Immunohistochemical analysis of MMP-9 and COX-2 expression in carotid atherosclerotic plaques among patients undergoing carotid endarterectomy: A prospective study.

BACKGROUND: Matrix metalloproteinase-9 protein (MMP-9) and cyclooxygenase-2 (COX-2) proteins may have a role in remodelling of atherosclerotic plaques. We analysed and compared the radiological, histological and immunohistochemical characteristics of carotid atherosclerotic plaques between symptomatic and asymptomatic patients who underwent carotid endarterectomy (CEA). METHODS: This prospective single-blinded study included 31 patients (70 [64-75] years, 58% males, 42% symptomatic) who underwent CEA and a total of 155 carotid plaque sections that were analysed. Preoperative assessment and multimodality diagnostic imaging with magnetic resonance imaging (MRI) or computed tomography angiography (CTA), histological and immunohistochemical analyses of carotid plaques including the expression of MMP-9 and COX-2 proteins were performed. RESULTS: Symptomatic and asymptomatic patients did not significantly differ in respect to preoperative characteristics. Unstable plaques were detected in 12/13 (92.3%, p = 0.020) symptomatic patients using MRI or CTA. There was no perioperative mortality and perioperative outcomes were comparable in both groups. A significantly higher expression of MMP-9 in macrophages was observed among symptomatic patients (p = 0.020). ROC curve analysis showed statistically significant associations of both the higher intensity of COX-2 staining in CD68 PG-M1 positive macrophages (area under the curve [AUC]=0.701, p = 0.014) and higher MVD (AUC=0.821, p < 0.001) within the plaque with cerebrovascular symptoms. The expression of COX-2 and the intensity of COX-2 staining in macrophages within the unstable carotid plaques detected by preoperative MRI or CTA were significantly higher (76.1% vs. 40.0%, p = 0.038; 76.2% vs. 30.0%, p = 0.01, respectively). CONCLUSIONS: Advanced non-invasive multimodality diagnostic imaging including MRI or CTA is reliable in differentiating unstable from stable carotid plaques. High expression of MMP-9 and COX-2 in macrophages within the symptomatic plaque is associated with increased risk of cerebrovascular complications. TRIAL REGISTRATION: This study has been registered at the ISRCTN registry (ID ISRCTN46536832), isrctn.org Identifier: https://www.isrctn.com/ISRCTN46536832.

Current state of open access to journal publications from the University of Zagreb School of Medicine.

AIMS: To identify the share of open access (OA) papers in the total number of journal publications authored by the members of the University of Zagreb School of Medicine (UZSM) in 2014. METHODS: Bibliographic data on 543 UZSM papers published in 2014 were collected using PubMed advanced search strategies and manual data collection methods. The items that had "free full text" icons were considered as gold OA papers. Their OA availability was checked using the provided link to full-text. The rest of the UZSM papers were analyzed for potential green OA through self-archiving in institutional repository. Papers published by Croatian journals were particularly analyzed. RESULTS: Full texts of approximately 65% of all UZSM papers were freely available. Most of them were published in gold OA journals (55% of all UZSM papers or 85% of all UZSM OA papers). In the UZSM repository, there were additional 52 freely available authors' manuscripts from subscription-based journals (10% of all UZSM papers or 15% of all UZSM OA papers). CONCLUSION: The overall proportion of OA in our study is higher than in similar studies, but only half of gold OA papers are accessible via PubMed directly. The results of our study indicate that increased quality of metadata and linking of the bibliographic records to full texts could assure better visibility. Moreover, only a quarter of papers from subscription-based journals that allow self-archiving are deposited in the UZSM repository. We believe that UZSM should consider mandating all faculty members to deposit their publications in UZSM OA repository to increase visibility and improve access to its scientific output.

[Publications in the Croatian medical journals by doctoral candidates at University of Zagreb School of Medicine]. / Radovi doktorskih kandidata s medicinskog fakulteta sveucilista u zagrebu u hrvatskim casopisima.

By searching Medline/PubMed bibliographic database we collected data on publications of two groups of PhD candidates who earned their PhD degrees at University of Zagreb Medical School in 2000 and 2010. We identifed their publications in the Croatian medical journals and separately in the Croatian language. First group of PhD candidates (y 2000) published in the Croatian journals 34% of all published papers, with a share of 29% in the Croatian language. Another group (y 2010) published in the Croatian journals 44% of all published papers in which the number of papers published in the Croatian journals in English language grow significantly (5% vs. 31%). The number of papers published in the Croatian language decreased to 13%. Our results agreed with the global decreasing trend of the number of medical papers in non-English languages. The importance of mother-tongue in the medical education and health care may have influence on preserving scientific communication in non-English medical journals.

[Online information service: the library support for evidence-based practice]. / Informacijski mrezni servis: potpora knjiznice u provodenju prakse utemeljene na znanstvenim dokazima.

It frequently happens that physicians do not have adequate skills or enough time for searching and evaluating evidence needed in their everyday practice. Medical librarian can serve as a mediator in enabling physicians to utilize the potential offered by contemporary evidence-based medicine. The Central Medical Library (CML) at University of Zagreb, School of Medicine, designed a web-based information service aimed at the promotion of evidence-based practice in the Croatian medical community. The users can ask for a help in finding information on their clinical problems. A responsible librarian will analyse the problem, search information resources and evaluate the evidence. The answer is returned to the user by an e-mail. In the 2008-2012 period 166 questions from 12 clinical fields were received and most of them (36.1%) came from internal medicine doctors. The share of treatment-related questions was 70.5%. In the setting of underdeveloped ICT infrastructure and inadequate EBM resources availability, such information service can help in transfer of scientific evidence into the everyday clinical practice.

[Assessing research productivity in Department of Internal Medicine, University of Zagreb, School of Medicine and University Hospital Centre Zagreb]. / Procjena publicisticke produktivnosti klinike za unutrasnje bolesti Medicinskog fakulteta i Klinickoga bolnickog centra Zagreb.

Bibliometric analysis may give an objective information about publishing activity, citation rate and collaboration patterns of individuals, groups and institutions. The publication productivity of the present medical staff (79 with specialist degree and 22 residents) in Department of Internal Medicine, University of Zagreb School of Medicine in University Hospital Centre Zagreb was measured by the number of papers indexed by Medline, their impact was measured by the number of times these papers had subsequently been cited in the medical literature, while the collaboration pattern was estimated by the authors' addresses listed in the papers. PubMed database was a source for verifying the bibliographic data, and the citation data were searched via Thomson Web of Scence (WoS) platform. There were a total of 1182 papers, published from 1974 to date. The number of papers per author ranged from 0 to 252. Sixty of papers were published in English, and 39% in Croatian language. The roughly equal share was published in local and foreign journals. The RCT studies and practice guidelines were among the most cited papers and were at the same time published by the highly ranked journals. The collaboration analysis confirmed the extensive involment in the international multicentric clinical trials as well as in the development of international/local practice guidelines.

[Attitudes of health personnel in a university hospital toward evidence-based medicine]. / Medicina utemeljena na znanstvenim dokazima: stavovi zdravstvenog osoblja jedne klinicke bolnice.

Over the last few years the concepts and methods of the evidence-based medicine (EBM) have been increasingly recognized and applied in the Croatian medical community. Central Medical Library at Zagreb university Medical School has been developing a web-based service aimed to help practitioners find best evidence for solving specific clinical problems. Therefore, the health personnel affiliated to a teaching hospital were surveyed. The questionnaire included 18 questions evaluating attitudes towards EBM. It was displayed by the library's information desk. There were 204 respondents, 62% of them clinical specialists. Most respondents agreed that EBM is useful in clinical decision making (57.4%) as well as in improving patient care (55.4%). Lack of personal time (60.8%) and insufficient skills (60.3%) were percieved as the main barriers to practising EBM. The vast majority of respondents (96.6%) reported never having received EBM training. The study results show that medical librarians can play an expanded role in saving the practitioners' time by searching EBM resources and assessing the quality of the information.

Croatian Medical Journal citation score in Web of Science, Scopus, and Google Scholar.

AIM: To analyze the 2007 citation count of articles published by the Croatian Medical Journal in 2005-2006 based on data from the Web of Science, Scopus, and Google Scholar. METHODS: Web of Science and Scopus were searched for the articles published in 2005-2006. As all articles returned by Scopus were included in Web of Science, the latter list was the sample for further analysis. Total citation counts for each article on the list were retrieved from Web of Science, Scopus, and Google Scholar. The overlap and unique citations were compared and analyzed. Proportions were compared using chi(2)-test. RESULTS: Google Scholar returned the greatest proportion of articles with citations (45%), followed by Scopus (42%), and Web of Science (38%). Almost a half (49%) of articles had no citations and 11% had an equal number of identical citations in all 3 databases. The greatest overlap was found between Web of Science and Scopus (54%), followed by Scopus and Google Scholar (51%), and Web of Science and Google Scholar (44%). The greatest number of unique citations was found by Google Scholar (n=86). The majority of these citations (64%) came from journals, followed by books and PhD theses. Approximately 55% of all citing documents were full-text resources in open access. The language of citing documents was mostly English, but as many as 25 citing documents (29%) were in Chinese. CONCLUSION: Google Scholar shares a total of 42% citations returned by two others, more influential, bibliographic resources. The list of unique citations in Google Scholar is predominantly journal based, but these journals are mainly of local character. Citations received by internationally recognized medical journals are crucial for increasing the visibility of small medical journals but Google Scholar may serve as an alternative bibliometric tool for an orientational citation insight.

Information literacy in continuing professional development of medical practitioners: a Croatian example.

OBJECTIVES: This paper reports on the training of medical practitioners in information literacy. The course is carried out by an academic medical library in collaboration with its parent institution and the local physicians' licensing body. SETTING: The University of Zagreb Medical School (UZMS) developed an extensive continuing education programme for residents and practitioners, in partnership with the Croatian Chamber of Physicians. Within this programme, the Central Medical Library (CML) offers a hands-on course on searching and appraisal of medical information. DESCRIPTION: Continuing professional development (CPD) helps physicians update and develop the skills and knowledge they require in their everyday practice. The ability to locate, critically evaluate, and use medical information is an important component of CPD. The CML has developed a course entitled "Finding and Appraisal of Medical Information" which has been reviewed and accepted by its parent institution and the physicians' chamber. The course has been introduced in 2005 on a half-year base. OUTCOME: The course provides participants with the information on the most important medical information resources and with the basic skills needed for their effective usage. An evaluation questionnaire is used to assess the effectiveness of the course.

For free or for fee? Dilemma of small scientific journals.

Biomedical publishing is becoming increasingly dominated by multinational companies, advertising research articles at the international market, presenting them electronically through web-based services, and distributing them to readers-consumers. It seems that they will soon become the sole publishers for the majority of biomedical journals. In the past decade, however, we witnessed a quiet revolution in the whole structure of scientific communication, influenced by new technologies and initiatives such as Open Access, PubMedCentral, PLoS, and BioMedCentral. The Croatian Medical Journal (CMJ) has recently been approached by two major publishing companies and offered to become one of the journals in their group. The editorial decision was to join neither of the publishers. We felt that the decision had to be explained to our readers by defining CMJ's position in global scientific and medical journal publishing. Our experience may be similar to that of the many biomedical journals which find themselves in a dilemma whether to join major publishers or not.

[Does visibility matter? International visibility of the Lijecnicki vjesnik]. / Je li vazan odjek? Medunarodna vidljivost Lijecnickog vjesnika.

From the very beginning Lijecnicki vjesnik has been fulfilling the role of the official organ of the Croatian Medical Association publishing also original reports of the Croatian authors. To identify the international visibility of the Lijecnicki vjesnik, its coverage by international indexing and abstracting services has been analysed. Lijecnicki vjesnik has been covered by Index Medicus since 1957, and more then 4200 items are accessible through PubMed service. In the ISI Web of Science database 399 papers published in Lijecnicki Vjesnik have been cited so far. The international medical community can access the papers published by Lijecnicki vjesnik and there is no need to change its mission of the most important general medical journal in the Croatian language.

Journal publications from Zagreb University Medical School in 1995-1999.

AIM: To analyze a five-year publication output of the Zagreb University Medical School in scientific journals, especially in the journals covered by the Current Contents (CC), bibliographic database of the Institute for Scientific Information. METHODS: Medical School of the Zagreb University is organized in 10 preclinical, 6 public health, and 17 clinical departments, with 359 faculty members. Research activity is important for the academic promotion, with the number of publications (especially in journals covered by CC) and their impact as a key element. Bibliographic data on the published papers by the authors affiliated to the Zagreb University Medical School in the 1995-1999 period were searched in the CC and Biomedicina Croatica databases, according to the official faculty name list. The collected data were classified into three groups according to the source journals: papers published in international journals covered by the CC, Croatian journals covered by the CC, and Croatian journals not covered by the CC. The publication production was measured on individual and departmental levels by using two counting schemes: a) full publication to each author/department; and b) an equal fraction of a publication (1/n) to each author/department. RESULTS: In the 1995-1999 period, the faculty published 578 papers in the journals covered by the CC, 22.6% of them in the subset of Croatian journals. The differences among departments were considerable, with publishing activity per faculty member varying from 0.25 to 6.23 papers in CC journals and from 0.0 to 15.8 in Croatian non-CC journals. Preclinical departments published significantly less in the Croatian journals indexed in the CC then public health and clinical departments. There was a high variance in the number of publications on the individual level, with the 15.4% of the faculty in the professor rank and 45% in the assistant rank who did not publish a single paper in journals covered by the CC in the analyzed period. On the contrary, 10.1% of professors and 6.0% of assistants published more than 10 and more than 4 CC-indexed papers, respectively. A number of authors who have been very productive in international journals indexed in the CC (11 or more papers) did not publish in Croatian journals indexed in the same database, and vice versa. CONCLUSION: Publication output of the Zagreb University Medical School shows imbalances characteristic of a small scientific community: productivity with extreme values, relatively unsatisfactory number of papers published in the international journals covered by the CC database as compared to their importance in the process of the academic promotion, and disproportional role of certain domestic journals covered by the CC.

Scientific biomedical journals in Croatia.

AIM: To assess the current situation in biomedical journal publishing in Croatia, according to the journals editorial and publishing characteristics. METHOD: A survey questionnaire with 38 questions was sent to the editors-in-chief of 43 biomedical journals in Croatia. Thirty-seven journals were analyzed. RESULTS: In 2000, there were 14 general and 23 specialized biomedical journals in Croatia. Twenty-five journals received financial support from the government. Six journals were indexed in MEDLINE, with two of them also in Current Contents, 20 in other bibliographic databases, and 11 were not indexed at all. Twelve journals published articles in English, 11 in Croatian, and 14 in either English or Croatian. Only 9 journals were available on-line: 5 offered abstracts only and 4 offered full-text articles. There were more indexed than non-indexed journals that were financially supported by the government (p=0.031) and published in English or either English or Croatian (p=0.011). Indexed journals published more pages (p=0.020) and received more articles (p=0.030) per year. Five journals provided salary for the editorial staff and 4 paid the reviewers services. Median number of subscribers was 250 (range, 0-7,000) and median circulation 650 (range, 300-7,200). Finances, number and quality of articles, and problems with the review process were perceived by editors as the most important problems. CONCLUSION: Many journals had financial problems despite receiving governmental or other support. Low number/quality of articles received and inefficient review process could reflect the self-containment of Croatian medical community, which comprises around 11,000 physicians and dentists. Large ranges in circulation, number of subscribers, and number of pages published per year, as well as in indexing rates, might imply large differences among the journals in their target readership and editorial policies and performance.