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Article ; Online: Rare Purulent Cardiac Tamponade Caused by Streptococcus Constellatus in a Young Immunocompetent Patient: Case Report and Review of the Literature.

Hindi, Zakaria

2016 Volume 17, Page(s) 855–859

Abstract: BACKGROUND Purulent pericardial tamponade is a very rare occurrence in the current era of widespread antibiotic use. It is even rarer when caused by Streptococcus constellatus: a microorganism usually classified among the normal flora of the human body. ... ...

Abstract	BACKGROUND Purulent pericardial tamponade is a very rare occurrence in the current era of widespread antibiotic use. It is even rarer when caused by Streptococcus constellatus: a microorganism usually classified among the normal flora of the human body. It is occasionally diagnosed with certain predisposing factors. CASE REPORT We present the third case of Streptococcus constellatus cardiac tamponade reported in the current medical literature, occurring in a previously healthy young man who was initially admitted and treated for possible community-acquired pneumonia. The patient required immediate subxyphoid pericardiocentesis. He was also treated successfully with a lengthy course of both intravenous and oral antibiotics. Two months post-hospitalization, he was confirmed clinically stable with complete resolution of his purulent effusion. We also conducted a review of the literature for all Streptococcus milleri group purulent pericardial infections between 1984 and 2015. CONCLUSIONS Purulent cardiac tamponade caused by Streptococcus constellatus is extremely rare. It can be life threatening, however. Early appropriate diagnosis and therapeutic intervention are critical for a good outcome.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Cardiac Tamponade/diagnosis ; Cardiac Tamponade/etiology ; Cardiac Tamponade/therapy ; Echocardiography ; Humans ; Male ; Pericardiocentesis/methods ; Pericarditis/complications ; Pericarditis/diagnosis ; Pericarditis/microbiology ; Rare Diseases ; Streptococcal Infections/complications ; Streptococcal Infections/diagnosis ; Streptococcal Infections/therapy ; Streptococcus constellatus/isolation & purification ; Tomography, X-Ray Computed ; Young Adult
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2016-11-16
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/ajcr.900904
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: A Rare Case of Complete Heart Block in a Young Patient.

Hindi, Zakaria / Hindi, Yousef / Batarseh, Rami

Case reports in cardiology

2018 Volume 2018, Page(s) 1493121

Abstract: Introduction: Complete heart block (CHB) is considered as one of the dangerous rhythms since it can progress to lethal arrhythmias such as ventricular tachycardia. It can be congenital or acquired. Patients may present with frequent palpitations, ... ...

Abstract	Introduction: Complete heart block (CHB) is considered as one of the dangerous rhythms since it can progress to lethal arrhythmias such as ventricular tachycardia. It can be congenital or acquired. Patients may present with frequent palpitations, presyncope, dyspnea, or chest pain but also may remain asymptomatic. Extensive work-up should be conducted to exclude secondary causes such as infections, cardiac ischemia or myopathies, autoimmune diseases, or endocrinological diseases. In our paper, we would like to present a case of CHB in the setting of aortic abdominal thrombus that nearly occluded both renal arteries. The CHB in this case is thought to be caused by hypertensive cardiomyopathy due to ongoing uncontrolled hypertension, which is caused by bilateral renal artery stenosis. Case presentation: A 31-year-old male with history of active smoking was incidentally found to have high blood pressure, bradycardia, and CHB on electrocardiogram. The patient was admitted to a cardiology ward and extensive work-up revealed hypokinesia of the left ventricle with low ejection fraction and left ventricle concentric hypertrophy, large abdominal aortic thrombus with bilateral renal artery stenosis, and evidence of arterial collateral connections, which suggest chronicity. The patient then was placed on four antihypertensive medications but eventually, he underwent bilateral renal artery stenting and insertion of permanent pacemaker for his CHB. The patient's blood pressure then was under control with only one medication, and subsequent CT angiogram showed no evidence of stenosis of both renal arteries. Conclusion: Uncontrolled hypertension can lead to hypertensive cardiomyopathy, which in turn can cause conduction abnormalities such as CHB. Although hypertension can be secondary to a treatable underlying cause, permanent pacemaker is essential to treat CHB.
Language	English
Publishing date	2018-06-06
Publishing country	United States
Document type	Case Reports
ZDB-ID	2627627-6
ISSN	2090-6412 ; 2090-6404
ISSN (online)	2090-6412
ISSN	2090-6404
DOI	10.1155/2018/1493121
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Article: The Effect of Perioperative Bevacizumab on Disease-Free and Overall Survival in Locally Advanced HER-2 Negative Breast Cancer: A Meta-Analysis.

Alnimer, Yanal / Hindi, Zakaria / Katato, Khalil

Breast cancer : basic and clinical research

2018 Volume 12, Page(s) 1178223418792250

Abstract: Introduction: Multiple trials demonstrated that adding Bevacizumab to the standard neoadjuvant chemotherapy in HER-2 negative breast cancer increases pathological complete response. We conducted this meta-analysis to evaluate that effect on survival.: ...

Abstract	Introduction: Multiple trials demonstrated that adding Bevacizumab to the standard neoadjuvant chemotherapy in HER-2 negative breast cancer increases pathological complete response. We conducted this meta-analysis to evaluate that effect on survival. Methods: We performed a systematic search for randomized trials measuring the effect of adding either neoadjuvant or adjuvant Bevacizumab to the standard chemotherapy on disease-free and overall survival in breast cancer surgical candidates. The Mantel-Haenszel method and random effect model were used to analyze the data. A total of 7 randomized controlled trials were included in the analysis with a mean follow-up of 45 months. Results: No statistically significant difference in overall survival was found after adding Bevacizumab to the standard chemotherapy in the overall study population, HR=0.9, 95% CI (90.72-1.13), estrogen/ progesterone positive subgroup, HR=0.99, 95% CI (0.72-1.35), or in triple negative breast cancer, HR=0.88, 95% CI (0.77-1.01). However, there was a small but significant improvement in disease-free survival in triple negative breast cancer with a HR of 0.88, 95% CI (0.78-0.98), but not in estrogen/ progesterone receptor positive tumors, HR=1.01, 95% CI (0.81-1.26). Conclusions: The addition of Bevacizumab along with the standard chemotherapy would not improve overall survival in breast cancer surgical candidates, however, due to a small but significant improvement on disease-free survival in triple negative breast cancer, that would not eliminate the possibility of a certain subgroup of the latter who might benefit from adding Bevacizumab.
Language	English
Publishing date	2018-08-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2423804-1
ISSN	1178-2234
ISSN	1178-2234
DOI	10.1177/1178223418792250
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Article ; Online: Idiopathic Bilateral External Jugular Vein Thrombosis.

Hindi, Zakaria / Fadhel, Ehab

The American journal of case reports

2015 Volume 16, Page(s) 554–557

Abstract: Background: Vein thrombosis is mainly determined by 3 factors, which constitute a triad called Virchow's triad: hypercoagulability, stasis, and endothelial injury. Venous thrombosis commonly occurs in the lower extremities since most of the blood ... ...

Abstract	Background: Vein thrombosis is mainly determined by 3 factors, which constitute a triad called Virchow's triad: hypercoagulability, stasis, and endothelial injury. Venous thrombosis commonly occurs in the lower extremities since most of the blood resides there and flows against gravity. The veins of the lower extremities are dependent on intact valves and fully functional leg muscles. However, in case of valvular incompetency or muscular weakness, thrombosis and blood stasis will occur as a result. In contrast, the veins of the neck, specially the jugulars, have distensible walls which allow flexibility during respiration. In addition, the blood directly flows downward towards the heart. Nevertheless, many case reports mentioned the thrombosis of internal jugular veins and external jugular veins with identified risk factors. Jugular vein thrombosis has previously been associated in the literature with a variety of medical conditions, including malignancy. Case report: This report is of a case of idiopathic bilateral external jugular vein thrombosis in a 21 year-old male construction worker of Southeast Asian origin with no previous medical history who presented with bilateral facial puffiness of gradual onset over 1 month. Doppler ultrasound and computed tomography were used in the diagnosis. Further work-up showed no evidence of infection or neoplasia. The patient was eventually discharged on warfarin. The patient was assessed after 6 months and his symptoms had resolved completely. Conclusions: Bilateral idiopathic external jugular veins thrombosis is extremely rare and can be an indicator of early malignancy or hidden infection. While previous reports in the literature have associated jugular vein thrombosis with malignancy, the present case shows that external jugular vein thrombosis can also be found in persons without malignancy.
MeSH term(s)	Anticoagulants/therapeutic use ; Humans ; Jugular Veins ; Male ; Venous Thrombosis/diagnosis ; Venous Thrombosis/drug therapy ; Young Adult
Chemical Substances	Anticoagulants
Language	English
Publishing date	2015-08-20
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.895124
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Article: Segmental arterial mediolysis presenting as spontaneous bilateral renal artery dissection.

Onteddu, Nirmal K / Hindi, Zakaria / Rajashekar, Gaurav / Kalva, Sanjeeva P

Radiology case reports

2018 Volume 13, Issue 2, Page(s) 495–498

Abstract: The commonest site of primary dissection involving the visceral vessels is renal arteries; however, spontaneous bilateral renal artery dissection is an extremely rare entity. Spontaneous renal artery dissection (SRAD) is rarely a cause of renovascular ... ...

Abstract	The commonest site of primary dissection involving the visceral vessels is renal arteries; however, spontaneous bilateral renal artery dissection is an extremely rare entity. Spontaneous renal artery dissection (SRAD) is rarely a cause of renovascular hypertension. Segmental arterial mediolysis is a rare arteriopathy of unknown etiology which is a nonatherosclerotic and noninflammatory condition. We report a case of a 51-year-old male patient with spontaneous dissection of bilateral renal arteries with clinical, laboratory, and angiographic findings consistent with segmental artery mediolysis. Early diagnosis and treatment of this condition will decrease morbidity and mortality.
Language	English
Publishing date	2018-01-11
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2406300-9
ISSN	1930-0433
ISSN	1930-0433
DOI	10.1016/j.radcr.2017.11.017
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Article: Hemophagocytic syndrome masquerading as septic shock: An approach to such dilemma.

Hindi, Zakaria / Khaled, Abdallah A / Abushahin, Ashraf

SAGE open medical case reports

2017 Volume 5, Page(s) 2050313X17746309

Abstract: Introduction: Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis is a rare condition characterized by excessive inflammation that is thought to be caused by the absence of normal downregulation of activated macrophages and lymphocytes. The ... ...

Abstract	Introduction: Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis is a rare condition characterized by excessive inflammation that is thought to be caused by the absence of normal downregulation of activated macrophages and lymphocytes. The treatment of hemophagocytic lymphohistiocytosis can depend on whether it is primary or secondary. In secondary hemophagocytic lymphohistiocytosis, the treatment can be directed according to the cause. In general, protocol HLH-94 (which consists of dexamethasone and etoposide in induction and maintenance) has been widely used as it has good outcomes. Hemophagocytic lymphohistiocytosis and septic shock largely overlap which can lead to refractory septic shock and death if not treated. Unfortunately, there is no clear approach for such dilemma. Thereby, we would like to present our case as it has a valuable approach to hemophagocytic lymphohistiocytosis in the setting of sepsis. Case description: A 60-year-old female, with history of hypertension, came with fever, productive cough, and dyspnea; she was admitted for acute exacerbation of chronic obstructive pulmonary disease and was transferred to intensive care unit for septic shock. The patient progressed to refractory septic shock with no focus of infection. After further investigations, detailed history raised the suspicion of hemophagocytic lymphohistiocytosis; a bone marrow biopsy was collected and confirmed the diagnosis. The patient was on methylprednisolone while waiting for other investigation results and improved markedly. After ruling out secondary causes of hemophagocytic lymphohistiocytosis, she was switched to protocol-94 and continued to improve. Conclusion: It should be emphasized that septic shock, with or without focus of infection, overlaps with hemophagocytic lymphohistiocytosis and can consequently lead to refractory septic shock and death. Thus, our aim of this case is to encourage further investigations, specifically for hemophagocytic lymphohistiocytosis in the setting of septic shock of unknown origin, to decrease mortality rate. More importantly, early initiation of immunosuppression therapy may be a crucial step before switching to hemophagocytic lymphohistiocytosis-specific treatment.
Language	English
Publishing date	2017-12-17
Publishing country	England
Document type	Case Reports
ZDB-ID	2736953-5
ISSN	2050-313X
ISSN	2050-313X
DOI	10.1177/2050313X17746309
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Article ; Online: Superior mesenteric venous thrombosis complicating acute appendicitis: A case report.

Gad, AbdAllah / Hindi, Zakaria / Zahoor, Talal / Zock, Rémy Zock À

Medicine

2018 Volume 97, Issue 25, Page(s) e11168

Abstract: Rationale: Superior mesenteric venous thrombosis (SMVT) is a rare condition that carries high mortality. Very few cases have been reported of SMVT, complicating acute appendicitis. Early recognition requires a high index of suspicion and is crucial in ... ...

Abstract	Rationale: Superior mesenteric venous thrombosis (SMVT) is a rare condition that carries high mortality. Very few cases have been reported of SMVT, complicating acute appendicitis. Early recognition requires a high index of suspicion and is crucial in successful treatment of such a life-threatening condition. Patient concerns: A 33-year-old male presents with a 4-day history of right lower abdominal pain, nausea and subjective fever. CT scan showed acute appendicitis and a central filling defect in the superior mesenteric vein. Diagnoses: Acute appendicitis complicated by SMVT. Interventions: Intravenous antibiotics, appendectomy, and anticoagulation. Outcomes: Repeat CT scan showed successful resolution of the SMVT at a 3-month follow up. Lessons: Clinical awareness and high index of suspicion are essential to diagnose and manage SMVT, a serious complication of acute appendicitis.
MeSH term(s)	Adult ; Anti-Bacterial Agents/administration & dosage ; Anticoagulants/administration & dosage ; Appendectomy/methods ; Appendicitis/complications ; Appendicitis/physiopathology ; Appendicitis/surgery ; Diagnostic Errors/prevention & control ; Early Medical Intervention ; Heparin, Low-Molecular-Weight/administration & dosage ; Humans ; Male ; Mesenteric Vascular Occlusion/diagnosis ; Mesenteric Vascular Occlusion/etiology ; Mesenteric Vascular Occlusion/physiopathology ; Mesenteric Vascular Occlusion/therapy ; Mesenteric Veins/diagnostic imaging ; Mesenteric Veins/pathology ; Penicillanic Acid/administration & dosage ; Penicillanic Acid/analogs & derivatives ; Piperacillin/administration & dosage ; Tazobactam ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; Venous Thrombosis/diagnosis ; Venous Thrombosis/etiology ; Venous Thrombosis/physiopathology ; Venous Thrombosis/therapy
Chemical Substances	Anti-Bacterial Agents ; Anticoagulants ; Heparin, Low-Molecular-Weight ; Penicillanic Acid (87-53-6) ; Tazobactam (SE10G96M8W) ; Piperacillin (X00B0D5O0E)
Language	English
Publishing date	2018-06-08
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000011168
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Metformin-associated lactic acidosis mimicking ischaemic bowel.

Ali, Sajjad / Labuschagne, Heloise / Azarov, Nickolay / Hindi, Zakaria / Oud, Lavi

BMJ case reports

2018 Volume 2018

Abstract: Metformin-associated lactic acidosis (MALA) is a rare complication among patients who are diabetic, commonly presenting with non-specific findings, and developing mostly among those with other risk factors for lactic acidosis. We report the development ... ...

Abstract	Metformin-associated lactic acidosis (MALA) is a rare complication among patients who are diabetic, commonly presenting with non-specific findings, and developing mostly among those with other risk factors for lactic acidosis. We report the development of MALA in a 67-year-old man with diabetes who presented with progressive abdominal pain and bloody diarrhoea. On presentation the patient was in shock, with signs suggestive of peritonitis, and with severe lactic acidosis, renal failure and non-specific findings on abdominal CT. Neither the patient nor family could provide details of his home pharmaceuticals. Circulatory resuscitation with intravenous crystalloids and vasopressors was commenced, along with empiric broad-spectrum antibiotics. Emergent laparotomy did not show pathological findings. Emergent haemodialysis, initiated postoperatively, resulted in rapid resolution of shock and lactic acidosis. A list of patient's medications, provided afterwards by the family, included metformin. Microbiological studies remained negative and renal function normalised by the time of patient's hospital discharge after 9 days.
MeSH term(s)	Abdominal Pain/chemically induced ; Acidosis, Lactic/chemically induced ; Acidosis, Lactic/diagnosis ; Acidosis, Lactic/therapy ; Aged ; Diabetes Mellitus/drug therapy ; Diagnosis, Differential ; Emergency Medical Services ; Feces ; Gastrointestinal Hemorrhage/chemically induced ; Hemodiafiltration ; Humans ; Hypoglycemic Agents/administration & dosage ; Hypoglycemic Agents/adverse effects ; Male ; Metformin/administration & dosage ; Metformin/adverse effects ; Renal Insufficiency/chemically induced ; Renal Insufficiency/therapy ; Shock/chemically induced ; Treatment Outcome
Chemical Substances	Hypoglycemic Agents ; Metformin (9100L32L2N)
Language	English
Publishing date	2018-02-01
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2017-221686
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Article ; Online: Hemophagocytic syndrome masquerading as septic shock

Zakaria Hindi / Abdallah A Khaled / Ashraf Abushahin

SAGE Open Medical Case Reports, Vol

An approach to such dilemma

2017 Volume 5

Abstract	Introduction: Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis is a rare condition characterized by excessive inflammation that is thought to be caused by the absence of normal downregulation of activated macrophages and lymphocytes. The treatment of hemophagocytic lymphohistiocytosis can depend on whether it is primary or secondary. In secondary hemophagocytic lymphohistiocytosis, the treatment can be directed according to the cause. In general, protocol HLH-94 (which consists of dexamethasone and etoposide in induction and maintenance) has been widely used as it has good outcomes. Hemophagocytic lymphohistiocytosis and septic shock largely overlap which can lead to refractory septic shock and death if not treated. Unfortunately, there is no clear approach for such dilemma. Thereby, we would like to present our case as it has a valuable approach to hemophagocytic lymphohistiocytosis in the setting of sepsis. Case description: A 60-year-old female, with history of hypertension, came with fever, productive cough, and dyspnea; she was admitted for acute exacerbation of chronic obstructive pulmonary disease and was transferred to intensive care unit for septic shock. The patient progressed to refractory septic shock with no focus of infection. After further investigations, detailed history raised the suspicion of hemophagocytic lymphohistiocytosis; a bone marrow biopsy was collected and confirmed the diagnosis. The patient was on methylprednisolone while waiting for other investigation results and improved markedly. After ruling out secondary causes of hemophagocytic lymphohistiocytosis, she was switched to protocol-94 and continued to improve. Conclusion: It should be emphasized that septic shock, with or without focus of infection, overlaps with hemophagocytic lymphohistiocytosis and can consequently lead to refractory septic shock and death. Thus, our aim of this case is to encourage further investigations, specifically for hemophagocytic lymphohistiocytosis in the setting of septic shock of unknown ...
Keywords	Medicine (General) ; R5-920
Subject code	616
Language	English
Publishing date	2017-12-01T00:00:00Z
Publisher	SAGE Publishing
Document type	Article ; Online
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Article ; Online: Effect of Serum Deprivation Stress on Signal Induction Regulatory Protein-Alpha (SIRP-Alpha)-Mediated Erythrophagocytosis by Macrophages.

Hindi, Zakaria / Gad, AbdAllah / Jarvis, Courtney / Zahoor, Talal / Spellman, Craig / Filleur, Stephanie

Medical science monitor basic research

2019 Volume 25, Page(s) 100–106

Abstract: BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome that involves loss of macrophages' self-cells recognition resulting in auto-phagocytosis of erythrocytes, leukocytes, and platelets and leading to multi-system effects. The ... ...

Abstract	BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome that involves loss of macrophages' self-cells recognition resulting in auto-phagocytosis of erythrocytes, leukocytes, and platelets and leading to multi-system effects. The pathogenesis of HLH is unclear but can be explained by malfunction of the physiologic inhibitory pathway through interaction between macrophage SIRP-alpha and erythrocyte CD 47. The goal of the present study was to evaluate if erythrocytes phagocytosis occurs as a result of altered macrophage SIRP-alpha expression during inflammatory/stressful conditions as seen in HLH. MATERIAL AND METHODS RAW264.7 macrophages were cultured in serum-free media (SFM) and complete media (CM) to simulate stressful and physiologic conditions, respectively. CD47+ mouse erythrocytes were used to test interactions with macrophages at different stages. SIRP-alpha expressions and phagocytosis assays were measured and analyzed at different steps. The study was in vitro and used murine cells to simulate in vivo human interactions. RESULTS SIRP-alpha expressions and phagocytosis rates were higher in SFM compared to CM. Interestingly, after adding SIRP-alpha blocking antibodies (Ab), phagocytosis rates significantly decreased. CONCLUSIONS Serum deprivation and LPS/INF-Gamma induction resulted in increased SIRP-alpha expression and erythrophagocytosis. Using SIRP-alpha Ab during this condition decreased the rate of erythrophagocytosis, which indicates that SIRP-alpha receptor can have pro-phagocytic activity.
MeSH term(s)	Animals ; CD47 Antigen/metabolism ; Culture Media, Serum-Free ; Erythrocytes/metabolism ; Gene Expression Regulation ; Macrophages/metabolism ; Mice ; Phagocytosis ; RAW 264.7 Cells ; RNA, Messenger/genetics ; RNA, Messenger/metabolism ; Receptors, Immunologic/genetics ; Receptors, Immunologic/metabolism
Chemical Substances	CD47 Antigen ; Culture Media, Serum-Free ; Ptpns1 protein, mouse ; RNA, Messenger ; Receptors, Immunologic
Language	English
Publishing date	2019-03-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2711344-9
ISSN	2325-4416 ; 2325-4416
ISSN (online)	2325-4416
ISSN	2325-4416
DOI	10.12659/MSMBR.912946
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