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If the gel pack is warm or fully thawed, the medication may have been exposed to unsafe temperatures during transit

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Endocrinology 158(10):32353248 Ihedioha O, Blanchard AA, Balhara J, Okwor I, Jia P, Uzonna J, Myal Y (2018) The human breast cancer-associated protein, the prolactin-inducible protein (PIP), regulates intracellular signaling events and cytokine production by macrophages