Universitätszahnklinik Wien

Zusammenfassung Integrative Therapie (IT) entwickelt seit den 1960er-Jahren ein multimodales Behandlungsmodell, das unterschiedliche Therapieschulen in einem konsistenten Rahmen verbindet. Eine naturalistische Studie mit Psy-III-Ärzt:innen zeigt deutliche und nachhaltige Verbesserungen depressiver und ängstlicher Symptome. Die Ergebnisse belegen hohe und stabile Wirksamkeit der IT unter realen Versorgungsbedingungen.

Zusammenfassung Wir berichten über den Fall einer 56-jährigen Patientin mit Morbus Basedow, ausgeprägter Hyperkalzämie und gesteigertem Knochenstoffwechsel. Die Patientin zeigte starken Gewichtsverlust, Müdigkeit, Übelkeit und erhöhte Leberwerte, was zunächst auf eine mögliche maligne oder paraneoplastische Erkrankung hindeutete. Laboruntersuchungen bestätigten eine ausgeprägte manifeste Hyperthyreose und positive TSH-Rezeptor (TRAK)-Antikörper. Kalzium war mit 3,08 mmol/l deutlich erhöht, während Parathormon mit 0,95 pmol/l erniedrigt war, wodurch ein primärer Hyperparathyreoidismus ausgeschlossen werden konnte. Da einzelne Tumormarker initial leicht erhöht waren und die Serumelektrophorese eine Hypergammaglobulinämie ergab, standen mehrere Ursachen für die Hyperkalzämie und den gesteigerten Knochenstoffwechsel im Raum. Die weiterführende Bildgebung und Durchuntersuchung ergab jedoch keine Hinweise auf eine maligne Ursache. Nach Beginn einer Therapie mit Thiamazol, β‑Blocker und Flüssigkeitssubstitution besserten sich die klinischen Beschwerden rasch und die Schilddrüsenwerte, Kalzium und die Knochenstoffwechselparameter Osteocalcin und β‑Crosslaps normalisierten sich. Die Hyperkalzämie wurde somit als Folge der gesteigerten Schilddrüsenfunktion und des dadurch erhöhten Knochenstoffwechsels interpretiert. Dieser Fall zeigt, dass eine Hyperkalzämie im Rahmen eines unbehandelten Morbus Basedow auftreten kann und bei der differenzialdiagnostischen Abklärung erhöhter Kalziumwerte berücksichtigt werden sollte.

Background: AMR is a public health concern which leads to high global morbidity and mortality. Immunocompromised patients, who are more susceptible to contracting potentially life-threatening infections, are faced with reduced treatment options due to emerging AMR. Ceftolozane/tazobactam is a novel β-lactam/β-lactamase inhibitor which displays effectiveness against resistant Gram-negative infections. Methods: SPECTRA was a multinational, observational study conducted in seven countries including 617 patients who received ≥48 h of ceftolozane/tazobactam. Medical-record data were collected up to 6 months before treatment and 30 days after the final dose or until death. This analysis describes clinical outcomes and healthcare resource use in patients with sepsis or who were immunocompromised, specifically in patients with hematologic malignancy with and without solid tumor, febrile neutropenia, and solid organ transplant patients. Results: Clinical success ranged from 50.0% in patients with hematologic malignancy and solid tumor to 69.4% in 38 patients with febrile neutropenia. All-cause in-hospital mortality was 23.1-42.9%, with the lowest rates in patients with solid organ transplant. ICU admission was 46.4-68.2% across subpopulations (excluding febrile neutropenia) with the lowest rates in patients with hematologic malignancy. ICU length of stay was lowest within transplant patients (9 days) and highest within the hematologic malignancy and solid tumor population (32 days). Conclusions: The results from this sub analysis of SPECTRA showed that ceftolozane/tazobactam was associated with clinical success in the selected immunocompromised and sepsis patient populations and may lead to reduced morbidity, mortality, and healthcare-resource use. Further research is required to standardize treatment protocols and improve patient outcomes.

Ageing populations in high-income countries reduce the proportion of potential blood donors while increasing transfusion demand. Sustaining an adequate blood supply requires higher donor motivation among younger age groups. We analysed long-term trends in whole blood donations (WBDs) in one German federal state as an indicator for challenges that may arise in other high-income countries. In our prospective longitudinal study (starting 2005), we obtained the age and sex of the donors of all WBDs in the German federal state Mecklenburg-Western Pomerania in 2019 and 2020 and compared them with the data from 2005 to 2015. Population data from the German statistical office were used to predict future WBD in two models, population-based and population-based with behaviour-adjusted prediction. WBD decreased from 118,419 in 2005 to 83,871 in 2019 (-29.2%) and 76,912 in 2020 (-35.1%). Donation rates per 1000 inhabitants declined by 19.1% between 2005 and 2019, indicating a loss of donor motivation beyond demographic effects. Based on the donation numbers of 2019, we predict a further decline of WBD in 2030 by -12.7% (population-based projection) or -15.1% (behaviour-adjusted projection), respectively. The decline in blood donations is no longer solely driven by demographic changes but also by reduced motivation among younger donors. As ageing populations and changing donor behaviour are common to many high-income countries, these findings likely reflect an emerging international trend. Targeted strategies to recruit and retain young donors are urgently needed to ensure sustainable blood supplies in ageing societies.

Famous tourist resorts have usually been also health resorts. At the same time, the development of high-altitude spas was closely linked to the treatment of tuberculosis. One of the reasons for locating sanatoriums away from large cities was to minimise the risk of infection. Tuberculosis sanatoria had the image of being dangerous places that should be avoided by the local population. Their construction was often accompanied by debates that delayed or prevented them from being built. In one of the most famous health resorts of the Habsburg Monarchy, the Semmering region, there were massive conflicts with representatives of tourism interests. Although the most important medical experts in the Habsburg Monarchy spoke out in favour of the construction and its safety, the authorities could not be convinced. A contemporary newspaper carried the headline: "The battle for Semmering". The conflicts surrounding the establishment of tuberculosis sanatoriums are shown, and the struggle for the first sanatoriums in the Austro-Hungarian Empire is made visible. The establishment of the first tuberculosis sanatoriums was accompanied by irrational fears, which could not be dispelled by expert opinions and statistical data. In the Semmering region, local representatives felt that tourism interests were under threat. This study examined the work of Leopold Schrötter von Kristelli, a laryngologist and social physician, within the context of the sanatorium movement. Schrötter von Kristelli made great efforts to establish a tuberculosis sanatorium and encountered significant opposition in his endeavours. The essay also highlights the important work of the Austrian Central Committee for Tuberculosis under the leadership of the social physician Ludwig Teleky. Teleky encouraged several important medical associations to investigate "danger of spreading tuberculosis through sanatoriums in their vicinity" in order to dispel these fears and prove the safety of such institutions. The College of Physicians in Vienna drew up a memorandum addressed to the relevant authorities demanding approval for the institution, but to no avail.

To map the risk profile of drug classes at the population level by identifying associations between newly prescribed reimbursed drugs and sudden cardiac arrest (SCA), thereby providing a systematic basis for assessing individual drug effects. Population-based, matched case-control study. Greater Vienna area, Austria, using linked data from the Austrian Healthcare Reimbursement Database and the Vienna Ambulance Service between 2013 and 2020. A total of 31 330 insured individuals were included from an estimated 14 448 612 person-years at risk. Cases (n=6266) were patients with SCA, each matched 1:4 to controls (n=25 064) without SCA by age, sex and event date. The estimated absolute case risk equals 43.4 per 100 000 person-years. Newly prescribed reimbursed drugs within 4 weeks before the SCA event, classified according to four-digit Anatomical Therapeutic Chemical (ATC) codes. Associations between newly prescribed drug classes and SCA, estimated using conditional logistic regression and expressed as ORs with 95% CIs, adjusted for comorbidities and concomitant medications prescribed 120-29 days before the event. Among 322 relevant ATC drug classes, 245 were newly prescribed within 28 days prior to the SCA event. Of these, 57 (23%) were significantly associated with SCA. Eight drug classes demonstrated a markedly elevated risk (OR≥10), including oripavine derivatives (OR 64, 95% CI 8 to 486), other cardiac preparations (OR 22, 95% CI 2 to 204), plain antiandrogens (OR 18, 95% CI 1.2 to 275) and phenylpiperidine derivatives (OR 16, 95% CI 7 to 38). The most frequently prescribed associated drug classes were penicillins with beta-lactamase inhibitors (179 cases; OR 2.17, 95% CI 1.8 to 2.7), pyrazolones (167 cases; OR 2.14, 95% CI 1.7 to 2.7) and adrenergics combined with anticholinergics (130 cases; OR 2.94, 95% CI 2.2 to 3.9). Numerous outpatient-prescribed drug classes were associated with SCA. This exploratory, population-based analysis provides a systematic map of potential safety signals to inform more detailed pharmaco-epidemiological investigations, in which confounding and causality can be examined more rigorously.

Abstract Description Distinct expression of the alarmins S100A8 (A8), S100A9 (A9) and their antimicrobial Calprotectin (CP) hetero-complex has been documented in Inflammatory Skin Diseases (ISDs). The cell-specific functions of A8 and A9 in local and extra-cutaneous manifestations of ISD were evaluated using genetically engineered mouse models (GEMMs). ISDs such as Atopic Dermatitis are accompanied by Osteopenia, a musculoskeletal complication, while skin infections can lead to osteomyelitis and septic arthritis. A9 or A8 were inactivated in epidermal cells or neutrophils in the JunB?ep genetic mouse model for skin inflammation. Inactivation of epidermal A9 promoted, while A8 inactivation ameliorated experimental ISD. Skin inflammation was also ameliorated when A9 was inactivated in neutrophils or in all cells. However, complete A9 knock-out was associated with worsened systemic effects, such as neutrophilic inflammation and bone loss. Staphylococcus aureus overgrowth, bone destruction and increased A8 protein expression were also observed in the distal phalanges of the digits. Epidermal A8 inactivation ameliorated bone loss, but promoted bone destruction in the digits, likely through A8-positive neutrophilic infiltrates. These data show that site- and cell-type-specific A8 and A9 expression modulates chronic skin and systemic inflammation. These findings pave the way for novel therapies targeting divergent functions of A8 and A9 to restore homeostasis and prevent systemic complications. Funding Sources Marie Sklodowska-Curie postdoctoral grant INTERACT-101111333, European Research Council. APART-MINT postdoctoral fellowship/11998, Austrian Academy of Sciences (ÖAW). European Research Council Advanced grant (ERC AdG 2016-741888-CSI-Fun). Topic Categories Mucosal and Regional Immunology (MUC)

In recent years, we have witnessed remarkable progress in organ donation and the preservation of donor lungs. Several transformative innovations have been particularly influential:1. Normothermic ex vivo lung perfusion (EVLP): EVLP is a groundbreaking advancement in lung transplantation. This technology not only enables expansion of the donor pool by reconditioning marginal lungs, but also improves transplantation outcomes, through optimised assessment and therapeutic intervention prior to implantation. Lungs considered high-risk or initially unsuitable for transplantation can be evaluated and, in many cases, rehabilitated using EVLP, resulting in post-transplant outcomes comparable to those of conventionally selected lungs. With ongoing technological advancements and increasing clinical acceptance, EVLP could soon become the standard of care in lung transplantation.2. Donation after circulatory death (DCD): DCD has emerged as an essential strategy to address the shortage of transplantable lungs. Despite logistical challenges and ethical considerations, transplantation outcomes using DCD lungs are comparable to those achieved with traditional donation after brain death. As research and technology continue to advance, DCD donors are expected to play an increasingly significant role in lung transplantation.3. Controlled hypothermic preservation at 10°C: Controlled hypothermic storage at 10°C offers extended preservation times, reduces cold-induced injury, and enhances flexibility in transplant scheduling. This method has the potential to revolutionise the currently rigid logistics of lung transplantation, allowing semi-elective procedures to be integrated into daily surgical programs as research progresses.With a particular focus on these innovations, we aim to summarise the current state of knowledge regarding lung donors and donor lung preservation.