AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Ji-Ming Zou, Department of Health Care, Yantaishan Hospital, 264008，Shandong Province, China
Citation: Chao Han, Xiao-Yu Li, Ji-Ming Zou (2022). Medium Term Study of Incidence, Risk Factors and Type of Stroke in Hypertensive Patients. J. Neuroscience and Neurological Surgery. 11(4); DOI:10.31579/2578-8868/232
Copyright: © 2022 Ji-Ming Zou, 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: 01 January 2022 | Accepted: 25 February 2022 | Published: 07 February 2022
Keywords: hypertension; stroke; prognosis; risk factors
Background and Aims: To investigate the incidence and risk factors of stroke in hypertension patients over 60 years of age, and to investigate the correlation.
Methods: A retrospective analysis of 454 hypertension patients who were diagnosed through examination were divided into 4 groups, of which included group A (hypertension plus type 2 diabetes) were 4 cases, group B (hypertension plus hyperlipidemia) were 367 cases, group C (hypertension plus type 2 diabetes and hyperlipidemia) were 47 cases, and group D (hypertension) were 36cases. Every patient was given observation after definite diagnosis and treatment of 54 months, and to investigate the incidence of acute cerebral infarction, cerebral hemorrhage.
Results: There were 44 patients occurred acute cerebral infarction in all 4 groups. Of these cases, there were 1 case in group A, 31 cases in group B,10 cases in group C and 2 cases in group D. In group B, 3 cases occurred cerebral hemorrhage. Logistic regression analysis showed systolic blood pressure (OR=1.106, P=0.001), fasting glucose (OR=2.059, P=0.000) and low-density lipoprotein cholesterol (LDL-C) (OR=0.104, P=0.025) were risk factors for stroke.
Conclusions: Higher levels of blood glucose and/or blood lipid associate with higher risk of stroke in patients with hypertension.
Hypertension leads to the over-activation of sympathetic nervous system, resulting in the excessive release of catecholamines. Kidney causes water and sodium retention, blood volume overload; Overactivation of renin-angiotensin-aldosterone system causes water and sodium retention; Vascular endothelial function is reduced, carbon monoxide release is reduced, causing excessive vasoconstriction. Diabetes mellitus lipid metabolism, vascular endothelial dysfunction, platelet dysfunction. Elevated blood lipids in the blood lipid easier to deposit on the blood vessels in the membrane, lipid and compound carbohydrate gathered in the lining of the blood vessels, causing the lining of the blood vessels inflammatory reaction, and further lead to fibrous tissue hyperplasia, calcium precipitation, gradually lose the artery wall elasticity, gradually hardens, thickening, blood vessel lumen, if there is a blood vessel is blocked, or brittle strengthen blood vessel walls, Rupture bleeding and other problems, easy to cause infarction, cerebral hemorrhage and other problems.
Stroke is one of the leading causes of death and disability in adults worldwide [1]. It is a group of acute cerebrovascular diseases with cerebral tissue ischemia or hemorrhagic injury as the main clinical manifestations, including cerebral hemorrhage, cerebral infarction and subarachnoid hemorrhage. This study investigated the incidence of stroke in patients with hypertension who were first diagnosed by physical examination, aiming to understand the relationship between the levels of risk factors such as blood glucose and blood lipid and the occurrence of stroke in patients with hypertension.
The subjects were enrolled in the physical examination department of yantai mountain hospital on June 1, 2008 and December 31, 2011. The inclusion criteria were as follows: 454 patients with ≥60 years of essential hypertension (EH) were found and diagnosed for the first time, including 425 males, aged from 61 to 75 years old, with an average age of (65.2±3.9) years. There were 29 females aged from 60 to 74 years old, with an average age of (64.7±4.1) years. According to the fasting blood glucose (FBG), triglyceride(TG), total cholesterol(TC), low density lipoprotein cholesterol(LDL- C) level is divided into four groups,4 cases of Type 2 diabetes mellitus (T2DM) were combined with EH (Group A).All are male. There were 367 cases in EH combined hyperlipidemia group (Group B), including 353 males and 14 females. There were 47 EH patients with T2DM and hyperlipidemia (Group C), including 41 males and 6 females. There were 36 cases in simple EH group (D group), including 27 males and 9 females. There were 7 cases with a history of T2DM and 119 cases with a history of hyperlipidemia, all of which did not receive standard treatment in community hospitals. No history of cerebrovascular and renal disease. Family history of stroke. The occupation was workers (1 case in Group A, 235 cases in group B, 11 cases in Group C, 5 cases in Group D), and the others were teachers and civil servants.
The data of cases, age, sex, initial blood pressure, smoking, and Body Mass Index (BMI) were normally distributed in each group. After multiple mean anova tests, there was no statistically significant difference between the four groups in terms of each indicator (P >0.05).There was no significant difference in urea nitrogen, creatinine and uric acid among the groups (P >0.05).The comparison of clinical data of the 4 groups before treatment is shown in Table 1.
Treatment Methods
Roche Roche-PPE instrument in Switzerland. Philips Brilliance 64 row volume CT or GE MRI Signa HDxT 1.5T cranial scan. Blood pressure was measured with OMRON electronic sphygmomanometer after 10 minutes of rest.
Relevant standards
All the selected patients met the diagnostic criteria formulated by the fourth National Academic Conference on Cerebrovascular Disease and The Chinese Guidelines for diagnosis and Treatment of acute ischemic stroke 2014[2], and the Oxfordshire Community Stroke Plan typing method was used to determine the subtype of the patient [3].It was divided into total anterior circulation (TACI), partital anterior circulation (PACI), posterior circulation (POCI), lacunar Coinfarction (LACI). T2DM and EH are in accordance with the target standards for diagnosis and control of T2DM according to the 2007 Chinese Guidelines for prevention and Treatment of Type 2 diabetes and the 2005 Revised Chinese Guidelines for prevention and Treatment of hypertension. Dyslipidemia is determined by The Chinese Guidelines for the Prevention and Treatment of dyslipidemia in Adults (2007) [4]. Analysis was performed on the two-factor factorial design data, count data were compared for X2 test, and logistic regression and Cox's proportional hazards regression model analyses were used for correlation test. P <0>
Standard of treatment for 4 groups of patients
(1) Blood pressure < 140 mmHg=0.133kPa).>
Incidence of cerebral infarction and cerebral hemorrhage in the 4 groups
There were 44 cases of acute cerebral infarction and 1 case of LACI in group A.There were 1 case of TACI, 5 cases of PACI, 11 cases of POCI and 14 cases of LACI in group B.There were 2 cases of TACI, 2 cases of PACI, 2 cases of POCI and 4 cases of LACI in group C.POCI was found in 2 patients in group D.The incidence of TACI, PACI, LACI and POCI was 0.66%, 1.54%, 4.19% and 3.30%.There were 3 cases of cerebral hemorrhage, which occurred in group B, with a history of physical activity before the onset of the disease. The bleeding volume was about 18ml, 11ml and 7ml.Are shown in table 2. 33 cases of coronary atherosclerotic heart disease occurred during follow-up treatment, including 22 cases in group B, 8 cases in group C, and 3 cases in group D.There were 4 cases of acute myocardial infarction, including 2 cases in Group B, 1 case in group C, and 1 case in group D. No other vascular events occurred.
Risk factors for stroke
Logistic regression analysis showed that systolic blood pressure (OR =1.106, P =0.001), fasting blood glucose (OR =2.059, P =0.000) and
LDL-C (OR =0.104, P =0.025) were risk factors for stroke, as shown in Table 3.
The relationship between hypertension subtypes and stroke incidence
The incidence of stroke in the study cohort was the highest in the simple systolic hypertension group (1.12/100 person-year), and the HR of total stroke and hemorrhagic stroke in patients with this subtype of hypertension was significantly higher than that in other hypertensive groups (P <0>
Hypertension is the primary and interventional risk factor for stroke. Increased blood pressure is in direct proportion to the occurrence of stroke, and effective control of blood pressure can reduce the incidence of stroke [5]. Hypertension has been troubling countless people for many years, often accompanied by disorders of fat and sugar metabolism and changes in heart, brain, kidney, retina and other organs. Gong Tao reported the statistics of the Ministry of Health in 2007 in China, cerebrovascular disease ranks the first among public death diseases [6]. Stroke is the most common type of cerebrovascular disease, among which ischemic stroke accounts for 80% ~ 85% of all strokes. Hypertension leads to hyaline or fibrous changes in the wall of the small artery at the skull base and pathological changes such as focal hemorrhage, ischemia and necrosis, etc. The strength of the wall of the vessel is weakened, resulting in localized dilation and formation of tiny aneurysms. On this pathological basis, the cerebral vascular rupture of the lesion causes hypertensive intracerebral hemorrhage. Patients with cerebral hemorrhage before the presence of emotional excitement, excessive physical activity or other factors can induce a sudden increase in blood pressure. There were also three cases of cerebral hemorrhage in 454 hypertensive patients.
Data show that the global incidence of ischemic stroke is 169/100,000 and the incidence of stroke increases with age [7]. Acute progressive stroke refers to progressive or stepped-up progression of neurological deficit symptoms within 48h after stroke onset. It is a clinical process rather than an independent disease unit. Patients often suffer from deterioration of the condition due to aggravation of brain damage, with significantly increased disability rate and fatality rate. Tei H et al. reported that the study of oxfordshire Community Stroke Project(OCSP) showed that the incidence of progressive Stroke was 41.9%, 6.3%, 26.2%, and 21.7%, respectively, among the four types of TACI, PACI, LACI, and POCI, with the highest incidence of progressive Stroke among TACI patients[8]. In this study, 5 cases of progressive stroke occurred in the 4 groups, including group B and Group C. The incidence of progressive stroke in patients with TACI, PACI, LACI and POCI was 33.3%, 0%, 13.2% and 7.7%, respectively. It was also confirmed that TACI patients had the highest incidence of progressive stroke, indicating that the identification of subtypes of acute cerebral infarction is of great significance to the prognosis of patients and the formulation of treatment plans.
It has been reported in the literature that smooth muscle cell recombination occurs in the arteriole wall, extracellular matrix, especially collagen increase, arteriole wall thickening and lumen thrombosis during hypertension, and hypertension is one of the major independent risk factors. Hypertension leads to increased vascular shear stress, hypertrophy of the inner wall of blood vessels, changes the ability of vascular endothelial cells to release vasoactive substances, brain circulatory regulation dysfunction, and right shift of the regulation curve [9]. Chen Yuhui et al. showed that the incidence of hypertension, hyperfibrinogenemia, atrial fibrillation and carotid artery plaque was higher in elderly patients with ischemic stroke, and systolic hypertension was the most important risk factor for elderly patients with ischemic stroke [10]. Xu Xin et al. found in their study that the important influencing factor of first cerebral infarction in hypertensive patients was compliance with antihypertensive drug therapy, good compliance was a protective factor, and poor compliance and last treatment for hypertensive patients were prone to cerebral infarction [11]. Vemmos KN et al. showed that blood pressure was positively correlated with the occurrence of stroke regardless of gender, age and type of stroke [12]. Therefore, sufficient attention should be paid to the active and effective control of blood pressure in the secondary prevention of cerebrovascular diseases. The benefits of antihypertensive treatment mainly come from the antihypertensive itself. It is necessary to understand the antihypertensive ability of various antihypertensive drugs under the guarantee of safety.
Diabetes is an important risk factor for cerebrovascular disease. The incidence of stroke in diabetic patients is more than 1 times higher than that in non-diabetic patients, and about 20% of diabetic patients eventually die of stroke [13]. The measurement of HbA1c in high-risk population of cerebrovascular disease is very helpful to assess the risk of first stroke.HbA1c in diabetic patients can reflect the average blood glucose level 2 to 3 months before blood collection. Compared with fasting blood glucose, HbA1c is less affected by various factors, and is an important indicator to measure blood glucose control in diabetic patients. Daimon M et al. proved that increased HbA1c can induce and promote atherosclerosis [14]. Possible mechanisms of stroke in diabetes mellitus: (1) Hyperglycemia causes endothelial injury: Vascular endothelium specific injury is one of the characteristics of T2DM. The bioactivity of endothelial nitric oxide in brain circulation of diabetic patients is reduced compared with that of normal subjects. (2) Hyperglycemia causes accumulation of blood lactic acid: Accumulation of lactic acid causes intracellular acidosis, increases lipid peroxidation and produces free radicals, promotes intracellular calcium overload, destroys mitochondrial functional mechanisms, and aggravates and promotes ischemic brain tissue damage. (3) Hyperglycemia destroys the blood-brain barrier: hyperglycemia after stroke leads to the destruction of the blood-brain barrier, leading to cerebral edema and hemorrhagic transformation after ischemia. (4) Hyperglycemia promotes the accumulation of central excitatory amino acid glutamate: glutamate accumulates in the extracellular area and activates the post-synaptic glutamate receptor, which induces the over-opening of calcium channels and leads to mitochondrial damage and neuronal death.
Hyperlipidemia, which is a cause and effect of hypertension and diabetes mellitus, is an important risk factor for cerebrovascular disease. The European 4S test showed that statins and various lipid-lowering drugs may stabilize atherosclerotic plaques and promote plaque stability by improving vascular endothelial function, anti-inflammator and anti-sympathetic effects [15].SPARCL study also verified that further lowering LDL-C level, even if LDL-C≥2.60 ≤4.94mmol/L, can reduce recurrent stroke in patients with recent stroke or TRANSIENT ischemic attack [16]. Gong Tao pointed out the role of dyslipidemia in atherosclerotic stroke and the principles of clinical treatment [17]. Hypertriglyceridemia participates in the arteriosclerosis process by increasing small-particle LDL-C, lowering HDL-C and inhibiting fibrinolytic system. High concentration of LDL-C inactivates endothelium-derived relaxation factor or nitric oxide, reduces its deoxidization capacity, and induces excessive expression of plasminogen activator inhibitor-1 mRNA in vascular endothelial cells, thus increasing the plasma level. In the case of hypertriglyceridemia, lipidization of cholesterol in phagocytes is enhanced, which promotes the formation and aggregation of foam cells and reduces the stability of atherosclerotic plaque. Hyperlipidemia has a strong effect of causing cerebrovascular diseases, especially when accompanied by hyperinsulinemia, insulin resistance and hyperglycemia. Effective prevention and control of hyperlipidemia, hyperglycemia and hyperinsulinemia in clinical practice is of great significance for reducing the incidence and mortality of stroke. Inzitari D et al. reported that hyperlipidemia was also an independent risk factor[18].Pan Xiaodong et al. found that T2DM patients with dyslipidemia were relatively simple in their study on the detection of thrombus formation indicatorsT2DM patients are more likely to be in a state of high adhesion and high coagulation, and more likely to form thrombosis[19].
Current research using stroke risk assessment tools, such as the Framingham stroke risk assessment (FSP), FSP using Cox proportional hazards model, to stroke risk factors (age, systolic blood pressure, high blood pressure, diabetes, smoking, have cardiovascular disease, atrial fibrillation and ecg showed left ventricular hypertrophy) as a covariate, score is calculated based on weighting coefficient model [20]. In some studies, FSP was used as reference for scoring, and indicators such as serum creatinine and stroke history were added [21,22]. Flossmann E et al. found that ischemic stroke was affected by genetic factors, and the risk of ischemic stroke increased by about 30% in those with positive family histories [23].The application of stroke risk assessment tools is helpful to identify high-risk patients with stroke, and the screened high-risk patients should adopt individualized intervention treatment according to specific risk factors.
The American Heart Association, stroke Association and Chinese Neurology Branch of the Chinese Medical Association point out in the guidelines of "Primary prevention of stroke" that screening and prevention management of high-risk groups for stroke should be strengthened in addition to general prevention [24-26]. Hypertension, diabetes, dyslipidemia and other factors have been recognized as important risk factors for recurrent cerebrovascular disease, also known as etiological vascular risk factors, and the incidence and level of etiological vascular risk factors can also affect the risk of recurrence [27]. Therapeutic lifestyle changes are not only the basis for the treatment of dyslipidemia in diabetic patients, but also the fundamental means to prevent dyslipidemia in diabetic patients [28]. Therefore, patients should be educated to adjust their diet and promote a healthy lifestyle, which includes weight loss, smoking cessation, alcohol control, salt restriction, aerobic exercise, attention to mental health, and optimistic and open-minded attitude towards life [29]. Gyundy SM et al. pointed out that statins can reduce LDL-C by 25% ~ 55%, and statins should be the first choice for both primary and secondary prevention[30].In the process of EH prevention and treatment, the treatment rate and control rate of EH can be improved through effective community intervention to improve patients' medication compliance [31] . In this study, 44 patients were followed up after 54 months of treatment for acute cerebral infarction, with the incidence of 9.69%, among which the incidence of TACI, PACI, LACI and POCI was 0.66%, 1.54%, 4.19% and 3.30%.The incidence of acute cerebral infarction was 25.00% in group A, 8.45% in group B, 21.28% in group C and 5.56% in group D. At present, sufficient evidence-based medicine has proved that the treatment of hypertension is beneficial to the primary and secondary prevention of stroke. The treatment of hypertension and the control of blood glucose and blood lipids, two risk factors, can reduce the risk of stroke, which has important clinical significance for the prevention of stroke.
Based on these considerations, the following recommendations are made.
(1) Antihypertensive therapy is recommended for patients with ischemic stroke and TIA to reduce the risk of recurrent stroke and other vascular events (grade I recommendation, Grade A evidence). Under the reference of advanced age, basic blood pressure, daily medication, tolerance, etc., the hypotensive target should generally be≤140/90 mmHg, and the ideal target is≤130/80 mmHg (gradeⅡ recommendation, Grade B evidence).
(2) The benefits of antihypertensive therapy in preventing recurrence of stroke and TIA were mainly derived from the antihypertensive therapy itself (grade I recommendation, Grade A evidence). Single drug or combination therapy is recommended for antihypertensive therapy (gradeⅡrecommendation, Grade A evidence). The selection of specific drugs and combination regiments should be individualized.
Funding
This study does not need any fund support, and all the work is completed within the normal work content and time. The data used in the study is also easy to access.
Conflicts of interest
We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work. There is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of this manuscript.
Ethics approval and consent to participate
We declare that all human participants, human material, and human data, have been approved by Yantaishan Hospital Ethics Committee and Yantai Medical Ethics Committee (the reference number: 2008027) and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We have to state that specific national laws have been observed, too. The informed consent of all subjects and/or their legal guardians has been obtained for all procedures performed in this study.
Availability of data and materials
All data generated or analyzed during this study are included in this published article.
Conceptualization : Ji-ming Zou, Xiao-yu Li, Chao Han.
Data curation : Xiao-yu Li.
Investigation : Ji-ming Zou.
Methodology : Ji-ming Zou, Chao Han.
Writing – original draft : Ji-ming Zou, Xiao-yu Li.
Writing – review & editing : Ji-ming Zou, Xiao-yu Li, Chao Han.
Thanks to our hospital and related departments for their strong support in this study, and thanks to all the participating patients for their understanding and support.
Consent for Publication(Not Applicable)
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.
