Worldwide research productivity in critical care medicine

INTRODUCTION: The number of publications and the impact factor of journals are accepted estimates of the quantity and quality of research productivity. The objective of the present study was to assess the worldwide scientific contribution in the field of critical care medicine. METHOD: All research studies published between 1995 and 2003 in medical journals that were listed in the 2003 Science Citation Index (SCI(®)) of Journal Citation Reports under the subheading 'critical care' and also indexed in the PubMed database were reviewed in order to identify their geographical origin. RESULTS: Of 22,976 critical care publications in 14 medical journals, 17,630 originated from Western Europe and the USA (76.7%). A significant increase in the number of publications originated from Western European countries during the last 5 years of the study period was noticed. Scientific publications in critical care medicine increased significantly (25%) from 1995 to 2003, which was accompanied by an increase in the impact factor of the corresponding journals (47.4%). Canada and Japan had the better performance, based on the impact factor of journals. CONCLUSION: Significant scientific progress in critical care research took place during the period of study (1995–2003). Leaders of research productivity (in terms of absolute numbers) were Western Europe and the USA. Publications originating from Western European countries increased significantly in quantity and quality over the study period. Articles originating from Canada, Japan, and the USA had the highest mean impact factor.. Canada was the leader in productivity when adjustments for gross domestic product and population were made

Progression of mouse skin carcinogenesis is associated with increased ERα levels and is repressed by a dominant negative form of ERα.

Estrogen receptors (ER), namely ERα and ERβ, are hormone-activated transcription factors with an important role in carcinogenesis. In the present study, we aimed at elucidating the implication of ERα in skin cancer, using chemically-induced mouse skin tumours, as well as cell lines representing distinct stages of mouse skin oncogenesis. First, using immunohistochemical staining we showed that ERα is markedly increased in aggressive mouse skin tumours in vivo as compared to the papilloma tumours, whereas ERβ levels are low and become even lower in the aggressive spindle tumours of carcinogen-treated mice. Then, using the multistage mouse skin carcinogenesis model, we showed that ERα gradually increases during promotion and progression stages of mouse skin carcinogenesis, peaking at the most aggressive stage, whereas ERβ levels only slightly change throughout skin carcinogenesis. Stable transfection of the aggressive, spindle CarB cells with a dominant negative form of ERα (dnERα) resulted in reduced ERα levels and reduced binding to estrogen responsive elements (ERE)-containing sequences. We characterized two highly conserved EREs on the mouse ERα promoter through which dnERα decreased endogenous ERα levels. The dnERα-transfected CarB cells presented altered protein levels of cytoskeletal and cell adhesion molecules, slower growth rate and impaired anchorage-independent growth in vitro, whereas they gave smaller tumours with extended latency period of tumour onset in vivo. Our findings suggest an implication of ERα in the aggressiveness of spindle mouse skin cancer cells, possibly through regulation of genes affecting cell shape and adhesion, and they also provide hints for the effective targeting of spindle cancer cells by dnERα

Impact of Definitive Therapy with Beta-Lactam Monotherapy or Combination with an Aminoglycoside or a Quinolone for Pseudomonas aeruginosa Bacteremia

BACKGROUND: Bacteremia by Pseudomonas aeruginosa represents one severe infection. It is not clear whether beta-lactam monotherapy leads to similar rates of treatment success compared to combinations of beta-lactams with aminoglycosides or quinolones. METHODS: Retrospective cohort study from 3 tertiary hospitals (2 in Greece and 1 in Italy). Pseudomonas aeruginosa isolates were susceptible to a beta-lactam and an aminoglycoside or a quinolone. Patients received appropriate therapy for at least 48 hours. Primary outcome of interest was treatment success in patients with definitive beta-lactam combination therapy compared to monotherapy. Secondary outcomes were treatment success keeping the same empirical and definitive regimen, mortality, and toxicity. RESULTS: Out of 92 bacteremias there were 54 evaluable episodes for the primary outcome (20 received monotherapy). Treatment success was higher with combination therapy (85%) compared to beta-lactam monotherapy (65%), however not statistically significantly [Odds ratio (OR) 3.1; 95% Confidence Interval (CI) 0.69-14.7, p = 0.1]. Very long (>2 months) hospitalisation before bacteremia was the only factor independently associated with treatment success (OR 0.73; 95% CI 0.01-0.95, p = 0.046), however this result entailed few episodes. All-cause mortality did not differ significantly between combination therapy [6/31 (19%)] and monotherapy [8/19 (42%)], p = 0.11. Only Charlson comorbidity index was associated with excess mortality (p = 0.03). CONCLUSION: Our study, in accordance with previous ones, indicates that the choice between monotherapy and combination therapy may not affect treatment success significantly. However, our study does not have statistical power to identify small or moderate differences. A large randomized controlled trial evaluating this issue is justified

Toxicity after prolonged (more than four weeks) administration of intravenous colistin

BACKGROUND: The intravenous use of polymyxins has been considered to be associated with considerable nephrotoxicity and neurotoxicity. For this reason, the systemic administration of polymyxins had been abandoned for about 20 years in most areas of the world. However, the problem of infections due to multidrug-resistant (MDR) Gram-negative bacteria such us Pseudomonas aeruginosa and Acinetobacter baumanniii has led to the re-use of polymyxins. Our objective was to study the toxicity of prolonged intravenous administration of colistin (polymyxin E). METHODS: An observational study of a retrospective cohort at "Henry Dunant" Hospital, a 450-bed tertiary care center in Athens, Greece, was undertaken. Patients who received intravenous colistin for more than 4 weeks for the treatment of multidrug resistant Gram-negative infections were included in the study. Serum creatinine, blood urea, liver function tests, symptoms and signs of neurotoxicity were the main outcomes studied. RESULTS: We analyzed data for 19 courses of prolonged intravenous colistin [mean duration of administration (± SD) 43.4 (± 14.6) days, mean daily dosage (± SD) 4.4 (± 2.1) million IU, mean cumulative dosage (± SD) 190.4 (± 91.0) million IU] in 17 patients. The median creatinine value increased by 0.25 mg/dl during the treatment compared to the baseline (p < 0.001) but returned close to the baseline at the end of treatment (higher by 0.1 mg/dl, p = 0.67). No apnea or other evidence of neuromuscular blockade was noted in any of these patients who received prolonged treatment with colistin. CONCLUSIONS: No serious toxicity was observed in this group of patients who received prolonged intravenous colistin. Colistin should be considered as a therapeutic option in patients with infections due to multidrug resistant Gram-negative bacteria

Arabidopsis Coexpression Tool:a tool for gene coexpression analysis in Arabidopsis thaliana

Gene coexpression analysis refers to the discovery of sets of genes which exhibit similar expression patterns across multiple transcriptomic data sets, such as microarray experiment data of public repositories. Arabidopsis Coexpression Tool (ACT), a gene coexpression analysis web tool for Arabidopsis thaliana, identifies genes which are correlated to a driver gene. Primary microarray data from ATH1 Affymetrix platform were processed with Single-Channel Array Normalization algorithm and combined to produce a coexpression tree which contains ∼21,000 A. thaliana genes. ACT was developed to present subclades of coexpressed genes, as well as to perform gene set enrichment analysis, being unique in revealing enriched transcription factors targeting coexpressed genes. ACT offers a simple and user-friendly interface producing working hypotheses which can be experimentally verified for the discovery of gene partnership, pathway membership, and transcriptional regulation. ACT analyses have been successful in identifying not only genes with coordinated ubiquitous expressions but also genes with tissue-specific expressions

Volume of blood suctioned during vacuum-assisted breast biopsy predicts later hematoma formation

<p>Abstract</p> <p>Background</p> <p>To evaluate whether the volume of blood suctioned during vacuum-assisted breast biopsy (VABB) is associated with hematoma formation and progression, patient's age and histology of the lesion.</p> <p>Findings</p> <p>177 women underwent VABB according to standardized protocol. The volume of blood suctioned and hematoma formation were noted at the end of the procedure, as did the subsequent development and progression of hematoma. First- and second-order logistic regression was performed, where appropriate. Cases with hematoma presented with greater volume of blood suctioned (63.8 ± 44.7 cc vs. 17.2 ± 32.9 cc; p < 0.001, Mann-Whitney-Wilcoxon test for independent samples, MWW); the likelihood of hematoma formation was increasing till a volume equal to 82.6 cc, at which the second-order approach predicts a maximum. The volume of blood suctioned was positively associated with the duration of the procedure (Spearman's rho = 0.417, p < 0.001); accordingly, hematoma formation was also positively associated with the latter (p = 0.004, MWW). The volume of blood suctioned was not associated with patients' age, menopausal status and histopathological diagnosis.</p> <p>Conclusion</p> <p>The likelihood of hematoma is increasing along with increasing amount of blood suctioned, reaching a plateau approximately at 80 cc of blood lost.</p

HGCA2.0: An RNA-Seq Based Webtool for Gene Coexpression Analysis in Homo sapiens

Genes with similar expression patterns in a set of diverse samples may be considered coexpressed. Human Gene Coexpression Analysis 2.0 (HGCA2.0) is a webtool which studies the global coexpression landscape of human genes. The website is based on the hierarchical clustering of 55,431 Homo sapiens genes based on a large-scale coexpression analysis of 3500 GTEx bulk RNA-Seq samples of healthy individuals, which were selected as the best representative samples of each tissue type. HGCA2.0 presents subclades of coexpressed genes to a gene of interest, and performs various built-in gene term enrichment analyses on the coexpressed genes, including gene ontologies, biological pathways, protein families, and diseases, while also being unique in revealing enriched transcription factors driving coexpression. HGCA2.0 has been successful in identifying not only genes with ubiquitous expression patterns, but also tissue-specific genes. Benchmarking showed that HGCA2.0 belongs to the top performing coexpression webtools, as shown by STRING analysis. HGCA2.0 creates working hypotheses for the discovery of gene partners or common biological processes that can be experimentally validated. It offers a simple and intuitive website design and user interface, as well as an API endpoint

Abortions in First Trimester Pregnancy, Management, Treatment

The miscarriages’ investigation should include a familiar history, gynecological examination and a full laboratory testing including hormonal control, as well as karyotype, maternal immune control and thrombophilia testing. If the physician suspects the cause of abortions is chromosomal due to heredity, a special blood test (karyotype) for the pair is recommended. Chromosomal abnormalities are the most common reason for first trimester abortions, and are impossible to be prevented. Based on the above data, abortion and the subsequent possible infertility should not be considered as a personal failure for the woman and the treating physician. Nowadays, medical advancement provides many options combined with psychological support can actually reduce the miscarriages’ risk

Abortions in First Trimester Pregnancy, Management, Treatment

Tujuan dari penelitian: 1. Mendeskripsikan penerepan pendekatan Client Centered dalam mengatasi kepribadian introvert pada siswa kelas XI IPS MA Al Hidayah Kudus Tahun Pelajaran 2016/2017. 2. Mendeskripsikan kepribadian introvert pada konseli siswa kelas XI IPS MA Al Hidayah Kudus setelah diberikan konseling dengan pendekatan Client Centered. Pendekatan client centered adalah pendekatan yang berpusat pada diri klien, yang mana seorang konselor hanya memberikan konseling serta mengawasi klien pada saat mendapatkan pemberian konseling tersebut agar klien dapat berkembang atau keluar dari masalah yang dihadapinya. Introvert merupakan tipe kepribadian individu yang mempunyai kecenderungan menutup diri dari dunia luar. Jenis penelitian yang digunakan adalah peneltian kualitatif studi kasus. Penelitian dilakukan di MA NU Al Hidayah Kudus Tahun Pelajaran 2016/2017, dengan dua subjek penelitian (ABS, DAS). Metode pengumpulan data yang digunakan: 1. Wawancara, 2. Observasi, 3. Dokumentasi dan 4. Home Visit. Analisis data yang digunakan adalah: analisis sistem Bacon. Hasil penelitian: 1. Konseli I (ABS) faktor yang menyebabkan memiliki kepribadian intovert: 1. Tidak percaya diri. ABS yang berusia 16 tahun dan saat ini tengah duduk di kelas XI IPS MA NU Al Hidayah Kudus merasa kurang percaya diri dengan bentuk kaki yang dimiliki membuat ABS menjadi pibadi yang tidak percaya diri dalam pergaulan, sehingga membuat konseli sering mendapatkan perlakuan yang tidak menyenangkan dari siswa-siswi lain. Konseli memang terlahir dengan keadaan yang tidak sempurna karena cacat fisik pada salah satu kakinya atau yang biasa disebut sebagai (Clubfoot) atau kaki pengkor. 2. Perlakuan diskriminasi. Karena bentuk fisik yang dimiliki oleh konseli yang berbeda, konseli mendapatkan perlakuan diskrinasi dari siswa-siswi lain. 2. Konseli II (DAS) faktor yang menyebabkan konseli memiliki kepribadian introvert: 1. Rendahnya kemampuan interaksi konseli. Konseli sering berpindah tempat tinggal sejak usia sekolah dasar membuat kemampuan interaksi DAS kurang. Di sekolah, konseli banyak diperhatikan oleh siswa-siswi di sekolah karena secara fisik DAS merupakan siswa yang berpenampilan menarik. Tetapi kurang interaksi sosial, konseli lebih banyak memilih menyendiri dan tidak terlihat aktif dalam hubungan pertemanan yang sering terjalin pada anak usia sekolah atau remaja awal. 2. Perceraian kedua orang tua konseli. Perceraian yang ditimbulkan karena keuangan keluarga yang memburuk membuat konseli harus bekerja keras untuk membiayai sekolahnya semakin membuat konseli tidak memiliki waktu untuk bersosialisasi dengan teman sebayanya. Setelah pelaksanaan tiga kali konseling client centered terhadap kedua konseli diperoleh keterangan bahwa, konseli I (ABS) telah mampu menerima kekurangan dirinya yang memiliki keterbatasan pada kakinya. ABS telah percaya diri dan mampu bersosialisasi dengan baik. Konseli II (DAS) telah menyadari bahwa kehidupan yang ia alami harus tetap berjalan, dan DAS juga telah memahami bahwa makna kehidupan adalah terus bekerja dan bahagia atas apa yang dimilikinya sekarang. Berdasarkan kesimpulan di atas peneliti dapat memberikan saran: 1. Kepala sekolah: Dalam penelitian ini menunjukkan bahwa konseling individual sangat membantu siswa dalam memberikan mengatasi perilaku introvert siswa. Sehingga diharapkan kepala sekolah dapat mendukung adanya layanan konseling indivual ini dengan memfasilitasi guru pembimbing dalam memberikan layanan konseling individual. 2. Guru bimbingan dan konseling: Diharapkan guru bimbingan dan konseling dapat menjadikan hasil penelitian sebagai acuan dalam memberikan pelayanan konseling individual dengan konseling client centered. 3. Siswa: Diharapkan siswa dapat bergaul dengan baik dan semakin meningkatkan hubungan interpersonal. 4. Penelitian selanjutnya: Diharapkan peneliti selanjutnya dapat mengembangkan penelitian yang sejenis dengan menggunakan layanan konseling yang lebih varatif, sehingga didapatkan komparasi yang berbeda dengan penelitian ini

Vacuum-assisted breast biopsy in close proximity to the skin: a case report

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