Wiener Klinische Wochenschrift最新文献

Early interventions of laypersons can improve the survival and neurological outcome in patients with out-of-hospital cardiac arrest. There are several organizations in Austria which train lay people in basic life support and raise awareness for sudden cardiac death. To obtain an overview of the various initiatives, a questionnaire was sent to 26 organizations, and 15 of the organizations (58%) replied. The geographical distribution of the organizations between rural and urban areas was illustrated in a map. Most of them are situated in a university city, resulting in accessibility disparities for individuals in urban and rural settings. Layperson resuscitation education in Austria is largely dependent on the individual commitments of volunteers. The time spent practicing chest compressions in resuscitation courses ranges from 25% to 90% of the total course time. Furthermore, reasons for a lack of scientific endeavours could be identified, and solutions are suggested. Through better networking between organizations and initiatives, more laypersons could be trained in the future, which would lead to improved survival chances for persons suffering from out-of-hospital cardiac arrest in Austria. Appropriate support by political bodies and public authorities is and will remain a key element.

Critical illness is an exquisitely time-sensitive condition and follows a disease continuum, which always starts before admission to the intensive care unit (ICU), in the majority of cases even before hospital admission. Reflecting the common practice in many healthcare systems that critical care is mainly provided in the confined areas of an ICU, any delay in ICU admission of critically ill patients is associated with increased morbidity and mortality. However, if appropriate critical care interventions are provided before ICU admission, this association is not observed. Emergency critical care refers to critical care provided outside of the ICU. It encompasses the delivery of critical care interventions to and monitoring of patients at the place and time closest to the onset of critical illness as well as during transfer to the ICU. Thus, emergency critical care covers the most time-sensitive phase of critical illness and constitutes one missing link in the chain of survival of the critically ill patient. Emergency critical care is delivered whenever and wherever critical illness occurs such as in the pre-hospital setting, before and during inter-hospital transfers of critically ill patients, in the emergency department, in the operating theatres, and on hospital wards. By closing the management gap between onset of critical illness and ICU admission, emergency critical care improves patient safety and can avoid early deaths, reverse mild-to-moderate critical illness, avoid ICU admission, attenuate the severity of organ dysfunction, shorten ICU length of stay, and reduce short- and long-term mortality of critically ill patients. Future research is needed to identify effective models to implement emergency critical care systems in different healthcare systems.

Extracorporeal membrane oxygenation (ECMO) initiation at a non-ECMO-capable facility by specialized mobile teams aims for a stabilization prior to center admission, internationally referred to as ECMO retrieval. It is a recommended strategy to avoid primary interhospital transfer of compromised patients with a high risk of life-threatening incidents and potentially death. Deploying the unique skill set of ECMO installation and transportation to an unfamiliar environment, however, adds a further degree of complexity to the demanding fields of both transporting the critically ill and ECMO management itself. Although recommendations for the initiation of ECMO retrieval programs exist, centers globally tailor their course of action to local individual needs and so do we.The purpose of this work is to portray the decision-tree-based protocol of the intensive care unit 13i2 (Department of Medicine I, Medical University of Vienna) with its operational standards for optimal patient selection and transport organization.

Background: The effects of cardiovascular risk factors (CVRF) on the development of most acute cardiac conditions are well established; however, little is known about the frequency and effects of CVRF in Takotsubo syndrome (TTS) patients.

Objective: The aim of our study was to compare the frequency of CVRF and pre-existing diseases (PD) of TTS patients to ST-elevation myocardial infarction (STEMI) patients and analyze their effects on short-term outcome.

Methods: We analyzed the frequency of CVRF (hypertension, hyperlipidemia, type II diabetes mellitus, smoking, chronic kidney disease, family history) as well as somatic and psychiatric PD at admission in TTS patients and compared them with STEMI patients. Their effect on short-term outcome was calculated using a combined endpoint of cardiogenic shock, cardiopulmonary resuscitation, mechanical ventilation, and/or in-hospital death.

Results: In total, 150 TTS and 155 STEMI patients were included in our study. We observed a higher frequency of psychiatric (30% vs. 7%, p < 0.001), neurological (5% vs. 0%, p = 0.01), and pulmonary (18% vs. 5%, p < 0.001) PD in TTS patients as compared to STEMI patients. There were less smokers (47% vs. 61%, p = 0.03) and patients with hyperlipidemia (24% vs. 51%, p < 0.001) in the TTS cohort than in the STEMI cohort. None of the CVRF or PD behaved as an independent predictor for adverse short-term outcome in TTS patients.

Conclusion: Psychiatric, neurological, and pulmonary pre-existing diseases are more common in TTS than in STEMI patients. Interestingly, PD and CVRF do not seem to have any impact on the short-term outcome of TTS patients.

The curriculum for interventional cardiology outlines a structured training program for advanced training in interventional procedures. It specifies requirements for candidates, trainers, and centers. The curriculum specifically defines learning objectives, competence levels, and essential skills needed for on-duty shift in the catheterization laboratory. The program is based on the European Core Curriculum, tailored to Austrian healthcare needs, and aims to ensure high-quality care.

Background: Next-generation sequencing (NGS) has recently entered routine acute myeloid leukemia (AML) diagnostics. It is paramount for AML risk stratification and identification of molecular therapeutic targets. Most NGS feasibility and results data are derived from controlled clinical intervention trials (CCIT). We aimed to validate these data in a real-world setting.

Patients, materials and methods: This study retrospectively analyzed 447 AML patients treated at an Austrian tertiary cancer care center. A total of 284 out of the 447 cases were treated between 2013-2023 when NGS was locally available for the clinical routine.

Results: The NGS was successfully performed from bone marrow biopsies and aspirates, with processing times decreasing from 22 days in 2013/2014 to 10 days in 2022. Molecular therapeutic target(s) were identified by NGS in 107/284 (38%) cases and enabled risk stratification in 10 cases where conventional karyotyping failed. Concerning molecular landscape, TET2 (27%), FLT3 (25%), DNMT3A (23%), and NPM1 (23%) were most frequently mutated. Comparing older and younger patients (cut-off 70 years) showed enrichment in older people for mutations affecting DNA methylation (72% vs. 45%; P < 0.001) and the spliceosome (28% vs. 11%; P = 0.006) and more cellular signaling mutations in younger patients (61% vs. 46%; P = 0.022). Treatment outcomes corroborated a significant survival benefit in the recent NGS era and patients treated with novel/molecularly targeted drugs. Ultimately, biospecimens of these patients are stored within a leukemia biobank, generating a valuable tool for translational science.

Conclusion: Our study validates data from CCIT and supports their relevance for treatment decisions in a real-world setting. Moreover, they demonstrate the feasibility and benefits of NGS within a routine clinical setting.

Background: Besides surgery, chemotherapy including high-dose methotrexate is a mainstay of osteosarcoma treatment. Methotrexate is known to accumulate in tissues and cavities, so-called third spaces (e.g., periprosthetic seromas) leading to local toxicity and delayed elimination (third space effect). We compared the concentrations of methotrexate in serum and periprosthetic seromas to evaluate a potential toxic risk based on a third space effect.

Methods: In 45 osteosarcoma patients who were treated with endoprosthesis and high-dose methotrexate (HDMTX) between 1991 and 2011 we retrospectively analyzed methotrexate concentrations in periprosthetic seromas and serum. Differences were assessed by means of the Wilcoxon test.

Results: A total of 112 periprosthetic seroma punctures were performed in 18 out of 45 patients. At 24 h the periprosthetic seroma concentrations were in median 14.86-fold (range 1.49-42.97-fold, p = 0.001), at 48 h in median 8.50-fold (range 1.36-52.56, p < 0.001) and at 72 h in median 2.66-fold (range 0.66-5.82, p = 0.015) of the corresponding serum concentrations. At 24 h highly toxic concentrations (≥ 20 μmol/l) were observed in 30% of all analyzed seromas (median 109.83 μmol/l, range 4.91-170.71 μmol/l). A significantly higher serum concentration (range 0.16-0.75 μmol/l, median 0.36 µmol/l) was found in patients with prior puncture than patients without puncture at 45 h after HDMTX.

Conclusion: Methotrexate concentrations of periprosthetic seromas are significantly higher than corresponding serum concentrations possibly contributing to a third space effect. To avoid severe adverse effects punctures of these effusions should be considered.

Amyloid-beta (Aβ) antibody treatment has emerged as a promising approach for the treatment of Alzheimer's disease (AD), targeting the accumulation of Aβ plaques, which are a hallmark of the disease. This review provides an update on recent clinical trial data, highlighting the efficacy and safety of various antibodies targeting Aβ. Recent trials have demonstrated that certain Aβ antibodies can reduce amyloid plaques and slow cognitive decline in patients with early AD. Key findings from trials of drugs are discussed, including their mechanisms of action, dosing regimens, and observed side effects. The potential for Aβ antibody therapy to be integrated into routine clinical practice is also explored. While Aβ antibody therapy represents a significant advancement in AD treatment, ongoing research is needed to optimize their use and understand their long-term impact. This review underscores the importance of personalized medicine in AD and the need for continued innovation in therapeutic strategies.