AUCTORES
Globalize your Research
Review ariticle | DOI: https://doi.org/10.31579/2690-4861/421
1Nephrology Department, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
2Intensive Care Unit, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
*Corresponding Author: Tania Leme da Rocha Martinez, Rua Comandante Ismael Guilherme, 358 - Jardim Lusitânia 04031-120 - São Paulo – SP, BrazilTania Leme da Rocha Martinez, Rua Comandante Ismael Guilherme, 358 - Jardim Lusitânia 04031-120 - São Paulo – SP, Brazil
Citation: Anita L R Saldanha, Pantoja Margeotto AP, Valera Gasparoto AL, Elisa R. Nunes, Rose V. Salgueiro, et al, (2024), Fibrinogen and Atherosclerosis, International Journal of Clinical Case Reports and Reviews, 17(1); DOI:10.31579/2690-4861/421
Copyright: © 2024, Tania Leme da Rocha Martinez. 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: 15 March 2024 | Accepted: 02 April 2024 | Published: 12 April 2024
Keywords: fibrinogen; acute myocardial infarction; risk markers; cerebrovascular accident; atherogenesis; thrombosis; platelet aggregation
Cardiovascular disease has a multifactorial origin. Among these risk markers, fibrinogen is the most prominent. Interest in the role of fibrinogen in the atherogenic process is long-standing. In the 1960s, one of the first studies correlating fibrinogen and coronary artery disease was published. Since then, much evidence has been accumulating establishing elevated plasma levels of fibrinogen as an independent risk factor for coronary artery disease. As in acute myocardial infarction, fibrinogen is also elevated in cases of cerebrovascular accident and peripheral artery disease. It is noteworthy that fibrinogen levels are elevated in patients with transient ischemic attacks, suggesting that fibrinogen levels should be elevated before necrosis occurs. It is known that plasma fibrinogen is a dimer made up of alpha, beta and gamma chains, whose union is made through disulfide bonds. Measures to reduce plasma fibrinogen include diet, alcohol, physical activity, and drugs. Since fibrinogen is a risk factor for coronary artery disease, measures to reduce its levels should be adopted. In the future, with the evolution of genetic studies, the detection of individuals predisposed to hyperfibrinogenemia may be performed. It is up to pharmaceutical research to continue the investigation of effective and easy-to-use drugs to reduce fibrinogen levels.
AMI: Acute Myocardial Infarction
CAD: Coronary Artery Disease
CVA: Cerebrovascular Accident
CVD: Cardiovascular Disease
RFLP: Restriction Fragment Lenght Polymorphism
Cardiovascular disease (CVD) has a multifactorial origin. No risk factor related to it is strictly essential or sufficient for its triggering, if analyzed in isolation [1]. In general, the greater the number or severity of risk markers observed, the greater the likelihood of early morbidity and mortality. In addition, the relationship between the risk markers seems to be one of multiplication, and not simply of addition [2]. Therefore, the recognition of the factors involved in the development of CVD is essential, as it allows a better understanding of its pathogenesis and directs the development of preventive and therapeutic plans.
In recent years, several studies have pointed to the association between components of the hemostatic system and atherosclerosis [3-6]. Among these risk markers, fibrinogen is the most prominent.
It has been demonstrated, both in case-control and cohort studies [7], that the elevation of its levels maintains a positive correlation with the development of coronary heart disease. The mechanisms by which fibrinogen contributes to the development of atherosclerosis are not yet fully understood. It is known that it acts on the coagulation process, modifies blood flow (fibrinogen is one of the main determinants of blood viscosity) and interferes with platelet aggregation and endothelial function [8]. In addition, both fibrinogen and its breakdown products stimulate the proliferation and migration of smooth muscle cells. This fact denotes the involvement of fibrinogen in the early stages of atheromatous plaque formation [3].
Interest in the role of fibrinogen in the atherogenic process is long-standing. In 1960, Merskey et al. published one of the first studies correlating fibrinogen and coronary artery disease (CAD) [9]. Since then, much evidence has been accumulating establishing elevated plasma fibrinogen levels as an independent risk factor for CAD. All in all, high level of fibrinogen is considered a risk marker or a risk factor for cardiovascular disease [10].
Clinical evidences: among the clinical evidence, we can highlight the studies carried out with patients with angina pectoris. Many have shown that fibrinogen levels are elevated in these patients [8,11]. Some even correlate the extent of CAD and elevated fibrinogen levels, suggesting an association between clinical and biochemical abnormalities [12]. In a study involving 229 patients of both genders, aged between 25 and 82 years, who underwent coronary angiography, Handa et al. demonstrated that there was a progressive increase in fibrinogen levels according to the severity of coronary atherosclerosis (the magnitude of the disease was evaluated in terms of the number of vessels involved with stenosis greater than or equal to 75%, and according to the Gensini score) [13].
The ECAT (European Concerted Action on Thrombosis and Disabilities) Angina Pectoris Study, a Multicenter European study investigating the pathogenesis and possible predictive value of the hemostatic system in the progression of atherosclerosis, is in agreement with that of Handa et al. with regard to the association between elevated fibrinogen levels and patients with coronary stenosis (less than or equal to 50%). However, the extent of arteriosclerosis and fibrinogen levels was only found when the parameter was the number of coronary arteries with total occlusion [14].
Therefore, in addition to being a risk factor for CAD, fibrinogen is considered an indicator of severity for coronary atherosclerosis.
Regarding the relationship between acute myocardial infarction (AMI) and fibrinogen plasma levels, the data in the literature are similar to those previously reported. In other words, in AMI, fibrinogen levels are elevated. Hamsten et al., in a study on hemostatic changes after AMI, demonstrated a correlation between the extent of necrosis and the increase in fibrinogen [15]. Another interesting finding is the one reported by Fulton and Ductett in a prospective study: when analyzing 120 patients who had suffered AMI, reinfarction only occurred in those who had higher initial fibrinogen levels [16].
The data presented in relation to angina pectoris and AMI make us realize that the increase in fibrinogen levels contributes to the pathogenesis of these events, being, therefore, more than an acute phase reaction.
As in AMI, fibrinogen is also elevated in cases of cerebrovascular accident (CVA) [17] and peripheral arterial disease [18]. It is noteworthy that fibrinogen levels are elevated in patients with transient ischemic attacks, suggesting that fibrinogen levels should be elevated before necrosis occurs.
In cases of peripheral arterial disease, fibrinogen has been described as an important screening test for asymptomatic stages [18]. In both CVA and peripheral arterial disease, the measurement of fibrinogen has prognostic value: the higher its plasma concentration, the worse the clinical outcome. In the case of CVA, elevated fibrinogen levels limit cerebral perfusion, reducing blood flow to areas adjacent to tissue infarction [19]. In peripheral arterial disease, hyperfibrinogenemia, through its action on plasma viscosity and red blood cell aggregation, potentiates the hemodynamic effects of ischemic vascular lesions [20].
The fact that fibrinolytic agents have been reported to be clinically effective in CAD and claudication is perhaps one of the most significant clinical evidences [21].
Epidemiological evidence: several epidemiological articles [10] conclude that fibrinogen can be considered an independent risk factor for CAD.
The Northwick Park Heart Study was one of the first prospective epidemiological studies to draw attention to the association between fibrinogen and atherosclerotic disease. It involved a sample of 1511 white men, aged between 40 and 64 years. The mean follow-up ranged from 7.3 to 13.5 years. In this study [22], the incidence of cardiac events was higher in patients who had elevated fibrinogen levels at the beginning of the study. Through multiple regression analysis, it was shown that the association between fibrinogen levels and ischemic cardiac events is independent of other risk markers. Also in the same study, fibrinogen had a higher prognostic value than cholesterol in relation to the risk of AMI [23-28].
In the Gothenburg Study [29], 792 54-year-old men were followed over a period of about 13.5 years. A total of 92 cases of AMI and 37 cases of CVA were revealed. In univariate analysis, fibrinogen was listed as a risk factor for AMI and CVA. However, in multivariate analysis, it only maintained this role in relation to CVA. An interesting finding was the additive effect found between elevated systolic pressure levels and fibrinogen in relation to the risk of CAD [30].
The Leigh Study involved a smaller number of participants (297 men), but their data were similar to those of previous studies. Like the Gothenburg study, his results emphasize the relationship between fibrinogen levels and blood pressure. The incidence of ischemic cardiac events was significantly higher among hypertensive patients, who had elevated fibrinogen levels [31].
The Framingham Study [32] stood out for the fact that it involved individuals of both genders. A total of 1315 individuals participated in it. In multivariate analysis, the predictive value of fibrinogen for cardiovascular events was independent of established risk markers. In addition, its prognostic value was found to be at least of equal magnitude to that of the other risk markers. It is worth noting that the study draws attention to the dose-dependent relationship between smoking and fibrinogen. This relationship was so significant that the authors even postulated that the increase in fibrinogen levels would be one of the mechanisms by which smoking would promote CVD [25,30,33-35].
The PROCAM (Prospective Cardiovascular Munster Study) [36] aimed to identify individuals at high risk for CVD. Through the analysis of the components of the hemostatic system of the patients (2,187), it was possible to demonstrate that the initial concentrations of fibrinogen were significantly elevated in those who later became affected by AMI or sudden cardiac death, when compared to the others [37,38].
The ARIC Study (Atherosclerosis Risk in Communities), a prospective, multicenter study focused on the etiology and natural history of atherosclerosis, concluded that both thrombosis and fibrinolysis participate in the early stages of the atherosclerotic process [39]. In addition, there has been an increase in fibrinogen levels as a function of age, smoking, obesity, diabetes, fasting serum insulin, low-density lipoprotein cholesterol (LDL-c), lipoprotein(a), leukocyte count, and menopause. Alcohol consumption, exercise, high-density lipoprotein cholesterol (HDL-c) and use of hormone replacement during menopause were associated with decreased levels of hormone replacement therapy [39].
In a meta-analysis of epidemiological studies involving the participation of fibrinogen in the atherosclerotic process, Ernst and Resch demonstrated that fibrinogen is an independent risk factor for CAD [31]. As illustrated in Kaplan-Meier analysis, the high-fibrinogen group recorded a much higher Main Adverse Cardiovascular and Cerebrovascular Events (MACCEs) rate (Log-Rank test: P < 0>
Figure 1: Kaplan-Meier survival analysis of Main Adverse Cardiovascular and Cerebrovascular Events (MACCEs) found that there was a higher occurrence of MACCEs in the high-fibrinogen group (Log-Rank test: P = 0.0002).
Since clinical and epidemiological evidence leaves no doubt regarding the participation of fibrinogen in the atherosclerotic process, it is necessary to know the determining factors of its plasma concentration. An increasing number of studies [10] demonstrate the influence of age, smoking, obesity, hypercholesterolemia, diabetes mellitus, alcohol consumption, oral contraceptive use, and menopause in determining plasma fibrinogen levels. However, despite many investigations and experimental studies, the true extent of the genetic contribution remains uncertain.
Fibrinogen and genetic inheritance: the heritability for plasma fibrinogen concentration was established by Hamsten et al. as being 51% [41]. The mode of inheritance still remains unknown [3].
It is known that plasma fibrinogen is a dimer consisting of alpha (α), beta (β) and gamma (y) chains, whose union is made through disulfide bonds [42].
Each fibrinogen strand is encoded by different messenger RNA, and its genes lie on the long arm of chromosome 4 [43].
Molecular biology, through the analysis of restriction fragment lenght polymorphisms (RFLPs), has enabled the identification of genetic variations responsible for the determination of plasma fibrinogen levels [43]. This type of analysis is able to identify genetic polymorphisms using a variety of chromosomal probes and restriction enzymes. Studies of RFLPs in Caucasian populations indicate that β-chain gene polymorphisms are associated with higher plasma levels of fibrinogen [43,44]. It is believed that the markers of the β chain gene have a stronger correlation with fibrinogen levels than those referring to the other chains (α and -y), due to the fact that hepatic synthesis of the β chain is a limiting factor in the rate of fibrinogen formation [42,45].
Much remains to be investigated regarding the real genetic impact on fibrinogen concentration. In the future, the use of RFLPs may be useful in assessing the risk of CAD, since this method will make it possible to identify individuals with a predisposition to high levels of fibrinogen [45].
Association with other risk markers: in addition to genetic predisposition, other factors already mentioned influence the plasma determination of fibrinogen. They are:
Age: many studies focus on the relationship between fibrinogen levels and age. Balleisen et al. [46], in a prospective epidemiological study involving 3186 individuals of both genders, revealed that there was a direct and significant correlation between age and fibrinogen levels. There are several articles presenting similar data [47]. However, Ernst et al. discuss this correlation, suggesting that, in part, it may be influenced by the selection criteria adopted: older individuals are more susceptible to presenting diseases associated with high fibrinogen levels. Therefore, if stricter selection criteria were adopted in order to exclude "hidden" diseases, the age/fibrinogen ratio would disappear [21]. It is worth noting that fibrinogen levels are elevated in C. pneumoniae and H. pylori infections [30].
Smoking: the studies are concordant with regard to the relationship between smoking and fibrinogen. Smoking is capable of increasing fibrinogen levels in healthy individuals [46,48]. Comparing smokers, ex-smokers and non-smokers, it is found that there is a decreasing relationship in fibrinogen levels, with the lowest being observed among those who have never smoked [48]. It is known that the effect of smoking on fibrinogen concentration is dose-dependent [49] and reversible with its cessation [50]. Although fibrinogen concentration declines after about two weeks of abstinence from smoking, it takes an average of five years for the levels of ex-smokers to become similar to those of non-smokers [51].
Blood pressure: the relationship between blood pressure levels and fibrinogen concentration is well known. Hypertensive patients have higher fibrinogen levels than normotensive patients [52]. Among hypertensive patients, the concentration of fibrinogen is higher in the forms of malignant and renopaarenchymal hypertension [53].
Diabetes mellitus: fibrinogen is elevated in both type I and type II diabetes [54]. The highest levels of fibrinogen are found among those with microvascular involvement [55].
Obesity: elevated fibrinogen levels are also seen among obese individuals. The increase in plasma fibrinogen concentration is directly related to body mass index [46,56] and skinfold thickness [21,57]. Adults with adequate weight in childhood have lower fibrinogen levels [58].
Hyperlipidemia: several studies have reported a correlation between fibrinogen levels and lipid profile [24,25,30,33-37]. The PROCAM study demonstrated a direct and significant relationship between fibrinogen levels and cholesterol and triglycerides in both men and women [37]. There is also a positive correlation with the levels of total cholesterol, LDL-c and apoprotein B [58].
In individuals with familial hypercholesterolemia, elevated fibrinogen levels are added to an increase in platelet aggregation [12].
Hyperfibrinogenemia and a significant reduction in fibrinolytic activity have been reported in patients with severe hypertriglyceridemia [59].
Oral contraceptives: there is a dose-dependent relationship between the use of oral contraceptives and fibrinogen levels [46].
Stress and social class: some studies focus on a direct, but reversible, relationship between stress and fibrinogen levels. The association described between fibrinogen and social class has been attributed, in part, to different levels of stress [58,60].
Diet: some isolated studies report that dietary measures are related to decreased fibrinogen levels. The vegetarian diet [61], the high-carbohydrate and low-fat diet [62], and the diet containing large amounts of omega 3 and 6 acids have been described as able to reduce the plasma concentration of fibrinogen. However, most authors believe that diet is not capable of influencing the determination of fibrinogen levels.
Alcohol: moderate alcohol consumption is related to lower fibrinogen levels [63].
Physical activity: there is a difference between the fibrinogen levels of sedentary individuals and those who engage in regular physical activity. The higher the activity, the lower the fibrinogen level [64].
Drugs: to date, there is no known ideal drug for lowering plasma fibrinogen levels. Some lipid-lowering drugs have been shown to reduce fibrinogen levels [65], such as fibrate analogues. The mechanism by which they act remains unclear. It is speculated to be through reduced hepatic synthesis of fibrinogen [66]. Beta-blockers and omega-3 fatty acids are also associated with a relative, but significant, decrease in fibrinogen levels.
Uroxinase and streptokinase have fibrinolytic properties [67]. However, they are expensive therapies that require constant monitoring. Its use is reserved for restricted clinical conditions.
The above measures (physical activity, diet and use of certain medications) aim to reduce fibrinogen levels. To date, there is no consensus regarding the concept of optimal levels. Most laboratories consider values between 150 and 400 mg/dl to be normal (based on the Gaussian distribution). Some of the prospective studies divide fibrinogen values into tertiles [24,35,37]. A higher incidence of cardiovascular events was observed in patients whose fibrinogen levels were in the upper tertile. The majority of laboratories adopt as epidemiological risk level those above 300 mg/dl. Although the Framingham and Northwick Park studies refer to values of 310 and 320 mg/dl, respectively, as markers of the highest risk tertile, we believe that we will provide our patients with a greater margin of protection if we reduce fibrinogen levels to values below 270 mg/dl. It is worth remembering that the Leiden Thrombophilia Study (LETS) considers that fibrinogen levels above 500 mg/dl increase the thrombotic risk by four times. The method adopted for fibrinogen measurement is the Automated Clauss method (koagulab 32-S). This choice is due to the fact that this is a well-established method capable of measuring the active fibrinogen part, and whose calibration technique is performed with internationally calibrated plasma of the referred value [68].
Since fibrinogen is a risk factor for CAD, measures to reduce its levels should be adopted. In the future, with the evolution of genetic studies, the detection of individuals predisposed to hyperfibrinogenemia may be performed. It is up to pharmaceutical research to continue the investigation of effective and easy-to-use drugs to reduce fibrinogen levels.
None.
None.
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.
