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7 Fragen an den Träger des «Promotionspreises der Deutschen Gesellschaft für Thoraxchirurgie (DGT)» 2022 7问者的«Promotionspreises德国Thoraxchirurgie协会(DGT)»2022年
Pub Date : 2023-06-05 DOI: 10.1159/000530534
D. Strohleit
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引用次数: 0
NSCLC: Cemiplimab plus platinbasierte Chemotherapie NSCLC: Cemiplimab +铂基化疗
Pub Date : 2023-06-05 DOI: 10.1159/000531227
information@karger.com www.karger.com des Statistischen Bundesamtes (Stand 2020) [2] stünden bösartige Erkrankungen der Bronchien und Lunge an dritter Stelle, noch vor dem Myokardinfarkt und der Herzinsuffizienz, erläuterte Gütz. Ein Problem sei, dass die meisten Patient*innen mit NSCLC im fortgeschrittenen Stadium diag nostiziert werden. Oft führten erst die Metastasen zur Diagnose und nicht die frühen, meist noch unspezifischen Symptome des Primärtumors, ergänzte PD Dr. med. Florian Fuchs, Universitätsklinikum Erlangen.
信息(联邦统计局网站www.karger.com) 2020年版[2]在心肌梗塞和血激素衰竭之前排在了第三位。一个问题是大多数病人*在高级的阶段驯养NSCLC的病人。更多的时候,转移有利于诊断,而不是早期(多数是模糊的)原生肿瘤的症状。
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引用次数: 0
Veranstaltungskalender 酒店
Pub Date : 2023-06-05 DOI: 10.1159/000530551
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引用次数: 0
PneumoCampus
Pub Date : 2023-06-05 DOI: 10.1016/b978-3-437-22532-1.00051-3
K. Paul-Buck
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引用次数: 0
Digital Health 数字医疗
Pub Date : 2023-06-05 DOI: 10.1093/oso/9780197503133.001.0001
E. Perakslis, M. Stanley, Erin Brodwin
Digital health has been touted as a true transformation of health care, but all medical interventions have associated risks that must be understood and quantified. The Internet has brought many advancements, which quickly jumped from our computers into our pockets via powerful and completely connected mobile devices that are now being envisioned as devices for medical diagnostics and care delivery. As health care struggles with cost, inequity, value, and rapid virtualization, solid models of benefit-risk determination, new regulatory approaches for biomedical products, and clear risk-based conversations with all stakeholders are essential. Detailed examination of emerging digital health technologies has revealed 10 categories of digital side effects or “toxicities” that must be understood, prevented when possible, and managed when not. These toxicities include cyberthreat, loss of privacy, cyberchondria and cyber addiction, threats to physical security, charlatanism, overdiagnosis and overtreatment, medical/user error, and the plague of medical misinformation. For digital health to realize its promise, these toxicities must be understood, measured, warned against, and managed as concurrent side effects, in the same fashion as any other medical side effect.
数字医疗一直被吹捧为医疗保健的真正变革,但所有医疗干预措施都存在相关风险,必须加以了解和量化。互联网带来了许多进步,这些进步通过功能强大且完全连接的移动设备迅速从我们的电脑跳到我们的口袋里,这些移动设备现在被设想为医疗诊断和护理提供的设备。随着医疗保健与成本、不平等、价值和快速虚拟化的斗争,确定利益-风险的可靠模型、生物医学产品的新监管方法以及与所有利益相关者进行明确的基于风险的对话至关重要。对新兴数字卫生技术的详细审查揭示了10类数字副作用或“毒性”,这些副作用或“毒性”必须加以了解,尽可能加以预防,不能加以管理。这些危害包括网络威胁、隐私丧失、网络疑病症和网络成瘾、对人身安全的威胁、江湖骗子、过度诊断和过度治疗、医疗/用户错误以及医疗错误信息的瘟疫。为了实现数字健康的承诺,必须以与任何其他医疗副作用相同的方式,将这些毒性作为并发副作用加以理解、测量、警告和管理。
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引用次数: 4
Spektrum Pneumologie – wissenswert, kompakt, anregend
Pub Date : 2023-06-05 DOI: 10.1159/000530886
der Onkologie und der Rheumatologie, an der Kooperation beteiligt. «Die Interdisziplinarität ist eine große Stärke des neuen Lungenzentrums. Sie gewährleistet eine optimale Diag-nostik und Therapie der Lungenerkrankungen unserer Patientinnen und Patienten», betont Kreuter.
这项合作项目的主要目标是肿瘤学和风湿病学。«Interdisziplinarität是巨大力量在于新Lungenzentrums .它们确保最佳Diag-nostik和治疗肺部疾病的病人和病人»强调Kreuter .
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引用次数: 0
Digital Health 数字健康
Pub Date : 2023-06-05 DOI: 10.1159/000530742
Livia Mertens
Ein Arzt oder eine Ärztin braucht viel Erfahrung, Kenntnisse und jahrelanges Training, um etwa ein EKG profund auswerten zu können. Automatisierte Verfahren auf der Basis von KI können hier unterstützend wirken. Auch ein KI-System muss trainiert werden, und zwar (in diesem Fall) mit sehr vielen und hochwertigen EKGDaten, um beispielsweise auch kleinste Auffälligkeiten in EKGs zu finden und so zuverlässige Hinweise zur Diagnosestellung zu liefern. Was aber sind hochwertige Daten für diesen Zweck? Wann ist ein KI-System verlässlich? Das sind die Fragen, mit denen sich die PTB im Projekt TEF-Health beschäftigen wird. PTB-Wissenschaftler Daniel Schwabe leitet ein dynamisches Projektteam von PTB, Fraunhofer Heinrich-Hertz-Institut und TÜV AI Lab, das die Arbeitspakete «Standards und Qualität» und «Zertifizierung» bearbeitet. «Die PTB will darin die Qualitätssicherung von Daten als Grundlage von KI-Systemen in der Medizin maßgeblich vorantreiben», erläutert Schwabe. «So werden wir eine Basis für eine vertrauenswürdige Verwendung von KI innerhalb der EU schaffen», ergänzt Prof. Tobias Schäffter. Er ist Leiter der PTB-Abteilung «Medizinphysik und metrologische Informationstechnik», hat die Projektgruppe initiiert und begleitet sie strategisch. KI in der Medizin (Symbolbild). © PTB. Physikalisch-Technische Bundesanstalt Von der KI-Software zu Operationsrobotern
例如,医生需要大量的经验、知识和多年的培训才能深入分析心电图。基于人工智能的自动程序可以在这方面提供支持。人工智能系统也需要经过培训,而且(在这种情况下)需要大量高质量的心电图数据,才能发现心电图中最微小的异常,从而为诊断提供可靠的信息。但什么是高质量的数据?什么时候人工智能系统才是可靠的?这些都是 PTB 将在 TEF-Health 项目中解决的问题。PTB 科学家丹尼尔-施瓦布(Daniel Schwabe)领导着一个充满活力的项目团队,该团队来自 PTB、弗劳恩霍夫海因里希-赫兹研究所(Fraunhofer Heinrich Hertz Institute)和 TÜV 人工智能实验室(TÜV AI Lab),负责 "标准与质量 "和 "认证 "工作包。"PTB希望大力推进数据的质量保证,将其作为医疗领域人工智能系统的基础,"Schwabe解释道。"Tobias Schäffter 教授补充说:"通过这种方式,我们将为在欧盟范围内可信地使用人工智能奠定基础。他是 PTB "医学物理和计量信息技术 "部门的负责人,发起了该项目组并提供战略支持。医学中的人工智能(符号图像)。PTB.从人工智能软件到手术机器人
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引用次数: 0
PharmaNews
Pub Date : 2023-06-05 DOI: 10.1159/000531223
W. Schütte
Die Therapielandschaft beim Lungenkarzinom ist in den letzten Jahren deut­ lich umfassender, individueller und damit auch komplexer geworden. Das ist das Ergebnis einer Reihe neuer Erkenntnisse zu Diagnostik und Therapiemög­ lichkeiten. In der Folge sollen die aktualisierten Leitlinien es den Therapeut*in­ nen erleichtern, fundierte Entscheidungen zu treffen: Die Einführung der Krebsimmuntherapie beim primär operablen nichtkleinzelligen Lungenkar­ zinom (NSCLC) sowie beim fortgeschrittenen kleinzelligen Lungenkarzinom (ES­SCLC), eine umfassendere und frühzeitige Biomarker­Testung beim NSCLC – die kürzlich aktualisierten S3­ [1] und Onkopedia­Leitlinien [2, 3] hal­ ten einige praxisrelevante Neuerungen bereit. So empfehlen die Leitlinien nun beim primär operablen NSCLC die adjuvante Krebsimmuntherapie (KIT) mit dem PD­L1­Inhibitor Tecentriq. Diese Neue­ rung ist gleichzeitig mit einer Empfehlung zur frühzeitigen Bestimmung des PD­L1­Status mittels Immunhistochemie verbunden: Die adjuvante Krebs­ immuntherapie mit Tecentriq soll allen Patient*innen vom Stadium II bis IIIA mit einer PD­L1­Expression von ≥ 50% auf Tumorzellen (ohne EGFR­ oder ALK­Alteration) nach vollständiger Resektion und durchgeführter postopera­ tiver Chemotherapie angeboten werden [1, 2].
近年来,肺癌的治疗由此变得更加个人化,更具个人破坏力。这是一些有关诊断和治疗方法的新研究的结果。随后应修订的准则,协助医生*溜进作出知情决定:引入Krebsimmuntherapie主要起着operablen nichtkleinzelligen Lungenkar zinom (NSCLC)和起亚先进kleinzelligen Lungenkarzinom (ES-SCLC)更全面地和早期Biomarker-Testung在NSCLC,最近修订的300 -[1]和[2,3]Onkopedia-Leitlinien哈尔)。一些praxisrelevante创新准备.比如,现在准则主要是对NSCLC的治疗建议建议使用pet / l中和剂Tecentriq进行治疗。这个新的rung是同时同时建议,尽早确定优先权PD-L1-Status通过Immunhistochemie相连:Tecentriq用于杀灭癌症——immuntherapie叫所有病人*里面从第二阶段到紫色PD-L1-Expression≥50%,而肿瘤细胞(EGFR或索性Resektion ALK-Alteration)和美国对化疗tiver postopera治疗提供[1,2].
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引用次数: 0
MPA-ILD: Eine seltene Manifestation mit schwieriger Diagnose 一种难诊断的罕见现象
Pub Date : 2023-05-09 DOI: 10.1159/000530755
F. Drakopanagiotakis, A. Günther
Background: Interstitial lung disease (ILD) is a significant complication associated with microscopic polyangiitis (MPA) that has a poor prognosis. However, the longterm clinical course, outcomes, and prognostic factors of MPA-ILD are not well defined. Hence, this study aimed to investigate the long-term clinical course, outcomes, and prognostic factors in patients with MPA-ILD. Methods: Clinical data of 39 patients with MPA-ILD (biopsy proven cases, n = 6) were retrospectively analyzed. High resolution computed tomography (HRCT) patterns were assessed based on the 2018 idiopathic pulmonary fibrosis diagnostic criteria. Acute exacerbation (AE) was defined as the worsening of dyspnea within 30 days, with new bilateral lung infiltration that is not fully explained by heart failure or fluid overload and that does not have identified extra-parenchymal causes (pneumothorax, pleural effusion, or pulmonary embolism). Results: The median follow-up period was 72.0 months (interquartile range: 44–117 months). The mean age of the patients was 62.7 years and 59.0% were male. Usual interstitial pneumonia (UIP) and probable usual interstitial pneumonia patterns on high resolution computed tomography were identified in 61.5 and 17.9% of the patients, respectively. During the follow-up, 51.3% of patients died, and the 5- and 10-year overall survival rates were 73.5% and 42.0%, respectively. Acute exacerbation occurred in 17.9% of the patients. The non-survivors had higher neutrophil counts in bronchoalveolar lavage (BAL) fluid and more frequent acute exacerbation than the survivors. In the multivariable Cox analysis, older age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.01–1.14; p = 0.028) and higher BAL counts (HR, 1.09; 95% CI, 1.01–1.17; p = 0.015) were found to be the independent prognostic factors associated with mortality in patients with MPA-ILD. Conclusion: During the 6 years-follow-up, about half of patients with MPA-ILD died and approximately one-fifth experienced acute exacerbation. Our results suggest that older age and higher BAL neutrophil counts mean poor prognosis in patients with MPA-ILD.
背景:间质性肺疾病(ILD)是与显微多血管炎(MPA)相关的重要并发症,预后不良。然而,MPA-ILD的长期临床病程、预后和预后因素尚未明确。因此,本研究旨在探讨MPA-ILD患者的长期临床病程、预后和预后因素。方法:回顾性分析39例MPA-ILD患者(活检证实病例6例)的临床资料。根据2018年特发性肺纤维化诊断标准评估高分辨率计算机断层扫描(HRCT)模式。急性加重(AE)定义为30天内呼吸困难加重,伴有新的双侧肺浸润,不能完全由心力衰竭或体液超载解释,也不能确定肺实质外原因(气胸、胸腔积液或肺栓塞)。结果:中位随访时间为72.0个月(四分位数范围:44-117个月)。患者平均年龄62.7岁,男性占59.0%。在高分辨率计算机断层扫描中,分别有61.5%和17.9%的患者发现了常见性间质性肺炎(UIP)和可能的常见性间质性肺炎。随访期间,51.3%的患者死亡,5年和10年总生存率分别为73.5%和42.0%。17.9%的患者出现急性加重。非幸存者在支气管肺泡灌洗液(BAL)中有较高的中性粒细胞计数,并且比幸存者更频繁的急性加重。在多变量Cox分析中,年龄较大(风险比[HR], 1.07;95%置信区间[CI], 1.01-1.14;p = 0.028), BAL计数较高(HR, 1.09;95% ci, 1.01-1.17;p = 0.015)是与MPA-ILD患者死亡率相关的独立预后因素。结论:在6年的随访中,大约一半的MPA-ILD患者死亡,大约五分之一的患者急性加重。我们的研究结果表明,年龄较大和BAL中性粒细胞计数较高意味着MPA-ILD患者预后较差。
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引用次数: 0
Pleurodese durch getunnelten Pleurakatheter: Können wir den Erfolg vorhersagen? 我们可以预测成功吗?
Pub Date : 2023-04-28 DOI: 10.1159/000530735
S. Keymel
Background: A well-recognized therapy to improve the symptoms of patients with malignant pleural effusion (MPE), indwelling pleural catheters (IPCs) can also achieve spontaneous pleurodesis. Chemical pleurodesis is associated with a significant pro-coagulation and fibrinolytic environment. Hence, anticoagulation could theoretically interfere with this process. Objective: The aim of this study was to evaluate if anticoagulation can interfere with successful spontaneous pleurodesis in patients treated with IPC. Methods: This was a cohort study of all patients with MPE treated with IPC. The primary objective was to determine if anticoagulant use after IPC placement decreased the rate of spontaneous pleurodesis. The secondary objective was to identify other factors associated with spontaneous pleurodesis. We used a Fine-Gray subdistribution hazard model and a direct acyclic graph to identify variables associated with time to spontaneous pleurodesis. Results: Of the included 410 patients, 210 patients (51.2%) achieved pleurodesis and had their IPC removed. We found no association between anticoagulation and likelihood of pleurodesis. Multivariate analyses revealed that prior chemotherapy, ECOG score of 2–4 were associated with unsuccessful pleurodesis, while chemotherapy or radiotherapy after IPC placement remained associated with increased likelihood of spontaneous pleurodesis. Conclusions: We failed to demonstrate an association between anticoagulation and pleurodesis. We found that better performance status and chemotherapy or radiotherapy after IPC placement can increase the rate of pleurodesis and catheter removal.
背景:留置胸膜导管(IPCs)是一种公认的改善恶性胸腔积液(MPE)患者症状的治疗方法,也可以实现自发性胸膜积液。化学性胸膜穿刺术与显著的促凝和纤溶环境有关。因此,抗凝剂理论上可以干扰这一过程。目的:本研究的目的是评估抗凝是否会干扰IPC患者成功的自发性胸膜切除术。方法:这是一项队列研究,纳入了所有接受IPC治疗的MPE患者。主要目的是确定IPC放置后使用抗凝剂是否降低自发性胸膜切除术的发生率。次要目的是确定与自发性胸膜切除术相关的其他因素。我们使用Fine-Gray亚分布风险模型和直接无环图来识别与自发性胸膜切除术时间相关的变量。结果:在纳入的410例患者中,210例(51.2%)患者实现了胸膜切除术并切除了IPC。我们没有发现抗凝和胸膜萎缩之间的联系。多因素分析显示,先前的化疗,ECOG评分2-4与不成功的胸膜切除术有关,而IPC放置后的化疗或放疗仍然与自发性胸膜切除术的可能性增加有关。结论:我们未能证明抗凝和胸膜穿刺术之间的联系。我们发现IPC放置后较好的表现状态和化疗或放疗可以增加胸膜切除术和导管拔除的发生率。
{"title":"Pleurodese durch getunnelten Pleurakatheter: Können wir den Erfolg vorhersagen?","authors":"S. Keymel","doi":"10.1159/000530735","DOIUrl":"https://doi.org/10.1159/000530735","url":null,"abstract":"Background: A well-recognized therapy to improve the symptoms of patients with malignant pleural effusion (MPE), indwelling pleural catheters (IPCs) can also achieve spontaneous pleurodesis. Chemical pleurodesis is associated with a significant pro-coagulation and fibrinolytic environment. Hence, anticoagulation could theoretically interfere with this process. Objective: The aim of this study was to evaluate if anticoagulation can interfere with successful spontaneous pleurodesis in patients treated with IPC. Methods: This was a cohort study of all patients with MPE treated with IPC. The primary objective was to determine if anticoagulant use after IPC placement decreased the rate of spontaneous pleurodesis. The secondary objective was to identify other factors associated with spontaneous pleurodesis. We used a Fine-Gray subdistribution hazard model and a direct acyclic graph to identify variables associated with time to spontaneous pleurodesis. Results: Of the included 410 patients, 210 patients (51.2%) achieved pleurodesis and had their IPC removed. We found no association between anticoagulation and likelihood of pleurodesis. Multivariate analyses revealed that prior chemotherapy, ECOG score of 2–4 were associated with unsuccessful pleurodesis, while chemotherapy or radiotherapy after IPC placement remained associated with increased likelihood of spontaneous pleurodesis. Conclusions: We failed to demonstrate an association between anticoagulation and pleurodesis. We found that better performance status and chemotherapy or radiotherapy after IPC placement can increase the rate of pleurodesis and catheter removal.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130252883","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}
引用次数: 0
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Kompass Pneumologie
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