Startseite Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
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Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study

  • Vladislava Stojic , Natasa Zdravkovic EMAIL logo , Tamara Nikolic-Turnic , Nebojsa Zdravkovic , Jelena Dimitrijevic , Aleksandra Misic , Kristijan Jovanovic , Stefan Milojevic und Jelena Zivic
Veröffentlicht/Copyright: 17. Oktober 2023
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Aus der Zeitschrift Open Medicine Band 18 Heft 1

Abstract

The aim of this study was to evaluate the efficacy of endoscopic polypectomy as a therapeutic treatment for malignant alteration of colorectal polyps. In a 5-year research, 89 patients were included, who were tested and treated at the University Clinical Center Kragujevac, Kragujevac, Serbia, with the confirmed presence of malignant alteration polyps of the colon by colonoscopy, which were removed using the method of endoscopic polypectomy and confirmed by the histopathological examination of the entire polyp. After that, the same group of patients was monitored endoscopically within a certain period, controlling polypectomy locations and the occurrence of a possible remnant of the polyp, in the period of up to 2 years of polypectomy. We observed that, with an increasing size of polyps, there is also an increase in the percentage of the complexity of endoscopic resection and the appearance of remnant with histological characteristics of the invasive cancer. The highest percentage of incomplete endoscopic resection and the appearance of remnant with histological characteristics of the invasive cancer were shown at malignant altered polyps in the field of tubulovillous adenoma. Eighteen patients in total underwent the surgical intervention. In conclusion, our data support the high efficacy of endoscopic polypectomy for the removal of the altered malignant polyp.

Keywords: colonic polyps; colorectal neoplasms; endoscopic polypectomy; post-polypectomy surveillance colonoscopy; surgery

1 Introduction

The removal of the malignant colon polyps during endoscopy raises a number of concerns, including the risk of the procedure and the possibility of inadequate polypectomy, ptsince these polyps have an increased risk of harboring the invasive carcinoma [1]. Colorectal cancer is most often caused by a malignant alteration in the adenoma (adenoma-carcinoma sequence) which was not promptly detected and removed (Morson theory) [2]. All adenomas have a dysplastic epithelium, which does not always take the polypoid shape and therefore the term adenoma–carcinoma sequence is replaced by the term dysplasia–carcinoma sequence [3]. In a minority of patients, colorectal cancer develops from de novo lesions, which grow from the mucosa [4].

The malignant potential of colorectal adenomas depends on their size, histological type, and degree of dysplasia [5]. Because of the specificity of the colorectal mucosa, unlike malignant tumors in other localizations, the malignant polyp includes intraepithelial and intramucosal carcinoma, as well as tumors, with the penetration of malignant cells into the mucosa muscularis, but not beyond [6]. The malignant polyps, respectively, represent the middle stage of the final one in the process of colorectal carcinogenesis, and the frequency of the malignant polyps is considered to be 9.5% [7]. A high-grade dysplasia (carcinoma in situ) and intramucosal carcinoma which contains intracryptal cell proliferation are considered to be the non-invasive cancer that has the metastatic potential. When the neoplastic tissue lesions exceed this limit, it is referred to as the invasive carcinoma [8,9].

Colorectal cancer screening and endoscopic polyp resection can reduce mortality from colorectal cancer and are now recommended by many national guidelines. Endoscopic polypectomy and endoscopic mucosal resection are the standard treatment options for colorectal neoplasia. Endoscopic submucosal dissection has great potential for the en bloc resection of larger flat or sessile lesions. However, it is technically demanding and time consuming and should be reserved for histologically advanced lesions. Endoscopic full-thickness resection is a welcome addition of endoscopic resection techniques and is very useful for the treatment of smaller difficult-to-resect lesions. The colonoscopic polypectomy technique was first described by Wolff and Shinya [10,11]. The diagnosis is made after the histological examination of entirely removed polyps [12,13,14,15]. The endoscopic polypectomy is much simpler, less expensive, and more comfortable than the surgical one; however, the final decision on the selection of the therapy depends on the shape, size, and histopathologic features of the polyp [8]. Special therapeutic problems are the malignant polyps, because of the increased possibility for the development of residual or metastatic carcinoma, especially if polypectomy was inadequate [16]. If the adenoma with the noninvasive carcinoma is completely removed with the endoscopic method, this procedure is considered curative.

There are two issues after electro-resections of colorectal polyps: whether that is the appropriate therapy for the malignant polyps, and if not, which types of polyps can lead to residues or relapse after electro-resections. That influences the decision concerning the laparotomy and resection of the intestine as a complement to adenoma electro-resections [16]. To avoid the possibility of residual or metastatic carcinoma after the endoscopic polypectomy, the subsequent endoscopy, and biopsy are required to detect possible carcinoma infiltration to the resection border area, the presence of carcinoma, and malignant affection of the lymph and blood vessels. If the malignant tissue infiltrates the border intestinal resection plates, polypectomy is considered inappropriate and the surgical resection should be performed [17].

Minimally invasive surgical techniques have proven to be superior to conventional open techniques in colorectal surgery for short-term outcomes, such as improved postoperative recovery and a reduced postoperative systemic immune response. There are various minimally invasive local excision treatments for malignant polyps, such as trans-anal resection, trans-anal endoscopic microsurgery, and laparoscopic-assisted colectomy as another minimally invasive alternative to open colorectal surgery. However, there are lack of studies that have compared the outcome of transanal minimally invasive surgery (TAMIS) and endoscopic mucosal resection.

Different complication rates between minimally invasive colorectal surgery and endoscopic polypectomy are compared in one of the studies through surgical-related outcomes and postoperative complications. Surgical-related outcomes were operating time (9.49 vs 15.28 min), blood loss (no significant differences), and lesion fragmentation rate (22.6 vs 0%), compared between the endoscopic mucosal resection and TAMIS groups. The establishment of pneumorectum and placement of a single-hole laparoscope prolong the operation time in TAMIS. The secondary outcomes were complications such as hemorrhage (higher rate in the endoscopic mucosal resection group), urinary retention (13.6% in TAMIS vs 1.9% in other groups), and postoperative infection (no significant differences) [18].

Other studies also have shown that endoscopic mucosal resection is simpler, has less morbidity and mortality, is more suitable for the treatment of rectal polyps with a longer distance from the anus, can be performed by a single person with a shorter operating time, and is cost-effective than surgery. It also should be considered the first line of treatment for patients with polyps (≥20 mm) lesions [19,20]. A meta-analysis of 50 studies, including patients with colorectal polyps treated with endoscopic mucosal resection, showed an initial success rate of 92% for endoscopic resection and 8% of patients underwent surgery due to non-curative endoscopic resection. Complications such as endoscopic recurrence, perforation, and bleeding occur in 13.8, 1.5, and 6.5% [21]. Bleeding (in 0.7–24% of the cases) and perforation (risk of 1–2%) are two main complications associated with endoscopic mucosal resection procedure [22]. Other complications include such as non-specific postprocedural pain and post-polypectomy syndrome (1%) [23].

2 Materials and methods

2.1 Ethics approval and consent to participate

The study was conducted at the Clinic of Gastroenterology and Hepatology, the University Clinical Center Kragujevac, Kragujevac, Serbia. All of the patients gave their written and informed consent to participate and the research project was approved by the Ethics Committee of the University Clinical Center Kragujevac and the Faculty of Medical Sciences, the University of Kragujevac, Serbia (n. 01/1627 and 01-311/6, date: March 8, 2010, and January 20, 2010). Additionally, adherence to the Principle of Good Clinical Practice and the Helsinki Declaration were valued throughout the process.

2.2 Consent for publication

All of the patients gave their consent for the publication of their data.

2.3 Design of study and study population

In this cross-sectional study, we investigated the total of 89 patients with the malignant altered polyp (60 male and 29 female patients; 30–89 years of age) who were, during that period of time, tested and treated at the Clinic of Gastroenterology and Hepatology, the University Clinical Center Kragujevac, Kragujevac, Serbia, and in whom colonoscopy confirmed the incidence of malignant alteration of polyps in the colon that was removed by polypectomy including endoscopic mucosal resection and confirmed by the histopathological examination of the entire polyp. The same group of patients was then followed by the endoscopic defined protocol within 2 years after the polypectomy. The study did not include the patients with initially verified existence of the invasive carcinoma through the histopathological examination of endoscopic polypectomy of the entire polyp. Neither did the study include patients diagnosed with the invasive carcinoma, after the initial polypectomy of the malignant polyps in the line of resection. Instead, these patients were sent to the surgeon. The study included patients who, besides the malignant polyps had had synchronous carcinoma at other locations that were surgically removed, and then, the malignant polyp was removed endoscopically.

2.4 Criteria for diagnosing the malignant altered polyp

In this study, the following described criteria were used for the diagnosis of malignant altered polyp, and histologic features that had to be included in the pathology report were emphasized.

Architectural alterations and cytologic abnormalities, principally cellular and nuclear pleomorphism, hyperchromatic cells with multilayered irregular nuclei and loss of mucin, high nuclear/cytoplasmic ratio, marked nuclear atypia with prominent nuclei, and focal cribriform patterns are considered in high-grade dysplasia. Not all these features are necessarily present to the same degree [24].

For the diagnosis of a carcinoma “in situ,” high dysplasia, intramucosal carcinoma or intraepithelial carcinoma, by definition, the main step is identifying changes with the above-mentioned characteristics in the stage at which they are solely confined to the epithelium, lamina propria, or muscularis mucosa and no extending into the submucosa. It is classified as pTis in the AJCC staging system and the National Comprehensive Cancer Network guidelines [25]. These terms were defined as non-invasive high-grade neoplasia in the Vienna classification [26]. Carcinoma in situ or severe dysplasia or intraepithelial carcinoma corresponds to a carcinoma that is restricted to the epithelial layer without invasion into the lamina propria. Intramucosal carcinoma is a carcinoma characterized by the invasion into the lamina propria. When the carcinoma spreads to the submucosa, the polyp is considered to have become malignant, being able to spread to the lymph nodes or distant sites. It is believed that the endoscopic therapy is sufficient for the malignant altered polyps that meet the following criteria (Practice Parameters Committee of the American College of Gastroenterology) [17]: the excision of the entire polyp; a regular finding of mucosa that is more than or equal to 1 mm from the edge of the polyp; well or moderately well-differentiated histology of carcinoma without lymph nodes’ invasion, without invasion of blood vessels, and a negative follow-up colonoscopy 3 months after the polypectomy.

2.5 Endoscopic polypectomy

Colonoscopy and endoscopic polypectomy with endoscopic mucosal resection were performed in the endoscopic cabinet of the Clinic of Gastroenterology and Hepatology, the University Clinical Center Kragujevac, Kragujevac, Serbia, using a colonoscopy device of the brand Olympus EXERA II, while the endoscopic polypectomy was performed with the electrosurgical unit of ERBE brand. The malignant polyps were removed entirely, using the standard method “in a single act” (en bloc resection) or “piece by piece.” The polyps from the colon were drawn along the top of the endoscope with biopic forceps or a polypectomy belt loop.

2.6 Histological analysis of samples

The electro-resected material was distributed and treated at the Department of Pathology of the University Clinical Center Kragujevac, Kragujevac, Serbia. The fixation was carried out in 10% formalin, the tissue was routinely processed, embedded in paraffin, and the classic method of staining with hematoxylin-eosin was applied. The histopathological examination was carried out on the entire polyps/lesions up to 3 cm in size. As for the bigger polyps, they were examined through numerous samples, to the deepest layers and the basal part of the polyp (with pedicle or without it), which corresponds to the insertion location of the polyp. The classical protocol of histopathological reports for polyps and precursor lesions contains the following information: (1) the verification and description of the received material and how representative it is; (2) the histological diagnosis and/or (sub) type of the lesion; (3) the presence and extent of neoplasia (adenoma and/or carcinoma) in samples; (4) the presence of the highest grade dysplasia or grade of histological malignancy; (5) the level of carcinoma invasion, which includes the depth and position of carcinoma; (6) the presence of vascular (lymphoid, venular) invasion; and (7) the residual status of the polypectomy: complete-radical excision of polyps (R 0 category), involvement of the resection margins of a base or a pedicle (R 1 category), indistinct involvement of resection margins (fragmented parts of the polyp), or estimation is not possible for other reasons (R x category) [27].

2.7 Statistical analysis

All statistical analyses were conducted using the software package IBM SPSS Statistics version 22.0 (SPSS, Chicago, IL, USA). Categorical variables were presented in frequencies and percentages. The results were analyzed using Student’s t-test or a Mann–Whitney test on the dependence of normal distribution determined by a Kolmogorov–Smirnov test. For determining the correlation between the categorical variables, the chi-square test was used. The data were expressed as the mean ± standard error. All statistical analyses in this article were conducted with a confidence interval of 95%. The values of p < 0.05 were considered statistically significant.

3 Results

3.1 Socio-epidemiological data

Eighty-nine patients with the malignant polyp, 60 (67.4%) males and 29 (32.6%) females with the mean age of 62.5 ± 10.4 years, were studied. Two-thirds of the patients were male. The age of patients of both sexes was in the variation interval 30–89 years old. The highest frequency of patients for the whole group was in the age group 50–69 with 60.6% of the patients, and the lowest frequency was in the age group 30–49, with 13.5% of the patients. The male patients had the identical age structure as the whole group, while in the female patients, the representation was equal in the age intervals 30–49 and 70–89 years. Malignant polyps affect persons of all ages above 30, with the age frequency that increases and reaches the peak in the age group of 50–69 years. In support of this statement are χ² test values, with frequency schedule 30 (p < 0.05).

3.2 Characteristics of polyps and endoscopic polypectomy

All the patients had one malignant polyp each. The clinicopathological characteristics of the polyps are presented in Table 1. The dominant localization of the malignant polyps is in the sigmoid area, where the tumor was diagnosed in 77.6% of the patients. In the distal colon and rectum, 94.4% of the malignant polyps are localized, and in the right colon 5.6%. The malignant polyps were from 5 mm to over 30 mm in endoscopic size, an average of 19.2 ± 6.46. The most frequent are malignant polyps 10–19 and 20–29 mm in size that were diagnosed in 77.5% of patients – a much higher percentage in relation to the malignant polyps 1–9 and over 30 mm in size. The sigma malignant polyps are, on average, significantly bigger than the malignant polyps of other localizations. The pedunculated altered malignant polyps were 3.4 times more frequent than the polyps of the extensive base. The malignant polyps in the tubulovillous adenoma are statistically significantly more represented in relation to the malignant polyps in the tubular and villous colon adenoma (p < 0.05). Intramucosal depth of invasion of the malignant polyps is 2.3 times more frequent than the intraepithelial depth of invasion (p < 0.05).

Table 1

Epidemiological data, polyps’ characteristics, and endoscopic polypectomy

Number of patients 89
Age (years), mean (s.d.) 62.5 ± 10.4
Gender, n (%)
Women 29 (32.6%)
Men 60 (67.4%)
Location, n (%)
Rectum 13 (14.6%)
Sigmoid colon 69 (77.6%)
Descending colon 2 (2.2%)
Transverse colon 2 (2.2%)
Ascending colon 2 (2.2%)
Cecum 1 (1.1%)
Size, n (%)
1–9 mm 8 (8.9%)
10–19 mm 38 (42.7%)
20–29 mm 31 (34.8%)
>30 mm 12 (13.5%)
Configurations, n (%)
Pedunculated 65 (73.1%)
Sessile 22 (24.7%)
Flat 2 (2.2%)
Histological characteristics, n (%)
Tubular adenomas 23 (25.8%)
Villous adenomas 18 (20.2%)
Tubulovillous adenomas 48 (53.9%)
Polypectomy, n (%)
Complete resection 62 (69.7%)
Incomplete resection 27 (30.3%)
Technique of polypectomy, n (%)
In one act 71 (79.8%)
Piece by piece 18 (20.2%)
Depth of invasion, n (%)
Intraepithelial 27 (30.3%)
Intramucous 62 (69.7%)
Line of resection, n (%)
Not available 20 (22.5%)
Without dysplasia 47 (52.7%)
Dysplasia grade I 2 (2.3%)
Dysplasia grade II 3 (3.4%)
Dysplasia grade III 8 (9.0%)
Carcinoma in situ 9 (10.1%)
Residual status, n (%)
Radical excision of polyps 47 (52.8%)
Vague involvement of resection margins 37 (41.6%)
Involvement of resection margins 5 (5.5%)

At localities of the malignant polyps, polypectomy in 69.7% of patients who had endoscopic controls at prescribed intervals within 2 years, the control colonoscopy did not verify the residual adenomatous tissue, recurrence of polyps, nor nodular growth. In 30.3% of patients, polypectomy was incomplete. In 79.8% of total study patients, polypectomy was performed in one act, and in 52.7% of patients, after polypectomy, the line of resection with no signs of dysplasia and invasion was verified. Radical excision of polyp was diagnosed in 52.8% of patients.

3.3 Histopathological characteristics of the polypectomy localization

In the group of patients with incomplete resection, 11 patients were diagnosed with benign remnant histopathological characteristics, and in 16 patients, the remnant was with malignant histological characteristics. All 11 patients with benign remnant histopathologic features had the endoscopic treatment and had a regular finding at the location of previous polypectomy in endoscopic examinations within 2 years of the follow-up period (Table 2).

Table 2

Histological characteristics of the polypectomy localization

Histological characteristics Percentage (%) Number
Tubular adenomas 22.2 6
Villous adenomas 7.4 2
Tubulovillous ademonas 11.1 3
Invasive carcinoma 29.7 8
Carcinoma in situ 29.6 8

The lowest percentage of incomplete resection was identified in the malignant polyps 1–9 mm in size. With an increased size of polyps, there is also an increase in percentage of the incomplete resection, so that it is 3.2 times more frequent in a group of the malignant polyps bigger than 30 mm (p < 0.05) (Figure 1a).

Figure 1 Incomplete resection and referral to the surgeon according to the size and configuration of the polyp. (a) With an increase in the size of polyps, there grows also the percentage of the incomplete resection. (b) The highest percentage of referral to the surgeon is in the category of polyps size over 30 mm. (c) Higher percentage of incomplete resection in the sessile configuration of the malignant polyps. (d) Patients with sessile configuration of malignant-altered polyps were referred to the surgeon.
Figure 1

Incomplete resection and referral to the surgeon according to the size and configuration of the polyp. (a) With an increase in the size of polyps, there grows also the percentage of the incomplete resection. (b) The highest percentage of referral to the surgeon is in the category of polyps size over 30 mm. (c) Higher percentage of incomplete resection in the sessile configuration of the malignant polyps. (d) Patients with sessile configuration of malignant-altered polyps were referred to the surgeon.

The examination of the number of patients who were referred to the surgeon and those who were not, for each size category of polyps, revealed that the group of polyps larger than 30 mm had the highest percentage of referrals to the surgeon (χ² = 0.036, p < 0.05) (Figure 1b).

A higher percentage of incomplete resection was verified in a sessile configuration of the malignant polyps (p < 0.05) compared to other macro-types (Figure 1c). The patients with sessile configuration of the malignant polyps were 2.8 times more referred to the surgeon, compared to the patients with a peduncle configuration (χ² = 0.008, p < 0.05) (Figure 1d).

In patients with incomplete resection of the malignant polyps, it was 66.7% who had polypectomy in one act and 33.3% who had polypectomy performed in a technique piece by piece. A higher percentage of incomplete resection is seen in a polypectomy technique piece by piece (p < 0.05) (Figure 2a).

Figure 2 Incomplete resection and referral to the surgeon according to the type of polypectomy and residual polypectomy status. (a) Higher percentage of incomplete resection is in polypectomy technique piece by piece. (b) The percentage of referral to the surgeon is greater in those patients with the malignant polyps, in which resection was performed using technique piece by piece. (c) Verified incomplete polypectomy in 7 patients with the radical excision of polyps, and in 5 patients including involvement of resection margins. (d) Surgeon is not addressed to a single patient with a residual status that showed the radical excision of polyp.
Figure 2

Incomplete resection and referral to the surgeon according to the type of polypectomy and residual polypectomy status. (a) Higher percentage of incomplete resection is in polypectomy technique piece by piece. (b) The percentage of referral to the surgeon is greater in those patients with the malignant polyps, in which resection was performed using technique piece by piece. (c) Verified incomplete polypectomy in 7 patients with the radical excision of polyps, and in 5 patients including involvement of resection margins. (d) Surgeon is not addressed to a single patient with a residual status that showed the radical excision of polyp.

In the group of 16 patients who were referred to the surgeon, 56.2% polypectomy was performed the “in one act” technique and 43.8% the “piece by piece” technique. The percentage of referral to the surgeon is greater in those patients with malignant-altered polyps, in which resection was performed using the “piece by piece” technique (χ² = 0.016, p < 0.05) (Figure 2b).

3.4 Distribution of polypectomy localizations in relation to the histopathological alterations

Analyzing the polypectomy localizations, depending on the histopathological characteristics of the malignant polyps, we got the results that in the group of patients with incomplete resection, most of the malignant polyps were in the area of tubulovillous adenoma, however, without statistical significance (Figure 3a). The surgeon has referred 15 patients with malignant changed tubulovillous adenoma. No patient with malignant changed villous adenoma was identified (χ² = 0.043, p < 0.05) (Figure 3b).

Figure 3 Incomplete resection and referral to the surgeon according to the histopathological characteristics and resection line. (a) Incomplete resection is more common in the tubulovillous malignant polyps. (b) The highest percentage of patients with the malignant-altered tubulovillous polyp was referred to the surgeon. (c) A high percentage of incomplete resection has been verified in resected polyp dysplasia grade III and a focus of carcinoma in situ at the line of resection. (d) With the gradation lines, resection increases the percentage of patients referred to the surgeon.
Figure 3

Incomplete resection and referral to the surgeon according to the histopathological characteristics and resection line. (a) Incomplete resection is more common in the tubulovillous malignant polyps. (b) The highest percentage of patients with the malignant-altered tubulovillous polyp was referred to the surgeon. (c) A high percentage of incomplete resection has been verified in resected polyp dysplasia grade III and a focus of carcinoma in situ at the line of resection. (d) With the gradation lines, resection increases the percentage of patients referred to the surgeon.

Incomplete resection was verified at 22.2% of malignant-altered polyps with intraepithelial depth of invasion, and 77.8% with intramucosal depth of invasion. The completeness of resection is independent of the depth of invasion of the malignant-altered polyp which is removed by polypectomy (p > 0.05). The patients referred to the surgeon scaled as 31.3% of patients with intraepithelial depth of invasion of the malignant polyps and 68.7% with intramucosal depth of invasion of the malignant polyps. The percentage of patients referred to the surgeon does not depend on the depth of invasion of malignant-altered polyps (χ² = 0.754, p > 0.05).

3.5 Distribution of malignant polyps with/without resection

All malignant polyps with a resection line with no signs of dysplasia and invasion were fully resected. A high percentage of incomplete resection was verified in resected polyp dysplasia grade III with a focus of carcinoma in situ at the line of resection (Figure 3c). The completeness of resection is dependent on the line of resection (χ² = 0.039, p < 0.05), and odds ratio is 4.928 (each gradation line of resection of increased risk for restoration to about 2 times). With the gradation of the line of resection, the percentage of patients referred to the surgeon increases, so that no patient was referred to the surgeon with the line of resection without signs of dysplasia and the invasion, nor with dysplasia grade I. One patient who was sent to the surgeon had the line of resection of a dysplasia grade II and 7 patients referred to the surgeon had the line of resection grade III dysplasia. Eight patients referred to the surgeon had on the line of resection with the focus of carcinoma in situ (Figure 3d).

The frequency of referring to the surgeon depends on the line of resection (χ² = 0.009, p < 0.05), and the odds ratio is 3.441 (each gradation of the line of resection increases the risk of referring to the surgeon about 3.5×). Incomplete polypectomy was verified in 7 patients with a radical excision of polyps, and in 5 patients including involvement of resection margins (p < 0.05) (Figure 2c). 68.8% of patients with an unclear margin were sent to the surgeon as well as 31.2% of patients with a clear one including involvement of resection (χ² = 0.000, p < 0.05) (Figure 2d). No patient with a residual status showing the radical excision of polyp (χ² = 0.000, p < 0.05) was referred to the surgeon.

3.6 Histopathological features of polypectomy in situ referred to the surgeon

The clinicopathological features of in situ polypectomy referred to the surgeon are presented in Table 3. Eight out of 16 patients who went to the surgeon’s check-up after the endoscopic examination had carcinoma in situ at the polypectomy location, 7 invasive carcinomas, and one of them, dysplasia grade III. The highest percentage of patients with the remnant of invasive cancer had the sigmoid localization of malignant-altered polyps (p = 0.001), over 30 mm in size (p = 0.001), of the sessile configurations (χ² = 0.024, p = 0.001, odds ratio 4.957) at the area of tubulovillous adenoma (p = 0.001). With each gradation of the line of resection, the risk of malignant remnant characteristics increases by 5 times (χ² = 0.010, p < 0.001, odds ratio 5.041). There was no remnant with a malignant histological status, after the radical excision of the malignant-altered polyp; in 45.5% of the patients with unclear invasion of the resection margins, there was rest and histological characteristics of the invasive carcinoma and the same percentage is obtained in the group where invasion of the resection margins was confirmed (χ² = 0.001, p < 0.001).

Table 3

Clinicopathological features of the polypectomy localization addresed surgeon

Dysplasia grade III Carcinoma in situ Invasive carcinoma p value
Location, n (%)
Rectum 0 (0.0%) 3 (75.0%) 1 (25%)
Sigmoid colon 1 (9.0%) 3 (27.2%) 7 (63.6%) p = 0.001
Descending colon 0 (0.0%) 0 (0.0%) 0 (0.0%)
Transverse colon 0 (0.0%) 1 (100.0%) 0 (0.0%)
Ascending colon 0 (0.0%) 0 (0.0%) 0 (0.0%)
Cecum 0 (0.0%) 0 (0.0%) 0 (0.0%)
Size, n (%)
1–9 mm 0 (0.0%) 1(100.0%) 0 (0.0%)
10–19 mm 1 (16.6%) 3 (50.0%) 2 (33.3%)
20–29 mm 0 (0.0%) 3 (75.0%) 1 (25.0%)
>30 mm 0 (0.0%) 1 (20.0%) 4 (80.0%) p = 0.005
Configurations, n (%)
Pedunculated 0 (0.0%) 3 (57.1%) 3 (42.9%)
Sessile 1 (12.5%) 3 (37.5%) 4 (50.0%) p = 0.042
Flat 0 (0.0%) 1 (100.0%) 0 (0.0%)
Histological characteristics, n (%)
Tubular adenomas 0 (0.0%) 0 (0.0%) 0 (0.0%)
Villous adenomas 1 (100.0%) 0 (0.0%) 0 (0.0%)
Tubulovillous adenomas 0 (0.0%) 8 (53.3%) 7 (46.7%) p = 0.003
Technique of polypectomy, n (%)
In one act 1 (11.1%) 7 (77.8%) 1 (11.1%)
Piece by piece 0 (0.0%) 1 (14.3%) 6 (85.7%) p = 0.023
Depth of invasion, n (%)
Intraepithelial 1 (20.0%) 3 (60.0%) 1 (20.0%)
Intramucous 0 (0.0%) 5 (45.5%) 6 (54.5%)
Line of resection, n (%)
Not available 0 (0.0%) 0 (0.0%) 0 (0.0%)
Dysplasia grade I 0 (0.0%) 0 (0.0%) 0 (0.0%)
Dysplasia grade II 0 (0.0%) 1 (100.0%) 0 (0.0%)
Dysplasia grade III 1 (14.3%) 2 (28.6%) 4 (56.1%)
Carcinoma in situ 0 (0.0%) 5 (62.5%) 3 (37.3%) p = 0.001
Residual status, n (%)
Radical excision of polyps 0 (0.0%) 0 (0.0%) 0 (0.0%)
Vague involvement of resection margins 1 (9.1%) 5 (45.4%) 5 (45.4%)
Involvement of resection margins 0 (0.0%) 3 (60.0%) 2 (40.0%) p = 0.003

4 Discussion

The progress of the visual techniques [28,29,30] and techniques of polypectomy, which allow detection and removal of polypoid transformations, have resulted in a decrease in the incidence of colorectal carcinoma [31,32,33], which is consistent with the theory of adenoma-carcinoma sequence [34,35]. The precursor lesions for developing the colorectal cancer have been defined, as well as the aberrant crypt focuses [36,37,38]; the genes responsible for colorectal apoptosis have been discovered [39,40,41], as well as the genes responsible for the incidence of familial adenomatous polyposis [42], and hereditary un-polypoid colorectal cancer [43,44,45,46]. Flat adenomas [47,48,49,50] and a flat colorectal carcinoma [30,51], adenomas showing a depressed surface, colorectal carcinoma [52,53] as well as de novo colorectal carcinoma [54] have been described in the literature so far.

However, in spite of those important discoveries and satisfactory doctrine of primary and secondary preventions of colorectal carcinomas, the incidence is increasing. Good prevention of colorectal carcinomas implies timely diagnosis and removal of adenomas. It is necessary to make clinical, endoscopic, histologic, and histochemical analyses to define the optimal plan for further treatment. The removal of the malignant polyps directly prevents cancer development and reduces the incidence of colorectal cancer to 90.0% [55].

Based on the number of colonoscopy examinations, the number of patients who had polypectomy, and the total number of endoscopically removed polyps in our study, the malignant polyps were diagnosed in 12.5% of patients who had polypectomy and represent 8.7% of all polyps removed endoscopically. The literature data show that the malignant polyps are diagnosed in 0.2–9.0% of endoscopically removed adenomatous polyps, and 9.0–11.0% of the surgically treated polyps [51]. The diagnosis of malignant alteration of the adenoma is exclusively histological. Friability, hardness, ulceration, the shape of “Christmas tree,” the asymmetry [52], and to a lesser extent, lobular surface adenoma are macroscopic criteria indicating malignancy. Theoretically, the endoscopic polypectomy is curative; however, in practice, there are some restrictions [53]. Recommendations of some authors have clearly defined that adenomas with carcinoma in situ should be treated only by polypectomy [51,52,53].

In our study, at polypectomy localizations of the malignant polyps in 69.7% of patients, who were endoscopically controlled at prescribed intervals up to 2 years, the control colonoscopy did not verify the residual adenomatous tissue, recurrence of polyps, nor nodular growth. In 30.3% of patients, the control colonoscopy verified relapse. In the group of patients with incomplete resection, 11 patients were diagnosed with residual adenomatous tissue benign pathohistological characteristics and 16 patients had malignant histological characteristics. All 11 patients with benign pathohistological characteristics were resolved endoscopically and they had neat polypectomy sites at control endoscopic examinations in follow-up 2 years later. A high percentage of success of the polypectomy of the malignant polyps with normal endoscopy findings at control colonoscopy examinations is described also by other authors [34,35,36,37,38,39,40].

Also, in our study, the highest frequency of patients for the group as a whole is at the age group 50–69 years. The prevalence of malignant polyps was in a decline after the age of 70, which is explained by the fact that the small number of patients of this age had been examined, due to intolerance to the examination or reduced possibilities of patients of that age to be correctly prepared for colonoscopy. According to Morson and associates [53] the malignant polyps most frequently occur at the age of 60–79 years. The slightly higher average age of the patients was verified in studies by Seitz and associates [55]. The older age is a risk factor, because during aging, there is an accumulation of genetic changes and mutations in the cells. Hakama et al. noted the risk for developing colorectal cancer considering the age and displayed the rate of incidence of 19.2/100,000 in patients older than 65 and 37.1/100,000 in patients older than 65 [54].

We have shown sexual predilection, i.e., a dominant representation of the malignant polyps in male patients. Song et al. [53] showed some higher prevalence of the malignant polyps in females. In some reports, there is an equal representation of both sexes [55]. The explanation for the evident difference between the sexes can be found in the results of controlled experiments. It has been proven that men and women differ in terms of the intestinal transit time, volume of feces, and production of short-chain fatty acids and bile acids [48,51,53].

The malignant polyps in the colon can be found in all of its segments. The dominant localization of the malignant polyp is in the sigmoid area. There is an evident trend of decreasing the prevalence of malignant polyps from distal toward proximal segments. The higher appearance of the malignant polyps distally located is confirmed by other authors [34,41,52,54]. The observed higher incidence of distal parts, verified in our and other studies, explains the earlier manifestation of symptoms in the distal colon compared to the proximal. There are studies, in which the results indicate a trend of increase in the incidence of colorectal carcinoma in the proximal segment of the large intestine, instead of a decrease in the distal parts [41].

There are suggested different genetic mechanisms of cancer appearance in the right and left colon and rectum. It is believed that the increase in the incidence of colorectal carcinoma in the right column is a result of the routine use of colonoscopy [36]. The most common localization of the malignant polyps at the distal part of the colon is in accordance with the predominant prevalence of colorectal cancer in precisely this part of the colon, which is one of the significant confirmations of the theory of adenoma-carcinoma sequence. The altered malignant polyps, regardless of the histological structure, were most rarely represented in the caecoascedent part of the colon. Since malignant polyps may be found in all segments of the colon, colonoscopy is the method of choice for the optimal endoscopic analysis of such tumors.

The most common are malignant polyps 10–29 mm in size. It has been observed that the increasing size of the malignant polyp is followed by the trend of malignant polyp localization in the distal segments of the colon. Many studies [53,55] have revealed an increasing incidence of the malignant polyp size >20 mm. The increase in the size of the adenoma increased the risk for malignancy [31,37,53,56]. Some studies have shown that a K-ras mutation is more frequently represented in larger adenomas [38].

The macroscopic tumor type is an important factor in determining the recurrence and metastatic potential of tumor cells [30]. By analyzing the configuration of the polyp, we have shown the dominance of the peduncular polyps, which are 3.4 times stronger than the polyp of the extensive base. Similar results have been shown in studies by other authors [56,57,58,59].

Significantly more frequent incomplete resection of the polyp was at those sessile configurations and patients with sessile configurations of malignant-altered polyps were 2.8 times more often referred to the surgeon. Similar results were shown by other authors [52]. The sessile macro-morphological configuration of the adenoma facilitates the development of residual and metastatic cancer. In all these cases, surgical intervention is necessary [27]. A polyp with a non-invasive carcinoma becomes an invasive polyp in a time [42] which can be interrupted by a polypectomy [37].

Endoscopic polypectomy and endoscopic mucosal resection were the endoscopic techniques available in our study for the removal of colon polyp. Considering endoscopic mucosal resection as a lower risk of adverse events, relatively simple to perform, and endoscopic submucosal dissection as a more complex, high-risk procedure performed by endoscopists associated with a higher perforation rate.

The most common complication after the endoscopic mucosal resection is bleeding, reported in 0.7–24% of the cases. Intraprocedural bleeding has been reported in 11–22% of cases [60].

The risk factor for intraprocedural bleeding includes large polyps, tubulovillous or villous lesion, and minimally elevated sessile polyps. Previously published articles showed that postprocedural bleeding occurs in 2–11% of cases, however, the rate of clinically significant bleeding is present in only 6% of cases and occurs hours to days after the procedure [61]. The bleeding rate after submucosal endoscopic resection has been reported in 0–11.9% for up to 15 days post-procedure [61]. Meta-analysis of 104 studies showed the rate of immediate and delayed major bleeding after submucosal endoscopic resection for colorectal lesions of 0.75 and 2.1% [62]. Risk factors for delayed bleeding include the lesion’s size, sessile type, the occurrence of intraprocedural bleeding, use of prior anti-thrombotic agents, and lesions in the cecum and rectum with a higher incidence [63].

Perforation is also a potential complication after endoscopic mucosal and submucosal resections. The perforation rate after endoscopic mucosal resection is low, reported as 1–2%.

Perforation is more common following colorectal endoscopic submucosal resection, with reported rate 3.3–10% [64]. Risk factors include using larger diameter snares (≥20 mm), proximal location, bulky lesions, and cutting current. Meta-analysis of 66 studies comparing these two endoscopic procedures for colorectal lesions found higher perforation rate with submucosal compared to mucosal resection [65]. Risk factors for perforations during submucosal resection, besides tumor size and location, include submucosal fibrosis and perforations are more in the ascending colon and cecum due to its thin wall. With reference to 2022 European Society of Gastrointestinal Endoscopy (ESGE) guidelines, submucosal endoscopic resection should be considered for en bloc resection of colorectal (but particularly rectal) lesions with suspicion of limited submucosal invasion (demarcated depressed area with irregular surface pattern or a large protruding or bulky component, particularly if the lesions are larger than 20 mm) or for lesions that otherwise cannot be completely removed by snare-based techniques [66]. Submucosal endoscopic resection showed benefits in the technical, histological, and oncological outcomes as it provides curative treatment without the need for surgery for lesions with a significant likelihood of submucosal invasion. ESD showed benefits in the technical, histological, and oncological outcomes as it provides curative treatment, associated with higher rate of en bloc and complete resection and lower recurrence compared to mucosal resection but, at the cost of increased procedural time, needs for additional surgical operations and perforation risk. [67].

Most of the malignant polyps are removed by polypectomy in one act; however, a higher percentage of incomplete resections was verified using the technique piece by piece. The results of other studies also show a slightly higher percentage of polypectomy technique in one act [43,44,45,46,47,52].

Most of the malignant polyps, as well as the highest percentage of remnant polyps, were in the area of tubulovillous adenoma type. The reports of other studies have shown the highest percentage of the polyp in the field of tubular adenoma, and the highest percentage of malignant alteration is in the field of villous adenoma, wherein the percentage of malignant tubulovillous adenomas is closer to the villous type instead of the tubular adenoma types [52,53,54,55,56,57]. The data from these and other studies are confirmation that the villous adenomas are the rarest histologic type of adenomas of the colon, but with the greatest malignant potential. Despite numerous tests, it cannot be claimed with certainty that the histological structure of villous adenoma is only directly responsible for the increased level of their malignant alteration.

The line of resection on the site of malignant-altered polyps which were removed by polypectomy in patients with complete resection was, in the highest percentage, without dysplasia and invasion. The radical excision of the polyp existed in 52.8% of patients and none of the patients from this group were sent to the surgeon. Five patients were diagnosed with the clear resection margin involvement, and all five patients on the control endoscopy had histological characteristics of remnant carcinoma in situ and invasive carcinoma and all were sent to the surgeon. The recurrent potential of adenoma or adenoma with carcinoma depends on the residual status, hereditary load, age, anatomical location, and histopathological features [56,58].

The group of patients who were referred to the surgeon for further treatment had shown malignant polyps over 30 mm in size and sessile configurations in the field of tubulovillous adenoma with a clear and ambiguous invasion of resection margins. The efficiency of a polypectomy and the rest of sessile polyps are dependent on several factors: the size of the polyp, the resection technique, endoscopist experiences, and histological type [54].

It should be noted that all adenomas grow over time and can change their size and the level of their appeared components. The process of malignant transformation is a lengthy multistep process that, depending on the characteristics of the adenoma, can last for years. In terms of the residual status, it is shown that for R 0 status, there is a high risk of recurrence or alterations and it requires an intensive monitoring within 3, 6, and 12 months. R x and R 1 are the status of a very high risk of recurrence or alteration with an intense monitoring or surgical resection [16]. The presence of neoplasia/cancer in adenoma always gives a long-term risk of adenoma recurrence (20.0–60.0% in the first 2 years) or the occurrence of carcinoma in the colon (5.0% in the next 15 years). The metastatic risk of the malignant polyps is dependent on the existence of submucosal invasion, presence of lymphatic-vascular invasion in 9.7–44.0% of neoplastic lesions, venular invasion in 3.5% malignant polyps, residual tumors at the resection margins, and poor histological differentiation of carcinoma [31,58,59].

Witold and colleagues have tried to define the histopathological criteria that were used to decide the therapeutic treatment of the malignant polyps [59]. The distance of the tumor from the resection margin, which is less than 1 mm of resection and/or grade III and/or lymphatic invasion and/or venous invasion, has been defined as unfavorable histological criteria [59]. The post-polypectomy follow-up period confirmed that the malignant polyp size over 3 cm with the incomplete resection, vascular space invasion, and poor histological differentiation requires the surgical resection [58].

5 Conclusions

Our data support the high efficacy of endoscopic polypectomy for the removal of the malignant polyp. Histology of the varied polyps and polypectomy were an adequate treatment except in cases with an invasive cancer. Most polyps were located in the left colon. The endoscopic polypectomy is effective in the removal of the malignant polyp and, thus, it reduces the risk of developing cancer, as supported by the literature. A regular follow-up program for these patients is mandatory.

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Acknowledgments

Not applicable.

  1. Funding information: The research was funded by the Faculty of Medical Sciences University of Kragujevac (Junior Project No. 09/10 “Expression of p16, p53, and VEGF, and cytokine profile in malignomas of the colorectal region”).

  2. Author contributions: VS, NZ2, and JD performed the statistical analyses of all data, NZ1, JZ, TNT, AM, KJ, and SM designed the study and collected all data. All authors approved the final version of the article.

  3. Conflict of interest: The authors declare that there is no conflict of interest regarding the publication of this article.

  4. Data availability statement: The datasets generated and/or analyzed during the current study are available at the Department of Internal Medicine, the Faculty of Medical Sciences the University of Kragujevac, Serbia.

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Received: 2023-03-18
Revised: 2023-09-02
Accepted: 2023-09-05
Published Online: 2023-10-17

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

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

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
https://doi.org/10.1515/med-2023-0811
Schlagwörter für diesen Artikel
colonic polyps; colorectal neoplasms; endoscopic polypectomy; post-polypectomy surveillance colonoscopy; surgery
Creative Commons
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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 13.10.2025 von https://www.degruyterbrill.com/document/doi/10.1515/med-2023-0811/html?srsltid=AfmBOopLj4jKGX9s8o9BhbgsMuEqlxcJ5UNYpqsvr65Bb-Ro8UazW4z0
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