AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Yirupaiahgari K S Viswanath, FRCS, FRCSI, FRCS (Glas), MS, MBBS, Consultant, Department of General Surgery, James Cook University Hospital, Marton Road, Middlesbrough, United Kingdom TS4 3BW.
Citation: Yirupaiahgari Viswanath K S, Sharmaine Quake, Bennett C. Peter, Dina Saleh, Phanibhushana C. Munipalle, (2024), Giant hiatal hernia and P4HB Phasix TMST mesh hiatoplasty outcomes, Clinical Research and Clinical Trials, 11(1); DOI:10.31579/2693-4779/238
Copyright: © 2024, Yirupaiahgari K S Viswanath. 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: 16 October 2024 | Accepted: 23 October 2024 | Published: 28 October 2024
Keywords: Giant hiatus hernia; Phasix TMST mesh; hiatoplasty; paraesophageal hernia; hiatal repair
Surgical repair of giant hiatal hernia (GHH) and associated high recurrence rate defy technological advances in surgical sciences despite better instrumentation and availability of various mesh prostheses.
Aim: This study evaluates the safety and efficacy of long-lasting biosynthetic absorbable Poly 4 Hydroxybutyrate Phasix TMST mesh outcomes in patients with GHH undergoing hiatal hernia repair.
Methods:
We studied a prospectively maintained database of all patients who underwent GHH repair between September 2020 and October 2023. Primary outcome measures were 30-day mortality and postoperative morbidities. Secondary outcome measures were 90-day readmission rates, patient-reported outcomes derived through modified Visick grading and recurrence of hiatus hernia.
Results:
44 patients were included in this study. Median follow-up is twenty-four months. There was no mortality at 30 days. 4.5% (n=2) experienced significant complications at 30 days. Median length of stay was 3 days. 81% reported clinical improvement with enhanced Visick grade, and proton-pump inhibitor (PPI) cessation rate was 77.4%. There were no readmissions at 90 days. 9.1% who reported symptom recurrence had anatomical hiatus hernia recurrence.
Conclusion:
The study showed laparoscopic hiatoplasty with P4B Phasix TMST mesh has low morbidity and recurrence with medium-term follow-up.
GHH – Giant Hiatus Hernia
ST – Sepra Technology
NSM – Non-absorbable Synthetic Mesh
BSM – Bio Synthetic Mesh
The surgical management of giant hiatus hernia (GHH) remains a contentious topic about the best repair technique. Despite technological advances, the recurrence rate of hiatus hernia remains high(Zhang et al., 2017). The laparoscopic mesh hiatoplasty is associated with lower recurrence rates and is recommended to repair GHH(Rajkomar et al., 2023; Tam, Winger, & Nason, 2016). A few studies have not shown a consistent advantage of mesh usage over suture repair in the management of GHH. However, the types of mesh to be used – synthetic, biological or biosynthetic – are controversial, with differing opinions among surgeons(Rajkomar et al., 2023; Tam et al., 2016).
The safety profile and complications associated with mesh hiatoplasty have been well studied(Lima et al., 2023; Sathasivam et al., 2019; Zhang et al., 2017). Non-absorbable synthetic meshes (NSM) have lower recurrence rates than biological or biosynthetic meshes (BSM). However, evidence shows that mesh erosion and luminal stenosis occur after NSM repairs of the hiatus, in some cases leading to esophagectomy (Rajkomar et al., 2023). Absorbable biologic meshes are more costly and can be associated with early recurrence due to their early absorption profile (Sathasivam et al., 2019). This led to the development of biosynthetic meshes (BSM), which have delayed resorptive rates while retaining the biological properties of reduced risk of infection and increased compatibility with surrounding viscera (Finch, Mehmood, & Varghese, 2021).
Over the last decade, there has been a growing tendency towards BSM usage in patients with GHH (Tartaglia et al., 2021). This editorial covers the use of biosynthetic PhasixTM ST mesh in managing GHH (>5cm2 maximum hiatal diameter). PhasixTM ST mesh comprises the natural polymer of transgenic Escherichia coli, Poly-4-hydroxybutyrate(P4HB)
This study assesses patient outcomes following laparoscopic repair of GHH with mesh cruroplasty in the medium-term follow-up. We have reviewed the literature on the role of biological and biosynthetic hiatal meshes to date.
We aimed to evaluate patient outcomes following laparoscopic repair of hiatus hernia with mesh hernioplasty using resorbable PhasixTM ST mesh. This is an observational cohort study at our tertiary Upper GI centre, North of England, UK. Patients who underwent laparoscopic repair of giant hiatal hernias between September 2020 and October 2023 were identified from a prospectively maintained database at our institution. Giant hiatal hernia was defined as hiatal width >5cm2 determined intra-operatively irrespective of the type of hiatus hernia.
Adults >18 years old undergoing laparoscopic repair of giant hiatal hernias with mesh hernioplasty for both primary and revisional procedures were included. Patients with incomplete data collection or who underwent suture cruroplasty alone were excluded from the study.
Primary outcome measures are 30-day mortality and significant post-operative morbidities (Clavien-Dindo grades III to V). Secondary outcome measures include 90-day readmission rates, clinical outcomes reported during follow-up and recurrence of hiatus hernia. Clinical outcomes were recorded using a modified Visick grade (Watson et al., 2004) (Table 1). The recurrence of hiatus hernia was defined as patient-reported symptoms, with objective evidence of anatomical recurrence of >2cm supported by endoscopic and radiological investigations. Data was analysed using descriptive statistics.
| MODIFIED VISICK GRADING | |
| Grade 1 | No symptoms |
| Grade 2 | Mild symptoms, easily controlled by simple measures such as avoiding certain foods |
| Grade 3 | Moderate symptoms not controlled by simple measures, but not interfering with social or economic life |
| Grade 4 | Moderate symptoms interfering with social or economic life |
| Grade 5 | Symptoms bad or worse than preoperatively |
Table 1: Modified Visick grading system
At our tertiary institution in the United Kingdom, upper gastrointestinal surgeons have standardized the laparoscopic approach to repair GHH with mesh hernioplasty. The patient is supine, secured with two straps, and placed in the reverse Trendelenburg position. Five trocars were used, including one for liver retraction. Pneumoperitoneum was induced, with pressure set at 12-15mm Hg. The whole hernia sac and associated contents are dissected free and reduced into the abdomen with adequate esophageal mobilization. The target was to achieve at least 3 cm tension-free esophagus below the diaphragm. Most of the sac was excised, and short gastric vessel division was performed where necessary. Care was taken to avoid injury to mediastinal structures and both Vagi nerves. A transabdominal large bore Robinson mediastinal drain was placed in selected cases where pleural breach occurred, which was removed after 48 hours.
The Crura were approximated with Ethibond sutures (Ethibond 2-0, Ethicon, Zug, Switzerland) posteriorly, and in selected, an additional anterior suture was taken, depending on the hiatal morphology. We use the monofilament PhasixTM ST mesh (BD, Allschwil, Switzerland) made of poly-4-hydroxybutyrate with a hydrogel barrier. We performed On-lay crural reinforcement with the mesh following the primary closure of the hiatal defect. The PhasixTM ST mesh was prepared as 'U-shaped' and secured with intracorporeal absorbable tackers on the crural area and atraumatic fixation of tissue glue or suture to secure the outer mesh perimeter. For sizing the mesh hiatus, we used fully opened laparoscopic Johann graspers, and the mesh hiatus was trimmed accordingly. Partial fundoplication (anterior or Toupet) is performed after the combined mesh and suture cruroplasty. All patients are advised on the liquid to a soft diet for six weeks postoperatively.
Figure 1 A: Phasix ST mesh prepared as 'U-shaped' mesh. B and C: on-lay crural reinforcement of Phasix ST mesh with intracorporeal tackers and tissue glue. D: The final outcome of combined mesh and suture cruroplasty with partial fundoplication.
Forty-four patients underwent laparoscopic repair of hiatus hernia with PhasixTM ST mesh hernioplasty for giant hiatal hernia between September 2020 and October 2023. 77% were females, and the median age was 68 years old (IQR 16, range 33 – 86). The majority (88.6%) performed as primary procedures (88.6%) and in elective settings (97.7%), with five patients undergoing the above procedure for recurrent hiatus hernia. All procedures were completed laparoscopically without needing conversion to open procedure. All (100%) patients followed up with a median follow-up period of twenty-four months (IQR 13, range 3-41).
Primary outcome measures
There was no mortality (0%) at 30 days. 4.5% (n=2) of patients experienced major complications at 30 days, defined as Clavien-Dindo grades III – V, with one patient requiring return to theatre for suspected viscus perforation (Table 2). In this patient, there was oedema and florid inflammatory changes, secondary to a small, localized perforation, with no features of a frank perforation at re-laparoscopy. The perforation was managed conservatively with drains and antibiotics. The median length of stay was 3 days (IQR 5, 1-69).
| Clavien-Dindo classification | Percentages of patient post-operative complications (%) | |
| Grade I | 6.8% | Acute kidney injury n=2, Pneumonia n=1 |
| Grade II | 2.3% | Atrial fibrillation n=1 |
| Grade IIIa | 2.3% | Pneumothorax n=1 |
| Grade IIIb | 2.3% | Suspected viscus perforation n=1 |
| Grade IV | 0% | |
| Grade V | 0% | |
Table 2: Post-operative complication rates according to Clavien-Dindo classification.
Secondary outcome measures
The majority (81%) reported clinical improvement in their symptoms with better Visick grades during the follow-up period, with a proton-pump inhibitor (PPI) cessation rate of 77.4% - see Table 3 & Figure 2. There were no readmissions at 90 days. Endoscopic and radiological investigations were performed in patients with recurrent or persistent symptoms. These reported anatomical recurrences greater than 2cm with symptoms in 9.1% of patients at a median follow-up length of twenty-four months. These patients are being
treated with pharmacotherapy with a continued follow-up in the future. Altogether, around 19% did not report clinical improvement and were all managed non-operatively, with pharmacotherapy except one patient, who had re-laparoscopy during return to theatre for suspected viscus perforation, due to complex type 3/4 hiatus hernia needing extensive hiatal dissection secondary to adhesions. To date, there are no reports of mesh-related complications. There was no hiatal hernia recurrence in patients with persistent or unchanged symptoms after surgery on imaging or endoscopy.
| Presurgery | Postsurgery | |
| Visick Grade 1 | 0 | 20 |
| Visick Grade 2 | 0 | 15 |
| Visick Grade 3 | 14 | 6 |
| Visick Grade 4 | 30 | 2 |
| Visick Grade 5 | 0 | 1 |
Table 3: Visick Grades before and after Phasix Hiatoplasty
Figure 2: Patient-reported outcomes based on improvement in symptoms during follow-up, according to percentages.
P4HB; Poly 4 Hydroxy Butyric Acid, PGA; Poly Glycolic Acid.
Figure 3: P4HB PhasixTM ST Mesh, the image used with permission from BD.
To our knowledge, this is the first study in the United Kingdom reporting on patient outcomes in the medium-term follow-up after laparoscopic repair of GHH using biosynthetic PhasixTM ST mesh. PhasixTM ST mesh is made up of an interwoven sheet of hydrogel coating with poly 4 hydroxy butyric acid (Figure 3). As per our study, there was no mortality in our cohort of patients. In a 2023 European study conducted by Tonucci et al, 8.2% patients had reported post-operative morbidities which is similar to our findings of 4.5%(n=2) major morbidities post-operatively. Additionally, there were no PhasixTM ST mesh related complications in the study, similar to our current findings (Panici Tonucci, Asti, Sironi, Ferrari, & Bonavina, 2020; Ukegjini, Vetter, Dirr, & Gutschow, 2023).
The majority (81%) of our cohort reported improvement in their symptoms during the follow-up period; this is objectively reflected in the rates of PPI cessation (77.4%) and improvement in their Visick scores. In a study of 50 patients with 1 year follow up conducted by Abdelmoaty et al, 8% of patients had a recurrence of hiatus hernia (Abdelmoaty et al., 2020). In another, more recent observational study conducted by Aiolfi et al. the recurrence rates reported following a 2-year median follow up was 8.8% (Aiolfi et al., 2022). These are comparable to our finding of 9.1% recurrence as part of 2-year median follow-up.
The median time to recurrence in this cohort of patients was seven months. In comparison, the absorption rate of PhasixTM ST mesh was reported to be 12-18 months in animal models (Martin et al., 2013). Early recurrence in our subgroup of patients before the average time of Phasix mesh resorption suggests that other risk factors, such as patient and technical-related factors, play a role in the recurrence of hiatus hernia (Ellis et al., 2019; Saad & Velanovich, 2020).
In literature, mesh augmentation is a highly controversial and debated topic of hiatus hernia (HH) surgery; several types of repairs have been employed in this context. More recently, different prosthetic vs biological mesh materials have been used to repair the defect (Sathasivam et al., 2019).
The ideal material for mesh cruroplasty should aim to provide enough tensile strength to aid reinforcement of the hiatus and hence reduce the risk of recurrent herniation whilst avoiding mesh erosion into the viscera and post-operative dysphagia. Employment of a synthetic mesh at the oesophageal hiatus differs from that of inguinal or ventral hernia repairs due to the dynamic nature of the hiatal defect. The continuous diaphragmatic respiratory motion results in the friction effect of the mesh at the esophageal and stomach interface around the hiatus. This has resulted in some cases of mesh erosion into the oesophagus and migration into the stomach (Sathasivam et al., 2019). The latter can result in catastrophic complications, including esophageal resection. Standardizing the mesh fixation techniques used in hiatal hernia surgery is essential. Different centres have used various methods such as sutures, metallic tacks, absorbable tacks, and glue. In our unit, we fix the mesh with glue (Liquiband Cyanoacrylate) and or absorbable tacks for crural edge (Figure 1). In selected cases, absorbable sutures are added. However, for consistency and best practices, it is necessary to establish a standard protocol for mesh fixation.
A variety of non-absorbable and absorbable meshes are utilized in literature worldwide. PTFE was the first mesh documented in the literature and used by Frantzides and Gouvas et al. (Sathasivam et al., 2019). No mesh-related complications were reported in the PTFE group. Partially absorbable mesh (Poliglecaprone- 25/Polypropylene composite was used in one study (Panici Tonucci et al., 2020).
Other options included absorbable (biodegradable) material that acts as a scaffolding for significant tissue growth for persistent reinforcement. Ringley et al. used a Human acellular dermal matrix (ACDM) patch to reinforce the hiatal closure during laparoscopic hiatal hernia repair (Sathasivam et al., 2019). Oelschlager et al. used porcine small intestinal submucosa for laparoscopic repair of large para esophageal hernias. However, the layered nature of this material made it more challenging to suture to the hiatus during laparoscopic cruroplasty and hence the initial tensile strength before tissue in-growth (Panici Tonucci et al., 2020).
The current scientific evidence remains unclear, and even experts disagree on indications and surgical techniques. Biosynthetic long-term resorbable meshes (BSM) such as Phasix have been developed to avoid the downsides of both non-resorbable synthetic and short term resorbable biological meshes. They are becoming increasingly popular and have been cited in previous studies (Sathasivam et al., 2019).
Absorbable allogenic and xenogeneic materials ("bio meshes") have been introduced and widely promoted to overcome the undesirable characteristics of permanent synthetic meshes. P4HB PhasixTM ST Biomesh is a biosynthetic mesh that gets revascularized and reincorporated with added advantage of having high resistance to bacterial contamination (Panici Tonucci et al., 2020).
Such new-generation long-term absorbable biosynthetic meshes (BSM) have recently been developed to combine the advantages and avoid the downsides of synthetic materials and bio meshes. Phasix ST® (BD, Allschwil, Switzerland) is made from poly-4-hydroxybutyrate (P4HB), a material that handles well laparoscopically, absorbs and remodels to native host tissue within 18 months, and hence carries a lower risk of long-term complications. The mesh provides a monofilament scaffold allowing rapid incorporation with enhanced tissue strength along with remodelling characteristics of a biological prosthesis (Figure 4).
Hiatal Hernia repair with the Phasix bioabsorbable mesh, crural reinforcement, and appropriate tension-reducing techniques is associated with a low early hernia recurrence rate and no mesh-related complications. However, as we stand now, more studies are required to elaborate on using this mesh to confirm long-term efficacy (Sathasivam et al., 2019).
Although promising in concept, few studies have reported clinical outcomes after P4HB reinforcement in HH repair (Panici Tonucci et al., 2020)
Invariably, COVID-19 impacted our elective operating capacity in the United Kingdom. Therefore, our sample size is smaller than expected for a consecutive period of thirty-seven months. A long-term follow-up would determine whether the overall recurrence in patients undergoing P4HB PhasixTM ST hiatoplasty is less than primary suture repair. Additionally, this is a single centre study and warrants recruitment of other hospitals to increase generalization and understand the outcomes of the study.
One of the major strengths of this study is the application of the modified Visick grading system, standardizing the clinical outcomes of the patients. Additionally, the procedure for all patients were standardized and hence gives a more robust understanding of the outcomes of mesh hernioplasty pertaining to the operative procedure.
We conducted a study on Laparoscopic Hiatoplasty using Biosynthetic PhasixTM ST Mesh in patients with GHH. The study showed this procedure has low morbidity and recurrence with medium-term follow-up. Aside, it also affirms that patients sustain symptomatic improvement along with an improved quality of life. The study results are comparable to a few studies published earlier. We intend to continue following these patients as part of a continued long-term observational study.
Despite the positive outcomes, determining what type and when to use a mesh in patients with giant hiatal hernia remains challenging. For all technological advances and surgical endeavours, the quest by foregut surgeons in the world to standardize the procedure continues. Further randomized control studies need to be conducted to understand the outcomes of using different types BSM for the repair of GHH. Additional research needs to be done to create the ideal mesh for complete repair of GHH.
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
