AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2641-0419/055Copyright
*Corresponding Author: Gary L Murray, The Heart and Vascular Institute, 7205 Wolf River Blvd, Germantown, TN, 38138, USA
Citation: Gary L. Murray, Colombo J (2020) The Feasibility of Blood Pressure Control with Autonomic- Assisted Hypertension Therapy Versus JNC 8 Therapy. J. Clinical Cardiology and Cardiovascular Interventions, 3(4); Doi:10.31579/2641-0419/055
Copyright: © 2020 Gary L. Murray. 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: 29 February 2020 | Accepted: 13 March 2020 | Published: 18 March 2020
Keywords: hypertension; parasympathetic nervous system; sympathetic nervous system; autonomic nervous system.
Background: Over one billion people have Hypertension (HTN); mortality and morbidity are increasing. The Parasympathetic and Sympathetic (P&S) nervous systems prominently affect the onset and progression of HTN, yet P&S measures are not used to assist in management. Our objective was to determine the feasibility of HTN control using P&S-guided to JNC 8 HTN therapy.
Methods: 46 uncontrolled HTN patients were randomized prospectively to P&S-assisted management, adjusting JNC 8 therapy using the ANX 3.0 Autonomic Monitor and adding (r) Alpha Lipoic Acid (Group 1) vs. JNC 8 (Group 2).
Results: The two Groups were similar in: 1) age (mean 66 vs. 70 y/o for Groups 1 and 2, respectively; 2) initial resting home Blood Pressure (BP, Group 1 mean=162/90 mmHg vs. Group 2 mean=166/87 mmHg, 3) initial resting office BP Group 1 mean=151/75 mmHg vs. Group 2 mean=155/73 mmHg, and 4) ethnicity. Upon follow-up (mean=8.35 mo.): 1) mean resting home BPs were 145/77 mmHg (Group 1, 74% of patients at JNC 8 goal) vs. 155/83.5 mmHg (Group 2, 30.4% at JNC 8 goal), and 2) mean resting office BPs were 138/71 mmHg (Group 1) vs. 146/65 mmHg (Group 2). At the study’s conclusion, Group 1 Sympathetic tone was lower than that for Group 2 both at rest and upon standing, and Group 1 Parasympathetic tone was higher than that for Group 2 both at rest and upon standing.
Conclusion: P&S-assisted HTN therapy is feasible, resulting in improved BP control, through healthier P&S tone on fewer prescription medications.
Hypertension (HTN) is the most common disorder seen in family practice, affecting over 25% of primary care patients. Less than 50% of hypertensives are controlled, and mortality as well as morbidity is increasing. While several causative mechanisms of HTN have been elucidated, much investigation remains [1,2].
A neuroadrenergic cause is prominent: Increased Sympathetic (S) tone and Cardiac Output (CO) with low systemic vascular resistance (Rs) occur in young hypertensives; eventually, the high CO and S-tone usually come down (3); Rs increases, uncoupling it from S-tone; and decreased Baroreceptor Reflex (BR), cardiopulmonary receptor sensitivity, and Parasympathetic (P) tone are present, likely resulting from end-organ damage [1,3-8]. If P<
Despite the involvement of Parasympathetic and Sympathetic function in HTN, routine pharmacologic management of HTN is not tailored for it, potentially contributing to reduced time in therapeutic range that is inversely associated with all-cause mortality, resistant HTN, the 24% HTN recidivism, as well as undesirable orthostasis and fatigue [12,13]. Additionally, the increased oxidative stress that can contribute to the development of HTN and ANS dysfunction is also not specifically addressed therapeutically.
We, as have others, have found the potent, natural antioxidant (r) Alpha Lipoic Acid ([r]-ALA) can reduce sitting systolic and diastolic BP [14-16]. Therefore, our hypothesis is that pharmacologic HTN treatment, adjusted for P&S dysfunction when present treated with adjunctive (r)-ALA, could result in improved P&S function and HTN control using fewer prescription medications. The cost and side effects of treatment might be reduced. This is a prospective, controlled, hypothesis- generating, feasibility study.
In a suburban, mid-west cardiology clinic 46 consecutive patients (70% Female, average age 66 years, age range 33 to 88 years, 92% Caucasian, see (Table 1) were recruited for this feasibility study. At baseline, all patients were under standard care based on the Eighth Joint National Committee (JNC-8) guidelines. At baseline, all patients recruited: 1) Were treated but uncontrolled HTN (unmet JNC goals) patients with any abnormality in P-and/or S-tone regardless of all other vital characteristics, 2) Signed informed consent, and 3) Were randomly, prospectively assigned to P&S-assisted therapy (Group 1) or JNC 8- guided only therapy (Group 2).
All patients were on a 2 gm. sodium diet and asked to perform at least
2.5 hr. aerobic activity/wk. and to stop smoking. All patients with obstructive sleep apnea were appropriately treated. P&S-assisted therapy consisted of adjusting JNC 8 therapy as well as adding (r)- ALA per our usual treatment for dysautonomia in patients without HTN. The groups’ ages are similar: Group 1 averaged 66 y/o and Group 2 averaged 70 y/o (p<0.001). The groups’ follow-up times are similar: Group 1 averaged 8.7 months and Group 2 averaged 8.0 (p<0.001). Five days of home morning and evening BP monitoring were collected.
Each monitoring event recorded BP after 5 minutes of quiet sitting and the data were averaged upon entry. Three days of b.i.d BPs were averaged 2 months of adding (r)-ALA in Group 1, in order to allow it to take full effect and monthly thereafter, whereas BPs were repeated 2 weeks after entry in Group 2 and monthly afterwards. Physician measured BPs were never used in this unblinded trial and doses of antihypertensive medications, along with changes, were per JNC 8 guidelines in both groups; only the choice of medication, the use of alpha lipoic acid, and the frequency of medication change (less frequent in Group 1 since alpha lipoic acid requires at least 2 months for full effect, thereby excluding bias in favor of Group 1) differed Blood pressure goals were identical: patient recorded home BPs that would meet JNC goals. Office P&S testing measurements were taken with the ANX 3.0 autonomic monitor (TMCAMS, Inc., Atlanta, GA, USA, formerly ANSAR Medical Technologies, Inc., and Philadelphia, PA, USA). P&S activity were computed simultaneously and independently based upon concurrent, continuous time-frequency analyses of Respiratory Activity (RA) and Heart Rate Variability (HRV) [17-21]. P-activity (measured as the Respiratory Frequency area (RFa) is defined as the spectral power within a 0.12 Hz-wide window centered on the Fundamental Respiratory Frequency (FRF) in the HRV spectrum. FRF is identified as the peak spectral mode of the time- frequency analysis of RA.
Effectively, FRF is a measure of vagal outflow as it affects the heart (a measure of cardio-vagal activity). S-activity (measured as the Low Frequency area (LFa) is defined as the remaining spectral power, after computation of RFa, in the low- frequency window (0.04-0.15 Hz) of the HRV spectrum. High Sympathovagal Balance (SB=LFa/RFa) is defined as a resting ratio >2.5, established in our 483 patient study [9]. P&S activity was recorded from 5 mins of quiet sitting (normal ranges for both P&S at rest, including sitting, is defined as 0.5-10 beats/minute2 [bpm2]). The reported average SB is the average of the ratios of 4 second samples during sitting, not a ratio of the averages. Cardiac Autonomic Neuropathy (CAN) is defined as critically low, resting P-activity, RFa of <0.10 bpm2.
High SB and CAN define a high risk of mortality, including: acute coronary syndromes, congestive heart failure or ventricular tachycardia/fibrillation alone or as a composite endpoint [9]. With challenge (e.g., head-up postural change or standing), a normal S- response (LFa) is defined as up to a 400% increase with respect to rest (e.g., sitting) and a normal P-response (RFa) is a decrease with respect to rest. Follow-up BPs and P&S measures were recorded 2 months after therapy adjustment in Group 1, whereas BPs were rechecked 2-4 weeks after adjustments in Group 2. Statistical analyses were performed in SPSS v22.0. Dichotomous data were analyzed using the chi-square test. A p-value of 0.05 or less was significant. Student t-tests as two-tailed with equal variance.
Although the two groups had similar initial BPs, home BP control was more normalized in the P&S-assisted patients. After a mean f/u of 8.35 mo., mean resting, home BPs were lower in Group 1 (145/77 mmHg, 74% 0f patients at JNC 8 goal, mean pulse 61 bpm) vs. Group 2 (155/83.5 mmHg, 30.4% of patients meeting JNC 8 goal, mean pulse 73 bpm; p<0.001 systolic, p= <0.001 diastolic, p<0.001 pulse). Similarly, Group 1 mean sitting office BPs were 138/71 mmHg vs. Group 2’s 146/65 mmHg; p<0.001 systolic, p<0.001 diastolic.
All Group 1 patients demonstrated at least 1 abnormal autonomic measure initially, managed exactly as in normotensives, and improved final office P&S measures (Table 2), including: lower resting (sitting) S-tone (LFa=0.90, p<0.001), higher final P-tone (RFa=0.71, p<0.001), and higher standing P-tone (RFa=1.56, p=0.005) as compared with final Group 2 values were present. All of these differences are consistent with improved HTN control. Prescribed sympatholytics influenced the results. Initially, 6 of 23 (23%) Group 1 patients had low sitting S-tone (LFa<0.5 bpm2) vs. 17 of 23 (74%) in Group 2, p<0.001. Group 2 had a higher percentage of patients prescribed sympatholytic.
As a result, with P&S-Assisted therapy, all but one (5 of 6 or 83%) of the Group 1 patients with low resting S-tone improved vs. 9 of 17 (53%) of similar Group 2 patients, p<0.001. These improvements also reduced the symptoms of fatigue and orthostatic hypotension in these low resting S-tone patients. P-tone directly and indirectly affects S-tone and thereby may affect BP. Low-resting P-tone may result in high resting S-tone, since P-and S-tone typically variate reciprocally. High S-tone increases BR activity, attempting to lower BP; low P-tone does the opposite. These opposing actions may increase difficulty in controlling BP in hypertensives. Initially, 7 of 23 (30%) Group 1 patients had low resting P-tone (<0.5 bpm2), vs. 15 of 23 (65%) Group 2 patients (p<0.001).
Group 1 final P-tone increased in 4 of 7 (57%) patients with low P-tone vs. Group 2 in which only 3 of 15 (20%) patients increased P-tone (p<0.001). CAN is extremely low P-tone (<0.01 bpm2). CAN is often associated with high SB. CAN with high SB is associated with increase MACE risk [9]. Initially, no Group 1 patient presented with CAN, vs. 7 of 23 (30%) Group 2 patients (p<0.001). At the end of the study, 3 of 23 (13%) Group 1 patients had CAN vs.5 of 23 (22%) with CAN in Group 2 (p=ns). A lower S-tone in Group 1 is associated with a smaller, increased MACE risk of CAN [9]. High SB was demonstrated by 8 of 23 (35%) of the Group 1 patients vs.4 of 23 (17%) patients in Group 2 (p<0.001). SB was corrected (normalized SB) in 5 of the 8 (62.5%) high SB patients of Group 1 vs. no (0%) high SB patients of Group 2 demonstrated normalized SB (p<0.001).
High SB is a measure of (relatively) high resting S-tone. Combining the resting S-tone results and CAN (very low P-tone) results, these findings support the hypothesis that lower S-tone lowers the risk of CAN [9]. At the end of the study, Group 1 patients had more patients with lower S-tone and patients with lower CAN risk. Upon standing, 8 of 23 (35%) of Group 1 patients initially had Sympathetic Withdrawal (SW, consistent with BR and cardiopulmonary receptor dysfunction) vs. 12 of 23 (52%) of Group 2 patients (p=0.01). SW was corrected in 5 of the 8 (62.5%) Group 1 SW patient vs. 4 of the 12 (33.3%) Group 2 SW patients (p<0.003).
Corrected SW indicates improved BR function. Inappropriately increased P-tone (P excess, PE) upon standing (the normal change is to decrease) initially occurred in 9 of 23 (39%) of Group 1 vs. 5 of 23 (21%) of Group 2 patients (p=0.004). PE was corrected in 6 of 9 (67%) of Group 1 PE patients and in 1 (20%) of the patients in Group 2 PE patients (p<0.001). However, PE developed in 3 (21%) of the other Group 1 patients and in 2 (11%) of the other Group 2 patients. Therefore, final PE was equally present (26%) in both Groups. Probably PE indicates a compensatory mechanism (vasodilatation) to increase blood volume thus attempting to maintain HTN.
While increased standing P-tone lowers BP, a pronounced increase can result in orthostasis, as can extreme SW. SB improved dramatically in Group 1 patients from 3.26 to 1.86 (p=0.004, Table 2), despite fewer patients using beta blockers, contrasted with essentially no change of SB in Group 2. This is consistent with the difference in HTN control. Despite nearly equal mean lower final S-and P-tone in Group 1, SB fell substantially, because SB is reported as the average of ratios, rather than the ratio of averages.
Since the final SB in both Groups was virtually equal, SB cannot be inferred solely by the BPs which was significantly different. With adjunctive P&S-guided therapy, home BP control was more normalized in Group 1 than without in Group 2: 134/77 mmHg vs. 155/83.5 mmHg, respectively (p<0.001 for systolic BP and p<0.001 for diastolic BP). The two patient groups were prescribed a mean of 2.3 vs. 3.0 prescription anti-hypertensives, respectively. More Group 2 patients were prescribed Calcium Channel Blockers (CCB) and at a higher daily mean dose (7.1 mg vs. 12.1 mg of Amlodipine for Groups 1 and 2 respectively). Both groups were prescribed Beta Blockers (BB) at similar mean doses, except for Carvedilol (40 mg for Group 1 vs. 32.5 mg for Group 2).
Both groups were prescribed Angiotensin Receptor Blockers (ARB) or Angiotensin Converting Enzyme Inhibitors (ACEI) at similar mean doses, except for Losartan (100 mg for Group 1 vs. 50 mg for Group 2) and Lisinopril (40 mg for Group 1 vs. 22 mg for Group 2). More Group 1 patients took Clonidine at a lower mean dose (0.24 mg vs. 0.6 mg) and Hydralazine was used similarly in both Groups (Table 1). Changes in medications were as follows: 5 of 23 (22%) of Group 1 vs. 7 of 23 (30%) of Group 2 patients were prescribed higher doses of medication; 14 of 23 (61%) of Group 1 vs. 100% of Group 2 had a new drug introduced; 3 of 23 (13%) of Group 1 vs. 2 of 23 (9%) of Group 2 were prescribed lower doses of medications and 17% of Group 1 vs. 9% of Group 2 had a change of medication drug class. Group 1 took a mean dose of 761 mg (r)-ALA.
This study demonstrates improved HTN BP control on fewer prescriptions using adjunctive (r)-ALA in Group 1 (74% of patients at JNC 8 goal vs. 30.4% of Group 2 patients, p<0.001). We and others have shown (r)-ALA can reduce resting BP and in this study concomitantly may assist lowering standing BP [16,22]. Superficially, the medication administration profiles do not explain the improvement in BP control, as more Group 2 patients took beta blockers, CCBs, and ARB/ACEIs. It may be that (r)-ALA’s favorable P&S effects significantly contributed to better HTN control via S-and P-dependent as well as its ANS-independent endothelial effects. Two Group 1 patients normalized BP solely by taking (r)-ALA.
Based upon P&S measures, 17% of Group 1 patients had a change of drug class vs. 9% in Group 2. This likely was also beneficial. High SB corrected in 71% of Group 1 patients vs. none in Group 2, contributing to lowering HTN [22]. Amlodipine increases SB, while beta blockers and clonidine decrease SB; beta-blockers and ARB/ACEIs improve BRS; and non-dihydropyridine CCBs decrease BRS [22-27]. (r)-ALA is a powerful natural antioxidant that improves P&S function including BRS, nitric oxide levels, and endothelial dysfunction [15,16,22,28]. Sympathetic Withdrawal upon standing results in compensatory mechanisms to preserve perfusion of vital organs that include increasing S-tone, both supine and sitting.
This exacerbates HTN, thereby causing its control to be more difficult. Sympatholytics, therefore, can worsen SW (only clonidine has a minimal adverse effect as it increases BRS [24,25,29]. Group 1 patients significantly improved SW. This is consistent with improved BRS, probably by (r)-ALA and higher doses of Lisnopril and Losartan. P- excess (PE) upon standing is indicative of ANS dysfunction, and 9 of 23 (39%) of Group 1 vs. 5 of 23 (22%) of Group 2 patients initially displayed PE. PE may also trigger compensatory measures, including secondary S-excesses that increase BP.
The central alpha action of Carvedilol, Low Dose Serotonin Reuptake Inhibitors (SSRI), as well as Tricyclics (TC) may help to reduce PE. One Group 1 patient normalized PE and HTN with addition of (r)-ALA alone. Resting P&S measures were utilized in choosing medications as follows. If P&S balance (as measured by SB) was normal, then any anti-hypertensive was prescribed.
If SB was high due to a relative, resting S-excess), then sympatholytics were chosen or adjusted. If SB was high due to low P, then sympatholytics were avoided and an ARB/ACEI and/or Diltiazem were chosen or adjusted. High dose (r)-ALA may increase resting P-activity and thereby lower SB. Upon standing, if SW was absent, then any antihypertensive was prescribed. If SW was demonstrated, then sympatholytics were avoided (excepting Clonidine) as was Diltiazem and Amlodipine, Hydralazine and/or high dose (r)-ALA prescribed. Diuretics were utilized only for dependent edema, since intravascular volume needed to be maintained. Low dose ARB/ACEI also might be prescribed. If PE presented, again intravascular volume should be preserved, so diuretics were avoided. Since an increase in S-activity is a compensatory mechanism to combat orthostasis, sympatholytics were avoided (except low dose carvedilol whose central alpha action reduces P-tone and possibly clonidine). Amlodipine is a good choice only if S- tone isn’t high, since it increases S-activity.
Adjunctive low dose TC or SSRI would have useful to reduce P- activity, but we confined our therapy to traditional anti-hypertensives. The uncoupling of P&S function to Rs in HTN results in variable P&S profiles. Anti-hypertensives have variable P&S effects. Consequently, knowledge of S-and P-tone is essential for choosing the best anti- hypertensive drugs and (r)-ALA enhances their effectiveness, given (r)- ALA’s ANS antioxidant effect which reduces ANS dysfunction secondary to the increased oxidative stress associated with HTN, chronic diseases and the aging process (Tables 3, 4 and 5 are illustrative).
P&S-assisted treatment of HTN, with adjunctive (r)-ALA for
dysautonomia is feasible and results in more normalized BP control within one year. Our hope is that reduced long-term medication costs, mortality, and morbidity will follow if BP control is sustained. A randomized, prospective clinical outcome study should be dome.
These results are short-term, single center, in 46 patients. Our accent was specifically lowering SB. Reducing standing PE with low dose TCs or SSRIs could have improved BP control further.
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.
