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These radicals initiate lipid radical chain reactions, promoting iron-dependent LPO and culminating in ferroptosis ( Under DCM conditions, elevated 4-HNE levels have been shown to upregulate ACSL4a key enzyme catalyzing PUFA esterificationand concurrently downregulate GPX4, the primary antioxidant enzyme responsible for reducing lipid hydroperoxides (Saimoto et al., 2025)

(Reference Gayatri, Kumar and Kumar28) , participants were not randomly assigned to the intervention and control groups, and seven studies described an allocation concealment method (Reference Hassan, Alalfy and Hassan18,Reference Badawy, El Nashar and El Totongy20Reference Hashim, Anwar and El-Fatah22,Reference Elgindy, El-Huseiny and Mostafa23,Reference Ghomian, Khadem and Moeindarbari5,Reference Maged, Elsawah and Abdelhafez8)

A 3mL syringe with a 21-gauge needle is typically ideal for this mixing step