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Erschienen in: European Journal of Trauma and Emergency Surgery 6/2011

01.12.2011 | Original Article

Effects on the ubiquitin proteasome system after closed soft-tissue trauma in rat skeletal muscle

verfasst von: N. Ponelies, D. Gosenca, N. Ising, M. Schoen, K. Ruppel, B. Vollmar, U. Obertacke

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 6/2011

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Abstract

Previous studies have suggested that an increased catabolic stage of skeletal muscle in pathological situations is mainly a reflection of ubiquitin–proteasome system-controlled proteolysis. The proteolytic mechanisms that occur after local muscle trauma are poorly defined. We investigated the effects of closed soft-tissue trauma on ubiquitin–proteasome dependent protein breakdown in rats (n = 25). The enzymatic activities of the ubiquitination and proteasome reactions were both reduced (p < 0.05) immediately after contusion of the hind limb musculus extensor digitorum longus. The same effect was observed in extracts of lung tissue from the injured animals. Cellular levels of free and protein-conjugated ubiquitin were significantly elevated upon decreased proteolytic activity. Our data support an early-state anti-proteolytic role of the ubiquitin–proteasome pathway after local injury. This further implies that there is a yet-to-be elucidated complex regulatory mechanism of muscle regeneration that involves various proteolytic systems.
Literatur
1.
Zurück zum Zitat Medina R, Wing SS, Goldberg AL. Increase in levels of polyubiquitin and proteasome mRNA in skeletal muscle during starvation and denervation atrophy. Biochem J. 1995;307(Pt 3):631–7.PubMed Medina R, Wing SS, Goldberg AL. Increase in levels of polyubiquitin and proteasome mRNA in skeletal muscle during starvation and denervation atrophy. Biochem J. 1995;307(Pt 3):631–7.PubMed
2.
Zurück zum Zitat Song XM, Ryder JW, Kawano Y, Chibalin AV, Krook A, Zierath JR. Muscle fiber type specificity in insulin signal transduction. Am J Physiol. 1999;277:R1690–6.PubMed Song XM, Ryder JW, Kawano Y, Chibalin AV, Krook A, Zierath JR. Muscle fiber type specificity in insulin signal transduction. Am J Physiol. 1999;277:R1690–6.PubMed
3.
Zurück zum Zitat Goldberg AL, Tischler M, DeMartino G, Griffin G. Hormonal regulation of protein degradation and synthesis in skeletal muscle. Fed Proc. 1980;39:31–6.PubMed Goldberg AL, Tischler M, DeMartino G, Griffin G. Hormonal regulation of protein degradation and synthesis in skeletal muscle. Fed Proc. 1980;39:31–6.PubMed
4.
Zurück zum Zitat Li JB, Goldberg AL. Effects of food deprivation on protein synthesis and degradation in rat skeletal muscles. Am J Physiol. 1976;231:441–8.PubMed Li JB, Goldberg AL. Effects of food deprivation on protein synthesis and degradation in rat skeletal muscles. Am J Physiol. 1976;231:441–8.PubMed
5.
Zurück zum Zitat Reid MB. Response of the ubiquitin–proteasome pathway to changes in muscle activity. Am J Physiol Regul Integr Comp Physiol. 2005;288:R1423–31.PubMedCrossRef Reid MB. Response of the ubiquitin–proteasome pathway to changes in muscle activity. Am J Physiol Regul Integr Comp Physiol. 2005;288:R1423–31.PubMedCrossRef
6.
Zurück zum Zitat Sugden PH, Fuller SJ. Regulation of protein turnover in skeletal and cardiac muscle. Biochem J. 1991;273(Pt 1):21–37.PubMed Sugden PH, Fuller SJ. Regulation of protein turnover in skeletal and cardiac muscle. Biochem J. 1991;273(Pt 1):21–37.PubMed
7.
Zurück zum Zitat Lecker SH, Solomon V, Mitch WE, Goldberg AL. Muscle protein breakdown and the critical role of the ubiquitin–proteasome pathway in normal and disease states. J Nutr. 1999;129:227S–37S.PubMed Lecker SH, Solomon V, Mitch WE, Goldberg AL. Muscle protein breakdown and the critical role of the ubiquitin–proteasome pathway in normal and disease states. J Nutr. 1999;129:227S–37S.PubMed
8.
Zurück zum Zitat Mitch WE, Goldberg AL. Mechanisms of muscle wasting. The role of the ubiquitin–proteasome pathway. N Engl J Med. 1996;335:1897–905.PubMedCrossRef Mitch WE, Goldberg AL. Mechanisms of muscle wasting. The role of the ubiquitin–proteasome pathway. N Engl J Med. 1996;335:1897–905.PubMedCrossRef
9.
Zurück zum Zitat Hasselgren PO, Menconi MJ, Fareed MU, Yang H, Wei W, Evenson A. Novel aspects on the regulation of muscle wasting in sepsis. Int J Biochem Cell Biol. 2005;37:2156–68.PubMedCrossRef Hasselgren PO, Menconi MJ, Fareed MU, Yang H, Wei W, Evenson A. Novel aspects on the regulation of muscle wasting in sepsis. Int J Biochem Cell Biol. 2005;37:2156–68.PubMedCrossRef
10.
Zurück zum Zitat Hasselgren PO, Wray C, Mammen J. Molecular regulation of muscle cachexia: it may be more than the proteasome. Biochem Biophys Res Commun. 2002;290:1–10.PubMedCrossRef Hasselgren PO, Wray C, Mammen J. Molecular regulation of muscle cachexia: it may be more than the proteasome. Biochem Biophys Res Commun. 2002;290:1–10.PubMedCrossRef
11.
Zurück zum Zitat Khal J, Wyke SM, Russell ST, Hine AV, Tisdale MJ. Expression of the ubiquitin–proteasome pathway and muscle loss in experimental cancer cachexia. Br J Cancer. 2005;93:774–80.PubMedCrossRef Khal J, Wyke SM, Russell ST, Hine AV, Tisdale MJ. Expression of the ubiquitin–proteasome pathway and muscle loss in experimental cancer cachexia. Br J Cancer. 2005;93:774–80.PubMedCrossRef
12.
Zurück zum Zitat Lecker SH, Jagoe RT, Gilbert A, Gomes M, Baracos V, Bailey J, et al. Multiple types of skeletal muscle atrophy involve a common program of changes in gene expression. FASEB J. 2004;18:39–51.PubMedCrossRef Lecker SH, Jagoe RT, Gilbert A, Gomes M, Baracos V, Bailey J, et al. Multiple types of skeletal muscle atrophy involve a common program of changes in gene expression. FASEB J. 2004;18:39–51.PubMedCrossRef
13.
Zurück zum Zitat Voisin L, Breuille D, Combaret L, Pouyet C, Taillandier D, Aurousseau E, et al. Muscle wasting in a rat model of long-lasting sepsis results from the activation of lysosomal, Ca2+-activated, and ubiquitin–proteasome proteolytic pathways. J Clin Invest. 1996;97:1610–7.PubMedCrossRef Voisin L, Breuille D, Combaret L, Pouyet C, Taillandier D, Aurousseau E, et al. Muscle wasting in a rat model of long-lasting sepsis results from the activation of lysosomal, Ca2+-activated, and ubiquitin–proteasome proteolytic pathways. J Clin Invest. 1996;97:1610–7.PubMedCrossRef
14.
Zurück zum Zitat Tisdale MJ. The ubiquitin–proteasome pathway as a therapeutic target for muscle wasting. J Support Oncol. 2005;3:209–17.PubMed Tisdale MJ. The ubiquitin–proteasome pathway as a therapeutic target for muscle wasting. J Support Oncol. 2005;3:209–17.PubMed
15.
Zurück zum Zitat Attaix D, Ventadour S, Codran A, Bechet D, Taillandier D, Combaret L. The ubiquitin–proteasome system and skeletal muscle wasting. Essays Biochem. 2005;41:173–86.PubMedCrossRef Attaix D, Ventadour S, Codran A, Bechet D, Taillandier D, Combaret L. The ubiquitin–proteasome system and skeletal muscle wasting. Essays Biochem. 2005;41:173–86.PubMedCrossRef
16.
Zurück zum Zitat Lecker SH, Goldberg AL, Mitch WE. Protein degradation by the ubiquitin–proteasome pathway in normal and disease states. J Am Soc Nephrol. 2006;17:1807–19.PubMedCrossRef Lecker SH, Goldberg AL, Mitch WE. Protein degradation by the ubiquitin–proteasome pathway in normal and disease states. J Am Soc Nephrol. 2006;17:1807–19.PubMedCrossRef
17.
Zurück zum Zitat Larbaud D, Balage M, Taillandier D, Combaret L, Grizard J, Attaix D. Differential regulation of the lysosomal, Ca2+-dependent and ubiquitin/proteasome-dependent proteolytic pathways in fast-twitch and slow-twitch rat muscle following hyperinsulinaemia. Clin Sci (Lond). 2001;101:551–8.CrossRef Larbaud D, Balage M, Taillandier D, Combaret L, Grizard J, Attaix D. Differential regulation of the lysosomal, Ca2+-dependent and ubiquitin/proteasome-dependent proteolytic pathways in fast-twitch and slow-twitch rat muscle following hyperinsulinaemia. Clin Sci (Lond). 2001;101:551–8.CrossRef
18.
Zurück zum Zitat Lee SW, Dai G, Hu Z, Wang X, Du J, Mitch WE. Regulation of muscle protein degradation: coordinated control of apoptotic and ubiquitin–proteasome systems by phosphatidylinositol 3 kinase. J Am Soc Nephrol. 2004;15:1537–45.PubMedCrossRef Lee SW, Dai G, Hu Z, Wang X, Du J, Mitch WE. Regulation of muscle protein degradation: coordinated control of apoptotic and ubiquitin–proteasome systems by phosphatidylinositol 3 kinase. J Am Soc Nephrol. 2004;15:1537–45.PubMedCrossRef
19.
Zurück zum Zitat Dixon CE, Clifton GL, Lighthall JW, Yaghmai AA, Hayes RL. A controlled cortical impact model of traumatic brain injury in the rat. J Neurosci Methods. 1991;39:253–62.PubMedCrossRef Dixon CE, Clifton GL, Lighthall JW, Yaghmai AA, Hayes RL. A controlled cortical impact model of traumatic brain injury in the rat. J Neurosci Methods. 1991;39:253–62.PubMedCrossRef
20.
Zurück zum Zitat Schaser KD, Vollmar B, Menger MD, Schewior L, Kroppenstedt SN, Raschke M, et al. In vivo analysis of microcirculation following closed soft-tissue injury. J Orthop Res. 1999;17:678–85.PubMedCrossRef Schaser KD, Vollmar B, Menger MD, Schewior L, Kroppenstedt SN, Raschke M, et al. In vivo analysis of microcirculation following closed soft-tissue injury. J Orthop Res. 1999;17:678–85.PubMedCrossRef
21.
Zurück zum Zitat Tscherne H, Oestern HJ. A new classification of soft-tissue damage in open and closed fractures (author’s transl). Unfallheilkunde. 1982;85:111–5.PubMed Tscherne H, Oestern HJ. A new classification of soft-tissue damage in open and closed fractures (author’s transl). Unfallheilkunde. 1982;85:111–5.PubMed
22.
Zurück zum Zitat Ponelies N, Hirsch T, Krehmeier U, Denz C, Patel MB, Majetschak M. Cytosolic ubiquitin and ubiquitylation rates in human peripheral blood mononuclear cells during sepsis. Shock. 2005;24:20–5.PubMedCrossRef Ponelies N, Hirsch T, Krehmeier U, Denz C, Patel MB, Majetschak M. Cytosolic ubiquitin and ubiquitylation rates in human peripheral blood mononuclear cells during sepsis. Shock. 2005;24:20–5.PubMedCrossRef
23.
Zurück zum Zitat Majetschak M, Ponelies N, Hirsch T. Targeting the monocytic ubiquitin system with extracellular ubiquitin. Immunol Cell Biol. 2006;84:59–65.PubMedCrossRef Majetschak M, Ponelies N, Hirsch T. Targeting the monocytic ubiquitin system with extracellular ubiquitin. Immunol Cell Biol. 2006;84:59–65.PubMedCrossRef
24.
Zurück zum Zitat Schaser KD, Bail HJ, Schewior L, Stover JF, Melcher I, Haas NP, Mittlmeier T. Acute effects of N-acetylcysteine on skeletal muscle microcirculation following closed soft tissue trauma in rats. J Orthop Res. 2005;23:231–41.PubMedCrossRef Schaser KD, Bail HJ, Schewior L, Stover JF, Melcher I, Haas NP, Mittlmeier T. Acute effects of N-acetylcysteine on skeletal muscle microcirculation following closed soft tissue trauma in rats. J Orthop Res. 2005;23:231–41.PubMedCrossRef
25.
Zurück zum Zitat Kessler BM, Tortorella D, Altun M, Kisselev AF, Fiebiger E, Hekking BG, et al. Extended peptide-based inhibitors efficiently target the proteasome and reveal overlapping specificities of the catalytic beta-subunits. Chem Biol. 2001;8:913–29.PubMedCrossRef Kessler BM, Tortorella D, Altun M, Kisselev AF, Fiebiger E, Hekking BG, et al. Extended peptide-based inhibitors efficiently target the proteasome and reveal overlapping specificities of the catalytic beta-subunits. Chem Biol. 2001;8:913–29.PubMedCrossRef
26.
Zurück zum Zitat Meng L, Mohan R, Kwok BH, Elofsson M, Sin N, Crews CM. Epoxomicin, a potent and selective proteasome inhibitor, exhibits in vivo antiinflammatory activity. Proc Natl Acad Sci USA. 1999;96:10403–8.PubMedCrossRef Meng L, Mohan R, Kwok BH, Elofsson M, Sin N, Crews CM. Epoxomicin, a potent and selective proteasome inhibitor, exhibits in vivo antiinflammatory activity. Proc Natl Acad Sci USA. 1999;96:10403–8.PubMedCrossRef
27.
Zurück zum Zitat Hobler SC, Williams A, Fischer D, Wang JJ, Sun X, Fischer JE, et al. Activity and expression of the 20S proteasome are increased in skeletal muscle during sepsis. Am J Physiol. 1999;277:R434–40.PubMed Hobler SC, Williams A, Fischer D, Wang JJ, Sun X, Fischer JE, et al. Activity and expression of the 20S proteasome are increased in skeletal muscle during sepsis. Am J Physiol. 1999;277:R434–40.PubMed
28.
Zurück zum Zitat Mitch WE, Bailey JL, Wang X, Jurkovitz C, Newby D, Price SR. Evaluation of signals activating ubiquitin–proteasome proteolysis in a model of muscle wasting. Am J Physiol. 1999;276:C1132–8.PubMed Mitch WE, Bailey JL, Wang X, Jurkovitz C, Newby D, Price SR. Evaluation of signals activating ubiquitin–proteasome proteolysis in a model of muscle wasting. Am J Physiol. 1999;276:C1132–8.PubMed
29.
Zurück zum Zitat Jagoe RT, Goldberg AL. What do we really know about the ubiquitin–proteasome pathway in muscle atrophy? Curr Opin Clin Nutr Metab Care. 2001;4:183–90.PubMedCrossRef Jagoe RT, Goldberg AL. What do we really know about the ubiquitin–proteasome pathway in muscle atrophy? Curr Opin Clin Nutr Metab Care. 2001;4:183–90.PubMedCrossRef
30.
Zurück zum Zitat Mansoor O, Beaufrere B, Boirie Y, Ralliere C, Taillandier D, Aurousseau E, et al. Increased mRNA levels for components of the lysosomal, Ca2+-activated, and ATP-ubiquitin-dependent proteolytic pathways in skeletal muscle from head trauma patients. Proc Natl Acad Sci USA. 1996;93:2714–8.PubMedCrossRef Mansoor O, Beaufrere B, Boirie Y, Ralliere C, Taillandier D, Aurousseau E, et al. Increased mRNA levels for components of the lysosomal, Ca2+-activated, and ATP-ubiquitin-dependent proteolytic pathways in skeletal muscle from head trauma patients. Proc Natl Acad Sci USA. 1996;93:2714–8.PubMedCrossRef
31.
Zurück zum Zitat Fang CH, Li BG, James JH, King JK, Evenson AR, Warden GD, Hasselgren PO. Protein breakdown in muscle from burned rats is blocked by insulin-like growth factor i and glycogen synthase kinase-3β inhibitors. Endocrinology. 2005;146:3141–9.PubMedCrossRef Fang CH, Li BG, James JH, King JK, Evenson AR, Warden GD, Hasselgren PO. Protein breakdown in muscle from burned rats is blocked by insulin-like growth factor i and glycogen synthase kinase-3β inhibitors. Endocrinology. 2005;146:3141–9.PubMedCrossRef
32.
Zurück zum Zitat Seiffert M, Gosenca D, Ponelies N, Ising N, Patel MB, Obertacke U, Majetschak M. Regulation of the ubiquitin proteasome system in mechanically injured human skeletal muscle. Physiol Res. 2007;56:227–33.PubMed Seiffert M, Gosenca D, Ponelies N, Ising N, Patel MB, Obertacke U, Majetschak M. Regulation of the ubiquitin proteasome system in mechanically injured human skeletal muscle. Physiol Res. 2007;56:227–33.PubMed
33.
Zurück zum Zitat Fisher BD, Baracos VE, Shnitka TK, Mendryk SW, Reid DC. Ultrastructural events following acute muscle trauma. Med Sci Sports Exerc. 1990;22:185–93.PubMed Fisher BD, Baracos VE, Shnitka TK, Mendryk SW, Reid DC. Ultrastructural events following acute muscle trauma. Med Sci Sports Exerc. 1990;22:185–93.PubMed
34.
Zurück zum Zitat Fisher BD, Rathgaber M. An overview of muscle regeneration following acute injury. J Phys Ther Sci. 2006;18:57–66.CrossRef Fisher BD, Rathgaber M. An overview of muscle regeneration following acute injury. J Phys Ther Sci. 2006;18:57–66.CrossRef
35.
Zurück zum Zitat Gierer P, Vollmar B, Schaser KD, Andreas C, Gradl G, Mittlmeier T. Efficiency of small-volume resuscitation in restoration of disturbed skeletal muscle microcirculation after soft-tissue trauma and haemorrhagic shock. Langenbecks Arch Surg. 2004;389:40–5.PubMedCrossRef Gierer P, Vollmar B, Schaser KD, Andreas C, Gradl G, Mittlmeier T. Efficiency of small-volume resuscitation in restoration of disturbed skeletal muscle microcirculation after soft-tissue trauma and haemorrhagic shock. Langenbecks Arch Surg. 2004;389:40–5.PubMedCrossRef
36.
Zurück zum Zitat Tjader I, Essen P, Garlick PJ, McMnurlan MA, Rooyackers O, Wernerman J. Impact of surgical trauma on human skeletal muscle protein synthesis. Clin Sci (Lond). 2004;107:601–7.CrossRef Tjader I, Essen P, Garlick PJ, McMnurlan MA, Rooyackers O, Wernerman J. Impact of surgical trauma on human skeletal muscle protein synthesis. Clin Sci (Lond). 2004;107:601–7.CrossRef
37.
Zurück zum Zitat Luo JL, Hammarqvist F, Andersson K, Wernerman J. Surgical trauma decreases glutathione synthetic capacity in human skeletal muscle tissue. Am J Physiol. 1998;275:E359–65.PubMed Luo JL, Hammarqvist F, Andersson K, Wernerman J. Surgical trauma decreases glutathione synthetic capacity in human skeletal muscle tissue. Am J Physiol. 1998;275:E359–65.PubMed
38.
Zurück zum Zitat Farges MC, Balcerzak D, Fisher BD, Attaix D, Bechet D, Ferrara M, Baracos VE. Increased muscle proteolysis after local trauma mainly reflects macrophage-associated lysosomal proteolysis. Am J Physiol Endocrinol Metab. 2002;282:E326–35.PubMed Farges MC, Balcerzak D, Fisher BD, Attaix D, Bechet D, Ferrara M, Baracos VE. Increased muscle proteolysis after local trauma mainly reflects macrophage-associated lysosomal proteolysis. Am J Physiol Endocrinol Metab. 2002;282:E326–35.PubMed
39.
Zurück zum Zitat Tawa NE Jr, Odessey R, Goldberg AL. Inhibitors of the proteasome reduce the accelerated proteolysis in atrophying rat skeletal muscles. J Clin Invest. 1997;100:197–203.PubMedCrossRef Tawa NE Jr, Odessey R, Goldberg AL. Inhibitors of the proteasome reduce the accelerated proteolysis in atrophying rat skeletal muscles. J Clin Invest. 1997;100:197–203.PubMedCrossRef
40.
Zurück zum Zitat Zhu Q, Wani G, Wang QE, El-mahdy M, Snapka RM, Wani AA. Deubiquitination by proteasome is coordinated with substrate translocation for proteolysis in vivo. Exp Cell Res. 2005;307:436–51.PubMedCrossRef Zhu Q, Wani G, Wang QE, El-mahdy M, Snapka RM, Wani AA. Deubiquitination by proteasome is coordinated with substrate translocation for proteolysis in vivo. Exp Cell Res. 2005;307:436–51.PubMedCrossRef
41.
Zurück zum Zitat Kim JH, Park KC, Chung SS, Bang O, Chung CH. Deubiquitinating enzymes as cellular regulators. J Biochem (Tokyo). 2003;134:9–18.CrossRef Kim JH, Park KC, Chung SS, Bang O, Chung CH. Deubiquitinating enzymes as cellular regulators. J Biochem (Tokyo). 2003;134:9–18.CrossRef
42.
Zurück zum Zitat Combaret L, Adegoke OA, Bedard N, Baracos V, Attaix D, Wing SS. USP19 is a ubiquitin-specific protease regulated in rat skeletal muscle during catabolic states. Am J Physiol Endocrinol Metab. 2005;288:E693–700.PubMedCrossRef Combaret L, Adegoke OA, Bedard N, Baracos V, Attaix D, Wing SS. USP19 is a ubiquitin-specific protease regulated in rat skeletal muscle during catabolic states. Am J Physiol Endocrinol Metab. 2005;288:E693–700.PubMedCrossRef
43.
Zurück zum Zitat Fuster G, Busquets S, Almendro V, Lopez-Soriano FJ, Argiles JM. Antiproteolytic effects of plasma from hibernating bears: a new approach for muscle wasting therapy? Clin Nutr. 2007;26:658–61.PubMedCrossRef Fuster G, Busquets S, Almendro V, Lopez-Soriano FJ, Argiles JM. Antiproteolytic effects of plasma from hibernating bears: a new approach for muscle wasting therapy? Clin Nutr. 2007;26:658–61.PubMedCrossRef
44.
Zurück zum Zitat Fielding RA, Manfredi TJ, Ding W, Fiatarone MA, Evans WJ, Cannon JG. Acute phase response in exercise. III. Neutrophil and IL-1 beta accumulation in skeletal muscle. Am J Physiol. 1993;265:R166–72.PubMed Fielding RA, Manfredi TJ, Ding W, Fiatarone MA, Evans WJ, Cannon JG. Acute phase response in exercise. III. Neutrophil and IL-1 beta accumulation in skeletal muscle. Am J Physiol. 1993;265:R166–72.PubMed
45.
Zurück zum Zitat Tidball JG, Berchenko E, Frenette J. Macrophage invasion does not contribute to muscle membrane injury during inflammation. J Leukoc Biol. 1999;65:492–8.PubMed Tidball JG, Berchenko E, Frenette J. Macrophage invasion does not contribute to muscle membrane injury during inflammation. J Leukoc Biol. 1999;65:492–8.PubMed
46.
Zurück zum Zitat Gates C, Huard J. Management of skeletal muscle injuries in military personnel. Oper Tech Sports Med. 2005;13:247–56.CrossRef Gates C, Huard J. Management of skeletal muscle injuries in military personnel. Oper Tech Sports Med. 2005;13:247–56.CrossRef
47.
Zurück zum Zitat Charge SB, Rudnicki MA. Cellular and molecular regulation of muscle regeneration. Physiol Rev. 2004;84:209–38.PubMedCrossRef Charge SB, Rudnicki MA. Cellular and molecular regulation of muscle regeneration. Physiol Rev. 2004;84:209–38.PubMedCrossRef
Metadaten
Titel
Effects on the ubiquitin proteasome system after closed soft-tissue trauma in rat skeletal muscle
verfasst von
N. Ponelies
D. Gosenca
N. Ising
M. Schoen
K. Ruppel
B. Vollmar
U. Obertacke
Publikationsdatum
01.12.2011
Verlag
Springer-Verlag
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 6/2011
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-011-0083-8

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