AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2690-4861/206
Retired from Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Via Pio II, 3, Milan, Italy.
*Corresponding Author: Claudio Bazzi, Retired from Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Via Pio II, 3, Milan, Italy.
Citation: C Bazzi. (2022). Which is the most Powerful Proteinuric Marker in GN and NS for Outcome Prediction, Correlation with Functional and Histologic Parameters and Assessment of Responsiveness to Steroids and Cyclophosphamide?. International Journal of Clinical Case Reports and Reviews. 11(1); DOI:10.31579/2690-4861/206
Copyright: © 2022 Claudio Bazzi, 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: 21 February 2022 | Accepted: 10 March 2022 | Published: 30 March 2022
Keywords: steroids; cyclophosphamide; urinary proteinuric biomarkers
Background: In glomerulonephritis (GN) with nephrotic syndrome (NS), proteinuric and novel molecular biomarkers do not achieve 100% accuracy in predicting outcome and treatment responsiveness.
Aim of study: To verify whether the combined excretion of IgG/C and α2m/C, markers of damage to the epithelial cell layer (podocytes and slit diaphragm) of the glomerular filtration barrier (GFB) can assess disease severity, and predict outcome and responsiveness to steroids and cyclophosphamide.
Methods: In 151 patients with glomerulonephritis and nephrotic syndrome a new proteinuric marker was developed based on a combination of different median values of urinary excretion of IgG/C and α2m/C: IgG/C < or > than the median was classified as IgG/C0 or IgG/C1, respectively. The median of α2m/C was calculated independently in IgG/C0 and IgG1, and classified as α2m/C0 and α2m/C1 if < or > than the median. Thus 4 groups were defined: IgG/C0 & α2m/C0, IgG/C0 & a2m/C1, IgG/C1 & α2m/C0, IgG/C1 & α2m/C1.
Results: The groups from 1+1 to 0+0 are characterized by increasingly severe disease, with progressively higher eGFR and progressively lower histologic (GGS%, TID and AH scores) and proteinuric parameters (TUP/C, IgG/C, α2m/C and α1m/C). In 151 patients the functional outcomes rates were: IgG/C1&α2m/C1&BP 1: “Remission and persistent NRF”, 15%; “Progression and eGFR reduction”, 85%. In IgG/C0&α2m/C0&BP 0: “Remission and persistent NRF”, 96%; “Progression and eGFR reduction”, 4%. In 84 patients treated with steroids + cyclophosphamide: IgG/C1&α2m/C 1&BP 1: “Progression and eGFR reduction”, 100%: “Remission and persistent NRF”, 0%; IgG/C0&α2m/C0& BP 0: “Remission and persistent NRF”, 100%; “Progression and eGFR reduction”, 0%.
Conclusions: Combined urinary excretion of IgG/C and α2m/C in association with blood pressure offers 100% prediction of outcome and responsiveness to steroid and cyclophosphamide treatment.
The prediction of functional outcome and responsiveness to treatment in glomerulonephritis (GN) with nephrotic syndrome (NS) is of paramount importance in clinical practice and has been the subject of several studies over recent decades. Some proteinuric biomarkers, mainly low and high molecular weight (MW) urinary proteins (α1-microglobulin, β2-microglobulin, IgG, IgM), have been useful for predicting remission and progression to ESRD (1-12). Fractional excretion of IgG (FE IgG), according to cut offs assessed by ROC analysis, can predict remission and ESRD in several types of GN (IMN, FSGS, IgAN, Crescentic IgAN, MPGN) (13-21), but none of these proteinuric markers predicts outcome with 100 percentage accuracy. A new marker with 100 percentage predictive power would therefore be useful in clinical practice. In a recent review, Remuzzi et al. (22) asked the question: “Novel Biomarkers for Renal Diseases?”. Their answer was: “None for the Moment (but One)”, stating that “to date it is still uncertain whether and to what extent novel biomarkers will provide diagnostic and prognostic information over and above what is already granted by established, cheap and easily available biomarkers such as proteinuria”. Moreover, not all clinical laboratories have access to some novel biomarkers. Thus, the assessment of urinary protein excretion remains a useful target. Since excretion of high MW proteins [IgG/C (MW 150 kDa) and α2m/C (MW 720 kDa)] is a marker for damage to the final glomerular filtration barrier (GFB) (podocytes and slit diaphragms) that also regulates macromolecule movements (23-26) we recently developed a new proteinuric marker that combines median excretion of IgG/C with median excretion of α2m/C, with definition of 4 groups: IgG/C 1 & α2m/C 1, IgG/C 1 & α2m/C 0, IgG/C 0 & α2m/C 1, IgG/C 0 & α2m/C 0. These 4 groups assess renal disease severity, and accurately predict functional outcome and responsiveness to treatment with steroids and cyclophosphamide (27). A large systematic review and meta-analysis (28) of 36 clinical trials that included 1,762 patients with IMN compared several immuno-suppressive treatments (steroids, steroids in combination with alkylating agents, cyclosporine, tacrolimus, mycophenolate mofetil, adreno-corticotropic hormone, azathioprine and mizoribine) and concluded that corticosteroids in combination with alkylating agents significantly reduced all-cause mortality. The difference between the 4th and 1st quartile of IgG/C shows a highly significant eGFR increase (from 48.3 to 89.7 ml/min/1.73m2, p < 0 xss=removed p =0.0001),>
The aim of this study is to verify whether the combined excretion of these two proteins, also in association with normal or high blood pressure, might be useful for evaluating disease severity, and predicting outcome and responsiveness to treatment with steroids and cyclophosphamide.
The study included 151 patients with GN and NS attending the Nephrology and Dialysis Unit of San Carlo Borromeo Hospital, Milan, Italy, diagnosed by renal biopsy between January 1992 and April 2006. The patients with acute reversible renal failure (ARF) at biopsy were excluded from analysis as they did not meet the inclusion criterion (chronic glomerulonephritis). All patients had known functional outcomes with a rather long follow up (mean 85±70 months, range 2-311). The diagnosis of GN were breakdown: crescentic IgAN (12 pts), focal segmental glomerulosclerosis (FSGS, 32 pts), idiopathic membranous nephropathy (IMN, 66 pts), minimal change disease (MCD, 11 pts), membrano-proliferative glomerulonephritis (MPGN, 15 pts); IgA nephropathy (IgAN, 2 pts), and lupus nephritis [LN, 13 pts: (LN classes: 3+5, 2 pts; 4, 8 pts; 4+5 1 pt; 5, 2 pts)]. Inclusion criteria: nephrotic syndrome (proteinuria ≥3.5 g/24h and/or serum albumin <3>
Proteinuria was measured by 24-hour urine collection and second morning urine sample using the Coomassie blue method (modified with sodium-dodecyl-sulphate), expressed as 24-hour proteinuria and protein creatinine/ratio (mg urinary protein/g urinary creatinine). Serum and urinary creatinine concentrations were measured enzymatically and expressed in mg/dL. Serum albumin and IgG and urinary IgG, α2-macroglobulin (α2m), albumin and α1-microglobulin (α1m) were measured by immunonephelometry; urinary proteins were expressed as urinary protein/creatinine ratio (IgG/C, α2m/C, Alb/C, α1m/C). Estimated glomerular filtration rate (eGFR) was measured by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula (29). Three types of renal lesions that are markers for disease severity in any type of GN were evaluated: percentage of glomeruli with global glomerulosclerosis (GGS%); extent of tubulo-interstitial damage (TID) evaluated semi-quantitatively by a score: tubular atrophy, interstitial fibrosis and inflammatory cell infiltration graded 0, 1 or 2 if absent, focal or diffuse (TID global score: 0-6), and extent of arteriolar hyalinosis (AH) evaluated semi-quantitatively by a score: 0, 1, 2, 3 if absent, focal, diffuse, diffuse with lumen reduction, respectively (AH global score 0-4). In all 151 patients with functional outcomes were calculated the median of IgG/C (IgG/C0 < median> median); the median α2m/C was calculated independently in IgG/C1 and IgG/C0 patients, respectively, and defined as α2m/C0 and α2m/C1 if < or> than the median; thus 4 groups could be defined: IgG/C1 & α2m/C1, IgG/C1 & α2m/C0, IgG/C0 & α2m/C1, and IgG/C0 & α2m/C0) (abbreviated as 1+1, 1+0, 0+1, and 0+0) (27).
Data for continuous variables are expressed as the mean ± SD. Categorical variables are expressed as the number of patients (%). The difference in means was determined by t-test and in categorical variables by chi-square test. All statistical analyses were performed using Stata version 15.1 (StataCorp LP, TX, USA). Two-sided p<0>
In all the 151 patients the 4 groups defined by combination of IgG/C and α2m/C show from IgG/C1 & α2m/C1 to IgG/C0 & α2m/C0 a reliable picture of disease severity showing a progressive increase of eGFR and reduction of GGS%, TID score and AH score, TUP/C, IgG/C, α2m/C, Alb/C and α1m/C and a high prediction of functional outcomes (Table 3). In patients with Groups 1+1 and 0+0 the functional outcome was also evaluated in combination with BP1 and BP0, respectively. The patients with IgG/C1 & α2m/C1 in combination with BP1 show 15% of “Remission & persistent NRF” and 85% of “Progression & progression risk”; the patients with IgG/C0 & α2m/C0 in combination with BP0 show 96% of “Remission & persistent NRF” and 4% of “Progression & progression risk”.
In 84 patients treated with Steroids and Cyclophosphamide the treatment improves the functional outcome (Table 5): in patient’s IgG/C1 & α2m/C1 & BP1 “Remission & persistent NRF” is 0% and “Progression & progression risk” is 100%; in patients with IgG/C0, α2m/C0 and BP0 “Remission & persistent NRF” is 100% and “Progression & progression risk” is 0%. Very similar results in 30 patients with IMN and NS treated with Steroids and Cyclophosphamide.
The prediction of functional outcome and responsiveness to treatments in GN and NS is of paramount importance in clinical practice. Several studies in last decades evaluated the predictive power of functional outcome of several proteinuric and novel molecular biomarkers but none of them reached 100% of outcome prediction. Thus the identification of a new marker with high outcome prediction would be markedly useful in clinical practice also to assess responsiveness to new therapies. A recent article (23) “New insight into podocyte slit diaphragm, a therapeutic target of proteinuria” reviews the extracellular molecular components forming a molecular sieve of the slit diaphragm and the cytoplasmic molecules that link the slit diaphragm to the cytoskeleton; on the basis of increased knowledge of molecular components of podocytes and slit diaphragm, the Authors hope the definition of novel therapeutic strategy for proteinuria reduction but at present no one proteinuric or molecular marker may evaluate the extent of damage of podocytes and slit diaphragm and predicts outcome and treatment responsiveness. The proteinuric marker proposed in this study evaluating the combined excretion of two high MW proteins (IgG, 150 kDa and α2-macroglobulin, 720 kDa), may be considered on the basis of functional, histologic and proteinuric data a reliable marker of disease severity and damage of the epithelial cell layer of GFB (podocytes and slit-diaphragms) and may be useful to predict outcome and responsiveness to treatments. The IgG/C1 & α2m/C1 group, associated with the highest excretion of IgG/C (577) and α2m/C (29.52), suggest severe alteration of the epithelial cell layer of GFB (podocytes and slit-diaphragms) and the association with the lowest value of baseline eGFR (47.7 ml/min/1.72 m2) and the highest values of the histologic and proteinuric parameters (GGS.7%, TID score 2.73 and AH score 0.78, TUP/C 6562, Alb/C 5023 and α1m/C 96.8). The data of this group suggest the ability of this marker to identify the patients with the highest level of disease severity. By contrast the marker IgG/C 0 & α2m/C 0 associated with the lowest excretion of IgG/C (53) and α2m/C (0) and with the highest value of baseline eGFR (92.3 ml/min/1,72 m2) and the lowest values of the histologic and protenuric parameters (GGS%, 5.1%, TID score 0.90, AH score 0.24; TUP/C 2620, IgG/C 53, α2m/C 0, Alb/C 2330 and α1m/C 17.5) suggest the ability of this marker to identify the patients with the lowest level of disease severity. The 4 groups of IgG/C and α2m/C in combination, show a high predictive value of functional outcome both for “Remission & persistent NRF” (No progr.) and “Progression & progression risk” (Progr.). In 84 patients treated with Steroids and Cyclophosphamide the combination of IgG/C 0 & α2m/C 0 with normal blood pressure (BP 0) is associated with the highest values of eGFR and the lowest values of histologic and proteinuric parameters and the functional outcome reachs 100% of “Remission & persistent NRF” (No ptrogr.) and 0% of “Progression & progression risk”. The combination of IgG/C1 & α2m/C1 with high blood pressure (BP 1) is associated with worsening of all the parameters and 100% of “Progression & progression risk” (Progr.) and 0% of “Remission & persistent NRF” (No progr.). To reach the highest rate of functional outcome it is necessary a combination with normal or high blood pressure also in patients treated with steroids and cyclophosphamide. Very similar results in 30 patients with IMN and NS treated with Steroids and Cyclophosphamide.
The combined urinary excretion of IgG/C and α2m/C realizes a reliable evaluation of disease severity in 151 patients with chronic glomerulonephritis and NS and long term functional outcome and in 84 patients treated with Steroids and Cyclophosphamide; in these last patients not only assess disease severity but also achieves 100% of outcome prediction: the patients with IgG/C 1 & α2m/C 1 & and BP 1 show 100% of “Progression & progression risk” and 0% of “Remission & persistent NRF”; the patients with IgG/C 0 & α2m/C 0 & and BP 0 show 100% of “Remission & persistent NRF” and 0% of “Progression & progression risk”. This new proteinuric marker could be very useful to assess functional outcome with new treatments such as Rituximab.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
