AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2578-8965/259
Health Sciences University Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Bahçelievler/ Istanbul, Turkey.
*Corresponding Author: Bilge Aslan, Health Sciences University Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Bahçelievler/ Istanbul, Turkey.
Citation: Bilge Aslan, (2025), Our Experience Anesthetic and Surgical Approach of Debulking Procedures in Ovarian Cancer, J. Obstetrics Gynecology and Reproductive Sciences, 9(2) DOI:10.31579/2578-8965/259
Copyright: © 2025, Bilge Aslan. 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: 31 January 2025 | Accepted: 05 February 2025 | Published: 13 February 2025
Keywords: anesthesia; complications; ovarian ca; mortality; debulking operation
Objective: We aimed to determine the rescue approach of anesthesiologists and discussed operations of debulking procedures in Ovarian Cancer (CA) and survey, in this study.
Background: Most patients with ovarian cancer usually relapse during the first 5 years. Overall life expectancy is less than 50 % for 5 years, depending on the stage of the disease. Therefore, we follow the patients with an interval of 3-4 months for 5 years after the end of the operative treatment. Recurrent ovarian cancer diseases have the chance to be treated with surgery and different chemotherapy protocols.
Materiel and Methods: This clinical study aimed to evaluate the approaches to cytoreductive surgery in our reference center. We only included studies that defined optimal cytoreduction as surgery leading to residual tumors with a maximum diameter of any threshold up to 2 cm. Patients of 2008 - 2018 operated from cytoreductive over carcinoma were retrospectively evaluated. This study includes perioperative clinical management, preoperative approach, fluid and blood management, prevention, and treatment of major complications in women of 2187 seconder operated ovarian CA.
Results: Postoperative hyponatremia and anemia were detected. The fact that Ca 125 does not return to the target value after surgery supports the idea that surgery alone is insufficient in ovarian cancers. However, when the tumor burden decreases, the value of Ca 125 in the blood also decreases.
Conclusion: In our study, we showed with statistical analysis the importance of monitoring the debulking operations in preoperative, intraoperative and postoperative periods and the effect of the procedures on the mortality.
Anesthesiologists play an important role in the selection of patients for gynecological cytoreductive surgery, as well as in long-term surgical procedures, with significant loss of fluid or blood, or both, in the delivery of safe anesthesia and postoperative care in these long surgical procedures. Guidelines for these procedures have been provided professionally for clinical anesthesia with numerous sections [1].
Epithelial ovarian cancer (EOC) is the sixth most common cancer in women and the second most common malignancy of the female genital tract after endometrial cancer. In the United States, the EOC is diagnosed in approximately 22.000 women each year, with 15.000 women dying of illness. It is estimated that more than 200.000 women worldwide develop ovarian cancer each year and approximately 100.000 die from the disease. A woman who develops an EOC has a lifetime risk of one in 70. EOC can be seen in women younger than 15 years, but the average age is 56 [2,3]. Primary gynecologic cytoreductive surgery remains the standard and preferred approach for women with advanced ovarian CA and peritoneal cancer and is performed by experienced gynecological oncologists in a fully equipped hospital. Every effort should be made to completely resolve all visible peritoneal and retroperitoneal diseases as much as possible. This requires cooperation with more experienced surgeons, especially for intensive upper abdomen and perihepatic diseases. Gynecological oncologists should continue to advance their expertise and training in radical abdominal and retroperitoneal surgery, and adapt the surgical techniques and approaches routinely used by other surgical oncologists to obtain the best approach and skills necessary for gynecological cytoreductive surgical malignant lesions of the ovaries. It includes primary lesions arising from normal structures within the ovary and secondary lesions in cancers occurring anywhere in the body. Primary lesions include epithelial ovarian carcinoma (70% of all ovarian malignancies), germ cell tumors, sex cord-stromal tumors, and other rare types. Ovarian metastases are relatively common, with the most common being the endometrium, breast, colon, stomach, and cervix. The origin of ovarian carcinomas is controversial [4-7]. The risk of ovarian cancer is associated with a common variant of the mismatch repair gene, the promoter sequence of MLH1. In our study, the 5-year survival rate was 30% in patients undergoing cytoreductive and debulking operations. We aimed to evaluate the anesthetic and surgical management, in this study.
After the approval of the Ankara City Hospital Gynecology Local Ethics Committee (17.08.19, Decision no: 2), patients who underwent debulking operation due to ovarian CA between 01.01.2008 and 30.12.2018 were retrospectively evaluated. Demographic data of the patients and type of surgery, duration of surgery, perioperative hemodynamic data, ephedrine, vasopressor, crystalloid, or colloid consumption were collected (Table 1). Besides, perioperative Erythrocyte Suspension usage (ES), fresh frozen plasma (TDP) need, platelet suspension (PS) consumption, preoperative and postoperative hemoglobin (Hb), platelet counts, Alanine Transaminase (ALT) and Aspartate Aminotransferase (AST), Creatine (Cr), Ca 125 and Ca 19-9 values were recorded. Percentages of central venous catheters and intraarterial monitorization were evaluated. Different treatment methods were used for intraoperative bleeding. The duration of hospitalization was evaluated. In our study, we also examined intraoperative, postoperative treatment methods and results.
The data were entered in the EXCEL file and transferred to IBM SPSS.23 program and evaluated by statistical analysis. Before the statistical analysis, checks were made on the absence of data entry errors and whether the parameters were within the expected range. Normality assumptions of continuous variables were examined by skewness and kurtosis (Skewness and Kurtosis) coefficients and Kolmogorov Smirnov test, and whether excessive and outlier values were calculated by calculating z values and using the boxplot method. Wilcoxon signed ranks test (Wilcoxon signed-ranks test) was used to determine whether there was a significant difference between some laboratory parameters before and after surgery, and p <0>Age (years) 50 ± 12 (30-80) Height (cm) 160 ± 8 (150-170) Weight (kg) 80 ± 15 (50-100) Operation time(minute) 240 ± 30 (64-280) Time of anesthesia (min.) 190 ± 20 (74-300) 〖Pressure〗_systolic (mmHg) 125 (±12) (60-120) 〖Pressure〗_diastolic (mmHg) 60 (±15) (40-80) Heart 
(beats/min)110 (±12) (70-160) Heart 
(beats/min)80 (± 16) (45-125) Patients developing hypotension (n,%) 1530.9 (70%) Patients used ephedrine (n,%) 656.1 (30%) Ephedrine (mg) 250.2 (±10) (0-40) Patients used erythrocyte suspension (n,%) 874.8 (40%) Erythrocyte suspension (U) 4 (±2) Patients used fresh frozen plasma (n,%) 656.1 (30%) Fresh frozen plasma (U) 4 (±1) Crystalloid (ml) 3000 (± 500) Colloid (ml) 1000 (± 200) Lowest hermoglobin (g.(g. 
))9.2(±3.5) (8-13.5) Intraoperative i.v dopamine or noradrenaline support 10 % (218.7)
Table 1: Demographic and intraoperative values.
According to the Wilcoxon signed-rank test results, the preoperative whole blood hemogram values (Median = 10.10) were statistically significantly higher than the postoperative (Median = 9.90) (Z = -2,886; p =, 004). According to the Wilcoxon signed-rank test results, the preoperative AST values (Median = 18.00) of the patients were found statistically significantly lower than the postoperative (Median= 19.00) (Z = -2.965; p = 0.003). According to the Wilcoxon signed-rank test results, there was no statistically significant difference between patients preoperative ALT values and postoperative values (Z = -1,516; p = 0.130). According to the Wilcoxon signed rank test results, the preoperative CA 19-9 values (Median= 5.54) were statistically significantly higher than the postoperative (Median = 5.50) (Z = -45.990; p < 0.001). According to the Wilcoxon signed-rank test result, the patient Na values before the operation (Median= 138.00) were found statistically significantly lower than the postoperative (Median = 139.00) (Z = -8.334; p< 0.001). According to the Wilcoxon signed-rank test results, the patients preoperative Potassium (K) values (Median= 3.89) were found to be statistically significantly higher than the postoperative (Median = 3.86) (Z = -2.598; p = 0.009). According to the Wilcoxon signed rank test results, the preoperative Ca 125 values (Median = 22.20) were found to be statistically significantly higher than the postoperative (Median = 21.00) (Z = -20.888; p< 0.001) (Table2, Figure 1). These findings obtained according to the Wilcoxon signed rank test result are shown in Table 2.
The study includes 2187 patients who were diagnosed with ovarian cancer patients who underwent debulking and cytoreductive operation in Gynecology Oncology Clinic of Zekai Tahir Burak Training and Research Hospital. The day of hospitalization varies between minimum 2 and maximum 6 days, while the average duration of hospitalization was found to be 3.42 standard deviation of 1.29 days (Table 3). Postoperatively, hospital stay and frequency percentages are given in Table 3. The length of hospital stay of patients varies between 2 days (34.2%) and 6 days (7.5%), and the length of hospital stay is usually 4 days (25.6% = 559 patients). Ca 125 values in mucinous, mixed type tumors and stage III + IV tumors were statistically significantly higher in blood than other tumor types and stage I+III over cancer (Table 4).
| Mean.±Standart Deviation | Median (Min. - Mak.) | z | P value | |
| Hb (gr/dL) | -2.886 | 0.004 | ||
| Before the operation | 10.12±1,88 | 10.10 (4.10-15.80) | ||
| After the operation | 9.99±1.31 | 9.90 (5.90-14.40) | ||
| AST | -2.965 | 0.003 | ||
| Before the operation | 23.14±21.11 | 18.00 (5.00-262.00) | ||
| After the operation | 23.00±20.62 | 19.00 (4.00-446.00) | ||
| ALT | -1.516 | 0.130 | ||
| Before the operation | 15.77±18.00 | 11.00 (2.00-181.00) | ||
| After the operation | 15.75±16.09 | 11.00 (2.00-191.00) | ||
| CA 19-9 | -45.990 | <0> | ||
| Before the operation | 5.42±1.43 | 5.54 (0.50-22.00) | ||
| After the operation | 5.37±1.40 | 5.50 (0.50-22.00) | ||
| Na | -8.341 | <0> | ||
| Before the operation | 137.52±7.84 | 138.00 (42.00-200.00) | ||
| After the operation | 138.69±3.48 | 139.00 (122.00-155.00) | ||
| K | -2.598 | 0.009 | ||
| Before the operation | 3.89±.49 | 3.89 (2.45-6.43) | ||
| After the operation | 3.87±.50 | 3.86 (2.30-6.21) | ||
| Ca125 | -20.889 | <0> | ||
| Before the operation | 148.44±314.37 | 22.20 (5.90-2000.00) | ||
| After the operation | 52.73±95.75 | 21.00 (5.90-950.00) |
Table 2: Comparison of Laboratory Parameters of Patients Before and After the Operation
| Duration of Hospital Stay (Days) | Frequency | Percentage (%) |
| 2 | 748 | 34.2 |
| 3 | 412 | 18.8 |
| 4 | 559 | 25.6 |
| 5 | 305 | 13.9 |
| 6 | 163 | 7.5 |
| Total | 2187 | 100.0 |
Table 3: Frequency and Percentage of the Patients According to Duration of Hospital Stay
| Ca 125 | P | ||
| Age group | Under 40 age | 539±390 | 0.120 |
| Above 40 age | 950±450 | ||
| Tumor type | Mucinous type (15%) | 325±230 | 0.005* |
| Serous type (70%) | 458±400 | ||
| Mix type (5%) | 400±320 | 0.003** | |
| Stage | I+III | 318±300 | 0.0001*** |
| III+IV | 1645±950 |
Table 4: Evaluation of age, stage, tumor type according to Ca 125 in maling + borderline group.
The cancer with the highest mortality among all gynecological cancers is ovarian cancer. Generally, they are classified as benign, borderline and malign according to their histological and biological activities. Sex cord-stromal tumors in the ovary are usually hormonal active (85%) [7,9]. Ovarian neoplasms remain asymptomatic for appropriate periods. Patients have ambiguous or nonspecific complaints. Although the size of residual tumor masses after surgery has been shown to be an important prognostic factor for advanced ovarian cancer, it is unclear whether it is the surgical procedure that is directly responsible for the superior outcome that is associated with less residual disease.
In clinical data, especially when the disease progresses, it can be diagnosed by acid fluid or tissue sample. Symptoms of admission are chronic and progressive compression of the pelvic structures. Most of the patients had abdominal distension, heartburn, acid swelling, nausea due to intestinal obstruction [3,10-12]. In our study, the rate of distention and acid was 80%. Ovarian cancer is the leading cause of gynecological cancer death in the United Kingdom, which causes about 11 deaths per day in the UK [13]. Lack of disease-specific symptoms during early illness makes diagnosis difficult and most women are diagnosed at an advanced stage of cancer spreading beyond the ovaries. Diagnosis at an earlier stage (Stage 1) has a better prognosis with more than 90% of patients surviving 5 years after diagnosis. To follow recurrent ovarian cancer and the re-operation decision requires great responsibility and attention. Tumor reduction procedures are very risky and complex. We have to develop strategies that can lead to early detection of ovarian cancer. There is some evidence to suggest that serial serum sampling (annual or quarterly) and selective transvaginal ultrasound screening (TVS) and selective transvaginal ultrasound screening (TVS) are a screening strategy [14,15]. In our study, we followed up our patients every 6 months with TVS and by looking at tumor markers in the blood. It is very important to monitor cytoreduction operations in preoperative, intraoperative, and postoperative periods.
There are signs of spread metastasis, such as vomiting. Patients present with malnutrition, low serum albumin, transferrin levels, and weight loss, although the abdominal environment increases. During the operation, hemodynamic changes of the patient should be monitored, fluid-electrolyte, blood, and blood product needs should be met and blood sugar monitoring should be done meticulously and carefully. Invasive arteries and central venous procedures are usually necessary for this follow-up. In large surgical cases, we should monitor electrolyte changes well and reinforce them if necessary [10,11]. In our study, postoperative hyponatremia was common. 10 patients who did not improve in the intensive care unit were given 6 % NaCl supplementation intravenously. Albumin supplementation was done in 100 patients (2.2 %). Each patient received an average of 4 ES and 4 TDP during the operation. Preoperative blood product preparation should be done well and blood bank should be contacted preoperatively.
CA 125 may be more useful in conjunction with one or more other tumor biomarkers. Additional markers could play a role if, when used with CA 125, they identify some carcinomas missed by CA 125 (i.e., they improve sensitivity), rule out false positives (i.e., improve specificity), or can detect the same cancers earlier [5,15]. Ca 125 serum values in ovarian carcinomas are highest in serous and mixed adenocarcinomas, moderate in endometrioid and clear cell carcinomas, and lowest in mucinous carcinomas. Ca 125 values are an important prognostic factor in epithelial ovarian tumors [6,15]. MJ et al. in a study conducted of CA 125 and Ca 19-9 serum levels in borderline ovarian tumors, reported that Ca19-9 was more significant in borderline tumors than Ca125 [8,15]. Ovarian cancers are the highest mortality in gynecological cancers. Also, the first symptoms are often not specific, but spreading (60%) to the pelvic and abdominal spaces was observed. A special emphasis, as it is often diagnosed at an advanced stage carries [15]. Bast et. al [16] identified CA-125 of ovarian cancer patients and since then CA-125 had been many studies investigating prognostic value. Chi et al. emphasized the relationship between preoperative CA-125 levels and optimal surgery. In this study, 43 patients (78%) of total 55 patients had undergoing suboptimal surgery, CA-125 level 500 U / ml and above, specificity was found to be 73% (17). CA 19-9 should be included if someone chooses to use serum markers in the follow-up of muesli borderline ovarian tumors. The measurement of serum tumor markers in the follow-up of patients with borderline ovarian tumors leads to early detection of recurrence in only a very small proportion of patients and the clinical value of early detection of recurrence is important for early treatment (Figure 1). CA 19-9 should be included if someone chooses to use serum markers in the follow-up of muesli borderline ovarian tumors. The measurement of serum tumor markers in the follow-up of patients with borderline ovarian tumors leads to early detection of recurrence in only a very small proportion of patients and the clinical value of early detection of recurrence is important for early treatment. Other a study was reported limit 500 U / ml as CA-125 value 62% sensitivity, 83% specificity in their studies [18]. Memarzadeh et. al reported, only CA-125 values using, in optimal surgery performed the sensitivity of CA-125 58% in predicting that it cannot be specificity 54%, positive predictive value 78%, negative predictive the value was found to be 31% and alone it is advocated that CA-125 value is not enough [18,19]. Research in recent years, CA-125 values shows that it goes to the correlation with tumor load.
Figure 1: Median Values of Laboratory Parameters of Patients Before and After the Operation
During primary surgery for advanced stage epithelial ovarian cancer all attempts should be made to achieve complete cytoreduction. When this is not achievable, the surgical goal should be optimal (< 1 cm) residual disease. Due to the high risk of bias in the current evidence, randomized controlled trials should be performed to determine whether it is the surgical intervention or patient-related and disease-related factors that are associated with the improved survival in these groups of women. The findings of this review that women with residual disease < 1 cm still do better than women with residual disease > 1 cm should prompt the surgical community to retain this category and consider re-defining it as 'near optimal' cytoreduction, reserving the term 'suboptimal' cytoreduction to cases where the residual disease is > 1 cm (optimal/near optimal/suboptimal instead of complete/optimal/suboptimal) [18,20].
A Cochrane review did not identify any studies that compared the effectiveness and safety of secondary surgical cytoreduction to chemotherapy alone for women with recurrent epithelial ovarian cancer (20). In our study, 80 % of our patients had preoperative or postoperative adjuvant chemotherapy.
In our study, when the preoperative CA-125 value was taken as 300 U / ml limit, sensitivity was 80% and selectivity was 60% in predicting whether there would be suboptimal surgery. In addition, no significant result could be obtained between age, histopathological type and surgical type of CA-125 decrease after the operation. Optimal cytoreduction is one of the most prognostic factors in ovarian cancers. First, Griffiths et al. showed the success of cytoreductive surgery, which was demonstrated by, has been demonstrated many times over the following years [21,22]. For this reason, many authors advocate maximal effort for optimal cytoreduction.
The standard management of primary ovarian cancer is optimal cytoreductive surgery followed by platinum-based chemotherapy. Most women with primary ovarian cancer achieve remission on this combination therapy. For women achieving clinical remission after completion of initial treatment, most (60%) with advanced epithelial ovarian cancer will ultimately develop recurrent disease. However, the standard treatment of women with recurrent ovarian cancer remains poorly defined. Surgery for recurrent ovarian cancer has been suggested to be associated with increased overall survival [23].
A retrospective study evaluated the prognostic significance of the serum CA125 level after 6 cycles of systemic adjuvant chemotherapy. The median progression-free survival was 26, 14, and 10 months, and the median overall survival was 105, 42, and 37 months in group I (< 10 U/ml), group II (10-21 U/ml), and group III (> 21 U/ml) respectively [24]. One study determined whether CA125 is an independent predictor of overall survival (OS) in patients with surgically defined disease status at the end of primary therapy prior to intraperitoneal (IP) consolidation chemotherapy. When considered as a continuous variable, CA125 was a predictor of OS. Using the median CA125 level as a cut-off, OS was increased in patients with CA125 ≤ 12 U/ml (median 5.8 years) compared with > 12 (3.7 years) [25, 26]. CA125 is the gold standard tumor marker in ovarian cancer. Serum level of CA125 is used to monitor response to chemotherapy, relapse, and disease progression in ovarian cancer patients. Thus, it is reasonable to investigate whether CA125 may have utility as a prognostic indicator as well in ovarian cancer [26]. Intra - abdominal chemotherapeutic perfusion with 0.9% isotonic makes temporary significant hyponatremia and metabolic acidosis [27]. In our study, our patients were previously diagnosed with Over Ca and they completed chemotherapy programs because they were opened for the second time due to the tumor debulking operation.
Multidisciplinary teamwork is very important in ovarian cancer treatment. It should be kept in mind that the approach of anesthesiologists in the preoperative, intraoperative perioperative and postoperative periods is life-saving in patients who will undergo gynecologic-oncologic cytoreductive surgery.
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.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
