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Objectives: To validate SAPS II-AM, a recently customized version of the Simplified Acute Physiology Score II (SAPS II) in a larger cohort of Austrian intensive care patients and to evaluate the effect of the customization process on the ratio of observed to expected mortality.Design: Prospective, multicentric cohort study.Patients and Setting: A total of 2,901 patients consecutively admitted to 13 adult medical, surgical, and mixed intensive care units (ICUs) in Austria.Measurements and Results: After the database was divided randomly into a development sample (n = 1,450) and a validation sample (n = 1,451), logistic regression was used to develop a new model (SAPS II-AM2). The original SAPS II, the SAPS IIAM, and the newly developed SAPS II-AM2 were then compared by means of calibration, discrimination and O/E ratios. Differences in O/E ratios before and after customization (deltaO/E) were calculated. The Hosmer-Lemeshow goodness-of-fit H and C statistics revealed poor calibration of the original SAPS II on the database. The new model, SAPS II-AM2, performed better than the SAPS II-AM and excellent in the validation data set. However, mean O/E ratios varied widely among diagnostic categories (range 0.55-1.05 for the SAPS II). Moreover, the deltaO/E of the 13 ICUs ranged from -3.6 % to +25 %.Conclusions: Today's severity scoring systems, such as the SAPS II, are limited by not measuring (and adjusting for) a profound part of what constitutes case mix. Changes in the distribution of patient characteristics (known and unknown) therefore affect prognostic accuracy. First-level customization was not able to solve all these problems. Using O/E ratios for quality of care comparisons one must therefore be critical when using these data and should search for possible confounding factors. In the case of unsatisfactory calibration, customized severity of illness models may be useful as an adjunct for quality control. [ABSTRACT FROM AUTHOR]

Background: Glycosylation analysis is still challenging, not only because of the extreme structure complexity and conjugation diversity of glycans but also because of instrumental aspects such as the sensitivity limits of analyses. Therefore, glycan analysis by chromatographic methods is very often combined with fluorescence detection in addition to MS. The majority of fluorescent labeling employed before LC separation is based on 2-aminobenzamide, which has several disadvantages such as low labeling yield, poor fluorescence properties, and MS ionization efficiency. Therefore, even after several decades of development of new labels, there is still a need for new labeling tags with improved characteristics., Results: We present the application of a newly synthesized fluorescent label designed for oligosaccharide and glycan analysis by high-performance liquid chromatography with fluorescence detection (HPLC/FLD). The novel hydrazide derivative of dipyrrometheneboron difluoride (BODIPY) was synthesized from 2,4-dimethylpyrrole, methyl succinyl chloride, and boron trifluoride etherate followed by a reaction with hydrazine. The synthesized label was characterized by several analytical methods including NMR, UV/Vis and fluorescence spectroscopy, and mass spectrometry. The labeling reaction via hydrazone formation chemistry was optimized by labeling of maltooligosaccharide standards. The analysis of maltohexaose labeled by BODIPY-hydrazide followed by HPLC/FLD analysis provided the limit of detection in the low tens of femtomole. The presented method based on fluorescence detection is at least 30 times more sensitive than the standard approach employing labeling by 2-aminobenzamide. In addition, the labeling method by BODIPY-hydrazide was used for N-linked glycan profiling of several glycoproteins (ribonuclease B, immunoglobulin G) by RP-HPLC/FLD as well as HILIC/FLD analysis., Significance: This work represents the design, synthesis, and application of a new fluorescent label based on the BODIPY core and hydrazone formation chemistry for oligosaccharide and glycan analysis by HPLC/FLD. The proposed approach significantly improved the oligosaccharide and glycan analysis in comparison to the commonly used procedure employing 2-aminobenzamide., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: With 17.6% of all primary parotid neoformations the benign Warthin's tumor (cystadenolymphoma) is the second common parotid gland tumor. Males > 50 years are affected predominantly. After surgery the recurrence rate is less than 5%. Histomorphologically the tumor is characterized by cystoid ducts lined by epithelial cells as well as lymphoid stroma. The lymphoid component has been described as radioresponsive whereas the epithelial parts are less radiosensitive. Since 1960 only one patient treated by primary radiotherapy has been published., Case Report: A 77-year-old woman suffered from cystadenolymphoma (maximal diameter 7 cm). Because of its extension and the reduced performance status of the patient surgery was no option. Radiotherapy was performed with a total dose of 50 Gy. Clinically, the tumor regressed completely after 30 Gy, which was confirmed by CT at 6 weeks after completion of radiotherapy. After 6 and 12 months the patient stayed free of tumor. EPICRISIS: In our case the cystadenolymphoma was unusually large (7 cm). Radiotherapy with 50 Gy induced complete tumor regression. The good clinical response after 30 Gy suggests that the necessary dose may be lower for less extended cystadenolymphomas., Conclusion: We present a case of cystadenolymphoma treated by radiotherapy with 50 Gy resulting in a complete remission. Due to missing published experiences no common recommendation for the total dose can be given. In the following situations radiotherapy should be considered: 1. high surgical risk of damage to the facial nerve, 2. unfavorable cosmetic outcome after surgery, 3. inoperability for internal risks, 4. refusal of operation.

Objectives: To evaluate the ability of an interdisciplinary data set (recently defined by the Austrian Working Group for the Standardization of a Documentation System for Intensive Care [ASDI]) to assess intensive care units (ICUs) by means of the Simplified Acute Physiology Score II (SAPS II) for the severity of illness and the simplified Therapeutic Intervention Scoring System (TISS-28) for the level of provided care., Design: A prospective, multicentric study., Setting: Nine adult medical, surgical, and mixed ICUs in Austria., Patients: A total of 1234 patients consecutively admitted to the ICUs., Interventions: Collection of data for the ASDI data set., Measurements and Main Results: The overall mean SAPS II score was 33.1+/-2.1 points. SAPS II overestimated hospital mortality by predicting mortality of 22.2%+/-2.9%, whereas observed mortality was only 16.8%+/-2.2%. The Hosmer-Lemeshow goodness-of-fit test for SAPS II scores showed lacking uniformity of fit (H = 53.78, 8 degrees of freedom; p < .0001). TISS-28 scores were recorded on 8616 days (30.6+/-1.5 points). TISS-28 scores were higher in nonsurvivors than in survivors (30.4+/-0.9 vs. 25.7+/-0.4, respectively; p < .05). No significant correlation between mean TISS-28 per patient per unit on the day of admission and mean predicted hospital mortality (r2 = .23; p < .54) or standardized mortality ratio per unit (r2 = -.22; p < .56) was found., Conclusions: Implementation of an interdisciplinary data set for ICUs provided data with which to evaluate performance in terms of severity of illness and provided care. The SAPS II did not accurately predict outcomes in Austrian ICUs and must, therefore, be customized for this population. A combination of indicators for both severity of illness and amount of provided care is necessary to evaluate ICU performance. Further data acquisition is needed to customize the SAPS II and to validate the TISS-28.

Following four weeks of conservative treatment of acute pancreatitis a 43 years old female was admitted to our ICU in severe circulatory shock (MAP less than 50 mmHg despite dopamine and dobutamine 5 mcg/kg/min, and norepinephrine 0.4 mcg/kg/min), respiratory failure, incipient renal failure and coma. Laboratory examination revealed thrombopenia (14 G/l) and leucopenia (0.5 G/l), as well as impaired prothrombine time (20%) and partial thromboplastine time (greater than 2 min). As abdominal sepsis was suspected to be the most likely cause of the patients multiple organ failure, a laparotomy was planned. To improve coagulation prior to surgery, plasmapheresis was performed exchanging 4.8 liters of plasma with fresh frozen plasma. In addition 3 units of platelets were transfused. The effects of the plasmapheresis were an improvement of circulatory as well as coagulatory parameters. Laparotomy revealed toxic megacolon, whereas the pancreas seemed to be normal; a coecostomy and a transversostomy were performed. The patient thereafter improved gradually; catecholamine doses were reduced, renal function recovered and five days postoperatively weaning from the ventilator was possible. Platelet substitution (6 more units), fresh frozen plasma administration (76 units à 200 ml) and AT III substitution (total 10,500 U) had to be continued throughout the first week. Five weeks after this operation, which would have been impossible without preoperative plasmapheresis, the patient was discharged in good health.