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Research Article | DOI: https://doi.org/10.31579/2578-8868/391
Neurophysiology Department, Ysbyty Gwynedd Hospital, Bangor, North Wales.
*Corresponding Author: Salim Hirani, Neurophysiology Department, Ysbyty Gwynedd Hospital, Bangor, North Wales.
Citation: Salim Hirani, (2025), Comparison Between Uniportal and Biportal Endoscopic Techniques in Spine Surgeries, J. Neuroscience and Neurological Surgery, 18(2); DOI:10.31579/2578-8868/391
Copyright: © 2025, Salim Hirani. 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: 07 November 2025 | Accepted: 21 November 2025 | Published: 10 December 2025
Keywords: grading tools for carpal tunnel syndrome ; cts gradings ; neurophysiological cts grading
Background:The severity of carpal tunnel syndrome (CTS) may be categorised in a number of ways, utilising one of a range of presently available grading tools. The grading systems proposed by Bland and Padua are the most commonly used, however, both have limitations, which are discussed in detail in this paper. The aim of this research is to establish, using the best available evidence, a clinically appropriate revision of the current CTS nerve conduction grading tool, and to compare with existing grading tools used in UK Neurophysiology clinics. The revised scale is designed from a clinical physiologist perspective and based on the numerical values of nerve conduction findings. The proposed revised grading system is based on more nuanced, descriptive categories, ranging from Normal to Early, Mild Sensory, Mild Sensory Motor, Moderate Sensory, Moderate Sensory Motor, Severe Sensory Motor, Extremely Severe Sensory Motor, and Complete absence.Method: A total of 1123 patients (2246 hands) were included in this study, with the aim of evaluating the revised grading system. Data were collected based on the extensive and detailed grading systems previously described by Bland and Padua. All data were recorded numerically to ensure methodological reliability. Result:Of the 2246 patients’ hands tested, the nerve conduction was graded as normal in 968 hands; nerve conduction showed early changes in 271 hands; mild sensory changes in 215 hands, mild changes in both motor and sensory response in 51 hands; moderate sensory changes in 134 hands; moderate sensory and motor changes in 356 hands; severe changes in motor and sensory responses in 204 hands; extremely severe sensory and motor changes in 33 hands and complete absence of response in 14 hands. Conclusion: The revised grading tool could offer a more numerical grading to the Clinical Physiologist and could help the surgeon to ascertain the level of severity in order to decide on either a conservative or surgical approach to treatment if they decide to use the proposed grading which could support them to defend their decision in cases of litigation.
The pathology of Carpal Tunnel Syndrome (CTS) is described as “A Neuropathy caused by entrapment of the median nerve at the level of the carpal tunnel” ², ³. Nerve Conduction Studies (NCS) are one of the basic tools used to support clinical diagnosis. NCS are objective tests that assess the physiological status of the median nerve across the carpal tunnel7.
Reason for Grading Carpal Tunnel Syndrome:
The Grading tool is used for the diagnostic assessment of CTS in conjunction with the patient’s clinical history and symptoms in order to diagnose the degree of severity of CTS3. The revised grading tool using a physiological basis offers a more precise numerical grading, which is both objective and repeatable. This could not only help the Clinical Physiologist to grade their result according to the proposal grading scale, but probably it also supports the surgeon to ascertain the level of severity and could help to decide on either a conservative or surgical approach to treatment.
There are several primary grading tests mentioned in the different literature, associated with Phalen’s, Tinel’s and Durkan’s signs, which are subjective and are based on patient clinical response. Other tests like Ultrasound, NCS and EMG needle examination are objective tests that have been used for CTS grading which are reliable, evidence-based and objective, not dependent on patient clinical response2.
However, to ascertain the severity level of CTS, specific neurophysiological grading is required12. There are several grading scales for investigations specifically related to CTS; [Campbell5, Padua12, Bland4, Giannini7, Carvalho6, Ajeena2, Jeong9 and Jerosh-Herold10]. Most of the studies show grading in subjectivity. Some lack a neurophysiological focus in objectivity6 during the collection of the data. Some researches only use either Sensory Nerve Conduction Study (NCS) or Motor NCS to differentiate the severity of CTS grading. Not all researchers have used sensitive techniques to diagnose early CTS or in severe cases, Lumbricals responses to differentiate its severity from complete absence, which therefore cannot be diagnosed as CTS with complete certainty.
It appears that whilst there is an accepted dominance of both the Bland4 and Padua12 grading systems, there are also clear limitations which are discussed comprehensively in this paper.
In the UK, the Bland4 grading is largely followed due to its depth of detail. In 2014 the Association of Neurophysiological Science (ANS), in collaboration with the British Society for Clinical Neurophysiology (BSCN) published guidelines outlining the accepted grading of CTS in the United Kingdom, which follows the Bland4 grading system. The reason given was that it focuses on the clinical physiologist specialism, as well as its element of flexibility.
The aim of this research was to establish evidence-based revision of the current CTS nerve conduction Grading Tool used in the UK and to evaluate its effectiveness in terms of acceptability and usability for Clinical Physiologist. It also provided a tool for intervention prediction for the Surgeon. This could support the Surgeon to ascertain the level of severity and decide on a conservative or surgical approach to treatment. Although surgeons must take their own decision for the treatment of CTS, if they want to consider the treatment on the basis of the proposed Nerve conduction study grading, this will probably allow defending their decisions in the Magistrate Court. A numerical value is given to each of the grade bandings to enable objective reporting and comparision.12
No clinical assessment was conducted during the Neurophysiological test so as to secure the biasness from patient’s condition.
Ethical approval for the research project was obtained from the Health Research Authority National Research Ethics Service London – Queen Square Research Ethics Committee (Reference 17/LO/0750).
Neurophysiological data were collected based on the extensive and complete description of previous study designs by Padua12 and Bland4, and which is understood to be followed by most of the clinical laboratories in the United Kingdom. In addition, Second Lumbrical-Interosseous Latency was also recorded to distinguish between ‘very severe’ and ‘complete absent’ response grading of CTS11.
The Association of Neurophysiological Scientists (ANS) (2014) guidelines and the minimum standards for the practice of Clinical Neurophysiology in the United Kingdom were followed. Few new grading was introduced during collection of the data to cover the full range of grading.
The test was performed by a qualified Clinical Physiologist (Neurophysiology) using Keypoint 9033A07 (Skovlunde, Denmark) machine, on the bases of departmental protocol (Peripheral protocol1, 2015). A quantitative method was used for collecting data1, to ensure accuracy and to avoid bias. The sample size of patients in the study was use for all those tested for NCS over a period of one calendar year (2017), across the population of North Wales. The data were collected from patients with an age range above 18 years, who were referred to the Neurophysiology department from the Orthopaedics and Neurology departments within the local Health Board, as well as General Practices (GPs) in North Wales. No individual patient was recruited in this research. The inclusion criteria were considered only on the basis of the referral diagnosis. No clinical assessment was conducted prior to the study in the department. Referral of CTS was considered based on paraesthesia, pain, swelling in median distribution area or digits I-V, worsened by sleep. The test was carried out by testing both hands (symptomatic and asymptomatic) to fulfil department protocol.
Data were analysed on certain widely accepted assumptions of sensory amplitude and CV and distal motor latency (DML), amplitude and CV3, 4. To introduce the terms “mild”, “moderate” and “severe”, a numerical value was used which could be accepted widely, and which can be used to compare with others studies12.
The procedure started by carrying out the sensory testing, by placing the stimulating ring electrodes on digit III (which is more sensitive than digit II4) and the recording electrode on the surface of the median nerve on the wrist. The orthodromic technique was used for the sensory and motor NCS test, through the median and ulnar nerves. A maximal current was applied to record the full response of the nerve, at the digits II-IV for median sensory and digit V for ulnar sensory recording. A maximal current was applied to stimulate median nerve pathways at the wrist and at the elbow for motor recording from abductor pollicis brevis (APB)1 and ulnar nerve pathways from First dorsal interosseous (FDI). Digit II was stimulated only when either the response from digit III was less than 3µV or absent; digit IV was stimulated only when the response from digit III showed conduction velocity between 45-50m/sec. Amplitude was recorded from peak to peak for sensory responses, and base to peak for motor responses. If responses were not recordable from median sensory digit II, III, and motor from APB muscles, then motor responses were elicited by placing recording electrodes on 2nd lumbricals by stimulating median and ulnar nerves at the wrist1,6,11,13.
All patient data was collected by fulfilling the criteria mentioned in above paragraph depending on the severity. The reason for using the new criteria is to describe the full range of severity, which was not fully covered by other research mentioned earlier in this paper. Criteria were mentioned in above paragraph are intended to be more reliable in terms of grading for Clinical Physiologist and probably will allow support to the Surgeon in terms of patient treatment decisions.
The grades are:
Normal (Grade 0): where sensory conduction velocity (SCV) is above 50 m/s and amplitude ≥5 µV with DML ≤4.2 ms, amplitude ≥5mV and motor conduction velocity (MCV) ≥50 m/s.
Early (Grade 1): where SCV is between 45-50 m/s from digit III and double peak latency in digit IV is >0.5ms with DML ≤4.2ms and normal sensory and motor amplitude >5 (sensory in µV and motor in mV).
Mild Sensory (Grade 2): where SCV is between 40-44.9 m/s from digits III with normal sensory amplitude and motor values mentioned in Grade 0.
Mild Sensory-Motor (Grade 3): where SCV is between 40-44.9 m/s from digits III with normal sensory amplitude mentioned in Grade 0, DML ≥4.2ms with normal motor amplitude and CV.
Moderate Sensory (Grade 4): where SCV is less than 40 m/s from digits III with normal sensory amplitude and normal motor values mentioned in Grade 0.
Moderate Sensory-Motor (Grade 5): where SCV is less than 40 m/s from digits III with normal sensory amplitude, DML ≥4.2ms with normal motor amplitude and CV.
Severe Sensory-Motor (Grade 6): where sensory potentials from digits III and digit II are absent or <3>
Extremely Severe Sensory-Motor (Grade 7): where sensory and motor potentials are absent and response recordable only from 2nd lumbricals, where median lumbricals are prolonged compared and low amplitude to ulnar lumbricals.
Complete (Grade 8): where both sensory and motor potentials are absent and responses are not recordable from median 2nd lumbricals but recordable from ulnar 2nd lumbricals. (Please refer to a Comparison of the Bland4 grading with the proposed revised grading is given at the end of this study for more understanding).
The data was collected for a period of one year (2017). Initially a total of 1132 patients were included in this study. During data collection, two referrals were not included, because the patients declined to participate in all study procedures; and seven participants’ data sets were excluded from the analysis because the departmental protocol was breached. Therefore, 1123 patients (2246 hands) were included in the final data collection.
Of the 1123 patients, 687 were female and 436 were male. The age range was 19 to 98 years, median age 56 years. The numbers of hands in each grade of severity are shown in Figure 1 and Table 1.
The Bland4 grading system, which was collected for Canterbury region, enables the neurophysiologist to differentiate between the levels of severity for the Clinical Physiologist point of view12. However, due to the limited numerical grading, it is felt that the Bland4 grading does not enable the level of severity to be objectively and fully ascertained as possible to cover all level of grading of CTS.
Bland4 recorded that prolongation of the motor terminal latency to APB is not significant in mild cases, which the author partially agrees with, as it appears insignificant in the graph (Please refer to the graph) compared to mild sensory CTS. It was noted that neither Bland4 nor Padua12 separate between mild sensory and mild sensory-motor in their grading. This clearly indicates that there is a need for some revision and a separate grading in mild CTS. However, when compared to moderate sensory-motor CTS with moderate sensory CTS, moderate sensory-motor CTS has significantly higher patient numbers than the moderate sensory. This indicates that there is room for revision and a separate grading in moderate CTS. (Please refer to percentage table)
In theory, the higher the grade, the worse nerve dysfunction4. The analysis of the data, however, in this study appears to show mixed levels of severity. A majority of CTS studies in this investigation appear normal, due to the fact that non-symptomatic hands were also recorded to fulfil department protocol. Although, normal (Grade 0) has much higher numbers compared to other grades. This does not detract from the fact that levels of severity for CTS were found. In this study, comparison of the grading scales shows that there are big differences in the mild sensory-motor groups between Bland’s4 and this proposed grading. 11% in Bland’s4 mild sensory-motor category with 10% mild sensory and only 2% mild mixed sensory motor in propose grading, which might suggest that the separation is marked, although the separation has value in demonstrating the effects in the motor fascicles and this may have an impact in choosing treatment option. However, at the moderate degree of severity, there is a notable difference with 16% in Bland’s4 moderate category and 6% moderate sensory and 16% moderate mixed sensory motor, suggestive that these are 2 groups worth separating.
The table 3 summarises and compares the variance in Bland4 and Padua12 Gradings with the revised grading system.
Padua12 relates the outcome of grading with surgical decompression compared to Bland’s4 grading which is based purely on neurophysiological concepts. Bland’s4 grading scale was based on a very large population. However, in a ‘severe’ grading, the values were not clear. Bland4 has given the amplitude for the motor response, but has not taken into account the DML and CV, and for ‘extremely severe’ grading the values was not clear either. At ‘extremely severe’ grading, although the amplitude in the motor CMAP has been taken into account, no account has been taken of distal latency and CV4.
Comparing, the Bland4 grading system of CTS with the grading suggested in this paper, it seems that Bland4 Grade 0 and 1 are comparable with the propose grading. The author would suggest that the Bland4 grading for Grade 2 needs to become more elaborate by dividing them into two separate groups, i.e. mild sensory and mild sensory-motor, as more patient’s data shows just mild sensory changes compared with mild sensory and motor together. In the revised grading the sensory involvement is graded as Grade 2 and the sensory and motor where both functions are involved is graded as Grade 3.
Bland4 covers a moderate degree of severity in grade 3, which again warrants further elaboration to make the gradings more objective and more descriptive. In propose revised system grade 4 covers sensory involvement and grade 5 covers both sensory and motor involvement together.
Bland’s4 Grade 4 which is a severe CTS compares favourably with Grade 6 of the revised grading system.
Bland4 only describes a prolonged DML in his Grade 5 as ‘very severe’ CTS which the author believes do not fulfil all the criteria to separate from his Grade 6. Bland4 appears not to have taken any account changes in sensory potentials or motor conduction velocity values. The revised grading system has graded ‘Very Severe’ CTS where both sensory and motor responses are absent, and responses were only recordable from the 2nd lumbrical with prolonged median distal latency compared to ulnar lumbricals as Grade 7.
The Grade 6 in Bland4 again has the potential to create confusion as it refers to a low amplitude motor potential. It appears not to have taken into account the DML in Grade 6. CV was also not included in the Grade 6 grouping in the Bland4 grading. The author has considered the latency and amplitude with CV and graded as complete median nerve dysfunctions where both median motor and sensory as well as median 2nd lumbrical responses are absent, and the only response appears in the ulnar 2nd lumbrical. This grade appears as grade 8 in the revised grading system.
Table 2 summarises and compares the Bland4 Gradings with the revised grading system
The grading system devised by Bland4 and used to grade the levels of severity of CTS over the last 17 years within the UK has certain limitations, and the author believes system needs modification in order to accommodate current practice. The revised grading system for CTS is based on a review of a current and past literature.
Bland4 and Padua12 both limited the DML and CV in motor study and amplitude potentials and CV for sensory study. Author follows the same rule and precedes the study with given cut off values to grade them accordingly. Most of the Clinical laboratories in UK use the above criteria of cut off values for sensory and motor study to create their own normative values. Presently, there is no standard of CTS grading followed throughout the UK due to their limitations, the propose grading scale, preferably was felt to be an acceptable and useable tool for Clinical Physiologist and could use for intervention allocation.
The revised grading tool using a physiological basis offers a more precise numerical grading, which is both objective and repeatable. This could not only help the Clinical Physiologist to grade there result according to the propose grading scale but probably it also support the surgeon to ascertain the level of severity and could help to decide on either a conservative or surgical approach to treatment. Please note that this research was made to amend the grading for Clinical Physiologist. Although surgeons have to take their own decision for the treatment of CTS, but if they want to consider the treatment on the basis of the proposed nerve conduction study grading, this will probably aid defence of their decisions for the court. This is advisable (but not necessary to follow) that Surgeons could consider proposed Grade 1-2 for physiotherapy treatment, Grade 3-4 for conservative or intervention of steroid treatment and Grade 5-7 for surgical intervention where the chances of full recovery. Surgeon could decide for surgical intervention of Grade 8 cases, whether it would be beneficial or not in keeping with the patient’s age and other medical history.
Future studies looking at prognosis may be helpful in looking at the outcomes from different interventions for those with different gradings of severity and to look at the implications of motor involvement compared with just sensory fascicle involvement. Collections of data are under process for post-surgery CTS outcome which will publish later after approval from BCUHB research committee.
Abbreviations:
Carpal tunnel syndrome -CTS, Nerve Conduction Studies -NCS, Betsi Cadwaladr University Health Board -BCUHB, General Practices -GPs, Association of Neurophysiological Scientists - ANS, abductor polices braves - APB, sensory conduction velocity - SCV, conduction velocity -CV, British Society for Clinical Neurophysiology - BSCN, Distal Motor Latency - DML, normal sensory amplitude - NSA, Sensory nerve action potentials -SNAP, normal motor amplitude - NMA, Motor nerve action potentials -MNAP, motor conduction velocity – MCV
Declaration:
Ethics Approval: We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Ethical approval for the research project was obtained from the Heath Research Authority National Research Ethics Service London – Queen Square Research Ethics Committee (Reference 17/LO/0750).
Written Consent from participants:
A written consent was obtained from all participants and filed in patient notes and a copy kept in the department.
Consent for Publication:
Not Applicable
Availability of data and materials:
The datasets analyzed during the current study are not publicly available as they are held within patient records but are available from the corresponding author on request.
Competing Interests:
The authors declare that they have no competing interests.
Funding:
Betsi Cadwaladr University Health Board (BCUHB) funded this study for publication. Awarded Number: 1770146124202136. The role of the funding body is to support financially in publication this research paper. The Author contributed by the collection, analysis and interpretation of data and in writing the manuscript.
Acknowledgements:
The author would like to acknowledge and thank Mrs.Julie Evans, Dr Gareth Payne, and Dr. Bashir Kassam for their encouragement, guidance and help with this study.
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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
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
