Table of Content

10 May 2024, Volume 32 Issue 5

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Consensus

Expert consensus on the construction of traditional Chinese medicine child health care specialty

Child Health Care Branch of Chinese Preventive Medicine

2024, 32(5):  465-470.  DOI: 10.11852/zgetbjzz2023-1318

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Professional Forum

Establishment of joint intervention in hospital-school-home model for developmental coordination disorder

JIA Feiyong

2024, 32(5):  471-474.  DOI: 10.11852/zgetbjzz2024-0281

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Developmental coordination disorder (DCD) is a kind of movement disorder with lifelong adverse effects.According to motor learning and motor control theories, improving movement should be combined with individual, task and environment of children.Interventions for DCD children should not only be limited to the hospital, a more reasonable model should include the hospital, school and home three scenarios of combined treatment.This article expounds the importance and specific content of this intervention model, so as to provide reference for the healthy development of children with DCD.

Early screening and intervention of children with developmental coordination disorder

LIU Zhenhuan

2024, 32(5):  475-479.  DOI: 10.11852/zgetbjzz2024-0280

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Developmental coordination disorder (DCD) is a neurodevelopmental disorder with high incidence, low diagnosis rate and early onset of symptoms, which hinders thedevelopment ofphysical and mental health in children.Early identification and intervention of DCD can help reduce the lifelong adverse effects of the disease.However,general public in China still lacks awareness of this condition,and healthcare workers do not pay enough attention to the early screening and intervention of DCD.This paper summarizes the clinical characteristics, early screening and diagnosis of DCD, and expounds the clinical treatment of DCD from the two aspects of western and Chinese medicine intervention, and proposes the intervention treatment of integrated Chinese and western medicine for the first time, hoping to promote the development of early screening work, provide a new method for the research and development of DCD intervention in China, and improve the effectiveness of treatment.

Original Articles

Correlation between deformational plagiocephaly and/or brachycephaly and motor developmental delay in infants

XU Wei, HE Chengchuan, CHEN Xuejiao, HUANG Mingshou, SONG Guan

2024, 32(5):  480-483.  DOI: 10.11852/zgetbjzz2023-0665

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Objective To analyze the correlation between deformational plagiocephaly and/or brachycephaly (DPB) and motor developmental delay in infants, so as to provide theoretical basis for early motor development screening and intervention in DPB infants. Methods A total of 7 826 children aged 6 - 12 months who visited Mianyang Maternal & Child Health Care Hospital from January 2021 to December 2022 were inlcuded in this study. DPB infants were selected as the study subjects, and the prevalence rate was analyzed.2 761 DPB infants were divided into mild, moderate, and severe DPB groups, and 1 900 normal children were included as the control group. Peabody Developmental Motor Scale-2 (PDMS-2) was used to evaluate the levels of gross and fine motor development in children in each case group and control group. Univariate analysis and LSD-t test were used to analyze the differences in gross motor quotient (GMQ) and fine motor quotient (FMQ) of children in each group. χ² test was used to analyze the rate of motor developmental delay in children in each group. Results The prevalence rate ofDPB was 35.47%. There were statistically significant differences in GMQ and FMQ among the mild DPB group, moderate DPB group, severe DPB group, and control group (F=171.271, 194.877, P<0.05). Further statistical comparison showed that there was no statistically significant difference in GMQ and FMQ between mild DPB group and control group (P＞0.05). The GMQ and FMQ of the moderate and severe DPB groups were significantly lower than those of the control group (P<0.05). There was no statistically significant difference in the rate of developmental delay in gross and fine motor development between each case group and the control group (χ²=7.478, 5.777, P＞0.05). Conclusions The prevalence of DPB in Mianyang area is relatively high, and DPB do not increase the probability of motor development delay. However, infants with moderate to severe DPB have significantly lower levels of motor development compared to healthy infants. It is recommended to screen infants with DPB as soon as possible, and conduct motor development screening and exercise promotion for infants with moderate to severe DPB.

Study on the development of foot arch and rehabilitation treatment plan for children with spastic diplegia in cerebral palsy gross motor function classification system grade Ⅰ-Ⅱ

GAO Funing, TANG Jian, CHEN Wenxiang, ZHANG Lei, ZHU Min

2024, 32(5):  484-490.  DOI: 10.11852/zgetbjzz2023-0522

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Objective To investigate the development of the foot arch and develop a rehabilitation treatment plan for children with spastic diplegia of cerebral palsy gross motor function classification(GMFCS) system grade Ⅰ-Ⅱ. Methods Fifty children with spastic diplegia and flat exostosis with GMFCS grade Ⅰ-Ⅱ were selected into this study, and were divided into observation group (n=25) and control group (n=25) using the random number table method. The control group received conventional exercise therapy, while the observation group received arch correction exercises additionally. Both groups underwent treatment once a day for 5 days a week. Children in both groups were evaluated before and 6 months after the intervention. The arch index F, electronic plantar pressure measurement index, and the D and E scores of the Gross Motor Function Measure (GMFM-88) were used to assess the severity of clubfoot and the level of motor development. Results Bofore intervention, there were no significant differences in the arch index F, electronic plantar pressure measurement index, and GMFM-88 score between the observation group and the control group (P>0.05). After 6 months of intervention, the scores of arch index F(t=9.89, 5.35),and GMFM-88 (t＝6.59, 3.46) in both groups increased significantly(P<0.05). The scores of foot arch index F (26.08±0.73) and GMFM-88 (30.24±7.94) in the observation group and control group were significantly higher than those in the control group (25.34±0.64, 25.20±7.06) (t=3.81, 2.37, P<0.05). Plantar pressure pictures showed a gradual increase in lateral foot pressure compared to medial pressure, and a decrease in pressure in the midfoot arch area, indicating a decrease in foot valgus and progressive development of the arch. Conclusion The comprehensive rehabilitation therapy technique incorporating arch correction and gymnastics treatment can promote the arch development in children with GMFCS grade Ⅰ-Ⅱ spastic diplegia, which is important for improving their foot and ankle function and motor development level.

Effects of mirror neuron system theory on hand dexterity and fine motor function in preschool children with developmental coordination disorder

GE Xiangyang, WANG Feiying, XU Renjie, GU Qiuyan, NI Yufei

2024, 32(5):  491-495.  DOI: 10.11852/zgetbjzz2023-0798

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Objective To observe the effects of mirror neuron system theory(MNST) on hand dexterity and fine motor function in preschool children with developmental coordination disorder(DCD), so as to provide reference for the rehabilitation of children with DCD. Methods A total of 51 children with DCD treated at Nantong Maternal and Child Health Care Hospital from June 2021 to April 2023 were enrolled in this study, and were randomly assigned to treatment group (n=26) and control group (n=25) except for 5 cases who missed in the follow-up. Both groups received conventional rehabilitation training, while the treatment group received MNST additionally. The hand dexterity and fine motor function of both groups were assessed using the hand dexterity subscale of the Movement Assessment Battery for Children-Second Edition (MABC-2), Peabody Developmental Motor Scale-Fine Motor (PDMS-FM), and Function Independence Measure for Children (WeeFIM) before and after 12 weeks of treatment. Results Before treatment, there were no significant differences in hand dexterity subscale of MABC-2, PDMS-FM, and WeeFIM scores between the two groups (P＞0.05). After treatment, both groups showed improvements in hand dexterity subscale of MABC-2, PDMS-FM, and WeeFIM scores (treatment group:t=35.620, 42.084, 40.072; control group:t=14.000, 12.017, 14.054, P＜0.001), with the treatment group showing significantly greater improvements compared to the control group (t=2.611, 3.120, 2.331, P＜0.05). Conclusion MNST combined with conventional rehabilitation training can enhance hand dexterity and fine motor function in children with DCD, thereby improving children′s activities of daily living.

Effects of physical fitness training on social adaptive behavior of children with global developmental delay

YU Xinlu, LI Xin, YANG Tingting, ZHANG Bo, LAN Shiling, PANG Wei

2024, 32(5):  496-501.  DOI: 10.11852/zgetbjzz2023-0934

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Objective To explore the effect of physical fitness training on social adaptive behavior of children with global developmental delay (GDD), in order to provide treatment experience for GDD children. Methods From November 2021 to December 2022, a total of 60 children with GDD diagnosed and treated in the Third Affiliated Hospital of Jiamusi University were enrolled in this study, and were randomly divided into control group (n=30) and test group (n=30).The control group received routine rehabilitation treatment, and the test group received physical fitness training additionally.The intervention lasted for 12 weeks, with the frequency of 3times/week, 30min/time.All subjects were tested for physical fitness and children′s social adaptive behavior before and after training. Results Before treatment, the difference between the results of physical fitness test and social adaptive behavior scores of the GDD children in two groups was not statistically significant (P>0.05).After 3 months of treatment, the physical fitness test scores, except body mass index (BMI), and social adaptive behavior scores of the GDD children in two groups were significantly different from those before treatment (P<0.05), and the physical fitness test scores (except for height, weight and BMI) and the social adaptive behavior of the test group were better than those of the control group (t=2.363,4.020,3.331,3.338,P<0.05). Conclusion Physical fitness training can significantly improve the adaptive behavior, independent function, cognitive function and social/self-control ability of GDD children.

Nested case-control study on the risk factors and interaction analysis of positive screening for infant motor development

HU Yue, BAO Zheng, WANG Ronghuan

2024, 32(5):  502-506.  DOI: 10.11852/zgetbjzz2023-0555

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Objective To identify the influencing factors of infant motor development,and to explore the potential interactive factors, so as to provide scientific basis for early prediction and targeted prevention of infant motor developmental delay. Methods Data of infants receiving "0~1 motor development screening" at 21 community health service centers in Tongzhou District, from January 1st, 2020 to August 31st, 2021 were collected through the Beijing Maternal and Child Information System.Using the method of nested case-control study, 416 infants with positive screening results were selected as case group, 416 infants with negative screening result were selected into the control group by 1∶1 case-control matching of screening age.Chi-square test, Logistic regression analysis, and Exhaustive CHAID decision tree model were used to explore the influencing factors of infant motor development, the interaction effect was investigated by using the additive and multiplicative interaction models. Results Multivariate Logistic analysis showed that birth weight<2 500g (OR=3.28), cesarean section (OR=1.63), outdoor activity≤ 1h/d (OR=3.07), and no supplementation of vitamin D (OR=2.68) were risk factors for positive screening results of infant motor development (P＜0.01).The Exhaustive CHAID decision tree showed that low birth weight was the primary risk factor for infant with positive screening results, followed by outdoor activity, vitamin D supplementation and delivery.The interaction analysis showed that there was a multiplicative interaction (OR=13.76, 95% CI:1.20 - 158.08) and an additive interaction (RERI=10.22, 95%CI:5.05 - 15.38) between non supplementation of vitamin D and low birth weight on infant motor development with positive screening results. Conclusions Attention should be paid to the early motor development of infants with low birth weight and those born by cesarean section, with emphasis on the dosage of vitamin D supplementation and outdoor activity duration.Moreover, the early screening and hierarchical management of infant motor development should also be strengthened.

Original Articles

Reference values for inspiratory muscle related indexes of preschool children in Nanjing

HE Yanlu, YANG Zhiyong, CHEN Weiding, CHI Xia, TONG Meiling

2024, 32(5):  507-510.  DOI: 10.11852/zgetbjzz2023-0787

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Objective To generate reference values for inspiratory muscle of preschool children in Nanjing, so as to provide a reference index for evaluating children′s lung function and exercise performance. Methods A total of 236 preschool children were selected from the main urban area of Nanjing by stratified cluster sampling.The inspiratory muscles were evaluated by breath link respiratory function evaluation system to obtain the maximum inspiratory pressure (MIP) and inspiratory peak flow rate.Pearson analysis was used to determine the correlation of MIP and inspiratory peak flow rate with gender, age, height and weight.Multiple linear stepwise regression analysis was used to obtain the formula of MIP and inspiratory peak flow rate. Results Differences in MIP and peak inspiratory flow rate were not significant between boys and girls (P>0.05), but were statistically significant among different age groups and showed an increasing trend with age (F=13.660, 33.581, P<0.001).MIP and peak inspiratory flow rate were positively correlated with children′s age, height and weight (P＜0.001).The regression model, proved to be statistically significant(F=12.913、22.398,P<0.08), indicated that height was the best predictor of MIP and age was the best predictor of inspiratory peak flow rate. Conclusions This study is the first study on the predicted value of inspiratory muscle in preschool children in China.The predicted value formula can provide a reference for clinical inspiratory muscle evaluation.

Review

Etiology and intervention measures of comorbid fracture in children with cerebral palsy

LIU Jiahao, GONG Chao, LIAN Beibei, GUO Jin

2024, 32(5):  511-515.  DOI: 10.11852/zgetbjzz2023-0475

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Children with cerebral palsy (CP) frequently experience secondary musculoskeletal issues, with a high incidence of fractures and severe symptoms. These factors cannot be overlooked in the rehabilitation process for children with CP. This article examines the causes of fractures in children with CP, including low bone mineral density, abnormal training, premature delivery, and falls. Furthermore, it outlines intervention measures to improve bone mineral density and exercise training, in order to assist in the prevention and treatment of fractures in children with CP.

Application of multiple exemplar training in the rehabilitation of children with autism

CHEN Lili, GUAN Wenjun

2024, 32(5):  516-521.  DOI: 10.11852/zgetbjzz2023-0649

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Generalization, the ability to apply learned knowledge or skills to different materials, individuals, or situations, is a challenge for children with autism. This difficulty in generalization hampers their development of independent living, learning, and working skills. Multiple exemplar training is a widely-used and effective teaching method in the field of autism education. This article provides an explanation of the different types of exemplars used in multiple exemplar training, the steps involved in teaching, and various areas of application. Practical recommendations are also offered based on this information, aiming to support skill learning and generalization research for children with autism in our country.

Status que and its influencing factors of the use of child safety seats from the perspective of social ecology

HE Xiaochun, WANG Lan, XIAO Guihua, SHUI Dan, JIANG Fengbi

2024, 32(5):  522-526.  DOI: 10.11852/zgetbjzz2023-0701

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Child safety seats have been proven to be one of the most effective tools for protecting child passengers. However, the widespread phenomenon of safety seats being "unavailable," "owned but not used," or "used incorrectly" is prevalent globally. This paper aims to summarize the obstacles to the use of child safety seats from four aspects: Individual, society, environment and policy, in order to provide a basis for follow-up comprehensive intervention to ensure the safety of children.

Research progress on the neurocognitive development of small for gestational age

WANG Weiqin, LIU Zhongling, HUO Yanyan, WAN Qin, LIU Qiaoyun, WU Dan, CHEN Lingyan, CHEN Jinjin

2024, 32(5):  527-533.  DOI: 10.11852/zgetbjzz2023-0382

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Small for gestational age (SGA) infants are more likely to experience neurocognitive impairments compared to appropriate for gestational age (AGA) infants. This paper reviews recent research on the neurocognitive development of SGA children. SGA can lead to a "brain-sparing effect" due to growth restriction, which may affect cerebral blood flow and brain structure. However, this does not guarantee normal brain development. Restrictive blood flow can result in changes in brain structure, such as reduced total white matter and gray matter volume in various brain regions, including the cerebral cortex, hippocampus and cerebellum, ultimately leading to decreased head circumference. SGA children also exhibit lower scores in all neurocognitive domains, including intelligence, attention, memory, and executive function. This may result in poor academic performance and an increased risk of social, behavioral, and neurological problems, such as cerebral palsy, epilepsy, visual and hearing impairments, as well as comorbidities like attention deficit hyperactivity disorder(ADHD), autism spectrum disorder(ASD), anxiety, depression, and schizophrenia. Several risk factors for SGA-related neurocognitive impairments have been identified, including gestational hypertension, abnormal gestational weight, smoking, and catch-up growth. Studies have shown that the best interventions to improve cognitive dysplasia include nutrient supplementation, continued breastfeeding, high-quality education, and appropriate early intervention (responsive parenting) are effective in improving cognitive outcomes for SGA children.

Application of proprioceptive assessment in children with cerebral palsy

LIU Fang, YUN Guojun, HUANG Meihuan, GUO Yingying, ZHAO Xin

2024, 32(5):  534-537.  DOI: 10.11852/zgetbjzz2023-0786

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Sensory dysfunction is a common clinical problem for children with cerebral palsy.Proprioception plays a key role in maintaining postural adjustment and balance coordination, so proprioceptive assessment is of great significance for further rehabilitation of children with cerebral palsy.At present, proprioception assessment is mainly used in adults such as stroke and joint injury, but there is still a lack of research in children, especially in children with cerebral palsy.Therefore, this paper aims to review the evaluation of proprioception of children with cerebral palsy at home and abroad.

Advances in the predictive application of abnormal early motor development in infants and toddlers

SUN Zerong, QIAN Yongdong

2024, 32(5):  538-542.  DOI: 10.11852/zgetbjzz2023-1042

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Despite a more significant improvement in survival rates of premature and high-risk infants, surviving infants face a high risk of developing neurodevelopmental disorders such as cerebral palsy.Infant development is characterized by a dynamic continum, which makes it difficult to classify a child′s level of motor development as normal or abnormal on the basis of a single examination.This article provides a review of advances in the application of the predictive validity of General Movement Assessment (GMA) and the Alberta Infant Motor Scale (AIMS) in the early assessment and follow-up of infants and toddlers, in order to intervene in a timely manner with young children at potential motor risk.

Meta Analysis

Network Meta-analysis of the effect of different rehabilitation therapies on improving motor dysfunction in children with spastic cerebral palsy

ZAI Weiyi, XU Ning, WU Wei, WANG Yueying

2024, 32(5):  543-551.  DOI: 10.11852/zgetbjzz2023-0585

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Objective To systematically evaluate the effects of various rehabilitation therapies, including hydrotherapy, rehabilitation robot, core stability training (CST), whole-body vibration training (WBV), repetitive transcranial magnetic stimulation (rTMS), sling exercise training (SET), task-oriented training (TOT) and virtual reality (VR), on motor dysfunction in children with spastic cerebral palsy, so as to provide a reference for the scientific selection of rehabilitation programs for children. Methods Randomized controlled trials (RCTs) of the 8 rehabilitation therapies in the treatment of motor dysfunction in children with spastic cerebral palsy were searched from various databases, including PubMed, The Cochrane Library, Web of Science, EmBase, CNKI, CBM, VIP, and WanFang Database, from database inception to December 2022. Two researchers independently conducted literature screening, data extraction, and literature quality evaluation. Network Meta-analysis was performed using ADDIS 1.16.6 software, and Stata 16.0 software was used for graphic representation. Results A total of 43 RCTs involving 2 722 children with spastic cerebral palsy were included in the analysis. The results of the network Meta-analysis indicated that WBV had the most significant effect in improving the GMFM-88 score (MD=18.56, 95%CI: 34.91 - 2.45, P＜0.05). Rehabilitation robot had the most significant effect in improving dimensions D (MD=6.30, 95%CI: 8.44 - 4.41, P＜0.05) and E (MD=10.03, 95%CI: 15.03 - 4.84, P＜0.05) of the GMFM-88 score. Additionally, hydrotherapy showed the most significant effect in improving the BBS score (MD=11.24, 95%CI: 22.26 - 0.20, P＜0.05). Conclusions For children with spastic cerebral palsy, WBV is the most effective rehabilitation therapy to improve gross motor function, rehabilitation robot is the most effective therapy for improving standing and walking function, and hydrotherapy is the most effective therapy for improving balance.

Bibliometric analysis on pediatric hotspots and trends of childhood diabetes from 2013 to 2023

MAO Bin, LUO Chuhong, ZENG Yuan, YANG Yide

2024, 32(5):  552-558.  DOI: 10.11852/zgetbjzz2023-0761

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Objective To investigate current research hotspots and trends in the field of pediatric diabetes both domestically and globally, in order to provide valuable references for further research in this area. Methods Web of Science and CNKI were utilized as sources for English and Chinese literature databases to search for relevant papers on pediatric diabetes research from 2013 to 2023. CiteSpace software was then used to analyze the data, allowing for visual analysis of publication numbers, authors, research institutions, keywords, and other relevant content. Results A total of 6 683 English literature and 1 730 Chinese literature papers were included in the analysis. The number of published English papers showed an overall upward trend, while the number of published Chinese papers exhibited an initial rise before 2016 followed by a decline. The University of Colorado System had the highest number of international publications, and the Endocrinology Department of Tianjin Children′s Hospital had the highest number of domestic publications. Keyword analysis revealed that in English literature, "glycemic control", "prevalence", "risk", "body mass index", "adherence", "trends", and "continuous glucose monitoring" were among the prominent keywords, highlighting current research hotspots and trends in pediatric diabetes. In contrast, in Chinese literature, keywords such as "insulin", "diabetic ketoacidosis", "nursing","obesity", "quality of life", "insulin resistance", and "metabolic syndrome" were identified as key research areas and trends in pediatric diabetes. Conclusions There has been a significant increase in research on pediatric diabetes in recent years, both domestically and globally, with the research scope continuously expanding and new hot topics emerging, particularly concerning obesity, nursing, and quality of life. However, there still exists a disparity between the depth and breadth of research conducted domestically versus globally.

Clinical Research

Study on the correlation between home rearing environment and social emotional competence of infants and toddlers

XU Yuying, GUO Chenming, MEI Fangxuan, ZHANG Xi, YU Liping, DONG Jiali

2024, 32(5):  559-565.  DOI: 10.11852/zgetbjzz2023-0892

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Objective To understand the current situation of social emotional competence of infants and toddlers, and analyze its relationship with home rearing environment, in order to provide the basis for improving the level of infant social emotional development. Method A study was conducted on 390 individuals from a child health institution in Hubei and Henan provinces.The "Infant and Toddler Social-Emotional Assessment Scale" and "1 - 3Years Child Home Rearing Environment Scale" were used to investigate the social emotions ability and home rearing environment of infants and toddlers. Results A total of 390 valid questionnaires were collected in this survey, of which 199 were boys (51.0%) and 191 girls (49.0%).The average age of infants was (27.13±6.86)months.The age distribution is mainly among infants and young children aged 24 to 36 months, with a total of 305 people (78.2%).The caregiver′s registered residence (Z=-3.570), father′s education level (H=17.106), mother′s education level (H=7.980), per capita monthly income of the family (H=13.986), and the home rearing environment (Z=-8.881) had statistical significance on the social emotional competence of infants(P<0.05 or <0.01).There was a significant positive correlation between family rearing environment and infants′ social emotion (r=0.582,P<0.01).Multiple regression analysis showed that the social adaptation/self-care(β=0.30,95%CI:0.18 - 0.52,P<0.01)and language cognition dimensions(β=0.22,95%CI:0.07 - 0.59,P<0.05) in the home rearing environment had a statistically significant impact on the social emotional ability of infants and toddlers. Conclusion The home rearing environment is closely related to the social emotional development of infants and young children.Improve the parenting knowledge and skills of the main caregivers of infants and young children, build a good family rearing environment for infants and young children, which is beneficial to promote the development of children′s social emotions.

Influence of play-based metaphors on negative emotion and behavior in children recovering from brain injury

WANG Chenjun, LI Xia, LIU Yiwei

2024, 32(5):  566-571.  DOI: 10.11852/zgetbjzz2023-0742

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Objective To explore the effect of metaphors based on children′s games on the negative emotion and behavior of children during the recovery period of traumatic brain injury, in order to provide reference for making intervention strategy for these children. Methods From May 2021 to October 2022, a total of 60 children aged 6-12 years who underwent rehabilitation in the rehabilitation center of the Second Affiliated Hospital of Wenzhou Medical University were selected into this study, and were randomly divided into experimental group and control group, with 30 cases in each group.The control group was given routine nursing, while the experimental group was given metaphorical intervention based on children′s games.The scores of social living ability, abnormal behavior detection rate, depression score, anxiety score and cognitive function were compared between the two groups. Results The scale score of the two groups was not significantly different before intervention(P>0.05).After intervention, the infant-junior high school students′ social living ability score, Mini-Mental State Examination and the Loewenstein Occupational Therapy Cognitive Assessment score in the experimental group were higher than those in the control group (t=3.175, 5.265,7.835,P<0.001).The scores of Child Behavior Checklist (CBCL), the children′s depression inventory and the screen for child anxiety related emotional disorders in the experimental group were lower than those in the control group (Z=7.823, t=6.398, 6.248, P<0.001). Conclusions Metaphorical intervention based on children′s games can reduce the negative emotions of anxiety and depression in children with traumatic brain injury, improve their social life ability, reduce the CBCL score, and improve the cognitive function.

Case Report

Case report and literature review on NFIX gene variation associated overgrowth, macrocephaly and intellectual disability

LI Sixiu, DENG Jia, WANG Yanjuan, et al

2024, 32(5):  572-575.  DOI: 10.11852/zgetbjzz2023-0591

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Genetic analysis of two cases with Smith-Magenis syndrome

FENG Xuan, ZHU Shaohua, LIN Pengwu, et al

2024, 32(5):  576-580.  DOI: 10.11852/zgetbjzz2023-0785

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