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期刊信息  
创刊日期：1990年
主管单位：中国人民共和国卫生部
主办单位：中国医学影像技术研究会
　　　　　中国医科大学
承办单位：中国医科大学附属盛京医院
　　　　　辽宁省医学影像学会
编辑出版：《中国临床医学影像杂志》
　　　　　编辑部
刊　　期：月刊
2017 Vol. 28, No. 10
Published: 2017-10-20
 
685 Advances in imaging study of liver fibrosis
GUO Qi-yong, SHI Yu, WANG Wei
Liver fibrosis is the core pathological process in various chronic liver diseases. Early detection, quantitative and accurate diagnosis are of great significance for the prevention of hepatic fibrosis. Because of the limitations of liver biopsy, imaging examination has become an important method to evaluate hepatic fibrosis. In recent years, functional imaging represented by elastography and molecular imaging have developed rapidly and have replaced pathological examination to a certain extent. The rate of liver biopsy decreased year by year. Therefore, this article will review the current status and progress of imaging studies of hepatic fibrosis.
2017 Vol. 28 (10): 685-691 [Abstract] ( 677 ) HTML (1 KB)  PDF  (0 KB)  ( 129 )
692 Clinical application and challenges of amide proton transfer imaging
WANG Xiao-ming, ZHENG Yang
 In recent years, amide proton transfer(APT) imaging, as a new modality of MR imaging, has attracted more and more attention in clinical applications. APT imaging can detect the exchange characteristics of amide protons in free proteins and peptides and water protons by means of water signal changes. APT imaging can reflect tumor, stroke, neonatal hypoxic-ischemic encephalopathy related to protein and pH at the molecular level. In addition to the nervous system, APT imaging has now been used in several other systems. APT imaging, as an in vivo, noninvasive, cellular and molecular level MR imaging modality without exogenous contrast agents, can provide more information for clinical studies and will be further developed in future studies.
2017 Vol. 28 (10): 692-696 [Abstract] ( 689 ) HTML (1 KB)  PDF  (0 KB)  ( 299 )
697 Application of amide proton transfer imaging in glioma
ZHENG Yang, WANG Xiao-ming
Objective: To investigate the prospect of amide proton transfer(APT) imaging based on protein concentration in brain gliomas. Methods: A total of 19 patients with brain glioma underwent needle biopsy or surgical resection were collected. They were proved to be low-grade, 4 cases were grade Ⅰ, 7 cases were grade Ⅱ, with high-grade tumors of 5 cases were grade Ⅲ, 3 cases were grade Ⅳ. All patients underwent conventional magnetic resonance sequences(T1WI, T2WI, DWI, FLAIR, and Gd-T1WI) and APT sequence scans, APT imaging was performed prior to enhancement scan. The signal difference of the APT imaging signal was compared between the tumor parenchymal area(represented by APTmax) and the peritumoral region(the edema area or the parenchymal area within 0.5 cm, represented by APTmin). The independent sample t test was used to analyze whether the difference in APTmin and APTmax values between low-grade tumors(grade Ⅰ and Ⅱ) and high-grade tumors(grade Ⅲ and Ⅳ) was statistically significant. ANOVA was used to analyze statistically significant differences in APTmax and APTmin between gliomas. Spearman correlation analysis was used to analyze the correlation between glioma grading and APTmax and APTmin. And through the receiver operating characteristic curve(ROC curve) to analyze the differential diagnosis ability of APTmax. The difference of P<0.05 was statistically significant. Results: The APTmax and APTmin values of low-grade tumors were lower than those of high-grade tumors. There were significant differences in the APTmax and APTmin values from grade Ⅰ to grade Ⅳ. The APTmax of all tumors was higher than APTmin. Glioma grade was positively correlated with tumor APTmax and APTmin. Conclusion: As a non-invasive MR imaging modality, APT imaging plays an important role in the diagnosis, classification and differential diagnosis of brain tumors.
2017 Vol. 28 (10): 697-701 [Abstract] ( 758 ) HTML (1 KB)  PDF  (0 KB)  ( 264 )
702 NOE and APT mediated MT imaging at 7.0T
TANG Xiang-yong, SHEN Yuan-yu, HU Wei, ZHANG Zhi-yan, DAI Zhuo-zhi, SHEN Zhi-wei, WU Ren-hua
 Objective: Magnetization transfer(MT) imaging has recently emerged as a new and hot field for MRI in cellular and molecular imaging. Nuclear overhauser enhancement(NOE) and amide proton transfer(APT) are two special types of MT imaging. Our study is to image NOE and APT weighted MT imaging at 7.0T. Methods: Fresh egg white, bovine serum albumin(BSA), fresh lemon juice were put in tubes respectively for pre-experiment. C6 glioma cells were cultivated to plant in the rats’ right basal ganglia for making tumor models. We scanned these tubes and rats using a continuous wave pre-saturating PRESS sequence(CW-PRESS sequence). B1 was 0.6, 0.8, 1.0, 1.3, 1.6, 2.0, 3.0 μT. At the same time, we acquired rats’ MT imaging using CW-EPI sequence. The RF offset ranges from 5～-5 ppm. The parameters were set up as follows: TR 6 000 ms, TE 26.51 ms, RF duration time 4 s. Results: NOE and APT effect were obviously observed in egg white and BSA, but NOE effect wasn’t observed in lemon juice. NOE signal declined and the APT signal heightened with the increase of B1, particularly when B1<1.0 μT, NOE signal was relatively strong and APT signal was relatively small. When B1> 1.0 μT, these showed the opposite results. This tendency corresponds to that of glioma rats whose NOE signal declined and APT signal heightened. Conclusion: There must be proper parameters to acquire NOE and APT images. B1 makes a big contribution to them, even too big or too little B1 can’t get clear NOE and APT images. We firstly demonstrated the protein made contribution to NOE and APT effect and then got the decision that NOE signal declined and the APT signal heightened in glioma. Hence, we suspected that these variations were related to protein concentration.
2017 Vol. 28 (10): 702-706 [Abstract] ( 1017 ) HTML (1 KB)  PDF  (0 KB)  ( 153 )
707 Effect of levetiracetam in benign childhood epilepsy with centro-temporal spikes: #br# a resting-state fMRI study based on amplitude of low frequence fluctuation
LI Zhi-peng1, YANG Fang1, HU Zheng2, ZHANG Qi-rui1, QUAN Wei1, XU Qiang1, ZHANG Zhi-qiang1, LU Guang-ming1
Objective: To use amplitude of low frequence fluctuation(ALFF) to evaluate the brain functional change of benign childhood epilepsy with centro-temporal spikes(BECTS) and the influence of levetiracetam(LEV) on BECTS. Methods: Twenty-two BECTS treated with LEV, twenty-two BECTS with no treatment and twenty-two age and sex-matched healthy children were included to preform functional magnetic resonance imaging(fMRI). After data preprocessing, the difference of ALFF among the three groups was obtained by the analysis of variance, and their correlation with clinical index were reported. Results: Compared to the healthy group, the ALFF of bilateral Rolandic areas in both untreated group and the LEV group were increased. And compared to the non-treatment group, the ALFF of bilateral Rolandic areas in the LEV group were decreased. The ALFF of left precentral/postcentral gyrus and left inferior frontal gyrus showed positive correlation with the duration of untreated BECTS, while the left precentral gyrus and the right superior frontal gyrus showed negative correlation with the duration of the LEV effects and the left precuneus and right middle temporal gyrus showed a positive correlation with the duration of the LEV effects in LEV group. Conclusion: The discharge areas of BECTS in brain show increased activities, and LEV can effectively reduce the intrinsic brain activity in these areas of BECTS and impact on the areas about language, attention and default mode network(DMN). These evidences based on fMRI show that LEV is useful in the treatment of BECTS.
2017 Vol. 28 (10): 707-711 [Abstract] ( 611 ) HTML (1 KB)  PDF  (0 KB)  ( 275 )
712 Evaluation of secondary functional changes in rats with spinal cord injury using BOLD-fMRI at 7.0T
WANG Lei1, WANG Yu-qing2, CHEN Yu-shu1, WANG Ting-hua1, GAO Fa-bao1
Objective: To explore the imaging trends of secondary brain function changes in resting state and task state after spinal cord injury(SCI) in rats using the blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI). Methods: Complete spinal cord transected injury model was established in 12 SD rats, and categorized as Stage A, B and C according to the stimulation time after modeling. Stage A, as a control, performed after 5 minutes of modeling, the electrodes were inserted into the muscle at 2 mm on the right side of the spinal cord. Stage B, after 30 minutes of modeling, the electrodes were inserted into the lower section of the spinal cord at about 2 mm. Stage C, after 24 hours of modeling, the electrodes were inserted into the lower section of the spinal cord at about 2 mm. The resting and task state 7.0T fMRI was performed for all stages of the rats, and the electrical stimulation(0.5 A, 1 Hz) in task state lasted about 320 seconds. SPM8 and DPARSF software were used to analyze the task state and resting state fMRI data. Results: There were significant differences in the resting state and task state brain activity for the three stages. The resting brain activity areas of rats were mainly located in the prefrontal lobe, anterior cingulate gyrus and hippocampus. The number of active voxels in stage B increased by 10% compared with that in stage A, and the fractional amplitude of low-frequency fluctuations(fALFF) increased by 21%; the number of active voxels in stage C decreased by 4.4% compared with that in stage A, fALFF decreased by 6%. The brain activation areas of the task states in the three periods included the precentral gyrus, the postcentral gyrus, and the striatum. The number of active voxels in stage B decreased by 64% compared with that in stage A, and the mean value of t value decreased by 49%. The number of active voxels in stage C increased by 61% compared with that in stage A, and the mean value of t value decreased by 9%. Conclusion: BOLD-fMRI can dynamically, quantitatively and noninvasively evaluate the secondary changes of brain function activity in resting and task state after SCI in rats in vivo. After SCI, there is a stress effect in the static brain function, which disappears after 24 hours. After SCI, the activation of the brain function in the task state is from low level to high level.
2017 Vol. 28 (10): 712-715 [Abstract] ( 524 ) HTML (1 KB)  PDF  (0 KB)  ( 287 )
716 BOLD-fMRI study on the function analysis of the brain in major depression disorder and#br# their first-degree relatives
SONG Yu-lu1, MU Xin-nuan2, SONG Xiao-lei1, FANG Jun-fang2, MAO Ning3, WANG Bin1
Objective: We studied the characteristics and differences of the regional homogeneity(ReHo) of the major depression disorder(MDD) and their first-degree relatives in the resting state by functional magnetic resonance imaging(fMRI), in order to understand the early changes of the brain function in patients with MDD. Methods: The experiments were performed by 3.0T fMRI in 15 patients with MDD(the depression group), 15 first-degree relatives of MDD(the first-degree relatives group) and 15 healthy volunteers(the control group). A statistics analysis of ReHo was performed subsequently. Results: The ReHo values measured in right middle frontal gyrus, right precentral gyrus, right superior frontal gyrus, right anterior cingulate cortex, right insular, left putamen, left superior temporal gyrus, left middle temporal gyrus, left dorsal cingulate cortex of MDD group were significantly lower than those of the first-degree relatives group(P<0.05). The ReHo values measured in left postcentral gyrus, left superior temporal gyrus, left middle temporal gyrus, left inferior frontal gyrus, left orbitofrontal cortex, left dorsal cingulate cortex, right precentral gyrus, right medial prefrontal cortex, right superior frontal gyrus, the middle frontal gyrus, the anterior cingulate cortex, right insular of MDD group were significantly lower than those of the control group(P<0.05). The ReHo values measured in left anterior lobe of cerebellum, left middle temporal gyrus, left inferior frontal gyrus, left orbitofrontal cortex, left superior frontal gyrus, left dorsal cingulate cortex, left insular, right middle frontal gyrus, right anterior cingulate cortex of the first-degree relatives group were significantly lower than those of the control group(P<0.05). Conclusion: With the widespread abnormal ReHo values of brain in MDD and first-degree relatives, we can get a hypothesis that these abnormalities may be associated with cognitive network disorders and emotional distress in MDD.
2017 Vol. 28 (10): 716-721 [Abstract] ( 566 ) HTML (1 KB)  PDF  (0 KB)  ( 277 )
722 The value of MDCT combined with multi window parameters and #br# curved planar reformation in diagnosis of esophageal fistula
LIU Cai-yun, MIAO Xin-zhong, SHA Zheng-bu, MENG Chong, XU Xu, MA Yun-song, JIANG Yue
Objective: To assess the diagnostic value of axial combined with multi window technique and curved planar reformation(CPR) for esophageal fistula. Methods: A retrospective analysis was based on data collected from 110 patients for suspected esophageal fistula from October 2010 to October 2016. All patients underwent MDCT axial, multi window parameters and CPR. The chi-square test was used to compare differences of the results of esophageal fistula, fistula position diagnosed by axial combined with multi window technique and CPR. Taking the results of endoscopy, or follow-up as the standard, the diagnostic value of axial combined with multi window technique and CPR, axial were analyzed and compared by ROC. Wilcoxon test was used to examine the difference of the length of the fistula examined by MDCT and endoscopy. Results: Among these 110 patients of suspected esophageal fistula, a total of 53 patients(55 fistulas) were diagnosed using endoscopy and 1 patient had 3 fistulas. The efficiency of axial combined with multiple window technique and CPR in the diagnosis of esophageal fistula was higher than that of axial, the difference was statistically significant(χ2=8.787, P=0.032), which was no difference for fistula position(χ2=0.104, P>0.05). Compared with the length of fistula using endoscopy, significant difference was observed using CPR fat window(z=-2.722, P=0.006). There was no significant difference using CPR mediastinal window(z=    -1.807, P=0.071). Conclusion: Axial combined with multi window technique and CPR has unique value in the diagnosis of esophageal fistula, which can evaluate the position and range of the fistula, and improve the accuracy of diagnosis.
2017 Vol. 28 (10): 722-726 [Abstract] ( 650 ) HTML (1 KB)  PDF  (0 KB)  ( 245 )
727 Validity and repeatability of CMR GRE for evaluating the heart function of rhesus monkey
ZHU Tong1, GONG Li2, CHEN Yu-shu1, ZHANG Yu1, LIANG Zhi-gang2, SUN Jia-yu1, CHENG Wei1, WANG Lei1, WU Bing1, ZHENG Jie3, ZENG Wen2, GAO Fa-bao1
Objective: To evaluate the validity and repeatability of GRE cine sequence when it was used to evaluate the heart function of rhesus monkey, and to provide an accurate and optimal cardiac function assessment strategy for the study of rhesus monkey cardiac disease models. Methods: Eight healthy rhesus monkeys underwent conventional echocardiography and CMR GRE cine sequence scanning to assess cardiac function and got left ventricular end-diastolic volume(EDV), left ventricular end-systolic volume(ESV), stroke volume(SV), ejection fraction(EF), cardiac output(CO), left ventricular end-diastolic mass (Myo Mass(Diast)) and left ventricular end-systolic mass(Myo Mass(Syst)). The repeatability of GRE was evaluated by the test-retest analysis. The validity of the GRE was evaluated by criterion-related validity by comparing the results of ultrasound and GRE. Results: The results of test-retest analysis showed that correlation coefficient(ICC) values of all function parameters were within 0.75～0.97, the P value was less than 0.01, and the results of repeated evaluation were better. The results of criterion-related validity showed that except for CO, the Pearson correlation coefficient(r) values of the other function parameters were 0.80～0.92, and the difference was statistically significant. It was found that EF, CO and Myo Mass(Diast) acquired by GRE were smaller than those measured by ultrasound, and the difference was statistically significant. Conclusion: There are good validity and repeatability using the CMR GRE cine sequence to evaluate the cardiac function of normal rhesus monkey.
2017 Vol. 28 (10): 727-730 [Abstract] ( 677 ) HTML (1 KB)  PDF  (0 KB)  ( 158 )
731 Study on the correlation between ultra-high-b-value diffusion-weighted MR imaging and #br# aquaporin-4 in a hepatic ischemia-reperfusion model in rats
ZHANG Si-ying1, YAO Lin-peng1, WANG Qi-dong1, HONG Yuan2, XUE Xing1, KONG De-xing2, CHEN Feng1
Objective: To study the expression of aquaporin-4(AQP-4) in hepatic ischemia-reperfusion tissue, and to explore the correlation between ultra-high-b-value magnetic resonance diffusion-weighted imaging(DWI) and the expression of AQP-4. Methods: Forty-two SD rats weighting 250～300 g were divided into 7 groups(n=6). The rats in the experimental group were treated with ligating the right lobe portal vein and hepatic artery for 3 h. The rats in the control group were treated with sham operation. 3.0T MRI scanning including plain scan T1WI, T2WI, conventional DWI(b=0 s/mm2, 1 000 s/mm2) and 15 b-values DWI(b=0～4 500 s/mm2) were performed in both groups at 0 h, 6 h, 12 h, 1 d, 3 d, 7 d and 14 d after reperfusion. Standard apparent diffusion coefficient(ADCs) and ultra-high apparent diffusion coefficient(ADCu) were measured based on single b-value DWI and 15 b-values DWI respectively. The dynamic changes of each parameter were observed at each time point. After scanning, the animals were euthanized and liver specimens were taken for HE staining. The morphological changes of the liver were noted under light microscope. The expression of AQP-4 was measured qualitatively and quantitatively by Western blot. Results: The ADCs in the experimental group were higher than those of the control group starting from 12 hours after operation and returned to normal at 7 d after operation. ADCu in the experimental group began to significantly higher than those in the control group at 6 h after operation and returned to normal at 14 d after operation. The expression of AQP-4 in the experimental group decreased gradually at 6 h, 12 h, 1 d and 3 d after operation but still higher than that in the control group and began to approach normal at 7 d after operation. ADCs did not correlate with AQP-4 expression(P=0.416), but ADCu was significantly correlated with AQP-4 expression(P=0.034) and the correlation coefficient was 0.721. Conclusion: The ultra-high-b-value DWI can reflect the transport of AQPs.
2017 Vol. 28 (10): 731-735 [Abstract] ( 727 ) HTML (1 KB)  PDF  (0 KB)  ( 249 )
736 Intravoxel incoherent motion diffusion weighted imaging for the evaluation of pancreatic fibrosis: a preliminary study
LIU Yan-qing1, LIU Ying1, SHI Kai-ning2, WANG Xiao-qi2, WANG Min1, SHI Yu1, GUO Qi-yong1
Objective: To evaluate the diagnostic performance of intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI) for the evaluation of pancreatic fibrosis. Methods: A total of 15 healthy volunteers and 45 patients(F0: 15, F1: 10, F2: 11, F3: 9) with pancreatic or ampullary masses and subsequent pancreaticoduodenectomy underwent preoperative 3.0T MR IVIM imaging within less than one week. IVIM-DWI parameters(true diffusion coefficient(D), pseudo-diffusion coefficient(D*), and perfusion fraction(f)) were measured independently by two radiologists with more than 5 years of experience in abdominal imaging diagnosis. Spearman rank correlation coefficient was used to analyze the correlation between D, D*, f values and pancreatic fibrosis. Receiver operating characteristic curve(ROC) analysis was to determine the diagnostic performance of IVIM parameters for staging of pancreatic fibrosis(F0～F3). Results: The D, D* and f values measured by the two subjects were excellent(ICC: 0.925, 0.907, 0.823). f values showed a better negative correlation with fibrosis stages(r=-0.651, P<0.001) than D(r=-0.392, P=0.002) and D*(r=-0.523, P<0.001). f values had higher area under the curve(AUC) than that of D and D*(F0 vs (F1～F3): AUC=0.822, 0.662, 0.764, respectively; (F0, F1) vs (F2, F3): AUC=0.876, 0.772, 0.799, respectively), though without statistical significance(all P>0.05). Conclusion: IVIM-DWI is a promising method for staging of pancreatic fibrosis.
2017 Vol. 28 (10): 736-741 [Abstract] ( 532 ) HTML (1 KB)  PDF  (0 KB)  ( 122 )
742 Evaluation of early renal injury development in diabetic rats using BOLD MRI
GUO Chuan-gen1, ZHANG Lan2, WANG Qi-dong1, WANG Zhao-ming1, XU Ying1, XIAO Wen-bo1
Objective: To observe changes in renal oxygenation levels using BOLD MRI, and to evaluate the usefulness of BOLD MRI in development of early diabetic renal injury. Methods: A total of 62 diabetic rats with successful modeling were used as the experimental group(DN group, n=62), and 10 normal rats served as the normal control group(NC group, n=10). The NC group was used as the baseline for the BOLD MRI scan, and the rats in the DN group underwent MR imaging at 3, 7, 14, 21, 28, 35, 42, 49, 56, 63, and 70 days after modeling. Renal cortical and medullary R2*(CR2*, MR2*) values were measured and R2* ratio between medulla and cortex(MCR) was calculated. The urine albumin concentration and histopathological examination(GSI, Vvmes, Svcap) were evaluated at different time points. Results: CR2* and MR2* values of DN group were significantly higher than those of NC group. Those R2* values raised gradually and reached the peak at 35 days(CR2*=(33.95±0.34) s-1, MR2*=(43.79±1.46) s-1, then dropped gradually at 70 days(CR2*=(33.17±0.69) s-1, MR2*=(41.61±0.95) s-1), MCR in DN group gradually increased to the peak of 1.32 at 42 days and then decreased to 1.25 at 70 days. UAE of DN group increased gradually, it was significantly higher than that of NC group at 7 days(P<0.01). The GSI and Vvmes and Svcap were higher in DN group compared to NC group(P<0.01). Conclusions: BOLD MRI can noninvasively evaluate the renal hypoxia in diabetes and detect diabetic renal injury earlier than UAE. The dynamic changes of MCR in our study may suggest that renal injury may be from functional hypertonic compensation into organic lesions such as mesangial proliferation and glomerulosclerosis.
2017 Vol. 28 (10): 742-746 [Abstract] ( 543 ) HTML (1 KB)  PDF  (0 KB)  ( 105 )
747 Comparison of PERCIST1.0 and RECIST1.1 for the evaluation of #br# concurrent chemoradiotherapy response in advanced cervical cancer
XU Wei-na1, YU Li-juan2, YANG Zhi-guang1, XIN Jun1
Objective: To compare 18F-FDG metabolism with morphologic criteria for evaluating concurrent chemoradiotherapy(CCRT) response of cervical cancer, and to analyze to relationship between treatment response and serum squamous cell carcinoma antigen(SCC-Ag) levels. Methods: From October 2011 to February 2016, twenty-two patients with primary advanced cervical cancer confirmed by pathology were enrolled in this retrospective study, with FIGO stage ⅡB～Ⅳ. 18F-FDG PET/CT was performed before and after CCRT and therapeutic response evaluation was performed according to both PERCIST1.0 and RECIST1.1. Pre- and post-treatment SCC-Ag levels were observed. Results: In PERCIST1.0 analysis, 3 cases had CMR, 9 cases had PMR, 7 cases had SMD, and 3 cases had PMD. In RECIST1.1 analysis, 11 cases had PR, 7 cases had SD, 4  cases had PD and no patient had CR. There was significant difference in response classification between the two criteria(χ2=16.76, P=0.01). There was 45.45%(10/22) disagreement found with a fair agreement(P=0.018). The therapeutic response rates(CMR/CR+PMR/PR) were 54.55%(12/22) and 50%(11/22), respectively. Of the 11 patients with PR by RECIST1.1 were classified to 2 CMR, 6 PMR and 3 SMD by PERCIST1.0. At same time, of the 7 cases with SD by RECIST1.1 were classified to 1 CMR, 3 PMR and 3 SMD by PERCIST1.0. The post-treatment SCC-Ag levels of different therapeutic response groups were significantly different(F=7.08, P=0.002), and there was positive correlated between them(γ=0.529, P=0.011). There was a significant difference between pre- and post-treatment SCC-Ag levels for therapeutic response group(T=2.28, P=0.044), while there was no significantly different for therapy no-response group(T=-0.42, P=0.687). Conclusion: Disagreement was found in CCRT therapeutic response of cervical cancer evaluation and PERCIST1.0 may be more accurately distinguish to therapeutic response.
2017 Vol. 28 (10): 747-751 [Abstract] ( 581 ) HTML (1 KB)  PDF  (0 KB)  ( 139 )
752 The role of CT and MRI in the diagnosis, staging, and treatment planning of neuroblastomas in children
CHEN Li-ying1, WANG Ya-zhu2, ZOU Jie3, ZHANG Jin-hua1
2017 Vol. 28 (10): 752-755 [Abstract] ( 683 ) HTML (1 KB)  PDF  (0 KB)  ( 188 )
760 Ultrasonic diagnosis of Masson tumor in cephalic vein: report of one case
SONG Yan-peng, LI Jie, LIU Su-xia
2017 Vol. 28 (10): 760-760 [Abstract] ( 1020 ) HTML (1 KB)  PDF  (0 KB)  ( 303 )
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