Development and validation of headspace gas chromatography with a flame ionization detector method for the determination of ethanol in the vitreous humor
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Filip Mihajlović
, Ivana Andrić
, Živana Slović
, Maja Vujović
, Kristina Piskulić
und Snežana Đorđević
Abstract
Introduction
Qualitative and quantitative testing of ethanol in post-mortem samples is an important analytical procedure that provides accurate, precise, and reliable results. Given the complexity of the issue, obtaining a realistic picture of lifelong alcoholemia requires supporting blood ethanol findings with analyses of alternative samples, primarily vitreous humor (VH).
Objective
The objective of this study was to develop and validate a headspace gas chromatography with flame ionization detection (HS/GC-FID) method for determining ethanol concentration in VH.
Materials and methods
Conditions for the HS/GC-FID method were established and the method was validated according to the guidelines of the European Medicines Agency. Validation parameters such as precision, accuracy, specificity, sensitivity, and linearity over a wide concentration range were evaluated through statistical analysis.
Results
The method demonstrated precision, accuracy, specificity, and sensitivity. Additionally, it proved to be linear across a wide concentration range and relatively fast, making it suitable for rapid and routine determination of ethanol concentration in VH, particularly for forensic applications.
Conclusion
Results from validation and application of the method to VH samples indicate that ethanol concentration in VH can be reliably determined using the presented HS/GC-FID method, making it a valuable tool in forensic investigations.
1 Introduction
Excessive consumption of alcoholic beverages and the state of intoxication always play a significant role in incidents, fatal injuries, drownings, suicides, and many other crimes registered by the police and emergency services [1]. Moreover, alcohol-induced intoxication is frequently the reason for accidents in the workplace, among family members, and in transport. There is also a strong link between alcohol consumption and violence.
Qualitative and quantitative testing of ethanol in postmortem samples is an analytical procedure that provides accurate, precise, and reliable results [2,3]. However, explaining postmortem results of blood alcohol concentration and drawing correct conclusions regarding antemortem levels, state of drunkenness, and degree of alcoholism at the time of death can be very complex [4,5,6]. The condition of the body, the time between death and autopsy, environmental conditions (temperature and humidity), and the nature of the samples collected for analysis are important factors to consider. Under some circumstances, alcohol may be produced after death due to microbial activity and glucose fermentation, which is a real problem if the corpse is in the stage of decomposition [7,8]. Postmortem diffusion of alcohol from the stomach is another aggravating factor if the person dies shortly after heavy drinking [9,10]. In addition, biological samples may be contaminated with ethanol or some other solvent during life-saving treatment [11]. Due to the complexity of the problem, to obtain a realistic picture of lifelong alcoholemia, the finding of alcohol in the blood should be supported by the analysis of alternative samples, primarily the vitreous humor (VH). Research shows that this analysis requires special attention from doctors and toxicologists when considering postmortem cases, especially when the process of decomposition of the body has begun, in the context of its importance for the legal consequences of a verified alcohol finding [12].
Bearing in mind the frequency of ethanol abuse, the increase in the number of acute and chronic ethanol poisonings, the importance of ethanol in forensic practice, and the state of the corpse during autopsies, determining the concentration of ethanol in the VH is of great forensic importance. Today, the method of choice for qualitative and quantitative analyses of ethanol in body fluids is gas chromatography (GC) with a flame ionization detector (FID), both in forensic toxicology and clinical laboratories, using headspace (HS) sampling [13,14]. The aim of this article was the development and introduction of an analytical method of GC with an FID detector (GC/FID) for the routine determination of ethanol in the VH samples.
2 Materials and methods
2.1 Basic principles
We used the internal standard method for the quantification of ethanol in VH. For the internal standard, we chose n-propanol, which, with ethanol, has, in a wider temperature interval, a constant vapor pressure. Ethanol from VH is converted into a gas phase by heating in a hermetically sealed bottle. A part of the gaseous phase is introduced into the gas chromatograph, and after separation on a column of the appropriate polarity, it is detected by an FID.
2.2 Chromatographic system and conditions
The chromatographic separation and quantification of the ethanol were performed on a Hewlett Packard 5890 series II Gas Chromatograph with an HS sample injection device: (Hewlett Packard HS sampler 19395A) and flame-ionizing detector heated to 2,600°C. The temperature in the autosampler is set to 850°C. We used Zebra BAC1, 30 m × 0.53 mm ID column for separation. The carrier gas is nitrogen, where the nitrogen flow rate is 30 mL/min, hydrogen 40 mL/min, and air 400 mL/min.
2.3 Chemicals and reagents
For the preparation of calibration solutions and control samples, as well as standard ethanol solutions for selectivity testing, we used 96% ethanol with a density of 0.801 kg/m3. In addition to ethanol, for research purposes, we used n-propranol and distilled water of liquid chromatography with mass spectrophotometry grade. All reagents were obtained from the same manufacturer (Merck, Darmstadt, Germany). The basic standard ethanol solution with a concentration of 10 mg/mL was obtained by dissolving 1.18 mL of 96% ethanol in a 100 mL measuring vessel. In the further procedure, standard solutions of ethanol in water were made in the following concentrations: 0.2, 0.5, 0.75, 1.0, and 2.5 mg/mL.
2.4 Preparation of VH samples
Pool samples for the preparation of loaded VHs, which were used for method validation, were obtained from seven deceased patients in whom no ethanol was detected at the time of death. Vitreous humor from cadaver material was obtained by puncturing the wall of the eyeball in the area of the outer corner of the eyelid with a sterile, thin needle. The samples were taken during the forensic autopsy at the Department of Forensic Medicine and Toxicology, University Clinical Center Kragujevac. The VH samples were placed in test tubes, adequately transported, then transferred to the toxicological laboratory, and homogenized in a beaker. Until analysis, the samples were stored at −20°C.
2.5 Preparation of vitreous samples loaded with ethanol and determination procedure
Ethanol-loaded VH samples were obtained by measuring a certain volume of ethanol working solution 10.0 mg/mL and VH, to obtain loaded VH solutions in concentrations: 0.2, 0.5, 0.75, 1.0, and 2.5 mg/mL. The further process of determining and preparing the samples involved measuring 200 µL of loaded VH solution samples and 2,000 µL of the internal standard n-propanol into a 10 mL glass vial. The samples are then closed with a rubber and metal closure, hermetically, with the help of forceps, and such samples are ready for further analysis. The samples are heated before injection, and this incubation period enables the establishment of a dynamic balance of ethanol concentrations in the blood and vapor above the liquid sample. Then, automatic injection of the sample is performed using the HS technique, and in this way, the gas phase is introduced into the GC column.
2.6 Method validation
Method validation was carried out in accordance with the official European Medicines Agency (EMA) [15] guideline for bioanalytical method validation through the assessment of the following validation parameters: selectivity, linearity of the method and working range, limit of detection (LOD), limit of quantification (LOQ), precision, accuracy, and stability.
2.6.1 Selectivity
Selectivity represents the ability of the method to determine exactly the specific investigated substance (analyte of interest) without interference from other components that can be found in the analyzed sample. This parameter shows and confirms the possibility of separation, identification, and quantification of the analyte of interest in relation to other analytes present in the sample (if any). The selectivity was tested by comparing the chromatograms of five blank ethanol samples and five loaded samples of VH, in concentrations that are of the greatest forensic importance (0.20, 0.50, 0.75, 1.0, and 2.50 mg/mL).
2.6.2 Linearity
To test linearity in the selected range of concentrations (from 0.001 to 2.50 mg/mL) and obtain calibration standards, a series of standard ethanol solutions were measured and analyzed by GC, and the response of the detector was registered over the area of the peak characteristic of the analyzed compound. Based on the obtained results, the parameters of the regression equation (slope (a), intercept, and correlation coefficient) were determined. For each concentration, three consecutive measurements were performed.
2.6.3 LOD
The LOD is the lowest concentration of the tested substance that can be detected by an analytical method but not quantified with particular precision and accuracy. It is the lowest concentration that differs from the baseline signal. The LOD was determined by calculating the standard deviation of the lowest point of the calibration curve (0.15 mg/mL) during the linearity test according to the following formula: LOD = (3.3 × standard deviation [SD])/a.
2.6.4 LOQ
The LOQ is the lowest concentration that can be reliably determined by an analytical method. The LOQ was determined by calculating the standard deviation of the lowest point of the calibration curve (0.15 mg/mL) during the linearity test according to the following formula: LOD = (10 × SD)/a.
2.6.5 Precision
The repeatability of the method is one way of expressing its precision under the same working conditions in a short time interval. It shows the intra-laboratory variability obtained in a short time interval, with one analyst on the same equipment. Repeatability represents the closeness of agreement between mutually independent test results and is expressed in the form of a standard deviation or relative standard deviation. The relative standard deviation or coefficient of variation, as it is otherwise called, can be different in cases where the influence of concentration should be eliminated because it is independent of it. The reproducibility of the method is determined by preparing ten standard samples of ethanol with a concentration of 1.0 mg/mL and by chromatography.
2.6.6 Accuracy
The recovery test was used to test the accuracy of the method. Three samples of standard solutions of ethanol in VH were measured for five concentration levels in the range of the calibration curve for ethanol. The measured concentrations were compared with the expected ones. The ratio between the obtained and expected concentrations was calculated and expressed as a percentage, which represents the recovery value.
2.6.7 Stability
As part of the validation of the method, the short-term stability of the samples and working solutions, the stability of the autoinjector, and the stability of the sample during freezing and thawing were examined. To test the short-term stability of the samples, the stability in the autoinjector, as well as the stability after the freezing and thawing processes, a sample “loaded” with ethanol at a concentration of 5 mg/mL was used. All samples were made in triplicate. Short-term stability was evaluated by comparing freshly prepared samples with samples that had been standing at room temperature for 4 h. Stability during freezing and thawing was evaluated after three cycles, with the period between two cycles being from 12 to 24 h. Stability in the autoinjector was assessed by analyzing samples at the beginning and end of the analytical sequence.
The stability of the working solutions, stored in a refrigerator at a temperature of 2–8°C, was tested for a period of 1 month. The obtained results were compared, whereby the allowed deviation for the stability of the samples and the working solution is 15%, in accordance with the recommendations of the guide for the validation of bioanalytical methods of the EMA [15].
2.6.8 Measurement uncertainty
In accordance with the procedure of assessment and determination of measurement uncertainty, all its potential sources were considered. Quantification of sources of uncertainty was done so that the individual contributions of each source were expressed as standard deviations, and they are:
The concentration of the ethanol reference standard ( u 1) – according to the certificate provided by the manufacturer, the concentration of the ethanol reference standard is 1.002 ± 0.034. The measurement uncertainty of the measurement results is expressed as an expanded measurement uncertainty, which is obtained by multiplying the combined measurement uncertainty by the factor k = 2, which for a normal distribution corresponds to a confidence interval of 95% and is 0.034;
Measurement uncertainty of the pipette ( u 2) – according to the ethanolization certificate provided by the accreditation laboratory for ethanolization, the measurement uncertainty of the measurement results is expressed as an expanded measurement uncertainty, which is obtained by multiplying the combined measurement uncertainty by the factor k = 2, which for a normal distribution corresponds to a confidence interval of 95% and for a 1,000 µL pipette is 0.0064, and for a 200 µL pipette is 0.0009;
Measurement uncertainty of the instrument ( u 3) – the measurement uncertainty of the instrument, which is confirmed by the authorized service, is given for the reproducibility of surfaces (relative standard deviation [RSD] = 1.72%) and retention time (RSD = 0.012%);
Ethanol concentration from the calibration curve ( u 4) – the uncertainty of the concentration read from the calibration curve is defined with the standard deviation from several repeated readings of the same sample. Data for method validation were used for this measurement uncertainty parameter. An ethanol solution with a concentration of 1.0 mg/mL was passed through the complete measurement procedure ten times. The calculated mean value of ethanol was 1.03203 mg/mL, and the obtained real standard deviation was 0.5672%.
Recovery ( u 5) – determining the measurement uncertainty that comes from recovery includes the uncertainty of the measurement conditions, the influence of temperature, humidity, pressure, the uncertainty of extracting the analyte from the matrix, and the uncertainty of repeatability. The measurement uncertainty arising from the recovery (yield) was calculated using data for method validation, as the standard deviation of the recovery values obtained in the repeated preparation procedure.
After quantifying all sources of uncertainty and expressing them as standard uncertainty, the combined standard measurement uncertainty (u) for the method of determining ethanol in the vitreous fluid as the root of the sum of the squares of the individual components was calculated. The combined measurement uncertainty for the method of determining ethanol in the vitreous fluid is u = 1.80%. The results of the determination of ethanol will be expressed with the total measurement uncertainty of the method (U), which is obtained as a result of multiplying the combined measurement uncertainty (u) and a numerical factor (k) that is 2. The reason for calculating the expanded measurement uncertainty is to achieve a sufficiently high confidence (on average 95%) that the true value lies within the interval determined by the measurement result. For this method, the total measurement uncertainty is U = 3.60%.
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Ethical approval: The samples were taken after receiving the decision of the Ethics Committee of the University Clinical Center Kragujevac (No. 01/22-433).
3 Results
The results showed that under our chromatography conditions, the average retention time for ethanol is 2.13 min, while for n-propanol it is 2.47 min. As shown in Figure 1, a representative chromatogram of VH obtained by the HS/GC-FID method is presented. The equation of the calibration curve is y = 0.5174x + 0.0039, the correlation coefficient is r = 0.9989. The calibration curve is presented in Figure 2. The linearity of an analytical method is defined as the direct proportionality between the measurement results (detector response, i.e., the area under the curve) and the analyte concentration in the sample, within a defined concentration range. Linearity is evaluated by calculating the regression curve using the least squares method and is expressed through the correlation coefficient (r), y-intercept, and slope of the regression curve. The equation for the calibration curve takes the form: y = ax + b, where:
x represents the concentration of the analyte (ethanol),
y corresponds to the ratio of the area under the curve of the analyte to that of the internal standard (n-propanol),
a is the intercept on the y-axis (the value of y when x = 0), and
b is the regression coefficient.

Representative chromatogram of ethanol in VH.

Calibration curve.
The working measurement range is 0.15–2.50 mg/mL. Figure 1 shows the graph of the calibration curve of ethanol where the peak area ratio of ethanol/n-propanol was plotted versus the concentration of the respective six calibration standards. Table 1 shows concentrations of standard ethanol solutions, obtained surfaces, and parameters of regression equations. Table 1 presents the investigation of linearity within the selected concentration range (0.2–2.5 mg/mL) to obtain calibration curves. A series of standard ethanol solutions were prepared and analyzed using GC. The detector response was recorded based on the peak area characteristic of the analyzed compound. From the obtained results, the parameters of the regression equation, including the slope, intercept, and correlation coefficient, were determined. For each concentration, three consecutive measurements were conducted.
Concentrations of standard ethanol solutions, obtained surfaces, and parameters of regression equations
| Concentration of standard solution of ethanol (mg/mL) | P area of ethanol | Average value of P area of ethanol | P area of n-propanol (internal standard) | Average value of P area of n-propanol (internal standard) | Average value of P area ethanol/n-propanol |
|---|---|---|---|---|---|
| 0.20 | 187,942 | 191,615 | 767,480 | 829,475 | 0.22 |
| 188,569 | 855,416 | ||||
| 198,334 | 865,531 | ||||
| 0.50 | 752,278 | 744,180 | 819,598 | 813,675 | 0.91 |
| 745,715 | 812,677 | ||||
| 734,549 | 808,751 | ||||
| 0.75 | 1,195,872 | 1,217,427 | 805,509 | 813,994 | 1.49 |
| 1,201,679 | 800,410 | ||||
| 1,254,730 | 836,064 | ||||
| 1.00 | 1,506,794 | 1,480,198 | 796,929 | 786,055 | 1.88 |
| 1,436,882 | 768,451 | ||||
| 1,496,920 | 792,785 | ||||
| 2.50 | 3,021,305 | 2,984,733 | 793,352 | 779,456 | 3.82 |
| 3,011,825 | 790,450 | ||||
| 2,921,070 | 754,568 |
The calculated LOD was 0.005 mg/mL, while the LOQ was determined to be 0.017 mg/mL, indicating that the method is highly accurate. The method’s accuracy is presented in Table 2, which also highlights method repeatability, a key indicator of precision under consistent operating conditions over a short period. This reflects intra-laboratory variability within a brief timeframe, with one analyst using the same equipment. Repeatability, which represents the degree of agreement between independent test results, is quantified using standard deviation or relative standard deviation. The relative standard deviation, also known as the coefficient of variation, can vary in instances where the influence of concentration needs to be minimized, as it is independent of concentration. Method repeatability was assessed by preparing ten ethanol standard samples at a concentration of 1.0 mg/mL and performing chromatographic analysis. The mean recovery values (mean ± SD) for all five tested concentrations are provided in Table 3. This table details the results of the recovery test conducted to evaluate method accuracy. Three samples of ethanol standard solutions in VH were analyzed at five different concentration levels along the ethanol calibration curve. Measured concentrations were compared to the expected values, and the ratio between the two was calculated and expressed as a percentage, representing the recovery value. To complete the analysis, additionally, the mean values, standard deviations, and relative standard deviations were determined. All validation parameters are summarized in Table 4.
Examination of the accuracy of the method for the determination of ethanol in the VH
| Expected concentration (mg/mL) | Determined concentration (mg/mL) | Recovery (%) |
|---|---|---|
| 1.00 | 1.0437 | 104.37 |
| 1.00 | 1.0285 | 102.85 |
| 1.00 | 1.0285 | 102.68 |
| 1.00 | 1.0368 | 103.11 |
| 1.00 | 1.0311 | 103.28 |
| 1.00 | 1.0288 | 102.88 |
| 1.00 | 1.0276 | 102.76 |
| 1.00 | 1.0428 | 104.28 |
| 1.00 | 1.0281 | 102.81 |
| 1.00 | 1.0301 | 103.01 |
| SD = 0.005854 | ||
| RSD (%) = 0.5672 | ||
SD – standard deviation; RSD – relative standard deviation.
Recovery test
| Number of measurement | Real concentration (mg/mL) | Measured concentration (mg/mL) | Mean value | Accuracy (%) | |
|---|---|---|---|---|---|
| I | 0.20 | 0.201 | 0.201 | 101.50 | |
| II | 0.20 | 0.202 | 101.00 | ||
| III | 0.20 | 0.200 | 100.00 | ||
| I | 0.50 | 0.502 | 0.499 | 100.46 | |
| II | 0.50 | 0.493 | 98.62 | ||
| III | 0.50 | 0.502 | 100.38 | ||
| I | 0.75 | 0.751 | 0.750 | 100.13 | |
| II | 0.75 | 0.750 | 100.00 | ||
| III | 0.75 | 0.749 | 99.87 | ||
| I | 1.00 | 0.996 | 0.992 | 99.56 | |
| II | 1.00 | 1.002 | 100.20 | ||
| III | 1.00 | 0.978 | 97.79 | ||
| I | 2.50 | 2.510 | 2.511 | 100.40 | |
| II | 2.50 | 2.511 | 100.44 | ||
| III | 2.50 | 2.512 | 100.48 | ||
| Accuracy of method | |||||
| Accuracy for concentration of 0.20 mg/mL | Accuracy for concentration of 0.50 mg/mL | Accuracy for concentration of 0.75 mg/mL | Accuracy for concentration of 1.00 mg/mL | Accuracy for concentration of 2.50 mg/mL | |
| 100.50 | 100.46 | 100.13 | 99.56 | 100.44 | |
| 100.00 | 98.62 | 100.00 | 100.20 | 100.48 | |
| 101.00 | 100.38 | 99.87 | 97.79 | 100.40 | |
| Mean value | 100.50 | 99.82 | 100.00 | 99.18 | 100.44 |
| Accuracy (80–120%) | 100.11 | ||||
| SD | 0.656 | ||||
| %RSD | 0.655 | ||||
| 95% limit | 0.504 | ||||
SD – standard deviation; RSD – relative standard deviation.
Presentation of the obtained parameters of the validation study for the determination of ethanol in the vitreous fluid
| Results of validation tests | |
|---|---|
| Operating range | 0.15–2.5 mg/mL |
| The correlation coefficient | r = 0.9989 |
| Calibration curve equation | y = 0.5174x + 0.0039 |
| Detection limit | 0.005 |
| LOQ | 0.017 |
| Precision | 0.00572 |
| Accuracy | 100.11 |
| Stability | 15% |
| Measurement uncertainty | 3.6% |
4 Discussion
The analytical methods to detect the volatile substance in post-mortem samples, such as peripheral or central blood, VH, kidney, brain, liver, and urine, have long been studied in forensic literature [16,17]. Ethanol analysis by HS/GC-FID is well established in the literature [18]. In combination with appropriate detectors, it enables the identification and quantification of a wide range of toxic agents from gases, organic converters, and pesticides to a wide variety of natural and synthetic drugs and medicines [19].
When HS/GC-FID is used for quantitative analysis, it is necessary to minimize or eliminate the matrix effect [20], which was achieved by adding small amounts of NaCl. The best way to eliminate the matrix effect is to saturate the biological sample with an inorganic salt such as NaCl [21]. This salting-out technique allows for an increase in the vapor pressure of the non-electrolyte (ethanol) in the vial and increases the sensitivity of the HS/GC-FID analysis. The method of salting out is not recommended in everyday practice, but it can be used if extremely small amounts of volatile substances in the sample are analyzed and it does not affect the result. Biological samples for ethanol content should be analyzed in duplicate on two different chromatographic systems that would provide different retention times for ethanol and internal standards. Some laboratories recommend using two different internal standards, e.g., n-propanol and t-butanol. A small amount of n-propanol can be produced during the process of decay and putrefaction [22], but in this work, VH samples obtained from rotting corpses were not used for the analysis of ethanol concentration. However, recent research [23] has shown that n-propanol is not produced in VH after death, which supports the use of n-propanol as an internal standard for the validation of this method.
Using highly specific GC for analysis, ethanol can be reliably determined in the presence of potentially interfering substances (e.g., acetaldehyde, ethyl acetate, 2-propanol, n-butanol) that may be produced during body decomposition. Low values of blood alcohol concentrations in post-mortem samples (<30 mg/100 mL or 0.30 mg/mL) are debatable without supporting evidence of ethanol analysis in vitreous fluid and/or urine [24]. High values of ethanol concentration in VH (<2.00 mg/mL) can be a consequence of various circumstances of death (fires, combined causes of poisoning), so high ethanol values in VH are supported by the analysis of ethanol in other body fluids.
The advantage of this work is that the presented method is validated by all validation parameters, overlooked by the International Organization for Standardization/International Electrotechnical Commission (ICO/IEC 17025) [25]. Compared to other studies [26,27], the results of this article match those of others, when it comes to the dynamic range, regression coefficient, LOD, and LOQ. In the study by Chun et al. [27], it was shown that the results regarding the stability of the method were identical to the results obtained for the same standard and conditions. The literature search so far did not find any publications on this topic, which examined the measurement uncertainty of the method as part of the validation. In addition to ethanol, the method is suitable for the quantification of methanol and formaldehyde in VH [28]. It may be useful for future research, according to the diversity of the circumstances of death in forensic medicine. The validated method offers a distinct advantage by incorporating the calculation of measurement uncertainty, which traditional methods do not have as data. Considering that VH is the most common alternative sample in forensic toxicology, the precision of the chosen analytical method is of great importance in that case. Therefore, it is important to determine all types of measurement uncertainty of the method, which include measuring instruments, laboratory vessels, and accessories and apparatus. Through the determination of both total and combined measurement uncertainty, the influence of analytical and post-analytical factors contributing to potential errors has been minimized. Notably, previous studies on this subject [28,29] have not addressed the issue of measurement uncertainty. How much more precise the set method is compared to traditional methods that have been validated for the analysis of ethanol in VH is best shown by the accuracy of 0.005721.
5 Conclusion
With this work, we have developed a reliable, precise, and accurate HS/GC-FID method for the identification and quantitative analysis of ethanol in the VH. The introduced method represents an important contribution to the work of the forensic toxicology laboratory and provides significant help in obtaining a realistic picture of life-long alcoholism, when, according to the order of the prosecution, the finding of ethanol in the blood needs to be supported by the analysis of ethanol in one of the alternative samples, first of all, the VH.
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Funding information: None.
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Author contributions: FM: conceptualization, data curation, formal analysis, investigation, validation, roles/writing – original draft. IA: data curation, investigation, resources. ŽS: conceptualization; formal analysis; funding acquisition; investigation; methodology, project administration, roles/writing – original draft. MV: conceptualization, formal analysis, methodology, software, supervision, validation, writing – review and editing. SĐ: conceptualization, formal analysis, methodology, software, supervision, validation, writing – review and editing. KP: data curation, formal analysis, investigation, validation, roles/writing – original draft.
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Conflict of interest: The authors report there are no competing interests to declare.
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Data availability statement: Data can be made available upon motivated request to the corresponding author.
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© 2025 the author(s), published by De Gruyter
This work is licensed under the Creative Commons Attribution 4.0 International License.
Artikel in diesem Heft
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Artikel in diesem Heft
- Research Articles
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- Predictive value of plasma sB7-H3 and YKL-40 in pediatric refractory Mycoplasma pneumoniae pneumonia
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- Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis
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- Association between statin administration and outcome in patients with sepsis: A retrospective study
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- A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
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- Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
- Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
- Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
- Vitamin D replacement therapy may regulate sleep habits in patients with restless leg syndrome
- The first-line antihypertensive nitrendipine potentiated the therapeutic effect of oxaliplatin by downregulating CACNA1D in colorectal cancer
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- Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
- Examination of the causal role of immune cells in non-alcoholic fatty liver disease by a bidirectional Mendelian randomization study
- Clinical analysis of ten cases of HIV infection combined with acute leukemia
- Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
- Clinical observation of probiotics combined with mesalazine and Yiyi Baitouweng Decoction retention enema in treating mild-to-moderate ulcerative colitis
- Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection
- Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
- Core muscle strength and stability-oriented breathing training reduces inter-recti distance in postpartum women
- The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial
- The serum IL-17A levels in patients with traumatic bowel rupture post-surgery and its predictive value for patient prognosis
- Impact of Kolb’s experiential learning theory-based nursing on caregiver burden and psychological state of caregivers of dementia patients
- Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
- Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
- The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
- Tetrahydropalmatine improves mitochondrial function in vascular smooth muscle cells of atherosclerosis in vitro by inhibiting Ras homolog gene family A/Rho-associated protein kinase-1 signaling pathway
- A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
- A comparative analysis of the impact of repeated administration of flavan 3-ol on brown, subcutaneous, and visceral adipose tissue
- Identifying early screening factors for depression in middle-aged and older adults: A cohort study
- Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
- Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
- High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
- RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
- Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
- Clinical efficacy of azacitidine in the treatment of middle- and high-risk myelodysplastic syndrome in middle-aged and elderly patients: A retrospective study
- The effect of ambulatory blood pressure load on mitral regurgitation in continuous ambulatory peritoneal dialysis patients
- Expression and clinical significance of ITGA3 in breast cancer
- Single-nucleus RNA sequencing reveals ARHGAP28 expression of podocytes as a biomarker in human diabetic nephropathy
- rSIG combined with NLR in the prognostic assessment of patients with multiple injuries
- Toxic metals and metalloids in collagen supplements of fish and jellyfish origin: Risk assessment for daily intake
- Exploring causal relationship between 41 inflammatory cytokines and marginal zone lymphoma: A bidirectional Mendelian randomization study
- Gender beliefs and legitimization of dating violence in adolescents
- Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia
- Effect of smoking and smoking cessation on hematological parameters in polycythemic patients
- Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
- Necroptosis of hippocampal neurons in paclitaxel chemotherapy-induced cognitive impairment mediates microglial activation via TLR4/MyD88 signaling pathway
- Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
- Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
- GATA1: A key biomarker for predicting the prognosis of patients with diffuse large B-cell lymphoma
- Influencing factors of false lumen thrombosis in type B aortic dissection: A single-center retrospective study
- MZB1 regulates the immune microenvironment and inhibits ovarian cancer cell migration
- Integrating experimental and network pharmacology to explore the pharmacological mechanisms of Dioscin against glioblastoma
- Trends in research on preterm birth in twin pregnancy based on bibliometrics
- Four-week IgE/baseline IgE ratio combined with tryptase predicts clinical outcome in omalizumab-treated children with moderate-to-severe asthma
- Single-cell transcriptomic analysis identifies a stress response Schwann cell subtype
- Acute pancreatitis risk in the diagnosis and management of inflammatory bowel disease: A critical focus
- Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients
- Interleukin-37 mediates the anti-oral tumor activity in oral cancer through STAT3
- CA199 and CEA expression levels, and minimally invasive postoperative prognosis analysis in esophageal squamous carcinoma patients
- Efficacy of a novel drainage catheter in the treatment of CSF leak after posterior spine surgery: A retrospective cohort study
- Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
- Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
- Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
- Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
- Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
- Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
- The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
- The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
- Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
- Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
- The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
- Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
- Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
- Correlation of serum calprotectin with outcome of acute cerebral infarction
- Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
- Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
- The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
- Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
- Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
- Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
- Analysis of serum metabolomics in patients with different types of chronic heart failure
- Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
- Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
- Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
- METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
- The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
- Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
- Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
- Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
- Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
- Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
- Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
- Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
- Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
- Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
- Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
- Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
- HALP score in Demodex blepharitis: A case–control study
- Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
- Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
- Comparison of the two intestinal anastomosis methods in pediatric patients
- Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
- Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
- Lateral transperitoneal laparoscopic adrenalectomy: A single-centre experience of 21 procedures
- Petunidin attenuates lipopolysaccharide-induced retinal microglia inflammatory response in diabetic retinopathy by targeting OGT/NF-κB/LCN2 axis
- Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
- Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients
- Development of a nomogram for predicting cancer-specific survival in patients with renal pelvic cancer following surgery
- Inhibition of ATG7 promotes orthodontic tooth movement by regulating the RANKL/OPG ratio under compression force
- A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
- Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
- FAHD1 prevents neuronal ferroptosis by modulating R-loop and the cGAS–STING pathway
- Association of placenta weight and morphology with term low birth weight: A case–control study
- Investigation of the pathogenic variants induced Sjogren’s syndrome in Turkish population
- Nucleotide metabolic abnormalities in post-COVID-19 condition and type 2 diabetes mellitus patients and their association with endocrine dysfunction
- TGF-β–Smad2/3 signaling in high-altitude pulmonary hypertension in rats: Role and mechanisms via macrophage M2 polarization
- Ultrasound-guided unilateral versus bilateral erector spinae plane block for postoperative analgesia of patients undergoing laparoscopic cholecystectomy
- Profiling gut microbiome dynamics in subacute thyroiditis: Implications for pathogenesis, diagnosis, and treatment
- Delta neutrophil index, CRP/albumin ratio, procalcitonin, immature granulocytes, and HALP score in acute appendicitis: Best performing biomarker?
- Anticancer activity mechanism of novelly synthesized and characterized benzofuran ring-linked 3-nitrophenyl chalcone derivative on colon cancer cells
- H2valdien3 arrests the cell cycle and induces apoptosis of gastric cancer
- Prognostic relevance of PRSS2 and its immune correlates in papillary thyroid carcinoma
- Association of SGLT2 inhibition with psychiatric disorders: A Mendelian randomization study
- Motivational interviewing for alcohol use reduction in Thai patients
- Luteolin alleviates oxygen-glucose deprivation/reoxygenation-induced neuron injury by regulating NLRP3/IL-1β signaling
- Polyphyllin II inhibits thyroid cancer cell growth by simultaneously inhibiting glycolysis and oxidative phosphorylation
- Relationship between the expression of copper death promoting factor SLC31A1 in papillary thyroid carcinoma and clinicopathological indicators and prognosis
- CSF2 polarized neutrophils and invaded renal cancer cells in vitro influence
- Proton pump inhibitors-induced thrombocytopenia: A systematic literature analysis of case reports
- The current status and influence factors of research ability among community nurses: A sequential qualitative–quantitative study
- OKAIN: A comprehensive oncology knowledge base for the interpretation of clinically actionable alterations
- The relationship between serum CA50, CA242, and SAA levels and clinical pathological characteristics and prognosis in patients with pancreatic cancer
- Identification and external validation of a prognostic signature based on hypoxia–glycolysis-related genes for kidney renal clear cell carcinoma
- Engineered RBC-derived nanovesicles functionalized with tumor-targeting ligands: A comparative study on breast cancer targeting efficiency and biocompatibility
- Relationship of resting echocardiography combined with serum micronutrients to the severity of low-gradient severe aortic stenosis
- Effect of vibration on pain during subcutaneous heparin injection: A randomized, single-blind, placebo-controlled trial
- The diagnostic performance of machine learning-based FFRCT for coronary artery disease: A meta-analysis
- Comparing biofeedback device vs diaphragmatic breathing for bloating relief: A randomized controlled trial
- Serum uric acid to albumin ratio and C-reactive protein as predictive biomarkers for chronic total occlusion and coronary collateral circulation quality
- Multiple organ scoring systems for predicting in-hospital mortality of sepsis patients in the intensive care unit
- Single-cell RNA sequencing data analysis of the inner ear in gentamicin-treated mice via intraperitoneal injection
- Suppression of cathepsin B attenuates myocardial injury via limiting cardiomyocyte apoptosis
- Review Articles
- The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
- Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
- Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
- Review of mechanisms and frontier applications in IL-17A-induced hypertension
- Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
- The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
- The application of augmented reality in robotic general surgery: A mini-review
- The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
- Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
- Plant polyphenols, terpenes, and terpenoids in oral health
- Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
- End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
- The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
- Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
- PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
- Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
- Giant borderline ovarian tumours – review of the literature
- Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
- Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
- Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
- Supplement strategies for infertility in overweight women: Evidence and legal insights
- Scurvy, a not obsolete disorder: Clinical report in eight young children and literature review
- A meta-analysis of the effects of DBS on cognitive function in patients with advanced PD
- Protective role of selenium in sepsis: Mechanisms and potential therapeutic strategies
- Strategies for hyperkalemia management in dialysis patients: A systematic review
- C-reactive protein-to-albumin ratio in peripheral artery disease
- Case Reports
- Delayed graft function after renal transplantation
- Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
- Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
- Giant right atrial hemangioma presenting with ascites: A case report
- Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
- EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
- Molecular hydrogen-rhodiola as an adjuvant therapy for ischemic stroke in internal carotid artery occlusion: A case report
- Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
- Rapid Communication
- Biological properties of valve materials using RGD and EC
-
A single oral administration of flavanols enhances short
-term memory in mice along with increased brain-derived neurotrophic factor - Letter to the Editor
- Role of enhanced external counterpulsation in long COVID
- Expression of Concern
- Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
- Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
- Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
- Corrigendum
- Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
- Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
- Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
- Retraction
- Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
- Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
- Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
- Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
- Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
- Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
- The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
- Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
- Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
- Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
- Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
- Special Issue The evolving saga of RNAs from bench to bedside - Part III
- Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
- The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
- Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
- Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
- A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
- Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
- Special Issue Diabetes mellitus: pathophysiology, complications & treatment
- Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
- Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
- A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
- A review of brain research on T2DM-related cognitive dysfunction
- Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
- Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
- CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms