Osteoblastogenesis from synovial fluid-derived cells is related to the type and severity of juvenile idiopathic arthritis

Introduction

Juvenile idiopathic arthritis (JIA) is characterized by synovial inflammation, followed by hyperplastic changes of the synovium, and destruction of articular cartilage along with underlying bone. This hyperplastic process is the result of inflammation-induced activation of NF-κB, which may be accompanied by decreased osteogenic differentiation of synovial mesenchymal progenitors and contribute to bone resorption. We aimed to explore osteoblast differentiation of synovial fluid (SF)-derived mesenchymal progenitors and correlate it with intensity of inflammation in patients with JIA.

Methods

Peripheral blood from 18 patients with oligoarticular (o)JIA, 22 patients with polyarticular (p)JIA and 18 controls was collected along with SF from 18 patients with oJIA and 9 patients with pJIA. SF-derived cells were cultured to assess osteoblastogenesis, using alkaline phosphatase histochemical staining and colorimetric activity assay. The expression of osteoblast-related genes, Runt-related transcription factor 2 (Runx2), Osteoprotegerin (OPG), Receptor activator of nuclear factor κB ligand (RANKL) and arthritis-related cytokine/chemokine genes, Tumor necrosis factor alpha (TNF-α, Fas, Fas ligand (FasL), Interleukin (IL)-1β, IL-4, IL-6, IL-17, IL-18, CC chemokine ligand (CCL)-2, CCL3, CCL4 was evaluated. Osteoblastogenesis was correlated with systemic and local inflammatory indicators. Expression of osteoblast genes was also analyzed in peripheral blood mononuclear cells (PBMC) and total SF-derived cells from patients with JIA. Additionally, we assessed the inhibitory effect of SF from patients with JIA on differentiation of human bone marrow (hBM)-derived osteoblasts.

Results

Osteoblastogenesis from SF-derived progenitors was decreased in patients with pJIA compared to those with oJIA. Osteoblastogenesis from primary SF-derived cells negatively correlated with erythrocyte sedimentation rate (ρ = -0.391, P = 0.05), C-reactive protein concentration (ρ = -0.527, P<0.01) and synovial concentration of IL-17 (ρ = -0.552, P = 0.01). SF-derived osteoblasts from pJIA patients expressed more CCL2 and CCL3 genes than in oJIA (P = 0.04 and P = 0.03, respectively; Mann-Whitney test). Expression of Fas was significantly higher in osteoblasts from patients with pJIA than those with oJIA (P = 0.03, Mann-Whitney test). SF-derived cells from patients with pJIA expressed higher levels of RANKL than in oJIA (P = 0.05, Mann-Whitney test). PBMCs from patients with JIA expressed less OPG than healthy control patients (P = 0.05, Kruskal-Wallis test). SF from all tested JIA patients inhibited differentiation of hBM-derived osteoblasts (P = 0.04, Kruskal-Wallis test).

Conclusions

Osteoblast differentiation was decreased in patients with severe forms of JIA and accompanied by altered cytokine/chemokine expression pattern. Development of therapeutic interventions targeting synovial mesenchymal or osteoblast lineage cells in JIA would contribute to alleviating both bone destruction and inflammation in severe forms of the disease.

Bridging knowledge translation gap in health in developing countries: visibility, impact and publishing standards in journals from the Eastern Mediterranean

Background

Local and regional scientific journals are important factors in bridging gaps in health knowledge translation in low-and middle-income countries. We assessed indexing, citations and publishing standards of journals from the Eastern Mediterranean region.

Methods

For journals from 22 countries in the collection of the Index Medicus for the Eastern Mediterranean Region (IMEMR), we analyzed indexing in bibliographical databases and citations during 2006–2009 to published items in 2006 in Web of Science (WoS) and SCOPUS. Adherence to editorial and publishing standards was assessed using a special checklist.

Results

Out of 419 journals in IMEMR, 19 were indexed in MEDLINE, 23 in WoS and 46 in SCOPUS. Their impact factors ranged from 0.016 to 1.417. For a subset of 175 journals with available tables of contents from 2006, articles published in 2006 from 93 journals received 2068 citations in SCOPUS (23.5% self-citations) and articles in 86 journals received 1579 citations in WoS (24.3% self-citations) during 2006–2009. Citations to articles came mostly from outside of the Eastern Mediterranean region (76.8% in WoS and 75.4% in SCOPUS). Articles receiving highest number of citations presented topics specific for the region. Many journals did not follow editorial and publishing standards, such addressing requirements about the patient’s privacy rights (68.0% out of 244 analyzed), policy on managing conflicts of interest (66.4%), and ethical conduct in clinical and animal research (66.4%).

Conclusion

Journals from the Eastern Mediterranean are visible in and have impact on global scientific community. Coordinated effort of all stakeholders in journal publishing, including researchers, journal editors and owners, policy makers and citation databases, is needed to further promote local journals as windows to the research in the developing world and the doors for valuable regional research to the global scientific community.

Completeness and changes in registered data and reporting bias of randomized controlled trials in ICMJE journals after trial registration policy

Objective

We assessed the adequacy of randomized controlled trial (RCT) registration, changes to registration data and reporting completeness for articles in ICMJE journals during 2.5 years after registration requirement policy.

Methods

For a set of 149 reports of 152 RCTs with ClinicalTrials.gov registration number, published from September 2005 to April 2008, we evaluated the completeness of 9 items from WHO 20-item Minimum Data Set relevant for assessing trial quality. We also assessed changes to the registration elements at the Archive site of ClinicalTrials.gov and compared published and registry data.

Results

RCTs were mostly registered before 13 September 2005 deadline (n = 101, 66.4%); 118 (77.6%) started recruitment before and 31 (20.4%) after registration. At the time of registration, 152 RCTs had a total of 224 missing registry fields, most commonly ‘Key secondary outcomes’ (44.1% RCTs) and ‘Primary outcome’ (38.8%). More RCTs with post-registration recruitment had missing Minimum Data Set items than RCTs with pre-registration recruitment: 57/118 (48.3%) vs. 24/31 (77.4%) (χ²₁ = 7.255, P = 0.007). Major changes in the data entries were found for 31 (25.2%) RCTs. The number of RCTs with differences between registered and published data ranged from 21 (13.8%) for Study type to 118 (77.6%) for Target sample size.

Conclusions

ICMJE journals published RCTs with proper registration but the registration data were often not adequate, underwent substantial changes in the registry over time and differed in registered and published data. Editors need to establish quality control procedures in the journals so that they continue to contribute to the increased transparency of clinical trials.

A systematic review of research on the meaning, ethics and practices of authorship across scholarly disciplines

Background

The purpose of this systematic review was to evaluate evidence about authorship issues and provide synthesis of research on authorship across all research fields.

Methods

We searched bibliographical databases to identify articles describing empirical quantitive or qualitative research from all scholarly fields on different aspects of authorship. Search was limited to original articles and reviews.

Results

The final sample consisted of 123 articles reporting results from 118 studies. Most studies came for biomedical and health research fields and social sciences. Study design was usually a survey (53%) or descriptive study (27%); only 2 studies used randomized design. We identified four 4 general themes common to all research disciplines: authorship perceptions, definitions and practices, defining order of authors on the byline, ethical and unethical authorship practices, and authorship issues related to student/non-research personnel-supervisor collaboration. For 14 survey studies, a meta-analysis showed a pooled weighted average of 29% (95% CI 24% to 35%) researchers reporting their own or others' experience with misuse of authorship. Authorship misuse was reported more often by researcher outside of the USA and UK: 55% (95% CI 45% to 64%) for 4 studies in France, South Africa, India and Bangladesh vs. 23% (95% CI 18% to 28%) in USA/UK or international journal settings.

Interpretation

High prevalence of authorship problems may have severe impact on the integrity of the research process, just as more serious forms of research misconduct. There is a need for more methodologically rigorous studies to understand the allocation of publication credit across research disciplines.

Less work, less respect: authors' perceived importance of research contributions and their declared contributions to research articles

BACKGROUND

Attitudes towards authorship are connected with authors' research experience and with knowledge of authorship criteria of International Committee of Medical Journal Editors (ICMJE). The objective of this study was to assess association between authors' perceived importance of contributions for authorship qualification and their participation in manuscripts submitted to a journal.

METHODS

Authors (n = 1181) of 265 manuscripts submitted to the Croatian Medical Journal were asked to identify and rate their contribution in the preparation of the submitted manuscript (0-none to 4-full for 11 listed contributions) and the importance of these contributions as authorship qualifications (0-none to 4-full). They were randomly allocated into 3 groups: the first (n = 90 manuscripts, n = 404 authors) first received the contribution disclosure form and then contribution importance-rating questionnaire; the second (n = 88 manuscripts, n = 382 authors) first received the rating questionnaire and then the contribution disclosure form, and the third group (n = 87 manuscripts, n = 395 authors) received both questionnaires at the same time. We compared authors' perception of importance of contribution categories.

RESULTS

1014 (85.9%) authors of 235 manuscripts responded. Authors who declared contribution to a specific category rated it as more important for authorship than those authors who did not contribute to the same category (P>0.005 for all contribution categories, Mann-Withney test). Authors qualifying for ICMJE authorship rated all contribution categories higher than non-qualifying authors. For all contributions, associations between perceived importance of contribution and actual author's contribution were statistically significant.

CONCLUSIONS

Authorship seems to be not a normative issue subjective to categorization into criteria, but also a very personal view of the importance and value of one's contributions.

Developing biobanks in developing countries

We call for the development of human biobanks in developing countries and describe several examples from low income countries which are already building their own biobanks. Developing human biobanks in developing countries requires strengthening of the research capacity to use the new technologies, as well as a shift in research investment priorities in order to reduce the inequity in international research that currently exists. A responsible approach from low-income countries to ethical issues will be another pre-requisite to the success of the 'hypothesis-free' research that will target the needs of the world's poor.

Food safety and security: what were favourite topics for research in the last decade?

The world is faced with the challenge to feed an estimated 9 billion population of the Earth by 2050. To address the scientific evidence for the safety of food, I searched the Web of Science bibliographical and citation database for most cited articles from this research area. The topics with greatest impact on the research community, judged by their annual rate of citations during the last decade, were food-borne pathogens and toxins, with emerging genetic studies and new methods of visualising toxins on surfaces. Epidemiological and survey studies demonstrated that there was systematic effort to document, rapidly detect and control epidemic spread of disease and that these measures decreased the threat to food safety in developed countries, but that there is still much room for improvement. Research relevant for developing countries included the potential molecular targets to alleviate accumulation of arsenic in rice. As in other areas of research and life, human factor seems to be the most important one for the safety of food. The five keys to safer food of the WHO - keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures, use safe water and raw materials - are thus still very relevant for the developed as much as the developing world.

Regression of moral reasoning during medical education: combined design study to evaluate the effect of clinical study years

Background

Moral reasoning is important for developing medical professionalism but current evidence for the relationship between education and moral reasoning does not clearly apply to medical students. We used a combined study design to test the effect of clinical teaching on moral reasoning.

Methods

We used the Defining Issues Test-2 as a measure of moral judgment, with 3 general moral schemas: Personal Interest, Maintaining Norms, and Postconventional Schema. The test was applied to 3 consecutive cohorts of second year students in 2002 (n = 207), 2003 (n = 192), and 2004 (n = 139), and to 707 students of all 6 study years in 2004 cross-sectional study. We also tested 298 age-matched controls without university education.

Results

In the cross-sectional study, there was significant main effect of the study year for Postconventional (F(5,679) = 3.67, P = 0.003) and Personal Interest scores (F(5,679) = 3.38, P = 0.005). There was no effect of the study year for Maintaining Norms scores. 3^rd year medical students scored higher on Postconventional schema score than all other study years (p<0.001). There were no statistically significant differences among 3 cohorts of 2^nd year medical students, demonstrating the absence of cohort or point-of-measurement effects. Longitudinal study of 3 cohorts demonstrated that students regressed from Postconventional to Maintaining Norms schema-based reasoning after entering the clinical part of the curriculum.

Interpretation

Our study demonstrated direct causative relationship between the regression in moral reasoning development and clinical teaching during medical curriculum. The reasons may include hierarchical organization of clinical practice, specific nature of moral dilemmas faced by medical students, and hidden medical curriculum.