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  • 1
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    Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol
    Elsevier BV ; 2021
    In:  Journal of the American College of Cardiology Vol. 78, No. 5 ( 2021-08), p. 421-433
    Details
    In: Journal of the American College of Cardiology, Elsevier BV, Vol. 78, No. 5 ( 2021-08), p. 421-433
    Type of Medium: Online Resource
    ISSN: 0735-1097
    URL: Article
    DOI: 10.1016/j.jacc.2021.04.102
    RVK:
    XA 17760
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 1468327-1
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  • 2
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    Apolipoprotein B, Residual Cardiovascular Risk After Acute Coronary Syndrome, and Effects of Alirocumab
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. 9 ( 2022-08-30), p. 657-672
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. 9 ( 2022-08-30), p. 657-672
    Abstract: Apolipoprotein B (apoB) provides an integrated measure of atherogenic risk. Whether apoB levels and apoB lowering hold incremental predictive information on residual risk after acute coronary syndrome beyond that provided by low-density lipoprotein cholesterol is uncertain. Methods: The ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) compared the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome and elevated atherogenic lipoproteins despite optimized statin therapy. Primary outcome was major adverse cardiovascular events (MACE; coronary heart disease death, nonfatal myocardial infarction, fatal/nonfatal ischemic stroke, hospitalization for unstable angina). Associations between baseline apoB or apoB at 4 months and MACE were assessed in adjusted Cox proportional hazards and propensity score–matched models. Results: Median follow-up was 2.8 years. In proportional hazards analysis in the placebo group, MACE incidence increased across increasing baseline apoB strata (3.2 [95% CI, 2.9–3.6], 4.0 [95% CI, 3.6–4.5] , and 5.5 [95% CI, 5.0–6.1] events per 100 patient-years in strata 〈 75, 75– 〈 90, ≥90 mg/dL, respectively; P trend 〈 0.0001) and after adjustment for low-density lipoprotein cholesterol ( P trend =0.035). Higher baseline apoB stratum was associated with greater relative ( P trend 〈 0.0001) and absolute reduction in MACE with alirocumab versus placebo. In the alirocumab group, the incidence of MACE after month 4 decreased monotonically across decreasing achieved apoB strata (4.26 [95% CI, 3.78–4.79], 3.09 [95% CI, 2.69–3.54] , and 2.41 [95% CI, 2.11–2.76] events per 100 patient-years in strata ≥50, 〉 35– 〈 50, and ≤35 mg/dL, respectively). Compared with propensity score–matched patients from the placebo group, treatment hazard ratios for alirocumab also decreased monotonically across achieved apoB strata. Achieved apoB was predictive of MACE after adjustment for achieved low-density lipoprotein cholesterol or non–high-density lipoprotein cholesterol but not vice versa. Conclusions: In patients with recent acute coronary syndrome and elevated atherogenic lipoproteins, MACE increased across baseline apoB strata. Alirocumab reduced MACE across all strata of baseline apoB, with larger absolute reductions in patients with higher baseline levels. Lower achieved apoB was associated with lower risk of MACE, even after accounting for achieved low-density lipoprotein cholesterol or non–high-density lipoprotein cholesterol, indicating that apoB provides incremental information. Achievement of apoB levels as low as ≤35 mg/dL may reduce lipoprotein-attributable residual risk after acute coronary syndrome. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01663402.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.121.057807
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 3
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    Relation of Lipoprotein(a) Levels to Incident Type 2 Diabetes and Modification by Alirocumab Treatment
    American Diabetes Association ; 2021
    In:  Diabetes Care Vol. 44, No. 5 ( 2021-05-01), p. 1219-1227
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 44, No. 5 ( 2021-05-01), p. 1219-1227
    Abstract: In observational data, lower levels of lipoprotein(a) have been associated with greater prevalence of type 2 diabetes. Whether pharmacologic lowering of lipoprotein(a) influences incident type 2 diabetes is unknown. We determined the relationship of lipoprotein(a) concentration with incident type 2 diabetes and effects of treatment with alirocumab, a PCSK9 inhibitor. RESEARCH DESIGN AND METHODS In the ODYSSEY OUTCOMES trial alirocumab was compared with placebo in patients with acute coronary syndrome. Incident diabetes was determined from laboratory, medication, and adverse event data. RESULTS Among 13,480 patients without diabetes at baseline, 1,324 developed type 2 diabetes over a median 2.7 years. Median baseline lipoprotein(a) was 21.9 mg/dL. With placebo, 10 mg/dL lower baseline lipoprotein(a) was associated with hazard ratio 1.04 (95% CI 1.02−1.06, P & lt; 0.001) for incident type 2 diabetes. Alirocumab reduced lipoprotein(a) by a median 23.2% with greater absolute reductions from higher baseline levels and no overall effect on incident type 2 diabetes (hazard ratio 0.95, 95% CI 0.85–1.05). At low baseline lipoprotein(a) levels, alirocumab tended to reduce incident type 2 diabetes, while at high baseline lipoprotein(a) alirocumab tended to increase incident type 2 diabetes compared with placebo (treatment–baseline lipoprotein(a) interaction P = 0.006). In the alirocumab group, a 10 mg/dL decrease in lipoprotein(a) from baseline was associated with hazard ratio 1.07 (95% CI 1.03−1.12; P = 0.0002) for incident type 2 diabetes. CONCLUSIONS In patients with acute coronary syndrome, baseline lipoprotein(a) concentration associated inversely with incident type 2 diabetes. Alirocumab had neutral overall effect on incident type 2 diabetes. However, treatment-related reductions in lipoprotein(a), more pronounced from high baseline levels, were associated with increased risk of incident type 2 diabetes. Whether these findings pertain to other therapies that reduce lipoprotein(a) is undetermined.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc20-2842
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2021
    detail.hit.zdb_id: 1490520-6
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  • 4
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    Contemporary Management of Severe Symptomatic Aortic Stenosis
    Elsevier BV ; 2021
    In:  Journal of the American College of Cardiology Vol. 78, No. 22 ( 2021-11), p. 2131-2143
    Details
    In: Journal of the American College of Cardiology, Elsevier BV, Vol. 78, No. 22 ( 2021-11), p. 2131-2143
    Type of Medium: Online Resource
    ISSN: 0735-1097
    URL: Article
    DOI: 10.1016/j.jacc.2021.09.864
    RVK:
    XA 17760
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 1468327-1
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  • 5
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    A vesefunkció hatása a gyógyszeres terápia optimalizálására és a mortalitásra csökkent ejekciós frakciójú szívelégtelenségben
    Akademiai Kiado Zrt. ; 2023
    In:  Orvosi Hetilap Vol. 164, No. 35 ( 2023-09-03), p. 1387-1396
    Details
    In: Orvosi Hetilap, Akademiai Kiado Zrt., Vol. 164, No. 35 ( 2023-09-03), p. 1387-1396
    Abstract: Bevezetés: Csökkent ejekciós frakciójú szívelégtelenségben (HFrEF) szenvedő betegekben az irányelvekben javasolt gyógyszeres terápia bevezetésének és a céldózis elérésének egyik fő limitáló tényezője a vesefunkció-károsodás. Célkitűzés: Egycentrumos, retrospektív vizsgálatunk célja a kombinált neurohormonális antagonista hármas terápia (RASi: ACEI/ARB/ARNI + béta-blokkoló + MRA) alkalmazási arányának, valamint a 12 hónapos összmortalitásnak az elemzése a vesefunkció-károsodás súlyosságának függvényében, szívelégtelenség klinikai tünetegyüttese miatt hospitalizált HFrEF-betegpopulációban. Módszer: Tercier kardiológiai centrumunk Szívelégtelenség Részlegén 2019 és 2021 között hospitalizált, konszekutív HFrEF-betegpopuláció adatait elemeztük. A hármas terápia alkalmazási gyakoriságát a kórházi elbocsátáskor, a felvételi becsült glomerularis filtrációs ráta (eGFR) alapján felállított öt alcsoportban (eGFR≥90, eGFR = 60–89, eGFR = 45–59, eGFR = 30–44, eGFR 〈 30 ml/min/1,73 m 2 ) khi-négyzet-próbával, a mortalitásbeli különbségeket Kaplan–Meier-analízissel és log-rank teszttel hasonlítottuk össze. Eredmények: Vizsgálatunkban 257 beteg adatait elemeztük. A felvételi medián eGFR 57 (39–75) ml/min/1,73 m 2 volt, a betegek 54%-a 60 ml/min/1,73 m 2 alatti eGFR-rel rendelkezett. A bevont betegek aránya az eGFR≥90, 60–89, 45–59, 30–44, 〈 30 ml/min/1,73 m 2 csoportokban 12%, 34%, 18%, 21%, 15% volt. Reguláris dialízisben 2%-uk részesült. Bár a teljes betegcsoport kiemelkedően nagy arányban részesült hármas terápiában (77%), az előrehaladott vesefunkció-károsodás a hármas terápia szignifikánsan kisebb alkalmazási arányához vezetett (94%, 86%, 91%, 70%, 34%, p 〈 0,0001). Mind a RASi- (100%, 98%, 96%, 89%, 50%, p 〈 0,0001), mind a béta-blokkoló (94%, 88%, 96%, 79%, 68%; p = 0,003), mind az MRA- (97%, 99%, 98%, 94%, 82%; p = 0,001) kezelés alkalmazási aránya különbözött az alcsoportokban. A 12 hónapos összmortalitás 23% volt a teljes kohorszban. A halálozási ráta nagyobbnak bizonyult az előrehaladott vesefunkció-károsodásban szenvedő betegek esetén (3%, 15%, 22%, 31%, 46%, p 〈 0,0001). Következtetés: Eredményeink alapján a teljes betegcsoport kiemelkedően nagy arányban részesült hármas terápiában, azonban az előrehaladott vesefunkció-károsodás a hármas terápia szignifikánsan kisebb alkalmazási arányához vezetett, mely kedvezőtlenebb túléléssel párosult. Eredményeink felhívják a figyelmet arra, hogy még előrehaladott vesefunkció-károsodás esetén is meg kell kísérelni a HFrEF kezelésében stratégiai fontosságú készítmények széles körű alkalmazását. Orv Hetil. 2023; 164(35): 1387–1396.
    Type of Medium: Online Resource
    ISSN: 0030-6002 , 1788-6120
    URL: Article
    DOI: 10.1556/650.2023.32836
    Language: Unknown
    Publisher: Akademiai Kiado Zrt.
    Publication Date: 2023
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  • 6
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    Az optimális gyógyszeres és eszközös terápia szerepe a peripartum cardiomyopathia komplex kezelésében
    Cardiologia Hungarica ; 2023
    In:  Cardiologia Hungarica Vol. 53, No. 4 ( 2023), p. 386-392
    Details
    In: Cardiologia Hungarica, Cardiologia Hungarica, Vol. 53, No. 4 ( 2023), p. 386-392
    Abstract: Bevezetés: A peripartum cardiomyopathia (PPCM) optimális, individualizált terápiája elengedhetetlen a mortalitás és a morbiditás csökkentésében. Eset: Egy 39 éves nőbeteg esetét mutatjuk be, aki 35 hetes gravidaként akut, dekompenzált, de novo csökkent ejekciós frakciójú szívelégtelenség (HFrEF) diagnózisával került kórházi felvételre (NTproBNP: 5680 pg/ml, NYHA IV). A transztorakális echokardiográfia (TTE) tág (LVEDD: 66 mm), normál falvastagságú, súlyos fokban csökkent szisztolés funkciójú bal kamrát (LVEF: 25%) igazolt. A súlyos, dekompenzált PPCM-re tekintettel a multidiszciplináris konzílium urgens császármetszést javasolt. Bromokriptint, illetve antikoaguláns és direkt vazodilatátor-kezelést indítottunk. Az emellett alkalmazott komplex antikongesztív, és a HFrEF-nek megfelelően bevezetett kombinált neurohormonális antagonista (ACEI + βB + MRA), illetve SGLT2i-terápia mellett állapota stabilizálódott, euvolémia elérhető és fenntartható volt. Szív MR-vizsgálata súlyos fokú szisztolés balkamra-diszfunkciót (LVEF: 22%, LVEDV: 191 ml), koronária-CT ép koszorúereket igazolt. NYHA II funkcionális osztályban történt hazabocsátást követően gondozását Szívelégtelenség Ambulanciánkon folytattuk. A súlyos balkamra-diszfunkció 〉 6 havi optimális gyógyszeres terápia ellenére is perzisztált (LVEF: 25%, NYHA II), így primer prevenciós CRT-D implantációt végeztünk (bal Tawara-szár-blokkot, QRS: 140 msec-ot mérlegelve). A CRT-D-beültetés után a kontroll TTE már normalizálódott bal kamrai dimenziókat (LVEDD: 52 mm) és LVEF-et (56%) ábrázolt. 20 hónapos utánkövetés után betegünk jó klinikai állapotban van (NTproBNP: 203 pg/ml, NYHA I). Következtetés: Ugyan a PPCM lefolyása során gyakran remisszió lép fel, perzisztáló HFrEF esetén 〉 6 havi irányelvek szerint optimalizált gyógyszeres kezelést követően az eszközös terápia mérlegelendő.
    Type of Medium: Online Resource
    ISSN: 0133-5596 , 1588-0230
    URL: Article
    DOI: 10.26430/CHUNGARICA.2023.53.4.386
    Language: Unknown
    Publisher: Cardiologia Hungarica
    Publication Date: 2023
    detail.hit.zdb_id: 2162219-X
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  • 7
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    Aortastenosis – kihívást jelentő diagnosztikától egy nem mindennapi terápiáig
    Cardiologia Hungarica ; 2023
    In:  Cardiologia Hungarica Vol. 53, No. 1 ( 2023), p. 43-47
    Details
    In: Cardiologia Hungarica, Cardiologia Hungarica, Vol. 53, No. 1 ( 2023), p. 43-47
    Abstract: Az aortastenosis napjainkban egy egyre gyakoribbá váló életminőséget jelentősen limitáló kórkép. Mára mind a betegség diagnosztizálásához, mind a definitív ellátáshoz számos módszer áll rendelkezésre. A 88 éves csökkent ejekciós frakciójú szívelégtelen nőbeteg kórelőzményéből korábbi perkután koronáriaintervenció (PCI) valamint 2021-ben többszöri kardiális dekompenzáció miatti hospitalizáció emelendő ki. Ezek során transthoracalis echokardiográfia (TTE) low-flow low-gradient aortastenosist, ismételt koronarográfia két ág betegséget igazolt. Az aortavitium szignifikanciájának megítélése kapcsán dobutamin stressz-echokardiográfia (DBSE) történt, amely alapján „true severe” aortastenosist véleményeztek, további terápia céljából a beteget intézetünknek referálták. A nem egyértelműen diagnosztikus DBSE miatt CT-vizsgálattal billentyű kalcium score-t, invazív hemodinamikai méréssel Gorlin szerinti aortabillentyű area-meghatározást végeztünk. Az invazív beavatkozással egy ülésben a koronáriabetegség is revaszkularizációra került. Tekintettel a beteg magas életkorára és extrém műtéti kockázatra (STS PROM-score: 14,9% EURO-score: 18,7%) transzkatéteres aortabillentyű-beültetést (TAVI) terveztünk. A CT során leírt aorta ascendenst és descendenst, valmint az aorto-iliacalis átmenetet érintő súlyos kalcifikáció miatt transzapikális behatolás mellett döntöttünk. 2021 decemberében ismételt kardiális dekompenzációt követően a beavatkozást sürgőséggel és sikeresen elvégeztük.
    Type of Medium: Online Resource
    ISSN: 0133-5596 , 1588-0230
    URL: Article
    DOI: 10.26430/CHUNGARICA.2023.53.1.43
    Language: Unknown
    Publisher: Cardiologia Hungarica
    Publication Date: 2023
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  • 8
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    The impact of serum concentration‐guided digoxin therapy on mortality of heart failure patients: A long‐term follow‐up, propensity‐matched cohort study
    Wiley ; 2020
    In:  Clinical Cardiology Vol. 43, No. 12 ( 2020-12), p. 1641-1648
    Details
    In: Clinical Cardiology, Wiley, Vol. 43, No. 12 ( 2020-12), p. 1641-1648
    Abstract: Recently published studies suggested that digoxin may increase mortality in heart failure with reduced ejection fraction (HFrEF). However, in the vast majority of former trials serum digoxin concentration (SDC) was not measured and therapy was not SDC‐guided. Aim To assess the impact of SDC‐guided digoxin therapy on mortality in HFrEF patients. Methods Data of 580 HFrEF patients were retrospectively analyzed. In patients on digoxin, SDC was measured every 3 months and digoxin dosage was SDC‐guided (target SDC: 0.5‐0.9 ng/mL). All‐cause mortality of digoxin users and nonusers was compared after propensity score matching (PSM). Results After 7.1 ± 4.7 years follow‐up period (FUP) all‐cause mortality of digoxin users (n = 180) was significantly higher than nonusers (n = 297) (propensity‐adjusted HR = 1.430; 95% CI = 1.134‐1.804; P = .003). Patients having SDC of 0.9 to 1.1 ng/mL (n = 60) or  〉  1.1 ng/mL (n = 44) at any time during the FUP had an increased risk of all‐cause mortality (HR = 1.750; 95% CI = 1.257‐2.436, P = .001 and HR = 1.687; 95% CI = 1.153‐2.466, P = .007), while patients having a maximal SDC  〈  0.9 ng/mL (n = 76) had similar mortality risk (HR = 1.139; 95% CI = 0.827‐1.570, P = .426), compared to digoxin nonusers. Conclusions According to our propensity‐matched analysis, SDC‐guided digoxin therapy was associated with increased all‐cause mortality in optimally treated HFrEF patients, especially with SDC ≥0.9 ng/mL. These results reinforce the expert opinion that digoxin in HFrEF can only be used among carefully selected patients with close SDC monitoring.
    Type of Medium: Online Resource
    ISSN: 0160-9289 , 1932-8737
    URL: Issue
    URL: Article
    DOI: 10.1002/clc.v43.12
    DOI: 10.1002/clc.23500
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2048223-1
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  • 9
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    Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation: a pilot study
    Springer Science and Business Media LLC ; 2020
    In:  Journal of Interventional Cardiac Electrophysiology Vol. 57, No. 2 ( 2020-3), p. 295-301
    Details
    In: Journal of Interventional Cardiac Electrophysiology, Springer Science and Business Media LLC, Vol. 57, No. 2 ( 2020-3), p. 295-301
    Type of Medium: Online Resource
    ISSN: 1383-875X , 1572-8595
    URL: Article
    DOI: 10.1007/s10840-019-00596-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2006887-6
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  • 10
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    The Optimization of Guideline-Directed Medical Therapy during Hospitalization among Patients with Heart Failure with Reduced Ejection Fraction in Daily Clinical Practice
    S. Karger AG ; 2023
    In:  Cardiology Vol. 148, No. 1 ( 2023), p. 27-37
    Details
    In: Cardiology, S. Karger AG, Vol. 148, No. 1 ( 2023), p. 27-37
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Hospitalization due to heart failure (HF) progression is associated with poor prognosis. This highlights the role of the implementation of guideline-directed medical therapy (GDMT) in improving the morbidity and mortality of patients with heart failure with reduced ejection fraction (HFrEF). There are limited data about the intrahospital applicability of GDMT in real-world circumstances. We aimed to assess retrospectively the use of cornerstone GDMT including RASi (ACEI/ARB/ARNI), βB, MRA, and SGLT2i treatment in a consecutive real-world HFrEF patient population admitted with signs and symptoms of HF to the HF Unit of a Hungarian tertiary cardiac center between 2019 and 2021. The independent predictors of therapy optimization and the applicability of new HFrEF medication (ARNI, SGLT2i, vericiguat) were also investigated. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Statistical comparison of admission and discharge medication was accomplished with Fisher’s exact test. The independent predictors of the introduction of triple therapy (RASi + βB + MRA) were analyzed using univariate and multivariate logistic regression. The proportion of patients eligible for vericiguat based on the inclusion and exclusion criteria of the VICTORIA trial was also investigated, as well as the number of patients suitable for ARNI and SGLT2i, taking into account the contraindications of application contained in the ESC 2021 HF Guidelines. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 238 patients were included. During hospitalization, the use of RASi (69% vs. 89%) (ACEI/ARBs [58% vs. 70%], ARNI [10% vs. 19%] ), βBs (69% vs. 85%), and MRAs (61% vs. 95%) increased significantly ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.05) compared to at admission, and the use of SGLT2i (3% vs. 11%) also rose ( 〈 i 〉 p 〈 /i 〉 = 0.0005). The application ratio of triple (RASi + βB + MRA; 43% vs. 77%) and quadruple (RASi + βB + MRA + SGLT2i; 2% vs. 11%) therapy increased as well ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.0001). The independent predictors of discharge application of triple therapy revealed through multivariate logistic regression analysis were age, duration of hospitalization, eGFR, NTproBNP, and presence of diabetes mellitus. Sixty-eight percent of the cohort would have been suitable for vericiguat, 83% for ARNI, and 84% for SGLT2i. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 High rates of application of disease-modifying drugs are achievable among hospitalized HFrEF patients in severe clinical condition; thus, awareness of the need for their initiation must be raised.
    Type of Medium: Online Resource
    ISSN: 0008-6312 , 1421-9751
    URL: Article
    DOI: 10.1159/000528505
    RVK:
    XA 36200
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 1482041-9
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