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Svensson, Olle
Publications (10 of 43) Show all publications
Unneby, A., Svensson, O., Gustafson, Y. & Olofsson, B. (2017). Femoral nerve block in a representative sample of elderly people with hip fracture: a randomised controlled trial. Injury, 48(7), 1542-1549
Open this publication in new window or tab >>Femoral nerve block in a representative sample of elderly people with hip fracture: a randomised controlled trial
2017 (English)In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, no 7, p. 1542-1549Article in journal (Refereed) Published
Abstract [en]

Introduction: The number of elderly people with hip fracture and dementia is increasing, and many of these patients suffer from pain. Opioids are difficult to adjust and side effects are common, especially with increased age and among patients with dementia. Preoperative femoral nerve block is an alternative pain treatment. Aim: To investigate whether preoperative femoral nerve block reduced acute pain and opioid use after hip fracture among elderly patients, including those with dementia. Patients and methods: In this randomised controlled trial involving patients aged >= 70 years with hip fracture (trochanteric and cervical), including those with dementia, we compared femoral nerve block with conventional pain management, with opioid use if required. The primary outcome was preoperative pain, measured at five timepoints using a visual analogue scale (VAS). Preoperative opioid consumption was also registered. Results: The study sample comprised 266 patients admitted consecutively to the Orthopaedic Ward. The mean age was 84.1 (+/- 6.9) years, 64% of participants were women, 44% lived in residential care facilities, and 120 (45.1%) had dementia diagnoses. Patients receiving femoral nerve block had significantly lower self-rated pain scores from baseline to 12 h after admission than did controls. Self-rated and proxy VAS pain scores decreased significantly in these patients from baseline to 12 h compared with controls (p < 0.001 and p = 0.003, respectively). Patients receiving femoral nerve block required less opioids than did controls, overall (2.3 +/- 4.0 vs. 5.7 +/- 5.2 mg, p < 0.001) and in the subgroup with dementia (2.1 +/- 3.3 vs. 5.8 +/- 5.0 mg, p < 0.001). Conclusion: Patients with hip fracture, including those with dementia, who received femoral nerve block had lower pain scores and required less opioids before surgery compared with those receiving conventional pain management. Femoral nerve block seems to be a feasible pain treatment for elderly people, including those with dementia. 

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2017
Keywords
Hip fracture, Femoral neck fracture, Femoral nerve block, Pain, Opioid, Preoperative period, Frail derly, Dementia
National Category
Orthopaedics Nursing
Identifiers
urn:nbn:se:umu:diva-138233 (URN)10.1016/j.injury.2017.04.043 (DOI)000405997100041 ()28501287 (PubMedID)
Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2018-06-09Bibliographically approved
Röding, F., Lindkvist, M., Bergström, U., Svensson, O. & Lysholm, J. (2016). Trauma recidivism at an emergency department of a Swedish medical center. Injury Epidemiology, 3, Article ID 22.
Open this publication in new window or tab >>Trauma recidivism at an emergency department of a Swedish medical center
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2016 (English)In: Injury Epidemiology, ISSN 0176-3733, E-ISSN 2197-1714, Vol. 3, article id 22Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: To inform targeted prevention, we studied patterns of trauma recidivism and whether a first injury predicts the risk for a recurrent injury.

METHODS: In a population-based study of 98,502 adult injury events 1999-2012, at the emergency department of Umeå University Hospital, Sweden, we compared non-recidivists with recidivists in terms of patients' sex, age, type of injury and severity of the injury.

RESULTS: Thirty-six percent of all patients suffered recurrent injuries, which were associated with a higher proportion of inpatient care and more hospital days. Young men and elderly women were at the highest risk for trauma recidivism. At 20 to 24 years, men had a 2.4 (CI 95 % 2.3-2.5) higher risk than women, a 90 years old woman had almost a 10-fold higher risk for another moderate/severe injury than a 20 years old one. A fracture were associated with a hazard ratio of 1.28 (CI 95 % 1.15-1.42) among men younger than 65 years and 1.31 (CI 95 % 1.12-1.54) for men older than 65 years for a subsequent moderate/severe injury. For women younger than 65 years a fracture was associated with a hazard ratio of 1.44 (CI 95 % 1.28-1.62) for a subsequent moderate/severe injury. A sprain carries a higher risk for a new moderate/severe injury for both men and women and in both age groups; the hazard ratio was 1.13 (CI 95 % 1.00-1.26) for men younger than 65 years, 1.42 (CI 95 % 1.01-1.99) for men older than 65 years, 1.19 (CI 95 % 1.05-1.35) for women younger than 65 years and 1.26 (CI 95 % 1.02-1.56) for women older than 65 years. A higher degree of injury severity was associated with a higher risk for a new moderate/severe injury.

CONCLUSION: Trauma recidivism is common and represents a large proportion of all injured. Age and sex are associated with the risk for new injury. Injury types and severity, also have implications for future injury.

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-127497 (URN)10.1186/s40621-016-0087-2 (DOI)27747558 (PubMedID)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2018-06-09Bibliographically approved
Zheng, H.-F., Forgetta, V., Hsu, Y.-H., Estrada, K., Rosello-Diez, A., Leo, P. J., . . . Richards, J. B. (2015). Whole-genome sequencing identifies EN1 as a determinant of bone density and fracture. Nature, 526(7571), 112-+
Open this publication in new window or tab >>Whole-genome sequencing identifies EN1 as a determinant of bone density and fracture
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2015 (English)In: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 526, no 7571, p. 112-+Article in journal (Refereed) Published
Abstract [en]

The extent to which low-frequency (minor allele frequency (MAF) between 1-5%) and rare (MAF <= 1%) variants contribute to complex traits and disease in the general population is mainly unknown. Bone mineral density (BMD) is highly heritable, a major predictor of osteoporotic fractures, and has been previously associated with common genetic variants(1-8), as well as rare, population specific, coding variants(9). Here we identify novel non-coding genetic variants with large effects on BMD (n(total) = 53,236) and fracture (n(total) = 508,253) in individuals of European ancestry from the general population. Associations for BMD were derived from whole-genome sequencing (n = 2,882 from UK10K (ref. 10); a population-based genome sequencing consortium), whole-exome sequencing (n = 3,549), deep imputation of genotyped samples using a combined UK10K/1000 Genomes reference panel (n = 26,534), and de novo replication genotyping (n = 20,271). We identified a low-frequency non-coding variant near a novel locus, EN1, with an effect size fourfold larger than the mean of previously reported common variants for lumbar spine BMD8 (rs11692564(T), MAF51.6%, replication effect size510.20 s.d., P-meta = 2 x 10(-14)), which was also associated with a decreased risk of fracture (odds ratio = 0.85; P = 2 x 10(-11); ncases = 98,742 and ncontrols = 409,511). Using an En1cre/flox mouse model, we observed that conditional loss of En1 results in low bone mass, probably as a consequence of high bone turnover. We also identified a novel low frequency non-coding variant with large effects on BMD near WNT16 (rs148771817(T), MAF = 1.2%, replication effect size +10.41 s.d., P-meta = 1 x 10(-11)). In general, there was an excess of association signals arising from deleterious coding and conserved non-coding variants. These findings provide evidence that low-frequency non-coding variants have large effects on BMD and fracture, thereby providing rationale for whole-genome sequencing and improved imputation reference panels to study the genetic architecture of complex traits and disease in the general population.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-112272 (URN)10.1038/nature14878 (DOI)000362095100044 ()26367794 (PubMedID)
Available from: 2015-12-08 Created: 2015-12-04 Last updated: 2018-08-31Bibliographically approved
Oei, L., Hsu, Y.-H., Styrkarsdottir, U., Eussen, B. H., de Klein, A., Peters, M. J., . . . Estrada, K. (2014). A genome-wide copy number association study of osteoporotic fractures points to the 6p25.1 locus. Journal of Medical Genetics, 51(2), 122-131
Open this publication in new window or tab >>A genome-wide copy number association study of osteoporotic fractures points to the 6p25.1 locus
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2014 (English)In: Journal of Medical Genetics, ISSN 0022-2593, E-ISSN 1468-6244, Vol. 51, no 2, p. 122-131Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Osteoporosis is a systemic skeletal disease characterised by reduced bone mineral density and increased susceptibility to fracture; these traits are highly heritable. Both common and rare copy number variants (CNVs) potentially affect the function of genes and may influence disease risk.

AIM: To identify CNVs associated with osteoporotic bone fracture risk.

METHOD: We performed a genome-wide CNV association study in 5178 individuals from a prospective cohort in the Netherlands, including 809 osteoporotic fracture cases, and performed in silico lookups and de novo genotyping to replicate in several independent studies.

RESULTS: A rare (population prevalence 0.14%, 95% CI 0.03% to 0.24%) 210 kb deletion located on chromosome 6p25.1 was associated with the risk of fracture (OR 32.58, 95% CI 3.95 to 1488.89; p=8.69×10(-5)). We performed an in silico meta-analysis in four studies with CNV microarray data and the association with fracture risk was replicated (OR 3.11, 95% CI 1.01 to 8.22; p=0.02). The prevalence of this deletion showed geographic diversity, being absent in additional samples from Australia, Canada, Poland, Iceland, Denmark, and Sweden, but present in the Netherlands (0.34%), Spain (0.33%), USA (0.23%), England (0.15%), Scotland (0.10%), and Ireland (0.06%), with insufficient evidence for association with fracture risk.

CONCLUSIONS: These results suggest that deletions in the 6p25.1 locus may predispose to higher risk of fracture in a subset of populations of European origin; larger and geographically restricted studies will be needed to confirm this regional association. This is a first step towards the evaluation of the role of rare CNVs in osteoporosis.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2014
Keywords
Osteoporosis, Copy-Number, Calcium and Bone, Genetic Epidemiology, Genome-Wide
National Category
Orthopaedics Medical Genetics Genetics
Identifiers
urn:nbn:se:umu:diva-84732 (URN)10.1136/jmedgenet-2013-102064 (DOI)000331191300008 ()24343915 (PubMedID)
Available from: 2014-01-17 Created: 2014-01-17 Last updated: 2018-06-08Bibliographically approved
Nilsson Sommar, J., Pettersson-Kymmer, U., Lundh, T., Svensson, O., Hallmans, G. & Bergdahl, I. A. (2014). Hip Fracture Risk and Cadmium in Erythrocytes: A Nested Case-Control Study with Prospectively Collected Samples. Calcified Tissue International, 94(2), 183-190
Open this publication in new window or tab >>Hip Fracture Risk and Cadmium in Erythrocytes: A Nested Case-Control Study with Prospectively Collected Samples
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2014 (English)In: Calcified Tissue International, ISSN 0171-967X, E-ISSN 1432-0827, Vol. 94, no 2, p. 183-190Article in journal (Refereed) Published
Abstract [en]

Several studies have investigated the relation between bone mass density and cadmium exposure, but only few studies have been performed on fractures and biomarkers of cadmium. This study analyzed the association between hip fracture risk and cadmium in erythrocytes (Ery-Cd). Prospective samples from the Northern Sweden Health and Disease Study's biobank were used for 109 individuals who later in life had sustained a low-trauma hip fracture, matched with two controls of the same age and gender. The mean concentration of Ery-Cd (±SD) in case samples was 1.3 ± 1.4 versus 0.9 ± 1.0 μg/L in controls. The odds ratio (OR) was 1.63 [95 % confidence interval (CI) 1.10-2.42] for suffering a hip fracture for each microgram per liter increase in Ery-Cd. However, when taking smoking into consideration (never, former, or current), neither Ery-Cd nor smoking showed a statistically significant increase in fracture risk. Using multiple conditional logistic regression with BMI, height, and smoking, the estimated OR for a 1-μg/L increase in Ery-Cd was 1.52 (95 % CI 0.77-2.97). Subgroup analysis showed an increased fracture risk among women (OR = 1.94, 95 % CI 1.18-3.20, for a 1 μg/L increase), which also remained in the multiple analysis (OR = 3.33, 95 % CI 1.29-8.56). This study shows that fracture risk is associated with Ery-Cd. It is, however, not possible to draw firm conclusions on whether cadmium is the causal factor or whether other smoking-related factors cause this association. Subgroup analysis shows that cadmium is a risk factor for hip fracture among women.

Place, publisher, year, edition, pages
Springer, 2014
Keywords
Cadmium, Environmental exposure, Heavy metal, Hip fracture, Prospective
National Category
Clinical Medicine Occupational Health and Environmental Health Orthopaedics
Identifiers
urn:nbn:se:umu:diva-84733 (URN)10.1007/s00223-013-9796-5 (DOI)000330827700007 ()24101229 (PubMedID)
Funder
Swedish Research Council Formas, 2005-875Swedish Research Council, K2006-72X-20155013EU, European Research Council, FOOD-CT-2006-016253
Available from: 2014-01-17 Created: 2014-01-17 Last updated: 2018-06-08Bibliographically approved
Haney, M., Löfvenberg, R. & Svensson, O. (2014). Optimize perioperative health and begin with insistence on pre-operative smoking cessation. Acta Anaesthesiologica Scandinavica, 58(2), 133-134
Open this publication in new window or tab >>Optimize perioperative health and begin with insistence on pre-operative smoking cessation
2014 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 2, p. 133-134Article in journal, Editorial material (Other academic) Published
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-86823 (URN)10.1111/aas.12242 (DOI)000330633200001 ()
Available from: 2014-03-18 Created: 2014-03-11 Last updated: 2018-06-08Bibliographically approved
Englund, U., Nordström, P., Nilsson, J., Hallmans, G., Svensson, O., Bergström, U. & Pettersson Kymmer, U. (2013). Active commuting reduces the risk of wrist fractures in middle-aged women: the UFO study. Osteoporosis International, 24(2), 533-540
Open this publication in new window or tab >>Active commuting reduces the risk of wrist fractures in middle-aged women: the UFO study
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2013 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 24, no 2, p. 533-540Article in journal (Refereed) Published
Abstract [en]

Middle-aged women with active commuting had significantly lower risk for wrist fracture than women commuting by car/bus.

INTRODUCTION: Our purpose was to investigate whether a physically active lifestyle in middle-aged women was associated with a reduced risk of later sustaining a low-trauma wrist fracture.

METHODS: The Umeå Fracture and Osteoporosis (UFO) study is a population-based nested case-control study investigating associations between lifestyle and fragility fractures. From a cohort of ~35,000 subjects, we identified 376 female wrist fracture cases who had reported data regarding their commuting habits, occupational, and leisure physical activity, before they sustained their fracture. Each fracture case was compared with at least one control drawn from the same cohort and matched for age and week of reporting data, yielding a total of 778 subjects. Mean age at baseline was 54.3 ± 5.8 years, and mean age at fracture was 60.3 ± 5.8 years.

RESULTS: Conditional logistic regression analysis with adjustments for height, body mass index, smoking, and menopausal status showed that subjects with active commuting (especially walking) were at significantly lower risk of sustaining a wrist fracture (OR 0.48; 95 % CI 0.27-0.88) compared with those who commuted by car or bus. Leisure time activities such as dancing and snow shoveling were also associated with a lower fracture risk, whereas occupational activity, training, and leisure walking or cycling were unrelated to fracture risk.

CONCLUSION: This study suggests that active commuting is associated with a lower wrist fracture risk, in middle-aged women.

Place, publisher, year, edition, pages
Springer, 2013
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-29829 (URN)10.1007/s00198-012-1988-8 (DOI)000314274400015 ()22525983 (PubMedID)
Available from: 2009-11-25 Created: 2009-11-24 Last updated: 2018-06-08Bibliographically approved
Crnalic, S., Hildingsson, C., Bergh, A., Widmark, A., Svensson, O. & Löfvenberg, R. (2013). Early diagnosis and treatment is crucial for neurological recovery after surgery for metastatic spinal cord compression in prostate cancer. Acta Oncologica, 52(4), 809-815
Open this publication in new window or tab >>Early diagnosis and treatment is crucial for neurological recovery after surgery for metastatic spinal cord compression in prostate cancer
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2013 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 52, no 4, p. 809-815Article in journal (Refereed) Published
Abstract [en]

Background. Spinal cord compression is an oncological and surgical emergency. Delays in referral and diagnosis may influence functional outcome. It is therefore important to identify patients who will regain or maintain ability to walk after surgery. The aim of the present study was to examine current practice for referral and diagnosis of prostate cancer patients with spinal cord compression and to identify prognostic factors for neurological outcome after surgery.

Patients and methods. The study includes 68 consecutive patients with prostate cancer who underwent surgery due to neurological compromise.  Intervals from onset of neurological symptoms to referral, diagnosis, and treatment were analyzed in relation to functional outcome. The prognostic significance of preoperative clinical parameters on gait function one month after surgery was evaluated.

Results. Patients who were referred from local hospitals had longer delay to surgery than those who directly presented to the cancer centre (p=0.004). The rate of diagnosis with MRI increased through the week and peaked on Friday, with few patients being diagnosed during weekends. Ability to walk before surgery, hormone-naive prostate cancer, and/or shorter time from loss of ambulation were associated with more favorable neurological outcome. In patients with hormone-refractory disease who were unable to walk before surgery regaining of ambulation was associated with: duration of paresis <48 hours (p=0.005), good preoperative performance status (p=0.04), preoperative PSA serum level <200 ng/ml (p=0.03), and surgery with posterior decompression and stabilization (p=0.03).

Conclusion. Early diagnosis and rapid treatment of spinal cord compression in prostate cancer patients is crucial for neurological recovery. Rising of awareness for the condition among patients at risk and among physicians is mandatory as well as improvement of local and regional guidelines for treatment.

Place, publisher, year, edition, pages
London: Informa Healthcare, 2013
Keywords
surgical management, prognostic factors, survival, time, complications, deficit, audit, care
National Category
Orthopaedics Cancer and Oncology
Research subject
Orthopaedics; Oncology
Identifiers
urn:nbn:se:umu:diva-54460 (URN)10.3109/0284186X.2012.705437 (DOI)000317239200016 ()
Available from: 2012-04-27 Created: 2012-04-26 Last updated: 2018-06-08Bibliographically approved
Benetou, V., Orfanos, P., Pettersson-Kymmer, U., Bergström, U., Svensson, O., Johansson, I., . . . Trichopoulou, A. (2013). Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporosis International, 24(5), 1587-1598
Open this publication in new window or tab >>Mediterranean diet and incidence of hip fractures in a European cohort
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2013 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 24, no 5, p. 1587-1598Article in journal (Refereed) Published
Abstract [en]

Prevention of hip fractures is of critical public health importance. In a cohort of adults from eight European countries, evidence was found that increased adherence to Mediterranean diet, measured by a 10-unit dietary score, is associated with reduced hip fracture incidence, particularly among men. INTRODUCTION: Evidence on the role of dietary patterns on hip fracture incidence is scarce. We explored the association of adherence to Mediterranean diet (MD) with hip fracture incidence in a cohort from eight European countries. METHODS: A total of 188,795 eligible participants (48,814 men and 139,981 women) in the European Prospective Investigation into Cancer and nutrition study with mean age 48.6 years (±10.8) were followed for a median of 9 years, and 802 incident hip fractures were recorded. Diet was assessed at baseline through validated dietary instruments. Adherence to MD was evaluated by a MD score (MDs), on a 10-point scale, in which monounsaturated were substituted with unsaturated lipids. Association with hip fracture incidence was assessed through Cox regression with adjustment for potential confounders. RESULTS: Increased adherence to MD was associated with a 7 % decrease in hip fracture incidence [hazard ratio (HR) per 1-unit increase in the MDs 0.93; 95 % confidence interval (95 % CI) = 0.89-0.98]. This association was more evident among men and somewhat stronger among older individuals. Using increments close to one standard deviation of daily intake, in the overall sample, high vegetable (HR = 0.86; 95 % CI = 0.79-0.94) and high fruit (HR = 0.89; 95 % CI = 0.82-0.97) intake was associated with decreased hip fracture incidence, whereas high meat intake (HR = 1.18; 95 % CI = 1.06-1.31) with increased incidence. Excessive ethanol consumption (HR high versus moderate = 1.74; 95 % CI = 1.32-2.31) was also a risk factor. CONCLUSIONS: In a prospective study of adults, increased adherence to MD appears to protect against hip fracture occurrence, particularly among men.

Place, publisher, year, edition, pages
Springer London, 2013
Keywords
A priori methods, Bone health, Diet, Dietary patterns, Hip fractures, Mediterranean diet
National Category
Endocrinology and Diabetes Orthopaedics
Research subject
Medicine; Orthopaedics
Identifiers
urn:nbn:se:umu:diva-60746 (URN)10.1007/s00198-012-2187-3 (DOI)000318280100006 ()23085859 (PubMedID)
Funder
EU, European Research Council
Available from: 2012-10-24 Created: 2012-10-24 Last updated: 2018-06-08Bibliographically approved
Estrada, K., Styrkarsdottir, U., Evangelou, E., Hsu, Y.-H., Duncan, E. L., Ntzani, E. E., . . . Rivadeneira, F. (2012). Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture. Nature Genetics, 44, 491-501
Open this publication in new window or tab >>Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture
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2012 (English)In: Nature Genetics, ISSN 1061-4036, E-ISSN 1546-1718, Vol. 44, p. 491-501Article in journal (Refereed) Published
Abstract [en]

Bone mineral density (BMD) is the most widely used predictor of fracture risk. We performed the largest meta-analysis to date on lumbar spine and femoral neck BMD, including 17 genome-wide association studies and 32,961 individuals of European and east Asian ancestry. We tested the top BMD-associated markers for replication in 50,933 independent subjects and for association with risk of low-trauma fracture in 31,016 individuals with a history of fracture (cases) and 102,444 controls. We identified 56 loci (32 new) associated with BMD at genome-wide significance (P < 5 × 10(-8)). Several of these factors cluster within the RANK-RANKL-OPG, mesenchymal stem cell differentiation, endochondral ossification and Wnt signaling pathways. However, we also discovered loci that were localized to genes not known to have a role in bone biology. Fourteen BMD-associated loci were also associated with fracture risk (P < 5 × 10(-4), Bonferroni corrected), of which six reached P < 5 × 10(-8), including at 18p11.21 (FAM210A), 7q21.3 (SLC25A13), 11q13.2 (LRP5), 4q22.1 (MEPE), 2p16.2 (SPTBN1) and 10q21.1 (DKK1). These findings shed light on the genetic architecture and pathophysiological mechanisms underlying BMD variation and fracture susceptibility.

Place, publisher, year, edition, pages
Nature Publishing Group, 2012
National Category
Medical Genetics
Research subject
Genetics; Orthopaedics
Identifiers
urn:nbn:se:umu:diva-54103 (URN)10.1038/ng.2249 (DOI)22504420 (PubMedID)
Note

Published online 15 April 2012

Available from: 2012-04-17 Created: 2012-04-17 Last updated: 2018-06-08Bibliographically approved
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