Wiener Klinische Wochenschrift最新文献

Background: Environmental noise, particularly from road and railway traffic, has been identified as a significant public health concern. The World Health Organization (WHO) has highlighted the adverse effects of noise exposure on cardiovascular health, including ischemic heart disease (IHD). Despite the European Union's regulations on air pollution, there are no mandatory limits for environmental noise exposure, necessitating further investigation into its health impacts.

Methods: Noise exposure data were obtained from strategic noise maps and linked to Geographic Information System (GIS) data of Austrian buildings. Mortality data covering 5 years (1 Nov 2016 - 31 Oct 2021) were analyzed using Poisson regressions to evaluate the association between noise exposure at residential locations and mortality, specifically focusing on IHD. The analysis adjusted for age, sex, and noise bands, with sensitivity analyses to assess the robustness of the findings.

Results: The study included 37,066,299 individuals, with 372,638 deaths recorded over 5 years. Higher noise bands were associated with increased incidence rate ratios (IRR) for IHD and all-cause mortality. The IRR for IHD increased by approximately 3% per 5 dB increase in noise levels. Sensitivity analyses confirmed the robustness of these findings, with stronger effects observed for railway traffic noise compared to road traffic noise.

Conclusion: The findings underscore the significant health impacts of transportation noise, particularly on cardiovascular mortality. These results support the need for stricter noise regulations and comprehensive health impact assessments to mitigate the adverse effects of environmental noise exposure in Austria.

Hyperkalemia represents a potentially life-threatening electrolyte disturbance that often necessitates prompt diagnosis and treatment. Although uncommon in the general population, the risk is substantially increased in the presence of comorbidities, such as chronic kidney disease, diabetes mellitus or heart failure. Pharmacological therapies that interfere with the renin-angiotensin-aldosterone system further increase this risk. The treatment of hyperkalemia is based on acute interventions to stabilize cardiac conduction abnormalities, promote intracellular potassium redistribution, and enhance renal or gastrointestinal potassium elimination. Early identification of clinical situations that can lead to severe hyperkalemia, such as fever or diarrhea is essential in high-risk patients to timely initiate preventive measures.

Introduction: The use of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) effectively controls portal hypertension (PH)-related complications while reducing risks related to fully expanded stents. We evaluated the effectiveness of CX-TIPS in a large Viennese patient cohort.

Method: We assessed the number of patients evaluated for CX-TIPS placement by interdisciplinary discussion at the Medical University of Vienna and included all patients from the prospective AUTIPS registry undergoing CX-TIPS placement between June 2018 - December 2024. After clinical and laboratory characterization at baseline, patients were followed up for clinical events.

Results: Overall, 200 patients underwent interdisciplinary evaluation for CX-TIPS. In 62.5% CX-TIPS was recommended and 82.4% of these patients underwent CX-TIPS placement. Among 103 patients with CX-TIPS placement between June 2018 - December 2024 (median age 57 years, 67.0% male, median MELD 11), the primary indication for CX-TIPS implantation was ascites (65.0%). The median portal pressure gradient decreased from 18 mm Hg to 8 mm Hg after CX-TIPS. Underdilated CX-TIPS placement was performed in 13.6% (n = 14) of patients and portal vein recanalization (PVR-TIPS) was performed in 4 patients. During a median follow-up time of 13.5 months, 30.1% of patients experienced hepatic encephalopathy and 5.8% cardiac decompensation. Kaplan-Meier survival analyses revealed 1‑year and 3‑year transplant-free survival rates of 78.0% and 74.7%, respectively.

Conclusion: Implementation of interdisciplinary case discussions and the use of CX-TIPS enable personalized medicine in patients with cirrhosis. Underdilation of CX-TIPS should be considered in patients at high risk for complications.

Objective: The study aims to elucidate a possible effect of individual reflection (IR) or group reflection (GR) on short-term and long-term memory retention in a large group lecture-based environment.

Methods: In this quasi-experimental study 656 medical students were enrolled to compare the impact of IR and GR directly after the lectures and 2 months later. Students were divided into two groups and given two different lectures using IR or GR in a cross-over fashion. Memory retention was estimated using multiple-choice questions analyzed by Student's T‑test.

Results: Memory retention was similar using both reflection methods at baseline (p = 0.867; p = 0.971) and follow-up (p = 0.885; p = 0.945). Interestingly, both reflection methods fostered good memory retention over time. Students' self-assessment initially favored GR as more beneficial, an effect that faded over time.

Conclusion: Reflection might be a promising tool to foster memory retention in large lecture cohorts without added benefit from social interaction.