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Significance for heterogeneity was set at p 50% considered to be evidence of substantial heterogeneity

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Key mechanisms include: Stimulation of collagen and elastin synthesis in fibroblasts Activation of lysyl oxidase for collagen cross-linking Enhanced production of glycosaminoglycans and decorin Modulation of metalloproteinase activity for controlled matrix breakdown The copper ion serves as an essential cofactor for enzymes involved in collagen synthesis and provides antioxidant protection through superoxide dismutase activation