1
|
Borrell A, Garcia-Garin O, Aguilar A, Vighi M, Valdivia M, González EM, Páez-Rosas D, Drago M. High aluminum content in bone of marine mammals and its relation with source levels and origin. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023:121936. [PMID: 37263563 DOI: 10.1016/j.envpol.2023.121936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/13/2023] [Accepted: 05/29/2023] [Indexed: 06/03/2023]
Abstract
Although aluminum is widely distributed in the earth's crust, its environmental availability and wildlife assimilation rates are only partially known. Here we analyze aluminum concentrations in bone from 10 species of marine mammals inhabiting 3 geographic areas subject to different aluminum inputs: the Río de la Plata estuary (Uruguay), the coastal waters of Mauritania and the Galapagos archipelago (Ecuador). Overall, concentrations were unusually high as compared to those of terrestrial animals, with lowest concentrations in the Galapagos archipelago, then the Río de la Plata estuary and finally Mauritania. The aluminum source varied between regions, prevailing anthropogenic sources in the Río de la Plata Estuary and natural sources (wind-blown dust) in Mauritanian waters. The type of source determined contamination levels: anthropogenic sources were most significant for coastal species and showed a decline with distance of habitat from shoreline, while natural sources had a higher influence on open waters because of the dearth of biogenic silica that eliminates aluminum from the water column. Since aluminum remains in bone for several decades, marine mammal bone reflects historical levels of aluminum and therefore is a good bioindicator of the aluminum concentration of the marine environment.
Collapse
Affiliation(s)
- A Borrell
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Universitat de Barcelona, Barcelona 08028, Spain; Biodiversity Research Institute (IRBio), Universitat de Barcelona, Barcelona 08028, Spain.
| | - O Garcia-Garin
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Universitat de Barcelona, Barcelona 08028, Spain; Biodiversity Research Institute (IRBio), Universitat de Barcelona, Barcelona 08028, Spain
| | - A Aguilar
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Universitat de Barcelona, Barcelona 08028, Spain; Biodiversity Research Institute (IRBio), Universitat de Barcelona, Barcelona 08028, Spain
| | - M Vighi
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Universitat de Barcelona, Barcelona 08028, Spain; Biodiversity Research Institute (IRBio), Universitat de Barcelona, Barcelona 08028, Spain
| | - M Valdivia
- National Museum of Natural History (MNHN), 11000, Montevideo, Uruguay
| | - E M González
- National Museum of Natural History (MNHN), 11000, Montevideo, Uruguay
| | - D Páez-Rosas
- Universidad San Francisco de Quito (USFQ), Galapagos Science Center, Isla San Cristóbal, EC200150, Islas Galápagos, Ecuador; Dirección Parque Nacional Galápagos, Unidad Técnica Operativa San Cristóbal, Isla San Cristóbal, EC200150, Islas Galápagos, Ecuador
| | - M Drago
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Universitat de Barcelona, Barcelona 08028, Spain; Biodiversity Research Institute (IRBio), Universitat de Barcelona, Barcelona 08028, Spain
| |
Collapse
|
2
|
Wang M, Zhu Y. Defect Induced Charge Redistribution and Enhanced Adsorption of Lysozyme on Hydroxyapatite for Efficient Antibacterial Activity. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2021; 37:10786-10796. [PMID: 34463099 DOI: 10.1021/acs.langmuir.1c01666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Defects in hydroxyapatite (HA) have attracted increasing research interest due to their significant functions to increase the bioactivity and antibacterial ability of hard-tissue implants. However, little is known about the natural property and functional mechanism of the defects in HA. Herein, we reported on the defect property concerned with the coordination state and charge distribution in Al doped HA, as well as the consequent interface and protein capture ability for improved antibacterial activity. Systemic investigations suggested that Al replacing Ca in HA induced coordination defect with decreased coordination number and bond distance, caused charge transfer and redistribution of surrounding O atom and resulted in an increase in negative charge of coordinated O atoms. These O atoms coordinated with Al further served as docking sites for lysozyme molecules via electrostatic and H-bonding interaction. The capacity of lysozyme adsorption for Al-HA increased approximately 10-fold more than that of HA, which significantly increased the antibacterial activity through lysozyme-catalyzed splitting of cell wall of bacteria. Moreover, in vitro studies indicated that Al-HA materials showed good cytocompatibility. These findings not only provided new insights into the important effect of defects on the performances of HA biomaterials by modulation of the coordination state, charge distribution, and chemical activity, but also proposed a promising method for efficient antibacterial activity of HA biomaterials.
Collapse
Affiliation(s)
- Ming Wang
- Key Lab of Inorganic Coating Materials CAS, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China
| | - Yingchun Zhu
- Key Lab of Inorganic Coating Materials CAS, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Science, Beijing 100049, China
| |
Collapse
|
3
|
Wang M, Wang L, Shi C, Sun T, Zeng Y, Zhu Y. The crystal structure and chemical state of aluminum-doped hydroxyapatite by experimental and first principles calculation studies. Phys Chem Chem Phys 2016; 18:21789-96. [DOI: 10.1039/c6cp03230c] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The crystal structure and chemical state of Al-doped hydroxyapatite have been explored using first principles calculation to provide the possible crystallographic mechanism for Al-induced bone metabolic diseases.
Collapse
Affiliation(s)
- Ming Wang
- Key Lab of Inorganic Coating Materials CAS
- Shanghai Institute of Ceramics
- Chinese Academy of Sciences
- Shanghai 200050
- China
| | - Liping Wang
- Key Lab of Inorganic Coating Materials CAS
- Shanghai Institute of Ceramics
- Chinese Academy of Sciences
- Shanghai 200050
- China
| | - Chao Shi
- Key Lab of Inorganic Coating Materials CAS
- Shanghai Institute of Ceramics
- Chinese Academy of Sciences
- Shanghai 200050
- China
| | - Tian Sun
- Key Lab of Inorganic Coating Materials CAS
- Shanghai Institute of Ceramics
- Chinese Academy of Sciences
- Shanghai 200050
- China
| | - Yi Zeng
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure
- Shanghai Institute of Ceramics
- Chinese Academy of Sciences
- Shanghai 200050
- China
| | - Yingchun Zhu
- Key Lab of Inorganic Coating Materials CAS
- Shanghai Institute of Ceramics
- Chinese Academy of Sciences
- Shanghai 200050
- China
| |
Collapse
|
4
|
Factors affecting the aluminium content of human femoral head and neck. J Inorg Biochem 2015; 152:167-73. [DOI: 10.1016/j.jinorgbio.2015.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/10/2015] [Accepted: 08/20/2015] [Indexed: 12/12/2022]
|
5
|
Kubaszewski Ł, Zioła-Frankowska A, Frankowski M, Rogala P, Gasik Z, Kaczmarczyk J, Nowakowski A, Dabrowski M, Labedz W, Miękisiak G, Gasik R. Comparison of trace element concentration in bone and intervertebral disc tissue by atomic absorption spectrometry techniques. J Orthop Surg Res 2014; 9:99. [PMID: 25342441 PMCID: PMC4220064 DOI: 10.1186/s13018-014-0099-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 10/08/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Trace element (TE) analysis in human tissue has the dual purpose of assessing environmental pollution and metabolism. In literature, bone TE analysis is common, but studies in intervertebral disc (IVD) tissue are lacking. The aim of the study was evaluation of the difference of TE concentration in intervertebral disc and bone in patients with degenerative changes. The comparison of the tissues differing in metabolism, blood perfusion, or separateness from adjoining tissues but playing similar biomechanical role and presenting some common morphological traits may shed new light on metabolism nuances, degenerative process, as well as accumulation potential of IVD in respect to bone. METHODS In the study, we analyzed two types of samples: intervertebral disc (n =30, from 22 patients operated due to degenerative disc disease) and femoral bone (n =26, separately femoral head and neck, from 26 patients, acquired in total hip arthroplasty procedure in course of idiopathic osteoarthritis of the hip joint). In the samples we analyzed, with atomic absorption spectrometry, the concentrations of Pb, Ni, Mo, Cu, Mg, and Zn. RESULTS The element concentrations identified in bone are comparable to those presented in the literature. In the case of Pb, Ni, Mo, Mg, and Zn, the concentration in the bone was 2 to 25.8 times higher than that observed in the disc. Only the Cu concentration was higher in disc tissue than in bone. In disc tissue, fewer samples had TE concentrations below the detection threshold. We found significant differences in TE profiles in the compared tissues. CONCLUSIONS The results show that the disc could serve as a more stable compartment for evaluating TE concentration, especially for TEs that are environmentally related.
Collapse
Affiliation(s)
- Łukasz Kubaszewski
- Department of Orthopedics and Traumatology, W. Dega University Hospital, University of Medical Science Poznan, 28 Czerwca 1956r St., Poznań, 61-545, Poland.
- Clinic and Polyclinic of Neuroorthopedic and Neurology, Institute of Rheumatology, Warsaw, Spartańska 1, Warsaw, 02-637, Poland.
| | - Anetta Zioła-Frankowska
- Department of Water and Soil Analysis, Faculty of Chemistry, Adam Mickiewicz University in Poznań, Umultowska 89b, Poznań, 61-614, Poland.
| | - Marcin Frankowski
- Department of Water and Soil Analysis, Faculty of Chemistry, Adam Mickiewicz University in Poznań, Umultowska 89b, Poznań, 61-614, Poland.
| | - Piotr Rogala
- Department of Spine Surgery, Oncologic Orthopaedics and Traumatology, W. Dega University Hospital, University of Medical Science Poznan, 28 Czerwca 1956r St., Poznań, 61-545, Poland.
| | - Zuzanna Gasik
- Clinic and Polyclinic of Neuroorthopedic and Neurology, Institute of Rheumatology, Warsaw, Spartańska 1, Warsaw, 02-637, Poland.
| | - Jacek Kaczmarczyk
- Department of Orthopedics and Traumatology, W. Dega University Hospital, University of Medical Science Poznan, 28 Czerwca 1956r St., Poznań, 61-545, Poland.
| | - Andrzej Nowakowski
- Department of Spine Surgery, Oncologic Orthopaedics and Traumatology, W. Dega University Hospital, University of Medical Science Poznan, 28 Czerwca 1956r St., Poznań, 61-545, Poland.
| | - Mikolaj Dabrowski
- Department of Spine Surgery, Oncologic Orthopaedics and Traumatology, W. Dega University Hospital, University of Medical Science Poznan, 28 Czerwca 1956r St., Poznań, 61-545, Poland.
| | - Wojciech Labedz
- Department of Orthopedics and Traumatology, W. Dega University Hospital, University of Medical Science Poznan, 28 Czerwca 1956r St., Poznań, 61-545, Poland.
| | - Grzegorz Miękisiak
- Department of Neurosurgery, Specialist Medical Center, Polanica-Zdroj, Poland.
| | - Robert Gasik
- Clinic and Polyclinic of Neuroorthopedic and Neurology, Institute of Rheumatology, Warsaw, Spartańska 1, Warsaw, 02-637, Poland.
| |
Collapse
|
6
|
House E, Polwart A, Darbre P, Barr L, Metaxas G, Exley C. The aluminium content of breast tissue taken from women with breast cancer. J Trace Elem Med Biol 2013; 27:257-66. [PMID: 23870171 DOI: 10.1016/j.jtemb.2013.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/09/2013] [Accepted: 05/14/2013] [Indexed: 01/22/2023]
Abstract
The aetiology of breast cancer is multifactorial. While there are known genetic predispositions to the disease it is probable that environmental factors are also involved. Recent research has demonstrated a regionally specific distribution of aluminium in breast tissue mastectomies while other work has suggested mechanisms whereby breast tissue aluminium might contribute towards the aetiology of breast cancer. We have looked to develop microwave digestion combined with a new form of graphite furnace atomic absorption spectrometry as a precise, accurate and reproducible method for the measurement of aluminium in breast tissue biopsies. We have used this method to test the thesis that there is a regional distribution of aluminium across the breast in women with breast cancer. Microwave digestion of whole breast tissue samples resulted in clear homogenous digests perfectly suitable for the determination of aluminium by graphite furnace atomic absorption spectrometry. The instrument detection limit for the method was 0.48 μg/L. Method blanks were used to estimate background levels of contamination of 14.80 μg/L. The mean concentration of aluminium across all tissues was 0.39 μg Al/g tissue dry wt. There were no statistically significant regionally specific differences in the content of aluminium. We have developed a robust method for the precise and accurate measurement of aluminium in human breast tissue. There are very few such data currently available in the scientific literature and they will add substantially to our understanding of any putative role of aluminium in breast cancer. While we did not observe any statistically significant differences in aluminium content across the breast it has to be emphasised that herein we measured whole breast tissue and not defatted tissue where such a distribution was previously noted. We are very confident that the method developed herein could now be used to provide accurate and reproducible data on the aluminium content in defatted tissue and oil from such tissues and thereby contribute towards our knowledge on aluminium and any role in breast cancer.
Collapse
Affiliation(s)
- Emily House
- The Birchall Centre, Lennard-Jones Laboratories, Keele University, Staffordshire ST5 5BG, UK.
| | | | | | | | | | | |
Collapse
|
7
|
Abstract
Human activities have circumvented the efficient geochemical cycling of aluminium within the lithosphere and therewith opened a door, which was previously only ajar, onto the biotic cycle to instigate and promote the accumulation of aluminium in biota and especially humans. Neither these relatively recent activities nor the entry of aluminium into the living cycle are showing any signs of abating and it is thus now imperative that we understand as fully as possible how humans are exposed to aluminium and the future consequences of a burgeoning exposure and body burden. The aluminium age is upon us and there is now an urgent need to understand how to live safely and effectively with aluminium.
Collapse
Affiliation(s)
- Christopher Exley
- The Birchall Centre, Lennard-Jones Laboratories, Keele University, Staffordshire, UK.
| |
Collapse
|
8
|
Kruger PC, Parsons PJ, Galusha AL, Morrissette M, Recker RR, Howard LJ. Excessive Aluminum Accumulation in the Bones of Patients on Long-Term Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2013; 38:728-35. [DOI: 10.1177/0148607113491981] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 05/06/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Pamela C. Kruger
- Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, New York
| | - Patrick J. Parsons
- Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, New York
- Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, New York
| | - Aubrey L. Galusha
- Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, New York
| | - Michelle Morrissette
- Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, New York
| | - Robert R. Recker
- Osteoporosis Research Center, Creighton University School of Medicine, Omaha, Nebraska
| | - Lyn J. Howard
- Department of Medicine, Division of Gastroenterology and Nutrition, Albany Medical College, Albany, New York
| |
Collapse
|
9
|
Kruger PC, Schell LM, Stark AD, Parsons PJ. A study of the distribution of aluminium in human placental tissues based on alkaline solubilization with determination by electrothermal atomic absorption spectrometry. Metallomics 2010; 2:621-7. [PMID: 21072353 PMCID: PMC3315392 DOI: 10.1039/c0mt00010h] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aluminium (Al) is a nonessential element known to induce neurotoxic effects, such as dialysis dementia, in patients on hemodialysis, with compromised kidney function. The role of Al in the progression of some neurodegenerative diseases, such as Alzheimer's disease (AD), is controversial, and remains unclear. The effects of Al on other vulnerable populations, such as fetuses and infants, have been infrequently studied. In the present study, Al has been measured in human placenta samples, comprising ∼160 each of placenta bodies, placenta membranes, and umbilical cords, using electrothermal atomic absorption spectrometry (ETAAS) after atmospheric pressure digestion with tetramethylammonium hydroxide (TMAH) and ethylenediaminetetraacidic acid (EDTA). The sensitivity, or characteristic mass (m(0)), for Al at the 309.3-nm line was found to be 30 ± 4 pg. The instrumental detection limit (IDL) (3s) for Al in solution was calculated as 0.72 μg L(-1) while the method detection limit (MDL) (3s) was 0.25 μg g(-1). Accuracy was assessed through analysis of quality control (QC) materials, including certified reference materials (CRMs), in-house reference materials (RMs), and spike recovery experiments, of varying matrices. Placental tissue analyses revealed geometric mean concentrations of approximately 0.5 μg g(-1) Al in placenta bodies (n = 165) and membranes (n = 155), while Al concentrations in umbilical cords (n = 154) were about 0.3 μg g(-1). Al was detected in 95% of placenta bodies, and 81% of placenta membranes, but only in 46% of umbilical cords.
Collapse
Affiliation(s)
- Pamela C. Kruger
- Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, P.O. Box 509, Albany, NY 12201-0509, USA
- Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, P.O. Box 509, Albany, NY 12201-0509, USA
| | - Lawrence M. Schell
- Department of Anthropology, University at Albany, State University of New York, Albany, NY 12222, USA
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Albany, NY 12222, USA
| | - Alice D. Stark
- Office of Public Health, New York State Department of Health, Albany, NY 12237
| | - Patrick J. Parsons
- Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, P.O. Box 509, Albany, NY 12201-0509, USA
- Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, P.O. Box 509, Albany, NY 12201-0509, USA
| |
Collapse
|
10
|
Hellström HO, Mjöberg B, Mallmin H, Michaëlsson K. No association between the aluminium content of trabecular bone and bone density, mass or size of the proximal femur in elderly men and women. BMC Musculoskelet Disord 2006; 7:69. [PMID: 16928265 PMCID: PMC1560132 DOI: 10.1186/1471-2474-7-69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 08/23/2006] [Indexed: 11/22/2022] Open
Abstract
Background Aluminium is considered a bone toxic metal since poisoning can lead to aluminium-induced bone disease in patients with chronic renal failure. Healthy subjects with normal renal function retain 4% of the aluminium consumed. They might thus also accumulate aluminium and eventually be at risk of long-term low-grade aluminium intoxication that can affect bone health. Methods We therefore examined 62 patients with femoral neck fractures or osteoarthritis of the hip (age range 38–93), with the aim of examining whether aluminium in bone is associated with bone-mineral density (BMD), content (BMC) or width of the femoral neck measured by dual-energy X-ray absorptiometry (DXA). During operations bone biopsies were taken from the trabecular bone of the proximal femur. The samples were measured for their content of aluminium using a mass spectrometer. Results No significant association between the aluminium content in bone and femoral neck BMD, BMC or width could be found after multivariate adjustment. Conclusion Our results indicate that the accumulated aluminium content in bone during life does not substantially influence the extent of osteoporosis.
Collapse
Affiliation(s)
| | | | - Hans Mallmin
- Department of Orthopaedics, Uppsala University Hospital, Sweden
| | | |
Collapse
|
11
|
Hellström HO, Mjöberg B, Mallmin H, Michaëlsson K. The aluminum content of bone increases with age, but is not higher in hip fracture cases with and without dementia compared to controls. Osteoporos Int 2005; 16:1982-8. [PMID: 16047227 DOI: 10.1007/s00198-005-1981-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 06/23/2005] [Indexed: 11/30/2022]
Abstract
Aluminum is considered a potentially toxic metal, and aluminum poisoning may lead to three types of disorders: aluminum-induced bone disease, microcytic anemia and encephalopathy. This is well known in patients with chronic renal failure, but since healthy subjects with normal renal function retain 4% of the aluminum consumed, they are also at risk of long-term low-grade aluminum intoxication. Included in this study were a total of 172 patients (age range 16-98 years) with the aim of examining whether aluminum accumulates in bone with increasing age. Additionally, we aimed to investigate whether the aluminum content of bone differs between controls and hip fracture cases with and without dementia, in particular in those with Alzheimer's disease. During operations for all cases, bone biopsies were taken with an aluminum-free instrument from the trabecular bone. The samples were measured for their content of aluminum using an inductively coupled mass spectrometer. We found an exponential increase in aluminum content of bone with age. The average aluminum values, adjusted for age, were similar in men and women (P=0.46). No significant differences in sex- and age-adjusted mean aluminum values between the controls and the hip fracture cases with (P=0.72) and without (P=0.33) dementia could be detected. The average aluminum concentration among cases with Alzheimer's disease was also similar to the values of hip fracture patients with other types of dementia (P=0.47). Odds ratios of hip fracture for each quartile of aluminum content in bone were also estimated to detect non-linear effects, but we did not find any statistically significant association remaining after age and sex adjustment. Thus, our results indicate that we accumulate aluminum in bone over our life span, but this does not seem to be of major pathogenetic significance for the occurrence of hip fracture or dementia.
Collapse
Affiliation(s)
- Hans-Olov Hellström
- Department of Orthopedics, Uppsala University Hospital, 7518, Uppsala, Sweden.
| | | | | | | |
Collapse
|