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If you are not improving with this approach, then the next step maybe a course of shockwave therapy

BardetBiedl syndrome, a ciliopathy with autosomal recessive inheritance, is frequently associated with hyperphagia and obesity, in addition to syndromic features such as polydactyly, retinal dystrophy, and renal abnormalities [73]

Nudleman, E

A non-canonical mechanism of Nrf2 activation by autophagy deficiency due to direct interaction between Keap1 and p62 has been recently proposed [56,57]