Rudolfinerhaus Hospital

Microbial contamination in food processing remains a persistent and complex challenge. Understanding the sources, contributing factors, and control measures is essential for effective mitigation. In this study we employed a combination of metagenomic sequencing, targeted culturomics, and whole-genome sequencing of key isolates to gain a comprehensive view of bacterial dynamics and functional capabilities throughout a working shift in a beef slaughter and cutting facility. This allowed us to identify which bacteria are i) most prevalent in the clean facility before the start of the work, ii) able to establish themselves over time, and iii) detectable in the final product. We further generated a functional profile of the microbial community within the facility, with a particular focus on antimicrobial resistance and biofilm formation genes, and the presence of specific pathogens and spoilage organisms. Both culture-based and sequencing data showed that Psychrobacter and Pseudomonas strains present in the final product were also detected on the membrane skinner, a machine used to remove all the excess tissues from meat, and in the drains even after cleaning. We found a high number of genes involved in biofilm formation in Psychrobacter immobilis, a characteristic that may explain their biofilm capacity and the survival of this species during the cleaning process and persistence throughout the facility. Taken together, our findings suggest potential sources of contamination and highlight the advantages of integrating culture-dependent methods with high-throughput sequencing technologies to enhance microbial monitoring and control strategies in food production environments.

Purpose To compare implant–acromion collision risk between the transdeltoid and anterolateral surgical approaches for straight antegrade humeral nailing (SAHN) using a CT-based simulation, and to evaluate whether the Acromion Index (AI) predicts collision.Methods Sixty-eight anonymized shoulder CTs were segmented to generate scapular and humeral surface models. A straight 8-mm nail was virtually advanced along the medullary axis under two conditions: (I) transdeltoid with 0° glenohumeral extension and (II) anterolateral with 30° extension. Two trained investigators independently repeated all simulations and recorded nail-acromion collisions. Agreement was assessed with Cohen’s κ and intraclass correlation coefficients (ICC). Collision rates were compared with paired McNemar tests. The predictive value of AI was analyzed using logistic regression and receiver-operating-characteristic (ROC) analysis. Results Implant-acromion collision occurred in 32/68 shoulders (47.1%) with the transdeltoid approach, versus 2/68 (2.9%) with the anterolateral approach (absolute risk reduction 44%; number-needed-to-treat 2.3; p< 10⁻⁶). AI independently predicted transdeltoid failure (adjusted odds ratio 2.81 per +0.10; p = 0.011); a cut-off ≥ 0.69 yielded an AUC of 0.72 (63% sensitivity, 72% specificity). Inter-observer reliability was substantial for collision (κ 0.86) and excellent for morphometrics (ICC ≥ 0.90). Conclusion CT-based simulation demonstrates that the anterolateral approach markedly reduces the risk of implant-acromion collision in SAHN and should therefore be considered the preferred option. However, if the transdeltoid approach is selected, preoperative AI screening with a threshold of ≥0.69 is essential, as larger acromia increase collision risk and must be factored into surgical planning. Level of evidence Level IV – paired in-silico simulation study.

Presence of deep infiltrating bowel endometriosis (DE) is associated with occurrence of dyschezia and gastrointestinal symptoms. The degree of the disease, the lesion length, and the location, that is, lesion-to-anal-verge distance (LAVD) of DE, as well as the severity of the symptoms appear to be correlated. Nevertheless, it is not yet known to what extent the size and LAVD of bowel DE influence the severity of gastrointestinal symptoms. The present study aims to evaluate a possible correlation of lesion location (LAVD) and size (according to the #Enzian classification) with preoperative symptoms. In this prospective study, premenopausal patients with histologically confirmed DE undergoing modified limited nerve-vessel sparing rectal segmental bowel resection or full-thickness discoid resection were evaluated. Extent of endometriosis was defined according to the #Enzian classification during surgery. The primary outcome measure was the correlation between lesion size and location with the GI function impairment reflected by presurgical lower anterior resection syndrome (LARS) scores; the secondary outcome was differences in presurgical numeric rating scale pain scores of dyschezia, dyspareunia, and dysmenorrhea as well as the impact of concomitant DE of other locations on symptom intensity. Of 162 consecutive patients, 151 were included in the final analysis. No significant correlation was observed between lesion size (#Enzian compartments C1/C2/C3) or LAVD and GI dysfunction reflected by LARS-like symptoms (p = 0.314 and p = 0.185, respectively) or pain symptoms (dyschezia, p = 0.440; dyspareunia, p = 0.136; and dysmenorrhea p = 0.221). Furthermore, no significant correlation was observed between lesion size and GI dysfunction when merging two severity grades (#Enzian compartments C1 plus C2 vs. C3; p = 0.611). In addition, LAVD did not affect the degree of dyschezia (p = 0.892), dyspareunia (p = 0.395), or dysmenorrhea (p = 0.705). Finally, the presence of concomitant DE lesions infiltrating the vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/parametrium (#Enzian compartment B) did not alter the severity of preoperative dyschezia (p = 0.493) or dysmenorrhea (p = 0.128) but showed a trend toward affecting gastrointestinal function (p = 0.078) and was significantly associated with dyspareunia (p = 0.035). In present study, we could not find a correlation between colorectal DE lesion size and location (LAVD) and gastrointestinal function impairment or intensity of dyschezia and dysmenorrhea. Additional involvement of vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/parametrium (#Enzian compartment B) exerts a significant impact on the degree of dyspareunia in women with colorectal DE.

ObjectiveThe efficacy of combined BRAF and MEK inhibition for BRAF V600–mutant melanoma in a broad patient population, including subgroups excluded from phase 3 trials, remains unanswered. This noninterventional study (DATUM-NIS) assessed the real-world efficacy, safety and tolerability of dabrafenib plus trametinib in Austrian patients with unresectable/metastatic melanoma.MethodsThis multicenter, open-label, non-interventional, post-approval, observational study investigated the effectiveness of dabrafenib plus trametinib prescribed in day-to-day clinical practice to patients (N = 79) with BRAF V600–mutant unresectable/metastatic melanoma with M1c disease (American Joint Committee on Cancer staging manual version 7), ECOG > 1, and elevated serum lactate dehydrogenase (LDH). The primary endpoint was 6-, 12- and 18-month progression-free survival (PFS) rates. Secondary endpoints were median PFS, disease control rate and overall survival (OS).ResultsThe 6-, 12- and 18-month PFS rates were 76%, 30.6% and 16.2%, respectively. Subgroup analysis showed a significant PFS benefit in the absence of lung metastasis. The median PFS and OS were 9.1 (95% CI, 7.1–10.3) months and 17.9 (95% CI, 12.7–27.8) months, respectively. The 12- and 24-month OS rates were 62.7% and 26.8%, respectively. Subgroup analyses showed significant OS benefits in the absence of bone or lung metastasis and the presence of other metastases (excluding bone, lung, brain, liver and lymph nodes). Furthermore, S100 and Eastern Cooperative Oncology Group performance status (ECOG PS) showed a significant impact on survival. No new safety signals were observed.ConclusionDespite an unselected population of melanoma patients with higher M1c disease, ECOG PS > 1 and elevated LDH, this real-world study demonstrated comparable efficacy and safety with the pivotal phase 3 clinical trials for dabrafenib–trametinib.

To assess whether routine examination of the sacral plexus (SP) on transvaginal sonography (TVS) can identify nerve involvement by deep endometriosis (DE) and should therefore be recommended in all patients with DE. Prospective single, tertiary referral-centre observational study including consecutive women undergoing TVS for clinically suspected pelvic DE before laparoscopic surgery, between January 2020 and February 2023 at Semmelweis University, Budapest, Hungary. TVS and gynecological examination were performed within 2 months before surgery, preoperative TVS signs were analysed and compared with laparoscopic and histological findings The main outcome of interest was the presence of infiltration of the SP by DE. Of the 797 consecutive patients scheduled for surgery with DE, 22 women were not tolerating TVS on the SPs, 3 patients were not consenting participation in the study, and by one woman Tarlov cyst was diagnosed by MRI prior to TVS. The remaining 771 patients were enrolled in the study. Among them DE associated SP infiltration was diagnosed on TVS in 15 (1.9%) cases. SP involvement was confirmed intraoperatively in all 15 cases and verified histologically. DE lesions infiltrating the SP were hypoechoic nodules of the parametrium and the uterosacral ligaments with a median diameter of 33 mm (range, 23–45 mm). Of the 15 lesions 8 were on the right side, and 7 on the left side. The following spinal nerves were involved: S1 (8/15) S2 (13/15) S3 (8/15) S4 (3/15). At one patient the lumbosacral trunc and by another woman the right obturator nerve was also infiltrated. Associated DE in extragenital organs was found: rectum (10/15), ipsilateral ureters (7/15), bladder (6/15). TVS examination is reliable diagnostic tool for the detection of SP involvement by DE. Applying TVS, DE is encountered in this location in 1-2% of women attending tertiary referral centres for suspected pelvic DE. Associated DE lesions in the rectum and in the urinary tract are frequent.

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): ZOLL Background The wearable cardioverter-defibrillator (WCD) is a temporary treatment option for patients at high risk for sudden cardiac death (SCD) in whom implantation of a cardioverter defibrillator (ICD) is temporarily not possible. Exercise training and rehabilitation has an IA recommendation in these patients. There are no data on safety and outcomes of patients with a WCD undergoing cardiac rehabilitation. Purpose The aim of this study is to evaluate the safety and feasibility of wearing a WCD while undergoing a cardiac rehabilitation program. Methods We performed a retrospective analysis of all patients with a successfully completed stationary rehabilitation program. Results 55/896 patients (6.1%) registered in the Austrian WCD registry completed a stationary rehab program (60±11 years, 1% female). Underlying cardiac disease was ischaemic cardiomyopathy (CMP) in 27/55 (49%), dilatative CMP in 15/55 (27%), inflammatory CMP in 10/55 (18%) patients. One patient had valvular CMP, one patient had tako tsubo CMP, one patient had a primary electrical disease (each 1,8%). The baseline LVEF at rehab start was 36% [12;80%], duration of rehab was 28 days [18;42] compared to a total prescription duration of 94 days [26;294]. 75.6% (41/55) patients completed a regular rehab duration with a WCD, 3.6% (2/55) got their WCD stopped during rehab due to recovery of the LV function, 21,8% (12/55) got a WCD prescribed during rehab. The daily wearing duration was 23.4h [12.6;23.9]. 2848 (mean 52±117/patient) automatic alarms and 340 (mean 6±9/patient) manual alarms were generated. Within this cohort 3,6% (2/55) patients had shocks for VT/VF during prescription: one patient for a VF event that was terminated with the first shock, another patient had three VT events that were also terminate with the first WCD shock. All events happened before rehabilitation, so no patient had a WCD treatment during rehab, neither appropriate, nor inappropriate. Two patient had recurrent stable VTs that were controlled with antiarrhythmic drugs during prescription, only one of them during rehab. 3 patients had a reported syncope during rehab, all of them associated with hypotension, one patient had an ambulatory check-up at the CIED clinic because of false automatic alarms due to artefacts. Following a relevant weight loss through rehab measurements, the fabric garment of the WCD had a poor fit and was adapted. The LVEF after rehab was 42% [23;73%]. At the end of WCD prescription 33/55 (60%) had a restitution of their cardiac function with no need for an ICD, 19/55 (35%) patients were implanted with an ICD. One patient (1,8%) had a heart transplantation, one patient (1,8%) had the desire to stop WCD prescription and one patient (1,8%) had a terminal non-cardiac disease. Conclusion Completing a cardiovascular rehabilitation program is feasible and safe for patients prescribed with a WCD and may contribute positively to the restitution of the cardiac function.

ABSTRACTObjectivesTo compare transvaginal sonography (TVS) and magnetic resonance imaging (MRI) with intraoperative measurement (IOM) using a rectal probe in the estimation of the location of rectosigmoid endometriotic lesions, i.e. lesion‐to‐anal‐verge distance (LAVD), and to compare two different MRI techniques for measuring LAVD.MethodsThis was a prospective single‐center observational study that included women undergoing surgery for symptomatic rectosigmoid endometriosis by discoid (DR) or segmental (SR) resection from December 2018 to December 2019. TVS and MRI were performed presurgically for each participant to evaluate LAVD, and the measurements on imaging were compared with IOM using a rectal probe. Clinically acceptable difference and limits of agreement (LoA) between TVS and MRI compared with IOM were set at ± 20 mm. Two different measuring methods for MRI, MRICenter and MRIDirect, were proposed and evaluated, as there is currently no guideline to describe deep endometriosis on MRI. Bland–Altman plots and LoA were used to assess agreement of TVS and both MRI methods with IOM. Systematic and proportional biases were assessed using paired t‐test and Bland–Altman plots.ResultsSeventy‐five women were eligible for inclusion. Twenty‐eight women were excluded, leaving 47 women for the analysis. Twenty‐three DR and 26 SR procedures were performed, with both procedures performed in two women. The Bland–Altman plots showed that there were no systematic differences between TVS or MRICenter when compared with IOM for all included participants. MRIDirect systematically underestimated LAVD for lesions located further from the anal verge. TVS, MRICenter and MRIDirect had LoA outside the preset clinically acceptable difference when compared with IOM. LAVD was within the clinically acceptable difference from IOM of ± 20 mm in 70% (33/47) of women on TVS, 72% (34/47) of women on MRICenter and 47% (22/47) of women on MRIDirect.ConclusionsTVS should be the preferred method to estimate the location of a rectosigmoid endometriotic lesion, i.e. LAVD, as it is more available, less expensive and has a similar accuracy to that of MRI. Estimating LAVD can be relevant for planning colorectal surgery for rectosigmoid endometriosis. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.