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However, the clinical heterogeneity observed in PEM suggests that other pathophysiological systems, such as coagulation cascade abnormalities, autonomic dysfunction, and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, may coexist within the same patient population and potentially interact with the mechanisms outlined in this framework

Regarding CSSS, there was a significant decrease in CSSS in all studied patients after intervention (the range decreased from an initial of 19118 to 1099 after intervention with a P-value of 0.025)

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