Startseite Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section
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Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section

  • Hong Yang , Yun Zhao , Jiahui Tu , Yanan Chang und Chanyun Xiao EMAIL logo
Veröffentlicht/Copyright: 1. April 2024

Abstract

Uterine rupture is a rupture of the body or lower part of the uterus during pregnancy or delivery. Total of 98 cases with incomplete uterine rupture were classified as the incomplete uterine rupture group, 100 cases with a history of cesarean delivery without uterine rupture were classified as the non-ruptured uterus group, and controls were selected using a systematic sampling method. The maternal age ≥35 years were associated with 2.18 times higher odds of having an incomplete uterine rupture. The odd of having an incomplete uterine rupture was 3.744 times higher for a woman with delivery interval ≤36 months. Having pregnancy complication was associated with 3.961 times higher odds of having an incomplete uterine rupture. The neonatal weight was lighter in the incomplete uterine rupture group (P = 0.007). The number of preterm birth and transfer to the NICU were higher in the incomplete uterine rupture group (P < 0.01). The operation time and the length of time in hospital were longer in the group with incomplete uterine rupture (P < 0.01). Age ≥35 years, delivery interval ≤36 month, and pregnancy with complication were independent risk factors of incomplete rupture of the uterus secondary to previous cesarean section.

1 Introduction

Uterine rupture is a catastrophic obstetric emergency that can lead to maternal and neonatal death in severe cases [1]. The incidence of uterine rupture varies widely in the published literature because of the study population base and the definition given. According to WHO (World Health Organization), the average incidence of uterine rupture is 5.3/10,000. Globally, the incidence of uterine rupture is 0.07% with the tendency of being lower in the developed countries than the developing countries [2]. The incidence was 0.18% in 96 hospitals covering most regions of China in 2015–2016 [3]. The most common risk factor is scarred uterus, usually due to a previous cesarean section, with rupture occurring mostly in the anterior lower uterine segment [4].

According to the analysis of national maternal and child health care statistics, the cesarean section rate in China rose from 28.8% in 2008 to 34.9% in 2014 and reached 36.7% in 2018 [5], even in some megalopolis the cesarean rate is greater than 60% [6]. Selective repeat cesarean section has emerged as a major cause of high cesarean section incidence in many countries [7]. In general, complete uterine rupture was defined as a laceration in all layers of the uterine wall, including the plasma membrane and amniotic membrane. Incomplete uterine rupture was defined as a tear in the layer of the muscle but the plasma membrane or amniotic membrane remained intact [8,9].

In this study, we found that there was a gradual increase in the number of incomplete uterine ruptures secondary to a history of previous cesarean delivery, such cases were collected in our hospital in the past 4 years for study, with the aim of early detection and prevention of such incomplete uterine ruptures.

2 Materials and methods

2.1 Study setting

Total 98 cases of incomplete uterine rupture recorded in Hubei Provincial Maternal and Child Health Hospital, Wuhan, China from 2018 to 2021 were collected and retrospectively analyzed, and 100 cases with a history of cesarean delivery during the same period were selected to elective repeat cesarean delivery without uterine rupture as the non-ruptured uterus group. This hospital is one of the critical maternity transfer centers in Hubei Province, with an average of more than 20,000 deliveries per year in recent years. All aspects of this study were conducted under the approval of Maternal and Child Health Hospital of Hubei Province.

2.2 Inclusion criteria

Delivery records of all pregnant women with a history of at least one previous cesarean section and diagnosed with incomplete uterine rupture during the current cesarean section were retrieved and included in the study as the incomplete uterine rupture group. A systematic sampling method was used to select cases of scarred uterus with previous cesarean delivery who underwent cesarean delivery without uterine rupture at our hospital during the same period in a ratio of 1:1 to be included in the control group. All cases had a complete medical history and auxiliary examination findings.

2.3 Variables of the study

  • Socio-demographic variables: age, height, weight, and BMI.

  • Obstetric factors: gravida, para, and gestational age, interval time since previous cesarean section, pregnancy-related complications such as hypertension (including pre-eclampsia), diabetes, history of hysteroscopic surgery (such as endometrial polyposectomy, intrauterine adhesiolysis, subserosal myomectomy), duration of surgery, bleeding, number of days in hospital, postoperative infection.

  • Neonatal outcome: preterm birth, weight, gestational week, transfer to NICU.

  • Auxiliary examination: ultrasound measurement of the thickness of the lower myometrium by abdominal ultrasound within 24 h before hospitalization and delivery.

2.4 Statistical analysis

Quantitative data were expressed in mean ± SD. Statistical analyses were performed using SPSS for 23.0. Quantitative data were compared using student’s t-test for continuous variables and chi-square tests for categorical variables. Multivariable logistic regression was used to analyze the relationship between maternal conditions and uterine rupture. Receiver operating curve (ROC) analyses were used to determine optimal cut-off values for sensitivity and specificity. The significant difference was pre-set at P < 0.05.

3 Results

3.1 Characteristics of participants

This study revealed that age ≥35 years, multiparous, number of previous cesarean section ≥2, delivery interval ≤36 months, history of hysteroscopic surgery, women with pregnancy complications were highly proportionate among cases of incomplete uterine rupture compared to controls (P < 0.05).

The proportion of age ≥35 years was 40 (40.8%) among cases and 21 (21%) among controls. Incomplete uterine rupture cases of 32 (32.7%) and 13 (13%) of controls belonged to gravidity of three and above. Women with number of previous cesarean section ≥2 were slightly higher in proportion among cases of incomplete uterine rupture 14(14.3%) compared to controls 4(4%). Delivery interval ≤36 months was highly proportionate among cases with 43 (43.9%) whereas 18 (18%) among controls. The proportion of women with history of hysteroscopic surgery is slightly higher among cases 10 (10.2%) compared to controls 3 (3%). Women with pregnancy complication were higher in proportion among cases of incomplete uterine rupture 49(50%) compared to controls 21(21%) (Table 1).

Table 1

Comparison of demographic and obstetric characteristics of pregnant women with incomplete ruptured uterus secondary to previous cesarean section

Variables Incomplete uterine ruptures group (n = 98) Non-ruptured uterus group (n = 100) P value
Maternal age (year) 33.74 ± 3.33 32.30 ± 3.15 0.002
Age ≥35 years 0.003
 Yes 40 (40.8%) 21 (21%)
 No 58 (59.2%) 79 (79%)
Pre-pregnancy BMI (kg/m2) 22.06 ± 2.63 22.99 ± 3.87 0.05
Gravidity >3 0.005
 Yes 32 (32.7%) 13 (13%)
 No 66 (67.3%) 87 (87%)
Number of previous cesarean section ≥2 0.014
 Yes 14 (14.3%) 4 (4%)
 No 84 (85.7%) 96 (96%)
Delivery interval <0.001
 ≤36 months 43 (43.9%) 18 (18%)
 >36 months 55 (56.1%) 81 (81%)
History of hysteroscopic surgery 0.048
 Yes 10 (10.2%) 3 (3%)
 No 88 (89.8%) 97 (97%)
Pregnancy complication <0.001
 Yes 49 (50%) 21 (21%)
 No 49 (50%) 79 (79%)

BMI, body mass index. Calculating formula: BMI = Weight (kg) ÷ Height2 (m).

P values in bold indicate that the difference was significant.

3.2 Factors associated with incomplete ruptured uterus secondary to previous cesarean section

The odds of happening incomplete uterine rupture in relation to different characteristics of women were estimated by odds ratio using multivariate logistic regression analysis (Table 2). The result of multivariate analysis maternal age ≥35 years were associated with 2.18 (AOR = 2.18; 95% confidence interval [CI]: 1.059, 4.490) times higher odds of having an incomplete uterine rupture compared to maternal age <35 years. The odd of having an incomplete uterine rupture was 3.744 (AOR = 3.744; 95% CI: 1.828, 7.665) times higher for a woman with delivery interval ≤36 months. Having pregnancy complication was associated with 3.961 (AOR = 3.961; 95% CI: 1.989, 7.889).

Table 2

Multivariate logistic regression analysis for factors associated with incomplete ruptured uterus secondary to previous cesarean section

Factor B P value Adjust odds ratio 95% CI lower 95% CI upper
Age ≥35 years 0.780 0.034 2.180 1.059 4.490
Parity >3 0.673 0.132 1.959 0.816 4.704
Number of previous cesarean section ≥2 0.791 0.233 2.205 0.601 8.084
Delivery interval ≤36 months 1.320 0.000 3.744 1.828 7.665
History of hysteroscopic surgery 0.304 0.683 1.356 0.315 5.834
Pregnancy complication 1.376 0.000 3.961 1.989 7.889

P values in bold indicate that the difference was significant (P < 0.05).

3.3 Maternal and neonatal outcomes

There were no maternal deaths and hysterectomy secondary to incomplete uterine rupture. Maternal and neonatal outcomes are shown in Table 3. The gestational weeks of incomplete uterine rupture group and non-ruptured uterus group were 37.29 ± 1.26 weeks and 38.50 ± 0.52 weeks, respectively (P < 0.001). The neonatal weight was lighter in the incomplete uterine rupture group than in the control group (P = 0.007). The number of preterm birth was highly proportionate among cases with 31 (31.6%) whereas 1 (1%) among controls. The number of cases (11, 11.2%) transferred to the NICU was higher than controls (1, 1%). The main reasons for referral to the neonatal unit are neonatal asphyxia and neonatal respiratory distress. The operation time and the length of time in hospital were longer in the group with incomplete uterine rupture than in the control group (P < 0.01). The number of placental adhesions in the incomplete uterine rupture group was 21 (21.4%) compared to 5 (5%) in the control group. The differences in intraoperative bleeding and the number of postoperative infections between the two groups were not statistically significant (P > 0.05). The difference in ultrasound measurement of myometrial thickness values of the lower uterine segment between the two groups was statistically significant (P < 0.001).

Table 3

Comparison of maternal and neonatal outcomes

Variables Incomplete uterine ruptures group (n = 98) Non-ruptured uterus group (n = 100) P value
Gestational weeks 37.29 ± 1.26 38.50 ± 0.52 <0.001
Neonatal weight (g) 3136.78 ± 420.26 3282.70 ± 334.235 0.007
Preterm birth <0.001
31 (31.6%) 1 (1%)
67 (68.4% 99 (99%)
Transfer to the NICU 0.003
11 (11.2%) 1 (1%)
87 (88.8%) 99 (99%)
Operating time (min) 41.10 ± 9.83 37.68 ± 6.22 0.002
Hospitalization time (day) 6.91 ± 4.02 5.38 ± 0.88 <0.001
Placenta adhesion 0.001
 Yes 21 (21.4%) 5 (5%)
 No 77 (78.6%) 95 (95%)
Intraoperative blood Loss (mL) 325.00 ± 86.23 317.00 ± 46.17 0.415
Postoperative infection 0.366
 Yes 3 (3.1%) 1 (1%)
 No 95 (96.9%) 99 (99%)
Thickness of the lower uterine myometrium (mm) 0.84 ± 0.50 1.61 ± 0.51 <0.001

P values in bold indicate that the difference was significant (P < 0.05).

3.4 ROC analysis

ROC analysis demonstrated that lower uterine myometrial thickness was linked with the incomplete ruptured uterus secondary to previous cesarean, with an area under the curve of 87.9% (95% CI: 83–92%, P < 0.001) as shown in Figure 1. The cut-off values of lower uterine myometrial thickness were determined by selecting the values that produced the highest sensitivity plus specificity combination value. The lower uterine myometrial thickness of 0.64 mm was the cut-off value with the best combination of sensitivity and specificity (75.5 and 88%, respectively) for the incomplete ruptured uterus secondary to previous cesarean.

Figure 1 
                  ROC: The sensitivity and specificity of lower uterine myometrial thickness with the incomplete ruptured uterus secondary to previous cesarean.
Figure 1

ROC: The sensitivity and specificity of lower uterine myometrial thickness with the incomplete ruptured uterus secondary to previous cesarean.

4 Discussion

The study was designed to identify the factors associated with incomplete uterine rupture during delivery of a second pregnancy in a scarred uterus, to compare maternal and infant prognosis with that of an unruptured scarred uterus, to find a way to predict incomplete uterine rupture in scarred uteri. The analysis showed that the likelihood of incomplete uterine rupture secondary to previous cesarean section was associated with the following factors: advanced maternal age, delivery interval ≤36 months, pregnancy with complications, which were consistent with the results of other studies [3,10]. The myometrium, like muscles in other parts of the body, may undergo age-related morphologic changes accompanied by a decrease in tissue elasticity. The results of uterine biopsies suggested an increase in the cholesterol content of muscle cells and an increase in the connective tissue between muscle bundles with age [11]. The risk of uterine rupture increases with shorter interval between cesarean pregnancies, with a sharp decline in the rate of uterine rupture until the tenth month of interval, then a moderate and steady decline until a very moderate decline after the fortieth month [12]. Wound healing in the myometrium is associated with multiple complex cellular interactions, of which the mechanisms of abnormal uterine healing and myometrial rupture remain unclear [13]. Poor healing of the uterine scar after a previous cesarean section may lead to thinning of the anterior uterine wall. Cesarean scar defect (CSD) of the lower uterine segment then occurs and its presence becomes a fatal problem, especially in the case of the next pregnancy.

A study comparing maternal and children outcomes in complete uterine rupture with incomplete uterine rupture suggested a significantly higher need for blood transfusion, more frequent puerperal complications, and higher rates of neonatal asphyxia and transfer to the neonatal unit in women with complete uterine rupture [14]. However, few cases of incomplete uterine rupture secondary to a previous cesarean delivery have been specifically compared with maternal and child outcomes in cases of previous cesarean delivery without uterine rupture. In our study, the number of preterm birth, transfer to the NICU, and placental adhesions were higher, the operation time and the length of time in hospital were longer in the group with incomplete uterine rupture than in the control group.

The absence of peritoneal signs in incomplete uterine rupture may delay the diagnosis, especially if there is little or no abdominal bleeding [13]. This study also found that most incomplete uterine ruptures do not have obvious clinical symptoms. Currently, obstetricians work with ultra-sonographers in clinical practice. This has also become a safe and reliable method for clinicians to predict the risk of uterine rupture, and to combine it with the women’s conscious symptoms for a comprehensive analysis to guide clinicians to terminate the pregnancy at the right time [15]. The definition of uterine incision thinness has varied in many previous studies. Nagy Afifi’s study concluded that total lower uterine segment thickness of <3.65 mm is considered a thin scar, and <2.85 mm is associated with a higher risk of uterine dehiscence [16]. Alalaf et al.’s research showed that a lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm are associated with a high risk of uterine defects [17]. While a meta-analysis indicated that an lower uterine segment thickness of less than 2 mm likely identifies women at a higher risk of uterine rupture [15]. We usually determine the risk of rupture of the uterine incision based on a combination of the thinness and continuity of the lower myometrium. In our study, results showed that pregnant women with a previous history of lower uterine segment cesarean delivery had an increased risk of incomplete uterine rupture when the thickness of the lower uterine segment myometrium was less than 0.64 mm.

A pathological cardiotocogram (CTG) should lead to particular attention on threatening uterine rupture [18]. A recent work showed that the risk for neonatal acidemia increases very rapidly when pathologic CTG is found [19]. More so bradicardia and long second stages are also substantially associated to neonatal acidemia and to catastrophic events such as uterine rupture [19,20].

CSD, also known as niche, isthmocele, uteroperitoneal fistula, and uterine diverticulum, is a known complication after cesarean delivery [21]. As there are no definitive criteria for diagnosing an isthmocele, several imaging methods can be used to assess the integrity of the uterine wall and thus diagnose an isthmocele [22]. Isthmocele is usually asymptomatic, but its main symptom is abnormal or postmenstrual bleeding, chronic pelvic pain can also occur, and uterine rupture can be one of the complications of this condition [22].

Since this study included elective cesarean section without vaginal trial labor, the patient did not enter labor, there were no data for duration of labor (particularly second stage) in the results and consider assessing this covariate as well as CTG abnormalities. Because the sample size included in this study was limited, it was not a prospective randomized controlled study, and no reproducibility of ultrasound measurements was performed, the reliability of the measurements should be considered.

5 Conclusion

In general, according to the current study, for women with a history of at least one cesarean section, there are increased risks of incomplete uterine rupture at age >35 years, delivery interval ≤36 months, pregnancy with complications. For pregnant women at high risk of uterine rupture in late-trimester, it is necessary to combine ultrasound findings of the lower myometrium, maternal conscious symptoms, and the results of fetal heart monitoring to terminate the pregnancy at the appropriate time according to the condition of the mother and child to avoid adverse medical outcomes.

  1. Funding information: None.

  2. Conflict of interest: None.

  3. Data availability statement: All data generated or analyzed during this study are included in this published article.

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Received: 2022-09-06
Revised: 2023-08-28
Accepted: 2024-02-28
Published Online: 2024-04-01

© 2024 the author(s), published by De Gruyter

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

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  79. miR-let-7a inhibits sympathetic nerve remodeling after myocardial infarction by downregulating the expression of nerve growth factor
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  81. The H2Valdien derivatives regulate the epithelial–mesenchymal transition of hepatoma carcinoma cells through the Hedgehog signaling pathway
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  84. Lycopene inhibits pyroptosis of endothelial progenitor cells induced by ox-LDL through the AMPK/mTOR/NLRP3 pathway
  85. Methylation regulation for FUNDC1 stability in childhood leukemia was up-regulated and facilitates metastasis and reduces ferroptosis of leukemia through mitochondrial damage by FBXL2
  86. Correlation of single-fiber electromyography studies and functional status in patients with amyotrophic lateral sclerosis
  87. Risk factors of postoperative airway obstruction complications in children with oral floor mass
  88. Expression levels and clinical significance of serum miR-19a/CCL20 in patients with acute cerebral infarction
  89. Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022
  90. Evaluating anemia in HIV-infected patients using chest CT
  91. Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court
  92. Causal association of circulating immune cells and lymphoma: A Mendelian randomization study
  93. Assessment of the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals on treating renal fibrosis: A systematic review and meta-analysis
  94. Comprehensive landscape of integrator complex subunits and their association with prognosis and tumor microenvironment in gastric cancer
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  105. Exploring anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-coronary artery bypass graft surgery
  106. Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism
  107. Analysis of the risk factors of the radiation-induced encephalopathy in nasopharyngeal carcinoma: A retrospective cohort study
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  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
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  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
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  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
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  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
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  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
  228. Single-cell analysis identified key macrophage subpopulations associated with atherosclerosis
Heruntergeladen am 29.10.2025 von https://www.degruyterbrill.com/document/doi/10.1515/med-2024-0927/html?lang=de
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