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Lowe Syndrome: A Complex Clinical Diagnosis with a Novel Mutation in the OCRL Gene Lowe综合征:OCRL基因新突变的复杂临床诊断
IF 0.3 Q4 Medicine Pub Date : 2021-01-01 DOI: 10.1055/s-0041-1724042
A. Parikh, P. Gadgil
Abstract Lowe syndrome (LS) is a rare X-linked condition having a clinical triad of congenital cataracts, intellectual disability, and progressive tubular nephropathy. Although the easily recognizable symptom complex usually evolves by infancy, a unifying diagnosis is often missed. We present a young boy with a prolonged history of multisystem affection, finally leading to the clinical suspicion of LS. The diagnosis was confirmed on genetic analysis as well as a previously unreported mutation in the OCRL gene was discovered. A 9-year-old boy with intellectual disability and recent onset seizures was referred for the evaluation of rickets. In addition, there was a significant past history of neonatal cataracts, infantile glaucoma, persistent albuminuria, and severe short stature with growth hormone deficiency. The characteristic involvement of eyes, brain, and kidneys along with a family history of a maternal uncle being similarly affected led to the clinical suspicion of LS. A whole exome sequencing was performed, which not only confirmed a nonsense mutation, c.2530C > T, in exon 23 of the Lowe gene (OCRL) but also revealed it to be a novel pathogenic variant. This case highlights the importance of piecing together the different facets of a complex clinical syndrome in reaching a challenging diagnosis. Also, LS must be kept as a differential in any child with neonatal cataracts and intellectual disability. Genetic confirmation of LS in our patient partly relieved the parental anxiety, and the child continued to remain under follow-up with multiple specialists, only now with a definite diagnosis.
Lowe综合征(LS)是一种罕见的x连锁疾病,临床表现为先天性白内障、智力残疾和进行性肾小管肾病。虽然容易识别的症状复杂通常在婴儿期发展,但一个统一的诊断经常被遗漏。我们提出一个年轻的男孩与多系统情感的长期历史,最终导致临床怀疑LS。基因分析证实了诊断,并发现了以前未报道的ocl基因突变。一名患有智力残疾和最近发作的癫痫的9岁男孩被转介进行佝偻病的评估。此外,还有明显的新生儿白内障、婴儿青光眼、持续性蛋白尿和严重身材矮小伴生长激素缺乏的既往病史。眼睛、大脑和肾脏的特征性受累,以及舅舅有类似的家族史,导致临床怀疑LS。全外显子组测序结果表明,在Lowe基因(OCRL)第23外显子中存在c.2530C > T无义突变,且该突变是一种新的致病变异。本病例强调了将复杂临床综合征的不同方面拼凑在一起以达到具有挑战性的诊断的重要性。此外,LS必须作为任何新生儿白内障和智力残疾儿童的鉴别指标。本例患者LS的遗传确认部分缓解了家长的焦虑,该儿童继续接受多名专家的随访,直到现在才得到明确的诊断。
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引用次数: 0
Current Treatment Guidelines of SARS-CoV-2 Related Multisystem Inflammatory Syndrome in Children: A Literature Review and Expert Opinion 儿童严重急性呼吸系统综合征冠状病毒2型相关多系统炎症综合征的治疗指南:文献综述和专家意见
IF 0.3 Q4 Medicine Pub Date : 2021-01-01 DOI: 10.1055/s-0041-1731077
A. Ghodsi, Mehrdad Sarabi, A. Malek, A. Khakshour
Abstract Multisystem inflammatory syndrome in children (MIS-C) is a systemic disorder that seems to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since April 2020, there have been multiple reports about children with this new condition worldwide, including Europe, Asia, Latin America, and North America. The symptoms of this syndrome mimic the clinical manifestations of Kawasaki disease; therefore, the treatment of Kawasaki disease, as well as supportive care, was the management of choice in children with MIS-C in the early days of recognizing it. It is important to precisely ascertain the risk of COVID-19 infection and its severity in children and to acknowledge the management of this syndrome, with reliable data from cohorts, trials, and experts' opinions. In the current review, we summarize the current management guidelines for MIS-C and present our own protocol to answer some clinical questions regarding MIS-C management during the COVID-19 pandemic.
摘要儿童多系统炎症综合征(MIS-C)是一种系统性疾病,似乎与严重急性呼吸综合征冠状病毒2型(严重急性呼吸系统综合征冠状病毒冠状病毒2型)有关。自2020年4月以来,包括欧洲、亚洲、拉丁美洲和北美在内的世界各地都有多份关于患有这种新疾病的儿童的报告。该综合征的症状与川崎病的临床表现相似;因此,川崎病的治疗以及支持性护理是MIS-C儿童早期认识的选择。重要的是,根据来自队列、试验和专家意见的可靠数据,准确确定儿童感染新冠肺炎的风险及其严重程度,并确认该综合征的管理。在当前的综述中,我们总结了MIS-C的当前管理指南,并提出了我们自己的方案,以回答新冠肺炎大流行期间有关MIS-C管理的一些临床问题。
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引用次数: 3
A Study on Burden of Prehypertension in Youth (or Pediatric Hypertension) in West Bengal, India 印度西孟加拉邦青少年(或儿童高血压)高血压负担的研究
IF 0.3 Q4 Medicine Pub Date : 2021-01-01 DOI: 10.1055/s-0041-1736240
S. RoyChoudhury, K. Nayek, Jinia Saha
Abstract Hypertension is a silent threat to the developing countries in recent times. The aim of this article was to determine the burden of prehypertension and hypertension among school-going children and the risk factors associated with those conditions. A cross-sectional study was conducted among school-going children (6–18 years) in seven schools of Burdwan, West Bengal, India, selected by stratified random sampling from March 2017 to August 2018. Anthropometric and blood pressure measurements were obtained along with sociodemographic parameters. Prehypertension and hypertension were defined as per American Pediatric Society's definition. Mean age of the study population was 11.3 ± 3.8 years (n = 604). Prevalence of prehypertension and hypertension was estimated to be 5% and 4.6%, respectively. Both prehypertension and hypertension were more common among children aged > 15 years (10.3% and 15.5%). In logistic regression, the independent determinants of hypertension were higher socioeconomic condition, increasing age, obesity, increased intake of junk food, parental hypertension, and obesity among first-degree relatives. Proper preventive measures are the need of the hour to tackle the emerging epidemic at its root. Periodic measurements of blood pressure at regular intervals are advisable at community levels to recognize high-risk children, control obesity, and prevent irreversible end organ damages.
摘要近年来,高血压对发展中国家是一种无声的威胁。本文的目的是确定学龄前儿童的高血压和高血压负担,以及与这些情况相关的风险因素。2017年3月至2018年8月,通过分层随机抽样对印度西孟加拉邦布尔德万七所学校的在校儿童(6-18岁)进行了一项横断面研究。人体测量和血压测量与社会人口学参数一起获得。根据美国儿科学会的定义,对高血压前期和高血压进行了定义。研究人群的平均年龄为11.3岁 ± 3.8年(n = 604)。高血压前期和高血压的患病率估计分别为5%和4.6%。高血压前期和高血压在年龄较大的儿童中更为常见 > 15岁(10.3%和15.5%)。在逻辑回归中,高血压的独立决定因素是较高的社会经济状况、年龄增长、肥胖、垃圾食品摄入增加、父母高血压和一级亲属肥胖。适当的预防措施是从根本上解决新出现的流行病的当务之急。建议在社区层面定期测量血压,以识别高危儿童,控制肥胖,防止不可逆的末端器官损伤。
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引用次数: 0
Assessment of the Utility of Plusoptix A09 Handheld Photo-refractometer in Screening Refractory Errors and Amblyopia in Children Plusoptix A09手持式照片折射仪在筛查儿童难治性错误和弱视中的应用评估
IF 0.3 Q4 Medicine Pub Date : 2021-01-01 DOI: 10.1055/s-0041-1728731
M. S. Sinanoglu, Y. Cengiz, S. Demirel
Abstract The aim of this study is to find out the frequency of anisometropic amblyopia in children and to increase awareness about this disease. All children between the ages of 4 and 10 years who were attending 11 kindergarten and primary schools determined by provincial directorate for national education in the center of Malatya were included. A screening team including interns and a resident from the Department of Pediatrics have used Plusoptix A09 handheld photo-refractometer device for detecting amblyopia and its reasons. A total of 7,000 students were screened. The mean age of the students was 7.4 ± 2 years. Amblyopia was suspected in 357 cases with the Plusoptix S09 screening. After eye examinations performed by an ophthalmologist, 303 cases were found to have pathologic eye examination. Amblyopia was found in 67 (18.8%) of the 303 cases, and anisometropic amblyopia was found in 59 of 67 cases. As a result of the screening, sensitivity of Plusoptix A09 was found to be 88.1%, while its specificity was found to be 88.6%. Its positive predictive value was found to be 64.0% and its negative predictive value was found to be 97.0%. We believe that with screenings performed by health professionals who are given short-term training by using a device that can conduct remote measurements, detection of anisometropic amblyopia, which is the most frequent reason for amblyopia, can be done in a fast and relatively less expensive way and with the minimum number of specialist physician required. This way, children with amblyopia can reach the ophthalmologist earlier for treatment.
摘要本研究的目的是了解儿童屈光参差性弱视的发生频率,并提高对该疾病的认识。所有4至10岁的儿童都被包括在内,他们就读于马拉蒂亚中心省国民教育局确定的11所幼儿园和小学。包括实习生和一名儿科住院医生在内的筛查小组使用Plusoptix A09手持式照片折射仪检测弱视及其原因。共有7000名学生接受了筛查。学生的平均年龄为7.4岁 ± 2年。Plusoptix S09筛查发现357例疑似弱视。在眼科医生进行眼科检查后,发现303例患者进行了眼科病理检查。303例中有67例(18.8%)出现弱视,67例中有59例出现屈光参差性弱视。筛查结果显示,Plusoptix A09的敏感性为88.1%,特异性为88.6%。其阳性预测值为64.0%,阴性预测值为97.0%。我们相信,通过由接受短期培训的卫生专业人员使用可以进行远程测量的设备进行筛查,屈光参差性弱视是弱视最常见的原因,可以用一种快速、相对便宜的方法进行检测,并且所需的专科医生人数最少。这样,弱视儿童可以更早地找到眼科医生进行治疗。
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引用次数: 0
The Clinical Profile, Early Warning Score, and Outcome of Children Aged 0–12 Years Referred to a Tertiary Care Hospital in North India 北印度0-12岁儿童转诊至三级护理医院的临床概况、预警评分和结果
IF 0.3 Q4 Medicine Pub Date : 2021-01-01 DOI: 10.1055/s-0041-1731334
B. Eswaramoorthy, R. Gupta, M. Bhatt, M. Roy
Abstract Pediatric patients are referred for multiple reasons, either for better therapeutic services or diagnostic purposes. The clinical condition of patients at the time of referral can significantly affect the outcome of such patients and there is not much data on this aspect. The overall objective of this study was to study the demographic and clinical profile, the causes for referral, and the outcome of pediatric patients being referred to a single tertiary care hospital. This was a prospective observational study done in the Department of Pediatrics of a single tertiary care hospital in North India over the course of 1 year. Patients referred from other health facilities in the age group 0 to 12 years who were admitted in the pediatric ward of the hospital were enrolled. The primary objective was to study the clinical profile and outcome (mortality) of these patients. The secondary objectives were to study the referral pattern of the referred patients, causes for referral, and the severity of illness at the time of admission as assessed by Irish Pediatric Early Warning Score (PEWS) and its correlation with the outcome. The outcomes were categorized as: discharge, death, left against medical advice, referred to other centers, others. Early warning scores are useful to measure the severity of disease and to follow patients' progress. The Irish PEWS score was used in this study to provide a rapid measure of the degree of sickness. Respiratory system disorders and neonatal illnesses were the most common illnesses observed. Most patients had low disease severity as per Irish PEWS score. The overall mortality rate among the referred patients was 19.25%. Patients with younger age, higher scores, neonatal illnesses, and neurological disorders had higher risk of mortality. Training of health personnel at primary and secondary levels in the commonly encountered illnesses will improve provision of care at the local level and decrease low risk referrals.
摘要儿科患者被转诊有多种原因,要么是为了更好的治疗服务,要么是出于诊断目的。转诊时患者的临床状况会显著影响此类患者的预后,这方面的数据不多。本研究的总体目标是研究转诊至单一三级护理医院的儿科患者的人口统计学和临床特征、转诊原因和结果。这是在北印度一家三级护理医院的儿科进行的一项为期1年的前瞻性观察性研究。从其他卫生机构转诊的0至12岁年龄组患者被纳入医院儿科病房。主要目的是研究这些患者的临床特征和结果(死亡率)。次要目标是研究转诊患者的转诊模式、转诊原因以及爱尔兰儿科早期预警评分(PEWS)评估的入院时疾病的严重程度及其与结果的相关性。结果被分类为:出院、死亡、违背医嘱、转诊到其他中心、其他。早期预警评分有助于衡量疾病的严重程度和跟踪患者的进展。爱尔兰PEWS评分用于本研究,以提供疾病程度的快速测量。呼吸系统疾病和新生儿疾病是观察到的最常见的疾病。根据爱尔兰PEWS评分,大多数患者的疾病严重程度较低。转诊患者的总死亡率为19.25%。年龄较小、评分较高、新生儿疾病和神经系统疾病的患者死亡率较高。对初级和中级卫生人员进行常见疾病方面的培训将改善地方一级的护理,减少低风险转诊。
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引用次数: 1
Infantile Isolated Absence of Right Pulmonary Artery with an Absent Stump and No Collaterals 婴儿孤立性右肺动脉缺失,残端缺失,无络腮
IF 0.3 Q4 Medicine Pub Date : 2021-01-01 DOI: 10.1055/s-0040-1722567
S. Patil, Sayantan Ghoshbag, U. Pillay
Abstract Unilateral absence of pulmonary artery (UAPA) is a rare entity. Diagnosis is often incidental based on echocardiography (ECHO)/computed tomography (CT) findings done for a cardiac evaluation or recurrent pulmonary pathology not responding to conventional treatment. Childhood-onset symptoms are often rare, and most of these cases are reported in adulthood or postpuberty. Here, we present a 5-month-old child with an isolated absence of right pulmonary artery without even an arterial stump or collaterals. Treatment options depend on the severity of symptoms and anatomy of the abnormal vessels, and in some cases, patients get better, if not completely well with the available medical and surgical treatments.
摘要单侧肺动脉缺失(UAPA)是一种罕见的疾病。诊断通常是偶然的,基于超声心动图(ECHO)/计算机断层扫描(CT)所做的心脏评估或复发性肺部病理对常规治疗无效。儿童期发病的症状通常很少见,这些病例大多发生在成年期或青春期后。在这里,我们提出了一个5个月大的孩子孤立的没有右肺动脉甚至没有动脉残端或侧支。治疗方案取决于症状的严重程度和异常血管的解剖结构,在某些情况下,患者即使不能完全康复,也会在现有的药物和手术治疗下好转。
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引用次数: 0
Primary Teeth Stains and Discoloration: A Review 乳牙染色和变色:综述
IF 0.3 Q4 Medicine Pub Date : 2021-01-01 DOI: 10.1055/s-0040-1722276
Abdulfatah Alazmah
Abstract The current review assesses the literature concerning the etiology of primary teeth staining and discoloration. The appearance of the dentition is of concern to many children and their caregivers seeking dental treatment as the color of the teeth is of aesthetic importance. The correct diagnosis of the cause of the discoloration is important as, invariably, it has a profound effect on treatment outcomes. It would seem reasonable, therefore, that dental practitioners understand the etiology of tooth discoloration to make a diagnosis and enable appropriate treatment to be conducted. Knowledge of the etiology of tooth staining is of importance to the dental practitioner to explain the patient the exact nature of the condition. In some instances, the mechanism of staining affects the outcome of the treatment and influences the options the dentist will be able to offer. Many of these contributing factors are preventable if parents are educated, managed by professional interventions, or provide a multidisciplinary approach. In this review, we highlight the importance of children smiles and the difference between primary and permanent teeth. We discuss the different types of primary teeth staining and discoloration and whether it is intrinsic or extrinsic, as well as the different impacts of some conditions on primary teeth compared with permanent teeth.
摘要本文综述了有关乳牙染色和变色病因的文献。牙列的外观是许多寻求牙科治疗的儿童及其护理人员关注的问题,因为牙齿的颜色具有美学重要性。变色原因的正确诊断很重要,因为它总是对治疗结果产生深远影响。因此,牙科医生了解牙齿变色的病因以进行诊断并进行适当的治疗似乎是合理的。了解牙齿染色的病因对于牙科医生向患者解释病情的确切性质至关重要。在某些情况下,染色机制会影响治疗的结果,并影响牙医能够提供的选择。如果父母接受教育、通过专业干预进行管理或提供多学科方法,这些促成因素中的许多都是可以预防的。在这篇综述中,我们强调了儿童微笑的重要性以及乳牙和恒牙之间的区别。我们讨论了不同类型的乳牙染色和变色,是内在的还是外在的,以及与恒牙相比,某些条件对乳牙的不同影响。
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引用次数: 4
Lactoferrin Efficacy versus Ferrous Sulfate in Treatment of Children with Iron Deficiency Anemia 乳铁蛋白与硫酸亚铁治疗儿童缺铁性贫血的疗效比较
IF 0.3 Q4 Medicine Pub Date : 2021-01-01 DOI: 10.1055/s-0041-1731073
O. El-Asheer, Ahmed G. Ahmed, Z. Hafez, M. Dahpy, Amal A. S. Soliman
Abstract Lactoferrin (LF) is an iron-binding globular glycoprotein that is structurally and chemically similar to serum transferrin. Many studies have been done to evaluate the effect of oral LF administration on iron deficiency anemia (IDA) with controversial results. This study was designed to compare the efficacy of LF versus oral ferrous sulfate (OFS) therapy in the treatment of children with IDA. A significant increase in mean hemoglobin and serum iron concentrations was noted in the group that received oral bovine LF (11.06 ± 0.96 and 42.79 ± 6.14, respectively) versus the group that received OFS (10.24 ± 0.57 and 28.94 ± 5.05, respectively, with p < 0.001 for each) after 30 days of the treatment with fewer side effects (9.3 vs. 33.3% with p = 0.043). Oral bovine LF is a more effective and safer alternative in treating iron deficiency and IDA compared with OFS with clinical benefits of fewer side effects and better patient compliance.
摘要乳铁蛋白(LF)是一种与铁结合的球状糖蛋白,在结构和化学上与血清转铁蛋白相似。已经进行了许多研究来评估口服LF治疗缺铁性贫血(IDA)的效果,但结果存在争议。本研究旨在比较LF与口服硫酸亚铁(OFS)治疗IDA儿童的疗效。口服牛LF组的平均血红蛋白和血清铁浓度显著增加(11.06 ± 0.96和42.79 ± 6.14)与接收OFS的组(10.24 ± 0.57和28.94 ± 分别为5.05,p < 0.001),副作用较少(9.3对33.3% = 0.043)。与OFS相比,口服牛LF在治疗缺铁和IDA方面是一种更有效、更安全的替代方案,具有副作用更少和患者依从性更好的临床益处。
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引用次数: 2
Delayed Cord Clamping in Infants of Diabetic Mothers: Laboratory and Clinical Outcomes 糖尿病母亲婴儿延迟脐带夹闭的实验室和临床结果
IF 0.3 Q4 Medicine Pub Date : 2021-01-01 DOI: 10.1055/s-0041-1726460
S. Abdelmaksoud, Heba Elsayed Abdelraziq, R. Khashaba, A. Diab
Abstract The aim of this study was to compare the effects of delayed cord clamping (DCC) and early cord clamping (ECC) on venous hematocrit (htc) and clinical outcomes in infants of diabetic mothers (IDMs). This prospective randomized study included 157 term IDMs. The umbilical cords of these infants were clamped at least 60 seconds in group I (DCC group, n = 79) and as soon as possible after birth in group II (ECC group, n = 78). The two groups were compared regarding neonatal venous htc levels, hypoglycemia rates, jaundice requiring phototherapy, respiratory distress, and admission to the neonatal intensive care unit (NICU). Hematocrit levels were significantly higher in the DCC group, both at 6 and 24 hours postnatally (p = 0.039 and 0.01), respectively. Polycythemia frequency was higher in DCC than the ECC group, but no patient in either group needed partial exchange transfusion (PET). Rates of jaundice were significantly higher in the DCC group (p = 0.028), but there was no significant difference between the two groups regarding jaundice requiring phototherapy (p = 0.681). There were no differences between the groups regarding hypoglycemia rates, need for glucose infusion, or respiratory distress. The incidence of admission to NICU was lower in the DCC group (p = 0.005). Early clamping was a significant predictor for increased risk of NICU admission. DCC increased polycythemia and jaundice rates but did not increase the need for PET or phototherapy. Also, DCC reduced the severity of respiratory distress and the subsequent need for NICU admission.
摘要本研究的目的是比较延迟脐带夹紧(DCC)和早期脐带夹紧(ECC)对糖尿病母亲(IDMs)婴儿静脉血细胞比容(htc)和临床结果的影响。这项前瞻性随机研究包括157名足月IDM。这些婴儿的脐带被夹住了至少60 第I组(DCC组,n = 79),并在出生后尽快在组II(ECC组,n = 78)。比较两组新生儿静脉htc水平、低血糖率、需要光疗的黄疸、呼吸窘迫和新生儿重症监护室(NICU)的入院情况。DCC组的红细胞压积水平在6岁和24岁时均显著升高 产后小时数(p = 0.039和0.01)。DCC组的红细胞增多症发生率高于ECC组,但两组均无患者需要部分换血(PET)。DCC组的黄疸发生率明显高于对照组(p = 0.028),但两组在需要光疗的黄疸方面没有显著差异(p = 0.681)。两组在低血糖发生率、葡萄糖输注需求或呼吸窘迫方面没有差异。DCC组新生儿重症监护室的入院率较低(p = 0.005)。早期钳夹是NICU入院风险增加的重要预测因素。DCC增加了红细胞增多症和黄疸的发生率,但没有增加PET或光疗的需要。此外,DCC降低了呼吸窘迫的严重程度以及随后需要NICU入院的情况。
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引用次数: 0
Van Buchem Disease: First Case Report from the Indian Subcontinent with an Early Presentation Van Buchem病:印度次大陆首例早期表现的病例报告
IF 0.3 Q4 Medicine Pub Date : 2021-01-01 DOI: 10.1055/s-0041-1723956
S. Maheshwari, S. Yangzom, K. Bhanu, U. Rajesh, Ashok Narayan
Abstract Van Buchem disease is a rare autosomal recessive genetic disorder that causes a compromised inhibitory feedback mechanism resulting in increased bone formation and overgrowth of the skeleton leading to a variety of neurological symptoms. It has been reported in less than 50 patients most of which were in western Europe. We report the first case of this condition from the Indian subcontinent with an early presentation. This patient presented with a global delay in attaining the developmental milestones and progressive reduction in visual acuity and loss of hearing. He had dysmorphic facies, multiple cranial nerve palsies, and severe visual and auditory deficits. Imaging revealed sclerosing bone dysplasia. This case illustrates the clinical and imaging findings of this rare condition.
摘要Van Buchem病是一种罕见的常染色体隐性遗传病,它会导致抑制性反馈机制受损,导致骨形成增加和骨骼过度生长,从而导致各种神经症状。据报道,只有不到50名患者出现这种情况,其中大多数在西欧。我们报告了来自印度次大陆的第一例这种情况的早期表现。该患者在达到发育里程碑方面出现了全面延迟,视力逐渐下降,听力下降。他有畸形相,多发性脑神经麻痹,严重的视觉和听觉缺陷。影像学检查显示硬化性骨发育不良。这个病例说明了这种罕见疾病的临床和影像学表现。
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引用次数: 0
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Journal of Child Science
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