Mechanical Performance of Extensive Restorations Made with Short Fiber-Reinforced Composites without Coverage: A Systematic Review of In Vitro Studies

In recent years, composite resin materials have been the most frequently used materials for direct restorations of posterior teeth. These materials have some clinically relevant limitations due to their lack of fracture toughness, especially when used in larger cavities with high volume factors or when utilized as direct or indirect overlays or crown restorations. Recently, short-fiber-reinforced composite materials have been used in bi-structure restorations as a dentine substituting material due to their superior mechanical properties; however, there is no scientific consensus as to whether they can be used as full restorations. The aim of our review was to examine the available literature and gather scientific evidence on this matter. Two independent authors performed a thorough literature search using PubMed and ScienceDirect up until December 2023. This study followed the PRISMA guidelines, and the risk of bias was assessed using the QUIN tool. The authors selected in vitro studies that used short-fiber-reinforced composite materials as complete restorations, with a conventional composite material as a comparison group. Out of 2079 potentially relevant articles, 16 met our inclusion criteria. All of the included studies reported that the usage of short-fiber-reinforced composites improved the restoration's load-bearing capacity. Fifteen of the included publications examined the fracture pattern, and thirteen of them reported a more favorable fracture outcome for the short-fiber-reinforced group. Only one article reported a more favorable fracture pattern for the control group; however, the difference between groups was not significant. Within the limitations of this review, the evidence suggests that short-fiber-reinforced composites can be used effectively as complete restorations to reinforce structurally compromised teeth.

Robots for surgeons? Surgeons for robots? Exploring the acceptance of robotic surgery in the light of attitudes and trust in robots

BACKGROUND

Over the last century, technological progress has been tremendous, and technological advancement is reflected in the development of medicine. This research assessed attitudes towards surgical robots and identified correlations with willingness to participate in robotic surgery based on factors influencing trust in automated systems.

METHOD

Using data from a survey, which included the Multi-dimensional Robot Attitude Scale (MdRAS) and a questionnaire consisting of attitude statements regarding the factors affecting trust in automated systems, the experiment assessed the attitudes of healthcare workers and potential patients towards surgery robots, and attempted to find a correlation between these attitudes, age, and gender.

RESULTS AND CONCLUSION

Statistical evaluation of the responses (N = 197) showed that positive attitude towards surgical robots showed a high correlation with the willingness to participate in robotic surgery and gave the strongest correlations with the MdRAS utility and negative attitude towards robots subscales. For the assessment of willingness, the MdRAS subscales alone did not provide a strong enough correlation. All factors examined showed a significant correlation with participation. Having faith in the surgery robot, the propensity to trust technology, the designer's reputation, the ease of work that a surgical robot provides, positive experience with robots, and believing the surgeon is competent at operating the machine seemed to have been the most important positive correlations, while fear of errors gave the highest negative correlation. The healthcare workers and potential patients showed significant differences in the subscales of the questionnaire perceived risk and knowledge but no significant difference in the characteristics of the surgical robot. There was no difference in willingness to participate between the samples. Age did not show a significant correlation with the score achieved and willingness in any of the samples. Significant differences were found between male and female respondents, with men having more positive attitudes and being more likely to participate in surgeries using surgery robots than women. As a result, the research potentially sheds light on the factors that need to be considered when building trust in robotic surgery.

Novel Insights into the Inheritance of Gibberella Ear Rot (GER), Deoxynivalenol (DON) Accumulation, and DON Production

Gibberella ear rot (GER) is an important fungal ear pathogen of maize that causes ear rot and toxin contamination. Most previous works have only dealt with the visual symptoms, but not with the toxins of GER. As food and feed safety rankings depend on toxin contamination, including deoxynivalenol (DON), without toxins, nothing can be said about the risks involved in food and feed quality. Therefore, three susceptible, three medium-susceptible, and three medium-resistant mother lines were crossed with three testers with differing degrees of resistance and tested between 2017–2020. Two plot replicates and two fungal strains were used separately. The highest heterosis was found at the GER% with a 13% increase across 27 hybrids, including 7 hybrids showing negative heterosis (a higher hybrid performance above the parental mean), with a variance ranging between 63.5 and −55.4. For DON, the mean heterosis was negative at −35%, and only 10 of the 27 hybrids showed a positive heterosis. The mean heterosis for DON contamination, at 1% GER, was again negative (−19.6%, varying between 85% and 224%). Only 17 hybrids showed heterosis, while that of the other 17 was rated higher than the parental mean. A positive significant correlation was found only for GER% and DON; the other factors were not significant. Seven hybrids were identified with positive (2) or negative (5) heterosis for all traits, while the rest varied. For DON and GER, only 13 provided identical (positive or negative) heteroses. The majority of the hybrids appeared to diverge in the regulation of the three traits. The stability of GER and DON (variance across eight data sets) did not agree—only half of the genotypes responded similarly for the two traits. The genetic background for this trait is unknown, and there was no general agreement between traits. Thus, without toxin analyses, the evaluation of food safety is not possible. The variety in degrees of resistance to toxigenic fungi and resistance to toxin accumulation is an inevitable factor.

Physiological measurements in social acceptance of self driving technologies

The goal of the present study is to examine the cognitive/affective physiological correlates of passenger travel experience in autonomously driven transportation systems. We investigated the social acceptance and cognitive aspects of self-driving technology by measuring physiological responses in real-world experimental settings using eye-tracking and EEG measures simultaneously on 38 volunteers. A typical test run included human-driven (Human) and Autonomous conditions in the same vehicle, in a safe environment. In the spectrum analysis of the eye-tracking data we found significant differences in the complex patterns of eye movements: the structure of movements of different magnitudes were less variable in the Autonomous drive condition. EEG data revealed less positive affectivity in the Autonomous condition compared to the human-driven condition while arousal did not differ between the two conditions. These preliminary findings reinforced our initial hypothesis that passenger experience in human and machine navigated conditions entail different physiological and psychological correlates, and those differences are accessible using state of the art in-world measurements. These useful dimensions of passenger experience may serve as a source of information both for the improvement and design of self-navigating technology and for market-related concerns.

Digitális technika alkalmazása parodontalis betegségek diagnózisában és a sebészi megoldás tervezésében

A fogágybetegség súlyosságának megítélésében elsődleges szerepet játszanak a képalkotó eljárások, ugyanakkor a röntgenfelvételek sokszor elégtelennek bizonyulnak a reális szituáció feltárásában. Az egyik nehezen eldönthető kérdés, hogy milyen a fogak körüli defektusok pontos kiterjedése, mert ez alapvetően meghatározza a terápia választását (reszektív, illetve regeneratív sebészi terápia) vagy azt, hogy az adott defektus formája milyen bioanyag alkalmazását teszi szükségessé. A CBCT- (cone-beam computed tomography) felvételek nagy pontossággal mutatják meg a laesio jellegét. A háromdimenziós (3D) nézet lehetőséget ad arra, hogy ne csupán a síkoknak megfelelő szeleteken vizsgálhassuk a szituációt, ugyanakkor ennek minősége, használhatósága sokszor hagy maga után kívánnivalót. Egy lehetőség a jobb megjelenítésre és elemezhetőségre a CBCT-felvétel segítségével, szegmentációval létrehozott 3D modell. Itt gyakorlatilag a szegmentált elemek (alveolaris csont, fogak, defektus és egyéb anatómiai képletek stb.) valós 3D objektumként jelennek meg, és méretük, formájuk, egymáshoz viszonyított helyzetük lényegesen jobban vizsgálható, mint az előzőek esetében. Ezáltal tehát meglehetősen jó kiindulási képet kapunk a defektusról, a meglévő csontos falak számáról, és biztonságosabban dönthetünk a terápia milyenségéről. Célunk ezen metódus (szegmentálás) parodontalis sebészetben betöltött szerepének egy eseten keresztüli bemutatása. A módszer jó ideje elterjedt és használt az általános orvoslásban; fejlődése és térnyerése töretlen. Orv Hetil. 2022; 163(25): 1005–1011.

The adaptation of The parental reflective functioning questionnaire adolescent version to the Hungarian language and presentation of its psychometric characteristics

Introduction

Parental reflective function is the ability of a parent to attribute mental states to their child and to themselves. The Parental Reflective Functioning Questionnaire is widely used for the measurement of this construct, the adolescent version of which can be used by parents of children aged 12-18.

Objectives

The aim of our research was to adapt the adolescent version of The Parental Reflective Functioning Questionnaire to the Hungarian language.

Methods

In our study 240 mothers completed the adolescent version of The Parental Reflective Functioning Questionnaire (PRFQ-A), and the Reflective Function Questionnaire (RFQ).

Results

Confirmatory factor analysis did not confirm the original three-factor structure. The principal component analysis resulted in a two-factor structure. Factors corresponded to the original questionnaire’s certainty in mental states (Alpha = .81) and interest and curiosity subscales (Alpha = .70). When analyzing the relationship between parental reflective function and reflective function, the subscales of the parental reflective function questionnaire were examined with two types of median coding in addition to polar coding. During the first median coding, the frequency of scores in the middle of the scales reflected optimal mentalization, while the frequency of extreme values on the scales corresponded to less favorable reflective functioning. With the second median coding, hypermentalization and hypomentalization subscales were also created. The second median transcoding proved to be the most suitable for capturing the relationship between RFQ and PRFQ-A.

Conclusions

The questionnaire proved to be a reliable measure on the Hungarian sample and we recommend using the additional subscales.

Disclosure

No significant relationships.

Children living in institutional care: How can mentalization-based interventions improve their perspective-taking and conflict resolution skills?

Introduction

Trauma, stress, and attachment problems are negatively related to the development of mentalization. Children raised in institutional care are more exposed to these difficulties, therefore the development of population-specific interventions that aim to improve mentalization skills would be highly desirable.

Objectives

Our goal is to develop mentalization-based intervention programs for specific age groups (9-13 years, 14-18 years, and adult staff members of institutional care centers) - that support children’s and adolescents’ social functioning and conflict resolution skills.

Methods

The mentalization-based intervention targeting institutional care staff was launched first. Due to the pandemic, this intervention was executed online with two intervention (N = 17) and two passive control (N = 15) groups. Before and after the intervention, participants completed a demographic questionnaire, the Parenting Sense of Competence Scale, the Reflective Functioning Questionnaire, the Mini Oldenburg Burnout Inventory, The Strengths, and Difficulties Questionnaire, and the Ways of Coping Questionnaire.

Results

The intervention protocol and our results will be shown at the conference. There was no significant difference between the two intervention and two passive control groups in the demographic features. Mentalization uncertainty and burnout was positively related(rs(23) = .42, p = .034), while mentalization uncertainty and parental competence was negatively associated (rs(23) = - .41, p = .041).

Conclusions

The intervention program will be fine-tuned and optimized based on the results of the pilot study. In the next interventions, we plan to focus on the issues that the staff perceived as most difficult and to conduct interventions among the children.

Disclosure

No significant relationships.

The relationship between parental reflective functioning, attachment style, parental competence, and stress

Introduction

Previous studies indicated, that mentalization mediates the link between adult attachment and stress, however, this relationship was not tested before among non-clinical parents of children aged between 12 and 18 years.

Objectives

The aim of this study was to explore the relationship between parental reflective functioning, attachment style, perceived parental sense of competence, and stress among parents.

Methods

After providing written consent, 186 non-clinical mothers completed a questionnaire packet that included a demographic form, The Parental Reflective Functioning Questionnaire - Adolescent version, the Attachment Style Questionnaire, the Parental Sense of Competence Scale, and the Perceived Stress Scale. A moderated mediation analysis with parental sense of competence as a dependent variable, mother’s attachment style as an independent variable, certainty about mental states hypermentalization subscale as a mediator, and stress as a moderator was conducted.

Results

In the moderated mediation analysis, the direct effect of the attachment style on the parental sense of competence in the case of preoccupied attachment style was significant (p < .001). The interaction term of the hypermentalization subscale by perceived stress was also significant in the case of low level (w = -1.57, p < .001) and high level of perceived stress (w= 1.21, p = .049) among mothers with a preoccupied attachment style.

Conclusions

These findings suggest that the preoccupied attachment style is related to the parental sense of competence through certainty about mental states hypermentalization in case of low level and high level of perceived stress, so mentalization-based interventions are warranted.

Disclosure

No significant relationships.

The relationship between mothers’ attachment style, mindful parenting, and perception of the child

Introduction

Maternal attachment style plays a major role in the intergenerational transmission of psychopathology. Previous studies indicated that a secure attachment style is associated with higher levels of mindfulness and a higher quality of the parent-child relationship.

Objectives

The aim of this study was to explore the relationship between the mothers’ attachment style, mindful parenting, and perception of the child.

Methods

Data was collected from 144 non-clinical mothers, who have a child below the age of 3 years. Mothers completed self-report questionnaires including the following scales: a demographic questionnaire, Attachment Style Questionnaire (ASQ), Interpersonal Mindfulness in Parenting Scale (IMP), and the Mothers’ Object Relations Scale (MORS-SF). Mediation analyses with Mothers’ Object Relations Scale warmth and invasion subscales as dependent variables, mother’s attachment style as an independent variable and, mindful parenting as a mediator were conducted.

Results

In mediation analysis, the direct effects of the mothers’ attachment style on the perception of the child were not significant. However, indirect effects through mindful parenting were significant; higher levels of mindful parenting were associated with higher levels of MORS-SF warmth and lower levels of MORS-SF invasion.

Conclusions

These findings suggest that attachment styles are related to the perception of the child through mindful parenting. Mindfulness-based parenting training might be useful in case of attachment-related problems to improve the parent-child relationship.

Disclosure

No significant relationships.

Multimodal Assessment of the Pulse Rate Variability Analysis Module of a Photoplethysmography-Based Telemedicine System

Alterations of heart rate variability (HRV) are associated with various (patho)physiological conditions; therefore, HRV analysis has the potential to become a useful diagnostic module of wearable/telemedical devices to support remote cardiovascular/autonomic monitoring. Continuous pulse recordings obtained by photoplethysmography (PPG) can yield pulse rate variability (PRV) indices similar to HRV parameters; however, it is debated whether PRV/HRV parameters are interchangeable. In this study, we assessed the PRV analysis module of a digital arterial PPG-based telemedical system (SCN4ALL). We used Bland–Altman analysis to validate the SCN4ALL PRV algorithm to Kubios Premium software and to determine the agreements between PRV/HRV results calculated from 2-min long PPG and ECG captures recorded simultaneously in healthy individuals (n = 33) at rest and during the cold pressor test, and in diabetic patients (n = 12) at rest. We found an ideal agreement between SCN4ALL and Kubios outputs (bias < 2%). PRV and HRV parameters showed good agreements for interbeat intervals, SDNN, and RMSSD time-domain variables, for total spectral and low-frequency power (LF) frequency-domain variables, and for non-linear parameters in healthy subjects at rest and during cold pressor challenge. In diabetics, good agreements were observed for SDNN, LF, and SD2; and moderate agreement was observed for total power. In conclusion, the SCN4ALL PRV analysis module is a good alternative for HRV analysis for numerous conventional HRV parameters.

EGFR Alterations Influence the Cetuximab Treatment Response and c-MET Tyrosine-Kinase Inhibitor Sensitivity in Experimental Head and Neck Squamous Cell Carcinomas

Background: Anti-EGFR antibody therapy is still one of the clinical choices in head and neck squamous cell carcinoma (HNSCC) patients, but the emergence of cetuximab resistance questioned its effectiveness and reduced its applicability. Although several possible reasons of resistance against the antibody treatment and alternative therapeutic proposals have been described (EGFR alterations, activation of other signaling pathways), there is no method to predict the effectiveness of anti-EGFR antibody treatments and to suggest novel therapeutics. Our study investigated the effect of EGFR R521K alteration on efficiency of cetuximab therapy of HNSCC cell lines and tried to find alternative therapeutic approaches against the resistant cells.

Methods: After genetic characterization of HNSCC cells, we chose one wild type and one R521K+ cell line for in vitro proliferation and apoptosis tests, and in vivo animal models using different therapeutic agents.

Results: Although the cetuximab treatment affected EGFR signalization in both cells, it did not alter in vitro cell proliferation or apoptosis. In vivo cetuximab therapy was also ineffective on R521K harboring tumor xenografts, while blocked the tumor growth of EGFR-wild type xenografts. Interestingly, the cetuximab-resistant R521K tumors were successfully treated with c-MET tyrosine kinase inhibitor SU11274.

Conclusion: Our results suggest that HNSCC cell line expressing the R521K mutant form of EGFR does not respond well to cetuximab treatment in vitro or in vivo, but hopefully might be targeted by c-MET tyrosine kinase inhibitor treatment.

Integrated twin-screw wet granulation, continuous vibrational fluid drying and milling: A fully continuous powder to granule line

Highly homogeneous low-dose (50 μg) tablets were produced incorporating perfectly free-flowing granules prepared by a fully integrated Continuous Manufacturing (CM) line. The adopted CM equipment consisted of a Twin-Screw Wet Granulator (TSWG), a Continuous Fluid Bed Dryer (CFBD) and a Continuous Sieving (CS) unit. Throughout the experiments a pre-blend of lactose-monohydrate and corn starch was gravimetrically dosed with 1 kg/h into the TSWG, where they were successfully granulated with the drug containing water-based PVPK30 solution. The wet mass was subsequently dried in the CFBD on a vibratory conveyor belt and finally sieved in the milling unit. Granule production efficiency was maximized by determining the minimal Liquid-to-Solid (L/S) ratio (0.11). Design of Experiments (DoE) were carried out in order to evaluate the influence of the drying process parameters of the CFBD on the Loss-on-Drying (LOD) results. The manufactured granules were compressed into tablets by an industrial tablet rotary press with excellent API homogeneity (RSD < 3%). Significant scale-up was realized with the CM line by increasing the throughput rate to 10 kg/h. The manufactured granules yielded very similar results to the previous small-scale granulation runs. API homogeneity was demonstrated (RSD < 2%) with Blend Uniformity Analysis (BUA). The efficiency of TSWG granulation was compared to High-Shear Granulation (HSG) with the same L/S ratio. The final results have demonstrated that both the liquid distribution and more importantly API homogeneity was better in case of the TSWG granulation (RSD 1.3% vs. 4.5%).

Fracture behavior of root-amputated teeth at different amount of periodontal support - a preliminary in vitro study

Background

The purpose of this study was to evaluate the effect of the amount of periodontal support on the fracture resistance of root-amputated maxillary molar teeth restored with either direct class. I. restorations or class II. mesio-occluso-distal (MOD) indirect overlay restorations with cuspal coverage.

Methods

Sixty sound maxillary first molars were collected and randomly divided into four groups. In Groups 1 and 2, MOD cavities were prepared and all cusps were reduced by 2 mm, whereas in Group 3 and 4, only a conservative Class I. cavity was prepared. Subsequently, root canal treatment was performed and the mesio-buccal roots were amputated. Groups 1 and 2 were restored with indirect composite overlay, while Groups 3 and 4 received direct composite fillings. After restoration, teeth were embedded as follows: Groups 1 and 3: normal bone level, Groups 2 and 4: furcation involvement. The specimens were submitted to static fracture resistance testing. Fracture thresholds and fracture patterns were measured and evaluated.

Results

Group 1 had the highest fracture resistance (2311,6 N) among the restored groups and showed statistically significant difference compared to Group 2 (p = 0.038) and Group 4 (p = 0.011). There was no statistically significant difference in terms of fracture resistance between the rest of the groups. In terms of the fracture patterns, Group 3 was characterized by the highest percentage (60%) of mostly favorable fractures, while the rest of the groups showed predominantly unfavorable ones.

Conclusions

The amount of periodontal support seems to influence the fracture resistance of root-amputated and restored maxillary molars.

[Mucosal melanoma primary and metastatic cases with urogenital localization in our department]

INTRODUCTION

Both primary and metastatic cases of mucosal melanoma in urogenital localization are rare tumors. Only 4-5% of all primary melanomas do not arise from the skin. Extracutaneous melanomas have a complex clinical presentation, but these aggressive tumors have a poor prognosis.

MATERIALS AND METHOD

In our department, we found 7 patients with malignant melanoma of the genitourinary tract in the past few years. The 7 cases were: primary amelanotic melanoma of the female urethra, a primary melanoma of the bladder, two primary melanomas of the penis, a metastatic melanoma of the urethra and another to the testis and a metastatic melanoma of the bladder with melanuria. We retrospectively analyzed the available data to describe the presentation, management, and clinical outcome of the patients.

RESULTS

In the three inoperative cases, palliative, urologic surgical procedures and systemic antitumor therapy were performed. Two of the four primary urogenital tumors were localized to the penis. In one case, local recurrence developed after surgical treatment, but with a radical, repeated surgery, the patient has been asymptomatic for a year and a half. In the other, neglected case, the penis melanoma spread through the urethra and the inguinal lymph nodes two years after radical surgery and inguinal block dissection. In the female primary urethral melanoma case, the first histological study reported a primary mesenchymal tumor, and the recurrent tumor that occurred one and a half years later showed melanoma diagnosis. Radical surgery performed because of urethral involvement resulted in a 5-year asymptomatic state, followed by local recurrence and distant metastasis. In the fourth case of a primary bladder melanoma, the rapid progression of the disease and the BRAF positivity of the tumor suggested that not the firstly diagnosed bladder melanoma was the primary tumor.

CONCLUSION

The occurrence of urinary tract melanoma is very rare and its discovery happens often in a disseminated state, so the expected prognosis of the cases is also poor. The most important factors for increasing therapeutic efficacy are early diagnosis and radical surgical intervention. Tumors appearing in different localizations require different urological surgical approaches. The literature recommendations for treatment are not uniform. Their prognosis is worse compared to the cutaneous melanoma, which may be due to clinical and pathological diagnostic difficulties. The latest targeted and immunotherapeutic agents can significantly improve the survival of metastatic patients. Orv Hetil. 2019; 160(10): 378-385.

A Novel, Domino Synthesis of Tricyclic Benzimidazole Derivatives Using Continuous Flow

A novel method for synthesis of tricyclic benzimidazole derivatives by using continuous flow reactor is reported. Disadvantages of the well-known batch methods have been avoided utilizing the flow chemistry technology. Beside the one pot reductive cyclization using H-Cube Pro®, the dehydration step was also optimized producing the desired lactam compounds. Then the acylation was optimized under microwave conditions and that reaction was also integrated into the flow system using an Asia heater module. This acylation dramatically reduced the reaction time under continuous-flow conditions, with a residence time of 30 min.

Next-generation sequencing identifies novel mitochondrial variants in pituitary adenomas

PURPOSE

Disrupted mitochondrial functions and genetic variants of mitochondrial DNA (mtDNA) have been observed in different human neoplasms. Next-generation sequencing (NGS) can be used to detect even low heteroplasmy-level mtDNA variants. We aimed to investigate the mitochondrial genome in pituitary adenomas by NGS.

METHODS

We analysed 11 growth hormone producing and 33 non-functioning [22 gonadotroph and 11 hormone immunonegative] pituitary adenomas using VariantPro™ Mitochondrion Panel on Illumina MiSeq instrument. Revised Cambridge Reference Sequence (rCRS) of the mtDNA was used as reference. Heteroplasmy was determined using a 3% cutoff.

RESULTS

496 variants were identified in pituitary adenomas with overall low level of heteroplasmy (7.22%). On average, 35 variants were detected per sample. Samples harbouring the highest number of variants had the highest Ki-67 indices independently of histological subtypes. We identified eight variants (A11251G, T4216C, T16126C, C15452A, T14798C, A188G, G185A, and T16093C) with different prevalences among different histological groups. T16189C was found in 40% of non-recurrent adenomas, while it was not present in the recurrent ones. T14798C and T4216C were confirmed by Sanger sequencing in all 44 samples. 100% concordance was found between NGS and Sanger method.

CONCLUSIONS

NGS is a reliable method for investigating mitochondrial genome and heteroplasmy in pituitary adenomas. Out of the 496 detected variants, 414 have not been previously reported in pituitary adenoma. The high number of mtDNA variants may contribute to adenoma genesis, and some variants (i.e., T16189C) might associate with benign behaviour.

Effectiveness of the Gerundium Youth Educating Program in Hungary

The acceptance of brain death and the legitimation of organ transplantation is very much dependent on the general knowledge of the society. In Hungary, the legislation of brain death is based on presumed consent. There is no structural education about the topic so far.

AIM

The role of the Gerundium program is to educate high school students about the importance of transplantation and the meaning of brain death. The goal of this study was to evaluate the effectiveness of the Gerundium contemporary educational program in a pilot study.

METHOD

The education was held by medical students who successfully completed a preparatory elective course consisting of relevant information in the topic. Medical students used simple language during the 45-minute presentations. Two tests with simple but representative questions created by experts were completed by high school students: one directly before contemporary education and another 5 to 6 weeks after the lecture.

RESULTS

A total of 147 tests were completed: 78 before and 69 after the presentation in the city of Debrecen and 294 before the lecture in the city of Győr. In Debrecen, the overall correct answers increased by 6.05% (P < .05; before vs after). The results show that the knowledge transfer is highly effective in this manner and the students know significantly more weeks after the lectures.

CONCLUSION

There is much to do to broadly inform society about transplantation and brain death, but we will continue to increase the number of students and measure the dynamic change of the students' knowledge.

Flow of anisometric particles in a quasi-two-dimensional hopper

The stationary flow field in a quasi-two-dimensional hopper is investigated experimentally. The behavior of materials consisting of beads and elongated particles with different aspect ratio is compared. We show, that while the vertical velocity in the flowing region can be fitted with a Gaussian function for beads, in the case of elongated grains the flowing channel is narrower and is bordered with sharper velocity gradient. For this case, we quantify deviations from the Gaussian velocity profile. Relative velocity fluctuations are considerably larger and slower for elongated grains.

Frustrated packing in a granular system under geometrical confinement

Optimal packings of uniform spheres are solved problems in two and three dimensions. The main difference between them is that the two-dimensional ground state can be easily achieved by simple dynamical processes while in three dimensions, this is impossible due to the difference in the local and global optimal packings. In this paper we show experimentally and numerically that in 2 + ε dimensions, realized by a container which is in one dimension slightly wider than the spheres, the particles organize themselves in a triangular lattice, while touching either the front or rear side of the container. If these positions are denoted by up and down the packing problem can be mapped to a 1/2 spin system. At first it looks frustrated with spin-glass like configurations, but the system has a well defined ground state built up from isosceles triangles. When the system is agitated, it evolves very slowly towards the potential energy minimum through metastable states. We show that the dynamics is local and is driven by the optimization of the volumes of 7-particle configurations and by the vertical interaction between touching spheres.

Left atrial thrombus under dabigatran in a patient with nonvalvular atrial fibrillation

Dabigatran is a new direct competitive inhibitor of thrombin and is equally effective and safe as warfarin in the prevention of thromboembolism in patients with nonvalvular atrial fibrillation. We present a case of a 60-year-old man with persistent nonvalvular atrial fibrillation who switched from acenocoumarol to dabigatran 110 mg twice daily. After five months the patient developed a large atrial thrombus, occlusion of the tibial arteries of the right foot, cerebellar infarction and multiple infarctions in kidneys and spleen. Blood test showed a dabigatran concentration of 35 ng/ml six hours after intake, correlating with a low trough concentration of 24-27 ng/mL and significantly increased thromboembolic risk. Other risk factors for thromboembolism were excluded. The present case indicates that in selected patients, there might be an indication for dose adjustments based on serum levels of dabigatran to ensure patient efficacy (thromboembolic events) and safety (bleeding).

Heaping, secondary flows and broken symmetry in flows of elongated granular particles

In this paper we report experiments where we shear granular rods in split-bottom geometries, and find that a significant heap of height of least 40% of the filling height can form at the particle surface. We show that heaping is caused by a significant secondary flow, absent for spherical particles. Flow reversal transiently reverses the secondary flow, leading to a quick collapse and slower regeneration of the heap. We present a symmetry argument and experimental data that show that the generation of the secondary flow is driven by a misalignment of the mean particle orientation with the streamlines of the flow. This general mechanism is expected to be important in all flows of sufficiently anisometric grains.

Vitamin D-neutralizing CYP24A1 expression, oncogenic mutation states and histological findings of human papillary thyroid cancer

OBJECTIVE

The aims of the present study were to examine gene and protein expression of the vitamin D-inactivating 24-hyroxylase (CYP24A1) and the activating 1-alpha-hydroxylase (CYP27B1) enzyme in human papillary thyroid cancer (PTC), furthermore, to investigate the association between CYP24A1 expression and numerous clinical, histological parameters and somatic oncogene mutation status of thyroid tumor tissues.

MATERIALS AND METHODS

Gene expression analysis was carried out in 100 Hungarian thyroid samples, both normal and papillary tumor tissue sections of the same patient. The specific mRNA to the selected genes was analyzed by TaqMan probe-based quantitative real-time RT-PCR. The somatic oncogene mutation states of BRAF, NRAS, HRAS and KRAS were also tested.

RESULTS

CYP24A1 mRNA expression was markedly increased in 52 cases (52%) of the examined papillary cancers compared with that of normal thyroid tissue. There was a tendency toward difference in the distribution of high-level CYP24A1 in the PTC accompanied with somatic oncogene mutation. Positive correlation was seen between increased CYP24A1 expression rate and a group of variables reflecting tumor malignity (mainly vascular invasion, lymph node metastasis, tumor size, hypothyreosis) by principal components analysis. No significant alteration was seen in CYP27B1 gene expression between neoplastic and normal tissues.

CONCLUSIONS

A definite alteration was seen in vitamin D3-inactivating CYP24A1 gene activity in PTC compared to their normal tissues on a relatively large patient population. Our findings raise the possibility that CYP24A1 may also directly be involved in thyroid carcinogenesis.

Evolution of shear zones in granular materials

The evolution of wide shear zones or shear bands was investigated experimentally and numerically for quasistatic dry granular flows in split bottom shear cells. We compare the behavior of materials consisting of beads, irregular grains, such as sand, and elongated particles. Shearing an initially random sample, the zone width was found to significantly decrease in the first stage of the process. The characteristic shear strain associated with this decrease is about unity and it is systematically increasing with shape anisotropy, i.e., when the grain shape changes from spherical to irregular (e.g., sand) and becomes elongated (pegs). The strongly decreasing tendency of the zone width is followed by a slight increase which is more pronounced for rodlike particles than for grains with smaller shape anisotropy (beads or irregular particles). The evolution of the zone width is connected to shear-induced packing density change and for nonspherical particles it also involves grain reorientation effects. The final zone width is significantly smaller for irregular grains than for spherical beads.

Effects of grain shape on packing and dilatancy of sheared granular materials

A granular material exposed to shear shows a variety of unique phenomena: Reynolds dilatancy, positional order and orientational order effects may compete in the shear zone. We study granular packing consisting of macroscopic prolate, oblate and spherical grains and compare their behaviour. X-ray tomography is used to determine the particle positions and orientations in a cylindrical split bottom shear cell. Packing densities and the arrangements of individual particles in the shear zone are evaluated. For anisometric particles, we observe the competition of two opposite effects. On the one hand, the sheared granules are dilated, on the other hand the particles reorient and align with respect to the streamlines. Even though aligned cylinders in principle may achieve higher packing densities, this alignment compensates for the effect of dilatancy only partially. The complex rearrangements lead to a depression of the surface above the well oriented region while neighbouring parts still show the effect of dilation in the form of heaps. For grains with isotropic shapes, the surface remains rather flat. Perfect monodisperse spheres crystallize in the shear zone, whereby positional order partially overcompensates dilatancy effects. However, even slight deviations from the ideal monodisperse sphere shape inhibit crystallization.

[Evolution of sentinel lymph node biopsy in breast cancer--axillary staging in the past 15 years at the Uzsoki Street Hospital]

INTRODUCTION

Sentinel biopsy technique was performed in Europe in 1996.It was a great improvement in the surgical treatment of breast cancer, it decreased the number of patients suffering from early and late morbidity following axillary lymph node dissection (ALND). In our paper we demonstrate the evolution of sentinel biopsy technique (SLNB), as well as the changes in our policy on axillary treatment in line with the European trends.

METHODS

The authors of this article give an overview and analyse the relevant literature concerning sentinel lymph node biopsy and data of patients on whom sentinel lymph node biopsy was performed from 01/01/2001 to 31/12/2012.

RESULTS

Between 2001 and 2013 we performed 3756 breast operations, 2742 of those were done for malignant disease. Altogether we performed 744 sentinel lymph node biopsies in the Uzsoki teaching Hospital. The proportion of SLNB patients is increasing, it was 24.6% between 2001-2006 and 29.2% between 2007-2012, respectively. The indication of SLNB is widening, there might be justification of the technique even by multifocal or multilocular disease, in male patients, after former breats surgery or even in pregnant patients.

CONCLUSION

Histological examination of sentinel lymph node and its effect on complex treatment of breats cancer may place the role of surgical axillary staging in a brand new aspect in the near future perhaps.

Cell sorting in a Petri dish controlled by computer vision

Fluorescence-activated cell sorting (FACS) applying flow cytometry to separate cells on a molecular basis is a widespread method. We demonstrate that both fluorescent and unlabeled live cells in a Petri dish observed with a microscope can be automatically recognized by computer vision and picked up by a computer-controlled micropipette. This method can be routinely applied as a FACS down to the single cell level with a very high selectivity. Sorting resolution, i.e., the minimum distance between two cells from which one could be selectively removed was 50–70 micrometers. Survival rate with a low number of 3T3 mouse fibroblasts and NE-4C neuroectodermal mouse stem cells was 66±12% and 88±16%, respectively. Purity of sorted cultures and rate of survival using NE-4C/NE-GFP-4C co-cultures were 95±2% and 62±7%, respectively. Hydrodynamic simulations confirmed the experimental sorting efficiency and a cell damage risk similar to that of normal FACS.

Shear-induced alignment and dynamics of elongated granular particles

The alignment, ordering, and rotation of elongated granular particles was studied in shear flow. The time evolution of the orientation of a large number of particles was monitored in laboratory experiments by particle tracking using optical imaging and x-ray computed tomography. The experiments were complemented by discrete element simulations. The particles develop an orientational order. In the steady state the time- and ensemble-averaged direction of the main axis of the particles encloses a small angle with the streamlines. This shear alignment angle is independent of the applied shear rate, and it decreases with increasing grain aspect ratio. At the grain level the steady state is characterized by a net rotation of the particles, as dictated by the shear flow. The distribution of particle rotational velocities was measured both in the steady state and also during the initial transients. The average rotation speed of particles with their long axis perpendicular to the shear alignment angle is larger, while shear aligned particles rotate slower. The ratio of this fast/slow rotation increases with particle aspect ratio. During the initial transient starting from an unaligned initial condition, particles having an orientation just beyond the shear alignment angle rotate opposite to the direction dictated by the shear flow.

Orientational order and alignment of elongated particles induced by shear

Shear induced alignment of elongated particles is studied experimentally and numerically. We show that shear alignment of ensembles of macroscopic particles is comparable even on a quantitative level to simple molecular systems, despite the completely different types of particle interactions. We demonstrate that for dry elongated grains the preferred orientation forms a small angle with the streamlines, independent of shear rate across three decades. For a given particle shape, this angle decreases with increasing aspect ratio of the particles. The shear-induced alignment results in a considerable reduction of the effective friction of the granular material.

Clinical significance of genetic alterations and expression of epidermal growth factor receptor (EGFR) in head and neck squamous cell carcinomas

The significance of epidermal growth factor receptor (EGFR) signaling is well studied in a number of different tumors, but limited data is available with regard to head and neck squamous cell carcinoma (HNSCC). Since anti-EGFR therapies are currently under investigation in these malignancies as well, comprehensive information about the alteration of EGFR in HNSCC is necessary to design the most appropriate therapeutic protocols. We examined retrospectively the gene copy number of EGFR by FISH and the protein expression by immunohistochemistry using different epitope-specific antibodies in paraffin-embedded primary tumors of five different regions, from 71 HNSCC patients who had not been treated with anti-EGFR therapy. In seven cases corresponding lymph node metastases were also available for comparative analyses. We also determined the mutational status of tyrosine kinase (TK) domain (exon 19 and 21) and the extracellular deletion mutation (vIII) of EGFR, the KRAS mutation at codon 12 and the presence of HPV infection. Eight of the 71 cases (11.3%) showed EGFR gene amplification (most of them localized into the hypopharyngeal region) and the increased gene copy number (amplification+polysomy) was 43.7%. Despite pronounced intratumoral heterogeneity of EGFR protein expression being found, the high EGFR expression correlated with poor prognosis. On the other hand, the phosphorylation of EGFR was associated with prolonged survival. No mutations in the TK domain of EGFR were found in any of the HNSCC patients and only two cases were KRAS mutant at codon 12. We detected vIII deletion mutation of EGFR in 21% of the samples, but there was no statistically significant correlation between the presence of vIII mutant form and patient survival. EGFR vIII mutation was, however, associated with increased gene copy number. Fourteen of 71 cases (19.7%) were HPV-positive and the incidence of infection showed a decreasing tendency from the oral cavity towards the larynx. Interestingly, in contrast to previous findings, we could not observe improved survival in HPV-positive patients compared to non-infected patients, most probably due to the fact that the majority of these HNSCC patients were smokers and alcohol consumers. In conclusion, we found that increased EGFR protein levels and gene copy numbers (not gene amplification alone) have prognostic significance in the investigated HNSCC patient population. However, the relatively high incidence of the EGFR-vIII mutant form warrants careful therapeutic decision-making when choosing between different anti-EGFR treatment options.

Psychological distress and mortality in systolic heart failure

BACKGROUND

Depression, anxiety, and type D ("distressed") personality (tendency to experience negative emotions paired with social inhibition) have been associated with poor prognosis in coronary heart disease, but little is known about their role in chronic heart failure. Therefore, we investigated whether these indicators of psychological distress are associated with mortality in chronic heart failure.

METHOD AND RESULTS

Consecutive outpatients with chronic heart failure (n=641; 74.3% men; mean age, 66.6+/-10.0 years) filled out a 4-item questionnaire to assess mixed symptoms of anxiety and depression and the 14-item type D scale. End points were defined as all-cause and cardiac mortality. After a mean follow-up of 37.6+/-15.6 months, 123 deaths (76 due to cardiac cause) were recorded. Cumulative hazard functions for elevated anxiety/depression symptoms differed marginally for all-cause (P=0.06), but not cardiac, mortality (P=0.43); type D personality was associated with neither all-cause mortality (P=0.63) nor cardiac mortality (P=0.87). In multivariable analyses, neither elevated anxiety/depression symptoms nor type D personality was associated with all-cause mortality (hazard ratio [HR]=1.18; 95% CI, 0.76 to 1.84; P=0.45 and HR=1.09; 95% CI, 0.67 to 1.77; P=0.73, respectively) or cardiac mortality (HR=1.13; 95% CI, 0.63 to 2.04; P=0.65 and HR=1.16; 95% CI, 0.62 to 2.18; P=0.67). In secondary analyses, a 1-point increase in anxiety/depression (range, 0 to 16) was associated with an 8% increase in risk for all-cause mortality (HR=1.08; 95% CI, 1.01 to 1.15; P=0.02).

CONCLUSIONS

Neither elevated anxiety/depression symptoms nor type D personality was associated with an increased risk for all-cause or cardiac mortality. Future studies with adequate power and a longer follow-up duration are needed to further elucidate the role of psychological distress in chronic heart failure.

Shear zone refraction and deflection in layered granular materials

Refraction and deflection of shear zones in layered granular materials were studied experimentally and numerically. We show that (i) according to a recent theoretical prediction [T. Unger, Phys. Rev. Lett. 98, 018301 (2007)] shear zones refract in layered systems in analogy with light refraction, (ii) zone refraction obeys Snell's law known from geometric optics, and (iii) under natural pressure conditions (i.e., in the presence of gravity) the zone can also be deflected by the interface, so that the deformation of the high friction material is avoided.

The relationship between type D personality and chronic heart failure is not confounded by disease severity as assessed by BNP

Psychological factors, like Type D personality (i.e., the tendency to experience negative emotions and to inhibit emotional distress) have been linked to impaired health outcomes. Criticism on the role of psychological factors in cardiac disease has postulated that such constructs may be confounded by disease severity. Hence, we examined whether Type D personality is associated with brain natriuretic peptide (BNP), a sensitive marker of disease severity in chronic heart failure (CHF), in 202 consecutive CHF outpatients. No differences in logBNP levels were found between Type D and non-Type D patients (t(200) = -1.03, p = .30). After adjusting for demographic and clinical confounders, Type D personality remained unassociated with logBNP levels (β=.04, p = .55), whereas older age (β = .27, p<.001), being prescribed beta-blockers (β = .15, p = .02), lower left ventricular ejection fraction (β = -.38, p<.0001), and kidney dysfunction (β = .17, p = .01) were associated with higher logBNP. To conclude, Type D personality was not associated with BNP in CHF outpatients, whereas clinical variables were associated with BNP. These findings oppose the suggestion that Type D personality is confounded by indicators of disease severity.

Astroglia‐derived retinoic acid is a key factor in glia‐induced neurogenesis

Astroglial cells are essential components of the neurogenic niches within the central nervous system. Emerging evidence suggests that they are among the key regulators of postnatal neurogenesis. Although astrocytes have been demonstrated to possess the potential to instruct stem cells to adopt a neuronal fate, little is known about the nature of the glia-derived instructive signals. Here we propose that all-trans retinoic acid, one of the most powerful morphogenic molecules regulating neuronal cell fate commitment, may be one of the glia-derived factors directing astroglia-induced neurogenesis. According to data obtained from several complementary approaches, we show that cultured astrocytes express the key enzyme mRNAs of retinoic acid biosynthesis and actively produce all-trans retinoic acid. We show that blockage of retinoic acid signaling by the pan-RAR antagonist AGN193109 prevents glia-induced neuron formation by noncommitted stem cells. Therefore, we provide strong in vitro evidence for retinoic acid action in astroglia-induced neuronal differentiation.

Phase transition in the collective migration of tissue cells: experiment and model

We have recorded the swarming-like collective migration of a large number of keratocytes (tissue cells obtained from the scales of goldfish) using long-term videomicroscopy. By increasing the overall density of the migrating cells, we have been able to demonstrate experimentally a kinetic phase transition from a disordered into an ordered state. Near the critical density a complex picture emerges with interacting clusters of cells moving in groups. Motivated by these experiments we have constructed a flocking model that exhibits a continuous transition to the ordered phase, while assuming only short-range interactions and no explicit information about the knowledge of the directions of motion of neighbors. Placing cells in microfabricated arenas we found spectacular whirling behavior which we could also reproduce in simulations.

Relative lack of depressive cognitions in post-myocardial infarction depression

BACKGROUND

Depression has been associated with adverse clinical events in myocardial infarction (MI) patients, but many questions about the nature of post-MI depression remain unanswered. We examined whether depressive cognitions characteristic of depression in psychiatric patients are also present in post-MI patients with major depression (MD).

METHODS

Non-depressed (n=40) and depressed (n=40) post-MI patients, and psychiatric outpatients (n=40) treated for clinical depression, matched on age and sex, were interviewed using a structured clinical interview to diagnose DSM-IV MD. All patients also completed the Beck Depression Inventory (BDI) and the Beck Cognition Checklist-Depression subscale (CCL-D).

RESULTS

Mean levels of depressive cognitions were considerably higher in depressed psychiatric patients compared with depressed post-MI patients (34.9 versus 28.0; p=.013), and higher in depressed post-MI patients compared with non-depressed post-MI patients (28.0 versus 17.8; p<.0001), adjusted for age, sex, educational level, and marital status. Younger age (p=.024), absence of a partner (p=.016) and depressed psychiatric status (p=.016) were independently associated with depressive cognitions. Psychiatric patients also had higher mean levels of depressive symptoms as compared to depressed post-MI patients (25.1 versus 17.8; p=.001).

LIMITATIONS

This study is based on a cross-sectional design.

CONCLUSIONS

The symptom presentation of MD in post-MI patients is both quantitatively and qualitatively different from that seen in psychiatric patients, suggesting that depressive symptoms in post-MI patients differ in content from those in psychiatric patients. These findings could have important consequences for the design and contents of therapeutic programs for treating depression in post-MI patients.