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The strong correlation in the German population seems to be due to the low status in winter rather than the peak in summer

The oxygen-binding site on CIV is comprised of a binuclear heme iron/copper center, which exists in an oxidized or reduced state depending on the surrounding oxygen concentrations (Pappas et al., 2023)

Thus, the patient was referred to our department for further treatment, given that the treatment of acidosis and anemia at the birth hospital resulted in no improvements