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[13] This trial was conducted in 20 countries: multiple European countries, Russia, Turkey, Brazil, Israel, Malaysia, Mexico, Thailand, Taiwan, Canada, and the United States

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If they overlap in your system, you get additive stimulation of those receptors, and the result is not better efficacy

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[DOI] [PubMed] [Google Scholar] 73.Maejima Y, Yokota S, Shimizu M, Horita S, Kobayashi D, Hazama A, et al