Orvosi hetilap最新文献

Recent studies using molecular diagnostic and imaging techniques have shed new light on the mesenteric complex, its intra-abdominal location and role, and its role in local and systemic pathogenesis. One of the most important aims is the clarification of the role of mesenteric adipocytes and the adipokines they produce in inflammatory processes. There is now growing evidence that among the multifactorial origins described in the development of Crohn's disease, mesenteric "fat wrapping", proinflammatory cytokines, oxidative stress processes due to the reactive oxygen species, and an altered microbiota localizing to the mesentery as a whole play a mutually potentiating role. The clinical implication of basic research is that newly developed mesenteric-based surgical strategies after Crohn's disease surgery are associated with improved outcomes, fewer relapses and fewer reoperations. Nowadays, the role of the mesenterium as mediator, as "ambassador", is unquestionable. Orv Hetil. 2026; 167(3): 88-97.

The World Health Organization's survey indicates that cancer is the second leading cause of death globally. The identification of early markers and the early detection of asymptomatic tumors remain the most critical objectives for effective treatment and improved survival. Human blood sample analysis is a noninvasive technique used in patient care and cancer research. Currently, certain genes, gene products and tumor markers measured in blood are routinely used for diagnosis and monitoring. The thermoanalytical examination of the human blood plasma proteome is a promising new area, where blood sampling can be considered a type of liquid biopsy. Differential scanning calorimetry (DSC) directly measures the stability and decomposition of proteins, lipids, or nucleic acids during a controlled increase or decrease in temperature, allowing the study of individual substances in their native and denatured states. This thermoanalytical DSC curve of a biomolecule or biostructure is unique, like a fingerprint, and shows normal or pathomorphological changes under specific circumstances. Various clinical conditions (malignant melanoma, breast tumor, pancreatic tumor) showed unique but disease-specific DSC thermograms obtained from measurements of patients' blood plasma, which correlated with disease severity, progression, or response to treatment. Following further development, deconvolution analysis of blood plasma DSC curves raises the possibility of early diagnosis of cancerous or inflammatory conditions, disease monitoring, or testing the effectiveness of therapy used from a single drop of blood. Orv Hetil. 2026; 167(3): 98-108.

The scientific understanding of hydrogen peroxide (H2O2) has undergone several paradigm shifts. Research over the last 30 years has shown that it has only harmful effects. There is now a scientific consensus that endogenously formed H2O2 molecule is a cellular messenger in cell signaling at physiological (low) concentrations, an active and positive player in all phases of wound healing, a mediator of many metabolic processes, involved in the regulation of apoptosis, gene transcription, can modify protein function, localization and activity through oxidative post-translational modification. Elevated tissue levels are always an indicator of some disease state (tumor, inflammation, etc.), while high concentrations of oxidative effects generate further damage. Catalase is present in all cells in variable concentrations and is a sensitive modulator of H2O2 concentration. H2O2 can exert its bactericidal effect only on bacteria containing catalase. Routine wound and tissue cleansing with 3% H2O2 solution in patient care dissolves clots and removes dead cells preventin thereby infection. However, it induces severe oxidative stress and tissue damage. It is classified as an "old antiseptic" according to European guidelines and is no longer recommended for the treatment of acute or chronic wounds due to a number of adverse properties. However, lipid-stabilized 1% H2O2 cream can be used for wound treatment. Among complementary therapies that have gained increasing attention in response to the rising prevalence of bacterial antibiotic resistance, hyperbaric oxygen therapy and medical honey-impregnated dressings act, at least in part, because they contain H2O2. Recent research aims at supporting tissue redox balance from the antioxidant enzyme side by developing biomimetic and nanoenzyme systems that can fill the missing catalase function for H2O2. Overall, among the reactive oxygen species, the endogenous H2O2 molecule has highly active physiological functions, while for routine exogenous administration, a less harmful concentration or a stabilized formula is recommended. Orv Hetil. 2026; 167(3): 119-128.

Introduction: Acute ischemic stroke is one of the leading causes of disability and mortality in adults, representing a major public health burden also in Hungary. Functional recovery is influenced by a wide range of clinical, imaging and vascular risk factors; however, the relative contribution of these predictors is still poorly understood in the Hungarian population.

Method: The aim of this study was to identify the independent predictors of a 3-month functional outcome among ischemic stroke patients treated within 24 hours of symptom onset, using hierarchical linear regression based on data from the stroke registry of the National Laboratory of Translational Neuroscience.

Results: A total of 1,062 patients were included in this retrospective cohort (mean age 71.9 ± 12.6 years, 52% female). The full model explained 20% of the variance (R² = 0.20, p<0.001). Age (β = -0.25; p<0.001), diabetes mellitus (β = -4.12; p = 0.02), chronic kidney disease (β = -5.45; p = 0.03), and multiple vascular disease (β = -3.89; p = 0.04) emerged as independent negative predictors. Among the acute clinical variables, admission NIHSS (β = -1.78; p<0.001) and ASPECTS (β = +2.34; p = 0.01) showed independent associations with favorable functional outcome, whereas intravenous thrombolysis administered within 60 minutes (β = +4.56; p = 0.02) was a positive predictor and beyond 60 minutes (β = -3.67; p = 0.04) a negative predictor; similarly, endovascular thrombectomy within 120 minutes (β = +5.23; p< 0.001) was a positive, and beyond 120 minutes (β = -4.89; p = 0.03) a negative predictor. Recanalization showed an independent positive effect (β = +0.12; p = 0.04).

Conclusion: Our findings indicate that functional recovery is primarily determined by stroke severity, the extent of ischemic injury, and patient age, whereas metabolic and vascular comorbidities exert a moderate but statistically significant negative effect on outcome. The separated time windows for intravenous thrombolysis and endovascular treatment underscore the importance of in-hospital treatment speed, reduce exposure misclassification, and enhance the explanatory power of the model. A key strength of the hierarchical approach is its ability to incorporate predictors in successive blocks, allowing for a more precise evaluation of the multifactorial determinants of functional recovery. Orv Hetil. 2026; 167(2): 43-50.

Introduction: Esophageal cancer is an extremely malignant disease with a 5-year survival rate of just over 20%. The 7% survival measured in Hungary is notably low on a global scale, mainly due to the late detection of tumors and consequently delayed initiation of oncological treatment.

Objective: Our aim was to obtain a more precise understanding of the general and nutritional status, as well as the nutritional capacity and their impact on survival of Hungarian patients at diagnosis by reviewing the patient population treated at our clinic.

Method: A retrospective data analysis was performed on 183 patients treated at the Department of Surgery, Transplantation and Gastroenterology at Semmelweis University between 2006 and 2021.

Results: Our study demonstrated a strong correlation between the degree of dysphagia (p = 0.001) and the duration of symptomatic weeks (p = 0.001) with the extent of weight loss. Furthermore, the degree of weight loss and the rate of dysphagia progression significantly influenced overall survival. Patients with weight loss exceeding 10 kg had less than half the overall survival compared to those with less than 10 kg weight loss (1347 vs. 560 days, p = 0.01). Rapid progression corresponded to an average survival of 413 days, whereas patients with slow worsening swallowing difficulties survived for an average of 1138 days (p = 0.006). Among patients with adenocarcinoma, weight loss was more pronounced (p = 0.05), although this did not translate into a significant survival difference.

Discussion: Compared to international data, our findings suggest a considerably worse condition of Hungarian patients, implying a multifactorial problem.

Conclusion: Improving disease survival requires addressing numerous challenges from public health through primary care to specialized treatment centers. Increasing patient awareness, early identification and evaluation of those presenting with swallowing difficulties, early detection of nutritional risk, and immediate appropriate intervention are of fundamental importance. Orv Hetil. 2026; 167(2): 58-64.

Introduction: Dementia represents a major global health and social challenge today, with an estimated 55 million people currently affected. The quality of care has a significant impact on the patients' quality of life, while ensuring such care imposes considerable physical and mental burdens on healthcare personnel. In Hungary, person-centered care for people living with dementia is not always provided, and the role of family members in caregiving is often undervalued.

Objective: The authors examined the burdens experienced by Hungarian nurses/caregivers in dementia care, the practice of person-centered care, the role of family involvement, and the training needs of nurses.

Method: The study was conducted as a quantitative, cross-sectional survey. A questionnaire survey was carried out among 121 Hungarian nurses and social caregivers who provide care for patients with dementia. Data collection took place between October 22 and November 22, 2024. The aim was to assess knowledge and practical experience related to person-centered care, as well as to explore nurses' physical and mental burdens and the role of family participation in caregiving.

Results: Nurses reported significant physical and psychological strain during healthcare and social institutional care. Although they possessed theoretical knowledge of person-centered care, its application in practice was often limited. The extent of family involvement varied. The majority of participants emphasized the need for training tailored to their qualifications and experience, focusing on the specific aspects of dementia care.

Conclusion: The high burden on Hungarian nurses and the limitations in person-centered care highlight the need for further development in dementia care. Training programs and greater family involvement could improve the quality of care and support the advancement of person-centered nursing, thereby contributing to enhanced quality of life for both patients and their relatives. Orv Hetil. 2026; 167(2): 51-57.

In this case report, we present a young female patient exhibiting pathological misidentification symptoms, in which we employ differential diagnostic methods to distinguish between Capgras syndrome and Fregoli syndrome. The uniqueness of the case lies in the fact that the object of misidentification is not a human being but an animal - in this instance, a dog. Moreover, the underlying psychiatric disorder does not conform to the typical patterns commonly associated with such symptom formations. Following the presentation of findings from a comprehensive psychodiagnostic evaluation, we interpret the psychopathological process within a psychodynamic explanatory framework, placing particular emphasis on the differential diagnostic implications. To the best of our knowledge, in Hungary this is the first documented case of a pathological misidentification in which the primary etiopathogenetic factor can be attributed to a pathological trajectory of personality development. Orv Hetil. 2026; 167(2): 65-69.