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Phase I is purely post-synaptic with constant twitch depression, whereas Phase II reflects combined mechanisms with characteristic fade on repetitive stimulation

Specifically, IR affects the expression and integrity of mtDNA-encoded genes such as 16S ribosomal RNA (16S rRNA), ATP synthase F0 subunit 6 (ATP6), and cytochrome c oxidase subunits 1, 2, and 3 (COX1, COX2, and COX3), which are essential for mitochondrial oxidative phosphorylation and energy production