Home Medicine Risk factors of postoperative airway obstruction complications in children with oral floor mass
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Risk factors of postoperative airway obstruction complications in children with oral floor mass

  • Ying Liu , Chen Zhuo , Yujiao Guo , Yang Jiang , Mingzhe Li , Yangyang Zhao , Xiaolu Wu and Guoxia Yu EMAIL logo
Published/Copyright: July 2, 2024
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Open Medicine
From the journal Open Medicine Volume 19 Issue 1

Abstract

The aim of the present study was to explore the risk factors of postoperative airway complications in children with oral floor mass. The first choice of auxiliary examination method for children with oral floor mass is also proposed. This retrospective study included 50 children with floor-of-mouth (FOM) masses. Medical records were reviewed, and information on age of onset, functional impacts present, age at consultation, imaging findings, history of preoperative aspiration, pathology findings, properties of biopsied fluid, treatment modality, postoperative outcomes, and operation were recorded. A total of 20 patients exhibited functional impacts such as difficulty in breathing and feeding. Ultrasound examination was performed in 28 cases; and magnetic resonance imaging, in 38 cases. The diagnosis was lymphatic malformation in 12 cases, developmental cyst in 29 cases, and solid mass in 7 cases. There were 28 cases of surgical resection, 9 cases underwent multiple puncture volume reduction followed by surgery, 11 cases treated using sclerotherapy injection, and 1 case treated using sclerotherapy injection and surgical resection. Young age, functional impact, and high grade of lymphatic duct malformation increased the risk of surgical treatment. B-scan ultrasound is the first choice for the diagnosis of FOM masses in children.

Keywords: floor-of-mouth mass; airway obstruction; risk factors; surgical treatment; children

1 Introduction

The oral cavity is the starting point of the gastrointestinal and respiratory tracts and has complex anatomical and functional structures. Floor-of-mouth (FOM) masses have complex and varied functional impacts. They may elevate the body of the tongue, which may affect feeding, swallowing, articulation, and push the root of the tongue backward, which may cause breathing difficulty and cause asphyxia in serious cases [1]. FOM masses in younger children, particularly newborns, may interfere with breathing and feeding. Owing to specific characteristics of children, the FOM has a loose tissue structure, and it is more susceptible to life-threatening conditions such as bleeding and infection. Therefore, clinical management is more difficult than that in adults, and there are several possible diagnoses and different treatment principles for children with FOM masses [2,3,4]. Accurate assessment of FOM masses and treatment with the right approach and right time are essential

We reviewed 50 cases of children with FOM masses and proposed factors related to airway obstruction risk after surgery for FOM masses in children.

2 Materials and methods

2.1 Study participants

Children with FOM masses who were hospitalized for surgical treatment between June 2009 and December 2021 at the Department of Oral and Maxillofacial Surgery, Beijing Children’s Hospital, Capital Medical University, were selected.

The inclusion criteria were as follows: (1) preliminary diagnosis of FOM mass in medical history, clinical examination, and imaging and (2) treatment by surgical removal of mass or drug injection after admission.

The exclusion criteria were as follows: (1) diagnosed with ranula or mucous cyst on clinical examination and aspiration biopsy, imaging, or pathological examination and (2) having with FOM mass but failed to undergo treatment because of systemic diseases or other reasons.

2.2 General information

The following data were collected and analyzed: age of onset, age at consultation, and whether there were any effects on breathing and feeding.

2.3 Imaging findings

We identified whether the patients underwent ultrasound examination or magnetic resonance imaging (MRI) and analyzed the findings thereof: single cyst, multiple cysts, solid cyst, and uncertain for ultrasound examination/MRI. The postoperative airway risk was then predicted, and the accuracy of the prediction was calculated.

2.4 Biopsy

We determined whether preoperative aspiration biopsy was performed and the aspiration fluid properties (clear, off-white, other colors, could not be biopsied) and whether multiple preoperative cyst punctures for fluid volume reduction or fine needle aspiration (FNA) cytology was performed.

2.5 Treatment modality and postoperative complications

The following data were collected and analyzed: surgical resection, multiple volume reductions and surgical resection, sclerotherapy injection, sclerotherapy injection, surgical resection, whether there was postoperative pediatric intensive care unit (PICU) admission, and whether recurrence occurred.

2.6 Diagnostic data

Statistical data on preliminary diagnosis, pathological diagnosis, and diagnosis at discharge were collected. Diagnostic data were classified into one of the three categories: solid mass, lymphatic malformation, and developmental cyst. The agreement between B-scan ultrasound examination and properties of the mass and between B-scan ultrasound and aspiration and diagnosis were determined.

2.7 Statistical analysis

SPSS23.0 was used to analyze the correlation between the age of onset and age at surgery to their effect on breathing, eating, puncture volume reduction, diagnostic information, treatment methods, and postoperative PICU admission. We used the Pearson chi square test (Pearson X 2) method, and the P-value was set to 0.05. If P < 0.05, the significance level was reached, indicating that this factor has a significant difference in postoperative PICU. On this basis, calculate the Cramer’s V, with a significance P value of 0.05. If P < 0.05, it indicates a significant correlation between this factor and postoperative PICU.

  1. Ethical approval: This study was conducted following the principles of the Declaration of Helsinki (revised by the World Medical Association in 2013) and approved by the Ethics Committee of the Beijing Children’s Hospital, Capital Medical University (approval number, [2022]-E-109-R).

  2. Informed consent: As this study was retrospective and did not contain identifying patient information, the need for informed consent was waived.

3 Results

After screening by applying the inclusion and exclusion criteria, a total of 50 children, 32 boys, and 18 girls aged between 2 months and 13 years were included in the study. Details of the age of onset and treatment of the patients are shown in Table 4. Of the 41 children with an age of onset <2 years, 28 were detected at birth, accounting for 56% of the total number of cases. The median age at the time of treatment was 16.5 months.

Of the 33 children who underwent puncture aspiration of cystic fluid, 12 had clear or slightly bloody fluid, which was considered a lymphatic malformation, and 16 had yellow, creamy white, or brown fluid, which was considered a developmental cyst. There were two cases of FNA cytology, one of primitive neuroectodermal tumor and one of alveolar soft part sarcoma (Table 1).

Table 1

Functional impacts, imaging findings, aspiration biopsy results, diagnosis, and treatment data of the 50 cases of FOM masses in children

Cases Percentage (%)
Functional impact 20 40.0
Respiration 12 24.0
Feeding 13 26.0
B-scan ultrasound 28 56.0
Single 16 32.0
Multiple 11 22.0
Solid (nodular) 1 2.0
MRI 38 76.0
Single 20 40.0
Multiple 14 28.0
Solid (nodular) 4 8.0
Aspiration data 33 66.0
Clear fluid 12 24.0
Other colors 16 32.0
Not possible 3 6.0
FNAC 2 4.0
Multiple cystic reduction 9 18.0
Treatment modality
Surgical resection 28 56.0
Reduction + surgery 9 18.0
Sclerotherapy injection 11 22.0
Sclerotherapy + surgery 1 2.0
Diagnostic data
Lymphatic 12 24.0
Malformation developmental cyst 29 58.0
Solid (nodular) masses 7 14.0

FNAC, fine needle aspiration cytology; FOM, floor of mouth; MRI, magnetic resonance imaging.

The agreement between B-scan ultrasound results and properties of the mass and between B-scan ultrasound and aspiration biopsy examination and diagnosis is shown in Table 2.

Table 2

Agreement between B-scan ultrasound and mass properties and between B-scan ultrasound + aspiration biopsy and diagnosis

Cases Accurately diagnosed cases Agreement rate (%)
B-scan ultrasound 28
Lymphatic malformation 10 10 100
Developmental cyst 14 13 92.6
Solid (nodular) mass 2 1 50
B-scan ultrasound + aspiration biopsy 18
Lymphatic malformation 10 10 100
Developmental cyst 8 8 100

The results of the correlation analysis between the age of onset and age at surgery to their effect on breathing, eating, puncture volume reduction, diagnostic information, treatment methods, and PICU admission after surgery are shown in Table 3. The results show statistically significant (P value 0.010) difference in feeding on PICU after surgery, with a correlation coefficient of 0.365 (Cramer’s V = 0.365, P = 0.01).

Table 3

Analysis of related factors of postoperative PICU admission

Postoperative PICU admission
Pearson X 2 Significance (bilateral)
Age at onset 3.178 0.204
Age at treatment 7.415 0.116
Respiration 3.429 0.064
Feeding** 6.652* 0.010
Multiple cystic reduction 0.374 0.541
Diagnostic data 3.464 0.177
Treatment modality 7.857 0.097

*Significant differences at 0.05 level (bilateral).

**Cramer’s V is 0.365. Significance is 0.01. Significant correlation at 0.05 level.

PICU, pediatric intensive care unit.

Seven children were admitted to the PICU after puncture or surgical treatment (Table 4). In five cases (71.4%), the children were younger than 1 year. There were three cases (42.9%) of lymphatic malformation.

Table 4

Age of the 50 patients with FOM mass and of those admitted to the PICU

Cases of age group Total
<1 year 1–2 years 2–4 years >4 years
Age at onset 36 5 0 9 50
Age at treatment 21 11 7 11 50
Postoperative PICU admission 5 1 0 1 7

FOM, floor of mouth; PICU, pediatric intensive care unit.

4 Discussion

If children are required to admit to PICU, it will increase the cost of treatment, and increase the economic burden on their families. The purpose of this study was to identify the relevant factors that increase the risk of airway obstruction after treatment of oral floor masses and explore how to avoid them.

4.1 High-risk factors for surgical complications

The results of this study showed that there was a significant correlation between impaired feeding before the operation of FOM mass and admission to the PICU after the operation. This may be due to a mass large in size and located posteriorly at the bottom of the mouth, causing difficulties in eating.

Although correlation analysis showed that there was no significant correlation between the age of surgery, diagnosis information, and entering PICU after surgery, from Table 4, we can see that of the seven children who entered PICU after operation, five were younger than 1 year old. Young age is a risk factor for serious postoperative airway obstruction. Ueno et al. reported the airway status of 518 children with head and neck lymphatic malformations after treatment, of whom 43 required tracheotomy and 32 were younger than 1 year [5]. Therefore, we suggest that “active observation” should be practiced for children with FOM masses as well as children with lymphatic malformation; children without functional impairment can be closely observed and treated at a later age.

In the present study, three of the seven children admitted to the PICU had lymphatic malformations. In 1995, Serres et al. graded lymphatic malformations in the head and neck based on anatomical sites to predict preoperative and postoperative complications [6]. In 2001, Hamoir et al. further validated this staging method, classifying head and neck lymphatic malformations into six stages according to anatomical site: (I) unilateral infrahyoid; (II) unilateral suprahyoid; (III) unilateral suprahyoid and infrahyoid; (IV) bilateral suprahyoid; (V) bilateral suprahyoid and infrahyoid; and (VI) bilateral infrahyoid. Higher grades correspond to higher risk of preoperative and postoperative complications, including infection, bleeding, airway compression, and feeding difficulties [7]. Therefore, lymphatic malformations in the FOM should be evaluated before treatment to assess the risk of postoperative complications, which can be predicted using the Serres classification system. Balakrishnan et al. also concluded that treatment modality is not associated with postoperative complications, and the higher the stage, the higher the risk of postoperative admission to the ICU and tracheotomy [8].

Due to the above-mentioned reasons, regular aspiration can be used as a palliative treatment when the FOM mass causes breathing and feeding difficulties in children for whom surgery is not appropriate, to delay surgery to a later age and reduce airway complication risk. It should not be performed too early as younger children have a smaller space in the FOM, resulting in a higher risk of respiratory and feeding difficulties after aspiration.

4.2 Selection and application of imaging methods

Consistent with the Schwanke study, the present study showed that B-scan ultrasound was highly accurate for determining the properties of the FOM mass: single or multiple cysts or solid (nodular). In addition, B-scan ultrasound is noninvasive and radiation-free and can serve as the preferred auxiliary examination method for FOM masses.

MRI helps visualize the extent of the FOM mass and accurately demonstrate the relationship between the mass and surrounding anatomical structures. Lymphatic malformations have characteristic manifestations on MRI: lobulated, separated masses with long T1 and T2 signals; microcystic lymphatic malformations have no significant enhancement; and macrocystic lymphatic malformations show only marginal and interval enhancement. The present study also suggests that MRI can predict postoperative airway obstruction risk more accurately prior to surgery.

Therefore, we believe that further MRI can be performed in the following cases: (1) B-scan ultrasound results suggest a solid mass and a multi-cystic lesion that cannot be clearly identified as a lymphatic malformation, (2) prior to drug injection or surgical treatment, and (3) contents have not been punctured.

4.3 FOM mass treatment principles

In this study, “observation” was used as a treatment option for children with FOM masses. The choice between observation and invasive treatment depended on whether the child had difficulty in breathing, feeding, and articulating or other functional impairments. The results were consistent with those of Bonilla-Velez et al. [9] who in 2021 proposed that children with lymphatic duct malformations should be treated with “active observation” because invasive treatment increases the number of treatments for children under 6 months of age and lymphatic duct malformations tend to resolve spontaneously [10]. In other words, children with lymphatic malformations without any functional impairment can be observed and only treated if any impairment of breathing or feeding develops [9].

In the present study, this principle was followed in the treatment of children with FOM masses, so that although 36 children developed the disease at under 1 year of age, only 21 were treated, which reduced postoperative airway obstruction risk.

The limitation of this study is that due to the small sample size of children under 1 year old, it is not possible to further group children under 1 year old. Further research with larger samples is needed.

Acknowledgements

We are particularly grateful to all the people who have helped us with our article.

  1. Funding information: This research was supported by the Respiratory Research Project of the National Clinical Research Center for Respiratory Diseases, No. HXZX-20210402.

  2. Author contributions: Ying Liu: conceptualization and writing – original draft; Chen Zhuo: methodology and validation; Yang Jiang: data collection; Yujiao Guo: formal analysis; Mingzhe Li: data collection; Yangyang Zhao and Xiaolu Wu: data curation; Guoxia Yu led the writing and was responsible for writing – review & editing.

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

  4. Data availability statement The data underlying this article will be shared on request to the corresponding author.

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Received: 2023-03-26
Revised: 2024-01-12
Accepted: 2024-03-31
Published Online: 2024-07-02

© 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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  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  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
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  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
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  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
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  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
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  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
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  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
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  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
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  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
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  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
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  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
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  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
https://doi.org/10.1515/med-2024-0959
Keywords for this article
floor-of-mouth mass; airway obstruction; risk factors; surgical treatment; children
Creative Commons
BY 4.0

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  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
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  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
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  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
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