Indian Journal of Orthopaedics welcomes articles that contribute to Orthopaedic knowledge from all sources in all countries. Articles are accepted only for exclusive publication in Indian Journal of Orthopaedics. Previously published articles, even those in peer-reviewed electronic publications, are not accepted by Indian Journal of Orthopaedics. Publication does not constitute official endorsement of opinions presented in articles. Published articles and illustrations become the property of the Journal. If the Editor of IJO requests additional data forming the basis for the work, the authors will make the data available for examination in a timely fashion. All manuscripts dealing with the study of human subjects must include a statement that the subjects gave Informed Consent to participate in the study and that the study has been approved by an institutional review board or a similar committee. All studies should be carried out in accordance with the World Medical Association Declaration of Helsinki. All manuscripts dealing with experimental results in animals must include a statement that the study has been approved by an animal study or Ethics committee. Manuscripts must be prepared in accordance with "Uniform requirements for Manuscripts submitted to Biomedical Journal" developed by International Committee of Medical Journal Editors (April 2010). The uniform requirements and specific requirement of Indian Journal of Orthopaedics are summarized below. Before sending a manuscript contributors are requested to check for the latest instructions available. Instructions are also available from the website of the journal (http://www.ijooline.com) and from the manuscript submission site (http://www.journalonweb.com/ortho).

The Editorial Process

The manuscripts will be reviewed for possible publication with the understanding that they are being submitted to one journal at a time and have not been published, simultaneously submitted, or already accepted for publication elsewhere. The Editors review all submitted manuscripts initially. Manuscripts with insufficient originality, serious scientific flaws, or absence of importance of message are rejected. All manuscripts received are duly acknowledged. The journal will not return the unaccepted manuscripts. Other manuscripts are sent to two or more expert reviewers without revealing the identity of the contributors to the reviewers. Each manuscript is also assigned to a member of the editorial team, who based on the comments from the reviewers takes a final decision on the manuscript. Within a period of 10 to 12 weeks, the contributors will be informed about the reviewers' comments and acceptance/rejection of manuscript. Articles accepted would be copy edited for grammar, punctuation, print style, and format. Page proofs will be sent to the first contributor, which has to be returned within seven days. Correction received after that period may not be included. The contributor may provide names of two or three qualified reviewers who have had experience in the subject of the submitted manuscript, but who are not affiliated with the same institutes as the contributor/s

Types of Manuscripts and Limits

Original articles: Randomised controlled trials, intervention studied, studies of screening and diagnostic test, outcome studies, cost effectiveness analyses, case-control series, and surveys with high response rate. Up to 3000 words excluding references and abstract.

Review articles: Systemic critical assessments of literature and data sources. Up to 4000 words excluding references and abstract. The review articles should reflect systematic reviews and contain substantive citations from current literature. The authors must state how they selected the literature and whether and how they judged the study quality.

Case reports: new/interesting/very rare cases can be reported. Cases with clinical significance or implications will be given priority, whereas, mere reporting of a rare case may not be considered. Up to 1000 words excluding references and abstract and up to 10 references.

Letter to the Editor: Should be short, decisive observation. They should not be preliminary observations that need a later paper for validation. Up to 400 words and 4 references.

Announcements of conferences, meetings, courses, awards, and other items likely to be of interest to the readers should be submitted with the name and address of the person from whom additional information can be obtained. Up to 100 words.

Authorship Criteria

Authorship credit should be based only on substantial contributions

1. to conception and design or acquisition of data or analysis and interpretation of data;
2. drafting the article or revising it critically for important intellectual content; and
3. final approval of the version to be published.

Conditions 1, 2, and 3 must all be met. Participation solely in the acquisition of funding or the collection of data does not justify authorship. General supervision of the research group is not sufficient for authorship. Each contributor should have participated sufficiently in the work to take public responsibility for appropriate portions of the content. The order of naming the contributors should be based on the relative contribution of the contributor towards the study and writing the manuscript. Once submitted the order cannot be changed without written consent of all the contributors. For a study from a single institute the number of contributors should not exceed six. For a case-report, images, Letter to the Editor and review article the number of contributors should not exceed four. A justification should be included, if the number of contributors exceed these limits. Only those who have done substantial work in a particular field can write a review article. A short summary of the work done by the contributor(s) in the field of review should accompany the manuscript. The journal expects the contributors to give post-publication updates on the subject of review. The update should be brief, covering the advances in the field after the publication of article and should be sent as letter to editor, as and when major development occur in the field.
 

Online Submission of the Manuscripts

Articles may be submitted online from http://www.journalonweb.com/ortho. New authors will have to register as author, which is a simple two step procedure. For online submission articles should be prepared in two files (first page file and article file). Images should be submitted in jpeg format directly on website at the time of submission of manuscript.

First Page File: Prepare the title page, covering letter, acknowledgement, etc. using a word processor program. All information which can reveal your identity should be here. Use doc files. Do not zip the files.

The covering letter must include

1. A full statement to the editor about all submissions and previous reports that might be regarded as redundant publication of the same or very similar work. Any such work should be referred to specifically, and referenced in the new paper. Copies of such material should be included with the submitted paper, to help the editor decide how to handle the matter.
2. A statement of financial or other relationships that might lead to a conflict of interest, if that information is not included in the manuscript itself or in an authors' form
3. A statement that the manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work, if that information is not provided in another form (see below); and
4. The name, address, and telephone number of the corresponding author, who is responsible for communicating with the other authors about revisions and final approval of the proofs, if that information is not included on the manuscript itself.

Article file: The main text of the article, beginning from Abstract till References (including tables) should be in this file. Do not include any information (such as acknowledgement, your names in page headers, etc.) in this file. Use doc files. Do not zip the files. Limit the file size to 2 MB. Do not incorporate images in the file. The text and figures MUST exclude all references to the source of work and the authors, otherwise the paper may be returned to the author for correction before it is sent out for review.

Images: Submit good quality color images. Each image should be less than 5 MB in size. The images must be high resolution, scanned at 300 dpi and approximately 1200 x 1800 pixels in size. Images are to be in jpeg format and to be uploaded with proper legends directly on website at the time of submission of new manuscript.

Legends: Legends for the figures/images should be included at the end of the article file.

Contributors' form and copyright transfer form

The contributors' form and copyright transfer form duly signed by all the authors/contributors is to be uploaded directly on website within two weeks from the date of submission of new manuscript.

Preparation of the Manuscript

The text of observational and experimental articles should be divided into sections with the headings: Introduction, Methods, Results, Discussion, References, Tables, Figure legends, and Acknowledgment. Do not make subheadings in these sections. Use double spacing throughout. Number pages consecutively, beginning with the title page. The language should be British English.

Title Page

The title page should carry

1. Type of manuscript (e.g. Original article, Case Report)
2. The title of the article, which should be concise, but informative;
3. Running title or short title not more than 50 characters;
4. The name by which each contributor is known (Last name, First name and initials of middle name), with his or her highest academic degree(s) and institutional affiliation;
5. The name of the department(s) and institution(s) to which the work should be attributed;
6. The name, address, phone numbers, facsimile numbers and e-mail address of the contributor responsible for correspondence about the manuscript;
7. The total number of pages, total number of photographs and word counts separately for abstract and for the text (excluding the references and abstract);
8. Source(s) of support in the form of grants, equipment, drugs, or all of these;
9. Acknowledgement, if any; and
10. If the manuscript was presented as part at a meeting, the organisation, place, and exact date on which it was read.

Abstract Page

The second page should carry the full title of the manuscript and a structured abstract, consisting of four paragraphs, with the headings Background (the primary research question must be clearly stated here), Methods, Results and Conclusion and level of evidence (for clinical articles) and level of relevance (for basic science articles). The abstract will precede the text of the published paper. An abstract is not needed for case reports. Below the abstract provide three to ten key words or short phrases that will assist indexers in cross indexing your article. Use terms from the medical subject heading list from the Index Medicus whenever possible. For the level of evidence section, describe the study type and assign a level of evidence rating to the primary research question, according to the criteria in this table. Levels of Evidence for Primary Research Question1

 

	Types of Studies
	Therapeutic Studies - Investigating the results of treatment Prognostic Studies	Prognostic Studies - Investigating the effect of a patient characteristic on the outcome of disease	Diagnostic Studies - Investigating a diagnostic test	Economic and Decision Analyses - Developing an economic or decision model
Level-I	High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals Systematic Review2 of Level I RCTs (and study results were homogenous3)	High quality prospective study4 (all patients were enrolled at the same point in their disease with 80% follow-up of enrolled patients) Systematic review2 of Level I studies	Testing of previously developed diagnostic criteria on consecutive patients (with universally applied reference "gold" standard) Systematic review2 of Level I studies	Sensible costs and alternatives; values obtained from many studies; with multiway sensitivity analyses Systematic review2 of Level I studies
Level-II	Lesser quality RCT (eg, 80% follow-up, no blinding, or improper randomization) Prospective4 comparative study5 Systematic review2 of Level II studies or Level 1 studies with inconsistent results	Retrospective6 study Untreated controls from an RCT Lesser quality prospective study (eg, patients enrolled at different points in their disease or 80% followup.) Systematic review2 of Level II studies	Development of diagnostic criteria on consecutive patients (with universally applied reference "gold" standard) Systematic review2 of Level II studies	Sensible costs and alternatives; values obtained from limited studies; with multiway sensitivity analyses Systematic review2 of Level II studies
Level-III	Case control study7 Retrospective6 comparative study5 Systematic review2 of Level III studies	Case control study7	Study of nonconsecutive patients; without consistently applied reference "gold" standard Systematic review2 of Level III studies	Analyses based on limited alternatives and costs; and poor estimates Systematic review2 of Level III studies
Level-IV	Case Series8	Case Series	Case-control study Poor reference standard	Analyses with no sensitivity analyses
Level-V	Expert Opinion	Expert Opinion	Expert Opinion	Expert Opinion

1. A complete assessment of quality of individual studies requires critical appraisal of all aspects of the study design.
2. A combination of results from two or more prior studies.
3. Studies provided consistent results.
4. Study was started before the first patient enrolled.
5. Patients treated one way (e.g., cemented hip arthroplasty) compared with a group of patients treated in another way (e.g., uncemented hip arthroplasty) at the same institution.
6. The study was started after the first patient enrolled.
7. Patients identified for the study based on their outcome, called "cases"; e.g., failed total arthroplasty, are compared with patients who did not have outcome, called "controls"; e.g., successful total hip arthroplasty.
8. Patients treated one way with no comparison group of patients treated in another way.

Introduction

State the purpose of the article and summarise the rationale for the study or observation. . State your hypothesis or primary research question and the purpose of the study.

Methods

The Methods section should include only information that was available at the time the plan or protocol for the study was written; all information obtained during the conduct of the study belongs in the Results section.

Selection and Description of Participants: Describe your selection of the observational or experimental participants (patients or laboratory animals, including controls) clearly, including eligibility and exclusion criteria and a description of the source population. Because the relevance of such variables as age and sex to the object of research is not always clear, authors should explain their use when they are included in a study report; for example, authors should explain why only subjects of certain ages were included or why women were excluded. The guiding principle should be clarity about how and why a study was done in a particular way. When authors use variables such as race or ethnicity, they should define how they measured the variables and justify their relevance.

Technical information: Identify the methods, apparatus (give the manufacturer's name and address in parentheses), and procedures in sufficient detail to allow other workers to reproduce the results. Give references to established methods, including statistical methods (see below); provide references and brief descriptions for methods that have been published but are not well known; describe new or substantially modified methods, give reasons for using them, and evaluate their limitations. Identify precisely all drugs and chemicals used, including generic name(s), dose(s), and route(s) of administration.

Authors submitting review manuscripts should include a section describing the methods used for locating, selecting, extracting, and synthesizing data. These methods should also be summarized in the abstract. Reports of randomised clinical trials should present information on all major study elements, including the protocol, assignment of interventions (methods of randomisation, concealment of allocation to treatment groups), and the method of masking (blinding), based on the CONSORT Statement (Moher D, Schulz KF, Altman DG: The CONSORT Statement: Revised Recommendations for Improving the Quality of Reports of Parallel-Group Randomised Trials. Ann Intern Med. 2001;134:657-662, also available at http://www.consort-statement.org). Authors submitting review article should include a section describing the methods used for locating, selecting, extracting, and synthesising data. These methods should also be summarised in the abstract.

Ethics

When reporting experiments on human subjects, indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975, as revised in 2000 (available at http://www.wma.net/e/policy/17-c_e.html). Do not use patients' names, initials, or hospital numbers, especially in illustrative material. When reporting experiments on animals, indicate whether the institution's or a national research council's guide for, or any national law on the care and use of laboratory animals was followed.

Statistics

Statistical methods should be described in detail. The statement "no significant difference was found between two groups" cannot be made unless a power study was done and the value of alpha or beta is reported. Use of the word significant requires reporting of a p value. Ninety-five percent confidence intervals are required whenever the results of survivorship analysis are given in the text or graphs. Use of the word correlation requires reporting of the correlation coefficient.

Results

These must be clearly expressed in simple language. Tables or similar diagrams can be used but must not duplicate material already expressed in the text. Provide a detailed report on the data obtained during the study. Results obtained after less than two years of follow-up are rarely accepted. For studies pertaining to joint replacement a minimum of five years follow up is desirable. All data in the text must be consistent throughout the manuscript, including any illustrations, legends, or tables. For studies of less than 20 subjects percentages should not be used. Extra or supplementary materials and technical detail can be placed in an appendix where it will be accessible but will not interrupt the flow of the text; alternatively, it can be published only in the electronic version of the journal.

Use graphs as an alternative to tables with many entries; do not duplicate data in graphs and tables. Avoid non-technical uses of technical terms in statistics, such as "random" (which implies a randomizing device), "normal," "significant," "correlations," and "sample." Where scientifically appropriate, analyses of the data by variables such as age and sex should be included.

Discussion

This section must be succinct, pointing out the relevance of the work described in the paper and its contribution to current knowledge. The results must be interpreted clearly, and deficiencies expressed. Discussion of pertinent references must be concise and short. Be succinct. What does your study show? Is your hypothesis affirmed or refuted? Discuss the importance of this article with regard to the relevant world literature; a complete literature review is unnecessary. Analyze your data and discuss their strengths, their weaknesses, and the limitations of the study.

Acknowledgments

As an appendix to the text, one or more statements should specify

1. contributions that need acknowledging but do not justify authorship, such as general support by a departmental chair;
2. acknowledgments of technical help; and
3. acknowledgments of financial and material support, which should specify the nature of the support. This should be included in the title page of the manuscript.

References

References in the text should include only those that are important and have been studied in full by the authors. All references will be checked by us; we will request photocopies of the first and last pages of referenced articles which we have been unable to verify. References should only be used from published work. Proof of acceptance is required for references cited "in press". References should be numbered consecutively in the order in which they are first mentioned in the text (not in alphabetic order). Identify references in text, tables, and legends by Arabic numerals in square bracket (e.g. [10]). References cited only in tables or figure legends should be numbered in accordance with the sequence established by the first identification in the text of the particular table or figure. Use the style of the examples below, which are based on the formats used by the NLM in Index Medicus. The titles of journals should be abbreviated according to the style used in Index Medicus. Use complete name of the journal for non-indexed journals. Avoid using abstracts as references. Information from manuscripts submitted but not accepted should be cited in the text as "unpublished observations" with written permission from the source. Avoid citing a "personal communication" unless it provides essential information not available from a public source, in which case the name of the person and date of communication should be cited in parentheses in the text. For scientific articles, contributors should obtain written permission and confirmation of accuracy from the source of a personal communication. The commonly cited types of references are shown here, for other types of references such as electronic media, newspaper items, etc. please refer to ICMJE Guidelines ( http://www.icmje.org or http://www.nlm.nih.gov/bsd/uniform_requirements.html).

Download a PowerPoint presentation on common reference styles and using the reference checking facility on the manuscript submission site.

Articles in Journals

Standard journal article:

Kulkarni SB, Chitre RG, Satoskar RS. Serum proteins in tuberculosis. J Postgrad Med 1960;6:113-20.

List the first six contributors followed by et al.

1. Volume with supplement: Shen HM, Zhang QF. Risk assessment of nickel carcinogenicity and occupational lung cancer. Environ Health Perspect 1994; 102 Suppl 1:275-82.
2. Issue with supplement: Payne DK, Sullivan MD, Massie MJ. Women's psychological reactions to breast cancer. Semin Oncol 1996; 23(1, Suppl 2):89-97.

Books and Other Monographs

1. Personal author(s): Ringsven MK, Bond D. Gerontology and leadership skills for nurses. 2nd ed. Albany (NY): Delmar Publishers; 1996.
2. Editor(s), compiler(s) as author: Norman IJ, Redfern SJ, editors. Mental health care for elderly people. New York: Churchill Livingstone; 1996.
3. Chapter in a book: Phillips SJ, Whisnant JP. Hypertension and stroke. In: Laragh JH, Brenner BM, editors. Hypertension: pathophysiology, diagnosis, and management. 2nd ed. New York: Raven Press; 1995. pp. 465-78.

Tables

• Tables should be self-explanatory and should not duplicate textual material.
• Tables with more than 10 columns and 25 rows are not acceptable.
• Type or print out each table with double spacing on a separate sheet of paper. If the table must be continued, repeat the title on a second sheet followed by "(contd.)".
• Number tables, in Arabic numerals, consecutively in the order of their first citation in the text and supply a brief title for each.
• Place explanatory matter in footnotes, not in the heading.
• Explain in footnotes all non-standard abbreviations that are used in each table.
• Obtain permission for all fully borrowed, adapted, and modified tables and provide a credit line in the footnote.

For footnotes use the following symbols, in this sequence: *, †, ‡, §, ||, , **, ††, ‡‡

Illustrations (Figures)

• Upload colour photographs on website in jpeg format.
• Symbols, arrows, or letters used in photomicrographs should contrast with the background and should be marked neatly with transfer type or by tissue overlay and not by pen.
• The photographs and figures should be trimmed to remove all the unwanted areas.
• If photographs of people are used, either the subjects must not be identifiable or their pictures must be accompanied by written permission to use the photograph.
• If a figure has been published, acknowledge the original source and submit written permission from the copyright holder to reproduce the material. A credit line should appear in the legend for figures for such figures.
• The Journal reserves the right to crop, rotate, reduce, or enlarge the photographs to an acceptable size.

Legends for Illustrations

• Type or print out legends (maximum 40 words, excluding the credit line) for illustrations using double spacing, with Arabic numerals corresponding to the illustrations.
• When symbols, arrows, numbers, or letters are used to identify parts of the illustrations, identify and explain each one in the legend.
• Explain the internal scale and identify the method of staining in photomicrographs.

Protection of Patients' Rights to Privacy

Identifying information should not be published in written descriptions, photographs, sonograms, CT scans, etc., and pedigrees unless the information is essential for scientific purposes and the patient (or parent or guardian) gives written informed consent for publication. Informed consent for this purpose requires that the patient be shown the manuscript to be published. When informed consent has been obtained, it should be indicated in the article and copy of the consent should be attached with the covering letter.

Electronic Version

• The manuscript must be accompanied by a CD containing the manuscript.
• Use a new diskette or fully format the CD before use. There should be no other document, file, and material on the CD other than the final manuscript. Text, references, tables and legends, all should be in one electronic file.
• Label each CD with first contributor's name, short title of the article, software (e.g. MS Word), version (e.g. 7.0) and file name. Name the file on the diskette with the corresponding contributor's last name (up to eight characters) and a three-letter extension to signify the format (e.g. sharma.doc). For a revised manuscript name the file with the manuscript number (e.g. jcrt58). Use any word-processing program (e.g. Microsoft Word, Word Perfect) or provide text files.
• Do not use 'oh' (O) for 'zero' (0), 'el' (l) for one (1). Do not use space bar for indentation. Do not type headings or any other text in ALL CAPITALS. Do not break words at the end of lines. Do not use an extra hard return/enter between paragraphs. Do not insert a tab, indent, or extra spaces before beginning of a paragraph. Do not use software's facility of automatic referencing, footnotes, headers, footers, etc.
• Use a hyphen only to hyphenate compound words. Use only one letter space at the end of sentence. Use hard return/enter only at the end of paragraphs and display lines (e.g. titles, headings and subheadings). Incorporate notes or footnotes in the text, within parentheses, rather than their usual place at the foot of the page.
• Use single space between lines for the manuscript on the CD. Provide the tables and charts at the appropriate place in the text and not at the end of the manuscript.
• Care should be taken to prevent damage to CD while sending it through post.

Sending a revised manuscript

Before submitting a revised manuscript, contributors are requested to ensure that each and every comment of the reviewers/editorial board is answered. Also mention the changes in the column in form of Page No. & Line No. These changes should be clearly mentioned in the revised manuscript. There is no need to send hard copies of the manuscript for articles submitted online.

Reprints

Journal provides free printed reprints to the corresponding authors.

Copyrights

The whole of the literary matter in the journal is copyright and cannot be reproduced without the written permission of the Editorial Board.

Checklist

(to be tick marked as applicable and one copy attached with the manuscript)

Manuscript Title
Covering letter

• Signed by all contributors
• Previous publication / presentations mentioned
• Source of funding mentioned
• Conflicts of interest disclosed

Authors

• Middle name initials provided
• Author for correspondence, with e-mail address provided
• Number of contributors restricted as per the instructions
• Identity not revealed in paper except title page (e.g. name of the institute in Methods, citing previous study as 'our study', names on figure labels, name of institute in photographs, etc.)

Presentation and format

• Double spacing
• Margins 2.5 cm from all four sides
• Title page contains all the desired information
• Running title provided (not more than 50 characters)
• Abstract page contains the full title of the manuscript
• Abstract provided (about 150 words for case reports and 250 words for original articles)
• Structured abstract provided for an original article
• Key words provided (three or more)
• Introduction of 75-100 words
• Headings in title case (not ALL CAPITALS)
• References cited in square brackets
• References according to the journal's instructions, punctuation marks checked

Language and grammar

• Uniformly English
• Abbreviations spelt out in full for the first time
• Numerals from 1 to 10 spelt out
• Numerals at the beginning of the sentence spelt out

Tables and figures

• No repetition of data in tables and graphs and in text
• Actual numbers from which graphs drawn, provided
• Figures necessary and of good quality (colour)
• Table and figure numbers in Arabic letters (not Roman)
• Labels pasted on back of the photographs (no names written)
• Figure legends provided (not more than 40 words)
• Patients' privacy maintained (if not permission taken)
• Credit note for borrowed figures/tables provided
• Manuscript provided on a CD (with single spacing)

Contributors' form

 (to be modified as applicable and one singed copy attached with the manuscript)

Manuscript Title: _______________________________________________________________

I/we certify that I/we have participated sufficiently in the intellectual content, conception and design of this work or the analysis and interpretation of the data (when applicable), as well as the writing of the manuscript, to take public responsibility for it and have agreed to have my/our name listed as a contributor. I/we believe the manuscript represents valid work. Neither this manuscript nor one with substantially similar content under my/our authorship has been published or is being considered for publication elsewhere, except as described in the covering letter. I/we certify that all the data collected during the study is presented in this manuscript and no data from the study has been or will be published separately. I/we attest that, if requested by the editors, I/we will provide the data/information or will cooperate fully in obtaining and providing the data/information on which the manuscript is based, for examination by the editors or their assignees. Financial interests, direct or indirect, that exist or may be perceived to exist for individual contributors in connection with the content of this paper have been disclosed in the cover letter. Sources of outside support of the project are named in the cover letter.

I/We hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership, including any and all rights incidental thereto, exclusively to the Indian Journal of Orthopaedics, in the event that such work is published by the Indian Journal of Orthopaedics. The Indian Journal of Orthopaedics shall own the work, including 1) copyright; 2) the right to grant permission to republish the article in whole or in part, with or without fee; 3) the right to produce preprints or reprints and translate into languages other than English for sale or free distribution; and 4) the right to republish the work in a collection of articles in any other mechanical or electronic format.

We give the rights to the corresponding author to make necessary changes as per the request of the journal, do the rest of the correspondence on our behalf and he/she will act as the guarantor for the manuscript on our behalf.

All persons who have made substantial contributions to the work reported in the manuscript, but who are not contributors, are named in the Acknowledgment and have given me/us their written permission to be named. If I/we do not include an Acknowledgment that means I/we have not received substantial contributions from non-contributors and no contributor has been omitted.

                  Name       Signature   Date signed
1                ------------   ---------         --------------
2                ------------   ---------         --------------
3                 ------------   ---------         --------------
4                ------------   ---------         --------------  (up to 4 contributors for case report/images/review)
5                 ------------   ---------         --------------
6                 ------------   ---------         -------------- (up to 6 contributors for original studies)