Deutsches Arzteblatt international最新文献

{"title":"The Administrative Prevalence and Pharmacotherapy of Chronic Inflammatory Bowel Diseases, 2012–2020.","authors":"Karsten H Weylandt, Astrid Wiese, Adelheid Jung, Christoph Schmöcker, Daniel C Baumgart, Felicia Turowski, Claudia Kohring, Kerstin Klimke, Manas K Akmatov, Jörg Bätzing, Dawid Pieper, Jakob Holstiege","doi":"10.3238/arztebl.m2024.0138","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0138","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 25","pages":"847-848"},"PeriodicalIF":6.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumatosis Intestinalis in Metastatic Colon Cancer During Cetuximab Treatment.","authors":"Till Orlemann, Sebastian Zundler, Teresa Graetz","doi":"10.3238/arztebl.m2024.0148","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0148","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 24","pages":"799"},"PeriodicalIF":6.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Diagnosis and Treatment of Hypertrophic Cardiomyopathy.","authors":"Maximilian N Möbius-Winkler, Ulrich Laufs, Karsten Lenk","doi":"10.3238/arztebl.m2024.0196","DOIUrl":"10.3238/arztebl.m2024.0196","url":null,"abstract":"<p><strong>Background: </strong>Hypertrophic cardiomyopathy (HCM) with or without left ventricular outflow tract (LVOT) obstruction is a common primary myocardial disease, with a prevalence of 1:500. It is characterized by thickening of the myocardium. Its diagnostic evaluation includes history-taking and physical examination, genetic studies, transthoracic echocardiography, and cardiac MRI. When optimally treated, it carries a mortality of less than 1% per year.</p><p><strong>Methods: </strong>This review is based on pertinent publications retrieved by a selective literature search, including the current guidelines.</p><p><strong>Results: </strong>In symptomatic patients with high LVOT gradients (≥ 50 mm Hg), the treatment of first choice is pharmacotherapy with nonvasodilating beta-blockers or non-dihydropyridine-type calcium channel antagonists. Common side effects include bradycardia and hypotension, and there is a risk of AV nodal blockade. Both substance classes lower the LVOT gradient. Beta-blockers alleviate dyspnea and improve patients' quality of life. Verapamil can increase physical resilience. A further option is mavacamten, a myosin inhibitor that gained approval in Germany in mid-2023: it, too, lowers the LVOT gradient and improves quality of life. In 7-10% of patients, there is a reversible reduction of the left ventricular ejection fraction to less than 50%. Septal reduction treatments can be considered if drug therapy fails. Attention must also be paid to the management of sequelae such as atrial fibrillation, malignant arrhythmias, and mitral valve insufficiency.</p><p><strong>Conclusion: </strong>Patients with HCM have a near-normal life expectancy if the disease is diagnosed early and treated according to the guidelines. The treatment of HCM and HOCM (hypertrophic obstructive cardiomyopathy) have been studied in no more than a few clinical trials, and randomized studies with clinical endpoints are needed.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"805-811"},"PeriodicalIF":6.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Onconephrology: The Significance of Renal Function for the Development, Diagnosis, and Treatment of Cancer.","authors":"Susanne Delecluse, Fridtjof Harder, Frieder Keller, Martin Zeier, Stefanie Zschäbitz","doi":"10.3238/arztebl.m2024.0193","DOIUrl":"10.3238/arztebl.m2024.0193","url":null,"abstract":"<p><strong>Background: </strong>Modern treatment strategies have markedly improved the chances of survival for patients with cancer. As the population ages, cancer is becoming more common, as is chronic kidney disease (CKD). CKD increases the risk of cancer; conversely, cancer treatments can cause CKD.</p><p><strong>Methods: </strong>This review is based on publications retrieved by a selective literature search concerning the epidemiology and comorbidities of cancer and kidney diseases, the renal side effects of new anticancer drugs, and the need to consider renal function in cancer treatment.</p><p><strong>Results: </strong>The prevalence of severe CKD in Germany is 2.3%. Persons who have CKD, are on dialysis, or have undergone kidney transplantation are 1.2 to 3.5 times more likely to develop cancer than the general population. For patients who have CKD or are dialysis-dependent, the doses of approximately 67% of anticancer drugs need to be adjusted on the basis of their glomerular filtration rate and the renally excreted fraction of the drug. The optimal efficacy of therapeutic drugs, as well as of those used for diagnostic purposes, and the minimization of side effects, depend critically on adapted dosing and on proper timing of administration before or after dialysis. Modern anticancer drugs can also cause acute kidney damage (incidence with checkpoint inhibitors: 2-16%).</p><p><strong>Conclusion: </strong>Patients who have CKD, are on dialysis, or have undergone kidney transplantation make up a considerable fraction of persons being treated for cancer, and they need interdisciplinary treatment.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"793-799"},"PeriodicalIF":6.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Practice Guideline: Condylar Hyperplasia of the Mandible—Diagnosis and Treatment.","authors":"Merle Riechmann, Nils-Claudius Gellrich, Bodo Kress, Christopher Schmidt, Cornelia Schröder, Andreas Neff","doi":"10.3238/arztebl.m2024.0210","DOIUrl":"10.3238/arztebl.m2024.0210","url":null,"abstract":"<p><strong>Background: </strong>Condylar hyperplasia of the mandible is characterized by abnormal size and configuration of the condylar process. In Germany, the administrative prevalence of diagnosed and/or treated condylar hyperplasia is 2.4-9.6 cases per 100 000 persons. Misdiagnosis is common and can lead to severe esthetic and functional complications, including facial deformity that can progress into the patient's twenties, as well as dysfunctional speech and mastication.</p><p><strong>Methods: </strong>We conducted a systematic review of the literature and a structured consensus-finding process with the Delphi method.</p><p><strong>Results: </strong>The experts recommend timely diagnosis of condylar hyperplasia so that its progression can be prevented by appropriate treatment. The basic diagnostic evaluation consists of history taking, physical examination, and imaging with orthopantomography. If condylar hyperplasia is confirmed, three-dimensional imaging is performed, usually with SPECT. The treatment is mainly surgical: partial condylectomy techniques and orthognathic surgery are the most common methods. If left untreated, the disorder causes severe dysfunction of mastication as well as disfigurement. Most studies of treatments for condylar hyperplasia have been based on low case numbers and have yielded only level 4 or level 5 evidence.</p><p><strong>Conclusion: </strong>Condylar hyperplasia is a common, but not widely known problem. Its early diagnosis and treatment can prevent severe jaw asymmetry and further complications such as craniomandibular dysfunction and arthrosis of the temporomandibular joints.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"816-823"},"PeriodicalIF":6.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous Sarcoidosis Following Microblading of the Eyebrows.","authors":"Moritz Ronicke, Petra Wörl, Franklin Kiesewetter","doi":"10.3238/arztebl.m2024.0170","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0170","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 24","pages":"824"},"PeriodicalIF":6.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ameboma—a Rare Differential Diagnosis of Cecal Cancer.","authors":"Sandrina Thiesen, Martin W Baumgärtel, Bernhard Glasbrenner","doi":"10.3238/arztebl.m2024.0155","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0155","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 24","pages":"824"},"PeriodicalIF":6.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Homeless Persons in the Emergency Room—A Single-Center Study on the Performance and Completeness of Recommended Diagnostic Tests.","authors":"Johannes Heymer, Anna Sophie Hein, Matthias Ott, Martina Müller-Schilling, Tobias Schilling, Alexander Krohn, Florian Dengler","doi":"10.3238/arztebl.m2024.0183","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0183","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 24","pages":"812-813"},"PeriodicalIF":6.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interrupted Time Series for Assessing the Causality of Intervention Effects. Part 35 of a Series on Evaluating Scientific Publications.","authors":"Tim Mathes, Dominik Röding, Constance Stegbauer, Michael Laxy, Dawid Pieper","doi":"10.3238/arztebl.m2024.0150","DOIUrl":"10.3238/arztebl.m2024.0150","url":null,"abstract":"<p><strong>Background: </strong>The gold standard for evaluating interventions in medicine and health care is the randomized controlled trial (RCT). In practice, however, RCTs may be difficult to conduct because of high costs, ethical aspects, or practical considerations. This is particularly true of studies on the population level, e.g., for the evaluation of health policy measures.</p><p><strong>Methods: </strong>We present a type of study design called the interrupted time series (ITS) and its critical interpretation, with several illustrative examples. This discussion is based on selected meth - odological publications.</p><p><strong>Results: </strong>ITS are suitable for the assessment of interventions with a clear point of intervention (interruption). They are analyzed with the statistical methods of time-series analysis. One strength of ITS is that they can be used to estimate an immediate effect as well as a gradually developing effect. Under certain assumptions, the findings of an ITS analysis can be interpreted causally. The main assumption underlying an ITS is that the trend after the intervention would have been exactly the same as the trend before the intervention if the intervention had not taken place and all other conditions had remained unchanged. A further assumption is that there should be no differences in the pre- versus postintervention phases in the subjects or other entities being tested (e.g., hospitals) that might affect the measured endpoints (e.g., differences in mean age affecting measured mortality). Moreover, the intervention periods must be properly distinct from one another in order to prevent biased effect estimates. The robustness of the assumptions should also be checked with sensitivity analyses.</p><p><strong>Conclusion: </strong>As long as all sources of bias have been avoided and the findings are both plausible and robust, the effects revealed by ITS can be interpreted as causal. ITS may serve as an alternative method for evaluating intervention effects when an RCT cannot be performed.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"800-804"},"PeriodicalIF":6.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Changes in Vaccination Protection Against Severe Courses of COVID-19 by Non-adapted MRNA-Based Vaccines—A Retrospective Observational Study in Elderly Persons During the XBB Wave.","authors":"Andreas Beyerlein, Katharina Katz, Helmut Küchenhoff, Wolfgang Hartl","doi":"10.3238/arztebl.m2024.0179","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0179","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 24","pages":"814-815"},"PeriodicalIF":6.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}