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The two mechanisms are independent and complementary

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Biomaterials 31(25):65976611 Moore B, Sheets G, Doss J, Umrigar A, Norman M, Fang Z, Prasad P, Musso A, Clay S, Tsien F (2023) Is methotrexate ototoxic

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doi: 10.3945/jn.115.213439 43