Journal of Neurological Disorders and Stroke

Association of Diagnostic Stroke Biomarkers with Post Stroke Cognitive Impairment

Review Article | Open Access | Volume 6 | Issue 1

  • 1. Division of Chemical Biology, CSIR- Indian Institute of Chemical Technology, India
  • 2. CSIR- Centre for Cellular and Molecular Biology, India
  • 3. Academy of Scientific & Innovative Research (AcSIR), India
  • 0. These authors contributed equally to this work
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Corresponding Authors
Sumana Chakravarty, Division of Chemical Biology, CSIR- Indian Institute of Chemical Technology (IICT), Tarnaka, Hyderabad- 500 007 (AP), India, Fax: 040-2719-3189; Tel: 91-040-2719-1856

Stroke patients are at a higher risk of developing progressive cognitive impairment, often retarding patient rehabilitation. Studies have been carried out to find out the molecular mechanism associated with the stroke and its consequences on the various brain regions implicated in cognitive function. The current available therapy does not improve long- term outcome and remains a substantially unmet medical need. The review is an approach to emphasize the risk factors and diagnostic biomarkers of stroke that can be associated with post-stroke cognitive deficit, which may help in detecting patients at increased risk of cognitive deterioration and prevent or delay the occurrence of post-stroke cognitive impairments.


Wahul AB, Joshi PC, Kumar A, Chakravarty S (2018) Association of Diagnostic Stroke Biomarkers with Post Stroke Cognitive Impairment. J Neurol Disord Stroke 6(1): 1134.


•    Stroke
•    Cognition
•    Risk factors
•    Biomarkers


PBA: Pseudo-Bulbar Affect; AD: Alzheimer’s Disease; MMSE: Mini-Mental State Examination; NVU: Neurovascular Unit; BBB: Blood Brain Barrier; fMRI: functional Magnetic Resonance Imaging; PSCI: Post Stroke Cognitive Impairment


Stroke is a leading cause of death and functional disability [1] in which a sudden loss of neurologic function results from focal disturbance in the cerebral blood flow due to ischemia or hemorrhage. Cognitive impairment and memory loss is quite common after the stroke. Approximately 30% of stroke patients develop memory impairment within one year of stroke onset. Stroke affects the cognitive domain, which includes attention, memory, language, and orientation etc. There has been a tremendous effort to understand the molecular mechanisms involved in post stroke neural regions in exploring biomarkers for clinical diagnosis of stroke, its prognosis and treatment response [2]. Range of biomarkers is related for its association with risk assessment, diagnostic purpose and to predict poststroke therapeutic outcome. Various biomarkers associated with risk and even prevention strategies have been reviewed extensively [2-4]. In addition to this, American stroke association reviewed markers of prospective stroke risk for primary and secondary prevention [5]. Moreover, the effect of stroke as a result of reductions in blood flow to the brain for sufficient duration results in damage to neuronal networks or circuitries leading to various mood disorders such as depression, anxiety and pseudo-bulbar affect (PBA), impairment of sensation, movement or cognition [6,7].

The molecular mechanism underlying cognitive impairment after stroke remains uncertain. Evidences suggest that the cognitive impairment develops within 3 months post stroke [8] and the prevalence of stroke induced cognitive impairment varies from 6 to 27%. Though, a recent study shows its prevalence up to41.8% and it appears an exponential increase with age 65 years and older [9,10]. Furthermore, stroke not only involved in the vascular cognitive impairment, which took over vascular dementia, but also the pathogenesis of Alzheimer’s disease (AD) suggesting an overlap between both. The clinical study suggests that the pathogenesis of AD makes contribution to 1/3rdof demented cases post stroke [11]. Clinically patients with the cognitive impairment can be divided into the mild cognitive impairment and dementia based on the degree of cognitive decline [12]. The prevalence of short-term post-stroke dementia, including cognitive impairment, has been reported in many studies, that have used various standardized diagnostic measures such as Diagnostic and Statistical Manuals of Mental Disorders IV, or a Mini-Mental State Examination (MMSE) score of <24 as an outcome [13-15].

The association of various biomarkers in the diagnosis of stroke and in post-stroke cognitive impairment has rarely been studied. In this review, we summarize such biomarkers that offer promise to achieve successful candidates in the regulation of post-stroke cognitive impairment.

Mechanism of post-stroke cognitive impairment

The basic concept for stroke development and degree of post stroke cognitive impairment is paucity of energy or oxygen to the brain resulting in region specific neural damage and/or white matter lesions depending on the severity and duration. The neurovascular unit (NVU) consisting of neuro-glial population and the endothelial cells of blood brain barrier (BBB) etc. is a vital to this process and sustains a ‘metabolic coupling’ between neuronal processes and blood circulation to uphold the high metabolic need of the vascular system and the microcirculation of the brain to altered conditions [16]. Some studies with functional magnetic resonance imaging (fMRI) have shown that following stroke there is an uncoupling among metabolic needs, particularly for oxygen and vascular supply and this can worsen the outcomes [17].

The other cells of the NVU, astrocytes play a key role in supporting neurons and maintaining synaptic functions [18]. Since end feet structures of astrocytes are in close contact with cerebral endothelial cells and deliver a physical link to the microvasculature. Hence, astrocytes are therefore uniquely placed to exercise control over local alterations in cerebral blood flow as well as modifiable tight junction integrity. Astrocytes, and other cellular components of the NVU, seem to play a critical role in monitoring changes in synaptic activity and signaling between micro vascular units. The BBB, is a critical interface that maintains the brain’s need for constant perfusion and consists of a dynamic and functional NVUs that are formed from astrocytes, microglia, capillary endothelium, neurons, pericytes and extracellular matrix all acting in a corresponding manner. In CNS disease, however, the well-organized structure of the NVU breaks down resulting in breaches in the BBB leading to neuronal damage and cognitive impairment.

Several CNS conditions include molecular mechanisms leading to disruption in the NVU that share common pathways such as neuro-inflammation (interleukin IL-6, tumor necrosis factor-alpha [TNF-α]), oxidative stress (reactive oxygen species), apoptosis (caspase-3), neurotrophic alterations (brain-derived neurotrophic factor [BDNF]), astrocytic loss (GFAP, S100β) other factors resulting in the neurovascular damage and degeneration. The combined effects of this are the synaptic loss and, ultimately, a progressive cognitive impairment [19] (Figure 1).

Stroke leads to impairment in memory function by alteration of diverse molecular mechanisms that ultimately cause drop in neuronal and glial cell population. (-) sign indicates deleterious mechanism followed by stroke.

Apart from these factors several other biomarkers contribute to the diagnosis of stroke and are involved in post-stroke cognitive impairment such as neuron-specific enolase (NSE), Homocysteine, hFABP (Heart fatty acid-binding protein), CRP (C-reactive protein), MMP2 (matrix metalloproteinase-2, PARK7 (Parkinson disease protein 7), NDKA (Nucleoside diphosphate kinase A), ASIC-1 (Acid-sensing icon channel-1). In brief, NSE is an enzyme in the glycolysis pathway and similar to S100β, NSE concentration rises in the CSF following ischemic stroke and becomes detectable between 4 and 8 h after the onset of stroke. One study has reported that NSE levels along with S100β predict cognitive dysfunction [20]. The concentrations of total homocysteine (tHcy) represent a potentially modifiable risk factor for stroke [21] and its elevated levels have been a risk factor in stroke patients [22]. One mechanism could be that the reduced level of SOD1 leads to hyper-homocysteinemia thus promoting ischemic stroke [23]. Another marker, hFABP, elevated early in acute ischemic stroke indicates that especially hFABP might have the potential to be a rapid marker of brain damage and clinical severity [24]. Furthermore, an increase in CSF and serum levels of hFAB has been reported in the patients with neurodegenerative diseases [25]. Another biomarker in same family namely B- Fatty Acid Binding Protein (B-FABP) considered as a biomarker for small sub-cortical and lacunar infarcts but might be non-specific since it’s also associated with mild Traumatic Brain Injury (TBI) and electroconvulsive therapy. Growing evidence suggests that CRP is not only an inflammatory marker but also has influential pro-atherogenicaction which directly involved in the process of atherogenesis, causing stroke, leukoaraiosis and vascular dementia [26]. Experimental studies also showed its potential role in neurotoxicity [27]. Among matrix metalloproteinase (MMPs), gelatinases (MMP-2 and MMP-9) are the most investigated enzymes and are widely reviewed [28], that possess ability to active numerous proinflammatory agents. Furthermore, clinical studies had shown that lipid-lowering drugs possess the ability to inhibit the activity of MMP-9 during acute ischemic stroke also synthetic inhibitors decreases the infarct volume in animal models of ischemic stroke and also prevents the cognitive impairment [28-30]. PARK7 protein and nucleoside diphosphate kinase A in the spinal fluid were identified as candidates for ischemic stroke biomarkers [31,32]. The ASIC1a channels are highly populated in the neurons and has shown its association with cerebral ischemia [33]. While melondialdehyde was found to be associated with post-stroke depression condition [34].

Among the haemostatic factors, studies showed that increased fibrinogen levels increases the risk of cognitive impairment [35]. Others biomarkers do not show any direct relevance associated with the post stroke cognitive decline, however their role in the in the diagnosis of stroke could not be overlooked. On the contrary few biomarkers like Apolipoprotein C1 and C3, plasma DNA, baseline levels of thrombin activablefibrinolysis inhibitor, MMP3 and tissue inhibitor for metalloproteinase 2(TIMP-2) helps in hemorrhagic stroke detection [3,36]. Different biomarkers in the diagnosis of different types of stroke and its association with post stroke cognitive impairment was elaborated in Table 1.


A number of potential biomarkers of ischemic stroke have been identified, which will improve patient quality life. Many of these markers relate to the pathophysiology of ischemic stroke, including ischemia of CNS tissue, acute thrombosis and inflammatory response. Animal-based research and the outcome of human trials have led to better understanding of the complexity in stroke and comorbid cognitive condition. Identification of early diagnostic markers in stroke associated cognitive impairment could be the successful approach for detection of increased risk of post-stroke cognitive deterioration which can lead to the identification of therapeutic targets and monitor response to treatment, for promising potential therapeutic applications.

Table 1: Different biomarkers in the diagnosis of Ischemic stroke and its association with post stroke cognitive impairment.

  Types of stroke Biomarkers Description of Biomarker Association of marker with post stroke cognitive impairment Reference
CNS related markers Ischemic BNDF (Serum Neurotrophin, essential for neuronal plasticity and long term potentiation ++ [37]
Ischemic Hemorrhagic and Traumatic Brain injury S100β (Serum Calcium binding protein secreted by astrocytes. In general promote neuroplasticity but in disease condition like stroke exacerbates gliosis. ++ [38]
Ischemic and Hemorrhagic GFAP (Plasma GFAP is principle intermediate filament protein secreted by astrocytes ++ [38]
Ischemic and Hemorrhagic NSE (Plasma, CSF Prognostic indicator followed by cardiac arrest ++ [38]
Ischemic and Transient Ischemic Attack (TIA NMDA-R Ab (Autoantibodies to the NR2A / NR2B subunits of the NMDA receptor By decreasing SK2 Channel activity by repolarization /depolarization of Ca2+ influx, Specific to ischemic condition ++ [39, 40]
Ischemic and Small vessel stroke MBP (Myelin basic protein (Blood, CSF Rarefaction of white matter due to loss of nerve fiber degeneration, gliosis and demyelination. Also it predominantly expressed in acute sever ischemic condition ++ [41]
Ischemic NAA (Serum Acts as a molecular water pump which helps in flow of metabolic water ++ [3]
Ischemic and Hemorrhagic VLP1 (Plasma , CSF Neuronal Ca2+ sensor protein abundantly fund in neurons ++ [42, 43]
Ischemic UFDP-1 Degradation of ubiquitin   [44]
Ischemic and Hemorrhagic hFABP( serum Involved in transport of long chain fatty acid which influences the functions like cellular growth and differentiation ++ [24, 45]
Ischemic GST-π Detoxifying ROS - [46]
Ischemic IMA (Blood IMA produced in ischemic – hypoxic condition, binding affinity for metal ions reduces under ischemic condition - [47]
Ischemic Plasma glutamate Excitotoxic,progression of ischemic stroke but no direct correlation with ischemic output - [48]
Ischemic ASIC-1a Calcium regulation + [33]
Ischemic SOD(Plasma ROS ++ [23, 49]
Ischemic (serum Malondialdehyde Lipid oxidation, post stroke depression   [50]
Inflammatory Biomarkers Ischemic + TIA CRP Acute phase protein associated with inflammation and responsible for BBB disruption ++ [51]
Ischemic and Hemorrhagic IL-6 Anti-inflammatory mediators associated with infract volume ++ [52]
  IL-8 + [53]
  IL-12 ++ [53]
Ischemic TNF-α Secreted by endothelial cells, microglia and astrocytes, ROS activation,Associated with infract volume ++ [52]
Ischemic VCAM 1 (Blood Part of immunoglobulin superfamily which plays role in inflammation and immune response as well as migration of leucocytes - [54]
Ischemic ICAM-1(Blood, CSF Leucocyte infiltration from blood to brain - [55]
Ischemic and Hemorrhagic MMP2-2& 9 Proteolytic enzymes secreted by astrocytes and microglia which are responsible for damaging BBB and capillaries and promotes the inflammatory mechanism ++ [30]
Ischemic Lp-PLA2 Pro-inflammatory - [51, 56]
Hemorrhagic ApoC-I, III (Plasma   - [57, 58]
Ischemic Caspase-3(plasma DNA fragmentation + [59]
Haemostatic markers Ischemic Fibrinogen   + [51, 60]
Ischemic +TIA D-Dimer Strongest prognostic indicator - [61]
Ischemic vWF Exacerbate stroke outcome by increasing death rate - [54, 62]
Ischemic Thrombomodulin (Serum No direct co-relation with stroke condition but elevated levels may responsible for higher death rate - [4]
Ischemic + TIA Fibrinopeptide A Increase death rate - [63]
Ischemic +TIA β-thromboglobulin Exacerbate stroke outcome by increasing death rate - [64]
Miscellaneous Ischemic and Hemorrhagic (Plasma Plasma DNA Nonspecific stroke biomarker since expressed in other disease condition - [65]
Ischemic (CSF, Plasma PARK7 (Parkinson disease protein 7 Redox sensitive molecular chaperone activated after oxidative stress + [31, 66]
Ischemic (CSF, Plasma NDKA Kinase which catalyzes transfer of terminal phosphate from ATP to nucleotide. - [32, 46]
Ischemic (Plasma Homocysteine Elevated level causes oxidative stress, endothelial dysfunction , atherothrombosis + [23]
Direct Relevance: ++; Indirect relevance: +; No direct relevance: -
Abbreviations: BNDF: Brain Derived Neurotrophic Factor; GFAP: Glial Fibrillary Acidic Protein; NSE: Neuron Specific Enolase; MBP: Myelin Basic 
Protein; NAA: N-Acetyl-L-Aspartate; VLP1: Visinin Like Protein 1; NDKA: Nucleoside Diphosphate Kinase A; UFDP-1: Ubiquitin Fusion Degradation 
Protein 1; hFAB: Heart Fatty Acid-Binding Protein; GST-π: Glutathione S Transferase π; IMA: Ischemia Modified Albumin; ASIC-1a: Acid Sensing Ion 
Channels-1a; SOD: Superoxide Dismutase; ROS: Reactive Oxygen Species; CRP: C-Reactive Protein; IL: Interleukin; TNF-α: Tumor Necrosis Factor; 
VCAM 1: Vascular Cell Adhesion Protein 1; ICAM 1: Intercellular Adhesion Molecule 1; MMP: Matrix Metalloproteinase; Lp-PLA2: LipoproteinAssociated Phospholipase A2; ApoC-I, III: Apolipoprotein C-I, III; vWF: Von Willebrand Factor; PARK7: Parkinson Disease Protein 7; NDKA: Nucleoside 
Diphosphate Kinase A



This work was supported by the Council of Scientific and Industrial Research (BSC-0103/UNDO), India. ABW was supported by senior research fellowship of the University Grants Commission (UGC). In addition, the authors would like to acknowledge Dr. Sikta Bandopadhyay for the critical reading of the manuscript.


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Received : 01 Dec 2017
Accepted : 03 Jan 2018
Published : 04 Jan 2018
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ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
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