American journal of epidemiology最新文献_第6页

SARS-CoV-2 incidence, seroprevalence, and antibody dynamics in a rural, population-based cohort: March 2020-July 2022. 2020 年 3 月至 2022 年 7 月农村人口队列中的 SARS-CoV-2 发病率、血清流行率和抗体动态。

IF 5 2区医学

American journal of epidemiology Pub Date : 2025-06-03 DOI: 10.1093/aje/kwae125

Joshua G Petrie, David Pattinson, Jennifer P King, Gabriele Neumann, Lizheng Guan, Peter Jester, Melissa A Rolfes, Jennifer K Meece, Burney A Kieke, Edward A Belongia, Yoshihiro Kawaoka, Huong Q Nguyen

{"title":"SARS-CoV-2 incidence, seroprevalence, and antibody dynamics in a rural, population-based cohort: March 2020-July 2022.","authors":"Joshua G Petrie, David Pattinson, Jennifer P King, Gabriele Neumann, Lizheng Guan, Peter Jester, Melissa A Rolfes, Jennifer K Meece, Burney A Kieke, Edward A Belongia, Yoshihiro Kawaoka, Huong Q Nguyen","doi":"10.1093/aje/kwae125","DOIUrl":"10.1093/aje/kwae125","url":null,"abstract":"Studies of SARS-CoV-2 incidence are important for response to continued transmission and future pandemics. We followed a rural community cohort with broad age representation with active surveillance for SARS-CoV-2 identification from November 2020 through July 2022. Participants provided serum specimens at regular intervals and after SARS-CoV-2 infection or vaccination. We estimated the incidence of SARS-CoV-2 infection identified by study reverse transcriptase-polymerase chain reaction, electronic health record documentation or self-report of a positive test, or serology. We also estimated the seroprevalence of SARS-CoV-2 spike and nucleocapsid antibodies measured by ELISA. Overall, 65% of the cohort had ≥ 1 SARS-CoV-2 infection by July 2022, and 19% of those with primary infection were reinfected. Infection and vaccination contributed to high seroprevalence: 98% (95% CI, 95-99) of participants were spike or nucleocapsid seropositive at the end of follow-up. Among those seropositive, 82% were vaccinated. Participants were more likely to be seropositive to spike than nucleocapsid after infection. Infection among seropositive individuals could be identified by increases in nucleocapsid, but not spike, ELISA optical density values. Nucleocapsid antibodies waned more quickly after infection than spike antibodies. High levels of SARS-CoV-2 population immunity, as found in this study, are leading to changing epidemiology necessitating ongoing surveillance and policy evaluation.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"1574-1583"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141417276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

A large study of metabolomics reveals common and distinct metabolic biomarkers for type 2 diabetes, coronary heart disease, and stroke. 一项大型代谢组学研究揭示了 2 型糖尿病、冠心病和中风的共同和独特的代谢生物标志物。

IF 5 2区医学

American journal of epidemiology Pub Date : 2025-06-03 DOI: 10.1093/aje/kwae167

Yanqiang Lu, Guochen Li, Vivian Viallon, Pietro Ferrari, Heinz Freisling, Yanan Qiao, Liping Shao, Luying Wu, Yi Ding, Chaofu Ke

{"title":"A large study of metabolomics reveals common and distinct metabolic biomarkers for type 2 diabetes, coronary heart disease, and stroke.","authors":"Yanqiang Lu, Guochen Li, Vivian Viallon, Pietro Ferrari, Heinz Freisling, Yanan Qiao, Liping Shao, Luying Wu, Yi Ding, Chaofu Ke","doi":"10.1093/aje/kwae167","DOIUrl":"10.1093/aje/kwae167","url":null,"abstract":"We aimed at examining the shared and unique associations of metabolites with multiple cardiometabolic diseases, including type 2 diabetes (T2D), coronary heart disease (CHD), and stroke. In this study, a total of 168 plasma metabolites were measured by high-throughput nuclear magnetic resonance spectroscopy among 98 162 participants free of T2D, CHD, and stroke at baseline. Cox proportional hazard models estimated hazard ratios for a 1-SD increase in metabolite concentration levels, and false discovery rate (at 10%) was used to correct for multiple comparisons. Over 12.1 years of follow-up on average, 3463 T2D, 6186 CHD, and 1892 stroke events were recorded. Most lipoprotein metabolites were associated with risks of T2D and CHD but not with the risk of stroke, with stronger associations for T2D than for CHD. Phospholipids within intermediate-density lipoprotein or large low-density lipoprotein particles showed positive associations with CHD and inverse associations with T2D. Metabolites indicating very small very low-density lipoprotein, histidine, creatinine, albumin, and glycoprotein acetyls were associated with risks of all 3 conditions. This large-scale metabolomics study revealed common and distinct metabolic biomarkers for T2D, CHD, and stroke, providing instrumental information to possibly implement precision medicine for preventing and treating these conditions.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"1650-1660"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141465443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Racial, ethnic, and sex differences in eating disorder onset among US military service members. 美国现役军人中饮食失调症发病的种族、民族和性别差异。

IF 5 2区医学

American journal of epidemiology Pub Date : 2025-06-03 DOI: 10.1093/aje/kwae207

Patrycja Klimek-Johnson, Isabel G Jacobson, Toni Rose Geronimo-Hara, Neika Sharifian, Hope S McMaster, Rudolph P Rull, Shira Maguen

{"title":"Racial, ethnic, and sex differences in eating disorder onset among US military service members.","authors":"Patrycja Klimek-Johnson, Isabel G Jacobson, Toni Rose Geronimo-Hara, Neika Sharifian, Hope S McMaster, Rudolph P Rull, Shira Maguen","doi":"10.1093/aje/kwae207","DOIUrl":"10.1093/aje/kwae207","url":null,"abstract":"Bulimia nervosa (BN) and binge eating disorder (BED) are the most prevalent eating disorders (EDs) among military personnel. Although sex differences are noted in ED prevalence in military and civilian samples, mixed findings have emerged when evaluating racial and ethnic differences. This study examined independent associations and interactions among sex, race, ethnicity, and probable BED and BN onset. The sample included 91 413 and 96 245 service members and veterans from the Millennium Cohort Study for BED and BN analyses, respectively. Up to 4 data points (2001-2013) were used to conduct longitudinal complementary log-log regression analyses, as participants were followed until the outcome occurred or until study completion. BN was more likely among women than men, and no sex difference emerged for BED onset. BN was more likely among Hispanic/Latinx, multiracial, Black, and Asian/Pacific Islander (API) service members, whereas BED was less likely among Black and API participants compared with non-Hispanic/Latinx White service members. Interactions revealed a greater likelihood of BN in Hispanic/Latinx service members was driven by men. Additional efforts are needed among racially and ethnically diverse groups to prevent and detect EDs in military personnel. Future intersectionality research could elucidate systemic inequities and other contributing factors to ED onset to inform prevention and treatment efforts.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"1642-1649"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141618998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Fitting a progressive 3-state colorectal cancer model to interval-censored surveillance data under outcome-dependent sampling using a weighted likelihood approach. 使用加权似然法将渐进式三态结直肠癌模型拟合到结果依赖性抽样下的区间删失监测数据中。

IF 5 2区医学

American journal of epidemiology Pub Date : 2025-06-03 DOI: 10.1093/aje/kwae307

Eddymurphy U Akwiwu, Thomas Klausch, Henriette C Jodal, Beatriz Carvalho, Magnus Løberg, Mette Kalager, Johannes Berkhof, Veerle M H Coupé

{"title":"Fitting a progressive 3-state colorectal cancer model to interval-censored surveillance data under outcome-dependent sampling using a weighted likelihood approach.","authors":"Eddymurphy U Akwiwu, Thomas Klausch, Henriette C Jodal, Beatriz Carvalho, Magnus Løberg, Mette Kalager, Johannes Berkhof, Veerle M H Coupé","doi":"10.1093/aje/kwae307","DOIUrl":"10.1093/aje/kwae307","url":null,"abstract":"To optimize colorectal cancer (CRC) surveillance, accurate information on the risk of developing CRC from premalignant lesions is essential. However, directly observing this risk is challenging since precursor lesions, that is, advanced adenomas (AAs), are removed upon detection. Statistical methods for multistate models can estimate risks, but estimation is challenging due to low CRC incidence. We propose an outcome-dependent sampling (ODS) design for this problem in which we oversample CRCs. More specifically, we propose a 3-state model for jointly estimating the time distributions from baseline colonoscopy to AA and from AA onset to CRC accounting for the ODS design using a weighted likelihood approach. We applied the methodology to a sample from a Norwegian adenoma cohort (1993-2007), comprising 1495 individuals (median follow-up $6.8$ years; IQR, 1.1-12.8) of whom 648 did and 847 did not develop CRC. We observed a 5-year AA risk of 13% and 34% for individuals having nonadvanced adenoma (NAA) and AA removed at baseline colonoscopy, respectively. Upon AA development, the subsequent risk to develop CRC in 5 years was 17% and age-dependent. These estimates provide a basis for optimizing surveillance intensity and determining the optimal trade-off between CRC prevention, costs, and use of colonoscopy resources.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"1764-1775"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Rejoinder to "'Harm' in personalized medicine-an alternative perspective". 对“个体化医疗的‘危害’——另一种观点”的反驳。

IF 5 2区医学

American journal of epidemiology Pub Date : 2025-06-03 DOI: 10.1093/aje/kwae366

Aaron L Sarvet, Mats J Stensrud

引用次数: 0

Adjusting mobile phone data to account for children's travel and the impact on measles dynamics in Zambia. 调整手机数据以考虑赞比亚儿童的出行情况及其对麻疹动态的影响。

IF 5 2区医学

American journal of epidemiology Pub Date : 2025-06-03 DOI: 10.1093/aje/kwae304

Natalya Kostandova, Christine Prosperi, Simon Mutembo, Chola Nakazwe, Harriet Namukoko, Bertha Nachinga, Gershom Chongwe, Innocent Chilumba, Elliot N Kabalo, Kabondo Makungo, Kalumbu H Matakala, Gloria Musukwa, Mutinta Hamahuwa, Webster Mufwambi, Japhet Matoba, Irene Mutale, Edgar Simulundu, Phillimon Ndubani, Alvira Z Hasan, Shaun A Truelove, Amy K Winter, Andrea C Carcelen, Bryan Lau, William J Moss, Amy Wesolowski

{"title":"Adjusting mobile phone data to account for children's travel and the impact on measles dynamics in Zambia.","authors":"Natalya Kostandova, Christine Prosperi, Simon Mutembo, Chola Nakazwe, Harriet Namukoko, Bertha Nachinga, Gershom Chongwe, Innocent Chilumba, Elliot N Kabalo, Kabondo Makungo, Kalumbu H Matakala, Gloria Musukwa, Mutinta Hamahuwa, Webster Mufwambi, Japhet Matoba, Irene Mutale, Edgar Simulundu, Phillimon Ndubani, Alvira Z Hasan, Shaun A Truelove, Amy K Winter, Andrea C Carcelen, Bryan Lau, William J Moss, Amy Wesolowski","doi":"10.1093/aje/kwae304","DOIUrl":"10.1093/aje/kwae304","url":null,"abstract":"Models of measles transmission can be used to identify areas of high risk to tailor immunization strategies. Estimates of spatial connectivity can be derived from data such as mobile phone records, but it is not clear how this maps to the movement of children who are more likely to be infected. Using travel surveys across 2 districts in Zambia and national mobile phone data, we compared estimates of out-of-district travel for the population captured in the mobile phone data and child-specific travel from travel surveys. We then evaluated the impact of unadjusted and adjusted connectivity measures on simulated measles virus introduction events across Zambia. The number of trips made by children from the travel survey was 3 to 5 times lower than the general population estimates from mobile phone data. This decreased the percentage of districts with measles virus introduction events from 78% when using unadjusted data to 51% to 64% following adjustment. Failure to account for age-specific heterogeneities in travel estimated from mobile phone data resulted in overestimating subnational areas at high risk of introduction events, which could divert mitigation efforts to districts that are at lower risk.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"1584-1594"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142078782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Determinants of nonphysical intimate partner violence: a cross-sectional study with nationally representative data from Canada. 亲密伴侣间非身体暴力的决定因素：利用加拿大具有全国代表性的数据进行的横断面研究。

IF 5 2区医学

American journal of epidemiology Pub Date : 2025-06-03 DOI: 10.1093/aje/kwae305

Margot Shields, Lil Tonmyr, Nathaniel Pollock, Andrea Gonzalez, Wendy Hovdestad, Masako Tanaka, Harriet MacMillan

{"title":"Determinants of nonphysical intimate partner violence: a cross-sectional study with nationally representative data from Canada.","authors":"Margot Shields, Lil Tonmyr, Nathaniel Pollock, Andrea Gonzalez, Wendy Hovdestad, Masako Tanaka, Harriet MacMillan","doi":"10.1093/aje/kwae305","DOIUrl":"10.1093/aje/kwae305","url":null,"abstract":"Based on a nationally representative survey of the Canadian population conducted in 2019/2020, this study examined the prevalence and determinants of nonphysical intimate partner violence (NP-IPV). NP-IPV was defined as experiences of emotional abuse, controlling behaviors, or economic abuse during the past 5 years. Women (17.3%) and men (16.9%) were equally likely to report NP-IPV, often without co-occurring physical/sexual IPV. For both genders, the risk of NP-IPV decreased with age and increased with financial strain and having a disability. Childhood maltreatment (sexual abuse, emotional abuse, and exposure to emotional IPV for women and sexual abuse and emotional abuse for men) was associated with an increased likelihood of reporting NP-IPV in adulthood. Other risk factors included heavy episodic drinking (self and/or spouse/partner) for women and living in a neighborhood with high levels of social disorder for men. Having confidence in the police was a protective factor for both genders. These associations generally persisted in regression analyses controlling for co-occurring physical/sexual IPV. Future research should focus on methods of preventing NP-IPV and the development of gender-specific interventions to reach and support those who experience NP-IPV. Furthermore, there is a need to improve and standardize measures of NP-IPV.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"1695-1708"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

A primer on neural networks. 神经网络入门》。

IF 5 2区医学

American journal of epidemiology Pub Date : 2025-06-03 DOI: 10.1093/aje/kwae380

Paul N Zivich, Ashley I Naimi

引用次数: 0

Mixture effects of prenatal exposure to polybrominated diphenyl ethers on urinary oxidative stress biomarkers in the Chemicals in Our Bodies cohort. 产前接触多溴联苯醚对 "我们体内的化学品 "队列中尿液氧化应激生物标志物的混合效应。

IF 5 2区医学

American journal of epidemiology Pub Date : 2025-06-03 DOI: 10.1093/aje/kwae113

Neha Sehgal, Rachel Morello-Frosch, Amy M Padula, Erin DeMicco, Yunzhu Wang, Sabrina Smith, June-Soo Park, Ginger L Milne, Tracey J Woodruff, Stephanie M Eick

{"title":"Mixture effects of prenatal exposure to polybrominated diphenyl ethers on urinary oxidative stress biomarkers in the Chemicals in Our Bodies cohort.","authors":"Neha Sehgal, Rachel Morello-Frosch, Amy M Padula, Erin DeMicco, Yunzhu Wang, Sabrina Smith, June-Soo Park, Ginger L Milne, Tracey J Woodruff, Stephanie M Eick","doi":"10.1093/aje/kwae113","DOIUrl":"10.1093/aje/kwae113","url":null,"abstract":"Polybrominated diphenyl ether (PBDE) exposure is associated with preterm birth. Laboratory studies suggest that PBDEs lead to elevated oxidative stress, a known contributor to preterm birth, according to epidemiologic studies. We hypothesized that elevated levels of PBDEs would be associated with increased oxidative stress during human pregnancy. Participants in this analysis were enrolled in the Chemicals in Our Bodies cohort and resided in the San Francisco Bay Area (n = 201). Four PBDEs (BDE-47, -99, -100, and -153) were measured in second-trimester serum samples. Urinary oxidative stress biomarkers were measured at 2 time points (second and third trimesters) and included 8-isoprostane-prostaglandin-F2α (8-iso-PGF2α), 2,3-dinor-5,6-dihydro-8-iso-PGF2α, 2,3-dinor-8-iso-PGF2α, and prostaglandin-F2α (PGF2α). Associations between individual PBDEs and oxidative stress biomarkers (averaged and trimester specific) were examined using linear regression. Quantile g-computation and Bayesian kernel machine regression (BKMR) were used to assess cumulative effects of PBDEs. Quantile g-computation showed that higher concentrations of PBDEs were associated with increasing 8-iso-PGF2α, 2,3-dinor-8-iso-PGF2α, and PGF2α. Associations were greatest in magnitude for second-trimester levels of 2,3-dinor-8-iso-PGF2α (mean change per quartile increase = 0.25, 95% CI, 0.09-0.41). Associations were similar using BKMR and linear regression. Our findings suggest oxidative stress may be a plausible biological pathway by which PBDE exposure might lead to preterm birth. This article is part of a Special Collection on Environmental Epidemiology.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"1507-1514"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Prevalence and risk factors for the development of bulimia nervosa and binge eating disorder in a large US military cohort. 大型美国军人队列中暴食症和暴饮暴食症的发病率和风险因素。

IF 5 2区医学

American journal of epidemiology Pub Date : 2025-06-03 DOI: 10.1093/aje/kwae204

Isabel G Jacobson, Toni Rose Geronimo-Hara, Neika Sharifian, Hope S McMaster, Haley Mehlman, Rudolph P Rull, Shira Maguen

{"title":"Prevalence and risk factors for the development of bulimia nervosa and binge eating disorder in a large US military cohort.","authors":"Isabel G Jacobson, Toni Rose Geronimo-Hara, Neika Sharifian, Hope S McMaster, Haley Mehlman, Rudolph P Rull, Shira Maguen","doi":"10.1093/aje/kwae204","DOIUrl":"10.1093/aje/kwae204","url":null,"abstract":"While bulimia nervosa (BN) and binge eating disorder (BED) are prevalent in military populations, an understanding of risk and protective factors is limited by a lack of longitudinal population-based epidemiologic research. This study examined the prevalence of BN and BED among active-duty service members and identified military and psychosocial factors associated with their development. Millennium Cohort Study participants were followed for up to 15 years, and prevalence was ascertained using survey and electronic medical record data. Longitudinal multivariable logistic regression models evaluated risk factors associated with the development of BN (n = 96 245) or BED (n = 113 733). Weighted prevalence estimates from survey data (range, 0.80%-4.80%) were higher than those from medical records (0.04%-0.14%). Military factors significantly associated with increased risk for BN and BED included active-duty component (vs. Reserve/Guard); serving in the Army, Marine Corps, or Navy/Coast Guard (vs. Air Force); and combat deployment (vs. deployment without combat). Associated psychosocial factors included lack of social support, experiencing at least one life stressor, and screening positive for posttraumatic stress disorder or problem drinking. Findings highlight the critical need for disordered eating screening and prevention efforts that bolster coping skills, which can ultimately improve service member functioning and readiness.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"1611-1620"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141726730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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