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The symptoms could represent: Progressive diabetic neuropathy requiring tighter glycemic control Pyridoxine toxicity requiring immediate B6 discontinuation An unrelated cause requiring neurological workup Distinguishing between these requires a careful medication and supplement history, sometimes nerve conduction studies, and at minimum a trial of B6 dose reduction

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Additionally an anti-apoptotic signature was observed

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Of the three, cysteine has by far the lowest normal concentration in liver cells