Arrogance of the Rehabilitation Science in the Netherlands

Review Article | DOI: https://doi.org/10.31579/2639-4162/313

Arrogance of the Rehabilitation Science in the Netherlands

  • Jan Van de Rakt 1*
  • Steve McCarthy-Grunwald 2

1Physical Therapist NDT teacher IBITA, Course Leader and teacher on the Dutch Institute for Allied Health Sciences. Nursing Home “Waelwick” in Ewijk the Netherlands.

2MSc BSc RMN Lecturer in Mental Health Nursing with Dementia Specialty. University of Cumbria, Bowerham Road, Lancaster, LA1 3JD England.                                                                   

*Corresponding Author: Jan van de Rakt, Physical Therapist NDT teacher IBITA, Course Leader and teacher on the Dutch Institute for Allied Health Sciences. Nursing Home “Waelwick” in Ewijk the Netherlands.

Citation: Jan Van de Rakt, Steve McCarthy-Grunwald, (2025), Arrogance of the Rehabilitation Science in the Netherlands, J. General Medicine and Clinical Practice, 8(12); DOI:10.31579/2639-4162/313

Copyright: © 2025, Jan Van de Rakt. 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: 17 November 2025 | Accepted: 27 November 2025 | Published: 03 December 2025

Keywords: arrogance; rehabilitation research; bobath/ndt; therapy

Abstract

Background/ Aim: In the Netherlands, a neurorehabilitation programme was established after 2006 that should be as evidence-based as possible. There is nothing wrong with that in itself, but much has not yet been researched and much is best-practice. Instead of seeking cooperation, best- practice was stripped of its roots, or on his best rather put on hold, and a new “approach ‘was created in record time. 

Design: Back in history, until 2006, the knowledge network for stroke patients had been fully rolled out in the Netherlands, and all patients were treated by therapists/nurses according to the same concept. That concept was basically the Bo bath-N.D.T. concept, and perhaps that was where the problem lay. 

Result: A study of questionable quality indicated that this concept had no added value compared to other treatment concepts. But the others also had no added value compared to each other, and the evidence-based approach appeared to remain at the same level. Furthermore, it turned out that the evidence-based research was not so evidence-based, because the study design was not proper and replication was not possible. 

Discussion and Conclusion: It shows a considerable amount of arrogance on the part of Dutch rehabilitation science to completely undermine an existing treatment chain with essentially no evidence. On the other hand, their research was structured differently and focused mainly on the 10% who were treated in their rehabilitation centres. Their priorities apparently did not receive that attention. Now, after almost 20 years, much knowledge and expertise have been lost among the practitioners of the treatment, and the network is much smaller. So, it is high time to get everyone on the same page again and to optimally treat everyone after a stroke, while continuing to test and research that treatment.

Introduction

Around 2005 there is the publication of a thesis (Neurodevelopmental treatment after stroke [1]): a comparative study) which completely changes the treatment performance in the Netherlands. Of course there were other articles of investigation published, but this article was so devastating in the condemnation of the approach that was then dominant in the Netherlands. From the year 1950 in the Netherlands, the “classic” approach was changing to a more “hopeful” approach, as the Brunnstrom [2] and Bobath [3] methods and, at the end, the N.D.T. [4,5,6] (Neuro Developmental Treatment, a “next level” Bobath concept) were done in all situations that involved working with stroke survivors [7,8,9,10,11,12].  That gives the multidisciplinary team a framework in which every member has his task and was trained in the skills to manage the problem that, though the stroke, was developed.  In this team the rehabilitation doctor has a binding role, but the role was less active in the treatment performance. One of the discussion points at the end of the last century was the way people recover from a stroke. Burnnstrom gives us 6 stadia in which the tone increases to a high level with stereotyped movements that were poor and predictable. But in his view, this was replaced by more selectivity in the last stages and gave a full recovery.                                                                 

The reality was totally different and was often dependent on where the stroke took place, how massive it was, etc. The recovery was poor, especially in the areas that had only “one” cortical pathway, such as the arm/hand, and less clear in the foot. Still, many articles/books on the rehabilitation sciences were based on the “positive” effects of this tone increase and plasticity. [13]   Around 2005, in the Netherlands, the discussion was at its highest level about how to treat people after a stroke according to proven interventions and science, investigating how fast recovery takes place and which of the stroke survivors has the best opportunities for a full recovery. That was also an investment for the arm and often accompanied by a new (old) treatment approach, CIMT. (Constrained Induced Movement the ropy [15]) Old [14] was a treatment approach called “force used” that was changed in the new jacket. With this new approach (CIMT) and the most optimal prognosis of recovery, this approach made great progress in the treatment option, but the question was still justified:

 “Was this an approach for all or for a limited group?” 

There was a clear “battle” between the neurorehabilitation science and the workers on the floor, and then especially in the rehabilitation centres, the discussion of how to perform was intense.  Again, no problem; this will only give all people that are involved more power to participate in the treatment of this group of patients and will make the treatment and the education in all areas only better. 

But then there must be respect for all participants.

But then came the thesis [1].

The outcome of this investigation in which 6 hospitals participated.  Three of this hospital were “trained” in the NDT (Bobath) way, and the control group does not have this training at that level. Here is the first problem because the comparison between the hospitals makes a rehearsal of this investigation almost impossible, and that gives the outcome less strength.   This outcome was, that there was no clear surplus value of the N.D.T. (Bobath) concept in comparison with the control group treatment. The treatment of the control group was not clear but contained a hodgepodge of treatments, in which even elements of Bobath were present, often in the form of the Johnstone approach [9, 10].

Thus, the conclusion was no surplus value!!

The way an investigation was formed and executed was poor because no rehearsal was possible, but it wasn’t the only investigation that was done in that way. In fact, almost all investigations that follow, but also the investigation in an early stage, have all a control group that was classified as “usable treatment” and make it thus impossible to rehearse that investigation.                                                                                                   

Certainly, there was an outcry from the science group reaction that the quality of the investigation for the best treatment for stroke survivors was not done in this way, but here we see the first signs of the huge arrogance of the rehabilitation science, because they go on with investing in that way with a control group that wasn’t clear. With so little correct evidence about the concept, there was in the world a reaction of 'waits and see' and, at the same time, an attempt to get better cooperation with all members of the people that were busy with the best possible treatment for stroke survivors in every situation. But in the Netherlands a coup d'état took place in which the coup plotters directly came out of the rehabilitation centres of the Netherlands that have the care of about 10% of all stroke survivors. The next form of extreme arrogance is to know what the best approach was for everyone and at the same time to “kill” an education (NDT-Bobath education for therapists and nurses) and set up a new education, and that with the practice skills from almost all NDT-Bobath teachers in the Netherlands. That this group participated is still a miracle because the whole course was too theoretical to get proper practical treatment for the patients.                                                                                                                                                      

The dramatic effect was that almost immediately:                                                                                                                                        

  1. The education based on skill exercise and learning on stroke survivors was only still present for a select group of therapists, mostly working in rehabilitation centres (only 10% of the stroke survivors will get there) [17]. Education of other participants in this multidisciplinary team was stopped and never reached that level as before. That means that in rehabilitation centres, there was often an intern education and less also in hospitals, but especially in the chronic phase in all his situations, this was no longer present.                                                                   
  2. The knowledge, but especially the skills, was fast gone, especially because so many people that did not directly participate in the care had read the papers and were therefore “convinced” and stopped putting money in that education. One of the dramatic problems was the chronic care and the care for the hemiplegic shoulder that fell back.
  3. The last effect was the isolation that occurred for the leading therapist and special nurses from the international community, and that was a community that has practice and practice skills to be held in high regard, and that source was gone [12].                                                                                                  
  4. Table 1: Directly from the article [1] and thesis by Thora Hafsteindottir, the conclusion is that the NDT (Bobath) approach has no surplus value. Meaning that the comparison between the two groups with two different treatments has no clear differences in the outcome. But the characteristics of the two groups weren’t equal. There were huge differences, and that means that the comparison is difficult but also that the effect by the most severe group is equal on the less severe group, and that gives a conclusion that the treatment by the severe group has more positive effects than the other treatment. Look for yourself and compare it. Again, an arrogance to conclude that therapy doesn’t work.          The belief in an outcome (no surplus value) of one investigation, with no rehearsal, and then so dramatically changing the way of education and treatment and the international isolation at the practice level of the therapist is of an arrogance level that isn’t often seen.

A new approach was started.

An education was started with the cooperation of the practice skills of the “old”-IBITA teachers, in which the rehabilitation only implemented what, in their eyes, was “proven” as therapy. That also has as a consequence that all therapies that haven’t invested were excluded from the course, and that means that only studies done in hospitals and especially [rehabilitation centres]] were allowed in this course, and that makes this course very restricted. Again, most people that were in hospital go directly back to their home, 10% will enter a rehabilitation centre, and the most severe or difficult cases will end in nursing homes or long-stay facilities. The treatment was composed around the new scientific insights, and one of them was “more is better” [18]. Further, the treatment for the arm focused on the investigations around CIMT [15, 19, 20], the walking possibilities extended through huge apparatus, and the focus on the treatment of the hand was robotic. In the CIMT articles there was some criticism to read about the choice that was made of which stroke survivor was implemented and the comparison with other patients that received a conventional treatment [20], an example being that the prescription of the control group isn’t correct after so many years, even in 2022. The stroke survivors that have benefited from the CIMT approach are the people with the best recovery of arm and hand.  And then it is very important to compare on an equal level qua time but also on intensity.  That was immediately the greatest discussion because what is intensity?  In the beginning was this, regrettably, more time!

More time was “equal” to intensity!!!???

This “mantra” was the start of the scientific search for all kinds of treatments in which the skill of the therapist could be replaced by apparatus to create a treatment with a great amount of time.  The hands-on approach with abilities to facilitate the movements with a direct relation to the ADL was replaced by apparatus and/or robotics. Walking, balance training and also hand/arm training was done through commitment to technique and to obtain the more advanced time level.   Of course, there was the discussion about the “transfer” to the ADL, because that was the purpose of the rehabilitation.  The amount of literature that was published about the way of learning was immense, but in the area of motoric learning, it was often forgotten that a treatment isn’t only learning but also training and that it asks for a certain amount of heaviness to get a reaction in all systems that manage the coordination of our movement. Furthermore, there is a scale of problems through a stroke that all ask for different approaches and learning, but motoric learning is dependent on the remaining possibilities and the heaviness of the effort. [21, 22, 23, 24, 25] 

Here it was clear that the mantra “more is better” wasn’t equal with intensity, but regrettable was the arrogance of rehabilitation science that this stayed for years.          

 

                                                                                              Photo 1                                                            Photo 2

Photo 1 en 2: Examples of developments to increase the ability to give stroke survivors more opportunity to train without the presence of a skilled therapist, and mostly this was done additionally.  But the cost for this kind of apparatus was and is so high that only rehabilitation centres have the opportunity to give this treatment part.  That there is evidence that this therapy can be effective is clear [26, 27], but the base (more is better) isn’t correct, and the relation with daily life is difficult for both.  Still, it is clear that an a-functional hand has, certainly, in the chronic stage at this moment, only a change with the development of this robotic hand, but till today this will often work as a brace in the simple ADL actions.

In this period the focus lay on what science had found and found proven and thus suitable for the training. The skills of treatment of all kinds of problems, such as neck, shoulder, hand, wrist, oedema, and hip hypermobility, were quickly lost in the Netherlands because this wasn’t invested in. So, was there often, in the eyes of the “directors”, too little evidence to support old training such as aquatic therapy, and was this a good reason to dismantle the pool? And even good investigations, such as by Tripp [28], were pushed aside, because rehabilitation science hasn’t reacted positively. This period started in the Netherlands around 2007, and in the rest of the world there was discussion, but the cooperation and the respect for each other stayed, and the development of skills and treatment increased, and that was missed in the development of the people on the stroke survivors in all situations.                                                                                         

Around 2016, a reaction of the rehabilitation science top occurred when they set together and created the SRRR (Stroke Recovery Rehabilitation Roundtable) [30, 31] and started with a scientific base initiative to get the investigation on a level that it “means” something and could contribute to a further increase of optimal treatment.

This scientific shift starting in 2006 wasn’t correct.                                                                                                                                                             

“More is better” wasn’t the right way to give an indication about the intensity that is needed to stimulate the damaged brain to create plasticity. [32] It was clear that cortical pathways were much more vulnerable and that plasticity wasn’t possible.  Still the damaged brain asked for a certain heaviness (intensity) with a certain amount of time and rehearsal with a certain frequency. Only what counts for the great muscle pattern that has often much more innervation been different in demands than the fine motoric, etc. This asked for an individual approach and a combination of training and often implicit (differential) learning. [23, 24] Further, it was important to recognise the borders of recovery and see what is necessary to get further improvements, and then there is the research for robotics as a way to improve, especially the arm and hand function.

The second important decision was the call for better and good clinimetric and a fast investigation agreement about the experimental group but especially the control group. Only then was it possible through replication to make the evidence robust; here they develop the Template for Intervention Description and Replication (TIDieR) Checklist and Guide. [33, 34, 35, 36, 37] That means that all guidelines are, at this moment, not TIDIER-proof and that calls for a effort of the rehabilitation sciences to get that done. [38] The start was in 2006 with the total elimination of an approach in the Netherlands that was hands-on direct with the patient and in relation with the ADL to restore as much as possible the possibilities of a stroke survivor with such good control over the abnormal tone and synergies.  This elimination has led to more tone dis-control and dis-comfort, as we see in the increase of treatment with medicines and injection with BOTOX and/or operation.  But give a good reason to keep alert on the tone because there is growing evidence that a tone out of control makes movement only difficult and thus independence far away. Good investigation about this topic is still poor and often not TIDIER-proof. [38, 39, 40, 41]

In the first 10 years after the “coup”, there was a treatment proposal on scientific “grounds” that pushed in the Netherlands the rehabilitation in a direction where only evidence was the base of a good treatment and led a lot of stroke survivors to “stand in the cold”. All that hasn’t, had scientific support was considered “wrong” and could harm the patient.  After 2016 there were some changes because the evidence wasn’t there, and in the world, there was such a great amount of research that it was necessary to make that “evidence” robust. The template TIDIER should certainly take care for more robust evidence, but not everywhere is this used, and till today so many investigators still use the nomenclature for the control group with “usual care”, conventional care, etc., and often it is a combination of all kinds of therapy approaches that have developed during the last two centuries. Don’t forget that the therapist and others in all kinds of care institutes were working with stroke survivors long before rehabilitation science noticed that this group needed rehabilitation. World War Two was a start for the soldiers, but in the Netherlands in the 80s of the last centuries, there was room for stroke survivors (10%) in rehabilitation centres. Thus, more robust evidence is now the mission for rehabilitation science, and this must be for all stroke survivors from hospitals, rehabilitation centres, and nursing homes, as in the home situation, and from the onset to the end.  With an open mind for all facets, then we will find what treatment can be effective and can be the best for each individual after a stroke.

Photo 3: This photo has been taken during one of the meetings of the International Stroke Recovery and Rehabilitation Alliance as they have developed the SRRR (Stroke Recovery Rehabilitation Roundtable).

Photo 4: These are the people that participated in the annual meeting of the IBITA (International Bobath Instructors Training Association) members across the world to meet each other and practice and learned.  The discussion how to train people after a stroke is the main issue and here always scientist out the group on photo 3 are invited to discuss further improvement of the treatments.

Both groups can help to develop the treatment, not all elements, and not the focus on some elements and neglecting others, only because there are no scientific investigations that give ajustification.  Mostly no investigation is done and regrettably others don’t meet the TIDIER standard.  

Thus look Fysio wards today and what we miss on that floor.

                                                          Photo 5                                                                                                               Photo 6        

Photo 5 and 6: The accommodation to train (not relearn) walking capacity and then is it obvious where the focus lie on. A great scala of systems that make walking save and easier in an environment that is make for training of that element.           

The “transfer” to real world will an whole other story and the focus on only one element give this training less variation. And often the training- rules where not obtained with the consequences that the coordination and the power don’t increase.People that believe that patient “re-learning” the walking possibilities, don’t think of the fact that though the brain damage, a lot of coordination and power is lost, and this asks for a training that gives muscle fatigue to restore that. The other element of plasticity and restoring of the selectivity will only be obtained when this is possible through training.  Thus, not learning stand by restoring of body function primary, but training. Walking is a part, but other elements are maybe more important, because this can have a positive influence on the independency at home and the quality of life. Thus, it is important that treatment on all aspects is done, and that will give a great 

variation of movements and need great skills of therapists. Therefore, all kinds of activities in the Physio ward, but also on the ward in clinic, but certainly at home, focus on all elements that can contribute to a higher level.

The collection of photos on the next page will give a picture of what people after a stroke need to recover optimally, and the key factor is the skilled therapist that knows how to hold the mobility at the highest level and continues to search for movements that have a purpose to make daily life easier. 

Photos 7, 8, 9 and 10: Treatment and tone inhibition of the shoulder/shoulder blade to maintain optimal movement with as little risk of pain and limitations as possible. This is essential for all joints, including the foot, and requires skills that take a lot of practice.            

                                                                                                  

                                Photo 10: Integration of standing up and standing at the kitchen counter while cooking and making coffee.                                    

                                                                         Photo 11                                                                                             Photo 12            

Photos 11 and 12: Balance training with lots of variation, in which it remains important to explore the limits together in order to practise perception of the body schema, but also to practise the muscle patterns that must “guard” these limits [43]. This training requires that the training be performed with sufficient repetition of 75% of 1 R.M. [42] so that muscle fatigue [19] occurs, which is the stimulus to improve coordination and power.

                                                                     

                                                                                  Photo 12                                                                  Photo 13 

Photos 12 and 13: Balance training in a seated and standing position, again searching for the optimal limits and trying to maintain them. Standing on one leg, but again requiring sufficient power on the affected side so that the pelvis reaches and maintains an optimal position and can be trained according to the training rules.

                                                                                             Photo 14                                                      Photo 15

Photos 14 and 15: Descending stairs in two different ways.  Photo 15 shows the added value of a trained therapist in providing optimal training in descending stairs, and again it is possible to continue training according to the training rules.

The arrogance that only treatments that have been researched have added value ignores the fact that recovery depends primarily on how badly the brain is damaged and what is still possible. It is clear that these damaged brains must use systems [2,44] to enable some movement, but at what cost? It is clear that pathological tone in particular will eventually cause problems that can significantly affect quality of life. And this often happens when most patients are no longer in the “view” of rehabilitation science and are in a chronic phase, struggling to maintain their level of functioning. The decline is often too great. [46].

Photo 16: Is this incorrect, or is it a brilliant variation to influence walking in such a way that more weight is placed on the affected side? Walking, already one of the most practised and machine-trained ways of moving, requires adaptation to one's own situation. Walking with a four-legged stick requires a considerable amount of space and balance; technically, there is a lot of emphasis on the unaffected side, so this variation immediately increases the load, causing muscle fatigue that stimulates the system to improve coordination and power. This is an excellent example of how a trained therapist is able to create a safe situation in which balance and walking can be taken to a higher level. The damaged brain can benefit from this, which is not the case with a failure of the corticospinal tract to the hand, which makes selectivity much more difficult and often very limited.

                                                                

                                                                                 Photo 17                                                             Photo 18

Photos 17 and 18: Training movements in a lying position: direct training for the movements in and out of bed that are fundamental to independence.  [46,47]

Research by rehabilitation specialists in the field of training aimed at restoring independence in and out of bed is marginal, as is proper research by Dutch rehabilitation scientists into the effect of training in water on independence.

                                                                                          

Photo 19: Practising in water has been shown in literature to have an effect not only on pathological tone, reducing it and increasing the ability to move, but also, due to this increased movement and reduced tone, on selectivity.                                                                             

It also appears to have a very positive effect on perception. [48,49,50,51] The counterpart, hanging in a device that reduces weight, on the other hand, appears to be a favourite research topic in rehabilitation [52], but no one talks about its limitations.Because walking, balance and standing up are all well and good, but that's where it ends, whereas in water, all the movements needed to function independently at home are possible and, thanks to the resistance, there is always an optimal situation for training according to the training rules.                         

To top it all off, it also makes it possible to provide extra ADL training, which is such an essential part of independence.
                                                                                                                 

Conclusion

The conclusion can only be that the arrogance of rehabilitation science has led to the loss of a fantastic network for stroke patients and, not only that, but also a great deal of knowledge and expertise among those implementing the optimal approach identified by science.  And it is precisely this new scientifically based approach that appears to be unsustainable due to poor and often one-sided research, as a result of which there is still no clarity about what works and what does not. 

It would be to the credit of science, if they took a closer look at the workplace and provided their support there, so that stroke patients everywhere receive optimal support and the practitioners who do the work receive optimal support, instead of placing their ideas at the top of the guidelines in a dominant and one-sided manner. 

References

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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

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.

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Zhao Jia

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."

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Thomas Urban

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.

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Cristina Berriozabal

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.

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Dr Tewodros Kassahun Tarekegn

"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".

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Dr Shweta Tiwari

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.

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Dr Farooq Wandroo

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.

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Dr Anyuta Ivanova

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.

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Dr David Vinyes

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.

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Gertraud Teuchert-Noodt

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

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Dr 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.

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Dr Oleg Golyanovski

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.

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Dr Susan Anne Smith

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.

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Dr 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.

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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.

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Dr Susan Anne Smith

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

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Dr Eric S Nussbaum

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.

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Hala Al Shaikh

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.

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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.

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Dr 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.

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Dr Jelle 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

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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.

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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.

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Dr Aline Tollet

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.

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Dr Chiara Giuseppina Beccaluva

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

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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.

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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.

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Edouard Kujawski

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

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Dr Andriy Sinelnyk

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.

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Dr Meng-JouLe

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

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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.

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Dr 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

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Christoph Maurer

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.

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Baciulescu Laura

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.

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Dr Mamoun Magzoub