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Cardiovascular Research 2005 65(1):1-5; doi:10.1016/j.cardiores.2004.11.014
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Copyright © 2004, European Society of Cardiology

Which papers are most interesting to the readers of Cardiovascular Research? Information from download monitoring

David Garcia-Dorado, Klaus-Dieter Schlüter, Elizabeth A. Martinson* and Hans Michael Piper

Cardiovascular Research Editorial Office, Aulweg 129, D-35392 Giessen, Germany Email address: CVR{at}physiologie.med.uni-giessen.de

* Corresponding author. Tel.: +49 641 99 47 242; fax: +49 641 99 47 209.

Measuring the diffusion and impact of scientific papers is a difficult task with many potential applications. In recent years, download monitoring has emerged as a new tool that can help serve this purpose.

Currently, virtually all of the most prominent scientific journals have electronic versions that may be accessed over the Internet, and while journals that are exclusively electronic still have a very limited impact no matter how it is measured, electronic access has become an increasingly important method of diffusion of scientific papers as compared to classical, mail-distributed printed issues.

Monitoring of downloads permits an estimation of the number of readers attracted by an individual article, something that was not possible when diffusion was based only on hard-copy mailing. It is clear that simply reading an article is different from finding new and useful information in it that may contribute to subsequent scientific production, which is what the ISI impact factor aims to measure. It is also clear that download monitoring ignores the readers who obtain their articles as printed copies only. Nevertheless, download monitoring has the advantage of providing immediate information, something that any index based on citations cannot provide. We may take it now as an "interest factor" for our electronically published manuscripts. Unfortunately, this parameter can easily be spoiled, e.g., if authors become aware of download monitoring and start downloading their own articles.

We have analyzed downloads of articles published in Cardiovascular Research between June, 2003, and June, 2004. The number of times any individual article was downloaded during the 90 days following its online publication was counted, and articles were ranked according to this number. Analysis of this ranking provides a clear indication about the preferences of our readership. It must be stressed that, in principle, readers decide to download an article before having seen it in full text, based mainly on its title, abstract, authors, and keywords, and that, accordingly, this decision is not directly related to the quality of the full paper. Thus, the ranking should not be expected to reflect the quality of the full papers but rather to serve as a guide for which topics are currently interesting to our readers.

The first thing that we noticed in the top-ranked downloads is a preference for review articles; among the first 50 most downloaded articles, 28 are review articles. This is not surprising and agrees with the well-known fact that review articles tend to get more citations than regular papers. The topics of the most downloaded reviews seem to concentrate on a few areas (Table 1), most noticeably the areas covered by our Spotlight Issues. For example, 6 of the 10 most downloaded reviews were published in the Spotlight Issue on Reperfusion Injury in February of 2004. We take this as an acclaim for our concept of the Spotlight Issue in which this Journal has played a pioneering role.


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  		Table 1 The top 20 review articles in order of frequency of downloads from June, 2003, to June, 2004

 
Another important piece of information can be gleaned from an analysis of the downloads of original, full-length articles. The 20 most downloaded original articles (Table 2) can be grouped into four major areas of interest: (I) Vascular Biology/Atherosclerosis (seven articles); (II) Ischemia/Myocardial Protection (five articles); (III) Myocardial Disease/Remodeling/Arrhythmias (four articles); (IV) Cell Biology/Cell Differentiation (four articles). Each of these areas is discussed in greater detail below.


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  		Table 2 The top 20 original articles in order of frequency of downloads from June, 2003, to June, 2004

 
(I) The leading category based on number of original articles in the top 20 shows that there is substantial interest in papers published on vascular biology and atherosclerosis. This makes it apparent that the Journal has shifted its center of gravity from predominantly cardiac topics to the cardiovascular field in general. The seven original papers in this area include very different topics and approaches that have in common a high scientific and/or practical relevance. Atherosclerosis is the leading cause of death in industrialized countries and, far from being a receding epidemic, its social impact in the world as a whole is expected to continuously increase during the next 20 years. Devising strategies that could be useful for the primary prevention of atherosclerosis is, thus, a major goal in the cardiovascular field, and one of the most important approaches in this field is dietary intervention. In this regard, the inverse association between increased fish oil intake and cardiovascular mortality has aroused great interest, and thus the high number of downloads of the study by Wang et al. [37] is not surprising as this shows that fish oil may in fact be protective by reducing oxidative stress rather than, as often assumed, lowering the lipid load. In fact, oxidative stress is being increasingly recognized as a key factor in atherogenesis, although the exact mechanisms of this influence are not completely understood. The contribution from Barbieri et al. [34] proposed that one of these mechanisms is based on monocyte differentiation into macrophages. This differentiation is mediated by activation of COX-2 in response to reactive oxygen species (ROS) generated by NADPH, an enzyme whose prominent role in the genesis of oxidative stress is being revealed as essential in many pathologic conditions.

If oxygen radicals play usually the foe and can also be a friend, the opposite can be said of nitric oxide (NO) that, usually a friend, can behave as a foe. One of the mechanisms by which this can happen was described in the article by Takeuchi et al. [39] showing that high NO concentrations can be detrimental by inhibiting agonist-induced Ca2+ responses independent of cyclic GMP, reducing the production of endothelium-derived relaxation factors, and interfering with endothelial NO synthase protein expression.

Analysis of gene expression can be a powerful tool for investigating the mechanisms of atherogenesis, and Martinet et al. [27] made a Western array analysis of human atherosclerotic plaques to identify the potential role of changes in apoptosis-linked gene 2 expression leading to reduced apoptosis in plaque growth and progression. Changes in the expression of several proteins, in this case opposing oxidative stress, seem to play a crucial role in the genesis of endothelial dysfunction in spontaneously hypertensive rats according to a paper by Ülker et al. [31]. Another of the most downloaded papers dealt with other critical aspects of vascular disease and hypertension; Hong et al. [40] described that smooth muscle cell proliferation is mediated by ROS through the redox-sensitive ERK pathway and increased endothelin ET-1 gene expression. Finally, Mulhaupt et al. [29] described the pharmacological modulation of CD40, recently recognized as an important factor in the pathophysiology of acute coronary syndromes, by statins. The attention given this article was no doubt potentiated by the enormous therapeutic importance of these drugs and their administration to an increasing number of patients.

(II) Ischemia and cardioprotection have classically occupied a prominent place within the cardio part of our journal. Thus, it is not surprising that five of the most downloaded articles come from this area. Three of them deal with various mechanisms of cardioprotection and novel intracellular signaling pathways involved therein. Li et al. [22] extended the evidence supporting the protective role of the PI3K/Akt signaling pathway and described a mechanism by which inflammatory-like responses may aggravate postreperfusion necrosis: i.e., via Toll-like receptor-induced NF{kappa}B signaling. Bao et al. [23] provided additional evidence suggesting a role of Rho-kinase in lethal myocardial injury secondary to ischemia/reperfusion. Nishino et al. [36] described a new connection between two signaling pathways involved in ischemic preconditioning, PKC and the less-known (in its role in preconditioning signaling) AMP-activated protein kinase (AMPK), by showing in a model of myocardial stunning that preconditioning activates AMPK and up-regulates GLUT4 expression in a PKC-dependent manner.

The other two papers in this category provide new insights into the mechanisms responsible for reperfusion injury and apoptosis. Kin et al. [33] characterized some aspects of "postconditioning", a form of modified reperfusion that is starting to arouse great interest. The study confirms the importance of the first minute of reperfusion in the genesis of reperfusion injury and proposes an important role for oxidative stress. Tatsumi et al. [32], by exposing neonatal cardiomyocytes to prolonged hypoxia, extended the available evidence showing that apoptosis and necrosis may be different outcomes of the same pathways and that the cellular ATP concentration can play a pivotal role in deciding the type of cell death finally occurring. As the real importance of apoptosis as a form of cell death in reperfused myocardium is still a hotly debated subject, the interest stimulated by this article is easy to understand.

(III) Dilated cardiomyopathy and diabetes are two major diseases in the cardiovascular field. Thus, all attempts to improve our current understanding of the progression of these diseases is of great interest for basic and clinical science. Grzeskowiak et al. [25], in a paper on human idiopathic dilated cardiomyopathy, offered the "largest and most unbiased gene set interrogated in an array-based cardiovascular study", certainly a valuable resource for future studies. Desrois et al. [26] used the Goto–Kakizaki (GK) rat, a polygenic model of spontaneous type 2 diabetes, to show that insulin receptors, insulin receptor substrate-1, and GLUT4 glucose transporters are down-regulated in cardiac tissue in this model of type 2 diabetes.

Atrial structural and electrical remodeling has an important impact on the prognosis of patients with heart failure. Cardin et al. [38] investigated the influence of angiotensin-converting enzyme (ACE) inhibition on atrial cell apoptosis and atrial remodeling in dogs undergoing a ventricular tachypacing procedure. They showed that ACE inhibition has only a limited impact on atrial structural remodeling in spite of its potency in suppressing atrial apoptosis. Porter et al. [28] used cardiac myofibroblasts from human atrial biopsies and studied the impact of statins on their proliferation. They found that these substances reduce myofibroblast proliferation, suggesting that they may be of use in preventing adverse atrial remodeling. Their paper adds another aspect of the pleiotropic effects of statins to the literature.

(IV) Finally, studies representing areas of cell biology, cell differentiation, or development were well recognized by the readership of Cardiovascular Research. Among these was a report by Iglesias et al. [21] characterizing the synthesis and secretion of growth hormone releasing peptide (ghrelin) in cardiomyocytes from mice and humans. This paper certainly caught so much attention because it reports on a novel peptide with interesting pathophysiological perspectives, as ghrelin may confer an antiapoptotic effect. Another cell biology report investigated a polymorphism of the human cardiac sodium channel (SCN5A) promoter [30], suggesting a functional role of a common gene polymorphism. Compernolle et al. [35] studied the impact of HIF-1{alpha} on cardiovascular development. This study improves our current understanding by showing that this transcription factor modulates the interplay between neural crest cell migration and ventricle formation. The ever-popular and growing field of stem cell biology was represented by a study published by Le Ricousse-Roussanne et al. [24], who analyzed the differentiation and homing of progenitor cells for endothelial and smooth muscle cells.

In summary, the Editorial Board is quite pleased not only with the high interest in these specific manuscripts by the scientific community, but also with the fact that the most frequently downloaded manuscripts come from such a broad field of cardiovascular science.


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