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As mentioned above, hyperglycemia induces oxidative stress, which may lead to endothelial dysfunction, mainly manifested in: Endothelial nitric oxide synthase (eNOS) activity is inhibited, NO synthesis is reduced, thrombosis factors (such as tissue factor and plasminogen activator inhibitors1) or ET-1 production is increased, which induces thrombosis and vasoconstriction, and nuclear factor kappaB (NF-B) and activator protein1 are increased, leading to tissue inflammation (Defeudis et al

In research on B12 deficient elderly, the administration of B12 supplementation decreased homocysteine levels and led to an improvement in cognitive ability in participants [126]

Collectively, these actions reverse macrophagemediated immunosuppression, creating favorable conditions for improving the TME

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Known adverse reactions: May cause allergic reaction: discontinue use and consult a health practitioner if symptoms of allergy, nausea, or vomiting appear