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Metabolomic studies have revealed abnormalities in multiple metabolic pathways, including amino acid metabolism, lipid metabolism, and glucose metabolism, in COPD patients and experimental models such as cigarette smoke-exposed mice (51, 68), suggesting that metabolic reprogramming is a core component of the pathogenesis of COPD (69)

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For the outer thigh in lean patients, 45 degrees with a pinch is the safer choice