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The hazard caused by driving under the influence of drugs (DUID) is determined by the time of consumption, dose and biological effects of a substance, as well as by synergistic drug interactions after multi-drug use. The aim of this work was to investigate the prevalence and pattern of psychoactive substance use of suspected DUID drivers and to present the advantages and disadvantages of the system currently used for determination of impairment in Hungary. Blood and urine samples, collected between 2016 and 2018, were taken from 2369 drivers with a positivity rate of 95% for at least one substance. Classical illicit drugs were detected in 76-87%, prescription medications in 9-15%, stimulant New Psychoactive Substances (sNPS) in 3-8%, and synthetic cannabinoids (SCs) in 20-22% of the positive samples. The most frequent substances according to substance groups were: classical illicit drugs: cannabis (n = 1240), amphetamine and methamphetamine (AM/MA) (n = 753), MDMA (n = 196), and cocaine (n = 180), medicines: alprazolam (n = 188) and clonazepam (n = 83), sNPS: N-ethyl-hexedrone (n = 115), SCs: 5 F-MDMB-PINACA (n = 267), AMB-FUBINACA (n = 92) and ADB-FUBINACA (n = 90). The median age of classical illicit drugs users was 29 years, prescription medicine users were 33 years old, sNPS users were 28 years, and SC users were 26 years old. Compared to the previous two years, we found pronounced changes in the ratio of sNPS (14% decrease) and SC users (10% increase), and in the pattern of NPS consumption. The ratio of multi-drug use varied between 38% and 50%. 69% of drivers tested positive were deemed impaired. Impairment was determined according to impairment limits (80-82%), multi-drug use (12-13%), and the result of medical investigation when a single active substance with no set impairment limit was detected in the blood (6-8%). The results of medical investigations may be uncertain due to the long time delay between arrest and clinical examination and to the structure of medical investigations created for determination of alcoholic impairment. In conclusion, a revision of the current medical investigation protocol is warranted to standardize clinical symptom scores that better correlate with driving impairment. [ABSTRACT FROM AUTHOR]

Highlights: [•] Microstructural characteristics of biopolymer cast films were determined by PALS. [•] Macrostructure of the cast films was characterized by the puncture strength. [•] Macrostructural changes were visualized by SEM. [•] Similar trends were found in the macro- and microstructural properties of the films. [•] PALS is useful for the optimization of the composition. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to evaluate the interaction between the film-forming sodium alginate and lactose monohydrate. This combination is used in the co-spray-drying technique for microencapsulation, but no respect on the structure of the film formed has not been published previously. From mechanical tests, positronium lifetime measurements and FT-IR studies on free films containing different ratios of film-former and lactose, we concluded that the mechanical strength of the sodium alginate film decreased with the increasing proportion of lactose. The free volume in the polymer matrix decreased to a minimum as the lactose content was progressively increased to 40%, but subsequently increased at higher lactose contents. The explanation of this phenomenon is the filling of the holes with the sugar. As lactose became predominant component, the structure of the polymer network weakened. These conclusions were supported by the FT-IR findings. The present results permit a clear explanation of the previously reported favourable effects of this film-forming combination on the dissolution of the active agent from the microcapsules. [Copyright &y& Elsevier]

Abstract: Surface and structural investigations of natural biopolymer (chitosan) films containing various conventionally applied hydrophilic plasticizers (glycerol and poly(ethylene glycol) 400) were performed and the results were compared, with the aim of acquiring new information concerning the formation of these plasticized films. The surface tests revealed that the water uptake, the water-binding properties (moisture content) and the polarity were higher for the film containing glycerol as plasticizer. Positronium lifetime measurements and NMR studies performed to evaluate the effects of the plasticizer on the polymer structure demonstrated relevant differences in the effects of the plasticizers. The influence of glycerol on the structure of the film formed was more intensive than that of PEG 400. It can be concluded that the surface properties of the films, which are very important for their storage and application, cannot be established exactly by means of structural tests. Both surface and structural tests must be performed before the formulation of this type of plasticized mucoadhesive films. [Copyright &y& Elsevier]

Abstract: The plasticizing effects of poly(ethylene glycol) (PEG 400) on methylcellulose (Metolose) cast films were studied by conventional physicochemical methods and positron annihilation spectroscopy. The PEG concentrations relative to the total polymer content were varied within the range 0–75% (w/w). At low concentrations (below 33.3%, w/w), the plasticizer was found to build in into the methylcellulose structure. On the other hand, at higher concentrations (above 50%, w/w), it formed small separate phases in the films. Positron annihilation spectroscopy (PALS) was applied to track the Metolose–PEG interaction. Controlled ageing of Metolose–PEG films at room temperature and at 75% RH revealed a significant difference between the ageing processes of the monophase and those of the separate phase films. The ageing involves two steps in both cases: a fast and a slow one. The PALS measurements demonstrated that the slow process is hindered in the phase-separated samples. [Copyright &y& Elsevier]

Abstract: In pharmaceutical technology, film-forming agents are often applied in solution during the preparation of solid dosage forms. A wide range of polymers have already been examined, but many of the effects of the applied solvent on the properties of the film are still not fully known. The study of these phenomena might be of great help in the preparation of better films. In the present study, the frequently used polymer hydroxypropyl-cellulose was examined in water and ethanol. The latter solvent exhibits better wetting properties for this polymer. It was found that the use of ethanol enhanced the processibility because of the easier atomization and the shorter drying period. Properties characteristic of the chemical nature (wetting, surface free energy and thermal properties) and the physical behaviour (deformation process) of the poured films were studied. Relevant differences were detected only in the mechanical parameters. The sizes of the free volume holes in the differently prepared polymers were also determined, but this parameter proved irrelevant as concerns alterations of the breaking process. The explanation of the differences processibility of the films might be the different strengths of binding between the macromolecular chains. This phenomenon can also explain the different degrees of hydration of the polymer and the changes in the drying process. [Copyright &y& Elsevier]

Background : Vascular access site complications (VASCs) after endovascular interventions requiring a large-bore access are frequent and known to be associated with increased morbidity and mortality. Although balloon-expandable covered stents (BECSs) are increasingly used in such indications, their performance in this rather hostile territory is currently unknown. We aimed to evaluate the safety and efficacy of BECSs in common femoral artery (CFA) VASCs management. Methods : This is a national multicenter retrospective study of all patients who underwent BECS implantation of the CFA due to a VASCs after an endovascular procedure between January 2020 and May 2023 in major tertiary referral centers in Hungary. Operative data were collected and follow-up ultrasound examinations were performed. Our study is registered on ClinicalTrials.gov (NCT05220540) and followed the STROBE guidelines. Results : Of the 23 patients enrolled (13 females, mean age: 74.2 ± 8.6), technical success was achieved in 21 (91.3%) cases, with one perioperative death. After an average follow-up of 18.0 ± 11.4 months, another nine (39.1%) deaths occurred, and one was VASCs-associated. BECS occlusion was detected in one (4.3%) patient, being the only reintervention (4.3%) where revascularization was also achieved. Conclusions : Although BECS implantation for CFA VASCs is feasible with a relatively high technical success rate, the mortality rate is non-negligible. Until adequately evaluated, BECS implantation in such indications is to be used with caution, ideally only within the framework of a trial.

Background: We conducted an in vitro comparison of the snare loop reinforcement against a closed-loop reinforcement (Hungaroring) for physician-modified endograft (PMEG) fenestrations regarding preparation time and stability during flaring balloon dilatation., Materials and Methods: The time to complete a PMEG fenestration with reinforcement was measured and compared between the Hungaroring and snare loop groups. The number of stitches was counted. Each fenestration was dilated using a 10 mm high-pressure, non-compliant balloon up to 21 atm in pressure, and fluoroscopic images were taken. The presence of indentation on the oversized balloon at the level of the reinforcement was evaluated at each fenestration., Results: Five fenestrations were created in each group (n = 5) for a total of ten pieces. The completion time in the snare loop group was 1070 s (IQR:1010-1090) compared to 760 s (IQR:685-784) in the Hungaroring group ( p = 0.008). Faster completion time was achieved by faster stitching (23.2 s/stitch (IQR 22.8-27.3) for the snare loop group and 17.3 s/stitch (IQR 17.3-20.1) for the Hungaroring group ( p = 0.016). None of the fluoroscopic images of the snare loop reinforcement showed an indentation on the balloon during the overexpansion; on the contrary, the Hungaroring showed indentation in every case, even at 21 atm., Conclusion: Fenestrations reinforced with Hungaroring can be completed significantly faster. Furthermore, the Hungaroring resists over-dilation even at high pressures, while snare loop reinforcements dilate at nominal pressure.

Background: Air embolism is a known risk during thoracic endovascular aortic repair (TEVAR) and is associated with an incomplete deairing of the delivery system despite the saline lavage recommended by the instructions for use (IFU). As the delivery systems are identical and residual air remains frequently in the abdominal aortic aneurysm sac, endovascular aortic repair (EVAR) can be used to examine the effectiveness of deairing maneuvers. We aimed to evaluate whether increasing the flush volume can result in a more complete deairing., Methods: Patients undergoing EVAR were randomly assigned according to flushing volume (Group A, 1× IFU; Group B, 4× IFU). The Terumo Aortic Anaconda and Treo and Cook Zenith Alpha Abdominal stent grafts were randomly implanted in equal distribution (10-10-10). The quantity of air trapped in the aneurysm sac was measured using a pre-discharge computed tomography angiography (CTA). Thirty patients were enrolled and equally distributed between the two groups, with no differences observed in any demographic or anatomical factors., Results: The presence of air was less frequent in Group A compared to that in Group B [7 (47%) vs. 13 (87%), p  = .02], and the air volume was less in Group A compared to that in Group B (103.5 ± 210.4 vs. 175.5 ± 175.0 mm 3 , p  = .04). Additionally, the volume of trapped air was higher with the Anaconda graft type ( p  = .025)., Discussion: These findings suggest that increased flushing volume is associated with a higher amount of trapped air; thus, following the IFU might be associated with a reduced risk of air embolization. Furthermore, significant differences were identified between devices in terms of the amount of trapped air., Clinical Trial Registration: [NCT04909190], [ClinicalTrials.gov]., Competing Interests: ZS is a speaker, trainer, and proctor for Cook Medical. CC-N is a speaker, trainer, and proctor for Terumo Aortic and Cook Medical. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Szentiványi, Borzsák, Vecsey-Nagy, Süvegh, Hüttl, Fontanini, Szeberin and Csobay-Novák.)

The first-line treatment of common iliac artery aneurysms is endovascular repair. International guidelines recommend the preservation of the internal iliac artery, which is best achieved by the implantation of an iliac bifurcation device (IBD). Our aim was to evaluate the initial midterm results of IBDs in the leading vascular center of Hungary. In this single-center retrospective study, relevant clinical data and the results of the imaging examinations were collected and analyzed in all patients who underwent IBD implantation between December 2010 and July 2021. Thirty-five patients (31 males, mean age: 67.9 ± 8.5 years) underwent endovascular treatment with 37 IBD implantations. Technical success was achieved in 88.2% of the patients, with no perioperative mortality or open surgical conversion. One patient was lost during follow-up. Internal iliac artery occlusion was detected in three (8.8%) patients, and reintervention was performed in five (14.7%) patients. Primary patency of the internal iliac branch was 97.1% at 1 month, 93% at 2 months, and 89.0% at 5 years. The average follow-up time was 20.1 ± 26.2 months, during which two (5.9%) deaths occurred. Our initial experience with iliac branch devices was associated with a low complication rate and a favorable outcome, which confirms the midterm success of this intervention.

Methods: In our retrospective study, we analysed data from patients undergoing EVAR surgery augmented with prophylactic endosuturing. Demographic and anamnestic data, results of surgery and follow-up examinations and imaging studies were analyzed. Results: Between January 1, 2019 and September 30, 2021, 14 cases (11 men, mean age 70.4 +/- 8.1 years) underwent EVAR surgery with prophylactic endosuturing. In 86% of cases (12/14), endosuturing was performed due to a hostile neck, using an average of 6.4 +/- 1.7 screws. No technical complications occurred. No mechanical complications or persistent Ia endoleak were observed during the mean follow-up of 7.0 +/- 9.9 months. Reintervention did not occur. One patient was lost during follow-up due to a disease unrelated to the aorta, resulting in a mortality rate of 7% (1/14) and a clinical success rate of 92.9% (13/14). Discussion: In accordance with recent publications, we found a low complication rate and a technical success rate above 90%. Conclusion: We demonstrated the efficacy of the Medtronic Heli-FX system in a high-risk patient population. The technique can be successfully and safely used for endovascular treatment of infrarenal aneurysms complicated with hostile neck.