高温高湿环境下颅脑损伤动物创腔及周围组织细菌生长的特点
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高温高湿环境下颅脑损伤动物创腔及周围组织细菌生长的特点
中国临床康复第7D卷第理期2006—03~25出版
chi舶3eJoHmd《cltn记文Reh幽ahm幻‰M珊ch
25
20IMv01.10
No.12
187
?BAsICREsEARCH?
CharactersofbacterialgrowthinwoundCaVltyannDenDneraJanlmalSWltnCraln0CerebrallnlUryUnnerhyperthermiaand
●
●
●J1●■●J●●
nSSUeln
●●l●●●●●1
high-humidity术★
Guo
Yan—wul,ZhangShi—zhon91,ZhuHong—shen92,XuRu—xiang
1Departmentof
Neurosu唱ew,
5
zhujiangHospital,
of
Chinese
PLA,
SouthemMedicaluni—has
not
entered
h培h—rate
repair.
increasingstag。yet,due
to
which,it
isstill
s出
versity,GuangzhouNeumsu。gery,GuOYan—wu★,
the
10282,GuangdongPmvince,China;2DepartmentofHospital
fordebridement
422
Zhalljiang
524005,
Guo
GuangdongPmvince,China
Master,
Y眦zhangsZ.zhuHSpeapheraI
fissue
xuRXchoraderSofbocfenajgro、们h.nⅥ,ound
w计h
covify
Attendingphysician,Lecturer,
Depanmentof
andand
inanimals
crainocerebraIiniury
under
hypenhermia
Neumsurgery,zhujiangHospital,southem,Medicaluniversity,Guangzhou
510282,GuallgdongPmvjnce,Cbjna
Supportedby:MilitaryMedicalScienti矗candTechnologicalingNinthFive—YearPlanPeriod,No.96M0674
Received:2004一09一17
Accepted.2005—11—21
high—humid眦觋on昭聊∞比^“矾gK∞咖2006:10门2l:187—9(China)h^^^wzgIc睹coml
INTRoDUCTIoN
Ppojectdur-
(04一04—9—6136/YL)
Craniocereb矗ImissilewoundfCMWlisthecommon
ofwar’anditsincidenceis
severe
trauma
15%一20%。justIessthantheiniuIvof
isthetopofthe
Abstract
BACKGRoUND:Cminocerebral
verevates
fourlimbs,butits
missile
woundthe
fCMW)isthe
important
commonse—
traumaofwar.EnvimnmentaIfactorjsfactorthat
mortalityinjuIiesineverypartof
wholeboy,about30%to50%【¨.Thetypicalclimateishyperther—
miaandhighin
aggra—
thedeveloDmentofsicknessandthrea【ensthelifb
at
ofthesickand
humidityineveryprovinceandre西onalongthe
includingthe
vast
coast
wounded
under
earlvstage.Thestudv
and
onbasictheory
is
the
andmaior
treatmentof
CMW
thesouthofChina,territoryofHongKong,
hypenhe删ja
To
hi如一humi击tv
task
in
mili£aw
Macao。Taiwan.theXishaIslandsandNanshaIslands.Forsuchenvironmentisthemost
CMW.
and
medicine.oBJECTIVE:
cavity
majorfactorthat
the
li托
innuenceoflifb
aggravates
thede—
observethe
tissue
charactersof
bacterial舯wth
under
to
inwoundveloDmentwounded
at
ofsicknessandthI℃atensofthesick
andperipherd
so
as
to
after
the
CMW
incats
hvperthe瑚ia
tissue
repair
andand
high-humiditv
its
provide
in
referencedatathe
earlystage.The
significant
on
hypenhe硼iaandhigh—
functional
recoverv
CMW.
exDeriment.
in
humidityisveIyphysicalsignsandmortalityof
on
DESIGN:RandomizedcontmUedSETTDⅡG:Su唱eryed
to
CMW【刨.
Therefore.
thestudv
basictheonrandtreatmentof
ZhujiangHospitaI娟Iiat—
SouthemMedicalUniversitv(FirstMilitaryMedicalUniversity).
Department
ofNeumlog)r
CMWunderhyperthennjaandhigh-humidityisthemajortaskin
militarvmedicine.fection
at
Inthisresearch.
stage
on
thecharacterofbacterialin.
MATEmALS:
Medicineand2003.In
Theexperimem
was
pe面彻ed
inDepanmentofTropical
to
May
theeadvof10w.velocitvit
were
CMWandtheinnuenceof
so
as
HygieneinSouthemMedical
catswere
University
f而mApril
environmentalfhctor
expJoredinitiaIlv
Ian窖.e
to
providethesoft
hybridemployed,ofcleangmde,of
eithersex,body—weighted(2.5±0.2)kg,providedf而mExperimentalAnimal
theexperiment,24
tlleevidencesfororientatingthetissueofcerebral
ofdebridementin
CenterofSouthemMedicalUniversitv.The
4
animalswere豫ndomizedinto
fiream
woundaJldforchoosingtherightmoment
groups,namedthecontml
atcommon
perature
gmup(8cats),hyperthe咖ia
cat
andhigh—humidity
temperature(5cats),commontem—
gmup(8cats)andinjectedabdominallvwith30∥L
Aftersuccessfulestablishment
temperature
ofdebridementinviewofinfbctiouscontrDl.
blankcontmlf3catsl.
METHoDS:Afterwei加ted,the
pentobarbitolsodium
solution
at
was
MATERIALSMaterials
TheexperimentandHygienein
AND
METHoDS
30
mg/kg.
was
ofcraniocerebralblindgutwound
cats
model,incommon
gmup,the
peIfoHnedinDepartmentofTmpicalMedicine
wereDlaced
6
insimulated
in
cljmaticcabin
at
25℃and50%relevant
the
SouthemMedicalUniversity(FirstMilitar)『Medical
April
to
humidityfor
cats
hoursand
in
were
placed
the
hyperthe珊iaandhigh—humiditygmup,
hvperthe瑚iaandhigh.humiditvenvimnment
f}a5汹enfed
bIain
tissuein
0—5
Universi‘y)from
cats
were
May2003.Intheexperiment,24
hybrid
fbr6
employed,ofclean
bours.brain
were
Witbbiopsy。
tissue
on
thewound
mm
tI.actandthe
mmho—
(2.5±O.2)
Southem
gmde,ofeithersex,body—weighted
kg,providedf而mExperimentalAnimalCenterof
University
were
thewallofwound
tract
farf而mand5—10
and
to
Medical
(License
Number:2002—007
named
c01lectedandprepared.into
countingwas
in
successivelyin24
naturalsolution
culture
In
mogenate。andlatebacterialtrol-the
cats
done
hoursofbacterial
calcu—
con—
2003A050).
thecontml
at
Theanimalscommon
mndomizedinto4groups,
content
woundcavitv
a11dperipheral
tissue.blank
tempemture(5cats),commontemperature
were
rest
sacrifjced
were
withanesthesiasame
as
andthematerial
at
wascollected
group(8cats),hyperthe珊ia
blankcontml
andhigh?humiditygroup(8cats)and
JapaneseNarishige
temperature,
hu—No.1
directlv.me
steDs
thecontrol
commontemperature.
in
f3catsl.
Stereotaxicinstnlment
MAINoUTCOM[EM[EASURES:BacteriaI
peripheral
tissuein
contentwoundcavitvand
Instmments:
(SN—I,
each
gmup.
were
Company),
eⅡlploved
inoutcome
in
simulatedclimatic
speed,
cabin(adjustable
RESULTS:Totallv23animals
一al
analvsis.Bacte一dif玷rem
that
groupssi静1ifi—
com-
comemsjnsameregions
was
were
dif玷rentremarkably
in
midityandwindMilitary
Medical
developedin
ThernlalInstituteof
(。F=171.423.P=0.000).It
cant
indicated
paired
at
comparison
difference
happens
betweenthecontmlcommontemperature,
leadphysiologytemperature
University),gasgun(B5—2A,fmmGuangzhou),8一recorder(RM一600,NihonKohden,J印an),constant
(Shanghai
Rong-fengScientific
InstrIlmentShanghai
mon
temperature
gmupandhyperthe彻ia
at
blankcontmlsuccessivelv俨<O.01).The
the
control
andhigh—humidityg严oupanddifferencewasnotsigIlificantin
commontem—
incubator
Company,Ltd),table—styledentalelectmdrill(307—6,
Dental
thecomparisonamongcommontemperature,
peratur8夸oupandbperthermiaandterialcontentsatdiffbrentdistancesremarkablv
ineach
hi出-humiditygroup(p>O.05).Bac—
fromthe
woundcavitvwerediff色rent
InstmmentFacotory),portablesterilizationsystem(Suzhou
MedicalInstmmentCompany,Ltd.)andelectronicanalyzingscale
A&D
gmupfF_14.865,P=0.000).
and
CoNCLUSIoN:Hyperthe咖ia
cantly
the
high—hu而iditydoes
in
notimpactsignifi—
(ER—120A,JapaneseMethodsCalmrati彻“gas
Company).dete册inatjon
ofbulletvelocity
bacterjal卿wth
of
CMW6hoursandbacterialreproduction
gunand
IssN167l一5926CN2l一1470/R
188
一.召c够com
bullet,(0.60±0.01)g
used;thegun
was
妮刀8∞韶吼imcom郭燕舞,等高温高湿环境下颅脑损伤动物创腔及周围组织细菌生长的特点
Intheexperiment,the4.5mmindiameterletvelocitywith
one
in
massweightand
catwasdiedinblank
contIDl,te珊inaUy,23
catsweIe
inoutcome
was
calibratedanditsbul-
analysis.
Bacte—alcontentiIl
was
detemined.The
velocity
was
(65.72±1.43)In/s
with
two
aIlimaIbraintissueafterinjuryill明ch
’
pressureandwas(101.54士4.42)m/s
was
at
pressures.
group口able1)
Table
l
3】
PrepamtionofCMWmodel【1
BacterialcontentinaIlimalbraintissue甜ter
After
weighted,the
cat
injected
on
abdominallywith30g/Lpen—
success—
gmup
injuFineach
0±spcs-/曲
tobarbitolsodiumsolutionfully,thelater,
catwas
30mg/kg.Afteranesthetized
stereotaxic
was
fixedinsupinefhme;2—3hours
added
toto
1/3ofthe
originaldoseofsolution
was
maintainthe
venex
theanesthesia.Thescalpalongthe
was
vertex
incisedf而meyebIDws
midline,
to
about2cmexpose
skull.
inlengthandthesofttissueAforamen
was
sepamtedbluntly
drilled
on
It
was
shownin’Ihble1thatbacte订al
contents
inthesameregions
theanteriorwallofright
f而ntalsinuandtheanterior
bywhich,
waxwas
wasremoved
was
were
diffbrentremarkablyindifferentgmups(肚171.423,e=o.000).
was
with6nebonegougingforceps,
theposteriorwall
Itwas
indicatedinpairedcomparisonthatthedif玷Ience
sig—
maintainedentirely.Finally,boneIntheexperiment,
appliedforhemostasis.
one
ni矗cantincompadsonbetweenthecommontemperatureandtheblank
contml
at
commontemperature,
thegasgunwith
buⅡetof
pressure
was
gmup,hypenhe珊ia
and
high—humidity
group
used.Thegunmouthtouchedtheposteriorwallofrightfmntalsinu,line
to
20。wasavoidthe
fo瑚edinjury
betweenof
calibmtingtrajectoryandsagittaJ
was
contmlsuccessively(P<0.01),butt}lerewasnosig—
nificantdifkrence锄ong山emreegmups(P>0.05).Remarkable
difI.erence
was
bminstem,andthen,thegun
fixed.
indicatedinbacterial
fromwound
was
contents
intheregionsthat
Wheneyelashrejectionwasrecovered,t}Iegllnwasshottoaccom—plishcraniocerebmlblindgutwoundmodel.Incommontempera—
ture
were缸differentlycav咄too(肚14.865,佟0.000).
contentwas
Significantdifkrenceshowninpailedcomparisonamongthree
decreasedbythein—
at
gmup
and
hyperthe瑚ia
and
was
high—humiditygroup,after
appliedforthe
was
cases
I℃gions(尸<0.01).7Ihe
creased
bacterial
wounded,
assistantrespirationwithap—distance
tothewoundtractinthecontIolcommontem—
andhigh—
nea.whenthesubjectiverespiration
izeddenturebaseI℃sin
was
was
restored
nomlally,steril-perature,
common
tempemture
gmupandhyperthe瑚ia
usedtosealbonewindowandtheskin
humiditygroup.
stjtched.
DISCUSSloN
at
MaterialcollectionandbacteriacultuI℃After
success
ofmodeling’
inthecontml
commontemperature,
on
Thegmwthofculturebacteriaisdividedintolagphase,logphase,stablephaseanddeathphase阁.LagphaseIeferswhichbacteria
do
not
to
thefhgmentedbraintissueinthewallofwound1ected
tract
woundtmctandthebmintissue
0—5mmand5—10mm
were
theperiodin
f矗f而mc01.
adapt
totIleenvironmentanditsdumtion
environment.
withasepticsuqgical
instmmentfiomthewoundedanimals
depends
host
on
theadaptability
ofbacteda
tothenew
inthewayof
was
biopsy.Afterweighted,isotonicphysi0109icalsaline
was
Thegmwtllofhostbacteriaisrather
complicated,
It
theimmunityof
added2.5mLfbreachone,andthen,aseptic昏五nder
to
resists舳d
eliminatesbaeteIia,which
pmlongsthepreparation
seen
used
preparehomogenate
of
that
was
diluted
as
natumlsolution
agarmediumcollect
one
stageofbacteriaenteTinglogphase.experiment,althoughthere
hreen
was
a
wasintheresultof
aJldhomogenate
was
100g/Lrespectively.
was
Commonused
to
cenainchangeincompadsonbe—
adoptedand
quantitativedmpper
natumlthebacteriacontentin
woundcavitytissuein6hoursafter
homogenateanddilution100g/L,
them
on
1mLfbreach
was
anddmpinjury(common
miditymon
temperaturegroupandthat
at
hypenhemia
injury(the
andhigh—hu—
at
theplate.Aftercoated
at
evenly,theplate
was
placedinthegmup)and
themomentofcontrolcom—
incubatorforculture
35℃,andcounting
the
cats
donein24hours.
temperature),
are
thedifkrencewasnot
significantin
statistical
Incommontemperaturegroup,climaticcabinthemateriaJgroup,the
at
were
placedinsimulated
6hourslater,
analysis.Itisexplaipedthatin6houIsofexperiment,tllepollutedbacteria
not
25℃andrelevanthumidity50%,
collected.
placedinthehypenhennia
stillinadaptivestage
tothenewenvironmentandhas
was
InhyperthenTliaandhigh—humidityenteredrepmductionstageofh远h—rate
as
growthyet.
cats
at
weIe
andhigh—humidity
6hourslater,
as
‘rhemostadaptivemonly
seen
tempemtureis37℃fort11egrowthofthecom—
bacteria,such
environmentthematerial
at
35℃andrelevanthumidity85%,
collectedandthesteps
were
infectious
staph.epide册idis,staph.
very
wassame
cats
thecontrDlsacri6ced
auIeus,escherichiacoli,efc.ThegIDwthofbacteriaisfited
at
bene—
commontemperature.Inblankcontrol,the
was
were
37—44℃嘲.’rhebodytempemtureofexperimentalanimal37℃,at
w“hanest}lesiaandthematerial
collecteddiIectlyfjombilat—
on
isabout
hyperthe硼ia,the
upto
regulationofbody
anus
tempemture
can
e矗Ip丽eta】_lobetissuewithasepticsurgicalinstnImentbased
biopsy,the
rest
isimpaired
afterwoundedandthe
tempemture
e.
bein-
ex.
stepswere,same
as
thecontmlat
commontempe卜
500×counts/
fTom
creasedpersistentlyperiment,thebody
to
42.5℃,
thelimitativevaluIhthis
ature.Bacterialcounting:bacterialcontent(pcs/曲=2
counts
were
weight(阻曲/dilution
two
multiple.10一loo
coUected
42.4℃,
can
tempemtureofcatwasinthemngef南m36.9℃
whichisthesuitabletemperatureforbacterialgr州nh.
that
theoutside
cu】tllredishesfbrsta6stic【4】.Itbeless
seenon
tempemtuI℃andhumidityinnu—
content
Statisticalanalysis
ThefiIstandthirdwritersadoptedSPSS
10.Osoftwareforstatisti—
were
ences
thereproductionandgrowthofbacteriainthewound
was
a
inshortperiod.Therewound
cenainchangeofbacterial
at
in
calmanagement,ANOVAandmultiplecompaIisonst}lecomparison
ingroupandamong
usedfor
was
ex—
tmctincomp耐sonofthecontrolcommontemperature
and
gmups.Theresultwithcommontemperaturegmup,gmupsuccessively,
hyperthe珊jahigh—humidity
Itis
ex—
pressedwithMean±SD.
butwithoutstatisticalsignificance.
area
plainedthatbacterialreproductionisdelayedinlocal
RESULTS
bacteriainthewoundedregionhave
analysisofthe
not
andthe
for
attackedallaIDund,
at
QuantitativeexperimentalaIIimals
ofwhichl
which,itissuitableIt
is
verified
to
applydebridement
early
stateoftrauma.
‘I、otally24animalsweI℃employedintheexperiment,simultaneou童lyintheexperimentthata11kinasof
ISSN1671-5926CN21-1470/R
M%碱t詹m
infection.
content
中国临床康复2006年3月25日第lO卷第12期
189
studyattachmentofbacteria
firearmwoundhavebacterialInthecontrolin
wound
tract
atcon.
uD
a
modifiedRobbinsdevice
or
floweell
totosur.
montemperature,thebacterial103
pcs./g.
Bacteria
are
wasto
7
faees.Methods
JiangHT.bu
Enzymol2001;337:43-62
broughtmainly
bythebullet
YQ,ZhangMC,et以.Bacteriological,studyinsofttissuesinfee-byhighvelocity
missile.ZhonghuaChuangshang
during
8
tionofmaxillofaeialwoundZozhi
shootingandabsorbeddue
to
thenegativepressureformedinthe
1997:13f31:155-7
Ds,Pei
cavity.Inthisexperiment,thebulletvelocityofgasgunwaslower,whichresultsinlimitcavityactionandfewercountsofbacteriatT,s1.
Intheanalysisistedinthebacteriain
on
Zhao
Gx,WeiKH。et
woundinthelimbsofdogsXuebao200l:21f11:8—9
9
nf.Quantitativebacteriologicalstudyofgunshotirihotandhumidenvironment.Di.yiJunyiDoxn,e
experimentaldata.thebacteria
were
mainly
weretract
ex.
iniuredandfesteredbraintissue.There
more
10
MatthewsMA,CareyME,SobloskyJS,eta1.FocalbraininjuryanditseffectsOllcerebralmantle,neurons,andfibertracks.BrainRes1998;794f11:l—18
theregion5mmfarfromthewallofwound
Wei
KH.PeiGX,Zheng
on
L.eta1.Bacteriumcultureandfloraanalysisof
gun.
and
shotwoundXuebaoYu
1imbsofdogsinhotandhumidenvironment.Di.yiJunyiDo.x:/og
fewerbacteriaintheregion5mmbeyondthewall.Extremelysig—nificantdifferencehappensamongthethreeregions.Duringdebridement.
braintissue
istheregionthat
CMW
shouldbespecially
at.Effectofhightemperatureandhumidityenvi—
braintissuedamageofdogs.ZhonggnoLinchuangKangfu2004;8
f25、:5290:1ronment
on
2002;22(1):20—1L'XuRX,JiangXD,et
treasured;suchconclusionisalsosupportedinthisexperiment.Inthewounddebridementatearlystage,woundcavityaroundbrain
tissueshould
cept
beeliminatedinthe
range
from5mmto10mm.Ex—
on
高温高湿环境下颅脑损伤动物创腔及周围组织
eliminatedfesteredtissue,anattentionshouldbepaid
state
the
细菌生长的特点杜
郭燕舞1,张世忠1,朱红胜2,徐如祥1
1南方医科大学珠江医院神经外科,广东省广州市510282;2解放军第422医院神经外科,广东省湛江市524005
郭燕舞★,男,1977年生,河南省唐河县人,汉族,2002年第一军医大学毕业,硕士,主治医师,讲师,主要从事颅脑损伤的基础与临床研究。军队“九五”军事医学科研课题(96M067)4摘要
背景:颅脑火器伤是战时常见的严重创伤,而环境因素是加剧病情发展、早期危及伤病员生命的重要因素。开展高温高湿环境下颅脑火器伤基础与救治研究是军事医学的重要课题。
目的:观察高温高湿环境下猫颅脑火器伤后创腔及周围组织细菌生长特点,为颅脑火器伤组织修复及其功能恢复提供参考。设计:随机对照实验。
单位:南方医科大学(原第一军医大学)附属珠江医院神经外科。材料:实验于2003一04/05在南方医科大学热带医学与卫生系实验室完成。实验逸取清洁级杂种猫24只。雌雄不限,体质量(2.5土0.2)kg,由南方医科大学实验动物中心提供。将实验动物随机分为4组:常温火器伤对照组5只;常温火器伤组8只;高温高湿火器伤组8只;空白对照组3
只。
general
ofwounded
casesoasto
improveregionallyimpair-
solvetissueanoxiaand
mentofbloodflowandmicrocirculation,traumaticedema,
structure
maintainthe
stabilityofcellsandmembrane
to
andenhancetheimmunityoftissue
bacterial9,101.
can
Withtheapplicationofantibiotic.thedebridementofCMW
delayedin24hoursr“1.Inthisexperiment.theobservationonlyin6hours,because
be
was
done
underhyperthermiaandhigh-humidity,
over
the
anus
temperatureofanimalwillbeincreased42℃in4—5
hours.andtheis
not
animalwillbediedinquiteshorttime.Thereforeit
toat
allowed
recognizetheearly
furthertherelevantalternations.
6
Itis
indicatedthat
stage(inhours)ofCMWinhyperther-
affects
mia.andhigh?humidity,hyperthermiaweaklythegrowthof
andhigh—humidity
bacteria,butimpactsstronglythelifephysi—
ca/signs。whichresultsinanitaaldeathi/1shorttime.Therefore.thestudyandtreatmentofCMWin
ty
hyperthermia
as
and
high.humidi—
should
stress
on
howto
breakawayfromhyperthermiaandhigh—
early
as
humidity
andstabilizelifephysicalsigns
possible。To
breakawayfromhyperthermiaandthevitalityofwoundedtissue.In
high,humidity
benefitsrestoring
summary,hypeahermiaandhigh—humiditydoes
not
affectthe
not
growthofbacteriaofremarkablychangearoundaftertionhas
not
CMWin6hourssignificantly.Thereis
content
方法:将猫称重后用30鼻/L戊巴比妥钠液按30mg/kg行腹腔注射。构建颅脑盲管伤模型,待模型成立后,常温火器伤组伤后置于25℃、相对湿度50%的仿真模拟气候舱中6h,高温高湿火器伤组置于35℃、相对湿度为85%的高温高湿环境中6h。按活检法分别取伤道内碎裂脑组织,伤道壁0-5him和5~10ml/l的脑组织,称重后配制成原液和匀浆液,培养24h后计数,并计算创腔及周围组织细菌含量。空白对照组麻醉致死后直接取材,其余步骤同常温火器伤对照组。主要观察指标:各组创腔及周围组织细菌含量。
结果:23只动物纳入结果分析。相同部位细菌含量因分组不同而有明显
inbacterial
inwoundcavity
in5mm
CMWin6hours.explainingthatbacterialreproduc—
entered
high-rateincreasingphase,due
to
which,itis
safeforthedebridementofwonndin6hours.
REFERENCES
1
Guo
cats
YW,Ma
after
DX,XuRX.Vitalsigns
changesandsurvivalcurveanalysisofof
temperature
性差异(F=171.423,P=0.000)。两两比较显示常温火器伤对照组、常温
火器伤组、高温高湿火器伤组与空白对照组之间差异有显著性意义(P<0.01),而常温火器伤对照组、常温火器伤组和高温高湿火器伤组之间比较差异无显著性(P>0.05)。各组内距创腔距离的不同细菌含量亦有明显差异(F=14.865,P=0.000)。
结论:高温高湿环境对颅脑火器伤6h内的细菌生长情况无显著影响,细菌繁殖未进入高速增长期,进行清创性修复仍是安全的。主题词:创伤,枪击;微生物学;湿度;温度;细菌
中图分类号:R641
文献标识码:A文章编号:1671—5926(2006)12-0187—03
郭燕舞,张世忠,朱红胜,徐如祥.高温高湿环境下颅脑损伤动物创腔及周围组织细菌生长的特点叭中国临床康复,2006,10(121:187—9
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MillarMR,LintonCJ。SherriffA.Useof
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