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Its not so much about sterility, but about photolysis destruction by light

Effects on cognition and global function were evaluated with the Alzheimers Disease Assessment Scale Cognitive Subscale (ADAS-Cog) and the Clinician Interview-Based Impression of Change with Caregiver Input scale (CIBIC+) at 4, 12, and 24 weeks after the start of injections

BMJ Case Rep

[1] Persistently high B12 levels warrant medical investigation, as they may signal liver disease, kidney dysfunction, or certain haematological disorders

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