{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T07:11:19Z","timestamp":1781075479704,"version":"3.54.1"},"reference-count":67,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,3,13]],"date-time":"2022-03-13T00:00:00Z","timestamp":1647129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004844","name":"National Cheng Kung University Hospital","doi-asserted-by":"publisher","award":["NCKUH11002033"],"award-info":[{"award-number":["NCKUH11002033"]}],"id":[{"id":"10.13039\/501100004844","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Muscle biopsy is a fundamental procedure to assist the final diagnosis of myopathy. With the recent advances in molecular diagnosis, serology tests, and mechanism-based classification in myopathy, the pr\u00e9cised diagnosis for myopathy required the applications of multiple tools. This study intends to reappraise the benefit of muscle biopsy in adult-onset myopathy under the setting of an optimized muscle biopsy protocol and comprehensive serology tests. A one-group pretest-posttest study design was used. The pre- and post-biopsy diagnoses and treatments in 69 adult patients were compared. Muscle biopsy yielded 85.5% of definitive diagnoses, including changes in pre-biopsy diagnoses (40.6%) and narrowing down the suspicious myopathies (49.3%). The demographic data and clinical parameters between the group \u201cwith change\u201d and \u201cwithout change\u201d after biopsy were not different. Among those with changes in diagnosis, 39.3% also had a corresponding shift in treatment, which benefits the patients significantly. Regarding the most common adult-onset myopathy, idiopathic inflammatory myopathy (IIM), 41% of patients with pre-biopsy diagnosis as IIM had changes in their IIM subtype diagnosis, and 53% was finally not IIM after muscle biopsy. Although there have been advances in molecular diagnosis recently, muscle biopsy still undoubtedly critically guided the diagnosis and treatment of adult-onset myopathy in the era of precision medicine.<\/jats:p>","DOI":"10.3390\/jcm11061580","type":"journal-article","created":{"date-parts":[[2022,3,13]],"date-time":"2022-03-13T22:29:43Z","timestamp":1647210583000},"page":"1580","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Muscle Biopsy: A Requirement for Precision Medicine in Adult-Onset Myopathy"],"prefix":"10.3390","volume":"11","author":[{"given":"Meng-Ju","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-An","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8014-616X","authenticated-orcid":false,"given":"Po-Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan-Ting","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"},{"name":"Department of Medical Genomics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s13317-014-0060-4","article-title":"Myositis autoantibodies and clinical phenotypes","volume":"5","author":"Ghirardello","year":"2014","journal-title":"Autoimmun. Highlights"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1097\/BOR.0b013e3282f01a8c","article-title":"Autoantibodies in idiopathic inflammatory myopathy: An update on clinical and pathophysiological significance","volume":"19","author":"Mimori","year":"2007","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12016-015-8510-y","article-title":"A Comprehensive Overview on Myositis-Specific Antibodies: New and Old Biomarkers in Idiopathic Inflammatory Myopathy","volume":"52","author":"Satoh","year":"2017","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1007\/s12016-016-8527-x","article-title":"The Immune Response and the Pathogenesis of Idiopathic Inflammatory Myositis: A Critical Review","volume":"52","author":"Ceribelli","year":"2017","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1001\/jamaneurol.2018.2598","article-title":"Development of a New Classification System for Idiopathic Inflammatory Myopathies Based on Clinical Manifestations and Myositis-Specific Autoantibodies","volume":"75","author":"Mariampillai","year":"2018","journal-title":"JAMA Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100013","DOI":"10.1016\/j.jtauto.2019.100013","article-title":"Frequencies and clinical associations of myositis-related antibodies in The Netherlands: A one-year survey of all Dutch patients","volume":"2","author":"Platteel","year":"2019","journal-title":"J. Transl. Autoimmun."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s13052-017-0419-z","article-title":"Congenital myopathies: Clinical phenotypes and new diagnostic tools","volume":"43","author":"Cassandrini","year":"2017","journal-title":"Ital. J. Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1038\/jhg.2016.2","article-title":"New massive parallel sequencing approach improves the genetic characterization of congenital myopathies","volume":"61","author":"Oliveira","year":"2016","journal-title":"J. Hum. Genet."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1097\/WCO.0000000000000371","article-title":"Next-generation sequencing approaches for the diagnosis of skeletal muscle disorders","volume":"29","author":"Nigro","year":"2016","journal-title":"Curr. Opin. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.nmd.2013.12.011","article-title":"Diagnostic approach to the congenital muscular dystrophies","volume":"24","author":"Bonnemann","year":"2014","journal-title":"Neuromuscul. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Babic Bozovic, I., Maver, A., Leonardis, L., Meznaric, M., Osredkar, D., and Peterlin, B. (2021). Diagnostic yield of exome sequencing in myopathies: Experience of a Slovenian tertiary centre. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0252953"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.spen.2012.09.008","article-title":"Update on the genetics of limb girdle muscular dystrophy","volume":"19","author":"Mitsuhashi","year":"2012","journal-title":"Semin. Pediatr. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.nmd.2007.08.009","article-title":"Limb-girdle muscular dystrophy: Diagnostic evaluation, frequency and clues to pathogenesis","volume":"18","author":"Lo","year":"2008","journal-title":"Neuromuscul. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1007\/s10930-021-10006-9","article-title":"A Journey with LGMD: From Protein Abnormalities to Patient Impact","volume":"40","author":"Georganopoulou","year":"2021","journal-title":"Protein J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1038\/jhg.2016.116","article-title":"The sensitivity of exome sequencing in identifying pathogenic mutations for LGMD in the United States","volume":"62","author":"Reddy","year":"2017","journal-title":"J. Hum. Genet."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1001\/jamaneurol.2015.2274","article-title":"Use of Whole-Exome Sequencing for Diagnosis of Limb-Girdle Muscular Dystrophy: Outcomes and Lessons Learned","volume":"72","author":"Ghaoui","year":"2015","journal-title":"JAMA Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1111\/imj.15358","article-title":"Idiopathic inflammatory myopathies: A review","volume":"51","author":"Ashton","year":"2021","journal-title":"Intern. Med. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1097\/WCO.0000000000000740","article-title":"Classification of idiopathic inflammatory myopathies: Pathology perspectives","volume":"32","author":"Tanboon","year":"2019","journal-title":"Curr. Opin. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/j.1468-1331.2009.02765.x","article-title":"Open muscle biopsy in suspected myopathy: Diagnostic yield and clinical utility","volume":"17","author":"Lai","year":"2009","journal-title":"Eur. J. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1136\/annrheumdis-2017-211468","article-title":"2017 European League Against Rheumatism\/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups","volume":"76","author":"Lundberg","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_21","first-page":"e3449","article-title":"Association of Preoperative Diagnosis with Clinical Yield of Muscle Biopsy","volume":"10","author":"Tenny","year":"2018","journal-title":"Cureus"},{"key":"ref_22","unstructured":"Dubowitz, V., Sewry, C., and Oldfors, A. (2021). Muscle Biopsy: A Practical Approach, Elsevier. [5th ed.]."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1038\/s41379-018-0164-x","article-title":"A pattern-based approach to the interpretation of skeletal muscle biopsies","volume":"32","author":"Cai","year":"2019","journal-title":"Mod. Pathol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1007\/s11926-021-01017-7","article-title":"Updates on the Immunopathology in Idiopathic Inflammatory Myopathies","volume":"23","author":"Uruha","year":"2021","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1080\/14737175.2020.1825943","article-title":"Diagnostic challenges in metabolic myopathies","volume":"20","author":"Angelini","year":"2020","journal-title":"Expert Rev. Neurother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.pmr.2012.08.017","article-title":"Electrodiagnostic evaluation of myopathies","volume":"24","author":"Paganoni","year":"2013","journal-title":"Phys. Med. Rehabilitation Clin. N. Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e82","DOI":"10.1055\/s-0039-1684022","article-title":"Advanced MRI Patterns of Muscle Disease in Inherited and Acquired Myopathies: What the Radiologist Should Know","volume":"23","author":"Caetano","year":"2019","journal-title":"Semin. Musculoskelet. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1111\/ene.12984","article-title":"Muscle imaging in inherited and acquired muscle diseases","volume":"23","author":"Verhamme","year":"2016","journal-title":"Eur. J. Neurol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1007\/s00330-010-1799-2","article-title":"Neuromuscular imaging in inherited muscle diseases","volume":"20","author":"Wattjes","year":"2010","journal-title":"Eur. Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/j.ejrad.2016.02.007","article-title":"MR imaging of skeletal muscle signal alterations: Systematic approach to evaluation","volume":"85","author":"Kumar","year":"2016","journal-title":"Eur. J. Radiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s11926-019-0807-z","article-title":"Diagnostic Imaging of Inflammatory Myopathies: New Concepts and a Radiological Approach","volume":"21","author":"Guimaraes","year":"2019","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Huang, Z.G., Gao, B.-X., Chen, H., Yang, M.-X., Chen, X.-L., Yan, R., Lu, X., Shi, K.-N., Chan, Q., and Wang, G.-C. (2017). An efficacy analysis of whole-body magnetic resonance imaging in the diagnosis and follow-up of polymyositis and dermatomyositis. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0181069"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s13075-017-1219-y","article-title":"Comparative analyses of muscle MRI and muscular function in anti-synthetase syndrome patients and matched controls: A cross-sectional study","volume":"19","author":"Andersson","year":"2017","journal-title":"Arthritis Res. Ther."},{"key":"ref_34","first-page":"1897","article-title":"Magnetic resonance imaging criteria for distinguishing between inclusion body myositis and polymyositis","volume":"29","author":"Dion","year":"2002","journal-title":"J. Rheumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1093\/rheumatology\/keu422","article-title":"Magnetic resonance imaging changes of thigh muscles in myopathy with antibodies to signal recognition particle","volume":"54","author":"Zheng","year":"2015","journal-title":"Rheumatology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3499","DOI":"10.1007\/s00330-015-3783-3","article-title":"Whole-body MRI in adult inflammatory myopathies: Do we need imaging of the trunk?","volume":"25","author":"Filli","year":"2015","journal-title":"Eur. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1590\/S1806-37132011000100015","article-title":"Myositis-related interstitial lung disease and antisynthetase syndrome","volume":"37","author":"Solomon","year":"2011","journal-title":"J. Bras. Pneumol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/01.md.0000173991.74008.b0","article-title":"Novel classification of idiopathic inflammatory myopathies based on overlap syndrome features and autoantibodies: Analysis of 100 French Canadian patients","volume":"84","author":"Troyanov","year":"2005","journal-title":"Medicine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1136\/jnnp.2008.168294","article-title":"Toxic and drug-induced myopathies","volume":"80","author":"Dalakas","year":"2009","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.cger.2016.08.002","article-title":"Pathogenesis and Management of Sarcopenia","volume":"33","author":"Dhillon","year":"2017","journal-title":"Clin. Geriatr. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S51","DOI":"10.1007\/s40520-015-0427-z","article-title":"Sarcopenia: A histological and immunohistochemical study on age-related muscle impairment","volume":"27","author":"Tarantino","year":"2015","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1097\/00019052-200110000-00005","article-title":"Congenital myopathies and congenital muscular dystrophies","volume":"14","author":"Tubridy","year":"2001","journal-title":"Curr. Opin. Neurol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.ncl.2013.04.004","article-title":"Muscular dystrophies and other genetic myopathies","volume":"31","author":"Shieh","year":"2013","journal-title":"Neurol. Clin."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1017\/cjn.2015.311","article-title":"A Systematic Review and Meta-analysis on the Epidemiology of the Muscular Dystrophies","volume":"43","author":"Mah","year":"2016","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"109","DOI":"10.3233\/JND-180308","article-title":"Current Classification and Management of Inflammatory Myopathies","volume":"5","author":"Schmidt","year":"2018","journal-title":"J. Neuromuscul. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1002\/mus.24447","article-title":"Diagnostic outcome of muscle biopsy","volume":"51","author":"Shaibani","year":"2015","journal-title":"Muscle Nerve"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e12954","DOI":"10.1111\/bpa.12954","article-title":"MRI and muscle imaging for idiopathic inflammatory myopathies","volume":"31","author":"Malartre","year":"2021","journal-title":"Brain Pathol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.pedneo.2013.03.009","article-title":"Pompe disease: Early diagnosis and early treatment make a difference","volume":"54","author":"Chien","year":"2013","journal-title":"Pediatr. Neonatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"278","DOI":"10.21037\/atm.2019.04.13","article-title":"Molecular genetics of Pompe disease: A comprehensive overview","volume":"7","author":"Peruzzo","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2855","DOI":"10.1007\/s10072-020-04911-7","article-title":"The significance of myositis autoantibodies in idiopathic inflammatory myopathy concomitant with interstitial lung disease","volume":"42","author":"Huang","year":"2021","journal-title":"Neurol. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.jocn.2020.01.060","article-title":"Serological risk factors for concomitant interstitial lung disease in patients with idiopathic inflammatory myopathy","volume":"74","author":"Huang","year":"2020","journal-title":"J. Clin. Neurosci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1177\/1203475416665601","article-title":"Risk of Malignancy in Dermatomyositis and Polymyositis","volume":"21","author":"Qiang","year":"2016","journal-title":"J. Cutan. Med. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jaad.2019.06.1309","article-title":"Dermatomyositis: Clinical features and pathogenesis","volume":"82","author":"DeWane","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"5556","DOI":"10.21037\/jtd-20-3328","article-title":"A narrative review of interstitial lung disease in anti-synthetase syndrome: A clinical approach","volume":"13","author":"Sawal","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"609595","DOI":"10.3389\/fmed.2020.609595","article-title":"Antisynthetase Syndrome-Associated Interstitial Lung Disease: Monitoring of Immunosuppressive Treatment Effects by Chest Computed Tomography","volume":"7","author":"Korsten","year":"2020","journal-title":"Front. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.ccm.2019.05.004","article-title":"Interstitial Lung Disease in Polymyositis and Dermatomyositis","volume":"40","author":"Long","year":"2019","journal-title":"Clin. Chest Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"180076","DOI":"10.1183\/16000617.0076-2018","article-title":"Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases","volume":"27","author":"Cottin","year":"2018","journal-title":"Eur. Respir. Rev."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1136\/practneurol-2019-002465","article-title":"Muscle biopsy: What and why and when?","volume":"20","author":"Walters","year":"2020","journal-title":"Pract. Neurol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1016\/j.jpedsurg.2014.02.079","article-title":"Safety and yield of muscle biopsy in pediatric patients in the modern era","volume":"49","author":"Gibreel","year":"2014","journal-title":"J. Pediatr. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/j.1460-9592.2006.02043.x","article-title":"Anesthesia-related morbidity and mortality after surgery for muscle biopsy in children with mitochondrial defects","volume":"17","author":"Driessen","year":"2007","journal-title":"Pediatr. Anesthesia"},{"key":"ref_62","first-page":"175","article-title":"Incidence of adverse events associated with percutaneous muscular biopsy among healthy and diseased subjects. Scand","volume":"22","author":"Neves","year":"2012","journal-title":"J. Med. Sci. Sports"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1111\/sms.12808","article-title":"The muscle biopsy technique. Historical and methodological considerations","volume":"27","author":"Ekblom","year":"2016","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e889","DOI":"10.1212\/WNL.0000000000008005","article-title":"Idiopathic inflammatory myopathy: Interrater variability in muscle biopsy reading","volume":"93","author":"Olivier","year":"2019","journal-title":"Neurology"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s00415-011-6193-8","article-title":"Muscle biopsy","volume":"259","author":"Meola","year":"2012","journal-title":"J. Neurol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1016\/j.ajpath.2012.08.033","article-title":"Immune-mediated necrotizing myopathy is characterized by a specific Th1-M1 polarized immune profile","volume":"181","author":"Preusse","year":"2012","journal-title":"Am. J. Pathol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3389\/fneur.2016.00064","article-title":"Idiopathic Inflammatory Myopathies: Clinical Approach and Management","volume":"7","author":"Malik","year":"2016","journal-title":"Front. Neurol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/6\/1580\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:35:47Z","timestamp":1760135747000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/6\/1580"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,13]]},"references-count":67,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["jcm11061580"],"URL":"https:\/\/doi.org\/10.3390\/jcm11061580","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,13]]}}}