The Clinical Point of View

Surgeons frequently find pancreatic head mass when operating. The obvious difficulty is to make the correct preoperative differential diagnosis between chronic pancreatitis and pancreatic tumor. The first step is to reach a diagnosis, with some certainty, prior to the operation. The second step in the case of a tumor is the accurate staging and deciding whether or not it is resectable. On the one hand, time and cost must be considered; on the other hand, the therapy must be decided. Obtaining information about the characteristics of the pancreatic disease (nature, size, exact location) and establishing the tissue diagnosis preoperatively may simplify the decision to operate and the operation itself. In the case of chronic pancreatitis, the aim of the operation is to eliminate pain and other symptoms, while in the case of cancer, the purpose is to remove the malignant tissue. In most patients, it is possible to identify the disease on the basis of previous examinations together with preoperative diagnostic techniques such as exploration, palpation and fine-needle aspiration biopsy. Chronic pancreatic head mass should be operated upon with Beger’s or Frey’s procedure while pancreatic head tumors should be treated by means of head resection with the aim of preserving the pylorus or the Whipple procedure may be used. When the diagnosis is in doubt, a radical approach is thought to be best. Our conclusion is that there is no diagnostic method capable of making a definitive differential diagnosis as to the nature of the pancreatic head mass. Further study is required as to the extent to which differential diagnosis should be investigated.Image: 1st Surgical Department, Semmelweis University. Budapest, Hungary

Computed Tomography Scan

The diagnosis of different pancreatic diseases has recently become a recurrent problem. In cases with pancreatic head mass the main question is the differentiation between malignant and benign lesions. When a neoplasm is suspected, the main task is to judge operability. The usefulness of computed tomography imaging in the evaluation of pancreatic carcinoma has been well established. In this article the authors discuss the possibilities of computed tomography (CT) in diagnostic work-up.Image: CT after contrast medium administration shows multiple cystic lesions in the head of the pancreas

Surgical Treatment

Pancreatic carcinoma is a devastating disease. Untreated 5-year survival is 0%. The only possibility of being cured is given by surgical removal of the tumor. Pancreatoduodenectomy previously involved high morbidity and mortality rates until it was postulated that palliation gave better results. Today, morbidity and mortality rates have been decreased to an acceptable level, mortality rates in specialized centers being under 5%. Prognostic factors determining survival were found to be the size of the tumor, grade, lymph node involvement and stage. In order to be able to compare results of the different centers, standardization of the surgical technique is mandatory. It is unanimously accepted that in order to improve survival in pancreatic carcinoma, the radicality of the surgical procedure should be increased to include lymphadenectomy. Postoperative adjuvant therapy could also be a determinant factor. Prospective randomized clinical trials will give an answer to these still unanswered questions.Image: Semmelweis University logo. Budapest, Hungary

Age-specific modifications in healthy adults' knee joint position sense

Aim: Right-handed young adults perform target-matching tasks more accurately with the non-dominant (ND) compared to the dominant (D) limb, but it is unclear if age affects this disparity. We determined if age affects target-matching asymmetry in right-side dominant healthy adults. Method: Young (n = 12, age: 23.6 y, 6 females) and older (n = 12; age: 75.1 y, 7 females) adults performed a passive joint position-matching task with the D and ND leg in a randomized order. Result: Age affected absolute, constant, and variable knee JPS errors but, contrary to expectations, it did not affect target-matching asymmetries between the D and ND knees. However, older participants tended to underestimate while young subjects overestimated the target angles. Moreover, older as compared to young subjects performed the target-matching task with higher variability. Conclusion: Altogether, age seems to affect passive knee target-matching behaviour in right-side dominant healthy adults. The present data indicate that healthy aging produces age-specific modifications in passive joint position sense.</p

The C. elegans Hox gene ceh-13 regulates cell migration and fusion in a non-colinear way. Implications for the early evolution of Hox clusters

Background: Hox genes play a central role in axial patterning during animal development. They are clustered in the genome and specify cell fate in sequential domains along the anteroposterior (A-P) body axis in a conserved order that is co-linear with their relative genomic position. In the soil worm Caenorhabditis elegans, this striking rule of co-linearity is broken by the anterior Hox gene ceh-13, which is located between the two middle Hox paralogs, lin-39 and mab-5, within the loosely organized nematode Hox cluster. Despite its evolutionary and developmental significance, the functional consequence of this unusual genomic organization remains unresolved.Results: In this study we have investigated the role of ceh-13 in different developmental processes, and found that its expression and function are not restricted to the anterior body part. We show that ceh-13 affects cell migration and fusion as well as tissue patterning in the middle and posterior body regions too. These data reveal novel roles for ceh-13 in developmental processes known to be under the control of middle Hox paralogs. Consistently, enhanced activity of lin-39 and mab-5 can suppress developmental arrest and morphologic malformation in ceh-13 deficient animals.Conclusion: Our findings presented here show that, unlike other Hox genes in C. elegans which display region-specific accumulation and function along the A-P axis, the expression and functional domain of the anterior Hox paralog ceh-13 extends beyond the anterior region of the worm. Furthermore, ceh-13 and the middle Hox paralogs share several developmental functions. Together, these results suggest the emergence of the middle-group Hox genes from a ceh-13-like primordial Hox ancestor

Public Security as a Cooperative Activity a Few Thoughts on the Social and Public Image of Law Enforcement Work

Law enforcement is a unique, clearly delineated area of state involvement. Enhancing security is an important aim of state involvement, which affects diverse areas. Research thereon relate the interdisciplinary concept of security to conflicts and socio-economic crises. As a consequence, setting up a framework of policies for the topic demands a plurality of methods. The Good State and Governance report, published in 2015, names security and trust as defining spheres of influence. More specifically, the following 5 indicators presented as dimensions of public security and catastrophe management (citizens’ sense of security in public places of their residential area; citizens’ trust in the police; the number of registered wilful murders, intentional bodily injuries, and robberies; government expenditure on public order, civil protection, fire and catastrophe management per 1000 citizens; and the human resources of law enforcement) show well the importance of the common mindset associated with the Good State and Government special report. It is acknowledged that public security is a measurable social phenomenon; the objective state of private security is shown by criminal statistics; and public opinion concerning public security informs us about subjective security

Új paradigma felé: bizalom és biztonság a térben: A rendészeti szervezet működését meghatározó társadalmi keretek kapcsolatának néhány kérdése

The authors provide an overview of the importance and interrelation of trust and security in a democratic society governed by the rule of law.A szerzők áttekintést nyújtanak a bizalom és biztonság összekapcsolásának fontosságáról&nbsp;a demokratikus társadalomban

White plague among the “forgotten people” from the Barbaricum of the Carpathian Basin–Cases with tuberculosis from the Sarmatian-period (3rd–4th centuries CE) archaeological site of Hódmezővásárhely–Kenyere-ér, Bereczki-tanya (Hungary)

Tuberculosis (TB) is a bacterial infection that is well-known in the palaeopathological record because it can affect the skeleton and consequently leaves readily identifiable macroscopic alterations. Palaeopathological case studies provide invaluable information about the spatio-temporal distribution of TB in the past. This is true for those archaeological periods and geographical regions from when and where no or very few TB cases have been published until now–as in the Sarmatian period (1 st –5 th centuries CE) in the Barbaricum of the Carpathian Basin. The aim of our paper is to discuss five newly discovered TB cases ( HK199 , HK201 , HK225 , HK253 , and HK309 ) from the Sarmatian-period archaeological site of Hódmezővásárhely–Kenyere-ér, Bereczki-tanya (Csongrád-Csanád county, Hungary). Detailed macromorphological evaluation of the skeletons focused on the detection of bony changes likely associated with different forms of TB. In all five cases, the presence of endocranial alterations (especially TB-specific granular impressions) suggests that these individuals suffered from TB meningitis. Furthermore, the skeletal lesions observed in the spine and both hip joints of HK225 indicate that this juvenile also had multifocal osteoarticular TB. Thanks to the discovery of HK199 , HK201 , HK225 , HK253 , and HK309 , the number of TB cases known from the Sarmatian-period Carpathian Basin doubled, implying that the disease was likely more frequent in the Barbaricum than previously thought. Without the application of granular impressions, the diagnosis of TB could not have been established in these five cases. Thus, the identification of TB in these individuals highlights the importance of diagnostics development, especially the refinement of diagnostic criteria. Based on the above, the systematic macromorphological (re-)evaluation of osteoarchaeological series from the Sarmatian-period Carpathian Basin would be advantageous to provide a more accurate picture of how TB may have impacted the ancestral human communities of the Barbaricum