Abstract
Lymphoma relapse is very common in clinical work, but lineage switch at relapse is rare. Although some cases have reported acute lymphocytic leukemia (ALL) switch to acute myeloid leukemia (AML) or myeloid sarcoma upon relapse, phenotype switch seldom occurs in other types of lymphoma. Here we report six cases with lineage switch from lymphoma to myeloid neoplasms. In our cohort, three cases were mantle cell lymphoma (MCL), and the other three cases were T-cell lymphoblastic lymphoma (T-LBL), B-cell lymphoblastic lymphoma (B-LBL), and diffuse large B-cell lymphoma (DLBCL) at the initial diagnosis. When linage switch occurred, most cases were AML M5 phenotypes, and only one case was myelodysplastic syndrome (MDS) phenotype. 11q23/mixed-lineage leukemia (MLL) rearrangement was negative in all cases. Although intensive therapy and stem cell transplantation have been applied in most cases, the poor outcome cannot be reversed. Therefore, we found that lineage switch could occur not only from ALL to AML or vice versa, but also from MCL or DLBCL to AML. Moreover, the incidence of MLL rearrangement in lineage switch is lower in adult hematologic malignancies as compared with pediatric patients.
1 Introduction
Leukemia relapse/refractory presents a tough challenge for hematologists [1]. Leukemia stem cells (LSCs), which are derived from hematopoietic stem cells (HSCs), multipotent progenitors, committed progenitor cells, or even differentiated cells that undergo gene mutation, play a vital role in leukemia initiation and progression [2]. LSCs also exhibit lineage plasticity and reversibility due to lineage-specific transcription factors’ mutation, changes in cytokine profiles from microenvironment, and therapy [3,4,5]. Upon relapse, a phenomenon termed “lineage switch” is observed in a subset of leukemia patients [6].
Lineage switch rarely occurred in leukemia relapse/refractory patients, but it can result in high mortality rate. A recent study showed that the incidence of lineage switch, most with 11q23/mixed-lineage leukemia (MLL) rearrangement, was 0.6% in patients with childhood acute leukemia [6]. In addition, there are several casereports on lineage switch in adultleukemia. Lineage switch primarily occurs from acute lymphocytic leukemia (ALL) to acute myeloid leukemia (AML) [7,8,9,10,11], but some cases switched from AML to ALL [12], as well as from T-cell acute leukemia to B-cell acute leukemia [13], or repeatedly switched in T-cell lymphoblastic lymphoma (T-LBL)/ALL and AML [14]. Although studies have found that cell fate regulators, cytokine profiles, and treatment modalities can play a role in lineage switch, the mechanism of the process remains unclear [3,4]. Therefore, describing diverse leukemia cases with lineage switch in detail will deepen the understanding of rare lymphoma recurrence/refractory cases and help to develop new treatment strategies in the future.
In the present study, we reported six cases of lineage switch that occurred in adult LBL and B-cell lymphoma (mantle cell lymphoma [MCL] and diffuse large B-cell lymphoma [DLBCL]) patients. This is the largest case series studies in adults from a single institute. Unlike previous reported pediatric cases, 11q23/MLL rearrangement was negative in our cases. When lineage switch occurred, most of our cases were AML-M5 phenotypes.
2 Case presentation
2.1 Case 1
A 54-year-old male presented with abdominal distension and visited the local hospital in Jan 2013. Colon neoplasm was discovered by ultrasound. After colonoscopy and biopsy, immunohistochemistry (IHC) results showed the tumor cells expressed CD20, CD79a, BCL-2, CD5, and CyclinD1. Ki67 was positive in 20% of neoplastic cells. The patient was diagnosed with MCL and received 8 cycles of R-CHOP regimen. But the patient relapsed after 2 years of follow-up. Positron emission tomography/computer tomography (PET/CT) showed a retroperitoneal mass, and the high standardized uptake value (SUV) on bone marrow (BM). MCL relapse was confirmed in mass biopsy by IHC staining for CD20, CD79a, BCL2, CD5, and CyclinD1. BM morphology showed lymphoma invasion. The patient received 4 cycles of treatment (bortezomib, lenalidomide, and rituximab). Treatment response evaluation showed partial remission. After 2 months, blood test showed WBC 1.43 × 109/L, HGB 66 g/L, PLT 171 × 109/L. BM morphology showed 25% promonocytes, immunophenotype revealed diffuse infiltration of blast cells, expressing HLA-DR, CD11c, CD36, and CD64. Promonocytes expressed CD64 and CD56. 11q23/MLL rearrangement was negative. Cytogenetic analysis was normal. A diagnosis of AML (M5) was established and the patient started cladribine combine IA (idarubicin and cytarabine) for induction therapy. Post-treatment PET-CT scan showed multiple enlarged and hyper-metabolic lymph nodes throughout the whole body. There were no blast cells in BM morphology and immune-phenotype analysis, and the patient underwent allogeneic peripheral blood stem cell transplantation (allo-PBSCT). After 15 months, the patient presented with enlarged cervical lymph nodes. Due to progression of MCL (MCL) and pulmonary infection, the patient expired 34 months after his original diagnosis.
2.2 Case 2
A 32-year-old male presented with cough and shortness of breath. His symptoms occurred over 4 weeks beginning in March 2015. His chest CT showed a mediastinal mass and pleural effusion on the left chest. The mass biopsy by IHC staining results showed tumor cells expressing TDT, CD2, CD3, CD5, CD7, and BCL2, but negative for CD20, CD79a, CCND1, CD10, CD23, and BCL6. BM morphology and immunophenotype revealed 10% of blast cells with the same phenotypes. According to these results, the patient was diagnosed as T-LBL/ALL (IVA). He accepted induction therapy with BFM95 regimen and achieved complete remission (CR). Then, the patient received consolidation and maintenance therapy according to the protocol, along with prophylactic intrathecal lumbar injections for ten times. In August 2016, BM morphology and immunophenotype revealed 6% myeloid blast cells, expressing CD117, CD33, CD13, CD38, CD7, and partly expressing CD71, CD34, and HLA-DR, but negative for MPO, TDT, CD3, and CD79a. Molecular analysis showed TED2 and ASXL1 mutation. Chromosome karyotype and 11q23/MLL rearrangement were normal. The patient received sibling donor allo-PBSCT. After 4 years of follow-up, the patient relapsed in May 2020. BM morphology and immunophenotype revealed T-ALL/LBL relapse. Due to progression of disease and pulmonary infection, the patient expired 63 months after his original diagnosis.
2.3 Case 3
A 54-year-old female presented with chest pain for 1 week in September 2016. Her chest CT revealed mediastinal mass with swelling of multiple lymph nodes. Mass biopsy by IHC staining results showed tumor cells expressing TDT, CD19, BCL2, PAX5, but negative for CD3, CD5, CD20, CD10, BCL6, CD21, CD23, CyclinD1, and EBER. Proliferative index of Ki67 showed 70% positive. MYC rearrangement was negative. BM morphology, immunophenotype, and cytogenetic analysis were normal. A diagnosis of B-cell lymphoblastic lymphoma (B-LBL) (IIIA) was made. The patient started treatment with hyperCVAD/MA regimens for three cycles, as well as intrathecal lumbar injection for six times. In April 2017, BM morphology revealed 35% blast cells, immunophenotype showed blast cells expressed HLA-DR, CD33, CD11b, CD15, CD36, CD64, CD14, and CD13, but negative for CD34 and CD117. Molecular analysis showed CBL mutation, there were no TET2, SRSF2, and ASXL1 mutations. Chromosome karyotype and 11q23/MLL rearrangement were normal. A diagnosis of AML (M5) was established and the patient started IA regimen for induction therapy. The patient obtained CR and received D-HAG (decitabine, homoharringtonine, cytarabine, and G-CSF) regimen for consolidation therapy. After that, the patient underwent allo-PBSCT. At present, 58 months from her original diagnosis, the patient has achieved continuous CR status.
2.4 Case 4
A 62-year-old female presented with hematuria for 3 months in July 2018. Ultrasound scan showed calculus of kidney and enlarged inguinal lymph nodes. The lymph node biopsy by IHC staining results showed tumor cells were positive for CD20, CD79a, CyclinD1, and SOX11, but negative for CD3, CD10, and BCL6. Proliferative index of Ki67 showed 25% positive. BM morphology and immunophenotype analysis revealed that 80% myeloid blast cells expressing CD117, CD33, CD56, CD13, and CD64, but negative for CD34, HLA-DR, CD19, CD16, CD14, and CD20. BM histology revealed diffuse infiltration of blast cells, expressing MPO and CD117, but negative for CD20, SOX11, CyclinD1, CD10, TDT, and CD34. Next generation sequencing (NGS) showed CEBPA, FLT3-ITDlow, TET2, and NPM1 mutations. Chromosome karyotype was normal and 11q23/MLL rearrangement was negative. PET-CT scan showed multiple cervical, axillary and inguinal lymph nodes up to 3 cm, the maximal SUV (SUVmax) was 2.7 with splenomegaly. The diagnoses were: (1) AML (M5b, with CEBPA, FLT3-ITDlow, TET2, and NPM1 mutation; low risk group) and (2) MCL (MIPI score was 3; low risk group). The patient started induction therapy with IA regimen. After induction therapy, the minimum residual disease (MRD) of BM showed there were no myeloid blast cells, but CD19 and CD20 positive B lymphocytes accounted for 10%, expressing FMC7, CD5, CD22, and CD79a, but negative for CD23. We then used rituximab and high-dose cytarabine for consolidation therapy for four cycles. After consolidation therapy, MRD was negative, and no enlarged lymph nodes were found on PET-CT. Then, the patient underwent autologous peripheral blood stem cell transplantation (auto-PBSCT). At present, 36 months from her original diagnosis, the patient has achieved continuous CR status.
2.5 Case 5
A 52-year-old female presented with abdominal mass in December 2015. Mass biopsy by IHC staining results showed tumor cells expressing LCA, CD20, CD79a, Mum1, and BCL6, but negative for CD10, CD3, CD5, P53, and BCL2. Proliferative index of Ki67 showed 90% positive. MYC rearrangement was negative. A diagnosis of diffuse large B cell lymphoma (non-GCB, IA, IPI 0 score) was made, and the patient received 6 cycles of R-EPOCH treatment from January to July 2016. The efficacy was evaluated by PET-CT scan after 2 and 6 cycles of treatment and showed CR at both times. In December 2017, the patient presented with fever, and peripheral blood count showed WBC 118 × 109/L, HGB 74 g/L, PLT 44 × 109/L. The morphological examination of BM aspirate showed mixture of myeloblasts (70%) plus monoblasts and promonocytes (24%). Immunophenotype analysis showed 87.6% myeloid blast cells, expressing CD117, CD33, CD38, and partly expressing CD64 and CD56, but negative for TDT, MPO, CD13, CD34, HLA-DR, CD19, CD14, and CD20. Chromosome karyotype was normal and 11q23/MLL rearrangement was negative. NGS revealed FLT3-ITD, TET2, and NPM1 mutations. The patient was diagnosed with AML (M4, with FLT3-ITD, TET2, and NPM1 mutation; intermediate-risk group), and used IA regimen for induction therapy. After one cycle of therapy, BM aspirate showed no remission (NR), so the patient was given sorafenib combined CLAG regimen (cladribine, cytarabine, and G-CSF) for salvage therapy. Then, the patient achieved CR and MRD test was negative. The patient had no desire for HSC transplantation and there was no available donor. Therefore, we continued to administer HD Ara-C for consolidation therapy and the total 6 cycles of treatments were finished in November 2018. 27 months later, the patient presented with fever and enlarged inguinal lymph nodes. PET-CT scan showed hypermetabolism of inguinal lymph nodes, the maximum volume was 1.5 cm × 2 cm. Lymph nodes biopsy by IHC staining results showed inflammation, but there were no tumor cells. BM morphology and immunophenotype revealed AML relapse, chromosome karyotype showed 46, XX, t(1:8)(q31:q22) [10]. NGS revealed CBL, TET2, and NPM1 mutations. The patient then started CLAG combined mitoxantrone treatment and achieved CR again. At present, 6 months from her second relapse, the patient has achieved continuous CR status.
2.6 Case 6
A 50-year-old male presented with abdominal pain for 6 months in May 2015. Gastroscopy and biopsy were conducted, and IHC staining results showed the tumor cells were positive for CD20, CD79a, CyclinD1, and BCL2, but negative for CD3, CD10, and HP. Proliferative index of Ki67 showed 50% positive. A diagnosis of MCL was made and the patient started treatment with RCHOP regimen for six cycles. After chemotherapy, the gastroscopy and pathological examination still showed residual MCL tumor cells. The efficacy was evaluated as partial response, so the patient underwent 8 doses of rituximab for maintenance therapy and involved-site radiotherapy for 40GY. Regular follow-up showed no disease progression. After 2 years of observation, the patient presented with abdominal distension and CT scan showed tumor progression. Two cycles of GemOx (gemcitabine and oxaliplatin) regimen were used as salvage therapy. Three months later, the blood test showed WBC 124 × 109/L, HGB 66 g/L, PLT 81 × 109/L. BM morphology and immune-phenotype revealed AML (M5), NGS showed FLT3-ITD high mutation. Chromosome karyotype showed 46 XY, t(2:8) (p13:p21) del(9)(q22) [20]. 11q23/MLL rearrangement was negative. The patient received IA for induction therapy, but efficacy evaluation was no response. Then, sorafenib and venetoclax were used for salvage therapy, but the rapid agranulocytosis and infection resulted in death 20 days after chemotherapy was begun.
This study was reviewed and approved by the ethics review boards of Sun Yat-Sen Memorial Hospital, the informed consent has been obtained from all individuals included in this study.
3 Discussion
Cases of lineage conversions from lymphoma to myelodysplastic syndrome (MDS) or AML are extremely rare. In the literature, most of those cases were switches from ALL to AML [7,8,9,10,11], switches from AML to ALL [12] was also reported. But in our cohort, three cases were MCL lymphoma, and the other three cases were T-LBL, B-LBL, and DLBCL at initial diagnosis (Table 1). When lineage switch occurred, four cases were AML-M5 phenotypes (Table 1). Analysis of these special subsets not only let us better understand the mechanism of tumor progression, but also helped clinicians to explore more effective therapy for patients.
Characteristics of our cases and reported cases
Age/Sex | 1st diagnosis | 2nd diagnosis | Interval of two disease | Disease progression | Outcome | Overall survival | |
---|---|---|---|---|---|---|---|
Our cases | |||||||
Case 1 | 54/M | MCL | AML M5 | 34 mo | MCL | Died | 52 mo |
Case 2 | 32/M | T-LBL | MDS EB1 | 17 mo | T-LBL/ALL | Died | 63 mo |
Case 3 | 47/F | B-LBL | AML M5 | 8 mo | Alive | 58 mo | |
Case 4 | 62/F | MCL | AML M5 | 7 dy | Alive | 36 mo | |
Case 5 | 52/F | DLBCL | AML M4 | 24 mo | AML M4 | Alive | 67 mo |
Case 6 | 55/M | MCL | AML M5 | 24 mo | AML M4 | Died | 56 mo |
Reported cases [References] | |||||||
[7] | 25/F | Pro-B ALL | AML M5 | 22 mo | AML M5b | Died | 24 mo |
[8] | 60/F | Pre-B ALL | AML M5 | 42 dy | AML M5 | Died | 44 dy |
[9] | 30/M | B-LBL | AML M5 | 1 mo | B-LBL&AML M5 | Died | 2 mo |
[10] | 20/M | T-ALL | AML | 21 mo | AML M5 | Died | 30 mo |
[11] | 40/F | Pro-B | AML | 40 mo | AML | Died | 42 mo |
[12] | 46/M | AML M5 | Pre-B ALL | 10 mo | B-ALL | Died | 20 mo |
[13] | 31/M | T-ALL | B-ALL | 26 mo | AML M5 | Alive | 64 mo |
[5] | 77/M | B-ALL | Myeloid sarcoma | 8 mo | Myeloid sarcoma | No data | No data |
[14] | 32/M | T-LBL | AML | 1 mo | T-LBL | Died | 9 mo |
Abbreviation: M: male, F: female, MCL: mantle cell lymphoma, AML: acute myeloid leukemia, T-LBL: T cell lymphoblastic lymphoma, B-LBL: B-cell lymphoblastic lymphoma, DLBCL: diffuse large B-cell lymphoma, ALL: acute lymphocytic leukemia, mo: months, dy: days.
Some hypotheses may explain the mechanism of lineage switch. First, chemotherapy can screen out few drug-resistant clones. After several cycles of treatment, the small size of clone gradually converted into predominant clones and then phenotype switch happened [15]. Second, gene reprogramming happened at the level of neoplastic pluripotent stem cells, or the existence of bipotential lympho-myeloid progenitor cells. Third, lymphoid phenotype developed into myeloid phenotype through trans-differentiation or indirect dedifferentiation and differentiation. One study showed that cells from earliest thymic progenitors (ETPs) possess the ability to differentiate into T and natural killer lymphoid lineages, and few subsets of ETPs have the potential to differentiate into B lymphoid lineages [16]. Another study focused on the fact that most ETPs possess T and myeloid potential, so the author refuted the idea of an obligatory initial split in hematopoiesis between lymphoid lineages and myelo-erythroid lineages. Finally, ectopic expression or loss of lineage-specific transcription factor such as Pu.1, C/ebp-a, Gata1, Pax5, and Ikaros are often related with a changed network of transcription factors that control cell fate [3,4]. BM cytokine milieu and metabolic parameters of LSCs also profoundly affect their lineage commitment [17,2].
While LSCs are critical in the maintenance of leukemia, the existence of lymphoma stem cells remains uncertain. In B cell lymphoma, cloned translocation involved with immunoglobulin loci related to the pathogenesis of B-cell malignancies, but there is no defined role in stem cell characteristics [18,19]. In our cohort, the initial phenotype of three cases were MCL and 1 case was DLBCL, and none of the patients were positive for MYC rearrangement. Some researchers considered that when lymphoma-initiating cells acquire stem-cell features though secondary reprogramming mutations to become the lymphoma-originating cells, they were fully capable of generating and maintaining lymphomas [20]. Some cells such as centroblasts and memory B cells have certain stem-cell-like features [21,22], as well as lymphocytes with MYC rearrangements may directly function as the lymphoma-originating cells [20]. So, we considered those theories as applying to our MCL cases. Moreover, it is worth to study why monocytic phenotypes are more common in lineage switch.
Some studies suggest that MLL rearrangement plays a certain role in lineage switch. In the literature, lineage switch with MLL positive cases were more common in pediatric acute leukemia [1]. MLL rearranged leukemia seemed to possess lineage plasticity, and they were able to differentiate myeloid or lymphoid lineage through different cytokines culture conditions [23,24]. Microenvironmental cues can cooperate with MLL fusion proteins to determine lineage outcomes in leukemia of CD34 positive multipotent progenitors as well as CD19 or CD33 positive progenitors that have partially differentiated [25]. However, in our cohort, no patient showed positive for MLL rearrangement. From the data of nine reported cases, there was only one patient who showed MLL rearrangement (Table 2, ref. [5]). Therefore, we could conclude that the incidence of MLL rearrangements in lineage switch is lower in adult hematologic malignancies.
MICM information and treatment regimen of our cases and reported cases
Morphology or immunophenotype | Cytogenetics | Molecular biology (mutation) | Chemotherapy regimen | Stem cell transplantation | |
---|---|---|---|---|---|
Our cases | |||||
1 Diagnosis | MCL | 46,XY [20] | No data | RCHOP, RFC, R2 + bortezomib, IR + bortezomib | |
1 Switch | AML M5 | 46,XY [20] | NPM1, TET2, ASXL1 | CLAG, IA | Unrelated donor PBSCT |
2 Diagnosis | T-LBL | 46,XY [20] | Negative | BFM95 | |
2 Switch | MDS | 46,XY [20] | TET2, ASXL1 (SNP cites) | Sibling donor PBSCT | |
3 Diagnosis | B-LBL | 46,XX [20] | Negative | Hyper CVAD A/B | |
3 Switch | AML M5 | 46,XX [20] | CBL | IA, D-HAG | Sibling donor PBSCT |
4 Diagnosis | MCL | 46,XX [20] | Negative | IA, IA + VP-16 | |
4 Switch | AML M5 | 46,XX [7] | CEBPA, NPM1, TET2, FLT3-ITDlow | R + HDAra-C | Auto-PBSCT |
5 Diagnosis | DLBCL | 46,XX [20] | Negative | REP OCH + RT | |
5 Switch | AML M4 | t(1:8)(q31;q22) [17]/46,XX [3] | FLT3-ITD, TET2, NPM1, CEBPA | IA, Sorafenib + CLAG, HDArc-a | |
6 Diagnosis | MCL | 46,XY [20] | Negative | RCHOP, RT, GEMOX | |
6 Switch | AML M5 | 46 XY? t(2:8)(p13:p21) del(9)(q22) [20] | FLT3-ITDhigh | IA, Sorafenib, Venetoclax | |
Reported case [Reference] | |||||
[7] Diagnosis | Pro-B ALL | 46,XY [10] | TAF15 – ZNF384 | (GIMEMA) LAL 2000 | |
[7] Switch | AML M5b | 47,XX, t(12;17)(p13;q11) mar [6]/46,XX [6] | TAF15 – ZNF384 | FLAG | |
[8] Diagnosis | Pre-B ALL | No data | Negative | VCDLP | |
[8] Switch | AML M5 | No data | FLAG | ||
[9] Diagnosis | B-LBL | 46,XX | IGH rearrangement, MRP1, and BCRP1 overexpress | GMALL-2003 protocol | |
[9] Switch | AML M5 | No data | EVI-1 | IDA-FLAG | |
[10] Diagnosis | T-ALL | 52, XY, +? X, + 8, + 10, + 11, + 13, + 19 [11]/46, XY [9] | Negative | HOVON 70 | |
[10] Switch | AML | No data | Negative | HD Ara-c + VP16 | Auto-PBSCT |
[11] Diagnosis | Pro-B ALL | t(2;16) (p11;p11) [10] | SMC3 | GIMEMA 0904 protocol | |
[11] Switch | AML | t(2;16) (p11;p11), + 12[13] no data | SMC3, ETV6, JARID2, KLF4, PIK3C2A, PTPRG | Clofarabine and cytarabine | |
[12] Diagnosis | AML(M4) | Normal | Negative | IA | Autologous bone marrow transplantation |
[12] Switch | Pre-B ALL | Normal | Monoclonal pattern of IgH and TCR | VCDLP, MTX,6-MP | |
[13] Diagnosis | T-ALL | 46,XX [20] | No data | CTX + VDLD | |
[13] Switch | B-ALL | No data | BCR/ABL P210 positive | No data | |
[5] Diagnosis | B-ALL | 46,XY,t(4;11)(q21;q23) | No data | Blinatumomab study (NCT02143414) | |
[5] Switch | Myeloid sarcoma | No data | No data | No data | |
[14] Diagnosis | T-LBL | 46,XX | ALK, MAP3K14 mutation | AALL0434 protocol | |
[14] Switch | AML | 46,XX | ALK, MAP3K14 mutation | Cytarabine, mitoxantrone and etoposide, HDAra-c | Sibling ASCT |
Abbreviation: PBSCT: peripheral blood stem cell transplantation, Auto-PBSCT: Autologous peripheral blood stem cell transplantation, ?: uncertain.
In three cases from our cohort, NGS revealed the most common mutations of AML such as FLT3-ITD, TET2, ASXL1, NPM1, C/EBPα, or CBL (Table 2). In our cases, one case was C/EBPα mutation and two cases showed CBL gene mutation. C/EBPα is one of the master transcription factors to regulate myeloid cell fate, and promotion of differentiation of progenitor cells and aberrant expression confer a myeloid cell fate to T cells, B cells, or fibroblasts [26,27]. At present, CBL gene mutation does not have a prognostic significance gene in adult AML case according to NCCN guidelines. FLT3-ITD, TET2, ASXL1, and NPM1 are well recognized in hematologic malignancies.
In terms of treatment, due to the high mortality of this disease, most of the cases in the literature ended in death. In our cohort, although the treatment was adjusted according to phenotype conversion, and allo- or auto-PBSCT was conducted according to the patient’s condition, but only three patients have survived. Thus, we need to make individualized treatment regimens in clinical practice. The reason for this is that we found that no one therapy regimen is more effective than another from our cohort. In the era of immunotherapy, it still needs to be explored whether antibody-based or cell-based therapy is a good choice for those patients.
4 Conclusion
From our case studies, we conclude that lineage switch is rare but leads to high-mortality incidence in hematology malignance. Lineage switch can occur not only from ALL to AML or vice versa, but also from MCL or DLBCL to AML. The incidence of MLL rearrangements in lineage switch is lower in adult hematologic malignancies compared with pediatric leukemia. Meanwhile, poor outcomes often cannot be reversed, although intensive therapy and stem cell transplantation have been used in some cases. Due to low incidence, the characteristics and gene expression signature of those cases varied greatly. As a result, we need to accumulate more cases to describe biological and clinical characteristics of this type of disease, as well as to explore more treatment options in order to improve clinical outcomes.
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Funding information: This work was supported by National Natural Science Foundation of China (Grant numbers 82000198, 82000153, and 82070132), Guangdong Medical Research Foundation (Grant number A2019207), and Guangzhou Science and Technology Project (Grant number 202102010314).
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Conflict of interest: The authors declare no conflict of interest.
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Data availability statement: All data generated or analyzed during this study are available upon request from the corresponding author.
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© 2022 Wenjuan Yang et al., published by De Gruyter
This work is licensed under the Creative Commons Attribution 4.0 International License.
Artikel in diesem Heft
- Research Articles
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- circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury
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- Four drug metabolism-related subgroups of pancreatic adenocarcinoma in prognosis, immune infiltration, and gene mutation
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- LMO3 promotes proliferation and metastasis of papillary thyroid carcinoma cells by regulating LIMK1-mediated cofilin and the β-catenin pathway
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- miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells
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- lncRNA NONRATT013819.2 promotes transforming growth factor-β1-induced myofibroblastic transition of hepatic stellate cells by miR24-3p/lox
- NORAD modulates miR-30c-5p-LDHA to protect lung endothelial cells damage
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- A 16-gene signature associated with homologous recombination deficiency for prognosis prediction in patients with triple-negative breast cancer
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- Comprehensive analysis of molecular mechanism and a novel prognostic signature based on small nuclear RNA biomarkers in gastric cancer patients
- Smog and risk of maternal and fetal birth outcomes: A retrospective study in Baoding, China
- Let-7i-3p inhibits the cell cycle, proliferation, invasion, and migration of colorectal cancer cells via downregulating CCND1
- β2-Adrenergic receptor expression in subchondral bone of patients with varus knee osteoarthritis
- Possible impact of COVID-19 pandemic and lockdown on suicide behavior among patients in Southeast Serbia
- In vitro antimicrobial activity of ozonated oil in liposome eyedrop against multidrug-resistant bacteria
- Potential biomarkers for inflammatory response in acute lung injury
- A low serum uric acid concentration predicts a poor prognosis in adult patients with candidemia
- Antitumor activity of recombinant oncolytic vaccinia virus with human IL2
- ALKBH5 inhibits TNF-α-induced apoptosis of HUVECs through Bcl-2 pathway
- Risk prediction of cardiovascular disease using machine learning classifiers
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- Erratum to “lncRNA NORAD promotes lung cancer progression by competitively binding to miR-28-3p with E2F2”
- Retraction
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Artikel in diesem Heft
- Research Articles
- AMBRA1 attenuates the proliferation of uveal melanoma cells
- A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma
- Differences in complications between hepatitis B-related cirrhosis and alcohol-related cirrhosis
- Effect of gestational diabetes mellitus on lipid profile: A systematic review and meta-analysis
- Long noncoding RNA NR2F1-AS1 stimulates the tumorigenic behavior of non-small cell lung cancer cells by sponging miR-363-3p to increase SOX4
- Promising novel biomarkers and candidate small-molecule drugs for lung adenocarcinoma: Evidence from bioinformatics analysis of high-throughput data
- Plasmapheresis: Is it a potential alternative treatment for chronic urticaria?
- The biomarkers of key miRNAs and gene targets associated with extranodal NK/T-cell lymphoma
- Gene signature to predict prognostic survival of hepatocellular carcinoma
- Effects of miRNA-199a-5p on cell proliferation and apoptosis of uterine leiomyoma by targeting MED12
- Does diabetes affect paraneoplastic thrombocytosis in colorectal cancer?
- Is there any effect on imprinted genes H19, PEG3, and SNRPN during AOA?
- Leptin and PCSK9 concentrations are associated with vascular endothelial cytokines in patients with stable coronary heart disease
- Pericentric inversion of chromosome 6 and male fertility problems
- Staple line reinforcement with nebulized cyanoacrylate glue in laparoscopic sleeve gastrectomy: A propensity score-matched study
- Retrospective analysis of crescent score in clinical prognosis of IgA nephropathy
- Expression of DNM3 is associated with good outcome in colorectal cancer
- Activation of SphK2 contributes to adipocyte-induced EOC cell proliferation
- CRRT influences PICCO measurements in febrile critically ill patients
- SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis
- lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells
- circ_AKT3 knockdown suppresses cisplatin resistance in gastric cancer
- Prognostic value of nicotinamide N-methyltransferase in human cancers: Evidence from a meta-analysis and database validation
- GPC2 deficiency inhibits cell growth and metastasis in colon adenocarcinoma
- A pan-cancer analysis of the oncogenic role of Holliday junction recognition protein in human tumors
- Radiation increases COL1A1, COL3A1, and COL1A2 expression in breast cancer
- Association between preventable risk factors and metabolic syndrome
- miR-29c-5p knockdown reduces inflammation and blood–brain barrier disruption by upregulating LRP6
- Cardiac contractility modulation ameliorates myocardial metabolic remodeling in a rabbit model of chronic heart failure through activation of AMPK and PPAR-α pathway
- Quercitrin protects human bronchial epithelial cells from oxidative damage
- Smurf2 suppresses the metastasis of hepatocellular carcinoma via ubiquitin degradation of Smad2
- circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury
- Sonoclot’s usefulness in prediction of cardiopulmonary arrest prognosis: A proof of concept study
- Four drug metabolism-related subgroups of pancreatic adenocarcinoma in prognosis, immune infiltration, and gene mutation
- Decreased expression of miR-195 mediated by hypermethylation promotes osteosarcoma
- LMO3 promotes proliferation and metastasis of papillary thyroid carcinoma cells by regulating LIMK1-mediated cofilin and the β-catenin pathway
- Cx43 upregulation in HUVECs under stretch via TGF-β1 and cytoskeletal network
- Evaluation of menstrual irregularities after COVID-19 vaccination: Results of the MECOVAC survey
- Histopathologic findings on removed stomach after sleeve gastrectomy. Do they influence the outcome?
- Analysis of the expression and prognostic value of MT1-MMP, β1-integrin and YAP1 in glioma
- Optimal diagnosis of the skin cancer using a hybrid deep neural network and grasshopper optimization algorithm
- miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells
- Clinical value of SIRT1 as a prognostic biomarker in esophageal squamous cell carcinoma, a systematic meta-analysis
- circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8
- miR-22-5p regulates the self-renewal of spermatogonial stem cells by targeting EZH2
- hsa-miR-340-5p inhibits epithelial–mesenchymal transition in endometriosis by targeting MAP3K2 and inactivating MAPK/ERK signaling
- circ_0085296 inhibits the biological functions of trophoblast cells to promote the progression of preeclampsia via the miR-942-5p/THBS2 network
- TCD hemodynamics findings in the subacute phase of anterior circulation stroke patients treated with mechanical thrombectomy
- 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
- Tollip promotes hepatocellular carcinoma progression via PI3K/AKT pathway
- circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis
- Human amniotic fluid as a source of stem cells
- lncRNA NONRATT013819.2 promotes transforming growth factor-β1-induced myofibroblastic transition of hepatic stellate cells by miR24-3p/lox
- NORAD modulates miR-30c-5p-LDHA to protect lung endothelial cells damage
- Idiopathic pulmonary fibrosis telemedicine management during COVID-19 outbreak
- Risk factors for adverse drug reactions associated with clopidogrel therapy
- Serum zinc associated with immunity and inflammatory markers in Covid-19
- The relationship between night shift work and breast cancer incidence: A systematic review and meta-analysis of observational studies
- LncRNA expression in idiopathic achalasia: New insight and preliminary exploration into pathogenesis
- Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway
- Moscatilin suppresses the inflammation from macrophages and T cells
- Zoledronate promotes ECM degradation and apoptosis via Wnt/β-catenin
- Epithelial-mesenchymal transition-related genes in coronary artery disease
- The effect evaluation of traditional vaginal surgery and transvaginal mesh surgery for severe pelvic organ prolapse: 5 years follow-up
- Repeated partial splenic artery embolization for hypersplenism improves platelet count
- Low expression of miR-27b in serum exosomes of non-small cell lung cancer facilitates its progression by affecting EGFR
- Exosomal hsa_circ_0000519 modulates the NSCLC cell growth and metastasis via miR-1258/RHOV axis
- miR-455-5p enhances 5-fluorouracil sensitivity in colorectal cancer cells by targeting PIK3R1 and DEPDC1
- The effect of tranexamic acid on the reduction of intraoperative and postoperative blood loss and thromboembolic risk in patients with hip fracture
- Isocitrate dehydrogenase 1 mutation in cholangiocarcinoma impairs tumor progression by sensitizing cells to ferroptosis
- Artemisinin protects against cerebral ischemia and reperfusion injury via inhibiting the NF-κB pathway
- A 16-gene signature associated with homologous recombination deficiency for prognosis prediction in patients with triple-negative breast cancer
- Lidocaine ameliorates chronic constriction injury-induced neuropathic pain through regulating M1/M2 microglia polarization
- MicroRNA 322-5p reduced neuronal inflammation via the TLR4/TRAF6/NF-κB axis in a rat epilepsy model
- miR-1273h-5p suppresses CXCL12 expression and inhibits gastric cancer cell invasion and metastasis
- Clinical characteristics of pneumonia patients of long course of illness infected with SARS-CoV-2
- circRNF20 aggravates the malignancy of retinoblastoma depending on the regulation of miR-132-3p/PAX6 axis
- Linezolid for resistant Gram-positive bacterial infections in children under 12 years: A meta-analysis
- Rack1 regulates pro-inflammatory cytokines by NF-κB in diabetic nephropathy
- Comprehensive analysis of molecular mechanism and a novel prognostic signature based on small nuclear RNA biomarkers in gastric cancer patients
- Smog and risk of maternal and fetal birth outcomes: A retrospective study in Baoding, China
- Let-7i-3p inhibits the cell cycle, proliferation, invasion, and migration of colorectal cancer cells via downregulating CCND1
- β2-Adrenergic receptor expression in subchondral bone of patients with varus knee osteoarthritis
- Possible impact of COVID-19 pandemic and lockdown on suicide behavior among patients in Southeast Serbia
- In vitro antimicrobial activity of ozonated oil in liposome eyedrop against multidrug-resistant bacteria
- Potential biomarkers for inflammatory response in acute lung injury
- A low serum uric acid concentration predicts a poor prognosis in adult patients with candidemia
- Antitumor activity of recombinant oncolytic vaccinia virus with human IL2
- ALKBH5 inhibits TNF-α-induced apoptosis of HUVECs through Bcl-2 pathway
- Risk prediction of cardiovascular disease using machine learning classifiers
- Value of ultrasonography parameters in diagnosing polycystic ovary syndrome
- Bioinformatics analysis reveals three key genes and four survival genes associated with youth-onset NSCLC
- Identification of autophagy-related biomarkers in patients with pulmonary arterial hypertension based on bioinformatics analysis
- Protective effects of glaucocalyxin A on the airway of asthmatic mice
- Overexpression of miR-100-5p inhibits papillary thyroid cancer progression via targeting FZD8
- Bioinformatics-based analysis of SUMOylation-related genes in hepatocellular carcinoma reveals a role of upregulated SAE1 in promoting cell proliferation
- Effectiveness and clinical benefits of new anti-diabetic drugs: A real life experience
- Identification of osteoporosis based on gene biomarkers using support vector machine
- Tanshinone IIA reverses oxaliplatin resistance in colorectal cancer through microRNA-30b-5p/AVEN axis
- miR-212-5p inhibits nasopharyngeal carcinoma progression by targeting METTL3
- Association of ST-T changes with all-cause mortality among patients with peripheral T-cell lymphomas
- LINC00665/miRNAs axis-mediated collagen type XI alpha 1 correlates with immune infiltration and malignant phenotypes in lung adenocarcinoma
- The perinatal factors that influence the excretion of fecal calprotectin in premature-born children
- Effect of femoral head necrosis cystic area on femoral head collapse and stress distribution in femoral head: A clinical and finite element study
- 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?
- lncRNA HAGLR modulates myocardial ischemia–reperfusion injury in mice through regulating miR-133a-3p/MAPK1 axis
- Protective effect of ghrelin on intestinal I/R injury in rats
- In vivo knee kinematics of an innovative prosthesis design
- Relationship between the height of fibular head and the incidence and severity of knee osteoarthritis
- lncRNA WT1-AS attenuates hypoxia/ischemia-induced neuronal injury during cerebral ischemic stroke via miR-186-5p/XIAP axis
- Correlation of cardiac troponin T and APACHE III score with all-cause in-hospital mortality in critically ill patients with acute pulmonary embolism
- LncRNA LINC01857 reduces metastasis and angiogenesis in breast cancer cells via regulating miR-2052/CENPQ axis
- Endothelial cell-specific molecule 1 (ESM1) promoted by transcription factor SPI1 acts as an oncogene to modulate the malignant phenotype of endometrial cancer
- SELENBP1 inhibits progression of colorectal cancer by suppressing epithelial–mesenchymal transition
- Visfatin is negatively associated with coronary artery lesions in subjects with impaired fasting glucose
- 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
- Neonatal stroke surveillance study protocol in the United Kingdom and Republic of Ireland
- Oncogenic role of TWF2 in human tumors: A pan-cancer analysis
- Mean corpuscular hemoglobin predicts the length of hospital stay independent of severity classification in patients with acute pancreatitis
- Association of gallstone and polymorphisms of UGT1A1*27 and UGT1A1*28 in patients with hepatitis B virus-related liver failure
- TGF-β1 upregulates Sar1a expression and induces procollagen-I secretion in hypertrophic scarring fibroblasts
- Antisense lncRNA PCNA-AS1 promotes esophageal squamous cell carcinoma progression through the miR-2467-3p/PCNA axis
- NK-cell dysfunction of acute myeloid leukemia in relation to the renin–angiotensin system and neurotransmitter genes
- The effect of dilution with glucose and prolonged injection time on dexamethasone-induced perineal irritation – A randomized controlled trial
- miR-146-5p restrains calcification of vascular smooth muscle cells by suppressing TRAF6
- Role of lncRNA MIAT/miR-361-3p/CCAR2 in prostate cancer cells
- lncRNA NORAD promotes lung cancer progression by competitively binding to miR-28-3p with E2F2
- Noninvasive diagnosis of AIH/PBC overlap syndrome based on prediction models
- lncRNA FAM230B is highly expressed in colorectal cancer and suppresses the maturation of miR-1182 to increase cell proliferation
- circ-LIMK1 regulates cisplatin resistance in lung adenocarcinoma by targeting miR-512-5p/HMGA1 axis
- LncRNA SNHG3 promoted cell proliferation, migration, and metastasis of esophageal squamous cell carcinoma via regulating miR-151a-3p/PFN2 axis
- Risk perception and affective state on work exhaustion in obstetrics during the COVID-19 pandemic
- lncRNA-AC130710/miR-129-5p/mGluR1 axis promote migration and invasion by activating PKCα-MAPK signal pathway in melanoma
- SNRPB promotes cell cycle progression in thyroid carcinoma via inhibiting p53
- Xylooligosaccharides and aerobic training regulate metabolism and behavior in rats with streptozotocin-induced type 1 diabetes
- 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
- Silencing of CPSF7 inhibits the proliferation, migration, and invasion of lung adenocarcinoma cells by blocking the AKT/mTOR signaling pathway
- Ultrasound-guided lumbar plexus block versus transversus abdominis plane block for analgesia in children with hip dislocation: A double-blind, randomized trial
- Relationship of plasma MBP and 8-oxo-dG with brain damage in preterm
- Identification of a novel necroptosis-associated miRNA signature for predicting the prognosis in head and neck squamous cell carcinoma
- Delayed femoral vein ligation reduces operative time and blood loss during hip disarticulation in patients with extremity tumors
- The expression of ASAP3 and NOTCH3 and the clinicopathological characteristics of adult glioma patients
- Longitudinal analysis of factors related to Helicobacter pylori infection in Chinese adults
- HOXA10 enhances cell proliferation and suppresses apoptosis in esophageal cancer via activating p38/ERK signaling pathway
- Meta-analysis of early-life antibiotic use and allergic rhinitis
- Marital status and its correlation with age, race, and gender in prognosis of tonsil squamous cell carcinomas
- HPV16 E6E7 up-regulates KIF2A expression by activating JNK/c-Jun signal, is beneficial to migration and invasion of cervical cancer cells
- Amino acid profiles in the tissue and serum of patients with liver cancer
- Pain in critically ill COVID-19 patients: An Italian retrospective study
- Immunohistochemical distribution of Bcl-2 and p53 apoptotic markers in acetamiprid-induced nephrotoxicity
- Estradiol pretreatment in GnRH antagonist protocol for IVF/ICSI treatment
- Long non-coding RNAs LINC00689 inhibits the apoptosis of human nucleus pulposus cells via miR-3127-5p/ATG7 axis-mediated autophagy
- The relationship between oxygen therapy, drug therapy, and COVID-19 mortality
- Monitoring hypertensive disorders in pregnancy to prevent preeclampsia in pregnant women of advanced maternal age: Trial mimicking with retrospective data
- SETD1A promotes the proliferation and glycolysis of nasopharyngeal carcinoma cells by activating the PI3K/Akt pathway
- The role of Shunaoxin pills in the treatment of chronic cerebral hypoperfusion and its main pharmacodynamic components
- TET3 governs malignant behaviors and unfavorable prognosis of esophageal squamous cell carcinoma by activating the PI3K/AKT/GSK3β/β-catenin pathway
- Associations between morphokinetic parameters of temporary-arrest embryos and the clinical prognosis in FET cycles
- Long noncoding RNA WT1-AS regulates trophoblast proliferation, migration, and invasion via the microRNA-186-5p/CADM2 axis
- The incidence of bronchiectasis in chronic obstructive pulmonary disease
- Integrated bioinformatics analysis shows integrin alpha 3 is a prognostic biomarker for pancreatic cancer
- Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway
- Comparison of hospitalized patients with severe pneumonia caused by COVID-19 and influenza A (H7N9 and H1N1): A retrospective study from a designated hospital
- lncRNA ZFAS1 promotes intervertebral disc degeneration by upregulating AAK1
- Pathological characteristics of liver injury induced by N,N-dimethylformamide: From humans to animal models
- lncRNA ELFN1-AS1 enhances the progression of colon cancer by targeting miR-4270 to upregulate AURKB
- DARS-AS1 modulates cell proliferation and migration of gastric cancer cells by regulating miR-330-3p/NAT10 axis
- Dezocine inhibits cell proliferation, migration, and invasion by targeting CRABP2 in ovarian cancer
- 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
- Bifidobacterium lactis Probio-M8 ameliorated the symptoms of type 2 diabetes mellitus mice by changing ileum FXR-CYP7A1
- circRNA DENND1B inhibits tumorigenicity of clear cell renal cell carcinoma via miR-122-5p/TIMP2 axis
- EphA3 targeted by miR-3666 contributes to melanoma malignancy via activating ERK1/2 and p38 MAPK pathways
- Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block
- 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
- Review Articles
- Current management of cancer pain in Italy: Expert opinion paper
- Hearing loss and brain disorders: A review of multiple pathologies
- The rationale for using low-molecular weight heparin in the therapy of symptomatic COVID-19 patients
- Amyotrophic lateral sclerosis and delayed onset muscle soreness in light of the impaired blink and stretch reflexes – watch out for Piezo2
- Interleukin-35 in autoimmune dermatoses: Current concepts
- Recent discoveries in microbiota dysbiosis, cholangiocytic factors, and models for studying the pathogenesis of primary sclerosing cholangitis
- Advantages of ketamine in pediatric anesthesia
- Congenital adrenal hyperplasia. Role of dentist in early diagnosis
- Migraine management: Non-pharmacological points for patients and health care professionals
- Atherogenic index of plasma and coronary artery disease: A systematic review
- Physiological and modulatory role of thioredoxins in the cellular function
- Case Reports
- 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
- A case of successful pembrolizumab monotherapy in a patient with advanced lung adenocarcinoma: Use of multiple biomarkers in combination for clinical practice
- Unusual neurological manifestations of bilateral medial medullary infarction: A case report
- Atypical symptoms of malignant hyperthermia: A rare causative mutation in the RYR1 gene
- A case report of dermatomyositis with the missed diagnosis of non-small cell lung cancer and concurrence of pulmonary tuberculosis
- A rare case of endometrial polyp complicated with uterine inversion: A case report and clinical management
- Spontaneous rupturing of splenic artery aneurysm: Another reason for fatal syncope and shock (Case report and literature review)
- Fungal infection mimicking COVID-19 infection – A case report
- Concurrent aspergillosis and cystic pulmonary metastases in a patient with tongue squamous cell carcinoma
- Paraganglioma-induced inverted takotsubo-like cardiomyopathy leading to cardiogenic shock successfully treated with extracorporeal membrane oxygenation
- Lineage switch from lymphoma to myeloid neoplasms: First case series from a single institution
- Trismus during tracheal extubation as a complication of general anaesthesia – A case report
- Simultaneous treatment of a pubovesical fistula and lymph node metastasis secondary to multimodal treatment for prostate cancer: Case report and review of the literature
- Two case reports of skin vasculitis following the COVID-19 immunization
- Ureteroiliac fistula after oncological surgery: Case report and review of the literature
- Synchronous triple primary malignant tumours in the bladder, prostate, and lung harbouring TP53 and MEK1 mutations accompanied with severe cardiovascular diseases: A case report
- Huge mucinous cystic neoplasms with adhesion to the left colon: A case report and literature review
- Commentary
- Commentary on “Clinicopathological features of programmed cell death-ligand 1 expression in patients with oral squamous cell carcinoma”
- Rapid Communication
- COVID-19 fear, post-traumatic stress, growth, and the role of resilience
- Erratum
- Erratum to “Tollip promotes hepatocellular carcinoma progression via PI3K/AKT pathway”
- 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”
- Erratum to “lncRNA NORAD promotes lung cancer progression by competitively binding to miR-28-3p with E2F2”
- Retraction
- Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
- Retraction to “miR-519d downregulates LEP expression to inhibit preeclampsia development”
- Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part II
- Usefulness of close surveillance for rectal cancer patients after neoadjuvant chemoradiotherapy