Current Medical Research and Opinion最新文献

{"title":"Knowledge, attitudes, and practices of patients with hyperlipidemia towards stroke: a cross-sectional study.","authors":"Shanshan Zuo, Linlin Liu, Wentao Li, Jian Zhao","doi":"10.1080/03007995.2024.2425384","DOIUrl":"10.1080/03007995.2024.2425384","url":null,"abstract":"<p><strong>Objective: </strong>With the rising incidence and mortality rates of stroke, understanding the knowledge, attitudes, and practices (KAP) of patients with hyperlipidemia towards stroke is crucial for improving their health management and preventing stroke. This study aimed to investigate the KAP of patients with hyperlipidemia towards stroke.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at the First Hospital of Hebei Medical University between November 2, 2023, and December 31, 2023. Demographic information and KAP scores of the participants were collected <i>via</i> questionnaire administration.</p><p><strong>Results: </strong>In this study, a total of 385 patients diagnosed with hyperlipidemia were included. Among them, 211 (54.8%) were male, and 214 (55.6%) had been dealing with hyperlipidemia for less than one year. Multivariate analyses showed that age greater than or equal to 55 years (OR = 4.016, 95% CI: [2.128,7.579], <i>p</i> < .001) and attitude score greater than or equal to 21 (OR = 5.673, 95% CI: [3.432,9.376], <i>p</i> < .001) were independently associated with proactive practice. Mediation analysis showed that knowledge directly affected the attitude (β = 0.637, <i>p</i> = .010) and attitude directly affected the practice (β = 0.721, <i>p</i> = .010). Meanwhile, the direct effect of knowledge on practice was not significant (β = -0.059, <i>p</i> = .438), however, knowledge was found to indirectly affected practice through attitude (β = 0.459, <i>p</i> = .010).</p><p><strong>Conclusion: </strong>Our study reveals that patients with hyperlipidemia exhibit a concerning gap in their understanding of stroke, despite holding positive attitudes and displaying suboptimal preventive practices.</p>","PeriodicalId":10814,"journal":{"name":"Current Medical Research and Opinion","volume":" ","pages":"2165-2177"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"You don't have celiac disease: a patient perspective on potential issues with stress leading to misdiagnosis.","authors":"Ashley M Snyder","doi":"10.1080/03007995.2024.2425063","DOIUrl":"10.1080/03007995.2024.2425063","url":null,"abstract":"","PeriodicalId":10814,"journal":{"name":"Current Medical Research and Opinion","volume":" ","pages":"2163-2164"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of C-reactive protein and procalcitonin in community-acquired pneumonia in children: a narrative review.","authors":"Laura Omaggio, Letizia Franzetti, Roberta Caiazzo, Crescenzo Coppola, Maria Sole Valentino, Vania Giacomet","doi":"10.1080/03007995.2024.2425383","DOIUrl":"10.1080/03007995.2024.2425383","url":null,"abstract":"<p><p>The purpose of this narrative review is to analyze the most recent studies about the role of C-reactive protein (CRP) and procalcitonin (PCT), two of the main biomarkers of infection, in distinguishing viral from bacterial etiology, in predicting the severity of infection and in guiding antibiotic stewardship in children with community-acquired pneumonia (CAP). The studies examined reveal that both CRP and PCT play a valuable role in diagnosing pediatric CAP, though each has limitations. CRP has moderate accuracy in distinguishing bacterial from viral infections, but its elevated levels are not exclusive to bacterial infections; PCT, however, shows higher specificity for bacterial CAP, with studies confirming its ability to differentiate bacterial causes, especially in severe cases. When integrated with clinical findings, CRP and PCT improve the sensitivity of pneumonia diagnoses and help in predicting severe outcomes such as sepsis and empyema; furthermore, both biomarkers prove useful in guiding antibiotic therapy, with PCT showing a more dynamic response to treatment. However, even though CRP and PCT offer valuable insights into the diagnosis and management of pediatric CAP, their application should be always integrated with clinical assessment rather than used in isolation. More studies are needed to define standardized thresholds and decision algorithms that incorporate these biomarkers.</p>","PeriodicalId":10814,"journal":{"name":"Current Medical Research and Opinion","volume":" ","pages":"2191-2200"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of cerebral venous thrombosis: a review.","authors":"Hamish Patel, India Lunn, Sajid Hameed, Maria Khan, Fazeel M Siddiqui, Afshin Borhani, Arshad Majid, Simon M Bell, Mohammad Wasay","doi":"10.1080/03007995.2024.2423740","DOIUrl":"10.1080/03007995.2024.2423740","url":null,"abstract":"<p><p>Cerebral venous thrombosis (CVT) is an uncommon cause of stroke. COVID-19 infection and vaccination have been associated with CVT. Fibrinolysis and mechanical thrombectomy may play an emerging role in management. We conducted a literature review summarizing current evidence on use of antiplatelets, anticoagulants, thrombolysis, and mechanical thrombectomy for the management of CVT and COVID-19 related CVT. This was achieved through a review of MEDLINE, PubMed, and Cochrane Reviews databases, performed using the search terms CVT AND \"antiplatelets' aspirin\", \"ticagrelor\", \"clopidogrel\", \"eptifibatide\", \"Low-molecular-weight-heparin (LMWH)\", \"Unfractionated heparin (UH)\", \"warfarin\", \"DOACs\", \"rivaroxaban\", \"apixaban\", \"dabigatran\", \"fibrinolysis\", \"intra-sinus thrombolysis\", \"mechanical thrombectomy\", and \"craniectomy\". We found that LMWH and UH are safe and effective for the management of acute CVT and should be considered first line. Warfarin may be used in the sub-acute phase for secondary prevention but has weak evidence. DOACs are potentially a safe warfarin alternative, but only warfarin is currently recommended in international guidelines. Antiplatelets show little evidence for the prevention or management of CVT, but studies are currently limited. COVID-19 related CVT is treated similarly to non-COVID-19 CVT; however, vaccine-related CVT is a newly recognised disease with a different pathophysiology and is treated with a combination of non-heparin anticoagulants, immunotherapy, and steroids. Decompressive craniectomy may be used to reduce intracranial pressure in life-threatening cases. There is a small body of evidence for endovascular therapy in complex cases but should be reserved for complex cases in specialist centres. This paper is of relevance to clinical practice since the safe and effective management of CVT is important to reduce the risk of disability.</p>","PeriodicalId":10814,"journal":{"name":"Current Medical Research and Opinion","volume":" ","pages":"2223-2236"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technological advancements in glucose monitoring and artificial pancreas systems for shaping diabetes care.","authors":"Neha Ghosh, Saurabh Verma","doi":"10.1080/03007995.2024.2422005","DOIUrl":"10.1080/03007995.2024.2422005","url":null,"abstract":"<p><p>The management of diabetes mellitus has undergone remarkable progress with the introduction of cutting-edge technologies in glucose monitoring and artificial pancreas systems. These innovations have revolutionized diabetes care, offering patients more precise, convenient, and personalized management solutions that significantly improve their quality of life. This review aims to provide a comprehensive overview of recent technological advancements in glucose monitoring devices and artificial pancreas systems, focusing on their transformative impact on diabetes care. A detailed review of the literature was conducted to examine the evolution of glucose monitoring technologies, from traditional invasive methods to more advanced systems. The review explores minimally invasive techniques such as continuous glucose monitoring (CGM) systems and flash glucose monitoring (FGM) systems, which have already been proven to enhance glycemic control and reduce the risk of hypoglycemia. In addition, emerging non-invasive glucose monitoring technologies, including optical, electrochemical, and electro-mechanical methods, were evaluated. These techniques are paving the way for more patient-friendly options that eliminate the need for frequent finger-prick tests, thereby improving adherence and ease of use. Advancements in closed-loop artificial pancreas systems, which integrate CGM with automated insulin delivery, were also examined. These systems, often referred to as \"hybrid closed-loop\" or \"automated insulin delivery\" systems, represent a significant leap forward in diabetes care by automating the process of insulin dosing. Such advancements aim to mimic the natural function of the pancreas, allowing for better glucose regulation without the constant need for manual interventions by the patient. Technological breakthroughs in glucose monitoring and artificial pancreas systems have had a profound impact on diabetes management, providing patients with more accurate, reliable, and individualized treatment options. These innovations hold the potential to significantly improve glycemic control, reduce the incidence of diabetes-related complications, and ultimately enhance the quality of life for individuals living with diabetes. Researchers are continually exploring novel methods to measure glucose more effectively and with greater convenience, further refining the future of diabetes care. Researchers are also investigating the integration of artificial intelligence and machine learning algorithms to further enhance the precision and predictive capabilities of glucose monitoring and insulin delivery systems. With ongoing advancements in sensor technology, connectivity, and data analytics, the future of diabetes care promises to deliver even more seamless, real-time management, empowering patients with greater autonomy and improved health outcomes.</p>","PeriodicalId":10814,"journal":{"name":"Current Medical Research and Opinion","volume":" ","pages":"2095-2107"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing drug therapy-related problems and assessment of chronic diabetic wounds.","authors":"Maria Infant Majula Shifani Mahendran, Vinoj Gopalakrishnan, Vaijayanthi Saravanan, Ramasamy Dhamodharan, Pradeep Jothimani, M Balasubramanian, Abhimanyu Kumar Singh, Rajan Vaithianathan","doi":"10.1080/03007995.2024.2414893","DOIUrl":"10.1080/03007995.2024.2414893","url":null,"abstract":"<p><p>Type 2 diabetes mellitus (T2DM), responsible for most diabetes cases recorded worldwide, increases the risk of chronic wounds and amputation. Patients with T2DM appear to be more susceptible to delayed wound healing due to their treatment adherence. This review explores the specifics of polypharmacy, side effects, possible drug interactions and the importance of medication adherence for therapeutic efficacy. We discuss the effects of anti-diabetes medications on wound healing as well as the role that biofilms and microbial infections play in diabetic wounds. Inconsistent use of medications can lead to poor glycaemic control, which negatively affects the healing process of diabetic foot ulcers. Managing chronic wounds represents a substantial portion of healthcare expenditures. Biofilm-associated infections are difficult for the immune system to treat and respond inconsistently to antibiotics as these infections are slow growing and persistent. Additionally, we emphasize the critical role pharmacists play in enhancing patient adherence and optimizing diabetes treatment by offering comprehensive coverage of drugs associated with problems related to pharmacological therapy in type 2 diabetes.</p>","PeriodicalId":10814,"journal":{"name":"Current Medical Research and Opinion","volume":" ","pages":"2077-2093"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported outcomes related to migraine burden among patients treated with standard-of-care preventive medications or calcitonin gene-related monoclonal antibodies: a United States and Europe cross-sectional survey.","authors":"Oralee J Varnado, James Jackson, Lucas Scharf, Gilwan Kim, Sarah Cotton","doi":"10.1080/03007995.2024.2427884","DOIUrl":"10.1080/03007995.2024.2427884","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate quality of life, migraine disability, and work productivity and activity impairment in patients with migraine who received preventive treatment by comparing standard of care preventive medications and calcitonin gene-related monoclonal antibodies (CGRP mAbs), including galcanezumab alone.</p><p><strong>Methods: </strong>This cross-sectional study conducted across the United States (US) and Europe used data from the Adelphi Migraine Disease Specific Programme. Physicians completed record forms for consecutive patients, who then completed self-report forms assessing patient-reported outcomes (PROs) such as quality of life, migraine disability, and work productivity and activity impairment. <i>T</i>-tests, Fisher's exact test, and Mann-Whitney <i>U</i> test were used for analysis.</p><p><strong>Results: </strong>From May 2022 to June 2023, 557 physicians submitted data for 6723 patients. A total of 4036 patients (US 956; Europe 3080) with a history of preventive treatment were included (>60% female, >80% White, mean [standard deviation] age range, 38.7 [12.8] to 46.3 [12.1]). Patients who received 3+ lines of preventive therapy and were receiving CGRP mAbs (including galcanezumab alone) had enhanced health-related quality of life (HRQoL) compared to those who received standard of care. Similar findings were observed across Europe; however, in the US, there was no significant difference in any PROs.</p><p><strong>Conclusion: </strong>Patients with migraine in the overall population and Europe who received 3+ lines of preventive migraine therapy and were receiving CGRP mAbs/galcanezumab demonstrated enhanced HRQoL compared to those who received standard of care.</p>","PeriodicalId":10814,"journal":{"name":"Current Medical Research and Opinion","volume":" ","pages":"2179-2190"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world data in lupus nephritis: results from a European survey on renal function testing and burden of disease progression.","authors":"Francesco Pesce, Ancilla Fernandes, David Clamp, Beatriz Asin, Emily Goddard, Liane Gillespie-Akar, Alice Eberhardt","doi":"10.1080/03007995.2024.2425387","DOIUrl":"10.1080/03007995.2024.2425387","url":null,"abstract":"<p><strong>Objective: </strong>Patients with lupus nephritis (LN), a severe renal manifestation of systemic lupus erythematosus, should be monitored for progression of chronic kidney disease to end-stage renal disease but data on renal function testing in LN patients are limited. This real-world analysis aimed to evaluate nephrologists' use of renal function tests to support LN diagnosis and monitoring and to examine the impact of disease progression in LN patients in Europe.</p><p><strong>Methods: </strong>Data were drawn from the Adelphi Lupus Disease Specific Programme, a cross-sectional survey of nephrologists and their next five consulting patients with LN in France, Germany, Italy, Spain, and the United Kingdom in 2021. Nephrologists provided demographic and clinical information for each patient and the same patients completed a self-reported questionnaire. Using a checkbox, patients provided informed consent to take part in the survey.</p><p><strong>Results: </strong>Nephrologists (<i>n</i> = 72) provided data on 376 patients with LN. Estimated glomerular filtration rate (eGFR) or proteinuria testing was not undertaken in around 10% and 50% of these patients, respectively. Regression analysis predicted reduction in renal function (disease progression) following LN diagnosis whilst bivariate analyses showed significantly worse outcomes for patients with progressed disease: worse pain, fatigue, treatment satisfaction, and patient-reported health state and activity impairment.</p><p><strong>Conclusion: </strong>Our study revealed lower-than-expected nephrologist-reported use of renal function testing to support diagnosis/monitoring of patients with LN in real-world clinical settings in Europe. Lower quality of life (QoL) was observed in patients with more progressed disease. Increased use of renal function testing is needed so that all LN patients are monitored closely to manage disease progression and avoid the associated QoL impact.</p>","PeriodicalId":10814,"journal":{"name":"Current Medical Research and Opinion","volume":" ","pages":"2215-2222"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacology of chlorphenamine and pseudoephedrine use in the common cold: a narrative review.","authors":"Romain Douhard, Philippe Humbert, Jean-Yves Milon, Rassa Pegahi","doi":"10.1080/03007995.2024.2424422","DOIUrl":"10.1080/03007995.2024.2424422","url":null,"abstract":"<p><p>The common cold is the most frequent upper respiratory viral infection. Although benign, it represents a high socioeconomic burden. Many over-the-counter drugs are available to manage the symptoms of this condition, with antihistamines and vasoconstrictors being the most widely used. This review aimed to compare the potential mechanisms underlying the efficacy and safety of chlorphenamine and pseudoephedrine, the most commonly used agents in these two classes of drugs, and provide a useful perspective to impact appropriate decisions when considering these options for symptomatic common cold treatment. To conduct a comprehensive analysis, we systematically reviewed the use of pseudoephedrine and chlorphenamine using various databases, including MEDLINE, Google Scholar, Scopus, and Embase. We also perused the bibliographies of relevant articles and the EudraVigilance database. The findings suggest that pseudoephedrine may offer specific benefits in rapidly alleviating nasal congestion in the short term. Chlorphenamine appears to exhibit a higher degree of efficacy in alleviating rhinorrhea and other specific cold symptoms compared to pseudoephedrine. Pharmacovigilance data and case report reviews showed that pseudoephedrine may induce a higher incidence of less common but potentially life-threatening adverse effects compared to chlorphenamine. We concluded that antihistamine drugs exhibit a more favorable benefit/risk profile than vasoconstrictors for treating symptomatic common colds.</p>","PeriodicalId":10814,"journal":{"name":"Current Medical Research and Opinion","volume":" ","pages":"2125-2137"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical burden and healthcare resource utilization associated with managing sickle cell disease with recurrent vaso-occlusive crises in France.","authors":"Jessica Baldwin, Chuka Udeze, Nanxin Li, Lyes Boulmerka, Lila Dahal, Giancarlo Pesce, Nadia Quignot, Heng Jiang, Frédéric Galactéros","doi":"10.1080/03007995.2024.2421287","DOIUrl":"10.1080/03007995.2024.2421287","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective, real-world claims database analysis described the clinical burden and healthcare resource utilization (HCRU) among patients with sickle cell disease (SCD) with recurrent vaso-occlusive crises (VOCs) in France.</p><p><strong>Methods: </strong>The French National Health Data System database (système national des données de santé) was used to identify eligible patients from 1 January 2012 to 1 March 2019. Inclusion criteria were a SCD diagnosis, ≥2 VOCs/year for ≥2 consecutive years following the diagnosis, and ≥1 year of follow-up data to 1 March 2020. Patients with hereditary persistence of fetal hemoglobin or hematopoietic stem cell transplant in their medical records were excluded. Clinical complications, mortality, treatment use, and HCRU were evaluated during follow-up.</p><p><strong>Results: </strong>Overall, 4602 patients with SCD with recurrent VOCs were eligible; their mean (standard deviation [<i>SD</i>]) age was 19.8 (13.5) years, and 51.8% were female. Patients experienced a mean (SD) of 3.82 (3.57) VOCs per patient per year (PPPY). Prevalent complications were anemia or leukocytosis (44.1%), infections (42.0%), and organ failure (38.2%). In total, 101 (2.2%) patients died during follow-up (mean age of death [SD]: 39.3 [17.5] years; mortality rate: 0.64 deaths per 100 person-years). Most patients received opioids (89.1%) and hydroxycarbamide (72.8%). Patients had a mean of 5.7 inpatient hospitalizations, 6.0 emergency room visits, 6.6 outpatient visits, and 13.4 outpatient prescriptions PPPY.</p><p><strong>Conclusions: </strong>Patients with SCD with recurrent VOCs in France have substantial clinical complications, mortality, and HCRU despite currently available treatment options. Innovative treatments that reduce frequency of or eliminate VOCs are needed to alleviate the burden associated with SCD.</p>","PeriodicalId":10814,"journal":{"name":"Current Medical Research and Opinion","volume":" ","pages":"2117-2124"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}