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Beyond glycemic effects, ischemiareperfusion injury is strongly linked to mitochondrial ROS generation at reperfusion (including succinate-associated mechanisms), providing a rationale for exploring perioperative mitochondria-targeted metabolic modulation in IR-prone procedures such as cardiopulmonary bypass (93, 95)

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(3) Experimental or observational rigor whether confounding variables (e.g., body size, acclimation temperature, season, hydration state) were controlled or statistically accounted for

Our correlation results align with these findings, as the NP fecal microbiome demonstrated significant associations with metabolites, five of which belong to the amino acid class