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This depends on the severity of symptoms, B12 levels, and overall health

Some patients experience distinct symptoms, while others may have a tear without realizing it and continue normal activities

stiffness and resistance to limb movement caused by increased muscle tone and/or an excessive and continuous contraction of muscles, which may be uniform (lead-pipe rigidity) or ratchety (cogwheel rigidity), and which may be associated with joint pain

These observations were further confirmed by Hoechst 33342 staining, which revealed extensive detachment of cells from the cell culture substratum and increases in apoptotic bodies of HepG2 cells incubated with H 2 O 2 and TNF for 16 h (Fig