AUCTORES
Globalize your Research
Case Report
*Corresponding Author: Yuliya V. Tyravska. Bogomolets National Medical University, Kyiv, Ukraine.
Citation: Yuliya V. Tyravska, Savchenko O. V. and Lizogub V.G. (2024), Case of Lambl’s excrescences and microthrombosis intracardially in young female with INOCA, J, Clinical Case Reports and Studies, 5(8); DOI:10.31579/2690-8808/221
Copyright: ©, 2024, Yuliya V. Tyravska. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 12 September 2024 | Accepted: 02 October 2024 | Published: 28 October 2024
Keywords: case report; Lambl’s excrescences; cardiac microthrombosis; INOCA; spontaneous echocardiographic contrast; blood viscosity
Ischemia and No Obstructive Coronary Artery Disease (INOCA) causes angina pectoris in 30-50% of young females leading to higher risk of major adverse cardiovascular events (death, non-fatal myocardial infarction, stroke), increased frequency of hospitalization, decreased quality of life and functional status. Missed diagnosis and mismanagement is rather typical of patients with INOCA. It can be provoked by mental stress, vasoconstriction, infections (including viral), vaccination, Lambl’s excrescences, which may lead to local blood rheology disorders and intracardial microthrombi formation. This paper reported the case of INOCA in a 28-year-old female patient with floating microthrombi in the left atrium, Lambl’s excrescences in the aorta, and reviews the relevant literature regarding above-mentioned disorders.
Angina pectoris (AP) in elderly patients is caused by stenosing atherosclerosis of the coronary arteries (CA), coronary spasm [1], and while its destabilization – predominantly by atherothrombosis [2]. Cardiac microvascular dysfunction (CMD) may aggravate the course of atherothrombosis [3]. Thus, the no-reflow phenomenon develops in 35% of patients with acute coronary syndrome after recanalization due to microembolization and thrombosis of myocardial microvessels, defective mitochondrial quality control. All these significantly impairs the effectiveness of recanalization and leads to the myocardial infarction [4].
Approximately 70% of patients with AP, particularly 30% of elderly patients, according to coronary angiography, have either hemodynamically insignificant atherosclerotic plaque in CA or absolutely no plaques are registered. Currently, this type of AP is defined as INOCA – ischemia and no obstructed CA [5]. The number of patients with intact CA at a young age is significantly higher in comparison with older one and is characterized by female preponderance, particularly it is established as a cause of AP in 30-50% of young females who undergo coronary angiography [6]. CMD plays a crucial role in INOCA occurrence, especially in women [5]. Traditional cardiac risk factors (smoking, arterial hypertension, hyperlipidemia, hyperglycemia and insulin resistance) as well as sex-specific factors (changes in blood estrogens level, autoimmune disorders, treatment for breast cancer) provoke INOCA occurrence [7]. Microvascular ischemia is tightly associated with endothelial dysfunction of arterioles [8]. Furthermore, psychological stress is a powerful trigger of vasomotor disorders and provokes so called mental stress-induced myocardial ischemia [9]. Recently, SARS-CoV-2 infection is found out to be additional factor that may aggravate endothelial dysfunction and as a result provoke or intensify microvascular ischemia [10]. Moreover, SARS-CoV-2 vaccines are disputable in terms of side effects and the influence onto microcirculation [11]. Thus, it is defined three endotypes of INOCA, particularly coronary microvascular dysfunction, epicardial coronary vasospasm and mixed one [12].
All over the above, local disorders of blood rheology, sometimes leading to intracardiac thrombosis with micro-embolization of the coronary microvasculature and the clinic of microvascular AP, as well as vasomotor disorders at a young age are not sufficiently investigated. Current clinical report presents the case of AP with local blood rheology disorders and microthrombosis intracardially in young female that arises the suspicions regarding INOCA.
Patient information
Female patient I., 28 years old, visited a cardiologist on an outpatient basis with complaints of recurrent episodes of stabbing pain in the heart region without a clear connection with physical activity without irradiation.
History of present illness
For the first-time paroxysmal pain with pressure in the heart region and behind the sternum, accompanied by shortness of breath, occurred 1 month before visiting the doctor. The attack was coped on its own, but since that time periodic stabbing pain has begun to disturb the patient. The first attack was associated with stress – death of the patient’s father.
Personal history
The patient had no history of any therapeutical disorders (including autoimmune diseases), surgeries, traumas, no harmful habits. Nothing remarkable in obstetric history was: no pregnancies, no history of miscarriage or spontaneous abortion. No allergic reactions were registered. The patient did not take any medications, including oral contraceptives. She was vaccinated against coronavirus twice (mRNA vaccine) 2 months prior to current episode of disorder manifestation.
Family history
The father's cause of death was pulmonary embolism. It has been known that for many years he was observed by a surgeon for chronic thrombophlebitis of the lower extremities. 6 months before his death, the diagnosis of permanent form of atrial fibrillation was established. One month later, he had a stroke for which he was hospitalized and was discharged in a relatively satisfactory condition. 3 weeks before the date of death, he was vaccinated with 1 dose of the vaccine against coronavirus (mRNA vaccine).
Clinical findings
Objectively: general condition of the patient was normal. She was normostenik, body mass index - 23.2 kg/m2. The skin and visible mucous membranes were clean. Blood pressure - 120/80 mm Hg, pulse 80 bpm, rhythmic. While physical examination no pathological changes were noticed in the internal organs.
Diagnostic assessment
On the ECG (Fig. 1), sinus regular rhythm was registered, negative T wave in lead III, no other peculiarities.
Figure 1: ECG of patient.
The patient underwent two-dimensional transthoracic echocardiography (Toshiba Artida, SSH-880CV). The heart volumes, wall thickness and ejection fraction (EF=65%) were normal.
However, an additional floating thread-like structure in aorta was noticed. We suspected it was Lambl’s excrescences which were attached to the non-coronarogenic aortic cusp. In the lumen of the aorta in the region of the right coronary cusp and the outflow tract of the left ventricle, we noticed the local areas of spontaneous echocardiographic contrast (local hemorheological changes). At the same time, larger areas of spontaneous echocardiographic contrast were registered in the region of the left atrium. Besides, a more echogenic and formed microthrombus on a thread (presumably fibrin) was attached to the anterior leaflet of the mitral valve. Though this microthrombus was localized in the left atrium, it passed through the mitral valve into the left ventricle and then returned to the left atrium. It resembled the effect of a tennis ball on a string (Figure.2).
Figure 2: EchoCG of the patient: A, B, C - Parasternal long axis view; D – Apical short axis view; 1 – Lambl’s excrescences; 2 – phenomena of spontaneous echocardiographic contrast; 3 – microthrombus; 4 – thread of thrombus; LV – left ventricle, LA – left atrium, Ao – aorta.
Results of laboratory assessments have been aggregated in Table 1.
| Parameter | Result | Reference range |
| Complete blood count | ||
| Leukocytes, x109/L | 4.86 | 3.5-10.6 |
| Erythrocytes, x1012/L | 4.52 | 4.0-5.2 |
| Hemoglobin, g/L | 135 | 110-160 |
| Hematocrit, % | 42.8 | 35.0-47.0 |
| Mean corpuscular volume, fL | 94.7 | 75-98 |
| Mean corpuscular hemoglobin, pg | 29.9 | 27-34 |
| Mean corpuscular hemoglobin concentration, g/dL | 31.5 | 31.5-36.0 |
| Platelets, x109/L | 216 | 150-390 |
| Erythrocytes distribution width (RDW-SD) | 45.1 | 37-54 |
| Erythrocytes distribution width (RDW-CV) | 13.5 | 11-16 |
| Platelets distribution width, fL | 14.7 | 10-18 |
| Mean platelets volume, fL | 11.1* | 6.5-11 |
| Thrombocrit, % | 0.24 | 0.1-0.4 |
| Erythrocyte sedimentation rate, mm/h | 6 | < 15 |
| Blood differential test | ||
| Neutrophils, x109/L | 2.56 | 1.7-7 |
| Lymphocytes, x109/L | 1.92 | 1-4.8 |
| Monocytes, x109/L | 0.30 | 0-0.8 |
| Eosinophils, x109/L | 0.06 | 0-0.45 |
| Basophils, x109/L | 0.02 | 0-0.02 |
| Coagulogram | ||
| Prothrombin time, s | 11.6 | 9.8-12.5 |
| Prothrombin index, % | 88.4 | 70-130 |
| International normalization ratio | 1.10 | |
| Activated partially thromboplastin time, s | 30.2 | 22-32 |
| D-fibrinogen, g/L | 3.09 | 2-4 |
| Thrombin time, s | 19.6 | 14-21 |
| Closure time | ||
| Epinephrine/ Collagen, s | 152 | 84-160 |
| ADP/ Collagen, s | 88 | 68-121 |
| Lipidogram | ||
| Cholesterol, mmol/l | 4.86 | < 5.2 |
| Triglycerides, mmol/l | 0.48 | < 2.26 |
| High density lipoproteins, mmol/l | 2.4 | >1.68 – no risk (for females) |
| Low density lipoproteins, mmol/l | 2.67* | < 2.59 – optimal level |
| Very low density lipoproteins, mmol/l | 0.22* | 0.26-1.00 |
| Serum glucose, mmol/l | 4.81 | 4.11-5.89 |
Notes: * - out of reference ranges, ADP – adenosine diphosphate.
Table 1: Laboratory tests of the patient.
Diagnostic challenges. The patient had to go abroad in a few next days after visit. Consequently, the access to further profound investigational procedures was limited.
Diagnosis. We suspected AP caused by INOCA.
Therapeutic intervention
It was prescribed clopidogrel bisulfate 75 mg orally once a day and trimetazidine hydrochloride 35 mg MR twice a day.
Follow-up and outcomes
In 6 months, the patient had no possibility to visit the clinic to pass over the investigations (went abroad because of unforeseen circumstances). However, via cell phone call she mentioned about improvement in her condition (no pain in heart area, dyspnea or other unpleasant feelings) and well tolerated physical activity as well as emotional stresses.
It is well known that phenomenon of spontaneous echocardiographic contrast is observed mainly in patients with dilated heart cavities with a significant slowdown in blood flow velocity with low ejection fraction [13] or with atrial fibrillation, often in the left atrial appendage [14]. The effect itself is primarily associated with aggregation, erythrocytes agglutination and is one of the markers of the thrombi formation in the heart cavities [15].
However, according to the Virchow triad, in addition to the slow blood flow and its turbulence, the formation of a thrombus requires a violation of the vessel wall’s integrity (according to modern concepts, damage to the endothelium) and a violation of the blood rheological properties. The endothelium also lines the endocardium and the heart valves [16]. The coronavirus has a tropism for endothelial damage and microthrombosis [17]. Thus, according to autopsies of patients who died from coronavirus infection, endotheliocytes of small arteries and arterioles were located on the basement membrane unevenly in small groups or were single. For a long distance, the basement membrane remained bare, only individual cells retained their normal appearance. Most of the cells became rounded with light cytoplasm and prolapsed into the vessels’ lumen. Desquamated endothelial cells were also visualized. In places of cell desquamation, peri vassal erythrocytes’ aggregation and thrombus formation were detected [18]. The mechanisms of thrombus formation in COVID-19 continue to be studied but it was registered significantly greater fibrin and terminal complement C5b-9 [19].
Lambl’s excrescences on the cardiac valves during echocardiography have been registered for the last 15 years. The mechanism of their occurrence is still unknown. Presumably, these may be filaments of collagen and fibrin. These structures may result from damage to the valvular endothelium [20] and even are associated with acute myocardial infarction [21] or stroke [22] due to its embolization. As microthrombus is attached to the anterior leaflet of the mitral valve we suspect the damage of the valvular endothelium which can be among possible mechanisms of Lambl’s excrescences formation in current patient. Anyway, these findings highlight the increased risk of major adverse cardiovascular events in the patient. Further investigations are warranted to elucidate the association of these accessory structures on cardiac valves with immune-inflammatory processes in COVID-19.
Regarding erythrocytes sludge, that was manifested as local areas of phenomenon of spontaneous echo contrast in the aorta (the right and left CAs anatomically branch out from the aorta), as well as in the left atrium, it led to the formation of a mobile microthrombus. The phenomenon of local disorders in the blood rheological properties may be suspected. Erythrocytes aggregation coincides with an increase in blood viscosity leading to stasis [23]. The tissue or organ that is supplied with blood by these microvessels remains ischemic with all the ensuing consequences - hypoxia, acidosis, accumulation of metabolites, low-grade inflammation [24, 25, 26]. In the presented clinical episode, this is the microvasculature in the pool of the right CA.
The dependence of the blood plasma viscosity on the erythrocytes’ deformity has been established. The less erythrocytes membranes deformity, the greater blood viscosity [27]. The decrease in deformity may be due to an increase in the concentration of calcium ions in the erythrocyte membrane, which is observed, in particular, during hypoxia [28]. Viscosity becomes more pronounced with an increase in abnormal erythrocytes (for example, spherocytes) and erythrocytes containing an altered hemoglobin structure [27]. Besides, deviations in the deformity of erythrocyte membranes can change its electrical potential, which contributes to an increase in erythrocytes aggregation and a violation of the capillary’s spatial orientation [29]. Electrostatic forces and molecular bridges while rouleaux occurrence are considered as one of the leading aggregation mechanisms [30]. Blood viscosity depends on the protein and lipid plasma composition. An increase in the content of coarsely dispersed proteins in plasma leads to a blood viscosity enhancement. Thus, an increase in globulins up to 1-2% is accompanied by a doubling of viscosity. Thrombin and, especially, fibrinogen intensify blood viscosity (plasma viscosity is 20% higher than serum viscosity). The blood viscosity is increased by fibrinogen (fibrin) degradation products [31]. On the contrary, albumin leads to decrease in blood viscosity as an active antiplatelet agent [32]. The plasma lipid composition is of great importance. Blood viscosity intensifies with an increase in cholesterol / phospholipids ratio, low and very low density lipoproteins concentration, lipid peroxidation products [33]. Acidosis, in particular hypercapnia, also leads to blood hypercoagulability [25]. The slowdown in regional blood flow as a result of blood circulation centralization during stress is another factor causes widespread erythrocytes aggregation and sludge [34]. In the discussed particular clinical case, the patient had pain in the region of the heart after stress.
In complete blood count it was registered slightly increased mean platelets volume which is another marker of higher risk of cardiovascular events in patients as a sign of platelets activation triggered by endothelium dysfunction [35]. Several factors that can cause endothelium damage were found out in current patient, namely local blood rheology disorders, microthrombosis and Lambl’s excrescences. However, the platelets quantity and its aggregation quality were normal.
Among limitations of presented case report absence of appropriate follow-up should be mentioned. The monitoring of patient’s condition was provided only distantly via phone.
In the latest guides about INOCA management evidence-based data regarding treatment peculiarities for women are still absent [5]. However, according small sample-sized, short-term pilot studies of symptomatic women with INOCA, it is considered that statins in combination with angiotensin-converting enzyme inhibitor or receptor blockers improve angina, stress testing, myocardial perfusion, coronary endothelial function, and microvascular function [36].
The management of patients with enhanced blood viscosity is even less understandable. The principles for normalization of blood rheological properties should be based on [37, 38, 43]:
1. Normalization of hemodynamics (restoration of blood flow velocity);
2. Controlled hemodilution (blood thinning and viscosity reduction);
3. Antiplatelet agents and anticoagulants (prevention of thrombosis);
4. The usage of drugs that reduce the rigidity of erythrocyte membranes;
5. Normalization of the acid-base state of the blood;
6. Normalization of the protein composition of the blood (albumin solutions).
For the purpose of hemodilution and disaggregation of cells, hemodez and low molecular weight dextrans are used, which increase the electrostatic forces between blood cells due to an increase in the negative charge on their surface, lower blood viscosity by attracting water into the vessels, cover the endothelium and vessels with a separating membrane, form complex compounds with fibrinogen, reduce the lipids concentration [44].
In young patients, cardialgia may be caused by either microvascular ischemia due to local disturbance of blood rheology with the formation of intracardiac thrombi or vasospasm caused by mental stress. Physicians should take into account INOCA as one of possible differential diagnosis in young females with chest pain and cardiovascular risk factors.
The hand-written informed consent of the patient was obtained after detailed explanation of the purpose of the investigations. The patient was managed according to the ECS guidelines. The lack of some investigations is due to local specificity. Nonessential identifying details are omitted. The identifying characteristics of the patient are deidentified without distorting of the scientific meaning.
We are highly thankful the nurse Yuliia Sivtsova for assistance in data collection.
No AI-assisted technologies
No Financial, non-financial relationships and activities are declared
No conflicts of interest are declared.
Oleksandr Savchenko – conception and design of the case, acquisition of data, analysis and interpretation of data, critical revising, final approval;
Yuliya Tyravska – concept and design of the study, analysis and interpretation of data, drafting the article, critical revising, final approval;
Tarana Nadeem – acquisition of data, critical revising, final approval;
Viktor Lizogub – critical revising, final approval.
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
