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Mitochondria contribute to this balance by coupling oxidative phosphorylation (OXPHOS) to signaling: ROS generated primarily at Complexes I and III shape cytokine programs 1,2,3,4

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In the discovery cohort, preoperative plasma GLS1 levels did not differ significantly between non‑PND and PND patients, yet postoperative elevation was selectively observed in PND patients, correlated negatively with postoperative cognitive scores ( R 2 = 0.479), and preoperative levels showed moderate predictive value (AUC = 0.77)