Deutsche medizinische Wochenschrift (1946)最新文献

{"title":"[Rheumatoid Arthritis].","authors":"Jutta Bauhammer, Christoph Fiehn","doi":"10.1055/a-2286-6620","DOIUrl":"10.1055/a-2286-6620","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is an inflammatory systemic disease that mainly, but not exclusively, affects the joints and other structures of the musculoskeletal system. It most typically manifests in polyarthritis due to a highly inflammatory autoimmune synovitis. Extra-articular manifestations might also show in the shape of an interstitial lung disease or vasculitis, mainly affecting the small vessels. Early, well-targeted treatment can have a major impact on the progression of the disease; without treatment, however, patients are most likely to experience an irreversible loss of functionality and increased mortality. The administration of a DMARD starting as soon as being diagnosed is recommended. The first choice in medication should be methotrexate whenever there are no contraindications. In most cases, glucocorticoids are added temporarily with administration coming to a complete stop after 3-6 months. Therapy follows the treat-to-target principle aiming at remission. Disease activity and remission are calculated in scores combining clinical findings, patients' statements and laboratory tests for inflammatory activity. Treatment is considered responsive with achieving a minimum of a 50% reduction of the score. Score responses are evaluated after 12 weeks, therapeutic targets after 24. If 1 of the 2 is not met and there are no risk factors present for a severe progression of the disease, then another strategy with conventional systemic (cs)DMARD will first be used after methotrexate; otherwise biological (b)DMARD or other targeted synthetic (ts)DMARD can be given. Re-evaluation is carried out as described above, and if the target is not met, other b- or ts-DMARDs will be used.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 9","pages":"508-520"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Update on drug therapy for ulcerative colitis].","authors":"Elena Sonnenberg, Britta Siegmund, Carl Weidinger","doi":"10.1055/a-2368-7090","DOIUrl":"10.1055/a-2368-7090","url":null,"abstract":"<p><p>Ulcerative colitis (UC) is classified as a chronic inflammatory bowel disease (IBD) and can present in various degrees of severity. In addition to mild courses of the disease, such as uncomplicated proctitis, which can often be successfully treated with topical 5-ASA formulations, complicated courses can be observed, which can sometimes be life-threatening. Affected patients are often considerably burdened and often severely restricted in their quality of life, as they suffer from numerous, often bloody bowel movements, which are accompanied by abdominal cramps, urgency and sometimes even incontinence. In addition, many UC patients suffer from concomitant extraintestinal inflammatory manifestations including skin manifestations like psoriasis, erythema nodosum or joint involvement such as spondylarthritis. For many years, steroids and conventional immunosuppressants such as azathioprine were the only treatment options available. Twenty years ago, the approval of the first anti-TNF antibody, Infliximab, marked a significant turning point in IBD therapy. Despite the continuous progress in drug therapy, the rates of primary and/or secondary treatment failure are still considerable. With this in mind, a large number of additional substances have been developed and approved for the treatment of UC in the recent years. In addition to TNF antibodies and their biosimilars, the anti-integrin vedolizumab, various Janus kinase (JAK) inhibitors, an interleukin (IL)-12/-23p40 antibody, various IL-23p19 antibodies and sphingosine-1-phosphate receptor (S1PR) modulators have broadened the therapeutic landscape and found their way into the clinical treatment of UC patients. In this article we will discuss case-based decision paths for the selection of fitting anti-inflammatory treatments in UC patients and summarize the principles of the different therapeutic strategies for UC.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"412-418"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Pneumococcal sepsis 2015-2022: considerations on vaccination strategies].","authors":"Herbert Hof, Sabine Singer, Ika Steiner, Daniela Bertsch, Maria Kirstahler, Klaus Oberdorfer, Matthias Imöhl, Mark van der Linden","doi":"10.1055/a-2506-4928","DOIUrl":"10.1055/a-2506-4928","url":null,"abstract":"<p><p>In spite of available vaccines the frequency of sepsis caused by <i>Streptococcus pneumoniae</i> still remains rather high.In the years 2015-2022 <i>Streptococcus pneumoniae</i> could be isolated from 925 blood cultures in our laboratory. Serotyping was performed from 754 strains. In addition, their in vitro susceptibility to some antibiotics was assessed.In this period 925 blood cultures were positive, predominantly from aged patients (older than 60 years) and more frequently from men than from women. In the years 2020 and 2021 less positive blood cultures were found, which could be interpreted as a result from non-pharmaceutical interventions preventing aerogenically transmitted diseases such as coronavirus infections during the epidemic. Children were also relatively susceptible in their first year of life. 653 strains were serotyped, with serotypes 3 and 8 predominating. 67% of the serotypes found were covered by the 20-valent conjugate vaccine whereas the polysaccharide vaccine (PPV23) included 75%. The vast majority of isolates was susceptible to penicillin, erythromycin as well as to doxycycline. Multi-drug resistant strains were not detected.A large part of the infections might have been prevented by vaccination assuming a high vaccine effectiveness. However, 27% of <i>S. pneumoniae</i> serotypes detected were not covered by any of the vaccines currently available.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":" ","pages":"e11-e17"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Endoscopy in Inflammatory Bowel Diseases: From Proven to New].","authors":"Timo Rath, Markus F Neurath","doi":"10.1055/a-2344-7995","DOIUrl":"10.1055/a-2344-7995","url":null,"abstract":"<p><p>Inflammatory bowel diseases with the 2 main forms - ulcerative colitis and Crohn's disease - are chronic relapsing diseases of the gastrointestinal tract in which dysregulation of the intestinal immune system against commensal components of the microbiome leads to perpetuated intestinal inflammation based on a genetic predisposition. While in the past symptom control was the focus of therapy, more recent data show that achieving endoscopic remission is superior to sole clinical symptom control for the further course and prognosis of the diseases. In this review article, we will present the significance of endoscopy for inflammatory bowel diseases, describe established scoring systems for endoscopic graduation of inflammatory activity and, last but not least, also present and review new endoscopic developments.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"419-426"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Multimorbidity in endocrinological diseases: Clinical implications of PCOS].","authors":"Sita Arjune, Cornelius Bollheimer, Ruth Hanßen","doi":"10.1055/a-2365-9507","DOIUrl":"10.1055/a-2365-9507","url":null,"abstract":"<p><p>Polycystic ovary syndrome (PCOS) is one of the most common endocrinological disorders in women of reproductive age. It affects up to 15% of this population worldwide and is characterized by a complex hormonal, metabolic and reproductive dysfunction. In this article, the multimorbidity of PCOS is reviewed, with a particular focus on the clinical implications and management of this complex disorder.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 9","pages":"496-502"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Hospital service groups and quality indicators - A cross-comparison for pneumonia, ischemic stroke, and colorectal resection for carcinoma].","authors":"Ulrike Nimptsch, Daniel Schmithausen, Claudia Winklmair, Reinhard Busse, Boris Augurzky, Ralf Kuhlen","doi":"10.1055/a-2530-3973","DOIUrl":"10.1055/a-2530-3973","url":null,"abstract":"<p><p>In Germany, the Hospital Care Improvement Act (Krankenhausversorgungsverbesserungsgesetz) will introduce service groups for hospital reserve financing. The hospital planning of the federal states is also intended to allocate care contracts to hospitals based on service groups in conjunction with structural quality criteria. This paper analyzes service group-specific differences in treatment case characteristics as well as differences in process and outcome quality indicators.The study used the frequent treatment causes of pneumonia, cerebral infarction and colorectal resection for carcinoma as examples. Administrative data for the year 2023 from 422 hospitals were analyzed. Treatment cases were assigned to NRW hospital service groups and, in a cross comparison, to figures of the German Inpatient Quality Indicators (G-IQI).For the treatment causes of pneumonia (N=129666), cerebral infarction (N=95762) and colorectal resection for carcinoma (N=16578), more than 60% of cases were assigned to one dominant service group, while the remaining cases were distributed across different service groups. Care characteristics differed according to the service group assignment. For example, intracranial thrombectomy was documented in 10.3% of cases with cerebral infarction overall (9856 of 95762 cases). In the \"Stroke Unit\" service group, this proportion was 11.3% (6790 of 60246 cases), in the \"General Neurology\" service group it was 5.7% (836 of 14692 cases).The assignment of cases to service groups primarily reflects the type of care. To promote the intended control effect with the aim of increasing the hospital's specialization, the classification of service groups might be more strongly oriented towards the clinical care requirements of relevant treatment causes.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":" ","pages":"e18-e27"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[70-year-old male patient with Polycythaemia vera and chronic leg ulcer].","authors":"Daniel Craus, Valentina Laura Müller, Alexander Kreuter","doi":"10.1055/a-2432-7259","DOIUrl":"https://doi.org/10.1055/a-2432-7259","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"403-404"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[New and current therapeutic goals of chronic inflammatory bowel disease].","authors":"Raul Lande, Irina Blumenstein","doi":"10.1055/a-2335-5901","DOIUrl":"10.1055/a-2335-5901","url":null,"abstract":"<p><p>Chronic inflammatory bowel diseases (IBD), such as Crohn's disease (MC) and ulcerative colitis (CU), are serious immune-mediated diseases that affect the gastrointestinal tract and represent a considerable burden for patients. In recent decades, the treatment of IBD has shifted from symptomatic control to more precise, long-term goals. Advances in IBD research have led to therapy goals having been redefined and expanded in order to achieve complete inflammation control and prevent complications in the long term.An important component of modern therapeutic approaches is the definition of specific markers that serve as indicators for the achievement of these therapeutic goals. These markers enable objective monitoring of the success of treatment and thus offer a clear approach for controlling the therapy. The present article focuses on the new therapeutic goals in IBD treatment and discusses the role of therapeutic target markers in clinical practice.A central goal in modern IBD therapy is endoscopic healing, i.e. the complete macroscopic healing of the intestinal mucosa. In clinical practice this includes in particular an ulcer-free mucosa. In contrast to clinical remission alone, endoscopic healing provides an objective assessment of the inflammatory state and correlates strongly with an improved long-term prognosis.The histologic remission goes beyond endoscopic healing and aims to endoscopic healing to no longer detect signs of inflammation at the microscopic level. This is particularly relevant as the results show that patients who achieve a complete histological remission have an even lower recurrence rate and better long-term results than those who only achieve a clinical or endoscopic remission.Even though no curative therapy for IBD currently exists, the complete cure remains the ultimate goal of research. In current practice, this goal is still unattainable in current practice, but progress in genetic and immunological research offers hope. In the long term, the aim is to innovative approaches such as gene editing or immunotherapy to cure the disease. This could mean that patients are not only free of symptoms, but also freed from the burden of the disease in the long term.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"427-432"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demedikalisierung – weniger ist oft mehr.","authors":"Hans-Michael Mühlenfeld","doi":"10.1055/a-2492-9679","DOIUrl":"10.1055/a-2492-9679","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"438-450"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cardiovasular diseases and multimorbidity].","authors":"Markus Gosch, Matthias Pauschinger, Thomas Deneke","doi":"10.1055/a-2361-1753","DOIUrl":"https://doi.org/10.1055/a-2361-1753","url":null,"abstract":"<p><p>Cardiovascular diseases such as arteriosclerosis, arterial hypertension, heart failure or atrial fibrillation are most prevalent in advanced age and usually occur in combination with multimorbidity and functional deficits. Recommendations from guidelines can therefore only be applied to these patient groups to a limited extent. Due to the complexity and vulnerability of multimorbid, older adults, an interdisciplinary approach to care is required. For the future, there is a great need for studies that include these patient groups, also taking into account other outcome parameters.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 9","pages":"481-486"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}