1.Effect of electroacupuncture on denervated skeletal muscle atrophy in rats based on p38 MAPK signaling pathway.
Wei QIU ; Chenglin TANG ; Cai LIAO ; Yunhao YANG ; Yan YANG ; Kang YANG ; Wanchun PENG
Chinese Acupuncture & Moxibustion 2025;45(1):61-70
OBJECTIVE:
To assess the impacts of electroacupuncture (EA) on the gait, oxidative stress, inflammatory reaction, and protein degradation in the rats of denervated skeletal muscle atrophy, and explore the potential mechanism of EA for alleviating denervated skeletal muscle atrophy.
METHODS:
Forty male SD rats, 8 weeks old, were randomly assigned to a sham-surgery group, a model group, an EA group, and a p38 MAPK inhibitor group, with 10 rats in each group. The right sciatic nerve was transected to establish a rat model of denervated skeletal muscle atrophy in the model group, the EA group and the p38 MAPK inhibitor group. In the sham-surgery group, the nerve was exposed without transection. One day after successful modeling, the rats in the EA group received EA at "Huantiao" (GB30) and "Zusanli" (ST36) on the right side, using a continuous wave with a frequency of 2 Hz and current intensity of 1 mA, for 15 min in each session, EA was delivered once a day, 6 times a week. In the p38 MAPK inhibitor group, the rats received the intraperitoneal injection with SB203580 (5 mg/kg), once a day, 6 times a week. The intervention was composed of 3 weeks in each group. After the intervention completion, the CatWalk XT 10.6 animal gait analysis system was used to record the gait parameters of rats. The wet weight ratio of the gastrocnemius muscle was calculated after the sample collected. Using HE staining, the fiber morphology and cross-sectional area of the gastrocnemius muscle were observed; ELISA was employed to measure the content of interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α in the gastrocnemius muscle; the biochemical hydroxyamine method was adopted to detect the content of superoxide dismutase (SOD) and malondialdehyde (MDA) in the gastrocnemius muscle; with immunohistochemistry and Western blot used, the expression of p38 mitogen-activated protein kinase (p38 MAPK), phosphorylated (p)-p38 MAPK, muscle atrophy F-box gene (Atrogin-1), muscle RING finger 1 (Murf-1), nuclear factor E2-related factor 2 (Nrf2), and heme oxygenase-1 (HO-1) was detected in the gastrocnemius muscle.
RESULTS:
Compared to the sham-surgery group, in the model group, the standing duration, the swing time and the step cycle were increased (P<0.001), the footprint area of the maximum contact time, the print area, the average intensity of the maximum contact time, the average intensity, the swing speed, and the step length were decreased (P<0.001); the wet weight ratio of gastrocnemius muscle and fiber cross-sectional area were reduced (P<0.001); the content of IL-6, IL-1β, TNF-α and MDA in gastrocnemius muscle elevated (P<0.001), and that of SOD reduced (P<0.001); the positive and protein expression of p-p38 MAPK, Atrogin-1 and Murf-1 elevated (P<0.001) and that of Nrf2 and HO-1 dropped (P<0.001). When compared with the model group, in the EA group and the p38 MAPK inhibitor group, the standing duration, the swing time and the step cycle decreased (P<0.01), the footprint area of the maximum contact time, the print area, the average intensity of the maximum contact time, the average intensity, the swing speed, and the step length increased (P<0.01); the wet weight ratio of gastrocnemius muscle and fiber cross-sectional area were improved (P<0.01, P<0.05); the content of IL-6, IL-1β, TNF-α and MDA in gastrocnemius muscle dropped (P<0.05, P<0.01), and that of SOD elevated (P<0.01, P<0.05); the positive and protein expression of p-p38 MAPK, Atrogin-1 and Murf-1 dropped (P<0.01, P<0.05) and that of Nrf2 and HO-1 increased (P<0.01, P<0.05).
CONCLUSION
Electroacupuncture may alleviate skeletal muscle atrophy in denervated skeletal muscle atrophy rats by mediating the p38 MAPK activity, thereby suppressing oxidative stress, inflammatory reaction, and protein degradation.
Animals
;
Electroacupuncture
;
Male
;
Rats
;
p38 Mitogen-Activated Protein Kinases/genetics*
;
Rats, Sprague-Dawley
;
Muscular Atrophy/metabolism*
;
Muscle, Skeletal/metabolism*
;
Humans
;
Signal Transduction
;
Superoxide Dismutase/genetics*
;
Tumor Necrosis Factor-alpha/genetics*
;
Oxidative Stress
;
MAP Kinase Signaling System
;
Acupuncture Points
2.Qihuang needle therapy for autism spectrum disorder with sleep disorder: a multi-center randomized controlled trial.
Bingxu JIN ; Qizhen LIU ; Jiahao TANG ; Yong ZHAO ; Jing XIN ; Yuan ZHOU ; Haiyan CAI ; Zhanxin HUO ; Xiaohong CHEN ; Yan BAI
Chinese Acupuncture & Moxibustion 2025;45(3):322-326
OBJECTIVE:
To observe the clinical efficacy of Qihuang needle therapy for autism spectrum disorder (ASD) children with sleep disorder.
METHODS:
A total of 60 ASD children with sleep disorder were randomly divided into an observation group and a control group, 30 cases in each group. Both groups were treated with structured education intervention, 60 min each time, once a day, 6 times a week. Qihuang needle therapy was applied at Yintang (GV24+), Baihui (GV20) and bilateral Jueyinshu (BL14), Xinshu (BL15) in the observation group, multi-direction needling was delivered and without needle retaining. The treatment was given 2 times a week, each treatment was delivered at interval of 2 days at least. Behavioral intervention was adopted in the control group. Treatment for consecutive 12 weeks was required in both groups. Before and after treatment, the scores of children's sleep habits questionnaire (CSHQ), the autism behavior checklist (ABC), the childhood autism rating scale (CARS), and the childhood autism behavior scale (CABS) were observed in the two groups.
RESULTS:
After treatment, the scores of CSHQ, ABC, CARS and CABS were decreased compared with those before treatment (P<0.01), and the above scores in the observation group were lower than those in the control group (P<0.05).
CONCLUSION
Qihuang needle therapy can effectively treat ASD with sleep disorder, improve the core symptoms of ASD and the sleep quality.
Humans
;
Autism Spectrum Disorder/physiopathology*
;
Male
;
Female
;
Child
;
Sleep Wake Disorders/physiopathology*
;
Child, Preschool
;
Acupuncture Therapy
;
Acupuncture Points
;
Treatment Outcome
;
Sleep
;
Needles
3.Diabetic vascular calcification inhibited by soluble epoxide hydrolase gene deletion via regressing NID2-mediated IGF2-ERK1/2 signaling pathway.
Yueting CAI ; Shuiqing HU ; Jingrui LIU ; Jinlan LUO ; Wenhua LI ; Jiaxin TANG ; Siyang LIU ; Ruolan DONG ; Yan YANG ; Ling TU ; Xizhen XU
Chinese Medical Journal 2025;138(20):2657-2668
BACKGROUND:
Epoxyeicosatrienoic acids (EETs), which are metabolites of arachidonic acid catalyzed by cytochrome P450 epoxygenase, are degraded into inactive dihydroxyeicosatrienoic acids by soluble epoxide hydrolase (sEH). Many studies have revealed that sEH gene deletion exerts protective effects against diabetes. Vascular calcification is a common complication of diabetes, but the potential effects of sEH on diabetic vascular calcification are still unknown.
METHODS:
The level of aortic calcification in wild-type and Ephx2-/- C57BL/6 diabetic mice induced with streptozotocin was evaluated by measuring the aortic calcium content through alizarin red staining, immunohistochemistry staining, and immunofluorescence staining. Mouse vascular smooth muscle cell lines (MOVAS cells) treated with β-glycerol phosphate (0.01 mol/L) plus advanced glycation end products (50 mg/L) were used to investigate the effects of sEH inhibitors or sEH knockdown and EETs on the calcification of vascular smooth muscle cells, which was detected by Western blotting, alizarin red staining, and Von Kossa staining.
RESULTS:
sEH gene deletion significantly inhibited diabetic vascular calcification by increasing levels of EETs in the aortas of mice. EETs (especially 11,12-EET and 14,15-EET) efficiently prevented the osteogenic transdifferentiation of MOVAS cells by decreasing nidogen-2 (NID2) expression. Interestingly, suppressing sEH activity by small interfering ribonucleic acid or specific inhibitors did not block osteogenic transdifferentiation of MOVAS cells induced by β-glycerol phosphate and advanced glycation end products. NID2 overexpression significantly abolished the inhibitory effect of sEH gene deletion on diabetic vascular calcification. Moreover, NID2 overexpression mediated by adeno-associated virus 9 vectors markedly increased insulin-like growth factor 2 (IGF2) and phospho-ERK1/2 expression in MOVAS cells. Overall, sEH gene knockout inhibited diabetic vascular calcification by decreasing aortic NID2 expression and, then, inactivating the downstream IGF2-ERK1/2 signaling pathway.
CONCLUSIONS
sEH gene deletion markedly inhibited diabetic vascular calcification through repressed osteogenic transdifferentiation of vascular smooth muscle cells mediated by increased aortic EET levels, which was associated with decreased NID2 expression and inactivation of the downstream IGF2-ERK1/2 signaling pathway.
Animals
;
Mice
;
Vascular Calcification/metabolism*
;
Mice, Inbred C57BL
;
Epoxide Hydrolases/metabolism*
;
Diabetes Mellitus, Experimental/genetics*
;
Male
;
Gene Deletion
;
MAP Kinase Signaling System/genetics*
;
Cell Line
;
Immunohistochemistry
;
Muscle, Smooth, Vascular/metabolism*
;
Signal Transduction/genetics*
;
Mice, Knockout
4.Evaluation of pharmacokinetics and metabolism of three marine-derived piericidins for guiding drug lead selection.
Weimin LIANG ; Jindi LU ; Ping YU ; Meiqun CAI ; Danni XIE ; Xini CHEN ; Xi ZHANG ; Lingmin TIAN ; Liyan YAN ; Wenxun LAN ; Zhongqiu LIU ; Xuefeng ZHOU ; Lan TANG
Chinese Journal of Natural Medicines (English Ed.) 2025;23(5):614-629
This study investigates the pharmacokinetics and metabolic characteristics of three marine-derived piericidins as potential drug leads for kidney disease: piericidin A (PA) and its two glycosides (GPAs), glucopiericidin A (GPA) and 13-hydroxyglucopiericidin A (13-OH-GPA). The research aims to facilitate lead selection and optimization for developing a viable preclinical candidate. Rapid absorption of PA and GPAs in mice was observed, characterized by short half-lives and low bioavailability. Glycosides and hydroxyl groups significantly enhanced the absorption rate (13-OH-GPA > GPA > PA). PA and GPAs exhibited metabolic instability in liver microsomes due to Cytochrome P450 enzymes (CYPs) and uridine diphosphoglucuronosyl transferases (UGTs). Glucuronidation emerged as the primary metabolic pathway, with UGT1A7, UGT1A8, UGT1A9, and UGT1A10 demonstrating high elimination rates (30%-70%) for PA and GPAs. This rapid glucuronidation may contribute to the low bioavailability of GPAs. Despite its low bioavailability (2.69%), 13-OH-GPA showed higher kidney distribution (19.8%) compared to PA (10.0%) and GPA (7.3%), suggesting enhanced biological efficacy in kidney diseases. Modifying the C-13 hydroxyl group appears to be a promising approach to improve bioavailability. In conclusion, this study provides valuable metabolic insights for the development and optimization of marine-derived piericidins as potential drug leads for kidney disease.
Animals
;
Male
;
Mice
;
Aquatic Organisms/chemistry*
;
Biological Availability
;
Cytochrome P-450 Enzyme System/metabolism*
;
Glucuronosyltransferase/metabolism*
;
Microsomes, Liver/metabolism*
;
Molecular Structure
;
Biological Products/pharmacokinetics*
;
Pyridines/pharmacokinetics*
5.HIV Pretreatment Drug Resistance and Transmission Clusters among Newly Diagnosed Patients in the China-Myanmar Border Region, 2020-2023.
Huan LIU ; Yue Cheng YANG ; Xing DUAN ; Yi Chen JIN ; Yan Fen CAO ; Yi FENG ; Chang CAI ; He He ZHAO ; Hou Lin TANG
Biomedical and Environmental Sciences 2025;38(7):840-847
OBJECTIVE:
This study aimed to investigate the prevalence of HIV pretreatment drug resistance (PDR) and the transmission clusters associated with PDR-related mutations in newly diagnosed, treatment-naive patients between 2020 and 2023 in Dehong prefecture, Yunnan province, China.
METHODS:
Demographic information and plasma samples were collected from study participants. PDR was assessed using the Stanford HIV Drug Resistance Database. The Tamura-Nei 93 model within HIV-TRACE was employed to compute pairwise matches with a genetic distance of 0.015 substitutions per site.
RESULTS:
Among 948 treatment-naive individuals with eligible sequences, 36 HIV subtypes were identified, with unique recombinant forms (URFs) being the most prevalent (18.8%, 178/948). The overall prevalence of PDR was 12.4% (118/948), and resistance to non-nucleotide reverse transcriptase inhibitors (NNRTIs), nucleotide reverse transcriptase inhibitors (NRTIs), and protease inhibitors (PIs) was 10.7%, 1.3%, and 1.6%, respectively. A total of 91 clusters were identified, among which eight showed evidence of PDR strain transmission. The largest PDR-associated cluster consisted of six CRF01_AE drug-resistant strains carrying K103N and V179T mutations; five of these individuals had initial CD4+ cell counts < 200 cells/μL.
CONCLUSION
The distribution of HIV subtypes in Dehong is diverse and complex. PDR was moderately prevalent (12.4%) between 2020 and 2023. Evidence of transmission of CRF01_AE strains carrying K103N and V179T mutations was found. Routine surveillance of PDR and the strengthening of control measures are essential to limit the spread of drug-resistance HIV strains.
Humans
;
HIV Infections/virology*
;
China/epidemiology*
;
Drug Resistance, Viral
;
Male
;
Adult
;
Female
;
Middle Aged
;
HIV-1/genetics*
;
Anti-HIV Agents/therapeutic use*
;
Myanmar/epidemiology*
;
Young Adult
;
Prevalence
;
Adolescent
;
Mutation
6.Optimizing outdoor smoking points outside large exhibition halls based on real-time on-site PM2.5 and CO2 monitoring
Jin SUN ; Chenxi YAN ; Zhuohui ZHAO ; Chenchen XIE ; Zhengyang GONG ; Hao TANG ; Kunlei LE ; Yuzhi CHENG ; Zhuyan YIN ; Jingyi YUAN ; De CHEN ; Yunfei CAI
Journal of Environmental and Occupational Medicine 2024;41(6):673-680
Background Improper settings of outdoor smoking points in public places may increase the risk of secondhand smoke exposure among the population. Conducting research on air pollution in and around smoking spots and related influencing factors can provide valuable insights for optimizing the setting of outdoor smoking points. Objective To investigate the influence of the number of smokers at outdoor smoking points and the distance on the diffusion characteristics of surrounding air pollutants, in order to optimize the setting of outdoor smoking points. Methods Surrounding the exhibition halls in the China International Import Expo (CIIE), two outdoor smoking points were randomly selected, one on the first floor (ground level) and the other on the second floor (16 m above ground), respectively. At 0, 3, 6, and 9 m from the smoking points in the same direction, validated portable air pollutant monitors were used to measure the real-time fine particulate matter (PM2.5) and carbon dioxide (CO2) concentrations for consecutive 5 d during the exhibition, as well as the environmental meteorological factors at 0 m with weather meters including wind speed, wind direction, and air pressure. An open outdoor atmospheric background sampling point was selected on each of the two floors to carry out parallel sampling. Simultaneously, the number of smokers at each smoking point were double recorded per minute. The relationships between the number of smokers, distance from the smoking points, and ambient PM2.5 and CO2 concentrations were evaluated by generalized additive regression models for time-series data after adjustment of confounders such as temperature, relative humidity, and wind speed. Results The median numbers of smokers at smoking points on the first and second floors were 6 [interquartile range (IQR): 3, 9] and 9 (IQR: 6, 13), respectively. Windless (wind speed <0.6 m·s−1) occupied most of the time (85.9%) at both locations. The average concentration of ambient PM2.5 at the smoking points (0 m) [mean ± standard deviation, (106±114) μg·m−3] was 4.2 times higher than that of the atmospheric background [(25±7) μg·m−3], the PM2.5 concentration showed a gradient decline with the increase of distance from the smoking points, and the average PM2.5 concentration at 9 m points [(35±22) μg·m−3] was close to the background level (1.4 times higher). The maximum concentration of CO2 [(628±23) μmol·mol−1] was observed at 0 m, and its average value was 1.3 times higher than that of the atmospheric background [(481±40) μmol·mol−1], and there was no gradient decrease in CO2 concentration with increasing distance at 0, 3, 6, and 9 m points. The regression analyses showed that, taking smoking point as the reference, every 3 m increase in distance was associated with a decrease of ambient PM2.5 by 24.6 [95% confidence interval (95%CI): 23.5, 25.8] μg·m−3 (23.2%) and CO2 by 54.1 (95%CI: 53.1, 55.1) μmol·mol−1 (8.6%). Every one extra smoker at the smoking point was associated with an average increase of PM2.5 and CO2 by 2.0 (95%CI: 1.7, 2.8) μg·m−3 and 1.0 (95%CI: 0.7,1.2) μmol·mol−1, respectively. The sensitivity analysis indicated that, under windless conditions, the concentrations of PM2.5 and CO2 at the smoking points were even higher but the decreasing and dispersion characteristics remained consistent. Conclusion Outdoor smoking points could significantly increase the PM2.5 concentrations in the surrounding air and the risks of secondhand smoke exposure, despite of the noticeable decreasing trend with increasing distance. Considering the inevitable poor dispersion conditions such as windless and light wind, outdoor smoking points are recommended to be set at least 9 m or farther away from non-smoking areas.
7.Construction and verification of prognostic model of bladder cancer costimu-latory molecule-related genes
Zhicheng TANG ; Yueqiao CAI ; Haiqin LIAO ; Zechao LU ; Fucai TANG ; Zeguang LU ; Jiahao ZHANG ; Yongchang LAI ; Shudan YAN ; Zhaohui HE
Chinese Journal of Immunology 2024;40(3):564-571
Objective:To explore genes related to costimulatory molecule related to the prognosis of bladder cancer,and to construct and evaluate prognosis model based on costimulatory molecule-based signature(CMS).Methods:Gene expression matrix and clinical information of bladder cancer patients were downloaded from TCGA database and GEO database(GSE31684),and costimulatory molecule-related genes were retrieved from the literature.The univariate and multivariate Cox analysis were used to screened prognostic-related genes and constructed prognostic model.Forecast accuracy of model was verified in TCGA training group,TCGA validation data group and GEO group by Kaplan-Meier survival analysis and receiver operating characteristic curve(ROC).Considering risk score and clinical characteristics,we constructed a nomogram and evaluated its performance by consistency analysis and ROC.CIBERSORT algorithm was used to analyze immune cell composition of tumor microenvironment infiltration,and gene set enrichment analysis(GSEA)was performed to explore the potential mechanism.Results:Four prognostic-related CMSs were found:TNFRSF14,CD276,ICOS and TMIGD2,of which three were included in the risk score construction.Multivariate Cox regression results showed that the risk score based on CMS was an independent prognostic factor for bladder cancer patients.Consistency analysis and ROC results showed that the nomogram had ideal prognosis prediction accuracy.Immune infiltration analysis showed that the high risk group was likely to be in immunosuppressive state.GSEA results suggested that genes in high risk group were enriched in extracel-lular matrix(ECM)receptors interaction,cell cycle and other pathways.Conclusion:TNFRSF14,CD276 and ICOS may be potential prognostic biomarkers for bladder cancer patients.CMS-based risk score and nomogram could contribute to early prognosis and choice of personalized treatment.
8.Comparison of clinical characteristics between first-episode and relapse of major depressive disorder
Xiuyan ZHENG ; Chengxia TANG ; Zhaorui LIU ; Tingting ZHANG ; Yueqin HUANG ; Liang ZHOU ; Yuandong GONG ; Yan LIU ; Bo LIU ; Jie ZHANG ; Haiming WANG ; Zhengmin FENG ; Jun GUO ; Wenming CHEN ; Linling JIANG ; Defang CAI ; Jin LU
Chinese Mental Health Journal 2024;38(1):25-32
Objective:To describe demographic,clinical and physiological characteristics,treatment between first-episode major depressive disorder(MDD)and relapse MDD,and to explore characteristics of relapse MDD.Methods:Totally 858 patients who met the diagnostic criteria for depression of the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5),were included by using the Mini International Neuropsychiatric Interview(MINI),Clinician-Rated Dimensions of Psychosis Symptom Severity,and Hamilton Depression Scale etc.Among them,529(58.6%)were first-episode depression and 329(36.0%)were relapsed.The differences of demographic characteristics,clinical and physiological characteristics,treatment were compared byx2test and Kruskal-Wallis rank sum test.Multivariate logistic regression was used to explore the characteristics of MDD recur-rence.Results:Compared to first-episode MDD,relapse MDD had more comorbidity(OR=2.11,95%CI:1.00-4.44),more days out of role(OR=1.26,95%CI:1.01-1.56),more history of using psychiatric drug more than one month(OR=1.41,95%CI:1.02-1.97)and electroconvulsive therapy(OR=3.23,95%CI:1.42-7.36),and higher waist-hip ratio(OR=33.88,95%CI:2.88-399.32).Conclusion:Relapse MDD has positive as-sociation with comorbidity of mental disorders,out of role,and higher waist-hip ratio.
9.Changes of interleukin-34 levels in serum and bronchoalveolar lavage fluid of patients with severe pneumonia and their prognostic value
Yuxin LIU ; Yongmin YAN ; Jianke REN ; Jianlei TANG ; Sheliang XUE ; Zhifang ZHUANG ; Run CAI ; Yanjuan ZHOU
Journal of Clinical Medicine in Practice 2024;28(24):31-36
Objective To investigate the changes in interleukin-34 (IL-34)levels in serum and bronchoalveolar lavage fluid (BALF) of patients with severe pneumonia and their prognostic value. Methods A total of 66 patients with severe pneumonia (severe pneumonia group), 35 patients with non-severe pneumonia (non-severe pneumonia group), and 27 healthy adults (control group) were enrolled. The severe pneumonia group was further divided into survival group of 38 patients and non-survival group of 28 patients based on 28-day survival. Clinical data of all subjects were analyzed. Receiver operating characteristic (ROC) curves were plotted to assess the predictive power of serum IL-34 and relative
10.Clinical Observation on the Sanjiao Tiaoqi Acupuncture in the Treatment of Post-stroke Respiratory Dysfunction
Ye-Han ZHANG ; Ming TANG ; Fan HUANG ; Ke-Da CAI ; Xiao-Shan HUANG ; Yan-Qing LU ; Tian-Long CHEN
Journal of Guangzhou University of Traditional Chinese Medicine 2024;41(6):1517-1521
Objective To observe the clinical efficacy of Sanjiao Tiaoqi Acupuncture in the treatment of post-stroke respiratory dysfunction.Methods Seventy-two patients with post-stroke respiratory dysfunction were randomly divided into observation group and control group,36 cases in each group.The control group was given routine treatment,and the observation group was treated with Sanjiao Tiaoqi Acupuncture on the basis of the control group,both groups were treated for 14 consecutive days.After 2 weeks of treatment,the clinical efficacy of the two groups was evaluated,and the changes of white blood cell count(WBC),C-reactive protein(CRP)and clinical pulmonary infection score(CPIS)were observed before and after treatment.The changes of diaphragmatic activity were compared before and after treatment between the two groups.Results(1)After treatment,the WBC and CRP levels of patients in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving the WBC and CRP levels,with statistically significant differences(P<0.05).(2)After treatment,the CPIS scores of patients in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving CPIS scores,with a statistically significant difference(P<0.05).(3)After treatment,the diaphragm mobility of patients in the two groups was significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving diaphragm mobility,and the difference was statistically significant(P<0.05).(4)The total effective rate was 91.67%(33/36)in the observation group and 75.00%(27/36)in the control group.The efficacy of the observation group was superior to that of the control group,and the difference was statistically significant(P<0.05).Conclusion Sanjiao Tiaoqi Acupuncture for post-stroke respiratory dysfunction can significantly promote the absorption of inflammatory factors in patients and improve diaphragm mobility,with remarkable clinical efficacy.


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