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1.
Warady BA Zobrist RH Wu J Finan E;Ferrlecit Pediatric Study Group 《Pediatric nephrology (Berlin, Germany)》2005,20(9):1320-1327
Pediatric patients with end-stage renal disease undergoing hemodialysis (HD) frequently develop anemia. Administration of recombinant human erythropoietin (rHuEPO) is effective in managing this anemia, although the additional demand for iron often results in iron deficiency. In adult patients undergoing HD, intravenous (IV) iron administration is known to replenish iron stores more effectively than oral iron administration. Nevertheless, IV iron supplementation is underutilized in pediatric patients, possibly because of unproved safety in this population. This international, multicenter study investigated the safety and efficacy of two dosing regimens (1.5 mg kg–1 and 3.0 mg kg–1) of sodium ferric gluconate complex (SFGC) therapy, during eight consecutive HD sessions, in iron-deficient pediatric HD patients receiving concomitant rHuEPO therapy. Safety was evaluated in 66 patients and efficacy was evaluated in 56 patients. Significant increases from baseline were observed in both treatment groups 2 and 4 weeks after cessation of SFGC dosing for mean hemoglobin, hematocrit, transferrin saturation, serum ferritin, and reticulocyte hemoglobin content. Efficacy and safety profiles were comparable for 1.5 mg kg–1 and 3.0 mg kg–1 SFGC with no unexpected adverse events with either dose. Administration of SFGC was safe and efficacious in the pediatric HD population. Given the equivalent efficacy of the two doses, an initial dosing regimen of 1.5 mg kg–1 is recommended for pediatric HD patients.An erratum to this article can be found at
The Ferrlecit Pediatric Study Group is a co-author of this paper 相似文献
2.
Warady BA Zobrist RH Finan E;Ferrlecit Pediatric Study Group 《Pediatric nephrology (Berlin, Germany)》2006,21(4):553-560
Intravenous iron therapy is recommended for children and adults who receive hemodialysis (HD) and recombinant human erythropoietin
(rHuEPO). However, limited information exists on the use of any maintenance IV iron regimen in children. Therefore, we conducted
a prospective, multicenter, open-label trial of maintenance therapy with sodium ferric gluconate complex (SFGC) in iron-replete
pediatric HD patients receiving rHuEPO. Patients received SFGC weekly at an initial dose of 1.0 mg kg−1 week−1, not to exceed 125 mg. Doses could be adjusted based on iron indices. Twenty-three patients (mean age: 13.2±2.39 years) were
enrolled and received at least one dose of SFGC, while twelve patients completed the study. After 12 weeks of treatment, the
mean SFGC dose delivered was 1.0 mg/kg. Mean TSAT and serum ferritin levels remained within NKF-K/DOQI target ranges and the
mean Hgb level remained unchanged from baseline. No unexpected or unusual safety risks were associated with SFGC use. In summary,
this experience provides evidence for the safety and efficacy of intravenous SFGC and supports the recommendation that the
maintenance SFGC starting dose should be 1.0 mg/kg, not to exceed 125 mg, with subsequent adjustments made according to TSAT
and/or serum ferritin levels. 相似文献
3.
Sodium ferric gluconate complex in haemodialysis patients: a prospective evaluation of long-term safety. 总被引:4,自引:1,他引:3
Beckie Michael Daniel W Coyne Vaughn W Folkert Naomi V Dahl David G Warnock 《Nephrology, dialysis, transplantation》2004,19(6):1576-1580
BACKGROUND: A previous single dose placebo-controlled double-blinded trial showed an extremely low (0.4%) intolerance rate of sodium ferric gluconate complex (SFGC) in SFGC-naive haemodialysis patients. No large prospective trials have assessed the safety of SFGC during repeated exposure in the outpatient haemodialysis setting. METHODS: Chronic haemodialysis patients completing the single-dose trial of SFGC were eligible to participate in this prospective, multicentre, open-label, long-term evaluation of SFGC, designed to record adverse events occurring up to 72 h post-dose. Patients received as many as 20 ampules (1250 mg total) of SFGC at an investigator-determined dose and rate over a 9 month evaluation period. RESULTS: Among 1412 enrolled patients at 54 centres, 1321 received 13,151 infusions of SFGC. Most doses (94.8%) were < or =125 mg and the majority were given over 10 min. Infusion rates ranged from <5 to 125 mg/min. There were no life-threatening events. Fifty-one patients (3.9%) experienced an adverse event, possibly related to SFGC. Of these, one experienced a serious event (hypotension). Five patients (0.4%) experienced an event that precluded SFGC readministration: pruritus (three), vasodilatation (one) and loss of taste (one). Among 372 patients (28.2%) receiving angiotensin-converting enzyme inhibitor (ACEI) therapy, adverse events were neither more common nor more severe than in the other patients. CONCLUSIONS: Repeated doses of SFGC are very well tolerated in haemodialysis patients. No life-threatening events were observed in over 13,000 doses administered. Administration of SFGC to patients using ACEI is safe and does not increase the incidence or severity of adverse events to SFGC. 相似文献
4.
Lesley Rees 《Pediatric nephrology (Berlin, Germany)》1997,11(6):752-754
An anonymous questionnaire to investigate non-compliance with recombinant human growth hormone (rhGH), its causes and correlation
with growth response, was sent to 60 children with renal disease; 48% returned the questionnaires; 69% reported that they
were concerned about their size and 83% reported being treated as younger than they were. Understanding of the purpose and
administration of rhGH was good; 62% missed some rhGH injections, but there was no correlation with understanding or difficulty
with the injections, concern regarding size or growth response.
Received December 13, 1996; received in revised form and accepted June 24, 1997 相似文献
5.
Silverstein DM Palmer J Polinsky MS Braas C Conley SB Baluarte HJ 《Pediatric nephrology (Berlin, Germany)》2000,14(2):105-110
Hyperlipidemia (HL) is a common problem in adult renal transplant (TP) recipients, contributing to an increased risk of cardiovascular
disease and chronic TP nephropathy. There are multiple causes of HL post renal TP in adult patients, including pre TP HL,
immunosuppressive agents, renal dysfunction, hypoalbuminemia secondary to nephrotic syndrome, obesity, and conditions that
lead to end-stage renal disease (ESRD). We evaluated the incidence and risk factors of HL in 62 pediatric renal TP recipients
(15.4±4.2 years, range-3.0–22.3 years) with long-term (6.7±3.1 years) functioning [glomerular filtration rate (GFR) 66.7±23.2
ml/min per 1.73 m2] allografts. The mean serum cholesterol (C) level was 205.5±43.6 mg/dl. Thirty-two patients (51.6%) exhibited elevated serum
C levels. The mean serum triglyceride (TG) level was 157.3±88.4 mg/dl. Serum TG levels were elevated in 32 patients (51.6%).
In patients with elevated serum levels of either C or TG, the mean low-density lipoprotein level (LDL) was 138.6±44.1 mg/dl
(normal <130 mg/dl) and the high-density lipoprotein (HDL) level 54.6±15.9 mg/dl (normal>34 mg/dl). Of those patients studied,
45.5% had high LDL levels, whereas 9.1% exhibited low HDL levels. The two risk factors for elevated serum C levels in our
patient population were pre-TP HL and increased years since TP. The only risk factor for elevated serum TG levels was reduced
GFR. A family history of HL had a significant deleterious impact upon serum levels of C (P=0.01), but did not affect serum TG levels (P=0.7). Years on dialysis prior to TP, history of prior TP, gender, body mass index, and disease leading to ESRD had no influence
upon the development of post-TP HL. We conclude that post-renal TP HL is a significant problem in pediatric renal TP recipients.
Received: 13 January 1999 / Revised: 19 May 1999 / Accepted: 21 May 1999 相似文献
6.
Jacqz-Aigrain E Khan Shaghaghi E Baudouin V Popon M Zhang D Maisin A Loirat C 《Pediatric nephrology (Berlin, Germany)》2000,14(2):95-99
Mycophenolate mofetil (MMF) is a prodrug that is hydrolyzed to the active immunosuppressant mycophenolic acid (MPA). The drug
is now widely prescribed for adult renal transplant recipients and its use has been extended to pediatric patients, although
pharmacological data in this age group are limited. Nine pediatric renal transplant recipients received MMF with corticosteroids
and either cyclosporine or tacrolimus a median of 55 months (range 7.5–124 months) months after transplantation. The pharmacokinetic
parameters of MPA and MPA glucuronide (MPAG) were determined at steady state by high-performance liquid chromatography after
administration of MMF at the oral dose of 494±142 mg/m2 twice daily. MPA was rapidly absorbed, with a peak concentration at 1.4 h. The mean plasma concentration of MPA at steady
state was 4.7±1.3 μg/ml. The areas under the plasma concentration-time curves (AUCs) over 12 h (between two administrations)
were 57.0±15.3 μg.h/ml for MPA and 1,515±722 μg.h/ml for MPAG, and the apparent oral clearance was 11.7±7.0 and 0.5±0.4 l/h
for MPA and MPAG, respectively. Assuming that the pharmacokinetics of MPA was dose dependent, the mean concentration at steady
state and the AUC for MPA were calculated for the recommended dosage schedule of 600 mg/m2 every 12 h and were 6.3±2.7 μg/ml and 75.2±32.9 μg.h/ml, respectively. The tolerance of MMF was studied prospectively with
a follow-up of 1.1±0.2 years. Gastrointestinal disorders requiring dosage reduction or discontinuation of therapy, observed
in five of nine patients, occurred at an incidence higher than expected from adult data. Our results suggest that the dose
of 600 mg/m2 every 12 h extrapolated from adult data for use in pediatric patients would be associated with plasma levels and AUCs higher
than expected and may be associated with a higher incidence of side-effects, primarily gastrointestinal.
Received: 3 August 1998 / Revised: 19 January 1999 / Accepted: 19 January 1999 相似文献
7.
Chronic renal failure in Iranian children 总被引:5,自引:5,他引:0
We investigated chronic renal failure (CRF) in 166 Iranian children (95 boys and 71 girls) from July 1991 to June 1999. The
mean age at onset of CRF was 7.9±4.5 years. The most common cause of CRF was congenital urological malformations (78 cases).
The second most common cause of CRF was hereditary nephropathy (21%). Glomerular diseases accounted for only 10% of children
who later went on to develop renal failure. High rates of cystinosis and primary hyperoxaluria were seen, and these elevated
rates could be due to a high prevalence of parental consanguinity. Eighty-six patients required renal replacement therapy,
of whom the majority underwent hemodialysis. The prevalence of primary reflux as a cause of CRF was high compared with reports
from western countries. Earlier diagnosis and management of urinary tract infections in this group could reduce the prevalence
of reflux as a cause of CRF in this population.
Received: 15 May 2000 / Revised: 2 October 2000 / Accepted: 5 October 2000 相似文献
8.
Incidence of side-effects associated with high-dose ferric gluconate in patients with severe chronic renal failure 总被引:1,自引:0,他引:1
SUMMARY: Ferric gluconate complex in sucrose (Ferrlecit™) has been associated with less side-effects than iron dextran; however, the recommended dose of 62.5–125 mg per treatment is only suitable for haemodialysis (HD) patients. We retrospectively analysed the incidence of the side-effects associated with a high dose of Ferrlecit™ infusion (20 treatments in 13 patients; 10 treatments of 250 mg/3–4 h, and 10 treatments of 500 mg/5 h infusion). The patients were in the age range of 32–75 years old, seven with chronic renal failure (CRF), and six on dialysis treatment. One (10%) of the 10 treatments using a 250 mg dose was complicated with severe nausea/vomiting, diarrhoea and a burning sensation in the feet. Three (30%) of the 10 treatments using a 500 mg dose were complicated with: chills, severe nausea/vomiting, hypotension and syncope in one; severe nausea/vomiting, diarrhoea and hypotension in one; and an episode of vomiting in one patient. A single treatment with a 250 mg dose resulted in no significant change in haematological parameters. A single treatment with a 500 mg dose resulted in a significant increase in haemoglobin (Hgb) and haematocrit (Hct), but only a rising trend in serum iron,% transferrin saturation and ferritin pre versus 1–2 months postinfusion. In conclusion, Ferrlecit™ doses of 250 or 500 mg are complicated with significant untoward reactions in 10–30% of patients, in a dose-dependent fashion. 相似文献
9.
We describe a case of exercise-induced acute renal failure (ARF) in a patient with hypouricemia. Following recovery from ARF,
the patient’s serum urate concentration was 0.6–0.9 mg/dl, and the ratio of urate clearance to creatinine clearance (C
ua/C
Cr) was 41.9%–56.6%. There was no change in the C
ua/C
Cr following the administration of pyrazinamide or probenecid, suggesting defects of tubular urate/anion exchangers. Because
the renal biopsy revealed acute tubular necrosis without uric acid crystals, the ARF of this patient might be due to oxygen
free radicals resulting from exercise stress and hypouricemia.
Received: 15 March 1999 / Revised: 10 September 1999 / Accepted: 14 September 1999 相似文献
10.
Erythropoietin treatment in children with renal failure 总被引:6,自引:5,他引:1
Erythropoietin (EPO) treatment dramatically changes the life of a child with end-stage renal disease. The administration
of recombinant human (rHu)EPO is beneficial and safe in the predialysis period, during hemodialysis or peritoneal dialysis,
and after renal transplantation. The goal of hemoglobin correction should be the level at which normal quality of life is
possible without adverse events: in children this is usually 10–11 g/dl. rHuEPO is administered once to twice a week subcutaneously
to children before dialysis, during peritoneal dialysis, and after transplantation. There is no real benefit of intraperitoneal
administration. In children on hemodialysis two to three times a week IV administration is preferred. Among the many reasons
for non-response to rHuEPO, iron deficiency (absolute or functional), infections, and hyperparathyroidism are the most common
in the pediatric renal patient. Hypertension is the most-frequent side effect of rHuEPO treatment and needs careful monitoring.
Iron should be supplemented orally or IV. No significant beneficial effect of rHuEPO on growth has been demonstrated. However,
the association with recombinant human growth hormone therapy is not detrimental in children.
Received: 4 May 1998 / Revised: 31 July 1998 / Accepted: 31 July 1998 相似文献
11.
Sorof JM Goldstein SL Brewer ED Steiger HM Portman RJ 《Pediatric nephrology (Berlin, Germany)》1999,13(9):737-741
Evaluation of serial monthly estimated glomerular filtration rate (eGFR) may be useful for studying pediatric renal allograft
outcome. To determine the validity of this approach, we reviewed our single-center experience in pediatric renal transplant
recipients to determine the effect of risk factors for renal allograft failure on eGFR. Clinical parameters recorded monthly
through 5 years post transplant allowed serial assessment of eGFR. Monthly clinical data included height, weight, serum creatinine,
cumulative number of acute rejection episodes, cyclosporine dose, and cyclosporine trough levels. From these data, eGFR was
calculated monthly for each patient using the Schwartz formula. Time post transplant was grouped in 6-month intervals and
plotted against mean eGFR to compare eGFR in patients grouped by demographic and clinical factors; 1,786 monthly data sets
from 6 months post transplant (n=76 patients) to 5 years post transplant (n=25 patients) were analyzed. Overall mean eGFR from 6 months to 1 year was 75 ml/min per 1.73 m2 and from 4.5 to 5 years 46 ml/min per 1.73 m2. eGFR was lower at all time intervals for recipients of cadaver versus living-related donor grafts, and patients with ≥1
versus 0 acute rejections (P<0.01). After 1 year, eGFR was lower in black patients compared with white or Hispanic patients (P<0.01). Cyclosporine dose greater than 5 mg/kg per day was associated with better early and worse late graft function. These
results are similar to those reported in multi-center studies using the outcome variable of graft failure and suggest that
serial eGFR may be valid as an outcome variable to study chronic renal allograft dysfunction in children.
Received: 1 March 1999 / Revised: 7 June 1999 / Accepted: 10 June 1999 相似文献
12.
Neoral pharmacokinetics in Latino and Caucasian pediatric renal transplant recipients 总被引:1,自引:0,他引:1
Lemire J Capparelli EV Benador N Grimm P Macdonald D Reznik V 《Pediatric nephrology (Berlin, Germany)》2001,16(4):311-314
Interpopulation variability of drug pharmacokinetics (PK) has been described. For example, the systemic clearance of nifedipine
is higher in Mexicans than Caucasians. African-Americans have a lower cyclosporine bioavailability than Caucasians. Limited
data are available in the Latino population. Under identical conditions, we compared the PK profile of Neoral (cyclosporine
for microemulsion) obtained in stable pediatric renal transplant recipients of Latino and Caucasian origin. A slightly lower
area under the curve (AUC) when corrected for dose per body surface area or per kilogram of body weight was observed in Caucasians
compared with Latinos. This difference was more pronounced in the younger age group (<12 years) with a higher peak-to-trough
ratio. However, the Caucasians required a higher dosage of Neoral than the Latinos to achieve that same AUC. There was no
difference between the groups in the time (tmax) to reach maximal concentration (Cmax) of Neoral. A higher apparent clearance of the drug was observed in the Caucasians compared with the Latinos, especially
in the younger age group. No differences in pre- and post-dose levels were observed between the two groups. These differences
might affect dose adjustment between the two subpopulations.
Received: 30 June 2000 / Revised: 21 November 2000 / Accepted: 21 November 2000 相似文献
13.
14.
Rinaldi S D'Argenio P Fiscarelli E Farina C Rizzoni G 《Pediatric nephrology (Berlin, Germany)》2000,14(2):111-113
Six years after a renal cadaver transplant, a 20-year-old girl developed multiple painful cutaneous abscesses and bilateral
pneumonia secondary to Nocardia farcinica infection. Despite broad in vitro sensitivity to several antibiotic agents and aggressive medical treatment, the patient
failed to respond and died after 10 weeks of therapy. We conclude that Nocardia farcinica is a very aggressive organism in immunocompromised patients and is often resistant to antimicrobial agents.
Received: 28 April 1999 / Revised: 16 July 1999 / Accepted: 22 July 1999 相似文献
15.
Hibbs AM Bznik-Cizman B Guttenberg M Goldberg B Meyers K 《Pediatric nephrology (Berlin, Germany)》2001,16(7):543-546
A renal transplant was performed in a 6-year-old boy who developed end stage renal disease (ESRD) after presenting with antiglomerular
basement membrane (anti-GBM) disease. At 10 years of age he developed ulcerative colitis while being immunosuppressed with
cyclosporin, prednisone, and azothioprine. He had a pancolectomy, and at 14 years has no symptoms of ulcerative colitis or
anti-GBM disease. HLA typing revealed that he was homozygous for HLA DR2. The co-occurrence of anti-GBM disease and ulcerative
colitis has not previously been described. Although there is no known common etiology for these two autoimmune diseases, we
propose that the patient’s homozygosity at HLA DR2 may have predisposed him to both.
Received: 21 September 2000 / Revised: 26 January 2001 / Accepted: 1 February 2001 相似文献
16.
Gong XS 《Pediatric nephrology (Berlin, Germany)》1999,13(9):936-937
A 3-year-old girl developed acute oliguric renal failure after accidental ingestion of nitrofurantoin (190 mg/kg body weight).
The time interval between poisoning and the onset of renal failure was 9 days. She later recovered with symptomatic management.
Received: 4 September 1998 / Revised: 11 February 1999 / Accepted: 15 February 1999 相似文献
17.
Ardissino G Schmitt CP Testa S Claris-Appiani A Mehls O 《Pediatric nephrology (Berlin, Germany)》2000,14(7):664-668
Calcitriol oral pulse therapy has been suggested as the treatment of choice for secondary hyperparathyroidism, but its efficacy
and safety are still under discussion. The present randomized multicenter study compares the effect of an 8-week course of
daily versus intermittent (twice weekly) calcitriol therapy on parathyroid hormone (PTH) suppression in 59 children (mean
age 8.4±4.7 years) with chronic renal insufficiency (mean Ccr 22.4±11.6 ml/min per 1.73 m2) and secondary hyperparathyroidism. After a 3-week washout period, the patients were randomly assigned to treatment with
daily oral calcitriol (10 ng/kg per day) or intermittent oral calcitriol (35 ng/kg given twice a week). The calcitriol dose
was not changed throughout the study period of 8 weeks. At start of the study, the median intact PTH (iPTH) level was 485
pg/ml (range 83–2032) in the daily group (n=29) and 315 pg/ml (range 93–1638) in the intermittent group (n=30). After 8 weeks, the respective median iPTH concentrations were 232 pg/ml (range 63–1614) and 218 pg/ml (range 2–1785)
(ns). The mean iPTH decrease from baseline was 19.2±57.8% and 13.7±46.7% respectively (not significant). Calcitriol reduced
the iPTH concentration in 23/29 patients in the daily group and in 21/30 in the intermittent group. One episode of hypercalcemia
(>11.5 mg/dl) was observed in both groups and a single episode of hyperphosphatemia (>7.5 mg/dl) was observed in the daily
group. It is concluded that oral calcitriol pulse therapy does not control secondary hyperparathyroidism more effectively
than the daily administration of calcitriol in children with chronic renal failure prior to dialysis.
Received: 29 September 1999 / Revised: 2 February 2000 / Accepted: 9 February 2000 相似文献
18.
F. Fukuuchi M. Hida Y. Aiba Y. Koga M. Endoh K. Kurokawa H. Sakai 《Clinical and experimental nephrology》2002,6(2):99-104
Background. Phenols and indoles are fermentation products and putrefactants of intestinal bacterial origin. They present a problem in
chronic renal failure and hemodialysis patients because they accumulate in the body as uremic toxins.
Methods. A comparative study was performed in groups of patients with chronic renal failure (CRF) before the initiation of dialysis,
hemodialysis patients (HD), and healthy adults to investigate changes in intestinal flora and to measure the blood levels
of uremic toxins.
Results. The level of Escherichia coli was significantly increased in the CRF and HD groups compared with the healthy controls (P= 0.02, controls vs CRF before dialysis; P= 0.0014, controls vs HD). Fecal concentrations of phenol and scatole were most highly elevated in the HD group, and the difference
between the CRF and HD groups was significant (P= 0.02 for phenol; P= 0.01 for scatole). Serum concentrations of phenol, p-cresol, and indican were significantly elevated in the CRF group (P= 0.01; P= 0.008; and P < 0.0001 vs controls, respectively). For indican, a correlation was found between fecal and serum concentrations only in
the HD group (correlation coefficient of 0.821; P= 0.04). In the CRF group, a correlation was obtained between the urine and serum concentrations of phenol and p-cresol (0.852, P= 0.01; 0.758, P= 0.02, respectively). A correlation was also found between the serum concentrations of indican and serum creatinine (SCr)
(0.610; P= 0.004) and β2-microglobulin (β2-MG) (0.739; P= 0.005).
Conclusions. An abnormal balance of intestinal bacterial flora and increased intestinal bacteria-derived putrefactants were observed in
the CRF group. The increased concentration of toxins with renal sclerosing effects, such as indican, may contribute to further
deterioration of renal function.
Received: September 14, 2001 / Accepted: February 13, 2002 相似文献
19.
Mahmoud Loghman-Adham 《Pediatric nephrology (Berlin, Germany)》1999,13(8):701-708
In patients with chronic renal insufficiency, phosphate retention is a major factor in the development of secondary hyperparathyroidism,
renal osteodystrophy, and soft tissue calcification, and may contribute to progression of renal failure. Prevention of phosphate
retention with dietary and pharmacological means, along with the administration of calcitriol, may prevent or reverse secondary
hyperparathyroidism. With more-advanced renal failure, phosphate binders become necessary to maintain phosphate balance and
to prevent hyperphosphatemia. Because of toxicity, aluminum-containing phosphate binders are no longer used. Currently, calcium-containing
phosphate binders, such as calcium carbonate and calcium acetate, are the most widely prescribed. Although calcium salts eliminate
the problems associated with aluminum toxicity, they often result in transient hypercalcemia, requiring discontinuation of
calcitriol and the use of low-calcium dialysate. Several new non- aluminum- and non-calcium-containing phosphate binders are
currently at various stages of development, and may provide an alternative to the currently used binders. It is unlikely,
however, that the newer compounds will completely replace calcium salts, since mild hypercalcemia may be necessary in chronic
renal failure patients to suppress parathyroid hormone production. Other areas of investigation must include the development
of drugs to inhibit soft tissue and renal calcifications, and to enhance urinary phosphate excretion.
Received: 21 October 1998 / Revised: 7 April 1999 / Accepted: 7 April 1999 相似文献
20.
Psychological functioning and adjustment to dialysis were assessed in the families of 60 children and adolescents undergoing
chronic dialysis. Sociodemographic factors, treatment variables, health status and satisfaction with health care provision
were also measured. Correlation analyses identified a number of important factors associated with poor adjustment to dialysis
and/or anxiety and depression in children and parents. Particularly at risk are parents in lower socioeconomic status households,
parents with large families, parents with limited support and parents of young children. Children were more at risk where
there was greater functional impairment caused by illness.
Received: 10 December 1997 / Revised: 8 March 1999 / Accepted: 16 March 1999 相似文献