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1Current role of fenofibrate in the prevention and management of non-alcoholic fatty liver disease显示文摘Non-alcoholic fatty liver disease(NAFLD) is a common health problem with a high mortality burden due to its liver- and vascular-specific complications. It is associated with obesity, high-fat diet as well as with type 2 diabetes mellitus(T2DM) and metabolic syndrome(MetS).Impaired hepatic fatty acid(FA) turnover together with insulin resistance are key players in NAFLD pathogenesis. Peroxisome proliferator-activated receptors(PPARs)are involved in lipid and glucose metabolic pathways.The novel concept is that the activation of the PPARαsubunit may protect from liver steatosis. Fenofibrate, by activating PPARα, effectively improves the atherogenic lipid profile associated with T2DM and MetS. Experimental evidence suggested various protective effects of the drug against liver steatosis. Namely, fenofibraterelated PPARα activation may enhance the expression of genes promoting hepatic FA β-oxidation. Furthermore, fenofibrate reduces hepatic insulin resistance. It also inhibits the expression of inflammatory mediators involved in non-alcoholic steatohepatitis pathogenesis.These include tumor necrosis factor-α, intercellular cell adhesion molecule-1, vascular cell adhesion molecule-1and monocyte chemoattractant protein-1. Consequently, fenofibrate can limit hepatic macrophage infiltration. Other liver-protective effects include decreased oxidative stress and improved liver microvasculature function. Experimental studies showed that fenofibrate can limit liver steatosis associated with high-fat diet,T2DM and obesity-related insulin resistance. Few studies showed that these benefits are also relevant even in the clinical setting. However, these have certain limitations. Namely, these were uncontrolled, their sample size was small, fenofibrate was used as a part of multifactorial approach, while histological data were absent.In this context, there is a need for large prospective studies, including proper control groups and full assessment of liver histology.Michael S Kostapanos Anastazia Kei Moses S Elisaf 2013World Journal of Hepatology2013,5,9:16
2Hyponatremia in patients with heart failure显示文摘The present review analyses the mechanisms relating heart failure and hyponatremia,describes the association of hyponatremia with the progress of disease and morbidity/mortality in heart failure patients and presents treatment options focusing on the role of arginine vasopressin(AVP)-receptor antagonists.Hyponatremia is the most common electrolyte disorder in the clinical setting and in hospitalized patients.Patients with hyponatremia may have neurologic symptoms since low sodium concentration produces brain edema,but the rapid correction of hyponatremia is also associated with major neurologic complications.Patients with heart failure often develop hyponatremia owing to the activation of many neurohormonal systems leading to decrease of sodium levels.A large number of clinical studies have associated hyponatremia with increased morbidity and mortality in patients hospitalized for heart failure or outpatients with chronic heart failure.Treatment options for hyponatremia in heart failure,such as water restriction or the use of hypertonic saline with loop diuretics,have limited efficacy.AVP-receptor antagonists increase sodium levels effectively and their use seems promising in patients with hyponatremia.However,the effects of AVP-receptor antagonists on hard outcomes in patients with heart failure and hyponatremia have not been thoroughly examined.Theodosios D Filippatos Moses S Elisaf 2013World Journal of Cardiology2013,5,9:13
3Diabetes mellitus and electrolyte disorders显示文摘Diabetic patients frequently develop a constellation of electrolyte disorders. These disturbances are particularly common in decompensated diabetics, especially in the context of diabetic ketoacidosis or nonketotic hyperglycemic hyperosmolar syndrome. These patients are markedly potassium-, magnesium- and phosphatedepleted. Diabetes mellitus(DM) is linked to both hypo- and hyper-natremia reflecting the coexistence of hyperglycemia-related mechanisms, which tend to change serum sodium to opposite directions. The most important causal factor of chronic hyperkalemia in diabetic individuals is the syndrome of hyporeninemic hypoaldosteronism. Impaired renal function, potassiumsparing drugs, hypertonicity and insulin deficiency are also involved in the development of hyperkalemia. This article provides an overview of the electrolyte disturbances occurring in DM and describes the underlying mechanisms. This insight should pave the way for pathophysiology-directed therapy, thus contributing to the avoidance of the several deleterious effects associated with electrolyte disorders and their treatment.George Liamis Evangelos Liberopoulos Fotios Barkas Moses Elisaf 2014World Journal of Clinical Cases2014,2,10:13
4Effects of glucagon-like peptide-1 receptor agonists on renal function显示文摘Glucagon-like peptide-1(GLP-1)receptor agonists result in greater improvements in glycemic control than placebo and promote weight loss with minimal hypoglycemia in patients with type 2 diabetes mellitus.A number of case reports show an association of GLP-1receptor agonists,mainly exenatide,with the development of acute kidney injury.The present review aims to present the available data regarding the effects of GLP-1 receptor agonists on renal function,their use in subjects with chronic renal failure and their possible association with acute kidney injury.Based on the current evidence,exenatide is eliminated by renal mechanisms and should not be given in patients with severe renal impairment or end stage renal disease.Liraglutide is not eliminated by renal or hepatic mechanisms,but it should be used with caution since there are only limited data in patients with renal or hepatic impairment.There is evidence from animal studies that GLP-1 receptor agonists exert protective role in diabetic nephropathy with mechanisms that seem to be independent of their glucose-lowering effect.Additionally,there is evidence that GLP-1 receptor agonists influence water and electrolyte balance.These effects may represent new ways to improve or even prevent diabetic nephropathy.Theodosios D Filippatos Moses S Elisaf 2013World Journal of Diabetes2013,4,5:9
5JUPITER and satellites:Clinical implications of the JUPITER study and its secondary analyses显示文摘The justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin(JUPITER) study was a real breakthrough in primary cardiovascular disease prevention with statins,since it was conducted in apparently healthy individuals with normal levels of low-density lipoprotein cholesterol(LDL-C <130 mg/dL)and increased inflammatory state,reflected by a high concentration of high-sensitivity C-reactive protein(hs-CRP≥2 mg/L).These individuals would not have qualified for statin treatment according to current treatment guidelines.In JUPITER,rosuvastatin was associated with significant reductions in cardiovascular outcomes as well as in overall mortality compared with placebo.In this paper the most important secondary analyses of the JUPITER trial are discussed,by focusing on their novel findings regarding the role of statins in primary prevention.Also,the characteristics of otherwise healthy normocholesterolemic subjects who are anticipated to benefit more from statin treatment in the clinical setting are discussed.Subjects at'intermediate'or'high'10-year risk according to the Framingham score,those who exhibit low post-treatment levels of both LDL-C(< 70 mg/dL)and hs-CRP(<1 mg/L),who are 70 years of age or older,as well as those with moderate chronic kidney disease(estimated glomerular filtration rate <60 mL/min every 1.73 m2)are anticipated to benefit more from statin treatment.Unlikely other statin primary prevention trials,JUPITER added to our knowledge that statins may be effective drugs in the primary prevention of cardiovascular disease in normocholesterolemic individuals at moderate-to-high risk.Also,statin treatment may reduce the risk of venous thromboembolism and preserve renal function.An increase in physician-reported diabetes represents a major safety concern associated with the use of the most potent statins.Michael S Kostapanos Moses S Elisaf 2011World Journal of Cardiology2011,3,7:8
6Antihypertensive drugs and glucose metabolism显示文摘Hypertension plays a major role in the development and progression of micro-and macrovascular disease.Moreover,increased blood pressure often coexists with additional cardiovascular risk factors such as insulin resistance.As a result the need for a comprehensive management of hypertensive patients is critical.However,the various antihypertensive drug categories have different effects on glucose metabolism.Indeed,angiotensin receptor blockers as well as angiotensin converting enzyme inhibitors have been associated with beneficial effects on glucose homeostasis.Calcium channel blockers(CCBs)have an overall neutral effect on glucose metabolism.However,some members of the CCBs class such as azelnidipine and manidipine have been shown to have advantageous effects on glucose homeostasis.On the other hand,diuretics andβ-blockers have an overall disadvantageous effect on glucose metabolism.Of note,carvedilol as well as nebivolol seem to differentiate themselves from the rest of theβ-blockers class,being more attractive options regarding their effect on glucose homeostasis.The adverse effects of some blood pressure lowering drugs on glucose metabolism may,to an extent,compromise their cardiovascular protective role.As a result the effects on glucose homeostasis of the various blood pressure lowering drugs should be taken into account when selecting an antihypertensive treatment,especially in patients which are at high risk for developing diabetes.Christos V Rizos Moses S Elisaf 2014World Journal of Cardiology2014,6,7:7
7Albuminuria as a marker of arterial stiffness in chronic kidney disease patients显示文摘AIM:To access the association between albuminuria levels and arterial stiffness in non-diabetic patients with hypertension and chronic kidney disease(CKD) stages 1-2,treated with renin angiotensin blockade agents plus other hypertensive drugs when needed.METHODS:One hundred fifteen patients [median age 52 years(68% males)] were consequently enrolled in the study.For each patient,we recorded gender,age,body mass index(BMI),peripheral systolic blood pressure(p SBP),peripheral diastolic blood pressure,peripheral pulse pressure,central systolic blood pressure(c SBP),central diastolic blood pressure(c DBP),central pulse pressure(c PP),hematocrit,hemoglobin,hs CRP,total cholesterol triglycerides,high-density lipoprotein-C,low-density lipoprotein-C,calcium,phosphorus,parathormone,and albumin,as well as 24 h urine albumin excretion.According to 24-h urine albumin collection,patients were then classified as those with moderately increased albuminuria(formerly called macroalbuminuria)(≤ 300 mg/d) and those with severely increased albuminuria(formerly called macroaluminuria(> 300 mg/d).We considered aortic stiffness(AS) indices [carotid femoral pulse wave velocity(PWVc-f) and augmentation index(AIx)] as primary outcomes ofthe study.We explored potential correlations between severely increased albuminuria and AS indices using a multiple linear regression model.RESULTS:Fifty-eight patients were included in the moderately increased albuminuria group and 57 in the severely increased albuminuria.Blood pressure measurements of the study population were 138 ± 14/82 ± 1.3 mm Hg(systolic/diastolic).There were no significant differences in age,sex,and BP measurements between the two groups.Patients with severely increased albuminuria had higher PWV and AIx than patients with moderately increased albuminuria(P < 0.02,P < 0.004,respectively).In addition these patients exhibited higher BMI(P < 0.03),hs CRP(P < 0.001),and fibrinogen levels(P < 0.02) compared to patients with moderately increased albuminuria.In multivariate linear regression analysis,severely increased albuminuria(β = 1.038,P < 0.010) p SBP(β = 0.028,P < 0.034) and Ht(β = 0.171,P = 0.001) remained independent determinants of the increased PWVc-f.Similarly,severely increased albuminuria(β = 4.385,P < 0.012),c SBP(β = 0.242,P < 0.001),c PP(β = 0.147,P < 0.01) and Ht levels(β = 0.591,P < 0.013) remained independent determinants of increased AIx.CONCLUSION:These findings demonstrate an independent association between AS indices and severely increased albuminuria in non-diabetic,hypertensive patients with CKD stages 1-2 treated with renin angiotensin aldosterone system blockers.Rigas G Kalaitzidis Despina P Karasavvidou Athina Tatsioni Kosmas Pappas Giorgos Katatsis Angelos Liontos Moses S Elisaf 2015World Journal of Nephrology2015,4,3:5
8Proton pump inhibitor-induced hypomagnesemia: A new challenge显示文摘Proton pump inhibitors(PPIs)are commonly used in clinical practice for the prevention and treatment of peptic ulcer,gastritis,esophagitis and gastroesophageal reflux.Hypomagnesemia has recently been recognized as a side effect of PPIs.Low magnesium levels may cause symptoms from several systems,some of which being potentially serious,such as tetany,seizures and arrhythmias.It seems that PPIs affect the gastrointestinal absorption of magnesium.Clinicians should be vigilant in order to timely consider and prevent or reverse hypomagnesemia in patients who take PPIs,especially if they are prone to this electrolyte disorder.Matilda Florentin Moses S Elisaf 2012World Journal of Nephrology2012,1,6:5
9Attainment of multifactorial treatment targets among the elderly in a lipid clinic显示文摘ObjectiveTo 检验目标成就类脂化合物阴沉, antihypertensive 和 antidiabetic 治疗在在在 Greece.MethodsThis 的一所大学医院的一个专家背景老是包括连续题目 ≥ 的回顾的研究;65 岁(n = 465 ) 与后续 ≥3 年。低密度的脂蛋白胆固醇( LDL-C ),血压( BP )和 glycated 血红素( HbA1c )目标成就根据心病学/欧洲人动脉粥样硬化社会( ESC/EAS )的欧洲社会被记录,为糖尿病( EASD ) guidelines.ResultsThe LDL-C 目标的学习的高血压( ESH ) /ESC 和欧洲协会的欧洲社会被27%很高、高、中等的风险病人,48%和62%分别地达到。更高完成的那些收到的 statin + ezetimibe 与那些收到的 statin monotherapy 相比 LDL-C 目标成就评价(48% 对 33% , P <0.05 ) 。糖尿病的题目, 71% 有 BP <140/85 mmHg,当没有糖尿病, 78% 那些有 BP < 时;140/90 mmHg。非糖尿病的个人(86%) 的一个更高的比例有 BP <150/90 mmHg。另外,有糖尿病的那些的一个更高的比例有 HbA1c <8% 而非 <7%(88% 和 47% ,分别地) 。笔记,从三个非糖尿病的个人的几乎一个和从十个糖尿病的个人的一个在一所大学医院,在非最优的 LDL-C 的老遗体的一个高比例, BP 和 HbA1c 层次的一个专家背景完成了所有三治疗 targets.ConclusionsEven。药联合的使用能改进 multifactorial 治疗目标成就,当不太严格的目标能更容易在这张人口被完成时。Fotios Barkas Evangelos Liberopoulos Eleftherios Klouras Angelos Liontos Moses Elisaf 2015Journal of Geriatric Cardiology2015,12,3:5
10Role of ezetimibe in non-alcoholic fatty liver disease显示文摘Non-alcoholic fatty liver disease (NAFLD) encompasses a histological spectrum ranging from simple steatosis to steatohepatitis,advanced fibrosis and inflammatory changes.Ezetimibe inhibits cholesterol absorption from the intestinal lumen into enterocytes.The molecular target of ezetimibe is the sterol transporter Niemann-Pick C1-like 1 protein (NPC1L1).Human NPC1L1 is abundantly expressed in the liver and may facilitate the hepatic accumulation of cholesterol.Ezetimibe ex-erts beneficial effects on several metabolic variables.Ezetimibe treatment attenuates hepatic steatosis and is beneficial in terms of NAFLD biochemical markers.The combination of ezetimibe with other interventions may also be beneficial in NAFLD patients.Our group inves-tigated the ezetimibe-orlistat combination treatment in overweight and obese patients with hypercholeste-rolemia,with beneficial effects on NAFLD biochemical markers.These results are promising for patients with NAFLD,who usually have increased cardiovascular disease risk and need a multifactorial treatment.How-ever,it should be mentioned that most results are from animal studies and,although modest elevation of liver function tests may raise the suspicion of NAFLD,none of these tests are sensitive to establish the diagnosis of NAFLD with great accuracy.Theodosios D Filippatos Moses S Elisaf 2011World Journal of Hepatology2011,3,10:4
11Effect of hypolipidemic treatment on glycemic profile in patients with mixed dyslipidemia显示文摘AIM:To assess the effect of different hypolipidemic treatment strategies on glycemic profile in mixed dyslipidemia patients.METHODS:This is a prespecified analysis of a prospective,randomized,open-label,blinded end point(PROBE)study(ClinicalTrials.gov identifier:NCT01010516).Patients(n=100)with mixed dyslipidemia on a standard statin dose who had not achieved lipid targets were randomized to switch to the highest dose of rosuvastatin(40 mg/d)or to add-on-statin extended release nicotinic acid(ER-NA)/laropiprant(LRPT)or to addon-statin micronised fenofibrate for a total of 3 mo.Fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),homeostasis model assessment of insulin resistance(HOMA-IR)index and lipid profile were evaluated at baseline and 3 mo after treatment intervention.RESULTS:FPG increased in add-on ER-NA/LRPT and rosuvastatin monotherapy groups by 9.7%and 4.4%,respectively(P<0.01 between the 2 groups and compared with baseline),while it did not significantly change in the add-on fenofibrate group.Similarly,HbA1c increased by 0.3%in add-on ER-NA/LRPT group and by 0.2%in the rosuvastatin monotherapy group(P<0.01 for all comparisons vs baseline and for the comparison between the 2 groups),while no significant change was reported in the add-on fenofibrate group.HOMA-IR increased by 65%in add-on ER-NA/LRPT and by 14%in rosuvastatin monotherapy group,while it decreased by 6%in the add-on fenofibrate group(P<0.01 vs baseline and for all comparisons among the groups).Non-HDL-C decreased in all groups(by 237%,247%and 7%in the rosuvastatin,ER-NA/LRPT and fenofibrate group,respectively,P<0.01 for all vs baseline and P<0.01 for all vs with fenofibrate group).CONCLUSION:Both addition of ER-NA/LRPT and switch to the highest dose of rosuvastatin deteriorated glycemic profile in patients with mixed dyslipidemia,while add-on fenofibrate seems to increase insulin sensitivity.Anastazia Kei Evangelos Liberopoulos Moses Elisaf 2013World Journal of Diabetes2013,4,6:3
12High density lipoproteins and type 2 diabetes:Emerging concepts in their relationship显示文摘Patients with type 2 diabetes mellitus(T2DM) frequently exhibit macrovascular complications of atherosclerotic cardiovascular(CV) disease. High density lipoproteins(HDL) are protective against atherosclerosis. Low levels of HDL cholesterol(HDL-C) independently contribute to CV risk. Patients with T2 DM not only exhibit low HDL-C, but also dysfunctional HDL. Furthermore, low concentration of HDL may increase the risk for the development of T2 DM through a decreased β cell survival and secretory function. In this paper, we discuss emerging concepts in the relationship of T2 DM with HDL.Michael S Kostapanos Moses S Elisaf 2014World Journal of Experimental Medicine2014,4,1:3
13Thiazide-associated hyponatremia in the elderly: what the clinician needs to know显示文摘导致 Thiazide 的 hyponatremia 是在老个人的减少的钠层次的主要原因之一。这评论关于联系 thiazide 的 hyponatremia 介绍当前的证据。联系 Thiazide 的 hyponatremia 与象收到 thiazides 的大剂量的那些那样的某些风险因素主要在病人被观察,有许多 comorbidity,例如心失败,肝疾病或恶意,并且拿几药,例如 non-steroidal 反煽动性的药,选择血清素重新举起禁止者或 tricyclic 抗抑郁剂。钠集中应该为开发联系 thiazide 的 hyponatremia 与风险因素在病人被监视,临床医生们应该即时与显示减少的钠层次的神经符号在病人测量浆液钠层次。有联系 thiazide 的 hyponatremia 的病人的临床、生物化学的侧面可以是细胞外的体积弄空或不恰当的尿分泌抑制剂荷尔蒙分泌物(SIADH ) 的症候群的。可能的联系 thiazide 的 hyponatremia 的调查由于 thiazides (弄空相关的细胞外的体积或象 SIADH 一样) 包括减少的钠层次的另外的原因和 hyponatremia 的特征的鉴定的排除。治疗应该小心地被监视由于 overcorrection 避免严肃的神经复杂并发症。临床医生们应该阻止与联系利尿剂的 hyponatremia 的历史在病人规定 thiazides 并且应该为开发联系 thiazide 的 hyponatremia 与风险因素在病人比较喜欢 thiazides 的低剂量。George Liamis Theodosios D Filippatos Moses S Elisaf 2016Journal of Geriatric Cardiology2016,13,2:3
14Colonoscopy preparation-induced disorders in renal function and electrolytes显示文摘Colonoscopy and flexible sigmoidoscopy are commonly used mainly for colon cancer screening and detection, but also in several other situations such as inflammatory bowel disease (for diagnosis and follow up) and gastrointestinal hemorrhage. Bowel cleansing preparations mainly include polyethylene glycol and oral sodium phosphate solutions, with the later being most frequently used due to better toleration from patients. Despite their favourable safety profile these agents have been associated with renal function deterioration and electrolyte disorders, some of which were serious or even fatal. The present paper discusses the complications associated with colonoscopy preparation agents.Matilda Florentin George Liamis Moses S Elisaf 2014World Journal of Gastrointestinal Pharmacology and Therapeutics2014,5,2:2
15Plasma triglyceride levels and body mass index values are the most important determinants of preβ-1 HDL concentrations in patients with various types of primary dyslipidemia显示文摘Vasilis Tsimihodimos Irene Gazi Theodosios Filippatos Michael Kostapanos Kostantinos Lagos Christina Kostara Constantinos C. Tellis Moses Elisaf Alexandros D. Tselepis 2009Atherosclerosis2009,,2:2
16Statin escape phenomenon: Fact or fiction?显示文摘AIM To evaluate the presence of the so called 'statin escape' phenomenon among hyperlipidemic subjects attending a lipid clinic. METHODS This was a retrospective analysis of 1240 hyperlipidemic individuals followed-up for ≥ 3 years. We excluded those individuals meeting one of the following criteria: Use of statin therapy at baseline visit, discontinuation of statin treatment at most recent visit, change in statin treatment during follow-up and poor compliance to treatment. Statin escape phenomenon was defined as an increase in lowdensity lipoprotein cholesterol(LDL-C) levels at the most recent visit by > 10% compared with the value at 6 mo following initiation of statin treatment. RESULTS Of 181 eligible subjects, 31% exhibited the statin escape phenomenon. No major differences regarding baseline characteristics were found between statin escapers and non-statin escapers. Both escapes and non-escapes had similar baseline LDL-C levels [174(152-189) and 177(152-205) mg/d L, respectively]. In comparison with nonescapers, statin escapers demonstrated lower LDL-C levels at 6 mo after treatment initiation [88(78-97) mg/d L vs 109(91-129) mg/d L, P < 0.05], but higher levels at the most recent visit [103(96-118) mg/d L vs 94(79-114) mg/d L, P < 0.05]. CONCLUSION These data confirm the existence of an escape phenomenon among statin-treated individuals. The clinical significance of this phenomenon remains uncertain.Fotios Barkas Moses Elisaf Eleftherios Klouras Theodora Dimitriou Nikolaos Tentolouris Evangelos Liberopoulos 2017World Journal of Experimental Medicine2017,7,1:2
17Combination drug treatment in patients with non-alcoholic fatty liver disease显示文摘Non-alcoholic fatty liver disease (NAFLD) includes simple steatosis, a benign condition, and non-alcoholic steatohepatitis, a condition that beyond TG accumulation also includes necroinflammation and fibrosis. An association between NAFLD and cardiovascular disease (CVD) has been recently suggested. NAFLD patients usually have an increased CVD risk profile. NAFLD is also associated with metabolic syndrome (MetS) and is considered as the hepatic component of MetS by some authors. Currently, the only established treatment of NAFLD is gradual weight loss. However, multifactorial treatment of NAFLD risk factors may be needed to reduce the increased CVD risk of NALFD patients. Drug combinations that include antiobesity drugs (such as orlistat and sibutramine) and target CVD risk factors may be a good approach to NAFLD patients. Our group has investigated the orlistat-fenofibrate combination treatment in obese patients with MetS and the orlistatezetimibe and sibutramine-antihypertensive combination treatment in obese patients with hyperlipidaemia with promising results in CVD risk factor reduction and improvement of liver function tests. Small studies give promising results but double-blind, randomized trials examining the effects of such multifactorial treatment in hard CVD endpoints in NAFLD patients are missing.Theodosios D Filippatos Moses S Elisaf 2010World Journal of Hepatology2010,2,4:2
18Association of Helicobacter pylori infection with cardiovascular disease—Is it just a myth?显示文摘Dimitrios K. Christodoulou Haralampos J. Milionis Panagiota Pappa Konstantinos H. Katsanos Dimitrios Sigounas Matilda Florentin Moses Elisaf Epameinondas V. Tsianos 2010European Journal of Internal Medicine2010,,2:2
19Dyslipidemia in patients with thyroid disorders 显示文摘Liberopoulos EN Elisaf MS 2002Hormones (Athens)2002,1,4:1
20Early vascular benefits ofstatin therapy 显示文摘Tsiara S Elisaf M Mikhailidis DP 2003Curr Med Res Opin2003,19,8:1
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