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Flores T, Kerschbaumer C, Jaklin FJ, Rohrbacher A, Weber M, Luft M, Aspöck C, Ströbele B, Kitzwögerer M, Lumenta DB, Bergmeister KD, Schrögendorfer KF. Gram-Positive Bacteria Increase Breast Implant-Related Complications: Prospective Analysis of 100 Revised Implants. Plast Reconstr Surg 2024; 153:76-89. [PMID: 37036325 PMCID: PMC10729897 DOI: 10.1097/prs.0000000000010499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/08/2022] [Indexed: 04/11/2023]
Abstract
BACKGROUND Breast implant-related complications can be reduced by strict antiseptic precautions during insertion, but bacteria can often be found on implant surfaces on the occasion of revision surgery. The authors prospectively analyzed the association of bacteria found on breast implant surfaces with implant-related complications in breast implant revision cases. METHODS The authors analyzed a total of 100 breast implant revisions in 66 patients between August of 2018 and January of 2021. Capsular swabs and capsular samples were taken intraoperatively. Analyses on the occurrence of bacteria and the occurrence of implant-related complications were performed. In addition, correlations between bacteria-contaminated breast implant surfaces and implant-related complications were performed. RESULTS Implant-related complications (perforation, rupture, capsular contraction) were observed in 42 implant sites: eight unilateral and 34 bilateral cases. In total, 16 swabs showed positive bacterial growth, 10 of which were associated with a breast implant-related complication (χ 2 = x, y, and z; P = 0.006). The most common implant-based complication at contaminated prosthetics was implant rupture. The association of contaminated breast implants and implant rupture was statistically significant. CONCLUSIONS The authors identified a correlation between implant complications and Gram-positive bacteria found on breast implant surfaces. The most common implant-based complication seen at simultaneously positive samples was implant rupture in 50% of the authors' cases. No capsular contraction or other complications were seen. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Tonatiuh Flores
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
| | - Celina Kerschbaumer
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
| | - Florian J. Jaklin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna
| | | | - Michael Weber
- From the Karl Landsteiner University of Health Sciences
| | - Matthias Luft
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna
| | - Christoph Aspöck
- From the Karl Landsteiner University of Health Sciences
- Clinical Institute of Hygiene and Microbiology
| | - Barbara Ströbele
- From the Karl Landsteiner University of Health Sciences
- Clinical Institute of Hygiene and Microbiology
| | - Melitta Kitzwögerer
- From the Karl Landsteiner University of Health Sciences
- Clinical Institute for Pathology, University Clinic of St. Poelten
| | - David B. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz
| | - Konstantin D. Bergmeister
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna
| | - Klaus F. Schrögendorfer
- From the Karl Landsteiner University of Health Sciences
- Clinical Department of Plastic, Aesthetic and Reconstructive Surgery
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Tereshenko V, Maierhofer U, Hruby LA, Klepetko J, Dotzauer DC, Politikou O, Laengle G, Luft M, Festin C, Blumer R, Bergmeister KD, Aszmann OC. Axonal mapping of motor and sensory components within the ulnar nerve and its branches. J Neurosurg 2023; 139:1396-1404. [PMID: 37029679 DOI: 10.3171/2023.2.jns23180] [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] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Intrinsic function is indispensable for dexterous hand movements. Distal ulnar nerve defects can result in intrinsic muscle dysfunction and sensory deficits. Although the ulnar nerve's fascicular anatomy has been extensively studied, quantitative and topographic data on motor axons traveling within this nerve remain elusive. METHODS The ulnar nerves of 14 heart-beating organ donors were evaluated. The motor branches to the flexor carpi ulnaris (FCU) and flexor digitorum profundus (FDP) muscles and the dorsal branch (DoBUN) as well as 3 segments of the ulnar nerve were harvested in 2-cm increments. Samples were subjected to double immunofluorescence staining using antibodies against choline acetyltransferase and neurofilament. RESULTS Samples revealed more than 25,000 axons in the ulnar nerve at the forearm level, with a motor axon proportion of only 5%. The superficial and DoBUN showed high axon numbers of more than 21,000 and 9300, respectively. The axonal mapping of more than 1300 motor axons revealed an increasing motor/sensory ratio from the proximal ulnar nerve (1:20) to the deep branch of the ulnar nerve (1:7). The motor branches (FDP and FCU) showed that sensory axons outnumber motor axons by a ratio of 10:1. CONCLUSIONS Knowledge of the detailed axonal architecture of the motor and sensory components of the human ulnar nerve is of the utmost importance for surgeons considering fascicular grafting or nerve transfer surgery. The low number of efferent axons in motor branches of the ulnar nerve and their distinct topographical distribution along the distal course of the nerve is indispensable information for modern nerve surgery.
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Affiliation(s)
- Vlad Tereshenko
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Austria
| | - Udo Maierhofer
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Austria
| | - Laura A Hruby
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Austria
- Departments of2Orthopedics and Trauma Surgery and
| | - Johanna Klepetko
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Austria
| | - Dominik C Dotzauer
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Austria
| | - Olga Politikou
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Austria
| | - Gregor Laengle
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Austria
| | - Matthias Luft
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Austria
- 3Department of Plastic, Aesthetic and Reconstructive Surgery, Karl Landsteiner University of Health Sciences, University Hospital St. Poelten, Krems, Austria; and
| | - Christopher Festin
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Austria
| | - Roland Blumer
- 4Center for Anatomy and Cell Biology, Medical University of Vienna, Austria
| | - Konstantin D Bergmeister
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Austria
- 3Department of Plastic, Aesthetic and Reconstructive Surgery, Karl Landsteiner University of Health Sciences, University Hospital St. Poelten, Krems, Austria; and
| | - Oskar C Aszmann
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Austria
- 5Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Austria
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Tereshenko V, Maierhofer U, Dotzauer DC, Laengle G, Politikou O, Carrero Rojas G, Festin C, Luft M, Jaklin FJ, Hruby LA, Gohritz A, Farina D, Blumer R, Bergmeister KD, Aszmann OC. Axonal mapping of the motor cranial nerves. Front Neuroanat 2023; 17:1198042. [PMID: 37332322 PMCID: PMC10272770 DOI: 10.3389/fnana.2023.1198042] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Basic behaviors, such as swallowing, speech, and emotional expressions are the result of a highly coordinated interplay between multiple muscles of the head. Control mechanisms of such highly tuned movements remain poorly understood. Here, we investigated the neural components responsible for motor control of the facial, masticatory, and tongue muscles in humans using specific molecular markers (ChAT, MBP, NF, TH). Our findings showed that a higher number of motor axonal population is responsible for facial expressions and tongue movements, compared to muscles in the upper extremity. Sensory axons appear to be responsible for neural feedback from cutaneous mechanoreceptors to control the movement of facial muscles and the tongue. The newly discovered sympathetic axonal population in the facial nerve is hypothesized to be responsible for involuntary control of the muscle tone. These findings shed light on the pivotal role of high efferent input and rich somatosensory feedback in neuromuscular control of finely adjusted cranial systems.
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Affiliation(s)
- Vlad Tereshenko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik C. Dotzauer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Gregor Laengle
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Olga Politikou
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Genova Carrero Rojas
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Matthias Luft
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Florian J. Jaklin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Laura A. Hruby
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Gohritz
- Department of Plastic Surgery, University of Basel, Basel, Switzerland
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Roland Blumer
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Konstantin D. Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Oskar C. Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
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4
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Tereshenko V, Dotzauer DC, Luft M, Ortmayr J, Maierhofer U, Schmoll M, Festin C, Carrero Rojas G, Klepetko J, Laengle G, Politikou O, Farina D, Blumer R, Bergmeister KD, Aszmann OC. Autonomic Nerve Fibers Aberrantly Reinnervate Denervated Facial Muscles and Alter Muscle Fiber Population. J Neurosci 2022; 42:8297-8307. [PMID: 36216502 PMCID: PMC9653283 DOI: 10.1523/jneurosci.0670-22.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022] Open
Abstract
The surgical redirection of efferent neural input to a denervated muscle via a nerve transfer can reestablish neuromuscular control after nerve injuries. The role of autonomic nerve fibers during the process of muscular reinnervation remains largely unknown. Here, we investigated the neurobiological mechanisms behind the spontaneous functional recovery of denervated facial muscles in male rodents. Recovered facial muscles demonstrated an abundance of cholinergic axonal endings establishing functional neuromuscular junctions. The parasympathetic source of the neuronal input was confirmed to be in the pterygopalatine ganglion. Furthermore, the autonomically reinnervated facial muscles underwent a muscle fiber change to a purely intermediate muscle fiber population myosin heavy chain type IIa. Finally, electrophysiological tests revealed that the postganglionic parasympathetic fibers travel to the facial muscles via the sensory infraorbital nerve. Our findings demonstrated expanded neuromuscular plasticity of denervated striated muscles enabling functional recovery via alien autonomic fibers. These findings may further explain the underlying mechanisms of sensory protection implemented to prevent atrophy of a denervated muscle.SIGNIFICANCE STATEMENT Nerve injuries represent significant morbidity and disability for patients. Rewiring motor nerve fibers to other target muscles has shown to be a successful approach in the restoration of motor function. This demonstrates the remarkable capacity of the CNS to adapt to the needs of the neuromuscular system. Yet, the capability of skeletal muscles being reinnervated by nonmotor axons remains largely unknown. Here, we show that under deprivation of original efferent input, the neuromuscular system can undergo functional and morphologic remodeling via autonomic nerve fibers. This may explain neurobiological mechanisms of the sensory protection phenomenon, which is because of parasympathetic reinnervation.
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Affiliation(s)
- Vlad Tereshenko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Dominik C Dotzauer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Matthias Luft
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Joachim Ortmayr
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Johanna Klepetko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Gregor Laengle
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Olga Politikou
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
| | | | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
- Department of Plastic, Aesthetic, and Reconstructive Surgery, Karl Landsteiner University of Health Sciences, University Hospital, A-3500 Krems an der Donau, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
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5
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Tereshenko V, Maierhofer U, Dotzauer DC, Laengle G, Schmoll M, Festin C, Luft M, Carrero Rojas G, Politikou O, Hruby LA, Klein HJ, Eisenhardt SU, Farina D, Blumer R, Bergmeister KD, Aszmann OC. Newly identified axon types of the facial nerve unveil supplemental neural pathways in the innervation of the face. J Adv Res 2022; 44:135-147. [PMID: 36725185 PMCID: PMC9936413 DOI: 10.1016/j.jare.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/02/2022] [Accepted: 04/16/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Neuromuscular control of the facial expressions is provided exclusively via the facial nerve. Facial muscles are amongst the most finely tuned effectors in the human motor system, which coordinate facial expressions. In lower vertebrates, the extracranial facial nerve is a mixed nerve, while in mammals it is believed to be a pure motor nerve. However, this established notion does not agree with several clinical signs in health and disease. OBJECTIVES To elucidate the facial nerve contribution to the facial muscles by investigating axonal composition of the human facial nerve. To reveal new innervation pathways of other axon types of the motor facial nerve. METHODS Different axon types were distinguished using specific molecular markers (NF, ChAT, CGRP and TH). To elucidate the functional role of axon types of the facial nerve, we used selective elimination of other neuronal support from the trigeminal nerve. We used retrograde neuronal tracing, three-dimensional imaging of the facial muscles, and high-fidelity neurophysiological tests in animal model. RESULTS The human facial nerve revealed a mixed population of only 85% motor axons. Rodent samples revealed a fiber composition of motor, afferents and, surprisingly, sympathetic axons. We confirmed the axon types by tracing the originating neurons in the CNS. The sympathetic fibers of the facial nerve terminated in facial muscles suggesting autonomic innervation. The afferent fibers originated in the facial skin, confirming the afferent signal conduction via the facial nerve. CONCLUSION These findings reveal new innervation pathways via the facial nerve, support the sympathetic etiology of hemifacial spasm and elucidate clinical phenomena in facial nerve regeneration.
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Affiliation(s)
- Vlad Tereshenko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,Center for Biomedical Research, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,Center for Biomedical Research, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Dominik C. Dotzauer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,Center for Biomedical Research, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Gregor Laengle
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,Center for Biomedical Research, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Martin Schmoll
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,Center for Biomedical Research, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Matthias Luft
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,Center for Biomedical Research, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Genova Carrero Rojas
- Center for Anatomy and Cell Biology, Medical University of Vienna, Waehringer Street 13, 1090 Vienna, Austria
| | - Olga Politikou
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,Center for Biomedical Research, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Laura A. Hruby
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Holger J. Klein
- Clinic of Hand, Reconstructive, and Plastic Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Steffen U. Eisenhardt
- Department of Plastic and Hand Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Street 55, 79106 Freiburg, Germany
| | - Dario Farina
- Department of Bioengineering, Imperial College London, South Kensington Campus London, SW7 2AZ London, UK
| | - Roland Blumer
- Center for Anatomy and Cell Biology, Medical University of Vienna, Waehringer Street 13, 1090 Vienna, Austria
| | - Konstantin D. Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,Center for Biomedical Research, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,Karl Landsteiner University of Health Sciences, Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems an der Donau, Austria
| | - Oskar C. Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,Corresponding author at: Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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6
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Luft M, Klepetko J, Muceli S, Ibáñez J, Tereshenko V, Festin C, Laengle G, Politikou O, Maierhofer U, Farina D, Aszmann OC, Bergmeister KD. Proof of concept for multiple nerve transfers to a single target muscle. eLife 2021; 10:71312. [PMID: 34596042 PMCID: PMC8530510 DOI: 10.7554/elife.71312] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Surgical nerve transfers are used to efficiently treat peripheral nerve injuries, neuromas, phantom limb pain, or improve bionic prosthetic control. Commonly, one donor nerve is transferred to one target muscle. However, the transfer of multiple nerves onto a single target muscle may increase the number of muscle signals for myoelectric prosthetic control and facilitate the treatment of multiple neuromas. Currently, no experimental models are available. This study describes a novel experimental model to investigate the neurophysiological effects of peripheral double nerve transfers to a common target muscle. In 62 male Sprague-Dawley rats, the ulnar nerve of the antebrachium alone (n=30) or together with the anterior interosseus nerve (n=32) was transferred to reinnervate the long head of the biceps brachii. Before neurotization, the motor branch to the biceps’ long head was transected at the motor entry point. Twelve weeks after surgery, muscle response to neurotomy, behavioral testing, retrograde labeling, and structural analyses were performed to assess reinnervation. These analyses indicated that all nerves successfully reinnervated the target muscle. No aberrant reinnervation was observed by the originally innervating nerve. Our observations suggest a minimal burden for the animal with no signs of functional deficit in daily activities or auto-mutilation in both procedures. Furthermore, standard neurophysiological analyses for nerve and muscle regeneration were applicable. This newly developed nerve transfer model allows for the reliable and standardized investigation of neural and functional changes following the transfer of multiple donor nerves to one target muscle.
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Affiliation(s)
- Matthias Luft
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Johanna Klepetko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Silvia Muceli
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Jaime Ibáñez
- Department of Bioengineering, Imperial College London, London, United Kingdom.,Department of Clinical and Movement Neuroscience, University College London, London, London, United Kingdom.,BSICoS Group, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Vlad Tereshenko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Gregor Laengle
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Olga Politikou
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom.,Department of Clinical and Movement Neuroscience, University College London, London, London, United Kingdom
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konstantin Davide Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner University of Health Sciences, Department of Plastic, Aesthetic and ReconstructiveSurgery, University Hospital St. Poelten, St. Poelten, Austria
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Tereshenko V, Dotzauer DC, Maierhofer U, Festin C, Luft M, Laengle G, Politikou O, Klein HJ, Blumer R, Aszmann OC, Bergmeister KD. Selective Denervation of the Facial Dermato-Muscular Complex in the Rat: Experimental Model and Anatomical Basis. Front Neuroanat 2021; 15:650761. [PMID: 33828465 PMCID: PMC8019738 DOI: 10.3389/fnana.2021.650761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
The facial dermato-muscular system consists of highly specialized muscles tightly adhering to the overlaying skin and thus form a complex morphological conglomerate. This is the anatomical and functional basis for versatile facial expressions, which are essential for human social interaction. The neural innervation of the facial skin and muscles occurs via branches of the trigeminal and facial nerves. These are also the most commonly pathologically affected cranial nerves, often requiring surgical treatment. Hence, experimental models for researching these nerves and their pathologies are highly relevant to study pathophysiology and nerve regeneration. Experimental models for the distinctive investigation of the complex afferent and efferent interplay within facial structures are scarce. In this study, we established a robust surgical model for distinctive exploration of facial structures after complete elimination of afferent or efferent innervation in the rat. Animals were allocated into two groups according to the surgical procedure. In the first group, the facial nerve and in the second all distal cutaneous branches of the trigeminal nerve were transected unilaterally. All animals survived and no higher burden was caused by the procedures. Whisker pad movements were documented with video recordings 4 weeks after surgery and showed successful denervation. Whole-mount immunofluorescent staining of facial muscles was performed to visualize the innervation pattern of the neuromuscular junctions. Comprehensive quantitative analysis revealed large differences in afferent axon counts in the cutaneous branches of the trigeminal nerve. Axon number was the highest in the infraorbital nerve (28,625 ± 2,519), followed by the supraorbital nerve (2,131 ± 413), the mental nerve (3,062 ± 341), and the cutaneous branch of the mylohyoid nerve (343 ± 78). Overall, this surgical model is robust and reliable for distinctive surgical deafferentation or deefferentation of the face. It may be used for investigating cortical plasticity, the neurobiological mechanisms behind various clinically relevant conditions like facial paralysis or trigeminal neuralgia as well as local anesthesia in the face and oral cavity.
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Affiliation(s)
- Vlad Tereshenko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Dominik C Dotzauer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Matthias Luft
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Gregor Laengle
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Olga Politikou
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Holger J Klein
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Roland Blumer
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.,Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, Krems, Austria
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Enbergs A, Dorszewski A, Luft M, Mönnig G, Kleemann A, Schulte H, Assmann G, Breithardt G, Kerber S. Failure to confirm ferritin and caeruloplasmin as risk factors for the angiographic extent of coronary arteriosclerosis. Coron Artery Dis 1998; 9:119-24. [PMID: 9647413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND It has been suggested that iron overload, as assessed by increased serum ferritin concentration, may be a risk factor for coronary artery disease (CAD). Recent studies have reported conflicting data on the role of ferritin and other parameters of oxidative metabolism in CAD. OBJECTIVE The aim of this study was to assess the relation between the extent of CAD and parameters of oxidation. METHODS We studied 275 patients (208 men aged 55.1 +/- 9.6 years and 67 women aged 54.6 +/- 10.0 years) who underwent coronary angiography or percutaneous transluminal coronary angioplasty for the first time. The parameters assessed were: iron, ferritin, transferrin, copper, caeruloplasmin and lipid. Cinefilms were assessed by the use of three scores: (1) Vessel score: 0-3 points; 1 point for each of the three main coronary arteries with a stenosis >70%. (2) Stenosis score: 0-32 points; the coronary artery tree was divided into eight segments that were scored 1-4 points per segment with respect to the maximal degree of stenosis. (3) Extent score: 0-100 points; extent of diffuse coronary lesions in each segment in relation to the length of the vessel. Multiple regression analyses were used to evaluate the results. RESULTS Total cholesterol and low-density lipoprotein cholesterol (P < 0.001) in women, low-density lipoprotein cholesterol (P < 0.05) in men, and patient age showed a significant correlation with all three scores, but none of the parameters of oxidative metabolism (iron, transferrin, ferritin, copper, caeruloplasmin) correlated significantly with any of the three scores. CONCLUSION This study demonstrated a correlation between lipoproteins and the angiographic extent of CAD, but did not confirm a role for serum ferritin and other oxidative parameters as risk factors for the extent of CAD.
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Affiliation(s)
- A Enbergs
- Department of Cardiology and Angiology, Institute for Arteriosclerosis Research, Hospital of the Westfälische Wilhelms-Universität, Münster, Germany
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Rössle M, Luft M, Herz R, Klein B, Lehmann M, Gerok W. Amino acid, ammonia and neurotransmitter concentrations in hepatic encephalopathy: serial analysis in plasma and cerebrospinal fluid during treatment with an adapted amino acid solution. Klin Wochenschr 1984; 62:867-75. [PMID: 6149332 DOI: 10.1007/bf01712006] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We evaluated changes of advanced liver disease and hepatic encephalopathy on the concentrations of amino acids (AA) and ammonia in plasma and cerebrospinal fluid (CSF) and of the neurotransmitters norepinephrine, dopamine and 5-hydroxytryptamine (5-HT) as well as the 5-hydroxyindole acetic acid (5-HIAA) in CSF before and at the end of a 3-day period of treatment with infusions enriched with branched chain amino acids (BCAA). The subjects studied were 13 patients with alcoholic cirrhosis and hepatic encephalopathy stages 1-3 (n = 8) and stage 4 (n = 5). The patients in coma stages 1-3 recovered during the treatment (survivors), those in coma stage 4 died before the study period was finished (non-survivors). The data emerging from this study show: Alterations of AA concentrations are much more pronounced in the CSF than in the plasma. In the case of tryptophan the alterations in plasma and CSF were inverse. Before the treatment the CSF-plasma ratios of the concentrations of BCAA and aromatic amino acids (AAA) are increased reflecting an activated transport of both the BCAA and AAA through the blood-brain barrier. High dose BCAA nearly normalized CSF concentrations and CSF-plasma ratios of AAA assuming that the treatment brought about an effective competition of cerebral uptake between BCAA and AAA. The CSF concentrations of ammonia and glutamine decreased significantly during treatment while the plasma concentrations changed only moderately. As to the neurotransmitters, only the concentrations of 5-HT and its metabolite 5-HIAA correlated with the clinical picture and with the concentration of their precursor AA.(ABSTRACT TRUNCATED AT 250 WORDS)
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Luft M. The failed back syndrome; etiology and therapy. Orthopedics 1984; 7:946-8. [PMID: 24822689 DOI: 10.3928/0147-7447-19840601-05] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Rössle M, Herz R, Lehmann G, Luft M, Gerok W. [Therapy of hepatic encephalopathy. Changes in the cerebrospinal fluid concentration of catecholamine neurotransmitters, ammonia and amino acids in the course of an infusion treatment with branched-chain amino acids]. Infusionsther Klin Ernahr 1982; 9:256-8. [PMID: 7141673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Infusions containing branched-chain amino acids have recently been used for the therapy of hepatic coma. Their mode of action was attributed to a reduction in the intracerebral concentrations of the aromatic amino acids with resultant normalization of the neurotransmitters noradrenaline, dopamine and serotonin, synthesized from these amino acids. In order to further clarify this therapeutic mechanism an infusion solution consisting of branched-chain amino acids and ammonia-reducing amino acids was administered to patients with porto-systemic encephalopathy. The amino acid pattern, the ammonia in plasma and liquor, and the neurotransmitters noradrenaline, adrenaline and dopamine, in the liquor were determined before and after the course of treatment. Our studies show that the therapeutic effect of branched-chain amino acids in the therapy of hepatic encephalopathy is based on an effective intracerebral reduction of the ammonia concentration by 61%. The actual concentrations of the neurotransmitters were not significantly modified by the therapy. This opens to question the hypothesis that the neurotransmitters are responsible for the development of hepatic encephalopathy.
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Rössle M, Herz R, Lehmann G, Luft M, Gerok W. Therapie der hepatischen Enzephalopathie. Transfus Med Hemother 1982. [DOI: 10.1159/000221359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Seit kurzem werden Infusionen mit verzweigtkettigen Aminosäuren zur Therapie des Coma hepaticum verabreicht. Der Wirkungsmechanismus wurde auf eine Senkung der intrazerebralen Konzentrationen der aromatischen Aminosäuren und einer daraus resultierenden Normalisierung der aus diesen Aminosäuren synthetisierten Neurotransmitter Noradrenalin, Dopamin und Serotonin zurückgeführt. Es wurde zur weiteren Abklärung des Wirkungsmechanismus bei Patienten mit portosystemischer Enzephalopathie eine Infusionslösung, bestehend aus verzweigtkettigen und ammoniaksenkenden Aminosäuren, verabreicht; vor und nach der Behandlung wurden das Aminosäurenspektrum und der Ammoniak im Plasma und Liquor sowie die Neurotransmitter Noradrenalin, Adrenalin und Dopamin im Liquor bestimmt. Unsere Untersuchungen zeigen, daβ der Wirkungsmechanismus verzweigtkettiger Aminosäuren zur Therapie der hepatischen Enzephalopathie auf einer effektiven intrazerebralen Senkung der Ammoniakkonzentration um 61 % beruht. Die Neurotransmitter-Konzentrationen selbst werden durch die Behandlung nicht signifikant verändert. Dies stellt die Neurotransmitter-Hypothese zur Entstehung der hepatischen Enzephalopathie in Frage.
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