Alzheimer’s Disease

阿尔茨海默病
  • 文章类型: Journal Article
    阿尔茨海默病(AD)对全球健康构成重大挑战。它的特征是老年人的进行性认知恶化和发病率和死亡率增加。在AD的各种病理生理学中,线粒体功能障碍,包括增加活性氧产量等条件,钙稳态失调,线粒体动力学受损,起着举足轻重的作用。本文综述了线粒体功能障碍在AD中的作用机制。关注葡萄糖代谢受损等方面,线粒体生物能学,钙信号,tau蛋白和β淀粉样蛋白相关的突触功能障碍,线粒体自噬,老化,炎症,线粒体DNA,线粒体定位的microRNAs,遗传学,荷尔蒙,电子传输链和克雷布斯循环。虽然lecanemab是FDA批准的唯一治疗AD的药物,我们探索减轻AD线粒体功能障碍的各种治疗方式,包括抗氧化药物,抗糖尿病药,乙酰胆碱酯酶抑制剂(FDA批准用于治疗症状),营养补充剂,天然产品,苯丙素类化合物,疫苗,锻炼,和其他潜在的治疗方法。
    Alzheimer\'s disease (AD) presents a significant challenge to global health. It is characterized by progressive cognitive deterioration and increased rates of morbidity and mortality among older adults. Among the various pathophysiologies of AD, mitochondrial dysfunction, encompassing conditions such as increased reactive oxygen production, dysregulated calcium homeostasis, and impaired mitochondrial dynamics, plays a pivotal role. This review comprehensively investigates the mechanisms of mitochondrial dysfunction in AD, focusing on aspects such as glucose metabolism impairment, mitochondrial bioenergetics, calcium signaling, protein tau and amyloid-beta-associated synapse dysfunction, mitophagy, aging, inflammation, mitochondrial DNA, mitochondria-localized microRNAs, genetics, hormones, and the electron transport chain and Krebs cycle. While lecanemab is the only FDA-approved medication to treat AD, we explore various therapeutic modalities for mitigating mitochondrial dysfunction in AD, including antioxidant drugs, antidiabetic agents, acetylcholinesterase inhibitors (FDA-approved to manage symptoms), nutritional supplements, natural products, phenylpropanoids, vaccines, exercise, and other potential treatments.
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  • 文章类型: Journal Article
    随着阿尔茨海默病(AD)的患病率随着人口老龄化而增长,早期诊断的需要导致人们越来越关注脑电图(EEG)作为一种非侵入性诊断工具.
    这篇综述评估了脑电图分析的进展,包括机器学习的应用,用于检测2000年至2023年的AD。
    遵循PRISMA准则,在主要数据库中进行搜索,得出25项符合纳入标准的研究,重点介绍了EEG在AD诊断中的应用以及新型信号处理和机器学习技术的使用。
    脑电图分析的进展显示出早期AD识别的希望,使用Hjorth参数和信号压缩性等技术增强检测能力。机器学习提高了AD与轻度认知障碍的鉴别诊断精度。然而,标准化EEG方法和数据隐私方面的挑战仍然存在。
    脑电图是早期AD检测的宝贵工具,具有融入多模式诊断方法的潜力。未来的研究应旨在标准化脑电图程序并探索协作,隐私保护研究方法。
    UNASSIGNED: As the prevalence of Alzheimer\'s disease (AD) grows with an aging population, the need for early diagnosis has led to increased focus on electroencephalography (EEG) as a non-invasive diagnostic tool.
    UNASSIGNED: This review assesses advancements in EEG analysis, including the application of machine learning, for detecting AD from 2000 to 2023.
    UNASSIGNED: Following PRISMA guidelines, a search across major databases resulted in 25 studies that met the inclusion criteria, focusing on EEG\'s application in AD diagnosis and the use of novel signal processing and machine learning techniques.
    UNASSIGNED: Progress in EEG analysis has shown promise for early AD identification, with techniques like Hjorth parameters and signal compressibility enhancing detection capabilities. Machine learning has improved the precision of differential diagnosis between AD and mild cognitive impairment. However, challenges in standardizing EEG methodologies and data privacy remain.
    UNASSIGNED: EEG stands out as a valuable tool for early AD detection, with the potential to integrate into multimodal diagnostic approaches. Future research should aim to standardize EEG procedures and explore collaborative, privacy-preserving research methods.
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  • 文章类型: Journal Article
    背景:运动认知风险综合征(MCR)被定义为在没有运动障碍或痴呆的老年个体中存在缓慢的步态速度和主观认知能力下降。虽然一些研究表明MCR是痴呆前综合征,可能有助于预测认知障碍和痴呆的风险,并非所有研究都一致。这项研究的目的是全面总结和综合证据,以评估MCR与认知障碍和痴呆之间的关系。
    方法:遵循预先指定的协议,两位作者系统地搜索了PubMed,Embase,和Cochrane图书馆从开始到2024年8月19日,进行关于MCR与认知障碍和痴呆之间关联的观察性或随机研究。我们倾向于最大程度地调整风险和优势比,以确定认知障碍和痴呆的纵向和横断面风险。我们调查了异质性的潜在来源,并按大陆和认知结果的类型进行了敏感性和亚组分析。使用纽卡斯尔-渥太华量表(NOS)和建议分级评估证据质量,评估,发展和评价(等级)框架。
    结果:我们纳入了20项研究,包括1,206,782名参与者的组合队列,其中17项研究纳入定量分析。汇总分析显示,MCR患者患认知障碍和痴呆的风险高2.20倍。与对照组相比(RR=2.20;95CI=1.91-2.53)。这些发现在所有亚组分析中保持稳健,发表偏倚的敏感性分析和评估。
    结论:MCR可能被认为是长期认知障碍和痴呆的预测因素。在临床评估认知障碍和痴呆的风险时,应考虑到这一点,但需要进一步的研究才能使这种关联更加清晰。
    BACKGROUND: Motoric cognitive risk syndrome (MCR) is defined as the presence of slow gait-speed and subjective cognitive decline in older individuals without mobility disability or dementia. While some studies suggest that MCR is a pre-dementia syndrome and may help predict the risk of cognitive impairment and dementia, not all studies concur. The objective of this study is to comprehensively summarize and synthesize evidence to assess the association between MCR and cognitive impairment and dementia.
    METHODS: Following a pre-specified protocol, two authors systematically searched PubMed, Embase, and The Cochrane Library from inception to 19 August 2024 for observational or randomized studies pertaining to the association between MCR and cognitive impairment and dementia. We favoured maximally adjusted hazards and odds ratios to determine the longitudinal and cross-sectional risk of cognitive impairment and dementia. We investigated for potential sources of heterogeneity and also conducted sensitivity and subgroup analyses by continent and the type of cognitive outcome. The quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.
    RESULTS: We included 20 studies comprising a combined cohort of 1,206,782 participants, of which 17 studies were included in the quantitative analysis. The pooled analysis outlined that individuals with MCR exhibited 2.20-fold higher risk of cognitive impairment and dementia, compared to controls (RR=2.20; 95%CI=1.91-2.53). These findings remained robust across all subgroup analyses, sensitivity analyses and assessments of publication bias.
    CONCLUSIONS: MCR may be considered a predictive factor for long-term cognitive impairment and dementia. This should be taken into consideration when clinically evaluating the risk of cognitive impairment and dementia but further research is required to lend greater clarity to this association.
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  • 文章类型: Journal Article
    阿尔茨海默病(AD)是痴呆的主要原因之一,其特征是记忆力减退,精神和行为异常,以及日常活动能力受损。即使是威胁人类健康的全球性疾病,尚未发现减缓AD进展的有效治疗方法,尽管进行了大量的研究和大量的投资。近年来,感染在AD病因学中的作用引发了激烈的争论。病原体通过受损的血脑屏障或神经干侵入中枢神经系统,并通过一系列分子生物学事件破坏神经元结构和功能以及脑微环境的稳态。在这次审查中,我们总结了与AD病理有关的各种病原体,讨论病原体和AD之间的潜在相互作用,并概述了AD抗病原治疗的前景。
    Alzheimer\'s disease (AD) is one of the leading causes of dementia and is characterized by memory loss, mental and behavioral abnormalities, and impaired ability to perform daily activities. Even as a global disease that threatens human health, effective treatments to slow the progression of AD have not been found, despite intensive research and significant investment. In recent years, the role of infections in the etiology of AD has sparked intense debate. Pathogens invade the central nervous system through a damaged blood-brain barrier or nerve trunk and disrupt the neuronal structure and function as well as homeostasis of the brain microenvironment through a series of molecular biological events. In this review, we summarize the various pathogens involved in AD pathology, discuss potential interactions between pathogens and AD, and provide an overview of the promising future of anti-pathogenic therapies for AD.
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  • 文章类型: Journal Article
    全球最大的单一突变导致常染色体显性遗传阿尔茨海默病(ADAD)的家族是一个来自Antioquia的家族,哥伦比亚,携带早老素-1(PSEN1)E280A(Paisa)突变。大多数突变携带者会患上痴呆症,通常在30年代后期开始,发病年龄中位数为49岁。认知下降是一个标志性特征。
    这篇综述综合了有关PSEN1E280A突变携带者整个生命周期中神经心理学评估的现有文献。我们提供了这个独特人群的认知结果的全面概述。
    我们回顾并整合了已发表的研究,分析PSEN1E280A携带者的神经心理学评估研究。我们的重点是口头措施,语义,情节,和空间记忆,涵盖了其他认知领域,如语言,注意,视觉空间记忆,和执行功能。
    言语,语义,情节,和空间记忆成为PSEN1E280A携带者临床前变化的最敏感指标。在评估语言的测试结果中发现了不一致,注意,视觉空间记忆,和执行功能,提示检测PSEN1突变携带者早期认知变化的潜在局限性。为该人群开发的特定认知任务被证明是有效的,但未得到充分利用。
    该评论强调了为检测PSEN1E280A携带者的早期认知变化而量身定制的持续测试开发的重要性,可能增强ADAD筛查。此外,调查儿童的ADAD突变可能会发现AD的早期变化,并增强我们对整个生命周期中神经心理功能的理解。这一综合为研究人员提供了有价值的见解,临床医生,以及从事ADAD研究和管理的政策制定者。
    UNASSIGNED: The largest identified kindred worldwide with a single mutation causing autosomal-dominant Alzheimer\'s disease (ADAD) is a family from Antioquia, Colombia, carrying the Presenilin-1 (PSEN1) E280A (Paisa) mutation. The majority of mutation carriers develop dementia, typically commencing in their late 30 s, with a median onset age of 49 years. Cognitive decline is a hallmark feature.
    UNASSIGNED: This review synthesizes the existing literature on neuropsychological assessments in PSEN1 E280A mutation carriers throughout their lifespan. We provide a comprehensive overview of cognitive outcomes in this unique population.
    UNASSIGNED: We reviewed and integrated the published research, analyzing studies on neuropsychological assessments in PSEN1 E280A carriers. Our focus was on measures of verbal, semantic, episodic, and spatial memory, and encompassed other cognitive domains such as language, attention, visuospatial memory, and executive functioning.
    UNASSIGNED: Verbal, semantic, episodic, and spatial memory emerged as the most sensitive indicators of preclinical changes in PSEN1 E280A carriers. Inconsistencies were noted in findings from tests assessing language, attention, visuospatial memory, and executive functioning, suggesting potential limitations in detecting early cognitive changes in PSEN1 mutation carriers. Specific cognitive tasks developed for this population proved effective but underutilized.
    UNASSIGNED: The review underscores the importance of continued test development tailored to detect early cognitive changes in PSEN1 E280A carriers, potentially enhancing ADAD screening. Furthermore, investigating ADAD mutations in children may identify early changes in AD and enhance our understanding of neuropsychological functioning across the lifespan. This synthesis provides valuable insights for researchers, clinicians, and policymakers engaged in the study and management of ADAD.
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  • 文章类型: Journal Article
    痴呆症是全球残疾和依赖的主要原因。轻度认知障碍(MCI)被认为是发展为痴呆的早期指标。越来越多的努力来早期检测和诊断MCI;因此,我们需要了解个人和护理人员对MCI诊断的影响的观点.
    为了系统地回顾定性文献,以了解MCI诊断对个人及其照顾者的影响,专注于幸福,日常行为,和医疗保健利用。
    将关键搜索术语输入到五个数据库中。如果研究是以英语发表的同行评审的定性研究,则包括这些研究,这些研究获得了MCI或照顾者的社区居民的观点,并专注于他们的福祉,日常行为和/或医疗保健利用。该方案在PROSPERO(CRD42021291995)上预先注册。数据是叙述式合成的。
    来自15篇符合条件的文章的主要发现强调了MCI诊断对个人和护理人员福祉的负面影响。由于耻辱和对诊断/预后的理解有限。日常行为的变化各不相同,特别是关于参与体育活动的动机,爱好和社交机会。个人和护理人员有时都对医疗保健服务不满意;临床安慰期间的无效沟通强调了对临床医生缺乏信任的原因。
    结果表明,MCI诊断会影响MCI患者及其照顾者的生活关键方面。迫切需要有效地传达MCI的诊断和预后,以支持健康和日常活动,并确保对医疗保健服务的信任。
    UNASSIGNED: Dementia is a major cause of disability and dependency globally. Mild cognitive impairment (MCI) is considered an early indicator of developing dementia. There are growing efforts to detect and diagnose MCI earlier; consequently, we need to understand the perspectives of individuals and carers regarding the implications of an MCI diagnosis.
    UNASSIGNED: To systematically review qualitative literature to understand the impact of a MCI diagnosis on both the individual and their carers, focusing on wellbeing, everyday behaviors, and healthcare utilization.
    UNASSIGNED: Key search terms were input into five databases. Studies were included if they were peer-reviewed qualitative research published in English that obtained perspectives of community-dwellers with MCI or carers and focused on either their wellbeing, everyday behaviors and/or healthcare utilization. The protocol was pre-registered on PROSPERO (CRD42021291995). Data was synthesized narratively.
    UNASSIGNED: Key findings from 15 eligible articles highlighted the negative impact of an MCI diagnosis on the wellbeing of both individuals and carers, due to stigma and limited understanding regarding diagnosis/prognosis. Changes in everyday behavior varied, particularly regarding motivation to engage with physical activity, hobbies and social opportunities. Both individuals and carers were sometimes dissatisfied with healthcare services; ineffective communication during clinical consolations highlighted as a reason for lack of trust in clinicians.
    UNASSIGNED: Results indicate that an MCI diagnosis impacts both people with MCI and their carers across key facets of life. There is a critical need to effectively communicate the diagnosis and prognosis of MCI to support wellbeing and everyday activities and ensure trust in healthcare services.
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  • 文章类型: Journal Article
    海马的神经生物学变化是衰老的常见后果。然而,与轻度认知障碍(MCI)和阿尔茨海默病(AD)患者相比,无认知障碍患者的下降率和总体体积减少率存在差异。进行了这项系统的文献综述,以确定非认知障碍脑和MCI或AD患者的海马萎缩与海马体积变化之间的关系。
    本系统评价以系统评价和荟萃分析(PRISMA)方法的首选报告项目为指导。截至2022年9月15日,对PubMed数据库进行了搜索,以进行纵向磁共振成像研究,报告认知正常衰老个体和MCI和/或AD患者的海马萎缩或体积变化。研究选择分为两个步骤:(1)确定和检索相关研究;(2)通过(a)标题/摘要和(b)全文筛选研究。两个团队,每个人都由两名独立的审稿人组成,确定出版物是否符合系统评价的纳入标准.证据表填充了从合格出版物中提取的数据,并确认了最终系统审查的内容。
    系统搜索确定了最初按标题/摘要筛选的357种出版物,其中,检索了115份出版物,并通过全文审查合格性。17种出版物符合资格标准;然而,在数据提取过程中,两项研究被确定为不符合纳入标准,因此被排除.其余15项研究纳入系统评价。总的来说,这些研究的结果表明,海马和海马亚区随着时间的推移而变化,同时观察到海马体积减少和海马萎缩率增加。观察到AD的海马变化大于MCI的海马变化,并且观察到MCI的变化大于正常衰老人群的变化。
    已发表的文献表明,海马衰退的速度和损失程度是连续的,从没有认知障碍的人开始,并持续到MCI和AD,和没有认知障碍之间的差异,MCI和AD是定量的而不是定性的。
    UNASSIGNED: Neurobiological changes in the hippocampus are a common consequence of aging. However, there are differences in the rate of decline and overall volume loss in people with no cognitive impairment compared to those with mild cognitive impairment (MCI) and Alzheimer\'s disease (AD). This systematic literature review was conducted to determine the relationship between hippocampal atrophy and changes in hippocampal volume in the non-cognitively impaired brain and those with MCI or AD.
    UNASSIGNED: This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The PubMed database was searched up to September 15, 2022, for longitudinal magnetic resonance imaging studies reporting hippocampal atrophy or volume change in cognitively normal aging individuals and patients with MCI and/or AD. Study selection was divided into two steps: (1) identification and retrieval of relevant studies; (2) screening the studies by (a) title/abstract and (b) full text. Two teams, each consisting of two independent reviewers, determined whether the publications met the inclusion criteria for the systematic review. An evidence table was populated with data extracted from eligible publications and inclusion in the final systematic review was confirmed.
    UNASSIGNED: The systematic search identified 357 publications that were initially screened by title/abstract, of which, 115 publications were retrieved and reviewed by full text for eligibility. Seventeen publications met the eligibility criteria; however, during data extraction, two studies were determined to not meet the inclusion criteria and were excluded. The remaining 15 studies were included in the systematic review. Overall, the results of these studies demonstrated that the hippocampus and hippocampal subfields change over time, with both decreased hippocampal volume and increased rate of hippocampal atrophy observed. Hippocampal changes in AD were observed to be greater than hippocampal changes in MCI, and changes in MCI were observed to be greater than those in normal aging populations.
    UNASSIGNED: Published literature suggests that the rate of hippocampal decline and extent of loss is on a continuum that begins in people without cognitive impairment and continues to MCI and AD, and that differences between no cognitive impairment, MCI, and AD are quantitative rather than qualitative.
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  • 文章类型: Journal Article
    证据表明,神经退行性疾病和神经精神疾病受肠道微生物组改变的影响。各种疾病都与微生物群失调有关,然而,关于哪些微生物与每种疾病相关,尚无定论。我们研究的目的是系统地回顾过去十年的最新文献,以阐明肠道微生物组是否有助于理解神经退行性疾病的发病机制和进展。大多数纳入的研究表明,某些微生物的相对丰度之间存在很强的相关性,主要是厚壁门和拟杆菌,以及帕金森病(PD)和阿尔茨海默病(AD)等疾病。据推测,微生物及其副产物在脑蛋白积累中具有显著作用,神经炎症,和肠道通透性。微生物种群的估计可能会改善临床结果并阻碍疾病的进展。然而,需要进一步的研究包括更多的疾病和更大的患者样本,并确定与这些疾病相关的特定物种和亚种.
    Evidence shows that neurodegenerative and neuropsychiatric disorders are influenced by alterations in the gut microbiome. Various diseases have been linked to microbiome dysbiosis, yet there are inconclusive data regarding which microorganisms are associated with each disorder. The aim of our study is to systematically review the recent literature of the past decade to clarify whether the gut microbiome contributes to the understanding of pathogenesis and progression of neurodegenerative disorders. Most included studies showed a strong correlation between the relative abundance of certain microorganisms, mainly species of the phyla Firmicutes and Bacteroidetes, and disorders such as Parkinson\'s disease (PD) and Alzheimer\'s disease (AD). It is speculated that the microorganisms and their byproducts have a significant role in brain protein accumulation, neuro-inflammation, and gut permeability. The estimation of microbial populations could potentially improve clinical outcomes and hinder the progression of the disease. However, further research is needed to include more diseases and larger patient samples and identify specific species and subspecies associated with these disorders.
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  • 文章类型: Journal Article
    阿尔茨海默病是一种弱化的神经退行性疾病,具有深刻的认知意义,使早期和准确的检测对于有效的治疗至关重要。近年来,机器学习,特别是深度学习,在检测轻度认知障碍向阿尔茨海默病转化方面显示出显著的希望。这篇综述综合了使用磁共振成像预测从轻度认知障碍到阿尔茨海默病痴呆的机器学习方法的研究。正电子发射断层扫描,和其他生物标志物。文献中使用的各种技术,如机器学习,深度学习,和迁移学习在这项研究中进行了检查。此外,讨论了不同研究人员分析的数据模态和特征提取方法。本文综述了阿尔茨海默病检测的研究现状,并强调了未来的研究方向。
    Alzheimer\'s disease is a weakening neurodegenerative condition with profound cognitive implications, making early and accurate detection crucial for effective treatment. In recent years, machine learning, particularly deep learning, has shown significant promise in detecting mild cognitive impairment to Alzheimer\'s disease conversion. This review synthesizes research on machine learning approaches for predicting conversion from mild cognitive impairment to Alzheimer\'s disease dementia using magnetic resonance imaging, positron emission tomography, and other biomarkers. Various techniques used in literature such as machine learning, deep learning, and transfer learning were examined in this study. Additionally, data modalities and feature extraction methods analyzed by different researchers are discussed. This review provides a comprehensive overview of the current state of research in Alzheimer\'s disease detection and highlights future research directions.
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  • 文章类型: Case Reports
    背景:单基因阿尔茨海默病(AD)具有严重的健康和社会经济影响。其最罕见的原因是早老素2(PSEN2)基因突变。为了提供有关这些患者的病理生理学和符号学的更多信息,我们提出了两个推测为PSEN2-AD的新病例,这些病例具有异常的临床和神经影像学发现。
    方法:临床发病的69岁和62岁女性,以突出的行为和语言功能障碍为标志,包括在三年内进展为重度痴呆.描述了完整的研究。此外,对PSEN2-AD进行了系统评价.
    结果:神经影像学显示额叶白质高信号(WMH)和额颞叶萎缩/代谢低。遗传研究揭示了PSEN2变体:c.772G>A(p。Ala258Thr)和c.1073-2_1073-1del。脑脊液(CSF)和实验血液生物标志物均承担了AD的病因。
    结论:在文献中,提示额颞叶痴呆(FTD)的突出行为和语言功能障碍可能被低估为PSEN2突变的临床表现。因此,怀疑FTDL时,将PSEN2包括在遗传组中可能是合理的。PSEN2突变可能会导致惊人的WMH,可以说与淀粉样蛋白积累引起的髓磷脂破坏有关。
    BACKGROUND: Monogenic Alzheimer\'s disease (AD) has severe health and socioeconomic repercussions. Its rarest cause is presenilin 2 (PSEN2) gene mutations. We present two new cases with presumed PSEN2-AD with unusual clinical and neuroimaging findings in order to provide more information on the pathophysiology and semiology of these patients.
    METHODS: Women aged 69 and 62 years at clinical onset, marked by prominent behavioral and language dysfunction, progressing to severe dementia within three years were included. The complete study is depicted. In addition, a systematic review of the PSEN2-AD was performed.
    RESULTS: Neuroimaging revealed pronounced frontal white matter hyperintensities (WMH) and frontotemporal atrophy/hypometabolism. The genetic study unveiled PSEN2 variants: c.772G>A (p.Ala258Thr) and c.1073-2_1073-1del. Both cerebrospinal fluid (CSF) and experimental blood biomarkers shouldered AD etiology.
    CONCLUSIONS: Prominent behavioral and language dysfunction suggesting frontotemporal dementia (FTD) may be underestimated in the literature as a clinical picture in PSEN2 mutations. Thus, it may be reasonable to include PSEN2 in genetic panels when suspecting FTDL. PSEN2 mutations may cause striking WMH, arguably related to myelin disruption induced by amyloid accumulation.
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