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York B, Reineke EL, Sagen JV, Nikolai BC, Zhou S, Louet JF, et al

6,7 The total duration of a hyperammonemic coma and the extent of hyperammonemia are the most relevant prognostic factors and are negatively correlated with the patients neurological outcome

Mitigating factors to explain the lack of performance improvement could be either the use of a CM compound disproportionate to the target ratio of citrulline and malate, or the reliability of the exercise protocol