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New Algorithm of Stress Echocardiography with Adenosine Triphosphate 三磷酸腺苷应激超声心动图新算法
Pub Date : 2020-11-17 DOI: 10.20862/0042-4676-2020-101-5-288-295
N. Nelassov, M. Morgunov, R. Sidorov, N. Doltmurzieva, O. Eroshenko, E. Arzumanjan, E. Kreneva, S. Shlyk
Objective. Submaximal myocardial hyperemia is known not to be achieved in 16–18% of cases during cardiac stress tests and monotonic intracubital administration of adenosine triphosphate (ATP) at a dose of 140–160 μg/kg/min. The authors set a task to elaborate a new algorithm for stress echocardiography (SEchoCG) with ATP, providing for the possibility of a stepwise increase in the dosage of the drug, as well as to test it in healthy individuals and patients with coronary heart disease (CHD). Material and methods. The authors elaborated a new algorithm for SEchoCG on the basis of an analysis of the main science databases and their first own experience in using ATP during SEchoCG. The key provisions of the new algorithm were: (a) the exercise test consisted of 3 stages (EchoCG data should be recorded before, during, and 5 minutes after ATP infusion); (b) the criterion for achieving submaximal myocardial hyperemia during ATP administration is a systolic blood pressure (SBP) reduction of 5 and more mm Hg; (c) EchoCG was usually recorded at Stage 2 of the test 3 minutes after the start of ATP administration and with a decline in SBP; (d) the initial dose of ATP administration was 140 μg/kg/min; if SBP did not decrease at 3 minutes of the drug administration, the dosage should be first increased up to 175 μg/kg/ min at 1 minute; if there was no effect, the dosage should be increased up to 210 μg/kg/min at another 2–3 minutes. The algorithm was tested in 9 healthy volunteers, and in 26 patients with CHD. Results. Testing the new algorithm showed that all cases achieved submaximal myocardial hyperemia. SBP decreased below 90 mm Hg in 2 patients; 1 patient developed second-degree atrioventricular block; however, a simple decrease in the ATP infusion rate within 30 sec leveled this symptomatology. The SEchoCG data acceptable for the subsequent analysis of myocardial contractility and deformation could be recorded in all the examinees. Conclusion. The new algorithm for SEchoCG with ATP is effective in recording EchoCG findings. To have a final decision on the safety and information value of a new stress test protocol, it may be recommended to further test those in larger groups of patients during SEchoCG and in the use of other imaging procedures to assess myocardial contractility and perfusion.
目标。已知16-18%的病例在心脏负荷试验和按140-160 μg/kg/min剂量的三磷酸腺苷(ATP)单压皮下给药时未出现亚极大心肌充血。作者设定了一项任务,为ATP应激超声心动图(SEchoCG)设计一种新的算法,提供逐步增加药物剂量的可能性,并在健康个体和冠心病(CHD)患者中进行测试。材料和方法。作者在分析了主要科学数据库的基础上,结合自己在SEchoCG中首次使用ATP的经验,阐述了一种新的SEchoCG算法。新算法的关键规定是:(a)运动试验分为3个阶段(在ATP输注前、输注中、输注后5分钟分别记录EchoCG数据);(b)在ATP给药期间实现亚极大心肌充血的标准是收缩压(SBP)降低5毫米汞柱及以上;(c)超声心动图通常在试验第2阶段开始给ATP后3分钟记录,收缩压下降;(d)初始给药剂量为140 μg/kg/min;如给药3分钟收缩压未下降,应先在给药1分钟时增加剂量至175 μg/kg/ min;如无效果,再隔2 ~ 3分钟将剂量增加至210 μg/kg/min。该算法在9名健康志愿者和26名冠心病患者中进行了测试。结果。对新算法的测试表明,所有病例都达到了次极大心肌充血。2例患者收缩压降至90 mm Hg以下;1例发生二度房室传导阻滞;然而,在30秒内ATP输注速率的简单降低使这种症状趋于平缓。所有受测者均可记录可用于后续心肌收缩性和变形分析的SEchoCG数据。结论。该算法能有效地记录超声心动图。为了最终确定新的压力测试方案的安全性和信息价值,可能建议在更大的患者群体中进行进一步的测试,并使用其他成像程序来评估心肌收缩性和灌注。
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引用次数: 0
Successful Endovascular Treatment for Recanalized Post-Traumatic Carotid-Cavernous Fistula 创伤后颈海绵状瘘再通的成功血管内治疗
Pub Date : 2020-11-17 DOI: 10.20862/0042-4676-2020-101-5-313-318
A. Sufianov, S. M. Karasev, R. Khafizov, R. R. Rustamov, R. Sufianov, T. Khafizov
Carotid-cavernous fistulas (CCFs) are spontaneous or acquired communications between the internal carotid artery (ICA) and the cavernous sinus, which can be classified as direct or indirect. Direct fistulas between the ICA and the cavernous sinus can arise from injury, rupture of intracavernous carotid aneurysm, collagen deficiency syndrome, artery dissection, fibromuscular dysplasia, and direct surgical trauma. The symptoms caused by CCF are related to their size, duration, location, the direction of venous outflow, and the presence of arterial and venous collaterals. The goal of treatment for direct CCFs is to close the defect between the ICA and the cavernous sinus while maintaining the patency of the ICA. This goal can be achieved either by transarterial fistula occlusion using a removable balloon, transarterial or transvenous occlusion of the ipsilateral cavernous sinus with coils or other embolic material, or by implanting a covered stent in the fistula area. The choice of a method for CCF treatment remains relevant. The paper describes a clinical case of successful endovascular treatment for post-traumatic recanalized CCF in a patient with obvious ophthalmic manifestations as pulsating exophthalmos, conjunctival chemosis, and ischemic optic neuropathy of the right eye. Previously, the patient had undergone endovascular CCF embolization with coils and ICA reconstruction with flow diverting stents. Fistula embolization was performed with coils via transvenous access. In the opinion of the authors, the use of venous access in this case allowed them to perform total occlusion of the recanalized fistula and to achieve good angiographic and clinical results in the long-term period.
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引用次数: 0
Criteria for Responses of Renal Cancer Metastases to Targeted and Immunotherapy 肾癌转移对靶向和免疫治疗反应的标准
Pub Date : 2020-09-05 DOI: 10.20862/0042-4676-2020-101-4-206-213
V. Blinov, A. S. Blinova, V. Petkau, S. Demidov
Objective: to compare the criteria for tumor response to targeted therapy and immunotherapy for metastatic kidney cancer. Subjects and methods. The paper presents the results of diagnosis and treatment in 20 patients with metastatic renal cell carcinoma. Of these, 10 patients took interferon- α as immunotherapy, 10 patients received sorafenib as targeted therapy. The response of targeted foci was assessed using computed tomography according to the RECIST 1.1, Choi, mChoi, and SACT criteria. Control CTs were performed every 3 months until the disease progressed. The progression-free time was calculated using the Kaplan-Meier method. Results. The investigation revealed the coincidence according to the RECIST 1.1, Choi, mChoi and SACT criteria in terms of progression in all assessed cases; that according to the partial response criterion in 50% of cases, and that according to the stability criterion in 8.7%. Other cases displayed a discrepancy in the interpretation of the results. The progression-free time for patients receiving immunotherapy according to the RECIST 1.1 criteria, the Choi and mChoi criteria, and the SACT criteria was 6.3 ± 0.7, 4.3 ± 0.6, and 4.5 ± 0.7 months, respectively. The progression-free time for patients receiving targeted therapy according to the above criteria was 10.3 ± 1.2, 6.4 ± 1.2, and 6.7 ± 1.3 months. Conclusion. Tumor response to therapy is critical in evaluating the efficiency of anticancer treatment. Targeted and immunological drugs cause not only a tumor size change, but also necrosis and cystic degeneration. The criteria based not only on changes in size, but also on those in the density of tumor foci have a shorter progression-free time and make it possible to identify patients with disease progression at an earlier date.
目的:比较转移性肾癌靶向治疗与免疫治疗的肿瘤反应标准。研究对象和方法。本文报告20例转移性肾细胞癌的诊断和治疗结果。其中10例患者采用干扰素- α作为免疫治疗,10例患者采用索拉非尼作为靶向治疗。根据RECIST 1.1、Choi、mChoi和SACT标准,使用计算机断层扫描评估靶向病灶的反应。对照ct每3个月进行一次,直到疾病进展。采用Kaplan-Meier法计算无进度时间。结果。调查显示,在所有评估病例的进展方面,符合RECIST 1.1、Choi、mChoi和SACT标准;50%的病例符合部分反应标准,8.7%的病例符合稳定性标准。其他案例对结果的解释存在差异。根据RECIST 1.1标准、Choi和mChoi标准以及SACT标准接受免疫治疗的患者无进展时间分别为6.3±0.7个月、4.3±0.6个月和4.5±0.7个月。根据上述标准接受靶向治疗的患者无进展时间分别为10.3±1.2个月、6.4±1.2个月和6.7±1.3个月。结论。肿瘤对治疗的反应是评估抗癌治疗效果的关键。靶向和免疫药物不仅引起肿瘤大小的改变,而且引起坏死和囊性变性。该标准不仅基于肿瘤大小的变化,而且还基于肿瘤病灶密度的变化,具有较短的无进展时间,并且可以在较早的日期识别疾病进展的患者。
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引用次数: 1
The Role of Radionuclide Diagnostic Methods in Neuro-Oncology 放射性核素诊断方法在神经肿瘤学中的作用
Pub Date : 2020-09-05 DOI: 10.20862/0042-4676-2020-101-4-221-234
T. Skvortsova, Natalie Judov, Mikhail Plotkin, G. Stoffels, N. Galldiks, R. Krasikova, K. Langen
In recent years, positron emission tomography (PET) with amino acid radiopharmaceuticals has assumed increasing importance in the diagnosis of brain tumors and it has already become an additional method of examination along with magnetic resonance imaging (MRI) in many diagnostic centers. The markers of somatostatin receptors seem to be most promising for the PET diagnosis of meningiomas. PET provides important additional information in the diagnosis of brain changes of unknown origin and more accurate information about tumor boundaries, which is necessary for biopsy, neurosurgery, and radiation therapy. In addition, labeled amino acid PET aids in the assessment of disease prognosis, in the differentiation of continued tumor growth from nonspecific therapeutic pathomorphism of the brain, and in the evaluation of treatment efficiency at an earlier time than is possible with MRI.
近年来,氨基酸放射性药物正电子发射断层扫描(PET)在脑肿瘤的诊断中发挥着越来越重要的作用,在许多诊断中心已经成为与磁共振成像(MRI)相结合的一种新的检查方法。生长抑素受体的标记物似乎最有希望用于脑膜瘤的PET诊断。PET为未知来源的脑病变的诊断提供了重要的附加信息,并为肿瘤边界提供了更准确的信息,这是活检、神经外科和放射治疗所必需的。此外,标记氨基酸PET有助于评估疾病预后,区分持续肿瘤生长与非特异性脑治疗病理形态,并在比MRI更早的时间评估治疗效果。
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引用次数: 0
Wide-Detector Computed Tomography for Evaluating the Effectiveness of Microsurgical Autotransplantation of Tissue Complexes in the Urogenital Region 宽检测器计算机断层扫描评价显微外科自体移植在泌尿生殖区组织复合体的有效性
Pub Date : 2020-09-05 DOI: 10.20862/0042-4676-2020-101-4-198-205
I. O. Shchekoturov, R. Bakhtiozin, A. L. Istranov, N. Serova, O. A. Mkhitaryan, M. R. Ibregimova
Objective: to demonstrate the possibilities and advantages of wide-detector computed tomography for performing dynamic studies and evaluating the effectiveness of microsurgical autotransplantation of tissue complexes in the urogenital region, by using a perfusion computed tomography and dynamic voiding computed cystourethrography. Subjects and methods. This investigation enrolled 36 patients with different urogenital diseases, who were examined using a wide-detector computed tomographic scanner and the procedures of dynamic perfusion computed tomography and dynamic voiding computed cystourethrography. Results. Perfusion examination revealed that none of the patients had hypoperfused areas of autografts, which suggests their good engraftment. Dynamic voiding computed cystourethrography estimated the width of the urethral lumen in all segments and identified the regions of its greatest narrowing and their extension. Computed uroflowmetry was scheduled for all patients. Conclusion. The advantages of wide-detector systems with their unique properties made it possible to apply them in the new area – in planning and evaluating the effectiveness of the microsurgical reconstruction of the urogenital region, by obtaining additional, previously unavailable diagnostic information.
目的:通过灌注计算机断层扫描和动态排尿计算机膀胱尿道造影,展示宽检测器计算机断层扫描在进行动态研究和评估显微外科自体移植在泌尿生殖区组织复合物的有效性方面的可能性和优势。研究对象和方法。本研究纳入了36例患有不同泌尿生殖系统疾病的患者,他们使用宽探测器计算机断层扫描仪和动态灌注计算机断层扫描和动态排尿计算机膀胱尿道造影检查。结果。灌注检查显示无一例自体移植物灌注不足,提示移植物植入良好。动态排尿计算机膀胱尿道造影术估计尿道各节段的管腔宽度,并确定其最大变窄的区域及其延伸。所有患者均计划行计算机尿流仪检查。结论。宽探测器系统的优势及其独特的特性使其有可能应用于新的领域-在计划和评估泌尿生殖区域显微外科重建的有效性,通过获得额外的,以前无法获得的诊断信息。
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引用次数: 0
К вопросу о стандартизации МРТ-исследований с использованием автоматического инъектора для введения магнитно-резонансных контрастных средств 对于核磁共振研究的标准化问题,使用自动注射器引入磁共振对比工具
Pub Date : 2020-09-05 DOI: 10.20862/0042-4676-2020-101-4-235-243
Василий Александрович Фокин
The reproducibility of the conditions used during scanning, especially in MRI, is one of the important tasks in radiodiagnosis to obtain standardized data and to correctly assess them over time in the same patient. The important aspect is to use an automatic magnetic resonance contrast agent injector. The paper considers the aspects of obtaining standardized results using the automatic injector during standard contrast enhancement, by applying subtraction, dynamic contrast enhancement, magnetic resonance angiography, and magnetic resonance perfusion.
扫描过程中使用的条件的再现性,特别是在MRI中,是放射诊断中获得标准化数据并正确评估同一患者随时间变化的重要任务之一。重要的方面是使用自动磁共振造影剂注入器。本文考虑了在标准对比增强过程中使用自动注射器获得标准化结果的几个方面,包括应用减法、动态对比增强、磁共振血管造影和磁共振灌注。
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引用次数: 0
Grayscale Color Mapping with the Mathematical Analysis of an Ultrasound Image in the Differential Diagnosis of Cystic and Solid Breast Masses 灰度彩色成像与超声图像数学分析在乳腺囊性肿块和实体肿块鉴别诊断中的应用
Pub Date : 2020-06-30 DOI: 10.20862/0042-4676-2020-101-3-136-146
D. Pasynkov, I. Egoshin, A. Kolchev, I. V. Klyushkin, O. Pasynkova
Objective. Atypical breast cysts are often quite a serious problem in noninvasive ultrasound differential diagnosis. To develop a system for automated analysis of grayscale ultrasound images, which on the principles of mathematical processing would make it possible to increase the specificity of diagnosis in this situation.Material and methods. The authors developed the CystChecker 1.0 software package. To test this system, they used a set of 217 ultrasound images: 107 cystic (including 53 atypical lesions that were hardly differentially diagnosed by standard methods) and 110 solid (both benign and malignant) breast masses. All the masses were verified by cytology and/or histology. Visual assessment was carried out analyzing grayscale ultrasound, color/power Doppler, and elastography images.Results. Using the system developed by the authors could correctly identify all (n = 107 (100%)) typical cysts, 107 (97.3%) of 110 solid masses, and 50 (94.3%) of 53 atypical cysts. On the contrary, the standard visual assessment provided a possibility of correctly identifying all (n = 107 (100%)) typical cysts, 96 (87.3%) of 110 solid masses, and 32 (60.4%) of 53 atypical cysts (p < 0.05). The corresponding values of the overall specificity of automated and visual assessments were 98 and 87%, respectively.Conclusion. Using the system developed by the authors for automated analysis provides a higher specificity than the visual assessment of an ultrasound image, which is carried out by a qualified specialist.
目标。非典型乳腺囊肿在无创超声鉴别诊断中往往是一个相当严重的问题。开发一种基于数学处理原理的灰度超声图像自动分析系统,可以提高这种情况下诊断的特异性。材料和方法。作者开发了CystChecker 1.0软件包。为了测试这个系统,他们使用了一组217张超声图像:107张囊性(包括53张非典型病变,用标准方法很难区分诊断)和110张实性(包括良性和恶性)乳房肿块。所有肿块均经细胞学和/或组织学证实。对灰度超声、彩色/功率多普勒和弹性成像图像进行视觉评价。使用该系统可以正确识别所有典型囊肿(n = 107(100%)), 110个实性肿块中的107个(97.3%),53个非典型囊肿中的50个(94.3%)。与此相反,标准的视觉评估提供了正确识别所有典型囊肿(n = 107(100%)), 110个实性肿块中96个(87.3%),53个非典型囊肿中32个(60.4%)的可能性(p < 0.05)。自动评价和目视评价的总特异性值分别为98%和87%。使用作者开发的系统进行自动分析提供了比超声图像的视觉评估更高的特异性,这是由合格的专家进行的。
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引用次数: 1
Difficulties in the Differential Diagnosis of Tracheobronchomegaly in Children 儿童气管支气管肿大的鉴别诊断难点
Pub Date : 2020-06-30 DOI: 10.20862/0042-4676-2020-101-3-175-182
ya A. Il’ina, Lidiya E. Vorob’eva, Mayya D. Bakradze, A. S. Polyakova
Tracheobronchomegaly is a rare developmental defect in children, which is characterized by the expansion of the trachea and large bronchi, the diagnosis and treatment of which are made more often in adult practice, when the clinical diagnostic picture acquires the obvious features of Mounier-Kuhn syndrome. In this connection, the need arises for the early detection of this pathology in children and its differentiation from other diseases and malformations of the tracheobronchial tree, which mask a recurrent inflammatory process in the lung and upper respiratory tract, and primarily with those, such as cystic fibrosis and primary ciliary dyskinesia.The paper describes a case of secondary tracheobronchomegaly in a child with obvious clinical manifestations of Mounier-Kuhn syndrome in the presence of bronchiectasis, pulmonary fibrosis, and signs of systemic connective tissue disease. It discusses the possibilities of chest computed tomography in the diagnosis of this defect in children, as well as its causes. The sizes of the trachea and main bronchi in this patient are compared with those in the groups of children of the same age and sex who have cystic fibrosis or diffuse pulmonary fibrosis to identify a more significant role of hereditary connective tissue diseases in the development of secondary tracheobronchomegaly. The authors propose to separate the concepts of tracheobronchomegaly and Mounier-Kuhn syndrome in children and to recognize the threshold for tracheal expansion in these patients having +3SD or more.
气管支气管肿大是一种罕见的儿童发育缺陷,以气管扩张、支气管粗大为特征,在成人实践中多作诊断和治疗,其临床诊断表现具有明显的Mounier-Kuhn综合征特征。在这方面,需要在儿童中早期发现这种病理,并将其与其他疾病和气管支气管树畸形区分开来,这些疾病和畸形掩盖了肺部和上呼吸道的复发性炎症过程,主要是囊性纤维化和原发性纤毛运动障碍等。本文报告一例继发性气管支气管肿大的儿童,临床表现明显为穆尼埃-库恩综合征,伴有支气管扩张、肺纤维化和全身性结缔组织病的征象。它讨论了胸部计算机断层扫描在诊断儿童这种缺陷的可能性,以及它的原因。将本例患者的气管和主支气管的大小与同年龄、性别的囊性纤维化或弥漫性肺纤维化患儿进行比较,以确定遗传性结缔组织疾病在继发性气管支气管肥大的发展中更显著的作用。作者建议将儿童气管支气管扩张和穆尼埃-库恩综合征的概念分开,并在这些+3SD或以上的患者中识别气管扩张的阈值。
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引用次数: 0
Assessment of the Magnetic Resonance Imaging Features of Baker’s Cysts and Their Correlation with the Age of Patients 贝克囊肿的磁共振成像特征及其与患者年龄的相关性评价
Pub Date : 2020-06-30 DOI: 10.20862/0042-4676-2020-101-3-155-162
S. Chernyad’ev, V. B. Aretinskiy, N. Sivkova, A. Zhilyakov, N. Y. Korobova, V. Blinov, E. Grebenev
Objective. To determine the magnetic resonance imaging (MRI) morphological features of Baker’s cysts and to assess their correlation with the age of patients.Material and methods. The investigation was based on the assessment of MRI readings in 37 patients with Baker’s cysts; of them there were 29 (78.4%) women and 8 (21.6%) men. The mean age of the examinees was 60.3 years (25 to 82 years).Results. The mean dimensions of the cysts were measured. Their length, width, and height were 34 ± 2.1 mm, 5 ± 1.2 mm (range 4–31 mm), and 58 ± 2.9 mm, respectively. Their mean thickness was 0.7 mm. Intracystic chondral bodies were detected in 3 (7.5%) cases. These parameters were shown to be unrelated to age. It was found that all cysts were multi-chamber and an average of 6.8 chambers was detected. There was a weak, inversely proportional, statistically significant relationship between the age of the patients and the number of chambers in the cyst. The younger participants of the investigation exhibited no meniscal damage in an overwhelming case (57.1%); whereas complete and incomplete meniscal tears much more often occurred in older patients with Baker’s cysts (from 29 (78.4%) to 34 (91.9%) people, respectively).Conclusion. Degenerative bone and cartilage tissue changes in the joint increase with age, regardless of the cyst sizes.
目标。目的探讨贝克囊肿的MRI形态学特征及其与患者年龄的关系。材料和方法。该研究基于对37例贝克囊肿患者的MRI读数的评估;其中女性29例(78.4%),男性8例(21.6%)。考生平均年龄为60.3岁(25 ~ 82岁)。测量囊肿的平均尺寸。长34±2.1 mm,宽5±1.2 mm(范围4 ~ 31 mm),高58±2.9 mm。平均厚度为0.7 mm。囊内软骨体3例(7.5%)。结果表明,这些参数与年龄无关。发现所有囊肿均为多腔,平均检出6.8个腔。患者年龄与囊肿腔数呈弱的、反比的、有统计学意义的关系。调查的年轻参与者在绝大多数情况下没有半月板损伤(57.1%);而完全性和不完全性半月板撕裂更常见于老年贝克囊肿患者(分别从29人(78.4%)到34人(91.9%))。关节的退行性骨和软骨组织变化随年龄增长而增加,无论囊肿大小如何。
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引用次数: 0
Radiation Diagnosis and Therapy of Vertebral Hemangiomas 椎体血管瘤的放射诊断与治疗
Pub Date : 2020-06-30 DOI: 10.20862/0042-4676-2020-101-3-183-192
S. A. Mizyurov, V. Zaretskov, S. V. Likhachev, A. V. Zaretskov, K. K. Levchenko, V. B. Arsenievich, S. Kireev, D. Y. Sumin
The literature review is devoted to the current radiation methods for studying vertebral hemangiomas. The significance of basic (radiography, computed tomography, and magnetic resonance imaging) and additional (Doppler ultrasound, scintigraphy, and selective angiography) diagnostic techniques is analyzed and their role in determining the indications for surgical treatment is clarified. The priority of computed tomography over other imaging methods for this pathology is established. The use of radiation therapy for vertebral hemangiomas at the present stage of medicine development is highlighted.
本文综述了目前放射治疗椎体血管瘤的方法。分析了基础诊断技术(x线摄影、计算机断层摄影和磁共振成像)和附加诊断技术(多普勒超声、闪烁成像和选择性血管造影)的意义,并阐明了它们在确定手术治疗指征中的作用。对于这种病理,计算机断层扫描优先于其他成像方法是确定的。放射治疗椎体血管瘤在现阶段的医学发展是突出的。
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引用次数: 0
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