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1.
BackgroundThe aim of this study was to determine whether Central Corneal Thickness (CCT) is associated with intraocular pressure measurement (IOP) with a Non-contact tonometer and the Goldmann applanation tonometer in glaucoma patients.Materials and MethodsThe study involved two hundred and thirty-two eyes of clinically diagnosed glaucoma patients receiving care at a referral facility. IOP measurements were obtained using both the Non-Contact Tonometer (NCT) and Goldmann Applanation Tonometer (GAT). The association between age, ethnicity, and CCT, as well as CCT on the measures of NCT and GAT, were analyzed.ResultsThere were 64(55.2%) males and 52 (44.8%) females and their ages ranged from 18 to 85 years (mean age = 47.72; SD ± 15.75 years). There was a weak positive correlation between the CCT and NCT findings in the right eye (r = 0.19, n = 116, p < 0.05) and in the left eye (r = 0.25, n = 116, p < 0.05). However, there was no correlation between CCT and GAT measurements. Age had a significant correlation with CCT while gender and ethnicity had no significant correlation.ConclusionThe study found a significant association between CCT and NCT. However, there was no significant association between CCT and GAT. CCT had an association with age but independent of gender and ethnicity since there was no significant relationship between these variables.  相似文献   

2.
BackgroundThe objective of this study was to determine the causes and distribution of vision impairment and refractive error among children in Zimbabwe.MethodsA hospital-based retrospective cross-sectional study was conducted among children (3–16) who attended the Eye Institute, Harare, Zimbabwe, from January 2010 to December 2020. Patients'' records were collated, and variables such as visual acuity, ocular morbidities, and vision impairment were analysed.ResultsDuring this time, 1038 children with mean age of 10.63 ± 3.54 years visited the facility. The majority of them were males (53.2%). Prior to treatment, 9.9% of the children had vision impairment which reduced to 3.5% after intervention. Uncorrected refractive error accounted for the majority of vision impairment (67.0%), followed by keratoconus (7.8%), corneal opacity/ulceration (6.8%), and amblyopia (6.8%), among other conditions. Astigmatism (60.6%) was the most prevalent type of refractive error followed by myopia (37.5%).ConclusionThe prevalence of childhood vision impairment is higher than that found in similar hospital-based studies conducted in Africa. The most common reason for childhood vision impairment was uncorrected refractive error.  相似文献   

3.
A neurological and biochemical study of early lead poisoning   总被引:7,自引:6,他引:1       下载免费PDF全文
ABSTRACT Changes in nerve conduction velocity were found in 94 workers exposed to lead in a battery factory compared with 94 age-matched controls. There was no clinical evidence of nerve damage in the lead workers. The mean blood lead concentration in the 94 lead workers was 2·9 μmol/l (60 μg/100 ml) and their length of exposure to lead ranged from 6 months to 33 years.

All mean maximum motor nerve conduction velocities (MMCV) measured were highly statistically significantly lower in the lead-exposed group when compared with their age-matched controls. Thus mean ulnar MMCV was 53·4 m/s in lead workers and 55·6 m/s in control subjects (p < 0·0005); mean median MMCV was 55·9 m/s in lead workers and 57·3 m/s in control subjects (p < 0·01); mean radial MMCV was 63·9 m/s in lead workers and 71·1 m/s in control subjects (p < 0·0005); mean peroneal MMCV was 46·1 m/s in lead workers and 47·6 m/s in control subjects (p < 0·005).

The amplitude of the muscle action potential produced by proximal stimulation of a nerve was expressed as a percentage of the amplitude of the muscle action potential produced by distal stimulation and the percentage amplitude thus obtained used as an indicator of the conduction velocity of slower fibres (SFCV). Peroneal nerve percentage amplitude of lead workers was statistically significantly lower (p < 0·005) than in the control group (means 86·6% and 90·3% respectively). There were, however, no significant differences in the percentage amplitude in the ulnar and median nerves. It is suggested that percentage amplitude is an inappropriate indicator of SFCV in ulnar and median nerves.

There was no statistically significant correlation to indicate that progressive slowing of nerve conduction (MMCV and SFCV) was associated with increasing exposure to lead (as indicated by blood and urine lead concentrations) or with the commonly measured biochemical changes associated with disturbed haemopoiesis in lead exposure (δ-aminolaevulinic acid dehydrase; free erythrocytc protoporphyrin; haemoglobin and urinary δ-aminolaevulinic acid). MMCV of the ulnar nerve was the only conduction velocity statistically significantly correlated with length of exposure to lead. Increased length of exposure to lead was associated with a decrease in the ulnar MMCV.

Only 13 of the subjects had been exposed to lead for two years or less and in none of them had the blood lead ever risen above 3·9 μmol/l (80 μg/100 ml) in three-monthly tests (mean blood lead concentration at time of testing: 2·8 μmol/l). In these subjects the MMCV of ulnar, radial, and peroneal nerves and the peroneal percentage amplitude were statistically significantly reduced. The results from this group suggest that the onset of nerve conduction changes occurs within two years and at concentrations of lead in blood of less than 3·9 μmol/l (80 μg/100 ml).

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4.
Iron deficiency (ID) diagnosis in cystic fibrosis (CF) is challenging because of frequent systemic inflammation. We aimed to determine the prevalence and risk factors of ID in adult patients with CF. We conducted a single-centre prospective study in a referral centre. ID was defined by transferrin saturation ≤16% or ferritin ≤20 (women) or 30 (men) μg/L, or ≤100 μg/L in the case of systemic inflammation. Apparent exacerbation was an exclusion criterion. We included 165 patients (78 women), mean age—31.1 ± 8.9 years. ID prevalence was 44.2%. ID was significantly associated with female gender (58.9% vs. 38%), lower age (29.4 ± 8.5 vs. 32.5 ± 9.1), lower body mass index (20.5 ± 2.2 vs. 21.3 ± 2.5), and Pseudomonas aeruginosa colonization (70.8% vs. 55.1%). Diabetes mellitus, antiacid drug use and low pulmonary function were more frequent in patients with ID with no statistical significance. The use of CFTR correctors was not associated with ID. In the multivariate analysis, ID was associated with female gender (OR 2.64, CI95% 1.31–5.31), age < 30 years (OR 2.30, CI95% 1.16–4.56), and P. aeruginosa (OR 2.09, CI95% 1.04–4.19).  相似文献   

5.
目的 探讨近视眼患者视网膜神经纤维层(RNFL)厚度与中央角膜厚度(CCT)之间的关系.方法 选择91例眼科门诊近视患者(91眼),其中低度近视(等效球镜度数[SE]>-3.0D)28例(28眼),中度近视(SE-0.3D~-6.0D)33例(33眼),高度近视(SE<-6.0D)30例(30眼).均接受包括眼压、验光、裂隙灯、眼底等常规眼部检查,排除除屈光不正以外其他眼部疾病.利用RTVue Fourior OCT(Optovue Inc,USA)测量视盘周围RNFL厚度;利用CAM-L模块测量CCT.结果 近视眼患者RNFL厚度是(108.5±10.1)μm,CCT是(524.7±36.8)μm,在低中高近视组差异均无统计学意义(P>0.05).单因素相关及多元线性回归分析发现:颞侧(tl1,tu1)RNFL厚度与CCT呈正相关(tl1单因素及多因素r=0.281,0.093;tu1单因素及多因素r=0.352,0.163;P<0.05);鼻侧(nl2,nu2)和下方偏鼻侧(in2,in1)区域RNFL厚度与SE呈正相关(P<0.05);下方偏颞侧(it2)RNFL厚度与SE呈负相关(P<0.05);其他部位RNFL厚度与CCT、SE无相关(P>0.05).结论 近视眼视盘周围局部区域RNFL厚度与CCT存在相关性,表明中央角膜厚度与青光眼视神经病变敏感结构指标具有一定关系,对青光眼诊治具有重要指导意义.  相似文献   

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7.
BackgroundThe objective of the study was to report on the main parameters of ocular biometry and Intraocular lens (IOL)power of patients attending a cataract surgical campaign in Eastern Ethiopia.MethodsThe study was a cross-sectional study on 765 eyes which were eligible for cataract surgery during a mass cataract surgical campaign conducted from April 04 to April 10, 2018 at Bisidimo Hospital, Eastern Ethiopia. Ocular biometric parameters were measured by automated keratorefractometer and Sonomed A-Scan (Model 300AP) using contact applanation method. Multiple linear regression analysis was done to determine association of ocular biometry components with socio demography of the study subjects.ResultsThe mean corneal curvature and anterior chamber depth (ACD, measured from corneal epithelium to lens) were found to be 7.61 mm and 2.88mm respectively. The mean axial length was estimated to be 22.98 mm. The mean refractive power of IOL was calculated to be 19.34D. The mean axial length in females was shorter than that of males by 0.24 (P - value = 0.01). The mean ACD in males was also larger than that of females by 0.1 (P - value = 0.001).ConclusionThis study provided a larger population based normative data on ocular biometry in Ethiopia. The female sex was a strong predictor of small axial length. Increasing age had no effect on axial length but was found to be a stronger predictor of shallow ACD.  相似文献   

8.
BackgroundThe cardiothoracic ratio (CTR) is a radiographic parameter commonly used in assessing the size of the heart. This study evaluated the gender and age-based differences in the average cardiothoracic ratios, and transverse cardiac diameters (TCD) of adults in Ghana.MethodPlain chest radiography reports of 2004 patients (without known chest related diseases) generated by two radiologists with at least 15 years'' experience from July 2016 to June 2020 were retrospectively analyzed for this study. The CTR for each radiograph was calculated using the formula CTR=(TCD÷TTD)×100, where TCD and TTD represent transverse cardiac diameters and transverse thoracic diameters, respectively. Data were analyzed with the statistical package for social sciences version 23. The independent t-test and One-way Analysis of Variance tests were used in the analyses.ResultsA total of 2004 patients'' chest x-rays were used in the analyses. The ages of the patients ranged from 20–86 years old with a mean of 39.4±14.04 years. The mean CTR for males was 46.6 ± 3.7% while that of females was 47.7±3.7%. The difference in the overall CTR among the gender groupings was statistically significant (p = 0.001). There were statistically significant differences between the gender categories among patients in the following age groups: 30–39 (p=0.046), 40–49 (p=0.001), 50–59 (p=0.001) and 60–69 (p=0.001).ConclusionThe study reveals there are significant gender and age-related differences in cardiac size parameters obtained from routine, frontal chest radiographs. These differences, if considered, may result in early and appropriate treatment of cardiac pathology in some age groups.  相似文献   

9.
BackgroundVisual health is linked to school achievement, quality of life and productivity. But eye screening in school children is not routinely done in most Ethiopian schools. This study was done to determine prevalence and pattern of ocular morbidity among school children in Roman Dega-Kedida, Southern Ethiopia.MethodThis was a cross-sectional study. All children aged 16 years or less, attending the school during the study period were included. Data entry and statistical analyses were performed using SPSS Version 16. A P - value of < 0.05 was considered statistically significant.ResultA total of 778 children participated in this study. The female to male ratio was 1.06:1. The mean age was 11.34(±2.31) years. A total of 201 (25.8%) children had ocular morbidities. The most common was trachoma found in 85(10.9%). Of these, 49(56.5%) had active trachoma, while 37(43.5%) had either trachoma scar or trachomatous trichiasis. Allergic conjunctivitis was found in 49(6.3%), refractive error in 37(4.8%), and xerophthalmia in 17(2.2%) children. Visual impairment in one or both eyes was found in 41(5.3%) children. Thirty-two children (4.1%) had bilateral Visual impairment of which 6(18.8%) had moderate to severe visual impairment. The cause of visual impairment was refractive error in 37(90.2%), corneal opacity in 3(7.3%) and cataract in 1(2.4%) child.ConclusionMost of the ocular diseases observed were either preventable or treatable. Health education to the community and establishing regular school screening program is recommended.  相似文献   

10.
The air of loose-boxes holding pigs affected with swine vesicular disease was sampled for virus. In the multistage impinger virus to a titre of 102·6 TCID 50 was associated with particles greater than 6 μm., 101·6 with particles 3-6 μm. and 101·4 or less with particles less than 3 μm. In the noses of workers in contact with the pigs for periods not less than 5 min., virus to a titre of 102·4 TCID 50 was found. Virus was recovered from the air for 2-3 days during the disease and maximum titre in pigs infected by injection or by contact occurred on the second to third day after generalization of the lesions. The amounts of virus were about 160-fold less than those recovered from pigs affected with foot-and-mouth disease, and the quantity and time of excretion suggest that the source of swine vesicular disease virus in the aerosol may be from the lesions and skin rather than from the respiratory tract.  相似文献   

11.
In this study, we aimed to determine whether a postnatal trans fat diet (TFD) could aggravate prenatal bisphenol A (BPA) exposure effects on offspring’s small intestine and adulthood obesity, due to the relatively sparse findings on how the interaction between these two variables interrupt the small intestinal cells. Twelve pregnant rats were administered with either unspiked drinking water (control; CTL) or BPA-spiked drinking water throughout pregnancy. Twelve weaned pups from each pregnancy group were then given either a normal diet (ND) or TFD from postnatal week (PNW) 3 until PNW14, divided into control offspring on normal diet (CTL-ND), BPA-exposed offspring on normal diet (BPA-ND), control offspring on trans fat diet (CTL-TFD), and BPA offspring on trans fat diet (BPA-TFD) groups. Body weight (BW), waist circumference, and food and water intake were measured weekly in offspring. At PNW14, small intestines were collected for global DNA methylation and histological analyses. Marked differences in BW were observed starting at PNW9 in BPA-TFD (389.5 ± 10.0 g; p < 0.05) relative to CTL-ND (339.0 ± 7.2 g), which persisted until PNW13 (505.0 ± 15.6 g). In contrast, water and food intake between offspring were significantly different (p < 0.01–0.05) at earlier ages only (PNW4–6 and PNW7–9, respectively). Furthermore, substantial differences in the general parameters of the intestinal structures were exclusive to ileum crypt length alone, whereby both BPA-ND (150.5 ± 5.1 μm; p < 0.001), and BPA-TFD (130.3 ± 9.9 μm; p < 0.05) were significantly longer than CTL-ND (96.8 ± 8.9 μm). Moreover, BPA-ND (2.898 ± 0.147%; p < 0.05) demonstrated global small intestinal hypermethylation when compared to CTL-ND and CTL-TFD (1.973 ± 0.232% and 1.913 ± 0.256%, respectively). Prenatal BPA exposure may significantly affect offspring’s physiological parameters and intestinal function. Additionally, our data suggest that there might be compensatory responses to postnatal TFD in the combined BPA prenatal group (BPA-TFD).  相似文献   

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13.
An elevated serum phosphorus (P) has been anecdotally described in premature infants receiving human milk fortified with donor human milk-derived fortifier (HMDF). No studies have prospectively investigated serum P in premature infants receiving this fortification strategy. In this single center prospective observational cohort study, extremely premature infants ≤1250 grams (g) birth weight (BW) were fed an exclusive human milk-based diet receiving HMDF and serum P levels were obtained. We evaluated 93 infants with a mean gestational age of 27.5 ± 2.0 weeks (Mean ± SD) and BW of 904 ± 178 g. Seventeen infants (18.3%) had at least one high serum P level with a mean serum P of 9.2 ± 1.1 mg/dL occurring at 19 ± 11 days of life. For all infants, the highest serum P was inversely correlated to the day of life of the infant (p < 0.001, R2 = 0.175) and positively correlated with energy density of HMDF (p = 0.035). Serum P was not significantly related to gender, BW, gestational age, or days to full feeds. We conclude that the incidence of hyperphosphatemia was mild and transient in this population. The risk decreased with infant age and was unrelated to gender, BW, or ethnicity.  相似文献   

14.
IntroductionThe coronavirus pandemic (COVID-19) is an unprecedented global health crisis with emotional and physical impact on health care workers.ObjectiveThe purpose of this study was to investigate the levels of fatigue and burnout in nursing staff during the pandemic.MethodsThe present study involved nursing staff from hospitals in Greece in February 2021, who completed the Fatigue (FAS) and Burnout (CBI) questionnaires. Gender, age, years of work experience, workplace (COVID-19 or non-COVID-19 wards) and SARS-CoV-2 infection status were recorded.ResultsThe sample included 593 women and 108 men, with a mean age ± SD: 42.9 ± 9.9 years and 18.14 ± 10.8 years work experience. Slightly more than half, (367, 52.4%) worked in COVID-19 departments. Fifty-six (8%) tested positive for SARS-CoV-2 and 14 of them needed to be treated. The mean ± SD FAS and CBI scores were 25.6 ± 7.4 and 46.9 ± 18.8, respectively (67.9% and 42.9% had scores suggestive of fatigue and burnout, respectively). Women showed higher values in both scales (p < 0.01). Subjects working in COVID-19 wards scored significantly higher on both the FAS and CBI scales; they were also younger and with less work experience (p < 0.01). Staff treated for COVID-19 scored higher on the burnout scale (p < 0.01) than the uninfected staff. Fatigue showed a strong positive correlation with burnout (p < 0.01, r = 0.70). Stepwise multiple regression showed that the variation of fatigue was explained by 47.0% and 6.1% by the scores on the subscales of personal and work-related burnout, respectively.ConclusionIn conclusion, high rates of fatigue and burnout were found in the studied population. Nurses working with COVID-19 patients had higher rates of fatigue and burnout compared to those working elsewhere. There was a strong positive correlation (r = 0.70) between burnout and fatigue. Particular attention should be paid to staff who became ill and need to be treated.  相似文献   

15.
ABSTRACT Eighty-one percent of all hourly paid men who had been employed for more than six months in a factory making lead acid batteries and plastics completed a modified Cornell medical index health questionnaire. Blood lead and erythrocyte protoporphyrin (EPP) were also measured. The questions were grouped into symptom categories as follows: all physical, all psychological, “potentially lead induced,” pulmonary, cardiovascular, gastrointestinal, skin, nervous system, genitourinary, and fatigue. For each symptom category the pooled percentages of men whose symptom scores were above the common median of the three blood lead groups 10-, 40-, and 60 and over μg/100 ml (0·48-, 1·93-, and 2·90 and over μmol/l) within age/smoking subgroups were calculated. In every symptom category the percentages in the two lower blood lead groups differed little, but the percentages were consistently higher in men with blood concentration of 60 μg/100 ml (2·90 μmol/l) and over. Differences between a combined 10-59 μg/100 ml (0·48-2·85 μmol/l) blood lead group and the 60 and over μg/100 ml (≥2·90 μmol/l) group were statistically significant at the 0·01 level for “potentially lead induced” symptoms and at the 0·05 level for skin and psychological symptoms. Broadly similar results were obtained with four log10 EPP groups 0·6-, 1·5-, 1·7-, and ≥2·0, but differences did not reach statistical significance. There was no obvious explanation as to why symptoms that are not found in classic lead poisoning should be increased almost as much as those that are. It was thought that these results could be biased due to the men's knowledge of the symptoms associated with lead exposure, but the possibility that they may be partly due to lead absorption cannot be excluded.  相似文献   

16.
BackgroundThere is a gap in our knowledge of health-related quality of life (HRQoL) in a population presumed healthy, so this study aimed to assess the associations between HRQoL, demographics and clinical variables.MethodsThe participants were attendees, presumed healthy, at 40 pre-selected model family medicine practices (MFMPs), aged between 30 and 65 years and recruited during a preventive check-up in 2019. Each MFMP pragmatically invited 30 attendees to voluntarily participate. The EQ-5D questionnaire was administered as a measure of HRQoL; the independent variables were demographic characteristics, smoking, alcohol consumption, stress perception, physical activity, signs of depression, cardiovascular risk, body mass index, blood pressure values, and blood sugar and lipidogram laboratory test values. Ordinal logistic regression was used to calculate associations between self-assessed quality of life, demographics, and clinical variables, with P<0.05 set as statistically significant.ResultsOf 986 participants, 640 (64.9%) were women and 346 (35.1%) men, aged 42.7±8.6 years. The average values for the EQ-5D-3L were 0.91±0.15. In the multivariate model, a positive association between adequate physical activity (p=0.003), and a negative association between higher age (p<0.001), female gender (p=0.009), signs of depression (p<0.001), stress (p=0.013), and EQ-5D score were identified.ConclusionGiven that physical activity was shown to be positively associated with HRQoL, it is of the utmost importance for family physicians to motivate their middle-aged patients, especially women and those with signs of depression and excessive stress, to adopt a more rigorously physically active lifestyle.  相似文献   

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18.
The terms maximum allowable concentration (M.A.C.) and threshold limit value (T.L.V.) differ in their respective meanings. The M.A.C. is a ceiling concentration whereas the T.L.V. is a time-weighted average of the concentration of the hazardous agent in the atmosphere. The value attributed to M.A.C. or T.L.V. will vary with the criteria decided upon for the response selected. This response may be a clinical or biochemical change in human subjects resulting from the hazardous agent.

An investigation of lead workers is reported, and from the data obtained from them and from their working environment recommendations have been made. The survey was carried out in printing works and storage battery factories; the order of development of abnormal biochemical findings was reconfirmed. The T.L.V. was determined for each stage of lead absorption by a graphic method. T.L.V.s for an eight to 10-hour working day were determined as 0·10 mg./m.3 to produce a urinary lead of 0·15 mg./l., 0·12 mg./m.3 for a coproporphyrinuria of about 50 μg./l., 0·14 mg./m.3 for basophilic stippling at the 0·3 per thousand level, and most likely 0·14 to 0·15 mg./m.3 for lead anaemia. The biochemical function chosen was an increased excretion of coproporphyrin, and to keep this below 50 μg./l. we would suggest that the T.L.V. should be about 0·12 mg./m.3 or a little more in the case of a 40-hour week.

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19.

Objectives

This study was conducted to show the intraocular pressure (IOP) distribution and the factors affecting IOP in subjects with type 2 diabetes mellitus (DM) in India.

Methods

We measured the anthropometric and biochemical parameters for confirmed type 2 DM patients. A comprehensive ocular examination was performed for 1377 subjects aged > 40 years and residing in Chennai.

Results

A significant difference in IOP (mean ± standard deviation) was found between men and women (14.6±2.9 and 15.0±2.8 mmHg, p = 0.005). A significantly elevated IOP was observed among smokers, subjects with systemic hypertension and women with clinically significant macular edema (CSME). After a univariate analysis, factors associated significantly with higher IOP were elevated systolic blood pressure, elevated resting pulse rate and thicker central corneal thickness (CCT). In women, elevated glycosylated hemoglobin was associated with a higher IOP. After adjusting for all variables, the elevated resting pulse rate and CCT were found to be associated with a higher IOP.

Conclusions

Systemic hypertension, smoking, pulse rate and CCT were associated with elevated intraocular pressure in type 2 DM. Women with type 2 DM, especially those with CSME, were more prone to have an elevated IOP.  相似文献   

20.

Background

Associations between long-term exposure to air pollution and carotid intima-media thickness (CIMT) have inconsistent findings.

Objectives

In this study we aimed to evaluate association between 1-year average exposure to traffic-related air pollution and CIMT in middle-aged adults in Asia.

Methods

CIMT was measured in Taipei, Taiwan, between 2009 and 2011 in 689 volunteers 35–65 years of age who were recruited as the control subjects of an acute coronary heart disease cohort study. We applied land-use regression models developed by the European Study of Cohorts for Air Pollution Effects (ESCAPE) to estimate each subject’s 1-year average exposure to traffic-related air pollutants with particulate matter diameters ≤ 10 μm (PM10) and ≤ 2.5 μm (PM2.5) and the absorbance levels of PM2.5 (PM2.5abs), nitrogen dioxide (NO2), and nitrogen oxides (NOx) in the urban environment.

Results

One-year average air pollution exposures were 44.21 ± 4.19 μg/m3 for PM10, 27.34 ± 5.12 μg/m3 for PM2.5, and (1.97 ± 0.36) × 10–5/m for PM2.5abs. Multivariate regression analyses showed average percentage increases in maximum left CIMT of 4.23% (95% CI: 0.32, 8.13) per 1.0 × 10–5/m increase in PM2.5abs; 3.72% (95% CI: 0.32, 7.11) per 10-μg/m3 increase in PM10; 2.81% (95% CI: 0.32, 5.31) per 20-μg/m3 increase in NO2; and 0.74% (95% CI: 0.08, 1.41) per 10-μg/m3 increase in NOx. The associations were not evident for right CIMT, and PM2.5 mass concentration was not associated with the outcomes.

Conclusions

Long-term exposures to traffic-related air pollution of PM2.5abs, PM10, NO2, and NOx were positively associated with subclinical atherosclerosis in middle-aged adults.

Citation

Su TC, Hwang JJ, Shen YC, Chan CC. 2015. Carotid intima–media thickness and long-term exposure to traffic-related air pollution in middle-aged residents of Taiwan: a cross-sectional study. Environ Health Perspect 123:773–778; http://dx.doi.org/10.1289/ehp.1408553  相似文献   

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