Clinical breast cancer最新文献

{"title":"Comment on \"Clinical and Pathological Features of Early-Stage Metaplastic Carcinoma and Associated Patient Outcomes\".","authors":"Prajnasini Satapathy, Rachana Mehta, Ranjana Sah","doi":"10.1016/j.clbc.2025.08.011","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.08.011","url":null,"abstract":"","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmeasured Social Determinants and Residual Survival Differences in Early Triple-Negative Breast Cancer: A Cautionary Note to Gaba et al.","authors":"Da Qian","doi":"10.1016/j.clbc.2025.09.002","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.09.002","url":null,"abstract":"","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Breast Surgery on Quality of Life in BRCA Mutation Carriers With Invasive Breast Cancer: A CANTO Database Study.","authors":"Katia Mahiou, Claire Bonneau, Charles Coutant, Anne-Laure Martin, Catherine Gaudin, Marion Fournier, William Jacot, Anne Kieffer, Baptiste Sauterey, Olivier Tredan, Mario Campone, Carole Tarpin, Florence Lerebours, Marie-Ange Mouret-Reynier, Thierry Petit, Sophie Guillermet, Guillaume Constantin, Aurélie Bertaut","doi":"10.1016/j.clbc.2025.09.001","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.09.001","url":null,"abstract":"<p><strong>Introduction/background: </strong>Breast cancer affects over 61,000 women annually in France. While only 5-10% of breast cancers are hereditary, BRCA1/2 mutations significantly increase the lifetime risk of breast and ovarian cancer, with cumulative invasive breast cancer risks of 72% (BRCA1) and 69% (BRCA2) by age 80. Surgical management in this population is crucial, as it directly impacts quality of life (QoL). However, prospective comparative data on surgical strategies are lacking.</p><p><strong>Materials and methods: </strong>This prospective study analyzed data from the CANTO cohort to assess the impact of different surgical approaches on QoL in BRCA1/2 mutation carriers diagnosed with invasive breast cancer. Four surgical options were compared: breastconserving surgery (BCS), mastectomy, immediate breast reconstruction (IBR), and delayed breast reconstruction (DBR). Patient-reported outcomes were evaluated over time, focusing on body image, future perspective, sexual functioning, and physical symptoms.</p><p><strong>Results: </strong>BCS and IBR were associated with better preservation of body image throughout follow-up. DBR significantly improved body image, future perspective, and sexual functioning beginning at the time of surgery. Breast and arm symptoms were overall moderate, but mastectomy resulted in increased arm symptoms, likely due to the higher rate of axillary lymphadenectomy.</p><p><strong>Conclusion: </strong>When feasible, BCS should be preferred for BRCA1/2 mutation carriers, as it best preserves QoL. For patients requiring mastectomy, IBR is a valuable option, while DBR offers long-term benefits in body image and psychosocial well-being. Psychological support and structured postsurgical rehabilitation are strongly recommended to alleviate symptoms and optimize patient quality of life.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Different Glucose Concentrations and Hypoxia and its Impact on the Expression of Sox2 and CAIX in Breast Cancer: In Vitro And Silico Analysis.","authors":"Niloufar Esmaeilizadeh, Hadi Maleki-Kakelar, Rasoul Sharifi, Sevda Valilou, Akbar Jalili, Mohammad Reza Asgharzadeh","doi":"10.1016/j.clbc.2025.08.023","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.08.023","url":null,"abstract":"<p><strong>Background: </strong>Cancer is a an uncontrolled proliferation of transformed cells as a genetic variation in human diseases. In the present study, we investigated how different concentrations of glucose and hypoxia affect the expression of CAIX and Sox2 genes in breast cancer cell lines MCF-7 and MDA-MB-231.</p><p><strong>Methods: </strong>MCF-7 and MDA-MB-231 cells were exposed to different concentrations of glucose (5.5, 11, and 25 mM), normoxia, and hypoxia. SNARF-AM labeling was used to quantify intracellular pH, which was then evaluated using flow cytometry. Finally, the expression levels of CAIX and Sox2 genes were examined using quantitative real-time PCR. In addition, the interaction of the ligand with carbonic anhydrase was analyzed using Chimera software, and the docking results were checked in the corresponding servers. The relationship between structural disorder and pH was investigated using DispHred.</p><p><strong>Results: </strong>Metastasis and intracellular pH (pHi) are glucose-dependent in MCF-7 cells, but hypoxia-dependent in MDA-MB-231 cells. Our findings showed a significant increase in the expression of CAIX (P = .0032) and but Sox2 (P = .5309) also had an increase in expression, it was not significant in the MCF-7 cell line compared with control cells maintained in normal oxygen. In addition, the genes CAIX (P = .0712) and Sox2 (P = .0004) were up-regulated in MDA-MB-231 cells. The DispHred results showed that the total CAIX load changes somewhat with pH changes.</p><p><strong>Conclusions: </strong>Increased or decreased glucose concentration and hypoxia lead to changes in the gene expression patterns of cancer cells. Consequently, the genes may be used as biomarkers to aid in the diagnosis and prognosis of breast cancer.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Individual Patient Data Meta-Analysis on the Characteristics, Treatments, and Outcomes of the Patients With Neuroendocrine Neoplasm of the Breast Reported in Literature Until August 2024.","authors":"Lena Schnell, Helmut Orawa, Georg W Wurschi, Klaus Pietschmann","doi":"10.1016/j.clbc.2025.08.016","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.08.016","url":null,"abstract":"<p><p>Neuroendocrine neoplasm (NEN) of the breast is a rare type of breast cancer with limited knowledge about its characteristics and optimal management. The diagnostic criteria have been constantly updated by the World Health Organization (WHO) with increasing understanding, most recently in 2019. Focusing on characteristics, treatments and outcomes, we performed a comprehensive individual patient data (IPD) meta-analysis of the cases reported in literature between 2003 and August 2024. PubMed and Web of Science were searched systematically for case reports using predefined search terms. The protocol was prospectively registered with the international prospective register of systematic reviews (PROSPERO CRD42022356345). 185 publications, consisting of case reports or small case series published between 2003 and 2024, were eligible. They reported on 202 patients. Median age at diagnosis was 54 years (range 13-86). The 5-year overall survival proportion was 77%. On univariable analysis, overall survival was significantly influenced by regional and distant metastases, histologic grading, receptor status, Ki-67 index and surgical intervention. We did not observe any significant outcome improvement over time. Only poorly differentiated neuroendocrine carcinoma and lack of surgery were found to be prognostic factors for poor overall survival in multivariable analysis. This rare subtype of breast cancer is associated with a poor prognosis with no meaningful treatment progress in the last 2 decades. The present study identified key prognostic factors. However, the available data are insufficient to determine the optimal treatment approach. Establishing uniform diagnostic criteria and consistently reporting cases is crucial to generate a larger pool of data, thereby advancing our understanding and management of this rare disease.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Health Management via IKAP Theory Improves Upper Limb Function and Psychological Adaptation in Postmastectomy Patients: A Randomized Controlled Trial.","authors":"Panpan Xu, Xiaomei Zhang, Lihua Lu, Xiaofeng Chen, Yunxia Chen, Jia Chen, Xiaoling Yan, Xiaohong Jin, Yiju Li","doi":"10.1016/j.clbc.2025.08.017","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.08.017","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate IKAP theory-based digital health management in improving upper limb function and psychological adaptation in postmastectomy breast cancer survivors.</p><p><strong>Methods: </strong>We conducted a two-arm, parallel-group RCT with 200 postmastectomy patients at Nantong University Affiliated Hospital from July to December 2024. All patients were divided into two categories: 100 patients each in the experimental and control groups. The experimental group underwent a 12-week digital health management using IKAP theory, and the control group received routine care. We assessed all primary outcome measures, including the Information Needs Questionnaire (INQ), the Disabilities of the Arm, Shoulder and Hand (DASH) scale, the Cancer Post-Traumatic Growth Inventory (C-PTGI), the Breast Cancer Postoperative Functional Exercise Adherence Scale, and the Functional Assessment of Cancer Therapy-Breast (FACT-B) Questionnaire, at two distinct time points: before and after the intervention.</p><p><strong>Results: </strong>After 12 weeks of IKAP theory-based digital health management, breast cancer patients exhibited reduced information needs compared with the control group. Furthermore, this cohort exhibited marked improvement in upper extremity dysfunction when compared with the control cohort. The experimental group's post-traumatic growth levels, compliance with postoperative functional exercises, and quality of life were higher than the control group, respectively. The inter-group differences in all these indicators were statistically significant (P < .01).</p><p><strong>Conclusion: </strong>IKAP theory-based digital health management significantly enhanced breast cancer survivors' functional recovery and psychological adaptation.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-Assisted Versus Open Surgery in Early-Stage Breast Cancer: A Systematic Review and Meta-Analysis.","authors":"Shrouk Elghazaly, Sara Fakeh, Shaymaa Elbarbary, Khaled Mahmoud, Abdeljalil El Hilali, Peter Gamal, Elsayed Motawa","doi":"10.1016/j.clbc.2025.08.019","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.08.019","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is the most frequently diagnosed malignancy among women and remains a leading cause of cancer-related mortality. Nipple-sparing mastectomy (NSM), especially when combined with immediate reconstruction, has demonstrated oncologic safety and improved aesthetic outcomes. Robotic-assisted NSM (R-NSM) is a recent advancement offering better visualization and minimally invasive benefits, though its long-term safety and effectiveness remain under evaluation.</p><p><strong>Methods: </strong>Databases searched included PubMed, Scopus, Web of Science, and the Cochrane Library. Eligible studies compared R-NSM with open NSM for early-stage breast cancer and reported surgical or oncologic outcomes.</p><p><strong>Results: </strong>Eight studies including 1743 patients were included in the meta-analysis. R-NSM was associated with a significantly longer operative time (mean difference: 47.95 minutes; 95% CI, 13.89-82.02) but significantly lower intraoperative blood loss (mean difference: -34.29 mL; 95% CI, -43.63 to -24.95). Major complication risk was also lower (RR: 0.45; 95% CI, 0.23-0.86). Nipple-areola complex necrosis was significantly lower in R-NSM (RR: 0.55; 95% CI, 0.35-0.88). No significant differences were observed for skin necrosis, seroma, or surgical site infections. Heterogeneity was high in several outcomes.</p><p><strong>Discussion: </strong>R-NSM may improve perioperative outcomes by enabling precise dissection through remote incisions, potentially preserving vascular supply to the nipple-areola complex and reducing severe complications. The trade-off is longer operative time, largely due to robotic system setup and surgeons experience.</p><p><strong>Conclusion: </strong>Robotic-assisted NSM reduces blood loss and major complication at the cost of longer operative times. Further high-quality studies are needed to confirm its long-term oncologic outcomes and guide patient selection.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CanAssist Breast Provides Additional Insightful Prognostic Information in Retrospective, Pooled Secondary Analysis in Clinically Low/ High-Risk Patients With HR+/HER2- EBC.","authors":"Tejal Deepak Durgekar, Susmita Ghosh, Badada Ananthamurthy Savitha, Payal Shrivastava, Naveen Krishnamoorthy, Manvi Sunder, Deepti Ks, Manjiri Bakre","doi":"10.1016/j.clbc.2025.08.022","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.08.022","url":null,"abstract":"<p><strong>Background: </strong>In patients with early-stage HR+/ HER2- breast cancer, younger age, node positivity (N+), and higher Ki67 index are considered ``clinically high-risk'' and are treated with chemotherapy, although some can do well without it. Chemotherapy is often avoided in ``clinically low-risk'' patients with older age, small (T1-T2) or node-negative (N0) or lower Ki67 tumors; however, some of these patients do recur. Unlike earlier studies, this study aimed to explore the potential of CanAssist Breast (CAB), a prognostic test in providing ``additional'' information beyond ``clinicopathological parameters'' in ``clinically'' low-risk/ high-risk patients for effective treatment management.</p><p><strong>Methods: </strong>This is a secondary pooled data analysis of previously published retrospective studies wherein CAB risk stratification data of 3045 patients were used to assess the risk of recurrence at five years from diagnosis. Distant recurrence-free interval (DRFI) was evaluated from Kaplan-Meier curves.</p><p><strong>Results: </strong>In patients having N0 disease, CAB identified 13% and 8% high-risk patients with small tumors and small tumors with low Ki67 levels, respectively. In patients with N+ disease, CAB identified 44% of patients with higher Ki67 (≥20%) as low-risk. In younger patients, CAB identified >46% of patients as low-risk. In low ER-expressing patients, CAB identified 67% of patients as low-risk. All CAB low-risk patients have an acceptable DRFI of ≥ 89% at five years from diagnosis.</p><p><strong>Conclusions: </strong>CAB provides additional prognostic information by identifying ``low-risk'' and ``high-risk'' patients from the ``clinically'' high-risk and low-risk groups, thereby guiding oncologists to either avoid aggressive therapies or govern significant treatment decisions on additional therapies.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Census Tract-Level Social Determinants of Health and Cardiovascular Care among Individuals Diagnosed With Breast Cancer.","authors":"Pei-Lin Huang, Manu M Mysore, Brian Barr, Eberechukwu Onukwugha","doi":"10.1016/j.clbc.2025.08.020","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.08.020","url":null,"abstract":"<p><strong>Purpose: </strong>Cardiovascular care is impacted by social determinants of health (SDoH), however implications for physician visits among individuals diagnosed with breast cancer (BC) who received potentially cardio-toxic treatments (PCT) are poorly understood. We investigate these relationships among older adults.</p><p><strong>Methods: </strong>This study used Surveillance, Epidemiology, and End Results-Medicare data linked with Census tract SDoH measures. We included female patients diagnosed with BC between 2007 and 2018 who received PCT within 12 months of diagnosis. Framework-guided tract-level SDoH variables and empirically-derived tract-level SDoH domains were used in separate regression models. Study outcomes included cardiologist or primary care physician (PCP) visits within 90 days of treatment and time to first physician visit. Logistic regression and Cox proportional hazards models included patient- and tract-level measures.</p><p><strong>Results: </strong>A total of 2637 patients were included. Living in a low food access tract (aOR: 0.78, 95%CI: 0.63-0.96) and a primary care health professional shortage area (aOR: 0.66, 95%CI: 0.52-0.84) were associated with lower odds of first cardiologist visit within 90 days of treatment. Living in a tract ranked higher on the empirical domain of \"poor community infrastructure and inequity\" was associated with a longer time to a first cardiologist visit (aHR: 0.90, 95%CI: 0.81-0.99).</p><p><strong>Conclusions: </strong>Individuals residing in worse-off tracts experienced barriers to physician visits following PCT initiation. \"poor community infrastructure and inequity,\" was associated with a longer time to first cardiologist visit. These findings support incorporating contextual SDoH factors into pretreatment risk assessment tools to better identify patients who may benefit from cardio-oncology referrals.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Neutrophil-Lymphocyte Ratio as a Predictor of Long-Term Oncological and Survival Outcomes in Patients Treated Surgically for Breast Cancer.","authors":"Alisha A Jaffer, Carolyn Cullinane, Matthew G Davey, Amirhossein Jalali, Juliette Buckley, Chwanrow Baban, Brigid Anne Merrigan, Shona Tormey","doi":"10.1016/j.clbc.2025.08.015","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.08.015","url":null,"abstract":"<p><strong>Background: </strong>Neutrophil-lymphocyte ratio (NLR) is an emerging prognostic biomarker with potential utility in solid malignancies. Routine draw of full blood count in preoperative workup positions NLR as a cost-effective adjunct in risk stratification. This project explores associations between preoperative NLR and breast cancer outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study reviewed an institutional database of breast cancer patients undergoing primary curative surgery at University Hospital Limerick from January 1, 2010 to June 1, 2017. Primary endpoints included recurrence at 5 years, disease free survival (DFS) and OS (OS). Regression modelling examined associations between preoperative NLR ≥2.5 and endpoints, controlling for confounders.</p><p><strong>Results: </strong>Median preoperative NLR was 2.63 (SD 1.42). The cohort comprised 579 patients, with a recurrence rate of 15.7% (6% local recurrence and 9.7% distant metastasis). 106 (18.3%) patients were deceased at the administrative censoring time. Patients with NLR ≥ 2.5 had a 2-fold increase in rate of distant metastasis at 5 years (OR 2.00, 95% CI, 1.05-3.81, P = .036) and experienced worse OS (HR 1.84, 95% CI, 1.20-2.84, P = .006). Outcomes between NLR ≥2.5 and local recurrence at 5 years, as well as NLR ≥2.5 and DFS were equivocal.</p><p><strong>Conclusions: </strong>Preoperative NLR ≥2.5 was found to be an independent predictor of distant metastasis at 5 years and an independent predictor of OS, following adjustment of confounders. This finding is consistent with published literature and may help risk stratify patients at higher risk of breast cancer recurrence.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}