Radiotherapy for prostate cancer: DISCERN quality assessment of patient-oriented websites in 2018

Background Prostate cancer is the most commonly diagnosed cancer in men. Radiotherapy represents one major treatment option in different therapeutic settings. As patients increasingly rely on internet-based medical information, we examined the quality of information on radiotherapy and prostate cancer in websites used by laypersons. Methods An Internet search from a patients` perspective was carried out using different search engines (Google, Yahoo and Bing, search terms: “prostate cancer” and “radiotherapy”). The quality of search results was analyzed with regard to the DISCERN score, HON code certification, the JAMA criteria and the ALEXA traffic rank. Results In general, websites were of good quality. The highest quality was found for websites operated by charity organizations. No significant differences in results obtained via the above-mentioned tools were seen for the examined search engines, but Google revealed the most stable search results in terms of temporal changes. Conclusion Patients with prostate cancer can sufficiently inform themselves on general treatment options including radiotherapy on websites directed at laypersons. However, no simple strategy could identify high quality websites in general. For treating physicians, it is important to support patients in interpreting and ranking the vast quantity of information

Dringliche Eingriffe in der endokrinen Chirurgie

Während Notfalloperationen aus mechanischer Indikation immer wieder vorkommen (z. B. Chiasma-Syndrom, Atemwegsobstruktion), sind die kritischen Überfunktionen der endokrinen Drüsen in der Regel durch konservativ-medikamentöse Therapie ausreichend zu beherrschen. Ausnahmen: z. B. thyreotoxische Krise (bei nur kurz anhaltender Besserung durch Plasmapherese bei einer jodinduzierten Hyperthyreose) oder akutes Cushing-Syndrom (nicht beherrschbare hypokaliämische Alkalose). Solche Einzelfälle hängen von der optimalen Kooperation von Anaesthesie, Chirurgie und internistischer Intensivmedizin ab. Gesetze der Diagnose und der konservativen Vorbereitung für die operative Behandlung von endokrinen Überfunktionszuständen nur ultima ratio übertreten!Urgent surgery for emergency situations in endocrine diseases is needed for mechanical problems (e.g., chiasma syndrome or tracheal obstruction) and very rarely for endocrine hyperfunction, which can usually be treated by nonsurgical means. Exceptions are patients suffering from thyroid storm (impending early relapse after plasmapheresis due to excess iodine) or from acute Cushing's syndrome (intractable potassium loss and alkalosis whom we have successfully transferred to surgery. The rules for diagnosis and medical preparation for surgery of endocrine hyperfunctional states should only be disregarded ultima ratio

Corrigendum to "Particle hygroscopicity during atmospheric new particle formation events: implications for the chemical species contributing to particle growth" published in Atmos. Chem. Phys., 13, 6637–6646, 2013

No abstract available

Eine verbesserte fluorimetrische Cortisolbestimmung im Serum

Die fluorimetrische Methode zur Bestimmung von Serumcortisol wurde durch blasenfreie Füllung einer Spezialküvette mittels Pumpvorrichtung, durch Benützung eines Spectralfluorimeters, sowie Verlegung des Meßzeitpunktes (80 min) und durch optimale Anregung (464 nm) und Emissionsmessung (522 nm) verbessert. Empfindlichkeit (<1 µg Cortisol/100 ml), Richtigkeit, Genauigkeit, Reproduzierbarkeit von Tag zu Tag (VK=6–7%) und Störfaktoren der Methode werden angegeben. Mit dieser Methode wurden Normalberciche für die 9 Uhr-Nüchterncortisolwerte und die i.v. ACTH-Belastung ermittelt. Bei NNR-insuffizienten Patienten (M. Addison; Zustand nach Operation eines Hypophysentumors; total Adrenalektomierte) wurden i.v. ACTH-Belastungen durchgeführt, wobei sich bereits beim 9 Uhr-Nüchterncortisolwert eine diagnostisch gut brauchbare Trennung gegenüber dem Normalbereich ergab. Unter Dexamethasonsubstitution wurden bei NNR-Insuffizienz sehr niedrige Cortisolspiegel gemessen, was für die Spezifität der Methode spricht. Dic Bestimmung des 24 Std-Rhythmus der Cortisolwerte bei NNR-Insuffizienten zeigte, daß besonders in den frühen Morgenstunden im Vergleich zu Normalpersonen erniedrigte Cortisolspiegel bestehen. Daraus wird ein besserer Verteilungsvorschlag für die Cortisol-substitution abgeleitet.The fluorimetric determination of serum cortisol was improved 1. using a pumpdevice to fill a special microcuvette avoiding the development of small bubbles, 2. using a recording spectrofluorometer with optimal absorption (464 nm) and emission (522 nm), and 3. allowing for maximal fluorescence of cortisol (80 min). Sensitivity (<1 µg cortisol/100 ml), accuracy, precision and specificity of the method are reported. Normal values of 9.00 a.m. serum cortisol (9.7–32.0 µg/100 ml) and of values before and after ACTH infusion tests were determined. For adrenal insufficiency (Addisons disease, total adrenalectomy, or after hypophysectomy) the 9.00 a.m. values of serum cortisol were generally satisfactory for diagnosis. In partial adrenal insufficiency ACTH infusion tests had to be performed. Very low levels of serum cortisol (2–4 µg/100 ml) were obtained, when patients with adrenal insufficiency were substituted with dexamethasone for three days, proving the specificity of the method. Determination of circadian rhythms of serum cortisol in patients with adrenal insufficiency on cortisol substitutive therapy in divided doses demonstrated cortisol levels far below the normal values during the carly morning hours. This situation should be improved by dividing the cortisol dose as follows: 6 a.m.: 10 mg, 10 a.m.: 5 mg, 2 p.m.: 5 mg and 8 p.m. or later: 10 mg cortisol

Predator-scale spatial analysis of intra-patch prey distribution reveals the energetic drivers of rorqual whale super-group formation

Animals are distributed relative to the resources they rely upon, often scaling in abundance relative to available resources. Yet, in heterogeneously distributed environments, describing resource availability at relevant spatial scales remains a challenge in ecology, inhibiting understanding of predator distribution and foraging decisions. We investigated the foraging behaviour of two species of rorqual whales within spatially limited and numerically extraordinary super-aggregations in two oceans. We additionally described the lognormal distribution of prey data at species-specific spatial scales that matched the predator's unique lunge-feeding strategy. Here we show that both humpback whales off South Africa's west coast and blue whales off the US west coast perform more lunges per unit time within these aggregations than when foraging individually, and that the biomass within gulp-sized parcels was on average higher and more tightly distributed within super-group-associated prey patches, facilitating greater energy intake per feeding event as well as increased feeding rates. Prey analysis at predator-specific spatial scales revealed a stronger association of super-groups with patches containing relatively high geometric mean biomass and low geometric standard deviations than with arithmetic mean biomass, suggesting that the foraging decisions of rorqual whales may be more influenced by the distribution of high-biomass portions of a patch than total biomass. The hierarchical distribution of prey in spatially restricted, temporally transient, super-group-associated patches demonstrated high biomass and less variable distributions that facilitated what are likely near-minimum intervals between feeding events. Combining increased biomass with increased foraging rates implied that overall intake rates of whales foraging within super-groups were approximately double those of whales foraging in other environments. Locating large, high-quality prey patches via the detection of aggregation hotspots may be an important aspect of rorqual whale foraging, one that may have been suppressed when population sizes were anthropogenically reduced in the 20th century to critical lows.Office of Naval Research, Stanford University, South African Department of the Environment, Forestry and Fisheries National Science Foundation.http://wileyonlinelibrary.com/journal/fec2022-01-25hj2021Zoology and Entomolog

Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma

Craniopharyngiomas are locally aggressive tumors which typically are focused in the sellar and suprasellar region near a number of critical neural and vascular structures mediating endocrinologic, behavioral, and visual functions. The present study aims to summarize and compare the published literature regarding morbidity resulting from treatment of craniopharyngioma. We performed a comprehensive search of the published English language literature to identify studies publishing outcome data of patients undergoing surgery for craniopharyngioma. Comparisons of the rates of endocrine, vascular, neurological, and visual complications were performed using Pearson’s chi-squared test, and covariates of interest were fitted into a multivariate logistic regression model. In our data set, 540 patients underwent surgical resection of their tumor. 138 patients received biopsy alone followed by some form of radiotherapy. Mean overall follow-up for all patients in these studies was 54 ± 1.8 months. The overall rate of new endocrinopathy for all patients undergoing surgical resection of their mass was 37% (95% CI = 33–41). Patients receiving GTR had over 2.5 times the rate of developing at least one endocrinopathy compared to patients receiving STR alone or STR + XRT (52 vs. 19 vs. 20%, χ2P < 0.00001). On multivariate analysis, GTR conferred a significant increase in the risk of endocrinopathy compared to STR + XRT (OR = 3.45, 95% CI = 2.05–5.81, P < 0.00001), after controlling for study size and the presence of significant hypothalamic involvement. There was a statistical trend towards worse visual outcomes in patients receiving XRT after STR compared to GTR or STR alone (GTR = 3.5% vs. STR 2.1% vs. STR + XRT 6.4%, P = 0.11). Given the difficulty in obtaining class 1 data regarding the treatment of this tumor, this study can serve as an estimate of expected outcomes for these patients, and guide decision making until these data are available