Home 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
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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

  • Cristiano Spadaccio , Angelo Pisani , Antonio Salsano EMAIL logo , Antonio Nenna , Alexander Fardman , David D’Alessandro , Francesco Santini , Mario F. L. Gaudino , Thoralf M. Sundt and David Rose
Published/Copyright: September 6, 2022
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Open Medicine
From the journal Open Medicine Volume 17 Issue 1

Abstract

This study aims to compare treatments and outcomes of mechanical complications of acute myocardial infarction (MI) during the Covid-19 and in the pre-Covid-19 era. Electronic databases have been searched for MI mechanical complications during the Covid-19 era and in the previous period from January 1998 to January 2020 (pre-Covid-19 era), until October 2021. To perform a quantitative analysis of non-comparative series, a meta-analysis of proportion has been conducted. Early mortality after surgical treatment was 15.0% while it was significantly higher after conservative treatment (62.4%) (P = 0.026). Early mortality after surgical treatment was seemingly higher in the pre-Covid-19 era but the difference did not reach statistical significance (15.0% vs 38.9%; P = 0.13). Mortality in patients treated conservatively, or turned down for surgery, was lower during the Covid-19 pandemic (62.4% vs 97.7%; P = 0.001). The crude mean prevalence of the use rate of conservative or surgical treatment across the studies during Covid-19 and in the pre-Covid-19 era was comparable. The current increased incidence of MI mechanical complications might be a consequence of delayed presentation or restricted access to hospital facilities. Despite the general negative impact of Covid-19 on cardiac surgery volumes and outcomes and the apparent increase of the incidence of MI complications, the outcomes of their surgical and clinical treatment seem not to have been affected during the pandemic.

Keywords: myocardial infarction; mechanical complications; Covid-19

1 Introduction

Covid-19 pandemic has determined an unprecedented burden on the delivery of cardiovascular care worldwide [1,2,3,4]. An increasing amount of reports have been published on the development of mechanical complications of acute MI [5] as a direct consequence of the delayed presentation and inability to receive adequate treatment [6,7,8,9]. We performed a metanalysis of the currently available data on MI mechanical complications with the aim to describe the epidemiological characteristics of this phenomenon and compare it with the temporal trends and outcomes of the pre-Covid-19 era.

2 Methods

Study design is available online (PROSPERO registration CRD42021276091), and database search is updated to the end of October 2021. Full details are included in Supplemental Material. This study complies with the Declaration of Helsinki. Local ethics committee approval was not required considering the study design (secondary research not directly dealing with human subjects).

2.1 Search strategy

MEDLINE and the Cochrane Library databases have been systematically. Search strategies including exploded MeSH terms have been used. Search strings have been reported as Supplementary Material. English language restriction was imposed. Additional articles by manually searching the reference lists from recent reviews and the extracted papers have been looked for. Attempts have been made at collecting unpublished data from the authors of potentially pertinent papers.

2.2 Study selection criteria

Letters, editorial, reviews, animal studies, and reports with duplication data have been excluded. PICOS study design was used for inclusion/exclusion criteria. To identify eligible studies, a two-step selection process has been applied. Three reviewers (AS, CS, and AN) checked the eligibility criteria and selected the studies for inclusion in the present systematic review. Three researchers (AS, CS, and AN) independently screened records for inclusion. They were blinded to each other’s decisions. Disagreements between individual judgements have been resolved by consensus. Studies were excluded if they did not meet the criteria.

2.3 Data extraction and quality assessment

Three investigators (AS, CS, and AN) independently extracted data from all eligible studies using a standardized Excel file, focusing on study design, study size, type of intervention, and outcomes. Any disagreement was solved by consensus. We assessed the study quality with the Newcastle–Ottawa quality assessment scale.

2.4 Statistical analysis

To perform a quantitative analysis of non-comparative series, a meta-analysis of proportion has been conducted. To draw statistical inferences from heterogeneous studies, we employed non-iterative estimate of the inter-study variance component based on a random effects model (s2), taking into account that statistical heterogeneity is believed to be due to clinical diversity. Tau2 = 0 indicates no between-study heterogeneity. Double arcsine transformations have been applied to the observed proportions identified across a collection of studies to make the transformed proportions follow a normal distribution to accurately estimate the summary proportion and increase the validity of the associated statistical analyses. Multiple meta-regression with the Knapp–Hartung adjustment has been used to test the influence of the publication date and Covid-19 on early mortality. A P value of 0.05 was considered statistically significant. Statistical analyses have been done using the packages “meta” and “metafor” of R software, version 4.0.5.

  1. Ethic statement: This study complies with the Declaration of Helsinki. Reviews, meta-analyses, or descriptions of educational materials do not involve human subjects and do not require IRB review (Grad Med Educ. 2011 Mar; 3(1): 5–6. doi:10.4300/JGME-D-11-00005.1). This study does not directly involve human participants.

  2. Patient and public involvement: Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research

3 Results

The pooled prevalence of early mortality independently on the treatment received during the Covid-19 pandemic was 31.1% (95% CI 12.7−52.0%, pooled data from 67 patients in 30 studies including case reports, case series, and observational studies). When compared to patients treated before the Covid-19 pandemic (pooled data from 8,647 patients in 47 studies including case series and observational studies), there was no difference in the overall early mortality (independently on the treatment received) (46.4% vs 31.1%; P = 0.24). Early mortality after surgical treatment was seemingly higher in the pre-Covid-19 era, but the difference did not reach statistical significance (P = 0.135). Conversely, mortality in patients treated conservatively, or turned down for surgery, was lower during the Covid-19 pandemic (P = 0.001). The crude mean prevalence of the use-rate of conservative or surgical treatment across the studies during Covid-19 and in the pre-Covid-19 era was comparable, when considering only the studies reporting both the approaches (surgery: 56.7% vs 66.3%; conservative 43.3% vs 33.7%; P = 0.13). After adjusting for the publication date, the period relative to Covid-19 pandemic seemed to influence the effect size for early mortality after conservative treatment but did not have impact in the surgical group. Results are summarized in Table 1 and described in detail in Supplemental Material.

Table 1

Treatments and outcomes of mechanical complications of MI considering Covid-19 pandemic

Results of the metanalysis Pooled results Treatments/timing P value Egger’s test
Early mortality during Covid-19 pandemic, surgery vs no surgery 67 patients Surgery No surgery P = 0.026 P = 0.38
31% (13–52%) 22 studies, 38 patients 13 studies, 29 patients
I 2 = 26% 15% (1–37%), I 2 = 9% 62% (27–93%), I 2 = 35%
Early mortality after surgery, before vs during Covid-19 pandemic 8,504 patients Surgery before Covid-19 Surgery during Covid-19 P = 0.135 P = 0.77
35% (31–40%) 47 studies, 8,466 patients 22 studies, 38 patients
I 2 = 87% 39% (35–43%), I 2 = 91% 15% (1–37%), I 2 = 9%
Early mortality after conservative treatment, before vs during Covid-19 pandemic 210 patients No surgery before Covid-19 No surgery during Covid-19 P = 0.001 P = 0.06
95% (80–100%) 8 studies, 181 patients 13 studies, 29 patients
I 2 = 67% 98% (94–100%), I 2 = 0% 62% (27–93%), I 2 = 35%
Results of the meta-regression Coefficient Standard error 95% Confidence interval P value Interaction
Surgery
 Year of publication <0.01 0.003 −0.006/0.006 P = 0.982 P = 0.88
 Covid-19 pandemic −0.12 0.090 −0.300/0.058 P = 0.185
Conservative treatment
 Year of publication <0.01 0.009 −0.019/0.020 P = 0.964 P = 0.56
 Covid-19 pandemic −0.53 0.140 −0.820/−0.250 P = 0.001

To perform a quantitative analysis of non-comparative series, a meta-analysis of proportion has been conducted. To draw statistical inferences from heterogeneous studies, we employed non-iterative estimate of the inter-study variance component based on a random effects model, considering that statistical heterogeneity is believed to be due to clinical diversity. Double arcsine transformations have been applied to the observed proportions identified across a collection of studies to make the transformed proportions follow a normal distribution. Multiple meta-regression with the Knapp–Hartung adjustment has been used to test the influence of the publication date and Covid-19 on early mortality.

4 Discussion

Mortality for MI mechanical complications during Covid-19 pandemic was not dissimilar from the pre-Covid-19 era. However, underreporting of submersed populations of patients not reaching medical attention because of the gravity of the disease and/or the restricted access to specialized hospital facilities could have clearly affected our results. In support of this hypothesis, an increase in the incidence of out-of-hospital cardiac arrests and in the number of patients declared deceased on scene has been demonstrated in areas at high Covid prevalence [10,11].

Despite many reports advocated a worrisome disruption of the cardiac surgical and interventional activities due to the unprecedented overload of the healthcare facilities [2,3,6,8,12], the relative rate of surgical procedures for MI complications and surgical turndowns to conservative management did not change in respect to the pre-Covid-19 era. This might suggest that notwithstanding the significant resource and logistic burden posed on cardiac units, the ability to deliver high standards of care in these high-risk cases was not compromised during the pandemic.

Reasons underlying the results of surgery for MI complications and the apparent improved outcomes of conservative management during Covid-19 pandemic cannot be inferred with the present analysis. The modern improvements of intensive care and medical management might have played a role in the outcomes of the conservative subgroup, as suggested by the meta-regression analysis. However, significant selection and publication biases, implying a large population of critically ill patients not reaching medical attention, or a relatively more stable subset of patients being treated and reported during the pandemic, impedes to establish any explanatory or causative link in this context. However, it is intriguing to note that in the general impetus for publication during the Covid-19 era, there is a seemingly more frequent report of conservative treatments in the surgical literature. Whether this finding suggests that surgery is less offered in the recent era is difficult to ascertain, but it could at least partially balance the publication selection bias typical of the pre-Covid-19 periods. However, as this analysis is comparing consecutive rather than contemporary cohorts, the impact of the progressive advancements in the practice across the years in all the fields of medicine should also be considered. As additional limitations of this study, it remains difficult to evaluate if emergency cardiac surgical services have returned to normal in each country, and therefore, the “Covid era” has a different time span in each country. Moreover, there are no data about the percentage of patients with mechanical complications being offered or receiving surgery to be compared with the percentage of patients declined or turned down for surgery, in both eras; these data were not derivable from published studies and a possible “cherry picking” of low-risk cases by surgeons cannot be disproved.

5 Conclusions

Besides the inherent limitations of this study, this meta-analysis first and comprehensively described the current evidence on the management of MI complications during the pandemic. Despite the general negative impact of Covid-19 on cardiac surgery volumes and outcomes and the apparent increase of the incidence of MI complications, the outcomes of their surgical and clinical treatment seem not to have been affected during the pandemic.

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Acknowledgments

None.

  1. Funding information: This article received no funding support.

  2. Author contributions: Cristiano Spadaccio: conceptualization, data curation, investigation, methodology, writing –original draft. Angelo Pisani: conceptualization, data curation, investigation, writing – original draft. Antonio Salsano: data curation, investigation, writing – original draft. Antonio Nenna: data curation, investigation, writing – review and editing. Alex Fardman: data curation, writing – review and editing. David D’Alessandro: data curation, writing – review and editing. Francesco Santini: data curation, writing – review and editing. Mario F.L. Gaudino: conceptualization, data curation, methodology, writing – review and editing. Thoralf M. Sundt: conceptualization, methodology, writing – review and editing. David Rose: conceptualization, methodology, writing – review and editing.

  3. Conflict of interest: The corresponding author, AS, cooperates with Open Medicine as editor. The peer-review process was not influenced by this reason.

  4. Data availability statement: Data are available from the corresponding author upon reasonable request.

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Received: 2022-03-05
Revised: 2022-07-20
Accepted: 2022-07-21
Published Online: 2022-09-06

© 2022 Cristiano Spadaccio et al., published by De Gruyter

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

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  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
https://doi.org/10.1515/med-2022-0545
Keywords for this article
myocardial infarction; mechanical complications; Covid-19
Creative Commons
BY 4.0

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