Evaluation of Psychoacoustic Tests and P300 Event-Related Potentials in Elderly Patients With Hyperhomocysteinemia

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Homocysteine &#40;Hcy&#41; is a sulphurated amino acid formed by the conversion of methionine to cysteine&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its values in plasma range from 5 to 15<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;l in a rapid state&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The evidence of hyperhomocysteinemia &#40;HHcy&#41; as a factor of risk for cognitive deterioration in patients without dementia is controversial and limited by a few studies&#46; Sachdev<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> indicated that all the transversal studies reported up to that moment showed an inverse association between HHcy presence and cognitive deficit measurements&#46; Duthie et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported that HHcy represented approximately 7&#46;8&#37; of the variance in cognitive performance in the elderly&#46; Explanations for these HHcy-related alterations have been based on the consideration of the mechanisms of Hcy neurotoxicity&#44; such as&#58; generation reactive species of oxygen&#44; prothrombotic effects and promotion of oxidative stress&#44; among others&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The auditory pathway&#44; as it is a set of neural structures&#44; can be susceptible to presenting alterations from HHcy&#46; Cohen-Salmon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> published congenital hypoacusis related to connexin 30 in mice with HHcy&#44; as well as disruption of the vascular epithelium in the vascular stria of the inner ear associated with this same cause&#46; Kundu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> showed that Hcy regulated the composition and concentration of the extracellular matrix&#44; which forms part of the basement membranes of the inner ear&#46; It has also been reported that HHcy can be a factor of risk for developing sudden deafness&#59; Marcucci et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> found that patients with a diagnosis of idiopathic sudden deafness presented greater concentrations of Hcy when compared with a control group&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The central auditory functions are defined as &#8220;the perceptual processing of auditory information in the central nervous system &#40;CNS&#41;&#44; the neurobiological activity this process involves and the efficiency and effectiveness with which the CNS uses the auditory information&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Experimental and clinical methodologies in the study of central auditory functions are based on various techniques&#58; psychoacoustic&#44; electrophysiological&#8211;electroencephalographic&#44; imaging&#44; biochemical studies&#44; studies based on injuries and behavioural observation studies&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A few psychoacoustic tests are&#58; <span class="elsevierStyleItalic">Dichotic Digits&#58;</span> this has shown itself to be highly sensitive for CNS dysfunctions associated with hemispheric as well as interhemispheric injuries&#46; The results can also be affected by dysfunctions at the level of the brain stem&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleItalic">Filtered Speech</span>&#58; this is a test designed to assess skill in recognising speech under conditions of degradation of the acoustic signal&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleItalic">Word in Noise</span>&#58; this is a method to reduce redundancy&#44; consisting of presenting an ipsilateral masking noise that competes with the monosyllables&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> This test is capable of identifying injuries associated with the 8th cranial nerve&#44; intra- and extraaxial brainstem lesions&#44; affection of the temporal lobe and diffuse brain lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleItalic">Masking Level Differences</span> &#40;MLD&#41;&#58; the study of MLD seems to assess regions of the lower brain stem&#44; more specifically the superior olivary complex&#46; The test consists of presenting a continuous 1000<span class="elsevierStyleHsp" style=""></span>Hz tone dichotically and then dichotically in the presence of a continuous wide-band noise at 60<span class="elsevierStyleHsp" style=""></span>dB HL&#46; The result is established based on the differences in the detection of the threshold between both conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleItalic">Music Test&#58;</span> the degree to which a person can specifically identify a particular sound mostly depends on their experience&#59; however&#44; the cognitive associations and other &#8220;higher level&#8221; associations play a key role in identifying a sound&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The long-latency auditory evoked potentials &#40;P300&#41; offer the possibility of studying central auditory processes in an empirical manner&#44; making it possible to establish inference on the mental events implicit in the resolution of proposals&#46; The P300 potential occurs between 220 and 389<span class="elsevierStyleHsp" style=""></span>ms with an approximate amplitude of 12<span class="elsevierStyleHsp" style=""></span>&#956;V<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and constitutes the component of the cortical provoked response obtained with the task of discriminating 2 stimuli&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The clinical applications of P300 are varied&#59; given that its latency is related to processing time&#44; its application is very significant in the diagnosis of dementia or other illnesses in the context of the &#8220;central processes of hearing&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In this study&#44; it was of interest to pose the following research question&#58; Is HHcy a factor that alters peripheral hearing and central auditory processing tests in older adult patients&#63;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The objectives were to determine if older adult patients detected as having HHcy presented a greater risk of developing alterations in the central auditory processes than a group of patients with appropriate levels of Hcy&#44; and to define the behaviour of the psychoacoustic tests and of long latency potentials &#40;P300&#41; in these groups&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><p id="par0045" class="elsevierStylePara elsevierViewall">We carried out a prospective&#44; comparative and analytic study&#46; The patients gave their authorisation with a signed informed consent&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Criteria of Inclusion</span><p id="par0050" class="elsevierStylePara elsevierViewall">The inclusion criteria were&#58; patients of 60 years and older&#44; with a tonal auditory threshold at 1<span class="elsevierStyleHsp" style=""></span>kHz of 30<span class="elsevierStyleHsp" style=""></span>dB or less&#44; with adequate understanding&#59; if the patients had systemic arterial hypertension&#44; diabetes mellitus or dyslipidemia&#44; that they were under regular medical control&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Criteria of Exclusion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The exclusion criteria were&#58; patients younger than 60 years&#44; with chronic degenerative or metabolic diseases&#44; without regular medical control&#44; antecedents of epilepsy or seizures&#44; antecedents of drug addiction&#44; major depression&#44; psychiatric disorders&#44; antecedents of stroke or degenerative CNS diseases&#44; kidney failure or chronic hepatitis and antecedents of severe traumatic brain injury&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Relatives&#44; friends and patients of the institution who wished to participate and fulfilled the criteria of inclusion were convoked&#46; The case histories and a directed interrogation were prepared to identify the symptoms related to disorders in central auditory processing&#46; All patients had determinations of Hcy&#44; glucose&#44; total cholesterol and triglycerides&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">We confirmed that the patients did not have dementia by applying the Mini-Mental State exam&#46; In addition&#44; the abbreviated form of the Yesavage geriatric depression scale was applied to be able to rule out depressive states&#46; Otoscopy was performed&#44; and then tonal audiometry using the ascending method with a Madsen Orbiter 922<span class="elsevierStyleSup">&#174;</span> unit calibrated in trimester form as per ANSI regulations S3&#46;6 and S3&#46;26&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Tympanometry was carried out with a calibrated &#40;ANSI regulation S3&#46;39&#41; Zodiac 901<span class="elsevierStyleSup">&#174;</span> unit&#44; considering normal values to be as follows&#58; static compliance of 0&#46;5&#8211;1&#46;5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> and middle ear pressure of &#43;50 to &#8722;100<span class="elsevierStyleHsp" style=""></span>daPa&#46; These results were later catalogued in agreement with the Jerger classification&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The acoustic reflex was assessed&#44; determining the amount of decibels needed for the presentation of the frequencies of 500&#44; 1&#44; 2 and 4<span class="elsevierStyleHsp" style=""></span>kHz&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A group of cases with HHcy &#40;&#62;15<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;l&#41; and a group of patients with normal Hcy values &#40;5&#8211;15<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;l&#41; were formed&#44; pairing by age in the majority of the cases&#46; The following phase consisted of applying psychoacoustic tests&#44; beginning with dichotic digits&#59; in this test&#44; stimuli are presented in bilateral form 50<span class="elsevierStyleHsp" style=""></span>dB above the threshold at 1000<span class="elsevierStyleHsp" style=""></span>Hz&#46; Thirty items were evaluated and the percentage of right&#44; left&#44; mixed and omissions that the patient gave were quantified&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The filtered speech test was given next&#44; at 50<span class="elsevierStyleHsp" style=""></span>dB above the threshold for the ear being assessed&#44; while the contralateral ear was masked with white noise&#44; 30<span class="elsevierStyleHsp" style=""></span>dB&#47;s below the stimulus level used for the ear testing&#46; A total of 25 items was assessed and the percentage of appropriate responses was calculated&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The word in noise test was given sending stimuli to the ear being assessed&#44; 50<span class="elsevierStyleHsp" style=""></span>dB above the threshold at 1000<span class="elsevierStyleHsp" style=""></span>Hz&#44; as well as ipsilateral white noise 10<span class="elsevierStyleHsp" style=""></span>dB under the stimulus used to assess the words&#46; A total of 25 items as assessed and the percentage of correct responses that the patient had was calculated&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the music test 20 series &#40;each composed of 2 melodies&#41; were assessed&#59; there were 10 series for the right each and 10 for the left&#44; 50<span class="elsevierStyleHsp" style=""></span>dB above the threshold for 1<span class="elsevierStyleHsp" style=""></span>kHz&#44; using white noise to mask the contralateral ear&#46; The patients were asked to identify whether the melodies presented equal or different tones and&#44; after that&#44; the percentage of correct responses for each ear was calculated&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the MLD test the patients were instructed to listen to 2 sounds simultaneously and bilaterally&#58; 1 tone and 1 continuous noise&#46; The patients then had to keep pressing a switch during the entire time that they heard the tone&#44; letting go only when they stopped perceiving it entirely&#46; An initial SoNo was used with an S180No stimulus&#44; obtaining the difference in decibels between these 2 phases&#59; and the result was obtained as a binaural test for the two groups&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In the electrophysiological assessment&#44; brainstem auditory evoked potentials &#40;BAEP&#41; were performed&#46; Electrodes were applied at the vertex&#44; to both mastoids and ground electrode in Fz&#46; Electrode impedance was less than 5k Ohm&#46; Stimuli were sent at 80<span class="elsevierStyleHsp" style=""></span>dB with contralateral white noise masking at 50<span class="elsevierStyleHsp" style=""></span>dB&#46; The values for <span class="elsevierStyleSmallCaps">i</span>&#8211;<span class="elsevierStyleSmallCaps">v</span>&#44; <span class="elsevierStyleSmallCaps">i</span>&#8211;<span class="elsevierStyleSmallCaps">iii</span> and <span class="elsevierStyleSmallCaps">iii</span>&#8211;<span class="elsevierStyleSmallCaps">v</span> complexes were assessed by an expert neurophysiologist&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">For the P300 study&#44; the electrodes were placed in Fz&#44; Cz and Pz to obtain referenced optimum recordings in a mastoid link&#46; The frequent stimulus was replicated on 160 occasions with a tone of 750<span class="elsevierStyleHsp" style=""></span>Hz &#40;approximately 80&#37; of the time&#41;&#59; the infrequent or oddball stimulus was a tone of 2000<span class="elsevierStyleHsp" style=""></span>Hz that occurred randomly on 20&#37; of the occasions&#46; Both were presented binaurally at 70<span class="elsevierStyleHsp" style=""></span>dB HL&#46; The latency and amplitude of the P300 were then determined&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Using SPSS<span class="elsevierStyleSup">&#174;</span> version 16 software&#44; measurement of central tendency was measured&#58; arithmetic mean and standard deviation&#59; and as a measurement of significance&#44; the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> &#40;MWU&#41;&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0115" class="elsevierStylePara elsevierViewall">We assessed 38 individuals&#59; 5 of them were excluded because their auditory threshold in 1<span class="elsevierStyleHsp" style=""></span>kHz was greater than 30<span class="elsevierStyleHsp" style=""></span>dB&#46; The final population was 33 individuals&#44; 24 women &#40;73&#37;&#41; and 9 men &#40;27&#37;&#41;&#46; The mean age was 69 years&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Of the 33 patients assessed&#44; 16 had Hcy values that fell within normal limits &#40;&#60;15<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;l&#41; and 17 were classified as within the group of patients with HHcy&#46; The mean Hcy concentration in the case group was 19&#46;6<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;l with SD&#61;2&#46;3 and it was 11&#46;1<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;l with SD&#61;3&#46;3 for the control group &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Upon analysing the interview&#44; it was observed that 18 patients reported tinnitus&#44; 7 patients from the control group &#40;21&#46;2&#37;&#41; and 11 &#40;33&#46;3&#37;&#41; from the group with HHcy&#59; the remaining patients &#40;45&#46;5&#37;&#41; denied having this symptom&#46; The other questions asked were not statistically significant&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">After we analysed the audiometries performed by frequency&#44; we observed that the mean of the responses was similar in the deep frequencies&#44; as well as in the mean frequencies between the group with HHcy and the control group&#46; However&#44; the values of the group with HHcy were greater for the high-pitched frequencies&#46; There were no statistically significant values for any frequencies &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Tympanometry was performed on all the patients assessed in the study&#46; Of the total right ears assessed&#44; 72&#46;8&#37; presented a Jerger A curve &#40;36&#46;4&#37; of the control group and 36&#46;4&#37; of the group with HHcy&#41;&#46; Seven ears &#40;21&#46;2&#37;&#41; presented a Jerger As curve &#40;6&#46;1&#37; in the control group and 15&#46;1&#37; in the group with HHcy&#41;&#44; 3&#37; an Ad curve and 3&#37; a C curve&#46; Of the left ears assessed&#44; the A curve was present in 72&#46;7&#37; of the cases &#40;36&#46;4&#37; in the control group and 36&#46;4&#37; in the group with HHcy&#41;&#44; and the As curve was present in 21&#46;2&#37; &#40;12&#46;1&#37; in the control group and 9&#46;1&#37; in the group with HHcy&#41;&#46; A total of 6&#46;0&#37; had an Ad curve &#40;3&#37; in the control group and 3&#37; in the group with HHcy&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">When the acoustic reflex was analysed&#44; it was observed that the mean response at 500 and 1000<span class="elsevierStyleHsp" style=""></span>Hz for both ears was 90<span class="elsevierStyleHsp" style=""></span>dB&#44; in both the group with HHcy and in the control group&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">At the frequency of 2000<span class="elsevierStyleHsp" style=""></span>Hz&#44; the mean response in the right ear in both groups was 90<span class="elsevierStyleHsp" style=""></span>dB&#59; for the left ear&#44; the mean response for the group with HHcy was 90<span class="elsevierStyleHsp" style=""></span>dB&#44; while it was 95<span class="elsevierStyleHsp" style=""></span>dB for the control group&#46; At 4000<span class="elsevierStyleHsp" style=""></span>Hz&#44; we found that in the right ear the mean response for the control group was 80<span class="elsevierStyleHsp" style=""></span>dB&#44; while it was 90<span class="elsevierStyleHsp" style=""></span>dB for the group with HHcy&#46; For the left ear&#44; the mean response at 4000<span class="elsevierStyleHsp" style=""></span>Hz was 90<span class="elsevierStyleHsp" style=""></span>dB for both ears&#46; No statistically significant differences were observed in any of the frequencies&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">When the dichotic digits test was analysed&#44; we found that the mean of the percentage of responses for the right ear in the control group was 62&#46;6&#37;&#44; while for the group with HHcy it was 54&#46;7&#37;&#59; MWU test&#61;89 with <span class="elsevierStyleItalic">P&#61;&#46;</span>94&#46; For the left ear&#44; the mean of the responses for the control group was 17&#46;2&#37; and&#44; for the group with HHcy&#44; it was 16&#46;6&#37;&#59; MWU test &#61;130<span class="elsevierStyleHsp" style=""></span>500 with <span class="elsevierStyleItalic">P&#61;&#46;</span>845&#46; For the mixed responses&#44; the mean was 14&#46;9&#37; for the control group and 19&#46;3&#37; for the group with HHcy&#59; MWU test &#61;115<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>465&#46; In the omissions&#44; there was a mean of 3&#46;9&#37; in the control group&#44; while for the group with HHcy the mean was 9&#46;9&#37;&#59; MWU&#61;94<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>136&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In the filtered word test&#44; the mean of responses in the right ear for the control group was 58&#46;5&#37;&#44; while for the group with HHcy it was 52&#46;4&#37;&#59; MWU test &#61;113<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>423&#46; For the left ear&#44; the mean of correct responses for the control group was 61&#46;2&#37; and for the group with HHcy it was 56&#46;5&#37;&#59; MWU test &#61;125<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>709&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The word in noise test presented&#44; for the right ear&#44; a mean of correct responses of 74&#46;5&#37; for the control group&#44; while for the group with HHcy it was 73&#46;8&#37;&#59; the analysis with MWU&#61;130<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>845&#46; For the left ear&#44; the mean of correct responses was 69&#46;75&#37; in the control group and 70&#46;4&#37; in the group with HHcy&#59; MWU&#61;119<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>557&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In the music test&#44; the mean of correct responses for the right ear in the control group was 90&#46;6&#37; and for the group with HHcy&#44; 78&#46;2&#37;&#59; MWU&#61;88<span class="elsevierStyleHsp" style=""></span>500 with <span class="elsevierStyleItalic">P&#61;&#46;</span>87&#46; For the left ear&#44; the mean of correct answers in the control group was 90&#46;6&#37;&#44; while it was 78&#46;2&#37; for the group with HHcy&#59; MWU test &#61;92<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>118&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">For the MLD test&#44; the mean of responses obtained in the control group was 8&#46;7<span class="elsevierStyleHsp" style=""></span>dB while for the group with HHcy it was 13&#46;49<span class="elsevierStyleHsp" style=""></span>dB&#59; MWU&#61;81<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>049&#44; which was statistically significant &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> and <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">The BAEP study showed latency values in the <span class="elsevierStyleSmallCaps">i</span>&#8211;<span class="elsevierStyleSmallCaps">iii</span> complex for the right ear of the control group of 2&#46;12<span class="elsevierStyleHsp" style=""></span>ms on average with SD&#61;0&#46;23&#44; while for the group with HHcy the mean of the inter-wave latency for this same ear was 2&#46;15<span class="elsevierStyleHsp" style=""></span>ms with SD&#61;0&#46;28&#46; It should be pointed out that this complex could not be identified in 2 patients of the group with HHcy&#59; MWU&#61;93<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>299&#46; For the <span class="elsevierStyleSmallCaps">i</span>&#8211;<span class="elsevierStyleSmallCaps">iii</span> complex in the left ear of the control group&#44; the mean latency was 2&#46;04<span class="elsevierStyleHsp" style=""></span>ms with SD&#61;0&#46;46&#44; while for the group of patients with HHcy the mean latency was 2&#46;21<span class="elsevierStyleHsp" style=""></span>ms with SD&#61;0&#46;51&#59; MWU test&#61;82<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>224&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleSmallCaps">iii</span>&#8211;<span class="elsevierStyleSmallCaps">iv</span> complex for the right ear in the control group showed a mean inter-round latency of 2&#46;02<span class="elsevierStyleHsp" style=""></span>ms with SD&#61;0&#46;34&#44; while for the group with HHcy it was 2&#46;29<span class="elsevierStyleHsp" style=""></span>ms with SD&#61;0&#46;33&#59; MWU&#61;69<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>015&#46; In the left ear&#44; the mean latency for the control group was 2&#46;11<span class="elsevierStyleHsp" style=""></span>ms with SD&#61;0&#46;33&#44; while for the group with HHcy it was 2&#46;27<span class="elsevierStyleHsp" style=""></span>ms with SD&#61;0&#46;25&#59; MWU test &#61;86<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>74&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">When the <span class="elsevierStyleSmallCaps">i</span>&#8211;<span class="elsevierStyleSmallCaps">v</span> complex was assessed&#44; it was observed that the mean inter-round latency for the right ear in the control group was 4&#46;14<span class="elsevierStyleHsp" style=""></span>ms with SD&#61;0&#46;36&#44; while for the group with HHcy it was 4&#46;47<span class="elsevierStyleHsp" style=""></span>ms with SD&#61;0&#46;25&#59; MWU&#61;56<span class="elsevierStyleHsp" style=""></span>500 with <span class="elsevierStyleItalic">P&#61;&#46;</span>11&#46; For the left ear&#44; the mean latency in the <span class="elsevierStyleSmallCaps">i</span>&#8211;<span class="elsevierStyleSmallCaps">v</span> complex of the left ear in the control group was 4&#46;15<span class="elsevierStyleHsp" style=""></span>ms with SD&#61;0&#46;55&#44; while for the group with HHcy it was 4&#46;37<span class="elsevierStyleHsp" style=""></span>ms with SD&#61;0&#46;35&#59; MWU&#61;70<span class="elsevierStyleHsp" style=""></span>500 with <span class="elsevierStyleItalic">P&#61;&#46;</span>85&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Finally&#44; we analysed the P300 assessed in the patients&#44; finding a mean latency of 303<span class="elsevierStyleHsp" style=""></span>ms for the control group with SD&#61;28&#44; while in the group with HHcy there was a mean latency of 353<span class="elsevierStyleHsp" style=""></span>ms with SD&#61;44&#59; MWU test &#61;39&#46;00 with <span class="elsevierStyleItalic">P&#61;&#46;</span>000&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">With respect to the amplitude of P300&#44; we found a mean of 1&#46;04<span class="elsevierStyleHsp" style=""></span>mV for the control group with SD&#61;0&#46;58 and of 1&#46;46<span class="elsevierStyleHsp" style=""></span>mV with SD&#61;1&#46;04 for the group with HHcy&#59; MWU&#61;109<span class="elsevierStyleHsp" style=""></span>000 with <span class="elsevierStyleItalic">P&#61;&#46;</span>345 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0200" class="elsevierStylePara elsevierViewall">From the analysis of the clinical variables studied&#44; tinnitus stood out with a high rate in the entire population studied&#59; this seems to reflect the conditions of prevalence of the symptom in the older adults&#44; who normally present auditory sensorial deficits that affect central auditory functions responsible for its persistence&#46; Experts in the subject matter have commented on the association of tinnitus with vascular problems and states of depression and psychic conflict&#46; However&#44; in our study we found no differences between the groups&#44; in part because they were regulated by the criteria of exclusion&#46; The histological changes in structures identified as replacements in the auditory pathway&#44; from effects of age&#44; show successive changes in neuronal morphology&#44; synapsing and white matter density&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> which can explain the variations in response observed&#46; Added to the effect of age&#44; we find the metabolic condition under study&#44; the HHcy&#44; and &#40;in the opposite sense&#41; the cerebral plasticity&#44; which shows its characteristics in the elderly adult&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The psychoacoustic tests did not show any notable differences with respect to the control group except in the MLD test&#46; Nevertheless&#44; in spite of not being statistically significant&#44; it is noteworthy that the majority of the group with HHcy had a tendency to present lower average responses than the control group&#46; It is useful to emphasise that the rate of alterations in the central auditory processes &#40;evident by means of lower score in the psychoacoustic tests inherent to age&#41; could not be distinguished easily from the control of this variable&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The dichotic digits test requires the competence of the systems of attentional control<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and the integrity of the peripheral and central auditory pathways&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The greater number of omissions presented in the group with HHcy is probably explained by functional alteration of the mechanisms of selective attention&#44; which are related with cognitive systems and with the activation of cortical and subcortical areas that process information relevant for an individual&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">The results obtained in studies such as that of Olsen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> suggest that the patients with presbycusis tend to present low MLD values &#40;&#8804;7&#8211;8<span class="elsevierStyleHsp" style=""></span>dB&#41;&#44; which coincide with the values obtained by the control group&#46; The MLD test has been used to assess injuries in the brain stem<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> and the test has classically been related to the assessment of the superior olivary complex&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> The higher values of MLD in the group with HHcy make us suspect that HHcy may condition alterations in the integration&#44; comparison and analysis of the temporality of the auditory information related to alterations at this level or in superior levels&#46; In prior experiences in academic studies carried out by the authors&#44; there was evidence that suggested alterations in the highest portions of the auditory pathway&#44; especially in the cerebral cortex&#44; which eventually modified MLD scores towards high values&#46; It is speculated&#44; therefore&#44; that HHcy might be responsible for the altered values in this test&#46; Wack et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> studied the function anatomy of MLD using simultaneous application of functional magnetic resonance&#44; observing that with the improvement of the threshold registered by changing from a diotic processing to a dichotic one&#59; there was activation of the left inferior frontal gyrus&#44; of the left insular lobe and of other areas&#46; Those authors mentioned&#44; among their antecedents&#44; cases in which the individual MLD values could be more than 20<span class="elsevierStyleHsp" style=""></span>dB&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> as we have observed in individual cases of temporal cortical lesion&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleSmallCaps">iii</span>&#8211;<span class="elsevierStyleSmallCaps">v</span> inter-wave latency is an indicator of the conduction of the rostral area of the bridge and of the section of the auditory pathway in the midbrain&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The inter-latencies for the right ear of the group with HHcy were significantly greater&#59; however&#44; we have found no clear explanation for the reason why conduction times were more affected unilaterally in these patients&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">&#8220;The latency of the P300 wave tells us the speed with which the subject discriminates the infrequent stimulus&#44; compares the information in relation to the stimulus that is stored in memory and arrives at the appropriate decision&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Classically&#44; it has been related with cognitive perceptual processes that result from higher brain functions&#44; so its register makes it possible to make inferences about higher competencies or central auditory competencies&#46; In this study&#44; the group with HHcy showed greater P300 latency &#40;<span class="elsevierStyleItalic">P&#61;&#46;</span>000&#41;&#46; It is known that factors such as tonal auditory level&#44; age&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> education<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> and state of wakefulness&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> among others&#44; can affect the latency values of P300&#46; Fortunately&#44; our study presented the strength of having compared groups with tonal threshold close to normal and with similar age and wakefulness conditions&#44; so our findings coincide with the statements of several authors in indicating that HHcy conditions alteration in cognitive processes in elderly adults&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0230" class="elsevierStylePara elsevierViewall">The alterations in the psychoacoustic and electrophysiological tests observed in the study suggest that CNS is functionally compromised in patients with HHcy&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">In the clinical audiological symptoms&#44; there are various questions with respect to the vascular and metabolic implications of neural and sensorial hypoacusis&#44; as well as implications of disorders in the central processes of audition&#46; These questions might be clarified through further research on HHcy&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of Interests</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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            3 => "Results"
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        1 => array:2 [
          "identificador" => "xpalclavsec260415"
          "titulo" => "Keywords"
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          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Introducci&#243;n y objetivos"
            2 => "M&#233;todo"
            3 => "Resultados"
            4 => "Conclusiones"
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          "identificador" => "xpalclavsec260416"
          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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        5 => array:3 [
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          "titulo" => "Method"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Criteria of Inclusion"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Criteria of Exclusion"
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        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Results"
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        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Discussion"
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          "identificador" => "sec0035"
          "titulo" => "Conclusions"
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        9 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflict of Interests"
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        10 => array:1 [
          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2012-05-08"
    "fechaAceptado" => "2013-01-09"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec260415"
          "palabras" => array:5 [
            0 => "Homocysteine"
            1 => "Elderly"
            2 => "Central auditory processing disorder"
            3 => "Evoked brainstem auditory"
            4 => "P300 event-related potentials"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec260416"
          "palabras" => array:5 [
            0 => "Homociste&#237;na"
            1 => "Adulto mayor"
            2 => "Desorden de procesamiento auditivo central"
            3 => "Potenciales evocados auditivos de tallo cerebral"
            4 => "Potenciales relacionados a eventos P300"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hyperhomocysteinemia as a risk factor for hearing impairment&#44; neuronal damage and cognitive impairment in elderly patients is controversial and is limited by the small number of studies&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this work was determine if elderly patients detected with hyperhomocysteinemia have an increased risk of developing abnormalities in the central auditory processes as compared with a group of patients with appropriate homocysteine levels&#44; and to define the behaviour of psychoacoustic tests and long latency potentials &#40;P300&#41; in these patients&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This was a cross-sectional&#44; comparative and analytical study&#46; We formed a group of patients with hyperhomocysteinemia and a control group with normal levels of homocysteine&#46; All patients underwent audiometry&#44; tympanometry and a selection of psychoacoustic tests &#40;dichotic digits&#44; low-pass filtered words&#44; speech in noise and masking level difference&#41;&#44; auditory evoked brainstem potentials and P300&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patients with hyperhomocysteinemia had higher values in the test of masking level difference than did the control group &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;049&#41; and more protracted latency in P300 &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;000&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Hyperhomocysteinemia is a factor that alters the central auditory functions&#46; Alterations in psychoacoustic tests and disturbances in electrophysiological tests suggest that the central portion of the auditory pathway is affected in patients with hyperhomocysteinemia&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La hiperhomocisteinemia como un factor de riesgo para da&#241;o auditivo&#44; da&#241;o neuronal y deterioro cognitivo en pacientes adultos mayores es controversial y se encuentra limitado por un peque&#241;o n&#250;mero de estudios&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este trabajo es determinar si los pacientes adultos mayores con hiperhomocisteinemia presentan mayor riesgo de desarrollar alteraciones en los procesos centrales de la audici&#243;n contra un grupo de pacientes con niveles de homociste&#237;na adecuados y definir el comportamiento de las pruebas psicoac&#250;sticas y de potenciales de latencia larga &#40;P300&#41; en estos grupos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal&#44; comparativo y anal&#237;tico&#46; Se form&#243; un grupo de pacientes con hiperhomocisteinemia y un grupo control con valores normales de homociste&#237;na&#46; A todos los pacientes se les realiz&#243; audiometr&#237;a tonal&#44; impedanciometr&#237;a y una selecci&#243;n de pruebas psicoac&#250;sticas &#40;d&#237;gitos dic&#243;ticos&#44; palabras filtradas pasa bajo&#44; palabra en ruido y diferencia en niveles de enmascaramiento&#41; as&#237; como potenciales provocados auditivos de tallo cerebral y P300&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con hiperhomocisteinemia presentaron valores en la prueba de diferencia en los niveles de enmascaramiento superiores a los del grupo control &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#44; as&#237; como latencias m&#225;s prologadas en los P300 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La hiperhomocisteinemia es un factor que altera las funciones auditivas centrales&#46; Las pruebas psicoac&#250;sticas alteradas junto con la alteraci&#243;n en las pruebas electrofisiol&#243;gicas sugieren que la porci&#243;n central de la v&#237;a auditiva est&#225; afectada en pacientes con hiperhomocisteinemia&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; D&#237;az-Leines S&#44; et al&#46; Evaluaci&#243;n de pruebas psicoac&#250;sticas y de potenciales relacionados a eventos P300 en adultos mayores con hiperhomocisteinemia&#46; Acta Otorrinolaringol Esp&#46; 2013&#59;64&#58;265&#8211;272&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">MLD values obtained in each of the patients&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Group with HHcy</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Control group</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patient No&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Education&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Hcy level&#44; micromol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patient No&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Education&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Hcy level&#44; &#956;mol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High School&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High School&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Middle School&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Middle School&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postgraduate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Middle School&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postgraduate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postgraduate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Middle School&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Middle School&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Middle School&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High School&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab401959.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Demographic Characteristics and Homocysteine Values in the Populations Assessed&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variables studied&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Response threshold in dB</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Results</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Control&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">HHcy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mann Whitney <span class="elsevierStyleItalic">U</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">125</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hz</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right ear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123<span class="elsevierStyleHsp" style=""></span>000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;657&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Left ear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;683&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">250</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hz</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right ear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">117<span class="elsevierStyleHsp" style=""></span>500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;510&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Left ear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129<span class="elsevierStyleHsp" style=""></span>500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;817&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">500</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hz</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right ear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101<span class="elsevierStyleHsp" style=""></span>500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Left ear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">122<span class="elsevierStyleHsp" style=""></span>000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;631&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">1000</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hz</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right ear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104<span class="elsevierStyleHsp" style=""></span>500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;260&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Left ear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;465&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">2000</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hz</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right ear&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">8000</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hz</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  """
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                  \t\t\t\t">Variables studied&nbsp;\t\t\t\t\t\t\n
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