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Following structural damage and functional impairment of the muscle tissue, myofibrillar rupture and extravasation of intracellular proteins such as myoglobin, creatine kinase (CK), and lactate dehydrogenase (LDH), into the extracellular medium, trigger the local inflammatory response [47, 50,51,52]

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We proposed at 428.302(c)(5) that if a manufacturer believes severe supply chain disruption continues into a second, consecutive applicable period after the start of the natural disaster or other unique or unexpected event, the manufacturer may request a reduction of the total rebate amount for that second applicable period by submitting a rebate reduction extension request to CMS, along with any new supporting documentation

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