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An additional insult or pathogenic factor, often referred to in the literature as the second hit, is required to trigger the progression from simple steatosis to steatohepatitis (MASH), characterized by hepatocellular injury, inflammation, and varying degrees of fibrosis [32]

Some people run it continuously

Lambeir A

(2010) also reported that a 39-year-old white woman had increased levels of pyroglutamic acid in urine, which could be related to chronic APAP use
