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Dopamine-induced oxidative stress, impaired synaptic vesicle function and misfolding of -synuclein, due to mutations or to oxidative damage to this protein, might be components in a self-perpetuating vicious cycle that eventually leads to the demise of dopaminergic neurons

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(30,31) The authors acknowledged several limitations, including the use of a national patient database, which restricted their ability to control for prior diabetes management and preoperative glycemic control