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1.
通过实验获得了米曲霉 3.80 0固态发酵产腺苷酸 (AMP)脱氨酶的适宜培养基 ,麸皮为主原料 ,成分质量分数为蔗糖 2 % ,鱼粉 2 % ,(NH4 ) 2 SO4 0 .1% ,吐温 80 0 .1% ,含水量 5 0 % .最佳的培养条件为 :2 5 0mL的三角瓶装 2 0 g培养基 ,在 2 8~ 30℃培养 6 0h .发酵结束称取一定量的麸曲加 10倍质量的蒸馏水 ,调节 pH 6 .0 ,在 35℃条件振荡水浴 2h .酶的浸提液经盐析、透析、DEAE柱层析分离后 ,可收集到较单一的活性峰酶 . 相似文献
2.
以黑曲霉菌株A.niger103为出发株,通过紫外、亚硝基胍等诱变剂进行反复诱变处理,得到一株高产菌株A.niger537,果胶酶酶活提高了130%,同时测定了其纤维素酶、木聚糖酶、蛋白酶及淀粉酶的酶活,分别达到4.76,176.82,832.4,105.73 U/mL.并通过单因素试验研究了营养条件对改变各酶产酶量及其酶系组成的影响. 相似文献
3.
对作者所在实验室保藏的高产果胶酶的粥化酶产生菌株A.niger 537进行发酵营养和培养条件的优化,确定优化的工艺条件,果胶酶、纤维素酶、木聚糖酶、蛋白酶和糖化酶的干曲酶活分别达到4973,199.8,4993.3,26636.7,3170μ/g.同时对浸提条件及浓缩酶液的制备进行了考察. 相似文献
4.
研究了利用黑曲霉(Aspergillus niger)E-56菌株所产高活力β-甘露聚糖酶水解魔芋葡甘露聚糖的工艺条件.在单因素试验的基础上,进一步通过正交试验确定酶法制备甘露低聚糖的最佳工艺条件为:魔芋胶质量浓度240 g/L(去离子水配制),加酶量为120 U/g,50 ℃酶解8 h.在该工艺条件下,酶解液中葡甘露低聚糖的平均聚合度(DP)在1.8~1.9范围内. 相似文献
5.
通过单因素实验,对SYBC Wu-3菌摇床发酵产脂肪酶的培养基组成和培养条件进行优化,得出较佳的产酶培养基组成配方为:蛋白胨5 g/L,酵母膏 6 g/L,NaH2PO4 3 g/L; 油脂250 mL/L,乳化剂OP 25 mL/L.最优发酵条件为250 mL的摇瓶装液量50 mL,培养温度30 ℃,发酵时间72 h.经过优化后发酵液脂肪酶酶活力最高可达到10.68 U/mL,较优化前提高了2.8倍. 相似文献
6.
对Alkalibacteriumsp.F26发酵产碱性果胶酶的培养基和培养条件进行了优化.考察了碳源、氮源、无机盐、表面活性剂及起始pH、发酵时间、温度等发酵条件的影响.经单因素和响应面分析试验得到适宜的发酵培养基为(组分g/dL):葡萄糖0.95,蛋白胨1,NaCl 6.3,MgSO4.7H2O0.02,K2HPO4.3H2O 0.1,NaCO31,吐温-80 1;培养条件为:250 mL三角瓶装液量25 mL,35℃,起始pH值11.25,培养24 h.在此优化条件下培养,酶活达1 015 U/mL. 相似文献
7.
研究自行构建的产β-葡聚糖酶的工程菌E.coli BL21(DE3)-pET28a(+)-bgl在LB培养基中的生长特性,考察种子液的菌龄、培养基起始pH、接种量及诱导起始时发酵液菌浓度等对β-葡聚糖酶产生水平的影响;通过正交试验确定诱导剂IPTG及乳糖添加量、诱导温度及诱导剂作用时间.结果表明:培养基起始pH 7.0,对数生长中期的种子液(OD600为0.35)以接种量(体积分数)10%接入摇瓶发酵培养,37 ℃,200 r/min培养约3 h,菌液OD值达到1.0左右,添加终浓度分别为0.033 6 mmol/L的IPTG及10 mmol/L乳糖,24℃诱导6 h,发酵液清液中酶活达到最高(336.33 U/mL),菌体生长量为1.12 g/L,发酵液中总酶活达到459.32 U/mL,是原始菌株在相同条件下所产酶活的6.62倍.采用优化培养条件及诱导剂作用条件,重组菌在TB培养基中酶活水平进一步提高,诱导剂作用10 h,发酵清液中酶活为1 090.31 U/mL,总酶活1 570.83 U/mL,是原始菌在该条件下酶活的19.73倍,显示出重组菌具有广阔的工业化应用前景. 相似文献
8.
用大肠杆菌AS1.505进行液态发酵生产谷氨酸脱羧酶并优化培养基,考察了碳源、氮源、复合营养物质、起始pH及发酵时间对酶活的影响,确定最佳产酶培养基组成为:葡萄糖1.0 g/dL,蛋白胨3.0 g/dL,氯化钠0.3 g/dL,磷酸氢二钾0.1 g/dL,硫酸镁0.02 g/dL,L-谷氨酸0.01g/dL,玉米浆1.5 g/dL,生物素30 t,g/L,麸皮4 g/dL;pH 6.5.在此基础上,设计发酵条件的优化实验.实验结果表明为:250 mL的三角瓶装液量25 mL,37℃,起始pH 6.5,培养18 h达到产酶高峰,产酶活力可达1 290 U/mL. 相似文献
9.
研究了圆弧青霉PG3 7碱性脂肪酶的发酵工艺条件 ,优化了PG3 7的摇瓶最适产酶条件 .其中 ,发酵培养基的组成为 (g/dL) :豆饼粉 3 .0 ,玉米浆 3 .0 ,磷酸氢二钾 1 .0 ,硫酸镁 0 .1 ,大豆磷脂0 .5,柠檬酸钠 0 .0 5,花生油 0 .2 ;发酵培养基起始 pH 7.5,发酵温度 (2 9± 1 )℃ ,摇床转速 2 50r/min ,发酵周期 96h ,发酵期间于 3 6,54,72h分别流加 0 .4 g/dL花生油 .在此条件下 ,PG3 7的脂肪酶产率为 2 0 60 μmol/ (min·mL) .PG3 7在 2 5L的实验室小罐中的产酶水平为 1 90 0 μmol/ (min·mL) . 相似文献
10.
通过对溶壁微球菌培养基优化,确定最佳发酵培养基,并对发酵工艺条件进行了初步的优化.最适碳源是麦芽糖,最适氮源是蛋白胨和酵母膏,最近无机盐是MnSO4;该菌株产酶的最佳培养基配方为:60 g麦芽糖,13 g蛋白胨,8 g酵母膏,1 g MnSO4,5 g NaCl,2 g NaH2 PO4·2H2O,2 g K2HPO4·3H2O,0.5 g MgSO4·7H2O,0.5 g CaCl2,1 000 mL水.从该菌株发酵过程曲线发现,该菌株大量产酶期在12-14 h.摇瓶发酵最适初始pH值为7.0,250 mL三角瓶装液量为25mL,接种体积分数为5%,培养温度为37℃. 相似文献
11.
Vasopressor hormone response following mesenteric traction during major abdominal surgery 总被引:1,自引:0,他引:1
A. Brinkmann W. Seeling C. F. Wolf E. Kneitinger C. Schonberger N. Vogt K. H. Orend M. Buchler P. Radermacher M. Georgieff 《Acta anaesthesiologica Scandinavica》1998,42(8):948-956
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT. 相似文献
12.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required. 相似文献
13.
Kai von Appen Christoph Weber Udo Losert† Heinrich Schima† Hans-Jürgen Gurland Dieter Falkenhagen 《Artificial organs》1996,20(6):420-425
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal. 相似文献
14.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2 O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1 , n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1 , n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO. 相似文献
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO. 相似文献
15.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made
of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300
million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly
obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries
were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However,
health-care awareness of obesity and bariatric surgeons are slowly increasing. 相似文献
16.
Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts 总被引:3,自引:0,他引:3
B. Heindl B. F. Becker S. Zahler P. F. Conzen 《Acta anaesthesiologica Scandinavica》1998,42(8):995-1003
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress. 相似文献
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress. 相似文献
17.
D. Ma S. M. Sapsed-Byrne M. K. Chakrabarti J. G. Whitwam 《Acta anaesthesiologica Scandinavica》1998,42(6):670-677
Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg?1 i. v. and 32 μg · kg?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg?1. The mean ED50s, calculated from dose-response curves, were 5.4 mg · kg?1, 3.9 μg · kg?1 and 0.4 mg · kg?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg?1 and 8 μg · kg?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration. 相似文献
18.
Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery 总被引:1,自引:0,他引:1
J. Boldt M. Papsdorf S. Piper W. Padberg G. Hempelmann 《Acta anaesthesiologica Scandinavica》1998,42(8):941-947
Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg?1 · min?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min?1 · m?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416±91 to 717±110 ml/m2 · m2; VO2I: from 98±25 to 157±22 ml/m2 · m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow. 相似文献
19.
T. Tateishi M. Watanabe H. Nakura M. Tanaka T. Kumai T. Aoki S. Kobayashi 《Acta anaesthesiologica Scandinavica》1998,42(9):1028-1032
Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably. 相似文献
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably. 相似文献
20.
A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions. 相似文献