Journal of Tropical Pediatrics最新文献_第2页

Role of interleukin-10 and interferon-β as predictive factors of severity in a paediatric population with dengue. 白细胞介素-10和干扰素-β作为登革热患儿严重程度预测因素的作用

IF 1.8 4区医学

Journal of Tropical Pediatrics Pub Date : 2025-02-05 DOI: 10.1093/tropej/fmaf014

Melissa Reyes, Oscar Patiño, Hernando Pinzón-Redondo, Carlos Moneriz

{"title":"Role of interleukin-10 and interferon-β as predictive factors of severity in a paediatric population with dengue.","authors":"Melissa Reyes, Oscar Patiño, Hernando Pinzón-Redondo, Carlos Moneriz","doi":"10.1093/tropej/fmaf014","DOIUrl":"10.1093/tropej/fmaf014","url":null,"abstract":"The febrile illness caused by dengue is a global public health problem whose incidence is increasing. This infection can range from mild fever to severe illness with plasma leakage and shock; therefore, biomarkers of severity are urgently needed to elucidate the pathological mechanism of the disease. To explore the levels of interleukin (IL)-10 and interferon (IFN)-β in children with dengue to identify these proteins as biomarkers of severity. This study compared the serum levels of IL-10 and IFN-β in 208 Colombian paediatric patients with different degrees of severity of dengue virus infection. A total of three study groups (dengue without warning signs, dengue with warning signs, and severe dengue) were designated according to the World Health Organization classification system. Serotype type 2 was the most prevalent type, and the most frequently reported symptom was vomiting, followed by abdominal pain. Platelet values, aspartate transaminase and alanine transaminase levels and clotting times were the most altered laboratory parameters among the study groups and were more pathological in patients with severe dengue. In addition, IL-10 levels were significantly higher in those with severe dengue than in those with milder forms of infection (P < .05), and IFN-β levels were much lower in the group of patients with severe dengue than in the group with dengue without warning signs (P < .05). These results demonstrate differences in immune responses to dengue infections and suggest several molecular targets for the future development of biomarkers that can serve as diagnostic and prognostic tools for the severity of dengue disease.","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"71 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586203","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

Measuring the time it takes to achieve full oral feeding can be used as a low-resource tool to assess neurologic recovery after perinatal asphyxia. 测量实现完全口服喂养所需的时间可作为评估围产期窒息后神经系统恢复的低资源工具。

IF 1.8 4区医学

Journal of Tropical Pediatrics Pub Date : 2025-02-05 DOI: 10.1093/tropej/fmaf012

Anna Tuiskula, Leena Haataja, Marjo Metsäranta

{"title":"Measuring the time it takes to achieve full oral feeding can be used as a low-resource tool to assess neurologic recovery after perinatal asphyxia.","authors":"Anna Tuiskula, Leena Haataja, Marjo Metsäranta","doi":"10.1093/tropej/fmaf012","DOIUrl":"10.1093/tropej/fmaf012","url":null,"abstract":"The aims of this prospective study were to describe feeding difficulties in term infants with perinatal asphyxia and to determine whether the time it takes to achieve full oral feeding correlates with early neurological outcome in a high-income setting. Recruitment included 52 term infants with perinatal asphyxia: 32 without hypoxic-ischaemic encephalopathy (HIE), 9 with mild HIE, and 11 with moderate HIE. The time in days it takes to achieve full oral independent feeding was used as a marker of feeding difficulty. Early neurological outcome was evaluated using neonatal brain magnetic resonance imaging (MRI) and Hammersmith Infant Neurological Examination (HINE) at 3 months. In this cohort, 85% of infants (44/52) needed short-term assisted feeding after birth. The time it takes to achieve full oral feeding correlated with neonatal brain MRI findings and structured neurological examination results at three months. The time it takes to achieve full oral feeding could be a useful clinical measure to assess neurologic recovery after perinatal asphyxia, especially in low-resource settings.","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"71 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of nutritional supplementation with lipid-based therapeutic food on body composition of non-severely malnourished African children aged 6-59 months hospitalized with severe pneumonia. 以脂质为基础的治疗性食物补充营养对6-59个月非严重营养不良非洲重症肺炎住院儿童身体成分的影响

IF 1.8 4区医学

Journal of Tropical Pediatrics Pub Date : 2025-02-05 DOI: 10.1093/tropej/fmaf010

Damalie Nalwanga, Victor Musiime, Sarah Kiguli, Peter Olupot-Olupot, Florence Alaroker, Robert Opoka, Abner Tagoola, Hellen Mnjala, Christabel Mogaka, Eva Nabawanuka, Elisa Giallongo, Charles Karamagi, André Briend, Kathryn Maitland

{"title":"Effect of nutritional supplementation with lipid-based therapeutic food on body composition of non-severely malnourished African children aged 6-59 months hospitalized with severe pneumonia.","authors":"Damalie Nalwanga, Victor Musiime, Sarah Kiguli, Peter Olupot-Olupot, Florence Alaroker, Robert Opoka, Abner Tagoola, Hellen Mnjala, Christabel Mogaka, Eva Nabawanuka, Elisa Giallongo, Charles Karamagi, André Briend, Kathryn Maitland","doi":"10.1093/tropej/fmaf010","DOIUrl":"10.1093/tropej/fmaf010","url":null,"abstract":"Pneumonia remains an important cause of morbidity and mortality among children in low- and middle-income countries. Poor outcomes are associated with undernutrition. Nutritional supplementation may be beneficial. We examined the effect of supplementation with lipid-based ready-to-use therapeutic food (RUTF) on the body composition of children with severe pneumonia. Non-severely malnourished children (6-59 months) with severe pneumonia enrolled into the Children's Oxygen Administration Strategies and Nutrition trial in Uganda and Kenya, and randomized to receive a diet supplemented with RUTF (500 Kcal/day) for 56 days versus usual diet alone (control) were included. We assessed arm anthropometry and bioimpedance analysis at admission and days 28, 90, and 180 of follow-up. We used mixed effects linear regression to compare body composition between groups. We included 737 participants (369 in intervention; 368 in control group). The median age was 16 months (IQR; 9, 26), and 58.1% were male. Overall, baseline mean arm fat area (AFA), arm muscle area, and arm muscle circumference were 5.8 ± 1.8 cm2, 11.6 ± 2.3 cm2, and 12.3 ± 1.2 cm2, respectively. The mean fat mass and fat-free mass calculated in 116 participants were 5.5 ± 1.5 kg and 5.5 ± 1.5 kg, respectively. There were modest increases in most body composition parameters. RUTF significantly increased AFA at days 28 and 90 but not at day 180 (P-value = .03, .02, and .99, respectively). RUTF did not change other body composition parameters. Despite initial increases in AFA, RUTF did not change the body composition of children with severe pneumonia.","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"71 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476798","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

Colistin-resistant Klebsiella pneumoniae sepsis in neonates and infants: an alarming crisis in an Indian NICU. 新生儿和婴儿中耐粘菌素肺炎克雷伯菌败血症：印度新生儿重症监护室的一个令人震惊的危机。

IF 1.8 4区医学

Journal of Tropical Pediatrics Pub Date : 2025-02-05 DOI: 10.1093/tropej/fmae044

Sushil Kumar, Akanksha Verma, Anita Singh, Kirti M Naranje, Richa Misra

{"title":"Colistin-resistant Klebsiella pneumoniae sepsis in neonates and infants: an alarming crisis in an Indian NICU.","authors":"Sushil Kumar, Akanksha Verma, Anita Singh, Kirti M Naranje, Richa Misra","doi":"10.1093/tropej/fmae044","DOIUrl":"10.1093/tropej/fmae044","url":null,"abstract":"Emergence of multidrug-resistant strain of Klebsiella pneumoniae has led to limited number of antimicrobial options for treatment. Even though outbreaks of colistin-carbapenem-resistant K. pneumoniae (CCRKp) are evolving, reported literature is scarce. This is a retrospective case series of three infants who acquired CCRKp sepsis during an outbreak in a Level III neonatal intensive care unit (NICU) of a tertiary care centre in Northern India. Data were retrieved from medical records of patients. Three babies developed new onset clinical worsening during an outbreak of sepsis. All had respiratory comorbidities and previous antibiotic exposure prior to isolation of CCRKp sepsis from blood. The organism was sensitive to combination of ceftazidime plus avibactam and tetracyclines in two infants; in one other newborn, no sensitive antibiotic was found. Two neonates deceased due to multiorgan dysfunction. An outbreak investigation revealed one common source of sterile water used in a humidifier. The outbreak was resolved by temporarily closing the NICU, segregating the infected infants and using corrective measures such as procuring a fresh batch of sterile water bottles, disinfecting the NICU, and reinforcing the use of antiseptic techniques. The emergence of CCRKp is alarming, particularly in low- and middle-income countries and tropical regions where such outbreaks are difficult to control due to limited healthcare infrastructure. These findings highlight the urgent need for stringent antimicrobial stewardship practices, enhanced infection control, and tailored interventions in resource-limited settings. It is also to be emphasized that the main mechanism of carbapenem resistance in Kp organisms in Asia seems to be different from the West and is mainly mediated by metallo-beta-lactamases and Class D carbapenemases.","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"71 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425418","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

Fluid restriction for term infants with hypoxic-ischemic encephalopathy following perinatal asphyxia-a randomized controlled trial. 围产期窒息后足月婴儿缺氧缺血性脑病的液体限制：一项随机对照试验

IF 1.8 4区医学

Journal of Tropical Pediatrics Pub Date : 2025-02-05 DOI: 10.1093/tropej/fmaf009

Anitha Ananthan, Haribalakrishna Balasubramanian, Ruchi Nanavati, Prashanth Raghavendra

{"title":"Fluid restriction for term infants with hypoxic-ischemic encephalopathy following perinatal asphyxia-a randomized controlled trial.","authors":"Anitha Ananthan, Haribalakrishna Balasubramanian, Ruchi Nanavati, Prashanth Raghavendra","doi":"10.1093/tropej/fmaf009","DOIUrl":"10.1093/tropej/fmaf009","url":null,"abstract":"Fluid management in the first postnatal week among infants with perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) is an important knowledge gap. We aimed to evaluate the effects of fluid restriction on short- and long-term outcomes in infants with HIE. Term infants with moderate or severe HIE on therapeutic hypothermia were randomized within 6 hours of age to receive either restricted intravenous maintenance fluids (45 ml/kg/day on day 1 to a maximum of 120 ml/kg/day on day 6) vs conventional fluid (60 ml/kg/day on day 1 to a maximum of 150 ml/kg/day on day 6). The primary outcome was a composite of mortality or neurological abnormality at hospital discharge. We studied neurodevelopmental disability at 18-24 months using Bayley Scales of Infant Development, third edition. A total of 210 infants were randomized. Three infants died during the hospital stay. The primary outcome of mortality or neurological abnormality at discharge was not significantly different between the restricted and the conventional fluid group [57% vs 53%, RR: 1.07 (95% CI: 0.83, 1.37), P-value .58]. The incidence of cranial magnetic resonance imaging abnormalities was similar in the groups (65% vs 71%, P-value .30). There were no differences in the rates of severe neurodevelopmental disability at 18-24 months in the two groups [27% vs 28%, RR: 0.96 (95% CI: 0.62, 1.50), P-value .88]. Adverse outcomes were similar in both groups. Fluid restriction in the first postnatal week of life did not improve short- and long-term neurodevelopmental outcomes in term infants with moderate or severe HIE.","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"71 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476799","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

Scrub typhus masquerading as other conditions among the pediatric population in India: a case series. 在印度儿科人群中伪装成其他疾病的恙虫病：一个病例系列。

IF 1.8 4区医学

Journal of Tropical Pediatrics Pub Date : 2025-02-05 DOI: 10.1093/tropej/fmaf011

Deblina Patra, Ritajyoti Ghosh, Sumanta Laha, Aizuddin Sk, Sarbik Sarkar, Aditya Kayal, Tarak Nath Ghosh

引用次数: 0

Continuous positive airway pressure versus conventional oxygen therapy in meconium aspiration syndrome: a randomized controlled trial. 持续气道正压与传统氧疗治疗胎粪吸入综合征：一项随机对照试验。

IF 1.8 4区医学

Journal of Tropical Pediatrics Pub Date : 2025-02-05 DOI: 10.1093/tropej/fmaf002

Arifa Mustaqeem, Anita Yadav, Jogender Kumar, Pradeep Debata

引用次数: 0

Health-care providers' knowledge and quality of neonatal care in the first 2 h of life in a district hospital on Pemba Island, Tanzania: a prospective cohort study. 坦桑尼亚奔巴岛一家地区医院保健提供者在生命最初2小时的新生儿护理知识和质量：一项前瞻性队列研究。

IF 1.8 4区医学

Journal of Tropical Pediatrics Pub Date : 2025-02-05 DOI: 10.1093/tropej/fmaf018

Mathilde Languille Lassen, Lærke Vinge Larsen, Said Mzee, Said Mouhammed Ali, Ulrikka Nygaard, Anja Poulsen, Stine Lund

{"title":"Health-care providers' knowledge and quality of neonatal care in the first 2 h of life in a district hospital on Pemba Island, Tanzania: a prospective cohort study.","authors":"Mathilde Languille Lassen, Lærke Vinge Larsen, Said Mzee, Said Mouhammed Ali, Ulrikka Nygaard, Anja Poulsen, Stine Lund","doi":"10.1093/tropej/fmaf018","DOIUrl":"10.1093/tropej/fmaf018","url":null,"abstract":"To assess the knowledge of health workers on neonatal management, describe neonatal care in the first 2 h of life, and health outcomes of neonates in Tanzania. A prospective cohort study was performed from January to April 2022 at a district hospital on Pemba Island, Tanzania. Women admitted in active labor, and their neonates were eligible for inclusion. Standardized observations in the first 2 h after birth, followed by a clinical examination, and interviews on days 7 and 28 were performed. Health workers were given multiple-choice questions on neonatal management. Immediate skin-to-skin care was performed in 23% of neonates and breastfeeding was initiated during the first hour of life in 46%. At 2 h of life, 10% had blood glucose <2.5 mmol/L (mean: 3.71, SD 1.1), 44.6% had hypothermia with temperature <36.5°C (mean: 36.5, SD 0.5), and 2% low saturation <90%. Health workers had on average 42% correct answers on \"neonatal management\". The neonatal mortality rate (NMR) corresponds to 23 per 1000 livebirths. Considerable challenges in neonatal care were identified, including low-cost, high-impact interventions such as skin-to-skin care and immediate breastfeeding. The NMR was above the Sustainable Development Goal target. Further research is needed to assess the impact of training on neonatal care and outcomes in this and similar settings.","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"71 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753458","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

Congenital syphilis: epidemiological profile of Brazilian regions in the last decade. 先天性梅毒：近十年来巴西地区的流行病学概况。

IF 1.8 4区医学

Journal of Tropical Pediatrics Pub Date : 2025-02-05 DOI: 10.1093/tropej/fmaf003

Maria Eugênia Costa Casagrande, Anderson Soares da Silva, Altacílio Aparecido Nunes

{"title":"Congenital syphilis: epidemiological profile of Brazilian regions in the last decade.","authors":"Maria Eugênia Costa Casagrande, Anderson Soares da Silva, Altacílio Aparecido Nunes","doi":"10.1093/tropej/fmaf003","DOIUrl":"10.1093/tropej/fmaf003","url":null,"abstract":"Congenital syphilis (CS) is transmitted to the fetus through the transplacental route at any stage of gestation when the pregnant women are either untreated or inadequately treated. In this study, we aimed to analyze trends in epidemiological indicators of CS in Brazil. This is a cross-sectional study utilizing data on CS across Brazilian regions from 1 January 2012 to 31 December 2021. Epidemiological indicators such as incidence, prevalence, and case-fatality rates were calculated. During the evaluated period, 192 055 CS cases were recorded in Brazil. Among pregnant women who underwent prenatal care, 58.5% were diagnosed during pregnancy, 33.9% at the time of birth, and 7.5% after birth. In 77.5% of the notifications, the partners were not treated. The average number of cases diagnosed during prenatal care was 5.6 times higher than those not reported. The Southeast region presented the highest incidence rate per 1000 live births, whereas the Midwest region had the lowest incidence. Despite an increase in rates across all regions and Brazil overall, there was no significant difference (P-value > .05) between the means for the two evaluated periods. However, there was a significant decrease (P-value < .05) in the case-fatality rate in the Northeast (1.9%-1.25%) and South (2.15%-0.92%) regions, as well as throughout Brazil (from 1.77% to 1.24%). The findings indicate that the incidence rates of CS continue to rise, suggesting that the disease remains a significant public health issue in Brazil. Effective preventive measures are urgently required.","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"71 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476796","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

Evaluating the efficacy of very high-dose oral prednisolone in West syndrome: in Uttar Pradesh, India, a resource-limited setting. 评估非常大剂量口服强的松龙治疗West综合征的疗效：在资源有限的印度北方邦。

IF 1.8 4区医学

Journal of Tropical Pediatrics Pub Date : 2025-02-05 DOI: 10.1093/tropej/fmaf005

Chandra Prabha, Chandra Kanta, Arpita Bhriguvanshi, Sanjeev Kumar Verma

{"title":"Evaluating the efficacy of very high-dose oral prednisolone in West syndrome: in Uttar Pradesh, India, a resource-limited setting.","authors":"Chandra Prabha, Chandra Kanta, Arpita Bhriguvanshi, Sanjeev Kumar Verma","doi":"10.1093/tropej/fmaf005","DOIUrl":"10.1093/tropej/fmaf005","url":null,"abstract":"Managing West syndrome (WS) becomes arduous in regions where access to adrenocorticotropic hormone and vigabatrin is limited, particularly in developing nations. This study aimed to evaluate the efficacy of very high-dose oral prednisolone in children diagnosed with WS. Children aged 2-36 months presenting with WS were consecutively enrolled and given oral prednisolone @ 8 mg/kg/day (maximum 40 mg) for two weeks followed by tapering doses over the subsequent two weeks. Weekly follow-ups were conducted until therapy completion, followed by bi-weekly assessments for three months. Responses (primary outcome) were assessed at two weeks and categorized as complete (spasm-free), partial (>25% reduction), or no response (<25% reduction). Neurodevelopmental outcomes, clinical-radiological profiles, safety, and therapy response predictors were also assessed. Of the 80 children, 73.7% exhibited a complete response, while 21.2% and 5% showed partial and no response, respectively. The mean age at spasm onset and presentation was 4.98 ± 4.37 months and 14.36 ± 7.13 months, respectively. Perinatal brain injury accounted for 87.5% of WS cases. Adverse effects, including weight gain (8.7%), irritability, hypertension, and disturbed sleep (3.7% each), were noted. Spasm cessation at 2 weeks, appropriate gestational age, and the absence of other seizure types were predictive of a favorable response. High-dose oral prednisolone emerges as an effective, low-cost, and safer first-line treatment option with minimal adverse effects in the Uttar Pradesh region in India, and this would likely be true in other resource-limited settings.","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"71 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425511","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