Plasticity and seasonality of the vertical migration behaviour of Antarctic krill using acoustic data from fishing vessels.

Understanding the vertical migration behaviour of Antarctic krill is important for understanding spatial distribution, ecophysiology, trophic interactions and carbon fluxes of this Southern Ocean key species. In this study, we analysed an eight-month continuous dataset recorded with an ES80 echosounder on board a commercial krill fishing vessel in the southwest Atlantic sector of the Southern Ocean. Our analysis supports the existing hypothesis that krill swarms migrate into deeper waters during winter but also reveals a high degree of variability in vertical migration behaviour within seasons, even at small spatial scales. During summer, we found that behaviour associated with prolonged surface presence primarily occurred at low surface chlorophyll a concentrations whereas multiple ascent-descent cycles per day occurred when surface chlorophyll a concentrations were elevated. The high plasticity, with some krill swarms behaving differently in the same location at the same time, suggests that krill behaviour is not a purely environmentally driven process. Differences in life stage, physiology and type of predator are likely other important drivers. Finally, our study demonstrates new ways of using data from krill fishing vessels, and with the routine collection of additional information in potential future projects, they have great potential to significantly advance our understanding of krill ecology.

Gender effects on quality of life and symptom burden in patients with lung cancer: results from a prospective, cross-cultural, multi-center study.

BACKGROUND: Lung cancer causes impairment of health-related quality of life (QoL), but little is known about gender aspects in QoL and symptom burden of lung cancer patients. The aim of this study was to investigate gender differences in QoL as assessed by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the updated lung cancer module. METHODS: In a prospective, international, cross-cultural, multicenter study that was undertaken to update the lung cancer-specific module EORTC QLQ-LC13, patients filled in the core questionnaire EORTC QLQ-C30 and the updated lung cancer module. Gender differences were calculated for all QoL scores using ANCOVAs that controlled for known and suspected confounders. Comparisons with historic data were drawn. RESULTS: A total of 200 patients (82 female and 118 male, median age 65 years) were recruited. With the exception of coughing (estimated marginal means: women 33.86 and men 43.52, P=0.022) and diarrhea (estimated marginal means: women 26.01 and men 17.93, P=0.038) there were no significant QoL gender differences. Fatigue was the most pronounced symptom in both, men and women, outpacing typical respiratory symptoms. Quite generally, our sample of lung cancer patients showed considerably worse QoL in all scores when compared to EORTC reference data (lung cancer and combined cancer diagnoses, mean differences up to 13.70 and 21.54 score points, respectively) and to a German norm reference sample (up to 35.37 score points). CONCLUSIONS: This study adds to the literature in showing that the typical QoL gender difference effect (women doing worse than men) may not be generalizable across all patient samples.

[On the necessity of philosophy in medical education]. / Zur Notwendigkeit der Philosophie im Medizinstudium.

Today, the study and practice of medicine are treated with a natural scientific approach. However, medical action has its foundations not only in the natural sciences and technology, but also in ethics, humanity and philosophy. The Wuerzburg Philosophicum teaches, apart from medical ethics, a systematic analysis of a theory of medicine in the context of other sciences, the theory of knowledge, anthropology and hermeneutics.

Workload and quality of life of surgeons. Results and implications of a large-scale survey by the German Society of Surgery.

BACKGROUND: Quality of life is of vital importance for patients undergoing surgery. However, little is known about the quality of life of surgeons who are facing a stressful and dramatically changing working environment. For this reason, this large-scale study investigated the quality of life (QL) of surgeons in Germany in the context of occupational, private, and system-related risk factors. METHODS: The study population consisted of attendees (surgeons, non-surgical physicians, medical students) of the nine major annual conferences of the German Society of Surgery between 2008 and 2009. Participants filled in a single questionnaire including study-specific questions (demographic variables, professional position, and occupational situation) and a standardized quality of life instrument (Profiles of quality of life of the chronically ill, PLC). Surgeons' responses with regard to their professional situation and their quality of life were contrasted with those of the two controls (non-surgical physicians, medical students). Furthermore, PLC scores were compared with German population reference data and with reference data of several patient groups. RESULTS: Individuals (3,652) (2,991 surgeons, 561 non-surgical physicians, 100 medical students) participated in this study. The average age of surgeons and non-surgeons was in the low forties. In terms of professional qualifications, the majority of surgeons were residents (30%) and the majority of non-surgeons consultants in private practice (38%). Sixty-eight percent of the surgeons, only 39% of the non-surgeons worked more than 60 h per week on average (p < 0.001). Surgeons regarded their administrative workload as high (67% vs. controls 57%, p < 0.001). Surgeons reported restrictions on their private and family life due to work overload, more so than non-surgeons (74% vs. 59%, p < 0.001). Of the surgeons, 40% regarded their quality of life as worse than that of the general public (non-surgeons, 22%; p < 0.001). A third (32%) of the surgeons considered their quality of life even lower than that of their patients (non-surgeons, 17%; p < 0.001). Responses to the PLC quality of life questionnaire confirmed these results, showing score values lower than those of the German population reference data and of several patient groups. Multiple regression analyses showed that the strongest and most consistent influence variable for a low quality of life on all eight quality of life scores were restrictions in private life (range of standardized beta weights beta = 0.259 to 0.325), hierarchical and uncooperative working environment (beta = 0.057 to 0.235), lack of opportunities for continuing education (beta = 0.108 to 0.161), and inadequate salary (beta = 0.036 to 0.172). CONCLUSIONS: Improving the working conditions for surgeons requires a concerted action of all relevant parties, including hospital administrators, insurance companies, and the German Society of Surgery. The present study clearly identified measures that should be taken.

Sternal closure techniques and postoperative sternal wound complications in elderly patients.

OBJECTIVE: Postoperative sternal wound complications (PSWC) including deep sternal wound infection (DSWI) and sternal dehiscence (SD) cause significant morbidity and mortality. Elderly patients with several risk factors are particularly prone to suffer PSWC. METHODS: We present (I) a subset of 86 patients, all aged > or =75 years out of 339 cardiac surgery patients prospectively randomised to receive either conventional sternal closure or a Robicsek type closure. Primary end-points were SD and DSWI; secondary end-points included a composite of clinical parameters; (II) we retrospectively assessed data of 54/5273 patients with mediastinitis regarding the influence of advanced age. In addition, we report an epidemiological overview of different sternal closure techniques. RESULTS: (I) The Robicsek technique showed an impact on SD and DSWI, and several secondary end-points: ventilator support (p=0.03), postoperative blood loss (p=0.04), and chest pain >3 days (p=0.04). (II) A total of 54/5273 (1.02%) patients developed postoperative mediastinitis. Twelve out of 54 (22%) patients died within 6 months of the initial operation. Predictors of mortality were insulin-dependent diabetes mellitus (p=0.05), renal insufficiency (p=0.01), delayed sternal closure (p=0.05), ICU-stay >10 days (p=0.01), and methicillin-resistant Staphylococcus aureus (p=0.03) or fungal infection (p=0.02). CONCLUSIONS: No statistical difference in sternal dehiscence or mediastinitis was found irrespective of whether the bilateral and longitudinal parasternal closure or the conventional peri/trans-sternal wiring technique was used, but there was an obvious, positive influence on sternal dehiscence, deep sternal wound infection, and clinical parameters. However, the study population is relatively small.

Presence of depression and anxiety before and after coronary artery bypass graft surgery and their relationship to age.

BACKGROUND: Scientific literature on depression and anxiety in patients with coronary heart disease (CHD) consistently reports data of elevated anxiety and depression scores indicating clinically relevant quantities of these psychopathological conditions. Depression is considered to be a risk factor for the development of CHD and deteriorates the outcome after cardiac rehabilitation efforts. The aim of our study was to evaluate the presence of clinically relevant anxiety and depression in patients before and after coronary artery bypass grafting (CABG). Additionally we evaluated their relationship to age because of the increasing number of elderly patients undergoing CABG surgery. METHODS: One hundred and forty-two consecutive patients who underwent CABG in our hospital were asked to fill in the "Hospital Anxiety and Depression Scale - German Version (HADS)" to measure depression and anxiety scores two days before and ten days after CABG surgery. Differences between these pre- and post-surgical scores were then calculated as means for changes, and the amount of elevated scores were appraised. In order to investigate the relationship between age and anxiety and depression, respectively, Spearman correlations between age and the difference scores were calculated. In addition, ANOVA procedures with the factor "age group" and McNemar tests were calculated. Therefore the sample was divided into four equally sized age groups. RESULTS: 25.8% of the patients were clinically depressed before and 17.5% after surgery; 34.0% of the patients were clinically anxious before and 24.7% after surgery. This overall change is not significant. We found a significant negative correlation between age and the difference between the two time points for anxiety (Spearman rho = -.218; p = 0.03), but not for depression (Spearman rho = -.128; p = 0.21). ANOVA and McNemar-Tests revealed that anxiety scores and the number of patients high in anxiety declined statistically meaningful only in the youngest patient group. Such a relationship could not be found for depression. CONCLUSION: Our data show a relationship between age and anxiety. Younger patients are more anxious before CABG surgery than older ones and show a decline in symptoms while elderly patients show hardly any change.

Depression as a manifestation of latent chronic hypoparathyroidism.

The exact cause of depression in cases of hypoparathyroidism is not known. We report the first case of an elderly patient with a long history of major depression as a complication of an undiagnosed chronic hypoparathyroidism following surgery on a parathyroid adenoma. Her depression was completely eliminated by calcium supplementation therapy to restore the calcium homeostasis in serum. As it is well known that disturbances in the endocrine hypothalamus-pituitary-thyroid system might be consistent findings of depressive disorders concerning neuroendocrinological alterations, this case report and review of literature strongly supports our claim that also parathyroid diseases like chronic hypoparathyroidism, even in its latent form, might be a relevant factor in the development of depressive symptoms.

A clinical chameleon: postoperative hypoparathyroidism.

BACKGROUND: About 1,200 patients per year develop postoperative hypoparathyroidism alone in Germany. Many of those patients may be misdiagnosed as the symptoms of this disease may vary and can be atypical. PATIENT/RESULTS: As an example, we describe the first known case of an elderly patient with a long history of seizures as a complication of an undiagnosed chronic hypoparathyroidism after surgery of a pT4-esophageal carcinoma. The 63-year-old male patient underwent laryngo-hypopharyngo-esophagectomy with gastric transposition and partial thyroid resection for a proximal esophageal carcinoma in 1994. About half a year later, the patient developed for the first time a convulsive syncope. Misleading diagnoses were for years suspected metastasis formation and a dumping syndrome. The general physician of the patient called him the epilepsy man, while no cause of the seizures were found. More than a decade of years later, when the correct diagnosis was made, finally by determination of parathyroid hormone levels, the seizures of the patient were completely eliminated by calcium supplementation therapy. The patient's quality of life improved clearly in the following time. CONCLUSION: It is essential to consider chronic hypoparathyroidism in the differential diagnosis of patients with hypocalcemia who have undergone extended neck and proximal esophageal surgery before. In addition to that, it is mandatory to autotransplant parathyroids during the initial procedure which might be accidentally removed during surgery and to monitor parathyroid function in each patient in the further course postoperatively.

Left ventricular non-compaction associated with a genetic variant of the CYP2C9 gene.

Polymorphisms in the CYP2C9 gene can have a significant impact on drug therapy by affecting the pharmacokinetics of frequently prescribed drugs, such as phenprocoumon and warfarin. It is essential therefore that genetic CYP2C9 variants are excluded in patients with a suspected intolerance of anticoagulant therapy. Here we present the first report of a case of left ventricular non-compaction syndrome associated with a genetic variant of the CYP2C9 gene in a 45-year-old woman with myocardial insufficiency who was scheduled for implantation of a cardioverter defibrillator.