Role of carotid duplex in the assessment of carotid artery restenosis after endarterectomy or stenting.

Introduction: Redo carotid endarterectomy (CEA) and carotid stenting (CAS) are often performed when there is evidence of post-procedural restenosis. The incidence of restenosis after carotid reconstruction is not negligible, ranging from 5 to 33%. The diagnosis of significant internal carotid artery (ICA) restenosis is usually based on duplex ultrasound (US) criteria, mostly on peak-systolic flow velocity (PSV). However, there have been no generally accepted duplex US criteria for carotid restenosis after CAS or CEA. Methods: In this systematic review, the PubMed/ Medline and Scopus databases were screened to find trials that reported duplex US criteria for significant restenosis after CEA and/or CAS. Only those reports were analyzed in which the restenoses were also assessed by CT/MR or digital subtraction angiography as comparators for duplex US. Results: Fourteen studies met the predetermined search criteria and were included in this review. In most studies, PSV thresholds for significant in-stent ICA restenosis after CAS were higher than those for significant stenosis in non-procedurally treated (native) ICA. Many fewer studies investigated the US criteria for ICA restenosis after CEA. Despite the heterogeneous data, there is a consensus to use higher flow velocity thresholds for assessment of stenosis in stented ICA than in native ICA; however, there have been insufficient data about the flow velocity criteria for significant restenosis after CEA. Although the flow velocity thresholds for restenosis after CAS and CEA seem to be different, the large studies used the same duplex criteria to define restenosis after the two procedures. Moreover, different studies used different flow velocity thresholds to define ICA restenosis, leading to variable restenosis rates. Discussion: We conclude that (1) further examinations are warranted to determine appropriate duplex US criteria for restenosis after CAS and CEA, (2) single duplex US parameter cannot be used to reliably determine the degree of ICA restenosis, (3) inappropriate US criteria used in large studies may have led to false restenosis rates, and (4) studies are required to determine if there is a benefit from redo carotid artery procedure, such as redo-CEA or redo-CAS, starting with prospective risk stratification studies using current best practice non-invasive care alone.

Comparative analysis of three decades' experience in the management of pregnant women with epilepsy: a real-life scenario.

Introduction: People with epilepsy have to face many challenges, including regular follow-ups, the need to take antiseizure medications (ASMs), and the fear of seizures. Pregnant women with epilepsy (PWWE) are a special group with even more challenges because they are responsible for the fetus. We aimed to evaluate the change in the frequency of pregnancies over the years and the possible role of newer types of ASMs concerning this change, the shift in medication use over three decades, and their possible impact on the outcome of the observed pregnancies. Methods: Data were retrieved from the prospective Epilepsy Database of the Outpatient Clinic at our tertiary center between 1 January 1992 and 31 December 2020. Groups were formed for comparison in time and depending on whether regular care consultation was our task. Statistical analysis was carried out using Microsoft Office Excel 2021. Basic statistics and categorical variables were assessed using Pearson's χ2 test with Yates' correction. Differences were considered significant if the p-value was <0.05. The odds ratio and 95% confidence intervals were calculated wherever needed. Results: Altogether, 181 pregnancies were studied, mostly after 2002. The regular follow-up group consisted of 101 patients, with 44.5% presenting in the first trimester. The majority of seizures were either generalized or focal to bilateral tonic-clonic seizure types (85.6%). Pregnancies ended in live births in 91.7%, which gradually improved over time, while spontaneous abortion did not differ significantly in the time interval groups. Mostly, monotherapy was provided. PWWEs had higher chances for seizure freedom in the regular-care group I: OR = 2.9 (2.15-3.65) p < 0.0001. A shift toward newer-type ASMs was found as time passed. Levetiracetam and lamotrigine were more commonly used in the regular care group I than by those patients who were sent to consultation only and not treated at our center [OR = 3.18 (2.49-3.87)] p < 0.0001. Conclusion: This is the first study in our region to evaluate experience in the treatment and outcome of PWWE. Having received reliable care and safer ASMs, the number of pregnancies among PWWEs grew. Data suggested that specialized centers' care offered cooperation with obstetricians is important. Moreover, professional care can also enable PWWEs to have uneventful pregnancies.

[Cervical artery dissection - retrospective analysis of 19 cases]. / A nyaki ütoerek dissectiója ­ 19 eset retrospektív elemzése.

Cervical artery dissection is a common cause of stroke in young adults. It might occur shortly after a forceful neck trauma or a minor injury. However, spontaneous dissection is also common, which is associated with genetic, anatomical or environmental risk factors. Cervical artery dissection can produce a broad spectrum of clinical presentation varying from local symptoms to focal neurological deficits determined by the arterial territory involved. Early recognition is important since immediate initiation of treatment can significantly improve patient outcomes. While clinical features may raise suspicion for dissection, the diagnosis has to be confirmed by neuroimaging findings. The purpose of this paper is to give an overview on cervical (carotid and vertebral) artery dissections while presenting 19 cases. During three years, we evaluated the clinical features, risk factors, diagnostic and therapeutic procedures of these patients admitted with extracranial artery dissection. The prognosis of the disease can vary, 42% of our patients became asymptomatic. Orv Hetil. 2019; 160(22): 861-868.

The Relationship between Body Fat Percentage and Some Anthropometric and Physical Fitness Characteristics in Pre- and Peripubertal Boys.

The main aim of this study was to compare anthropometric and physical fitness indicators of boys of the same chronical age but with different fat percentages. Subjects were Hungarian boys aged 9⁻13 years (N = 6919). Anthropometry was measured according the guidelines of the International Biological Program. Relative body fat was estimated by Drinkwater⁻Ross's method (1980); Conrad's growth type of physique was also estimated (1963). Physical fitness was tested with 30 m dash (s), standing long jump (cm), fistball throw (m), and 1200 m run (s). Subjects of each cohort were grouped into seven subgroups with fat percentage ranges of 4%. Differences between subgroups were tested by one-way ANOVA. In the case of a significant F-test, Tukey's post-hoc tests were used. The level of effective random error was set at 5% in all significance tests (p < 0.05). Except for the three groups with low fat percentages, values of body weight, stature, body mass index, and plastic and metric indexes were significantly higher; results of 30 m, 1200 m running, and standing long jump were worse in all groups with higher fat percentages. An interesting finding of the current study is that body fat percentage also influenced the physical fitness of non-overweight and obese children as well when using merely the 4% ranges in grouping by fatness. The lower the fat the better the physical fitness was in this sample of pre- and peripubertal boys.

Retinoid machinery in distinct neural stem cell populations with different retinoid responsiveness.

Retinoic acid (RA) is present at sites of neurogenesis in both the embryonic and adult brain. While it is widely accepted that RA signaling is involved in the regulation of neural stem cell differentiation, little is known about vitamin A utilization and biosynthesis of active retinoids in the neurogenic niches, or about the details of retinoid metabolism in neural stem cells and differentiating progenies. Here we provide data on retinoid responsiveness and RA production of distinct neural stem cell/neural progenitor populations. In addition, we demonstrate differentiation-related changes in the expression of genes encoding proteins of the retinoid machinery, including components responsible for uptake (Stra6) and storage (Lrat) of vitamin A, transport of retinoids (Rbp4, CrbpI, CrabpI-II), synthesis (Rdh10, Raldh1-4), degradation of RA (Cyp26a1-c1) and RA signaling (Rarα,ß,γ, Rxrα,ß,γ). We show that both early embryonic neuroectodermal (NE-4C) stem cells and late embryonic or adult derived radial glia like progenitors (RGl cells) are capable to produce bioactive retinoids but respond differently to retinoid signals. However, while neuronal differentiation of RGl cells can not be induced by RA, neuron formation by NE-4C cells is initiated by both RA and RA-precursors (retinol or retinyl acetate). The data indicate that endogenous RA production, at least in some neural stem cell populations, may result in autocrine regulation of neuronal differentiation.

Body mass and body fat in Hungarian schoolboys: differences between 1980-2005.

The prevalence of juvenile excess weight keeps growing in the more developed world (WHO, 1998). The aim of the study was to compare the prevalence of overweight and obesity in Hungarian schoolboys in 1980 and 2005.Two independent representative data collections were performed in volunteer boys aged between 6.51 and 18.50 years in the same 90 settlements of the country in 1980 (n=13,061) and 2005 (n=13,060). Height, body mass, and five skinfolds were measured by the same investigators in both instances. Overweight and obesity were estimated by using BMI (Cole et al., 2000), respectively skinfold thicknesses (Parízková, 1961).The pair-wise differences between height means were consistently significant in the 12 age groups studied. Body mass differences were not exactly proportionate with height. The boys of 2005 had significantly more relative body fat than those of 1980. The prevalence of overweight and obesity was remarkably higher in 2005.Taller height and a part of the heavier body mass in 2005 was attributed to a positive secular growth trend. The increases in BMI and fat content are negative consequences of a markedly changed lifestyle associated with inactivity and dietary habits. Because of its public health importance the trends of childhood obesity should be closely monitored.

Longitudinal differences and trends in body fat and running endurance in Hungarian primary schoolboys.

Long-range repeated-measure sample differences in body dimensions, body composition and physical performance are considered accurately describing the changes in a population's life standards and lifestyle. The aim of our study was to analyse such changes in longitudinal studies repeated after a 15-year interval. Two six-monthly repeated data collections (1987-1991 and 2002-2006, respectively; n = 136 and n = 147, respectively) were carried out in non-athletic boys aged between 6.51 and 11.00 decimal years in the same schools of the city of Gyor, Hungary. The means of height, body mass, body mass index (BMI), body fat percentage and running distance in the Cooper-Test were compared as well as the slopes of the changes. The children of the second series of studies were significantly taller and heavier, had more depot fat and showed poorer cardio-respiratory endurance than their peers 15 years before. The increases with age in weight, BMI and depot fat were steeper in the second series. The significant differences that developed in body weight, fat content and physical performance between the two samples during these 15 years are regarded as an indirect evidence for how severely the average physical condition had declined, respectively how the health risks of the schoolchildren of the respective middle socio-economic strata had increased. Recent adverse changes in lifestyle are too strong, so that the presently obligatory physical education classes at school (four times in 10 days, 45 minutes per class) cannot be expected to provide any solution. Daily 90 minutes blocks of exercise only may promise some improvement.