Background: Endocrine therapy for hormone receptor-positive breast cancer is associated with accelerated bone loss and increased fracture risk. Vertebral fractures (VFs) are frequently asymptomatic and remain underdiagnosed, potentially leading to underestimation of fracture risk. Methods: We conducted a cross-sectional real-world study that included 172 women with breast cancer (mean age 58.2 ± 12.0 years), the majority receiving aromatase inhibitors. Vertebral fractures were assessed using vertebral fracture assessment (VFA) during dual-energy X-ray absorptiometry (DXA). Bone mineral density (BMD), trabecular bone score (TBS), quantitative ultrasound (QUS), and FRAX® scores were evaluated. Results: Vertebral fractures were identified in 13% of patients, and 78% of these occurred in women with normal or osteopenic BMD. Age was independently associated with VFs, while conventional densitometric and non-densitometric parameters showed limited discriminatory ability. The incorporation of VFA-detected fractures into FRAX significantly increased estimated fracture risk (hip fracture risk: 0.8% vs. 4.1%, p = 0.008). Conclusions: Vertebral fractures are common and frequently unrecognized in women receiving endocrine therapy and are not adequately captured by BMD. Routine use of VFA during DXA substantially improves fracture risk assessment and leads to a clinically meaningful reclassification of FRAX estimates. These findings support a more comprehensive approach to skeletal risk evaluation in this population.

Body composition, bone mineral density, and cardiopulmonary exercise testing (CPET) are commonly used to assess aerobic fitness in athletes, but their interrelationships remain unclear. This study compared these parameters by sex and examined their associations in elite athletes. Our study included 145 youth water polo players (age: 15.7 ± 1.6 years; male: 75). Body composition was measured by DEXA, and treadmill CPET was performed using a sport-specific protocol. We analysed the correlations between the following factors by multivariate linear regression: lean body mass (LBM, LBMindex); body fat mass (BFM); percent body fat (PBF); bone mineral content (BMC); lumbar, femoral, and radial bone mineral density (LBMD, FNBMD, FTBMD, RBMD); exercise time; absolute and relative maximal oxygen uptake (VO2absmax, VO2relmax); maximal ventilation (VEmax). Exercise time was found to be negatively correlated with BFM, while VO2relmax was found to be negatively correlated with BFM and PBF. VO2absmax was found to be positively correlated with BFM, LBM, BMC, FNBMD, and RBMD. VEmax was found to be positively correlated with LBM and LBMindex. In males, VO2absmax and VEmax were found to be positively correlated with LBMD and FTBMD. Correlations between bone density and CPET proved to be stronger in males. Our results indicate that body composition and bone density parameters influence CPET parameters, and their complex evaluation can support personalized diagnostics and athletes’ health.

Body composition and cardiopulmonary exercise testing (CPET) are vital for optimizing sports performance, but the correlations between them are still underexplored. Our study aimed to investigate the relationships between body composition and specific CPET variables describing physical fitness in young athletes, also adjusting for age and height, in a less-studied, female population. Seventy players participated in our study (age: 16.10 ± 1.63 y). After determining body composition using dual-energy X-ray absorptiometry, we conducted treadmill-based maximal-intensity CPET. Data were analyzed in R using multivariate linear regression, accounting for age and height as confounders. Lean body mass (LBM), body fat mass (BFM), and bone mineral content (BMC) showed no effect on resting, maximum, or recovery heart rates and no correlation with resting or maximal lactate values. LBM positively correlated with maximum ventilation (VE-max) (Est: 1.3 × 10−3; SE: 6.1 × 10−4; p < 0.05) and maximum absolute oxygen consumption (VO2abs-max) (Est: 7.710−5; SE: 6.9 × 10−6; p < 0.001)—with age as an influencing factor for VE-max and height as an influencing factor for VO2abs-max. Conversely, BFM showed a negative correlation with maximum relative oxygen consumption (VO2rel-max) (Est: −4.8 × 10−4; SE: 1.2 × 10−4; p < 0.001). Moreover, BFM and BMC were also negatively correlated with maximal exercise duration (Est: −2.2 × 10−4; SE: 8.0 × 10−5; p < 0.01; Est: −3.2 × 10−3; SE: 1.4 × 10−3; p < 0.05) with height as an influencing factor. Our findings indicate complex correlations between body composition and CPET parameters, providing important information for the analysis of individual ergospirometric data. Our results draw attention to the fact that body composition is more precise than weight and height in the evaluation of athletes’ physical fitness.

There is abundant evidence that bone mineral content is highly heritable, while the heritability of bone quality (i.e. trabecular bone score [TBS] and quantitative ultrasound index [QUI]) is rarely investigated. We aimed to disentangle the role of genetic, shared and unique environmental factors on TBS and QUI among Hungarian twins. Our study includes 82 twin (48 monozygotic, 33 same-sex dizygotic) pairs from the Hungarian Twin Registry. TBS was determined by DXA, QUI by calcaneal bone ultrasound. To estimate the genetic and environmental effects, we utilized ACE-variance decomposition. For the unadjusted model of TBS, an AE model provided the best fit with > 80

Rapidly evolving clinical data suggest that the novel coronavirus (SARS-CoV-2) and vaccination against COVID-19 might be associated with thyroid disturbances. However, studies remain limited among the pediatric population . Our aim was to assess the prevalence and permanence of thyroid autoimmunity (TA) and dysfunction in children after an acute infection and its potential association with vaccination. A prospective, multicenter registry analysis was performed among 458 children (mean age: 12.4 ± 3,8 years, 45.4% male) with preceding COVID-19. Patient inclusion lasted from 24 th March, 2021 to 23 rd March, 2022 at three pediatric outpatient facilities at Semmelweis University, Budapest. Primary outcomes were the rate of thyroid disturbances assessed by laboratory parameters (thyroid function tests, antithyroglobulin [ATG] and anti-thyroid peroxidase [ATPO] antibodies) and thyroid ultrasound. TA rate among vaccinated and unvaccinated children was determined. Children with newly diagnosed thyroid alterations were followed up for 12.7 ± 4.3 months. Six children had previous thyroid disease. Out of 452 children, 30 cases (6.6%) of newly diagnosed TA (six of them had abnormal thyroid-stimulating hormone [TSH] levels) and eight cases (1.8%) of isolated TSH elevation were observed. Ultrasound-proven autoimmune thyroiditis (AIT) was 4.0%. No association was found between COVID-19 vaccination and thyroid autoimmunity (χ 2 (1,N = 452) = 0.138, p = 0.815). Among children with TA, 73.3% had long-lasting alterations. Conclusion : Vaccination had no effect on the prevalence of TA. Until further controlled studies state otherwise, children with preceding COVID-19 might benefit from thyroid screening. What is Known: • Numerous case reports implicate that coronavirus disease-2019 (COVID-19) and vaccination against SARS-CoV-2 can be responsible for thyroid disturbances. • Thyroid alterations discovered during acute COVID-19 tend to cease by time and only incidental thyroid autoimmunity (TA) is diagnosed after COVID-19. In adults, no increase in vaccine-related hyper- or hypothyroidism was found. What is New: • TA rate after COVID-19 vaccination among children was not increased. TA had no role in long COVID syndrome. • We discovered a considerable rate of TA (6.6%) and ultrasound-proven autoimmune thyroiditis (AIT) (4.0%) after SARS-CoV-2 infection, and the majority of these alterations remained positive after 6 months.

Összefoglaló. A gyermekek közel fele szenved el csonttörést. Ez lehet traumás esemény vagy a csontfejlődést megzavaró genetikus, hormonális vagy egyéb eltérés a csontváz bármely részén. A leggyakoribb azonban az enyhe trauma kapcsán jelentkező csuklótáji törés, amely többnyire a pubertas alatt fordul elő. A jelenség alapja, hogy a serdülés során átmenetileg elválik egymástól a csontok méretének gyors növekedése és a csonttömeg gyarapodása, ami a longitudinális növekedést kb. egy év késéssel követi. Az így kialakuló átmeneti csontgyengeség a gyermekkori csonttörés fő oka, aminek a hatásához az említett genetikai, hormonális és életmódi rendellenességek is csatlakozhatnak. A gyermekkorban előfordult kistraumás csonttörés a felnőtt férfiaknál az osteoporosisos csonttörések fokozott rizikójával jár, ezért szűrővizsgálati kérdésként is szolgál. Nők esetében ugyanez az összefüggés még bizonyításra vár. Orv Hetil. 2021; 162(42): 1687-1692. Summary. Bone fracture occurs nearly in half of the children. Some fractures are severe traumatic events while others are the results of genetic or hormonal or other alterations disturbing the normal development of bone. However, the majority of fractures are associated with a mild trauma, dominantly in the pubertal period. The basic pathology of the pubertal fractures is the transient deviation of peak velocity of height growth from the gain velocity of bone mass; the latter goes to peak 1 year later than height growth. This difference has been resulted in a physiologic but transient weakening of bones that can coincide with genetic, hormonal or life-style problems and all of these factors together may cause the increased fragility of the pubertal bone. Low-trauma fractures in childhood may be followed in high fracture risk of adult and aging men, so the childhood fracture seems to be a useful screening question for testing the osteoporosis in males. However, the same relation is still not proved in aging women. Orv Hetil. 2021; 162(42): 1687-1692.

Context Glucocorticoids (GCs) prescribed for chronic pediatric illnesses are associated with osteoporotic fractures. Objective This study aims to determine the efficacy and safety of intravenous (IV) zoledronic acid (ZA) compared with placebo to treat pediatric GC-induced osteoporosis (GIO). Methods Children aged 5 to 17 years with GIO were enrolled in this multinational, randomized, double-blind, placebo-controlled phase 3 trial (ClinicalTrials.gov NCT 00799266). Eligible children were randomly assigned 1:1 to 6 monthly IV ZA 0.05 mg/kg or IV placebo. The primary end point was the change in lumbar spine bone mineral density z score (LSBMDZ) from baseline to month 12. Incident fractures and safety were assessed. Results Thirty-four children were enrolled (mean age 12.6 +/- 3.4 years [18 on ZA, 16 on placebo]), all with low-trauma vertebral fractures (VFs). LSBMDZ increased from -2.13 +/- 0.79 to -1.49 +/- 1.05 on ZA, compared with -2.38 +/- 0.90 to -2.27 +/- 1.03 on placebo (least squares means difference 0.41 [95% CI, 0.02-0.81; P = .04]); when corrected for height z score, the least squares means difference in LBMDZ was 0.75 [95% CI, 0.27-1.22; P = .004]. Two children on placebo had new low-trauma VF vs none on ZA. Adverse events (AEs) were reported in 15 of 18 children (83%) on ZA, and in 12 of 16 (75%) on placebo, most frequently within 10 days after the first infusion. There were no deaths or treatment discontinuations due to treatment-emergent AEs. Conclusion LSBMDZ increased significantly on ZA compared with placebo over 1 year in children with GIO. Most AEs occurred after the first infusion.

Összefoglaló. A gyermekek közel fele szenved el csonttörést. Ez lehet traumás esemény vagy a csontfejlődést megzavaró genetikus, hormonális vagy egyéb eltérés a csontváz bármely részén. A leggyakoribb azonban az enyhe trauma kapcsán jelentkező csuklótáji törés, amely többnyire a pubertas alatt fordul elő. A jelenség alapja, hogy a serdülés során átmenetileg elválik egymástól a csontok méretének gyors növekedése és a csonttömeg gyarapodása, ami a longitudinális növekedést kb. egy év késéssel követi. Az így kialakuló átmeneti csontgyengeség a gyermekkori csonttörés fő oka, aminek a hatásához az említett genetikai, hormonális és életmódi rendellenességek is csatlakozhatnak. A gyermekkorban előfordult kistraumás csonttörés a felnőtt férfiaknál az osteoporosisos csonttörések fokozott rizikójával jár, ezért szűrővizsgálati kérdésként is szolgál. Nők esetében ugyanez az összefüggés még bizonyításra vár. Orv Hetil. 2021; 162(42): 1687–1692. Summary. Bone fracture occurs nearly in half of the children. Some fractures are severe traumatic events while others are the results of genetic or hormonal or other alterations disturbing the normal development of bone. However, the majority of fractures are associated with a mild trauma, dominantly in the pubertal period. The basic pathology of the pubertal fractures is the transient deviation of peak velocity of height growth from the gain velocity of bone mass; the latter goes to peak 1 year later than height growth. This difference has been resulted in a physiologic but transient weakening of bones that can coincide with genetic, hormonal or life-style problems and all of these factors together may cause the increased fragility of the pubertal bone. Low-trauma fractures in childhood may be followed in high fracture risk of adult and aging men, so the childhood fracture seems to be a useful screening question for testing the osteoporosis in males. However, the same relation is still not proved in aging women. Orv Hetil. 2021; 162(42): 1687–1692.

Bloom filters and their variants are widely used as space efficient probabilistic data structures for representing set systems and are very popular in networking applications. They support fast element insertion and deletion, along with membership queries with the drawback of false positives. Bloom filters can be designed to match the false positive rates that are acceptable for the application domain. However, in many applications a common engineering solution is to set the false positive rate very small, and ignore the existence of the very unlikely false positive answers. This paper is devoted to close the gap between the two design concepts of unlikely and not having false positives. We propose a data structure, called EGH filter, that supports the Bloom filter operations and besides it can guarantee false positive free operations for a finite universe and a restricted number of elements stored in the filter. We refer to the limited universe and filter size as the false positive free zone of the filter. We describe necessary conditions for the false positive free zone of a filter and generalize the filter to support listing of the elements. We evaluate the performance of the filter in comparison with the traditional Bloom filters. Our data structure is based on recently developed combinatorial group testing techniques.

Összefoglaló. Bevezetés: A gyermekkori akut lymphoblastos leukaemia kezelése napjainkban 80% feletti túlélést tesz lehetővé, de fontos cél a kezelés okozta mellékhatások kivédése és a gyermekek hosszú távú életminőségének javítása is. Célkitűzés: A kemoterápia csontrendszerre kifejtett mellékhatásainak vizsgálata és a prognosztikai tényezők feltárása, a rizikófaktorok összegyűjtése. Módszerek: Retrospektív vizsgálatunkba a Semmelweis Egyetem II. Gyermekgyógyászati Klinikáján 2007 és 2016 között kezelt 215, akut lymphoblastos leukaemiás gyermek közül a csontelváltozást észlelt betegeket vontuk be a következő, csontrendszert érintő megbetegedésekkel: 38 gyermeknél csökkent csontásványianyag-tartalom, 5 főnél osteonecrosis, 3 főnél osteomyelitis és 2 fő esetében patológiás fractura volt detektálható. Különböző követési időpontokban gyűjtöttünk oszteodenzitometriai adatokat, D-vitamin-, foszfát-, alkalikusfoszfatáz- és lipidszinteket is. Eredmények: Az oszteodenzitometriai értékek már a diagnóziskor csökkent értéket mutatnak, az intenzív vénás kemoterápia hatására pedig további csökkenés figyelhető meg (a lumbális gerinc Z-score-értéke a kezelés kezdetén: –1,5 ± 1,02, az intenzív vénás kezelés végén –1,8 ± 0,5). A Z-score-értékek a fenntartó terápia végére javuló tendenciát mutattak (–1,6 ± 0,5; p<0,05), majd az utánkövetés során ismételt javulás (–1,2 ± 0,4 [p<0,01] és –0,9 ± 0,4) figyelhető meg. A D-vitamin-szintek esetében az intenzív vénás kemoterápiát követően fokozatos javulást láthattunk (20 ± 3,1 ng/ml vs. többéves utánkövetéskor 31 ± 2,6 ng/ml; p<0,001). A foszfát- és alkalikusfoszfatáz-szintek nem változtak számottevő mértékben a vizsgált időtartam során. A koleszterinszintek a terápia során folyamatos növekedést mutattak (a kemoterápia kezdetén 3,28 ± 0,3 mM/l vs. a fenntartó kezelés végén 4,62 ± 0,2 mM/l; p<0,0001). A HDL-koleszterin esetében szintén hasonló tendenciát figyelhettünk meg (a diagnóziskor 0,53 ± 0,09 mM/l vs. a fenntartó kezelés végén 1,48 ± 0,14 mM/l). Következtetés: Kiemelendő, hogy a gyógyult gyermekek utánkövetése, az oszteodenzitometriai mérések és a laborparaméterek ellenőrzése rendkívül fontos, mivel csontelváltozásokkal a leukaemiás betegek esetén számolni kell. Orv Hetil. 2020; 161(49): 2086–2093. Summary. Introduction: Current treatment of pediatric acute lymphoblastic leukemia allows survival above 80%, but it is also very important to prevent treatment-related side effects and to improve long-term quality of life. Objective: Our aim was to assess the side effects of chemotherapy on the skeletal system and to identify prognostic and risk factors. Methods: Between 2007 and 2016, 215 children were treated with acute lymphoblastic leukemia at the 2nd Department of Paediatrics, Semmelweis University. In our retrospective study, we analyzed data of these children with skeletal-related side-effects (38 children with reduced bone mineral density, 5 with osteonecrosis, 3 with osteomyelitis and 2 with pathologic fracture). Results: Osteodensitometric data, vitamin D, phosphate, alkaline phosphatase and lipid levels were collected at different follow-up times. Osteodensitometric values were already reduced at the time of diagnosis (lumbar spine Z-score: –1.5 ± 1.02) and intensive venous chemotherapy caused further decrease (–1.8 ± 0.5). Z-score showed an improving tendency at the end of the maintenance therapy (–1.6 ± 0.5; p<0.05), followed by further improvement later (–1.2 ± 0.4 [p<0.01] and –0.9 ± 0.4). Vitamin D levels showed improvement after intensive venous chemotherapy (20 ± 3.1 ng/ml vs. 31 ± 2.6 ng/ml at multi-year follow-up; p<001). Phosphate and alkaline phosphatase levels did not change considerably during the period considered. Cholesterol levels increased continuously during treatment (at the time of diagnosis 3.28 ± 0.3 mM/l vs. at the end of the maintenance therapy 4.62 ± 0.2 mM/l; p<0.0001). A similar trend was observed with HDL cholesterol levels (0.53 ± 0.09 mM/l vs. 1.48 ± 0.14 mM/l). Conclusion: In summary, we can conclude that follow-up of these children, osteodensitometric measurements and monitoring of laboratory parameters are extremely important, as bone abnormalities can occur in leukemia patients. Orv Hetil. 2020; 161(49): 2086–2093.

The paper deals with the classical problem of determining the minimum size of a separating system consisting of sets of size at most k. A set system is said to be a separating system if there are no two elements that are part of exactly the same sets. Separating systems of bounded test size play an important role in the field of group testing and its applications. The first and most important results are due to Katona (1966), who proved a theorem that determines the minimum size n(m,k) of a separating system of k-sets of an underlying set of size m implicitly and also gave lower and upper bounds. Wegener (1979), Luzgin (1980), and Ahlswede (2008) also proved important bounds, however, a closed formula or a fast algorithm to compute n(m,k) has not been known so far. We give a simple, short proof of a stronger version of Katona’s main theorem that also leads to a polynomial algorithm to compute n(m,k).

Abstract: Introduction: The isolated haploinsufficiency of the SHOX gene is one of the most common cause of short stature determined by monogenic mutations. The heterozygous deviation of the gene can be detected in 2–15% of patients with idiopathic short stature (ISS), in 50–90% of patients with Leri-Weill dyschondrosteosis syndrome (LWS), and in almost 100% of patients with Turner syndrome. Aim: The aim of our study was to evaluate the frequency of SHOX gene haploinsufficiency in children with ISS, LWS and in patients having Turner syndrome phenotype (TF), but normal karyotype, and to identify the dysmorphic signs characteristic for SHOX gene deficiency. Method: A total of 144 patients were included in the study. Multiplex Ligation-dependent Probe Amplification (MLPA) method was used to identify the SHOX gene haploinsufficiency. The relationships between clinical data (axiological parameters, skeletal disorders, dysmorphic signs) and genotype were analyzed by statistical methods. Results: 11 (7.6%) of the 144 patients showed SHOX gene deficiency with female dominance (8/11, 81% female). The SHOX positive patients had a significantly higher BMI (in 5/11 vs. 20/133 cases, p<0.02) and presented more frequent dysmorphic signs (9/11vs 62/133, p = 0.02). Madelung deformity of the upper limbs was also significantly more frequent among the SHOX positive patients (4/11, i.e. 36%, vs. 14/133, i.e. 10%, p = 0.0066). There were no statistically significant differences between the mean age, mean height and auxological measurements (sitting height/height, arm span/height) between the two groups of patients. Conclusions: The occurrence of SHOX gene haploinsufficiency observed in our population corresponds to the literature data. In SHOX positive patients, in addition to short stature, the dysmorphic signs have a positive predictive value for SHOX gene alterations. However, the SHOX deletion detected in a patient with idiopathic short stature without dysmorphic signs suggest that SHOX deletion analysis can be recommended in patients with ISS. Orv Hetil. 2017; 158(34): 1351–1356.