Factors predicting mortality in the cardiac ICU during the early phase of targeted temperature management in the treatment of post-cardiac arrest syndrome - The RAPID score.

Introduction: Survival rates after out-of-hospital cardiac arrest (OHCA) remain low, and early prognostication is challenging. While numerous intensive care unit scoring systems exist, their utility in the early hours following hospital admission, specifically in the targeted temperature management (TTM) population, is questionable. Our aim was to create a score system that may accurately estimate outcome within the first 12 h after admission in patients receiving TTM. Methods: We analyzed data from 103 OHCA patients who subsequently underwent TTM between 2016 and 2022. Patient demographic data, prehospital characteristics, clinical and laboratory parameters were already available in the first 12 h after admission were collected. Following a bootstrap-based predictor selection, we constructed a nonlinear logistic regression model. Internal validation was performed using bootstrap resampling. Discrimination was described using the c-statistic, whereas calibration was characterized by the intercept and slope. Results: According to the Akaike Information Criterion (AIC) heart rate (AIC = 9.24, p = 0.0013), age (AIC = 4.39, p = 0.0115), pH (AIC = 3.68, p = 0.0171), initial rhythm (AIC = 4.76, p = 0.0093) and right ventricular end-diastolic diameter (AIC = 2.49, p = 0.0342) were associated with 30-day mortality and were used to build our predictive model and nomogram. The area under the receiver-operating characteristics curve for the model was 0.84. The model achieved a C-statistic of 0.7974, with internally validated acceptable calibration (intercept: -0.0190, slope: 0.7772) and low error rates (mean absolute error: 0.040). Conclusion: The model we have developed may be suitable for early risk assessment of patients receiving TTM as part of primary post-resuscitation care. The calculator needed for scoring can be accessed at the following link: https://www.rapidscore.eu/.

Use of diffusive gradients in thin-film technique to predict the mobility and transfer of nutrients and toxic elements from agricultural soil to crops-an overview of recent studies.

The purpose of this review was to survey the recent applications of the diffusive gradients in thin films (DGT) technique in the assessment of mobility and bioavailability of nutrients and potentially toxic elements (PTEs) in agricultural soil. Many studies compared the capabilities of the DGT technique with those of classical soil chemical extractants used in single or sequential procedures to predict nutrients and PTE bioavailability to crops. In most of the published works, the DGT technique was reported to be superior to the conventional chemical extraction and fractionation methods in obtaining significant correlations with the metals and metalloids accumulated in crops. In the domain of nutrient bioavailability assessment, DGT-based studies focused mainly on phosphorous and selenium labile fraction measurement, but potassium, manganese, and nitrogen were also studied using the DGT tool. Different DGT configurations are reported, using binding and diffusive layers specific for certain analytes (Hg, P, and Se) or gels with wider applicability, such as Chelex-based binding gels for metal cations and ferrihydrite-based hydrogels for oxyanions. Overall, the literature demonstrates that the DGT technique is relevant for the evaluation of metal and nutrient bioavailability to crops, due to its capacity to mimic the plant root uptake process, which justifies future improvement efforts.

The investigation of the efficiency of basic life support education among high school students: Protocol, design and implementation of an interventional, prospective longitudinal, individually randomised, parallel 1:1 grouped trial.

Background: Basic life support (BLS) skills are crucial not only for healthcare workers but for all lay people as well. Timely recognition of out-of-hospital cardiac arrest (OHCA) and the initiation of BLS by bystanders before the arrival of healthcare personnel may improve survival. There are several methods of spreading BLS skills and improve BLS skill retention among lay people. One of these methods can be the education of adolescent school children. The introduction of mandatory BLS education in schools was very effective in some European countries to increase the rate of bystander BLS. Methods/design: The current study aims to investigate the efficacy of a BLS training and BLS curriculum among high school children in Hungary. Moreover, the investigators would like to optimise factors influencing skill retention in this first responder group and aim to compare two types of teaching methods: feedback given by the instructor or software-based feedback on the efficacy of chest compressions during the course. This study will be an interventional, assessor blinded, individually randomised parallel group trial recruiting 360 students. BLS skill retention will be assessed at the end of the course, two months after the training and six months after training. Discussion: The current study will increase our knowledge on the methods educating BLS among high school children. The results will help us to create an effective BLS curriculum at schools.Trial registration: ClinicalTrials.gov: NCT06016153. Prospectively registered on 08/2023.

Teaching nontechnical skills in the undergraduate education of health care professionals: a nationwide cross-sectional study in Hungary.

BACKGROUND: The aim of our cross-sectional study was to evaluate the current situation and curriculum of nontechnical skills (NTS) training in the undergraduate education of health care professionals in Hungary. METHODS: All institutes with relevant NTS training in Hungarian faculties of medicine and faculties of health sciences were asked to fill out a 19-item questionnaire. Descriptive statistics were performed, and the characteristics of NTS teaching and non-NTS teaching institutes were compared. The independent predictors of teaching NTS in a particular institute were identified with multiple logistic regression. RESULTS: Seventy-seven institutes responded (52% response rate), of which 66% trained NTS. The most frequent method of NTS training is talking about them during a practice or lecture, and less than half of NTS respondents use simulation. The most frequent cause of not teaching NTS is a lack of human or technical resources. The type of faculty (p = 0.025), academic year (p = 0.001), field of medicine (p = 0.025), and importance of teamwork (p = 0.021) differed between NTS and noNTS institutes. Teaching students in academic year two represented the only independent predictor of NTS education (p = 0.012). CONCLUSIONS: Our findings show that the undergraduate curriculum of Hungarian universities includes some type of NTS education; however, this education requires further development.

Use of intraoperative haemoadsorption in patients undergoing heart transplantation: a proof-of-concept randomized trial.

AIMS: The aim of this trial was to compare the clinical effects of intraoperative haemoadsorption versus standard care in patients undergoing orthotopic heart transplantation (OHT). METHODS AND RESULTS: In a randomized, controlled trial, OHT recipients were randomized to receive intraoperative haemoadsorption or standard care. Outcomes were vasoactive-inotropic score (VIS), frequency of vasoplegic syndrome (VS) in the first 24 h; post-operative change in procalcitonin (PCT) and C-reactive protein (CRP) levels; intraoperative change in mycophenolic acid (MPA) concentration; frequency of post-operative organ dysfunction, major complications, adverse immunological events and length of in-hospital stay and 1-year survival. Sixty patients were randomized (haemoadsorption group N = 30, control group N = 25 plus 5 exclusions). Patients in the haemoadsorption group had a lower median VIS and rate of VS (VIS: 27.2 [14.6-47.7] vs. 41.9 [22.4-63.2], P = 0.046, and VS: 20.0% vs. 48.0%, P = 0.028, respectively), a 6.4-fold decrease in the odds of early VS (OR: 0.156, CI: 0.029-0.830, P = 0.029), lower PCT levels, shorter median mechanical ventilation (MV: 25 [19-68.8] hours vs. 65 [23-287] hours, P = 0.025, respectively) and intensive care unit stay (ICU stay: 8.5 [8.0-10.3] days vs. 12 [8.5-18.0] days, P = 0.022, respectively) than patients in the control group. Patients in the haemoadsorption versus control group experienced lower rates of acute kidney injury (AKI: 36.7% vs. 76.0%, P = 0.004, respectively), renal replacement therapy (RRT: 0% vs. 16.0%, P = 0.037, respectively) and lower median per cent change in bilirubin level (PCB: 2.5 [-24.6 to 71.1] % vs. 72.1 [11.2-191.4] %, P = 0.009, respectively) during the post-operative period. MPA concentrations measured at pre-defined time points were comparable in the haemoadsorption compared to control groups (MPA pre-cardiopulmonary bypass: 2.4 [1.15-3.60] µg/mL vs. 1.6 [1.20-3.20] µg/mL, P = 0.780, and MPA 120 min after cardiopulmonary bypass start: 1.1 [0.58-2.32] µg/mL vs. 0.9 [0.45-2.10] µg/mL, P = 0.786). The rates of cardiac allograft rejection, 30-day mortality and 1-year survival were similar between the groups. CONCLUSIONS: Intraoperative haemoadsorption was associated with better haemodynamic stability, mitigated PCT response, lower rates of post-operative AKI and RRT, more stable hepatic bilirubin excretion, and shorter durations of MV and ICU stay. Intraoperative haemoadsorption did not show any relevant adsorption effect on MPA. There was no increase in the frequency of early cardiac allograft rejection related to intraoperative haemoadsorption use.

Factors improving mortality in critically ill patients with liver failure - A systematic review.

Background: Acute and chronic hepatic failure can lead to increased mortality in critically ill and perioperative patients. Understanding the pathophysiological principles of these conditions in critically ill patients is of great importance to reduce mortality. The aim of our systematic literature review was to identify all randomized controlled trials on any intervention that had a statistically significant documented reduction in mortality in patients with hepatic failure. Methods: We searched PubMed, Scopus and Embase databases for pertinent studies on January 1st 2021. The following studies were included: randomized controlled trials; studies investigating adult critically ill or perioperative patient populations with any form of hepatic failure; mortality as primary or secondary outcome; and statistically significant differences in mortality between the examined groups. Results: We finally found nine trials in our systematic review on the effect of antibiotic administration and infectious diseases among patients with cirrhosis (three studies); immune modulation after liver transplantation (one study); administration of colloids in cirrhotic patients (one study); the effect of high-volume plasma exchange in acute liver failure (one study); administration of N-acetylcysteine in acute liver failure (one study); and treatment with terlipressin (two studies). Conclusion: In the present review we found only nine randomized studies with a documented survival benefit in patients with liver failure. Strategies that most improved mortality were associated with the outcome of sepsis and renal function.

T cell immune response predicts survival in severely ill COVID-19 patients requiring venovenous extracorporeal membrane oxygenation support.

Introduction: There is a critical gap in understanding which SARS-CoV-2 patients would benefit most from venovenous extracorporeal membrane oxygenation (VV-ECMO) support. The potential role of a dysregulated immune response is still unclear in this patient population. Objectives: To assess the potential predictive value of SARS-CoV-2 specific cellular and humoral immune responses for survival in critically ill COVID-19 patients requiring VV-ECMO. Methods: We conducted a prospective single-center observational study of unvaccinated patients requiring VV-ECMO support treated at the intensive care unit of Semmelweis University Heart and Vascular Center between March and December 2021. Peripheral blood samples were collected to measure the humoral and cellular immune statuses of the patients at the VV-ECMO cannulation. Patients were followed until hospital discharge. Results: Overall, 35 COVID-19 patients (63% men, median age 37 years) on VV-ECMO support were included in our study. The time from COVID-19 verification to ECMO support was a median (IQR) of 10 (7-14) days. Of the patients, 9 (26%) were discharged alive and 26 (74%) died during their hospital stay. Immune tests confirmed ongoing SARS-CoV-2 infection in all the patients, showing an increased humoral immune response. SARS-CoV-2-specific cellular immune response was significantly higher among survivors compared to the deceased patients. A higher probability of survival was observed in patients with markers indicating a higher T cell response detected by both QuantiFeron (QF) and flow cytometry (Flow) assays. (Flow S1 CD8+ ≥ 0.15%, Flow S1 CD4+ ≥ 0.02%, QF CD4 ≥ 0.07, QF whole genome ≥ 0.59). In univariate Cox proportional hazard regression analysis BMI, right ventricular (RV) failure, QF whole genome T cell level, and Flow S1 CD8+ T cell level were associated with mortality, and we found that an increased T cell response showed a significant negative association with mortality, independent of BMI and RV failure. Conclusion: Evaluation of SARS-CoV-2 specific T cell response before the cannulation can aid the risk stratification and evaluation of seriously ill COVID-19 patients undergoing VV-ECMO support by predicting survival, potentially changing our clinical practice in the future.

Impact of Low Lithium Concentrations on the Fatty Acids and Elemental Composition of Salvinia natans.

The photosynthetic pigments, protein, macro and microelements concentrations, and fatty acids composition of Salvinia natans, a free-floating aquatic plant, were analyzed after exposure to Hoagland nutrient solution containing 1, 3, and 5 mg/L Li. The Li content of Salvinia natans grew exponentially with the Li concentration in the Hoagland nutrient solution. The exposure to Li did not induce significant changes in Na, Mg, K, Cu, and Zn content but enhanced the Ba, Cr, Mn, Ni and Mo absorption in Salvinia natans. The most abundant fatty acids determined in oils extracted from Salvinia natans were C16:0, C18:3(n6), C18:2(n6), and C18:3(n3). The photosynthetic pigments did not change significantly after exposure to Li. In contrast, chlorophyll and protein content decreased, whilst monounsaturated and polyunsaturated fatty acids content increased after the exposure to 1 mg/L Li. The results indicated that Salvinia natans exposed to low Li concentrations may be a good source of minerals, omega 6 and omega 3.

L-Poly(lactic acid) Production by Microwave Irradiation of Lactic Acid Obtained from Lignocellulosic Wastes.

L-polylactic acid (PLA), a semi-crystalline aliphatic polyester, is one of the most manufactured biodegradable plastics worldwide. The objective of the study was to obtain L-polylactic acid (PLA) from lignocellulosic plum biomass. Initially, the biomass was processed via pressurized hot water pretreatment at a temperature of 180 °C for 30 min at 10 MPa for carbohydrate separation. Cellulase and the beta-glucosidase enzymes were then added, and the mixture was fermented with Lacticaseibacillus rhamnosus ATCC 7469. The resulting lactic acid was concentrated and purified after ammonium sulphate and n-butanol extraction. The productivity of L-lactic acid was 2.04 ± 0.18 g/L/h. Then, the PLA was synthesized in two stages. Firstly, lactic acid was subjected to azeotropic dehydration at 140 °C for 24 h in the presence of xylene, using SnCl2 (0.4 wt.%) as a catalyst, resulting in lactide (CPLA). Secondly, microwave-assisted polymerization was carried out at 140 °C for 30 min with 0.4 wt.% SnCl2. The resulting powder was purified with methanol to produce PLA with 92.1% yield. The obtained PLA was confirmed using electrospray ionization mass spectrometry, nuclear magnetic resonance, thermogravimetric analysis, Fourier transform infrared spectroscopy, scanning electron microscopy, and X-ray diffraction. Overall, the resulting PLA can successfully replace the traditional synthetic polymers used in the packaging industry.

[Cardiopulmonary resuscitation in special circumstances]. / Újraélesztés speciális körülmények között.

The standard process of basic and advanced life support can be complicated by a number of special circumstances. Over the last decade, the European Resuscitation Council developed an increasingly detailed guideline regarding the diagnosis and therapy of these situations. In our short review, we summarize the most important recommendations for the management of cardiopulmonary resuscitation in special circumstances. The proper training in non-technical skills and teamwork is crucial in the management of these situations. In addition, extracorporeal circulatory and respiratory support play an increasingly important role in some special circumstances with appropriate patient selection and timing. We also summarize the therapeutic options regarding the reversible causes of cardiac arrest as well as the steps of diagnostic and treatment methods in some special situations (cardiopulmonary resuscitation in the operating room, after cardiac surgery, in a catheterisation laboratory, after sudden cardiac arrest at dentistry or dialysis station) and among special patient populations (patient with asthma or COPD, neurologic disorders, obese patient, pregnant woman). Orv Hetil. 2023; 164(13): 488-498.

[Impact of the COVID-19 pandemic on basic resuscitation and success rate after sudden cardiac arrest]. / A COVID­19-pandémia hatása a hirtelen szívmegállást követo alapszintu újraélesztésre és annak sikerességére.

Since the onset of the coronavirus disease, infection-related mortality has been tracked worldwide and the number of deaths caused by the virus is counted daily. The coronavirus pandemic has not only transformed our daily life, but reorganized the whole healthcare system. In response to the increased demand for hospital admissions, leaders in different countries have implemented a number of emergency actions. The restructuring has had both direct and indirect negative effects on the epidemiology of sudden cardiac death, the willingness of lay rescuer to give cardiopulmonary resuscitation and the use of automated external defibrillators, but these negative effects vary widely across continents and countries. In order to protect lay people and health workers as well as to prevent the spread of the pandemic, the previous recommendations of the European Resuscitation Council on basic and advanced life support have undergone a few modifications. Orv Hetil. 2023; 164(13): 483-487.

[The role of extracorporeal life support in cardiopulmonary resuscitation]. / Az extracorporalis keringéstámogatás helye az újraélesztésben.

The frequency of the administration of extracorporeal cardiopulmonary resuscitation is increasing both in the treatment of in-hospital and out-of-hospital cardiac arrest. The latest resuscitation guidelines support the use of mechanical circulatory support devices in the cases of prolonged cardiopulmonary resuscitation in certain selected patient groups. However, only little evidence is available regarding the effectiveness of extracorporeal cardiopulmonary resuscitation, and many open questions remained unanswered regarding the adequate conditions of this modality. The timing and location of extracorporeal cardiopulmonary resuscitation are important factors, as well as the appropriate training of the personnel using extracorporeal techniques. Our review briefly summarizes, according to the current literature and recommendations, in which cases extracorporeal resuscitation may be beneficial, which type of mechanical circulatory support is the first choice of extracorporeal cardiopulmonary resuscitation, which factors influence the efficacy of this supportive treatment, and which complications may be expected during mechanical circulatory support during resuscitation. Orv Hetil. 2023; 164(13): 510-514.

[The novelties of adult advanced life support and post-resuscitation therapy]. / A felnott emelt szintu újraélesztés és a postresuscitatiós ellátás újdonságai.

The fourth element of chain-of-survival contains advanced life support and post-resuscitation treatment. Both treatment options influence the outcome of patients suffering cardiac arrest. Advanced life support includes all interventions that require special medical equipment and expertise. High-quality chest compressions and early defibrillation (if indicated) compose the main elements of advanced life support. Clarifying and treating the cause of cardiac arrest have also high priority, in which point-of-care ultrasound plays an important role. In addition, securing higher level of airway and capnography, securing intravenous or intraosseous line, and the parenteral administration of drugs - such as epinephrine or amiodarone - are the most important steps of advanced life support. If conventional therapy is unsuccessful, extracorporeal circulatory support can be used in special patient populations. The protection of vital organs that are sensitive to hypoxia (brain and heart) has a high priority after the return of spontaneous circulation beside the causative treatment of cardiac arrest. The most important parts of the supportive post-resuscitation treatment are: targeting normoxia, normocapnia, normotension, normoglycemia, and the application of target temperature management. Orv Hetil. 2023; 164(12): 454-462.

[Out-of-hospital adult basic life support: new guidelines and the involvement of bystanders]. / A kórházon kívüli felnott alapszintu újraélesztés új irányelvei és a laikusok bevonásának kérdései.

Survival rate for out-of-hospital cardiac arrest remains low across Europe. In the last decade, involving bystanders turned out to be one of the most important key factors in improving the outcome of out-of-hospital cardiac arrest. Beside recognizing cardiac arrest and initiate chest compressions, bystanders could be also involved in delivering early defibrillation. Although adult basic life support is a sequence of simple interventions that can be easily learnt even by schoolchildren, non-technical skills and emotional components can complicate real-life situations. This recognition combined with modern technology brings a new point of view in teaching and implementation. We review the latest practice guidelines and new advances in the education (including the importance of non-technical skills) of out-of-hospital adult basic life support, also considering the effects of COVID-19 pandemic. We briefly present the Szív City application developed to support the involvement of lay rescuers. Orv Hetil. 2023; 164(12): 443-448.

[In-hospital cardiac arrest and basic life support]. / Kórházon belüli keringésmegállás és alapszintu újraélesztés.

Survival of in-hospital cardiac arrests is still as low as 15-35%. Healthcare workers should closely monitor patients' vital signs, notice any deterioration, and initiate the necessary actions to prevent cardiac arrest. The introduction of early warning sign protocols (including the monitoring of respiratory rate, oxygen saturation, pulse, blood pressure, consciousness, etc.) can improve the recognition of periarrest patients during hospital stay. However, when a cardiac arrest occurs, healthcare workers should also be able to work in team and follow the relevant protocols delivering good quality chest compressions and early defibrillation. To achieve this goal, regular trainings, appropriate infrastructure and system-wide teamwork are needed. In this paper, we discuss the challenges of the first phase of in-hospital resuscitation and its integration into the hospital-wide medical emergency response system. Orv Hetil. 2023; 164(12): 449-453.

Poly(3-hydroxybutyrate) Production from Lignocellulosic Wastes Using Bacillus megaterium ATCC 14581.

This study aimed to analyze the production of poly(3-hydroxybutyrate) (PHB) from lignocellulosic biomass through a series of steps, including microwave irradiation, ammonia delignification, enzymatic hydrolysis, and fermentation, using the Bacillus megaterium ATCC 14581 strain. The lignocellulosic biomass was first pretreated using microwave irradiation at different temperatures (180, 200, and 220 °C) for 10, 20, and 30 min. The optimal pretreatment conditions were determined using the central composite design (CCD) and the response surface methodology (RSM). In the second step, the pretreated biomass was subjected to ammonia delignification, followed by enzymatic hydrolysis. The yield obtained for the pretreated and enzymatically hydrolyzed biomass was lower (70.2%) compared to the pretreated, delignified, and enzymatically hydrolyzed biomass (91.4%). These hydrolysates were used as carbon substrates for the synthesis of PHB using Bacillus megaterium ATCC 14581 in batch cultures. Various analytical methods were employed, namely nuclear magnetic resonance (1H-NMR and13C-NMR), electrospray ionization mass spectrometry (EI-MS), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), and thermogravimetric analysis (TGA), to identify and characterize the extracted PHB. The XRD analysis confirmed the partially crystalline nature of PHB.

High-Pressure Supercritical CO2 Pretreatment of Apple Orchard Waste for Carbohydrates Production Using Response Surface Methodology and Method Uncertainty Evaluation.

This study's objective was to separate cellulose, hemicellulose, and lignin after high-pressure supercritical carbon dioxide pretreatment for further valorization. The study investigated the supercritical carbon dioxide pretreatment of apple orchard waste at temperatures of 160-200 °C, for 15-45 min, at a pressure of 10 MPa. Response Surface Methodology (RSM) was used to optimize the supercritical process and to improve its efficiency. The change of functional groups during different pretreatment conditions was examined by Fourier transform infrared (FTIR) spectroscopy. Scanning electron microscopy (SEM) and X-ray diffraction (XRD) confirmed the structural changes in the biomass structure before and after pretreatment. A new ultra-high performance liquid chromatography (UHPLC) coupled with an evaporative light scattering detector (ELSD) method was developed and validated for the determination of carbohydrates in the liquid fraction that resulted after pretreatment. The estimated uncertainty of the method ranged from 16.9 to 20.8%. The pre-treatment of high-pressure supercritical CO2 appears to be an effective and promising technique for the recovery of sugars and secondary by-products without the use of toxic solvents.

Lithium Accumulation in Salvinia natans Free-Floating Aquatic Plant.

The new context of the intensive use of lithium-based batteries led to increased production of Li and Li-containing wastes. All these activities are potential sources of environmental pollution with Li. However, the negative impact of Li on ecosystems, its specific role in the plants' development, uptake mechanism, and response to the induced stress are not fully understood. In this sense, the Li uptake and changes induced by Li exposure in the major and trace element contents, photosynthetic pigments, antioxidant activity, and elemental composition of Salvinia natans were also investigated. The results showed that Salvinia natans grown in Li-enriched nutrient solutions accumulated much higher Li contents than those grown in spring waters with a low Li content. However, the Li bioaccumulation factor in Salvinia natans grown in Li-enriched nutrient solutions was lower (13.3-29.5) than in spring waters (13.0-42.2). The plants exposed to high Li contents showed a decrease in their K and photosynthetic pigments content, while their total antioxidant activity did not change substantially.

Heavy metals and health risk assessment in vegetables grown in the vicinity of a former non-metallic facility located in Romania.

Soil contamination represents a serious and significant issue, especially when it comes to soil used in agricultural practices. This research was carried out in order to investigate the accumulation level of potentially toxic trace elements (Cr, Cd, Cu, Mn, Ni, Pb and Zn) in soil and vegetables (Solanum lycopersicum and Daucus carota). The transfer of the trace elements from soil to vegetables and the potential risk assessment were studied as well. Results indicated relatively high levels of heavy metals. Cd, Cu and Pb exceeded the alert limits established by the Romanian legislation. Zn was high as well. Positive correlations between the Cr, Cu and Pb indicated similar source of pollution, possibly related to the activities occurred in the non-metallic facility, nearby the study area. The heavy metals determined in the Solanum lycopersicum fruits and Daucus carota roots were below the maximum allowable concentrations, according to the WHO/FAO guideline. Slightly higher amounts of Cr and Cu were measured in tomatoes, compared to the carrots. Nevertheless, carrots were richer in Ni and Mn. The applied pollution indices indicated a contamination with heavy metals in 90% of the soil samples, with 9% probability of toxicity, the remaining 10% being classified into the precaution domain category. The plant bioconcentration of heavy metals into the Solanum lycopersicum fruits and Daucus carota roots is characterized using transfer factors. Generally, the results indicate that Daucus carota was the most susceptible to uptake Cu and Mn, while Solanum lycopersicum would rather uptake Cd and Zn. The estimated non-carcinogenic risk, based on the human health risk indices, indicates that the studied vegetables are safe for consumption with no impact on the human health. The results are lower than the critical value. Similarly, the carcinogenic risk indices results showed acceptable risks of cancer developing. It is important to assess and monitor the heavy metals levels in soil and in the vegetables intended to be consumed, in order to prevent contamination and potential negative effects on the environment and implicitly on the human health. The obtained data can be used in remediation techniques, as well as in implementing control measures of heavy metal contamination in soil and vegetables.

The application of landiolol in the cardiovascular and intensive care / A landiolol alkalmazási lehetoségei a kardiológiai és intenzív terápiás ellátásban.

Összefoglaló. A landiolol intravénásan alkalmazandó, kifejezetten cardioselectiv, gyors hatású és rövid felezési ideju béta-1-receptor-blokkoló, mely elsosorban negatív chronotrop és inotrop hatással bír, vérnyomáscsökkento hatása elhanyagolható. Foleg hemodinamikailag instabil állapotú, supraventricularis ritmuszavarban szenvedo betegek kamrafrekvenciájának csökkentésére használható. Nagy esetszámú, randomizált vizsgálatok igazolták hatékonyságát szívmutétek után jelentkezo pitvarfibrilláció megelozésében, valamint súlyos akut szívelégtelenségben és szívmutétek posztoperatív szakában jelentkezo pitvari tachyarrhythmiák kezelésében. Ezek mellett kisebb vizsgálatok alapján a használata biztonságosnak tunik akut myocardialis infarctusban, hatékony szeptikus állapotú, pitvarfibrillációban szenvedo betegek kamrafrekvencia- és ritmuskontrolljára, valamint nem cardialis mutétek esetén a pitvarfibrilláció prevenciójára és kezelésére. Sikerrel alkalmazható elektromos vihar esetén is, és jól használható angiográfiás coronaria-CT-vizsgálat elott az optimális szívfrekvencia elérésére. A gyógyszer 2016 óta Európában, 2018 óta Magyarországon is elérheto. Orv Hetil. 2022; 163(2): 53-62. Summary. Landiolol is an intravenous, selective beta-1-receptor blocking agent with rapid onset of action and ultra-short half-life that has a predominant negative chronotropic and only mild negative inotropic effect without significant reduction of blood pressure. Landiolol is indicated to control the ventricular heart rate predominantly in patients with hemodynamic instability due to supraventricular tachyarrhythmia. Large randomized controlled trials have proven the efficacy of landiolol in the prevention of atrial fibrillation and atrial tachyarrhythmias in severe acute heart failure or post-cardiac surgery. Based on lower case-number studies, the administration of landiolol has been proven to be efficient and safe in rhythm and rate control in atrial fibrillation complicating acute myocardial infarction, sepsis, and in the prevention of atrial fibrillation in non-cardiac surgery. Landiolol may be used in electrical storm, and even during coronary CT-angiography to achieve an optimal heart rate for imaging. The drug is available in Europe since 2016 and in Hungary since 2018. Orv Hetil. 2022; 163(2): 53-62.