Startseite A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry
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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

  • Lisheng Yan , Donglu Cai , Huafeng Zhuang EMAIL logo und Yongjun Lin
Veröffentlicht/Copyright: 12. September 2023

Abstract

To investigate whether there is an influence on the results of lumbar spine bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) under three different hip flexion angles (90°, 45°, 0° of hip flexion). We collected a total of 60 outpatients, including 44 females (56.4 ± 5.7 years) and 16 males (50.2 ± 13.7 years). The DXA results of the lumbar spine were scanned and analyzed in three different positions with hip flexion of 90°, 45°, and 0°. We found that there was no significant difference in the area of interest, bone mineral content, BMD, and vertebral body height of the lumbar vertebral body measured by DXA in three hip flexion positions of 90°, 45°, and 0°; Pearson’s correlation analysis showed that lumbar BMD in hip flexion 90° was correlated with it in hip flexion 45° (r = 0.998, P<0.01) and in hip flexion 0° (r = 0.996, P<0.01) respectively. There was no statistically significant difference in the diagnosis of BMD between 90° and 45° hip flexion (P = 0.903), which was the same as 90° and 0° hip flexion (P = 0.822). Therefore, we conclude that different hip flexion angles can be used in lumbar BMD detection by DXA, which is beneficial to patients who have difficulty in hip flexion, especially for elderly patients with osteoporosis.

1 Introduction

Dual-energy X-ray absorptiometry (DXA) is a commonly used bone mineral density (BMD) measurement method in clinical settings. It is essential for the diagnosis of osteoporosis, the risk assessment of osteoporotic fractures, and therapeutic monitoring [1]. Therefore, achieving a maximum DXA accuracy is primordial since it can significantly impact crucial outcome assessments such as efficacy monitoring and treatment effects. Yet, clinicians often encounter patients unable to meet the standard 90° hip flexion posture required by lumbar BMD scan protocols due to several reasons, such as the initial fracture or the related pain. Such situations have always been the subject of concern among imaging technicians since it is unclear whether a non-standard posture can affect the measurement results, subsequently leading to misdiagnosis or missed diagnosis. This work aims to explore whether variations in hip flexion angle have a significant impact on lumbar BMD measurements using DXA.

2 Materials and methods

2.1 Research participants

Data from 60 subjects who underwent DXA scans in our hospital’s outpatient department from November 1, 2021 to November 31, 2021 were collected and analyzed. All participants were between 42 and 75 years old, with an average age of 54.7 ± 7.8 years and a body mass index of 22.4 ± 2.3 kg/m2. Forty-four of the included patients were females, and 16 were males, with average ages of 56.4 ± 5.7 and 50.2 ± 13.7 years and body mass indexes of 22.0 ± 1.8 and 23.3 ± 3.5 kg/m2, respectively. This study was preapproved by The Ethics Committee of The Second Affiliated Hospital of Fujian Medical University. All participants and their families approved the procedures.

2.2 Inclusion criteria

All patients received in our hospital and requiring lumbar spine BMD measurements using DXA.

2.3 Exclusion criteria

(1) Patients with irremovable biomaterials such as bone cement or metal implants within their lumbar spines; (2) subjects suffering from lumbar spine disorders including severe scoliosis and lumbar osteophytes, lumbar spondylolisthesis, and a history of lumbar fracture; (3) a history of neoplastic growth; (4) recent use of drugs or medical diagnostic tests that affect bone metabolisms; and (5) an unclear scan due to various reasons.

2.4 Instruments and methodology

The DXA Discovery A model was purchased from Hologic, Inc. (Massachusetts, USA). Daily quality controls and repeated prechecks were meticulously performed before use to ensure instrument stability. The CV value of our machine was 0.244%. All scanning and analysis procedures were performed by the same International Society for Clinical Densitometry (ISCD)-trained technician, and all scans carried out on a patient were completed within 24 h. Scans were obtained with the patient posed at three different hip flexion angles, including 90°, 45°, and 0°. The standard 90° hip flexion images were acquired with the patient in the supine position at the center of the scanner bed, his hip on the positioning device and bent at a 90° angle, and his feet resting on the apparatus. The scan starting point was set at the level of the fifth lumbar vertebra before imaging and data collection. The 45° hip flexion images were obtained after those of the standard 90° positioning. The patient was maintained in the same posture as previously mentioned, with the minor difference of having his knees bent. The scan starting point was still at the level of the fifth lumbar vertebra. Finally, the 0° hip flexion data were collected with the patient lying in the same posture and having his legs resting straightly on the scanner bed. The scan starting point was also set at the level of the fifth lumbar vertebra. The required standard for the viability and analysis of various posture images was as follows: an excellent lumbar spine scan obtained following the protocol, the projection of the spinous process within the center of the vertebral body, clear visibility of the bilateral iliac crests, an upper limit encompassing the middle section of the T12 and a lower limit including the L5, a clearly displayed image. The following standard was used for the analysis of the three angle variations data: (1) the region of interest (ROI) was defined as the area with the upper limit located just above the L1 endplate and the lower limit situated just below the L4 endplate, (2) L1–L4 vertebral contours were considered as the lumbar spine edges during the scans, (3) the intervertebral line was placed in the center of the space between the two vertebral bodies. Finally, the three postures data comprised of several lumbar BMD parameters such as bone area, vertebral bone mineral content (BMC), vertebral BMD, and total vertebral body height were collected, compared, and analyzed.

2.5 Statistical analysis

All data were analyzed using SPSS 25.0 statistical software (IBM Software, Chicago, IL, USA). Measurement data were expressed as mean ± standard deviation. The paired t-test was used to compare the measurement data between different postures. Meanwhile, the comparison of count data between different body positions was performed using the contingency table chi-square analysis. Correlations between various hip flexion angles were assessed using Pearson’s correlation method. P < 0.05 was considered statistically significant.

Figure 1 
                  Correlation of vertebral BMD between hip flexion 90° and 45°.
Figure 1

Correlation of vertebral BMD between hip flexion 90° and 45°.

Figure 2 
                  Correlation of vertebral BMD between hip flexion 90° and 0°.
Figure 2

Correlation of vertebral BMD between hip flexion 90° and 0°.

Table 1

Comparison of DXA measurements in 90° and 45° hip flexion

90° hip flexion 45° hip flexion t P
Area 59.09 ± 7.14 59.01 ± 7.11 0.901 0.375
BMC 52.58 ± 11.84 52.65 ± 12.13 −0.505 0.617
BMD 0.888 ± 0.156 0.890 ± 0.162 −1.123 0.271
Total vertebral body height 131.4 ± 6.1 131.2 ± 6.1 1.542 0.134
Table 2

Comparison of DXA measurements in 90° and 0° hip flexion

90° hip flexion 0° hip flexion t P
Area 59.09 ± 7.14 58.91 ± 7.2 1.610 0.118
BMC 52.58 ± 11.84 52.4 ± 11.75 −1.437 0.162
BMD 0.888 ± 0.156 0.890 ± 0.156 −1.938 0.062
Total vertebral body height 131.4 ± 6.1 131.1 ± 6.2 1.882 0.070
Table 3

Comparison of BMD diagnosis in different hip flexion positions

Angle of hip flexion Diagnosis of BMD χ 2 P
Normal (n) Osteopenia (n) Osteoporosis (n)
90° 30 14 16
45° 28 16 16 0.2023 0.903*
28 17 15 0.3915 0.822#

P*: Comparison between hip flexion 90° and 45°; P #: comparison between hip flexion 90° and 0°.

3 Results

  1. No statistically significant differences in the ROI, vertebral BMC, vertebral BMD, and total vertebral body heights were observed between the 90° and the 45° angles (P > 0.05) as well as the 90° and the 0° hip flexion postures (P > 0.05) (Tables 1 and 2).

  2. The BMD correlation analyses yielded coefficients of 0.998 and 0.996 between the 90° and the 45° angles, as well as the 90° and the 45° hip flexion postures, respectively. Additionally, the results showed significant correlations between the 90° and the remaining two angle variations (P < 0.05) (Figures 1 and 2).

  3. Furthermore, the results showed that there were no significant differences in the diagnostic outcomes of BMD results between both the 90° and the 45° angles (P = 0.903) as well as the 90° and the 0° hip flexion postures (P = 0.822) (Table 3).

4 Discussion

The aging population in China is currently becoming an immediate and serious public health concern. The latest census data have shown that 260 million individuals are above 60 years, accounting for 18.70% of the overall population. Additionally, of the 260 million, 13.50% or 190 million individuals are above 65 years. Yet, osteoporosis is a major affliction impacting the elderly, with serious consequences such as cancellous fractures. Indeed, previous predictive studies have suggested that there will be around 5.99 million cases of osteoporosis by 2050 [2]. DXA is currently one of the primary means for the diagnosis of osteoporosis, with an 1A grading evidence quality and recommendation strength [3]. Therefore, its importance is further stressed by the observed trends in the population age curve, osteoporosis prevalence, and osteoporotic fracture incidences. Interestingly, research [4] has shown that variations and errors in DXA measurements are often human-made (operator or patient-derived) rather than the products of the machine itself. All 60 patients in our work were scanned by the same ISCD-certified technician, significantly reducing operator-related factors and increasing the test results’ accuracy and reliability, thus, leaving the patient’s posture as one of the major unaccounted influencing factors. The vast majority of daily encountered BMD test population are elderly patients suffering from several severe conditions such as arthritis, fractures, pain, and other mobility affecting afflictions, rendering them uncooperative or unable to comply with the 90° hip flexion posture required by the lumbar BMD examination. Therefore, it is imperative that answers to questions such as whether non-standard postures affect the accuracy of BMD measurements become the main subjects of focus.

Lekamwasam [5], in his analysis and comparison of lumbar BMD measurements from 56 postmenopausal women in the supine and the 90° hip flexion positions, discovered that there were no significant differences in the measured variables and obtained t values between the two positions. Coincidentally, Ikegami [6] also collected lumbar BMD data from 878 women and 161 men. The measurements were obtained with the patients in the supine and 90° hip flexion positions. The results confirmed that there were no significant differences in lumbar BMD between the two positions at various ages. Additionally, the findings also showed that the variation in hip position (supine and 90° flexion) did not impact the diagnostic rate of osteoporosis. In light of some pathological conditions that can lead to the patient’s inability to comply with the supine or the 90° hip flexion required, we proceeded to add a 45° flexion angle to expand BMD patients’ options. Our study showed that the variations in hip flexion angles (90°, 45°, and 0°) did not significantly affect parameters such as lumbar area of interest, BMC, BMD, and vertebral body height. Additionally, the lumbar BMD correlation results between the two postures (90° and 45°, 90° and 0°) were highly positive, with no significant differences in osteoporosis diagnostic rate between the various positions. The reason explaining our findings might be that even though the hip flexion angle varied significantly (from 90° to 0°), there is only a minimal change in lumbar curvature observed on the DXA two-dimensional image projection at different positions [7]. Furthermore, the changes in lumbar curvature are much more negligible, especially in elderly patients, due to loss of lumbar mobility and preexisting conditions such as degeneration. This is further supported by our vertebral body height comparison findings.

The current results suggested that there is no significant correlation between the lumbar BMD measurement results and the variations in hip flexion angles. Therefore, aiming to improve patients’ satisfaction and the test’s availability, we put forward the idea of safely adopting alternative hip flexion angles in clinical settings when the patient is unable to comply with the standard 90° posture since such changes have little effect on lumbar BMD measurement results. Additionally, it was found, during our study that the 45° and 0° hip flexion angles are not only more practical but also significantly improve work efficiency since they eliminate the need for a hip positioning device as well as shorten the scanning duration. However, it should also be pointed out that the 90° angle has the advantage of better image quality and is more suitable for image analysis since it reduces the possibility of a lumbar vertebral body and intervertebral space overlap. In summary, we believe that technicians should intuitively decide which posture to adopt on a case-to-case basis according to their patients’ specific situations.

5 Limitations

Our research had several limitations, including relatively small sample size and the use of a single DXA (Hologic, Inc., Massachusetts, USA), which might not be reflective of other brands.

6 Conclusions

Adaptive variations in hip flexion angles have minimal impacts on the outcome and are beneficial to DXA-measured lumbar BMD patients with hip flexion difficulties, especially the middle-aged and elderly subjects.


# Co-first author: Donglu Cai.

tel: +86-15359598590

  1. Funding information: This research was supported by Quanzhou Science and Technology Plan Project (2019N094S), Natural Science Foundation of Fujian Province (2021J01272), and Health Young and Middle-aged Key Talents Training Program of Fujian Province (2020GGB034).

  2. Conflict of interest: The authors declare that they have no conflicts of interest.

  3. Data availability statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

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Received: 2022-06-06
Revised: 2023-06-05
Accepted: 2023-07-30
Published Online: 2023-09-12

© 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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  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
Heruntergeladen am 9.9.2025 von https://www.degruyterbrill.com/document/doi/10.1515/med-2023-0778/html
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