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doi:10.1016/j.mcna.2016.09.013

However, the degree of reduction in alkaline phosphatase activity is not related to the severity of clinical manifestations [31]

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Magnetic resonance imaging (MRI) in September 2016 revealed bilateral degeneration of the forearm proximal tendons and degenerative changes of the neck muscles, with progression of these changes shown in the study of March 2018 (Figure 1)