Wiener Klinische Wochenschrift最新文献

Background: Physicians are at high risk of developing burnout and several studies have evaluated burnout prevention programs. This meta-analysis and systematic review aimed to assess the effectiveness of burnout prevention programs and to evaluate whether one approach is superior to other programs.

Patients, material and methods: The methods were based on the Cochrane Handbook of Systematic Reviews. We searched the literature in five medical databases from October 2019 to June 2022. We included randomized controlled trials that examined the effect of burnout prevention programs on physicians.

Results: A total of 22 studies were included in our analysis, with 20 studies targeting individual interventions and 2 studies targeting structural interventions. Mindfulness-based stress reduction (MBSR) or similar programs were the most common interventions. The main analysis showed a significant reduction of burnout in the intervention groups with an standardised mean difference (SMD) of -0.32 (95% confidence interval, CI: -0.41 to -0.22), which suggests a small to moderate effect. MBSR did not appear superior to other interventions in the subgroup analysis SMD -0.25 (95% CI: -0.48 to -0.02) versus SMD -0.61 (95% CI: -1.19 to 0.03).

Discussion: This analysis shows that individual burnout prevention programs may reduce burnout rates in physicians; however, the effect was relatively small. The effect was reduced even further when removing studies causing severe heterogeneity and those with a high risk of bias. Future research programs should focus on structural programs that address the lack of mentoring, rising administrative tasks, or long working hours, which may be more effective in reducing burnout in physicians.

The [¹⁷⁷Lu]Lu-PSMA radioligand therapy is a prostate-specific membrane antigen (PSMA) targeting treatment approved for patients with metastatic castration-resistant prostate cancer, after failure of androgen deprivation therapy or taxane-based chemotherapy. We report a unique case of a patient with metastatic hormone-sensitive prostate cancer (mHSPC) who received PSMA radioligand therapy as the sole treatment, without any prior or additional systemic treatment. Over a span of 8 years, the patient underwent 12 cycles of [¹⁷⁷Lu]Lu-PSMA radioligand therapy, demonstrating favorable therapeutic response and a prolonged androgen deprivation therapy-free period. This case highlights the potential of long-term PSMA radioligand therapy as a standalone option in selected mHSPC patients.

Background: Fat grafting is widely utilized in reconstructive and esthetic plastic surgery, typically with minimal complications. Nevertheless, the occurrence of fat necrosis is dependent on the technique used for fat extraction, tissue processing and the volume of the graft. The longevity of the graft critically depends on the presence of adipose-derived stromal cells (ADSC) and their promotion of a reconstituted vascular supply.

Objective: This study seeks to determine whether there are differences in 13 angiogenesis-related adipokines based on their grouping by vascular endothelial growth factor (VEGF) expression levels.

Methods: The expression of 14 adipokines related to angiogenesis in 12 cultured ADSCs was evaluated using Human Adipokine Profiler kits, which simultaneously detect 58 mediators. Adipokines of the high and low VEGF expression groups were evaluated for their expression of the remaining 13 angiogenic proteins.

Results: We were able to show that there are significant differences in VEGF^low and VEGF^high ADSCs regarding fibroblast growth factor 19 (p = 0.043) and insulin like growth factor binding protein 3 (p = 0.028). Furthermore, ADSCs with differentially highly expressed VEGF show a different pattern in the amount of protein levels regarding the 13 other adipokines observed.

Conclusion: The VEGF has been described as a key angiogenic factor in fat grafts that may be linked to successful grafting; however, two of the fat samples analyzed exhibited high expression of VEGF but lacked significant co-expression of a range of other angiogenic factors. Thus, the assessment of the expression of predisposing mediators for graft angiogenesis for wound healing or contouring should include further angiogenesis promoters aside VEGF as parameters.

The present case report describes a completely ulcerated infantile hemangioma (UIH) in a 5-month-old infant on the left proximolateral thigh initially misdiagnosed as pyoderma gangrenosum, sporotrichosis or atypical mycobacterial infection. Clinical assessment, histological findings, and GLUT‑1 immunohistochemistry confirmed the diagnosis of UIH. Systemic propranolol treatment led to rapid ulcer healing within 3 weeks and complete recovery without relapse after 18 months of treatment. The report emphasizes the diagnostic challenges, effective propranolol treatment and the importance of considering UIH in the differential diagnoses of solitary pediatric ulcers.

Background: Acute liver failure (ALF) is characterized by a rapid deterioration of liver function and a high mortality without transplantation depending on etiology and onset. Immediate transfer to a dedicated intensive care unit (ICU) and evaluation for high-urgency liver transplantation (HU-LTx) is recommended to maximize chances of survival. Data on ALF epidemiology are limited, particularly for Central Europe.

Methods: This retrospective single-center study included all ALF patients admitted to the ICU of the Department of Gastroenterology and Hepatology at the Vienna General Hospital between 2012 and 2024.

Results: Overall, 31 patients (median age of 44 [interquartile range, IQR 32-56] years, 20 [65%] female) were included. The primary causes of ALF were viral infections (n = 8; 26%), autoimmune hepatitis (n = 5; 16%), drug-induced liver injury (DILI; n = 3; 10%), and Wilson's disease (n = 4; 13%), while in 8 patients (26%) no cause was identified. Median length of ICU stay was 12 (IQR 4-21) days, with mean sequential organ failure assessment (SOFA) and simplified acute physiology score II (SAPS II) scores of 10.55 ± 4.56 and 40.97 ± 14.84. Overall ICU survival was 61% (n = 19). Non-HU-LTx patients (n = 18) had an ICU survival of 44%. HU-LTx was performed in 13 patients (42%), with 12 patients (92%) surviving 28 days. The 6‑month overall survival of HU-LTx patients was 85%.

Conclusion: The diverse causes of ALF in Central Europe include most commonly viral infections, autoimmune hepatitis, and DILI. HU-LTx was required and performed in almost half of patients and was associated with favorable survival rates, underscoring the importance of ICU management and early transfer to liver transplantation centers in the management of ALF.

Bruton's tyrosine kinase inhibitors (BTKi) are being increasingly used to treat patients with chronic lymphocytic leukemia (CLL). Pathological bleeding is a well-known side effect of BTKi but identifying its predictors remains a challenge. This retrospective multicenter study analyzed whether baseline absolute lymphocyte count (ALC) may be associated with bleeding risk in CLL patients treated with BTKi. Time to bleeding (TTB) was the primary outcome of interest. A total of 108 CLL patients treated with BTKi (ibrutinib, n = 86, acalabrutinib, n = 22) were included. The median age was 70 years (range 41-88 years) and 48 (44.4%) were female. The median follow-up time was 32 months (range 1-108 months) and 17 (15.7%) bleeding events occurred during this time. Receiver operating curve analysis set the optimal cut-off value of the ALC at > 77.4 × 10⁹/L. Patients with higher ALC presented with higher total white blood cell count (p < 0.001), lower hemoglobin (p = 0.012), higher Rai stages (p = 0.037) and higher total tumor mass (p < 0.001). Univariately, patients with higher ALC had an inferior TTB when compared to those with lower ALC (hazard ratio, HR 3.27, p = 0.016); this effect persisted in the multivariate Cox regression analysis where higher ALC (HR 4.59, p = 0.032), higher Cumulative Illness Rating Scale (CIRS, HR 4.21, p = 0.040) and the use of antiplatelets/anticoagulants (HR 3.96, p = 0.046) remained independently of each other associated with an inferior TTB. This study provides an important signal regarding the higher risk of bleeding in CLL patients treated with BTKi who present with higher ALC and higher CIRS. Further studies are needed to validate our findings and to unravel the exact pathophysiological mechanisms behind this interesting observation.

Background: Wild-type transthyretin cardiac amyloidosis (ATTRwt CA) is increasingly recognized as an important cause of heart failure and arrhythmias in older people. There are several clinical, echocardiographic, electrocardiographic (ECG) and laboratory features that increase the suspicion for ATTRwt CA. Presentation and phenotype can, however, be associated with atypical findings making it difficult to make a correct diagnosis. A 65-year-old man was admitted for an acute coronary syndrome. Echocardiography revealed diffuse concentric left ventricular (LV) thickening. Because of a history of bilateral carpal tunnel syndrome and polyneuropathy, the patient underwent dedicated laboratory testing and diphosphonate scintigraphy the results of which were suggestive of transthyretin cardiac amyloidosis. Also, a dynamic LV outflow tract obstruction due to the systolic anterior motion of the anterior mitral valve was noted on echocardiography during the initial investigations. Genetic testing for hypertrophic cardiomyopathy was negative. Seeking a conclusive diagnosis, endomyocardial biopsy was performed. This confirmed the diagnosis of ATTRwt CA.

Discussion: The presence of dynamic LV outflow tract obstruction is typically seen in patients with sarcomeric hypertrophic cardiomyopathy. It can be rarely seen also in individuals with cardiac amyloidosis, including ATTR-wt CA. The presence of so-called red flags in patients' history, physical examination, laboratory test, ECG and imaging should raise suspicion for other etiologies of LV wall thickening than hypertrophic cardiomyopathy. Although noninvasive diagnosis of ATTRwt CA is possible in most patients, endomyocardial biopsy remains necessary in cases with diagnostic ambiguity.