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Bevezetés: A súlyos férfi terheléses inkontinencia a radikális prostatectomia után kialakult leggyakoribb szövődmény, sebészi kezelésében „gold standard” a művi záróizom-beültetés. A készüléket dr. Brantley Scott fejlesztette ki és ültette be először 1972-ben, majd az évtizedek során számos fejlesztésen ment keresztül. A ma is használt formája 1982-ben került forgalomba AMS 800 néven, amely azóta több, mint 250 ezer esetben került beültetésre. Az irodalmi adatok alapján a leggyakoribb szövődmény magának az eszköznek a meghibásodása, uroinfekció, húgycsőlézió, illetve hibás méretválasztás. Ezekben az esetekben a műsphincter cseréje, illetve eltávolítása szükséges. A relatíve magas szövődményráta ellenére is a súlyos esetekben elsőként választandó műtéti terápiás megoldás, mivel a betegek 79%-ánál a kontinencia jelentős javulása érhető el. Betegek és módszerek: Munkacsoportunk által 2010 és 2022 között 21 betegnél került beültetésre AMS 800 műsphincter. Összefoglalónk célja az volt, hogy az általunk végzett beavatkozások szövődményeit összehasonlítsuk az irodalmi adatokkal. Eredmények: 21 beteg nyomon követését végeztük, 16 esetben radikális prostatectomia, míg 5 esetben transurethralis prosztatareszekció után történt AMS 800 beültetése. 6 beteg adjuváns irradiációban is részesült. Az esetek 9%-ában infekciós szövődményt észleltünk, emellett 9-9%-ban húgycsőatrófia, illetve húgycsőerózió került felismerésre. A készülék meghibásodását az esetek 19%-ában észleltük. Az adjuváns irradiáción átesett betegeknél a sebészei reintervenció szignifikánsan gyakrabban vált szükségessé. Következtetés: A jelentős és tartós kontinenciajavulás miatt a gyakori szövődmények ellenére a súlyos férfi terheléses inkontinencia kezelésében a műsphincter-implantáció a „gold standard” megoldás. A gyakori szövődményarány miatt ezen betegek rendszeres utánkövetése alapvető fontosságú.

A kardiális autonóm neuropathia (CAN) a cukorbetegség gyakori mikrovaszkuláris szövődménye, amely összefüggést mutat a kardiovaszkuláris betegségekkel. A CAN diagnosztikájára a Ewing-féle kardiovaszkuláris reflextesztek használatosak. A paraszimpatikus beidegzés működését a mélylégzéses vizsgálat, a Valsalva-manőver és a felálláskor bekövetkező szívfrekvencia-változás mérésével értékeljük. Az ortosztatikus hipotenzió és a kézizom-szorító erő (handgrip teszt) vizsgálata a szimpatikus idegrendszer működéséről nyújt tájékoztatást. Azonban a Ewing-tesztek elvégzése időigényes folyamat és a beteg részéről is nagyfokú kooperációt igényel. A CAN legtöbbször tünetszegényen jelentkezik és késői stádiumban kerül felismerésre, ezért felmerült az igény egy egyszerű, kérdőíves szűrőmódszer kidolgozására. A Composite Autonomic Symptom Score 31 (COMPASS-31) kérdőív 6 vegetatív tünetcsoportot ölel fel, és a válaszokra adott pontértékek megfelelő súlyozásával megbízható módszernek bizonyult az autonóm neuropathia korai felimerésében. Célkitűzésünk a COMPASS-31 kérdőív alkalmazhatóságának vizsgálata diabeteses neuropathiás betegeink körében. Betegek és módszerek: A vizsgálatunk során a debreceni Diabeteses Neuropathia Centrumban 36 diabeteses neuropathiás beteg (24 nő/12 férfi) töltötte ki a kérdőívet, amelyek pontértékeit a Ewing-teszteken elért eredményeikkel hasonlítottunk össze, ROC analízist végeztünk, és meghatároztuk azt a pontszámot, amelyet határértékként használva a legkedvezőbb diagnosztikai szenzitivitás és specificitás érhető el. Eredmények: A paraszimpatikus és szimpatikus kardiovaszkuláris reflexteszteket együttesen összehasonlítva a COMPASS-31 teszt eredményeivel, a ROC görbe alatti terület (AUC) 0,83 (95%-os CI: 0,69–0,97, p=0,002), a kérdőív szenzitivitása 88%, specificitása 73%, ha a kérdőíven elért 14 feletti pontszámot tekintettük diagnosztikusnak. Ha a CAN diagnózisát a handgrip teszt megbízhatatlansága miatt a paraszimpatikus reflextesztek és az ortosztatikus hipotenzió fennállása alapján állítottuk fel, akkor a ROC-AUC 0,92 (95%-os CI: 0,81–1,03, p

Background/aim It has been suggested that eosinophilic variant of chromophobe renal cell carcinoma (chRCC) with low chromosome number or lack of genomic alteration has an excellent prognosis in comparison to classic chRCC. The aim of our study was to analyse the phenotypical variations of 77 chRCCs, including 7 eosinophilic ones, each diagnosed unequivocally by genetic means. Materials and methods DNA isolated from chRCCs was subjected to array comparative genomic hybridisation (CGH) for establishing the chromosome alteration. Original histological slides were evaluated for cellular phenotype and growth pattern and compared to the genetic alterations. Results Loss of the entire chromosome 1, 2, 6, 10, 13, 17 and 21 occurred in 95%, 94%, 86% 90% 82% 90% and 66% of the cases, respectively. The number of chromosome alterations in eosinophilic forms of chRCC corresponded to those found in classic chRCC with pale-reticular cytoplasm or mixed cellular characteristics. Three of seven eosinophilic variants with loss of 4, 10 and 11 chromosomes showed metastasis at the time of diagnosis whereas only 3 metastatic tumors were noticed among the 70 classic chRCC. We did not find discriminating difference in number of chromosome alteration between classic and eosinophilic forms of chRCC. Conclusion Eosinophilic chRCC has a more aggressive biology than the classic form. To avoid diagnostic pitfall of eosinophilic renal cell tumors with uncertain diagnosis, a genetic analysis should be carried out.

Absztrakt: Bevezetés: Világszerte jelentősen növekszik a cukorbetegség előfordulása. A distalis típusú szenzomotoros polyneuropathia (DSPN) a leggyakrabban előforduló és a legkorábban kimutatható microvascularis szövődmény, mely változatos klinikai megjelenése és sokszor atípusos tünetei miatt gyakran csak a cukorbetegség előrehaladott stádiumában kerül felismerésre. Célkitűzés és módszer: Munkánk során 431 beteg adatait dolgoztuk fel, akiket 2011 és 2018 között a Debreceni Egyetem Diabeteses Neuropathia Centrumában vizsgáltunk Neurometer® segítségével, és összefüggéseket kerestünk a különböző szív-ér rendszeri és microvascularis szövődmények (retinopathia, microalbuminuria), a laboratóriumi paraméterek és a DSPN súlyossága között. Eredmények: A betegek átlagéletkora 63,4 év, 62%-uk nő volt, 92%-uk 2-es típusú cukorbetegségben szenvedett. A cukorbetegség fennállásának átlagos ideje 13,7 év volt. Cardiovascularis betegség a betegek 42%-ánál volt ismert. A microvascularis szövődmények közül a retinopathia előfordulása 12% volt, perzisztáló microalbuminuria a betegek 16%-ánál volt igazolva. A vizsgált betegek 19%-ánál a típusos DSPN-panaszok ellenére sem tudtunk idegi károsodást kimutatni; 49%-ban enyhe fokú, 19%-ban közepes fokú és 13%-ban súlyos fokú neuropathia volt kimutatható Neurometer® segítségével. A cukorbetegséggel összefüggő idegi károsodás kifejezettebb volt diabeteses retinopathia (pKövetkeztetés: Eredményeink alapján a diabeteses neuropathia progressziója előre jelezheti az egyéb microvascularis szövődmények megjelenését 2-es típusú cukorbetegségben, adataink azonban nem mutattak összefüggést a cardiovascularis betegségek kialakulásával. A Neurometer® segítségével végzett perifériás idegrendszeri vizsgálat alkalmas a DSPN követésére és a neuropathia súlyosságának megállapítására. A cardiovascularis kockázatot az autonóm idegrendszeri funkciót vizsgáló Ewing-féle reflextesztek segítségével jobban meg tudjuk ítélni cukorbetegeinknél. Orv Hetil. 2020; 161(30): 1243–1251.

Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale (PFO) detection, for patient selection for transcatheter ASD/PFO closure, for intraoperative guidance and for long-term follow-up. The size, shape, location and the number of the atrial communications schould be determined. The accuracy of PFO detection can be improved by using agitated saline together with maneuvers to transiently increase the right atrial (RA) pressure. The appearance of microbubbles in the left atrium (LA) within 3 cardiac cycles after opacification of the RA is considered positive for the presence of an intracardiac shunt. Three dimensional TEE identifies further septal fenestrations and describes the dynamic morphology of ASD/PFO and atrial septal aneurysm. Follow-up evaluations with TTE is recommended at 1, 6, and 12 months after the procedure, with a subsequent evaluation every year. Previous studies showed an increased incidence of atrial arrhythmias early after device closure. Speckle tracking analysis may help to understand functional left atrial remodeling following percutaneous closure and its impact on atrial arrhythmias.

Aortic valve stenosis (AS) is the most common valvular heart disease. The incidence of AS increases with age, however, a significant proportion of elderly people have no significant AS, indicating that both aging and nonaging pathways are involved in the pathomechanism of AS. Age-related and stress-induced cellular senescence accompanied by further active processes represent the key elements of AS pathomechanism. The early stage of aortic valve degeneration involves dysfunction and disruption of the valvular endothelium due to cellular senescence and mechanical stress on blood flow. These cells are replaced by circulating progenitor cells, but in an age-dependent decelerating manner. When endothelial denudation is no longer replaced by progenitor cells, the path opens for focal lipid deposition, initiating subsequent oxidation, inflammation and micromineralisation. Later stages of AS feature a complex active process with extracellular matrix remodeling, fibrosis and calcification. Echocardiography is the gold standard method for diagnosing aortic valve disease, although computed tomography and cardiac magnetic resonance are useful additional imaging methods. To date, no medical treatment has been proven to halt the progression of AS. Elucidation of differences and similarities between vascular and valvular calcification pathomechanisms may help to find effective medical therapy and reduce the increasing health burden of the disease.

The prevalence of diabetes mellitus is significantly increasing worldwide. Distal sensorimotor neuropathy (DSPN) is the most common and the earliest detectable microvascular complication. Due to its diverse clinical appearance and atypical symptoms, DSPN is often recognized in an advanced stage.In our study, the data of 431 patients who were examined using the Neurometer® between 2011 and 2018 at the Diabetic Neuropathy Center of the University of Debrecen were processed and the correlations between cardiovascular and microvascular complications, laboratory parameters and the severity of DSPN were investigated.The average age of patients was 63.4 years, 62% of them were women, and 92% had type 2 diabetes mellitus. The average duration of diabetes was 13.7 years. Cardiovascular disease (CVD) was diagnosed in 42% of the patients. The incidence of retinopathy was 12%, persistent microalbuminuria was 16%. Despite DSNP complaints, neuronal damage could not be detected in 19%; in the examined patients 49% had mild, 19% moderate and 13% severe neuropathy. Diabetes-related neurological damage was more serious in the presence of both diabetic retinopathy (p0.001) and microalbuminuria (p0.001). The incidence of these microvascular complications and the severity of DSPN showed a significant positive correlation (p0.001). There was no correlation between the severity of peripheral neuropathy and the development of CVD, and we did not find any correlations between the severity of DSPN and CVD.Based on our investigation, correlation between the progression of diabetic neuropathy and cardiovascular complications was not found, although the progression of diabetic neuropathy indicated the development of other microvascular diseases. Peripheral neurological examination using the Neurometer® is appropriate for controlling the DSPN status and the establishment of the severity of neuropathy determines the quality of life in diabetic patients. Among these patients, the risk of CVD can be assessed by Ewing's test for autonomic nervous system function. Orv Hetil. 2020; 161(30): 1243-1251.

Frost hardiness of flower buds of three plum (Prunus domestica L.) cultivars (‘Cacanska lepotica’, ‘Stanley’, ‘Besztercei’) was characterised by the LT50 values calculated from artificial freezing experiments conducted during eight dormancy periods between 2004 and 2016. Of the two variance components, the year effect was the strongest at the beginning of dormancy explaining around 60% of the phenotypic variation in LT50 values, while the effect of genotype started to increase from November and reached its maximum in the middle of January, when 81.2% of the variance in LT50 was due to the genotype. During the first part of winter the frost hardiness of the overwintering organs developed gradually in parallel to the decreasing ambient temperature. Flower buds were the most frost tolerant in the first half of January, when the maximum LT50 of ‘Cacanska lepotica’ was −22.8 °C, for ‘Stanley’ −24.8 °C and for ‘Besztercei’ it was −26.5 °C, averaged over the 8 dormancy periods. From the end of dormancy the effect of year became much stronger over the genotypic differences from the second half of January. Milder days during this period resulted in faster flower bud development paralleled by a steeper and quicker decline in frost tolerance, which may significantly increase the probability of frost damages in flowers caused by late winter and spring frosts.

Diabetic neuropathy may be one of the most common and severe complications of diabetes mellitus. Oxidative stress plays a pivotal role in the development of microvascular complications of diabetes. The majority of related pathways like polyol and hexosamine, advanced glycation end products, poly-ADP-ribose polymerase, and protein kinase-C all originated from initial oxidative stress. In this review, the authors present the current oxidative stress hypothesis in diabetes mellitus and summarize the pathophysiological mechanisms of diabetic neuropathy associated with increased oxidative stress. The development of modern medicines to treat diabetic neuropathy needs intensive long-term comparative trials in the future. Orv. Hetil., 2016, 157(49), 1939–1946.

Increased O-linked β- N-acetylglucosamine glycosylation ( O-GlcNAcylation) is a known contributor to diabetes; however, its relevance in diabetic nephropathy (DN) is poorly elucidated. Here, we studied the process and enzymes of O-GlcNAcylation with a special emphasis on Akt-endothelial nitric oxide synthase (eNOS) and heat shock protein (HSP)72 signaling. Since tubular injury is the prominent site of DN, the effect of hyperglycemia was first measured in proximal tubular (HK2) cells cultured in high glucose. In vivo O-GlcNAcylation and protein levels of O-GlcNAc transferase (OGT), O-GlcNAcase (OGA), phosphorylated (p)Akt/Akt, peNOS/eNOS, and HSP72 were assessed in the kidney cortex of streptozotocin-induced diabetic rats. The effects of various renin-angiotensin-aldosterone system (RAAS) inhibitors were also evaluated. In proximal tubular cells, hyperglycemia-induced OGT expression led to increased O-GlcNAcylation, which was followed by a compensatory increase of OGA. In parallel, peNOS and pAkt levels decreased, whereas HSP72 increased. In diabetic rats, elevated O-GlcNAcylation was accompanied by decreased OGT and OGA. RAAS inhibitors ameliorated diabetes-induced kidney damage and prevented the elevation of O-GlcNAcylation and the decrement of pAkt, peNOS, and HSP72. In conclusion, hyperglycemia-induced elevation of O-GlcNAcylation contributes to the progression of DN via inhibition of Akt/eNOS phosphorylation and HSP72 induction. RAAS blockers successfully inhibit this process, suggesting a novel pathomechanism of their renoprotective action in the treatment of DN.

Background/aim Renal oncocytoma (RO) and chromophobe renal cell carcinoma (chRCC) are suggested to develop from α- and β-intercalated (IC) cells of the collecting duct expressing solute carrier family 4 member 1 (SLC4A1) and SLC26A4 under control of forkhead box 1 (FOXI1) transcription factor. The aim of this study was to clarify the possible cellular origin and of RO and chRCC. Materials and methods Immunohistochemistry for aquaporin 2 (AQP2), FOXI1, SLC4A1 and SLC16A4 was applied to distinct types of renal cell tumors. Results Nuclear FOXI1 staining occurred in 96% of 83 ROs, in 3% of 90 chRCCs and none of the other tumor types. The α-IC cell marker SLC4A1 was seen in 60% of RO and 11% of chRCC, whereas staining for the β-IC cell marker SLC26A4 was negative in all but one tumor. Conclusion Although the origin of RO remains unclear, our findings suggest that FOXI1 immunohistochemistry is useful in differential diagnosis of RO from chRCC with overlapping histology.

Over urban areas in Hungary, the annual average PM10 concentrations are not frequently higher than 40 µg m–3. Despite the mitigation efforts of the local governments, the annual number of exceedances of the daily limit of 50 µg m–3 is higher than what is outlined in EU Directive No 2008/50/EC. The goal of the present study is to assess the characteristics of the temporal (annual, seasonal, daily) variations in PM10 concentrations in selected Hungarian cities with large populations, where most of the exceedances have been reported. The impacts of meteorological conditions on the measured PM10 concentrations and their temporal variations are also evaluated. An important aspect of studying the trends of air pollution is that the tendencies depend not only on the emissions of certain pollutants but also on the meteorological conditions in the area of interest. To analyse emission-related trends, the meteorological signal must be removed from the data series. In this study, the Kolmogorov-Zurbenko (KZ) filter was used for this type of trend separation. Moreover, multiple nonlinear regression analysis was used to find relationships between the PM10 concentration and several meteorological parameters. The goal of this analysis is to estimate the expected daily mean PM10 concentration values. The results of this analysis demonstrate that the regression equation can provide an adequate method for PM pollution forecasting. In addition to the hourly PM10 concentrations and basic meteorological data, global radiation and boundary layer height were considered in the characterization process.

Secondary aerosol particle production via new particle formation (NPF) has been shown to be a major source for global aerosol load. It has been also observed frequently in urban environments affecting the human health. Here, we investigate the effect of regional NPF on urban aerosol load under well-defined atmospheric conditions. The Carpathian Basin, the largest orogenic basin in Europe, represents an excellent opportunity for exploring these interactions. Based on long-term observations, we revealed that NPF seen in a central large city of the basin (Budapest) and its regional background occur in a consistent and spatially coherent way as result of a joint atmospheric phenomenon taking place over large horizontal scales. We found that NPF events at the urban site are usually delayed by > 1 hour relative to the rural site or even inhibited above a critical condensational sink level. The urban processes require higher formation rates and growth rates to be realised, by mean factors of 2 and 1.6, respectively, than the regional events. Regional- and urban-type NPF events sometimes occur jointly with multiple onsets, while they often exhibit dynamic and timing properties which are different for these NPF types.

The aim of this paper is to study the wintertime physical properties of atmospheric aerosol particles on the basis of data observed at the K-puszta regional background station in Hungary. In Hungary wintertime smog episodes are linked to strong stable air (high pressure blocking events) with thermal inversion. These atmospheric conditions are frequently formed during winter months (November–February) due to the special geographical location of the country. The formation of smog events is highly probable in cases of thermal inversion periods sustaining for at least 4 days. We discuss in the paper the role of high-pressure blocking events in aerosol properties in terms of PM10 concentrations, aerosol size distributions, new particle formation and optical properties. We found that high-pressure blocking events have significant impacts on the size distribution and particle formation processes. At K-puszta the aerosol is in highly aged state with size distribution dominated by the accumulation mode. This is further supported by the optical properties, e.g., by high scattering Angstrom exponent and by relatively weak absorption. The most significant effect of extreme episodes is manifested in the changes in PM10 concentrations and, consequently, in aerosol optical properties. The PM10 concentrations, scattering coefficients and absorption coefficients considerably increase to extreme values that are characteristic of a heavily polluted atmosphere rather than rural air. Our results indicate that in winter, the air quality at Kpuszta is often influenced by regional air pollution as shown by spatial distribution of PM10 concentration. It is found that PM10 had almost the same concentration in regional background air and in different types of urban environments. The special meteorological conditions and the role of regional-scale transport can explain why local abatements in cities cannot lead to significant improvement of the air quality during smog events.

The incidence of depression doubles in diabetic patients and is associated with poor outcomes. Studies indicate that renin-angiotensin-aldosterone system inhibitors (RAASi) might relieve depression, however the mechanism of action is not well understood. We recently showed that angiotensin receptor blockers have antidepressant effects in experimental diabetes comorbid depression. Here we investigated whether all types of RAASi exhibit antidepressant and neuroprotective properties. Diabetes was induced by streptozotocin in adult male Wistar rats. After 5 weeks of diabetes, rats were treated per os with non-pressor doses of enalapril, ramipril, spironolactone or eplerenone for 2 weeks. Behavior was evaluated using forced swim test and open field test. Inflammatory response and brain-derived neurotrophic factor (BDNF) signaling were investigated in the hippocampus. Both ACEi and MR antagonists reversed diabetes-induced behavioral despair confirming their antidepressant-like effect. This may occur via alterations in hippocampal cytokine-mediated inflammatory response. Repressed BDNF production was restored by RAASi. Both ACEi and MR antagonists facilitated the BDNF-tropomyosin receptor kinase B-cAMP response element-binding protein signaling pathway as part of their neuroprotective effect. These data highlight the important benefits of ACEi and MR antagonists in the treatment of diabetes-associated depressive symptoms. Our novel findings support the link between diabetes comorbid depression, inflammation and repressed BDNF signaling. RAASi could provide new therapeutic options to improve the outcomes of both disorders.

Visibility is a simple indicator of air quality, and its drastic decrease is often related to poor air quality resulting from an increase in aerosol (particulate matter PM) concentration. Visibility is also related to water vapor due to the hygroscopicity of aerosols. As a result, water vapor may considerably influence PM measurements especially in the case of low-cost PM sensors which typically measure the ambient (wet) size of PM. Several possibilities are available to eliminate the effect of aerosol hygroscopicity on PM10 measurements, and we aimed to discuss and compare three of the methods: gravimetry (mass change of aerosol filters due to RH variation), application of the AIM model (based on aerosol chemical composition) and estimation derived from visibility data. In this work, we discuss how hygroscopic growth factors, obtained from different methods, are related, as well as the relevance of the hygroscopic growth rate derived from visibility observations in PM10 measurements. Moreover, since in PM monitoring – including the low-cost PM sensors – a quasi-real time, appropriate and simple method would be desirable for consideration of aerosol hygroscopicity, we aimed to construct a proxy for this purpose. We found that the visibility-derived mass growth rate could serve as a simple basis for these requirements.

Background Since the global economic crisis in 2007, unemployment rates have escalated in most European and North American countries. Unemployment protection policies, particularly the unemployment insurance (UI) system, have become a weighty issue for many modern welfare states. Decades of research have established concrete findings on the adverse impacts of unemployment on poverty- and health-related outcomes. This provided a foundation for further exploration into the potential protective effects of UI in offsetting these adverse outcomes. Methods We developed a systematic review protocol in four stages (literature search, study selection, data extraction and quality appraisal) to ensure a rigorous data collection and inter-rated reliability. We examined the full body of empirical research published between 2000 and 2013 on the pathways by which UI impacts poverty and health. Results Out of 2233 primary studies identified, a total of 12 met our inclusion criteria. The selected studies assessed poverty-related outcomes (absolute/relative poverty and material hardship) or one or more health-related outcomes (health behaviors, self-rated health, well-being and mental health). Across various UI systems, jurisdictions from high income countries, and study designs, we found good support for our conceptual framework, by which UI attenuates the effect of unemployment on both poverty and health, with a few exceptions. Conclusion Whether UI impacts differ by age and region might be explored further in future research. The complex mediating relationship between unemployment, UI, poverty and health should further be assessed in light of economic and historical contexts. This could inform decision-making processes during future periods of economic recession.

‡SUMMARY The Commission on Social Determinants of Health (CSDH) formulated recommendations along which health inequalities can be successfully tackled anywhere in the world. The situation of the Roma minority in Europe provides countless opportunities for the translation of these guidelines into action that should be guided by coherent and evidence-based strategies integrating lessons learned in smaller-scale field projects. Our paper describes the longterm evaluation of a locally initiated housing project in Hungary carried out more than a decade after implementation, which highlights the salience of the CSDH’s recommendations and critical factors for success and sustainability. The project provides evidence for the longterm positive impact on education of the social housing project implemented by an empowered community through delegating decision making to a board of representatives of the beneficiaries in all decisions, including financial ones. Educational level greatly improved, and all houses – inhabited by 17 out of 20 families who initially entered the project—remained in good condition, properly equipped and decorated after 13 years of implementation, in spite of an increase of unemployment during the same period which led to reduced income and deterioration of the families’ economic situation. Better housing conditions for vulnerable people can be sustained and result in increased educational level if incremental improvement is aimed for and coupled with the redistribution of power at the local level.

The assessment of health risks of policies is an inevitable, although challenging prerequisite for the inclusion of health considerations in political decision making. The aim of our project was to develop a so far missing methodological guide for the assessment of the complex impact structure of policies. The guide was developed in a consensual way based on experiences gathered during the assessment of specific national policies selected by the partners of an EU project. Methodological considerations were discussed and summarized in workshops and pilot tested on the EU Health Strategy for finalization. The combined tool, which includes a textual guidance and a checklist, follows the top-down approach, that is, it guides the analysis of causal chains from the policy through related health determinants and risk factors to health outcomes. The tool discusses the most important practical issues of assessment by impact level. It emphasises the transparent identification and prioritisation of factors, the consideration of the feasibility of exposure and outcome assessment with special focus on quantification. The developed guide provides useful methodological instructions for the comprehensive assessment of health risks of policies that can be effectively used in the health impact assessment of policy proposals.

Background In spite of increasing research into intersections of public policy and health, little evidence shows how policy processes impact the implementation of Health in All Policies (HiAP) initiatives. Our research sought to understand how and why strategies for engaging partners from diverse policy sectors in the implementation of HiAP succeed or fail in order to uncover the underlying social mechanisms contributing to sustainable implementation of HiAP. Methods In this explanatory multiple case study, we analyzed grey and peer-review literature and key informant interviews to identify mechanisms leading to implementation successes and failures in relation to different strategies for engagement across three case studies (Sweden, Quebec and South Australia), after accounting for the role of different contextual conditions. Findings Our results yielded no support for the use of awareness-raising or directive strategies as standalone approaches for engaging partners to implement HiAP. However, we found strong evidence that mechanisms related to “win-win” strategies facilitated implementation by increasing perceived acceptability (or buy-in) and feasibility of HiAP implementation across sectors. Win-win strategies were facilitated by mechanisms related to several activities, including: the development of a shared language to facilitate communication between actors from different sectors; integrating health into other policy agendas (eg., sustainability) and use of dual outcomes to appeal to the interests of diverse policy sectors; use of scientific evidence to demonstrate the effectiveness of HiAP; and using health impact assessment to make policy coordination for public health outcomes more feasible and to give credibility to policies being developed by diverse policy sectors. Conclusion Our findings enrich theoretical understanding in an under-unexplored area of intersectoral action. They also provide policy makers with examples of HiAP across wealthy welfare regimes, and improve understanding of successful HiAP implementation practices, including the win-win approach.

Absztrakt Bevezetés/célkitűzés: A hasfali sérvek laparoscopos megoldásában a sebészi háló intraperitonealis pozícióban kerül beültetésre. Állatmodellekben és a humángyakorlatban egyaránt ígéretesek a kombinált, többrétegű hálók. Jelen kísérlet célja két eltérő szerkezetű, szilikonbevonatú polipropilén háló biológiai viselkedésének összehasonlítása volt. Anyag és módszerek: Új-zélandi fehér nyulak hasfalán egy 3 × 4 cm nagyságú, teljes vastagságú hasfaldefektust készítettünk, melyet összetett hálóval fedtünk. 20 állatba a felszínén lamináris szilikonréteggel bevont hálót (LSPP), a másik 20 nyúl esetében szilikonnal impregnált polipropilén filamentumból szőtt hálót (MSPP) ültettünk be. Az intraperitonealis adhaesioképződés mértékét és a hálók beépülését vizsgáltuk. Immunhisztokémiai módszerrel az osztódó sejtek jelenlétét és eloszlását az idegen anyag környezetében (Ki-67), az érújdonképződést (VEGF) és a kialakuló neoperitoneum-réteget (CK) vizsgáltuk, scanning elektronmikroszkóppal a halók felszínét tanulmányoztuk. Eredmények: Az intraperitonealis adhaesioképződés mértéke az első héten nem mutatott eltérést, míg a harmadik héten az LSPP szignifikánsan kevesebb kitapadást generált. A Ki-67 antitest jelölés szignifikánsan alacsonyabb aktivitású volt a makroporózus hálók csoportjában. Ugyanebben a csoportban a VEGF pozitivitás időarányosan nőtt, míg az LSPP esetében nem változott. A vékony neoperitoneum-réteg csak a makroporózus háló felszínén volt szövettanilag kimutatható (CK jelölés), az LSPP esetében hiányzott. Következtetések: A sebészi háló alapanyaga és textúrája is meghatározó szerepet játszik a befogadó szövetbe történő integrációban, mely arányos a kiváltott idegentest-reakcióval.

The spatial distribution and temporal variability of visibility data measured at 23 stations in Hungary show that changes have occurred between 1996 and 2002. Extinction coefficients were calculated from visual range observations using the Koschmieder formula, and dry extinction coefficients were estimated by fitting them to power functions of relative humidity. The lowest visibilities were found over the Great Hungarian Plain, probably because of the effects of particles of surface origin. At all but two stations the visibility increased from 1996 to 2002, probably due to the decreased load of anthropogenic aerosol particles. This finding is in excellent agreement with the significant decrease in the emission of sulfur dioxide. During the 6 years studied there was an important improvement in atmospheric light attenuation over Hungary.

Background: During implementation of a community development project involving a severely disadvantaged Roma community, the community was threatened with eviction. Two scenarios, eviction with placement on the waiting list for social housing versus a replacement housing development, were identified and specified. A health impact assessment (HIA) was carried out to inform subsequent negotiations. Aims: To assess the health effects of eviction in comparison with that of a housing project for a Roma community; to make recommendations on short-term and long-term benefits of the two scenarios in order to inform the local government; and to develop a demonstration HIA that can act as a model for other disadvantaged Roma populations. Method: A prospective assessment, based on a broad model of health, was carried out to assess health effects of a housing project compared with eviction. By design, it ensured full involvement of members of the community, local decision makers and relevant stakeholders. Results and conclusion: This HIA identified numerous positive and some probable negative health effects of a housing project. Despite the uncertainty around some of its predicted effects, the overall health benefit of a housing project clearly outweighed that of eviction. Although the immediate financial advantages of eviction for the municipal government are clear, this example provides further evidence to support the adoption of a statutory requirement to assess both economic and health outcomes. It also provides an example that other Roma communities can emulate.

The recent global recession and concurrent rise in job loss makes unemployment insurance (UI) increasingly important to smooth patterns of consumption and keep households from experiencing extreme material poverty. In this paper, we undertake a realist review to produce a critical understanding of how and why UI policies impact on poverty and health in different welfare state contexts between 2000 and 2013. We relied on literature and expert interviews to generate an initial theory and set of propositions about how UI might alleviate poverty and mental distress. We then systematically located and synthesized peer-review studies to glean supportive or contradictory evidence for our initial propositions. Poverty and psychological distress, among unemployed and even the employed, are impacted by generosity of UI in terms of eligibility, duration and wage replacement levels. Though unemployment benefits are not intended to compensate fully for a loss of earnings, generous UI programs can moderate harmful consequences of unemployment.

Background. It is estimated that 347 million people suffer from diabetes mellitus (DM), and almost 5 million are blind due to diabetic retinopathy (DR). The progression of DR can be slowed down with early diagnosis and treatment. Therefore our aim was to develop a novel automated method for DR screening.Methods. 52 patients with diabetes mellitus were enrolled into the project. Of all patients, 39 had signs of DR. Digital retina images and tear fluid samples were taken from each eye. The results from the tear fluid proteomics analysis and from digital microaneurysm (MA) detection on fundus images were used as the input of a machine learning system.Results. MA detection method alone resulted in 0.84 sensitivity and 0.81 specificity. Using the proteomics data for analysis 0.87 sensitivity and 0.68 specificity values were achieved. The combined data analysis integrated the features of the proteomics data along with the number of detected MAs in the associated image and achieved sensitivity/specificity values of 0.93/0.78.Conclusions. As the two different types of data represent independent and complementary information on the outcome, the combined model resulted in a reliable screening method that is comparable to the requirements of DR screening programs applied in clinical routine.

Direct climate forcing due to scattering and absorption of the main aerosol components (ammonium sulfate and total carbon) was estimated seasonally in Hungary by a box model. Ammonium sulfate played an important role in the direct forcing while the carbonaceous aerosol contributed significantly to the development of extinction. In summer, the scattering effect of both species showed a maximum (ammonium sulfate: −2.21±1.73 W m −2 , total carbon: −0.88±0.73 W m −2 ), while the absorption of carbon was the most significant in autumn (+0.40±0.41 W m −2 ). Uncertainty of these data was obtained by using the theory of error propagation and by taking into consideration the standard deviation of the experimental parameters. The relatively high values of the calculated relative standard deviations of the climate forcing data were attributed partly to the large number of the model parameters (9 and 11) and partly to their large uncertainty. The calculated uncertainties of various forcings were found to be in between the factors of 1.7 and 2.1 which were lower than those generally applied in forcing calculations. Parameter sensitivity analysis of the model equation proved that the reliability of the calculated data could be improved if attention is paid to the measurement of certain parameters such as: mass concentration, cloud coverage, surface albedo, upscattered fraction, single-scattering albedo and the fractional transmittance of the atmosphere.

Size distribution of fine atmospheric aerosol was measured at K-puszta, Hungary during summer and winter of 2000 and spring and autumn of 2001. The sampling was carried out by an electrical low pressure impactor which fractionated fine particles (d

UNLABELLED Biobanks are essential tools in diagnostics and therapeutics research and development related to personalized medicine. Several international recommendations, standards and guidelines exist that discuss the legal, ethical, technological, and management requirements of biobanks. Today's biobanks are much more than just collections of biospecimens. They also store a huge amount of data related to biological samples which can be either clinical data or data coming from biochemical experiments. A well-designed biobank software system also provides the possibility of finding associations between stored elements. Modern research biobanks are able to manage multicenter sample collections while fulfilling all requirements of data protection and security. While developing several biobanks and analyzing the data stored in them, our research group recognized the need for a well-organized, easy-to-check requirements guideline that can be used to develop biobank software systems. International best practices along with relevant ICT standards were integrated into a comprehensive guideline: The Model Requirements for the Management of Biological Repositories (BioReq), which covers the full range of activities related to biobank development. The guideline is freely available on the Internet for the research community. AVAILABILITY The database is available for free at http://bioreq.astridbio.com/bioreq_v2.0.pdf.