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Ingle MP, Carroll AM, Matlock DD, Gama KD, Valle JA, Allen LA, Knoepke CE. Decision Support Needs for Patients with Severe Symptomatic Aortic Stenosis. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:589-603. [PMID: 34809525 DOI: 10.1080/01634372.2021.1995095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
Social workers in healthcare settings often support patient decision-making processes for complex medical decisions. The objective of this study was to examine decision support needs for patients considering aortic valve replacement (AVR) for aortic stenosis. Seventeen qualitative interviews were conducted to explore treatment decision experiences of patients who accepted AVR. Analysis was conducted using a mixed inductive-deductive approach. Fear was a prevalent response for most participants in the face of AVR. Two general paths of decision making emerged: an "active" information seeking approach, or a "passive" simplicity seeking approach. Patients with unique clinical presentations felt alienated by the decision-making process. Acknowledging fear while understanding different decision-making styles provide opportunities for social workers and other members of multidisciplinary teams to support complex patient decisions.
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Affiliation(s)
- M Pilar Ingle
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Adam M Carroll
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel D Matlock
- Adult & Child Consortium for Outcomes Research & Delivery Science (Accords), University of Colorado School of Medicine, Aurora, Colorado, USA
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Geriatric Research Education and Clinical Center, Veterans Affairs Eastern Colorado, Denver, Colorado, USA
| | - Kristy D Gama
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Javier A Valle
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Interventional Cardiology, Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Larry A Allen
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christopher E Knoepke
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Schulte B, Wübbolding M, Marra F, Port K, Manns MP, Back D, Cornberg M, Stichtenoth DO, Höner Zu Siederdissen C, Maasoumy B. Frequency of Potential Drug-Drug Interactions in the Changing Field of HCV Therapy. Open Forum Infect Dis 2020; 7:ofaa040. [PMID: 32104719 PMCID: PMC7033915 DOI: 10.1093/ofid/ofaa040] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
Background With the introduction of direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection, drug-drug interactions (DDIs) emerged as significant challenge. Since then, HCV therapy and the infected population have rapidly changed. So far, very limited data are available regarding the clinical relevance of DDIs when using most modern DAA regimens. We aimed to assess how the importance of DDIs has evolved over time. Methods From January 2014 to July 2018, 668 consecutive HCV patients were evaluated for their outpatient medication and assessed for DDIs with DAAs. Different time periods were defined based on market approval of key DAAs: A (01/2014-11/2014), B (11/2014-08/2016), and C (08/2016-07/2018). Results The frequency of patients with real-world DDIs was highest in period B (A: 37.1%, B: 49.6%, C: 38.8%). The recently approved DAAs (period C) theoretically showed a lower DDI risk profile. However, real-world DDIs were still comparable to period A, as HCV patients' characteristics changed (eg, age ≥75 years: A: 3.1%, B: 9.8%, C: 5.6%; polypharmacy/patients with ≥8 drugs: A: 11.1%, B: 15.2%, C: 17.2%). Furthermore, although DDIs via CYP 3A4 became less important for some modern regimens, other mechanisms like an altered pH value in the stomach, causing reduced bioavailability, evolved. Relevant DDIs most frequently occurred with proton pump inhibitors, metamizole, statins, and carvedilol. Conclusions DDIs during antiviral treatment still affect about 40% of HCV patients. The lower DDI potential of modern DAA regimens is partly counteracted by changing patient characteristics. Therefore, DDIs should not be underestimated.
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Affiliation(s)
- Benjamin Schulte
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (Deutsches Zentrum für Infektionsforschung DZIF), partner site Hannover-Braunschweig, Hannover, Germany
| | - Maximilian Wübbolding
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Fiona Marra
- University of Liverpool, Clinical Pharmacology, Liverpool, United Kingdom
| | - Kerstin Port
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (Deutsches Zentrum für Infektionsforschung DZIF), partner site Hannover-Braunschweig, Hannover, Germany
| | - David Back
- University of Liverpool, Clinical Pharmacology, Liverpool, United Kingdom
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (Deutsches Zentrum für Infektionsforschung DZIF), partner site Hannover-Braunschweig, Hannover, Germany
| | - Dirk O Stichtenoth
- Department of Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | | | - Benjamin Maasoumy
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (Deutsches Zentrum für Infektionsforschung DZIF), partner site Hannover-Braunschweig, Hannover, Germany
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Evon DM, Golin CE, Stoica T, Jones RE, Willis SJ, Galanko J, Fried MW. What's Important to the Patient? Informational Needs of Patients Making Decisions About Hepatitis C Treatment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 10:335-344. [PMID: 27882509 DOI: 10.1007/s40271-016-0207-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Multiple treatment options with direct-acting antivirals are now available for hepatitis C virus (HCV). Study aims were to understand (1) the informational topics patients want to have to make informed treatment decisions; (2) the importance patients place on each topic; and (3) the topics patients prioritize as most important. METHODS We used a mixed-methods study of two samples recruited from an academic liver center. Participants were not currently on treatment. Sample I (n = 45) free listed all informational topics deemed important to decision making. Raw responses were coded into several broad and subcategories. Sample II (n = 38) rated the importance of the subcategories from Sample I and ranked their highest priorities on two surveys, one containing topics for which sufficient research existed to inform patients ('static'), and the other containing topics that would require additional research. RESULTS The topics listed by Sample I fell into six broad categories with 17 total subcategories. The most oft-cited informational topics were harms of treatment (100%), treatment benefits (62%), and treatment regimen details (84%). Sample II rated 16 of 17 subcategories as "pretty important' or "extremely important". Sample II prioritized (1) viral cure, (2) long-term survival, and (3) side effects on the survey of topics requiring additional research, and (1) liver disease, (2) lifestyle changes, and (3) medication details on the second survey of the most important static topics patients needed. CONCLUSIONS Patients weighed several informational topics to make an informed decision about HCV treatment. These findings lay the groundwork for future patient-centered outcomes research in HCV and patient-provider communication to enhance patients' informed decision making regarding direct-acting antiviral treatment options.
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Affiliation(s)
- Donna M Evon
- Division of Gastroenterology and Hepatology, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC, 27599, USA.
| | - Carol E Golin
- Department of Medicine, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Teodora Stoica
- Division of Gastroenterology and Hepatology, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC, 27599, USA
| | - Rachel E Jones
- Division of Gastroenterology and Hepatology, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC, 27599, USA
| | - Sarah J Willis
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Joseph Galanko
- Division of Gastroenterology and Hepatology, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC, 27599, USA
| | - Michael W Fried
- Division of Gastroenterology and Hepatology, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC, 27599, USA
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Vutien P, Jin M, Le MH, Nguyen P, Trinh S, Huang JF, Yu ML, Chuang WL, Nguyen MH. Regional differences in treatment rates for patients with chronic hepatitis C infection: Systematic review and meta-analysis. PLoS One 2017; 12:e0183851. [PMID: 28877190 PMCID: PMC5587234 DOI: 10.1371/journal.pone.0183851] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/12/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Treatment rates with interferon-based therapies for chronic hepatitis C have been low. Our aim was to perform a systematic review of available data to estimate the rates and barriers for antiviral therapy for chronic hepatitis C. METHODS We conducted a systematic review and meta-analysis searching MEDLINE, SCOPUS through March 2016 and abstracts from recent major liver meetings for primary literature with available hepatitis C treatment rates. Random-effects models were used to estimate effect sizes and meta-regression to test for potential sources of heterogeneity. RESULTS We included 39 studies with 476,443 chronic hepatitis C patients. The overall treatment rate was 25.5% (CI: 21.1-30.5%) and by region 34% for Europe, 28.3% for Asia/Pacific, and 18.7% for North America (p = 0.008). On multivariable meta-regression, practice setting (tertiary vs. population-based, p = 0.04), region (Europe vs. North America p = 0.004), and data source (clinical chart review vs. administrative database, p = 0.025) remained significant predictors of heterogeneity. The overall treatment eligibility rate was 52.5%, and 60% of these received therapy. Of the patients who refused treatment, 16.2% cited side effects, 13.8% cited cost as reasons for treatment refusal, and 30% lacked access to specialist care. CONCLUSIONS Only one-quarter of chronic hepatitis C patients received antiviral therapy in the pre-direct acting antiviral era. Treatment rates should improve in the new interferon-free era but, cost, co-morbidities, and lack of specialist care will likely remain and need to be addressed. Linkage to care should even be of higher priority now that well-tolerated cure is available.
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Affiliation(s)
- Philip Vutien
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States of America
- Rush University Medical Center, Chicago, Illinois, United States of America
| | - Michelle Jin
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States of America
| | - Michael H. Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States of America
| | - Pauline Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States of America
| | - Sam Trinh
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States of America
| | - Jee-Fu Huang
- Hepatobiliary Section, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Section, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Section, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States of America
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Chronic hepatitis C: treat or wait? A prospective study on reasons for treatment or nontreatment in the era of first-generation protease inhibitors. Eur J Gastroenterol Hepatol 2016; 28:164-72. [PMID: 26560750 DOI: 10.1097/meg.0000000000000506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS In many countries, current treatment for patients with chronic hepatitis C involves a combination of peginterferon and ribavirin, associated with a protease inhibitor for hepatitis C virus genotype 1. More recent and efficient less toxic antiviral treatments are now available for some patients. Thus, the decision to treat or to wait is challenging. The aims of this study were to: (a) estimate the proportion of treated patients, (b) evaluate the reasons for this decision, and (c) examine the patients' points-of-view in treatment decision. METHODS This was a prospective study conducted at three French referral centers between March and June 2013. Epidemiological and virological data, reasons for treatment or nontreatment, and data on the doctors' and patients' choices were collected. RESULTS A total of 255 patients were analyzed. Only 52.6% of patients with fibrosis of 2 or higher were treated. Treatment uptake was reduced in the following groups: previously treated patients, those with poor tolerance during prior treatment, those with heavy alcohol consumption, and those with hepatocellular carcinoma. Of the cirrhotic patients, 55% were not treated: 51.1% had a contraindication, 22.2% had a previous nonresponse. When treatment was refused by the patient, fear of side effects and professional problems were the most frequently cited reasons (90 and 40%, respectively). CONCLUSION Patients were treated primarily according to consensus guidelines. However, only 45% of cirrhotic patients were treated. In 7.6% of the cases, the patient refused therapy. This study enabled us to measure the importance of patient choice in medical decision-making. Well-informed patients expected not only more efficient but also well-tolerated therapy.
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Höner Zu Siederdissen C, Maasoumy B, Deterding K, Port K, Sollik L, Mix C, Kirschner J, Cornberg J, Manns MP, Wedemeyer H, Cornberg M. Eligibility and safety of the first interferon-free therapy against hepatitis C in a real-world setting. Liver Int 2015; 35:1845-52. [PMID: 25556625 DOI: 10.1111/liv.12774] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/22/2014] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Several real world data demonstrated that eligibility for and tolerability of triple therapy against hepatitis C virus (HCV) infection with a first-wave protease inhibitor is limited. With the approval of sofosbuvir (SOF) effective treatment with and without pegylated interferon (PEG-IFN) has become available for most genotypes. However, no data are available regarding the added benefit of an interferon-free treatment concerning eligibility and tolerability in a real-world scenario. We aimed to assess the eligibility and safety of SOF based therapies in patients with primarily advanced cirrhosis, including decompensated cirrhosis, in a real-world setting. RESULTS In total, 207 patients were evaluated for a SOF based treatment with and without PEG-IFN. Twenty-six patients did not receive treatment because of safety reasons. Common causes were severe concomitant cardiac disease and advanced renal disease. Autoimmune disease, thrombopaenia, anaemia or hepatic dysfunction did not preclude treatment. Eighty-four patients started treatment, 15 with decompensated cirrhosis. During the first 12 weeks hospitalization occurred in 11 patients most frequently because of typical complications of advanced liver disease. Risk factors for hospitalization were low platelet count and deteriorated liver function. Overall, 982 of 1008 planned treatment weeks (97%) were successfully completed within the first 12 weeks of therapy. CONCLUSION With the better safety profile of interferon-free therapies, eligibility for HCV treatment will expand broadly, including patients with decompensated cirrhosis. Current limitations are renal failure and concomitant cardiac disease. Patients with advanced cirrhosis still have a high risk for hospitalization even with interferon-free therapies, but can continue HCV treatment in most cases.
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Affiliation(s)
| | - Benjamin Maasoumy
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Katja Deterding
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Kerstin Port
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Lisa Sollik
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Carola Mix
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Janina Kirschner
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Janet Cornberg
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Markus Cornberg
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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Mangia A, Cenderello G, Orlandini A, Piazzolla V, Picciotto A, Zuin M, Ciancio A, Brancaccio G, Forte P, Carretta V, Zignego AL, Minerva N, Brindicci G, Marignani M, Baroni GS, Bertino G, Cuccorese G, Mottola L, Ripoli M, Pirisi M. Individualized treatment of genotype 1 naïve patients: an Italian multicenter field practice experience. PLoS One 2014; 9:e110284. [PMID: 25340799 PMCID: PMC4207756 DOI: 10.1371/journal.pone.0110284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/15/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Triple therapy including Telaprevir or Boceprevir still represents in many European countries the standard of care for patients with Hepatitis C Virus genotype 1 infection. The number of patients who received this treatment resulted generally lower than expected. We investigated, among naïve patients, number and characteristics of treatment candidates who were started on triple or dual therapy in comparison to those who were deferred. PATIENTS AND METHODS 621 naïve treatment candidates were prospectively evaluated at each center. Factors associated with decision to defer or treat with dual or triple therapy were investigated by univariate and multivariate analyses. Rates of Sustained Virological Response and safety profile were analysed. RESULTS Of candidates to treatment, 33% did not received it. It was mostly due to high risk of Interferon-induced decompensation. Of 397 patients who were started on treatment, 266 (67%) received triple, 131 dual. Among patient receiving treatment, unfavorable IL28B, severe liver damage and higher albumin were independently associated with the physician decision to administer triple therapy. Sustained Virological Response after dual therapy was 66.4%, after triple 73.7% (p = 0.14). 142 patients received Telaprevir. The choice of Telaprevir-based therapy was associated with higher Body Mass Index and advanced liver disease. Sustained Virological Response rates were 71.1% after Telaprevir and 76.6% after Boceprevir. CONCLUSIONS Individualizing treatment with available regimens allows to maximize Sustained Virological Response and to reduce the number of patients who remain untreated. High proportion of patients with severe liver damage urgently need Interferon free treatment.
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Affiliation(s)
- Alessandra Mangia
- Hospital IRCCS “Casa Sollievo della Sofferenza”, Liver Unit, San Giovanni Rotondo, Italy
| | | | | | - Valeria Piazzolla
- Hospital IRCCS “Casa Sollievo della Sofferenza”, Liver Unit, San Giovanni Rotondo, Italy
| | - Antonio Picciotto
- University of Genova, Department of Internal Medicine, Gastroenterology Unit, Genova, Italy
| | - Massimo Zuin
- “S. Paolo” Hospital, University of Milan, Department of Medicine, Milan, Italy
| | - Alessia Ciancio
- AOU “San Giovanni Battista” - Molinette, Department of Medical Sciences, Torino, Italy
| | | | - Paolo Forte
- “G. Careggi” Hospital, Department of Gastroenterology, Florence, Italy
| | | | - Anna Linda Zignego
- University of Milan, Department of Experimental and Clinical Medicine, Milan, Italy
| | - Nicola Minerva
- Hospital of Canosa, Department of Internal Medicine, Canosa, Italy
| | | | | | | | | | - Giuseppe Cuccorese
- “R. Dimiccoli” Hospital, Department of Gaastroenterology, Barletta, Italy
| | - Leonardo Mottola
- Hospital IRCCS “Casa Sollievo della Sofferenza”, Liver Unit, San Giovanni Rotondo, Italy
| | - Maria Ripoli
- Hospital IRCCS “Casa Sollievo della Sofferenza”, Liver Unit, San Giovanni Rotondo, Italy
| | - Mario Pirisi
- Università degli Studi del Piemonte Orientale, Department of Internal Medicine, Novara, Italy
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Alberti A, Colombo M, Craxì A, Rizzetto M. The dilemma for patients with chronic hepatitis C: treat now or warehouse? Dig Liver Dis 2014; 46:27-9. [PMID: 24268949 DOI: 10.1016/j.dld.2013.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/07/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Alfredo Alberti
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Massimo Colombo
- First Division of Gastroenterology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Antonio Craxì
- Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Italy.
| | - Mario Rizzetto
- Division of Gastroenterology, University of Torino, Torino, Italy
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