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Schwarz C, Bauer D, Dorn L, Jachs M, Hartl L, Chromy D, Weseslindtner L, Pfisterer N, Hennlich B, Stückler A, Strassl R, Voill-Glaninger A, Hübl W, Willheim M, Köhrer K, Jansen-Skoupy S, Tomez S, Krugluger W, Madl C, Schwarz M, Balcar L, Semmler G, Brinkmann L, Burghart L, Antonitsch L, Weidinger G, Riedl F, Laferl H, Kurteva V, Traugott M, Hind J, Wenisch C, Aburaia A, Sebesta C, Schmid D, Rothweiler S, Remetic J, Gschwantler M, Maieron A, Reiberger T. ELIMINATE: a PCR record-based macroelimination project for systematic recall of HCV-RNA-positive persons in Austria. Wien Klin Wochenschr 2024; 136:278-288. [PMID: 37773541 PMCID: PMC11078856 DOI: 10.1007/s00508-023-02275-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/23/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND AND AIMS Micro-elimination projects targeted to specific hepatitis C virus (HCV) risk populations have been successful. Systematic identification of persons with HCV viremia, regardless of risk group, based on already available laboratory records may represent an effective macroelimination approach to achieve global HCV elimination. METHODS Persons with a last positive HCV-RNA PCR result between 2008-2020 in the reference virology laboratories in eastern Austria were identified. First, (i) we described their demographic characteristics, (ii) we systematically recalled persons to the respective centers and (iii) started antiviral treatment if HCV-RNA viremia was confirmed, and (iv) recorded sustained virologic response (SVR). This interim report includes the preliminary results from 8 participating centers. RESULTS During the study period 22,682 persons underwent HCV-RNA PCR testing, 11,216 (49.4%) were positive at any point in time, and 6006 (26.5%) showed detectable HCV-RNA at the last PCR test, suggesting ongoing HCV viremia. At the time of this interim report, 2546/6006 HCV-RNA PCR(+) persons were evaluated: 443/2546 (17.4%) had died, 852/2546 (33.5%) had invalid contact data, and 547/2546 (21.5%) had achieved SVR between data retrieval and recall. Contact could be established in 236/704 (33.5%) of the remaining target population with 97/236 (41.1%) presenting at the clinic for treatment evaluation. Ultimately, 71/236 (30.1%) started antiviral treatment and SVR was documented in 47/71 (66.2%). CONCLUSION This ELIMINATE project based on systematic assessment of HCV-RNA PCR-records, identified 6006 persons with potential persisting HCV viremia. Invalid contact data and missed visits for treatment evaluation were the main barriers towards HCV elimination within this project. Importantly, many subjects with HCV viremia lost to follow-up were successfully linked to care and started antiviral treatment.
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Affiliation(s)
- Caroline Schwarz
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - David Bauer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Livia Dorn
- Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, St. Pölten, Austria
| | - Mathias Jachs
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - Lukas Hartl
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - David Chromy
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Nikolaus Pfisterer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine IV, Klinik Landstraße, Vienna, Austria
| | - Barbara Hennlich
- Department of Internal Medicine IV, Klinik Landstraße, Vienna, Austria
| | - Annika Stückler
- Department of Internal Medicine IV, Klinik Landstraße, Vienna, Austria
| | - Robert Strassl
- Clinical Institute for Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Wolfgang Hübl
- Central Laboratory, Klinik Ottakring, Vienna, Austria
| | - Martin Willheim
- Clinical Institute of Laboratory Medicine, University Clinic St. Pölten, St. Pölten, Austria
| | - Karin Köhrer
- Institute of Medical-Chemical and Molecularbiological Laboratory Diagnostics with Blood Depot, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | | | - Sabine Tomez
- Institute of Laboratory Medicine with Blood Depot, Klinik Donaustadt, Vienna, Austria
| | - Walter Krugluger
- Institute of Laboratory Medicine with Blood Depot, Klinik Donaustadt, Vienna, Austria
- Institute of Laboratory Medicine and Blood Depot, Klinik Floridsdorf, Vienna, Austria
| | - Christian Madl
- Department of Internal Medicine IV, Klinik Landstraße, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
| | - Michael Schwarz
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Lorenz Balcar
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - Georg Semmler
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - Leonard Brinkmann
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Lukas Burghart
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Lukas Antonitsch
- Department of Internal Medicine, Gastroenterology and Hepatology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Gerhard Weidinger
- Department of Internal Medicine, Gastroenterology and Hepatology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Florian Riedl
- Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, St. Pölten, Austria
| | - Hermann Laferl
- Department of Internal Medicine IV, Klinik Favoriten, Vienna, Austria
| | - Vesselina Kurteva
- Department of Internal Medicine IV, Klinik Favoriten, Vienna, Austria
| | - Marianna Traugott
- Department of Internal Medicine IV, Klinik Favoriten, Vienna, Austria
| | - Julian Hind
- Department of Internal Medicine IV, Klinik Favoriten, Vienna, Austria
| | - Christoph Wenisch
- Department of Internal Medicine IV, Klinik Favoriten, Vienna, Austria
| | - Abdelrahman Aburaia
- Department of Internal Medicine and Gastroenterology, Klinik Floridsdorf, Vienna, Austria
| | - Christian Sebesta
- Department of Internal Medicine and Gastroenterology, Klinik Floridsdorf, Vienna, Austria
- Department of Internal Medicine II, Klinik Donaustadt, Vienna, Austria
| | - Daniela Schmid
- Österreichische Agentur für Gesundheit und Ernährungssicherheit GmbH (AGES), Vienna, Austria
| | | | | | - Michael Gschwantler
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
| | - Andreas Maieron
- Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, St. Pölten, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria.
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Prosenz J, Stättermayer MS, Riedl F, Maieron A. Adherence to guidelines in patients with non-variceal upper gastrointestinal bleeding (UGIB) - results from a retrospective single tertiary center registry. Scand J Gastroenterol 2023; 58:856-862. [PMID: 36855301 DOI: 10.1080/00365521.2023.2183734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/12/2023] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Guidelines for the management of upper gastrointestinal bleeding (UGIB) are regularly published, yet little is known concerning adherence to recommendations in practice. OBJECTIVES We aimed to assess adherence to European Society of Gastrointestinal Endoscopy (ESGE) recommendations in patients with non-variceal UGIB. MATERIALS AND METHODS All hospitalized patients with an esophagogastroduodenoscopy (EGD) performed due to suspected non-variceal UGIB at our department were included in a prospective registry. Data between 2018-2020 from this registry were retrospectively analyzed. Adherence to the 2015 ESGE bleeding and propofol sedation guidelines was assessed. Adherence to recommendations concerning preendoscopic (risk) evaluation, preendoscopic PPI, transfusion management, and endoscopic management of peptic ulcers was analyzed. RESULTS Among 1005 patients (mean age 70.4 years, 42.1% women) the most common bleeding etiologies were gastric or duodenal ulcers (16.8%), esophagitis/GERD (11.1%), and angiodysplasia (9.9%); mortality was 7.6%. Adherence to preendosopic risk evaluation was low, in 0% a Mallampati classification and in 37.5% an ASA scoring was documented. Preendoscopic PPI was started at 58.6%, and adherence to recommended transfusion management was >98%. Peptic ulcers were Forrest-graded in 72.8%. High-risk ulcers were treated appropriately in 77.9% and low-risk ulcers were not treated in 73.6%. Especially Forrest Ib ulcers were undertreated, with an adherence of 59.6%. Only 22/179 (12.3%) patients with peptic ulcers and early endoscopy were consistently managed according to ESGE recommendations. CONCLUSIONS Adherence to ESGE guidelines in patients with non-variceal UGIB is moderate to low, even at a tertiary university hospital. Strategies must be devised for guidelines to reach patients in everyday practice.
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Affiliation(s)
- Julian Prosenz
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
- Research Programme for Medical Science, Paracelsus Medical University, Salzburg, Austria
| | - Marie-Sophie Stättermayer
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
| | - Florian Riedl
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
| | - Andreas Maieron
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
- Research Programme for Medical Science, Paracelsus Medical University, Salzburg, Austria
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Schwabl P, Seeland BA, Riedl F, Schubert TL, Königshofer P, Brusilovskaya K, Petrenko O, Hofer B, Schiefer AI, Trauner M, Peck-Radosavljevic M, Reiberger T. Splenectomy ameliorates portal pressure and anemia in animal models of cirrhotic and non-cirrhotic portal hypertension. Adv Med Sci 2022; 67:154-162. [PMID: 35272246 DOI: 10.1016/j.advms.2022.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/30/2021] [Accepted: 02/23/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE Portal hypertension (PH)-associated splenomegaly is caused by portal venous congestion and splanchnic hyperemia. This can trigger hypersplenism, which favors the development of cytopenia. We investigated the time-dependent impact of splenectomy on portal pressure and blood cell counts in animal models of non-cirrhotic and cirrhotic PH. MATERIALS AND METHODS Ninety-six rats underwent either partial portal vein ligation (PPVL), bile duct ligation (BDL), or sham operation (SO), with subgroups undergoing additional splenectomy. Portal pressure, mean arterial pressure, heart rate, blood cell counts and hemoglobin concentrations were evaluated throughout 5 weeks following surgery. RESULTS Following PPVL or BDL surgery, the animals presented a progressive rise in portal pressure, paralleled by decreased mean arterial pressure and accelerated heart rate. Splenectomy curbed the development of PH in both models (PPVL: 16.25 vs. 17.93 mmHg, p = 0.083; BDL: 13.55 vs. 15.23 mmHg, p = 0.028), increased mean arterial pressure (PPVL: +7%; BDL: +9%), and reduced heart rate (PPVL: -10%; BDL: -13%). Accordingly, splenectomized rats had lower von Willebrand factor plasma levels (PPVL: -22%; BDL: -25%). Splenectomy resulted in higher hemoglobin levels in PPVL (14.15 vs. 13.08 g/dL, p < 0.001) and BDL (13.20 vs. 12.39 g/dL, p = 0.097) animals, and significantly increased mean corpuscular hemoglobin concentrations (PPVL: +9%; BDL: +15%). Thrombocytopenia only developed in the PPVL model and was alleviated in the splenectomized subgroup. Conversely, BDL rats presented with thrombocytosis, which was not affected by splenectomy. CONCLUSIONS Splenectomy improves both cirrhotic and non-cirrhotic PH, and ameliorates the hyperdynamic circulation. Hypersplenism related anemia and thrombocytopenia were only significantly improved in the non-cirrhotic PH model.
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Affiliation(s)
- Philipp Schwabl
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Experimental (HEPEX) Laboratory, Medical University of Vienna, Vienna, Austria; Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Berit Anna Seeland
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Experimental (HEPEX) Laboratory, Medical University of Vienna, Vienna, Austria
| | - Florian Riedl
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Experimental (HEPEX) Laboratory, Medical University of Vienna, Vienna, Austria
| | - Tim Lukas Schubert
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Experimental (HEPEX) Laboratory, Medical University of Vienna, Vienna, Austria
| | - Philipp Königshofer
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Experimental (HEPEX) Laboratory, Medical University of Vienna, Vienna, Austria; Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Ksenia Brusilovskaya
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Experimental (HEPEX) Laboratory, Medical University of Vienna, Vienna, Austria; Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Oleksandr Petrenko
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Experimental (HEPEX) Laboratory, Medical University of Vienna, Vienna, Austria; Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Ludwig Boltzmann Institute, Vienna, Austria; CeMM Research Center for Molecular Medicine, Austrian Academy of Sciences, Vienna, Austria
| | - Benedikt Hofer
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Experimental (HEPEX) Laboratory, Medical University of Vienna, Vienna, Austria; Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Ana-Iris Schiefer
- Division of Pathology, Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Markus Peck-Radosavljevic
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Experimental (HEPEX) Laboratory, Medical University of Vienna, Vienna, Austria; Innere Medizin und Gastroenterologie (IMuG), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Thomas Reiberger
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Experimental (HEPEX) Laboratory, Medical University of Vienna, Vienna, Austria; Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Ludwig Boltzmann Institute, Vienna, Austria; CeMM Research Center for Molecular Medicine, Austrian Academy of Sciences, Vienna, Austria.
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Ciattaglia S, Federici G, Barucca L, de Magistris M, Gaio E, Gliss C, Koerber M, Moscato I, Porfiri MT, Riedl F, Tarallo A. Key EU DEMO plant and building layout criteria. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gliss C, Bachmann C, Ciattaglia S, García M, Federici G, Koerber M, Moscato I, Riedl F, Palermo I, Utili M. Integration of DEMO hazard piping into the tokamak building. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Casagrande R, Faugel H, Fischer F, Fünfgelder H, Riedl F, Siegl G, Bettini P, Noterdaeme JM, Crombé K. Development of an experimental facility for the study of microparticle initiated radio frequency vacuum breakdown. Rev Sci Instrum 2021; 92:013508. [PMID: 33514254 DOI: 10.1063/5.0034559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
An ongoing objective in the ion cyclotron range of frequencies (ICRF) systems is the improvement of power coupling to the plasma. During the last decade, this goal has been mainly pursued through the study of the coupling resistance, either by optimizing the antenna layout or by tailoring the scrape-off layer profile with gas puffing. Another approach is to increase the voltage handling capability of the ICRF system, limited by breakdown in the launchers or in the transmission lines. This paper describes the design of the ICRF Breakdown EXperiment (IBEX), a device to investigate fundamental aspects of radio frequency arcs under ICRF-relevant conditions. IBEX can achieve a peak voltage of 48 kV at 54 MHz with a 5 kW input power.
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Affiliation(s)
- R Casagrande
- Department of Applied Physics, Ghent University, 9000 Gent, Belgium
| | - H Faugel
- Max-Planck-Institut für Plasmaphysik, 85748 Garching, Germany
| | - F Fischer
- Max-Planck-Institut für Plasmaphysik, 85748 Garching, Germany
| | - H Fünfgelder
- Max-Planck-Institut für Plasmaphysik, 85748 Garching, Germany
| | - F Riedl
- Max-Planck-Institut für Plasmaphysik, 85748 Garching, Germany
| | - G Siegl
- Max-Planck-Institut für Plasmaphysik, 85748 Garching, Germany
| | - P Bettini
- Università degli Studi di Padova, 35122 Padova, Italy
| | - J-M Noterdaeme
- Department of Applied Physics, Ghent University, 9000 Gent, Belgium
| | - K Crombé
- Department of Applied Physics, Ghent University, 9000 Gent, Belgium
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Wenzel S, Riedl F, Engell S. An efficient hierarchical market-like coordination algorithm for coupled production systems based on quadratic approximation. Comput Chem Eng 2020. [DOI: 10.1016/j.compchemeng.2019.106704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Pfisterer N, Riedl F, Pachofszky T, Gschwantler M, König K, Schuster B, Mandorfer M, Gessl I, Illiasch C, Fuchs E, Unger L, Dolak W, Maieron A, Kramer L, Madl C, Trauner M, Reiberger T. Outcomes after placement of a SX-ELLA oesophageal stent for refractory variceal bleeding-A national multicentre study. Liver Int 2019; 39:290-298. [PMID: 30248224 PMCID: PMC6587452 DOI: 10.1111/liv.13971] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/25/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Current guidelines favour the use of bleeding stents over balloon tamponade (BT) for refractory variceal bleeding (VB) from oesophageal varices. However, data on the efficacy and safety of self-expandable metal SX-ELLA Danis stents (SEMS) are limited. METHODS Cirrhotic patients receiving SEMS for VB at four tertiary care centres were included in this retrospective multicentre study. Rates of failure-to-control bleeding (within 5 days) and bleeding-related mortality (6 weeks) were assessed. RESULTS SEMS controlled VB in 79.4% (27/34) of patients. In the rest of patients, other rescue treatments including endoscopic band ligation (EBL, n = 3), SEMS renewed (n = 2) or Linton (n = 2) were applied; however, VB was only controlled in one patient. Early rebleeding within six weeks occurred in 17.6% (6/34) patients. Median SEMS dwell time was three (IQR:6) days. Overall n = 13/34 (38.2%) patients died with SEMS in situ. After SEMS removal, rebleeding and bleeding-related death occurred in n = 7 (35%) and n = 5 (14.7%) patients respectively. Only 32.4% (10/34) patients did not experience any rebleeding within six weeks after SEMS removal. Bleeding-related mortality was 47.1% (n = 16/34) and the median survival after SEMS placement was 2.1 months. Notably, no patient received an early transjugular intrahepatic portosystemic shunt (TIPS). The most common adverse events were stent dislocations (n = 13; 38.2%), while ulcers/necrosis of the oesophageal mucosa was seen in only four (11.8%) patients. CONCLUSION SEMS controlled refractory VB in most patients. However, bleeding-related mortality remained high. While SEMS dislocations were frequent, ulcers/necrosis of the oesophagus was rare. Further studies should investigate whether the wider use of early TIPS reduces bleeding-related mortality after SEMS placement.
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Affiliation(s)
- Nikolaus Pfisterer
- Divsion of Gastroenterology and Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria,Vienna Hepatic Hemodynamic Laboratory, Medical University of ViennaViennaAustria,Division of Gastroenterology and HepatologyKrankenanstalt Rudolfstiftung, Krankenanstaltenverbund Wien (KAV)ViennaAustria
| | - Florian Riedl
- Vienna Hepatic Hemodynamic Laboratory, Medical University of ViennaViennaAustria,Division of Gastroenterology and HepatologyUniversitätsklinikum St. PöltenSt. PöltenAustria
| | - Thomas Pachofszky
- Division of Gastroenterology and HepatologyKrankenanstalt Rudolfstiftung, Krankenanstaltenverbund Wien (KAV)ViennaAustria
| | - Michael Gschwantler
- Wilhelminenspital, Krankenanstaltenverbund Wien (KAV)ViennaAustria,Sigmund Freud University, Private Medical SchoolViennaAustria
| | - Kurt König
- Division of Rheumatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Benjamin Schuster
- Divsion of Gastroenterology and Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria,Vienna Hepatic Hemodynamic Laboratory, Medical University of ViennaViennaAustria,Division of Gastroenterology and HepatologyKrankenanstalt Rudolfstiftung, Krankenanstaltenverbund Wien (KAV)ViennaAustria
| | - Mattias Mandorfer
- Divsion of Gastroenterology and Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria,Vienna Hepatic Hemodynamic Laboratory, Medical University of ViennaViennaAustria
| | - Irina Gessl
- Divsion of Gastroenterology and Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria,Division of General Surgery, Department of SurgeryMedical University of ViennaViennaAustria
| | - Constanze Illiasch
- Division of Gastroenterology and HepatologyKrankenanstalt Rudolfstiftung, Krankenanstaltenverbund Wien (KAV)ViennaAustria
| | - Eva‐Maria Fuchs
- Division of Gastroenterology and HepatologyKrankenanstalt Rudolfstiftung, Krankenanstaltenverbund Wien (KAV)ViennaAustria
| | - Lukas Unger
- Vienna Hepatic Hemodynamic Laboratory, Medical University of ViennaViennaAustria,Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Krankenanstaltenverbund Wien (KAV)ViennaAustria
| | - Werner Dolak
- Divsion of Gastroenterology and Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Andreas Maieron
- Division of Gastroenterology and HepatologyUniversitätsklinikum St. PöltenSt. PöltenAustria
| | - Ludwig Kramer
- Division of Rheumatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Christian Madl
- Division of Gastroenterology and HepatologyKrankenanstalt Rudolfstiftung, Krankenanstaltenverbund Wien (KAV)ViennaAustria,Sigmund Freud University, Private Medical SchoolViennaAustria
| | - Michael Trauner
- Divsion of Gastroenterology and Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria,Vienna Hepatic Hemodynamic Laboratory, Medical University of ViennaViennaAustria
| | - Thomas Reiberger
- Divsion of Gastroenterology and Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria,Vienna Hepatic Hemodynamic Laboratory, Medical University of ViennaViennaAustria
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Reiberger T, Bucsics T, Paternostro R, Pfisterer N, Riedl F, Mandorfer M. Small Esophageal Varices in Patients with Cirrhosis-Should We Treat Them? Curr Hepatol Rep 2018; 17:301-315. [PMID: 30546995 PMCID: PMC6267385 DOI: 10.1007/s11901-018-0420-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW The natural history and classification systems of small varices (≤ 5 mm in diameter) in cirrhotic patients with portal hypertension are summarized. Studies that assessed the course of and therapeutic intervention for small varices are discussed. RECENT FINDINGS Current non-invasive methods show suboptimal sensitivity to detect small varices in patients with cirrhosis. Next to etiological therapy, hepatic venous pressure gradient (HVPG)-guided non-selective betablocker or carvedilol treatment has shown to impact on natural history of small varices. SUMMARY The main therapeutic focus in cirrhotic patients with small varices is the cure of the underlying etiology. The optimal management of small varices should include measurement of HVPG. A pharmacological decrease in HVPG by non-selective betablocker therapy of ≥ 10% reduces the risk of progression to large varices, first variceal bleeding, and hepatic decompensation. If HVPG is not available, we would recommend carvedilol 12.5 mg q.d. for treatment of small varices in compensated patients without severe ascites. Only if small esophageal varices (EV) are not treated or in hemodynamic non-responders, follow-up endoscopies should be performed in 1-2 years of intervals considering the activity of liver disease or if hepatic decompensation occurs.
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Affiliation(s)
- Thomas Reiberger
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Theresa Bucsics
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Rafael Paternostro
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Pfisterer
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Florian Riedl
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology, Medicine II, Universitätsklinikum St. Pölten, St. Pölten, Austria
| | - Mattias Mandorfer
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
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10
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Schwabl P, Brusilovskaya K, Supper P, Bauer D, Königshofer P, Riedl F, Hayden H, Fuchs CD, Stift J, Oberhuber G, Aschauer S, Bonderman D, Gnad T, Pfeifer A, Uschner FE, Trebicka J, Rohr-Udilova N, Podesser BK, Peck-Radosavljevic M, Trauner M, Reiberger T. The soluble guanylate cyclase stimulator riociguat reduces fibrogenesis and portal pressure in cirrhotic rats. Sci Rep 2018; 8:9372. [PMID: 29921982 PMCID: PMC6008436 DOI: 10.1038/s41598-018-27656-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/05/2018] [Indexed: 01/22/2023] Open
Abstract
In cirrhotic patients, portal hypertension (PHT) deteriorates survival, yet treatment options are limited. A major contributor to increased intrahepatic vasoconstriction in PHT is dysfunctional nitric-oxide signaling. Soluble guanylate cyclase (sGC) is the receptor of nitric-oxide and can be stimulated by riociguat. Riociguat is approved for pulmonary hypertension but has not been studied in liver cirrhosis. In this study we assessed the effects of riociguat on PHT and liver fibrosis in cholestatic (bile duct ligation, BDL) and toxic (carbon-tetrachloride, CCl4) rat models. In cirrhotic livers sGC expression was upregulated. In BDL rats, riociguat reduced liver fibrosis and decreased portal pressure without affecting systemic hemodynamics. In an early BDL disease stage, riociguat decreased bile duct proliferation, improved sinusoidal vascular dysfunction and inhibited angiogenesis. In advanced BDL riociguat exhibited anti-inflammatory effects. In CCl4 rats the beneficial effects of riociguat treatment were less pronounced and confined to an early disease stage. Similarly, in patients with cholestatic cirrhosis and PHT nitrates (that induce sGC activity) decreased portal pressure more effectively than in patients with non-cholestatic etiology. We also found an improvement of transaminases in patients with pulmonary hypertension receiving riociguat. Our findings support the clinical development of sGC stimulators in patients with cirrhotic PHT.
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Affiliation(s)
- Philipp Schwabl
- Division of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Vienna, Austria
| | - Ksenia Brusilovskaya
- Division of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Vienna, Austria
| | - Paul Supper
- Division of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Vienna, Austria
| | - David Bauer
- Division of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Vienna, Austria
| | - Philipp Königshofer
- Division of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Vienna, Austria
| | - Florian Riedl
- Division of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Vienna, Austria
| | - Hubert Hayden
- Division of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Vienna, Austria
| | - Claudia Daniela Fuchs
- Division of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Judith Stift
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Georg Oberhuber
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Stefan Aschauer
- Division of Cardiology, Dept. of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Diana Bonderman
- Division of Cardiology, Dept. of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thorsten Gnad
- Institute of Pharmacology and Toxicology, University of Bonn, Bonn, Germany
| | - Alexander Pfeifer
- Institute of Pharmacology and Toxicology, University of Bonn, Bonn, Germany
| | | | - Jonel Trebicka
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- Department of Gastroenterology, Odense Hospital, University of Southern Denmark, Odense, Denmark
- European Foundation of the Study of Chronic Liver Failure - EF CLIF, Barcelona, Spain
- Institute for Bioengineering of Catalonia, Barcelona, Spain
| | - Nataliya Rohr-Udilova
- Division of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Vienna, Austria
| | - Bruno Karl Podesser
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Markus Peck-Radosavljevic
- Division of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Laboratory, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
- Vienna Hepatic Hemodynamic Laboratory, Vienna, Austria.
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11
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Pfisterer N, Dexheimer C, Fuchs EM, Bucsics T, Schwabl P, Mandorfer M, Gessl I, Sandrieser L, Baumann L, Riedl F, Scheiner B, Pachofszky T, Dolak W, Schrutka-Kölbl C, Ferlitsch A, Schöniger-Hekele M, Peck-Radosavljevic M, Trauner M, Madl C, Reiberger T. Betablockers do not increase efficacy of band ligation in primary prophylaxis but they improve survival in secondary prophylaxis of variceal bleeding. Aliment Pharmacol Ther 2018; 47:966-979. [PMID: 29388229 DOI: 10.1111/apt.14485] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/03/2017] [Accepted: 12/03/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Endoscopic band ligation (EBL) is used for primary (PP) and secondary prophylaxis (SP) of variceal bleeding. Current guidelines recommend combined use of non-selective beta-blockers (NSBBs) and EBL for SP, while in PP either NSBB or EBL should be used. AIM To assess (re-)bleeding rates and mortality in cirrhotic patients receiving EBL for PP or SP for variceal bleeding. METHODS (Re-)bleeding rates and mortality were retrospectively assessed with and without concomitant NSBB therapy after first EBL in PP and SP. RESULTS Seven hundred and sixty-six patients with oesophageal varices underwent EBL from 01/2005 to 06/2015. Among the 284 patients undergoing EBL for PP, n = 101 (35.6%) received EBL only, while n = 180 (63.4%) received EBL + NSBBs. In 482 patients on SP, n = 163 (33.8%) received EBL only, while n = 299 (62%) received EBL + NSBBs. In PP, concomitant NSBB therapy neither decreased bleeding rates (log-rank: P = 0.353) nor mortality (log-rank: P = 0.497) as compared to EBL alone. In SP, similar re-bleeding rates were documented in EBL + NSBB vs EBL alone (log-rank: P = 0.247). However, EBL + NSBB resulted in a significantly lower mortality rate (log-rank: P<0.001). A decreased risk of death with EBL + NSBB in SP (hazard ratio, HR: 0.50; P<0.001) but not of rebleeding, transplantation or further decompensation was confirmed by competing risk analysis. Overall NSBB intake reduced 6-months mortality (HR: 0.53, P = 0.008) in SP, which was most pronounced in patients without severe/refractory ascites (HR: 0.37; P = 0.001) but not observed in patients with severe/refractory ascites (HR: 0.80; P = 0.567). CONCLUSIONS EBL alone seems sufficient for PP of variceal bleeding. In SP, the addition of NSBB to EBL was associated with an improved survival within the first 6 months after EBL.
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Affiliation(s)
- N Pfisterer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.,Krankenanstalt Rudolfstiftung, Krankenanstaltsverbund (KAV) Wien, Vienna, Austria
| | - C Dexheimer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria
| | - E-M Fuchs
- Krankenanstalt Rudolfstiftung, Krankenanstaltsverbund (KAV) Wien, Vienna, Austria
| | - T Bucsics
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria
| | - P Schwabl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria
| | - M Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria
| | - I Gessl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - L Sandrieser
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - L Baumann
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - F Riedl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria
| | - B Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria
| | - T Pachofszky
- Krankenanstalt Rudolfstiftung, Krankenanstaltsverbund (KAV) Wien, Vienna, Austria
| | - W Dolak
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - C Schrutka-Kölbl
- Krankenanstalt Rudolfstiftung, Krankenanstaltsverbund (KAV) Wien, Vienna, Austria
| | - A Ferlitsch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria
| | - M Schöniger-Hekele
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - M Peck-Radosavljevic
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.,Department of Gastroenterology/Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - M Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - C Madl
- Krankenanstalt Rudolfstiftung, Krankenanstaltsverbund (KAV) Wien, Vienna, Austria
| | - T Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria
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12
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Bucsics T, Schoder M, Goeschl N, Schwabl P, Mandorfer M, Diermayr M, Feldner M, Riedl F, Bauer D, Angermayr B, Cejna M, Ferlitsch A, Sieghart W, Trauner M, Peck-Radosavljevic M, Karner J, Karnel F, Reiberger T. Re-bleeding rates and survival after early transjugular intrahepatic portosystemic shunt (TIPS) in clinical practice. Dig Liver Dis 2017; 49:1360-1367. [PMID: 28869158 DOI: 10.1016/j.dld.2017.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/19/2017] [Accepted: 08/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early implantation (<72h) of a transjugular intrahepatic portosystemic shunt (TIPS) after acute variceal bleeding (AVB) improves survival in highly selected patients. METHODS We retrospectively assessed bleeding control and survival of unselected cirrhotic patients undergoing early TIPS implantation within 72h. We compared the outcomes to patients meeting early TIPS criteria but receiving late TIPS within 3-28days after AVB and endoscopic/medical treatment. RESULTS Forty-nine patients were included. Mean MELD was 14.4 (±4.4). Thirteen patients (26.5%) presented characteristics that were exclusion criteria in previous early TIPS trials (age>75, CPS>13, HCC>Milan, previous beta-blocker/band-ligation, renal insufficiency). Bare metal and PTFE-covered stents were used in n=32 (65.3%) and n=17 (34.7%) patients, respectively, and showed similar early re-bleeding rates (9.9% vs. 7.1%; p=0.6905) and bleeding-related mortality (25.0% vs. 23.5%; p=0.9906). However, overall re-bleeding rate was lower with PTFE-TIPS (7.7% vs. 64.2%; p=0.0044) over a median follow-up of 18.5 months with a tendency towards improved survival (median 70.5 vs. 13.8 months; p=0.204). Additional 68 patients meeting stringent criteria but receiving late TIPS also showed a favorable bleeding-related mortality (8.8%), which was not achieved in similar n=34 patients by a medical/endoscopic strategy with bleeding-related mortality of 35.7%. CONCLUSIONS An early TIPS strategy using covered stents and implementation of 'stringent criteria' results in a favorable outcome in patients with acute variceal bleeding.
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Affiliation(s)
- Theresa Bucsics
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Maria Schoder
- Dept. of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Nicolas Goeschl
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Philipp Schwabl
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Mattias Mandorfer
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Magdalena Diermayr
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Maria Feldner
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Florian Riedl
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - David Bauer
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bernhard Angermayr
- Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Manfred Cejna
- Dept. of Radiology, Landeskrankenhaus Feldkirch, Austria
| | - Arnulf Ferlitsch
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Sieghart
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Markus Peck-Radosavljevic
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Josef Karner
- Dept. of Surgery, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Franz Karnel
- Dept. of Radiology, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Thomas Reiberger
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
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13
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Scheiner B, Parada-Rodriguez D, Bucsics T, Schwabl P, Mandorfer M, Pfisterer N, Riedl F, Sieghart W, Ferlitsch A, Trauner M, Peck-Radosavljevic M, Reiberger T. Non-selective beta-blocker treatment does not impact on kidney function in cirrhotic patients with varices. Scand J Gastroenterol 2017; 52:1008-1015. [PMID: 28532189 DOI: 10.1080/00365521.2017.1329456] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
GOALS AND BACKGROUND Non-selective beta-blockers (NSBBs) are used for bleeding prophylaxis in cirrhotic patients with gastroesophageal varices (GEVs). Recent data suggested that NSBB treatment might increase the risk of renal dysfunction in patients with refractory ascites due to an impaired response to acute haemodynamic stress. STUDY Retrospective longitudinal assessment of kidney function in a cohort of cirrhotic patients with GEVs with vs. without NSBB therapy. Serum creatinine (SCre), estimated glomerular filtration rate (eGFR), incidence of acute kidney injury (AKI), new onset of large volume ascites and TIPS-/transplant-free survival were compared. RESULTS Among 176 patients, 93 patients received NSBBs, while 83 did not. Most patients were male (77.8%), had alcoholic aetiology (52.3%) and compensated cirrhosis (51.1% Child-A, MELD: 12.1 ± 3.8). Over a 3-year follow-up, renal function was comparable between patients with and without NSBB treatment. Incidence of AKI was similar in NSBB vs. no-NSBB patients (p = .323). Even in potential risk groups (ascites, MAP <90 mmHg, baseline creatinine > ULN, hyponatraemia, MELD score ≥15 points, Child-Pugh B/C), there was no difference in SCre or eGFR with vs. without NSBBs (p = n.s. at 74/78 and 76/78 of analysed time points). However, multivariate analysis revealed that the presence of ascites (HR: 3.901, 95%CI: 1.352-11.251; p = .012) and pre-existing renal impairment (HR: 4.315, 95%CI: 1.054-17.672; p = .042) were independent risk factors for AKI. Importantly, NSBB use (HR: 0.319, 95%CI: 0.120-0.848; p = .022) was independently associated with improved TIPS-/transplant-free survival. CONCLUSIONS In our cohort of unselected, mostly compensated cirrhotic patients with GEVs, NSBB treatment was neither associated with worsening of kidney function nor with increased incidence of AKI. On the contrary, NSBB treatment improved TIPS-/transplant-free survival.
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Affiliation(s)
- Bernhard Scheiner
- a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.,b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria
| | - Diego Parada-Rodriguez
- a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.,b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria
| | - Theresa Bucsics
- a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.,b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria
| | - Philipp Schwabl
- a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.,b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria
| | - Mattias Mandorfer
- a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.,b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria
| | - Nikolaus Pfisterer
- a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.,b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria
| | - Florian Riedl
- a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.,b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria
| | - Wolfgang Sieghart
- a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.,b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria
| | - Arnulf Ferlitsch
- a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.,b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria
| | - Michael Trauner
- a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.,b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria
| | - Markus Peck-Radosavljevic
- a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.,b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria
| | - Thomas Reiberger
- a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.,b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria
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14
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Schwabl P, Hambruch E, Seeland BA, Hayden H, Wagner M, Garnys L, Strobel B, Schubert TL, Riedl F, Mitteregger D, Burnet M, Starlinger P, Oberhuber G, Deuschle U, Rohr-Udilova N, Podesser BK, Peck-Radosavljevic M, Reiberger T, Kremoser C, Trauner M. The FXR agonist PX20606 ameliorates portal hypertension by targeting vascular remodelling and sinusoidal dysfunction. J Hepatol 2017; 66:724-733. [PMID: 27993716 DOI: 10.1016/j.jhep.2016.12.005] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/27/2016] [Accepted: 12/07/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Steroidal farnesoid X receptor (FXR) agonists demonstrated potent anti-fibrotic activities and lowered portal hypertension in experimental models. The impact of the novel non-steroidal and selective FXR agonist PX20606 on portal hypertension and fibrosis was explored in this study. METHODS In experimental models of non-cirrhotic (partial portal vein ligation, PPVL, 7days) and cirrhotic (carbon tetrachloride, CCl4, 14weeks) portal hypertension, PX20606 (PX,10mg/kg) or the steroidal FXR agonist obeticholic acid (OCA,10mg/kg) were gavaged. We then measured portal pressure, intrahepatic vascular resistance, liver fibrosis and bacterial translocation. RESULTS PX decreased portal pressure in non-cirrhotic PPVL (12.6±1.7 vs. 10.4±1.1mmHg; p=0.020) and cirrhotic CCl4 (15.2±0.5 vs. 11.8±0.4mmHg; p=0.001) rats. In PPVL animals, we observed less bacterial translocation (-36%; p=0.041), a decrease in lipopolysaccharide binding protein (-30%; p=0.024) and splanchnic tumour necrosis factor α levels (-39%; p=0.044) after PX treatment. In CCl4 rats, PX decreased fibrotic Sirius Red area (-43%; p=0.005), hepatic hydroxyproline (-66%; p<0.001), and expression of profibrogenic proteins (Col1a1, α smooth muscle actin, transforming growth factor β). CCl4-PX rats had significantly lower transaminase levels and reduced hepatic macrophage infiltration. Moreover, PX induced sinusoidal vasodilation (upregulation of cystathionase, dimethylaminohydrolase (DDAH)1, endothelial nitric oxide synthase (eNOS), GTP-cyclohydrolase1) and reduced intrahepatic vasoconstriction (downregulation of endothelin-1, p-Moesin). In cirrhosis, PX improved endothelial dysfunction (decreased von-Willebrand factor) and normalized overexpression of vascular endothelial growth factor, platelet-derived growth factor and angiopoietins. While short-term 3-day PX treatment reduced portal pressure (-14%; p=0.041) by restoring endothelial function, 14week PX therapy additionally inhibited sinusoidal remodelling and decreased portal pressure to a greater extent (-22%; p=0.001). In human liver sinusoidal endothelial cells, PX increased eNOS and DDAH expression. CONCLUSIONS The non-steroidal FXR agonist PX20606 ameliorates portal hypertension by reducing liver fibrosis, vascular remodelling and sinusoidal dysfunction. LAY SUMMARY The novel drug PX20606 activates the bile acid receptor FXR and shows beneficial effects in experimental liver cirrhosis: In the liver, it reduces scarring and inflammation, and also widens blood vessels. Thus, PX20606 leads to an improved blood flow through the liver and decreases hypertension of the portal vein. Additionally, PX20606 improves the altered intestinal barrier and decreases bacterial migration from the gut.
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Affiliation(s)
- Philipp Schwabl
- Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Eva Hambruch
- Phenex Pharmaceuticals, Waldhofer Strasse 104, 69123 Heidelberg, Germany
| | - Berit A Seeland
- Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Hubert Hayden
- Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Wagner
- Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Lukas Garnys
- Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bastian Strobel
- Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Tim-Lukas Schubert
- Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Florian Riedl
- Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Dieter Mitteregger
- Vienna Medical Innovation Center (VMIC), Group Practice LABORS.at, Vienna, Austria
| | - Michael Burnet
- Synovo GmbH, Paul-Ehrlich-Str. 15, 72076 Tübingen, Germany
| | | | - Georg Oberhuber
- Dept. of Pathology, Medical University of Vienna, Vienna, Austria
| | - Ulrich Deuschle
- Phenex Pharmaceuticals, Waldhofer Strasse 104, 69123 Heidelberg, Germany
| | - Nataliya Rohr-Udilova
- Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bruno K Podesser
- Dept. of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Markus Peck-Radosavljevic
- Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Claus Kremoser
- Phenex Pharmaceuticals, Waldhofer Strasse 104, 69123 Heidelberg, Germany
| | - Michael Trauner
- Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
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Schwabl P, Brusilovskaya K, Riedl F, Bauer D, Strobel B, Fida S, Supper P, Hayden H, Trauner M, Peck-Radosavljevic M, Reiberger T. The soluble guanylyl cyclase stimulator riociguat reduces liver fibrosis and portal pressure in cirrhotic rats. Z Gastroenterol 2015. [DOI: 10.1055/s-0035-1551789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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König P, Chwatal K, Havelec L, Riedl F, Schubert H, Schultes H. Amantadine versus biperiden: a double-blind study of treatment efficacy in neuroleptic extrapyramidal movement disorders. Neuropsychobiology 1996; 33:80-4. [PMID: 8927233 DOI: 10.1159/000119254] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Anticholinergic treatment of neuroleptic extrapyramidal movement disorders (EPS) has been associated with induction of tardive dyskinesia. Also an increasing abuse of anticholinergics by schizophrenic patients is noted. Since as early as 1976, positive effects of amantadine (AMA) on neuroleptic EPS have been described, therefore a controlled study of these reports seemed worthwhile. Forty-two schizophrenic patients (of which 7 were dropouts) of three centers entered the study and were treated for EPS in a double-blind design: 18 (11 m, 7 f) with AMA and 17 (8 m, 9 f) with biperiden (BIP). Identical preparations of AMA 100 mg, tid) and BIP (2 mg, tid) were used in treatment of haloperidol-induced EPS (AMA, mean 22.4 mg haloperidol; BIP, mean 19.6 mg haloperidol). Effects of treatment and possible side effects were rated: EPS for the intensity of EPS, BPRS for quantification of psychotic symptoms, FSUCL for rating the side effects and KUSTA to document patients' mood. Ratings were recorded on days 0, 3, 7, 14, 28 and at discontinuation, respectively. All patients were treated with haloperidol and levomepromazine (for tranquilization/sleep induction) and the respective antiparkinsonian agent for 14 days. Patient characteristics did not differ significantly in either groups. In the AMA treatment group, 2 patients dropped out for noncompliance, in the BIP group, 5 (3 no effect, 1 noncompliance, 1 agitation). All results as recorded with the different rating instruments showed a significant (p < 0.01) overall improvement, whereas no significant differences between treatment groups could be determined, notably the treatment effect of both drugs on EPS was similar. Thus, the application of AMA in cases of neuroleptic EPS seems justified and is a useful alternative of anticholinergic drugs. Certain advantageous aspects of AMA treatment of EPS with regard to the glutamate hypothesis of schizophrenia and tardive dyskinesia are discussed.
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Affiliation(s)
- P König
- Psychiatric Hospital, Rankweil, Austria
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Riedl F, Stenzl W, Tscheliessnigg KH, Hermann W, Dacar D, Metzler H. [Morphologic and functional myocardial changes in experimental pulmonary artery embolism]. Wien Med Wochenschr 1983; 133:365-6. [PMID: 6636794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
After acute experimental obstruction of the pulmonary artery, focal ultrastructural lesions of the right ventricular myocardium were observed in domestic swine. These lesions, mainly myofibrillar fragmentation, were not reflected in hemodynamic measurements, which remained unchanged.
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18
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Riedl F. [Elastic reproduction of the gingival margin and papilla]. Dent Labor (Munch) 1974; 22:384-5. [PMID: 4600287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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19
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Riedl F. [Selective grinding]. Dent Labor (Munch) 1973; 21:1299-1302. [PMID: 4525143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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