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Összefoglaló. Bevezetés: A májtranszplantációs program részeként 1995 óta létezik folyamatosan vezetett várólista Magyarországon. Célkitűzés: A legfontosabb várólista-paraméterek megállapítása és nemzetközi összehasonlítása. Módszer: A szerzők az 1995. január 1. és 2019. december 31. között első májátültetés céljából várólistára helyezett betegek adatait elemezték. Eredmények: Összesen 1722 beteget helyeztek várólistára, 1608 felnőttet, 114 gyermeket. A férfiak aránya 51,2%, az átlagéletkor 45,6 év. Az évente regisztrált új jelöltek száma 25 év során közel az ötszörösére emelkedett. A listára helyezés leggyakoribb indikációja a víruseredetű cirrhosis volt (n = 451). Ezt követte a cholestaticus (n = 314) és az alkoholos májbetegség (n = 264). Rosszindulatú daganat, 82%-ban hepatocellularis carcinoma miatt 215 beteget regisztráltak. Krónikus betegségekben az átlagos Model for End-Stage Liver Disease pontszám a regisztráláskor 13,5 volt. A 2018. december 31-ig listára helyezettek (n = 1618) 61%-a részesült májátültetésben, 24%-a várakozás közben meghalt, 7%-a a műtétre alkalmatlanná vált. A műtét előtti medián várakozási idő 248 nap volt a krónikus és 2 nap az akut betegek listáján. A transzplantált tumoros betegek (n = 132) szignifikánsan rövidebb ideig vártak műtétre (medián 115,5 nap), mint a többi krónikus beteg (n = 803, medián 282 nap). Az Eurotransplanthoz való csatlakozás utáni időszakban (2013. július 1. és 2018. december 31. között) a transzplantációs arány növekedett (67%), a várólista-halálozás (meghaltak + műtétre alkalmatlanná váltak) 24%-ra csökkent. Megbeszélés: A várólista folyamatos bővülése hozzájárult a hazai májátültetési program fejlődéséhez. A hazai várólista diagnózis szerinti összetétele a mások által közöltekkel nagyrészt egyezik. A transzplantáltak aránya a nemzetközi átlagnak megfelelő. A várólista-halálozás és a műtét előtti várakozási idő a magyarországinál alacsonyabb donációs aktivitású vagy jelentősen nagyobb várólistával rendelkező országokéhoz hasonló. Következtetés: Várólista-paramétereink javításához a transzplantációk számának további növelése szükséges. Orv Hetil. 2022; 163(8): 301–311. Summary. Introduction: The Hungarian liver transplant program including waiting list started in 1995. Objective: Evaluation of the wait-list parameters and comparing them with those in the literature. Method: Data of patients listed for primary liver transplantation between 1995 and 2019 were analyzed. Results: A total of 1722 recipient candidates were registered on the liver transplant waiting list: 1608 adults (51.2% men) with mean age of 45.6 year and 114 patients aged versus 282 days). Discussion: The composition of our waiting list by primary liver disease was similar to that of countries with large burden of hepatitis C. Transplant rate was average, wait-list mortality and waiting time were in line with those observed in low-donation countries or in the case of large volume waiting list. Conclusion: Listing of increasing the number of patients contributed to evolution of our liver transplant program. To improve our parameters, increasing transplant activity is warranted. Orv Hetil. 2022; 163(8): 301–311.

In the nature, larvae living in watercourses are exposed to a complex system of environmental influences. It is known that different watercourse types (creeks, brooks, streams, little rivers and medial rivers) provide different conditions for larval development (water depth, flow rate, temperature, oxygen content, substrate type, nutrient supply, etc.). These conditions can vary significantly between watercourse types, but be very similar within types. In this work, we examined the body sizes and wing morphometric characteristics of males of Calopteryx splendens reared from different watercourse types (brook, stream, creek, little river, medial river). Although there were no significant differences in body size among watercourse types, we found significant differences in the wing features. We found the most differences between the individuals reared from streams and creeks and between the individuals reared from stream and medial river. Our results show that the individuals reared from different watercourse types were clearly separated on the two wings. The results also suggest that there are significant differences in the number and pattern of allometric features on the wings of individuals reared from different watercourse types.

Hepatocellular carcinoma (HCC) is the leading primary liver tumor and a main indication for transplant. Transplant criteria are based on clinicopathologic features, meanwhile adequate downstaging and molecular mechanisms are getting more attention in evolving therapeutic algorithm of HCC. The aim of our study was to overview the results of the Hungarian Liver Transplant Program in the field of HCC and introduce new aspects of personalized treatment options.We performed retrospective analysis of survival and tumor recurrence of HCC-associated liver transplant recipients between October 2013 and December 2020. Patients were categorized in Milan criteria (MC), beyond MC but within University of California, San Francisco (UCSF), and beyond UCSF criteria groups after pathologic examination of the explanted liver. Demographic data and preoperative locoregional treatments were assessed.A total of 529 primer liver transplants were performed, 88 because of HCC. A total of 87 patients had underlying cirrhosis because of hepatitis C (54%), alcohol-related liver disease (33.7%), hepatitis B (4.5%), or unknown etiology. A total of 55.6% of the patients had at least one locoregional treatment. A total of 67.4% of the patients were within MC, 5.6% were within UCSF criteria, and 27% were beyond UCSF criteria. The 1-, 3-, and 5-year survival rates were 80%, 79%, and 75%. The outcome was better in early-stage tumors, but the difference was not significant (P = .745) CONCLUSIONS: The favorable survival in our department legitimates the strict transplant criteria of HCC. Adequate locoregional therapy as downstaging can expand recipient pool. Molecular tumor profiling may lead to personalized treatment of HCC.

The purpose of this 30-day feeding study was to elucidate the changes, correlations, and mechanisms caused by the replacement of the starch content of the AIN-93G diet (St) with glucose (G), fructose (F) or lard (L) in body and organ weights, metabolic changes and caecal microbiota composition in rats (Wistar, SPF). The body weight gain of rats on the F diet was 12% less (P = 0.12) than in the St group. Rats on the L diet consumed 18.6% less feed, 31% more energy and gained 58.4% more than the animals on the St diet, indicating that, in addition to higher energy intake, better feed utilisation is a key factor in the obesogenic effect of diets of high nutrient and energy density. The G, F and L diets significantly increased the lipid content of the liver (St: 7.01 ± 1.48; G: 14.53 ± 8.77; F: 16.73 ± 8.77; L: 19.86 ± 4.92% of DM), suggesting that lipid accumulation in the liver is not a fructose-specific process. Relative to the St control, specific glucose effects were the decreasing serum glucagon (–41%) concentrations and glucagon/leptin ratio and the increasing serum leptin concentrations (+26%); specific fructose effects were the increased weights of the kidney, spleen, epididymal fat and the decreased weight of retroperitoneal fat and the lower immune response, as well as the increased insulin (+26%), glucagon (+26%) and decreased leptin (–25%) levels. This suggests a mild insulin resistance and catabolic metabolism in F rats. Specific lard effects were the decreased insulin (–9.14%) and increased glucagon (+40.44%) and leptin (+44.92%) levels. Relative to St, all diets increased the operational taxonomic units of the phylum Bacteroidetes. G and L decreased, while F increased the proportion of Firmicutes. F and L diets decreased the proportions of Actinobacteria, Proteobacteria and Verrucomicrobia. Correlation and centrality analyses were conducted to ascertain the positive and negative correlations and relative weights of the 32 parameters studied in the metabolic network. These correlations and the underlying potential mechanisms are discussed.

To provide a cost-efficient parentage testing kit for red deer (Cervus elaphus), a 63 SNP set has been developed from a high-density Illumina BovineHD BeadChip containing 777 962 SNPs after filtering of genotypes of 50 stags. The successful genotyping rate was 38.6 % on the chip. The ratio of polymorphic loci among effectively genotyped loci was 6.5 %. The selected 63 SNPs have been applied to 960 animals to perform parentage control. Thirty SNPs out of the 63 had worked on the OpenArray platform. Their combined value of the probability of identity and exclusion probability was 4.9×10-11 and 0.99803, respectively. A search for loci linked with antler quality was also performed on the genotypes of the above-mentioned stags. Association studies revealed 14 SNPs associated with antler quality, where low-quality antlers with short and thin main beam antlers had values from 1 to 2, while high-quality antlers with long and strong main beams had values between 4 and 5. The chance for a stag to be correctly identified as having high-value antlers is expected to be over 88 %.

Introduction We would like to present the case of a young patient with acute stress disorder and recurrent nightmares following the psychological trauma caused by a severe road traffic accident. The comprehensive therapy carried out at the Department of Traumatology included medication, trauma processing and a psychological method whose aim is to cease the development of nightmares. Case Presentation Psychiatric assessment and treatment was asked for a polytraumatised female patient at the Intensive Care Unit after she had undergone a neurosurgical intervention. Her medicinal treatment was continued at the Department of Traumatology. Besides the antidepressant venlafaxine she was treated in accordance with the EMDR protocol for acute stress disorder, and we also applied imagery rescripting to prevent her from having recurrent (daily) nightmares. As a result of the therapy, her symptoms were fast relieved, the nightmares stopped almost instantly, her mood improved, rumination and anxiety decreased significantly. Conclusions In view of the fast and significant symptomatic improvement, we can expect that the EMDR therapy and its protocol for acute stress disorder have successfully reactivated information processing, and besides the subjective relief we have managed to prevent a mental crisis that could lead to a suicide risk as well as the development of post-traumatic stress disorder. We also hope that the improvement will be long-lasting.

Background In the Eurotransplant, 12.6% of kidney transplantations are a repeat procedure. Third transplants are significantly more complex than first and second ones. We compared the results of first (PRT) versus third (TRT) transplantations. Methods Between 2011 and 2016, we performed 779 deceased donor adult kidney transplantations, 14.2% out of them were second, 2.6% (20) third, and 0.3% fourth. We compared the pre-, intra-, and postoperative data, kidney function, and survival rate. Results Recipients of TRT were younger (53.4 vs. 47.3 p = 0.02). HCV infection rate (20%, p = 0.00) is ten times higher. The operation time is longer (132 vs. 152 min, p = 0.02), and delayed graft function is much more frequent (22.4% vs. 60%, p = 0.00). Induction therapy was given to every TRT (7.9% vs.100%), but as a result, the rejection rate was the same (~ 15%). Hospital stay is a week longer. Patient’s survival at 1, 3, and 5 years for PRT is 96.4%, 93.9%, and 91.2% and for TRT is 90%, 85%, and 78.4%, respectively (p = 0.023). TRT’s odds ratio of fatal outcome is 4.35 (1.5–12.5). Graft survival at 1, 3, and 5 years for PRT is 93.1%, 91.4%, and 90.3% and for TRT is 75%, 75%, and 75%, respectively (p = 0.020). TRT’s odds ratio of graft loss is 3.14 (1.1–8.9). Of PRT 85.76%, out of PRT 85.76%, while out of TRT 60% live with a functioning graft, p=0.00149. Conclusion In a third transplant, both graft and patient survival are significantly inferior to primer ones. Careful selection is required to minimize the patient risk and graft loss.

Összefoglaló. Bevezetés: A prosztatarák diagnosztikájában az utóbbi években paradigmaváltás történt. Az MR-vizsgálat fejlődése lehetővé tette a prosztatatumor gyanús elváltozásainak célzott mintavételét. Az mpMR fúziós biopszia pontos és költséghatékony módszer. Célkitűzés: Célkitűzésünk az volt, hogy összegezzük az mpMR fúziós biopsziák terén szerzett tapasztalatainkat. Módszer: A Semmelweis Egyetem Urológiai Klinikáján 2017 és 2019 között 40, mpMR fúziós biopsziát végeztünk a BioJet-program segítségével, transperinealis behatolásból. Az MR-vizsgálatok kiértékelése a PI-RADS v2 ajánlása szerint történt. Megvizsgáltuk, hogy a laesiók PI-RADS-besorolása, elhelyezkedése, mérete, az extraprosztatikus terjedés jeleinek megléte, a páciensek PSA-, illetve PSAD-értékei, valamint a prosztata volumene befolyásolja-e a mintavételek kimenetelét. Eredmények: A célzott mintavételek során pácienseink 80%-ánál igazolódott malignitás. PI-RADS 5. és 4. besorolású laesiók esetén a detektációs ráta 91%, illetve 85%, míg PI-RADS 3. laesióknál 20% volt. A perifériás zóna elváltozásainál szignifikánsan magasabb volt a pozitív eredmény valószínűsége, mint a tranzicionális zóna laesióinál (khi2(1) = 6,555, p = 0,010, Fisher-féle egzakt p = 0,017, V = 0,355). Az extraprosztatikus terjedés jelei és a magasabb PSAD-értékek növelték a pozitív minták valószínűségét (khi2(1) = 7,704, p = 0,006, Fisher-féle egzakt p = 0,004, V = 0,355; illetve 0,47 ± 0,50 ng/ml2 vs. 0,18 ± 0,17 ng/ml2; Z = 3,447, pKövetkeztetések: Az elvégzett fúziós biopsziák detektációs rátája magasabb volt az irodalmi átlagnál. Eredményeink alapján a mintavételek kimenetelét befolyásolhatja az elváltozások PI-RADS-besorolása, elhelyezkedése, az extraprosztatikus terjedés, a PSAD-értékek, valamint a prosztatatérfogat. A fenti szempontok figyelembevételével kiválaszthatók azok a páciensek, akik a legtöbbet profitálhatnak a beavatkozásból. Orv Hetil. 2020; 161(52): 2188–2194. Summary. Introduction: The past decade has seen some major changes in the diagnostics of prostate cancer. Progress in MR imaging has allowed us to better visualise prostate cancer and thus perform targeted biopsies of tumour suspect lesions. mpMRI-ultrasound fusion-guided prostate biopsy is a precise and cost-effective method to diagnose prostate cancer. Objective: The purpose of this study was to summarise our results in mpMRI-ultrasound fusion biopsy between 2017 and 2019 and compare them with the findings in the current literature. Method: Between 2017 and 2019, fully 40, mpMRI-ultrasound fusion biopsies were performed transperineally using the BioJet fusion system at Semmelweis University Urology Clinic. The MRI evaluations were done in line with the PI-RADS v2 guidelines. It was analysed whether the PI-RADS score, the location of the tumour, lesion size, the signs of extraprostatic extension, PSA/PSAD density and prostate volume have an influence on the outcome of mpMRI-ultrasound fusion biopsy. Results: Prostate cancer was diagnosed in 80% of the cases during targeted biopsies. The detection rate was 91%, 85%, and 20% for PI-RADS 5, 4 and 3 lesions, respectively. The detection rate was significantly higher for lesions located at the peripheral zone compared to the ones in the transitional zone (khi2(1) = 6.555, p = 0.010, Fisher-exact p = 0.017, V = 0.355). Signs of extraprostatic extension and higher PSAD correlated with better detection rate (khi2(1) = 7.704, p = 0.006, Fisher-exact p = 0.004, V = 0.355; and 0.47 ± 0.50 ng/ml2 vs. 0.18 ± 0.17 ng/ml2; Z = 3.447, pConclusions: The detection rate of prostate cancer with targeted biopsies was higher than the data found in the international literature. The PI-RADS score, the location of the tumour, MRI signs of extraprostatic extension, PSAD and prostate volume had an influence on the detection rate. Our findings may promote a better selection of the best candidates for targeted biopsies in the future. Orv Hetil. 2020; 161(52): 2188–2194.

A LEGO® Education módszertan lényege, hogy játékeszközök segítségével olyan megismerő, alkotó, kreatív tevékenységet végezzenek a gyerekek, ami segíti többek között a kommunikációs, kooperatív kompetenciák vagy az algoritmikus gondolkodás fejlesztését. A metódus már a koragyermekkortól kezdve alkalmazható, így tanulmányunkban ezt a korosztályt helyezzük középpontba. Bemutatjuk a LEGO® módszertan alapjait jelentő pedagógiai hátteret, melyben a háromévesnél fiatalabb korosztály megismerési és játéktevékenységére jellemző sajátosságokra fókuszálunk, majd magát a módszertant, végül néhány tematikus szettet.

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.

To provide a cost-efficient parentage testing kit for red deer (

Over the last decades extensive work has been done on sampling optimization. Many of the related papers focused on the optimization of sampling for only one soil property. However, there is a necessity to prepare a sampling strategy which is optimized for multivariate digital soil mapping (DSM) purposes. The aim of our work was to elaborate a sampling optimization methodology for multivariate DSM considering the demands on economic efficiency. We presented and tested it through a real-time survey at Tokaj Wine Region, Hungary. The soil properties of interest were pH, soil organic matter (SOM), and calcium carbonate (CaCO3) content. The end-users defined the minimal requested precision for the DSM products (in terms of the average range of the 90% prediction interval), and priority areas on which more detailed survey was requested. We planned a two-phase soil survey based on regression kriging (RK). The results from the first-phase sampling were used to parameterize the second-phase sampling in which spatial simulated annealing (SSA) was applied. The spatially averaged range of the 90% prediction interval was the pre-survey quality measure which can be readily derived from the RK variance. The workflow can be summarized as follows: (1) rank the soil properties considering their spatial variabilities, and precision requests, (2) optimize the sampling design by SSA for the dominant soil property, (3) optimize the sampling by the invers application of SSA for the next soil property using the optimized design from the previous step, and (4) repeat the previous step until all soil property are being selected. In our case, SOM was the dominant property. According to the plot of the sample size vs. quality measure, the optimized design with 500 samples will ensure the minimal requested precision for the SOM map (i.e. 0.5%). In the next step, the optimal removal of those sampling points was targeted which have less information content. In the cases of pH and CaCO3, 100 and 175 could be removed from the 500 samples, and the remaining 400 and 325 samples will ensure the requested precision for the pH (i.e. 1.2) and CaCO3 (i.e. 5%) maps. We computed the relative sampling density on priority and non-priority areas for each sampling designs which showed that densities on priority areas were at least 1.5 times higher than on non-priority areas. We could conclude that the methodology is able to optimize the sampling design for multivariate DSM purposes considering numerous sampling constraints such as the predefined precision, priority areas, and economic efficiency.

Optimal water supply of plants is key to high yields. However, irrigation in drier regions must be accompanied by soil conservation. Nationwide planning of irrigation needs spatially exhaustive, functional soil maps, which may support proper recommendations for the different areas. For supporting the Hungarian national irrigation strategy, a series of countrywide functional soil maps was created, which reveal the pedological constraints, conditions and circumstances of irrigation by the spatial modelling of the relevant functional features of the soil mantle. Irrigation can improve productivity, while its negative effects may lead to soil degradation. This paper focuses on threats, the spatial identification of potentially affected areas. The thematic maps spatially model the irrigability and vulnerability of soils. Estimation of salt accumulation hazard, and soil structure degradation risks were targeted. The salinization hazard assessment was carried out by two ways. We applied the steady state concept of critical water-table depth and a more dynamic, process-based method. To estimate soil structural degradation hazard, class-based relationships were developed based on soil profile data of MARTHA 1.0 (Hungarian Detailed Soil Hydraulic Database). Soil type, organic matter content, carbonate content, soil reaction and texture class (USDA) were taken into consideration to develop pedotransfer functions for modelling the correlations between primary soil properties and threats indicators. The new maps can help decision makers to improve land use management, and sustainable agronomy.

The Nitrates Directive aims (a) to protect water quality across Europe from nitrates originating from agricultural sources that pollute ground and surface water, and (b) to promote good farming practices. One of the most controversial measures of the directive is the winter prohibition period of fertilization, which has been extended by a month in two steps in recent years. According to the regulation, it is forbidden to apply nitrogen fertilization in Hungary between 31st October and 15th February, even though the winter climate is gradually becoming milder. Using the fertilization data of nearly half a million parcels of land in the Hungarian Nitrate Database, a crop model-based spatial analysis was carried out. Our aim was to test if a shift in the prohibition period starting date from 31st October to 30th November caused any differences in the nitrate amount leached at a 90 cm depth. Detailed nitrate inputs and soil and weather databases were coupled with the 4M crop model. The yield, plant nitrogen uptake, and nitrate leaching under five major crops were simulated, covering a considerable portion of arable land. Shifting the prohibition period starting date did not result in significant changes in the nitrate leaching. Further runs of the 4M model with different weather scenarios are needed to decide whether the modification of the prohibition period significantly affects the amount of nitrate leached.

A pandémia, és az ennek következményeként indított távolléti oktatás jelentős változást hozott az egyetemi oktatók és a hallgatók számára. Kutatásunk az oktatókat érintő hatásokat vizsgálta a Debreceni Egyetemen a 2020/21 tanév második félévében. A vizsgálatban az egyetemen mindegyik kara részt vett, így kijelenthetjük, hogy a felmérés ugyan nem volt teljeskörű és nem volt reprezentatív, de a minta alapján az egyetemi oktatók tevékenységére megfelelő információs hátteret nyújtott. Az online kérdőíves felméréssel többek között arra kérdeztünk rá, hogy milyen terhelést jelentett az oktatóknak a távolléti oktatás, hogyan tudták megoldani a tervezett oktatási feladatokat. Vizsgáltuk azt is, hogy tudományos és publikációs tevékenységet milyen mértékben befolyásolta a kialakult helyzet. Az eredmények azt mutatják, hogy a felmerült technikai és informatikai nehézségek ellenére a tervezett oktatási feladatokat döntően sikerült megoldani, viszont a fokozott terhelés és az új megoldásokra történő átállás a tudományos munkát jelentősen hátráltatta. Az oktatók az adott helyzetben elsősorban a kurzusok minél magasabb színvonalú megtartására törekedtek, amit véleményük szerint sikerült megoldani. The pandemic and the online education resulting to it has brought a significant change to the faculty of the university and to its students. Our research examined the effects on teachers at the University of Debrecen in the second semester of the year 2020/21. All faculties at the university participated in the study, so we can state that although the survey was not comprehensive and was not representative, it provided an adequate information background for the of university lecturers based on the sample. With the online survey, we asked about the burden of the absence online education, how were they able to solve the planned educational tasks. We also examined, how scientifical and publication activities were affected by the situation. The results show that despite the technical and IT difficulties encountered, the planned educational tasks were decisively solved but the increased pressure and the transition to new solutions have significantly hampered scientific work. In the given situation, the teachers primarily sought to keep the courses as high as possible, which they believe has been resolved.

Összefoglaló. Bevezetés: A prosztatarák diagnosztikájában az utóbbi években paradigmaváltás történt. Az MR-vizsgálat fejlődése lehetővé tette a prosztatatumor gyanús elváltozásainak célzott mintavételét. Az mpMR fúziós biopszia pontos és költséghatékony módszer. Célkitűzés: Célkitűzésünk az volt, hogy összegezzük az mpMR fúziós biopsziák terén szerzett tapasztalatainkat. Módszer: A Semmelweis Egyetem Urológiai Klinikáján 2017 és 2019 között 40, mpMR fúziós biopsziát végeztünk a BioJet-program segítségével, transperinealis behatolásból. Az MR-vizsgálatok kiértékelése a PI-RADS v2 ajánlása szerint történt. Megvizsgáltuk, hogy a laesiók PI-RADS-besorolása, elhelyezkedése, mérete, az extraprosztatikus terjedés jeleinek megléte, a páciensek PSA-, illetve PSAD-értékei, valamint a prosztata volumene befolyásolja-e a mintavételek kimenetelét. Eredmények: A célzott mintavételek során pácienseink 80%-ánál igazolódott malignitás. PI-RADS 5. és 4. besorolású laesiók esetén a detektációs ráta 91%, illetve 85%, míg PI-RADS 3. laesióknál 20% volt. A perifériás zóna elváltozásainál szignifikánsan magasabb volt a pozitív eredmény valószínűsége, mint a tranzicionális zóna laesióinál (khi2(1) = 6,555, p = 0,010, Fisher-féle egzakt p = 0,017, V = 0,355). Az extraprosztatikus terjedés jelei és a magasabb PSAD-értékek növelték a pozitív minták valószínűségét (khi2(1) = 7,704, p = 0,006, Fisher-féle egzakt p = 0,004, V = 0,355; illetve 0,47 ± 0,50 ng/ml2 vs. 0,18 ± 0,17 ng/ml2; Z = 3,447, p0,001), míg az elváltozások mérete nem befolyásolta a kimenetelt. A prosztatavolumen szignifikánsan magasabb volt azoknál, akiknél nem igazolódott malignitás (50,9 ± 18,8 ml vs. 119,6 ± 91,6 ml; Z = -3,505, p0,001). Következtetések: Az elvégzett fúziós biopsziák detektációs rátája magasabb volt az irodalmi átlagnál. Eredményeink alapján a mintavételek kimenetelét befolyásolhatja az elváltozások PI-RADS-besorolása, elhelyezkedése, az extraprosztatikus terjedés, a PSAD-értékek, valamint a prosztatatérfogat. A fenti szempontok figyelembevételével kiválaszthatók azok a páciensek, akik a legtöbbet profitálhatnak a beavatkozásból. Orv Hetil. 2020; 161(52): 2188-2194.The past decade has seen some major changes in the diagnostics of prostate cancer. Progress in MR imaging has allowed us to better visualise prostate cancer and thus perform targeted biopsies of tumour suspect lesions. mpMRI-ultrasound fusion-guided prostate biopsy is a precise and cost-effective method to diagnose prostate cancer.The purpose of this study was to summarise our results in mpMRI-ultrasound fusion biopsy between 2017 and 2019 and compare them with the findings in the current literature.Between 2017 and 2019, fully 40, mpMRI-ultrasound fusion biopsies were performed transperineally using the BioJet fusion system at Semmelweis University Urology Clinic. The MRI evaluations were done in line with the PI-RADS v2 guidelines. It was analysed whether the PI-RADS score, the location of the tumour, lesion size, the signs of extraprostatic extension, PSA/PSAD density and prostate volume have an influence on the outcome of mpMRI-ultrasound fusion biopsy.Prostate cancer was diagnosed in 80% of the cases during targeted biopsies. The detection rate was 91%, 85%, and 20% for PI-RADS 5, 4 and 3 lesions, respectively. The detection rate was significantly higher for lesions located at the peripheral zone compared to the ones in the transitional zone (khi2(1) = 6.555, p = 0.010, Fisher-exact p = 0.017, V = 0.355). Signs of extraprostatic extension and higher PSAD correlated with better detection rate (khi2(1) = 7.704, p = 0.006, Fisher-exact p = 0.004, V = 0.355; and 0.47 ± 0.50 ng/ml2 vs. 0.18 ± 0.17 ng/ml2; Z = 3.447, p0.001, respectively). The size of the lesions did not influence the outcome. The analysis showed a significant correlation between large prostate volumes and negative biopsies (50.9 ± 18.8 ml vs. 119.6 ± 91.6 ml; Z= -3.505, p0.001).The detection rate of prostate cancer with targeted biopsies was higher than the data found in the international literature. The PI-RADS score, the location of the tumour, MRI signs of extraprostatic extension, PSAD and prostate volume had an influence on the detection rate. Our findings may promote a better selection of the best candidates for targeted biopsies in the future. Orv Hetil. 2020; 161(52): 2188-2194.

Absztrakt

The spatial complexity of floodplains is a function of several processes: hydrodynamics, flow direction, sediment transportation, and land use. Sediments can bind toxic elements, and as there are several pollution sources, the risk of heavy metal accumulation on the floodplains is high. We aimed to determine whether fluvial forms have a role in metal accumulations. Topsoil samples were taken from point bars and swales in the floodplain of the Tisza River, North-East Hungary. Soil properties and metal concentrations were determined, and correlation and hypothesis testing were applied. The results showed that fluvial forms are important drivers of horizontal metal patterns: there were significant differences (p &lt, 0.05) between point bars and swales regarding Fe, K, Mg, Mn, Cr, Cu, Ni, Pb, and Zn. Vertical distribution also differed significantly by fluvial forms: swales had higher metal concentrations in all layers. General Linear Models had different results for macro and micro elements: macro element concentrations were determined by the organic matter, while for micro elements the clay content and the forms were significant explanatory variables. These findings are important for land managers and farmers because heavy metal concentration has a direct impact on living organisms, and the risk of bioaccumulation can be high on floodplains.

Abstract: The first lung transplantation in Hungary was performed on 12th of December, 2015. It was a joint effort of the National Institute of Oncology and the Semmelweis University. Hereby we summarise the results and experiences from the first three years. Until August, 2018, 55 lung transplantations were performed in Hungary. This was a retrospective analysis. All patients were listed according to the recommendation of the Lung Transplantation Committee. All implanted lungs have been procured from brain dead donors. Postoperative treatment and rehabilitation of the patients were continued at the Semmelweis University. Between 12. 12. 2015 and 31. 07. 2018, our team performed 76 organ retrievals: out of 45 Hungarian offers, 23 came from Eurotransplant countries and 8 outside of the Eurotransplant region. From these donations, 54 double and 1 single side transplantations were successfully performed. The surgical approach was single side thoracotomy (n = 1), bilateral thoracotomy (n = 1) and in the majority of the cases clamshell incision (n = 53). For the intraoperative veno-arterial extracorporeal membrane oxygenation support was used. The extracorporeal membrane oxygenation support had to be prolonged in 3 patients into the early postoperative period, two other recipients were bridged to transplant with extracorporeal membrane oxygenation. In the same time period, one combined lung-kidney transplantation was also performed. The distribution of recipients according to the underlying disease was: chronic obstructive pulmonary disease (n = 28); idiopathic pulmonary fibrosis (n = 8); cystic fibrosis (n = 12); primary pulmonary hypertension (n = 2); hystiocytosis-X (n = 1); bronchiectasis (n = 2); lymphangioleiomyomatosis (n = 1); and re-transplantation following bronchiolitis obliterans syndrome (n = 1), respectively. The mean age of recipients was 47.5 ± 15.18 years. The youngest recipient was 13 years old. We unfortunately lost 12 patients on our waiting list. The mean intensive care unit stay was 24.6 ± 18.18 days. Two patients were lost in the early postoperative phase. Tracheostomy was necessary in 13 cases due to the need of prolonged ventilation. 1-year survival of the recipients was 82.96% (until 31. 07. 2018). When looking at the first three years of the program, the case numbers elevated quickly throughout the years which is rather unique when compared to other centres in their starting period. Perioperative mortality and morbidity is comparable with high-volume lung transplantation centres. In the future we would like to increase the number of patients on the waiting list, thus increasing the total number of transplantations performed, and we are also planning to implement the use of the ex vivo lung perfusion system (EVLP) in our program. Orv Hetil. 2018; 159(46): 1859–1868.

The aim of our study was to verify the effectiveness of passive nature conservation with regard to the preservation of species, by examining a typical mesozooplankton community. We investigated five oxbow lakes which were similar to each other in terms of size, depth and close-to-each, but which differed markedly from one to another in terms of lake management. One is under passive protection, the others are under different forms of management. Based on the NMDS (Non-metric Dimensional Scaling) analysis, we identified the variable (transparency) which is responsible for the segregation. In the case of rare species IndVal (Indicator Value) analysis was used to evaluate the occurrence and significance of indicator species. We also found marked differences in the species composition; seven species showed indicator values for the protected oxbow lake, five of which were significant (p

Traditionally in Hungary the soil cover under agricultural and forestry management is typically characterized independently and just approximately identically. Soil data collection is carried out and the databases of soil features are managed irrespectively. As a consequence, nationwide soil maps cannot be considered homogeneously predictive for soils of croplands and forests, plains and hilly/mountainous regions. In order to compile a national soil type map with harmonized legend as well as with spatially relatively homogeneous predictive power and accuracy, the authors unified their resources. Soil profile data originating from the two sources (agriculture and forestry) were cleaned up and harmonized according to a common soil type classification. Various methods were tested for the compilation of the target map: segmentation of a synthesized image consisting of the predictor variables, multi stage classification by Classification and Regression Trees, Random Forests and Artificial Neural Networks. Evaluation of the results showed that the object based, multi-level mapping approach performs significantly better than the simple classification techniques. A combination of best performing classifiers, when each classifier's vote on the same object is weighted according to its confidence in the voted class, led to the final product: a unified, national, soil type map with spatially consistent predictive capabilities.

Somnambulism has a low prevalence, but its intriguing features occasionally cause it to become the focus of scientific interest. Although it mostly occurs in childhood and ceases spontaneously in the majority of cases, sometimes it can persist or reactivate in adulthood. This reactivation tends to be associated with the use of certain medications. Some antipsychotic medications and antidepressants have already been proved to reactivate childhood somnambulism, and some studies have suggested that β-blockers, mostly propranolol, may also play a role. Our study presents the case of a 30-year-old female patient whose past medical history is significant for childhood somnambulism. Four months prior to her presentation to our sleep clinic, she was put on antithyroid medication and propranolol for tachycardia. At the same time her childhood somnambulism reactivated and she fractured her leg during a sleepwalking episode. Polysomnography did not detect any abnormalities. When propranolol was withdrawn, she experienced immediate symptomatic relief. The professional literature we found and analysed and the case we presented both suggest that propranolol with its broad spectrum of indications can trigger somnambulism, especially if it already occurred in the patient’s past medical history. As a result, we recommend listing somnambulism as a potential side effect of propranolol and treating childhood sleepwalking as an absolute contraindication of propranolol.