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1.
Accumulation of the tumour suppressor gene p53 product due to a gene mutation is frequently seen in human carcinomas, including lung carcinoma. Another indirect mechanism involving p53 in malignant growth relates to the E6 protein of the human papillomavirus (HPV), which is able to bind and degrade wild-type p53 protein, thus eliminating its tumour suppressor activities. Bronchiolo-alveolar carcinoma (BAC) is a rare type of lung carcinoma. The aim of our study was to examine the occurrence of p53 accumulation and the presence of HPV DNA in BAC. Sections of 22 BACs were immunohistochemically stained using a p53 antibody, CM-1. The presence of HPV DNA in BACs was verified by in situ hybridisation for HPV types 6, 11, 16, 18, 31 and 33 and confirmed by PCR. Thirty-six percent of the tumours showed abnormal p53 nuclear accumulation, and HPV DNA, revealed by in situ hybridisation, was found in 36%. Unexpectedly, only 13% of the type 1 BACs were positive for p53, whereas 45% of the type 2 BACs were positive. During a follow-up of 12-176 months, only 10% of the patients with BACs negative for both p53 and HPV died of the disease, compared with 42% of the patients with either p53 or HPV positivity. No inverse relationship between abnormal p53 protein accumulation and the presence of HPV DNA was found. © 1995 Wiley-Liss, Inc.  相似文献   

2.
目的:探讨人乳头瘤病毒16 和18 型及抑癌基因p53 突变对宫颈的致癌作用以及 H P V 感染与p53 基因突变的相关性。方法:采用聚合酶链反应( P C R) 技术和限制性酶切片段多态性分析( R F L P) 技术对34 例原发性宫颈癌组织及30 例正常宫颈组织 H P V16 ,18 型 D N A 及抑癌基因p53 的突变进行了检测。结果: H P V16 ,18 D N A 在宫颈癌的总阳性率为647 % (22/34) ,正常宫颈组织只有67 % 阳性,8例宫颈癌组织出现p53 基因第6 外显子突变,其中2 例为 H P V16 D N A 阳性、1 例 H P V18 D N A 阳性。结论:宫颈癌的发病与 H P V 感染及p53 基因突变有关,宫颈癌组织中p53 基因突变与 H P V 感染无关。  相似文献   

3.
细胞周期相关蛋白在非小细胞肺癌中的意义   总被引:1,自引:0,他引:1  
目的:探讨细胞周期相关蛋白p53和p16基因在非小细胞肺癌(NSCLC)中的表达及其与临床病理因素的关系。方法:采用免疫组化SP法检测80例NSCLC组织中p53和p16的表达和组织学类型、分期等临床病理参数之间的关系。结果:在80例NSCLC组织中,p53、p16的表达率分别为55%(44/80)、41.25%(33/80)。其中,66例患者显示至少有一种基因表达异常。除p16蛋白的表达与肿瘤组织学类型之间有相关性,p53、p16蛋白的表达异常与其他临床病理参数均无相关性。结论:p53和p16蛋白异常表达是NSCLC中的常见事件。NSCLC的发生与p53/p21和pRb/p16两条重要的细胞生长周期调控路径密切相关。  相似文献   

4.
黄平  任占平 《现代肿瘤医学》2008,16(12):2090-2091
目的:探讨人乳腺浸润性导管癌组织中HPV18DNA和p53蛋白的表达及二者间的关系。方法:采用分子原位杂交和免疫组化技术检测60例乳腺浸润性导管癌、30例乳腺腺病和30例正常乳腺组织中HPV18DNA和p53蛋白。结果:癌组中HPV18DNA阳性和HPV18DNA阴性两组间p53蛋白的阳性表达均有显著性差异(P〈0.03),HPV18DNA阳性组与p53蛋白阳性表达呈显著负相关(r=-0.2954、P〈0.04)。结论:HPV18感染后导致野生型p53的灭活和降解可能涉及HPV18感染后人乳腺上皮细胞癌变的转化过程。  相似文献   

5.
 目的 检测人乳腺浸润性导管癌组织中HPV16DNA和p53蛋白,探讨HPV16型感染和p53蛋白表达与人乳腺癌之间的关系。方法 采用分子原位杂交和免疫组化技术检测和分析50例乳腺浸润性导管癌、30例正常乳腺组织中HPV16DNA和p53蛋白二者之间的表达关系。结果 癌组中HPV16DNA阳性和HPV16DNA阴性两组阃p53蛋白的表达均有显著性差异(P〈0.01),HPV16DNA阳性组显示与p53蛋白表达呈负相关(P〈0.02)。结论 HPV16感染后导致野生型p53的降解可能涉及HPV16感染后人乳腺上皮细胞癌变的病理发生过程。  相似文献   

6.
The product of HPV E6 and E7 genes is able to inactivate both the p53 and pRb proteins. The aim of this study was to evaluate the correlation among anal HPV infection and nuclear p53 overexpression. The Authors evaluated HPV DNA by PCR and p53 nuclear expression by immunohistochemistry in 12 cloacogenic and 6 squamocellular carcinoma. HPV DNA was detected in 71.4% of the squamocellular tumors and in 57.1% of the cloacogenic tumors. In squamocellular tumors HPV types 31-33 and 16 were found; in cloacogenic tumors type 16 alone was detected. Nuclear accumulation of p53 was found to be associated with the presence of HPV. There was no significant difference in parietal infiltration, lymph nodes involvement and prognosis between HPV+p53+ patients and HPV-p53- patients. Tumor aggressiveness is likely to be enhanced by factors other than HPV infection and p53 overexpression.  相似文献   

7.
Besides well-known risk factors such as tobacco use and alcohol consumption, oncogenic human papillomavirus (HPV) infection also has recently been suggested to promote head and neck tumorigenesis. HPV is known to cause cancer by inactivation of cell cycle regulators p53 and pRb via expression of viral oncoproteins E6 and E7. This indicates that p53 mutations are not a prerequisite in HPV-induced tumor development. However, discrepancy exists with respect to the frequency of head and neck squamous cell carcinomas (HNSCC) harboring DNA of oncogenic HPV and the fraction of these tumors showing p53 mutations. In our study, we examined the frequency of HNSCC demonstrating HPV 16/18 integration as identified by fluorescence in situ hybridization (FISH) and investigated their p53 (mutation) status by immunohistochemistry and single-strand conformation polymorphism (SSCP) analysis of exons 5-8. Paraffin-embedded, archival biopsy material from 27 premalignant mucosal lesions and 47 cases of HNSCC were analyzed. Ten of the 47 (21%) HNSCC unequivocally exhibited HPV 16 integration, including 8 of 12 (67%) tonsillar carcinomas. This is supported by the immunohistochemical detection of p16(INK4A) overexpression in all 10 HPV-positive tumors. Although FISH is considered to be less sensitive than PCR-based methods for HPV detection, our data clearly demonstrate clonal association of HPV with these tumors, as illustrated by the presence of integrated HPV 16 in both the primary tumor and their metastases in 2 patients. In contrast, HPV 16/18 DNA could not be detected in the premalignant lesions. In 30 of 47 (64%), HNSCC accumulation of p53 was observed, including 8 of the 10 HPV-positive carcinomas. However, in none of the latter cases could mutations in exons 5-8 be identified, except for a polymorphism in codon 213 of exon 6 in one patient. Evaluation of clinical data revealed a significant inverse relation between tobacco use with or without alcohol consumption, and HPV positivity of the tumors.  相似文献   

8.
To study the role of ras, p53 genes and HPV virus (16 and 18) in the development of prostate cancer, we analyzed tissue sections from 27 patients affected with carcinomas (stages A to D) and from 24 patients with adenomas. Mutations of H, K and N-ras and p53 (exons 2-9) were studied by SSCP and DNA sequencing. Accumulation of p53 protein was studied by immu-nohistochemistry on tissue sections. Tumors were also analyzed for the presence of HPV 16 and -18 sequences by PCR and DNA hybridization with sequence-specific oligonucleotides. No mutation was found in the three ras genes studied, either in carcinomas or adenomas. By SSCP analysis we identified p53 mutations in only 2 of 19 carcinomas studied, both in exon 7. Immunohistochemical results strongly correlate with the SSCP results: p53 protein was positive in tumors with p53 mutation but not in others; 32% of studied adenomas had detectable HPV16 DNA, while 53% of carcinomas were HPV16+. Among these I presented a p53 mutation. No HPV 18 E6 sequence could be detected. Our data show that in prostate tumors from France, mutations of p53 and ras are rare events but that these tumors display detectable HPV 16 DNA at a high frequency. The low incidence of p53 mutation, associated to a significant proportion of tumors showing HPV16 DNA, could suggest that in prostate cancer HPV 16 infection could participate in p53 inactivation by E6. © 1995 Wiley-Liss, Inc.  相似文献   

9.
背景与目的:人乳头瘤病毒(HPV)是宫颈癌的主要病因,但近来发现在非小细胞肺癌(NSCLC)中能检测到HPV,两者间的关系已经引起了人们的重视。本研究探讨人乳头瘤病毒(HPV)16、18型感染与非小细胞肺癌(NSCLC)是否存在相关性及其意义。方法:应用PCR、免疫组化和TUNEL分别检测76例NSCLC及13例肺良性病变中HPV16、18型DNA及其原癌蛋白E6 E7、端粒酶hTERT、P53、MDM2、桩蛋白(paxillin)和细胞凋亡的表达。结果:NSCLC中HPV16、18型总阳性率为40.8%(31/76),而肺良性病变组阳性率为7.7%(1/13),差异有显著性(P〈0.05)。NSCLC中HPV阳性组与阴性组之间细胞凋亡、P53、MDM2、paxillin的表达均有显著性差异(P〈0.05),而端粒酶hTERT无显著性差异。HPV感染与组织学类型及淋巴结转移无关,而与组织分化程度有显著性差异(P〈0.05)。结论:HPV16、18型感染在NSCLC发生中可能有病因学意义,其致癌机制可能与细胞凋亡、P53、MDM2及paxillin表达变化有关。  相似文献   

10.
目的探讨肺鳞癌组织中人乳头瘤病毒(humanpapillomavirus,HPV)感染与p53蛋白和Rb蛋白表达的关系并分析作用机理。方法采用地高辛标记的HPV-DNA探针,用原位杂交法检测84例肺鳞癌49例支气管黏膜慢性炎标本,组织中的HPV-DNA存在情况,并用免疫组化SABC法检测肺鳞癌组织中p53及Rb蛋白。结果HPV原位杂交阳性信号位于细胞核内,肺鳞癌HPV检出率为48.81%(41/84)、对照组黏膜慢性炎HPV检出率为6.12%(3/49),两组比较差异有统计学意义(P=0)。84例肺鳞癌中31例检出Rb蛋白表达,其中18例HPV阳性,13例HPV阴性,HPV阳性组与阴性组差异无统计学意义(P=0.2588)。84例肺鳞癌中30例检出p53蛋白表达,其中17例HPV阳性,13例HPV阴性,HPV阳性组与阴性组差异无统计学意义(P=0.3634)。结论肺鳞癌与HPV感染关系密切,肺鳞癌组织中也存在p53蛋白积聚,p53蛋白积聚与HPV感染无明显相关性,Rb蛋白积聚与HPV感染无明显相关性。  相似文献   

11.
目的:探讨人乳头瘤病毒(humanpapillomavirus,HPV)感染在非小细胞肺癌(nonsmallcelllungcancer,NSCLC)发生中的病因学意义及其与p53蛋白和P糖蛋白(Pgp)表达之间的相关性。方法:应用PCR、免疫组化方法分别检测76例NSCLC组织中HPVDNA及其E6、E7原癌蛋白、p53蛋白和Pgp的表达情况。结果:NSCLC中HPVDNA及其E6、E7原癌蛋白的检出率分别为40.8%(31/76)、43.4%(33/76),2种检测方法的符合率为78.9%(60/76);p53蛋白和Pgp的阳性率分别为63.2%(48/76)、59.2%(45/76),且HPV感染阳性组中p53蛋白的表达率为80.6%(25/31),显著高于阴性组51.1%(23/45)(P<0.05);p53蛋白表达阳性组中Pgp的表达率为68.8%(33/48),显著高于阴性组42.9%(12/28)(P<0.05);而HPV感染阳性组与阴性组间Pgp的表达无显著性差异(P>0.05)。HPV感染与高、中分化程度的NSCLC及吸烟有关。结论:HPV感染可能是NSCLC发生的另一重要病因学因素,且HPV感染可能导致p53基因突变,后者可能促进肺癌耐药性的增加。  相似文献   

12.
抗癌灵治疗原发性肝癌的实验研究   总被引:3,自引:0,他引:3       下载免费PDF全文
柳锋  李红 《肿瘤防治研究》2002,29(2):118-120
 目的 观察抗癌灵水煎剂对小鼠移植性肝癌 (H2 2 )的治疗作用。方法 以瘤株 (H2 2 )接种小鼠创作模型 ,设正常对照组、荷瘤模型组及抗癌灵治疗组 ,共 3组 ,观察各组小鼠瘤重和抑瘤率、肿瘤坏死因子(TNF)的体内活性表达、各组H2 2 小鼠生命延长率以及对肝癌细胞增殖周期的影响等指标。结果 用抗癌灵治疗后的H2 2 小鼠其抑瘤率达 61 .2 0 % ,明显高于模型组 (P <0 .0 1 ) ,并能抑制荷瘤肌体TNF水平的异常表达 ,提高H2 2 荷瘤小鼠的生命延长率 ,而且该药还能阻滞肿瘤细胞周期G1期向S期进展 ,从而阻断DNA的合成和复制。结论 抗癌灵对小鼠肝癌 (H2 2 )具有明显的杀伤作用  相似文献   

13.
Although the role of human papillomavirus (HPV) in the development of uterine cervical cancer is well established, the role of HPV in lung carcinogenesis remains controversial. The detection rates of HPV DNA are subject to a wide variation from 0 to 100 %. This is partly influenced by the detection techniques employed. To elucidate the impact of HPV infection on lung parenchyma, we analyzed 100 non-small cell lung cancer (NSCLC) specimens (39 squamous cell carcinomas, 50 adenocarcinomas, 5 samples with characteristics of both squamous cell and adenocarcinoma, 5 undifferentiated and 1 large cell carcinoma) from the region of Crete, Greece. Sixteen non-cancerous samples served as the negative controls. DNA was extracted from 100 paraffin-embedded tissue sections obtained from NSCLC patients. The specimens were examined for the detection of HPV DNA by Real-Time PCR using GP5+/GP6+ primers. Furthermore, the HPV-positive samples were subjected to genotyping. In contrast to the absence of viral genomes in the control samples, HPV DNA was detected in 19 NSCLC specimens (19 %). In particular, 4 squamous cell carcinomas, 12 adenocarcinomas, 1 sample with characteristics of both squamous cell and adenocarcinoma, and 2 undifferentiated samples were HPV-positive. The distribution of HPV genotypes was as follows: HPV 16: eight cases (42.1 %); HPV 11: three cases (15.8 %); HPV 6: one case (5.2 %); HPV 59: one case (5.2 %); HPV 33: two cases (10.5 %); HPV 31: two cases (10.5 %) and HPV 18: two cases (10.5 %). The presence of HPV in the tumor samples provides evidence of the potential role of HPV in NSCLC and strongly argues for additional research on this issue.  相似文献   

14.
 目的 研究人乳头瘤病毒(HPV)与大肠癌的相关性以及p53的关系。方法 应用聚合聚合酶链反应(PCR)和免疫组化技术分别检测对例大肠癌组织和15例正常结肠粘膜中的HPVDNA和p53蛋白。结果 大肠癌中HPVDNA阳性9例(27.27%),p53蛋白阳性18例(54.55%);正常粘膜中二者均阴性9例HPVDNA阳性的大肠癌中p53蛋白阳性3例,另外6例阴性。结论 大肠癌的发生与HPV感染有关(P<0.05),HPV感染与p53基因突变在大肠癌发生过程中可能单独起作用,HPV的致癌作用主要不是通过使p53基因失活这个途径。  相似文献   

15.
Cheng YW  Chiou HL  Sheu GT  Hsieh LL  Chen JT  Chen CY  Su JM  Lee H 《Cancer research》2001,61(7):2799-2803
Lung cancer is the leading cause of cancer death in Taiwanese women since 1982. High lung cancer mortality ratio of male:female in Taiwan (2:1) was observed, although less than 10% of female lung cancer patients are smokers. Until now, the etiological factor remains unknown. We hypothesize that high-risk human papillomavirus (HPV) 16/18 may be associated with lung cancer development based on high prevalence of p53 negative immunostainings in female lung tumors compared with that of male lung tumors. In this study, 141 lung cancer patients and 60 noncancer control subjects were enrolled to examine whether HPV 16/18 DNA existed in lung tumor and normal tissues by nested PCR and in situ hybridization (ISH), respectively. The concordant detection of HPV 16 and 18 DNA between nested PCR and ISH method was 73 and 85.5%, respectively. Our data showed that 77 (54.6%) of 141 lung tumors had HPV 16/18 DNA compared with 16 (26.7%; P = 0.0005) of 60 noncancer control subjects. In addition, ISH data showed that HPV 16/18 DNA was uniformly located in lung tumor cells, but not in the adjacent nontumor cells. When study subjects were stratified by gender, age, and smoking status, nonsmoking female lung cancer patients who were older than 60 years old had significantly high prevalence of HPV 16/18 infection. The odds ratio of HPV 16/18 infection of nonsmoking female lung cancer patients is much higher at 10.12 (95% confidence interval, 3.88-26.38) compared with 1.98 (95% confidence interval, 0.84-4.76) of nonsmoking male lung cancer patients. This result strongly suggests that HPV infection is associated with lung cancer development of nonsmoking female lung cancer patients. The high prevalence of HPV 16/18 infection may explain to a certain extent why Taiwanese women nonsmokers had a higher lung cancer mortality rate.  相似文献   

16.
To determine the etiologic factors of human oral cancer, we examined the prevalence of microsatellite instability (MSI), the inactivation of mismatch repair (MMR) genes, p53 mutation, and human papillomavirus (HPV) infection (HPV-16, -18, and -33) in 86 Korean oral cancer specimens, including 76 squamous cell carcinomas and 10 salivary gland tumors. MSI was observed in 3 of the 76 squamous cell carcinomas (4%) and 2 of 10 salivary gland tumors (20%). As MSI is a hallmark of the inactivation of the MMR genes, the genetic status of hMSH2 and hMLH1, and hypermethylation of the hMLH1 promoter region were investigated in oral cancers displaying MSI. Inactivation of the hMLH1 gene by either mutation or hypermethylation was observed 4 of the 5 MSI oral cancers. Mutation of the p53 gene was found in 11 of 76 squamous cell carcinomas (14.5%) but not in the salivary gland tumors. PCR assay revealed the presence of HPV DNA in 11 of the 76 squamous cell carcinomas (14.5%) and 4 of the 10 salivary gland tumors (40%). Type 18 HPV DNA was predominant in 11 of the HPV-infected squamous cell carcinomas (72.7%) and 4 of the HPV-infected salivary gland tumors (50%). Two squamous cell carcinoma tissues were found both to be HPV-infected and to harbor the p53 mutation. Our results suggest: i) that MSI plays a role in the pathogenesis of Korean oral cancers, squamous cell carcinomas (4%) and salivary gland tumors (20%); ii) that genetic alteration or hypermethylation of the hMLH1 gene may be the principal inactivating mechanism in Korean oral cancer with MSI; and iii) that inactivation of the p53 gene by either mutation or HPV infection is frequent in Korean squamous cell carcinomas (26%) and salivary gland tumors (40%).  相似文献   

17.
宫颈鳞癌HPV16感染及其与c-myc p53表达的关系   总被引:2,自引:0,他引:2  
目的:探讨HPV16在宫颈鳞癌发生发展中的作用及其与c-myc、p53表达产物之间的关系。方法:采用原位杂交和免疫组化方法检测了18例慢性宫颈炎、28例CIN、4例宫颈浸润性腺鳞癌和55例宫颈浸润性鳞癌HPV16 E6 DNA及其蛋白和c-myc、p53蛋白的表达情况。结果:浸润性宫颈癌。HPV16 E6 DNA及其蛋白、p53蛋白阳性率明显高于慢性宫颈炎组,c-myc蛋白阳性率则明显低于慢性宫颈炎组。p53蛋白阳性率与HPV16 E6 DNA的检出率之间无负相关关系。结论:宫颈鳞癌的发生发展可能与HPV16 E6 DNA的检出及c-myc、p53蛋白的表达异常相关。  相似文献   

18.
Human papillomavirus (HPV) infection is a causative event for the development of uterine cervical carcinoma. Human papillomavirus (HPV) 16, 18, and 33 DNA has been also detected frequently in lung adenocarcinomas (AdCs) in East Asian countries; however, its prevalence in Japan remains unclear. We therefore screened for HPV 16/18/33 DNA in 297 lung AdCs in a Japanese population by multiplex PCR with type‐specific primers. As reported previously, HPV 16 DNA was detected in two cervical cancer cell lines, CaSki and SiHa, while HPV 18 DNA was detected in HeLa cells, and 0.1–1.0 copies of HPV‐DNA per cell were detectable by this method. However, with this method, none of the 297 lung AdCs showed positive signals for HPV 16/18/33 DNA, indicating that HPV‐DNA is not or is very rarely integrated in lung AdC genomes in the Japanese. Furthermore, none of the lung AdCs showed positive signals by nested PCR with HPV 16/18 type‐specific primers. Therefore, we further attempted to detect HPV 16/18/33 DNA in 91 lung cancer cell lines, including 40 AdC cell lines. Among them, 30 have been established in Japan and the remaining 61 in the USA. No HPV signals were obtained in any of the 91 cell lines by either multiplex or nested PCR, while the p53 gene was mutated in 81 of them including 35 of the 40 AdC cell lines. These results indicate that HPV 16/18/33 infection does not play a major role in the development of lung AdC in Japan nor in the USA. (Cancer Sci 2010)  相似文献   

19.
To clarify the role of human papillomavirus (HPV) and Epstein-Barr virus (EBV) infection in gastric carcinogenesis in relation to overexpression of mutated p53 anti-oncogene, we used PCR to amplify DNA sequences of these viruses and immunohistochemistry to detect p53 overexpression in formaline-fixed, paraffin embedded blocks including 12 normal gastric and 51 gastric carcinoma specimens. HPV and EBV DNA were found in 17% and 0% of normal gastric tissues and in 45% and 27% of gastric carcinoma specimens, respectively. p53 overexpression was shown in 37% of gastric carcinoma specimens only. HPV infection rate was significantly higher in stage I gastric carcinomas as compared with stage IV carcinomas (p<0.03). p53 overexpression was significantly increased in well-differentiated adenocarcinomas as compared with poorly differentiated carcinomas (p<0.01). The rates of both HPV infection and p53 overexpression were significantly higher in gastric carcinomas without vascular invasion than in those with the invasion (p<0.02). No correlation was found between p53 overexpression and/or the presence of viral DNA (HPV/EBV) in regard to the depth of invasion, lymph node involvement, distant metastasis, and the location of the tumors. Our results suggest that some of the gastric carcinomas are associated with HPV and/or EBV infection and p53 mutations, and that all of these may be involved in the early stage of this malignancy. There was no correlation between HPV and or EBV infection and overexpression of p53 in gastric carcinoma.  相似文献   

20.
The presence of human papillomavirus (HPV) genome in lung carcinomas has been reported worldwide but its frequency varies from country to country. We examined HPV genome in 36 lung carcinomas, consisting of 14 squamous cell carcinomas, 13 adenocarcinomas, and 9 small cell carcinomas, collected from Colombia, Mexico and Peru. PCR analysis using GP5+/GP6+ primers, combined with Southern blot hybridization, found the presence of HPV genome in 10 (28%) of 36 cases. This percentage is similar to the value of 22% reported by Syrj?nen, who conducted a meta-analysis of nearly 2500 lung carcinomas examined to date. Genotype analysis revealed that the most predominant genotype was HPV-16 (7 cases), followed by HPV-18 (2 cases) and HPV-33 (1 case). HPV-16 was more frequently found among female than male cases (P=0.008) but was not detected in any adenocarcinoma cases. On the other hand, HPV-18 and HPV-33 were detected only among male cases. These HPV genotypes were detected only in adenocarcinomas, and all the HPV genotypes detected in this histological type were HPV-18 or HPV-33. The frequency of HPV-16 positive cases among all the HPV positive cases differed in the sexes (P=0.033) and differed in the three histological types (P=0.017). The presence of HPV tended to be more frequent in well-differentiated tumors when squamous cell carcinomas and adenocarcinomas were combined. However, it was not statistically significant (P=0.093). Neither p16 nor p53 expression in carcinoma cells was related to the proportion of HPV-positive cases. In conclusion, high-risk HPV DNA was detected in 28% of lung carcinomas. The predisposition of HPV-16 to female cases and to non-adenomatous carcinomas warrants further investigation.  相似文献   

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