{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T15:29:45Z","timestamp":1778254185853,"version":"3.51.4"},"reference-count":63,"publisher":"Georg Thieme Verlag KG","issue":"05","license":[{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"vor","delay-in-days":31,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Non-cerebral palsy motor impairments have been increasing over time, especially in preterm-born children, with a variety of labels, including, but not limited to, developmental coordination disorder and minor neurological dysfunction. They may not only negatively affect the child in their daily life activities, but are also associated with cognitive, emotional, and behavioral disorders, as well as decreased academic performance.\ufeff Since there is a paucity of literature on non-cerebral palsy motor impairment, the main objective of the present study is to assess minor neurological dysfunction in the context of neurodevelopment. We reviewed the medical literature using the following search terms: preterm infants; follow-up; non-cerebral palsy motor impairment or disability; minor neurological dysfunction; developmental coordination disorder; neurological soft signs; and Touwen Neurological Examination. We compiled evidence-based data on minor neurological dysfunction critical domains, diagnosis, etiological factors and the influence of age and puberty in minor neurological signs. We also listed the cohort studies that used the Touwen Neurological Examination for premature or term-born follow-up, including those that suggest an association between minor neurological dysfunction and developmental coordination disorder as a motor impairment beyond cerebral palsy. Moreover, we found significant evidence of a correlation involving minor neurological dysfunction and cognitive, behavioral, and learning abilities, which, all in all, means that these children particularly deserve special attention regarding social, educational and healthcare resources. Furthermore, since motor activity seems to play an important role in the physical, mental, and neurological health of typical children, different approaches to education could have a positive impact on neurological development.<\/jats:p>","DOI":"10.1055\/s-0045-1809359","type":"journal-article","created":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T22:36:22Z","timestamp":1748817382000},"page":"001-011","source":"Crossref","is-referenced-by-count":3,"title":["Could minor neurological dysfunction be a type of non-cerebral palsy motor impairment?"],"prefix":"10.1055","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1884-7264","authenticated-orcid":false,"given":"Ana Paula","family":"Hamad","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina de Ribeir\u00e3o Preto, Departamento de Neuroci\u00eancias e Ci\u00eancias do Comportamento, Ribeir\u00e3o Preto SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7164-0457","authenticated-orcid":false,"given":"Carla Andrea Tanuri Cardoso","family":"Caldas","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina de Ribeir\u00e3o Preto, Departamento de Neuroci\u00eancias e Ci\u00eancias do Comportamento, Ribeir\u00e3o Preto SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4565-4810","authenticated-orcid":false,"given":"Isabella Cristina Mendes de S\u00e1 e","family":"Silva","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina de Ribeir\u00e3o Preto, Departamento de Neuroci\u00eancias e Ci\u00eancias do Comportamento, Ribeir\u00e3o Preto SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3873-5956","authenticated-orcid":false,"given":"Marina Estima Neiva","family":"Nunes","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina de Ribeir\u00e3o Preto, Departamento de Neuroci\u00eancias e Ci\u00eancias do Comportamento, Ribeir\u00e3o Preto SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,6,1]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"publisher","first-page":"e20173410","DOI":"10.1542\/peds.2017-3410","article-title":"Motor Impairment Trends in Extremely Preterm Children: 1991-2005","volume":"141","author":"A J Spittle","year":"2018","journal-title":"Pediatrics"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.ejpn.2023.05.007","article-title":"Changes in prevalence of non-optimal neurological condition between 6.5 and 12 years in children born extremely preterm","volume":"45","author":"D Nosko","year":"2023","journal-title":"Eur J Paediatr Neurol"},{"issue":"03","key":"ref3","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1111\/j.1469-8749.2009.03544.x","article-title":"Prevalence of motor-skill impairment in preterm children who do not develop cerebral palsy: a systematic review","volume":"52","author":"J Williams","year":"2010","journal-title":"Dev Med Child Neurol"},{"issue":"03","key":"ref4","doi-asserted-by":"publisher","first-page":"e180","DOI":"10.1002\/hsr2.180","article-title":"Analysis of neurodevelopmental outcomes of preadolescents born with extremely low weight revealed impairments in multiple developmental domains despite absence of cognitive impairment","volume":"3","author":"V Tommiska","year":"2020","journal-title":"Health Sci Rep"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.ejpn.2021.10.005","article-title":"Neonatal hypoxic-ischaemic encephalopathy: Motor impairment beyond cerebral palsy","volume":"35","author":"G Erdi-Krausz","year":"2021","journal-title":"Eur J Paediatr Neurol"},{"issue":"03","key":"ref6","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1111\/dmcn.14132","article-title":"International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder","volume":"61","author":"R Blank","year":"2019","journal-title":"Dev Med Child Neurol"},{"key":"ref7","volume-title":"Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed","year":"2013"},{"key":"ref8","volume-title":"Exame neurol\u00f3gico evolutivo","author":"A B Lef\u00e8vre","year":"1972"},{"key":"ref9","volume-title":"Examination of the child with minor neurological dysfunction. 2nd ed","author":"B CL Touwen","year":"1979"},{"issue":"08","key":"ref10","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1017\/s0012162201002560","article-title":"Two distinct forms of minor neurological dysfunction: perspectives emerging from a review of data of the Groningen Perinatal Project","volume":"44","author":"M Hadders-Algra","year":"2002","journal-title":"Dev Med Child Neurol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1155\/NP.2003.39","article-title":"Developmental coordination disorder: is clumsy motor behavior caused by a lesion of the brain at early age?","volume":"10","author":"M Hadders-Algra","year":"2003","journal-title":"Neural Plast"},{"issue":"01","key":"ref12","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1111\/j.1469-8749.2009.03305.x","article-title":"The assessment of minor neurological dysfunction in infancy using the Touwen Infant Neurological Examination: strengths and limitations","volume":"52","author":"M Hadders-Algra","year":"2010","journal-title":"Dev Med Child Neurol"},{"issue":"02","key":"ref13","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1111\/j.1651-2227.2010.01998.x","article-title":"Limited motor performance and minor neurological dysfunction at school age","volume":"100","author":"L H Peters","year":"2011","journal-title":"Acta Paediatr"},{"issue":"01","key":"ref14","doi-asserted-by":"publisher","first-page":"F9","DOI":"10.1136\/fn.76.1.f9","article-title":"Minor neurological signs and perceptual-motor difficulties in prematurely born children","volume":"76","author":"M Jongmans","year":"1997","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"04","key":"ref15","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1097\/PRA.0000000000000312","article-title":"Scientific Evidence for the Evaluation of Neurological Soft Signs as Atypical Neurodevelopment Markers in Childhood Neuropsychiatric Disorders","volume":"24","author":"E D'Agati","year":"2018","journal-title":"J Psychiatr Pract"},{"key":"ref16","volume-title":"Examination of the child with minor neurological dysfunction. 3rd ed","author":"M Hadders-Algra","year":"2010"},{"key":"ref17","volume-title":"The neurological examination technique for toddler-age","author":"M S Hempel","year":"1993"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.earlhumdev.2017.06.004","article-title":"Neurological condition assessed with the Hempel examination and cognition and behaviour at 4years","volume":"112","author":"P Schendelaar","year":"2017","journal-title":"Early Hum Dev"},{"issue":"03","key":"ref19","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/BF01543465","article-title":"The reliability and diagnostic validity of the physical and neurological examination for soft signs (PANESS)","volume":"6","author":"J S Werry","year":"1976","journal-title":"J Autism Child Schizophr"},{"issue":"05","key":"ref20","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1097\/00004583-198909000-00017","article-title":"Reliability of subtle (soft) neurological signs in children","volume":"28","author":"B Vitiello","year":"1989","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"11","key":"ref21","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1111\/dmcn.12265","article-title":"Minor neurological dysfunction and behaviour in 9-year-old children born at term: evidence for sex dimorphism","volume":"55","author":"H K Kikkert","year":"2013","journal-title":"Dev Med Child Neurol"},{"issue":"04","key":"ref22","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/j.ejpn.2007.09.006","article-title":"Test-retest, inter-assessor and intra-assessor reliability of the modified Touwen examination","volume":"12","author":"L H Peters","year":"2008","journal-title":"Eur J Paediatr Neurol"},{"issue":"12","key":"ref23","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1080\/08035250310006926","article-title":"Neurological assessment at five years of age in infants born preterm","volume":"92","author":"A Fily","year":"2003","journal-title":"Acta Paediatr"},{"issue":"12","key":"ref24","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1111\/j.1469-8749.1993.tb07927.x","article-title":"Some aspects of the reliability of Touwen's examination of the child with minor neurological dysfunction","volume":"35","author":"T H Kakebeeke","year":"1993","journal-title":"Dev Med Child Neurol"},{"issue":"05","key":"ref25","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1111\/j.1469-8749.2007.00325.x","article-title":"Developmental coordination disorder at 8 years of age in a regional cohort of extremely-low-birthweight or very preterm infants","volume":"49","author":"N M Davis","year":"2007","journal-title":"Dev Med Child Neurol"},{"issue":"08","key":"ref26","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1111\/dmcn.13738","article-title":"Minor neurological dysfunction and associations with motor function, general cognitive abilities, and behaviour in children born extremely preterm","volume":"60","author":"L Brostr\u00f6m","year":"2018","journal-title":"Dev Med Child Neurol"},{"issue":"9615","key":"ref27","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/S0140-6736(08)60380-3","article-title":"Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study","volume":"371","author":"B Larroque","year":"2008","journal-title":"Lancet"},{"issue":"03","key":"ref28","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/S2352-4642(20)30034-1","article-title":"Mijna Hadders-Algra","volume":"4","author":"R Stirrups","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/0378-3782(85)90076-3","article-title":"Minor neurological dysfunction and behavioural development. A report from the Groningen Perinatal Project","volume":"11","author":"M Hadders-Algra","year":"1985","journal-title":"Early Hum Dev"},{"issue":"11","key":"ref30","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1001\/archpedi.161.11.1053","article-title":"Prevalence and associated factors of minor neuromotor dysfunctions at age 5 years in prematurely born children: the EPIPAGE Study","volume":"161","author":"C Arnaud","year":"2007","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"10","key":"ref31","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1177\/002221949202501004","article-title":"Minor neurological dysfunction is more closely related to learning difficulties than to behavioral problems","volume":"25","author":"M Hadders-Algra","year":"1992","journal-title":"J Learn Disabil"},{"issue":"04","key":"ref32","doi-asserted-by":"publisher","first-page":"e16","DOI":"10.1111\/j.1469-8749.2010.03879.x","article-title":"Minor neurological dysfunction and IQ in 9-year-old children born at term","volume":"53","author":"H K Kikkert","year":"2011","journal-title":"Dev Med Child Neurol"},{"issue":"12","key":"ref33","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1111\/j.1469-8749.2010.03712.x","article-title":"Minor neurological dysfunction in children with dyslexia","volume":"52","author":"M Punt","year":"2010","journal-title":"Dev Med Child Neurol"},{"issue":"04","key":"ref34","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1111\/j.1469-8749.1988.tb04775.x","article-title":"Perinatal risk factors and minor neurological dysfunction: significance for behaviour and school achievement at nine years","volume":"30","author":"M Hadders-Algra","year":"1988","journal-title":"Dev Med Child Neurol"},{"issue":"04","key":"ref35","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1111\/j.1469-8749.1993.tb11644.x","article-title":"Is minor neurological dysfunction at 12 years related to behaviour and cognition?","volume":"35","author":"R J Soorani-Lunsing","year":"1993","journal-title":"Dev Med Child Neurol"},{"issue":"05","key":"ref36","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1111\/j.1469-8749.1992.tb11451.x","article-title":"Minor neurological dysfunction from birth to 12 years. I: Increase during late school-age","volume":"34","author":"R J Lunsing","year":"1992","journal-title":"Dev Med Child Neurol"},{"issue":"05","key":"ref37","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1111\/j.1469-8749.1992.tb11452.x","article-title":"Minor neurological dysfunction from birth to 12 years. II: Puberty is related to decreased dysfunction","volume":"34","author":"R J Lunsing","year":"1992","journal-title":"Dev Med Child Neurol"},{"issue":"04","key":"ref38","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1111\/j.1469-8749.1994.tb11854.x","article-title":"Neurobehavioural relationships after the onset of puberty","volume":"36","author":"R J Soorani-Lunsing","year":"1994","journal-title":"Dev Med Child Neurol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1155\/NP.2003.165","article-title":"Discussion: significance and treatment of clumsiness in children","volume":"10","author":"M Hadders-Algra","year":"2003","journal-title":"Neural Plast"},{"issue":"02","key":"ref40","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1080\/1034912X.2019.1614154","article-title":"Minor neurological dysfunction in preterm children and its association with school readiness","volume":"67","author":"R Yildiz","year":"2020","journal-title":"Int J Disabil Dev Educ"},{"issue":"06","key":"ref41","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1111\/dmcn.12295","article-title":"Motor impairment in very preterm-born children: links with other developmental deficits at 5 years of age","volume":"56","author":"J W Van Hus","year":"2014","journal-title":"Dev Med Child Neurol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.earlhumdev.2016.07.002","article-title":"Minor neurological dysfunction in five year old very preterm children is associated with lower processing speed","volume":"103","author":"T Kurpershoek","year":"2016","journal-title":"Early Hum Dev"},{"issue":"06","key":"ref43","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1542\/peds.2005-0171","article-title":"Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1996-1997","volume":"116","author":"K Mikkola","year":"2005","journal-title":"Pediatrics"},{"issue":"09","key":"ref44","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1097\/DBP.0b013e31822a396a","article-title":"Developmental coordination disorder in school-aged children born very preterm and\/or at very low birth weight: a systematic review","volume":"32","author":"J Edwards","year":"2011","journal-title":"J Dev Behav Pediatr"},{"issue":"S 04","key":"ref45","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1111\/dmcn.12309","article-title":"Neural correlates of developmental coordination disorder","volume":"55","author":"L HJ Peters","year":"2013","journal-title":"Dev Med Child Neurol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"996472","DOI":"10.3389\/fpsyg.2022.996472","article-title":"Extremely preterm children and relationships of minor neurodevelopmental impairments at 6 years","volume":"13","author":"U Niutanen","year":"2022","journal-title":"Front Psychol"},{"issue":"11","key":"ref47","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1001\/archpedi.1975.02120480037009","article-title":"The minimal brain dysfunction myth","volume":"129","author":"B D Schmitt","year":"1975","journal-title":"Am J Dis Child"},{"issue":"04","key":"ref48","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1007\/s12402-010-0045-8","article-title":"The history of attention deficit hyperactivity disorder","volume":"2","author":"K W Lange","year":"2010","journal-title":"Atten Defic Hyperact Disord"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1016\/j.bbr.2015.07.009","article-title":"Attention deficit hyperactivity disorder and developmental coordination disorder: Two separate disorders or do they share a common etiology","volume":"292","author":"J B Goulardins","year":"2015","journal-title":"Behav Brain Res"},{"issue":"02","key":"ref50","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1177\/0031512517690607","article-title":"Attention Deficit Hyperactivity Disorder and Motor Impairment","volume":"124","author":"J B Goulardins","year":"2017","journal-title":"Percept Mot Skills"},{"issue":"01","key":"ref51","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1001\/archneur.1989.00520370050018","article-title":"Striatal dysfunction in attention deficit and hyperkinetic disorder","volume":"46","author":"H C Lou","year":"1989","journal-title":"Arch Neurol"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1080\/00223980.1979.9915081","article-title":"Construct validation of children's behavior problem dimensions: relationship to activity level, impulsivity, and soft neurological signs","volume":"101","author":"K Paulsen","year":"1979","journal-title":"J Psychol"},{"issue":"06","key":"ref53","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1111\/j.1469-8749.1981.tb02066.x","article-title":"Neurological \u2018soft\u2019 signs in low-birthweight children","volume":"23","author":"M E Hertzig","year":"1981","journal-title":"Dev Med Child Neurol"},{"issue":"02","key":"ref54","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1080\/01688638208401121","article-title":"Developmental neuropsychiatry: concepts, issues and prospects","volume":"4","author":"M Rutter","year":"1982","journal-title":"J Clin Neuropsychol"},{"issue":"03","key":"ref55","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1111\/j.1442-200x.2004.01883.x","article-title":"Behavioral outcome including attention deficit hyperactivity disorder\/hyperactivity disorder and minor neurological signs in perinatal high-risk newborns at 4-6 years of age with relation to risk factors","volume":"46","author":"M Sato","year":"2004","journal-title":"Pediatr Int"},{"issue":"06","key":"ref56","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1080\/13546805.2016.1235029","article-title":"Neurological soft signs are associated with attentional dysfunction in children with attention deficit hyperactivity disorder","volume":"21","author":"M Pitzianti","year":"2016","journal-title":"Cogn Neuropsychiatry"},{"issue":"05","key":"ref57","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.earlhumdev.2012.10.001","article-title":"Minor neurological dysfunction and cognition in 9-year-olds born at term","volume":"89","author":"H K Kikkert","year":"2013","journal-title":"Early Hum Dev"},{"key":"ref58","volume-title":"Desenvolvimento psicomotor e aprendizagem","author":"Vd Fonseca","year":"2008"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1146\/annurev-psych-010418-102836","article-title":"Motor development: embodied, embedded, enculturated, and enabling","volume":"70","author":"K E Adolph","year":"2019","journal-title":"Annu Rev Psychol"},{"issue":"01","key":"ref60","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1542\/peds.2011-1066","article-title":"Children, adolescents, obesity, and the media","volume":"128","author":"V C Strasburger","year":"2011","journal-title":"Pediatrics"},{"issue":"05","key":"ref61","doi-asserted-by":"publisher","first-page":"1350","DOI":"10.1111\/j.1467-8624.2009.01337.x","article-title":"The impact of background television on parent-child interaction","volume":"80","author":"H L Kirkorian","year":"2009","journal-title":"Child Dev"},{"issue":"10","key":"ref62","doi-asserted-by":"publisher","first-page":"4840","DOI":"10.1093\/cercor\/bhab126","article-title":"Widespread Positive Direct and Indirect Effects of Regular Physical Activity on the Developing Functional Connectome in Early Adolescence","volume":"31","author":"S J Brooks","year":"2021","journal-title":"Cereb Cortex"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.dcn.2015.11.005","article-title":"Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not","volume":"18","author":"A Diamond","year":"2016","journal-title":"Dev Cogn Neurosci"}],"container-title":["Arquivos de Neuro-Psiquiatria"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0045-1809359.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T22:36:27Z","timestamp":1748817387000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0045-1809359"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":63,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2025,5,9]]},"published-print":{"date-parts":[[2025,5]]}},"alternative-id":["s00451809359"],"URL":"https:\/\/doi.org\/10.1055\/s-0045-1809359","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0004-282X","1678-4227"],"issn-type":[{"value":"0004-282X","type":"print"},{"value":"1678-4227","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]}}}