Deutsches Arzteblatt international最新文献

{"title":"The Differential Diagnosis and Management of Pancreatic Cystic Neoplasms.","authors":"Daniel Schmitz, Albrecht Stenzinger, Robert Grützmann, Irene Esposito, Hans-Jürgen Raatschen, Thomas Theodor Werner Seufferlein","doi":"10.3238/arztebl.m2025.0151","DOIUrl":"10.3238/arztebl.m2025.0151","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of pancreatic cyst lesions in the general population worldwide is 16%. The majority of these cysts are intraductal papillary mucinous neoplasms (IPMN), which are associated with a risk of developing pancreatic cancer. In this article, we summarize the current knowledge of the differential diagnosis and management of cystic pancreatic neoplasms.</p><p><strong>Methods: </strong>This narrative review is based on a selective search for pertinent literature (1 January 2014 to 9 January 2025).</p><p><strong>Results: </strong>Most cysts are less than 10 mm in diameter and have practically no potential for malignant transformation. If a small cyst remains unchanged in the absence of risk factors, monitoring can be ended five years after initial detection. Magnetic resonance imaging (MRI) is the best method of characterizing and following up such lesions. If the diagnosis is unclear, endosonography should be performed. For IPMN, the most common type of pancreatic cystic neoplasm, the international Kyoto guideline 2024 contains a revised management algorithm based on risk factors. IPMN with high-grade dysplasia is an ideal indication for surgical resection. Serous cystic adenomas should generally not be operated on, and mucinous cystic neoplasia or a cystic neuroendocrine tumor of the pancreas should be operated on only if it has reached a certain size. Minimally inva - sive and parenchyma-sparing techniques are now being increasingly used in pancreatic surgery.</p><p><strong>Conclusion: </strong>Oncological criteria as well as potential surgical risks and long-term sequelae must enter into the decision whether a pancreatic lesion should be resected. Exocrine and endocrine insufficiency are relevant and sometimes irreversible complications.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"617-622"},"PeriodicalIF":7.1,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12693675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polysubstance Use Among the Homeless In Germany: A Nationwide, Cross-Sectional Multicenter Study.","authors":"Fabian Heinrich, Jakob Manthey, Birgit Wulff, Franziska Stallbaum, Katharina Dost, Wiebke Graf, Veronika Kowalski, Anna Brennecke, André Hajek, Hans-Helmut König, Klaus Püschel, Benjamin Ondruschka, Stefanie Iwersen-Bergmann","doi":"10.3238/arztebl.m2025.0132","DOIUrl":"10.3238/arztebl.m2025.0132","url":null,"abstract":"<p><strong>Background: </strong>The number of people experiencing homelessness (PEH) in Germany reached 440 000 in 2024, double the total from 2022. Representative data on substance use among PEH is largely lacking. In this study, we estimate the prevalence of substance use among PEH and identify subgroups at risk of polysubstance use.</p><p><strong>Methods: </strong>A cross-sectional study of 674 PEH was conducted in four German metropolitan areas in 2021. All PEH were interviewed and provided blood samples in homeless support facilities. Toxicological analysis of serum samples revealed the presence of 22 substances, which were grouped as alcohol, central nervous system (CNS) stimulants, narcotic analgesics, and cannabis. Polysubstance use was defined as the detection of substances belonging to at least two of these groups.</p><p><strong>Results: </strong>The toxicological analyses revealed that 35% of PEH had no recent substance use (95% confidence interval [31; 39]), while 34% had recently engaged in polysubstance use ([30; 38]). Alcohol was the most prevalent substance (39% [35; 43]), followed by CNS stimulants (30% [27; 34]), cannabis (28% [24; 32]), and narcotic analgesics (18% [15; 21]). Polysubstance use was linked to younger age, prior incarceration, current tobacco use, and geographical location.</p><p><strong>Conclusion: </strong>In Germany today, the number of PEH is growing, substance availability is widespread, and drug-related deaths are on the rise. It is, therefore, vitally important to continue monitoring the situation and to provide targeted support to those who need it.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"597-603"},"PeriodicalIF":7.1,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12693712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Survival of Extremely Premature Neonates in Perinatal Care Centers of Different Care Levels: An Analysis from the German Federal States of Thuringia and Saxony.","authors":"Yvonne Heimann, Zazie Giró-Paños, Ekkehard Schleußner, Janine Zöllkau","doi":"10.3238/arztebl.m2025.0136","DOIUrl":"10.3238/arztebl.m2025.0136","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 21","pages":"586-587"},"PeriodicalIF":7.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Income, Educational Level, and Depressive Symptoms in a Time of Multiple Crises: Trends Revealed by High-Frequency Mental Health Surveillance in Germany, 2019–2024.","authors":"Christina Kersjes, Stephan Junker, Elvira Mauz, Florian Beese, Lena Walther, Stephan Müters, Susanne Schnitzer, Jens Hoebel","doi":"10.3238/arztebl.m2025.0130","DOIUrl":"10.3238/arztebl.m2025.0130","url":null,"abstract":"<p><strong>Background: </strong>An increase in depressive symptoms among adults was observed in Germany from late 2020 onward, during a time of multiple collective stressors. In view of the uneven distribution across society of vulnerability to depressive disorders, we studied the varying impact of this trend on different socioeconomic groups.</p><p><strong>Methods: </strong>Using population-based data from the German Health Update (Gesundheit in Deutschland aktuell) study of the Robert Koch Institute (n = 95 267, data collected from April 2019 to February 2024), we calculated time series analyses for the proportion of the population screening positive for possible depressive disorder (Patient Health Questionnaire 2 summed score of 3 or above) with the aid of moving 3-month estimators and smoothing curves, stratified by socioeconomic status (educational level and income). Absolute and relative inequalities were quantified with regressionbased methods.</p><p><strong>Results: </strong>The proportion of the population screening positive for possible depressive disorder was higher in groups with lower educational levels and lower incomes. Particularly from 2022 onward, it rose to a much larger extent in these groups than in those with higher educational levels and higher incomes. From 2019 to 2024, the absolute inequalities, i.e., the differences between the groups with lowest and highest educational level and between the groups with lowest and highest income, rose from 10 [7;14] to 22 [8;36] and from 12 [7;17] to 30 [17;44] percentage points, respectively (means and 95% confidence intervals).</p><p><strong>Conclusion: </strong>Socioeconomic inequalities in depres - sive symptoms in adults rose over the period 2019-2024. Such inequalities in mental health should be systematically monitored, and measures should be developed to improve equity with respect to health.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"573-578"},"PeriodicalIF":7.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calcinosis Cutis in Triple Overlap Syndrome.","authors":"Milica Ilic, Andreas G Schreyer","doi":"10.3238/arztebl.m2025.0133","DOIUrl":"10.3238/arztebl.m2025.0133","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 21","pages":"585"},"PeriodicalIF":7.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Differential Diagnosis of Thromobocytopenia.","authors":"Wolfgang Miesbach, Jan Stratmann, Rosa Sonja Alesci, Jörg Chromik, Tamam Bakchoul, Ralph Wendt","doi":"10.3238/arztebl.m2025.0160","DOIUrl":"10.3238/arztebl.m2025.0160","url":null,"abstract":"<p><strong>Background: </strong>Thrombocytopenia is defined as a platelet count below 150 000/μL. It increases the risk of bleeding, often due to an existing underlying condition. A meticulous diagnostic evaluation is needed so that specific treatment can be initiated and complications avoided.</p><p><strong>Methods: </strong>This review is based on clinical studies up to June 2025 that were retrieved by a selective search with pertinent key words in the MEDLINE/PubMed database, and on current guidelines.</p><p><strong>Results: </strong>Thrombocytopenia often arises in association with pregnancy (7-10 %), immune-mediated diseases such as idiopathic thrombocytopenic purpura (ITP), certain drugs (e.g., heparin-induced thrombocytopenia [HIT] in as many as 1% of patients treated with unfractionated heparin), infections, and systemic and hematologic diseases. The diagnostic evaluation is by an algorithm involving the clinical history, a complete blood count, and other, specific tests. Emergencies such as thrombotic microangiopathy (TMA) and disseminated intravascular coagulation require rapid therapeutic intervention. The treatment depends on the cause and severity of thrombocytopenia; it can include the discontinuation of precipitating drugs, the use of immunosuppressive drugs or thrombopoietin receptor agonists in immune-mediated cases, and specific measures against infection, TMA, or malignant diseases. Prophylactic platelet transfusion can be considered if the platelet count drops below 10 000-20 000/μL, or below 50 000/μL before an intervention or operation, but not in cases of ITP or thrombotic thrombocytopenic purpura (TTP).</p><p><strong>Conclusion: </strong>The treatment depends on the clinical manifestations, platelet count, and underlying cause.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"588-596"},"PeriodicalIF":7.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relative Poverty and Mental Illness in Adults, Children, and Adolescents in Industrialized Countries.","authors":"Olivia Kalinowski, Wulf Rössler","doi":"10.3238/arztebl.m2025.0144","DOIUrl":"10.3238/arztebl.m2025.0144","url":null,"abstract":"<p><strong>Background: </strong>Economic resources are vital for the formation of individualized living conditions. By definition, persons suffering from absolute poverty live below the minimum standard at which basal life needs can be securely met; relative poverty is characterized by an income level that is no more than 50% or 60% of the median for the population in question. In 2024, 15.5% of persons living in Germany were relatively poor. In this narrative review, we discuss the link between relative poverty and mental illness among adults, children, and adolescents in industrialized countries.</p><p><strong>Methods: </strong>We review pertinent studies (2004-2024) of relative poverty and mental illnesses as defined by the ICD or DSM criteria that were retrieved by a search in five scientific databases.</p><p><strong>Results: </strong>Of the 3038 publications that were initially identified, 44 met the inclusion criteria. They revealed significant associations between relative poverty and mental illness, particularly depression, in adults as well as in children and adolescents. Five of the 44 studies did not demonstrate any association. Attempts were made to explain these associations in various ways; the dominant hypotheses were of a social decline because of mental illness, and of mental illness because of poor social conditions. Both the causation of poverty by mental illness and the causation of mental illness by poverty appear plausible. Combinations of the two explanations are conceivable as well.</p><p><strong>Conclusion: </strong>The findings confirm the association of relative poverty with mental illness, yet the causal relationship remains largely unexplained despite the existence of comprehensive explanatory models. Sociopolitical measures might alleviate mental illnesses or lower their prevalence by reducing socio - economic inequality.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"579-585"},"PeriodicalIF":7.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of the Intestinal Microbiome in Inflammation and Cancer.","authors":"Sebastian Zeissig, Fabian Frost, Dirk Haller, Andreas Stallmach, Maria J G T Vehreschild, Kai Markus Schneider","doi":"10.3238/arztebl.m2025.0142","DOIUrl":"10.3238/arztebl.m2025.0142","url":null,"abstract":"<p><strong>Background: </strong>Changes in the microbiome have been described in many diseases and are thought to play a role in their pathogenesis and progression. In this article, we approach the topic critically and discuss the areas in which the development of microbiome-based clinical applications may soon be expected.</p><p><strong>Methods: </strong>We selectively review the literature on diseaseassociated microbiome signatures and therapeutic modulation of the microbiome. We discuss clinical studies as well as relevant preclinical studies that reveal causal relationships between the microbiome and disease.</p><p><strong>Results: </strong>The intestinal microbiome undergoes dynamic regulation by lifestyle factors such as the diet. Particularly in inflammatory and malignant neoplastic diseases, changes in the microbiome have been identified that contribute to the progression of disease in animal models. Studies have also shown that the response to systemic antitumor therapy is regulated by the microbiota. In view of this, initial clinical trials have been conducted that document the efficacy of fecal microbiome transfer and of selective approaches to microbiome modulation in the treatment of several inflammatory and malignant diseases.</p><p><strong>Conclusion: </strong>Evidence from animal models and initial clinical studies indicates that therapeutic modulation of the microbiome can be of benefit to patients suffering from a number of inflammatory and malignant diseases. The further translation of research of this kind into clinical applications will require the validation of these data in controlled trials and the development of targeted approaches to microbiome modulation.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"567-572"},"PeriodicalIF":7.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triage of Stable Patients With Suspected Acute Myocardial Infarction and Left Bundle Branch Block: A Multicenter, Propensity Score-Matched Analysis.","authors":"Sascha Macherey-Meyer, Sebastian Heyne, Max Maria Meertens, Karl Finke, Victor Mauri, Johannes Terporten, Ingo Ahrens, Frank Michael Baer, Frank Eberhardt, Marc Horlitz, Jan-Malte Sinning, Axel Meissner, Benjamin Rosswinkel, Stephan Baldus, Christoph Adler, Samuel Lee","doi":"10.3238/arztebl.m2025.0126","DOIUrl":"10.3238/arztebl.m2025.0126","url":null,"abstract":"<p><strong>Background: </strong>A pragmatic immediate invasive strategy is recommended in patients with ischemic symptoms and suspected left bundle branch block acute myocardial infarction (LBBB-AMI). It is important to identify patients with LBBB-AMI who do not need to be treated with the same strategy as those with ST-segment elevation myocardial infarction (STEMI). In this study, we aimed to compare the outcome of stable but symptomatic patients with suspected LBBB-AMI with that of matched STEMI patients.</p><p><strong>Methods: </strong>All consecutive patients who were referred for percu - taneous coronary intervention (PCI) in a metropolitan, multicenter STEMI network in Germany were analyzed and stratified according to their ECG findings (STEMI or LBBB). Propensity score matching (PSM) and adjusted analyses were performed.</p><p><strong>Results: </strong>4563 patients were included: 4219 (92.5%) with STEMI, and 344 (7.5%) with LBBB-AMI. After the identification of stable patients and PSM (n = 187 LBBB-AMI, n = 557 STEMI), the odds ratios for LBBB-AMI patients were 1.61 (95% confidence interval, [0.78; 3.32]) for in-hospital mortality, 0.56 [0.32; 0.91] for culprit lesion, and 2.18 [1.24; 3.84] for impaired patency of infarct-related artery after PCI. The median peak creatine kinase level was 1075 U/L in the STEMI patients and 478 U/L in the LBBB-AMI patients (estimated difference: -153 U/L [-504; 196]). Approximately, 70% of the LBBB-AMI patients had a culprit lesion in combination with myocardial necrosis implying acute stenosis.</p><p><strong>Conclusion: </strong>Approximately, seven of ten symptomatic LBBB-AMI patients had acute culprit lesions requiring timely PCI. The findings support routine emergency coronary angiography in these patients. Future prospective trials should address more selective triage.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"541-545"},"PeriodicalIF":7.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Practice Guideline: Nonspecific Neck Pain.","authors":"Ahmad El-Allawy, Nils Hecht, Kerstin Luedtke, Philipp Schleicher, Norbert Weidner, Thomas Kötter","doi":"10.3238/arztebl.m2025.0119","DOIUrl":"10.3238/arztebl.m2025.0119","url":null,"abstract":"<p><strong>Background: </strong>Nearly half of the adults in Germany have neck pain at least once a year. Neck pain is distressing to those who suffer from it and costly to society at large. Its treatment requires a coordinated approach with the participation of general practitioners, physician specialists, and other health care professionals, such as physical therapists. The German Society for General Medicine and Family Medicine has now issued an upgraded (S1 to S3 level) set of recommendations for rational diagnosis and treatment.</p><p><strong>Methods: </strong>The new recommendations were developed in an interdisciplinary and interprofessional collaboration as specified by the rules of the Association of the Scientific Medical Societies in Germany (AWMF). Systematic searches for scientific evidence were conducted in Medline (latest update, 11/2024), and the recommendations were formulated in a structured consensus process. The guideline was practically tested in physiotherapeutic and general medical practice settings.</p><p><strong>Results: </strong>The diagnostic evaluation begins with meticulous medical history-taking and physical examination. In cases of acute neck pain (0-3 weeks) without any evidence of a structural cause (e.g., motor deficit, night pain, precipitating trauma), diagnostic imaging should generally not be per - formed. Activating therapeutic measures with a focus on self-management have shown high effect sizes (up to d >1.0). The success of such measures may depend on patient education (moderate effect size, d = 0.73). For chronic neck pain (longer than 12 weeks), exercise therapy is recommended as well. Analgesic drugs may yield short-term relief (low effect size).</p><p><strong>Conclusion: </strong>In patients with neck pain for which the medical history and physical examination do not point to a structural cause, activation is recommended as the central element of treatment.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"552-557"},"PeriodicalIF":7.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}