Biomedicine and Chemical Sciences
2022, Volume 1, Issue 2 : 70-77 doi: https://doi.org/10.48112/bcs.v1i2.99
Research Article
Pathogenesis, Diagnosis and Treatment of Gallstone Disease
Published
April 1, 2022
Abstract

Gallstone disease is a gastrointestinal disease that results from the dysfunction of cholesterol, bile, and bilirubin metabolism. Gallstones in the gallbladder are common and form through cholelithiasis. They can also grow in biliary ducts through choledocholithiasis. In industrial countries, gallstone disease has increased in prevalence and affects up to 20% of the adult population. Its major risk factors are female gender, age, obesity, type 2 diabetes, rapid weight loss, physical inactivity, and genetic traits. Various systems for gallstone classification are available. Gallstones are classified as cholesterol, pigmented, and mixed gallstones in accordance with their chemical composition. Gallstone disease is either asymptomatic or has symptoms that manifest as pain in the right upper part of the abdomen, fever, and jaundice. The pathogenesis of this disease is related to the interaction between genetic and environmental factors, which include hepatic cholesterol hypersecretion, bile supersaturation, mucin, inflammatory changes, intestinal hypomotility, intestinal cholesterol hyperabsorption, and gut microbe alterations. The major genetic factors of this disease are the mutations in the hepatic cholesterol transporter ABCC8 and the cholecystokinin a receptor gene. Metabolic syndrome, insulin resistance, and type 2 diabetes increase the risk of developing gallstone disease. The standard diagnostic method for gallstone disease is ultrasound imaging. Medical treatment involves the administration of bile acid drugs and/or cholecystectomy.

Keywords
REFERENCES
  1. Abdullah, U. Y., Jassim, H. M., Baig, A. A., Khorsheed, R. M., Al-Khayat, A. M., Sulong, A. F., ... & Yassin, W. A. (2015). Gallstones in patients with inherited hemolytic diseases. International Journal of Pharmacy and Pharmaceutical Sciences, 7(7), 9-15.
  2. Afdhal, N. H. (2007). Diseases of the Gallbladder and Bile Ducts/Ed. by L. Goldman, D. Ausiello. Cecil Textbook of Medicine.—23rd ed.—Philadelphia: Saunders Elsevier.
  3. Amaral, J., Xiao, Z. L., Chen, Q., Yu, P., Biancani, P., & Behar, J. (2001). Gallbladder muscle dysfunction in patients with chronic acalculous disease. Gastroenterology, 120(2), 506-511. https://doi.org/10.1053/gast.2001.21190
  4. Aslam, H. M., Saleem, S., Edhi, M. M., Shaikh, H. A., Hafiz, M., & Saleem, M. (2013). Assessment of gallstone predictor: comparative analysis of ultrasonographic and biochemical parameters. International archives of medicine, 6(1), 1-7. https://doi.org/10.1186/1755-7682-6-17
  5. Bagepally, B. S., Haridoss, M., Sasidharan, A., Jagadeesh, K. V., & Oswal, N. K. (2021). Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy. BMJ open gastroenterology, 8(1), e000675. http://dx.doi.org/10.1136/bmjgast-2021-000675
  6. Berger, M. Y., & Bohnen, A. M. (2003). Abdominal symptoms: do they disappear after cholecystectomy?. Surgical Endoscopy And Other Interventional Techniques, 17(11), 1723-1728. https://doi.org/10.1007/s00464-002-9154-6
  7. Buch, S., Schafmayer, C., Völzke, H., Becker, C., Franke, A., von Eller-Eberstein, H., ... & Hampe, J. (2007). A genome-wide association scan identifies the hepatic cholesterol transporter ABCG8 as a susceptibility factor for human gallstone disease. Nature genetics, 39(8), 995-999. https://doi.org/10.1038/ng2101
  8. Carey, M. C. (1993). Pathogenesis of gallstones. The American journal of surgery, 165(4), 410-419. https://doi.org/10.1016/S0002-9610(05)80932-8
  9. Chong, V. H. (2005). Iatrogenic biliary stone. Surgical technology international, 14, 147-155.
  10. Chuang, S. C., Hsi, E., & Lee, K. T. (2012). Mucin genes in gallstone disease. Clinica Chimica Acta, 413(19-20), 1466-1471. https://doi.org/10.1016/j.cca.2012.06.015
  11. Chuang, S. C., Hsi, E., Wang, S. N., Yu, M. L., Lee, K. T., & Juo, S. H. H. (2011). Polymorphism at the mucin-like protocadherin gene influences susceptibility to gallstone disease. Clinica Chimica Acta, 412(23-24), 2089-2093. https://doi.org/10.1016/j.cca.2011.07.015
  12. Cohen, D. E., Kaler, E. W., & Carey, M. C. (1993). Cholesterol carriers in human bile: are “lamellae” involved?. Hepatology, 18(6), 1522-1531. https://doi.org/10.1002/hep.1840180635
  13. Cox, M. R., Eslick, G. D., & Padbury, R. (Eds.). (2018). The management of gallstone disease: a practical and evidence-based approach. Springer.
  14. Dai, X. Z., Li, G. Q., Zhang, F., Wang, X. H., & Zhang, C. Y. (2013). Gallstone ileus: case report and literature review. World Journal of Gastroenterology: WJG, 19(33), 5586. https://dx.doi.org/10.3748%2Fwjg.v19.i33.5586
  15. De Bari, O., Wang, T. Y., Liu, M., Portincasa, P., & Wang, D. Q. (2015). Estrogen induces two distinct cholesterol crystallization pathways by activating ERα and GPR30 in female mice. Journal of Lipid Research, 56(9), 1691-1700. https://doi.org/10.1194/jlr.M059121
  16. Di Ciaula, A., & Portincasa, P. (2014). Fat, epigenome and pancreatic diseases. Interplay and common pathways from a toxic and obesogenic environment. European Journal of Internal Medicine, 25(10), 865-873. https://doi.org/10.1016/j.ejim.2014.10.012
  17. Di Ciaula, A., Wang, D. Q. H., & Portincasa, P. (2018). An update on the pathogenesis of cholesterol gallstone disease. Current opinion in gastroenterology, 34(2), 71. https://dx.doi.org/10.1097%2FMOG.0000000000000423
  18. Di Ciaula, A., Wang, D. Q. H., Bonfrate, L., & Portincasa, P. (2013). Current views on genetics and epigenetics of cholesterol gallstone disease. Cholesterol, 2013.
  19. Everhart, J. E., Khare, M., Hill, M., & Maurer, K. R. (1999). Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology, 117(3), 632-639. https://doi.org/10.1016/S0016-5085(99)70456-7
  20. Febyan, F. (2020). Cholelithiasis: A Brief Review on Diagnostic Approach and Management in Clinical Practice. International Journal of Medical Reviews, 7(3), 98-101. https://doi.org/10.19080/argh.2020.15.555913
  21. Ghai, C. L. (2012). A textbook of practical physiology. JP Medical Ltd.
  22. Giljaca, V., Gurusamy, K. S., Takwoingi, Y., Higgie, D., Poropat, G., Štimac, D., & Davidson, B. R. (2015). Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for common bile duct stones. Cochrane Database of Systematic Reviews, (2). https://doi.org/10.1002/14651858.CD011549
  23. Grigorieva, I. N. (2007). Major risk factors of cholelithiasis. Rossiyskiy Zhurnal Gastroenterologii, Gepatologii i Koloproktologii, 6, 17-19.
  24. Guarino, M. P. L., Cocca, S., Altomare, A., Emerenziani, S., & Cicala, M. (2013). Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. World Journal of Gastroenterology: WJG, 19(31), 5029. https://dx.doi.org/10.3748%2Fwjg.v19.i31.5029
  25. Gutt, C., Schläfer, S., & Lammert, F. (2020). The treatment of gallstone disease. Deutsches Ärzteblatt International, 117(9), 148. https://dx.doi.org/10.3238%2Farztebl.2020.0148
  26. Gylling, H., Hallikainen, M., Pihlajamäki, J., Simonen, P., Kuusisto, J., Laakso, M., & Miettinen, T. A. (2010). Insulin sensitivity regulates cholesterol metabolism to a greater extent than obesity: lessons from the METSIM Study 1. Journal of lipid research, 51(8), 2422-2427. https://doi.org/10.1194/jlr.P006619
  27. Heuman, D.M., Mihas, A.A., Allen, J. (2019). Gallstones (Cholelithiasis). Emedicine.medscape.com. Retrieved 29 March 2022, from https://emedicine.medscape.com/article/175667-overview.
  28. Hirobe-Jahn, S., Harsch, S., Renner, O., Richter, D., Müller, O., & Stange, E. F. (2015). Association of FXR gene variants with cholelithiasis. Clinics and research in hepatology and gastroenterology, 39(1), 68-79. https://doi.org/10.1016/j.clinre.2014.07.002
  29. Hofmann, A. F. (2007). Biliary secretion and excretion in health and disease: current concepts. Annals of hepatology, 6(1), 15-27.
  30. Hsing, A. W., Bai, Y., Andreotti, G., Rashid, A., Deng, J., Chen, J., ... & Gao, Y. T. (2007). Family history of gallstones and the risk of biliary tract cancer and gallstones: a population‐based study in Shanghai, China. International journal of cancer, 121(4), 832-838. https://doi.org/10.1002/ijc.22756
  31. Ilychenko, A. A. (2004). Gallstone disease. Lechashchiy Vrach, 4, 27-33.
  32. Iqbal, M. N., Iqbal, M. A., Javaid, R., & Abbas, M. W. (2019). Gall stones: A fundamental clinical review.
  33. Jüngst, C., Sreejayan, N., Eder, M. I., Von Stillfried, N., Zündt, B., Spelsberg, F. W., ... & Von Ritter, C. (2007). Lipid peroxidation and mucin secretagogue activity in bile of gallstone patients. European journal of clinical investigation, 37(9), 731-736. https://doi.org/10.1111/j.1365-2362.2007.01853.x
  34. Kaechele, V., Wabitsch, M., Thiere, D., Kessler, A. L., Haenle, M. M., Mayer, H., & Kratzer, W. (2006). Prevalence of gallbladder stone disease in obese children and adolescents: influence of the degree of obesity, sex, and pubertal development. Journal of pediatric gastroenterology and nutrition, 42(1), 66-70.
  35. Katsika, D., Grjibovski, A., Einarsson, C., Lammert, F., Lichtenstein, P., & Marschall, H. U. (2005). Genetic and environmental influences on symptomatic gallstone disease: a Swedish study of 43,141 twin pairs. Hepatology, 41(5), 1138-1143. https://doi.org/10.1002/hep.20654
  36. Keren, N., Konikoff, F. M., Paitan, Y., Gabay, G., Reshef, L., Naftali, T., & Gophna, U. (2015). Interactions between the intestinal microbiota and bile acids in gallstones patients. Environmental microbiology reports, 7(6), 874-880. https://doi.org/10.1111/1758-2229.12319
  37. Kern, F. (1994). Effects of dietary cholesterol on cholesterol and bile acid homeostasis in patients with cholesterol gallstones. The Journal of clinical investigation, 93(3), 1186-1194. https://doi.org/10.1172/JCI117072
  38. Keus, F., de Jong, J., Gooszen, H. G., & Laarhoven, C. J. (2006). Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane database of systematic reviews, (4). https://doi.org/10.1002/14651858.CD006231
  39. Krawczyk, M., Lütjohann, D., Schirin‐Sokhan, R., Villarroel, L., Nervi, F., Pimentel, F., ... & Miquel, J. F. (2012). Phytosterol and cholesterol precursor levels indicate increased cholesterol excretion and biosynthesis in gallstone disease. Hepatology, 55(5), 1507-1517. https://doi.org/10.1002/hep.25563
  40. Lammert, F., Gurusamy, K., Ko, C. W., Miquel, J. F., Méndez-Sánchez, N., Portincasa, P., ... & Wang, D. Q. H. (2016). Gallstones. Nature reviews Disease primers, 2(1), 1-17. https://doi.org/10.1038/nrdp.2016.24
  41. Lin, J., Shao, W. Q., Chen, Q. Z., Zhu, W. W., Lu, L., Jia, H. L., & Chen, J. H. (2017). Osteopontin deficiency protects mice from cholesterol gallstone formation by reducing expression of intestinal NPC1L1. Molecular medicine reports, 16(2), 1785-1792. https://doi.org/10.3892/mmr.2017.6774
  42. Liu, Q., Shao, W., Zhang, C., Xu, C., Wang, Q., Liu, H., ... & Gu, A. (2017). Organochloride pesticides modulated gut microbiota and influenced bile acid metabolism in mice. Environmental pollution, 226, 268-276. https://doi.org/10.1016/j.envpol.2017.03.068
  43. Loginov, A. S., Chebanov, S. M., Petrakov, A. V., Saparin, G. V., Obyden, S. K., & Ivannikov, P. V. (1998). Investigation of cholesterol, bilirubin, and protein distribution in human gallstones by color cathodoluminescence scanning electron microscopy and transmission electron microscopy. Scanning: The Journal of Scanning Microscopies, 20(1), 17-22. https://doi.org/10.1002/sca.1998.4950200103
  44. Loginov, A. S., Chebanov, S. M., Saparin, G. V., & Obyden, S. K. (1998). The morphology and composition of cholesterol, protein, and bilirubin deposits in dried human bile: cathodoluminescence and backscattered electron imaging. Scanning: The Journal of Scanning Microscopies, 20(6), 442-446. https://doi.org/10.1002/sca.1998.4950200604
  45. Martinez-Lopez, E., Curiel-Lopez, F., Hernandez-Nazara, A., Moreno-Luna, L. E., Ramos-Marquez, M. E., Roman, S., & Panduro, A. (2015). Influence of ApoE and FABP2 polymorphisms and environmental factors in the susceptibility to gallstone disease. Annals of hepatology, 14(4), 515-523.
  46. Moore, K. J., Rayner, K. J., Suárez, Y., & Fernández-Hernando, C. (2010). microRNAs and cholesterol metabolism. Trends in Endocrinology & Metabolism, 21(12), 699-706. https://doi.org/10.1016/j.tem.2010.08.008
  47. Nakeeb, A., Comuzzie, A. G., Martin, L., Sonnenberg, G. E., Swartz-Basile, D., Kissebah, A. H., & Pitt, H. A. (2002). Gallstones: genetics versus environment. Annals of surgery, 235(6), 842. https://dx.doi.org/10.1097%2F00000658-200206000-00012
  48. Olokoba, A. B., Bojuwoye, B. J., Olokoba, L. B., Wahab, K. W., Salami, A. K., Braimoh, K. T., & Inikori, A. K. (2008). The relationship between gallstone disease and gall bladder volume. Nigerian journal of clinical practice, 11(2), 89-93.
  49. Origa, R., Galanello, R., Perseu, L., Tavazzi, D., Domenica Cappellini, M., Terenzani, L., ... & Piga, A. (2009). Cholelithiasis in thalassemia major. European journal of haematology, 82(1), 22-25. https://doi.org/10.1111/j.1600-0609.2008.01162.x
  50. Pamuk, G. E., Ümit, H., Harmandar, F., & Yeşil, N. (2009). Patients with iron deficiency anemia have an increased prevalence of gallstones. Annals of hematology, 88(1), 17-20. https://doi.org/10.1007/s00277-008-0557-x
  51. Paramsothy, P., Knopp, R. H., Kahn, S. E., Retzlaff, B. M., Fish, B., Ma, L., & Ostlund Jr, R. E. (2011). Plasma sterol evidence for decreased absorption and increased synthesis of cholesterol in insulin resistance and obesity. The American journal of clinical nutrition, 94(5), 1182-1188. https://doi.org/10.3945/ajcn.110.006668
  52. Poupon, R., Rosmorduc, O., Boëlle, P. Y., Chrétien, Y., Corpechot, C., Chazouillères, O., ... & Barbu, V. (2013). Genotype‐phenotype relationships in the low‐phospholipid‐associated cholelithiasis syndrome: a study of 156 consecutive patients. Hepatology, 58(3), 1105-1110. https://doi.org/10.1002/hep.26424
  53. Ramaswamy, K., Killilea, D. W., Kapahi, P., Kahn, A. J., Chi, T., & Stoller, M. L. (2015). The elementome of calcium-based urinary stones and its role in urolithiasis. Nature Reviews Urology, 12(10), 543-557. https://doi.org/10.1038/nrurol.2015.208
  54. Renner, O., Lütjohann, D., Richter, D., Strohmeyer, A., Schimmel, S., Müller, O., ... & Harsch, S. (2013). Role of the ABCG8 19H risk allele in cholesterol absorption and gallstone disease. BMC gastroenterology, 13(1), 1-11. https://doi.org/10.1186/1471-230X-13-30
  55. Reshetnyak, T. M., Saparin, G. V., Ivannikov, P. V., & Reshetnyak, V. I. (2009). Corticosteroids and cholelithiasis in systemic lupus erythematosus. Scholarly Research Exchange, 2009.
  56. Reshetnyak, V. I. (2012). Concept of the pathogenesis and treatment of cholelithiasis. World journal of hepatology, 4(2), 18. https://dx.doi.org/10.4254%2Fwjh.v4.i2.18
  57. Rudkowska, I., & Jones, P. J. (2008). Polymorphisms in ABCG5/G8 transporters linked to hypercholesterolemia and gallstone disease. Nutrition reviews, 66(6), 343-348. https://doi.org/10.1111/j.1753-4887.2008.00042.x
  58. Ruhl, C. E., & Everhart, J. E. (2011). Gallstone disease is associated with increased mortality in the United States. Gastroenterology, 140(2), 508-516. https://doi.org/10.1053/j.gastro.2010.10.060
  59. Sayers, C., Wyatt, J., Soloway, R. D., Taylor, D. R., & Stringer, M. D. (2007). Gallbladder mucin production and calcium carbonate gallstones in children. Pediatric surgery international, 23(3), 219-223. https://doi.org/10.1007/s00383-006-1867-5
  60. Shabanzadeh, D. M. (2018). New determinants for gallstone disease. Dan Med J, 65(2), B5438.
  61. Singh, V. K., Singh, V., Rai, A. K., Thakur, S. N., Rai, P. K., & Singh, J. P. (2008). Quantitative analysis of gallstones using laser-induced breakdown spectroscopy. Applied Optics, 47(31), G38-G47. https://doi.org/10.1364/AO.47.000G38
  62. Stewart, L., Grifiss, J. M., Jarvis, G. A., & Way, L. W. (2006). Biliary bacterial factors determine the path of gallstone formation. The American journal of surgery, 192(5), 598-603. https://doi.org/10.1016/j.amjsurg.2006.08.001
  63. Sun, H., Tang, H., Jiang, S., Zeng, L., Chen, E. Q., Zhou, T. Y., & Wang, Y. J. (2009). Gender and metabolic differences of gallstone diseases. World journal of gastroenterology: WJG, 15(15), 1886. https://dx.doi.org/10.3748%2Fwjg.15.1886
  64. Takemoto, M., Tada, K., Nakatsuka, K., Moriyama, Y., Kazui, H., Yokote, K., ... & Mori, S. (1999). Effects of aging and hyperlipidemia on plasma osteopontin level. Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics, 36(11), 799-802. https://doi.org/10.3143/geriatrics.36.799
  65. Tayeb, M., Raza, S. A., Khan, M. R., & Azami, R. (2005). Conversion from laparoscopic to open cholecystectomy: multivariate analysis of preoperative risk factors. Journal of postgraduate medicine, 51(1), 17.
  66. Tazuma, S., Unno, M., Igarashi, Y., Inui, K., Uchiyama, K., Kai, M., ... & Shimosegawa, T. (2017). Evidence-based clinical practice guidelines for cholelithiasis 2016. Journal of gastroenterology, 52(3), 276-300. https://doi.org/10.1007/s00535-016-1289-7
  67. Thomas, L. A., Veysey, M. J., Murphy, G. M., Russell-Jones, D., French, G. L., Wass, J. A. H., & Dowling, R. H. (2005). Octreotide induced prolongation of colonic transit increases faecal anaerobic bacteria, bile acid metabolising enzymes, and serum deoxycholic acid in patients with acromegaly. Gut, 54(5), 630-635. http://dx.doi.org/10.1136/gut.2003.028431
  68. Tsukanov, V. V., Nozdrachev, K. G., IuL, T., Bronnikova, E. P., & EIu, K. (2007). The mechanism of reverse cholesterol transport and cholelithiasis in northern ethnic groups. Klinicheskaia meditsina, 85(2), 33-35.
  69. Uchiyama, K., Kawai, M., Tani, M., Terasawa, H., Tanimura, H., & Yamaue, H. (2007). Pathogenesis of hepatolithiasis based on the analysis of components of intrahepatic stones. Hepato-gastroenterology, 54(78), 1798-1804.
  70. Villanacci, V., Del Sordo, R., Salemme, M., Cadei, M., Sidoni, A., & Bassotti, G. (2016). The enteric nervous system in patients with calculous and acalculous gallbladder. Digestive and Liver Disease, 48(7), 792-795. https://doi.org/10.1016/j.dld.2016.03.014
  71. Von Kampen, O., Buch, S., Nothnagel, M., Azocar, L., Molina, H., Brosch, M., ... & Hampe, J. (2013). Genetic and functional identification of the likely causative variant for cholesterol gallstone disease at the ABCG5/8 lithogenic locus. Hepatology, 57(6), 2407-2417. https://doi.org/10.1002/hep.26009
  72. von Schönfels, W., Buch, S., Wölk, M., Aselmann, H., Egberts, J. H., Schreiber, S., ... & Schafmayer, C. (2013). Recurrence of gallstones after cholecystectomy is associated with ABCG5/8 genotype. Journal of gastroenterology, 48(3), 391-396. https://doi.org/10.1007/s00535-012-0639-3
  73. Wang, D. Q. H. (2007). Regulation of intestinal cholesterol absorption. Annu. Rev. Physiol., 69, 221-248. https://doi.org/10.1146/annurev.physiol.69.031905.160725
  74. Wang, D. Q. H., & Lee, S. P. (2008). Physical chemistry of intestinal absorption of biliary cholesterol in mice. Hepatology, 48(1), 177-185. https://doi.org/10.1002/hep.22286
  75. Wang, D. Q. H., Neuschwander-Tetri, B. A., & Portincasa, P. (2012). The Biliary System, Colloquium Series on Integrated Systems Physiology: From Molecule to Function. Morgan & Claypool, 109-145.
  76. Wang, H. H., Li, T., Portincasa, P., Ford, D. A., Neuschwander-Tetri, B. A., Tso, P., & Wang, D. Q. H. (2017). New insights into the role of Lith genes in the formation of cholesterol-supersaturated bile. Liver Research, 1(1), 42-53. https://doi.org/10.1016/j.livres.2017.05.005
  77. Wang, H. H., Portincasa, P., & Wang, D. Q. (2008). Molecular pathophysiology and physical chemistry of cholesterol gallstones. Front Biosci, 13(4), 401-423.
  78. Wang, L. J., Wang, J., Li, N., Ge, L., Li, B. L., & Song, B. L. (2011). Molecular characterization of the NPC1L1 variants identified from cholesterol low absorbers. Journal of Biological Chemistry, 286(9), 7397-7408. https://doi.org/10.1074/jbc.M110.178368
  79. Wang, R., Hong, J., Cao, Y., Shi, J., Gu, W., Ning, G., & Wang, W. (2015). Elevated circulating microRNA-122 is associated with obesity and insulin resistance in young adults. Eur J Endocrinol, 172(3), 291-300. https://doi.org/10.1530/eje-14-0867
Recommended Articles
Original Article Open Access
A FRAMEWORK OF MONOCLONAL ANTIBODIES AND RELATED PRODUCTION ENGINEERING
2025, Volume 4, Issue 4 : 26-34
Research Article Open Access
Investigation of Tritrichomonas Foetus in Cattle Using Different Methods in Basrah City – Iraq
2023, Volume 2, Issue 1 : 39-43
DOI: https://doi.org/10.48112/bcs.v2i1.334
Research Article Open Access
The Role of Vitamin D and Zinc In Facing COVID-19 Injury
2022, Volume 1, Issue 1 : 6-10
DOI: https://doi.org/10.48112/bcs.v1i1.76
Research Article Open Access
Design and Synthesis Ligands Tetradents Substituted with Halogenes in α- Position and Conjugation with Riboflavin (Bioconjugates)
2022, Volume 1, Issue 2 : 47-56
DOI: https://doi.org/10.48112/bcs.v1i2.85
Biomedicine and Chemical Sciences journal thumbnail
Volume 1, Issue 2
Citations
3 Views
4 Downloads
Share this article
License
Copyright (c) Biomedicine and Chemical Sciences
Creative Commons Attribution License Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All papers should be submitted electronically. All submitted manuscripts must be original work that is not under submission at another journal or under consideration for publication in another form, such as a monograph or chapter of a book. Authors of submitted papers are obligated not to submit their paper for publication elsewhere until an editorial decision is rendered on their submission. Further, authors of accepted papers are prohibited from publishing the results in other publications that appear before the paper is published in the Journal unless they receive approval for doing so from the Editor-In-Chief.
Biomed. Chem. Sci. open access articles are licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. This license lets the audience to give appropriate credit, provide a link to the license, and indicate if changes were made and if they remix, transform, or build upon the material, they must distribute contributions under the same license as the original.
Biomedicine and Chemical Sciences Logo
Biomedicine and Chemical Sciences
About Us
Biomedicine and Chemical Sciences (BCS), an international journal, publishes double blind peer-reviewed full-length, original papers, reviews or letters. BCS covers the latest developments in various fields of biomedicine such as cardiology, immunology, genetics, environmental health, neurology, oncology and toxicology
Support
Follow Us
facebook twitter linkedin mendeley research-gate
© Copyright Biomedicine and Chemical Sciences (BCS). All Rights Reserved.