l*h
发帖数: 4124 | 1 post a description of the events in chronological order, with exact dates of
occurrence. there seem to be things that don't add up.
1. if the "lymphoma" was based on bone marrow biopsy, this would be a late
stage lymphoma with bone marrow infiltration.
2. the biopsy specimen should be good for immunotyping.
3. the management of the high fever baffles me: for high fever of unknown
cause/origin, infection should be the first suspect. the initial management
should be to take sufficient blood sample... 阅读全帖 |
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a**********2
发帖数: 3726 | 2 Let's see how you put here: "一天早晨我妈起床上厕所，不知怎么就摔倒在床边，
短暂昏迷。我爸随后扶她去了医院。诊断是脑梗"--- How was it diagnosed? MRI? If
MRI said so, then it is stroke. If not, then where did you hear that word?
I am sure that no doctor will make that diagnosis without imaging studies.
"这次住院又作了核磁共振，和一两年前比较，并无大变化，但脑梗的诊断不变"---
from what you described here, MRI was at least done this time, and you also
mentioned that compared with 1-2 years ago, that means MRI was done even in
the first time, then if it showed up in MRI, then... 阅读全帖 |
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l*****y
发帖数: 5737 | 3 ☆─────────────────────────────────────☆
MakingWaves (making waves) 于 (Mon Dec 31 14:28:31 2012, 美东) 提到:
今年我妈住了两次院。现在我看， 好像都不是非住院不可的毛病。但医院从利益出发
，轻易建议住院, 过度治疗， 病人结果适得其反。
第一次是年初。一天早晨我妈起床上厕所，不知怎么就摔倒在床边，短暂昏迷。我爸随
后扶她去了医院。诊断是脑梗，收住院，点滴稀释血液的药， 同时点滴所谓有营养功
能的中药制剂。最多的时候，一天里输液有七种药品。我妈本来血压还不大高，输了几
天液，血压就高上去了， 腿走路都没劲了。她以前做过核磁共振， 当时大夫说，那结
果，不要说是六十多岁的人的，就算是四十多岁的人，都算正常。这次住院又作了核磁
共振，和一两年前比较，并无大变化，但脑梗的诊断不变。每次我妈抱怨不舒服，大夫
就再给加一种药输液。后来我妈实在受不了了，说，“走着进的医院， 住了几天，反
倒不能走路了”。终于在两个多星期后坚持出院。回家后， 不用那些药， 血压又正常
了，人有劲了, 也没再摔过... 阅读全帖 |
|
s*******2
发帖数: 1182 | 4 i doubt it is abcess，how about: brain mass-->aspiration pneumonia->sepsis?
upload your other results pls. CT or MRI should tell it is liquid or mass
in brain. |
|
|
A*S
发帖数: 354 | 6 关于脑脓肿，当地医院脑外科的意见？
my point:
1.TB is excluded, no chill in TB patients normally.
2. diagnosis: sepsis, pneiunomia, brain abscess
3. tx: steroids, antibiotics, surgery. |
|
b***S
发帖数: 29 | 7 脓肿住院，肠镜时发现高度怀疑克罗恩，已转内科
外科让我出院了，给了出院报告，目前为止，2个肛瘘给我生活带来极大不便，可是外
科医生也没说后续如何处理，估计要等内科专家意见
下面是肛瘘相关结论，请问是一个内口，2个外口，还是2条不同肛瘘？这种情况一般如
何后续处理？
active perianal sepsis, transsphincteric perianal fistula at 1 o'clock, with
secondary tracts extending superiorly involving the puborectalis muscle and
anteroinferiorly to the anterior perineum at the root of the penis. |
|
L*******7
发帖数: 14902 | 8 GBS是啥东东？刚放狗搜了下，是这东东么？
Group B Streptococcus (GBS) is the most common cause of sepsis (blood
infection) and meningitis (infection of the fluid and lining surrounding
the brain) in newborns.
Between 10 and 35 percent of women carry this bacteria within the vagina
and or the lower intestine. Most of the time, the bacteria does not cause
any symptoms in the pregnant woman, although it can cause bladder and
uterine infections (amnionitis, endometritis)......... |
|
L**c
发帖数: 475 | 9 我恐怕不能接受，尤其新生宝宝，多少会接触。
以前看到国内一则消息，爷爷嘴周围长了个疱什么的，亲了下刚出生不久的孙子，孙子
被感染->sepsis，最后进了医院…
灰指甲没这个严重，但心里总会不舒服。 |
|
w******y
发帖数: 4871 | 10 感觉感染好严重。就白细胞少，其它的呢（红细胞，血小板）？
临床上有sepsis的迹象嘛？
建议如果持续都狠低，就要avoid live vaccine, use CMV free leuk irradiated
blood product if transfusion is needed. start antibiotics prophylaxis for
opportunistic infection. 持续低，估计就要查immunoglobulin level, lymphocyte
subset了。现在看着还不需要。
Bless! |
|
w******y
发帖数: 4871 | 11 感觉感染好严重。就白细胞少，其它的呢（红细胞，血小板）？
临床上有sepsis的迹象嘛？
建议如果持续都狠低，就要avoid live vaccine, use CMV free leuk irradiated
blood product if transfusion is needed. start antibiotics prophylaxis for
opportunistic infection. 持续低，估计就要查immunoglobulin level, lymphocyte
subset了。现在看着还不需要。
Bless! |
|
l*********e
发帖数: 5385 | 12 ☆─────────────────────────────────────☆
zyjyw (糖糖) 于 (Wed Oct 31 23:10:57 2012, 美东) 提到:
不知道是不是mmr+flu shot太强了，礼拜四打的，礼拜六就发croup住了院，当时是呼
吸都困难了，医生说是virus infection，给了类固醇的药。礼拜天discharge，回家还
是不好，昨天又去了ER，在ER发烧100.6，现在中性粒细胞（neutrophils）跌到100，
正常值是1300-7500，免疫系统很弱，病房门口贴条说让进出都洗手，有病戴口罩。医
生跟我说，这种是rare case， 一般小娃打了类固醇，很快就会好，现在5天都没好，
而且还发烧，情况不大好。而且今天的血指标比昨天还低，明天会让血液专科的过来看。
我当时眼睛就红了，医生一走，对着还蹦蹦跳跳的娃就哭了，女儿看见我掉眼泪，眼睛
瞪得大大地看着我，然后做小眼睛朝我笑，拿着故事书给我让我讲。
当时就想，要是娃有点什么事，我也不要活了。只要她好起来，让我怎么都行。
发包子求祝福，另外有没有知道这方面的信息的啊？多谢！... 阅读全帖 |
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S*****i
发帖数: 90 | 13 看来自愈不了，才2天已经发烧了，再下去就SEPSIS，我今天真是后悔昨天没带她去医院 |
|
f******e
发帖数: 247 | 14 来自主题: NextGeneration版 - 为宝宝求祝福 宝宝刚满3岁。三周前支气管炎，吃抗生素。上周四起又发烧，时不时说肚子疼。上周
五这周三儿医都没查出什么。周四凌晨1点多去了儿童急诊，胸透说肺炎，同时抽血作
血液培养。今天凌晨起急诊打电话，早上才听到，说是血液细菌阳性。上午又到急诊，
重新抽血看是否是血液是前次抽血受到污染（医生说it happens）。之后上强效抗菌素
，怀疑sepsis（败血症），需尽快处理。明天上午能知道是否是因为污染。宝宝版一直
灵验，求大家祝福宝宝的血液正常。阳性是因为污染。谢谢大家。 |
|
g*********9
发帖数: 3528 | 15 how could you know your kid's 104C is not caused by bacterial infection?
and why you think "大家放心了吧,104度都不用降的?"
you are assuming your kid does not have meningitis/sepsis, then you come to
the conclusion "104度都不用降的"
but what if you are wrong at the first place? |
|
S*P
发帖数: 7575 | 16 Progenics Pharmaceuticals Inc. (PGNX) fell the most in 14 months after a
study summary showed two patients died of sepsis in a trial of the company’
s experimental prostate cancer treatment。 |
|
w*****n
发帖数: 36 | 17 资格太浅，屡被杂志编辑拒绝。急需审稿经验，请大拿相援，邮箱为 wuyuyanmitbbs@
gmail.com
先行拜谢！ |
|
F***i
发帖数: 110 | 18 来自主题: Immigration版 - 审稿转让 This study is to apply a previously developed methodology for evaluating
heart rate which is depicted in phase space in ordered pairs with
probability theory and proportional entropy as well as differentiate both
normal and septic cardiac dynamics on Intensive Care Unit.
Keywords: chaotic attractor, cardiac dynamic, entropy, probability, sepsis.
有意者请把个人研究背景及发表文章发信箱(two page CV)，谢谢！ |
|
P*******1
发帖数: 704 | 19 外科领域的，和创伤和烧伤有关的。
麻烦有相关背景和意愿的同学发私信给我。请把自己的背景和联系方式列一下。我会把
相关信息发给编辑。信息我自己不会保留的。
谢谢。
00201
The utility of C-reactive protein and Procalcitonin for sepsis diagnosis in
critically burned patients: a preliminary study.
00202
Evaluation of Aluminum Sulfate in Controlling Superficial Haemorrage; an
Animal Model Study |
|
i********n
发帖数: 171 | 20 Please send your CV to [email protected]/* */ with selected MS#. 请务必认真审稿并及
时提交意见，谢谢
1. Iptakalim induces mitochondria-dependent apoptosis in hypoxic rat
pulmonary arterial smooth muscle cells
2. Fyn-related kinase expression predicts favorable prognosis in patients
with cervical cancer and suppresses malignant progression by regulating
migration and invasion
3. The Protective effect of Citrus limon essential oil on Hepatotoxicity
and nephrotoxicity induced by aspirin in rats
4. ... 阅读全帖 |
|
o********y
发帖数: 139 | 21 must take antibiotics, otherwise very dangerous, one case a few months ago,
17 year old boy died from extraction of wisdom teeth due to infection and
sepsis. |
|
g*2
发帖数: 658 | 22 刚看到。同意dai的意见，不要剪，外面的皮留着保护下面的新肉长出来。等长好了，
外面的皮会自己掉下来。如果已经剪开了，那就要象对开放伤口那样处理，比如要用纱
布或dressings包扎。
最好去医生那里看看，有的医生会把那个切开的皮剪掉（我在急诊室做volunteer的时
候看到他们这么做的），然后涂上bactrim等抗生素，包扎。
如果感兴趣可以看看这个
Management of friction blisters includes sterile drainage of the site while
leaving the blister roof intact to serve as a dressing. This method helps
relieve some discomfort and protects the site from superinfection. A donut
of moleskin may also be applied to minimize additional trauma to the blister
and to relieve dis... 阅读全帖 |
|
g*2
发帖数: 658 | 23 死亡的直接原因总是cardiac arrest, respiratory failure. 但真正的原因可能是其
他，比如电解质紊乱，低钠， 低钾，脱水，代谢性酸中毒等，并不一定是心脏的问题。
我们医院不让我们写death certificate的时候，写死亡原因是cardiac arrest,
respiratory failure。 因为每例死亡都是这样的。我们一般常见的写sepsis,
pneumonia, intracranial hemorrhage之类的。 |
|
l******k
发帖数: 27533 | 24 是neonates ICU
还好啦，大部分是premie，有几个withdrawal, 有几个sepsis...
远远不如adult ICU 那么多挑战，不然我哪有空上网，偶尔还能跟护士阿姨们聊聊～
★ 发自iPhone App: ChineseWeb 8.7 |
|
M*****a
发帖数: 7122 | 25 赞专业知识。能给解释下什么是培养？
the
least
work but depending on how deep the wound is and whether the surgery is
cutting all the infection tissue out, that may why the vet said he might
need multiple surgery. right now is to prevent bacterimia and sepsis which
can cause end organ failure. |
|
x********u
发帖数: 15396 | 26 那我需要让他们做cbc吗？
the
least
work but depending on how deep the wound is and whether the surgery is
cutting all the infection tissue out, that may why the vet said he might
need multiple surgery. right now is to prevent bacterimia and sepsis which
can cause end organ failure. |
|
n**v
发帖数: 2109 | 27 这个阿莫西林直接上的办法太不靠谱了，哈哈，熟我直言。阿莫西林对于皮肤方面的病
本来就效果很差，甚至没用，因为不是同一种细菌，何况本来吃的药要外用。实在要应
急，去超市里买triple antibiotic或者bactroban。后者是处方药的low dose formula
。但是这个伤口一定要医生治疗，因为太深，害怕万一bone and blood infected 引起
sepsis，而且可能除了bacterial infection,还有yeast什么的。 |
|
b********n
发帖数: 38600 | 28 http://www.nytimes.com/2012/03/25/opinion/sunday/bruni-a-cathol
March 24, 2012
Rethinking His Religion
By FRANK BRUNI
I MOVED into my freshman-year dorm at the University of North Carolina after
many of the other men on the hall. One had already begun decorating. I
spotted the poster above his desk right away. It showed a loaf of bread and
a chalice of red wine, with these words: “Jesus invites you to a banquet in
his honor.”
This man attended Catholic services every Sunday in a jacket and tie,
... 阅读全帖 |
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l**********1
发帖数: 5204 | 29 Johns Hopkins too 连tenure都过不了
不是看已有领域的挖掘 还要看新领域的digged out data and results.
please refer:
for example:
Lee Martin, Ph.D.
Professor of Pathology, Neuroscience
//pathology.jhu.edu/department/divisions/neuropathology/faculty-staff.cfm
his group recent paper:
线粒体上的控制 NO 的通道控制着细胞老化和自然死亡的过程
"The mitochondrial permeability transition pore regulates nitric oxide-
mediated apoptosis of neurons induced by target deprivation.” (2011)
J Neurosci. 31: 359-370.
PubMed link:
//www.ncbi.nlm.nih.gov/pubmed/2... 阅读全帖 |
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a***y
发帖数: 19743 | 30 肝脏不是免疫器官，肝细胞可以吃细菌吗？
老鼠里sepsis之后可以测血液，肝和肾里面细菌含量。 |
|
i***i
发帖数: 33 | 31 Oberbeck R,et al. Adrenergic modulation of survival and cellular immune
functions during polymicrobial sepsis.Neuroimmunomodulation. 2004;11(4):214-
23.
Please email to
m******[email protected]
Many thanks! |
|
|
a***y
发帖数: 19743 | 33 今天早些时候 看到了原文
感觉对研究trauma， burn和sepsis的影响大一些。
it's not the end of the world.
been
human |
|
z*******6
发帖数: 679 | 34 不知道该从哪说起... 首先声明我也不是专家，还在学习... 提一些简单的general的
看法吧...
就像楼上说的，bacteria很少只在blood stream里面，一般都会同时存在于各种organ
里面，而且一般出现感染都是局部的，很少会disseminate到blood里面（除非局部不行
了，这种情况一般都很严重了，就像sepsis），如果在blood里面neutrophil什么的会
帮助monocyte一起干掉bacteria...
monocyte除了进入组织去分泌很多proinflammatory cytokine刺激各种immune细胞、
endothelial cell、resident macrophage以外，还会分化成macrophage最后去清理战
场什么的... Monocyte主要不是去战斗，而是分泌指挥其他免疫细胞和局部炎症反应...
hope it helps... |
|
r******g
发帖数: 600 | 35 1. 比如说，我拿一把刀把我的胳膊的皮肤割了一刀，然后就流血了，因为刀割到了小
血管，然后血液从小血管里面流出来
2. 但是，皮肤里面可都不是血管。可以这么理解，血管外面有大量的胶状的matrix
protein并且还有很多组织里面的细胞，比如fibroblast之类的，他们支撑起来了组织
的机构，大多数重要功能性细胞都在组织里面。
3. 再拿肺当例子，肺里面通气的管子是branchiole，支气管是有血管伴行的！ 可以这
么理解，如果你把肺横着切一刀，除了血管和气管，其他的都是组织成分。
4. 组织里面不是血液，组织里面是有“组织液”流动。组织液里面含有很多脏东西，
比如死了的细胞debris，比如细菌。这个很好理解，因为细菌想直接钻进血管的概率很
小，要是infection多半是血管外组织被侵染了。
5. 组织液流去哪儿？ 这个就涉及到淋巴系统了，淋巴系统可以理解为淋巴管，淋巴液
和外周组织液。 那些脏组织液都跑到理他们最近的淋巴节，叫draining lymph nodes
6. 这就是为什么，你如果上呼吸道感染，鼻子堵，或者牙齿痛时候经常会有脖子淋巴
结肿大。因为，脏东西都跑去... 阅读全帖 |
|
h***a
发帖数: 145 | 36 Soluble adhesion molecules as markers for sepsis and the potential
pathophysiological discrepancy in neonates, children and adults
Rens Zonneveld , Roberta Martinelli , Nathan I Shapiro , Taco W Kuijpers ,
Frans B Plötz and Christopher V Carman
Thank you in advance. |
|
a***y
发帖数: 19743 | 37 T2 Biosystems has developed the T2Dx instrument that is designed to
rapidly detect the bacterial and fungal pathogens that lead to sepsis in as
quickly as 3.5 hours and at limits of detection as low as 1 CFU/mL. Multiple
studies have shown that providing the appropriate antimicrobial therapy to
a patient within hours may reduce the mortality rate of bloodstream
infections by as much as 70%. The cost savings to the healthcare system in
the U.S. alone could be $12 billion per year from reduced h... 阅读全帖 |
|
s*********y
发帖数: 579 | 38 一般的撤稿都是把责任推给一作，老板是清白的。大家看这个
http://www.sciencemag.org.offcampus.lib.washington.edu/content/
Retraction
There are several problems with the Report “Sphk1 regulates proinflammatory
responses associated with endotoxin and polymicrobial sepsis” by P. Puneet
et al. (1). Specifically, Figs. 3D and 4B contain images that were
generated by author Puneet for the Science paper, but had been used in
previous publications [see (2, 3)] without her knowledge or consent. Images
in Fig. 3D are also found in Fig... 阅读全帖 |
|
T*R
发帖数: 36302 | 39 临床价值很高吧。
现在临床上万古霉素是神药了，要是走下神坛医院和病人就惨了。
基本上只要不是社区感染，不管是肺炎还是UTI或是SEPSIS，都是上来就给万古霉素。
经验治疗。但是现在VRE感染越来越多了。 |
|
h******c
发帖数: 10 | 40 The sepsis caused by urinary obstruction is a surgical emergency, and the
definitive treatment is release the obstruction ASAP. IV antibiotics alone
is ineffective most of time. |
|
L****n
发帖数: 12932 | 41
first of all, thanks for your valuable insight.
i agree, the treatment option is release of pressure. The patient is usually
very sick and not able to tolerate open surgery. Pylonephrocentesis under
CT by a radiologist is the best choice if the service is available. I had
handle a patient just like this before and it was one of the most difficult
case i had, anesthesia wise.
coming back to the topic of malpractice. be it sepsis or side effect of
vasoconstrictor, the bad outcome is not cause by |
|
n*******c
发帖数: 501 | 42 Thanks again.
Fever and back pain should prompt consideration of pyelonephritis. I think a non-contrast CT would be necessary in this case then. Or IVP? which i think they did within 16 hours.
I have had a case in which a female presented with RUQ pain and adm with acute
cholecystitis but she turned out to be pyelonephritis as we examined her. She then developed E Coli sepsis and was treated with antibiotics. She did not have stone shown on the subsequent CT scan though. But the CT was done 48 h |
|
c*****0
发帖数: 9 | 43 For the patients with acute pyelonephritis, without response to the
antibiotics after 3 days of treatment. CT or U/S need to be done to look for
any obstruction even without history of stone.
For this case, release the obstruction and drainage is the fundamental for
the successful treatment of sepsis from pyelonephritis. If the septic shock
can be early recovered then the vessel constrictors could be avoid or can be
withdrawal earlier. The related side effects will be reduced.
Did the vasssconst |
|
n*******c
发帖数: 501 | 44 Thanks all the input and I learned a lot from the discussion.
In this case the stone was removed 16 hours after the patient presented but
still not early enough to save her from sepsis shock. I may consider earlier
imaging r/o of obstruction for pyelo given the outcome could be so bad as
shown in this case. |
|
s*******r
发帖数: 174 | 45 来自主题: MedicalCareer版 - 殊途同归 这个月在icu,第一个call收的两个病人都是pneumonia/sepsis/septic shock.第一个83
岁，我收的时候他还好好的，冲我笑呢，就是sats低，lactate只有4。overnight就被
intubate拉，we did everything we need to do, 可他还是接着一天不如一天，挺了
一周，kidney开始down，platelets也开始drop，家里很快就决定withdraw care了。当
时还想着应该再给他一些时间。。。。
另外一个72，收得时候lactate7点几，一度11点几，ph7.0几，k7点几，fluids
,pressors, bicarb drip, dialysis。。。能用的全用了，当时觉得他肯定是不行的了
。。。。没想到一天一天好起来，前两天居然extubate了。。。就在我感叹年龄真是
icu病人的prognostic factor啊的时候，他还是tolerate不了拔管后的destress，面临
再度被intubate和long term weaning process， 刚上去看，已经决定comfort |
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k**********n
发帖数: 438 | 46 老柳细节讲得很好了，俺胡了八图昏了一年了，早听受益更多。
我个人体会是要抓住主要矛盾以及看住不良倾向。主治大夫基本也就关注主要矛盾，你
把主要矛盾cover了，他们对其他小节就纠结的少一些。例如，嗯嗯，例如...
感染你得说血象，band, left shift, trend.你还得说fever, 细菌培养。你还得说病
人从哪里来的，从家里来的那就是community aquired，从nursing home来的那就是
hospital aquired,抗生素的用法就不一样了。说sepsis你得说血压的趋势，脉搏(80那
可能不是septic shock，130你得考虑把心律降下来了，ventricular filling要不灵光
了)。尿量(ml/hr)，反映peripheral perfusion，line，CVP,液体出入量. Bicarb,gap
, lactic acid，还有用药。
CHF那你得说病因，diastolic还是systolic，EF多少。体重，尿量，lasix用量，肺湿
不湿，腿肿不肿，O2 sat行不行，dig level， K, Mg.
COPD你对说吸 |
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L*****r
发帖数: 722 | 47 4。（ICU 病人）高血糖直接导致高死亡率的说法，根本上还是想当然尔，并没有严格
的依据。因为高血糖也可能只不过间接反映了underlying disease的病情更为严重。导致
高死亡率的，也许是更为严重的underlying disease，而不一定是高血糖本身。这样的
话，试图用降低血糖来降低死亡率，其实是建立在一个很不可靠的理论假说上面：
http://www.mitbbs.com/article_t/MedicalCareer/31354467.html ， 21 楼
打个不太恰当的比方：在ICU ，某天某CMG observer说了句“马瘦毛长”，遂引发大家
注意：病人的病情越重，好像毛发就越长，于是做了多中心trial, 果然证明，死亡率
和毛发长度成正比，于是就说，原来毛发越长，导致死亡率越高啊！―――不是马瘦毛
长，而是毛长马更瘦啊！
于是就开始了一场轰轰烈烈的的万例临床研究，以证明剃毛可以减少死亡率。
可是后来又发现，剃毛太严格，反而会增加死亡率，也许是因为剃毛增加割破皮肤的几
率，导致sepsis 以及 HIV 等其他血源传播疾病的高发，等等等等吧，于是又开始了 |
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f******l
发帖数: 455 | 48 手术或者放射碘治疗都会造成甲减。给我的感觉美国这里更favor碘治疗，除非
contraindicated. 我见过一个病人，因为amiodarone，成甲亢，后来用methimazole，
complicated with agranulocytosis and sepsis， 像他这样，没有办法，只能用手
术治疗，因为iodine uptake too low。 |
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k********n
发帖数: 756 | 49 This is wrong.
In general, you will be failed by your answers that you posted above.
To me and generally speaking, it is not a honest statement. You made it up.
If you can not hide from my eye, you will be disliked or mocked by the
person whose visual acuity is far beyond our imagination.
Don't use big word and conceptualize something that actually is not existing
, such as my personality matching up with the specialty. Only genius can
make that comment, not common people like me. If people d... 阅读全帖 |
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