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This combination triggers potent inflammatory stimuli via macrophage and neutrophil activation and accompanying release of pro-inflammatory cytokines (150), resulting in a buildup of ROS O and H 2 O 2 , and also malondialdehyde, at the site of the ovary and in follicular fluid and peritoneal fluid ( 3+ released from the stagnated refluxed erythrocytes magnifies the damage by driving production of hydroxyl radical OH

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Gene expression analysis further confirmed this enzymatic activation at the transcriptional level, with SOD, CAT, and APX transcripts upregulated in both treatments, and the strongest induction observed in stress + FFA

Bearing in mind potential hematologic benefits, athletes with a vitamin B 12 concentration of 200400 pg/mL require special attention, wider monitoring and personalized supplementation