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Soeda K, Komaba H, Nakagawa Y, Kawabata C, Wada T, Takahashi H, Takahashi Y, Hyodo T, Hida M, Suga T, Kakuta T, Fukagawa M. Association of serum sodium levels with fractures and mortality in patients undergoing maintenance hemodialysis. J Nephrol 2024:10.1007/s40620-024-01904-z. [PMID: 38512372 DOI: 10.1007/s40620-024-01904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/15/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Hyponatremia is implicated in pathological bone resorption and has been identified as a risk factor for bone fracture in the general population. However, there are limited data on the association between serum sodium levels and fracture risk in patients undergoing hemodialysis (HD). METHODS We analyzed a historical cohort of 2220 maintenance HD patients to examine the association between serum sodium levels and the risk of fracture and mortality. We also examined the association between serum sodium levels and osteoporosis, based on metacarpal bone mineral density, in a subcohort of 455 patients with available data. In addition, we examined the association between serum sodium levels and bone turnover markers in a separate cross-sectional cohort of 654 maintenance HD patients. RESULTS During a median follow-up of 5.4 years, 712 patients died, 113 experienced clinical fractures, and 64 experienced asymptomatic vertebral fractures. Lower serum sodium levels were associated with an increased risk of mortality (HR 1.06 per 1 mEq/L decrease; 95% CI 1.03-1.09) but not with the risk of clinical fracture (HR 1.04 per 1 mEq/L decrease; 95% CI 0.97-1.11). A similar lack of association was observed for asymptomatic vertebral fracture and any fracture. Serum sodium levels were also not associated with osteoporosis in a subcohort with available data (n = 455) or with bone alkaline phosphatase or tartrate-resistant acid phosphatase-5b in a separate cross-sectional cohort. CONCLUSION Serum sodium levels were associated with mortality but not with fracture risk, osteoporosis, or bone turnover markers in maintenance HD patients.
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Affiliation(s)
- Keisuke Soeda
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, 143 Shimo-Kasuya, Isehara, 259-1193, Japan
| | - Hirotaka Komaba
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, 143 Shimo-Kasuya, Isehara, 259-1193, Japan.
- The Institute of Medical Sciences, Tokai University, Isehara, Japan.
| | - Yosuke Nakagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, 143 Shimo-Kasuya, Isehara, 259-1193, Japan
| | - Chiaki Kawabata
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, 143 Shimo-Kasuya, Isehara, 259-1193, Japan
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Takehiko Wada
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, 143 Shimo-Kasuya, Isehara, 259-1193, Japan
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Hiroo Takahashi
- Division of Nephrology and Diabetes, Tokai University Oiso Hospital, Oiso, Japan
- Jinken Clinic, Ebina, Japan
| | | | - Toru Hyodo
- Medical Corporation Kuratakai, Hiratsuka, Japan
| | - Miho Hida
- Medical Corporation Kuratakai, Hiratsuka, Japan
| | - Takao Suga
- Medical Corporation Showakai, Tokyo, Japan
| | - Takatoshi Kakuta
- Division of Nephrology, Endocrinology and Metabolism, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, 143 Shimo-Kasuya, Isehara, 259-1193, Japan
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Tzoulis P, Yavropoulou MP. Association of hyponatremia with bone mineral density and fractures: a narrative review. Ther Adv Endocrinol Metab 2023; 14:20420188231197921. [PMID: 37736657 PMCID: PMC10510353 DOI: 10.1177/20420188231197921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 07/13/2023] [Indexed: 09/23/2023] Open
Abstract
Recent studies suggest a possible association of hyponatremia with osteoporosis, falls and bone fractures. The objectives of this narrative review were to further explore this association and the related pathophysiological mechanisms and to suggest a practical approach to patients with osteoporosis or chronic hyponatremia in clinical practice. We conducted an extensive PubMed search until October 2022 with the combination of the following keywords: 'hyponatremia' or 'sodium' or 'SIADH' and 'fractures' or 'bone' or 'osteoporosis', as MeSH Terms. Review of numerous observational studies confirms a significant independent association of, even mild, hyponatremia with two- to three-fold increase in the occurrence of bone fractures. Hyponatremia is a risk factor for osteoporosis with a predilection to affect the hip, while the magnitude of association depends on the severity and chronicity of hyponatremia. Chronic hyponatremia also increases the risk for falls by inducing gait instability and neurocognitive deficits. Besides the detrimental impact of hyponatremia on bone mineral density and risk of falls, it also induces changes in bone quality. Emerging evidence suggests that acute hyponatremia shifts bone turnover dynamics towards less bone formation, while hyponatremia correction increases bone formation. The key unanswered question whether treatment of hyponatremia could improve osteoporosis and lower fracture risk highlights the need for prospective studies, evaluating the impact of sodium normalization on bone metabolism and occurrence of fractures. Recommendations for clinical approach should include measurement of serum sodium in all individuals with fracture or osteoporosis. Also, hyponatremia, as an independent risk factor for fracture, should be taken into consideration when estimating the likelihood for future fragility fracture and in clinical decision-making about pharmacological therapy of osteoporosis. Until it is proven that normalization of sodium can lower fracture occurrence, correcting hyponatremia cannot be universally recommended on this basis, but should be decided on a case-by-case basis.
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Affiliation(s)
- Ploutarchos Tzoulis
- Department of Metabolism & Experimental Therapeutics, Division of Medicine, University College London Medical School, Gower Street, London, WC1E6BT, UK
| | - Maria P. Yavropoulou
- Department of Propaedeutic and Internal Medicine, Medical School of University of Athens, Endocrinology Unit, Athens, Attica, Greece
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Fratangelo L, Nguyen S, D'Amelio P. Hyponatremia and aging-related diseases: key player or innocent bystander? A systematic review. Syst Rev 2023; 12:84. [PMID: 37173774 PMCID: PMC10182618 DOI: 10.1186/s13643-023-02246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Hyponatremia is frequent in older age; whether it is a key player, a surrogate marker, or an innocent bystander in age-related diseases is still unclear. OBJECTIVE To understand the role of hyponatremia in falls, osteoporosis, fractures, and cognitive impairment in old patients. METHOD Eligibility criteria for study inclusions were: written in English, peer-reviewed observational and intervention studies, clinical trial, prospective and retrospective controlled cohort studies, and case-controlled studies without limitations regarding the date of publication. INFORMATION SOURCES Protocol available on the International Prospective Register of Systematic Reviews (PROSPERO, CRD42021218389). MEDLINE, Embase, and PsycINFO were searched. Final search done on August 8, 2021. Risk-of-bias assessment: Risk-of-Bias Assessment tool for Non-randomized Studies (RoBANS) and the Bradford Hill's criteria for causality. RESULTS Includes studies: One-hundred thirty-five articles retained for the revision. Synthesis of results - Falls: Eleven studies were included. Strong association between hyponatremia and falls in all the studies was found. Osteoporosis and fractures: nineteen articles were included. The association between hyponatremia and osteoporosis is unclear. Cognitive impairment: Five articles were included. No association between hyponatremia and cognitive impairment was found. DISCUSSION Interpretation: Falls, osteoporosis, and fractures are multifactorial. Hyponatremia is not temporally related with the outcomes; we suggest that hyponatremia may be regarded as a marker of unhealthy aging and a confounder instead of a causal factor or an innocent bystander for falls and fractures. Concerning cognitive impairment, there are no evidence supporting a real role of hyponatremia to be regarded as an innocent bystander in neurodegeneration.
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Affiliation(s)
- Luigia Fratangelo
- Service of Geriatric Medicine & Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Sylvain Nguyen
- Service of Geriatric Medicine & Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrizia D'Amelio
- Service of Geriatric Medicine & Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Medical Science, Geriatric Unit, University of Torino, 10126, Turin, Italy
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Yu Y, Wang Y, Hou X, Tian F. Recent advances in the identification of related factors and preventive strategies of hip fracture. Front Public Health 2023; 11:1006527. [PMID: 36992874 PMCID: PMC10040558 DOI: 10.3389/fpubh.2023.1006527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
Hip fracture is the most devastating type of osteoporosis-related fracture, and is a major worldwide public health problem with a high socioeconomic burden, morbidity rate, and mortality rate. Thus, it is crucial to uncover the risk factors and protective factors to create a hip fracture prevention strategy. In addition to a briefly review of some well accepted risk and protective factors of hip fracture, this review mainly summarized the recent advances in the identification of emerging risk or protective factors for hip fracture, in terms of regional differences in medical services, diseases, drugs, mechanical load, neuromuscular mass, genes, blood types, cultural differences. This review provides a comprehensive review of the associated factors and effective prevention measures for hip fracture, and discusses issues that need further investigation. These issues include the determination of the influencing mechanism of risk factors triggering hip fracture and their interlinked correlation with other factors, as well as the confirmation or correction of emerging factors associated with hip fracture, particularly those that are still controversial. These recent findings will aid in optimizing the strategy for preventing hip fracture.
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Influence of Hyponatremia on Spinal Bone Quality and Fractures Due to Low-Energy Trauma. Medicina (B Aires) 2021; 57:medicina57111224. [PMID: 34833442 PMCID: PMC8619985 DOI: 10.3390/medicina57111224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Hyponatremia is the most common electrolyte disorder in elderly and associated with increased risk of falls. Clinical studies as well as small animal experiments suggested an association between chronic hyponatremia and osteoporosis. Furthermore, it has been assumed that subtle hyponatremia may be an independent fracture risk in the elderly. Therefore, this study was designed to evaluate the possible influence of chronic hyponatremia on osteoporosis and low-energy fractures of the spine. Materials and Methods: 144 patients with a vertebral body fracture (mean age: 69.15 ± 16.08; 73 females and 71 males) due to low-energy trauma were treated in a level one trauma center within one year and were included in the study. Chronic hyponatremia was defined as serum sodium < 135 mmol/L at admission. Bone mineral density (BMD) of the spine was measured using quantitative computed tomography in each patient. Results: Overall, 19.44% (n = 28) of patients in the low-energy trauma group had hyponatremia. In the group with fractures caused by low-energy trauma, the proportion of hyponatremia of patients older than 65 years was significantly increased as compared to younger patients (p** = 0.0016). Furthermore, there was no significant gender difference in the hyponatremia group. Of 28 patients with chronic hyponatremia, all patients had decreased bone quality. Four patients showed osteopenia and the other 24 patients even showed osteoporosis. In the low-energy trauma group, the BMD correlated significantly with serum sodium (r = 0.396; p*** < 0.001). Conclusions: The results suggest that chronic hyponatremia affects bone quality. Patients with chronic hyponatremia have an increased prevalence of fractures after low-energy trauma due to a decreased bone quality. Therefore, physicians from different specialties should focus on the treatment of chronic hyponatremia to reduce the fracture rate after low-energy trauma, particularly with elderly patients.
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Ayus JC, Nigwekar SU, Negri AL. Risks of Hip and Nonvertebral Fractures in Patients With CKD. Am J Kidney Dis 2021; 77:546. [PMID: 33589288 DOI: 10.1053/j.ajkd.2020.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Juan Carlos Ayus
- Renal Consultants of Houston, Houston, Texas; University of California Irvine, Irvine, California
| | - Sagar U Nigwekar
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Armando Luis Negri
- Instituto de Investigaciones Metabólicas, Universidad del Salvador, Buenos Aires, Argentina
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Vilaca T, Salam S, Eastell R. In Reply to "Risks of Hip and Nonvertebral Fractures in Patients With CKD". Am J Kidney Dis 2021; 77:546-547. [PMID: 33581880 DOI: 10.1053/j.ajkd.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Tatiane Vilaca
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Syazrah Salam
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Richard Eastell
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
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Ayus JC, Negri AL. Hyponatremia and falls. Osteoporos Int 2021; 32:393-394. [PMID: 33155119 DOI: 10.1007/s00198-020-05712-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Affiliation(s)
- J C Ayus
- Clinical Research Renal Consultants of Houston, University of California Irvine, Irvine, CA, USA
| | - A L Negri
- Institute for Metabolic Research, Universidad del Salvador, Buenos Aires, Argentina.
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Woitok BK, Funk GC, Walter P, Schwarz C, Ravioli S, Lindner G. Dysnatremias in emergency patients with acute kidney injury: A cross-sectional analysis. Am J Emerg Med 2020; 38:2602-2606. [DOI: 10.1016/j.ajem.2020.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/25/2019] [Accepted: 01/04/2020] [Indexed: 01/24/2023] Open
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Hoffmann DB, Popescu C, Komrakova M, Welte L, Saul D, Lehmann W, Hawellek T, Beil FT, Dakna M, Sehmisch S. Chronic hyponatremia in patients with proximal femoral fractures after low energy trauma: A retrospective study in a level-1 trauma center. Bone Rep 2019; 12:100234. [PMID: 31909095 PMCID: PMC6940722 DOI: 10.1016/j.bonr.2019.100234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/13/2019] [Accepted: 12/05/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction We evaluated the prevalence and influence of chronic hyponatremia in patients with low energy trauma. We also investigated the influence of medication and diseases on hyponatremia. Material and methods This retrospective study included 314 cases of proximal femoral fracture due to low energy trauma. Patients were treated in the University Medical Center Goettingen within 3 years. Hyponatremia was defined as serum sodium <135 mmol/L at admission. Results Overall, 15.6% of patients in the low energy trauma group had hyponatremia. Among patients older than 80 years, women showed distinctly higher rates of hyponatremia (female: 16.4%; male: 5.9%). In contrast only 4.7% of patients who underwent elective hip arthroplasty showed hyponatremia. Patients on sartanes and aldosterone antagonists showed significantly higher rates of hyponatremia. Alcoholism was significantly associated with hyponatremia. Conclusions We confirmed a high prevalence of chronic hyponatremia in patients with fractures due to low energy trauma. Our data underscore chronic hyponatremia as a contributing factor to hip fractures. Women older than 80 have a higher risk of developing hyponatremia. Sartanes, aldosterone antagonists, and alcohol disease are associated with hyponatremia. Treating hyponatremia may decrease the risk of fracture after low energy trauma. Therefore, physicians of different specialties should focus on treatment of chronic hyponatremia to reduce the fracture rate associated with low energy trauma. 15.6% of patients with prox. femur fracture after low energy trauma had hyponatremia. Hyponatremia rate in group of patients before hip arthroplasty was only 4.7%. Sartanes, aldosterone antagonists, and alcohol disease are associated with hyponatremia. Women older than 80 have a higher risk of developing hyponatremia.
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Affiliation(s)
- Daniel Bernd Hoffmann
- Department of Trauma-, Orthopaedic- and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Christian Popescu
- Department of Trauma-, Orthopaedic- and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Marina Komrakova
- Department of Trauma-, Orthopaedic- and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Lena Welte
- Department of Trauma-, Orthopaedic- and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Dominik Saul
- Department of Trauma-, Orthopaedic- and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma-, Orthopaedic- and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Thelonius Hawellek
- Department of Trauma-, Orthopaedic- and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Frank Timo Beil
- Department of Trauma-, Orthopaedic- and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Mohammed Dakna
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Stephan Sehmisch
- Department of Trauma-, Orthopaedic- and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
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Huang Y, Ren K, Yao T, Zhu H, Xu Y, Ye H, Chen Z, Lv J, Shen S, Ma J. MicroRNA-25-3p regulates osteoclasts through nuclear factor I X. Biochem Biophys Res Commun 2019; 522:74-80. [PMID: 31740002 DOI: 10.1016/j.bbrc.2019.11.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022]
Abstract
Osteoporosis is a bone metabolic disease, characterized by loss of bone density leading to fractures. Its incidence increases with age and affects patient quality of life. Although osteoclasts play a significant role in osteoporosis, their underlying regulatory mechanisms remain unclear. In this study, we found that microRNA (miR)-25-3p negatively regulates osteoclast function through nuclear factor I X (NFIX). Overexpression of NFIX promoted osteoclast proliferation and increased the expression of the osteoclast differentiation and activity markers tartrate-resistant acid phosphatase and cathepsin K. MiR-25-3p transfection inhibited NFIX expression, which in turn inhibited osteoclast proliferation. Collectively, our results suggest that miR-25-3p promotes osteoclast activity by regulating the expression of NFIX. Therefore, targeting miR-25-3p in osteoclasts could be a promising strategy for treating skeletal disorders involving reduced bone formation.
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Affiliation(s)
- Yizhen Huang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, China; Medical College of Zhejiang University, Hangzhou, China
| | - Keyi Ren
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, China
| | - Teng Yao
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, China; Medical College of Zhejiang University, Hangzhou, China
| | - Hongfang Zhu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, China
| | - Yining Xu
- Medical College of Shaoxing University, China
| | - Huali Ye
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, China
| | - Zizheng Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, China; Medical College of Zhejiang University, Hangzhou, China
| | - Jiawen Lv
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, China
| | - Shuying Shen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, China; Medical College of Zhejiang University, Hangzhou, China.
| | - Jianjun Ma
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, China; Medical College of Zhejiang University, Hangzhou, China.
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