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In a large meta-analysis of 41 randomized controlled trials including 2,768 patients with systemic inflammatory response syndrome or sepsis, late application (more than 24 hours after the onset of symptoms) of N-acetylcysteine was associated with cardiovascular instability (31)

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However, cross-reactivity with INSR-B can modulate glucose metabolism in vivo, leading to insulin resistance and hyperglycemia [21, 71, 72]

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Furthermore, low expression of pyruvate dehydrogenase kinase 4 (Fig