With the aging population in Europe, particularly Hungary, unhealthy aging is emerging as a growing public health challenge. Physical inactivity is a modifiable risk factor for age-related diseases and remains highly prevalent. Increasing daily physical activity is a key strategy for extending health span. Step-count-based interventions, including motivational interviewing and email-based feedback, have been shown to promote physical activity, but direct comparisons of these approaches in workplace settings are limited. Conducted within the framework of the Semmelweis-EUniWell Workplace Health Promotion Model Program, this study aimed to evaluate the effect of two scalable workplace interventions compared with a control group on increasing daily step count and total weekly physical activity, and to examine the sustainability of intervention effects over six months. In this three-armed randomized controlled trial, Semmelweis university employees were assigned to one of three groups: combined program of face-to-face motivational interviewing and email-based motivation, email-based motivation program alone or a control group with no intervention. Daily step counts were self-reported using participants' personal smart devices and recorded at baseline, every two weeks during an eight-week intervention, and at 1-, 3-, and 6-month follow-up. Total weekly physical activity was assessed using the International Physical Activity Questionnaire. Changes were modeled and compared with mixed model regression. A total of 155 employees participated (49 in the face-to-face motivational interviewing group, 53 in the email-based motivation group, and 53 controls). Both interventions were associated with increased step counts during the intervention period compared with control, with an average increase of 1,624 steps per day. Initial improvements were comparable between the two intervention groups, but the decline in step count during follow-up was slower in the face-to-face group. Additionally, at one-month post-intervention, the face-to-face group also showed a significantly higher total MET-minutes per week (997 MET/week) compared with controls. Both face-to-face and email-based interventions were effective in increasing physical activity during the intervention period. The slower decline in the face-to-face group suggests differences in sustainability between approaches. The results suggest a potential short-term benefit of workplace health promotion programs on physical activity, and that motivational interviewing may support longer-term maintenance of gains. Embedding such hybrid interventions into broader healthy aging strategies, such as those promoted by the Semmelweis-EUniWell Workplace Health Promotion Model Program, offers a promising pathway to address the aging challenge in Hungary and across Europe. Looking ahead, artificial intelligence-driven tools could enhance these programs by delivering personalized feedback, adaptive goal setting, and real-time engagement at scale, complementing human-delivered motivational support and further extending their reach and impact.

Europe is experiencing a significant demographic shift, with aging populations posing economic and social challenges due to increased healthcare costs and a higher prevalence of age-related diseases. Hungary, in particular, faces these challenges acutely due to higher morbidity and mortality rates from a range of chronic age-related diseases and behavioral risk factors. Addressing these issues requires innovative approaches to promote healthy aging. Semmelweis University, the largest healthcare provider and leading health sciences university in the region, is developing a comprehensive healthy aging program. A critical pillar of this program is the Semmelweis-EUniWell Workplace Health Promotion Model Program, a pioneering initiative aimed at tackling unhealthy aging within Hungary's workforce by leveraging the workplace as a platform for health promotion. Central to this program's goal of combating sedentary lifestyles-a significant contributor to age-related health issues-is the innovative use of micro-gyms and motivational interviewing. Micro-gyms, with their compact size and accessibility, provide convenient exercise opportunities, while motivational interviewing fosters intrinsic motivation and personalized counseling to encourage sustained physical activity. Through concerted efforts and innovative approaches, including the implementation of micro-gyms, the Semmelweis-EUniWell Workplace Health Promotion Model Program aims to set a benchmark for workplace health promotion, fostering a healthier and more resilient aging population in Hungary. This program not only enhances the well-being of employees at Semmelweis University and its EUniWell partner institutions but also catalyzes broader transformations in workplace health promotion and healthy aging nationwide.

The Semmelweis Study is a prospective occupational cohort study that seeks to enroll all employees of Semmelweis University (Budapest, Hungary) aged 25 years and older, with a population of 8866 people, 70.5% of whom are women. The study builds on the successful experiences of the Whitehall II study and aims to investigate the complex relationships between lifestyle, environmental, and occupational risk factors, and the development and progression of chronic age-associated diseases. An important goal of the Semmelweis Study is to identify groups of people who are aging unsuccessfully and therefore have an increased risk of developing age-associated diseases. To achieve this, the study takes a multidisciplinary approach, collecting economic, social, psychological, cognitive, health, and biological data. The Semmelweis Study comprises a baseline data collection with open healthcare data linkage, followed by repeated data collection waves every 5 years. Data are collected through computer-assisted self-completed questionnaires, followed by a physical health examination, physiological measurements, and the assessment of biomarkers. This article provides a comprehensive overview of the Semmelweis Study, including its origin, context, objectives, design, relevance, and expected contributions.

2008-ban kezdte meg működését Kaposváron a Prevenciós és Egészségfejlesztési Iroda, mely 14 éves munkája során számos innovatív programot dolgozott ki és valósított meg a Somogy megyében élők egészségi állapotának javítása érdekében. A népegészségügyi szűrővizsgálatokon való alacsony részvételi hajlandóság miatt 2009-ben országosan is egyedülálló program indult el. A programba bevonásra került minden, 45–65 év közötti Somogy megyei nő, melynek köszönhetően a leghátrányosabb, zsáktelepülésen élő nők is eljuthatnak a népegészségügyi szűrésekre. A program lényege, hogy a szervezett szűrés keretein belül, a meghívott nők az emlőszűrés mellett méhnyak- és tüdőszűrésen is részt vehetnek egy időben. A program pozitívuma és eredménye, hogy enélkül a nők nem jutottak volna el sem méhnyak-, sem tüdőszűrésre, valamint megállt az emlőszűrésen résztvevők csökkenő aránya. A komplex szűrés és a folyamatosan zajló egészségfejlesztési programok mellett a Prevenciós és Egészségfejlesztési Iroda további, Somogy megyére kiterjedő programokat is megvalósít. A kaposvári Prevenciós és Egészségfejlesztési Iroda nemcsak hazai, hanem nemzetközi színtéren is részt vesz az egészségfejlesztésben. A Somogy Megyei Kaposi Mór Oktató Kórház 2021-ben csatlakozott a Nemzetközi Egészségfejlesztő Kórházak és Egészségügyi Szolgáltatások Hálózatához, melyben egyelőre egyedüli magyar kórházként vesz részt.

OBJECTIVES:Clinical data and cost-effectiveness analyses from several countries support the use of low-dose computed tomography (LDCT) to screen patients with high risk of lung cancer (LC). This study aimed to explore the economic value of screening LC with LDCT in Hungary. METHODS:Cohorts of screened and nonscreened subjects were simulated in a decision analytic model over their lifetime. Five steps in the patient trajectory were distinguished: no LC, nondiagnosed LC, screening, diagnosed LC, and post-treatment. Patient pathways were populated based on the Hungarian pilot study of screening, the Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) LC screening trial, and local incidence and prevalence data. Healthcare costs were obtained from the National Health Insurance Fund. Utility data were obtained from international sources and adjusted to local tariffs. Scenarios according to screening frequency, age bands (50-74, 55-74 years), and smoking status were analyzed. RESULTS:Annual LDCT-based screening compared with no screening for 55- to 74-year-old current smokers showed 0.031 quality-adjusted life-year (QALY) gains for an additional €137, which yields €5707 per QALY. Biennial screening for the same target population showed that purchasing 1 QALY would cost €10 203. The least cost-effective case was biennial screening of the general population aged 50 to 74 years, which yielded €37 931 per QALY. CONCLUSIONS:Screening LC with LDCT for a high-risk population could be cost-effective in Hungary. For the introduction of screening with LDCT, targeting the most vulnerable groups while having a long-term approach on costs and benefits is essential.

The aim of our prospective study was to evaluate the clinical impact of hybrid [18F]-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ([18F]-FDG PET/MRI) on the decision workflow of epileptic patients with discordant electroclinical and MRI data. A novel mathematical model was introduced for a clinical concordance calculation supporting the classification of our patients by subgroups of clinical decisions. Fifty-nine epileptic patients with discordant clinical and diagnostic results or MRI negativity were included in this study. The diagnostic value of the PET/MRI was compared to other modalities of presurgical evaluation (e.g., electroclinical data, PET, and MRI). The results of the population-level statistical analysis of the introduced data fusion technique and concordance analysis demonstrated that this model could be the basis for the development of a more accurate clinical decision support parameter in the future. Therefore, making the establishment of "invasive" (operable and implantable) and "not eligible for any further invasive procedures" groups could be much more exact. Our results confirmed the relevance of PET/MRI with the diagnostic algorithm of presurgical evaluation. The introduction of a concordance analysis could be of high importance in clinical and surgical decision-making in the management of epileptic patients. Our study corroborated previous findings regarding the advantages of hybrid PET/MRI technology over MRI and electroclinical data.

Various applications of farm animal imaging are based on estimating the weight of specific body parts and cuts from CT images of animals. In many cases, the complexity of the problem is increased by the enormous variability in body postures in the CT images due to scanning unsedated live animals. In this work, we propose a general and robust approach to estimate the weights of sections and body parts from CT images of (possibly) live animals. We adapt the segmentation by elastic registration and joint feature and model selection for the regression component to cope with the large number of features and small number of samples. The proposed technique is evaluated and illustrated by real applications in rabbit breeding programs. The r(2) values are 12% higher than those of previous techniques and methods used in the breeding selection programs. The proposed technique is easily transferable to similar problems and is therefore made available in an open source software package for the benefit of the community.

OnkoNetwork is a patient navigation program established in the Moritz Kaposi General Hospital to improve the timeliness and completeness of cancer investigations and treatment. The H2020 SELFIE consortium selected OnkoNetwork as a promising integrated care initiative in Hungary and conducted a multicriteria decision analysis based on health, patient experience, and cost outcomes. In this paper, a more detailed analysis of clinical impacts is provided in the largest subgroup, non-small cell lung cancer (NSCLC) patients. A retrospective cohort study was conducted, enrolling new cancer suspect patients with subsequently confirmed NSCLC in two annual periods, before and after OnkoNetwork implementation (control and intervention cohorts, respectively). To control for selection bias and confounding, baseline balance was improved via propensity score weighting. Overall survival was analyzed in univariate and multivariate weighted Cox regression models and the effect was further characterized in a counterfactual analysis. Our analysis included 123 intervention and 173 control NSCLC patients from early to advanced stage, with significant between-cohort baseline differences. The propensity score-based weighting resulted in good baseline balance. A large survival benefit was observed in the intervention cohort, and intervention was an independent predictor of longer survival in a multivariate analysis when all baseline characteristics were included (HR = 0.63, p = 0.039). When post-baseline variables were included in the model, belonging to the intervention cohort was not an independent predictor of survival, but the survival benefit was explained by slightly better stage distribution and ECOG status at treatment initiation, together with trends for broader use of PET-CT and higher resectability rate. In conclusion, patient navigation is a valuable tool to improve cancer outcomes by facilitating more timely and complete cancer diagnostics. Contradictory evidence in the literature may be explained by common sources of bias, including the wait-time paradox and adjustment to intermediate outcomes.

Összefoglaló. Bevezetés: Általánosságban elmondható, hogy a fekvőbeteg-ellátást nyújtó egészségügyi intézmények intenzív terápiás osztályain (ITO) jelennek meg a legsúlyosabb kórképekkel és a legmagasabb halálozási aránnyal bíró esetek, rendszerint megkésve. Eltérően az ITO-tól, más betegellátó osztályokon előfordulhat, hogy nem észlelik megfelelően és időben a betegek olyan állapotváltozásait, melyek előre jelzik például a szívleállást vagy a keringési rendszer várható összeomlását. Ennek kiküszöbölésére jelenthet megoldást az úgynevezett gyors reagálású rendszer (RRS), melynek segítségével csökkenthető a kórházon belüli mortalitás. Célkitűzés: A Somogy Megyei Kaposi Mór Oktató Kórház a teljes intézményre kiterjedően a 2016. évtől alkalmazza az RRS-t. A jelen tanulmány célja a kórházi mortalitás csökkentésével kapcsolatos első eredmények bemutatása. Módszer: Vizsgálatunkban az ITO-ra került betegek adatbázisán alapuló kereszttáblás, illetve nemparametrikus statisztikai módszereket alkalmaztuk. Eredmények: A statisztikai próbák eredményei alapján megállapítottuk, hogy az intenzív ellátás felvételi diagnózisai (légzési elégtelenség, neurológiai ok, reanimáció, szepszis, szív/keringési, egyéb ok) között statisztikailag igazolható eltérés tapasztalható (p = 3,815e-14) RRS alkalmazásával és a nélkül. Az RRS-sel felvettek között magasabb arányt képviseltek a légzési elégtelenséggel és szepszissel érkező, súlyosabb betegek, ugyanakkor kisebbnek bizonyult a reszuszcitáltak száma. Megbeszélés: Az RRS nélküli időszak 2,983%-os intézményi mortalitása az RRS-időszakban 2,932%-ra csökkent, azonban a beküldő osztályonkénti adatokban jelentős különbségeket tapasztaltunk. 21 fekvőbeteg-osztály közül 19 osztály esetén csökkent a mortalitás az RRS bevezetését követően. Következtetés: Arra a megállapításra jutottunk, hogy a nemzetközi szakirodalom alapján bevezetett RRS növelte az egészségügyi ellátás hatékonyságát, és ezáltal sikerült csökkenteni az intézményi szintű mortalitást. Orv Hetil. 2021; 162(20): 782–789. Summary. Introduction: In general, the cases with the most severe diseases and highest mortality rate are admitted to the intensive care units (ICU) usually late. Contrary to ICU, in other in-patient units it can happen that those changes in patients’ condition, which pre-indicate, e.g., cardiac arrest or collapse of circulatory system, are not noticed properly and in time. To eliminate this, the so-called rapid response system (RRS) can be the solution, by the help of which hospital mortality can be reduced. Objectve: The RRS has been used all institution-wide in Somogy County Kaposi Mór Teaching Hospital from 2016. The aim of this study is to demonstrate the results concerning hospital mortality cutdown. Method: Our analysis was based on ICU patients’ database and we applied cross-tabulation and non-parametric statistical methods. Results: We appointed, that among admission diagnosises to ICU (respiration insufficiency, neurological reason, reanimation, sepsis, cardiac/circulatory condition, other), statistically verifiable discrepancy can be experienced (p = 3.815e-14) with using RRS or without it. Among those admitted via RRS, more severe patients with respiration insufficiency and septic conditions were represented in higher rate, while the number of the admitted ones after resuscitation has decreased. Discussion: Hospital mortality rate of 2.983% without using RRS decreased into 2.932% in the period of using RRS, though we observed remarkable differences in data of non-ICU in-patient departments. Mortality has reduced in 19 in-patient departments out of 21, after implementing RRS. Conclusion: To sum it up, we identified that RRS implemented on the basis of international references has increased the efficiency of healthcare and owing to it, institution-level mortality has successfully decreased. Orv Hetil. 2021; 162(20): 782–789.

The standardized incidence of melanoma almost doubled in Hungary. Incidence and mortality of melanoma could be reduce by prevention and early detection. The frst health promotion ofces as actors in Public Health appeared in 2008. The authors present their good practices and possible programs of melanoma prevention through the experience of their health promotion ofce. Their study revealed that prevention should place greater emphasis on individual risk factors, estimated risk, and sun protection. Particular attention should be paid to the prevention of sunburn in childhood, and more men and those with lower levels of education should be able to take advantage of the possibility of skin examination.

Primary MALT non-Hodgkin’s lymphoma (NHL) of the uterus is an extremely rare entity. Both etiology and pathogenesis of these primary extranodal NHL lymphomas are unknown. Some researchers suppose a possible association between chronic inflammation, autoimmune diseases and lymphomas. We report a case of MALT uterine lymphoma of a 73-year-old woman. Postmenopausal vaginal bloody discharge was the leading symptom. Fractionated curettage was made and hystological analysis proven the MALT lymphoma diagnosis. Because of the low incidence of female genital tract lymphomas, there is no evidence-based consensus on its treatment. Eight cycles of rituximab plus CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone; R-CHOP) chemoimmunotherapy was administered. The patient is disease-free after 20 months of therapy. R-CHOP is a good and tolerable treatment option in elderly patients. Further case reports and multicenter analysis can help to evaluate the long-term results of chemoimmunotherapy. Keywords: MALT uterine lymphoma, primary extranodal lymphoma, Rituximab-based therapy, rheumatoid arthritis linked lymphoma

The purpose of this study was to create a detailed cross‐sectional anatomical reference atlas of the Pannon minipig by correlating good resolution CT and MR images with high quality cross‐sectional anatomical images. According to the authors knowledge, no detailed anatomical atlas is available for the minipig.

Összefoglaló. Bevezetés: Korábbi vizsgálatunk szerint a kis dózisú komputertomográfiával évente végzett tüdőrákszűrés 50–74 éves dohányzók körében költséghatékony, és az 55–74 évesek körében költségmegtakarító. Célkitűzés: Ennek a vizsgálatnak a célja a korábbi hosszú távú költséghatékonysági elemzés kiegészítése egy finanszírozó szempontú, rövid és középtávú költségvetési hatásvizsgálattal. Módszer: Egészség-gazdaságtani modellünk az 50–74 éves, naponta dohányzó lakosság tüdőrákszűrésének költségét hasonlítja össze a szervezett szűrésben nem részesülő, naponta dohányzó lakosság költségével. Ehhez megvizsgáljuk a célpopuláció létszámának alakulását, az eredményes elérés és felfedezés valószínűségét, továbbá a szűrés nyomán felmerülő terápiás költségeket és megtakarításokat. A szűrés és a kivizsgálások után diagnosztizált betegek útját az érvényben lévő hazai ellátási protokollnak megfelelően követjük. A kezelések eredményességét a HUNCHEST-felmérés adatai alapján, a kezelésekhez tartozó beavatkozások költségét közfinanszírozási adatok alapján számoljuk. Eredmények: A kis dózisú komputertomográfiával történő tüdőrákszűrés az érintett lakosság 10%-ának várható részvétele mellett a kezdeti évben mintegy 3,3 milliárd, az 5. évben 1,9 milliárd Ft éves többletkiadással jár. A 3. évig szűréssel felfedezett betegek terápiája többe kerül, mint a szűrés nélkülieké, ugyanakkor a 4. és 5. évben a szűrés nélküli csoportban a későbbi stádiumban felismert betegek kezelési költsége már meghaladja a szűrt betegek terápiás költségét. A 3. évtől folyamatosan növekvő terápiás megtakarítás a teljes szűrés költségét a 10. évre az 1. év kiadásának 20%-ára csökkenti. Következtetések: A kis dózisú komputertomográfiával történő tüdőrákszűrés bevezetése évi 2,6 milliárd Ft többletforrást igényelne, és folyamatos kiadáscsökkenés mellett hosszú távon akár nettó megtakarítást is eredményezhet a nem szervezett szűréshez képest. A kockázati csoportok pontosítása, például kiemelt földrajzi területeken végzett célzott szűrés tovább javíthatja az eredményeket. Orv Hetil. 2021; 162(24): 952–959. Summary. Introduction: Our earlier analysis indicated that screening lung cancer patients with low-dose computed tomography amongst smokers between age of 50–74 and between age of 55–74 is cost-effective and cost-saving, respectively. Objective: This study aims to extend the long-term cost-effectiveness analysis with short- and mid-term budget impact analysis. Method: The health economic model compares the cost of nationwide screening amongst smokers between 50–74 years to the current occasional screening policy. The analysis determines the size of the target population, recruitment rates and market uptake. Health care finance costs associated with the patient pathways are determined by national guidelines and clinical practice. Screening and treatment effectiveness are based on the HUNCHEST survey and international scientific literature, while the cost of health states and events are determined using national tariffs. Results: Assuming 10% uptake of low-dose computed tomography screening for the target population will cost an additional 3.3 billion HUF and 1.9 billion HUF in the 1st and 5th years, respectively. Until the 3rd year, new patients’ treatment costs exceed costs due to late discovery and delay in treatment. This pattern is changing from the 4th year on. Due to timely care savings by the 10th year in the screened population will reduce total costs to the 20% of the first year costs. Conclusions: Introduction of national screening for lung cancer patients with low-dose computed tomography is estimated to cost around additional 2.6 billion HUF/year and could end up in net savings in the long run. Identification of risk groups according to regional or other strata could increase the effectiveness and efficiency of the program. Orv Hetil. 2021; 162(24): 952–959.

The leadership of the Semmelweis University as a leading institution of higher education in Hungary and the Central Eastern European region within the area of medicine and health sciences has decided to reflect on the unfavorable public health situation in the country as well as the deteriorating health behavior and health status indicators in the Hungarian population by the development of an occupational setting-based personalized public health model program targeting its about 8500 employees. Based on its infrastructure and human resources the core element of the program is the establishment of the Center of Preventive Services (CPS) with units providing health risk assessment for each employee, and whenever necessary consultation with medical specialist in preventive medicine and public health, as well as counseling with dietician, physiotherapist and/or health psychologist. The service providers are the staff members of the relevant faculties in collaboration with partner primary and occupational care physicians. The units of the CPS can also serve as practical training sites for students at various levels of medical and health sciences training, and strongly contribute to the development and improvement of their skills to be able for working as a team in service provision. The employees are not only beneficiaries of health risk assessment and screening repeated on a regular basis and adequate interventions at the right time, but they also serve as a sample for a longitudinal cohort study and further ad hoc surveys for defining and implementing interventions to support health protection, disease prevention and healthy aging among them.

Tandem occlusive lesions are responsible for up to 20% of acute ischemic stroke cases and are associated with poor prognosis if complete recanalization cannot be achieved. Endovascular recanalization might be challenging due to difficulties in the safe passage of the occluded plaque at the origin of the internal carotid artery (ICA). The balloon-assisted tracking technique (BAT), where a partially deflated balloon is exposed out of the catheter tip to facilitate its passage through stenosed or spastic arterial segments was introduced by interventional cardiologists and the applicability of the technique has been recently proposed in the field of neurointervention as well. Here we describe our experience using the BAT technique in the endovascular recanalization of tandem occlusive lesions. Procedures were performed from June 2013 to December 2020 in a single center. Baseline clinical and imaging data, procedural and follow-up details and clinical outcomes were retrospectively collected. In this study 107 patients, median age 66 years, median admission NIHSS 14 and median ASPECTS 8 were included. Successful recanalization of the ICA using the BAT technique was achieved in 100 (93%) and successful intracranial revascularization in 88 (82%) patients. There were no complications attributable to the BAT technique. Intraprocedural complications occurred in 9 (8%) patients. Emergent stenting was performed in 40 (37%) at the end of the procedure. Postprocedural adverse events (intracerebral hemorrhage [ICH], malignant infarction) occurred in 6 (5%) patients. Good clinical outcome at 3 months (modified Rankin scale [mRS] 0–2) was 54 (50%) and mortality 26 (24%). Delayed stent placement during follow-up occurred in 21 cases. Application of BAT technique in tandem occlusions appears feasible, safe, and efficient. Further evaluation of this technique is awaited.

Összefoglaló. Bevezetés: Általánosságban elmondható, hogy a fekvőbeteg-ellátást nyújtó egészségügyi intézmények intenzív terápiás osztályain (ITO) jelennek meg a legsúlyosabb kórképekkel és a legmagasabb halálozási aránnyal bíró esetek, rendszerint megkésve. Eltérően az ITO-tól, más betegellátó osztályokon előfordulhat, hogy nem észlelik megfelelően és időben a betegek olyan állapotváltozásait, melyek előre jelzik például a szívleállást vagy a keringési rendszer várható összeomlását. Ennek kiküszöbölésére jelenthet megoldást az úgynevezett gyors reagálású rendszer (RRS), melynek segítségével csökkenthető a kórházon belüli mortalitás. Célkitűzés: A Somogy Megyei Kaposi Mór Oktató Kórház a teljes intézményre kiterjedően a 2016. évtől alkalmazza az RRS-t. A jelen tanulmány célja a kórházi mortalitás csökkentésével kapcsolatos első eredmények bemutatása. Módszer: Vizsgálatunkban az ITO-ra került betegek adatbázisán alapuló kereszttáblás, illetve nemparametrikus statisztikai módszereket alkalmaztuk. Eredmények: A statisztikai próbák eredményei alapján megállapítottuk, hogy az intenzív ellátás felvételi diagnózisai (légzési elégtelenség, neurológiai ok, reanimáció, szepszis, szív/keringési, egyéb ok) között statisztikailag igazolható eltérés tapasztalható (p = 3,815e-14) RRS alkalmazásával és a nélkül. Az RRS-sel felvettek között magasabb arányt képviseltek a légzési elégtelenséggel és szepszissel érkező, súlyosabb betegek, ugyanakkor kisebbnek bizonyult a reszuszcitáltak száma. Megbeszélés: Az RRS nélküli időszak 2,983%-os intézményi mortalitása az RRS-időszakban 2,932%-ra csökkent, azonban a beküldő osztályonkénti adatokban jelentős különbségeket tapasztaltunk. 21 fekvőbeteg-osztály közül 19 osztály esetén csökkent a mortalitás az RRS bevezetését követően. Következtetés: Arra a megállapításra jutottunk, hogy a nemzetközi szakirodalom alapján bevezetett RRS növelte az egészségügyi ellátás hatékonyságát, és ezáltal sikerült csökkenteni az intézményi szintű mortalitást. Orv Hetil. 2021; 162(20): 782-789. SUMMARY INTRODUCTION In general, the cases with the most severe diseases and highest mortality rate are admitted to the intensive care units (ICU) usually late. Contrary to ICU, in other in-patient units it can happen that those changes in patients' condition, which pre-indicate, e.g., cardiac arrest or collapse of circulatory system, are not noticed properly and in time. To eliminate this, the so-called rapid response system (RRS) can be the solution, by the help of which hospital mortality can be reduced. Objectve: The RRS has been used all institution-wide in Somogy County Kaposi Mór Teaching Hospital from 2016. The aim of this study is to demonstrate the results concerning hospital mortality cutdown. METHOD Our analysis was based on ICU patients' database and we applied cross-tabulation and non-parametric statistical methods. RESULTS We appointed, that among admission diagnosises to ICU (respiration insufficiency, neurological reason, reanimation, sepsis, cardiac/circulatory condition, other), statistically verifiable discrepancy can be experienced (p = 3.815e-14) with using RRS or without it. Among those admitted via RRS, more severe patients with respiration insufficiency and septic conditions were represented in higher rate, while the number of the admitted ones after resuscitation has decreased. DISCUSSION Hospital mortality rate of 2.983% without using RRS decreased into 2.932% in the period of using RRS, though we observed remarkable differences in data of non-ICU in-patient departments. Mortality has reduced in 19 in-patient departments out of 21, after implementing RRS. CONCLUSION To sum it up, we identified that RRS implemented on the basis of international references has increased the efficiency of healthcare and owing to it, institution-level mortality has successfully decreased. Orv Hetil. 2021; 162(20): 782-789.

Embryological, anatomical, and immunological differences between the right-sided and left-sided colons are well known, but the difference in oncological behavior of colon tumors has only recently become the main subject of studies. Published articles propose that there is a difference not only in symptoms, but also in survival. Our aim was to analyze the clinicopathological and oncological differences among our patients who had been operated for colon cancer in our department. We examined the historical data of our patients who underwent colon resection for malignancy between 1st of January 2016 and 31st of December 2018. Tumor markers, histological results, postoperative complications, and oncological therapies were investigated. The primary outcome was overall survival. We analyzed our patients’ survival data with Kaplan–Meier log-rank test and Cox regression analysis. In our study, 267 patients were enrolled. One hundred thirty-three (49.8%) patients had right-sided colon cancer; 134 (50.2%) patients had left-sided colon cancer. Patients with right-sided colon cancer were significantly more likely to have mucinous adenocarcinoma (p = 0.037). No significant differences were revealed in overall survival between right-sided colon cancer and left-sided colon cancer patients (p = 0.381). Additional subgroup analysis showed that there were no significant differences in overall survival for laterality neither in the metastatic group (p = 0.824) nor in the non-metastatic group (p = 0.345). Based on the conflicting previous study results, our findings repeatedly highlight that the relationship between tumor location in the colon and overall survival is not straightforward.

Metabolic syndrome (MetS) is a cluster of clinical conditions that poses a major health burden worldwide. In the present study, we investigate the changes in the prevalence of MetS and its components among the Roma in two disadvantaged counties in Northeastern Hungary focusing on a seven-year-long period. The database of the present study is based on cross-sectional surveys of the Hungarian Roma population (aged 20–64 years) conducted in 2011 (n = 458) and 2018 (n = 374). The increase in the prevalence of MetS itself in the whole Roma population was not found to be significant in the period examined (although it increased from 40.0% up to 46.0%, p = 0.080); however, regarding its components, there was a significant increase in the prevalence of central obesity (from 62.7% to 73.3%, p = 0.001) and raised blood pressure (BP) or treated hypertension (from 45.2% to 54.5%, p = 0.007). These changes were mainly observed in the younger age groups, so the risk for MetS increased significantly in the 20–34 (OR = 1.10, p = 0.038) and 35–49 (OR = 1.07, p = 0.048) year age groups in the 2018 study population compared the 2011 one. The increasing prevalence of hidden hypertension and, consequently, untreated individuals with raised BP (from 29.6% to 43.5%, p = 0.014) among females is quite alarming; therefore, a targeted public health strategy and targeted interventions are desperately needed to prevent further worsening of the current situation.

OBJECTIVE The aim of the study was to evaluate the predictive value of pretreatment positron emission tomography (PET) standardized uptake value (SUVmax), standardized uptake value corrected for lean body mass (SULpeak) value, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) parameters of the primary tumour assessed with PET/computed tomography (CT) in the clinical out-come in patients diagnosed with histopathologically confirmed head and neck squamous cell carcinoma. MATERIALS AND METHODS Retrospective evaluation was performed using PET/CT image datasets of 52 histologically proven head and neck cancer patients in 4 weeks' prior receiving definitive chemo-radiotherapy (CRT). Positron emission tomography /CT was performed before the CRT and 12 weeks after it for response evaluation. Image data was used for target volume delineation and for specify SUVmax, SULpeak, MTV and TLG parameters of the primary tumour. According to the results of the therapeutic response evaluation two patient subgroups were created in relation to the presence or absence of viable tumour. Metabolic data from pre-treatment PET/CT and therapeutic response were correlated using Kruskal-Wallis test. RESULTS After completion of the CRT in 24/52 (46%) cases viable residual tumour was detected on restaging PET/CT, while in 28/52 (54%) patients showed complete remission. For the therapeutic success prediction assessment, we could not find any significant correlation with pre-treatment SUVmax and SULpeak values (P>0.44, P>0.33). Total lesion glycolysis provided nearly significant difference (P=0.052) and MTV had shown significant difference (P=0.001) between the two patient subgroups statistically. CONCLUSION Simple metabolic data (SUVmax and SULpeak) from pretreatment fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT were unable to predict therapeutic response, while volumetric information containing MTV and TLG parameters proved to be more useful, thus their inclusion to risk stratification may also have additional value.

ABSTRACT Introduction Different therapies can improve clinical and motor symptoms of multiple sclerosis (MS) similarly, but studies comparing the effects of different exercise therapies on clinical and motor outcomes are scant. We compared the effects of exergaming (EXE), balance (BAL), cycling (CYC), proprioceptive neuromuscular facilitation (PNF), and a standard care wait-listed control group (CON) on clinical and motor symptoms and quality of life (QoL) in people with MS (PwMS). Methods PwMS ( n = 68, 90% female; age, 47.0 yr; Expanded Disability Status Scale score 5–6) were randomized into five groups. Before and after the interventions (five times a week for 5 wk), PwMS were tested for MS-related clinical and motor symptoms (Multiple Sclerosis Impact Scale-29 (MSIS-29), primary outcome), QoL (EuroQol Five Dimensions Questionnaire), symptoms of depression, gait and balance ability (Tinetti Assessment Tool), static and dynamic balance and fall risk (Berg Balance Scale), walking capacity (6-min walk test), and standing posturography on a force platform. Results EXE, BAL, and CYC improved the MSIS-29 scores similarly. EXE and CYC improved QoL and walking capacity similarly but more than BAL. Only EXE improved gait and balance scores (Tinetti Assessment Tool). EXE and BAL improved fall risk and standing balance similarly but more than CYC. PNF and CON revealed no changes. The EuroQol Five Dimensions Questionnaire moderated the exercise effects on the MSIS-29 scores only in EXE. Changes in QoL and changes in the MSIS-29 scores correlated ( R 2 = 0.73) only in EXE. Conclusion In conclusion, BAL and CYC but EXE in particular, but not PNF, can improve clinical and motor symptoms and QoL in PwMS (Expanded Disability Status Scale score 5 to 6), expanding the evidence-based exercise options to reduce mobility limitations in PwMS.