AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2640-1053/030
1 Department of nuclear medicine, The first people's Hospital of Huaihua, Huaihua, Hunan, China
2 Department of nuclear medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
*Corresponding Author: Zhi-xiao Wei ,Department of Nuclear Medicine, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, China
Citation: Zhi-xiao Wei, The clinical value of Stimulated Thyroglobulin/TSH ratio in patients with differentiated thyroid cancer for successful initial ablation after total thyroidectomy, J Cancer Research and Cellular Therapeutics, Doi: 10.31579/2640-1053/030
Copyright: © 2018 Zhi-xiao Wei. 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: 30 July 2018 | Accepted: 30 September 2018 | Published: 09 October 2018
Keywords: Differentiated Thyroid Carcinoma, Thyroglobulin, Thyroid Stimulating Hormone, Predictive Valve, Treatment Effect
Objective
This study aim to using thyroid stimulating hormone(TSH) to correct Thyroglobulin(Tg) and analyzing Tg/TSH ratio to predict the value of successful radioactive iodine remnant ablation（RIRA）, and assess whether Tg/TSH ratio can be used as a good predictor and compared with stimulated thyroglobulin.
Methods
One hundred and ninety DTC patients with total thyroidectomy were retrospectively analyzed to compare the ability of Tg level and the Tg/TSH ratio to predict successful RIRA.
Results
One hundred and twenty-eight (67.37%) patients were successful ablation. Patients’ gender, age, pathological types and cervical lymph node metastasis did not difference between successful and unsuccessful group(all P＞0.05). There were significance statistically difference between successful and unsuccessful group about Tg level and Tg/TSH ratio (t=6.85，9.46, respectively, all P＜0.01). The optimum cutoff value for Tg to predict ablation curative effect was 38.18 ng/ml and the sensitivity and specificity was 87.50% and 58.06%, respectively. And for the Tg/TSH ratio optimum cutoff value was 0.969 and the sensitivity and specificity was 93.75% and 56.45%, respectively. According multivariate regression analysis showed only initial ablation (131)iodine doses, Tg level and Tg/TSH ratio remained significantly associated with successful ablation. The correlation for Tg/TSH ratio with OR 9.43(3.45-25.64) was more stronger than alone Tg with OR 3.14(1.25-7.87).
Conclusions
This study conclude that the Tg/TSH ratio has more stronger than alone Tg in predicting successful RIRA in patients of DTC.
Thyroid cancer is a common malignant tumor in the endocrine system, and the incidence is different in the various ethnic groups and regions（1). Differentiated thyroid cancer (DTC) accounted for the vast majority of all thyroid cancer(90%)（2）. In recent years, surgical resection of lesions and radioactive iodine remnant ablation（RIRA）and suppression therapy for thyroid stimulating hormone(TSH) with thyroxine have became the optimal treatment mode for DTC （3）, but there isn’t still an unified and effective prediction index of risk stratification for the patients before RIRA. Thyroglobulin(Tg) is usually regarded as an important reference index in follow-up for postsurgical thyroid removal of DTC（4）. Stimulated thyroglobulin is a good predictor in the predicting factors for success RIRA, but its result was restricted by the tumor staging, the level of TSH and other factors（5）.
Therefore, this study aimed to using TSH to correct Tg and analyzing Tg/TSH ratio to predict the value of successful RIRA, and assess whether Tg/TSH ratio can be used as a good predictor and compared with stimulated thyroglobulin.
Patients: We retrospectively analyzed the patients with DTC after total thyroidectomy treated at the department of nuclear, First Affiliated Hospital of Guangxi Medical University, from January 2014 to November 2015. We authorized an approval from Ethical Review Committee First Affiliated Hospital of Guangxi Medical University for this study. Only 190 patients with DTC met according to the inclusion and exclusion criteria.
Inclusion criteria: (1)all patients with DTC were adults ;(2) all patients were underwent total thyroidectomy; (3)those who postoperative pathology confirmed thyroid papillary carcinoma and follicular carcinoma;(4) those who accepted RIRA after 3-4 weeks with total thyroidectomy; (5)those who having thyroxinere placement should be discontinued about 3-4 weeks;(6)those who underwent treatment whole body iodine scan (WBIS) after RIRA a week.
Exclusion criteria:(1) the patients with thyroglobulin antibody (TgAb) were positive; (2)TgAb, TSH, and Tg levels measured from different time or different samples; (3)the patients underwent contrast-enhanced CT within one-month preablation; (4)The patients were followed-up for lost;(5)the patients were without total thyroidectomy; (6) the patients have done diagnostic WBIS before RIRA because of possible stunning effect.
Serum index's determination: TSH, Tg, and TgAb levels of all patients were measured by a fully automatic chemiluminescence apparatus(DXI 800, Beckman, USA) at a clinical laboratory before RIRA. Reportable range of TSH is 0.34 to 5.60 uIU/mL Reportable range of Tg is 5 to 40 μg/L. Reportable range of TgAb is no less 30%.
(131)iodine dose activities: (131)iodine was produced by Chengdu in nuclear isotope co., LTD(CNNC). All patients signed the inform consent form before RIRA. Therapeutic dose activities of (131)iodine were administrated by two physicians depend on thyroid residues status and whether had distant metastasis. In general, the dose activities were as follows: 1.11～3.7 GBq（30~100 mCi）of (131)iodine for low-risk cases; 3.7 ~5.55 GBq (100~150 mCi) for intermediate-risk cases (26); and 150~200 mCi (5.55~7.40 GBq) for high-risk cases. In order to enhance the effect of intestinal absorption for (131)iodine, we suggested patients having a abrosia two hours before and after taking (131)iodine. And physicians also suggested patients having a good rest and scaling up nutrition in hospital. Post-treatment WBIS was curried out 5~7 days after giving therapeutic dose activities of (131)iodine, including the whole body, regional imaging of cervical region and chest imaging .We used dual head digital gamma camera(Infinia Hawkeye 4, GE, USA) for both Post-treatment and diagnostic WBIS. The apparatus has high-powered parallel aperture collimator, and the set up parameters for energy peaks with 364 keV, window width with 20% , matrix with 64×64 and enlargement factor with 2 times, respectively.
Therapeutic evaluation: All patients have underwent neck ultrasound and diagnostic WBIS after taking (131)iodine 4~6 months and measured serum indexes. Successful ablation judgment standard is defined as no evidence of lesions on diagnostic WBIS, Tg < 1ng>
Statistical analysis：SPSS version 20.0 was used to analyzing our data. Normally distributed continuous data were analyzed using unpaired Student’s t-test, and were showed as mean ± standard deviation. Non-normally distributed data were showed median(M) and inter-quartile range(IQR), and data compared were analyzed using Mann–Whitney’s U test. We have used receiver operating characteristic (ROC) analysis to generating ROC curves and getting the optimum cutoff values of Tg and Tg/TSH ratio. Univariate and multivariate logistic regression analysis was performed to assess the predictors of successful RIRA. The significance level was 0.05 of the P analysis values.
Baseline characteristics
A total of 190 patients who were accepted RIRA and assessed in this study. Baseline characteristics of the study population successful ablations are summarized in Table I. The study most were female (137; 72.1%) . The patients’ age range 18 to 77 years(39.98±0.88). One hundred and seventy-one patients (90.0%) were papillary carcinomas, and another patient (19; 10.0%) were follicular carcinomas. Nineteen patients (65; 34.2%) were cervical lymph node metastases and 33 patients (17.4%) had distant metastasis. One hundred and twenty-eight (67.37%) patients were successful ablation, and another patient (62; 32.63% ) were unsuccessful ablation. Patients’ gender, age, pathological types and cervical lymph node metastasis did not difference between successful and unsuccessful group(all P＞0.05). However, there was significance statistically difference between successful and unsuccessful group about whether had distant metastasis or not(F=4.57, P＜0.05). There were significance statistically difference between successful and unsuccessful group about Tg and Tg/TSH ratio (t=6.85，9.46, respectively, all P＜0.01). The group of successful has hold 51.61% when the Tg levels more than 38.18 ng/ml, however, the unsuccessful just 6.92%. The group of successful has hold 58.06% when the Tg/TSH ratio more than 0.969, however, the unsuccessful just 12.5%.
M, Median, IQR, Interquartile range.
The result of ROC analysis for prediction efficacy of Tg and Tg/TSH ratio with RIRA
According to the ROC curve (Fig 1), the areas under the curve (AUC) for Tg level and Tg/TSH ratio were 0.772 [95% confidence interval(CI): 0.698-0.847] and 0.802 (95%CI: 0.728-0.876) , respectively. The optimum cutoff value for Tg to predict ablation curative effect was 38.18 ng/ml and the sensitivity and specificity were 87.50% and 58.06%, respectively. And for the Tg/TSH ratio optimum cutoff value was 0.969, and the sensitivity and specificity was 93.75% and 56.45%, respectively. The other related statistical indicators with ROC analysis of cutoff values for Tg and Tg/TSH ratio are summarized in Table II.
TTR, Tg/TSH ratio ;SEN, Sensitivity；SPE, Specificity; +LR, positive likelihood ratio；-LR，negative likelihood ratio; +PV, positive likelihood ratio; -PV, negative likelihood ratio; CI, confidence interval.
Outcomes of logistic regression analysis
In univariate logistic regression analysis, distant metastasis, initial ablation (131)iodine dose, TSH level, Tg level and Tg/TSH ratio were related predictor of successful RIRA(all P＜0.05), so they were performed with multivariate regression analysis(Table III). According multivariate regression analysis shows only initial ablation (131)iodine dose, Tg level and Tg/TSH ratio remained significantly associated with successful ablation. The more initial ablation (131)iodine dose is, the higher successful ablation rate will. The correlation for Tg/TSH ratio with OR 9.43(3.45-25.64) was more stronger than alone Tg with OR 3.14(1.25-7.87).
OR, odds ratio.
Thyroglobulin is one of iodide glycoprotein of thyroid follicular cell produced, stored in the follicular cavity. Its plasma half-life is 29.9±2.8 hours and biological half-life is 3~4 days. Its secretory rate is 1.67 mg/kg/d under the stable state. The Tg stored follicular cavity will release into blood under the condition of TSH stimulated and lysosomal enzyme hydrolyzed（7）. In healthy people, only a few physiological dosage Tg release into blood（8）. However, the half-life of Tg for patients with DTC will shorten and become no circadian and seasonal change. So measured Tg level is both sensitivity and specificity higher means, especially under the condition of TSH stimulated for patients of DTC after underwent total thyroidectomy（9,10）. But, levels of Tg measured will be restricted by some factors. Therefore, this study aim to use TSH to correct Tg and analyzing Tg/TSH ratio to predict value of RIRA for the patients with DTC. There is a very important significance to assess the outcome for DTC of RIRA, and it helps to guide making more appropriate individualized plan of diagnosis and treatment in the clinical work.
In this study, we found age, gender, pathological types and cervical lymph node metastasis did not difference between successful and unsuccessful group, while the levels of Tg have significant correlation, and the view is consistent with other studies（5,11,12）. This study also found that the success rate for distant metastasis group is lower than non-distant metastasis group, which is perhaps the metastasis lesion have more stronger ability taking in (131)iodine than residual thyroid tissue while the later getting less under the same therapeutic (131)iodine dose. Besides, our results show the more initial therapeutic dose gives, the higher success rate will. The point is consistent with other studies（13,14）. So the guides（3, 6） suggested that if the patients have distant metastasis, they should be increased the initial therapeutic dose activities（15）.
In this study, optimum cutoff value is 38.18 ng/ml. Meanwhile, patients with Tg level < 38> 38.18 ng/mL with sensitivity of 87.50%, specificity of 58.06%, PPV of 81.2%, and NPV of 69.2%. This indicates that the lower Tg before RIRA is, the more chance for successful ablation will. Therefore, we can suggest that the surgeon as much as possible to eliminate the thyroid lesion and residual tissue for DTC patients. The cutoff value and the rate successful ablation of this study is slightly higher than Kendler’ finding, who thought the Tg levels < 18> 18 ng/mL with sensitivity of 71.4%, specificity of 70.2%, PPV of 71.4%, and NPV of 70.2% （5）.As well, Nosheen’s study also performed ROC analysis and found the higher sensitivity and specificity, and the rate of successful ablation was 89% with Tg ≤14.5 ng/ml, while it just was 33% with Tg ＞14.5 ng/ml（12）. Tg with optimum cutoff value of this study is different with other studies （11,16） ,it maybe due to the different laboratories and measurement kit and different intervals. Besides, the ability of thyroid intake iodine also is different because of regional differences, and our study analyzed the patients used higher (131) iodine therapeutic dose activities, which may affect the level of Tg.
Another retrospective study（17）had analyzed 133 patients with DTC of total thyroidectomy, and concluded that before RIRA the Tg＜8.55 ng/ml with sensitivity of 88%, specificity of 72%, PPV of 47%, and NPV of 95%. Above of these studies showing that the Tg has high sensitivity for predicting curative effect for initial ablation, and the lower the Tg is, the higher the effect will. However, the specificity of Tg is not high, it can’t eliminate the situation of negative Tg.
What’s more, our study also found the Tg/TSH having the more stronger correlation than alone Tg in the outcome of initial ablation. It is precisely because of this stronger correlation. Tg/TSH maybe helps to predict curative effect for initial ablation.
According to the ROC analysis, this study has got the optimum cutoff value of Tg and Tg/TSH. And we indicated that the optimum cutoff value of Tg/TSH with 0.969. The group of successful has held 58.06% when the Tg/TSH ratio more than 0.969, however, the unsuccessful just 12.5%. Besides, patients with Tg/TSH < 0> 0.969 with sensitivity of 93.75%, specificity of 56.45%. Therefore, using Tg/TSH with higher sensitivity and PPV to evaluate the outcome of initial ablation has more advantages than alone Tg, that is 93.75% vs. 87.50% and 2.15 vs. 2.09. Zubair（5） similar studies analyzed the value of Tg and Tg/TSH for 75 patients with DTC, found the same success rate(60%) in our study. Lin’s research indicated both Tg and Tg/TSH can be used as a predictor for distant metastasis in patients with DTC with total thyroidectomy（18）.
In summary, our study concludes that the Tg/TSH ratio has stronger than alone Tg in predicting successful RIRA in patients with DTC. In order to provide more reliable theoretical foundation for clinical diagnosis and treatment, more clinical studies with larger samples and better tests with prospective designs are necessary to test and verify the real value of Tg/TSH ratio of DTC patients in the future.
Thanks all our colleagues working in the Department of Nuclear Medicine, First Affiliated Hospital of Guangxi Medical University and the first people's Hospital of Huaihua . The authors would like to thank Qiujin Niu for translation support the manuscript.
Funding
Funding information is not applicable.
Availability of data and materials
Not applicable.
Ethics approval and consent to participate
This study was authorized an approval from Ethical Review Committee First Affiliated Hospital of Guangxi Medical University.
Consent for publication
The information to be published in this article is approved by the patients.
Publication of clinical datasets
The information to be published in this article is approved by the patients.
Competing interests
There are no conflicts of interests.
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.
