1.Effect of Serum Containing Zhenwutang on Apoptosis of Myocardial Mast Cells and Mitochondrial Autophagy
Wei TANG ; Meiqun ZHENG ; Xiaolin WANG ; Zhiyong CHEN ; Chi CHE ; Zongqiong LU ; Jiashuai GUO ; Xiaomei ZOU ; Lili XU ; Lin LI
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(3):11-21
ObjectiveTo explore the effect of serum containing Zhenwutang on myocardial mast cell apoptosis induced by angiotensin Ⅱ (AngⅡ) and the mechanism of the correlation between apoptosis and mitochondrial autophagy. MethodsIn this experiment, AngⅡ and serum containing Zhenwutang with different concentrations were used to interfere with H9C2 cardiomyocytes for 24 h, and the survival rate of H9C2 cardiomyocytes was detected by cell counting kit-8 (CCK-8) to screen the optimal concentration for the experiment. Enzyme-linked immunosorbent assay (ELISA) was used to detect the content of B-type natriuretic peptide (BNP) in cell culture supernatant, and immunofluorescence was used to detect the cell surface area to verify the construction of the myocardial mast cell model. Subsequently, the experiment was divided into a blank group (20% blank serum), a model group (20% blank serum + 5×10-5 mol·L-1 AngⅡ), low-, medium-, and high-dose (5%, 10% and 20%) serum containing Zhenwutang groups, an autophagy inhibitor group (1×10-4 mol·L-1 3-MA), and autophagy inducer group (1×10-7 mol·L-1 rapamycin). The apoptosis level of H9C2 cells and the changes of mitochondrial membrane potential were detected by flow cytometry. The lysosomal probe (Lyso Tracker) and mitochondrial probe (Mito Tracker) co-localization was employed to detect autophagy. Real-time fluorescence quantitative polymerase chain reaction (Real-time PCR) was used to detect Caspase-3, Caspase-9, B-cell lymphoma 2 (Bcl-2), Bcl-2-related X protein (Bax), and cytochrome C (Cyt C) in apoptosis-related pathways and the relative mRNA expression of ubiquitin ligase (Parkin), phosphatase and tensin homolog (PTEN)-induced kinase 1 (PINK1), and p62 protein in mitochondrial autophagy-related pathways. Western blot was used to detect cleaved Caspase-3, cleaved Caspase-9, Bax, Bcl-2, and Cyt C in apoptosis-related pathways, phosphorylated ubiquitin ligase (p-Parkin), phosphorylated PTEN-induced kinase 1 (p-PINK1), p62, and Bcl-2 homology domain protein Beclin1 in mitochondrial autophagy-related pathways, and the change of microtubule-associated protein 1 light chain 3 (LC3) Ⅱ/Ⅰ ratio. ResultsCCK-8 showed that when the concentration of AngⅡ was 5×10-5 mol·L-1, the cell activity was the lowest, and there was no cytotoxicity. At this concentration, the surface area of cardiomyocytes was significantly increased (P<0.01), and the content of BNP in the supernatant of culture medium was significantly increased (P<0.05). Therefore, AngⅡ with a concentration of 5×10-5 mol·L-1 was selected for the subsequent modeling of myocardial mast cells. Compared with the blank group, the model group and the autophagy inhibitor 3-MA group had a significantly increased apoptosis rate (P<0.01) and significantly decreased mitochondrial membrane potential (P<0.01). The results of immunofluorescence co-localization showed that compared with the blank group, the model group had a significantly decreased number of red and green fluorescence spots. The results of Real-time PCR showed that compared with that in the blank group, the relative mRNA expression of Bax, Caspase-3, Caspase-9, Cyt C, and p62 in the model group was significantly up-regulated (P<0.01), while the relative mRNA expression of Bcl-2, Parkin, and PINK1 was significantly down-regulated (P<0.01). In addition, the relative protein expression of Bax, cleaved Caspase-3, cleaved Caspase-9, Cyt C, and p62 was significantly up-regulated (P<0.01). The LC3Ⅱ/Ⅰ was significantly decreased, and the relative protein expression of Bcl-2, p-Parkin, p-PINK1, and Beclin1 was significantly down-regulated (P<0.01). Compared with the model group, the serum containing Zhenwutang groups and the autophagy inducer group had significantly decreased apoptosis rate (P<0.01), and the decrease ratio of mitochondrial membrane potential is significantly lowered (P<0.01) in a dose-dependent manner. Additionally, both red and green fluorescence spots became more in these groups. In the 3-MA group, the number of red and green fluorescence spots decreased significantly. The relative mRNA expression of Bax, Caspase-3, Caspase-9, Cyt C, and p62 was significantly down-regulated (P<0.05, P<0.01), while that of Bcl-2, Parkin, and PINK1 was significantly up-regulated (P<0.01). In the serum containing Zhenwutang groups, the relative protein expression levels of Bax, cleaved Caspase-3, cleaved Caspase-9, Cyt C, and p62 were significantly down-regulated (P<0.05,P<0.01). The LC3Ⅱ/Ⅰ was significantly increased, and the relative protein expression levels of Bcl-2, p-Parkin, p-PINK1, and Beclin1 were significantly up-regulated (P<0.01). ConclusionThe serum containing Zhenwutang can reduce the apoptosis of myocardial mast cells and increase mitochondrial autophagy. This is related to the inhibition of intracellular Bax/Bcl-2/Caspase-3 apoptosis pathway and regulation of Parkin/PINK1 mitochondrial autophagy pathway.
2.Preliminary report of a fully automatic feedback perimeter based on eye gaze tracking technique in the detection of college students
Lingxiao ZHOU ; Lili ZHAO ; Xiujuan ZHENG
International Eye Science 2025;25(2):319-322
AIM: To observe the preliminary application of fully automatic feedback perimeter based on the eye gaze tracking technique in the college students and to verify its test performance.METHODS: Home computer, monitor and eye tracker were used to complete the new automatic feedback perimeter meter. Based on the two characteristic eye movements of fixation and pulsation, the abnormal visual field is determined by analyzing whether the participant perceives the visual target, line-of-sight scan path and the fixation towards the visual target. RESULTS: A total of 63 participants(119 eyes)were collected with valid eye movement data. The average time for all participants was 82.46±14.68 s, the average time for right eyes was 88.21±15.30 s, and average time for the left eyes was 76.42±11.29 s(P<0.05).CONCLUSION: The fully automatic feedback perimeter based on eye gaze tracking technique can realize automatic human-computer interaction, and the detection method is simple and easy, which shortens the time of perimetry and improves the experience of participants.
3.Effect of Mori Folium-Ginseng Radix et Rhizoma on Glucose and Lipid Metabolism and Mechanism in Mouse Model of Type 2 Diabetes Mellitus
Congyi LIU ; Ning WANG ; Jingjing XU ; Tingting WANG ; Na ZHENG ; Zimeng HUANG ; Lingling QIN ; Lili WU ; Tonghua LIU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(17):20-28
ObjectiveTo study the effect of the herb pair Mori Folium-Ginseng Radix et Rhizoma (HMG) on glucose and lipid metabolism in the mouse model of type 2 diabetes mellitus and decipher the possible treatment mechanism. MethodsThe db/db mice were chosen as the mouse model of type 2 diabetes mellitus and then treated with HMG at low and high doses (1.56, 3.12 g∙kg-1, respectively) or metformin (0.26 g∙kg-1) by gavage for 6 weeks. The normal group and the model group were treated with double distilled water at the same time according to body weight. The 8-h fasting blood glucose and body weight were measured once a week. The oral glucose tolerance test (OGTT) was conducted at the 6th week of dosing. The mice were sacrificed after the end of dosing. Serum levels of lipids [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL), and low-density lipoprotein cholesterol (LDL)], liver function indicators [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)], non-esterified fatty acids (NEFA), glycosylated serum protein (GSP), serum glucose (GLU), fasting insulin (FINS), and renal function indicators [creatinine (Crea) and blood urea nitrogen (BUN)] were measured by enzyme-linked immunosorbent assay. The protein levels of peroxidase proliferator-activating receptor gamma (PPARγ), acetyl coenzyme A carboxylase (ACC), and sterol regulatory element-binding protein-1 (SREBP-1) were determined by Western blot. The pathological changes in the liver and pancreas were examined. ResultsCompared with the normal group, the model group presented increased body weight, elevated levels of blood glucose, TG, TC, AST, ALT, GLU, NEFA, GSP, and HDL-C, up-regulated protein levels of ACC and SREBP-1, and down-regulated protein level of PPARγ (P<0.01). Meanwhile, the model group presented a large amount of lipid droplets and steatosis in the liver, as well as karyopyknosis and lymphocyte infiltration in the pancreas. Compared with the model group, the high- and low-dose HMG groups showed decreased body weight, declined levels of blood glucose, TG, TC, AST, ALT, GLU, NEFA, and GSP, and elevate level of HDL-C (P<0.05, P<0.01). Moreover, the two groups showcased reduced lipid droplets and steatosis in the liver, as well as enlarged islets with clear boundaries and alleviated lymphocyte infiltration and karyopyknosis. Western blot results showed that the high-dose herb pair group demonstrated down-regulated protein levels of ACC and SREBP-1 and up-regulated protein level of PPARγ (P<0.01). ConclusionThe HMG can effectively improve the glucose and lipid metabolism in db/db mice by regulating the expression of PPARγ, SREBP-1, and ACC.
4.Effect of Mori Folium-Ginseng Radix et Rhizoma on Glucose and Lipid Metabolism and Mechanism in Mouse Model of Type 2 Diabetes Mellitus
Congyi LIU ; Ning WANG ; Jingjing XU ; Tingting WANG ; Na ZHENG ; Zimeng HUANG ; Lingling QIN ; Lili WU ; Tonghua LIU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(17):20-28
ObjectiveTo study the effect of the herb pair Mori Folium-Ginseng Radix et Rhizoma (HMG) on glucose and lipid metabolism in the mouse model of type 2 diabetes mellitus and decipher the possible treatment mechanism. MethodsThe db/db mice were chosen as the mouse model of type 2 diabetes mellitus and then treated with HMG at low and high doses (1.56, 3.12 g∙kg-1, respectively) or metformin (0.26 g∙kg-1) by gavage for 6 weeks. The normal group and the model group were treated with double distilled water at the same time according to body weight. The 8-h fasting blood glucose and body weight were measured once a week. The oral glucose tolerance test (OGTT) was conducted at the 6th week of dosing. The mice were sacrificed after the end of dosing. Serum levels of lipids [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL), and low-density lipoprotein cholesterol (LDL)], liver function indicators [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)], non-esterified fatty acids (NEFA), glycosylated serum protein (GSP), serum glucose (GLU), fasting insulin (FINS), and renal function indicators [creatinine (Crea) and blood urea nitrogen (BUN)] were measured by enzyme-linked immunosorbent assay. The protein levels of peroxidase proliferator-activating receptor gamma (PPARγ), acetyl coenzyme A carboxylase (ACC), and sterol regulatory element-binding protein-1 (SREBP-1) were determined by Western blot. The pathological changes in the liver and pancreas were examined. ResultsCompared with the normal group, the model group presented increased body weight, elevated levels of blood glucose, TG, TC, AST, ALT, GLU, NEFA, GSP, and HDL-C, up-regulated protein levels of ACC and SREBP-1, and down-regulated protein level of PPARγ (P<0.01). Meanwhile, the model group presented a large amount of lipid droplets and steatosis in the liver, as well as karyopyknosis and lymphocyte infiltration in the pancreas. Compared with the model group, the high- and low-dose HMG groups showed decreased body weight, declined levels of blood glucose, TG, TC, AST, ALT, GLU, NEFA, and GSP, and elevate level of HDL-C (P<0.05, P<0.01). Moreover, the two groups showcased reduced lipid droplets and steatosis in the liver, as well as enlarged islets with clear boundaries and alleviated lymphocyte infiltration and karyopyknosis. Western blot results showed that the high-dose herb pair group demonstrated down-regulated protein levels of ACC and SREBP-1 and up-regulated protein level of PPARγ (P<0.01). ConclusionThe HMG can effectively improve the glucose and lipid metabolism in db/db mice by regulating the expression of PPARγ, SREBP-1, and ACC.
5.Scientific Research Paradigm and Technological Layout Ideas Based on Clinical Dominant Disease of Traditional Chinese Medicine (Allergic Rhinitis)
Lili LIU ; Zheng GONG ; Linjing ZHANG ; Haiyang ZHANG ; Xiaoxiao ZHANG ; Zhanfeng YAN
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(20):241-251
To implement the instructions and directives of General Secretary Xi Jinping on important documents related to traditional Chinese medicine (TCM), adhere to the equal emphasis on TCM and Western medicine, and promote mutual complementarity, win-win cooperation, and coordinated development between TCM and Western medicine, the China Association of Chinese Medicine has organized seminars on the clinical dominant diseases of TCM in multiple professional fields, achieving a series of results. The aim is to implement the research on dominant diseases of TCM described in the Law of the People's Republic of China on Traditional Chinese Medicine and the Opinions of the Central Committee of the Communist Party of China and the State Council on Promoting the Inheritance, Innovation and Development of Traditional Chinese Medicine, thus serving the construction of advantageous specialties, clinical talent cultivation, national scientific and technological layout, and academic innovation leadership. In the field of otolaryngology, the China Association of Chinese Medicine and many Chinese and Western medicine experts across the country have conducted multiple in-depth discussions and research. At the 10th Clinical Dominant Disease Series Youth Salon, they have elaborated and demonstrated the basic and specific suggestions and consensus on the clinical advantages of TCM and integrated TCM and Western medicine in the treatment of allergic rhinitis (AR), making great progress. However, there is still a lack of detailed research paths. Under the guidance of the China Association of Chinese Medicine and based on the TCM Dominant Disease Series Salon for AR, this study analyzed the difficulties encountered in AR diagnosis and treatment according to the occurrence and development law of AR. Based on the advantages and characteristics of AR diagnosis and treatment by TCM and integrated TCM and Western medicine, it explored the research paradigm and technological layout points of AR and put forward suggestions. The layout involved four aspects: Optimization of the AR diagnosis and treatment system, prevention and control of comorbidities, management of chronic diseases, and a platform for TCM inheritance. Additionally, suggestions for layout and research directions, expected goals and values, and priority levels for funding were proposed. The study is expected to provide a theoretical basis and development ideas for the future prevention and treatment of AR with TCM and integrated TCM and Western medicine and promote the high-quality development of TCM.
6.Investigation of the current status of radiation diagnosis and treatment resources and their use in Taiyuan City, China
Jianhua SHI ; Wenyan GUO ; Qiyu ZHAO ; Lixian ZHENG ; Li XU ; Fengjiao WU ; Xiaoai ZHAO ; Lili GUO
Chinese Journal of Radiological Health 2025;34(4):508-514
Objective To understand the current status of radiation diagnosis and treatment resources and their use in Taiyuan City, China, and provide data support for optimizing resource allocation and standardizing diagnosis and treatment. Methods A census-based approach was implemented using a standardized questionnaire to collect basic information on radiation diagnosis and treatment institutions in Taiyuan City. The number and use frequency of radiation diagnosis and treatment resources were calculated based on the resident population of Taiyuan City at the end of 2023. Results There were a total of 562 radiation diagnosis and treatment institutions in Taiyuan City, with
7.Intravitreal injection of Conbercept for the treatment of diabetic neovascular glaucoma
Lili CHEN ; Huiqin WU ; Bo ZHENG
International Eye Science 2025;25(11):1848-1853
AIM: To observe the efficacy of intravitreal Conbercept injection(IVC)in diabetic neovascular glaucoma(NVG).METHODS:Retrospective study. Totally 57 patients(57 eyes)with NVG(stage II)secondary to proliferative diabetic retinopathy(PDR)treated in our hospital were collceted from January 2019 to December 2022. Among them, 30 patients(30 eyes)were treated by IVC and panretinal photocoagulation(PRP)in the observation group, and 27 patients(27 eyes)were treated by PRP in the control group. The best corrected visual acuity(BCVA, LogMAR), intraocular pressure, neovascularization of the iridocorneal angle(NVA), central macular thinkness(CMT)changes and disease progression were analyzed with a follow-up of 2 years.RESULTS: There were no significant differences in baseline characteristics between the two groups(P>0.05). At the last follow-up, the BCVA in the observation group was better than the control group(P<0.05). The intraocular pressure, CMT and progression of NVA in the observation group were less than the control group(all P<0.05). The patients with NVG developed from stage II to stage III in the observation group was less than the control group(P<0.05). In the observation group, the BCVA improved compared with preoperative at 6 mo(P<0.05). In the control group, the BCVA decreased compared with preoperative after 24 mo(P<0.05). Multiple linear regression analysis indicated that NVG progression and intraocular pressure were factors affecting BCVA(LogMAR)changes(β=0.511, 0.014; t=4.461, 2.092; P<0.01, 0.041, respectively). In the observation group, the IOP decreased at 1, 6 and 12 mo compared with preoperative(all P<0.05), while there were no significant differences at 18 and 24 mo compared with preoperative(all P>0.05). In the control group, the intraocular pressure decreased at 6 mo compared with preoperative(P<0.05), while there were no significant differences at 1, 12, 18 and 24 mo compared with preoperative(all P>0.05). There were no significant difference about the types of glaucoma drugs between the observation group and the control group(all P>0.05). There were no infectious endophthalmitis and other complications observed in both groups.CONCLUSION: IVC combined with PRP demonstrates superior efficacy over PRP monotherapy in treating NVG(stage II)secondary to PDR. IVC combined with PRP showed better outcomes in controlling iris neovascularization, slowing visual impairment progression, reducing intraocular pressure, and delaying disease advancement.
8.Application and research progress of nanotechnology in atherosclerosis
Tingting WANG ; Lili YU ; Xiangli SHEN ; Junmeng ZHENG ; Yushan CHEN ; Shasha SHANG ; Jianru WANG
The Journal of Practical Medicine 2024;40(1):53-58
Atherosclerosis(AS)is a common cardiovascular disease,and its treatment and prevention have been the focus of medical research.AS an emerging technology,nanotechnology has unique advantages and plays an important role in the prevention,diagnosis and treatment of AS.This paper reviews the latest research on the application of nanotechnology in AS diseases,systematically discusses the role of nanotechnology in the diag-nosis and treatment of AS,and comprehensively analyzes the effects of nano-drug carriers based on different sur-face trimmers,loading diagnostic and therapeutic drugs so as to monitordisease progression of AS and its targeted treatment.The aim is to provide new thought for the clinical treatment of AS.
9.Effect of visual feedback on landing biomechanics in chronic ankle instability patients
Lili ZHANG ; Xinglai ZHANG ; Jie ZHANG ; Jiejiao ZHENG
Chinese Journal of Tissue Engineering Research 2024;28(6):900-904
BACKGROUND:The landing test can effectively observe the biomechanical indexes of the lower limbs of patients with chronic ankle instability,analyze the balance adjustment strategies that affect the stability of chronic ankle instability posture,and provide a valuable reference for chronic ankle instability patients to avoid re-injury and clinical rehabilitation after injury. OBJECTIVE:To analyze the effects of vision on the balance of chronic ankle instability and the changes in balance adjustment strategies by observing the kinematics and kinetics of chronic ankle instability patients during landing with and without vision. METHODS:Totally 31 patients with chronic ankle instability landed on a single leg from a 40 cm platform with their eyes open and closed.The dynamic and kinematic data during the landing process were collected using a three-dimensional motion capture system.The difference in landing between the healthy and the ill side legs under the two conditions was compared by paired t-test. RESULTS AND CONCLUSION:(1)Dynamic indexes:The relative value of the peak ground reaction force in the front,rear and vertical directions of the affected ankle joint when eyes were closed was greater than that when eyes were open,and the peak ground reaction force in the vertical direction appeared later than that when eyes were open(P<0.05).(2)Kinematics indexes:The flexion angle of the knee of the healthy and affected sides when touching the ground was greater under the condition of closed eyes than under the condition of open eyes(P<0.05).The maximum flexion angle and feedforward angle of the affected knee and ankle were greater than those of the affected side with eyes open(P<0.05).The time of landing stability was longer than that of eye opening(P<0.05).(3)It is indicated that under the condition of removing visual input,the peak of ground reaction force increases,the contact angle joint increases,and the time to stabilization of chronic ankle instability is prolonged during landing in patients with chronic ankle instability,which increases the probability of landing injury.Visual maintenance of the balance of chronic ankle instability patients cannot compensate for the vestibular sense and proprioception.
10.Effects of helium-oxygen mechanical ventilation on inflammatory response of diseased lung segments and diaphragm function in patients with pneumonia
Decai REN ; Lili ZHOU ; Chengqing ZHENG ; Shanmin XIE ; Ranjie YU
Chinese Critical Care Medicine 2024;36(3):260-265
Objective:To investigate the clinical effect of helium-oxygen mechanical ventilation on inflammation of the diseased lung segment and diaphragm function in patients with acute respiratory distress syndrome (ARDS) caused by pneumonia who suffered difficulty weaning from mechanical ventilation.Methods:A prospective controlled study was conducted. A total of 40 patients with ARDS caused by pneumonia and requiring tracheal intubation with difficulty weaning from mechanical ventilation, admitted to the department of critical care medicine in Pingtan Branch of Fujian Medical University Union Hospital from October 2020 to December 2021 were enrolled. Patients were divided into nitrogen oxygen ventilation group and helium-oxygen ventilation group according to random number table, with 20 cases in each group. The nitrogen oxygen ventilation group was given 60% nitrogen and 40% oxygen ventilation treatment, and the helium-oxygen ventilation group was given 60% helium and 40% oxygen ventilation treatment. Peak airway pressure (Ppeak), plateau airway pressure (Pplat), tidal volume (V T), minute ventilation volume (MV) and pulse oxygen saturation (SpO 2) were collected at 0, 1, 2, 3 hours after ventilation treatment. At the same time, the concentrations of inflammatory factors interleukin-6 (IL-6) and C-reactive protein (CRP) in epithelial lining fluid in patients with diseased lung segments were measured before and after ventilation treatment for 3 hours, and the diaphragmatic excursion and the diaphragmatic thickening fraction were measured before and after ventilation treatment for 3 hours. Results:There were no significant differences in gender, age, oxygenation index, serum CRP, serum procalcitonin (PCT), body temperature, serum creatinine (SCr), alanine aminotransferase (ALT), fasting blood glucose (FPG), hemoglobin (Hb), and basic heart and lung diseases between the two groups. Under the condition that V T and SpO 2 are relatively unchanged, the airway pressure in helium-oxygen ventilation group decreased significantly after 1 hour of ventilation [Ppeak (cmH 2O, 1 cmH 2O≈0.098 kPa): 22.80±4.47 vs. 28.00±5.07, Pplat (cmH 2O): 19.15±3.90 vs. 23.20±3.81, both P < 0.05], and the airway pressure in the nitrogen oxygen ventilation group increased significantly after 1 hour [Ppeak (cmH 2O): 22.35±2.13 vs. 19.75±1.94, Pplat (cmH 2O): 18.50±1.70 vs. 16.50±1.88, both P < 0.05]. There were no significant differences in CRP and IL-6 levels in epithelial lining fluid in the diseased lung segment before and after ventilation in the nitrogen oxygen ventilation group, while the levels of these indexes in the helium-oxygen ventilation group after ventilation were significantly lower than those before ventilation, and significantly lower than those in the nitrogen oxygen ventilation group [CRP (mg/L): 10.15 (6.39, 15.84) vs. 16.10 (11.63, 18.66), IL-6 (μg/L): 1.15 (0.78, 1.86) vs. 2.67 (1.67, 4.85), both P < 0.05]. There were no statistically significant differences in the diaphragmatic excursion and the diaphragmatic thickening fraction before and after ventilation in the nitrogen oxygen ventilation group, while the above indexes in the helium-oxygen ventilation group were significantly higher than those before ventilation, and were significantly higher than those in the nitrogen oxygen ventilation group [diaphragmatic excursion (cm): 1.93 (1.69, 2.20) vs. 1.34 (1.22, 1.83), diaphragmatic thickening fraction: (48.22±8.61)% vs. (33.29±11.04)%, both P < 0.05]. Conclusion:Helium-oxygen ventilation can reduce the airway pressure of patients with mechanical ventilation, alleviate the inflammatory response of lung segment, improve the function of respiratory muscle, and is expected to be an important treatment for severe lung rehabilitation.

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