2020年 · 第133卷第17期

出版日期 2020-09-05电子版￥0.00元

收藏本期

Editorial

开放获取

冠状病毒疾病2019时代黑色素瘤和非黑色素瘤皮肤癌患者的管理

Conforti Claudio, di Meo Nicola, Giuffrida Roberta, Zalaudek Iris

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000930

摘要

Original Article

开放获取

皮肤肿瘤人工智能辅助决策软件在真实临床环境中的诊断能力

Li Cheng-Xu, Fei Wen-Min, Shen Chang-Bing, Wang Zi-Yi, Jing Yan, Meng Ru-Song, Cui Yong

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000001002

摘要

Background: Youzhi artificial intelligence (AI) software is the AI-assisted decision-making system for diagnosing skin tumors. The high diagnostic accuracy of Youzhi AI software was previously validated in specific datasets. The objective of this study was to compare the performance of diagnostic capacity between Youzhi AI software and dermatologists in real-world clinical settings. Methods: A total of 106 patients who underwent skin tumor resection in the Dermatology Department of China-Japan Friendship Hospital from July 2017 to June 2019 and were confirmed as skin tumors by pathological biopsy were selected. Dermoscopy and clinical images of 106 patients were diagnosed by Youzhi AI software and dermatologists at different dermoscopy diagnostic levels. The primary outcome was to compare the diagnostic accuracy of the Youzhi AI software with that of dermatologists and that measured in the laboratory using specific data sets. The secondary results included the sensitivity, specificity, positive predictive value, negative predictive value, F-measure, and Matthews correlation coefficient of Youzhi AI software in the real-world. Results: The diagnostic accuracy of Youzhi AI software in real-world clinical settings was lower than that of the laboratory data (P < 0.001). The output result of Youzhi AI software has good stability after several tests. Youzhi AI software diagnosed benign and malignant diseases by recognizing dermoscopic images and diagnosed disease types with higher diagnostic accuracy than by recognizing clinical images (P = 0.008, P = 0.016, respectively). Compared with dermatologists, Youzhi AI software was more accurate in the diagnosis of skin tumor types through the recognition of dermoscopic images (P = 0.01). By evaluating the diagnostic performance of dermatologists under different modes, the diagnostic accuracy of dermatologists in diagnosing disease types by matching dermoscopic and clinical images was significantly higher than that by identifying dermoscopic and clinical images in random sequence (P = 0.022). The diagnostic accuracy of dermatologists in the diagnosis of benign and malignant diseases by recognizing dermoscopic images was significantly higher than that by recognizing clinical images (P = 0.010). Conclusion: The diagnostic accuracy of Youzhi AI software for skin tumors in real-world clinical settings was not as high as that of using special data sets in the laboratory. However, there was no significant difference between the diagnostic capacity of Youzhi AI software and the average diagnostic capacity of dermatologists. It can provide assistant diagnostic decisions for dermatologists in the current state.

开放获取

利用皮肤镜图像开发的基于深度学习的计算机辅助分类器在中国人群的皮肤病诊断中显示出与164名皮肤科医生相当的性能

Wang Shi-Qi, Zhang Xin-Yuan, Liu Jie, Tao Cui, Zhu Chen-Yu, Shu Chang, Xu Tao, Jin Hong-Zhong

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000001023

摘要

Background: Diagnoses of Skin diseases are frequently delayed in China due to lack of dermatologists. A deep learning-based diagnosis supporting system can facilitate pre-screening patients to prioritize dermatologists’ efforts. We aimed to evaluate the classification sensitivity and specificity of deep learning models to classify skin tumors and psoriasis for Chinese population with a modest number of dermoscopic images. Methods: We developed a convolutional neural network (CNN) based on two datasets from a consecutive series of patients who underwent the dermoscopy in the clinic of the Department of Dermatology, Peking Union Medical College Hospital, between 2016 and 2018, prospectively. In order to evaluate the feasibility of the algorithm, we used two datasets. Dataset I consisted of 7192 dermoscopic images for a multi-class model to differentiate three most common skin tumors and other diseases. Dataset II consisted of 3115 dermoscopic images for a two-class model to classify psoriasis from other inflammatory diseases. We compared the performance of CNN with 164 dermatologists in a reader study with 130 dermoscopic images. The experts’ consensus was used as the reference standard except for the cases of basal cell carcinoma (BCC), which were all confirmed by histopathology. Results: The accuracies of multi-class and two-class models were 81.49% ± 0.88% and 77.02% ± 1.81%, respectively. In the reader study, for the multi-class tasks, the diagnosis sensitivity and specificity of 164 dermatologists were 0.770 and 0.962 for BCC, 0.807 and 0.897 for melanocytic nevus, 0.624 and 0.976 for seborrheic keratosis, 0.939 and 0.875 for the "others" group, respectively; the diagnosis sensitivity and specificity of multi-class CNN were 0.800 and 1.000 for BCC, 0.800 and 0.840 for melanocytic nevus, 0.850 and 0.940 for seborrheic keratosis, 0.750 and 0.940 for the "others" group, respectively. For the two-class tasks, the sensitivity and specificity of dermatologists and CNN for classifying psoriasis were 0.872 and 0.838, 1.000 and 0.605, respectively. Both the dermatologists and CNN achieved at least moderate consistency with the reference standard, and there was no significant difference in Kappa coefficients between them (P > 0.05). Conclusions: The performance of CNN developed with relatively modest number of dermoscopic images of skin tumors and psoriasis for Chinese population is comparable with 164 dermatologists. These two models could be used for screening in patients suspected with skin tumors and psoriasis respectively in primary care hospital.

开放获取

沉默新型长非编码RNA FKBP9P1抑制头颈部鳞状细胞癌恶性进展和PI3K/AKT信号传导体外

Yang Yi-Fan, Feng Ling, Shi Qian, Ma Hong-Zhi, He Shi-Zhi, Hou Li-Zhen, Wang Ru, Fang Ju-Gao

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000933

摘要

Background: Long non-coding RNAs (lncRNAs) play key roles in human cancers. In our previous study, we demonstrated that lncRNA FKBP prolyl isomerase 9 pseudogene 1 (FKBP9P1) was highly expressed in head and neck squamous cell cancer (HNSCC) tissues. However, its functional significance remains poorly understood. In the present study, we identify the role and potential molecular biologic mechanisms of FKBP9P1 in HNSCC. Methods: Quantitative real-time polymerase chain reaction was used to detect the expression of FKBP9P1 in HNSCC tissues, matched adjacent normal tissues, human HNSCC cells (FaDu, Cal-27, SCC4, and SCC9), and human immortalized keratinocytes cell HaCaT (normal control). Cal-27 and SCC9 cells were transfected with sh-FKBP9P1-1, sh-FKBP9P1-2, and normal control (sh-NC) lentivirus. Cell counting kit-8 assay, colony formation assay, wound healing assay, and trans-well assay were used to explore the biologic function of FKBP9P1 in HNSCC cells. Furthermore, western blotting was used to determine the mechanism of FKBP9P1 in HNSCC progression. Chi-squared test was performed to assess the clinical significance among FKBP9P1 high-expression and low-expression groups. Survival analyses were performed using the Kaplan-Meier method and assessed using the log-rank test. The comparison between two groups was analyzed by Student t test, and comparisons among multiple samples were performed by one-way analysis of variance and a Bonferroni post hoc test. Results: FKBP9P1 expression was significantly up-regulated in HNSCC tissues (tumor vs. normal, 1.914 vs. 0.957, t = 7.746, P < 0.001) and cell lines (P < 0.01 in all HNSCC cell lines). Besides, the median FKBP9P1 expression of HNSCC tissues (1.677) was considered as the threshold. High FKBP9P1 level was correlated with advanced T stage (P = 0.022), advanced N stage (P = 0.036), advanced clinical stage (P = 0.018), and poor prognosis of HNSCC patients (overall survival, P = 0.002 and disease-free survival, P < 0.001). Knockdown of FKBP9P1 led to marked repression in proliferation, migration, and invasion of HNSCC cells in vitro (P all < 0.01). Mechanistically, silencing FKBP9P1 was observed to restrain the PI3K/AKT signaling pathway. Conclusions: Silencing lncRNA FKBP9P1 represses HNSCC progression and inhibits PI3K/AKT (phosphatidylinositol 3 kinase/AKT Serine/Threonine Kinase) signaling in vitro. Therefore, FKBP9P1 could be a potential new target for the diagnosis and treatment of HNSCC patients.

开放获取

鼻咽癌分期系统10年来的演变：对未来修订的意义

Tang Si-Qi, Mao Yan-Ping, Xu Cheng, Guo Rui, Li Wen-Fei, Tang Ling-Long, Sun Ying, Ma Jun

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000978

摘要

开放获取

接受辅助生殖治疗的妇女宫外孕发生率的相关因素

Jin Xiao-Ying, Li Chao, Xu Wen, Liu Liu, Wei Min-Ling, Fei Hai-Yi, Li Jing, Zhou Feng, Zhang Song-Ying

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000001058

摘要

Background: Ectopic pregnancy (EP) is a common complication in women undergoing assisted reproductive treatment, but the underlying causes for this remain unclear. This study aimed to explore factors affecting the incidence of EP in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Methods: This was a retrospective study on the incidence of EP in IVF/ICSI cycles between January 1, 2013 and December 31, 2017. Patient age, infertility diagnosis (tubal factor or not), primary or secondary infertility, type of cycle (frozen-thawed or fresh), type of embryo(s) transferred (cleavage embryo or blastocyst), number of embryos transferred (one, two, or three), previous history of EP, and endometrial combined thickness were analyzed to explore their relationships with the incidence of EP. Based on clinical typing results, the patients were divided into an EP group or a non-EP group. Categorical variables were analyzed using Chi-squared test or Fisher exact test. Logistic regression analysis was performed to explore their associations with the incidence of EP. Results: The percentage of patients with primary infertility in EP group was significantly lower than that in non-EP group (31.3% vs. 46.7%, χ2 = 26.032, P < 0.001). The percentage of patients with tubal infertility in EP group was also significantly higher than that in non-EP group (89.2% vs. 63.6%, χ2 = 77.410, P < 0.001). The percentages of patients with transfer of cleavage-stage embryo or blastocyst (91.4% vs. 84.4%, χ2 = 10.132, P = 0.001) and different endometrial combined thickness (ECT) (χ2 = 18.373, P < 0.001) differed significantly between EP and non-EP groups. For patients who had a previous history of one to four EPs, the percentage of patients undergoing transfer of a cleavage-stage embryo was significantly higher in EP group than that in non-EP group (92.2% vs. 77.6%, χ2 = 13.737, P < 0.001). In multivariate logistic regression analysis, tubal infertility was strongly associated with EP (adjusted odds ratio: 3.995, 95% confidence interval: 2.706-5.897, P < 0.001). Conclusions: In IVF/ICSI cycles, transfer of a blastocyst-stage embryo, especially for patients with a previous history of EP, reduced the rate of EP. Tubal infertility was strongly associated with EP.

开放获取

口服造影剂导致骨盆照射调容弧治疗计划中剂量计算低估

Jing Hao, Tian Yuan, Tang Yu, Wang Shu-Lian, Jin Jing, Song Yong-Wen, Liu Yue-Ping, Fang Hui, Chen Bo, Qi Shu-Nan 等

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000001025

摘要

Background: The effects of oral contrast agents (OCAs) on dosimetry have not been studied in detail. Therefore, this study aimed to examine the influence of OCAs on dose calculation in volumetric-modulated arc therapy plans for rectal cancer. Methods: From 2008 to 2016, computed tomography (CT) images were obtained from 33 rectal cancer patients administered OCA with or without intravenous contrast agent (ICA) and 14 patients who received no contrast agent. CT numbers of organs at risk were recorded and converted to electronic densities. Volumetric-modulated arc therapy plans were designed before and after the original densities were replaced with non-enhanced densities. Doses to the planned target volume (PTV) and organs at risk were compared between the plans. Results: OCA significantly increased the mean and maximum densities of the bowels, while the effects of ICA on these parameters depended on the blood supply of the organs. With OCA, the actual doses for PTV were significantly higher than planned and doses to the bowel increased significantly although moderately. However, the increase in the volume receiving a high-range doses was substantial (the absolute change of intestine volume receiving ≥52 Gy: 1.46 [0.05-3.99, cubic centimeter range: -6.74 to 128.12], the absolute change of colon volume receiving ≥50 Gy: 0.34 [0.01-1.53 cc, range: -0.08 to 3.80 cc]. Dose changes due to ICA were insignificant. Pearson correlation showed that dose changes were significantly correlated with a high intestinal volume within or near the PTV (ρ > 0.5, P < 0.05) and with the density of enhanced intestine (ρ > 0.3, P < 0.05). Conclusions: Contrast agents applied in simulation cause underestimation of doses in actual treatment. The overdose due to ICA was slight, while that due to OCA was moderate. The bowel volume receiving ≥50Gy was dramatically increased when OCA within the bowel was absent. Physicians should be aware of these issues if the original plan is barely within clinical tolerance or if a considerable volume of enhanced intestine is within or near the PTV.

开放获取

之间的关联PTCH1中国汉族人群基因多态性与慢性阻塞性肺疾病易感性的病例对照研究

Kang Xi, Guo Ting, Liu Lyu, Ding Shui-Zi, Lei Cheng, Luo Hong

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000858

摘要

开放获取

评估肾细胞癌和下腔静脉癌栓患者下腔静脉壁侵犯的影像学预测因素：一项回顾性研究

Wang Bin-Shuai, Li You-Zhao, Fang Yang-Yi, Zhang Shu-Dong, Ma Lu-Lin

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000828

摘要

Background: Renal cell carcinoma (RCC) has the propensity to lead to venous tumor thrombus (VTT). Nephrectomy with tumor thrombectomy is an effective treatment option but is a technically challenging surgical procedure that is accompanied by a high rate of complications. The aims of this study were to investigate pre-operative imaging parameters for the assessment of inferior vena cava (IVC) wall invasion due to a tumor thrombus in patients with RCC and to identify predictors from the intra-operative findings. Methods: Clinical and imaging data were collected from 110 patients who underwent nephrectomy with IVC tumor thrombectomy (levels I-IV) for RCC and IVC tumor thrombus at the Peking University Third Hospital between May 2015 and March 2018. Univariable and multivariable logistic regression and receiver operating characteristic curves were used to assess the correlations between pre-operative imaging features and intra-operative macroscopic invasions of the IVC wall by tumor thrombus. Results: Among the 110 patients, 41 underwent partial or segmental resection of IVC. There were univariate associations of pre-operative imaging parameters that could be used to predict the need for IVC resection, including those of the Mayo classification, maximum anterior-posterior (AP) diameter of the renal vein at the renal vein ostium (RVo), maximum AP diameter of the VTT at the RVo and IVC occlusion. For the multivariable analysis, the AP diameter of the VTT at the RVo and IVC occlusion were associated with a significantly increased risk of invasion of the IVC wall by tumor thrombus. The optimum imaging thresholds included an AP diameter of the VTT at the RVo larger than 17.0 mm and the presence of IVC occlusion, with which we predicted invasions of the IVC wall requiring IVC resection. The probabilities of intra-operative IVC resection for patients without both independent factors, with an AP diameter of the VTT at the RVo larger than 17.0 mm, with IVC occlusion, and with both concurrent factors were 5%, 23%, 56%, and 66%, respectively. Conclusion: An increase in the AP VTT diameter at the RVo and the presence of complete occlusion of the IVC are independent risk factors for a high probability of IVC wall invasion by tumor thrombus.

开放获取

ciRS-7表达对肾透明细胞癌进展的影响

Zhao Yan-Hui, Wang Zhi, Zhang Na, Cui Tao, Zhang Yan-Hui

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000867

摘要

开放获取

TOSO与SYK相互作用并增强慢性淋巴细胞白血病BCR通路激活

Zhang Yan-Ru, Yu Zhen, Xiong Wen-Jie, Liu Xu-Xiang, Liu Hui-Min, Cui Rui, Wang Qi, Chen Wen-Ming, Qiu Lu-Gui, Yi Shu-Hua

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000999

摘要

Background: TOSO, also named Fas inhibitory molecule 3 (FAIM3), has recently been identified as an immunoglobulin M (IgM) Fc receptor (FcμR). Previous studies have shown that TOSO is specifically over-expressed in chronic lymphocytic leukemia (CLL). However, the functions of TOSO in CLL remain unknown. The B-cell receptor (BCR) signaling pathway has been reported to be constitutively activated in CLL. Here, we aimed to investigate the functions of TOSO in the BCR signaling pathway and the pathogenesis of CLL. Methods: We over-expressed TOSO in B-cell lymphoma cell lines (Granta-519 and Z138) by lentiviral transduction and knocked down TOSO by siRNA in primary CLL cells. The over-expression and knockdown of TOSO were confirmed at the RNA level by polymerase chain reaction and protein level by Western blotting. Co-immunoprecipitation with TOSO antibody followed by liquid chromatography coupled with tandem mass spectrometry (IP/LCMS) was used to identify TOSO interacting proteins. Western blotting was performed to detect the activation status of BCR signaling pathways as well as B-cell lymphoma 2 (BCL-2). Flow cytometry was used to examine the apoptosis of TOSO-over-expressing B lymphoma cell lines and TOSO-down-regulated CLL cells via the staining of Annexin V and 7-AAD. One-way analyses of variance were used for intergroup comparisons, while independent samples t tests were used for two-sample comparisons. Results: From IP/LCMS, we identified spleen tyrosine kinase (SYK) as a crucial candidate of TOSO-interacting protein and confirmed it by co-immunoprecipitation. After stimulation with anti-IgM, TOSO over-expression increased the phosphorylation of SYK, and subsequently activated the BCR signaling pathway, which could be reversed by a SYK inhibitor. TOSO knockdown in primary CLL cells resulted in reduced SYK phosphorylation as well as attenuated BCR signaling pathway. The apoptosis rates of the Granta-519 and Z138 cells expressing TOSO were (8.46 ± 2.90)% and (4.20 ± 1.21)%, respectively, significantly lower than the rates of the control groups, which were (25.20 ± 4.60)% and (19.72 ± 1.10)%, respectively (P < 0.05 for both). The apoptosis rate was reduced after knocking down TOSO in the primary CLL cells. In addition, we also found that TOSO down-regulation in primary cells from CLL patients led to decreased expression of BCL-2 as well as lower apoptosis, and vice versa in the cell line. Conclusions: TOSO might be involved in the pathogenesis of CLL by interacting with SYK, enhancing the BCR signaling pathway, and inducing apoptosis resistance.

Review Article

开放获取

慢性阻塞性肺疾病全球倡议疾病评估方法二十年变迁

Liao Yi-Xuan, Chen Ya-Hong

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000920

摘要

Perspective

开放获取

无创检测技术在黄褐斑治疗评价中的进展与展望

Meng Xiao, Xu Chen-Chen

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000984

摘要

Clinical Observation

开放获取

小汗腺水囊瘤的多维皮肤影像学评价

Wang Yu-Kun, Gao Yuan-Jing, Liu Jie, Zhu Qing-Li

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000975

摘要

开放获取

国人morphea和生殖器外硬化性苔藓的皮肤镜特征

Wang Yu-Kun, Hao Jian-Chun, Liu Jie, Liu Yue-Hua, Jin Hong-Zhong

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000977

摘要

开放获取

保留十二指肠胰头切除术与胰十二指肠切除术的对比分析

Sun Yong-Hui, Ding Nan, Cheng Kun, Lin Hai, Xu Jia-Qi, Chen Qi-Long

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000968

摘要

开放获取

结肠镜息肉切除术后息肉复发

Wang Qi-Pu, He Xu-Xia, Xu Tao, Ji Wen, Qian Jia-Ming, Li Jing-Nan

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000990

摘要

Rapid Report

开放获取

皮肤镜联合反射共聚焦显微镜对临床可疑蓝痣的诊断价值

Fei Wen-Min, Li Cheng-Xu, Cui Yong

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000001007

摘要

Correspondence

开放获取

获得性反应性穿孔性胶原病

Wang Chen, Liu Ying-Hui, Wang Yu-Xin, Zhang Jian-Zhong, Jin Jiang

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000906

摘要

开放获取

皮脂腺痣皮脂腺癌的皮肤镜线索

Pradhan Sushmita, Xiao Hui, Yang He-Li, Ran Yu-Ping

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000956

摘要

开放获取

抗程序性死亡-1诱导肺癌急性加重斑块型银屑病的皮肤镜特征

Sui Chang-Lin, Lin Xue-Fei, He Li, Zhu Wei

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000958

摘要

开放获取

阴囊皮肤局限性淋巴管瘤的皮肤镜特征

Dong Jing, Lin Er-Yi, Zhang Liang, Chen Liu-Qing

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000957

摘要

开放获取

我国部分公立医院皮肤影像设备的现状与展望

Li Cheng-Xu, Fei Wen-Min, Cui Yong

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000980

摘要

开放获取

酒渣鼻与敏感皮肤鉴别诊断的预测模型：一项横断面研究

Wang Xiao-Yan, Liu Yun-Yi, Liu Yi-Xuan, Ma Wei-Wei, Zhang Jia-Wen, Liu Zi-Jing, Liu Juan, Zhou Bing-Rong, Xu Yang

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000001001

摘要

开放获取

穿孔性两面针苔藓皮肤镜检查1例

Li Xiang-Qian, Chen Xi, Li Bo, Du Juan, Hong You-Shu, Zhang Jian-Zhong, Zhou Cheng

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000001011

摘要

开放获取

青斑样血管病的临床和皮肤镜特征

Wen Juan, Li Xiao-Hong, Yang Qiu-Ping, Yu Jian-Bin

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000001048

摘要

开放获取

皮肤镜下模拟基底细胞癌的脂溢性角化病1例

Gao Yao-Ying, An Xiang-Jie, Yang Jing, Huang Chang-Zheng, Tao Juan

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000001010

摘要

开放获取

膳食硝酸盐通过增强血液灌注对应激性胃粘膜损伤的保护作用

Pang Bao-Xing, Bu Ling-Xue, Jia Mu-Yun, Chen Li-Qiang, Song Kai, Liu Yan-Shan, Yuan Rong-Tao, Shang Wei

中华医学杂志英文版2020年 133卷 17期

DOI: 10.1097/CM9.0000000000000943

摘要

上一期下一期

本期目次

2020年 133卷 17期

下载本期封面下载本期目录

MedNexus

本期目次