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Sun H, Yang R, Jiang H, Tian X, Zhao Y, Gao Z, Wu H. Typewriter Tinnitus: Value of ABR as a Diagnostic and Prognostic Indicator. Ear Hear 2023; 44:1430-1436. [PMID: 37171375 PMCID: PMC10583909 DOI: 10.1097/aud.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/03/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Typewriter tinnitus refers to a special kind of staccato tinnitus, which is mostly described by patients as Morse code, popcorn, or machine-gun. It has been accepted that the mechanism of typewriter tinnitus is caused by the neurovascular compression of the cochleovestibular nerve. Patients who suffered from typewriter tinnitus have exhibited a good response to carbamazepine or oxcarbazepine, but there is a risk of recurrence after treatment cessation. The present study aims to determine the value of auditory brainstem response (ABR) in diagnosing typewriter tinnitus and predicting relapse after drug withdrawal. METHODS Patients who presented with typewriter tinnitus from March 2019 to March 2022 were included for the present retrospective study. The auditory and vestibular test results and drug treatment effects were collected and analyzed. Patients with idiopathic unilateral subjective tinnitus, who were matched by age to patients with typewriter tinnitus at a ratio of 2:1, were consecutively recruited for the control group. RESULTS Eighteen patients with typewriter tinnitus and 38 controls were included. Ears with typewriter tinnitus had longer interpeak latency (IPL) I-III, and wave III and V latencies, and a higher ratio of IPL I-III ≥2.3 ms based on ABR, when compared to the unaffected side and controls ( p <0.05). Seventeen patients with typewriter tinnitus responded positively to medication. Among these patients, seven patients had a relapse after drug cessation, while 10 patients did not have a relapse. The relapse group had significantly longer IPL I-III and wave V latency, older age, and poorer hearing, when compared to the nonrelapse group ( p < 0.05). Furthermore, IPL I-III had the largest area under the receiver operating characteristic curve, and the optimal cutoff was 2.4 ms (sensitivity, 100.0%; specificity, 66.7%). There were no significant differences in other demography or other clinical test results between the relapse and nonrelapse groups ( p > 0.05). Ramsay Hunt syndrome and neuromyelitis optica spectrum disorders were identified in two cases. CONCLUSION Prolonged IPL I-III based on ABR can help in the diagnosis of typewriter tinnitus and its prognosis after treatment cessation. Patients with IPL I-III greater than 2.4 ms, older age and poorer hearing are more likely to relapse. In addition to the neurovascular conflict of the cochleovestibular nerve, the etiologies of neuroinflammation and demyelinating diseases are also possible for typewriter tinnitus.
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Affiliation(s)
- Huiying Sun
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruizhe Yang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Jiang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Tian
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiqiang Gao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyan Wu
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Gupta T, Munawara R, Kaur M, Ram K, Rao A, Gupta S, Gupta SK. Central myelin-peripheral myelin junction in trigeminal, facial, and vestibulocochlear nerve: A histo-morphometric study. Ann Anat 2023; 250:152128. [PMID: 37399929 DOI: 10.1016/j.aanat.2023.152128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND The study aimed to locate the central myelin and peripheral myelin junction (CNS PNS Junction, CPJ) in trigeminal, facial and vestibulocochlear nerves. METHODS The cisternal segments of the nerves were cut from the brainstem to the proximal margin of trigeminal ganglia (trigeminal nerve) and internal acoustic meatus (facial and vestibulocochlear nerve) from cadavers. Horizontal sections of H&E stained slides were analysed and histo morphometry was performed. The CPJ was confirmed by immunohistochemistry using monoclonal myelin basic protein antibody. RESULTS The mean length of the trigeminal, facial and vestibulocochlear nerves were 13.6 ± 3.1 mm, 12.4 ± 1.9 mm and 11.5 ± 2.0 mm respectively; mean length of the centrally myelinated segment at the point of maximum convexity was 4.1 ± 1.5 mm, 3.7 ± 1.6 mm, 3.6 ± 1.4 mm respectively. Six different patterns were observed fortheCPJ.Utilizing the derived values, the CPJwas located at a distance of 18 - 48% and 17 - 61% of the total length of the nerve in all the cases in trigeminal and facial nerve respectively. In vestibulocochlear nerve, it was located at a distance of about 13 - 54% of the total length of the nerve. CONCLUSIONS The location of the CPJ in the vestibulocochlear nerve was midway between the brainstem and internal acoustic meatus which is a novel observation.For all the nerves, the CPJ was located either at or before the half way along the length of the nerve in huge majority (97%); never crossing the 60% of the nerve length.
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Affiliation(s)
- Tulika Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Rafika Munawara
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Mandeep Kaur
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Kalu Ram
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Asha Rao
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shivani Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sunil Kumar Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Brînzeu A, Sindou M. The Pierre Wertheimer Neurological and Neurosurgical Hospital in Lyon: history of its development and contributions to neurosurgery. J Neurosurg 2022; 138:1457-1466. [PMID: 36087314 DOI: 10.3171/2022.7.jns212946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 07/19/2022] [Indexed: 11/06/2022]
Abstract
At the end of the 1950s, at the direction of Pierre Wertheimer, the first French professor of neurosurgery, the treatment of neurological and neurosurgical diseases for Lyon's 2 million people was concentrated in a single center functioning as not only a hospital but also a campus for neuroscience. The ideas behind the structure revolve around concepts such as spatial unity, comprehensive specialized fields, a critical mass of patients, a structured training program, and essential cross-communication between areas in the same field. Through several generations of doctors, researchers, and professors, the Pierre Wertheimer Neurological and Neurosurgical Hospital in Lyon (NHL) has had an important impact on clinical practice, fundamental neuroscientific research, and specialist training. Under Wertheimer's stewardship, functional neurosurgery became one of the fields of excellence at the NHL with contributions in pain surgery and physiology but also epilepsy surgery and surgery for spasticity. Typically, these contributions were the result of the collaboration of separate teams, ultimately laying the groundwork for a neuroscientific doctoral school. The large mass of patients treated at the NHL provided opportunities for other, more isolated insights, such as the classification of pineal tumors and contributions to interventional neuroradiology. The present work endeavors to illustrate the contributions of the NHL to neuroscience and discuss the background allowing for their occurrence.
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Affiliation(s)
- Andrei Brînzeu
- 2Pain Research Unit (Neuropain) Lyon Neuroscience Research Center, University of Lyon, France.,3Neuroscience Research Center, University of Medicine and Pharmacy "Victor Babes" Timisoara; and.,4Neurosurgery Department, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
| | - Marc Sindou
- 1Neurosurgery Department, University of Lyon.,3Neuroscience Research Center, University of Medicine and Pharmacy "Victor Babes" Timisoara; and
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Vestibular paroxysmia: clinical characteristics and long-term course. J Neurol 2022; 269:6237-6245. [PMID: 35595969 PMCID: PMC9618515 DOI: 10.1007/s00415-022-11151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022]
Abstract
In 2016, the Bárány Society defined new diagnostic criteria for the neurovascular compression syndrome of the eighth nerve, called “vestibular paroxysmia” (VP), differentiating between definite (dVP) and probable (pVP) forms. The aim of this study was (1) to describe clinical symptoms and laboratory findings in a well-diagnosed large patient cohort according to those criteria, and (2) to evaluate the long-term course over years in dVP. We identified 146 patients (73 dVP, 73 pVP) from our tertiary dizziness center registry. Data of structured history-taking, clinical neurological, neuro-ophthalmological/-otological examinations as well as MRI imaging were extracted for analyses. Overall, attack frequency ranged between 5 and 30 attacks per day; spinning vertigo was the most frequent type. In two-thirds of patients, attacks occurred spontaneously; in one-quarter, they were triggered by head movements. The majority (approximately 70%) reported no accompanying symptoms; in those with symptoms, mild unilateral cochlear symptoms prevailed. One-third of patients initially showed hyperventilation-induced nystagmus without specific direction, and a deviation of the subjective visual vertical between 3° and 6°. Complete loss of peripheral vestibular function was never evident. dVP and pVP significantly differed concerning the vertigo type, e.g., spinning vertigo was more frequent in dVP. Fortunately, three-quarters of dVP patients remained attack-free during follow-up (mean 4.8 years, standardized questionnaire), more than half of them even without any medication. Patients with ongoing attacks showed significantly higher attack frequency at baseline, but reported persistent frequency reduction. Overall, the long-term prognosis of VP appears favorable, not necessarily requiring ongoing treatment.
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Karamitros A, Kalamatianos T, Stranjalis G, Anagnostou E. Vestibular paroxysmia: Clinical features and imaging findings; a literature review. J Neuroradiol 2021; 49:225-233. [PMID: 34364914 DOI: 10.1016/j.neurad.2021.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
According to the definition of neurovascular compression syndromes (NVCS), a vascular structure in direct contact with a cranial nerve is causing mechanical irritation of the neural tissue producing correlating symptoms. Vestibular paroxysmia is an example of a neurovascular compression which is caused by neurovascular contact between the eighth cranial nerve and a vessel. It is crucial to understand the unique anatomy of the vestibulocochlear nerve in order to study the syndrome which is the result of its compression. More specifically, the long transitional zone between central and peripheral myelin plays a central role in clinical significance, as the transitional zone is the structure most prone to mechanical injury. Imaging techniques of the eighth cranial nerve and the surrounding structures are substantial for the demonstration of clinically significant cases and potential surgical decompression. The goal of the current review is to present and study the existing literature on vestibular paroxysmia and to search for the most appropriate imaging technique for the syndrome. An extensive literature search of PubMed database was performed, and the studies were ranked based on evidence-based criteria, followed by descriptive statistics of the data. The present analysis indicates that 3D CISS MRI sequence is superior to any other sequence, in the most studies reviewed, regarding the imaging of neurovascular compression of the eighth cranial nerve.
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Affiliation(s)
- Andreas Karamitros
- Neurosurgery, Atkinson Morley Wing, St George's University Hospitals NHS Trust, Blackshaw Rd, Tooting, London SW17 0QT.
| | - Theodosis Kalamatianos
- Department of Neurosurgery, University of Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Stranjalis
- Department of Neurosurgery, University of Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Dlugaiczyk J. Rare Disorders of the Vestibular Labyrinth: of Zebras, Chameleons and Wolves in Sheep's Clothing. Laryngorhinootologie 2021; 100:S1-S40. [PMID: 34352900 PMCID: PMC8363216 DOI: 10.1055/a-1349-7475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The differential diagnosis of vertigo syndromes is a challenging issue, as many - and in particular - rare disorders of the vestibular labyrinth can hide behind the very common symptoms of "vertigo" and "dizziness". The following article presents an overview of those rare disorders of the balance organ that are of special interest for the otorhinolaryngologist dealing with vertigo disorders. For a better orientation, these disorders are categorized as acute (AVS), episodic (EVS) and chronic vestibular syndromes (CVS) according to their clinical presentation. The main focus lies on EVS sorted by their duration and the presence/absence of triggering factors (seconds, no triggers: vestibular paroxysmia, Tumarkin attacks; seconds, sound and pressure induced: "third window" syndromes; seconds to minutes, positional: rare variants and differential diagnoses of benign paroxysmal positional vertigo; hours to days, spontaneous: intralabyrinthine schwannomas, endolymphatic sac tumors, autoimmune disorders of the inner ear). Furthermore, rare causes of AVS (inferior vestibular neuritis, otolith organ specific dysfunction, vascular labyrinthine disorders, acute bilateral vestibulopathy) and CVS (chronic bilateral vestibulopathy) are covered. In each case, special emphasis is laid on the decisive diagnostic test for the identification of the rare disease and "red flags" for potentially dangerous disorders (e. g. labyrinthine infarction/hemorrhage). Thus, this chapter may serve as a clinical companion for the otorhinolaryngologist aiding in the efficient diagnosis and treatment of rare disorders of the vestibular labyrinth.
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Affiliation(s)
- Julia Dlugaiczyk
- Klinik für Ohren-, Nasen-, Hals- und Gesichtschirurgie
& Interdisziplinäres Zentrum für Schwindel und
neurologische Sehstörungen, Universitätsspital Zürich
(USZ), Universität Zürich (UZH), Zürich,
Schweiz
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Trapp B, Hsu CCT, Panwar J, Krings T. High Resolution MRI of Vestibulocochlear Nerve Involvement by a Posterior Fossa Ganglioglioma: Case Report and Review of Literature. Clin Neuroradiol 2018; 29:171-174. [PMID: 29858609 DOI: 10.1007/s00062-018-0698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Bárbara Trapp
- Division of Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Charlie Chia-Tsong Hsu
- Division of Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Canada.
| | - Jyoti Panwar
- Division of Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Timo Krings
- Division of Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Canada
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Morphometric evaluation of facial and vestibulocochlear nerves using magnetic resonance imaging: comparison of Menière’s disease ears with normal hearing ears. Eur Arch Otorhinolaryngol 2017; 274:3029-3039. [DOI: 10.1007/s00405-017-4616-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 05/19/2017] [Indexed: 01/11/2023]
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Affiliation(s)
- Joseph H Donahue
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908, USA
| | - David A Ornan
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908, USA.
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Haller S, Etienne L, Kövari E, Varoquaux AD, Urbach H, Becker M. Imaging of Neurovascular Compression Syndromes: Trigeminal Neuralgia, Hemifacial Spasm, Vestibular Paroxysmia, and Glossopharyngeal Neuralgia. AJNR Am J Neuroradiol 2016; 37:1384-92. [PMID: 26892985 DOI: 10.3174/ajnr.a4683] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neurovascular compression syndromes are usually caused by arteries that directly contact the cisternal portion of a cranial nerve. Not all cases of neurovascular contact are clinically symptomatic. The transition zone between the central and peripheral myelin is the most vulnerable region for symptomatic neurovascular compression syndromes. Trigeminal neuralgia (cranial nerve V) has an incidence of 4-20/100,000, a transition zone of 4 mm, with symptomatic neurovascular compression typically proximal. Hemifacial spasm (cranial nerve VII) has an incidence of 1/100,000, a transition zone of 2.5 mm, with symptomatic neurovascular compression typically proximal. Vestibular paroxysmia (cranial nerve VIII) has an unknown incidence, a transition zone of 11 mm, with symptomatic neurovascular compression typically at the internal auditory canal. Glossopharyngeal neuralgia (cranial nerve IX) has an incidence of 0.5/100,000, a transition zone of 1.5 mm, with symptomatic neurovascular compression typically proximal. The transition zone overlaps the root entry zone close to the brain stem in cranial nerves V, VII, and IX, yet it is more distal and does not overlap the root entry zone in cranial nerve VIII. Although symptomatic neurovascular compression syndromes may also occur if the neurovascular contact is outside the transition zone, symptomatic neurovascular compression syndromes are more common if the neurovascular contact occurs at the transition zone or central myelin section, in particular when associated with nerve displacement and atrophy.
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Affiliation(s)
- S Haller
- From the Faculty of Medicine (S.H.), University of Geneva, Geneva, Switzerland Centre de Diagnostique Radiologique de Carouge (S.H.), Carouge, Switzerland Departments of Surgical Sciences and Radiology (S.H.), Uppsala University, Uppsala, Sweden Department of Neuroradiology (S.H., H.U.), University Hospital Freiburg, Germany
| | - L Etienne
- Departments of Radiology (L.E., M.B.)
| | - E Kövari
- Psychiatry (E.K.), Geneva University Hospitals, Geneva, Switzerland
| | - A D Varoquaux
- Department of Radiology (A.D.V.), University Hospital La Timone, Marseille, France
| | - H Urbach
- Department of Neuroradiology (S.H., H.U.), University Hospital Freiburg, Germany
| | - M Becker
- Departments of Radiology (L.E., M.B.)
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Tagoe T, Barker M, Jones A, Allcock N, Hamann M. Auditory nerve perinodal dysmyelination in noise-induced hearing loss. J Neurosci 2014; 34:2684-8. [PMID: 24523557 PMCID: PMC6802753 DOI: 10.1523/jneurosci.3977-13.2014] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/08/2014] [Accepted: 01/14/2014] [Indexed: 11/21/2022] Open
Abstract
Exposure to loud sound (acoustic overexposure; AOE) induces hearing loss and damages cellular structures at multiple locations in the auditory pathway. Whether AOE can also induce changes in myelin sheaths of the auditory nerve (AN) is an important issue particularly because these changes can be responsible for impaired action potential propagation along the AN. Here we investigate the effects of AOE on morphological and electrophysiological features of the centrally directed part of the rat AN projecting from the cochlear spiral ganglion to brainstem cochlear nuclei. Using electron microscopy and immunocytochemistry, we show that AOE elongates the AN nodes of Ranvier and triggers notable perinodal morphological changes. Compound action potential recordings of the AN coupled to biophysical modeling demonstrated that these nodal and perinodal structural changes were associated with decreased conduction velocity and conduction block. Furthermore, AOE decreased the number of release sites in the cochlear nuclei associated with the reduced amplitudes of EPSCs evoked by AN stimulation. In conclusion, AN dysmyelination may be of fundamental importance in auditory impairment following exposure to loud sound.
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Affiliation(s)
- Thomas Tagoe
- Department of Cell Physiology and Pharmacology, and
| | - Matt Barker
- Department of Cell Physiology and Pharmacology, and
| | - Andrew Jones
- Department of Cell Physiology and Pharmacology, and
| | - Natalie Allcock
- Electron Microscopy Facility, University of Leicester, Leicester LE1 9HN, United Kingdom
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