AUCTORES
Globalize your Research
Research Article
*Corresponding Author: María Cuaresma-González, Department of Obstetrics and Gynecology, University Clinical Hospital of Valladolid, Management Regional Health of Castilla y León (SACYL), Spain.
Citation: María C. González, Sonia D. M. Manso, Elena G. García, Marta I. Nieto, Julio G. Tejedor et al. (2022) Results of Treatment of Female Stress Urinary Incontinence Treated with Transobturator Suburethral Banding: 9-Years Follow-Up. An Observational Prospective, Single-Center Study. J.Obstetrics Gynecology and Reproductive Sciences 6(5); DOI: 10.31579/2578-8965/132
Copyright: © 2022, María Cuaresma-González, 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: 25 August 2022 | Accepted: 05 September 2022 | Published: 19 September 2022
Keywords: stress urinary incontinence; suburethral bands; transobturator; continence rate and complications.
Background: tension-free suburethral bands represent the "gold standard" for the surgical treatment of stress urinary incontinence (SUI). Specifically, the transobturator approach is the most widely used because of its high cure rates in the medium term, and its good safety profile. These data support the use of suburethral bands and, since the beginning of this century, they have displaced retropubic colposuspension.
Objective: Study the long-term efficacy and safety (9 years) of transobturator suburethral band surgery (TOT) in the treatment of SUI.
Material and methods: An observational descriptive study with N=133 patients operated with TOT between 2012 and 2021 at the Valladolid University Clinical Hospital (Spain), who had completed at least one year of postoperative follow-up.
Variables analyzed: total continence and objective healing rates, subjective healing rate and postoperative complications.
Statistics: Statistics: Student t-test or U-Mann-Whitney for quantitative variables, Chi-Square for categorical variables.
Results: total continence rate from 1 to 9 years: 70.7%, 63.4%, 63.9%, 55.4%, 54.2%, 51.2%, 52.4%, 33.3%, and 100%. Objective cure rate from 1 to 9 years: 92.1%, 91.5%, 89.7%, 80%, 85.4%, 75.6%, 71.4%, 66.7%, and 100%. Subjective cure rate according to the median score on the ICIQ-IU-SF questionnaire from 1 to 9 years: 0, 1.5, 2, 4, 4, 6, 8, 12, and 0. Immediate complications were reported in 12.8% of cases, intermediate in 5.3%, and late in 30.1%. Of note was the occurrence of “de novo” urge urinary incontinence (UUI) in 8.3% and recurrence of SUI in 12%.
Conclusions: TOT surgery is one of the main therapeutic tools in the surgical treatment of SUI, with high efficacy and a good safety profile. However, more long-term studies are needed to consolidate the results obtained with this technique.
Stress urinary incontinence (SUI) is defined such as the involuntary loss of urine related to physical activity, coughing or any situation that increases intra-abdominal pressure [1]. It is a pathology with an increasing prevalence, ranging between 10 and 40% in women worldwide, which significantly affects their quality of life. This high prevalence represents also a significant social burden in economic terms [2]. Multiple risk factors are associated with SUI but, above all, age, parity and type of delivery, constipation or body mass index (BMI) [1].
SUI is usually due to a mechanical or anatomical defect, or weakness of the urethra or pelvic floor; this is why the therapeutic approach tends to focus on mechanical therapies [3]. Management depends on the severity of incontinence, the criteria of the doctor and the characteristics of the patient. In our country there are no drugs marketed for the treatment of SUI. The therapeutic possibilities are, therefore, conservative management and surgery. Lifestyle modifications, bladder reeducation and rehabilitation of the pelvic floor muscles are three important therapeutic pillars prior to surgical management [4]. The surgical treatment of SUI has evolved greatly in recent decades, thanks to the appearance in 1996 of surgery with a sling or retropubic mediourethral band, and later the transobutrator approach in 2001. Since 1999, mini-slings with bio-materials have been designed, and it was in 2006 that polypropylene mini-bands with specific insertion systems were developed [5]. Currently, tension-free suburethral bands represent the "gold standard" for the surgical treatment of SUI. Specifically, the transobturator approach is the most widely used due to its high objective and subjective cure rates in the medium term and its good safety profile, with fewer intraoperative and postoperative complications. These data support the use of suburethral bands and since the beginning of this century they have displaced retropubic colposuspension [6].
The aim of the study is to analyze the long-term (9 years) efficacy of transobturator suburethral banding (TOT) in the treatment of SUI, using objective and subjective cure rates. Other secondary objective is to examine the complications derived from the procedure at long-term follow-up.
An observational, prospective, single-center study was carried out for 9 years (2012-2021) at the Valladolid University Clinical Hospital (Spain), in women who had underwent TOT band surgery, and who had completed one year of postoperative follow-up.
Inclusion criteria: SUI due to urethral hypermobility, associated or not with mixed urinary incontinence (MUI) and failed or undesired conservative treatment.
Exclusion criteria: diagnosis of neurogenic bladder and postvoid residual >100ml.
Age and BMI did not limit inclusion in the study because both are important variables that could determine surgical outcomes.
At the initial visit, patients were evaluated clinically and ultrasonographically, using validated questionnaires such as ICIQ-IU-SF. Urodynamic study (EUD) was performed in complex or recurrent incontinence or in patients with previous incontinence surgery. In the first two years of follow-up, patients were evaluated in the Pelvic Floor Unit by exhaustive anamnesis, physical examination and ultrasound, assessing the efficacy of TOT and analyzing immediate (<7>
Statistical analysis: continuous quantitative variables with normal distribution were described by mean and standard deviation, and those with non-normal distribution by median and interquartile range (P25-P75). Qualitative variables are described by “n” and percentage. The Student t-test was used to study quantitative variables with a normal distribution, and the U-Mann-Whitney test was used otherwise. The Chi-square test with Yates correction was used to study categorical variables. In all cases, less than 0.05 was the value taken as statistically significant. SSPS v. 25 was the statistic software used.
Ethical approval: authorization of the study by the ethics and research committee of the Valladolid East health area (Code: FO-P07-12). Verbal informed consent was obtained from the patients included.
Demographic characteristics are shown in Table 1: average age was 66.5 (56.3-72) years. The average BMI was 27.5 ± 4.2 kg/m2. The 96.2% were multiparous, 9% had had an instrumented delivery with forceps, and 21.1% had fetal macrosomia.
| VARIABLE | RESULT |
| Age | Median (P25-P75): 66.5 (56.3-72) |
| BMI | Average ± SD: 27.5 ± 4.2 |
| Physical activity | 30 (22.6%) |
| Parity | Primiparous: 5 (3.8%) |
| 1 delivery: 13 (9.8%) | |
| ≥2 delivery: 115 (86.4%) | |
| Instrumented delivery with forceps | 12 (9%) |
| Fetal macrosomia | 28 (21.2 %) |
| Respiratory disease | 8 (6%) |
| Psychiatric disease | 28 (21.1%) |
| Neurological disease | 5 (4%) |
| Smoke | 11 (8.3%) |
Gynecological surgery | Abdominal hysterectomy 15 (11.3%) |
| Laparoscopic hysterectomy 1 (0.8%) | |
| Vaginal hysterectomy 8 (6%) | |
| Anterior colporrhaphy 15 (11.3%) | |
| Posterior colporrhaphy 11 (8.3%) | |
| Anterior prolapse mesh 2 (1.5%) | |
| Posterior prolapse mesh 2 (1.5%) | |
| Mini-Sling 8 (6%) | |
| Burch 1 (0.8%) | |
| Marshall-Marchetti 3 (2.3%) | |
| TOT 7 (5.3%) |
Table 1: Demographic characteristics:
Regarding the type of urinary incontinence: 36.8% presented SUI, 54% MUI and 9% occult urinary incontinence; in 75.2% the SUI was grade II and in 20.3% grade III. DUS was performed in 10.5% of the patients. The average initial ICIQ-IU-SF was 15 (14-17) points.
The approach and type of suburethral band are described in Table 2; the In-Out technique with I-Stop® band was the most frequently used. The median surgery time was 65 (45-90) minutes.
IN-OUT TECHNIQUE 100 (75.2%) | I-Stop® (CL Medical) 61 (45.9%) |
| In Gyne S® (Dipromed) 17 (12.8%) | |
| Gynecare TVT obturador® (Ethicon-Johnson) 13 (9.8%) | |
| TOA® (Presurgy) 9 (6.7%) | |
OUT-IN TECHNIQUE 33 (24.8%) | In Gine S® (Dipromed) 1 (0.8%) |
| Monarc® 32 (24%) |
Table 2: approach and type of suburethral band.
Immediate complications were reported in 12.8% of cases, intermediate in 5.3% and late in 30.1% (Table 3). Of note was the occurrence of “de novo” urinary incontinence (UUI) in 8.3% and recurrence of SUI in 12%.
Inmediate (<7> Bladder injury Fever Urinary tract infection Urinary retention Urinary catheter Pain Reoperation for bleeding Vaginal perforation | 17 (12.8%) 1 (0.8%) 1 (0.8%) 2 (1.5%) 11 (8.3%) 4 (3%) 1 (0.8%) 1 (0.8%) 2 (1.5%) |
Intermediate (≥ 7 days- < 30> Fever Bleeding Urinary tract infection Urinary retention Urinary catheter Pain | 7 (5.3%) 1 (0.8%) 1 (0.8%) 3 (2.3%) 2 (1.5%) 1 (0.8%) 1 (0.8%) |
Late (≥ 30 days) “De novo” UUI Urinary retention Mesh extrusion Pain Recurrence of SUI Urethrolysis | 40 (30.1%) 11 (8.3%) 3 (2.3%) 3 (2.3%) 13 (9.8%) 16 (12%) 3 (2.3%) |
Table 3: postoperative complications:
The number of patients completing follow-up each year is detailed in Table 4, with only one patient having finished the complete follow-up at 9 years.
Table 4: patients follow-up. *Covid-19 pandemic.
The total continence rate at 12 months was 70.7%, and during follow-up: 63.4% (2 years), 63.9% (3 years), 55.4% (4 years), 54.2% (5 years), 51.2% (6 years), 52.4% (7 years), 33.3% (8 years) and 100% (9 years) (Figure 1).
N=numer of patients who completed the follow-up.
Figure 1: Total continence rate.
The objective cure rate at 12 months was 92.1%, and subsequently 91.5% (2 years), 89.7% (3 years), 80% (4 years), 85.4% (5 years), 75.6% (6 years), 71.4% (7 years), 66.7% (8 years), 100% (9 years) (Figure 2).
N=numer of patients who completed the follow-up.
Figure 2: Objective cure rate.
Regarding subjective cure according to the degree of satisfaction: at 12 months 81.7% were considered very satisfied. At follow-up: 76.6% (2 years), 73.1% (3 years), 65.6% (4 years), 68.1% (5 years), 56.1% (6 years), 47.7% (7 years), 33.3% (8 years) and 100% (9 years). According to the PGI-1 scale: in the first year 83.5% of the patients gave scores of 1-2, reporting feeling much and much better, respectively, compared to before the surgery. Subsequently, these scores were maintained at 89.6% (2 years), 85.4% (3 years), 78.1% (4 years), 77.1% (5 years), 68.3% (6 years), 57% (7 years), 66.7% (8 years) and 100% (9 years). According to the ICIQ-IU-SF questionnaire, the median was 0 the first year, 1.5 (2 years), 2 (3 years), 4 (4 years), 4 (5 years), 6 (6 years), 8 (7 years), 12 (8 years) and, the only patient with complete follow-up of 9 years, expressed a score of 0. (Figure 3)
N=numer of patients who completed the follow-up.
Figure 3: Subjective cure rate using the ICIQ-IU-SF questionnaire.
In the last few years, many data about the efficacy of treatment of SUI with TOT have been published [6][7]. However, there are few publications [8][9][10] of long-term results, such as this study with nine years of follow-up. In the latest Cochrane review (2017) about the use of mediourethral bands, the authors conclude in the same sense, that longer-term studies are needed to clarify both the evidence and the uncertainty about the effectiveness and complications of TOT [11].
In the analysis of these patients, it is interesting to evaluate the objective cure rate. According to published data, patients who undergo TOT maintain high stress continence, especially during the first years [8][10][12][13][14][15][16]. It should be noted that in this study, after 7 years of follow-up, it remains above 70%, supporting the medium and long-term efficacy.
The degree of satisfaction remained above 80% during the first year, with PGI-1 scores of 1-2, similar to that reported by other authors [7][13][14][15] and with better results compared to another 4-year follow-up study [17]. The subjective cure rate decreases over time, partly due to the appearance of aging-related symptoms such as urgency. The subjective cure rate is also demonstrated by the ICIQ-IU-SF questionnaire by comparing how the initial median value is higher than that observed during follow-up and, although the score gets worse over the years [especially after the seventh year], it does not reach the initial median [16].
A meta-analysis by Fusco et al. [19] showed that bladder perforation, pelvic hematomas and urinary retention were less common after transobturator band [TOT] surgery. The obturator approach leads to limited intraoperative damage to the urinary bladder, but does not exempt from other intraoperative and postoperative complications.
In general, complications were classified as minor (Clavien-Dindo [18] Grade I and II), except two major complications Clavien-Dindo [18] Grade III]: a bladder injury and a perforation of the inferior epigastric artery in the space of Retzius.
The frequency of complications is higher in the long term [30.1%]. The most frequent complications, also observed in other studies [7][12][13][14][15][16] are urinary retention, pain and mesh extrusion. Only one case of bladder perforation occurred, which is consistent with other publications [4][19]. The rate of “de novo” UUI, the main reason for the worsening of patients, was 8.3%, a lower value than the obtained in other studies [6][7][13][15], although higher than that found in short-term follow-up studies [15][20]. Recurrence of SUI occurred in 12% of patients, a higher value than the published by Tulokas in 2020 (17-year follow-up) [9] or by Sharma in 2021 (3-year follow-up) [16], although lower than that described in most studies on the medium-term efficacy of TOT [6][7][14][21]. The main limitations of the study are the sample size, because it is not very large, and the fact than only one patient has completed the fully follow-up period.
TOT surgery is a great therapeutic alternative in the management of SUI after failure of conservative treatment, with high long-term efficacy, reflected in both objective and subjective cure, and a good safety profile, with few minor and more frequent late complications. Overall patient satisfaction and objective outcomes should be standardized and reappraised at each postoperative visit in order to be able to analyze the evolution throughout the follow-up. Finally, more long-term studies are needed to consolidate the results obtained and to allow comparison of inclusion and exclusion criteria, as well as evaluation of effectiveness.
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
