Teleradiology-based stroke network in Western and Southern Transdanubia in Hungary / Stroke-ellátást támogató teleradiológiai hálózat a Nyugat- és Dél-Dunántúlon.

Összefoglaló. Bevezetés: A stroke kezelésének lehetoségei az utóbbi években jelentosen megváltoztak: a thrombolysis után bevezetésre került a mechanikus thrombectomia, és a terápiás idoablak is jelentosen kitágult az utóbbi évek nagy multicentrikus tanulmányai alapján. Ezek a lehetoségek új igényeket fogalmaztak meg a képalkotó diagnosztikával szemben: az ischaemia okozta morfológiai elváltozások mellett az artériás és a kollaterális rendszer állapotát, valamint bizonyos esetekben az agy szöveti perfúzióját is szükséges meghatározni. Ezeket a komplex kiértékelési feladatokat ma már mesterségesintelligencia-algoritmusok támogathatják, melyek a kiértékelést pár perc alatt elvégezve segítenek a terápiás döntés kialakításában. Célkituzés: A Dél- és a Nyugat-dunántúli régióban hat intézmény részvételével egy dedikált stroke teleradiológiai hálózat kialakítása. Módszer: A stroke-CT-kiértékelo szoftver és a képkommunikáció integrációja, a vizsgálati protokollok technikai paramétereinek egységesítése, a kiértékelési eredmények teleradiológiai megjelenítése valósult meg a hálózat kialakítása során. Eredmények: A hálózat egységesítette nemcsak a stroke-CT-protokollok beállításait, de beutalási és értékelési szempontjait is. A stroke-CT-kiértékelések és a mechanikus thrombectomiák száma is emelkedett az elmúlt egy évben. Következtetés: A dedikált teleradiológiai stroke-hálózat segítségével optimalizálni kívánjuk a régió stroke-ellátását: egyrészt lehetoleg ne maradjanak ellátatlanul a thrombectomiából valószínuleg profitáló betegek, másrészt ne terheljük az ellátórendszert olyan esetekkel, melyekrol a teljes dokumentáció ismeretében derül ki, hogy nem javasolt a beavatkozás. Orv Hetil. 2021; 162(17): 668-675. INTRODUCTION: The possibilities of cerebral stroke management have changed substantially during the last few years. Following a few multicentric studies, mechanical thrombectomy became an established method besides thrombolysis. In addition, the therapeutic window for both methods is much wider now than before. These changes described above demanded more information of CT morphological changes due to ischemia, but the condition and functionality of the arterial and collateral system, and occasionally tissue perfusion performance should also be characterized. Recently, evaluation of different computer tomographic (CT) measurements can be done using artificial intelligence based methods, which perform data analysis in a few minutes. OBJECTIVE: To establish a dedicated stroke teleradiology network with artificial intelligence based image analysis in Western and Southern Transdanubia in Hungary that involves six partner institutes. METHOD: Integration of automated image analysis with teleradiology software was established, and the technical parameters of examination protocols were unified. Results of stroke CT image analysis became accessible through the teleradiology network. RESULTS: The daily use of integrated central image analysis and image communication had a positive impact on referrals and therapeutic evaluation of stroke cases. The number of image processing and mechanical thrombectomy increased during the last year. CONCLUSION: With the help of the dedicated teleradiology stroke network, we want to optimize the stroke care in the region: on the one hand, patients who are likely to benefit from thrombectomy should not be left unattended, on the other, the health care system should not be burdened with cases, when intervention is not recommended having the complete clinical data accessed. Orv Hetil. 2021; 162(17): 668-675.

Serum prolactin as a biomarker for the study of intracerebral dopamine effect in adult patients with phenylketonuria: a cross-sectional monocentric study.

BACKGROUND: It has been previously postulated that high phenylalanine (Phe) might disturb intracerebral dopamine production, which is the main regulator of prolactin secretion in the pituitary gland. Previously, various associations between Phe and hyperprolactinemia were revealed in studies performed in phenylketonuria (PKU) children and adolescents. The aim of the present study was to clarify whether any relation between serum phenylalanine and prolactin levels can be found in adult PKU patients. PATIENTS AND METHODS: We conducted a cross-sectional, monocentric study including 158 adult patients (male n = 68, female n = 90) with PKU. All patients were diagnosed during newborn screening and were treated since birth. Serum Phe, tyrosine (Tyr), prolactin (PRL), and thyroid-stimulating hormone (TSH) levels were measured, and Phe/Tyr ratio was calculated. Males and females were analyzed separately because the serum prolactin level is gender-dependent. RESULTS: No significant correlations were found between serum phenylalanine, tyrosine, or the Phe/Tyr ratio and serum prolactin level either in the male or in the female group. CONCLUSIONS: In treated adult PKU patients, the serum prolactin level may not be significantly influenced by Phe or Tyr serum levels.

Evolution and predictors of morphological and functional arterial changes in the course of type 1 diabetes mellitus.

BACKGROUND: Diabetes mellitus results in accelerated atherosclerosis. We evaluated preclinical, morphological and functional vascular changes in type 1 diabetes mellitus. METHODS: Diameter, intima-media thickness, intima-media cross-section area, and elasticity features (compliance, distensibility coefficient, circumferential strain, stiffness index, incremental elastic modulus) of the common carotid arteries and carotid-femoral pulse wave velocity were studied in 42 patients with type 1 diabetes mellitus without macroangiopathy, and 41 control subjects matched for sex, age and body mass index using an ultrasonographic vessel wall-movement tracking system and applanation tonometry. RESULTS: Significantly larger intima-media thickness (523 ± 55 versus 567 ± 89 µm, p < 0.01), intima-media cross-section area (11.60 ± 1.81 versus 13.08 ± 3.02 mm(2) , p < 0.01), SI (5.58 ± 1.24 versus 7.08 ± 2.69, p < 0.01) and pulse wave velocity (6.00 ± 0.82 versus 6.61 ± 1.56 m/s, p < 0.05) were found in type 1 diabetes mellitus patients compared to controls. When type 1 diabetes mellitus patients with short and long disease duration (≤ or > 10 years) were compared, diameter (6450 ± 433 versus 6847 ± 750 µm, p < 0.05), intima-media cross-section area (11.97 ± 1.98 versus 14.01 ± 3.43 mm, p < 0.05) and pulse wave velocity (5.90 ± 0.92 versus 7.20 ± 1.74 m/s, p < 0.01) differed significantly. When multivariate analyses were restricted to type 1 diabetes mellitus patients, age was an independent predictor of stiffness index and pulse wave velocity, the duration of diabetes mellitus of intima-media cross-section area and pulse wave velocity, systolic blood pressure of diameter and pulse wave velocity, and low-density lipoprotein-cholesterol of intima-media thickness, intima-media cross-section area and stiffness index. CONCLUSIONS: There are differences in the time course of evolution and in predictors of morphological and functional changes in arteries in type 1 diabetes mellitus.

Drugs, gene transfer, signaling factors: a bench to bedside approach to myocardial stem cell therapy.

In the past few years, the dogma that the heart is a terminally differentiated organ has been challenged. Evidence from preclinical investigations emerged that there are cells, even in the heart itself, that may be able to restore impaired cardiac function after myocardial infarction. Although the exact mechanisms by which the infarcted heart can be repaired by stem cells are not yet fully defined, there is a new optimism among cardiologists that this treatment will prove successful in addressing the cause of heart failure after myocardial infarction-myocyte loss. Despite the promising preliminary data of human myocardial stem cell trials, scientists have also focused on the possibility of enhancing the underlying mechanisms of stem cell repair to gain healthier myocardial tissue. Attempts to induce neo-angiogenesis by transfecting stem cells with signaling factors (such as VEGF), to raise the number of endothelial progenitor cells with medical treatments (such as statins), to transfect stem cells with heat shock protein 70 (as a cardioprotective agent against ischemia) and to enhance the healing process after myocardial infarction with the use of various forms of stimulating factors (G-CSF, SCF, GM-CSF) have been made with notable results. In this article, we summarize the evidence from preclinical and clinical myocardial stem cell studies that have addressed the possibility of enhancing the regenerative capacity of cells used after myocardial infarction.

[Endoscopy in pregnancy]. / Endoszkópos vizsgálatok terhességben.

Assessing the need of endoscopy and performing the examination is a difficult task which requires an experienced investigator. Though it is prudent to postpone the investigation to the third trimester or rather to the postpartum period; in certain clinical situations like upper gastrointestinal bleeding or biliary pancreatitis it is not possible; endoscopic intervention has to be performed in these cases just like in non-pregnant patients. There is a paucity of data in medical literature to rely on and the retrospective nature of these data makes it even more problematic. There is not more than one such a case per year per endoscopist in Hungary which requires decision in these situations; we have to think of the factors endangering the fetus but we have to keep in mind the factors that ensure the well-being of the mother by all means.

Remote ischaemic postconditioning protects the heart during acute myocardial infarction in pigs.

BACKGROUND: Ischaemic preconditioning results in a reduction in ischaemic-reperfusion injury to the heart. This beneficial effect is seen both with direct local preconditioning of the myocardium and with remote preconditioning of easily accessible distant non-vital limb tissue. Ischaemic postconditioning with a comparable sequence of brief periods of local ischaemia, when applied immediately after the ischaemic insult, confers benefits similar to preconditioning. OBJECTIVE: To test the hypothesis that limb ischaemia induces remote postconditioning and hence reduces experimental myocardial infarct size in a validated swine model of acute myocardial infarction. METHODS: Acute myocardial infarction was induced in 24 pigs with 90 min balloon inflations of the left anterior descending coronary artery. Remote ischaemic postconditioning was induced in 12 of the pigs by four 5 min cycles of blood pressure cuff inflation applied to the lower limb immediately after the balloon deflation. Infarct size was assessed by measuring 72 h creatinine kinase release, MRI scan and immunohistochemical analysis. RESULTS: Area under the curve of creatinine kinase release was significantly reduced in the postconditioning group compared with the control group with a 26% reduction in the infarct size (p<0.05). This was confirmed by MRI scanning and immunohistochemical analysis that revealed a 22% (p<0.05) and a 47.52% (p<0.01) relative reduction in the infarct size, respectively. CONCLUSION: Remote ischaemic postconditioning is a simple technique to reduce infarct size without the hazards and logistics of multiple coronary artery balloon inflations. This type of conditioning promises clear clinical potential.