Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Mar 2023
[Immunotherapy in Hepatogastroenterology - update 2022: efficacy and immune-related adverse events].
Immune-checkpoint-inhibitors (ICI) are used for adjuvant therapy of squamous cell carcinoma and adenocarcinoma of the esophagogastric junction after prior radiotherapy. The combination of ICI with chemotherapy (CTx) is approved for first-line therapy in a palliative setting (Nivolumab and Ipilimumab) and as second-line option (Nivolumab). Squamous cell carcinoma probably has a higher response rate to ICI and Nivolumab and Ipilimumab are approved as a single therapy for this entity. ⋯ The disinhibition of the immune response by ICI can cause irAE. IrAE most frequently affect the skin, gastrointestinal tract, liver, and endocrine organs. Starting with grade 2 irAE, ICI should be paused, differential diagnosis excluded and if necessary steroid therapy has to be started. Early high-dose use of steroids negatively affects patient outcome. New therapy strategies for irAE are currently tested, such as extracorporeal photopheresis, but larger prospective trials are lacking.
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Bone and joint infections are becoming of great concern in an elderly population with growing numbers of prosthetic joints and comorbidities. This paper summarizes recently published literature on periprosthetic joint infections, vertebral osteomyelitis and diabetic foot infections. According to a new study, in the presence of a hematogenous periprosthetic infection and other inserted joint prostheses that are unremarkable on clinical examination, further invasive or imaging diagnostics may not be necessary. ⋯ Empirical therapy continues to be based on the severity of the infection and other risk factors (such as previous therapies or ischemia). Microbiological diagnosis from tissue samples is described as superior to smears. According to a randomized pilot study, 3 weeks therapy length for osteomyelitis after debridement appears to be noninferior to 6 weeks.
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Dtsch. Med. Wochenschr. · Mar 2023
Review[Methods of autoantibody diagnostics - when immunofluorescence test, when ELISA?].
The detection of circulating autoantibodies against a variety of structural and functional molecules present in ubiquitous or tissue-specific cells is critical to the diagnosis of many autoimmune diseases (systemic - such as systemic rheumatic diseases - and organ-specific diseases). In particular, the determination of autoantibodies is one of the classification and/or diagnostic criteria for some autoimmune diseases and has a relevant predictive value, since many autoantibodies can be detected years before the clinical manifestation of a disease. ⋯ Many different immunoassay methods have been developed and used in laboratory practice, from the early conventional (or monoplex) analytical methods that can detect single autoantibodies to the newer multiplex platforms that can quantify dozens of molecules. Various diagnostic immunoassays commonly used in current laboratory practice for the detection of autoantibodies are presented in this review.
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Dtsch. Med. Wochenschr. · Mar 2023
[Guideline-based digital smoking cessation with computer, tablet or smartphone].
Tobacco smoking is related with a substantial morbidity and mortality as well as with tremendous socioeconomic burden. Therefore, an early successful smoking cessation bears an enormous medical and socioeconomic importance. The gold standard of smoking cessation, a combination of behavioral und pharmacologic therapy reaches only few smokers every year and so, guideline-based, low-threshold and broadly available digital cessation support could considerably increase the annual cessation rate. With the digital cessation program "Nichtraucherhelden" such a guideline-based program is available in Germany since December 2016. ⋯ The study shows that a digital guideline-based cessation program is feasible and effectual. For confirmation a control and randomized study is required.
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The treatment of patients with chronic wounds is still an interdisciplinary and interprofessional challenge. The basis of successful therapy for these patients is based on causal treatment of the underlying, pathophysiologically relevant diseases. In addition, however, local wound therapy should always be provided to support wound healing and avoid complications. ⋯ S. T. concept is intended to provide healthcare professionals a guidance for systematic planning and also for education with regard to the local therapy of patients with chronic wounds. The 2022 update of this concept is now presented here for the first time.