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When reproducible physiology and biochemistry persist across years, modalities, and care settings, the question stops being is anything wrong? and becomes a governance one: Who owns the trigger for reevaluation when signals persist but dont fit a textbook pathway and where is that ownership documented so cases dont stall between handoffs

We have also conducted another group comparison by separating samples between fasting TMAO 6.2 M, and did not find significant difference of the microbial profiles (Figure S4a)

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doi: 10.1152/ajpcell.00046.2002