AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Horacio Tabares Neyra, Center for Longevity, Aging and Health Research
Citation: Tiemure Wu, and Horacio Tabares Neyra. (2023), Total Hip Arthroplasty in An Orthopedic Institution in Cuba, J Clinical Orthopaedics and Trauma Care, 5(3); DOI: 10.31579/2694-0248/063
Copyright: © 2023, Horacio Tabares Neyra. 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: 13 June 2023 | Accepted: 22 June 2023 | Published: 03 July 2023
Keywords: total hip arthroplasty; surgical approaches; anterior approach to the hip
Introduction: Total, hip arthroplasty is a safe and effective procedure. It relieves pain, as well as improves physical health and quality of life in patients undergoing it.
Purpose: Study that allows to determine and show some characteristics of patients and the procedure, who underwent total hip arthroplasty in an important specialized institution in Cuba.
Design: Retrospective descriptive study with patients who underwent total hip arthroplasty in a hospital specializing in Orthopedics and Traumatology in Cuba; the "Fructuoso Rodríguez" Teaching Orthopedic Hospital, between September 2019 and March 2021.
Results: Predominance of the female sex between the ages of 60 and 62 with left laterality. The main preoperative diagnosis was coxarthrosis, the size of the acetabular cup and the head of the femoral component were very similar, with pressure fixation of the acetabular prosthesis. The posterolateral approach was used, in addition to the lateral, anterolateral and anterior approaches.
Conclusions: Great similarities were found in relation to the variables age, sex, laterality, size of the acetabular components and femoral head, type of fixation of the acetabular component and number of screws used in it. Only in three used an anterior approach to the hip.
Total, hip arthroplasty is considered a safe and effective procedure that provides clinically significant pain relief, as well as improvement in physical health and quality of life in patients with end-stage hip osteoarthritis [1,2]. Total, hip arthroplasty has been shown to improve pain, mobility and quality of life in patients with coxarthrosis [3]. but few studies are available in older age groups, particularly in those over 85 years of age.
It is estimated that more than 1 million hip arthroplasties are performed worldwide each year with a 10-year survival rate of 95% [4]. With the increase in life expectancy and the increase in the percentage of the elderly population, the demand for primary hip arthroplasty procedures by 2030 would grow by 174% [5]. Therefore, the number of older patients requiring hip arthroplasty is expected to increase significantly in the near future.
Current data reported that people age 85 and older represent the fastest growing demographic group in the United States, projected to represent 2.3% of the US population in 2030 and 4.3% in 2050 [6,7]. In Switzerland, according to recent demographic data, the reported median life expectancy was 83.2 years in 2014, and by 2025 more than 20% of the total Swiss population would be over 65 [8]. Although patients older than 80 years could benefit significantly from elective hip arthroplasty [9,10]. they represent a significant challenge for both the anesthesiologist and the arthroplasty surgeon, due to their limited physiologic reserves and increased postoperative complications compared with younger patients [11,12] Today, more often than ever, the orthopedic surgeon is faced with the ethical dilemma of whether to operate on patients with debilitating hip osteoarthritis, who have already exceeded the average life expectancy, without inflicting more harm than good, and suffering a unnecessary use of resources [13].
The elderly population of developed countries has been increasing in recent decades due to the increase in life expectancy. According to the National Institute of Statistics, overall life expectancy is 83.19 years in Spain [14]. The group of 85 years or older, which represents more than 1.5 million people in Spain, has increased exponentially, coining terms such as “older-elderly” or “fourth age” [15,16]. An increasing number of patients aged 85 years or older will be candidates for total hip arthroplasty in the coming years due to the higher prevalence of hip osteoarthritis in the elderly population [17].
For years, age was considered a relative surgical contraindication, due to the greater medical comorbidity and the short life expectancy of elderly patients. However, the latest studies recommend not ruling out surgery just because of age, since the preoperative conditions of each patient must be assessed individually. In fact, some studies show that total hip arthroplasty in patients over 80 years of age has more benefits than in other younger age groups [17-20].
The increase in the elderly population coincides with a greater demand for total hip replacement. Despite the greater risk of the procedure in octogenarian patients, the overall rate of adverse effects is low, which is why total hip arthroplasty in this population is considered to be reliable in most cases [21,22]. Different early recovery protocols have proven to be effective even in patients older than 85 years, once the risks have been identified [23-25]. On the other hand, despite the fact that cemented total hip arthroplasty has shown excellent results, especially in elderly patients, the indication for non-cemented fixation continues to gain popularity in all age groups [26]. Another of the controversies that exist in this group of patients is the type of survival analysis that must be done to evaluate the results in populations with higher mortality [27-29].
The purpose of this work was to carry out a study that allows determining and showing some characteristics of the patients and the procedure that underwent total hip arthroplasty in an important specialized institution in Cuba.
Methodological design
A retrospective descriptive study was developed with patients who underwent total hip arthroplasty at the hospital specialized in Orthopedics and Traumatology in Cuba; the "Fructuoso Rodríguez" Teaching Orthopedic Hospital, in the period between September 2019 and March 2021.
Data were obtained from the institution's medical records. The variables studied were: age, sex, laterality of the operated hip, preoperative diagnosis, type of surgical approach used, size of the acetabular component and the head of the femoral stem, and the type of adjustment used to fix the acetabular cup.
The universe of the study was all the patients operated on to perform total hip arthroplasty in the mentioned hospital center and in the established period of time.
The sample was made up of those patients who met the established criteria:
Inclusion- Patients whose clinical histories allowed the aforementioned study variables to be collected.
Exclusion- Patients with incomplete or illegible medical records that prevented data collection.
The variables were analyzed for their presentation in totals and average values with standard deviation to favor the presentation in tables and graphs.
In accordance with the declared purpose and design, the sample of this work consisted of 74 patients with 80 operated hips (six bilateral arthroplasties); with a mean age of 60.3 ± 14.6 years, female predominance and very similar laterality between the left and right hip. All of the above is visible in Table 1 referring to the demographic variables.
| Variable | “Fructuoso Rodríguez” | |||
| Total | Estatístics/ category | SD/ No | % | |
| Age | 74 | Half/SD | 60,3 ± 14,6 | - |
Sex Male Female |
74 80 | Número/%
|
32 42 |
43,2 56,8 |
Laterality Left Right | Número/% |
41 39 |
51,2 48,8 | |
Source: Clinical History.
Reading: No- number of patients; SD- Standard deviation.
Table 1: Demographic variables
We wanted to determine the diagnostics of the intervened hips (N=80) that forced the surgical procedure of total hip arthroplasty, where it was found that the diagnosis of coxarthrosis was the predominant one with 63 hips of the 80 intervened (78.6%), followed by avascular necrosis of the femoral head with eight hips (10.0%). The remaining diagnostics showed very similar results, all of which is visible in Table 2.
| Diagnostics | “Fructuoso Rodríguez” | |
| Number | % | |
| Fracture of the upper end of the femur | 3 | 3.8 |
| Femoral head avascular necrosis | 8 | 10.0 |
| Coxarthrosis | 63 | 78.6 |
| Prosthetic dislocation | 3 | 3.8 |
| Painful partial prosthesis | 3 | 3.8 |
| Total | 80 | 100.0 |
Source: Clinical History.
Table 2: Preoperative diagnoses
Graph 1 allows an easier understanding of the incidence of preoperative diagnoses found in the "Fructuoso Rodríguez" Teaching Orthopedic Hospital.
Graph 1: Preoperative diagnostics at the "Fructuoso Rodríguez" Teaching Orthopedic Hospital.
Another variable declared in the design and considered very important for this study is to describe the surgical approach used to perform the total hip arthroplasty procedure. In "Fructuoso Rodríguez" four surgical approaches were used with a great predominance of the posterolateral approach (73.8% of the hips), followed by the lateral approach (12.5%). It is noteworthy that only three arthroplasties out of the total number of those performed were performed by an anterior approach (two in a patient who underwent bilateral hip arthroplasty and the other by a non-Cuban surgeon), as shown in Table 3.
| Approach | “Fructuoso Rodríguez” | |
| Frequency | % | |
| PLA | 59 | 73.8 |
| LA | 10 | 12.5 |
| A-L | 8 | 10.0 |
| Anterior | 3 | 3.7 |
| Total | 80 | 100.0 |
Source: Clinical History.
Reading: PLA- Posterolateral approach; LA- Lateral approach; A-L- Anterolateral approach.
Table 3: Surgical approach used to perform total hip arthroplasty.
Graph 2 was elaborated to make even more visible the relationship of surgical approaches used in this center specialized in Orthopedics and Traumatology that we present.
Reading: PLA- Posterolateral approach; LA- Lateral approach; A-L- Anterolateral approach
Graph 2: Surgical approaches used at the "Fructuoso Rodríguez" Teaching Orthopedic Hospital.
Table 4 shows the technical details related to what was found regarding the size of the acetabular components and femoral head, as well as the type of adjustment of the acetabular component and the number of screws used when adjustment was made using these. All this collected in the reviewed medical records.
| Variables | “Fructuoso Rodríguez” | ||
Statistics/ Category | SD/ Number | % | |
Acetabular component size (mm) Femoral Head Component Size (mm)
Acetabular Component Fit Type by pressure by screws Number of screws | Half/SD
Half/SD No/% No/% Half/SD |
50.8 ± 3.7 29.3 ± 2.4
63 17 1.7 ± 0.5 |
- -
78.7 21.3 - |
Source: Clinical History.
Reading: No- number of patients; SD- Standard deviation.
| Variables | “Fructuoso Rodríguez” | ||
Statistics/ Category | SD/ Number | % | |
Acetabular component size (mm) Femoral Head Component Size (mm)
Acetabular Component Fit Type by pressure by screws Number of screws | Half/SD
Half/SD No/% No/% Half/SD |
50.8 ± 3.7 29.3 ± 2.4
63 17 1.7 ± 0.5 |
- -
78.7 21.3 - |
Source: Clinical History.
Reading: No- number of patients; SD- Standard deviation.
Table 4: Variables related to the prosthesis.
Severe osteoarthritis of the hip is one of the main causes of disabling pain, functional impairment, and decreased quality of life in the older adult population [19,30]. Total, hip arthroplasty is a highly successful surgery in the treatment of symptomatic osteoarthritis in terms of pain relief, restoration of function, and improvement of quality of life. Due to changing world population demographics, the number of older people undergoing hip arthroplasty for osteoarthritis and other causes such as avascular necrosis of the femoral head is increasing. With the reported increased rates of mortality and complications from major surgery in the geriatric population, the orthopedic surgeon must face an ethical dilemma as to whether to operate on patients with debilitating hip osteoarthritis, who have already exceeded the average life expectancy. However, the benefits of hip arthroplasty are well documented in the literature.
As in this study, most of the publications reflect a majority percentage of women (range 60.29-74.40%) [31]. which in this review resulted in a close relationship between women and men in the hospital studied (although with a predominance of women) and an age greater than 60 years in this group. However, some studies report a predominance of right hips, for example, the Finnish registry by Ogino et al. (57.6%) [31]. which does not coincide with what was found in this work, since a slight predominance of the left hips was found.
As in most of the studies reviewed [29-31]. hip osteoarthritis was the main diagnosis that led to the decision to perform surgical treatment by placing a total hip prosthesis. It should be noted that only in three hips the diagnosis was prosthetic dislocation; In another three hips, total hip arthroplasty was performed due to a history of painful partial prosthesis.
A good exposure of the hip favors the implementation of the prosthesis; however, as exposure of the bony structure of the joint increases, damage to the soft tissues around the hip is also aggravated, resulting in excessive intraoperative bleeding, muscle weakness around the hip, increased postoperative complications, decreased prosthetic stability. How to minimize soft tissue damage while ensuring good exposure is an issue that must be considered in hip arthroplasty. The direct anterior approach exposes the hip through the space between the tensor fascia latae and the sartorius muscle, without sacrificing the musculatures around the hip, with relatively little damage to the soft tissues; The structural integrity of the hip abductor muscles is preserved, which improves the stability of the prosthesis and allows the patient to mobilize earlier, therefore, it is beneficial for early recovery [32,33].
As can be seen in the results of this work, the posterolateral, lateral, antero-lateral and anterior surgical approaches were used, although there was a wide predominance of the posterolateral approach performed in 59 hips out of the 80 operated on. The most significant thing was that in 80 hips operated on to perform total hip arthroplasty, only three of them used the anterior approach, according to the data collected, by foreign surgeons, which is striking because currently this approach has It has gained many followers, and publications related to it predominate in specialized magazines.
When comparing the size of the acetabular component and the component of the femoral head in the group, it is observed that the size of the prosthesis was found in similar mean values, with a wide predominance of acetabular prostheses fixed by "pressure" (78.7%), as well as the number of screws used in the few hips in which this fixation was completed through screws.
In this descriptive-retrospective study, great similarities were found with what was published in relation to the variables age, sex, laterality, size of the acetabular components and femoral head, type of fixation of the acetabular component, and number of screws used in it. There were small differences in relation to the preoperative diagnosis, although with a frank predominance of hip osteoarthritis. Only in three hips was an anterior approach to the hip used
The authors declare that they have no conflicts.
DrC. Horacio Tabares Neyra- He planned the research and wrote the paper.
Dr. Tiemur Wu- Performed the data collection.
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.
