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In addition, it is clear that the gut microbiota, involved in the energy metabolism of host proteins and peptides, will produce various bioactive compounds, including tryptophan, SCFAs, branched-chain fatty acids, ammonia, phenols, indoles, and amines (Ratzke and Gore, 2018)

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It is unusual for a single anomalous pulmonary venous connection of only 1 pulmonary lobe to result in significant shunting