抽象的
假单胞菌铜绿假单胞菌由于其对社区获得性肺炎(CAP)患者最常用的抗生素具有固有耐药性,是一种极具挑战性的治疗细菌。有关全球负担和相关风险因素的数据P.铜绿假单胞菌-cap是有限的。我们评估了与之相关的跨国负担和具体风险因素P铜绿假单胞菌-帽。
我们在54个国家登记了3193名确诊为CAP的患者,他们在入院时接受了微生物检测。患病率根据患者的身份进行计算P.铜绿假单胞菌. Logistic回归分析用于确定抗生素敏感和耐药的危险因素P铜绿假单胞菌-帽。
的患病率P.铜绿假单胞菌抗药性P铜绿假单胞菌-CAP分别为4.2%和2.0%。的速度P.铜绿假单胞菌患者患者以前感染/殖民P.铜绿假单胞菌三种独立相关慢性肺病中至少一种(即。气管造口术、支气管扩张和/或非常严重的慢性阻塞性肺疾病)占67%。相比之下,P铜绿假单胞菌-既往无CAP的患者CAP为2%P.铜绿假单胞菌感染/定殖,没有任何选定的慢性肺病。
跨国普遍存在P铜绿假单胞菌-上限很低。本研究中确定的风险因素可指导医疗专业人员确定CAP患者的经验性抗生素覆盖率。
抽象的
P.铜绿假单胞菌帽患者不常见。应在选择帽子抗生素时进行特定的风险因素。http://ow.ly/jpP130koSMX
介绍
社区获得性肺炎(CAP)是世界范围内发病率和死亡率最高的传染病[1那2].50 - 60亿人被诊断为CAP,每年有350万人死于CAP [1那3.].有几种病毒和细菌会引起CAP [4.], 但肺炎链球菌肺炎料仍然是成人中最常见的细菌病原体[5.].在过去的几十年里,CAP的病因一直在变化:以前被认为只在医院环境中重要的耐抗生素细菌现在在社区环境中变得更加普遍[6.-8.].这种新病原体生态的进化正威胁着我们治疗CAP患者的能力[9.-11].
假单胞菌铜绿假单胞菌,一种革兰氏阴性细菌,对几种抗生素具有内在的耐药性,如β-内酰胺[12[已常常在概要的患者中报道,具有特定的医疗保健相关的危险因素,例如在过去90天内在护理家庭和住院中的住所(即。医疗保健相关肺炎(HCAP)) [13-15].此外,严重疾病和临床结果不佳P.铜绿假单胞菌感染CAP患者[15-17].近年来,流行的菌株P.铜绿假单胞菌往往对假单胞菌抗生素有更高的耐药性模式,导致感染难以治疗[6.].
CAP的流行是由于P.铜绿假单胞菌在不同的患者组和特定的危险因素之间有显著差异P铜绿假单胞菌-CAP是有争议的[18那19].有关的发病率目前掌握的数据P铜绿假单胞菌-帽及其电阻模式仅限于单中心研究[15那20.],并用一些方法的局限性研究[15那21-23].在元分析中,C卤虫等等。[24]报告的数据来自22项研究的患病率在不同的帽子种群中的0%至23%,池流行率为8.6%P.铜绿假单胞菌患者多药耐药性(MDR)的风险因素和患者4%无危险因素。所有都是单中心/ -region和大部分被评为具有差的方法论状态[24].因此,真正流行的P.铜绿假单胞菌-CAP全局未知。目前,危险因素与P.铜绿假单胞菌传染病社会(IDSA)/美国胸部社会(ATS)的感染众所周知的HCAP指南不同于上限指南中发表的指导方针[13那25].此外,耐多药耐药性的全球流行P.铜绿假单胞菌在CAP患者中的作用尚不清楚。因此,要缩小全球患病率和相关危险因素的差距P绿脓杆菌,我们设计了一项跨国,多中心,世界范围的研究来确定点流行率P.铜绿假单胞菌,其耐药谱及住院CAP患者的相关危险因素。
材料和方法
学习规划
这是一项针对54个国家222家医院住院的CAP患者的多中心、点流行研究。该项目的协调机构是德克萨斯大学圣安东尼奥分校(UT Health)(圣安东尼奥,德克萨斯州,美国)。UT卫生机构审查委员会批准了该项目,以收集数据并作为研究的协调机构(#HSC20150184E)。研究地点必须遵守当地和国家的研究规定才能参与研究。各医学专业协会的成员收到了电子邀请,代表传染病、肺病、危重症和内科医生。此外,先前发表的关于CAP中耐多药病原体研究的第一作者也收到了个别邀请。这个项目没有得到任何资金。受试者在2015年3月、4月、5月和6月随机选择4天入组。每个现场研究者选择研究天数,以遵守IRB规定,并避免潜在的患者去识别[26].由于该研究的观察性质,不需要患者的同意。
研究对象
纳入标准
P.atients aged ≥18 years hospitalised with CAP were eligible for the study. CAP had to be diagnosed per the current IDSA/ATS guidelines [13]:在最初的48小时内,胸部成像(胸片、计算机胸部断层扫描或肺部超声)出现新的肺部浸润 h住院时间和以下一种或多种情况:1)新的或增加的咳嗽,伴有或不伴有痰生成和/或化脓性呼吸道分泌物;2) 发热(口腔或直肠温度)≥37.8°C)或低温(口腔或直肠温度<36°C);3) 全身炎症症状(白细胞计数异常(白细胞计数>10 000 细胞·厘米-3,球员> 10%,白蜂鸟<4000个细胞·厘米-3),降钙素原水平高于正常或升高的c反应蛋白的局部上限)[26].
排除标准
患者参与该研究排除如果他们有医院获得性肺炎(HAP)或呼吸机相关性肺炎(VAP)25].此外,没有从医院入院24小时内收集的血液,降低呼吸道培养或痰无微生物检测的患者。
数据收集
数据收集和使用红帽子™(研究电子数据采集),举办了UT健康圣安东尼奥服务器上的电子数据采集工具进行管理。红帽子™的目的是收集研究数据保护基于Web的应用[27].Confirmation of microbiological results and all electronic data entry had to be completed within 7 days of study enrolment.
微生物分析
诊断检测,如血液培养和呼吸系统采集,以及临床护理决定是由主治医生决定的,而不是根据研究方案[26].采用当地微生物检测方案处理在住院前24小时内采集的血液和痰标本。如有,收集胸膜液、气管支气管抽吸液和支气管肺泡灌洗液的资料。每家医院进行的地方检测包括呼吸和血液培养、尿抗原和药物敏感性检测。根据当地法规和协议,遵循最低抑菌浓度断点和临床和实验室标准协会(CLSI)或欧洲抗菌药物敏感性检测委员会(EUCAST)标准的当地质量控制协议[28那29].
研究的定义
在住院的最初24小时内需要有创呼吸和/或血管加压素支持(IRVS)的患者被归类为IRVS+[30.].P铜绿假单胞菌-CAP被定义为任何病人在其中CAP的确诊P.铜绿假单胞菌在任何呼吸道液体中分离,包括胸腔积液、痰和/或支气管肺泡灌洗和/或血液中。耐药P.铜绿假单胞菌是当分离的病原体对至少一种抗生素和耐多药P.铜绿假单胞菌通过电阻定义为至少三个的评价抗生素。以下抗假单胞菌抗生素的抗生素抗性进行了评价:哌拉西林/三唑巴坦,头孢吡肟,头孢他啶,丁胺卡那霉素,庆大霉素,妥布霉素,左氧氟沙星,环丙沙星,亚胺培南,美罗培南,多利培南,多粘菌素E和多粘菌素B.
之前P.铜绿假单胞菌感染/殖民化被定义为在住院前的过去一年内确诊的感染/殖民化,由患者或可用的患者记录记录。慢性阻塞性肺疾病(COPD)根据1 S强迫呼气量定义(FEV)定义1)/强迫肺活量比<0.7,临床病史一致(如有相关,包括吸烟史)。非常严重的COPD被定义为有非常严重梗阻证据的COPD患者,由FEV确定1入院前<30%(完整的研究词典可在在线补充材料).在开始收集数据之前,研究方案手册和研究词典向现场调查者提供了这些定义[26].
统计分析
的患病率P.铜绿假单胞菌作为帽的微生物疾病学(即:铜绿假单胞菌-CAP)的计算基于P.铜绿假单胞菌孤立除以研究队列(即。完成微生物学测试的CAP患者),并以百分比表示。分类变量比较采用卡方检验,用n(%)表示。连续变量以中位数(四分位差(IQR))表示,并使用非参数Mann-Whitney u检验进行比较。评估CAP之间的关系P.铜绿假单胞菌对67个人口学、临床、流行病学和治疗变量进行逐步logistic回归模型分析。p值<0.05为具有统计学意义。Tableau Desktop, Professional for Mac (Seattle, WA, USA),用于生成流行地图。所有统计分析均使用IBM SPSS、Statistics for Mac (version 22.0;IBM, Armonk, NY, USA)。
结果
在四个研究日内,共从54个国家的222家医院招募了3193名患者(n=1877(58.8%)男性,年龄中位数(IQR)为68(54–80)岁)。人口统计学、危险因素、共病、疾病严重程度和慢性治疗报告见表格1.在六大洲中,大部分患者来自欧洲(n=1941, 60.8%),其次是北美(n= 484,15.2%)、亚洲(n=405, 12.7%)、南美洲(n=203, 6.4%)、非洲(n=128, 4.0%)和大洋洲(n=32, 1.0%)。血液(n=2211, 69.2%)、痰(n=1630, 51.0%)和支气管肺泡灌洗液(n=311, 9.7%)中获得微生物培养物。1173例患者中至少发现一种病原体(36.7%)(在线补充图E1).表2.和在线补充表E1显示了P.铜绿假单胞菌帽和抗生素耐药P.铜绿假单胞菌-每个大陆和国家的CAP。
患病率P.铜绿假单胞菌-帽
P铜绿假单胞菌-在133名(4.2%)患者中鉴定了帽,代表了所有患者的11.3%(1173分中,13.3分,13.3分)患者对细菌病原体的阳性培养。大陆普遍存在P铜绿假单胞菌-CAP在欧洲为3.8%,北美洲为4.3%,亚洲为5.2%,南美洲为4.9%,非洲为5.5%,大洋洲为3.1% (图1). 流行P铜绿假单胞菌-在每个国家的帽子,大陆和国家之间的比较显示在表2和在线补充表E1.在患病率方面无统计学差异P铜绿假单胞菌-在不同的大陆之间。克罗地亚是唯一一个在统计上显著高于艾滋病流行率的国家P铜绿假单胞菌-CAP(在线补充表E1).
普遍存在的耐药P铜绿假单胞菌-帽
抗生素耐药P铜绿假单胞菌-CAP在64(2.0%)患者被确定,代表谁了培养阳性的患者的5.4%(64出1173)。的抗生素抗性大陆患病P.铜绿假单胞菌欧洲的CAP是1.6%,北美2.5%,亚洲2.2%,南美3.0%,非洲3.9%(图1). 没有抗生素耐药的患者P铜绿假单胞菌-在大洋洲确定的CAP。耐药发生率差异无统计学意义P铜绿假单胞菌-不同大陆之间的CAP (表2).
MDR患病率P.铜绿假单胞菌-帽
耐多药P.铜绿假单胞菌在33例(1.0%)患者中发现,占所有患者的2.8%(1173例中33例)。耐多药耐多药在大陆的流行P铜绿假单胞菌-CAP是欧洲的0.9%,在北美的1.2%,在亚洲的0.5%,在南美2%,非洲2.3%。目前还没有患者MDRP.铜绿假单胞菌在大洋洲。在耐多药流行率方面没有发现有统计学意义的差异P铜绿假单胞菌-盖子在不同的大陆之间。没有患者感染泛毒剂P.铜绿假单胞菌(即。对三组或三组以上的抗生素和粘菌素有耐药性)[31].
危险因素
比较患者人口统计和危险因素P铜绿假单胞菌-限制和非P.铜绿假单胞菌CAP(表格1).危险因素与P铜绿假单胞菌-在多变量分析中的帽是之前的假单胞菌感染/定位(OR 16.10, 95% CI 9.48-27.35)、既往气管造口术(OR 6.50, 95% CI 2.61-16.19)、支气管扩张(OR 2.88, 95% CI 1.65-5.05)、IRVS (OR 2.33, 95% CI 1.44-3.78)和重度COPD (OR 2.76, 95% CI 1.25-6.06) (表3那在线补充图E2). 此外,与抗生素耐药相关的危险因素P。铜绿假单胞菌-CAP是优先的假单胞菌感染/定植(OR 17.29, 95% CI 9.95-33.42)、气管切开(OR 5.55, 95% CI 1.73-17.80)和IRVS (OR 3.12, 95% CI 1.63-5.97)。在双因素分析中仅发现有统计学意义的危险因素是过去12个月期间COPD、冠状动脉疾病、吸入皮质类固醇使用、留置导管和下呼吸道感染/急诊室就诊/住院/抗生素治疗(在线补充表E3).表3显示与不同抗生素耐药模式有统计学显著相关性的所有危险因素(多变量分析见在线补充表E2)。
图2.强调艾滋病流行的重要性P.铜绿假单胞菌-CAP,根据IRVS的要求,对所有CAP住院患者或分层后的患者进行两种主要危险因素之一的检测。在所有CAP患者中,只有11%的患者存在危险因素(既往感染/定居假单胞菌患有慢性肺病(即。气管造口术、支气管扩张和/或非常严重的COPD)。缺乏这两组风险因素(即。以前感染/殖民假单胞菌气管造口术、支气管扩张和/或非常严重的COPD(基于FEV)1)证实只有2-6%的患者可能仍然受到影响,与IRV的需要无关。这些危险因素的敏感性、特异性、阳性/阴性预测值和阳性/阴性似然比见在线补充表E3.
讨论
这项跨国点流行率研究发现P.铜绿假单胞菌仅4.2%、2.0%和1.0%的住院患者有CAPP绿脓杆菌,抗生素耐药P.铜绿假单胞菌或耐多药(MDR)P.铜绿假单胞菌分别地未发现泛耐药患者P绿脓杆菌。不同大陆之间的流行率没有统计学意义差异。克罗地亚是唯一具有统计学上显着更高的国家P.铜绿假单胞菌帽流行。之前假单胞菌感染/定植、气管造口、支气管扩张、IRVS和非常严重的COPD是独立相关的P.铜绿假单胞菌-帽。此外,患者患有过去的病史假单胞菌感染/定居或慢性肺病(即。气管造口术、支气管扩张和/或非常严重的COPD)感染抗生素耐药性的风险较高P.铜绿假单胞菌.
由于耐药细菌的新出现患病率,决定对帽患者的实证治疗变得挑战,例如P.铜绿假单胞菌[6.].在一项针对美国培养阳性患者的大型回顾性研究中,K奥利夫等等。[15据报道,19%的流行率P.铜绿假单胞菌在住院治疗患者帽。在欧洲的预期队列研究中,C卤虫等等。[32]报告的患病率为0.7%P.铜绿假单胞菌CAP组的患病率为2.2%,CAP组的阳性率为2.2%。j还等等。[5.]发现P.铜绿假单胞菌在美国的一项前瞻性队列研究中,0.4%的CAP患者和1%的培养阳性肺炎患者中均存在这种情况。我们发现跨国点流行P.铜绿假单胞菌作为CAP的致病病原体为4.2%,其对应于患者的阳性培养肺炎11.3%。在不同的研究报告患病率的变化可以通过在研究设计,特别是用来计算患病率[分母的差异来解释26].然而,这些最新报道的流行率P.铜绿假单胞菌-CAP低于以往的报告[13-15],表明只有一个小患者亚组可能需要经验抗杀螨型抗生素覆盖率。
IDSA/ATS CAP指南推荐抗假药β-内酰胺类抗生素加氟喹诺酮类或氨基糖苷类药物治疗有危险因素的患者P.铜绿假单胞菌-cap [13].已推荐双抗生素覆盖,用于MDR的HCAP,HAP或VAP假单胞菌被认为是一个重要的问题[25].我们的研究结果对这种方法提出了挑战,表明耐多药耐药性在世界范围内普遍存在P.铜绿假单胞菌CAP患者的死亡率非常低(在培养阳性肺炎患者中为1%或3%)。我们的结果与西班牙Cillóniz等等。[33报告了多药耐药的流行P.铜绿假单胞菌在CAP培养阳性患者的前瞻性队列研究中,这一比例为1.1%。因此,推荐使用双重抗假药经验覆盖高估了耐多药的实际发生率P.铜绿假单胞菌与在医院感染中发现的情况相比,医院的耐药率似乎高于来自社区的患者。然而,我们建议重症肺炎感染性休克患者应接受经验性双抗假药覆盖[25].
一些研究人员假设评估负责帽的病原体患病率的研究难以概括,因为这些研究在不同的环境中进行(即。单一医院(地区、国家或大陆),在医疗服务提供方面存在具体差异,包括抗生素可用性和抗菌药物使用政策[19那21那23那34].在我们的研究中,我们发现普遍存在P.铜绿假单胞菌-CAP在代表不同大洲的参与中心之间没有显著差异。相比之下,克罗地亚是唯一一个在统计数据上明显偏高的国家P.铜绿假单胞菌帽流行。这项研究的新颖之处在于,它招募了来自世界各地50多个国家的大量中心的患者,以确定艾滋病的流行程度P.铜绿假单胞菌在CAP患者。
一般来说,许多住院患者在等待48-72小时以确定特定病原体和抗生素敏感性的同时,接受初步的经验性抗假药覆盖[1那3.]. 这一做法增加了广谱抗生素的使用,并促进了抗生素的过度使用,从而有诱发耐药性的风险[11那26].此外,由于抗生素覆盖不当,最初诊断和抗生素敏感性可用性之间的延迟可能会对CAP患者的预后产生负面影响[13].因此,对经验性抗癫地覆盖的启动应基于病原体在受影响的社区中循环的可能性以及特定危险因素的存在P.铜绿假单胞菌-cap [6.那13那25].在这方面,IDSA / ATS肺炎指南中列出的风险因素P铜绿假单胞菌-帽是重症监护室入院,结构肺疾病,如支气管扩张或具有多种加剧的COPD [13].已经报道了几个危险因素P铜绿假单胞菌-在过去的几十年中盖帽[6.]但是这些先前报告的风险因素(例如心力衰竭,管饲[35],等.)在本研究的双变量分析中有统计学意义,但在多变量分析中没有统计学意义。相反,我们发现之前假单胞菌感染/定植、既往气管造口、支气管扩张、IRVS和非常严重的COPD (FEV)1≤30%)P铜绿假单胞菌-这些发现支持在严重肺部疾病患者中考虑经验性抗假单胞菌抗生素的这些危险因素,但不是在所有结构性肺部疾病患者中。更重要的是,以前的病人P.铜绿假单胞菌感染/定植的风险最高P.铜绿假单胞菌无论疾病的严重程度如何,都可以从经验的抗假性抗生素覆盖中获益。使用这些特定的危险因素不同于IDSA/ATS指南推荐的方法,可能有助于防止CAP患者过度使用抗菌药物。更重要的是,抗菌药物管理项目试图最小化无特异性患者使用抗菌药物的覆盖假单胞菌危险因素可能有助于预防不良事件和过度使用不必要的抗菌疗法。
这一点患病率的研究有一定的局限性。首先,我们无法确定临床结果由于研究设计。然而,以确定患病率和识别风险因素,时点患病率研究是理想的,因为它们产生大样本和收集数据普遍意义。其次,微生物样品没有由于实验设计和可行性了集中药敏试验。然而,在研究点的实验室被鼓励按照CLSI或EUCAST准则来确定抗生素耐药[28那29].第三,帽子患者的微生物诊断可以被其他病原体混淆呼吸道;但是,在我们的研究中,我们只报告了根据目前章程临床指南的代表性增长的病原体。第四,肺炎以外的感染是可能的,但不太可能呈现患有临床症状和症状的患者和帽的放射性确认。第五,不进行质量评估,因为收集的所有数据都是可辨认的;但是,所有当地调查人员都被指示如何注册患者以及如何使用研究协议,数据字典和教学视频中所述的数据收集平台。第六,囊性纤维化(CF)是慢性常见的原因P.铜绿假单胞菌殖民化;虽然CF的大多数患者可能包含在支气管扩张组中,但在我们的研究中没有直接记录CF。最后,根据医疗保健提供者进行抗生素和诊断方法的实证选择,而不是根据预先确定的标准进行。
总之,这项跨国的,点流行研究发现P.铜绿假单胞菌,耐药P.铜绿假单胞菌和耐多药P.铜绿假单胞菌因为CAP的病原菌较低(<5%)。我们确定了5个危险因素P.铜绿假单胞菌前盖:假单胞菌感染/定植、气管造口、支气管扩张、IRVS和非常严重的COPD。这些危险因素可以指导经验性抗假性抗生素治疗。缺乏这些特定的危险因素表明,推荐给CAP患者的经验性抗生素治疗将包括最可能流行的细菌病原体。经验性抗假药覆盖范围应保留给一个小的亚组明确的患者过去的病史假单胞菌感染/定居及严重肺部疾病(即。既往气管造口术、支气管扩张和/或非常严重的COPD),无论疾病严重程度如何。重要的是,并不是所有慢性肺病患者都需要经验性的抗假药覆盖CAP。
补充材料
致谢
我们要感谢欧洲呼吸协会,世界各种社会联合会密集和关键护188bet官网地址理医学,美国胸部医师学院,AsociaciónAtinoAmericanaDeTórax和Sociedad Argentina deInfectología支持这个项目。
脚注
这篇文章有补充资料可从www.qdcxjkg.com.
GLIMP研究人员:我们要感谢以下研究贡献者的宝贵合作:阿根廷:阿根廷布宜诺斯艾利斯阿尔弗雷多·拉纳里大学医院内科Patricia Karina Aruj;Silvia Attorri,阿根廷门多萨Luis Lago Maggiore医院;阿根廷门多萨市中心医院Enrique Barimboim;胡安·帕布罗·卡埃罗和玛丽亚·艾利。阿根廷科尔多瓦大学私立医院Garzón;维克多·雨果·坎伯萨诺,V.H.卡扎博士A。Servicio de Neumologia,罗森医院,科尔多瓦,阿根廷;Adrian Ceccato,阿根廷国立医院Alejandro Posadas教授;Julio Chertcoff、Florencia Lascar和Fernando Di Tulio,阿根廷布宜诺斯艾利斯英国医院重症监护室和呼吸内科;Ariel Cordon Díaz,阿根廷门多萨市Ciudad Alvear将军医院;阿根廷布宜诺斯艾利斯穆尼茨医院呼吸重症监护室Lautaro de Vedia;Maria Cristina Ganaha,阿根廷布宜诺斯艾利斯罗德里格斯将军医院分区间Agudos将军“Vicente Lopez y Planes”传染病病房;桑德拉·兰伯特(Sandra Lambert),阿根廷阿尔塔红综合医院;古斯塔沃·洛帕尔多,阿根廷比森特·洛佩斯贝尔纳多·霍赛医院;卡洛斯M。阿根廷布宜诺斯艾利斯大学克利尼卡斯医院内科肺内科Luna;阿莱西奥·杰拉尔多·马尔伯蒂,阿根廷努埃斯特拉·塞尼奥拉·德尔·卡门医院;Nora Morcillo和Silvina Tartara,Agudos和Crónicos分区医院Antonio A。阿根廷塞特兰戈洛;Claudia Pensotti,阿根廷蒙特格兰德私人诊所布宜诺斯艾利斯传染病和感染控制部;阿根廷科尔多瓦圣罗克医院Betiana Pereyra;传染病部Pablo Gustavo Scapellato, 阿根廷D.F.桑托詹尼医院;Juan Pablo Stagnaro,HZGA Mi Pueblo,弗洛伦西奥瓦雷拉,阿根廷。澳大利亚:Sonali Shah,澳大利亚海德堡奥斯汀医院普通医学部。奥地利:菲利克斯L和Florian Thalhammer,奥地利维也纳大学医学部传染病与热带医学分会。比利时:比利时安特卫普斯图文堡ZNA校区Kurt Anseeuw;卡米尔A。Francois,比利时布鲁塞尔Erasme大学医院麻醉和重症监护部;比利时根特大学医院呼吸内科Eva Van Braeckel;Jean-Louis Vincent,比利时布鲁塞尔自由大学Erasme大学医院重症监护科。贝宁:Marcel Zannou Djimon、Jules Bashi和Roger Dodo,贝宁科托努HKM大学中心医院。巴西:Simone Aranha Nou,里约热内卢联邦大学,巴西。保加利亚:保加利亚索非亚军事医学院肺病诊所Peter Chipev和Milena Encheva;Darina Miteva,UMHAT“St.Marina”,保加利亚瓦尔纳;Diana Petkova,保加利亚瓦尔纳大学医院。喀麦隆:喀麦隆雅温得雅温得Jamot医院Adamou Dodo Balkissou;埃里克·沃尔特·佩弗拉·尤恩,雅温德大学,喀麦隆雅多利大学D·D·D·德莱因特恩大学;Bertrand Hugo Mbatchou Ngahane,杜阿拉总医院,杜阿拉,喀麦隆。中国:沈宁,北京大学第三医院呼吸内科,北京,中国;徐金福,同济大学上海肺医院呼吸内科,中国。哥伦比亚:哥伦比亚波哥大Clinica Shaio的Carlos Andres Bustamante Rico和Ricardo Buitraco;费尔南多·何塞·佩雷拉·帕特尼娜,哥伦比亚麦德林市拉斯美洲诊所。刚果:让-马里·卡因贝·恩图巴,金沙萨倩碧大学,刚果民主共和国。克罗地亚:Vesna Vladic Carevic,Interne Medicine,杜布罗夫尼克,克罗地亚;Marko Jakopovic,医学院,萨格勒布大学,呼吸系统疾病部门,约旦诺瓦克,大学医院中心,萨格勒布,萨格勒布,克罗地亚;克罗地亚萨格勒布萨格勒布大学医院中心呼吸疾病科Mateja Jankovic;克罗地亚萨格勒布杜布拉瓦大学医院Zinka Matkovic;Ivan Mitrecic,克罗地亚卡洛瓦茨卡洛瓦茨总医院。丹麦:玛丽·劳尔·布希·雅各布森,丹麦希尔勒德北新西兰医院急诊科;丹麦维堡地区医院麻醉科Anette Bro Christensen;Uffe Christian Heitmann Bødtger,丹麦奈斯特维德医院肺内科;丹麦罗斯基德哥本哈根大学医院罗斯基德医院内科Christian Niels Meyer;Andreas Vestergaard Jensen、Gertrud Baunbæk-Knudsen、Pelle Trier Petersen和Stine Andersen,丹麦希尔勒德诺德斯格兰兹医院肺病和传染病科。埃及:易卜拉欣·赛义德·阿卜杜·瓦哈布,埃及曼苏拉大学医学院胸内科;Nesreen Elsayed Morsy,埃及曼苏拉曼苏拉大学医学院肺、重症监护和睡眠医学;Facu胸部疾病科Hanaa Shafieklty of Medicine, Alexandria University, Egypt; Eman Sobh, Chest Diseases Department, Al-Azhar University, Cairo, Egypt. Ethiopia: Kedir Abdella Abdulsemed, Department of Medical Laboratory Science and Pathology, College of Health Sciences, Mycobacteriology Research Centre, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia. France: Fabrice Bertrand, Critical Care Unit, Robert Ballanger Hospital, Aulnay sous Bois, France; Christian Brun-Buisson, Univ Hospital Henri Mondor, 94000 Créteil, France; Etienne de Montmollin, Intensive Care Unit, Hôpital Delafontaine, Centre hospitalier de Saint-Denis, Saint-Denis, France; Muriel Fartoukh, Unité de réanimation médico-chirurgicale, Pôle Thorax Voies aériennes, Hôpital Tenon, Groupe Hospitalier Est Parisien, France; Jonathan Messika, Publique-Hôpital de Paris, Service de Réanimation Médico-chirurgicale, Hôpital Louis Mourier, Colombes, France and Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; Pierre Tattevin, Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France; Abdo Khoury, Department of Emergency Medicine and Critical Care, University of Franche – Comté, Medical Center, France. Gambia: Bernard Ebruke, Medical Research Council Unit, Gambia. Germany: Michael Dreher, Department of Cardiology, Pneumology, Vascular Medicine and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany; Martin Kolditz, Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Matthias Meisinger, Klinikum Niederlausitz GmbH, Klinik für Innere Medizin und Intensivmedizin, Senftenberg, Germany; Mathias W. Pletz and Stefan Hagel, Center for Infectious Diseases and Infection Control, Jena University Hospital, Germany; Jan Rupp, Department of Molecular and Infectious Diseases, University of Lübeck, Lübeck, Germany; Tom Schaberg, Zentrum für Pneumologie, Agaplesion Diakonieklinikum Rotenburg, Germany; Marc Spielmanns, Internal Medicine Department, Pulmonary Rehabilitation and Department of Health, School of Medicine, University Witten-Herdecke, St. Remigius-Hospital, Leverkusen, Germany; Petra Creutz and Norton Suttorp, Department of Infectious Disease and Respiratory Medicine, Charité – University Medicine, Berlin, Germany. Ghana: Beatrice Siaw-Lartey, Komfo-Anokye Teaching Hospital, Kumasi, Ghana. Greece: Katerina Dimakou, 5th Respiratory Medicine Dpt, “SOTIRIA” Chest Hospital, Athens 11527, Greece; Dimosthenis Papapetrou, Medical Group of Athens (Paleo Faliro Clinic), Athens, Greece; Evdoxia Tsigou and Dimitrios Ampazis, Agioi Anargiroi Hospital, Kifissia, Athens, Greece; Evangelos Kaimakamis, Intensive Care Unit, “G. Papanikolaou” General Hospital of Thessaloniki, Greece. India: Mohit Bhatia, S.S. Hospital IMS BHU Varanasi, India; Raja Dhar, Fortis Hospitals, Kolkata, India; George D'Souza, Department of Pulmonary Medicine, St John's Medical College Hospital, Bangalore, India; Rajiv Garg, Department of Respiratory Medicine, King George's Medical University UP, Lucknow, India; Parvaiz A. Koul, Department of Internal and Pulmonary Medicine, SheriKashmir Institute of Medical Sciences, Srinagar, India; P.A. Mahesh and B.S. Jayaraj, Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, India; Kiran Vishnu Narayan, Pulmonary Medicine, Government Medical College Kozhikode, Kerala, India; Hirennappa B. Udnur and Shashi Bhaskara Krishnamurthy, Columbia Asia Hospital, Hebbal, Bengaluru, Karnataka, India; Surya Kant, Department of Respiratory Medicine, King George's Medical University, Chowk, Lucknow, India; Rajesh Swarnakar, Getwell Hospital and Research Institute, Dhantoli, Nagpur, India; Sneha Limaye and Sundeep Salvi, on behalf of the Respiratory Research Network of India (RRNI) from the Chest Research Foundation in Pune, India. Iran: Keihan Golshani, Isfahan University of Medical Sciences, Iran. Ireland: Vera M. Keatings, Letterkenny General Hospital, Co. Donegal, Ireland; Ignacio Martin-Loeches, Multidisciplinary Intensive Care Research Organization (MICRO), St James's University Hospital, Trinity Centre for Health Sciences Dublin, Ireland. Israel: Yasmin Maor, Infectious Disease Unit, Affiliated to Tel Aviv University, Wolfson Medical Center, Holon, Israel; Jacob Strahilevitz, Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University, Jerusalem, Israel. Italy: Salvatore Battaglia, University of Palermo, Pneumologia DiBiMIS, Palermo, Italy; Maria Carrabba, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122, Milano, Italy; Piero Ceriana, Pulmonary Rehabilitation, IRCCS Fondazione Maugeri, 27100, Pavia, Italy; Marco Confalonieri, Department of Pulmunology, University Hospital, Trieste, Italy; Antonella d'Arminio Monforte, Department of Health Sciences, Clinic of Infectious Disease, San Paolo Hospital, University of Milan, Italy; Bruno Del Prato, Interventional Pneumology, Hospital Antonio Cardarelli, Naples, Italy; Marino De Rosa, UOC Pneumologia P.O. San Filippo Neri ASL RM E Roma, Italy; Riccardo Fantini, Respiratory Diseases clinic, Policlinico di Modena, 41124 Modena, Italy; Giuseppe Fiorentino, UOC Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli PO Monaldi, Italy; Maria Antonia Gammino, Pulmonary Medicine Unit, San Martino Hospital, ASL 5 Oristano, Sardegna, Italy; Francesco Menzella, Department of Cardiac-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Giuseppe Milani, Azienda Ospedaliera Sant Anna di Como, Presidio Ospedale S. Anna Nuovo, Unità Operativa di Pneumologia, Como, Italy; Stefano Nava, Alma Mater University of Bologna, DIMES, Respiratory and Critical Care Unit Sant'Orsola Malpighi Hospital, Italy; Gerardo Palmiero, Respiratory Unit, Versilia Hospital, Azienda USL 12 Viareggio, Lido di Camaiore, Lucca, Italy; Roberta Petrino and Barbra Gabrielli, Emergency Medicine Unit, S. Andrea Hospital, Vercelli, Italy; Paolo Rossi, Internal Medicine Department, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy; Claudio Sorino, Pulmonology Unit, A.O. Sant'Anna di Como, Italy; Gundi Steinhilber, Spedali Civili Brescia, U.O. Pneumologia e Fisiopatologia Respiratoria, Brescia, Italy; Alessandro Zanforlin, ULSS 18 Rovigo, Ospedale San Luca, 45027 Trecenta (RO), Italy; Fabio Franzetti, Manuela Carugati, Manuela Morosi and Elisa Monge, Department of Biomedical and Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy; Mauro Carone, Fondazione Salvatore Maugeri, IRCCS, Cassano Murge, Italy; Vincenzo Patella, Allergology and Clinical Immunology Unit, Department of Medical Sciences, Battipaglia Hospital, Battipaglia, Salerno, Italy; Simone Scarlata, Geriatrics, Unit of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio Medico University and Teaching Hospital, Rome, Italy; Andrea Comel, UO Pneumologia, Ospedale Pederzoli, Peschiera del Garda, Italy. Japan: Kiyoyasu Kurahashi, Yokohama City University Medical Center, Japan. Lebanon: Zeina Aoun Bacha, Medicine School, St Joseph University, Beyrouth, Lebanon. Mexico: Daniel Barajas Ugalde, National Institute of Respiratory Diseases, Mexico; Omar Ceballos Zuñiga, Hospital General de Mexicali, Mexicali, Baja California, Mexico; José F. Villegas, Hospital Universitario Monterrey, n. l. México CP 64030. Montenegro: Milic Medenica, Hospital for Lung Diseases – Brezovik, Niksic, Montenegro. Nepal: Deebya Raj Mihsra, Internal Medicine, BP Koirala Institute of Health Sciences, Nepal; Poojan Shrestha, Oxford University Clinical Research Unit, Patan Hospital, Nepal. The Netherlands: E.M.W. van de Garde, Dept Clinical Pharmacy, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands. New Zealand: Elliott Ridgeon, Medical Research Institute of New Zealand. Nigeria: Babatunde Ishola Awokola, Department of Family Medicine and Primary Care, Lily Hospitals Limited, Warri, Nigeria; Ogonna N.O. Nwankwo, University of Calabar Teaching Hospital, Calabar, Nigeria; Adefuye Bolanle Olufunlola, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria; Segaolu Olumide, Department of Medicine (Pulmonary Unit), University College Hospital, Ibadan, Nigeria; Kingsley N. Ukwaja, Department of Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria. Pakistan: Muhammad Irfan, Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi-74800, Pakistan. Poland: Lukasz Minarowski, Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Poland; Skoczyński Szymon, Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland. Portugal: Felipe Froes, Hospital Pulido Valente – CHLN, Lisboa, Portugal; Pedro Leuschner, Centro Hospitalar do Porto, Porto, Portugal; Mariana Meireles, Cláudia Ferrão, Pedro Leuschner and João Neves, Serviço de Medicina, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal; Sofia B Ravara, Faculty of Health Sciences, University of Beira Interior; Cova da Beira Hospital Center, 6200-251 Covilhã, Portugal. Republic of Moldova: Victoria Brocovschii, Department of Pneumology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu” Republic of Moldova; Chesov Ion, Clinic of Anesthesia and Intensive Care “Valeriu Ghrerg”, Institute of Emergency Medicine, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Republic of Moldova; Doina Rusu, SMFU “N. Testemitanu”, Chisinau, Republic of Moldova; Cristina Toma, Department of Pneumology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Republic of Moldova. Romania: Daniela Chirita, Hospital Sfantul Stefan, Bucharest, Romania; Carmen Mihaela Dorobat, Universitatea de Medicină şi Farmacie “Gr. T. Popa” Iaşi Facultatea de Medicină Stomatologică, Spitalul Clinic de Boli Infecţioase “Sfânta Parascheva”, Iaşi, Romania. Russia: Alexei Birkun, Department of Anesthesiology, Critical Care and Emergency Medicine, Medical Academy named after S. I. Georgievsky, Russian Federation; Anna Kaluzhenina, Volgograd State Medical University, Russia. Saudi Arabia: Abdullah Almotairi, King Fahad Medical City (KFMC), Riyadh, KSA; Zakeya Abdulbaqi Ali Bukhary, College of Medicine, Taibah University, Medina, KSA; Jameela Edathodu, Al Faisal University, King Faisal Specialist Hospital, Riyadh, KSA; Amal Fathy, Pulmonary and Respiratory Critical Care Medicine, Mansoura University Egypt, Affiliate at Taibah University, KSA; Abdullah Mushira Abdulaziz Enani and Nazik Eltayeb Mohamed, Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh, KSA; Jawed Ulhadi Memon, Pulmonology Division, Department of Internal Medicine, King Fahad Hospital, Hofuf, Al Ahasa, 31982, KSA; Abdelhaleem Bella, Dammam University-Saudi Arabia and King Fahad Hospital, KSA. Serbia: Nada Bogdanović, Pulmonary Department of KHC Dr. Dragiša Mišović, Belgrade, Serbia; Branislava Milenkovic, Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Dragica Pesut, University of Belgrade School of Medicine, Teaching Hospital of Pulmonology, Clinical Centre of Serbia, Belgrade, Serbia. South Africa: Charles Feldman, Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. South Korea: Ho Kee Yum, Inje Univ. Seoul Paik Hospital, South Korea. Spain: Luis Borderìas, Respiratory and Sleep Unit, Hospital San Jorge, Huesca, Spain; Noel Manuel Bordon Garcia, Barcelona Policlínic and Moises Broggi Hospital at sant Joan Despí, Spain; Hugo Cabello Alarcón, Sant Hospital Seu de Urgell, Catalonia, Spain; Catia Cilloniz and Antoni Torres, Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Vicens Diaz-Brito and Xavier Casas, Infectious Diseases Unit and Pneumology Service, Parc Sanitari Sant Joan de Deu, Sant Boi, Barcelona, Spain; Alicia Encabo González, Hospital Complex of Pontevedra, Spain; Maria Luisa Fernández-Almira, Medicina Interna, Hospital Universitario Central de Asturias, Spain; Miguel Gallego, Department of Respiratory Medicine, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain; Inmaculada Gaspar-García, Department of Respiratory Medicine, Hospital Costa del Sol, Marbella, Málaga, Spain; Juan González del Castillo, Emergency Department, Hospital Universitario Clínico San Carlos, Madrid, Spain; Patricia Javaloyes Victoria, Hospital General Universitario de Alicante, Alicante, Spain; Elena Laserna Martínez, Hospital Mollet, Barcelona, Spain; Rosa Malo de Molina, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Pedro J. Marcos, Servicio de Neumología, Complejo Hospitalario Universitario de A Coruña (CHUAC), INIBIC, Sergas, Universidade de A Coruña (UDC), Spain; Rosario Menéndez, Pneumology Service, Universitary and Polytechnic Hospital La Fe, Valencia, Spain; Ana Pando-Sandoval, Hospital Universitario Central de Asturias. Area de Gestion Clinica de Pulmon. Servicio de Neumologia, Oviedo, Spain; Cristina Prat Aymerich, Alicia Lacoma de la Torre and Ignasi García-Olivé, Microbiology Department and Pneumology Department, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Spain; Jordi Rello and Silvia Moyano, Critical Care Department, Hospital Vall d'Hebron, Barcelona, Spain; Francisco Sanz, Servicio de Neumología, Consorci Hospital General Universitari de Valencia, Valencia, Spain; Oriol Sibila and Ana Rodrigo-Troyano, Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain; Jordi Solé-Violán, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain; Ane Uranga, Pulmology Department, Hospital of Galdakao-Usansolo, Spain; Job F.M. van Boven, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Ester Vendrell Torra and Jordi Almirall Pujol, Intensive Care Medicine, Hospital de Mataró, Spain. Togo: Arnauld Attannon Fiogbe, Pulmonology and Infectious Diseases Service/University Hospital of Sylvanus Olympio, Lomé, Togo. Tunisia: Ferdaous Yangui, Department of Pneumology, Hospital of Internal Forces Security (I.F.S), Marsa, Tunis, Tunisia. Turkey: Semra Bilaceroglu, Izmir Dr. Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery, Izmir, Turkey; Levent Dalar, Pulmonary Medicine, Istanbul Bilim University, Istanbul, Turkey; Ufuk Yilmaz, Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey. Ukraine: Artemii Bogomolov, Vinnitsa National Pirogov Memorial Medical University, Vinnitsa Regional Antituberculosis Hospital, Vinnitsa, Ukraine. United Arab Emirates: Naheed Elahi, Dubai Hospital, UAE. UK: Devesh J. Dhasmana, Victoria Hospital, Kirkcaldy, NHS Fife, UK; Andrew Feneley, Rhiannon Ions, Julie Skeemer and Gerrit Woltmann, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK; Carole Hancock, Royal Respiratory Research Team, Royal Liverpool University Hospital, Liverpool, UK; Adam T. Hill, Royal Infirmary and University of Edinburgh, UK; Banu Rudran, The Royal London Hospital, Barts Health Trust, London, UK; Silvia Ruiz-Buitrago and Marion Campbell, Hairmyres Hospital, East Kilbride, UK; Paul Whitaker, Department of Respiratory Medicine, St James's Hospital, Leeds, UK; Alexander Youzguin, Southport and Ormskirk Hospitals NHS Trust, UK; Anika Singanayagam, Imperial College Healthcare NHS Trust, London, UK. USA: Karen S. Allen, University of Oklahoma Health Sciences Center, USA; Veronica Brito, Texas A&M Health Science Center, Division of Pulmonary, Critical Care and Sleep Medicine Baylor Scott and White Health, USA; Jessica Dietz, Fargo VA Health Care System, Fargo, North Dakota, USA; Claire E. Dysart and Susan M. Kellie, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA, Division of Infectious Diseases, University of New Mexico School of Medicine, Raymond G. Murphy VA Medical Center, Albuquerque, NM, USA; Ricardo A. Franco-Sadud and Garnet Meier, Division of Hospital Medicine, Cook County Hospital, Chicago, USA; Mina Gaga, 7th Resp. Med. Dept and Asthma Center, Athens Chest Hospital, USA; Thomas L. Holland and Stephen P. Bergin, Department of Medicine, Duke University Medical Center and School of Medicine, Duke Clinical Research Institute, USA; Fayez Kheir, Department of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA; Mark Landmeier, Division of Pulmonary and Critical Care Medicine, Northwestern Memorial Hospital, Chicago, IL, USA; Manuel Lois, John Peter Smith Hospital, Fort Worth, TX, USA; Girish B. Nair, Interstitial Lung Disease Program and Pulmonary Rehabilitation, SUNY Stony Brook Winthrop University Hospital, Mineola, NY, USA; Hemali Patel, Department of Medicine, Division of General Internal Medicine, Hospital Medicine Group, University of Colorado, USA; Katherine Reyes, Henry Ford Hospital, Detroit, IL, USA; William Rodriguez-Cintron, Pulmonary/Critical Care Medicine VA Caribbean Healthcare System, USA; Shigeki Saito, Tulane University, New Orleans, USA; Nilam J. Soni, Julio Noda, Cecilia I. Hinojosa, Stephanie M. Levine, Luis F. Angel and Antonio Anzueto, Divisions of Hospital Medicine and Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center San Antonio, San Antonio, TX, USA; K. Scott Whitlow, John Hipskind, Kunal Sukhija and Vicken Totten, Kaweah Delta Health Care District, Department of Emergency Medicine, Visalia, CA, USA; Richard G. Wunderink and Ray D. Shah, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Zambia: Kondwelani John Mateyo, Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia. Other investigators: Lorena Noriega; Ezequiel Alvarado; Mohamed Aman; Lucía Labra.
Conflict of interest: J.D. Chalmers has received research grants for COPD studies and personal fees from GlaxoSmithKline, Boehringer Ingelheim and Pfizer, research grants for COPD studies from AstraZeneca, research grants for bronchiectasis studies and personal fees from Bayer Healthcare and Grifols, and personal fees for consultancy from Napp, outside the submitted work. S. Aliberti reports grants and personal fees from Bayer Healthcare, Aradigm Corporation, Grifols, Chiesi and INSMED, and personal fees from AstraZeneca, Basilea, Zambon, Novartis, Raptor, Actavis UK Ltd and Horizon, outside the submitted work.
支持声明:该项目是资金没有着落。然而,Nilam酒店Soni的时间部分是由退伍军人事务部,质量提高研究计划(QUERI)合作评估倡议格兰特(HX002263-01A1)资助。内容完全是作者的责任,并不一定代表退伍军人事务部,也不是美国政府的官方意见。
- 收到2017年6月15日。
- 公认2018年6月6日。
- 本作品的内容不受版权保护。版权所有©ERS 2018