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This is cosmetic rather than clinical but can affect compliance

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In conclusion, the CEG openly admits that "The EPIC trial did not investigate a cutoff for cardiac enlargement by VHS alone at which to start pimobendan therapy." And, the CEG also admits that its x-ray-only parameter is "not based on evidence." In essence, by these admissions, the only professional course of action for the CEG to take would be to not make any such x-ray-only recommendation at all

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(1) Moreover, eumelanin production also reportedly contributes to increasing levels of pigmentation in skin cells

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