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Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis

  • Yan Huang , Yuzhen Zhou , Huixian Chen and Yanyi Xu EMAIL logo
Published/Copyright: March 5, 2024
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Open Medicine
From the journal Open Medicine Volume 19 Issue 1

Abstract

This study aimed to investigate the changes of serum carbohydrate antigen 125 (CA125) and prostaglandin E2 (PGE2) in patients with adenomyosis before and after treatment with high-intensity focused ultrasound (HIFU) combined with gonadotropin-releasing hormone agonist (GnRH-a). One hundred and sixty-five patients with adenomyosis who received HIFU combined with GnRH-a were selected as case group. Sixty-five healthy women who underwent physical examination at the same time were taken as normal control group. At the end of follow-up 6 months after treatment, the case group were divided into effective subgroup and ineffective subgroup according to clinical efficacy. Changes of serum CA125 and PGE2 were analyzed. Serum CA125 and PGE2 levels in the case group were higher than those in the normal control group before treatment (both P < 0.001). Serum CA125 and PGE2 levels in the case group 6 months after treatment were lower than those before treatment (both P < 0.001). There was no difference in serum CA125 and PGE2 levels between effective subgroup and ineffective subgroup before treatment (P = 0.351, 0.284, respectively). Serum CA125 and PGE2 levels in the effective subgroup were lower than those in the ineffective subgroup 6 months after treatment (both P < 0.001). Serum CA125 and PGE2 may be involved in the development of adenomyosis, and their expression levels may be related to the prognosis of patients. Levels of serum CA125 and PGE2 in patients with adenomyosis decrease after treatment with HIFU combined with GnRH-a. The detection of serum CA125 and PGE2 may be used as an index to diagnose adenomyosis and evaluate the therapeutic effect of HIFU combined with GnRH-a.

Keywords: CA125; PGE2; HIFU; GnRH-a

1 Introduction

Adenomyosis, also known as intrinsic endometriosis, refers to the pathological changes caused by the invasion of endometrium (including gland and stroma) into the growth of uterine muscle layer [1]. Injection of gonadotropin-releasing hormone agonist (GnRH-a) is the main treatment of adenomyosis currently. The short-term effect of this drug is obvious, while the long-term use can cause low estrogen symptoms, and adenomyosis is easy to recover after withdrawal [2].

High-intensity focused ultrasound (HIFU) is noninvasive. It focuses on hyperacoustic energy on the target tissue or organ through injection in vitro and makes use of the thermal effect and cavitation effect produced by ultrasonic energy deposition to inactivate the lesion tissue, leading to the coagulative necrosis of lesions [3]. However, HIFU also has limitations, including skin toxicity, nerve, periosteal injury and intestinal injury, and other adverse reactions, and the symptoms may recur after treatment. It has been shown that HIFU combined with GnRH-a is more effective in the treatment of adenomyosis than HIFU or GnRH-a alone [4,5].

Carbohydrate antigen 125 (CA125) is a molecular glycoprotein, and it often appears in the epithelial tissue of cavities. As a kind of surface antigen in the mesothelial tissue and accessory middle renal tube epithelial tissue, it is highly expressed in epithelial tissues of cervix, pelvic peritoneum, fallopian, and endometrium [6]. Serum CA125 has been reported to be closely related to adenomyosis [7].

Prostaglandin E2 (PGE2) is a kind of vasoactive substance transformed by prostaglandins, which is considered to be an important inflammatory mediator and painkiller in the body [8]. High content of PGE2 in the abdominal cavity of sufferers with endometriosis may involve in the pathogenesis of endometriosis [9]. The changes of serum CA125 and PGE2 in sufferers with adenomyosis before and after treatment with HIFU combined with GnRH-a remain obscure.

The objective of this study was to investigate the clinical significance of the changes of serum CA125 and PGE2 in patients with adenomyosis before and after treatment with HIFU combined with GnRH-a.

2 Materials and methods

2.1 Clinical materials

This study was conducted in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, China, from August 2018 to December 2021. One hundred and sixty-five patients with adenomyosis who received HIFU combined with GnRH-a were selected as case group. Inclusion criteria were that sufferers with dysmenorrhea as the main symptom, and the degree of dysmenorrhea assessed by visual analog score was 4–10 points with or without menstruation; sufferers with adenomyosis diagnosed with pelvic magnetic resonance plain scan and contrast-enhanced examination, with the diameter of lesions greater than 3 cm; and sufferers who were willing to be treated with HIFU combined with GnRH-a; color Doppler ultrasound showed adenomyosis, and the focal point of transducer of HIFU equipment could reach the center of the lesion, no obstacle to communication.

Exclusion criteria were that lactating and pregnancy women; sufferers complicated with hypertension, diabetes mellitus, hepatic, renal, or cardiac dysfunction; sufferers who were unable to prone or fill bladder for more than 1 h; allergic to steroid drugs; sufferers with acute pelvic inflammation or chronic pelvic inflammation; sufferers with the overuse of steroid drugs recently; sufferers with enhanced magnetic resonance examination and anesthesia sedation taboo; sufferers with severe coagulation dysfunction; and sufferers who received other related treatments in the first 3 months before inclusion.

Sixty-five healthy women who underwent physical examination in this hospital at the same time were taken as normal control group. Case group was treated with HIFU combined with GnRH-a. Patients were administrated with HIFU ablation therapy with HIFU tumor therapy system. On the 1st to 2nd day of the first menstruation after HIFU ablation, the patients were subcutaneously injected with GnRH-a (leuprorelin acetate) 3.75 mg and then injected every 28 days for three consecutive courses. After the aforementioned treatment, the case group was followed up for 6 months from the first recovery of menstruation after treatment. At the end of follow-up, sufferers in the case group were divided into the effective subgroup and ineffective subgroup according to the clinical efficacy.

The criteria for judging the clinical efficacy of the case group were as follows: (i) remarkably effective: the symptoms such as dysmenorrhea and abnormal menstruation disappeared or basically disappeared, the shape of uterus was normal, and the volume of lesion was reduced by more than 70%; (ii) effective: the clinical symptoms such as dysmenorrhea and abnormal menstruation were obviously improved, the shape of uterus was basically normal, and the volume of lesion was reduced by 50–70%; and (iii) ineffective: the clinical symptoms and uterine size of the patients were not significantly improved, and the volume of the focus decreased by less than 50% or even increased [10]. The remarkably effective sufferers and effective patients in the case group were considered as effective subgroup, and invalid sufferers were considered as ineffective subgroup.

2.2 Detection method

The fasting venous blood of sufferers in the case group was collected before and on the third day of the last menstruation in the 6 months of follow-up. The fasting venous blood was collected in the morning on the day of physical examination in the normal control group. The level of serum CA125 was measured by automatic electrochemiluminescence immunoassay. The level of serum PGE2 was measured by enzyme-linked immunosorbent assay.

2.3 Statistical analysis

Data were processed using SPSS 25.0. Measurement data conforming to the normal distribution were expressed as mean ± standard deviation, compared between groups by independent samples t-test, and paired samples t-test was used for comparison before and after treatment within groups. Count data were expressed as n (%). P < 0.05 was statistically significant.

  1. Informed consent: Informed consent has been obtained from all individuals included in this study.

  2. Ethical approval: The research related to human use has been complied with all the relevant national regulations, institutional policies, and in accordance with the tenets of the Helsinki Declaration and has been approved by the authors’ institutional review board or equivalent committee.

3 Results

3.1 Comparison of demographic characteristic and serum indexes between case group and normal control group before treatment

There was no difference in age between the case group and the normal control group (P = 0.152). Serum CA125 and PGE2 levels in the case group were higher than those in the normal control group before treatment (both P < 0.001) (Table 1).

Table 1

Comparison of demographic characteristic and serum indexes between the case group and the normal control group before treatment

Index Case group before treatment (n = 165) Normal control group (n = 65) P value
Age (years) 34.42 ± 5.19 35.46 ± 4.20 0.152
Serum CA125 (U/mL) 42.81 ± 3.64 17.95 ± 1.89 <0.001
Serum PGE2 (pg/mL) 263.16 ± 21.96 98.28 ± 10.33 <0.001

3.2 Comparison of serum indexes in case group pretreatment and 6 months after treatment

Serum CA125 and PGE2 levels in the case group 6 months after treatment were lower than those before treatment (both P < 0.001), as shown in Table 2.

Table 2

Comparison of serum indexes in case group pretreatment and 6 months after treatment

Index Case group before treatment (n = 165) Case group 6 months after treatment (n = 165) P value
Serum CA125 (U/mL) 42.81 ± 3.64 36.82 ± 3.32 <0.001
Serum PGE2 (pg/mL) 263.16 ± 21.96 185.26 ± 17.52 <0.001

3.3 Comparison of serum indexes between effective subgroup and ineffective subgroup

After treatment, all sufferers in the case group were followed up for 6 months. Among 165 sufferers in the case group, 63 (38.18%) were remarkably effective, 85 (51.52%) were effective, and 17 (10.30%) were ineffective. The remarkably effective patients and effective patients in the case group were included in effective subgroup, namely, there were 148 cases in the effective subgroup. The ineffective patients were included in the ineffective subgroup, namely, there were 17 cases in the ineffective subgroup.

There was no difference in serum CA125 and PGE2 levels between the effective subgroup and the ineffective subgroup before treatment (P = 0.351, 0.284, respectively). Serum CA125 and PGE2 levels in the effective subgroup were lower than those in the ineffective subgroup 6 months after treatment (both P < 0.001) (Table 3).

Table 3

Comparison of serum indexes between effective subgroup and ineffective subgroup

Index Point of time Effective subgroup (n = 148) Ineffective subgroup (n = 17) P value
Serum CA125 (U/mL) Before treatment 42.90 ± 3.67 42.03 ± 3.30 0.351
At 6 months after treatment 36.37 ± 3.12 40.68 ± 2.46 <0.001
Serum PGE2 (pg/mL) Before treatment 262.54 ± 22.50 268.58 ± 16.07 0.284
At 6 months after treatment 182.37 ± 15.61 210.40 ± 12.59 <0.001

3.4 Magnetic resonance imaging (MRI) analysis of a typical case in case group

The typical case in the case group was a 36-year-old female with adenomyosis. Before treatment, MRI plain scan and enhanced images were obtained (Figure 1(a) and (b)). Imaging features showed anteflexed and anteverted uterus, with a large nearly round mass in the posterior wall of the uterus measuring approximately 67 × 62 × 50 mm. The boundary was unclear, and the signal was uneven. Patchy high signals were seen in the T1W image, T2fs suppression showed mixed high and low signals, and DWI showed an iso-signal shadow. Enhancement showed progressive strengthening with uneven distribution and protrusion into the uterine cavity, indistinctly displayed in the binding zone. An elliptical abnormal signal was observed in the muscular layer of the uterine fundus, showing T1W equal signals, slightly low signals in T2fs suppression, uniform signals, clear edges, and uniform enhancement.

Figure 1 MRI image before treatment: (a) T2 sagittal MRI image and (b) enhanced sagittal MRI image.
Figure 1

MRI image before treatment: (a) T2 sagittal MRI image and (b) enhanced sagittal MRI image.

At 6 months after treatment, MRI plain scan and enhanced images were obtained (Figure 2(a) and (b)), showing an anteflexed and anteverted uterus with a large nearly round mass in the posterior wall of the uterus measuring approximately 48 × 48 × 48 mm. The boundary was unclear and the signal was uneven. Patchy high signals were seen in the T1W image, T2fs suppression showed mixed high and low signals, and DWI showed an iso-signal shadow. Enhancement showed a peripheral ring strengthening, protrusion into the uterine cavity, and indistinctly displayed in the binding zone. An elliptical abnormal signal was observed in the muscular layer of the uterine fundus, showing T1W equal signals, slightly low signals in T2fs suppression, uniform signals, clear edges, and uniform enhancement.

Figure 2 MRI image at 6 months after treatment: (a) T2 sagittal MRI image and (b) enhanced sagittal MRI image.
Figure 2

MRI image at 6 months after treatment: (a) T2 sagittal MRI image and (b) enhanced sagittal MRI image.

4 Discussion

Adenomyosis is a special type of endomyosis. The traditional diagnosis of adenomyosis mainly depends on clinical symptoms, physical signs, and B-ultrasound examination, which cannot help diagnose accurately and timely, so pathological examination is finally needed to confirm the diagnosis. Pathological examination is not suitable for early diagnosis due to invasive nature. Although nuclear magnetic resonance imaging is sensitive in the diagnosis of adenomyosis, the high cost limits its clinical applications [11]. Therefore, it is urgent to find a reliable marker or marker combination that can help in diagnosis and differential diagnosis for adenomyosis patients.

Expression of serum CA125 in sufferers with adenomyosis is relatively high [12]. However, it has been found that the diagnostic accuracy of serum CA125 alone in adenomyosis is limited [13]. PGE2 is an important inflammatory mediator and painkiller, which is related to inflammation, anaphylaxis, immunoreaction, and other pathological processes [14]. However, the value of serum PGE2 in the diagnosis of adenomyosis is still unclear.

We found that the levels of serum CA125 and PGE2 in the case group were higher than those in the control group before treatment, suggesting that the levels of serum CA125 and PGE2 in sufferers with adenomyosis are higher than those in normal women.

Many adenomyosis patients refuse to remove the uterus, so conservative treatment is particularly important. HIFU is a new conservative treatment [15,16]. GnRH-a is widely used in the treatment of gynecological diseases [17]. HIFU can inactivate the tissue of adenomyosis and cause coagulative necrosis, while GnRH-a can inhibit the pituitarium and keeps the estrogen in a low level, thus enhancing the curative effect [18]. We found that the levels of serum CA125 and PGE2 in the case group before treatment were lower than those after 6 months of follow-up. There was no difference in serum CA125 and PGE2 levels between the remarkably effective subgroup and the ineffective subgroup before treatment. The serum CA125 and PGE2 levels in the effective subgroup were lower than those in the ineffective subgroup after 6 months of follow-up. We found that the levels of serum CA125 and PGE2 in sufferers with adenomyosis were high before treatment, while their levels decreased significantly after treatment with HIFU combined with GnRH-a. The reason may be that HIFU combined with GnRH-a is effective in the treatment of adenomyosis, which can improve the condition of adenomyosis and reduce the expression of CA125 and PGE2.

It is worth mentioning that the follow-up duration of patients with adenomyosis treated with HIFU and GnRH-a in this study was short, and cases in the ineffective subgroup were limited. These factors may cause bias of the results in our research. Therefore, further well-designed studies with long follow-up period and large sample are needed to verify results in this research.

5 Conclusion

Serum CA125 and PGE2 may be involved in the development of adenomyosis, and their expression levels may be related to the prognosis of sufferers. Levels of serum CA125 and PGE2 in sufferers with adenomyosis decrease after treatment with HIFU combined with GnRH-a. Detection of serum CA125 and PGE2 may be used as an index to diagnose adenomyosis and evaluate the therapeutic effect of HIFU combined with GnRH-a.

  1. Funding information: This study was supported by funds from the project of Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province, China (No.YJ2020003).

  2. Conflict of interest: The authors state no conflict of interest.

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

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Received: 2022-09-21
Revised: 2023-06-18
Accepted: 2023-08-11
Published Online: 2024-03-05

© 2024 the author(s), published by De Gruyter

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

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  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
  120. Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway
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  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
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  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
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  137. The unusual location of primary hydatid cyst: A case series study
  138. Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
  139. Obesity and risk of placenta accreta spectrum: A meta-analysis
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  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
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  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
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  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
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  170. Review Articles
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  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
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  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
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  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
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  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
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  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
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  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
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  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
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https://doi.org/10.1515/med-2023-0794
Keywords for this article
CA125; PGE2; HIFU; GnRH-a
Creative Commons
BY 4.0

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  117. The relationship between IFN-γ, IL-10, IL-6 cytokines, and severity of the condition with serum zinc and Fe in children infected with Mycoplasma pneumoniae
  118. Paraquat disrupts the blood–brain barrier by increasing IL-6 expression and oxidative stress through the activation of PI3K/AKT signaling pathway
  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
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  121. Association of polymorphisms in FBN1, MYH11, and TGF-β signaling-related genes with susceptibility of sporadic thoracic aortic aneurysm and dissection in the Zhejiang Han population
  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
  130. Role of FOXM1 and AURKB in regulating keratinocyte function in psoriasis
  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
  136. The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study
  137. The unusual location of primary hydatid cyst: A case series study
  138. Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
  139. Obesity and risk of placenta accreta spectrum: A meta-analysis
  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
  228. Single-cell analysis identified key macrophage subpopulations associated with atherosclerosis
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