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In this review, we focus on the mechanisms that facilitate intracellular fatty-acid mobilization, drawing on canonical and noncanonical enzymatic pathways

[26] A complication of severe chronic PA is subacute combined degeneration of spinal cord, which leads to distal sensory loss (posterior column), absent ankle reflex, increased knee reflex response, and extensor plantar reflex response

The effects may last longer for some, while others may require more frequent injections to maintain consistent energy levels

If a patient has neurological symptoms, the frequency might be every two months