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Factors associated with gastrointestinal dysmotility in critically ill patients

  • Nemanja Petrović EMAIL logo , Miodrag Žunić , Ana Pejčić , Miloš Milosavljević and Slobodan Janković
Published/Copyright: October 5, 2023
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Open Medicine
From the journal Open Medicine Volume 18 Issue 1

Abstract

Critical illness may disrupt nutritional, protective, immune, and endocrine functions of the gastrointestinal tract, leading to a state of gastrointestinal dysmotility. We aimed to identify factors associated with the occurrence of gastrointestinal dysmotility in critically ill patients. A cross-sectional retrospective study was conducted, using patient files as a source of data. The study included 185 critically ill patients treated in the intensive care unit of the University Clinical Center, Kragujevac, Serbia, from January 1, 2016, to January 1, 2022. Significant risk factors associated with some form of gastrointestinal dysmotility were acute kidney injury (with paralytic ileus, nausea, vomiting, and constipation), recent abdominal surgery (with ileus, nausea, vomiting, and constipation), mechanical ventilation (with ileus, and nausea), age (with ileus and constipation), and use of certain medication such as opioids (with ileus, gastro-esophageal reflux, nausea, vomiting, and constipation), antidepressants (with ileus, nausea, and vomiting), and antidiabetics (with ileus). On the other hand, Charlson comorbidity index had divergent effects, depending on the form of gastrointestinal dysmotility: it increased the risk of gastro-esophageal reflux but protected against ileus, nausea, and vomiting. In clonclusion, recognition of factors associated with gastrointestinal dysmotility should initiate preventative measures and, thus, accelerate the recovery of critically ill.

Keywords: gastrointestinal dysmotility; critically ill patients; risk factors; intensive care unit

1 Introduction

Patients who suffer from, or are at risk of developing life-threatening conditions or diseases, are considered critically ill. As a rule, critically ill patients are treated in intensive care unit (ICU), where the attention of physicians is mainly focused on respiratory and cardiovascular functions [1]. However, critical illness also may disrupt nutritional, protective, immune, and endocrine functions of the gastrointestinal tract (GIT). Diarrhea, nausea, vomiting, gastro-esophageal reflux, abdominal distension, ileus, constipation, and high residual gastric volume, are features of GIT dysfunction classified to the category of gastrointestinal dysmotility (GID). Patients presenting three or more clinical manifestations of GIT dysmotility have a threefold increase in the risk of death [2]. GID is estimated to affect approximately 60% of critically ill patients [3].

Gastroparesis, or slowed gastric emptying occurs with a prevalence of 4–5% in the general population, while among critically ill patients in the ICU, it is encountered more frequently [4]. Acute intestinal pseudo-obstruction, also known as Ogilvy's syndrome, is an acute dilatation of the colon without any mechanical obstruction; it significantly increases mortality [5]. Other modalities of GID are also frequently encountered and may hamper the recovery of critically ill patients. The etiology of gastrointestinal motor dysfunction in critical illness is unclear, but it is likely multifactorial. Factors associated with GID in earlier studies were burns [6], head injuries [7], sepsis, polytrauma [8], chronic diseases like diabetes mellitus type 2 [9], electrolyte abnormalities, advanced age, gender, some medication (such as opioids or alpha-adrenergic agonists), recent abdominal surgery, circulatory shock, and increased plasma levels of some cytokines [10]. However, not all studies confirmed the influence of these factors, and a number of other potentially important ones were not investigated to date.

Considering the significant controversies concerning risk factors and their interaction, our study aimed to test known predictors and investigate some new potential predictors of GID in critically ill patients, as well as to quantify the strength of their effects.

2 Methods

A cross-sectional retrospective study design was used for the study. The study population consisted of critically ill patients treated in the ICU of the University Clinical Center Kragujevac in Kragujevac, Serbia, from January 1, 2016, to January 1, 2022. The criteria for the inclusion of patients were: the existence of an acutely occurring critical illness (patients with acute dysfunction of one or more organs or organ systems or a threatening risk for its occurrence, with the need for intensive follow-up and monitoring) and a stay in the ICU for longer than 48 h. Patients were excluded from the study if they were younger than 18 years, on a chronic hemodialysis program, with decompensated liver cirrhosis, with chronic gastrointestinal diseases (gastroesophageal reflux disease, peptic ulcer, gastritis, inflammatory bowel disease, irritable colon, chronic diarrhea, etc.), if the data from the medical history were not complete, and if a patient was a pregnant woman. The sample used for the study was of convenient type, although consecutive, i.e., all patients who satisfied inclusion and without exclusion criteria within the study period were included.

The main study outcomes were GID in general, and its specific types: paralytic ileus, gastroesophageal reflux, nausea, vomiting, and constipation. The specific types of GID were accounted for each of the study patients only if their diagnoses were recorded in the patient files by the responsible physician during the patients’ stay in the ICU, using the ICD-10 codes: K56.0 for paralytic ileus, K21.0 for gastroesophageal reflux, R11.0 for nausea, R11.1, R11.2, R11.10, R11.11, R11.12, and K91.0 for vomiting, and K59.01 for constipation. The patient was considered to have GID in general if at least one of the abovementioned specific types of GID was recorded in his/her file. Apart from several independent variables known from previous research that may influence gastrointestinal motility (opioids, previous abdominal surgery, mechanical ventilation, sepsis, shock, and diabetes mellitus), a plethora of confounders was also extracted from the patient files: routine blood biochemistry and hematology, Charlson comorbidity index, prescribed medication, and diagnoses of acute events occurring during hospitalization in the ICU. The data were extracted by two independent investigators from electronic patients’ histories embedded in the hospital information system “ZIS” (Comtrade, Belgrade) and then harmonized among themselves by consensus.

A minimal sample size was sufficient for the purpose of finding factors significantly associated with GID as the main outcome was calculated by the Schlesselman’s method [11]. The following inputs were used for the calculation: probability of type 1 error of 0.05, minimal statistical power 0.8, incidence of the outcome 51%, prevalence of inhalation injury as a risk factor of 54%, and meaningful adjusted odds ratio of 1.61 for the risk factor. The minimal sample size satisfying the inputs was 68 patients per the study group, or in total 136 patients.

The data collected from the ZIS information system were first numerically coded, tabulated, and checked for errors by both investigators independently. The data were then described by measures of central tendency and variability (if continuous), or by frequencies and relative numbers and percentages (if categorical). Mean and standard deviation were used as descriptors of normally distributed continuous data, while median and interquartile range described the data distributed in other way. Effects of putative predictors and confounders on the study outcomes were analyzed by multivariate binary logistic regression. Before applying these multivariate techniques, their assumptions were checked whether being satisfied (binary outcome, independency of observations, no multicollinearity, no extreme outliers, and sufficiently large sample for multivariate binary logistic regression). The quality of the regression models was checked by the Hosmer and Lemeshow test, Cox & Snell R square, and Nagelkerke R square. The results were considered statistically significant if the probability of null hypothesis was 0.05 or below. All calculations were made by the Statistical Package for the Social Sciences (SPSS), version 18.0.

  1. Ethical approval: The research has been complied with all the relevant national regulations, institutional policies, and in accordance the tenets of the Helsinki Declaration and has been approved by the institutional review board, the Ethics Committee of University Clinical Center Kragujevac (approval number: 01/22-198).

  2. Informed consent: This is a retrospective study, and for this type of study, formal consent is not required.

3 Results

The study included a total of 185 patients treated in the ICU. The number of cases that had ileus is 95 (51.4%), and the total number of controls is 90 (48.6%). Patients were matched by gender and age. No controls were found for 5 subjects. A total of 121 patients (65.4%) had gastro-esophageal reflux. Nausea was experienced by 92 patients (49.7%). Vomiting was experienced by 60 patients (32.4%). Constipation was experienced by 104 patients (56.2%). A total of 160 patients (86.5%) had some form of GID. Detailed data of the study sample of patients are shown in Table 1.

Table 1

Characteristics of respondents

Parameter Value
Gender (m/f) 103/82 (55.7%/44.3%)
Age 65.55 ± 16.128, 69, 19
Ileus (yes/no) 95/90 (51.4%/48.6%)
Gastro-esophageal reflux (yes/no) 121/64 (65.4%/34.6%)
Nausea (yes/no) 92/93 (49.7%/50.3%)
Vomiting (yes/no) 60/125 (32.4%/67.6%)
Constipation (yes/no) 104/81 (56.2%/43.8%)
Mechanical ventilation (yes/no) 138/47 (74.6%/25.4%)
Recent abdominal surgeries (yes/no) 51/134 (27.6%/72.4%)
Sepsis (yes/no) 86/99 (46.5%/53.5%)
Diabetes mellitus 2 (yes/no) 122/63 (65.9%/34.1%)
Shock (yes/no) 89/96 (48.1%/51.9%)
Myocardial infarction (yes/no) 51/134 (27.6%/72.4%)
Congestive heart failure (yes/no) 138/47 (74.6%/25.4%)
Peripheral vascular disease (yes/no) 66/119 (35.7%/64.3%)
Cerebrovascular event (yes/no) 62/123 (33.5%/66.5%)
Dementia (yes/no) 23/162 (12.4%/87.6%)
Chronic obstructive pulmonary disease (yes/no) 85/100 (45.9%/54.1%)
Connective tissue disease (yes/no) 3/182 (1.6%/98.4%)
Gastric ulcer (yes/no) 95/90 (51.4%/48.6%)
Liver disease (yes/no) 7/178 (3.8%/96.2%)
Hemiplegia (yes/no) 25/160 (13.5%/86.5%)
Solid tumor (yes/no) 104/81 (56.2%/43.8%)
Acute kidney injury (yes/no) 88/97 (47.6%/52.4%)
Fatality (yes/no) 91/94 (49.2%/50.8%)
Antidiabetics (yes/no) 116/69 (62.7%/37.3%)
Antihypertensives (yes/no) 121/64 (65.4%/34.6%)
Antibiotics (yes/no) 160/25 (86.5%/13.5%)
Opioids (yes/no) 112/73 (60.5%/39.5%)
NSAIDs (yes/no) 129/56 (69.7%/30.3%)
PPIs (yes/no) 135/50 (73.0%/27.0%)
Antidepressants (yes/no) 32/153 (17.3%/82.7%)
Antipsychotics (yes/no) 17/168 (9.2%/90.8%)
H2 blockers (yes/no) 55/130 (29.7%/70.3%)
Corticosteroids (yes/no) 31/154 (16.8%/83.2%)
Heparin (yes/no) 129/56 (69.7%/30.3%)
Pulse 94.92 ± 22.412, 94, 32
Respiration rates 21.74 ± 5.705, 19.5, 10
Platelets 226.41 ± 146.354, 202, 194
Serum creatinine 151.2 ± 120.251, 110, 133
Sodium 140.423 ± 8.3323, 139, 7
Potassium 4.16 ± 0.891, 4.1, 1.0
Hematocrit 0.3109 ± 0.05992, 0.30, 0.07
Leukocytes 14.675 ± 9.1162, 12.5, 8.3
QSOFA 1.57 ± 1.343, 2.0, 3
Glasgow Coma Scale 12.91 ± 2.395, 14.0, 3
Charlson comorbidity index 8.01 ± 3.767, 8, 5

Abbreviations: NSAIDs – non-steroidal anti-inflammatory drugs; PPIs – proton pump inhibitors; QSOFA – Quick Sequential Organ Failure Assessment score.

Note: Results for continuous variables are shown as mean ± standard deviation, median, interquartile range, and for categorical variables as frequency and percentages.

The characteristics of the subjects according to the groups formed based on the outcome (ileus, gastro-esophageal reflux, nausea, vomiting, constipation) are shown in Table 2. Since there was no normal distribution, the results for continuous variables are shown as median and interquartile range and for categorical variables as frequency and percentages. The results of the tests for examining the significance of the difference between groups, and for individual parameters, are shown in the last column of Table 2.

Table 2

Univariate analysis according to outcomes

Parameter Gastrointestinal dysmotility No gastrointestinal dysmotility Probability of null hypothesis (p)
Ileus
Gender (m/f) 48/47 (50.5%/49.5%) 55/35 (61.1%/38.9) 0.193
Age 70 (19) 68 (19) 0.094
Platelets 216 (198) 187 (188) 0.284
Serum creatinine 133 (135) 92 (119) 0.045
Pulse 97 (31) 90 (33) 0.185
Sodium 139 (7) 140 (9) 0.152
Potassium 4 (1.2) 4.2 (1) 0.070
Hematocrit 0.31 (0.07) 0.29 (0.07) 0.051
Leukocytes 12.2 (8.9) 12.8 (7.7) 0.979
QSOFA 1 (3) 2 (3) 0.747
Respiration rates 18 (10) 23 (10) 0.261
Charlson comorbidity index 8 (5) 8 (5) 0.069
Glasgow Coma Scale 14 (3) 13 (4) 0.984
Mechanical ventilation (yes/no) 85/10 (89.5%/10.5%) 53/37 (58.9%/41.1%) 0.000
Opioids (yes/no) 74/21 (77.9%/22.1%) 38/52 (42.2%/57.8%) 0.000
Recent abdominal surgeries (yes/no) 45/50 (47.4%/52.6%) 6/84 (6.7%/93.3%) 0.000
Sepsis (yes/no) 52/43 (54.7%/45.3%) 34/56 (37.8%/62.2%) 0.030
Diabetes mellitus 2 (yes/no) 69/26 (72.6%/27.4%) 53/37 (58.9%/41.1%) 0.069
Shock (yes/no) 53/42 (55.8%/44.2%) 36/54 (40.0%/60.0%) 0.045
Acute kidney injury (yes/no) 48/47 (50.5%/49.5%) 40/50 (44.4%/55.6%) 0.496
Operated (yes/no) 93/2 (97.9%/2.1%) 90/0 (100%/0%) 0.501
Antidiabetics (yes/no) 69/26 (72.6%/27.4%) 47/43 (52.2%/47.8%) 0.007
Antihypertensives (yes/no) 64/31 (67.4%/32.6%) 57/33 (63.3%/36.7%) 0.673
Antibiotics (yes/no) 79/16 (83.2%/16.8%) 81/9 (90.0%/10.0%) 0.252
Opioids (yes/no) 74/21 (77.9%/22.1%) 38/52 (42.2%/57.8%) 0.000
NSAIDs (yes/no) 62/33 (65.3%/34.7%) 67/23 (74.4%/25.6%) 0.231
PPIs (yes/no) 72/23 (75.8%/24.2%) 63/27 (70.0%/30.0%) 0.471
Antidepressants (yes/no) 25/70 (26.3%/73.7%) 7/83 (7.8%/92.2%) 0.002
Antipsychotics (yes/no) 13/82 (13.7%/86.3%) 4/86(4.4%/95.6%) 0.055
H2 blockers (yes/no) 27/68 (28.4%/71.6%) 28/62 (31.1%/68.9%) 0.811
Corticosteroids (yes/no) 11/84 (11.6%/88.4%) 20/70 (22.2%/77.8%) 0.082
Heparin (yes/no) 73/22 (76.8%/23.2%) 56/34 (62.2%/37.8%) 0.045
Gastro-esophageal reflux
Gender (m/f) 66/55 (54.5%/45.5%) 37/27(57.8%/42.2%) 0.787
Age 69 (17) 66 (24) 0.312
Platelets 195 (188) 220 (223) 0.364
Serum creatinine 118 (136) 95 (113) 0.056
Pulse 94 (35) 90 (30) 0.714
Sodium 140 (8) 139 (7) 0.632
Potassium 4.1 (0.9) 3.8 (1.2) 0.072
Hematocrit 0.30 (0.07) 0.31 (0.1) 0.776
Leukocytes 12.7 (8.4) 12.3 (8.6) 0.691
QSOFA 2 (3) 1 (3) 0.290
Respiration rates 23 (10) 18 (9) 0.052
Charlson comorbidity index 9 (4) 6 (7) 0.000
Glasgow Coma Scale 13 (4) 14 (3) 0.258
Mechanical ventilation (yes/no) 92/29 (76.0%/24.0%) 46/18 (71.9%/28.1%) 0.660
Opioids (yes/no) 78/43 (64.5%/35.5%) 34/30 (53.1%/46.9%) 0.179
Recent abdominal surgeries (yes/no) 36/85 (29.8%/70.2%) 15/49 (23.4%/76.6%) 0.458
Sepsis (yes/no) 57/64 (47.1%/52.9%) 29/35 (45.3%/54.7%) 0.938
Diabetes mellitus 2 (yes/no) 85/36 (70.2%/29.8%) 37/27 (57.8%/42.2%) 0.125
Shock (yes/no) 64/57 (52.9%/47.1%) 25/39 (39.1%/60.9%) 0.102
Acute kidney injury (yes/no) 61/60 (50.4%/49.6%) 27/37 (42.2%/57.8%) 0.362
Operated (yes/no) 120/1 (99.2%/0.8%) 63/1 (98.4%/1.6%) 1.000
Antidiabetics (yes/no) 81/40 (66.9%/33.1%) 35/29 (54.7%/45.3%) 0.139
Antihypertensives (yes/no) 84/37 (69.4%/30.6%) 37/27 (57.8%/42.2%) 0.157
Antibiotics (yes/no) 104/17 (86%/14%) 56/8 (87.5%/12.5%) 0.946
Opioids (yes/no) 78/43 (64.5%/35.5%) 34/30 (53.1%/46.9%) 0.179
NSAIDs (yes/no) 82/39 (67.8%/32.2%) 47/17 (73.4%/26.6%) 0.529
PPIs (yes/no) 89/32 (73.6%/26.4%) 46/18 (71.9%/28.1%) 0.944
Antidepressants (yes/no) 18/103 (14.9%/85.1%) 14/50 (21.9%/78.1%) 0.321
Antipsychotics (yes/no) 8/113 (6.6%/93.4%) 9/55 (14.1%/85.9%) 0.161
H2 blockers (yes/no) 31/90 (25.6%/74.4%) 24/40 (37.5%/62.5%) 0.130
Corticosteroids (yes/no) 22/99 (18.2%/81.8%) 9/55 (14.1%/85.9%) 0.612
Heparin (yes/no) 84/37 (69.4%/30.6%) 45/19 (70.3%/29.7%) 1.000
Nausea
Gender (m/f) 51/41 (55.4%/44.6%) 52/41 (55.9%/44.1%) 1.000
Age 70 (21) 68 (16) 0.297
Platelets 197 (207) 213 (182) 0.824
Serum creatinine 133 (135) 92(116) 0.017
Pulse 98 (33) 90 (35) 0.212
Sodium 139 (7) 140 (9) 0.085
Potassium 4.0 (1.3) 4.2 (0.9) 0.150
Hematocrit 0.31 (0.08) 0.30 (0.07) 0.839
Leukocytes 12.2 (8.6) 12.8 (7.9) 0.683
QSOFA 2 (3) 2 (3) 0.542
Respiration rates 19 (10) 23 (10) 0.147
Charlson comorbidity index 8 (5) 8 (5) 0.120
Glasgow Coma Scale 14 (4) 14 (3) 0.352
Mechanical ventilation (yes/no) 81/11 (88.0%/12.0%) 57/36 (61.3%/38.7%) 0.000
Opioids (yes/no) 70/22 (76.1%/23.9%) 42/51 (45.2%/54.8%) 0.000
Recent abdominal surgeries (yes/no) 41/51 (44.6%/55.4%) 10/83 (10.8%/89.2%) 0.000
Sepsis (yes/no) 51/41 (55.4%/44.6%) 35/58 (37.6%/62.4%) 0.023
Diabetes mellitus 2 (yes/no) 65/27 (70.7%/29.3%) 57/36 (61.3%/38.7%) 0.235
Shock (yes/no) 54/38 (58.7%/41.3%) 35/58 (37.6%/62.4%) 0.007
Acute kidney injury (yes/no) 48/44 (52.2%/47.8%) 40/53 (43%/57%) 0.271
Operated (yes/no) 90/2 (97.8%/2.2%) 93/0 (100%/0%) 0.472
Antidiabetics (yes/no) 65/27 (70.7%/29.3%) 51/42 (54.8%/45.2%) 0.038
Antihypertensives (yes/no) 62/30 (67.4%/32.6%) 59/34 (63.4%/36.6%) 0.682
Antibiotics (yes/no) 76/16 (82.6%/17.4%) 84/9 (90.3%/9.7%) 0.187
Opioids (yes/no) 70/22 (76.1%/23.9%) 42/51 (45.2%/54.8%) 0.000
NSAIDs (yes/no) 58/34 (63.0%/37.0%) 71/22 (76.3%/23.7%) 0.070
PPIs (yes/no) 70/22 (76.1%/23.9%) 65/28 (69.9%/30.1%) 0.434
Antidepressants (yes/no) 25/67 (27.2%/72.8%) 7/86 (7.5%/92.5%) 0.001
Antipsychotics (yes/no) 13/79 (14.1%/85.9%) 4/89 (4.3%/95.7%) 0.039
H2 blockers (yes/no) 27/65 (29.3%/70.7%) 28/65 (30.1%/69.9%) 1.000
Corticosteroids (yes/no) 13/79 (14.1%/85.9%) 18/75 (19.4%/80.6%) 0.451
Heparin (yes/no) 73/19 (79.3%/20.7%) 56/37 (60.2%/39.8%) 0.008
Vomiting
Gender (m/f) 28/32 (46.7%/53.3%) 75/50 (60.0%/40.0%) 0.121
Age 68 (21) 69 (18) 0.992
Platelets 194 (197) 205 (204) 0.642
Serum creatinine 133 (140) 101 (121) 0.069
Pulse 101 (28) 90 (35) 0.014
Sodium 139 (8) 139 (7) 0.592
Potassium 4.0 (1.1) 4.1 (1) 0.192
Hematocrit 0.31 (0.07) 0.30 (0.07) 0.837
Leukocytes 12.2 (9.1) 12.7 (7.9) 0.932
QSOFA 2 (3) 1 (3) 0.891
Respiration rates 22 (11) 19 (10) 0.766
Charlson comorbidity index 7 (6) 8 (5) 0.150
Glasgow Coma Scale 13 (3) 14 (4) 0.951
Mechanical ventilation (yes/no) 51/9 (85.0%/15.0%) 87/38 (69.6%/30.4%) 0.038
Opioids (yes/no) 48/12 (80.0%/20.0%) 64/61 (51.2%/48.8%) 0.000
Recent abdominal surgeries (yes/no) 29/31 (48.3%/51.7%) 22/103 (17.6%/82.4%) 0.000
Sepsis (yes/no) 33/27 (55.0%/45.0%) 53/72 (42.4%/57.6%) 0.147
Diabetes Mellitus 2 (yes/no) 42/18 (70.0%/30.0%) 80/45 (64.0%/36.0%) 0.522
Shock (yes/no) 36/24 (60.0%/40.0%) 53/72 (42.4%/57.6%) 0.037
Acute kidney injury (yes/no) 34/26 (56.7%/43.3%) 54/71 (43.2%/56.8%) 0.119
Operated (yes/no) 59/1 (98.3%/1.7%) 124/1 (99.2%/0.8%) 1.000
Antidiabetics (yes/no) 42/18 (70.0%/30.0%) 74/51 (59.2%/40.8%) 0.208
Antihypertensives (yes/no) 40/20 (66.7%/33.3%) 81/44 (64.8%/35.2%) 0.932
Antibiotics (yes/no) 46/14 (76.7%/23.3%) 114/11 (91.2%/8.8%) 0.013
Opioids (yes/no) 48/12 (80.0%/20.0%) 64/61 (51.2%/48.8%) 0.000
NSAIDs (yes/no) 36/24 (60.0%/40.0%) 93/32 (74.4%/25.6%) 0.068
PPIs (yes/no) 48/12 (80.0%/20.0%) 87/38 (69.6%/30.4%) 0.189
Antidepressants (yes/no) 16/44 (26.7%/73.3%) 16/109 (12.8%/87.2%) 0.033
Antipsychotics (yes/no) 10/50 (16.7%/83.3%) 7/118 (5.6%/94.4%) 0.030
H2 blockers (yes/no) 13/47 (21.7%/78.3%) 42/83 (33.6%/66.4%) 0.136
Corticosteroids (yes/no) 11/49 (18.3%/81.7%) 20/105 (16.0%/84.0%) 0.851
Heparin (yes/no) 43/17 (71.7%/28.3%) 86/39 (68.8%/31.2%) 0.821
Constipation
Gender (m/f) 56/48 (53.8%/46.2%) 47/34 (58.0%/42.0%) 0.676
Age 70 (18) 67 (21) 0.004
Platelets 213 (205) 187 (181) 0.452
Serum creatinine 142 (145) 89 (92) 0.000
Pulse 96 (32) 90 (34) 0.656
Sodium 139 (8) 139 (7) 0.790
Potassium 4.0 (1.3) 4.1 (0.9) 0.509
Hematocrit 0.31 (0.08) 0.3 (0.06) 0.392
Leukocytes 12.4 (9.8) 12.6 (7.3) 0.298
QSOFA 2 (3) 1 (3) 0.522
Respiration rates 22 (10) 19 (10) 0.329
Charlson comorbidity index 9 (6) 7 (6) 0.011
Glasgow Coma Scale 13 (4) 14 (3) 0.240
Mechanical ventilation (yes/no) 85/19 (81.7%/18.3%) 53/28 (65.4%/34.6%) 0.018
Opioids (yes/no) 77/27 (74.0%/26.0%) 35/46 (43.2%/56.8%) 0.000
Recent abdominal surgeries (yes/no) 42/62 (40.4%/59.6%) 9/72 (11.1%/88.9%) 0.000
Sepsis (yes/no) 55/49 (52.9%/47.1%) 31/50 (38.3%/61.7%) 0.067
Diabetes mellitus 2 (yes/no) 76/28 (73.1%/26.9%) 46/35 (56.8%/43.2%) 0.031
Shock (yes/no) 60/44 (57.7%/42.3%) 29/52 (35.8%/64.2%) 0.005
Acute kidney injury (yes/no) 59/45 (56.7%/43.3%) 29/52 (35.8%/64.2%) 0.007
Operated (yes/no) 103/1 (99.0%/1.0%) 80/1 (98.8%/1.2%) 1.000
Antidiabetics (yes/no) 73/31 (70.2%/29.8%) 43/38 (53.1%/46.9%) 0.026
Antihypertensives (yes/no) 69/35 (66.3%/33.7%) 52/29 (64.2%/35.8%) 0.882
Antibiotics (yes/no) 92/12 (88.5%/11.5%) 68/13 (84.0%/16.0%) 0.501
Opioids (yes/no) 77/27 (74.0%/26.0%) 35/46 (43.2%/56.8%) 0.000
NSAIDs (yes/no) 70/34 (67.3%/32.7%) 59/22 (72.8%/27.2%) 0.515
PPIs (yes/no) 79/25 (76.0%/24.0%) 56/25 (69.1%/30.9%) 0.384
Antidepressants (yes/no) 24/80 (23.1%/76.9%) 8/73 (9.9%/90.1%) 0.031
Antipsychotics (yes/no) 14/90 (13.5%/86.5%) 3/78 (3.7%/96.3%) 0.043
H2 blockers (yes/no) 28/76 (26.9%/73.1%) 27/54 (33.3%/66.7%) 0.433
Corticosteroids (yes/no) 14/90 (13.5%/86.5%) 17/64 (21.0%/79.0%) 0.245
Heparin (yes/no) 76/28 (73.1%/26.9%) 53/28 (65.4%/34.6%) 0.336

Abbreviations: NSAIDs – non-steroidal anti-inflammatory drugs; PPIs – proton pump inhibitors; QSOFA – Quick Sequential Organ Failure Assessment score.

Note: Results for continuous variables are shown as median and interquartile range, and for categorical variables as frequency and percentages.

Multivariate analysis was performed using binary logistic regression. The results are shown in Table 3, where crude odds ratio (OR) is the result of univariate logistic regression, and adjusted OR is the result of multivariate logistic regression.

Table 3

Multivariate analysis according to outcomes

Parameter Crude OR Adjusted OR p (for adjusted OR)
Ileus
Charlson comorbidity index 0.926 (0.855–1.002) 0.648 (0.531–0.792) 0.000
Acute kidney injury 1.277 (0.716–2.277) 4.737 (1.670–13.439) 0.003
Antidiabetics 2.428 (1.317–4.477) 2.969 (1.216–7.249) 0.017
Opioids 4.822 (2.542–9.146) 4.814 (2.038–11.368) 0.000
Antidepressants 4.235 (1.728–10.379) 4.225 (1.301–13.719) 0.016
Recent abdominal surgeries 12.600 (5.017–31.647) 14.143 (4.594–43.537) 0.000
Mechanical ventilation 5.934 (2.725–12.922) 4.060 (1.533–10.755) 0.005
Age 1.011 (0.992–1.029) 1.059 (1.023–1.097) 0.001
Gastro-esophageal reflux
Charlson comorbidity index 1.176 (1.076–1.286) 1.266 (1.123–1.429) 0.000
Opioids 1.601 (0.864–2.964) 1.919 (0.993–3.706) 0.052
Nausea
Charlson comorbidity index 0.938 (0.867–1.014) 0.854 (0.762–0.958) 0.007
Acute kidney injury 1.445 (0.810–2.580) 3.455 (1.448–8.243) 0.005
Opioids 3.864 (2.059–7.251) 3.216 (1.493–6.927) 0.003
Antidepressants 4.584 (1.870–11.241) 4.713 (1.683–13.200) 0.003
Heparin 2.539 (1.320–4.880) 3.075 (1.341–7.053) 0.008
Recent abdominal surgeries 6.673 (3.076–14.472) 5.894 (2.401–14.470) 0.000
Mechanical ventilation 4.651 (2.185–9.900) 3.398 (1.413–8.169) 0.006
Vomiting
Charlson comorbidity index 0.939 (0.864–1.021) 0.864 (0.775–0.964) 0.009
Acute kidney injury 1.719 (0.924–3.200) 3.914 (1.731–8.847) 0.001
Opioids 3.812 (1.850–7.858) 3.491 (1.561–7.810) 0.002
Antidepressants 2.477 (1.140–5.384) 2.563 (1.077–6.098) 0.033
Recent abdominal surgeries 4.380 (2.209–8.683) 4.428 (2.082–9.414) 0.000
Constipation
Acute kidney injury 2.351 (1.294–4.272) 3.112 (1.502–6.450) 0.002
Opioids 3.748 (2.015–6.973) 4.572 (2.187–9.558) 0.000
Antipsychotics 4.044 (1.121–14.594) 3.187 (0.819–12.405) 0.095
Recent abdominal surgeries 5.419 (2.445–12.013) 5.288 (2.168–12.896) 0.000
Age 1.032 (1.011–1.052) 1.033 (1.010–1.057) 0.005

Abbreviation: OR – odds ratio.

Association of independent and confounding variables with ileus was tested by multivariate binary logistic regression. The model was built by backward conditional stepwise method starting with a full set of potential predictors: serum creatinine, acute kidney injury, Charlson comorbidity index, prescribed antidiabetics, opioids, antidepressants, antipsychotics, heparin, sepsis, recent abdominal surgery, and mechanical ventilation. The assumptions of binary outcome (ileus or not), independency of observations, no multicollinearity (variance inflation factor – VIF was below 2 for all predictors), no extreme outliers, and sufficiently large sample were all met. The linear relationship between explanatory variables and the logit of the outcome was confirmed for all variables by the Box-Tidwell test. The final model of binary logistic regression included variables shown in Table 3 and was a satisfactory fit of the data: Hosmer and Lemeshow test was 14.793 (df = 8, p = 0.063), Cox & Snell R square 0.423, and Nagelkerke R square 0.564.

The association of independent and confounding variables with gastro-esophageal reflux was tested by multivariate binary logistic regression. The model was built by backward conditional stepwise method starting with a full set of potential predictors: serum creatinine, acute kidney injury, Charlson comorbidity index, prescribed antidiabetics, opioids, antidepressants, antipsychotics, heparin, sepsis, recent abdominal surgery, and mechanical ventilation. The assumptions of binary outcome (gastro-esophageal reflux or not), independency of observations, no multicollinearity (variance inflation factor – VIF was below 2 for all predictors), no extreme outliers, and sufficiently large sample were all met. The linear relationship between explanatory variables and the logit of the outcome was confirmed for all variables by the Box-Tidwell test. The final model of binary logistic regression included variables shown in Table 3 and was a satisfactory fit of the data: Hosmer and Lemeshow test was 4.164 (df = 8, p = 0.842), Cox & Snell R square 0.118, and Nagelkerke R square 0.163.

The association of independent and confounding variables with nausea was tested by multivariate binary logistic regression. The model was built by backward conditional stepwise method starting with a full set of potential predictors: serum creatinine, acute kidney injury, Charlson comorbidity index, prescribed antidiabetics, opioids, antidepressants, antipsychotics, heparin, sepsis, recent abdominal surgery, and mechanical ventilation. The assumptions of binary outcome (nausea or not), independency of observations, no multicollinearity (variance inflation factor – VIF was below 2 for all predictors), no extreme outliers, and sufficiently large sample were all met. The linear relationship between explanatory variables and the logit of the outcome was confirmed for all variables by the Box-Tidwell test. The final model of binary logistic regression included variables shown in Table 3 and was a satisfactory fit of the data: Hosmer and Lemeshow test was 11.986 (df = 8, p = 0.152), Cox & Snell R square 0.362, and Nagelkerke R square 0.482.

The association of independent and confounding variables with vomiting was tested by multivariate binary logistic regression. The model was built by backward conditional stepwise method starting with a full set of potential predictors: serum creatinine, acute kidney injury, Charlson comorbidity index, prescribed antidiabetics, opioids, antidepressants, antipsychotics, heparin, sepsis, recent abdominal surgery, and mechanical ventilation. The assumptions of binary outcome (vomiting or not), independency of observations, no multicollinearity (variance inflation factor – VIF was below 2 for all predictors), no extreme outliers, and sufficiently large sample were all met. The linear relationship between explanatory variables and the logit of the outcome was confirmed for all variables by the Box-Tidwell test. The final model of binary logistic regression included variables shown in Table 3 and was a satisfactory fit of the data: Hosmer and Lemeshow test was 8.460 (df = 8, p = 0.390), Cox & Snell R square 0.228, and Nagelkerke R square 0.319.

The association of independent and confounding variables with constipation was tested by multivariate binary logistic regression. The model was built by backward conditional stepwise method starting with a full set of potential predictors: serum creatinine, acute kidney injury, Charlson comorbidity index, prescribed antidiabetics, opioids, antidepressants, antipsychotics, heparin, sepsis, recent abdominal surgery, and mechanical ventilation. The assumptions of binary outcome (constipation or not), independency of observations, no multicollinearity (variance inflation factor – VIF was below 2 for all predictors), no extreme outliers, and sufficiently large sample were all met. The linear relationship between explanatory variables and the logit of the outcome was confirmed for all variables by the Box-Tidwell test. The final model of binary logistic regression included variables shown in Table 3 and was a satisfactory fit of the data: Hosmer and Lemeshow test was 6.309 (df = 8, p = 0.613), Cox & Snell R square 0.277, and Nagelkerke R square 0.371.

4 Discussion

Significant risk factors associated with some form of GID in our study were acute kidney injury (associated with ileus, nausea, vomiting, and constipation), recent abdominal surgery (associated with ileus, nausea, vomiting, and constipation), mechanical ventilation (associated with ileus and nausea), advanced age (associated with ileus and constipation), as well as the use of certain drugs such as opioids (associated with ileus, nausea, vomiting, and constipation), antidepressants (associated with ileus, nausea, and vomiting), and antidiabetics (associated with ileus only). However, Charlson comorbidity index had a divergent effect depending on the form of GID: it increased the risk of gastroesophageal reflux, but it was protective against ileus, nausea, and vomiting.

Previous studies have found that comorbidities are very common in patients with gastro-esophageal reflux [12], what could explain our finding that Charlson comorbidity index is associated with an increased risk of gastro-esophageal reflux. In a study on patients with colon cancer that were subjected to surgical resection, the age-adjusted Charlson comorbidity index was an independent predictor of the development of extended postoperative ileus [13]. In contrast, we found that Charlson comorbidity index was protective against ileus, as well as against nausea and vomiting. Given that our study was conducted in the ICU, it is possible that physicians were dedicated more to patients with high comorbidity burden, and therefore more often applied some prophylactic measures against ileus, nausea, or vomiting in these patients. A significant risk factor for the development of ileus in our study was acute kidney injury. As part of the acute kidney injury, electrolyte and hormone imbalance occur, together with metabolic abnormalities [14], which may cause ileus, often with bloating, vomiting or hiccup [15]. Development of ileus was favored by antidiabetic drugs, especially by metformin. Since the patients on therapy with metformin often have lactic acidosis, it could explain the emergence of paralysis of small and large bowel [16]. The well-known inhibitory effect of opioids on motility of small and large bowel has been confirmed in our study; this effect is mediated by the activation of peripheral μ-opioid receptors [17]. The association of administration of antidepressants with the appearance of ileus in our study was also not surprising. Particularly, tricyclic and many heterocyclic antidepressants have an anti-cholinergic effect, i.e., directly block muscarine M3 receptors involved in the initiation and propagation of normal peristaltic waves [18].

A recent surgery in the abdomen is another factor associated with the appearance of ileus; however, the mechanism of its inhibitory effect is unknown. Due to the activation of pain receptors, abdominal surgery leads to the hyperactivity of the sympathetic nervous system and hypertonia of intestinal sphincters; besides, electrolyte disorders that accompany blood loss, and an intensive administration of crystalloid solutions during and after operations can inhibit depolarization of neurons in the myenteric plexus and prevent initiation of peristalsis [19]. Mechanical ventilation, which is often administered to surgical patients, further leads to the inhibition of peristalsis, because it reduces blood flow through abdomen, so the resulting hypoxia inhibits the functioning of myenteric neurons and smooth muscle cells [20]. As mechanical ventilation, antidiabetic drugs and opioids are more often used in elderly patients, who otherwise have a slow passage of intestinal contents, it is not surprising that the age in our study was associated with ileus [21].

Over 50% of our patients had nausea, so a large number of factors were associated with its occurrence. First, patients with acute kidney injury had nausea due to the acidosis and accumulation of degradational metabolic products [14,22]. The administration of opioids also provoked nausea, which is known to be mediated through the μ-receptors in the chemoreceptor zone, especially in patients who have never taken opioids earlier (this was the most often the case with acutely ill critical patients) [23]. Nausea was more often present in our patients on chronic therapy with selective serotonin reuptake inhibitors. These drugs, and among them, especially fluoxetine, cause nausea as an unwanted effect due to interference with serotonergic transmission in the stomach wall, especially in the mucosal layer [24]. All factors associated with nausea also made patients prone to vomiting [25,26].

Postoperative vomiting was frequent in our patients; those submitted to longer operations experienced more often vomiting after the surgery: prolongation of surgery for 30 min increased the risk of vomiting by about 60% [27]. At least part of this phenomenon could be explained by effects of nitrogen-suboxide (N2O), which increases pressure in semicircular channels of internal ear, and also in the abdomen due to its passage through esophagus and stomachs into the small bowel during general anesthesia [27,28].

Constipation occurred in our study more often in patients with acute kidney injury. Possible reasons for the development of constipation in these patients are accumulation of inflammatory mediators and degradational products of metabolism in the GIT [29] and modification of the intestinal flora (dysbiosis) due to inadequate water intake and secretion of urea from the intestinal wall [30]. This hypothesis is further supported by the results of clinical studies where probiotics or fecal transplants helped establishing not only normal intestinal flora but also normal motility [31]. The administration of opioids also contributed to the development of constipation due to the stimulation of opioid receptors in the wall of intestines, which further inhibited myenteric neurons and smooth muscle cells [32]. Finally, patients after abdominal surgery often have constipation, which can be explained by low food intake, immobility, and depression that are often encountered postoperatively [33]. Elderly are significantly more susceptible to constipation due to reduced fluid intake, slowing of intestinal transit, and frequent polypharmacy [34,35].

This study has several limitations. As a unicentric study, it is subject to effect of local factors on outcomes (e.g., local treatment protocols, unstandardized medical practice, unavailability of certain drugs). A relatively small number of patients and the small statistical power of this study have created conditions for falsely negative results, e.g., effect of antipsychotics did not reach significance because they were prescribed to a small percentage of patients. Due to the unavailability of some laboratory analyses during the study (bilirubin, partial pressure of oxygen, fraction of oxygen in inspired air, and blood pH), we could not calculate Apache II score for many patients.

5 Conclusions

In conclusion, the factors we identified as associated with the GID should be kept in mind by physicians who work with critically ill patients in an ICU. Early detection of these factors enables the implementation of measures that can either prevent, or at least mitigate the GID, and thus accelerate the recovery of critically ill.

  1. Funding information: Authors state no funding involved.

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

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

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Received: 2023-06-22
Revised: 2023-09-18
Accepted: 2023-09-20
Published Online: 2023-10-05

© 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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  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
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  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
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  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
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  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
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  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
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  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
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  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-2023-0820
Keywords for this article
gastrointestinal dysmotility; critically ill patients; risk factors; intensive care unit
Creative Commons
BY 4.0

Articles in the same Issue

  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
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  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
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  26. UHRF1-induced connexin26 methylation is involved in hearing damage triggered by intermittent hypoxia in neonatal rats
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  41. Upregulation of lncRNA LANCL1-AS1 inhibits the progression of non-small-cell lung cancer via the miR-3680-3p/GMFG axis
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  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
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  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
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  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
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  78. Identification of key enzalutamide-resistance-related genes in castration-resistant prostate cancer and verification of RAD51 functions
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  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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