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Bevezetés: A COVID–19-pandémiát okozó SARS-CoV-2 koronavírusnak folyamatosan újabb variánsai jelennek meg, 2021. november óta a legtöbb fertőzést az omikron koronavírus-variáns okozta. Célkitűzés: A prospektív megfigyeléses kohorszvizsgálat célja a COVID–19-fertőzésre nagyobb rizikóval bíró, egészségügyben dolgozók körében két Pfizer–BioNTech-vakcina és az ezt követően önkéntesen felvett emlékeztető vakcina utáni COVID–19-fertőzések előfordulásának, a vakcina hatásosságának, biztonságosságának és immunogenitásának vizsgálata volt. Módszer: A Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza egészségügyi és egészségügyben dolgozó munkatársainak két Pfizer–BioNTech (BNT162b2)-oltását 2021. január 7. és március 8. között kezdték meg. A harmadik, emlékeztető védőoltás típusának választása és időpontjának meghatározása önkéntes volt. 2021. január 7. és 2022. június 29. között követtük nyomon a dolgozókat. Felmértük a COVID–19-fertőzés előfordulását, az oltási reakció súlyosságát, a fertőzésre hajlamosító tényezőket és az oltások után a ’spike’ (S)-protein és a nukleokapszid (N)-protein elleni ellenanyag szintjének változási kinetikáját. Eredmények: 294 dolgozó – 96 orvos, 127 nővér és 71, egészségügyben dolgozó – adatait elemeztük, akiknek legalább három ellenanyagszint-mérésük történt a megfigyelési idő alatt. A harmadik, emlékeztető oltást 280 dolgozó kapta meg, a vakcinák megoszlása a következő volt: Pfizer–BioNTech (BNT162b2) (n = 210), Moderna COVID–19 (mRNA-1273) (n = 37), Sinopharm COVID–19 (n = 21), Janssen COVID–19 (n = 10) és AstraZeneca (ChAdOx1 nCoV-19) (n = 2). A megfigyelési időszakban 121 esetben történt fertőzés (41%). A COVID–19-fertőzések lefolyása többségében enyhe volt (97%), egy hét alatt gyógyult. A vizsgált időszakban 2 dolgozó halt meg: egy 56 éves nő két oltás után, COVID–19-fertőzéssel összefüggésbe nem hozható okból, és egy 58 éves férfi, aki a harmadik Pfizer-védőoltás után 6 hónappal zajló COVID–19-fertőzés után elhunyt. A fertőzés előfordulását nem befolyásolta az életkor, a nem, a kísérő betegségek, a dohányzás, a munkakör és a BMI. Az S-ellenanyag szintjének medián értéke az alapimmunizálás második oltása után 1 hónapig emelkedett (medián: 1173,0 U/ml), a 8. hónapig lassú csökkenő tendenciát mutatott (678,5–625,8–538,0 U/ml). A harmadik oltás után 1 hónappal lényegesen emelkedett az S-ellenanyag szintjének medián értéke (16 535,0 U/ml), az oltás utáni 3. hónaptól csökkenő tendenciát mutatott (9697,7 U/ml). Az S-antitest szintjének az oltások utáni kiugróan magas emelkedése összefüggést mutat az előzetes COVID–19-fertőzéssel. Az N-protein elleni ellenanyagszintet az oltás nem befolyásolta, emelkedése a fertőzéssel mutat összefüggést. Következtetés: Az emlékeztető vakcináció kevésbé hatott az omikron variáns okozta fertőzésre, de a betegség lefolyása enyhébb volt. Az alapimmunizáláshoz képest az emlékeztető oltás az S-antitest szintjének jelentősebb emelkedését okozta, ami összefüggést mutat a korábbi COVID–19-fertőzéssel. Orv Hetil. 2023; 164(5): 163–171.

SCLC is an aggressive malignancy where immunotherapies show limited efficacy. We aimed to characterize the SCLC microenvironment according to the expression patterns of SCLC subtype markers and novel immune checkpoints to identify therapeutic vulnerabilities.We included SCLC tissue samples from 219 surgically resected, limited-stage patients in this cross-sectional study. We performed immunohistochemistry for STING and MHCII, as well as for the novel subtype markers (ASCL1, NEUROD1, POU2F3, YAP1). Moreover, we assessed CD45 + , CD8 + and CD68 + immune cell infiltration.36% of SCLC tumors showed significant stromal or intraepithelial CD45 + immune cell infiltration. These patients exhibited significantly increased overall survival (OS) (vs. patients with immune-deserted tumors). High CD8 expression was associated with increased median OS. We found STING expression on cancer-associated fibroblasts in the stroma and on T-cells and macrophages in both tumorous and stromal compartments. STING expression positively correlated with immune cell infiltration. Increased STING-positivity in tumor nests was an independent favorable prognosticator for OS. ASCL1 was the most frequently expressed subtype-specific protein. Concomitant expression of three or four subtype-defining markers was seen in 13.8% of the included samples, whereas 24.1% of the cases were classified as quadruple negative tumors. YAP1 expression was associated with increased immune infiltrates. Tumor cell MHCII expression positively correlated with immune cell infiltration and with STING- and YAP1 expressions.STING and MHCII are expressed in SCLC. The majority of immune-infiltrated SCLCs exhibit increased STING expression. Immune infiltration and STING expression are prognostic in limited-stage SCLC, making STING a potential therapeutic target.

Introduction. Due to the lifelong nature of diabetes mellitus (DM), it has been demonstrated to have significant effects on patients’ morbidity and mortality. The present study aimed to assess the effects of DM on the clinical outcome and survival in patients who underwent percutaneous coronary intervention (PCI) due to myocardial infarction (MI) and to examine the relationship of DM to the type of the MI and to left ventricular (LV) and renal functions. Methods. A total of 12,270 patients with ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) were revascularized at our Institution between 2005 and 2013. In this pool of patients, 4388 subjects had DM, while 7018 cases had no DM. Results. In both STEMI and NSTEMI, the 30-day and 1-year survival were worse in diabetic patients as compared to non-diabetic cases. In the patients with DM, NSTEMI showed worse prognosis within 1-year than STEMI similarly to non-diabetic subjects. Regarding survival, the presence of DM seemed to be more important than the type of MI. Regardless of the presence of DM, reduced LV function was a maleficent prognostic sign and DM significantly reduced the prognosis both in case of reduced and normal LV function. Survival is primarily affected by LV function, rather than DM. Worse renal function is associated with worse 30-day and 1-year survival in both cases with and without DM. Considering different renal functions, the presence of DM worsens both short- and long-term survival. Survival is primarily affected by renal function, rather than DM. Conclusions. The results from a high-volume PCI center confirm significant the negative prognostic impact of DM on survival in MI patients. DM is a more important prognostic factor than the type of the MI. However, survival is primarily affected by LV and renal functions, rather than DM. These results could highlight our attention on the importance of recent DM treatment with new drugs including SGLT-2 inhibitors and GLP-1 antagonists with beneficial effects on survival.

Liver diseases result in a re-balanced state of the haemostatic system with decreased haemostatic reserves. Increased fibrinolytic activity is commonly seen during liver transplants. The aim of this study was to assess whether ClotPro's ECA-test is able to detect hyperfibrinolysis earlier and with higher frequency than ClotPro's conventional viscoelastic assays for the intrinsic and the extrinsic coagulation pathway. From 25 liver transplant recipients, systemic blood samples were collected during surgery. Viscoelastic haemostatic assays with ClotPro's IN-test, EX-test and ECA-test were performed simultaneously from each blood sample. Hyperfibrinolysis was defined on the basis of the manufacturer's prespecified threshold value (maximal lysis15%). The incidence of hyperfibrinolysis detected with each test was compared with the McNemar test. For each assay, lysis detection time (LDT) was calculated and analysed with the nonparametric Kruskal-Wallis test. A total of 125 tests were performed simultaneously. Compared with the IN-test and the EX-test, the ECA-test detected hyperfibrinolysis in significantly (P 0.001) higher number of patients (9; 11; 14, respectively) and in more measurement points (14; 18; 28, respectively). The analysis of LDT values revealed significant superiority of the ECA-test to the IN-test (P = 0.046) and to the EX-test (P = 0.035), indicating the profibrinolytic state of the haemostasis 8.9 ± 0.65 and 8.7 ± 0.17 min earlier, respectively. These are preliminary results of the study NCT0424637. ClotPro's ECA-test appeared to detect fibrinolysis in a higher number of patients, more frequently, and the mean time of detection was 9 min earlier than that of the IN-test and the EX-test.

Treatment of the coronavirus disease (COVID-19) is still challenging due to the lack of evidence-based treatment protocols and continuously changing epidemiological situations and vaccinations. Remdesivir (RDV) is among the few antiviral medications with confirmed efficacy for specific patient groups. However, real-world data on long-term outcomes for a short treatment course are scarce.This retrospective observational cohort study included real-life data collected during the second and third wave of the COVID-19 pandemic in Hungary (September 1, 2020-April 30, 2021) from inpatients at a University Center (n = 947). Participants consisted of two propensity score-matched cohorts (370/370 cases): Group RDV including patients receiving RDV and supplementary oxygen and Group standard of care (SOC) as control. The primary outcome was the effect of 5-day RDV treatment on 30- and 60-day all-cause mortality. Multivariate analyses were performed to assess the effect of RDV by different covariates.Group RDV included significantly more patients from the alpha variant wave, with greater frequency of comorbidities diabetes and anemia, and larger degree of parenchymal involvement. All-cause mortality at 30- and 60-day were significantly lower in Group RDV compared to Group SOC. Significant risk reduction of 60-day all-cause mortality was observed for RDV treatment in men and patients with COPD or multiple comorbidities.Hospitalized COVID-19 patients with 5-day RDV treatment had significantly lower 30- and 60-day all-cause mortality, despite their more severe clinical condition. Men and patients with multiple comorbidities, including COPD, profited the most from RDV treatment in the long term. Due to the ongoing COVID-19 pandemic, effective treatment regimens are needed for hospitalized patients.

To date, few data on how the COVID-19 pandemic and restrictions affected children’s physical activity in Europe have been published. This study examined the prevalence and correlates of physical activity and screen time from a large sample of European children during the COVID-19 pandemic to inform strategies and provide adequate mitigation measures. An online survey was conducted using convenience sampling from 15 May to 22 June, 2020. Parents were eligible if they resided in one of the survey countries and their children aged 6–18 years. 8395 children were included (median age [IQR], 13 [10–15] years; 47% boys; 57.6% urban residents; 15.5% in self-isolation). Approximately two-thirds followed structured routines (66.4% [95%CI, 65.4–67.4]), and more than half were active during online P.E. (56.6% [95%CI, 55.5–57.6]). 19.0% (95%CI, 18.2–19.9) met the WHO Global physical activity recommendation. Total screen time in excess of 2 h/day was highly prevalent (weekdays: 69.5% [95%CI, 68.5–70.5]; weekend: 63.8% [95%CI, 62.7–64.8]). Playing outdoors more than 2 h/day, following a daily routine and being active in online P.E. increased the odds of healthy levels of physical activity and screen time, particularly in mildly affected countries. In severely affected countries, online P.E. contributed most to meet screen time recommendation, whereas outdoor play was most important for adequate physical activity. Promoting safe and responsible outdoor activities, safeguarding P.E. lessons during distance learning and setting pre-planned, consistent daily routines are important in helping children maintain healthy active lifestyle in pandemic situation. These factors should be prioritised by policymakers, schools and parents. HIGHLIGHTS: To our knowledge, our data provide the first multi-national estimates on physical activity and total screen time in European children roughly two months after COVID-19 was declared a global pandemic. Only 1 in 5 children met the WHO Global physical activity recommendations. Under pandemic conditions, parents should set pre-planned, consistent daily routines and integrate at least 2-hours outdoor activities into the daily schedule, preferable on each day. Schools should make P.E. lessons a priority. Decision makers should mandate online P.E. be delivered by schools during distance learning. Closing outdoor facilities for PA should be considered only as the last resort during lockdowns.

The reaction times of patients with Parkinson’s disease (PD) in tests of simultaneous dual-task accuracy are dependent on the subjects’ cognitive ability. We now report that one week training on dual-task tests improved cognitive function. Forty-six PD patients were compared with 47 age matched healthy controls and 26 patients were followed for one year. Five dual-task tests consisting of a primary cognitive task to be performed simultaneously with a secondary motor task were repeated for five consecutive days. Testing was repeated after 6 and 12 months. Participants’ reaction times, including Hits and Misses, were quantified. Initial tests indicated slower reaction times in patients compared to controls, with fewer Hits and more Misses, especially in PD patients over 65 years of age. Training by daily repeated dual-task tests improved performance within 3 days (p < 0. 01 or p < 0.001), with no deterioration after 6 months. We conclude that dual-tasks are objective and sensitive tests for detecting early cognitive difficulties in PD, with improvements in both by repeated exposure to testing. A few days of testing produced cognitive improvement lasting many months. It is recommended that the use of simultaneous, dual-task testing is used to produce long-lasting improvement of cognitive function in PD patients.

Absztrakt: Bevezetés: A lumbalis derékfájás a társadalomra és a gazdaságra is jelentős hatással bíró tényező. Magyarországon a derék- vagy hátfájástól szenved a lakosság 21%-a, és tízből hatan gyógyszert is szednek a betegségre. A fájdalom kezelésének terápiája összetett, jelenleg nincs egységesen igazolt, hatékony módszer a betegség kezelésére. A derékfájdalommal kapcsolatban négy összetevőt érdemes megvizsgálni: a gerinc geometriáját, a gerinc degeneratív morfológiai elváltozásait, a betegeknek az elváltozással együtt járó fájdalmát és a funkciókárosodás mértékét. Célkitűzés: Megvizsgálni a lumbalis lordosis eloszlásának és a porckorongok degenerációjának kapcsolatát matematikai analízissel és annak szoftveres alkalmazásával. Módszer: 60 beteg MRI-felvételeinek algoritmikus elemzése és diszkriminanciaanalízis alkalmazásával degenerációs osztályokba történő besorolása. Eredmények: A kidolgozott degenerációs osztályokba sorolás esetén három vizsgált független változó mutat szignifikáns hatást: a nem, az életkor és a kitérési százalék (K), a sztenderdként használt Cobb-szög viszont nem. Az alkalmazott diszkriminanciafüggvények összes helyes besorolási (ún. prediktív) értéke 83%, a legrelevánsabb, súlyos degenerációs osztályba történő helyes besorolási érték pedig 92%. Következtetés: A vizsgálati minta elemzése alapján a nem, az életkor és a lumbalis gerinc geometriáját jellemző K (lordosisdisztribúció) értékeivel az ágyéki gerinc átlagos degenerációjának mértéke indirekt módon meghatározható az ingyenesen és online használható Spinalyze Software segítségével. Orv Hetil. 2020; 161(31): 1286–1292.

Absztrakt: Bevezetés: A májtranszplantáció során a haemostasis a hagyományos alvadásifaktor-szintekkel és a viszkoelasztikus tesztekkel monitorizálható, nem szokványos megközelítése a coagulatiósfaktor-specifikus vérveszteség dinamikus követése. Célkitűzés: Kutatásunk célja az alvadásifaktor-specifikus vérveszteség alapján kiszámolt térfogati tartalékok vizsgálata, a vér- és faktorkészítmény-mentes májtranszplantáció első 48 órájában a Child–Pugh-score tükrében is. Módszer: 59, vér- és faktorkészítményt nem igénylő, májtranszplantált beteg hagyományos alvadásifaktor-szintjeit, viszkoelasztikus paramétereit és faktorspecifikus vérveszteségeit elemeztük Gross-metódus segítségével, kiindulási és „coagulopathiás” triggerszintek alapján. A haemostasistartalékokat Child–Pugh-osztályozás szerint is összehasonlítottuk. A hagyományos laboratóriumi vizsgálatok és a faktorspecifikus térfogati tartalékok kiszámítása a májtranszplantáció előtt (T1), végén (T2) és 12–24–48 órával utána (T3–T4–T5) történt. A viszkoelasztikus tesztek eredményeit a májtranszplantáció előtt (T1) és végén (T2) rögzítettük. Eredmények: A műtét végére az alapszintről a fibrinogén 1,2 g/l-rel, míg a protrombin és az V-ös, a VII-es és a X-es faktor 26–40%-kal csökkent. A posztoperatív időszakban a fibrinogénszint 0,9 g/l-rel (T2–T4, pKövetkeztetés: A haemostasis térfogatalapú megközelítése kiegészíti a hagyományos laboratóriumi vizsgálatokat és a viszkoelasztikus teszteket, mivel dinamikusan jelzi a haemostasis aktuális tartalékát faktoronként, és a „leggyengébb láncszemet” mutatja meg a rendszerben. Orv Hetil. 2020; 161(7): 252–262.

Abstract: Introduction: Airway management is an integral part of general anaesthesia, which may lead to severe short- and long-term complications. Aim: We assessed whether the application of a checklist for the steps of airway management reduces the number of complications in our institute. Method: In our observational, prospective, controlled study we made a checklist and a data collection sheet. Each airway management was performed for one month without the checklist and then for one month in the possession of the checklist. We evaluated the outcome of airway maneuvers and the occurrence of related early complications before and after the introduction of the checklist. The primary endpoint was the incidence of unexpected difficult airway. The secondary endpoints were difficult intubation, successful first intubation, aspiration, cardiac arrest, post-induction hypotension and desaturation, soft tissues/teeth injuries. Our results were also corrected for factors that affect the risk of complications (urgency of interventions, medical experience). Results: We did not find any difference in the frequency of acute complications before the introduction of the checklist (n = 439) and during the subsequent period (n = 423). At the primary endpoint (7.29% and 6.14%), there was no substantive difference (1.15%, 95% CI: –2.26%–4.56%, p = 0.5). No differences were found regarding the secondary and other endpoints. Following the correction of risk factors, there was no impact of the checklist on the incidence of complications. Conclusion: The introduction of the checklist in itself did not result in a significant change in the risk of short-term complications of airway management in our institution. Orv Hetil. 2019; 160(26): 1025–1035.

Background The COVID-19 pandemic brought quick, severe and unexpected changes to our everyday life and also changed the traditional education pattern of Semmelweis University in the middle of academic year 2019–2020. We explored adaptive changes in Hungarian students’ behaviour and their time-budget in order to determine whether quarantine and/or fear of infection were responsible for these changes. Methods A self-administered online questionnaire was distributed to all students in the Hungarian language program (N = 7436) of Semmelweis University. Information was collected on basic demographic data, knowledge and attitude about COVID-19, methods of prevention as well as the students’ behaviour before, during and after the first wave of the pandemic. Statistical analyses were processed using the IBM-SPSS 25.0 software package. Results The overall response rate was 11% (N = 816). Only complete responses were processed (55%, N = 447). Among these responders, 83% did not fear the pandemic. Those who greatly feared COVID-19 infection strictly kept all regulations. The number of non-smokers increased by the end of the first wave. The nutrition of 100 students (21%) became healthier and the lockdown reduced the level of physical activity. Conclusion Social and health-related behaviour of medical students changed basically during the first wave of the pandemic and some changes remained after it in tobacco smoking, nutrition and sleeping habits. Time-budget of students changed significantly during the pandemic and did not return to the baseline values. Results of this study justify future multiple systematic research to analyse and better understand the short- and long-term effects of the current crisis.

Early ventricular fibrillation (EVF) predicts mortality in ST-segment elevation myocardial infarction (STEMI) patients. Data are lacking about prognosis and management of non-ST-segment elevation myocardial infarction (NSTEMI) EMI with EVF, especially at higher age. In the daily clinical practice, there is no clear prognosis of patients surviving EVF. The present study aimed to investigate the risk factors and factors influencing the prognosis of NSTEMI patients surviving EVF, especially at higher age. Clinical data, including 30-day and 1-year mortality of 6179 NSTEMI patients, were examined; 2.44% (n=151) survived EVF and were further analyzed using chi-square test and uni- and multivariate analyses. Patients were divided into two age groups below and above the age of 70 years. Survival time was compared with Kaplan-Meier analysis. EVF was an independent risk factor for mortality in NSTEMI patients below (HR: 2.4) and above the age of 70 (HR: 2.1). Mortality rates between the two age groups of NSTEMI patients with EVF did not differ significantly: 30-day mortality was 24% vs 40% (p=0.2709) and 1-year mortality was 39% vs 55% (p=0.2085). Additional mortality after 30 days to 1 year was 15% vs 14.6% (p=0.9728). Clinical characteristics of patients with EVF differed significantly from those without in both age groups. EVF after revascularization—within 48 h—had 11.2 OR for 30-day mortality above the age of 70. EVF in NSTEMI was an independent risk factor for mortality in both age groups. Invasive management and revascularization of NSTEMI patients with EVF is highly recommended. Closer follow-up and selection of patients (independent of age) for ICD implantation in the critical first month is essential.

Background The most common, potentially fatal complication following an acute myocardial infarction (AMI) is early ventricular fibrillation (EVF). According to the guidelines, the assessment of implanting an implantable cardioverter defibrillator (ICD) is sufficient 6 weeks after the event, in patients with reduced left ventricular ejection fraction (LVEF), regardless of VF. The present study aimed to evaluate the 6-week prognosis of patients surviving an EVF. We divided the patients in two group based on their general condition at the time they left the hospital. We investigated the clinical characteristics of patients discharged in good general health but still dying within 6 weeks. Methods The present study comprised 12,270 patients with AMI following their primary revascularization in the first 12 h of symptom onset. Five hundred and forty-seven of them suffered EVF due to the AMI. Clinical and 6-week mortality data were examined. Results Poor general condition correlates with multiple comorbidities, higher troponin levels, more severe complications after the event. Patients leaving in good condition thought to be low risk, from dying. But low LVEF, high blood sugar, high cardiac biomarker level, poor renal function elevates the risk of dying within 6 weeks. However, there is no difference in clinical characteristics between EVF- cases and EVF+ cases in good condition who dies within 6 weeks. Conclusions According to our study we can select patients who are safe in the critical 6-week period and those who need closer follow-up despite leaving in good general condition.

Low back pain is a major factor that influences both society and economy. In Hungary, 21% of the population suffers from low back pain or back pain, and six out of ten take medication for the disease. Therapy is complex and no single method has been proved effectively to treat this disease. There are four main factors associated with low back pain: the geometry of the spine, morphological degeneration, the pain of the patients associated with the degeneration and the degree of the impairment.To investigate the relationship between the distribution of lumbar lordosis and the degeneration of intervertebral discs by mathematical analysis and its software application.Algorithmic analysis of 60 MRIs and their classification into degeneration classes using discriminant analysis.By the classification, three independent variables show significant results: the gender, the age, and the digression percentage (K), but not the gold standard Cobb-angle. The common correct predicted classification value of the classification functions is 83% and the correct predicted classification value is 92% in the most relevant serious degeneration class.According to our results, the average degeneration of lumbar spine can be determined indirectly by the gender, the age, and the K (lordosis distribution) values with the Spinalyze Software which is available online for free. Orv Hetil. 2020; 161(31): 1286-1292.

Absztrakt

Introduction. Low back pain and disc degeneration could be linked to global spinal geometry. Our study aimed to develop a reliable new mathematical method to assess the local distribution of total lumbar lordosis with a single numeric parameter and compare it with lumbar intervertebral disc degeneration using routine MRI scans. Methods. An online, open access, easy-to-use platform for measurements was developed based on a novel mathematical approach using MRIs of 60 patients. Our Spinalyze Software can be used online with uploaded MRIs. Several new parameters were introduced and assessed to describe variation in segmental lordosis distribution with a single numerical value. The Pfirrmann grading system was used for the classification of lumbar intervertebral disc degeneration. Relationships were investigated between the grade categories of L1-S1 lumbar discs and the MRI morphological parameters with correlation analysis. Results. Results confirm that the determination of measurement points and calculated parameters are reliable (ICCs and Pearson r values > 0.90), and these parameters were independent of gender. The digression percentage (K%), one of our new parameters, did not show a statistical relationship with the Cobb-angle. According to our results, the maximum deflection breaking-point of lumbar lordosis and its location can be different with the same Cobb-angle and the distribution of global lordosis is uneven because the shape of the lumbar lordosis is shifted downward and centered around the L4 lumbar vertebra. The interobserver reliability of the Pfirrmann grades reading was in the excellent agreement category (88.33% agreement percentage, 0.84 kappa), and digression percentage (K%) showed a significant negative correlation with all L1-S1 disc grades with increasing r correlation values. This means that the smaller the value of digression percentage (K%), the more the number of worn discs in the lower lumbar sections. Conclusions. Spinalyze Software based on a novel mathematical approach provides a free, easy-to-use, reliable, and online measurement tool using standard MRIs to approximate the curvature of lumbar lordosis. The new reliable K% (digression percentage) is one single quantitative parameter to assess the local distribution of total lumbar lordosis. The results indicate that digression percentage (K%) may possibly be associated with the development of lumbar intervertebral disc degeneration. Further evaluation is needed to assess its behavior and advantage.

Background: \ud Transcranial magnetic stimulation (rTMS) may influence the progression of PD compared with levodopa. The long term mind modification effect of repeated rTMS and tDCS is not known, nor are the predictors for the effect of NBS.\ud \ud Objective/hypothesis: \ud We hypothesized that the regularly repeated rTMS would decrease the development of PD. Later, the treatment protocol was completed with transcranial direct current stimulation (tDCS), supposing that there is an add-on effect. NBS may differently influence motor and mental aspects of the disease.\ud \ud Methods: \ud Thirty patients with PD were followed for 3.5 years in an open study. They were stimulated with 1 Hz rTMS every half year for 1.5 years. After that the tDCS was add to the stimulation over both sides of the cerebellum for the next 2 years. UPDRS, Trail Making Test and dual tests were used. The linear regression lines of score systems and percentage of yearly increment were counted, analyzed by ANOVA.\ud \ud Results: \ud The yearly progression rate for UPDRS total was 2% for 3.5 years, 0.6% ≤65 years, 3.6% >65 years. The increment was around zero during the rTMS + tDCS stimulations in patients ≤65 years. The slope of the equation showed the same tendency. The individual sensitivity to the NBS was high. tTMS and tDCS >65 yrs improved pathological executive function (p 65 years. The cognitive function of patients >65 yrs was favorable influenced by rTMS and tDCS. Age is the main predictor of the effect of NBS. rTMS and tDCS can slow the progression of PD without any side effects but in an age-dependent way.

Absztrakt: Bevezetes: A ClinicalTrials.gov az Amerikai Egyesult Allamok kormanyzata altal műkodtetett weboldal, amely a klinikai vizsgalatokkal kapcsolatos adatokat gyűjti. Celkitűzes: Vizsgalatunkban az oldalrol XML fajlok formajaban letolthető, magyar vonatkozasu adatokat dolgoztuk fel. Modszer: Nagyobb mennyisegben a 2000-es evektől allnak rendelkezesre adatok, igy jo attekintő kepet kaphatunk az elmult 10–15 ev klinikai kutatasairol. Az adatmezők jelentős resze szabad szoveges, ezert az adatok elemzese előtt jelentős munkat kellett fektetni az adattisztitas elvegzesebe. Eredmenyek: Az adatbazisban 2863 magyar vonatkozasu klinikai vizsgalat szerepelt az elemzes elkeszitesekor, amelyek 189 telepulesen rendelkeznek vizsgalati hellyel. A konkret intezmenyeket sokszor nem lehet azonositani, a vizsgalati helyek alig otodenel sikerult ez. A tobbi esetben csak valamilyen azonosito vagy altalanos megnevezes szerepel, igy ezt a publikusnak szant informaciot anonimma teszik. Kovetkeztetes: Vizsgalatunk az adatba...

Introduction The changing of some meteorological parameters have major burden on the human body. That's why it became necessary to adopt to the altering conditions. The air temperature, atmospheric pressure have a significant influence on the patient's physical shape, blood pressure and response to stress. The aim of our study was to assess the impact of the fronts and all the factors forming the weather at the same time on the incidence of myocardial infarction and its prognosis. Methods We performed a retrospective analysis on the data of 11820 consecutive patients surviving acute myocardial infarction between 2005 and 2014. We used to scales applied in meteorology to characterise the days (Péczely Scale, Front Scale). We studied the incidence of the values of the different scales 2 days before and after the infarction. Results We had a database of 11820 patients, STEMI (n=5183) and NSTEMI (n=6004). We created different subgroups (age, 30-day mortality, occurrence of primary ventricle fibrillation) to make our estimation. Considering non VF patients the effect of Front 3 whereas among VF positive patients Front 5 is more significant. The incidence rates of Front 3 one day before and on the day of the infarction in the non-VF and NSTEMI group is 0.2041 and 0.1735, in the non-VF and STEMI group it is 0.1939 two days before the event. The incidence rate of Front 5 on the 2nd day in the NSTEMI and VF positive group is 0.0357, it is 0.0714 among STEMI and VF positive patients on the day of the event. The influence of the approaching warm front is significant (p Conclusion The influence of the weather is not irrelevant in the occurrence of MI. The mortality rates are higher in several subgroups on days having a Péczely Scale 3. The different fronts have a major impact on the severity of the infarction. The Front 5 causes higher incidence of VF due to MI. We proved that warm fronts have a significant effect on patients dying within 30 days.

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The early stage of Parkinson's disease (PD) (Hoehn-Yahr (HY) I-II stages) is characterized by a negative pull test, which clinically excludes postural instability. Previous studies with dynamic posturography detected balance disturbances even at the onset of the disease but the age dependency or prediction of dyskinesia with dynamic posturography are not known.We hypothesized that the postural instability evoked by dynamic posturography was part of the early stage of PD. Furthermore, we studied how we can provoke dyskinesia.Postural instability with static and dynamic posturography (passing balls with different weights around the body) was studied in 45 patients with PD in their HY I, II stages. They were compared with 35 age-matched healthy controls. Eighteen patients with dyskinesia were involved in the study. Fourteen patients were followed for two years.The pathway and velocity of the movement assessed by static and the dynamic posturography were significantly higher in the group65 years than that of age-matched healthy controls, while the group ≤65 years showed a significant increment only in the antero-posterior sway during dynamic posturography. The imbalance of patients with dyskinesia was significantly (p 0.05) provoked by dynamic posturography compared to patients with PD without dyskinesia. The results were independent of age.Postural instability is part of the early symptoms of PD. Non-dopaminergic pathways may be involved in the early stage of PD.

The Simplified Therapeutic Intervention Scoring System adapted to liver transplantation by King's College Hospital rank 138 activities to determine the nursing workload, diagnostic, monitoring and therapeutic needs.To evaluate nursing activities of "King's-TISS" score grouped in organ systems and nurse patient ratio in the perioperative 48 hours of blood product free liver transplantations (LT).The "King's-TISS" score's were analysed by nursing procedures and grouped, scored according to organ systems. The nursing workloads were studied during LT (T1), on arrival on the ICU (T2) and 12-24-48 hours after LT (T3-T4-T5).The total of "King's-TISS" score points were decreased by ≥20% daily (p = 0.001). The mean score of 104 ± 3.5 points (CI:104-105) during LT decreased to 84.7 ± 12 points (CI:83-86) in 48 hours (T5). The "metabolic" and "haemostasis" points increased (p = ).01), the "immunology" points unchanged (T2-T5) postoperatively. A slight decrease was observed in case of "basic nursing care", "monitoring", "neurologic support", "renal support" and "cardiovascular support" points (T2-T5, p .01). The "invasive intervention" and "ventilatory support" points strongly decreased (T2-T5, p .001). One "King's-TISS" point was found to equal 7.4 minutes with a nurse patient ratio of 2:1 intraoperatively and 1:1 postoperatively.Absence of blood product administration in LT decreases the total and organ specific workload, except the metabolic, haemostasis, immunology and basic support requirement. It was not within the scope of the King's-TISS score to analyse the application of viscoelastic haemostasis test and coagulation factor concentrate administration.

In the present study, the possible localization and role of vascular endothelial growth factor receptor type 2 (VEGFR2) in the regulation of gingival venules in a rat model of experimental diabetes are examined.Six weeks after streptozotocin premedication, Wistar male rats presenting blood sugar levels20 mmol/L were selected for investigation. The VEGFR2 antagonist ZM323881 [5-((7-benzyloxyquinazolin-4-yl)amino)-4-fluoro-2-methylphenol-hydrochloride] (20 μg/mL) was dripped onto the gingiva between the mandibular incisors. Changes in diameter of the selected gingival venule were measured by vital microscopy combined with digital photography at specified times. Immunohistochemical staining was used to localize VEGFR2. For controls, the same protocol was used on animals with normal blood sugar levels and healthy gingiva.There was a significant difference between the baseline venule diameter of the diabetic and the control groups (47 ± 1 and 28 ± 2 μm, respectively). After 15, 30, and 60 minutes of local application of ZM323881, significant vasoconstriction was observed in the venules of diabetic rats compared with the baseline (81.4% ± 4.6%, 81.8% ± 4.4%, and 80.6% ± 5.1%, respectively). The control group showed no change in the venule diameter. The immunohistochemical analysis showed significantly increased VEGFR2 expression in the mast cells along the venules in the diabetic group, whereas mast cells were rarely found in the control group.The findings suggest that VEGF expression is increased in gingiva in experimentally induced diabetes. After VEGFR2 activation, the mast cell-derived vasodilatory and inflammatory mediators may contribute markedly to the concomitant changes in the microcirculation.

The term “Big Data” is commonly used to describe the growing mass of information being created recently. New conclusions can be drawn and new services can be developed by the connection, processing and analysis of these information. This affects all aspects of life, including health and medicine. The authors review the application areas of Big Data, and present examples from health and other areas. However, there are several preconditions of the effective use of the opportunities: proper infrastructure, well defined regulatory environment with particular emphasis on data protection and privacy. These issues and the current actions for solution are also presented. Orv. Hetil., 2015, 156(49), 1979–1986.

Following a stroke, balance disturbances often persist despite full recovery of the paretic side.The aims were to determine how long postural instability could be detected after stroke and the differences in post-stroke patients under and above 65 years of age.Static and dynamic posturography (passing weights from hand to hand around the body) measurements were performed on 29 patients with stroke after 3 ± 2.4 years (≤65 years) and 4.7 ± 3.3 years. (65 years) compared with 38 controls.Only the pathway and the velocity assessed by dynamic posturography were significantly higher (p 0.05) in the younger group of patients compared with the controls. The older group of patients had significantly elevated parameters measured by both static (p 0.01) and dynamic posturography (p 0.05).we conclude, using a sensitive and reproducible method to assess both static and dynamic adjustments to maintain balance, that postural instability is significantly greater in post-stroke patients than control subjects. This difference is demonstrable up to 4 years after stroke, despite full recovery of the affected side.

Background rTMS may influence on both cognitive and motor function in PD but the daily routine and the predictors of responders to rTMS are not known. Objective/hypothesis We hypothesized that the frequency and intensity of stimulation somehow relate to each other. Our goal was to select the optimal frequency with low intensity for PD. We clarified the importance of age in the effect of rTMS. Methods A total sixty-six patients with PD were included in the study. In an open investigation, randomly selected patients were divided into three groups. The effects of 1 Hz (N = 28), 5 Hz (N = 13) and 5 + 1 Hz (N = 25) frequency at low intensity over each DLPFC and the brain stem for 7 days were compared. Patients were followed for six months. UPDRS, the Trail Making Test, and dual tasks were applied. Patients ≤65 years >65 yrs were compared. Data were analyzed by repeated measure ANOVA. Results Only 1 Hz had an effect on motor scores. Before the trial patients ≤ 65 yrs had UPDRS total scores of 30.3 ± 16.9, after 1 month: 17.8 ± 8.9 p 65 yrs was observed after one month (p 65 yrs (N = 16) was significantly worse compared with C (N = 15) and it was improved temporarily by 1 Hz. Five Hertz and 5 + 1 Hz did not cause improvement. Conclusion One Hertz with proper intensity has a good outcome in PD. Patients >65 yrs show deterioration in their executive function and they have shorter duration in their therapeutic effect of rTMS. This study draws attention to the importance of stimulation intensity and age as a predictor of the effect of rTMS.

Besides psychological and social effects, biological, biochemical and genetic factors also play a role in the background of suicide. The aim is developing a complex model incorporating all the above factors so that suicide could be predicted and prevented in those at risk. Based on several studies 5-HTTLPR s allele frequency is increased in case of violent completed suicides. The aim of the present study was to validate this association in a sample of completed suicides.During autopsy sample DNA samples were obtained for 5-HTTLPR genotyping from 200 subjects deceased due to suicide and 200 controls deceased due to other causes. Chi square tests and logistic regressions were performed according to additive, dominant and recessive models to analyse the possible association between 5-HTTLPR genotype distribution and suicide.Ratio of violent and non-violent suicides was 81% and 19% respectively. No significant difference was found in the distribution of 5-HTTLPR genotypes between the suicide and controls samples. No difference was found between violent and nonviolent suicides with respect to genotype distribution. A significant association was found between sl genotype and suicide at a younger age.Our pilot study did not support the supposed association between 5-HTTLPR and completed suicides or with violent completed suicides. However we found a significant association between sl genotype and suicide in young suicidals.

Intorduction: The ClinicalTrials.gov website, which is operated by the US government, collects data about clinical trials.We have processed data related to Hungary by downloading from the website as XML files.Most of the data describe trials performed after 2000, so we got an overview about the clinical research of the last 10 to 15 years. As the majority of the data fields are collected as free text, significant data cleaning was needed.The database contained 2863 trials related to Hungary from 189 settlements. Only 20 per cent of the actual research organizations could have been identified as many times only an "id" number or a general name was given, thus this information was anonymised in many cases.Besides the analysis of the information obtained from this database, our study points out the relevant issues that may influence the international view of the Hungarian clinical research. Orv. Hetil., 2017, 158(9), 345-351.

Certain steroidal compounds have an antioxidant effect in humans. Our aim was to test whether the synthetic steroid tibolone and its metabolites are also able to display such a property. For this, granulocytes from healthy men and women were incubated for two hours with different concentrations (10(-7), 10(-8), 10(-9 )M) of either estradiol, tibolone, 3α-hydroxytibolone, 3β-hydroxytibolone, Δ(4)-tibolone, 3α-sulfated-tibolone, 3α-17β-disulfated-tibolone, 3β-sulfated-tibolone or 3β-17β-disulfated-tibolone. Superoxide anion generation of neutrophils was measured by photometry. Results of different steroids were given as percentages of their controls. A more simple superoxide generating system, the xanthine-xanthine oxidase reaction was also tested. We found that granulocyte superoxide production did not differ from the control using 10(-9 )M of steroids. Using 10(-8 )M concentration: estradiol (80.9 ± 2.5%); 3β-sulfated-tibolone (83.3 ± 4.7%); 3β-17β-disulfated-tibolone (81.0 ± 4.2%) caused a significant decrease in superoxide production, compared to the control. In addition at 10(-7 )M, 3β-hydroxytibolone and 3α-sulfated-tibolone also showed antioxidant effects. In the xanthine-xanthine oxidase system estradiol (67.4 ± 1.0%), 3α-sulfated-tibolone (85.8 ± 5.3%), 3α-17β-disulfated-tibolone (71.9 ± 2.5%), 3β-sulfated-tibolone (73.9 ± 5.0%), and 3β-17β-disulfated-tibolone (65.8 ± 3.4%) caused a significant decrease in superoxide production. Conclusively, although tibolone itself did not show significant antioxidant capacity, most of its active metabolites have antioxidant effects.

Telemedicine is used more and more frequently worldwide. It is increasingly popular in North America, Australia, South Africa, as well as the Scandinavian countries. However, it is not commonly used in Hungary despite various attempts, which is presumably due to earlier dismissive governmental attitude. In this paper the authors analyze ethical, legal and financial aspects of telemedicine from the viewpoints of physicians and patients, too. The results indicate that it cannot be clearly decided whether telemedicine is worth to apply at present. Further, introduction of telemedicine should be based on experience gained in local application.A telemedicina alkalmazása világszerte feltörekvő irányzat. Népszerűsége vitathatatlan Észak-Amerikában, Ausztráliában, Dél-Afrikában és a skandináv országokban. Hazai elterjedése a különféle próbálkozások ellenére nem ért el átütő sikert – ez a korábbi elutasító kormányzati megnyilvánulásoknak is köszönhető. Jelen tanulmány etikai, jogi és finanszírozási szempontokból vizsgálja a telemedicinát, mind az orvos, mind a beteg nézőpontjából. Az elvégzett elemzések alapján az alkalmazás mellett és ellen szóló érvek ütköztetése után megállapítható, hogy a hazai üzemeltetésben szerzett gyakorlati tapasztalat alapján lehet csak objektív következtetésekre jutni abban, hol és hogyan érdemes alkalmazni. Orv. Hetil., 2013, 154, 1167–1171.

Background: In our earlier studies both corticosterone and cortisol had antioxidant effect in vitro. Objectives: Our aim was to clarify whether corticosterone and cortisol oral administration results in beneficial antioxidant changes in Sprague-Dawley adult male rats in vivo. Methods: Experimental animals were fed a lipid rich diet and treated with corticosterone or cortisol in the drinking fluid. Control group was fed only lipid rich diet with untreated drinking water. The untreated group was fed a normal diet with untreated water. Total scavenger capacity (TSC) was measured before and after 4 weeks of treatment in blood samples using a chemiluminometric assay. Results: Both corticosterone and cortisol treatment caused increased TSC. The control group and the untreated group showed no significant changes in TSC. Conclusion: Our results support the hypothesis that corticosterone and cortisol administration can improve the antioxidant status not only in vitro but also in vivo.

Neutrophil granulocytes form the biggest free radical producing system of the human body. The importance of this system in atherosclerotic plaque formation and other free radical mediated disorders is confirmed by both in vivo and in vitro studies. Estrogen’s effect on free radical production involves multiple estrogen receptors and occurs both on transcriptional and on protein phosphorylational level. Estrogen decreases the superoxide production of neutrophil granulocytes in such a short time frame it is unlikely to be mediated by transcription regulation. We investigated the underlying mechanism through which the mentioned estrogen effect takes place using an immunabsorption-based method. Phosphorylation data of 43 different messenger proteins were used for pathway analysis. The newly identified pathway involved largely second messengers from previously described non-genomic estrogen effects and affected superoxide production via Rac1 – an important regulator of free radical production and chemotaxis. Selective inhibition of the participating second messengers altered superoxide production in the predicted direction confirming that this pathway is at least partly responsible for the effect of 17-β-estradiol on chemoattractant induced superoxide production.

Objective The aim of the present study was to investigate the possible microvascular regulatory role of vascular endothelial growth factor receptor type 2 (VEGFR2) in experimental gingivitis in rats. Background Our previous results demonstrated that functionally active VEGFR2s are located in the venules of rat gingiva. While there is no remarkable endogenous gingival VEGF production under normal circumstances, exogenous VEGF, via VEGFR2, shows venodilatory effects. We assumed that VEGF plays an important role in vasoregulatory processes (vasodilation, increased permeability, angiogenesis) of gingival inflammation. Methods Gingivitis was induced by placing ligatures and composite material around and between the lower incisors of anesthetized Wistar rats next to the gingival margin. Seven days later, VEGFR2 antagonist (ZM323881), was dripped upon the labial gingiva next to the lower incisors. Diameter changes of the selected gingival venules were measured by vital microscopy. Animals with healthy gingiva served as controls. Venule diameter changes were compared to the baseline and to control groups (no ligature). Immunohistochemical and Western blot analysis for VEGFR2 were utilized. Results After 15, 30 and 60 min of local application of ZM323881, there was a significant venoconstriction in the inflamed gingiva compared to the baseline, while no change was recorded in controls. Endothelium, smooth muscle cells and pericytes of the gingivitis group showed increased VEGFR2 expression. Conclusion Our findings suggest that there is an increased VEGF production in gingivitis, which may play an important role in vasodilation of rat gingival venules.

Aims The aim of the study was to explore possible differences in temperament and character dimensions between 2 monodiagnostic adolescent groups of depression, namely, one with a present episode of major depression and subjects with the other being their dysthymic peers. Sample From a multisite Western Hungarian sample of consecutively referred 14- to 18-year-old new psychiatric adolescent outpatients, 2 groups were compared: group I, n = 56 (9 males, 47 females), with major depressive disorder (MDD) and group II, n = 27 (6 males, 21 females), with a diagnosis of dysthymic disorder (DD). All other comorbid diagnoses including bipolar and double depression (MDD + DD) cases were excluded. Present suicide events, if the attempter had an underlying diagnosis of depression, were not causes for exclusion. Assessment methods used were the adapted Hungarian versions of the Mini International Neuropsychiatric Interview and the Junior Temperament (Cloninger) Character Inventory. Results The only difference between the major depressive and dysthymic adolescents was harm avoidance, adolescents with major depression having a higher level practice of harm avoidance, whereas the temperament type of MDD vs DD seems to differ only in the aspect of avoiding painful stress. Expectations regarding a worse degree of self-directedness and lower levels of persistence and cooperativeness in the MDD sample were not proved. Conclusions No essential temperament differences were found between the 2 adolescent depressive groups. Scarce differences between temperament qualities of MDD and DD may support Akiskal's continuum theory of depressive disorders. More research and the use of closer clinical personality typologies are warranted to explore possible personality trait differences (if they exist) between clinical diagnostic groups of adolescent patients.

The determination of carbohydrate deficient transferrin (CDT) concentration is primarily used in social security studies as a proof of regular alcohol consumption exceeding the amount of 60 grams per day. Aims: The present study was performed to investigate into how carbohydrate deficient transferrin CDT values in serum are affected by the so-called food supplements and chemicals included in doping lists. Methods: The investigation was carried out in 15 bodybuilders of two sport clubs and in 10 boxers. All sportsmen were males. In both groups serum carbohydrate deficient transferrin (CDT%), median red blood cell volume and (MCV) gamma-glutamyl-transpeptidase (GGT) values were measured. Results: The authors found a significant difference between the two groups only in carbohydrate deficient transferrin CDT% that was the CDT% value in bodybuilders was twice as high as in boxers. Conclusion: Not all the details of the specificity of carbohydrate deficient transferrin (CDT) concentration are known, however, the remarkably high sensitivity of the method makes it suitable and probably cost-financially effective for serving as a pre-screening tool in doping tests. Orv. Hetil., 2012, 153, 514–517.