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Significance of pure sensory manifestations in estimating electromyography results in cervical radiculopathy 单纯感觉表现在评估神经根型颈椎病肌电图结果中的意义
IF 0.4 4区 医学 Q4 NEUROSCIENCES Pub Date : 2022-07-01 DOI: 10.4103/nsn.nsn_10_22
M. Ercan, H. Kuruoğlu
Background: The sensitivity of electromyography (EMG) in cervical radiculopathy (CR) is reportedly higher in patients with objective neurological findings, but many patients are sent to the EMG laboratory with only pain and paresthesias. Aims: We aimed to assess the diagnostic contribution of EMG in patients with sensory manifestations without objective neurological deficits. Settings and Design: The files of patients with neck pain radiating to the shoulder and arm on the same side referred to the EMG Laboratory were retrospectively evaluated. EMG findings of those with pure sensory manifestations were compared with the results obtained from patients with objective neurological deficits. Subjects and Methods: Patients with subjective sensory manifestations were separated into two groups according to the specificity of the presenting symptoms, who were compared with subjects with neurological findings in the upper extremity. Clinical diagnoses of the patients were compared with the electrodiagnostic testing results. Statistical Analysis: Categorical variables were analyzed with multi-span Chi-square test, while individual groups were compared utilizing Fisher's exact test. One-way analysis of variance was employed to assess the significance of group differences for quantitative values. Results: EMG rarely confirmed CR in patients with purely sensory symptoms. Some of these patients were found to have unexpected peripheral neuropathy syndromes. Both paraspinal and limb muscle EMG abnormalities indicative of CR were not only more common, but also helpful in localization in patients with objective clinical findings. Conclusions: CR patients presenting only with pain and paresthesias even in a specific dermatomal distribution usually demonstrate no abnormalities in EMG examination. However, some of these patients harbor unsuspected entrapment neuropathies.
背景:据报道,在有客观神经学表现的患者中,神经根型颈椎病(CR)的肌电图(EMG)灵敏度更高,但许多患者被送到EMG实验室时只有疼痛和感觉异常。目的:我们旨在评估肌电图对无客观神经功能缺损的感觉表现患者的诊断作用。设置和设计:回顾性评估EMG实验室参考的同侧肩臂颈痛患者的档案。将有纯粹感觉表现的患者的肌电图结果与有客观神经功能缺陷的患者的结果进行比较。受试者和方法:根据症状的特异性,将有主观感觉表现的患者分为两组,并与有上肢神经系统表现的受试者进行比较。将患者的临床诊断和电诊断测试结果进行比较。统计分析:分类变量采用多跨度卡方检验进行分析,各组采用Fisher精确检验进行比较。采用单向方差分析来评估定量值的组间差异的显著性。结果:在单纯感觉症状的患者中,肌电图很少证实CR。其中一些患者被发现患有意外的周围神经病变综合征。提示CR的棘旁和四肢肌肉肌电图异常不仅更常见,而且有助于在有客观临床表现的患者中定位。结论:CR患者仅表现为疼痛和感觉异常,即使是在特定的皮肤分布中,EMG检查通常没有异常。然而,这些患者中的一些人患有未经怀疑的卡压性神经病。
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引用次数: 0
Axonal excitability findings in acute inflammatory demyelinating polyneuropathy related to SARS-CoV-2 与严重急性呼吸系统综合征冠状病毒2型相关的急性炎症性脱髓鞘多发性神经病的轴突兴奋性研究
IF 0.4 4区 医学 Q4 NEUROSCIENCES Pub Date : 2022-07-01 DOI: 10.4103/nsn.nsn_111_21
A. Alaamel, R. Sahin, Merve Hashan, T. Taşkınoğlu, T. Özel, N. Erdem, H. Uysal
Guillain–Barré syndrome (GBS) is a disorder of the peripheral nervous system characterized by acute-onset ascendance paresis. We present a patient who was diagnosed as having facial-onset acute inflammatory demyelinating polyneuropathy after being infected with SARS-CoV-2. A 51-year-old man presented to the emergency department with facial diplegia. He then developed bilateral ascendance paralysis. He had noticed that for 1 month, he had smell and taste disturbances. SARS-CoV-2 infection was suspected. Nasopharyngeal swab polymerase chain reaction test was negative, but anti-SARS-CoV-2 antibody was found to be positive. A nerve conduction study showed prolonged motor distal and F wave latencies with decreased motor and sensory compound muscle action potential amplitudes. Lumbar puncture revealed albuminocytologic dissociation. According to the neurologic examination and laboratory findings, the patient was diagnosed as having acute inflammatory demyelinating polyneuropathy. An axonal excitability study revealed fanning in pattern with prolonged refractoriness, which indicates nodal sodium channel disturbances. Facial-onset SARS-CoV-2–related GBS has been rarely reported; however, facial involvement seems to be one of the features of the neurologic findings.
格林-巴罗综合征(GBS)是一种周围神经系统疾病,其特征是急性发作的优势性麻痹。我们报告了一位在感染SARS-CoV-2后被诊断为面部发病的急性炎症性脱髓鞘性多神经病变的患者。一名51岁男子因面部双瘫被送往急诊室。然后他出现了双侧优势麻痹。他注意到一个月来,他有嗅觉和味觉障碍。疑似SARS-CoV-2感染。鼻咽拭子聚合酶链反应试验阴性,抗sars - cov -2抗体阳性。神经传导研究显示运动远端和F波潜伏期延长,运动和感觉复合肌动作电位幅度下降。腰椎穿刺显示白蛋白细胞分离。根据神经学检查和实验室检查结果,诊断为急性炎性脱髓鞘性多神经病变。轴突兴奋性研究显示扇形模式具有延长的耐火性,这表明节点钠通道受到干扰。面部发病的sars - cov -2相关的GBS很少报道;然而,面部受累似乎是神经学发现的特征之一。
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引用次数: 0
Rituximab-induced leukocytoclastic vasculitis 利妥昔单抗诱导的白细胞破裂性血管炎
IF 0.4 4区 医学 Q4 NEUROSCIENCES Pub Date : 2022-07-01 DOI: 10.4103/nsn.nsn_153_21
D. Tezer, I. Dogan, C. Arican, S. Demir, M. Tutuncu
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引用次数: 1
Dynamic somatosensory evoked potential and magnetic resonance imaging in pudendal neuropathy: A comparative study with respect to the clinical diagnostic criteria 阴部神经病变的动态体感诱发电位和磁共振成像:临床诊断标准的比较研究
IF 0.4 4区 医学 Q4 NEUROSCIENCES Pub Date : 2022-07-01 DOI: 10.4103/nsn.nsn_239_21
B. Ormeci, Handan Uyanik, N. Taşdelen, E. Keles, T. Erdoğru, A. Öge
Aim: Pudendal neuropathy (PN) is a common cause of chronic perineal pain and usually diagnosed long after the onset of symptoms. Diagnostic work-up of PN mainly includes radiologic and neurophysiological studies. However, there is no established diagnostic test to confirm the clinical diagnosis. This study aims to evaluate the correlation between the dynamic pudendal somatosensory evoked potential (SEP) and pudendal magnetic resonance imaging (MRI) in patients with PN diagnosed clinically based on Nantes criteria as the gold standard for comparison. Methods: Forty-three patients (25 females, 18 males) were included in the study. Dynamic pudendal SEP as a novel method, which includes both provocative positioning and stimulation of each side separately, and pudendal MRI were performed in each patient. Results: Dynamic pudendal SEPs were found to be abnormal in 42, normal in 12 of the 54 clinically symptomatic nerves and abnormal in 2, normal in 30 of the 32 clinically asymptomatic nerves. Pudendal MRI was abnormal in 19, normal in 35 of the 54 clinically symptomatic nerves and abnormal in 8 and normal in 24 of the 32 clinically asymptomatic nerves. There was 84% agreement between clinical diagnosis and dynamic pudendal SEP (high sensitivity and specificity), 49% agreement between clinical diagnosis and pudendal MRI (low sensitivity and acceptable specificity), 53% agreement between dynamic pudendal SEP and pudendal MRI. Conclusions: The novel dynamic pudendal SEP method seems to be useful in supporting the clinical diagnosis of PN, while pudendal MRI lacks sufficient sensitivity to be used alone in diagnosis of PN.
目的:Pudendal神经病(PN)是慢性会阴疼痛的常见原因,通常在症状出现后很长时间才被诊断出来。PN的诊断检查主要包括放射学和神经生理学研究。然而,目前还没有确定的诊断测试来确认临床诊断。本研究旨在评估临床诊断为PN患者的动态阴部体感诱发电位(SEP)和阴部磁共振成像(MRI)之间的相关性,以Nantes标准作为比较的金标准。方法:43名患者(25名女性,18名男性)被纳入研究。动态阴部SEP作为一种新的方法,包括分别对每侧进行挑衅性定位和刺激,并对每位患者进行阴部MRI检查。结果:动态阴部SEP异常42例,54条临床症状神经中有12条正常,异常2例,32条临床无症状神经中30条正常。Pudendal MRI异常19条,在54条临床症状神经中有35条正常,异常8条,正常24条。临床诊断与动态阴部SEP(高灵敏度和特异性)的一致性为84%,临床诊断与阴部MRI的一致性(低灵敏度和可接受的特异性)为49%,动态阴部SEP与阴部MRI的一致性达53%。结论:新的动态阴部SEP方法似乎有助于支持PN的临床诊断,而阴部MRI缺乏足够的灵敏度单独用于PN的诊断。
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引用次数: 0
Clinical course and outcomes of complicated mild traumatic brain injury in children: A single-center series of 124 cases 儿童复杂轻度颅脑损伤的临床过程和转归:124例单中心系列病例
IF 0.4 4区 医学 Q4 NEUROSCIENCES Pub Date : 2022-07-01 DOI: 10.4103/nsn.nsn_35_22
Ş. Hanalioğlu, D. Hanalioğlu, Ç. Elbir, O. Sahin, Balkan Sahin, M. Turkoglu, H. Kertmen
Objective: Mild traumatic brain injury (mTBI) constitutes majority of TBI cases. A considerable portion of mTBI cases has intracranial imaging abnormalities (complicated mTBI), which pose challenges in the diagnosis and management to clinicians. Here, we aimed to evaluate the early clinical course and outcomes of pediatric complicated mTBI cases treated at a large-volume tertiary referral center. Materials and Methods: A single-center retrospective cohort study was conducted at a large-volume tertiary trauma referral center for 12-month period between 2017 and 2018. Pediatric mTBI cases with at least one of the following computed tomography (CT) findings were included a depressed skull fracture, pneumocephalus, intracranial hemorrhage, edema, or contusion. Demographic, clinical, and radiological data were collected and analyzed. Results: One hundred and twenty-four patients with complicated mTBI were identified. Falls were the leading mechanisms of trauma (71.8%). Most patients (90.3%) had a Glasgow coma score (GCS) of 15 at initial evaluation. Most frequent radiological findings on initial CT scan were epidural hematoma (EDH) (34.7%) and pneumocephalus (31.5%), followed by subdural hematoma (SDH) (19.4%), subarachnoid hemorrhage (16.9%), contusion (14.5%), and depressed skull fracture (8.1%). Radiological findings in the routine repeat CT scan were stable in 55.6% of the patients, whereas the findings progressed in 15.3% and improved in 29% of patients during this interval period (median 7 h). Neurosurgical operation was performed in 7 (5.6%) patients. Thirty-six (29%) patients were identified as having clinically important TBI (ciTBI). Average length of stay at emergency department was 9.7 ± 4.9 h, and the average length of hospital stay was 3.6 ± 2.3 days. Multivariate analysis revealed that age, GCS, pneumocephalus, depressed skull fracture, EDH, and SDH were independent predictors of ciTBI. Conclusion: Pediatric complicated mTBI is associated with higher rates of hospitalization and therefore ciTBI but relatively lower rates of need for neurosurgery. Effective decision-making tools and algorithms are needed to guide optimal management strategies of these patients.
目的:轻度颅脑损伤(mTBI)占大多数。相当一部分mTBI病例具有颅内成像异常(复杂的mTBI),这对临床医生的诊断和管理提出了挑战。在这里,我们旨在评估在大容量三级转诊中心治疗的儿科复杂mTBI病例的早期临床过程和结果。材料和方法:2017年至2018年间,在一家大型三级创伤转诊中心进行了为期12个月的单中心回顾性队列研究。至少有以下一种计算机断层扫描(CT)结果的儿童mTBI病例包括颅骨凹陷性骨折、肺头畸形、颅内出血、水肿或挫伤。收集并分析人口统计学、临床和放射学数据。结果:共发现124例复杂mTBI患者。跌倒是创伤的主要机制(71.8%)。大多数患者(90.3%)在最初评估时格拉斯哥昏迷评分(GCS)为15。初次CT扫描最常见的放射学表现是硬膜外血肿(EDH)(34.7%)和肺炎球菌(31.5%),其次是硬膜下血肿(SDH)(19.4%)、蛛网膜下腔出血(16.9%)、挫伤(14.5%)和凹陷性颅骨骨折(8.1%),而在这段时间间隔(中位数7小时)内,15.3%的患者病情进展,29%的患者病情改善。7例(5.6%)患者进行了神经外科手术。36名(29%)患者被确定患有临床上重要的TBI(ciTBI)。急诊科平均住院时间9.7±4.9小时,平均住院时间3.6±2.3天。多因素分析显示,年龄、GCS、肺炎球菌、颅骨凹陷性骨折、EDH和SDH是ciTBI的独立预测因素。结论:儿童复杂mTBI与较高的住院率相关,因此ciTBI与相对较低的神经外科需求率相关。需要有效的决策工具和算法来指导这些患者的最佳管理策略。
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引用次数: 0
Understanding pathophysiology of cluster headache: Heart rate variability and parasympathetic activation 理解丛集性头痛的病理生理学:心率变异性和副交感神经激活
IF 0.4 4区 医学 Q4 NEUROSCIENCES Pub Date : 2022-07-01 DOI: 10.4103/nsn.nsn_154_21
Erdi Şahin, E. Ekizoğlu, E. Orhan, A. Bilge, B. Baykan
Aim: The underlying mechanisms of cluster headache (CH) have not been fully understood yet. The cranial autonomic activation suggests that both sympathetic and parasympathetic systems are impaired in the clinical presentation; however, the systemic autonomic involvement during pain-free episodes is not well-known. Methods: Thirty-five subjects were included in 24 h Holter monitoring and electrophysiological studies in this controlled study. Results: In Holter monitoring, heart rate variability parameters, RMSSD (P = 0.001), and pNN50 (P = 0.024) were significantly higher in patients compared to age and gender-matched controls. The R-R variations during breathing and deep breathing and sympathetic skin responses of all patients were normal. Conclusions: High RMSSD and pNN50 levels are the two indicators of increased parasympathetic activity in CH patients. Considering the intense stress because of severe pain of the CH patients, who are mostly adult men and smokers, there is an urgent need for broader studies with prospective follow-up in terms of cardiac health.
目的:丛集性头痛(CH)的潜在机制尚不完全清楚。颅内自主神经的激活表明交感神经和副交感神经系统在临床表现中都受到损害;然而,在无疼痛发作期间全身自主神经的参与并不为人所知。方法:在本对照研究中,35名受试者被纳入24小时动态心电图监测和电生理研究。结果:在动态心电图监测中,与年龄和性别匹配的对照组相比,患者的心率变异性参数、RMSSD(P=0.001)和pNN50(P=0.024)显著较高。呼吸和深呼吸期间的R-R变化以及所有患者的交感神经皮肤反应均正常。结论:高RMSSD和pNN50水平是CH患者副交感神经活动增加的两个指标。考虑到CH患者因剧烈疼痛而产生的巨大压力,他们大多是成年男性和吸烟者,迫切需要在心脏健康方面进行更广泛的前瞻性随访研究。
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引用次数: 0
Periodic legs movements in sleep persisting after positive airway pressure titration is significantly associated with cardiovascular diseases 气道正压滴定后睡眠中持续的周期性腿部运动与心血管疾病显著相关
IF 0.4 4区 医学 Q4 NEUROSCIENCES Pub Date : 2022-01-01 DOI: 10.4103/nsn.nsn_149_21
Aygul Mahmudova, H. Kurucu, G. Şenel, D. Karadeniz
Purpose: Obstructive sleep apnea syndrome (OSAS) and periodic limb movement disorder in sleep (PLMS) are highly prevalent diseases of sleep and both are associated with a negative cardiovascular outcome. The purpose of this study was to investigate the presence of PLMS in patients with OSAS in positive airway pressure (PAP) titration and examine its relation to cardiovascular diseases. Materials and Methods: All patients who were diagnosed as having OSAS after one-night polysomnographic (PSG) recording during a 1-year period and were been treated successfully through PAP titration PSG were investigated retrospectively. Results: Out of 460 medical files investigated, 300 patients were included in the study (204 males, 68%) with a mean age of 54.2 ± 10.6 years. A comparison between patients with a PLMS index >15/h and PLMS index <15/h revealed that cardiac diseases (P = 0.040), hypertension (HT) (P = 0.006), and hyperlipidemia (P = 0.019) were all more common if patients had a PLMS index >15/h. Furthermore, a significant correlation was detected between the PLMS index and cardiac diseases (ß = 39.908, P = 0.012) and HT (ß = 32.884, P = 0.021). Conclusions: The risk of cardiovascular diseases is markedly increased in patients with OSAS with PLMS, and this was positively correlated with the PLMS index. Physicians should be aware that PLMS persisting after PAP titration might prevent the efficiency of PAP therapy in OSAS, especially in preventing cardiovascular complications.
目的:阻塞性睡眠呼吸暂停综合征(OSAS)和睡眠中周期性肢体运动障碍(PLMS)是非常普遍的睡眠疾病,两者都与负面心血管结局相关。本研究旨在探讨呼吸道正压(PAP)滴定时OSAS患者是否存在PLMS,并探讨其与心血管疾病的关系。材料与方法:回顾性分析1年内经1夜多导睡眠图(PSG)记录诊断为OSAS并经PAP滴定PSG治疗成功的患者。结果:460份医学档案中纳入300例患者,其中男性204例,占68%,平均年龄54.2±10.6岁。PLMS指数为bbb15 /h和PLMS指数为15/h患者的比较。此外,PLMS指数与心脏疾病(ß = 39.908, P = 0.012)和HT (ß = 32.884, P = 0.021)有显著相关性。结论:OSAS合并PLMS患者发生心血管疾病的风险明显增加,且与PLMS指数呈正相关。医生应该意识到,PAP滴定后持续的PLMS可能会影响osa患者PAP治疗的有效性,特别是在预防心血管并发症方面。
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引用次数: 1
Association of circadian locomotor output cycles kaput rs1801260 and hypocretin receptor 1 rs2271933 polymorphisms in patients with chronic migraine and sleep disorder 慢性偏头痛和睡眠障碍患者昼夜运动输出周期缺失rs1801260与下丘脑分泌素受体1 rs2271933多态性的关系
IF 0.4 4区 医学 Q4 NEUROSCIENCES Pub Date : 2022-01-01 DOI: 10.4103/nsn.nsn_195_21
Genc Hamit, OzdemirAsena Ayca, BarlasIbrahim Omer, Oksuz Nevra, Ozge Aynur
{"title":"Association of circadian locomotor output cycles kaput rs1801260 and hypocretin receptor 1 rs2271933 polymorphisms in patients with chronic migraine and sleep disorder","authors":"Genc Hamit, OzdemirAsena Ayca, BarlasIbrahim Omer, Oksuz Nevra, Ozge Aynur","doi":"10.4103/nsn.nsn_195_21","DOIUrl":"https://doi.org/10.4103/nsn.nsn_195_21","url":null,"abstract":"","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70838577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neurophysiological testing in the diagnosis of amyotrophic lateral sclerosis 神经生理学测试在肌萎缩侧索硬化症诊断中的应用
IF 0.4 4区 医学 Q4 NEUROSCIENCES Pub Date : 2022-01-01 DOI: 10.4103/nsn.nsn_199_21
D. Burke
Neurophysiological testing plays a very important role in the diagnosis of amyotrophic lateral sclerosis (known in the British world as motor neuron disease). As specified in the Awaji criteria, electromyography is critical for defining the neurogenic changes due to involvement of the lower motor neuron (LMN), and it can do so for muscles that are not involved clinically or are so only minimally. Demonstrating LMN involvement can be enhanced by the judicious use of neuromuscular ultrasound and imaging, particularly whole-body magnetic resonance imaging. There is a gap with involvement of the upper motor neuron (UMN), with promising procedures yet to be adopted widely. Reflex function can be used to demonstrate hyperreflexia and sometimes that paresis is at least partly of UMN origin. Protocols using transcranial magnetic stimulation can demonstrate enhanced excitability of interneuronal circuits in motor cortex and thereby pathology involving the UMN. The motivation behind studies using these and other techniques is to be able to make the diagnosis before the disease has spread significantly from its site of onset, when the clinical deficit is still minor.
神经生理学测试在肌萎缩侧索硬化症(在英国被称为运动神经元疾病)的诊断中起着非常重要的作用。正如Awaji标准中所规定的那样,肌电图对于确定下运动神经元(LMN)受累引起的神经源性变化至关重要,它可以对临床上未受累或仅轻微受累的肌肉进行检查。通过明智地使用神经肌肉超声和成像,特别是全身磁共振成像,可以增强LMN的参与。上运动神经元(UMN)的参与存在差距,有希望的程序尚未被广泛采用。反射功能可以用来证明反射亢进,有时轻瘫至少部分是UMN引起的。使用经颅磁刺激的方案可以证明运动皮层神经元间回路的兴奋性增强,从而导致涉及UMN的病理学。使用这些和其他技术进行研究的动机是能够在疾病从发病地显著传播之前做出诊断,而此时临床缺陷仍然很小。
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引用次数: 0
Why electrophysiological reassessment is needed? The experience of our laboratory – A cross-sectional study 为什么需要电生理重新评估?我们实验室的经验-横断面研究
IF 0.4 4区 医学 Q4 NEUROSCIENCES Pub Date : 2022-01-01 DOI: 10.4103/nsn.nsn_233_21
I. Gençdal, Ayşe Nur Özdağ Acarlı, AyşeDeniz Elmalı, A. Emekli, A. Öge, M. Baslo, E. Orhan
{"title":"Why electrophysiological reassessment is needed? The experience of our laboratory – A cross-sectional study","authors":"I. Gençdal, Ayşe Nur Özdağ Acarlı, AyşeDeniz Elmalı, A. Emekli, A. Öge, M. Baslo, E. Orhan","doi":"10.4103/nsn.nsn_233_21","DOIUrl":"https://doi.org/10.4103/nsn.nsn_233_21","url":null,"abstract":"","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"13 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70838728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Neurological Sciences and Neurophysiology
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