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The melanocytes may be normal or slightly increased in number, but appear to be functionally hyperactive because there is a marked increase in the amount of melanin production (Fig

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One leading hypothesis involves the autonomic nervous system

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Biochemically, tirzepatide is a larger and more complex peptide with sequence elements and receptor-binding domains optimized to engage two incretin receptors, while semaglutide is engineered specifically for high-affinity GLP-1R activation