Deutsches Arzteblatt international最新文献

{"title":"Rabies in Europe: Epidemiology, Clinical Management, and Prevention.","authors":"Fabian Reinhardt, Sebastian Wendt, Martin Pfeffer, Conrad Freuling, Thomas Müller, Christoph Lübbert","doi":"10.3238/arztebl.m2025.0220","DOIUrl":"10.3238/arztebl.m2025.0220","url":null,"abstract":"<p><strong>Background: </strong>Rabies is one of the oldest known zoonoses. In Europe, because cases are rare and medical experience is limited, there is often uncertainty about the indications and modalities of pre- and post-exposure prophylaxis (PrEP, PEP).</p><p><strong>Methods: </strong>This review is based on studies of the epidemiology, diagnosis, treatment, and prophylaxis of rabies that were published from January 2000 to October 2025 and retrieved by a selective search in PubMed, supplemented by data from the WHO, CDC, ECDC, RKI, and FLI and the current recommendations of the German Standing Committee on Vaccination (STIKO).</p><p><strong>Results: </strong>The WHO reports that approximately 60 000 persons die of rabies each year around the world, mainly in southern Asia and Africa, and that dogs are the source of the infection in more than 99% of cases. Once the disease has become manifest, its lethality is nearly 100%. Terrestrial rabies is considered to have been largely eliminated in the member states of the European Union (EU) since 2008, although zoonotically relevant bat lyssaviruses are still being regularly documented. As a result, even in Germany, a low risk of infection remains through contact with bats and through importation of infected animals from endemic areas abroad. The use of modern cell-culture vaccines for PrEP yields protection rates of 96-100%, with rare severe side effects (< 1:10 000). PEP is highly effective: after its administration in more than 29 million cases per year around the world from 1980 to 2022, only 122 breakthrough infections were registered, mainly because of faulty administration of rabies immunoglobulin, inadequate wound cleansing, and a late start of PEP. The main preventive measures are PrEP, avoidance of exposure, rapid wound disinfection, early PEP, and counseling by specialists in travel medicine.</p><p><strong>Conclusion: </strong>Despite the favorable epidemiological situation, the possibility of rabies should be considered early on for anyone in Europe who has had an unclear animal exposure-especially to bats-or a potential rabies exposure abroad. When questions remain about the indication or modalities of PEP, expert advice should be obtained from an infectious disease unit or a rabies information center.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"108-114"},"PeriodicalIF":7.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762540","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":"Transarterial Embolization in Osteoarthritis of the Knee: Mechanism of Action and Current Results.","authors":"Federico Collettini, Florian N Fleckenstein, Tobias Winkler, Dieter C Wirtz, Carsten Perka, Bernhard Gebauer","doi":"10.3238/arztebl.m2025.0221","DOIUrl":"10.3238/arztebl.m2025.0221","url":null,"abstract":"<p><strong>Background: </strong>Approximately 5.2 million people in Germany suffer from osteoarthritis of the knee. Minimally invasive embolization of the genicular artery (GAE) was first described in 2015. It reduces pathologically altered synovial vascularization in the periarticular tissue and the associated inflammatory processes. It is thought that this can inhibit the disease process and relieve pain in patients with symptomatic osteoarthritis of the knee who do not respond to conservative treatment. In this review, we assess this technique with regard to its safety and efficacy.</p><p><strong>Methods: </strong>This narrative review is based on pertinent publications (2015-2025) retrieved by a search in the PubMed/Medline and Google Scholar databases for prospective and retrospective clinical studies and meta-analyses.</p><p><strong>Results: </strong>25 studies on GAE have appeared since 2015, among them three randomized controlled trials (RCTs) with sham controls (n = 21; n = 59; n = 58). In a small-scale multicenter RCT (n = 21), GAE reduced pain to a markedly greater extent at 1 month compared to controls (VAS difference 50.1 mm, 95% confidence interval [29.0-72.3]; p < 0.01). Two larger RCTs did not reveal any significant additional benefit compared to sham treatment. In the Australian triple-blind RCT (n = 59) the mean improvement in the KOOS pain score at 12 months was higher in the GAE group (41.3% vs 29.4%), but the difference between groups was not significant. In the Dutch RCT (n = 58), the mean improvement in the KOOS pain score at 4 months was 21.4 points [13.9-28.8] after GAE and 18.4 [11.6-25.1] after sham treatment; the intergroup difference of 3 points was not significant ([-7.1 to 13.0], p = 0.31). Adverse events were rare and generally self-limiting.</p><p><strong>Conclusion: </strong>Before-and-after studies showed safe pain relief by GAE, but these findings have not been confirmed by the RCTs that have been carried out to date. Current evidence is mixed. Larger-scale, methodologically robust RCTs are needed so that the efficacy of GAE and its role in the treatment of symptomatic knee osteoarthritis can be reliably evaluated.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"97-101"},"PeriodicalIF":7.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910917","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":"In Reply.","authors":"Thomas Kötter","doi":"10.3238/arztebl.m2025.0231","DOIUrl":"10.3238/arztebl.m2025.0231","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 4","pages":"m1056"},"PeriodicalIF":7.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722001","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":"Pneumatosis Cystoides Intestinalis Following Voglibose Therapy.","authors":"Yuan-Lu Shan, Wen-Xiu Lin, Wei Xie","doi":"10.3238/arztebl.m2025.0168","DOIUrl":"10.3238/arztebl.m2025.0168","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 4","pages":"114"},"PeriodicalIF":7.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834142","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":"Psychosomatic Connection Needs to Be Considered.","authors":"Roland Wörz","doi":"10.3238/arztebl.m2025.0230","DOIUrl":"10.3238/arztebl.m2025.0230","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 4","pages":"m1056"},"PeriodicalIF":7.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721968","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 Surgical Stabilization of Rib Fractures: Secular Trends in Epidemiology and Treatment.","authors":"Michael David Huelskamp, Martial Mboulla Nzomo, Laura Acar, Ursula Marschall, Michael Johannes Raschke, Steffen Rosslenbroich","doi":"10.3238/arztebl.m2025.0228","DOIUrl":"10.3238/arztebl.m2025.0228","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 4","pages":"115-116"},"PeriodicalIF":7.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13074469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721978","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":"Evaluation of Online Large Language Models as Decision Support for the Management of Abdominal Pain in the Emergency Department: A Pilot Study.","authors":"Jonas Henn, Philipp Feodorovici, Jonas Dohmen, Jörg C Kalff, Ingo Gräff, Hanno Matthaei","doi":"10.3238/arztebl.m2025.0237","DOIUrl":"10.3238/arztebl.m2025.0237","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 4","pages":"117-118"},"PeriodicalIF":7.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722019","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":"Changes in Mental Health During the COVID-19 Pandemic: An Analysis of Data From the German National Cohort (NAKO) for the Years 2014–2022.","authors":"Yanding Wang, Yue Xi, Susanne Breitner-Busch, Frank Padberg, Andrea Rachow, Hermann Brenner, Stefanie Castell, Volker Harth, Stefan Haug, Muhammad Nasir Khan Khattak, Lena Koch-Gallenkamp, Lilian Krist, Benedikt M J Lampl, Berit Lange, Michael Leitzmann, Wolfgang Lieb, Claudia Meinke-Franze, Rafael Mikolajczyk, Ilais Moreno Velásquez, Nadia Obi, Cara Övermöhle, Laura Pfrommer, Tobias Pischon, Stefan Rach, Börge Schmidt, Stefan N Willic, Marie-Theres Huemer, Annette Peters","doi":"10.3238/arztebl.m2025.0218","DOIUrl":"10.3238/arztebl.m2025.0218","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic and its effects have aroused concern all over the world about its impact on mental health. The German National Cohort (NAKO) lends an opportunity to examine trends in altered mental health among adults in Germany during the pandemic.</p><p><strong>Methods: </strong>We analyzed data from 79 239 participants in the NAKO study who were surveyed with respect to depressive and anxiety symptoms, stress, and self-perceived health at three points in time: at baseline (2014-2019) and in the early (2020) and late (2022) stages of the pandemic. Changes in mental health over time were analyzed with descriptive statistics, Sankey diagrams, and a post-hoc multinomial logistic regression.</p><p><strong>Results: </strong>We observed an initial improvement in self-perceived health from baseline to 2020, but a deterioration from 2020 to 2022. The mental health of most participants remained the same over time. From baseline to 2022, the percentage of participants reporting depressive symptoms rose from 5.9% to 9.7%; rises were also seen in moderate to severe anxiety symptoms, from 3.9% to 6.2%, and in moderate to severe stress, from 4.1% to 10.2%. Both among young adults and among women, deterioration in self-perceived health was more common than improvement.</p><p><strong>Conclusion: </strong>Our findings indicate a rise in mental health symptoms among adults in Germany during the pandemic. These findings underscore the need for continuous monitoring and targeted strategies to improve public mental health.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"93-96"},"PeriodicalIF":7.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721463","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":"Discrepancies Between DRG-Based, Physician-Planned, and Actual Discharge Dates: A Retrospective Analysis of Oncological and Palliative Hospitalizations.","authors":"Ora-Elena Kox, Lorenz Oelschläger, Kati Luisa Dageförde, Nikolas von Bubnoff, Cyrus Khandanpour","doi":"10.3238/arztebl.m2025.0224","DOIUrl":"10.3238/arztebl.m2025.0224","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 3","pages":"82-83"},"PeriodicalIF":7.1,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722033","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":"Thyrostatic Drugs and Severe Skin Reactions: A Registry Evaluation Over 20 Years.","authors":"Nadja Simone Hertenstein, Ulrich Michael Hemmeter, Maren Paulmann, Maja Mockenhaupt","doi":"10.3238/arztebl.m2025.0216","DOIUrl":"10.3238/arztebl.m2025.0216","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 3","pages":"80-81"},"PeriodicalIF":7.1,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722013","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}