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The European Court of Justice (ECJ) has ruled that the daily rest period according to the EU Working Time Directive is not part of the weekly rest period, but must be granted in addition. The decision relates to the case of a train driver at the Hungarian railway company MÁV-START. The daily rest period and the weekly rest period are two separate rights of employees that must be granted independently of each other. Austrian labor law is not directly affected by this decision, as it is a case-by-case decision based on the specific circumstances of Hungarian law. It is emphasized that the ECJ's ruling has no impact on rest period regulations in Austria and no changes in practice are required. [Extracted from the article]

Simple Summary: Veterinarians face a range of challenges when attending competition horses. Athletic goals and high expectations surrounding the performance of the horse may impact treatment decisions, and the veterinarians working at competitions may feel reputational pressure in this very public working context. Using a questionnaire, we found that a majority of German, Austrian and Swiss equine veterinarians (N = 172) agreed that competition horse owners have higher expectations than the owners of leisure horses as regards their medical services, and that the veterinarian's reputation plays a more important role. Our data also show that owners are better informed about the diagnostics and therapies that may positively impact the care of their competition horses. Using a case vignette, we established that, on the grounds of equine welfare, the majority of respondents indicated that they were against starting a dressage horse with low-grade lameness in a competition. The respondents who indicated that they would approve a start of the dressage horse indicated that a horse with a low-grade lameness was fit enough "to compete". We conclude that clearer definitions of phrases, such as "fit to compete", may support veterinarians to conduct their professional responsibilities during competitions and reduce the reputational stress they experience in this working context. Equine veterinarians face a range of challenges when attending competition horses. Athletic goals may significantly impact veterinary decision making, and the veterinarian's work can be complicated by reputational considerations and rival opinions during an assessment of whether a horse is "fit to compete". Using an online questionnaire, we found that the majority of German, Austrian and Swiss equine veterinarians (N = 172) surveyed agreed that the owners of competition horses are more likely than owners of leisure horses to approach them with clear treatment ideas, and that the former have higher expectations of the medical services provided. The data also show that the veterinarian's reputation plays a more important role in the competition sphere. Using a case vignette, we established that, on the grounds of equine welfare, the majority of respondents indicated that they would decide against starting a dressage horse with low-grade lameness in a competition. Those respondents who indicated that they would approve a start of the dressage horse indicated that a horse with a low-grade lameness was fit enough "to compete". We conclude that clearer definitions of phrases, such as "fit to compete", may be helpful in guiding veterinarians as they discharge their professional responsibilities during competitions and reduce the reputational stress they experience in this working context. [ABSTRACT FROM AUTHOR]

Nivolumab is used after platinum-based chemotherapy in patients with metastatic urothelial carcinoma. Studies suggest improved outcomes for dual checkpoint inhibition with high ipilimumab doses. We aimed to examine the safety and activity of nivolumab induction and high-dose ipilimumab as an immunotherapeutic boost as a second-line treatment for patients with metastatic urothelial carcinoma. TITAN-TCC is a multicentre, single-arm, phase 2 trial done at 19 hospitals and cancer centres in Germany and Austria. Adults aged 18 years or older with histologically confirmed metastatic or surgically unresectable urothelial cancer of the bladder, urethra, ureter, or renal pelvis were eligible. Patients had to have progression during or after first-line platinum-based chemotherapy and up to one more second-line or third-line treatment, a Karnofsky Performance Score of 70 or higher, and measurable disease as per Response Evaluation Criteria in Solid Tumors version 1.1. After four doses of intravenous nivolumab 240 mg induction monotherapy every 2 weeks, patients with a partial or complete response at week 8 continued maintenance nivolumab, whereas those with stable or progressive disease (non-responders) at week 8 received a boost of two or four doses of intravenous nivolumab 1 mg/kg plus ipilimumab 3 mg/kg every 3 weeks. Patients who subsequently had progressive disease during nivolumab maintenance also received a boost, using this schedule. The primary endpoint was the confirmed investigator-assessed objective response rate in the intention-to-treat population and had to exceed 20% for the null hypothesis to be rejected (based on the objective response rate with nivolumab monotherapy in the CheckMate-275 phase 2 trial). This study is registered with ClinicalTrials.gov , NCT03219775 , and is ongoing. Between April 8, 2019, and Feb 15, 2021, 83 patients with metastatic urothelial carcinoma were enrolled and all received nivolumab induction treatment (intention-to-treat population). The median age of enrolled patients was 68 years (IQR 61–76), and 57 (69%) were male and 26 (31%) were female. 50 (60%) patients received at least one boost dose. A confirmed investigator-assessed objective response was recorded in 27 (33%) of 83 patients in the intention-to-treat population, including six (7%) patients who had a complete response. This objective response rate was significantly higher than the prespecified threshold of 20% or less (33% [90% CI 24–42]; p=0·0049). The most common grade 3–4 treatment-related adverse events were immune-mediated enterocolitis (nine [11%] patients) and diarrhoea (five [6%] patients). Two (2%) treatment-related deaths were reported, both due to immune-mediated enterocolitis. Treatment with nivolumab and nivolumab plus ipilimumab boosts in early non-responders and patients who progress late significantly improved objective response rate after previous platinum-based chemotherapy compared with the rate reported with nivolumab in the CheckMate-275 trial. Our study provides evidence for the added value of high-dose ipilimumab 3 mg/kg and suggests a potential role for the combination as a rescue strategy in platinum-pretreated patients with metastatic urothelial carcinoma. Bristol Myers Squibb. [ABSTRACT FROM AUTHOR]

Simple Summary: Owners of dogs, cats, and other companion animals increasingly make use of the internet to find out how to best care for their animals. This may affect owners' relations with veterinarians in both positive and negative ways. A positive consequence could be that owners are better informed when they approach a veterinarian. However, there can also be challenging situations in which the owners may question veterinarians' professional advice based on online information. Using a questionnaire, we found that a majority of Austrian, Danish, and UK veterinarians (n = 641) surveyed were occasionally confronted with clients who question their medical advice based on information obtained from the internet. In addition, the veterinarians were concerned about the potential for clients to misunderstand information found on the internet, or to develop unrealistic expectations of what is possible in small animal practices. As internet use becomes ever more widespread, we suggest that the types of resources that are available and used by animal owners should be further explored. Veterinary medicine is increasingly affected by animal owners having the opportunity to become better informed on pet health issues by using various internet resources. Using an online questionnaire including a section on clients' use of internet resources to obtain medical information, this study aimed to investigate veterinarians' estimates of the percentage of clients using internet resources, how often clients question veterinarians' professional medical advice based on online information, and veterinarians' attitudes towards clients' use of internet resources, across Austrian, Danish, and UK veterinarians (n = 641). The results show that 48.8% of respondents estimated that 40–79% of their clients use internet resources to find medical information. Further, 70–80% of respondents stated that they are occasionally challenged by clients questioning their advice based on online information. Although veterinarians recognized the potential advantages related to clients' use of internet resources, such as an increased acceptance of advanced diagnostics and treatments, they also highlighted clients' increased expectations or false impressions of small animal practices as potentially negative aspects in this context. As internet use increases, it seems likely that these issues will become increasingly important in the future. [ABSTRACT FROM AUTHOR]

Small animal veterinarians frequently have to manage conflicting interests. Beside the key consideration of the patient's interests, small animal veterinarians are often challenged to consider not only client's emotional needs, but also their own personal aspirations to provide quality patient care and to make a good living as a professional. Further, veterinarians have an interest in continuous professional development and the use of the newest treatments, which may influence their decision-making process. Based on published work, we hypothesize the existence of four decision ethics orientations that veterinarians can use to manage potentially conflicting concerns. These are: the patient-focused, the client-empathetic, the client-devolved and the development-oriented decision ethics orientations. We surveyed small animal veterinarians in Austria, Denmark, and the UK using a questionnaire (N = 648), and successfully identified the four decision ethics orientations in all three countries. The patient-focused and client-empathetic decision ethics orientations are salient in all countries, whereas Danish and UK veterinarians are slightly more client-empathetic and client-devolved compared to their Austrian colleagues. Across countries our findings show that experienced and older veterinarians tend to be more client-empathetic. Younger and less experienced professionals are more development-oriented compared to their older and more experienced colleagues. In contrast to other studies investigating ethical issues in small animal practice, we found no evidence that gender plays a decisive role in the tendency towards any decision ethics orientation. We also show that veterinarians with a higher client-empathetic orientation and development-orientation more often discuss the possibility of health insurance with clients who do not have it. The present study provides a first empirical insight into how veterinarians manage challenging expectations and ethical concerns as part of decision making in modern small animal practice. [ABSTRACT FROM AUTHOR]

In 1918 Austria was changed into a democratic republic. Despite the difficult political and economic situation at the end of the First World War self-confident and future oriented school reform programs were developed in Austria. Influences of international New Education as well as of German Humanities Pedagogy can be determined. The Social Democrats under the leadership of Otto Glöckel, influenced by the ideas and concepts of New Education (such as "learning by doing"), postulated the creation of one comprehensive school ("Allgemeine Volksschule") up to the age of 14 in order to realize equal opportunity. The Christian Socials on the other side were influenced by ideas of the German Humanities Pedagogy and advocated under the Leadership of Alois Höfler and Richard Meister for maintaining the variety of types of secondary education at level I: "Volksmittelschule", "Untergymnasium", "Unterrealschule". Because of these great differences no agreement on a school reform program could be realized. Nevertheless in 1927 a compromise was decided: the "Haupt and Mittelschulgesetz". But type diversity in the field of secondary education remains and characterizes the Austrian school system even in the 21st century. [ABSTRACT FROM AUTHOR]

Background: The wearable cardioverter-defibrillator is a treatment option for patients at temporarily high risk of sudden cardiac death or in whom implantation of a cardioverter-defibrillator is temporarily not possible. Objectives: The aim of this study was to provide real-world data on patients receiving this therapy in a nurse-based wearable cardioverter-defibrillator training programme. Methods: A registry including all patients prescribed with a wearable cardioverter-defibrillator in Austria between 2010 and 2016. Overall, 448 patients received a wearable cardioverter-defibrillator in 48 centres. Patients received structured nurse-based wearable cardioverter-defibrillator educational initial training followed by remote monitoring. Results: Main indications were: severe non-ischaemic cardiomyopathy (21%); recent myocardial infarction and percutaneous coronary intervention (20%); and stable coronary artery disease with percutaneous coronary intervention/coronary artery bypass grafting (14%). Eleven patients (2.5%) received 22 appropriate wearable cardioverter-defibrillator shocks. Two patients (0.4%) received three inappropriate shocks. The risk of sudden cardiac death varied between different aetiologies. Eight out of 11 (73%) patients received their first wearable cardioverter-defibrillator shock within 30 days. The main reasons for termination of the wearable cardioverter-defibrillator therapy were implantable cardioverter-defibrillator implantation (55.5%) and improvement of left ventricular ejection fraction to more than 35% (33%). Conclusion: The wearable cardioverter-defibrillator is an effective and safe treatment option in patients at either transiently elevated risk of ventricular tachycardia/ventricular fibrillation or mandated postponed implantable cardioverter-defibrillator implantation, with a 2.5% shock rate over a median 54 days wearable cardioverter-defibrillator treatment period. However, both the wearable cardioverter-defibrillator shock rate and implantable cardioverter-defibrillator implantation rate vary widely depending on the wearable cardioverter-defibrillator indication. Nurse-based wearable cardioverter-defibrillator training is associated with high patient adherence, with a median wearing duration per day of 23.5 (1–24) hours. [ABSTRACT FROM AUTHOR]

Background: Euthanasia of pets has been described by veterinarians as "the best and the worst" of the profession. The most commonly mentioned ethical dilemmas veterinarians face in small animal practice are: limited treatment options due to financial constraints, euthanizing of healthy animals and owners wishing to continue treatment of terminally ill animals. The aim of the study was to gain insight into the attitudes of Austrian veterinarians towards euthanasia of small animals. This included assessing their agreement with euthanasia in exemplified case scenarios, potentially predicted by demographic variables (e.g. gender, age, working in small animal practice, employment, working in a team, numbers of performed euthanasia). Further describing the veterinarians' agreement with a number of different normative and descriptive statements, including coping strategies. A questionnaire with nine euthanasia scenarios, 26 normative and descriptive statements, and demographic data were sent to all members of the Austrian Chamber of Veterinary Surgeons (n = 2478). Results: In total, 486 veterinarians answered sufficiently completely to enable analyses. Responses were first explored descriptively before being formally analysed using linear regression and additive Bayesian networks - a multivariate regression methodology - in order to identify joint relationships between the demographic variables, the statements and each of the nine euthanasia scenarios. Mutual dependencies between the demographic variables were found, i.e. female compared to male veterinarians worked mostly in small animal practice, and working mostly in small animal practice was linked to performing more euthanasia per month. Conclusions: Gender and age were found to be associated with views on euthanasia: female veterinarians and veterinarians having worked for less years were more likely to disagree with euthanasia in at least some of the convenience euthanasia scenarios. The number of veterinarians working together was found to be the variable with the highest number of links to other variables, demographic as well as ethical statements. This highlights the role of a team potentially providing support in stressful situations. The results are useful for a better understanding of coping strategies for veterinarians with moral stress due to euthanasia of small animals. [ABSTRACT FROM AUTHOR]

Background Low serum albumin levels are associated with cardiovascular disease and mortality risk. This study evaluated the predictive value of low serum albumin for all-cause-mortality in a large Viennese patient cohort and investigated sex differences in the association between serum albumin and mortality. Materials and methods Serum albumin concentrations of 285 930 patients, who attended the General Hospital Vienna between 1992 and 2002, were evaluated and linked with the Austrian Death Registry. The median observation period was 7·4 ± 4·0 years and the death rate was 16·8%. For Cox regression analysis, albumin levels were divided into deciles, the highest category served as reference value. To analyse associations between albumin and mortality independent of liver function, results were adjusted for cholinesterase, which indicates protein synthesis capacity of the liver. Results Hazard ratios for all-cause-mortality increased linearly with decreasing albumin levels from 1·05 in the 9th to 2·98 in the 1st decile. Adjusted for cholinesterase, the relative risk for mortality was still 1·91 in the lowest category. Compared with women, men had an average 50% increased risk of death in almost every decile, adjusting for cholinesterase reduced the sex difference to a 10–20% higher mortality risk for men. In critically ill patients, hazard ratios for all-cause-mortality ranged from 4·5 in the 9th decile to 9·5 in the lowest albumin category. Conclusion This study demonstrates a strong inverse association between serum albumin and mortality in a large patient cohort. The predictive value of low albumin was remarkably higher in men than in women. [ABSTRACT FROM AUTHOR]

The article reports on a March 2009 trilateral conference held at the Michael's Monastery in Hildesheim, Germany, on the subject "Italy, Austria, and the Federal Republic of Germany in Europe. A Triangular Relationship in Its Mutual Connections and Perceptions of 1945-1949 Up to the Present." The meeting focused on such topics as the South Tyrolean question and statesmen in the post-World War II era in Europe.

Background: Health insurance offers many benefits to clients and veterinarians, such as the ability to perform necessary and possibly cost‐intensive medical interventions without financial constraints, or to potentially prevent euthanasia based on financial challenges. However, concerns about negative consequences, such as the overuse of diagnostic tests or overtreatment, have also been raised. Methods: Using an online questionnaire distributed via e‐mail, which included a section on health insurance, we investigated the relative number of insured dogs and cats treated by Austrian, Danish and UK veterinarians (N = 636) and the attitudes of those veterinarians toward health insurance. Further, using a case vignette, we examined whether coverage by health insurance may influence treatment suggestions. Results: Even though veterinarians in all three countries believe that health insurance reduces stress since clients' financial resources will be less important, we found that Austrian veterinarians are more likely to agree that health insurance is unnecessary compared to Danish and UK veterinarians. Further, many raised the concern that insurance policies influence clinical decisions; and less than half supported the idea of making insurance mandatory. A majority of veterinarians in Austria and the UK thought that insurance can lead to the overuse of diagnostic tests, and in the UK a majority also thought that it can lead to overtreatment. Using case vignettes, we found that veterinarians were significantly more likely to suggest a CT scan to a client with an insured animal, in contrast to a client with stated financial limitations. Further, UK veterinarians were more likely to suggest a CT scan to a client with an insured animal, in contrast to a client without insurance. Conclusion: In conclusion, we found that veterinarians, in general, were in favour of health insurance, and that greater coverage may increase more cost‐intensive veterinary care. Our findings also raise a potential ethical challenge of health insurance causing differential access to clinical care for patients. [ABSTRACT FROM AUTHOR]

This article draws from theories of business-government relations and Austrian economics to develop a model relating firm performance to the firm's market and nonmarket actions. Nonmarket actions represent one mechanism for the implementation of firm strategies. The model is tested using an original data set covering airlines serving international routes in the North Atlantic region. Results suggest that nonmarket actions have a positive and significant impact on performance, measured in three ways: profits, market share, and capacity utilization. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the daily activity of the pest slug Arion lusitanicus Mabille in the grassland near Saint Marein/Graz, Austria. Two experiments where conducted in the study area in August 1995. An increase slug activity in the late afternoon was observed in both experiments, while a decrease activity was observed in the morning. An illustration of the level of activity at different times of day for both experiments during the first 116 or 135 hours after release is presented.

Drawing on the Austrian school of economics and the structure-conduct-performance (s-c-p) paradigm of industrial organization, the authors present and test a dynamic model of competitive activity and performance. They examine the model in two stages. First, they explore the influence of industry-level and firm-Level cooperative mechanisms on firm-level competitive activity. Second, they examine the effect of firm- and industry-level competitive activity on firm performance. The authors use the dynamic model of competitive activity to examine the complex linkages between the firm's environment, its actions, and its performance outcomes. They report a longitudinal analysis of a sample of 1,903 competitive moves undertaken in the software industry. Hypothesis testing supports the relationships in the model argued from the Austrian perspective, hut provides only partial support for those derived from the s-c-p paradigm. Firm-level cooperative mechanisms are found to increase the firm's competitive activity, and firm-level competitive activity is related positively to the firm's return on assets and return on sales. Contrary to expectation based on the s-c-p paradigm, industry-level cooperative mechanisms are not related to the firm's competitive activity or to its performance. Consistent with the 10 paradigm, however, a measure of industry rivalry that directly captures industry-level competitive activity is related negatively to firm-level performance. [ABSTRACT FROM AUTHOR]

Background: Treating cancer according to its molecular alterations (i.e., targeted treatment, TT) is the goal of precision medicine tumor boards (PTBs). Their clinical applicability has been evaluated for ovarian cancer patients in this analysis. Methods: All consecutive ovarian cancer patients discussed in a PTB at the Medical University of Vienna, Austria, from April 2015 to April 2019 were included (n = 44). Results: In 38/44 (86%) cases, at least one mutation, deletion or amplification was detected. The most frequently altered genes were p53 (64%), PI3K pathway (18%), KRAS (14%), BRCA1 (11%) and BRCA2 (2%). In 31 patients (70%) a TT was recommended. A total of 12/31 patients (39%) received the recommended therapy. Median time from indication for PTB to TT start was 65 days (15–216). Median time to treatment failure was 2.7 months (0.2–13.2). Clinical benefit rate (CBR) was 42%. Reasons for treatment discontinuation were disease progression (42%), poor performance status (PS > 2; 25%), death (17%) or treatment related side effects (8%). In 61% the TT was not administered—mainly due to PS > 2. Conclusion: Even though a TT recommendation can be derived frequently, clinical applicability remains limited due to poor patients' general condition after exploitation of standard treatment. However, we observed antitumor activity in a substantial number of heavily pretreated patients. [ABSTRACT FROM AUTHOR]

An editorial is presented on the topic of funding for research purpose and the ranking for universities in Austria. It also states the research strategy sustainability for budget funding. Topics discussed includes importance of Austrian universities, research funding law and research funding institution and transparency in research funding.

To evaluate the prevalence of low anterior resection syndrome (LARS) in patients with debulking surgery for primary advanced epithelial ovarian cancer and to identify potential risk factors for development of LARS. We reviewed data on 552 consecutive patients with primary epithelial ovarian cancer (EOC), who underwent upfront or interval cytoreductive surgery including low anterior resection at two different academic institutions (Kliniken-Essen-Mitte, Germany, and Medical University of Vienna, Austria). Intestinal dysfunction was assessed by the validated LARS-questionnaire via telephone call. We performed descriptive statistics and a binary logistic regression model to evaluate risk factors for LARS. In total, 341 patients were eligible and 206 (60.4%) were successfully contacted and provided complete information. Major LARS was observed in 78 (37.9%) patients, minor LARS in 44 (21.4%) patients, and no LARS in 84 (40.8%) patients. The prevalence rate of major LARS was not influenced by time interval between surgery and LARS assessment, type of cytoreductive surgery, and recurrent disease at the time of assessment. In multivariate analyses, number of anastomosis was independently associated with an increased risk for presence of major LARS (OR 3.76 [1.95–7.24]). In the present cohort, 25.2% patients had more than one bowel anastomosis. LARS in general and major LARS in particular seem to be a frequent long-term complication after debulking surgery including low anterior resection in primary advanced EOC patients. Particularly EOC patients with more than one bowel anastomosis during surgery seem to be at an increased risk for major LARS. • LARS is a common and significant postoperative complication in ovarian cancer patients. • The prevalence of major LARS - described to impair patient's quality of life - is almost 40%. • LARS prevalence is stable irrespective of time interval between surgery and LARS evaluation. • Multiple bowel anastomoses increase the risk for developing major LARS. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the association between fibrinogen plasma levels on disease-free patients and overall survival in patients with cervical cancer. Study Design: Pretherapeutic fibrinogen plasma levels were examined in 313 patients with cervical cancer who were treated at the Department of Obstetrics and Gynecology, Medical University of Vienna. Fibrinogen plasma levels were correlated with clinical-pathologic findings and patient survival. Results: Mean (± SD) pretherapeutic fibrinogen plasma levels were 417.4 mg/dL (± 130.3 mg/dL). Elevated fibrinogen plasma levels were associated with advanced tumor stage (P < .001) and patient age (P < .001), but not with histologic type (P = .4), histologic grade (P = .1), and pelvic lymph node involvement (P = .9). In a multivariate survival analysis, fibrinogen plasma levels (P < .001 and < .001) and lymph node involvement (P < .001 and = .001), but not patients'' age (P = .8 and .4) and histologic type (P = .7 and .5) were associated with overall or disease-free survival, respectively. Histologic grade was associated with disease-free (P = .01), but not with overall, survival (P = .2). Conclusion: Fibrinogen plasma levels are an independent prognostic parameter in patients with cervical cancer. [Copyright &y& Elsevier]

Recently, the new 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer (EC) critically integrating new pathological and molecular features was published. The present study evaluated the clinical impact of the new 2023 FIGO staging system by comparing it to the previous 2009 system. This is an international, pooled retrospective study of 519 EC patients who underwent primary treatment (and molecular characterisation) at three European Society of Gynaecological Oncology (ESGO) accredited centres in Austria/Italy. Patients were categorised according to the 2009 and the 2023 FIGO staging systems. Stage shifts were analysed and (sub)stage specific 5-year progression-free (PFS) and overall survival (OS) rates were calculated and compared. Different statistical tests were applied to evaluate the prognostic precision of the two FIGO staging systems and to compare them to each other. (Sub)stage shifts occurred in 143/519 (27.6%) patients: 123 upshifts (23.7%) and 20 (3.9%) downshifts. 2023 FIGO staging system identified a stage I cohort with a notably higher 5-year PFS rate compared to 2009 (93.0% versus 87.4%, respectively). For stage II disease, the 5-year PFS rate was similar in the 2023 and the 2009 FIGO staging systems (70.2% versus 71.2%, respectively). The two new molecularly defined 2023 FIGO substages IAm POLEmut and IICm p53abn displayed distinct, particularly favourable and adverse oncologic outcomes within early stage disease, respectively. A remarkably lower 5-year PFS rate for stage III patients was revealed in the 2023 FIGO staging system compared to 2009 (44.4% versus 54.1%, respectively). All applied statistical tests confirmed a more accurate prediction of PFS and OS by the 2023 FIGO staging system compared to 2009. The new 2023 FIGO stating system led to a substantial stage shift in about one quarter of patients leading to a higher prognostic precision. In early stage disease, the new substages added further prognostic granularity and identified treatment relevant subgroups. [Display omitted] • A substantial stage shift occurred between the 2009 and 2023 FIGO staging systems. • The 2023 FIGO staging system has an improved prognostic precision compared to 2009. • New 2023 FIGO substages in early stage disease add further prognostic granularity. • New molecularly defined FIGO substages identify patients with distinct outcomes. • 2023 FIGO substages in early stage disease identify treatment-relevant subgroups. [ABSTRACT FROM AUTHOR]

Background: Plasminogen activator inhibitor-1 (PAI-1) plays an important role in the regulation of fibrinolysis and extracellular matrix turnover. PAI-1 4G/5G insertion/deletion polymorphism in the PAI-1 promoter region has been shown to modulate PAI-1 plasma levels. We investigated the relationship between this polymorphism and the prevalence of diabetic nephropathy and retinopathy in patients with type 2 diabetes in the Austrian population., Patients and Methods: 147 consecutive patients with type 2 diabetes mellitus (96 men, 51 women; median age, 65 years; IQR, 59-71) were analyzed for the PAI-1 4G/5G genotype., Results: The genotype distribution in the individuals tested was as follows: 17% (n = 25) 5G/5G, 54% (n = 80) 4G/5G, and 29% (n = 42) 4G/4G. Patients homozygous for allele 4G had a significantly higher risk of diabetic proliferative retinopathy than patients without signs of diabetic retinopathy or nonproliferative retinopathy (OR, 7.3; 95% CI, 1.4-38.8; P = 0.02). No significant associations were observed between the PAI-1 genotype and the presence of albuminuria., Conclusion: According to our results, diabetic proliferative retinopathy might be associated with the prevalence of PAI-1 genotype 4G/4G.

The aim of this study was to analyze the prevalence and severity of sensorimotor and autonomic neuropathic symptoms within an outpatients diabetic population. A total of 350 consecutive Type 1 (26.9%) and Type 2 diabetic subjects were investigated using the Michigan Neuropathy Screening Instrument (MNSI). The original questionnaire was extended with questions on autonomic neuropathy and to include a six-point scale to rate the severity of symptoms, which were recorded accurately in order to avoid overrating. More than one half of Type 2 and nearly a third of Type 1 diabetic subjects suffer from at least one neuropathic symptom; the former suffered significantly more often from paresthesia (P<.05) and burning pain (P=.05). Less than 10% of the study population had autonomic symptoms. The prevalence of symptomatic polyneuropathy (PNP), diagnosed by an abnormal MNSI together with the presence of any symptom, was 16.0% in Type 1 and 37.5% (P<.001) in Type 2 diabetic subjects. Subjects with an abnormal ankle reflex (54.6%) had in 48.2% any sensorimotor, in 35.1% any autonomic, and in 25.7% any sensorimotor plus autonomic symptoms. The corresponding percentages for subjects with an abnormal vibration perception threshold (VPT; 28.9%) were 59.4%, 46.5%, and 34.7%, respectively. An abnormal ankle reflex was significantly correlated to numbness, and to the the sum of sensorimotor and autonomic symptoms. An abnormal vibration perception was significantly correlated to numbness, to paresthesia pain, and to the sum of sensorimotor and autonomic symptoms. A higher percentage of Type 2 diabetic subjects had symptoms of neuropathy and the most frequent symptoms were numbness, muscle cramps and postural hypotension.