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Transcript of Siriraj Thailand 20141022
Writing a Clinical Research Manuscript that Has Impact
Siriraj Hospital22 October 2014
Download at: edanzediting.com/siriraj2014
Dr Jeffrey RobensSenior Research Consultant
Education Group Leader
S
Be an effective communicator
Your goal is not only to be published, but also to be widely read/cited
Academic publishing
Clinical research design
Ethics
Professional writing skills
Manuscript structure
Session 1
Before you begin…
Section 1.1
Academic publishing
Academic publishing
Why English?
International language of academics
International reputation
International collaborations
Career advancement
Academic publishing
Publication success = Academic success
S
Publication Metrics and Success on the Academic Job Marketvan Dijk et al. Current Biology. 2014; 24: R516-R517.
• >25,000 researchers in PubMed• Determined which factors positively correlated
with academic success
Publication rate Especially in first few years
Impact factor Become PI more quickly
Citations Can helps those with low IFs
University rank Especially post-doc > PhD
Gender Men have better chances
Academic publishing
Writing a manuscript –4 common myths
S
My manuscript is a written record of my findings
My findings speak for themselves, even if the manuscript is written poorly
Good English means only grammar and spelling
Complex words makes my writing more impressive
Your manuscript is to communicate your findings
You need a well-written manuscript to effectively communicate your findings
Complex words makes your writing more difficult to understand
Good English means clear Englishwith high readability
Academic publishing
What do journal editors want?
Increase impact
High quality research
Interesting to journal’s readership
Original and novel research Well-designed study
Transparent reportingClinical applications
Academic publishing
Clinical relevance
Technical quality
Novelty
Surgical resections of 500 Thai HCC patients
What do journal editors want?
Academic publishing
Clinical relevance
Technical quality
Novelty Surgical resections of Thai HCC patients raised in the US
What do journal editors want?
Academic publishing
Clinical relevance
Technical quality
Novelty
Surgical resections of normal vs. diabetic HCC patients
What do journal editors want?
Section 1.2
Identifying a good research question
Good researchquestion
Clinical research that has impact
1. Read primary literature
2. Read systematic reviews and meta-analyses
3. Identify an important question
• Is the question focused?• Do you have the expertise/resources?• What is new?• How is it clinically useful?
Good researchquestion
Reading improves manuscript writing
Read often!
Learn how native English speakers write
Learn proper argument structure
Learn manuscript structure and style
Get new ideas, identify problems
Discuss with colleagues
Good researchquestion Make time to read
Most researchers read 60–90 min per day
Spend 20–30 min every day reading abstracts
Spend 60 min 3 days a week reading papers
Good researchquestion
How to read an article
From start to finish?
Section by section?
Not efficient!
What do you want to know?
Where can you find it?
Good researchquestion
Self-assess knowledge of topic
Read Title and Abstract first
Strategies for reading
Have you read similar papers?
Familiar with the terminology?
Do you understand the relevance of the hypothesis
Good researchquestion
Read Figures and then Results
Read Discussion for interpretation
Self-assess knowledge of topic
Read Title and Abstract first
Refer to Introduction and Methods if necessary
Strategies for reading
Read last paragraph of introductionfor hypothesis/objectives
Good researchquestion
Reacting to published literature
Discuss with colleagues/co-authors:
• What was addressed, what wasn’t addressed, what could have been improved?
• Will need to discuss these points in your manuscript
Assume your idea is not new
Search for what has been done already
Read Discussion carefully for future directions
Section 1.3
Clinical research design
Research design “Hierarchy of evidence”
Randomized controlled trials
Observational studies
Cohort/case-controlled studies
Case reports
Laboratory research
Systematic reviews& meta-analyses
Research design Meta-analyses
Determine clinical efficacy/safety of an intervention based on what has already been done
• Integrates published and unpublished studies• Improves power by increasing sample size• Improves robustness by increasing heterogeneity of
sample population (broader generalization)
Research design Searching for trials
http://onlinelibrary.wiley.com/cochranelibrary/search/
Research design Clinical trials
Prospectively determines clinical efficacy/safety of a new intervention
• Single- or multi-center study?• Appropriate sample population?• Single- or double-blinded?• Placebo or active comparator control?
Consult a statistician!
Research design Clinical trial registration
Retrospective registration is sometimes possible
Should be registered before journal submission
Where to register? Thai Clinical Trials Registrywww.clinicaltrials.in.th
Research design Observational study
Determine clinical efficacy/safety of a currently used intervention
• Intervention not assigned by investigator• Does not need to be publically registered• Usually retrospective, but can be prospective• Bias can result from lack of randomization and
patient is usually not blinded
Research design Cohort/longitudinal studies
Determine risk factors for a disease
• Often prospective, but can be retrospective• Compare two similar healthy populations with
different exposures• Calculate incidence of disease• Can take a long time, risk of missing data
Research design Case-controlled studies
Retrospectively determine risk factors for a (rare) disease
• Compare sample population that has a diseases with a similar sample that does not
• Compare histories and calculate odds ratio• Sample sizes much smaller than cohort studies• Unlike cohort studies, cannot calculate incidence
Research design Case reports
Describes patient with unique presentation
• Needs to be an important unreported case• Tells a story, a timeline of events• Short, 500–1500 words• Needs to have educational value in addition to
novelty• Improves clinical reasoning skills
• Supports case-based learning
Research design Laboratory research
Determine underlying mechanism of disease or treatment
• Performed under ideal (laboratory) conditions• Important in understanding pathogenesis and drug
development• Often difficult to translate to clinical relevance
Research design Reporting guidelines
CONSORT Randomized clinical trials
PRISMA Systematic reviews &Meta-analyses
CARE Case reports
STROBE Observational studies
http://www.equator-network.org/
Research design Sample size
Expected variability in each group
Significance level
Expected difference between groups
Small sample size
Large sample size
Low High
p < 0.05 p < 0.01
Large Small
Should always do a power calculation!
Research design
Fernandes-Taylor et al. BMC Res Notes. 2011; 4: 304.
Statistical problems
Surveyed 25 editors from high impact medical journals
“…respondents expressed concern over researchers’ choice of statistical tests. Specifically, frequent problems exist in the appropriateness of statistical tests ...”
When in doubt, consult a statistician
Research design Common statistical problems: normality
Distribution of data affects analysis and presentation
• Parametric tests (e.g., t-test and ANOVA) can only be used with normally distributed data
• The mean ± SD only for normally distributed data
Simple guide:• If SD is ≥ mean, most likely not normally distributed• If SD is > 0.5 × mean, may not be normally distributed
Use Shapiro-Wilk’s W test for normality
Research design Common statistical problems: P-values
Statistical significance does not equal clinical significance!
“When possible, quantify findings and present them with appropriate indicators of measurement error or uncertainty (such as confidence intervals). Avoid relying solely on statistical hypothesis testing, such as P values, which fail to convey important information about effect size and precision of estimates.”*
*http://www.icmje.org/recommendations/browse/manuscript-preparation/preparing-for-submission.html
Research design
Statistical significance does not equal clinical significance!
“After treatment, Drug A reduced LDL cholesterol by 28% (P<0.05). Therefore, Drug A is effective in reducing cholesterol levels…”
• How much is 28%? Is that a clinically relevant reduction?• How does this effect generalize to the population? What is the
95% CI?
Common statistical problems: P-values
Research design
This sample: LDL dropped 1.5 mmol/L to 3.2 mmol/L95% of similar samples, LDL expected to drop from 0.8 to 2.2 mmol/L (3.9 mmol/L to 2.5 mmol/L)
Inconclusive result!
Bad: After treatment, Drug A reduced LDL cholesterol by 28% (P<0.05).
Better: After treatment, Drug A reduced LDL cholesterol from 4.7±0.3 mmol/L to 3.2±0.6 mmol/L (P=0.02).
Best: After treatment, Drug A reduced LDL cholesterol from 4.7±0.3 mmol/L to 3.2±0.6 mmol/L (P=0.02, 95% CI: 0.8–2.2).
Good: <3.3; Borderline: 3.4–4.1; High: 4.1–4.9; Very high: >4.9 mmol/L
What does this mean?
Common statistical problems: P-values
Research design
“After treatment, Drug A reduced LDL cholesterol levels from 4.7±0.3 mmol/L to 3.2±0.6 mmol/L (P=0.02, 95% CI: 0.8–2.2). Because a minimal reduction of 1.4 mmol/L is required to be clinically effective, the efficacy of Drug A is still unclear.”
Useful to state minimum clinically effective difference
Common statistical problems: P-values
Research design Statistical tests
2 categorical endpoints
Paired (within sample)
Unpaired (between sample)
McNemar Fisher’s exact test2 treatment groups
*for sample sizes > 60
Chi-square test*2+ treatment groups
du Prel et al. Dtsch Arztebl Int 2010; 107: 343–8.
Research design
Continuous endpoints
Parametric Nonparametric
Paired Unpaired Paired Unpaired
2 groups:Paired t-test
>2 groups:Repeated measures
ANOVA
2 groups:Unpaired t-test
>2 groups:ANOVA
2 groups:Wilcoxon Signed
rank sum test
>2 groups:Friedman
test
2 groups:Mann–Whitney
U test>2 groups:
Kruskal–Wallis test
du Prel et al. Dtsch Arztebl Int 2010; 107: 343–8.
Statistical tests
Session 2
Ethics and writing skills
Section 2.1
Research and publication ethics
Customer ServiceEthics
Transparent reporting
It needs to be very clear how your study was conducted
• How patients were enrolled• Inclusion and exclusion criteria• How patients were randomized into treatment groups• Used intention-to-treat (all enrolled patients analyzed)
or per-protocol analysis (only patients that complete the study analyzed)
Patients
Customer ServiceEthics
Transparent reporting
It needs to be very clear how your study was conducted
• Unclear data (blue vs. blue-ish)• Uninterpretable data (glucose levels in patients who
did not fast overnight)• Missing data• Why missing? E.g., outliers or lost to follow-up?• Imputed methods (e.g., last observation carried
forward)
Data
Customer ServiceEthics
Transparent reporting
It needs to be very clear how your study was conducted
• How you analyzed your data (levels of measurement)?
• Continuous (e.g., systolic pressure in mmHg)• Nominal categories (unranked: e.g., normal vs.
abnormal blood pressure)• Ordinal categories (ranked; e.g., hypotensive, normal,
and hypertensive)
Data
Customer ServiceEthics
Transparent reporting
It needs to be very clear how your study was conducted
• How you categorized continuous data
• Continuous: height of your patients in cm• Subjective ranking: short <150 cm, normal 151–175
cm, tall >176 cm• Logical ranking: short <1 SD of the mean, normal ±1
SD of the mean, tall >1 SD of the mean
Data
Customer ServiceEthics Ethical treatment
of humans
Informed consent
Participants in a study need to be informed of the:
• Study objectives• Potential benefits or risks involved• Confidentiality
This is usually written informed consent
Templates: http://www.who.int/rpc/research_ethics/informed_consent/en/
Customer ServiceEthics Data manipulation
Never
Fabricate data Move data on a graph
Manipulate images
Hide bad results
Customer ServiceEthics
Four criteria for authorship
1. Significantly involved in study design, data collection/analysis
2. Writing and revising the manuscript
3. Approval of final version
4. Responsible for the content (accuracy and integrity)
http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html
Customer ServiceEthics Gift/ghost
authorshipMaking someone an author when they do
not deserve it (friends, colleagues, etc.)Gift
authorship
• Try to make paper more prestigious by adding a ‘big name’• Adding the department head to every paper from their department• Thanking someone for a contributed material
Not making someone an author when they do deserve it
Ghost authorship
• Hide conflict of interest (e.g., company employee)• If someone did not conduct the study, but wrote the paper (e.g.,
‘ghost writer’)
Customer ServiceEthics
Professional, financial, or personal relationships that may bias your research Declare any conflicts of interest to the journal Disclose all sources of funding Disclose all personal and financial relationships Declaration of the role of the study sponsor:• study design• collection, analysis, and interpretation of data• writing of the manuscript
Conflicts of interest
Customer ServiceEthics Conflicts of interest
form
Customer ServiceEthics
Makes readers think others’ words or ideas are your own
Plagiarism
Copying published text
Stating ideas of someone else without citing the source
Customer ServiceEthics
Expressing published ideasusing different words
Paraphrasing
Tips on paraphrasing:1. Write about the text a couple hours later
without looking at the source2. Verbally explain ideas to a colleague3. Summarize in a flowchart (e.g., methods)
Customer ServiceEthics Good paraphrasing
24. Llovet at al. N Engl J Med. 2008; 359: 378 –390.
“This trial shows that sorafenib improves overall survival by nearly 3 months in patients with advanced liver cancer.”
Sorafenib improves survival by almost 3 months in patients with advanced liver cancer.24
Sorafenib has been shown to improve the survival of liver cancer patients. 24
Too similar!
Customer ServiceEthics ‘Salami publishing’
You cannot divide one larger paper into two or more smaller ones
• Makes readers think that these are two independent studies
• Relevant information from one paper not available to reader of other paper
• Interferes with the critical evaluation of the study
One larger paper will have more impact for the field (and more citations!)
Section 2.2
Professional writing skills
Writing skills Prepare an outline
I. IntroductionA. General backgroundB. Related studiesC. Problems in the fieldD. Aims
II. MethodsA. Subjects/Samples/MaterialsB. General methodsC. Specific methodsD. Statistical analyses
III. ResultsA. Key points about Figure 1B. Key points about Table 1C. Key points about Figure 2D. Key points about Figure 3E. Key points about Figure 4
IV. DiscussionA. Major conclusionB. Key findings that support conclusionC. Relevance to published studiesD. LimitationsE. Unexpected resultsF. ImplicationsG. Future directions
Knowing what you need to discuss, write down the key ideas
Use short bullet points to list ideas
Don’t let “writing correct English sentences” get in the way of outlining your ideas
Use reporting guidelines!
Writing skills Getting feedback
After completing your outline, discuss it with your colleagues
Make the necessary changes before you begin writing
Write your manuscript section-by-section, do not get overwhelmed by thinking about writing an entire manuscript
Set deadlines as to when the first draft of each section will be completed
Get feedback from you colleagues after each section and make changes before beginning the next section
Writing skills The ‘write’ order
Manuscript sections
• Title• Abstract• Introduction• Methods• Results• Figures• Discussion
Writing order
• Methods• Figures• Results• Discussion• Introduction• Abstract• Title
Writing skills Improving readability
Use short sentencesLimit your sentences to 15–20 words
One idea per sentence
Use active voiceMore simple, direct, and easier to read
AMA Manual of Style: “In general, authors should use the active voice…”. (10th ed., pg. 320)
Writing skills Stress position
Readers focus at the end of the sentence to determine what is important.
1. You deserve a raise, but the budget is tight.
Which sentence suggests that you will get a raise?
2. The budget is tight, but you deserve a raise.
http://writingcenter.unc.edu/handouts/flow/
Writing skills
The budget is tight, but you deserve a raise. Your salary
will increase at the beginning of next year.Stress position Topic position
The topic position introduces the idea of the current sentence
The stress position also introduces the topic of the next sentence
Stress position
Writing skills Topic position
The patient went to the hospital to see a gastroenterologist. The doctor then performed a series of diagnostic tests. The results showed the patient suffered from a bacterial infection. Antibiotics were prescribed to treat the infection before the patient developed an ulcer.
idea ideaideaidea
Topic link
sentence
Writing skills
Lung cancer is the leading cause of cancer mortality for men and women. Despite smoking prevention and cessation programs and advances in early detection, the 5-year survival rate for lung cancer is only 16% with current therapies. Although lung cancer incidence rates have recently declined in the United States, more lung cancer is now diagnosed when considered together in former- and never-smokers than in current smokers. Thus, even if all of the national anti-smoking campaign goals are met, lung cancer will remain a major public health problem for decades. New ways to treat or prevent lung cancer are therefore needed.
One potential therapeutic target for lung cancer is the Wnt signaling pathway. The canonical Wnt signaling pathway in mammals consists of a family of secreted lipid-modified Wnt protein ligands that bind to a family of 7-pass transmembrane Frizzled (Fzd) receptors, as reviewed…
Busch et al. BMC Cancer. 2012; 13: 211.
Linking your ideas in your manuscript
Topic sentence
Stress sentence
Topic sentence
Support
Writing skills
Compared with is for comparing similar things Compared to is for comparing different things
The tumors of the treatment group were compared to those of the control group.
The tumors of the treatment group were compared with those of the control group.
Common mistakes
Writing skills Common mistakes
Data is the plural form of datum
The data was analyzed...This data suggests…
The data were analyzed…These data suggest…
Writing skills
Avoid subjective terms: – Surprisingly, shockingly, unexpectedly
Surprisingly, Drug A showed increased cell death compared with that observed with Drug B.
Interestingly, Drug A showed increased cell death compared with that observed with Drug B.
Common mistakes
Writing skills
www.nature.com/nature/authors/gta/index.html#a4
Common mistakes
Nature’s guide to authors:
Nature is an international journal covering all the sciences. Contributions should therefore be written clearly and simply so that they are accessible to readers in other disciplines and to readers for whom English is not their first language.
“I should use complex words to make my writing more impressive.”
Writing skills
To ascertain the efficaciousness of the program, we interrogated the participants upon completion.
To determine the success of the program, we questioned the participants upon completion.
Simple language
Writing skills
PreferredEnoughClearDetermineTryVerySizeAskedKeepEndUse
AvoidAdequateApparentAscertainEndeavorExceedinglyMagnitudeRequestedRetainTerminateUtilization
Simple language
Session 3
Manuscript structure
Section 3.1
Main text
Coverage and Staffing Plan
Main text Introduction
General introduction
Specific aimsAims
Current state of the field
Problem in the field
Coverage and Staffing Plan
Main text Specific aims
Aims…we examined the effect of the severity of kidney dysfunction on the risks of death, cardiovascular events, and hospitalization among a large, diverse group of adults.
Problem…whether chronic kidney disease independently increases the risk of any type of cardiovascular disease has not been established.In addition, few studies have investigated the association between chronic kidney disease and the risk of hospitalization…
• Identify an important problem• State aims that directly address the problem
Go et al. N Engl J Med. 2004; 351: 1296–1305.
Coverage and Staffing Plan
Main text Methods
How the study was done
Treatments (controls)Patient management
Follow-up
Quantification methodsStatistical tests
Consult a statistician
Participants used
DemographicsEnrollment procedure
Inclusion/exclusion criteria
Data analysis
Study design
Coverage and Staffing Plan
Main text Results
1. Study design2. Treatment efficacy3. Safety
Each subsection corresponds to
one figure
What you found, not what it means
Logical presentation
Subsections
Factual description
Coverage and Staffing Plan
Main text Factual description
Drug A is more effective in treating liver cancer as we observed a 32.7% decrease in tumor size compared with only a 22.1% decrease after Drug B treatment.
The efficacy of Drug A was significantly higher than that for Drug B, with decreased tumor size 32.7% or 22.1%, respectively.
Belongs in the Discussion
Exception is when the Results and Discussion sections are combined
“These results suggest that Drug A may be more effective…”
Coverage and Staffing Plan
Main text Group repetitive results
Drug A reduced tumor volume by 32.7%, increased blood pressure by 12.3%, and decreased the patient’s weight by 7.3 kg.
Drug B reduced tumor volume by 22.3%, increased blood pressure by 15.6%, and decreased the patient’s weight by 2.4 kg.
Drug C reduced tumor volume by 38.1%, increased blood pressure by 6.9%, and decreased the patient’s weight by 9.2 kg.
Coverage and Staffing Plan
Main text
Patients treated with Drug C showed the greatest reduction in tumor volume (28.1%) compared with those treated with Drug A (32.7%) or Drug B (22.3%).
Drug C also had the lowest increase in blood pressure (6.9%) compared with that seen after treatment with Drug A (12.3%) or Drug B (15.65).
However, patients treated with Drug C had the highest weight gain among the three groups (Drug A, 7.3 kg; Drug B, 2.4 kg; Drug C, 9.2 kg).
Group repetitive results
Coverage and Staffing Plan
Main text
Present large amount of data quickly and
efficiently
Keep it simple: use separate panels if
necessary
Must be able to stand alone: clear labels and figure legends
Usually the first thing readers will look at
Figures, graphs & tables
Coverage and Staffing Plan
Main text FiguresClear figure legend
Kindlin-2 knockdown and focal adhesion localization. Confocal immunofluorescent microscopy with anti-β1 integrin and anti-paxillin on C2C12 cells transfected with RNAi and then changed to differentiation media for 2 days. Control cells show linear staining consistent with localization to costameres (arrows), as well as punctate focal contact staining (arrowheads). Focal contact proteins in the kindlin-2 RNAi cells fail to form linear structures and instead are concentrated in unusual appearing puncta (*). (Scale bar = 20 μM).
Dowling et al. (2008) BMC Cell Biol 9:36.
Clear indicators
Title of the experiment
Brief methodology
Key findings
Coverage and Staffing Plan
Main text
Data aligned and formatted
Table formatting
Muñoz et al. New Engl J Med. 2003;348:518−527.
Clear and concise table caption
Abbreviations defined
Coverage and Staffing Plan
Main text Use tables for large data sets
Modified from: Go et al. New Engl J Med. 2004;351:1296.
Characteristic Total Cohort(N=1,120,295)
≥ 60 ml/min/1.73 m2
(N=924,136)
< 60 ml/min/1.73 m2
(N=196,159)*
Age (yr) 52.2 ± 16.3 49.1 ± 15.1 66.6 ± 13.0
Female sex (%) 54.6 53.4 60.2
Ethnic group
White 50.9 47.2 68.6
Black 7.4 7.2 5.3
Hispanic 5.9 6.3 4.1
Asian 8.1 8.5 6.7
Mixed 2.4 2.4 2.8
Other 25.3 28.4 12.5
Medical history
Coronary heart disease
6.3 4.5 17.8
Stroke 2.6 1.7 8.3
Peripheral arterial disease
1.8 1.1 6.7
Chronic heart failure
2.1 1.0 19.8* estimations
Coverage and Staffing Plan
Main text Use graphs for small data sets
Modified from: Go et al. New Engl J Med. 2014;351:1296.
Coronary hea
rt dise
aseStr
oke
Periphera
l arte
rial d
isease
Chronic hea
rt fai
lure0
5
10
15
20
25
HealthyKidney disease
Perc
ent o
f pati
ents
with
at l
east
on
e ca
rdio
vasc
ular
eve
nt
Coverage and Staffing Plan
Main text When not to use bar graphs
Bar graphs Mean ± SD Normally distributed data
What if you don’t have normally distributed data?
Should present median and interquartile range (IQR) Box plots
Coverage and Staffing Plan
Main text Box plots
Hijikata et al. Hum Genetics. 2012;131:675−682.
Figure 2 Dual luciferase reporter assays. The ratios of Firefly luciferase activity (signal S) to Renilla luciferase (control C) are displayed using box and whisker plots…
Minimum25%
Median75%
Maximum
Coverage and Staffing Plan
Main text Discussion
Summary of findings
Relevance of findings
Implications for the field
Similarities/differencesUnexpected resultsNegative resultsLimitations
Coverage and Staffing Plan
Main text Writing a strong conclusion paragraph
Why your study is important
In conclusion, we found an independent, graded association between lower levels of the estimated GFR and the risks of death, cardiovascular events, and hospitalization. These risks were evident at an estimated GFR of less than 60 ml per minute per 1.73 m2 and substantially increased with an estimated GFR of less than 45 ml per minute per 1.73 m2. Our findings support the validity of the National Kidney Foundation staging system for chronic kidney disease but suggest that the system could be further refined, since all persons with stage 3 chronic kidney disease (GFR, 30 to 59 ml per minute per 1.73 m2) may not be at equal risk for each outcome. Our findings highlight the clinical and public health importance of chronic kidney disease that does not necessitate dialysis.
Conclusion
Key finding
Implications
Future directions
Clinical importance
Go et al. N Engl J Med. 2004; 351: 1296–1305.
Coverage and Staffing Plan
Main text Linking your ideas
General background
Objectives
Methodology
Results and figures
Summary of findings
Implications for the field
Relevance of findings
Problems in the field
Logically link your ideas throughout your manuscript
Current state of the fieldIntroduction
Methods
Results
Discussion
Coverage and Staffing Plan
Main text Linking your ideas
New ways to treat or prevent lung cancer are therefore needed.
This study explored the hypothesis that inhibition of TNKS…would inhibit lung cancer growth…
Pharmacological or genetic inhibition of TNKS1 and TNKS2…reduces lung cancer proliferation...
Problem
Objectives
Conclusion
Discussion
Introduction
Busch et al. BMC Cancer. 2012;13:211.
Coverage and Staffing Plan
Main text Writing effective conclusions
Your conclusion is a summary of your findings
Your conclusion should be the answer to your research problem that is supported by your findings
Emphasizes how your study will help advance the field
Titles and abstracts
Section 3.2
Customer ServiceTitles and abstracts
Important points
Summarize key finding Study design Contains keywords Less than 20 words
Avoid
Effective titles
Your title should be a concise summary of your most important finding
QuestionsDescribing methodsAbbreviations“New” or “novel”
Customer ServiceTitles and abstracts Abstract
First impression of your paper
Importance of your results
Validity of your conclusions
Relevance of your aims
Judge your writing style
Probably only part that will be read
Customer ServiceTitles and abstracts
Writing clinical abstracts
Background Why does this trial/case need to be reported?
Results Treatment outcomesAdverse events
Conclusion Clinical relevanceLearning points
Patients and methods
Patient informationInterventions given
List source of funding and trial registration number after abstract
Customer ServiceTitles and abstracts
Unstructured abstract
ErbB-2 has been implicated as a target for cancer-initiating cells in breast and other cancers. ErbB-2-directed peptide vaccines have been shown to be effective in prevention of spontaneous tumorigenesis of breast in neu transgenic mouse model, and cellular immunity is proposed as a mechanism for the anti-tumor efficacy. However, there has been no explanation as to how immunity suppresses tumorigenesis from the early stage carcinogenesis, when ErbB-2 expression in breast is low. Here, we investigated a peptide-based vaccine, which consists of two MHC class II epitopes derived from murine ErbB-2, to prevent the occurrence of spontaneous tumors in breast and assess immune impact on breast cancer stem cells. Female MMTV-PyMT transgenic mice were immunized with either ErbB-2 peptide vaccine, or a peptide from tetanus toxoid, or PBS in immune adjuvant. ErbB-2 peptides vaccine completely suppressed spontaneous breast tumors, and the efficacy was correlated with antigen-specific T-cell and antibody responses. In addition, immune serum from the mice of ErbB-2 vaccine group had an inhibitory effect on mammosphere-forming capacity and signaling through ErbB-2 and downstream Akt pathway in ErbB-2 overexpressing mouse mammary cancer cells. We provide evidence that multi-epitope class II peptides vaccine suppresses tumorigenesis of breast potentially by inhibiting the growth of cancer stem cells. We also suggest that a strategy of inducing strong immune responses using multi-epitope ErbB-2-directed helper vaccine might be useful in preventing breast cancer recurrence.
Gil et al. Breast Cancer Res Treat. 2014; 147: 69‒80.
Customer ServiceTitles and abstracts
Unstructured abstract
Gil et al. Breast Cancer Res Treat. 2014; 147: 69‒80.
ConclusionWe provide evidence that multi-epitope class II peptides vaccine suppresses tumorigenesis of breast potentially by inhibiting the growth of cancer stem cells. We also suggest that a strategy of inducing strong immune responses using multi-epitope ErbB-2-directed helper vaccine might be useful in preventing breast cancer recurrence.
ResultsErbB-2 peptides vaccine completely suppressed spontaneous breast tumors, and the efficacy was correlated with antigen-specific T-cell and antibody responses. In addition, immune serum from the mice of ErbB-2 vaccine group had an inhibitory effect on mammosphere-forming capacity and signaling through ErbB-2 and downstream Akt pathway in ErbB-2 overexpressing mouse mammary cancer cells.
MethodsHere, we investigated a peptide-based vaccine, which consists of two MHC class II epitopes derived from murine ErbB-2, to prevent the occurrence of spontaneous tumors in breast and assess immune impact on breast cancer stem cells. Female MMTV-PyMT transgenic mice were immunized with either ErbB-2 peptide vaccine, or a peptide from tetanus toxoid, or PBS in immune adjuvant.
Background
ErbB-2 has been implicated as a target for cancer-initiating cells in breast and other cancers. ErbB-2-directed peptide vaccines have been shown to be effective in prevention of spontaneous tumorigenesis of breast in neu transgenic mouse model, and cellular immunity is proposed as a mechanism for the anti-tumor efficacy. However, there has been no explanation as to how immunity suppresses tumorigenesis from the early stage carcinogenesis, when ErbB-2 expression in breast is low.
Customer ServiceTitles and abstracts Writing your abstract
ErbB-2 has been implicated as a target for cancer-initiating cells in breast and other cancers. ErbB-2-directed peptide vaccines have been shown to be effective in prevention of spontaneous tumorigenesis of breast in neu transgenic mouse model, and cellular immunity is proposed as a mechanism for the anti-tumor efficacy. However, there has been no explanation as to how immunity suppresses tumorigenesis from the early stage carcinogenesis, when ErbB-2 expression in breast is low. Here, we investigated a peptide-based vaccine, which consists of two MHC class II epitopes derived from murine ErbB-2, to prevent the occurrence of spontaneous tumors in breast and assess immune impact on breast cancer stem cells. Female MMTV-PyMT transgenic mice were immunized with either ErbB-2 peptide vaccine, or a peptide from tetanus toxoid, or PBS in immune adjuvant. ErbB-2 peptides vaccine completely suppressed spontaneous breast tumors, and the efficacy was correlated with antigen-specific T-cell and antibody responses. In addition, immune serum from the mice of ErbB-2 vaccine group had an inhibitory effect on mammosphere-forming capacity and signaling through ErbB-2 and downstream Akt pathway in ErbB-2 overexpressing mouse mammary cancer cells. We provide evidence that multi-epitope class II peptides vaccine suppresses tumorigenesis of breast potentially by inhibiting the growth of cancer stem cells. We also suggest that a strategy of inducing strong immune responses using multi-epitope ErbB-2-directed helper vaccine might be useful in preventing breast cancer recurrence.
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Gil et al. Breast Cancer Res Treat. 2014; 147: 69‒80.
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