AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2578-8868/234
1 Department of Neuroscience, Biomedicine and Movement Sciences - Verona University, Verona, Italy.
2 Centre of Economic Documentation (CIDE) – Verona University, Verona, Italy
*Corresponding Author: Sheila Veronese, Department of Neuroscience, Biomedicine and Movement Sciences - Verona University, Verona, Italy
Citation: Sheila Veronese, Marco Cambiaghi, Nicola Tommasi, Andrea Sbarbati, (2022). Intraoperative Electrically Auditory Brainstem Responses to Monitor Auditory Functionality Preservation During Auditory Brainstem Implant Application. J. Neuroscience and Neurological Surgery. 11(4); DOI:10.31579/2578-8868/234
Copyright: © 2022 Sheila Veronese, 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: 02 February 2022 | Accepted: 12 April 2022 | Published: 21 April 2022
Keywords: ABI; EABR; intraoperative monitoring; nf2; perceptive outcomes
Background: Perceptual outcomes of individuals with neurofibromatosis type II implanted with auditory brainstem implant are poor, and many factors seem to be involved. Undoubtedly, the preservation of neural functionality is the crucial aspect. The aim of this study is to verify that the use of intraoperative electrically auditory brainstem responses can help to understand if there is neural damage related to the tumor, and / or surgery.
Material and Methods: A retrospective case series analysis was performed to review data from 6 adult patients affected by neurofibromatosis type 2 who received an auditory brainstem implant. A correlation was sought between intraoperative electrophysiological data, auditory performance at 1 and 2.5 years of follow-up, and auditory brainstem implant stimulation levels.
Results: Patients with a better perceptual outcomes were those with more intraoperative peaks and peaks with wider amplitudes in the electrically auditory brainstem response recordings.
Conclusions: Electrically auditory brainstem responses used for auditory brainstem implant placement can be a valuable tool for monitoring the preservation of neural acoustic functionality.
The multichannel auditory brainstem implant (ABI) is a device which can restore auditory functionality. However, so far, its use is controversial both in the pathologies for which it is indicated and for the perceptive hearing results obtained [1-5].In the intraoperative phase, implant placement is crucial. Different evaluation procedures have been developed for Cochlear Nucleus ABIs, based on different combinations of electrode stimulation [1,6-9], but all with the common aim of obtaining a favorable implant placement to provide patients with auditory sensations. In fact, it has been demonstrated that intraoperative evoked auditory brainstem responses (EABRs) are correlated with postoperative auditory sensations [8,10,11]. A correlation between intraoperative EABR and the level of perceptual outcomes achieved by the patient has not yet been demonstrated. Obtaining auditory sensations does not mean obtaining good perceptual results and there is a clear difference, also in terms of quality of life, between sound awareness (minimum obtainable level) and understanding of words and phrases without lip reading (maximum obtainable level).The first pathology for which the application of ABI is indicated is neurofibromatosis type II (NF2). Patients with NF2 are those with the worst perceptual outcomes [12]. This leads to the question whether, in case of anatomical preservation of the acoustic nerve during the tumour removal surgery, it is advisable to insert a cochlear implant (CI), whose hearing performance is generally better [13,14]. It should be noted that even with an CI, the perceptual outcomes of individuals with NF2 are not always optimal [15,16]. This means that for this type of patient it is not possible to predict what the results will be, whatever the rehabilitation aid used, even if the neural structure appears anatomically preserved before and during the tumour removal surgery.The aim of this study is to verify that the use of intraoperative electrically auditory brainstem responses (EABRs) can help to understand if there is neural damage related to the tumour and / or surgery.
Surgical and electrophysiological procedures were approved by the Ethics Committee of Verona Hospital. For these procedures, an informed written consent was acquired from the patients. This study was carried out in accordance with the Declaration of Helsinki.
Subjects
A retrospective case series analysis was performed to examine the data from 6 adult patients affected by neurofibromatosis type 2 who received ABI (Nucleus 24 ABI, Cochlear Corporation) at the ENT Department of Verona between October 2004 and March 2009. There were 2 female and 4 male patients in the age range 22,5 to 56,3 years.See Table 1 for tumor characterization and further demographic details.
Patient no. | Sex | Age at surgery [years] | ABI side | Koos classification of tumor | Controlateral side |
Pt1 | M | 32 | Right | grade IV | tumor grade IV (Koos) |
Pt2 | F | 28 | Right | grade IV | complete deafness – previous AN exeresi |
Pt3 | M | 22 | Left | grade IV | tumor grade I (Koos) |
Pt4 | M | 56 | Right | grade I | complete deafness – previous AN exeresi |
Pt5 | F | 22 | Right | grade III | tumor grade II (Koos) |
Pt6 | M | 23 | Right | grade II | partial deafness -previous AN exeresi |
ABI, Auditory Brainstem Implant; AN, acoustic neuroma; F, female; M, male; Pt, patient.
TABLE 1: Patient Demographics.
Surgery
A retrosigmoid approach was used for auditory brainstem implantation [17,18]. One patient was implanted on the left side. The other five patients were implanted on the right side. During all of the surgery, the facial and lower cranial nerves were monitored to detect unwanted stimulations that may cause non-auditory sensations. After electrode paddle insertion and before closure, all 6 patients underwent EABR measurements, for ABI placement optimization. Details on equipment and stimulation procedure utilized for EABR recordings and on interpretation of the obtained waveforms are described in Veronese et al. [9]. The new stimulation protocol presented in this study was used for Pt1, Pt3, and Pt6, while Cochlear's standard protocol was utilized for Pt2, Pt4, and Pt5.
Activation
ABIs were activated 5 to 6 weeks after surgery based on patient recovery. Tests were performed at activation using the Cochlear Nucleus R126 V2.1 (Cochlear Corporation) software. During activation, each electrode was tested in monopolar stimulation mode through a down-up-down procedure to define the electrodes auditory threshold levels (T-levels). The active electrodes were identified and the presence of non-auditory sensations was recorded. The T-levels of all the active electrodes were converted into µA, using the formula:T(µA)=10*175T(CL)/255where T(CL) represents the electrodes threshold values, expressed in the software unit of measure, the clinical level (CL). To improve the comparison of patients T-levels, the pulse width (PW) utilized was also considered and µA were converted in nC, using the formula:T(nC)=PW*T(µA)/1000
Perceptive evaluations
All patients underwent auditory rehabilitation for, at least, 1 year after activation. For all patients, perceptual results were collected during the activation and at 1, and 2.5 years of implant use. The performed tests were: sound awareness test, sounds and Italian phonemes detection, identification of words in close set of 10 items, words and sentences recognition, words and sentences comprehension [19].The tests were performed in auditory mode only, in a quiet common environment. The examiner was seated about 1 meter away from the patient, in a latero-posterior position and ipsilaterally to the implant. If the patient presented contralateral auditory residue, adequate auditory masking was performed.
Data analysis
For each follow up, the patients were divided into two groups, based on perceptual results:group A = without result, awareness of environmental noises and detection of sounds and voices;group B = identification, recognition and understanding of words and sentences;and a difference between the groups was sought based on the technical parameters.Subsequently, the same analyzes were repeated considering different groups:group C = group A + identification and recognition of words and sentences;group D = understanding of words and sentences.Fisher's exact test was used to compare the distribution of intraoperative EABR. To compare the differences in peak characteristics (percentage presence and amplitude of single peaks), in the number of active electrodes, in the number of electrodes presenting side-effects and in T(µA) and T(nC) an unpaired t-test was applied.
Table 2 presents the main characteristics of intraoperative EABR recordings and the technical data of the activations. Table 3 summarizes the perceptive results at the various follow up.
Patient no. | No. of recordings | No. of peaks | Peak presence | Peak amplitude (nV) | Activation | ||||||||||
0 | 1 | 2 | 3 | P1 | P2 | P3 | P1 | P2 | P3 | No. elec. | No. elec. s-eff. | T (µA) | T (nC) | ||
| Pt1 | 58 | 9 | 29 | 19 | 1 | 12 | 29 | 29 | 107 | 62 | 94 | 11 | 13 | 172 | 9 |
% | 15.52 | 50.00 | 32.76 | 1.72 | 20.69 | 50.00 | 50.00 | ||||||||
| Pt2 | 20 | 0 | 3 | 16 | 1 | 16 | 8 | 14 | 8 | 172 | 441 | 14 | 6 | 483 | 48 |
% | 0.00 | 15.00 | 80.00 | 5.00 | 80.00 | 40.00 | 70.00 | ||||||||
| Pt3 | 24 | 0 | 5 | 16 | 3 | 3 | 23 | 20 | 133 | 313 | 211 | 19 | 2 | 144 | 4 |
% | 0.00 | 20.83 | 66.67 | 12.50 | 12.50 | 95.83 | 83.33 | ||||||||
| Pt4 | 21 | 3 | 10 | 8 | 0 | 2 | 16 | 8 | 50 | 226 | 118 | 13 | 8 | 196 | 10 |
% | 14.29 | 47.62 | 38.10 | 0.00 | 9.52 | 76.19 | 38.10 | ||||||||
| Pt5 | 14 | 0 | 4 | 8 | 2 | 3 | 14 | 9 | 150 | 520 | 186 | 19 | 2 | 105 | 4 |
% | 0.00 | 28.57 | 57.14 | 14.29 | 21.43 | 100.00 | 64.29 | ||||||||
| Pt6 | 59 | 15 | 28 | 9 | 7 | 9 | 41 | 17 | 254 | 223 | 352 | 13 | 8 | 179 | 4 |
% | 25.42 | 47.46 | 15.25 | 11.86 | 15.25 | 69.49 | 28.81 | ||||||||
EABR, electrically evoked auditory brainstem response; elec., electrodes; No., number; Pt, patient; s-eff., side effects; T, auditory threshold.
Table 2: Intraoperative EABR waveforms characterization and activation data.
Patient no. | Activation | 1 year | 2.5 year |
Pt1 | 2 | 2 | 2 |
Pt2 | 2 | 2 | 2 |
Pt3 | 3 | 5 | 5 |
Pt4 | 2 | 3 | 2 |
Pt5 | 3 | 3 | 4 |
Pt6 | 2 | 3 | 3 |
no., number; Pt, patient. Legend: 0=no results; 1=sounds awareness; 2=sounds and Italian phonemes detection; 3=identification of words in close set of 10 items; 4=words and sentences recognition; 5=words and sentences comprehension.
TABLE 3: Perceptive results.
Tumor size and perceptive results
No correlations were found between tumor size in the various patient groups and perceptual results at the different follow up (p=1.000).
EABR morphology and perceptive results
The intraoperative EABRs were 1-peak to 3-peak waveforms. The distribution of peaks in the intraoperative waveforms recorded for group A vs group B was statistically different:- at activation since patients of group A presented 44.38% of intraoperative recordings with a single peak, while patients of group B presented 63.16% of recordings with two peaks (p=0.000);- at 2.5 years of follow up since patients of group A presented more intraoperative recordings with two peaks (+9.41%) and less with three peaks (-10.35) than patients of group B (p=0.025).The distribution of peaks was not statistically different at 1 year of follow up (p=0.134).The distribution of peaks in the intraoperative waveforms recorded for group C vs group D was analyzed at 1, and 2.5 of follow up as no patient reached comprehension level during perceptive tests at activation. The distribution was statistically different at all follow ups (p=0.003) with differences stable over the time and group C presenting more intraoperative recordings with no peaks (+15.70%) and one peak (+22.19%) and less with two peaks (-31.79%) than group D.Intraoperative peaks presence was statistically different between group A vs group B:- at 1 year of follow up since for group A patients the P1 peak was more present (+15.63) while the P2 peak was less detected (-22.71) than for group B patients (p=0.000);- at 2.5 years of follow up since for group A patients the P1 peak was more present (+11.60) while the P2 peak was less detected (-16.57) than for group B patients (p=0.007).Intraoperative peaks presence was not statistically different at activation (p=0.082), even if the trend of presence of these two peaks was the same identified in the subsequent follow-ups.Differences in the P3 peak presence were less substantial.For peaks of the groups C and D the presence was not statistically different at all follow up (p=0.099), but this is attributable to the small number of recordings considered for group D.The number of patients in the various groups was limited and this made it impossible to perform a statistical analysis to correlate the amplitude of intraoperative EABRs peaks to perceptual results at the different follow up. Nevertheless, by comparing group A and group B patients at activation and at 1 year of follow up, the intraoperative amplitude of the P2 peak turned out to be wider for group B. At 2.5 years of follow up, both the intraoperative P1 and P2 peaks were wider for group B than for group A patients.Comparing group C and group D patients at the different follow up was not possible because at activation no patient reached the comprehension level and at the other follow up only a patient (Pt3) reached that level. Considering the average intraoperative amplitudes of all three peaks for the patient of group C and comparing these values with the three amplitudes of the Pt3 peaks, a clear difference was noted for the P2 peak, which was wider for Pt3 compared to the patients of the group C (343 against 240 nV).
Activation data and perceptive results
The number of patients in the various groups was limited and this made it impossible to perform a statistical analysis to correlate activation data to perceptual results at the different follow up. Nonetheless, clear trends can be underlined (Table 4):
Group | Activation | 1 year follow up | 2.5 years follow up | |||||||||
No. elec. | No. elec. s- eff. | T (µA) | T (nC) | No. elec. | No. elec. s-eff. | T (µA) | T (nC) | No. elec. | No. elec. s-eff. | T (µA) | T (nC) | |
A | 13 ±1 | 9 ±3 | 258 ±151 | 18 ±20 | 13 ±2 | 10 ±5 | 328 ±220 | 28 ±28 | 13 ±3 | 9 ±4 | 284 ±37 | 22 ±23 |
B | 19 ±0 | 2 ±0 | 125 ±28 | 4 ±0 | 16 ±3 | 5 ±3 | 156 ±40 | 5 ±3 | 17 ±3 | 4 ±3 | 143 ±37 | 4 ±0 |
C | - | - | - | - | 13 ±2 | 10 ±5 | 328 ±220 | 28 ±28 | 14 ±3 | 9 ±3 | 227 ±147 | 15 ±19 |
D | - | - | - | - | 16 ±3 | 5 ±3 | 156 ±40 | 5 ±3 | 19
| 2
| 144 | 4 |
elec. electrodes; No., number; s-eff., side effects; T, auditory threshold.
Table 4: Activation and follow up data for the different groups.
- group A patients presented fewer active electrodes and more electrodes that caused side-effects than group B patients;- group C patients presented fewer active electrodes and more electrodes that elicided side-effects than group D patients;- group A patients presented lower T-levels than group B patients, considering the T-levels expressed in both µA and nC;- group C patients presented lower T-levels than group D patients, considering the T-levels expressed in both µA and nC;- at 2.5 years of follow up, only a patient reached comprehension level in perceptive tests. This patient presented a higher number of active electrodes, fewer electrodes which elicited side-effects and lower T-levels than all other patient groups.
Poor results are reported on the use of ABI in patients with NF2 [12,16]. A small number of these patients are able to obtain speech recognition results [22]. The results described in this study confirm the variability of the perceptual outcomes of NF2 subjects using ABI.Several factors seem to influence perceptual outcomes [22,23,24], but its extent is not yet clear [24]. Undoubtedly, it can be said that a key role for the success of the ABI rehabilitation process is the pre- and post-surgical preservation of neural functionality. In this study, while considering a limited number of patients, this aspect was investigated. As Behr et al. (2014) [22] pointed out, it's not the size of the tumour that makes the difference. Pt2 reached a performance level of 2 after 2.5 years, despite being the patient with the smallest tumour compared to the group of subjects considered. It is believed that the degree of infiltration of the tumour into the neural tissue, the toxicity that this entails, and the subsequent surgery (more or less conservative) are particularly relevant factors for the results.Although assessment of neural function, performed prior to surgery [25], is critical, this particular type of surgery can significantly change final functionality [26], even over time [27]. For this reason, the development of new minimally invasive surgical techniques for the removal of tumours is essential [28,29].The results obtained in this study demonstrate that intraoperative EABR tests for ABI placement can also be used to monitor neural functionality, as already advanced by Møller (2011) [30]. Patients who had better perceptual outcomes at 2.5 years of follow-up were patients who had more peaks (particularly P1 and P2) and peaks with wider amplitudes, both after tumor removal and after ABI insertion. This improved electrophysiology appears to be related to functional acoustic conservation. The fact that the amplitude and presence of the P3 peak are similar between different groups could coincide with the fact that hearing loss sometimes occurs after surgery [27]. Further studies with larger numbers of patients are needed to investigate this aspect.Also, of interest is the fact that improved electrophysiology is associated with lower postoperative ABI stimulation currents (Table 4), which means that a conserved neural system is stressed with fewer currents. Furthermore, lower stimulation currents are essential to avoid the occurrence of channel interactions, the appearance of non-auditory side-effects, and to improve perceptual outcomes [31].
Intraoperative EABRs used for ABI placement can be a valuable tool for monitoring the preservation of neural acoustic functionality. If after the removal of the tumour the preservation of neural functionality is evident, does it make sense to continue with the ABI, the results of which are not certain? Or is it worthwhile to retrace our steps and, if the auditory nerve is intact (even if only partially), apply a CI? This is the dilemma!Conflict of Interest
The authors have no conflicts of interest to disclose.
Funding sources
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.
