Startseite Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
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Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy

  • Yongchao Wang , Xiaolin Wang , Yulin Yang , Hao Xu und Jian Li EMAIL logo
Veröffentlicht/Copyright: 8. November 2023
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Aus der Zeitschrift Open Medicine Band 18 Heft 1

Abstract

Our objective was to evaluate the long-term prognostic value of high-sensitivity cardiac troponin-I (hs-cTn-I) in idiopathic dilated cardiomyopathy (DCM). First, patients were divided into an end-event group (n = 55) and a non-end-event group (n = 67). Then, patients were included in the subgroup analysis to compare the diagnostic value of brain natriuretic peptide (BNP) and hs-cTn-I in different populations. hs-cTn-I and BNP concentrations were higher in the end-event group. The Cox regression analysis indicated that high hs-cTn-I was a risk factor for poor long-term prognosis. Receiver operating characteristic analysis showed that the area under the curve (AUC) for hs-cTn-I to predict end events was 0.751, and the AUC for BNP was 0.742. The correlation analysis suggested that hs-cTn-I was related to the percentage change in left ventricular internal diameter at end-diastolic and left ventricular ejection fraction. Subgroup analysis showed that compared with BNP, hs-cTn-I was more suitable for predicting end events in patients with preserved renal function (AUC: 0.853 vs 0.712, P = 0.04). In conclusion, hs-cTn-I is a potential biomarker for evaluating long-term prognosis in idiopathic DCM, and its predictive value is higher than that of BNP in patients with preserved renal function.

Keywords: idiopathic dilated cardiomyopathy; high-sensitivity cardiac troponin-I; brain natriuretic peptide; long-term prognosis

1 Introduction

Idiopathic dilated cardiomyopathy (DCM) is defined as left ventricular or biventricular dilation and systolic dysfunction in the absence of an abnormal load (hypertension and vascular disease) or coronary artery disease sufficient to cause global systolic impairment according to the recommendations for classifying cardiomyopathies [1]. DCM is the main cause of heart failure with a reduced ejection fraction and the main indication for heart transplantation worldwide [2]. Troponin-I has been demonstrated to be related to all-cause mortality [3], heart transplantation, and the clinical need for an automatic implantable cardioverter defibrillator [4] in individuals with idiopathic DCM. Brain natriuretic peptide (BNP) is widely used for the diagnosis [5] and prognosis [6] of heart failure, the symptom of idiopathic DCM in the end stage [7]. Studies have also indicated a strong association of high-sensitivity cardiac troponin-I (hs-cTn-I) with the risk of new-onset heart failure [8]. However, there is currently a lack of studies directly comparing the ability of hs-cTn-I and BNP to predict long-term adverse outcomes, such as heart failure and cardiac death, in patients with idiopathic DCM. This study aimed to clarify the correlations among hs-cTn-I, BNP, and the long-term prognosis of patients with idiopathic DCM to provide a method for the clinical evaluation of long-term prognosis in patients with idiopathic DCM.

2 Subjects and methods

2.1 Subjects

This study was a retrospective study. Patients over 18 years of age diagnosed with idiopathic DCM at The Affiliated Hospital of Qingdao University from January 2020 to December 2021 were included in this study. Diagnosis referred to the recommendations for classifying cardiomyopathies [1]. The exclusion criteria were as follows: (1) severe valve regurgitation or stenosis; (2) uncontrolled hypertension (average blood pressure exceeding 160/100 mmHg) for more than 2 years; (3) patients with a history of drinking alcohol with a daily alcohol intake exceeding 125 mL for more than 10 years; (4) patients with a previous diagnosis of myocarditis; (5) patients with previous diagnosis of malignancy; (6) patients with end-stage heart failure which was defined as New York Heart Association class Ⅲ–Ⅳ, despite optimal medical and device therapy, intolerance or withdrawal of evidence-based heart failure medications such as beta blockers, angiotensin converting enzyme inhibitors due to hypotension, diuretic-refractory volume overload, or need for intravenous inotrope; (7) patients with severe liver and kidney dysfunction, where severe hepatic dysfunction was defined as an increase in bilirubin that exceeded 10 times the normal value, prothrombin activity <40%, or the presence of hepatic encephalopathy, and severe renal insufficiency was defined as the estimated glomerular filtration rate less than 60 mL/min; (8) patients with elevated hs-cTn-I that can be explained by myocardial infarction, aortic disease, myocarditis, or other heart diseases; and (9) patients with ischemic heart disease. All patients underwent coronary artery CT angiography or coronary angiography. Patients with stenosis of more than 50% in one or more main coronary arteries (right coronary artery, left main coronary artery, left anterior descending artery, left circumflex artery) or stenosis of more than 50% in two or more branch coronary arteries were excluded from the study. A total of 122 patients were enrolled in the study.

2.2 Data collection

Clinical data of the patients, including sex, age, past medical history, diagnosis, and treatment process, were obtained by consulting the electronic medical records. At the end of the follow-up period, all patients underwent cardiac ultrasonography a second time to evaluate the development of idiopathic DCM. This study has been approved by the Ethics Committee of The Affiliated Hospital of Qingdao University (QYFY WZLL 26432).

2.3 Study endpoint

The primary endpoint of this study was a composite endpoint consisting of (1) death due to DCM during the follow-up period; (2) readmission or emergency visit due to acute or chronic heart failure confirmed by symptoms, objective evidence, and biomarkers, such as BNP, while ruling out other causes of heart failure, such as myocardial infarction and infection, during the follow-up period; and (3) new-onset arrhythmias (e.g., atrial fibrillation). The definition of endpoint referenced 2017 cardiovascular and stroke endpoint definitions for clinical trials [9].

2.4 Research grouping

According to whether they had an end event within the follow-up period, the patients were split into two groups: the end-event group (n = 55) and the non-end-event group (n = 67). According to the estimated glomerular filtration rate (more than 60 mL/min or not), sex, age (greater than 60 years or not), and whether there was diabetes mellitus, patients were included in a subgroup analysis to assess the efficacy of hs-cTn-I and BNP in predicting the long-term prognosis in patients with idiopathic DCM.

2.5 Statistical processing

SPSS 22.0 software was used for statistical analysis. Measurement data conforming to a normal distribution are expressed herein as mean ± standard deviation (SD), and those conforming to a skewed distribution are expressed as Q 1(Q 2, Q 3). Measurement data with a normal distribution and uniform variance were analyzed by independent sample t tests, and those with a skewed distribution or uneven variance were analyzed by nonparametric tests. Count data are expressed herein as frequencies or percentages, and comparisons between groups were made by Pearson’s chi-square tests. Clinical characteristics were all initially tested with univariate Cox regression analysis, and all variables with a value of <0.1 were considered for inclusion in the multivariate model. The association between hs-cTn-I, BNP, and percentage changes in cardiac ultrasound indices during the follow-up period was analyzed by Spearman’s correlation test. Baseline left ventricular internal diameter at end-diastole (LVIDd), left ventricular internal diameter at end-systole, and left ventricular ejection fraction (LVEF) were control variables to expel their influence on the correlation coefficients. When comparing the efficacy of hs-cTn-I and BNP in predicting the occurrence of endpoint events in idiopathic DCM patients, a receiver operating characteristic (ROC) curve was employed. The Hanley & McNeil test was used as the method for ROC comparison. We calculated the Youden index (sensitivity + specificity – 1) for each coordinate point in the ROC curve and selected the value of the biomarker corresponding to the maximum Youden index as the cut-off value. Net reclassification index (NRI) was used to compare the prognostic value between hs-cTn-I and BNP. All tests were bilateral tests, and P < 0.05 was considered statistically significant.

3 Results

3.1 General clinical features

The median follow-up period was 18 months (8–18 months). Of 122 patients with idiopathic DCM, 32 patients were readmitted due to heart failure, 20 patients had emergency visits due to heart failure, 2 had new-onset atrial fibrillation, and 1 died due to heart failure caused by DCM during the follow-up period. Table 1 summarizes the baseline characteristics between the non-end-event group (n = 67) and the end-event group (n = 55). Compared with the non-end-event group, the end-event group presented higher serum concentrations of cardiac troponin-I (median: 0.082 vs 0.026 ng/mL, P < 0.01) and BNP (median: 770 vs 424 pg/mL, P < 0.01). Other characteristics were comparable between the two groups (all P > 0.05).

Table 1

Baseline data of the non-end-event group and the end-event group

Non-end-event group (n = 67)a End-event group (n = 55)a P value
General characteristics
Male (%) 52 (77.61%) 41 (74.55%) 0.83
Age (year) 54.82 ± 12.9 58.64 ± 11.85 0.09
BMIb (kg/m2) 25.71 (23.88, 29.07) 25 (23, 27.46) 0.12
Hypertension (%) 27 (40.3%) 18 (32.73%) 0.45
Diabetes mellitus (%) 11 (16.42%) 13 (23.64%) 0.37
Healthy dietary habitsc (%) 37 (55.22%) 29 (52.73%) 0.86
Sufficient exercised (%) 26 (38.81%) 14 (25.45%) 0.13
Daily salt intake (g) 6.19 ± 0.97 6.17 ± 0.93 0.94
Laboratory test
hs-cTn-Ib (ng/mL) 0.026 (0.015, 0.058) 0.082 (0.047, 0.202) <0.01e
BNPb (pg/mL) 424 (146, 804) 770 (612, 1715) <0.01e
CK-MBb (ng/mL) 1.7 (0.9, 2.3) 1.8 (1.1, 3) 0.68
Myoglobin (ng/mL) 63.9 (37.2, 78.2) 74.6 (57.4, 91.3) 0.08
WBCb (109/L) 6.5 (5.2, 8.3) 6.73 (5.53, 8.05) 0.51
RBCb (1012/L) 4.61 ± 0.67 4.63 ± 0.86 0.92
HBb (g/L) 137.94 ± 20.32 140.56 ± 24.44 0.52
Hematocrit (%) 40.8 (37.6, 45.4) 42.1 (36.4, 46.7) 0.61
MCVb (fL) 89.5 (87.1, 92.8) 89.9 (86.1, 93.8) 0.83
MCHb (pg) 30.2 (29.4, 31.3) 30.2 (28.9, 31.9) 0.72
MCHCb (g/L) 334 (326, 342) 334 (325, 343) 0.74
RDWb SD (fl) 44 (40, 47.4) 42.8 (40.6, 47.3) 0.78
RDWb variability (%) 13.3 (12.6, 14.7) 13.2 (12.4, 14.4) 0.7
PLTb (109/L) 206.84 ± 62.99 213.84 ± 75.82 0.58
CRPb (mg/L) 3.61 (0.01, 15.47) 5.78 (1.26, 20.5) 0.12
INRb 1.11 (1.01, 1.22) 1.15 (1.05, 1.34) 0.07
APTTb (s) 27.5 (25.5, 30) 28 (25.3, 30.6) 0.75
Fibrinogen (g/L) 2.98 (2.47, 3.41) 3.04 (2.55, 3.45) 0.59
D-dimer (ng/mL) 330 (190, 710) 590 (210, 1140) 0.14
ALTb (U/L) 26 (15.3, 42.4) 25.8 (13, 49) 0.9
ASTb (U/L) 22 (17.4, 30) 23.6 (16, 37.3) 0.65
Triglyceride (mmol/L) 1.1 (0.81, 1.58) 1.12 (0.88, 1.38) 0.65
Total cholesterol (mmol/L) 4.24 (3.65, 5.05) 4.37 (3.54, 4.75) 0.59
HDL-Cb (mmol/L) 1.17 ± 0.35 1.1 ± 0.35 0.26
LDL-Cb (mmol/L) 2.55 (2.11, 3.28) 2.64 (2.17, 3.15) 0.96
Lipoprotein A (mg/L) 182 (131, 261) 150 (101, 235) 0.1
Potassium ion (mmol/L) 4.12 ± 0.44 4.07 ± 0.6 0.64
Sodium ion (mmol/L) 141 (139, 143.4) 141 (139, 143) 0.88
TSHb (mIU/L) 2.21 (1.49, 2.54) 2.05 (1.2, 2.58) 0.21
FT3b (pmol/L) 3.71 (3.43, 4) 3.72 (3.13, 3.96) 0.32
FT4b (pmol/L) 15.18 (14.38, 16.37) 14.75 (13.67, 16.1) 0.12
eGFRb (mL/min) 69.96 (59.6, 92.18) 64.49 (50.87, 86.21) 0.07
Cardiac ultrasound indices
LVIDdb (cm) 6.21 ± 0.83 6.47 ± 0.82 0.09
LVIDsb (cm) 5.16 ± 0.93 5.37 ± 0.92 0.21
LVEFb (%) 32 (28, 39) 34 (29, 40) 0.74

aData are presented as the mean ± SD, Q 2 (Q 1, Q 3) or n (%).

bBMI, body mass index; hs-cTn-I, high-sensitivity cardiac troponin I; BNP, brain natriuretic peptide; CK-MB, creatine kinase, MB form; WBC, white blood cell; RBC, red blood cell; HB, hemoglobin; MCV, mean corpusular volume; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; RDW, red blood cell distribution width; PLT, platelet; CRP, C-reactive protein; INR, international normalized ratio; APTT, activated partial thromboplastin time; ALT, alanine aminotransferase; AST, aspartate aminotransferase; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TSH, thyroid stimulating hormone; FT3, free triiodothyronine; FT4, free tetraiodothronine; eGFR, estimate glomerular filtration rate; LVIDd, left ventricular internal diameter at end-diastolic; LVIDs, left ventricular internal diameter at end-systole; LVEF, left ventricular ejection fraction.

cMore than four servings of fruits or vegetables per day and a daily fat intake less than 80 g and a daily free sugar intake less than 25 g.

dEither 30 min of moderate to vigorous physical activity (MVPA) on 5 days of the week and/or 30 min of vigorous physical activity three or more times per week.

e P < 0.05, which means statistically significant.

3.2 Cox regression analysis of the correlation between clinical features and long-term prognosis in patients with idiopathic DCM

The factors associated with long-term outcome were analyzed by the multivariate Cox model. Table 2 demonstrates that high hs-cTn-I (HR = 5.91, 95% CI: 1.2–29.08, P value = 0.03) and high BNP (HR = 1.02, 95% CI: 1.01–1.03, P value < 0.01) were associated with an increased risk of poor prognosis in patients with idiopathic DCM. Patients with high hs-cTn-I and/or BNP levels had a higher incidence of endpoint events than patients with low hs-cTn-I and BNP levels, according to the survival curve (Figure 1a–c).

Table 2

COX regression analysis of risk factors related to end point events

Univariate Multivariate
HR P value HR 95% CI P value
Male 0.86 0.62
Age 1.02 0.06d 1.01 0.99–1.04 0.34
BMIa 0.95 0.11
Hypertension 0.76 0.33
Diabetes mellitus 1.45 0.24
Healthy dietary habitsb 0.92 0.77
Sufficient exercisec 0.62 0.12
Daily salt intake 1.02 0.9
hs-cTn-Ia 5.69 0.01d 5.91 1.2–29.08 0.03e
BNPa 1.02 <0.01d 1.02 1.01–1.03 <0.01e
CK-MBa 0.98 0.65
Myoglobin 1 0.63
WBCa 1 0.93
RBCa 0.96 0.84
HBa 1 0.77
Hematocrit 1 0.53
MCVa 0.99 0.58
MCHa 1.02 0.21
MCHCa 1 0.15
RDWa SD 1.03 0.18
RDWa variability 0.99 0.47
PLTa 1 0.7
CRPa 1.01 0.07d 1.01 0.99–1.03 0.17
INRa 2.42 0.05d 0.93 0.36–2.4 0.87
APTTa 1.02 0.62
Fibrinogen 1.06 0.7
D-dimer 1 0.46
ALTa 1 0.68
ASTa 1 0.63
Triglyceride 0.68 0.12
Total cholesterol 0.88 0.3
HDL-Ca 0.65 0.28
LDL-Ca 0.95 0.74
Lipoprotein A 1 0.86
Potassium ion 0.8 0.42
Sodium ion 0.97 0.47
TSHa 0.89 0.3
FT3a 0.73 0.1
FT4a 0.94 0.28
eGFRa 0.99 0.08d 0.99 0.99–1.01 0.92
LVIDda 1.28 0.13
LVIDsa 1.18 0.27
LVEFa 1.01 0.51

aBMI, body mass index; hs-cTn-I, high-sensitivity cardiac troponin I; BNP, brain natriuretic peptide; CK-MB, creatine kinase, MB form; WBC, white blood cell; RBC, red blood cell; HB, hemoglobin; MCV, mean corpusular volume; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; RDW, red blood cell distribution width; PLT, platelet; CRP, C-reactive protein; INR, international normalized ratio; APTT, activated partial thromboplastin time; ALT, alanine aminotransferase; AST, aspartate aminotransferase; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TSH, thyroid stimulating hormone; FT3, free triiodothyronine; FT4, free tetraiodothronine; eGFR, estimate glomerular filtration rate; LVIDd, left ventricular internal diameter at end-diastolic; LVIDs, left ventricular internal diameter at end-systole; LVEF, left ventricular ejection fraction.

bMore than four servings of fruits or vegetables per day and a daily fat intake less than 80 g and a daily free sugar intake less than 25 g.

cEither 30 min of moderate to vigorous physical activity (MVPA) on 5 days of the week and/or 30 min of vigorous physical activity three or more times per week.

d P < 0.1, which means that variable was considered for inclusion in the multivariate model.

e P < 0.05, which means statistically significant in the multivariate model.

Figure 1 Survival curve for patients with different high-sensitivity cardiac troponin I and brain natriuretic peptide levels.
Figure 1

Survival curve for patients with different high-sensitivity cardiac troponin I and brain natriuretic peptide levels.

3.3 ROC analysis of the prognostic value of hs-cTn-I in patients with idiopathic DCM

Figure 2 shows the comparison of the predictive ability of hs-cTn-I and BNP for endpoint events by ROC analysis. The areas under the curve (AUCs) of hs-cTn-I and BNP for predicting endpoint events were comparable (0.751 vs 0.742, P = 0.86, NRI = 0.086). The best cut-off value of hs-cTn-I to predict long-term prognosis by ROC analysis was 0.053 ng/mL (sensitivity: 74.5%, specificity: 74.6%). The best cut-off value of BNP to predict long-term prognosis by ROC analysis was 607.5 pg/mL (sensitivity: 76.4%, specificity: 64.2%).

Figure 2 ROC analysis of the prognostic value of hs-cTn-I and BNP in patients with idiopathic dilated cardiomyopathy.
Figure 2

ROC analysis of the prognostic value of hs-cTn-I and BNP in patients with idiopathic dilated cardiomyopathy.

3.4 Correlation among hs-cTn-I, BNP, and percentage change in cardiac ultrasound indices

Table 3 shows the correlations between hs-cTn-I and BNP levels and percentage changes in cardiac ultrasound indices during the follow-up period. hs-cTn-I was correlated with the percentage change in LVEF (correlation coefficient = −0.21, P value = 0.03) and the percentage change in LVIDd (correlation coefficient = 0.2, P value = 0.02), and BNP was correlated with the percentage change in LVEF (correlation coefficient = −0.21, P value = 0.02). These results indicate that high hs-cTn-I and BNP may be related to the deterioration of cardiac ultrasound indicators in idiopathic DCM patients.

Table 3

Correlation of the degree of high-sensitivity cardiac troponin I, brain natriuretic peptide and percentage change in cardiac ultrasound indexes

hs-cTn-Ia BNPa
Correlation coefficient P value Correlation coefficient P value
Percentage change in LVIDda 0.2 0.03b −0.01 0.99
Percentage change in LVIDsa 0.09 0.34 0.07 0.46
Percentage change in LVEFa −0.21 0.03b −0.22 0.02b

ahs-cTn-I, high-sensitivity cardiac troponin I; BNP, brain natriuretic peptide; LVIDd, left ventricular internal diameter at end-diastolic; LVIDs, left ventricular internal diameter at end-systole; LVEF, left ventricular ejection fraction.

b P < 0.05, which means statistically significant.

3.5 Subgroup analysis

Table 4 and Figures 3–8 show the comparison of the predictive ability of hs-cTn-I and BNP for endpoint events in various subgroups by ROC analysis. Table 4 and Figure 3 show that the AUCs of hs-cTn-I and BNP for predicting endpoint events in patients with preserved renal function (estimated glomerular filtration rate >60 mL/min) were 0.853 vs 0.712, P = 0.04, NRI = 0.26, indicating that, compared with BNP, hs-cTn-I had a superior predictive value in patients with preserved renal function. The best cut-off value of hs-cTn-I to predict long-term prognosis by ROC analysis was 0.045 ng/mL (sensitivity: 82.8%, specificity: 85.7%). The best cut-off value of BNP to predict long-term prognosis by ROC analysis was 602.41 pg/mL (sensitivity: 69%, specificity: 73.5%). Table 4 and Figures 4–8 show that the AUCs of hs-cTn-I and BNP for predicting endpoint events in males, females, patients aged less than 60 years, patients aged 60 years or more, and patients without diabetes mellitus were comparable (all P > 0.05). Table 4 shows that the P values of hs-cTn-I for predicting endpoint events in idiopathic DCM patients with renal function insufficiency and the P values of BNP for predicting endpoint events in idiopathic DCM patients with diabetes mellitus were more than 0.05; consequently, we did not conduct further analysis on these two subgroups.

Table 4

The AUC of high-sensitivity cardiac troponin I and BNP for predicting endpoint events

hs-cTn-Ia BNPa Compare P value NRIa,d
AUCa P value AUC P value
All patients 0.751 <0.01b 0.742 <0.01b 0.86 0.086
Patients with eGFRa >60 mL/min 0.853 <0.01b 0.712 <0.01b 0.04b 0.26
Patients with eGFRa ≤ 60 mL/min — 0.99c — — — —
Males 0.761 <0.01b 0.735 <0.01b 0.4 0.133
Females 0.714 0.03b 0.774 <0.01b 0.64 −0.191
Patients with age <60 years 0.79 <0.01b 0.715 <0.01b 0.33 0.179
Patients with age ≥60 years 0.696 <0.01b 0.783 <0.01b 0.35 −0.074
Patients with diabetes mellitus — — — 0.2c — —
Patients without diabetes mellitus 0.747 <0.01b 0.763 <0.01b 0.81 0.018

ahs-cTn-I, high-sensitivity cardiac troponin I; BNP, brain natriuretic peptide; eGFR, estimate glomerular filtration rate; AUC, area under the curve; NRI, net reclassification.

b P < 0.05, which means statistically significant.

c P > 0.05, no further analysis was conducted.

dBrain natriuretic peptide as control.

Figure 3 ROC analysis of the prognostic value of hs-cTn-I and BNP in idiopathic dilated cardiomyopathy patients with preserved renal function.
Figure 3

ROC analysis of the prognostic value of hs-cTn-I and BNP in idiopathic dilated cardiomyopathy patients with preserved renal function.

Figure 4 ROC analysis of the prognostic value of hs-cTn-I and BNP in males with idiopathic dilated cardiomyopathy.
Figure 4

ROC analysis of the prognostic value of hs-cTn-I and BNP in males with idiopathic dilated cardiomyopathy.

Figure 5 ROC analysis of the prognostic value of hs-cTn-I and BNP in females with idiopathic dilated cardiomyopathy.
Figure 5

ROC analysis of the prognostic value of hs-cTn-I and BNP in females with idiopathic dilated cardiomyopathy.

Figure 6 ROC analysis of the prognostic value of hs-cTn-I and BNP in idiopathic dilated cardiomyopathy patients with age less than 60 years.
Figure 6

ROC analysis of the prognostic value of hs-cTn-I and BNP in idiopathic dilated cardiomyopathy patients with age less than 60 years.

Figure 7 ROC analysis of the prognostic value of hs-cTn-I and BNP in idiopathic dilated cardiomyopathy patients with age equal or more than 60 years.
Figure 7

ROC analysis of the prognostic value of hs-cTn-I and BNP in idiopathic dilated cardiomyopathy patients with age equal or more than 60 years.

Figure 8 ROC analysis of the prognostic value of hs-cTn-I and BNP in idiopathic dilated cardiomyopathy patients without diabetes mellitus.
Figure 8

ROC analysis of the prognostic value of hs-cTn-I and BNP in idiopathic dilated cardiomyopathy patients without diabetes mellitus.

4 Discussion

During the follow-up period of our study, the most common endpoint was readmission or an emergency visit due to heart failure (n = 52, 94.5%). BNP is the most common biomarker used for the diagnosis [5] and prognosis [6] of heart failure. In individuals with DCM, BNP has been demonstrated to predict the deterioration of LVEF [10]. Our study showed that patients in the end-event group tended to have higher hs-cTn-I and BNP levels. Therefore, we focused on calculating the prognostic value of hs-cTn-I in idiopathic DCM and compared it with that of BNP. The major findings from the present study are as follows. First, patients with poor outcomes had significantly elevated baseline hs-cTn-I and BNP levels, and high hs-cTn-I and BNP levels were associated with an increased risk of poor prognosis in patients with idiopathic DCM. Second, hs-cTn-I and BNP were potential prognostic biomarkers for long-term prognosis in patients with idiopathic DCM. Finally, compared with BNP, hs-cTn-I had a better predictive value for long-term prognosis in idiopathic DCM patients with preserved renal function.

Troponins are proteins that directly transmit the excitation of myocardial cells to cause contraction. When troponin-I maintains the stability of tropomyosin by binding actin and blocking the myosin binding site, relaxation of striated muscle occurs. When the conformation of the troponin complex changes due to Ca2+ influx, releasing troponin-I from the myosin binding site on actin, contraction of striated muscle occurs [11]. Cardiac troponin-I has unique expression in myocardial tissue, and it cannot be detected in developing or adult skeletal muscle samples. Therefore, degenerative muscle disease or muscle development can be excluded as the source of circulating cardiac troponin-I [12]. When the myocardium is damaged, the cardiac troponin-I levels in circulating blood change early and can be maintained for a long time, and therefore, such levels are a sensitive indicator of myocardial injury. Since its discovery, hs-cTn-I has played an important role in the diagnosis of acute myocardial infarction [13]. With the increasing sensitivity of detection methods, it should be emphasized that cardiac troponin-I is related not only to myocardial infarction but also to various cardiovascular diseases [14]. Studies have shown that hs-cTn-I can be used to evaluate the prognosis of patients with aortic stenosis [15], atrial fibrillation [16], and intracerebral hemorrhage [17]. Castiglione et al. [18] found that cardiac troponin-I was a potential diagnostic indicator for heart failure. Moreover, Xue et al. [19] found that elevated hs-cTn-I levels were linked to a poor prognosis in heart failure patients. In fact, the ACC/AHA guidelines advised using hs-cTn-I/T levels upon admission for risk stratification of heart failure (IA) [20], the endpoint event that occurred the most frequently in our study. According to an animal study [21], cardiac troponin-I is a factor in the diagnosis of DCM in Dobermanns. A clinical trial involving 310 patients with idiopathic DCM [3] revealed that in contrast to creatine kinase-MB (CK-MB) or myoglobin, serum cardiac troponin-I concentration was an independent predictor of all-cause mortality. However, the association between hs-cTn-I and cardiovascular events (e.g., cardiovascular death, heart failure) in patients with idiopathic DCM has rarely been reported. Our research showed that both hs-cTn-I and BNP were potential biomarkers for predicting the long-term prognosis of idiopathic DCM (AUC: 0.751, 0.742).

The following are possible explanations for the elevated hs-cTn-I in idiopathic DCM patients. Idiopathic DCM can lead to cardiac remodeling, which pathophysiologically manifests as a decrease in cardiac output, an increase in end-diastolic pressure, and an increase in cardiac preload. These changes lead to the activation of the renin–angiotensin–aldosterone system, an increase in sympathetic adrenergic activity, and a reduction in cardiac vagal activity [7]. The elevation of left ventricular end-diastolic pressure results in the release of cardiac troponin [22], and secondary neurohormonal changes lead to an increase in cardiac afterload, elevation of myocardial oxygen demand, and direct cardiotoxicity [23]. The combination of these changes injures myocardial cells, releasing cardiac troponin. There are also studies suggesting that the elevated cardiac troponin-I in patients with DCM is also related to immune-mediated dysfunction [24] or that a decline in energy supply results from the loss of healthy mitochondria in the heart [25]. In addition, elevated NLPR-3 has been reported to be associated with poor prognosis in patients with idiopathic DCM [26], and inhibition of NLRP-3 improves the prognosis of patients with DCM [27].

Nellessen et al. [28] demonstrated that persistent myocardial cell injury and ongoing cardiac troponin-I release are related to the onset and progression of chronic heart failure in patients with ischemic and nonischemic DCM. In patients with idiopathic DCM, the concentration of hs-cTn-I eventually stabilizes in the progressive and ongoing myocardial damage process that reflects the rate of myocardial injury caused by idiopathic DCM. In other words, patients with high concentrations of hs-cTn-I exhibit more severe myocardial damage caused by idiopathic DCM.

A clinical study [29] including 1,555 patients showed that renal function can influence the diagnostic and prognostic performance of hs-cTn-I. This may be because cTn-I is partially metabolized by the kidney, and thus, the hs-cTn-I levels in patients with poor renal function may be higher than those in patients with normal renal function. This partly explains why some patients with poor renal function and high hs-cTn-I levels did not have an end event during follow-up. To exclude the influence of renal function, patients with an estimated glomerular filtration rate >60 mL/min were included in the subgroup for analysis. Our results show that the AUCs of hs-cTn-I and BNP for predicting endpoint events in patients with preserved renal function were 0.853 vs 0.712, P = 0.04, indicating that hs-cTn-I had a superior predictive value compared with BNP. However, this finding needs to be further confirmed by studies with large samples. The P values of hs-cTn-I for predicting endpoint events in idiopathic DCM patients with renal function insufficiency and the P values of BNP for predicting endpoint events in idiopathic DCM patients with diabetes mellitus were more than 0.05. We believe that this is due to the small number of patients included in the subgroup analysis. Other subgroup analyses showed that the AUCs of hs-cTn-I and BNP for predicting endpoint events in patients with idiopathic DCM were comparable.

In the early stage of idiopathic DCM, the myocardial injury is too mild to be found by routine auxiliary examination, such as ECG and cardiac ultrasound. An animal study [30] showed that only 40 mg of myocardial necrosis is sufficient to increase the serum concentrations of cardiac troponin above the 99th percentile, which means that hs-cTn-I can be detected in the early stage of myocardial injury caused by idiopathic DCM. A recent study [31] found that late gadolinium enhancement is valuable for identifying high-risk patients with DCM, but due to the complexity of this method, it is difficult to promote in primary medical institutions. hs-cTn-I concentration detection is a simple laboratory test that can be performed in most medical institutions. The results of this study suggest that hs-cTn-I can be used to evaluate the long-term prognosis of patients with idiopathic DCM. According to our research findings, if hs-cTn-I is measured in patients with idiopathic DCM after their diagnosis, it can identify those patients who are at high risk of a poor prognosis and enable more aggressive treatment to improve their prognosis.

This study has some limitations. First, it is a retrospective and observational study, which may be affected by some confounding factors. Although we analyzed several factors that may influence prognosis, unmeasured factors could not be analyzed. Second, this study only performed one measurement of troponin and did not monitor the levels of troponin or other biomarkers during the follow-up period. Third, the diagnosis of idiopathic DCM was made by excluding common causes of secondary DCM, such as myocarditis, hypertension, valve disease, and ischemic heart disease, without an endomyocardial biopsy to support the diagnosis.

5 Conclusion

Based on whether the patient had an end event within the follow-up period, we divided patients initially diagnosed with idiopathic DCM into an end-event group and a non-end-event group. Patients in the end-event group had higher hs-cTn-I and BNP levels. Cox regression analysis suggested that hs-cTn-I and BNP were risk factors for poor long-term prognosis in patients with idiopathic DCM. The correlation analysis suggested that hs-cTn-I was related to the decrease in LVEF and the increase in LVIDd in patients with idiopathic DCM, while BNP was related to the decrease in LVEF. According to the results of the ROC analysis, both hs-cTn-I and BNP are potential biomarkers for predicting the long-term prognosis of idiopathic DCM. Moreover, compared with BNP, hs-cTn-I has a superior predictive value in patients with preserved renal function.

Acknowledgements

The authors extend their gratitude to the participants and staff of this study.

  1. Funding information: This work was supported by Shandong Provincial Natural Science Foundation (ZR2017MH056) and Shandong Provincial Natural Science Foundation (ZR2023MH083).

  2. Author contributions: Yongchao Wang completed the project, analyzed data, and wrote the manuscript. Xiaolin Wang, Hao Xu, and Yulin Yang contributed to data collection. Jian Li is the guarantor of this work and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript.

  3. Conflict of interest: The authors declare that they have no competing interests.

  4. Data availability statement: The data used and analyzed in the current study are available from the corresponding author on reasonable request.

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Received: 2022-08-29
Revised: 2023-09-05
Accepted: 2023-10-10
Published Online: 2023-11-08

© 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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  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-2023-0837
Schlagwörter für diesen Artikel
idiopathic dilated cardiomyopathy; high-sensitivity cardiac troponin-I; brain natriuretic peptide; long-term prognosis
Creative Commons
BY 4.0

Artikel in diesem Heft

  1. Research Articles
  2. Exosomes derived from mesenchymal stem cells overexpressing miR-210 inhibits neuronal inflammation and contribute to neurite outgrowth through modulating microglia polarization
  3. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia
  4. circ-IARS depletion inhibits the progression of non-small-cell lung cancer by circ-IARS/miR-1252-5p/HDGF ceRNA pathway
  5. circRNA ITGA7 restrains growth and enhances radiosensitivity by up-regulating SMAD4 in colorectal carcinoma
  6. WDR79 promotes aerobic glycolysis of pancreatic ductal adenocarcinoma (PDAC) by the suppression of SIRT4
  7. Up-regulation of collagen type V alpha 2 (COL5A2) promotes malignant phenotypes in gastric cancer cell via inducing epithelial–mesenchymal transition (EMT)
  8. Inhibition of TERC inhibits neural apoptosis and inflammation in spinal cord injury through Akt activation and p-38 inhibition via the miR-34a-5p/XBP-1 axis
  9. 3D-printed polyether-ether-ketone/n-TiO2 composite enhances the cytocompatibility and osteogenic differentiation of MC3T3-E1 cells by downregulating miR-154-5p
  10. Propofol-mediated circ_0000735 downregulation restrains tumor growth by decreasing integrin-β1 expression in non-small cell lung cancer
  11. PVT1/miR-16/CCND1 axis regulates gastric cancer progression
  12. Silencing of circ_002136 sensitizes gastric cancer to paclitaxel by targeting the miR-16-5p/HMGA1 axis
  13. Short-term outcomes after simultaneous gastrectomy plus cholecystectomy in gastric cancer: A pooling up analysis
  14. SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways
  15. Molecular mechanism by which the Notch signaling pathway regulates autophagy in a rat model of pulmonary fibrosis in pigeon breeder’s lung
  16. lncRNA TPT1-AS1 promotes cell migration and invasion in esophageal squamous-cell carcinomas by regulating the miR-26a/HMGA1 axis
  17. SIRT1/APE1 promotes the viability of gastric cancer cells by inhibiting p53 to suppress ferroptosis
  18. Glycoprotein non-metastatic melanoma B interacts with epidermal growth factor receptor to regulate neural stem cell survival and differentiation
  19. Treatments for brain metastases from EGFR/ALK-negative/unselected NSCLC: A network meta-analysis
  20. Association of osteoporosis and skeletal muscle loss with serum type I collagen carboxyl-terminal peptide β glypeptide: A cross-sectional study in elder Chinese population
  21. circ_0000376 knockdown suppresses non-small cell lung cancer cell tumor properties by the miR-545-3p/PDPK1 pathway
  22. Delivery in a vertical birth chair supported by freedom of movement during labor: A randomized control trial
  23. UBE2J1 knockdown promotes cell apoptosis in endometrial cancer via regulating PI3K/AKT and MDM2/p53 signaling
  24. Metabolic resuscitation therapy in critically ill patients with sepsis and septic shock: A pilot prospective randomized controlled trial
  25. Lycopene ameliorates locomotor activity and urinary frequency induced by pelvic venous congestion in rats
  26. UHRF1-induced connexin26 methylation is involved in hearing damage triggered by intermittent hypoxia in neonatal rats
  27. LINC00511 promotes melanoma progression by targeting miR-610/NUCB2
  28. Ultra-high-performance liquid chromatography-tandem mass spectrometry analysis of serum metabolomic characteristics in people with different vitamin D levels
  29. Role of Jumonji domain-containing protein D3 and its inhibitor GSK-J4 in Hashimoto’s thyroiditis
  30. circ_0014736 induces GPR4 to regulate the biological behaviors of human placental trophoblast cells through miR-942-5p in preeclampsia
  31. Monitoring of sirolimus in the whole blood samples from pediatric patients with lymphatic anomalies
  32. Effects of osteogenic growth peptide C-terminal pentapeptide and its analogue on bone remodeling in an osteoporosis rat model
  33. A novel autophagy-related long non-coding RNAs signature predicting progression-free interval and I-131 therapy benefits in papillary thyroid carcinoma
  34. WGCNA-based identification of potential targets and pathways in response to treatment in locally advanced breast cancer patients
  35. Radiomics model using preoperative computed tomography angiography images to differentiate new from old emboli of acute lower limb arterial embolism
  36. Dysregulated lncRNAs are involved in the progress of myocardial infarction by constructing regulatory networks
  37. Single-arm trial to evaluate the efficacy and safety of baclofen in treatment of intractable hiccup caused by malignant tumor chemotherapy
  38. Genetic polymorphisms of MRPS30-DT and NINJ2 may influence lung cancer risk
  39. Efficacy of immune checkpoint inhibitors in patients with KRAS-mutant advanced non-small cell lung cancer: A retrospective analysis
  40. Pyroptosis-based risk score predicts prognosis and drug sensitivity in lung adenocarcinoma
  41. Upregulation of lncRNA LANCL1-AS1 inhibits the progression of non-small-cell lung cancer via the miR-3680-3p/GMFG axis
  42. CircRANBP17 modulated KDM1A to regulate neuroblastoma progression by sponging miR-27b-3p
  43. Exosomal miR-93-5p regulated the progression of osteoarthritis by targeting ADAMTS9
  44. Downregulation of RBM17 enhances cisplatin sensitivity and inhibits cell invasion in human hypopharyngeal cancer cells
  45. HDAC5-mediated PRAME regulates the proliferation, migration, invasion, and EMT of laryngeal squamous cell carcinoma via the PI3K/AKT/mTOR signaling pathway
  46. The association between sleep duration, quality, and nonalcoholic fatty liver disease: A cross-sectional study
  47. Myostatin silencing inhibits podocyte apoptosis in membranous nephropathy through Smad3/PKA/NOX4 signaling pathway
  48. A novel long noncoding RNA AC125257.1 facilitates colorectal cancer progression by targeting miR-133a-3p/CASC5 axis
  49. Impact of omicron wave and associated control measures in Shanghai on health management and psychosocial well-being of patients with chronic conditions
  50. Clinicopathological characteristics and prognosis of young patients aged ≤45 years old with non-small cell lung cancer
  51. TMT-based comprehensive proteomic profiling identifies serum prognostic signatures of acute myeloid leukemia
  52. The dose limits of teeth protection for patients with nasopharyngeal carcinoma undergoing radiotherapy based on the early oral health-related quality of life
  53. miR-30b-5p targeting GRIN2A inhibits hippocampal damage in epilepsy
  54. Long non-coding RNA AL137789.1 promoted malignant biological behaviors and immune escape of pancreatic carcinoma cells
  55. IRF6 and FGF1 polymorphisms in non-syndromic cleft lip with or without cleft palate in the Polish population
  56. Comprehensive analysis of the role of SFXN family in breast cancer
  57. Efficacy of bronchoscopic intratumoral injection of endostar and cisplatin in lung squamous cell carcinoma patients underwent conventional chemoradiotherapy
  58. Silencing of long noncoding RNA MIAT inhibits the viability and proliferation of breast cancer cells by promoting miR-378a-5p expression
  59. AG1024, an IGF-1 receptor inhibitor, ameliorates renal injury in rats with diabetic nephropathy via the SOCS/JAK2/STAT pathway
  60. Downregulation of KIAA1199 alleviated the activation, proliferation, and migration of hepatic stellate cells by the inhibition of epithelial–mesenchymal transition
  61. Exendin-4 regulates the MAPK and WNT signaling pathways to alleviate the osteogenic inhibition of periodontal ligament stem cells in a high glucose environment
  62. Inhibition of glycolysis represses the growth and alleviates the endoplasmic reticulum stress of breast cancer cells by regulating TMTC3
  63. The function of lncRNA EMX2OS/miR-653-5p and its regulatory mechanism in lung adenocarcinoma
  64. Tectorigenin alleviates the apoptosis and inflammation in spinal cord injury cell model through inhibiting insulin-like growth factor-binding protein 6
  65. Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer
  66. F-box and WD repeat domain containing 7 inhibits the activation of hepatic stellate cells by degrading delta-like ligand 1 to block Notch signaling pathway
  67. Knockdown of circ_0005615 enhances the radiosensitivity of colorectal cancer by regulating the miR-665/NOTCH1 axis
  68. Long noncoding RNA Mhrt alleviates angiotensin II-induced cardiac hypertrophy phenotypes by mediating the miR-765/Wnt family member 7B pathway
  69. Effect of miR-499-5p/SOX6 axis on atrial fibrosis in rats with atrial fibrillation
  70. Cholesterol induces inflammation and reduces glucose utilization
  71. circ_0004904 regulates the trophoblast cell in preeclampsia via miR-19b-3p/ARRDC3 axis
  72. NECAB3 promotes the migration and invasion of liver cancer cells through HIF-1α/RIT1 signaling pathway
  73. The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk
  74. miR-2053 inhibits the growth of ovarian cancer cells by downregulating SOX4
  75. Nucleophosmin 1 associating with engulfment and cell motility protein 1 regulates hepatocellular carcinoma cell chemotaxis and metastasis
  76. α-Hederin regulates macrophage polarization to relieve sepsis-induced lung and liver injuries in mice
  77. Changes of microbiota level in urinary tract infections: A meta-analysis
  78. Identification of key enzalutamide-resistance-related genes in castration-resistant prostate cancer and verification of RAD51 functions
  79. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies – (lessons learned from) a prospective study
  80. Outcomes of low-risk birth care during the Covid-19 pandemic: A cohort study from a tertiary care center in Lithuania
  81. Vitamin D protects intestines from liver cirrhosis-induced inflammation and oxidative stress by inhibiting the TLR4/MyD88/NF-κB signaling pathway
  82. Integrated transcriptome analysis identifies APPL1/RPS6KB2/GALK1 as immune-related metastasis factors in breast cancer
  83. Genomic analysis of immunogenic cell death-related subtypes for predicting prognosis and immunotherapy outcomes in glioblastoma multiforme
  84. Circular RNA Circ_0038467 promotes the maturation of miRNA-203 to increase lipopolysaccharide-induced apoptosis of chondrocytes
  85. An economic evaluation of fine-needle cytology as the primary diagnostic tool in the diagnosis of lymphadenopathy
  86. Midazolam impedes lung carcinoma cell proliferation and migration via EGFR/MEK/ERK signaling pathway
  87. Network pharmacology combined with molecular docking and experimental validation to reveal the pharmacological mechanism of naringin against renal fibrosis
  88. PTPN12 down-regulated by miR-146b-3p gene affects the malignant progression of laryngeal squamous cell carcinoma
  89. miR-141-3p accelerates ovarian cancer progression and promotes M2-like macrophage polarization by targeting the Keap1-Nrf2 pathway
  90. lncRNA OIP5-AS1 attenuates the osteoarthritis progression in IL-1β-stimulated chondrocytes
  91. Overexpression of LINC00607 inhibits cell growth and aggressiveness by regulating the miR-1289/EFNA5 axis in non-small-cell lung cancer
  92. Subjective well-being in informal caregivers during the COVID-19 pandemic
  93. Nrf2 protects against myocardial ischemia-reperfusion injury in diabetic rats by inhibiting Drp1-mediated mitochondrial fission
  94. Unfolded protein response inhibits KAT2B/MLKL-mediated necroptosis of hepatocytes by promoting BMI1 level to ubiquitinate KAT2B
  95. Bladder cancer screening: The new selection and prediction model
  96. circNFATC3 facilitated the progression of oral squamous cell carcinoma via the miR-520h/LDHA axis
  97. Prone position effect in intensive care patients with SARS-COV-2 pneumonia
  98. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children
  99. Dihydroartemisinin ameliorates cerebral I/R injury in rats via regulating VWF and autophagy-mediated SIRT1/FOXO1 pathway
  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
  101. Low Ang-(1–7) and high des-Arg9 bradykinin serum levels are correlated with cardiovascular risk factors in patients with COVID-19
  102. Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study
  103. Potential protective effects of Huanglian Jiedu Decoction against COVID-19-associated acute kidney injury: A network-based pharmacological and molecular docking study
  104. Clinical significance of serum MBD3 detection in girls with central precocious puberty
  105. Clinical features of varicella-zoster virus caused neurological diseases detected by metagenomic next-generation sequencing
  106. Collagen treatment of complex anorectal fistula: 3 years follow-up
  107. LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through down-regulating SP-A by sponging to miR-424
  108. Efficacy analysis of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy as a first-line Helicobacter pylori eradication regimen – An open-label, randomized trial
  109. SMOC2 plays a role in heart failure via regulating TGF-β1/Smad3 pathway-mediated autophagy
  110. A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults
  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
  112. hsa_circ_0000285 sponging miR-582-3p promotes neuroblastoma progression by regulating the Wnt/β-catenin signaling pathway
  113. Long non-coding RNA GNAS-AS1 knockdown inhibits proliferation and epithelial–mesenchymal transition of lung adenocarcinoma cells via the microRNA-433-3p/Rab3A axis
  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
  115. Twenty-four-color full spectrum flow cytometry panel for minimal residual disease detection in acute myeloid leukemia
  116. Hsa-miR-223-3p participates in the process of anthracycline-induced cardiomyocyte damage by regulating NFIA gene
  117. Anti-inflammatory effect of ApoE23 on Salmonella typhimurium-induced sepsis in mice
  118. Analysis of somatic mutations and key driving factors of cervical cancer progression
  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
  121. Effects of pharmacological delay with roxadustat on multi-territory perforator flap survival in rats
  122. Analysis of heroin effects on calcium channels in rat cardiomyocytes based on transcriptomics and metabolomics
  123. Risk factors of recurrent bacterial vaginosis among women of reproductive age: A cross-sectional study
  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
  126. Correlation between microvessel maturity and ISUP grades assessed using contrast-enhanced transrectal ultrasonography in prostate cancer
  127. The protective effect of caffeic acid phenethyl ester in the nephrotoxicity induced by α-cypermethrin
  128. Norepinephrine alleviates cyclosporin A-induced nephrotoxicity by enhancing the expression of SFRP1
  129. Effect of RUNX1/FOXP3 axis on apoptosis of T and B lymphocytes and immunosuppression in sepsis
  130. The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity
  131. Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU
  132. Calycosin protects against chronic prostatitis in rats via inhibition of the p38MAPK/NF-κB pathway
  133. Pan-cancer analysis of the PDE4DIP gene with potential prognostic and immunotherapeutic values in multiple cancers including acute myeloid leukemia
  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
  136. Clinical characteristics of current COVID-19 rehabilitation outpatients in China
  137. Luteolin alleviates ulcerative colitis in rats via regulating immune response, oxidative stress, and metabolic profiling
  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
  139. The application of iliac fascia space block combined with esketamine intravenous general anesthesia in PFNA surgery of the elderly: A prospective, single-center, controlled trial
  140. Elevated blood acetoacetate levels reduce major adverse cardiac and cerebrovascular events risk in acute myocardial infarction
  141. The effects of progesterone on the healing of obstetric anal sphincter damage in female rats
  142. Identification of cuproptosis-related genes for predicting the development of prostate cancer
  143. Lumican silencing ameliorates β-glycerophosphate-mediated vascular smooth muscle cell calcification by attenuating the inhibition of APOB on KIF2C activity
  144. Targeting PTBP1 blocks glutamine metabolism to improve the cisplatin sensitivity of hepatocarcinoma cells through modulating the mRNA stability of glutaminase
  145. A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry
  146. Clinical analysis of AN69ST membrane continuous venous hemofiltration in the treatment of severe sepsis
  147. Antibiotics therapy combined with probiotics administered intravaginally for the treatment of bacterial vaginosis: A systematic review and meta-analysis
  148. Construction of a ceRNA network to reveal a vascular invasion associated prognostic model in hepatocellular carcinoma
  149. A pan-cancer analysis of STAT3 expression and genetic alterations in human tumors
  150. A prognostic signature based on seven T-cell-related cell clustering genes in bladder urothelial carcinoma
  151. Pepsin concentration in oral lavage fluid of rabbit reflux model constructed by dilating the lower esophageal sphincter
  152. The antihypertensive felodipine shows synergistic activity with immune checkpoint blockade and inhibits tumor growth via NFAT1 in LUSC
  153. Tanshinone IIA attenuates valvular interstitial cells’ calcification induced by oxidized low density lipoprotein via reducing endoplasmic reticulum stress
  154. AS-IV enhances the antitumor effects of propofol in NSCLC cells by inhibiting autophagy
  155. Establishment of two oxaliplatin-resistant gallbladder cancer cell lines and comprehensive analysis of dysregulated genes
  156. Trial protocol: Feasibility of neuromodulation with connectivity-guided intermittent theta-burst stimulation for improving cognition in multiple sclerosis
  157. LncRNA LINC00592 mediates the promoter methylation of WIF1 to promote the development of bladder cancer
  158. Factors associated with gastrointestinal dysmotility in critically ill patients
  159. Mechanisms by which spinal cord stimulation intervenes in atrial fibrillation: The involvement of the endothelin-1 and nerve growth factor/p75NTR pathways
  160. Analysis of two-gene signatures and related drugs in small-cell lung cancer by bioinformatics
  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
  169. Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia
  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
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Heruntergeladen am 3.10.2025 von https://www.degruyterbrill.com/document/doi/10.1515/med-2023-0837/html
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