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Collectively, these data imply that the impact of NSW on telomere length may depend on the duration and intensity of exposure, with short to moderate durations having a limited effect, but long-term or consecutive NS contributing to telomere shortening and potentially premature cellular aging

31, 32 When a conclusive mtDNA abnormality could not be identified, nuclear mitochondrial gene testing and/or a muscle and/or skin biopsy was recommended

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