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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case report
Full Version
Successful Management of Metastatic Lymph Nodes in the Chest by Laser Ablation via Endoscopic Ultrasound: A Case Report
Correspondence Address :
Dr. Rusy Bhalla,
Criticare Asia Hospital, Kurla (West), Mumbai-400070, Maharashtra, India.
E-mail: rusybhalla@gmail.com
Isolated spread of metastatic breast carcinoma to mediastinal lymph nodes is not an uncommon phenomenon. The prognosis worsens with the advent of any metastases in the chest. Conventional treatment mandates chemotherapy or radiotherapy as a control measures. Laser treatment has helped many patients with inaccessible or inoperable tumours, as it works on devascularisation and can benefit both benign and malignant tumours. This is a case report of a patient who did not respond to Trastuzumab and T-DM1 (Trastuzumab with Emtansine). She developed mediastinal lymph nodes during treatment with TDM1. Additionally, she had a documented change in hormonal status from Human Epidermal growth factor Receptor-2 (HER2) positive to negative. She underwent laser ablation of mediastinal lymph nodes around the trachea. A Positron Emission Tomography (PET) scan after six months showed a total resolution of the lymph nodes with no significant uptake in the chest or any other part of the body. Laser ablation of mediastinal lymph nodes is a very skillful and demanding procedure that can be attempted in refractory and isolated cases where chemotherapy and radiation have failed. Further studies are needed to assess the long-term results of this new procedure.
Interventional endoscopic ultrasound, Mediastinal lymph nodes, Trastuzumab
A 65-year-old lady presented with a history of left-sided infiltrating duct carcinoma of the breast, which had been present for four months. She subsequently underwent mastectomy surgery. Her hormonal status was Estrogen/Progesterone (ER/PR) negative and HER2 positive. She received chemotherapy (paclitaxel) for three months and Trastuzumab for a period of one year. Additionally, she received 60 Gy of radiation to the surgical area following the standard radiotherapy protocol. After one year, she experienced a relapse in the neck nodes. These lymph nodes were treated with a diode laser using a 400 μm laser fiber. The fiber was inserted via an 18G needle.
The patient was administered T-DM1 or Trastuzumab with Emtansine for a period of one year as per the EMILIA trial protocol. PET scans were done twice within the year, and regular Magnetic Resonance Imaging (MRI) scans were conducted at two-month intervals. She did not show any relapse in the neck nodes, but after 14 months, suspicious lymph nodes were found in the mediastinum (Table/Fig 1). Endoscopic Bronchial Ultrasound (EBUS) confirmed the presence of precarinal and paratracheal lymph nodes (Table/Fig 2), ranging in size from 1 cm to 2.8 cm. The largest node measured 2.8 cm in the precarinal region. A biopsy using a 22G bronchoscopy needle was performed during the same session, confirming the presence of metastatic cells from breast carcinoma in the precarinal lymph node (Table/Fig 3). There was a change in hormonal status, as the lymph node metastases were found to be HER2 negative. A decision was made to ablate the lymph nodes using laser treatment after discussion with the patient and the gastroenterology department, which had expertise in Endoscopic Ultrasound (EUS) (Table/Fig 4). The procedure was performed under general anaesthesia with the Olympus EUS system. The procedure went smoothly, and no bleeding in the mediastinum or oesophagus was observed.
The patient was observed for any bleeding, pneumomediastinum, or mediastinitis for a week, but she did not develop any such complications. After discharge, she received six cycles of the DCF (Docetaxel, Cisplatin, and 5-fluorouracil) protocol at three-week intervals for three months, which she tolerated well. A repeat PET scan after six months showed complete resolution of all previously enlarged lymph nodes with no uptake (Table/Fig 5),(Table/Fig 6). Additionally, she gained two kg during the same period.
Breast cancer is increasingly becoming a common cancer in developing countries, accounting for approximately 25% of all cancer cases in females (1). The incidence of breast cancer in India varies from 25 to 40 per 100,000 females (1). Breast cancer typically develops slowly and can eventually metastasize to various parts of the body, including the mediastinum, over time. When mediastinal lymph nodes with or without lung involvement are detected on a PET scan, the first step in their management is to obtain a biopsy. This is crucial because hormonal treatments like Trastuzumab, commonly used in breast cancer treatment, can create lesions that resemble sarcoidosis on Computed Tomography (CT) scans (2). In the past, biopsies were performed using methods such as median sternotomy or CT scan guidance, but more recently, EBUS (endobronchial ultrasound) or endoscopic bronchoscopic ultrasound have been utilised (3),(4),(5),(6).
EUS is a viable approach for studying and biopsying mediastinal lymph nodes for diagnosis and staging (7),(8),(9). Since this case involves stage 4 disease, aggressive treatment should be avoided, and conventional options such as radiotherapy or stereotactic radiotherapy combined with chemotherapy are recommended. Laser ablation of lymph nodes is an established procedure for managing lymph nodes in ultrasound-accessible areas (10),(11),(12). Laser ablation has been successfully performed in the abdominal and retroperitoneal regions. Endoscopic ultrasound is a technique that allows for traversing the mediastinal area, and gastroenterologists, who are familiar with this area, employ EUS for lymph node biopsy (7),(13),(14). In this particular case, a combination of these two procedures was performed.
Transbronchial laser ablation has been reported in the literature for the treatment of both benign and malignant tumours. The principles of laser ablation are similar in any clinical setting, as it disrupts the blood supply of the lymph node, leading to necrosis of the node and any malignant cells within it. The processes involved in laser ablation include devascularisation of afferent vessels, coagulative necrosis, thermal damage to cells, and retrograde thrombosis (10),(14). Studies have consistently reported favourable responses, with necrosis of lymph nodes ranging from 60-100%. The size of the lymph nodes is an important factor, as lymph nodes larger than 3 cm may have extracapsular extensions and are more likely to have residual disease due to extranodal blood supply. Complications of the procedure can include injury to major blood vessels and surrounding vital structures (10),(12),(14).
Other ablative methods, such as radiofrequency and microwave, have been suggested for the treatment of central airway obstruction with minimal postoperative complications. Complications tend to be more pronounced in transthoracic ablative techniques under CT scan control (15),(16). Despite an extensive literature search over the past eight years, no mention of EUS or EBUS laser ablation of mediastinal lymph nodes was found. Discussions with various chest and gastroenterology departments in hospitals also revealed that they had no knowledge of this procedure. Therefore, this may be the first reported case of this procedure in the world. It is worth noting that the observed response in this case may also be attributed to post procedure chemotherapy. To validate the efficacy of this procedure for isolated malignant mediastinal lymph nodes, further studies need to be conducted.
This case is being reported for novel reasons. Laser ablation of lymph nodes in the mediastinum is considered safe and can be performed in centres with sufficient experience and skill sets in both laser ablation and EUS. Laser ablation may serve as an alternative to radiation therapy for lymph node metastases in the thorax. It also offers the advantage of being repeatable in cases of relapse. However, further studies are necessary to provide detailed information on factors such as lymph node position, size, energy levels, and duration of laser ablation in order to draw valid conclusions on this subject.
DOI: 10.7860/JCDR/2024/67665.18922
Date of Submission: Sep 23, 2023
Date of Peer Review: Oct 30, 2023
Date of Acceptance: Nov 18, 2023
Date of Publishing: Jan 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 25, 2023
• Manual Googling: Nov 02, 2023
• iThenticate Software: Nov 15, 2023 (4%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
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- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com