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The objective of this study was to determine the myocardial perfusion and wall motion recovery two months after coronary revascularization best 200 mg avanafil, the period considered optimal to avoid angioplasty restenosis interference in the results order genuine avanafil online. The coronary angiography was performed over a range of 1-231 days prior to the perfusion scan (mean: 37 days) purchase avanafil 200mg overnight delivery. The data corresponded to 16 cases of three vessel disease, ten of two vessel and ten of one vessel disease, considering 50% of artery occlusion. The use of beta blockers and other cardiovascular drugs was minimal, according to their clinician. There were no serious collateral effects and amynophilline was indicated as usual. Eight frames were acquired in each study with 32 steps of 40 s (180°, circular orbit, matrix 64, step and shoot). The processing was performed in a similar way in both perfusion studies using uniformity correction and a Ramp-Hamming filter. Perfusion scan Two independent specialists as ‘blinded’ observers read the perfusion scans, comparing the different diastolic slices. Regional wall motion from anterior, septal, apical, lateral, inferior and postero-basal segments was observed and defined as normo-, hypo- or dis-kinetic. Post-revascularization studies were compared with initial basal studies evaluating persistence or changes in left ventricular motion. Only revascularized segments were included in the analysis, disregarding their initial perfusion or wall motion. Five myocardial segments were correlated (anterior, septal, apical, inferior and lateral): (a) Those segments with worse 2-D echo motion or perfusion after revasculari zation were assigned to the no change group (two in each group not in the same patients), (b) Only one segment was excluded owing to the impossibility of reading by echo. The patients were separated according to those with and without 2-D echo improvement and then quantitative perfusion parameters were compared globally. Discordant segments were read as follows: improvement only in perfusion scan in 20%, and only in wall motion in 14% (Table I). However, this does not always happen and the discordance could be explained by timing mismatch in the recovery of wall motion and flow, and also due to the presence of hibernated myocardium . At hibernation, the myocardium has a minimal metabolic state, is severely hypoper- fused and presents severe alteration of wall motion. Probably, some cells remain in a more prolonged state of hibernation and the wall motion recovery could be delayed. It should also be considered that bypass surgery allows some collateral vessel contribution from other territories and stress radionuclide perfusion studies are able to evaluate residual ischaemia. It is clear that if there is more ischaemic or viable tissue, the results of revascularization will be better . Currently, rest redistribution, delay images and especially reinjection techniques are widely used in order to detect the maximum viable tissue [6-11]. With hibernation, stress or even contrast 2-D echo studies could be helpful in evaluating viability, but they are somewhat operator dependent . Another important situation to be considered is the stunned myocardium produced by severe ischaemia, observed especially after reperfusion in acute myocardial infarction, due probably to cell incapacity for recovering energetic reserve, and its contractile capacity in a variable period proportional to prolongation of the ischaemia. Post-infarction revascularization diminishes the proportion of coronary events and, by the opposite revascularization of non-viable territories, is not associated with event reduction; it has also been demonstrated that viability in the infarcted zone, measured metaboli- cally, presents fewer events with revascularization [9, 24-26], which are important in reducing myocardial remodelling and using the best available viability marker. In the present investigation, there was moderate concordance (66%) between wall motion and perfusion findings post-revascularization. The quantitative data support the idea that with coronary revascularization there is some amelioration of perfusion defects even in those segments not presenting wall motion changes (the differences according to 2-D echo were significant for reduction in size and severity parameters). The important proportion of segments remaining without changes is easily explained by the high prevalence of myocardial infarction in the group. It is even possible that both methods do not analyse exactly the same topographic segment, especially in the posterobasal region. The explanation for this fact could be collateral arteries opened by the procedure. We also analysed the value of Amrinone associated with 2-D echo predicting the exit of revascularization [29-33], with simi lar results, concluding that perhaps both methods together could offer a better approach to recognize pre-revascularization viability. These metabolic studies are principally directed to the evaluation of viability, and in the future they should be the ‘gold standard’ to assess the everyday more complex group of patients submitted for revas cularization, especially after myocardial infarction, who intend to obtain the best cost-benefit procedure [35-40]. However, at the present time, it is possible to obtain a reasonable approach complementing two techniques such as perfusion and function for (1) evaluation of viability (pre-revascularization) and (2) later (post-procedure) for measuring the recovered myocardium. Comparison with metabolic activity by positron emission tomography, Circulation 88 3 (1993) 952. Twenty segments per patient were analysed: six segments each from a representative apical, midventricular and basal portion of the short axis view and the antero- apical and inferoapical segments from a representative midventricular vertical long axis view. The scoring sheet therefore indicates the segment with the perfusion defect, its severity and whether it is reversible (decreases in severity) after redistribution or rest imag ing. This scoring sheet is meant to help the referring physician objectively visualize the extent and severity of the perfusion defect and to supplement the final report and the polar maps generated. The quan titative difference between the means of the four grades of perfusion defect using computer quantitation was highly significant ip value <0. It is a re producible technique with moderate to good agreement between two observers. Depending on the computer system interfaced to the gamma camera, the tomographic slices are then compared with a set of normal or near-normal databases for quantitation of the perfusion defects. Polar maps of the severity, extent and reversibility of the perfusion defect and the percentage of the myocardium affected are usually displayed for the referring physician to better appreciate and understand the test. One perceivable problem is that the patient population of the normal database is different from the patients seen in a particular centre. In the Philippine Heart Center, the patients are mostly Filipinos, Chinese and other Asians. However, there is no database for the normal population and the laboratory relies on the database group of its computer, which is presumably derived from a popula tion of Caucasians. Since the grading system is subjective, especially between grades 0 and 1 and grades 2 and 3, this study will also determine the intra- and inter-observer variability. Scoring sheet for myocardial perfusion scintigraphy in use at the Philippine Heart Center. Study patients The study group consisted of 65 non-consecutive patients referred to the Nuclear Medicine Section of the Philippine Heart Center for myocardial perfusion scintigraphy from July to December 1994. Quantitative analysis For the difference between the four grades in the scoring system, 30 different segments for each grade were analysed quantitatively. Regions of interest analysis using a box was done for the segment with the hottest activity, the segment with the perfu sion defect and background (Fig. Calculation of the percentage of tracer activity in a segment was as follows: Quantitative activity — countsScgn,eni withperfusion defect ~ mean countshackground Mean C0untsscgmcnl W;! Schematic diagram o f the computation o f quantitative activity using regions o f interest over perfusion defect, hottest activity and background. Statistical analysis The mean and standard deviations of the 30 different samples for each of the four grades were determined.
Divalproex sodium (Depakote) is a 1:1 enteric formulation of valproic acid and valproate so- dium that is absorbed more slowly than valproic acid and is often preferred by patients avanafil 100mg on line. Rare: Idiosyncratic hepatotoxicity; may be fatal in infants and in patients using multiple anticonvulsants 100 mg avanafil free shipping. Fetal malformations: Spina bifida; orofacial and cardiovascular anomalies have been reported buy avanafil 100mg with amex. Although it is effective in fewer patients with absence seizures than valproic acid, ethosuxi- mide is often the drug of choice because of its greater safety. Phenobarbital at less than hypnotic doses is used most often as a first-line drug for neonatal seizures and for maintenance control of status epilepticus. Benzodiazepines: Diazepam, lorazepam, clonazepam, and clorazepate (see also I B) 1. Diazepam and lorazepam are highly effective in short-term treatment of status epilepticus. Other anticonvulsant agents (for partial and generalized tonic-clonic seizures) 1. Adverse effects include headache, ataxia, dizziness, and (rarely) a rash that may be life- threatening, particularly in children. It suppresses weight loss and has been used to treat patients with eating disorders. Its use is limited by development of aplastic anemia (1:3,000) and severe hepatitis with liver failure (1:10,000). Zonisamide acts at the sodium channel and possibly the voltage-dependent calcium channel. It binds to voltage- gated calcium channels and reduces release of excitatory neurotransmitters. It is also approved for use in treating postherpetic neuralgia and diabetic peripheral neuropathy. Its major adverse effects are dizziness, dry mouth, blurred vision, and weight gain. It is a schedule V controlled substance because of reports that it causes euphoria. General anesthesia is characterized by a loss of consciousness, analgesia, amnesia, skeletal muscle relaxation, and inhibition of autonomic and sensory reflexes. Balanced anesthesia refers to a combination of drugs used to take advantage of individual drug properties while attempting to minimize their adverse actions. The stages and planes of anesthesia identify the progression of physical signs that indicate the depth of anesthesia. Newer, more potent agents progress through these stages rapidly, and therefore, the stages are often obscured. Mechanical ventila- tion and the use of adjunct drugs also obscure the signs indicating the depth of anesthesia. Nitrous oxide, isoflurane, desflurane, and sevoflurane are the most commonly used inhala- tion anesthetics. They decrease cerebral vascular resist- ance with increased perfusion of the brain. These anesthetics are all respiratory depressants; consequently, assisted or controlled venti- lation is usually necessary during surgical anesthesia. Also, they are generally administered with nitrous oxide, which decreases the extent of cardiovascular and respiratory depression at equivalent anesthetic depths. Inhalation and intravenous anesthetic agent interaction with discrete protein binding sites in nerve endings to activate ligand-gated ion channels best explains their mechanism of action. Ligand-gated potassium (K ) channels, where these anesthetic agents increase potassium conductance to hyperpolarize and inhibit neuronal membrane activity 3. The relative solubility of an inhalation anesthetic in blood relative to air is defined by its blood–gas partition coefficient, lambda (k), which is directly related to the pharmacoki- netics of an anesthetic (see Table 5-9): λ =[anesthetic] in blood/[anesthetic] in gas Relatively few molecules of an anesthetic with low solubility in blood are necessary to increase its partial pressure in blood. Increased pulmonary flow from, for example, increased cardiac output decreases the rate of rise in partial pressure by presenting a larger volume of blood into which the anesthetic can dissolve. Conversely, decreased pulmonary flow, such as occurs during shock, increases the rate of induction of anesthesia. For soluble anesthetics, the longer the exposure, the lon- ger the time to recovery, because of accumulation of anesthetic in various tissues. Other factors that affect recovery include pulmonary ventilation and pulmonary blood flow. Nitrous oxide (N2O) (1) Advantages (a) Nitrous oxide is an anesthetic gas that has good analgesic and sedative properties but no skeletal muscle relaxant properties. When given in large volumes, it increases the volume of uptake of a second blood-soluble gas such as halothane (second-gas effect), which then speeds the induction of anesthesia. Isoflurane (1) Advantages (a) Isoflurane produces more rapid induction and emergence than halothane. However, paradoxically, isoflur- ane may precipitate cardiac ischemia in patients with underlying coronary heart disease. Desflurane (1) Advantages (a) Desflurane produces more rapid induction and rapid emergence than isoflurane and, therefore, is often preferred for outpatient surgical procedures. Sevoflurane (1) Advantages (a) Sevoflurane produces a very rapid and smooth induction and rapid recovery with no respiratory irritation. Sevoflurane produces fluoride ions during its liver metabolism that potentially could be nephrotoxic. Halothane (1) Advantages (a) Halothane has a pleasant odor and produces a smooth and relatively rapid induc- tion. Enflurane (1) Advantages (a) Enflurane produces a rapid induction and recovery with little excitation. It is less likely than halothane to sensitize the heart to catecholamines or cause arrhythmias. Inhalation anesthetics are bronchodilators, particularly halothane and sevoflurane, which allows use in patients with underlying respiratory problems. It is highly metabolized, resulting in dose- related fluoride-induced renal toxicity. Inhalation anesthetics, except nitrous oxide, relax uterine muscle, an advantage during cer- tain obstetrical procedures. Inhalation anesthetics increase cerebral blood flow, which may indirectly result in increased intracranial pressure. Genetically susceptible patients may (rarely) develop potentially lethal malignant hyperther- mia, which includes tachycardia, hypertension, acid–base and electrolyte abnormalities, muscle rigidity, and hyperthermia. Treatment is supportive with dantrolene, a muscle relaxant that blocks calcium channels.
However cheap avanafil 200 mg overnight delivery, it can be the eye (vitreous humor) shrinks and tugs on the triggered by the use of certain drugs 50mg avanafil with amex, such as thi- retina generic 200mg avanafil. These flashes of light can appear off and on azide diuretics, phenothiazines, and antimalarials. Flashes of light that appear as jagged lines or (fat) metabolism that involves the partial or total “heat waves” in both eyes, often lasting 10 to 20 absence of fat, and often abnormal deposition and minutes, are frequently caused by migraine, a distribution of fat in the body. Some of them are present at birth (congenital), and others are limb An arm or a leg. In lipodystrophy syndrome, the face, together as a package because of their location near arms, and legs become thin due to loss of subcuta- one another on the same chromosome. See also cephalothoracic lipody- lip One of the two fleshy folds that surround the strophy; protease inhibitor. The upper lip is separated from the nose by the philtrum, the area that lies lipoma A benign tumor of adipocytes (fat cells). Small blind pits lipomatosis, familial benign cervical See are sometimes seen at the corners of the mouth; cephalothoracic lipodystrophy. The lips may be abnor- lipoprotein A molecule that is a combination of mally thin or thick. Lipids do not travel in the blood alcohol syndrome typically have a thin upper lip and by themselves, but they are carried through the flat philtrum. Most frequently seen in older adults (age 40 and above), liposarcomas are the most common of lipid A fat. Lipids are easily stored in the body liposuction The surgical suctioning of fat and serve as fuel. Among the well-known lipids are deposits from specific parts of the body, the most cholesterol, triglycerides, fatty acids, and steroids common being the abdomen, buttocks, hips, thighs (such as cortisone). A phospholipids are all compound lipids (lipids in hollow instrument called a cannula is inserted combination with other types of chemicals). A high-pressure vacuum is then applied to the cannula to suck out lipid profile A pattern of lipids in the blood. Lipid storage diseases result in the abnormal includes the local anesthetic lidocaine to numb accumulation of lipids in various organs. Examples the area and the vessel-constrictor epinephrine include Gaucher disease, Fabry disease, Niemann- (adrenaline) to help minimize bleeding. This technique has an advantage in areas of scar tissue, such as the male breast, the back, and lithotomy Surgical removal of a stone. Its disadvantages include the need for lithotripsy A procedure that uses shock waves to longer incisions in the skin, a potential for skin or break a stone in the kidney, urinary tract, or gall- internal burns, greater cost, and a longer time bladder. Anesthesia may be necessary to control the pain, Listeriosis A disease that is caused by eating depending on the size and density of the stone and food contaminated with the bacterium Listeria on the energy of the shock wave needed to break it monocytogenes. The urologist may opt to place a catheter (stent) health problem in North America. The disease in the ureter from below to facilitate passage of the affects primarily pregnant women, newborns, and shattered fragments. The Listeriosis can prevent the infection by avoiding cer- procedure is done under anesthesia, using real- tain high-risk foods and by handling food properly. Raw food from animal sources (such as beef, pork, or poultry) should be thoroughly cooked and lithotriptor A machine that is used to shatter uncooked meats should be kept separate from veg- kidney stones and gallstones by physical or other etables, cooked foods, and ready-to-eat foods. Livedo reticularis can be a nor- mal condition that is simply more obvious when a the volume of 1 kilogram of water at 4° Celsius and at standard atmospheric pressure of 760 millime- person is exposed to the cold. A liter is a little more been reported in association with autoimmune dis- than 1 quart (1. Treatment of lithium toxicity store, and process fats, including fatty acids (used involves immediately reducing or discontinuing for energy) and cholesterol; to metabolize and store carbohydrates (used as the source for the sugar in lithium use under medical supervision. The procedure can be biochemical products produced by the body, such as done in the physician’s office and requires only a bilirubin, from the breakdown of old red blood cells local anesthetic. The most common method for ence and math education, the environment, energy, obtaining a liver biopsy is percutaneous (“through and national security. The most common rea- fissures, connective tissue, or other natural bound- son for liver transplantation in children is biliary aries. The most common reason for liver transplantation in adults is lobectomy An operation to remove an entire cirrhosis (a disease in which healthy liver cells are lobe of the lung. There is no effective treatment for end-stage liver disease other lobular carcinoma of the breast, infiltrating than transplantation. At first the specifies what types of medical treatment are lochia is primarily blood, followed by a more desired. A living will can be very specific or very mucousy fluid that contains dried blood, and finally general. More specific living wills may include information locomotion 1 Movement from one place to regarding an individual’s desire for services such as another. The aortic aneurysms of Loeys-Dietz syndrome are prone to Lou Gehrig’s disease See amyotrophic lateral rupture at a smaller size than other aneurysms, with sclerosis. The irregular heartbeats are typically brought lower segment cesarean section See cae- on by stress or vigorous activity. The lumbar vertebrae and their longitudinal section A section that is cut along disks are situated below the thoracic vertebrae and the long axis of a structure. Longitudinal section is above the sacral vertebrae in the spinal column and the opposite of cross-section. For example, a longitudinal study of lumbar puncture A procedure in which cere- children with Down syndrome might involve the brospinal fluid is removed from the spinal canal for study of 100 children with this condition from birth diagnostic testing or treatment. Longitudinal study is the opposite patient usually lies sideways for the procedure, of cross-sectional (synchronic) study. As inflammation continues, scar tissue may done for therapeutic purposes, as a way of adminis- form, including keloid scarring in patients prone to tering antibiotics, cancer drugs, or anesthetic agents keloid formation. Lupus is more common in patients with conditions such as normal-pressure women than in men, and although it occurs in all hydrocephalus or benign intracranial hypertension. These complications vation of symptoms, and through testing of the are uncommon, with the exception of headache, blood for signs of autoimmune activity. Headaches ment is essential to prevent progression of the dis- are less likely to occur if the patient remains lying ease. A rheumatologist can provide treatment for flat for 1 to 3 hours after the procedure. Also known lupus, and this treatment has two objectives: treat- as spinal tap, spinal puncture, thecal puncture, and ing the difficult symptoms of the disease and treat- rachiocentesis. It may include use of steroids and other anti-inflammatory lumbar vertebrae The five vertebrae situated agents, antidepressants and/or mood stabilizers, between the thoracic vertebrae and the sacral verte- intravenous immunoglobulin, and, in cases in brae in the spinal column. The lumbar vertebrae are which lupus involves the internal organs, represented by the symbols L1 through L5.
Indeed purchase 100mg avanafil amex, Amaee approaches in the experiments cheap 50 mg avanafil overnight delivery, intravenously discount avanafil 50mg otc, intraperitoneally, et al. None of the administration methods could hearing loss–induced by bacterial meningitis (92). The microperfusion was effective in azathioprine were administered intravenously according to proto- the acute phase that is associated with elevations in cytokines, col used for treatment of severe rheumatoid arthritis. The chronic phase leads to irre- was that one of the subjects responded to corticosteroids with an versible ossiﬁcation of the labyrinth demanding other kinds of improvement of hearing of 50 dB, but did not show a similar treatment to facilitate removal of inﬂammatory cells and their responsiveness to inﬂiximab. The beneﬁt of microperfusion may be sustained Inﬂiximab may cause severe adverse effects, the main being when combined with local delivery of immunosuppressive hypersensitivity reactions, development of antinuclear antibod- agents to the inner ear. They also show that glutamate neutropaenia and thrombocytopaenia associated with inﬂix- antagonists can have a protective effect on the inner ear and pos- imab (84). Inﬂiximab infusions are accompanied by acute reac- sibly be a treatment for peripheral tinnitus, which is generated by tions in approximately 5% of infusions (85). Several such drugs are currently under investigation Pharmacotherapy of the inner ear 229 for hearing loss and tinnitus as, for example, memantine, carover- acoustic trauma or aminoglycoside ototoxicity in vivo raise the ine and magnesium. Caroverine has been shown to restrict the question of whether other neurotrophic factors can also protect activity of glutamate receptors and protect the hearing of guinea the hair cells in vivo (103–106). Its safety and tolerance have been demonstrated in some from neomycin ototoxicity in vitro, and an in vivo study has clinical studies. No severe adverse effects However, no signiﬁcant difference in threshold shifts was were identiﬁed for the majority of patient. However, a few patients observed between the treated and untreated ears in any of the experienced mild transient side effects. The extent of hair cell damage was also compara- ﬂicting data that suggest that the placebo effect may have been ble among the different treatment groups. Aminoglycoside-induced hearing disorders could be pre- from vibration-induced hearing loss. For example, the combination of vival of injured cochlear neurones both in vitro and in vivo. The rat spinal cord ﬂuid volume could be in the range of 10 L, as the guinea pig perilymph respecting the human perilymph volume. The normal cortisol production in human In the group treated with dexamethasone, no morphological dif- plasma is 14 to 70 mol/day (5–25 mg/day) and peaks in the ferences were found between the steroid group and the control early morning. However, epithelial thickening and inﬂammatory cells fold and a greater increase in the rate of production of cortisol. The authors suggest that every instillation to ﬁve hours [baxter dexamethasone data sheet, (114)]. For cor- of ﬂuid into the middle ear causes some swelling, but dexam- tisol, this is about 80 minutes. The anti-inﬂammatory effect ethasone reduces the symptoms because it is the most potent lasts longer than the half time in the plasma. They applied the middle ear cavity of rats caused irreversible threshold shift in 0. The steroid concentration in the scala tympani reaches dissolved in distilled water. Distilled water served as control in a peak of 1 mg/mL after one hour, which is equal to 2% of the the other ear. The dexamethasone concentration found by Parnes in the It has been suggested that acute noise trauma can also be cochlea was about 10 times higher than that found by Chan- treated with corticosteroids or other treatments aimed at drasekhar et al. Also, Bachmann put the steroid solution directly onto the round window niche (the oth- Novel substances still at an experimental stage ers just ﬁlled the bulla) and left the animal under anaesthesia for a longer time. They concluded that a dose of acoustic trauma (cochlear implant electrode insertion), and 300 ng/day ( 12. In order to transfer this ﬁgure into noise exposure (6 kHz pure tone, 120 dB for 30 minutes) and in humans, the relevant volume of the spinal cord ﬂuid of the rat just one single dose. Compounds based on the K252a structure were synthe- Latanoprost sised to enhance the neurotrophic effects of K252a while decreas- Endogenous production of prostaglandins has been demon- ing its ability to inhibit tyrosin kinase (Trk) phosphorylation. The patients’ vertigo was assessed on a visual analogue linkers to ensure that the uptake is speciﬁc. It is likely that latanoprost may be a use- tors in vitro, it is possible to select and isolate peptides with dif- ful agent for acute hearing loss and also environmental noise- ferent binding speciﬁcities. Several genes regulate the differentiation of cochlear hair Targeted drug delivery—future treatment cells and supporting cells, during mammalian embryogenesis, The speciﬁc cell targeting treatment of the inner ear disease from their common precursor cells. Atoh1 has been shown to act as a “prohair cell gene” and structures, or sonication. Recently our adjunct research institute demon- polymers, but typically suffer from low drug incorporation and strated that, in mammals, by using gene therapy the lost hair cells rapid drug release rates for low-molecular-weight organic drug will regenerate and also return hearing to the profoundly deaf molecules. This ﬁnding opens new perspectives for the rials, demonstrate better incorporation and slower release rates, treatment of hearing loss and justiﬁes the efforts to incapsulate but suffer from poorer biodegradability and biocompatibility. Additionally, physicochemical properties of drugs affect loading Another approach for the inner ear-targeted treatment is to and release, thus choice of drugs and compatible polymers will selectively open the passage from blood to perilymph without be important for development and clinical therapy. Unless particles demonstrate signif- icant charge stabilisation, they will tend to aggregate due to their hydrophobic action. Proteins and buffering salts may increase aggregation or may adsorb to the particle surface, result- ing in nontargeted cell uptake. Hydrophobic particles and posi- tively charged complexes (as in uncoated polyplexes) will also tend to bind to cell surfaces, which will lead to a nonspeciﬁc uptake by macrophages into cells. Auditory hair cell replacement and hearing improvement by Atoh1 gene therapy in deaf mammals. Rapid recovery from acoustic trauma: chicken soup, potato knish, or drug interaction? Shearing motion in the hearing organ measured by confocal laser heterodyne interferom- etry. Structure of the stereocilia side links and mor- action with internet-based data collection interface, genotyping with phology of auditory hair bundle in relation to noise exposure in proteomics, data mining and evaluation with artiﬁcial intelligence-based the chinchilla. Intensity-dependent changes in oxygenation of cochlear perilymph during acoustic exposure. This site-speciﬁc response might be in the development of the vertebrate inner ear. Apoptosis 2004; explained by the different structure of the blood–labyrinth barrier 9(3):255–264. Successful treatment of noise-induced References cochlear ischemia, hypoxia, and hearing loss. The effect of blood ﬂow promoting drugs on of outer hair cell apoptosis in the chinchilla cochlea following cochlear blood ﬂow, perilymphatic pO(2) and auditory function exposure to impulse noise. Biochemical pathways of caspase activation role in oxidative stress-induced apoptosis of inner ear sensory during apoptosis. Proliferation of functional perform distinct, non-redundant roles during the demolition hair cells in vivo in the absence of the retinoblastoma protein. F-actin cleavage in apop- porting cells share a common progenitor in the avian inner ear. Association between shear stress, angiogene- the aged cochlea of Mongolian gerbils.