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PEP is used by pyruvate kinase to phosphorylate ADP, yielding pyruvate and the second ATP, again by substrate-level phosphorylation

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What that means isnt always straightforward: In the Swiss study mentioned above, nearly three-quarters of primary-care docs surveyed reported using a multi-step approach (and not always the same one) when testing for B12 deficiencya practice that Miller says improves the odds of an accurate diagnosis since serum B12 levels alone dont always accurately identify a deficiency

Circulation 96 : 25422544

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