AUCTORES
Globalize your Research
Chat with us
Review ariticle | DOI: https://doi.org/10.31579/2690-1897/206
Department of Pediatrics, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons,630 West 168th Street, New York, New York-10032, USA.
*Corresponding Author: Thyyar M Ravindranath, Department of Pediatrics, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons,630 West 168th Street, New York, New York-10032, USA.
Citation: Thyyar M Ravindranath, (2024), Trauma to the Ureter and the Urinary Bladder: The Conductor and the Collector, J, Surgical Case Reports and Images, 7(6); DOI:10.31579/2690-1897/206
Copyright: © 2024, Thyyar M Ravindranath. 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: 02 July 2024 | Accepted: 19 July 2024 | Published: 29 July 2024
Keywords: ureter; urinary bladder; diagnostic modalities; injury classification; treatment; complications
Although uncommon, trauma to the ureter and the urinary bladder is diagnosed based on a suspicion, following multiple abdominal trauma. Both forms of trauma can result from penetrating, blunt, as well as iatrogenic injuries. While bladder trauma more commonly results from blunt injuries, trauma to the ureter more commonly results from penetrating trauma. The diagnosis involves subtle clinical findings which are confirmed by radiological examination. In this brief description of these two types of trauma, the embryology, applied anatomy, physiology, clinical presentation, radiological diagnosis, and treatment options are discussed.ureter; urinary bladder; diagnostic modalities; injury classification; treatment; complications
Epidemiology:
The genitourinary system is involved in 10% of all abdominal injuries [1]. The urinary bladder is the most frequently involved organ while the ureter is injured less often (less than 1%) [2]. However, following multiple abdominal organ injuries, both the urinary bladder and the ureter are involved simultaneously [3]. Blunt trauma, for example motor vehicle accidents, (MVA) accounts for 60%-85% while penetrating trauma, for instance gunshot wounds, (GSW) is responsible for 40% to 15% of the injuries [3]. Injury to the urinary bladder can also be incurred during sporting events. Isolated urinary bladder injury is uncommon and is seen in iatrogenic trauma [1]. Urinary bladder injury can be either extraperitoneal (66%) or intraperitoneal (34%). While extraperitoneal injury is associated with pelvic fracture, especially in children whose pelvis is underdeveloped, intraperitoneal injury results from direct injury to a full bladder. The roof of the urinary bladder is the feeble spot for rupture when it is full due to the weakening of the bladder wall from urachal attachment [4].
The ureter, like urinary bladder, can be involved in blunt, penetrating, and iatrogenic trauma. Penetrating injuries more commonly involve the lower third of the ureter [1] from stab and GSW and are more common (77%) than blunt trauma (23%) [5]. In comparison, iatrogenic injury occurs in less than 1% of cases from pelvic surgery.
Embryology of the ureter and the bladder:
Urogenital tract develops as an elevation of intermediate mesoderm on each side of the fetus during the 3rd and 5th weeks of the gestational period. Part of the urogenital tract develops into the nephrogenic ridge. Each nephrogenic ridge give raise to a mesonephros and a mesonephric duct. Each mesonephric duct gives rise to an ureteric bud between 4th and 5th week of fetal development and elongates upward and becomes a metanephric duct that develops into the future ureter. During the 7th week of fetal development, the cloacae is divided into the hind gut and the urogenital sinus by the urorectal septum. The upper part of the urogenital sinus develops into the urinary bladder. The incorporation of the metanephric ducts into the bladder at trigone forms the ureterovesical junction [6].
Applied anatomy:
The ureter:
Anatomy:
The S shaped ureter is 30 cm. long and is related to the height of an individual. As it courses down, the ureter rests on the psoas muscle, passing medial to the sarco-iliac joint, lateral to the ischial spine, and then moves medially to join the base of the bladder. The ureters are covered by the posterior peritoneum with their lowest portion attached to it while the juxta vesical portion is embedded in the vascular retroperitoneal fat. In women, the ureters are related to the uterine arteries in juxta vesical area.
Histological features:
The ureters are lined by transitional epithelium internally under which is the lamina propria consisting of loose connective tissue. Externally the ureters consist of a smooth muscle layer composed of longitudinal and helical muscles. The adventitia forms the outermost layer and contains fibrous connective tissue.
Blood supply:
Arterial supply:
While the renal arteries supply the upper ureter, the mid-ureter derives its blood supply from internal spermatic or ovarian arteries, and the lower ureters are supplied by common iliac, internal iliac, and vesical arteries.
Venous drainage:
The venous drainage of the ureters follows the arterial supply.
Lymphatic drainage:
The lymphatic drainage of the upper ureters is into the lumbar lymph nodes, that of the mid ureters is into internal iliac and common iliac lymph nodes, and that of the lower ureters is into vesical and hypogastric lymph nodes.
Innervation:
The preganglionic sympathetic innervation is from T10 to L2 segments. The aorticorenal, superior, and inferior hypogastric autonomic plexuses generate the postganglionic fibers. S2 to S4 sacral pelvic splanchnic nerves supply the ureteral parasympathetic innervation [7].
The bladder:
The bladder, which works as the reservoir for urine, is a muscular organ that holds about 400-500 milliliters of urine. The wall of the bladder is 3-5 millimeters (mm.) thick and is thinner when it is distended. Whereas the adult empty bladder lies behind the pubic symphysis, it is situated higher in children. When the bladder is distended, it perches above the pubic symphysis and can be seen as a bulge in the lower abdomen when overdistended. The obliterated urachus is represented by the median umbilical ligament that extends as a fibrous band from the dome of the bladder to the umbilicus. The ureters enter the posterior aspect of the bladder in an oblique fashion and are 5 centimeters (cm.) apart. The ureteric orifices are located at the ends of a crescentic ridge and are 2.5 cm. apart. The area between the crescentic ridge and the bladder neck forms the trigone. The internal sphincter of the bladder is a thickening that is formed by the intermingling and connecting of muscle fibers of the detrusor which pass distally to become the smooth muscle part of the urethra.
Anatomical relationship:
In females, the uterus and vagina are located between the bladder and rectum whereas in males, the bladder is placed posteriorly to the seminal vesicles, vas deferens, ureters, and rectum. Superiorly and posteriorly the bladder is covered by peritoneum with close relationship to the small gut and the sigmoid colon. The bladder is closely situated behind the pubic symphysis and when distended it contacts the abdominal wall.
Histological features:
The mucosa of the bladder consists of transitional epithelium followed by a basement layer and lamina propria. The submucosa consists of connective and elastic tissue. Muscle layer is found outside the submucosal layer and is called the detrusor. It consists of smooth muscle fibers that are disposed in longitudinal, circular, and spiral mode in a haphazard organization except near the internal meatus where they form outward longitudinal, middle circular, and inner longitudinal layers.
Blood supply:
Arterial supply:
The arterial supply arises from the anterior trunk of the internal iliac artery via superior, middle, and inferior vesical arteries and branches from the inferior gluteal and obturator arteries. In females, the blood supply also comes from uterine and vaginal arteries.
Venous drainage:
Venous drainage is into the internal iliac vein.
Lymphatic drainage:
The lymphatic drainage is into the external, internal, common iliac, and vesical lymph nodes.
Innervation:
The bladder receives nerve supply from both sympathetic and parasympathetic nerves. The sensory afferent comes from subepithelial nerve endings and between detrusor muscle [7].
Physiological function of the ureter and the bladder:
As alluded to earlier, the wall of the ureter is composed of smooth muscle arranged in circular, longitudinal, and spiral fashion in an indistinct layer. Peristaltic waves that appear every 1-5 minutes moves urine along the ureters into the bladder in spurts. Although the lower ends of the ureters possess no valves, the oblique entrance of the ureter into the bladder prevents reflux of urine into the urinary bladder during bladder contraction.
The physiology of micturition:
The urinary bladder exhibits plasticity i.e., the initial volume expansion of the bladder is followed by an increase in intra-vesicular pressure (section 1a) which is followed by a flat portion of the pressure curve (section 1b) and then, as the urinary bladder fills further, there is a sudden rise in pressure (section 11). The initial urge to void is felt at urinary volume of 150 cc. and fullness is felt at 400 cc. The passage of urine is heralded by the relaxation of pelvic muscles which initiates contraction of the detrusor muscle and relaxation of the outer urethral sphincter, which allows urine to pass out via the urethra. The pelvic muscles and external urethral sphincter can be voluntarily contracted once the flow of urine is initiated and thus stop the flow of urine until the urge to void urine presents itself again. Whereas the female urethra empties by gravity, bulbocavernosus muscle contraction expels urine that remains in the urethra in the male. This voiding reflex has facilitatory and inhibitory centers in the brain stem. The facilitatory center is in the pontine region and the inhibitory center is in the midbrain. The voiding reflex can be initiated by voluntary contraction of the urinary bladder facilitated by abdominal muscle contraction even when the urinary bladder is nearly empty.
The reflex control of the urinary bladder is initiated when the bladder volume reaches 300-400 cc. and involves local stretch receptors in the bladder wall. The afferent pathway is endowed in the pelvic nerves and the efferent pathway consists of parasympathetic fibers that also traverse via the pelvic nerves. The center for reflex control is located in the sacral region of the spinal cord [8].
Presentation:
Injury to the ureter:
The ureter is injured by penetrating trauma, including iatrogenic injury or blunt trauma with penetrating trauma occurring in two-thirds and blunt trauma encompassing the other third [9, 10]. Penetrating trauma involves the lower one-third of the ureter and is often found among young adult males. Iatrogenic trauma occurs in less than 1% of cases following pelvic and gynecological surgeries. Injury to the ureter must be suspected in multiple traumata involving bowel, bladder, vascular or deceleration injuries [5]. Children are at risk for ureteropelvic injury due to deceleration movement [11].
The location of the ureter amidst surrounding muscles, bony structures, and retroperitoneal setting makes it well protected from injury with an injury incidence of less than 1% [1].
Clinical features:
A high index of suspicion is essential in diagnosing ureteral injury although flank pain with ecchymosis, tenderness over the side, hematuria, and hypotension may be present following penetrating trauma to the flank without any specific features pointing to the ureter itself [12].
Radiological diagnosis:
Radiological confirmation in a hemodynamically stable patient includes CT urogram which consists of intravenous contrast augmented CT with 10-minute interrupted films helps to precisely diagnose the injury to the ureter. The tell-tale sign of injury to the ureter includes the absence of contrast distal to the injury, contrast extravasation, delayed pyelogram, and hydronephrosis [2].
A retrograde pyelogram is utilized when there is a suspected delayed iatrogenic ureteral injury following revelation of urinary fistula, urinoma, or an abscess. It also allows placement of a stent [1].
Ureteral injury is diagnosed in a hemodynamically unstable patient by exploratory laparotomy either by direct visualization or extravasation of injected dye such as methylene blue [1].
| Injury Grade | Type of Injury | Description of Injury |
| I | Hematoma | Contusion or hematoma without devascularization |
| II | Laceration | <50> |
| III | Laceration | ≥50% transection |
| IV | Laceration | Complete transection with <2> |
| V | Laceration | Avulsion with >2 cm devascularization |
Table 1: Ureter Injury Scale [13]
Treatment:
The Management of injury to the ureter is dictated by its hemodynamic status, the site of injury, the status of the ureter, and associated injuries. The majority of injuries are tackled by surgical approach [13]. The main aim is to maintain the ability of the ureter to drain urine.
Once hemodynamic and metabolic stability is attained, the procedure of choice is to use a Foley catheter or a percutaneous nephrostomy tube placement to drain urine followed by delayed definitive surgery [1].
Hemodynamically stable patients can be managed by radiographic studies followed by appropriate surgical approach such as urinary drainage including the usage of a stent. If a non-surgical approach fails then a surgical approach is used [12].
Ureteral reconstruction is more complicated and depends on the site and length of injury. Injury to the ureter above the pelvic brim is repaired with primary anastomosis. Injury to the distal ureter caudad to iliac vessels is tackled by reimplantation into the bladder.
Iatrogenic injury can be managed by stenting.
Complications:
Complications include urine leak, urinoma development, periureteral abscess, ureter fistula, and stricture.
Prognosis:
The prognosis of ureteral injury depends on the injuries to other organs and the average mortality is 7% [5].
Injury to the bladder:
Trauma to the urinary bladder must be suspected in individuals with painful or difficulty in passing urine, lower abdominal pain with bruising, gross hematuria, acute abdomen, entry wound near the suprapubic area with tenderness, ileus, and pelvic fracture especially following blunt trauma [2,10]. Extraperitoneal bladder rupture is associated with pelvic fracture which results in a shearing movement from deformation of the bony pelvis.
Diagnostic studies:
Hemodynamically stable patients [12]:
Traumatic urinary bladder injury is best studied by using transurethral cystography with a Foley catheter in place. Three views namely, a plain film, a film with full bladder filled to a volume of 250 cc, and a post-void film are strongly suggested.
CT cystogram:
CT cystogram can also be used to diagnose injury to the urinary bladder. Indications include any trauma to the pelvis, pelvic fracture with gross hematuria, blunt trauma with gross hematuria, penetrating trauma with any grade of hematuria, low density free abdominal fluid, blunt trauma with pelvic ring fracture, and over 30 red blood cells per high power field. CT cystogram can also identify bladder neck injury which needs immediate repair in order to prevent urinary incontinence.
Retrograde urethrogram:
Indication:
Retrograde urethrogram is performed when CT scan doesn’t show the presence of the urinary bladder injury but when it is strongly suspected, especially in the presence of anterior pelvic fracture.
Extraperitoneal bladder rupture on CT shows extravasation of the dye around the base of the bladder restricted to perivascular space and space of Retzius (retro pubic space) with fluid in front and adjacent to the bladder.
Management:
The management of traumatic bladder injury is based on the American Association for Surgery of Trauma Organ Injury Scale (AASTOIS) [13].
| Grade | Injury type | Description of injury | Treatment |
| Bladder injury scale | |||
| I | hematoma | Contusion, intramural hematoma | Nonoperative |
| Laceration | Partial thickness | Nonoperative | |
| II | Laceration | Extraperitoneal bladder wall laceration <2> | May need immediate intervention |
| III | Laceration | Extraperitoneal ≥ 2 cm or intraperitoneal < 2> | May need immediate intervention |
| IV | Laceration | Intraperitoneal bladder wall laceration ≥ 2cm laceration | May need immediate intervention |
| V | Laceration | Intraperitoneal or extraperitoneal bladder wall laceration extending into the bladder neck or ureteral orifice (trigone) | May need immediate intervention |
Table 2: AASTOIS classification of the urinary bladder injury
In a hemodynamically unstable patient, a catheter drainage is performed until the patient is stabilized and this is followed by definitive procedure.
Extraperitoneal injury to the urinary bladder:
Nonoperative management involves catheter drainage of the bladder or suprapubic cystostomy if there is an associated urethral trauma.
Persistent urine leaks are managed by embalotherapy utilizing copolymer [14].
Absolute indication for surgery:
Penetrating trauma, persistent hematuria, tenacious urine leak (greater than 4 weeks), urine infection, related pelvic organ injury, the presence of foreign body or projecting bone fragments into the urinary bladder, and urinary bladder neck injury [15].
Intraperitoneal injury to the urinary bladder:
Intraperitoneal injury to the bladder is tackled by surgical intervention [16].
A postoperative urinary bladder drainage is essential for the successful healing of the urinary bladder.
The mortality following the urinary bladder injury is between 0%-34% with a mean of 8%. Factors that determine the outcome include the condition of the patient at the time of admission, hemodynamic instability, fracture to the pelvis, an injury severity score of less than 25, and an undiagnosed urinary leak that can predispose to sepsis [16].
The diagnosis of injury to the ureter and to the urinary bladder is fraught with difficulty. A high degree of suspicion with an appropriate analysis of the mechanism of injury in a multiple abdominal trauma victim followed by appropriate radiological studies helps to make the diagnosis. The key aspect of treatment involves establishing urinary drainage.
The author would like to thank Malini Ravindranath, PhD, for her help in reading and editing the manuscript.
None
None
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!”
