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A digitális 3D tomoszintézises mammográfia az emlőrák diagnosztikájában és szűrésében
Digital 3D tomosynthesis in the diagnosis and screening of breast cancer
Breast cancer mortality and morbidity are significantly reduced with the introduction of the mammography screening program. From the point of view of complete recovery, there is an extremely high demand for early detection. Digital 3D tomosynthesis is a complementary modality to digital mammography (full-field digital mammography – FFDM), which has been accepted by the FDA since 2011, and is well suited for the diagnosis of breast diseases and breast screening. Basic principle of digital 3D tomosynthesis: during the examination, an x-ray tube moving in a given circular arc takes 10–15 overlapping digital images of the breast – with a small dose of radiation – in a short time. From the data set obtained in this way, thin-slice layer images (3D tomosynthesis) and reconstructed, so-called synthetic 2D images – similar to the traditional mammographic image – are also produced. In addition to the advantages (higher cancer detection rate, more accurate assessment of abnormal patterns, structural distortion, asymmetric density, reduction of the number of unnecessary biopsy, decreasing recall rate in screening), knowing the dilemmas related to the disadvantages (e.g., radiation exposure, need for larger storage space) is also important. Orv Hetil. 2024; 165(37): 1443–1451.
Dr. Romics Imre urológusprofesszor (1947–2024)
In memoriam Dr. Imre Romics professor of urology (1947–2024)
Abstract
Background and Aims
Problem gambling (PG) represents a significant public health concern with widespread effects in various cultures and regions globally, with younger individuals and males at a particularly higher risk. This disparity is attributed to a mix of cultural, developmental, and biological influences. To date, there has not been a comprehensive examination to determine whether this risk pattern holds consistently across different jurisdictions.
Methods
We performed a systematic review and meta-analysis using the PRISMA framework, identifying 21 eligible studies from 18 countries, encompassing 156,249 participants (47.6% male and 52.4% female).
Results
The studies varied considerably by region (Asia: 19%, Europe: 52%, Oceania: 19%, North America: 10%), the diagnostic criteria for PG, and participation rates in gambling (ranging from 12% to 92%). Data on PG prevalence was categorised by gender and three age groups (young: 18–35, middle: 30–55, and older: 45–65). Using a random-effects meta-analysis, we found a global PG prevalence of 1.9%. Europe reported a significantly lower prevalence (1.3%) compared to North America (5.3%). Men were found to be 3.4 times more likely than women to engage in problem gambling, although the gap narrows in North America. The young demographic showed a 1.51 times higher likelihood of reporting PG compared to the middle-aged group, whereas older adults were 0.80 times less likely to report PG. Notably, age-related effects varied significantly across regions.
Conclusions
Our findings confirm that age and gender significantly influence PG risk across cultures, with significant heterogeneity observed across jurisdictions.
Abstract
Background and aims
The aim of the present study was to estimate the complex association between Internet Gaming Disorder (IGD), substance use, and other risky behaviours in Czech adolescents whilst providing prevalence estimates of IGD and psychometric information regarding the Czech Internet Gaming Disorder Scale–Short-Form (IGDS9-SF).
Methods
A representative sample of 3,950 Czech adolescents was recruited through stratified random sampling in the school setting.
Results
Disordered gamers showed frequent use of specific substances such as pharmaceuticals, methylenedioxymethamphetamine, and lysergic acid diethylamide. In contrast, non-gamers had higher prevalence of alcohol, cigarettes, sedatives and tranquillisers, and marijuana use. A logistic regression, utilising IGDS9-SF raw scores and average daily gaming time, revealed a U-shaped relationship between gaming and both alcohol and cigarette use. Additionally, conduct problems such as bullying, and risky in-game behaviours were more prevalent among disordered gamers, with the exception of forging parents' signatures. The overall prevalence of IGD was 3.62% (95% CI = [3.1%, 4.3%]), with higher rates in males (5.89%; 95% CI = [4.9%, 7.0%]) than in females (1.45%; 95% CI = [1.0%, 2.1%]).
Discussion and conclusions
The Czech IGDS9-SF used in the present study showed adequate psychometric properties. The association between gaming and substance use behaviours may be specific and multifaceted depending on the severity of the gaming-related problems. Furthermore, disordered gamers may become more vulnerable due to a higher incidence of conduct problems, bullying (victimisation), and in-game risky behaviours such as engagement with microtransactions mechanics (e.g., loot box) within video games.
Abstract
Background
Research on individual differences in brain structural features of internet gaming disorder (IGD) and established addictions such as tobacco use disorder (TUD) is currently limited. This study utilized normative modeling to analyze the cortical thickness (CT) development patterns of male patients with IGD and TUD, aiming to provide further insights into whether IGD qualifies as an addiction.
Methods
Surface-based brain morphometry (SBM) was used to calculate CT from T1-weighted magnetic resonance imaging data of 804 male participants (665 healthy individuals, 68 IGD and 71 TUD). Gaussian process regression was employed to generate normative models of CT development. Deviation maps were produced to depict deviations of IGD and TUD participants from the typical developmental patterns.
Results
Both addiction groups exhibited widespread cortical thinning, particularly in regions such as the bilateral temporal pole and medial orbitofrontal cortex. The TUD group demonstrated a higher degree of individualization and limited spatial overlap compared to the IGD group. Opposite trends in CT changes were observed between the two groups in the bilateral pericalcarine cortex and pars triangularis.
Conclusions
These findings regarding the similarities and differences between IGD and TUD provide support for the idea that IGD shares common features with substance-related addictions and contribute to a deeper understanding of the neural mechanisms underlying IGD.
Abstract
Background and Aims
This naturalistic mixed methods field study, aimed to assess the potential of a psilocybin induced experience, to help Emergency Medical Service Workers (EMSW) to address psychological and stress related symptoms stemming from a challenging working environment, known to contribute to occupational burnout (OB).
Methods
This exploration was conducted with an intentional sample of five participants, recruited through an online survey who self-administered a therapeutic dose of psilocybin mushrooms to manage psychological symptoms resulting from their work as EMSW, allowing the authors to assess the outcome. To measure the impact of the experience, changes in OB measures were assessed with psychometric instruments previously used in this population at three timepoints, before and after the session. The subjective impact of the psychedelic experience, through psychological insights and emotional breakthroughs, was also assessed, and two follow-up interviews were conducted to collect further data.
Results
The results showed that, two weeks after the session, a visible improvement was noticed in several measures of pre-existent OB, that remained stable after two months. Additionally, most participants reported a strong subjective impact, that they perceived as fundamental for the positive outcome.
Conclusions
After one therapeutic psylocibin session, several measures of OB showed an encouraging level of improvement and may constitute an important step towards finding alternative and innovative solutions to address high rates of psychological distress experienced by EMSWs, also benefiting the organization and the quality of patient care. The limitations and implications of the study and suggestions for future research are discussed.
Alvászavarok kora gyermekkorban krónikus szomatikus állapotok és atipikus fejlődés esetén – különös tekintettel a Down-szindrómára
Sleep disorders in early childhood with chronic somatic conditions and atypical development – with particular reference to Down syndrome
Literature and parental reports suggest that young children with chronic illness or disability, particularly those diagnosed with neurodevelopmental disorders, have a significantly higher prevalence of sleep problems than typically developing children of similar age. In the majority of cases, symptoms have a multifactorial etiology, with the child’s somatic condition, associated neurological and psychiatric disorders, as well as relationship characteristics and environmental circumstances, influencing their presentation. In groups of children with chronic illness, atypical developmental trajectories, specific neurological functioning and behavioral phenotypes, sleep disorders are underdiagnosed because it is difficult to separate the child’s illness from the characteristics and consequences of sleep symptoms in the complex symptom picture. For families of children with chronic illnesses or disabilities, the presence of sleep disorders can further complicate adjustment to more challenging life situations and have a significant impact on the well-being and quality of life of the family members. Children with Down syndrome face the challenges of the special needs groups of children that are the focus of our study, where syndrome-specific features, chronic somatic conditions, and structural and functional changes in the nervous system contribute in complex ways to the increased prevalence of sleep-related problems. In addition to early identification of sleep problems, prevention and intervention initiatives in practice can prevent, treat and alleviate a range of short- and long-term negative developmental and behavioral consequences, and contribute to improving the relationship characteristics and quality of life of affected children and their families. Orv Hetil. 2024; 165(36): 1411–1422.
Meddőségi kezelésben részt vevő nők és férfiak életviteli szokásainak felmérése
Assessment of lifestyle habits of women and men participating in infertility treatment
Introduction: According to WHO data, about 17.5% of adults struggle with fertility problems, both women and men are equally affected. It can also be observed that over the past decades there has been a continuous increase in the number of people in need of infertility treatment, and this trend affects developed/industrialized countries much more. In these decades, our living conditions have also changed, which can be linked to the increase in the number of sterile relationships at several points. Objectives: We know from the literature that being overweight, smoking, alcohol consumption, high levels of untreated stress and even excessive vitamin consumption can negatively affect chances of fertility. The purpose of our study was to determine the extent of the known harmful lifestyle factors exist in couples undergoing infertility treatment. Methods: In our study, we assessed the lifestyle habits of couples applying for in vitro fertilization at our institute between 2020 and 2021, and compared our results descriptively with domestic statistics. 200 couples filled in the questionnaire. The age of the female respondents was 22–46 years, and the age of the men was 23–66 years. Results: 45% of women and 79.2% of men are overweight or obese. 24% of women and 54% of men drink alcohol at least once a week. Every fifth woman (19%) and every fourth man (26%) smoke regularly. In addition to this, only 21.5% of the respondents exercise at least 3 times a week. Our survey also covered our patients’ experience of stress. 27.8% of the participating women and 12.5% of the men claimed to be depressed, while 41% of the women and 15% of the men were stressed due to the difficulties of having children. Discussion and conclusion: According to our survey, the lifestyle risk factors discussed in detail in the literature are also typical in the lives of our patients, and this is a good indication for health awareness and importance of family planning education. The above factors may be partly due to cardiovascular and diabetes problems of the applicants presenting to our institute. Knowing the results, the high consumption of vegetables and fruits among the patients is surprising, and it is important to highlight that many of them use some form of vitamin preparation practically every day. Overall, it can be claimed that our patients have an unfavorable health picture, which fits the data of domestic statistics. Orv Hetil. 2024; 165(36): 1423–1432.
A nanomedicina lehetőségei és korlátai a stroke-on átesett betegek gyógykezelésében
Potentials and limitations of nanomedicine in the treatment of stroke patients
While nanomedicine is already helping stroke patients, it will offer many new opportunities in the future by enabling targeted therapy, faster and more accurate diagnosis and more effective drug treatment. Nanotechnology can be used to deliver specially designed molecules to the damaged brain area. There, the concentration of a given drug can be effectively increased to reduce unwanted side effects. This can lead to more efficient clot dissolution, improved reperfusion efficacy and more effective cyto- and neuroprotective strategies. Knowledge of the specific properties of the blood–brain barrier could facilitate drug delivery through a number of transport mechanisms that have so far been unexploited for drug delivery. Nanosensors and nano-based imaging techniques can significantly improve the early detection of stroke lesions and the accurate determination of the extent of injury. Nanotechnological solutions can significantly enhance the translational value of neuroprotective drugs previously found to be effective in animal models. This also offers hope for the regeneration of brain tissue and microcirculation. Furthermore, the very broad toolbox of nanomedicine allows the development of personalised therapies. Orv Hetil. 2024; 165(36): 1403–1410.
Új módszer a májregeneráció fokozására: a máj kettős vénás sorvasztása
A new method to enhance liver regeneration: double venous deprivation of the liver
The resectability of liver tumors depends on having a sufficient amount of liver tissue remaining after surgery to ensure proper liver function. With portal vein occlusion techniques, slower and more modest growth can be achieved during a low-risk intervention. If hypertrophy is insufficient or there is a risk of rapid tumor progression, Associating Liver Partition and Portal vein ligation for Staged hepatectomy can be used, which provides the most significant induced hypertrophy in a short time. However, the morbidity associated with the combined surgery is high. The dual venous deprivation of the liver, which involves the occlusion of the ipsilateral portal vein and hepatic vein, aims to combine the advantages of the above techniques. This approach allows for rapid and significant contralateral lobe hypertrophy, comparable to the latter method, to be achieved safely. Through our case, we demonstrate this liver hypertrophy technique. A 75-year-old female patient, during the investigation of her abdominal complaints, was diagnosed with a large intrahepatic cholangiocellular tumor in the right lobe of the liver, also affecting the middle sector. Considering the localization, the tumor could only be removed with a right-sided trisegmentectomy. We performed liver volumetry, which showed that the volume of the remaining liver (S1-2-3) was less than 35%. We decided on dual liver vein deprivation. On the 7th day following the occlusion of the right portal vein and the ipsilateral right hepatic vein, significant hypertrophy (41%) was observed. We successfully performed the planned surgery. During the postoperative period, mild ascites was managed conservatively, and no other complications occurred. The patient was discharged on the 8th postoperative day. If the expected volume of the remaining liver is insufficient for planned liver resection, liver regeneration techniques are necessary. Among the available techniques, the newest solution offering low complication risks is dual venous deprivation, involving occlusion of the ipsilateral portal vein and hepatic vein. The above case demonstrates that rapid and effective liver regeneration can be expected with this method, with minimal burden, enabling the safe performance of extended liver resections. Orv Hetil. 2024; 165(36): 1433–1439.
