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Experimental studies have demonstrated that CVB3 infection markedly induces the expression of hexokinase 2, phosphofructokinase, and pyruvate kinase M2, accompanied by a reduced proportion of pyruvate entering mitochondrial oxidation (71)

This decision intersects multiple clinical domains: metabolic health, lactation physiology, medication safety, and individual risk tolerance

Severe deficiency causes irreversible neurological damage and subacute combined degeneration of the spinal cord, a condition that does not fully reverse even with aggressive B12 repletion

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