Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Oncology Letters
      • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Biomedical Reports
      • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • Information for Authors
    • Information for Reviewers
    • Information for Librarians
    • Information for Advertisers
    • Conferences
  • Language Editing
Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • For Authors
    • For Reviewers
    • For Librarians
    • For Advertisers
    • Conferences
  • Language Editing
Login Register Submit
  • This site uses cookies
  • You can change your cookie settings at any time by following the instructions in our Cookie Policy. To find out more, you may read our Privacy Policy.

    I agree
Search articles by DOI, keyword, author or affiliation
Search
Advanced Search
presentation
Experimental and Therapeutic Medicine
Join Editorial Board Propose a Special Issue
Print ISSN: 1792-0981 Online ISSN: 1792-1015
Journal Cover
March-2020 Volume 19 Issue 3

Full Size Image

Sign up for eToc alerts
Recommend to Library

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

Medicine International

An International Open Access Journal Devoted to General Medicine.

Journal Cover
March-2020 Volume 19 Issue 3

Full Size Image

Sign up for eToc alerts
Recommend to Library

  • Article
  • Citations
    • Cite This Article
    • Download Citation
    • Create Citation Alert
    • Remove Citation Alert
    • Cited By
  • Similar Articles
    • Related Articles (in Spandidos Publications)
    • Similar Articles (Google Scholar)
    • Similar Articles (PubMed)
  • Download PDF
  • Download XML
  • View XML
Article Open Access

Determination of the ED50 and ED95 of intravenous bolus of norepinephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery

  • Authors:
    • Tingting Wang
    • Qiuli He
    • Wangping Zhang
    • Jianjun Zhu
    • Huadong Ni
    • Rui Yang
    • Qianying Liu
    • Longsheng Xu
    • Ming Yao
  • View Affiliations / Copyright

    Affiliations: The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, P.R. China, Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China, Department of Anesthesiology, Affiliated Women and Children's Hospital of Jiaxing University, Jiaxing, Zhejiang 314001, P.R. China
    Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Pages: 1763-1770
    |
    Published online on: December 20, 2019
       https://doi.org/10.3892/etm.2019.8360
  • Expand metrics +
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )
Cited By (CrossRef): 0 citations Loading Articles...

This article is mentioned in:



Abstract

Norepinephrine is considered as a potential alternative for blood pressure stabilization during spinal anesthesia for cesarean delivery, as it maintains a better maternal heart rate and cardiac output compared with phenylephrine. However, its use as a bolus dose for hypotension treatment remains largely unexplored. Therefore, the present study investigated the ED50 and ED95 of norepinephrine as a bolus for maternal hypotension during cesarean delivery. In the present prospective trial, 42 patients were enrolled for elective delivery under spinal anesthesia. The dose of norepinephrine was decided by the up‑and‑down sequential allocation method (UDM) with an initial dose of 0.075 µg/kg and a 0.025 µg/kg increment. The 42 patients received a bolus of norepinephrine when systolic blood pressure fell to <80% of baseline. The ED50 was calculated by the sequential method and the probit regression model. The ED95 was then calculated using the probit regression model. The ED50 of norepinephrine, which was determined by the UDM, was 0.067 µg/kg (95% CI, 0.056‑0.081). The probit regression model calculated an ED50 of 0.072 µg/kg (95% CI, 0.056‑0.088) and an ED95 of 0.121 µg/kg (95% CI, 0.1‑0.207). In summary, the present results suggested the ED50 of a bolus norepinephrine for preventing hypotension in elective CD is 0.067 µg/kg (95% CI, 0.056‑0.081), with an ED95 of 0.121 µg/kg (95% CI, 0.1‑0.207).
View Figures

Figure 1

Figure 2

Figure 3

View References

1 

Mercier FJ, Augè M, Hoffmann C, Fischer C and Gouez AL: Maternal hypotension during spinal anesthesia for caesarean delivery. Minerva Anestesiol. 79:62–73. 2013.PubMed/NCBI

2 

Antoine C and Young BK: Fetal lactic acidosis with epidural anesthesia. Am J Obstet Gynecol. 142:55–59. 1982. View Article : Google Scholar : PubMed/NCBI

3 

Ali Elnabtity AM and Selim MF: Norepinephrine versus ephedrine to maintain arterial blood pressure during spinal anesthesia for cesarean delivery: A prospective double-blinded trial. Anesth Essays Res. 12:92–97. 2018. View Article : Google Scholar : PubMed/NCBI

4 

Lee A, Kee WD and Gin T: A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 94:920–926. 2002. View Article : Google Scholar : PubMed/NCBI

5 

Ngan Kee WD, Lee A, Khaw KS, Ng FF, Karmakar MK and Gin T: A randomized double-blinded comparison of phenylephrine and ephedrine infusion combinations to maintain blood pressure during spinal anesthesia for cesarean delivery: The effects on fetal acid-base status and hemodynamic control. Anesth Analg. 107:1295–1302. 2008. View Article : Google Scholar : PubMed/NCBI

6 

Ngan Kee WD, Khaw KS, Tam YH, Ng FF and Lee SW: Performance of a closed-loop feedback computer-controlled infusion system for maintaining blood pressure during spinal anaesthesia for caesarean section: A randomized controlled comparison of norepinephrine versus phenylephrine. J Clin Monit Comput. 31:617–623. 2017. View Article : Google Scholar : PubMed/NCBI

7 

Stewart A, Fernando R, McDonald S, Hignett R, Jones T and Columb M: The dose-dependent effects of phenylephrine for elective cesarean delivery under spinal anesthesia. Anesth Analg. 111:1230–1237. 2010. View Article : Google Scholar : PubMed/NCBI

8 

Ngan Kee WD, Lee SW, Ng FF, Tan PE and Khaw KS: Randomized double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology. 122:736–745. 2015. View Article : Google Scholar : PubMed/NCBI

9 

Chooi C, Cox JJ, Lumb RS, Middleton P, Chemali M, Emmett RS, Simmons SW and Cyna AM: Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 8:CD0022512017.PubMed/NCBI

10 

Chen D, Qi X, Huang X, Xu Y, Qiu F, Yan Y and Li Y: Efficacy and safety of different norepinephrine regimens for prevention of spinal hypotension in cesarean section: A randomized trial. Biomed Res Int. 2018:27081752018.PubMed/NCBI

11 

Onwochei DN, Ngan Kee WD, Fung L, Downey K, Ye XY and Carvalho JC: Norepinephrine intermittent intravenous boluses to prevent hypotension during spinal anesthesia for cesarean delivery: A sequential allocation dose-finding study. Anesth Analg. 125:212–218. 2017. View Article : Google Scholar : PubMed/NCBI

12 

Doyle DJ and Garmon EH: American Society of Anesthesiologists Classification (ASA Class). StatPearls Publishing LLC; Treasure Island, FL: 2019

13 

Harten JM, Boyne I, Hannah P, Varveris D and Brown A: Effects of a height and weight adjusted dose of local anaesthetic for spinal anaesthesia for elective Caesarean section. Anaesthesia. 60:348–353. 2005. View Article : Google Scholar : PubMed/NCBI

14 

Vallejo MC, Attaallah AF, Elzamzamy OM, Cifarelli DT, Phelps AL, Hobbs GR, Shapiro RE and Ranganathan P: An open-label randomized controlled clinical trial for comparison of continuous phenylephrine versus norepinephrine infusion in prevention of spinal hypotension during cesarean delivery. Int J Obstet Anesth. 29:18–25. 2017. View Article : Google Scholar : PubMed/NCBI

15 

Apgar V: A proposal for a new method of evaluation of the newborn infant. Anesthesia Analgesia. 32:250–259. 1953. View Article : Google Scholar

16 

Ngan Kee WD: A Random-allocation graded dose-response study of norepinephrine and phenylephrine for treating hypotension during spinal anesthesia for cesarean delivery. Anesthesiology. 127:934–941. 2017. View Article : Google Scholar : PubMed/NCBI

17 

Ngan Kee WD, Khaw KS and Ng FF: Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section. Br J Anaesth. 92:469–474. 2004. View Article : Google Scholar : PubMed/NCBI

18 

Liu H, Huang Y, Diao M, Li H, Ma Y, Lin X and Zhou J: Determination of the 90% effective dose (ED90) of phenylephrine for hypotension during elective cesarean delivery using a continual reassessment method. Eur J Obstet Gynecol Reprod Biol. 194:136–140. 2015. View Article : Google Scholar : PubMed/NCBI

19 

Stylianou M and Flournoy N: Dose finding using the biased coin up-and-down design and isotonic regression. Biometracs. 58:171–177. 2002. View Article : Google Scholar

20 

Dixon WJ: Staircase bioassay: The up-and-down method. Neurosci Biobehav Rev. 15:47–50. 1991. View Article : Google Scholar : PubMed/NCBI

21 

Pace NL and Stylianou MP: Advances in and limitations of up-and-down methodology: A précis of clinical use, study design, and dose estimation in anesthesia research. Anesthesiology. 107:144–152. 2007. View Article : Google Scholar : PubMed/NCBI

22 

Dixon WJ: The up-and-down method from small samples. J Am Stat Assoc. 60:967–978. 1965. View Article : Google Scholar

23 

Miller JM Jr, Bernard M, Brown HL, St Pierre JJ and Gaber HA: Umbilical cord blood gases for term healthy newborns. Am J Perinatol. 7:157–159. 1990. View Article : Google Scholar : PubMed/NCBI

24 

Sell A, Olkkola KT, Jalonen J and Aantaa R: Minimum effective local anaesthetic dose of isobaric levobupivacaine and ropivacaine administered via a spinal catheter for hip replacement surgery. Br J Anaesth. 94:239–242. 2005. View Article : Google Scholar : PubMed/NCBI

25 

Lynde GC: Determination of ED50 of hydromorphone for postoperative analgesia following cesarean delivery. Int J Obstet Anesth. 28:17–21. 2016. View Article : Google Scholar : PubMed/NCBI

26 

Johnston DF, Sondekoppam RV, Giffin R, Litchfield R and Ganapathy S: Determination of ED50 and ED95 of 0.5% Ropivacaine in adductor canal block to produce Quadriceps weakness: A dose-finding study. Reg Anesth Pain Med. 42:731–736. 2017. View Article : Google Scholar : PubMed/NCBI

27 

Tallarida RJ: Drug Synergism and Dose-Effect Data Analysis. Chapman and Hall/CRC; New York, NY: pp. 21–39. 2000

28 

Macarthur A and Riley ET: Obstetric anesthesia controversies Vasopressor choice for postspinal hypotension during cesarean delivery. Int Anesthesiol Clin. 45:115–132. 2007. View Article : Google Scholar : PubMed/NCBI

29 

Thomas D, Robson S, Redfern N, Hughes D and Boys R: Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for Caesarean section. Br J Anaesth. 76:61–65. 1996. View Article : Google Scholar : PubMed/NCBI

30 

Ngan Kee WD, Khaw KS, Lee BB, Lau TK and Gin T: A dose-response study of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 90:1390–1395. 2000. View Article : Google Scholar : PubMed/NCBI

31 

Puolakka J, Kauppila A, Tuimala R, Jouppila R and Vuori J: The effect of parturition on umbilical blood plasma levels of norepinephrine. Obstet Gynecol. 61:19–21. 1983.PubMed/NCBI

32 

Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, Palanisamy A, Sia AT, Van de Velde M and Vercueil A; Consensus Statement Collaborators, : International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 73:71–92. 2018. View Article : Google Scholar : PubMed/NCBI

33 

Doherty A, Ohashi Y, Downey K and Carvalho JC: Phenylephrine infusion versus bolus regimens during cesarean delivery under spinal anesthesia: A double-blind randomized clinical trial to assess hemodynamic changes. Anesth Analg. 115:1343–1350. 2012. View Article : Google Scholar : PubMed/NCBI

34 

Langesæter E, Rosseland LA and Stubhaug A: A randomized, double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion. Anesthesiology. 109:856–863. 2008. View Article : Google Scholar : PubMed/NCBI

35 

Smiley RM: More perfect? Int J Obstet Anesth. 29:1–4. 2017. View Article : Google Scholar : PubMed/NCBI

36 

Greenwald HP, Gootnick A, Luger NM and King JA: Tissue necrosis following subcutaneous infiltration with nor-epinephrine; Report of two cases. N Engl J Med. 246:252–253. 1952. View Article : Google Scholar : PubMed/NCBI

37 

Turner DA and Kleinman ME: The use of vasoactive agents via peripheral intravenous access during transport of critically III infants and children. Pediatr Emerg Care. 26:563–566. 2010. View Article : Google Scholar : PubMed/NCBI

38 

Medlej K, Kazzi AA, El Hajj Chehade A, Saad Eldine M, Chami A, Bachir R, Zebian D and Abou Dagher G: Complications from administration of vasopressors through peripheral venous catheters: An observational study. J Emerg Med. 54:47–53. 2018. View Article : Google Scholar : PubMed/NCBI

Related Articles

  • Abstract
  • View
  • Download
  • Twitter
Copy and paste a formatted citation
Spandidos Publications style
Wang T, He Q, Zhang W, Zhu J, Ni H, Yang R, Liu Q, Xu L and Yao M: Determination of the ED50 and ED95 of intravenous bolus of norepinephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery. Exp Ther Med 19: 1763-1770, 2020.
APA
Wang, T., He, Q., Zhang, W., Zhu, J., Ni, H., Yang, R. ... Yao, M. (2020). Determination of the ED50 and ED95 of intravenous bolus of norepinephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery. Experimental and Therapeutic Medicine, 19, 1763-1770. https://doi.org/10.3892/etm.2019.8360
MLA
Wang, T., He, Q., Zhang, W., Zhu, J., Ni, H., Yang, R., Liu, Q., Xu, L., Yao, M."Determination of the ED50 and ED95 of intravenous bolus of norepinephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery". Experimental and Therapeutic Medicine 19.3 (2020): 1763-1770.
Chicago
Wang, T., He, Q., Zhang, W., Zhu, J., Ni, H., Yang, R., Liu, Q., Xu, L., Yao, M."Determination of the ED50 and ED95 of intravenous bolus of norepinephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery". Experimental and Therapeutic Medicine 19, no. 3 (2020): 1763-1770. https://doi.org/10.3892/etm.2019.8360
Copy and paste a formatted citation
x
Spandidos Publications style
Wang T, He Q, Zhang W, Zhu J, Ni H, Yang R, Liu Q, Xu L and Yao M: Determination of the ED50 and ED95 of intravenous bolus of norepinephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery. Exp Ther Med 19: 1763-1770, 2020.
APA
Wang, T., He, Q., Zhang, W., Zhu, J., Ni, H., Yang, R. ... Yao, M. (2020). Determination of the ED50 and ED95 of intravenous bolus of norepinephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery. Experimental and Therapeutic Medicine, 19, 1763-1770. https://doi.org/10.3892/etm.2019.8360
MLA
Wang, T., He, Q., Zhang, W., Zhu, J., Ni, H., Yang, R., Liu, Q., Xu, L., Yao, M."Determination of the ED50 and ED95 of intravenous bolus of norepinephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery". Experimental and Therapeutic Medicine 19.3 (2020): 1763-1770.
Chicago
Wang, T., He, Q., Zhang, W., Zhu, J., Ni, H., Yang, R., Liu, Q., Xu, L., Yao, M."Determination of the ED50 and ED95 of intravenous bolus of norepinephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery". Experimental and Therapeutic Medicine 19, no. 3 (2020): 1763-1770. https://doi.org/10.3892/etm.2019.8360
Follow us
  • Twitter
  • LinkedIn
  • Facebook
About
  • Spandidos Publications
  • Careers
  • Cookie Policy
  • Privacy Policy
How can we help?
  • Help
  • Live Chat
  • Contact
  • Email to our Support Team