Startseite Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
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Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach

  • Mohamed Badie Ahmed ORCID logo EMAIL logo , Salim Al Lahham , Ghanem Aljassem , Ayman A. H. Asnaf , Zaki T. N. Alyazji , Rand Y. Omari , Fatima Saoud Al-Mohannadi , Abeer Alsherawi und Semir Vranic
Veröffentlicht/Copyright: 3. Oktober 2023

Abstract

Global brachial plexus injury (GBPI) mainly affects adults and causes severe life-changing consequences that lead to the deterioration of patients’ quality of life. Several surgical approaches have been described and reported in the literature to improve patients’ functional ability. A literature review is done on PubMed/MEDLINE and Embase using specific keywords to retrieve relevant articles assessing different surgical approaches for GBPI management. Inclusion and exclusion criteria were applied, and eligible articles were included in the review. The literature survey revealed that various surgical options had been used to manage GBPI patients. In this concise review, we discuss and compare the different surgical approaches related to GBPI and its outcome in terms of restoring elbow flexion and extension, shoulder abduction, and wrist and hand function. The primary surgical intervention relies mainly on transferring single or multiple nerves with/without nerve grafts to restore the function of the targeted muscle. Different techniques using a variety of nerve donors and recipients are compared to assess the functional outcomes of each option. Moreover, further options are addressed for delayed GBPI injuries or failed nerve transfer procedures, as in free functional muscle transfer techniques. In addition, information about brachial plexus injury cases faced in our center is presented along with our center’s approach to diagnosing and managing partial and GBPI cases.

1 Introduction

Global brachial plexus injuries (GBPI) are life-altering injuries that might lead to physical and psychological impairment and disability. The most common cause of these injuries is trauma, and most affected patients are adults [1]. It has been reported that approximately 1.2% of the patients presenting to a trauma facility suffer from brachial plexus injury, most of whom are young male patients [2]. The brachial plexus might be injured at any level including upper, lower and total, or global injury (Table 1). GBPI is a severe and devastating event where all the plexus is injured, causing a severe functional deficit. Moreover, the nature of the injury limits surgeons due to scanty treatment options and the number of donor nerves. Thus, surgical management aims to restore essential upper limb functions. The highest priority is elbow flexion, followed by shoulder abduction and stability, and wrist and hand functions [3]. Although many surgical techniques have been applied and investigated to assess its outcome and success rate, managing GBPI represents a major challenge in upper limb reconstruction. Nerve transfer is considered the best option in treating brachial plexus injuries compared with other options, such as muscle transfer or tendon transfer. The same applies to GBPI but with fewer nerve donors available for the transfer. Therefore, multiple nerve transfer procedures have been described in GBPI events and their outcomes have been reported to assess the best option required to restore certain functions. In this mini-review, we aim to discuss the surgical options reported in the management of GBPI and its functional outcome.

Table 1

Brachial plexus level of injury with their rate

Study Lemus et al. [23] Cho et al. [24]
Level of injury Rate (%)
Upper injury (mainly C5, C6) 66.67 59
Lower injury (C8, T1) 10.71 8
Total injury C5-T1 22.61 33

2 Methods

The literature review was conducted on the available sources that describe surgical management and outcomes of traumatic brachial plexus injuries between 1990 and 2022. The databases used in this review were PubMed/MEDLINE and Embase. The following keywords were used: (surgical management) OR (surgical intervention)) OR (surgical treatment)) AND (trauma)) OR (traumatic)) AND (global brachial plexus injury)) OR (total brachial plexus injury)) OR (global brachial plexus avulsion)) OR (total brachial plexus avulsion)) OR (global brachial plexus palsy)) OR (total brachial plexus palsy)) AND (adults). Articles were classified based on their appropriateness and relevancy for this review. Most studies were excluded based on their titles and abstracts (Figure 1). Then, the final exclusion was based on the full article. Additionally, we performed a manual reference search of retrieved studies. Inclusion criteria were English-written articles, articles that investigate GBPI, trauma as a cause of the injury, articles that target the adult population, articles that discuss surgical management, and articles that assess the surgical outcome based on validated methods. Exclusion criteria were non-English articles, articles that investigate partial brachial plexus injuries, causes of BPI other than trauma, pediatric or geriatric population, articles that discuss non-surgical interventions or diagnosis approach, and articles that did not assess the surgical outcome.

Figure 1 
               Flow chart of the selected studies.
Figure 1

Flow chart of the selected studies.

The review is divided into subheadings containing the management and outcomes of each movement based on the reconstruction priority. The last section focuses on the muscle transfer options that could be used for various brachial plexus injuries and are not limited to traumatic global injuries. The information found in the selected studies on surgical management and outcomes of traumatic GBPI was thoroughly evaluated, and it is presented and discussed in the following sections.

3 Results

3.1 Elbow flexion

Elbow flexion is the first action that surgeons aim to restore as it is a primary movement needed in most daily activities. Thus, several articles discussed different approaches that could be used to reinnervate the muscles responsible for the action. Liu et al. conducted a study comparing phrenic and intercostal nerves’ ability to restore elbow flexion in GBPI patients after their transfer to the anterolateral bundle of the anterior division of the upper trunk anterolateral bundles of the musculocutaneous nerve, respectively [4]. The British Medical Research Council grading system was applied to evaluate the flexion strength in the two groups. The scale ranges from 0 to 5, and a grade of 3 or above was considered effective muscle power. The phrenic group’s effective motor recovery rate (EMRR) was 83% compared with 70% in the intercostal group. Moreover, the outstanding elbow flexion angle rate (>120°) was 48 and 40% in the phrenic and intercostal groups, respectively. However, the prognosis of the phrenic group was better; however, no statistical significance was observed between the groups regarding EMRR and the outstanding elbow flexion angle rate.

Another study compared phrenic nerve transfer with and without nerve graft and its ability to restore elbow flexion [5]. The direct nerve transfer group had an EMRR of 86%, while the nerve graft group had 84%; however, statistical significance was not reached. However, the timing of the surgery (within or more than 4 months) showed a statistically significant difference in muscle motor functional recovery. Moreover, Liu et al. assessed EMRR in biceps after transferring the phrenic nerve, intercostal nerves, or the contralateral seventh cervical nerve to the musculocutaneous nerve and showed an 86% recovery rate [6]. Further studies showed biceps muscle EMRR of 66, 77.7, and 33% when using a spinal accessory, intercostal, and contralateral C7 as donor nerves, respectively [7]. In addition, the proximal C5 stump was grafted in 7 patients and 5 (71%) had effective biceps muscle recovery.

Other options to restore elbow flexion in the case of failure of nerve transfer or unsatisfactory results are reported in the literature. Functioning-free muscle transfer (FFMT) is an effective option in GBPI [8]. Yang et al. explored the functional outcome of transferring free gracilis to reconstruct elbow flexion in GBPI patients [9]. The results showed that elbow flexion muscle power was effective (M3 or above) in 85.7% of the patients, and the average range of motion of elbow flexion was 106.5°. Another study assessed elbow flexion in traumatic brachial plexus injury patients. No difference in elbow flexion outcome was detected when comparing patients with FFMT innervated by either intercostal nerve or spinal accessory nerve grafts [10].

3.2 Shoulder abduction

Shoulder stability and abduction is the second most crucial action that should be restored after elbow flexion [3]. Several studies discussed options to restore this function. However, the options in GBPI are sparse due to the severity of the injury and the number of nerves affected. Bhatia et al. conducted a cohort study on patients with GBPI and assessed the role of nerve reconstruction in restoring several functions, including shoulder abduction [7]. Transferring the spinal accessory nerve to the suprascapular nerve showed 88% EMRR of the supraspinatus muscle. Moreover, the abduction angle restored in most cases was 30–45° and reached up to 70–80° in a few cases.

Another study examined the transfer of the spinal accessory nerve or the contralateral lateral thoracic nerve to the suprascapular nerve on supraspinatus muscle recovery [6]. The reported EMRR was 54%. A new technique to restore shoulder stability and abduction was reported in one case with GBPI in the literature [11]. The technique utilizes the contralateral spinal accessory nerve and transfers it to the suprascapular nerve using a nerve graft (sural nerve). The patient regained active shoulder abduction (26°) and external rotation (15°) after 24 months of follow-up after the surgery. The authors proposed this technique as a reliable option for GBPI shoulder reanimation in cases where transferring the ipsilateral spinal accessory nerve is impossible.

3.3 Elbow extension

Restoring elbow extension is essential for elbow stability and normal movement without using the contralateral hand to stabilize the elbow. Thus, surgeons started paying attention and considering different techniques to restore elbow extension [12]. Zheng et al. studied the possibility of using phrenic and intercostal nerves to restore elbow flexion and extension in the same patients [13]. The results showed that 85% of the patients had efficient elbow flexion, while none of them had efficient elbow extension. Thus, they recommended avoiding intercostal nerve transfer after phrenic nerve transfer in patients with GBPI.

On the other hand, Gao et al. evaluated the outcome of intercostal nerve transfer to the nerve of the long head of the triceps muscle [14]. The study included two groups, one with two intercostal and three intercostal nerve transfers. The first group (two intercostals) had an EMRR of 55.56%, while the second group had 57.14% with no significant statistical difference. Moreover, the results approved the possibility of transferring intercostal nerves to restore elbow extension even if combined with phrenic nerve transfer to restore elbow flexion, which is opposite to the previous article’s suggestion. In this study, the EMRR of the biceps and triceps muscles in patients with phrenic and intercostal nerve transfer was 88 and 56%, respectively. Therefore, combining phrenic and intercostal nerve transfer is a valid option for patients requiring these surgeries.

Another study compared intercostal nerves with contralateral C7 nerve transfer to the long head branch of the triceps and evaluated elbow extension outcomes [15]. The elbow extension EMRR was 47 and 28.5% in the intercostal and contralateral C7 nerve groups, respectively, with no significant difference. Bhatia et al. assessed triceps function after intercostal nerve transfer and reported grade 2 muscle recovery as a successful outcome since patients cannot abduct shoulders above 90° [7]. As a result, the successful muscle recovery rate was 80%. In contrast, Liu et al. reported efficient triceps muscle recovery after nerve transfer as grade 3 or above, and the EMRR was 46% [6].

3.4 Hand and wrist functions

Restoring hand and wrist functions is not a priority in GBPI patients; elbow flexion and shoulder stability are at the top. However, restoring their functions improves patients’ satisfaction and quality of life. One study assessed the efficacy of transferring contralateral C7 to different recipient groups (median nerve, median nerve + biceps branch, median nerve + triceps branch) [16]. Flexor carpi radialis EMRR was 57.7% in the median nerve, 45.5% in the median nerve + biceps branch, and 36.4% in the median nerve + triceps branch groups, with no significant difference. Moreover, wrist and digital flexion range of motions significantly improved across the three groups after the surgery. In cases of two nerve transfers, the biceps branch showed a better outcome than the triceps branch. Thus, the authors recommended the use of the biceps branch with a median nerve in the transfer.

Another study evaluated the possibility of restoring wrist and intrinsic muscle flexion using a nerve graft for the median nerve from ipsilateral proximal nerve root stumps or contralateral C7 [7]. The first group results showed that 27% of the patients had grade 2 muscle recovery, while finger flexion was achieved in 26% of the second group. In addition, intercostal nerves and contralateral C7 nerve were transferred to the median nerve, and the outcome was reported by Liu et al. Finger flexor muscles showed an EMRR of 43% [6].

3.5 Muscle transfer options

Muscle transfers are an optimal approach to restore many upper limb functions in cases of delayed GBPI reconstruction or failure of nerve transfer options.

Free gracilis muscle transfer was used in the late 1990s to restore hand functions and resulted in a good outcome [17]. It was also used to restore elbow flexion and finger extension. However, the outcome was less effective when compared with the combined gracilis adductor longus triple free functioning muscle transfer, described by Sananpanich et al. [18]. This technique outcome showed satisfactory finger extension and good hook grip of the hand with good elbow flexion [19].

One study assessed the functional outcome of GBPI patients managed by nerve transfer, single-free muscle, or double-free muscle transfer [20]. The results showed no difference in shoulder abduction and flexion among the three groups. However, the shoulder’s external rotation and the elbow flexion range were significantly higher in DFMT patients.

Using double-free functioning muscle transfer to restore elbow flexion and hand functions was also reported by Doi et al. [21]. The study outcomes showed the ability to restore excellent to good elbow flexion in 96% of the treated patients. In addition, 65% restored >30° of total active finger motion with the second muscle transfer. Moreover, Dodakundi et al. reported a significant improvement in the arm, shoulder, and hand scores after double-free functioning muscle transfer in traumatic total brachial plexus palsy patients [22].

3.6 Our center approach

The cases we encounter at our center are closed (90%) or open injuries (10%). Most open injuries are due to penetrating injuries affecting the whole plexus. This type is usually explored and repaired immediately. The closed type is usually secondary to road traffic accidents or direct trauma to the shoulder and is managed conservatively at the beginning. After comprehensive clinical assessment and determining the level of brachial plexus injury, we perform magnetic resonance imaging (MRI) and electromyography (EMG) over 3 weeks as a baseline investigation. Then, another set of investigations is done 3 months postinjury if needed. Patients are referred to occupational therapy and physical rehabilitation to prevent any muscle atrophy or contracture deformity and to prepare them for surgical interventions if required. At 3 months, if there is no recovery of elbow flexion or a paradoxical recovery pattern is observed, new EMG and MRI are requested to accurately determine the type and level of brachial plexus injury. Then, the surgical intervention will be planned based on the clinical assessment and investigation outcome.

Modified Oberlin transfer is usually conducted in case of lower roots recovery with no signs of elbow flexion (Figures 2 and 3). However, if GBPI is confirmed, the following procedures are usually done. Spinal accessory nerve transfer to the suprascapular nerve is done to restore shoulder function. After that, elbow flexion is restored after transfer of intercostal nerves through free innervated muscle (mainly gracilis muscle). Then, wrist fusion is done, followed by elongation of the free innervated muscle using fascia lata for finger flexion and elbow flexion simultaneously. In patients with supination fixed deformity, rotational osteotomy is done to correct the forearm posture into a mid-pronation position for functional outcome. The recovery period might take up to 2 years, where patients are followed at 2 weeks postoperative and then after 1 month. After that, follow-up appointments are given every 3 months. EMG can be done after 3 months of nerve transfer to check for any signs of reinnervation and can be repeated at 6 months postoperative if the clinical assessment shows progression.

Figure 2 
                  Exploration findings of brachial plexus peripheral nerves through a medial arm incision. The biceps muscle is retracted to the lateral side.
Figure 2

Exploration findings of brachial plexus peripheral nerves through a medial arm incision. The biceps muscle is retracted to the lateral side.

Figure 3 
                  Transfer of one of the fascicles that innervate FCU muscle from the ulnar nerve to the MCN branch of the biceps brachii muscle. Transfer of one of the fascicles that innervate the FCR muscle from the median nerve to the MCN branch of the brachialis muscle. The choice of the fascicles was confirmed intra-operatively using a nerve stimulator.
Figure 3

Transfer of one of the fascicles that innervate FCU muscle from the ulnar nerve to the MCN branch of the biceps brachii muscle. Transfer of one of the fascicles that innervate the FCR muscle from the median nerve to the MCN branch of the brachialis muscle. The choice of the fascicles was confirmed intra-operatively using a nerve stimulator.

4 Conclusions

GBPI is a devastating event that can lead to major restrictions and a severe decline in patients’ quality of life. Also, the nature of the injury limits many surgical options that could be used to manage these cases. Several surgical managements have been suggested to restore the most important functions that may improve patients’ ability to perform essential daily activities independently. However, the functional outcome varies across studies due to several factors. Based on our center’s experience, managing GBPI patients is very challenging. The management should address several factors, including feasible surgical options, patient priorities and needs, and follow-up system availability. More extensive studies should be conducted to validate the optimal surgical options for different GBPI cases.



Acknowledgments

The authors acknowledge Qatar National Library for funding the open-access publication of this review.

  1. Funding information: The authors thank Qatar National Library for funding the open-access publication of this article.

  2. Author contributions: All authors were actively involved in the review and read and approved the final manuscript for publication.

  3. Conflict of interest: The authors have no conflict of interest to declare.

  4. Data availability statement: The data supporting this study’s findings are available from the corresponding author upon reasonable request.

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Received: 2022-09-05
Revised: 2023-09-14
Accepted: 2023-09-18
Published Online: 2023-10-03

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

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

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  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
Heruntergeladen am 16.9.2025 von https://www.degruyterbrill.com/document/doi/10.1515/med-2023-0817/html
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