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Her office upper esophagoscopy using a 3.7 mm ENT scope without air insufflation shows typical findings: The column of her own un-burped air, holding the esophagus in always open position all the way to the gastro-esophageal junction

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Other factors, including hormonal changes, UV cumulative damage, declining stem cell function, and altered immune function, contribute to skin aging independently of GHK levels

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