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de Lima TM, Martins RB, Miura CS, Souza MVO, Cassiano MHA, Rodrigues TS, Veras FP, Sousa JDF, Gomes R, de Almeida GM, Melo SR, da Silva GC, Dias M, Capato CF, Silva ML, Luiz VEDDB, Carenzi LR, Zamboni DS, Jorge DMDM, Cunha FDQ, Tamashiro E, Anselmo-Lima WT, Valera FCP, Arruda E. Tonsils are major sites of persistence of SARS-CoV-2 in children. Microbiol Spectr 2023; 11:e0134723. [PMID: 37737615 PMCID: PMC10581087 DOI: 10.1128/spectrum.01347-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023] Open
Abstract
In the present study, we show that SARS-CoV-2 can infect palatine tonsils, adenoids, and secretions in children without symptoms of COVID-19, with no history of recent upper airway infection. We studied 48 children undergoing tonsillectomy due to snoring/OSA or recurrent tonsillitis between October 2020 and September 2021. Nasal cytobrushes, nasal washes, and tonsillar tissue fragments obtained at surgery were tested by RT-qPCR, immunohistochemistry (IHC), flow cytometry, and neutralization assay. We detected the presence of SARS-CoV-2 in at least one specimen tested in 27% of patients. IHC revealed the presence of the viral nucleoprotein in epithelial surface and in lymphoid cells in both extrafollicular and follicular regions, in adenoids and palatine tonsils. Also, IHC for the SARS-CoV-2 non-structural protein NSP-16 indicated the presence of viral replication in 53.8% of the SARS-CoV-2-infected tissues. Flow cytometry showed that CD20+ B lymphocytes were the most infected phenotypes, followed by CD4+ lymphocytes and CD123 dendritic cells, CD8+ T lymphocytes, and CD14+ macrophages. Additionally, IF indicated that infected tonsillar tissues had increased expression of ACE2 and TMPRSS2. NGS sequencing demonstrated the presence of different SARS-CoV-2 variants in tonsils from different tissues. SARS-CoV-2 antigen detection was not restricted to tonsils but was also detected in nasal cells from the olfactory region. Palatine tonsils and adenoids are sites of prolonged RNA presence by SARS-CoV-2 in children, even without COVID-19 symptoms. IMPORTANCE This study shows that SRS-CoV-2 of different lineages can infect tonsils and adenoids in one quarter of children undergoing tonsillectomy. These findings bring advancement to the area of SARS-CoV-2 pathogenesis, by showing that tonsils may be sites of prolonged infection, even without evidence of recent COVID-19 symptoms. SARS-CoV-2 infection of B and T lymphocytes, macrophages, and dendritic cells may interfere with the mounting of immune responses in these secondary lymphoid organs. Moreover, the shedding of SARS-CoV-2 RNA in respiratory secretions from silently infected children raises concern about possible diagnostic confusion in the presence of symptoms of acute respiratory infections caused by other etiologies.
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Affiliation(s)
- Thais Melquiades de Lima
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Ronaldo Bragança Martins
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
- Department of Clinical, Toxicological and Bromatological Analysis, University of São Paulo School of Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil
| | - Carolina Sponchiado Miura
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Maria Vitória Oliveira Souza
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Murilo Henrique Anzolini Cassiano
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Tamara Silva Rodrigues
- Department of Biochemistry and Immunology, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Flávio Protásio Veras
- Department of BioMolecular Sciences, University of São Paulo School of Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil
| | - Josane de Freitas Sousa
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Rogério Gomes
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Glaucia Maria de Almeida
- Department of Biochemistry and Immunology, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Stella Rezende Melo
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Gabriela Condé da Silva
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Matheus Dias
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Carlos Fabiano Capato
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Maria Lúcia Silva
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Veridiana Ester Dias de Barros Luiz
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Lucas Rodrigues Carenzi
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Dario Simões Zamboni
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
- Department of Biochemistry and Immunology, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Daniel Macedo de Melo Jorge
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Fernando de Queiroz Cunha
- Department of Pharmacology, University of Sao Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Edwin Tamashiro
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Wilma Terezinha Anselmo-Lima
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Cardoso Pereira Valera
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Eurico Arruda
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
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Zhu Y, Wang S, Yang Y, Shen B, Wang A, Zhang X, Zhang X, Li N, Gao Z, Liu Y, Zhu J, Wei Z, Guan J, Su K, Liu F, Gu M, Yin S. Adenoid lymphocyte heterogeneity in pediatric adenoid hypertrophy and obstructive sleep apnea. Front Immunol 2023; 14:1186258. [PMID: 37283767 PMCID: PMC10239814 DOI: 10.3389/fimmu.2023.1186258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Adenoid hypertrophy is the main cause of obstructive sleep apnea in children. Previous studies have suggested that pathogenic infections and local immune system disorders in the adenoids are associated with adenoid hypertrophy. The abnormalities in the number and function of various lymphocyte subsets in the adenoids may play a role in this association. However, changes in the proportion of lymphocyte subsets in hypertrophic adenoids remain unclear. Methods To identify patterns of lymphocyte subsets in hypertrophic adenoids, we used multicolor flow cytometry to analyze the lymphocyte subset composition in two groups of children: the mild to moderate hypertrophy group (n = 10) and the severe hypertrophy group (n = 5). Results A significant increase in naïve lymphocytes and a decrease in effector lymphocytes were found in severe hypertrophic adenoids. Discussion This finding suggests that abnormal lymphocyte differentiation or migration may contribute to the development of adenoid hypertrophy. Our study provides valuable insights and clues into the immunological mechanism underlying adenoid hypertrophy.
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Affiliation(s)
- Yaxin Zhu
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengming Wang
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingchao Yang
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bojun Shen
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anzhao Wang
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoman Zhang
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxu Zhang
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Niannian Li
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenfei Gao
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuenan Liu
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyu Zhu
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhicheng Wei
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Guan
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaiming Su
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Liu
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meizhen Gu
- Department of Otolaryngology Head and Neck Surgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Dorna J, Kaufmann A, Bockmann V, Raifer H, West J, Matrosovich M, Bauer S. Effects of Receptor Specificity and Conformational Stability of Influenza A Virus Hemagglutinin on Infection and Activation of Different Cell Types in Human PBMCs. Front Immunol 2022; 13:827760. [PMID: 35359920 PMCID: PMC8963867 DOI: 10.3389/fimmu.2022.827760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Humans can be infected by zoonotic avian, pandemic and seasonal influenza A viruses (IAVs), which differ by receptor specificity and conformational stability of their envelope glycoprotein hemagglutinin (HA). It was shown that receptor specificity of the HA determines the tropism of IAVs to human airway epithelial cells, the primary target of IAVs in humans. Less is known about potential effects of the HA properties on viral attachment, infection and activation of human immune cells. To address this question, we studied the infection of total human peripheral blood mononuclear cells (PBMCs) and subpopulations of human PBMCs with well characterized recombinant IAVs differing by the HA and the neuraminidase (NA) but sharing all other viral proteins. Monocytes and all subpopulations of lymphocytes were significantly less susceptible to infection by IAVs with avian-like receptor specificity as compared to human-like IAVs, whereas plasmacytoid dendritic cells (pDCs) and myeloid dendritic cells were equally susceptible to IAVs with avian-like and human-like receptor specificity. This tropism correlated with the surface expression of 2-3-linked sialic acids (avian-type receptors) and 2-6-linked sialic acids (human-type receptors). Despite a reduced infectivity of avian-like IAVs for PBMCs, these viruses were not less efficient than human-like IAVs in terms of cell activation as judged by the induction of cellular mRNA of IFN-α, CCL5, RIG-I, and IL-6. Elevated levels of IFN-α mRNA were accompanied by elevated IFN-α protein secretion in primary human pDC. We found that high basal expression in monocytes of antiviral interferon-induced transmembrane protein 3 (IFITM3) limited viral infection in these cells. siRNA-mediated knockdown of IFITM3 in monocytes demonstrated that viral sensitivity to inhibition by IFITM3 correlated with the conformational stability of the HA. Our study provides new insights into the role of host- and strain-specific differences of HA in the interaction of IAVs with human immune cells and advances current understanding of the mechanisms of viral cell tropism, pathogenesis and markers of virulence.
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Affiliation(s)
- Jens Dorna
- Institute for Immunology, Philipps University Marburg, Marburg, Germany
| | - Andreas Kaufmann
- Institute for Immunology, Philipps University Marburg, Marburg, Germany
| | - Viktoria Bockmann
- Institute for Immunology, Philipps University Marburg, Marburg, Germany
| | - Hartmann Raifer
- Core Facility FACS, Philipps University Marburg, Marburg, Germany
| | - Johanna West
- Institute of Virology, Philipps University Marburg, Marburg, Germany
| | | | - Stefan Bauer
- Institute for Immunology, Philipps University Marburg, Marburg, Germany
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Proal AD, VanElzakker MB. Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms. Front Microbiol 2021; 12:698169. [PMID: 34248921 PMCID: PMC8260991 DOI: 10.3389/fmicb.2021.698169] [Citation(s) in RCA: 463] [Impact Index Per Article: 154.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/17/2021] [Indexed: 12/23/2022] Open
Abstract
The novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic of coronavirus disease 2019 (COVID-19). Across the globe, a subset of patients who sustain an acute SARS-CoV-2 infection are developing a wide range of persistent symptoms that do not resolve over the course of many months. These patients are being given the diagnosis Long COVID or Post-acute sequelae of COVID-19 (PASC). It is likely that individual patients with a PASC diagnosis have different underlying biological factors driving their symptoms, none of which are mutually exclusive. This paper details mechanisms by which RNA viruses beyond just SARS-CoV-2 have be connected to long-term health consequences. It also reviews literature on acute COVID-19 and other virus-initiated chronic syndromes such as post-Ebola syndrome or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to discuss different scenarios for PASC symptom development. Potential contributors to PASC symptoms include consequences from acute SARS-CoV-2 injury to one or multiple organs, persistent reservoirs of SARS-CoV-2 in certain tissues, re-activation of neurotrophic pathogens such as herpesviruses under conditions of COVID-19 immune dysregulation, SARS-CoV-2 interactions with host microbiome/virome communities, clotting/coagulation issues, dysfunctional brainstem/vagus nerve signaling, ongoing activity of primed immune cells, and autoimmunity due to molecular mimicry between pathogen and host proteins. The individualized nature of PASC symptoms suggests that different therapeutic approaches may be required to best manage care for specific patients with the diagnosis.
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Affiliation(s)
- Amy D. Proal
- PolyBio Research Foundation, Kenmore, WA, United States
| | - Michael B. VanElzakker
- PolyBio Research Foundation, Kenmore, WA, United States
- Division of Neurotherapeutics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Xu M, Perdomo MF, Mattola S, Pyöriä L, Toppinen M, Qiu J, Vihinen-Ranta M, Hedman K, Nokso-Koivisto J, Aaltonen LM, Söderlund-Venermo M. Persistence of Human Bocavirus 1 in Tonsillar Germinal Centers and Antibody-Dependent Enhancement of Infection. mBio 2021; 12:e03132-20. [PMID: 33531399 PMCID: PMC7858059 DOI: 10.1128/mbio.03132-20] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022] Open
Abstract
Human bocavirus 1 (HBoV1), a nonenveloped single-stranded DNA parvovirus, causes mild to life-threatening respiratory tract infections, acute otitis media, and encephalitis in young children. HBoV1 often persists in nasopharyngeal secretions for months, hampering diagnosis. It has also been shown to persist in pediatric palatine and adenoid tonsils, which suggests that lymphoid organs are reservoirs for virus spread; however, the tissue site and host cells remain unknown. Our aim was to determine, in healthy nonviremic children with preexisting HBoV1 immunity, the adenotonsillar persistence site(s), host cell types, and virus activity. We discovered that HBoV1 DNA persists in lymphoid germinal centers (GCs), but not in the corresponding tonsillar epithelium, and that the cell types harboring the virus are mainly naive, activated, and memory B cells and monocytes. Both viral DNA strands and both sides of the genome were detected, as well as infrequent mRNA. Moreover, we showed, in B-cell and monocyte cultures and ex vivo tonsillar B cells, that the cellular uptake of HBoV1 occurs via the Fc receptor (FcγRII) through antibody-dependent enhancement (ADE). This resulted in viral mRNA transcription, known to occur exclusively from double-stranded DNA in the nucleus, however, with no detectable productive replication. Confocal imaging with fluorescent virus-like particles moreover disclosed endocytosis. To which extent the active HBoV1 GC persistence has a role in chronic inflammation or B-cell maturation disturbances, and whether the virus can be reactivated, will be interesting topics for forthcoming studies.IMPORTANCE Human bocavirus 1 (HBoV1), a common pediatric respiratory pathogen, can persist in airway secretions for months hampering diagnosis. It also persists in tonsils, providing potential reservoirs for airway shedding, with the exact location, host cell types, and virus activity unknown. Our study provides new insights into tonsillar HBoV1 persistence. We observed HBoV1 persistence exclusively in germinal centers where immune maturation occurs, and the main host cells were B cells and monocytes. In cultured cell lines and primary tonsillar B cells, we showed the virus uptake to be significantly enhanced by HBoV1-specific antibodies, mediated by the cellular IgG receptor, leading to viral mRNA synthesis, but without detectable productive replication. Possible implications of such active viral persistence could be tonsillar inflammation, disturbances in immune maturation, reactivation, or cell death with release of virus DNA, explaining the long-lasting HBoV1 airway shedding.
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Affiliation(s)
- Man Xu
- Department of Virology, University of Helsinki, Helsinki, Finland
| | | | - Salla Mattola
- Department of Biological and Environmental Science, University of Jyväskylä, Jyväskylä, Finland
- Nanoscience Center, University of Jyväskylä, Jyväskylä, Finland
| | - Lari Pyöriä
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - Mari Toppinen
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - Jianming Qiu
- Department of Microbiology, Molecular Genetics and Immunology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Maija Vihinen-Ranta
- Department of Biological and Environmental Science, University of Jyväskylä, Jyväskylä, Finland
- Nanoscience Center, University of Jyväskylä, Jyväskylä, Finland
| | - Klaus Hedman
- Department of Virology, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Johanna Nokso-Koivisto
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
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