Betegutak elemzése az akut stroke ellátásban

Az akut stroke ellátó rendszer ellátási gyakorlatát kívánjuk jellemezni elsősorban a Tételes Egészségügyi Adattár adataira támaszkodva, a 2010-2017 közötti nyolc éves időtartományban. A módszer lényege az ellátási esetek és események tipizálása, ezek alapján epizódok alkotása, az epizódok tipizálása, az ellátók de facto ellátási területének meghatározása és ellátási gyakorlatuk jellemzése az epizód-típusok relatív gyakoriságával. Az elemzés alapján rámutattunk a területi és ellátóhoz köthető anomáliákra. Egyrészt figyelemre méltó az esettípusok, eseménytípusok, epizódtípusok gyakorisága közötti olykor 10-szeresnél is nagyobb különbség az egyes régiók között, de még inkább a kiugró értékkel rendelkező területek foltszerű elhelyezkedése. Az anomáliák egy részét a jelentési rendszer hiányosságai is okozhatják. A konkrét állítások és javaslatok megfogalmazása a felvetett kérdések statisztikai módszerekkel való vizsgálata után történhe

Az új Nemzeti Rákregiszter előnyei kutatói szempontból

A Nemzeti Rákregiszter jelenlegi formájában 1998. óta üzemel, és gyűjti a magyarországi daganatos megbetegedések statisztikáit. Ez idő alatt az informatika hatalmas változáson ment keresztül, és olyan lehetőségek nyíltak meg a gyógyítás és megelőzés előtt, amelyekre akkoriban még nem is gondolhattak az eredeti rendszer megalkotói. Az ORG GVOP projekt keretében, az Országos Onkológiai Intézet, az MTA SZTAKI és az Arvato Systems a mai kor követelményeinek megfelelően felújította a Rákregisztert. Ebben az új, web technológiai alapokra helyezett környezetben, könnyebbé, és automatizálttá vált a jelentés a központ felé, az automatikus hibadetekció és javítás révén javult az adatok megbízhatósága és minősége, és a Nemzeti Rákregiszterben dolgozók munkáját is megkönnyíti az a kutatói modul, melynek segítségével könnyen és gyorsan nyomon követhetők a rákos megbetegedések statisztikái. Az új rendszer arra is lehetőséget nyújt a kutatóknak, hogy környezeti, gazdasági, vagy egyéb egészségügyi adatokat, statisztikákat is összevessenek a rákos megbetegedésekkel, és összefüggéseket keressenek. Ezzel az új rendszer hozzájárul a rák kialakulási okainak könnyebb vizsgálatához, és így reményeink szerint hosszú távon a megelőzésben is nagy szerepe lehet

Effectiveness and Waning of Protection With Different SARS-CoV-2 Primary and Booster Vaccines During the Delta Pandemic Wave in 2021 in Hungary (HUN-VE 3 Study)

BackgroundIn late 2021, the pandemic wave was dominated by the Delta SARS-CoV-2 variant in Hungary. Booster vaccines were offered for the vulnerable population starting from August 2021.MethodsThe nationwide HUN-VE 3 study examined the effectiveness and durability of primary immunization and single booster vaccinations in the prevention of SARS-CoV-2 infection, Covid-19 related hospitalization and mortality during the Delta wave, compared to an unvaccinated control population without prior SARS-CoV-2 infection.ResultsThe study population included 8,087,988 individuals who were 18–100 years old at the beginning of the pandemic. During the Delta wave, after adjusting for age, sex, calendar day, and chronic diseases, vaccine effectiveness (VE) of primary vaccination against registered SARS-CoV-2 infection was between 11% to 77% and 18% to 79% 14–120 days after primary immunization in the 16–64 and 65–100 years age cohort respectively, while it decreased to close to zero in the younger age group and around 40% or somewhat less in the elderly after 6 months for almost all vaccine types. In the population aged 65–100 years, we found high, 88.1%–92.5% adjusted effectiveness against Covid-19 infection after the Pfizer-BioNTech, and 92.2%–95.6% after the Moderna booster dose, while Sinopharm and Janssen booster doses provided 26.5%–75.3% and 72.9%–100.0% adjusted VE, respectively. Adjusted VE against Covid-19 related hospitalization was high within 14–120 days for Pfizer-BioNTech: 76.6%, Moderna: 83.8%, Sputnik-V: 78.3%, AstraZeneca: 73.8%, while modest for Sinopharm: 45.7% and Janssen: 26.4%. The waning of protection against Covid-19 related hospitalization was modest and booster vaccination with mRNA vaccines or the Janssen vaccine increased adjusted VE up to almost 100%, while the Sinopharm booster dose proved to be less effective. VE against Covid-19 related death after primary immunization was high or moderate: for Pfizer-BioNTech: 81.5%, Moderna: 93.2%, Sputnik-V: 100.0%, AstraZeneca: 84.8%, Sinopharm: 58.6%, Janssen: 53.3%). VE against this outcome also showed a moderate decline over time, while booster vaccine types restored effectiveness up to almost 100%, except for the Sinopharm booster.ConclusionsThe HUN-VE 3 study demonstrated waning VE with all vaccine types for all examined outcomes during the Delta wave and confirmed the outstanding benefit of booster vaccination with the mRNA or Janssen vaccines, and this is the first study to provide clear and comparable effectiveness results for six different vaccine types after primary immunization against severe during the Delta pandemic wave

Opposite trends in incidence of breast cancer in young and old female cohorts in Hungary and the impact of the Covid-19 pandemic: a nationwide study between 2011–2020

BackgroundThis nationwide study examined breast cancer (BC) incidence and mortality rates in Hungary between 2011–2019, and the impact of the Covid-19 pandemic on the incidence and mortality rates in 2020 using the databases of the National Health Insurance Fund (NHIF) and Central Statistical Office (CSO) of Hungary.MethodsOur nationwide, retrospective study included patients who were newly diagnosed with breast cancer (International Codes of Diseases ICD)-10 C50) between Jan 1, 2011 and Dec 31, 2020. Age-standardized incidence and mortality rates (ASRs) were calculated using European Standard Populations (ESP).Results7,729 to 8,233 new breast cancer cases were recorded in the NHIF database annually, and 3,550 to 4,909 all-cause deaths occurred within BC population per year during 2011-2019 period, while 2,096 to 2,223 breast cancer cause-specific death was recorded (CSO). Age-standardized incidence rates varied between 116.73 and 106.16/100,000 PYs, showing a mean annual change of -0.7% (95% CI: -1.21%–0.16%) and a total change of -5.41% (95% CI: -9.24 to -1.32). Age-standardized mortality rates varied between 26.65–24.97/100,000 PYs (mean annual change: -0.58%; 95% CI: -1.31–0.27%; p=0.101; total change: -5.98%; 95% CI: -13.36–2.66). Age-specific incidence rates significantly decreased between 2011 and 2019 in women aged 50–59, 60–69, 80–89, and ≥90 years (-8.22%, -14.28%, -9.14%, and -36.22%, respectively), while it increased in young females by 30.02% (95%CI 17,01%- 51,97%) during the same period. From 2019 to 2020 (in first COVID-19 pandemic year), breast cancer incidence nominally decreased by 12% (incidence rate ratio [RR]: 0.88; 95% CI: 0.69–1.13; 2020 vs. 2019), all-cause mortality nominally increased by 6% (RR: 1.06; 95% CI: 0.79–1.43) among breast cancer patients, and cause-specific mortality did not change (RR: 1.00; 95%CI: 0.86–1.15).ConclusionThe incidence of breast cancer significantly decreased in older age groups (≥50 years), oppositely increased among young females between 2011 and 2019, while cause-specific mortality in breast cancer patients showed a non-significant decrease. In 2020, the Covid-19 pandemic resulted in a nominal, but not statistically significant, 12% decrease in breast cancer incidence, with no significant increase in cause-specific breast cancer mortality observed during 2020

Effects of whole-body 50-Hz magnetic field exposure on mouse Leydig cells.

The main goal of this study was to evaluate the possible effect of whole-body magnetic field (MF) exposure on the steroidogenic capacity of Leydig cells in vitro. In four separate experiments, male CFLP mice were exposed to sinusoidal 50-Hz, 100-µT MF. The duration of exposure was 23.5 h/day over a period of 14 days. At the end of the exposure, interstitial (Leydig) cells were isolated from the testicles of the sham-exposed and exposed animals. The cells were cultured for 48 h in the presence or absence of 1, 10, or 100 mIU/ml human chorionic gonadotropin (hCG). The luteinizing hormone (LH) analog hCG was used to check the testosterone (T) response of the sham-exposed controls and to evaluate the possible effect of the whole-body MF exposure on the steroidogenic capacity of Leydig cells in vitro. Testosterone content of the culture media and blood sera was measured by radioimmunoassay (RIA). In the cultures obtained from MFexposed animals, the hCG-stimulated T response was significanly higher (p < 0.01) compared with the sham-exposed controls, while the basal T production of cells and the level of serum T remained unaltered. No MF exposure-related histopathological alterations were found in testicles, epididymes, adrenals, prostates, and pituitary glands. The MF exposure did not affect the animal growth rate and the observed hematologic and serum chemical variables. Our results indicate a presumably direct effect of whole-body MF exposure on the hCG-stimulated steroidogenic response of mouse Leydig cells. KEYWORDS: ELF magnetic fields, power-line frequency, testosterone, Leydig cell culture, radioimmunoassay, hCG, histology, hematology, serum chemistry DOMAINS: microscopy, cell and tissue culture, endocrinology, hematology, reproduction, biophysics INTRODUCTION In the last decades, utilization of electricity has increased and diffused in both households and industries. The frequency of the current used in these systems is 0-300 Hz. This frequency interval is termed ©2004 with author. Forgács et al.: Magnetic Field Effect on Mouse Leydig Cells TheScientificWorldJOURNAL (2004) 4(S2), 83-90 extremely low frequency magnetic field (ELF-MF), which is a nonionizing radiation having photon energy too weak to break the atomic bonds. One of the most important fields of research in this topic is the investigation of the possible biological effects of power-line frequency (50/60 Hz) MF. At these frequencies, male and female reproductive functions have been proposed as possibly sensitive targets for the biological actions of MF. However, experimental data on male reproduction are quite limited and contradictory. Kato et al. [5] also found increased T levels in rats that they left for 5 weeks, 3 h/day in a 50-Hz/0.8-mT MF. In addition, statistical difference was found between the control and exposed animals with respect to head with lack of hook and isolated head type sperm. Besides this, they observed decreased spermatogenesis in some seminiferous tubules, congestion in blood vessels of the interstitium, and increases in interstitial edema and Sertoli cells. Al-Akhras et al. [6] observed a partly reversible reduction in male rat fertility after 90-day exposure to a 50-Hz MF of 25 µT. However, this working group did not find any MF exposure-related effects on the fertility of male mice at the same parameters of exposure Heredia-Rojas et al. [10] observed a statistically significant decrease in elongated spermatids obtained from rats 28 days after exposure to sinusoidal 50-Hz, 1.7-mT MF for 4 h. The authors suggested a possible cytotoxic and/or cytostatic effect of the applied MF on differentiating spermatogonia. In our previous experiments, we found that in vitro exposure to sinusoidal 50-Hz, 100-µT MF was able to stimulate the basal T production of primary mouse Leydig cell culture The main goal of this study was to evaluate the possible direct effect of whole-body 50-Hz MF exposure on the in vitro steroidogenic capacity of cultured Leydig cells. MATERIALS AND METHODS Animals CFLP mice (HUMAN, Gödöllő, Hungary) weighing 32-37 g (8-9 weeks old) were kept in a room with a 12:12 light/dark photoperiod, temperature of 20-23°C, and relative humidity of 50-60%. In each experiment, 10-13 sham-exposed and another 10-13 exposed mice were kept in plastic cages and allowed free access to standard laboratory pellets (Altromin) and tap water. The MF exposure was carried out in four repeated experiments. Magnetic Field Exposure The sinusoidal, 50-Hz MF was generated by a pair of double-wound coils connected to an internally developed, stabilized AC-current generator. The coils were embedded in molded epoxy resin to avoid vibration. The inner diameter of the coils was 42 cm. The distance between the two parallel coils, mounted horizontally above and below the mouse cage, was 32 cm. The orientation of MF was vertical 84 Forgács et al.: Magnetic Field Effect on Mouse Leydig Cells TheScientificWorldJOURNAL Body weights were recorded on the first and the last day of the treatment. Following the termination of exposure, between 10:30 and 11:00 a.m., mice were anesthetized with 60 mg/kg ip. pentobarbital (RhonePoulenc Rorer, Vitry sur Seine, France) and testicles, epididymes, adrenals, prostates, and pituitary glands were removed and blood samples were taken. After surgery, the animals were overdosed with pentobarbital. Interstitial Cell Preparation and Incubation Interstitial cells were prepared and cultured from the right testicles of the animals. (The left testicles were used for histology.) For isolation of interstitial cells by mechanical dissociation without enzyme treatment, the method of Stoklosowa[13] was used with some modification, as described earlier Testosterone Radioimmunoassay Quantification of T directly from aliquots of the cell culture media was performed by RIA. In addition, blood samples were taken from randomly selected animals to check the T levels of blood sera Histological Techniques Testes (left), epididymes, adrenals, prostates, and pituitary glands were fixed in buffered formol saline for histological examination. These tissues were dehydrated in ethanol, embedded in paraffin wax, and stained with hematoxylin and eosin. 85 Forgács et al.: Magnetic Field Effect on Mouse Leydig Cells TheScientificWorldJOURNAL (2004) 4(S2), 83-90 Hematology Blood was taken from aorta, collected in plastic Eppendorf tubes containing K 3 EDTA. White (WBC) and red (RBC) blood cells counts, hemoglobine concentration (HGB), volume of packed red cells (VPRC), and platelets (PLT) were determined using the Animal Blood Counter Vet abc™ (Roche). Serum Chemistry At sacrifice, free-flowing blood was collected in plastic Eppendorf tubes. After centrifugation, serum was removed and the samples were then analyzed for serum alkaline phosphatase, glutamic-oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), cholesterol, and triglycerides by an auto analyzer instrument (A.L. Instruments, France). Statistics The data were analyzed by Student's t-test and ANOVA using GraphPad Prism 3.01 computer software. To eliminate heterogeneity of variance among the data of experiments performed at different times, T levels of the culture media were expressed in percent of sham-exposed, in vitro 100 mIU/ml hCGstimulated controls. A value of p < 0.05 was considered to be significant. RESULTS Testosterone Production of Interstitial Cell Culture The Leydig cells used in all experiments were viable (>90% viability; checked by trypan blue exclusion test) and steroidogenically active. The sham-exposed mean 100-mIU/ml hCG-stimulated T response (control, 100%) was 245.21 ± 35.92 ng/10 6 cells. In the Leydig cells obtained from animals subjected to MF exposure, a significant elevation in hCG-stimulated T response was seen over a 48-h culture, while the basal T production and initial cell yield remained unaltered Serum Testosterone Concentration of serum T was also checked in randomly selected animals (n = 19). The mean (±SEM) T level of the exposed animals (350.26 ± 47.40 pg/ml) was found not to be significantly different from the sham-exposed controls (364.89 ± 40.88 pg/ml). Histology No MF exposure-related histopathological alterations were found in testicles, epididymes, adrenals, prostates, and pituitary glands. Body Weight There was no significant difference in the body weights of exposed animals compared to the shamexposed controls on the first and the last day of the exposure. 86 Forgács et al.: Magnetic Field Effect on Mouse Leydig Cells TheScientificWorldJOURNAL Hematology The hematologic variables (mean ± SEM) of exposed and sham-exposed mice are summarized in Serum Chemistry The mean values (± SEM) of alkaline phosphatase, GOT, GPT, cholesterol, and triglycerides for exposed and sham-exposed mice are shown in 87 Forgács et al.: Magnetic Field Effect on Mouse Leydig Cells TheScientificWorldJOURNAL (2004) 4(S2), 83-90 DISCUSSION In toxicological experiments, in vitro measures of T production of Leydig cells seem to be more sensitive than in vivo indicators of testicular damage Physiological T production in male vertebrates is stimulated by LH (or its analog hCG) through interaction with specific receptor located on the Leydig cell plasma membrane. Hormone-receptor interaction stimulates the classical second messenger pathway involved in steroidogenesis: adenylate cyclase -cAMP -protein kinase A Our results indicate an elevated hCG-stimulated T response of Leydig cell cultures obtained from whole-body MF-exposed mice, while the basal T production of cells and the serum T level of the animals remained unaltered. These data suggest a presumably direct effect of whole-body MF exposure on Leydig cells. These results are in agreement with our previous findings about the effect of in vitro MF exposure on T response of mouse Leydig cells The mechanism of action of the applied MF exposure cannot be discerned from present results. The MF exposure might alter the sensitivity and/or density of LH receptors on the surface of the cell membrane of Leydig cells. It is known that the initial biochemical or metabolic state of the cell membrane, as well as the functional and supramolecular organization of its specific regions (cell contact areas, receptors), are sensitive targets of electric and electromagnetic field (EMF) exposures Second messengers of signal transduction processes, mainly cAMP and Ca 2+ , also seem to play a decisive role in this effect of MF exposure on steroidogenesis. A possible mechanism of action on steroidogenesis may be associated with the alterations in cAMP content and intercellular communication may be induced by the applied MF. Schimmelpfeng et al. MF exposure can alter the local Ca 2+ concentration in different types of cells The results of our experiments show that whole-body MF exposure is able to increase the steroidogenic responsiveness of mouse Leydig cells to LH at a flux density that does not elicit any histopathological alterations in the investigated organs or changes in hematology and serum chemistry. The level of serum T was unaltered probably due to the feedback mechanisms of hypothalamic-pituitarygonadal axis. Further investigations are required to clarify the subcellular action of applied MF in Leydig cells, as well as to establish the biological significance of this phenomenon. ACKNOWLEDGMENT

Joint Modeling of Disease Pairs

Aim: Exploring the spatial patterns in joint distribution of incidences of two diseases. Material and method: A Poisson-Binomial regression model was used in analysing hospitalisation counts data in Hungary, 2008. Model parameters were estimated by MCMC implemented in WinBUGS. Results: Spatial patterns of laryngeal and hypopharyngeal cancer differ significantly from that of their ratio. Conclusion: The Poisson-Binomial model proposed here might help clarify us the different spatial dependencies of the sum and the ratio of incidences of two diseases