Browse our Medical Journals - AKJournals
Among all scientific traditions alive, medical publishing has a good chance to be the oldest. The first fully peer reviewed academic journal, “Medical Essays and Observations” was launched in 1731 by the Royal Society in Edinburgh. Since then, hundreds of medical journals have been published worldwide. Medical publication in Hungary started in 1857 when the famous physician, Markusovszky founded “Orvosi Hetilap”, which has been published since then every week (with short breaks during the world wars). It is now a most prestigious piece in AKJournals’ portfolio, listed in Journal Citation Reports, with a remarkable impact factor.
Medical and Health Sciences
Abstract
Purpose
The aim of our study was to compare intraoperative complication rates in cataract surgeries performed by women and men surgeons and to analyse the possible impact of surgeon–patient gender difference on intraoperative complication rates in a tertiary eye care centre in Hungary.
Materials/Methods
This retrospective study looked at cases of cataract surgery involving phacoemulsification performed between January and December 2019. There were no exclusion criteria. In each case, patient demographics, patient clinical history, surgeon gender, case complexity, and operative details were reviewed. Primary outcomes included intraoperative complication rates.
Results
A total of 2,156 operations were included in the study, 1,295 (60.1%) of which were performed by men surgeons and 861 (39.9%) by women surgeons. The overall complication rate was 4.7% (n = 101). There was no significant difference (P = 0.728) in the intraoperative complication rate between the surgeries performed by women (n = 42, 4.9%) and men (n = 59, 4.6%) in either the simple (P = 0.214) or the complex (P = 0.508) cataract cases. Intraoperative complication rates were analysed in the two surgeon gender groups among both women and men patients. No significant difference was found in any of the compared groups.
Conclusions
Intraoperative complication rates were similar in the surgeries performed by women and men specialists. Our study showed that neither surgeon–patient gender difference nor surgeon–patient gender concordance had a significant impact on complication rates during phacoemulsification cataract surgery.
Az új generációs genomszekvenálás lehetséges helye a kutyaharapások kezelésében
Perspectives of next generation sequencing in the microbiological evaluation and treatment of dog bites
Az antibiotikum-rezisztencia a modern orvoslás egyre több kihívást adó problémája. A kutyaharapás gyógyításának számos esetben elengedhetetlen része az antibiotikus kezelés. Az eredményes gyógyításhoz minél hamarabb ismerni kellene a kórokozókat és azok antibiotikum-érzékenységét. A jelenlegi módszerekkel – baktériumtenyésztés és antibiogram-készítés – napokba, akár hetekbe telhet, mire lelethez jutunk. A közben alkalmazott empirikus antibiotikum-kezelés újabb rezisztens törzseket szelektálhat ki. Az új generációs genomszekvenálással (NGS), illetve nanopore szekvenálással nyert genomszintű adatok gyors, teljes-körű mikrobiológiai lelet lehetőségét ígérik kutyaharapás esetében is. A harmadik generációs nanopore szekvenálás jövőbe mutató módszernek látszik a humán orvoslásban is a mikrobiológiai leletek elkészítésében.
Főszerkesztői előszó
Editor-in-Chief's greetings
Hírek a hematológia világából
News from the world of hematology
Lenalidomid-rezisztencia eredményes áttörése 134 hónapos első vonalbeli lenalidomid-kezelést követően myelomás betegnél – Esetbemutatás
Successful salvage of lenalidomide refractoriness emerging after a 134 month-long first-line lenalidomide therapy in a myeloma patient – Case report
Közleményünkben egy transzplantációra alkalmatlan korú myelomás nőbeteg kiemelkedően eredményes lenalidomid-dexamethason dublet kezeléséről számolunk be, mellyel 134 négyhetes cikluson át tudtuk myeloma multiplex betegségét remisszióban tartani. További érdekessége az esetnek, hogy a kialakult lenalidomid-rezisztenciát melphalan-prednisolon-bortezomib másodvonalbeli kezeléssel eredményesen tudtuk áttörni és a terápiát követően hosszú kezelésmentes remissziót elérni.
Abstract
Background and aims
Video games are a common form of entertainment in adolescents, which may result in gaming habits characterized by impairment to reward-related decision-making. The aim of the current study was to investigate the relationship between reward processing and symptoms of gaming addiction in adolescents.
Methods
Data from three consecutive follow-up years (years 2, 3 and 4) of the Adolescent Brain Cognitive Development (ABCD) Study were analyzed (n = 6,143, total observations = 12,745, mean age at year-2 = 12 years). Participants completed the Video Game Addiction Questionnaire (VGAQ) at each visit. Discrete stages of reward processing were measured at the year-2 visit using the Monetary Incentive Delay task while the participant completed a functional magnetic resonance imaging (fMRI) scan. Bayesian hierarchical linear models were employed to examine the longitudinal association between reward processing in regions of interest at year-2 and VGAQ scores over time.
Results
Lower activation in the bilateral caudate during the anticipation of a large reward (β = −0.87, 95% CI: −1.68, −0.07) was associated with greater VGAQ scores over time. This implies that for each one-unit increase in brain activity in the caudate, there was an associated 0.87-point decrease in symptoms of gaming addiction as measured by the VGAQ. No association was found between reward feedback and VGAQ scores.
Discussion and Conclusions
The findings suggest that abnormal reward processing in the caudate nucleus is associated with symptoms of gaming addiction in adolescents. These results provide a clearer understanding of the brain mechanisms involved in gaming addiction, which could inform future preventive and therapeutic strategies.
A Magyar Sebész Társaság Sebészeti Onkológiai Szekciójának 4. Kongresszusa
Előadás-összefoglalók
A Society of Hematologic Oncology éves konferenciájának aktuális témái
Current topics of the annual conference of the Society of Hematologic Oncology
A Society of Hematologic Oncology (SOHO) éves konferenciáján a hematológiai malignitások legfrissebb kutatási eredményei és terápiás újításai kerültek bemutatásra. Az előadások betekintést nyújtottak a specifikus terápiás megközelítések hatékonyságába és a multidiszciplináris együttműködés fontosságába a betegellátásban. Az alábbi összefoglaló közlemény a legfontosabb előadásokat mutatja be, amelyek a klonális hematopoiezis, mielofibrózis, mielodiszpláziás neoplazma, krónikus limfocitás leukémia, akut mieloid leukémia, akut limfoblasztos leukémia, diffúz nagy B-sejtes limfóma és a follikuláris limfóma témaköreit érintik.
Abstract
Background
The lower risk gambling guidelines (LRGG) represent an evidence-based collaborative effort to provide clear advice to people on the limits of safe gambling consumption. The guidelines are as follows: 1) Gamble no more than 1% of household income per month; and 2) Gamble no more than 4 days per month; and 3) Avoid regularly gambling at more than 2 types of games.
Methods
In an online survey study (N = 778), we evaluated the feasibility and acceptability of the LRGG among different subpopulations in Finland.
Results
We found that the guidelines were generally evaluated positively as understandable, sensible, clear, and “just right” in terms of their content. There were some notable differences between subpopulations: Individuals who were at risk of gambling problems evaluated the LRGG more negatively than others, while professionals working in the field of gambling prevention were the most optimistic about the guidelines. Thus, increased level of potentially harmful gambling engagement was linked with a somewhat more pessimistic attitude towards the guidelines. On the other hand, those who had not gambled in the past year viewed the guidelines as too permissive compared with those who had gambled, or those working in gambling prevention.
Discussion
Overall, our results show clear differences of opinion between the various subpopulations, which appear to be associated with the individuals' level and nature of gambling experience. We conclude that the LRGG can likely be adopted into wider use in Finland.
Újdonságok a mastocytosis diagnózisában és kezelésében
News in the diagnosis and therapy of mastocytosis
A mastocytosis ritka megbetegedés: kb. 10 új beteg megjelenésével lehet számolni évente 100 000 lakosra vonatkozóan. Ez annyit jelent, hogy ma Magyarországon ezres nagyságrendben kellene felismerésre és gondozásra kerüljenek, ami nem történik meg. A klinikánkon megalakult Semmelweis Mastocytosis hálózat elnyerte az európai, 21 ország szakembereit magában foglaló European Competence Network on Mastocytosis (ECNM) kiválósági központjaként történő elismerést. Évente 10–15 új beteget látunk és több mint 150 beteget gondozunk. Az egész országból érkeznek hozzánk. A hálózatban bőrgyógyász, hematológus, patológus működik együtt. Differenciáldiagnosztika tekintetében hálózatunkban HANO (örökletes angioneurotikus oedema) kivizsgálás is történik, triptázszintmérés is bevezetésre került, illetve lehetőség van a myeloid panelben vizsgálni a prognosztikus jelentőségű RUNX1, ASXL1 és SF3B1 mutációkat, valamint tervezzük a herediter alpha triptazaemia TPSAB1 gén mutációjának vizsgálatát. Ez utóbbi a következő WHO-klasszifikációban mint minor kritérium fog szerepelni. Alábbiakban az utóbbi években megjelent legfontosabb publikációk rövid ismertetésén túl az ECNM legutóbbi éves konferencián elhangzott a diagnosztikát és terápiát érintő újdonságokról számolok be.
Anatómia és divat. Thanhoffer Lajos 123 évvel ezelőtt megjelent könyvéről
Anatomy and fashion. On the book of Lajos Thanhoffer published 123 years ago
Az epehólyag adenosquamosus daganata
Gallbladder adenosquamous carcinoma
Adenosquamous carcinoma is a rare subtype of gallbladder tumours that often spreads to surrounding anatomical structures and, like malignant tumours of the gallbladder, is very aggressive. The 70-year-old female patient presented in this study was investigated due to abdominal pain, and thickened gallbladder wall was revealed with imaging techniques. The gallbladder was removed along with the surrounding liver parenchyma and the adjacent colon due to continuous spread. Histological examination confirmed primary adenosquamous carcinoma of the gallbladder. The squamous cell carcinoma component that revealed keratinization, was positive with p40 immunohistochemistry. In the 1 month since diagnosis, the patient was stable and is currently receiving adjuvant oncological treatment. According to the available literature, gallbladder adenosquamous carcinoma shows female predominance, and is occurring in the 6th–7th decade. Abdominal pain is the most common first symptom. The current WHO classification specifies a minimum of 25% squamous cell carcinoma component during the histological examination. Exclusion of metastatic process is necessary for a definitive diagnosis. Orv Hetil. 2024; 165(49): 1945–1950.
Detre László, ahogy nem ismerjük: egy fantasztikus regény írója
László Detre, as we do not know him: the writer of a fantastic novel
Fejezetek az alkohológia tárgyköréből
3. Alkoholos ketoacidosis
Chapters from alcohology
3. Alcoholic ketoacidosis
Alcoholic ketoacidosis is a combined metabolic complication of alcohol consumption and starvation without hyperglycemia, and it may be seen in alcohol-dependent patients upon cessation of drinking or after binge drinking. Alcoholic ketoacidosis usually presents with nausea, vomiting and abdominal pain, and can affect multiple organ systems. Untreated alcoholic ketoacidosis is often fatal. Its treatment is complex. The effective and timely treatment improves the outcome of the condition, but according to the long-term prognosis, alcoholics surviving alcoholic ketoacidosis still die earlier than non-drinkers. After appropriate treatment, the patient has to be referred to a rehabilitation program in order to prevent relapse and to prevent/minimalize long-term irreversible damage caused by alcohol consumption. Orv Hetil. 2024; 165(49): 1927–1933.
A gyógyszer-repozicionálás és klinikai diabetológiai vonatkozásai
Drug repositioning and its aspects in clinical diabetology
Drug repositioning is a special and increasingly utilized way of drug development. As a result of the procedure, drugs and active ingredients that are already on the market for the treatment of certain diseases or are in various phases of development are being successfully used with new indications, some of which are sometimes completely different from the original ones. In the first half of our review, we give a brief overview of this process, outline its various advantages and potential pitfalls. After the general introductory part, we will examine the more successful areas of application of the drugs that were previously marketed as antidiabetics, and then we will mention some preparations that can now also be used in the treatment of diabetes mellitus, due to their significant blood sugar lowering properties that have been recognized in the meantime. Orv Hetil. 2024; 165(49): 1919–1926.
Mesterséges intelligencián alapuló szervkontúrozó szoftverek alkalmazása és eredményeinek összehasonlítása sugárterápiás besugárzástervezés során
Application of artificial intelligence-based organ contouring software and comparison of results in treatment planning for radiotherapy
Introduction: The first step in the radiotherapy treatment of cancer patients is the treatment planning, which involves delineations of the target volume (tumour) and organs at risk on a series of CT scans. This process is called contouring or segmentation. The delineation is performed in two dimensions on axial CT slices, but the dose distribution calculation and plan evaluation are carried out in three dimensions. Contouring has traditionally been done manually, but automatic organ contouring software are now available to make the process more accurate and consistent. Objective: To compare the quality of contouring software using artificial intelligence-based algorithms, and to define the organs that can be outlined with the best consistency, and those organs where there are large differences in segmentation between different software. Method: Contours of organs at risk defined by three contouring software (MVision, ART-Plan, Limbus) in four anatomical regions on a series of 93 CT scans were compared. MVision contours were the references, and contours defined by the two systems were compared with them based on volumes, centers of mass location, and spatial similarity and conformity indices. We ranked the spatial similarity, defining the organs with the smallest and largest differences. Results: Order of the organs with the best agreement: lungs, brain, liver, spleen, stomach, heart, eyes, mandible, kidneys, spinal cord, breasts, and bladder. The largest deviations were found at small-volume organs: thyroid, chiasma, left anterior descending artery, and pituitary. Large variations were found in the prostate and differences in the trachea were due to different interpretations of the anatomical boundaries. Discussion: For organs where the tissue density differs significantly from their surroundings (air–soft tissue, bone–soft tissue), the software can determine the organ in question with the appropriate quality. Small differences in contours were found for larger and relatively large differences for smaller organs. Conclusions: The contours were defined with good agreement by the software for most of the organs, large deviations were found only in small-volume organs. Orv Hetil. 2024; 165(49): 1934–1944.
Abstract
Background and aims
The authors of the present study wanted to know whether the previously reported psychiatric comorbidities of internet gaming disorder (IGD) based on DSM-5 criteria were also more prevalent among gaming disorder (GD) or hazardous gaming (HG) based on ICD-11 criteria. Therefore, the present case-control study evaluated the psychiatric comorbidities and associative factors of GD and HG based on ICD-11 criteria.
Methods
A sample of 60 individuals with GD, 45 with HG, and 120 controls were assessed with an ICD-11 criteria-based diagnostic interview along with attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder (GAD), depressive disorder, and social anxiety disorder (SAD). Participants also completed Conners' Continuous Performance Test (CCPT), Dickman's Impulsivity Inventory, the Emotion Regulation Questionnaire, and the Behavior Inhibition System and Behavior Approach System Scales.
Results
GD was associated with ADHD, depressive disorder, and GAD. ADHD was the most associative comorbidity of HG. Depressive disorder was associated with GD relative to HG. Moreover, individuals with lower reappraisal, higher aversion sensitivity, and impulsivity were more likely to be diagnosed with GD. Those with higher fun-seeking were more likely to be diagnosed with HG.
Conclusion
In the present study, ADHD was the psychiatric comorbidity most significantly associated with GD, followed by depressive disorder and GAD, as previously reported for IGD. ADHD was also associated with HG. Depressive disorder was more associated with GD compared to HG. Intervention for HG and GD should be tailored by the consideration of the clients' psychiatric comorbidity as well as their reappraisal skills, impulsivity, aversion sensitivity, and fun-seeking.
Abstract
Purpose
We investigated health development offices (HDOs) in Hungary as key providers of preventive healthcare services (nutrition, exercise, and mental hygiene programmes) for the general population, with a particular emphasis on health maintenance among people aged 60 and over.
Materials and Methods
Our research was informed by the fact that there are currently 113 HDOs operating in Hungary. We carried out a short online survey, for which the sample size (n = 44) was big enough to apply descriptive statistical methods and make statistically significant estimates for different age groups, using a significance level of α = 5% for the target group.
Results
Our research yielded a remarkable finding: around one in two of the clients using the services of the HDOs were over the age of 60. As many as 89% (39 out of 44) of the HDOs participating in the survey provided specific health promotion programmes for individuals over 60 years of age.
Conclusions
Our research showed that HDOs are key players in the field of primary prevention among older people, suggesting that they are an important aspect of gerontological care.
Abstract
As the changeful history of psychedelic research and therapy since the 1950s can be assumed to be well enough known to this journal's audience, it is only recalled briefly in this article. Rarely has it been addressed, though, that the discursive struggles through which this history has been spawned have antecedents in much older controversies in the 18th and 19th centuries. As knowledge of this prehistory may shed new light on the current state of affairs in psychedelic matters, this article starts with an account of the transformations that animal magnetism underwent during the so-called ‘long century of mediumship’, transformations by which it was ultimately tamed by science. Based on this historical sensitization, the text then turns to a recent strand of the scientific debate on psychedelic therapy – to seminal journal articles from the Johns Hopkins research group – and subjects these articles to a fine-grained discourse analysis. In doing so, the inner cohesion of the forces that are currently tugging at the psychedelic, mostly pushing aside its emancipatory, resistive, utopian, and ‘spiritual’ connotations, becomes more apparent.
Abstract
Objective
2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ([18F]-FDG PET/CT) can be developed in association with contrast-enhanced CT (ceCT), specifically in oncologic patients. This study aimed to evaluate emergency cases incidentally detected in our clinical practice with [18F]-FDG PET/ceCT.
Method
We retrospectively evaluated 3661 [18F]-FDG PET/ceCT, developed between 2017 and 2023, collecting emergency cases needing prompt treatment.
Results
In 34/3661 patients (0.9%) an emergency case was recorded, in particular through contrast-enhanced CT, linked to a vascular (65%) or extravascular (35%) disease. The more frequent findings were pulmonary thromboembolism (0.5%). [18F]-FDG PET/CT was positive in 13/34 cases.
Conclusions
A significant minority of patients undergoing PET/ceCT present vascular or extravascular emergency diseases. The [18F]-FDG uptake improves confidence in diagnosing inflammatory findings. Properly trained diagnostic physicians approaching PET/ceCT can change the prognosis of a small but significant number of cancer patients through a life-saving approach. Future studies are needed to ensure the possibility of emergency findings with non-[18F]-FDG tracers.
Abstract
This study aimed to contribute to the conservation of red pandas by improving the understanding of their oestrus cycle through examining urinary hormone changes during their breeding season. To minimize stress associated with blood sample collection, we used urine samples Sex hormone levels were measured over six months in pregnant and nonpregnant red pandas, to help understand changes in oestrogen concentrations during oestrus, post-mating progesterone concentrations and differences in ceruloplasmin concentrations. The results of the study revealed that female red pandas are polyoestrous, with a second oestrogen peak after mating. Progesterone changed in a cascading fashion, peaking and then gradually declining. Successfully mated females showed higher levels of progesterone than unsuccessfully mated females, which had no peak in progesterone after mating. Ceruloplasmin was measured to confirm pregnancy, but its value as a pregnancy diagnostic factor was not confirmed. These results provide significant insights into the reproductive physiology of red pandas and lay the foundation for additional research towards improving the management and breeding strategies for this threatened species.
Abstract
Shigellosis, a diarrheal disease caused by Shigella species, is a significant public health concern, particularly in developing countries with inadequate sanitation systems. This study aimed to investigate the patterns of antibiotic resistance, ESBL and AmpC genes, integrons, and enterotoxin genes in Shigella species isolated from patients with gastroenteritis in Northeast Iran. This cross-sectional study was conducted between January 2017 and December 2019 at a tertiary care hospital in Northeast Iran. A total of 110 Shigella isolates were collected from stool samples of patients with gastroenteritis. The isolates were identified using conventional biochemical tests and confirmed by PCR. The highest resistance rates were detected for ampicillin (88.2%) and cotrimoxazole (84.5%). Altogether 64.5% of isolates exhibited multidrug resistance however, ESBL and AmpC phenotypes were detected in 34.54% and 1.81% of isolates, respectively. Interestingly, bla CTX-M-15 and bla TEM were detected in all ESBL-positive isolates but integron class 1, 2, and 3 were identified in 97.3%, 76.4%, and 59.1% of isolates, respectively. The sen gene was present in 72.7% of the isolates. In this study CTX-M-15 production was detected in 31 strains of Shigella sonnei and in 7 strains of Shigella flexneri. The high prevalence of multidrug-resistant Shigella isolates is concerning and shows the need for continuous monitoring and rational use of antibiotics.
Abstract
Psychedelic drugs show promising therapeutic potential; however, some users experience extended difficulties following their use. This study investigated the prevalence, severity, duration, and associated coping strategies of post-psychedelic difficulties. We conducted an online survey of 159 participants, all of whom reported experiencing difficulties lasting more than one day after psychedelic use within the past 2–10 years. Participants rated the severity and duration of 11 types of difficulties and indicated effective coping strategies. Results revealed that social disconnection (72%), anxiety and panic attacks (68%), and existential struggle (65%) were the most prevalent difficulties. Anxiety and panic attacks were rated as most severe, while existential struggle and diminished self-esteem persisted the longest, with mean durations exceeding 15 months. Derealization and depersonalization, despite being common, were consistently rated as less severe than other difficulties. Self-education emerged as the predominant coping strategy for multiple difficulties, including social disconnection and existential struggle. Professional therapy was most effective for depression and diminished self-esteem, while peer and family support were particularly beneficial for managing anxiety and panic attacks. These findings highlight the diverse nature of post-psychedelic difficulties and the varying effectiveness of different coping strategies. Our results contribute to the development of more nuanced, effective approaches to harm reduction and integration in psychedelic use, emphasizing the importance of multifaceted support systems that include professional, educational, and community-based resources.
Abstract
Objectives
Sesamol, a polyphenolic compound isolated from roasted sesame seeds exhibits significant anti-inflammatory effect, but the molecular mechanism is poorly understood. Peritoneal macrophages play a pivotal role in the control of infections and inflammatory pathologies and are also found in injured tissues along with resident macrophages. The present study aimed to examine the anti-inflammatory effect of sesamol and the molecular mechanisms involved, particularly the role of sesamol in modulating SIRT1- and SIRT1-mediated deacetylation of NF-κB p65 using in vivo activated peritoneal macrophages.
Materials
Sprague Dawley rats were injected with LPS to induce inflammation and sesamol was intraperitoneally administered to study its anti-inflammatory effect. ELISA and real time PCR were used to study the expression of proinflammatory cytokines. Effects of sesamol on iNOS and COX-2 were studied with activity assays and ELISA. ICAM-1, MMP-9 and TIMP-1 expressions were analysed by ELISA, RT PCR and zymography. Western blot analysis was performed to determine p65 acetylation. Nuclear translocation of p65 was evaluated by ELISA. The gene and protein expression of SIRT1 was analysed with ELISA and real time PCR.
Results
Sesamol downregulated the expression of proinflammatory markers TNF-α, IL-6, iNOS, COX-2, TLR-4, ICAM-1 and MMP-9 in rat peritoneal macrophages. Additionally, sesamol upregulated SIRT1expression and attenuated the nuclear translocation of NF-κB p65 by promoting its deacetylation. Inhibition of SIRT1 by its specific inhibitor EX527 diminished the inhibitory effect of sesamol on TNF-α and IL-6. Moreover, EX527 reduced the suppressive impact of sesamol on p65 acetylation and subsequent nuclear translocation.
Conclusion
Our findings suggest that the anti-inflammatory effect of sesamol involves upregulation of SIRT-1, leading to the downregulation of the nuclear translocation of NF-κB p65 through its deacetylation. Therefore, the dietary bioactive compound sesamol shows potential as a promising strategy for preventing inflammatory diseases by modulating SIRT1 expression.
Abstract
Background and aims
Deficits in emotion regulation (ER) are considered a key factor in the development of addiction, highlighting ER as a potential target for treatment. However, ER in problematic pornography use (PPU) remains poorly understood.
Methods
The current study investigated both spontaneous and instructed ER in male individuals at-risk for PPU (n = 35, average age = 20.40 ± 1.29) and in a control group (n = 33, average age = 20.06 ± 1.44). Initially, participants were evaluated with the Emotion Regulation Profile-Revised (ERP-R) to measure their spontaneous use of eight ER strategies across various negative emotion-eliciting scenarios. Subsequently, they completed an emotion reappraisal task, in which they were instructed to either observe or reappraise their reactions to negative images. Subjective emotional ratings (valence and arousal) and event-related potentials (ERPs) were recorded to examine the effects of deliberate ER on emotional processing.
Results
The results indicated that individuals at-risk for PPU reported less frequent spontaneous use of reappraisal compared to those in the control group. Furthermore, in both groups, reappraisal led to a decrease in the late positive potential (LPP) and the self-reported intensity of emotions elicited by negative images.
Discussion and conclusions
This indicates that both groups were able to effectively downregulate negative emotions through reappraisal when instructed. Our findings underscore the importance of incorporating ER skills, particularly reappraisal-based strategies, into the prevention and psychotherapy of PPU.
Abstract
Background
Gambling content on streaming platforms has gained popularity. Given their intense, cue-laden nature, watching gambling streams may trigger cravings among viewers. At the same time, people who gamble may be motivated to watch gambling streams in an attempt to regulate their cravings.
Methods
We tested these ideas across two preregistered online studies, recruiting i) people who gamble to compare a subgroup of gambling stream viewers with non-viewers (Study 1; n viewers = 221, n non-viewers = 642), and ii) a group of gambling stream viewers (Study 2; n viewers = 271).
Results
Gambling stream viewers were younger, tended to identify as men, and displayed higher levels of problem gambling and gambling cravings compared to non-viewers. Problem gambling severity was correlated positively with both the motivation to use gambling streams to regulate cravings and with cravings elicited by watching gambling streams.
Discussion
Our findings indicate that while viewers with higher levels of problem gambling may use gambling streams to regulate their cravings, doing so might evoke cravings.
Az orrmelléküregek mucormycosisa
Mucormycosis of the paranasal sinuses
Until nowadays, mucormycosis is the most aggressive fungal disease spreading in humans. Currently the Rhizopus, Lichtheimia and Mucor species are responsible for the development of diseases in the greatest number. The prevalence of mucormycosis appears to be much higher because in many cases achieving histological sample is difficult and the presence of risk factors is getting higher. While the classification systems, examination protocols, pharmaceutical and surgical treatment methods have developed, it is important to highlight that the continuous increase in the number of diabetes and the accompanying ketoacidosis, the recurrence of the COVID–19 epidemics in our overpopulated society had a high benefit factor in the spread of the disease, especially the one which affects the paranasal sinuses: the rhino-orbito-cerebral form. The purpose of this publication is to provide a detailed presentation of the disease, in which the effective treatment depends in many cases on the establishment of an accurate, early diagnosis, through a targeted drug therapy and, in several cases, an aggressive surgical debridement is indispensable. Orv Hetil. 2024; 165(48): 1878–1887.
In the first decade after the turn of the millennium, a high-risk behavior, called drunkorexia, became fashionable, mainly among college students. Drunkorexia is a syndrome that is a combination of deliberate starvation or binge eating and vomiting with alcohol abuse, and has an increasing frequency among the young adult population, but with an insufficiently known prevalence. It has significant physical, psychological and social-health consequences. The interference between metabolic changes caused by starvation and excessive alcohol consumption can result in the development of a life-threatening condition. Refinement of the diagnostic criteria makes possible to establish an accurate diagnosis. In the course of the therapy, in addition to psychoeducation and psychotherapy methods, there is also a place for drug treatment. Orv Hetil. 2024; 165(48): 1888–1893.
A képi diagnosztikai adatmennyiség, esetszám, valamint a diagnosztikus munkaterhelés emelkedése egy magyar klinikai centrumban
Increase in the radiology imaging case volume and workload in a Hungarian university clinical center
Introduction: The number and complexity of radiological examinations (number of images, data volume) have significantly increased in the recent decades. Objective: We aimed to determine how the number of medical imaging examinations and their complexity, as well as the trends of radiology workforce have changed in the last decade in our clinical center. Method: We analyzed the number and characteristics of medical imaging studies archived in the picture archiving and communication system between 2012 and 2023. This analysis was compared with data on the radiologist resources of the department. Results: Compared to the base year, by 2023, there was a substantial increase in annual imaging data volume (200.7%), number of images (506.3%), and number of examinations (69.4%). Image number increased the most in angiography (3161%) and the least in conventional X-ray examinations (34.4%). Annual archived study volume showed the highest increase in ultrasound (447.9%) and the lowest in X-ray examinations (9.2%). CT examinations exhibited the largest increase in image numbers (50–140%) among specific, common examination types. Annual examinations (66.6%) and image numbers per consultant (496.3%) significantly increased. The COVID–19 pandemic caused a temporary decline in the number of studies. Discussion: During the studied period, significant growth was observed in cross-sectional imaging, ultrasound examinations, and interventional angiography but not in x-ray. This growth partly stems from technological advances and changing data archival practice. The substantial growth in examination numbers and image data was not matched by available human resources. The decline in examination numbers during the COVID–19 pandemic highlights reduced access to elective and screening diagnostics. Conclusion: Consistent with international trends, the period under review witnessed significant increases in the complexity and number of imaging examinations, resulting in considerable workload growth. Comprehensive, systemic solutions are needed to prevent compromising patient safety. Orv Hetil. 2024; 165(48): 1894–1903.
Magas kreatin-kináz-szint igen lassú csökkenése sztatin elhagyását követően a myopathiás klinikai tünetek gyors javulásával, osteoporosisban szenvedő idős nőbetegben
Sztatin-biszfoszfonát szinergista hatás?
Quick improvement of clinical symptoms of statin myopathy but very slow decrease of high creatine kinase level after statin withdrawal in an old osteoporotic female patient
Synergistic statin-bisphosphonate action?
Both statins and nitrogen-containing bisphosphonates act via the mevalonate pathway. When used together, not only their beneficial effects but also their side effects may cumulate. Thus, the possibility of rhabdomyolysis in osteoporotic female patients treated with lipid-lowering agents as well was already highlighted in 2009 by Japanese authors. In very rare cases, this side effect has also been observed in chronic statin treatment immediately after bisphosphonate administration. In the case described, creatine kinase levels approaching the threshold for rhabdomyolysis with myopathic symptoms were observed during chronic co-administration of the two drugs. The 81-year-old woman after 18 months of atorvastatin treatment with a dose of 30 mg/day was examined for joint complaints, proximal lower leg muscle pain and muscle weakness of 6 months duration, with creatine kinase level of 5638 U/L and lactate dehydrogenase level of 2129 U/L. After 6 weeks of statin withdrawal, clinical symptoms resolved but creatine kinase levels decreased very slowly being above 7 times the normal upper limit after 5 months. The euthyroid, non-diabetic patient had previously been treated with per os alendronate for 4 years and per os risedronate for almost 1 year (the latter was still given continuously after the presentation), with continuous calcium and vitamin D supplementation throughout. Thus, a statin-bisphosphonate interaction was suspected to be responsible for the development of the high levels of creatine kinase and their very slow decline. Although a creatine kinase level of 18 times the upper limit of normal with permanently normal renal function does not correspond to the currently accepted value for rhabdomyolysis guidelines, a level above 5000 IU/L is considered a risk factor for rhabdomyolysis, a value prompting investigations for other trigger factors and indicating that the patient is not suitable for statin treatment. The patient had no cardiovascular risk factors other than hyperlipemia and died at her age of 89 years following surgery for gastric perforation without continuation of statin. Our case illustrates the peculiar situation where drugs acting through the mevalonate pathway translate their enzyme action intended to be physiological into pathophysiological, similar to the case where their combined use unexpectedly resulted in pathological bone fracture due to reduced steroid synthesis. Orv Hetil. 2024; 165(48): 1911–1916.
Tudatos jelenlét alapú kognitív terápia krónikus fejfájással élők számára
Mindfulness-based cognitive therapy for individuals with chronic headaches
Introduction: Chronic headache is one of the most common health issues leading to long-term disability, which results not only in a decline in the quality of life but also increases depressive and anxiety-related symptoms. In the case of chronic pain, the effectiveness of acute pain relief is limited. International research increasingly highlights the importance of modifying psychological and behavioral factors associated with pain. According to the literature, mindfulness-based cognitive therapy has been proven effective in reducing the burden of chronic headaches, primarily by improving the quality of life, enhancing self-efficacy, and reducing pain catastrophizing and depression. Objectives: Our primary goal was to make mindfulness-based cognitive therapy accessible for the first time in Hungary to individuals living with chronic headaches. Secondly, we aimed to measure the impact of this method on the quality of life, coping with pain, and depression. Method: We initiated 8-session groups following the structure developed by Melissa Day (2012) at the Department of Clinical Psychology, Semmelweis University. Measurement tools: Beck Depression Inventory, Pain Catastrophizing Scale, Comprehensive Headache-Related Quality of Life Questionnaire, Mindfulness Questionnaire, Perceived Stress Questionnaire, Self-Compassion Questionnaire. Results: After the group sessions, there was a significant reduction in the negative impact of pain on the quality of life (p<0.001, Cohen’s d = 0.92), pain catastrophizing (p<0.001, Cohen’s d = 0.76), and depression (p<0.01, Cohen’s d = 0.51). Additionally, there was an increase in mindfulness skills (p<0.001, Cohen’s d = –0.55) and self-compassion (p<0.001, Cohen’s d = –0.7). Discussion: Our clinical trial supports the effectiveness of mindfulness-based cognitive behavioral therapy in improving the quality of life for individuals living with chronic headaches. Conclusions: Since mindfulness-based cognitive therapy is a relatively brief psychological intervention, it can be easily implemented at various levels of care, including general practitioners’ offices or headache clinics. Orv Hetil. 2024; 165(48): 1904–1910.
Abstract
Background
In the international literature, several questionnaires measuring everyday activities are known with the aim of examining patients' quality of life. In the Hungarian language, few validated questionnaires focus on daily activities, examining both basic and moderately difficult physical activity, as well as mental health.
Objective
Our goal was to translate the Functional Status Questionnaire (FSQ) into Hungarian and examine its reliability and validity.
The validation of the questionnaire into Hungarian followed the six-step principle formulated in 2000. In our cross-sectional study, 376 participants took part. For convergent validity, we used the 36-Item Short Form Survey (SF-36) and the Functional Independence Measure (FIM) questionnaires. The examination of internal consistency was performed through Cronbach's alpha calculations. Test-retest reliability within the class was assessed with the intraclass correlation coefficient (ICC). We conducted discriminant validity for pain and general health.
Results
Internal consistency values demonstrated reliability. Participants' demographic data showed that the majority live in cities and have secondary education. The individuals included in the study exhibited unusually high levels of sports activity compared to the Hungarian average. Convergent validity examinations revealed significant relationships between dimensions of health-related quality of life of the different measurement tools.
Conclusions
The validated Hungarian questionnaire is valid and reliable. Similar to the original questionnaire, it is quickly and easily completed, allowing healthcare professionals in clinical settings to assess the patient's functional status before initiating examinations.
Abstract
Introduction
Smoking and alcohol consumption remain the two most important risk factors for the development of oropharyngeal tumours, but there is an increasing number of younger patients (age <50 years) with human papillomavirus (HPV) association origin, also known as positivity. The role of radiotherapy (RT) in the treatment of this disease is paramount.
Aim
To describe the radiotherapy results for oropharyngeal tumours and to search for prognostic parameters that influence the response of these malignant lesions to radio-chemotherapy.
Methods
95 patients underwent definitive radio- or radio-chemotherapy (RCT) for histologically squamous cell, oropharyngeal carcinoma at our Institute between 1 January 2019 and 31 December 2020, of which 51 (54%) received the latter. The mean age was 61.9 years (37–82 years) and the male-female ratio was 69:26. The average total dose was 69 Gy (range: 54–70 Gy).
Results
The 5-year local control (LC), cancer-specific survival (CCS), and overall survival (OS) calculated by the Kaplan-Meier method were 71, 69, and 58%, respectively. Forty-four cases (46%) were confirmed to have HPV involvement. HPV positive (+) tumours showed significantly better behaviour compared to HPV negative (−) cases in LC, CCS and OS. Smoking had a significant negative effect on cure rates: LC, CCS and OS were better in non-smokers. A significant negative effect of smoking on survival was also observed in HPV-associated cases. For HPV- lesions, RCT had a stronger effect on LC than RT alone (64 vs 43%, P = 0.03).
Conclusions
HPV-associated malignancies show better survival outcomes to radio ± chemotherapy than their HPV- counterparts. In all cases, smoking worsens the response to treatment. For HPV- tumours, chemotherapy with radiation, compared to irradiation alone, has a more significant effect on survival outcomes, whereas for HPV+ tumours this effect is less pronounced.
Abstract
In this publication various serum biochemistry and haematology parameters were determined from blood samples obtained from captive adult individuals of an exotic quail species, the mountain quail (Oreortyx pictus, Douglas, 1829). Venipuncture was performed in the second half of the breeding season from six roosters (males) and seven hens (females). During the examination, in addition to the haematological elements, basic parameters of serum enzyme levels, the products of protein metabolism, uric acid and the most important ions were monitored. The results are presented as a reference in future diagnostic tests for certain diseases. The blood parameters of the bird species examined in this study have not yet been published earlier.
Abstract
This study investigated a strain of Klebsiella pneumoniae, identified as GRTHES, which exhibited extensive antibiotic resistance. The strain was resistant to all beta-lactams, including combinations with newer agents such as meropenem/vaborbactam and imipenem/relebactam, as well as to aminoglycosides, fluoroquinolones, fosfomycin, trimethoprim-sulfamethoxazole and colistin. It remained susceptible to tigecycline. Whole-genome sequencing was performed by Ion Torrent platform on the K. pneumoniae strain. Genomic analysis revealed a genome length of 5,808,650 bp and a GC content of 56.9%. Advanced sequencing techniques and bioinformatic tools were used to assess resistance genes and plasmid replicons, highlighting the emergence of multidrug resistance and virulence traits. The strain carried bla NDM-1 and bla KPC-3 genes and was designated to KL107 O2afg type. Colistin resistance-associated mgrB/pmrB gene mutations were present, and the strain also harbored yersiniabactin-encoding ybt gene. Our findings provide insights into the genomic context of bla NDM-1 and bla KPC-3 carbapenemase-producing K. pneumoniae and emphasize the importance of continuous surveillance and novel therapeutic strategies to combat multidrug-resistant bacterial infections. It is the first time that an NDM-1 and KPC-3 co-producing strain of K. pneumoniae ST512 is identified in Greece. This study highlights the essential role of genomic surveillance as a proactive strategy to control the spread of carbapenemase-producing K. pneumoniae isolates, particularly when key antimicrobial resistance genes, such as bla NDM-1 and bla KPC-3, are plasmid-mediated. Detailed characterization of these isolates could reveal plasmid similarities that facilitate adaptation and transmission within and between hospitals. Although data on patient movements are limited, it is plausible that carbapenem-resistant isolate was selected to co-produce KPC and NDM through plasmid acquisition.
Abstract
Depression is the leading cause of disability worldwide. Major Depressive Disorder (MDD) is a condition characterized mostly by low or depressed mood as well as difficulty experiencing emotions, whether positive or negative. Poor adherence has sparked the interest from both physicians and patients in these alternative therapeutic approaches. Ketamine and Electroconvulsive Therapy (ECT) are emerging as promising options.
Objective
To evaluate the results related to the efficacy and safety of the therapeutic use of ketamine within its various application methods and ECT in patients with MDD.
Method
Systematic review that employed the PubMed database to collect the clinical trials that analyzed and compared the efficacy and safety of intramuscular ketamine, oral ketamine, and ECT in MDD. The files were screened by title and selected by reading the abstracts. The selected files were then read for a complete analysis according to the inclusion and exclusion criteria.
Results
Seven randomized clinical trials (RCT) were selected. Ketamine displayed potential in the treatment of MDD due to its rapid-onset effect, but ECT is even more effective in terms of remission. Both treatments are safe, but they involve long-term side effects that require further study.
Conclusion
Exploring how the characteristics of individual patients affect the response to ketamine and ECT can propel the development of more personalized treatments. However, the lack of long-term studies on the efficacy and safety of these therapies highlights the need for more RCTs comparing ketamine and ECT in patients with MDD.
Abstract
Background
In the Compensatory-Dissociative Online Gaming (C-DOG; Giardina et al., 2024) model, we proposed a continuum from compensatory to dissociative gaming involvement. This continuum represents different degrees of integration between physical and virtual environments with three core processes – Active Escapism, Escape, and Dissociation – and two peripheral processes – Gaming-Related Relaxation and Body-Mind Detachment. Here, we developed and tested a multidimensional measure based on this model.
Method
We capitalized on existing items for measuring escapism and dissociation and we generated new items consistent with the hypothesized model dimensions. A total of 54 items were administered to 1,176 online gamers playing different game genres, together with measures of problematic gaming, passion for gaming, and other psychological distress indicators.
Results
Exploratory and confirmatory factor analyses yielded a six-factor, 36-item structure, with multiple hierarchical regression analyses highlighting unique associations with other psychological constructs assessed.
Discussion
The following factors were identified: (1) Emotional Displacement - redirection of negative emotion into the game with associated relaxation; (2) Absorption - detachment of the player from time and space while gaming; (3) Active Escapism - simulative use of the game to compensate for lack of self-confidence in reaching physical life objectives; (4) Virtual Withdrawal – maladaptive gaming to balance impaired social functioning, predicted by traumatic experiences and pervasive depression; (5) Dissociative Regulation - dysfunctional level of engagement associated with excessive anxiety; (6) Failure Escape - problematic avoidance via gaming related to fear of future failures.
Conclusions
The C-DOG factors identify critical psychological processes associated with problematic gaming, with relevant research and clinical implications.
Akut coronaria szindrómát utánzó EKG-jelek szeptikus cardiomyopathiákban
ECG signs mimicking acute coronary syndrome in septic cardiomyopathies
The authors present four cases of septic cardiomyopathy. These presentations highlight that patients without chest pain may have ECG and troponin elevations mimicking acute coronary artery syndrome without significant stenosis of coronaries in the background. This supports the experimental observation that sepsis is caused by vascular involvement and cellular damage behind septic cardiomyopathy. This underlines the importance of the fact that in these cases the primary focus should not be on immediate coronary angiography, but on adequate, early treatment of sepsis. Otherwise, hospital mortality will be very high. Since only a few ECG abnormalities in septic cardiomyopathy are published, the authors consider these important to publish. Orv Hetil. 2024; 165(47): 1871–1876.
Fejezetek az alkohológia tárgyköréből
1. A bélfermentációs tünetegyüttes
Chapters from alcohology
1. Auto-brewery syndrome
Auto-brewery or intestinal fermentation syndrome is a rare disorder in which the symptoms of alcohol intoxication of varying severity develop without alcohol consumption. The fermentation activity of the altered intestinal microbiome is responsible for endogenous alcohol production. The set of symptoms not only raises differential diagnostic questions, but also has serious legal implications due to the resulting alcohol intoxication. The article reviews both the steps of diagnostic work and therapeutic options, the basis of the latter is the antifungal treatment. As the intestinal fermentation syndrome may lead to the development of non-alcoholic hepatic and pancreatic pathology, accurate diagnosis is important to prevent the development of such complications. Orv Hetil, 2024; 165(47): 1854–1859.
A korai laboratóriumi vizsgálatok jelentősége hűtött asphyxiás újszülöttek kezelésében
Role of early laboratory parameters in treatment of cooled asphyxiated infants
Laboratory tests performed at a specific time point of the hypoxic injury may help the clinical care of neonates with hypoxic-ischemic encephalopathy and could provide additional information to determine the severity of the initial insult more precisely. Additionally, laboratory biomarkers may be useful to predict the neurodevelopmental outcome of these infants, which is especially important for parents and caregivers. Moreover, multi-organ dysfunction frequently complicates the clinical presentation of neonates with hypoxic-ischemic encephalopathy, and the appropriate treatment can also be facilitated by the analysis of laboratory tests. In our review article, we discuss the most important routinely measured and specific laboratory parameters, grouped by organ systems, hoping that we can thereby contribute to the improvement of the complex clinical care of asphyxiated, cooled neonates. Orv Hetil. 2024; 165(47): 1843–1853.
Változások a könnyűlánc-amyloidosis kezelésében – egy nagy budapesti centrum adatai
Changes in the treatment outcomes of light chain amyloidosis – findings of a large center in Budapest
Introduction: Primary or light chain amyloidosis is caused by monoclonal immunoglobulin fragments that accumulate in the organs, and the resulting amyloid deposits cause organ dysfunction. Objective and method: During our research, we examined the clinical and survival data of patients diagnosed with light chain amyloidosis between 2010 and 2024, at the Department of Internal Medicine and Hematology of Semmelweis University. We paid special attention to exploring what factors may affect the prognosis, therefore we reviewed the connection between survival and the date of diagnosis, the age of the patient, the cytogenetics, and different treatment schemes. Results: In the examined period, 56 patients were diagnosed with light chain amyloidosis. Based on the growing number of cases, we can see an increasing tendency in the recognition of the illness, however, the diagnosis was still mostly made in the advanced stages. The median overall survival of the group was 44 months, and it showed no significant improvement between the examined eras. The prognosis was considerably influenced by the age of the patients and the stage of the disease at the time of the diagnosis. The treatment of light chain amyloidosis went through considerable change in the past 15 years. The newer therapeutic agents – such as daratumumab and venetoclax – induce complete hematologic remission more often and offer a higher rate of organ response compared to previous treatment options. Conclusion: Due to the more favorable response rates to newer agents, in the future we can expect to see improvements in survival as well, although our study was not yet able to demonstrate this. Early stage remains the most important prognostic marker, which highlights the importance of early recognition of this condition. Orv Hetil. 2024; 165(47): 1860–1870.
Machine Learning(s) in gaming disorder through the user-avatar bond: A step towards conceptual and methodological clarity
Reply to: User-avatar bond as diagnostic indicator for gaming disorder: A word on the side of caution (2024)
Abstract
In response to our study, the commentary by Infanti et al. (2024) raised critical points regarding (i) the conceptualization and utility of the user-avatar bond in addressing gaming disorder (GD) risk, and (ii) the optimization of supervised machine learning techniques applied to assess GD risk. To advance the scientific dialogue and progress in these areas, the present paper aims to: (i) enhance the clarity and understanding of the concepts of the avatar, the user-avatar bond, and the digital phenotype concerning gaming disorder (GD) within the broader field of behavioral addictions, and (ii) comparatively assess how the user-avatar bond (UAB) may predict GD risk, by both removing data augmentation before the data split and by implementing alternative data imbalance treatment approaches in programming.
User-avatar bond as diagnostic indicator for gaming disorder: A word on the side of caution
Commentary on: Deep learning(s) in gaming disorder through the user-avatar bond: A longitudinal study using machine learning (Stavropoulos et al., 2023)
Abstract
In their study, Stavropoulos et al. (2023) capitalized on supervised machine learning and a longitudinal design and reported that the User-Avatar Bond could be accurately employed to detect Gaming Disorder (GD) risk in a community sample of gamers. The authors suggested that the User-Avatar Bond is a “digital phenotype” that could be used as a diagnostic indicator for GD risk. In this commentary, our objectives are twofold: (1) to underscore the conceptual challenges of employing User-Avatar Bond for conceptualizing and diagnosing GD risk, and (2) to expound upon what we perceive as a misguided application of supervised machine learning techniques by the authors from a methodological standpoint.
Abstract
Bloodstream infections (BSI) result in significant morbidity and mortality rates, and delayed administration of appropriate antimicrobial treatment is a major predictor of poor outcomes. T2 magnetic resonance (T2MR®) (T2 Biosystems®, Lexington, MA, USA) is an innovative technology that can rapidly identify pathogens from a sample of whole blood in a remarkably short time frame of 3–5 h. We are evaluating if the T2Bacteria Panel (T2BP) contributes to the etiological diagnosis of bloodstream infections when combined with standard blood cultures (BC). The study was performed between December 2018 and March 2019, and a total of 28 patients with suspected BSI were included. The most notable finding of our study was that the addition of T2BP to BC in a diagnostic workflow led to a statistically significant higher rate of T2BP-targeted bacteria identification in patients with suspected BSI (46.4% versus 7.1%, P = 0.001) when compared to BC alone. Considering the measures of diagnostic accuracy, T2BP showed 100.00% sensitivity, 88.24% specificity, 100% negative predictive value (NPV), and 84.62% positive predictive value (PPV). Our findings give valuable insights for microbiologists and clinicians into this molecular method and its advantages in routine diagnostics of BSI.
Abstract
Purpose
To assess the accuracies of airway resistance (Raw) and compliance (Crs) calculations using the expiratory time constant (RCexp) method as well as the accuracy of Pmus estimation in obstructive lung models.
Methods
A Respironics V60 ventilator was connected to an active lung simulator. The driving pressure was maintained at 5–10 cmH2O and positive end-expiration pressure (PEEP) was 5 cmH2O. Maximal Pmus, estimated based on equations of motion and respiratory mechanical properties, was calculated by the RCexp method to derive respiratory system compliance (Crs) and inspiratory (Rinsp) and expiratory (Rexp) resistance.
Results
During PAV, the assist proportion was adjusted to 55% and 40% with Pmus of 5 and 10 cmH2O, respectively. Pmus measurement errors were <20% of the preset values in most lung conditions. In the active lung model with PAV, an overestimation of Raw was found in the normal resistance condition, and Rinsp was underestimated in the severe obstructive model (P < 0.01). Crs was overestimated significantly except in the severe obstructive model at a Pmus of 10 cmH2O (all P < 0.01). Using the RCexp method, the target of ≤20% between the calculated and preset values in airway resistance was achieved in most obstructive models at a Pmus of 5 cmH2O.
Conclusions
The RCexp method might provide real-time assessments of respiratory mechanics (elastance and resistance) in the PAV mode. With low inspiratory effort, the estimation error was acceptable (<20%) in most obstructive lung models.