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This paper presents a complex heuristic method for the evaluation of fetal heart sounds, applying simultaneously several algorithms, where the autocorrelation technique has been completed with the wavelet transform and the matching pursuit methods. In this way, a more reliable heart rate variability can be achieved and further parameters of the cardiac operation can be assessed in addition to the conventional cardiotocographic examination. This also comprises those parameters, which can be investigated only with long-term or continuous monitoring, and those, which rely on a very accurate estimation of the heart rate variability. The proposed method provides a way for assessing fetal heart murmurs, which is a completely new possibility for monitoring the well-being of the fetus.

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We report the case of a melioidosis-like abscess of the liver caused by Stenotrophomonas (Xanthomonas) maltophilia infection in a Chinese man living in Hungary. Although this appears to be the first documentation of a liver abscess of this origin in a nonimmunocompromised patient, our case report demonstrates that this common facultative pathogen can also cause liver abscess and sepsis. After repeated negative blood cultures, histological examinations of liver biopsies suggested the possibility of chronic melioidosis, but the microbiological examination performed directly on the same specimen identified a Stenotrophomonas maltophilia infection. Surgical drainage was performed and sulphamethoxazole/trimethoprim therapy was commenced, after which the patient recovered fully. The facultative pathogen S. maltophilia, which most often causes nosocomial infections, may cause severe sepsis and liver abscess. We wish to draw attention to the fact that the antibiotic sensitivity of S. maltophilia is not necessarily the same in vivo and in vitro. This can create difficulties in both diagnosis and treatment.

IntroductionMotivation deficit is a significant aspect of lack of improvement in patients with schizophrenia especially with predominant negative symptoms (PNS). Therefore, improvement depends not only on symptoms reduction and better social functioning but also on patient engagement which is a key but less investigated aspect of successful treatment.ObjectivesTo investigate and compare patient engagement in PNS patients after cariprazine and risperidone treatment characterized by the 11 items of the Positive and Negative Syndrome Scale (PANSS-11).MethodsIn this phase 3 study patients suffering from PNS of schizophrenia (PANSS-FSNS≥24) were randomized to 26 weeks of treatment with either cariprazine or risperidone (target dose 4.5 and 4 mg/day, respectively). To compare the effects of the two drugs on patient engagement the PANSS-11 scale was used. Change from baseline (CfB) on the selected items and PANSS-11 total score were analyzed using mixed model of repeated measures approach without correction for multiplicity.ResultsPANSS-11 total score mean CfB were -11.20 (SD=0.43) for cariprazine-, and -9.44 (SD=0.45) for risperidone-treated patients with a -1.79 (95% CI=-3.01, -0.56) mean difference (p=0.004) in favor of cariprazine. Most item differences were statistically significant (N1, N2, N3, N4, N5, G16) or numerically higher (N6, G7, G13) for cariprazine versus risperidone.ConclusionsCariprazine significantly improved patient engagement in patients with PNS of schizophrenia compared to risperidone based on the PANSS-11 post-hoc analysis. These results suggest that cariprazine treatment may improve not only the symptoms and everyday functioning of PNS patients but their engagement with life.Conflict of interestStudies were funded by Gedeon Richter Plc. and Allergan Plc (prior to its acquisition by AbbVie). Dr. Laszlovszky, Dombi, Balogh, Dr Barabassy, Dr Vass, Dr. Szatmári and Dr. Németh are employees of Gedeon Richter Plc.

The purpose of this article is to describe a new, phonocardiography-based fetal telemonitoring system, which, due to its passive nature, allows long-term measurements even at the home of the pregnant woman. The input element of the system was the home monitor with two sensors for recording the trans-abdominal fetal heart signal and the uterine contractions. The recorded signal was transmitted by mobile network and Internet to an Evaluation Center, where it was analyzed in detail to obtain information about possible dysfunction of the fetal heart. The investigations on this system made clear that by advanced processing of the recorded signal the system captured many additional cardiac features compared with the traditional ultrasound-based cardiotocographic procedure.

A large proportion of congenital heart diseases (CHD) remain undetected during pregnancy or even after birth. Many of them generate turbulent blood flow, resulting heart murmur. Doppler ultrasound cardiotocography (CTG) is suitable for the assessment of the fetal heart rate and some derived parameters, but it is inadequate for detecting heart murmurs. Although comprehensive examination can be carried out with echocardiography, it is expensive and requires expertise; therefore, it is not applicable for widespread screening. This paper presents a new possibility for screening for some CHDs using phonocardiography, which can be combined with Doppler ultrasound CTG as an extension of it. Furthermore it can be carried out at home allowing repeated measurements, which increases also the reliability of filtering out innocent murmurs. The diagnostic capability of this screening method is supported by a large number of evaluated fetal heart sound records. Moreover, according to experiences pregnant women prefer this reliable, easy to use method, which facilitates their examination.