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Adolfsson, Lars
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Moloney, M., Farnebo, S. & Adolfsson, L. (2023). Distal ulna fractures in adults - subcapitular, transverse fractures did not benefit from surgical treatment. Archives of Orthopaedic and Trauma Surgery, 143(1), 381-387
Öppna denna publikation i ny flik eller fönster >>Distal ulna fractures in adults - subcapitular, transverse fractures did not benefit from surgical treatment
2023 (Engelska)Ingår i: Archives of Orthopaedic and Trauma Surgery, ISSN 0936-8051, E-ISSN 1434-3916, Vol. 143, nr 1, s. 381-387Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Introduction Fractures of the distal ulna, excluding the styloid, are rare. The cause of injury is often a fall on an outstretched hand with an extended wrist, and in most cases there is a concomitant distal radius fracture. The aims of this retrospective study were to investigate the results of the current treatment of distal ulna fractures in adults, with or without a concomitant distal radius fracture, and if a recently presented fracture classification could predict outcome. Materials and methods Patients, 18 years or older, treated for a fracture of the distal third of ulna in our county, were included. Fractures of the styloid tip were excluded. The radiographs of the fractures were independently classified by two specialists in radiology according to the 2018 AO/OTA classification. Follow-up was performed 5-7 years after the injury, through the questionnaire Patient-Rated Wrist Evaluation (PRWE) and new radiographs of both wrists. Results Ninety-six patients with 97 fractures were included and filled out the PRWE. 65 patients also had new radiographs taken. 79 patients were women and the mean age at the time of injury was 63 years (SD 14.5). The most common fracture class was the extra-articular transverse fracture, 2U3A2.3 (42%). We found that 40% of the fractures had been treated by internal fixation and only 2 fractures had not healed, one conservatively treated and one operated. The median PRWE was 15 (IQR 33.5). The PRWE score was significantly worse in the operated ulna fractures (p = 0.01) and this was also true for extra-articular transverse fractures 2U3A2.3 (p = 0.001). Initial displacement was more common in operated transverse fractures, but it could not be proven that this was the reason for the inferior result. Conclusions Distal ulna fractures almost always unite and the result is comparable to that of isolated distal radius fractures when measured by PRWE. Based on the opinions of the radiologists and how often a consensus discussion was needed for classification, we found the updated AO classification system difficult to use, if dependent only on standard radiographic views. In the present study, transverse extra-articular ulna fractures did not benefit from internal fixation regardless if associated with a distal radius fracture or isolated.

Ort, förlag, år, upplaga, sidor
Springer, 2023
Nyckelord
AO, DRUJ, Fracture, PRWE, Distal ulna, Wrist
Nationell ämneskategori
Ortopedi
Identifikatorer
urn:nbn:se:liu:diva-182625 (URN)10.1007/s00402-022-04336-1 (DOI)000745532900004 ()35064293 (PubMedID)2-s2.0-85123386397 (Scopus ID)
Anmärkning

Funding Agencies: Linköping University

Tillgänglig från: 2022-02-01 Skapad: 2022-02-01 Senast uppdaterad: 2024-01-10Bibliografiskt granskad
Moloney, M., Kåredal, J., Persson, T., Farnebo, S. & Adolfsson, L. (2022). Poor reliability and reproducibility of 3 different radiographical classification systems for distal ulna fractures. Acta Orthopaedica, 93, 438-443
Öppna denna publikation i ny flik eller fönster >>Poor reliability and reproducibility of 3 different radiographical classification systems for distal ulna fractures
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2022 (Engelska)Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 93, s. 438-443Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background and purpose - Classification of fractures can be valuable for research purposes but also in clinical work. Especially with rare fractures, such as distal ulna fractures, a treatment algorithm based on a classification can be helpful. We compared 3 different classification systems of distal ulna fractures and investigated their reliability and reproducibility. Patients and methods - patients with 97 fractures of the distal ulna, excluding the ulnar styloid, were included. All fractures were independently classified by 3 observers according to the classification by Biyani, AO/OTA 2007, and AO/OTA 2018. The classification process was repeated after a minimum of 3 weeks. We used Kappa value analysis to determine inter- and intra-rater agreement.

Results - The inter-rater agreement of the AO/OTA 2007 classification was judged as fair,. 0.40, whereas the agreement of AO/OTA 2018 and Biyani was moderate at. 0.42 and 0.43 respectively. The intra-rater agreement was judged as moderate for all classifications. Interpretation - The differences between the classifications were small and the overall impression was that neither of them was good enough to be of substantial clinical value. The Biyani classification, being developed specifically for distal ulna fractures, was the easiest and most fitting for the fracture patterns seen in our material, but lacking options for fractures of the distal diaphysis. Standard radiographs were considered insufficient for an accurate classification. A better radiographic method combined with a revised classification might improve accuracy, reliability, and reproducibility.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2022
Nyckelord
Classification, Fractures, Radiological imaging, Ulna, Wrist
Nationell ämneskategori
Ortopedi
Identifikatorer
urn:nbn:se:liu:diva-185054 (URN)10.2340/17453674.2022.2509 (DOI)000790823500066 ()35438183 (PubMedID)
Tillgänglig från: 2022-05-19 Skapad: 2022-05-19 Senast uppdaterad: 2024-01-10Bibliografiskt granskad
Müller, S. A., Adolfsson, L., Baum, C., Müller-Gerbl, M., Müller, A. M. & Rikli, D. (2021). Fluoroscopy of the Elbow: A Cadaveric Study Defining New Standard Projections to Visualize Important Anatomical Landmarks. JB & JS open access, 6(2), Article ID e20.00160.
Öppna denna publikation i ny flik eller fönster >>Fluoroscopy of the Elbow: A Cadaveric Study Defining New Standard Projections to Visualize Important Anatomical Landmarks
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2021 (Engelska)Ingår i: JB & JS open access, ISSN 2472-7245, Vol. 6, nr 2, artikel-id e20.00160Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Despite new 3-dimensional imaging modalities, 2-dimensional fluoroscopy remains the standard intraoperative imaging modality. The elbow has complex anatomy, and defined standard fluoroscopic projections are lacking. Therefore, the aim of this study was to define standard projections of the elbow for intraoperative fluoroscopy. Methods: This study consisted of 2 parts. In part I, dissected cadaveric elbows were examined under fluoroscopy, and their radiographic anatomical features were assessed, with focus on projections showing defined anatomical landmarks. In part II, projections from part I were verified on entire cadavers to simulate intraoperative imaging. Standard projections for anteroposterior (AP) and lateral views as well as oblique and axial views were recorded. Results: Eight standardized projections could be defined and included 3 AP, 1 lateral, 2 oblique, and 2 axial views. By applying these specific projections, we could visualize the epicondyles, the trochlea with its medial and lateral borders, the capitellum, the olecranon, the greater sigmoid notch, the coronoid process including its anteromedial facet, the proximal radioulnar joint with the radial tuberosity, and the anterior and posterior joint lines of the distal part of the humerus. These standard projections were reliably obtained using a specific sequence. Conclusions: Knowledge about radiographic anatomy and standard projections is essential for visualizing important landmarks. With the presented standard projections of the elbow, important anatomical landmarks can be clearly examined. Thus, fluoroscopic visualization of anatomical fracture reduction and correct implant placement should be facilitated. Clinical Relevance: This basic science cadaveric study defines fluoroscopic standard projections of the elbow essential for visualization of anatomical landmarks during surgery. 

Ort, förlag, år, upplaga, sidor
Lippincott, Williams & Wilkins, 2021
Nationell ämneskategori
Medicinsk bildbehandling
Identifikatorer
urn:nbn:se:liu:diva-185061 (URN)10.2106/JBJS.OA.20.00160 (DOI)001111220400001 ()34056508 (PubMedID)2-s2.0-85118885070 (Scopus ID)
Tillgänglig från: 2022-05-16 Skapad: 2022-05-16 Senast uppdaterad: 2024-01-08
Nordqvist, J., Öberg, B., Adolfsson, L., Holmgren, T. & Johansson, K. (2021). Heterogeneity among patients with subacromial pain – variabilities within clinical presentation and its impact on daily life. Physiotherapy, 112, 113-120
Öppna denna publikation i ny flik eller fönster >>Heterogeneity among patients with subacromial pain – variabilities within clinical presentation and its impact on daily life
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2021 (Engelska)Ingår i: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 112, s. 113-120Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: The primary aim was to describe the variability within clinical presentation of patients with subacromial pain in primary care, secondly to investigate associations between clinical presentation and self-reported pain intensity, shoulder function, level of anxiety and depression, and health-related quality of life. Design and setting A cross-sectional study based on data from two clinical studies in primary care, one randomized controlled trial and one implementation study. Three components: active range of motion (AROM), rotator cuff function and scapular kinematics were analyzed to describe variability within clinical presentation and patient-reported measurements were used to investigate the impact on daily life. Participants Patients aged 30-67 years, describing pain for more than two weeks, and positive signs for a minimum of three out of the following five clinical tests: impingement sign according to Neer, impingement test according to Hawkins-Kennedy, Pattes maneuver, Jobe’s test, and painful arc. Results Among the 164 patients included, 24% displayed dysfunction in one, 50% two and 24% in all three components. Limited AROM was seen in 46%, rotator cuff dysfunction in 91% and scapular dyskinesia in 57% of the patients. Conclusions These results reveal a heterogeneity among primary care patients with subacromial pain confirming a large variability regarding the components AROM, rotator cuff function and scapular kinematics. All three components appear unique (not significantly correlated) where a rotator cuff dysfunction is very frequent while limited AROM and scapular dyskinesia are more inconsistent. There are significant, but rather weak, associations between clinical presentation and impact on daily life.

Ort, förlag, år, upplaga, sidor
ELSEVIER SCI LTD, 2021
Nyckelord
Shoulder Impingement Syndrome, Clinical Presentation, Range of Motion Articular, Rotator Cuff, Scapular Dyskinesia, Primary Health Care
Nationell ämneskategori
Sjukgymnastik
Identifikatorer
urn:nbn:se:liu:diva-172380 (URN)10.1016/j.physio.2020.10.001 (DOI)000687805600014 ()34058616 (PubMedID)
Forskningsfinansiär
Region ÖstergötlandLinköpings universitet
Anmärkning

Funding: Linkoping University, Sweden; County council of ostergotland

Tillgänglig från: 2021-01-08 Skapad: 2021-01-08 Senast uppdaterad: 2023-12-28Bibliografiskt granskad
Nordqvist, J., Holmgren, T., Adolfsson, L., Öberg, B. & Johansson, K. (2021). The minimal important change for the seven-item disability of the arm, shoulder, and hand (DASH 7) questionnaire - Assessing shoulder function in patients with subacromial pain.. JSES international, 5(3), 474-479
Öppna denna publikation i ny flik eller fönster >>The minimal important change for the seven-item disability of the arm, shoulder, and hand (DASH 7) questionnaire - Assessing shoulder function in patients with subacromial pain.
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2021 (Engelska)Ingår i: JSES international, ISSN 2666-6383, Vol. 5, nr 3, s. 474-479Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: The DASH 7 is a recently published activity-related 7-item short form of the disability of the arm, shoulder, and hand (DASH) questionnaire developed to assess shoulder function in patients with subacromial pain. Before implementation in both intervention studies and in clinical practice, it is essential to evaluate its responsiveness. The objective of this study was to determine the minimal important change (MIC) in the DASH 7 questionnaire for patients with subacromial pain after a 3 months exercise intervention in a primary care context.

Methods: In this psychometric study the anchor-based MIC-distribution method was used to establish the MIC. The Patient Global Impression of Change (PGIC) was used as external criterion. Data from a clinical implementation study, aimed to implement a specific exercise strategy for patients with subacromial pain among physiotherapists in primary care, were used. Data from 70 patients were included in the analyses.

Results: The correlation coefficient between Patient Global Impression of Change and the DASH 7 score change was 0.67 and the area under the curve was 0.94 (95% confidence interval: 0.88-1.0). The MICROC for improvement was detected at a mean change in 6.5 points with the sensitivity at 0.98 (98%) and the specificity at 0.78 (78%), and the MIC95% limit for improvement was detected at a mean change of 25.7 points. There were 77% of the patients who reached at least this MICROC and 51% who reached at least the MIC95% limit after 3 months of exercise intervention.

Conclusion: The DASH 7 is responsive to change over time and can discriminate between patients considered to be improved and patients considered not improved. These MIC values for patients with subacromial pain in the primary care setting can be used in clinical practice and in intervention studies as an indication on the patients clinically important level of score change for improvement.

Ort, förlag, år, upplaga, sidor
Philadelphia, PA, United States: Elsevier, 2021
Nyckelord
Anchor-based approach, DASH 7, Disabilities of the arm, shoulder, and hand questionnaire, Distribution-based approach, Minimal important change, Subacromial pain
Nationell ämneskategori
Sjukgymnastik
Identifikatorer
urn:nbn:se:liu:diva-184175 (URN)10.1016/j.jseint.2021.01.008 (DOI)34136857 (PubMedID)2-s2.0-85122748626 (Scopus ID)
Tillgänglig från: 2022-04-06 Skapad: 2022-04-06 Senast uppdaterad: 2023-12-28Bibliografiskt granskad
Moloney, M., Farnebo, S. & Adolfsson, L. (2020). Incidence of distal ulna fractures in a Swedish county: 74/100,000 person-years, most of them treated non-operatively. Acta Orthopaedica, 91(1), 104-108
Öppna denna publikation i ny flik eller fönster >>Incidence of distal ulna fractures in a Swedish county: 74/100,000 person-years, most of them treated non-operatively
2020 (Engelska)Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 91, nr 1, s. 104-108Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background and purpose - Fractures of the distal ulna can occur in isolation or in conjunction with a distal radius fracture. They may result in incongruence and instability of the distal radioulnar joint. We investigated the incidence of distal ulna fractures, whether any fracture types were more common, and the methods of treatment used. Patients and methods - Data were collected from patients 18 years or older, treated for a fracture of the distal ulna in ostergotland, Sweden, during 2010-2012. Patients were identified in the patient registry. The fractures were classified according to the AO comprehensive classification of fractures. Results - The incidence of distal ulna fractures was 74/100,000 person-years. The most common fracture type was that of the ulnar styloid Q1 (79%), followed by the ulnar neck Q2 (11%). Rarest was ulna head fracture, type Q4 (1%). Incidental findings were a mean age of 63 years (SD 18), a concomitant distal radius fracture in 92% of the patients and that 79% were caused by falling from standing height. Internal fixation was performed in 30% of the Q2-Q6 fractures. This indicates that most were considered stable without internal fixation or stable after fixation of a concomitant radius fracture. Interpretation - Our results show that fractures of the distal ulna are not very common, and some fracture types are even rare. There seem to be no consensus on treatment.

Ort, förlag, år, upplaga, sidor
TAYLOR & FRANCIS LTD, 2020
Nationell ämneskategori
Ortopedi
Identifikatorer
urn:nbn:se:liu:diva-162051 (URN)10.1080/17453674.2019.1686570 (DOI)000493871300001 ()31680591 (PubMedID)
Tillgänglig från: 2019-11-19 Skapad: 2019-11-19 Senast uppdaterad: 2024-01-10
Adolfsson, L. (2018). Post-traumatic stiff elbow. EFORT open reviews, 3(5), 210-216
Öppna denna publikation i ny flik eller fönster >>Post-traumatic stiff elbow
2018 (Engelska)Ingår i: EFORT open reviews, ISSN 2058-5241, Vol. 3, nr 5, s. 210-216Artikel, forskningsöversikt (Refereegranskat) Published
Abstract [en]

Post-traumatic and post-operative stiffness of the elbow joint is relatively common and may in pronounced cases markedly interfere with normal upper extremity function.Soft-tissue contractures and heterotopic bone formation are two major causes of limited movement.Extensive recent research has elucidated many of the pathways contributing to these conditions, but the exact mechanisms are still unknown.In the early phase of soft-tissue contractures conservative treatment may be valuable, but in longstanding cases operative treatment is often necessary.Several different options are available depending on the severity of the condition and the underlying offending structures. Surgical treatment may allow significant gains in movement but rarely complete restoration, and complications are not uncommon.The following presentation reviews the recent literature on pathomechanisms and treatment alternatives. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170062.

Ort, förlag, år, upplaga, sidor
British Editorial Society of Bone & Joint Surgery, 2018
Nyckelord
contracture release; heterotopic bone formation; post-traumatic contracture; stiff elbow; treatment
Nationell ämneskategori
Medicinsk apparatteknik
Identifikatorer
urn:nbn:se:liu:diva-155858 (URN)10.1302/2058-5241.3.170062 (DOI)000438949600008 ()29951258 (PubMedID)
Tillgänglig från: 2019-03-29 Skapad: 2019-03-29 Senast uppdaterad: 2020-01-14
Nordqvist, J., Johansson, K., Holmgren, T., Adolfsson, L. & Öberg, B. (2017). A short activity-related scale for measuring shoulder function in patients with subacromial pain: the DASH 7. JSES Open Access, 1(2), 113-118
Öppna denna publikation i ny flik eller fönster >>A short activity-related scale for measuring shoulder function in patients with subacromial pain: the DASH 7
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2017 (Engelska)Ingår i: JSES Open Access, ISSN 2468-6026, Vol. 1, nr 2, s. 113-118Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background Subacromial pain is a common cause of shoulder dysfunction that negatively affects quality of life. Currently, most outcome measures for shoulder pain are applied to a heterogeneous group of patients. Of these measures, the Disabilities of the Arm, Shoulder, and Hand (DASH) is the most widely recognized test with which to assess patients with subacromial pain. The primary aim of this study was to assess the content validity of DASH for patients with subacromial pain, with a secondary aim to test responsiveness to a modified set of DASH items tailored to these patients. Methods There were 129 patients who reported activities in the Patient-Specific Functional Scale (PSFS). To assess validity, 5 independent physiotherapists matched PSFS activities to the most appropriate DASH item. DASH items identified as being of greatest importance to patients were those corresponding to the highest number of PSFS-matched activities. Calculations were made for responsiveness and internal consistency. Results Physiotherapists matched DASH items to 271 PSFS activities, reaching agreement for almost 80%. Seven DASH items (DASH 7) were identified as being particularly important. Effect size data (Cohen's d) were 0.93 for DASH 7, 0.92 for DASH 30, and 0.85 for QuickDASH; the corresponding Cronbach's α values (for DASH 7, DASH 30, and QuickDASH) were 0.84, 0.94, and 0.86, respectively. Conclusions DASH 7 is a short, patient-centered, and activity-related scale that can measure shoulder function in patients with subacromial pain using a quarter of the original DASH items. DASH 7 demonstrated responsiveness, with a satisfactory level of internal consistency.

Ort, förlag, år, upplaga, sidor
Elsevier, 2017
Nyckelord
Shoulder impingement syndrome, Patient outcome assessments, Human activity, Shoulder pain, Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Specific Functional Scale (PSFS)
Nationell ämneskategori
Sjukgymnastik
Identifikatorer
urn:nbn:se:liu:diva-172379 (URN)10.1016/j.jses.2017.04.001 (DOI)30675551 (PubMedID)
Tillgänglig från: 2021-01-08 Skapad: 2021-01-08 Senast uppdaterad: 2023-12-28Bibliografiskt granskad
Svernlöv, B., Nestorson, J. & Adolfsson, L. (2017). Subjective ulnar nerve dysfunction commonly following open reduction, internal fixation (ORIF) of distal humeral fractures and in situ decompression of the ulnar nerve. Strategies in trauma and limb reconstruction (Online), 12(1), 19-25
Öppna denna publikation i ny flik eller fönster >>Subjective ulnar nerve dysfunction commonly following open reduction, internal fixation (ORIF) of distal humeral fractures and in situ decompression of the ulnar nerve
2017 (Engelska)Ingår i: Strategies in trauma and limb reconstruction (Online), ISSN 1828-8928, Vol. 12, nr 1, s. 19-25Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The aim of this retrospective study was to investigate the frequency of persistent ulnar affection in patients who underwent open reduction and internal fixation (ORIF) of distal humeral fractures without ulnar nerve transposition or mobilisation. Eighty-two patients (53 women), mean age 62 years, were, at a mean of 48 months, reviewed through medical records and a subjective evaluation form concerning ulnar nerve problems. Ulnar nerve affliction, in most cases regarded as mild, was experienced by 22 patients (27%; 14 women) and significantly associated with multiple surgeries. Three patients had been operated with late neurolysis and one with transposition without reported improvement. The proportion of ulnar nerve dysfunction was equally common regardless of medial or lateral plating. ORIF with plate fixation and without ulnar nerve transposition seems to be an acceptable option for patients with distal humeral fractures. The frequency of ulnar nerve affection in our series does not appear higher than previously reported. Subjective ulnar nerve symptoms were, however, relatively common and appear related to the trauma itself, the surgery, or the post-operative management which highlights the need for further analysis of these factors.

Ort, förlag, år, upplaga, sidor
Springer, 2017
Nyckelord
Dellon; Fracture; Humeral; McGowan; ORIF; Transposition
Nationell ämneskategori
Ortopedi
Identifikatorer
urn:nbn:se:liu:diva-146069 (URN)10.1007/s11751-016-0271-5 (DOI)000404431600003 ()27909969 (PubMedID)
Tillgänglig från: 2018-03-27 Skapad: 2018-03-27 Senast uppdaterad: 2024-02-01
Schilcher, J., Scheer, J. & Adolfsson, L. (2016). Transclavicular Osseous Sutures for the Treatment of Displaced Distal Clavicular Fractures in Children. Journal of Orthopaedic Trauma, 30(5), E181-E185
Öppna denna publikation i ny flik eller fönster >>Transclavicular Osseous Sutures for the Treatment of Displaced Distal Clavicular Fractures in Children
2016 (Engelska)Ingår i: Journal of Orthopaedic Trauma, ISSN 0890-5339, E-ISSN 1531-2291, Vol. 30, nr 5, s. E181-E185Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

We describe a novel surgical technique for the treatment of displaced distal clavicular fractures in children. These fractures are rare, and recommendations on treatment vary. Conservative treatment might lead to persistent deformity and limitations of function. Previous reports of surgical treatment involve fracture fixation with K-wires. This requires a routine sequential reoperation to remove the implant and has been associated with serious complications in some patients. The surgical technique described here is based on osseous sutures through the clavicular shaft and coracoclavicular ligaments and is found successful for the treatment of distal clavicular fractures in children and may also be feasible for true acromioclavicular dislocations. The main principle of the technique is a fixation of the displaced clavicle through transclavicular drill holes, against the intact inferior periosteal sleeve at the insertion of the coracoclavicular ligaments. No temporary K-wire fixation is needed. To date, we have treated 7 patients with this technique. All fractures healed uneventfully with an excellent functional result and without skeletal deformity.

Ort, förlag, år, upplaga, sidor
LIPPINCOTT WILLIAMS & WILKINS, 2016
Nyckelord
clavicular fracture; children; osseous suture
Nationell ämneskategori
Klinisk medicin
Identifikatorer
urn:nbn:se:liu:diva-128739 (URN)10.1097/BOT.0000000000000527 (DOI)000374833200007 ()27101169 (PubMedID)
Anmärkning

Funding Agencies|Ostergotland County Council, Sweden

Tillgänglig från: 2016-05-31 Skapad: 2016-05-30 Senast uppdaterad: 2021-12-29
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