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As the process advances, macrophage activation shifts significantly, with pro-inflammatory macrophages dominating the local microenvironment

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10.1186/s12958-018-0436-9 15

At the time of entering the study, all patients were off Botox except for one (#7) who used it to control epiphora and was free of any other contributary modalities that could interfere with the study

4 Both conditions share common symptoms, such as chronic pain, fatigue, and non-restorative sleep, making differential diagnosis challenging