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Cardiac arrest outcomes in children with preexisting neurobehavioral impairment 已有神经行为障碍儿童的心脏骤停结果
Pub Date : 2019-11-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2019.11.101
方伯梁, 钱素云
目的 了解纳入两项关于目标体温控制的平行随机临床研究之一的已存在神经行为损害儿童的存活情况及3个月,12个月时神经行为预后。 设计 二次分析儿童心脏骤停后治疗性低体温(therapeutic hypothermia after pediatric cardiac arrest,THAPCA)院内及院外试验数据。 场所 美国,加拿大及英国的41家PICU。 对象 共纳入84例患儿[59例院内心跳骤停(in-hospital cardiac arrest,IH-CA),25例院外心跳骤停(out-of-hospital cardiac arrest,OH-CA)],男49例,女35例,平均年龄4.6岁(标准差5.36),均在CA前已存在神经行为损害[Vineland适应性行为量表第2版(Vineland Adaptive Behavior Scales-Second Edition,VABS-Ⅱ)综合评分<70]。所有患儿均需胸外按压≥2 min,昏迷且循环恢复后需要机械通气。 干预 采用VABS-Ⅱ评估基线(反应CA前状态),CA后3个月、12个月神经行为功能,随后进行现场认知评估。VABS-Ⅱ评分100±15,分值越高功能越佳。分析结果评估存活情况,VABS-Ⅱ改变及认知功能。 测量方法与主要结果 28/84(33%)存活至12个月[IH-CA为19/59 (32%),OH-CA为9/25 (36%)]。IH-CA组存活率显著低于THAPCA组内CA前无神经行为损害患儿。25例存活患儿VABS-Ⅱ降低≤15分[IH-CA为18/59 (31%),OH-CA为7/25 (28%)]。CA后3个月,平均VABS-Ⅱ评分显著降低(P<0.05)。12个月时OH-CA患儿VABS-Ⅱ降低(P<0.05),IH-CA无降低;43% (12/28)评分无变化或改善。 结论 本研究证实了将此部分人群纳入临床神经保护研究的可行性,实用性及面临的挑战。既往存在神经行为损害的儿童中,1/3存活至12个月且神经行为预后差异显著。
目的 了解纳入两项关于目标体温控制的平行随机临床研究之一的已存在神经行为损害儿童的存活情况及3个月,12个月时神经行为预后。 设计 二次分析儿童心脏骤停后治疗性低体温(therapeutic hypothermia after pediatric cardiac arrest,THAPCA)院内及院外试验数据。 场所 美国,加拿大及英国的41家PICU。 对象 共纳入84例患儿[59例院内心跳骤停(in-hospital cardiac arrest,IH-CA),25例院外心跳骤停(out-of-hospital cardiac arrest,OH-CA)],男49例,女35例,平均年龄4.6岁(标准差5.36),均在CA前已存在神经行为损害[Vineland适应性行为量表第2版(Vineland Adaptive Behavior Scales-Second Edition,VABS-Ⅱ)综合评分<70]。所有患儿均需胸外按压≥2 min,昏迷且循环恢复后需要机械通气。 干预 采用VABS-Ⅱ评估基线(反应CA前状态),CA后3个月、12个月神经行为功能,随后进行现场认知评估。VABS-Ⅱ评分100±15,分值越高功能越佳。分析结果评估存活情况,VABS-Ⅱ改变及认知功能。 测量方法与主要结果 28/84(33%)存活至12个月[IH-CA为19/59 (32%),OH-CA为9/25 (36%)]。IH-CA组存活率显著低于THAPCA组内CA前无神经行为损害患儿。25例存活患儿VABS-Ⅱ降低≤15分[IH-CA为18/59 (31%),OH-CA为7/25 (28%)]。CA后3个月,平均VABS-Ⅱ评分显著降低(P<0.05)。12个月时OH-CA患儿VABS-Ⅱ降低(P<0.05),IH-CA无降低;43% (12/28)评分无变化或改善。 结论 本研究证实了将此部分人群纳入临床神经保护研究的可行性,实用性及面临的挑战。既往存在神经行为损害的儿童中,1/3存活至12个月且神经行为预后差异显著。
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引用次数: 0
Imaging features of adenovirus pneumonia in children 儿童腺病毒性肺炎的影像学特征
Pub Date : 2019-10-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2019.10.002
Yan Wang, Yun Peng
The detailed and advanced chest radiographic features of adenovirus pneumonia in children was described.The most frequently dominant imaging pattern adenovirus pneumonia in children was bilateral fused patchy parenchymal opacities or consolidation with a peribronchovascular distribution and bilateral lung hyperinflation.Severe adenovirus pneumonia may be associated with complications and sequela such as bronchiolitis obliterans.Presence of dominant consolidation findings during the early stage in adenovirus pneumonia may be a noteworthy finding for differentiating this condition from other types of viral pneumonia.A better understanding of the typical radiographic findings of adenoviral pneumonia in children may help physicians identify infections at an earlier stage and elucidate the natural course of the disease. Key words: Children; Pneumonia; Adenoviruses; Radiographic
描述了儿童腺病毒肺炎的详细和晚期胸部影像学特征。儿童腺病毒肺炎最常见的主要影像学模式是双侧融合斑片状实质影或合并支气管血管周围分布和双侧肺过度充气。严重的腺病毒肺炎可能伴有并发症和后遗症,如闭塞性细支气管炎。腺病毒性肺炎早期存在显性合并症可能是将这种情况与其他类型的病毒性肺炎区分开来的一个值得注意的发现。更好地了解儿童腺病毒性肺炎的典型放射学表现可能有助于医生在早期识别感染并阐明疾病的自然病程。关键词:儿童;肺炎;腺病毒;射线照相
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引用次数: 1
Early recognition and treatment of adenovirus pneumonia complicated with bronchiolitis obliterans 腺病毒肺炎合并闭塞性细支气管炎的早期识别和治疗
Pub Date : 2019-10-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2019.10.006
H. Fan, G. Lu, J. Tao
Adenovirus pneumonia is a common infectious disease of the respiratory tract in children, and severe cases developed post-infectious bronchiolitis obliterans (PIBO), which is chronic airflow obstruction syndrome caused by small airway inflammatory injury.The major clinical manifestations of PIBO are persistent cough, wheezing and dyspnea after acute stage of adenovirus pneumonia, and nowadays there is no specific treatment.PIBO has a prolonged course and very poor prognosis without early intervention, and it influences patients on health and life seriously.The article reviewed the early recognition and the therapeutic progress of adenovirus pneumonia complicated with PIBO. Key words: Adenovirus; Bronchiolitis obliterans; Recognition; Treatment
腺病毒性肺炎是一种常见的儿童呼吸道感染性疾病,重症病例发展为感染后闭塞性细支气管炎(PIBO),这是一种由小气道炎症损伤引起的慢性气流阻塞综合征。PIBO的主要临床表现是腺病毒肺炎急性期后持续咳嗽、喘息和呼吸困难,目前尚无特效治疗方法。PIBO病程长,预后极差,不进行早期干预,严重影响患者的健康和生活。本文综述了腺病毒肺炎合并PIBO的早期认识和治疗进展。关键词:腺病毒;闭塞性支气管炎;认可;治疗
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引用次数: 0
Epidemiological investigation of adenovirus pneumonia in children in Hunan province 湖南省儿童腺病毒肺炎流行病学调查
Pub Date : 2019-10-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2019.10.008
Qin Liu, Leyun Xie, Bing Zhang, L. Zhong, Tian Yu
Objective To investigate the detection results and epidemiological characteristics of human adenovirus (HAdV) among children with community acquired pneumonia (CAP) in Hunan province. Methods A descriptive retrospective survey was conducted to investigate the clinical epidemiological data of 33 056 children with CAP admitted to the Children′s Medical Center of Hunan People′s Hospital from May 1st, 2014 to April 30th, 2019.The seasonal distribution and demographic characteristics of HAdV infection were analyzed. Results (1) A total of 33 056 children with CAP were included in this study.A total of 3 770 children with HAdV positive were detected, with a total detection rate of 11.40% (3 770/33 056). From May 2014 to April 2019, the detection rates of adenovirus in different years were 13.76%, 8.57%, 7.94%, 9.53%, 12.36% and 24.75% respectively.Adenovirus detection rate reached its peak in 2019.(2) The detection rate of HAdV among male children were higher than that among female children (χ2= 6.374, P=0.012). Among 3 770 children with HAdV infection, 3 036 (80.53%) were from 6 months to 5 years old.The detection rate of adenovirus were different in different age groups.The highest detection rate was 16.65% in 3 to 5 years old group (χ2=526.494, P<0.001). Among children with severe pneumonia, the detection rate of adenovirus was 18.43% (415/2 252). The detection rate of adenovirus was the highest in the age group of 6 months to 1 years, and the difference was statistically significant(χ2=71.485, P<0.001). (3) The detection rate of adenovirus was the lowest in autumn, and the other three seasons were all high- incidence seasons (χ2= 268.744, P<0.001). (4) The hospitalization days of adenovirus pneumonia were longer than those of non-adenovirus pneumonia (Z=-10.419, P<0.001). Conclusion The prevalence of HAdV infection is related to age, season and sex.The susceptibility of adenovirus varies with severity of pneumonia.We should be vigilant against the outbreak of adenovirus infection characterized by years. Key words: Community acquired pneumonia; Adenovirus; Children; Epidemiology
目的了解湖南省社区获得性肺炎(CAP)患儿中人腺病毒(HAdV)的检测结果及流行病学特征。方法采用描述性回顾性调查方法,对湖南省人民医院儿童医学中心2014年5月1日至2019年4月30日收治的33056例CAP患儿的临床流行病学资料进行调查,分析HAdV感染的季节分布和人口学特征。结果(1)本研究共纳入33056例CAP患儿。共检测到3770例HAdV阳性儿童,总检出率为11.40%(3770/33056)。2014年5月至2019年4月,不同年份腺病毒检出率分别为13.76%、8.57%、7.94%、9.53%、12.36%和24.75%。腺病毒检测率在2019年达到峰值。(2)男性儿童的HAdV检测率高于女性儿童(χ2=6.374,P=0.012)。在3770名感染HAdV的儿童中,6个月至5岁的儿童有036人(80.53%)。不同年龄组腺病毒检出率不同。3~5岁组腺病毒检出率最高,为16.65%(χ2=526.494,P<0.001),在重症肺炎患儿中腺病毒的检出率为18.43%(415/2 252)。腺病毒的检出率在6个月至1岁年龄组最高,差异有统计学意义(χ2=71.485,P<0.001)。(3)秋季腺病毒检出率最低,其他三个季节均为高发季节(χ2=268.744,P<0.001)。(4)腺病毒性肺炎住院天数明显长于非腺病毒肺炎(Z=10.419,P<0.01)。腺病毒的易感性随肺炎的严重程度而变化。我们应该警惕以年份为特征的腺病毒感染的爆发。关键词:社区获得性肺炎;腺病毒;儿童;流行病学
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引用次数: 4
Current status and challenges of diagnosis and treatment of adenovirus pneumonia in children 儿童腺病毒肺炎的诊断和治疗现状及挑战
Pub Date : 2019-10-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2019.10.001
Suyun Qian
儿童是腺病毒肺炎的易感人群,重症患儿并发症多、病死率高且存活者容易遗留后遗症。目前缺乏特效抗腺病毒药物,临床以综合治疗为主,诸多治疗方法的疗效和时机尚存在争议。早识别,早诊断,合理综合治疗,防治并发症仍是现阶段降低其病死率、致残率的关键措施。
Children are susceptible to adenovirus pneumonia, and severe cases have more complications, a high mortality rate, and survivors are prone to leaving behind sequelae. At present, there is a lack of specific antiviral drugs, and clinical treatment is mainly based on comprehensive treatment. The efficacy and timing of many treatment methods are still controversial. Early identification, early diagnosis, reasonable comprehensive treatment, and prevention and treatment of complications are still key measures to reduce their mortality and disability rates at present.
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引用次数: 0
Severe adenovirus infection damage to the blood system 严重腺病毒感染对血液系统的损害
Pub Date : 2019-10-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2019.10.003
Xiaoxu Ren
Severe adenovirus pneumonia and disseminated adenovirus infection can cause damage to the blood system.Those damages included coagulopathy, hemolytic phagocytosis, acquired hemophagocytic lymphohistiocytosis, leukocyte abnormalities.All of the above injuries are related to the uncontrolled immune inflammatory response to adenovirus infection.Direct injury caused by adenovirus infection and immune inflammation are the main injury mechanisms. Key words: Adenovirus infection; Coagulopathy; Acquired hemophagocytic lymphohistiocytosis; Immune inflammation
严重的腺病毒肺炎和播散性腺病毒感染可对血液系统造成损害。这些损害包括凝血功能障碍,溶血性吞噬,获得性噬血细胞淋巴组织细胞症,白细胞异常。上述所有损伤均与腺病毒感染引起的不受控制的免疫炎症反应有关。腺病毒感染引起的直接损伤和免疫炎症是主要的损伤机制。关键词:腺病毒感染;凝血障碍;获得性噬血细胞淋巴组织细胞病;免疫炎症反应
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引用次数: 1
Analysis of respiratory pathogens for children respiratory tract infection by capillary electrophoresis-based multiplex PCR 基于毛细管电泳的多重PCR分析儿童呼吸道感染的呼吸道病原体
Pub Date : 2019-10-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2019.10.010
Liu Yuqi, Yanzhi Huang, Liwei Sun, Hongbo Jiang, Yuling Tian, Tingyu Meng, Yan Ma, H. Yan, Yanling Zhao, Yi-la Ma
Objective To investigate the effect of capillary electrophoresis-based multiplex PCR (CEMP) in detecting pathogens for children respiratory tract infection, and to provide scientific basis for clinical diagnosis and treatment rapidly and accurately. Methods The cases were defined according to the national monitoring program of febrile respiratory syndrome during the 12th Five-Year Plan, and the samples were collected from nasopharyngeal swabs, bronchoalveolar lavage fluid and sputum of children with respiratory tract infection hospitalized in Changchun Children′s Hospital from January 2017 to February 2018.Multiplex PCR amplification was performed by one-step method, then PCR products were separated by DNA length size with capillary electrophoresis and pathogens were analyzed by "Genemapper software" software.Detecting pathogens included Influenza A virus (InfA), Human Adenovirus (HADV), Boca virus (Boca), Human Rhinovirus (HRV), Novel InfA-09H1 (InfA-09H1) and Seasonal Influenza virus H3N2 (InfA-H3N2), Parainfluenza virus (HPIV), Human metapneumonia virus (HMPV), Influenza B virus (InfB), Mycoplasma pneumoniae (Mp), Chlamydia pneumoniae (CP), Human Coronavirus (HCOV), Human Respiratory Syncytial virus (HRSV). Results The effective detection rate of the CEMP assay was 95.71%.The positive detection rate of respiratory tract pathogens was 62.84% and the mixed infection rate was 9.61%.The mixed infection was mainly InfA and HRSV.The highest three positive rates were named InfA, HRSV and Mp.The positive rate of HRSV was significantly higher in the 0-3 age group than that in older group.Different pathogens were detected in different age groups, and the high-occurrence season of respiratory tract infection with virus was from December to March of the next year.InfA-09H1 was the main prevalent influenza virus in January, February and March 2017, InfA-H3N2 was the main prevalent influenza virus in November and December 2017, and the outbreak of InfB was happened in Changchun in late 2017 and early 2018.HRSV was detected only in the coldest season in Changchun from November to March of the next year.Different pathogens were detected in different respiratory infection.HRSV was the main pathogen detected in pneumonia; InfA-03H2 and HPIV were the main pathogens detected in acute bronchitis; HRV and InfA were the main pathogens detected in upper respiratory tract infection. Conclusion CEMP is an efficient, rapid and accurate method for the detection of pathogens in patients with respiratory tract infections, and it will have a broad application prospect to develop reagents suitable for clinical diagnosis. Key words: Capillary electrophoresis; Respiratory tract infection; Respiratory pathogen; Multiplex PCR
目的探讨基于毛细管电泳的多重PCR (CEMP)检测儿童呼吸道感染病原菌的效果,为临床快速准确的诊断和治疗提供科学依据。方法根据国家“十二五”期间发热性呼吸综合征监测规划确定病例,采集2017年1月至2018年2月长春市儿童医院呼吸道感染患儿鼻咽拭子、支气管肺泡灌洗液和痰液样本。采用一步法进行多重PCR扩增,用毛细管电泳法对扩增产物进行DNA长度大小分离,用Genemapper软件对病原菌进行分析。检测病原体包括甲型流感病毒(InfA)、人腺病毒(hav)、博卡病毒(Boca)、人鼻病毒(HRV)、新型流感病毒- 09h1 (InfA- 09h1)和季节性流感病毒H3N2 (InfA-H3N2)、副流感病毒(HPIV)、人肺炎病毒(HMPV)、乙型流感病毒(InfB)、肺炎支原体(Mp)、肺炎衣原体(CP)、人冠状病毒(HCOV)、人呼吸道合胞病毒(HRSV)。结果该方法有效检出率为95.71%。呼吸道病原菌检出率为62.84%,混合感染率为9.61%。混合感染以猪流行性感冒和HRSV为主。阳性率最高的3种分别为ina、HRSV和Mp。0 ~ 3岁年龄组HRSV阳性率明显高于老年组。不同年龄组的病原菌检测结果不同,呼吸道病毒感染高发季节为12月~次年3月。2017年1月、2月和3月主要流行流感病毒为InfA-09H1, 11月和12月主要流行流感病毒为InfA-H3N2,长春市于2017年底和2018年初暴发流感病毒。长春市仅在11月至次年3月的最冷季节检测到HRSV。在不同的呼吸道感染中检出不同的病原体。肺炎检出的主要病原体为HRSV;急性支气管炎检出的主要病原体为InfA-03H2和HPIV;HRV和InfA是上呼吸道感染的主要病原体。结论CEMP是一种高效、快速、准确的呼吸道感染病原菌检测方法,开发适合临床诊断的试剂具有广阔的应用前景。关键词:毛细管电泳;呼吸道感染;呼吸道病原体;多重聚合酶链反应
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引用次数: 0
Application of blood purification in children with severe adenoviral disease 血液净化在重症腺病毒病患儿中的应用
Pub Date : 2019-10-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2019.10.004
Yun Cui
Severe hypoxia respiratory failure or acute respiratory distress syndrome, acute renal injury, liver function disorder, and multiple organ dysfunction syndrome caused by severe adenoviral disease have high mortality.Blood purification have become more widely available for acute renal injury, fluid overload, hyperlactacidemia, inflammatory reaction, coagulopathy and so on.The methods include renal replacement therapy(RRT) and therapeutic plasma exchange, usually combined with extracorporeal membrane oxygenation (ECMO). The appropriate blood purification strategy has not been available.Based on experience of RRT in acute renal injury, liver dysfunction, currently continuous renal replacement therapy/RRT technologies are reasonable used by personalized decision-making. Key words: Continuous renal replacement therapy; Therapeutic plasma exchange; Adenoviral disease; Adenoviral pneumonia; Critically ill; Children
严重腺病毒性疾病引起的严重缺氧呼吸衰竭或急性呼吸窘迫综合征、急性肾损伤、肝功能紊乱和多器官功能障碍综合征的死亡率很高。血液净化已越来越广泛地用于急性肾损伤、液体超负荷、高乳酸血症、炎症反应、凝血障碍等。方法包括肾脏替代治疗(RRT)和治疗性血浆置换,通常与体外膜肺氧合(ECMO)相结合。目前还没有合适的血液净化策略。根据RRT治疗急性肾损伤、肝功能不全的经验,目前连续性肾脏替代治疗/RRT技术在个性化决策中的应用是合理的。关键词:持续性肾脏替代疗法;治疗性血浆交换;腺病毒性疾病;腺病毒性肺炎;病危;儿童
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引用次数: 0
Application of ECMO in the treatment of severe adenovirus pneumonia ECMO在重症腺病毒肺炎治疗中的应用
Pub Date : 2019-10-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2019.10.005
Zi-hao Yang
Adenovirus is one of the common pathogens causing respiratory tract infection in children, which can cause severe pneumonia.Severe adenovirus pneumonia has an acute onset, rapid progress, and many complications, but there is no specific treatment and the mortality rate is high.Mechanical ventilation is an important means of respiratory support for the treatment of severe adenoviral pneumonia, and ventilator-associated lung injury is an inevitable drawback of mechanical ventilation.ECMO can replace and support cardiopulmonary function for a long time, reduce the occurrence of such damage, and improve oxygenation.When patients with severe adenovirus pneumonia develop respiratory failure or ARDS, and conventional treatment fails to improve hypoxemia, or accompanied by air leakage and other complications, ECMO treatment should be considered.However, there are few relevant studies in China, and further experience needs to be accumulated in the selection of respiratory support modes, intervention opportunities and management points of ECMO respiratory support for severe adenovirus pneumonia. Key words: Extracorporeal membrane oxygenation; Severe adenovirus pneumonia; Respiratory support
腺病毒是引起儿童呼吸道感染的常见病原体之一,可导致严重肺炎。重型腺病毒肺炎发病急,进展快,并发症多,但尚无特效治疗,死亡率高。机械通气是治疗严重腺病毒性肺炎的重要呼吸支持手段,而呼吸机相关性肺损伤是机械通气不可避免的缺点。ECMO可以长期替代和支持心肺功能,减少这种损伤的发生,并改善氧合。当重症腺病毒肺炎患者出现呼吸衰竭或ARDS,常规治疗未能改善低氧血症,或伴有漏气等并发症时,应考虑ECMO治疗。但国内相关研究较少,在重症腺病毒肺炎ECMO呼吸支持的呼吸支持模式选择、干预时机和管理要点等方面还需要进一步积累经验。关键词:体外膜肺氧合;严重腺病毒肺炎;呼吸支持
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引用次数: 0
Current status of Acinetobacter baumannii infection and antibiotic selection in children 儿童鲍曼不动杆菌感染现状及抗生素选择
Pub Date : 2019-10-20 DOI: 10.3760/CMA.J.ISSN.1673-4912.2019.10.011
Caifang Xu
Acinetobacter baumannii is an important pathogen of clinical infection in critically ill patients.The clinical detection rate of Acinetobacter baumannii is increasing and the drug resistance is becoming more and more serious.The selection of antibiotics to antibiotic-resistant Acinetobacter baumannii is very limited, particularly in children with the special age and physiological characteristics, which aggravates the clinical burden.This article reviewed the status of Acinetobacter baumannii infection, especially on different diseases including pneumonia, bloodstream infections, intracranial infections and antibiotics using. Key words: Acinetobacter baumannii; Drug resistance; Children; Antibiotics
鲍曼不动杆菌是危重病人临床感染的重要病原菌。鲍曼不动杆菌的临床检出率越来越高,耐药性也越来越严重。对抗生素耐药的鲍曼不动杆菌的抗生素选择非常有限,尤其是在具有特殊年龄和生理特征的儿童中,这增加了临床负担。本文综述了鲍曼不动杆菌的感染情况,特别是肺炎、血液感染、颅内感染和抗生素使用等不同疾病的感染情况。关键词:鲍曼不动杆菌;耐药性;儿童;抗生素
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引用次数: 0
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中国小儿急救医学
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