Home Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer
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Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer

  • Ping-Chia Cheng , Chih-Ming Chang , Li-Jen Liao , Chen-Hsi Hsieh , Pei-Wei Shueng , Po-Wen Cheng and Wu-Chia Lo EMAIL logo
Published/Copyright: April 12, 2023
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Open Medicine
From the journal Open Medicine Volume 18 Issue 1

Abstract

In this study, we determined the diagnostic performance of adding ultrasound (US) with/without fine‐needle aspiration cytology (FNAC) to computed tomography (CT)/magnetic resonance imaging (MRI) in evaluating neck lymphadenopathy (LAP) in patients with head and neck cancer treated with irradiation. We included 269 patients who had neck LAP after radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) resulting from cancers of the head and neck region between October 2008 and September 2018. The diagnostic methods consisted of the following: 1) CT/MRI alone, 2) CT/MRI combined with a post-RT US predictive model, and 3) CT/MRI combined with US + FNAC. We compared their diagnostic performance using receiver operating characteristic (ROC) curves. In total, 141 (52%) malignant and 128 (48%) benign LAPs were observed. Regarding the diagnostic accuracy, the area under the ROC curves was highest for the combined CT/MRI and US + FNAC (0.965), followed by the combined CT/MRI and post-RT US predictive model (0.906) and CT/MRI alone (0.836). Our data suggest that the addition of a US examination to CT/MRI resulted in higher diagnostic performance than CT/MRI alone in terms of diagnosing recurrent or persistent nodal disease during the evaluation of LAP in patients with irradiation-treated head and neck cancer.

Keywords: lymphadenopathy; ultrasound; fine‐needle aspiration cytology; computed tomography; magnetic resonance imaging

1 Introduction

Radiotherapy (RT) is the standard treatment for advanced stage head and neck cancer. However, following neck irradiation, the surveillance of nodal malignancy is challenging. RT may result in tissue fibrosis, increasing the difficulty of palpating an enlarged node [1,2]. The lymph node (LN) recurrence rate of head and neck cancer after RT ranges from <10 to 29% [2,3]. Magnetic resonance imaging (MRI) or computed tomography (CT) is typically applied to detect such recurrence [4], although ultrasound (US) has been gradually introduced for more precise detection [5,6]. The 2020 National Comprehensive Cancer Network (NCCN) guidelines report that US, CT, MRI, and positron emission tomography (PET)/CT have distinct advantages in the posttreatment follow-up of patients with locoregionally advanced head and neck cancer [7]. The follow-up intervals for CT, MRI, and PET/CT are clearly defined in the 2020 NCCN guidelines. However, US is typically used as an adjuvant imaging tool, and its role is less emphasized. In this study, we explored whether adding US with or without fine‐needle aspiration cytology (FNAC) to CT/MRI improves diagnostic accuracy. Studies comparing the diagnostic rate of US and CT/MRI during the posttreatment evaluation of patients with head and neck cancer remain limited. Investigating patients with nasopharyngeal carcinoma (NPC), Toh et al. reported that the positive predictive value (PPV) of recurrent nodal metastasis was 93.8% for FNAC and 78.6% for CT during posttreatment follow-up [8]. In patients with head and neck cancer who had completed concurrent chemoradiotherapy (CCRT), Nishimura et al. observed that the sensitivity and specificity of diagnosing malignant LN were 52.9 and 74.2% for CT/MRI, 88.2 and 66.1% for US, and 71.4 and 95.6% for FNAC, respectively [9]. In our previous study, we developed a post-RT US predictive model for the prediction of recurrent or persistent nodal disease in irradiation-treated patients [10]. The model was 1.35 × (long axis) + 2.03 × (short axis) + 2.27 × (margin) + 1.48 × (echogenic hilum) + 3.7. If the score was equal to or greater than 7, an LN was regarded as malignant. This predictive model exhibited favorable sensitivity, PPV, negative predictive value (NPV), and accuracy (85, 82, 83, and 83%, respectively). In this study, we explored the effect of adding US with or without FNAC to CT/MRI in the assessment of recurrent or persistent lymphadenopathy (LAP) in patients with irradiation-treated head and neck cancer under a retrospective setting. Furthermore, we compared the diagnostic performance of CT/MRI alone, CT/MRI in combination with the post-RT US predictive model, and CT/MRI in combination with US + FNAC.

2 Materials and methods

2.1 Inclusion and exclusion criteria

This retrospective study was performed at a tertiary medical center. The reporting of the study followed the Standards for Reporting Diagnostic accuracy studies (STARD) statement. Data from patients who received RT or CCRT for the treatment of cancers in the head and neck region between October 2008 and September 2018 were reviewed. Patients who had LAP, which was defined as the presence of one or many LN(s) detected through a palpation or imaging study, after neck irradiation were included in this study. We included both patients who had or did not have previous neck dissection. All patients received either CT or MRI together with US with or without FNAC approximately 2–3 months after RT/CCRT, followed by every 6 months or under suspicion of recurrence. The CT or MRI was performed with contrast under a 3 mm or 5 mm slice, respectively. Usually, we arranged MRI for the surveillance. If patients were intolerant to MRI examination due to claustrophobia, dyspnea, or not suitable for the prolonged supine position, we arranged CT for the evaluation. US was performed using the brightness and Doppler mode without contrast. Ultrasound-guided fine-needle aspiration (USgFNA) was performed in patients exhibiting suspicious US features during examination [11]. If a patient had one or multiple LNs with suspicion of malignancy, we chose the largest LN for USgFNA. Patients who were lost to follow-up after neck irradiation or did not undergo an imaging study were excluded (Figure 1).

Figure 1 Flow chart of study inclusion and exclusion criteria.
Figure 1

Flow chart of study inclusion and exclusion criteria.

The final diagnoses were obtained according to either clinical diagnoses after multidisciplinary discussions or pathological diagnoses through means of core needle biopsy, excisional biopsy, or neck dissection. In clinical diagnosis, an LAP was regarded as benign when no size change was observed during the course of 12-month follow-up; an LAP was considered malignant when the disease was clearly observed during the imaging study, which was verified with an abnormal cytological report (malignancy, suspicion of malignancy, or atypical cells), or when an LAP was observed to be obviously enlarged during further image study.

2.2 Clinical characteristics and outcome assessment

We recorded information on the age, gender, duration between RT/CCRT and the imaging study, primary malignancy, CT or MRI imaging, US examination, and FNAC report from the medical records. The short axis, long axis, and short-to-long axis (S/L) ratio of neck LN were documented from the US images. Nishimura et al. evaluated the ability of CT/MRI, US, or FNAC to diagnose malignant LNs [9]. However, in clinical practice, FNAC is seldom performed without US. Thus, in this study, the single diagnostic examinations analyzed were CT/MRI, the post-RT US predictive model, and US + FNAC. The diagnosis of CT/MRI was determined by an experienced radiologist based on the patient’s medical history. Following neck irradiation, an enhancement and expansion feature, such as an irregular margin, on an LN was regarded as a malignancy [12]. The post-RT US predictive model was that used in our earlier study [10]. If its score was ≥7, a node was considered to be malignant. The diagnosis of US + FNAC was mainly based on the cytological report, which was supported using the post-RT US predictive model. If the cytological report indicated the presence of malignancy, suspicion of malignancy, or atypical cells, this LN was regarded as malignant. If no cytological report was available, we used the post-RT US predictive model to determine LN malignancy or benignity.

2.3 Statistical analysis

A two-sample t-test was used for continuous variables, and the chi-squared or Fisher exact test was used for categorical variables. The odds ratio (OR) with a 95% confidence interval was reported. Other studies have only focused on the accuracy of single diagnostic examinations rather than that of combined methods. In our study, we evaluated the effect of adding a US examination to CT/MRI by assessing the following diagnostic methods: 1) CT/MRI alone, 2) CT/MRI combined with the post-RT US predictive model, and 3) CT/MRI combined with US + FNAC. According to the final diagnoses, we calculated the predicted probability for nodal malignancy using logistic regression. The diagnostic performance was also compared using receiver operating characteristic (ROC) curves and the area under the receiver operating characteristic curves (AUC). AUC differences by using paired-sample area differences under the ROC curves were also executed. Statistical significance was indicated if p < 0.05. Statistical analysis was conducted using SPSS software version 28 (IBM, Armonk, NY, USA).

  1. Ethical considerations: This study was approved by the institutional ethical review board of Far Eastern Memorial Hospital (No. 109140-E). The study did not influence the patients’ treatment or outcome. All data were analyzed using a deidentified form; the data set is presented in the supplementary material (Table S1).

3 Results

A total of 269 patients who exhibited LAP following neck RT were included in our study (Table 1); these patients were predominantly men (85% [228 of 269]). The mean (standard deviation [SD]) age was 53 (10) years, and the mean (SD) duration between RT/CCRT and imaging study was 583 (763) days. According to the final diagnosis, the malignancy rate was 52%. We recorded 141 malignant LNs and 128 benign LNs. The most common primary sites were oral cancer, NPC, and hypopharyngeal cancer. Among these three primary malignancies, oral cancer (66% [61 of 93]) and hypopharyngeal cancer (62% [23 of 37]) had higher nodal malignancy rates and NPC (35% [30 of 85]) had lower malignancy rate. The clinical characteristics were compared according to the final diagnoses. We observed significant differences in age (p < 0.001), duration between RT/CCRT and imaging study (p = 0.04), short axis (p < 0.001), long axis (p < 0.001), and the S/L ratio (p < 0.001) but not gender (Table 1).

Table 1

Comparison of the clinical characteristics between the malignant and benign nodal diseases

Variables ALL Malignancy Benignity
No. (%) or mean (SD) (N = 269) (N = 141) (N = 128) Difference (95% CI) p-value
Age, years 53 (10) 56 (10) 50 (11) 5.54 (3.11–7.96) <0.001*
Gender −7% (−24 to 9%) 0.398
 Female 41 (15%) 19 (13%) 22 (17%)
 Male 228 (85%) 122 (87%) 106 (83%)
Duration between RT/CCRT and imaging study, days 583 (763) 491 (676) 683 (840) −192 (−374 to −9.88) 0.039*
Exams that patients received
 MRI 259 (96%) 133 (94%) 126 (98%)
 CT 10 (4%) 8 (6%) 2 (2%)
 US 269 (100%) 141 (100%) 128 (100%)
 FNAC 251 (93%) 140 (99%) 111 (87%)
US image
 Short axis, cm 0.92 (0.54) 1.17 (0.57) 0.64 (0.33) 0.53 (0.42–0.64) <0.001*
 Long axis, cm 1.48 (0.82) 1.80 (0.93) 1.12 (0.48) 0.67 (0.49–0.85) <0.001*
 S/L ratio 0.64 (0.17) 0.68 (0.16) 0.59 (0.18) 0.09 (0.05–0.13) <0.001*
Primary malignancy
 Oral cancer 93 (34%) 61 (43%) 32 (25%)
 NPC 85 (32%) 30 (21%) 55 (43%)
 Hypopharyngeal cancer 37 (14%) 23 (16%) 14 (11%)
 Oropharyngeal cancer 24 (9%) 8 (6%) 16 (12%)
 Laryngeal cancer 17 (6%) 12 (9%) 5 (4%)
 Parotid cancer 7 (3%) 2 (1%) 5 (4%)
 Unknown primary tumors of head and neck 3 (1%) 2 (1%) 1 (1%)
 Cervical esophageal cancer 1 (0.3%) 1 (1%) 0 (0%)
 Nasal malignant melanoma 1 (0.3%) 1 (1%) 0 (0%)
 Conjunctival cancer 1 (0.3%) 1 (1%) 0 (0%)

Abbreviations: CT, computed tomography; FNAC, fine-needle aspiration cytology; LAP, lymphadenopathy; MRI, magnetic resonance imaging; RT/CCRT, radiotherapy/concurrent chemoradiotherapy; S/L, short-to-long axis; US, ultrasound.

*Statistical significance, p < 0.05.

The diagnostic examinations for assessing neck LAP were compared according to the final diagnoses (Table 2). We noted significant differences in distinguishing benign from malignant nodal disease in all three diagnostic exams (p < 0.001). The OR was highest in US + FNAC, followed by the CT/MRI report, and then the post-RT US predictive model (103.9, 30.1, and 28.4, respectively).

Table 2

Comparison of the diagnostic exams in assessing neck LAP in post-irradiation head and neck cancer patients

Diagnostic exam Final diagnosis OR (95% CI) Difference (95% CI) p-value
Malignancy Benignity
CT/MRI 30.1 (15.0–60.4) 68% (56–80%) <0.001*
 As malignancy 109 (89%) 13 (11%)
 As benignity 32 (22%) 115 (78%)
Post-RT US predictive model† 28.4 (14.3–56.3) 68% (56–80%) <0.001*
 As malignancy (score ≥7) 127 (80%) 31 (20%)
 As benignity (score <7) 14 (13%) 97 (87%)
US + FNAC 103.9 (44.9–240.4) 82% (70–94%) <0.001*
 As malignancy 129 (91%) 12 (9%)
 As benignity 12 (9%) 116 (91%)

Abbreviations: CT/MRI, computed tomography/magnetic resonance imaging; FNAC, fine-needle aspiration cytology; LAP, lymphadenopathy; RT, radiotherapy; US, ultrasound. †It was composed of 1.35 × (long axis) + 2.03 × (short axis) + 2.27 × (margin) + 1.48 × (echogenic hilum) + 3.7. *Statistical significance, p < 0.05.

The predicted probability for malignancy for CT/MRI alone, the combined CT/MRI and post-RT US predictive model, and the combined CT/MRI and US + FNAC is presented in Table 3. For cases where the diagnostic exams revealed malignancy, the predicted probability for malignancy was highest in the CT/MRI and US + FNAC combination (0.988), followed by the CT/MRI and post-RT US predictive model combination (0.933), and CT/MRI alone (0.893).

Table 3

Predicted probability for malignancy among CT/MRI alone, the combined CT/MRI and post-RT US predictive model, and the combined CT/MRI and US + FNAC in the evaluation of neck LAP in post-irradiation head and neck cancer patients

CT/MRI result Post-RT US predictive model result US + FNAC result Predicted probability for malignancy
CT/MRI alone
Malignancy 0.893
Benignity 0.107
Combined CT/MRI and post-RT US predictive model
Malignancy Malignancy 0.933
Malignancy Benignity 0.530
Benignity Malignancy 0.509
Benignity Benignity 0.077
Combined CT/MRI and US + FNAC
Malignancy Malignancy 0.988
Benignity Malignancy 0.731
Malignancy Benignity 0.440
Benignity Benignity 0.026

Abbreviations: CT/MRI, computed tomography/magnetic resonance imaging; FNAC, fine-needle aspiration; RT, radiotherapy; US, ultrasound.

The ROC curves of CT/MRI alone, the combination of CT/MRI with the post-RT US predictive model, and the combination of CT/MRI with US + FNAC in the evaluation of nodal recurrence or persistence are illustrated in Figure 2. The AUC was highest in the combination of CT/MRI with US + FNAC (0.965), followed by the combination of CT/MRI with post-RT US (0.906), and then CT/MRI alone (0.836). We further compared the performance of three diagnostic methods by using paired-sample area difference under the ROC curves, and all AUC differences showed significant differences (AUC differences [95% CI], −0.07 [−0.10 to −0.05] for CT/MRI vs CT/MRI + US, −0.13 [−0.17 to −0.09] for CT/MRI vs CT/MRI + US + FNAC, and −0.06 [−0.09 to −0.03] for CT/MRI + US vs CT/MRI + US + FNAC, all p-values < 0.001). Table 4 summarizes the false-negative results if the LAP diagnosis was based on CT/MRI alone and on CT/MRI combined with US + FNAC during the follow-up period after completion of RT/CCRT. The false-negative rate was significantly higher in patients who were diagnosed using CT/MRI alone than that of patients diagnosed using combined CT/MRI and US + FNAC (11% [29/269] vs 1% [3/269], p < 0.001).

Figure 2 ROC curves for diagnosing nodal malignancy among CT/MRI alone, the combined CT/MRI and post-RT US predictive model, and the combined CT/MRI and US + FNAC. The AUC differences (95% CI) were −0.07 (−0.10 to −0.05) for CT/MRI vs CT/MRI + US, −0.13 (−0.17 to −0.09) for CT/MRI vs CT/MRI + US + FNAC, and −0.06 (−0.09 to −0.03) for CT/MRI + US vs CT/MRI + US + FNAC; all p-values < 0.001.
Figure 2

ROC curves for diagnosing nodal malignancy among CT/MRI alone, the combined CT/MRI and post-RT US predictive model, and the combined CT/MRI and US + FNAC. The AUC differences (95% CI) were −0.07 (−0.10 to −0.05) for CT/MRI vs CT/MRI + US, −0.13 (−0.17 to −0.09) for CT/MRI vs CT/MRI + US + FNAC, and −0.06 (−0.09 to −0.03) for CT/MRI + US vs CT/MRI + US + FNAC; all p-values < 0.001.

Table 4

False-negative results if the LAP diagnosis was based on CT/MRI alone and on the combined CT/MRI and US + FNAC

False-negative cases
Variables, No. (%) or mean (SD) CT/MRI alone (N = 29) Combined CT/MRI and US + FNAC (N = 3) Difference (95% CI) p-value
Incidence rate 29/269 (11%) 3/269 (1%) 10% (6–14%) <0.001*
Age, years 57 (10) 56 (7) 1.20 (−10.36 to 12.75) 0.834
Gender 0.1 (0.0–8.39)† 0.181†
 Female 1 (3%) 1 (33%)
 Male 28 (97%) 2 (67%)
Duration between RT/CCRT and imaging study, days 423 (433) 498 (398) −75 (−609 to 458) 0.775
US image
 Short axis, cm 1.08 (0.53) 0.46 (0.21) 0.62 (−0.01 to 1.25) 0.055
 Long axis, cm 1.64 (0.76) 0.98 (0.36) 0.66 (−0.26 to 1.58) 0.154
 S/L ratio 0.67 (0.13) 0.46 (0.04) 0.20 (0.05–0.36) 0.013*
Prior malignancy
 Oral cancer 13 (45%) 0 (0%)
 NPC 5 (17%) 3 (100%)
 Hypopharyngeal cancer 6 (21%) 0 (0%)
 Laryngeal cancer 2 (7%) 0 (0%)
 Unknown primary tumors of head and neck 2 (7%) 0 (0%)
 Nasal malignant melanoma 1 (3%) 0 (0%)

Abbreviations: CT/MRI, computed tomography/magnetic resonance imaging; FNAC, fine needle aspiration cytology; RT/CCRT, radiotherapy/concurrent chemoradiotherapy; S/L, short-to-long axis; US, ultrasound. †Fisher exact test with corresponding OR and 95 CI. *Statistical significance, p < 0.05.

4 Discussion

Although the improved survival rate for the early detection of malignancy may result from lead time bias, regular surveillance for nodal recurrence or persistence is still crucial during the follow-up period after primary treatment for head and neck cancer. Several studies have demonstrated that early detection of malignancy benefits the survival rate [5,13,14]. However, for patients with head and neck cancer who have undergone neck irradiation, clinicians may face difficulty in the evaluation of nodal disease because of tissue fibrosis [1,2]. In this study, we determined that for detecting nodal recurrence or persistence, the combined CT/MRI and post-RT US predictive model had a higher AUC than that of CT/MRI alone (0.906 vs 0.836; Figure 2). Moreover, we observed that the combined CT/MRI and US + FNAC resulted in an improved AUC (0.965). Consequently, the addition of a US examination to CT/MRI assisted in the early diagnosis of nodal malignancy in patients with irradiation-treated head and neck cancer.

The combination of CT/MRI with US + FNAC remained the most accurate in terms of the diagnosis of nodal recurrence or persistence. At our institution, FNAC was performed simultaneously when suspicious echogenic findings for malignancy were noted during US studies. These findings included irregular margins, heterogeneous internal echogenicity, the presence of calcification, cystic architecture, absence of echogenic hilum, and a peripheral or mixed vascular pattern [11]. Our results revealed that the false-negative rate was significantly higher in patients who were diagnosed using CT/MRI alone than that of patients diagnosed using CT/MRI combined with US + FNAC (11% [29/269] vs 1% [3/269], p < 0.001) during the evaluation of neck LAP. Thus, we suggest not only performing a US examination during follow-up but also obtaining FNAC simultaneously when presented with suspicious ultrasonographic features in the assessment of neck LAP in patients with irradiation-treated head and neck cancer.

CT/MRI had a lower NPV than the post-RT US predictive model in our study (78.2% [115 of 147] vs 87.4% [97 of 111]; Table 2). This result may be attributable to post-RT LNs’ tendency to have higher heterogeneity and lower radiodensity in contrast-enhanced CT imaging [15]. Furthermore, our earlier study indicated that the size of recurrent LNs tends to be smaller in patients with a history of RT than that in patients who have never undergone irradiation treatment [16]. Smaller LNs may not be easily detected using a 5 mm cut MRI or 3 mm cut CT. Therefore, a small and less enhanced malignant LN may be classified as benign in a CT/MRI report, generating a false-negative result (Figure 3). The US examination represents a high-resolution continuous imaging study for evaluation of the cervical node [17] and, with the assistance of the predictive model, could produce a higher NPV than CT/MRI.

Figure 3 One representative patient. A 59-year-old male was diagnosed with oropharyngeal cancer, stage IVA and received definite CCRT. The follow-up MRI showed no abnormal cervical LN. US showed a round, ill-defined, heterogeneous, and hypoechogenic mass (0.74 cm × 0.92 cm) at right level II (arrow). The cytological and further pathological reports both showed metastatic squamous cell carcinoma. Abbreviations: T, tumor; ECA, external carotid artery; ICA, internal carotid artery; IJV, internal jugular vein.
Figure 3

One representative patient. A 59-year-old male was diagnosed with oropharyngeal cancer, stage IVA and received definite CCRT. The follow-up MRI showed no abnormal cervical LN. US showed a round, ill-defined, heterogeneous, and hypoechogenic mass (0.74 cm × 0.92 cm) at right level II (arrow). The cytological and further pathological reports both showed metastatic squamous cell carcinoma. Abbreviations: T, tumor; ECA, external carotid artery; ICA, internal carotid artery; IJV, internal jugular vein.

Although we combined CT/MRI and US + FNAC to increase the diagnostic performance, three false negatives were observed (Table 4). All of these cases involved NPC patients and small LNs (mean [SD] long axis, 0.98 [0.36] cm) of a normal shape (mean [SD] S/L ratio, 0.46 [0.04]). Chan et al. reported a lower NPV (36% vs 74%, p = 0.03) and accuracy (54% vs 88%, p = 0.05) for FNAC in patients with NPC who had received RT treatment compared with those of patients who were newly diagnosed [18]. A possible reason for this is the histological change of LNs after RT. Cancer cells within LNs might be isolated and unevenly distributed after RT treatment, leading to an increase in false-negative results [8,18]. To address this shortcoming and increase the diagnostic rate for NPC patients, the addition of plasma Epstein–Barr virus (EBV) DNA testing was proposed in one study [18], and the implementation of a combination PET examination during the follow-up period was suggested in another study [8]. Further study may evaluate the diagnostic ability for LAPs when combining the CT/MRI and US + FNAC with plasma EBV DNA or PET.

4.1 Limitations

This study has several limitations. First, unnoticed or unavoidable selection bias might have played a role owing to the retrospective study design. Second, this study is based on a convenience sample and we did not calculate the sample size initially. Third, not all our final diagnoses of nodal disease were obtained through pathological diagnosis. Some patients with obvious nodal disease or those that were unsuitable for neck dissection were diagnosed following FNAC and multidisciplinary discussions. Moreover, this study did not identify the most suitable interval at which US imaging studies should be performed. The frequency at which the US study must be conducted and the most cost-effective method requires further evaluation.

5 Conclusion

Surveillance of nodal recurrence or persistence is critical during post-RT follow-up in patients with head and neck cancer. Based on this study, CT/MRI combined with either the post-RT US predictive model or US + FNAC had stronger diagnostic performance than CT/MRI alone in assessing nodal malignancy in patients with LAPs treated with irradiation. Postirradiation recurrence or persistent LAPs tend to be more heterogeneous and smaller, which may lead to a lower accuracy rate in evaluations when employing CT/MRI alone. Besides, in this study, the US with CT/MRI was also performed when suspicion of recurrence. Therefore, the results cannot support regular screening over screening on indication. Although this was a retrospective study and the most suitable interval of US examination was not identified, we still recommend performing US studies alongside CT/MRI when suspicion of recurrence increases the early and precise diagnosis of nodal malignancy in patients with irradiation-treated head and neck cancer. Moreover, FNAC can be implemented simultaneously when suspicious ultrasonographic features are detected.

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Acknowledgments

The authors thank Chien-Hao Chen, Ph.D. (ESTAT Statistical Consulting Co., Ltd, Taipei, Taiwan) for statistical analysis advise and revision.

  1. Funding information: This work was supported by the Far Eastern Memorial Hospital Research Program (Grant numbers [FEMH-2020-C-048] and [FEMH-2021-C-039]).

  2. Author contributions: All authors contributed to the study design. PCC, CMC, LJL, and CHH conducted experiments and analyzed data. PWS, PWC, and WCL conceived the study and interpreted the data. The first draft of the manuscript was written by PCC, CMC, and WCL, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

  3. Conflict of interest: The authors declare no potential conflicts of interest.

  4. Data availability statement: The data set is available in the supplement (Table S1).

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Received: 2022-03-04
Revised: 2023-02-11
Accepted: 2023-03-01
Published Online: 2023-04-12

© 2023 the author(s), published by De Gruyter

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

Articles in the same Issue

  1. Research Articles
  2. Exosomes derived from mesenchymal stem cells overexpressing miR-210 inhibits neuronal inflammation and contribute to neurite outgrowth through modulating microglia polarization
  3. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia
  4. circ-IARS depletion inhibits the progression of non-small-cell lung cancer by circ-IARS/miR-1252-5p/HDGF ceRNA pathway
  5. circRNA ITGA7 restrains growth and enhances radiosensitivity by up-regulating SMAD4 in colorectal carcinoma
  6. WDR79 promotes aerobic glycolysis of pancreatic ductal adenocarcinoma (PDAC) by the suppression of SIRT4
  7. Up-regulation of collagen type V alpha 2 (COL5A2) promotes malignant phenotypes in gastric cancer cell via inducing epithelial–mesenchymal transition (EMT)
  8. Inhibition of TERC inhibits neural apoptosis and inflammation in spinal cord injury through Akt activation and p-38 inhibition via the miR-34a-5p/XBP-1 axis
  9. 3D-printed polyether-ether-ketone/n-TiO2 composite enhances the cytocompatibility and osteogenic differentiation of MC3T3-E1 cells by downregulating miR-154-5p
  10. Propofol-mediated circ_0000735 downregulation restrains tumor growth by decreasing integrin-β1 expression in non-small cell lung cancer
  11. PVT1/miR-16/CCND1 axis regulates gastric cancer progression
  12. Silencing of circ_002136 sensitizes gastric cancer to paclitaxel by targeting the miR-16-5p/HMGA1 axis
  13. Short-term outcomes after simultaneous gastrectomy plus cholecystectomy in gastric cancer: A pooling up analysis
  14. SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways
  15. Molecular mechanism by which the Notch signaling pathway regulates autophagy in a rat model of pulmonary fibrosis in pigeon breeder’s lung
  16. lncRNA TPT1-AS1 promotes cell migration and invasion in esophageal squamous-cell carcinomas by regulating the miR-26a/HMGA1 axis
  17. SIRT1/APE1 promotes the viability of gastric cancer cells by inhibiting p53 to suppress ferroptosis
  18. Glycoprotein non-metastatic melanoma B interacts with epidermal growth factor receptor to regulate neural stem cell survival and differentiation
  19. Treatments for brain metastases from EGFR/ALK-negative/unselected NSCLC: A network meta-analysis
  20. Association of osteoporosis and skeletal muscle loss with serum type I collagen carboxyl-terminal peptide β glypeptide: A cross-sectional study in elder Chinese population
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  41. Upregulation of lncRNA LANCL1-AS1 inhibits the progression of non-small-cell lung cancer via the miR-3680-3p/GMFG axis
  42. CircRANBP17 modulated KDM1A to regulate neuroblastoma progression by sponging miR-27b-3p
  43. Exosomal miR-93-5p regulated the progression of osteoarthritis by targeting ADAMTS9
  44. Downregulation of RBM17 enhances cisplatin sensitivity and inhibits cell invasion in human hypopharyngeal cancer cells
  45. HDAC5-mediated PRAME regulates the proliferation, migration, invasion, and EMT of laryngeal squamous cell carcinoma via the PI3K/AKT/mTOR signaling pathway
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  49. Impact of omicron wave and associated control measures in Shanghai on health management and psychosocial well-being of patients with chronic conditions
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  52. The dose limits of teeth protection for patients with nasopharyngeal carcinoma undergoing radiotherapy based on the early oral health-related quality of life
  53. miR-30b-5p targeting GRIN2A inhibits hippocampal damage in epilepsy
  54. Long non-coding RNA AL137789.1 promoted malignant biological behaviors and immune escape of pancreatic carcinoma cells
  55. IRF6 and FGF1 polymorphisms in non-syndromic cleft lip with or without cleft palate in the Polish population
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  57. Efficacy of bronchoscopic intratumoral injection of endostar and cisplatin in lung squamous cell carcinoma patients underwent conventional chemoradiotherapy
  58. Silencing of long noncoding RNA MIAT inhibits the viability and proliferation of breast cancer cells by promoting miR-378a-5p expression
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  67. Knockdown of circ_0005615 enhances the radiosensitivity of colorectal cancer by regulating the miR-665/NOTCH1 axis
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  96. circNFATC3 facilitated the progression of oral squamous cell carcinoma via the miR-520h/LDHA axis
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  98. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children
  99. Dihydroartemisinin ameliorates cerebral I/R injury in rats via regulating VWF and autophagy-mediated SIRT1/FOXO1 pathway
  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
  101. Low Ang-(1–7) and high des-Arg9 bradykinin serum levels are correlated with cardiovascular risk factors in patients with COVID-19
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  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
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  118. Analysis of somatic mutations and key driving factors of cervical cancer progression
  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
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  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
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  132. Calycosin protects against chronic prostatitis in rats via inhibition of the p38MAPK/NF-κB pathway
  133. Pan-cancer analysis of the PDE4DIP gene with potential prognostic and immunotherapeutic values in multiple cancers including acute myeloid leukemia
  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
  136. Clinical characteristics of current COVID-19 rehabilitation outpatients in China
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  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
  139. The application of iliac fascia space block combined with esketamine intravenous general anesthesia in PFNA surgery of the elderly: A prospective, single-center, controlled trial
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  145. A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry
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  147. Antibiotics therapy combined with probiotics administered intravaginally for the treatment of bacterial vaginosis: A systematic review and meta-analysis
  148. Construction of a ceRNA network to reveal a vascular invasion associated prognostic model in hepatocellular carcinoma
  149. A pan-cancer analysis of STAT3 expression and genetic alterations in human tumors
  150. A prognostic signature based on seven T-cell-related cell clustering genes in bladder urothelial carcinoma
  151. Pepsin concentration in oral lavage fluid of rabbit reflux model constructed by dilating the lower esophageal sphincter
  152. The antihypertensive felodipine shows synergistic activity with immune checkpoint blockade and inhibits tumor growth via NFAT1 in LUSC
  153. Tanshinone IIA attenuates valvular interstitial cells’ calcification induced by oxidized low density lipoprotein via reducing endoplasmic reticulum stress
  154. AS-IV enhances the antitumor effects of propofol in NSCLC cells by inhibiting autophagy
  155. Establishment of two oxaliplatin-resistant gallbladder cancer cell lines and comprehensive analysis of dysregulated genes
  156. Trial protocol: Feasibility of neuromodulation with connectivity-guided intermittent theta-burst stimulation for improving cognition in multiple sclerosis
  157. LncRNA LINC00592 mediates the promoter methylation of WIF1 to promote the development of bladder cancer
  158. Factors associated with gastrointestinal dysmotility in critically ill patients
  159. Mechanisms by which spinal cord stimulation intervenes in atrial fibrillation: The involvement of the endothelin-1 and nerve growth factor/p75NTR pathways
  160. Analysis of two-gene signatures and related drugs in small-cell lung cancer by bioinformatics
  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
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  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
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  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
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  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
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  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
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  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
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  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
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  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
https://doi.org/10.1515/med-2023-0682
Keywords for this article
lymphadenopathy; ultrasound; fine‐needle aspiration cytology; computed tomography; magnetic resonance imaging
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. Exosomes derived from mesenchymal stem cells overexpressing miR-210 inhibits neuronal inflammation and contribute to neurite outgrowth through modulating microglia polarization
  3. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia
  4. circ-IARS depletion inhibits the progression of non-small-cell lung cancer by circ-IARS/miR-1252-5p/HDGF ceRNA pathway
  5. circRNA ITGA7 restrains growth and enhances radiosensitivity by up-regulating SMAD4 in colorectal carcinoma
  6. WDR79 promotes aerobic glycolysis of pancreatic ductal adenocarcinoma (PDAC) by the suppression of SIRT4
  7. Up-regulation of collagen type V alpha 2 (COL5A2) promotes malignant phenotypes in gastric cancer cell via inducing epithelial–mesenchymal transition (EMT)
  8. Inhibition of TERC inhibits neural apoptosis and inflammation in spinal cord injury through Akt activation and p-38 inhibition via the miR-34a-5p/XBP-1 axis
  9. 3D-printed polyether-ether-ketone/n-TiO2 composite enhances the cytocompatibility and osteogenic differentiation of MC3T3-E1 cells by downregulating miR-154-5p
  10. Propofol-mediated circ_0000735 downregulation restrains tumor growth by decreasing integrin-β1 expression in non-small cell lung cancer
  11. PVT1/miR-16/CCND1 axis regulates gastric cancer progression
  12. Silencing of circ_002136 sensitizes gastric cancer to paclitaxel by targeting the miR-16-5p/HMGA1 axis
  13. Short-term outcomes after simultaneous gastrectomy plus cholecystectomy in gastric cancer: A pooling up analysis
  14. SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways
  15. Molecular mechanism by which the Notch signaling pathway regulates autophagy in a rat model of pulmonary fibrosis in pigeon breeder’s lung
  16. lncRNA TPT1-AS1 promotes cell migration and invasion in esophageal squamous-cell carcinomas by regulating the miR-26a/HMGA1 axis
  17. SIRT1/APE1 promotes the viability of gastric cancer cells by inhibiting p53 to suppress ferroptosis
  18. Glycoprotein non-metastatic melanoma B interacts with epidermal growth factor receptor to regulate neural stem cell survival and differentiation
  19. Treatments for brain metastases from EGFR/ALK-negative/unselected NSCLC: A network meta-analysis
  20. Association of osteoporosis and skeletal muscle loss with serum type I collagen carboxyl-terminal peptide β glypeptide: A cross-sectional study in elder Chinese population
  21. circ_0000376 knockdown suppresses non-small cell lung cancer cell tumor properties by the miR-545-3p/PDPK1 pathway
  22. Delivery in a vertical birth chair supported by freedom of movement during labor: A randomized control trial
  23. UBE2J1 knockdown promotes cell apoptosis in endometrial cancer via regulating PI3K/AKT and MDM2/p53 signaling
  24. Metabolic resuscitation therapy in critically ill patients with sepsis and septic shock: A pilot prospective randomized controlled trial
  25. Lycopene ameliorates locomotor activity and urinary frequency induced by pelvic venous congestion in rats
  26. UHRF1-induced connexin26 methylation is involved in hearing damage triggered by intermittent hypoxia in neonatal rats
  27. LINC00511 promotes melanoma progression by targeting miR-610/NUCB2
  28. Ultra-high-performance liquid chromatography-tandem mass spectrometry analysis of serum metabolomic characteristics in people with different vitamin D levels
  29. Role of Jumonji domain-containing protein D3 and its inhibitor GSK-J4 in Hashimoto’s thyroiditis
  30. circ_0014736 induces GPR4 to regulate the biological behaviors of human placental trophoblast cells through miR-942-5p in preeclampsia
  31. Monitoring of sirolimus in the whole blood samples from pediatric patients with lymphatic anomalies
  32. Effects of osteogenic growth peptide C-terminal pentapeptide and its analogue on bone remodeling in an osteoporosis rat model
  33. A novel autophagy-related long non-coding RNAs signature predicting progression-free interval and I-131 therapy benefits in papillary thyroid carcinoma
  34. WGCNA-based identification of potential targets and pathways in response to treatment in locally advanced breast cancer patients
  35. Radiomics model using preoperative computed tomography angiography images to differentiate new from old emboli of acute lower limb arterial embolism
  36. Dysregulated lncRNAs are involved in the progress of myocardial infarction by constructing regulatory networks
  37. Single-arm trial to evaluate the efficacy and safety of baclofen in treatment of intractable hiccup caused by malignant tumor chemotherapy
  38. Genetic polymorphisms of MRPS30-DT and NINJ2 may influence lung cancer risk
  39. Efficacy of immune checkpoint inhibitors in patients with KRAS-mutant advanced non-small cell lung cancer: A retrospective analysis
  40. Pyroptosis-based risk score predicts prognosis and drug sensitivity in lung adenocarcinoma
  41. Upregulation of lncRNA LANCL1-AS1 inhibits the progression of non-small-cell lung cancer via the miR-3680-3p/GMFG axis
  42. CircRANBP17 modulated KDM1A to regulate neuroblastoma progression by sponging miR-27b-3p
  43. Exosomal miR-93-5p regulated the progression of osteoarthritis by targeting ADAMTS9
  44. Downregulation of RBM17 enhances cisplatin sensitivity and inhibits cell invasion in human hypopharyngeal cancer cells
  45. HDAC5-mediated PRAME regulates the proliferation, migration, invasion, and EMT of laryngeal squamous cell carcinoma via the PI3K/AKT/mTOR signaling pathway
  46. The association between sleep duration, quality, and nonalcoholic fatty liver disease: A cross-sectional study
  47. Myostatin silencing inhibits podocyte apoptosis in membranous nephropathy through Smad3/PKA/NOX4 signaling pathway
  48. A novel long noncoding RNA AC125257.1 facilitates colorectal cancer progression by targeting miR-133a-3p/CASC5 axis
  49. Impact of omicron wave and associated control measures in Shanghai on health management and psychosocial well-being of patients with chronic conditions
  50. Clinicopathological characteristics and prognosis of young patients aged ≤45 years old with non-small cell lung cancer
  51. TMT-based comprehensive proteomic profiling identifies serum prognostic signatures of acute myeloid leukemia
  52. The dose limits of teeth protection for patients with nasopharyngeal carcinoma undergoing radiotherapy based on the early oral health-related quality of life
  53. miR-30b-5p targeting GRIN2A inhibits hippocampal damage in epilepsy
  54. Long non-coding RNA AL137789.1 promoted malignant biological behaviors and immune escape of pancreatic carcinoma cells
  55. IRF6 and FGF1 polymorphisms in non-syndromic cleft lip with or without cleft palate in the Polish population
  56. Comprehensive analysis of the role of SFXN family in breast cancer
  57. Efficacy of bronchoscopic intratumoral injection of endostar and cisplatin in lung squamous cell carcinoma patients underwent conventional chemoradiotherapy
  58. Silencing of long noncoding RNA MIAT inhibits the viability and proliferation of breast cancer cells by promoting miR-378a-5p expression
  59. AG1024, an IGF-1 receptor inhibitor, ameliorates renal injury in rats with diabetic nephropathy via the SOCS/JAK2/STAT pathway
  60. Downregulation of KIAA1199 alleviated the activation, proliferation, and migration of hepatic stellate cells by the inhibition of epithelial–mesenchymal transition
  61. Exendin-4 regulates the MAPK and WNT signaling pathways to alleviate the osteogenic inhibition of periodontal ligament stem cells in a high glucose environment
  62. Inhibition of glycolysis represses the growth and alleviates the endoplasmic reticulum stress of breast cancer cells by regulating TMTC3
  63. The function of lncRNA EMX2OS/miR-653-5p and its regulatory mechanism in lung adenocarcinoma
  64. Tectorigenin alleviates the apoptosis and inflammation in spinal cord injury cell model through inhibiting insulin-like growth factor-binding protein 6
  65. Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer
  66. F-box and WD repeat domain containing 7 inhibits the activation of hepatic stellate cells by degrading delta-like ligand 1 to block Notch signaling pathway
  67. Knockdown of circ_0005615 enhances the radiosensitivity of colorectal cancer by regulating the miR-665/NOTCH1 axis
  68. Long noncoding RNA Mhrt alleviates angiotensin II-induced cardiac hypertrophy phenotypes by mediating the miR-765/Wnt family member 7B pathway
  69. Effect of miR-499-5p/SOX6 axis on atrial fibrosis in rats with atrial fibrillation
  70. Cholesterol induces inflammation and reduces glucose utilization
  71. circ_0004904 regulates the trophoblast cell in preeclampsia via miR-19b-3p/ARRDC3 axis
  72. NECAB3 promotes the migration and invasion of liver cancer cells through HIF-1α/RIT1 signaling pathway
  73. The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk
  74. miR-2053 inhibits the growth of ovarian cancer cells by downregulating SOX4
  75. Nucleophosmin 1 associating with engulfment and cell motility protein 1 regulates hepatocellular carcinoma cell chemotaxis and metastasis
  76. α-Hederin regulates macrophage polarization to relieve sepsis-induced lung and liver injuries in mice
  77. Changes of microbiota level in urinary tract infections: A meta-analysis
  78. Identification of key enzalutamide-resistance-related genes in castration-resistant prostate cancer and verification of RAD51 functions
  79. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies – (lessons learned from) a prospective study
  80. Outcomes of low-risk birth care during the Covid-19 pandemic: A cohort study from a tertiary care center in Lithuania
  81. Vitamin D protects intestines from liver cirrhosis-induced inflammation and oxidative stress by inhibiting the TLR4/MyD88/NF-κB signaling pathway
  82. Integrated transcriptome analysis identifies APPL1/RPS6KB2/GALK1 as immune-related metastasis factors in breast cancer
  83. Genomic analysis of immunogenic cell death-related subtypes for predicting prognosis and immunotherapy outcomes in glioblastoma multiforme
  84. Circular RNA Circ_0038467 promotes the maturation of miRNA-203 to increase lipopolysaccharide-induced apoptosis of chondrocytes
  85. An economic evaluation of fine-needle cytology as the primary diagnostic tool in the diagnosis of lymphadenopathy
  86. Midazolam impedes lung carcinoma cell proliferation and migration via EGFR/MEK/ERK signaling pathway
  87. Network pharmacology combined with molecular docking and experimental validation to reveal the pharmacological mechanism of naringin against renal fibrosis
  88. PTPN12 down-regulated by miR-146b-3p gene affects the malignant progression of laryngeal squamous cell carcinoma
  89. miR-141-3p accelerates ovarian cancer progression and promotes M2-like macrophage polarization by targeting the Keap1-Nrf2 pathway
  90. lncRNA OIP5-AS1 attenuates the osteoarthritis progression in IL-1β-stimulated chondrocytes
  91. Overexpression of LINC00607 inhibits cell growth and aggressiveness by regulating the miR-1289/EFNA5 axis in non-small-cell lung cancer
  92. Subjective well-being in informal caregivers during the COVID-19 pandemic
  93. Nrf2 protects against myocardial ischemia-reperfusion injury in diabetic rats by inhibiting Drp1-mediated mitochondrial fission
  94. Unfolded protein response inhibits KAT2B/MLKL-mediated necroptosis of hepatocytes by promoting BMI1 level to ubiquitinate KAT2B
  95. Bladder cancer screening: The new selection and prediction model
  96. circNFATC3 facilitated the progression of oral squamous cell carcinoma via the miR-520h/LDHA axis
  97. Prone position effect in intensive care patients with SARS-COV-2 pneumonia
  98. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children
  99. Dihydroartemisinin ameliorates cerebral I/R injury in rats via regulating VWF and autophagy-mediated SIRT1/FOXO1 pathway
  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
  101. Low Ang-(1–7) and high des-Arg9 bradykinin serum levels are correlated with cardiovascular risk factors in patients with COVID-19
  102. Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study
  103. Potential protective effects of Huanglian Jiedu Decoction against COVID-19-associated acute kidney injury: A network-based pharmacological and molecular docking study
  104. Clinical significance of serum MBD3 detection in girls with central precocious puberty
  105. Clinical features of varicella-zoster virus caused neurological diseases detected by metagenomic next-generation sequencing
  106. Collagen treatment of complex anorectal fistula: 3 years follow-up
  107. LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through down-regulating SP-A by sponging to miR-424
  108. Efficacy analysis of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy as a first-line Helicobacter pylori eradication regimen – An open-label, randomized trial
  109. SMOC2 plays a role in heart failure via regulating TGF-β1/Smad3 pathway-mediated autophagy
  110. A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults
  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
  112. hsa_circ_0000285 sponging miR-582-3p promotes neuroblastoma progression by regulating the Wnt/β-catenin signaling pathway
  113. Long non-coding RNA GNAS-AS1 knockdown inhibits proliferation and epithelial–mesenchymal transition of lung adenocarcinoma cells via the microRNA-433-3p/Rab3A axis
  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
  115. Twenty-four-color full spectrum flow cytometry panel for minimal residual disease detection in acute myeloid leukemia
  116. Hsa-miR-223-3p participates in the process of anthracycline-induced cardiomyocyte damage by regulating NFIA gene
  117. Anti-inflammatory effect of ApoE23 on Salmonella typhimurium-induced sepsis in mice
  118. Analysis of somatic mutations and key driving factors of cervical cancer progression
  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
  121. Effects of pharmacological delay with roxadustat on multi-territory perforator flap survival in rats
  122. Analysis of heroin effects on calcium channels in rat cardiomyocytes based on transcriptomics and metabolomics
  123. Risk factors of recurrent bacterial vaginosis among women of reproductive age: A cross-sectional study
  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
  126. Correlation between microvessel maturity and ISUP grades assessed using contrast-enhanced transrectal ultrasonography in prostate cancer
  127. The protective effect of caffeic acid phenethyl ester in the nephrotoxicity induced by α-cypermethrin
  128. Norepinephrine alleviates cyclosporin A-induced nephrotoxicity by enhancing the expression of SFRP1
  129. Effect of RUNX1/FOXP3 axis on apoptosis of T and B lymphocytes and immunosuppression in sepsis
  130. The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity
  131. Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU
  132. Calycosin protects against chronic prostatitis in rats via inhibition of the p38MAPK/NF-κB pathway
  133. Pan-cancer analysis of the PDE4DIP gene with potential prognostic and immunotherapeutic values in multiple cancers including acute myeloid leukemia
  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
  136. Clinical characteristics of current COVID-19 rehabilitation outpatients in China
  137. Luteolin alleviates ulcerative colitis in rats via regulating immune response, oxidative stress, and metabolic profiling
  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
  139. The application of iliac fascia space block combined with esketamine intravenous general anesthesia in PFNA surgery of the elderly: A prospective, single-center, controlled trial
  140. Elevated blood acetoacetate levels reduce major adverse cardiac and cerebrovascular events risk in acute myocardial infarction
  141. The effects of progesterone on the healing of obstetric anal sphincter damage in female rats
  142. Identification of cuproptosis-related genes for predicting the development of prostate cancer
  143. Lumican silencing ameliorates β-glycerophosphate-mediated vascular smooth muscle cell calcification by attenuating the inhibition of APOB on KIF2C activity
  144. Targeting PTBP1 blocks glutamine metabolism to improve the cisplatin sensitivity of hepatocarcinoma cells through modulating the mRNA stability of glutaminase
  145. A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry
  146. Clinical analysis of AN69ST membrane continuous venous hemofiltration in the treatment of severe sepsis
  147. Antibiotics therapy combined with probiotics administered intravaginally for the treatment of bacterial vaginosis: A systematic review and meta-analysis
  148. Construction of a ceRNA network to reveal a vascular invasion associated prognostic model in hepatocellular carcinoma
  149. A pan-cancer analysis of STAT3 expression and genetic alterations in human tumors
  150. A prognostic signature based on seven T-cell-related cell clustering genes in bladder urothelial carcinoma
  151. Pepsin concentration in oral lavage fluid of rabbit reflux model constructed by dilating the lower esophageal sphincter
  152. The antihypertensive felodipine shows synergistic activity with immune checkpoint blockade and inhibits tumor growth via NFAT1 in LUSC
  153. Tanshinone IIA attenuates valvular interstitial cells’ calcification induced by oxidized low density lipoprotein via reducing endoplasmic reticulum stress
  154. AS-IV enhances the antitumor effects of propofol in NSCLC cells by inhibiting autophagy
  155. Establishment of two oxaliplatin-resistant gallbladder cancer cell lines and comprehensive analysis of dysregulated genes
  156. Trial protocol: Feasibility of neuromodulation with connectivity-guided intermittent theta-burst stimulation for improving cognition in multiple sclerosis
  157. LncRNA LINC00592 mediates the promoter methylation of WIF1 to promote the development of bladder cancer
  158. Factors associated with gastrointestinal dysmotility in critically ill patients
  159. Mechanisms by which spinal cord stimulation intervenes in atrial fibrillation: The involvement of the endothelin-1 and nerve growth factor/p75NTR pathways
  160. Analysis of two-gene signatures and related drugs in small-cell lung cancer by bioinformatics
  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
  169. Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia
  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
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