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Uniform Requirements for Manuscripts Submitted to Biomedical Journals

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International Committee of Medical Journal Editors*. *For a list of members of the Committee, see end of text. Inquiries and comments should be sent to Kathleen Case at the ICMJE secretariat office, Annals of Internal Medicine, American College of Physicians, Independence Mall West, Sixth Street at Race, Philadelphia, PA 19106-1572, USA. Phone, 215-351-2661; fax, 215-351-2644; e-mail: Kathyc@acp.mhs.compuserve.com. This document may be copied and distributed without charge for not-for-profit, educational purposes. A digital version is available on various web sites, including ACP Online (http://www.acponline.org). Rates for 10 or more reprints are available from the American College of Physicians Customer Service Department, phone, 215-351-2600; fax, 215-351-2448. The Uniform Requirements has been published in several journals. Please cite a version that appeared in the primary journal literature on or after 1 January 1997.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;126(1):36-47. doi:10.7326/0003-4819-126-1-199701010-00006
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A small group of editors of general medical journals met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the National Library of Medicine, were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually; gradually it has broadened its concerns.

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N-Acetylcysteine Lowers Serum Creatinine By Itself
Posted on March 4, 2008
Donald A. Feinfeld
Beth Israel Medical Center, New York, New York
Conflict of Interest: None Declared

TO THE EDITOR: The meta-analysis by Kelly et al. (1) of interventions that might prevent contrast-induced nephropathy covers a large and growing number of trials of various drugs and maneuvers. The problem, as the authors make clear, is that all studies to date have defined contrast- induced nephropathy as a rise in serum creatinine of either 0.5 mg/dL or 25% from the patient's baseline. Reliance on this single parameter might lead to a false positive result because creatinine is not simply filtered; it is also secreted into the proximal tubular lumen and is therefore subject to influences that affect such secretion but may not reflect actual changes in glomerular filtration. Specifically, N-acetylcysteine, although virtually non-toxic, has been shown to increase renal excretion of creatinine when administered in the doses used to try to prevent contrast-induced nephropathy. (2) Obviously, if the serum creatinine starts at a lower level before radiocontrast agent is given, the final level will be lower. Hence, it is not clear that N-acetylcysteine is effective at preventing contrast-induced nephropathy; the meta-analysis only shows that it is safe and keeps serum creatinine levels down. Until it can be shown that this drug actually preserves kidney function or that it reduces morbidity and mortality in patients at risk for contrast- induced nephropathy, we do not oppose its use but feel it should not be considered the standard of care.

1. Kelly AM, Dwamena B, Cronin P, Bernstein SJ, Carlos RC: Meta- analysis: effectiveness of drugs for preventing contrast-induced nephropathy. Ann Intern Med 2008;148:284-294.

2. Hoffman U, Fischereder M, Kruger B, Drobnik W, Kramer BK: The value of N-acetylcysteine in the prevention of radiocontrast agent-induced nephropathy seems questionable. J Am Soc Nephrol 2004;15:407-410.

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None declared

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