{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:48:35Z","timestamp":1785473315598,"version":"3.56.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100014584","name":"Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014584","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Intervent Radiol"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Porto-systemic pressure gradient is used to prognosticate rebleeding and resolution of ascites after TIPS. This study investigates the reliability of portal pressure characteristics as quantified immediately after TIPS placement and at short-term control.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Patients and Methods<\/jats:title>\n                <jats:p>Portal venous pressure (PVP) and right atrial pressure (RAP) were prospectively obtained before and after TIPS as well as\u2009\u2265\u200948\u00a0h after TIPS procedure. Porto-systemic pressure gradients (PSG) and pressure changes were calculated. A multivariate regression analysis was performed to predict portal hemodynamics at short-term control.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The study included 124 consecutive patients. Indications for TIPS were refractory ascites, variceal bleeding or combinations of both. Pre- and post-interventional PSG yielded 16.4\u2009\u00b1\u20095.3\u00a0mmHg and 5.9\u2009\u00b1\u20092.7\u00a0mmHg, respectively. At that time, 105\/124 patients (84.7%) met the target (PSG\u2009\u2264\u20098\u00a0mmHg). After 4\u00a0days (median), PSG was 8.5\u2009\u00b1\u20093.5\u00a0mmHg and only 66 patients (53%) met that target. In patients exceeding the target PSG at follow-up, PVP was significantly higher and RAP was lower resulting in the increased PSG. The highly variable changes of RAP were the main contributor to different pressure gradients. In the multivariate regression analysis, PVP and RAP immediately after TIPS were predictors for PSG at short-term control with moderately predictive capacity (AUC\u2009=\u20090.75).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Besides the reduction of portal vein pressure, the highly variable right atrial pressure was the main contributor to different pressure gradients. Thus, immediate post-TIPS measurements do not reliably predict portal hemodynamics during follow-up. These findings need to be further investigated with respect to the corresponding clinical course of the patients.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00270-021-03003-z","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T17:02:59Z","timestamp":1638378179000},"page":"102-111","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Transjugular Portosystemic Stent Shunt: Impact of Right Atrial Pressure on Portal Venous Hemodynamics Within the First Week"],"prefix":"10.1007","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5572-7763","authenticated-orcid":false,"given":"Michael Bernhard","family":"Pitton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arndt","family":"Weinmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Kloeckner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Mittler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Ruckes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"D\u00fcber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerd","family":"Otto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,1]]},"reference":[{"issue":"9930","key":"3003_CR1","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1016\/S0140-6736(14)60121-5","volume":"383","author":"EA Tsochatzis","year":"2014","unstructured":"Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet. 2014;383(9930):1749\u201361.","journal-title":"Lancet"},{"key":"3003_CR2","doi-asserted-by":"crossref","unstructured":"EASL. EASL clinical parctice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenals syndrome in cirrhosis. Journal of hepatology. 2010;53(53):397\u2013417.","DOI":"10.1016\/j.jhep.2010.05.004"},{"issue":"3","key":"3003_CR3","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1016\/j.jhep.2015.05.022","volume":"63","author":"R de Franchis","year":"2015","unstructured":"de Franchis R, Baveno VIF. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743\u201352.","journal-title":"J Hepatol"},{"issue":"25","key":"3003_CR4","doi-asserted-by":"publisher","first-page":"5780","DOI":"10.3748\/wjg.v22.i25.5780","volume":"22","author":"EW Lee","year":"2016","unstructured":"Lee EW, Kuei A, Saab S, Busuttil RW, Durazo F, Han SH, et al. Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt. World J Gastroenterol. 2016;22(25):5780\u20139.","journal-title":"World J Gastroenterol"},{"issue":"3","key":"3003_CR5","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1055\/s-0034-1382792","volume":"31","author":"ZL Bercu","year":"2014","unstructured":"Bercu ZL, Fischman AM. Outcomes of transjugular intrahepatic portosystemic shunts for ascites. Semin Interv Radiol. 2014;31(3):248\u201351.","journal-title":"Semin Interv Radiol"},{"issue":"25","key":"3003_CR6","doi-asserted-by":"publisher","first-page":"2370","DOI":"10.1056\/NEJMoa0910102","volume":"362","author":"JC Garcia-Pagan","year":"2010","unstructured":"Garcia-Pagan JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362(25):2370\u20139.","journal-title":"N Engl J Med"},{"issue":"10","key":"3003_CR7","first-page":"19709","volume":"8","author":"GQ Li","year":"2015","unstructured":"Li GQ, Yang B, Liu J, Wang GC, Yuan HP, Zhao JR, et al. Hepatic venous pressure gradient is a useful predictor in guiding treatment on prevention of variceal rebleeding in cirrhosis. Int J Clin Exp Med. 2015;8(10):19709\u201316.","journal-title":"Int J Clin Exp Med"},{"issue":"23","key":"3003_CR8","doi-asserted-by":"publisher","first-page":"7523","DOI":"10.3748\/wjg.v20.i23.7523","volume":"20","author":"XS Qi","year":"2014","unstructured":"Qi XS, Fan DM. Hepatic venous pressure gradient measurement before TIPS for acute variceal bleeding. World J Gastroenterol. 2014;20(23):7523\u20134.","journal-title":"World J Gastroenterol"},{"issue":"4","key":"3003_CR9","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1159\/000444551","volume":"34","author":"G Garcia-Tsao","year":"2016","unstructured":"Garcia-Tsao G. Current Management of the Complications of Cirrhosis and Portal Hypertension: Variceal Hemorrhage, Ascites, and Spontaneous Bacterial Peritonitis. Dig Dis. 2016;34(4):382\u20136.","journal-title":"Dig Dis"},{"issue":"3","key":"3003_CR10","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1056\/NEJM199401203300303","volume":"330","author":"M Rossle","year":"1994","unstructured":"Rossle M, Haag K, Ochs A, Sellinger M, Noldge G, Perarnau JM, et al. The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding. N Engl J Med. 1994;330(3):165\u201371.","journal-title":"N Engl J Med"},{"issue":"5","key":"3003_CR11","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.1007\/s00330-016-4570-5","volume":"27","author":"B Geeroms","year":"2017","unstructured":"Geeroms B, Laleman W, Laenen A, Heye S, Verslype C, van der Merwe S, et al. Expanded polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunts in cirrhotic patients: Long-term patency and clinical outcome results. Eur Radiol. 2017;27(5):1795\u2013803.","journal-title":"Eur Radiol"},{"issue":"1","key":"3003_CR12","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1007\/s00270-018-2040-y","volume":"42","author":"R Miraglia","year":"2019","unstructured":"Miraglia R, Maruzzelli L, Di Piazza A, Mamone G, Caruso S, Gentile G, et al. Transjugular Intrahepatic Portosystemic Shunt Using the New Gore Viatorr Controlled Expansion Endoprosthesis: Prospective, Single-Center. Preliminary Experience Cardiovasc Intervent Radiol. 2019;42(1):78\u201386.","journal-title":"Preliminary Experience Cardiovasc Intervent Radiol"},{"issue":"110","key":"3003_CR13","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1007\/s00270-018-1992-2","volume":"41","author":"MW Rowley","year":"2018","unstructured":"Rowley MW, Choi M, Chen S, Hirsch K, Seetharam AB. Refractory Hepatic Encephalopathy After Elective Transjugular Intrahepatic Portosystemic Shunt: Risk Factors and Outcomes with Revision. Cardiovasc Intervent Radiol. 2018;41(110):1765\u201372.","journal-title":"Cardiovasc Intervent Radiol."},{"issue":"6","key":"3003_CR14","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1053\/j.gastro.2017.01.011","volume":"152","author":"G Silva-Junior","year":"2017","unstructured":"Silva-Junior G, Turon F, Baiges A, Cerda E, Garcia-Criado A, Blasi A, et al. Timing Affects Measurement of Portal Pressure Gradient After Placement of Transjugular Intrahepatic Portosystemic Shunts in Patients With Portal Hypertension. Gastroenterology. 2017;152(6):1358\u201365.","journal-title":"Gastroenterology"},{"issue":"3","key":"3003_CR15","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1152\/ajplegacy.1957.189.3.609","volume":"189","author":"AC Guyton","year":"1957","unstructured":"Guyton AC, Lindsey AW, Abernathy B, Richardson T. Venous return at various right atrial pressures and the normal venous return curve. Am J Physiol. 1957;189(3):609\u201315.","journal-title":"Am J Physiol"},{"key":"3003_CR16","first-page":"214","volume":"7","author":"AC Guyton","year":"1957","unstructured":"Guyton AC. Physiology of heart failure. Trans Am Coll Cardiol. 1957;7:214\u201324.","journal-title":"Trans Am Coll Cardiol"},{"issue":"2","key":"3003_CR17","doi-asserted-by":"publisher","first-page":"H408","DOI":"10.1152\/ajpheart.00081.2017","volume":"313","author":"PW Moller","year":"2017","unstructured":"Moller PW, Winkler B, Hurni S, Heinisch PP, Bloch A, Sondergaard S, et al. Right atrial pressure and venous return during cardiopulmonary bypass. Am J Physiol Heart Circ Physiol. 2017;313(2):H408\u201320.","journal-title":"Am J Physiol Heart Circ Physiol"},{"issue":"12","key":"3003_CR18","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1016\/j.dld.2017.06.011","volume":"49","author":"TM Busk","year":"2017","unstructured":"Busk TM, Bendtsen F, Henriksen JH, Fuglsang S, Clemmesen JO, Larsen FS, et al. Effects of transjugular intrahepatic portosystemic shunt (TIPS) on blood volume distribution in patients with cirrhosis. Digestive Liver Dis. 2017;49(12):1353\u20139.","journal-title":"Digestive Liver Dis."},{"issue":"2","key":"3003_CR19","doi-asserted-by":"publisher","first-page":"G275","DOI":"10.1152\/ajpgi.00094.2017","volume":"314","author":"TM Busk","year":"2018","unstructured":"Busk TM, Bendtsen F, Poulsen JH, Clemmesen JO, Larsen FS, Goetze JP, et al. Transjugular intrahepatic portosystemic shunt: impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis. Am J Physiol Gastrointest Liver Physiol. 2018;314(2):G275\u201386.","journal-title":"Am J Physiol Gastrointest Liver Physiol"},{"issue":"1","key":"3003_CR20","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1002\/hep.28906","volume":"65","author":"G Garcia-Tsao","year":"2017","unstructured":"Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2017;65(1):310\u201335.","journal-title":"Hepatology"},{"issue":"3","key":"3003_CR21","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1055\/s-0038-1660793","volume":"35","author":"J Kibrit","year":"2018","unstructured":"Kibrit J, Khan R, Jung BH, Koppe S. Clinical Assessment and Management of Portal Hypertension. Semin Interv Radiol. 2018;35(3):153\u20139.","journal-title":"Semin Interv Radiol."},{"issue":"1","key":"3003_CR22","doi-asserted-by":"publisher","first-page":"138","DOI":"10.3349\/ymj.2016.57.1.138","volume":"57","author":"TY Kim","year":"2016","unstructured":"Kim TY, Lee JG, Sohn JH, Kim JY, Kim SM, Kim J, et al. Hepatic Venous Pressure Gradient Predicts Long-Term Mortality in Patients with Decompensated Cirrhosis. Yonsei Med J. 2016;57(1):138\u201345.","journal-title":"Yonsei Med J."},{"issue":"3","key":"3003_CR23","doi-asserted-by":"publisher","first-page":"132","DOI":"10.11622\/smedj.2016054","volume":"57","author":"TT Tey","year":"2016","unstructured":"Tey TT, Gogna A, Irani FG, Too CW, Lo HG, Tan BS, et al. Application of a standardised protocol for hepatic venous pressure gradient measurement improves quality of readings and facilitates reduction of variceal bleeding in cirrhotics. Singapore Med J. 2016;57(3):132\u20137.","journal-title":"Singapore Med J."},{"issue":"1","key":"3003_CR24","doi-asserted-by":"publisher","first-page":"88","DOI":"10.3904\/kjim.2018.151","volume":"35","author":"JG Lee","year":"2020","unstructured":"Lee JG, Sohn JH, Jeong JY, Kim TY, Kim SM, Cho YS, et al. Combined effect of hepatic venous pressure gradient and liver stiffness on long-term mortality in patients with cirrhosis. Korean J Intern Med. 2020;35(1):88\u201398.","journal-title":"Korean J Intern Med."},{"issue":"4","key":"3003_CR25","doi-asserted-by":"publisher","first-page":"91","DOI":"10.21037\/atm.2019.12.143","volume":"8","author":"C Liu","year":"2020","unstructured":"Liu C, Liu Y, Shao R, Wang S, Wang G, Wang L, et al. The predictive value of baseline hepatic venous pressure gradient for variceal rebleeding in cirrhotic patients receiving secondary prevention. Ann Transl Med. 2020;8(4):91.","journal-title":"Ann Transl Med."},{"issue":"12","key":"3003_CR26","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.7150\/ijms.37040","volume":"16","author":"H Maruyama","year":"2019","unstructured":"Maruyama H, Kobayashi K, Kiyono S, Ogasawara S, Ooka Y, Suzuki E, et al. Incidence and hemodynamic feature of risky esophageal varices with lower hepatic venous pressure gradient. Int J Med Sci. 2019;16(12):1614\u201320.","journal-title":"Int J Med Sci."},{"issue":"6","key":"3003_CR27","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.1002\/hep.23612","volume":"51","author":"V La Mura","year":"2010","unstructured":"La Mura V, Abraldes JG, Berzigotti A, Erice E, Flores-Arroyo A, Garcia-Pagan JC, et al. Right atrial pressure is not adequate to calculate portal pressure gradient in cirrhosis: a clinical-hemodynamic correlation study. Hepatology. 2010;51(6):2108\u201316.","journal-title":"Hepatology"},{"issue":"8","key":"3003_CR28","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1016\/j.jvir.2016.03.028","volume":"27","author":"M Rossle","year":"2016","unstructured":"Rossle M, Blanke P, Fritz B, Schultheiss M, Bettinger D. Free Hepatic Vein Pressure Is Not Useful to Calculate the Portal Pressure Gradient in Cirrhosis: A Morphologic and Hemodynamic Study. J Vasc Interventional Radiol. 2016;27(8):1130\u20137.","journal-title":"J Vasc Interventional Radiol"},{"issue":"4","key":"3003_CR29","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1002\/hep.510290421","volume":"29","author":"AF Steinlauf","year":"1999","unstructured":"Steinlauf AF, Garcia-Tsao G, Zakko MF, Dickey K, Gupta T, Groszmann RJ. Low-dose midazolam sedation: an option for patients undergoing serial hepatic venous pressure measurements. Hepatology. 1999;29(4):1070\u20133.","journal-title":"Hepatology"},{"issue":"1","key":"3003_CR30","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1111\/liv.12229","volume":"34","author":"E Reverter","year":"2014","unstructured":"Reverter E, Blasi A, Abraldes JG, Martinez-Palli G, Seijo S, Turon F, et al. Impact of deep sedation on the accuracy of hepatic and portal venous pressure measurements in patients with cirrhosis. Liver Int. 2014;34(1):16\u201325.","journal-title":"Liver Int."},{"issue":"8","key":"3003_CR31","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1111\/liv.13065","volume":"36","author":"P Tandon","year":"2016","unstructured":"Tandon P, Ripoll C, Assis D, Wongcharatrawee S, Groszmann RJ, Garcia-Tsao G. The interpretation of hepatic venous pressure gradient tracings - excellent interobserver agreement unrelated to experience. Liver Int. 2016;36(8):1160\u20136.","journal-title":"Liver Int"},{"issue":"1","key":"3003_CR32","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1148\/radiol.2017161644","volume":"284","author":"R Miraglia","year":"2017","unstructured":"Miraglia R, Maruzzelli L, Tuzzolino F, Petridis I, D\u2019Amico M, Luca A. Transjugular Intrahepatic Portosystemic Shunts in Patients with Cirrhosis with Refractory Ascites: Comparison of Clinical Outcomes by Using 8- and 10-mm PTFE-covered Stents. Radiology. 2017;284(1):281\u20138.","journal-title":"Radiology"},{"issue":"6","key":"3003_CR33","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1093\/qjmed\/hcn037","volume":"101","author":"S Masson","year":"2008","unstructured":"Masson S, Mardini HA, Rose JD, Record CO. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt insertion: a decade of experience. QJM. 2008;101(6):493\u2013501.","journal-title":"QJM"},{"issue":"12","key":"3003_CR34","doi-asserted-by":"publisher","first-page":"2156","DOI":"10.1136\/gutjnl-2017-314634","volume":"67","author":"Y Lv","year":"2018","unstructured":"Lv Y, Qi X, He C, Wang Z, Yin Z, Niu J, et al. Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial. Gut. 2018;67(12):2156\u201368.","journal-title":"Gut"},{"issue":"3","key":"3003_CR35","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1053\/j.gastro.2015.05.011","volume":"149","author":"T Sauerbruch","year":"2015","unstructured":"Sauerbruch T, Mengel M, Dollinger M, Zipprich A, Rossle M, Panther E, et al. Prevention of Rebleeding From Esophageal Varices in Patients With Cirrhosis Receiving Small-Diameter Stents Versus Hemodynamically Controlled Medical Therapy. Gastroenterology. 2015;149(3):660\u20138.","journal-title":"Gastroenterology."},{"issue":"3","key":"3003_CR36","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1016\/j.jvir.2014.10.021","volume":"26","author":"CC Pieper","year":"2015","unstructured":"Pieper CC, Sprinkart AM, Nadal J, Hippe V, Meyer C, Schild HH, et al. Postinterventional passive expansion of partially dilated transjugular intrahepatic portosystemic shunt stents. J Vasc Interventional Radiol. 2015;26(3):388\u201394.","journal-title":"J Vasc Interventional Radiol"}],"container-title":["CardioVascular and Interventional Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00270-021-03003-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00270-021-03003-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00270-021-03003-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,29]],"date-time":"2021-12-29T16:04:45Z","timestamp":1640793885000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00270-021-03003-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,1]]},"references-count":36,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1]]}},"alternative-id":["3003"],"URL":"https:\/\/doi.org\/10.1007\/s00270-021-03003-z","relation":{},"ISSN":["0174-1551","1432-086X"],"issn-type":[{"value":"0174-1551","type":"print"},{"value":"1432-086X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,1]]},"assertion":[{"value":"9 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"For this type of study, formal consent is not required, approved by the local ethic committee (Rhineland Palatinate Ethics Committee, Germany).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"For this type of study, informed consent is not required.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}},{"value":"For this type of study, consent for publication is not required.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}}]}}