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Buy N-Acetyl Semax Amidate

N-Acetyl Semax Amidate is a modified version of the nootropic peptide Semax, showing enhanced pharmacokinetics and stability, and increased resistance to enzymatic degradation. It is thought to retain Semax’s cognitive and neuroprotective benefits, and is likewise suitable for intranasal administration.

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    What is N-Acetyl Semax Amidate?

    N-Acetyl Semax Amidate is an enhanced version of the nootropic peptide Semax, which was developed by Russian scientists in the 1980s. N-Acetyl Semax Amidate and Semax are structurally similar and possess the same seven-amino-acid sequence.

    This sequence merges a segment of adrenocorticotropic hormone (ACTH, specifically ACTH 4-7, or Met-Glu-His-Phe) with a Pro-Gly-Pro extension at the C-terminus. Thanks to its design, Semax effectively passes through the blood-brain barrier (BBB), exerting its nootropic benefits without any known endocrine effects [1, 2, 3, 4, 5].

    N-Acetyl Semax Amidate is characterized by the integration of acetic acid at the N-terminus and amidation at the C-terminus, which have been shown to confer additional advantages, such as fortifying the N-terminus and C-terminus against leucine aminopeptidase-mediated degradation and hydrolysis [6, 7].

    As a result, N-Acetyl Semax Amidate has been reported to last 30 minutes longer than Semax before being degraded in blood plasma, while also expressing increased stability in brain tissue, indicating potentially extended nootropic effects after application [6, 8].

    Unfortunately, data on N-Acetyl Semax Amidate predominantly address its pharmacokinetics, while studies on its mechanisms and potential benefits are lacking. Nonetheless, it is anticipated that the peptide harbors therapeutic potential akin to that of Semax, which itself is approved in Russia for therapy in cognitive disturbances and stroke [1].

    Thus, the available scientific data on Semax's mechanisms may serve as a reference for the potential pharmacodynamics of N-Acetyl Semax Amidate:

    • Semax enhances Brain-Derived Neurotrophic Factor (BDNF) and Nerve Growth Factor (NGF) levels in the brain, which are neurotrophic factors facilitating neural survival and plasticity. Studies report a 40% increase in BDNF levels following Semax application [9, 10].
    • The peptide may increase the expression of the tropomyosin receptor kinase B (TrkB) receptors in the brain by 100%. These receptors mediate many of BDNF's neuroprotective effects [9, 10].
    • Semax may enhance serotonin, dopamine, and enkephalin signaling, thus modulating mood, stress, cognition, and reward-driven behavior [11, 12, 13].

    Unrelated to its nootropic benefits, Semax may also regulate gastrointestinal blood flow, microcirculation, and vascular permeability, potentially exhibiting anti-ulcer effects [14].

    The potential for N-Acetyl Semax Amidate to mirror these effects remains a subject for future research. The peptide is currently available strictly as a research chemical for educational and experimental purposes.

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    Benefits of N-Acetyl Semax Amidate

    As mentioned, data on the benefits of N-Acetyl Semax Amidate are limited. Yet, the modified peptide is expected to have similar effects as Semax while boasting improved pharmacokinetics.

    Thus, we will outline the latest evidence on Semax's benefits to better understand N-Acetyl Semax Amidate's potential.

    Neuroprotective Potential of N-Acetyl Semax Amidate

    Based on available Semax data, N-Acetyl Semax Amidate may have potential neuroprotective benefits in settings of stroke, nerve damage, and exposure to neurotoxins.

    • Stroke: A trial in 110 stroke patients receiving intranasal Semax at 6000mcg/daily for 10 days saw increased BDNF levels and improved motor function [15]. Another trial in stroke patients also reported reduced inflammation, which may help improve recovery [16].
    • Nerve damage reduction: One clinical study revealed that administering Semax intranasally can alleviate pressure-driven nerve damage experienced by individuals with glaucoma [17].
    • Neurotoxin protection: An explorative study involving 30 individuals experiencing alcohol delirium demonstrates that those administered Semax show potential resistance to the neurotoxic effects of alcohol intoxication [18].

    Nootropic Potential of N-Acetyl Semax Amidate

    Researchers may refer to the extensive nootropic research on Semax before conducting N-Acetyl Semax Amidate experiments. Most notably, the peptide has been tested for its effects on brain activity and mental fatigue:

    • Brain activity: A study probed into Semax's influence on the brain's Default Mode Network (DMN) in 24 middle-aged individuals, using a 1% Semax solution or placebo. Functional magnetic resonance imaging (fMRI) scans revealed that Semax notably enhanced volume in the DMN's rostral subcomponent, particularly in the medial frontal cortex, suggesting improved episodic memory and information processing [19].
    • Mental fatigue: A clinical study in healthy participants explored the cognitive benefits of a 16mcg/kg intranasal Semax dose after an 8-hour work shift. The Semax group showcased 71% accuracy in a subsequent memory test, substantially outperforming the 41% accuracy of the control group [20].

    Anti-Ulcer Potential of N-Acetyl Semax Amidate

    N-Acetyl Semax Amidate may have extra-neurological effects, similar to Semax. The latter has been reported to cause increased healing of peptic ulcers following application of 1% Semax nasal drops (2000-4000mcg x3/daily) for 10 days.

    In a study published by Russian researchers Ivanikov et al. in 2002, the authors reported a 90% healing rate for peptic ulcers in Semax-treated patients, which was about three times higher than the placebo's 30% healing rate. The Researchers suggest Semax may increase the healing of peptic ulcers by managing blood flow and vessel health [14].

    It is important to note that the aforementioned study, while encouraging, does not reach the level of a noninferiority study, a trial in which an experimental treatment is compared with the standard of care, to determine whether the experimental treatment is at least as beneficial as established therapies. Consider that, in settings of peptic ulcer caused by Helicobacter pylori, sequential therapy has been demonstrated to cure more than 94 percent of cases [33].

    N-Acetyl Semax Amidate Dosing for Research Only

    N-Acetyl Semax Amidate can be administered in research settings as either nasal spray or subcutaneous injections.

    Researchers must refer to the official dosing for Semax, as data on N-Acetyl Semax Amidate are lacking. Intranasal Semax is available for therapy in Russia as either 0.1% or 1% nasal drops [1].

    According to the package insert, 0.1% Semax nasal drops are indicated for conditions such as mental fatigue, optic nerve disorders, and various degrees of cognitive impairment. Depending on the indication, the peptide can be administered in daily doses between 400 and 8000mcg, split into 2-4 daily applications. The recommended duration of therapy is up to 30 days [21].

    The package insert of 1% Semax nasal drops is indicated for moderate to severe strokes, in doses ranging from 2000-3000mcg per application, given x3-6 times/daily depending on severity [22]. This therapy has been administered for up to 10 days, followed by 20 days of washout and then another 10-day course if needed [15].

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    Where to Buy N-Acetyl Semax Amidate Online? | 2024 Edition

    N-Acetyl Semax Amidate can be acquired online for research purposes.

    To ensure research peptide purity, buyers are advised to select a vendor who uses accredited production facilities and third-party purity testing.

    Here are our top two recommendations based on these criteria.

    Limitless Life

    We endorse Limitless Life as a vendor of N-Acetyl Semax Amidate nasal spray and other intranasal peptides. Here’s where they shine:

    • Purity Assurance: Their N-Acetyl Semax Amidate nasal spray products undergo high-performance liquid chromatography and mass spectrometry (HPLC-MS) testing to ensure 98%+ purity levels.
    • U.S. Sourcing: Their peptide nasal sprays are sourced from accredited manufacturers within the U.S., ensuring products that are free of fillers and impurities.
    • Convenient Payment Options: Limitless Life offers various secure payment methods, including Cash App, credit cards, and even cryptocurrency payments. Further, they currently provide discounts for orders placed using select methods.
    • Efficient and Free Shipping: Orders of $350+ ship free within the U.S., with most being processed on the same day they are placed.

    We strongly recommend Limitless Life for N-Acetyl Semax Amidate in intranasal form for research.

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    PureRawz

    PureRawz is known for their reliability in supplying research-grade peptides, offering benefits like:

    • Third-Party Testing: PureRawz is fully committed to quality and transparency, submitting peptides for thorough third-party laboratory testing and providing researchers with comprehensive Certificates of Analysis.
    • Customer Service: Noted for their excellent service, PureRawz’ support staff promptly address shipping errors and any customer concerns.
    • Payment Options and Discounts: They accept various payment methods, including major credit cards and e-checks, and offer promotions and discounts on their website.

    With their high-quality peptides and fair pricing, PureRawz is a top supplier of research peptides.

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    N-Acetyl Semax Amidate Side Effects and Safety

    Researchers are advised to refer to the safety data on Semax before incorporating N-Acetyl Semax Amidate into their experiments. Based on clinical data on Semax, the peptide is well tolerated when administered intranasally in doses between 600mcg/daily and 12000mcg/daily [23, 24, 25].

    Semax injections, on the other hand, have been studied only in preclinical research. Yet, the available preclinical data also report a favorable safety profile [4, 26, 27, 28].

    Only one study involving Semax nasal drops has reported a potential increase in anxiety due to the potent stimulant-like effects of the peptide. While no such data exist for N-Acetyl Semax Amidate, researchers may consider limiting the use of other stimulants, such as caffeine, in their test subjects [20].

    Further, elevated BDNF levels have been suspected as a potential cause of hair loss. Yet, there is no research linking hair loss with the use of N-Acetyl Semax Amidate, despite its BDNF-boosting potential [29].

    Researchers should also consider the potential side effects related to the route of administration, which may include nose and throat irritation following the use of nasal spray and local skin reactions following subcutaneous injection.

    N-Acetyl Semax Amidate vs. Regular Semax

    Qualified researchers looking to purchase N-Acetyl Semax Amidate for their studies may wonder how it compares to the base version Semax. Below, we compare the two peptides based on available research, legal status, pharmacokinetics, and potential benefits.

    Research and Regulatory Status

    • Semax:
      - Initially formulated and rigorously examined by Russian researchers.
      - Approved by Russian regulatory bodies for addressing several neurological conditions, including cognitive impairments, mental fatigue, and stroke repercussions [1].
      - In the United States, Semax is classed as a research peptide and does not hold approval for human use.
    • N-Acetyl Semax Amidate:
      - It has not undergone clinical research.
      - It is provided strictly as a research chemical.

    Stability and Pharmacokinetics

    • Semax:
      - Demonstrates capability of passing the BBB when administered via subcutaneous injection or intranasal delivery [2, 3].
      - Studies suggest that the half-life of Semax in the presence of the plasma membranes is longer than 1h [30].

    • N-Acetyl Semax Amidate:
      - Hypothesized to not only penetrate the BBB but also manifest augmented bioavailability.
      - It possesses enhanced stability, evident in both blood plasma and brain tissue, due to the acetylation and amidation procedures that serve to protect the peptide's N- and C-terminal groups from enzymatic degradation [6, 8].

    Potential Efficacy

    • Semax:
      - Acknowledged for its cognitive enhancement and neuroprotective potential.

    • N-Acetyl Semax Amidate:
      - It is presumed to have comparable, if not amplified, benefits owing to its superior pharmacokinetics.
      - Research shows enhanced stability of N-Acetyl Semax Amidate in brain tissue vs. Semax, which is potentially indicative of extended nootropic and neuroprotective effects [8].

    N-Acetyl Semax Amidate Nasal Spray vs. Injectable Forms

    Deciding between N-Acetyl Semax in a nasal spray or injection form for research involves considering research needs, study design, and cost.

    Both have been proven useful in various studies, but understanding the pros and cons of both formats is crucial to making an informed decision.

    • Pharmacokinetics: Based on the available research into the pharmacokinetics of different therapeutic peptides, injections offer accurate dosing, ensuring consistent absorption in test subjects [31]. However, researchers may also consider referring to laboratory animal studies in Semax, which suggest that the nasal spray might be more effective in enhancing learning abilities [32].
    • Compliance: N-Acetyl Semax nasal spray is easy to use, making it a handy choice when simplicity is crucial. While injections can be uncomfortable or cause site reactions, which might discourage some participants, they still hold merit in certain research contexts.
    • Safety: Neither the N-Acetyl Semax nasal spray nor injections have been studied for their safety. Yet, researchers may refer to Semax trials, which show great safety with both formulations in preclinical studies and limited clinical research.
    • Cost: Pricing for N-Acetyl Semax nasal spray and injections can vary based on the supplier. The nasal spray, available in a 30mg bottle from Limitless Life, is priced at $84.99.

    Buying N-Acetyl Semax Amidate Online | Final Thoughts

    N-Acetyl Semax Amidate is a research peptide with improved pharmacokinetics over regular Semax. Similar to the latter, the enhanced version is believed to offer a spectrum of potential cognitive and neurological benefits.

    Such potential benefits may include neuro-regeneration, enhanced neuroplasticity, and amplified memory and attention span.

    Researchers looking to study these potential effects may consult a number of online peptide vendors offering Semax for sale, available in either nasal spray or injectable format.

    Our team suggests acquiring N-Acetyl Semax Amidate nasal spray from Limitless Life.

    References

    1. Kolomin, T., Shadrina, M., Slominsky, P., Limborska, S., & Myasoedov, N. (2013). A new generation of drugs: synthetic peptides based on natural regulatory peptides. Neuroscience and Medicine, 4(04), 223-252.
    2. Khavinson, V., Ilina, A., Kraskovskaya, N., Linkova, N., Kolchina, N., Mironova, E., Erofeev, A., & Petukhov, M. (2021). Neuroprotective Effects of Tripeptides-Epigenetic Regulators in Mouse Model of Alzheimer's Disease. Pharmaceuticals (Basel, Switzerland), 14(6), 515. https://doi.org/10.3390/ph14060515
    3. Shevchenko, K. V., Nagaev, I. I.u, Alfeeva, L. I.u, Andreeva, L. A., Kamenskiĭ, A. A., Levitskaia, N. G., Shevchenko, V. P., Grivennikov, I. A., & Miasoedov, N. F. (2006). Bioorganicheskaia khimiia, 32(1), 64–70. https://doi.org/10.1134/s1068162006010055
    4. Manchenko, D. M., Glazova, N. I.u, Levitskaia, N. G., Andreeva, L. A., Kamenskiĭ, A. A., & Miasoedov, N. F. (2010). Rossiiskii fiziologicheskii zhurnal imeni I.M. Sechenova, 96(10), 1014–1023.
    5. Tsai S. J. (2007). Semax, an analogue of adrenocorticotropin (4-10), is a potential agent for the treatment of attention-deficit hyperactivity disorder and Rett syndrome. Medical hypotheses, 68(5), 1144–1146. https://doi.org/10.1016/j.mehy.2006.07.017
    6. Shevchenko, K. V., Nagaev, I. Y., Andreeva, L. A., Shevchenko, V. P., & Myasoedov, N. F. (2019). Prospects for Intranasal Delivery of Neuropeptides to the Brain. Pharmaceutical Chemistry Journal, 53, 89-100.
    7. Markov, D. D., Dolotov, O. V., & Grivennikov, I. A. (2023). The Melanocortin System: A Promising Target for the Development of New Antidepressant Drugs. International journal of molecular sciences, 24(7), 6664. https://doi.org/10.3390/ijms24076664
    8. Shevchenko, K. V., Nagaev, I. Y., Andreeva, L. A., Shevchenko, V. P., & Myasoedov, N. F. (2013). Stability of Semax acetyl to proteolysis in various biological media. Doklady biological sciences : proceedings of the Academy of Sciences of the USSR, Biological sciences sections, 449, 110–112. https://doi.org/10.1134/S0012496613020166
    9. Shadrina, M., Kolomin, T., Agapova, T., Agniullin, Y., Shram, S., Slominsky, P., Lymborska, S., & Myasoedov, N. (2010). Comparison of the temporary dynamics of NGF and BDNF gene expression in rat hippocampus, frontal cortex, and retina under Semax action. Journal of molecular neuroscience : MN, 41(1), 30–35. https://doi.org/10.1007/s12031-009-9270-z
    10. Dolotov, O. V., Karpenko, E. A., Inozemtseva, L. S., Seredenina, T. S., Levitskaya, N. G., Rozyczka, J., Dubynina, E. V., Novosadova, E. V., Andreeva, L. A., Alfeeva, L. Y., Kamensky, A. A., Grivennikov, I. A., Myasoedov, N. F., & Engele, J. (2006). Semax, an analog of ACTH(4-10) with cognitive effects, regulates BDNF and trkB expression in the rat hippocampus. Brain research, 1117(1), 54–60. https://doi.org/10.1016/j.brainres.2006.07.108
    11. Eremin, K. O., Kudrin, V. S., Saransaari, P., Oja, S. S., Grivennikov, I. A., Myasoedov, N. F., & Rayevsky, K. S. (2005). Semax, an ACTH(4-10) analogue with nootropic properties, activates dopaminergic and serotoninergic brain systems in rodents. Neurochemical research, 30(12), 1493–1500. https://doi.org/10.1007/s11064-005-8826-8
    12. Kost, N. V., Sokolov, O. I.u, Gabaeva, M. V., Grivennikov, I. A., Andreeva, L. A., Miasoedov, N. F., & Zozulia, A. A. (2001). Ingibiruiushchee deĭstvie semaksa i selanka na énkefalindegradiruiushchie fermenty syvorotki krovi cheloveka [Semax and selank inhibit the enkephalin-degrading enzymes from human serum]]. Bioorganicheskaia khimiia, 27(3), 180–183. https://doi.org/10.1023/a:1011373002885
    13. Le Merrer, J., Becker, J. A., Befort, K., & Kieffer, B. L. (2009). Reward processing by the opioid system in the brain. Physiological reviews, 89(4), 1379–1412. https://doi.org/10.1152/physrev.00005.2009
    14. Ivanikov, I. O., Brekhova, M. E., Samonina, G. E., Myasoedov, N. F., & Ashmarin, I. P. (2002). Therapy of peptic ulcer with semax peptide. Bulletin of experimental biology and medicine, 134(1), 73–74. https://doi.org/10.1023/a:1020621124776
    15. Gusev, E. I., Martynov, M. Y., Kostenko, E. V., Petrova, L. V., & Bobyreva, S. N. (2018). Éffektivnost' semaksa pri lechenii bol'nykh na raznykh stadiiakh ishemicheskogo insul'ta [The efficacy of semax in the tretament of patients at different stages of ischemic stroke]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova, 118(3. Vyp. 2), 61–68. https://doi.org/10.17116/jnevro20181183261-68
    16. Miasoedova, N. F., Skvortsova, V. I., Nasonov, E. L., Zhuravleva, E. I.u, Grivennikov, I. A., Arsen'eva, E. L., & Sukhanov, I. I. (1999). Izuchenie mekhanizmov neĭroprotektivnogo deĭstviia semaksa v ostrom periode ishemicheskogo insul'ta [Investigation of mechanisms of neuro-protective effect of semax in acute period of ischemic stroke]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova, 99(5), 15–19.
    17. Kurysheva, N. I., Shpak, A. A., Ioĭleva, E. E., Galanter, L. I., Nagornova, N. D., Shubina, N. I.u, & Shlyshalova, N. N. (2001). "Semaks" v lechenii glaukomatoznoĭ opticheskoĭ neĭropatii u bol'nykh s normalizovannym oftal'motonusom [Semax in the treatment of glaucomatous optic neuropathy in patients with normalized ophthalmic tone]. Vestnik oftalmologii, 117(4), 5–8.
    18. Strelets, N. V., & Utkin, S. Y. (2005). P. 6.020 Use of the neurometabolic drug "Semax" for complex treatment of alcohol delirium. European Neuropsychopharmacology, (15), S275.
    19. Lebedeva, I. S., Panikratova, Y. R., Sokolov, O. Y., Kupriyanov, D. A., Rumshiskaya, A. D., Kost, N. V., & Myasoedov, N. F. (2018). Effects of Semax on the Default Mode Network of the Brain. Bulletin of experimental biology and medicine, 165(5), 653–656. https://doi.org/10.1007/s10517-018-4234-3
    20. Kaplan, A. Y. A., Kochetova, A. G., Nezavibathko, V. N., Rjasina, T. V., & Ashmarin, I. P. (1996). Synthetic acth analogue semax displays nootropic‐like activity in humans. Neuroscience Research Communications, 19(2), 115-123.
    21. Семакс инструкция по применению: Показания, противопоказания, побочное действие – описание Semax капли назальные 0.1%: фл. 3 мл с крышкой с прилагаемой пипеткой с крышкой, фл. 3 мл с крышкой-капельницей (28676) - справочник препаратов и лекарств. (n.d.-a). [in Russian] Retrieved July 11, 2023, from https://www.vidal.ru/drugs/semax__28676
    22. Семакс инструкция по применению: Показания, противопоказания, побочное действие – описание Semax капли назальные 1%: фл. 3 мл с крышкой с прилагаемой пипеткой с крышкой, фл. 3 мл с крышкой-капельницей (37577) - справочник препаратов и лекарств. (n.d.-b). [in Russian] Retrieved July 11, 2023, from https://www.vidal.ru/drugs/semax__37577
    23. Cherkasova, K. (2003). P. 6.013 Step forward in research of chronic ischemic brain disease during Semax therapy. European Neuropsychopharmacology, (13), S432.
    24. Serdiuk, A. V., Levitskiĭ, G. N., Miasoedov, N. F., & Skvortsova, V. I. (2007). Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova, 107(4), 29–39.
    25. Strakhov, V. V., Popova, A. A., & Fedorov, V. N. (2014). The results of Semax neuroprotective efficacy investigation. Ophthalmology Reports, 7(4), 43-51.
    26. Sudarkina, O. Y., Filippenkov, I. B., Stavchansky, V. V., Denisova, A. E., Yuzhakov, V. V., Sevan'kaeva, L. E., Valieva, L. V., Remizova, J. A., Dmitrieva, V. G., Gubsky, L. V., Myasoedov, N. F., Limborska, S. A., & Dergunova, L. V. (2021). Brain Protein Expression Profile Confirms the Protective Effect of the ACTH(4-7)PGP Peptide (Semax) in a Rat Model of Cerebral Ischemia-Reperfusion. International journal of molecular sciences, 22(12), 6179. https://doi.org/10.3390/ijms22126179
    27. Potaman, V. N., Antonova, L. V., Dubynin, V. A., Zaitzev, D. A., Kamensky, A. A., Myasoedov, N. F., & Nezavibatko, V. N. (1991). Entry of the synthetic ACTH(4-10) analogue into the rat brain following intravenous injection. Neuroscience letters, 127(1), 133–136. https://doi.org/10.1016/0304-3940(91)90912-d
    28. Levitskaya, N. G., Sebentsova, E. A., Andreeva, L. A., Alfeeva, L. Y., Kamenskii, A. A., & Myasoedov, N. F. (2004). The neuroprotective effects of Semax in conditions of MPTP-induced lesions of the brain dopaminergic system. Neuroscience and behavioral physiology, 34(4), 399–405. https://doi.org/10.1023/b:neab.0000018752.59465.28
    29. Panchaprateep, R., Korkij, W., & Asawanonda, P. (2011). Brain-derived nerve factor and neurotrophins in androgenetic alopecia. The British journal of dermatology, 165(5), 997–1002. https://doi.org/10.1111/j.1365-2133.2011.10514.x
    30. Dolotov, O. V., Zolotarev, I.uA., Dorokhova, E. M., Andreeva, L. A., Alfeeva, L. I.u, Grivennikov, I. A., & Miasoedov, N. F. (2004). Sviazyvanie analoga ACTH-(4-10)-geptapeptida Semaks s plazmaticheskimi membranami bazal'nykh iader perednego mozga krysy i ego biodegradatsiia [The binding of Semax, ACTH 4-10 heptapeptide, to plasma membranes of the rat forebrain basal nuclei and its biodegradation]. Bioorganicheskaia khimiia, 30(3), 241–246. https://doi.org/10.1023/b:rubi.0000030127.46845.f0
    31. Meredith, M. E., Salameh, T. S., & Banks, W. A. (2015). Intranasal Delivery of Proteins and Peptides in the Treatment of Neurodegenerative Diseases. The AAPS journal, 17(4), 780–787. https://doi.org/10.1208/s12248-015-9719-7
    32. Manchenko, D. M., Glazova, N. I.u, Levitskaia, N. G., Andreeva, L. A., Kamenskiĭ, A. A., & Miasoedov, N. F. (2010). Rossiiskii fiziologicheskii zhurnal imeni I.M. Sechenova, 96(10), 1014–1023.
    33. Auesomwang C, Maneerattanaporn M, Chey WD, Kiratisin P, Leelakusolwong S, Tanwandee T. Ten-day high-dose proton pump inhibitor triple therapy versus sequential therapy for Helicobacter pylori eradication. J Gastroenterol Hepatol. 2018 Nov;33(11):1822-1828. doi: 10.1111/jgh.14292. Epub 2018 Jun 27. PMID: 29804294.

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