Journal Authors Research Articles

Temporal and geogrpahic trends in female representation within European cardiovascular imaging among 13,436 individuals associated with EACVI

Abstract Introduction Women are under-represented in cardiology trial enrolment, specialty training, faculty, scientific authorship and board membership in cardiology journals and societies. An EACVI Task Force on Women in Cardiovascular Imaging aims to promote women’s representation and leadership, but data is lacking in this area. Purpose To characterise the representation of women in cardiovascular imaging within Europe and examine temporal and geographic trends. Methods We scraped publicly available name data from over 100 online sources including EACVI taskforces, committees, research project members, consensus and position paper authors, board membership and past presidents alongside members of affiliated cardiovascular imaging national societies and working groups. We also included names from EACVI or national accreditation records for cardiac imaging. We recorded data on country location and year of affiliation. We defined gender in a binary manner as either male or female. The previously validated artificial intelligence (AI) system Namsor assigned gender based on name morphology and geolocation data. We pre-set a confidence of gender-name matching of 95%. Results The AI was able to assign gender at 95% confidence to 12,643/13,436 (94.1%) names. The overall number of names assigned female gender was 5903/12643 (46.7%), rejecting the null hypothesis that gender was equally distributed (i.e. 50% female) [p<0.0001]. Among the 9712 individuals with year of affiliation we observed female representation to increase over time: 1989-2000 4/18 (22.2%), 2001-2004 107/287 (37.8%) 2005-2009 77/170 (45.3%), 2010-2014 109/203 (53.7%), 2015-2019 1063/2022 (51.3%) and 2020-2024 3352/3064 (52.2%) (Cochran-Armitage trend test 24.196 [p<0.0001]) (Figure 1). Female representation was lower in countries outside of Europe, compared to within Europe; 740/2654 (27.9%) vs. 5163/9989 (51.7%) [p<0.0001]. The lowest rate of female representation was in Saudia Arabia (15.1%), the highest in Lithuania (83.3%). Figure 2 displays a choropleth of gender representation (%) between European countries with n>20. Conclusion(s) There are significant limitations in this form of analysis, including that we have arbritarily defined gender in a binary format, thereby excluding individuals who do not identify with such a social construct. It is also likely that the excluded names based on the 95% confidence of the AI software disproportionately represents individuals from ethnic minorities. However, our data provides a basic understanding of the representation of women in European cardiovascular imaging over time and between countries. We observed a trend of increasing female participation but with substantial variation between countries both inside and outside of Europe. This data may be useful to refine and direct efforts to improve female representation in areas in which it is needed most.

Editorial diversity correlates with journal impact factor and author diversity in cardiothoracic surgery.

While there are no widely accepted diversity, equity, and inclusion (DEI) metrics for journals, geographic and sex diversity across a journal's editorial board may provide a surrogate measure of its commitment to DEI. We explored the association between journal quality and DEI metrics for cardiothoracic surgery (CTS) journals and investigated whether editorial diversity correlates with diversity across published articles. We collected the following data for 30 CTS journals: country of publication (categorized by income level), journal quality metrics (citation-based metrics, e.g., impact factor (IF) or H-index), and sex and geographic representation across editorial boards and published articles. Bivariate correlations between numeric variables were assessed using Spearman's correlation. Female representation across editorial boards was 12.1%. Most editorial board members belonged to the United States (35.2%), with only 7.4% from the lower-middle-income countries and 0% from low-income countries. IF showed a strong positive correlation with female editorial representation (r=0.70) but an inverse correlation with low- and middle-income countries (LMICs) editorial representation (r=-0.45). Female editorial representation demonstrated a significant positive correlation with female first authorship (r=0.45), whereas LMIC editorial representation correlated strongly with LMIC corresponding authorship (r=0.85). Women and researchers from LMICs are in the minority across editorial boards of CTS journals. However, a strong correlation between journal H-index and female editorial representation indicates that top-ranked journals are spearheading efforts to improve equitable sex-based and gender representations. Similar efforts are required to ensure more global geographic representation across editorial boards and top-ranked CTS journals are the best placed to lead by example.

The BIAD Standards: Recommendations for Archaeological Data Publication and Insights From the Big Interdisciplinary Archaeological Database

Abstract This article presents a series of recommendations for the publication of archaeological data, to improve their usability. These 12 recommendations were formulated by archaeological data experts who mined thousands of publications for different data types (including funerary practices, accelerator mass spectrometry dating, stable isotopes, zooarchaeology, archaeobotany and pathologies) during the initial construction of the Big Interdisciplinary Archaeological Database (BIAD). We also include data harmonisation vocabularies utilised for the integration of data from different recording systems. The case studies we cite to illustrate the recommendations are grounded in examples from the published literature and are presented in a problem/solution format. Though practically oriented towards the facilitation of efficient databasing, these recommendations – which we refer to as the BIAD Standards – are broadly applicable by those who want to extract scientific data from archaeological information, those who work with a specific region or theoretical focus and journal editors and manuscript authors. We anticipate that the use of the BIAD Standards will increase the usability, visibility, interoperability and longevity of published data and also increase the citations of those publications from which data were mined. The Standards will also help frame a unified foundation to support the continued integration of the natural sciences with archaeological research in the future.

“O Author, Where Art Thou?” An Analysis of Affiliation Indexing in Canadian Journals and Bibliometric Research Potential

Bibliometrics in the social sciences, humanities and arts (SSHA) are hampered by the limited presence of scholarly journals in analysis tools traditionally used. We analyzed the level of indexing of Canadian journal author affiliations in Dimensions.ai and OpenAlex to assess effects on bibliometric research. Annually, around 3,500 articles signed by Canadian researchers and published in Canadian journals remained irretrievable. Incomplete indexing particularly affects journals associated with not-for-profit publishers and those publishing in French. A fair representation of national SSHA research could enhance our understanding of publishing trends and contribute to the sustainability of the Canadian journals.

Comparison of Instructions to Authors and Reporting of Ethics Components in Selected African Biomedical Journals: 2008 and 2017.

Journal editors instruct authors to describe human participant protections in original research reports. However, little is known about African biomedical journal authors' adherence to such journal editors' instructions. This study investigated changes in editors' instructions to authors and authors' reporting of research ethics information in selected African biomedical journals between 2008 and 2017. Twelve selected journal websites and online articles were reviewed in Eastern, Southern, and Western African [ESWA] countries. A pre-tested schema and a checklist were used to collect data from journal websites and articles published in 2008 and 2017, and the data were analysed using descriptive and inferential statistics. Half of the journals requested prospective authors to disclose ethics approval and related issues in their manuscripts between 2008 and 2017. There was a significant increase in instructions to authors regarding information on the protection of research participants within this period; more authors complied with these requirements in 2017 than in 2007.

Sex and gender bias in chronic coronary syndromes research: analysis of studies used to inform the 2019 European Society of Cardiology guidelines

Sex and gender inequalities in ischemic heart diseases persist. Although ischemic heart disease is less common in women, they experience worse clinical outcomes and are less likely to receive guideline-recommended treatments. The primary scientific literature from which clinical guideline recommendations are derived may not have considered potential sex- and gender biases. This study aims to determine whether the literature cited in recent cardiovascular guidelines' clinical recommendations contain sex and gender biases. We analysed publications cited in the 2019 European Society of Cardiology (ESC) guideline recommendations on chronic coronary syndromes, using a checklist to guide data extraction and evaluate the individual studies for sex- and gender-related aspects, such as inclusion/exclusion criteria, outcome measures, and demographic data reporting. To assess representation over time, the proportion of women participants in each study was computed and analysed using a beta regression model. We also examined the associations between women's representation, journal impact factor and author gender. Among the 20 ESC recommendations on chronic coronary syndromes, four contained sex-related statements; we did not identify any gender-specific suggestions. The referenced literature upon which these recommendations were based consisted of 108 articles published between 1991 and 2019, encompassing more than 1.6 million study participants (26.8%; 432,284 women). Only three studies incorporated sex-sensitive designs; none were gender-specific. The term "gender" did not occur in 84% (n=91/108) of the publications; when used, it was exclusively to denote biological sex. The proportion of women (assumed by investigators) among study participants fluctuated over time. Having a woman as first (odds ratio (OR)=1.68, 95% CI: 1.19-2.39) or last author (OR=2.28, 95% CI: 1.31-3.97), was significantly associated with having more women participants in the study. The data underlying ESC guideline recommendations largely lack reporting of possible sex- and gender-specific aspects, and women are distinctly underrepresented. To what extent these recommendations apply to members of specific population groups who are not well-represented in the underlying evidence base remains unknown. This study is part of the Gender and Health Inequalities (GENDHI) project, ERC-2019-SyG. This project has received funding from the European Research Council (ERC).

Identifying the Most Cited Articles and Authors in Educational Psychology Journals from 1988 to 2023

Identifying the Most Cited Articles and Authors in Educational Psychology Journals from 1988 to 2023

Research and publication at crossroads

Writing and publishing scientific and rigorous work needs a high level of integrity and adherence to ethical guidelines. Several publications have been rejected by authentic journals as a result of not adhering to a deontological standpoint. This laxity has posed deadly repercussions to the beholder including ruining its institutional image in academic scholarship. Notwithstanding, numerous writers are acquainted with the consequences of not observing ethical standards in research and publication, yet in trying to put up their pieces of work get caught in the same quandary. Anchored on a thematically oriented review of literature, it was imperative to try to explain the key ethical misconduct bases in research and publication. To fulfil this quest many journal articles were analysed. It was found that numerous aspects form the basis for misconduct in research and publication including; the pressure to ‘publish or perish’, the limitation of mentorship and guidance programs, knowledge on research and publication, promotion and academic advancement, competition among colleagues, workload pressure, financial motives, pressure from individual morality, and the challenge of research culture. Consequently, it is imperative to note that to publish a scholarly piece of work, adhering to ethical standards is non-negotiable.

The cutting-edge roles of lasers in endodontics: A bibliometric and scientometric analysis of the 100 most-cited articles

Purpose: This bibliometric and scientometric analysis aimed to delve into the forefront roles of lasers in endodontics from 1990 to 2024. Methods: A comprehensive electronic search was conducted using “Clarivate Analytics Web of Science, All Databases” to retrieve the most-cited articles pertaining to the topic. These articles were then ranked in descending order according to their citation counts and the top 100 were selected for further analysis. Parameters including citation density, publication year, journal, journal impact factor (IF), country, institution, author, study design, study field, evidence level, laser type, and keywords were meticulously analyzed. Results: The mean and standard deviations of total citation and citation density were 106.47 ± 65.76 and 7.61 ± 5.13, respectively. Positive and negative correlations were found between the number of citations and citation density and age of publication. While the mean number of citations was significantly higher in the period 2001–2010 compared to the other periods (P < 0.05), values were similar between the periods 1990–2000 and 2011–2014 (P > 0.05). Articles were mainly published in the Journal of Endodontics. The most productive country, institutions, and author were the United States, the University of Showa, and Koukichi Matsumoto. Diode and Er: YAG lasers were commonly investigated. Ex vivo studies were mainly performed followed by in vitro ones. The main study field was “antimicrobial effect”. Among keywords, “photodynamic therapy” was used more frequently. Conclusion: Lasers are predominantly utilized to leverage their antimicrobial efficacy. Advancements in technology will lead to improvements in the properties of lasers, thereby enhancing the disinfection of the root canal system.

Sharing practices of software artefacts and source code for reproducible research

AbstractWhile source code of software and algorithms depicts an essential component in all fields of modern research involving data analysis and processing steps, it is uncommonly shared upon publication of results throughout disciplines. Simple guidelines to generate reproducible source code have been published. Still, code optimization supporting its repurposing to different settings is often neglected and even less thought of to be registered in catalogues for a public reuse. Though all research output should be reasonably curated in terms of reproducibility, it has been shown that researchers are frequently non-compliant with availability statements in their publications. These do not even include the use of persistent unique identifiers that would allow referencing archives of code artefacts at certain versions and time for long-lasting links to research articles. In this work, we provide an analysis on current practices of authors in open scientific journals in regard to code availability indications, FAIR principles applied to code and algorithms. We present common repositories of choice among authors. Results further show disciplinary differences of code availability in scholarly publications over the past years. We advocate proper description, archiving and referencing of source code and methods as part of the scientific knowledge, also appealing to editorial boards and reviewers for supervision.

Effect of Progressive Muscle Relaxation on Reducing Anxiety in Cancer Patients: Literature Review

One of the symptoms of cancer is the emergence of pain and anxiety related to each other, especially in patients who suffer from cancer. This can be caused by pain from cancer, examinations carried out and treatment that sufferers undergo. Anxiety can be caused by uncertainty about the prognosis of the disease, the effectiveness of treatment for recovery of the condition which is often found in cancer patients, especially at an advanced stage. Anxiety management is provided through the main nursing interventions, namely progressive muscle relaxation techniques. The purpose of this study was to identify progressive muscle relaxation to reduce anxiety in cancer patients. The database used by the author in the literature search comes from studies that have been conducted and published online with the latest research. To find search results that include the author's journal, authors use Garuda Ristekbrin, PubMed, Google Scholar and Science Direct searches. After filtering, the author examines the contents of the article in accordance with the subject matter in accordance with the author's title. There were 10 journals selected for review by the authors, 6 of which used a quasy experiment, 3 used a systematic review, and 1 used a randomized controlled trial. The results of statistical tests for the 10 journals selected, all journals showed a significant influence on the nursing intervention carried out, namely Progressive Muscle Relaxation therapy in reducing anxiety in cancer sufferers. It is hoped that this literature review will become a reference and reference for nursing interventions in reducing anxiety in cancer patients, one of which is progressive muscle relaxation therapy

Evaluation of Geohazards Research in the World and Pacific Region: A Comparative Bibliometric Study

Geohazards are natural phenomena that endanger infrastructure, the environment, and human activity. Understanding and mitigating them is crucial for public safety, disaster preparedness, and sustainable land and resource management. This research objective is to analyze geohazard research trends globally and then compare them with countries around the Pacific Ring. Ninety-six geohazard publications were analyzed using bibliometric analysis and the VOSviewer application. The general trend of geohazard research increased slightly. It is critical in dealing with the expanding threats posed by geohazards, adapting to changing conditions, protecting vulnerable people, and leveraging technological improvements for more effective hazard management and disaster risk reduction. The Annual Offshore Technology Conference Proceedings and Engineering Geology are the most popular scholarly journals for authors to publish research on geohazard. The most popular topic area for geohazard papers is Earth and Planetary Sciences, followed by engineering, environmental science, and computer science. It is consistent with the growing use of technology in geohazard research. This study also includes an authorship profile. This research implies enhancing disaster risk reduction strategies and contributing to global efforts to address the challenges posed by geohazards.

Evolution of research related to how a sedentary lifestyle influences the aging process: a bibliometric review

Abstract Aim The world’s population suffers greatly from sedentary lifestyles, which are becoming more common as a result of factors such as a lack of easily accessible places to exercise, a rise in sedentary work practices such as office work, and the pervasive use of television and video devices. Consequently, associated health problems are escalating. The primary goal of this study was to examine the state and features of current trends in international publications regarding the effects of sedentary behavior on the elderly. Subject and methods A bibliometric analysis spanning the years 1994–2022, identifying a total of 311 documents, was carried out using the Web of Science Core Collection. Results The findings showed an exponential increase of 79% from 1997 to the present. The most productive journal categories, authors, and countries were Geriatrics &amp; Gerontology and Public, Environmental &amp; Occupational Health; authors S. Amagasa, N. Fukushima, S. Inoue, and H. Kikuchi; and the United States, respectively. Considerable variation was found in the keywords; “aging” and “sedentary lifestyle” were the most frequent terms, with 97 and 37 instances, respectively. Conclusion Maximum investment in programs promoting physical activity is necessary to improve quality of life as people age. Participants’ mental health will improve as a result of these programs, and their risk of illness will decrease.

Evaluation of the appropriateness of nursing case studies using the CARE checklist

Case report is a narrative description of the problem of one or several patients. The CARE checklist (CAse REport) is the consensus document for reporting clinical case reports and through adaptations to the different CARE disciplines is used to define standards for authors in scientific journals; however, the specificity of the nursing process makes it difficult to adjust nursing case reports to CARE. The aim was to analyze the publications of clinical cases with a nursing perspective in scientific journals, as well as the quality standards and evaluation systems used. Few journals reviewed agreed to publish nursing case reports or stated standards for authors to adjust to CARE. Preliminary results indicated average or poor adherence to CARE, with the most reported elements being: Keywords, patient information and introduction. Adherence was lower for the elements: Timeline, therapeutic intervention, follow-up and outcomes, and patient perspective. The characteristics of the nursing process implies a low adherence to CARE, so it is necessary to unify criteria to guide researchers, authors, reviewers and editors of scientific journals, as well as to improve the rigor and quality of the reports. Currently, there are no specific guidelines for reporting clinical case reports with a nursing perspective available. These normative gaps could be solved by developing a CARE extension adapted to the methodological characteristics of the nursing process.

Research integrity in Instructions for Authors in Japanese medical journals using ICMJE Recommendations: A descriptive literature study.

The International Committee of Medical Journal Editors (ICMJE) has published Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals. These provide a global standard for writing and editing medical articles, including research integrity. However, no study has examined the research integrity-related content of Japanese medical journals' Instructions for Authors. We therefore compared research integrity content in ICMJE member journals with those in the English- and Japanese-language journals of the Japanese Association of Medical Sciences (JAMS). This was a descriptive literature study. We obtained Instructions for Authors from English- and Japanese-language journals listed on the JAMS website and the ICMJE member journals listed on the ICMJE website as of September 1, 2021. We compared the presence of 20 topics (19 in the ICMJE Recommendations plus compliance with ICMJE) in the Instructions for Authors, and analyzed the content of the conflict of interest disclosure. We evaluated 12 ICMJE member journals, and 82 English-language and 99 Japanese-language subcommittee journals. The median number of topics covered was 10.5 for ICMJE member journals, 10 for English-language journals, and three for Japanese-language journals. Compliance with ICMJE was mentioned by 10 (83%) ICMJE member journals, 75 (91%) English-language journals, and 29 (29%) Japanese-language journals. The ICMJE Conflicts of Interest Disclosure Form was requested by seven (64%) ICMJE member journals, 15 (18%) English-language journals, and one (1%) Japanese-language journal. Although the topics in the JAMS English-language journals resembled those in the ICMJE member journals, the median value of ICMJE-related topic inclusion was approximately one-third lower in JAMS Japanese-language journals than in ICMJE member journals. It is hoped that Japanese-language journals whose conflict of interest disclosure policies differ from ICMJE standards will adopt international standards to deter misconduct and ensure publication quality.

Carbapenem-resistant Enterobacteriaceae in the livestock, humans and environmental samples around the globe: a systematic review and meta-analysis

Carbapenem-resistant Enterobacteriaceae (CRE) have diminished treatment options causing serious morbidities and mortalities. This systematic review and meta-analysis assessed the prevalence and associated factors of Enterobacteriaceae infections in clinical, livestock and environmental settings globally. The population intervention comparison and outcome strategy was used to enroll studies using the preferred reporting system for systematic review and meta-analysis to include only cross-sectional studies. Search engines used to retrieve articles included journal author name estimator, PubMed, Google Scholar and African Journals Online (AJOL). The Newcastle–Ottawa scale was used to assess the quality of studies. Sixteen articles from 2013 to 2023 in Africa, Asia, Europe and South America were studied. The pooled prevalence of CRE was 43.06% (95% CI 21.57–66.03). Klebsiella pneumoniae (49.40%), Escherichia coli (26.42%), and Enterobacter cloacae (14.24%) were predominant. Klebsiella pneumoniae had the highest resistance with the blaKPC-2 in addition to blaNDM, blaOXA-48, blaIMP and blaVIM. The blaKPC-2 genes occurrence was associated with environmental (P-value < 0.0001) and South American studies (P-value < 0.0001), but there was no difference in the trends over time (P-value = 0.745). This study highlights the high rates of CRE infections, particularly within blaKPC production. Monitoring and surveillance programs, research and infection control measures should be strengthened. Additionally, further studies are needed to explore the mechanisms driving the predominance of specific bacterial species and the distribution of resistance genes within this bacterial family.

Ethical requirements of instructions for authors of complementary and alternative medicine journals: a cross-sectional study

BackgroundMedical research in complementary and alternative medicine (CAM) has increased recently, raising ethical concerns about the moral status of CAM. Medical academic journals are responsible for conducting ethical review (ER) of manuscripts to protect the interests of human subjects and to make ethical results available before deciding to publish. However, there has been no systematic analysis of the ER in CAM journals. This study is aim to evaluate the current status of ethical requirements and compliance in CAM journals.MethodsThis is a cross-sectional study. We reviewed instructions for authors (IFAs) of CAM journals included in the Journal Citation Reports (2021) (https://jcr.clarivate.com) for general information and requirements for ER. We also browsed the manuscripts regarding randomized controlled trials published by CAM journals in Q1 and Q2 section from January to June, 2023, to check the actual situation of ethical requirement. Descriptive statistics and Fisher’s exact test were used for statistical analysis.Results27 journals and 68 manuscripts were ultimately included. 92.6% (25/27) IFAs included keywords of ER, indicating the presence of ethical considerations. However, no specific ER was required for CAM (n = 0). We categorized journals by Geographic origin, JCR section, Year of electronic JCR, Types of studies, % of OA Gold to explore the factors that could influence CAM journals to have certain ethical review policies. The results showed there was no statistical significance in certain ethical review policy in any classification of journals (p > 0.05). All RCT manuscripts included in the study generally met the requirements of the published journals for ethical review.ConclusionsAll IFAs discussed ER, but the content was scattered, unfocused, and there were no specific ER requirements regarding CAM. Although the manuscripts basically met the requirements of the journal, it was not possible to get closer to the process of ER in the manuscript. To ensure full implementation of these policies in the future, CAM journals should require authors to provide more details, or to form a list of items necessary for CAM ethical review.

Evaluación de la adecuación de los estudios de casos clínicos enfermeros a través de la lista de comprobación Case Report

Case report is a narrative description of the problem of one or several patients. The CARE checklist (Case Report) is the consensus document for reporting clinical case reports and through adaptations to the different CARE disciplines is used to define standards for authors in scientific journals; however, the specificity of the nursing process makes it difficult to adjust nursing case reports to CARE. The aim was to analyze the publications of clinical cases with a nursing perspective in scientific journals, as well as the quality standards and evaluation systems used. Few journals reviewed agreed to publish nursing case reports or stated standards for authors to adjust to CARE. Preliminary results indicated average or poor adherence to CARE, with the most reported elements being: Keywords, patient information and introduction. Adherence was lower for the elements: Timeline, therapeutic intervention, follow-up and outcomes, and patient perspective. The characteristics of the nursing process implies a low adherence to CARE, so it is necessary to unify criteria to guide researchers, authors, reviewers and editors of scientific journals, as well as to improve the rigor and quality of the reports. Currently, there are no specific guidelines for reporting clinical case reports with a nursing perspective available. These normative gaps could be solved by developing a CARE extension adapted to the methodological characteristics of the nursing process.

Expression of Concern: Garlic (Allium sativum) and mushroom (Agaricus bisporus) powder: Investigation of performance, immune organs and humoural and cellular immune response in broilers.

H. Noruzi and F. Aziz-Aliabadi, "Garlic (Allium Sativum) and Mushroom (Agaricus Bisporus) Powder: Investigation of Performance, Immune Organs and Humoural and Cellular Immune Response in Broilers," Veterinary Medicine and Science 10, no. 2 (2024): e31367, https://doi.org/10.1002/vms3.1367. This Expression of Concern is for the above article, published online on 15 February 2024 in Wiley Online Library (wileyonlinelibrary.com), and has been published by agreement between the journal Editor-in-Chief, Gayle Hallowell and John Wiley & Sons Ltd. The Expression of Concern has been agreed due to concerns raised by a third party regarding the availability of an ethical approval. The authors have received Higher Degree by Research (HDR) committee approval and a bioethical course certificate. The authors and their institute confirmed that this was equivalent to an ethical approval from the Ferdowsi University of Mashhad at the time when the research was conducted but could not provide the HDR committee approval documentation. Since this does not fully comply with the ethics policy of the journal, as noted on the journal's author guidelines page, the journal has decided to issue an Expression of Concern to inform and alert the readers.

The Scar-Hidden Surgery on Gynecomastia: Experiences from a Single-Institutional Large Case Series.

To summarize the experiences on the mastoscopic subcutaneous mastectomy for gynecomastia by "nine-step method" based on the "5S" goal and standardize this operation. Between January 1, 2002, and October 31, 2021, a total of 2035 breasts of 1082 male patients with gynecomastia, of which 129 patients with one side, were underwent mastoscopic subcutaneous mastectomy. The follow-up endpoint was 3months after surgery. All patients were successfully completed the operation, and none of them was transferred to open operation. The operation time for unilateral breast was 12-28min, and the average time was 17.7 ± 6.2min. The amount of bleeding during unilateral operation was very small, about 5-10ml. The total drainage volume was 5-50ml after the operation, and the drainage tube was removed in 3-5days. The epidermal necrosis occurred in 0.3% nipple. 0.2% chest wall had a little ecchymosis in the supero-medial region of the breast. All patients had the normal feeling of nipples and areola, the smoothing and symmetrical chest wall, and the natural contour. There was no recurrence during the follow-up period. The mastoscopic subcutaneous mastectomy for gynecomastia by "nine-step method" based on the "5S" goal has a short operation time, few surgical complications and good esthetics. It achieves the "5S" goals on the complete removal of glandular tissue (sweeping), small and scar-hidden incision are small (scarless), good symmetry of bilateral chest wall (symmetry), normal chest shape (shape), and smoothing chest wall (smoothing). The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .