AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2690-4861/312
Gülhane Askerî Tıp Akademisi, Turkey.
*Corresponding Author: Ali Osman AVCI, Gülhane Askerî Tıp Akademisi, Turkey.
Citation: Ali Osman AVCI, (2023), Comparison of serum levels of SIL-2R, IL-6, IL-10, TNF-α, CRP, ESR and Fibrinogen in Patients with Active and Inactive Behçet’s Disease, International Journal of Clinical Case Reports and Reviews, 13(5); DOI: 10.31579/2690-4861/312
Copyright: © 2023, Ali Osman AVCI. 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: 09 May 2023 | Accepted: 22 May 2023 | Published: 31 May 2023
Keywords: Behçet’s Disease; SIL-2R; IL-6; IL-10; TNF-α
Behçet's disease (BD) is a chronic inflammatory illness that affects the entire body and is characterized by recurring episodes of oral aphthae, ocular and cutaneous lesions, and scrotal or vaginal ulcerations. The involvement of other organs and systems increases mortality in addition to the significant morbidity.
This study involved a total of 40 participants, 20 of whom were healthy controls and 20 of whom were patients (of the 20 Behçet's patients, 12 (60%) were in the active phase and 8 (40%) were in the inactive phase). There was no therapy being given to any of the 20 patients that would have affected their cytokine levels.
Only young men made up the patient and control groups because both early onset and male sex are signs of poor prognosis.
The ELISA method was used to measure the levels of serum cytokines. The statistical analysis of the derived numerical values employed the Mann-Whitney U Test.
We found a significant correlation between serum cytokine levels and classical acute phase markers in active Behçet’s patients. ESR (P < 0,001), CRP (P < 0,001), fibrinogen (P < 0,001), IL-10 (P < 0,001), IL-6 (P < 0,001), SIL-2R (P < 0,001) and TNFα (P < 0,001).
There was no statistically significant difference in serum levels of classical acute phase markers ESR (P = 0,746), CRP (P = 0,476) and fibrinogen (P = 0,940) when inactive Behçet’s patients and healthy controls were compared. However, serum levels of IL-10 (P < 0,001), IL-6 (P = 0,001), SIL-2R (P < 0,001) and TNFα (P = 0,001) were statistically different between inactive Behcet's patients and the control group.
Our research shows that even in the inactive phase, serum cytokine levels of Behçet’s patients are much higher than the healthy control group. However, the levels of ESR, CRP and fibrinogen, which are classical acute phase markers, were found at normal levels in Behçet’s patients in the inactive phase. These findings show that measurement of serum interleukin levels will enable us to take preventive measures for morbidity and mortality follow-up of Behçet's patients.
Behçet's disease (BD) is a systemic, long-term inflammatory condition marked by recurring episodes of oral aphthae, cutaneous, ophthalmic, and scrotal or vaginal lesions. Vascular, articular, gastrointestinal, cardiac, pulmonary, renal, and neurologic dysfunction are all linked to Behçet's Disease. Despite the fact that the discoveries date back to Hippocrates, Turkish Professor Dr. Hulusi Behçet was the first to describe it as a distinct illness in 1937 [1, 2].
The "Silk Road," the Middle East, the Mediterranean coast, and Central Asia all have higher rates of BD. The disease's greatest documented prevalence, which ranges from 110 to 420 cases per 100,000 individuals, was originally noted in Turkey. BD is present practically everywhere in the world, despite the fact that regional prevalence varies greatly. The disease, which affects both sexes equally, is the most It often occurs between the ages of 20–40. Male sex and disease early onset as causes of poor prognosis accepted [2, 3].
The exact cause of BD is not known yet. The theory that BD is an aberrant immune response that is brought on by bacterial, viral, and other environmental antigens or autoantigens like heat shock proteins (HSPs) is the one that is now most widely supported [4–7].
Only clinical signs and symptoms can be used to make the diagnosis of BD because there isn't a universally recognized diagnostic laboratory test for the condition. The most widely used and widely acknowledged diagnostic criteria for Behçet's disease are the International Working Group for the criteria for BD (the presence of either typical eye lesions, typical cutaneous lesions, or a positive skin pathergy test in addition to oral ulcers and recurrent genital ulcers). Increased serum levels of biochemical factors including CRP and cytokines have been suggested as indicators of disease activity [8–12].
In order to better understand the etiopathogenesis of BD, numerous cytokines have been studied. Regarding the blood cytokine levels of BP in the active and inactive stages, these investigations found remarkably disparate findings.
Patients with BD have higher levels of proinflammatory cytokines, particularly when the disease is active. The enhanced inflammatory response is thought to be caused by this elevation, particularly those implicated in Th1-mediated inflammation, along with genetic susceptibility. The SlL-2 receptor is thought to contribute to local inflammation. (13,14). TNFα enhances all types of humoral and cellular immune response and acts synergistically with IL-6 [15, 16].
Since IL-10 inhibits the production of various cytokines, IL-10 was designated as “Cytokine Synthesis Inhibitory Factor” (CSIF) when it was first identified. However, IL-10 reduces inflammation by reducing nitric oxide synthase induction and toxic oxygen radicals and monocyte prostaglandin H synthase-2 (COX-2) in macrophages [17–20].
It has been reported that circulating levels of SIL-2R, TNFα, and IL-6 are increased in Behçet’s patients [21]. It has been suggested that the increase in serum SIL-2R, TNFα and IL-6 levels is more pronounced in active-stage Behçet's patients.
It was also found that the increase in serum SIL-2R and IL-6 levels was more pronounced in BP with complications; It has been reported that IL-6 levels increase in the cerebrospinal fluid of patients with neuro-Behçet's disease. There are also studies reporting that serum SIL-2R, IL-6, IL-4, IL-10 and TNFα levels in Behçet’s patients do not increase in both active and inactive periods. Serum cytokine levels and conventional acute phase reactants have also been compared in several research [22–27].
This study was conducted to compare serum SIL-2R, IL-6, IL-10, TNF-α levels with serum CRP, ESR and fibrinogen levels in active and inactive young male Behçet's patients.
A total of 40 persons participated in this study, 20 of whom were Behçet’s Patients and 20 of whom were healthy controls. Only young men made up the patient and control groups because both early onset and male sex are signs of poor prognosis.
The patient and control groups were selected from among the young men who came for enlistment examinations. A control group was formed from those who did not have any health problems or complaints and had no pathological findings according to the results of physical examination and blood tests. Those who had a history of Behçet's disease and still had active findings and did not use drugs constituted the active patient group, and those without active findings constituted the inactive patient group. Those currently using any medication were not included in any group.
The patients with Behçet ranged in age from 20 to 30, with a mean age of 22.55 years. Their diagnoses were made in accordance with the clinical standards established by the "International Study Group". Twelve (12%) of the 20 Behçet’s patients were included in the trial during the inactive phase, while eighty (40%) were in the active phase. Patients with at least two of the oral ulcers, genital ulcers, eye lesions and active arthritis were considered active patients.
Healthy men in the same age range made up the control group. The control group's age range was 20 to 29, and the average age was 22.45 years.
Blood samples were taken from the patient and control groups in the morning, fasting, into sterile tubes for ESR, CRP, fibrinogen, cytokine levels (IL-6, IL-10, SIL-2R and TNFα). Blood samples taken for cytokine levels were centrifuged sterilely at 3000 rpm for 10 minutes and their serums were separated. The serums were placed in sterile tubes with patient names on them and stored in deep-freeze at -40°C.
Determination of Soluble Interleukin-2 Receptor: Serum SIL-2R level was measured using commercially available ELISA kit (CYTELISA; Cytimmunesciences, Paris, France).
Obtained results were evaluated by comparison with standard calibrators. The optical densities of the calibrators were analyzed with the graph obtained by performing linear-log regression analysis. The minimum SIL-2R level that the test can measure is 5 pg/ml. was in the form.
Tumor Necrosis Factor-α determination: Serum TNFα level was measured using commercially available ELISA kit (CYTELISA; Cytimmune sciences, Paris, France).
Obtained results were evaluated by comparison with standard calibrators. The optical densities of the calibrators were analyzed with the graph obtained by performing linear-log regression analysis. The minimum TNFα level that the test can measure is 5 pg/ml. was in the form.
Interleukin-6 determination: Serum IL-6 level was measured using commercially available ELISA kit (CYTELISA; The Cytoscreen, Paris, France).
Obtained results were evaluated by comparison with standard calibrators. The optical densities of the calibrators were analyzed with the graph obtained by performing linear-log regression analysis. The minimum IL-6 level that the test can measure is 10 pg/ml. was in the form.
Interleukin-10 determination: Serum IL-10 level was measured using commercially available ELISA kit (CYTELISA; The Cytoscreen, Paris, France).
Obtained results were evaluated by comparison with standard calibrators. The optical densities of the calibrators were analyzed with the graph obtained by performing linear-log regression analysis. The minimum IL-10 level that the test can measure is 5 pg/ml. was in the form.
In the statistical calculations of the numerical values obtained, the "Significance Test of the Difference Between Two Means" or the "Mann-Whitney U Test" was used in accordance with the number of cases. Results are given as arithmetic mean ± standard error. Values of P ≤ 0,05 were considered statistically significant.
Table 1 summarizes the results of the active (12 patients) BP, while Table 2 summarizes the results of the inactive (8 patients) BP. Table 3 summarizes the results of the control group.
| Lower value | Upper value | Average | Standard error | Standard deviation | |
|---|---|---|---|---|---|
| Age (Year) | 20 | 30 | 22,55 | 1,20 | 2,71 |
| ESR (mm/h) | 20 | 105 | 66,25 | 6,50 | 22,52 |
| CRP (mg/dl) | 11,00 | 47,00 | 25,25 | 3,36 | 11,63 |
| Fibrinogen (mg/dl) | 386 | 585 | 474,08 | 16,93 | 58,64 |
| IL-10 (pg/ml) | 93,40 | 500,00 | 257,78 | 45,54 | 157,76 |
| IL-6 (pg/ml) | 7,80 | 93,40 | 32,96 | 7,18 | 24,90 |
| SIL-2R (pg/ml) | 7,80 | 125,00 | 34,62 | 9,27 | 32,14 |
| TNF-α (pg/ml) | 7,80 | 62,50 | 47,36 | 5,53 | 19,17 |
Table 1: Findings of Active Behçet's Patients (n = 12)
| Lower value | Upper value | Average | Standard error error | Standard deviation | |
|---|---|---|---|---|---|
| Age (Year) | 20 | 30 | 22,60 | 1,18 | 2,68 |
| ESR (mm/h) | 3 | 20 | 12,38 | 4,51 | 8,40 |
| CRP (mg/dl) | 5,90 | 7,00 | 6,03 | 0,14 | 0,38 |
| Fibrinogen (mg/dl) | 265 | 622 | 391,50 | 38,56 | 109,05 |
| IL-10 (pg/ml) | 15,20 | 125,00 | 29,80 | 13,62 | 38,54 |
| IL-6 (pg/ml) | 7,80 | 22,40 | 11,45 | 2,38 | 6,75 |
| SIL-2R (pg/ml) | 7,80 | 15,60 | 10,72 | 1,42 | 4,03 |
| TNF-α (pg/ml) | 7,80 | 42,50 | 14,08 | 4,24 | 12,01 |
Table 2: Findings of Inactive Behçet's Patients (n = 8)
| Lower value | Upper value | Average | Standard error | Standard deviation | |
|---|---|---|---|---|---|
| Age (Year) | 20 | 29 | 22,45 | 1,30 | 2,61 |
| ESR (mm/h) | 2 | 20 | 7,65 | 3,25 | 4,48 |
| CRP (mg/dl) | 5,90 | 5,90 | 5,90 | 0,28 | 0,00 |
| Fibrinogen (mg/dl) | 191 | 382 | 288,20 | 21,45 | 47,05 |
| IL-10 (pg/ml) | 7,80 | 15,60 | 8,58 | 1,38 | 2,40 |
| IL-6 (pg/ml) | 7,80 | 15,60 | 10,14 | 1,45 | 3,66 |
| SIL-2R (pg/ml) | 7,80 | 15,60 | 9,36 | 1,40 | 3,20 |
| TNF-α (pg/ml) | 15,60 | 42,50 | 19,63 | 8,42 | 9,85 |
Table 3: Findings of the control group (n = 20)
Comparison the serum levels of conventional acute phase markers of active and inactive BP with control group is showed in Figure 1.
Figure 1: Comparison of serum levels of classical acute phase markers
Comparison the serum levels of SIL2-R, IL-6, IL-10 and TNFα of active and inactive BP with control group is showed in Figure 2.
Figure 2: Comparison of serum levels of cytokines
Serum levels of ESR (P < 0,001), CRP (P < 0,001), fibrinogen (P < 0,001), IL-10 (P < 0,001), IL-6 (P < 0,001), SIL-2R (P < 0,001), and TNFα (P < 0,001) were statistically different between active and inactive Behçet’s Patients (Table 4, Fig. 1).
| ESR | CRP | Fibrinogen | IL-10 | IL-6 | SIL-2R | TNF-α | |
|---|---|---|---|---|---|---|---|
| Mann-Whitney U | 0,500 | 0,000 | 18,500 | 10,500 | 22,500 | 14,500 | 8,000 |
| Wilcoxon W | 36,500 | 36,00 | 54,500 | 46,500 | 58,500 | 50,500 | 44,000 |
| Z value | -3,672 | -3,714 | -2,279 | -2,971 | -2,052 | -2,777 | -3,304 |
| Asymp. Sig. [2- tailed] | 0,000 | 0,000 | 0,023 | 0,003 | 0,017 | 0,005 | 0,001 |
| P value | 0,000 | 0,000 | 0,020 | 0,002 | 0,047 | 0,007 | 0,001 |
Table 4: Comparison of Findings of Active-Inactive Behçet's Patients
Serum levels of ESR (P < 0,001), CRP (P < 0,001), fibrinogen (P < 0,001), IL-10 (P < 0,021), IL-6 (P < 0,001), SIL-2R (P < 0,001), and TNFα (P < 0,001) were statistically different between active Behçet’s Patients and the control group (Table 5, Figure. 1).
| ESR | CRP | Fibrinogen | IL-10 | IL-6 | SIL-2R | TNF-α | |
|---|---|---|---|---|---|---|---|
| Mann-Whitney U | 0,500 | 0,000 | 13,500 | 2,000 | 24,000 | 11,500 | 6,000 |
| Wilcoxon W | 210,500 | 210,00 | 225,500 | 212,00 | 234,00 | 221,500 | 216,000 |
| Z value | -4,668 | -4,729 | -4,147 | -5,076 | -4,139 | -4,880 | -4,886 |
| Asymp. Sig. [2- tailed] | 0,000 | 0,000 | 0,000 | 0,000 | 0,000 | 0,000 | 0,000 |
| P value | 0,000 | 0,000 | 0,000 | 0,000 | 0,000 | 0,000 | 0,000 |
Table 5: Comparison of Active Behçet's Patients-Control Group.
Serum levels of ESR (P = 0,746), CRP (P = 0,746), and fibrinogen (P = 0,940)) were not statistically different between inactive Behçet’s Patients and the control group (Table 6, Fig. 1).
| ESR | CRP | Fibrinogen | IL-10 | IL-6 | SIL-2R | TNF-α | |
|---|---|---|---|---|---|---|---|
| Mann-Whitney U | 73,500 | 73,000 | 78,00 | 10,000 | 20,000 | 14,000 | 20,000 |
| Wilcoxon W | 109,500 | 283,00 | 114,00 | 220,000 | 223,000 | 224,000 | 223,000 |
| Z value | -0,334 | -0,373 | -0,102 | -4,170 | -3,517 | -4,287 | -4,291 |
| Asymp. Sig. [2- tailed] | 0,738 | 0,709 | 0,919 | 0,000 | 0,000 | 0,000 | 0,000 |
| P value | 0,746 | 0,746 | 0,940 | 0,000 | 0,001 | 0,000 | 0,001 |
Table 6: Comparison of Inactive Behçet's Patients-Control Group
Serum levels of IL-10 (P < 0,001), IL-6 (P = 0,001), SIL-2R (P < 0,001), and TNFα (P = 0,001) were statistically different between inactive Behçet’s patients and the control group (Fig. 2).
The exact cause of BD is not yet known. The theory that BD is an aberrant immune response in people who are genetically predisposed to the disease that is brought on by environmental antigens or autoantigens like heat shock proteins (HSPs) is currently the one with the greatest evidence [28, 29].
Patients with BD have higher levels of proinflammatory cytokines, particularly when the disease is active. The enhanced inflammatory response is thought to be caused by this elevation, particularly those implicated in Th1-mediated inflammation, along with genetic susceptibility [28–30].
The literature is replete with studies examining IL-10 serum levels. Sadeghi et al. discovered no significant difference in serum levels of IL-10 between Behçet's patients and a control group, according to Aridogan et al. and Guenane et al [31, 32].
However, in our study, we found a substantial difference in serum IL-10 levels between patients with active BD and the control group, as well as between patients with inactive BD and those who did not have it.
Acute phase reactant CRP is known to be increased in a range of inflammatory diseases. The CRP level may potentially be a sign of tissue damage caused by the immune system. In our investigation, a substantial difference was found between the CRP levels of active BP and the control group.
Numerous studies examining CRP serum levels have been published, and several of these studies (e.g. Karada et al., Müftüolu et al., Balta et al., Bekpınar et al., Adam et al.) reveal that serum CRP levels are elevated in individuals with active BD [33–35].
In several disorders, including Behçet's patients in the active phase, investigations have shown that ESR and CRP rise as acute phase reactants [36, 37]. Most active BD symptoms are linked to both ESR and CRP. They can be applied to Behçet's patients to forecast disease activity and active vascular symptoms [37].
In addition to serving as a marker of inflammation, fibrinogen, an acute phase reactant, is essential for the production of clots in both the fibrin network and platelet aggregation. In order to understand the vascular involvement and to demonstrate the disease activity, the increase in fibrinogen in Behçet's illness is crucial [38].
These cytokines were chosen because IL-6, SIL-2R and TNFα are proinflammatory; IL-10 is known as an anti-inflammatory cytokine and there is more research and knowledge about these cytokines. In addition, the increase in serum levels of these cytokines in many inflammatory diseases suggests that they will be effective both in the pathogenesis of the disease and in the evaluation of disease activity, as well as in the treatment.
This study can be criticized in two aspects: One of them is the low number of participants, and the other is that the results were obtained in this way because there may be organ involvement in Behçet's patients in the inactive period (no real inactive period). However, it is not easy to find young male patients who have never received treatment. Yes, it would be better if more young men participated in this study. Perhaps in the future, such a study will be conducted with a large number of participants.
Secondly, it is important that although the classical acute phase markers are normal, cytokines are high in these patients, even though Behçet's patients in the inactive period are not really in the inactive period due to organ involvement. Because detecting a condition that cannot be detected with conventional acute phase markers with cytokine levels is very important for morbidity and mortality follow-up.
Another question that may come to mind: Why was IL-10, an anti-inflammatory cytokine, found to be high, as well as high levels of proinflammatory cytokines in Behçet's patients in the inactive period? In response to this: Perhaps the inactive period of these patients is due to this anti-inflammatory cytokine. IL-10, which is an anti-inflammatory cytokine, increases more because proinflammatory cytokines increase more in the active period, and IL-10 increases less in the inactive period, since the increase in proinflammatory cytokines is less.
Acknowledgements
I would like to thank my thesis advisor, Prof. Dr. Yavuz Baykal and helping with statistics Prof. Dr. Mustafa Turan and Ankara Gülhane Military Medical Academy Internal Medicine Department nurses and Immunology and Biochemistry Laboratory staff.
Funding
No funding was received
Availability of data and materials
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
Authors’ contributions
This article is derived from the specialty thesis in medicine. Therefore, the only author is Ali Osman Avcı, MD. Those who contributed during the thesis work are included in the acknowledgment section.
Ethics approval and consent to participate
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University Gulhane Military Medical Academy (2020/27).
Patient consent for publication
The author affirms that human research participants provided informed consent for publication.
Competing interests
The authors declare that they have no competing interests.
Additional Declarations
No competing interests reported.
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.
