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Figure 2 shows the biosynthesis as described above, as well as an arrow-pushing mechanism of NADPH being used as the final cofactor in the biosynthesis of oxytetracycline. Following the formation of the linear tetracyclic skeleton, four successive cyclization reactions must occur in a regioselective manner to produce the aromatic natural product known as pretetramid, a common precursor to both oxytetracycline and other tetracycline antibiotics. The process of elongating the polypeptide skeleton occurs through a series of Claisen-like decarboxylation reactions until the linear tetracyclic skeleton is formed.
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Furthermore, the authors argue that because hypothyroidism is common among BD patients regardless of lithium treatment, regular thyroid testing should be applied to all BD patients, not just those on lithium. The nasal catheter should not be used in comatose, debilitated, or elderly patients, whose impaired reflexes may permit large amounts of gas to flow into the stomach, resulting in Venturi masks are designed to mix oxygen with ah. General:y; a flow rate between 8 and 12 liters per minute will enswe adequate oxygen delivery.
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