Startseite The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk
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The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk

  • Li Qin , Qiang Luo , Yinlan Hu , Shuangshuang Yan , Xiaoqian Yang , Yiwen Zhang , Feng Xiong EMAIL logo und Han Wang EMAIL logo
Veröffentlicht/Copyright: 17. Mai 2023
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Aus der Zeitschrift Open Medicine Band 18 Heft 1

Abstract

Framingham risk score (FRS), systematic coronary risk evaluation (SCORE), the 10-year atherosclerotic cardiovascular disease risk algorithm (ASCVD), and their modified risk scores are the most common cardiovascular risk scores. The aim of this case–control study was to evaluate the performance of cardiovascular risk scores in detecting carotid subclinical atherosclerosis (SCA) in patients with idiopathic inflammatory myopathies (IIMs). A total of 123 IIMs patients (71.5% female, mean age 50 ± 14 years) and 123 age- and gender-matched healthy controls were included in this study. Carotid SCA was more prevalent in IIMs patients compared with controls (77.2 vs 50.4%, P < 0.001). Moreover, patients with carotid SCA+ had older age, and all risk scores were significantly higher in IIMs patients with SCA+ compared to subjects with SCA− (all P < 0.001). According to FRS, SCORE, and ASCVD risk scores, 77.9, 96.8, and 66.7% patients with SCA+ were classified as low risk category, respectively. The modified scores also demonstrated a modest improvement in sensitivity. Notably, by adopting the optimal cutoff values, these risk scores had good discrimination on patients with SCA+, with area under curves of 0.802–0.893. In conclusion, all cardiovascular risk scores had a poor performance in identifying IIMs patients at high cardiovascular risk.

Keywords: autoimmune diseases; cardiovascular risk score; subclinical atherosclerosis

1 Introduction

Idiopathic inflammatory myopathies (IIMs) are a group of relatively rare systemic autoimmune diseases, and the annual prevalence of IIMs ranges from 14.0 to 17.4 per 100,000 person-years [1,2]. The heart is an important target organ in IIMs patients, but cardiac involvement typically remains silent that seldom attracts the attention of clinicians [3]. However, numerous studies demonstrated that atherosclerotic cardiovascular diseases (ASCVD) such as myocardial infarction and stroke were the leading cause of death in IIMs patients, and the risk of cardiovascular diseases (CVD) in these patients was increased in comparison with the general population [3–5]. Therefore, early and accurate identification of CVD risk is essential to reduce the incidence of cardiovascular events and improve the prognosis of IIMs patients. At present, the assessment of cardiovascular risk can be based on risk assessment algorithms or imaging, specifically on vascular ultrasound. In the general population, Framingham risk score (FRS), systematic coronary risk evaluation (SCORE), and the 10-year ASCVD risk algorithm are the most commonly used risk scores [6–8]. Nevertheless, the majority of studies revealed that the above risk scores cannot accurately reflect the actual cardiovascular risk of patients with autoimmune diseases, such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and psoriatic arthritis (PsA) [9–11]. Furthermore, the performance of EULAR-modified risk score (a 1.5 multiplication factor for risk score) in RA patients was still unsatisfactory [12,13].

Recent studies have confirmed that subclinical atherosclerosis (SCA) is a reliable surrogate marker of CVD, and several non-invasive imaging techniques can be employed to determine SCA [14,15]. Among them, carotid ultrasonography is a simple, rapid, sensitive, reproducible, and relatively cheap tool for identifying and quantifying SCA, which can detect increased carotid intimal-media thickness (IMT) and the presence of plaque [16,17]. To date, the reports on SCA in patients with IIMs are relatively rare. Limited evidence indicated that patients with IIMs had increased carotid IMT compared to healthy controls, implying that IIMs patients may have a higher risk of SCA than the general population [18,19]. Moreover, only one study on patients with antisynthetase syndrome (a special subtype of IIMs) points out that SCORE/mSCORE has a poor performance in assessing patients at high cardiovascular risk, but no detailed study has been conducted to test the performance of other risk scores in IIMs patients [19]. Thus, the primary aim of the current study is to identify the feasibility of FRS, SCORE, and ASCVD in IIMs patients at high cardiovascular risk. Besides, it also explores potential factors associated with carotid SCA in patients with IIMs.

2 Methods

2.1 Study population

This case–control study was conducted in the Third People’s Hospital of Chengdu. Cases were identified from the individuals who were diagnosed with IIMs referred to the Cardiology and Rheumatology Department between January 2016 and January 2021. Controls were randomly selected from healthy individuals who received physical examination at the same period and were matched to cases based on gender and age (within 3 years). All IIMs patients were diagnosed in accordance with the criteria of Bohan and Peter by skilled clinicians [20]. Patients were excluded if they had previous history of malignant tumor, cardiovascular events (ischemic heart disease, cerebrovascular disease, peripheral arterial disease, or heart failure), respiratory failure, renal failure, severe liver impairment, severe infectious diseases, as well as other connective tissue diseases, such as SLE, RA, and mixed connective tissue disease. In addition, elderly patients (age >80 years) and those <20 years old, and subjects with incomplete data were also not included. The same exclusion criteria were also applied to the control group. Finally, a total of 123 consecutive IIMs patients and 123 healthy subjects were included in this study, and they all underwent carotid ultrasonography. The current study was ethical approved by the ethics committee of the Third People’s Hospital of Chengdu (2019-S-20), and written informed consent was taken from each participant according to the Declaration of Helsinki.

2.2 Data collection and definition of variables

A self-designed questionnaire drawn up by the research team was used to collect the information of participants. Demographics, clinical manifestations, laboratory data, and treatments were systematically extracted from electronic medical records by two trained medical students and reviewed by a senior clinician. Venous blood samples were collected from all individuals in the morning (after at least 12 h of fasting) for routine laboratory analysis by following standard procedures. The following laboratory parameters were measured: fasting blood glucose (FBG), serum urea, serum creatinine (Scr), triglyceride (TG), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), C-relative protein (CRP), erythrocyte sedimentation rate (ESR), antinuclear antibodies (ANA), anti SSA antibody, anti SSB antibody, anti-Jo1 antibody, and creatine kinase (CK). The values of ESR ≥40 mm/h and CRP ≥10 mg/L were considered positive. Drug administration referred to the use of antihypertensive drugs, hypoglycemic drugs, glucocorticoids (GC), and disease modifying anti-rheumatic drugs (DMARDs) within 1 month before admission. In addition, lung involvement of IIMs patients was evaluated by high resolution CT, which mainly included pulmonary infection, pulmonary interstitial fibrosis, and pleural effusion.

The diagnostic criteria of hypertension were systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg, or use of antihypertensive drugs [21]. Diabetes mellitus was defined as FBG ≥7.0 mmol/L and/or a plasma glucose level ≥11.1 mmol/L at 2 h after a 75 g glucose load, and/or use of oral hypoglycemic agents or insulin [22]. Smokers were defined as individuals who were smoking at least one cigarette per day for more than 1 year or had recently stopped smoking within the last year, and the rest of subjects were considered as non-smokers [23].

2.3 Cardiovascular risk assessment

Cardiovascular risk assessment was performed using clinical risk scores and ultrasound imaging of carotid arteries. In the present study, online software was used for calculating FRS, SCORE, and ASCVD risk score in IIMs patients. In addition, EULAR-modified scores (multiplied by 1.5) were calculated for all risk scores and labeled with the prefix “m-.” Patients with FRS/m-FRS risk >10% [7], SCORE/m-SOCRE risk score >5% [6], and ASCVD/m-ASCVD risk score >7.5% [8] were considered as having high risk of CVD. Carotid IMT was measured by high-resolution B-mode ultrasonography using a Philips iE 33 machine equipped with a 7–13 MHz linear vascular probe (Philips Healthcare, USA) [9]. As previously described, carotid IMT was measured at six locations, including the left and right distal common carotid arteries (10 mm proximal to the carotid bulb), carotid bulbs, and proximal internal carotid arteries (10 mm distal to the carotid bifurcation) [11]. The average IMT of six carotid segments was used for further analysis. Carotid plaque presence was defined as a focal wall thickness (IMT ≥1.5 mm), or increased by at least 0.5 mm or 50% compared with the IMT of the adjacent vascular wall [24]. Patients with average IMT ≥0.9 mm and/or the presence of plaque were considered as SCA+ [25]. It was worth noting that the carotid IMT of all participants was measured by a highly skilled sonographer and was read by an experienced cardiologist. Moreover, they were blinded to patients’ clinical information.

2.4 Statistical analysis

Categorical variables were expressed as frequency (percentage), and quantitative variables were described as mean ± standard deviation or median (interquartile range) according to data distribution. Comparisons between both groups were performed with the independent sample t-test or Mann–Whitney U-test for continuous variables, and Chi-square test or Fisher’s exact test for categorical variables. Binary logistic regression analysis was used to identify the related factors of SCA in patients with IIMs. Notably, before the binary logistic regression analysis, multi-collinearity was carried out on all the statistically significant variables using the variance inflation factor (VIF). In general, there was no multi-collinearity among the variables when all values of VIF were less than 10. To evaluate the diagnostic performance of cardiovascular risk scores in comparison to carotid ultrasonography, the receiver operating characteristic (ROC) curve analysis was performed. The optimal cutoff values of the cardiovascular risk scores were obtained according to the sensitivity and specificity at the point where the Youden index was maximized. The Hosmer–Lemeshow test was applied to assess the goodness of fit for the observed and expected risk of carotid SCA+ estimated by the cardiovascular risk scores. The larger the P-value of Hosmer–Lemeshow test, the better the fit. All statistical analyses were conducted using IBM SPSS Version 26 (SPSS, Chicago, USA). All tests were two-tailed, and P-value <0.05 was considered statistically significant.

3 Results

3.1 Subjects’ characteristics and cardiovascular risk scores

A total of 123 patients with IIMs (71.5% female, mean age 50 ± 14 years) and 123 age- and gender-matched healthy subjects were included in this study. The detailed characteristics between cases and controls are shown in Table 1. The case group consisted of 36 patients with polymyositis, 83 patients with dermatomyositis, and 4 patients with inclusion body myositis, with the median disease duration of 6 months. In addition, IIMs patients had higher levels of TG (2.0 vs 1.1 mmol/L), LDL-C (3.5 vs 2.7 mmol/L), and serum urea (5.5 vs 5.0 mmol/L), lower levels of FBG (4.6 vs 4.9 mmol/L) and Scr (51.8 vs 63.0 μmol/L) compared to controls. Carotid ultrasound revealed that 77.2% of IIMs patients and 50.4% healthy controls had carotid SCA+, and the difference between the two groups was statistically significant (P < 0.001). Different cardiovascular risk scores had different applicable conditions, especially ASCVD risk score was applied to the study population aged 40–79 years. In the current study, there were 30 subjects younger than 40 years old in both the case and control groups. Finally, the data of 123, 123, and 93 individuals were qualified to calculate FRS/m-FRS, SCORE/m-SCORE, and ASCVD/m-ASCVD risk score in both the groups, respectively. The results demonstrated that all cardiovascular risk scores were not significantly different between IIMs patients and controls.

Table 1

Main characteristics of IIMs patients and controls

Vaiables IIMs (n = 123) Controls (n = 123) P-value
Age (years) 50 ± 14 50 ± 14 0.731
Gender (n, %) 1.000
 Female 88 (71.5) 88 (71.5)
 Male 35 (28.5) 35 (28.5)
Smoking (n, %) 8 (6.5) 13 (10.6) 0.254
Hypertension (n, %) 26 (21.1) 18 (14.6) 0.183
Diabetes mellitus (n, %) 16 (13.0) 14 (11.4) 0.697
SBP (mmHg) 122 ± 18 119 ± 15 0.090
DBP (mmHg) 75 (65–84) 74 (68–79) 0.231
FBG (mmol/L) 4.6 (4.2–5.5) 4.9 (4.6–5.6) 0.001
TG (mmol/L) 2.0 (1.6–2.6) 1.1 (0.9–1.5) <0.001
TC (mmol/L) 5.7 ± 1.1 4.7 ± 1.1 0.995
HDL-C (mmol/L) 1.5 (1.1–1.7) 1.3 (1.2–1.6) 0.231
LDL-C (mmol/L) 3.5 (3.1–3.8) 2.7 (2.2–3.3) <0.001
Serum urea (mmol/L) 5.5 (4.3–7.0) 5.0 (4.1–5.9) 0.003
Serum creatinine (μmol/L) 51.8 (41.2–61.4) 63.0 (57.9–71.4) <0.001
Use of antihypertensive drugs (n, %) 4 (3.3) 6 (6.9) 0.518
SCA+ (n, %) 95 (77.2) 62 (50.4) <0.001
FRS (%) 2 (0.5–6) 1 (0.5–5) 0.062
mFRS (%) 3 (0.8–9) 1.5 (0.8–7.5) 0.062
SCORE (%) 0.4 (0.1–1.4) 0.4 (0.1–1.1) 0.907
mSCORE (%) 0.6 (0.2–2.1) 0.6 (0.2–1.5) 0.907
ASCVD (%) 3.2 (1.7–11.4) 2.9 (1.2–6.1) 0.226
mASCVD (%) 4.8 (2.6–17.1) 4.4 (1.8–9.2) 0.226
Disease duration (n, %) (months) —
 <6 49 (39.8) —
 ≥6 74 (60.2) —
Dysphagia (n, %) 32 (26.0) — —
Myalgia (n, %) 65 (52.8) — —
Arthralgia (n, %) 40 (32.5) — —
Rash (n, %) 84 (68.3) — —
Lung involvement (n, %) 58 (47.2) — —
Gottron’s sign (n, %) 26 (21.1) — —
Raynaud’s phenomenon (n, %) 12 (9.8) — —
ESR positive (n, %) 41 (33.3) — —
CRP positive (n, %) 52 (42.3) — —
ANA positive (n, %) 79 (64.2) — —
Anti SSA antibody positive (n, %) 9 (7.3) — —
Anti SSB antibody positive (n, %) 5 (4.1) — —
Anti-Jo1 antibody positive (n, %) 6 (4.9) — —
CK (IU/L) 198 (54–1,762) — —
Use of GC (n, %) 60 (48.8) — —
Use of MTX (n, %) 19 (15.4) — —
Use of CTX (n, %) 3 (2.4) — —
Use of HCQ (n, %) 10 (8.1) — —
Use of AZA (n, %) 5 (4.1) — —
Use of TII (n, %) 7 (5.7) — —
Use of TGP (n, %) 4 (3.3) — —

Abbreviations: IIMs, idiopathic inflammatory myopathies; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose; TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol; SCA, subclinical atherosclerosis; FRS, Framingham risk score; SCORE, systematic coronary risk evaluation; ASCVD, atherosclerotic cardiovascular disease risk algorithm; ESR, erythrocyte sedimentation rate; CRP, C-relative protein; ANA, antinuclear antibodies; CK, creatine kinase; GC, glucocorticoid; MTX, methotrexate; CTX, cyclophosphamide; HCQ, hydroxychloroquine; AZA, azathioprine; TII, Tripterygium wilfordii; TGP, total glucosides of paeony.

3.2 Performance of cardiovascular risk scores in IIMs patients

There were 95 IIMs patients who were defined as carotid SCA+ with average IMT ≥0.9 mm and/or the presence of carotid plaque. As presented in Table 2, all cardiovascular risk scores were significantly higher in patients with SCA+ compared with those with SCA− (FRS: 2 vs 0.5%; SCORE: 0.6 vs 0.07%; ASCVD: 3.7 vs 1.0%; all P < 0.001). However, by adopting the preset cutoff values, only 21 (22.1%), 3 (3.2%), and 28 (33.3%) patients with SCA+ were classified as high risk category according to FRS, SCORE, and ASCVD, respectively. Considering that systemic autoimmune diseases often share many clinical and laboratory features, we also tested whether modified risk scores would enhance the diagnostic accuracy in IIMs patients. The findings found that EULAR modified scores increased the sensitivity of m-FRS, m-SCORE, and m-ASCVD in discriminating against carotid SCA from 22.1 to 29.5%, 3.2 to 12.6%, and 33.3 to 41.7%, respectively (Figure 1). It was worth mentioning that 7.1% patients with SCA− were also categorized as high risk by applying FRS and m-FRS. Nevertheless, none of the patients with SCA− was included in the high risk group by applying SCORE, m-SCORE, ASCVD, and m-ASCVD. ROC analysis was conducted to evaluate the performance of cardiovascular risk scores in discriminating patients with high risk, and the results were not satisfactory. The areas of the ROC curve were 0.575 (95% CI: 0.461–0.688) for FRS, 0.612 (95% CI: 0.503–0.721) for m-FRS, 0.516 (95% CI: 0.396–0.636) for SCORE, 0.563 (95% CI: 0.450–0.677) for m-SCORE, 0.677 (95% CI: 0.521–0.812) for ASCVD, and 0.708 (95% CI: 0.576–0.840) for m-ASCVD (Figure 2). From the above results, we found that the performance of ASCVD/m-ASCVD was better than FRS/m-FRS and SCORE/m-SCORE, but the former performed suboptimal in identifying the actual high CVD risk in IIMs patients with carotid SCA.

Table 2

Characteristics of IIMs patients with SCA+ and SCA−

Vaiables SCA+ (n = 95) SCA− (n = 28) P-value
Age (years) 55 ± 12 35 ± 9 <0.001
Gender (n, %) 0.623
 Female 69 (72.6) 19 (67.9)
 Male 26 (27.4) 9 (32.1)
Smoking (n, %) 7 (7.4) 1 (3.6) 0.779
Hypertension (n, %) 25 (26.3) 1 (3.6) 0.010
Diabetes mellitus (n, %) 14 (14.7) 2 (7.1) 0.465
Disease duration (n, %) (months) 0.418
 <6 36 (37.9) 13 (46.4)
 ≥6 59 (62.1) 15 (53.6)
SBP (mmHg) 125 ± 17 109 ± 14 <0.001
DBP (mmHg) 78 (68–85) 67 (59–80) 0.002
FBG (mmol/L) 4.6 (4.2–5.7) 4.6 (4.1–5.2) 0.679
TG (mmol/L) 1.9 (1.5–2.6) 2.0 (1.6–2.6) 0.798
TC (mmol/L) 5.8 ± 1.0 5.5 ± 1.4 0.314
HDL-C (mmol/L) 1.4 (1.1–1.7) 1.5 (1.1–1.7) 0.988
LDL-C (mmol/L) 3.5 (3.1–3.9) 3.5 (2.9–3.7) 0.606
Serum urea (mmol/L) 5.6 (4.5–7.5) 5.2 (4.1–6.0) 0.031
Serum creatinine (μmol/L) 54.8 ± 17.0 45.3 ± 14.0 0.008
Dysphagia (n, %) 26 (27.4) 6 (21.4) 0.529
Myalgia (n, %) 50 (52.6) 15 (53.6) 0.930
Arthralgia (n, %) 28 (29.5) 12 (42.9) 0.184
Rash (n, %) 66 (69.5) 18 (64.3) 0.604
Lung involvement (n, %) 47 (49.5) 11 (39.3) 0.343
Gottron’s sign (n, %) 19 (20.0) 7 (25.0) 0.569
Raynaud’s phenomenon (n, %) 9 (9.5) 3 (10.7) 1.000
ESR positive (n, %) 29 (30.5) 12 (42.9) 0.224
CRP positive (n, %) 38 (40.0) 14 (50.0) 0.347
ANA positive (n, %) 64 (67.4) 15 (53.6) 0.181
Anti SSA antibody positive (n, %) 8 (8.4) 1 (3.6) 0.650
Anti SSB antibody positive (n, %) 4 (4.2) 1 (3.6) 1.000
Anti-Jo1 antibody positive (n, %) 4 (4.2) 2 (7.2) 0.893
CK (IU/L) 153 (53–1,394) 287 (55–4,948) 0.538
Use of antihypertensive drugs (n, %) 4 (4.2) 0 (0.0) 0.573
Use of GC (n, %) 45 (47.4) 15 (53.6) 0.564
Use of MTX (n, %) 14 (14.7) 5 (17.9) 0.917
Use of CTX (n, %) 3 (3.2) 0 (0.0) 1.000
Use of HCQ (n, %) 7 (7.4) 3 (10.7) 0.860
Use of AZA (n, %) 4 (4.2) 1 (3.6) 1.000
Use of TII (n, %) 6 (6.3) 1 (3.6) 0.931
Use of TGP (n, %) 3 (3.2) 1 (3.6) 1.000
FRS (%) 2 (1–8) 0.5 (0.5–1) <0.001
mFRS (%) 3 (1.5–12) 0.8 (0.8–1.5) <0.001
SCORE (%) 0.6 (0.22–2.28) 0.07 (0.03–0.13) <0.001
mSCORE (%) 0.9 (0.33–3.42) 0.1 (0.05–0.20) <0.001
ASCVD (%) 3.7 (1.9–12.4) 1.0 (0.6–1.8) <0.001
mASCVD (%) 5.6 (2.9–18.6) 1.5 (0.9–2.7) <0.001

Abbreviations: IIMs, idiopathic inflammatory myopathies; SCA, subclinical atherosclerosis; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose; TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol; ESR, erythrocyte sedimentation rate; CRP, C-relative protein; ANA, antinuclear antibodies; CK, creatine kinase; GC, glucocorticoid; MTX, methotrexate; CTX, cyclophosphamide; HCQ, hydroxychloroquine; AZA, azathioprine; TII, Tripterygium wilfordii; TGP, total glucosides of paeony; FRS, Framingham risk score; SCORE, systematic coronary risk evaluation; ASCVD, atherosclerotic cardiovascular disease risk algorithm.

Figure 1 Cardiovascular risk scores and EULAR-modified risk scores in discriminating carotid subclinical atherosclerosis using the preset cutoff values. Abbreviations: FRS, Framingham risk score; SCORE, systematic coronary risk evaluation; ASCVD, atherosclerotic cardiovascular disease risk algorithm.
Figure 1

Cardiovascular risk scores and EULAR-modified risk scores in discriminating carotid subclinical atherosclerosis using the preset cutoff values. Abbreviations: FRS, Framingham risk score; SCORE, systematic coronary risk evaluation; ASCVD, atherosclerotic cardiovascular disease risk algorithm.

Figure 2 ROC curve of the risk scores and modified risk scores in discriminating subclinical atherosclerosis. Abbreviations: FRS, Framingham risk score; SCORE, systematic coronary risk evaluation; ASCVD, atherosclerotic cardiovascular disease risk algorithm; AUC, area under the curve.
Figure 2

ROC curve of the risk scores and modified risk scores in discriminating subclinical atherosclerosis. Abbreviations: FRS, Framingham risk score; SCORE, systematic coronary risk evaluation; ASCVD, atherosclerotic cardiovascular disease risk algorithm; AUC, area under the curve.

Notably, by adopting the optimal cutoff values (FRS >1.5%, SCORE >0.14%, and ASCVD >1.5%), the performance of these risk scores were in good agreement with carotid SCA, and the areas of the ROC curve were 0.802 (95% CI: 0.721–0.868) for FRS, 0.893 (95% CI: 0.824–0.941) for SCORE, and 0.860 (95% CI: 0.773–0.924) for ASCVD. Besides, the P-value of Hosmer–Lemeshow test was 0.085 for FRS, 0.185 for SCORE, and 0.239 for ASCVD, which indicated that these cardiovascular risk scores had a moderate fit. Therefore, we assumed that the lower high-risk threshold may improve the diagnostic performance between cardiovascular risk scores and carotid SCA. Sensitivity and specificity of the different cutoff values are presented in Table 3.

Table 3

Sensitivity and specificity of preset and modified cutoffs for risk scores, and cutoffs with highest overall accuracy

Risk scores Cutoff (%) Sensitivity (%) Specificity (%) AUC
Highest Youden index
 FRS 1.5 66.3 85.7 0.802
 SCORE 0.14 88.4 78.6 0.893
 ASCVD 1.5 82.1 77.8 0.860
Preset
 FRS 10 22.1 92.9 0.575
 SCORE 5 3.2 100 0.516
 ASCVD 7.5 33.3 100 0.667
Modified
 m-FRS 10 29.5 92.9 0.612
 m-SCORE 5 12.6 100 0.563
 m-ASCVD 7.5 41.7 100 0.708

Abbreviations: AUC, area under curve; FRS, Framingham risk score; SCORE, systematic coronary risk evaluation; ASCVD, atherosclerotic cardiovascular disease risk algorithm.

3.3 Predictors of carotid SCA in IIMs patients

The demographics, clinical manifestations, laboratory data, and treatments of SCA+ and SCA− patients are summarized in Table 2. The patients with SCA+ were significantly older (55 ± 12 vs 35 ± 9 years, P < 0.001), had higher levels of SBP (125 ± 17 vs 109 ± 14 mmHg, P < 0.001), DBP (78 vs 67 mmHg, P = 0.002), serum urea (5.6 vs 5.2 mmol/L, P = 0.031), and Scr (54.8 ± 17.0 vs 45.3 ± 14.0 mmol/L, P = 0.008). In addition, hypertension was indeed more prevalent among patients with SCA+ compared with individuals with SCA− (26.3 vs 3.6%, P = 0.01). The numbers of smoking and diabetes mellitus were higher in patients with SCA+, but there was no statistically significant difference between the two groups (all P > 0.05). The collinearity diagnostics indicated that there was no obvious multi-collinearity among variables, with the value of VIF ranging from 1.244 to 3.501. All variables which showed statistically significant in univariate analyses were included in the binary logistic regression model, and the results presented that age (OR = 1.160, 95%CI: 1.083–1.242, P < 0.001) was associated with carotid SCA in IIMs patients (Table 4).

Table 4

Associated factors of subclinical atherosclerosis in IIMs patients

Variables β OR (95% CI) P-value
Age (years) 0.148 1.160 (1.083–1.242) <0.001
SBP (mmHg) 0.075 1.078 (0.997–1.167) 0.061
DBP (mmHg) −0.059 0.943 (0.852–1.042) 0.249
Hypertension 0.582 1.789(0.164–19.567) 0.634
Serum urea (mmol/L) 0.157 1.170 (0.801–1.708) 0.417
Serum creatinine (μmol/L) 0.003 1.003 (0.959–1.048) 0.908

Abbreviations: IIMs, idiopathic inflammatory myopathies; SBP, systolic blood pressure; DBP, diastolic blood pressure.

4 Discussion

In the current study, IIMs patients showed a frequent carotid SCA+ compared with the general population, and all cardiovascular risk scores were higher in IIMs patients with SCA+ than in cases with SCA− (all P < 0.001). By adopting the optimal cutoff values, these risk scores had good discrimination in carotid SCA, with area under the ROC curves of 0.802–0.893. The Hosmer–Lemeshow test suggested that these cardiovascular risk scores had moderate goodness of fit (P ranging from 0.085 to 0.239). However, by adopting the preset cutoff values, there was a poor agreement between these risk scores and carotid SCA, with area under the ROC curves of 0.516–0.667. When the 1.5 multiplication factor was introduced to the risk scores, the sensitivity of these risk scores in discriminating against carotid SCA only had a slight increase.

More recently, some studies confirmed that there was a relatively poor consistency between the above cardiovascular risk scores and carotid ultrasonography in patients with autoimmune diseases, such as SLE, PsA, as well as antisynthetase syndrome, which was consistent with the results of this study [9,19,26]. In patients with IIMs, the increased risk of CVD was not only attributed to traditional risk factors, such as age, hypertension, dyslipidemia, diabetes mellitus, but also related to immune-mediated inflammation [3,27]. Accumulating studies uncovered that higher levels of serum pro-inflammatory cytokines and chemokines were common in IIMs patients, which may be involved in the pathogenesis of CVD by modulating a series of mechanisms, such as induce vascular endothelial dysfunction, damage of arterial wall, vascular fibrosis and smooth muscle cell proliferation, and atherosclerotic plaque formation and rupture, eventually resulting in arterial stiffness and atherosclerosis [3,27–29]. Nevertheless, the above cardiovascular risk scores were mainly calculated based on traditional cardiovascular risk factors, which did not contain systemic inflammatory indicators. Hence, it was not surprising that the risk scores would underestimate the cardiovascular risk in IIMs patients. In this study, the positive frequency of inflammatory markers, such as ESR and CRP, was higher in patients with SCA+ than in subjects with SCA−, but there was no significant difference between the two groups. It might be attributed to the following two aspects. On the one hand, since SCA may be associated with the median of a series of measurements of these inflammatory markers, the measurement of serum ESR and CRP at a single time-point failed to identify the relationship between inflammatory markers and SCA in IIMs patients. On the other hand, the therapeutic drugs for IIMs, such as GC and DMARDs, had a certain anti-inflammatory effect, which may reduce the effect of inflammation on SCA [30].

In fact, the potential influence of GC and immunosuppressive treatment on CVD risk in IIMs remains controversial. For example, GC is the cornerstone of treatment for autoimmune diseases, but the effects of GC on cardiovascular events are often considered as a double-edged sword. Although GC could reduce inflammation and immune responses in the disease by inhibiting recruitment and migration of lymphocytes and interfering with the synthesis and secretion of pro-inflammatory cytokines, they promote the occurrence and development of traditional cardiovascular risk factors (e.g., hypertension, diabetes mellitus, and obesity) in a dose- and time-dependent manner [31,32]. In the current study, nearly half (48.8%) of IIMs patients were treated with GC, but the dosage and exposure of GC in individuals varied with the severity of the disease and the treatment regimen. This therefore made it difficult to accurately assess the relationship between GC and cardiovascular risk in IIMs patients. Some evidence pointed out that methotrexate was a potentially cardioprotective drug in rheumatic diseases, but the exact mechanism is still unclear [33]. In addition, the effect of azathioprine, cyclophosphamide, and other DMARDs has not been sufficiently confirmed. Strikingly, there was no significant difference of the use of GC and DMARDs in IIMs patients with SCA+ and SCA−, which may be attributed to the relatively small sample size in this study. Therefore, large prospective studies are required to verify the effects of GC and DMARDs in patients with an increased CV risk. Strikingly, previous studies revealed that body composition, namely lean tissue mass (LTM), fat mass, and bone mineral content, had good diagnostic values for IIMs patients, with the area under the curve (AUC) of 0.718–0.787 [34,35]. Moreover, IIMs patients had lower LTM of the upper limbs and appendicular region, higher body fat percentage, and higher android fat: gynoid fat ratio than healthy controls [35]. In addition, the altered body composition and metabolic functions in IIMs patients may be linked to increased secretion of pro-inflammatory cytokines and chemokines, such as monocyte chemoattractant protein and high sensitivity CRP [35]. Still, no link between body composition and cardiovascular risk in IIMs has been reported so far, which may provide a new direction for future research in this field.

It was worth mentioning that high-risk threshold selection may also partly explain the underestimation of carotid SCA risk in IIMs patients. As shown in Table 3, the cutoff values with best accuracy (highest Youden index) of all three risk scores were significantly lower than the preset ones, but the performance of the former was better. By applying optimal high-risk cutoff values (FRS >1.5%, SCORE >0.14%, ASCVD >1.5%), 33.7, 11.6, and 17.9% cases with SCA+ were classified as low risk. However, up to 77.9, 96.8, and 66.7% patients with SCA+ were identified as having low cardiovascular risk when the preset high risk thresholds (FRS >10%, SCORE >5%, and ASCVD >7.5%, respectively) were used. In addition, although the sensitivity of EULAR-modified risk scores (multiplied by 1.5) increased by 7.4 to 9.4%, a considerable proportion (58.3–87.4%) of patients with SCA+ were still misclassified in the low risk category. These results were also not surprising, as applying a multiplication factor of 1.5, the cutoff values of FRS, SCORE, and ASCVD were reduced to 6.7, 3.3, and 5%, and these cutoffs were significantly higher than the optimal high-risk cutoff values. Based on the above discussions, we speculate that cardiovascular risk scores at low cutoff values may be more useful in detecting IIMs patients at high cardiovascular risk, which still needs further validation.

The present study also demonstrated that carotid SCA was more prevalent in IIMs patients compared with the general population, which was in accordance with the study by Triantafyllias et al. focused on patients with antisynthetase syndrome [19]. Until now, little is known regarding the related factors of carotid SCA in patients with IIMs, but it may play a certain role in improving cardiovascular risk assessment. Therefore, we also explore the factors associated with carotid SCA in IIMs patients. The results of logistic regression analysis revealed that age was related to carotid SCA. In fact, all cardiovascular risk scores already included age. For every year increase in age, the risk of SCA in IIMs patients increases by 1.16 times (95% CI: 1.083–1.242). However, the underlying mechanism between age and carotid SCA is still unknown, which is worthy of further exploration. Similarly, studies from patients with SLE and RA pointed out that the prevalence of atherosclerotic plaques in patients was higher than in the general population, and age was associated with atherosclerotic plaques in patients with SLE (RR = 1.09, 95% CI: 1.05–1.13, P < 0.001) [36,37]. In addition, carotid IMT was an established risk marker for SCA and cardiovascular event, and a multicenter study reported that there was also a significant positive correlation between age and carotid IMT in antisynthetase syndrome patients (r = 0.697, P < 0.001) [19,38]. Notably, despite the results of logistic regression analysis this study revealed that there was no statistical significance among SBP, DBP, and hypertension between patients with SCA+ and those with SCA−. Vincze et al. revealed that SBP was positively correlated with carotid IMT in patients with polymyositis and dermatomyositis (r = 0.548, P = 0.006) [18]. Moreover, previous studies on other autoimmune diseases or general population had shown similar results. For example, a prospective cohort study of SLE patients also demonstrated that age and hypertension were associated with carotid SCA [39]. In addition, there was a relationship between hypertension and carotid SCA in the general population [40]. To date, the exact mechanism between hypertension and carotid SCA in patients with IIMs is unclear, which may be connected with vascular structure damage caused by arterial wall stretch with the increase of blood pressure, including vascular smooth muscle cell proliferation, vascular wall fibrosis and thickening, and increased arterial stiffness [41]. We speculate that the inconsistency between the current study and previous studies may be attributed to the relatively small sample size in this study; thus, prospective studies with large samples should be carried out to confirm the above findings.

The current study also has some limitations. First, the risk scores are originally developed in the United States or Europe; thus, the performance of these may be underestimated or overestimated in other counties. Second, the population in this study is mainly from southwest China, and the sample size of the current study is relatively small, which may not accurately represent the whole population of IIMs patients. Nonetheless, as far as we know, this is the largest study focused on cardiovascular risk assessment in IIMs patients. Third, increased carotid IMT and/or carotid plaques presence as a surrogate marker for CVD do not reflect the actual cardiovascular events. Fourth, body composition and specific serum levels of cytokines/chemokines are not included in the current study. Therefore, further prospective studies with larger sample size should be carried out to verify the results of the current study.

5 Conclusion

In conclusion, all cardiovascular risk scores underestimate the risk of SCA in IIMs patients, and EULAR-modified scores only provide a modest improvement in sensitivity. Age may play an important role in the development of carotid SCA among patients with IIMs. New CVD risk prediction tools of IIMs patients should be developed in the future study.

Acknowledgements

The authors would like to thank the Third People’s Hospital of Chengdu for the help with this study.

  1. Funding information: This study was supported by the National Nature Science Foundation (grant number 81300243).

  2. Author contributions: L.Q., F.X., and H.W. contributed to conception and design of the study. Q.L. and S.Y. organized the database. X.Y. and Y.Z. performed the statistical analysis. L.Q. wrote the first draft of the manuscript. Y.H. and H.W. assisted in the linguistic modification. All authors contributed to manuscript revision, read, and approved the submitted version. The authors applied the SDC approach for the sequence of authors.

  3. Conflict of interest: Authors state no conflict of interest.

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

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Received: 2022-03-22
Revised: 2023-03-22
Accepted: 2023-04-10
Published Online: 2023-05-17

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

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

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  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
https://doi.org/10.1515/med-2023-0703
Schlagwörter für diesen Artikel
autoimmune diseases; cardiovascular risk score; subclinical atherosclerosis
Creative Commons
BY 4.0

Artikel in diesem Heft

  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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Heruntergeladen am 8.9.2025 von https://www.degruyterbrill.com/document/doi/10.1515/med-2023-0703/html
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