Reliability of B-line quantification by different-level observers and a software algorithm using point-of-care lung ultrasound.

Quantification of B-lines on lung ultrasonographs is operator-dependent and considered a semi-quantitative method. To avoid this variability, we designed a software algorithm for counting B-lines. We compared the number of B-lines obtained in real-time by observers with three different levels of experience and by the software algorithm, and analyzed intra-rater variability in terms of the estimated number of B-lines in two successive examinations. Forty mechanically ventilated adult (≥ 18 years) intensive care unit patients were included in this prospective study. All patients underwent two consecutive ultrasound examinations for B-lines detection by three human observers (OB1 = high, OB2 = medium, OB3 = low level of experience) and by the software (OBS). Ultrasound scans were obtained on the anterior right and left thoracic side along the midclavicular line, in the second and fourth intercostal space; B-lines counting for each position lasted 10 s. To assess intra-observer variability, a second ultrasound scan was obtained 15-30 min after the first scan. For all lung zones, the intraclass correlation for B-lines counting between OB1 and OB2 was 0.663; between OB1 and OB3, 0.559; and between OB1 and OBS, 0.710. OBS had a better concordance coefficient (0.752) between the first and the second measurements than did the human observers. Our results show that the software algorithm for B-lines counting is a potentially promising alternative when observers have little lung ultrasound experience.

The evolvement of the renographic curve pattern in early childhood.

The purpose of this study was to evaluate renographic parameters obtained from healthy renal units (RUs) in newborns and infants with unilateral kidney condition. Thirty three children including twenty newborns, referred to Technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) diuretic scintigraphy due to unilateral kidney condition entered the study. Only contralateral, healthy RUs were analyzed. Since many children returned for follow up, there were altogether 78 dynamic studies included. Kidney length was compared to ultrasound measurements. Renographic curve parameters (time to maximum counts, T max and time to half maximum counts, T1/2 max) were evaluated. The results showed that the kidney length measured on Tc-99m MAG3 scintigraphy correlated well with ultrasound measurements. Regarding the renographic curve parameters, in the newborn period a significantly shorter T max (mean T max 3.65 +/- 1.2 min, p = 0.026) was found compared to the group of two months old infants (5.12 +/- 2.2 min). In older age groups mean T max gradually shortened again. On the contrary, T1/2 max was significantly longer in newborn and early infant period than in older age groups (16.7 +/- 8.2 min, p = 0.018), but generally showed variable values until the age of three years. It can be concluded that it is important to be aware of possible diversities of renographic curve pattern of healthy kidneys in early childhood, especially in the elimination part. Therefore, when interpreting a dynamic renal study, one should also consider other parameters like kidney growth, morphology and differential function, which can be reliably monitored with repeated Tc-99m MAG3 scintigraphy, to discern between normal and pathologic finding.

Proinflammatory cytokine levels in saliva in patients with burning mouth syndrome before and after treatment with low-level laser therapy.

The aim of this study was to determine the levels of proinflammatory tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) cytokines in whole unstimulated saliva in subjects with burning mouth syndrome (BMS) before and after treatment with low-level laser therapy (LLLT). BMS is characterized by a continuous, painful burning sensation in a clinically normal-appearing oral mucosa. A sample consisting of 40 consecutive subjects was selected on a voluntary basis from the pool of patients who presented for diagnosis and treatment of BMS at the Oral Medicine Unit of the Faculty of Medicine of the University of Rijeka. For determination of salivary levels of TNF-α and IL-6, ELISA (Sigma Immunochemicals, St. Louis, MO, USA) was performed to determine the salivary levels of TNF-α and IL-6. After 4 weeks of LLLT, the salivary levels of TNF-α and IL-6 in the experimental group decreased significantly (p < 0.001). There was no significant difference in the experimental group regarding visual analogue scale.

Prevalence of plagiarism in recent submissions to the Croatian Medical Journal.

To assess the prevalence of plagiarism in manuscripts submitted for publication in the Croatian Medical Journal (CMJ). All manuscripts submitted in 2009-2010 were analyzed using plagiarism detection software: eTBLAST, CrossCheck, and WCopyfind. Plagiarism was suspected in manuscripts with more than 10% of the text derived from other sources. These manuscripts were checked against the Déjà vu database and manually verified by investigators. Of 754 submitted manuscripts, 105 (14%) were identified by the software as suspicious of plagiarism. Manual verification confirmed that 85 (11%) manuscripts were plagiarized: 63 (8%) were true plagiarism and 22 (3%) were self-plagiarism. Plagiarized manuscripts were mostly submitted from China (21%), Croatia (14%), and Turkey (19%). There was no significant difference in the text similarity rate between plagiarized and self-plagiarized manuscripts (25% [95% CI 22-27%] vs. 28% [95% CI 20-33%]; U = 645.50; P = 0.634). Differences in text similarity rate were found between various sections of self-plagiarized manuscripts (H = 12.65, P = 0.013). The plagiarism rate in the Materials and Methods (61% (95% CI 41-68%) was higher than in the Results (23% [95% CI 17-36%], U = 33.50; P = 0.009) or Discussion (25.5 [95% CI 15-35%]; U = 57.50; P < 0.001) sections. Three authors were identified in the Déjà vu database. Plagiarism detection software combined with manual verification may be used to detect plagiarized manuscripts and prevent their publication. The prevalence of plagiarized manuscripts submitted to the CMJ, a journal dedicated to promoting research integrity, was 11% in the 2-year period 2009-2010.

Difference in the periapical status of endodontically treated teeth between the samples of Croatian and Austrian adult patients.

Aim. To compare the periapical status of endodontically treated teeth between Austrian and Croatian adult patients and determine its relation to age, sex, position of teeth, and length of root canal filling. Methods. The study was conducted from 2007 to 2009 at two university dental clinics and included 163 Croatian (412 teeth) and 101 Austrian (430 teeth) patients. We assessed the periapical status of endodontically treated teeth by using the periapical index system and determined its relation to age, sex, position of teeth, and length of root canal filling. Results. Austrian patients had a greater number of diseased endodontically treated teeth than Croatian patients (P=0.001). In the age group 31-40 years, Austrian patients had apical periodontitis significantly more often (22.1% vs 12.2%, P<0.001) than Croatian patients. In relation to sex and position of teeth, no significant difference was found between the two groups. In Croatian patients, apical periodontitis was significantly more often present in molar than premolar (46.2% vs 29.7%, P=0.022) and front teeth (46.2% vs 24.1%, P<0.001). In Austrian patients, apical periodontitis was significantly more often present in molar and premolar than front teeth (molar-front teeth: 38.2% vs 25.5%, P=0.011; premolar-front teeth: 36.3% vs 25.5%, P=0.029). Croatian and Austrian patients with AP significantly differed in the number of adequately filled and underfilled teeth (both P<0.001). Conclusion. Apical periodontitis was significantly more present in endodontically treated teeth in Austrian patients. The difference in the periapical status between Croatian and Austrian patients was most related to age and length of root canal filling.

Epidemiologic characteristics of human campylobacteriosis in the County Primorsko-goranska (Croatia), 2003-2007.

The aim of the study was to investigate campylobacteriosis incidence in the County Primorsko-goranska (Croatia) between 2003 and 2007 and to find out possible connection with environmental factors (the average monthly temperature and total monthly precipitation). The data (number of stool samples examined, age and sex distribution of patients, monthly distribution of isolates and distribution of isolates according to the species) from the Laboratory for Diagnostics of Enteric Infections of the Teaching Institute of Public Health of the County Primorsko-goranska (Croatia) were analyzed retrospectively. During the observed period 30,164 stool samples were examined for Campylobacter spp. Campylobacters were identified in 1,242 (4.12%) samples. The overall annual campylobacter incidence rate was 81.3 +/- 21.9/100,000 population. Campylobacter jejuni was found in 1,093 (88%) and C. coli in 149 (12%) patients. Our findings showed age distribution of patients typical for developed countries. The patients were mostly children under 5 years (484.4 +/- 129.1/ 100,000, p < 0.001) and between 5 and 9 years of age (226.5 +/- 60.5/100,000, p < 0.05). Male consistently experienced higher rates, but the difference between genders was significant in the age groups from birth till late twentieth (p < 0.001). Campylobacter rates were significantly associated with monthly average temperatures (p < 0.05), but not with precipitation. Further investigations into the incidence of campylobacteriosis on the national level are necessary. The causes of the noticed monthly distribution, sources of infection and connection with the routes of transmission in humans need to be elucidated as well.

The role of omega6 to omega3 ratio in development and progression of age-related macular degeneration.

The aim of this study is to investigate possible connection between omega-6/omega-3 fatty acid ratio and development and progression of Age-Related Macular Degeneration (ARMD). We examined 125 patients diagnosed with ARMD and divided into 5 groups of 25 patients according to CARMS (Clinical Age-Related Maculopathy Staging System). Control group consists of 51 patients with similar ages, without ARMD. All of them underwent stereobiomicroscopy, fundus photography and fluorescein angiography. Dietary fatty acids intake was measured using food frequency questionnaire (FFQ). The FFQ was based on previously validated questionnaire (DIETQ, Tinuviel Software, Warington, Ches, UK) and FFQ2 from Blue MountainEye Study. The data were analysed using food nutritient dana from McCance and Widdowson's Food Composition Tables, supplemented with a food fatty acid content database (Foodbase, London, UK). We noticed statistically significant difference between omega-6/omega-3 ratio in neovascular ARMD (stage 5) and all other groups including control group (p = 0.000020). The ratio in Stage 5 was about 11:1 like in Western diet. Stage 4-geographic atrophy (GA) has statistically significant difference in o-mega-6/omega-3 ratio compared with stage 1 (p = 0.000571), stage 2 (p = 0.000112) and stage3 (p = 0.000430). The ratio in first three groups is about 7-7.5:1 (greater then Mediteran-4-5:1, but lower then Western Diet-10-20:1). There is no statistically significant difference between first three stages (p > 0.05) and stage 4 and control group (p = 0.172388). Omega-6/omega-3 ratio is connected with development of neovascular ARMD. Decreased ratio protects against neovascular ARMD. On the contrary, GA seems to be connected with prolonged sunlight exposure (the ratio is about 6:1). It is good to know that changing nutrition habits someone can prevent development of severe neovascular form of ARMD because intravitreal anti-VEGF therapy limitations.

Construction and validation of attitudes toward plagiarism questionnaire.

AIM: To develop and test the psychometric characteristics of a questionnaire measuring attitudes toward plagiarism. METHODS: Participants were 227 undergraduates and graduate students (128 women and 99 men) from three Croatian universities, with a median age of 21 years (range 18 to 48). Research was conducted from March to June 2009. For the purpose of construction of the first version of the questionnaire, 67 statements (items) were developed. The statements were based on the relevant literature and were developed following rules and recommendations for questionnaire writing, and 36 items were chosen for final validation. Factor analysis was used to find out the factor structure of the questionnaire and to measure construct validity. RESULTS: The final version of the questionnaire consisted of 29 items divided into a three-factor structure: factor I - positive attitude toward plagiarism (12 items); factor II - negative attitude toward plagiarism (7 items); and factor III - subjective norms toward plagiarism (10 items). Cronbach alpha was calculated to confirm the reliability of the scale: factor I - alpha=0.83; factor II - alpha=0.79; and factor III - alpha=0.85. Correlations between factors were: -0.37 between I and II, -0.41 between I and III, and +0.31 between II and III. CONCLUSION: Attitudes Toward Plagiarism questionnaire was developed, with good psychometric characteristics. It will be used in future research as a standardized tool for measuring attitudes toward plagiarism.

Health condition of first permanent molars in year 1977 and 2007 in children in Istria (Croatia).

The aim of this study was to examine differences between health condition of the first permanent molar (M1) in children in 1977 and 2007. The materials for the study consisted of data on the health condition of M1 determined in a study in 1977 (Group I) for children from the district of Buje in Istria. The health condition of M1 was examined again in the same area in 2007 (Group II). The first permanent molar is most frequently affected by caries and represent a good indicator for general caries incidence of children. Study included 709 subjects in Group I (363 boys, 346 girls) and 460 subjects in Group II (242 boys, 218 girls), aged from 6 years and 0 months to 12 years and 5 months. The difference in the frequency of intact, decayed, filled and missingd M1 was examined in both groups. Chi2 test was used to determine the differences between the number of I (intact), D (decayed), F (filled) and M (missing) teeth for each age group in Group I and Group II. In Group I there were 29.3% intact, 48.9% decayed, 17.4% filled and 4.3% missing M1, and in Group II there were 53.0% intact, 22.6% decayed, 22.1% filled and 2.1% missing M1. During the period of 30 years, a significant increase of number of dental surgeries, and thus better preventive and health education, resulted in the significant increase in the number of intact (24.0%) and filled (4.7%) M1, and decrease in the number of decayed (26.3%) and missing (2.2%) M1. From 1977 to 2007, the number of intact M1 in group II increased considerably according to group I, while the number of decayed M1 in group II significant decreased according to group I. These changes were the result of a considerably increased number of dental surgeries.

Survival of stress exposed Campylobacter jejuni in the murine macrophage J774 cell line.

Although campylobacters are relatively fragile and sensitive to environmental stresses, Campylobacter jejuni has evolved mechanisms for survival in diverse environments, both inside and outside the host. Their survival properties and pathogenic potential were assessed after subjecting food and clinical C. jejuni isolates to different stress conditions. After exposure to starvation (5 h and 15 h of nutrient depletion), a temperature shock (3 min at 55 degrees C) or oxidative stress (5 h and 15 h of atmospheric oxygen) we studied the culturability, viability and capability of adhesion, internalization and survival within the in vitro cell culture model using J774 murine macrophages. Starvation severely impaired C. jejuni culturability, particularly after 15 h of nutrient depletion. The number of viable cells decreased by 30-40%. Starved bacterial cells also showed a lower capability of adhesion, internalization and survival within macrophages. Despite the reduced culturability and viability of the heat treated cells, C. jejuni efficiently adhered to, and entered murine macrophages. However, the number of heat treated cells started to decrease more quickly than non-stressed cells. Within 24 h post infection all the cells were killed. The bacterial mechanisms involved in inactivating toxic oxygen products may enhance bacterial persistence through increased binding, entry and survival of both oxidatively stressed C. jejuni isolates inside the macrophages. Oxygen exposure increased the internalization and intracellular survival, although the cells cannot remain viable for extended periods within murine macrophages. However, any prolongation of survival in macrophages may increase the probability of transmission of bacteria in the host organism and have further implications in the pathogenesis of campylobacteriosis. This indicates that environmental stress conditions may be involved.

Attitude of physiotherapists toward electronic health record in Croatia.

BACKGROUND: Electronic health record can facilitate everyday clinical practice of physiotherapists. The aim of this study is to determine attitude of physiotherapists towards implementation of information technology in their work and the differences in attitude in relation to gender, age, level of education and type of health institutions. METHODS: This study is a cross-sectional survey of Croatian physiotherapists. The questionnaire ″Attitude of physiotherapists towards implementation of electronic health record included 12 items scored on a Likert-type scale from 1 to 5 and presented the award values as "Disagree", "Neither agree nor disagree" and "Agree". Croatian physiotherapists were (n = 267) recruited from 13 health care institutions. For analysis chi square test, t-test, one-way analysis of variance and as a post-hoc Tukey test were used. RESULTS: Explanatory factorial analysis confirmed two factors: Satisfaction in the work of physiotherapists using computers (SAT) and Necessity of computers in the work of physiotherapists (NEC). Most physiotherapists agree on (SAT) (47.9%) and on (NEC) (51.3%). Male physiotherapists were significantly more likely to disagree with statements related to SAT (p < 0.001) and NEC (p = 0.035) than female physiotherapists. Physiotherapists aged between 46 and 55 years were significantly more like to disagree on NEC in comparison to all the other groups of participants (p < 0.001). Physiotherapists with secondary school degree were significantly more like to disagree on NEC as compared with participants with bachelor's degree (p = 0.009), as well as in comparison with physiotherapists with a university degree (p = 0.002). Most of the physiotherapists who are employed in Clinical hospitals and in the Speciality hospital agree with that statement (all p > 0.05). CONCLUSION: The attitude of Croatian physiotherapists towards electronic health record differs according to the age, gender, level of education and type of health care institutions. This finding can facilitate implementation of electronic health record in physiotherapy. TRIAL REGISTRATION: Not applicable.

A simple prognostic model for assessing in-hospital mortality risk in patients with acutely decompensated heart failure.

Background An assessing of the in-hospital mortality risk for an emergency hospitalized patient with acutely decompensated heart failure (ADHF) is challenging task. Simple formula can help. Methods On the base of six indicators identified in derivation group, simple formula for assessing the risk for in-hospital mortality of ADHF patients was derived and later tested in validation group. Results The retrospective analysis of a derivation group (533 survivors, 121 deceased) identified six risk indicators: age, heart rate (HR), systolic blood pressure (SBP) and serum concentrations of urea, sodium (Na) and uric acid (UA). The final formula was created ([age/10]2 × HR/SBP)+(Urea-Na/10)+UA/100 and formula result of 53 was established as cut-off result. In the derivation group, at the cut-off point of 53, area under the ROC curve (AUC) was 0.741 (95% CI 0.701-0.776); with sensitivity 54% and specificity 83%. The discriminative capacity of the formula was significantly higher than each of its components. In the validation group of 591 patients (527 survived, 64 died) AUC was also 0.741 (95% CI 0.706-0.774), sensitivity was 66% and specificity 76%. Positive predictive value (PPV) of the developed formula was modest (34%), but negative predictive value (NPV) was 95%. N-terminal pro-B type natriuretic peptide and troponin I were determined, but not included into formula. Conclusions The developed formula enables simple, rapid and inexpensive risk assessment, but its disadvantage is a low PPV. However, a high NPV permits the identification of patients with a low risk of in-hospital mortality, which could lead to a more rational patient treatment.

Immunohistochemical analysis of vocal cord polyps applying markers of squamous cell carcinogenesis.

OBJECTIVE: The aim of the study was to perform a pathohistological and immunohistochemical analysis of squamous cell (SC) carcinogenesis markers on epithelial linings of vocal cord polyps. The vocal box, being a heavily burdened organ with intensive cell renewal and regenerative processes, is therefore a favourable environment for constant epithelial growth and hyperplasia. In our ongoing projects on laryngeal carcinogenesis and research on laryngeal tissue, we encountered atypia on diagnosed nodules and polyps that are usually considered as benign formations, resulting from the above-mentioned cell renewal and regeneration, which lead to further investigation. The purpose was to see if changes in molecular markers of SC carcinogenesis follow, or, may appear in immunohistochemical (IHC) analysis, before histological atypia in standard haematoxylin-eosin (HE) staining, and contribute in early diagnosis of potentially suspect polyps. METHODS: After classical pathohistological (PH) analysis on HE slides, IHC analysis of EGFR, cyclin D1, p53, Ki-67, and IMP3 was performed on tissue microarrays of laryngeal tissue (50 samples), ranging from normal to hyperplastic lesions with no atypia (34 samples), low-grade atypia (11 samples), and high-grade atypia (5 samples). RESULTS: This study established an increase and correlation of EGFR, cyclin D1, p53, Ki-67 and IMP3 IHC expressions with pathohistological findings of dysplasia in glottic polypoid lesions. Low and high-grade dysplasia had statistically higher percentages of EGFR-positive cells than normal epithelium and simple hyperplasia (SH) (low vs. normal/SH P = 0.007; high vs. normal/SH P = 0.001). High-grade dysplasia had statistically more positive cells than low-grade dysplasia (P = 0.004), and low-grade dysplasia had statistically more positive cells than specimens without atypia (P = 0.007). The percentage of positive cells was statistically higher for cyclin D1, p53 and Ki-67 in high-grade dysplasia versus low-grade dysplasia (cyclin D1 P = 0.011, p53 P = 0.002; Ki-67 P = 0.026; respectively) and versus normal epithelium and SH (cyclin D1 P = 0.003; p53 P = 0.001; Ki-67 P = 0.002; respectively). An increase of IMP3-positive cells with an increase of atypical changes in the laryngeal epithelium, from superficial towards basal layers was noticed, contrary to the usually seen positivity pattern of SC carcinogenesis markers from basal to superficial layers. A statistically significant difference of IMP3 IHC staining between the pathohistological groups (P = 0.003) was recorded. CONCLUSION: Only polyps that present with simple hyperplasia as the greatest mucosal change can be considered as benign formations. Pathohistologically detected atypia in polypoid changes of vocal cords, confirmed by molecular atypia with an increase of SC carcinogenesis markers, suggest their inclusion in studies of laryngeal carcinogenesis. Our results suggest that in problematic cases IHC analysis could be of interest in detection of biological aggressiveness in polypoid laryngeal tissue and beneficiary for polyp patients' follow-up. Further research of laryngeal carcinogenesis markers and their meaning in fibrovascular polyps is of interest.

Pregnant women's attitudes toward amniocentesis before receiving Down syndrome screening results.

OBJECTIVES: We sought to evaluate pregnant women's knowledge about features of second-trimester screening for Down syndrome and to assess whether knowledge and educational level influence their attitude toward amniocentesis before receiving test results. METHODS: Pregnant Caucasian women (n = 300) <35 years old with no personal or family history of Down syndrome were surveyed. Women were randomized to 2 groups. One group of women (n = 150) were surveyed by questionnaire before consultation with specially trained midwives; the other group of women (n = 150) were surveyed after consultation. The questionnaire consisted of 3 sections: 1) participants' demographic data, 2) knowledge about prenatal screening for Down syndrome, and 3) readiness to undergo amniocentesis if there was an increased risk of Down syndrome. RESULTS: Women surveyed after consultation had greater total knowledge scores than those surveyed before consultation (p < .001). A statistically significant difference in knowledge scores in relation to educational levels was observed only in women who were surveyed before consultation (p = .007). Significantly more women were prepared to accept amniocentesis in the group surveyed after consultation (74%) than before consultation (53%; p < .001). CONCLUSION: Knowledge gained during a prescreening consultation influenced pregnant women's attitudes toward further diagnostic investigation. A smaller proportion of women who were indecisive was observed in the group surveyed after prescreening consultation. Indecisiveness was not affected by poor knowledge about screening, but rather by difficulty in knowing how they will feel and what they will do if their screening result is positive.

Correlation between the pattern of facial growth and the position of the mandibular third molar.

PURPOSE: The purpose of this study was to examine the correlation between variables that determine the position of the third molar (M3) and correlation between the pattern of facial growth and examined variables. MATERIALS AND METHODS: Material for the study consisted of 130 panoramic radiographs and lateral radiographs of subjects' heads in whom orthodontic therapy had been started. Analysis of the position of the mandibular M3 and its relation to the bone and other teeth were determined by 4 variables: evaluation of the space for both M3, spatial relation between the second molar and M3, vertical position of the M3 in relation to the alveolar ridge, and inclination of the germ of the M3. RESULTS: In boys, significant correlation was determined on the right side of the jaw, between the retromolar area and the vertical position of M3. Significant correlation was determined in girls, between the retromolar area and the vertical position of M3 on both sides, retromolar area and M3 inclination on the left side, and retromolar area and spatial relation of M3 on the right side. Analysis of correlation between facial growth pattern and 4 variables that determinate the position of M3 showed positive correlation only for the lower right M3 inclination in subjects with anterior facial rotation. CONCLUSION: The present study showed that the amount of retromolar space for the position of the M3 is not a sign of its normal development. No significant differences were determined between the position of M3 and type of facial growth.

Examining the medical blogosphere: an online survey of medical bloggers.

BACKGROUND: Blogs are the major contributors to the large increase of new websites created each year. Most blogs allow readers to leave comments and, in this way, generate both conversation and encourage collaboration. Despite their popularity, however, little is known about blogs or their creators. OBJECTIVES: To contribute to a better understanding of the medical blogosphere by investigating the characteristics of medical bloggers and their blogs, including bloggers' Internet and blogging habits, their motivations for blogging, and whether or not they follow practices associated with journalism. METHODS: We approached 197 medical bloggers of English-language medical blogs which provided direct contact information, with posts published within the past month. The survey included 37 items designed to evaluate data about Internet and blogging habits, blog characteristics, blogging motivations, and, finally, the demographic data of bloggers. Pearson's Chi-Square test was used to assess the significance of an association between 2 categorical variables. Spearman's rank correlation coefficient was utilized to reveal the relationship between participants' ages, as well as the number of maintained blogs, and their motivation for blogging. The Mann-Whitney U test was employed to reveal relationships between practices associated with journalism and participants' characteristics like gender and pseudonym use. RESULTS: A total of 80 (42%) of 197 eligible participants responded. The majority of responding bloggers were white (75%), highly educated (71% with a Masters degree or doctorate), male (59%), residents of the United States (72%), between the ages of 30 and 49 (58%), and working in the healthcare industry (67%). Most of them were experienced bloggers, with 23% (18/80) blogging for 4 or more years, 38% (30/80) for 2 or 3 years, 32% (26/80) for about a year, and only 7% (6/80) for 6 months or less. Those who received attention from the news media numbered 66% (53/80). When it comes to best practices associated with journalism, the participants most frequently reported including links to original source of material and spending extra time verifying facts, while rarely seeking permission to post copyrighted material. Bloggers who have published a scientific paper were more likely to quote other people or media than those who have never published such a paper (U= 506.5, n(1)= 41, n(2)= 35, P= .016). Those blogging under their real name more often included links to original sources than those writing under a pseudonym (U= 446.5, n(1)= 58, n(2)= 19, P= .01). Major motivations for blogging were sharing practical knowledge or skills with others, influencing the way others think, and expressing oneself creatively. CONCLUSIONS: Medical bloggers are highly educated and devoted blog writers, faithful to their sources and readers. Sharing practical knowledge and skills, as well as influencing the way other people think, were major motivations for blogging among our medical bloggers. Medical blogs are frequently picked up by mainstream media; thus, blogs are an important vehicle to influence medical and health policy.

Cell apoptosis as assessed by M30 expression in keratoacanthoma and squamous cell carcinoma.

Involution displayed by keratoacanthoma (KA) represents an important difference between KA and squamous cell carcinoma (SCC). It has been suggested that apoptosis plays a part in process of involution of KA. Altogether 150 specimens were included in this study, 30 cases of each; normal skin (NS), proliferative (pKA) and regressing keratoacanthoma (rKA), well differentiated (wdSCC) and poorly differentiated (pdSCC) squamous cell carcinoma. All samples were examined immunohistochemically for expression of M30 protein. A significantly lower number of M30 positive cells has been detected in NS as compared to skin tumors examined (p<0.001), except for rKA (p=0.057). The highest percentage of M30 positive cells was detected in pdSCC (p<0.001) as compared with all other examined groups. Keratinocytes of normal and changed epidermis expressing higher levels of M30 protein were predominately found in sun-exposed areas (chi2=14.93; p=0.060). There was an increasing trend of M30 protein expression with increasing age of the patient in NS and skin tumors examined. Majority of skin tumors with higher percentage of M30 positive cells tended to display higher Ki-67 expression. M30 expression was highly correlated with bak (r=0.811; p=0.048) and granzyme B expression in rKA (r=0.733; p=0.015). Cell apoptosis as assessed by M30 expression is, generally, increased in examined skin tumors and related to cell proliferation. Cell apoptosis mediated by bak and granzyme B expression could contribute to KA regression.

Tumor necrosis factor-alpha and interleukin 6 in human periapical lesions.

AIM: The aim of this study was to evaluate the presence of the cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in human periapical lesions. SUBJECTS AND METHODS: Samples were obtained from three groups of teeth: symptomatic teeth, asymptomatic lesions, and uninflamed periradicular tissues as a control. RESULTS: TNF-alpha levels were significantly increased in symptomatic lesions compared to control. Group with asymptomatic lesions had significantly higher concentrations compared to control. There were no significant differences in TNF-alpha levels between symptomatic and asymptomatic lesions. In group with symptomatic lesions, IL-6 levels were significantly higher than in group with asymptomatic lesions. The IL-6 levels in symptomatic group also showed significantly higher concentration in comparison with control group. In asymptomatic group, the IL-6 level had significantly higher concentrations compared to control. CONCLUSION: These results indicate that symptomatic lesions represent an immunologically active stage of disease, and asymptomatic lesions are the point from which the process advances toward healing.

Quantitative analysis of nasal vascularization in allergic patients treated with mometasone furoate.

The purpose of this study was to compare vascularization of the nasal mucous membrane among non-allergic, non-treated allergic and allergic patients treated with mometasone furoate, by means of the stereology method in quantitative analysis. Three groups of patients (GP), each containing 10 patients were examined. The first group (GP 1) had a negative inhalatory allergen test while the second (GP 2) and third (GP 3) group both had positive results with the same test. GP 3 included allergic patients treated with mometasone furoate for 15 days before analysis, when a small piece of the nasal mucous membrane was taken from the frontal pole of the lower nasal shell. The specimens were examined immunohistochemically for expression of CD31 and VEGF-C. Vascular phase was determined by using length density (L(v)). Differences in CD31 and VEGF-C expression were compared using one-way ANOVA and Tukey HSD post-hoc tests. CD31 expression in GP 1 had significantly lower values than in the GP 2 and GP 3 groups (p < 0.001). VEGF-C expression in GP 1 was significantly lower than in GP 2 (p = 0.007), but not in GP 3 (p = 0.292). We have shown that 15-day treatment with mometasone furoate results in a significant reduction of the density of vascular elements in allergic patients.

Expression of Bcl-2 family proteins in psoriasis.

AIM: To elucidate the mechanisms involved in apoptosis of psoriatic keratinocytes by examining the expression of pro-apoptotic (Bak, Bax) and anti-apoptotic (Bcl-2, Bcl-X) Bcl-2 family of proteins, as well as the expression of p53 and Ki-67 proteins in normal skin, and uninvolved and involved psoriatic skin. METHODS: A total of 90 skin samples (30 cases of involved and uninvolved psoriatic skin and normal skin) were examined immunohistochemically to determine the protein expression of p53, Ki-67, Bcl-2, Bcl-X, Bax, and Bak. The results were quantified and expressed as a percentage of positive keratinocytes. RESULTS: There was a significant increase in Ki-67 (17.05 vs 3.65; P<0.001), Bcl-X (40.21 vs 13.97; P<0.001), Bak (89.46 vs 73.36; P<0.001), and Bax (50.00 vs 29.25; P<0.001) expression and a decrease in Bcl-2 (3.23 vs 6.25; P=0.008) expression in involved psoriatic skin, as well as an increase in Bcl-X (25.13 vs 13.97; P<0.001) expression in uninvolved psoriatic skin, when compared to normal skin. Samples with higher percentage of Ki-67 positive cells showed a higher percentage of p53 positive cells (correlation coefficient r=0.75 in involved psoriatic samples, P<0.001; r=0.88 in uninvolved psoriatic samples, P<0.001; and r=0.85 in normal skin samples, P<0.001). Samples with higher percentage of p53 positive cells expressed pro-apoptotic Bak and Bax in higher percentage of cells; the correlation coefficients were r=0.74 and r=0.68 in involved psoriatic samples (P<0.001 for both), r=0.75 and r=0.69 in uninvolved psoriatic samples (P<0.001, for both), and r=0.87 and r=0.70 in normal skin samples (P<0.001, for both). CONCLUSION: Increased expression of Bcl-X protein was associated with psoriatic epidermal hyperplasia. Strong Bax and Bak expression in involved psoriatic skin are probably inhibitory mechanisms counteracting intensive proliferation.