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Writing for Scientific Papers Lecture 10 of the Course “Medical English”

Writing for Scientific Papers Lecture 10 of the Course “Medical English” for Sophomore Medical Students of Taipei Medical University School of Medicine Taipei Medical University. Winston W. Shen, M.D. Professor and Chairman Department of Psychiatry

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Writing for Scientific Papers Lecture 10 of the Course “Medical English”

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  1. Writing for Scientific Papers Lecture 10 of the Course “Medical English” for Sophomore Medical Students of Taipei Medical University School of Medicine Taipei Medical University Winston W. Shen, M.D. Professor and Chairman Department of Psychiatry Taipei Medical University College of Medicine and Chief, Department of Psychiatry TMU-Wan Fang Medical Center Taipei, TAIWAN E-mail address: Shenwinw@gmail.com

  2. The Schedule for the Course “Medical English” (Version of 3/29/07) • Week 1 (March 1) The Digestive System • Week 2 (March 8) The Respiratory System • Week 3 (March 15) The Cardiovascular System • Week 4 (March 22) The Musculoskeletal System (Turning in a 400-word essay on “My Visit to the Clinic (Hospital)” (in double-line space hard copy) • Week 5 (March 29) The Central Nervous System • Week 6 (April 5) No class (Spring break) • Week 7 (April 12) Urinary and Reproductive Systems • Week 8 (April 19) The First Examination • Week 9 (April 26) Medical Records (Turning in a 400-word essay on “My Favorite Book” (in double-line space hard copy) • Week 10 (May 3) Scientific Papers • Week 11 (May 10) Hematology • Week 12 (May 17) Infectious Diseases • Week 13 (May 24) The Second Examination • Week 14 (May 31) Endocrinology (Turning in a 400-word essay on “How to Be a Good Physician” (in double line space hard copy) • Week 15 (June 7) Immunology • Week 16 (June 14) Oncology • Week 17 (June 21) No Class • Week 18 (June 28) Final (The Third) Examination

  3. The IMRAD Writing • Introduction • Method • Results • and • Discussion

  4. “Where shall I begin, please you Majesty?” he asked. “Begin at the beginning,” the King said gravely, and go on till you come to the end, then stop.” Lewis Carroll (1832-1898) Alice in Wonderland

  5. “A bad beginning makes a bad ending.” -- Euripides

  6. How to Write the Results Section(What did I find?) • To summarize the data collected and their • statistical treatment • To collect the study data in tables or figures • To make sure they can give independent stories • in tables or figures • To include only relevant data but give sufficient • details to justify the conclusion

  7. “A tabular presentation of data is often the heart, or better, the brain, of a scientific paper.” -- Peper Morgan

  8. “If a man can group his ideas, then he is writer.” -- Euripides

  9. Twenty-four-hour Cortisol Changes inDepressed Patients vs. Normal Controls Sachar EJ et al.. Archives of General Psychiatry. 1973; 28 (7): 19-24.

  10. Indications Approved by Drug and Food Administration* as of June 2006 Antimanic indication Prophylaxis treatment Treatment for bipolar depression Lithium Valproate Olanzapine Olanzapine/fluoxetine (Symbyax) Risperidone Quetiapine Ziprasidone Aripiprazole Lamotrigine Carbamazepine ER (Equetro) 1975 1995 2000, 20031 2003, 20031 20041,2 2004 20042 2004 1978 2003 2005 2004 2003 2006 *Chlorpromazine (Thorazine) is not included here; 1Adding lithium or valproate can increase antimanic efficacy. 2Up to 3 months; Modified from: Shen WW (2007), Clinical Psychopharmacology for the 21 Century, The Second Edition (Mandarin) Taipei: Hochi Publishing Co.

  11. “I can give birth to a baby, but I can not produce the data you want.” -- Yao-Chi Koa Minister of Transportation Replying at a congressional hearing regarding the FTC scandal in March 2006 Winston W. Shen, M.D./5-2006

  12. To Simplify the Large Table • To remove unneeded rows and columns • To combine columns that are closedly related by using slashes or dashes • Not to repeat data that are already in the text or in another table • Not to repeat any label information in the heading that may already be in the title or the footnote Mary Helen Briscoe 1995

  13. Table 1. Demographics Healthy Controls 39 26/13 30.5 ± 7.1 27 W/7B/5O Recent Onset Patients 26 14/12 30.3 ±6.7 9W/11B/6 0 First Episode Patients 26 19/7 23.9 ±5.5a 19W/12B/410 Chronic Patients 25 17/8 39.0 ± 86a 12W/10B/2O n M/F Age Race M, male; F, female; W, white; O, other aSignificantly different from Healthy Controls A table from:Umbricht DSD, et al. Biological Psychiatry 2006; 59: 762-772 Winston W. Shen, M.D./5-2006

  14. Subjects’ characteristic and the mean lumber spin bone mass density (LS-BMD) z scores (Original Version) Number (%) 28 (100%) 16 (57%) 12 (43%) 17 (61%) 11 (39%) 21 (75%) 7 (25%) 13 (46%) 13 (46%) 7 (25%) 10 (36%) 11 (39%) - Mean ± SD 2.46 ± 1.06 2.58 ± 1.31 2.31 ± 0.60 2.04 ± 0.79 3.12 ± 1.12 2.29 ± 0.96 2.97 ± 1.25 2.01 ± 0.75 2.89 ± 1.24 1.66 ± 0.66 2.13 ± 0.74 3.28 ± 0.99 p-Value NS a p < 0.01 NS p< 0.01 A-Bb, p < 0.05 W-Bc, p < 0.05 Variable All subjects Sex Male Female Age (years) 2-10 11-24 Taking anticonvulsants Absent Present Disable pattern Non-quadriplegia Quadriplegia Mobility level Ambulatory (A) Wheelchaire (W) Bedridden (B) a. Not significant b. The mean difference of LS-BMD z score between A and B subjects c. The mean difference of LS-BMD z score between W and B subjects

  15. Subjects’ characteristic and the mean lumber spin bone mass density (LS-BMD) z scores (Problems Shown) Number (%) 28 (100%) 16 (57%) 12 (43%) 17 (61%) 11 (39%) 21 (75%) 7 (25%) 13 (46%) 13 (46%) 7 (25%) 10 (36%) 11 (39%) Mean ± SD -2.46 ± 1.06 -2.58 ± 1.31 -2.31 ± 0.60 -2.04 ± 0.79 -3.12 ± 1.12 -2.29 ± 0.96 -2.97 ± 1.25 -2.01 ± 0.75 -2.89 ± 1.24 -1.66 ± 0.66 -2.13 ± 0.74 -3.28 ± 0.99 p-Value NSa p< 0.01 NS p < 0.01 A-Bb, p < 0.05 W-Bc, p < 0.05 Variable All subjects Sex Male Female Age (years) 2-10 11-24 Taking anticonvulsants Absent Present Disable pattern Non-quadriplegia Quadriplegia Mobility level Ambulatory (A) Wheelchaire (W) Bedridden (B) a. Not significant b. The mean difference of LS-BMD z score between A and B subjects c. The mean difference of LS-BMD z score between W and B subjects

  16. Subjects’ characteristic and the mean lumber spin bone mass density z scores (n = 28) (Revision) Number (%) 16 (57%) 12 (43%) 17 (61%) 11 (39%) 21 (75%) 7 (25%) 13 (46%) 13 (46%) 7 (25%) 10 (36%) 11 (39%) Mean ± SD -2.58 ± 1.31 -2.31 ± 0.60 -2.04 ± 0.79a -3.12 ± 1.12 -2.29 ± 0.96 -2.97 ± 1.25 -2.01 ± 0.75b -2.89 ± 1.24 -1.66 ± 0.66c -2.13 ± 0.74d -3.28 ± 0.99 Variable Sex Male Female Age (years) 2-10 11-24 Taking anticonvulsants Absent Present Disable pattern Non-quadriplegic Quadriplegic Mobility level Ambulatory Wheelchaire Bedridden aSignificantly different, vs. the age group of 11-24 years, p< 0.01 bSignificantly different, vs. the qualdriplegic group, p < 0.05 cSignificantly different, vs. bedridden group, p < 0.005 dSignificantly different, vs. bedridden group, p < 0.05

  17. Editing the TableExample 1 (1/3) Original Version Table 3. Prevalence of ESR and CRP in JRA patients at the time of diagnosis, and after treatment for three and six months Time tested Pre-treatment Treatment for 3 months Treatment for 6 months ESR > 20 mm/h 46/53 (86%) 24/43 (55.8%) 26/52 (50.0%) ESR > 20 mm/h 25/53 (47.2%) 16/43 (37.2%) 17/52 (32.7%) Pa-value 0.05 0.13 0.11 Expressed as the number of patients with positive results over total patients checked (percentage) aCalculated by Fisher’s exact test

  18. Editing the TableExample 1 (2/3) Problems Indicated Table 3. Prevalence of ESR and CRP in JRA patients at the time of diagnosis, and after treatment for three and six months Time tested Pre-treatment Treatment for 3 months Treatment for 6 months ESR > 20 mm/h 46/53 (86%) 24/43 (55.8%) 26/52 (50.0%) ESR > 20 mm/h 25/53 (47.2%) 16/43 (37.2%) 17/52 (32.7%) Pa-value 0.05 0.13 0.11 Expressed as the number of patients with positive results over total patients checked (percentage) aCalculated by Fisher’s exact test

  19. Editing the TableExample 1 (3/3) Final Version Table 3. Prevalence of in JRA patients’ ESR and CRP at the time of diagnosis, and after treatment for three and six months Time tested Pre-treatment Treatment for 3 months Treatment for 6 months ESR > 20 mm/h 46/53 (86%) 24/43 (55.8%) 26/52 (50.0%) ESR > 20 mm/h 25/53 (47.2%) 16/43 (37.2%) 17/52 (32.7%) p-valuea 0.05 0.13 0.11 Expressed as the number of patients with positive results over total patients checked (percentage) aFisher’s exact test

  20. Not to Repeat Any Information in Tables or Figures in the Text • Table 1 lists patients’ clinical characteristics. • Fig. 2 represents the differences of HAM-D • scores of the two groups. • The patients had the mean age of 35 (ranges • 19-30) years. • Do not paraphrase the information in the tables or • in the figures in the text of the result section.

  21. Incidence of Adverse Events of Number (%) of Patients Receiving Mirtazapine or Paroxetine Mirtazapine group ( n = 128) Paroxetine group ( n = 126) Adverse event Dry mouth 34 (26.6)* 13 (10.3) Weight gain 14 (10.9)* 0 Nausea 8 (6.3) 24 (19.0)* Flatulence 4 (3.1) 15 (11.9)* Tremor 5 (3.9) 14 (11.1)* Somnolence 39 (30.5) 37 (29.4) Fatigue 22 (17.2) 15 (11.9) Headache 20 (15.6) 31 (24.6) Insomnia 15 (11.7) 14 (11.1) Dizziness 20 (15.6) 18 (14.3) Constipation 15 (11.7) 14 (11.1) Diarrhea 19 (14.8) 22 (17.5) Sweating increased 8 (6.3) 17 (13.5) *Significantly different, p < 0.05, Fisher’s exact test Schatzberg AF, et al. Am J Geriat Psychiatry 2002; 10: 541-550

  22. The Comorbidity between Six Major Psychiatric Disorders as Assessed by the Tetrachoric Correlation(N = 1,030 Female-Female Twin Pairs) Panic Major Phobia GAD disorder Bulimia depression Alcoholism Phobia. . . GAD0.382. . . Panic disorder0.520 0.484. . . Bulimia 0.181 0.234 0.221 . . . Major depression0.293 0.677 0.427 0.232 . . . Alcoholism 0.237 0.281 0.275 0.316 0.329 . . . All tetrachorics are significant at p < 0.000 GAD indicates generalized anxiety disorder From: Kendler KS et al, Archieves of General Psychiatry 1995; 52: 374-383

  23. Percentage of Psychiatric Outpatient Prescription Numberbetween the US vs. Taiwan % 70- 60- 50- 40- 30- 20- 10- 0- 62.3 *46.3 Number of outpatients US 32.1 TW 18.1 US TW Antidepressants Benzodiazepines *Combining anxiolytics 24.1% with hypnotics 22.2% Adapted by Shen WW, based on data of: (1) Pincus HA, et al., Archives of General Psychiatry 1999; 56: 441-449, (2) Su TP, et al., Chinese Medical Journal (Taipei) 2002; 65: 378-391 Shen WW. Antidepressants are underused in Taiwan. Taiwanese Journal of Psychiatry 2004; 18 (2): 77-78.

  24. Chronic Antidepressant Treatment Increases BDNF Expression in Hippocampus 200- 150- 100- 50- 0- * * * * * BDNF mRNA (% of vehicle) Veh FLX DEP STL TCP ECS MOR COC HAL Note: Veh, vehicle; STL, sertraline; DEP, desipramine; TCP, tranycypromine; FLX, fluoxetine; ECS, electroconvulsive shock; MOR, morphine; COC, cocaine; HAL, haloperidol Significantly different vs. vehicle (p < 0.001) Adapted from: Nibuya M, Morinobu S, Duman RS, Journal of Neuroscience, 1995; 15: 7539-7547

  25. Association between Depression Duration and Cerebral Gray Matter Volume in 19 Female Patients with Recurrent Major Depressive Disordera 650- 600- 550- 500- 450- 400- 350- • • • • • • • • • • • • • • • Cerebral gray matter volume (ml) • • • • 100 0 50 150 200 250 300 350 400 Duration of depression (months) ar=-0.66, df=16, P=0.003 Lampe IK, et al. American Journal of Psychiatry. 2003: 160: 2052-2054

  26. Response and Remission RatesDuloxetine, Fluoxetine vs. Placebo 100- 80- 60- 40- 20- 0- Duloxetine Fluoxetine Placebo P = 0.02 64 56 52 48 % of patients 18% 32 30 0 Response Remission Goldstein DJ, et al. Journal of Clinical Psychiatry 2002; 63: 225-231.

  27. Writing the Method Section How did I do it? • To describe the procedures used to come up with the data collected in the past tense •To report the statistics used in tables or figures in the past tense

  28. Randomized, Placebo-controlled Trial of Fluoxetine for Acute Treatment of Minor Depressive Disorder (1/2) 226 patients recruited 64 patients not randomized 4—major depressive disorder 14—not a minor depressive disorder 4—having adverse effects 6— inability to be contacted 22—patients’ withdrawal to participate 10—medically contraindicated condition 3—other protocol violation 4-week placebo lead-in 162 patients* randomized 81 received fluoxetine 81 received placebo *Female 59.3%, Caucasian 90.1%, average age 43.5 years (SD = 11.7, range = 18-72) Judd LL, et al. American Journal of Psychiatry. 2004: 161 (10) : 1864-1871

  29. The Design of the 605 Study: A Placebo-controlled 18-month Trial of Lamotrigine and Lithium Maintenance Treatment Preliminary open-label phase Screen Double-blind phase Lamotrigine 400 mg/d, n = 47 Concomitant psychotropics Lamotrigine 100-200 mg/d Lamotrigine 200 mg/d, n = 124 Bipolar I disorder currently or recently depressed Lamotrigine 50 mg/d, n = 50 Lithium 0.8-1.1 mEq/L/d, n = 121 Placebo, n = 121 Stable patients randomized 2 weeks 8-16 weeks 76 weeks Calabrese CR, et al. Journal of Clinical Psychiatry. 2003; 64: 1013-1024 (GW 605)

  30. Describing Statistical Analysis (Examples in Text) • We presented the mean of body weights (±SD) in kilograms of the study patients and the normal controls.. • We used t-test to compare the continuous variables and X-square for the categorical variables. • The differences between those two groups were considered significant if the p-values were smaller than 0.05.

  31. Writing the Discussion SectionWhat does it all mean? • To discuss the most important findings of the study first •To cite the literature with references in the present tense • To mention the study findings (described in tables, figures or text) in the past tense •To compare both of them constantly • To throw away any undiscussed tables and figures •To list limitations of the study

  32. Writing the Discussion SectionWhat does it all mean?(Samples in text) • This study is the first to concurrently assess electrophysiological indices of the first episode patients. . . (The opening paragraph) • Our study has several limitations. . . . (The beginning in the last paragraph) Umbricht DSD, et al. Biological Psychiatry 2006; 59: 762-772 Winston W. Shen, M.D./5-2006

  33. To Cite All the Sources of Information Brought up in the Discussion Section (Examples: Part 1 of 2) • As shown in Fig. 1, mirtazapine therapy was associated with a significantly greater decrease in sleep latency and a significantly greater increase in total sleep time as compared with fluoxetine therapy. • As compared with fluoxetine, mirtazapine was associated with a significantly greater decrease in sleep latency and a significantly greater increase in total sleep time (Fig. 1).

  34. To Cite All the Sources of Information Brought up in the Discussion Section (Examples:Part 2 of 2) • Effects of mirtazepine at the 5-HT2 receptor have been speculated to underline its profile of enhancing sleep.27 • Stahl28 in 1996 speculated that mirtazepine’s effects at the 5-HT2 receptor can underline its profile of enhancing sleep. Winston W. Shen, M.D./5-2006

  35. To List Limitations of the Study (Examples in Text) • The present study has several limitations. Thus, the findings should be viewed as preliminary. • The limitations of the study are: (A) The sample size was small, (B) The medication assignment was not randomized, and (C) The data were collected retrospectively. • The weaknesses of the study are (1) small sample size in total study subjects, (2) not being randomized in medication assignment, and (3) being from chart review in data collection.

  36. To Conclude the Discussion with the Need of Further Studies in the Future (Examples in Text) • These issues may be further clarified in the future as refinements in symptom measures and electro-encephalographic technique unfold. • Apparently, further studies are imperative to clarify the issues of conflicting findings of the present study and those reported in the literature. • To clarify those conflicting issues, we are carrying out a prospective, double-blind, placebo-controlled study. • To further explore those issue, a study is currently underway.

  37. Conclusion • To put the interpretation into the context of the original problem • Not to repeat discussion points or include irrelevant materials • To be based on the evidence presented Janet S. Dodd 1997

  38. Writing the Introduction SectionWhat is the problem? • To build a platform of story-telling by introducing the research question • To highlight the research done to date •To identify a question that has not yet been answered (i.e. your study). •To state the hypotheses that you plan to be tested

  39. Molecular Structure of Nucleic AcidsA Structure for Deoxyribose Nucleic Acid We wish to suggest a structure for the salt of deoxyribose nucleic acid (D.N.A.). This structure has novel features which are of considerable biological interest. A structure for nucleic acid has already been proposed by Pauling and Corey (1953). They kindly made their manuscript available to us in advance of publication. Their model consists of three intertwined chains, with the phosphates near the fibre axis, and the bases on the outside. In our opinion, this structure is unsatisfactory for two reasons. (1) We believe that the material which gives the X-ray diagrams is the salt, not the free acid. Without the acidic hydrogen atoms it is not clear what forces would hold the structure together, especially as the negatively charged phosphates near the axis will repel each other. (2) Some of the van der Waals distances appear to be too small. Another three-chain structure has also been suggested by Fraser (in the press). In his model the phosphates are on the outside and the bases on the inside, linked hydrogen bonds. This structure as described is rather ill-defined, and for this reason we shall not comment on it.

  40. Figure 1. This figure is purely diagramatic. The two ribbons symbolize the two phosphate-sugar chains, and the horizontal rods the pairs of bases holdingthe chains together. The vertical line marks the axis.

  41. We wish to put forward a radically different structure for the salt of deoxyribose nucleic acid. This structure has two helical chains each coiled around the same axis (see diagram). We have made the usual chemical assumptions, namely, that each chain consists of phosphate diester groups joining b-D-deoxyribofuranose residues with 3', 5' linkages. The two chains (but not their bases) are related by a dyad perpendicular to the fibre axis. Both chains follow right-handed helices, but owing to the dyad the sequences of the atoms in the two chains run in opposite directions. Each chain loosely resembles Furberg's (1952) model No. 1; that is, the bases are on the inside of the helix and the phosphates on the outside. The configuration of the sugar and the atoms near it is close to Furbergs's standard configuration, the sugar being roughly perpendicular to the attached base. There is a residue on each chain every 3.4A. in the z-direction. We have assumed an angle of 36Á between adjacent residues in the same chain, so that the structure repeats after ten residues on each chain, that is, after 34A. The distance of a phosphorous atom from the fibre axis is 10A. As the phosphates are on the outside, cations have easy access to them. The structure is an open one, and its water content is rather high. At lower water contents we would expect the bases to tilt so that the structure could become more compact. The novel feature of the structure is the manner in which the two chains are held together by the purine and pyrimidine bases. The planes of the bases are perpendicular to the fibre axis. They are joined together in pairs, a single base from one chain being hydrogen-bonded to a single base from the other chain, so that the two lie side by side with identical z-co-ordinates. One of the pair must be a purine and the other a pyrimidine for bonding to occur. The hydrogen bonds are made as follow: purine to position 1 to pyrimidine position 1; purine position 6 to pyrimidine position 6.

  42. If it is assumedthat the bases only occur in the structure in the most plausible tautomeric forms (that is, with the keto rather than the enol configurations) it is found that only specific pairs of bases can bond together. These pairs are: adenine (purine) with thymine (pyrimidine), and guanine (purine) with cytosine (pyrimidine). In other words, if an adenine forms one member of a pair, on either chain, then on these assumptions the other member must be thymine; similarly for guanine and cytosine. The sequence of bases on a single chain does not appear to be restricted in any way. However, if only specific pairs of bases can be formed, it follows that if the sequence of bases on one chain is given, then the sequence on the other chain is automatically determined. It has been found experimentally (Chargaff; Wyatt, 1952) that the ratio of the amounts of adinine to thymine, and the ratio of guanine to cytosine, are always very close to unity for deoxyribose nucleic acid. It is probably impossible to build this structure with a ribose sugar in place of deoxyribose, as the extra oxygen atom would make too close a van der Waals contact. The previously published X-ray data (Astbury, 1947; Wilkins and Randall, 1953) on deoxyribose nucleic acid are insufficcient for a rigorous test of our structure. So far as we can tell, it is roughly compatible with the experimental data, but it must be regarded as unproved until it has been checked against more exact results. Some of these are given in the following communications. We were not aware of the details of the results presented there when we devised our structure, which rests mainly though not entirely on published experimental data and stereochemical arguments.

  43. It has not escaped our notice that the specific pairing we have postulated immediately suggests a possible copying mechanism for the genetic material. Full details of the structure, including the conditions assumed in building it, together with a set of co-ordinates for the atoms, will be published elsewhere. We are much indebted to Dr. Jerry Donohue for constant advice and criticism, especially on interatomic distances. We have also been stimulated by a knowledge of the general nature of the unpublished experimental results and ideas of Dr. M.H.F. Wilkins, Dr. R.E. Franklin and their co-workers at King's College, London. One of us (J.D.W.) has been aided by a fellowship from the National Foundation for Infantile Paralysis. J.D.Watson F.H.C. Crick ReferencesPauling, L. and Corey, R.B. Nature, 171: 346, 1953; Proc. U.S. Nat. Acad. Sci. 39:84, 1953Furberg, S., Acta Chem. Scand. 6:634, 1952Chargaff, E., for references see Zamenhof, S., Brawerman, G., and Chargaff, E., Biochim. Et Biophys. Acta 9:402, 1952Wyatt, G.R., J.Gen. Physiol. 36:201, 1952Astbury, W.T., Symp. Soc. Exp. Biol. 1, Nucleic Acid, 66 (Cambridge Univ. Press) 1947Wilkins, M.H.F., and Randall, J.T., Biochim. et Biophys. Acta 10:192, 1953

  44. Molecular Structure of Deoxyribose Acid Nature 1953; 157: 737-738 We wish to suggest a structure for the salt of deoxyribose acid (D.N.A.) This structure has novel features which are of considerable biologic interest. A structure for nucleic acid has already been proposed by Pauling and Corley1. They kindly make their manuscript available in advance of this publication. The model consist of three interwined chains, with the phosphates near the fibre axis, and the bases on the outside. In our opinion, this structure is unsatisfactory for two reason. . . It has not escaped our notice that specific pairing we have postulated immediately a copying mechanism for genetic material. Full details of structure, including the conditions assumed in building it, together with it co-ordinates for the atoms, will be published elsewhere. We are much indebted to Dr. Jerry Donahue. . . J. D. Watson F. H. C. Crick

  45. Choosing a Title of the Article • Be brief • Be concise • Be retrievable in Medline check

  46. Choosing a Title of the Article Example in Text 1 (1/3) Original title “Successful treatment of severely conjugated hyperbilirubinemia due to gram-negative sepsis using high dose steroids”

  47. Choosing a Title of the Article Example in Text 1 (2/3) Original title (Potential areas to be trimmed) “Successful treatment of severely conjugated hyperbilirubinemia due to gram-negative sepsis using high dose steroids”

  48. Choosing a Title of the Article Example in Text 1 (3/3) Original title “Successful treatment of severely conjugated hyperbilirubinemia due to gram-negative sepsis using high dose steroids” Revised titles “The steroids treatment for a patient with sepsis- induced conjugated hyperbilirubinemia” or “The steroids treatment of sepsis-induced conjugated hyperbilirubinemia”

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