Standards and Methodological Rigor in Pulmonary Arterial Hypertension Preclinical and Translational Research

Despite advances in our understanding of the pathophysiology and the management of pulmonary arterial hypertension (PAH), significant therapeutic gaps remain for this devastating disease. Yet, few innovative therapies beyond the traditional pathways of endothelial dysfunction have reached clinical trial phases in PAH. Although there are inherent limitations of the currently available models of PAH, the leaky pipeline of innovative therapies relates, in part, to flawed preclinical research methodology, including lack of rigour in trial design, incomplete invasive hemodynamic assessment, and lack of careful translational studies that replicate randomized controlled trials in humans with attention to adverse effects and benefits. Rigorous methodology should include the use of prespecified eligibility criteria, sample sizes that permit valid statistical analysis, randomization, blinded assessment of standardized outcomes, and transparent reporting of results. Better design and implementation of preclinical studies can minimize inherent flaws in the models of PAH, reduce the risk of bias, and enhance external validity and our ability to distinguish truly promising therapies form many false-positive or overstated leads. Ideally, preclinical studies should use advanced imaging, study several preclinical pulmonary hypertension models, or correlate rodent and human findings and consider the fate of the right ventricle, which is the major determinant of prognosis in human PAH. Although these principles are widely endorsed, empirical evidence suggests that such rigor is often lacking in pulmonary hypertension preclinical research. The present article discusses the pitfalls in the design of preclinical pulmonary hypertension trials and discusses opportunities to create preclinical trials with improved predictive value in guiding early-phase drug development in patients with PAH, which will need support not only from researchers, peer reviewers, and editors but also from academic institutions, funding agencies, and animal ethics authorities.

A moral panic over cats

Some conservationists believe that free-ranging cats pose an enormous risk to biodiversity and public health and therefore should be eliminated from the landscape by any means necessary. They further claim that those who question the science or ethics behind their arguments are science deniers (merchants of doubt) seeking to mislead the public. As much as we share a commitment to conservation of biodiversity and wild nature, we believe these ideas are wrong and fuel an unwarranted moral panic over cats. Those who question the ecological or epidemiological status of cats are not science deniers, and it is a false analogy to compare them with corporate and right-wing special interests that perpetrate disinformation campaigns over issues, such as smoking and climate change. There are good conservation and public-health reasons and evidence to be skeptical that free-ranging cats constitute a disaster for biodiversity and human health in all circumstances. Further, there are significant and largely unaddressed ethical and policy issues (e.g., the ethics and efficacy of lethal management) relative to how people ought to value and coexist with cats and native wildlife. Society is better served by a collaborative approach to produce better scientific and ethical knowledge about free-ranging cats.

Assessing the Completeness of Reporting in Preclinical Oncolytic Virus Therapy Studies

Irreproducibility of preclinical findings could be a significant barrier to the "bench-to-bedside" development of oncolytic viruses (OVs). A contributing factor is the incomplete and non-transparent reporting of study methodology and design. Using the NIH Principles and Guidelines for Reporting Preclinical Research, a core set of seven recommendations, we evaluated the completeness of reporting of preclinical OV studies. We also developed an evidence map identifying the current trends in OV research. A systematic search of MEDLINE and Embase identified all relevant articles published over an 18 month period. We screened 1,554 articles, and 236 met our a priori-defined inclusion criteria. Adenovirus (43%) was the most commonly used viral platform. Frequently investigated cancers included colorectal (14%), skin (12%), and breast (11%). Xenograft implantation (61%) in mice (96%) was the most common animal model. The use of preclinical reporting guidelines was listed in 0.4% of articles. Biological and technical replicates were completely reported in 1% of studies, statistics in 49%, randomization in 1%, blinding in 2%, sample size estimation in 0%, and inclusion/exclusion criteria in 0%. Overall, completeness of reporting in the preclinical OV therapy literature is poor. This may hinder efforts to interpret, replicate, and ultimately translate promising preclinical OV findings.

Critical Appraisal of Qualitative Studies of Muslim Females' Perceptions of Physical Activity Barriers and Facilitators

Muslim women’s perceptions of cultural, religious, and secular determinants of physical activity have been studied for many years, with information typically acquired through focus groups or interviews. Multiple reviews synthesizing the research have been published, however, individual studies have not been scrutinized for their quality/rigor. Therefore, I critically appraised the quality of the body of qualitative research studies that utilized focus groups to identify Muslim women’s perceptions of physical activity barriers and facilitators. I utilized 26 items from the Consolidated Criteria for Reporting Qualitative Research (COREQ) to assess the quality of 56 papers published between 1987 and 2016. Using crosstabulations, I also examined associations between paper quality (low vs. high) and binary categorical variables for impact factor, maximum paper length allowed, publication year, and database the paper was indexed. Overall, papers averaged only 10.5 of 26 COREQ reporting criteria and only two out of 26 items were reported in more than 75% of the papers. Paper quality was not associated with impact factor and length. High quality papers were more likely published more recently (i.e., 2011 or later) and in journals indexed in the PubMed database compared to low quality papers. There is contention among qualitative researchers about standardizing reporting criteria, and while the trend in quality appears to be improving, journal reviewers and editors ought to hold authors to greater accountability in reporting.

How can we address the surge of low-quality systematic reviews and their impact on high journal rejection rates?

Journals have experienced a significant rise in submissions of systematic reviews and other types of reviews that often fall short of acceptable quality standards. These shortcomings typically stem from insufficient rigor in their methodology, reporting, or critical appraisal. As a result, these submissions are frequently rejected raising concerns about the standards authors are following when preparing such work. This growing trend of low-quality reviews not only places a burden on editorial teams but also poses a risk to the scientific community by potentially disseminating flawed or unreliable conclusions. Ensuring that articles maintain high standards is crucial for preserving the integrity of the scientific literature and facilitating evidence-based decision-making. In an effort to address this problem, this viewpoint editorial aims to offer concepts and recommendations on available tools for future authors to improve the quality of their reviews, as well as to guide readers and potential journal reviewers on how to critically interpret these articles.

Learning Landscape in Gamification: The Need for a Methodological Protocol in Research Applications

In education, the term "gamification" refers to of the use of game-design elements and gaming experiences in the learning processes to enhance learners' motivation and engagement. Despite researchers' efforts to evaluate the impact of gamification in educational settings, several methodological drawbacks are still present. Indeed, the number of studies with high methodological rigor is reduced and, consequently, so are the reliability of results. In this work, we identified the key concepts explaining the methodological issues in the use of gamification in learning and education, and we exploited the controverses identified in the extant literature. Our final goal was to set up a checklist protocol that will facilitate the design of more rigorous studies in the gamified-learning framework. The checklist suggests potential moderators explaining the link between gamification, learning, and education identified by recent reviews, systematic reviews, and meta-analyses: study design, theory foundations, personalization, motivation and engagement, game elements, game design, and learning outcomes.

Advancing Pediatric Sarcomas through Radiomics: A Systematic Review and Prospective Assessment Using Radiomics Quality Score (RQS) and Methodological Radiomics Score (METRICS)

Pediatric sarcomas, rare malignancies of mesenchymal origin, pose diagnostic and therapeutic challenges. In this review, we explore the role of radiomics in reshaping our understanding of pediatric sarcomas, emphasizing methodological considerations and applications such as diagnostics and predictive modeling. A systematic review conducted up to November 2023 identified 72 papers on radiomics analysis in pediatric sarcoma from PubMed/MEDLINE, Web of Knowledge, and Scopus. Following inclusion and exclusion criteria, 10 reports were included in this review. The studies, predominantly retrospective, focus on Ewing sarcoma and osteosarcoma, utilizing diverse imaging modalities, including CT, MRI, PET/CT, and PET/MRI. Manual segmentation is common, with a median of 35 features extracted. Radiomics Quality Score (RQS) and Methodological Radiomics Score (METRICS) assessments reveal a consistent emphasis on non-radiomic features, validation criteria, and improved methodological rigor in recent publications. Diagnostic applications dominate, with innovative studies exploring prognostic and treatment response aspects. Challenges include feature heterogeneity and sample size variations. The evolving landscape underscores the need for standardized methodologies. Despite challenges, the diagnostic and predictive potential of radiomics in pediatric oncology is evident, paving the way for precision medicine advancements.

Canine organoids: state-of-the-art, translation potential for human medicine and plea for standardization

Organoids have already shown great promise as research tools in human medicine. However, in veterinary medicine, such applications are limited and largely confined to canine organoids. In the Cross Health context, the potential of canine organoids lies in the translation to human diseases, such as cancer. This review provides a state-of-the-art, highlights the current challenges, and at first compares the reported culture conditions of canine organoids derived from both non-neoplastic and neoplastic tissue (i.e., tumoroids), identifying substantial gaps and discrepancies in used culture methods. We make a plea for the standardization of canine organoid culture characteristics and increased rigor in parameter reporting, which will ultimately enhance the reproducibility and applicability of canine organoids in both veterinary and human medicine, especially in the oncology field.

Assessing Prognostic Studies of Tubularized Incised Plate Urethroplasty in Hypospadias: A Systematic Review of Methodological Rigor

INTRODUCTION

Hypospadias is a congenital anomaly of male genitalia that requires surgical correction to achieve normal anatomy and function. Tubularized incised plate urethroplasty (TIP) is a common repair method, but prognostic studies of TIP outcomes are limited by their methodological quality. This systematic review evaluates the methodological rigor of prognostic studies on TIP urethroplasty in hypospadias cases, employing the Quality in Prognosis Studies (QUIPS) Cochrane tool.

METHODS

Following PRISMA guidelines, a systematic review of single-arm prognostic studies of TIP was conducted. Inclusion criteria were primary studies (first attempt of surgery), evaluating prognostic factors and outcomes, with the QUIPS tool used for quality assessment. Review studies and reports without full text were excluded. Inter-rater agreement was then evaluated using Cohen's kappa analysis.

RESULTS

Among 14 included studies, most exhibited low risk of bias (RoB). Inter-rater agreement varied across domains, being strongest for statistical analysis (κ = 0.89) and weakest for prognostic factor measurement (κ = 0.42). Nevertheless, overall assessment showed minimal agreement (κ = 0.49), indicating poor reliability of the included studies. Our findings highlight biases inherent in existing literature, particularly with respect to outcome measurement domains, underscoring the need for standardized methods and validated patient-reported outcomes. Selection bias and lack of standardized outcome measures pose significant challenges in interpreting study findings.

CONCLUSION

Low inter-rater agreement indicates methodological shortcomings in prognostic studies of TIP in the context of hypospadias. Future research should prioritize methodological rigor to enhance the reliability and generalizability of findings, thus improving clinical practice and future patient outcomes.