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Book ; Online ; Thesis: Prädiktion von Infektionen bei hospitalisierten Patientinnen und Patienten mit Leberzirrhose

Wittmann, Sebastian Giacomo Verfasser] / [Kluwe, Johannes [Akademischer Betreuer] / Horvatits, Thomas [Akademischer Betreuer]

2023

Author's details	Sebastian Giacomo Wittmann ; Johannes Kluwe, Thomas Horvatits
Keywords	Medizin, Gesundheit ; Medicine, Health
Subject code	sg610
Language	German
Publisher	Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky
Publishing place	Hamburg
Document type	Book ; Online ; Thesis
Database	Digital theses on the web

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Article ; Online: 4D flow MRI-guided treatment of portal-hypertensive complications in a patient with multiple extrahepatic arterioportal shunts.

Riedel, Christoph / Bannas, Peter / Lenz, Alexander / Ittrich, Harald / Perez, Daniel / Adam, Gerhard / Lohse, Ansgar W / Kluwe, Johannes / Piecha, Felix

Magnetic resonance imaging

2023 Volume 101, Page(s) 54–56

Abstract: Portal hypertension is the underlying reason for complications like ascites or gastrointestinal varices in end-stage liver disease. On rare occasions, portal hypertension may be caused by extrahepatic arterioportal shunts. This report illustrates an ... ...

Abstract	Portal hypertension is the underlying reason for complications like ascites or gastrointestinal varices in end-stage liver disease. On rare occasions, portal hypertension may be caused by extrahepatic arterioportal shunts. This report illustrates an outstanding case of extrahepatic arterioportal shunting as an uncommon cause of TIPS-refractory portal hypertension. Four-dimensional flow magnetic resonance imaging (4D flow MRI) is a novel non-invasive technique that enables the visualization of complex vascular disorders but has not been put into daily clinical practice in hepatology. In this case, 4D flow MRI enabled the visualization of three abdominal arterioportal shunts as the reason for TIPS-refractory portal hypertension. The quantification of individual shunt flow rates by 4D flow MRI guided our treatment strategy consisting of embolization during interventional angiography and surgical resection of all three arterioportal shunts. In conclusion, this case highlights the usefulness of 4D flow MRI for evaluating shunt flow in cases of complex vascular disorders and portal-hypertensive complications, thus helping to guide therapeutic decisions and monitoring the therapeutic success.
MeSH term(s)	Humans ; Hypertension, Portal/etiology ; Hypertension, Portal/surgery ; Magnetic Resonance Imaging/adverse effects ; Embolization, Therapeutic/adverse effects
Language	English
Publishing date	2023-04-01
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	604885-7
ISSN	1873-5894 ; 0730-725X
ISSN (online)	1873-5894
ISSN	0730-725X
DOI	10.1016/j.mri.2023.03.018
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Article: SOP Spontan bakterielle Peritonitis bei Leberzirrhose

Wege, Henning / Kluwe, Johannes

Gastroenterologie up2date

2019 Volume 15, Issue 04, Page(s) 321–325

Keywords	spontan bakterielle Peritonitis ; diagnostische Parazentese ; antibiotische Therapie ; Primärprophylaxe ; Sekundärprophylaxe
Language	German
Publishing date	2019-12-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2203033-5
ISSN	1616-9727 ; 1616-9670
ISSN (online)	1616-9727
ISSN	1616-9670
DOI	10.1055/a-0784-9169
Database	Thieme publisher's database

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Book ; Online ; Thesis: Einfluss der Enzyme Myeloperoxidase und Lipoproteinlipase auf die Progression der nicht-alkoholischen Steatohepatitis

Koop, Anja Christina [Verfasser] / Kluwe, Johannes [Akademischer Betreuer]

2020

Author's details	Anja Christina Koop ; Betreuer: Johannes Kluwe
Keywords	Medizin, Gesundheit ; Medicine, Health
Subject code	sg610
Language	German
Publisher	Staats- und Universitätsbibliothek Hamburg
Publishing place	Hamburg
Document type	Book ; Online ; Thesis
Database	Digital theses on the web

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Article ; Online: Stop of proton-pump inhibitor treatment in patients with liver cirrhosis (STOPPIT): study protocol for a prospective, multicentre, controlled, randomized, double-blind trial.

Wehmeyer, Malte H / Horvatits, Thomas / Buchholz, Anika / Krause, Linda / Walter, Sarah / Zapf, Antonia / Lohse, Ansgar W / Kluwe, Johannes

Trials

2022 Volume 23, Issue 1, Page(s) 302

Abstract: Background: Proton-pump inhibitors (PPI) are liberally prescribed in patients with liver cirrhosis. Observational studies link PPI therapy in cirrhotic patients with an increased risk for infectious complications, hepatic encephalopathy and an increased ...

Abstract	Background: Proton-pump inhibitors (PPI) are liberally prescribed in patients with liver cirrhosis. Observational studies link PPI therapy in cirrhotic patients with an increased risk for infectious complications, hepatic encephalopathy and an increased risk for hospitalization and mortality. However, patients with liver cirrhosis are also considered to be at risk for peptic ulcer bleeding. The STOPPIT trial evaluates if discontinuation of a pre-existing PPI treatment delays a composite endpoint of re-hospitalization and/or death in patients (recently) hospitalized with liver cirrhosis compared to patients on continued PPI medication. Methods: The STOPPIT-trial is a prospective, multicentre, randomized, double-blinded, placebo-controlled, parallel-group trial. In total, 476 patients with complicated liver cirrhosis who already receive long-term PPI therapy without evidence-based indication are 1:1 randomized to receive either esomeprazole 20 mg (control group) or placebo (intervention group) for 360 days. Patients with an indication for PPI therapy (such as a recent diagnosis of peptic ulcers, severe reflux esophagitis, severe hemorrhagic gastritis, recent endoscopic therapy for oesophageal varices) are excluded. The primary composite endpoint is the time-to re-hospitalization and/or death. Secondary endpoints include rates of re-hospitalization, mortality, occurrence of infections, hepatic decompensation and acute-on-chronic liver failure. The safety endpoint is defined as manifestation of an evidence-based indication for PPI re-therapy. The impact of PPI continuation or discontinuation on the intestinal microbiota will be studied. The recruitment will take place at 18 study sites throughout Germany. Recruitment has started in April 2021. Discussion: The STOPPIT trial is the first clinical trial to study the effects of PPI withdrawal on relevant outcome variables in patients with complicated liver cirrhosis. If the hypothesis that PPI withdrawal improves clinical outcomes of cirrhosis patients is confirmed, this would argue for a strong restriction of the currently liberal prescription practice of PPIs in this population. If, on the other hand, the trial demonstrates an increased risk of gastrointestinal bleeding events in patients after PPI withdrawal, this could create a rationale for a more liberal, prophylactic PPI treatment in patients with liver cirrhosis. Trial registration: EU clinical trials register EudraCT 2019-005008-16 (registered December 27, 2019). Clinicaltrials: gov NCT04448028 (registered June 25, 2020). German Clinical Trials Register DRKS00021290 (registered March 10, 2021).
MeSH term(s)	COVID-19 ; Humans ; Liver Cirrhosis/complications ; Liver Cirrhosis/diagnosis ; Liver Cirrhosis/drug therapy ; Multicenter Studies as Topic ; Prospective Studies ; Proton Pump Inhibitors/adverse effects ; Randomized Controlled Trials as Topic ; SARS-CoV-2
Chemical Substances	Proton Pump Inhibitors
Language	English
Publishing date	2022-04-12
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-022-06232-w
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Article ; Online: Arginine and NASH--do macrophages deliver the first hit?

Scheja, Ludger / Kluwe, Johannes

Journal of hepatology

2015 Volume 62, Issue 2, Page(s) 260–261

MeSH term(s)	Animals ; Arginase/metabolism ; Fatty Liver/immunology ; Hyperargininemia/complications ; Immunity, Innate ; Kupffer Cells/immunology ; Lipid Metabolism ; Lipogenesis/immunology ; Male
Chemical Substances	Arg2 protein, mouse (EC 3.5.3.1) ; Arginase (EC 3.5.3.1)
Language	English
Publishing date	2015-02
Publishing country	Netherlands
Document type	Comment ; Editorial ; Research Support, Non-U.S. Gov't
ZDB-ID	605953-3
ISSN	1600-0641 ; 0168-8278
ISSN (online)	1600-0641
ISSN	0168-8278
DOI	10.1016/j.jhep.2014.11.001
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Zs.A 2027: Show issues

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Article: High prevalence of periodontal disease in patients with NASH- possible association of poor dental health with NASH severity.

Pischke, Sven / Shiprov, Anita / Peters, Ulrike / Schulze Zur Wiesch, Julian / Kluwe, Johannes / Westphal, Tim / Fischer, Frank / Mader, Maria / Fründt, Thorben / Horvatits, Karoline / Horvatits, Thomas / Aarabi, Ghazal / Beikler, Thomas

Annals of hepatology

2023 Volume 28, Issue 2, Page(s) 100887

Abstract: Introduction and objectives: Recent translational research indicated a bidirectional relationship between NASH (non-alcoholic steatohepatitis) and periodontitis; however, few clinical cohorts have studied this in detail. Thus we investigated this ... ...

Abstract	Introduction and objectives: Recent translational research indicated a bidirectional relationship between NASH (non-alcoholic steatohepatitis) and periodontitis; however, few clinical cohorts have studied this in detail. Thus we investigated this assumed association in a well-defined cohort. Materials and methods: Data were generated prospectively for 132 patients (32 patients with NASH and 100 unselected, consecutively collected, anonymized controls from a local dental practice): detailed periodontal parameters, i.e., pocket-probing-depths (PPD), bleeding-on-probing (BOP), plaque-index, and utilization of dental care were assessed and correlated with relevant hepatic parameters (liver stiffness via fibroscan, AST, ALT, bilirubin, and MELD-score). Gingiva samples were tested for Porphyromonas gingvalis (P.g.) and Actinobacillus actinomyctemcomitans (A.a.) by PCR. Results: 87.5% of NASH patients and 47% of controls suffered from moderate to severe periodontitis (p=0.01). Liver stiffness was significantly correlated with elevated PPD (p=0.02) and BOP (p=0.03). 34 % of the NASH patients did not make use of regular dental health care. In these patients, AST (p=0.04), MELD score (p<0.01), and liver stiffness (p=0.01) were significantly elevated compared to those who see a dentist regularly. The severity of NASH was not associated with the intraoral detection of P.g. and A.a. Conclusions: The present study suggests that NASH might be associated with periodontitis, irrespective of the intraoral presence of P.g. and A.a. Moreover, regular dental care utilization might mitigate the course of NASH, and patients should be reminded by their hepatologists of the importance of regular dental visits. Future studies should investigate the role of regular dental care and additional anti-inflammatory treatments of the oral cavity.
MeSH term(s)	Humans ; Prevalence ; Porphyromonas gingivalis ; Periodontal Diseases/diagnosis ; Periodontal Diseases/epidemiology ; Periodontal Diseases/complications ; Periodontitis/diagnosis ; Periodontitis/epidemiology ; Periodontitis/complications ; Non-alcoholic Fatty Liver Disease/diagnosis ; Non-alcoholic Fatty Liver Disease/epidemiology ; Non-alcoholic Fatty Liver Disease/complications
Language	English
Publishing date	2023-01-13
Publishing country	Mexico
Document type	Journal Article
ZDB-ID	2188733-0
ISSN	1665-2681
ISSN	1665-2681
DOI	10.1016/j.aohep.2022.100887
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Article ; Online: TREM2 Regulates the Removal of Apoptotic Cells and Inflammatory Processes during the Progression of NAFLD.

Liebold, Imke / Meyer, Simon / Heine, Markus / Kuhl, Anastasia / Witt, Jennifer / Eissing, Leah / Fischer, Alexander W / Koop, Anja Christina / Kluwe, Johannes / Wiesch, Julian Schulze Zur / Wehmeyer, Malte / Knippschild, Uwe / Scheja, Ludger / Heeren, Joerg / Bosurgi, Lidia / Worthmann, Anna

Cells

2023 Volume 12, Issue 3

Abstract: Nonalcoholic fatty liver disease (NAFLD) is the most common liver pathology worldwide. In mice and humans, NAFLD progression is characterized by the appearance of TREM2-expressing macrophages in the liver. However, their mechanistic contributions to ... ...

Abstract	Nonalcoholic fatty liver disease (NAFLD) is the most common liver pathology worldwide. In mice and humans, NAFLD progression is characterized by the appearance of TREM2-expressing macrophages in the liver. However, their mechanistic contributions to disease progression have not been completely elucidated. Here, we show that TREM2
MeSH term(s)	Humans ; Mice ; Animals ; Non-alcoholic Fatty Liver Disease/metabolism ; Liver Cirrhosis/pathology ; Macrophages/metabolism ; Apoptosis ; Membrane Glycoproteins/genetics ; Receptors, Immunologic
Chemical Substances	TREM2 protein, human ; Membrane Glycoproteins ; Receptors, Immunologic ; Trem2 protein, mouse
Language	English
Publishing date	2023-01-17
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2661518-6
ISSN	2073-4409 ; 2073-4409
ISSN (online)	2073-4409
ISSN	2073-4409
DOI	10.3390/cells12030341
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Article ; Online: Preoperative TIPS and in-hospital mortality in patients with cirrhosis undergoing surgery.

Piecha, Felix / Vonderlin, Joscha / Frühhaber, Friederike / Graß, Julia-Kristin / Ozga, Ann-Kathrin / Harberts, Aenne / Benten, Daniel / Hübener, Peter / Reeh, Matthias / Riedel, Christoph / Bannas, Peter / Izbicki, Jakob R / Adam, Gerhard / Huber, Samuel / Lohse, Ansgar W / Kluwe, Johannes

JHEP reports : innovation in hepatology

2023 Volume 6, Issue 1, Page(s) 100914

Abstract: Background & aims: Cirrhosis is associated with an increased surgical morbidity and mortality. Portal hypertension and the surgery type have been established as critical determinants of postoperative outcome. We aim to evaluate the hypothesis that ... ...

Abstract	Background & aims: Cirrhosis is associated with an increased surgical morbidity and mortality. Portal hypertension and the surgery type have been established as critical determinants of postoperative outcome. We aim to evaluate the hypothesis that preoperative transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with cirrhosis is associated with a lower incidence of in-house mortality/liver transplantation (LT) after surgery. Methods: A retrospective database search for the years 2010-2020 was carried out. We identified 64 patients with cirrhosis who underwent surgery within 3 months after TIPS placement and 131 patients with cirrhosis who underwent surgery without it (controls). Operations were categorised into low-risk and high-risk procedures. The primary endpoint was in-house mortality/LT. We analysed the influence of high-risk surgery, preoperative TIPS placement, age, sex, baseline creatinine, presence of ascites, Chronic Liver Failure Consortium Acute Decompensation (CLIF-C AD), American Society of Anesthesiologists (ASA), and model for end-stage liver disease (MELD) scores on in-house mortality/LT by multivariable Cox proportional hazards regression. Results: In both the TIPS and the control cohort, most patients presented with a Child-Pugh B stage (37/64, 58% Conclusions: A preoperative TIPS might be associated with reduced postoperative in-house mortality in selected patients with cirrhosis. Impact and implications: Patients with cirrhosis are at risk for more complications and a higher mortality after surgical procedures. A transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of cirrhosis, but it is unclear if it also helps to lower the risk of surgery. This study takes a look at complications and mortality of patients undergoing surgery with or without a TIPS, and we found that patients with a TIPS develop less complications and have an improved survival. Therefore, a preoperative TIPS should be considered in selected patients, especially if indicated by ascites.
Language	English
Publishing date	2023-09-23
Publishing country	Netherlands
Document type	Journal Article
ISSN	2589-5559
ISSN (online)	2589-5559
DOI	10.1016/j.jhepr.2023.100914
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Article ; Online: Liver damage promotes pro-inflammatory T-cell responses against apolipoprotein B-100.

Plochg, Bastian F J / Englert, Hanna / Rangaswamy, Chandini / Konrath, Sandra / Malle, Mandy / Lampalzer, Sibylle / Beisel, Claudia / Wollin, Salma / Frye, Maike / Aberle, Jens / Kluwe, Johannes / Renné, Thomas / Mailer, Reiner K

Journal of internal medicine

2022 Volume 291, Issue 5, Page(s) 648–664

Abstract: Objectives: Liver-derived apolipoprotein B-100 (ApoB100) is an autoantigen that is recognized by atherogenic CD4: Methods: We identified ApoB100-specific T cells in blood from healthy controls, nonalcoholic fatty liver disease (NAFLD) patients, and ... ...

Abstract	Objectives: Liver-derived apolipoprotein B-100 (ApoB100) is an autoantigen that is recognized by atherogenic CD4 Methods: We identified ApoB100-specific T cells in blood from healthy controls, nonalcoholic fatty liver disease (NAFLD) patients, and CVD patients by activation-induced marker expression and analyzed their differentiation pattern in correlation to the lipid profile and liver damage parameters in a cross-sectional study. To assess the induction of extrahepatic ApoB100-specific T cells upon transient liver damage in vivo, we performed hydrodynamic tail vein injections with diphtheria toxin A (DTA)-encoding plasmid in human ApoB100-transgenic mice. Results: Utilizing immunodominant ApoB100-derived peptides, we found increased ApoB100-specific T-cell populations in NAFLD and CVD patients compared to healthy controls. In a peptide-specific manner, ApoB100 reactivity in healthy controls was accompanied by expression of the regulatory T (Treg)-cell transcription factor FOXP3. In contrast, FOXP3 expression decreased, whereas expression of pro-inflammatory cytokine interleukin (IL)-17A increased in ApoB100-specific T cells from NAFLD and CVD patients. Dyslipidemia and liver damage parameters in blood correlated with reduced FOXP3 expression and elevated IL-17A production in ApoB100-specific T-cell populations, respectively. Moreover, DTA-mediated transient liver damage in human ApoB100-transgenic mice accumulated IL-17a-expressing ApoB100-specific T cells in the periphery. Conclusion: Our results show that liver damage promotes pro-inflammatory ApoB100-specific T-cell populations, thereby providing a cellular mechanism for the increased CVD risk in liver disease patients.
MeSH term(s)	Animals ; Apolipoprotein B-100/metabolism ; Atherosclerosis ; Cross-Sectional Studies ; Forkhead Transcription Factors/metabolism ; Humans ; Interleukin-17/metabolism ; Mice ; Mice, Transgenic ; Non-alcoholic Fatty Liver Disease/metabolism ; T-Lymphocytes, Regulatory
Chemical Substances	Apolipoprotein B-100 ; Forkhead Transcription Factors ; Interleukin-17
Language	English
Publishing date	2022-01-13
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	96274-0
ISSN	1365-2796 ; 0954-6820
ISSN (online)	1365-2796
ISSN	0954-6820
DOI	10.1111/joim.13434
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