Deutsches Arzteblatt international最新文献

{"title":"Getting Involved Is the Key to Success.","authors":"Stephan Mertens","doi":"10.3238/arztebl.m2026.0070","DOIUrl":"10.3238/arztebl.m2026.0070","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 15","pages":"431-432"},"PeriodicalIF":8.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879327","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 Diagnosis, Treatment, and Aftercare of Ankle Fractures.","authors":"Sebastian Felix Baumbach, Hans Polzer, Sabine Ochman, Thomas Mittlmeier, Stefan Rammelt","doi":"10.3238/arztebl.m2026.0071","DOIUrl":"10.3238/arztebl.m2026.0071","url":null,"abstract":"<p><strong>Background: </strong>Ankle fractures are among the most common types of fracture among adults in Germany, with an incidence of 74 ± 32 cases per 100 000 persons per year. Treatment strategies have changed considerably over the past decade. In this review, we present the current treatment strategies for ankle fractures, aftercare, and long-term results.</p><p><strong>Methods: </strong>Current treatment strategies for ankle fractures were summarized in the framework of a narrative review and expert consensus of the German Orthopaedic Foot and Ankle Society (<i>Deutsche Assoziation für Fuß und Sprunggelenk,</i> D.A.F.). The current mode of postoperative aftercare for ankle fractures and the long-term results were retrieved from structured literature reviews.</p><p><strong>Results: </strong>Stable, non- or minimally displaced unimalleolar fractures (AO 44A and 44B) can be treated non-operatively with an early return to function. Stability should be verified by bilateral, weight-bearing radiography. Fractures that are unstable or displaced should be treated surgically. Active individuals seem to benefit from anatomic reduction and the stabilization of all fractures and unstable syndesmotic injuries (360° treatment). Minimally invasive techniques are recommended in case of critical soft-tissue conditions or major comorbidity. The benefit of the currently prevailing restrictive postoperative regimens (six weeks of immobilization and reduced or no weight-bearing) has been called into question by the findings of a large number of randomized controlled trials. Early weight-bearing and mobilization improve early functional outcomes without increasing complication rates. Long-term studies have shown that a moderate to poor functional outcome can be expected in up to 20% of cases ≥ 10 years after the operative treatment of an ankle fracture.</p><p><strong>Conclusion: </strong>Treatment strategies and aftercare regimens have evolved over the past decade. Future studies will need to determine whether these new strategies yield better long-term clinical outcomes.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 15","pages":"405-412"},"PeriodicalIF":8.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980865","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":"Giant Colonic Diverticulum.","authors":"Georgios Spyridonos, Martin Schnell, Iliana Ivanova-Mutafchieva","doi":"10.3238/arztebl.m2026.0067","DOIUrl":"10.3238/arztebl.m2026.0067","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 15","pages":"432"},"PeriodicalIF":8.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879282","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":"High-Risk Locations for Suicide in Saxony.","authors":"Katharina König, Thomas Reisch, Maria Meinhardt, Arina Vorobyeva, Nadine Glasow, Ute Lewitzka","doi":"10.3238/arztebl.m2026.0052","DOIUrl":"10.3238/arztebl.m2026.0052","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 15","pages":"420-421"},"PeriodicalIF":8.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879407","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":"Thyroid Cancer: Epidemiology, Diagnosis, and Treatment.","authors":"Katharina Holzer, Viktoria Florentine Koehler, Jörg Bojunga, Markus Luster, Detlef K Bartsch, Friederike Eilsberger","doi":"10.3238/arztebl.m2026.0050","DOIUrl":"10.3238/arztebl.m2026.0050","url":null,"abstract":"<p><strong>Background: </strong>Thyroid cancer, including carcinoma, metastases, sarcoma, and lymphoma of the thyroid gland, is much rarer (incidence of thyroid carcinoma, ca. 7 per 100 000 people per year in Germany) than benign nodular thyroid disease (prevalence: ca. 10% in young men to 80% in older women). The incidence of differentiated thyroid carcinoma has risen around the world in recent years.</p><p><strong>Methods: </strong>This narrative review is based on publications retrieved by a search of PubMed.</p><p><strong>Results: </strong>In Germany in 2022, approximately 4200 women and 1800 men received a diagnosis of thyroid carcinoma. The relative 10-year survival rate for this disease was 94% in women and 86% in men. Differentiated thyroid carcinoma (DTC), mainly of the papillary subtype (PTC), was the most common type of thyroid carcinoma in Germany (76% in women, 66% in men). Combined surgery and radio-iodine therapy are still the most common treatment for DTC, although initially available prospective studies currently cast doubt on the benefit of radio-iodine therapy in certain risk groups. The option of active surveillance has been introduced for selected patients with a small PTC. The treatment of radio-iodine-refractory, poorly differentiated, and anaplastic thyroid carcinoma has improved with the introduction of targeted molecular therapies and immunotherapeutic drugs.</p><p><strong>Conclusion: </strong>The treatment of thyroid carcinoma has become more individualized, with less aggressive approaches for small tumors and an expansion of systemic options for advanced cases.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 15","pages":"423-430"},"PeriodicalIF":8.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765476","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":"Friedrich A von Samson-Himmelstjerna","doi":"10.3238/arztebl.m2026.0101","DOIUrl":"10.3238/arztebl.m2026.0101","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 15","pages":"m1067-m1068"},"PeriodicalIF":8.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879466","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":"Increase in Cannabis-Specific Hospital Admissions After Partial Legalization in Germany: A Nationwide Time-Series Analysis.","authors":"Jakob Manthey, Senadin Radas, Ludwig Kraus","doi":"10.3238/arztebl.m2026.0123","DOIUrl":"10.3238/arztebl.m2026.0123","url":null,"abstract":"<p><strong>Summary: </strong>In April 2024, the possession and cultivation of non-medical cannabis for adults were legalized in Germany, and the regulation of cannabis for medical purposes was liberalized. We studied whether the rate of hospital admissions with cannabis-specific diagnoses has risen since then.</p><p><strong>Methods: </strong>The number of inpatient admissions each week from January 2022 to September 2025 was ascertained from DRG and PEPP statistics. The primary endpoint was the rate of admissions with a cannabis-specific ICD-10 main diagnosis (F12.0-F12.9; T40.7) as a proportion of all admissions, determined separately for minors and adults. Secondary endpoints for adults were the admission rates for acute intoxication and poisoning (F12.0; T40.7) and for cannabis-induced psychosis (F12.5) as a percentage of all admissions. Immediate and gradual changes after the modification in the law were examined with time-series analyses.</p><p><strong>Results: </strong>After 1 April 2024, the rate of hospital admissions with a cannabis-specific diagnosis initially rose by 5.6% (risk ratio (RR) = 1.056) and remained stable thereafter (RR = 1.000). Among minors, an initial immediate rise of 14.9% (RR = 1.149) was followed by a decline of 0.4% (RR = 0.996) per week. Among adults, cases of acute cannabis poisoning saw an immediate rise of 37.1% (RR = 1.371), followed by a slight, non-significant, gradual decline (RR = 0.998). The hospitalization rate of cannabis-induced psychosis among adults rose immediately by 16.4% (RR = 1.164) and remained stable thereafter (RR = 1.000).</p><p><strong>Conclusion: </strong>The change in cannabis laws in Germany was followed by a rise in cannabis-specific hospital admissions, particularly among adults, mainly because of acute intoxication and cannabis-induced psychosis. The reason may be increased consumption of highly potent medical cannabis.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 15","pages":"413-417"},"PeriodicalIF":8.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316359","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":"What Anticoagulants Should We Use to Treat Atrial Fibrillation?","authors":"Paulus Kirchhof","doi":"10.3238/arztebl.m2026.0080","DOIUrl":"10.3238/arztebl.m2026.0080","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 14","pages":"375-376"},"PeriodicalIF":8.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879590","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":"Regional Variation in the Prevalence of Frailty Among Very Old Adults in Germany: Findings of the Nationwide Study \"Old Age in Germany\" (D80+).","authors":"Manuel Amthor, Elisabeth Zwinge, Maximilian König","doi":"10.3238/arztebl.m2026.0072","DOIUrl":"10.3238/arztebl.m2026.0072","url":null,"abstract":"<p><strong>Background: </strong>Frailty is a key geriatric syndrome that determines the care of the affected old adults. The goal of this study is to quantify the prevalence and regional distribution of frailty among very old adults in Germany, on which no nationwide data have been available to date.</p><p><strong>Methods: </strong>We analyzed data obtained by questionnaire from 9855 persons aged 80 and above in the nationwide D80+ survey. Frailty was operationalized with a frailty index (cutoff value: ≥0.25) encompassing 40 items. Its prevalence was estimated with logistic regression adjusted for age and sex. Socio-economic factors (education, income, type of residence) were additionally taken into account in an extended model.</p><p><strong>Results: </strong>The overall prevalence of frailty was 54.5% (95% confidence interval [53.2; 55,7]). Frail persons were more commonly female, widowed, living in a nursing or old-age home, and of lower socio-economic status. Regional variation was identified that persisted after the additional consideration of socio-economic factors and type of residence. The two federal states with the lowest prevalence were Bremen (42.6%) and Schleswig-Holstein (49.9%); those with the highest prevalence were Brandenburg (59.7%) and Saxony (60.8%).</p><p><strong>Conclusion: </strong>Frailty is highly prevalent among very old adults in general, with regional disparities that imply an effect of region-specific factors. The awareness of regional variability and a better understanding of its causes can be used to inform future public health strategies and regional care planning.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 15","pages":"385-389"},"PeriodicalIF":8.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980854","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":"Direct Oral Anticoagulants Versus Phenprocoumon: Mortality, Thromboembolism and Major Hemorrhage. A Systematic Review and Meta-Analysis of Routine Data Studies.","authors":"Christiane Engelbertz, Holger Reinecke, Jeanette Köppe","doi":"10.3238/arztebl.m2026.0064","DOIUrl":"10.3238/arztebl.m2026.0064","url":null,"abstract":"<p><strong>Background: </strong>In the randomized controlled trials (RCTs) of the non-vitamin K dependent oral anticoagulants (NOACs) that led to their approval, the vitamin K antagonist (VKA) warfarin was used as a comparator drug. The efficacy and safety of NOACs compared to phenprocoumon, the VKA predominantly used in Germany, are unknown, as it has not been studied in RCTs.</p><p><strong>Methods: </strong>For this systematic review and meta-analysis (registration: CRD42024619047), we systematically searched 3 databases for studies based on routine data that yielded matched or adjusted results for overall mortality, thromboembolism, and major hemorrhage in anticoagulant-naïve patients who were treated with either phenprocoumon or a NOAC.</p><p><strong>Results: </strong>Seven studies based on German routine data were identified, covering a total of 1 842 015 anticoagulant-naïve patients. In a pooled analysis of all NOACs (apixaban, dabigatran, edoxaban, and rivaroxaban), these were associated with a notably higher risk of mortality (hazard ratio [HR] 1.14, 95% confidence interval [1.00; 1.30]), a higher risk of thromboembolic events (HR 1.08, [1.01; 1.15]), and a lower risk of major hemorrhages (HR 0.80, [0.72; 0.90]) than phenprocoumon. Among individual NOACs, rivaroxaban was associated with a notably higher risk of mortality than phenprocoumon; the other NOACs also displayed a higher risk of mortality than phenprocoumon, but the differences were not statistically significant.</p><p><strong>Conclusion: </strong>In this meta-analysis of NOACs versus phenprocoumon, the former were found in a pooled analysis to be associated with a higher overall risk of mortality and a higher risk of thromboembolic events on the one hand, but a lower risk of major hemorrhages on the other hand. Warfarin was the comparator drug in all of the clinical trials that led to the approval of NOAC. The findings of this meta-analysis cast doubt on the benefit of the preferential use of NOACs in countries where phenprocoumon is the standard VKA.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 14","pages":"377-384"},"PeriodicalIF":8.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980929","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}