Clinical and experimental obstetrics & gynecology最新文献_第7页

Predicting factors of clomiphene citrate responsiveness in infertile women with normogonadotropic anovulation (WHO group II anovulation) 促性腺激素正常无排卵(WHO II组无排卵)不孕妇女柠檬酸克罗米芬反应性的预测因素

IF 0.2 4区医学

Clinical and experimental obstetrics & gynecology Pub Date : 2022-02-09 DOI: 10.31083/j.ceog4902039

Theeraporn Areetheerapas, Artitaya Singwongsa, K. Suwannarurk, J. Pattaraarchachai

{"title":"Predicting factors of clomiphene citrate responsiveness in infertile women with normogonadotropic anovulation (WHO group II anovulation)","authors":"Theeraporn Areetheerapas, Artitaya Singwongsa, K. Suwannarurk, J. Pattaraarchachai","doi":"10.31083/j.ceog4902039","DOIUrl":"https://doi.org/10.31083/j.ceog4902039","url":null,"abstract":"Background: Clomiphene responsiveness has been varied in WHO group II anovulatory patients. Our study evaluates factors associated with clomiphene citrate responsiveness in this population. Various parameters were studied, including anthropometric, hormonal and transvaginal ultrasonographic measurements. Methods: A retrospective case-control study was done over a period of three years. A total of 260 women with WHO group II anovulatory related infertility treated with clomiphene citrate 100 mg/d for five consecutive days were enrolled. 173 women were categorized in clomiphene citrate resonsive group (CCR), defined as patients with at least one dominant follicle ≥17 mm or at least 2 dominant follicles ≥15 mm. 87 women were categorized in the non-ovulatory group (NCCR), defined as patients who not meet the responsive group criteria. Various clinical, metabolic, hormonal and ultrasound features were compared between two groups. Logistic regression analysis was used to analyze the significant factors. Results: Among all participants, the mean age was 32.6 ± 4.0 years. The mean body mass index in CCR and NCCR group was 23.9 ± 10.7 kg/m and 24.0 ± 4.0 kg/m, respectively. The mean waist-hip ratio (WHR) of the NCCR group was higher than that of the CCR group, i.e., 0.83 ± 0.06 vs 0.81 ± 0.05 (p = 0.004). The waist-hip ratio was the most sensitive anthropometric predictor of non-responsiveness to clomiphene: cut-off value of 0.775 (90.8% sensitivity and 20.2% specificity) and cut-off value of 0.805 (73.6% sensitivity and 42.2% specificity). Age, clinical hyperandrogenism, polycystic ovarian morphology, low antral follicle count (≤5 follicles), baseline follicle-stimulating hormones and estradiol levels were not significantly different. Conclusions: Thewaist-hip ratio is a clinically useful parameter in predicting clomiphene responsiveness in normogonadotropic anovulatory women (WHO group II anovulation).","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44506494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Progesterone: the key to success? 黄体酮:成功的关键?

IF 0.2 4区医学

Clinical and experimental obstetrics & gynecology Pub Date : 2022-02-08 DOI: 10.31083/j.ceog4902036

A. Riva, G. Buzzaccarini, A. Vitagliano, A. Laganà, G. Cucinella, G. Gullo

引用次数: 4

Vanishing twin after 12 gestational weeks is associated with adverse perinatal outcomes in in vitro fertilization cycles 在体外受精周期中，12孕周后消失的双胞胎与不良围产期结局相关

IF 0.2 4区医学

Clinical and experimental obstetrics & gynecology Pub Date : 2022-02-08 DOI: 10.31083/j.ceog4902034

Jun Liu, Chun-Lin Liu, Qinhong Luo, Zhufeng Wu, Fengxiang Li, D. Chen, Chao Li, Ling Sun

{"title":"Vanishing twin after 12 gestational weeks is associated with adverse perinatal outcomes in in vitro fertilization cycles","authors":"Jun Liu, Chun-Lin Liu, Qinhong Luo, Zhufeng Wu, Fengxiang Li, D. Chen, Chao Li, Ling Sun","doi":"10.31083/j.ceog4902034","DOIUrl":"https://doi.org/10.31083/j.ceog4902034","url":null,"abstract":"Background: To assess the associations between vanishing gestational age and the adverse perinatal outcomes following in vitro fertilization cycles. Methods: This is a retrospective cohort study conducted in Guangzhou Women and children hospital from January 2011 to January 2019. We identified 350 vanishing twin pregnancies including 54 secondary fetal deaths and 296 singleton deliveries compared to 2080 infants from single gestations. The children detected by transvaginal ultrasonography in gestational week 6. By linking with the hospital’s registries, the main endpoints were gestational age (weeks), birth weight (g), low birth weight (LBW), preterm birth and neonatal malformation rate. Perinatal outcomes were compared among study groups and controls. Results: Of the 350 vanishing twin, there were 15.4% (54) secondary fetal death. Of the 2376 singleton deliveries, 12.5% (296) originated from a twin gestation. In the assessment of perinatal outcome, there were no significant differences between the singleton cohort and vanishing twin before the presence of fetal cardiac activity cohort (VT before CA) and early vanishing cohort. The late vanishing twin group had a higher risk of preterm delivery (P < 0.001) and LBW (P < 0.001). There were no significant differences between all cohorts in assessing neonatal malformation rate (P> 0.05). Conclusion: Vanishing twin after 12 weeks is a predictor of adverse perinatal outcome. The couples with a viable fetus or a non-viable fetus and an empty gestational sac in early pregnancy (<12 weeks) have a similar outcome as the baby from a singleton delivery without vanishing.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42764003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Immunological aspects of ovarian malignancy 卵巢恶性肿瘤的免疫学方面

IF 0.2 4区医学

Clinical and experimental obstetrics & gynecology Pub Date : 2022-02-08 DOI: 10.31083/j.ceog4902035

Agrimaldo Martins-Filho, M. P. Jammal, Eddie Fernando Cândido Murta, R. Nomelini

引用次数: 0

Low serum triiodothyronine and potassium levels are associated with increased risk of eclampsia among women in the Eastern Cape Province of South Africa 南非东开普省妇女血清三碘甲状腺原氨酸和钾水平低与子痫风险增加有关

IF 0.2 4区医学

Clinical and experimental obstetrics & gynecology Pub Date : 2022-01-26 DOI: 10.31083/j.ceog4902032

C. Businge, B. Longo-Mbenza, Andre Pascal Kengne

{"title":"Low serum triiodothyronine and potassium levels are associated with increased risk of eclampsia among women in the Eastern Cape Province of South Africa","authors":"C. Businge, B. Longo-Mbenza, Andre Pascal Kengne","doi":"10.31083/j.ceog4902032","DOIUrl":"https://doi.org/10.31083/j.ceog4902032","url":null,"abstract":"Background: There is paucity of data on the relationship between thyroid hormones, potassium and eclampsia. Moderate-to-severe iodine deficiency that worsens during pregnancy leads to decreased thyroid hormone output and bioavailability to the brain. Apart from metabolic functions, T3 and T4 are essential fast acting cytosolic and synaptosomal neural transmitters that also regulate neuronal excitatory-inhibitory mechanisms. T3 also regulates the Na + -K + -ATPase pump that maintains the membrane ionic gradient. Hence altered serum potassium, thyroxine and triiodothyronine levels could increase the risk of eclamptic seizures. Methods: Forty-five women with eclampsia, 45 severe preeclampsia and 90 normotensive pregnant controls were enrolled into this study. Levels of thyroid hormones, thyroglobulin and urine iodine concentration (UIC) were measured and compared between the three groups. Results: Eclamptic participants had significantly lower median serum potassium (K), triiodothyronine (FT3), urinary iodine concentration (UIC) but higher serum thyroglobulin (Tg) (K = 3.7 mmol/L; FT3 = 3.8 pmol/L; UIC = 69.5 μg/L; Tg = 39.0 μg/L) than normotensive pregnant controls (K = 4.3 mmol/L; T3 = 4.7 pmol/L; UIC = 169.5 μg/L; Tg = 19.5 μg/L) and participants with severe preeclampsia (K = 4.2 mmol/L; T3 = 4.4 pmol/L; UIC = 95.7 μg/L; Tg = 22.4 μg/L), p < 0.05. Low UIC, low serum T3 and potassium and elevated Tg were independent predictors of eclampsia. Conclusions: Women with iodine deficiency in pregnancy may be at increased risk of eclampsia secondary to the ensuing rapid peripheral turnover of thyroid hormones leading to hypothyroxinaemia and reduced triiodothyronine bioavailability to the central nervous system that can be exacerbated by hypokalaemia.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46009886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Coagulopathy complicating intraoperative blood salvage in patients receiving cesarean section: three case reports and a literature review 剖宫产患者术中凝血障碍并发血液抢救3例报告及文献复习

IF 0.2 4区医学

Clinical and experimental obstetrics & gynecology Pub Date : 2022-01-26 DOI: 10.31083/j.ceog4902033

Yang Zhang, Weiling Gu, Xi-rong Xiao

{"title":"Coagulopathy complicating intraoperative blood salvage in patients receiving cesarean section: three case reports and a literature review","authors":"Yang Zhang, Weiling Gu, Xi-rong Xiao","doi":"10.31083/j.ceog4902033","DOIUrl":"https://doi.org/10.31083/j.ceog4902033","url":null,"abstract":"Background: Intraoperative cell salvage (ICS) has been used in more than 1100 published obstetrics cases and can reduce the need for allogeneic transfusion effectively. However, ICS could lead to a life-threatening coagulopathy called salvaged blood syndrome (SBS). SBS was reported in several non-obstetric cases but has rarely been reported in obstetric patients. Cases: We reviewed all 841 cell savage cases that occurred in our hospital prior to October 2018. Here, we present 3 cases of coagulopathy in patients who received ICS after cesarean section. The rate of obstetrical SBS in our hospital was 0.46%. Dicussion: Cesarean section was performed without severe hemorrhage, and we performed the surgical hemostatic procedures as usual. Then, several hours after the surgery and after ICS, bleeding occurred, in which hypofibrinogenemia was more severe than expected based on the amount of postpartum hemorrhage. In addition, other marked changes in coagulation function-related parameters, including a decline in the platelet count and obvious prolongation of the PT and aPTT levels, were also observed. More specific and in-depth studies concerning obstetric SBS are needed.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45902882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Vaping in pregnancy: a geographically focused assessment of OBGYN provider knowledge regarding the safety and usage of electronic nicotine delivery systems 妊娠期吸食尼古丁：对妇产科医生关于电子尼古丁输送系统的安全性和使用知识的地理评估

IF 0.2 4区医学

Clinical and experimental obstetrics & gynecology Pub Date : 2022-01-26 DOI: 10.31083/j.ceog4902031

Madeleine Craig, A. Tamirisa, R. Madhavan, Ellen Jochum, Ariel Cohen, D. Zoorob

{"title":"Vaping in pregnancy: a geographically focused assessment of OBGYN provider knowledge regarding the safety and usage of electronic nicotine delivery systems","authors":"Madeleine Craig, A. Tamirisa, R. Madhavan, Ellen Jochum, Ariel Cohen, D. Zoorob","doi":"10.31083/j.ceog4902031","DOIUrl":"https://doi.org/10.31083/j.ceog4902031","url":null,"abstract":"Background: Electronic nicotine delivery systems (ENDS), or vaping, usage has become increasingly popular and generally has a positive perception by the public. However, ENDS are known to contain harmful chemicals and teratogens that induce numerous health consequences to both the pregnant mother and fetus. Despite this, physician knowledge and discussion of ENDS with their pregnant patients remains limited. Themain objective of this study was to assess the knowledge of Obstetrics and Gynecology (OBGYN) providers regarding the safety and usage of ENDS in pregnancy. A secondary objective was to understand providers’ practices to increase patient education and awareness of the effects of ENDS on pregnant women and developing fetuses. Methods: A 40-question online anonymous survey was developed for this study. The survey aimed at assessing OBGYN providers’ understanding of the usage of ENDS and potential harms. The questionnaire was distributed to OBGYN providers in the Midwest and South of the United States of America. Results: One Hundred and four respondents completed the survey (95% response rate). While 96% of providers investigated alcohol and tobacco use during prenatal visits, only 44% routinely inquired about ENDS use. Most providers noted that they had received no formal education about ENDS usage and 55% of providers reported an insufficient understanding of vaping. Conclusions: These results demonstrate that providers lack the education and knowledge about ENDS usage in pregnancy. This is concerning as ENDS usage is rapidly increasing in the United States of America. It is essential to develop educational resources for providers about the risks of vaping and incorporate questions ENDS usage into the social history, especially in pregnancy.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47615851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cervical balloon combined with oxytocin improves clinical efficacy and safety for induction of labor with scarred uterus 宫颈球囊联合催产素提高瘢痕子宫引产的临床疗效和安全性

IF 0.2 4区医学

Clinical and experimental obstetrics & gynecology Pub Date : 2022-01-20 DOI: 10.31083/j.ceog4901029

Dong-ha Ji, J. Ding, Xiaoqiong Li, Gang Li, D. Yin

{"title":"Cervical balloon combined with oxytocin improves clinical efficacy and safety for induction of labor with scarred uterus","authors":"Dong-ha Ji, J. Ding, Xiaoqiong Li, Gang Li, D. Yin","doi":"10.31083/j.ceog4901029","DOIUrl":"https://doi.org/10.31083/j.ceog4901029","url":null,"abstract":"Background: To evaluate cervical balloon combined with oxytocin improves clinical efficacy and safety for induction of labor with scarred uterus. Methods: The clinical data of pregnant women undergoing vaginal trial delivery after cesarean section in Huai’an Maternal and Child Health Hospital, from January 2020 to January 2021 were retrospectively analyzed. Among them, 80 pregnant women with scarred uterus who were induced by cervical balloon combined with oxytocin were considered as CBO group. 80 pregnant women with natural delivery scar uterus were considered as control, who were matched to CBO group for age, gestational age, and pre-pregnancy BMI. In CBO group, Bishop score before and after induction of labor was compared. Between the CBO and control groups, mode of delivery and duration of labor were analyzed, and maternal and infant outcomes were compared. Results: The overall effective rate of cervical maturation after labor induction was 88.8%, and the proportion of vaginal delivery in the CBO group were significantly higher than that in the control group. Besides, the induced labor time, first stage of labor time and the total stage of labor time in the CBO group were significantly shorter than those in the control group. There was no significant difference in maternal and infant outcomes between the two groups. Conclusion: Cervical balloon combined with oxytocin could significantly improve the clinical effect of parturients with scar uterine without increasing maternal and infant complications, which is a safe and effective strategy that can be applied in clinical practice.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49543631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Retained products of conception in placenta previa without placenta accreta spectrum: who requires transarterial embolization and/or hysterectomy? 无胎盘增生的前置胎盘保留妊娠产物:谁需要经动脉栓塞和/或子宫切除术?

IF 0.2 4区医学

Clinical and experimental obstetrics & gynecology Pub Date : 2022-01-20 DOI: 10.31083/j.ceog4901028

M. Ohashi, Hironori Takahashi, Y. Baba, Hirotada Suzuki, S. Nagayama, K. Horie, M. Ogoyama, R. Usui, A. Ohkuchi, S. Matsubara

{"title":"Retained products of conception in placenta previa without placenta accreta spectrum: who requires transarterial embolization and/or hysterectomy?","authors":"M. Ohashi, Hironori Takahashi, Y. Baba, Hirotada Suzuki, S. Nagayama, K. Horie, M. Ogoyama, R. Usui, A. Ohkuchi, S. Matsubara","doi":"10.31083/j.ceog4901028","DOIUrl":"https://doi.org/10.31083/j.ceog4901028","url":null,"abstract":"Background: To characterize patients with retained products of conception (RPOC) in placenta previa (PP), and to determine who requires transarterial embolization (TAE) and/or hysterectomy after cesarean section (CS). We focused on RPOC in PP without placenta accreta spectrum. Methods: The retrospective cohort study was performed in patients with RPOC in PP between April 2006 and June 2019 in our institute. Results: Of 498 patients with PP, RPOC were observed in 25. The median RPOC length was 4.4 cm (interquartile range: 2.8–5.7). RPOC hypervascularity was observed in 10 (10/18, 56%) patients. Of the 25 patients, an additional hemostatic intervention (TAE and/or hysterectomy) was required in 12 (48%). The duration between CS and TAE and/or hysterectomy ranged from 0–66 days. Of those, eight (8/12: 67%) patients needed the interventions on the day of surgery (day 0). Univariate analyses showed that patients having received TAE and/or hysterectomy bled more at CS (p = 0.011) and more frequently required blood transfusions at CS (p = 0.011), and were more likely to have hypervascular RPOC (p = 0.036). Conclusion: Hypervascular RPOC and bleeding episodes at CS may predict the requirement of TAE and/or hysterectomy after CS in patients with PP.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45979540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Concurrent hysterectomy and umbilical hernia repair via transvaginal notes among morbidly obese patients 病态肥胖患者经阴道同时行子宫切除术和脐疝修补术

IF 0.2 4区医学

Clinical and experimental obstetrics & gynecology Pub Date : 2022-01-20 DOI: 10.31083/j.ceog4901030

M. Altıntaş, Betul Kuru, H. Küçük, S. Kaya, E. Mat, Ayhan Cevik

{"title":"Concurrent hysterectomy and umbilical hernia repair via transvaginal notes among morbidly obese patients","authors":"M. Altıntaş, Betul Kuru, H. Küçük, S. Kaya, E. Mat, Ayhan Cevik","doi":"10.31083/j.ceog4901030","DOIUrl":"https://doi.org/10.31083/j.ceog4901030","url":null,"abstract":"Background: Umbilical hernias are especially common along with overweight, multiparous women. Laparoscopic hernia repair is preferred due to many advantages. On the other hand, the risk of trocar site hernia is disadvantageous. Trocars do not go through the abdominal wall via transvaginal natural orifice transluminal endoscopic surgery (V-NOTES). We investigate the V-NOTES hysterectomy and concomitant umbilical hernia repairment feasibility and outcomes. Methods: Six morbidly obese patients underwent V-NOTES hysterectomy and concurrent umbilical hernia repair between April 2020 and January 2021. Demographic features of patients, operating time, hernia size, complications, hospitalization time, recurrence of the hernia, visual analog scale (VAS) at 6th, 12th, and 24th hours, first, fourth, 12th weeks, and sixth months were recorded. Results: The average age of patients was 47.667 ± 2.422 (45–52). Mean body mass index (BMI), hernia and operating time size were 44.367 ± 3.217 kg/m (40.3–48.5), 6.167 ± 1.722 cm (4–9) and 88 ± 12.791 minutes (75–110), respectively. Intraoperative complications did not occur. Seroma was detected in one patient(16.6%). In six month follow-up period, we did not establish a diagnosis of hernia recurrence and postoperative chronic pain. Conclusion: Our study offers a novel perspective on V-NOTES umbilical hernia repair and hysterectomy in morbidly obese patients. According to our study, performing V-NOTES umbilical hernia repairment in a risky patient population is feasible and has promising outcomes.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44614914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1