Medical University of Graz

The increasing global burden of liver disease leads to more frequent encounters of anesthesiologists with these high-risk patients. This review summarizes current evidence on perioperative management of patients with liver disease, acute liver failure, and acute-on-chronic liver failure undergoing surgery. The etiology of liver disease is evolving with metabolic dysfunction on the rise creating new perioperative challenges. Patients with liver disease are particularly at risk of cardiovascular events, impaired glucose regulation, and delayed anesthetic recovery. Conventional coagulation assays inadequately reflect bleeding risk in patients with liver disease, whereas viscoelastic-guided coagulation strategies are associated with reduced transfusion requirements. Overall, 90-day mortality is about five-fold higher in patients with liver cirrhosis compared with the general population. Risk scores and clinical assessments are necessary to balance patient- and procedure-related risks during preoperative evaluation. Patients with liver disease undergoing surgery constitute one of the highest-risk surgical populations. Systematic preoperative assessment, individualized anesthetic drug selection, viscoelastic-guided coagulation management, and early multidisciplinary involvement are essential to improve outcomes. High-quality prospective evidence to guide anesthetic practice in patients with liver disease is urgently needed.

Mitochondrial calcium ([Ca2+]mito) homeostasis is a key regulator of cellular physiology, controlling signal transduction, energy metabolism, and cell survival. To examine how these processes change with age in vivo, we used the pharyngeal muscle of Caenorhabditis elegans (C. elegans) as a tractable model for studying [Ca2+]mito dynamics. We introduced electric field stimulation as a robust trigger for [Ca2+]mito uptake that overcomes limitations of compound stimulation, which relies on pharyngeal pumping and endoplasmic reticulum store filling and is typically confined to single-stimulus protocols. In contrast, electric field stimulation enables physiologically relevant repeated excitation that challenges [Ca2+]mito uptake and recovery. Stimulation with 10V for 10s reliably evoked reproducible [Ca2+]mito transients in the pharyngeal muscle of C. elegans and produced higher responder rates than compound stimulation. Basal [Ca2+]mito increased with age, and the first field-evoked transient was significantly larger in aged animals, an effect not detected with pharmacological triggers. Repeated pulses unmasked cumulative [Ca2+]mito loading and incomplete recovery in aged pharynx, indicative of [Ca2+]mito overload, which was attenuated by inhibition of the mitochondrial Ca2+ uniporter (MCU) with mitoxantrone. Regional analyses identified the corpus as a hotspot for electric field-evoked [Ca2+]mito uptake and overload, while MCU inhibition reduced repeated responses in both corpus and posterior bulb. Electric field stimulation enables precise, repeated in vivo probing of [Ca2+]mito uptake and recovery, revealing overload in the C. elegans pharynx. This approach identified age-enhanced, MCU-dependent, and region-specific [Ca2+]mito loading, providing a pathophysiologically relevant readout of impaired Ca2+ handling that may contribute to age-related muscle dysfunction.

Autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR) are techniques that are commonly employed following mastectomy, yet their comparative impact on health-related quality of life (HRQL) remains debated. Although both approaches have demonstrated positive effects, studies regarding the superiority of one technique over another are lacking consensus, possibly owing to variations in complications and revision surgery requirements. We aimed to investigate and compare factors associated with HRQL in both techniques. This retrospective single-center study analyzed complication rates using the Clavien-Dindo classification and BREAST-Q-based patient-reported outcomes in patients undergoing immediate ABR or IBR between 2010 and 2023 at the Medical University of Graz, Austria. Patient- and surgery-related factors were analyzed for statistical correlations with outcomes. Among the 162 included patients, 64 (39.5%) underwent ABR and 98 (60.5%) underwent IBR. ABR patients experienced significantly higher rates of Clavien-Dindo grade I-IIIb complications (p < 0.001). However, ABR patients also reported significantly higher long-term satisfaction with the reconstructed breast (79.5 vs. 62.0; p = 0.001) and sexual well-being (76.4 vs. 58.6; p = 0.008). Given the generally low severity of complications, ABR and IBR emerged as safe procedures, each significantly improving HRQL. In our cohort, ABR was associated with higher early complication rates, yet it demonstrated superior long-term satisfaction. However, reconstruction strategies should be personalized to balance surgical risks with patient-centered long-term outcomes. Autologous and implant-based breast reconstructions after mastectomy are safe and improve quality of life. Autologous reconstruction has more early complications but leads to higher long-term satisfaction and sexual well-being.

The COVID-19-pandemic prompted global vaccination campaigns, raising important questions about vaccine-induced immune responses in lactating women and the transfer of SARS-CoV-2-specific antibodies through human milk. This study investigated the presence of SARS-CoV-2-specific IgA and IgG antibodies in breastmilk for up to 6 months following COVID-19 vaccination and booster doses with either mRNA or adenoviral vector (AVV) vaccines. The COVALAC-study was a prospective cohort study conducted in Belgium. Women were recruited between February and March 2021, followed for 180 days post-vaccination and 28 days post-booster. Breastmilk samples were collected at multiple timepoints and analyzed for IgA and IgG antibodies. Participants received either mRNA (BNT162b2, mRNA-127) or AVV (ChAdOx1 nCoV-19) vaccines. Antibody concentrations were measured using an in-house immunoassay, and analyses compared responses between vaccine types. Of the 115 participants, 40% received BNT162b2, 4.3% mRNA-1273, and 55.7% ChAdOx1-S as their primary vaccination. Of these, 31 participants received an mRNA booster (11 homologous, 20 heterologous boosters). IgA and IgG antibody levels were monitored pre- and post-vaccination, showing a stronger antibody response after mRNA vaccination compared to AVV, after roughly 14 days (IgA receptor binding domain [RBD] 1.13 BAU/mil; 0.61-1.67; IgG RBD 2.56 BAU/mil; 0.76-4.71, up to 1 month, for most antibodies. Both homologous and heterologous boosters further increased antibody titers (IgA RBD 0,85 BAU/ml; 1.09-1.72). COVID-19 vaccination during lactating induces SARS-CoV-2 specific IgA and IgG antibodies in human milk. Antibody levels were higher following mRNA vaccination compared to AVV vaccination, with booster doses enhancing these levels further.

In this Current Opinion, we revisit key terminological distinctions in sports sciences, emphasizing the implications of conflating related but distinct concepts, particularly range of motion (ROM) versus flexibility and flexibility training versus stretching. While often used interchangeably, these terms represent nuanced constructs with distinct physiological and practical implications. ROM encompasses both modifiable (e.g., soft tissue extensibility, neural control) and non-modifiable factors (e.g., bone structure), whereas flexibility is only one of several trainable components of ROM, largely referring to the extensibility of periarticular soft tissues. Misunderstanding these distinctions risks erroneous assessments and inappropriate exercise prescriptions. We also challenge the common practice of equating flexibility training with stretching. While stretching is effective to enhance flexibility, other methods, such as strength training at long muscle lengths and foam rolling, produce comparable chronic ROM gains. Furthermore, stretching has a diverse array of effects that extend beyond flexibility, including strength development and neural modulation. Mischaracterizing flexibility training as synonymous with stretching perpetuates myths and constrains innovation in training practices. By differentiating these terms, we advocate for clearer language in research and practice to avoid miscommunication and ensure effective training interventions. In summary, we propose that flexibility is only one component of ROM, and that flexibility training and stretching should not be equated. We hope this Current Opinion paper generates a healthy discussion within the sports science and medicine communities.

Background Despite growing scientific evidence and health guidelines, the global health paradox persists, with rising lifestyle-related diseases and escalating healthcare costs exposing the inadequacy of current efforts. Objective Three multidisciplinary congresses were held to generate evidence-based conclusions aimed at addressing the global health paradox. Methods A total of 58 experts from 62 entities participated in the international research and knowledge-exchange panels. Experts reviewed the latest findings to develop practical strategies and identify key research and policy priorities, focusing on the Healthy Eating &amp;amp; Active Living (HEAL) approach. Results, conclusion, and relevance The expert consortium endorsed a 33 evidence-based consensual-statement policy roadmap for addressing global health challenges, emphasizing that the HEAL approach can significantly contribute to the “Prevention First” appeal and broad ethical, social, ecological, and economic advantages, and ultimately supporting policy change.

BackgroundAlthough prior research has explored the roles of attachment styles and defense mechanisms in marital satisfaction, limited attention has been given to how these two factors interact. This study investigates the combined influence of attachment styles and defense mechanisms on marital satisfaction in Iranian couples.MethodsA total of 228 participants (114 couples) completed three online questionnaires: The Revised Adult Attachment Scale, the Marital Intimacy Needs Questionnaire, and the Defense Style Questionnaire. Hierarchical multiple regression with interaction terms was used to examine the moderating effects of attachment styles and defense mechanisms on marital satisfaction.ResultsAnalyses showed several connections between marital satisfaction and attachment styles as well as defense mechanisms. Notably, in the prediction of marital satisfaction, secure attachment enhanced marital satisfaction when paired with mature defense mechanisms.DiscussionOur findings highlight potential interactive effects of attachment styles and defense mechanisms in shaping marital satisfaction. The results emphasize the need for therapeutic interventions that integrate both attachment-based and defense-oriented approaches to enhance marital well-being.