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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
Original article / research
Full Version
Tortuous Vertebral Arteries-Incidence and Clinical Implications
Correspondence Address :
Dr Poonam, Assistant Professor (Anatomy),
Department of Anatomy, Jhalawar Medical College,
Jhalawar, Rajasthan, India-326001
Mob: 09602512911, 09799333445
E-mail: drpoonamdel@yahoo.co.in
Aim: The present study was aimed at investigating the incidence of the tortuosity of the vertebral artery in adult cadavers in order to offer useful data to anatomists, radiologists, endovascular interventionalists and surgeons. In addition, the literature was reviewed so as to enable a comparison of our results with those of previous studies and an analysis of the clinical implications which are related to these variations.
Methods: Seventy cadavers were dissected to study the pathway which was carried by the prevertebral segment of 140 vertebral arteries.
Result: A total of 31 vertebral arteries (22.1%) were showing the tortuous pathway in 25 cadavers (bilateral in six and unilateral in 19 cadavers single coil tortuosity in 26 and double coil in five vertebral arteries).
Conclusions: The described variations in the pathway of the V1 segment of the vertebral artery have clinical implications in a wide field of pathologies in that region. Careful preoperative planning is essential in cases with tortuous vertebral arteries to avoid potentially life threatening complications.
Prevertebral segment, Arterial tortuosity, Scalenovertebral trigone
The vertebral artery (VA), after taking its origin from the 1st part of the subclavian artery, runs straight upwards in a scalenovertebral trigone and usually reaches the transverse foramen of the C6 vertebra, which is also known as the prevertebral (V1) segment. Between its origin and its entrance into the transverse foramen, the segment of the vertebral artery may show some tortuosity which can take a variety of forms and occupy several orientations (1).
Before undertaking any surgeries in the cervical region, the knowledge of the variant pathway of the V1 segment is mandatory to avoid a potentially catastrophic injury to the vertebral artery (2) and to take decisions on the appropriate corrective surgery options (3).
Dissection was carried out in 70 formalin fixed cadavers (sixty two males and eight females) who were aged between 35-80 years, in the scalenovertebral region (between the scalenus anterior and the longus colli) on both the sides, so a total of 140 vertebral arteries were exposed. The path which was taken by the prevertebral segment of the vertebral artery was studied in detail. Any form of tortuosity, either having a single coil or a double coil, was noted. The plane of the tortuous vertebral arteries along with the direction of the convexity with respect to its plane was examined.
Thirty one (22.1%) vertebral arteries showed the tortuous pathway (Table/Fig 1), (Table/Fig 2), and (Table/Fig 3)). Bilateral tortuosity was encountered in six cadavers and unilateral tortuosity in 19 (13 on the left and six on the right). Twenty six (18.6%) vertebral arteries had a single coil tortuosity, while in the rest (3.5%), a double coil was encountered. The maximum number of single coil tortuositieswere observed in the transverse plane (medial convexity in 15 cadavers and lateral convexity in four), followed by tortuosity in the sagittal plane (ventral convexity in four and dorsal in three cadavers). Among the double coil tortuosities, two in the transverse plane, two in the sagittal plane and one in the transverse-sagittal plane were reported.
Developmentally, the vertebral artery is formed between the 32nd and the 40th gestational day (7-18mm embryo) from the fusion of the secondary persistent segments of the cervical arteries and the primitive dorsal aortic arch. It is a firm belief that whereas an abnormal arrangement of this fusion process is definitely responsible for any abnormal origins, the possibility of these abnormalities in fusion contributing to some tortuosities of the vessel also cannot be ruled out (1).
The tortuosity in the VA was not recognized until 1958, when Hadler described four cases in 21 subjects who were aged between 45 and 91 years and were examined post mortem (4).
Clinically, the tortuosity of the V1 segment does not have a haemodynamically significant consequence. However, the loops can cause radiculopathy via nerve root compression (5). Cervical spinal fractures have been reported to be secondary to the bony erosion from a V1 loop which is in contact. Also, a vertebral loop which is caused by the displacement from a mass lesion in the scalenovertebral trigone may be compressed and it may lead tovertebro-basilar insufficiency. These asymptomatic loops may be corrected by a bypass procedure (1). The intervertebral for a men is often widened and its appearance may be confused with the congenital absence of the pedicle or the presence of a neurofibroma, which is the most common cause of this lesion (6).
The reported incidences of tortuous vertebral arteries by earlier authors are shown in (Table/Fig 1). Earlier, Tschabitscher et al (7) and Matula et al (1) encountered tortuous vertebral arteries in 47.2% and 39.1% of their dissections respectively (Table/Fig 4). The incidence which was noted by them is much more than the 22.1% incidence which was encountered with this anomaly in the present study. A possible explanation which has been given for such a high incidence in their study is the larger age group (59–82 years) of their study material, which might have been responsible for the atherosclerotic changes in the carotid and the subclavian arteries and also the extension into their branches as well resulting in the lengthening and dilatation of the same (8) (9). But, other authors have suggested that the deflection of the VA may result from cervical osteophytosis (10) and yet others have suggested that this condition may be congenital (11).
Most of the tortuosities (48.3%) which were encountered in our study were found in the transverse plane, with the direction of their convexities towards the medial side. The details of the tortuosities with their planes and the direction of their convexities which were encountered in our studies have been described in (Table/Fig 5). Curylo et al suggests that during the anterior decompression surgery of the cervical spine, the medially located vertebral artery carries the risk of VA injury (8).
The operative indications for surgery in the cervical region include spondylosis, a herniated inter-vertebral disc, tumour, infection and trauma. Although the lateral position of the VA does not hinder the anterior approach to the cervical vertebra, the presence of an abnormally tortuous VA, by using anatomic landmarks to guidedecompression may not prevent iatrogenic injury to the VA. The failure to recognize this anomaly during the preoperative planning can lead to the laceration of the vessel (8).
The laceration of the VA is the most challenging surgical dilemma which is faced during anterior cervical spinal surgery (12). Such an injury may cause catastrophic consequences, especially in those patients who present with an inappropriate blood deficit by the contralateral artery (e.g. by atherosclerotic occlusion) (13), which may cause brain stem infarction (14) and central respiratory dysfunction (15).
In a nutshell, apart from understanding the clinical implications, the data which is derived from the gross anatomical dissections of cadavers can be a useful guideline to the surgeons for careful preoperative planning in cases with an unusual course of VA and can help them in avoiding potentially life threatening complications.
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