The role of artificial intelligence in informed patient consent for radiotherapy treatments-a case report.

Recent advancements in large language models (LMM; e.g., ChatGPT (OpenAI, San Francisco, California, USA)) have seen widespread use in various fields, including healthcare. This case study reports on the first use of LMM in a pretreatment discussion and in obtaining informed consent for a radiation oncology treatment. Further, the reproducibility of the replies by ChatGPT 3.5 was analyzed. A breast cancer patient, following legal consultation, engaged in a conversation with ChatGPT 3.5 regarding her radiotherapy treatment. The patient posed questions about side effects, prevention, activities, medications, and late effects. While some answers contained inaccuracies, responses closely resembled doctors' replies. In a final evaluation discussion, the patient, however, stated that she preferred the presence of a physician and expressed concerns about the source of the provided information. The reproducibility was tested in ten iterations. Future guidelines for using such models in radiation oncology should be driven by medical professionals. While artificial intelligence (AI) supports essential tasks, human interaction remains crucial.

Impact of Surgical Margins in Breast Cancer After Preoperative Systemic Chemotherapy on Local Recurrence and Survival.

BACKGROUND: While "no tumour on ink" is an accepted margin width for R0 resection in primary surgery, it's unclear if it's oncologically safe after neoadjuvant chemotherapy (NAC). Only limited data demonstrate that surgery within new margins in cases of a pathological complete response (pCR) is safe. We therefore investigated the influence of different margins and pCR on local recurrence and survival rates after NAC. METHODS: We retrospectively analysed data of 406 women with invasive breast cancer, treated with NAC and breast-conserving therapy between 1994 and 2014 in two certified Austrian breast health centres. We compared R ≤ 1 mm, R > 1 mm and RX (pCR) for local recurrence-free survival (LRFS), disease-free survival (DFS) and overall survival (OS). RESULTS: After a median follow-up of 84.3 months, the 5-year LRFS (R ≤ 1 mm: 94.2%, R > 1 mm: 90.6%, RX: 95.0%; p = 0.940), the 5-year DFS (R ≤ 1 mm: 71.9%, R > 1 mm: 74.1%, RX: 87.2%; p = 0.245) and the 5-year OS (R ≤ 1 mm: 85.1%, R > 1 mm: 88.0%, RX: 96.4%; p = 0.236) did not differ significantly between narrow, wide, nor RX resections. Regarding DFS and OS, a negative nodal status reduced the hazard ratio significantly. CONCLUSION: There is no significant difference in LRFS, DFS and OS comparing close, wide or unknown margins after pCR. We suggest that resection in new margins after NAC is safe according to "no tumour on ink". Resection of the clipped area in cases of pCR is emphasized.

Bounds on Lorentz Invariance Violation from MAGIC Observation of GRB 190114C.

On January 14, 2019, the Major Atmospheric Gamma Imaging Cherenkov telescopes detected GRB 190114C above 0.2 TeV, recording the most energetic photons ever observed from a gamma-ray burst. We use this unique observation to probe an energy dependence of the speed of light in vacuo for photons as predicted by several quantum gravity models. Based on a set of assumptions on the possible intrinsic spectral and temporal evolution, we obtain competitive lower limits on the quadratic leading order of speed of light modification.

Comparison of PDR brachytherapy and external beam radiation therapy in the case of breast cancer.

Pulsed dose rate brachytherapy (PDR) was compared to external beam radiation therapy (EBRT) in the case of breast cancer. The benefits were figured out by evaluation of dosimetric parameters and calculating the normal tissue complication probability (NTCP). PDR plans were set up for five randomly chosen left-sided breast cancer patients delivering a total dose of 50.4 Gy to the target (dose rate 0.8 Gy h(-1)). For EBRT five left-sided breast cancer patients were planned using 3D-conformal tangential photon beams with a prescribed total dose of 50 Gy (2 Gy/fraction) to the total breast volume. For plan ranking and NTCP calculation the physical dose was first converted into the biologically effective dose (BED) and then into the normalized total dose (NTD) using the linear quadratic model with an alpha/beta ratio of 3 Gy. In PDR the relative effectiveness (RE) was calculated for each dose bin of the differential dose volume histogram to get the BED. NTCPs were calculated for the ipsilateral lung and the heart as contoured on CT slices based on the Lyman model and the Kutcher reduction scheme. Dosimetric parameters as V(th) (percentage of the total volume exceeding a threshold dose) and Jackson's f(dam) (fraction of the organ damaged) were also used to figure out the benefits. The comparison of calculated NTCPs in PDR and EBRT showed no difference between these two modalities. All values were below 0.01%. f(dam) derived from EBRT was always higher (mean value 8.95% versus 1.21% for the lung). The mean V(10) and V(20) of the lung related to BED were 6.32% and 1.72% for PDR versus 11.72% and 9.59% for EBRT. When using dosimetric parameters as V(th) and f(dam), PDR was mostly superior to EBRT in respect of sparing normal tissues. NTCP calculation as a single method of modality ranking showed a lack of information, especially when normal tissue was exposed to low radiation doses.

Carotid endarterectomy: is an indwelling shunt necessary?

Three hundred and four consecutive endarterectomies were performed with general anesthesia and without a temporary indwelling shunt. Eight patients (2.6%) awoke from anesthesia with a new neurological deficit. Eight additional patients later developed neurological symptoms, suggesting that the absence of a shunt did not contribute to their complication. Of these 16 patients, two (0.6%) died, nine (3.0%) had a temporary neurological deficit, and five (1.6%) had a permanent neurological deficit. A prolonged occlusion time, a stump pressure of less than 50 mm Hg, or the presence of additional carotid lesions did not show a significant statistical relationship to postoperative neurological deficit.

Percutaneous subclavian vein catheter hemodialysis--impact on vascular access surgery.

The problem of the immediate need for access to the circulation for hemodialysis arises because of an acute renal failure (ARF), the failure of an established access route, or the acute presentation of end-stage renal disease. Prior to 1976 emergent hemodialysis at our center necessitated either surgical placement of an external shunt or intermittent femoral vein cannulization, Since 1976 indwelling percutaneous subclavian vein catheterization (SVC) has been used on a routine basis for emergency hemodialysis. We have evaluated retrospectively the clinical courses of 50 patients with ARF and 48 patients with chronic renal failure (CRF) who underwent SVC dialysis in comparison with the clinical courses of 50 patients with ARF and 35 patients with CRF who had external shunt dialysis. In the ARF group, SVC dialysis resulted in lower incidences of serious infection, hemorrhage, and access thrombosis and reduced the number of replacement access procedures needed. In the CRF group, SVC permitted creation of more autogenous fistulas, rarely failed because of infection or thrombosis, and could therefore be used for extended periods, allowing primary autogenous fistula placement and maturation. Future access sites were also saved. SVC dialysis has become our primary interval angioaccess procedure for acute hemodialysis.

Operative cholangiomanometry as a guide to common duct exploration.

A trial of operative cholangiomanometry was proposed as a guide to common duct exploration to see if this technique would help in reducing the incidence of unnecessary common bile duct explorations and the incidence of retained stones. The technique for operative cholangiomanometry as modified from White is described. This method was used in 21 patients. A very close correlation between manometry and cholangiography in predicting the presence of pathology within the common duct at the time of extrahepatic biliary surgery was shown. Flow was the most accurate diagnostic parameter. Seven patients who were found to have common duct stones had both abnormal manometry and cholangiography. Fourteen patients without stones included 12 with negative cholangiography and manometry, and two in which manometry was normal but cholangiography suggested pathology. Common duct manometry and cholangiography can be used to decrease the number of unnecessary common duct explorations and the incidence of retained stones. The theory that common duct pathology will increase pressure and decrease flow rates is supported by this study. Manometry and cholangiography should be used in combination as they are additive studies. Criteria for deciding when to explore the common duct are presented.

[Knowledge, emotions and regulation of actions or the reason of feelings]. / Wissen, Emotionen und Handlungsregulation oder Die Vernunft der Gefühle.

This paper concerns the interaction of emotion and knowledge in action regulation. First a new theory of emotions is developed. Emotions are considered as modulations of cognitive processes. Such a modulation is for instance the change of the resolution level of cognitive processes. Another modulation is the change of the "updating rate" of the image of the environment. A theory is developed how these modulations are dependent on "context parameters". Action regulation is a process, which is considered as consisting of three levels. The first one is the level of the automatisms. The second level is reasoning and planning, the third level is information collection by observation or trial and error behaviour. The change between these levels is dependent on the state of the knowledge about the respective domain of reality. It can be shown, that the concept of emotion and emotional change as consisting on a context dependent change of the modulation of cognitive processes and the three stage theory of action regulation is sufficient to explain emotional forms of behaviour.

Black hole physics. Black hole lightning due to particle acceleration at subhorizon scales.

Supermassive black holes with masses of millions to billions of solar masses are commonly found in the centers of galaxies. Astronomers seek to image jet formation using radio interferometry but still suffer from insufficient angular resolution. An alternative method to resolve small structures is to measure the time variability of their emission. Here we report on gamma-ray observations of the radio galaxy IC 310 obtained with the MAGIC (Major Atmospheric Gamma-ray Imaging Cherenkov) telescopes, revealing variability with doubling time scales faster than 4.8 min. Causality constrains the size of the emission region to be smaller than 20% of the gravitational radius of its central black hole. We suggest that the emission is associated with pulsar-like particle acceleration by the electric field across a magnetospheric gap at the base of the radio jet.

Very-high-energy gamma rays from a distant quasar: how transparent is the universe?

The atmospheric Cherenkov gamma-ray telescope MAGIC, designed for a low-energy threshold, has detected very-high-energy gamma rays from a giant flare of the distant Quasi-Stellar Radio Source (in short: radio quasar) 3C 279, at a distance of more than 5 billion light-years (a redshift of 0.536). No quasar has been observed previously in very-high-energy gamma radiation, and this is also the most distant object detected emitting gamma rays above 50 gigaelectron volts. Because high-energy gamma rays may be stopped by interacting with the diffuse background light in the universe, the observations by MAGIC imply a low amount for such light, consistent with that known from galaxy counts.

Observation of pulsed gamma-rays above 25 GeV from the Crab pulsar with MAGIC.

One fundamental question about pulsars concerns the mechanism of their pulsed electromagnetic emission. Measuring the high-end region of a pulsar's spectrum would shed light on this question. By developing a new electronic trigger, we lowered the threshold of the Major Atmospheric gamma-ray Imaging Cherenkov (MAGIC) telescope to 25 giga-electron volts. In this configuration, we detected pulsed gamma-rays from the Crab pulsar that were greater than 25 giga-electron volts, revealing a relatively high cutoff energy in the phase-averaged spectrum. This indicates that the emission occurs far out in the magnetosphere, hence excluding the polar-cap scenario as a possible explanation of our measurement. The high cutoff energy also challenges the slot-gap scenario.

Variable very-high-energy gamma-ray emission from the microquasar LS I +61 303.

Microquasars are binary star systems with relativistic radio-emitting jets. They are potential sources of cosmic rays and can be used to elucidate the physics of relativistic jets. We report the detection of variable gamma-ray emission above 100 gigaelectron volts from the microquasar LS I 61 + 303. Six orbital cycles were recorded. Several detections occur at a similar orbital phase, which suggests that the emission is periodic. The strongest gamma-ray emission is not observed when the two stars are closest to one another, implying a strong orbital modulation of the emission or absorption processes.

The logic of failure.

Unlike other living creatures, humans can adapt to uncertainty. They can form hypotheses about situations marked by uncertainty and can anticipate their actions by planning. They can expect the unexpected and take precautions against it. In numerous experiments, we have investigated the manner in which humans deal with these demands. In these experiments, we used computer simulated scenarios representing, for example, a small town, ecological or economic systems or political systems such as a Third World country. Within these computer-simulated scenarios, the subjects had to look for information, plan actions, form hypotheses, etc.

Strategic thinking and stress.

In this study we investigate the behaviour and the performance of experimental subjects, who had to solve a series of tasks of 'strategic thinking' under a stress and a non-stress condition. No significant differences between the conditions could be found with respect to performance and improvement of performance within the series of tasks, but the experimental subjects exhibited under the different conditions different forms of behaviour. Unexpectedly the Ss working under the stress-condition exhibited a more 'analytical' behaviour and increased their workload, instead of decreasing it. Additionally they exhibited a tendency for measures with salient effects and proved to be better in finding the right points of main effort. The results are discussed with respect to a general theory of action regulation.