Virtual reality as a simulation tool for field hospital's and COVID-19 hospital's staff training / A virtuális valóság mint szimulációs módszer alkalmazása a telepített sürgosségi egységek, valamint COVID-19-kórházak személyzetének képzésében.

Összefoglaló. Bevezetés: A COVID-19-pandémia okozta nagyfokú betegszám-növekedés ellátásának érdekében az egészségügyi rendszerek gyakran a kórházak teljes átszervezésére kényszerültek. A szakállomány gyors és hatékony felzárkóztatása kulcsfontosságú ilyen körülmények között. A telepített kórházi egységek személyzetének felkészítésére a virtuális valóságban levezetheto csoportos gyakorlatozás ígéretes módszernek mutatkozik. Célkituzés: Célunk egy telepített kórház személyzetének felkészítésére alkalmazott virtuális szimulációs gyakorlatsorozat tapasztalatainak bemutatása, valamint a létrehozott és kipróbált virtuális gyakorlatcsomagok adaptálási lehetoségeinek elméleti bemutatása a COVID-19-kórházak személyzetének gyors felzárkóztatását szolgáló gyakorlatsorozat lehetséges kivitelezése érdekében. Módszer: Három, prototípusként eloállított virtuális gyakorlat került alkalmazásba két próbatanfolyam keretén belül. A virtuális színterek kialakítására az XVR szimulációs szoftvert használtuk. A gyakorlatok alkalmazhatóságának és hasznosságának kiértékelésére anonim kérdoíves felméréseket készítettünk. Az adatok feldolgozásában kereszttábla-elemzést és khi-négyzet-próbát alkalmaztunk. Eredmények: A két próbaképzésen nyolc ország képviseletében összesen 76 gyakornok vett részt. A résztvevok 63,9%-a szerint a módszer alkalmas ilyen jellegu gyakorlatok levezetésére, de további fejlesztéseket igényel. Véleményük, hogy technikai használata "elég könnyen" elsajátítható (59,7%), és interaktív (90,32%), valósághu (45,0%) szimulációs közeget biztosít. Megbeszélés: Eredményeink alapján a virtuális valóság egy alkalmazható módszer a telepített kórházak szakállományának valós bevetésekre való felkészítésére. A létrehozott virtuális gyakorlatcsomagok tartalma és szerkezete könnyen adaptálható egy COVID-19 ideiglenes egészségügyi egység sajátos munkakörülményeihez való gyors személyzeti felzárkóztatást szolgáló muhelygyakorlatok megszervezéséhez. Következtetés: A virtuális valóság ígéretes oktatási eszköz, amely kiegészítheti a nagy költségekkel és bonyolult szervezéssel járó terepgyakorlatokat, megközelítve azok oktatási hatásfokát. A virtuális térben megélt tapasztalatok valós szakmai élményekké alakulnak, és hozzájárulnak egy biztonságos és hatékony munkaközeg gyors kialakításához. Orv Hetil. 2021; 162(40): 1591-1600. INTRODUCTION: COVID-19 pandemic imposed sudden increase in hospital admissions, thus medical systems needed to reorganize entire hospitals quite often. Quick and efficient training is of outmost importance. Virtual reality team training is a promising tool for newly organized hospital units' staff. OBJECTIVE: Our goal was to present the usefulness and applicability of virtual simulation exercises for training of field hospital personnel and to evaluate the adaptability of these created and tested exercise packs for urgent staff training of COVID-19 hospitals. METHOD: Three prototypes of virtual reality exercises were assessed through two test courses. XVR simulation software was used to create virtual environments. Evaluation of exercise applicability and utility was performed by anonymous questionnaires. Statistical data-processing was performed using contingency table and chi-square tests. RESULTS: 76 trainees from eight countries participated in the two pilot courses. 63.9% of the participants stated that the method is suitable for conducting such exercises, but needs further development. Its technical use is "easy enough" to learn (59.7%) and provides an interactive (90.32%) and realistic (45.0%) working environment. DISCUSSION: Virtual reality is applicable to train field hospital staffs for real missions. The created virtual exercise packages are easily adaptable, both in content and structure, to workshops dedicated for quick training of specific COVID-19 temporary medical facility's personnel. CONCLUSION: Virtual reality is a promising educational tool that can complement the expensive and laborious field exercises, with comparable training efficiency. These virtual reality experiences may become real professional memories and create swiftly a secure and efficient professional milieu. Orv Hetil. 2021; 160(40): 1591-1600.

Pregnancy and Colorectal Cancer, from Diagnosis to Therapeutical Management - Short Review.

Colorectal cancer (CRC) is one of the most common human malignancies, affecting one of 20 persons in areas with high socio-economic standard but cases of digestive cancers during pregnancy are rare. From an etiological point of view, CRC represents an entity induced on the one hand by environmental factors and on the other hand by genetic factors or, not rarely, by their combination. The difficulty of diagnosing digestive cancers in pregnancy is the consequence of a symptomatology often masked by signs and symptoms that can be attributed to pregnancy. Essential in terms of assessing the staging of TNM in CRC, CT remains the subject of numerous debates. Over the last 40 years CT has been contraindicated in pregnant women due to teratogenic and carcinogenic effects on the fetus. Pregnancy MRI method is preferable to any other method of investigation that uses ionizing radiation. The CRC's treatment plan must take into account the interests of two people, the mother and the fetus, so that the "interest" of one does not affect the other, respecting an axiom: for the mother, treatment as soon as possible after birth, respectively, for the foetus, delaying the therapy until it is viable. Colorectal neoplasia is, in generally, a predominantly surgical pathology at the time of disease discovery, especially in conditions of a major complication that leaves no time for a therapeutic alternative (obstruction, perforation, significant bleeding). A chemotherapy-type oncology protocol option is preferred for cases with advanced, metastatic neoplasms.

Benefits and Disadvantages of Neoadjuvant Radiochemotherapy (RCT) in the Multimodal Therapy of Squamous Esophageal Cancer (ESC).

INTRODUCTION: The purpose of this paper is to present the advantages and disadvantages of neoadjuvant RCT in multimodal therapyof ESC. MATERIAL AND METHOD: Between 1998-2014 221 patients were treated with ESC, 85 of whom received neoadjuvant RCT. For these we have made imaging and pathologic assessment of response using RECIST and MANDARD criteria and statistical data were interpreted in terms of the factors that influence the response. Also, they were evaluated statistical correlations between RCT and resectability, postoperative morbidity, mortality and long-term survival. RESULTS: 45 patients were imagistic responders and 34 underwent surgery, 40 non-responders of which 14 underwent surgery. Of the 48 surgical patients with preoperative RCT, histopathological evaluation showed that 32 were pathological responders and 16 non responders. There were performed statistical analyzes of correlations between RCT and resectability, stage, location of ESC, morbidity, mortality and survival. CONCLUSION: RCT increase resectability, improves survival and maximum duration of survival, more in responders than in nonresponders and does not affect postoperative complications and postoperative mortality, nor among the responders or nonresponders. Imaging evaluation result of the response to RCT overestimate responders.

KRAS gene mutations - prognostic factor in colorectal cancer?

The colorectal cancer (CRC) modern therapy is using adjuvant and neoadjuvant companion therapeutic agents, part of them having an anti-angiogenic action. Their benefic effect can be annulated by some gene mutations, which are interfering in signal transduction pathways. One of the more frequent activating mutations is occurring in the KRAS gene. We assessed the KRAS mutations by two molecular methods, in a group of patients with a follow-up until 144 months, aiming to establish eventual correlations between the presence of mutations and the evolution of patients. We tried to appreciate the prognostic value of these mutations. A retrospective study was conducted on 74 patients treated by radical surgery; the surgical specimens were analyzed macroscopically and the histopathological type and degree were established. PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) and pyrosequencing were performed on paraffin-embedded tumor specimens. Statistical analysis showed significant differences in survival between patients with wild type gene and patients with mutation in codon 13; the same results were also obtained regarding TNM I, II stages or Dukes type A and B cases. However, for the patients in stage IV pTNM, the evolution was slightly better in association with a KRAS mutation than in wild type cases.