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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
Variations in the Origin of Middle Hepatic Artery in Living Liver Donors using CT Angiography in South Indian Population: A Retrospective Study
Correspondence Address :
Dr. P Ashok,
Research Scholar, Department of Anatomy, Saveetha Medical College, Chennai-602105, Tamil Nadu, India.
E-mail: drashokpanjala123@gmail.com
Introduction:The middle hepatic artery is an artery which supplies blood to the fourth segment of the liver. Most commonly, it originates from the right hepatic artery. Injury to the middle hepatic artery during liver transplant surgeries may lead to ischaemia and also may lead to life threatening conditions like hepatic artery thrombosis in donor as well as recipient. The variations in the origin of the middle hepatic artery in the living donors were focused in the present study as it has surgical importance in the liver transplantations.
Aim: To find out the incidence of the variations in the origin of the middle hepatic artery in living liver donors using Computed Tomography (CT) angiography.
Materials and Methods: This was a retrospective observational study conducted from August 2018 to October 2021 in the Department of Anatomy, Deccan College of Medical Sciences, Hyderabad, Telangana, India. The images of CT angiographies of 100 living liver donors were collected from the Department of Radiology, Global Hospital, Hyderabad, Telangana, India. All the CT angiographs of the living liver donors were observed for any variations in the origin of the middle hepatic artery and recorded and the percentage of each variation was calculated.
Results: Out of 100 CT angiographs studied, the incidence of the origin of middle hepatic artery was reported as 55% from right hepatic artery, 34% from the left hepatic artery, 5% from replaced left hepatic artery, 2% from the hepatic artery proper, 1% from the common hepatic artery, 1% from left gastric artery. Double middle hepatic arteries were observed in 1% of cases. Accessory middle hepatic artery was observed in 1% cases.
Conclusion: To increase the success rate of liver transplantations, the clear knowledge on the possible variations of the middle hepatic artery is needed. The variations of the middle hepatic artery reported in this study are rare and will be useful for the liver transplant surgeons.
Computed tomography, Hepatic artery thrombosis, Hepatocellular carcinoma, Liver transplantation
Liver diseases such as hepatocellular carcinoma and cirrhosis are the leading cause of deaths worldwide (1). The liver cirrhosis is a condition where there is a progressive fibrosis of the liver along with distortion of the liver architecture. Hepatocellular carcinoma is reported as the 3rd most common cancer causing death and 5th most common cancer globally. It occurs with a background of liver chirrhosis (2),(3)]. The incidence of hepatocellular carcinoma in Indian men ranges from 0.7-7.5 and in women 0.2-2.2 per million population per year. Literature shows the incidence of hepatocellular carcinoma in cirrhotics in India is reported as 1.6% (4). Cirrhosis of the liver progresses to end stage liver disease and the liver transplantation is the only treatment option for both, cirrhosis and hepatocellular carcinoma (5).
In the liver transplantation surgeries, the liver can be received from the cadaver or the living donors. In case of the living donor liver transplantation, the hepatic arterial system of the liver must be observed by CT angiogram to avoid or minimise intraoperative and postoperative complications. The middle hepatic artery is an artery which supplies to fourth hepatic segment and most commonly it originates from the right hepatic artery. While performing living donor liver transplantation surgeries, there is an increased risk of injuries to the middle hepatic artery which may cause reduced functional volume of the left lobe of the liver followed by ischaemia to the bile ducts of this lobe. The most common complications of the arterial injuries in the living donor liver transplant are insufficient hepatic volume, ischaemic cholangiopathy, and hepatic artery thrombosis usually observed in the right hepatic lobe of the donor or the left hepatic lobe of the recipient. The hepatic artery thrombosis may cause graft loss in the recipient or may also cause significant decrease in the blood supply to the donor and the recipient [6,7]. Studies on the variations in the origin of the middle hepatic artery and arterial supply to the segment four of the liver were carried out in Chinese, Korean and Indian population on cadavers and CT angiograms of abdomen (8),(9),(10),(11). But CT angiographic studies on the variations of the middle hepatic artery in living liver donor were not much available in the south Indian population. Holbert BL et al., reported that the fourth segment is at a greater risk of undergoing hepatic artery thrombosis in postoperative phase. As per Michels NA, the fourth segment of the liver is supplied by the middle hepatic artery (12),(13). Thus, the detailed knowledge about the origin of the middle hepatic artery must be evaluated by CT angiography to consider for the prevention or reconstruction of the middle hepatic artery. Hence, the present study was undertaken to find out the variations in the origin of the middle hepatic artery.
The present study was a retrospective study conducted from August 2018 to February 2021 in the Department of Anatomy, Deccan College of Medical Sciences, Hyderabad, Telangana, India. The analysis of the study was done from February 2021 to October 2021. The study was permitted by the Institutional Review Board (IRB No: 2018/23/015) Hyderabad.
Inclusion criteria: A total of 100 CT angiograms of adult healthy living liver donors were included in the study irrespective of gender.
Exclusion criteria: The CT angiograms of the patients with a history of abdominal surgeries, pathological conditions of the abdomen, thrombosis of hepatica arteries were excluded from the study.
The images of the CT angiograms were studied carefully observing celiac trunk, common hepatica artery, hepatic artery proper, gastroduodenal artery, right and left hepatic arteries, left gastric artery, replaced right and left hepatic arteries to find out the variations in the origins of the middle hepatic artery and the observations were recorded. The variations were classified based on the classification of Wang S et al., (8).
STATISTICAL ANALYSIS The percentage of the variations observed was calculated and the incidence was reported in terms of frequency and percentages.
Among the total, 63 belonged to female and 37 belonged to male. The average age of the female and male donors was 35.36±8.92 and 30.31±11.41 years, respectively. The age ranges from 18-56 years in both. Total eight types of variations were observed in the origin of the middle hepatic artery. The variations of the middle hepatic artery were observed as follows (Table/Fig 1); Out of 100 CT angiograms, 55 (55%) cases showed the origin of the middle hepatic artery from the right hepatic artery (Table/Fig 2). In 34 cases (34%) middle hepatic artery was originated from the left hepatic artery (Table/Fig 3). In 5 (5%) cases the replaced left hepatic artery originated from the left gastric artery and the middle hepatic artery originated from this replaced left hepatic artery (Table/Fig 4). In 1 (1%) case double middle hepatic arteries was observed, one from the left gastric artery and another from the common hepatic artery (Table/Fig 5). In 1 (1%) case an accessory middle hepatic artery was observed which was originated from the left gastric artery along with an accessory left hepatic artery from the left gastric artery (Table/Fig 6). In 2 (2%) cases middle hepatic artery originated from the hepatic artery proper in this case the right hepatic artery originated from the superior mesenteric artery and the left hepatic artery originated from the left gastric artery (Table/Fig 7). In 1 (1%) case the middle and the left hepatic arteries both originated from the left gastric artery (Table/Fig 8). In 1 (1%) case the common hepatic artery terminated by giving rise to 4 branches; gastroduodenal artery, left hepatic artery, right hepatic artery and middle hepatic artery (Table/Fig 9).
The advanced stage of the liver cirrhosis and the hepatocellular carcinoma are the end stage liver diseases. The best treatment option for the end stage liver disease is the liver transplantation. The cadaveric liver donors are not frequently available, so the living donor liver transplantation is adopted (14).
The middle hepatic artery is not mentioned and neglected in most of the anatomy textbooks. It is an artery which supplies to fourth segment of the liver. The blood supply to the liver was first described by Healey JE et al., and the name middle hepatic artery which supplies to the fourth segment of the liver was proposed by Michels NA [13,15]. Putta T et al., reported that the segment four was predominantly supplied by a branch from the left hepatic artery followed by right hepatic artery which is contrary with the present study (11). The incidence of origin of middle hepatic artery from the common hepatic artery was similar with the findings of Wang S et al., when compared with the present study (8). Jin GY et al., reported higher incidence of origin of middle hepatic artery from Proper Hepatic Artery (PHA) compared to the present study (Table/Fig 10) [8-10]. Double and accessory middle hepatic arteries were reported in the present study were rarely reported in the literature (11).
In live donor liver transplantation cases, presence of replaced right hepatic artery is favourable, as in these cases the middle hepatic artery arises from the left hepatic artery. Whereas presence of replaced left hepatic artery is not favourable in both lobes of the liver as the middle hepatic artery if present, it commonly arises from the right hepatic artery in these cases (8). Harada N et al., reported in their study that, in living donor liver transplantation, the middle and left hepatic artery reconstruction is recommended and also safe to prevent biliary stricture caused by dual hepatic artery reconstruction especially when the graft has left and middle hepatic artery stumps. So, the variations in the origin of the middle hepatic artery must be assessed preoperatively when the transplant surgeon plans for the reconstruction of the middle hepatic artery (16). In live donor liver transplantation, reconstruction of the arteries to the remaining part of the liver is very much essential to avoid postoperative complications. So, preoperative identification of the variations of the middle hepatic artery need to be considered to avoid unnecessary extensive dissection at the hilum of the liver and also minimises the damage to the liver parenchyma and bile ducts [17,18].
Limitation(s)
The present study was limited to study the variations in the origin of middle hepatic artery in living liver donors in single centre. Further multicentric studies can be carried out in large population.
The proper knowledge on the variations of the middle hepatic artery is very much necessary for the surgeons who deal with live donor liver transplantation, to minimise the damage to the hepatic tissue and bile ducts and also will help in arterial reconstruction. The variations reported in this study will be useful for the liver transplant surgeons to achieve the higher success rate.
DOI: 10.7860/JCDR/2022/53227.15858
Date of Submission: Nov 12, 2021
Date of Peer Review: Dec 07, 2021
Date of Acceptance: Dec 29, 2021
Date of Publishing: Jan 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 13, 2021
• Manual Googling: Nov 20, 2021
• iThenticate Software: Dec 29, 2021 (19%)
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