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1.
An interlaboratory trial for the determination of patulin in apple juice and fruit puree was conducted, involving 17 participants representing a cross section of industry, official food control, and research facilities. Mean recoveries reported ranged from 74 (10 ng/g) to 62% (25 ng/g) for apple juice and from 72 (25 ng/g) to 74% (10 ng/g) for fruit puree. Based on results for spiked samples (blind pairs at 2 levels), as well as naturally contaminated samples (blind pairs at 3 levels), the relative standard deviation for repeatability (RSDr) in juice ranged from 8.0 to 14.3% and in puree from 3.5 to 9.3%. The relative standard deviation for reproducibility (RSD(R)) in juice ranged from 19.8 to 39.5% and in puree from 12.5 to 35.2%, reflecting HORRAT values from 0.6 to 1.0 for juice and 0.4 to 0.9 for puree. The method showed acceptable within-laboratory and between-laboratory precision for each matrix, as required by current European legislation.  相似文献   

2.
A liquid chromatographic (LC) method for the determination of fumonisins B1 (FB1) and B2 (FB2) in corn and corn flakes was collaboratively studied by 23 laboratories, which analyzed 5 blind duplicate pairs of each matrix to establish the accuracy, repeatability, and reproducibility characteristics of the method. Fumonisin levels in the corn ranged from <0.05 (blank) to 1.41 microg/g for FB1 and from <0.05 to 0.56 microg/g for FB2, whereas in the corn flakes they ranged from <0.05 to 1.05 microg/g for FB1 and from <0.05 to 0.46 microg/g for FB2. The method involved double extraction with acetonitrile-methanol-water (25 + 25 + 50), cleanup through an immunoaffinity column, and LC determination of the fumonisins after derivatization with o-phthaldialdehyde. Relative standard deviations for the within-laboratory repeatability (RSDr) of the corn analyses ranged from 19 to 24% for FB1 and from 19 to 27% for FB2; for the corn flakes analyses, RSDr ranged from 9 to 21 % for FB1 and from 8 to 22% for FB2. Relative standard deviations for the between-laboratories reproducibility (RSDR) of the corn analyses ranged from 22 to 28% for FB1 and from 22 to 30% for the FB2; for corn flakes analyses, RSDR ranged from 27 to 32% for FB1 and from 26 to 35% for FB2. Mean recoveries of FB1 and FB2 from corn spiked with FB1 at 0.80 microg/g and with FB2 at 0.40 microg/g were 76 and 72%, respectively; for corn flakes spiked at the same levels recoveries were 110 and 97% for FB1 and FB2, respectively. HORRAT ratios for the analyses of corn ranged from 1.44 to 1.53 for FB1 and from 0.96 to 1.48 for FB2, whereas for corn flakes they ranged from 1.60 to 1.82 for FB1 and from 1.39 to 1.68 for FB2.  相似文献   

3.
The accuracy, repeatability, and reproducibility characteristics of a liquid chromatographic method for the determination of ochratoxin A (OTA) in white wine, red wine, and beer were established in a collaborative study involving 18 laboratories in 10 countries. Blind duplicates of blank, spiked, and naturally contaminated materials at levels ranging from < or =0.01 to 3.00 ng/mL were analyzed. Wine and beer samples were diluted with a solution containing polyethylene glycol and sodium hydrogen carbonate, and the diluted samples were filtered and cleaned up on an immunoaffinity column. OTA was eluted with methanol and quantified by reversed-phase liquid chromatography with fluorometric detection. Average recoveries from white wine, red wine, and beer ranged from 88.2 to 105.4% (at spiking levels ranging from 0.1 to 2.0 ng/mL), from 84.3 to 93.1% (at spiking levels ranging from 0.2 to 3.0 ng/mL), and from 87.0 to 95.0% (at spiking levels ranging from 0.2 to 1.5 ng/mL), respectively. Relative standard deviations for within-laboratory repeatability (RSDr) ranged from 6.6 to 10.8% for white wine, from 6.5 to 10.8% for red wine, and from 4.7 to 16.5% for beer. Relative standard deviations for between-laboratories reproducibility (RSDR) ranged from 13.1 to 15.9% for white wine, from 11.9 to 13.6% for red wine, and from 15.2 to 26.1% for beer. HORRAT values were < or =0.4 for the 3 matrixes.  相似文献   

4.
The accuracy, repeatability, and reproducibility characteristics of a method using multitoxin immunoaffinity column cleanup with liquid chromatography (LC) for determination of aflatoxins (AF; sum of aflatoxins B1, B2, G1, and G2) and ochratoxin A (OTA) in powdered ginseng and ginger have been established in a collaborative study involving 13 laboratories from 7 countries. Blind duplicate samples of blank, spiked (AF and OTA added) at levels ranging from 0.25 to 16.0 microg/kg for AF and 0.25 to 8.0 microg/kg for OTA were analyzed. A naturally contaminated powdered ginger sample was also included. Test samples were extracted with methanol and 0.5% aqueous sodium hydrogen carbonate solution (700 + 300, v/v). The extract was centrifuged, diluted with phosphate buffer (PB), filtered, and applied to an immunoaffinity column containing antibodies specific for AF and OTA. After washing the column with water, the toxins were eluted from the column with methanol, and quantified by high-performance LC with fluorescence detection. Average recoveries of AF from ginseng and ginger ranged from 70 to 87% (at spiking levels ranging from 2 to 16 microg/kg), and of OTA, from 86 to 113% (at spiking levels ranging from 1 to 8 microg/kg). Relative standard deviations for within-laboratory repeatability (RSDr) ranged from 2.6 to 8.3% for AF, and from 2.5 to 10.7% for OTA. Relative standard deviations for between-laboratory reproducibility (RSDR) ranged from 5.7 to 28.6% for AF, and from 5.5 to 10.7% for OTA. HorRat values were < or = 2 for the multi-analytes in the 2 matrixes.  相似文献   

5.
An interlaboratory study was conducted for the determination of deoxynivalenol in baby food and animal feed by high-performance liquid chromatography with UV detection. The study included 14 participants representing a cross section of industry, official food control, and research facilities. Mean recoveries reported ranged from 89% (at 120 microg/kg) to 85% (at 240 microg/kg) for baby food and from 100% (at 200 microg/kg) to 93% (at 400 microg/kg) for animal feed. On the basis of the results for spiked samples (blind duplicates at 2 levels), as well as those for naturally contaminated samples (blind duplicates at 3 levels), the relative standard deviation for repeatability (RSDr) in analyses of baby food ranged from 6.4 to 14.0% and in analyses of animal feed, from 6.1 to 16.5%. The relative standard deviation for reproducibility (RSDR) in analyses of baby food ranged from 9.4 to 19.5% and in analyses of animal feed, from 10.5 to 25.2%. The HorRat values ranged from 0.4 to 1.0 and from 0.7 to 1.3, for baby food and animal feed, respectively. The method showed acceptable performance for within-laboratory and between-laboratory precision for each matrix, as required by European legislation.  相似文献   

6.
An interlaboratory study of the liquid chromatographic (LC) determination of tetracyclines--oxytetracycline (OTC), tetracycline (TTC), and chlortetracycline (CTC)--in animal tissues was conducted. Isolation was performed with oxalic buffer followed by dechelation and deproteination with oxalic acid-acetonitrile. The extract was cleaned with a styrene-divinylbenzene cartridge. LC analysis was performed with a PLRP-S column and 0.01 M oxalic acid-acetonitrile (75 + 25, v/v) as mobile phase. Participants analyzed 2 control and 10 fortified porcine muscle and kidney samples. Additionally, porcine muscle samples containing incurred residues of tetracyclines were analyzed. Mean recoveries of fortified residues from porcine tissue ranged from 76.00 to 86.89%. Repeatabilities varied from 2.05% for OTC to 3.61% for TTC for muscle samples and from 6.75% for CTC to 8.74% for OTC for kidney samples. Reproducibilities ranged from 2.05 to 4.30% for muscle samples and from 15.77 to 18.81% for kidney samples.  相似文献   

7.
Thirteen laboratories participated in an interlaboratory method performance (collaborative) study on a method for the determination of arsenic, cadmium, mercury, and lead by inductively coupled plasma/mass spectrometry (ICP/MS) after pressure digestion including the microwave heating technique. Prior to the study, the laboratories were able to practice on samples with defined element levels (pretrial test). The method was tested on a total of 7 foodstuffs: carrot puree, fish muscle, mushroom, graham flour, simulated diet, scampi, and mussel powder. The elemental concentrations in mg/kg dry matter (dm) ranged from 0.06-21.4 for As, 0.03-28.3 for Cd, 0.04-0.6 for Hg, and 0.01-2.4 for Pb. The materials used in the study were presented to the participants as blind duplicates, and the participants were asked to perform single determinations on each sample. The repeatability relative standard deviations (RSDr) for As ranged from 3.8 to 24%, for Cd from 2.6 to 6.9%, for Hg from 4.8 to 8.3%, and for Pb from 2.9 to 27%. The reproducibility relative standard deviations (RSDR) for As ranged from 9.0 to 28%, for Cd from 2.8 to 18%, for Hg from 9.9 to 24%, and for Pb from 8.0 to 50%. The HorRat values were less than 1.5 for all test samples, except for the determination of Pb in wheat flour at a level close to the limit of quantitation (0.01 mg/kg dm). The study showed that the ICP/MS method is satisfactory as a standard method for elemental determinations in foodstuffs.  相似文献   

8.
A rapid method, based on sonication-assisted extraction in small columns (SAESC) and subsequent quantification and identification by gas chromatography-mass spectrometry (GC-MS), was developed for the determination of cyclic and linear siloxanes in soil. In the experiments with spiked samples (10-50 ng g(-1)), the recovery of cyclic and linear siloxanes ranged from 87.7 to 108.0% and from 84.9 to 107.6%, respectively. The validated method was used to determine the levels of these compounds in various types of soil samples collected from different locations in Spain. The cyclic siloxanes, decamethylcyclopentasiloxane (D5) and dodecamethylcyclohexasiloxane (D6) were detected in all the soil samples analyzed at concentrations from 9.2 to 56.9 ng g(-1) for D5 and from 5.8 to 27.1 ng g(-1) for D6 in agricultural soils and from 22 to 184 ng g(-1) for D5 and from 28 to 483 ng g(-1) for D6 in industrial soils. The total linear siloxanes concentrations (L5-L14) (sum of the 10 congeners) ranged from 191 to 292 ng g(-1) in agricultural soils and from 1411 to 8532 ng g(-1) in industrial soils.  相似文献   

9.
The hydride affinities (defined as the enthalpy changes in this work) of 15 polarized dienes [five phenyl sulfone substituted allenes (1a), the corresponding five isolated dienes (1b), and the corresponding five conjugated dienes (1c)] in acetonitrile solution were determined by titration calorimetry for the first time. The results display that the hydride affinity scales of the 15 dienes in acetonitrile range from -71.6 to -73.9 kcal/mol for 1a, from -46.2 to -49.7 kcal/mol for 1b, and from -45.0 to -46.5 kcal/mol for 1c, which indicates that the hydride-obtaining abilities of the cumulated dienes (1a) are not only much larger than those of the corresponding conjugated dienes (1c) but also much larger than those of the corresponding isolated dienes (1b). The hydrogen affinities of the 15 dienes as well as the hydrogen affinities and the proton affinities of the radical anions of the dienes (1(-*)) in acetonitrile were also evaluated by using relative thermodynamic cycles according to Hess's law. The results show that (i) the hydrogen affinities of the neutral dienes 1 cover a range from -44.5 to -45.6 kcal/mol for 1a, from -20.4 to -21.4 kcal/mol for 1b, and from -17.3 to -18.5 kcal/mol for 1c; (ii) the hydrogen affinities of the radical anions of the dienes (1(-*)) in acetonitrile cover a range from -40.6 to -47.2 kcal/mol for 1a(-*), from -21.6 to -29.6 kcal/mol for 1b(-*), and from -10.0 to -15.4 kcal/mol for 1c(-*); (iii) the proton affinities of the 15 1a(-*) in acetonitrile cover a range from -97.0 to -100.6 kcal/mol for 1a(-*), from -77.8 to -83.4 kcal/mol for 1b(-*), and from -66.2 to -68.9 kcal/mol for 1c(-*). The main reasons for the great difference between the cumulated dienes and the corresponding isolated and conjugated dienes in the hydride affinity, hydrogen affinity, and proton affinity have been examined. It is evident that these experimental results should be quite valuable to facilitate the elucidation of the origins of the especially high chemical potencies of the allenes, the choice of suitable hydride reducing agents to reduce the dienes, and the analyses on the reduction mechanisms.  相似文献   

10.
The isotope effects in the reaction of [p-(Me2CH)C6H4Me]Ru(NHCHPhCHPhNSO2C6H4-p-CH3) (1) with isopropyl alcohol were 1.79 for transfer of hydrogen from OH to N and 2.86 for transfer from CH to Ru. The isotope effect for transfer of deuterium from doubly labeled material (kCHOH/kCDOD = 4.88) was within experimental error of the product of the two individual isotope effects. These isotope effects provide convincing evidence for a mechanism involving concurrent transfer of hydrogen from oxygen to nitrogen and from carbon to ruthenium.  相似文献   

11.
The ability to quantify mixtures of bile acids using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry directly from urine has been demonstrated. Six cholic acid derivatives were selected for analysis: taurocholic acid (TCA), taurochenodeoxycholic acid (TCDCA), taurolithocholic acid (TLCA), glycocholic acid (GCA), glycochenodeoxycholic acid (GCDCA), and glycolithocholic acid (GCDCA). Urine samples were pre-concentrated and purified using solid-phase extraction (SPE) columns. The method was optimized to eliminate suppression effects, and proved to be reproducible from day to day. Calibration curves averaged from three days were obtained for the bile acids directly from urine, and then tested for their ability to accurately determine concentrations from one measurement. In summary, a simple, rapid method has been developed for the quantification of bile salts from urine with SPE clean-up by MALDI-MS.  相似文献   

12.
Electronic structure calculations have been carried out for all possible alkali tetramers that can be formed from X(2) + X(2) → X(2)X(2), X(2) + Y(2) → X(2)Y(2), and XY + XY → X(2)Y(2) alkali dimer association reactions. Vibrationally stable rhombic (D(2h)) and planar (C(s)) structures are found for all possible tetramers formed from the alkali metals, Li to Cs. All tetramer formation reactions (from ground state singlet homonuclear or heteronuclear dimers) are found to be exothermic with binding energies ranging from 6282 cm(-1) for Li(2)Li(2) to 1985 cm(-1) for Cs(2)Cs(2). Extensive calculations, carried out at long-range for several reactant pairs, indicate that there are barrier-less pathways for the formation of tetramers from dimer association reactions. At low temperatures, direct formation of tetramers is unlikely, owing to the large exothermicity associated with these association reactions, but atom exchange reactions (X(2) + Y(2) ? XY + XY) are possible for some species.  相似文献   

13.
A new method has been developed to simultaneously analyse bisphenol A (BPA) and bisphenol A diglycidyl ether (BADGE) in aqueous based food simulants. The method consists on direct immersion solid-phase microextraction (SPME) of the analytes from the liquid matrix and subsequent chromatographic analysis by gas chromatography-mass spectrometry. Using the proposed method, a whole analysis (including chromatographic step) can be completed in less than 40 min, with minimum sample handling. The SPME method shows good analytical performance for simultaneous BPA and BADGE analysis, except for BADGE determination in the aqueous alcohol (simulant C) solution. Detection limits ranging from 0.1 to 2.0 ng/g for BPA and from 13 to 15 ng/g from BADGE were obtained, with a linear range from the low-ng/g to several-microg/g range for BPA and from 0.1 microg/g to 40 microg/g for BADGE. A possible optimisation method has been also developed and introduced.  相似文献   

14.
Knudsen cell mass spectrometry was applied to the evaluation of the ionization efficiency curves for the ions originating from CoF(4) molecules. Cobalt tetrafluoride was obtained in the gas phase over the CoF(3)(s)-TbF(4)(s) system in the temperature range from 640 to 690 K. From the ionization efficiency curves the appearance energies of the ions formed from the CoF(4) molecules were determined by means of Vogt's deconvolution method. Clausius-Clapeyron plots for the ions from CoF(4) molecules were measured. Evaporation of pure CoF(3)(s) was carried out, and the appearance energies of the ions formed from CoF(3) molecules were determined. The ionization energies for CoF(4) and CoF(3) molecules were found to be (14.3 +/- 0.2) and (13.3 +/- 0.1) eV, respectively.  相似文献   

15.
The results of collaborative study are reported for a method that determines the site-specific isotope ratios of deuterium/hydrogen (D/H)i in vanillin by deuterium-nuclear magnetic resonance (2H-NMR) spectrometry. This method allows characterization of all the main commercial sources of commercial vanillin and detection of undeclared mixtures. It is based on the fact that the amounts of deuterium at various positions in the vanillin molecule are significantly different from one source to another. Vanillin is dissolved in acetonitrile and analyzed with a high-field NMR spectrometer fitted with a deuterium probe and a fluorine lock. The proportions of isotopomers monodeuterated at each hydrogen position of the molecule are recorded, and the corresponding (D/H) ratios are determined by using a calibrated reference. Nine laboratories analyzed 5 materials supplied as blind duplicates (1 natural vanillin from vanilla beans, 2 synthetic vanillins from guaiacol, 1 semisynthetic vanillin from lignin, and a mixture of natural and synthetic vanillins). The precision of the method for measuring site-specific ratios was as follows: for (D/H)1 the within-laboratory standard deviation (Sr) values ranged from 2.2 to 5.8 ppm, and the among-laboratories standard deviation (sR) values ranged from 3.6 to 5.1 ppm; for (D/H)3 the Sr values ranged from 1.7 to 3.2 ppm, and the SR values ranged from 2.4 to 3.7 ppm; for (D/H)4 the Sr values ranged from 2.3 to 6.2 ppm, and the SR values ranged from 2.4 to 6.4 ppm; for (D/H)5 the Sr values ranged from 0.8 to 2.7 ppm, and the SR values ranged from 0.9 to 2.3 ppm. It was shown that these values allow a satisfactory discrimination between vanillin sources. Therefore, the Study Director recommends the method for adoption as a First Action Official Method by AOAC INTERNATIONAL.  相似文献   

16.
Seventeen laboratories from six different countries, using their usual in-house methods, participated in an interlaboratory comparison test for the determination of the Fusarium mycotoxins deoxynivalenol (DON) in wheat and zearalenone (ZON) in maize. The toxins generally were extracted from maize and wheat employing mixtures of water, acidified water with an organic solvent or even pure water (for DON). While participants who used enzyme linked immuno sorbent assays (ELISA) for the determination of DON did not perform any clean-up, various techniques were applied for the purification of raw extracts (e.g. liquid/liquid extraction, solid phase extraction (SPE), immuno affinity chromatography (IAC)). For the final separation/quantification step either high performance liquid chromatography (HPLC) (mostly for ZON), gas chromatography (GC) (for DON) or ELISA were employed by participants. The aim of this study was to obtain information about the state of the art of mycotoxin analysis in cereals and to support a knowledge and experience exchange between the participating laboratories in the field of mycotoxin analysis. For each mycotoxin 5 different sample types were distributed, standard solutions (10.10 μg/ml ZON in methanol, 10.09 μg/ml DON in ethyl acetate), blank materials, spiked samples (75.1 μg/kg and 378.3 μg/kg ZON in maize, 126.2 μg/kg and 2519 μg/kg DON in wheat) and naturally contaminated maize and wheat. Coefficients of variation (CV) between laboratory mean results (outliers excluded) ranged from 6.2 to 27.7% for ZON and from 18.9 to 30.0% for DON. Except for the maize samples spiked at 75.1 μg/kg ZON the overall means (outliers rejected) statistically could not be distinguished from the respective target values. Average recoveries of the reported results ranged from 87.7 to 96.2% for ZON and from 94.2 to 108.5% for DON.  相似文献   

17.
A rapid, selective, sensitive, and reproducible method for the analysis of environmental estrogens, either natural or synthetic, present in samples from sewage treatment works (STW) has been developed. Isolation of these compounds from STWs was performed by applying a simple extraction procedure using an ENVI-CARB cartridge (a graphitized non porous carbon black) as the solid-phase extraction (SPE) system. Liquid chromatography coupled with atmospheric pressure chemical ionization (APCI) and tandem mass spectrometry was used for detection. For the multiple reaction monitoring (MRM) mode, the [M + H](+) ion of estrone and the [M + H-H(2)O](+) ions of 17beta-estradiol, estriol and 17alpha-ethynylestradiol were selected as the precursors for collisionally induced dissociation (CID). The average recoveries from sewage final effluent samples ranged from 84 to 93% for low levels, and from 89 to 95% for high levels. The precision of the method ranged from 11 to 8% for low level and from 9 to 7% for high level samples. The lower level of quantitation for these estrogens in STW samples was determined at 0.5 ng/L for 17beta-estradiol and 17alpha-ethynylestradiol, and 1 ng/L for estrone and estriol, based on 1-L aliquots of sewage treatment works water, using the optimum tuning parameters for each individual selected precursor ion/product ion transition. Compared to a previous gas chromatography/mass spectrometry (GC/MS) method for the analysis of ten STW samples, this method was shown to provide higher sensitivity and lower time consumption.  相似文献   

18.
Due to the physicochemical properties of linear alkylbenzene sulfonates (LAS), an anionic surfactant, it is difficult to obtain representative samples from sampling sites. Further, the high biodegradability of these compounds makes it necessary to study their biodegradation intermediates, sulfophenylcarboxylic acids (SPC) that do not have a surfactant character and show a different behavior. A procedure for determining and quantifying LAS and SPC in different environmental matrices by Soxhlet and solid-phase extractions and high-performance liquid chromatography is presented. The recoveries varied in the range from 85 to 102% for the water samples, and from 75 to 105% for sediment samples, with a standard deviation of between 1 and 7, and 2 and 11, respectively. Detection limits obtained were in the range from 5 to 10 microg kg(-1) for sediment samples (10 g) and from 0.2 to 0.4 microg l(-1) for water samples (250 ml). The method was applied to the simultaneous determination of LAS (C10-C13) and SPC (C4-C13) homologues in water, sediment and interstitial water collected from different areas of Spain.  相似文献   

19.
A method was developed for the simultaneous determination of imazalil and its major metabolite, R 14821, in citrus fruit. This method (designated the SPE method) is based on solid-phase extraction (SPE) and capillary gas chromatography (GC) with electron-capture detection (ECD). The SPE method is highly sensitive for both compounds (limit of detection for each: 0.001 microg/g) and is less time consuming than the previously reported method based on repeated liquid-liquid partitioning and GC-ECD. Recoveries for 3 levels of fortification (0.02, 0.2, and 2.5 microg/g) from satsuma mandarins ranged from 94.3 to 96.5% for imazalil and from 93.9 to 96.3 % for R 14821, with coefficients of variation (CVs) ranging from 3.1 to 6.3% for imazalil and from 4.5 to 5.6% for R 14821. Average residual levels found in grapefruit, oranges, and lemons by the SPE method and the previously reported method, and the corresponding CVs, were similar.  相似文献   

20.
For first-line non-small-cell lung cancer(NSCLC) therapy, detecting mutation status of the epidermal growth factor receptor(EGFR) geneconstitutes a prudent test to identify patients who are most likely to benefit from EGFR-tyrosine kinase inhibitor(TKI) therapy. Now, the material for detecting EGFR gene mutation status mainly comes from formalin-fixed and paraffin-embedded(FFPE) tissues. DNA extraction from FFPE and the amplification of EGFR gene by polymerase chain reaction(PCR) are two key steps for detecting EGFR gene mutation. We showed a simple method of DNA extraction from FFPE tissues for the effective amplification of EGFR gene. Extracting DNA from the FFPE tissues of NSCLC patients with 1% Triton X-100(pH=10.0) was performed by heating at 95℃ for 30 min. Meanwhile, a commercial kit was used to extract DNA from the same FFPE tissues of NSCLC patients for comparison. DNA extracted products were used as template for amplifying the exons 18, 19, 20 and 21 of EGFR by PCR for different amplified fragments. Results show that DNA fragment size extracted from FFPE tissues with 1% Triton X was about 250-500 base pairs(bp). However,DNA fragment size extracted from FFPE tissues via commercial kit was about from several hundreds to several thousands bp. The DNA yield extracted from FFPE tissues with 1% Triton X was larger than that via commercial kit. For about 500 bp fragment, four exons of EGFR could not be amplified more efficiently from extracted DNA with 1% Triton X than with commercial kit. However, for about 200 bp fragment. This simple and non-laborious protocol could successfully be used to extract DNA from FFPE tissue for the amplification of EGFR gene by PCR, further screening of EGFR gene mutation and facilitating the molecular analysis of a large number of FFPE tissues from NSCLC patients.  相似文献   

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