Deutsche medizinische Wochenschrift (1946)最新文献

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and a leading cause of cancer-related death worldwide. The incidence is increasing globally, primarily due to the rising prevalence of chronic liver diseases. While chronic viral hepatitis (HBV, HCV) and alcohol abuse have traditionally been considered the main risk factors, metabolic dysfunction-associated steatohepatitis (MASH) is increasingly gaining importance, especially in Western industrialized nations. In the vast majority of cases, HCC develops on the basis of liver cirrhosis. When cirrhosis is present, diagnosis can usually be reliably made through dynamic imaging techniques. However, despite established surveillance programs, most cases of HCC are often diagnosed only at advanced stages, which significantly limits therapeutic options. The treatment of HCC depends on tumor stage, overall health, and liver function of the affected patients. Selecting the appropriate therapy requires a multidisciplinary decision-making process. While curative options include resection, transplantation, and local ablation, advanced stages are managed with loco-regional therapies or systemic treatments. In recent years, the therapeutic spectrum has been significantly expanded by the introduction of immune checkpoint inhibitors. Particularly, immunotherapeutic combination therapies approved for first-line treatment have significantly improved the overall survival of patients with advanced HCC. Nevertheless, the prognosis remains unfavorable in many cases, highlighting the need for further research to identify predictive biomarkers and develop innovative therapies.

Nowadays, a wide range of targeted therapies are available for the treatment of chronic lymphocytic leukemia, offering superior efficacy and a longer-lasting responses compared to chemoimmunotherapy in both first- and second-line settings. Owing to the favorable tolerability of novel targeted agents, genetic factors have superseded age and fitness as key determinants in the selection of first-line therapy. Currently, high-risk genetic features include del(17p13) or TP53 mutations, complex karyotype (≥3 chromosomal aberrations), and unmutated IGHV status. Initial risk stratification focuses on detecting del(17p13)/TP53 mutations and assessing karyotype. This new strategy, along with the improved tolerability of these agents, offers particular benefit to older and frail patients, with dosing tailored to comorbidities and concomitant therapies.Given the heterogeneity in older patients' health status, geriatric assessments (e.g., CIRS, FRAIL score) are additional key for individualized therapy decisions and adverse events influence therapy choice (e.g. cardiovascular risk with BTK inhibitors. Beyond clinical factors, patient preferences-such as opting for continuous (e.g., BTK inhibitor monotherapy) versus time-limited therapy (e.g., venetoclax plus obinutuzumab or ibrutinib plus venetoclax)-and treatment tolerability are decisive.

Langerhanscell histiocytosis (LCH) is a rare malignant disease, which commonly occurs during childhood and adolescence, but may also be seen in adult patients. Although LCH lesions are mostly found in bones, skin and the pituitary gland, the disease may affect almost each organ and cause a variety of symptoms. There are differences between pediatric and adult patients regarding diagnostics and therapy. Better insights in the pathophysiology of the disease resulted in the development of new therapeutic approaches such as the use of RAF or MAP-Kinase inhibitors and may help to guide therapy. Although each patient with LCH should be referred to a pediatric or internal oncologist, long-term interdisciplinary care is needed for many patients.

Tuberculosis remains the leading cause of death from a single infectious pathogen. Despite global health initiatives and the WHO's "End TB" Strategy, progress toward TB elimination has been slow, particularly in low- and middle-income countries.The standard treatment for drug-susceptible tuberculosis involves a 6-month combination of rifampicin, isoniazid, pyrazinamide, and ethambutol. However, results from recent clinical trials suggest that with novel treatment regimens standard tuberculosis treatment can be shortened substantially in the majority of affected patients. In the field of drug-resistant tuberculosis, innovations include 6-9-month all-oral regimens with improved efficacy and tolerability.An integrated management approach includes patient support, culturally sensitive education, management of adverse drug reactions, and close clinical monitoring. Novel diagnostic tools and biomarkers may enhance treatment monitoring in the future. Additionally, 20 new drug candidates are currently in clinical development and may offer shorter, safer, and more effective therapies.

The transition from compensated to decompensated advanced chronic liver disease (ACLD) is associated with increased mortality. Clinically significant portal hypertension (CSPH), defined by a hepatic venous pressure gradient (HVPG) ≥10 mmHg, is the main precondition of decompensation. Non-invasive tools like transient elastography help identifying patients at risk. Preventing the first decompensation, especially ascites, is a key therapeutic goal. Non-selective beta-blockers (NSBBs), particularly carvedilol, reduce portal pressure and have shown efficacy in preventing decompensation, independent of variceal status. Lifestyle modification and treating underlying liver disease (e.g., alcohol abstinence, viral eradication) remain essential. Early identification and initiation of therapy in CSPH can change the natural history of cirrhosis and improve patient outcomes.

Since 2022, an estimated 150000 to 200000 patients with heart failure (HF) in Germany have met the inclusion criteria for HF telemonitoring in accordance with the Federal Joint Committee's (G-BA) decision. Currently, only a few artificial intelligence (AI) applications are used in standard cardiovascular telemedicine care. However, AI applications could improve the predictive accuracy of existing telemedical sensor technology by recognising patterns across multiple data sources. AI-based biomarkers are also being developed for use in telemedical sensor technology. Voice analysis to recognise pulmonary congestion appears to be a promising approach. In the future, AI-based decision support systems could help optimise the diagnostic process in telemedicine centres. Large language models offer the potential to support the diagnostic process. The European Union's AI regulation has established the first framework for testing new AI-based technologies in healthcare. Real-world laboratories provide an opportunity to research innovative technologies in a protected environment.

The COVID-19 pandemic led to a sharp increase in the recognitions of COVID-19 as an occupational disease in Germany. The patients often report diverse symptoms, whereas causality and objectification remain difficult.A selective literature research in PubMed was carried out, assessment recommendations and guidelines were included, too.Long-term consequences of COVID-19 belong to various medical fields. Direct and indirect objectification are necessary. The latter requires concrete indications for the connection between COVID-19 and symptoms. An individual case assessment is also required regarding the reduction in earning capacity. Official recommendations for assessment were published shortly before this review in June 2025.Objectification is a crucial factor, whereas its implementation is complex. Effects on the degree of damage and the degree of disability should be taken into account.