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Nature 327 , 293297 (1987)

The metabolic change affects the balance of pro-inflammatory and anti-inflammatory cytokines and other immune factors, promoting the decline of the gut epithelial barrier

Renal, or kidney, deterioration because of increased bladder pressure

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Vitamin B12 injections are a common and effective treatment for B12 deficiency

Patients with thyroid nodules noted on physical examination or neck imaging should also be further evaluated