by targeting MED12
  12. Does diabetes affect paraneoplastic thrombocytosis in colorectal cancer?
  13. Is there any effect on imprinted genes H19, PEG3, and SNRPN during AOA?
  14. Leptin and PCSK9 concentrations are associated with vascular endothelial cytokines in patients with stable coronary heart disease
  15. Pericentric inversion of chromosome 6 and male fertility problems
  16. Staple line reinforcement with nebulized cyanoacrylate glue in laparoscopic sleeve gastrectomy: A propensity score-matched study
  17. Retrospective analysis of crescent score in clinical prognosis of IgA nephropathy
  18. Expression of DNM3 is associated with good outcome in colorectal cancer
  19. Activation of SphK2 contributes to adipocyte-induced EOC cell proliferation
  20. CRRT influences PICCO measurements in febrile critically ill patients
  21. SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis
  22. lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells
  23. circ_AKT3 knockdown suppresses cisplatin resistance in gastric cancer
  24. Prognostic value of nicotinamide N-methyltransferase in human cancers: Evidence from a meta-analysis and database validation
  25. GPC2 deficiency inhibits cell growth and metastasis in colon adenocarcinoma
  26. A pan-cancer analysis of the oncogenic role of Holliday junction recognition protein in human tumors
  27. Radiation increases COL1A1, COL3A1, and COL1A2 expression in breast cancer
  28. Association between preventable risk factors and metabolic syndrome
  29. miR-29c-5p knockdown reduces inflammation and blood–brain barrier disruption by upregulating LRP6
  30. Cardiac contractility modulation ameliorates myocardial metabolic remodeling in a rabbit model of chronic heart failure through activation of AMPK and PPAR-α pathway
  31. Quercitrin protects human bronchial epithelial cells from oxidative damage
  32. Smurf2 suppresses the metastasis of hepatocellular carcinoma via ubiquitin degradation of Smad2
  33. circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury
  34. Sonoclot’s usefulness in prediction of cardiopulmonary arrest prognosis: A proof of concept study
  35. Four drug metabolism-related subgroups of pancreatic adenocarcinoma in prognosis, immune infiltration, and gene mutation
  36. Decreased expression of miR-195 mediated by hypermethylation promotes osteosarcoma
  37. LMO3 promotes proliferation and metastasis of papillary thyroid carcinoma cells by regulating LIMK1-mediated cofilin and the β-catenin pathway
  38. Cx43 upregulation in HUVECs under stretch via TGF-β1 and cytoskeletal network
  39. Evaluation of menstrual irregularities after COVID-19 vaccination: Results of the MECOVAC survey
  40. Histopathologic findings on removed stomach after sleeve gastrectomy. Do they influence the outcome?
  41. Analysis of the expression and prognostic value of MT1-MMP, β1-integrin and YAP1 in glioma
  42. Optimal diagnosis of the skin cancer using a hybrid deep neural network and grasshopper optimization algorithm
  43. miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells
  44. Clinical value of SIRT1 as a prognostic biomarker in esophageal squamous cell carcinoma, a systematic meta-analysis
  45. circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8
  46. miR-22-5p regulates the self-renewal of spermatogonial stem cells by targeting EZH2
  47. hsa-miR-340-5p inhibits epithelial–mesenchymal transition in endometriosis by targeting MAP3K2 and inactivating MAPK/ERK signaling
  48. circ_0085296 inhibits the biological functions of trophoblast cells to promote the progression of preeclampsia via the miR-942-5p/THBS2 network
  49. TCD hemodynamics findings in the subacute phase of anterior circulation stroke patients treated with mechanical thrombectomy
  50. Development of a risk-stratification scoring system for predicting risk of breast cancer based on non-alcoholic fatty liver disease, non-alcoholic fatty pancreas disease, and uric acid
  51. Tollip promotes hepatocellular carcinoma progression via PI3K/AKT pathway
  52. circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis
  53. Human amniotic fluid as a source of stem cells
  54. lncRNA NONRATT013819.2 promotes transforming growth factor-β1-induced myofibroblastic transition of hepatic stellate cells by miR24-3p/lox
  55. NORAD modulates miR-30c-5p-LDHA to protect lung endothelial cells damage
  56. Idiopathic pulmonary fibrosis telemedicine management during COVID-19 outbreak
  57. Risk factors for adverse drug reactions associated with clopidogrel therapy
  58. Serum zinc associated with immunity and inflammatory markers in Covid-19
  59. The relationship between night shift work and breast cancer incidence: A systematic review and meta-analysis of observational studies
  60. LncRNA expression in idiopathic achalasia: New insight and preliminary exploration into pathogenesis
  61. Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway
  62. Moscatilin suppresses the inflammation from macrophages and T cells
  63. Zoledronate promotes ECM degradation and apoptosis via Wnt/β-catenin
  64. Epithelial-mesenchymal transition-related genes in coronary artery disease
  65. The effect evaluation of traditional vaginal surgery and transvaginal mesh surgery for severe pelvic organ prolapse: 5 years follow-up
  66. Repeated partial splenic artery embolization for hypersplenism improves platelet count
  67. Low expression of miR-27b in serum exosomes of non-small cell lung cancer facilitates its progression by affecting EGFR
  68. Exosomal hsa_circ_0000519 modulates the NSCLC cell growth and metastasis via miR-1258/RHOV axis
  69. miR-455-5p enhances 5-fluorouracil sensitivity in colorectal cancer cells by targeting PIK3R1 and DEPDC1
  70. The effect of tranexamic acid on the reduction of intraoperative and postoperative blood loss and thromboembolic risk in patients with hip fracture
  71. Isocitrate dehydrogenase 1 mutation in cholangiocarcinoma impairs tumor progression by sensitizing cells to ferroptosis
  72. Artemisinin protects against cerebral ischemia and reperfusion injury via inhibiting the NF-κB pathway
  73. A 16-gene signature associated with homologous recombination deficiency for prognosis prediction in patients with triple-negative breast cancer
  74. Lidocaine ameliorates chronic constriction injury-induced neuropathic pain through regulating M1/M2 microglia polarization
  75. MicroRNA 322-5p reduced neuronal inflammation via the TLR4/TRAF6/NF-κB axis in a rat epilepsy model
  76. miR-1273h-5p suppresses CXCL12 expression and inhibits gastric cancer cell invasion and metastasis
  77. Clinical characteristics of pneumonia patients of long course of illness infected with SARS-CoV-2
  78. circRNF20 aggravates the malignancy of retinoblastoma depending on the regulation of miR-132-3p/PAX6 axis
  79. Linezolid for resistant Gram-positive bacterial infections in children under 12 years: A meta-analysis
  80. Rack1 regulates pro-inflammatory cytokines by NF-κB in diabetic nephropathy
  81. Comprehensive analysis of molecular mechanism and a novel prognostic signature based on small nuclear RNA biomarkers in gastric cancer patients
  82. Smog and risk of maternal and fetal birth outcomes: A retrospective study in Baoding, China
  83. Let-7i-3p inhibits the cell cycle, proliferation, invasion, and migration of colorectal cancer cells via downregulating CCND1
  84. β2-Adrenergic receptor expression in subchondral bone of patients with varus knee osteoarthritis
  85. Possible impact of COVID-19 pandemic and lockdown on suicide behavior among patients in Southeast Serbia
  86. In vitro antimicrobial activity of ozonated oil in liposome eyedrop against multidrug-resistant bacteria
  87. Potential biomarkers for inflammatory response in acute lung injury
  88. A low serum uric acid concentration predicts a poor prognosis in adult patients with candidemia
  89. Antitumor activity of recombinant oncolytic vaccinia virus with human IL2
  90. ALKBH5 inhibits TNF-α-induced apoptosis of HUVECs through Bcl-2 pathway
  91. Risk prediction of cardiovascular disease using machine learning classifiers
  92. Value of ultrasonography parameters in diagnosing polycystic ovary syndrome
  93. Bioinformatics analysis reveals three key genes and four survival genes associated with youth-onset NSCLC
  94. Identification of autophagy-related biomarkers in patients with pulmonary arterial hypertension based on bioinformatics analysis
  95. Protective effects of glaucocalyxin A on the airway of asthmatic mice
  96. Overexpression of miR-100-5p inhibits papillary thyroid cancer progression via targeting FZD8
  97. Bioinformatics-based analysis of SUMOylation-related genes in hepatocellular carcinoma reveals a role of upregulated SAE1 in promoting cell proliferation
  98. Effectiveness and clinical benefits of new anti-diabetic drugs: A real life experience
  99. Identification of osteoporosis based on gene biomarkers using support vector machine
  100. Tanshinone IIA reverses oxaliplatin resistance in colorectal cancer through microRNA-30b-5p/AVEN axis
  101. miR-212-5p inhibits nasopharyngeal carcinoma progression by targeting METTL3
  102. Association of ST-T changes with all-cause mortality among patients with peripheral T-cell lymphomas
  103. LINC00665/miRNAs axis-mediated collagen type XI alpha 1 correlates with immune infiltration and malignant phenotypes in lung adenocarcinoma
  104. The perinatal factors that influence the excretion of fecal calprotectin in premature-born children
  105. Effect of femoral head necrosis cystic area on femoral head collapse and stress distribution in femoral head: A clinical and finite element study
  106. Does the use of 3D-printed cones give a chance to postpone the use of megaprostheses in patients with large bone defects in the knee joint?
  107. lncRNA HAGLR modulates myocardial ischemia–reperfusion injury in mice through regulating miR-133a-3p/MAPK1 axis
  108. Protective effect of ghrelin on intestinal I/R injury in rats
  109. In vivo knee kinematics of an innovative prosthesis design
  110. Relationship between the height of fibular head and the incidence and severity of knee osteoarthritis
  111. lncRNA WT1-AS attenuates hypoxia/ischemia-induced neuronal injury during cerebral ischemic stroke via miR-186-5p/XIAP axis
  112. Correlation of cardiac troponin T and APACHE III score with all-cause in-hospital mortality in critically ill patients with acute pulmonary embolism
  113. LncRNA LINC01857 reduces metastasis and angiogenesis in breast cancer cells via regulating miR-2052/CENPQ axis
  114. Endothelial cell-specific molecule 1 (ESM1) promoted by transcription factor SPI1 acts as an oncogene to modulate the malignant phenotype of endometrial cancer
  115. SELENBP1 inhibits progression of colorectal cancer by suppressing epithelial–mesenchymal transition
  116. Visfatin is negatively associated with coronary artery lesions in subjects with impaired fasting glucose
  117. Treatment and outcomes of mechanical complications of acute myocardial infarction during the Covid-19 era: A comparison with the pre-Covid-19 period. A systematic review and meta-analysis
  118. Neonatal stroke surveillance study protocol in the United Kingdom and Republic of Ireland
  119. Oncogenic role of TWF2 in human tumors: A pan-cancer analysis
  120. Mean corpuscular hemoglobin predicts the length of hospital stay independent of severity classification in patients with acute pancreatitis
  121. Association of gallstone and polymorphisms of UGT1A1*27 and UGT1A1*28 in patients with hepatitis B virus-related liver failure
  122. TGF-β1 upregulates Sar1a expression and induces procollagen-I secretion in hypertrophic scarring fibroblasts
  123. Antisense lncRNA PCNA-AS1 promotes esophageal squamous cell carcinoma progression through the miR-2467-3p/PCNA axis
  124. NK-cell dysfunction of acute myeloid leukemia in relation to the renin–angiotensin system and neurotransmitter genes
  125. The effect of dilution with glucose and prolonged injection time on dexamethasone-induced perineal irritation – A randomized controlled trial
  126. miR-146-5p restrains calcification of vascular smooth muscle cells by suppressing TRAF6
  127. Role of lncRNA MIAT/miR-361-3p/CCAR2 in prostate cancer cells
  128. lncRNA NORAD promotes lung cancer progression by competitively binding to miR-28-3p with E2F2
  129. Noninvasive diagnosis of AIH/PBC overlap syndrome based on prediction models
  130. lncRNA FAM230B is highly expressed in colorectal cancer and suppresses the maturation of miR-1182 to increase cell proliferation
  131. circ-LIMK1 regulates cisplatin resistance in lung adenocarcinoma by targeting miR-512-5p/HMGA1 axis
  132. LncRNA SNHG3 promoted cell proliferation, migration, and metastasis of esophageal squamous cell carcinoma via regulating miR-151a-3p/PFN2 axis
  133. Risk perception and affective state on work exhaustion in obstetrics during the COVID-19 pandemic
  134. lncRNA-AC130710/miR-129-5p/mGluR1 axis promote migration and invasion by activating PKCα-MAPK signal pathway in melanoma
  135. SNRPB promotes cell cycle progression in thyroid carcinoma via inhibiting p53
  136. Xylooligosaccharides and aerobic training regulate metabolism and behavior in rats with streptozotocin-induced type 1 diabetes
  137. Serpin family A member 1 is an oncogene in glioma and its translation is enhanced by NAD(P)H quinone dehydrogenase 1 through RNA-binding activity
  138. Silencing of CPSF7 inhibits the proliferation, migration, and invasion of lung adenocarcinoma cells by blocking the AKT/mTOR signaling pathway
  139. Ultrasound-guided lumbar plexus block versus transversus abdominis plane block for analgesia in children with hip dislocation: A double-blind, randomized trial
  140. Relationship of plasma MBP and 8-oxo-dG with brain damage in preterm
  141. Identification of a novel necroptosis-associated miRNA signature for predicting the prognosis in head and neck squamous cell carcinoma
  142. Delayed femoral vein ligation reduces operative time and blood loss during hip disarticulation in patients with extremity tumors
  143. The expression of ASAP3 and NOTCH3 and the clinicopathological characteristics of adult glioma patients
  144. Longitudinal analysis of factors related to Helicobacter pylori infection in Chinese adults
  145. HOXA10 enhances cell proliferation and suppresses apoptosis in esophageal cancer via activating p38/ERK signaling pathway
  146. Meta-analysis of early-life antibiotic use and allergic rhinitis
  147. Marital status and its correlation with age, race, and gender in prognosis of tonsil squamous cell carcinomas
  148. HPV16 E6E7 up-regulates KIF2A expression by activating JNK/c-Jun signal, is beneficial to migration and invasion of cervical cancer cells
  149. Amino acid profiles in the tissue and serum of patients with liver cancer
  150. Pain in critically ill COVID-19 patients: An Italian retrospective study
  151. Immunohistochemical distribution of Bcl-2 and p53 apoptotic markers in acetamiprid-induced nephrotoxicity
  152. Estradiol pretreatment in GnRH antagonist protocol for IVF/ICSI treatment
  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
Heruntergeladen am 15.12.2025 von https://www.degruyterbrill.com/document/doi/10.1515/med-2022-0517/html
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