Interesting images
PET/CT imaging of post-stroke upper extremity spasticity without and with botulinum toxin A
Imágenes de PET/TC de espasticidad de la extremidad superior después de un accidente cerebrovascular sin y con toxina botulínica A
Department of Radiology, Mayo Clinic Arizona, United States
Read
3
Timeswas read the article
1
Total PDF
2
Total HTML
Share statistics
array:24 [ "pii" => "S2253808922000933" "issn" => "22538089" "doi" => "10.1016/j.remnie.2022.09.004" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "1372" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "copyrightAnyo" => "2022" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2023;42:113-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S2253654X22000269" "issn" => "2253654X" "doi" => "10.1016/j.remn.2022.02.003" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "1372" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2023;42:113-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imágenes de interés</span>" "titulo" => "Imágenes de PET/TC de espasticidad de la extremidad superior después de un accidente cerebrovascular sin y con toxina botulínica A" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "113" "paginaFinal" => "115" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "PET/CT imaging of post-stroke upper extremity spasticity without and with botulinum toxin A" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1415 "Ancho" => 2508 "Tamanyo" => 210843 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Imágenes de RM TSE axial T2 (A) y T1 mejoradas con contraste axial (B) de la encefalomalacia del territorio de la arteria cerebral media izquierda (flechas) responsable de la espasticidad de la extremidad superior derecha.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.V. Khuong, B.D. Nguyen" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J.V." "apellidos" => "Khuong" ] 1 => array:2 [ "nombre" => "B.D." "apellidos" => "Nguyen" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2253808922000933" "doi" => "10.1016/j.remnie.2022.09.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808922000933?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X22000269?idApp=UINPBA00004N" "url" => "/2253654X/0000004200000002/v2_202303161341/S2253654X22000269/v2_202303161341/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2253808922000283" "issn" => "22538089" "doi" => "10.1016/j.remnie.2022.01.003" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "1369" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2023;42:116-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "Use of <span class="elsevierStyleSup">125</span>I seeds in the surgical management of a complex oncological case" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "116" "paginaFinal" => "118" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de semillas de <span class="elsevierStyleSup">125</span>I en el manejo quirúrgico de un caso oncológico complejo" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 476 "Ancho" => 1305 "Tamanyo" => 73728 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">SPECT/CT axial and volumetric reconstruction images showing the localization of the <span class="elsevierStyleSup">125</span>I seeds placed, under ultrasound guidance, in the occipital and retroauricular lymph nodes the day before surgery, which also defined the suspected area of malignant tissue planned to be resected.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.G. Castillo-Simón, M. Tormo-Ratera, A. Ferrer-Fuertes, F.J. Cuesta-González, S. Vidal-Sicart" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A.G." "apellidos" => "Castillo-Simón" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Tormo-Ratera" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Ferrer-Fuertes" ] 3 => array:2 [ "nombre" => "F.J." "apellidos" => "Cuesta-González" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Vidal-Sicart" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X22000087" "doi" => "10.1016/j.remn.2022.01.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X22000087?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808922000283?idApp=UINPBA00004N" "url" => "/22538089/0000004200000002/v2_202311010503/S2253808922000283/v2_202311010503/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808923000022" "issn" => "22538089" "doi" => "10.1016/j.remnie.2023.01.002" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "1420" "copyright" => "The Authors" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2023;42:106-12" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special collaboration</span>" "titulo" => "Nuclear Cardiology in the COVID-19 pandemic" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "106" "paginaFinal" => "112" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La Cardiología Nuclear en la pandemia COVID-19" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1954 "Ancho" => 2508 "Tamanyo" => 351291 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Recommendations for safely performing myocardial perfusion SPECT for patients and health care personnel during the COVID-19 pandemic.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CZT: cadmium, zinc, telluride. *Following the peak phases and initial recession of the pandemic it was considered important to return to physical exercise if indicated. †In later phases of the pandemic the 2-day protocol was also recommended for the shorter time of patients in the facilities.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Milà López, Amelia Jiménez Heffernan, Elena Sánchez de Mora, María Patricia Fierro Alanis" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Milà López" ] 1 => array:2 [ "nombre" => "Amelia" "apellidos" => "Jiménez Heffernan" ] 2 => array:2 [ "nombre" => "Elena" "apellidos" => "Sánchez de Mora" ] 3 => array:2 [ "nombre" => "María Patricia" "apellidos" => "Fierro Alanis" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X23000033" "doi" => "10.1016/j.remn.2023.01.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X23000033?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808923000022?idApp=UINPBA00004N" "url" => "/22538089/0000004200000002/v2_202311010503/S2253808923000022/v2_202311010503/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "PET/CT imaging of post-stroke upper extremity spasticity without and with botulinum toxin A" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "113" "paginaFinal" => "115" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.V. Khuong, B.D. Nguyen" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J.V." "apellidos" => "Khuong" ] 1 => array:4 [ "nombre" => "B.D." "apellidos" => "Nguyen" "email" => array:1 [ 0 => "Nguyen.ba@mayo.edu" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Radiology, Mayo Clinic Arizona, United States" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Imágenes de PET/TC de espasticidad de la extremidad superior después de un accidente cerebrovascular sin y con toxina botulínica A" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2321 "Ancho" => 2508 "Tamanyo" => 343657 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anterior PET maximum intensity projection (MIP) and axial fused PET/CT images of the initial staging (A & C) showing hypermetabolic lung cancer with bone metastasis (arrowheads), and diffuse muscle uptake features of the right neck and right upper extremity involving mostly the right sternocleidomastoid muscle, right scalenus anterior muscle, right pectoralis muscles, right subscapularis muscle, right infraspinatus muscle, right biceps muscle, part of the triceps muscle and extensor muscle group of the right forearm (arrows). Subsequent post-therapeutic monitoring images (B & D) of improved lung cancer, resolved bone metastasis and resolved muscle uptake.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 62-year old woman, with lung cancer, was staged with <span class="elsevierStyleSup">18</span>F FDG PET/CT. This initial exam showed, in addition to a hypermetabolic right upper lung lesion and scattered tracer-avid bone metastasis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A & C), asymmetrically diffuse muscular uptake features of the right neck, shoulder girdle and upper extremity (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A & C). The patient’s clinical history was remarkable for an early infancy cerebro-vascular accident with spastic cerebral palsy. Her right upper extremity spasticity was treated periodically with botulinum toxin A (BTA). The initial PET/CT was acquired after the weaning of BTA effects. Subsequent post-treatment PET/CT surveillance showed improvement of the right upper lung lesion and resolution of bone metastasis. This second PET/CT was acquired one month after repeat BTA injections (200 IU) of the right upper limb with resolved tracer uptake of the relaxed muscles (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B & D).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Muscle uptake of <span class="elsevierStyleSup">18</span>F FDG on PET/CT may be from physiologic, artifactual and pathologic causes<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. Physiologic voluntary activities encompass simple tasks such as talking or chewing to more strenuous exercises with the more vigorous the muscle use and the closer the activities to the PET/CT imaging the more intense the tracer uptake. Physiologic involuntary activities may be from labored breathing, coughing, muscle spasm, spastic cerebral palsy, and epilepsy. Artifactual causes of muscle uptake are related to improper fasting prior to PET/CT imaging acquisition or medically induced effects of insulin or corticosteroids. Pathologic causes are inflammatory, infectious, traumatic, and malignant. Our patient showed diffuse muscle uptake features of the right neck and right upper extremity secondary to the known history of post-stroke cerebral palsy (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Her spasticity has been treated with intermittent BTA injections. The depiction of tracer-avid muscles on the initial PET/CT was coincidental to the cessation of BTA effects. The subsequent PET/CT resolution of spastic muscle uptake was secondary to the full relaxation impact of this re-administered drug. PET/CT has been reported in the imaging of cervical dystonia/spasmodic torticollis and documentation of improvement of this syndrome under BTA therapy<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. This treatment has also shown reduction of upper limb spasticity in cerebral palsy patients<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. As the most potent neurotoxin of Clostridium botulinum, BTA irreversibly binds to cholinergic presynaptic membranes at the neuromuscular junctions and inhibits acetylcholine release with dual effect of chemodenervation and reduction of spasticity. Due to its short duration of 3–4 months, repeat BTA injections are necessary to maintain the spasticity reduction.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2321 "Ancho" => 2508 "Tamanyo" => 343657 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anterior PET maximum intensity projection (MIP) and axial fused PET/CT images of the initial staging (A & C) showing hypermetabolic lung cancer with bone metastasis (arrowheads), and diffuse muscle uptake features of the right neck and right upper extremity involving mostly the right sternocleidomastoid muscle, right scalenus anterior muscle, right pectoralis muscles, right subscapularis muscle, right infraspinatus muscle, right biceps muscle, part of the triceps muscle and extensor muscle group of the right forearm (arrows). Subsequent post-therapeutic monitoring images (B & D) of improved lung cancer, resolved bone metastasis and resolved muscle uptake.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1415 "Ancho" => 2508 "Tamanyo" => 210843 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Axial T2 TSE and (B) Axial contrast enhanced T1 MR images of the encephalomalacia of the left middle cerebral artery territory (arrows) responsible for the right upper extremity spasticity.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "FDG-PET/CT in skeletal muscle: pitfalls and pathologies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.K. Parida" 1 => "S.G. Roy" 2 => "R. Kumar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.semnuclmed.2017.02.003" "Revista" => array:7 [ "tituloSerie" => "Semin Nucl Med" "fecha" => "2017" "volumen" => "47" "paginaInicial" => "362" "paginaFinal" => "372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28583276" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673606685784" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Localization of dystonic muscles with 18F-FDG PET/CT in idiopathic cervical dystonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.H. Sung" 1 => "J.Y. Choi" 2 => "D.H. Kim" 3 => "E.S. Kim" 4 => "Y.I. Son" 5 => "Y.S. Cho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Nucl Med" "fecha" => "2007" "volumen" => "48" "paginaInicial" => "1790" "paginaFinal" => "1795" "itemHostRev" => array:3 [ "pii" => "S1474442209700195" "estado" => "S300" "issn" => "14744422" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of Botulinum Toxin Type A on cerebral palsy with upper limb spasticity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.F. Yang" 1 => "C.P. Fu" 2 => "N.T. Kao" 3 => "R.C. Chan" 4 => "S.J. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.PHM.0000056989.67763.07" "Revista" => array:7 [ "tituloSerie" => "Am J Phys Med Rehabil" "fecha" => "2003" "volumen" => "82" "paginaInicial" => "284" "paginaFinal" => "289" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12649654" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1474442204009305" "estado" => "S300" "issn" => "14744422" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000004200000002/v2_202311010503/S2253808922000933/v2_202311010503/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000004200000002/v2_202311010503/S2253808922000933/v2_202311010503/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808922000933?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 January | 2 | 1 | 3 |
