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Lamby P, Wolff D, Mielke S, Grigoleit GU, Ljungman P, Hilgendorf I, Holler E, Holler B, Weber D, Herr W, Schiltz D, Klein S, Graf S, Bjornhagen-Safwenberg V, Dolderer J, Prantl L. Allogeneic donor split skin grafts for treatment of refractory ulcers in cutaneous chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation-a retrospective analysis on seven patients. Ann Hematol 2019; 98:1867-1875. [PMID: 30993415 DOI: 10.1007/s00277-019-03687-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/06/2019] [Indexed: 12/19/2022]
Abstract
Refractory skin ulcers due to severe chronic graft-versus-host disease (cGVHD) remain to be associated with significant morbidity and mortality.We performed an allogeneic donor skin transplantation in seven adult patients after allogeneic hematopoietic stem cell transplantation for cGVHD-associated refractory skin ulcers. While four patients received a split skin graft (SSG), in one patient, a full thickness skin graft for two small refractory ulcers of the ankle was performed, and one patient received in vitro expanded donor keratinocyte grafts derived from hair roots of the original unrelated donor. In one additional patient, a large deep fascial defect of the lower leg was covered with an autologous greater omentum free graft before coverage with an allogeneic SSG. An additional patient was treated with an autologous scrotal skin graft for a refractory ulcer associated with deep sclerosis of cGVHD after unrelated donor transplantation.All skin grafts engrafted and resulted in permanent coverage of the grafted ulcers without any signs of immunological mediated damage. In the patient receiving in vitro expanded keratinocyte grafts, two localized ulcers were permanently covered by donor skin while this approach failed to cover extensive circular ulcers of the lower legs.Allogeneic donor skin grafts are a valuable treatment option in refractory ulcers due to cGVHD but are restricted mainly to related donors while keratinocyte grafts from unrelated donors remain experimental. In male patients lacking a related donor, autologous scrotal skin graft may be an alternative option.
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Affiliation(s)
- P Lamby
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany
| | - D Wolff
- Department of Internal Medicine III, University of Regensburg, F.J. Strauss Allee 11, 93053, Regensburg, Germany.
| | - S Mielke
- Allogeneic Stem Cell Transplantation Section, Department of Internal Medicine II, Würzburg University Medical Center, Würzburg, Germany.,Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - G U Grigoleit
- Allogeneic Stem Cell Transplantation Section, Department of Internal Medicine II, Würzburg University Medical Center, Würzburg, Germany
| | - P Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - I Hilgendorf
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Jena, Deutschland, Germany
| | - E Holler
- Department of Internal Medicine III, University of Regensburg, F.J. Strauss Allee 11, 93053, Regensburg, Germany
| | - B Holler
- Department of Internal Medicine III, University of Regensburg, F.J. Strauss Allee 11, 93053, Regensburg, Germany
| | - D Weber
- Department of Internal Medicine III, University of Regensburg, F.J. Strauss Allee 11, 93053, Regensburg, Germany
| | - W Herr
- Department of Internal Medicine III, University of Regensburg, F.J. Strauss Allee 11, 93053, Regensburg, Germany
| | - D Schiltz
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany
| | - S Klein
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany
| | - S Graf
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany
| | | | - J Dolderer
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany
| | - L Prantl
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany
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Klein SM, Prantl L, Geis S, Felthaus O, Dolderer J, Anker AM, Zeitler K, Alt E, Vykoukal J. Circulating serum CK level vs. muscle impairment for in situ monitoring burden of disease in Mdx-mice. Clin Hemorheol Microcirc 2017; 65:327-334. [PMID: 27716655 DOI: 10.3233/ch-16195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) consists of a lack in the expression of the subsarcolemmal protein dystrophin causing progressive muscle dysfunction. Among the widely applied animal models in DMD research is the C57BL/1010ScSn-Dmdmdx mouse, commonly referred to as the "mdx mouse". The potential benefit of novel interventions in this model is often assessed by variables such as functional improvement, histological changes, and creatine kinase (CK) serum levels as an indicator for the extent of in situ muscle damage. OBJECTIVE Our objective was to determine to what extent the serum CK-level serves a surrogate for muscle dysfunction. METHODS In this trial mdx mice were subjected to a four-limb wire-hanging test (WHT) to assess the physical performance as a reference for muscle function. As CK is a component of the muscle fiber cytosol, its serum activity is supposed to positively correlate with progressing muscle damage. Hence serum CK levels were measured to detect the degree of muscle impairment. The functional tests and the serum CK levels were analyzed for their specific correlation. RESULTS Although physical performance decreased during the course of the experiment, latency to fall times in the WHT did not correlate with the CK level in mdx mice. CONCLUSION Our data suggests that the serum CK activity might be a critical parameter to monitor the progression of muscle impairment in mdx mice. Further this study emphasizes the complexity of the DMD phenotype in the mdx mouse, and the care with which isolated parameters in this model should be interpreted.
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Affiliation(s)
- S M Klein
- Center for Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - L Prantl
- Center for Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - S Geis
- Center for Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - O Felthaus
- Center for Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - J Dolderer
- Center for Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - A M Anker
- Center for Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - K Zeitler
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - E Alt
- Translational Molecular Pathology, University of Texas MD, Houston, TX, USA
| | - J Vykoukal
- Translational Molecular Pathology, University of Texas MD, Houston, TX, USA
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Ranieri M, Klein S, Taeger C, Kotrade A, Nerlich M, Dolderer J, Prantl L, Geis S. Transepidermal oxygen flux measurement - First clinical application for postoperative wound monitoring. Clin Hemorheol Microcirc 2017; 66:175-182. [PMID: 28372323 DOI: 10.3233/ch-170265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Measurement of skin oxygen is of great interest in diverse fields of medicine. Different pathologies, e.g. infection, ischemia cancer or chronic wounds show a characteristic oxygen distribution and skin oxygen tension. Additionally diverse operative procedures require a reliable postoperative monitoring in order to ensure success of the therapy. OBJECTIVE Aim of this study was to assess transepidermal oxygen flux for postoperative wound monitoring after operative treatment of fractures close to the hip. METHODS 22 patients underwent transepidermal oxygen flux measurement at the first postoperative day. Transepidermal oxygen flux measurement was performed using ratiometric luminescence imaging. Examination was conducted in close proximity to the operation wound. The corresponding area at the contralateral side served as reference. RESULTS Oxygen flux in the operation area was higher (0.084±0.021) than the contralateral side (0.071±0.029). CONCLUSIONS Transepidermal oxygen flux imaging by ratiometric luminescence imaging seems to be a reliable tool to assess postoperative wound healing. However further investigations in greater populations and under pathologic conditions have to be performed to prove these first results.
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Affiliation(s)
- M Ranieri
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Klein
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C Taeger
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - A Kotrade
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Nerlich
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - J Dolderer
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L Prantl
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Geis
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Geis S, Prantl L, Schoeneich M, Lamby P, Klein S, Dolderer J, Mueller S, Jung E. Contrast enhanced ultrasound (CEUS) – an unique monitoring technique to assess microvascularization after buried flap transplantation. Clin Hemorheol Microcirc 2016; 62:205-14. [DOI: 10.3233/ch-151964] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S. Geis
- Center for Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L. Prantl
- Center for Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M. Schoeneich
- Center for Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - P. Lamby
- Center for Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S. Klein
- Center for Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - J. Dolderer
- Center for Plastic-, Hand-, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S. Mueller
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - E.M. Jung
- Department of Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
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Geis S, Klein S, Prantl L, Dolderer J, Lamby P, Jung EM. Quantitative Assessment of Free Flap Viability with CEUS Using an Integrated Perfusion Software. HANDCHIR MIKROCHIR P 2015; 47:389-95. [DOI: 10.1055/s-0035-1559712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- S. Geis
- Center of Plastic-, Hand- and Reconstructive Surgery, University hospital, Regensburg, German
| | - S. Klein
- Center of Plastic-, Hand- and Reconstructive Surgery, University hospital, Regensburg, German
| | - L. Prantl
- Center of Plastic-, Hand- and Reconstructive Surgery, University hospital, Regensburg, German
| | - J. Dolderer
- Center of Plastic-, Hand- and Reconstructive Surgery, University hospital, Regensburg, German
| | - P. Lamby
- Center of Plastic-, Hand- and Reconstructive Surgery, University hospital, Regensburg, German
| | - E.-M. Jung
- Interdisciplinary ultrasound department, University hospital, Regensburg, Germany
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Klein S, Prantl L, Geis S, Eisenmann-Klein M, Dolderer J, Felthaus O, Loibl M, Heine N. Pressure monitoring during lipofilling procedures. Clin Hemorheol Microcirc 2014; 58:9-17. [DOI: 10.3233/ch-141872] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S.M. Klein
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L. Prantl
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S. Geis
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M. Eisenmann-Klein
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - J. Dolderer
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - O. Felthaus
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M. Loibl
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - N. Heine
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Geis S, Prantl L, Dolderer J, Lamby P, Mueller S, Jung EM. Postoperative monitoring of local and free flaps with contrast-enhanced ultrasound (CEUS)--analysis of 112 patients. Ultraschall Med 2013; 34:550-558. [PMID: 24127394 DOI: 10.1055/s-0033-1355758] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Tissue defects are a common problem in trauma surgery and oncology. Flap transplantation is often the only therapy to cover such defects. Several monitoring systems are currently available but none has made it to the clinical routine. The aim of this study was to assess perfusion disturbances of local and free flaps using contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS 112 patients were examined during the first 72 hours after operation. CEUS was performed by one experienced examiner with a linear transducer (6 - 9 MHz, LOGIQE9/GE) after a bolus injection of 2.4 ml sulfohexa-fluoride microbubbles (SonoVue®, Bracco, Italy). Retrospective vascular perfusion was quantified by evaluating the stored DICOM cine loops using the perfusion software QONTRAST® (Bracco, Italy). Over a total penetration depth of 3 cm, every centimeter was analyzed separately. 27 complications were observed. Complete flap loss was only seen in 4 cases, while 23 flaps had to undergo minor revision and survived. RESULTS Regarding the complete flap size, quantitative analysis showed significantly higher perfusion values in patients without complications compared to patients with complications: PEAK 16.5 vs. 10.0 (p = 0.001), TTP 32.6 vs. 22.2 (p = 0.001), RBV: 738.8 vs. 246.2 (p < 0.001), RBF 17.5 vs. 10.1 (p < 0.001) and MTT 43.1 vs. 29.5 (p = 0.001). Analysis of the correlation of the different flap types, age, sex and etiology of the tissue defect to the complication rate showed no statistical correlation. CONCLUSION CEUS was capable of detecting vascular disturbances after flap transplantation. TTP, RBV and MTT seem to be the most accurately parameters and are not susceptible to malfunction during measurement.
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Affiliation(s)
- S Geis
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg
| | - L Prantl
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg
| | - J Dolderer
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg
| | - P Lamby
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg
| | - S Mueller
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg
| | - E M Jung
- Interdisciplinary ultrasound department, University Hospital Regensburg
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Dolderer J, Medved F, Haas R, Siegel-Axel D, Schiller S, Schaller HE. Angiogenese und Vaskularisation beim Tissue Engineering von Fettgewebe. HANDCHIR MIKROCHIR P 2013; 45:99-107. [DOI: 10.1055/s-0032-1329944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- J. Dolderer
- Hochschulzentrum für Plastische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg
| | - F. Medved
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
| | - R. Haas
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
| | - D. Siegel-Axel
- Klinik für Innere Medizin, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Eberhard Karls Universität Tübingen, Tübingen
| | - S. Schiller
- Freiburg Institute for Advanced Studies (FRIAS), Albert-Ludwigs Universität Freiburg, Freiburg
| | - H.-E Schaller
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
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Siegel-Axel D, Rittig K, Dolderer J, Stefan N, Schaller HE, Stock U, Häring HU. Fetuin-A beeinflusst das erhöhte angiogenetische Potential humaner perivaskulärer Fettzellen. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Siegel-Axel D, Dolderer J, Rittig K, Balletshofer B, Machann J, Staiger H, Machicao F, Stock U, Häring HU. Das besondere angiogenetische und inflammatorische Potential perivaskulärer Fettzellen im Vergleich zu subkutanen und viszeralen Fettzellen. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Diagnosis-related groups (DRGs) are a patient classification system grouping related types of patients treated to the resources they consumed. In this analysis we compared the Italian and the German DRG systems regarding hand surgery with an emphasis on reimbursement of clinical cases. The 15 most common hand surgical diagnoses and their corresponding operative treatment in our clinic in 2009 were processed using a DRG grouper. The underlying data were transferred to the Italian system. Thus, the length of stay and the reimbursement of both countries could be obtained and compared. The latter was adjusted and corrected by the purchasing power of each country. The mean of the upper threshold of length of stay was 10 days in the German as well as the Italian system whereas the median was 2 times higher in Italy (6 vs. 12 days). Fifteen out of 19 cases showed higher reimbursement in Germany. The case mix index (CMI) of 0.917 in Germany represents a mean payment of 2,676 € per case. In Italy the hypothetical CMI of 0.635 resulted in a mean reimbursement of 1,853 € per case. The biggest difference in remuneration could be found for replantation of multiple fingers. For this service the German health-care system pays 12,320 € more than the Italian. Total proceeds of the top 15 diagnoses applying the number of cases treated in our clinic revealed 1.7 million € in the German and 1.2 million € in the Italian DRG system. Considering the purchasing power utilizing consumer prize parities, the difference of reimbursement between the countries decreased to 300,000 €. There is no mean length of stay per DRG in Italy, only the upper threshold of length of stay is determined. In most cases the latter is higher in Italy compared to Germany. The consumption of resources for finger replantation is not adequately represented in the Italian DRG system compared to finger amputation. Reimbursement of inpatient care is influenced by multiple factors not being subject to the free market economy. For this reason only descriptive comparison is feasible.
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Affiliation(s)
- O Lotter
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik/Eberhard-Karls-Universität Tübingen, Tübingen.
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Schuldes H, Dolderer J, Knobloch J, Bade S, Bickeböller R, Woodcock BG, Jonas D, Zimmer G. Relationship between plasma membrane fluidity and R-verapamil action in CHO cells. Int J Clin Pharmacol Ther 1998; 36:71-3. [PMID: 9520147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- H Schuldes
- Klinik für Urologie und Kinderurologie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main, Germany
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