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1.
Mortality from coronary heart disease in civil servants in the lowest grade of employment has been found to be about three times that of men in the highest grade of employment. As part of an investigation of this finding several haemostatic variables were measured in a sample of 29 men in lower grades of employment and 45 men in higher grades. There was a significant difference in plasma fibrinogen concentrations between men in lower grades of employment and those in higher grades (mean 3.39 g/l v 2.95 g/l, respectively; p less than 0.01) but not in other haemostatic variables. Multiple regression analyses showed significant independent associations of fibrinogen concentration with smoking (p less than 0.05) and grade of employment (p less than 0.05). The size of the observed difference between the grades of employment was similar to that between those dying of coronary heart disease or surviving during longitudinal study; it may therefore be an important part of the mechanism underlying social class differences in coronary heart disease. The statistical relation between fibrinogen concentrations and other characteristics that may be concerned in the aetiology of coronary heart disease was examined. A summary measure of job stress was significantly related to fibrinogen concentration (p less than 0.01) and made a substantial contribution to explaining the differences between grades of employment. Behaviour type and a score of physical activity were not significantly related to fibrinogen concentration.  相似文献   

2.
OBJECTIVE--To determine whether reduced fetal and infant growth are associated with higher plasma fibrinogen and factor VII concentrations in adult life. DESIGN--Follow up study of men born during 1920-30 whose weights at birth and at 1 year had been recorded by health visitors, and men born during 1935-43 whose size at birth had been measured in detail. SETTING--Hertfordshire and Preston, England. SUBJECTS--591 men born in east Hertfordshire who still lived there and 148 men born in Preston who still lived in or close to the city. MAIN OUTCOME MEASURES--Plasma fibrinogen and factor VII concentrations. RESULTS--Among men in Hertfordshire mean plasma fibrinogen and factor VII concentrations fell with increasing weight at 1 year (from 3.21 g/l in men of less than or equal to 18 lb to 2.93 g/l in men greater than or equal to 27 lb and from 122% of standard to 103%; p less than 0.001, p less than 0.005 respectively). The trends were independent of cigarette smoking, alcohol consumption, body mass index, and social class. Neither plasma fibrinogen nor factor VII concentration was related to birth weight. In men in Preston, however, fibrinogen concentration fell progressively as the ratio of placental weight to birth weight decreased (p = 0.01). CONCLUSIONS--Reduced growth in fetal life and infancy is strongly related to high plasma concentrations of the haemostatic factors fibrinogen and factor VII. This may be a persisting response to impaired liver development during a critical early period.  相似文献   

3.
The objective was to examine BMI of working‐age Canadian adults in relation to occupational prestige, adjusting for other aspects of social class including household income and respondent's education. We analyzed data from 49,252 adults (age 25–64) from Cycle 2.1 of the Canadian Community Health Survey, a cross‐sectional self‐report survey conducted in 2003. Multiple linear regression was used to examine the relation between BMI and occupational prestige, adjusting for other sociodemographic variables. For women, higher ranking occupations showed lower average BMI relative to the lowest ranking occupations, but this effect was largely eliminated when adjusting for education. For men, occupation effects endured in adjusted models and we detected some evidence of a pattern whereby men in occupations characterized by management/supervisory responsibilities were heavier than those in the lowest ranking occupations (i.e., elemental sales and service). Results are interpreted in light of the symbolic value of body size in western culture, which differs for men and women. Men in positions of management/supervision may benefit from the physical dominance conveyed by a larger body size, and thus occupational prestige rankings may help us to understand the gender differences in the patterning of BMI by different indicators of social class.  相似文献   

4.
Red blood cell (RBC) aggregation is of prime importance in vivo and in vitro for low flow rates. It may be estimated by rheometrical measurements at low shear rates, but these are perturbed by slip and migrational effects which have already been highlighted in the past. These effects lead to a torque decay with time so that the true value of the stress at low shear rates may be greatly underestimated. Elevated aggregation being associated with different diseases, pathological blood samples show more pronounced perturbing effects and a strong time dependency in low shear rate rheometry. To test the dependence of slip and migrational effects on RBC aggregation, and particularly to determine the way in which they depend upon fibrinogen concentration ([Fb]), a home-made measuring system with roughened internal and external walls (170 microns roughness) was used to study low shear rate rheometry for RBC suspensions in PBS buffer containing albumin (at 50 g/l) and fibrinogen at various concentrations. The influences of hematocrit, shear rate, and fibrinogen concentration were investigated. Particular attention was paid to data acquisition at low shear rates (10(-3) s-1 to 3 x 10(-2) s-1). The combined influence of hematocrit and fibrinogen was investigated by adjusting hematocrit to 44 or 57% and fibrinogen concentration ([Fb]) to 3.0-4.5-6.5 g/l. Microscopic observations of the blood samples at rest were performed. They showed that different structures were formed according to fibrinogen concentration. The rheometrical measurements indicated that torque decay with shearing duration was strongly dependent on fibrinogen concentration and on shear rate at fixed hematocrit. Migrational and slip effects were more pronounced as shear rate decreased, fibrinogen concentration was raised, and hematocrit was lowered. The results have been explained on the basis of the expected microstructure of flowing blood in relation to the microscopic observations at rest.  相似文献   

5.
Thiocyanates (SCN-) are ubiquitous in nature. There are indispensable part of host defense system that act as a substrate for lactoperoxidase (LPO). In our study we present initial data on SCN- concentration in saliva of CF patients in comparison to healthy non-smokers and healthy smokers. 5 ml of saliva was collected from each subject to a sterile tube and thiocyanate concentration was measured in each sample. The results of the measurements are presented on Fig. 1. Mean concentration of SCN- in saliva of CF patients was 0.031 +/- 0.0052 g/l, in healthy non-smokers 0.039 +/- 0.0048 g/l and in healthy smokers 0.048 +/- 0.0161 g/l. The differences between each group were statistically significant. Studies on larger group of patients and probably on different material (BALF or induced sputum) should present interesting data complementing the in vitro studies.  相似文献   

6.
As part of a study to determine the extent to which the haemostatic system is implicated in the onset of clinically manifest ischaemic heart disease, characteristics influencing fibrinolytic activity (FA) and plasma fibrinogen concentrations were examined in 1601 men aged 18-64 and 707 women aged 18-59 in several occupational groups in North-west London. In men FA noticeably decreased till the age of about 58, when there was a small rise. In women a small increase in FA between 18 and about 40 was followed by a slightly larger fall between 40 and 59. There was a pronounced negative association of FA with obesity. FA was significantly less in smokers than non-smokers, though the effect was not large. FA increased with alcohol consumption. FA in men appeared to be greatest in the lower social classes, and men on night shift had poorer FA than those on day work. FA was greater in women using oral contraceptives than in those not using these preparations. In both sexes FA increased with exercise, but there were no associations between any of the characteristics studied and the increase. Plasma fibrinogen concentrations increase with age and obesity, are higher in smokers than non-smokers, and fall with alcohol consumption. In women the concentrations are higher in those using oral contraceptives. The general epidemiology of FA and plasma fibrinogen concentrations suggests that they may well be implicated in the pathogenesis of ischaemic heart disease.  相似文献   

7.
8.
Objective To evaluate an occupational therapy intervention to improve outdoor mobility after stroke.Design Randomised controlled trial.Setting General practice registers, social services departments, a primary care rehabilitation service, and a geriatric day hospital.Participants 168 community dwelling people with a clinical diagnosis of stroke in previous 36 months: 86 were allocated to the intervention group and 82 to the control group.Interventions Leaflets describing local transport services for disabled people (control group) and leaflets with assessment and up to seven intervention sessions by an occupational therapist (intervention group).Main outcome measures Responses to postal questionnaires at four and 10 months: primary outcome measure was response to whether participant got out of the house as much as he or she would like, and secondary outcome measures were response to how many journeys outdoors had been made in the past month and scores on the Nottingham extended activities of daily living scale, Nottingham leisure questionnaire, and general health questionnaire.Results Participants in the treatment group were more likely to get out of the house as often as they wanted at both four months (relative risk 1.72, 95% confidence interval 1.25 to 2.37) and 10 months (1.74, 1.24 to 2.44). The treatment group reported more journeys outdoors in the month before assessment at both four months (median 37 in intervention group, 14 in control group: P < 0.01) and 10 months (median 42 in intervention group, 14 in control group: P < 0.01). At four months the mobility scores on the Nottingham extended activities of daily living scale were significantly higher in the intervention group, but there were no significant differences in the other secondary outcomes. No significant differences were observed in these measures at 10 months.Conclusion A targeted occupational therapy intervention at home increases outdoor mobility in people after stroke.  相似文献   

9.
A method was developed for the determination in human urine of S-phenylmercapturic (PMA) and S-benzylmercapturic (BMA) acids, metabolites respectively of benzene and toluene. PMA and BMA were determined, after alkaline hydrolysis, to give respectively thiophenol and benzylmercaptan, and coupling of the thiol-containing compounds with monobromobimane (MB), by reversed-phase HPLC on a diphenyl-silica bonded cartridge (100×4.6 mm I.D., 5 μm particle size) with fluorimetric detection. Wavelengths for excitation and emission were 375 and 480 nm, respectively. The recovery of PMA and BMA from spiked urines was >90% in the 10–500 μg/l range; the quantification limits were respectively 1 and 0.5 μg/l; day-to-day precision at 42 μg/l was C.V. <7%. The suitability of the proposed procedure for the biological monitoring of exposure to low-level airborne concentrations of benzene and toluene, was evaluated by analyzing the urinary excretion of PMA and BMA in subjects exposed to different sources of aromatic hydrocarbons, namely occupationally-unexposed referents (non-smokers, n=15; moderate smokers, n=8; mean number of cigarettes smoked PER-DAY=17 cig/day) and non-smoker workers occupationally exposed to toluene in maintenance operations of rotogravure machines (non-smokers, n=17). Among referents, non-smokers showed values of PMA ranging from <1 to 4.6 μg/l and BMA from 1.0 to 10.4 μg/l; in smokers, PMA values ranging from 1.2 to 6.7 μg/l and BMA from 9.3 to 39.9 μg/l, were observed. In occupationally exposed non-smoker subjects, BMA median excretion value (23.6 μg/l) was higher than in non-smoker referents (3.5 μg/l) (P<0.001) and individual BMA values (y, μg/l) were associated and increased with airborne toluene concentration (x, mg/m3) according to the equation y=6.5+0.65x (r=0.69, P<0.01, n=17). The proposed analytical method appears to be a sensitive and specific tool for biological monitoring of low-level exposure to benzene and toluene mixtures in occupational and environmental toxicology laboratory.  相似文献   

10.
A method was developed for sensitive determination of the specific benzene metabolite S-phenylmercapturic acid and the corresponding toluene metabolite S-benzylmercapturic acid in human urine for non-occupational and occupational exposure. The sample preparation procedure consists of liquid extraction of urine samples followed by precolumn derivatization and a clean-up by normal-phase HPLC. Determination of analytes occurs by gas chromatography with electron-capture detection. With this highly sensitive method (detection limits 60 and 65 ng/l, respectively) urinary S-phenylmercapturic and S-benzylmercapturic acid concentrations for non-occupationally exposed persons (e.g. non-smokers) can be measured precisely in one chromatographic run. Validation of the method occured by comparison with a HPLC method we have published recently.  相似文献   

11.
Using a simple self-administered questionnaire, habitual physical activity was assessed on a population composed of those engaging in fruit culture and those of salaried workers in a town of Yamanashi prefecture, Japan. Principal components analysis was applied to find meaningful dimensions of habitual physical activity using 5-point scale for responses to the 13 items of questions, and suggested 3 substantial dimensions: work intensity, work posture and leisure time scores. While aging is generally characterized by a progressive decline in both occupational and leisure time activity, this population was characterized by positive correlation between age and work intensity (only in male subjects). There were clear differences in habitual physical activities by gender- or age-related household membership. In all three indices, mean scores were significantly higher in a group of farm households than that of non-farm households. Low level of physical activity was associated with both occupational work and leisure time physical activity.  相似文献   

12.
There is growing evidence that social rhythms (e.g., daily activities such as getting into or out of bed, eating, and adhering to a work schedule) have important implications for sleep. The present study used a prospective measure of daily activities to assess the relation between sleep and social rhythms. College students (n=243) 18 to 39 yrs of age, completed the Social Rhythm Metric (SRM) each day for 14 d and then completed the Pittsburgh Sleep Quality Index (PSQI). The sample was divided into groups of good or poor sleepers, according to a PSQI cut‐off score of 5 points and was compared on the regularity, frequency, timing, and extent of social engagement during activities. There was a lower frequency and less regularity of social rhythms in poor sleepers relative to good sleepers. Good sleepers engaged more regularly in activities with active social engagement. Earlier rise time, first consumption of a beverage, going outdoors for the first time, and bedtime were associated with better sleep. Greater variability in rise time, consuming a morning beverage, returning home for the last time, and bedtime were associated with more disturbed sleep. The results are consistent with previous findings of reduced regularity in bedtime and rise time schedules in undergraduates, other age groups, and in clinical populations. Results augment the current thought that regulating behavioral zeitgebers may be important in influencing bed and rise times, and suggest that engaging in activities with other people may increase regularity.  相似文献   

13.
The selenium levels and the glutathione peroxidase activity GSH-PX of whole blood and of erythrocytes, respectively, were determined in 139 normal Danes and related to sex and smoking habits. No differences were found in relation to sex apart from a higher GSH-PX activity of females when assayed with tertiary butyl hydroperoxide. Smokers showed significantly lower selenium values than non-smokers (p<0.05), but the two groups had identical GSH-PX activities. Individuals from the above-mentioned group were divided into four groups, receiving daily oral doses of 200 μg of selenium in the form of selenite, selenate, L-selenomethionine, and selenium as contained in yeast. Whole blood selenium values and the erythrocyte glutathione peroxidase activities were determined during three months of supplementation followed by a withdrawal period of four months. Both the inorganic selenium compounds and the organic derivatives gave rise to steady state levels of GSH-PX after one month of supplementation. However, the selenium levels in the groups receiving organic selenium showed a steady rise during the whole period, whereas those supplemented with inorganic selenium leveled off after a period of one to three months. The data for smokers and non-smokers revealed identical results when organic selenium was supplemented. However, selenite gave rise to significantly higher selenium levels and GSH-PX activities in smokers than in non-smokers. Less significant (p<0.08) elevations of both parameters were also observed among the smokers in the selenate group. By taking both the selenium level and the GSH-PX activity into consideration, organic selenium (i.e.,l-(+) selenomethionine) was judged to be more bioavailable than selenite and selenate.  相似文献   

14.
In the Gothenburg primary prevention study 7083 middle aged men were classified into five categories by occupational state. A retrospective analysis of the data showed that low occupational class was associated with slight increases in smoking rates, systolic blood pressure, serum cholesterol concentration, body mass index, and heart rate. Alcohol abuse was strongly associated with low occupational class. After a mean of 11.8 years'' follow up the incidence of coronary heart disease was found to be strongly and inversely related to occupational class. For death from coronary heart disease this association fell just below significance when other risk factors were taken into account, but the inverse association between non-fatal myocardial infarction and occupational class persisted even in multivariate analysis. A weak but independent inverse relation was found between occupational class and fatal cancer. Mortality from all causes in the lowest occupational class was 12% compared with 6% in the highest class, and this difference could only partly be explained by other factors. After 10 years a sub-sample of the men were examined again. Risk factors had decreased in all occupational classes, but the changes in risk were not associated with occupational class. Social class, defined by occupation, in Sweden is clearly related to the incidence of coronary heart disease.  相似文献   

15.
OBJECTIVES--To investigate the relation between cognitive function and cause specific mortality in people aged 65 and over. DESIGN-A 20 year follow up study of a cohort of randomly selected elderly people living in the community who in 1973-4 had taken part in a nutritional survey funded by the Department of Health and Social Security. SETTING--Eight areas in Britain (five in England, two in Scotland, and one in Wales). SUBJECTS--921 men and women whose cognitive function was assessed by a geriatrician in 1973-4 and for whom data on health, socioeconomic circumstances, and diet had been recorded. RESULTS--Cognitive impairment was associated with increased mortality, in particular death from ischaemic stroke. Those who scored 7 or less on the Hodkinson mental test had a relative risk of dying from stroke of 2.8 (95% confidence interval 1.4 to 5.5), compared with those who gained the maximum score (10), after adjustment for age, sex, blood pressure, serum cholesterol concentration, and vitamin C intake. These associations were independent of illness or social class. At the time of the nutritional survey, cognitive function was poorest in those with the lowest vitamin C status, whether measured by dietary intake or plasma ascorbic acid concentration. The relation between vitamin C status and cognitive function was independent of age, illness, social class, or other dietary variables. CONCLUSION--The relation between cognitive function and risk of death from stroke suggests that cerebrovascular disease is an important cause of declining cognitive function. Vitamin C status may be a determinant of cognitive function in elderly people through its effect on atherogenesis. A high vitamin C intake may protect against both cognitive impairment and cerebrovascular disease.  相似文献   

16.
Analyses of entheseal changes (EC) in identified skeletal samples employ a common research strategy based on the comparison between occupations grouped on the basis of shared biomechanical and/or social characteristics. Results from this approach are often ambiguous, with some studies that point to differences in EC between occupational samples and others failing to provide evidence of behavioral effects on EC. Here we investigate patterns of EC among documented occupations by means of a multivariate analysis of robusticity scores in nine postcranial entheses from a large (N = 372) contemporary skeletal sample including specimens from one Italian and two Portuguese identified collections. Data on entheseal robusticity, analyzed by pooled sides as well by separated sides and levels of asymmetry, are converted in binary scores and then analyzed through nonlinear principal component analysis and hierarchical cluster analysis. Results of these analyses are then used for the classification of occupations. Differences between occupational classes are tested by MANOVA and pairwise Hotelling's test. Results evidence three classes which separate occupations related to farming, physically demanding but generalized occupation, and physically undemanding occupations, with the more consistent differences between the first and the last classes. Our results are consistent with differences in biomechanical behavior between the occupations included in each class, and point to the physical and social specificity of farming activities. On the other hand, our study exemplifies the usefulness of alternative analytical protocols for the investigation of EC, and the value of research designs devoid of a priori assumptions for the test of biocultural hypotheses. Am J Phys Anthropol 156:215–223, 2015. © 2014 Wiley Periodicals, Inc.  相似文献   

17.
《BMJ (Clinical research ed.)》1990,300(6724):573-578
OBJECTIVE--To determine whether recombinant human erythropoietin improves the quality of life and exercise capacity of anaemic patients receiving haemodialysis. DESIGN--A double blind, randomised, placebo controlled study. SETTING--Eight Canadian university haemodialysis centres. PATIENTS--118 Patients receiving haemodialysis aged 18-75 with haemoglobin concentrations less than 90 g/l, no causes of anaemia other than erythropoietin deficiency, and no other serious diseases. INTERVENTIONS--Patients were randomised to three groups to receive placebo (n = 40), erythropoietin to achieve a haemoglobin concentration of 95-110 g/l (n = 40), or erythropoietin to achieve a haemoglobin concentration of 115-130 g/l (n = 38). Erythropoietin was given intravenously thrice weekly, initially at 100 units/kg/dose. The dose was subsequently adjusted to achieve the target haemoglobin concentration. All patients with a serum ferritin concentration less than 250 micrograms/l received oral or intravenous iron for one month before the study and as necessary throughout the trial. MAIN OUTCOME MEASURES--Scores obtained with kidney disease questionnaire, sickness impact profile, and time trade off technique; and results of six minute walk test and modified Naughton stress test. RESULTS--The mean (SD) haemoglobin concentration at six months was 74 (12) g/l in patients given placebo, 102 (10) g/l in those in the low erythropoietin group, and 117 (17) g/l in those in the high erythropoietin group. Compared with the placebo group, patients treated with erythropoietin had a significant improvement in their scores for fatigue, physical symptoms, relationships, and depression on the kidney disease questionnaire and in the global and physical scores on the sickness impact profile. The distance walked in the stress test increased in the group treated with erythropoietin, but there was no improvement in the six minute walk test, psychosocial scores on the sickness impact profile, or time trade off scores. There was no significant difference in the improvement in quality of life or exercise capacity between the two groups taking erythropoietin. Patients taking erythropoietin had a significantly increased diastolic blood pressure despite an increase in either the dose or number of antihypertensive drugs used. Eleven of 78 patients treated with erythropoietin had their sites of access clotted compared with only one of 40 patients given placebo. CONCLUSIONS--Patients receiving erythropoietin were appreciably less fatigued, complained of less severe physical symptoms, and had moderate improvements in exercise tolerance and depression compared with patients not receiving erythropoietin. At the doses used in this trial there was a higher incidence of hypertension and clotting of the vascular access in patients treated with erythropoietin.  相似文献   

18.
There is growing evidence that social rhythms (e.g., daily activities such as getting into or out of bed, eating, and adhering to a work schedule) have important implications for sleep. The present study used a prospective measure of daily activities to assess the relation between sleep and social rhythms. College students (n=243) 18 to 39 yrs of age, completed the Social Rhythm Metric (SRM) each day for 14 d and then completed the Pittsburgh Sleep Quality Index (PSQI). The sample was divided into groups of good or poor sleepers, according to a PSQI cut-off score of 5 points and was compared on the regularity, frequency, timing, and extent of social engagement during activities. There was a lower frequency and less regularity of social rhythms in poor sleepers relative to good sleepers. Good sleepers engaged more regularly in activities with active social engagement. Earlier rise time, first consumption of a beverage, going outdoors for the first time, and bedtime were associated with better sleep. Greater variability in rise time, consuming a morning beverage, returning home for the last time, and bedtime were associated with more disturbed sleep. The results are consistent with previous findings of reduced regularity in bedtime and rise time schedules in undergraduates, other age groups, and in clinical populations. Results augment the current thought that regulating behavioral zeitgebers may be important in influencing bed and rise times, and suggest that engaging in activities with other people may increase regularity.  相似文献   

19.
BackgroundAlthough physical activity has been associated with a reduced risk of breast cancer risk in high income countries (HIC), its role has not been widely studied in sub-Saharan Africa. Our aim was to investigate the association between physical activity (PA) and the risk of breast cancer in Nigeria.MethodsWe conducted a hospital-based case-control study involving participants from five hospitals in Lagos and Abuja. Women were interviewed in-person between October 2016 and May 2017 using a semi-structured questionnaire. Total PA was estimated by summing occupational, household, transport and leisure PA scores. PA was summarised as metabolic equivalents (MET) hours per week (MET-hr/wk). The putative association between breast cancer incidence and PA was analysed using multivariable logistic regression.Results379 histologically confirmed breast cancer cases and 403 controls took part. Compared to women in the lowest categories, women in the upper middle category of total PA(adjusted OR-AOR 0.44, 95% CI: 0.27, 0.78),uppermost categories of total non-vigorous PA (AOR 0.26, 95%CI:0.09,0.75), household PA(AOR 0.0.38, 95% CI: 0.20, 0.71) and occupational PA (AOR 0.64, 95% 0.40, 1.02) had a reduced risk of breast cancer following adjustment for relevant confounders. Transport and leisure PA were not significantly associated with a reduced risk of breast cancer.ConclusionThe total effect of various PA related to regular activities of Nigerian women was associated with a reduced risk of breast cancer. PA especially at household and occupational environments should be promoted as part of breast cancer prevention strategy in Nigeria.  相似文献   

20.
Liu W  Vogt CA  Luo J  He G  Frank KA  Liu J 《PloS one》2012,7(4):e35420
Nature-based tourism has the potential to enhance global biodiversity conservation by providing alternative livelihood strategies for local people, which may alleviate poverty in and around protected areas. Despite the popularity of the concept of nature-based tourism as an integrated conservation and development tool, empirical research on its actual socioeconomic benefits, on the distributional pattern of these benefits, and on its direct driving factors is lacking, because relevant long-term data are rarely available. In a multi-year study in Wolong Nature Reserve, China, we followed a representative sample of 220 local households from 1999 to 2007 to investigate the diverse benefits that these households received from recent development of nature-based tourism in the area. Within eight years, the number of households directly participating in tourism activities increased from nine to sixty. In addition, about two-thirds of the other households received indirect financial benefits from tourism. We constructed an empirical household economic model to identify the factors that led to household-level participation in tourism. The results reveal the effects of local households' livelihood assets (i.e., financial, human, natural, physical, and social capitals) on the likelihood to participate directly in tourism. In general, households with greater financial (e.g., income), physical (e.g., access to key tourism sites), human (e.g., education), and social (e.g., kinship with local government officials) capitals and less natural capital (e.g., cropland) were more likely to participate in tourism activities. We found that residents in households participating in tourism tended to perceive more non-financial benefits in addition to more negative environmental impacts of tourism compared with households not participating in tourism. These findings suggest that socioeconomic impact analysis and change monitoring should be included in nature-based tourism management systems for long-term sustainability of protected areas.  相似文献   

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