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The first is extracellular matrix biology, where fibroblast culture and rat wound-chamber studies from the Maquart and Simeon groups (1988-2000) reported stimulation of collagen synthesis, sulfated glycosaminoglycan synthesis and small proteoglycan expression, alongside upregulation of matrix metalloproteinase-2 and its tissue inhibitors, a simultaneous increase in both matrix deposition and matrix turnover

Weekly weigh-ins are encouraged for accountability and progress tracking

Other manifestations include decreased insulin secretion, increased insulin resistance and increased blood sugar levels [86]

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