A dentin-túlérzékenység és kezelése
Dentin hypersensitivity and its treatment
Nowadays, the occurrence of dentin hypersensitivity affects almost every person during their lifetime. Various stimuli – such as cold, heat, osmotic effects – can cause intense pain if the external structure of the tooth, enamel or cement layer are damaged or the anatomy of the enamel–cement border provides free dentin surface. Pain can trigger symptoms similar to tooth decay and its consequent diseases, so it is unclear to the patient what is causing the pain. The determination of dentin hypersensitivity is the task of the practising dentist. The prevention of the main root causes and the solution of the already existing problem cannot be managed without the knowledge of today’s modern treatment options. This review describes dentin hypersensitivity’s causes and effects and possible therapeutic solutions. Orv Hetil. 2024; 165(44): 1723–1727.
A medullaris pajzsmirigyrák diagnosztikája és kezelése négy magyarországi egyetemi centrumban (2000–2023)
Diagnosis and treatment of medullary thyroid cancer in four Hungarian university centers (2000–2023)
Introduction: Medullary thyroid carcinoma is a rare malignancy originating from the calcitonin-secreting parafollicular C-cells. Despite distinct histological and biochemical markers, diagnosing and managing of medullary thyroid carcinoma remain complex. Objective and method: Our study retrospectively analyzed medullary thyroid carcinoma cases from four Hungarian university centers diagnosed between 2000 and 2023. Demographic data, serum calcitonin and calcitonin doubling time, disease stage, therapeutic interventions and disease progression were investigated. Results: Out of 171 cases, 156 patients were eligible for inclusion. Lymph node involvement was seen in 37.5% of cases at diagnosis. Preoperative calcitonin levels were recorded in 84.2% of cases, and fine-needle aspiration biopsy was performed in 72%. Preoperative cytology confirmed medullary thyroid carcinoma in 67.4% of cases. Nearly one-third of the patients were diagnosed with stage IV. Total thyroidectomy with lymph node dissection was performed in 53.8% of cases, with a higher rate after 2015 (p<0.05). Based on postoperative serum calcitonin measurements, 44 patients were considered cured. Disease progression occurred in 47.8% of patients. In the first postoperative year, calcitonin measurements were available for 75% of patients. A postoperative calcitonin doubling time (Ct-DT) of less than two years was associated with significantly lower progression-free survival than a Ct-DT of more than two years (p<0.05). Discussion: Genetic testing identified germline receptor tyrosine kinase (RET) mutations in 34.2% of patients, predominantly at codon 634. Tyrosine kinase inhibitors were used in 35 advanced cases. Treatment with selpercatinib was associated with less frequent disease progression and fewer adverse events than with the use of multi-kinase inhibitors (p<0.05). Conclusion: Despite recent advances, medullary thyroid carcinoma management remains challenging. Although the routine screening is debated, calcitonin measurement remains crucial for preoperative diagnosis. Fine-needle aspiration biopsy alone often fails to provide an accurate preoperative diagnosis; immunohistology or calcitonin measurement from washout fluid enhances sensitivity. Surgery can cure localized diseases, while advanced cases require personalized approaches. Germline and somatic RET mutation analyses are essential for selecting targeted therapies for medullary thyroid carcinoma. Orv Hetil. 2024; 165(44): 1735–1745.
Optimalizált lipidcsökkentéssel és thrombocytaaggregáció-gátló kezeléssel elérhető potenciális cardiovascularis nyereség akut coronaria szindrómán átesett betegekben – szimulációs elemzés
Potential cardiovascular benefit of optimized lipid-lowering and antiplatelet therapy in patients with acute coronary syndrome – a simulation analysis
Introduction: Lipid lowering therapy – despite the accumulated clinical trial evidence behind it and its significant preventive role reflected in the guidelines – does not have its rightful place in the value system of patients or doctors, there is a great gap between practice and principles. Objective: In order to increase the prestige of lipid-lowering therapy, the potential benefit of lowering LDL cholesterol was compared with antiplatelet therapy, which is generally more accepted. Method: We processed the data of 531 patients of the Bekes County Central Hospital Pandy Kalman Branch in Gyula who underwent percutaneous coronary intervention for acute coronary syndrome for one year starting on April 1, 2020. A simulation study was conducted during which, based on the results of large clinical studies, the cardiovascular prevention effect of optimal lipid reduction and platelet aggregation inhibition for one year was estimated. Results: In all 531 patients treated for acute coronary syndrome, if LDL cholesterol levels had remained at the mean level of 3.37 mmol/L found at admission, 59 major cardiovascular events could have occurred within one year after the index event. If LDL-cholesterol levels were to be reduced to 1.4 mmol/L, which is the very high-risk target value in the lipid recommendations of the European Society of Cardiology, the number of events would be 13, and 16 if the theoretical, very low, non-target value of 0.5 mmol/L was reached. Lowering LDL cholesterol levels is therefore expected to avoid 13 and 16 major cardiovascular events, respectively. If aspirin alone was given for antiplatelet aggregation, 14 events could be prevented over a year, 17 events could be prevented using aspirin and clopidogrel combination, and 20 events with aspirin and prasugrel or aspirin and ticagrelor. Discussion: Based on the low rates of achieving LDL cholesterol targets, there is a considerable potential for optimizing lipid-lowering treatment worldwide. In patients with acute coronary syndrome, one of the most vulnerable patient groups in cardiology practice, the study results suggest that lipid reduction and platelet aggregation inhibition could achieve a similar reduction in the number of major cardiovascular events. Conclusion: The simulation study confirms the comparable cardiovascular benefit of the two interventions. Since the attainment rate of LDL cholesterol targets set in the guidelines is very poor – with physicians’ therapeutic inertia playing a major role –, we hope our findings will convince colleagues that more attention should be paid to more optimal lipid reduction. Orv Hetil. 2024; 165(44): 1746–1752.
Szükséges-e a subarachnoidealis vérzésen átesett betegek pszichológiai követése?
Pszichológiai megvalósíthatósági tanulmány a szegedi Idegsebészeti Klinikán
Is psychological follow-up of patients with subarachnoid haemorrhage necessary?
Psychological pilot study at the Department of Neurosurgery, Szeged
Introduction: After aneurysmal subarachnoid haemorrhage (SAH), even apparently fully recovered patients often report serious psychological problems (anxiety, depression, mood swings, loss of concentration, memory impairment). Objective: Our aim is to assess, in a pilot study, the effectiveness of available and commonly used psychological tests in assessing the condition of patients after SAH and to start the development of a post-SAH psychological care system. Methods: From May 2023 to January 2024, a total of 52 patients with aneurysmal subarachnoid haemorrhage who had a good outcome, i.e., were asymptomatic or mildly symptomatic but still self-sufficient (modified Rankin scale <2), were included in our study. In addition to general patient data (age, sex, education), we recorded the treatment modality and excluded patients with significant deterioration as a complication of aneurysm treatment. According to the main aim of our study, we used the following psychological tests: Montreal Cognitive Assessment (MoCa), Spielberger State/Trait Anxiety Questionnaire (STAI-S/T), Beck Depression Questionnaire (short version; BDI-R). Results: According to the above criteria, a total of 38 women and 14 men with a mean age of 53 years (SD = 7.14) were included in our study. Psychological examination revealed cognitive impairment in 1/3 of the patients, 74% with some degree of depression, 10% with high levels of depression, and 42% with above average anxiety. There is a correlation between the level of anxiety, the severity of depression and the likelihood of developing cognitive impairment. Discussion and conclusion: Our results so far suggest that even in somatically almost asymptomatic patients, moderate to severe psychological problems occur regularly after SAH, which requires psychological care. Our study has shown that the psychological tests available in Hungarian are not suitable for accurate mapping the condition of patients with SAH and then tracking changes due to the learning effect. Furthermore, it became clear that the modified Rankin scale used to classify the outcome of the disease is not sufficient information on the psychological state of the patients, as it does not differentiate well in terms of symptoms, and therefore a new, complementary SAH-specific test needs to be applied, adopted and localised, which our institution has started to do. Orv Hetil. 2024; 165(44): 1753–1759.
A transzplantált szív kilökődésének előrejelzése endomyocardialis biopsziás minták mesterségesintelligencia-alapú patológiai vizsgálatával
Pathology of transplanted heart rejection using artificial intelligence-based image analysis of endomyocardial biopsies
Introduction: Technologies based on digital image analysis are becoming an increasingly prominent feature of pathological diagnostics. The application of artificial intelligence to data analysis has the potential to offer a more objective and detailed morphological characterization than that achievable through visual inspection. This could lead to a reduction in the time necessary for a diagnosis to be reached. Objective: The aim of this study was to optimize the nuclear recognition and nuclear separation capabilities of the image analysis software BIAS (Single-Cell Technologies). Method: To this end, the recognition and morphological characteristics (distance, density) of five to five Gr0R, Gr1R, Gr2R stage endomyocardial biopsies of hematoxylin-eosin stained, digitized sections of lymphocytes, myocytes, and other tissue structures were investigated. Results: The data demonstrated a clear increase in lymphocyte density averages during the progression of histological signs of graft rejection (Gr0R: 127.02/mm² < Gr1R: 324.03/mm² < Gr2R: 686.49/mm²), with the results for Gr0R showing a significant difference compared to Gr1R. The mean distance between lymphocytes exhibited a corresponding variation (Gr0R: 32.44 µm > Gr1R: 19.37 µm > Gr2R: 11.63 µm), with the latter two values being significantly below the Gr0R cases. The mean myocyte–lymphocyte distances of the first ten lymphocytes in order of distance from the myocytes were found to be similar (Gr0R: 55.32–193 µm > Gr1R: 35.16–109.96 µm > Gr2R: 32.46–92.95 µm). This indicates that the mean distance of lymphocytes from myocytes in Gr0R cases was significantly greater than in the other groups. In 1 mm² of myocardium, the mass of intramyocardial connective tissue exhibited a notable decline following a substantial increase (Gr0R: 1013.72 µm², Gr1R: 1942.65 µm², Gr2R: 1686.79 µm²). Conversely, the prevalence of intramyocardial oedema demonstrated an appreciable surge subsequent to a moderate decline (Gr0R: 202.42 µm², Gr1R: 181.56 µm², Gr2R: 273.91 µm²) throughout the progression of the rejection process. Discussion: The results of our study indicate that our artificial intelligence-based method, when adequately trained, is suitable for objective pathological analysis of lymphocyte, myocyte and connective tissue volume, as well as the extent of oedema and morphological parameters (distance, density) that are important from the perspective of rejection in endomyocardial biopsies of transplanted hearts. Conclusion: Complex digital image analysis may prove to be a valuable tool for the efficient pathological evaluation of organ rejection in heart transplant recipients. Orv Hetil. 2024; 165(44): 1728–1734.
Abstract
This paper explores innovative and contemporary approaches to preserving and repurposing Mongolian temples, with a focus on maintaining their cultural and historical significance while adapting to modern needs. It examines the unique architectural and cultural aspects of these temples, the challenges they face, and presents design and preservation strategies that can ensure their continued relevance.
Abstract
This study examines the impact of various external shading devices on key lighting metrics, such as spatial daylight autonomy, annual sunlight exposure, and mean illuminance in classrooms. By comparing the performance of different shading options, the study offers insights into optimizing natural lighting, enhancing visual comfort, and improving sustainability in educational buildings in warm, humid climates. The findings provide valuable guidance for architects, designers, and school facility managers aiming to improve energy efficiency and occupant comfort in educational environments.
This study explored the effects of salicylic acid on the growth and biochemical responses of peppermint (Mentha piperita L.) under different soil salinity levels, a major challenge in agricultural productivity. The experiment was conducted using a factorial design with salicylic acid applied at concentrations of 0, 5, 10, and 50 ppm, combined with sodium chloride-induced salinity at 0, 1,000, 2,000, and 3,000 mg kg–1 soil. Results demonstrated that increasing soil salinity negatively impacted plant growth, reducing plant height, leaf number, and the dry weight of aerial parts. Salinity stress also led to reduced nutrient uptake, particularly for essential elements like calcium and potassium, while increasing sodium levels in plant tissues. However, the foliar application of salicylic acid, especially at 50 ppm, significantly improved growth parameters and mitigated the detrimental effects of salinity. Notably, at the highest salinity level (3,000 mg kg–1), salicylic acid enhanced plant height by 11.1% and leaf number by 30.9% compared to untreated plants. Salicylic acid also boosted biochemical responses, such as increasing total phenolic and flavonoid content, which are critical for stress tolerance. This study underscores the potential of salicylic acid as a stress mitigator, promoting better growth and physiological resilience in peppermint under saline conditions, offering valuable insights for improving crop performance in salinity-affected regions.
Abstract
Background and aims
Conflicting findings have been reported for the longitudinal course of behavioral addictions, especially for social media addiction (SMA) and work addiction (WA). Therefore, evaluating whether these constructs are more trait-like or state-like might be informative. The aim of the present study was to examine the proportion of variance of SMA and WA symptoms (as defined by the components model of addiction) explained by trait and occasion-specific factors in addition to exploring cross-lagged relationships between SMA and WA.
Methods
Young adults from a representative sample who continuously used social media and worked at least 40 hours a week during the first three waves of the Budapest Longitudinal Study were included (N = 1,551; Females: 50.6%; Age: M = 27.7 years [SD = 4.40]). The Bergen Social Media Addiction Scale and the Bergen Work Addiction Scale were administered in all three waves.
Results
A latent state-trait model with a general trait factor was considered for both SMA and WA. Symptomatic variability in SMA was explained approximately equally by trait and state-like factors, while WA-related symptom variability was mostly attributed to state-like factors. SMA negatively predicted WA over time, while WA showed a positive cross-lagged effect on SMA.
Discussion and Conclusions
While the symptoms of WA were more state-like, the trait-like effects were stronger in SMA. Situational influences and previous symptom severities might have to be considered in the screening process.
Abstract
Background
The study assessed replicative human immunodeficiency virus-(HIV-) infection and replicative co-infections as well as molecular determinants of reduced susceptibility towards anti-retroviral therapy in a Ghanaian population of known HIV patients and a control group.
Methods
Real-time PCRs for HIV-1, HIV-2, hepatitis B virus (HBV) and hepatitis C virus (HCV) were run with serum samples from known Ghanaian HIV-patients (n = 975) and control individuals (n = 105). For 108 individuals, HIV-sequence analysis was performed.
Results
Prevalence of replicative HIV-1 infection was 59.8% (583/975) in the known HIV-positive population and 2.9% (3/105) in the controls. Prevalences of replicative HBV-infection were comparable with 3.4% (33/975) in the HIV-positive individuals and 3.8% (4/105) in the controls. HIV-2 and HCV sequences were not recorded. Almost perfect concordance between two compared HIV-1-PCR assays was indicated by Fleiss' Kappa >0.8. Sanger sequencing indicated CRF_02AG, G and A3 as the quantitatively dominating HIV-1 subtypes, a minority of 3.4% CXCR4 tropism and high detection rates of mutations mediating reduced susceptibility towards nucleoside reverse transcriptase inhibitors (71.9%, 64/89), non-nucleoside reverse transcriptase inhibitors (95.5%, 85/89), protease inhibitors (95.9%, 93/97) and integrase inhibitors (22.4%, 22/98).
Conclusions
The assessment did not suggest HIV-triggered increased replication of HBV and HCV in the investigated Ghanaian population.