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Clinical characteristics of current COVID-19 rehabilitation outpatients in China

  • Bingxu Chen EMAIL logo , Jie Shi , Jie Chen and Yuangang Qiu
Published/Copyright: August 30, 2023

Abstract

To understand the clinical characteristics of omicron in COVID-19 Rehabilitation Clinic after the current shift of dynamic zeroing policy, we consecutively collected the patients’ data who visited in COVID-19 Rehabilitation Clinic of a Grade-A tertiary hospital in Hangzhou, Zhejiang Province, from January 3 to January 10, 2023, analyzed related data and then compared the pneumonia between elderly and non-elderly groups. The results showed that 95.68% of the patients in COVID-19 Rehabilitation Clinic had symptoms, 70.10% had a dry cough, 12.36% had abnormal complete blood count or C-reactive protein, 19.35% had electrolyte disorder, and 2% had abnormal troponin or creatine kinase-MB. 40.45% of patients had abnormal lung CT findings, among them 86.49% of elderly patients had abnormal lung CT findings, and the utilization rate of glucocorticoids in COVID-19 Rehabilitation Clinic was only 5.98%, although people are all susceptible to getting the COVID-19 infection, the elderly are more prone to getting pneumonia, and the glucocorticoids utilization rate is relatively insufficient. It is needed to be stressed that Chinese medical staff should pay more attention to the elderly patients who are vulnerable to getting pneumonia during this period.

1 Introduction

COVID-19 is a worldwide epidemic, currently in the omicron variant. For Western countries, the virulence and pathogenicity of omicron are greatly reduced. At present, many countries have adopted mRNA vaccination, which has mostly achieved the effect of herd immunity.

Since 2019, China has adopted the policy of dynamic-zeroing policy against COVID-19 virus strains (alpha, beta, and delta) and achieved effective clinical results. Nevertheless, since the spread of the omicron variant from South Africa, most countries in the world have gradually adopted herd immunity measures against the more transmissible (R0 = 18), less virulent virus [1]. In a recent view of the characteristics of Omicron, the Chinese government ended the dynamic-zeroing policy since December 8, 2022, and shifted to the policy of rapid peak crossing and herd immunity. By mid-January, more than 80% of the public in some parts of China had been infected with Omicron [2] or were being infected with Omicron.

Scientists have reported that omicron also has the ability to cause syncytia formation, which is often seen in the lungs of patients dying of COVID-19 [3]. Vogel et al. found that omicron tends to evade the bronchi tissue compared to the delta variant, but it also causes the lung tissue damage [4]. Although it is unclear about elderly patients with omicron infection in China, we thought that the elderly are more susceptible to the infection and might need more attention during this period. For patients with pneumonia, some scholars advised to use short-term corticosteroid to prevent the interstitial lung disease [5]. However, the impact of omicron on Chinese people and the cognition and treatment of Omicron in Chinese medical staff on the disease is still unclear. Therefore, this study was based on real-world data review and analysis of patients who visited the COVID-19 Rehabilitation Clinic to provide related data for future treatment.

2 Methods

2.1 Study patients and location

From January 3 to January 10, 2023, patients who visited COVID-19 virus rehabilitation at Zhejiang Hospital of Traditional Chinese Medicine (TCM) clinic for the treatment of COVID-19 infection were consecutively enrolled in this study. This study location is mainly at Zhejiang Hospital of TCM which has combined TCM and modern medicine and has acquired solid trust from the surrounding neighborhood. Exclusion criteria included patients who disagreed with the study, patients who cannot apprehend the consent form, and patients with cognition problems.

2.2 Study design and procedures

All patients received COVID-19 Rehabilitation Clinic doctors’ diagnosis and treatment without any intervention by the investigators. After the treatment, we would get consent from patients and record their diagnosis and treatment plan from the outpatient clinical computer system. And then we check the basic information including sex, age, and medical history, collect the CT scan, blood test, lab results, and related treatment plan, and put clinical data into the relevant database.

2.3 Statistical analysis

Statistics were performed using the SPSS 1200 for Windows software (SPSS Institute, Chicago, IL, USA). Qualitative data with normal distribution were presented as mean ± standard deviation and compared using the Student’s t-test. Skewed data were presented as median (min–max) and compared using the Mann–Whitney U test. Quantitative data were presented as frequencies and compared by the χ 2 or Fisher’s exact test. A P-value of <0.05 was considered statistically significant.

A total of 602 patients from January 3 to January 10, 2023, in the COVID-19na-virus Rehabilitation Clinic of a Grade-A tertiary hospital in Hangzhou, Zhejiang Province, was investigated. The basic information, chief complaint, course of disease, past medical history, test results, and related treatment were retrospectively recorded and analyzed. SPSS 20 was used for statistical analysis.

  1. Informed consent: Informed consent has been obtained from all individuals included in this study.

3 Results

There were 602 patients in total, including 220 males and 382 females, with an average age of 43.8 ± 16.6, 508 young and middle-aged patients (84.39%), and 94 elderly patients (15.61%). The average course of disease was 9.71 ± 5.88 days. Among them, 26 were asymptomatic (4.32%), 5 had night sweats (0.83%), 4 had nausea and vomiting (0.66%), 1 had tinnitus (0.16%), 25 had fatigue (4.15%), 25 had fever (4.15%), 6 had diarrhea (0.99%), 422 had a cough (70.10%), 6 had phlegm ( 0.99%), 3 patients had phlegm mixed with phlegm (0.5%), 7 patients had muscle pain (11.63%), 2 patients had bitterness in mouth (0.33%), 10 patients had dizziness (16.61%), 12 patients had palpitation (1.99%), 53 patients had chest tightness (8.80%), 13 patients had chest pain (2.16%), 3 patients had anosmia (0.5%), 3 patients had throat discomfort (0.5%), and 1 patient had syncope (0.16%). See Table 1 for details.

Table 1

Distribution of chief complaints of COVID-19 rehabilitation outpatients

Chief complaints Total (n) %
Tinnitus 1 0.17
Syncope 1 0.17
Bitter taste in mouth 2 0.33
Hemoptysis 3 0.5
Anosmia 3 0.5
Sore throat 3 0.5
Nausea and vomiting 4 0.66
Night sweat 5 0.83
Diarrhea 6 0.99
Expectoration 6 0.99
Muscle soreness 7 1.16
Dizzy 10 1.66
palpitation 12 1.99
Chest pain 13 2.16
Weakness 25 4.15
Asymptomatic 26 4.32
Chest tightness 53 8.80
Dry cough 422 70.10

Twenty-three patients (3.82%) had other diseases, 10 patients (1.67%) had hypertension, 2 patients (0.33%) had diabetes, 1 (0.16%) had anemia, 1 (0.16%) had coronary heart disease, 1 (0.16%) had Chronic obstructive pulmonary disease (COPD), 2 patients (0.33%) had osteoporosis, 1 (0.16%) had stroke history, and 1 (0.16%) had asthma. Two patients (0.33%) had well-controlled tumor history and 1 (0.16%) had chronic kidney disease (CKD). See Table 2 for details.

Table 2

Distribution of basic diseases of patients in COVID-19 rehabilitation clinic

Past history Total (n) %
Anemia 1 0.16
Coronary artery disease 1 0.16
COPD 1 0.16
Stoke 1 0.16
Asthma 1 0.16
CKD 1 0.16
Diabetes 2 0.33
Osteoporosis 2 0.33
Tumor 2 0.33
Hypertension 10 1.67

A total of 178 patients took the complete blood cell count (CBC), 16 (8.99%) had abnormal leukocyte, 14 (7.87%) had abnormal neutrophils, 20 (11.24%) had abnormal lymphocytes, 13 (7.3%) had abnormal hemoglobin, and 20 (11.24%) had abnormal platelets. Twenty-two patients (12.36%) had abnormal C-reactive protein (CRP), 31 patients take electrolyte analysis examination, including 1 patient with high potassium (3.23%), 1 patient with low potassium (3.23%), 6 patients with low sodium (19.35%), 1 patient with high sodium (3.23%), 1 patient with high chlorine (3.23%), 1 patient with low chlorine (3.23%), and 1 patient with low calcium (3.23%). One hundred patients took the creatine kinase-MB (CK-MB) and troponin (TNI), 2 patients (2%) had abnormal TNI and 1 patient (1%) had abnormal CK-MB. See Table 3 for details.

Table 3

laboratory test of COVID-19 rehabilitation outpatients

Total (n) %
Complete blood cell test 178 29.57
16 8.99
Increase in neutrophil proportion 14 7.87
Decrease in lymphocytes 20 11.24
Decrease in hemoglobins 13 7.3
Increase in platelets 20 11.24
Increase in CRP 22 12.36
Electrolytes test 31 5.15
Hyperkalemia 1 3.23
Hypopotassium 1 3.23
Hypernatremia 1 3.23
Hyponatremia 6 19.35
Hyperchlorine 1 3.23
Hypochlorine 1 3.23
Hypocalcemia 1 3.23
Myocardial enzymes 100 16.61
Increase in TNI 2 0.02
Increase in CK-M 1 0.01

A total of 440 patients took lung CT examination, 36 (8.18%) asked for CT examination voluntarily. 72.05% of young- and middle-aged patients took CT examination and 78.72% of elderly patients took CT examination. 40.45% of patients were found abnormal lung CT. See Table 4 for details.

Table 4

Pulmonary computer tomography (CT) results of COVID-19 Rehabilitation Clinic

Results Non-elderly patients (366) Elderly patients (74) Chi-square P value
Normal 252 (68.85) 10 (13.51) 78.25 <0.001
Abnormal 114 (31.15) 64 (86.49)
Little (<10%) 75 (20.49) 18 (24.32)
Mild (10–30%) 24 (6.56) 28 (37.84)
Multiple (30–50%) 15 (4.10) 17 (22.97)
White lung (>50%) 0 1 (1.35)

Note: 2 groups are analyzed by Chi-square test, P < 0.05 means significant statistically.

Five (0.83%) patients were admitted to wards for further treatment, 36 (5.98%) patients were treated with glucocorticoids therapy, 23 (3.82%) patients were treated with antibiotics, and 141 (23.42%) patients were treated with TCM, See Table 5 for details.

Table 5

Treatment prescriptions for COVID-19 rehabilitation outpatients

Treatment Total (n) %
Hospitalization 5 0.83
Glucocorticoid 36 5.98
Antibiotic 23 3.82
TCM 141 23.42

4 Discussion

Di Mitri et al. [6] collected the COVID-19 patients consecutively in the out-patient clinic and found that 17% of these patients developed pneumonia, and our study found that there was a higher prevalence of patients with pneumonia who were diagnosed with COVID-19 (40.45 vs 17.0%). The underlying reason might be that during the strict quarantine policy, people work out less than before and they are in a depressed mood during the period that might inactivate their immunity potent, and the majority were not exposed to the other relevant pathogens, which led to the general susceptibility of the Chinese population. The sharp shift in policy also caused the huge pressure on medical resources, and many patients failed to seek any medical treatment in time. In addition, most people were injected with inactivated vaccines other than the mRNA vaccine, which has been proven less effective in the health protection.

Our results showed that the COVID-19 Rehabilitation Clinic is mainly targeted at patients who still have symptoms after self-quarantine at home, and most patients have no other chronic diseases in the past. Only 3.82% of the patients had other diseases in the past, mostly hypertension (1.67%). Patients with acute onset and severe situation are mostly hospitalized through the pre-hospital ambulance system, which is not discussed in the article.

70.10% of patients went to the COVID-19 Rehabilitation Clinic with recurrent cough, all of which were post-COVID-19 irritant dry cough. The omicron virus may cause airway hypersensitive, and thus, patients’ exposure to cold air and other stimulus cause local airway spasm, resulting in dry cough. 0.99% of patients had a cough with yellow sputum, which is considered to be related to the apoptosis of epithelial cells and immune cells after COVID-19 infection and may be partly due to the presence of bacterial co-infection. 0.50% of the patients had sputum mixed with blood. After checking patients’ relevant history, it was found that the upper respiratory tract of these patients was relatively dry due to self-isolation at home with higher temperature caused by the heating system, and nearly absence of air humidity. Therefore, the capillary in the upper respiratory tract burst when coughing forcefully.

8.80% of patients came to see the doctor because of chest tightness, which may be related to the impaired ventilation diffusion function caused by pneumonia. 2.16% of patients visited the clinic for recurrent chest pain. Some might be linked with the pleura inflammation. 2% of patients who took the cardiac enzyme test are abnormal, suggesting myocardial damage, which may be related to the direct damage to the myocardium caused by vaccination or COVID-19 [7].

0.5% of patients have anosmia, which may be related to the damage of Bowman gland cells caused by the direct destruction of nerve support cells by COVID-19, mucus protection impairment in the olfactory epithelium, and energy exhaustion supporting the nerve cells [8].

0.66% of patients had nausea and vomiting, which might be related to abnormal secretion of interleukin after infection, and 0.99% of patients had diarrhea, which might be related to direct damage in the gastrointestinal tract by the novel COVID-19 or vagus nerves hyperactivity during rehabilitation [9].

11.63% of patients had musculoskeletal soreness, which may be related to disorder in immune systems, in which immune cell-mediated cytokines or relevant neural transmitters attack connective tissue causing the soreness [10].

0.83% of patients had night sweats, which may be related to vagus nerves hyperactivity during rehabilitation. 4.15% of patients presented with consistent fatigue which may be related to the slow recovery of the body and deficiency in the nutrition provision. 16.61% of patients had dizziness, and no obvious abnormalities were found in head CT which may be related to vestibular neuritis caused by the possible infection of the COVID-19. 0.16% of patients had tinnitus, which may also be related to the vestibular neuritis. 0.16% of patients had syncope during COVID-19 recovery, which may be related to hypoglycemic episodes caused by poor appetite, and further follow-up examination is needed for the patient. 29.57% of patients underwent CBC test, 8.99% of the patients had abnormal white blood cells, 7.87% had abnormal neutrophil proportion, 11.24% had abnormal lymphocyte proportion, 7.3% had abnormal hemoglobin, 11.24% had abnormal platelet proportion, 12.36% had abnormal CRP, and abnormal white blood cells in these patients were all mildly elevated with less than 15 × 109/L, accompanied by an increase in the proportion of neutrophils, a decrease in the proportion of lymphocytes, and an increase in CRP, which indirectly indicated the infection of the COVID-19 virus. 11.24% of patients had abnormal platelet elevation, which may be related to the stimulation of platelet production by inflammatory factors after infection with COVID-19, or the hypercoagulable state in the menstrual period of female patients. Mild anemia occurred in 7.3% of patients, which may be related to underlying diseases, poor intestinal absorption, or insufficient iron intake.

5.15% of the patients underwent electrolyte examination, among whom 3.23% had hyper-potassium, which was related to chronic renal insufficiency, and 3.23% had hypo-potassium, which might be related to long-term use of thiazide drugs. 19.35% of the patients with lots of water intake and light diets in the course of rehabilitation had mild hypo-natremia, partially due to the acceptation of twisted information from public media. 3.23% of patients had low calcium, which was related to their past medical history and lack of outdoor exercise.

73.09% of patients underwent lung CT examination, and 43.18% of patients had pneumonia according to the CT results. Among them, the pneumonia proportion in young- and middle-aged patients was 31.15%, while the pneumonia proportion in elderly patients without underlying diseases was as high as 86.49%, not to mention 1.35% white-out lungs among them. Although the omicron has a less toxicity compared to the alpha/delta, such a high proportion of pneumonia and severe disease indirectly reflects that Omicron’s disease progression in China is much different from that in other countries. On the one hand, it may be because only the symptomatic patients seek out for outpatient treatment, leading to the existence of bias. On the other hand, it is also indirectly suggested that although the toxicity of omicron has waned in comparison with the beginning, it is far from insignificant in the Chinese population. First, some elderly people have not been regularly vaccinated with domestic inactivated vaccines; second, compared with foreign countries, RNA vaccines that have more efficacy to prevent COVID-19 have not been widely applied in the Chinese people; moreover, the preceding dynamic zero elimination policy has resulted in the most Chinese people not being exposed to COVID-19. As a result, Chinese people are generally susceptible to COVID-19. Moreover, the abrupt turn of the policy caused a chaotic situation among Chinese people, for instance, some people cannot obtain any medical resources, and most of them fail to get any antipyretic, decongestants, expectorants, antihistamines, and antitussive and apophlegmatisant drugs at the beginning and some patients with high fever relieve their symptoms just by physical cooling or using primitive non-scientific methods, resulting in dehydration, internal environment disorders, or even ending up into liver or kidney dysfunction, which greatly increased the disease progression and the medical staff burdens. This is the current situation in China’s well-developed city, and the situation in under-developed rural hinterland may be even worse than that. For such reasons, medical staff in those areas require to be more vigilant in the coming months.

In terms of treatment, 0.83% of patients were assessed by clinicians and admitted for further treatment. Although the guidelines recommend that the COVID-19 pneumonia requires glucocorticoids and antiviral drug treatment rather than antibiotic treatment [11,12], merely 5.98% of patients received glucocorticoid therapy and up to 3.82% received antibiotics; the reason for this is that due to the serious reduction of medical staff in the respiratory department and the shortage of health carers, the COVID-19 Rehabilitation Clinic physicians are mostly made up of various auxiliary departments as a last resort, who are from cardiology, acupuncture, rehabilitation, ophthalmology, orthopedic, and other departments. Some doctors failed to grasp the relevant guidelines and recommendations in time. Additionally, they lack experience in the application of glucocorticoids leading to the relevant deficit of treatment. Since there is no antiviral drug in this outpatient department, and most patients have a longer course than 7 days, the outpatient department patients cannot receive any antiviral treatment.

About 23.42% of the patients were treated with the Chinese medicine prescription. The dialectical interpretation of the new coronavirus in TCM is Qi and Yin deficiency, spleen deficiency and loss of transport, and residual illness. Therefore, we have two Chinese prescriptions for two types of COVID-19 patients. One is the COVID-19 treatment formula, which contains forsythia, honeylonea, bitter platycodon, mint, bamboo leaves, Schizonepeta, stir-fried beef nuts, ephedra, bitter almonds, licorice, gypsum, sand ginseng, raw jade bamboo, mulberry leaves, etc., which is used for fever and other related symptoms. Another Chinese medicine treatment formula is for patients who have had COVID-19 infection but still remain some symptoms like cough, sneeze and fatigue. For some patients have generally accepted the Chinese traditional medicine, and this hospital also is a TCM research hospital, so the application rate of Chinese traditional medicine was relatively high. Besides, all patients were treated with anti-symptomatic therapy.

However, the efficacy has not been confirmed, and further follow-up observation is required. Based on the results above, we suggest that medical staff should be more vigilant, and patients with persistent COVID-19 symptoms should be given a CT examination and other tests to exclude related diseases. Also, the understanding of the treatment of COVID-19 should be strengthened and the treatment of COVID-19 should be standardized in medical staff, and physicians should diagnose these patients as soon as possible and prescribe antiviral drugs in time.

For patients with pneumonia, physicians should use hormones in short terms to avoid fibrosis of lung tissue and try not to use antibiotics for COVID-19 patients without bacterial infection. Finally, we suggested that the government should adopt mRNA vaccine to protect the high-risk group in China.

First of all, this article only selected patients from a Grade-A tertiary hospital in a coastal city in eastern China, without fully representation for other areas. Second, due to the special feature of the COVID-19 Rehabilitation Clinic, the clinic generally does not accept patients in emergency or severe situations, so it is impossible to actually estimate the serious patients’ proportion and mortality caused by Omicron infection. Furthermore, we did not follow up on out-patient patients at present, so we cannot predict the short- and long-term omicron outcomes for these patients.


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Acknowledgments

We would like to express deep appreciation for healthcare workers in the field of COVID-19 and wish all people be safe. We wish that proper control of the pandemic will be available through various approaches.

  1. Funding information: This article has no relative funding support.

  2. Author contributions: Bingxu Chen collected the clinic data during this time and finished the important part of the article, Jie Shi analyzed the data and collected relevant references, and Jie Chen and Yuangang Qiu formulated the design of this study.

  3. Conflict of interest: The author declares no financial or scientific conflicts of interest.

  4. Data availability statement: The data are available from the corresponding author on reasonable request.

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Received: 2023-03-01
Revised: 2023-07-18
Accepted: 2023-07-25
Published Online: 2023-08-30

© 2023 the author(s), published by De Gruyter

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

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  68. Long noncoding RNA Mhrt alleviates angiotensin II-induced cardiac hypertrophy phenotypes by mediating the miR-765/Wnt family member 7B pathway
  69. Effect of miR-499-5p/SOX6 axis on atrial fibrosis in rats with atrial fibrillation
  70. Cholesterol induces inflammation and reduces glucose utilization
  71. circ_0004904 regulates the trophoblast cell in preeclampsia via miR-19b-3p/ARRDC3 axis
  72. NECAB3 promotes the migration and invasion of liver cancer cells through HIF-1α/RIT1 signaling pathway
  73. The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk
  74. miR-2053 inhibits the growth of ovarian cancer cells by downregulating SOX4
  75. Nucleophosmin 1 associating with engulfment and cell motility protein 1 regulates hepatocellular carcinoma cell chemotaxis and metastasis
  76. α-Hederin regulates macrophage polarization to relieve sepsis-induced lung and liver injuries in mice
  77. Changes of microbiota level in urinary tract infections: A meta-analysis
  78. Identification of key enzalutamide-resistance-related genes in castration-resistant prostate cancer and verification of RAD51 functions
  79. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies – (lessons learned from) a prospective study
  80. Outcomes of low-risk birth care during the Covid-19 pandemic: A cohort study from a tertiary care center in Lithuania
  81. Vitamin D protects intestines from liver cirrhosis-induced inflammation and oxidative stress by inhibiting the TLR4/MyD88/NF-κB signaling pathway
  82. Integrated transcriptome analysis identifies APPL1/RPS6KB2/GALK1 as immune-related metastasis factors in breast cancer
  83. Genomic analysis of immunogenic cell death-related subtypes for predicting prognosis and immunotherapy outcomes in glioblastoma multiforme
  84. Circular RNA Circ_0038467 promotes the maturation of miRNA-203 to increase lipopolysaccharide-induced apoptosis of chondrocytes
  85. An economic evaluation of fine-needle cytology as the primary diagnostic tool in the diagnosis of lymphadenopathy
  86. Midazolam impedes lung carcinoma cell proliferation and migration via EGFR/MEK/ERK signaling pathway
  87. Network pharmacology combined with molecular docking and experimental validation to reveal the pharmacological mechanism of naringin against renal fibrosis
  88. PTPN12 down-regulated by miR-146b-3p gene affects the malignant progression of laryngeal squamous cell carcinoma
  89. miR-141-3p accelerates ovarian cancer progression and promotes M2-like macrophage polarization by targeting the Keap1-Nrf2 pathway
  90. lncRNA OIP5-AS1 attenuates the osteoarthritis progression in IL-1β-stimulated chondrocytes
  91. Overexpression of LINC00607 inhibits cell growth and aggressiveness by regulating the miR-1289/EFNA5 axis in non-small-cell lung cancer
  92. Subjective well-being in informal caregivers during the COVID-19 pandemic
  93. Nrf2 protects against myocardial ischemia-reperfusion injury in diabetic rats by inhibiting Drp1-mediated mitochondrial fission
  94. Unfolded protein response inhibits KAT2B/MLKL-mediated necroptosis of hepatocytes by promoting BMI1 level to ubiquitinate KAT2B
  95. Bladder cancer screening: The new selection and prediction model
  96. circNFATC3 facilitated the progression of oral squamous cell carcinoma via the miR-520h/LDHA axis
  97. Prone position effect in intensive care patients with SARS-COV-2 pneumonia
  98. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children
  99. Dihydroartemisinin ameliorates cerebral I/R injury in rats via regulating VWF and autophagy-mediated SIRT1/FOXO1 pathway
  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
  101. Low Ang-(1–7) and high des-Arg9 bradykinin serum levels are correlated with cardiovascular risk factors in patients with COVID-19
  102. Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study
  103. Potential protective effects of Huanglian Jiedu Decoction against COVID-19-associated acute kidney injury: A network-based pharmacological and molecular docking study
  104. Clinical significance of serum MBD3 detection in girls with central precocious puberty
  105. Clinical features of varicella-zoster virus caused neurological diseases detected by metagenomic next-generation sequencing
  106. Collagen treatment of complex anorectal fistula: 3 years follow-up
  107. LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through down-regulating SP-A by sponging to miR-424
  108. Efficacy analysis of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy as a first-line Helicobacter pylori eradication regimen – An open-label, randomized trial
  109. SMOC2 plays a role in heart failure via regulating TGF-β1/Smad3 pathway-mediated autophagy
  110. A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults
  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
  112. hsa_circ_0000285 sponging miR-582-3p promotes neuroblastoma progression by regulating the Wnt/β-catenin signaling pathway
  113. Long non-coding RNA GNAS-AS1 knockdown inhibits proliferation and epithelial–mesenchymal transition of lung adenocarcinoma cells via the microRNA-433-3p/Rab3A axis
  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
  115. Twenty-four-color full spectrum flow cytometry panel for minimal residual disease detection in acute myeloid leukemia
  116. Hsa-miR-223-3p participates in the process of anthracycline-induced cardiomyocyte damage by regulating NFIA gene
  117. Anti-inflammatory effect of ApoE23 on Salmonella typhimurium-induced sepsis in mice
  118. Analysis of somatic mutations and key driving factors of cervical cancer progression
  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
  121. Effects of pharmacological delay with roxadustat on multi-territory perforator flap survival in rats
  122. Analysis of heroin effects on calcium channels in rat cardiomyocytes based on transcriptomics and metabolomics
  123. Risk factors of recurrent bacterial vaginosis among women of reproductive age: A cross-sectional study
  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
  126. Correlation between microvessel maturity and ISUP grades assessed using contrast-enhanced transrectal ultrasonography in prostate cancer
  127. The protective effect of caffeic acid phenethyl ester in the nephrotoxicity induced by α-cypermethrin
  128. Norepinephrine alleviates cyclosporin A-induced nephrotoxicity by enhancing the expression of SFRP1
  129. Effect of RUNX1/FOXP3 axis on apoptosis of T and B lymphocytes and immunosuppression in sepsis
  130. The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity
  131. Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU
  132. Calycosin protects against chronic prostatitis in rats via inhibition of the p38MAPK/NF-κB pathway
  133. Pan-cancer analysis of the PDE4DIP gene with potential prognostic and immunotherapeutic values in multiple cancers including acute myeloid leukemia
  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
  136. Clinical characteristics of current COVID-19 rehabilitation outpatients in China
  137. Luteolin alleviates ulcerative colitis in rats via regulating immune response, oxidative stress, and metabolic profiling
  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
  139. The application of iliac fascia space block combined with esketamine intravenous general anesthesia in PFNA surgery of the elderly: A prospective, single-center, controlled trial
  140. Elevated blood acetoacetate levels reduce major adverse cardiac and cerebrovascular events risk in acute myocardial infarction
  141. The effects of progesterone on the healing of obstetric anal sphincter damage in female rats
  142. Identification of cuproptosis-related genes for predicting the development of prostate cancer
  143. Lumican silencing ameliorates β-glycerophosphate-mediated vascular smooth muscle cell calcification by attenuating the inhibition of APOB on KIF2C activity
  144. Targeting PTBP1 blocks glutamine metabolism to improve the cisplatin sensitivity of hepatocarcinoma cells through modulating the mRNA stability of glutaminase
  145. A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry
  146. Clinical analysis of AN69ST membrane continuous venous hemofiltration in the treatment of severe sepsis
  147. Antibiotics therapy combined with probiotics administered intravaginally for the treatment of bacterial vaginosis: A systematic review and meta-analysis
  148. Construction of a ceRNA network to reveal a vascular invasion associated prognostic model in hepatocellular carcinoma
  149. A pan-cancer analysis of STAT3 expression and genetic alterations in human tumors
  150. A prognostic signature based on seven T-cell-related cell clustering genes in bladder urothelial carcinoma
  151. Pepsin concentration in oral lavage fluid of rabbit reflux model constructed by dilating the lower esophageal sphincter
  152. The antihypertensive felodipine shows synergistic activity with immune checkpoint blockade and inhibits tumor growth via NFAT1 in LUSC
  153. Tanshinone IIA attenuates valvular interstitial cells’ calcification induced by oxidized low density lipoprotein via reducing endoplasmic reticulum stress
  154. AS-IV enhances the antitumor effects of propofol in NSCLC cells by inhibiting autophagy
  155. Establishment of two oxaliplatin-resistant gallbladder cancer cell lines and comprehensive analysis of dysregulated genes
  156. Trial protocol: Feasibility of neuromodulation with connectivity-guided intermittent theta-burst stimulation for improving cognition in multiple sclerosis
  157. LncRNA LINC00592 mediates the promoter methylation of WIF1 to promote the development of bladder cancer
  158. Factors associated with gastrointestinal dysmotility in critically ill patients
  159. Mechanisms by which spinal cord stimulation intervenes in atrial fibrillation: The involvement of the endothelin-1 and nerve growth factor/p75NTR pathways
  160. Analysis of two-gene signatures and related drugs in small-cell lung cancer by bioinformatics
  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
  169. Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia
  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
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