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Abu Qubo A, Numan J, Snijder J, Padilla M, Austin JH, Capaccione KM, Pernia M, Bustamante J, O'Connor T, Salvatore MM. Idiopathic pulmonary fibrosis and lung cancer: future directions and challenges. Breathe (Sheff) 2022; 18:220147. [PMID: 36865932 PMCID: PMC9973524 DOI: 10.1183/20734735.0147-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive disease of pulmonary scarring. New treatments slow disease progression and allow pulmonary fibrosis patients to live longer. Persistent pulmonary fibrosis increases a patient's risk of developing lung cancer. Lung cancer in patients with IPF differs from cancers that develop in the non-fibrotic lung. Peripherally located adenocarcinoma is the most frequent cell type in smokers who develop lung cancer, while squamous cell carcinoma is the most frequent in pulmonary fibrosis. Increased fibroblast foci in IPF are associated with more aggressive cancer behaviour and shorter doubling times. Treatment of lung cancer in fibrosis is challenging because of the risk of inducing an exacerbation of fibrosis. In order to improve patient outcomes, modifications of current lung cancer screening guidelines in patients with pulmonary fibrosis will be necessary to avoid delays in treatment. 2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) computed tomography (CT) imaging can help identify cancer earlier and more reliably than CT alone. Increased use of wedge resections, proton therapy and immunotherapy may increase survival by decreasing the risk of exacerbation, but further research will be necessary.
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Affiliation(s)
- Ahmad Abu Qubo
- Department of Pathology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Jamil Numan
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Juan Snijder
- Department of Pediatrics, Einstein Medical Center, Philadelphia, PA, USA
| | - Maria Padilla
- Department of Pulmonary Medicine, Mount Sinai, New York, NY, USA
| | - John H.M. Austin
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | | | - Monica Pernia
- Department of Medicine, Metropolitan Hospital, New York, NY, USA
| | - Jean Bustamante
- Department of Oncology, West Virginia University, Morgantown, WV, USA
| | - Timothy O'Connor
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Mary M. Salvatore
- Department of Radiology, Columbia University Medical Center, New York, NY, USA,Corresponding author: Mary M. Salvatore ()
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Cantalino J, Pernia M, Obayomi-Davies O, Aghdam N, Danner M, Suy S, Conroy D, Collins S, Salvatore M, Makariou E, Rudra S, Lischalk J, Collins B. Adjuvant Stereotactic Body Radiation Therapy (ASBRT) for Early-Stage Breast Cancer: Symptomatic Fat Necrosis is Associated with Consecutive Daily Treatments. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pepin A, Shah S, Pernia M, Lei S, Ayoob M, Danner M, Yung T, Collins BT, Suy S, Aghdam N, Collins SP. Bleeding Risk Following Stereotactic Body Radiation Therapy for Localized Prostate Cancer in Men on Baseline Anticoagulant or Antiplatelet Therapy. Front Oncol 2021; 11:722852. [PMID: 34604059 PMCID: PMC8485025 DOI: 10.3389/fonc.2021.722852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Patients on anticoagulant/antiplatelet medications are at a high risk of bleeding following external beam radiation therapy for localized prostate cancer. SBRT may reduce the bleeding risk by decreasing the volume of bladder/rectum receiving high doses. This retrospective study sought to evaluate the rates of hematuria and hematochezia following SBRT in these patients. Methods Localized prostate cancer patients treated with SBRT from 2007 to 2017 on at least one anticoagulant/antiplatelet at baseline were included. The minimum follow-up was 3 years with a median follow-up of 72 months. Patients who had a rectal spacer placed prior to SBRT were excluded. Radiotherapy was delivered in 5 fractions to a dose of 35 Gy or 36.25 Gy utilizing the CyberKnife system. Hematuria and hematochezia were prospectively assessed before and after treatment using the Expanded Prostate Cancer Index Composite (EPIC-26). Toxicities were scored using the CTCAE v4. Cystoscopy and colonoscopy findings were retrospectively reviewed. Results Forty-four men with a median age of 72 years with a history of taking at least one anticoagulant and/or antiplatelet medication received SBRT. Warfarin (46%), clopidogrel (34%) and rivaroxaban (9%) were the most common medications. Overall, 18.2% experienced hematuria with a median time of 10.5 months post-SBRT. Altogether, 38.6% experienced hematochezia with a median time of 6 months post-SBRT. ≥ Grade 2 hematuria and hematochezia occurred in 4.6% and 2.5%, respectively. One patient required bladder neck fulguration and one patient underwent rectal cauterization for multiple non-confluent telangiectasia. There were no grade 4 or 5 toxicities. Cystoscopy revealed bladder cancer (40%) and benign prostatic bleeding (40%) as the most common hematuria etiology. Colonoscopy demonstrated hemorrhoids (54.5%) and radiation proctitis (9.1%) as the main causes of hematochezia. There was no significant change from the mean baseline EPIC-26 hematuria and hematochezia scores at any point during follow up. Conclusion In patients with baseline anticoagulant usage, moderate dose prostate SBRT was well tolerated without rectal spacing. High grade bleeding toxicities were uncommon and resolved with time. Baseline anticoagulation usage should not be considered a contraindication to prostate SBRT.
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Affiliation(s)
- Abigail Pepin
- George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Sarthak Shah
- George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Monica Pernia
- George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Marilyn Ayoob
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Malika Danner
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Thomas Yung
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Nima Aghdam
- Department of Radiation Medicine, Harvard, Boston, MA, United States
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
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Pepin A, Shah S, Pernia M, Lei S, Ayoob M, Danner M, Yung T, Collins B, Suy S, Aghdam N, Collins S. PO-1364 Bleeding Risk after Prostate SBRT in Men on Baseline Anticoagulant/Antiplatelet Therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pepin A, Pernia M, Danner MT, Ayoob M, Yung TM, Lei S, Collins BT, Simeng S, Aghdam N, Collins SP. Impact of Age on Patient-Reported Outcomes Following Stereotactic Body Radiation Therapy for Prostate Cancer. Cureus 2021; 13:e13780. [PMID: 33842156 PMCID: PMC8030122 DOI: 10.7759/cureus.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) delivers large radiation doses to the prostate while minimizing exposure to adjacent normal tissues. Large fraction sizes may increase the risks of functional decrements. Elderly men may be at an increased risk of these toxicities due to poor baseline function and hence limited reserve. This study describes patient-reported outcomes following SBRT for clinically localized prostate cancer in the elderly. Methods Between 2007 and 2017, 179 hormone-naive elderly patients (≥ 70 years old) and 210 patients under 70 years old with clinically localized prostate cancer were treated with 35-36.25 Gy SBRT in five fractions utilizing the CyberKnife Radiosurgical System (Accuray Inc.). Quality of life (QOL) was assessed using the Expanded Prostate Index Composite-Short Form (EPIC-26) questionnaire at baseline and at 1, 3, 6, 12, 18, 24, 30, and 36 months following the completion of treatment. EPIC scores range from 0 to 100, with lower values representing worsening symptoms. Results EPIC scores in the elderly cohort mirrored those in the younger cohort. EPIC urinary obstructive/irritative scores declined at one month post-SBRT (mean change from baseline ≥70: -7.9; <70: -11.1) before returning to baseline at three months post-SBRT (mean change from baseline ≥70: -0.4; <70: -1.4). The EPIC urinary incontinence scores declined slowly over the three years following treatment without recovery (mean change from baseline ≥70: -6.6; <70: -4.8). EPIC Bowel scores transiently declined at one month post-SBRT (mean change from baseline ≥70: -8.5; <70: -9.1) and then experienced a second more protracted decline over the next three years without recovery (mean change from baseline ≥70: -4.5; <70: -1.8). Hormonal EPIC scores were not impacted by radiation treatment or age. Older men had lower baseline and post-treatment EPIC sexual summary scores at all time points. However, there was no clinically significant difference in the EPIC sexual bother score between younger and older men at baseline and following treatment. Conclusions In the first three years following treatment, the impact of SBRT treatment on patient-reported outcomes was minimal. Our findings suggest that SBRT for clinically localized prostate cancer should not be deferred in older men solely due to concerns of increased morbidity. Further studies should be conducted to evaluate the impact of age on outcomes or morbidity following SBRT.
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Affiliation(s)
- Abigail Pepin
- Department of Radiation Oncology, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Monica Pernia
- Department of Geriatrics, George Washington University, Washington, USA
| | - Malika T Danner
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
| | - Marilyn Ayoob
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
| | - Thomas M Yung
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
| | - Suy Simeng
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
| | - Nima Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
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Pernia M, Díaz I, Colmenárez-Raga AC, Rivadulla C, Cudeiro J, Plaza I, Merchán MA. Cross-modal reaction of auditory and visual cortices after long-term bilateral hearing deprivation in the rat. Brain Struct Funct 2020; 225:129-148. [PMID: 31781971 PMCID: PMC6957565 DOI: 10.1007/s00429-019-01991-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 11/21/2019] [Indexed: 12/26/2022]
Abstract
Visual cortex (VC) over-activation analysed by evoked responses has been demonstrated in congenital deafness and after long-term acquired hearing loss in humans. However, permanent hearing deprivation has not yet been explored in animal models. Thus, the present study aimed to examine functional and molecular changes underlying the visual and auditory cross-modal reaction. For such purpose, we analysed cortical visual evoked potentials (VEPs) and the gene expression (RT-qPCR) of a set of markers for neuronal activation (c-Fos) and activity-dependent homeostatic compensation (Arc/Arg3.1). To determine the state of excitation and inhibition, we performed RT-qPCR and quantitative immunocytochemistry for excitatory (receptor subunits GluA2/3) and inhibitory (GABAA-α1, GABAB-R2, GAD65/67 and parvalbumin-PV) markers. VC over-activation was demonstrated by a significant increase in VEPs wave N1 and by up-regulation of the activity-dependent early genes c-Fos and Arc/Arg3.1 (thus confirming, by RT-qPCR, our previously published immunocytochemical results). GluA2 gene and protein expression were significantly increased in the auditory cortex (AC), particularly in layers 2/3 pyramidal neurons, but inhibitory markers (GAD65/67 and PV-GABA interneurons) were also significantly upregulated in the AC, indicating a concurrent increase in inhibition. Therefore, after permanent hearing loss in the rat, the VC is not only over-activated but also potentially balanced by homeostatic regulation, while excitatory and inhibitory markers remain imbalanced in the AC, most likely resulting from changes in horizontal intermodal regulation.
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Affiliation(s)
- M Pernia
- Instituto de Neurociencias of Castilla y León-INCyL, Universidad de Salamanca, Salamanca, Spain
| | - I Díaz
- Instituto de Neurociencias of Castilla y León-INCyL, Universidad de Salamanca, Salamanca, Spain
| | - A C Colmenárez-Raga
- Instituto de Neurociencias of Castilla y León-INCyL, Universidad de Salamanca, Salamanca, Spain
| | - C Rivadulla
- Centro de Investigaciones Científicas Avanzadas (CICA), Facultad de Ciencias de la Salud, Universidad de A Coruña and Instituto de Investigaciones Biomédicas de A Coruña (INIBIC), A Coruña, Spain
| | - J Cudeiro
- Centro de Investigaciones Científicas Avanzadas (CICA), Facultad de Ciencias de la Salud, Universidad de A Coruña and Instituto de Investigaciones Biomédicas de A Coruña (INIBIC), A Coruña, Spain
| | - I Plaza
- Instituto de Neurociencias of Castilla y León-INCyL, Universidad de Salamanca, Salamanca, Spain
| | - M A Merchán
- Instituto de Neurociencias of Castilla y León-INCyL, Universidad de Salamanca, Salamanca, Spain.
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Mene-Afejuku TO, Pernia M, Ibebuogu UN, Chaudhari S, Mushiyev S, Visco F, Pekler G. Heart Failure and Cognitive Impairment: Clinical Relevance and Therapeutic Considerations. Curr Cardiol Rev 2019; 15:291-303. [PMID: 31456512 PMCID: PMC8142355 DOI: 10.2174/1573403x15666190313112841] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Heart failure (HF) is a devastating condition characterized by poor quality of life, numerous complications, high rate of readmission and increased mortality. HF is the most common cause of hospitalization in the United States especially among people over the age of 64 years. The number of people grappling with the ill effects of HF is on the rise as the number of people living to an old age is also on the increase. Several factors have been attributed to these high readmission and mortality rates among which are; poor adherence with therapy, inability to keep up with clinic appointments and even failure to recognize early symptoms of HF deterioration which may be a result of cognitive impairment. Therefore, this review seeks to compile the most recent information about the links between HF and dementia or cognitive impairment. We also assessed the prognostic consequences of cognitive impairment complicating HF, therapeutic strategies among patients with HF and focus on future areas of research that would reduce the prevalence of cognitive impairment, reduce its severity and also ameliorate the effect of cognitive impairment coexisting with HF.
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Affiliation(s)
- Tuoyo O Mene-Afejuku
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Monica Pernia
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Uzoma N Ibebuogu
- Department of Internal Medicine (Cardiology), University of Tennessee Health Sciences Center, Memphis, Tennessee TN, United States
| | - Shobhana Chaudhari
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Savi Mushiyev
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Ferdinand Visco
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Gerald Pekler
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
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Kansara T, Pernia M, Kim Y, Saeed M. Rare Occurrence of Prosthetic Knee Septic Arthritis Due to Streptococcus viridans in the Background of a Dental Procedure. Cureus 2019; 11:e5980. [PMID: 31803562 PMCID: PMC6874422 DOI: 10.7759/cureus.5980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The American Academy of Oral Medicine, American Dental Association (ADA), in conjunction with the American Academy of Orthopedic Surgeons (AAOS) and the British Society for Antimicrobial Chemotherapy, advises against the universal use of antimicrobial prophylaxis prior to dental procedures for the prevention of prosthetic joint infection (PJI). Here, we discuss the case of a patient with PJI in the background of periodontal scaling, which was done a week prior to presentation to the hospital. The PJI occurred with Streptococcus (S.) viridans, a rare organism for PJI but a common oral commensal. As the number of prosthetic joint surgeries are increasing and more data become available, prophylactic antibiotics might be considered to prevent PJI, especially in high-risk patients.
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Affiliation(s)
- Tikal Kansara
- Internal Medicine, New York Medical College - Metropolitan Hospital Center, New York, USA
| | - Monica Pernia
- Internal Medicine, New York Medical College - Metropolitan Hospital Center, New York, USA
| | - Yoojin Kim
- Internal Medicine, New York Medical College - Metropolitan Hospital Center, New York, USA
| | - Mohammad Saeed
- Internal Medicine, New York Medical College - Metropolitan Hospital Center, New York, USA
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Aghdam N, Kataria S, Pernia M, Hall C, O’Connor T, Campbell L, Suy S, Collins S, Krochmal R, Anderson E, Lischalk J, Collins B. PV-0206 Gross endobronchial disease: predictor of clinical outcomes for early stage NSCLC treated with SBRT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Pernia M, Estevez S, Poveda C, Plaza I, Carro J, Juiz JM, Merchan MA. c-Fos and Arc/Arg3.1 expression in auditory and visual cortices after hearing loss: Evidence of sensory crossmodal reorganization in adult rats. J Comp Neurol 2017; 525:2677-2689. [PMID: 28472857 DOI: 10.1002/cne.24233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/03/2017] [Accepted: 04/22/2017] [Indexed: 02/03/2023]
Abstract
Cross-modal reorganization in the auditory and visual cortices has been reported after hearing and visual deficits mostly during the developmental period, possibly underlying sensory compensation mechanisms. However, there are very few data on the existence or nature and timeline of such reorganization events during sensory deficits in adulthood. In this study, we assessed long-term changes in activity-dependent immediate early genes c-Fos and Arc/Arg3.1 in auditory and neighboring visual cortical areas after bilateral deafness in young adult rats. Specifically, we analyzed qualitatively and quantitatively c-Fos and Arc/Arg3.1 immunoreactivity at 15 and 90 days after cochlea removal. We report extensive, global loss of c-Fos and Arc/Arg3.1 immunoreactive neurons in the auditory cortex 15 days after permanent auditory deprivation in adult rats, which is partly reversed 90 days after deafness. Simultaneously, the number and labeling intensity of c-Fos- and Arc/Arg3.1-immunoreactive neurons progressively increase in neighboring visual cortical areas from 2 weeks after deafness and these changes stabilize three months after inducing the cochlear lesion. These findings support plastic, compensatory, long-term changes in activity in the auditory and visual cortices after auditory deprivation in the adult rats. Further studies may clarify whether those changes result in perceptual potentiation of visual drives on auditory regions of the adult cortex.
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Affiliation(s)
- M Pernia
- Laboratory of Neurobiology of Hearing, Institute of Neurosciences of Castilla y León (Instituto de Neurociencias de Castilla y León - INCYL), University of Salamanca (Universidad de Salamanca - US), Salamanca, Spain
| | - S Estevez
- Laboratory of Neurobiology of Hearing, Institute of Neurosciences of Castilla y León (Instituto de Neurociencias de Castilla y León - INCYL), University of Salamanca (Universidad de Salamanca - US), Salamanca, Spain
| | - C Poveda
- School of Medicine of Albacete, Institute for Research in Neurological Disabilities (Instituto de Investigación en Discapacidades Neurológicas - IDINE), University of Castilla-La Mancha (Universidad de Castilla La Mancha - UCLM), Albacete, Spain
| | - I Plaza
- Laboratory of Neurobiology of Hearing, Institute of Neurosciences of Castilla y León (Instituto de Neurociencias de Castilla y León - INCYL), University of Salamanca (Universidad de Salamanca - US), Salamanca, Spain
| | - J Carro
- Laboratory of Neurobiology of Hearing, Institute of Neurosciences of Castilla y León (Instituto de Neurociencias de Castilla y León - INCYL), University of Salamanca (Universidad de Salamanca - US), Salamanca, Spain
| | - J M Juiz
- School of Medicine of Albacete, Institute for Research in Neurological Disabilities (Instituto de Investigación en Discapacidades Neurológicas - IDINE), University of Castilla-La Mancha (Universidad de Castilla La Mancha - UCLM), Albacete, Spain
| | - M A Merchan
- Laboratory of Neurobiology of Hearing, Institute of Neurosciences of Castilla y León (Instituto de Neurociencias de Castilla y León - INCYL), University of Salamanca (Universidad de Salamanca - US), Salamanca, Spain
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