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Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience

  • Alaa Rahhal EMAIL logo , Mostafa Najim , Ahmed Mahfouz , Mhd Baraa Habib , Sara Seife Hassen , Isra’a Al-Shekh , Ashraf Omer Ahmed , Haneen Toba , Shahem Abbarh , Mawahib El Hassan , Sumaya Al Yafei , Amr Badr and Khaled Mohamed Mahmoud
Published/Copyright: December 6, 2023
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Open Medicine
From the journal Open Medicine Volume 18 Issue 1

Abstract

Sustained low-efficiency dialysis (SLED) is usually performed over 6–12 h among hemodynamically unstable patients. Conduction of 4-h SLED may spare time and manpower during hospitalization. Therefore, we conducted a retrospective observational study to explore the appropriateness and clinical outcomes of 4-h SLED among critically ill patients admitted to our center from 1/06/2016 to 1/06/2020. Renal parameters including blood urea nitrogen, serum creatinine, sodium, phosphorus, potassium, and bicarbonate were determined on the day of dialysis before SLED and within 24 h after SLED, and clinical outcomes including, acute kidney injury (AKI) recovery, in-hospital mortality, 30-day mortality, 180-day mortality, and re-admission with AKI, were evaluated. Of the 304 patients included, 69.4% were male. The majority of patients were from the Middle East (65.8%), followed by 28.6% from Asia. Four-hour SLED resulted in a significant improvement in the renal parameters. Recovery from AKI was observed in 25.4%, in-hospital mortality rate was 48.7%, while the 30- and 180-day mortality outcomes were 3.2 and 9.6%, respectively, and re-admission with AKI was observed in 16.9%. Our findings suggest that 4-h SLED significantly improved renal parameters and was associated with favorable clinical outcomes in terms of survival and AKI recovery, suggesting possible utilization of SLED shorter than 6 h in the acute settings to preserve time and manpower for procedures.

Keywords: sustained low-efficiency dialysis; acute kidney injury; mortality; dialysis

1 Introduction

Acute kidney injury (AKI) is the rapid deterioration in renal parameters, including serum creatinine (SrCr) and urine output, as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria [1]. AKI continued to be a tremendous burden on the healthcare system in terms of mortality, prolongation of hospital stay, and the need to initiate renal replacement therapy (RRT) [2]. It is estimated that 8% of AKI patients require dialysis and the majority usually start the first dialysis session in the intensive care units (ICU) [2]. Furthermore, it is estimated that around 3% of the patients who develop AKI in hospital settings usually end up having long-term dialysis [3].

Hemodialysis was first started early in the 20th century and the spectrum of service has expanded since then worldwide [4,5]. According to previously published data, the most common predisposing factors to AKI are volume depletion and sepsis [6]. Around 7% of these patients ended up with chronic regular dialysis [6]. Over the years, several subtypes of hemodialysis have emerged and been implemented in the clinical practice. There are three main types of dialysis: intermittent hemodialysis (IHD), sustained low-efficiency dialysis (SLED), and continuous RRT (CRRT). Although the indications to start RRT are the same for all modalities, nephrologists may prefer the selection of one modality over another based on individual preferences and the appropriate clinical settings [7].

SLED is characterized by slower dialysate and blood flow rates than IHD [8]. The dialysis sessions in SLED are usually done over 6–12 h and they could be performed on a daily basis [7,9]. This offers better hemodynamic stability for critically ill patients with low mean arterial blood pressure [10]. Compared to CRRT, which is continuous throughout the day, SLED has cost advantages and less exposure to anticoagulation [11]. There are no clear differences among these dialysis modalities in terms of renal recovery or mortality [7].

According to our local practice at Heart Hospital (HH) in Qatar, which is the main tertiary cardiology center in the country, SLED is offered to critically ill patients over a duration of 4 h, rather than the standard 6–12 h. The rationale behind this deviation is to spare time for other procedures needed in the critical care units, better patient’s convenience, efficient utilization of manpower for other services and procedures, and less anticoagulation usage, and hence fewer complications. Nevertheless, to the best of our knowledge, the appropriateness and clinical outcomes of 4-h SLED have not yet been evaluated. Therefore, we conducted a retrospective observational study to explore the renal and clinical outcomes of 4-h SLED among patients admitted to HH over a 4-year period.

2 Methods

2.1 Study setting

This study was conducted at HH in Qatar. The hospital is the main tertiary cardiology center under Hamad Medical Corporation (HMC), which is the principal public healthcare provider in the country.

  1. Ethical approval and consent to participate: The study was approved by HMC Medical Research Centre and the Institutional Review Board (MRC-01-21-036).

2.2 Study design and population

We conducted a retrospective observational study involving patients with or without end-stage renal disease (ESRD) admitted to our center and required dialysis which was conducted as 4-h SLED during their hospital stay. The study was approved by the HMC Medical Research Centre and the Institutional Review Board (MRC-01-21-036). The study comprised two stages: (1) determining the change in blood pressure and renal parameters, including SrCr, blood urea nitrogen (BUN), potassium (K+), sodium (Na+), phosphorus (P), calcium (Ca++), and bicarbonate (HCO3 −) before and after 4-h SLED sessions and (2) assessing the clinical outcomes of 4-h SLED, including AKI recovery, in-hospital mortality, 30-day mortality, 180-day mortality, and re-admission with AKI.

2.3 Eligibility criteria

Patients were included in the study if they fulfilled the following criteria: (1) adult patients >18 years; (2) hemodynamically unstable ESRD already on IHD prior to admission; (3) hemodynamically unstable AKI or AKI on top of chronic kidney disease (CKD) requiring dialysis; and (4) underwent a minimum of one and a maximum of ten consecutive 4-h SLED session(s) during admission. Patients were excluded if they had one of the following: (1) hemodynamically stable ESRD patients on IHD; (2) did CRRT during the index admission; (3) underwent SLED of less than 4 h or more than 4 h; or (4) underwent isolated ultrafiltration. Eligible patients underwent 4-h SLED which is done at our institution at a blood flow rate of 150 mL/min, dialysate flow of 300 mL/min, and high-flux dialyzer, predominantly without anticoagulation with heparin unless deemed necessary by the treating nephrologist.

2.4 Outcome measures and follow-up

The primary outcomes of 4-h SLED were: renal parameters, including SrCr, BUN, K+, Na+, P, Ca++, and HCO3 − before and after all the 4-h SLED sessions done during the index admission. The secondary outcomes evaluated were: (1) the change in blood pressure before and after all the 4-h SLED sessions; (2) the volume of fluid removed per each SLED session; (3) the need for vasopressor support during SLED; and (4) clinical outcomes including, AKI recovery defined as return of SrCr to baseline value before developing AKI, in-hospital mortality defined all-cause mortality during the index admission, 30-day mortality defined all-cause mortality within 30 days of discharge, 180-day mortality defined all-cause mortality within 180 days of discharge, and re-admission with AKI defined as a rise in SrCr by at least 2 times the baseline value, according to the KDIGO criteria [1]. Patients were followed up for 180 days post-discharge after the index admission.

2.5 Data collection procedures

The baseline characteristics of the study participants and the outcomes of interest, including the primary and secondary outcomes as well as patient-, disease-, and medication-related factors, were collected from the HMC electronic medical records system (Cerner®) mainly by reviewing the physicians notes documented during the index admission and the results of all laboratory values done during the admission. Moreover, during the 180-day follow-up period, we reviewed the encounters between the patients and other healthcare providers within HMC as all facilities in the corporate have an integrated system. Data collection was conducted from 1 April 2021 to 31 October 2021. Relevant data were manually extracted using a pretested data collection form.

2.6 Statistical analyses

Data analyses were performed using the Statistical Package for Social Sciences program version 24.0 (IBM SPSS Statistics for Windows; IBM Corp, Armonk, NY). Descriptive statistics were reported in the form of frequencies and percentages for categorical variables, mean ± standard deviation (SD) for normally distributed continuous variables, and median with interquartile range for skewed continuous variables. The primary analysis was designed to demonstrate the change in the renal parameters, systolic blood pressure (SBP), and diastolic blood pressure (DBP) before and after SLED sessions done during the index admission. The change in all parameters was analyzed using Wilcoxon signed-rank test as all the primary outcome parameters were skewed. A p-value of <0.05 was used to indicate statistical significance.

3 Results

3.1 Subject selection

We have reviewed 493 patients admitted to HH for different reasons and required at least one session of 4-h SLED throughout their hospital stay. Of these, 189 were excluded for a variety of reasons as demonstrated in Figure 1, and the remaining 304 patients met the eligibility criteria of our study and served as the study cohort.

Figure 1 Screening and enrollment of study participants.
Figure 1

Screening and enrollment of study participants.

3.2 Baseline characteristics

The baseline characteristics of the subjects (n = 304) are presented in Table 1. Male gender represents 69.4% of the subjects. The majority of the subjects were originally from the Middle East and Asia, 65.8 and 28.6% respectively, while only 4.6 and 1% were Africans and Europeans. The most common comorbidities found in the study population were hypertension, diabetes mellitus, and heart failure, 76.3, 74.3, and 70.7%, respectively, followed by CKD and ESRD on regular hemodialysis. Almost 35% were admitted because of acute decompensated heart failure, and about 31% were admitted due to acute coronary syndrome. Patients admitted with acute decompensated heart failure secondary to acute coronary syndrome represented 13.8% of the study population. However, cardiogenic shock was the predominant underlying cause of the hemodynamic instability and it was found in 45.4% of the subjects.

Table 1

Baseline characteristics of patients undergoing 4-h SLED (N = 304)

Characteristic n (%)
Gender
 Male 211 (69.4)
 Female 93 (30.6)
Age (years) 64 [19]
Weight (kg) 74 [22]
Region of origin
 Middle East 200 (65.8)
 Asia 87 (28.6)
 Africa 14 (4.6)
 Europe 3 (1.0)
Medical history
 Hypertension 232 (76.3)
 Diabetes mellitus 226 (74.3)
 CKD 197 (64.8)
 ESRD on regular dialysis 45 (14.8)
 Heart failure 215 (70.7)
Reason for hospital admission
 Acute coronary syndrome 94 (30.9)
 Acute decompensated heart failure 106 (34.9)
 Acute decompensated heart failure due to acute coronary syndrome 42 (13.8)
 Elective admission for a cardiac procedure 12 (3.9)
 Other reasons 50 (16.5)
Reason for hemodynamic instability
 Cardiogenic shock 138 (45.4)
 Complete heart block 2 (0.7)
 Mixed septic and cardiogenic shock 31 (10.2)
 Septic shock 19 (6.3)
 Rhabdomyolysis 2 (0.7)
 Other reasons 112 (36.7)
Baseline laboratory values*
 BUN (mmol/L) 13 [16]
 SrCr (μmol/L) 183 [180]
 Na+ (mmol/L) 137 [5]
 K+ (mmol/L) 4.4 [0.8]
 HCO3 − (mmol/L) 21 [9]
 Ca++ (mmol/L) 2.2 [0.2]
 P (mmol/L) 1.2 [0.3]
 Parathyroid hormone 189 [244]
Laboratory values and vitals upon admission*
 BUN (mmol/L) 15 [15]
 SrCr (μmol/L) 213 [226]
 Na+ (mmol/L) 136 [8]
 K+ (mmol/L) 4.5 [1]
 HCO3 − (mmol/L) 22 [7]
 Ca++ (mmol/L) 2.3 [0.2]
 P (mmol/L) 1.4 [0.7]
 Parathyroid hormone (pg/mL)** 420 ± 332
 SBP (mmHg) 130 [43]
 DBP (mmHg) 71 [20]

*Presented as median [interquartile range].

**Presented as mean ± SD; SLED: sustained low-efficiency dialysis.

The renal parameters, including BUN and SrCr at baseline prior to admission were 13 mmol/L [interquartile range, 16] and 183 μmol/L [interquartile range, 180], respectively. The same parameters were worse upon admission as shown in Table 1.

3.3 Effectiveness outcomes

3.3.1 Vitals and renal parameters

The change in blood pressure and the majority of the renal parameters post 4-h SLED sessions was statistically significant as illustrated in Table 2. The BUN decreased from 22 mmol/L [interquartile range, 15] to 17 mmol/L [interquartile range, 10]; p < 0.001, and SrCr decreased from 383 μmol/L [interquartile range, 216] to 299 μmol/L [interquartile range, 191]; p < 0.001, as demonstrated in Figure 2a and b. Similarly, K+, HCO3 −, and P significantly improved with 4-h SLED, as shown in Figure 2c–e. While serum Ca++ was the only renal parameter that was not significantly affected by 4-h SLED with a p-value of 0.443. The characteristics of the individual SLED sessions are described in Table 3. Vasopressor support was primarily required in the first SLED session. Vasopressors, including noradrenaline, dopamine, and vasopressin were used in 9.9, 4.9, and 1.6% of the patients, respectively. With regard to the anticoagulation use for 4-h SLED, it was rarely used as demonstrated in Table 3. Additionally, SrCr and BUN before and after each session were described, and both parameters improved significantly in the individual SLED sessions except in the tenth SLED session where BUN change did not meet statistical significance.

Table 2

Comparison of the renal parameters and vitals before and after 4-h SLED (N = 304)

Variable Pre-SLED* Post-SLED* p -value
BUN (mmol/L) 22 [15] 17 [10] p < 0.001
SrCr (μmol/L) 383 [216] 299 [191] p < 0.001
Na+ (mmol/L) 136 [6] 137 [4] p < 0.001
K+ (mmol/L) 4.6 [0.9] 4.1 [0.6] p < 0.001
HCO3 − (mmol/L) 22 [6] 25 [5] p < 0.001
Ca++ (mmol/L) 2.1 [0.2] 2.1 [0.2] 0.443
P (mmol/L) 1.6 [0.8] 1.4 [0.7] p < 0.001
SBP (mmHg) 115 [25] 114 [31] 0.009
DBP (mmHg) 64 [14] 63 [12] 0.001

*Presented as median [interquartile range]; BUN: blood urea nitrogen; SLED: sustained low-efficiency dialysis.

Figure 2 Renal parameters before and after 4-h SLED. (a) Blood urea nitrogen, (b) serum creatinine, (c) potassium, (d) bicarbonate, (e) phosphorus.
Figure 2

Renal parameters before and after 4-h SLED. (a) Blood urea nitrogen, (b) serum creatinine, (c) potassium, (d) bicarbonate, (e) phosphorus.

Table 3

Characteristics of individual SLED sessions

Parameter SLED 1 (n = 304) SLED 2 (n = 215) SLED 3 (n = 155) SLED 4 (n = 115) SLED 5 (n = 97) SLED 6 (n = 82) SLED 7 (n = 67) SLED 8 (n = 54) SLED 9 (n = 44) SLED 10 (n = 37)
Loop diuretic, n (%)
 Furosemide bolus 59 (19.4) 41 (19.1) 23 (14.8) 19 (16.5) 13 (13.4) 8 (9.8) 4 (6.0) 1 (1.9) 4 (9.1) 4 (10.8)
 Furosemide infusion 105 (34.5) 37 (17.2) 26 (16.8) 8 (7.0) 4 (4.1) 5 (6.1) 4 (6.0) 3 (5.6) 3 (6.9) 3 (8.1)
 Oral furosemide 7 (2.3) 6 (2.8) 3 (1.9) 3 (2.6) 2 (2.1) 3 (3.7) 5 (7.5) 3 (5.6) 2 (4.5) 2 (5.4)
 None 133 (43.8) 131 (60.9) 103 (66.5) 85 (73.9) 78 (80.4) 66 (80.5) 54 (80.6) 47 (87.0) 35 (79.5) 28 (75.7)
Loop diuretic TDD (mg)* 235 ± 154 189 ± 158 175 ± 125 157 ± 139 175 ± 139 221 ± 170 168 ± 126 207 ± 151 116 ± 81 120 ± 92
Anticoagulation for dialysis, n (%) 4 (1.3) 6 (2.8) 4 (2.6) 2 (1.7) 4 (4.1) 3 (3.7) 3 (4.5) 1 (1.9) 0 0
Vasopressor support during SLED
 Dopamine 15 (4.9) 6 (2.8) 7 (4.5) 1 (0.9) 2 (2.1) 2 (2.4) 0 1 (1.9) 0 2 (5.4)
 Noradrenaline 30 (9.9) 6 (2.8) 8 (5.2) 4 (3.5) 5 (5.2) 2 (2.4) 4 (6.0) 4 (7.4) 1 (2.3) 1 (2.7)
 Vasopressin 5 (1.6) 3 (1.4) 3 (1.9) 0 1 (1.0) 0 0 0 0 1 (2.7)
 Vasopressor dose increased 68 (22.4) 44 (20.5) 24 (15.5) 17 (14.8) 8 (8.2) 8 (9.8) 6 (9.0) 5 (9.3) 4 (9.1) 1 (2.7)
 Others 8 (2.6) 8 (3.7) 1 (0.6) 0 1 (1.0) 0 1 (1.5) 0 1 (2.3) 0
 None 178 (58.6) 148 (68.8) 112 (72.3) 93 (80.9) 80 (82.5) 70 (85.4) 56 (83.6) 44 (81.5) 38 (86.4) 32 (86.5)
Midodrine, n (%) 7 (2.3) 7 (3.3) 9 (5.8) 8 (7.0) 6 (6.2) 10 (12.2) 8 (11.9) 5 (9.3) 5 (11.4) 4 (10.8)
Ultrafiltration volume (L)* 1.45 ± 0.82 1.79 ± 0.90 1.78 ± 0.81 1.96 ± 0.77 2.02 ± 0.66 1.98 ± 0.77 1.96 ± 0.72 2.02 ± 0.80 2.04 ± 0.67 2.04 ± 0.64
SrCr pre-SLED (μmol/L)** 400 [220] 364 [209] 355 [242] 361 [199] 321 [207] 310 [190] 314 [162] 309 [205] 331 [188] 316 [172]
SrCr post-SLED (μmol/L)** 312 [193] 284 [165] 274 [193] 273 [148] 268 [179] 255 [154] 271 [177] 263 [159] 292 [192] 195 [175]
p -value p < 0.001 p < 0.001 p < 0.001 p < 0.001 p < 0.001 p < 0.001 p < 0.001 p < 0.001 p < 0.001 p = 0.04
BUN pre-SLED (mmol/L)** 26.3 [20] 17.7 [18] 23.4 [14] 20.2 [14] 19.0 [12] 17.1 [13] 16.1 [12] 17.1 [11] 16.3 [11] 15.8 [13]
BUN post-SLED (mmol/L)** 18.6 [13] 15.8 [11] 16.8 [11] 10.8 [3] 15.7 [11] 14.1 [9] 15.1 [10] 13.8 [9] 14.7 [9] 15.7 [10]
p -value p < 0.001 p < 0.001 p < 0.001 p < 0.001 p < 0.001 p < 0.001 p < 0.001 p < 0.001 p = 0.007 p = 0.159

*Presented as mean ± SD.

**Presented as median [interquartile range]; SLED: sustained low-efficiency dialysis; TDD: total daily dose; BUN: blood urea nitrogen.

3.3.2 Clinical outcomes

Around half of the study population (n = 130, 48.1%) were successfully discharged from the ICU as shown in Table 4. In terms of AKI recovery, around a quarter of the study population (n = 66, 25.4%) achieved this outcome, while 25 (16.9%) were re-admitted with AKI. On the other hand, the in-hospital mortality was observed in 48.7% of the study population, while the 30- and 180-day mortality outcomes were 3.2 and 9.6% among those who were successfully discharged from hospital, respectively.

Table 4

Outcomes of 4-h SLED (N = 304)

Outcome n (%)
AKI recovery* 66 (25.4)
Discharge from ICU** 130 (48.1)
In-hospital mortality 148 (48.7)
30-Day mortality§ 5 (3.2)
180-Day mortality§ 15 (9.6)
Re-admission with AKI‡ 25 (16.9)

*Excluding 45 patients who had ESDR at baseline.

**Excluding 34 patients who didn’t require ICU admission. §Excluding patients who died during hospital stay. ‡Excluding patients who died either during the hospital stay or within 6 months of discharge; SLED: sustained low-efficiency dialysis; AKI: acute kidney injury; ICU: intensive care unit.

4 Discussion

The benchmark is to perform SLED over 6–12 h among hemodynamically unstable patients who require dialysis [7,9]. Nevertheless, at our center, SLED is performed over 4 h, which is considered shorter than the ideal SLED duration for a variety of reasons, including sparing time for other procedures needed in the critical care units, making the procedure more convenient to the patient and healthcare providers, utilizing the manpower for other services and procedures, and reducing the exposure to anticoagulation during dialysis. Therefore, we opted to evaluate the effectiveness of 4-h SLED. Our retrospective analysis over 4 years demonstrated that performing 4-h SLED among patients with hemodynamic instability requiring dialysis significantly improved the renal parameters, including SrCr, BUN, K+, and HCO3 −, and was associated with favorable short-term and long-term outcomes, including 30-day and 180-day mortality post-discharge.

We found that SLED as short as 4 h improved SrCr, BUN, Na+, K+, HCO3 −, and P among hemodynamically unstable patients requiring dialysis. Our findings were similar to the findings reported by Marshall et al. who demonstrated that 6–12-h SLED with a mean of 10.4 h, resulted in a significant reduction in SrCr, BUN, K+, and HCO3 − [12]. Likewise, a retrospective study of 91 patients with AKI treated with SLED that was conducted over 8–12 h showed that SLED significantly improved BUN, SrCr, and K+ within 24 h of SLED [13]. Other studies had evaluated the appropriateness and adequacy of SLED in comparison to other dialysis modalities by assessing Kt/V and urea reduction ratio (URR); however, we have not calculated Kt/V or URR as these calculations would require BUN to be withdrawn directly post-dialysis, which is not routinely done in our daily practice, and these calculations are of less utility for the evaluation of RRT adequacy in the acute settings, which resemble our study settings [14,15,16,17].

There is still a lack of solid evidence favoring a mode of RRT over another in patients with AKI in terms of survival [7]. We have demonstrated that the use of 4-h SLED resulted in an in-hospital mortality of 48.7%. Our observed mortality rate was lower than the rate reported by Marshall and colleagues in 2001 who showed that the in-hospital mortality of SLED conducted over a mean of 10.4 h was 62.2% [12]. Nevertheless, 3 years later, Marshall et al. reported that the observed in-hospital mortality of 8-h SLED was 46% among 24 critically ill patients, which is similar to the mortality rate we observed in our retrospective analysis [15]. AKI recovery was observed in 25.4% of our study population. In a retrospective observational study that compared 8-h SLED and CRRT in 232 patients with AKI, short-term RRT dependence was comparable between SLED and CRRT [11]. Additionally, we found that the 30-day mortality post-discharge among patients receiving 4-h SLED was 3.2% only. In comparison to other literature evaluating SLED clinical outcomes, our reported 30-day mortality is considered low. Kitchlu et al. reported that the 30-day mortality was 54% in 74 patients treated with 8-h SLED [11]. Similarly, a retrospective study of 91 patients with AKI treated with 8–12 h SLED showed that mortality at 1 month was 58% [13]. This huge variation in the 30-day mortality rate between our study and previous literature could be explained by separating the outcomes into in-hospital mortality and 30-day mortality in our study, while the two studies previously discussed combined the two outcomes; thus, their 30-day mortality was inclusive of in-hospital mortality as well [11,13]. On top of 30-day mortality, we have evaluated the long-term effect of 4-h SLED by assessing the 180-day mortality and we found it to be 9.6%. To the best of our knowledge, this is the first study to explore 180-day mortality as a long-term outcome of SLED.

This study was an observational retrospective study that has its inherent limitations. First, the retrospective nature of the study with the dependence on the electronic medical records to obtain the study data carries a risk of missing important information that may not be appropriately documented in the medical records. Second, to assess the adequacy of 4-h SLED, we have relied solely on the change in renal parameters withdrawn on the day of dialysis before SLED and within 24 h after SLED without calculating Kt/V or URR. The calculation of Kt/V or URR was not feasible, especially that in our institution, BUN is not withdrawn directly after dialysis, and our study was conducted in acute settings where Kt/V and URR are of less utility. Third, our study did not compare 4-h SLED to the standard SLED of 6–12 h due to underutilization of standard SLED at our institution. Nevertheless, this retrospective observational study, despite the previous limitations, had a good number of participants and most importantly, tried to answer a unique question and fill a gap in the existing literature to determine whether performing SLED with a shorter duration than the standard duration would achieve favorable renal and clinical outcomes.

5 Conclusion

This study suggests that the use of 4-h SLED significantly improved renal parameters among patients with hemodynamic instability requiring dialysis, which might encourage utilizing SLED shorter than the standard duration to preserve time and manpower for essential procedures during the hospital stay. Prospective trials comparing 4-h SLED with standard SLED need to be conducted to confirm the findings of our study.

fax: +974 4439 5490

Acknowledgments

Open Access funding provided by the Qatar National Library.

  1. Funding information: The publication of the article was supported by Qatar National Library.

  2. Author contributions: AR, MN, and KM conceived the study; AR, MN, AM, MBH, SSH, IA, AA, SA, and HT were involved in the data collection process; AR, MN, KM, and AM analyzed and interpreted the data; AR, MN, KM, AM, MBH, SSH, IA, AA, HT, SA, ME, SA, and AM interpreted the results; AR, MN, AB, and AA wrote the manuscript; all authors revised the manuscript and approved the final manuscript for submission.

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

  4. Data availability statement: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Received: 2023-07-15
Revised: 2023-10-20
Accepted: 2023-11-12
Published Online: 2023-12-06

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

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

Articles in the same Issue

  1. Research Articles
  2. Exosomes derived from mesenchymal stem cells overexpressing miR-210 inhibits neuronal inflammation and contribute to neurite outgrowth through modulating microglia polarization
  3. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia
  4. circ-IARS depletion inhibits the progression of non-small-cell lung cancer by circ-IARS/miR-1252-5p/HDGF ceRNA pathway
  5. circRNA ITGA7 restrains growth and enhances radiosensitivity by up-regulating SMAD4 in colorectal carcinoma
  6. WDR79 promotes aerobic glycolysis of pancreatic ductal adenocarcinoma (PDAC) by the suppression of SIRT4
  7. Up-regulation of collagen type V alpha 2 (COL5A2) promotes malignant phenotypes in gastric cancer cell via inducing epithelial–mesenchymal transition (EMT)
  8. Inhibition of TERC inhibits neural apoptosis and inflammation in spinal cord injury through Akt activation and p-38 inhibition via the miR-34a-5p/XBP-1 axis
  9. 3D-printed polyether-ether-ketone/n-TiO2 composite enhances the cytocompatibility and osteogenic differentiation of MC3T3-E1 cells by downregulating miR-154-5p
  10. Propofol-mediated circ_0000735 downregulation restrains tumor growth by decreasing integrin-β1 expression in non-small cell lung cancer
  11. PVT1/miR-16/CCND1 axis regulates gastric cancer progression
  12. Silencing of circ_002136 sensitizes gastric cancer to paclitaxel by targeting the miR-16-5p/HMGA1 axis
  13. Short-term outcomes after simultaneous gastrectomy plus cholecystectomy in gastric cancer: A pooling up analysis
  14. SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways
  15. Molecular mechanism by which the Notch signaling pathway regulates autophagy in a rat model of pulmonary fibrosis in pigeon breeder’s lung
  16. lncRNA TPT1-AS1 promotes cell migration and invasion in esophageal squamous-cell carcinomas by regulating the miR-26a/HMGA1 axis
  17. SIRT1/APE1 promotes the viability of gastric cancer cells by inhibiting p53 to suppress ferroptosis
  18. Glycoprotein non-metastatic melanoma B interacts with epidermal growth factor receptor to regulate neural stem cell survival and differentiation
  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
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  41. Upregulation of lncRNA LANCL1-AS1 inhibits the progression of non-small-cell lung cancer via the miR-3680-3p/GMFG axis
  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
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  45. HDAC5-mediated PRAME regulates the proliferation, migration, invasion, and EMT of laryngeal squamous cell carcinoma via the PI3K/AKT/mTOR signaling pathway
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  50. Clinicopathological characteristics and prognosis of young patients aged ≤45 years old with non-small cell lung cancer
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  53. miR-30b-5p targeting GRIN2A inhibits hippocampal damage in epilepsy
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  58. Silencing of long noncoding RNA MIAT inhibits the viability and proliferation of breast cancer cells by promoting miR-378a-5p expression
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  67. Knockdown of circ_0005615 enhances the radiosensitivity of colorectal cancer by regulating the miR-665/NOTCH1 axis
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  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
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  103. Potential protective effects of Huanglian Jiedu Decoction against COVID-19-associated acute kidney injury: A network-based pharmacological and molecular docking study
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  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
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  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
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  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
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  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
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  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
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  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
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  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
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  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
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  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
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  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
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  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
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  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
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  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
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  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
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  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
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  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
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  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
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  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
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  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
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  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
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  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-2023-0868
Keywords for this article
sustained low-efficiency dialysis; acute kidney injury; mortality; dialysis
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. Exosomes derived from mesenchymal stem cells overexpressing miR-210 inhibits neuronal inflammation and contribute to neurite outgrowth through modulating microglia polarization
  3. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia
  4. circ-IARS depletion inhibits the progression of non-small-cell lung cancer by circ-IARS/miR-1252-5p/HDGF ceRNA pathway
  5. circRNA ITGA7 restrains growth and enhances radiosensitivity by up-regulating SMAD4 in colorectal carcinoma
  6. WDR79 promotes aerobic glycolysis of pancreatic ductal adenocarcinoma (PDAC) by the suppression of SIRT4
  7. Up-regulation of collagen type V alpha 2 (COL5A2) promotes malignant phenotypes in gastric cancer cell via inducing epithelial–mesenchymal transition (EMT)
  8. Inhibition of TERC inhibits neural apoptosis and inflammation in spinal cord injury through Akt activation and p-38 inhibition via the miR-34a-5p/XBP-1 axis
  9. 3D-printed polyether-ether-ketone/n-TiO2 composite enhances the cytocompatibility and osteogenic differentiation of MC3T3-E1 cells by downregulating miR-154-5p
  10. Propofol-mediated circ_0000735 downregulation restrains tumor growth by decreasing integrin-β1 expression in non-small cell lung cancer
  11. PVT1/miR-16/CCND1 axis regulates gastric cancer progression
  12. Silencing of circ_002136 sensitizes gastric cancer to paclitaxel by targeting the miR-16-5p/HMGA1 axis
  13. Short-term outcomes after simultaneous gastrectomy plus cholecystectomy in gastric cancer: A pooling up analysis
  14. SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways
  15. Molecular mechanism by which the Notch signaling pathway regulates autophagy in a rat model of pulmonary fibrosis in pigeon breeder’s lung
  16. lncRNA TPT1-AS1 promotes cell migration and invasion in esophageal squamous-cell carcinomas by regulating the miR-26a/HMGA1 axis
  17. SIRT1/APE1 promotes the viability of gastric cancer cells by inhibiting p53 to suppress ferroptosis
  18. Glycoprotein non-metastatic melanoma B interacts with epidermal growth factor receptor to regulate neural stem cell survival and differentiation
  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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