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The Effect of Laser Acupuncture on Menopausal Symptoms

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Research Article | DOI: https://doi.org/10.31579/2578-8965/003

The Effect of Laser Acupuncture on Menopausal Symptoms

  • Ahmed Elsadeek Radwan 1*
  • Mohamed Amr Hussein Elnoury 1
  • Sherif Fathi ElMekkawi 1

*Corresponding Author: Ahmed Elsadeek Radwan– department of Obstetrics & Gynecology, Suez Insurance Hospital – Suez, Egypt.

Citation: Ahmed Elsadeek Radwan, The Effect of Laser Acupuncture on Menopausal Symptoms, J Obstetrics, Gynecology and Reproductive Sciences. 1(1); Doi: 10.31579/2578-8965/003

Copyright: © Ahmed Elsadeek Radwan. 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: 14 January 2017 | Accepted: 23 February 2017 | Published: 27 March 2017

Keywords: laser acupoint stimulation, acupuncture, menopause, hot flushes.

Abstract

Abstract:

Objective: Acupuncture is frequently utilized to manage climacteric symptoms and other gynecological conditions. Laser acupuncture has the advantages of being noninvasive, reproducible, and convenient. This study sought to explore the effectiveness of laser acupoint stimulation in relieving symptoms associated with menopause.

Methods: A randomized, double-blind, controlled study was conducted on 120 women diagnosed as menopausal patients (>1 year past last menstruation), aged 40 - 60 years with a Kupperman Menopause Index (KMI) equal or more than 15. women were randomized into Group A: Laser acupuncture (n=30), Group B: (HRT); Tibolone 2,5 mg/day (n=30) orally, Group C: Laser acupuncture and Tibolone 2,5 mg/day orally (n=30), Group D: Non interventional (self-care group) (n=30). Each patient was given a standard daily log and was required to record the frequency and severity of hot flashes and side effects of the treatment felt daily. The serum levels of follicle stimulating hormone (FSH), LH and E2 were detected before and after the treatment.

Results: 120 women with postmenopausal symptoms were divided randomly into four equal groups; After the treatment and the follow-up, in (Group A) there was no significant difference regarding FSH, LH and E2 level before treatment and after treatment with LASER acupuncture, as regard (Group B); there was statistically significant difference before and after treatment concerning hot flashes of KMI and he levels of FSH, LH decreased significantly and the level of E2 increased significantly. Combined treatment using hormonal replacement therapy with Laser Acupoints (Group C) showed dramatic improvement in study subjects and the improvement was more than that in group B. There were no significant differences were found regarding self-care group on either frequency of hot flashes, FSH, LH and E2 level.

Conclusions: Laser acupoints are effective and can be used as an alternative treatment to decrease the frequency and severity of postmenopausal hot flashes and postmenopausal symptoms especially if combined with Tibolone.

Introduction

Menopause is a normal physiologic event that every woman who lives long enough will experience. Menopause is said to have occurred once a period of 12 months of amenorrhoea (no menstrual periods) has elapsed. Perimenopause is the era preceding menopause and finishes 12 months after the last menstrual period (1).

It can occur naturally as the consequence of aging or from surgical removal of the ovaries, radiotherapy, or chemotherapy. Most ladies experience normal physiological menopause between 40 and 58 years of age (2-6). From perimenopause to late postmenopause, some ladies experience some difficulties "Menopausal symptom" which varies widely from mild to severe, and while many women transition through menopause with manageable symptoms, others experience more severe symptoms that include hot flashes and sweats (vasomotor instability) (7), new onset joint pain, vaginal dryness, sleep and mood disturbances (8).

While about 70% of women will seek symptom relief, some women will experience very mild symptoms and may not see the need to seek symptom relief from a health care provider (9). Vasomotor manifestations are exceptionally common crosswise over menopausal stages in many social orders (10).

Currently, menopausal women have an array of options for symptom management including hormone therapy, estrogen and/or progesterone(11), off label use of pharmaceutical agents such as antihypertensive or antidepressants (12), lifestyle changes, such as diet, exercise, alcohol and tobacco abstinence, and complementary and alternative therapies, such as herbs, meditation, or acupuncture (13).

For some women, such as estrogen receptor positive breast cancer survivors, estrogen therapy may be an absolute contraindication, and alternate pharmaceutical agents such as selective serotonin reuptake inhibitors (14), α-1 adrenergic agents, (15) or may be used anticonvulsants (16). Unfortunately, a body of evidence suggests these pharmaceutical agents may only provide marginal symptom relief yet carry significant side effects (17).

In the past 10 years, new information from two large studies, the Heart and Estrogen/Progestin Replacement Study(18), and the Women’s Health Initiative (19), have led women to consider the inherent safety of hormone therapy.

Both of these large, multi-center studies suggest risks of exogenous hormone therapy may outweigh benefits, has come under criticism after outcomes linking HRT specifically with an augmented risk of risks of breast cancer, stroke, heart disease or thrombosis (20).

For women who are not able to, or choose not to take hormones or pharmaceutical agents, alternative therapies may offer symptom relief with far fewer side effects (21).

Alternative therapies used by menopausal women may include herbs such as black cohosh, traditional Chinese herbs, exercise, mediation or paced respiration, and acupuncture (22).

However, to date, studies examining the effectiveness of complementary and alternative therapies for menopausal symptom relief have been small and yielded contradictory findings, which raise concerns regarding the efficiency of these therapies (23). This has driven ladies and healthcare staffs to search for alternative means of relieving the symptoms associated with menopause.

The executive summary identified several areas where further research is indicated: developing new methods for treating menopausal symptoms, attempting to increase the biologic and physiologic understanding of symptom etiology, and continuing to examine traditional and alternative, behavioral and non-pharmacologic therapies. Traditional Chinese medicine was specifically included in these recommendations (24).

Patients and Methods

A randomized, double-blind, controlled study was conducted on 120 women diagnosed as menopausal patients (>1 year past last menstruation), aged 40 - 60 years with a Kupperman Menopause Index (KMI) equal or more than 15. Precipitants were selected randomly from Department of Medical Laser Application/ Laser Medical Center National Institute of Laser Enhanced science, Cairo University & Department of Gynecology, Ain Shams Gynecology and Obstetrics Hospital, Ain shams University and Department of Gynecology, Suez Health Insurance Hospital, Egypt. The study was done from October 2015 to May 2016.  The participants divided into 4 groups (A&B&C&D):

  • Group A: Laser acupuncture (n=30)
  • Group B: (HRT); Tibolone 2.5 mg/day (n=30) orally.
  • Group C: Laser acupuncture and Tibolone 2.5 mg/day orally (n=30)
  • Group D: Non interventional (self-care group) (n=30)
Table:1

Spontaneous amenorrheic interval at least 6 months since the last regular menstruation. For those patients with an amenorrheic interval less than 12 months, the baseline level of E2 should not exceed 30 pg/ml. The level of thyroid-stimulating hormone (TSH) was normal and the serum FSH concentration was >50 mIU/ml. Kupperman Menopause Index at least 15. Good general health; a gynecologic examination and laboratory tests showed that the patient did not suffer from other organic diseases of the reproductive system after the bilateral ovariectomy. Written informed consent.

Exclusion criteria

 

  • Recent use of systemic hormone therapy or hormonal contraceptives in last 8 weeks before study entry; (wash out period: 8 weeks for systemic and 4 weeks for local use), use of SSRI (wash out period: 8 weeks).
  • Recent use of selective estrogen receptor modulators (SERMS) or aromatase inhibitors
  • Known hypersensitivity or contraindications (reasons not to take) to estrogen, or progestins
  • contraindication of tibolone
  • Pre-breast cancer or high-risk breast cancer condition; history of cancer within the past five years including use of tamoxifen
  • Abnormal bleeding suggestive of endometrial pre-cancer or endometrial hyperplasia
  • Abnormal screening blood tests; use of anticoagulant drugs.
  • More than eight years' amenorrhea
  • Thickness of postmenopausal endometrial thickness equal or more than 5 mm
  • Inability to complete the study procedures.
  • Surgical menopause.
  • Others; heart valve disease, poorly controlled hypothyroidism, hyperthyroidism, poorly controlled diabetes mellitus, tuberculosis, the body mass index (BMI) of the subject was more than 24, cigarette smoker, Organ transplant, psychological illness, overt drug or alcohol dependency.
  • Primary Outcome Measures:
  • Change in a mean number of moderate to severe hot flushes per week combination of the Mann Whitney values (MWV) of the Kupperman Menopause Index (KMI) and the frequency of adverse events at the end of treatment.

Secondary Outcome Measures

 

  • Menopausal symptoms and quality of life
  • Hot flush weekly weighted score
  • Kupperman Menopause Index (KMI)
  • Assessments of adverse events
  • Physical examinations
  • Urogenital symptoms
  • laboratory tests (FSH, LH, Estradiol, Cholesterol).

Methods

After taking written consent from all patients, all patients subjected to:

  • Full history.
  • Full general examination.
  • Hormonal profile.
  • Routine blood examination, a routine uronoscopy, a liver function test and a renal function test, respectively, 1 day before the treatment started and 1 day after the treatment ended.
  • Randomization lists were computer generated (block randomization, random block size).
  • We measured the frequency of menopausal symptoms by Registration forms using a Kupperman Menopause Index (KMI).

Intervention

 

  • The treatment program in the group (A) Laser acupuncture:  It consisted of application of laser acupoints (Sanyinjiao (sp6), Hegu (LI.4), Quchi (LI.11), Fengchi (GB.20.), Guanyuan (CV 4.) and Fuliu (KI7)) of both sides for 6 weeks, three sessions /week, Infrared laser diode applied 90 Sec. / each point, with wave length 904 nm and power output 5 mill watts. The head of the machine was perpendicular, with direct contact to each point.
  • The treatment program in the group (B) HRT Group: The patients were prescribed with oral Livial (Tibolone), in the dosage of one tablet a day (2.5 mg/tablet) for 12 consecutive weeks. One day before the treatment and at the end of the treatment, the levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) were measured with enzyme- linked immunosorbent assay (ELISA) and the levels of E2 were measured with double antibiotic ELISA.
  •  Patients in Group (C) were treated with Laser acupuncture and Tibolone 2,5 mg/day orally;
  • Patients in Self-care group were guided by the information leaflet on self-provided care for menopausal symptoms, the participants were free to use any over-the-counter medication and self-provided non- pharmaceutical interventions. No medical treatment for menopausal symptoms was prescribed to them within the study.
  • Hot flashes and sleep disturbances: Participants received a diary in which they recorded frequency and severity of hot flashes and amount of sleep at night for 14 days.

The severity of hot flashes was defined as follows:

Mild—a fleeting, warm sensation without sweating or disruption of normal activities;

Moderate—a warm sensation associated with sweating, and disruption of normal activities;

Severe—a hot sensation associated with sweating and the discontinuation of normal activities.

The score of the hot flash severity for a particular day is calculated by adding 1 × the number of mild hot flashes + 2 × the number of moderate hot flashes + 3 × the number of severe hot flashes.

The frequency of hot flashes is the total number of the mild, moderate and severe hot flashes occurred during 24 hours.

Table:2

Results

In this study, 120 women with postmenopausal hot flashes were divided randomly into four equal groups (A & B & C & D):

Group A: Laser acupuncture (n=30); the mean age and BMI were (49.4±5.38) years and (26.69±2.45) Kg/m2.

Group B: (HRT); Tibolone 2,5 mg/day (n=30) orally were included in this group; the mean age and BMI were (49.13±4.97) years and (26.88±2.52) Kg/m2.

Group C: Laser acupuncture and Tibolone 2,5 mg/day orally (n=30) were included in this group; the mean age and BMI were (50.37±4.97) years and (26.17±2.50) Kg/m2.

Group D: Non interventional (self-care group) (n=30) were included in this group; the mean age and BMI were (50.70±5.74) years and (26.53±2.60) Kg/m2.

Table (2): Comparison between groups according to age (years).
Table (3): comparison of the 4 groups as regard the hot flushes

 

Table (4): comparison of KMI among the 4 groups

Discussion

An earlier study showed that the transition from reproductive to non-reproductive years in women is characterized by increased reporting of psychological, somatic, vasomotor and urogenital symptoms (25).

Menopause is a natural biological process, not a medical illness that defined as the permanent end of menstruation and fertility that occurs 12 months after last menstrual period. It caused by the natural decline of reproductive hormones, that ovaries start making less estrogen and progesterone.

Vasomotor episodes with hot flashes and night sweating are the most prevalent complaints related to menopause. A hot flash is described as a feeling of intense heat in the face, neck and chest. It lasts on average four minutes, with a range from a few seconds up to 10 minutes or more (26).

Although menopause is associated with changes in the hypothalamic and pituitary hormones that regulate the menstrual cycle, menopause is not a central event, but rather primary ovarian failure. As the hypothalamic-pituitary-ovarian axis remains intact during the menopausal transition, FSH levels rise in response to ovarian failure and the absence of negative feedback from the ovary (27).

Atresia of the follicular apparatus, in particular the granulosa cells, results in the reduced production of estrogen and inhibin, which leads to the reduced inhibin levels and the elevated FSH levels, a cardinal sign of menopause (28).

Correlations between endocrine levels and symptom severity ratings over time revealed that hot flash severity was sig- nificantly and positively related to FSH (29).

Menopausal symptoms affect about 70% of women approaching menopause. Common menopausal symptoms are menstrual irregularities that periods may come more frequently, shorten or lengthen, and become light or heavy, hot flash which is sudden feeling of warmth or heat that spreads over the body creating redness particularly noticeable in face and upper body, mood swing that the mood one minute up and another minute down, insomnia, vaginal dryness that vagina loss usual moist and may be associated with irritation, fatigue, weight gain especially in abdomen and depression (30).

Vasomotor, somatic, and psychological symptoms associated with menopause are often treated with hormone replacement therapy (HRT), but the role of non-pharmacological interventions has received little attention. As hot flashes are the most common problem for post-menopausal women and the potential health risks of HRT, it is important to find out an effective, safe and non-pharmacological treatments to relieve their menopausal hot flashes (31).

It is well known that acupuncture is associated with homeostatic regulation, and possess effects such as buffering hormonal disturbance, modulating ovulation, as well as improving psychological or behavioral abnormity (32).

Acupuncture in specific acupoints has been found to significantly increase blood concentrations of E2 in the ovariectomized rats (33), while reducing the elevated plasma LH due to ovariectomy; in addition, acupuncture also restored the number of gonadotropin-releasing hormone (GnRH) neurons in the ovariectomized rats (34).

Laser acupuncture is the irradiation of acupuncture points with low intensity laser which is alternative to invasive acupuncture needling. Laser acupuncture is advantageous in terms of side effects compared to classical acupuncture techniques and studies showed that there are positive effects can be assumed in myofascial pain syndromes of the neck, back and shoulder (35).

Laser acupoints were found to assist in the alleviation of postmenopausal hot flashes frequency and intensity (36). This study was carried out to study the effect of laser acupuncture on menopausal symptoms. This prospective study was conducted in Suez Insurance Hospital, Ain Shams University Maternity Hospital and National Institute of Laser at the period starting October 2015 to May 2016 and included 120 postmenopausal women.

In the current study (Group A) women treated with LASER acupoints found to show improvement of symptoms associated with menopause especially the daily frequency of hot flushes.

also there was a little decrease in FSH and LH but there was no significant difference regarding FSH, LH and E2 level before treatment and after treatment with LASER acupuncture (P-value >0.05).

This agrees with another study which found that; laser acupoint stimulation using acupoints chosen from a limited set of acupoints is not efficacious in reducing symptoms associated with menopause (37).

Another study did not recommend laser acupuncture for relief of menopause symptoms (38). However, this disagrees with the finding of a study which stated that acupuncture and auricular acupressure significantly relieve the severity and frequency of menopausal hot flashes (39)

In another study, acupuncture was found to improve the reproductive disorders induced by ovariectomy in rats through modulating the blood E2 levels (40). Acupuncture may improve the function of the hypothalamic-pituitary-ovarian axis, increase blood adrenogenous androgen level and facilitate its transformation into estrogen by an aromatic enzyme in the brain, liver and fat tissues.

In another study, were comparison of laser-on versus laser- off acupuncture, laser-on treatments were ineffective in altering menopausal symptoms, over 3 months; the women documented their menopause symptoms (41).

During this time, 23 had laser-on and 17 had laser-off (sham) acupuncture to 10 specific body points every 14 days. On average, the laser-on and laser-off groups, respectively, reported about 37 and 33 percent fewer daytime and about 30 and 39 percent fewer nighttime hot flashes. They suggested further studies of laser acupuncture in menopausal women focus on alternative acupuncture points (41).

In (Group A) there was no significant difference regarding FSH, LH and E2 level before treatment and after treatment with LASER acupuncture (P-value >0.05).

As regard Group B; Tibolone administration relieves climacteric complaints. There was statistically significant difference before and after treatment concerning hot flashes of KMI. Also it shows highly significant statistically difference before and after treatment according to FSH, LH and E2 level.

This agrees with a previous study which found that tibolone exerts encouraging effects on climacteric symptoms. These effects have been attributed to its unique molecular profile and to the tissue-related metabolism into estrogenic, progestogenic, and androgenic metabolites (42).

In Group B; the levels of FSH, LH decreased significantly and the level of E2 increased significantly (P-value <0>Group B, Combined treatment using hormonal replacement therapy with Laser Acupoints (Group: C) it showed dramatic improvement in study subjects and the improvement was more than that in group B; as showed in Result chapter.

Studies compared electro acupuncture, or acupuncture plus auricular acupressure, versus hormonal therapy and reported hot flush frequency or severity, found that; acupuncture was associated with significantly more hot flushes per day than hormonal therapy (43).

Conclusion

We conclude that the protocol of treatment in HRT group alone (Group B) and the group of a combination of laser acupoints in addition to HRT protocol of treatment (Group C) led to significant improvements in hot flash frequency and intensity and improvement the menopausal symptoms according to a score of KMI before and after treatment.

Also improvement of the levels of FSH and LH which decreased significantly while the level of E2 increased significantly. In the present study, laser acupoints was found to improve the postmenopausal symptoms and may improve the function of the hypothalamic-pituitary-ovarian axis, increase blood adrenogenous androgen level and facilitate its transformation into estrogen by aromatic enzyme in the brain, liver and fat tissues but it found to be highly effective if combined with HRT; we recommend to be used as alternative treatments to relieve menopausal symptoms.

Finally, laser acupoints are effective and can be used as an alternative treatment to decrease the frequency and severity of postmenopausal hot flashes and postmenopausal symptoms especially if combined with Tibolone.

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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.

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Virginia E. Koenig

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.

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Delcio G Silva Junior

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.

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Ziemlé Clément Méda

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.

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Mina Sherif Soliman Georgy

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.

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Layla Shojaie

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.

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Sing-yung Wu

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.

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Orlando Villarreal

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.

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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.

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Anthony Kodzo-Grey Venyo

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.

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Pedro Marques Gomes

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.

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Bernard Terkimbi Utoo

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.

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Prof Sherif W Mansour

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.

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Hao Jiang

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.

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Dr Shiming Tang

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.

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Raed Mualem

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.

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Andreas Filippaios

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.

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Dr Suramya Dhamija

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.

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Bruno Chauffert

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!

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Baheci Selen

"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".

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Jesus Simal-Gandara

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.

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Douglas Miyazaki

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.

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Dr Griffith

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.

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Dr Tong Ming Liu

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.

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Husain Taha Radhi

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.

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S Munshi

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.

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Tania Munoz

“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”.

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George Varvatsoulias

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.

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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.

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Khurram Arshad

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.

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Gomez Barriga Maria Dolores

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.

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Lin Shaw Chin

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.

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Maria Dolores Gomez Barriga

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.

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Dr Maria Dolores Gomez Barriga

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¨.

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Dr Maria Regina Penchyna Nieto

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.

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Dr Marcelo Flavio Gomes Jardim Filho

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!”

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Zsuzsanna Bene

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

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Dr 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.

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Lin-Show Chin

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.

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Sonila Qirko

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.

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Luiz Sellmann