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Abstract In this paper we discuss the relevance of continuity equation based aortic valve area (AVA) calculation as a robust parameter suitable for accurate grading of aortic stenosis (AS) irrespective of flow conditions. Combining the AVA-based grading and echocardiography-based staging, can provide with the most comprehensive clinical assessment of patients with AS and preserved left ventricular systolic function to streamline management decisions.

Introduction: Reel syndrome resulting in lead dislodgement is a rare, but well-known complication of cardiac device implantation. Therefore, it has to be considered in case of device dysfunction. Case description: We present the case of a 64-year-old male patient who visited our ward following an ICD shock. He had heart failure with reduced ejection fraction, and had a CRT-D device implanted 2 years before. The 12-lead ECG showed a septal pacemaker rhythm. Device interrogation verified adequate ICD therapy, with left ventricular sensing and capture failure. Chest X-ray showed optimal right atrial and defibrillator lead position. The left ventricular lead was not present near the heart. Our patient reported that he regularly manipulated the area around the device. During the pacemaker system revision, the diagnosis of isolated coronary sinus lead Reel syndrome was verified. We removed the old lead and implanted a new one in a good position in a lateral vein. Discussion: Thorough patient education and regular check-ups for patients living with permanent pacemakers and implantable cardioverter defibrillators are essential. Migration of the device can occur in some rare cases, leading to lead dislodgement. We can reduce the risk of these complications by appropriately anchoring leads and generators.

We present the case of a 52-year-old female patient on optimal medical therapy (OMT) for heart failure with severely reduced ejection fraction. She was diagnosed with dextrocardia and congenital corrected transposition of the great arteries (ccTGA) by echocardiography. Despite 3 months of OMT and a persisting NYHA II functional state, she was referred for primary prevention ICD implantation. At admission echocardiography revealed a hypertrophic systemic ventricle with an ejection fraction of 27%. Cardiac CT confirmed ccTGA, dextrocardia, a normal extracardiac and epicardial venous system. Coronary artery disease was excluded. Our team opted for left-sided VDD-ICD implantation in case of a need for AV-synchronous pacing and to enhance arrhythmia discrimination. An active fixation shock lead was placed in the mid-septal region of the functional right ventricle. The defibrillation threshold test (DFT) was successful at 20 J. No periprocedural complications were observed. At the 12-month ambulatory visit, device interrogation showed good function, no detected arrhythmias, and no antitachycardia therapy was delivered. Preoperative imaging is essential prior to any invasive cardiac procedure in patients with congenital heart disease. Performing a DFT test at adult congenital heart disease patients may be reasonable.

Fuel combustion in various industrial and energy systems will remain critical, regardless of the realized efforts to achieve climate neutrality. The pollutant emission regulations feature mostly avoidable pollutants, such as NOx, which is emphasized in the present paper. Since frequently used pollutant emission sensors respond in about half a minute, direct, detailed temporal information on system operation is inaccessible with these technologies under real conditions. The presently used External exhaust Photoacoustic Analyzer (ExPA) system fills this gap. Its memory-free operation allows for temporally detailed information on pollutants and combustion conditions, enabling a better understanding of existing and contributing to advanced, clean combustion systems. Four different hydrocarbon fuels: natural gas, JP-8 kerosene, diesel fuel, and a 50 % diesel-biodiesel fuel blend were tested under various equivalence ratios, thermal powers, air preheating temperatures, and atomizing conditions. Based on the comparison of the NO emission of the two systems, it was concluded that the measurement results of stable flames generally matched. The match under transient operation was present only if intermittency existed longer. Otherwise, only the ExPA analyzer had a sufficiently low response time to reveal the characteristics of intermittent operation. Besides NO, NO2 was also measured by the ExPA system, concluding that the share of NO2 of conventional flames in the flue gas is about 2.5 % of that of NO concentration.

The urban environment is posing substantial challenges to both human well-being and the growth of plantations. Deploying advanced urban trees that effectively interact with atmospheric pollution will be a crucial step in urban planning. However, there is a paucity of knowledge in Hungary regarding these aspects. We studied the photosynthesis activities of three commonly planted trees (Acer platanoides, Fraxinus excelsior, and Tilia tomentosa) from two locations in Budapest, as well as their potential of capturing fine particulate matter on leaf surfaces. Our results reveal that T. tomentosa has developed a denser canopy and better photosynthetic activities, hence enhancing its adaptation to the urban environment in Budapest. F. excelsior showed a higher amount of fine PM wash-off, as it has a smoother leaf surface and was subjected to influences from wind speed and precipitation, making the captured particles more easily dislodged. Whereas fine PM concentration of A. platanoides and T. tomentosa were influenced by ambient PM10 and PM2.5, which might retain on their rough and hairy leaf surfaces. Approximately 38.17 tons of fine PM could be retained on urban greenery of Budapest at any given moment, highlighting the significant ecological and economic benefits of urban greenery. However, more accurate and long-term modeling is needed to develop a sustainable strategy for maximizing these benefits.

A panel of 24 international experts met in July 2022 to discuss challenges associated with pertussis detection, monitoring, and vaccination in adults; conclusions from this meeting are presented. There has been a shift in the epidemiology of pertussis toward older children and adults. This shift has been attributed to the waning of infection- or vaccine-induced immunity, newer detection techniques causing detection bias, and possibly the replacement of whole-cell pertussis with acellular vaccines in high-income countries, which may lead to immunity waning more quickly. The burden of adult pertussis is still likely under-ascertained due to widespread under-recognition by healthcare professionals (HCPs), under-diagnosis, and under-reporting in this age group. Non-standardized testing guidance and varied case definitions have contributed to under-reporting. Key barriers to HCP engagement with the tetanus, diphtheria, and pertussis (Tdap) vaccine include low awareness, lack of time/funding, and lack of motivation due to low prioritization of Tdap.

ABSTRACTPertussis has several notable consequences, causing economic burden, increased strain on healthcare facilities, and reductions in quality of life. Recent years have seen a trend toward an increase in pertussis cases affecting older children and adults. To boost immunity, and protect vulnerable populations, an enduring approach to vaccination has been proposed, but gaps remain in the evidence surrounding adult vaccination that are needed to inform such a policy. Gaps include: the true incidence of pertussis and its complications in adults; regional variations in disease recognition and reporting; and incidence of severe disease, hospitalizations, and deaths in older adults. Better data on the efficacy/effectiveness of pertussis vaccination in adults, duration of protection, and factors leading to poor vaccine uptake are needed. Addressing the critical evidence gaps will help highlight important areas of unmet need and justify the importance of adult pertussis vaccination to healthcare professionals, policymakers, and payers.

Background: Evidence on how decisions regarding escalation to triple therapy and de- or re-escalation are taken and the rationale on which these decisions are based is currently limited in Germany. Objectives: The TETRIS study aims to elucidate influences on treatment decisions surrounding triple therapy in a real-world practice setting in Germany. Design: TETRIS is an ongoing, multicenter, prospective, observational cohort study recruiting patients with chronic obstructive pulmonary disease (COPD) with or without asthma who have already been treated with triple therapy for 2–48 weeks. Methods: For better representation of the treatment reality in Germany, patients are recruited from general practitioners and pulmonologists. Data are collected in two parts. Part 1 involves cross-sectional phenotyping of patients at enrollment. Part 2 involves a 2-year longitudinal follow-up period to monitor/document all visits by the patients during the 24-month observation period per routine clinical practice. Here, we report the demographic and baseline characteristics of 1213 eligible patients recruited to part 1 of the study. Results: The mean patient age was 66.4 years overall, and 29.3% (356/1213) of patients had no comorbidities. The mean CAT score was 19.4; the number of exacerbations and hospitalizations due to exacerbations in the past 3 years before starting triple therapy was 0.6 and 0.1, respectively. Dual bronchodilation with a long-acting muscarinic antagonist (LAMA) plus a long-acting β-2 agonist (LABA) was the most common therapy for COPD before initiation of triple therapy in 58.3% of patients. Conclusion: In this real-world setting in Germany, patients with COPD have a relatively low reported exacerbation rate but high symptom burden, and over 70% are multimorbid. Triple therapy is initiated in patients who are primarily highly symptomatic despite being on LAMA + LABA. Future prospective studies in patients with multimorbidity are warranted to better understand the treatment landscape across the disease spectrum. Trial registration: https://clinicaltrials.gov/study/NCT04657211

IntroductionOne of the greatest challenges of our time is antimicrobial resistance, which could become the leading cause of death globally within a few decades. In the context of One Health, it is in the common interest to mitigate the global spread of antimicrobial resistance by seeking alternative solutions, alongside appropriate drug selection and responsible use. Probiotics offer a potential avenue to reduce antibiotic usage; however, there is a scarcity of research that examines commercial products in terms of carrying antimicrobial resistance genes (ARGs) involved in resistance development through microbial vectors.MethodsOur study investigated 10 commercially available probiotic products for cats and dogs. Initially, we conducted phenotypic testing through determination of minimum inhibitory concentration (MIC) for antibiotics important in animal and public health. Subsequently, we performed next-generation sequencing (NGS) of the products to elucidate the genetic background behind the decrease in phenotypic sensitivity.ResultsIn total, 19 types of ARGs were identified, with 57.9% being found on plasmids, and in two cases, carriage as mobile genetic elements were found. One of the genes identified was the APH(3′)-Ia gene, capable of inactivating aminoglycoside antibiotics through phosphotransferase enzyme production regulation, while the other was the tetS gene, capable of conferring reduced sensitivity to tetracycline antibiotics through target protection.DiscussionOur findings underscore the importance of approaching antimicrobial resistance investigations from a broader perspective. We suggest that further studies in this area are justified and raise questions regarding the need to extend legally required studies on probiotic products from their use in economic livestock to their use in companion animals.

In case of pacemaker implantation, axillary vein puncture remains a less common technique in both domestic and foreign institutions. In our article, we present the implementation of this method in a center where there was no prior experience with it. During our study, dividing the patients into two groups, we retrospectively compared the success and complication rates of subclavian and axillary punctures. Based on our results, introducing the electrode through the axillary vein is equally effective and safer than subclavian puncture. It can be easily mastered even without specific training by an electrophysiologist experienced in subclavian vein cannulation.

Abstract Freshwater ecosystems are increasingly affected by rising annual mean temperatures and heatwaves. While heatwaves are expected to have more immediate effects than mean temperature increases on local communities, comparative experimental studies are largely lacking. We conducted a 1‐month mesocosm experiment to test the effect of different warming treatments, constantly raised temperatures (+3°C) and recurring heatwaves (+6°C), on plankton communities. We specifically tested how shifts in zooplankton trait composition and functional groups are reflected in ecosystem function (top‐down control on primary producers). We found that heatwaves had a stronger and more immediate effect on zooplankton trait composition (specifically on body length and body mass) and functional groups. Heatwaves led to the decrease of small‐bodied grazers (i.e., Rotifera) and the dominance of larger omnivorous Copepoda, and these shifts resulted in weaker top‐down control, leading to elevated phytoplankton biomass. Altogether, our results highlight the importance of the indirect effects of heatwaves via inducing shifts in zooplankton functional groups and trait composition, which may lead to algal blooms.

A szerző alapos áttekintést nyújt a rendőrségi korrupció horizontális és vertikális szerkezetéről.

Cél: A tanulmány elkészítésének célja a nagyvárosokban általános problémát jelentő, a közterületeken hagyott, hulladékká vált gépjárművek elszállításával kapcsolatos, sokak által csak kevéssé ismert problémakör és az arra adható önkormányzati rendészeti válaszok, megoldási lehetőségek bemutatása. Módszertan: Jelen tanulmány szerzői az önkormányzati rendészet működésében jártas rendészeti szakemberként elemzik a közterületen elhagyott gépjárművek elszállításával kapcsolatos jogi környezetet, rámutatva az abban rejlő akadályokra és megoldási lehetőségekre. Megállapítások: A rendészettel, így a biztonságunk megteremtésének állami szereplőivel, kiemelten a rendőrség tevékenységével sokan és sokféleképpen foglalkoztak és foglalkoznak. A rendészettudomány kutatói közül viszont csak igen kevesen irányították figyelmüket a rendészet speciális szerveire, így a tanulmány tárgyát képező önkormányzati rendészeti szerv működésére. A szerzők egy sokakat érzékenyen érintő, mégis csak kevéssé ismert és kutatott problémakört, a hatékony rendészeti fellépést nehezítő jogi akadályokat mutatják be a hulladékká vált járművek közterületről történő eltávolításával összefüggésben. Bepillantást adva az önkormányzati rendészeti szervek összetett működésébe, a biztonság mint közös küldetésünk megteremtése egyik speciális szervének mindennapjaiba. Érték: A tanulmány szerzői az önkormányzati rendészeti szervek működésének átfogó tudományos kutatásához, feltérképezéséhez kívánnak hozzájárulni, felismerve annak tényét, hogy a kutatott téma a rendőri működés folyamatosan időszerű kérdése, ugyanis a rendőrség működésében az elmúlt két évtized számos, addig nem tapasztalt helyzetet eredményezett. A feladatok és elvárások mennyiségi és minőségi átalakulása a rendőri és az önkormányzati rendészeti szervek közötti kapcsolat átértékelését is szükségessé teszi. A tanulmány ezen tevékenység tanulmányozásához nyújt segítséget.

Abstract Hybridization can provide evolutionary benefits (e.g., population resilience to climate change) through the introduction of adaptive alleles and increase of genetic diversity. Nevertheless, management strategies may be designed based only on the parental species within a hybrid zone, without considering the hybrids. This can lead to ineffective spatial management of species, which can directly harm population diversity and negatively impact food webs. Three species of rockfish (Brown Rockfish (Sebastes caurinus), Copper Rockfish (S. auriculatus), and Quillback Rockfish (S. maliger)) are known to hybridize within Puget Sound, Washington, but genetic data from these species are used to infer population structure in the entire genus, including in species that do not hybridize. The goal of this project was to estimate the hybridization rates within the region and determine the effect of hybridization on geographic patterns of genetic structure. We sequenced 290 Brown, Copper, and Quillback rockfish using restriction‐site associated DNA sequencing (RADseq) from four regions within and outside Puget Sound, Washington. We show that (i) hybridization within Puget Sound was asymmetrical, not recent, widespread among individuals, and relatively low level within the genome, (ii) hybridization affected population structure in Copper and Brown rockfish, but not in Quillback Rockfish and (iii) after taking hybridization into account we found limited directional dispersal in Brown and Copper rockfish, and evidence for two isolated populations in Quillback Rockfish. Our results suggest that rockfish population structure is species‐specific, dependent on the extent of hybridization, and cannot be inferred from one species to another despite similar life history.

In the past decade we have seen new advances and thus remarkable progress in the therapeutic options for non-small cell lung cancer (NSCLC). Among cytostatic therapies with new approaches in molecularly targeted therapies, we see new developments in a wide range of applications for immunotherapies. In this review we discuss the new potential modalities for the use of immune checkpoint inhibitors (ICIs) in the frontlines, including in early-stage (perioperative) and metastatic settings. The perioperative use of ICIs in both neoadjuvant and adjuvant settings may show benefits for patients. In early-stage NSCLC (from stage IIB and above) a multimodality approach is recommended as the gold standard for the treatment. After surgical resection platinum-based adjuvant chemotherapy has been the standard of care for many years. Based on the benefit of disease-free survival, the approval of adjuvant atezolizumab and adjuvant pembrolizumab was a significant breakthrough. In the metastatic setting, the use of immune checkpoint inhibitors with chemotherapy, regardless of PD-L1 expression or ICI alone (PD-L1 expression equal to or greater than 50%) also improves overall survival and progression-free survival.