AANA journal最新文献_第5页

Exploring the Safety and Efficacy of Gabapentin Use In Perioperative Analgesia Protocols: An Integrative Review. 探讨加巴喷丁在围手术期镇痛方案中的安全性和有效性：一项综合综述。

AANA journal Pub Date : 2026-06-01 DOI: 10.70278/AANAJ/.0000001087

Kala Renard, Hsiang-Yuan Daphne Sung, Charles Griffis

{"title":"Exploring the Safety and Efficacy of Gabapentin Use In Perioperative Analgesia Protocols: An Integrative Review.","authors":"Kala Renard, Hsiang-Yuan Daphne Sung, Charles Griffis","doi":"10.70278/AANAJ/.0000001087","DOIUrl":"10.70278/AANAJ/.0000001087","url":null,"abstract":"Gabapentin is widely used in perioperative analgesic protocols. Many clinical studies supporting the safety and analgesic efficacy of gabapentin for postoperative pain have been published over the last two decades. Several studies, many recently, have questioned its effectiveness and safety for perioperative pain management in early recovery after surgery (ERAS) and non-ERAS protocols leading to the research question: Is the use of gabapentin in perioperative analgesic protocols efficacious and safe for all perioperative patients? An integrative review was performed to identify, analyze, and synthesize a carefully selected sample of the evidence surrounding the inclusion of gabapentin in perioperative pain management practice. Analysis of the literature showed that gabapentin was found to be effective and safe in multiple studies yet may not be an effective treatment to include in all opioid-free multimodal pain regimens for ERAS and non-ERAS surgical pathways. Instead, gabapentin appears safe and effective for some populations of surgical patients undergoing a variety of procedures, while for other populations the medication is less efficacious and potentially harmful because of its side effects, which include respiratory depression, ataxia, and sedation.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"94 3","pages":"210-216"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148051885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Resident Registered Nurse Anesthetists' Use of Cognitive Enhancers in the U.S. 美国住院注册护士麻醉师对认知增强剂的使用

AANA journal Pub Date : 2026-06-01 DOI: 10.70278/AANAJ/.0000001088

L Todd Hammon, Martha O Rojo, Leonie DeClerk, Jing Jin, Patricia Cowan, Tara Johnson

{"title":"Resident Registered Nurse Anesthetists' Use of Cognitive Enhancers in the U.S.","authors":"L Todd Hammon, Martha O Rojo, Leonie DeClerk, Jing Jin, Patricia Cowan, Tara Johnson","doi":"10.70278/AANAJ/.0000001088","DOIUrl":"10.70278/AANAJ/.0000001088","url":null,"abstract":"Graduate students, including medical students, use cognitive enhancer (CE) medications with or without legal prescription to aid academic performance despite little evidence that they improve performance in individuals without a medical diagnosis and subsequent prescription. However, there is limited information on CE medication use, with or without legal prescription, by resident registered nurse anesthetists (RRNAs). This cross-sectional survey assessed prevalence of CE medication use with or without legal prescription and its potential predictors (depression, anxiety, Attention Deficit Hyperactivity Disorder [ADHD] symptoms, and demographic variables) in 421 RRNAs. Descriptive and binary logistic regression analyses were conducted. The prevalence of CE use with or without prescription was 27.3%, with 93% obtained by prescription. The prevalence of clinically significant symptoms of ADHD (25.7%), depression (26.9%), and anxiety (23.1%) were assessed among RRNAs. No significant differences in age, gender, or program years were observed between CE medication users with or without legal prescription and CE non-users. However, white respondents were more likely to be CE medication users with or without legal prescription compared with respondents of other racial groups (P = .020). In the full logistic regression model, ADHD (aOR, 1.17; 95% CI, 1.10-1.24) was associated with increased odds of CE use. The Backward stepwise selection model retained ADHD and anxiety as significant predictors.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"94 3","pages":"217-224"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148051369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Substance Use Behaviors and Perceived Stress Among Resident Registered Nurse Anesthetists. 住院注册麻醉师护士的物质使用行为与感知压力。

AANA journal Pub Date : 2026-06-01 DOI: 10.70278/AANAJ/.0000001073

Daniel Jaworowski, Joey Klinowski, Marta Szulc, Meaghan Wakefield

{"title":"Substance Use Behaviors and Perceived Stress Among Resident Registered Nurse Anesthetists.","authors":"Daniel Jaworowski, Joey Klinowski, Marta Szulc, Meaghan Wakefield","doi":"10.70278/AANAJ/.0000001073","DOIUrl":"10.70278/AANAJ/.0000001073","url":null,"abstract":"One in four clinicians who seek treatment for substance use disorder are anesthesia providers. However, there is a dearth of research on substance use behaviors of doctoral resident registered nurse anesthetists (RRNA). The purpose of this study was to determine the prevalence and patterns of substance use and perceived stress levels among RRNAs. Anonymous surveys were distributed to RRNAs enrolled in doctoral programs in the United States. Respondents self-reported four substance use behaviors. Problematic substance use and perceived stress were self-reported using the Drug Abuse Screening Test (DAST-10) and the Perceived Stress Scale (PSS-10). Overall, 26.5% of respondents reported engaging in nonprescription substance use behaviors since enrollment. The prevalence of anesthetic agent use was 7.4%. Nine percent of respondents reported use of focus-enhancing drugs, 15% reported increased alcohol consumption, and 22% required a new prescription since enrollment. Mean PSS-10 scores were significantly higher in respondents who reported substance use behaviors (19.8 [SD, 6.5] vs 16.5 [SD, 6.3] P < 0.001). Predictive factors for substance use include enrollment period greater than 24 months, male gender, and elevated PSS-10 and DAST-10 scores.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"94 3","pages":"200-209"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148051483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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 Safety of a Ketamine Sedation Protocol In a Pediatric Oncology Population in Tanzania: A Quality Improvement Project. 评估氯胺酮镇静方案在坦桑尼亚儿科肿瘤人群中的安全性：一个质量改进项目。

AANA journal Pub Date : 2026-04-01 DOI: 10.70278/AANAJ/.0000001047

Heather Lenzmeier, Emily Funk, Kristin Schroeder, Brian Jones, Brett Morgan, Denise H Tola, Erick Moses Muyunga, Ally Munir Akrabi, Jane Blood-Siegfried, Benjamin Smallheer

{"title":"Evaluating the Safety of a Ketamine Sedation Protocol In a Pediatric Oncology Population in Tanzania: A Quality Improvement Project.","authors":"Heather Lenzmeier, Emily Funk, Kristin Schroeder, Brian Jones, Brett Morgan, Denise H Tola, Erick Moses Muyunga, Ally Munir Akrabi, Jane Blood-Siegfried, Benjamin Smallheer","doi":"10.70278/AANAJ/.0000001047","DOIUrl":"10.70278/AANAJ/.0000001047","url":null,"abstract":"This project aimed to reintroduce and evaluate a pediatric ketamine sedation protocol at a Zonal Referral Center in Mwanza, Tanzania, where nonanesthesia clinicians provide sedation when trained anesthesia personnel are unavailable. The objectives were to assess knowledge retention, confidence, and protocol compliance. The study design used a pre- and postintervention design. Nonanesthesia clinicians at a > 1,000-bed hospital were surveyed to assess their knowledge and confidence about ketamine sedation. Over 10 days, 50 clinicians received training that included lectures and cognitive aid resources in English and Swahili (the local language). Knowledge and confidence were measured using paired surveys. Clinicians were observed for compliance, skill demonstration, and feedback during postimplementation sedation encounters. Results showed significant improvements in knowledge (M = 6.93-8.77; P = .001) and confidence (M = 5.94-8.98; P = .001). Seven sedation encounters were observed over a 7-day period, and compliance with the presedation assessment was 100% for last food or drink intake, allergy history, and medication history. Reintroducing this protocol in a low-resource setting led to improvements in knowledge, confidence, and skills among nonanesthesia clinicians.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"94 2","pages":"107-114"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Editor's Desk: From Assignment to Publication: Transforming DNP/DNAP Projects into Scholarly Contributions. 编辑台：从任务到出版：将DNP/DNAP项目转化为学术贡献。

AANA journal Pub Date : 2026-04-01 DOI: 10.70278/AANAJ/.0000001089

Edwin N Aroke

引用次数: 0

AANA Journal Course-The Gut-Brain Axis and Chronic Pain: The Emerging Role of Microbiota. AANA期刊课程-肠-脑轴和慢性疼痛：微生物群的新作用。

AANA journal Pub Date : 2026-04-01 DOI: 10.70278/AANAJ/.0000001078

Jiale Hu, Rebekah Chung, Ryshona Odeneal, Sarah Jingying Zhang

{"title":"AANA Journal Course-The Gut-Brain Axis and Chronic Pain: The Emerging Role of Microbiota.","authors":"Jiale Hu, Rebekah Chung, Ryshona Odeneal, Sarah Jingying Zhang","doi":"10.70278/AANAJ/.0000001078","DOIUrl":"10.70278/AANAJ/.0000001078","url":null,"abstract":"Chronic pain is a complex and disabling condition that significantly impairs quality of life. It often arises from central sensitization, an amplified response to pain stimuli driven by neuroinflammatory changes in both the peripheral and central nervous systems. Emerging evidence highlights the gut microbiome's crucial role in the process because it modulates inflammation, immune function, and neurotransmitter production via the gut-brain axis. An imbalance in gut flora, known as dysbiosis, can exacerbate neuroinflammation by altering intestinal barrier integrity, facilitating the release of pro-inflammatory mediators, and activating microglia within the central nervous system. These changes contribute to increased pain sensitivity and the progression of chronic pain states. Consequently, strategies promoting a healthy gut microbiome, such as targeted dietary measures and microbiota-focused therapies, represent promising adjuncts to conventional chronic pain management. This journal course evaluates current research on the connection between the gut microbiome and chronic pain, offering a novel perspective on holistic, microbiome-centered interventions for alleviating pain disorders. As certified registered nurse anesthetists increasingly participate in pain management, understanding this emerging approach is vital for improving patient outcomes in chronic pain conditions.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"94 2","pages":"141-151"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Using a Nature-Based Mindfulness Intervention to Improve Mental Health in Nurse Anesthesia Students: A Pilot Study. 使用基于自然的正念干预来改善麻醉护士学生的心理健康：一项试点研究。

AANA journal Pub Date : 2026-04-01 DOI: 10.70278/AANAJ/.0000001058

Allan Lovern, May Watson, Alecia Hollis, Lindsay M Quinlan, Yuhua Su

{"title":"Using a Nature-Based Mindfulness Intervention to Improve Mental Health in Nurse Anesthesia Students: A Pilot Study.","authors":"Allan Lovern, May Watson, Alecia Hollis, Lindsay M Quinlan, Yuhua Su","doi":"10.70278/AANAJ/.0000001058","DOIUrl":"10.70278/AANAJ/.0000001058","url":null,"abstract":"Resident registered nurse anesthetists (RRNAs) face high levels of depression, anxiety, and stress (DAS) due to the academic, clinical, and financial demands of graduate anesthesia education. Nature-based mindfulness, which integrates nature exposure with mindfulness practices, has shown promise in reducing psychological distress but remains underexplored among RRNAs. This single-arm pilot, pre-/posttest study evaluated the effectiveness of a nature-based mindfulness intervention (NBMI) on DAS in a cohort of third-year RRNAs in the southeastern United States. The 8-week intervention included guided nature walks, box breathing exercises, and gratitude journaling. Depression, anxiety, and stress were measured pre- and postintervention using DASS-21. Focus groups explored participants' experiences postintervention. Quantitative analysis revealed a statistically significant reduction in anxiety levels (P = .039). Stress and depression scores decreased but did not reach statistical significance. Qualitative findings reflected improved mental clarity, emotional well-being, and peer connection. Findings suggest that NBMI is an effective, feasible, low-cost strategy to enhance well-being in RRNAs. Larger, randomized studies are warranted to examine the broader applicability of NBMI in nurse anesthesia education.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"94 2","pages":"133-138"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An Inclusive Approach to the Preanesthetic Interview: Consensus Development of the Perioperative Gender-Diverse Assessment Tool (PGDAT). 麻醉前访谈的包容性方法：围手术期性别多样化评估工具（PGDAT）的共识发展。

AANA journal Pub Date : 2026-04-01 DOI: 10.70278/AANAJ/.0000001075

Callie Dolan, Kelly Gallant, Maria van Pelt, Nelson Aquino

{"title":"An Inclusive Approach to the Preanesthetic Interview: Consensus Development of the Perioperative Gender-Diverse Assessment Tool (PGDAT).","authors":"Callie Dolan, Kelly Gallant, Maria van Pelt, Nelson Aquino","doi":"10.70278/AANAJ/.0000001075","DOIUrl":"10.70278/AANAJ/.0000001075","url":null,"abstract":"This study aimed to develop an evidence-based perioperative assessment tool for anesthesiology professionals to supplement standard preoperative assessments, targeting the unique health needs of transgender and gender-diverse (TGD) patients to enhance the perioperative experience. Many TGD patients express dissatisfaction with their care, while numerous healthcare professionals report feeling inadequately prepared to care for this population effectively. Using a modified Delphi design, a consensus-based Perioperative Gender-Diverse Assessment Tool (PGDAT) was developed to assist anesthesiology professionals in sensitively engaging with TGD patients and creating evidence-informed, patient-focused anesthetic plans. Fourteen expert panelists from the United States appraised the quality and clinical readiness of the PGDAT through iterative online surveys. Consensus was defined as 0.8 agreement among raters, and a thematic analysis was conducted following Braun and Clarke, with three core themes emerging. The interrater reliability was 0.75707 and 0.83977 using Gwet's AC2. The 0.8 consensus threshold was achieved after two survey rounds, which content-validated the PGDAT and established an evidence-based resource that future research opportunities can use to bring about systemic changes that promote safe and inclusive healthcare environments for all.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"94 2","pages":"123-131"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Estimating the Usefulness of Inferior Vena Cava Collapsibility Index as a Predictor for Post-Spinal Hypotension in Orthopedic Patients Undergoing Elective Surgery in a Tertiary Care Hospital. 估计下腔静脉坍缩指数作为三级医院骨科患者择期手术后脊柱低血压预测指标的有效性

AANA journal Pub Date : 2026-04-01 DOI: 10.70278/AANAJ/.0000001055

Sitara Raghavan Nandyal, Shweta Sinha, Arun Kumar Hd, Suvajit Podder, Deepali Shetty, Shaji Mathew

{"title":"Estimating the Usefulness of Inferior Vena Cava Collapsibility Index as a Predictor for Post-Spinal Hypotension in Orthopedic Patients Undergoing Elective Surgery in a Tertiary Care Hospital.","authors":"Sitara Raghavan Nandyal, Shweta Sinha, Arun Kumar Hd, Suvajit Podder, Deepali Shetty, Shaji Mathew","doi":"10.70278/AANAJ/.0000001055","DOIUrl":"10.70278/AANAJ/.0000001055","url":null,"abstract":"Subarachnoid block, colloquially referred to as spinal anesthesia, is a commonly employed method of anesthesia for most of the lower limb orthopedic procedures. Patients in preoperative hypovolemic states are more prone to post-spinal anesthesia hypotension (PSAH). Most orthopedic patients present in a preoperative fluid deficit state, thus, its recognition and appropriate correction are prudent. Ultrasonographic measurement of the inferior vena cava collapsibility index (IVCCI) is a tool to detect and correct hypotension secondary to hypovolemia. We hypothesized that pre-spinal IVCCI measurement is a reliable predictor of PSAH in patients undergoing elective lower limb orthopedic procedures. Ninety-nine participants, ASA grade I and II, aged 18-60 years, undergoing elective lower limb orthopedic surgeries were enrolled. Preoperative ultrasound inferior vena cava evaluation was performed and IVCCI was calculated. Preloading was done with intravenous crystalloid and subarachnoid block was administered in lateral position. Participants were placed supine and thereafter, level of sensory block was ascertained, and noninvasive blood pressure was measured every 2.5 min for 30 min. One hundred patients were screened and one was excluded due to failure of block. Mean IVCCI was 47.33 ± 9.62%. The receiver operating characteristic curve showed IVCCI has satisfactory predictive validity for predicting hypotension with AUC of 0.829 and P < 0.001. The sensitivity and specificity of IVCCI was found to be 87.36% and 83.3% at a cut-off value of 51.67%. Preoperative ultrasound evaluation of IVCCI is a reliable predictor for PSAH at a value of 51.67%.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"94 2","pages":"99-106"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Identifying Risk Factors and Creating a Point-Based Risk Calculator for Postoperative Pneumonia in Thoracic Surgery Patients. 胸外科患者术后肺炎的危险因素识别和建立基于点的风险计算器。

AANA journal Pub Date : 2026-04-01 DOI: 10.70278/AANAJ/.0000001053

Zachary Petterson, Sarah Cook, Hayden Johnston, Olivia Caldwell, Sadeeka Al-Majid, Cyril Rakovski, Mark H Gabot

{"title":"Identifying Risk Factors and Creating a Point-Based Risk Calculator for Postoperative Pneumonia in Thoracic Surgery Patients.","authors":"Zachary Petterson, Sarah Cook, Hayden Johnston, Olivia Caldwell, Sadeeka Al-Majid, Cyril Rakovski, Mark H Gabot","doi":"10.70278/AANAJ/.0000001053","DOIUrl":"10.70278/AANAJ/.0000001053","url":null,"abstract":"This secondary data analysis used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), logistic regression (Method 1), Xtreme Gradient Boosting (Method 2), and a 12-member expert panel (Method 3) to develop and validate a predictive model to identify patients undergoing thoracic surgery at risk for postoperative pneumonia (POP). Twenty-three covariates associated with POP were selected from the 2013-2022 ACS NSQIP dataset filtered for thoracic surgeries. Method 1 and Method 2 were assessed through area under the receiver operating characteristic curve (AUC ROC) using 10-fold cross-validation. Method 3 evaluated the 23 covariates for relevance to POP and relevant predictors were assessed through AUC ROC. Method 1 identified nine significant predictors (P < .05) with a 10-fold cross-validated AUC ROC = .72 (fair classifier). The significant preoperative predictors and their effect size were, sepsis (1.43), systemic inflammatory response syndrome (1.04), male gender (.77), bleeding disorder (.57), current smoker within 1 year (0.39), disseminated cancer (.39), hypoalbuminemia (.33), history of severe chronic obstructive pulmonary disease (.31), and anemia (.05). Method 2 achieved a 10-fold cross-validation AUC ROC = .75 (fair classifier). Method 3 had an AUC ROC = .6 (poor classifier). The nine significant predictors from Method 1 were used to develop a risk-based calculator.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"94 2","pages":"115-122"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0