Scientific publications in respiratory journals from Chinese authors in various parts of North Asia: 10-year survey of literature For peer review only

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1 Scientific publications in respiratory journals from Chinese authors in various parts of North Asia: 0-year survey of literature Journal: Manuscript ID: bmjopen Article Type: Research Date Submitted by the Author: 0-Oct-0 Complete List of Authors: Ye, Bo; Changhai hospital, Internal medicine Du, Ting-Ting; Changhai hospital, Internal medicine Xie, Ting; Zhongda hospital, Internal mdicine Ji, Jun-Tao; Changhai hospital, Internal medicine Zheng, Zhao-Hong; Changhai hospital, Internal medicine Liao, Zhuan; Changhai hospital, Internal medicine Hu, Liang-Hao; Changhai hospital, Internal medicine Li, Zhao-Shen; Changhai Hospital, Second Military Medical University, Digestive Endoscopy Center <b>primary Subject Heading</b>: Respiratory medicine Secondary Subject Heading: Respiratory medicine Keywords: INTERNAL MEDICINE, MEDICAL HISTORY, RESPIRATORY MEDICINE (see Thoracic Medicine) : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

2 Page of Title Page Scientific publications in respiratory journals from Chinese authors in various parts of North Asia: 0-year survey of literature Bo Ye *, M.D., Ting-Ting Du *, M.D., Ting Xie *, M.D., Jun-Tao Ji, M.D., Zhao- Hong Zheng, M.D., Zhuan Liao, M.D., Liang-Hao Hu, M.D., Zhao-Shen Li, M.D. Department of internal medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China; Department of internal medicine, Zhongda Hospital, the Southeast University, Nanjing,China Running title: Scientific Publications in respirology from Chinese authors. *Dr. Ye., Dr. Du and Dr. Xie contributed equally to this work. No conflicts of interest exist. No current external funding sources for this study. Correspondence: Prof. Zhao-Shen Li, OR Liang-Hao Hu Department of Gastroenterology, Digestive Endoscopy Center Changhai Hospital The Second Military Medical University Changhai Road Shanghai 00, China Tel: +-- Fax: zhaoshen-li@hotmail.com OR lianghao-hu@hotmail.com - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

3 Page of Article summary Article focus ) How many articles in respiratory journals were published from the three major regions of China from 000 to 00? ) What is the trend? ) How is the quality of these articles? Key messages ) 0 articles in respiratory journals were published from the three major regions of China from 000 to 00, from ML, 0 from TW and from HK. The total number of articles from the three regions has increased significantly from 000 and 00.The number of articles published per year from ML has exceeded that from HK in 00 and TW in 00. ) The accumulated IF of articles from TW (.) was much higher than that from ML (0.) and HK (.). ) HK got the highest average IF of respirology articles and the majority of articles were published in top general medicine journals. Strengths and limitations of this study A few journals covered resources beyond respiratory even selected from the respiratory systems of SCIE. Besides, some related journals not shown in SCIE were not collected. Some respiratory medicine research articles are published in general journals, rather than in the specialized ones. Searching by the author s address (China, HK or TW) led to another problem that the articles addressed other cities or provinces were not included. Actually, our previous design had taken Macau into consideration, but later we excluded it for its small amount and low correlation. - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

4 Page of Abstract Background: Respiratory disease remains one of the leading causes of morbidity and mortality in China. However, little is known about the research status of respirology in the three major regions of China Mainland (ML), Hong Kong (HK) and Taiwan (TW).A 0-year survey of literature was conducted to compare the three regions outputs in the research of respirology. Methods: We searched PubMed database to identify the related articles from 000 to 00. The number of total articles, randomized controlled trials, case reports, metaanalysis, impact factors (IF), citations, and articles published in top general medicine journals were conducted for quantity and quality comparisons. Results: 0 articles were collected, from ML, 0 from TW and from HK. The total number of articles from the three regions has increased significantly from 000 and 00.The number of articles published per year from ML has exceeded that from HK in 00 and TW in 00. The accumulated IF of articles from TW (.) was much higher than that from ML (0.) and HK (.). HK got the highest average IF of respirology articles and the majority of articles were published in top general medicine journals. Conclusion: The total number of published articles from the three major regions of China has increased notably from 000 to 00. The annual number of publications by ML researchers exceeded those from TW and HK. However, the quality of articles from TW and HK is better than that from ML. Keywords: impact factor (IF); science citation index expanded (SCIE); journal citation reports (JCR); respirology - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

5 Page of Abbreviation List ACCP American College of Chest Physicians BMJ British Medical Journal ChiCTR Chinese Clinical Trial Register HK Hong Kong ICMJE ICTPR International Committee of Medical Journal Editors International Clinical Trials Registry Platform IF impact factors ISI Institute for Scientific Information JAMA Journal of the American Medical Association JCR journal citation reports ML Mainland NCBI National Center for Biotechnology Information NEJM RCT SCIE TW WHO The New England Journal of Medicine randomized controlled trials science citation index expanded Taiwan World Health Organization - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

6 Page of Introduction: Pulmonary diseases are matters of concern for all the countries. Lung disease accounts for % of disability-adjusted life-years [] and may be the first cause of mortality in the world [, ]. In China, under the influence of the dramatic economic evolution and urbanization progress, the levels and patterns of outdoor and indoor air pollutants have greatly changed. Hundreds of cities suffer the substandard air quality according to the World Health Organization (WHO) guidelines [].Besides, with a population of. billion, China has become a major contributor to the worldwide respiratory disease burden []. In terms of the fatality rate, respiratory disease comes first in rural areas and the fourth in urban areas in China. However, little is known about the research status of respirology in the three major regions of China Mainland (ML), Hong Kong (HK) and Taiwan (TW) []. We therefore conducted a 0-year survey of literature and compared these three regions outputs in the research of respirology. - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

7 Page of Methods and Materials: A total of journals related to respirology were selected from the "respiratory systems" category of Science Citation Index Expanded (SCIE) subject categories by the Institute for Scientific Information(ISI) [].The category covers resources dealing with the diagnosis and treatment of respiratory disease and focuses on prevention, pharmacology, surgery, transplantation, and research. Annals of Thoracic Medicine, COPD and Portuguese Journal of Pulmonology (Revista Portuguesa de Pneumologia) were not indexed by PubMed, so they were excluded. A computerized literature search was conducted in the PubMed database on 0 September 0 []. Articles from ML, TW and HK from January 000 to December 00 in these journals were elicited respectively. We used the ISSN to perform searches in PubMed. The search terms used were: (00-00 OR 0-X OR 0- OR - OR 000- OR 000- OR - OR 00- OR - OR 0- OR - OR 00- OR 00-0 OR 00- OR 00- OR 0- OR 0- OR 0- OR - OR 0-00 OR 0-00 OR - OR 0- OR 00- OR -0 OR 0-00 OR 0-00 OR -X OR -0 OR - OR 0- OR 00- OR 000- OR 0- OR -0 OR - OR - OR 0- OR 0- OR 0- OR -00 OR 0- OR 0- OR 0- OR 000- OR - AND TAIWAN[AD] AND 000[DP] )AND Hong Kong[AD], Taiwan[AD],and China[AD] NOT Hong Kong[AD] NOT Taiwan[AD]. Articles that showed the first author's affiliation (AD) with these three regions were considered as research outputs from the regions. Articles in the fields of randomized controlled trials (RCT), review, meta-analysis and case reports were generated respectively, according to the - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

8 Page of publication types by PubMed. To compare the quality of the research articles, three methods were used: () the accumulated impact factors (IF) and the average IF were generated according to Journal Citation Reports (JCR) 00 established by the ISI [] ; () citation reports of articles showing an affiliation with a Chinese institution were conducted; () articles published in top general medicine journals [The New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), The Lancet, and British Medical Journal (BMJ)] were also generated. Articles related to respirology were first extracted independently by two reviewers (Hao J.F. and Hu L.H.), and any disagreement between the reviewers was resolved by viewing the titles, abstracts, and full text if necessary. The number of articles published by each region in the top 0 high-impact respiratory journals was also compared. We determined the 0 most popular respiratory journals containing articles from the three regions of China according to the number of such articles published by each journal. Statistical analysis Statistical analyses were performed using STATA.0 [0].The nonparametric test for trend was performed to confirm any significant change of the total numbers over the period of time. Kruskal-Wallis test was used for detecting the difference among the three regions, and rank-sum test between two if necessary. The test for significance was two-tailed and the value of P<0.0 was considered significant. - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

9 Page of Results: Total number of articles A total number of articles were published in the selected journals within the period 000 to 00 worldwide. There were 0 articles (0/,.%) from ML (/0,.%), TW (0/0.%) and HK (/0,.0%).The numbers increased significantly from 00 to 00 in the three regions (from to, P=0.00 for trend, to, P=0.00, to, P=0.0, respectively, Fig. ). From 00 onwards, the number of articles from ML has exceeded that from HK and in 00 ML exceeded TW. The share of articles was on the rise for ML (P=0.00) and TW (P=0.00), but not in HK (P=0., Fig. ). Randomized controlled trial, review, meta-analysis and case report In respect to randomized controlled trial (Fig. ), it shows no difference among the three regions (ML vs. TW vs. HK, P=0.). In respect to review, ML and TW (ML vs.tw P=0.) showed no significant difference, while less than HK (ML vs. HK P=0.0; TW vs. HK P=0.00). Besides, there was a number of meta-analysis from ML since 00, but few from TW and HK. However, showed for case report, ML and HK (ML vs. HK P=0.) were equal to each other, while less than TW (TW vs. HK P=0.000; TW vs.ml P=0.00). Impact factors According to the JCR, journals in the "respiratory systems" had IF in 00 []. journals in our study had no IF. Excluding them, the accumulated IF of articles from TW (.) was much higher than that from ML (0.) and HK (., P=0.0). However, HK took the highest average IF of., followed by TW of - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

10 Page of , ML of. (P=0.00, Table ). Citation reports of articles published in the respiratory journals. According to our analysis, TW got the highest total citations of 0 (0 articles), followed by HK with total citations in 00 articles, and ML with citations in articles. These differences among the three regions were not significant (P=0.; Fig. ). High-impact respiratory journals and top general medicine journals. 0 articles from these three regions were published in the 0 top-ranking respiratory journals, 0.% (0/0) were in American Journal of Respiratory and Critical Care Medicine, Thorax, Chest, and European Respiratory Journal. TW published articles in the high IF respiratory journals, while ML and HK had and articles, respectively, in the top 0 journals (Table ). A total number of articles (ML, TW, and HK ) were published in the top general medicine journals (NEJM, Lancet, JAMA and BMJ). articles in the field of respirology were selected by the two reviewers. HK owned the most articles of (original articles including RCT and guideline, review, case report, others ; NEJM, JAMA, Lancet, BMJ ), ML had articles (original articles including RCTs, case report, others ; NEJM, JAMA, Lancet 0, BMJ ), and TW had articles (original articles, case report ; NEJM, JAMA, Lancet ). Popular respiratory journals The most popular journals in the three regions are shown in Table. Chest ranked st in HK and TW, while Annals of Thoracic Surgery ranked st in ML. Annals of - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

11 Page 0 of Thoracic Surgery, European Journal of Cardio-Thoracic Surgery, Respirology, The International Journal of Tuberculosis and Lung Disease, Chest are all ranked top : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

12 Page of Discussion: To the best of our knowledge, this is the first report that showed clearly the contributions of Chinese authors in major regions of China ML, HK and TW to the worldwide research in the field of respirology. Our study results showed that the number of published articles from Mainland China had increased significantly in the past ten years, and surpassed HK in 00 and TW in 00. However, when impact factors (IF), citation reports, and articles published in top general medicine journals were taken into quality comparisons, the gap among the three regions appeared wide. HK had the highest average IF of., followed by TW of., ML of., mainly because the readers worldwide preferred English, which was an advantage of HK while a challenge for the other two regions. The number of articles from China in the "respiratory systems" category ranked worldwide in total (.0% for share), although a substantial number of high-quality articles were in Chinese. In addition, the increased articles in the field of respirology suggested similar academic levels as in other fields such as Cardiology, Cardiovasology and Gastroenterology [, ]. The three regions kept equal to each other in terms of randomized controlled trial for the past decades. However, ML has gradually come to the fore since 00. In 00, ML released more reports than TW and HK, suggesting its obvious superiority of large population and relatively low research cost []. However, the published essays, in fact, are just a small part of randomized controlled trials achievements. The reasons are as follows: The records were dispersed not only in the Chinese Clinical Trial Register (ChiCTR), but also in other WHO International Clinical Trials Registry Platform (ICTPR) primary registries or International Committee of Medical Journal Editors (ICMJE) approved registries []. Besides, part of the results were released in Chinese or in the journals not indexed by PubMed. - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

13 Page of Moreover, the randomized controlled trials in China showed a lower publication rate to average [,, ]. The great advances in China have also further promoted relevant research. More and more new Chinese journals are listed in the ISI database, many of which are in English and thus more accessible for the vast majority of researchers all around the world. These journals, though with lower impact factors, are necessary for every research in this area []. The data in our study mainly came from two sources: the PubMed search system and the JCR. The PubMed search system is a comprehensive database run by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine in Bethesda, Maryland, containing articles from high-quality medical journals. The JCR, published by the Institute for Scientific Information in, represents the most comprehensive citation index to the scientific literature, and covers more than 000 journals at 00. Although IF is not the optimal parameter for determining the quality of articles, it is at present the best available parameter for judging the quality of studies. Our study has its limitations, however. A few journals covered resources beyond respiratory even selected from the respiratory systems of SCIE. Besides, some related journals not shown in SCIE were not collected. Some respiratory medicine research articles are published in general journals, rather than in the specialized ones [0]. Searching by the author s address (China, HK or TW) led to another problem that the articles addressed other cities or provinces were not included. Actually, our previous design had taken Macau into consideration, but later we excluded it for its small amount and low correlation. ( in Heart Lung. 00 and in Respirology. 00) In conclusion, the number of articles published from ML, TW, and HK has increased - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

14 Page of significantly during the past ten years. There has also been an appreciable increase in the total number of articles from the three major regions of China from 000 to 00.The number of articles published per year from ML has exceeded that from TW and HK. However, the quality of articles from TW and HK is better than that from ML. - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

15 Page of References [] Guntupalli KK, Gutterman D, Raoof S et al. 00: the year of the lung. Chest 00; :-. [] Sandoval-Gutierrez JL, Reyes ES, Bautista EB. Pulmonary Diseases: First Cause of Mortality in the World. Chest 0; :0. [] Mathers CD, Boerma T, Ma Fat D. Global and regional causes of death. Br Med Bull. 00; :-. [] Chinese Academy of Engineering, Chinese Academy of Sciences, National Academy of Engineering, National Research Council. Introduction of urbanization, energy and air pollution in China: the Challenges Ahead, Proceedings of a symposium. The National Academies Press. Washington, D.C. (00), pp. -. []Fang X, Wang X, Bai C.COPD in China: the burden and importance of proper management.chest 0; :0-. [] Soteriades ES, Falagas ME. A bibliometric analysis in the fields of preventive medicine, occupational and environmental medicine, epidemiology, and public health. BMC Public Health 00; :0. [] Journal search: Science citation index expanded subject categories. Cited 0 September 0. [] PubMed. Cited 0 September 0. Available from URL: [] ISI Journal Citation Reports, Institute for Scientific Information, 0.Cited 0 September 0. Available from URL: [0] STATA statistical software (version.0, Stata. Corp, College Station, TX, U.S.A.) [] ISI Journal Citation Reports, Institute for Scientific Information, 0.Cited 0 September 0. Available from URL: [] Goh KL, Farrell GC. Publications from China: The sleeping giant awakens. J Gastroenterol Hepatol 00; :-. [] Hu LH, Liao Z, Gao R et al. Scientific publications in cardiology and cardiovasology journals from Chinese authors in various parts of North Asia: 0-year survey of literature. Int J Cardiol 00; 0; 0:0-. [] Mervis J. China's unique environment favors large intervention trials. Science ; 0: : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

16 Page of [] Liu XM, Li YP, Yu XT et al. Assessment of registration quality of trials sponsored by China. Journal of Evidence-Based Medicine 00; :. [] Song FJ, Parekh-Bhurke S, Hooper L et al. Extent of publication bias in different categories of research cohorts: a meta-analysis of empirical studies. BMC Medical research methodology 00;: [] Xuemei L, Youping L, Shangqi S et al. Ethical review reporting of Chinese trials records in WHO primary registries.j Med Ethics 0; :-. [] Michalopoulos A, Falagas ME. A Bibliometric Analysis of Global Research Production in Respiratory Medicine. Chest 00; :-. [] Makris GC, Spanos A, Rafailidis PI et al. Increasing contribution of China in modern biomedical research. Statistical data from ISI Web of Knowledge. Med Sci Monit 00; :SR-. [0] Partridge MR, Lewison G. Respiratory research output. Chest 00; 0:. - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

17 Page of Figure Legends Fig.. The trend of the number of articles from Mainland, Taiwan, and Hong Kong during the past ten years. Fig.. The share of articles from Mainland, Taiwan, and Hong Kong during the past ten years. Fig.. Number of articles on randomized controlled trial, case report, review and meta-analysis from Mainland, Taiwan and Hong Kong. Fig.. Total citations of articles from Mainland, Taiwan, and Hong Kong published on respiratory journals from 000 to : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

18 Page of Tables Table. The accumulated and average impact factor of articles from Mainland (ML), Taiwan (TW), and Hong Kong (HK) Year Accumulated impact factor Average impact factor ML HK TW ML HK TW TOTAL : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

19 Page of Table. Articles published on the 0 most influential journals from Mainland (ML), Taiwan (TW) and Hong Kong (HK) Rank Journal 00 IF ML (%) TW (%) HK (%) Total Am J Resp Crit Care 0. 0 Thorax Chest Eur Respir J. J Thorac Oncol. Am J Resp Cell Mol. 0 Am J Physiol Lung C.0. Ann Thorac Surg. 0 J Heart Lung Transpl. 0 Lung Cancer.0 0 Am J Resp Crit Care: American Journal of Respiratory and Critical Care Medicine. IF00=0.; Thorax: IF=.0; Chest: IF=.;Eur Respir J: European Respiratory Journal. IF=.; J Thorac Oncol: Journal of Thoracic Oncology. IF=. ; Am J Resp Cell Mol: American Journal of Respiratory Cell and Molecular Biology. IF=.; Am J Physiol Lung C: American Journal of Physiology - Lung Cellular and Molecular Physiology. IF=.0; Ann Thorac Surg: Annals of Thoracic Surgery. IF=.; J Heart Lung Transpl: The Journal of Heart and Lung Transplantation. IF=.; Lung Cancer: IF= : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

20 Page of Table.The 0 most popular respiratory journals in Mainland (ML), Taiwan (TW) and Hong Kong (HK) Rank ML(n=) N TW(n=0) N HK(n=) N ATS Chest Chest LC ATS 0 Respirology EJCT LC IJTLD JTCS JTCS ATS Respirology EJCT ERJ Respiration Respirology Thorax IJTLD IJTLD RM 0 Chest PP PP RR TCS AJRCC 0 PPT JA EJCT ATS: Annals of Thoracic Surgery. IF=.; LC: Lung Cancer. IF=.0; EJCT: European Journal of Cardio-Thoracic Surgery. IF=.; JTCS:Journal of Thoracic and Cardiovascular Surgery. IF=.0; Respirology: IF=.; Respiration: IF=.; IJTLD: The International Journal of Tuberculosis and Lung Disease. IF=.; Chest: IF=.; RR: Respiratory Research. IF=.; PPT: Pulmonary Pharmacology and Therapeutics. IF=.0; PP: Pediatric Pulmonology. IF=.; TCS: Thoracic and Cardiovascular Surgeon. IF=0.; JA: Journal of Asthma. IF=.; ERJ: European Respiratory Journal. IF=.; Thorax: IF=.0; RM: Respiratory Medicine. IF=.; AJRCC: American Journal of Respiratory and Critical Care Medicine. IF= : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

21 Page 0 of xmm ( x DPI) - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

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23 Page of xmm ( x DPI) - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

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25 Page of PRISMA 00 Checklist Reported Section/topic # Checklist item on page # TITLE Title Identify the report as a systematic review, meta-analysis, or both. 0 ABSTRACT Structured summary Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number. INTRODUCTION Rationale Describe the rationale for the review in the context of what is already known. Objectives Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS). 0 METHODS Protocol and registration Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide N/A registration information including registration number. Eligibility criteria Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale. Information sources Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched. 0 Search Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated. Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis). Data collection process 0 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators. Data items List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made. 0 Risk of bias in individual Describe methods used for assessing risk of bias of individual studies (including specification of whether this was studies done at the study or outcome level), and how this information is to be used in any data synthesis. Summary measures State the principal summary measures (e.g., risk ratio, difference in means). Synthesis of results Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I ) for each meta-analysis. - Page of on 0 April 0 by guest. Protected by copyright. : first published as 0./bmjopen on February 0. Downloaded from N/A

26 Page of PRISMA 00 Checklist Reported Section/topic # Checklist item on page # Risk of bias across studies Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective N/A reporting within studies). Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating 0 which were pre-specified. RESULTS Study selection Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram. Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations. Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment (see item ). N/A - Synthesis of results Present results of each meta-analysis done, including confidence intervals and measures of consistency. N/A Risk of bias across studies Present results of any assessment of risk of bias across studies (see Item ). N/A Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item ]). - DISCUSSION 0 Limitations Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias). Conclusions Provide a general interpretation of the results in the context of other evidence, and implications for future research. FUNDING Funding Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the N/A systematic review. 0 From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (00). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med (): e0000. doi:0./journal.pmed0000 For more information, visit: Page of Results of individual studies Summary of evidence 0 For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to 0 intervention group (b) effect estimates and confidence intervals, ideally with a forest plot. key groups (e.g., healthcare providers, users, and policy makers). on 0 April 0 by guest. Protected by copyright. : first published as 0./bmjopen on February 0. Downloaded from

27 Scientific publications in respiratory journals from Chinese authors in various parts of North Asia: 0-year survey of literature Journal: Manuscript ID: bmjopen r Article Type: Research Date Submitted by the Author: -Jan-0 Complete List of Authors: Ye, Bo; Changhai hospital, Internal medicine Du, Ting-Ting; Changhai hospital, Internal medicine Xie, Ting; Zhongda hospital, Internal mdicine Ji, Jun-Tao; Changhai hospital, Internal medicine Zheng, Zhao-Hong; Changhai hospital, Internal medicine Liao, Zhuan; Changhai hospital, Internal medicine Hu, Liang-Hao; Changhai hospital, Internal medicine Li, Zhao-Shen; Changhai Hospital, Second Military Medical University, Internal medicine <b>primary Subject Heading</b>: Respiratory medicine Secondary Subject Heading: Respiratory medicine Keywords: INTERNAL MEDICINE, MEDICAL HISTORY, RESPIRATORY MEDICINE (see Thoracic Medicine) : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

28 Page of Title Page Scientific publications in respiratory journals from Chinese authors in various parts of North Asia: 0-year survey of literature Bo Ye *, M.D., Ting-Ting Du *, M.D., Ting Xie *, M.D., Jun-Tao Ji, M.D., Zhao- Hong Zheng, M.D., Zhuan Liao, M.D., Liang-Hao Hu, M.D., Zhao-Shen Li, M.D. Department of internal medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China; Department of internal medicine, Zhongda Hospital, the Southeast University, Nanjing,China Running title: Scientific Publications in respirology from Chinese authors. *Dr. Ye., Dr. Du and Dr. Xie contributed equally to this work. Correspondence: Prof. Zhao-Shen Li, OR Liang-Hao Hu Department of internal medicine Changhai Hospital The Second Military Medical University Changhai Road Shanghai 00, China Tel: +-- Fax: zhaoshen-li@hotmail.com OR lianghao-hu@hotmail.com - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

29 Page of Keywords: impact factor (IF); science citation index expanded (SCIE); journal citation reports (JCR); respirology - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

30 Page of Abstract Background: Respiratory disease remains one of the leading causes of morbidity and mortality in China. However, little is known about the research status of respirology in the three major regions of China Mainland (ML), Hong Kong (HK) and Taiwan (TW).A 0-year survey of literature was conducted to compare the three regions outputs in the research of respirology. Methods: We searched PubMed database to identify the related articles from 000 to 00. The number of total articles, randomized controlled trials, case reports, metaanalysis, impact factors (IF), citations, and articles published in top general medicine journals were conducted for quantity and quality comparisons. Results: 0 articles were collected, from ML, 0 from TW and from HK. The total number of articles from the three regions has increased significantly from 000 and 00.The number of articles published per year from ML has exceeded that from HK in 00 and TW in 00. The accumulated IF of articles from TW (.) was much higher than that from ML (0.) and HK (.). HK got the highest average IF of respirology articles and the majority of articles were published in top general medicine journals. Conclusion: The total number of published articles from the three major regions of China has increased notably from 000 to 00. The annual number of publications by ML researchers exceeded those from TW and HK. However, the quality of articles from TW and HK is better than that from ML. - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

31 Page of Article summary Article focus ) How many articles in respiratory journals were published from the three major regions of China from 000 to 00? ) What is the trend? ) How is the quality of these articles? Key messages ) 0 articles in respiratory journals were published from the three major regions of China from 000 to 00, from ML, 0 from TW and from HK. The total number of articles from the three regions has increased significantly from 000 and 00.The number of articles published per year from ML has exceeded that from HK in 00 and TW in 00. ) The accumulated IF of articles from TW (.) was much higher than that from ML (0.) and HK (.). ) HK got the highest average IF of respirology articles and the majority of articles were published in top general medicine journals. Strengths and limitations of this study A few journals covered resources beyond respiratory even selected from the respiratory system of SCIE. Besides, some related journals not shown in SCIE were not collected. Some respiratory medicine research articles were published in general journals, rather than in the specialized ones. Searching by the author s address (China, HK or TW) led to another problem that the articles addressed other cities or provinces were not included. Actually, our previous design had taken Macau into consideration, but later we excluded it for its small amount and low correlation. - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

32 Page of Abbreviation List ACCP American College of Chest Physicians BMJ British Medical Journal ChiCTR Chinese Clinical Trial Register HK Hong Kong ICMJE ICTPR International Committee of Medical Journal Editors International Clinical Trials Registry Platform IF impact factors ISI Institute for Scientific Information JAMA Journal of the American Medical Association JCR journal citation reports ML Mainland NCBI National Center for Biotechnology Information NEJM RCT SCIE TW WHO The New England Journal of Medicine randomized controlled trials science citation index expanded Taiwan World Health Organization - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

33 Page of Introduction: Pulmonary diseases are matters of concern for all the countries. Lung disease accounts for % of disability-adjusted life-years [] and may be the first cause of mortality in the world [, ]. In China, under the influence of the dramatic economic evolution and urbanization progress, the levels and patterns of outdoor and indoor air pollutants have greatly changed. Hundreds of cities suffer the substandard air quality according to the World Health Organization (WHO) guidelines [].Besides, with a population of. billion, China has become a major contributor to the worldwide respiratory disease burden [, ].In terms of the fatality rate, respiratory disease comes the first in rural areas and the fourth in urban areas in China. However, little is known about the research status of respirology in the three major regions of China Mainland (ML), Hong Kong (HK) and Taiwan (TW) []. We therefore conducted a 0-year survey of literature and compared these three regions outputs in the research of respirology. - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

34 Page of Methods and Materials: A total of journals related to respirology were selected from the "respiratory system" category of Science Citation Index Expanded (SCIE) subject categories by the Institute for Scientific Information(ISI) [].The category covers resources dealing with the diagnosis and treatment of respiratory disease and focuses on prevention, pharmacology, surgery, transplantation, and research. Annals of Thoracic Medicine, COPD and Portuguese Journal of Pulmonology (Revista Portuguesa de Pneumologia) were not indexed by PubMed, so they were excluded. A computerized literature search was conducted in the PubMed database on 0 September 0 (URL: Articles from ML, TW and HK from January 000 to December 00 in these journals were elicited respectively. We used the ISSN to perform searches in PubMed. The search terms used were: (00-00 OR 0-X OR 0- OR - OR 000- OR 000- OR - OR 00- OR - OR 0- OR - OR 00- OR 00-0 OR 00- OR 00- OR 0- OR 0- OR 0- OR - OR 0-00 OR 0-00 OR - OR 0- OR 00- OR -0 OR 0-00 OR 0-00 OR -X OR -0 OR - OR 0- OR 00- OR 000- OR 0- OR -0 OR - OR - OR 0- OR 0- OR 0- OR -00 OR 0- OR 0- OR 0- OR 000- OR - AND TAIWAN[AD] AND 000[DP] )AND Hong Kong[AD], Taiwan[AD],and China[AD] NOT Hong Kong[AD] NOT Taiwan[AD]. Articles that showed the first author's affiliation (AD) with these three regions were considered as research outputs from the regions. Articles in the fields of randomized controlled trials (RCT), review, - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

35 Page of meta-analysis and case reports were generated respectively, according to the publication types by PubMed. To compare the quality of the research articles, three methods were used: () the accumulated impact factors (IF) and the average IF were generated according to Journal Citation Reports (JCR) 00 established by the ISI (URL: () citation reports of articles showing an affiliation with a Chinese institution were conducted; () articles published in top general medicine journals [The New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), The Lancet, and British Medical Journal (BMJ)] were also generated. Articles related to respirology were first extracted independently by two reviewers (Du T.T and Hu L.H.), and any disagreement between the reviewers was resolved by viewing the titles, abstracts, and full text if necessary. The number of articles published by each region in the top 0 high-impact respiratory journals was also compared. We determined the 0 most popular respiratory journals containing articles from the three regions of China according to the number of such articles published by each journal. Statistical analysis Statistical analyses were performed using STATA.0 [].The nonparametric test for trend was performed to confirm any significant change of the total numbers over the period of time. Kruskal-Wallis test was used for detecting the difference among the three regions, and rank-sum test between two if necessary. The test for significance was two-tailed and the value of P<0.0 was considered significant. - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

36 Page of Results: Total number of articles A total number of articles were published in the selected journals within the period 000 to 00 worldwide. There were 0 articles (0/,.%) from ML (/0,.%), TW (0/0.%) and HK (/0,.0%).The numbers increased significantly from 00 to 00 in the three regions (from to, P=0.00 for trend, to, P=0.00, to, P=0.0, respectively, Fig. ). From 00 onwards, the number of articles from ML has exceeded that from HK and in 00 ML exceeded TW. The share of articles was on the rise in ML (P=0.00) and TW (P=0.00), but not in HK (P=0., Fig. ). Randomized controlled trial, review, meta-analysis and case report In respect of randomized controlled trial (Fig. ), it shows no difference among the three regions (ML vs. TW vs. HK, P=0.). In respect of review, ML and TW (ML vs.tw P=0.) showed no significant difference, while less than HK (ML vs. HK P=0.0; TW vs. HK P=0.00). Besides, we found a number of meta-analysis from ML since 00, but few from TW and HK. However, showed for case report, ML and HK (ML vs. HK P=0.) were equal to each other, while less than TW (TW vs. HK P=0.000; TW vs.ml P=0.00). Impact factors According to the JCR, journals in the "respiratory system" had IF in 00 (URL: journals in our study had no IF. Excluding them, the accumulated IF of articles from TW (.) was much higher than that from ML (0.) and HK (., P=0.0). However, HK took the highest average IF - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

37 Page 0 of of., followed by TW of., ML of. (P=0.00, Table ). Citation reports of articles published in the respiratory journals. The ISI has not set up a function for finding a citation report of articles by limiting the department of the corresponding author, so in this citation reports the articles included were affiliated with a Chinese institution, more than the previous search results in PubMed [0]. According to our analysis, TW got the highest total citations of 0 (0 articles), followed by HK with total citations in 00 articles, and ML with citations in articles. These differences among the three regions were not significant (P=0.; Fig. ). High-impact respiratory journals and top general medicine journals. 0 articles from these three regions were published in the 0 top-ranking respiratory journals, 0.% (0/0) were in American Journal of Respiratory and Critical Care Medicine, Thorax, Chest, and European Respiratory Journal. TW published articles in the high IF respiratory journals, while ML and HK had and articles, respectively, in the top 0 journals (Table ). A total number of articles (ML, TW, and HK ) were published in the top general medicine journals (NEJM, Lancet, JAMA and BMJ). articles in the field of respirology were selected by the two reviewers. HK owned the most articles of (original articles including RCT and guideline, review, case report, others ; NEJM, JAMA, Lancet, BMJ ), ML had articles (original articles including RCTs, case report, others ; NEJM, JAMA, Lancet 0, BMJ ), and TW had articles (original articles, case report ; NEJM, JAMA, Lancet ). - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

38 Page of Popular respiratory journals The most popular journals in the three regions are shown in Table. Chest ranked the first in HK and TW, while Annals of Thoracic Surgery ranked the first in ML. Annals of Thoracic Surgery, European Journal of Cardio-Thoracic Surgery, Respirology, The International Journal of Tuberculosis and Lung Disease, Chest are all ranked top : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.

39 Page of Discussion: To the best of our knowledge, this is the first report that showed clearly the contributions of Chinese authors in major regions of China ML, HK and TW to the worldwide research in the field of respirology. Our study results showed that the number of published articles from Mainland China had increased significantly in the past ten years, and surpassed HK in 00 and TW in 00. However, when impact factors (IF), citation reports, and articles published in top general medicine journals were taken into quality comparisons, the gap among the three regions appeared wide. HK had the highest average IF of., followed by TW of., ML of., mainly because the readers worldwide preferred English, which gave HK an advantage over the other two regions. The number of articles from China in the "respiratory system" category ranked worldwide in total (.% for share), although a substantial number of high-quality articles were in Chinese. In addition, the situation that the articles increased in the field of respirology was also found in other fields, such as Cardiology, Cardiovasology and Gastroenterology [, ]. The three regions kept equal to each other in terms of randomized controlled trial for the past decades. However, ML has gradually come to the fore since 00. In 00, ML released more reports than TW and HK, indicating its obvious superiority of large population and relatively low research cost []. However, the published essays, in fact, are just a small part of randomized controlled trials achievements. The reasons are as follows: The records were dispersed not only in the Chinese Clinical Trial Register (ChiCTR), but also in other WHO International Clinical Trials Registry Platform (ICTPR) primary registries or International Committee of Medical Journal Editors (ICMJE) approved registries []. Besides, part of the results were released in Chinese or in the journals not indexed by PubMed. - : first published as 0./bmjopen on February 0. Downloaded from on 0 April 0 by guest. Protected by copyright.