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Recent mechanistic reviews emphasize that tumor entry can be dominated by active transcytosis and other transvascular routes, with substantial heterogeneity across vessel states, arguing for biomarker-guided stratification rather than generic enhanced permeability and retention assumptions ( 6.3 Safety, biodegradation, and manufacturing reproducibility Silica safety is context-dependent

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Hypertension may cause extensive damage and shedding of the endothelial glycocalyx due to increased or irregular shear forces [99]

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