Re-epithelialization

重新上皮化
  • 文章类型: Systematic Review
    背景:在一些临床试验中已经证明了自体皮肤细胞悬液(ASCS)的成功使用。然而,其有效性和安全性尚未得到验证。这项最新的系统评价和荟萃分析旨在研究自体表皮细胞悬液在皮肤病变再上皮化中的作用。
    方法:相关文章来自PubMed,Embase,Cochrane数据库,WebofScience,国际临床试验注册平台,中国国家知识基础设施,中国科技期刊VIP数据库和万方数据库。主要的输出测量是愈合时间,次要产出是有效率,用于治疗的供体部位的大小,研究治疗区域的大小,操作时间,疼痛评分,色素沉着,并发症,瘢痕量表评分和满意度评分。将数据汇总并表示为相对风险(RR),平均差(MD)和标准化平均差(SMD),置信区间为95%。
    结果:本系统综述和荟萃分析包括31项研究,914例患者接受自体表皮细胞悬液(治疗组)和883例患者接受标准治疗或安慰剂(对照组)。所有纳入研究的汇总数据表明,治疗组的愈合时间显着缩短(SMD=-0.86;95%CI:-1.59-0.14;p=0.02,I2=95%),治疗部位的大小(MD=-115.41;95%CI:-128.74-102.09;p<0.001,I2=89%),手术时间(MD=25.35;95%CI:23.42-27.29;p<0.001,I2=100%),疼痛评分(SMD=-1.88;95%CI:-2.86-0.90;p=0.0002,I2=89%)和并发症(RR=0.59;95%CI:0.36-0.96;p=0.03,I2=66%),以及显效率显着增加(RR=1.20;95%CI:1.01-1.42;p=0.04,I2=77%)。研究处理区的大小无显著差异,色素沉着,比较两组患者的瘢痕量表评分和满意度评分。
    结论:我们的荟萃分析表明,自体表皮细胞悬液有利于皮肤病变的再上皮化,因为它们显着缩短了愈合时间,治疗部位的大小,操作时间,疼痛评分和并发症,以及提高有效率。然而,这种干预对治疗面积的影响很小,色素沉着,瘢痕量表评分和满意度评分。
    BACKGROUND: Successful usage of autologous skin cell suspension (ASCS) has been demonstrated in some clinical trials. However, its efficacy and safety have not been verified. This latest systematic review and meta-analysis aim to examine the effects of autologous epidermal cell suspensions in re-epithelialization of skin lesions.
    METHODS: Relevant articles were retrieved from PubMed, Embase, Cochrane Database, Web of Science, International Clinical Trials Registry Platform, China National Knowledge Infrastructureris, VIP Database for Chinese Technical Periodicals and Wanfang database. The primary output measure was the healing time, and the secondary outputs were effective rate, size of donor site for treatment, size of study treatment area, operation time, pain scores, repigmentation, complications, scar scale scores and satisfaction scores. Data were pooled and expressed as relative risk (RR), mean difference (MD) and standardized mean difference (SMD) with a 95% confidence interval (CI).
    RESULTS: Thirty-one studies were included in this systematic review and meta-analysis, with 914 patients who received autologous epidermal cell suspensions (treatment group) and 883 patients who received standard care or placebo (control group). The pooled data from all included studies demonstrated that the treatment group has significantly reduced healing time (SMD = -0.86; 95% CI: -1.59-0.14; p = 0.02, I2 = 95%), size of donar site for treatment (MD = -115.41; 95% CI: -128.74-102.09; p<0.001, I2 = 89%), operation time (MD = 25.35; 95% CI: 23.42-27.29; p<0.001, I2 = 100%), pain scores (SMD = -1.88; 95% CI: -2.86-0.90; p = 0.0002, I2 = 89%) and complications (RR = 0.59; 95% CI: 0.36-0.96; p = 0.03, I2 = 66%), as well as significantly increased effective rate (RR = 1.20; 95% CI: 1.01-1.42; p = 0.04, I2 = 77%). There were no significant differences in the size of study treatment area, repigmentation, scar scale scores and satisfaction scores between the two groups.
    CONCLUSIONS: Our meta-analysis showed that autologous epidermal cell suspensions is beneficial for re-epithelialization of skin lesions as they significantly reduce the healing time, size of donar site for treatment, operation time, pain scores and complications, as well as increased effective rate. However, this intervention has minimal impact on size of treatment area, repigmentation, scar scale scores and satisfaction scores.
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  • 文章类型: Journal Article
    目前,各种急性和慢性伤口的全球发病率不断上升,强调伤口修复研究和治疗进展的迫切需要。水凝胶由于其独特的物理和化学性质而成为用于伤口愈合的有前途的材料。本文综述了水凝胶敷料的分类和特点,创新的准备策略,以及在递送和释放生物活性物质方面的进步。此外,它深入研究了水凝胶在伤口愈合中的功能应用,包括预防感染等领域,快速止血和粘连适应,炎症控制和免疫调节,肉芽组织形成,再上皮化,和疤痕的预防和治疗。还讨论了各种功能水凝胶的作用机理。最后,本文还讨论了水凝胶目前的局限性,并提供了对其潜在的未来应用和即将到来的创新设计的见解。
    Currently, there is a rising global incidence of diverse acute and chronic wounds, underscoring the immediate necessity for research and treatment advancements in wound repair. Hydrogels have emerged as promising materials for wound healing due to their unique physical and chemical properties. This review explores the classification and characteristics of hydrogel dressings, innovative preparation strategies, and advancements in delivering and releasing bioactive substances. Furthermore, it delves into the functional applications of hydrogels in wound healing, encompassing areas such as infection prevention, rapid hemostasis and adhesion adaptation, inflammation control and immune regulation, granulation tissue formation, re-epithelialization, and scar prevention and treatment. The mechanisms of action of various functional hydrogels are also discussed. Finally, this article also addresses the current limitations of hydrogels and provides insights into their potential future applications and upcoming innovative designs.
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  • 文章类型: Meta-Analysis
    目的:总结现有证据,并为成人部分厚度移植物供体部位的最有效管理提供建议,以增强上皮再形成为目标,减轻疼痛,预防感染。
    方法:雨伞综述。进行了系统的搜索,包括Pubmed,CUIDEN,科克伦图书馆,CINHALPlus,Scopus,和LILACS。自2011年以来发表的针对系统评价的搜索重点是检查不同方法治疗部分厚度移植物供体部位的有效性。排除了根据AMSTAR2的低临界评估得分的评论。使用SIGN量表对纳入的评论进行评估,以评估证据水平并对建议进行评级。
    结果:分析中纳入了5篇系统综述和meta分析。与对照组相比,富含血小板的血浆和人羊膜在上皮再生和疼痛减轻方面表现出统计学上的显着改善。此外,富含血小板的血浆也显示伤口感染率降低。发现重组人生长激素可加速上皮再形成过程。
    结论:根据调查结果,建议使用富含血小板的血浆来增强上皮再形成,缓解疼痛,并减少成人部分厚度移植物供体部位的感染。建议应用人羊膜以加速上皮再形成和减轻疼痛,而重组人生长激素被建议加快这些伤口的整体愈合时间。
    To summarize the existing evidence and provide recommendations for the most effective management of partial-thickness graft donor sites in adults, with the goals of enhancing re-epithelialization, reducing pain, and preventing infection.
    Umbrella review. A systematic search was conducted encompassing databases such as Pubmed, CUIDEN, Cochrane Library, CINHAL Plus, SCOPUS, and LILACS. The search targeted systematic reviews published since 2011 that focused on examining the effectiveness of different approaches for the treatment of partial-thickness graft donor sites. Reviews with a low critical appraisal score according to AMSTAR 2 were excluded. The included reviews were evaluated using the SIGN scale to assess the level of evidence and grade the recommendations.
    Five systematic reviews with meta-analysis were incorporated in the analysis. Platelet-rich plasma and human amniotic membrane demonstrated statistically significant improvements in re-epithelialization and pain reduction when compared to the control group. Moreover, platelet-rich plasma also exhibited a decrease in wound infection rates. Recombinant human growth hormone was found to expedite the re-epithelialization process.
    Based on the findings, the use of platelet-rich plasma is recommended to enhance re-epithelialization, alleviate pain, and reduce infection in partial-thickness graft donor sites among adults. Application of human amniotic membrane is recommended to accelerate re-epithelialization and alleviate pain, while recombinant human growth hormone is suggested to expedite the overall healing time of these wounds.
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  • 文章类型: Review
    光是一种有效的技术,对当代医学具有重大影响。光动力疗法(PDT),涉及光敏剂(PS)的联合作用,氧气和光,已经成为治疗多种实体瘤和感染性疾病的治疗方法。PDT是微创的,几乎没有副作用,减轻疤痕,减少组织损失,同时保留器官结构和功能。特别是,PDT对伤口具有很高的愈合潜力(PDT通过增强上皮再生来刺激伤口愈合,促进血管生成以及调节皮肤稳态)。伤口愈合涉及许多不同过程之间的相互作用,包括凝血,炎症,血管生成,细胞迁移和增殖。患有糖尿病或大面积烧伤的伤口愈合不良仍然是一项艰巨的挑战。这篇综述强调了PDT作为一个潜在的研究领域,并总结了PDT在伤口愈合中的作用。包括正常伤口,慢性伤口,老化的伤口。
    Light is an efficient technique that has a significant influence on contemporary medicine. Photodynamic therapy (PDT), which involves the combined action of photosensitizers (PSs), oxygen, and light, has emerged as a therapeutically promising method for treating a broad variety of solid tumors and infectious diseases. Photodynamic therapy is minimally invasive, has few side effects, lightens scars, and reduces tissue loss while preserving organ structure and function. In particular, PDT has a high healing potential for wounds (PDT stimulates wound healing by enhancing re-epithelialization, promoting angiogenesis as well as modulating skin homeostasis). Wound healing involves interactions between many different processes, including coagulation, inflammation, angiogenesis, cellular migration, and proliferation. Poor wound healing with diabetes or extensive burns remains a difficult challenge. This review emphasizes PDT as a potential research field and summarizes PDT\'s role in wound healing, including normal wounds, chronic wounds, and aging wounds.
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  • 文章类型: Journal Article
    伤口是皮肤正常解剖结构和功能的中断,这对防止外来病原体至关重要,调节体温和水平衡。伤口愈合是一个复杂的过程,涉及多个阶段,包括凝血,炎症,血管生成,再上皮化,重新建模。感染等因素,缺血,糖尿病等慢性疾病会损害伤口愈合,导致慢性和难治性溃疡。间充质干细胞(MSCs)已被用于治疗各种伤口模型,因为它们的旁分泌活性(分泌组)和含有几种分子的细胞外载体(外泌体)。包括长链非编码RNA(lncRNAs),micro-RNAs(miRNAs),蛋白质,和脂质。研究表明,与MSCs相比,使用分泌组和外泌体的基于MSCs的无细胞治疗在再生医学中具有巨大的潜力,因为安全问题较少。这篇综述概述了皮肤伤口的病理生理学以及基于MSCs的无细胞治疗在伤口愈合的每个阶段的潜力。它还讨论了基于MSC的无细胞疗法的临床研究。
    A wound is an interruption of the normal anatomic structure and function of the skin, which is critical in protecting against foreign pathogens, regulating body temperature and water balance. Wound healing is a complex process involving various phases, including coagulation, inflammation, angiogenesis, re-epithelialization, and re-modeling. Factors such as infection, ischemia, and chronic diseases such as diabetes can compromise wound healing, leading to chronic and refractory ulcers. Mesenchymal stem cells (MSCs) have been used to treat various wound models due to their paracrine activity (secretome) and extracellular vehicles (exosomes) that contain several molecules, including long non-coding RNAs (lncRNAs), micro-RNAs (miRNAs), proteins, and lipids. Studies have shown that MSCs-based cell-free therapy using secretome and exosomes has great potential in regenerative medicine compared to MSCs, as there are fewer safety concerns. This review provides an overview of the pathophysiology of cutaneous wounds and the potential of MSCs-based cell-free therapy in each phase of wound healing. It also discusses clinical studies of MSCs-based cell-free therapies.
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  • 文章类型: Journal Article
    有效的伤口愈合仍然是全球医疗保健的主要关注点,因为在目前的治疗下结果不令人满意。瘦素,一种脂肪细胞衍生的激素,主要作用于下丘脑,在各种生物过程中起着至关重要的作用。最近,越来越多的研究表明,瘦素在伤口愈合过程中发挥着重要作用。在这次审查中,我们首次尝试获取有关瘦素与伤口愈合之间关联的最新知识。经过全面审查,瘦素在伤口愈合中的分子机制推测与巨噬细胞和淋巴细胞炎症的调节有关,血管生成,再上皮化,扩散,和成纤维细胞的分化。受影响的基因和信号通路是多个。例如,据报道,瘦素通过抗炎作用改善伤口愈合,这可能与通过p38MAPK或JAK2激活STAT1和STAT3相关。然而,对每个过程中特定角色的理解(例如,炎症,增殖性,和成熟阶段)的伤口修复并不完全清楚,在宏观结构和微观尺度因素方面仍需进一步研究。因此,明确和验证瘦素在创面愈合中的生物学机制,对临床开发潜在的创面愈合治疗靶点具有重要意义。
    Efficacious wound healing is still a major concern for global healthcare due to the unsatisfactory outcomes under the current treatments. Leptin, an adipocyte-derived hormone, mainly acts in the hypothalamus and plays crucial roles in various biological processes. Recently, an increasing number of researches have shown that leptin played an important role in the wound healing process. In this review, we presented a first attempt to capture the current knowledge on the association between leptin and wound healing. After a comprehensive review, the molecular mechanisms underlying leptin in wound healing were speculated to be correlated to the regulation of inflammation of the macrophage and lymphocytes, angiogenesis, re-epithelialization, proliferation, and differentiation of fibroblasts. The affected genes and the signal pathways were multiple. For example, leptin was reported to ameliorate wound healing by its anti-inflammatory action, which might be correlated to the activation STAT1 and STAT3 via p38 MAPK or JAK2. However, the understanding of the specific role in each process (e.g., inflammatory, proliferative, and maturation phase) of wound repair is not entirely clear, and further studies are still warranted in both macrostructural and microscale factors. Therefore, identifying and validating the biological mechanisms of leptin in wound healing is of great significance to develop potential therapeutic targets for the treatment of wound healing in clinical practice.
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  • 文章类型: Journal Article
    在癌症中,肿瘤相关巨噬细胞(TAMs)在促进上皮-间质转化(EMT)方面具有重要作用。EMT是肿瘤转移的一个症结进程。肿瘤转移是癌症的标志之一,并导致患者死亡。癌细胞通常会找到逃避免疫系统检测和攻击的方法。这是通过癌细胞和改变的微环境之间的串扰来实现的。肿瘤相关巨噬细胞(TAM)在肿瘤微环境(TME)中的积累产生了免疫抑制和肿瘤支持环境。被募集到肿瘤中的循环单核细胞和巨噬细胞被定义为在TME中一次的肿瘤相关巨噬细胞。基于激活的刺激和功能,巨噬细胞可分为M1型巨噬细胞和M2型巨噬细胞。M1巨噬细胞,也被称为经典激活的巨噬细胞,表现出促炎和抗肿瘤活性。M2巨噬细胞,也被称为交替激活的巨噬细胞,表现出抗炎,促肿瘤性,和伤口愈合活动。TAM被认为是M2表型。TME将募集的巨噬细胞极化为M2巨噬细胞,因为它们提供免疫抑制性促肿瘤环境。越来越多的研究表明,食管鳞状细胞癌(ESCC)中TAM的存在会导致肿瘤进展。在这次审查中,我们讨论了如何通过TAM使用EMT来引起ESCC中的肿瘤迁移和转移。
    In cancer, tumor-associated macrophages (TAMs) possess crucial functions in facilitating epithelial-mesenchymal transition (EMT). EMT is a crucial process in tumor metastasis. Tumor metastasis is one of the hallmarks of cancer and leads to patient mortality. Cancer cells often find ways to evade being detected and attacked by the immune system. This is achieved by cross-talk between cancer cells and the altered microenvironment. The accumulation of tumor-associated macrophages (TAMs) in the tumor microenvironment (TME) creates an immunosuppressive and tumor-supportive environment. Circulating monocytes and macrophages which are recruited into tumors are defined as tumor-associated macrophages once in the TME. Based on the activated stimuli and function, macrophages can be divided into M1 macrophages and M2 macrophages. M1 macrophages, also known as classically activated macrophages, exhibit pro-inflammatory and antitumor activities. M2 macrophages, also known as alternatively activated macrophages, exhibit anti-inflammatory, pro-tumorigenic, and wound healing activities. TAMs are considered to be of the M2 phenotype. The TME polarizes recruited macrophages into M2 macrophages as they provide an immunosuppressive pro-tumoral environment. Accumulating studies show that the presence of TAMs in esophageal squamous cell carcinoma (ESCC) leads to tumor progression. In this review, we discuss how EMT can be used by TAMs to cause tumor migration and metastasis in ESCC. We also discuss the potential therapies targeting TAMs.
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  • 文章类型: Journal Article
    本综述的目的是确定和总结可用于支持使用HydroTac(HRWD-2)的关键体外证据,以解决与治疗急性和难愈合伤口相关的特定方面。
    提供湿润的伤口愈合环境以支持最佳的伤口愈合一直是伤口护理中的基本原则,因为在封堵以支持伤口愈合的益处方面进行了开创性的工作。现代伤口敷料通过其创新发展采用了湿润愈合的益处。HRWD-2已在临床研究中显示能够实现并支持良好的愈合结果,并且本文提供了支持这种敷料的体外证据。
    进行了在线文献检索(补充了在线不可用的资源的手动检索),以确定描述支持HRWD-2在重要方面的体外证据的文章和研究。促进临床环境中的愈合反应。
    体外研究表明,HRWD-2有助于平衡水分水平,并增强已知对上皮再形成重要的生长因子的可用性。临床前研究表明HRWD-2增强伤口上皮再形成。这些结果一起表明HRWD-2促进潮湿的愈合环境,导致敷料支持上皮再形成。体外数据表明HRWD-2的内在较低的体外粘附力可能在临床上转化为无创伤伤口敷料的益处。包括减少疼痛(特别是在换药时)。
    这篇综述中提供的体外证据支持HRWD-2在液体管理方面报告的成功临床结果,换药时伤口愈合和疼痛减轻。
    UNASSIGNED: The aim of this review is to identify and summarise the key in vitro evidence available to support the use of HydroTac (HRWD-2) to address specific aspects associated with the treatment of both acute and hard-to-heal wounds.
    UNASSIGNED: The provision of a moist wound healing environment to support optimal wound healing has been a basic tenet in wound care since the pioneering work on the benefits of occlusion to support wound healing. Modern wound dressings have adopted the benefits of moist healing through their innovative development. HRWD-2 has been shown in clinical studies to enable and support good healing outcomes and the in vitro evidence in support of this dressing is presented in this article.
    UNASSIGNED: An online literature search (supplemented with a manual search of resources not available online) was conducted to identify articles and studies describing in vitro evidence in support of HRWD-2 in aspects important for promoting a healing response in the clinical environment.
    UNASSIGNED: In vitro studies showed that HRWD-2 contributes to balancing moisture levels and enhances the availability of growth factors known to be important for re-epithelialisation. Pre-clinical studies indicate that HRWD-2 enhances wound re-epithelialisation. Together these results suggest that HRWD-2 promotes a moist healing environment leading to the dressing supporting re-epithelialisation. In vitro data indicating an intrinsic lower in vitro adherence of HRWD-2 likely translate clinically to the benefits of an atraumatic wound dressing, including reduced pain (specifically at dressing change).
    UNASSIGNED: The in vitro evidence presented in this review supports the successful clinical results reported for HRWD-2 in terms of fluid management, wound healing and pain reduction at dressing change.
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  • 文章类型: Journal Article
    背景:先前的研究已经评估了细菌纳米纤维素(BNC)治疗热损伤的有效性,但富血小板血浆(PRP)与BNC型烧伤敷料的协同作用仍需进一步研究.在这里,我们评估了BNC敷料在使用PRP治疗面部烧伤中的有效性.
    方法:面部二度烧伤患者清创后采用基于BNC的伤口敷料治疗。通过临床评估评估烧伤深度和上皮形成。除了使用敷料,我们将PRP皮下注射到左侧半面部烧伤处。右半脸只用敷料治疗。使用患者和观察者疤痕评估量表(POSAS)评估疤痕质量。
    结果:有8例患者的浅表二度烧伤占75%,深二度烧伤占25%。总的来说,在最初的侮辱后3.25天放置敷料。没有患者在敷料放置后出现并发症。不需要改变敷料,无需进一步的手术治疗.上皮化的平均时间为11.4天。在亚组分析期间,当比较基于BNC的敷料(11.8天)与基于BNC的敷料+PRP(11天,p=0.429)。患者(17对12.3,p=0.242)和外科医生(13.5对11.3,p=0.26)的平均POSAS评分使用基于BNC的敷料与基于BNC的敷料+PRP没有显着差异。
    结论:纳米纤维素敷料可有效治疗面部二度烧伤。在有或没有富含血小板的血浆的情况下,它以最佳的美学结果增强上皮再形成。
    Previous studies have evaluated the effectiveness of bacterial nanocellulose (BNC) for the treatment of thermal injuries, but the synergic effect of platelet-rich plasma (PRP) with BNC-based dressing for burns still requires further investigation. Herein, we evaluated the effectiveness of BNC dressings in the management of facial burns using PRP. Patients with second-degree facial burns were treated with BNC-based wound dressings after debridement. The burn\'s depth and epithelialization were evaluated by clinical assessment. Besides using the dressings, we injected PRP subcutaneously into the left-hemifacial burns. The right hemiface was only treated with the dressings. Scar quality was assessed using the Patient and Observer Scar Assessment Scale (POSAS). Eight patients were included with superficial second-degree burns in 75% of the cases and deep second-degree burns in 25%. Overall, dressings were placed 3.25 days after the initial insult. None of the patients presented with complications after dressing placement. Dressing changes were not required, and no further surgical management was necessary. The mean time for epithelialization was 11.4 days. During subgroup analysis, we did not find a significant difference in the epithelialization time when comparing BNC-based dressings (11.8 days) to BNC-based dressings + PRP (11 days, p = 0.429). The mean POSAS scores from a patient (17 vs. 12.3, p = 0.242) and surgeon (13.5 vs. 11.3, p = 0.26) standpoint were not significantly different using BNC-based dressings versus BNC-based dressings + PRP. Nanocellulose-based dressings are effective to treat second-degree facial burns. It enhances reepithelialization with optimal esthetic outcomes with or without PRP.
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  • 文章类型: Journal Article
    这篇叙述性临床综述总结了支持使用水力响应伤口敷料的关键证据。HydroTac(HRWD-2,PAULHARTMANNAG,德国)解决与治疗急性和难以治愈的伤口有关的关键方面。这篇综述展示了如何普遍使用HRWD-2来应对各种伤口类型和皮肤损伤带来的挑战。它突出了HRWD-2调节促进伤口进展和愈合的最佳湿润伤口环境的能力。本综述涵盖的关键方面包括敷料的能力:促进伤口愈合反应的某些阶段(例如,上皮再生)解决了TIME伤口管理框架中提出的伤口进展的概念和需求,提供了最佳的水合水平,以减少换药时的组织创伤和疼痛。
    This narrative clinical review summarises the key evidence in support for the use of a hydro-responsive wound dressing, HydroTac (HRWD-2, PAUL HARTMANN AG, Germany) to address key aspects associated with the treatment of both acute and hard-to-heal wounds. This review demonstrates how HRWD-2 can be used in general to address the challenges presented by a wide range of wound types and skin injuries. It highlights the ability of HRWD-2 to regulate an optimal moist wound environment that promotes wound progression and healing. Key aspects covered in this review include the dressing\'s ability to: promote certain phases of the wound healing response (for example, re-epithelialisation) address the concepts and needs for wound progression as set out in the TIME wound management framework provide an optimal hydration level reduce tissue trauma and pain at dressing change.
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