Home Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
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Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery

  • Wenyu Zhang , Guangjian Zhu , Beibei Li , Chen Chen and Yingzhi Zhu EMAIL logo
Published/Copyright: November 14, 2023

Abstract

This study aims to analyze the effect of cardiac rehabilitation therapy on cardiac autonomic nervous function in patients with cardiac insufficiency complicated with anxiety depression after cardiac operation to provide a reference for clinical practice. A total of 109 patients subject to cardiac operation in our hospital from January 2020 to March 2023 were enrolled as study subjects, including 50 patients who received conventional rehabilitation therapy (control group) and 69 patients who received cardiac rehabilitation therapy (research group). Before and after treatment, the left ventricular ejection fraction (LVEF) and central venous pressure (CVP) were determined, and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) was measured. Low frequency/high frequency (LF/HF), standard deviation of normal to normal (SDNN), and root mean of successive square differences (RMSSD) were measured by a multi-lead ECG system. Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Activity of daily living (ADL), and Barthel Index (BI) were applied for corresponding investigations, as well as the 6-min walk test (6MWT). After treatment, the research group showed higher LVEF, CVP, LF/HF, SDNN, and RMSSD, and lower NT-proBNP, SAS, and SDS than the control group (P < 0.05). Significantly elevated ADL score, BI, and 6MWT and reduced PSQI were observed in both groups after treatment, with more remarkable changes in the research group (P < 0.05). In conclusion, cardiac rehabilitation therapy effectively improved the cardiac function of patients with cardiac insufficiency complicated with anxiety and depression after the cardiac operation and alleviated their negative emotions.

1 Introduction

Cardiovascular disorder is one of the most common types of diseases in clinical practice, and its mortality rate is also among the highest in all diseases [1]. According to the World Health Organization (WHO) in 2015, out of the 56 million deaths worldwide, the number of deaths caused by cardiovascular disorders has reached 17.7 million, and the number of deaths due to cardiovascular disorders is estimated to increase by 6 million every year [2]. Cardiac operation is also increasingly used clinically as a treatment approach for many cardiovascular disorders [3]. After cardiac operation, cardiac insufficiency due to invasive operations is the most common pathological injury, which greatly affects the prognosis and recovery of patients, and increases the possibility of risk events such as arrhythmia and cardiac failure [4]. Patients’ negative emotions occurring after diseases and operations also need attention. According to statistics, more than 70% of the patients with a history of cardiac operation experience varying degrees of post-operative depression [5]. The occurrence of such negative emotions is detrimental to patient prognosis and recovery and may increase the cardiac preload and affect the pumping function of the heart [6]. Therefore, postoperative intervention is also important in managing the cardiac disorder of patients.

Psycho-cardiology is a sub-discipline of psychosomatic medicine and a sub-specialty of cardiology, which refers to the treatment of patients with both heart disorders and psychic disorders; it advocates not only paying attention to the heart but also to the psychology of patients, so as to achieve “mind-body” coordination and to jointly resolve the physical pain and psychological trauma of patients through multi-level interventions [7,8]. Although cardiac rehabilitation therapy has made many achievements in clinical practice [9,10], there are few reports on its value in improving the cardiac autonomic nervous function in patients with cardiac insufficiency complicated with anxiety and depression after cardiac operation. In order to further clarify its application effect, a detailed study is carried out, and the results are as follows.

2 Materials and methods

2.1 Sample size calculation

The sample size was calculated according to the sample size formula N = Z² × [P × (1–P)]/E², with the statistic (Z) set at 1.64, the probability value (P) set at 0.5, and the error value (E) set at 10%. The sample size (N) was obtained as 96, i.e., a minimum of 96 subjects were required for this study.

2.2 Clinical data of patients

Cardiac patients admitted to Affiliated Nanjing Brain Hospital from January 2020 to March 2023 were selected for the study, and after screening according to the inclusion criteria (patients clinically diagnosed with heart disorder by imaging and typical symptoms, with indications for interventional procedures; patients with postoperative cardiac insufficiency complicated with anxiety depression [all patients met the diagnostic criteria for depression in the International Classification of diseases, ICD-10, all patients in this study were mildly depressed]; patients informed of participation in this study; patients with high compliance; patients with complete clinical data; patients with good basic status), 241 patients were initially identified. After screening according to the exclusion criteria (patients with serious unstable or life-threatening conditions after operation; patients complicated with other cardiac disorders; patients with previous history of cardiac or thoracic operations; patients who used anti-anxiety, anti-depression or central nervous system sedative drugs; patients with poor compliance; patients with mental or consciousness disorders, or communication disorders), 119 patients were finally identified. The study population was cardiac patients who were referred to our cardiology department for cardiac rehabilitation within 3–7 days after surgery in other hospitals. The control group consisted of 50 patients who received conventional rehabilitation therapy after cardiac operation, and the research group consisted of the other 69 patients who received cardiac rehabilitation therapy after cardiac operation. All subjects were followed up by the same research team members (Table 1).

Table 1

Comparison of general inspection data

Group Age Gender Marital status Type of disease
Male Female Unmarried(or divorced) Married Coronary heart disease Heart valve disease Myocardial infarction Heart failure Other
Control group (n = 50) 70.36 ± 13.21 34 (68.00) 16 (32.00) 10 (20.00) 40 (80.00) 26 (52.00) 14 (28.00) 3 (6.00) 4 (8.00) 3 (6.00)
Research group (n = 69) 72.12 ± 9.86 47 (68.12) 22 (31.88) 8 (11.59) 61 (88.41) 40 (57.97) 16 (23.19) 3 (4.35) 7 (10.14) 3 (4.35)
t (or χ 2) 0.831 <0.001 1.596 0.911
P 0.408 0.983 0.207 0.923

2.3 Intervention schedule

Conventional rehabilitation therapy: The rehabilitation therapy was not performed until the patient’s condition was stable after the operation, within 24 h after the operation (or at the earliest time that the patient can tolerate). Once the patients were able to move independently, active exercises such as stretching the upper and lower limbs and deep breathing were to be completed on the bed. During the rehabilitation process, the patients’ heart rate and blood pressure were strictly monitored; the rehabilitation therapist assessed the patients’ exercise ability and recommended appropriate exercises for the patients according to his/her condition. Cardiac rehabilitation therapy: first, a cardiac rehabilitation therapy team was established. Team members were required to be familiar with the intervention schedule, understand the concept of cardiac rehabilitation, learn communication skills, and develop intervention measures according to the condition of each patient. Besides, the team members communicated with patients’ families about the completion of the operation, and encouraged the family members to accompany and encourage the patients; informed the patients about previous successful rehabilitation cases to enhance their self-confidence and improve rehabilitation compliance; promptly paid attention to the patients’ inner needs to provide corresponding assistance and support; followed the doctor’s advice to instruct the patients on postoperative medication; and informed the patients of the importance of postoperative rehabilitation training to help them establish a correct postoperative cognition. At the same time, staged rehabilitation exercises were carried out according to the physical conditions of each patient, from simple physical activities to short time exercises requiring endurance. During the process, the patients were monitored for heart rate and blood pressure, and the exercise plan was adjusted in time. Patients with positive attitudes or efforts to participate in rehabilitation exercises were complimented and taken as role models for other patients. Besides, the patients were instructed on negative emotion alleviation by meditation, music therapy, decompression via deep breathing, relaxation of whole body muscles, and other self-relief methods, and were encouraged to participate in group activities to divert attention and to establish a good state of mind to maintain a relaxed state. In addition, all patients need to be counseled by a psychiatrist: attention is paid to the psychological state of patients, and psychologists are regularly scheduled to provide psychological counseling treatment to patients weekly. Continuous intervention for 2 weeks was considered as a course of treatment, for a total of 2 courses of treatment.

2.4 Outcome measures

Before and at 4 weeks after treatment, the left ventricular ejection fraction (LVEF) and central venous pressure (CVP) were determined, and elbow venous blood was collected under fasting state to measure the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in both groups. Low frequency/high frequency (LF/HF), standard deviation of normal to normal (SDNN), and root mean of successive square differences (RMSSD) were measured by a multi-lead ECG system (MECG-300, Medex, Beijing). Before measurement, patients were required to rest quietly for 15 min. Such measurement was performed by the same senior professionals for three times, and the results were averaged. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) [11] were used to evaluate the patients’ anxiety and depression, and the scores were positively correlated with the degree of anxiety and depression. The Pittsburgh Sleep Quality Index (PSQI) [12] was applied to evaluate the sleep quality of patients, and the score was negatively correlated with the sleep quality. Activity of Daily Living (ADL) [13] and Barthel Index (BI) [14] were applied to evaluate the patients’ living ability, and the results were positively correlated with self-care ability. The 6-min walking test (6MWT) was applied to assess the patients’ mobility.

2.5 Statistical methods

Statistical analysis was performed using SPSS23.0 software. Measurement data were expressed as mean ± standard deviation ( χ ¯ ± s) and compared using independent samples t-test and paired t-test. The Enumeration data were expressed as percentages (%) and compared using the chi-square test. P < 0.05 indicated statistically significant differences.

  1. Ethics approval: The study was approved by the Ethics Committee of Affiliated Nanjing Brain Hospital (No.2014KY039).

3 Results

3.1 Comparison of cardiac function

Before treatment, there was no difference in LVEF, CVP, and NT-proBNP between the two groups (P > 0.05). After treatment, LVEF and CVP increased in both groups, and were higher in the research group; while NT-proBNP decreased, and was lower in the research group (P < 0.05, Figure 1).

Figure 1 
                  Cardiac function before and after treatment in both groups. Comparison of (a) LVEF, (b) CVP, and (c) NT-proBNP. Note: vs before treatment #
                     P < 0.05, vs control group &
                     P < 0.05.
Figure 1

Cardiac function before and after treatment in both groups. Comparison of (a) LVEF, (b) CVP, and (c) NT-proBNP. Note: vs before treatment # P < 0.05, vs control group & P < 0.05.

3.2 Comparison of cardiac autonomic nervous function

Similarly, there was no difference in the results of cardiac autonomic nervous function tests between the two groups before treatment (P > 0.05). LF/HF, SDNN, and RMSSD elevated in both groups after treatment and were higher in the research group (P < 0.05, Figures 2 and 3).

Figure 2 
                  Comparison of cardiac ultrasound findings before and after treatment in a patient (male, 57 years old); the first row is before treatment and the second row is after treatment.
Figure 2

Comparison of cardiac ultrasound findings before and after treatment in a patient (male, 57 years old); the first row is before treatment and the second row is after treatment.

Figure 3 
                  Cardiac autonomic nervous function before and after treatment in both groups. Comparison of (a) LF/HF, (b) SDNN, and (c) RMSSD. Note: vs before treatment #
                     P < 0.05, vs control group &
                     P < 0.05.
Figure 3

Cardiac autonomic nervous function before and after treatment in both groups. Comparison of (a) LF/HF, (b) SDNN, and (c) RMSSD. Note: vs before treatment # P < 0.05, vs control group & P < 0.05.

3.3 Comparison of psychological status

After treatment, SAS and SDS decreased to 24.51 ± 3.02 and 24.80 ± 2.99 in the research group and 28.02 ± 2.66 and 24.80 ± 2.99 in the control group, respectively, and both of them were lower in the research group (P < 0.05, Figure 4).

Figure 4 
                  Psychological status before and after treatment in both groups. Comparison of (a) SAS and (b) SDS. Note: vs before treatment #
                     P < 0.05, vs control group &
                     P < 0.05.
Figure 4

Psychological status before and after treatment in both groups. Comparison of (a) SAS and (b) SDS. Note: vs before treatment # P < 0.05, vs control group & P < 0.05.

3.4 Comparison of self-care ability

Before treatment, there was no statistically significant difference in ADL score and BI between the two groups (P > 0.05). After treatment, ADL score and BI increased significantly in both groups, with a more obvious trend of increase in the research group (P < 0.05, Figure 5).

Figure 5 
                  Self-care ability before and after treatment in both groups. Comparison of (a) ADL score and (b) BI. Note: vs before treatment #
                     P < 0.05, vs control group &
                     P < 0.05.
Figure 5

Self-care ability before and after treatment in both groups. Comparison of (a) ADL score and (b) BI. Note: vs before treatment # P < 0.05, vs control group & P < 0.05.

3.5 Comparison of sleep quality and activity

The results of PSQI and 6MWT were compared between the two groups. Compared with the control group, the research group had a lower PSQI score and better 6MWT result (P < 0.05). Both groups showed decreased PSQI scores and better 6MWT results after treatment (P < 0.05, Figure 6).

Figure 6 
                  Sleep quality and activity before and after treatment in both groups. Comparison of (a) PSQI and (b) 6MWT results. Note: vs before treatment #
                     P < 0.05, vs control group &
                     P < 0.05.
Figure 6

Sleep quality and activity before and after treatment in both groups. Comparison of (a) PSQI and (b) 6MWT results. Note: vs before treatment # P < 0.05, vs control group & P < 0.05.

4 Discussion

In this study, patients were first compared in terms of cardiac function, and both LVEF and CVP of patients in the research group were higher than those in the control group. As cardiac rehabilitation mode improves patients’ endurance for activities by organizing training such as breathing mindfulness and relaxation mindfulness, reduces the concentration of 5-hydroxytryptamine in patients, inhibits the secretion of inflammatory factors in the body, enhances the biological activity of nitric oxide synthase, decreases nitric oxide content and catecholamine secretion, reduces vascular endothelial damage, suppresses the development of atherosclerosis, improves vascular diastolic function and the windkessel effect, and reduces cardiac preload, and therefore, the cardiac pumping function is improved [15,16]. In addition, in previous studies, researchers also suggested that the cardiac rehabilitation mode improves physiological activity in the hippocampus and prefrontal cortex through the hypothalamic–pituitary–adrenal axis, inhibits the overactivated sympathetic nervous system while appropriately activating the parasympathetic nervous system, enhances autonomic nervous regulation function, and restores patients’ circadian rhythm, which has a positive effect on the regulation of neurological function [17]. When cardiac autonomic function was examined in both groups, a superior cardiac autonomic function was also observed in the research group, which verifies the point above.

In the investigation of the psychological status of patients in both groups, SAS and SDS scores in the research group after rehabilitation therapy decreased more remarkably than those in the control group, which also indicated that cardiac rehabilitation therapy effectively alleviated the negative emotions of patients, consistent with the findings of García-Bravo et al. [18]. Such effect was achieved by simultaneous psychological interventions and conventional physiological care in cardiac rehabilitation therapy so that patients achieved physical and psychological coordination. Weak status and inability to move in the early postoperative period lead to high psychological stress in patients, which gives rise to more severe anxiety, depression, and other negative emotions [19]. In cardiac rehabilitation therapy, the nursing staff explained to patients that postoperative weakness was a normal phenomenon through a friendly and patient attitude, and introduced the following rehabilitation schedule to the patients, so that the patients received and felt professional support, and the confidence in recovery was therefore improved. Since patients are in a special period, their family members are guided to communicate more with them and encourage them to express their inner demands, so that they can feel adequate family support, and their psychological pressure is relieved [20]. In addition, cardiac rehabilitation therapy also requires the nursing staff to introduce the dosage and time of administration of each drug to patients during drug distribution, and to explain the effects of each drug, thus enhancing patients’ medication adherence [21]. As mentioned above, cardiac rehabilitation therapy helps to improve the cardiac autonomic function of patients, which is also beneficial to regulate their dopamine secretion in the body; relieve their reflexive anxiety, panic, anger, and other adverse emotions; and finally relieve all of their negative emotions. Also, this view should be verified through more basic experiments.

A comparison of postoperative activity between the two groups also showed superior results in the research group, which further proves the positive role of cardiac rehabilitation therapy in cardiac operation. Cardiac rehabilitation therapy adopts different rehabilitation means based on different stages of patients’ postoperative recovery; when patients cannot get out of bed and move, passive training is applied to help them move their limbs, followed by bedside activities and aerobic training as they gradually get better so that their recovery is promoted by real-time rehabilitation schedule adjustment based on their recovery status [22,23]. Through the alleviation of patients’ negative emotions, cardiac rehabilitation therapy also allows patients to have reasonable expectations of their own recovery, so that they will have confidence in the rehabilitation process and participate in the rehabilitation work more actively, which ensures the effect of rehabilitation exercise and facilitates postoperative recovery.

5 Conclusion

Cardiac rehabilitation therapy effectively improved the cardiac function of patients with cardiac insufficiency complicated with anxiety and depression after cardiac operation, alleviated their negative emotions, fastened their recovery after operation, and improved the therapeutic effect and safety of operation. We believe that in the future, cardiac operation will be applied in the clinic in combination with cardiac rehabilitation therapy to provide patients with more scientific and effective treatment services.

Due to the limited experimental conditions, there are several limitations in this study. For example, the number of cases included in this study is small, making the results not comprehensive and representative enough. Moreover, since there are no unified clinical guidelines for cardiac rehabilitation therapy, there is still room for optimization and improvement in detail.

Acknowledgment

The authors acknowledge all coordinators and patients involved in this study.

  1. Funding information: This work was supported by The General Project of Science and Technology Development Fund of Nanjing Medical University (2014NJMU056) and The Nanjing Science and Technology Development Plan (Medical and Health Field) Project (201715044).

  2. Author contributions: YZZ built the study design; GJZ was involved in the collection of samples; BBL analyzed the data; CC interpreted data; WYZ prepared the draft of the manuscript; all authors were involved in editing and reviewing. All authors have read and agreed to the published version of the manuscript.

  3. Conflict of interest: The authors report no conflict of interest.

  4. Data availability statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Appendix

Table A1

Cardiac function before and after treatment in both groups

Control group (n = 50) Research group (n = 69) t P
LVEF (%) Before treatment 52.30 ± 5.86 52.96 ± 6.72 0.558 0.578
After treatment 55.72 ± 5.49* 58.14 ± 6.62* 2.111 0.037
CVP (mmHg) Before treatment 76.62 ± 8.78 75.45 ± 7.04 0.806 0.422
After treatment 85.14 ± 6.18* 89.41 ± 6.88* 3.489 <0.001
NT-proBNP (ng/L) Before treatment 215.09 ± 36.62 211.53 ± 43.52 0.470 0.639
After treatment 138.00 ± 24.96* 111.53 ± 43.52* 3.862 <0.001

Note: * indicates a statistically significant difference from before treatment (P < 0.05).

Table A2

Cardiac autonomic nervous function before and after treatment in both groups

Control group (n = 50) Research group (n = 69) t P
LE/HF Before treatment 1.08 ± 0.16 1.04 ± 0.26 0.963 0.338
After treatment 1.20 ± 0.22* 1.45 ± 0.32* 4.766 <0.001
SDNN (ms) Before treatment 47.92 ± 7.51 48.19 ± 9.20 0.170 0.865
After treatment 50.60 ± 9.08* 55.70 ± 8.52* 3.135 0.002
RMDSSD (ms) Before treatment 30.04 ± 6.64 30.51 ± 8.12 0.336 0.738
After treatment 33.42 ± 7.17* 36.46 ± 7.91* 2.151 0.034

Note: * indicates a statistically significant difference from before treatment (P < 0.05).

Table A3

Psychological status before and after treatment in both groups

Control group (n = 50) Research group (n = 69) t P
SAS Before treatment 31.76 ± 4.48 31.70 ± 4.42 0.073 0.942
After treatment 28.02 ± 2.66* 24.51 ± 3.02* 6.574 <0.001
SDS Before treatment 33.10 ± 3.84 32.72 ± 4.53 0.481 0.632
After treatment 28.34 ± 2.84* 24.80 ± 2.99* 6.510 <0.001

Note: * indicates a statistically significant difference from before treatment (P < 0.05).

Table A4

Self-care ability before and after treatment in both groups

Control group (n = 50) Research group (n = 69) t P
ADL score Before treatment 53.78 ± 3.71 54.19 ± 2.80 0.687 0.493
After treatment 62.18 ± 3.93* 66.65 ± 3.71* 6.328 <0.001
BI Before treatment 45.78 ± 6.23 45.23 ± 9.06 0.370 0.712
After treatment 73.52 ± 6.90* 80.68 ± 7.43* 5.345 <0.001

Note: * indicates a statistically significant difference from before treatment (P < 0.05).

Table A5

Sleep quality and activity before and after treatment in both groups

Control group (n = 50) Research group (n = 69) t P
PSQI Before treatment 13.00 ± 3.73 12.74 ± 2.75 0.438 0.662
After treatment 9.68 ± 1.95* 7.42 ± 2.02* 6.112 <0.001
6MWT (m) Before treatment 409.48 ± 43.17 414.03 ± 33.81 0.645 0.521
After treatment 426.38 ± 27.30* 450.68 ± 41.02* 3.643 <0.001

Note: * indicates a statistically significant difference from before treatment (P < 0.05).

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Received: 2023-07-09
Revised: 2023-08-24
Accepted: 2023-09-21
Published Online: 2023-11-14

© 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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  29. Role of Jumonji domain-containing protein D3 and its inhibitor GSK-J4 in Hashimoto’s thyroiditis
  30. circ_0014736 induces GPR4 to regulate the biological behaviors of human placental trophoblast cells through miR-942-5p in preeclampsia
  31. Monitoring of sirolimus in the whole blood samples from pediatric patients with lymphatic anomalies
  32. Effects of osteogenic growth peptide C-terminal pentapeptide and its analogue on bone remodeling in an osteoporosis rat model
  33. A novel autophagy-related long non-coding RNAs signature predicting progression-free interval and I-131 therapy benefits in papillary thyroid carcinoma
  34. WGCNA-based identification of potential targets and pathways in response to treatment in locally advanced breast cancer patients
  35. Radiomics model using preoperative computed tomography angiography images to differentiate new from old emboli of acute lower limb arterial embolism
  36. Dysregulated lncRNAs are involved in the progress of myocardial infarction by constructing regulatory networks
  37. Single-arm trial to evaluate the efficacy and safety of baclofen in treatment of intractable hiccup caused by malignant tumor chemotherapy
  38. Genetic polymorphisms of MRPS30-DT and NINJ2 may influence lung cancer risk
  39. Efficacy of immune checkpoint inhibitors in patients with KRAS-mutant advanced non-small cell lung cancer: A retrospective analysis
  40. Pyroptosis-based risk score predicts prognosis and drug sensitivity in lung adenocarcinoma
  41. Upregulation of lncRNA LANCL1-AS1 inhibits the progression of non-small-cell lung cancer via the miR-3680-3p/GMFG axis
  42. CircRANBP17 modulated KDM1A to regulate neuroblastoma progression by sponging miR-27b-3p
  43. Exosomal miR-93-5p regulated the progression of osteoarthritis by targeting ADAMTS9
  44. Downregulation of RBM17 enhances cisplatin sensitivity and inhibits cell invasion in human hypopharyngeal cancer cells
  45. HDAC5-mediated PRAME regulates the proliferation, migration, invasion, and EMT of laryngeal squamous cell carcinoma via the PI3K/AKT/mTOR signaling pathway
  46. The association between sleep duration, quality, and nonalcoholic fatty liver disease: A cross-sectional study
  47. Myostatin silencing inhibits podocyte apoptosis in membranous nephropathy through Smad3/PKA/NOX4 signaling pathway
  48. A novel long noncoding RNA AC125257.1 facilitates colorectal cancer progression by targeting miR-133a-3p/CASC5 axis
  49. Impact of omicron wave and associated control measures in Shanghai on health management and psychosocial well-being of patients with chronic conditions
  50. Clinicopathological characteristics and prognosis of young patients aged ≤45 years old with non-small cell lung cancer
  51. TMT-based comprehensive proteomic profiling identifies serum prognostic signatures of acute myeloid leukemia
  52. The dose limits of teeth protection for patients with nasopharyngeal carcinoma undergoing radiotherapy based on the early oral health-related quality of life
  53. miR-30b-5p targeting GRIN2A inhibits hippocampal damage in epilepsy
  54. Long non-coding RNA AL137789.1 promoted malignant biological behaviors and immune escape of pancreatic carcinoma cells
  55. IRF6 and FGF1 polymorphisms in non-syndromic cleft lip with or without cleft palate in the Polish population
  56. Comprehensive analysis of the role of SFXN family in breast cancer
  57. Efficacy of bronchoscopic intratumoral injection of endostar and cisplatin in lung squamous cell carcinoma patients underwent conventional chemoradiotherapy
  58. Silencing of long noncoding RNA MIAT inhibits the viability and proliferation of breast cancer cells by promoting miR-378a-5p expression
  59. AG1024, an IGF-1 receptor inhibitor, ameliorates renal injury in rats with diabetic nephropathy via the SOCS/JAK2/STAT pathway
  60. Downregulation of KIAA1199 alleviated the activation, proliferation, and migration of hepatic stellate cells by the inhibition of epithelial–mesenchymal transition
  61. Exendin-4 regulates the MAPK and WNT signaling pathways to alleviate the osteogenic inhibition of periodontal ligament stem cells in a high glucose environment
  62. Inhibition of glycolysis represses the growth and alleviates the endoplasmic reticulum stress of breast cancer cells by regulating TMTC3
  63. The function of lncRNA EMX2OS/miR-653-5p and its regulatory mechanism in lung adenocarcinoma
  64. Tectorigenin alleviates the apoptosis and inflammation in spinal cord injury cell model through inhibiting insulin-like growth factor-binding protein 6
  65. Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer
  66. F-box and WD repeat domain containing 7 inhibits the activation of hepatic stellate cells by degrading delta-like ligand 1 to block Notch signaling pathway
  67. Knockdown of circ_0005615 enhances the radiosensitivity of colorectal cancer by regulating the miR-665/NOTCH1 axis
  68. Long noncoding RNA Mhrt alleviates angiotensin II-induced cardiac hypertrophy phenotypes by mediating the miR-765/Wnt family member 7B pathway
  69. Effect of miR-499-5p/SOX6 axis on atrial fibrosis in rats with atrial fibrillation
  70. Cholesterol induces inflammation and reduces glucose utilization
  71. circ_0004904 regulates the trophoblast cell in preeclampsia via miR-19b-3p/ARRDC3 axis
  72. NECAB3 promotes the migration and invasion of liver cancer cells through HIF-1α/RIT1 signaling pathway
  73. The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk
  74. miR-2053 inhibits the growth of ovarian cancer cells by downregulating SOX4
  75. Nucleophosmin 1 associating with engulfment and cell motility protein 1 regulates hepatocellular carcinoma cell chemotaxis and metastasis
  76. α-Hederin regulates macrophage polarization to relieve sepsis-induced lung and liver injuries in mice
  77. Changes of microbiota level in urinary tract infections: A meta-analysis
  78. Identification of key enzalutamide-resistance-related genes in castration-resistant prostate cancer and verification of RAD51 functions
  79. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies – (lessons learned from) a prospective study
  80. Outcomes of low-risk birth care during the Covid-19 pandemic: A cohort study from a tertiary care center in Lithuania
  81. Vitamin D protects intestines from liver cirrhosis-induced inflammation and oxidative stress by inhibiting the TLR4/MyD88/NF-κB signaling pathway
  82. Integrated transcriptome analysis identifies APPL1/RPS6KB2/GALK1 as immune-related metastasis factors in breast cancer
  83. Genomic analysis of immunogenic cell death-related subtypes for predicting prognosis and immunotherapy outcomes in glioblastoma multiforme
  84. Circular RNA Circ_0038467 promotes the maturation of miRNA-203 to increase lipopolysaccharide-induced apoptosis of chondrocytes
  85. An economic evaluation of fine-needle cytology as the primary diagnostic tool in the diagnosis of lymphadenopathy
  86. Midazolam impedes lung carcinoma cell proliferation and migration via EGFR/MEK/ERK signaling pathway
  87. Network pharmacology combined with molecular docking and experimental validation to reveal the pharmacological mechanism of naringin against renal fibrosis
  88. PTPN12 down-regulated by miR-146b-3p gene affects the malignant progression of laryngeal squamous cell carcinoma
  89. miR-141-3p accelerates ovarian cancer progression and promotes M2-like macrophage polarization by targeting the Keap1-Nrf2 pathway
  90. lncRNA OIP5-AS1 attenuates the osteoarthritis progression in IL-1β-stimulated chondrocytes
  91. Overexpression of LINC00607 inhibits cell growth and aggressiveness by regulating the miR-1289/EFNA5 axis in non-small-cell lung cancer
  92. Subjective well-being in informal caregivers during the COVID-19 pandemic
  93. Nrf2 protects against myocardial ischemia-reperfusion injury in diabetic rats by inhibiting Drp1-mediated mitochondrial fission
  94. Unfolded protein response inhibits KAT2B/MLKL-mediated necroptosis of hepatocytes by promoting BMI1 level to ubiquitinate KAT2B
  95. Bladder cancer screening: The new selection and prediction model
  96. circNFATC3 facilitated the progression of oral squamous cell carcinoma via the miR-520h/LDHA axis
  97. Prone position effect in intensive care patients with SARS-COV-2 pneumonia
  98. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children
  99. Dihydroartemisinin ameliorates cerebral I/R injury in rats via regulating VWF and autophagy-mediated SIRT1/FOXO1 pathway
  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
  101. Low Ang-(1–7) and high des-Arg9 bradykinin serum levels are correlated with cardiovascular risk factors in patients with COVID-19
  102. Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study
  103. Potential protective effects of Huanglian Jiedu Decoction against COVID-19-associated acute kidney injury: A network-based pharmacological and molecular docking study
  104. Clinical significance of serum MBD3 detection in girls with central precocious puberty
  105. Clinical features of varicella-zoster virus caused neurological diseases detected by metagenomic next-generation sequencing
  106. Collagen treatment of complex anorectal fistula: 3 years follow-up
  107. LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through down-regulating SP-A by sponging to miR-424
  108. Efficacy analysis of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy as a first-line Helicobacter pylori eradication regimen – An open-label, randomized trial
  109. SMOC2 plays a role in heart failure via regulating TGF-β1/Smad3 pathway-mediated autophagy
  110. A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults
  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
  112. hsa_circ_0000285 sponging miR-582-3p promotes neuroblastoma progression by regulating the Wnt/β-catenin signaling pathway
  113. Long non-coding RNA GNAS-AS1 knockdown inhibits proliferation and epithelial–mesenchymal transition of lung adenocarcinoma cells via the microRNA-433-3p/Rab3A axis
  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
  115. Twenty-four-color full spectrum flow cytometry panel for minimal residual disease detection in acute myeloid leukemia
  116. Hsa-miR-223-3p participates in the process of anthracycline-induced cardiomyocyte damage by regulating NFIA gene
  117. Anti-inflammatory effect of ApoE23 on Salmonella typhimurium-induced sepsis in mice
  118. Analysis of somatic mutations and key driving factors of cervical cancer progression
  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
  121. Effects of pharmacological delay with roxadustat on multi-territory perforator flap survival in rats
  122. Analysis of heroin effects on calcium channels in rat cardiomyocytes based on transcriptomics and metabolomics
  123. Risk factors of recurrent bacterial vaginosis among women of reproductive age: A cross-sectional study
  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
  126. Correlation between microvessel maturity and ISUP grades assessed using contrast-enhanced transrectal ultrasonography in prostate cancer
  127. The protective effect of caffeic acid phenethyl ester in the nephrotoxicity induced by α-cypermethrin
  128. Norepinephrine alleviates cyclosporin A-induced nephrotoxicity by enhancing the expression of SFRP1
  129. Effect of RUNX1/FOXP3 axis on apoptosis of T and B lymphocytes and immunosuppression in sepsis
  130. The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity
  131. Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU
  132. Calycosin protects against chronic prostatitis in rats via inhibition of the p38MAPK/NF-κB pathway
  133. Pan-cancer analysis of the PDE4DIP gene with potential prognostic and immunotherapeutic values in multiple cancers including acute myeloid leukemia
  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
  136. Clinical characteristics of current COVID-19 rehabilitation outpatients in China
  137. Luteolin alleviates ulcerative colitis in rats via regulating immune response, oxidative stress, and metabolic profiling
  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
  139. The application of iliac fascia space block combined with esketamine intravenous general anesthesia in PFNA surgery of the elderly: A prospective, single-center, controlled trial
  140. Elevated blood acetoacetate levels reduce major adverse cardiac and cerebrovascular events risk in acute myocardial infarction
  141. The effects of progesterone on the healing of obstetric anal sphincter damage in female rats
  142. Identification of cuproptosis-related genes for predicting the development of prostate cancer
  143. Lumican silencing ameliorates β-glycerophosphate-mediated vascular smooth muscle cell calcification by attenuating the inhibition of APOB on KIF2C activity
  144. Targeting PTBP1 blocks glutamine metabolism to improve the cisplatin sensitivity of hepatocarcinoma cells through modulating the mRNA stability of glutaminase
  145. A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry
  146. Clinical analysis of AN69ST membrane continuous venous hemofiltration in the treatment of severe sepsis
  147. Antibiotics therapy combined with probiotics administered intravaginally for the treatment of bacterial vaginosis: A systematic review and meta-analysis
  148. Construction of a ceRNA network to reveal a vascular invasion associated prognostic model in hepatocellular carcinoma
  149. A pan-cancer analysis of STAT3 expression and genetic alterations in human tumors
  150. A prognostic signature based on seven T-cell-related cell clustering genes in bladder urothelial carcinoma
  151. Pepsin concentration in oral lavage fluid of rabbit reflux model constructed by dilating the lower esophageal sphincter
  152. The antihypertensive felodipine shows synergistic activity with immune checkpoint blockade and inhibits tumor growth via NFAT1 in LUSC
  153. Tanshinone IIA attenuates valvular interstitial cells’ calcification induced by oxidized low density lipoprotein via reducing endoplasmic reticulum stress
  154. AS-IV enhances the antitumor effects of propofol in NSCLC cells by inhibiting autophagy
  155. Establishment of two oxaliplatin-resistant gallbladder cancer cell lines and comprehensive analysis of dysregulated genes
  156. Trial protocol: Feasibility of neuromodulation with connectivity-guided intermittent theta-burst stimulation for improving cognition in multiple sclerosis
  157. LncRNA LINC00592 mediates the promoter methylation of WIF1 to promote the development of bladder cancer
  158. Factors associated with gastrointestinal dysmotility in critically ill patients
  159. Mechanisms by which spinal cord stimulation intervenes in atrial fibrillation: The involvement of the endothelin-1 and nerve growth factor/p75NTR pathways
  160. Analysis of two-gene signatures and related drugs in small-cell lung cancer by bioinformatics
  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
  169. Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia
  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
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