Deutsches Arzteblatt international最新文献

{"title":"Ocular Side Effects of Antibody-Drug Conjugates for Cancer Treatment.","authors":"Florian Heitz, Andreas Scheider, Philipp Harter, Maximilian Groeben","doi":"10.3238/arztebl.m2026.0060","DOIUrl":"10.3238/arztebl.m2026.0060","url":null,"abstract":"<p><strong>Background: </strong>Antibody-drug conjugates (ADCs) are approved for use in treating certain types of cancer and are now in clinical development for many others, as they are therapeutically effective. Some of these agents commonly cause ocular side effects, typically manifesting themselves as blurred vision or a foreign-body sensation.</p><p><strong>Methods: </strong>For this narrative review of the literature, we carried out a database search and a cross-reference search at the German Federal Institute for Drugs and Medical Devices (BfArM) to identify publications on the diagnosis, prevention, and treatment of ocular side effects associated with ADCs.</p><p><strong>Results: </strong>Of the 13 ADCs that have been approved to date, 4 cause ocular side effects in 5% to 89% of patients. Ocular side effects are severe in up to 43% of the cases in which they occur. Appropriate prophylactic measures must be taken to limit their frequency and intensity; these include not wearing contact lenses, using lubricating eye drops multiple times a day, and cooling the eyes during the administration of treatment. Severe ocular side effects can arise despite such measures and require treatment by a specialist. Ocular side effects can be managed successfully by rapid detection and adequate evaluation of their extent followed by proper treatment, thereby enabling the patient's cancer to be treated appropriately.</p><p><strong>Conclusion: </strong>Interdisciplinary collaboration between oncologists and ophthalmologists must be well-coordinated to ensure effective oncological treatment.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 14","pages":"397-402"},"PeriodicalIF":8.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834544","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":"Efficacy of an Unguided Digital Intervention for Adults With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial.","authors":"Anna Baumeister, Lea Schuurmans, Daniel Schöttle, Andreas Reif, Kai G Kahl, Steffen Moritz, Anne Karow, Martin Lambert, Felix Betzler, Alexandra Philipsen","doi":"10.3238/arztebl.m2026.0065","DOIUrl":"10.3238/arztebl.m2026.0065","url":null,"abstract":"<p><strong>Background: </strong>Psychotherapy for adults with ADHD is still underutilized in Germany and worldwide. Only a small percentage of these patients receive psychotherapy as recommended in the guidelines. Unguided digital interventions may help to lessen this treatment gap.</p><p><strong>Methods: </strong>An open-label, exploratory randomized controlled trial was conducted (trial registration: DRKS00033320). Adults with confirmed ADHD were recruited at six study centers in Germany, as well as via social media, and were randomly allotted to receive either the intervention (treatment as usual + app) or the control condition (treatment as usual). Data were collected from 2 February to 5 June 2024. The primary endpoint was patients' health-related quality of life (QOL) at 12 weeks. The secondary endpoints included changes in the severity of ADHD symptoms, functional impairment, and symptoms of anxiety or depression. The threshold for statistical significance was set at 10% in view of the exploratory nature of the trial.</p><p><strong>Results: </strong>307 subjects were randomized (intervention group: n = 155, control group: 152). 70% were women, 29% men, and 1% was gender diverse; their mean age was 36 years (SD, 9.5). The data were analyzed according to the intention-to-treat principle with a mixed-effects model. The improvement in QOL was greater in the intervention group than in the control group (<i>p</i> <0.001; <i>d</i> = 0.54; 90% confidence interval [0.33-0.74]), despite generally low adherence to the intervention in the intervention group. 40% of subjects in the intervention group attained clinically relevant improvement in QOL, compared to 27% of control subjects. Among the secondary endpoints, ADHD symptoms improved to a greater extent in the intervention group than in the control group.</p><p><strong>Conclusion: </strong>Limitations include that no standardized diagnostics were conducted within the study and that no conclusions can be drawn regarding long-term effects.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 14","pages":"390-396"},"PeriodicalIF":8.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155786","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":"Pleomorphic Adenoma of the Auditory Canal.","authors":"Wieland Behr, Rainer M Weiß, Boris A Stuck","doi":"10.3238/arztebl.m2026.0051","DOIUrl":"10.3238/arztebl.m2026.0051","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 14","pages":"389"},"PeriodicalIF":8.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879517","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":"Companion Animals and Diabetes Mellitus as Risk Factors for Diphtheria Due to Corynebacterium Ulcerans: An Analysis of Data Collected Through the Intensified Diphtheria Surveillance System in Germany, 2017-2022.","authors":"Franziska Badenschier, Wiebe Külper-Schiek, Lena Schneider, Cornelius Rau, Anja Berger, Achim Dörre","doi":"10.3238/arztebl.m2026.0076","DOIUrl":"10.3238/arztebl.m2026.0076","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 14","pages":"403-404"},"PeriodicalIF":8.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879494","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":"Mortality Data Collection by Local Authorities Compared to a Cancer Registry.","authors":"Jan Hovanec, Andreas Stang, Hiltraud Kajüter, Kaid Darwiche, Servet Bölükbas, Dirk Theegarten, Thomas Brüning, Thomas Behrens","doi":"10.3238/arztebl.m2026.0056","DOIUrl":"10.3238/arztebl.m2026.0056","url":null,"abstract":"<p><strong>Background: </strong>Mortality data, i.e., information on whether individuals are living or dead and the causes of death, provide essential endpoints for the assessment of disease progression in clinical-epidemiological studies. In Germany, mortality data for scientific research are often available only through municipal offices, and rarely from registries. In this study, we collected and compared mortality data from these two sources.</p><p><strong>Methods: </strong>As part of a study on the early detection of lung cancer and pleural mesothelioma, we collected mortality data on patients recruited in 2014-2015 and on control subjects in the general population. These data were obtained from registration and public health offices and (except for the control subjects) through record linkage with the Cancer Registry North Rhine-Westphalia.</p><p><strong>Results: </strong>448 of the 460 patients consented to follow-up via the cancer registry, and 429 consented to municipal-office-based follow up, as did 197 of the 207 control subjects. Much more effort was needed to collect data from municipal offices than through record linkage with the cancer registry. Over a 5-year period, the percentage of deaths recorded was slightly higher when assessed with data from the cancer registry (51.1% versus 49.7%). Further information on the causes of death was more frequently available through the cancer registry (98% versus 84%).</p><p><strong>Conclusion: </strong>Follow-up data from the cancer registry were generally more informative, and required less organizational effort to collect, than data from municipal offices. Obtaining data from cancer registries is, therefore, preferable for future cancer studies, although nationwide registry structures for mortality data are still lacking.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 13","pages":"353-356"},"PeriodicalIF":8.7,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13371969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834110","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":"Hypoglycemia Due to a Hormone-Secreting Tumor.","authors":"Philipp Ernst, Bernhard Theis, Tobias Franiel","doi":"10.3238/arztebl.m2026.0035","DOIUrl":"10.3238/arztebl.m2026.0035","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 13","pages":"352"},"PeriodicalIF":8.7,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668766","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":"Benefits of Diagnostic Evaluation and Therapy Should Be Assessed Realistically.","authors":"Alexander Sascha Hauber","doi":"10.3238/arztebl.m2026.0068","DOIUrl":"10.3238/arztebl.m2026.0068","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 13","pages":"m1065"},"PeriodicalIF":8.7,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668783","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":"Ambulatory HIV Care and Pre-exposure Prophylaxis Between 2014 and 2023: An Analysis of Nationwide Billing Data From the German Statutory Health Care System.","authors":"Clarissa Graf, Jan Lipovsek, Thomas Czihal, Monika Sander, Martin Albrecht, Markus Bickel, Dorian Doumit, Nikola Hanhoff, Anne von Fallois, Stefan Esser, Mandy Schulz","doi":"10.3238/arztebl.m2026.0054","DOIUrl":"10.3238/arztebl.m2026.0054","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 13","pages":"364-365"},"PeriodicalIF":8.7,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668753","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":"Glomerular Filtration Rate, Albuminuria, and Reported Kidney Disease in Comparison: Results From the German National Cohort (NAKO).","authors":"Peggy Sekula, Elena Butz, Elke Schaeffner, Janis M Nolde, Insa M Schmidt, Lara Kim Brackmann, Beate Fischer, Matthias Girndt, Kathrin Günther, Anke Hannemann, Volker Harth, Torben Heinsohn, André Karch, Thomas Keil, Lilian Krist, Berit Lange, Michael Leitzmann, Claudia Meinke-Franze, Jaroslawna Meister, Rafael Mikolajczyk, Ute Mons, Katharina Nimptsch, Nadia Obi, Cara Övermöhle, Tobias Pischon, Tamara Schikowski, Ben Schöttker, Matthias B Schulze, Julia Schwichtenberg, Andreas Stang, Henning Teismann, Henry Völzke, Karlhans Endlich, Matthias Nauck, Markus Scholz, Iris M Heid, Wolfgang Lieb, Anna Köttgen","doi":"10.3238/arztebl.m2026.0053","DOIUrl":"10.3238/arztebl.m2026.0053","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) can be asymptomatic for many years and is often diagnosed late. Given the availability of new treatments, the early identification of relevant findings from screening of the kidney markers estimated glomerular filtration rate (eGFR) and albuminuria in the general population is becoming increasingly important.</p><p><strong>Methods: </strong>In the NAKO study, self-reported medical diagnoses of kidney disease in 195 182 participants were compared with relevant findings from screening biomarkers (eGFR < 60 mL/min/1.73 m² and albuminuria). For the purpose of comparison, various equations for assessing kidney function were evaluated as well.</p><p><strong>Results: </strong>2% of the participants reported having received a medical diagnosis of kidney disease, and 2% had an eGFR below 60 mL/min/1.73 m². There was, however, little overlap between these two groups: more than 80% of participants with an eGFR between 30 and 59 mL/min/1,73 m²) did not report any diagnosis of kidney disease. The additional inclusion of data on albuminuria did not materially affect this discrepancy: 6213 persons (17.5% of the cohort) with an abnormal eGFR or urinary albumin-to-creatinine ratio (UACR) did not report any diagnosis of kidney disease. Even among participants whose eGFR was in the range of 30-59 mL/min/1.73 m² and whose UACR was above 300 mg/g, less than half reported having a medically diagnosed kidney disease.</p><p><strong>Conclusion: </strong>These findings indicate a low level of awareness regarding the possible presence of CKD in the general population. Many people with abnormal screening findings needing further investigation due to their potential clinical relevance are unaware that they might be suffering from a kidney disease. As more effective treatments for kidney disease are now available, these findings indicate a need for structured screening and evaluation strategies to promote kidney health.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 13","pages":"345-352"},"PeriodicalIF":8.7,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765481","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 Diplopia.","authors":"Wolf A Lagrèze, Thomas Lischka, Anja Eckstein, Michael Oeverhaus, Marianne Dieterich, Michael Strupp","doi":"10.3238/arztebl.m2026.0006","DOIUrl":"10.3238/arztebl.m2026.0006","url":null,"abstract":"<p><strong>Background: </strong>Diplopia is a common symptom of interdisciplinary significance that can lead to marked impairment of function. Its causes range from harmless to life-threatening conditions that must be precisely distinguished.</p><p><strong>Methods: </strong>For this CME review article, a PubMed search was conducted in an interdisciplinary collaboration of ophthalmologists and neurologists.</p><p><strong>Results: </strong>Systematic history-taking and a structured clinical examination are the basis for topographic-anatomical diagnosis and the differentiation of peripheral and central causes. It is important to distinguish monocular from binocular diplopia. Monocular diplopia persists when one eye is covered and is not dangerous. Binocular diplopia may arise from disturbances at a variety of anatomical levels that can result from many different causes: disturbances of fusion in strabismus, diseases of the eye muscles such as thyroid eye disease or mitochondropathies, orbital trauma, impaired neuromuscular transmission in myasthenia gravis, fascicular or nuclear lesions of the three nerves that supply the extraocular muscles (oculomotor, trochlear, and abducens), supranuclear lesions \"above\" the cranial nerve nuclei, and cerebellar diseases. The most common causes, together accounting for ca. 70% of cases, are decompensated latent strabismus and cranial nerve palsies, followed by orbital, brainstem, and cerebellar diseases.</p><p><strong>Conclusion: </strong>Diplopia can be accurately diagnosed through a systematic approach that includes precise history-taking and clinical examination of eye position and eye movements. On this basis, there can be a targeted and specific search for the various underlying causes. When the patient's leading symptom is isolated diplopia, the ophthalmologist is generally the specialist to whom the primary care physician should turn next.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"367-373"},"PeriodicalIF":8.7,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156358","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}