{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T18:10:35Z","timestamp":1770919835557,"version":"3.50.1"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T00:00:00Z","timestamp":1687910400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T00:00:00Z","timestamp":1687910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurol Sci"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>We aimed to evaluate beat-to-beat blood pressure variability (BPV) during head-up tilt test (HUTT) in patients with mild and moderate myasthenia gravis (MG) compared to healthy controls (HCs), and its association with the severity of autonomic symptoms.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A total of 50 MG patients and 30 HCs were evaluated. Patients were stratified into 2 groups regarding Myasthenia Gravis Foundation of America (MGFA) classification: mild (I,II MGFA), moderate form (III MGFA). Autonomic symptoms were assessed by COMPASS-31 questionnaire. Cardiovascular parameters, indices of very short-term systolic (SBPV), and diastolic blood pressure (BP) variability (DBPV) were assessed at rest, and during HUTT.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Moderate MG patients were characterized by an overall shift of sympathovagal balance toward sympathetic predominance, either at rest and during HUTT, as well as lower values of high frequency (HFnu) of DBPV during HUTT, compared to HCs and mild MG. Similarly, moderate MG showed higher resting low frequency (LFnu) of DBPV (<jats:italic>p<\/jats:italic>=0.035), higher COMPASS-31 score (<jats:italic>p<\/jats:italic>=0.031), and orthostatic intolerance sub-score (<jats:italic>p<\/jats:italic>=0.019) than mild MG patients. Compared to HCs, mild MG patients showed lower \u0394mean BP (<jats:italic>p<\/jats:italic>=0.029), \u0394diastolic BP (<jats:italic>p<\/jats:italic>=0.016). Autonomic symptoms were associated with lower BP values, at rest and during HUTT, and lower LF BPV parameters during HUTT.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>MG patients present significant alterations in BPV, both at rest and in response to orthostatic stress, which are related to autonomic symptoms and disease severity. This study confirms the importance of monitoring BPV when evaluating cardiovascular autonomic function and its evolution over the course of MG disease.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10072-023-06927-1","type":"journal-article","created":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T06:02:19Z","timestamp":1687932139000},"page":"4065-4075","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Alterations in short-term blood pressure variability related to disease severity and autonomic symptoms in myasthenia gravis patients"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3861-7113","authenticated-orcid":false,"given":"Monika","family":"Zawadka-Kunikowska","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u0141ukasz","family":"Rzepi\u0144ski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miros\u0142awa","family":"Cie\u015blicka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacek J.","family":"Klawe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ma\u0142gorzata","family":"Tafil-Klawe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,6,28]]},"reference":[{"issue":"1","key":"6927_CR1","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","volume":"5","author":"NE Gilhus","year":"2019","unstructured":"Gilhus NE, Tzartos S, Evoli A (2019) Myasthenia gravis. Nat Rev Dis Primers 5(1):30. https:\/\/doi.org\/10.1038\/s41572-019-0079-y","journal-title":"Nat Rev Dis Primers"},{"issue":"8","key":"6927_CR2","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1007\/s00415-016-8045-z","volume":"263","author":"N Melzer","year":"2016","unstructured":"Melzer N, Ruck T, Fuhr P et al (2016) Clinical features, pathogenesis, and treatment of myasthenia gravis: a supplement to the Guidelines of the German Neurological Society. J Neurol 263(8):1473\u20131494. https:\/\/doi.org\/10.1007\/s00415-016-8045-z","journal-title":"J Neurol"},{"issue":"1","key":"6927_CR3","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1111\/nyas.13522","volume":"1412","author":"JF Howard Jr","year":"2018","unstructured":"Howard JF Jr (2018) Myasthenia gravis: the role of complement at the neuromuscular junction. Ann N YAcad Sci 1412(1):113\u2013128. https:\/\/doi.org\/10.1111\/nyas.13522","journal-title":"Ann N YAcad Sci"},{"key":"6927_CR4","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1136\/jnnp-2012-304057","volume":"84","author":"S Suzuki","year":"2013","unstructured":"Suzuki S, Utsugisawa K, Suzuki N (2013) Overlooked non-motor symptoms in myasthenia gravis. J Neurol Neurosurg Psychiatry 84:989\u2013994. https:\/\/doi.org\/10.1136\/jnnp-2012-304057","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"9","key":"6927_CR5","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.2169\/internalmedicine.1990-18","volume":"58","author":"Y Tajima","year":"2019","unstructured":"Tajima Y, Yaguchi H, Mito Y (2019) Non-motor comorbidity of myasthenia gravis: myasthenia gravis as a systemic immunological disorder involving non-motor systems. Intern Med 58(9):1341\u20131347. https:\/\/doi.org\/10.2169\/internalmedicine.1990-18","journal-title":"Intern Med"},{"key":"6927_CR6","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.ijcme.2014.08.003","volume":"5","author":"P Shivamurthya","year":"2014","unstructured":"Shivamurthya P, Parkerb MW (2014) Cardiac manifestations of myasthenia gravis: a systematic review. IJC Metab Endocr 5:3\u20136. https:\/\/doi.org\/10.1016\/j.ijcme.2014.08.003","journal-title":"IJC Metab Endocr"},{"key":"6927_CR7","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.jns.2011.05.028","volume":"307","author":"S Peric","year":"2011","unstructured":"Peric S, Rakocevic-Stojanovic V, Nisic T et al (2011) Cardiac autonomic control in patients with myasthenia gravis and thymoma. J Neurol Sci 307:30\u201333. https:\/\/doi.org\/10.1016\/j.jns.2011.05.028","journal-title":"J Neurol Sci"},{"issue":"11","key":"6927_CR8","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.1007\/s00415-014-7465-x","volume":"261","author":"A Nikoli\u0107","year":"2014","unstructured":"Nikoli\u0107 A, Peri\u0107 S, Ni\u0161i\u0107 T et al (2014) The presence of dysautonomia in different subgroups of myasthenia gravis patients. J Neurol 261(11):2119\u20132127. https:\/\/doi.org\/10.1007\/s00415-014-7465-x","journal-title":"J Neurol"},{"key":"6927_CR9","doi-asserted-by":"publisher","first-page":"3697","DOI":"10.3390\/jcm11133697","volume":"11","author":"M Zawadka-Kunikowska","year":"2022","unstructured":"Zawadka-Kunikowska M, Rzepi\u0144ski \u0141, Tafil-Klawe M et al (2022) Association of cardiac autonomic responses with clinical outcomes of myasthenia gravis: short-term analysis of the heart-rate and blood pressure variability. J Clin Med 11:3697. https:\/\/doi.org\/10.3390\/jcm11133697","journal-title":"J Clin Med"},{"issue":"5","key":"6927_CR10","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1080\/01616412.2018.1446690","volume":"40","author":"ZU Kocabas","year":"2018","unstructured":"Kocabas ZU, Kizilay F, Basarici I et al (2018) Evaluation of cardiac autonomic functions in myasthenia gravis. Neurol Res 40(5):405\u2013412. https:\/\/doi.org\/10.1080\/01616412.2018.1446690","journal-title":"Neurol Res"},{"key":"6927_CR11","doi-asserted-by":"publisher","first-page":"329","DOI":"10.4103\/0972-2327.116912","volume":"16","author":"CS Puneeth","year":"2013","unstructured":"Puneeth CS, Chandra SR, Yadav R et al (2013) Heart rate and blood pressure variability in patients with myasthenia gravis. Ann Indian Acad Neurol 16:329\u2013332. https:\/\/doi.org\/10.4103\/0972-2327.116912","journal-title":"Ann Indian Acad Neurol"},{"key":"6927_CR12","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.clineuro.2012.05.013","volume":"115","author":"G Shukla","year":"2013","unstructured":"Shukla G, Gupta S, Goyal V, Singh S, Srivastava A, Behari M (2013) Abnormal sympathetic hyper-reactivity in patients with myasthenia gravis: a prospective study. Clin Neurol Neurosurg 115:179\u2013186. https:\/\/doi.org\/10.1016\/j.clineuro.2012.05.013","journal-title":"Clin Neurol Neurosurg"},{"key":"6927_CR13","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/0165-1838(92)90218-6","volume":"38","author":"E Stoica","year":"1992","unstructured":"Stoica E, Enulescu O (1992) Deficiency of sympathetic nervous system function in myasthenia. J Auton Nerv Syst 38:69\u201376. https:\/\/doi.org\/10.1016\/0165-1838(92)90218-6","journal-title":"J Auton Nerv Syst"},{"issue":"8","key":"6927_CR14","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1016\/s0025-6196(12)60631-4","volume":"68","author":"PA Low","year":"1993","unstructured":"Low PA (1993) Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure. Mayo Clin Proc 68(8):748\u2013752. https:\/\/doi.org\/10.1016\/s0025-6196(12)60631-4","journal-title":"Mayo Clin Proc"},{"issue":"2","key":"6927_CR15","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1016\/j.clinph.2020.11.024","volume":"132","author":"WP Cheshire","year":"2021","unstructured":"Cheshire WP, Freeman R, Gibbons CH et al (2021) Electrodiagnostic assessment of the autonomic nervous system: a consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology. Clin Neurophysiol 132(2):666\u2013682. https:\/\/doi.org\/10.1016\/j.clinph.2020.11.024","journal-title":"Clin Neurophysiol"},{"key":"6927_CR16","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1111\/j.1749-6632.1996.tb26704.x","volume":"783","author":"M Pagani","year":"1996","unstructured":"Pagani M, Lucini D, Rimoldi O, Furlan R et al (1996) Low and high frequency components of blood pressure variability. Ann N Y Acad Sci 783:10\u201323. https:\/\/doi.org\/10.1111\/j.1749-6632.1996.tb26704.x","journal-title":"Ann N Y Acad Sci"},{"issue":"4","key":"6927_CR17","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1007\/s10072-020-04620-1","volume":"42","author":"M Foschi","year":"2021","unstructured":"Foschi M, Giannini G, Merli E, Mancinelli L, Zenesini C, Viti B, Guaraldi P, Cortelli P, Lugaresi A (2021) Frequency and characteristics of dysautonomic symptoms in multiple sclerosis: a cross-sectional double-center study with the validated Italian version of the Composite Autonomic Symptom Score-31. Neurol Sci 42(4):1395\u20131403. https:\/\/doi.org\/10.1007\/s10072-020-04620-1","journal-title":"Neurol Sci"},{"issue":"1","key":"6927_CR18","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1007\/s10072-021-05764-4","volume":"43","author":"MJ Hilz","year":"2022","unstructured":"Hilz MJ, Wang R, Singer W (2022) Validation of the Composite Autonomic Symptom Score 31 in the German language. Neurol Sci 43(1):365\u2013371. https:\/\/doi.org\/10.1007\/s10072-021-05764-4","journal-title":"Neurol Sci"},{"issue":"36","key":"6927_CR19","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/j.ncl.2018.01.006","volume":"2018","author":"C Barnett","year":"2018","unstructured":"Barnett C, Herbelin L, Dimachkie MM (2018) Measuring clinical treatment response in myasthenia gravis. Neurol Clin 2018(36):339\u2013353. https:\/\/doi.org\/10.1016\/j.ncl.2018.01.006","journal-title":"Neurol Clin"},{"key":"6927_CR20","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1212\/wnl.55.1.16","volume":"55","author":"A Jaretzki","year":"2000","unstructured":"Jaretzki A, Barohn RJ, Ernstoff R et al (2000) Myasthenia gravis: recommendations for clinical research standards. Task force of the medical scientific advisory board of the myasthenia gravis foundation of America. Neurology 55:16\u201323. https:\/\/doi.org\/10.1212\/wnl.55.1.16","journal-title":"Neurology"},{"key":"6927_CR21","doi-asserted-by":"publisher","first-page":"2173","DOI":"10.3390\/jcm10102173","volume":"10","author":"\u0141 Rzepi\u0144ski","year":"2021","unstructured":"Rzepi\u0144ski \u0141, Zawadka-Kunikowska M, Newton JL et al (2021) Cardiac autonomic dysfunction in myasthenia gravis and relapsing-remitting multiple sclerosis\u2014a pilot study. J Clin Med 10:2173","journal-title":"J Clin Med"},{"key":"6927_CR22","first-page":"873","volume":"46","author":"Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology","year":"1996","unstructured":"Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (1996) Assessment clinical autonomic testing report of the therapeutics and technology subcommittee of the American Academy of Neurology. Neurology 46:873\u2013880","journal-title":"Neurology"},{"key":"6927_CR23","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/s11906-012-0290-7","volume":"14","author":"G Parati","year":"2012","unstructured":"Parati G, Ochoa JE, Bilo G (2012) Blood pressure variability, cardiovascular risk, and risk for renal disease progression. Curr Hypertens Rep 14:421\u2013431. https:\/\/doi.org\/10.1007\/s11906-012-0290-7","journal-title":"Curr Hypertens Rep"},{"key":"6927_CR24","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1109\/51.620497","volume":"16","author":"AM Bianchi","year":"1997","unstructured":"Bianchi AM, Mainardi L, Meloni C (1997) Continuous monitoring of the sympatho-vagal balance through spectral analysis. IEEE Eng Med Biol Mag 16:64\u201373. https:\/\/doi.org\/10.1109\/51.620497","journal-title":"IEEE Eng Med Biol Mag"},{"key":"6927_CR25","unstructured":"NIST\/SEMATECH e-Handbook of statistical methods. Available online: http:\/\/www.itl.nist.gov\/div898\/handbook\/.2012\/01\/20 (accessed on 21 August 2020)"},{"issue":"4","key":"6927_CR26","doi-asserted-by":"publisher","first-page":"H1245","DOI":"10.1152\/ajpheart.1999.276.4.H1245","volume":"276","author":"T Laitinen","year":"1999","unstructured":"Laitinen T, Hartikainen J, Niskanen L et al (1999) Sympathovagal balance is major determinant of short-term blood pressure variability in healthy subjects. Am J Physiol 276(4):H1245\u2013H1252. https:\/\/doi.org\/10.1152\/ajpheart.1999.276.4.H1245","journal-title":"Am J Physiol"},{"issue":"1","key":"6927_CR27","doi-asserted-by":"publisher","first-page":"42","DOI":"10.4103\/aian.AIAN_270_17","volume":"21","author":"RN Benjamin","year":"2018","unstructured":"Benjamin RN, Aaron S, Sivadasan A, Devasahayam S, Sebastin A, Alexander M (2018) The spectrum of autonomic dysfunction in myasthenic crisis. Ann Indian Acad Neurol 21(1):42\u201348. https:\/\/doi.org\/10.4103\/aian.AIAN_270_17","journal-title":"Ann Indian Acad Neurol"},{"key":"6927_CR28","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1186\/s12933-016-0399-0","volume":"15","author":"M Wijkman","year":"2016","unstructured":"Wijkman M, L\u00e4nne T, \u00d6stgren CJ et al (2016) Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study. Cardiovasc Diabetol 15:83. https:\/\/doi.org\/10.1186\/s12933-016-0399-0","journal-title":"Cardiovasc Diabetol"},{"issue":"6","key":"6927_CR29","doi-asserted-by":"publisher","first-page":"3050","DOI":"10.1007\/s00415-021-10891-1","volume":"269","author":"S Lehnerer","year":"2022","unstructured":"Lehnerer S, Jacobi J, Schilling R et al (2022) Burden of disease in myasthenia gravis: taking the patient\u2019s perspective. J Neurol 269(6):3050\u20133063. https:\/\/doi.org\/10.1007\/s00415-021-10891-1","journal-title":"J Neurol"},{"issue":"1-2","key":"6927_CR30","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.autneu.2004.05.002","volume":"113","author":"PP Soares","year":"2004","unstructured":"Soares PP, da N\u00f3brega AC, Ushizima MR et al (2004) Cholinergic stimulation with pyridostigmine increases heart rate variability and baroreflex sensitivity in rats. Auton Neurosci 113(1-2):24\u201331. https:\/\/doi.org\/10.1016\/j.autneu.2004.05.002","journal-title":"Auton Neurosci"},{"issue":"3","key":"6927_CR31","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/S1566-0702(01)00239-9","volume":"88","author":"S Vernino","year":"2001","unstructured":"Vernino S, Cheshire WP, Lennon VA (2001) Myasthenia gravis with autoimmune autonomic neuropathy. Auton Neurosci 88(3):187\u2013192. https:\/\/doi.org\/10.1016\/S1566-0702(01)00239-9","journal-title":"Auton Neurosci"},{"issue":"4","key":"6927_CR32","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1002\/acn3.524","volume":"5","author":"M Watari","year":"2018","unstructured":"Watari M, Nakane S, Mukaino A et al (2018) Autoimmune postural orthostatic tachycardia syndrome. Ann Clin Transl Neurol 5(4):486\u2013492. https:\/\/doi.org\/10.1002\/acn3.524","journal-title":"Ann Clin Transl Neurol"},{"issue":"1","key":"6927_CR33","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1002\/acn3.51706","volume":"10","author":"X Huang","year":"2023","unstructured":"Huang X, Xu M, Wang Y et al (2023) The systemic inflammation markers as possible indices for predicting respiratory failure and outcome in patients with myasthenia gravis. Ann Clin Transl Neurol 10(1):98\u2013110. https:\/\/doi.org\/10.1002\/acn3.51706","journal-title":"Ann Clin Transl Neurol"},{"key":"6927_CR34","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1186\/s13075-014-0504-2","volume":"16","author":"G Pongratz","year":"2014","unstructured":"Pongratz G, Straub RH (2014) The sympathetic nervous response in inflammation. Arthritis Res Ther 16:504. https:\/\/doi.org\/10.1186\/s13075-014-0504-2","journal-title":"Arthritis Res Ther"},{"issue":"6","key":"6927_CR35","doi-asserted-by":"publisher","first-page":"25886","DOI":"10.1038\/srep25886","volume":"13","author":"A Uzawa","year":"2016","unstructured":"Uzawa A, Kanai T, Kawaguchi N et al (2016) Changes in inflammatory cytokine networks in myasthenia gravis. Sci Rep 13(6):25886. https:\/\/doi.org\/10.1038\/srep25886","journal-title":"Sci Rep"},{"issue":"6","key":"6927_CR36","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1007\/s00281-020-00829-6","volume":"42","author":"D Sharma","year":"2020","unstructured":"Sharma D, Farrar JD (2020) Adrenergic regulation of immune cell function and inflammation. Semin Immunopathol 42(6):709\u2013717. https:\/\/doi.org\/10.1007\/s00281-020-00829-6","journal-title":"Semin Immunopathol"},{"issue":"3","key":"6927_CR37","doi-asserted-by":"publisher","first-page":"H1016","DOI":"10.1152\/ajpheart.00779.2004","volume":"288","author":"E Vila","year":"2005","unstructured":"Vila E, Salaices M (2005) Cytokines and vascular reactivity in resistance arteries. Am J Physiol Heart Circ Physiol 288(3):H1016\u2013H1021. https:\/\/doi.org\/10.1152\/ajpheart.00779.2004","journal-title":"Am J Physiol Heart Circ Physiol"},{"issue":"4","key":"6927_CR38","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.neucli.2022.06.003","volume":"52","author":"L Crno\u0161ija","year":"2022","unstructured":"Crno\u0161ija L, Mo\u0161tak I, Vi\u0161nji\u0107 N, Junakovi\u0107 A, Kari\u0107 A, Adamec I, Krbot Skori\u0107 M, Habek M (2022) Blood pressure variability is altered in secondary progressive multiple sclerosis but not in patients with a clinically isolated syndrome. Neurophysiol Clin 52(4):290\u2013298. https:\/\/doi.org\/10.1016\/j.neucli.2022.06.003","journal-title":"Neurophysiol Clin"},{"issue":"10","key":"6927_CR39","doi-asserted-by":"publisher","first-page":"3176","DOI":"10.3390\/jcm9103176","volume":"9","author":"M Zawadka-Kunikowska","year":"2020","unstructured":"Zawadka-Kunikowska M, Rzepi\u0144ski NJL et al (2020) Cardiac autonomic modulation is different in terms of clinical variant of multiple sclerosis. J Clin Med 9(10):3176. https:\/\/doi.org\/10.3390\/jcm9103176","journal-title":"J Clin Med"},{"issue":"8","key":"6927_CR40","doi-asserted-by":"publisher","first-page":"4829","DOI":"10.1007\/s10072-022-06099-4","volume":"43","author":"\u0141 Rzepi\u0144ski","year":"2022","unstructured":"Rzepi\u0144ski \u0141, Zawadka-Kunikowska M, Newton JL et al (2022) Cardiovascular autonomic dysfunction in multiple sclerosis\u2014findings and relationships with clinical outcomes and fatigue severity. Neurol Sci 43(8):4829\u20134839. https:\/\/doi.org\/10.1007\/s10072-022-06099-4","journal-title":"Neurol Sci"}],"container-title":["Neurological Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10072-023-06927-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10072-023-06927-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10072-023-06927-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T04:09:54Z","timestamp":1697083794000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10072-023-06927-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,28]]},"references-count":40,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["6927"],"URL":"https:\/\/doi.org\/10.1007\/s10072-023-06927-1","relation":{},"ISSN":["1590-1874","1590-3478"],"issn-type":[{"value":"1590-1874","type":"print"},{"value":"1590-3478","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,28]]},"assertion":[{"value":"24 February 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 June 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 June 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study complied with the principles of the Declaration of Helsinki and was approved by the Bioethical Committee of Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun (KB 747\/2017).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All subjects participated voluntarily and gave their written informed consent to store their data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}