AUCTORES
Globalize your Research
Review Article
*Corresponding Author: Darya Sitovskaya, Polenov Neurosurgical Institute – Branch of Almazov National Medical Research Centre, 191014, Mayakovskogo st., 12, Saint-Petersburg, Russia.Federal State budgetary Educational Institution of Higher Education «St. Petersburg State Pediat
Citation: Darya Sitovskaya., Aleksandra Naumova., Tatyana Sokolova., Yulia Zabrodskaya, (2024), Changes in Gfap and S100 Immunoreactivity in the Temporal Lobe in Pediatric Patients with Drug-Resistant Epilepsy Commoners, Psychology and Mental Health Care, 8(7): DOI:10.31579/2637-8892/288
Copyright: © 2024, Darya Sitovskaya. 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: 20 June 2024 | Accepted: 19 July 2024 | Published: 02 August 2024
Keywords: drug-resistant epilepsy; focal cortical dysplasia; children; GFAP; S100
Up to 10.5 million children suffer from epilepsy, one-third of whom develop drug-resistant epilepsy (DRE) requiring surgical treatment. In temporal lobe epilepsy, drug resistance reaches 38% of all cases, and patients with this form of the disease have a higher risk of disability and mortality. The European Commission of the International League Against Epilepsy (ILAE) has identified glial mechanisms of seizures and epileptogenesis as a research priority. The purpose of our study was to conduct a comparative analysis of the level of expression of the cytoskeletal protein glial fibrillar acid protein (GFAP) and the protective protein S100 in children with epilepsy associated with focal cortical dysplasia (FCD). Biopsy material from fragments of the temporal lobe of the brain was retrospectively studied at pathology department of Polenov Neurosurgical Institute, obtained intraoperatively from 16 patients (7 girls, 9 boys) with locally caused EEG aged from two to 17 years, with an average age of 9.5 years. Autopsy material from six patients who died from somatic diseases and had no history of neurological disorders was used as a comparison group. Of these, 2 girls and 4 boys aged from 3 to 14 years, with an average age of 8 years, were observed in our study. We observed a significant increase in the expression of GFAP and S100 in the brain tissue of children with FCD when simile to the comparison group. There were no differences in the expression of GFAP and S100 depending on the gender or age of the patients. The correlation between GFAP and S100 proteins was weak in all regions studied. Thus, in the area of the epileptic focus occur in children, active processes of repair of nervous tissue and the mechanisms for increasing the levels of the studied proteins can serve as potential therapeutic targets in DRE therapy, which will prevent secondary neurodegeneration in these patients.
Epilepsy is a well-known neurological disorder, ranking fourth in terms of prevalence and affecting approximately 65 million people worldwide [18, 20]. It is particularly prevalent among children, with up to 10.5 million cases reported [12]. Despite advances in treatment, epilepsy remains a leading cause of disability-adjusted life expectancy among neurological disorders [3]. While most pediatric patients with epilepsy can lead long and productive lives, there is a small risk of sudden unexpected death in epilepsy (SUDEP) [19]. The overall risk of SUDEP is 0.22/1000 patient-years, or 1 in 4500 children per year [13], which is significantly lower than the incidence in adults (approximately 1 in 1000 per year). However, one third of patients with epilepsy do not respond to antiepileptic drugs (AEDs) and require surgical treatment [37]. This condition is known as drug-resistant epilepsy (DRE) and is defined as inadequate seizure control despite the use of at least two AED regimens [28]. In certain types of epilepsy, such as temporal lobe epilepsy, the rate of drug resistance can be as high as 38% and has not decreased in recent years [6]. The social and economic burden of chronic DRE is significant, accounting for approximately 80% of the total costs associated with epilepsy [22]. Numerous studies have focused on the role of glia in maintaining and modulating abnormal neuronal activity in epilepsy [22]. Changes in the morphology, biochemistry, and physiology of glia can lead to reactive gliosis, a process that involves a range of physical and chemical changes in glial cells, particularly astrocytes and microglia, in response to various forms of CNS lesions and diseases, including epileptic seizures [30]. A key characteristic of gliosis is the increased expression of certain proteins, such as glial fibrillary acidic protein (GFAP) in astrocytes and the beta subunit of calcium channel binding protein S100 (S100B) [22]. These proteins have been implicated in the pathogenesis of epilepsy.
Despite the growing knowledge of epilepsy, ongoing pharmacological development of 3rd and 4th generation AEDs, and investment in research over the past 15–20 years, there has not been a significant increase in the number of seizure-free patients. Additionally, a proportion of patients still require surgical intervention. Therefore, there is a great need to find new therapeutic targets and further understand the pathophysiology of epilepsy.
Purpose of the study. To study the immunoreactivity of GFAP and S100 in the cortex and white matter of the temporal lobe of the brain in pediatric patients with drug-resistant epilepsy (DRE) associated with focal cortical dysplasia (FCD).
Biopsy material from fragments of the temporal lobe of the brain was retrospectively studied at Polenov Neurosurgical Institute – Branch of Almazov National Medical Research Centre. The material was obtained intraoperatively from 16 patients (7 girls and 9 boys) with locally caused DRE, aged 2 to 17 years, with an average age of 9.5 years. The area of the epileptic focus was determined using magnetic resonance imaging (MRI) according to the “epilepsy” program, positron emission tomography–computed tomography (PET-CT), and electroencephalography (EEG) with invasive monitoring. Autopsy material from 6 patients who died from somatic diseases and had no history of neurological disorders was used as a comparison group. The material was fixed in 10% buffered formalin, dehydrated in a standard manner, and embedded in paraffin. Histological sections were stained with hematoxylin and eosin and studied, as well as the results of immunohistochemical (IHC) reactions with antibodies to GFAP and S100 (antibodies from Dako (USA), EnVision imaging system). Histological analysis and microphotography were performed using a Leica DM2500 M microscope equipped with a DFC320 digital camera and using an IM50 image manager (Leica Microsystems, Wetzlar, Germany). The result of the reaction with antibodies to GFAP was assessed by calculating the densitometric density of stained cells in the cortex and white matter of the cerebral hemispheres in each case (PhotoM program, Russia). The program calculates densitometric density relative to background areas. The densitometric density of all cells within each field of view was calculated. Data are presented in mean and variance format. The result of the reaction with antibodies to S100 was assessed by quantitative counting of stained cells (positive and negative) in the cortex and white matter of the cerebral hemispheres in each case (ImageJ-win32 program). Statistical analysis was carried out using the Statistica v.10 program. Nonparametric statistics methods were used for the analysis. The study was approved by the Ethics Committee of the Almazov National Medical Research Centre (protocol No. 0305–2016 of May 16, 2016) and was carried out in accordance with the Helsinki Declaration of Human Rights. Preoperative examination and surgical treatment of patients were carried out in accordance with the Clinical Guidelines of the Association of Neurosurgeons of Russia 2015.
The histological examination showed that all patients had focal cortical dysplasia (FCD) of various histological subtypes (Fig. 1), according to the 2022 ILAE classification. The most common subtypes were types Ib and IIa, with four cases each. Type I is characterized by the formation of vertical microcolumns (Ia), disturbances in cortical lamination with mixing layers (Ib), or a combination of both (Ic). For FCD type II, the presence of dysmorphic neurons with aggregated Nissl substance (IIa) and balloon cells with abundant glassy cytoplasm and an eccentrically located nucleus (IIb) is pathognomonic. In two cases, type 1 sclerosis of the hippocampus (ILAE, 2013) and associated FCD IIIa were confirmed.
An immunohistochemical study using antibodies to GFAP and S100 showed increased protein expression in the cortex and white matter of the cerebral hemispheres in patients with DRE compared to the comparison group (Figure. 2-3). Increased expression of GFAP was observed in the cytoplasm of cells (Figure. 2, A-B), which had a star-shaped appearance due to the branching of numerous hypertrophied processes. In the comparison group, expression was mainly found in astrocytes of the white matter, with only a few fibers stained in the cortex (Figure. 2, C-D).
Immunohistochemical reaction, ×400
A – Cortex, B – White matter of a patient with epilepsy. Reactive astrocytes are indicated by an arrow.
C – Cortex, D – White matter of the patient of the comparison group.
Figure 2. GFAP expression in the cortex and white matter of the temporal lobe of the brain of patients with DRE and in the comparison group (description in the text).
The expression of S100 was predominantly detected in the cytoplasm and nuclei of glial cells (Figure. 3, A-B), as well as in single neurons. In the comparison group, nonspecific background staining was observed, along with expression in the nucleus/cytoplasm of a few cells (Figure. 3, C-D).
Immunohistochemical reaction, ×400
A – Cortex, B – White matter of a patient with epilepsy. Stained glial cells are indicated by an arrow.
C – Cortex, D – White matter of the patient of the comparison group.
Figure 3: S100 expression in the cortex and white matter of the temporal lobe of the brain of patients with DRE and in the comparison group (description in the text).
Quantitative cell counting in patients with DRE who reacted with antibodies to S100 revealed the following indicators: the number of S100-positive cells (Fig. 4) in the cortex ranged from 4 to 38 (μ = 18±5), and in the white matter it ranged from 11 to 108 (μ = 50±11). In the comparison group, the quantitative count of cells that reacted with the antibody was as follows: in the cortex, 5–25 (μ = 12±3); in the white matter, 4–30 (μ = 15±4). The ratio of reacted and unreacted cells with antibodies to S100 was also determined: in the cortex, K = 0.564, and in the white matter, K = 5.53. In the control group, this coefficient was: in the cortex, K = 0.434, and in the white matter, K = 0.551. When studying the densitometric density of stained cells that reacted with antibodies to GFAP, patients with DRE showed the following results (Fig. 4): in the cortex, the range was 0.0214–0.16 (μ = 0.048±0.014), and in the white matter, it was 0.0306–0.801 (μ = 0.087±0.065). In patients in the comparison group, the densitometric density of GFAP was as follows: in the cortex, 0–0.095 (μ = 0.025±0.015); in the white matter, 0.011–0.106 (μ = 0.04±0.0224).
A – GFAP in the cortex; B – GFAP in white matter; С – S100 in the cortex; D – S100 in white matter (explanation in the text).
Figure 4. Scope plot of GFAP and S100 expression data in the cortex and white matter of the temporal lobe of the brain, where 1 – patients with DRE, 0 – patients in the comparison group.
Based on the results of statistical analysis using the Mann-Whitney, Kolmogorov-Smirnov, and Wald-Wolfowitz criteria (p<0>Cortex Protein Descriptive statistics: μ p-value Patients Comparison group GFAP 0,05 0,025 0,001 S100 18 12 0,014 White matter Protein Descriptive statistics: μ p-value Пациенты Comparison group GFAP 0,09 0,04 0,0004 S100 51 15 0,001
Note: μ – arithmetic mean;
p-value – calculated level of significance.
Table 1: Comparative characteristics of protein expression values in the epileptic focus in patients with DRE and the comparison group (Mann-Whitney U-test).
However, there were no significant differences in protein expression based on the patients' gender and age.
Further analysis using the Spearman correlation coefficient and the Chaddock correlation coefficient scale to assess the strength of the relationship between the studied proteins in the cortex and white matter of the temporal lobe of the brain revealed a weak correlation between GFAP and S100 in all areas (see Table 2).
| Protein/region | S100 cortex | S100 wm | GFAP cortex | GFAP wm |
| S100 cortex | -0,34 | 0,26 | 0,38 | |
| S100 wm | -0,34 | 0,06 | -0,14 | |
| GFAP cortex | 0,26 | 0,06 | -0,11 | |
| GFAP wm | 0,38 | -0,14 | -0,11 |
Table №2: Values of the Spearman correlation coefficient for the studied proteins GFAP and S100 in the cortex and white matter (wm) of the temporal lobe of the brain.
This suggests that the interaction between these proteins should not be considered. Additionally, no correlation was found between changes in protein expression and the type of FCD, which may be due to the small sample size.
In 1957, Crome first described a form of “ulegyria” with “nerve cells with thick, tortuous processes” [8]. In 1971, David Taylor coined the term “focal cortical dysplasia” based on irregular dysmorphic neurons and enlarged bloated cells in the setting of microscopically discernible architectural disorganization of the neocortex in patients with focal epilepsy [33]. Since then, focal cortical dysplasia (FCD) has been associated with medically incurable [21] epilepsy, which has a less favorable prognosis for seizure-free outcome after surgical resection than hippocampal sclerosis and developmental brain tumors [4]. GFAP is an intermediate filament protein classified as type III, along with vimentin (expressed in many cell types), desmin (in skeletal and cardiac muscle), and peripherin (in neurons). Intermediate filaments are key components of the cytoplasmic cytoskeleton that perform various functions, including providing structural support, scaffolding for enzymes and organelles, and mechanosensory perception of the extracellular environment. During development, GFAP initially appears in radial glia, which are the precursors of astrocytes and neurons. The subsequent increase in GFAP expression as astrocytes differentiate is often considered a defining feature of astrocyte maturation. The highest level of GFAP in normal brain tissue is detected in subpial astrocytes and white matter astrocytes [16]. GFAP-expressing astrocytes play a critical role in responding to neuronal injury by undergoing reactive astrogliosis, characterized by cellular hypertrophy, astrocyte proliferation, and increased GFAP expression. This reaction ultimately leads to the formation of a glial scar, which serves to protect healthy cells from potential damage caused by harmful substances [10, 36]. Astrocytes play a crucial role in various functions, such as providing energy to neurons through the astrocyte-neuron lactate shuttle [29]. They also regulate Ca2+ influx, which affects neuronal activity by releasing gliotransmitters [23]. In our study, we observed a significant increase in GFAP expression in the brain tissue of children with FCD compared to the control group. There were no differences in GFAP expression based on the gender and age of the patients. This suggests that the reactive production of GFAP by astrocytes is not specific to children, regardless of their age and the maturity of their brain tissue. The formation of a glial scar, resulting from the activation of astrocytes, can have an epileptogenic effect, both directly and indirectly, through the subsequent action of cytokines on astrocytes [25]. Reactive astrocytes also disrupt their normal homeostatic functions, such as potassium ion uptake, ion buffering, calcium signaling, and excitatory neurotransmitter uptake [27]. S100β is an acidic zinc (Zn2+) and calcium (Ca2+) binding protein found in the nucleus and cytoplasm of a wide range of cells [15]. In the nervous system, S100β is found in astrocytes, oligodendrocytes, Schwann cells, ependymal cells, and single populations of neurons [17]. S100 proteins regulate a wide range of cellular activities,
including the cell cycle [5], cell differentiation and survival [2, 24], apoptosis [35], cell motility [7], membrane-cytoskeleton interaction [9], intracellular Ca2+ homeostasis [26], and more. S100β can also enter the
bloodstream and is one of the most studied serum biomarkers used to analyze brain damage [34]. Additionally, S100β plays a role in
modulating glial-neuronal interactions, promoting brain development and synaptic transmission, potentially through G protein-coupled receptor (GPCR) [32]. Studies have shown that the S100β protein regulates GFAP activation, tubulin polymerization, and DNA repair [1]. In our study, we observed a significant increase in S100 expression in the brain tissue of children with FCD when compared to the comparison group. There were no differences in S100 expression based on the gender and age of patients. The presence of S100β has been shown to potentially have pro-apoptotic effects by enhancing nitric oxide (NO) expression, which can lead to neuronal and glial cell death and may play a role in the development of epilepsy [31]. Previous studies have demonstrated that inhibiting NO can prevent seizures [14]. While elevated protein levels in epilepsy may initially serve as a protective and adaptive response to focal damage, long-term overexpression can also contribute to glial and neuronal apoptosis, as well as sustained neuroinflammation [35].
Our study found an increase in the expression of the cytoskeletal protein GFAP and the protective protein S100 in the epileptic focus of children with FCD. However, no correlations were found between their expression levels or the age and gender of patients. This may be due to the small sample size, highlighting the need for further research. These findings suggest active processes of nervous tissue repair in the epileptic focus, and the mechanisms behind the increased levels of these proteins could potentially serve as therapeutic targets in DRE therapy to prevent secondary neurodegeneration in these patients.
The author declares no conflict of interest.
The study was carried out within the framework of State assignment No. 121031000359-3 «Development of new approaches in the diagnosis of mediobasal pharmacoresistant epilepsy based on the histoproteomics of epileptic foci».
Compliance with patient rights and principles of bioethics. All patients (or their representatives) gave written informed consent to participate in the study. The study was approved by the Ethics Committee of the Polenov Neurosurgical Institute – Branch of Almazov National Medical Research Centre St. Petersburg (protocol No. 0305–2016 of May 16, 2016) and was carried out in accordance with the Helsinki Declaration of Human Rights.
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.
