Comparative effectiveness of second generation long-acting injectable antipsychotics based on nationwide database research in Hungary.

BACKGROUND: Schizophrenia is a severe condition that affects approximately 1% of the population. Certain elements of antipsychotic treatment can only be examined in large population, thus the need for population-based real-world analyses has been increasing. PATIENTS AND METHODS: Hungarian National Health Fund database includes all healthcare data of the population of Hungary. All patients diagnosed with schizophrenia between 01.01.2006 and 31.12.2015 were included in the study. We analyzed all patients with newly initiated second-generation antipsychotic during the inclusion period (01.01.2012-31.12.2013). Patients were followed for 2 years. All-cause treatment discontinuation served as the primary outcome of the study. Patients with newly initiated long-acting injectable treatments were further investigated in stratified analyses based on their previous treatment. RESULTS: 106,624 patients had schizophrenia diagnosis during the study period. 12,232 patients met the inclusion criteria for newly initiating second-generation antipsychotic during the inclusion period. The proportion of patients still on treatment after 1 year for oral treatments varied between 17% (oral risperidone) and 31% (oral olanzapine) while the analogous data for long acting injectables were between 32% (risperidone long acting) and 64% (paliperidone long acting one monthly). The 2-year data were similarly in favor of long-actings. Median time to discontinuation in the oral group varied between 57 days (clozapine) and 121 days (olanzapine). The median time to discontinuation for long-actings was significantly longer: between 176 and 287 days; in case of paliperidone long acting, median was not reached during the observation period. Patients receiving long-acting treatment switched from another long-acting remained on the newly initiated treatment significantly longer than those switched from orals. CONCLUSION: Our results indicate the superiority of second generation long-acting antipsychotics with regard to rates of treatment discontinuation and periods of persistence to the assigned medication.

Post-transplantation morphological and functional changes in kidneys from expanded criteria donors.

Introduction Despite an increase in the number of cadaver donors and overall organ transplantations, the dramatic increase in the waiting list makes it necessary to reconsider donor criteria. The authors wanted to examine whether differences could exist in the function and/or morphology of transplanted kidneys originated from expanded criteria donors (ECDs) and ideal donors 1 and 5 years after transplantation. Methods Kidney function and histopathologic findings were analyzed and compared 1 and 5 years after transplantation in 97 patients having ECD kidneys and in 178 patients who received ideal donor kidneys (IDK). Results Serum creatinine level was significantly higher (p = 0.001) and estimated glomerular filtration rate was significantly lower (p = 0.003) in patients having ECD kidneys as compared with those with IDK 5 years after transplantation. Morphological changes in the transplanted kidneys, such as tubulitis (p = 0.025) and interstitial inflammation (p = 0.002), were significantly more frequently present in patients with ECD kidneys than in those with IDK 1 year after transplantation. Conclusion Despite an absence of differences in kidney function 1 year after kidney transplantation between patients having ECD and IDK, morphological differences in the transplanted kidneys can be detected between the two groups of patients.

Mortality and the relationship of somatic comorbidities to mortality in schizophrenia. A nationwide matched-cohort study.

AIM: We conducted a matched-cohort study to assess mortality in schizophrenia and the relationship of mortality with comorbid somatic conditions and suicide attempts. METHOD: A full-population register-based prospective matched-cohort study was performed including all eligible patients with schizophrenia in Hungary between 01/01/2005 and 31/12/2013. Control subjects were individually matched to patients with schizophrenia at a 5:1 ratio. The principal outcome measure was death due to any reason. A non-parametric approach was used for descriptive statistical purposes, the Kaplan-Meier model for survival analysis, and the Cox proportional-hazards regression model for inferential statistics. RESULTS: Patients with schizophrenia (n=65,169) had substantially higher risk of all-cause mortality than the control subjects (n=325,435) (RR=2.4; P<0.0001). Comorbidities and suicide attempts were associated with significantly increased mortality in both groups. As compared to the controls, 20-year old males with schizophrenia had a shorter life expectancy by 11.5years, and females by 13.7years; the analogous numbers for 45-year old schizophrenics were 8.1 and 9.6years, respectively. CONCLUSIONS: A significant mortality gap - mainly associated with somatic comorbidities - was detected between patients with schizophrenia and individually matched controls. Improved medical training to address the disparity in mortality, and many other factors including lack of resources, access to and model of medical care, lifestyle, medication side effects, smoking, stigma, need for early intervention and adequate health care organization could help to better address the physical health needs of patients with schizophrenia.

Nerve stretch injury induced pain pattern and changes in sensory ganglia in a clinically relevant model of limb-lengthening in rabbits.

We used a model of tibial lengthening in rabbits to study the postoperative pain pattern during limb-lengthening and morphological changes in the dorsal root ganglia (DRG), including alteration of substance P (SP) expression. Four groups of animals (naive; OG: osteotomized only group; SDG/FDG: slow/fast distraction groups, with 1 mm/3 mm lengthening a day, respectively) were used. Signs of increasing postoperative pain were detected until the 10(th) postoperative day in OG/SDG/FDG, then they decreased in OG but remained higher in SDG/FDG until the distraction finished, suggesting that the pain response is based mainly on surgical trauma until the 10(th) day, while the lengthening extended its duration and increased its intensity. The only morphological change observed in the DRGs was the presence of large vacuoles in some large neurons of OG/SDG/FDG. Cell size analysis of the S1 DRGs showed no cell loss in any of the three groups; a significant increase in the number of SP-positive large DRG cells in the OG; and a significant decrease in the number of SP-immunoreactive small DRG neurons in the SDG/FDG. Faster and larger distraction resulted in more severe signs of pain sensation, and further reduced the number of SP-positive small cells, compared to slow distraction.

On some Palaearctic click beetles deposited in the Hungarian Natural History Museum, 2 (Coleoptera: Elateridae).

One new genus (Roznerathous gen. n.) and 31 new species of Elateridae are described: Athous szalokii sp. n. (Georgia), Agriotes balikesirensis sp. n. (Turkey), Agriotes rozneri sp. n. (Syria), Agriotes sakaryaensis sp. n. (Turkey), Cardiophorus anatolicus sp. n. (Turkey), Cardiophorus aranyos sp. n. (Afghanistan), Cardiophorus burkus sp. n. (Afghanistan), Cardiophorus dicronychoides sp. n. (Afghanistan), Cardiophorus podlussanyi sp. n. (Turkey), Cardiophorus tenuis sp. n. (Armenia), Coptostethus attilai sp. n. (Spain: Canary Isl.), Coptostethus buci sp. n. (Spain: Canary Isl.), Coptostethus kundratai sp. n. (Spain: Canary Isl.), Craspedostethus ferrugineus sp. n. (Iran), Craspedostethus hirticollis sp. n. (Afghanistan), Dicronychus decoroides sp.n. (Iran), Dicronychus diluvii sp. n. (Turkey), Dicronychus fabiani sp. n. (Iran), Dicronychus gurjevae sp. n. (Afghanistan), Dicronychus ilniczkyi sp. n. (Oman), Dicronychus kandaharensis sp. n. (Afghanistan), Dicronychus karolyvigi sp. n. (Iran), Dicronychus podlussanyi sp. n. (Turkey), Dicronychus povolnyi sp. n. (Afghanistan), Dicronychus quadrimaculatus sp. n. (Afghanistan), Glyphonyx occidentalis sp. n. (Afghanistan), Hartenius marocanus sp. n. (Morocco), Hemicrepidius rahmei (Iran) sp. n., Idotarmonides gracilis sp. n. (Turkey), Roznerathous hellenicus sp. n. (Greece), Oedostethus pektusanicus sp. n. (North Korea). Dicronychus marginalis comb. n. and Dicronychus oxypterus comb. n. New distributional data for species of the genera Aeoloides, Agriotes, Ampedus, Cardiohypnus, Cardiophorus, Cidnopus, Craspedostethus, Dicronychus, Drasterius, Haterumelater, Heteroderes, Hypnoidus, Isidus, Limonius, Liotrichus, Melanotus, Pseudocrepidophorus and Zorochros are given. The females of Astanchus ussuriensis (Gurjeva, 1975); Cidnopus macedonicus Cate et Platia, 1989; Peripontius orchymonti Platia, 2008 and the male of Agriotes barkulensis Jagemann, 1942 were unknown at the time of their description, are figured. With 137 figures. 

Expression of claudin-1 in canine peripheral nerve sheath tumours and perivascular wall tumours. Immunohistochemical study.

AIMS: A peripheral nerve sheath tumour consists of neoplastic Schwann cells or perineurial cells, or a mixture of Schwann cells, perineurial cells and fibroblasts. The first aim of the present study was to characterise the expression of the claudin-1 tight junction protein in canine intact peripheral nerves, canine benign peripheral nerve sheath tumours (cBPNSTs), such as schwannomas, neurofibromas, perineuriomas and canine malignant peripheral nerve sheath tumours (cMPNSTs), and in different other benign and malignant canine spindle cell tumours. The second aim of the present study was to examine whether claudin-1 can help to distinguish the subgroups of canine perivascular wall tumours. METHODS AND RESULTS: The biopsy and necropsy samples (n=203) included 10 intact peripheral nerves, 20 cBPNSTs (4 schwannomas, 8 neurofibromas, 8 perineuriomas), 16 cMPNSTs, 6 psammomatous meningiomas, 6 dermatofibromas, 6 leiomyomas, 6 myxomas, 4 spindle cell hemangiomas, 2 spindle cell lipomas, 6 fibrohistiocytic nodules, 8 fibrosarcomas, 8 leiomyosarcomas, 6 myxosarcomas, 8 hemangiosarcomas, 8 anaplastic sarcomas, 8 amelanotic spindle cell melanomas, 8 histiocytic sarcomas, 8 spindle cell carcinomas, 8 myoepitheliomas, 8 complex carcinomas, 5 cardiac rhabdomyosarcomas, 4 synovial sarcomas, 5 osteosarcomas, 4 chondrosarcomas and 4 liposarcomas; 31 canine perivascular wall tumours: 10 hemangiopericytomas, 8 myopericytomas, 6 angioleiomyomas, 4 angioleiomyosarcomas, 3 angiofibromas. The immunohistochemical panel consisted of humanized antibodies: anti-claudin-1, anti-neuron specific enolase, anti-S-100 protein, anti-α-smooth muscle actin, anti-vimentin, anti-cytokeratin AE1-AE3, anti-claudin-5, anti-Melan-A and anti-heavy caldesmon, anti-calponin and anti-desmin. The intact perineurial cells, all perineuriomas, neurofibromas, cMPNSTs, spindle cell carcinomas and epithelial components of the complex carcinomas, all hemangiopericytomas and myo-pericytomas showed claudin-1 positivity. The schwannomas and other spindle shape cell tumours were negative for claudin-1. CONCLUSION: Our findings suggest that an antibody against claudin-1, in combination with other antibodies, can be used as a novel diagnostic tool to differentiate canine peripheral nerve sheath tumours from other fusocellular tumours, and anti-claudin-1, together with other antibodies, can also be used to subclassify cBPNSTs. Furthermore, analysis of claudin-1 expression can help to differentiate between subgroups of canine perivascular wall tumours.

Retropharyngeal superficial angiomyxoma.

OBJECTIVE: To describe the first published case of superficial angiomyxoma with an epithelial component occurring in the retropharynx. METHOD: Case report of a patient with swallowing difficulties caused by a rare case of superficial angiomyxoma in the retropharynx. RESULTS: Superficial angiomyxoma is a distinct entity among the dermal myxomatous lesions. Superficial angiomyxoma is poorly circumscribed, and local recurrence is common unless the tumour is excised with clear margins. Distinctive histological features include a myxoid mass composed of spindle and stellate-shaped cells and occasional multinucleated cells. There is prominent vasculature and a mixed inflammatory infiltrate in the stroma, particularly by neutrophil polymorphs. Epithelial structures are seen in about one-third of cases. A case of retropharyngeal tumour with morphological features of superficial angiomyxoma is reported. The tumour cells, including multinucleated ones, were negative for soft tissue differentiation markers. The inflammatory cells included lymphocytes, histiocytes and neutrophil polymorphs. CONCLUSION: This case demonstrates that a cutaneous type of angiomyxoma with epithelial-lined structures can occur in deep soft tissue, such as the retropharynx.

Making soil containing numerous eggs of WCR for greenhouse and laboratory experiments.

In the course of our work we often faced to the problem that WCR lays its eggs unevenly (Berger, 2008) so it is impossible to find soils under field circumstances which contains eggs in homogenous distribution and in large numbers. Owing to the inhomogeneous distribution and low number of eggs it is quite difficult to study the effectiveness of soil disinfectant and seed-dressing insecticides on larvae of WCR in pot experiments. Therefore, the aim of our studies was to gain soil samples with known quantity and distribution of eggs. According to our prevailing idea, numerous adults are placed into a relatively small place under ideal environmental conditions and a small quantity of soil is provided for them to lay eggs.

Long-term results of subtotal colectomy for acquired hypertrophic megacolon in eight dogs.

OBJECTIVES: To evaluate the long-term results of subtotal colectomy for acquired hypertrophic megacolon in the dog. METHODS: Eight dogs with acquired hypertrophic megacolon underwent subtotal colectomy with preservation of the ileocolic junction. Long-term follow-up was obtained by clinical records and telephone interviews with the owners. RESULTS: Eight large-breed dogs (age range: 6 to 12 years; mean age: 10.75 years) were enrolled. The use of bone meal, low levels of exercise, chronic constipation with dyschesia and tenesmus refractory to medical management were factors predisposing dogs to acquired hypertrophic megacolon. The diagnosis was confirmed in all animals by abdominal palpation, plain radiography and postoperative histopathological findings. There were no intraoperative complications. One dog died as a result of septic peritonitis. The clinical conditions (that is, resolution of obstipation and stool consistency) of the remaining seven dogs were improved at discharge; all animals returned to normal defecation in five to 10 weeks (mean: 7.3 weeks) and were alive 11 to 48 months (mean: 40.5 months) after surgery. CLINICAL SIGNIFICANCE: Predominantly bony diet and/or low levels of physical activity may predispose dogs to acquired hypertrophic megacolon. Our results emphasise the long-term effectiveness of subtotal colectomy with preservation of the ileocolic junction in this condition.

Nutrient absorbtion of weeds in maize.

Our study was carried out in Hungary at Keszthely, in 2007. The effect of different cultivation methods: no-till drill, disk tillage, conventional tillage (ploughing) and five increasing N doses were studied on the weediness. The bi-factorial trial was arranged in split plot design with four replications. Crop rotation: winter wheat-winter wheat-maize-maize. The seeding of maize was 23rd of April in 2007. The weed survey was made with Balázs-Ujvárosi coenological method on the 17th of May. In the experiment were found 21 weed species. We collected all plants of every weed species by plots. The sample area was 1 m2. Furthermore five maize plants per plot were sampled on the 22nd of May. Maize was at 3-4 leaves stage. For reason of competition studies no herbicides were applied on sampling sites. The aerial parts of weeds and maize plants were collected, and the fresh and dry matter weight was measured. We analyzed in detail, the occurrence of weed species, and the biomass production of weeds in comparison with maize. The effect of different cultivation methods markedly demonstrated the weed cover, the number of perennial and annual weeds and the number of occurring weed species.

The dangers of intraosseous fibrosing agent injection in the treatment of bone cysts. The origin of major complications shown in a rabbit model.

Direct intraosseous injection of fibrosing agent is widely used in the treatment of aneurysmal bone cysts. The purpose of this study was to evaluate the consequences of fibrosing agent penetrating the medulla of bones. This may be the case when, by mistake, the fibrosing agent is administered into the medulla or when the wall of the cyst ruptures and fibrosing agent is able to drift into the medulla. Twelve rabbits were injected transcutaneously with a fibrosing agent directly into the proximal metaphysis of the tibia. Prior to injection 0.5 ml of liquid-like, bloody, intraosseal tissue was aspirated, then 0.5 ml of fibrosing agent was administered. Fibrosing agent was introduced slowly (20 s) to avoid overpressure. Nine rabbits (75%) died within minutes after the introduction of fibrosing agent. A full body roentgenogram was taken of each rabbit and the animals that died underwent autopsy to find the exact cause of death. Roentgenograms of the chest showed massive multiple pulmonary emboli confirmed in all lethal cases by the autopsy. This animal model was created to draw attention to the dangers of any leakage of the fibrosing agent into the medulla of bones.

Clinicopathological changes and effect of imidocarb therapy in dogs experimentally infected with Babesia canis.

In this study one spleen-intact dog (A) and two splenectomised dogs (BSE, CSE) were infected with Babesia canis. All animals developed an acute disease characterised by fever, haemoglobinuria and anaemia, the latter being more severe in the splenectomised dogs. Fever and parasitised red blood cells were detected for three days after imidocarb treatment in the splenectomised animals. Haematological abnormalities included regenerative anaemia, thrombocytopenia and leukopenia (due to neutropenia and lymphopenia) in the acute phase, soon followed by leukocytosis, neutrophilia and left shift a few days later. Acute hepatopathy was detected in all dogs with elevated ALT activity, which was more seriously altered in the splenectomised dogs. Diffuse changes in liver structure and hepatomegaly were seen by ultrasonography. Liver biopsy and histology revealed acute, non-purulent hepatitis in the splenectomised dogs. Both splenectomised dogs were successfully cured after collection of 400 ml highly parasitised blood, proving that large-amount antigen production is possible with rescuing the experimental animals. Whole blood transfusion, imidocarb and supportive care with infusions, antipyretics, glucocorticoids and diuretics were applied. The spleen-intact dog clinically recovered after receiving supportive treatment, with no imidocarb therapy. Microbial infections developed in both splenectomised animals (BSE: haemobartonellosis, CSE: osteomyelitis caused by Escherichia coli), probably as a consequence of immunosuppression after splenectomy and glucocorticoid therapy.

Spinal extradural arachnoid cyst causing cord compression in a 15-year-old girl: a case report.

The authors describe the case of a fifteen-year-old girl with progressive paraparesis of the lower limbs that was caused by an intraspinal extradural dorsal arachnoid cyst at the level of Th 3-6. Diagnosis was established with MRI and MRI myelography. The latter revealed the CSF-like content of the cyst. The patient underwent laminotomy and en bloc resection of the cyst. Ligation of the pedicle of the cyst was done with laminoplasty. Quick and complete recovery was observed after surgery.

A computer program for calculation of doses and prices of injectable medications based on body weight or body surface area.

A computer program (CalcAnesth) was developed with Visual Basic for the purpose of calculating the doses and prices of injectable medications on the basis of body weight or body surface area. The drug names, concentrations, and prices are loaded from a drug database. This database is a simple text file, that the user can easily create or modify. The animal names and body weights can be loaded from a similar database. After typing the dose and the units into the user interface, the results will be automatically displayed. The program is able to open and save anesthetic protocols, and export or print the results. This CalcAnesth program can be useful in clinical veterinary anesthesiology and research. The rationale for dosing on the basis of body surface area is also discussed in this article.

Experimental vascular graft for liver transplantation.

Hepatic artery thrombosis is a major cause of graft failure in liver transplantation. Use of donor interponates are common, but results are controversial because of necrosis or thrombosis after rejection. Reperfusion injury, hypoxia and free radical production determinate the survival. The aim of the study was to create an 'ideal' arterial interponate. Autologous, tubular graft lined with mesothelial cells, prepared from the posterior rectus fascia sheath, was used for iliac artery replacement in eight mongrel dogs for six months under immunosuppression. Patency rate was followed by Doppler ultrasound. Eight grafts remained patent and another two are patent after one year. The patency rate was good (median Doppler flow: 370 cm/sec) and there was no necrosis, thrombosis or aneurysmatic formation. The grafts showed viable morphology with neoangiogenesis, appearance of elastin, smooth muscle and endothelial cells. Electron microscopy showed intact mitochondrial structures without signs of hypoxia. Tissue oxygenation was good in all cases with normal (< 30 ng/ml) myeloperoxidase production. In conclusion, this autologous graft presents good long-term patency rate. Viability, arterialisation and low thrombogenicity are prognostic factors indicating usability of the graft in the clinical practice without the risk of rejection. Further investigations such as cell cultures and standardisation are necessary.

Elaboration of a complex GIS application in a catchment area.

Rearrangement of land resources after political changes has not yet been finished in Hungary. It is almost impossible to collect information necessary for planning activities on outer areas of settlements. The data are distributed among various organizations and can be found in diverse forms or there are no available data at all. However water quality protection has become legally ordered concerning municipal activities around Lake Balaton which is considered as the most important recreation area and tourist target in Hungary and is also affected by a number of factors providing sources of environmental conflicts. Settlements in a catchment area (Tetves Creek) on the southern shoreline of Lake Balaton in Central Hungary tendered a complex project for collecting sources of authentic data of the Hungarian rural areas along with systematizing and saving these data in a uniform GIS. An application using Autodesk MapGuide Program for Internet realization was developed. The implemented web-based system can be used in Internet and Intranet environments.

Ultrasonography and surgery of canine biliary diseases.

Findings of hepatic and gallbladder ultrasonography were analyzed in 12 dogs with gallbladder and/or extrahepatic biliary tract obstruction and compared with the results of exploratory laparotomy. Hepatic ultrasonography demonstrated normal liver in 2 dogs and hepatic abnormalities in 10 animals. The following ultrasonographic diagnoses were established compared to surgical findings: gallbladder obstruction caused by bile sludge (correct/incorrect: 1/2, surgical diagnosis: choleliths in one case), gallbladder obstruction caused by neoplasm (0/1, surgical diagnosis: mucocele), gallbladder and extrahepatic biliary tract obstruction due to choleliths (3/3), extrahepatic biliary tract obstruction caused by pancreatic mass (1/1) and small intestinal volvulus (1/1). Bile peritonitis caused by gallbladder rupture (4/4) was correctly diagnosed by ultrasound, aided with ultrasonographically-guided abdominocentesis and peritoneal fluid analysis. Rupture of the gallbladder should be suspected in the presence of a small, echogenic gallbladder or in the absence of the organ together with free abdominal fluid during ultrasonography. Laparotomy was correctly indicated by ultrasonography in all cases. However, the direct cause of obstruction could not be determined in 2 of the 12 dogs by ultrasonography alone.

Endoscopy and autopsy follow-up of biodegradable oesophageal anastomoses in dogs.

The biofragmentable Anastomosis Ring (BAR) is a mechanical device composed of absorbable material and creates an inverting, atraumatic compressive anastomosis with no foreign material at the anastomotic site after healing. The aim of the present experimental study was to assess the safety of oesophagoscopy in early days after oesophageal anastomoses performed with the BAR and to follow-up the healing of BAR anastomoses by in vivo endoscopy and autopsy examination. Thirty mongrel dogs divided into subgroups according to the time-points of endoscopy and autopsy (4th, 7th, 14th, 28th day) were used. There was no significant difference in the healing of anastomoses performed under or above the tracheal bifurcation. Pleural adhesions helped to cover and seal small subclinical leaks. The mortality was 13.3% (4 dogs) and the overall leakage rate 14.3%. We looked for bleeding, haematoma, erosion, ulceration and granulation tissue in the anastomosis. Due to the high mechanical strength of these anastomoses, oesophagoscopy was a safe, easy and feasible method for follow-up BAR intrathoracic anastomoses, with no significant difference between the number of lesions found with endoscopy as compared to the autopsy data. The overall sensitivity of oesophagoscopy to discover mucosal lesions was 73.1%. Endoscopy had no complications, therefore it is a useful method of follow-up and may help predict the normal or compromised healing of oesophageal anastomoses.