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nevertheless, given that the current evidence stems primarily from small, nonrandomized cohort studies, the efficacy, optimal target populations, and long-term safety of this treatment must be further investigated through prospective, controlled studies based on standardized protocols 177

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Figure 3 Figure 4 The direct antimicrobial and competitive effects of these strains are dominated by bacteriocin-producing lactobacilli and spore-forming Bacillus species (156)