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While hypothermia provides significant neuroprotection, its proposed mechanisms are multifactorial and may include modulation of neurotransmitter systems and potentially influencing metabolic pathways involving compounds like carnitine (56)

The complete selection process, including the number of records identified, screened, and excluded with explicit reasons (separated for preclinical and clinical/epidemiological literature), is documented in the PRISMA flow diagram (Figure 1)

Barriers to entry continue rising as clinical expectations increase and manufacturing requirements become more sophisticated

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