National Healthcare Service Center

Magnetic Resonance (MR)-only radiotherapy improves treatment accuracy and efficiency but requires a synthetic Computed Tomography (sCT) for dose calculations. Automatic MR-based Organs At Risk (OARs) contouring could further improve consistency and efficiency. A combined automatic MR OAR contouring and sCT solution has been developed, with each component separately validated. This study aimed to evaluate this combined MR-only workflow against a manual MR-CT workflow for pelvic cancers. Radiotherapy MR and CT scans were acquired for 20 patients (10 prostate, 4 rectum, 6 anus cancer). The MR-only workflow used sCTs and automatic contours for the bladder, bowel bag, femoral heads, rectum, penile bulb, prostate, seminal vesicles and urethra along with manual target contours to optimise a MR-only plan. Doses were compared to the current clinical standard of deformably registered CT and manual MR OAR contours (MR-CT). Mean dose differences were ; 1 percentage point relative volume for all OARs except the bowel bag. Mean absolute dose differences were also for all OARs except bowel bag in ano-rectal patients and except bowel bag, bladder V , V , V and rectum V in prostate patients. The automatic MR OAR contouring and sCT workflow had similar dose differences to manual inter-observer variability for all OARs except the lower dose bladder and rectum volumes (prostate patients only) and bowel bag (prostate and ano-rectal patients). This combined OAR contouring and MR-only workflow could enable more efficient and consistent pelvic radiotherapy treatment.

A vak és gyengénlátó emberek számára a természetélmény gyakran nehezen elérhető, pedig mentális jóllétük szempontjából különösen fontos lenne. Láthatatlan Zöld részvételi kutatásunk célja az volt, hogy feltárja, mi segíti a látássérültek számára a természetélmény minél teljesebb átélését. A kutatás során a kollaboratív tervezés eredményeként kvalitatív interjúk, fókuszcsoportos beszélgetések és terepi programok zajlottak. Az eredmények érzékeltetik, hogy a természetélmény egy minden érzékszerven keresztül átélhető, mélyen személyes tapasztalat. A biztonságos társas közeg, ill. a megélt autonómia meghatározó a látássérült személyek számára. Az inkluzív hozzáférést elősegíti a fizikai és infokommunikációs akadálymentesítés, illetve a „hozzáállásbeli akadálymentesség”: az empatikus, nyitott attitűd, a közös tanulás igénye, és a segítői protokoll kidolgozása az érintett intézményeknél.

To evaluate the effect of erenumab treatment beyond monthly migraine days in patients with high-frequency episodic migraine who did not respond to at least one previous migraine preventive treatment. Reduction in monthly migraine days has been the efficacy standard for migraine preventive treatments; however, it does not fully capture the holistic benefit of the therapy. Erenumab, a monoclonal antibody targeting the calcitonin gene-related peptide pathway, has demonstrated reduction in monthly migraine days and improvement in function in patients with episodic and chronic migraine. In this phase 4, interventional, double-blind, randomized, placebo-controlled, multicenter, global study, treatment with erenumab was assessed over 4 months in adults with high-frequency episodic migraine. The study was conducted at 61 sites located across North America and Europe between September 2020 and October 2023. Patients with ≥1 qualifying oral triptan-treated migraine attack at baseline were randomized to receive erenumab 140 mg or placebo subcutaneously once monthly. The primary endpoint was change from baseline in mean monthly hours of at least moderate headache pain intensity over months 1, 2, and 3; secondary endpoints included change from baseline in mean monthly function, mean monthly duration of at least moderate pain intensity in migraine attacks, and mean monthly peak migraine pain intensity. Safety outcomes were also assessed. Of 512 randomized patients, 510 received erenumab 140 mg (n = 254) or placebo (n = 256) once monthly. Demographics and baseline characteristics were balanced between the two treatment arms. Erenumab 140 mg was superior to placebo in reducing duration of moderate or severe headache pain intensity over months 1, 2, and 3 (least squares mean [95% confidence interval {CI}] difference, -7.95 [-11.45, -4.46]; p < 0.001). Compared with placebo, erenumab significantly reduced migraine functional impact as assessed by the four domains of the Migraine Functional Impact Questionnaire, with a least squares mean (95% CI) difference of -7.36 (-10.80, -3.92) for physical functioning, -7.10 (-10.34, -3.87) for usual activities, -6.82 (-10.37, -3.27) for social functioning, and - 7.05 (-10.76, -3.34) for emotional functioning (p < 0.001 for all domains). Significant reductions with erenumab compared with placebo were also observed in duration of at least moderate pain intensity in residual or break-through migraine attacks (least squares mean [95% CI] difference, -1.07 [-1.92, -0.22]; p = 0.013) and peak migraine pain intensity (-0.48 [-0.85, -0.11]; p = 0.011). Incidence of grade 3 adverse events was 1.6% with erenumab and 1.2% with placebo; no grade 4 or fatal adverse events were reported in either treatment arm. Findings from the EMBRACE study demonstrated that treatment with erenumab in patients with high-frequency episodic migraine can provide positive therapeutic effects on ictal burden and pain, with residual migraine attacks tending to be shorter and less painful, with less overall impact.

<bold>Introduction:</bold> COPD Assessment Test (CAT) is a commonly used 8-item questionnaire assessing disease-specific quality of life. While it is a good tool to quantify patients’ symptoms, and the GOLD guidelines suggest its use in each assessment, many parameters can affect the implementation. <bold>Aim:</bold> To determine patient and disease characteristics affecting CAT scores. <bold>Methods:</bold> A cross-sectional observational study was conducted among COPD patients in Hungary who have been >12 months under maintenance inhaled therapy. Disease specific characteristics, comorbidities, lung function, and general demographic data were recorded. Multiple linear regression models were used to estimate all imputed variables’ effect on CAT scores. The Least Absolute Shrinkage and Selection Operator was chosen for variable selection. <bold>Results:</bold> We analyzed the data of 6962 patients. Mean (standard deviation) and median (min-max) CAT scores were 15.5 (7.0) and 15.0. (0-40), respectively. Estimates (average difference in CAT score moving from the reference to the stated category while holding all other predictors constant) of the most statistically significant predictors are as follows: increasing Modified Medical Research Council categories: 4; 3; 2 and 1 (+10.89; +8.50; +4.76; +2.49 points, respectively), errors during the use of the inhaler for maintenance medication (+2.43 points), moderate exacerbations in the previous year (1; 2 or >2 events; +1.20 ; +0.77; +1.63 points respectively), insomnia (+1.91 points) and pMDI device use (+0.92 points); p<0.003 for all. <bold>Conclusion:</bold> Multiple modifiable and unmodifiable parameters affect CAT score in COPD patients, which should be adressed during daily clinical practice to improve patients’ quality of life.

Boron-modified SrTiO 3 nanostructures were obtained by hydrothermal crystallization. The presence of boron induced the formation of a new donor level (resulting in increased recombination time). Hence, the modified samples showed higher photooxidation efficiency for phenol than the pristine SrTiO 3 . Measurable boron doping was detected even with minimal amounts of boron applied at the synthesis step (0.5 at.% boron), which positively affected the photocatalytic activity. As the boron content increases so does the doping degree. In addition, boron compound (SrB 2 O 4 ) appeared on the surface of the nanostructures. The highest photocatalytic activity was achieved by the sample containing 2 at.% boron. The appearance of the new compound on the surface of doped SrTiO 3 reduces the number of photocatalytically active sites, but due to the increase in photocatalytic activity caused by doping, even these samples have higher photocatalytic activity than pristine SrTiO 3 .

Training an accurate segmentation model requires high quality expert annotation along with significant amount of data that is costly and time-consuming to collect, especially in medical imaging domain. In this work, we argue that model trained on a carefully selected well-representative sub-cohort of the data pool can achieve similar performance to the model trained on all collected data. The evaluation conducted on an in-house dataset demonstrated that by combining synthetic data with the training sub-cohort, the method yields superior performance with respect to the one trained on all available real data.

Introduction: The burnout of doctors has become an unavoidable issue worldwide, including among the Hungarian doctors. The COVID–19 pandemic has enhanced the burnout among doctors. Objective: To define te prevalence of burnout and to analyze its correlation with the demographic indicators and with the type of healthcare service. Method: Cross-sectional study (n = 481), in which we define the burnout with the Maslach Burnout Inventory HSS (Human Services Survey). Descriptive statistical analysis (mean, standard deviation, frequency) was used to analyze burnout and the prevalence of individual variables. In the case of continuous variables, the differences between the averages of the groups were examined with an independent sample t-test, as well as with variance analysis. In the case of categorical variables, the differences between the proportions of the groups were examined with the χ2 test. Results: Based on the study with 481 doctors, 89.6% of the respondents were affected with at least one dimension of burnout. Half of the sample (52.8%) had serious emotional exhaustion, while 42.8% of the sample had serious depersonalisation, 45.9% of respondents had seriously reduced personal accomplishment. Nearly every fourth doctor (24.7%) was in the serious range of all three dimensions of burnout. Differentiating the sample, we have found among the younger doctors (age of 25–35 years) an especially high prevalence of burnout. In the group of doctors working only in the private healthcare system, the prevalence of burnout was lower. Conclusion: The prevalence of burnout among doctors in Győr-Moson-Sopron County is high. It is needed to establish a national burnout prevention and intervention strategy for doctors, started already at the medical universities. Orv Hetil. 2024; 165(21): 822–831.

Abstract Funding Acknowledgements Type of funding sources: None. Background Spectral CT imaging and virtual non-contrast (VNC) reconstruction techniques allow coronary artery calcium score (CACS) calculations from coronary CT angiography (CCTA) datasets. A novel virtual material decomposition algorithm (PureCalcium, PC) developed for photon-counting detector CT (PCD-CT) yields the potential of further increasing the accuracy of CCTA-based CACS measurements, however, little is known about the means of optimizing its performance for routine Agatston-scoring. Purpose The aim of the current study was to determine the predictors of the performance of a novel virtual non-iodine algorithm for PCD-CT. Materials and Methods Calcium scoring on non-enhanced scans is predominantly used as a complementary examination to CCTA increasing both acquisition time and radiation dose, thus, acquiring accurate CACS from CCTA datasets are warranted. In the current study, CACS and CAC volumes were calculated using true non-contrast (TNC) images and PC reconstructions in 139 consecutive patients (61.5 ± 10.9 years, 41.7% female) undergoing clinically indicated CCTA. Relative differences (TNC–PC/TNC) of PC-based CACS calculations from non-enhanced scans was calculated for each patient. Predictors of the degree of discrepancy were determined using linear regression analysis. Results Overall, BMI and heart rate did not affect the accuracy of PC measurements. However, the application of a higher tube voltage (140 kVp instead of 120 kVp) significantly decreased the relative difference of PC-based measurements from TNC values (β=-0.33 [95%CI: −0.64 – −0.03]). Furthermore, the average volume/lesion ratio also proved to be an independent predictor of performance (β=-0.01 [95%CI: −0.02 – −0.004]). Conclusions Spectral imaging based PC reconstructions may substitute conventional calcium scoring for a selected population of patients. It seems plausible that its performance can be improved by increased tube voltage protocols, provided spectral information gathered from CTA datasets is enhanced by using 140 kVp. It must be noted that the accuracy of PC may be hindered for smaller calcified lesions.