Startseite Medizin Impact of combined diaphragm-lung ultrasound assessment on postoperative respiratory function in patients under general anesthesia recovery
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Impact of combined diaphragm-lung ultrasound assessment on postoperative respiratory function in patients under general anesthesia recovery

  • Ping Zhang , Wei-hong Huang , Long-cheng Fan , Zhong-yu Liu und Shan-liang Guo ORCID logo EMAIL logo
Veröffentlicht/Copyright: 22. Dezember 2025
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Aus der Zeitschrift Open Medicine Band 20 Heft 1

Abstract

Objectives

The study aims to evaluate whether the ultrasonographic assessment of diaphragm and lung function in postanaesthesia care unit (PACU) can improve postoperative respiratory function recovery in patients under general anesthesia recovery.

Methods

This study enrolled 130 participants scheduled for elective abdominal surgery with planned postoperative transfer to PACU. Participants were randomized to either the diaphragm-lung ultrasound-guided group (group DL) or standard resuscitation group without ultrasound guidance (group N). The group DL received diaphragm and lung ultrasonography at four predefined intervals and intervention based on the ultrasound results was performed. The primary outcomes were the incidence of hypoxemia (PaO2/FiO2≤300  mmHg) at discharge of PACU and the extubation time. The postoperative pulmonary complications (PPCs) within the first 7 days was measured as a key secondary outcome.

Results

Compared with the group N, the incidence of hypoxemia (p<0.01) and the extubation time (p<0.01) were significantly reduced in the group DL. There was no significant difference in the incidence of PPCs between the two groups (p>0.1).

Conclusions

Dynamic assessment of pulmonary and diaphragm function by ultrasound improved the recovery of respiratory function in patients but did not reduce the incidence of PPCs.

Keywords: ultrasound; respiratory function; post-anesthesia care unit

Introduction

General anesthesia rapidly reduces functional residual capacity by approximately 20 % and impairs respiratory muscle function, particularly diaphragmatic activity [1]. The incidence of postoperative pulmonary complications (PPCs) in major surgery ranges from 1 to 23 % [2]. Abdominal surgery further compromises respiratory function through tissue trauma, phrenic nerve inhibition, and pneumoperitoneum effects [3]. Weingarten et al. [4] demonstrated that even a single episode of respiratory depression in postanaesthesia care unit (PACU) was strongly associated with subsequent respiratory complications. Inadequate recovery of respiratory physiology can lead to severe hypoxemia-induced end-organ damage and even death [4], 5]. Thus, effective respiratory monitoring and accelerated functional recovery during anesthesia emergence are critical. In recent years, with the continuous popularization and promotion of bedside ultrasound technology, bedside ultrasound has been proved to be of great value in evaluating patients’ real-time status [6], [7], [8].

Lung ultrasound (LUS) has been validated for the diagnosis of atelectasis, pneumonia, pleural effusion and pneumothorax [8], [9], [10], [11], [12]. Chen et al. [8] showed high accuracy of LUS in diagnosing different aetiologies of postoperative hypoxia in the PACU with a high degree of sensitivity and specificity. Both diaphragmatic excursion and diaphragm thickening fraction (DTF) showed good diagnostic performance in predicting extubation outcomes [13]. Previous publications on LUS and diaphragm ultrasound were mostly from emergency departments and ICUs. There are still few related studies on the application of the combination of the two in postoperative anesthesia recovery period.

Therefore, this study evaluates whether combined diaphragm-lung ultrasound assessment guiding targeted interventions in PACU enhances respiratory recovery after general anesthesia.

Methods

Trial design

This prospective, patient-blinded, single-center randomized controlled trial was approved by the Ethics Committee of Jiangxi Provincial People’s Hospital (2022-037, 2022/8/15) and was registered at the Chinese Clinical Trial Registry (trial number: ChiCTR2200064548; Date of registration: 11/10/2022). We enrolled 135 patients, aged 18–85 years, ASA I-III, who underwent elective abdominal surgery in our hospital from October 2022 to February 2023 and were transferred to the PACU with the endotracheal tube postoperatively. Exclusion criteria included preexisting respiratory conditions (diaphragmatic dysfunction, pleural effusion, pneumothorax, mediastinal emphysema, interstitial lung disease, moderate to severe chronic obstructive pulmonary disease), cardiac impairment (NYHA classe ≥III), neuromuscular disorders and thoracic surgery history. Withdrawal criteria included failure to transfer to PACU as planned or postoperative pain/sedation issues (VAS >3 or Ramsay score >2 after extubation).

Patients were randomized to diaphragm-lung ultrasound-guided group (group DL) or standard resuscitation group without ultrasound guidance (group N) using a computer-generated sequence of random numbers. Allocation details were sealed in numbered envelopes. The group DL underwent pulmonary and diaphragmatic ultrasound assessments at four timepoints: admission in operating room (T0), admission in PACU (T1), 15 min after extubation (T2), and discharge of PACU (T3). The enrollment and allocation of participants are compiled in Figure 1.

Figure 1: Consort flow diagram.
Figure 1:

Consort flow diagram.

Anesthesia method

Standardized monitoring included three-lead electrocardiography, SpO2, blood pressure, and BIS was performed after patients entered the room. After a FiO2 60 % pre-oxygenation, general anesthesia was induced with standard doses of propofol, vecuronium bromide and sufentanil. Tracheal intubation was performed, followed by an anesthesia machine (Drager, Germany) for mechanical ventilation, using volume-controlled ventilation, tidal volume of 8 mL/kg, respiratory rate of 12–18 times/min, FiO2 40 %, positive end-expiratory pressure (PEEP) of 5–8 cmH2O and end-tidal CO2 (Philips IntelliVue MP, Philips Medizin Systeme, Germany) controlled between 35 and 45 mmHg. Maintenance of anesthesia used 1.0 MAC sevoflurane, remifentanil 0.1–0.5 ug⋅kg−1⋅h−1, propofol 4–6 mg⋅kg−1⋅h−1, intermittently gave vecuronium bromide 0.03 mg/kg, adjusting the dosage of drugs according to the depth of anesthesia, and the BIS was maintained at 40–60. During the operation, the fluctuation range of a mean arterial pressure (MAP) should not exceed 20 % of the base value. Vecuronium bromide was stopped about 40 min before the end of the operation. Sevoflurane was stopped about 10 min before the end of the operation. Remifentanil was stopped after the operation. In both group, recruitment maneuver was carried out by manual infation with 30 cmH2O airway pressure with FiO2 of 0.4 for 30s at the end of the operation [14].

All the patients were admitted to the PACU with tracheal intubation, and were placed at a head height of 30°. Patients in PACU were given neostigmine 0.02 mg/kg and atropine 10 μg/kg after spontaneous breathing occurs. Extubation was determined by the anesthesiologist in PACU when patients met the following criteria: responsive to verbal commands, return of spontaneous breathing with a tidal volume  ≥5 mL/kg, respiratory rate of 10–20 breaths/min, end-tidal CO2 <45 mmHg with a regular waveform, and SpO2 >95 %. After extubation, the VAS score and Ramsay sedation score were assessed, and oxygen was inhaled through a nasal oxygen tube at an oxygen flow rate of 5 L/min. When the patient’s Steward score is ≥6 points, the patient can be sent out of the PACU and transferred to the ward. At T3 (PACU discharge), arterial blood samples were obtained from all patients. The PaO2/FiO2 ratio was calculated from these analyses, with values ≤300 mmHg defining hypoxemia [15].

LUS assessment and intervention

The patient was examined for LUS by 12-zone approach. Each half of the chest is divided into front, outside, and rear areas by the anterior axillary line and the posterior axillary line, and divided into upper and lower areas through the nipple level. There are 6 areas in total and 12 areas in bilateral lungs [16]. A fixed lung sonographer scans and scores each area (0–3 points), and adopts the modified scoring standard of Monastesse et al. [17]: a (0 point): normal aeration-lung sliding sign with A lines or ≤2 separate B-lines; b (1 point): Mild aeration defect – multiple distinct B lines (fused B lines less than 50 % of intercostal space on vertical scan), one or more small pleura inferior consolidation is separated by normal pleural line; c (2 points): Moderate lung aeration defect-multiple merged B-lines (fused B lines are more than 50 % of the intercostal space on vertical scan), multiple small subpleural consolidations are separated by thickened or irregular pleural lines; d (3 points): white lung or lung consolidation-atelectasis: air bronchus sign, debris sign, tissue-like sign. The LUS scores of the 12 zones were pooled and analyzed to calculate LUS score (0–36 points).

The higher the score, the more severe the ventilation loss, except for pneumothorax. At T1 (PACU admission) – T2 (15 min post-extubation), lung ultrasound showed more than 15 B-lines in the anterior chest region, suggesting that extravascular lung water increased and furosemide 20 mg was given [12]. At T1, LUS score >2 points in a single area or >10 points in total, ultrasound-guided lung recruitment was performed.

Lung Recruitment Method: The ultrasound probe was placed in the most severe area of atelectasis, maintaining the airway pressure at 15 cmH2O, increasing PEEP by 5 cmH2O each time and maintaining it for 5 s after each increase, with a maximum of 40 cmH2O with FiO2 of 0.4 until the lung consolidation disappears under ultrasound. Besides, the pressure at that time was maintained for 30 s, and then decreased to maintain the previous ventilator setting [14], 18]. If MAP or heart rate changes >15 %, stop the recruitment maneuver.

Diaphragm ultrasound assessment and intervention

The patient was placed in a supine position with a head height of 30°, and a 10–15 MHz high-frequency linear array probe was placed perpendicular to the long axis of the ribs in the 8–10 intercostal space between the anterior axillary line and the midaxillary line, and 0.5–2 cm above the costophrenic sinus. Diaphragm thickness was assessed by the same sonographer. In B mode, find the diaphragm. In M mode, measure the end-inspiration and end-expiration diaphragm thickness, and calculate the DTF=(end-inspiration thickness – end-expiration thickness)/end-expiration thickness × 100 %, DTF is the average of 3 breaths. To ensure the reproducibility of the ultrasound examination, the position of the probe was carefully marked and the ultrasound examination of the diaphragm was performed at the same location in the PACU. Diaphragm ultrasonic images of one representative patient at different time points are displayed in Figure 2. DTF less than 30 % is a measure of ultrasonographic diaphragmatic dysfunction [19]. When the ultrasound evaluation of the diaphragm at T2 (15 min post-extubation) indicates diaphragmatic dysfunction, the patient will be given additional neostigmine 30 μg/kg plus atropine 10 μg/kg, and the maximum dose of neostigmine is 5 mg/d [20].

Figure 2: The left figure shows the end-inspiratory and end-expiration diaphragm thickening at T0 with the DTF reaching 50 %. The right figure shows the end-inspiratory and end-expiration diaphragm thickening of the same patient at T2, and the DTF is 23.5 %, suggesting that the patient’s diaphragm function is incompetent at this time point.
Figure 2:

The left figure shows the end-inspiratory and end-expiration diaphragm thickening at T0 with the DTF reaching 50 %. The right figure shows the end-inspiratory and end-expiration diaphragm thickening of the same patient at T2, and the DTF is 23.5 %, suggesting that the patient’s diaphragm function is incompetent at this time point.

Outcomes

The primary outcomes were the incidence of hypoxemia (PaO2/FiO2≤300  mmHg) at T3 (PACU discharge) and the extubation time(time from admission to PACU to extubation). The PPCs within the first 7 postoperative days was measured as a key secondary outcome. The PPCs were defined according to the ARISCAT study (the criteria of respiratory infection, respiratory failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, and aspiration pneumonitis.) [2], 21], 22]. Complications that do not need to be treated or have no clinical significance, such as a small amount of pneumothorax or pleural effusion, localized subcutaneous emphysema and so forth will not be recorded if they do not adversely affect the patient’s postoperative recovery and discharge.

The other secondary outcomes were defined as follows:(1) the DTF and LUS score at four time points, (2) the PACU length-of-stay and the interventions during PACU length-of-stay, (3) the SpO2 at four time points and the lowest SpO2 in each group after extubation, Details of the protocol are provided in Figure 3.

Figure 3: Schematic diagram of the study protocol.
Figure 3:

Schematic diagram of the study protocol.

Statistical analysis

According to the results of the pre-test, the incidence of hypoxemia in the two groups after extubation was taken as the main result (the incidence of hypoxemia in the two groups was 0.35 and 0.10 respectively). Setting α=0.05, 1-β=0.9, and loss-to-follow-up rate of 10 %, the sample size of at least 60 cases in each group was calculated by PASS 15 software (NCSS, Canada).The measurement data conforming to the normal distribution were expressed as mean±standard deviation (x±s), and the independent sample t-test was used for comparison between groups. The measurement data that were not normally distributed were expressed as the median (interquartile range) [M(IQR)], and the non-parametric Mann-Whitney U test was used for comparison between groups. The enumeration data was expressed as the number of cases (percentage), and the chi-square test or continuous corrected chi-square test was used for comparison between groups. One-way repeated measures analysis of variance (ANOVA) was used to analyze changes in SpO2, lung ventilation and diaphragm thickness at different time points. For all analyses, a two-sided p<0.05 was considered statistically significant. SPSS 26.0 statistical software (IBM, USA) was used when analyzing the data.

Results

Patient enrollment and characteristics

A total of 135 patients undergoing elective abdominal surgery at Jiangxi Provincial People’s Hospital (October 2022–February 2023) were assessed for eligibility. Five patients were excluded because they met any of the withdrawal criteria and 130 patients were finally enrolled. There were 65 cases in each group, including 61 males and 69 females. There was no significant difference between the two groups in gender, age, BMI, ASA class, smoking rate, operation time, operation type, operation method, intraoperative fluid intake and output, and muscle relaxant usage (Table 1). There were no reintubation events in both groups.

Table 1:

Patient characteristics (N=130).

Category Group DL Group N p-Value
Age, years 56.45 ± 14.13

 59.35 ± 13.10 0.226
Male gender 32 (49.2 %) 29 (44.6 %) 0.598
BMI, kg/m2 23.07 ± 3.46 22.33 ± 3.04 0.197
ASA Class/Case, % 0.103
II 36 (55.4 %) 45 (69.2 %)
III 29 (44.6 %) 20 (30.8 %)
Perioperative smoking 8 (12.3 %) 14 (21.15 %) 0.16
SpO2–T0,% 98.51 ± 1.59 98.35 ± 1.54 0.451
Operation time, min 199.11 ± 87.67 214.72 ± 96.02 0.335
Inpatient days, d 10.00 (6.50, 14.00) 9.00 (6.00, 13.00) 0.823
Operation type 0.625
Gastrectomy and pancreatectomy 15 (23.1 %) 17 (26.2 %)
Hepatectomy 8 (12.3 %) 12 (18.5 %)
Enterectomy 18 (27.7 %) 13 (20.0 %)
Others 24 (36.9 %) 23 (35.4 %)
Laparoscopy 57 (87.7 %) 59 (90.8 %) 0.571
Intraoperative fluid Intake, mL 1600.00 (1200.0, 2000.0) 1500.00 (1235.0, 2200.0) 0.450
Intraoperative fluid Output, mL 450.00 (275.00, 775.00) 450.00 (380.00) 0.307
Muscle relaxant usage, mg 14.00 (12.00, 17.00) 16.00 (12.00, 20.00) 0.095

Perioperative ultrasound findings

Compared with T0 (operating room admission), the end-inspiratory diaphragm thickening of patients in the group DL was significantly reduced at T1 (PACU admission) and T2 (15 min post-extubation) (p<0.01). The thickness of the diaphragm at the end of inspiration was minimum at T1, which was statistically different from other time points (p<0.01). There was still a statistically significant difference in end-inspiratory diaphragm thickening between T3 (PACU discharge) and T0 (p<0.01). Compared with T0, the DTF of patients at T1, T2, and T3 decreased significantly (p<0.01). The DTF of patients at T1 was the lowest, and began to increase at T1–T3, but T3 was still lower than T0 (p<0.01). Compared with T0, the LUS score of patients at T1, T2, and T3 was significantly increased (p<0.01) (Table 2).

Table 2:

LUS Score, Diaphragm thickening and DTF at different time points.

T0 T1 T2 T3
LUS Score 0.23 ± 0.52 5.22 ± 2.89a 4.31 ± 2.05a 3.89 ± 1.96a
End-inspiration, mm 0.29 ± 0.07 0.24 ± 0.07a 0.27 ± 0.06a 0.29 ± 0.07
End-exspiration, mm 0.20 ± 0.04 0.19 ± 0.05 0.19 ± 0.04 0.20 ± 0.04
DTF, % 49.06 ± 14.75 28.51 ± 12.62a 38.87 ± 9.36a 43.83 ± 8.26a

  1. Compared with T0, ap<0.05.

Primary outcomes

Post-extubation hypoxemia occurred in 20 patients in the group N vs. 5 patients in the group DL. The incidence of hypoxemia in the group DL was significantly lower than group N (7.7 VS 30.8 %, p<0.01). Time to extubation was significantly shorter in the group DL compared with the group N (p<0.01). The detailed results were presented in Table 3.

Table 3:

Comparison of extubation time, incidence rate of hypoxemia at T3 and pulmonary complications and PACU length-of-stay(two groups).

Group DL Group N p-Value
Extubation time 24.00 (12.50, 45.00)a 35.00 (20.50, 50.50) 0.009
Incidence rate of hypoxemia after extubation 7.7 %a 30.8 % 0.001
Incidence rate of pulmonary complications 3.1 % 6.2 % 0.680
PACU length-of-stay 62.00 (50.50, 83.00)a 83.00 (67.50, 100.50) 0.000

  1. Compared with the Group N, ap<0.05.

Secondary outcomes

There was no significant difference in the incidence of postoperative pulmonary complications between the two groups (3.1 VS. 6.2 %, p>0.1), including 2 cases in the group DL (1 case of pulmonary infection, 1 case of pulmonary infection combined with pleural effusion) and 4 cases in Group N (2 cases of pulmonary infection, 2 cases of pulmonary infection combined with pleural effusion). PACU length of stay was significantly shorter in the group DL vs. group N (p<0.01). The detailed results were summarized in Table 3.

There was no significant difference in SpO2 and the lowest SpO2 after extubation between the two groups at different time points (Table 4).

Table 4:

Comparison of SpO2 and lowest SpO2 at each time point (two groups).

SpO2–T0 SpO2–T1 SpO2–T2 SpO2–T3 Lowest SpO2
Group DL 98.51 ± 1.59 99.66 ± 0.67 99.06 ± 1.39 99.43 ± 0.88 98.17 ± 1.69
Group N 98.35 ± 1.54 99.75 ± 0.56 98.86 ± 1.57 99.38 ± 1.07 97.43 ± 2.90
P 0.451 0.471 0.330 0.906 0.078

In the group N, furosemide was used in 2 patients at T1, and 3 patients needed to use masks or oropharyngeal airway after extubation at T2. In the group DL, 5 patients received furosemide at T1, 9 patients underwent ultrasound-guided lung recruitment maneuvers, and 8 patients received neostigmine and atropine at T2. Total interventions were significantly higher in the group DL vs. group N (p<0.05). Compared with the group N, the number of intervention cases required at T1 in the group DL was significantly increased (p<0.05), referring to Table 5 for detailed data.

Table 5:

The number of cases requiring intervention at different time points after extubation (two groups).

Total number of cases T0 T1 T2 T3
Group N 5 0 2 3 0
Group DL 22a 0 14a 8 0
P 0.000 0.003 0.207

  1. Compared with the group N, ap<0.05.

Discussion

Respiratory insufficiency is common in patients recovering from anesthesia with delayed recognition risking hypoxic organ damage and mortality [23]. This underscores the critical need for enhanced respiratory monitoring during anesthesia recovery. Our study demonstrates that combined diaphragm-lung ultrasound assessment significantly reduced extubation time and post-extubation hypoxemia compared to conventional resuscitation.

Auscultation as one of the essential components of the clinical examination might be challenging as dorsal lung fields are difficult to reach in supine positioned patients, and the environment in PACU is often noisy. Cox’s [9] study suggested that the agreement between lung ultrasound and auscultation is poor where 33 % of patients showed ultrasound evidence of pulmonary edema, yet 51 % of these had normal auscultation findings. Meanwhile the diagnostic accuracy of auscultation was better in non-ventilated than in ventilated patients. In our study, more patients with increased extravascular lung water were screened in the ultrasound group than those who relied on auscultation and SpO2 solely, and diuretics were used before the patients developed obvious symptoms of pulmonary edema which is related to that ultrasound is highly sensitive, specific, and reproducible for diagnosing the increase of extravascular lung water and pulmonary edema in patients at the bedside [12], 24]. Studies by other scholars also showed that Ultrasound-guided alveolar recruitment, regardless of the technique, could be more effective because it facilitates real-time monitoring of the expansion of collapsed alveoli [17], 25]. An ultrasound-guided recruitment manoeuvre was performed in the ultrasound group which can be conducive to confirming the effects of lung recruitment manoeuvres [17] and 9 patients received it with immediate efficacy confirmation in the group DL.

Clinical implementation of quantitative neuromuscular monitoring remains limited by practicality constraints resulting in persistently high rates of postoperative residual curarization (PORC) [26], 27]. In addition, there is some uncertainty in the metabolism of neuromuscular blocking drugs, and PORC may occur when the antagonistic drug effect disappears. An observational study revealed that 18 % of patients maintained a train-of-four ratio (TOFr) <0.9 20 minutes after neostigmine administration [28]. In the absence of muscle monitoring, DTF measured by ultrasound can be used to evaluate the recovery of the diaphragm after operation, and for conscious patients, it is more comfortable than train-of-four (TOF) and can help anesthesiologists to detect PORC patients in PACU. In the group DL, we identified 8 patients (12.3 %) with DTF <30 % at T2 (15 min post-extubation), which was consistent with previous research results [29]. The results of this study showed that the DTF of the patient was the lowest at T1 (PACU admission), and began to increase at T1–T3 (PACU discharge), suggesting that the patient’s spontaneous breathing recovered after the operation, and the diaphragm and other respiratory muscle groups gradually recovered their contraction function. In the meantime, DTF at T3 was still lower than T0 (p<0.01), indicating that the contractile function of the diaphragm had not recovered to the preoperative awake state before the patient returned to the ward after spontaneous breathing, suggesting that the deep breathing function was impaired after the operation, which was consistent with the research results of Kim et al. [30].

While individual applications of lung or diaphragmatic ultrasound are established, their combined impact on respiratory recovery remained unverified. Integrating diaphragm-lung ultrasound with standard monitoring enables precision-guided interventions that significantly accelerate extubation and reduce hypoxemia incidence.

Hypoxemia represents a potentially life-threatening yet frequent perioperative complication. In our study, hypoxaemia was defined as PaO2/FiO2≤300 mmHg [15] rather than the indicator of SpO2. Studies have shown that when the inhaled oxygen concentration is 25–30 %, even if the patient has trespiratory depression and hypoventilation, the SpO2 remains above 95 % [31]. PaO2/FiO2 can better reflect the pulmonary oxygenation function of patients and the accuracy was greater than SpO2 under the condition of auxiliary oxygen supply [32]. Interestingly, inconsistent with the results of the incidence of hypoxemia in our study, there was no significant difference in SpO2 at each time point and the lowest SpO2 after extubation between the two groups of patients (Table 4), which may be related to the ability of auxiliary oxygen supply to cover up the abnormal respiratory function of patients after SpO2 detection. We expected that ultrasound assessment and intervention would reduce the incidence of postoperative pulmonary complications in patients. Although PPCs were numerically lower in the group DL (3.1 vs. 6.2 %), this difference lacked statistical significance (p>0.1). It may be related to limited sample size and absence of routine postoperative imaging.

This study still has the following limitations. Firstly, the feasibility of ultrasound assessment of diaphragm function has been confirmed, but it is easily interfered by factors such as BMI and sedation level. This experiment was not compared with other methods for assessing diaphragmatic function. Secondly, diaphragm and lung examination has high repeatability and feasibility, but its accuracy and effectiveness depend on the experience of the operator. Lastly, exclusion of patients with preexisting respiratory conditions limits generalizability to high-risk populations.

In summary, this study demonstrates that real-time assessment of pulmonary aeration and diaphragmatic function during anesthesia recovery facilitates rapid diagnosis of impairment etiology, early detection of PORC and targeted interventions accelerating respiratory recovery.

Corresponding author: Shan-liang Guo, Department of Anesthesiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, NO.152 Aiguo Road, Nanchang, Jiangxi 330006, China, E-mail:
Ping Zhang and Wei-hong Huang contributed equally to this work.

Acknowledgments

The authors appreciate the efforts of all those involved in the study and the members of the research team for their dedicated efforts in conducting the clinical trial and completing the follow-up.

  1. Funding information: This work was supported by the Health Commission of Jiangxi Province, 202310125.

  2. Author contribution: Shan-liang Guo: study design, methodology, Writing-Reviewing and Editing. Ping Zhang: Study design, Data analysis, study implementation. Wei-hong Huang: Data collection, writing – original draf. Long-cheng Fan: Data collection, Study design. Zhong-yu Liu: Data analysis, Software.

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

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

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Received: 2025-02-10
Accepted: 2025-09-17
Published Online: 2025-12-22

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

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

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ultrasound; respiratory function; post-anesthesia care unit
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Artikel in diesem Heft

  1. Research Articles
  2. Network pharmacological analysis and in vitro testing of the rutin effects on triple-negative breast cancer
  3. Impact of diabetes on long-term survival in elderly liver cancer patients: A retrospective study
  4. Knockdown of CCNB1 alleviates high glucose-triggered trophoblast dysfunction during gestational diabetes via Wnt/β-catenin signaling pathway
  5. Risk factors for severe adverse drug reactions in hospitalized patients
  6. Analysis of the effect of ALA-PDT on macrophages in footpad model of mice infected with Fonsecaea monophora based on single-cell sequencing
  7. Development and validation of headspace gas chromatography with a flame ionization detector method for the determination of ethanol in the vitreous humor
  8. CMSP exerts anti-tumor effects on small cell lung cancer cells by inducing mitochondrial dysfunction and ferroptosis
  9. Predictive value of plasma sB7-H3 and YKL-40 in pediatric refractory Mycoplasma pneumoniae pneumonia
  10. Antiangiogenic potential of Elaeagnus umbellata extracts and molecular docking study by targeting VEGFR-2 pathway
  11. Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer
  12. Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis
  13. Adhered macrophages as an additional marker of cardiomyocyte injury in biopsies of patients with dilated cardiomyopathy
  14. Association between statin administration and outcome in patients with sepsis: A retrospective study
  15. Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018
  16. A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
  17. Lysophosphatidic acid 2 alleviates deep vein thrombosis via protective endothelial barrier function
  18. Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
  19. Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
  20. Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
  21. Vitamin D replacement therapy may regulate sleep habits in patients with restless leg syndrome
  22. The first-line antihypertensive nitrendipine potentiated the therapeutic effect of oxaliplatin by downregulating CACNA1D in colorectal cancer
  23. Health literacy and health-related quality of life: The mediating role of irrational happiness
  24. Modulatory effects of Lycium barbarum polysaccharide on bone cell dynamics in osteoporosis
  25. Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
  26. Examination of the causal role of immune cells in non-alcoholic fatty liver disease by a bidirectional Mendelian randomization study
  27. Clinical analysis of ten cases of HIV infection combined with acute leukemia
  28. Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
  29. Clinical observation of probiotics combined with mesalazine and Yiyi Baitouweng Decoction retention enema in treating mild-to-moderate ulcerative colitis
  30. Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection
  31. Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
  32. Core muscle strength and stability-oriented breathing training reduces inter-recti distance in postpartum women
  33. The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial
  34. The serum IL-17A levels in patients with traumatic bowel rupture post-surgery and its predictive value for patient prognosis
  35. Impact of Kolb’s experiential learning theory-based nursing on caregiver burden and psychological state of caregivers of dementia patients
  36. Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
  37. Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
  38. The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
  39. 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
  40. A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
  41. A comparative analysis of the impact of repeated administration of flavan 3-ol on brown, subcutaneous, and visceral adipose tissue
  42. Identifying early screening factors for depression in middle-aged and older adults: A cohort study
  43. Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
  44. Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
  45. High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
  46. RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
  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
  49. The effect of ambulatory blood pressure load on mitral regurgitation in continuous ambulatory peritoneal dialysis patients
  50. Expression and clinical significance of ITGA3 in breast cancer
  51. Single-nucleus RNA sequencing reveals ARHGAP28 expression of podocytes as a biomarker in human diabetic nephropathy
  52. rSIG combined with NLR in the prognostic assessment of patients with multiple injuries
  53. Toxic metals and metalloids in collagen supplements of fish and jellyfish origin: Risk assessment for daily intake
  54. Exploring causal relationship between 41 inflammatory cytokines and marginal zone lymphoma: A bidirectional Mendelian randomization study
  55. Gender beliefs and legitimization of dating violence in adolescents
  56. Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia
  57. Effect of smoking and smoking cessation on hematological parameters in polycythemic patients
  58. Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
  59. Necroptosis of hippocampal neurons in paclitaxel chemotherapy-induced cognitive impairment mediates microglial activation via TLR4/MyD88 signaling pathway
  60. Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
  61. Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
  62. GATA1: A key biomarker for predicting the prognosis of patients with diffuse large B-cell lymphoma
  63. Influencing factors of false lumen thrombosis in type B aortic dissection: A single-center retrospective study
  64. MZB1 regulates the immune microenvironment and inhibits ovarian cancer cell migration
  65. Integrating experimental and network pharmacology to explore the pharmacological mechanisms of Dioscin against glioblastoma
  66. Trends in research on preterm birth in twin pregnancy based on bibliometrics
  67. Four-week IgE/baseline IgE ratio combined with tryptase predicts clinical outcome in omalizumab-treated children with moderate-to-severe asthma
  68. Single-cell transcriptomic analysis identifies a stress response Schwann cell subtype
  69. Acute pancreatitis risk in the diagnosis and management of inflammatory bowel disease: A critical focus
  70. Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients
  71. Interleukin-37 mediates the anti-oral tumor activity in oral cancer through STAT3
  72. CA199 and CEA expression levels, and minimally invasive postoperative prognosis analysis in esophageal squamous carcinoma patients
  73. Efficacy of a novel drainage catheter in the treatment of CSF leak after posterior spine surgery: A retrospective cohort study
  74. Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
  75. Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
  76. Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
  77. Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
  82. Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
  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
  85. Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  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
  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
  92. Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
  93. Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
  95. Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
  96. Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
  106. Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
  116. Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
  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
  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
  123. A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
  124. Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
  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. Suppression of cathepsin B attenuates myocardial injury via limiting cardiomyocyte apoptosis
  156. Influence of sevoflurane combined with propofol anesthesia on the anesthesia effect and adverse reactions in children with acute appendicitis
  157. Identification of hub genes related to acute kidney injury caused by sevoflurane anesthesia and endoplasmic reticulum stress
  158. 10.1515/med-2025-1313
  159. 10.1515/med-2025-1316
  160. Health education pathway for individuals with temporary enterostomies using patient journey mapping
  161. 10.1515/med-2025-1321
  162. 10.1515/med-2025-1324
  163. 10.1515/med-2025-1325
  164. 10.1515/med-2025-1327
  165. 10.1515/med-2025-1331
  166. Effect of timing of cholecystectomy on weight loss after sleeve gastrectomy in morbidly obese individuals with cholelithiasis: a retrospective cohort study
  167. 10.1515/med-2025-1337
  168. 10.1515/med-2025-1347
  169. 10.1515/med-2025-1360
  170. Multiple sclerosis and type 1 diabetes: a Mendelian randomization study of European ancestry
  171. Rapid pathogen identification in peritoneal dialysis effluent by MALDI-TOF MS following blood culture enrichment
  172. Comparison of open and percutaneous A1 pulley release in pediatric trigger thumb: a retrospective cohort study
  173. Impact of combined diaphragm-lung ultrasound assessment on postoperative respiratory function in patients under general anesthesia recovery
  174. Review Articles
  175. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  176. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  177. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  178. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  179. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  180. 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
  181. The application of augmented reality in robotic general surgery: A mini-review
  182. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  183. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  184. Plant polyphenols, terpenes, and terpenoids in oral health
  185. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  186. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  187. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  188. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  189. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  190. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  191. Giant borderline ovarian tumours – review of the literature
  192. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  193. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  194. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  195. Supplement strategies for infertility in overweight women: Evidence and legal insights
  196. Scurvy, a not obsolete disorder: Clinical report in eight young children and literature review
  197. A meta-analysis of the effects of DBS on cognitive function in patients with advanced PD
  198. Protective role of selenium in sepsis: Mechanisms and potential therapeutic strategies
  199. Strategies for hyperkalemia management in dialysis patients: A systematic review
  200. C-reactive protein-to-albumin ratio in peripheral artery disease
  201. 10.1515/med-2025-1251
  202. 10.1515/med-2025-1330
  203. 10.1515/med-2025-1332
  204. Antibiotic prescribing patterns in general dental practice- a scoping review
  205. Clinical and medico-legal reflections on non-invasive prenatal testing
  206. Case Reports
  207. Delayed graft function after renal transplantation
  208. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  209. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  210. Giant right atrial hemangioma presenting with ascites: A case report
  211. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  212. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  213. Molecular hydrogen-rhodiola as an adjuvant therapy for ischemic stroke in internal carotid artery occlusion: A case report
  214. Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
  215. Combined VAT and retroperitoneoscopy for pleural empyema due to nephro-pleuric fistula in xanthogranulomatous pyelonephritis
  216. 10.1515/med-2025-1362
  217. Rapid Communication
  218. Biological properties of valve materials using RGD and EC
  219. A single oral administration of flavanols enhances short-term memory in mice along with increased brain-derived neurotrophic factor
  220. Letter to the Editor
  221. Role of enhanced external counterpulsation in long COVID
  222. Expression of Concern
  223. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  224. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  225. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  226. Corrigendum
  227. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  228. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  229. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  230. Retraction
  231. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  232. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  233. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
  234. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  235. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  236. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  237. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  238. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  239. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  240. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  241. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  242. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  243. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  244. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  245. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  246. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  247. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  248. Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
  249. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  250. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  251. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  252. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  253. A review of brain research on T2DM-related cognitive dysfunction
  254. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  255. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
  256. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
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Heruntergeladen am 20.12.2025 von https://www.degruyterbrill.com/document/doi/10.1515/med-2025-1309/html
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