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Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients

  • Müslüm Ergün EMAIL logo and Süleyman Sağır
Published/Copyright: September 11, 2025
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Open Medicine
From the journal Open Medicine Volume 20 Issue 1

Abstract

Background and aim

The aim of this study is to investigate whether certain clinical nomograms influencing the success of extracorporeal shock wave lithotripsy (ESWL) also play a role in determining the number of treatment sessions required in patients who achieved stone-free status following ESWL.

Methods

The data of 354 patients with successful ESWL outcomes were analyzed. Patients were evaluated 4–6 weeks post-ESWL using X-ray, ultrasound, or computed tomography. The presence of residual stones larger than 4 mm was considered a treatment failure. Data recorded included age, gender, laterality of stone localization (right/left), stone location (renal pelvis, mid calyx, upper calyx, proximal ureter, mid ureter, distal ureter), stone size (maximum longitudinal dimension), body mass index (BMI), and stone Hounsfield unit (HU) values. Patients were categorized into two groups: single-session and multiple-session treatment.

Results

In the univariate model, factors such as age, BMI, distal ureter, renal pelvis, mid-calyx stone localization, stone size, and stone HU value showed a significant (p < 0.05) effect in distinguishing between single-session and multiple-session groups. Stone size and HU values were significantly higher (p < 0.05) in the multiple-session group compared to the single-session group. In the multivariate model, age, stone size, and HU value emerged as significant independent factors (p < 0.05) in differentiating between single-session and multiple-session treatments.

Conclusion

Several factors influencing the success of ESWL also affect the number of sessions required. BMI, age, stone size, stone HU value, and certain stone locations are key determinants of the number of ESWL sessions.

Keywords: extracorporeal shockwave therapy; session count; urolithiasis

1 Introduction

Despite advancements in laser technologies and endoscopic tools, extracorporeal shock wave lithotripsy (ESWL) remains a significant non-invasive method for the treatment of urinary stone disease. Currently, it is considered the first-line treatment for kidney and proximal ureter stones smaller than 2 cm [1,2]. Modern urologists utilize a wide range of techniques in the management of urolithiasis, including ESWL, ureteroscopy, percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), as well as open or laparoscopic procedures.

While ESWL holds a prominent place in the treatment of urinary stones, its success rates are generally lower compared to more invasive techniques such as PCNL, RIRS, flexible, and rigid ureterorenoscopy [3,4]. Reported success rates for ESWL in the literature range from 82 to 91% [5,6]. Variations in these rates may stem from differences in inclusion and exclusion criteria or clinical limitations. Numerous factors influencing ESWL success have been identified in the literature, leading to the development of various clinical nomograms.

These nomograms consider parameters such as urinary system anatomy, stone size, location, composition, body mass index (BMI), skin-to-stone distance (SSD), ESWL equipment used, hydronephrosis, and stone Hounsfield unit (HU) values [7,8,9]. By incorporating these factors, clinical nomograms aim to predict stone-free rates (SFR) and assess the likelihood of ESWL success.

The aim of this study is to investigate whether certain clinical nomograms influencing ESWL success also have an impact on the number of treatment sessions required in patients who achieved stone-free status following ESWL.

2 Materials and methods

Between January 2022 and March 2024, adult patients presenting to our outpatient clinic with kidney stones were included in the study after retrospective data collection. Patients with stones measuring 5–20 mm who consented to treatment underwent ESWL. Patients excluded from the study included those with unsuccessful ESWL outcomes (residual stones larger than 4 mm), those with double-J stents, stones larger than 20 mm, lower pole kidney stones, or BMI ≥ 35. Data from 354 patients with successful ESWL outcomes were analyzed.

Patients were evaluated 4–6 weeks after ESWL using X-ray, ultrasound (US), or computed tomography (CT). Residual stones larger than 4 mm were defined as treatment failure. In addition, all patients included in the study were given alpha blockers for 1 month. Parameters recorded included age, gender, stone laterality (right/left), stone localization (renal pelvis, mid calyx, upper calyx, proximal ureter, mid ureter, distal ureter), stone size (maximum longitudinal dimension), BMI, and stone HU values. Patients were categorized into two groups: single-session and multiple-session treatments.

All patients underwent pre-procedural non-contrast helical CT. Laboratory investigations included urinalysis and urine culture. Patients with positive urine cultures received antibiotic therapy based on culture antibiogram results before the procedure. Patients were informed about treatment methods. Each session involved administering 2,000–2,500 shock waves at 80 shocks per minute with a power range of 13–17 kV. Fluoroscopy was used throughout the procedure to ensure optimal stone localization and to monitor treatment response. An Elmed device (Elmed Medical Systems Multimedia Classic/Turkey) was used for ESWL.

2.1 Data analysis

Descriptive statistics, including mean, standard deviation, median, minimum, maximum, frequency, and percentage, were used to summarize the data. The distribution of variables was assessed using the Kolmogorov–Smirnov and Shapiro–Wilk tests. For non-normally distributed independent quantitative variables, the Mann-Whitney U test was applied. For independent qualitative variables, the Chi-square test was used, and Fisher’s test was applied when Chi-square assumptions were not met. The effect size and cutoff values were analyzed using the ROC curve. Univariate and multivariate logistic regression analyses were performed to assess effect sizes. Statistical analyses were conducted using SPSS version 28.0 (SPSS Inc, Chicago, IL, USA).

  1. Ethics approval and consent to participate: The study was conducted with the ethical approval from the University Faculty of Medicine Ethics Committee (E-22686390-050.99-42448) received date: 22/03/2023. All methods were performed in accordance with the relevant guidelines and regulations, and informed consent was obtained from all subjects and/or their legal guardians.

3 Results

The study included a total of 354 patients, comprising 96 females and 258 males. The mean age of the patients was 43.8 ± 11.9 years, and the mean BMI was 25.0 ± 4.5. Stones were located on the right side in 46.0% (163) of cases and on the left side in 54.0% (191). The mean stone size was 10.0 ± 4.4 mm, and the mean stone HU value was 770.0 ± 153.9 (Table 1).

Table 1

Demographic findings of the study

Min–Max Median Mean value ± SD/n (%)
Age 15.0–83.0 42.0 43.8 ± 11.9
Sex Female 96 27.1%
Male 258 72.9%
BMI 16.8–39.2 24.3 25.0 ± 4.5
Right 163 46.0%
Left 191 54.0%
Localization Proximal ureter 109 30.8%
Distal ureter 93 26.3%
Renal pelvis 73 20.6%
Mid ureter 41 11.6%
Mid calyx 26 7.3%
Upper calyx 12 3.4%
Stone size (mm) 5.0–20.0 9.0 10.0 ± 4.4
Stone HU 330.0–1260.0 790.0 770.0 ± 153.9
Number of sessions I 176 49.7%
II 88 24.9%
III 90 25.4%

The proportion of patients who underwent a single ESWL session was 49.7% (176), while 50.3% (178) required multiple sessions (Tables 1 and 2).

Table 2

Comparison of patients undergoing single-session and multiple-session ESWL

Single session (n:176) Multiple sessions (n:178)
Mean value ± SD/n (%) Median Mean value ± SD/n (%) Median p
Age 41.4 ± 11.4 40.0 46.1 ± 11.9 45.5 0.000 m
Sex Female 47 26.7% 49 27.5% 0.862 X²
Male 129 73.3% 129 72.5%
BMI 24.3 ± 4.3 24.1 25.7 ± 4.5 25.2 0.001 m
Right 79 44.9% 84 47.2% 0.664 X²
Left 97 55.1% 94 52.8%
Localization
Proximal ureter 58 33.0% 51 28.7% 0.381 X²
Distal ureter 61 34.7% 32 18.0% 0.000 X²
Renal pelvis 21 11.9% 52 29.2% 0.000 X²
Mid ureter 26 14.8% 15 8.4% 0.062 X²
Mid calyx 7 4.0% 19 10.7% 0.016 X²
Upper calyx 3 1.7% 9 5.1% 0.081 X²
Stone size (mm) 8.2 ± 3.1 7.0 11.9 ± 4.7 11.0 0.000 m
Stone HU 690.0 ± 136.9 700.0 849.0 ± 126.8 851.5 0.000 m

mMann-Whitney u test/ X²Ki-kare test (Fischer test).

In the group requiring multiple ESWL sessions, the mean age of the patients was significantly higher (p < 0.05) compared to the single-session group. Gender distribution did not show a statistically significant difference (p > 0.05) between the two groups. BMI was significantly higher (p < 0.05) in the multiple-session group compared to the single-session group. Laterality of stone localization (right/left) did not differ significantly (p > 0.05) between the two groups (Table 2).

Stone localization in the proximal ureter, mid ureter, and upper calyx did not show significant differences (p > 0.05) between the single-session and multiple-session groups. However, distal ureter stone localization was significantly lower (p < 0.05) in the multiple-session group compared to the single-session group. Conversely, stone localization in the renal pelvis and mid calyx was significantly higher (p < 0.05) in the multiple-session group compared to the single-session group (Table 2).

Stone size and HU values were significantly higher (p < 0.05) in the multiple-session group compared to the single-session group (Table 2).

In the univariate model, factors such as age, BMI, distal ureter, renal pelvis, mid-calyx stone localization, stone size, and stone HU values were observed to have a significant effect (p < 0.05) in distinguishing between single-session and multiple-session groups (Table 3).

Table 3

Univariate and multivariate model analysis

Univariate model Multivariate model
OR 95% GA p OR 95% GA p
Age 1.036 1.017–1.055 0.000 1.026 1.003–1.049 0.028
BMI 1.078 1.026–1.132 0.003
Localization
Distal ureter 2.420 1.479–3.961 0.000
Renal pelvis 0.328 0.188–0.574 0.000
Mid calyx 0.347 0.142–0.847 0.020
Stone size (mm) 1.285 1.200–1.376 0.000 1.226 1.142–1.316 0.000
Stone HU 1.010 1.007–1.012 0.000 1.009 1.007–1.012 0.000

Logistic Regression (Forward LR).

In the multivariate model, age, stone size, and HU values emerged as significant independent factors (p < 0.05) in differentiating between single-session and multiple-session treatments (Table 3).

Stone size demonstrated a significant effect in distinguishing between single-session and multiple-session patients, with an area under the curve (AUC) of 0.753 (95% CI: 0.702–0.805) (Table 4). A cutoff value of 10 mm for stone size was observed to have a significant effect, with an AUC of 0.729 (95% CI: 0.676–0.783) (Figure 1). At the 10 mm cutoff value, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for distinguishing between single-session and multiple-session patients were 66.3, 79.5, 76.6, and 70.0%, respectively (Table 4).

Table 4

Effectiveness of stone size between single-session and multi-session patients

AUC 95% CI p
Stone size (mm) 0.753 0.702–0.805 0.000
Stone size 10 cut off 0.729 0.676–0.783 0.000
Single session Multiple sessions %
Stone size <10 140 60 Sensitivity 66.3%
≥10 36 118 PPV 76.6%
Specificity 79.5%
NPV 70.0%

ROC Curve.

Figure 1 Efficacy graph of stone size between single-session and multi-session patients.
Figure 1

Efficacy graph of stone size between single-session and multi-session patients.

The HU value of the stone demonstrated a significant effect in distinguishing between single-session and multiple-session patients, with an AUC of 0.801 (95% CI: 0.756–0.846) (Table 5).

Table 5

Effectiveness of stone HU value between single-session and multi-session patients

AUC 95% CI P
Stone HU 0.801 0.756–0.846 0.000
Stone HU 755 cutoff 0.737 0.684–0.790 0.000
Single session Multiple sessions %
Stone HU <755 113 30 Sensitivity 83.1%
≥755 63 148 PPV 70.1%
Specificity 64.2%
NPV 79.0%

ROC Curve.

A cutoff value of 755 HU for the stone was also found to have a significant effect, with an AUC of 0.737 (95% CI: 0.684–0.790) (Figure 2).

Figure 2 Effectiveness graph of stone HU value in single-session and multi-session patients.
Figure 2

Effectiveness graph of stone HU value in single-session and multi-session patients.

At the 755 HU cutoff value, the sensitivity, specificity, PPV, and NPV for distinguishing between single-session and multiple-session patients were 83.1, 64.2, 70.1, and 79.0%, respectively (Table 5).

4 Discussion

Since the 1980s, ESWL has remained a popular and preferred method for the safe, non-invasive treatment of uncomplicated kidney and ureteral stones (≤20 mm in diameter) [10]. Previous studies have identified predictive factors such as patient age, stone size, stone location, SSD, stone density, severity of obstruction, BMI, urinary system anatomy, and the type of ESWL device, all of which can influence the success of ESWL [11,12]. This study sought to determine whether these predictive factors, in patients who achieved successful outcomes, also impacted the number of sessions required, by categorizing patients into single-session and multiple-session groups.

No significant difference was observed in gender or stone laterality between the groups, suggesting that these factors are not influential in determining the number of ESWL sessions. Similarly, prior research has shown that neither factor significantly affects SFR [13]. Regarding stone location, significant differences were observed between the groups for renal pelvis, mid calyx, and distal ureter stones, while no significant differences were found for stones located in the proximal ureter, mid ureter, or upper calyx. Multiple sessions were more effective for renal pelvis and mid calyx stones, whereas single sessions were more effective for distal ureter stones. Although the literature often associates lower ESWL success rates with distal ureter stones, potentially necessitating more sessions, discrepancies in our results may stem from factors such as stone size, stone HU value, and BMI.

Age and BMI have previously been identified as significant predictors of ESWL success [13,14,15]. In this study, both factors significantly influenced session count in the univariate model, with older age and higher BMI correlating with an increased number of sessions. The mean age of our cohort was 43.8 ± 11.9 years, aligning with the global prevalence of urolithiasis in individuals aged 40–50 years [16]. Although the influence of age diminishes over extended follow-up periods, it remains a strong determinant of SFR after ESWL [17]. Age-related sclerotic changes in renal parenchyma may increase acoustic impedance, leading to lower SFR and higher session counts [14]. Unlike BMI, age remained a significant independent factor in the multivariate model, highlighting its strong impact on session count.

While SSD measurements were not included in this retrospective study, SSD is known to correlate linearly with BMI [18]. Obese patients experience reduced energy transmission to the stone, resulting in decreased SFR [19,20]. In our study, higher BMI was a significant factor in the univariate model but did not demonstrate similar effects in the multivariate model. This aligns with findings from other studies where SSD was a predictor of ESWL failure in univariate analysis but not in multivariate analysis [18].

Both stone size and HU value were significant factors in distinguishing between single-session and multiple-session patients in both univariate and multivariate models. Stone size is a critical variable in determining the appropriateness of ESWL. A prospective study involving 130 patients reported that larger stone sizes required more ESWL sessions [21]. Similarly, other studies have identified a 10 mm cutoff for stone size as an independent predictor of ESWL success [22]. Our study also found a 10 mm cutoff for distinguishing between single-session and multiple-session groups, with an AUC of 0.729 (95% CI: 0.676–0.783). Stones larger than 10 mm necessitate more sessions for successful fragmentation, as corroborated by prior research indicating an average of 1.4 sessions for stones ≤10 mm and 2.1 sessions for stones >10 mm [18].

Stone HU value is another critical factor influencing stone clearance rates. Higher HU values are associated with lower ESWL success and are frequently used to predict treatment outcomes [5,8]. Studies have consistently shown a positive relationship between lower HU values and higher SFR [8,19,23,24]. Evidence from a prospective study demonstrated higher ESWL success rates for stones with HU <970, with a linear relationship observed between stone density and SFR for stones below this threshold [16]. In our study, a 755 HU cutoff was identified as significant in distinguishing between single-session and multiple-session groups, with an AUC of 0.737 (95% CI: 0.684–0.790). This finding underscores the potential of HU values in predicting ESWL success, enabling optimized session planning and cost reduction by minimizing unnecessary sessions.

5 Conclusion

Several factors influencing ESWL success also affect the number of sessions required. BMI, age, stone size, stone HU values, and certain stone locations emerged as significant determinants of session count. Among these, stone size and HU value were identified as the most critical independent factors. By considering these variables, the number of ESWL sessions required can be predicted, contributing to the optimization of treatment management.

6 Study limitations

This study has several limitations due to its retrospective design. Only sessions of patients who underwent successful ESWL treatment were analyzed, while sessions of those with unsuccessful outcomes were not included, limiting the ability to make comparisons. Additionally, clinical follow-up data did not include measurements for SSD or US shear wave elastography (SWE). Furthermore, data for lower pole kidney stones were insufficient, and therefore, these cases were excluded from the study. As a result, no conclusions regarding session requirements for SSD, SWE, or lower pole kidney stones can be drawn.

  1. Funding information: The authors state no funding involved.

  2. Author contributions: Concept – M.E.; design and supervision – S.S.; resources – M.E.; materials – M.E. and S.S.; data collection and/or processing – M.E.; analysis and/or interpretation – S.S.; literature search – M.E. and S.S.; writing manuscript – M.E. and S.S.; critical review – S.S.; and others – M.E.

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

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

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Received: 2024-12-12
Revised: 2025-05-31
Accepted: 2025-08-05
Published Online: 2025-09-11

© 2025 the author(s), published by De Gruyter

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

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  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
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  119. Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
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  121. Development of a nomogram for predicting cancer-specific survival in patients with renal pelvic cancer following surgery
  122. Inhibition of ATG7 promotes orthodontic tooth movement by regulating the RANKL/OPG ratio under compression force
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  125. FAHD1 prevents neuronal ferroptosis by modulating R-loop and the cGAS–STING pathway
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  127. Investigation of the pathogenic variants induced Sjogren’s syndrome in Turkish population
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  200. Corrigendum
  201. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  202. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  203. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  204. Retraction
  205. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  206. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  207. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
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  214. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
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  216. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  217. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  218. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
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  220. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  221. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
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  223. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  224. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  225. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  226. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  227. A review of brain research on T2DM-related cognitive dysfunction
  228. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  229. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
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https://doi.org/10.1515/med-2025-1276
Keywords for this article
extracorporeal shockwave therapy; session count; urolithiasis
Creative Commons
BY 4.0

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  47. Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
  48. Clinical efficacy of azacitidine in the treatment of middle- and high-risk myelodysplastic syndrome in middle-aged and elderly patients: A retrospective study
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  50. Expression and clinical significance of ITGA3 in breast cancer
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  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
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  84. The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
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  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
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  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
  89. Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
  91. Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
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  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
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  114. Comparison of the two intestinal anastomosis methods in pediatric patients
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  117. Lateral transperitoneal laparoscopic adrenalectomy: A single-centre experience of 21 procedures
  118. Petunidin attenuates lipopolysaccharide-induced retinal microglia inflammatory response in diabetic retinopathy by targeting OGT/NF-κB/LCN2 axis
  119. Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
  120. Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients
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  125. FAHD1 prevents neuronal ferroptosis by modulating R-loop and the cGAS–STING pathway
  126. Association of placenta weight and morphology with term low birth weight: A case–control study
  127. Investigation of the pathogenic variants induced Sjogren’s syndrome in Turkish population
  128. Nucleotide metabolic abnormalities in post-COVID-19 condition and type 2 diabetes mellitus patients and their association with endocrine dysfunction
  129. TGF-β–Smad2/3 signaling in high-altitude pulmonary hypertension in rats: Role and mechanisms via macrophage M2 polarization
  130. Ultrasound-guided unilateral versus bilateral erector spinae plane block for postoperative analgesia of patients undergoing laparoscopic cholecystectomy
  131. Profiling gut microbiome dynamics in subacute thyroiditis: Implications for pathogenesis, diagnosis, and treatment
  132. Delta neutrophil index, CRP/albumin ratio, procalcitonin, immature granulocytes, and HALP score in acute appendicitis: Best performing biomarker?
  133. Anticancer activity mechanism of novelly synthesized and characterized benzofuran ring-linked 3-nitrophenyl chalcone derivative on colon cancer cells
  134. H2valdien3 arrests the cell cycle and induces apoptosis of gastric cancer
  135. Prognostic relevance of PRSS2 and its immune correlates in papillary thyroid carcinoma
  136. Association of SGLT2 inhibition with psychiatric disorders: A Mendelian randomization study
  137. Motivational interviewing for alcohol use reduction in Thai patients
  138. Luteolin alleviates oxygen-glucose deprivation/reoxygenation-induced neuron injury by regulating NLRP3/IL-1β signaling
  139. Polyphyllin II inhibits thyroid cancer cell growth by simultaneously inhibiting glycolysis and oxidative phosphorylation
  140. Relationship between the expression of copper death promoting factor SLC31A1 in papillary thyroid carcinoma and clinicopathological indicators and prognosis
  141. CSF2 polarized neutrophils and invaded renal cancer cells in vitro influence
  142. Proton pump inhibitors-induced thrombocytopenia: A systematic literature analysis of case reports
  143. The current status and influence factors of research ability among community nurses: A sequential qualitative–quantitative study
  144. OKAIN: A comprehensive oncology knowledge base for the interpretation of clinically actionable alterations
  145. The relationship between serum CA50, CA242, and SAA levels and clinical pathological characteristics and prognosis in patients with pancreatic cancer
  146. Identification and external validation of a prognostic signature based on hypoxia–glycolysis-related genes for kidney renal clear cell carcinoma
  147. Engineered RBC-derived nanovesicles functionalized with tumor-targeting ligands: A comparative study on breast cancer targeting efficiency and biocompatibility
  148. Relationship of resting echocardiography combined with serum micronutrients to the severity of low-gradient severe aortic stenosis
  149. Effect of vibration on pain during subcutaneous heparin injection: A randomized, single-blind, placebo-controlled trial
  150. The diagnostic performance of machine learning-based FFRCT for coronary artery disease: A meta-analysis
  151. Comparing biofeedback device vs diaphragmatic breathing for bloating relief: A randomized controlled trial
  152. Serum uric acid to albumin ratio and C-reactive protein as predictive biomarkers for chronic total occlusion and coronary collateral circulation quality
  153. Multiple organ scoring systems for predicting in-hospital mortality of sepsis patients in the intensive care unit
  154. Single-cell RNA sequencing data analysis of the inner ear in gentamicin-treated mice via intraperitoneal injection
  155. Review Articles
  156. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  157. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  158. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  159. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  160. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  161. 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
  162. The application of augmented reality in robotic general surgery: A mini-review
  163. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  164. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  165. Plant polyphenols, terpenes, and terpenoids in oral health
  166. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  167. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  168. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  169. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  170. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  171. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  172. Giant borderline ovarian tumours – review of the literature
  173. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  174. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  175. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  176. Supplement strategies for infertility in overweight women: Evidence and legal insights
  177. Scurvy, a not obsolete disorder: Clinical report in eight young children and literature review
  178. A meta-analysis of the effects of DBS on cognitive function in patients with advanced PD
  179. Protective role of selenium in sepsis: Mechanisms and potential therapeutic strategies
  180. Strategies for hyperkalemia management in dialysis patients: A systematic review
  181. C-reactive protein-to-albumin ratio in peripheral artery disease
  182. Case Reports
  183. Delayed graft function after renal transplantation
  184. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  185. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  186. Giant right atrial hemangioma presenting with ascites: A case report
  187. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  188. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  189. Molecular hydrogen-rhodiola as an adjuvant therapy for ischemic stroke in internal carotid artery occlusion: A case report
  190. Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
  191. Rapid Communication
  192. Biological properties of valve materials using RGD and EC
  193. A single oral administration of flavanols enhances short-term memory in mice along with increased brain-derived neurotrophic factor
  194. Letter to the Editor
  195. Role of enhanced external counterpulsation in long COVID
  196. Expression of Concern
  197. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  198. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  199. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  200. Corrigendum
  201. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  202. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  203. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  204. Retraction
  205. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  206. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  207. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
  208. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  209. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  210. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  211. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  212. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  213. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  214. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  215. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  216. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  217. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  218. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  219. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  220. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  221. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  222. Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
  223. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  224. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  225. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  226. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  227. A review of brain research on T2DM-related cognitive dysfunction
  228. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  229. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
  230. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
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