Die moderne Behandlung des synchron oligometastasierten, nicht-kleinzelligen Lungenkarzinoms (sOMD-NSCLC) ist einem konzeptionellen Wandel von der Palliation auf die potentielle Kuration unterworfen. Danach soll die Lokaltherapie die Prognose der Erkrankung – ebenso wie die Systemtherapie – positiv beeinflussen. Ziel der Arbeit ist die Evaluierung der Behandlungsergebnisse bei Patienten mit sOMD-NSCLC.
Parental responses to offspring solicitation differ among species and have major implications for fitness, but the evolutionary drivers of this diversity are poorly studied. Here, we experimentally amplified begging calls at nests of 25 songbird species in tropical and north temperate communities. We analyzed parental provisioning responses using phylogenetic path analysis to test the possible roles of demographic (offspring predation or adult survival rates), ecological (food predictability) or physiological (offspring energy need) traits in the evolution of parental responsiveness to begging. Species with smaller body mass, more unpredictable food availability, and greater offspring predation rates were more responsive to begging. In contrast, we found little support for direct effects of adult survival on parental responses. Ultimately, the evolution of parental responsiveness to offspring solicitation is strongly related to energetic needs of young and the predation costs of begging.
Primary cortisol resistance (PCR) is a rare cause of hypercortisolism and usuallydoes not produce clinical manifestations. This report describes primary cortisol resistance ina boy with isosexual precocity. A 67/12-yr-old boy had Tanner stage 3 pubic hair, accelerated linear growth, and advanced bone age (10 yr), but normal (for age) testes. There were no features of glucocorticoid excess. Serum androstenedione and dehydroepiandrosterone concentrations were 4.7 ± 0.3 nmol/L (mean ± sem of four measurements; normal < 1.2) and 13.5 nmol/L (single measurement; normal, 1.0–2.2), respectively. The serum testosterone concentration was 0.9 nmol/L (normal, <0.7), and FSH and LH were normal. Serum cortisol concentrations were 1590 ± 110 nmol/L (normal, 190–630) and 580 ± 60 nmol/L (normal, 50–410) at 0800 and 2000 h, respectively. Serum cortisol responded normally to insulin-insulin-induced hypoglycemia. Glucocorticoids and adrenal androgens were resistant to suppression by dexamethasone. The Kd of [3H] dexamethasone binding to the glucocorticoid receptors of mononuclear leukocytes was increased (6.4 ± 0.8 nm; mean± sem of four determinations; normal, 1.4–3.4; P < 0.001), but the binding capacity was normal. This patient with isosexual precocity has PCR, as indicated by functionally abnormal glucocorticoid receptors and hypercortisolism without other clinical or biochemical manifestations of Cushing's syndrome. Excessive adrenal stimulation by ACTH caused increased secretion of both cortisol and adrenal androgens, and the latter caused the clinical manifestations. PCR should be considered in other male children with isosexual precocity or female children with heterosexual precocity.
To study the clinical relevance of tumor ploidy and micronucleus formation as prognostic factors.Twenty-eight patients with squamous cell carcinoma of the oral cavity were treated with primary radiochemotherapy consisting of irradiation up to 70 Gy in combination with cisplatin. Cell cycle distribution, micronucleus formation and ploidy were evaluated by flow cytometry of biopsies taken before treatment and after irradiation to 10 Gy (5x2 Gy). Sexteen out of 28 patients relapsed after a minimum follow-up period of two years.Flow cytometry of the recurrence biopsy showed hyperpentaploid (5c exceeding) cells in 13/16 (81%) of the relapsed patients. In 7 patients the hyperploid clone was not present in the flow cytometry of the primary tumors. Ploidy could retrospectively be determined also by image cytometry in archival tumor material of the pretreatment specimens. Patients with a level below 100 5c cells per 10,000 cell nuclei were shown to have a significantly better prognosis than patients with more than 100 hyperpentaploid tumor cells. The micronucleus formation was 2-5 times higher in tumors showing a good response to treatment than in carcinomas relapsing within two years.The 5c-exceeding ratio measured by image cytometry and micronucleus formation proved to be good prognostic parameters for the clinical outcome of patients with locally advanced head and neck carcinomas.
Incentive spirometers (ISs) were developed to reduce atelectasis and are in widespread clinical use. However, without IS use adherence data, the effectiveness of IS cannot be determined. To evaluate the effect of a use-tracking IS reminder on patient adherence and clinical outcomes following coronary artery bypass grafting (CABG) surgery. This randomized clinical trial was conducted from June 5, 2017, to December 29, 2017, at a tertiary referral teaching hospital and included 212 patients who underwent CABG, of whom 160 participants were randomized (intent to treat), with 145 completing the study per protocol. Participants were stratified by surgical urgency (elective vs nonelective) and sex (men vs women). A use-tracking, IS add-on device (SpiroTimer) with an integrated use reminder bell recorded and timestamped participants' inspiratory breaths. Patients were randomized by hourly reminder "bell on" (experimental group) or "bell off" (control group). Incentive spirometer use was recorded for the entire postoperative stay and compared between groups. Radiographic atelectasis severity (score, 0-10) was the primary clinical outcome. Secondary respiratory and nonrespiratory outcomes were also evaluated. A total of 145 per-protocol participants (112 men [77%]; mean age, 69 years [95% CI, 67-70]; 90 [62%] undergoing a nonelective procedure) were evaluated, with 74 (51.0%) in the bell off group and 71 (49.0%) in the bell on group. The baseline medical and motivation-to-recover characteristics of the 2 groups were similar. The mean number of daily inspiratory breaths was greater in bell on (35; 95% CI, 29-43 vs 17; 95% CI, 13-23; P < .001). The percentage of recorded hours with an inspiratory breath event was greater in bell on (58%; 95% CI, 51-65 vs 28%; 95% CI, 23-32; P < .001). Despite no differences in the first postoperative chest radiograph mean atelectasis severity scores (2.3; 95% CI, 2.0-2.6 vs 2.4; 95% CI, 2.2-2.7; P = .48), the mean atelectasis severity scores for the final chest radiographs conducted before discharge were significantly lower for bell on than bell off group (1.5; 95% CI, 1.3-1.8 vs 1.8; 95% CI, 1.6-2.1; P = .04). Of those with early postoperative fevers, fever duration was shorter for bell on (3.2 hours; 95% CI, 2.3-4.6 vs 5.2 hours; 95% CI, 3.9-7.0; P = .04). Having the bell turned on reduced noninvasive positive pressure ventilation use rates (37.2%; 95% CI, 24.1%-52.5% vs 19.2%; 95% CI, 10.2%-33.0%; P = .03) for participants undergoing nonelective procedures. Bell on reduced the median postoperative length of stay (7 days; 95% CI, 6-9 vs 6 days; 95% CI, 6-7; P = .048) and the intensive care unit length of stay for patients undergoing nonelective procedures (4 days; 95% CI, 3-5 vs 3 days; 95% CI, 3-4; P = .02). At 6 months, the bell off mortality rate was higher than bell on (9% vs 0%, P = .048) for participants undergoing nonelective procedures. The incentive spirometer reminder improved patient adherence, atelectasis severity, early postoperative fever duration, noninvasive positive pressure ventilation use, ICU and length of stay, and 6-month mortality in certain patients. With the reminder, IS appears to be clinically effective when used appropriately. ClinicalTrials.gov identifier: NCT02952027.
