AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2690-4861/921
1Department of Nutrition, Mihama Katori Clinic, Seijinkai Medical Corporation, Chiba, Japan.
2Department of Nutrition, Mihama Hospital, Seijinkai Medical Corporation, Chiba, Japan.
3Department of Clinical Engineering, Mihama Hospital, Seijinkai Medical Corporation, Chiba, Japan.
4Dialysis Department, Mihama Katori Clinic, Seijinkai Medical Corporation, Chiba, Japan.
5Dialysis Department, Mihama Hospital, Seijinkai Medical Corporation, Chiba, Japan.
*Corresponding Author: Keita Sugai, Department of Nutrition, Mihama Katori Clinic, Seijinkai Medical Corporation, Chiba, Japan 2-9-3 Tamatsukuri, Katori City, Chiba Prefecture, Japan.
Citation: Keita Sugai, Chihiro Sakurai, Akari Fujita, Yuika Akai, Etsuko Shitara, et al., (2025), The Changes in Cholinesterase During Overhydration in Hemodialysis Patients, International Journal of Clinical Case Reports and Reviews, 28(5); DOI:10.31579/2690-4861/921
Copyright: © 2025, Keita Sugai. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 16 July 2025 | Accepted: 23 July 2025 | Published: 29 August 2025
Keywords: maintenance hemodialysis; overhydration; serum cholinesterase; dry weight
Background/Aim: Overhydration is a serious complication of maintenance hemodialysis patients. Various predictive factors of overhydration have been mentioned, but the role of nutritional condition has not been fully established. We have encountered several cases whose nutritional indices, especially serum cholinesterase (ChE) and serum albumin (Alb), declined one to two months before the onset of overhydration.
Then, among cases suffering from overhydration, two groups were divided according to the changes of ChE during before and after 3 months from overhydration attack and were certified the features of both groups concerning cardiothoracic ratio (CTR) and blood pressure as well as body weight changes.
Subjects: The subjects were 20 patients suffering from overhydration during maintenance hemodialysis and were hospitalized.
Methods: Monthly changes of ChE, Alb, post-dialysis weight, CTR, and blood pressure for 3 months before and after overhydration.
Results: Among the 20 patients, 14 had a decrease in ChE values during overhydration, and 6 did not. The ChE-decreased groups tended to have lower BMI, Alb, and ChE than the non-ChE-decreased groups. In the ChE-decreased groups, CTR tended to increase, and ChE and Alb decreased significantly from two months before the onset of overhydration and further increase in CTR (P=0.026) and further decreases in ChE (P<0.001) and Alb (P=0.005) were observed at overhydration attack.
Conclusions: In patients with overhydration, there were two types; one is ChE-decreased groups (70%), and the other is non-ChE-decreased groups (30%). Both groups increased CTR and NT-proBNP at overhydration. The former decreased Alb, but latter did not. These results suggested that a decrease in food intake might be the main risk of overhydration and decrease in ChE might be sensitive warning signs for overhydration.
HD: Hemodialysis
ChE : Serum cholinesterase
Alb : Serum albumin
CTR : Cardiothoracic ratio
DW : Dry weight
NT-proBNP: N-terminal fragment of human brain natriuretic peptide precursor
1.Introduction
Overhydration is one of the serious complications frequently encountered during hemodialysis treatment. In addition to severe subjective symptoms such as chest discomfort and shortness of breath in the acute phase, overhydration itself is also known to have a poor prognosis. Therefore, overhydration should be avoided [1].
Usually, enhanced cardiothoracic ratio (CTR), high blood pressure, and subjective symptoms such as dyspnea and discomfort were paid attention to find overhydration. However, CTR can fluctuate if insufficient air is inhaled during X-ray imaging, especially in elderly patients, and high blood pressure is not always observed before overhydration. Then it is not easy to find signs and symptoms predicting overhydration.
In recent years, it has been reported that human brain natriuretic peptide (BNP) and N-terminal fragment of BNP precursor (NT-proBNP) are useful indicators for congestive heart failure even in hemodialysis patients [2]. And it might be expected to be a good marker for predicting overhydration [2]. In addition, monitoring of body water volume using bioelectrical impedance method [3] and Fluid indices calculated from the distribution balance of urea and uric acid are also expected to be useful [4], but a comprehensive clinical evaluation is necessary, as one alone is not necessarily sufficient. As for nutritional factors, overeating and excessive water intake are generally thought to be the main cause of overhydration [1].
Whereas, we have often encountered cases whose nutritional factors such as serum cholinesterase (ChE) and serum albumin (Alb) were decreased at the onset of overhydration. Alb is well known as an indicator of protein in the body [5], ChE is generally considered to be an indicator of liver function. And ChE shows high values in patients with fatty liver, obesity, nephrotic syndrome, and hyperthyroidism, and low values in patients with malignant tumors, liver cirrhosis, and organophosphate drug poisoning [6]. As for the relationship with nutritional condition, it is reported that ChE correlates with energy intake in healthy young men [7].
Recently, ChE has been reported to be a prognostic indicator for patients with heart failure and after surgery, but little has been reported about its significance in hemodialysis patients [8,9,10,11].
However, ChE reflects the increase in protein synthesis and lipid metabolism accompanying the influx of energy components into the liver and therefore can also be an indicator of food intake.[6] We also believe that ChE may be an indicator of dry weight (DW) adjustment by predicting weight gain or loss in dialysis patients.
Furthermore, we hypothesize that overhydration accompanied by a decrease in ChE is not due to overeating or drinking, but rather that overhydration is due to the DW setting not keeping up with the patient's actual weight loss.
In this study, we aimed to observe changes in various factors, mainly ChE, in dialysis patients who had experienced overhydration, to clarify the relationship between the occurrence of overhydration and ChE, and to examine whether ChE can be used as an adjustment indicator for the setting of DW.
2.1. Subjects
The subjects were all 20 cases who were taking maintenance hemodialysis therapy and suffered from overhydration. They were all hospitalized at Mihama Hospital between September 1, 2020. and August 31, 2022. The diagnosis of overhydration was based on the increased CTR, the presence of pleural effusion and symptoms of respiratory distress. Additionally, Pleural effusion occurring at the time of the initiation of emergency dialysis in patients with conservative renal failure and pleural effusion associated with malignant tumors and acute heart disease were excluded from this study.
The clinical background of all subjects at the time of admission is shown in Table 1. The clinical background (median [IQR]) was age 80.5 [72.5-82.25] years old, years of dialysis was 5.8 [3.7-10.2] years, and BMI 21.17 [18.42-23.35] kg/m2.
At the time of admission, patient’s DW was set to be 53.75 [43.5-63.63] kg, whereas the patient's weight after the last dialysis just before overhydration was 55.9 [44.9-63.95] kg. After removal water during hospitalization, the patient’s body weight was 51.1 [40.23-60.75] kg. All patients recovered and discharged after improvement of signs and symptoms.
Among patients suffering from overhydration, there were ChE decreasing patients and ChE increasing patients. Then, those patients were separated shown as follows. Patients 1 to 14 were cases whose ChE decreased at overhydration attack, compared to 3 months before. Patients 15 to 20 were cases whose ChE increased or did not change at overhydration attack, comparing 3 months before.
2.2. Study Design and Data Collection
The changes of ChE, Alb, CTR, post-dialysis weight, and intradialytic systolic blood pressure (start, median, and end values) were investigated monthly from 3 months before to 3 months after overhydration attack. NT-proBNP were measured at before 3 months, just overhydration attack and after 3 months.
Regarding the timing of data collection, blood test data were pre-dialysis test values on the regular blood draw day two days after dialysis and on the blood draw day at the time of overhydration hospitalization, post-dialysis weight was the value on the same day, and CTR was the value for the same month. The systolic blood pressure during dialysis was calculated as the average of three dialysis sessions during the regular blood sampling week each month and the average of three dialysis sessions immediately before overhydration and was used as the representative value for each individual.
In addition, post-dialysis weight and blood pressure were also collected immediately overhydration treatment was corrected.
The study design was observational, and all data were retrospectively collected using medical records.
2.3. Statical Analysis
BellCurveⓇ for Excel ver4.01 (Social Survey Research Information Co., Ltd., Tokyo, Japan) was used as statistical software, and the Wilcoxon signed rank test was used to compare data from three months prior to the overhydration with data from each subsequent month.
In addition, Spearman's rank correlation coefficient was calculated to examine the correlation between the decrease in ChE (U/L) from 3 months before overhydration to the time of onset of overhydration and the amount of weight loss from 3 months before overhydration after correction of overhydration.
The significance level was set at less than 0.05 in all cases.
3.1. Comparison of clinical backgrounds between ChE-decreased groups and non-ChE-decreased groups
Table 1 showed the background of 20 cases who suffered from overhydration. The means of various clinical features at overhydration were shown in the bottom. Actually, among those 20 cases, there were two groups: one is ChE-decreased groups (No. 1-14 cases, 70%), and the other is non-ChE-decreased groups (No. 15-20 cases, 30%). The main features of two groups were shown in Table 2. The changes of each factor between 3months before and just at overhydration were shown.
| Cases | Sex | Age | Years of dialysis | Primary Disease of dialysis | Dry weight (kg) | Weight after the last dialysis just before overhydration(kg) | BMI (kg/m2) | Weight adjusted for inpatient treatment(kg) | CTR (%) | Alb (g/dL) | BUN (mg/dL) | Cre (mg/dL) | ChE (U/L) | NT-proBNP (pg/mL) | EF (%) |
| A-1 | F | 87 | 1.3 | Unclear | 38.0 | 37.4 | 15.2 | 36.6 | 60.4 | 2.9 | 50.3 | 5.53 | 150 | 36100 | 89.4 |
| A-2 | F | 88 | 2.7 | Diabetic nephropathy | 46.0 | 46.6 | 21.8 | 40.9 | 54.9 | 3.3 | 73.9 | 6.19 | 170 | 337000 | 42.6 |
| A-3 | F | 73 | 23.1 | Chronic nephritic syndrome | 38.5 | 38.6 | 15.4 | 38.0 | 55.7 | 3.1 | 74.7 | 4.53 | 152 | 134000 | 39.0 |
| A-4 | M | 82 | 5.9 | Diabetic nephropathy | 61.5 | 60.8 | 23.2 | 56.6 | 52.7 | 3.7 | 24.9 | 5.13 | 147 | 54300 | 48.0 |
| A-5 | F | 81 | 11.6 | Diabetic nephropathy | 52.0 | 56.7 | 23.9 | 50.7 | 66.8 | 3.3 | 50.4 | 3.62 | 166 | 109000 | 34.4 |
| A-6 | M | 54 | 0.4 | Diabetic nephropathy | 63.5 | 63.6 | 21.5 | 60.0 | 46.1 | 3.3 | 60.5 | 11.67 | 193 | 10200 | 55.4 |
| A-7 | F | 71 | 6.6 | Preeclampsia | 47.0 | 47.2 | 21.3 | 45.6 | 61.7 | 3.7 | 49.0 | 6.46 | 251 | 22600 | 60.8 |
| A-8 | M | 83 | 9.6 | Diabetic nephropathy | 39.0 | 39.0 | 15.0 | 38.2 | 44.4 | 2.6 | 29.7 | 6.05 | 120 | 36700 | 51.5 |
| A-9 | M | 69 | 10.5 | Diabetic nephropathy | 66.0 | 65.3 | 20.6 | 63.0 | 53.2 | 3.4 | 24.6 | 5.94 | 149 | 31000 | 33.0 |
| A-10 | M | 82 | 4.9 | Diabetic nephropathy | 55.5 | 55.1 | 17.7 | 51.5 | 63.8 | 3.8 | 40.6 | 5.39 | 252 | 87800 | 21.0 |
| A-11 | M | 77 | 5.7 | Diabetic nephropathy | 75.0 | 77.3 | 27.1 | 74.0 | 47.6 | 3.4 | 57.2 | 12.30 | 181 | 4300 | 48.8 |
| A-12 | M | 96 | 0.6 | Nephrosclerosis | 47.0 | 47.6 | 18.7 | 43.0 | 48.7 | 2.5 | 48.9 | 4.73 | 146 | 61900 | 43.5 |
| A-13 | M | 82 | 4.3 | Polycystic kidney disease | 57.5 | 57.8 | 21.5 | 53.1 | 47.7 | 2.4 | 26.7 | 4.35 | 141 | 34200 | 57.8 |
| A-14 | M | 80 | 10.1 | Diabetic nephropathy | 45.0 | 46.9 | 20.0 | 45.6 | 52.6 | 3.7 | 51.4 | 8.85 | 234 | 34600 | 53.6 |
| B-1 | M | 54 | 9.0 | Diabetic nephropathy | 95.5 | 96.3 | 30.0 | 94.0 | 45.5 | 3.9 | 49.7 | 14.57 | 356 | 777 | 60.7 |
| B-2 | M | 79 | 22.6 | Diabetic nephropathy | 64.0 | 65.0 | 25.1 | 63.3 | 64.0 | 3.6 | 58.2 | 8.46 | 83 | 66400 | 35.2 |
| B-3 | M | 77 | 5.3 | Diabetic nephropathy | 74.0 | 74.4 | 25.3 | 72.0 | 53.5 | 3.8 | 52.8 | 8.09 | 253 | 56900 | 26.7 |
| B-4 | M | 82 | 2.9 | Diabetic nephropathy | 59.5 | 59.6 | 21.0 | 57.0 | 47.5 | 3.6 | 51.7 | 8.75 | 181 | 28600 | 62.1 |
| B-5 | F | 71 | 3.9 | Diabetic nephropathy | 38.5 | 39.8 | 19.5 | 37.0 | 55.4 | 3.0 | 54.0 | 6.77 | 225 | 38200 | 49.3 |
| B-6 | F | 83 | 22.8 | Chronic nephritic syndrome | 33.0 | 33.0 | 17.6 | 32.5 | 58.1 | 2.5 | 55.8 | 4.53 | 161 | 15100 | 63.8 |
median [IQR]
| M/F ＝13/7 | 80.5 [72.5-82.25] | 5.8 [3.7-10.2] | Diabetic nephropathy/Others ＝14/6 | 53.75 [43.5-63.63] | 55.9 [44.9-63.95] | 21.17 [18.42-23.35] | 51.1 [40.23-60.75] | 53.35 [47.68-58.68] | 3.35 [2.98-3.7] | 50.9 [43.83-56.15] | 6.12 [5.03-8.53] | 168 [148.5-227.25] | 37450 [30400-71750] | 49.05 [38.05-58.53] |
Table 1: Clinical background of the subjects at the time of admission.
| All cases | [A] ChE-decreased groups | [B] non-ChE-decreased groups | |||||||||
| n | 20 | 14 | 6 | ||||||||
| Sex(M/F) | 13/7 | 9/5 | 4/2 | ||||||||
| Age | 80.5 [72.5-82.25] | 81.5 [74-82.75] | 78 [72.5-81.25] | ||||||||
| Years of dialysis | 5.8 [3.7-10.2] | 5.79 [3.06-9.96] | 7.17 [4.27-19.19] | ||||||||
Primary disease of dialysis (Diabetic nephropathy / Others) | 14/6 | 9/5 | 5/1 | ||||||||
| EF (%) | 49.05 [38.05-58.53] | 48.4 [39.9-54.95] | 55 [38.73-61.75] | ||||||||
| 3M before | Overhydration at onset | p-value | 3M before | Overhydration at onset | p-value | 3M before | Overhydration at onset | p-value | |||
| ChE(U/L) | 194.5 [168-247.75] | 168 [148.5-227.25] | 0.033 | 205.5 [171.5-249.25] | 159 [147.5-190] | <0> | 185.5 [127.75-209.5] | 203 [166-246] | 0.028 | ||
| NT-proBNP(pg/mL) | 30000 [8755-37800] | 37450 [30400-71750] | <0> | 30000 [8225-38200] | 36400 [31800-81325] | 0.002 | 25900 [11900-32625] | 47550 [31000-64025] | 0.028 | ||
| Alb(g/dL) | 3.6 [3.3-3.725] | 3.35 [2.975-3.7] | 0.011 | 3.6 [3.325-3.378] | 3.3 [2.95-3.625] | 0.005 | 3.5 [3.175-3.6] | 3.6 [3.15-3.75] | 0.285 | ||
| Post-dialysis weight(kg) | 58.3 [44.85-64.75] | 55.4 [44.4-64.1] | 0.016 | 52.3 [46.03-62.95] | 51.35 [46.68-60.05] | 0.048 | 62.4 [46.28-72.53] | 62.3 [44.75-72.05] | 0.208 | ||
| CTR (%) | 51.2 [47.55-57.5] | 53.35 [47.68-59.8] | 0.022 | 50 [47.28-56.48] | 52.95 [47.95-59.23] | 0.026 | 53.9 [48.75-58.23] | 54.45 [49-58.55] | 0.529 | ||
(median [IQR])
Comparisons were made using the Wilcoxon signed rank test, with the significance level set at less than 0.05.
Table 2: Changes in indicators 3 months before and at the time of overhydration.
Usually, overhydration is thought to be due to over-drinking water or eating too much, and insufficient water removal during hemodialysis. Actually, No. 14-20 cases in Table2 showed a not change in body weight at overhydration, accompanying with increased CTR, in addition to an increase in ChE and Alb. The increases in the last two factors are usually due to the result of over drinking and or overeating. Whereas, No. 1-14 cases showed a decrease in body weight, ChE, and Alb, which means that 70% of cases suffered from overhydration were associated with a decrease in food intake.
From these results, the mechanism by which overhydration occurred might be different in both groups. Those two groups were different. Then we analyzed the features of the two groups separately as follows.
3.2. Changes in ChE, Alb, NT-proBNP, CTR, post-dialysis weight, and intradialytic systolic blood pressure (start, median, and end values) 3 months before and after the onset of overhydration in the ChE-decreased groups
The trends (median [p-value]) of ChE, Alb, NT-proBNP, CTR, post-dialysis weight, and intradialytic systolic blood pressure (start value, median value, and end value) in the ChE-decreased groups 3 months before overhydration, 2 months before overhydration, 1 month before overhydration, at the time of overhydration onset, 1 month after overhydration, 2 months after overhydration, and 3 months after overhydration are shown in Figure 1. Numbers in the text and figures indicate median values and p-value compared with baseline 3 months before overhydration.
n=14, median[p-value] Using the Wilcoxon signed rank test, the data from three months prior to the overhydration was used as the base period, and comparisons were made with each subsequent month. The significance level was set at a risk level of less than 0.05.
Figure 1: Changes in various factors before and after the onset of overhydration in the ChE-decreased groups.
3.2.1. Changes in pre-dialysis serum ChE values
Pre-dialysis serum ChE value (U/L) decreased from 205.5 three months before the overhydration to 177.5 [0.079] the following month, and continued to decrease thereafter, further decreasing to 159 [less than 0.001] at the time of the onset of overhydration. One month after the overhydration, the value remained at 149 [0.002], but then rose again, reaching 188 [0.019] three months after the overhydration.
3.2.2. Changes in pre-dialysis serum Alb values
Pre-dialysis serum Alb value (g/dL) was 3.6 three months before overhydration and decreased significantly to 3.35 [0.031] the following month, and at the time of the onset of overhydration, it had decreased to 3.3 [0.005]. It then dropped to 3.2 [0.003] one month after the overhydration. Three months after overhydration, it had risen to 3.4 [0.068].
3.2.3. Changes in pre-dialysis NT-proBNP values
Pre-dialysis NT-proBNP (pg/mL) values were shown for the values within 3 months before the overhydration, the values at the time of the onset of the overhydration, and the values within 3 months after the overhydration. The value of 30,000 before overhydration significantly increased to 36,400 [0.002] at the time of the onset of overhydration and showed a tendency to decrease to 22,800 [0.638] after overhydration treatment.
3.2.4. Changes in CTR
The CTR (%) tended to increase from 50 three months before overhydration to 52.6 [0.875] the following month, and at the time of the onset of overhydration, there was a significant increase to 52.95 [0.026]. After overhydration, the weight was corrected, and the index fell to 50.6 [0.136] but then rose to 54.85 [0.042].
3.2.5. Changes in post-dialysis weight
Post-dialysis weight (kg) tended to decrease from 52.3 three months before the onset of overhydration to 51.6 [0.255] the following month, and at the time of the onset of overhydration it had significantly decreased to 51.35 [0.048], and ChE and Alb values had also decreased, while NT-proBNP and CTR had increased. Post-dialysis weight after overhydration treatment was temporarily corrected to 48.15 [less than 0.001], then rose again and remained almost flat, but ChE and Alb values rose again, and NT-proBNP and CTR values decreased.
3.2.6. Changes in intradialytic systolic blood pressure
Intradialytic systolic blood pressure (mm/Hg) 3 months before the overhydration was 145.33 at the start of dialysis, 144.17 in the middle, and 157.92 at the end. There was a tendency for the end to be higher than the start, and this tendency was observed throughout the entire period, but there was no significant change compared to 3 months before the overhydration. Immediately after overhydration treatment, a decrease was observed in all areas, with a significant decrease of 130 [0.009] in the start blood pressure.
3.3. Changes in ChE, Alb, NT-proBNP, CTR, post-dialysis weight, and intradialytic systolic blood pressure (start, median, and end values) 3 months before and after the onset of overhydration in the non-ChE-decreased groups
The trends (median [p-value]) of ChE, Alb, NT-proBNP, CTR, post-dialysis weight, and intradialytic systolic blood pressure (start value, median value, and end value) in the non-ChE-decreased groups 3 months before overhydration, 2 months before overhydration, 1 month before overhydration, at the time of overhydration onset, 1 month after overhydration, 2 months after overhydration, and 3 months after overhydration are shown in Figure 2. Numbers in the text and figures indicate median values and p-value compared with baseline 3 months before overhydration.
3.3.1. Changes in pre-dialysis serum ChE values
Pre-dialysis serum ChE value (U/L) was 185.5 three months before the overhydration and decreased to 171 [0.465] the following month, a non-significant decrease, and continued to decrease thereafter, but at the time of the onset of overhydration, there was a significant increase to 203 [0.028].One month after the overhydration, the value dropped to 150.5 [0.753], but then increased slightly, reaching 160 [0.686] three months after the overhydration.
3.3.2. Changes in pre-dialysis serum Alb values
The pre-dialysis serum Alb value (g/dL) was 3.5 3 months before the onset of overhydration but had increased to 3.6 [0.285] at the time of the onset of overhydration. The value then showed a decreasing trend to 3.4 [0.500] one month after the overhydration but increased to 3.55 [0.893] three months after the overhydration.
3.3.3. Changes in pre-dialysis NT-proBNP values
Pre-dialysis NT-proBNP (pg/mL) values were shown for the values within 3 months before the overhydration, the values at the time of the onset of the overhydration, and the values within 3 months after the overhydration. The value of 25,900 before the overhydration significantly increased to 47,550 [0.028] at the time of the onset of overhydration and showed a tendency to decrease to 30,850 [0.249] after overhydration treatment.
3.3.4. Changes in CTR
The CTR (%) showed an increasing trend, increasing from 53.9 three months before the overhydration to 54.45 [0.529] at the time of the onset of overhydration. After the overhydration, the dry weight was corrected and dropped to 51.1 [0.345], but three months after the overhydration it rose to 53.3 [0.345].
3.3.5. Changes in post-dialysis weight
Post-dialysis body weight (kg) was 62.4 kg 3 months before the overhydration and remained almost unchanged at 62.3 [0.208] at the time of the onset of overhydration. After overhydration treatment, a non-significant downward trend was observed.
3.3.6. Changes in intradialytic systolic blood pressure
Intradialytic systolic blood pressure (mm/Hg) 3 months before overhydration was 126.17 at the start of dialysis, 128.17 at the middle, and 121 at the end, showing a tendency for it to be higher at the middle than at the start. No significant changes were observed in any period compared to three months prior to overhydration. At the time of the onset of overhydration, there was a tendency for the values to increase, although not significantly, from 147.5 [0.345] at the start, to 132.83 [0.345] at the middle, to 126.58 [0.753] at the end, which was particularly noticeable at the start.
3.4. Correlation between the amount of ChE reduction and the amount of weight loss during 3 months just before overhydration attack in ChE-decreased groups.
The correlation between the amount of ChE reduction and the amount of weight loss during 3 months just before overhydration attack in ChE-decreased groups in 13 cases is shown in Figure 3. Decreased in ChE (U/L) from 3 months before overhydration to the time of overhydration onset and the amount of weight loss from 3 months before overhydration after overhydration were corrected, and found a positive correlation (r=0.595, p=0.032).
n=6, median[p-value] Using the Wilcoxon signed rank test, the data from three months prior to the overhydration was used as the base period, and comparisons were made with each subsequent month. The significance level was set at a risk level of less than 0.05
Figure 2: Changes in various factors before and after the onset of overhydration in the non-ChE-decreased groups.
Correlation was calculated using Spearman's rank correlation coefficient, with the significance level set at less than 0.05.
One patient was excluded from the analysis because his weight loss was a statistical outlier.
Figure 3: Correlation between the amount of ChE reduction and the amount of weight loss during 3 months just before overhydration attack in ChE-decreased groups.
We observed the changes in weight, blood pressure, CTR, NT-proBNP, as well as ChE and Alb in 20 dialysis patients who were hospitalized for treatment of overhydration. The observation period was three months before and after hospitalization for treatment of overhydration. We found ChE-decreased groups (70%) and non-ChE-decreased groups (30%). In the ChE-decreased groups, ChE showed a tendency to decrease from 2 months before overhydration compared to 3 months before overhydration and was further decreased at the time of the onset of overhydration.
Compared to the ChE-decreased groups, the non-ChE-decreased groups had relatively good nutritional conditions and cardiac function indices such as Alb, ChE, BMI, and EF. And at the time of the onset of overhydration, CTR and NT-proBNP were elevated while ChE was also elevated, suggesting that the increase in body fluids due to overeating and increased fluid intake caused of overhydration. In other words, they were relatively in good nutritional condition.
On the other hand, the ChE-decreased groups had relatively poor nutritional status and cardiac function, and in such cases, ChE and Alb decreased further, and a significant decrease was observed at the time of the onset of overhydration.
ChE is generally considered an indicator of liver function, but it is also considered an indicator of nutritional intake status [7]. This is also confirmed by the correlation between ChE changes and boby weight-changes at show in figure 3. From the above, it is suggested that continuous measurement and observation of ChE in hemodialysis patients, might be useful in predicting overhydration caused by a decrease in food intake. Then, in the cases whose ChE began to decrease, nutritional intervention and adjust DW (figure 4) might be needed to prevent overhydration.
Figure 4: Schematic of net weight loss and dry weight adjustment.
Alb showed almost the same trends as ChE, but the changes in ChE appeared to be more sensitive markers for nutritional conditions. Because, ChE has a short half-life of approximately 10 days and a large molecular weight of 340,000, making it unlikely to leak through the dialysis membrane. This makes it useful as a nutritional indicator for predicting and evaluating weight changes in dialysis patients [6]. Alb has a relatively long half-life of 15 to 20 days and a molecular weight of 66,000. Therefore, it is possible that Alb leaks from dialyzers, which have high waste removal capabilities, and that its levels fluctuate due to the effects of dialysis itself [5,12].
Single-center study and the number of cases was small, a study with a larger number, of cases is needed.
When hemodialysis patients developed overhydration, ChE had been decreasing for the two months prior in 70 percentage cases in addition to an increase in CTR and NT-proBNP. These results suggest that watching ChE decrease may be useful to predict overhydration caused by actual weight loss and in adjusting DW for hemodialysis patients. To prevent overhydration, it might be important to intensify fluid removal by considering a decrease of ChE in addition to an increase in CTR and NT-proBNP.
K.S. (Keita Sugai) and K.S. (Kohji Shirai) contributed to the study design, and K.S. (Keita Sugai), C.S., A.F., and Y.A. contributed to data collection and interpretation. K.S. (Keita Sugai) performed the analyses, K.S. (Kohji Shirai) supervised the study, and K.S. (Keita Sugai) drafted the initial manuscript. E.S., J.U., T.S., and M.M. contributed to the analysis and critical revision of the manuscript. All authors have read and agreed to the published manuscript.
This study received no external funding.
The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Mihama Hospital, Seijinkai Medical Corporation (approval code number:22-003; 23 January 2023).
Only routine medical care data was obtained and anonymized to prevent identification of individuals, and then a retrospective analysis was performed.
We would like to thank our colleagues Keiko Miyamoto, Natsuko Hiroki, Manami Nihei, Honoka Wada, Izuki Mizuguchi, Rina Ogihara, and Mio Ishida (Department of Nutrition, Mihama Hospital, Seijinkai Medical Corporation) for their great help in utilizing the theory presented in this paper and in publishing it.
The authors declare no conflict of interest.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
