Schizophrenia (SCH) is a severe mental disorder and one of the top 20 causes of disability, associated with a reduction in life expectancy of more than 15 years. Excess mortality rates in SCH are mainly due to complex vascular and cardiometabolic causes. However, the exact nature of the detailed structural and functional alterations in myocardial mechanics, particularly regarding left ventricular (LV) function, remains insufficiently characterized in the chronic stage of SCH (CS-SCH). The novel three-dimensional (3D) speckle-tracking echocardiography (3DSTE) enables detailed volumetric and strain analysis of the LV from a single acquired 3D echocardiographic dataset. The present study aimed to evaluate LV deformation using 3DSTE in patients with CS-SCH and to compare their data to age-, gender- and body mass index (BMI)-matched healthy controls. In a cross-sectional case-control design, after the initial screening of 74 CS-SCH outpatients, due to non-compliance and suboptimal image quality, 23 patients (mean age: 45.9±9.3 years, 13 males, BMI: 30.4±5.1 kg/m2) were included in the final analysis and compared to 59 healthy individuals matched for age, gender and BMI (mean age: 46.7±9.4 years, 33 men, BMI: 30.1±4.5 kg/m2). All patients and controls underwent routine two-dimensional Doppler echocardiography extended with detailed 3DSTE analysis. Increased LV volumes were associated with reduced LV ejection fraction (EF) in patients with CS-SCH as compared to controls. All global and mean segmental LV strains were reduced in CS-SCH patients. From regional LV strains, only midventricular LV strains were reduced, whereas basal and apical LV strains did not differ between the two groups. Detailed 3DSTE-derived LV deformation analysis revealed significant abnormalities, including reduced LV-EF and reduced midventricular LV strains, indicating subclinical cardiac damage in the chronic stage of CS-SCH. These findings confirm the importance of cardiovascular assessment and management in this severe mental condition.
Background. Physiological remodeling resulting from chronic exercise-induced volume and pressure overload is a well-recognized characteristic of the athlete's heart. This study aimed to explore potential changes in three-dimensional speckle-tracking echocardiography-derived aortic valve annular (AVA) dimensions and dynamics in elite athletes engaged in high-dynamic sports with varying degrees of static components. Furthermore, we sought to determine whether these parameters differ depending on the magnitude of the sport's dynamic component. Methods. The athlete cohort included 56 individuals and was divided into three groups based on the static component of their sport: C. I. (high dynamic/low static) consisted of 13 elite athletes (mean age: 22.7 ± 3.8 years, 5 males), C. II. (high dynamic/moderate static) consisted of 18 elite athletes (mean age: 23.0 ± 4.6 years, 6 males) and C. III. (high dynamic/high static) consisted of 25 elite athletes (mean age: 21.7 ± 4.5 years, 9 males). Data of athletes were compared with those of 38 age- and sex-matched healthy non-athletic individuals (mean age: 23.8 ± 2.5 years, 14 males). Results. AVA dimensions did not differ significantly between athletes and controls nor among the athlete subgroups. AVA plane systolic excursion (AAPSE) was increased in all athletes compared with controls (1.31 ± 0.30 cm vs. 1.18 ± 0.36 cm, p < 0.05). All athletes showed a significantly larger proportion of individuals showing larger end-diastolic AVA than end-systolic AVA (55% vs. 24%, p < 0.05). All athletes demonstrated reduced basal LV-RS (26.5 ± 13.9% vs. 31.5 ± 13.2%, p < 0.05) and increased basal LV-LS (-21.4 ± 4.4 vs. 19.9 ± 4.2%, p < 0.05) compared with controls. This pattern of findings was consistent across all athlete subgroups. Conclusions. Although AVA is not dilated in elite athletes practicing dynamic sports, its spatial displacement, as represented by AAPSE, together with increased basal LV-LS and a higher proportion of larger end-diastolic AVA, is augmented, while basal LV-RS is reduced. These findings suggest a functional shift from radial contraction toward enhanced longitudinal dynamics. All these findings appear to be independent of the static component of dynamic sports.
Introduction: Health problems related to cardiovascular morbidity and mortality are overrepresented in patients with schizophrenia (SCH) and their rates have not declined in parallel with those of the general population. Cardiovascular diseases in patients with SCH are less likely to be diagnosed and treated, and data regarding structural and functional cardiac abnormalities-particularly those involving the left atrium (LA)-remain limited in this population. The present study is the first to provide a detailed three-dimensional speckle-tracking echocardiography (3DSTE)-derived volumetric and functional evaluation of LA properties in patients with chronic SCH compared with age-, gender- and body mass index (BMI)-matched healthy controls (HCs). Methods: A total of 36 patients with SCH were initially enrolled, from which 19 subjects (53%) were excluded due to inferior image quality. Ultimately, 17 SCH patients (mean age: 45.2 ± 7.7 years; 9 males, 53%) were compared with 40 age- and gender-matched HCs (mean age: 42.5 ± 5.7 years; 23 males, 58%). All participants underwent comprehensive two-dimensional Doppler echocardiography and 3DSTE. Results: LA volumes respecting the cardiac cycle were lower in SCH patients compared with controls. Among LA volume-derived functional properties, total and active LA stroke volumes were reduced in patients with chronic SCH, whereas passive LA emptying fraction was increased. All global and mean segmental peak LA strain parameters tended to be increased in SCH patients, with global and mean segmental LA area strain (AS) and mean segmental LA radial strain (RS) reaching statistical significance. Regarding regional peak LA strains, basal LA circumferential strain (CS) and LA-AS, as well as superior LA longitudinal strain (LS), LA-CS, and LA-AS, differed significantly between the groups. All global and mean segmental LA strain parameters measured at atrial contraction tended to be increased in chronic SCH patients, with global and mean segmental LA-AS and mean segmental LA-RS and LA-LS reaching statistical significance. Regional LA strains during atrial contraction demonstrated increased superior LA-RS, LA-CS, LA-LS and LA-AS, along with elevated mid-atrial LA-RS, LA-AS and LA-3D strain. All these abnormalities suggest reduced LA volumes in all phases of LA function, accompanied by overcompensating functional alterations. Conclusions: Chronic schizophrenia is associated with marked volumetric and functional abnormalities of the left atrium. These findings highlight the need for comprehensive cardiac functional evaluation extending beyond left ventricular-centered analysis in patients with this severe mental illness.
Introduction. Left ventricular (LV) function can be characterized by numerous parameters, the most well-known being the ejection fraction (EF), derived from LV end-systolic and end-diastolic volumes (ESV and EDV, respectively) throughout the cardiac cycle. M-mode echocardiography (MME-)-based determination of the longitudinal displacement of the mitral annulus (MA plane systolic excursion, MAPSE) remains a simpler and more practical parameter for assessing LV function in daily clinical routine. Although the relationships between MAPSE, LV deformation and LV rotational mechanics are well-established in healthy individuals, it remains unclear whether MAPSE also correlates with LV volumes themselves. To address this, the associations between LV-ESV and LV-EDV and MAPSE in a healthy cohort were investigated, exploring how these variables relate across average, sub-average, and above-average ranges. Methods. The present cohort study enrolled 115 healthy adult volunteers (mean age: 35.3 ± 12.1 years; 68 men). Complete two-dimensional (2D) Doppler echocardiography with MAPSE assessment and 3DSTE-derived measurement of LV volumes was performed in all cases. Results. Both end-diastolic and end-systolic LV diameters and volumes tended to be higher in individuals with lower- or higher-than-average MAPSE compared to those with average MAPSE. These differences reached statistical significance for 2D echocardiography-derived LV end-systolic diameter and volume, as well as for 3DSTE-derived LV-EDV and LV-ESV. MAPSE remained consistent regardless of the degree of LV-EDV and LV-ESV. No significant correlations were observed between MAPSE and LV-EDV or LV-ESV. Conclusions. LV longitudinal shortening, as represented by MAPSE, is not associated with 3DSTE-derived LV volumes in healthy adults. However, the observed lack of association may not necessarily reflect true physiological independence, but could instead result from limited statistical power, measurement variability, or model misspecification.
Introduction: Gestational physiology is characterized by an expansion of plasma volume and an elevation in cardiac output. Given the scarcity of existing data on pregnancy-related left atrial (LA) volumetric and functional features, this study aims to define LA volumes, volume-based functional properties and strains in healthy subjects during mid-term pregnancy. Methods: The present study comprised 19 healthy women in mid-term pregnancy (mean age: 30.5 ± 2.7 years, weight: 81.7 ± 14.0 kg, height: 166.9 ± 5.7 cm) without any symptoms, known diseases or other conditions, which could affect the results. Their results were compared to those of 43 healthy non-pregnant women (mean age: 28.6 ± 4.9 years, weight: 59.9 ± 8.5 kg, height: 167.8 ± 7.6 cm). All participants underwent comprehensive two-dimensional Doppler echocardiography with three-dimensional speckle-tracking echocardiography (3DSTE). Results: Thicker interventricular septum, increased left ventricular ejection fraction and impaired early and late transmitral flow velocities could be detected in healthy pregnant subjects as compared to those of non-pregnant individuals. End-systolic maximum LA volume was increased with elevated stroke volume and emptying fraction. While early diastolic LA volume was preserved with elevated stroke volume and emptying fraction, late diastolic LA volume, stroke volume and emptying fraction remained unchanged. However, indexed LA volumes did not differ between the groups. Among end-systolic peak global LA strains, only LA longitudinal strain (LS) was increased, while all others remained unchanged. Among regional strains, basal, midatrial and superior LA circumferential strain (CS) and LA-LS were increased except for basal LA-CS, which was impaired. Among late diastolic LA strains at atrial contraction, none of them showed any significant changes in healthy pregnant subjects compared with those of non-pregnant women. Conclusions: With a detailed 3DSTE study, elevated end-systolic LA volume and preserved diastolic LA volumes, together with enhanced end-systolic LA reservoir and early diastolic LA conduit functional properties, could be detected with features of preserved late diastolic booster pump function in healthy women during mid-term pregnancy (second trimester). When comparing indexed LA volumes, no significant difference could be confirmed between the pregnant and non-pregnant groups. This suggests that the increased end-systolic LA volume may be an adaptation to increased body weight.
Introduction. Pregnancy is characterized by a significant expansion of plasma volume and an increase in cardiac output, necessitating structural and functional adaptations of the cardiac chambers, including the right atrium (RA). To evaluate these changes, three-dimensional (3D) speckle-tracking echocardiography (STE) was used as a validated and sophisticated modality for the concurrent assessment of RA volumetric and functional alterations. This study aimed to characterize RA volumes, volume-based functional indices, and strain parameters in healthy women during mid-gestation, compared with a cohort of non-pregnant controls. Methods. This retrospective cohort analysis included 20 healthy, asymptomatic women in their second trimester (mean age: 29.9 ± 3.0 years; weight: 81.2 ± 14.2 kg; height: 166.9 ± 5.8 cm; body surface area [BSA]: 1.95 ± 0.17 m2). The control group consisted of 30 age-matched healthy non-pregnant women (mean age: 29.9 ± 4.1 years; weight: 58.7 ± 6.5 kg; height: 166.0 ± 5.4 cm; BSA: 1.68 ± 0.11 m2). All subjects underwent comprehensive two-dimensional Doppler echocardiography and 3DSTE. Results. Early and late diastolic RA volumes were significantly reduced, despite preserved end-systolic RA volume. Pregnant subjects exhibited reduced active RA stroke volume and increased passive RA emptying fraction, while all other parameters remained comparable between the groups. No significant differences were observed between groups in end-systolic peak RA global or mean segmental strains, nor in RA strains measured during atrial contraction. However, end-systolic peak regional RA strain analysis revealed decreased basal RA circumferential strain (CS) and increased superior RA-CS in pregnant participants compared with controls. Furthermore, during late diastole (at atrial contraction), superior RA-CS, RA-3D strain, and RA-area strain were significantly higher in healthy pregnant subjects than in controls. Conclusions. Substantial regional changes in RA function were detected by 3DSTE, likely reflecting adaptation to pregnancy-induced plasma volume expansion, and resulting in significant RA volumetric changes.
Attitudes toward vaccination play a crucial role in shaping vaccination behavior; however, in Hungary, there is currently no validated instrument suitable for the psychometrically sound assessment of such attitudes in the general adult population. The aim of this study was to adapt the Vaccination Attitudes Examination (VAX) scale into Hungarian and to examine its psychometric properties in a sample of the adult Hungarian population. We analyzed data from a nationally representative cross-sectional survey of adults aged 18 years and older (n = 1000). The factor structure of the scale was examined using exploratory and confirmatory factor analyses (the former using maximum likelihood estimation with oblimin rotation, the latter using DWLS estimation appropriate for ordinal items). Internal consistency was assessed using Cronbach's alpha and CFA-based reliability indices. Convergent validity was evaluated by examining associations with theoretically relevant attitudinal and trust-related variables. The findings supported a theoretically coherent four-factor structure. The total scale and subscales demonstrated good to excellent internal consistency (α = 0.69-0.92). VAX scores showed strong positive associations with conspiracy beliefs and moderate to strong negative associations with trust in science and institutions. Respondents who had not received a COVID-19 vaccine scored significantly higher on all subscales. The Hungarian version of the VAX scale reliably and validly measures the multidimensional structure of vaccine-skeptical attitudes. The results are consistent with international validation studies and support the applicability of the scale in the Hungarian context. The Hungarian version of the VAX scale is an appropriate instrument for research on vaccination attitudes and for examining the social and psychological determinants of vaccine hesitancy. Orv Hetil. 2026; 167(27): 1059-1067. Bevezetés: Az oltásokkal kapcsolatos attitűdök fontos szerepet játszanak az oltási magatartás alakításában, ugyanakkor Magyarországon jelenleg nem áll rendelkezésre validált, általános felnőtt populációra alkalmazható mérőeszköz ezen attitűdök pszichometriailag megalapozott vizsgálatára. Célkitűzés: A kutatás célja a Védőoltási Attitűdök Vizsgálata (Vaccination Attitudes Examination – VAX) skála magyar nyelvű adaptációja és pszichometriai validálása a felnőtt magyar lakosság körében. Módszer: A vizsgálat országosan reprezentatív, 18 éves és idősebb felnőttekből álló mintán (n = 1000) végzett keresztmetszeti adatfelvétel adatai alapján zajlott. A skála faktorstruktúráját feltáró és megerősítő faktoranalízissel vizsgáltuk (az előbbit „maximum likelihood” becsléssel és oblimin rotációval, az utóbbit ordinális tételekre alkalmas DWLS-becsléssel). A belső konzisztenciát Cronbach-alfa, valamint CFA-alapú megbízhatósági mutatók segítségével értékeltük. A konvergens validitást elméletileg releváns attitűd- és bizalmi változókkal való összefüggések elemzésével teszteltük. Eredmények: Az eredmények egy elméletileg koherens, négydimenziós faktorstruktúrát támasztottak alá. A skála és alskálái jó vagy kiváló belső megbízhatóságot mutattak (α = 0,69–0,92). A VAX-pontszámok erős negatív összefüggést jeleztek az összeesküvés-elméletekbe vetett hittel, valamint mérsékelt-erős negatív kapcsolatot a tudományba és az intézményekbe vetett bizalommal. A COVID–19 ellen oltatlan válaszadók szignifikánsan magasabb pontszámokat értek el valamennyi alskálán. Megbeszélés: A magyar nyelvű VAX-skála megbízhatóan és érvényesen méri az oltásokkal kapcsolatos szkeptikus attitűdök többdimenziós szerkezetét. Az eredmények összhangban állnak a nemzetközi validációs tanulmányokkal, és alátámasztják a skála alkalmazhatóságát a magyar kontextusban. Következtetés: A VAX-skála magyar változata alkalmas eszköz az oltási attitűdök kutatására, valamint az oltási bizonytalanság társadalmi és pszichológiai hátterének feltárására. Orv Hetil. 2026; 167(27): 1059–1067.
Migraine affects up to 10% of the primary school children (6-14 years old) and its diagnosis is challenging. The purpose of our study is to present the Hungarian-language validation process of the McMaster Paediatric Migraine Headache Questionnaire, which is an easy-to-use questionnaire for workers in both outpatient and inpatient care. The linguistic validation was conducted according to an international protocol: permission of the corresponding author, two independent forward translations, a synthesis of the translations, back translations and consensus team review. The comprehensibility of the resulting Hungarian version was tested during a pilot study involving 31 young children with headaches. The reliability of the questionnaire was examined by calculating the Cronbach's alpha coefficient showing the internal consistency of the items. A total of 31 people filled the questionnaire, their mean age was 12.58 ± 3.3 years (16 girls, mean age 11.56 ± 3.1 years; 15 boys, mean age 13.7 ± 3.2 years). Almost three quarters of the participants (23 people, 74.2%) reported 5 or more headache days in a month. Based on the results of the McMaster Pediatric Migraine Questionnaire, 41.9% (13 people) of the participants suffered from migraine, and 9.6% of them had migraine with aura. The respondents rated the comprehensibility of the questionnaire as 1.93 on a scale from 1 (very easy) to 10 (very hard), which indicates easy completion. The Cronbach's alpha value of the questionnaire is 0.709, which means adequate reliability, but the complex validation process requires a larger sample. The final Hungarian version of the questionnaire used is suitable for the next step of linguistic and cross-cultural adaptation, by examining a larger patient population for the screening of childhood migraines in both outpatient and inpatient care. A migrén az általános iskolás korosztály (6–14 évesek) akár 10%-át is érintheti, diagnosztizálása pedig kihívásokkal teli. Vizsgálatunk célja a McMaster Paediatric Migraine Headache Questionnaire – ami egy könnyen felhasználható kérdőív az alap- és szakellátásban dolgozók számára – magyar nyelvű validációs folyamatának bemutatása. Először az eredeti cikk levelező szerzőjének engedélyét kértük a validációs folyamatra, hozzájárulása után két szakfordító külön-külön lefordította a kérdőívet angol forrásnyelvről magyarra; egy harmadik szakfordító bevonásával elkészült a két verzió szintézise, majd azt két, angol anyanyelvű fordító visszafordította angol forrásnyelvre, amit konszenzusmegbeszélés követett. Az így kapott magyar verzió érthetőségét 31 fejfájós kisgyermek bevonásával pilótavizsgálat során teszteltük. A kérdőív megbízhatóságát a tételek belső konzisztenciáját mutató Cronbach-α együttható kiszámításával vizsgáltuk. A kérdőívet összesen 31 fő töltötte ki, átlagéletkoruk 12,58 ± 3,3 év volt (16 lány, átlagéletkor 11,56 ± 3,1 év; 15 fiú, átlagéletkor 13,7 ± 3,2 év). A résztvevők csaknem háromnegyede (23 fő, 74,2%) számolt be havi 5, vagy ennél több fejfájós napról. A McMaster Paediatric Migraine Questionnaire eredményei alapján a résztvevők 41,9%-a (13 fő) migrénben szenved, illetve 9,6%-uknál az aurás migrén diagnózisa is felmerül. A kitöltők a kérdőív érthetőségét az 1-től (nagyon könnyű) 10-ig (nagyon nehéz) terjedő skálán 1,93-ra értékelték, ami könnyű kitölthetőséget jelez. A kérdőív Cronbach-α-értéke 0,709, ami megfelelő konzisztenciát jelent, de a komplex validálási folyamathoz ennél nagyobb esetszám szükséges. A kérdőív végső magyar változata alkalmas a nyelvi és kultúrközi adaptáció következő lépésének elvégzésére, a nagyobb betegpopuláción történő vizsgálat után pedig a gyermekkori migrén szűrésére az alap- és szakellátásban.
In an iodine-deficient population, the consequences affect all age groups. In mild to moderate deficiency, goiter and, later in life, nodularity and thyroid dysfunction may develop. Fetal iodine insufficiency interferes with the development of the central nervous system of the fetus, resulting in lower IQ in later life. In order to eliminate iodine deficiency in Hungary, goiter screening and measurement of median urine iodine concentration in schoolchildren were introduced in recent decades, as well as promotion of access to information on the importance of conscious consumption of iodized salt and the importance of iodine-containing prenatal multivitamin use in pregnancy was initiated. An important government measure was the 2014 regulation which made the use of iodized salt mandatory in public catering. The aim of our work was to assess the iodine supply of the population in Hungary. Our laboratory is one of the accredited European centers for the measurement of urinary iodine excretion. Here we report on our recent study performed in four settlements in Eastern Hungary. Between 2018 and 2023, urinary iodine concentrations of 583 school-age children were measured to determine the current iodine supply. Results show that current iodine intake is adequate, with a median urinary iodine excretion of 202.4 µg/L (Q1: 133.5 µg/L, Q3: 317.3 µg/L). In order to ensure the current iodine intake level, continued widespread use of iodized salt, regular monitoring of iodine supply, and appropriate and continuous information of the population are necessary. With the collaboration of endocrinologists, public health experts and the entire medical community, the efforts of the past 50 years has achieved the complete elimination of iodine deficiency in Hungary. However, the consequences of iodine deficiency suffered in childhood remain present in the currently middle-aged population for decades. Orv Hetil. 2026; 167(26): 1027-1033. Bevezetés: Jódhiányos populációban annak következményei minden korosztályt érintenek. Zavart szenved a pajzsmirigyműködés, és már enyhe jódhiány esetén is strúma, magzati korban elszenvedett jódhiány esetén a központi idegrendszer fejlődésének alacsonyabb IQ-t okozó zavara léphet fel. Hazánkban az elmúlt évtizedekben a jódhiány felszámolására tett lépések között szerepelt az iskolai golyvaszűrés, majd a vizelet jódkoncentrációjának meghatározása és a lakosság figyelmének felhívása a jódozott só tudatos fogyasztására, várandósság esetén pedig a jódtartalmú terhesvitaminok alkalmazására. 2014-től rendelet írja elő a jódozott só használatát a közétkeztetésben. Célkitűzés: Munkánk célja annak felmérése volt, hogy milyen a lakosság jódellátottsága Magyarországon. Módszer: Tanszékünk laboratóriuma európai szinten akkreditált a vizeletjód-ürítés meghatározására. Kutatócsoportunk négy kelet-magyarországi településen végzett populációs vizsgálatot 2018 és 2023 között 583 iskoláskorú gyermek körében annak megállapítására, hogy milyen a jódellátottság jelenleg ebben a régióban. Eredmények: A vizsgálat alapján a jódellátottság megfelelőnek bizonyult, a vizeletjód-ürítés mediánja 202,4 µg/l (Q1: 133,5 µg/l, Q3: 317,3 µg/l) volt. Megbeszélés és következtetés: Ahhoz, hogy ez továbbra is így maradjon, a jódozott só folyamatos, széles körű használatára, a jódellátottság rendszeres monitorozására, valamint a lakosság megfelelő és folyamatos tájékoztatására van szükség. Az endokrinológusok, a népegészségügyi szakemberek és a hazai orvostársadalom összefogásával az elmúlt 50 év munkájával napjainkra sikerült felszámolni Magyarországon a jódhiányt, de a középkorú lakosságot a korábban elszenvedett jódhiány következményei még évtizedekig elkísérik. Orv Hetil. 2026; 167(26): 1027–1033.
Assessing fall risk is essential for older adults as well as for specific patient populations, including those with neurological or musculoskeletal disorders. The Activities-specific Balance Confidence Scale is a widely used instrument for evaluating perceived balance confidence, and its Hungarian version has already been validated. However, administering the original 16-item scale can be time-consuming. The aim of this study was to develop and validate the 6-item short version of the Hungarian Activities-specific Balance Confidence Scale among individuals with neurological and musculoskeletal conditions. Our investigation was conducted in two phases. In the first phase, 167 participants completed the full 16-item version of the Hungarian Activities-specific Balance Confidence Scale, data for the 6 selected items were extracted and analyzed. Convergent validity was tested against the Berg Balance Scale here. In the second phase, 63 participants completed the 6-item Hungarian short version of the scale along with other patient-reported surveys. Data on falls in the previous year and perceived pain levels were also collected. Internal consistency was evaluated using Cronbach's alpha and McDonald's omega, while test-retest reliability was assessed via the intraclass correlation coefficient. We also calculated floor and ceiling effects and minimal detectable change. Convergent validity was evaluated using the Hungarian version of the Falls Efficacy Scale - International. Discriminative validity was examined comparing the scores of patients with or without falls. The effect of perceived pain on scale results was also evaluated. The 6-item Hungarian short version of the Activities-specific Balance Confidence Scale demonstrated high reliability with no floor or ceiling effect. Strong to moderate correlations were found with the physical test and the Falls Efficacy Scale - International. The scale effectively discriminated between individuals with and without a history of falls. Perceived pain did not significantly influence the scores. The average completion time was under 4 minutes. The 6-item Hungarian version of the Activities-specific Balance Confidence Scale is a brief, reliable, and valid instrument for assessing balance confidence in patients with neurological and musculoskeletal conditions. Due to its sensitivity and short completion time, it is highly suitable for both clinical practice and research. Orv Hetil. 2026; 167(27): 1068-1078. Bevezetés: Az eleséskockázat felmérése alapvető jelentőségű mind idősek, mind speciális betegcsoportok, így a neurológiai és mozgásszervi betegek körében. A Tevékenységfüggő Egyensúlybiztonsági Skála (Activities-specific Balance Confidence Scale) a szubjektív egyensúlybiztonság értékelésére szolgál, magyarul is elérhető, azonban a teljes, 16 kérdéses változat kitöltése időigényes lehet. Célkitűzés: Tanulmányunk célja a Tevékenységfüggő Egyensúlybiztonsági Skála rövidített, 6 kérdéses magyar változatának létrehozása és pszichometriai jellemzőinek vizsgálata volt, neurológiai és mozgásszervi betegek körében. Módszer: Vizsgálatunk két fázisban zajlott. Az első fázisban 167 beteg töltötte ki a teljes, 16 kérdéses skálát, jelen tanulmányunkban a kiválasztott 6 kérdés értékeit vettük figyelembe. Ebben a fázisban a konvergens validitást fizikális teszttel, a Berg Egyensúlybiztonsági Skálával összehasonlítva vizsgáltuk. A második fázisban 63 beteg a skála rövid, 6 kérdéses változatát és más önkitöltős skálákat kapott. Itt rákérdeztünk az előző évben elszenvedett esésekre, illetve a megélt fájdalomra. A megbízhatósági vizsgálatok során a belső konzisztenciát Cronbach-alfa és McDonald-ómega, a teszt-reteszt megbízhatóságot osztályon belüli korrelációs együttható segítségével vizsgáltuk. Emellett plafon- és padlóhatást, illetve minimálisan kimutatható változást is számoltunk. A konvergens validitás vizsgálatához a Falls Efficacy Scale – International magyar változatát használtuk. A diszkriminatív validitás vizsgálata céljából összehasonlítottuk az esést szenvedett és nem szenvedett betegek eredményeit, és elemeztük a megélt fájdalom hatását a skála eredményére. Eredmények: A rövidített Tevékenységfüggő Egyensúlybiztonsági Skála megbízhatóságát jónak találtuk. Plafon- és padlóhatás nem jelentkezett. Erős vagy mérsékelt korrelációt találtunk a fizikális teszttel és más egyensúlybiztonsági skálákkal való összehasonlítás során. Ez a skála megfelelően különbséget tett az eleső és nem eleső betegek között, míg a fájdalom nem befolyásolta az eredményeket. A kitöltés átlagos ideje 4 percnél kevesebb volt. Következtetés: A 6 kérdéses Tevékenységfüggő Egyensúlybiztonsági Skála rövid, jól értelmezhető és megbízható eszköz a szubjektív egyensúlybiztonság mérésére neurológiai és mozgásszervi betegek körében. Rövid kitöltési ideje és érzékenysége alapján alkalmas a mindennapi klinikai gyakorlatban és kutatásokban való alkalmazásra. Orv Hetil. 2026; 167(27): 1068–1078.
Despite the fact that Hungarian school healthcare has a history dating back 140 years, no comprehensive study has yet been conducted to analyze the historical development and impact of system, particularly the institutionalization of the role of health visitors in educational institutions and the development of cooperation between school doctors and health visitors. 1) To explore the historical development of school health services and the takes of school doctors, 2) to analyze the involvement and role of public health visitors in school healthcare, 3) to examine the role of cooperating professionals (doctors, public health visitors, and other professionals present today), 4) to explore the challenges that determine current operations. We studied the relevant legislation, professional regulations, and literature through research, and carried out systematic and analytical work. The role of school doctors shifted from monitoring and epidemic control to preventive care and health promotion tasks. The development of school healthcare is linked to the name of József Fodor, who laid the foundations for the regular health monitoring of school-age children by introducing a public health approach. Health visitors gradually became involved in healthcare within the legal framework, and their role became increasingly important in the areas of prevention, care, and health education. Health visitors initially appeared as professionals supporting the work of doctors. Today, this cooperation extends to all areas of health visitors' professional activities and plays a fundamental role in the effective functioning of school healthcare. The cooperation between school doctors and public health visitors is one of the cornerstones of Hungarian school healthcare and plays a key role in maintaining children's health, prevention, and health promotion. Orv Hetil. 2026; 167(19): 753-764. Bevezetés: Annak ellenére, hogy a magyar iskola-egészségügyi ellátás 140 éves múltra tekint vissza, mindeddig nem készült átfogó tanulmány, amely a történeti fejlődést és annak hatását elemezve vizsgálta volna a rendszer kialakulásának folyamatát, különösen a védőnői szerep intézményesülését az oktatási intézményekben, valamint az iskolaorvos és a védőnő közötti együttműködés fejlődését. Célkitűzés: Az 1) iskola-egészségügyi szolgáltatás, az iskolaorvosok feladatainak történeti fejlődésének feltárása, 2) a védőnők iskola-egészségügyi ellátásba való bekapcsolódásának és szerepének elemzése, 3) az együttműködő szakemberek (orvos, védőnő, valamint a napjainkban jelen lévő szakemberek) szerepének vizsgálata, 4) a jelenkori működést meghatározó kihívások feltárása. Módszer: Szakirodalmi kutatómunkával tanulmányoztuk a témához kapcsolódó jogszabályokat, szakmai szabályozókat, szakirodalmi közleményeket, rendszerező, elemző munkát végeztünk. Eredmények: Az iskolaorvosok feladatköre az ellenőrző és járványügyi tevékenységektől a megelőző, gondozó és egészségfejlesztő feladatok felé mozdult. Az iskola-egészségügyi ellátás kialakulása Fodor József nevéhez fűződik, aki a közegészségügyi szemlélet meghonosításával megalapozta az iskoláskorú gyermekek rendszeres egészségügyi felügyeletét. A védőnők fokozatosan, jogszabályi keretek között kapcsolódtak be az ellátásba, és szerepük egyre hangsúlyosabbá vált a prevenció, a gondozás és az egészségnevelés területén. Megbeszélés: A védőnő kezdetben az orvos munkáját támogató szakemberként jelent meg. Napjainkban ez az együttműködés kiterjed a védőnő valamennyi szakmai tevékenységi területére, és alapvető szerepet játszik az iskola-egészségügyi ellátás hatékony működésében. Következtetés: Az iskolaorvos és a védőnő közötti együttműködés a magyar iskola-egészségügy egyik meghatározó pillére, és kulcsfontosságú a gyermekek egészségmegőrzésében, prevenciójában és egészségfejlesztésében. Orv Hetil. 2026; 167(19): 753–764.
Telemedicine is a key component of digital health; however, its practical implementation is highly heterogeneous. The structured description and interpretation of complex telemedicine programs reaching multiple levels of care, remain methodologically challenging, particularly in models addressing underserved populations. The aim of this study was to provide a structured, functional description of the telemedicine care model of the Hungarian Order of Malta Naszlady Attila Health Promotion Program and to interpret descriptive operational results using the digital health intervention classification framework of the World Health Organization. This descriptive study applied a functional analytical approach to the telemedicine components of the program. The presented results are based on aggregated routine operational data collected between 2023 and 2025. The program implements multiple integrated digital health interventions at client, provider and health system levels. Locally delivered, nurse-augmented teleconsultations, diagnostic tests, specialist teleconsultations and structured care pathway coordination jointly support improved access to healthcare services and more targeted use of specialist care capacities. The functional framework enables interpretation of the telemedicine model as a coherent system of interventions rather than a set of isolated technologies, facilitating international comparability and supporting future program evaluation and adaptation. A functional classification framework provides a robust methodological basis for the scientific description of complex telemedicine care models. The presented model highlights the role of telemedicine in strengthening local access to care and addressing healthcare inequalities. Orv Hetil. 2026; 167(23): 905-915. Bevezetés: A telemedicina a digitális egészségügy egyik meghatározó területe, ugyanakkor gyakorlati megvalósítása rendkívül heterogén. A komplex, több ellátási szintet érintő telemedicinális programok összehasonlítható leírása és értelmezése ezért módszertani kihívást jelent, különösen a hátrányos helyzetű populációkat célzó ellátási modellek esetében. Célkitűzés: A tanulmány célja a Magyar Máltai Szeretetszolgálat Naszlady Attila Egészségfejlesztési Programja telemedicinális ellátási modelljének strukturált, funkcionális bemutatása, valamint a program működéséből származó leíró eredmények értelmezése az Egészségügyi Világszervezet digitális egészségügyi beavatkozásokat osztályozó keretrendszere alapján. Módszer: Leíró tanulmányunkban a program telemedicinális ellátási elemeit funkcionális szempontból elemezzük. A bemutatott eredmények a program rutinszerű működése során keletkezett, aggregált ellátási adatokon alapulnak a 2023 és 2025 közötti időszakból. Eredmények: A program több, egymással integrált digitális egészségügyi beavatkozást valósít meg kliens-, ellátói és egészségügyirendszer-szinten. A lakóhelyközeli, ápolóasszisztált távvizitek, diagnosztikus vizsgálatok, a szakorvosi telekonzultációk és a strukturált betegútszervezés együttesen támogatják az egészségügyi ellátáshoz való hozzáférést és a szakellátási kapacitások célzott igénybevételét. Megbeszélés: A funkcionális megközelítés lehetővé teszi, hogy a telemedicinális ellátási modell ne kizárólag technológiai megoldásként, hanem egymással összefüggő beavatkozások rendszereként kerüljön bemutatásra, ami elősegíti a nemzetközi összehasonlíthatóságot és az adaptálhatóságot. Következtetés: A funkcionális osztályozási keret alkalmas a komplex telemedicinális ellátási modellek egységes, tudományos igényű leírására. A bemutatott modell rámutat a telemedicina szerepére a lakóhely közeli ellátás megerősítésében és az ellátási egyenlőtlenségek potenciális csökkentésében. Orv Hetil. 2026; 167(23): 905–915.
Fresh frozen tissues are considered the gold standard for proteomic analyses due to their superior preservation of protein integrity; however, their use is limited by the logistical and financial requirements of long-term cold storage. Formaldehyde-fixed paraffin-embedded (FFPE) tissues provide a practical alternative, owing to their stability and widespread availability in clinical settings. A critical step in FFPE proteomics is deparaffinization, which traditionally relies on organic solvents such as xylene, along with the efficient reversal of formaldehyde-induced crosslinks. In this study, we evaluated multiple FFPE protein extraction and digestion workflows including chaotropic, surfactant-based, and detergent-free approaches in combination with xylene-free deparaffinization strategies, using label-free data-independent acquisition (DIA) LC-MS/MS. Among the tested methods, a chaotropic, reductant, and surfactant-free in-solution digestion workflow demonstrated robust protein and peptide recovery. A modified version of this protocol further improved peptide coverage while maintaining comparable protein depth. The applicability of the optimized workflow was assessed using FFPE needle biopsy samples from control, hepatic steatosis, and liver fibrosis groups. Exploratory proteomic patterns were observed across conditions, with hepatic steatosis associated with early activation of stress-response pathways, while fibrosis showed evidence suggesting altered lipid metabolism. Overall, this study presents a simple, xylene-free, and MS-compatible workflow for FFPE proteomics that is suitable for low-input clinical samples and may support broader application of archival tissues in proteomic research.
During Pavlovian fear conditioning, presentation of a conditioned stimulus, such as a tone, together with an unconditioned stimulus, such as an electrical shock, excites neurons in the lateral amygdala (LA). Prevailing models propose that sensory stimulus-evoked activity in the LA is subsequently propagated to its downstream nuclei: the basal amygdala (BA) and central amygdala (CeA). To test this assumption, we performed in vivo electrophysiological recordings in awake, head-fixed male and female mice. We found that tone presentation did not elicit a significant increase in firing in BA or CeA neurons. In contrast, shock presentation evoked similarly robust spiking responses in LA and BA neurons but only a modest increase in CeA neurons. Notably, neurons in the amygdalostriatal transition area (AStria) exhibited LA-like sensory stimulus-evoked responses at both short (<25 ms) and longer (<500 ms) timescales. To examine the role of feedforward inhibition in tone- and shock-evoked activity, we investigated the contribution of parvalbumin interneurons using optogenetics and found that short-latency (<25 ms) spiking in both the LA and AStria was regulated by these inhibitory cells. Finally, LA and AStria neurons exhibited remarkably similar response types, spiking dynamics, and pairing-induced plasticity during repeated tone presentations, subsequent tone-shock pairings, and post-pairing tone presentations. Together, these findings support a model in which the LA and AStria operate in parallel, similarly integrating tone and shock signals during fear conditioning, whereas BA and CeA neurons are not robustly recruited by these sensory stimuli under the conditions tested.
Cohabiting companion dogs establish hierarchy among themselves. It is hypothesized that the owner represents the main and undividable resource, thus primary access to this is a main organizing factor of rank-related behaviors of dogs. Here we tested high- and low-ranking cohabiting companion dogs' (N = 70) reactions to their owner's absence in a 3 min separation test. Rank scores have been assigned with a validated questionnaire (DRA-Q). We predicted that dominant dogs would show stronger reactions to being separated from their owner. Indeed, we found that higher-ranking dogs showed more intense activity and sooner arising attempts to leave the room (rearing at the wall, scratching the door, moving around, barking) than lower-ranking dogs did. These reactions may show also the intention to reestablish their connection with the absent owner. The associations between dogs' rank and the behavioral responses were modified by the dogs' age (negatively), the number of cohabiting dogs (positively), and we found that subcategories of the dog's dominant status (such as 'agonistic' and 'leadership' subscales) were also associated with finer details of the outcome. These are the first results indicating that presence of the owner may provide more reassurance to higher-ranking dogs against stress than it does to lower-ranking dogs.
暂无摘要（点击查看详情）
In the present study, a distinctive lineage of lymnaeid gastropods from the deep-water deposits of the Late Miocene Lake Pannon (Central Europe) is revised. The examined material includes specimens from museum collections as well as newly collected fossils from different parts of the Pannonian Basin System. During the past 150 years, at least 30 deep-water lymnaeid species assigned to ten genera have been described from the Lake Pannon deposits; however, our examination of more than 700 specimens shows that these records represent only 11 species belonging to five genera. Lectotypes are designated for four species for which earlier type designations were invalid. Species belonging to the Radix-Velutinopsis-Undulotheca-Provalenciennesia-Valenciennius lineage form one of the most extraordinary molluscan groups of Lake Pannon. Their interest lies in their distinctive shell morphology - large (sometimes exceeding 10 cm), wide, thin, cap-like shells with reduced coiling and undulated ribs - and their deep-water mode of life, supported by occurrences in drill cores and bathymetrically calibrated by seismic sections. This taxonomic revision enables the lineage to be applied in deep-water biostratigraphy of Lake Pannon sediments. Based on first appearance datums of key lineage species and associated taxa from other mollusc groups, four new lineage zones are proposed, integrated with the established deep-water mollusc biozonation. In contrast to the anagenetic evolutionary patterns typical of biostratigraphically important Lake Pannon bivalves, this gastropod lineage shows predominantly anacladogenetic speciation.
This study evaluated the efficacy of adding nightly 0.025% atropine to Defocus Incorporated Multiple Segments (DIMS) spectacle treatment in children with ongoing myopia progression and explored whether dynamic pupillometry could help identify such progression. In a mixed-method design, a longitudinal arm included 20 DIMS non-responders, defined by annual progression of ≥ 0.5 D spherical equivalent refraction or ≥ 0.2 mm axial elongation, who received adjunctive atropine and were followed for 12 months. In a separate cross-sectional arm, dynamic pupillometry was performed in 60 DIMS-treated children classified as fast or slow progressors based on prior-year progression. Combination therapy significantly reduced myopia progression, with mean axial elongation decreasing from 0.39 ± 0.18 to 0.20 ± 0.18 mm/year and mean refractive progression improving from - 0.82 ± 0.67 to - 0.28 ± 0.45 D/year. Transient axial shortening was observed in 20% of patients, while 25% remained unresponsive, predominantly those with high maternal myopia. Dynamic pupillometry revealed that fast progressors exhibited slower and prolonged pupil constriction compared with slow progressors, whereas dilation parameters and static pupil size did not differ. In conclusion, adjunctive low-dose atropine effectively reduced progression in most DIMS non-responders, and altered pupil constriction dynamics may reflect underlying physiological differences associated with treatment resistance.
The relevance of prior antithrombotic and thrombolytic treatment for decision-making regarding endovascular thrombectomy (EVT) for acute ischemic stroke due to large vessel occlusion with established large infarcts is uncertain. This study investigates associations of prior antithrombotic medication and thrombolysis with the efficacy and safety of EVT for acute ischemic stroke due to large vessel occlusion with established large infarct. TENSION (Efficacy and Safety of Thrombectomy in Stroke With Extended Lesion and Extended Time Window) was a prospective randomized open-label blinded-end point clinical trial. Patients with acute ischemic stroke due to large vessel occlusion and established large infarct were randomized to EVT with medical therapy or medical therapy alone. Exposures were preadmission antithrombotic treatment with antiplatelet agents or anticoagulants and intravenous thrombolysis. The primary efficacy end point was functional outcome at 90 days. Safety outcomes included death and symptomatic intracranial hemorrhage. The study included 246 patients (median age, 74 years; interquartile range, 65 to 80 years; 49% women); 124 (50%) were assigned to EVT. Of 176 patients (72%) with prior antithrombotic therapy, 75 (31%) received antiplatelets, 56 (23%) anticoagulants, and 89 (36%) intravenous thrombolysis. EVT was associated with better functional outcome in patients with (common odds ratio [cOR], 2.40 [95% CI, 1.22-4.99]) and without (cOR, 2.29 [95% CI, 1.53-3.46]) antiplatelet therapy; with (cOR, 2.45 [95% CI, 1.17-5.28]) and without (cOR, 2.12 [95% CI, 1.44-3.15]) anticoagulation; as well as receiving (cOR, 1.46 [95% CI, 0.83-2.61]) and not receiving (cOR, 2.89 [95% CI, 1.87-4.51]) thrombolysis. Interaction analyses were consistent with similar treatment effects across subgroups. Mortality and rates of symptomatic intracranial hemorrhage were similar between groups. Benefit and safety of EVT were not modified by prior antithrombotic/thrombolytic therapy. Preadmission exposure to antiplatelets or anticoagulants or use of intravenous thrombolysis should not exclude eligible patients with stroke from EVT. URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03094715.
Upregulation of flotillins, the defining proteins of an incompletely characterized clathrin-independent form of endocytosis, is reported in a variety of human pathologies such as cancer, neurodegeneration, and infection. Several sorting nexin (Snx) proteins have established roles in the endosomal network, but the function of many members of this phospholipid-binding protein family such as Snx21 is still poorly investigated. Here, we show that Snx21 binds to the phospholipid PI(3)P enriched in endosomal membranes, and it localizes to the endosomal system in various Drosophila tissues. We find that Snx21 also binds to and colocalizes with flotillins in Drosophila. We propose that overexpression of Snx21 facilitates endocytic trafficking toward late endosomes/lysosomes leading to a large increase in the size of late endosomes, which requires Flotillin2. In parallel, Snx21 is required for multiple alterations caused by Flotillin2 overexpression: both the intracellular accumulation of Wingless/Wnt morphogen and ectopic wing vein formation that are induced by Flotillin2 overexpression in the developing wing depend on Snx21. Taken together, we identify Snx21 as a previously undescribed physical and functional interacting partner of flotillins, and our data point to the role of Snx21 as a potential positive regulator of flotillin-mediated endocytic trafficking.