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The raised flap is entirely dependent on blood flow through small vessels at its base, and any factor that compromises oxygen delivery (anaemia being a major one) puts the flap at risk

(2003) Insulin resistance in the liver-specific IGF-1 gene-deleted mouse is abrogated by deletion of the acid-labile subunit of the IGF-binding protein-3 complex: relative roles of growth hormone and IGF-1 in insulin resistance

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It's a cofactor in mitochondrial energy production and myelin synthesisthe insulation around your nerves