AUCTORES
Globalize your Research
Review Article
*Corresponding Author: Hilde H. Buzzá, São Carlos Institute of Physics, University of São Paulo (USP),Brazil
Citation: Hilde H. Buzzá, Mirian D. Stringasci1, Cintia T. Andrade2, Ana G. Salvio3, Expanding dermatologists view with fluorescence and thermograph J.Dermatology and Dermatitis, DOI : 10.31579/2578-8949/039
Copyright: © 2018 Hilde H. Buzzá et al. 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: 22 May 2018 | Accepted: 30 June 2018 | Published: 09 July 2018
Keywords: Fluorescence; Thermograph; Endogenous Fluorescence; Marked fluorescence; skin lesions.
Several skin lesions are characterized as public health problem due their high incidence. Some lesions denominated premalignant have the potential to progress to malignant lesions and the treatments can have great successful rates if it has a right and precise indication. Diagnosis depends on the experience of the physician to identify tissue changes, mainly in the early stages due to the similar clinical characteristics among different types of lesions. Therefore, the interest in noninvasive diagnosis techniques and not harmful to health is increasing. This study shows tools for skin lesions application complementing the initial clinical examination with fluorescence and thermograph methods. The fluorescence evaluation was performed using a device for the wide field image for the evidentiation of endogenous fluorescence and following Photodynamic Therapy with marked fluorescence. Infrared images were obtained using a thermal camera. Endogenous fluorescence diagnosis can improve the visual contrast between normal and abnormal tissue, contributing to biopsy site determination, lesion border delimitation and lesion identification, such as melanoma and pigmented seborrheic keratosis. Marked fluorescence with Protoporphyrin IX was used to check whether the treatment was as expected and can be used to increase the successful of results. Thermograph was used to discriminate lesions clinically similar, such as actinic keratoses and squamous cell carcinoma that can be simultaneously present, because AK is transformed in SCC in a continuous and progressive process. Fluorescence and thermograph were used to lesion discrimination, border identification and monitoring treatments enabling the physician to indicate the procedure with more confidence.
Among all types of cancer, the highest incidence in the world is the skin cancer, which 95% are non-melanoma lesions and its more common forms are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The exposure to ultraviolet (UV) radiation from sunlight is a major known risk factor for the non-melanoma skin cancer development. (1) Melanoma is the most invasive and aggressive type of skin cancer and, despite representing only 3% of incidence, it is responsible for about 65% of deaths. It can be clinically similar to pigmented seborrheic keratosis (PSK), which is a benign lesion (2,3).
Some lesions denominated premalignant have the potential to progress to malignant lesions. Actinic keratoses (AK) are one of the most incident ones and they are frequent in 60% of patients aged over 40 years, affecting, usually, the body areas most exposed to solar radiation. (4) Nearly 60% of SCCs is originated by AKs and the progression rate from AKs to SCCs varies from 4 to 16% a year (5). Early stages diagnosis of SCCs is important because it is responsible for 34% of deaths caused by skin cancer around the world (6).
The treatment will have great successful rates if it has a right and precise indication and, for this, it is necessary to determine clinical and histopathological characteristics of the lesion. That information ensures the therapeutic adequacy and individualization for each patient and it is resulting from several procedures, such as the search of patient record or clinic examination with visual analysis and palpation. Also, there are laboratory tests as cytology, biopsy and biochemical tests or imaging tests as X-ray or Magnetic Resonance Image (7). The following of treatments and the guarantee of the procedure were as expected with the exact diagnosis of disease are two of main requirements for a good clinical conduct. Photodynamic Therapy (PDT) is an alternative treatment with light that has been largely used in skin disorders(8).
Laser and optical fibers made possible the disease diagnosis with light, replacing highly invasive and mutilating procedures. Techniques with the wide-field image, optical coherence tomography, confocal microscopy and diagnostic by fluorescence are some examples of techniques with light to identify several diseases.
Fluorescence occurs when an atom absorbs an incident light of a certain wavelength and goes from the ground state (lowest energy) to an excited state (higher energy), which is unstable, thus the atom tries to return to the ground state. For this, the atom has to re-emit the absorbed energy, which decreased in the amount due to energy losses that occur inside the molecule. The emitted light (fluorescence) has, then, a longer wavelength that means a different color of absorbed light. Fluorescence characterizes the chemical and physical changes occurring in tissue since each difference will mean different energy losses and wavelength re-emitted. Thus, different tissues or different conditions of the same tissue have distinct endogenous fluorescence (9) and can be used as a detection method to improve the accuracy in diagnosis. The improvement can be by both helping the physician to differentiate types of lesions and allowing lesion borders delimitation, which could provide a most specific treatment, avoiding big surgery or remaining abnormal cells.
Another parameter that can be evaluated is the tissue temperature, which is influenced by blood perfusion and metabolic rate. A tissue with lesion has those characteristics different from a normal one, because its growth and consequent need for nutrient are higher, stimulating angiogenesis (10–12).The thermograph records a body temperature distribution using the infrared radiation emitted by the surface of this body, with a wavelength between 7 and 14 µm(13).
From several studies that have been conducted at the Skin Department of Amaral Carvalho Hospital Foundation in Jahu – SP, Brazil and Brazilian Program of Photodynamic Therapy, images of skin lesions were recorded, analyzed and compared with the diagnosis set by the physician and by histopathology. Eligible patients were subjects of both genders, over 18 years old with different lesions, such as primary superficial (sBCC), nodular (nBCC), or pigmented (pBCC) with a diameter less than of 20 mm, estimated clinically immediately prior to treatment, or AK, PSK, and melanoma. Pregnant always were excluded and all patients signed a written informed consent form.
The interest in these diagnosis ways is increasing, because they are noninvasive techniques and are completely not harmful to health. This report aimed to show tools for skin lesions application complementing the initial clinical examination with fluorescence and thermograph methods, gathering techniques already used with some applications little explored in the clinic. Despite many techniques available to use in dermatology, some techniques are easy to apply, non-invasive and multi-functions and are not frequently used by health professionals.
We are exploring especially fluorescence and thermography and the devices used by our group at São Carlos Institute of Physics and Skin Department of Amaral Carvalho Hospital Foundation in Jahu – SP.
The endogenous fluorescence evaluation could be performed using a device for wide-field fluorescence, LINCE® (MMOptics, São Carlos, Brazil). This equipment is composed of a set of LED arrays with emission in the UV-blue range of light (400 ± 10 nm) and irradiance around 50 mW/cm2. The optical arrangement allows the fluorescence viewing in a contrast visualization between colors and intensities of light in green and red. Health tissue emits fluorescence in the green region of the electromagnetic spectrum with excitation at 400 nm, due to the collagen fibers highly organized and the emission of some molecules such as NAD(H) and FAD(H) (12) while the characteristic protoporphyrin IX (PpIX) fluorescence is red. A digital color camera was coupled at the device with an adapter for image acquisition (14,15).
Figure 1 shows wide-field images from an AK in the left forearm. Figure 1-A is the white light picture where the determination of the lesion borders is difficult to establish by a non-specialist. However, the fluorescence image (Figure 1-B) allows the delimitation of the lesion borders due to the difference in fluorescence between the lesion and normal tissue, since the AK region is lighter than surroundings.
Another possibility is the use of fluorescence in discrimination of clinically similar lesions. PSK is a benign lesion that sometimes, even for the expert dermatologist, is very similar to melanoma, which is the most dangerous skin cancer (3). PSK has some tissue structures, as the corneal pseudocysts, that present different
fluorescence compared to the abnormal tissue and some light spots become evident in the fluorescence image inside of a dark area that is the lesion (Figure 2-A). Thus, this technique helps to differentiate between these two types of lesion, since the fluorescence image of melanoma is a dark area without any fluorescent spots (Figure 2-B) (15,16).
The interaction among light in a specific wavelength, a photosensitive compound (PS) and oxygen results in the cell death and characterize the principle of PDT. The main PS currently used in clinical application is the porphyrin, which accumulates mainly in modified cells and emits in the red region contrasting with the green of the health tissue.
In the Project “Photodynamic Therapy Brazil”, with national coverage, a protocol of non-melanoma skin cancer treatment was established to superficial basal cell carcinoma (sBCC) up to 2 cm in length and nodular basal cell carcinoma (nBCC) less than 2 mm in infiltration. For the treatment, the topic application was used with a cream containing the prodrug methyl aminolevulinate (MAL), the precursor of PpIX, which is an endogenous PS produced by the cells and has the fluorescence emitting in red when excited with blue light (17,18).
Therefore, the evidentiation was performed before the cream application, before the illumination to verify the production and accumulation of PS, and immediately after PDT to confirm the bleaching of PpIX showing to the health professional that the illumination occurred in the right place and with the expected dose (4).
The following of PDT over time in a sBCC is showed in Figure 3, after the incubation time (Figure 3-A) and after the illumination (Figure 3-B), showing almost all PpIX consumed.
However, there are some cases where the illumination happened in a non-efficient way and the PpIX is not consumed. Figure 4 shows the endogenous fluorescence before the cream application (Figure 4-A), after incubation (Figure 4-B) presenting a high red fluorescence indicating a PpIX production and after PDT (Figure 4-C), showing there is still a lot of this red fluorescence.
Infrared images can be obtained using the thermal imager (Fluke® FLK-Ti400 model), with thermal sensitivity ≤ 0.05 ° C and 320 x 240 pixels resolution. The imager has the advantage that shows the thermal image on its display without the need for coupling to a computer and has also auto focus adjustment. The visible light and thermal image are registered simultaneously and can be downloaded on the computer through its software Fluke SmartView 3.5 with color legend corresponding to temperatures.
The AK and SCC lesions can be clinically similar and are showed in the white light images, Figures 5-B and 5-D, respectively. The SCC region usually shows a significant increase of the temperature relative to healthy tissue in the thermal image (Figure 5-A) while in AK the temperature difference in relation to the surround region is less evident (Figure 5-C). This difference could be used to distinguish the type of lesions.
Diagnosis depends on the experience of the physician to identify tissue changes, mainly in the early stages of the lesion due to the similar clinical characteristics among different types of lesions. Although the clinical diagnosis of a PSK presents no difficulty, there are still some lesions that may be clinically similar to melanoma. For dermatologists, the differentiation of suspicious lesions is most of the time easily performed due to their specific training. On the other hand, for the general clinician or less experienced practitioner, this task could be more difficult.
PSK has structures correspondent to corneal pseudo cysts which, when viewed in dermoscopy are considered pathognomonic of this disease and, histologically, it is known that pseudocysts are filled with horny keratin, a highly fluorescent biomolecule when excited by 408 nm. (19–21) The fluorescence visualization provides a higher contrast to identify these structures showing some light spots in the fluorescence image. Therefore, the keratin fluorescence contrasts with the lack of fluorescence in the melanoma, visualized as a black area, due to the high melanin content that absorbs the most part of the light. Differentiating melanoma from PSK helps speed up the treatment of the higher risk lesion to the patient since corneal pseudocysts are not observed in the endogenous fluorescence of pigmented skin lesions, it may be considered of risk and be a priority for treatment.
Fluorescence also could be used to determine border of different types of lesions. Nowadays, the gold standard for diagnosis is biopsy, which is invasive and usually needs time for the result; however, if the procedure is performed on the right site, the result has accuracy (22).Endogenous fluorescence diagnosis can improve the visual contrast between normal and abnormal tissue, contributing to biopsy site determination, lesion border delimitation before treatment and lesion identification. (15,16) .The choice of the skin region that will be taken biopsy has fundamental importance, once the wrong place is chosen, the result may be a false negative, preventing the treatment of lesions in early stages.
The delimitation of the lesion border, on the other hand, contributes to choosing the safety margin, avoiding mutilating surgeries and compromised margins, which leads to the second round of treatment. This type of diagnosis helps the physician to guarantee more efficiency in the surgery.
In addition to the lesion identification, check whether the treatment was as expected is an alternative to increase the successful of results. Figures 3 and 4 showed different lesions treated with PDT and the difference between both procedures is clear. The first one is an example of efficient illumination and the last one shows a possibility of a problem during the treatment. It is clear that PpIX was not degraded for some reason during the illumination process.
This can happen, for example, when the illumination tip slid because the patient moved for some discomfort or the lesion site allowed a not good accommodation. If there is no full-time conference that the illumination is performing in the exact site, the red fluorescence will become clear in the end of PDT, which can indicate the physicist needs to repeat or change the procedure.
Monitoring PDT by fluorescence image, therefore, means an extension of the dermatologist view in a technique increasingly used in skin diseases, such as non-melanoma skin cancer or precancerous lesions.
Besides optical images, thermal images can also be used to extend the physician view. There is a difficulty in discriminating lesions clinically similar, such as AK and SCC that can be simultaneously present, because AK is transformed in SCC in a continuous and progressive process. (23–25)
In the thermal images, SCC usually presents a higher temperature compared to normal tissue, probably due to its more invasive characteristics as fast growth and high aggressively that increase its vascularization. (23) AK presented the temperature map similar to the size of the lesion and they showed no great difference of temperature in comparison with healthy tissue.
Summarizing different techniques and their application, Table 1 was done.
Lesion discrimination, border identification, and monitoring treatments may enable the physician to indicate the procedure with more confidence. Therefore, it is possible to ensure the treatment efficiency applied in any disease. About dermatology, the skin is the site of easier access to photonic and thermal techniques, opening several possibilities for both therapies and diagnosis presented in this study.
The authors acknowledge Professors Vanderlei Bagnato and Cristina Kurachi and financial support by BNDES (09.2.1458.1) and MMOptics. We appreciate the support from FAPESP (Program CEPID-INCT), CNPq, CAPES, and FINEP.
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.
