268
Views
2
CrossRef citations to date
0
Altmetric
ORIGINAL RESEARCH

Identification of Immuno-Inflammation-Related Biomarkers for Acute Myocardial Infarction Based on Bioinformatics

ORCID Icon & ORCID Icon
Pages 3283-3302 | Received 13 May 2023, Accepted 01 Aug 2023, Published online: 07 Aug 2023

References

  • Anderson HVS, Masri SC, Abdallah MS, et al. 2022 ACC/AHA key data elements and definitions for chest pain and acute myocardial infarction: a report of the American Heart Association/American College of Cardiology Joint Committee on clinical data standards. J Am Coll Cardiol. 2022;80(17):1660–1700. doi:10.1016/j.jacc.2022.05.012
  • Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation. 2023;147(8):e93–e621. doi:10.1161/CIR.0000000000001123
  • Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289–1367. doi:10.1093/eurheartj/ehaa575
  • Alfonso F, Gonzalo N, Rivero F, Escaned J. The year in cardiovascular medicine 2020: interventional cardiology. Eur Heart J. 2021;42(10):985–1003. doi:10.1093/eurheartj/ehaa1096
  • Guo J, Liu HB, Sun C, et al. MicroRNA-155 promotes myocardial infarction-induced apoptosis by targeting RNA-binding protein QKI. Oxid Med Cell Longev. 2019;2019:4579806. doi:10.1155/2019/4579806
  • Torp MK, Vaage J, Stensløkken KO. Mitochondria-derived damage-associated molecular patterns and inflammation in the ischemic-reperfused heart. Acta Physiol. 2023;237(3):e13920. doi:10.1111/apha.13920
  • Henein MY, Vancheri S, Longo G, Vancheri F. The role of inflammation in cardiovascular disease. Int J Mol Sci. 2022;23(21):12906. doi:10.3390/ijms232112906
  • Andreadou I, Cabrera-Fuentes HA, Devaux Y, et al. Immune cells as targets for cardioprotection: new players and novel therapeutic opportunities. Cardiovasc Res. 2019;115(7):1117–1130. doi:10.1093/cvr/cvz050
  • Wang Q, Liu B, Wang Y, Bai B, Yu T, Chu XM. The biomarkers of key miRNAs and target genes associated with acute myocardial infarction. PeerJ. 2020;8:e9129. doi:10.7717/peerj.9129
  • Zhang N, Zhou B, Tu S. Identification of an 11 immune-related gene signature as the novel biomarker for acute myocardial infarction diagnosis. Genes Immun. 2022;23(7):209–217. doi:10.1038/s41435-022-00183-7
  • Li H, Sun X, Li Z, Zhao R, Li M, Hu T. Machine learning-based integration develops biomarkers initial the crosstalk between inflammation and immune in acute myocardial infarction patients. Front Cardiovasc Med. 2023;9:1059543. doi:10.3389/fcvm.2022.1059543
  • Nie H, Yan C, Zhou W, Li TS. Analysis of immune and inflammation characteristics of atherosclerosis from different sample sources. Oxid Med Cell Longev. 2022;2022:5491038. doi:10.1155/2022/5491038
  • Xing M, Li J. A new inflammation-related risk model for predicting hepatocellular carcinoma prognosis. Biomed Res Int. 2022;2022:5396128. doi:10.1155/2022/5396128
  • Huang Y, Yang DD, Li XY, Fang DL, Zhou WJ. ZBP1 is a significant pyroptosis regulator for systemic lupus erythematosus. Ann Transl Med. 2021;9(24):1773. doi:10.21037/atm-21-6193
  • Ritchie ME, Phipson B, Wu D, et al. limma powers differential expression analyses for RNA-sequencing and microarray studies. Nucleic Acids Res. 2015;43(7):e47. doi:10.1093/nar/gkv007
  • Ito K, Murphy D. Application of ggplot2 to pharmacometric graphics. CPT Pharmacometrics Syst Pharmacol. 2013;2(10):e79. doi:10.1038/psp.2013.56
  • Yu G, Wang LG, Han Y, He QY. clusterProfiler: an R package for comparing biological themes among gene clusters. Omics. 2012;16(5):284–287. doi:10.1089/omi.2011.0118
  • Tan R, Zhang G, Liu R, et al. Identification of early diagnostic and prognostic biomarkers via WGCNA in stomach adenocarcinoma. Front Oncol. 2021;11:636461. doi:10.3389/fonc.2021.636461
  • Schriml LM, Arze C, Nadendla S, et al. Disease ontology: a backbone for disease semantic integration. Nucleic Acids Res. 2012;40:D940–6. doi:10.1093/nar/gkr972
  • Friedman J, Hastie T, Tibshirani R. Regularization paths for generalized linear models via coordinate descent. J Stat Softw. 2010;33(1):1–22. doi:10.18637/jss.v033.i01
  • Yang L, Pan X, Zhang Y, et al. Bioinformatics analysis to screen for genes related to myocardial infarction. Front Genet. 2022;13:990888. doi:10.3389/fgene.2022.990888
  • Guerriero S, Pascual M, Ajossa S, et al. Artificial intelligence (AI) in the detection of rectosigmoid deep endometriosis. Eur J Obstet Gynecol Reprod Biol. 2021;261:29–33. doi:10.1016/j.ejogrb.2021.04.012
  • Robin X, Turck N, Hainard A, et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinform. 2011;12:77. doi:10.1186/1471-2105-12-77
  • Dexter F. Wilcoxon-Mann-Whitney test used for data that are not normally distributed. Anesth Analg. 2013;117(3):537–538. doi:10.1213/ANE.0b013e31829ed28f
  • Abdelhafez OH, Othman EM, Fahim JR, et al. Metabolomics analysis and biological investigation of three Malvaceae plants. Phytochem Anal. 2020;31(2):204–214. doi:10.1002/pca.2883
  • He H, Zhang P, Li F, Zeng C, Liu D, Wu K. Predicting the prognosis of esophageal cancer based on extensive analysis of new inflammatory response-related signature. J Biochem Mol Toxicol. 2023;37(4):e23291. doi:10.1002/jbt.23291
  • Pan X, Jin X, Wang J, Hu Q, Dai B. Placenta inflammation is closely associated with gestational diabetes mellitus. Am J Transl Res. 2021;13(5):4068–4079.
  • Shao Z, Wang K, Zhang S, et al. Ingenuity pathway analysis of differentially expressed genes involved in signaling pathways and molecular networks in RhoE gene‑edited cardiomyocytes. Int J Mol Med. 2020;46(3):1225–1238. doi:10.3892/ijmm.2020.4661
  • Chen B, Khodadoust MS, Liu CL, Newman AM, Alizadeh AA. Profiling Tumor Infiltrating Immune Cells with CIBERSORT. Methods Mol Biol. 2018;1711:243–259.
  • Pripp AH. Pearsons eller Spearmans korrelasjonskoeffisienter [Pearson’s or Spearman’s correlation coefficients]. Tidsskr nor Laegeforen. 2018;138(8):1. Danish.
  • Li GM, Zhang CL, Rui RP, Sun B, Guo W. Bioinformatics analysis of common differential genes of coronary artery disease and ischemic cardiomyopathy. Eur Rev Med Pharmacol Sci. 2018;22(11):3553–3569. doi:10.26355/eurrev_201806_15182
  • Shannon P, Markiel A, Ozier O, et al. Cytoscape: a software environment for integrated models of biomolecular interaction networks. Genome Res. 2003;13(11):2498–2504. doi:10.1101/gr.1239303
  • Livak KJ, Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2(-Delta Delta C(T)) Method. Methods. 2001;25(4):402–408. doi:10.1006/meth.2001.1262
  • Zheng PF, Zou QC, Chen LZ, Liu P, Liu ZY, Pan HW. Identifying patterns of immune related cells and genes in the peripheral blood of acute myocardial infarction patients using a small cohort. J Transl Med. 2022;20(1):321. doi:10.1186/s12967-022-03517-1
  • Bejjani AT, Saab SA, Muhieddine DH, Habeichi NJ, Booz GW, Zouein FA. Spatiotemporal dynamics of immune cells in early left ventricular remodeling after acute myocardial infarction in mice. J Cardiovasc Pharmacol. 2020;75(2):112–122. doi:10.1097/FJC.0000000000000777
  • Weil BR, Neelamegham S. Selectins and immune cells in acute myocardial infarction and post-infarction ventricular remodeling: pathophysiology and novel treatments. Front Immunol. 2019;10:300. doi:10.3389/fimmu.2019.00300
  • He W, Chen P, Chen Q, Cai Z, Zhang P. Cytokine storm: behind the scenes of the collateral circulation after acute myocardial infarction. Inflamm Res. 2022;71(10–11):1143–1158. doi:10.1007/s00011-022-01611-0
  • Acosta-Martinez M, Cabail MZ. The PI3K/Akt pathway in meta-inflammation. Int J Mol Sci. 2022;23(23):15330. doi:10.3390/ijms232315330
  • Liang J, Luo Q, Shen N, et al. PEDF protects endothelial barrier integrity during acute myocardial infarction via 67LR. Int J Mol Sci. 2023;24(3):2787. doi:10.3390/ijms24032787
  • Liberale L, Puspitasari YM, Ministrini S, et al. JCAD promotes arterial thrombosis through PI3K/Akt modulation: a translational study. Eur Heart J. 2022;43:1849–1860. doi:10.1093/eurheartj/ehac143
  • Yao E, Luo L, Lin C, et al. OEA alleviates apoptosis in diabetic rats with myocardial ischemia/reperfusion injury by regulating the PI3K/Akt signaling pathway through activation of TRPV1. Front Pharmacol. 2022;13:964475. doi:10.3389/fphar.2022.964475
  • Ferreira LGR, Figueiredo RC, Das Graças Carvalho M, Rios DRA. Thrombin generation assay as a biomarker of cardiovascular outcomes and mortality: a narrative review. Thromb Res. 2022;220:107–115. doi:10.1016/j.thromres.2022.10.007
  • Sharma C, Osmolovskiy A, Singh R. Microbial fibrinolytic enzymes as anti-thrombotics: production, characterisation and prodigious biopharmaceutical applications. Pharmaceutics. 2021;13(11):1880. doi:10.3390/pharmaceutics13111880
  • El Khoury M, Karam B, Tabet R, Lafferty JC, Snyder ST. Current practice of percutaneous coronary intervention in patients with coagulation disorders. Cureus. 2021;13(9):e18284. doi:10.7759/cureus.18284
  • Feng B, Li H. Genetic polymorphism of matrix metalloproteinase-9 and susceptibility to myocardial infarction: a meta-analysis. Dis Markers. 2022;2022:5507153. doi:10.1155/2022/5507153
  • Nordeng J, Schandiz H, Solheim S, et al. TIMP-1 expression in coronary thrombi associate with myocardial injury in ST-elevation myocardial infarction patients. Coron Artery Dis. 2022;33(6):446–455. doi:10.1097/MCA.0000000000001128
  • Domínguez-Rodríguez A, Hernández-Vaquero D, Abreu-González P, et al. Early treatment of acute myocardial infarction with melatonin: effects on MMP-9 and adverse cardiac events. J Clin Med. 2022;11(7):248–252. doi:10.3390/jcm11071909
  • Brunton-O’Sullivan MM, Holley AS, Shi B, Harding SA, Larsen PD. Cluster analysis of extracellular matrix biomarkers predicts the development of impaired systolic function within 1 year of acute myocardial infarction. Heart Vessels. 2022;37(12):2029–2038. doi:10.1007/s00380-022-02118-8
  • Cheng P, Cheng L, Han H, et al. A pH/H(2) O(2) /MMP9 time-response gel system with sparc(high) tregs derived extracellular vesicles promote recovery after acute myocardial infarction. Adv Healthc Mater. 2022;11(22):e2200971. doi:10.1002/adhm.202200971
  • Mon NN, Ito S, Senga T, Hamaguchi M. FAK signaling in neoplastic disorders: a linkage between inflammation and cancer. Ann NY Acad Sci. 2006;1086:199–212. doi:10.1196/annals.1377.019
  • Ju S, Lim L, Ki YJ, Choi DH, Song H. Oxidative stress generated by polycyclic aromatic hydrocarbons from ambient particulate matter enhance vascular smooth muscle cell migration through MMP upregulation and actin reorganization. Part Fibre Toxicol. 2022;19(1):29. doi:10.1186/s12989-022-00472-z
  • Gałdyszyńska M, Radwańska P, Szymański J, Drobnik J. The stiffness of cardiac fibroblast substrates exerts a regulatory influence on collagen metabolism via α2β1 Integrin, FAK and src kinases. Cells. 2021;10(12):3506. doi:10.3390/cells10123506
  • Choi HJ, Kwon I, Kim NE, et al. Fc-saxatilin suppresses hypoxia-induced vascular leakage by regulating endothelial occludin expression. Thromb Haemost. 2017;117(3):595–605. doi:10.1160/TH16-06-0469
  • Harada T, Yoshimura K, Yamashita O, et al. Focal adhesion kinase promotes the progression of aortic aneurysm by modulating macrophage behavior. Arterioscler Thromb Vasc Biol. 2017;37(1):156–165. doi:10.1161/ATVBAHA.116.308542
  • Nimgulkar C, Ghosh S, Sankar AB, et al. Combination of spices and herbal extract restores macrophage foam cell migration and abrogates the athero-inflammatory signalling cascade of atherogenesis. Vascul Pharmacol. 2015;72:53–63. doi:10.1016/j.vph.2015.02.014
  • Coelho NM, Llopis-Hernández V, Salmerón-Sánchez M, Altankov G. Dynamic reorganization and enzymatic remodeling of type IV collagen at cell-biomaterial interface. Adv Protein Chem Struct Biol. 2016;105:81–104.
  • Zadeh FJ, Mohammadtaghizadeh M, Bahadori H, Saki N, Rezaeeyan H. The role of exogenous Fibrinogen in cardiac surgery: stop bleeding or induce cardiovascular disease. Mol Biol Rep. 2020;47(10):8189–8198. doi:10.1007/s11033-020-05880-y
  • Aydin S, Ugur K, Aydin S, Sahin İ, Yardim M. Biomarkers in acute myocardial infarction: current perspectives. Vasc Health Risk Manag. 2019;15:1–10. doi:10.2147/VHRM.S166157
  • Zielińska-Turek J, Dorobek M, Turek G, et al. MMP-9, TIMP-1 and S100B protein as markers of ischemic stroke in patients after carotid artery endarterectomy. Pol Merkur Lekarski. 2022;50(297):177–182.
  • Priego-Ranero Á, Opdenakker G, Uribe-Uribe N, et al. Autoantigen characterization in the lower esophageal sphincter muscle of patients with achalasia. Neurogastroenterol Motil. 2022;34(9):e14348. doi:10.1111/nmo.14348
  • Railwah C, Lora A, Zahid K, et al. Cigarette smoke induction of S100A9 contributes to chronic obstructive pulmonary disease. Am J Physiol Lung Cell Mol Physiol. 2020;319(6):L1021–l35. doi:10.1152/ajplung.00207.2020
  • Yang G, Wu C, Li L, et al. Neuregulin-1 protects cardiac electrical conduction through downregulating matrix metalloproteinase-9 and upregulating connexin 43 in a rat myocardial infarction model. Pharmazie. 2019;74(4):231–234. doi:10.1691/ph.2019.8941
  • Augustin RC, Bao R, Luke JJ. Targeting Cbl-b in cancer immunotherapy. J Immunother Cancer. 2023;11(2):L1021–L1035. doi:10.1136/jitc-2022-006007
  • Sitaram P, Uyemura B, Malarkannan S, Riese MJ. Beyond the cell surface: targeting intracellular negative regulators to enhance T cell anti-tumor activity. Int J Mol Sci. 2019;20(23):5821. doi:10.3390/ijms20235821
  • Fujiwara M, Anstadt EJ, Clark RB. Cbl-b deficiency mediates resistance to programmed death-ligand 1/programmed death-1 regulation. Front Immunol. 2017;8:42. doi:10.3389/fimmu.2017.00042
  • Yin X, Wang X, Wang S, et al. Screening for regulatory network of miRNA-inflammation, oxidative stress and prognosis-related mRNA in acute myocardial infarction: an in silico and validation study. Int J Gen Med. 2022;15:1715–1731. doi:10.2147/IJGM.S354359
  • Björkbacka H, Lavant EH, Fredrikson GN, et al. Weak associations between human leucocyte antigen genotype and acute myocardial infarction. J Intern Med. 2010;268(1):50–58. doi:10.1111/j.1365-2796.2009.02209.x
  • Huang K, Zhang X, Duan J, et al. STAT4 and COL1A2 are potential diagnostic biomarkers and therapeutic targets for heart failure comorbided with depression. Brain Res Bull. 2022;184:68–75. doi:10.1016/j.brainresbull.2022.03.014
  • Meng H, Ruan J, Tian X, Li L, Chen W, Meng F. High retinoic acid receptor-related orphan receptor A gene expression in peripheral blood leukocytes may be related to acute myocardial infarction. J Int Med Res. 2021;49(6):3000605211019663. doi:10.1177/03000605211019663
  • Cai X, Zhang P, Wang S, et al. lncRNA FGD5 antisense RNA 1 upregulates RORA to suppress hypoxic injury of human cardiomyocyte cells by inhibiting oxidative stress and apoptosis via miR‑195. Mol Med Rep. 2020;22(6):4579–4588. doi:10.3892/mmr.2020.11558
  • Li JN, Luo RY, Luo C, et al. Brain-derived neurotrophic factor precursor contributes to a proinflammatory program in monocytes/macrophages after acute myocardial infarction. J Am Heart Assoc. 2023;12(6):e028198. doi:10.1161/JAHA.122.028198
  • Shen WY, Luo C, Reinaldo Hurtado P, et al. The regulatory role of ProBDNF in monocyte function: implications in Stanford type-A aortic dissection disease. FASEB J. 2020;34(2):2541–2553. doi:10.1096/fj.201901905RR
  • Suzuki M, Katayama T, Suzuki C, Nakajima K, Magata Y, Ogawa M. Uptake of nicotinic acetylcholine receptor imaging agent is reduced in the proinflammatory macrophage. Nucl Med Biol. 2021;102–103:45–55. doi:10.1016/j.nucmedbio.2021.09.003
  • Bazzi S, Frangie C, Azar E, Daher J. The effect of myeloperoxidase-oxidized LDL on THP-1 macrophage polarization and repolarization. Innate Immun. 2022;28(2):91–103. doi:10.1177/17534259221090679
  • Kadl A, Meher AK, Sharma PR, et al. Identification of a novel macrophage phenotype that develops in response to atherogenic phospholipids via Nrf2. Circ Res. 2010;107(6):737–746. doi:10.1161/CIRCRESAHA.109.215715
  • Khallou-Laschet J, Varthaman A, Fornasa G, et al. Macrophage plasticity in experimental atherosclerosis. PLoS One. 2010;5(1):e8852. doi:10.1371/journal.pone.0008852
  • Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature. 2011;473(7347):317–325. doi:10.1038/nature10146
  • Profumo E, Maggi E, Arese M, et al. Neuropeptide Y promotes human M2 macrophage polarization and enhances p62/SQSTM1-dependent autophagy and NRF2 activation. Int J Mol Sci. 2022;23(21):13009. doi:10.3390/ijms232113009
  • Jing Y, Gao B, Han Z, Xin S. HOXA5 induces M2 macrophage polarization to attenuate carotid atherosclerosis by activating MED1. IUBMB Life. 2021;73(9):1142–1152. doi:10.1002/iub.2515
  • Marengo B, Bellora F, Ricciarelli R, et al. Oxysterol mixture and, in particular, 27-hydroxycholesterol drive M2 polarization of human macrophages. Biofactors. 2016;42(1):80–92.
  • Luo X, Xu Y, Zhong Z, Xiang P, Wu X, Chong A. miR-8485 alleviates the injury of cardiomyocytes through TP53INP1. J Biochem Mol Toxicol. 2022;36(10):e23159. doi:10.1002/jbt.23159
  • Du Y, Yang SH, Li S, et al. Circulating MicroRNAs as novel diagnostic biomarkers for very early-onset (≤40 years) coronary artery disease. Biomed Environ Sci. 2016;29(8):545–554. doi:10.3967/bes2016.073
  • Pang Y, Thomas P. mPRα and PR co-operate in progesterone inhibition of endothelial cell focal adhesion. J Mol Endocrinol. 2023;70(1):e220073. doi:10.1530/JME-22-0073
  • Groh LA, Verel DE, van der Heijden C, et al. Immune modulatory effects of progesterone on oxLDL-induced trained immunity in monocytes. J Leukoc Biol. 2022;112(2):279–288. doi:10.1002/JLB.3AB1220-846R
  • Fait T. Prescription rules of hormone replacement therapy and its alternative. Cas Lek Cesk. 2023;161(7–8):309–313.
  • Karim R, Xu W, Kono N, et al. Effect of menopausal hormone therapy on arterial wall echomorphology: results from the Early versus Late Intervention Trial with Estradiol (ELITE). Maturitas. 2022;162:15–22. doi:10.1016/j.maturitas.2022.02.007
  • Fuller KNZ, McCoin CS, Stierwalt H, et al. Oral combined contraceptives induce liver mitochondrial reactive oxygen species and whole-body metabolic adaptations in female mice. J Physiol. 2022;600(24):5215–5245. doi:10.1113/JP283733
  • De Falco S. Antiangiogenesis therapy: an update after the first decade. Korean J Intern Med. 2014;29(1):1–11. doi:10.3904/kjim.2014.29.1.1
  • Li Y, Zhu Y, Deng Y, et al. The therapeutic effect of bevacizumab on plaque neovascularization in a rabbit model of atherosclerosis during contrast-enhanced ultrasonography. Sci Rep. 2016;6:30417. doi:10.1038/srep30417
  • Melichar B, Kalábová H, Krcmová L, et al. Serum homocysteine, cholesterol, retinol, alpha-tocopherol, glycosylated hemoglobin and inflammatory response during therapy with bevacizumab, oxaliplatin, 5-fluorouracil and leucovorin. Anticancer Res. 2009;29(11):4813–4820.
  • Winnik S, Lohmann C, Siciliani G, et al. Systemic VEGF inhibition accelerates experimental atherosclerosis and disrupts endothelial homeostasis--implications for cardiovascular safety. Int J Cardiol. 2013;168(3):2453–2461. doi:10.1016/j.ijcard.2013.03.010
  • Touyz RM, Herrmann SMS, Herrmann J. Vascular toxicities with VEGF inhibitor therapies-focus on hypertension and arterial thrombotic events. J Am Soc Hypertens. 2018;12(6):409–425. doi:10.1016/j.jash.2018.03.008
  • De Negri Atanasio G, Ferrari PF, Baião A, et al. Bevacizumab encapsulation into PLGA nanoparticles functionalized with immunouteroglobin-1 as an innovative delivery system for atherosclerosis. Int J Biol Macromol. 2022;221:1618–1630. doi:10.1016/j.ijbiomac.2022.08.063
  • Sutton JT, Haworth KJ, Shanmukhappa SK, et al. Delivery of bevacizumab to atheromatous porcine carotid tissue using echogenic liposomes. Drug Deliv. 2016;23(9):3594–3605. doi:10.1080/10717544.2016.1212441
  • Tsivgoulis G, Katsanos AH, Sandset EC, et al. Thrombolysis for acute ischaemic stroke: current status and future perspectives. Lancet Neurol. 2023;22(5):418–429. doi:10.1016/S1474-4422(22)00519-1
  • Kunamneni A, Durvasula R. Streptokinase-A drug for thrombolytic therapy: a patent review. Recent Adv Cardiovasc Drug Discov. 2014;9(2):106–121. doi:10.2174/1574890110999150202150017
  • Zhou F, Zhu X, Liu Y, et al. Coronary atherosclerosis and chemotherapy: from bench to bedside. Front Cardiovasc Med. 2023;10:1118002. doi:10.3389/fcvm.2023.1118002
  • Zaborowska-Szmit M, Krzakowski M, Kowalski DM, Szmit S. Cardiovascular complications of systemic therapy in non-small-cell lung cancer. J Clin Med. 2020;9(5):1268. doi:10.3390/jcm9051268
  • Hayıroğlu Mİ, Altay S. The role of artificial intelligence in coronary artery disease and atrial fibrillation. Balkan Med J. 2023;40(3):151–152. doi:10.4274/balkanmedj.galenos.2023.06042023