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In a 2003 study by Khavinson et al

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The cost of replacing a vial or pen is nothing compared to the risk of injecting degraded or contaminated medication

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This includes the secretion of nitric oxide for vasodilation and endothelin-1 for vasoconstriction, which modulates vascular tension and diameter, directly influencing the balance of oxygen supply to meet tissue metabolic demands

J Mol Med (Berl) 2004;82(8):510529