International Wound Journal最新文献

{"title":"The Impact of Diagnostic Delay on Wound Healing—A Cohort Study in a Primary Care Setting","authors":"K. M. Ahmajärvi,&nbsp;K. M. Isoherranen,&nbsp;T. J. Pessi,&nbsp;M. A. Venermo","doi":"10.1111/iwj.70141","DOIUrl":"https://doi.org/10.1111/iwj.70141","url":null,"abstract":"<p>The impact of diagnostic delays on wound healing has not been investigated in the primary care setting. The aim of this cohort study was to examine how diagnostic delays influence the healing of a chronic wound. This is a retrospective study on patients who were assessed by a specialized wound care team of a primary health care unit, aiming to reduce diagnostic and treatment delays among patients with chronic wounds. The data consist of 197 consecutive patients who had their first appointment with the wound care team in 2016. Patients whose wounds had appeared less than one year prior to the diagnosis (<i>n</i> = 182) were included in the analyses. Primary and secondary outcome measures: The primary outcome measure was wound healing and its association with a diagnostic delay. Delays were categorized into three groups by the date of the diagnosis: (1) less than 4 weeks (<i>n</i> = 33), (2) 4–12 weeks (<i>n</i> = 94) and (3) over 12 weeks (<i>n</i> = 55) after the appearance of the wound. A diagnostic delay had a significant effect on the wound healing time. Wounds had a shorter healing time if they were diagnosed early. The cumulative healing rate at 12 weeks was 54.5% in Group 1, 17.0% in Group 2 and 0% in Group 3. And 62.5% of the arterial ulcers and 47.8% of the diabetic ulcers were diagnosed within 4–12 weeks. Most of the venous leg ulcers were diagnosed within 4–12 weeks (54.2%). Our data clearly show that the earlier the diagnosis, the shorter the healing time in a primary care setting. The wounds that were diagnosed the earliest were mainly post-traumatic and venous leg ulcers. On the other hand, wounds requiring prompt diagnosis, such as diabetic foot ulcers and arterial ulcers, were not included in the group of early diagnosis. We conclude that a speedy diagnosis and aetiology-driven treatment of a wound has a direct impact on the wound healing time. Therefore, it is essential to improve the diagnostic pathways from the onset of the wound, starting from the primary care setting.</p>","PeriodicalId":14451,"journal":{"name":"International Wound Journal","volume":"22 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iwj.70141","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144074355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Chronic Wound Exudate on the Patient, Clinician and Payer: Addressing the Challenges With Foam Dressings","authors":"Joshua S. Mervis","doi":"10.1111/iwj.70369","DOIUrl":"https://doi.org/10.1111/iwj.70369","url":null,"abstract":"<p>Chronic wounds are often highly exudative. If not managed properly, chronic wound exudate will result in complications that delay healing and have highly detrimental effects on patients and their carers, as well as add substantial costs to the healthcare system as a whole. This short review article focuses on the role that foam dressings play in achieving moisture balance in the wound while protecting surrounding skin, with emphasis on how their structure and composition contribute to their ability to accomplish these goals. Foam dressing properties can create a conducive environment for wound healing, which ultimately has positive health and economic benefits for patients and society at large. It is hoped that, by reading this article, healthcare professionals will have a better understanding of the role of foam dressings in managing exudate and be better equipped to critique laboratory and clinical studies that have been undertaken to evaluate their performance.</p>","PeriodicalId":14451,"journal":{"name":"International Wound Journal","volume":"22 S1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iwj.70369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laboratory Evaluations of Wound Dressings: Key Advances to Reflect Clinical Reality","authors":"Erik Nygren,&nbsp;Matthew Malone,&nbsp;Amit Gefen","doi":"10.1111/iwj.70333","DOIUrl":"https://doi.org/10.1111/iwj.70333","url":null,"abstract":"<p>Laboratory evaluations are essential for determining the safety and effectiveness of wound dressings. These evaluations assist clinicians in selecting optimal products for their patients. It is crucial that laboratory tests closely mimic real clinical conditions. This review highlights the collaboration between scientists, clinicians and industry experts to improve laboratory testing methods for wound dressings. The goal is to ensure that laboratory tests are relevant to real-world use. Key advancements include a new simulated wound fluid and a fluid handling test system that better reflects actual wound care environments. These improvements aim to support more reliable, evidence-based decisions in clinical practice.</p>","PeriodicalId":14451,"journal":{"name":"International Wound Journal","volume":"22 S1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iwj.70333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical appraisal of ‘The Diabetic Sausage Toe: Prevalence, Presentation and Outcomes’","authors":"Arefeh Babazadeh,&nbsp;Mohammad Barary,&nbsp;Zeinab Mohseni Afshar,&nbsp;Soheil Ebrahimpour","doi":"10.1111/iwj.70092","DOIUrl":"https://doi.org/10.1111/iwj.70092","url":null,"abstract":"<p>We read the article titled ‘The Diabetic Sausage Toe: Prevalence, Presentation, and Outcomes’ by Yammine et al.<span>¹</span> with great interest. This study represents an important contribution to understanding diabetic foot infections by exploring the under-recognized condition of ‘sausage toe’, a unique manifestation of diabetic osteomyelitis (OM). Given the study's focus on prevalence and treatment outcomes, its findings provide a valuable basis for improving diabetic wound classification systems and clinical management. However, we believe that addressing certain methodological limitations could enhance the study's robustness and applicability.</p><p>First, while the study provided insightful results, it omitted key laboratory parameters that could have offered a deeper understanding of disease severity and outcomes. Biomarkers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) are valuable indicators of inflammatory response and infection activity.<span>^{2, 3}</span> Including these markers would have contributed to a more comprehensive analysis of disease progression and therapeutic effectiveness.</p><p>Second, the study needed more details on antibiotic regimens, such as the types of antibiotics administered, their duration and other medications used. This information is particularly pertinent as multidrug-resistant organisms (MDROs) are known to complicate treatment outcomes in diabetic foot ulcers (DFUs).<span>⁴</span> Culture results and the specific types of microorganisms involved should also have been reported, as they are essential for tailoring treatment plans.</p><p>Moreover, while the authors documented treatment outcomes, they did not consider comorbidities like nephropathy, retinopathy and cardiovascular disease, which are prevalent in diabetic patients and can significantly affect recovery.<span>⁵</span> Analysing the impact of these conditions on sausage toe outcomes would have strengthened the study's conclusions regarding prognosis and individualized care.</p><p>Lastly, patient lifestyle factors, such as smoking, alcohol consumption and histories of invasive procedures (e.g., amputations or revascularizations), were not addressed. Including these factors could have shed light on their potential influence on the severity of the condition and the differential outcomes between acute and chronic cases.</p><p>In conclusion, Yammine et al. have made a significant contribution by identifying the prevalence and presentation of diabetic sausage toe. However, addressing the outlined limitations could improve the generalizability and clinical impact of their findings. We believe that incorporating these considerations in future studies will further advance the understanding and treatment of this critical condition.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":14451,"journal":{"name":"International Wound Journal","volume":"22 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iwj.70092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bench to Bedside Evaluation of an Innovative, Non-Bordered Foam Dressing for Use in Exudating Chronic Wounds","authors":"Hadar Lev-Tov,&nbsp;Thomas Serena,&nbsp;Felix Sigal,&nbsp;Erik Nygren","doi":"10.1111/iwj.70414","DOIUrl":"https://doi.org/10.1111/iwj.70414","url":null,"abstract":"<p>To investigate a dimpled, non-bordered foam dressing with a soft silicone wound contact layer, the research spans from bench (fluid handling performance) to bedside (clinical effectiveness on exuding chronic wounds). In vitro methodology was used to monitor the fluid handling capacity and fluid retention capacity of the investigational dressing compared to other commercially available foam dressings according to standard EN 13726:2023. To provide complementary clinically relevant fluid handling results, more advanced laboratory tests were conducted using the FLUHTE (FLUid Handling Test Equipment) wound simulator. In a paired clinical investigation, moderately to highly exuding chronic wounds of patients had the investigational dressing applied as part of the wound management regime, and healing-related parameters were assessed for up to six weeks. The investigational dressing significantly outperformed the other dressings in fluid dispersion ability. Overall, the investigational dressing performed well in terms of fluid handling, including under compression. In the clinical investigation, the use of the dressing was associated with substantial wound improvement, reductions in size and exudate levels, and improved patient quality of life scores. At the final visit, nine (13.2%) patients had wounds that had healed. There were no adverse device effects reported. Data from the advanced laboratory tests highlighted the substantial impact of dressing design on fluid handling performance. The investigational dressing effectively handled fluid, even when subjected to mechanical forces mimicking those that it would be subjected to in the clinical setting. The clinical results support the use of the dressing on moderately and highly exuding chronic wounds of various clinical origins.</p>","PeriodicalId":14451,"journal":{"name":"International Wound Journal","volume":"22 S1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iwj.70414","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protein Biomarkers in Venous Leg Ulcer Fluid: A Systematic Review","authors":"Renitha Reddi,&nbsp;Matthew Tan,&nbsp;Alun Huw Davies,&nbsp;Sarah Onida","doi":"10.1111/iwj.70675","DOIUrl":"https://doi.org/10.1111/iwj.70675","url":null,"abstract":"<p>Venous leg ulcers (VLUs) are common and cause significant morbidity and poor quality of life. There is a poor understanding of the biology underlying non-healing VLUs. VLU exudates may reflect the underlying wound microenvironment. This systematic review aims to identify potentially diagnostic and/or prognostic protein biomarkers within VLU fluid/exudates reported in the literature. A systematic review was reported according to PRISMA guidelines. MEDLINE and Embase databases were searched up to 31st March 2024. Full text, primary studies in English reporting on proteins identified in VLU fluid/exudate were included. Two independent reviewers performed the abstract and full-text screen. Additional publications were identified by searching the references of included studies. 46 studies were identified, with nine comparing healing and non-healing VLUs. Cytokines (e.g., IL-1a, IL-1ra, IL-6, eotaxin, GM-CSF, PDGF, VEGF) and proteins involved in extracellular matrix (ECM) homeostasis (e.g., MMP-7, MMP-10, MMP-13, TIMP-4) were significantly increased in non-healing compared to healing VLUs. Collagen subunits (PICP and PIIINP) significantly increased as the VLU healed. Inflammatory proteins (e.g., complement type 6, S100A8, S100A9) and ECM proteins (e.g., fibronectin, lumican) were found to be increased in non-healing VLUs compared to acute surgical wounds. Altered levels of specific proteins in wound exudates may be indicative of healing and non-healing VLUs. Further work is essential to elucidate a comprehensive protein phenotype that may help early identification and prognostication of non-healing VLUs.</p>","PeriodicalId":14451,"journal":{"name":"International Wound Journal","volume":"22 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iwj.70675","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wound Management Amongst Doctors in Training: A Cross-Sectional Study of Education and Capability","authors":"Hamza Duffaydar,&nbsp;Octavi Casals-Farre,&nbsp;Jessica Morgan,&nbsp;Harri Jones,&nbsp;Hassan Duffaydar,&nbsp;Amy Smith,&nbsp;Charles Kimberly,&nbsp;James Brock,&nbsp;Rhidian Morgan-Jones,&nbsp;Arwel Poacher","doi":"10.1111/iwj.70674","DOIUrl":"https://doi.org/10.1111/iwj.70674","url":null,"abstract":"<p>Wound care in the UK is a resource-intensive challenge, costing the NHS £8.3 billion annually and growing with an ageing population. However, there is no evidence of whether doctors in training receive adequate teaching to perform wound care competently. Our study aimed to investigate doctors’ confidence when assessing and managing wounds and their preferred learning modality. This cross-sectional study comprised 262 doctors training across the UK. We assessed the correlation between confidence in managing wounds, seniority in training, and trainee speciality. Only 65% of doctors had received teaching on wound healing during medical school, and 25% received further teaching during postgraduate training. Surgical trainees felt more confident in assessing and managing wounds than their medical counterparts (<i>p</i> &lt; 0.01), and surgeons were the only group demonstrating a positive correlation between seniority and confidence in wound management (<i>p</i> = 0.02). All speciality groups favoured bedside teaching and thought wound management was integral to clinical practice. Our study has shown that training is sub optimally delivered and insufficient for trainee requirements. Incorporating dedicated teaching across specialities will be essential to manage the increasing demand for wound care.</p>","PeriodicalId":14451,"journal":{"name":"International Wound Journal","volume":"22 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iwj.70674","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preclinical Evaluation of Closed Incisional Negative Pressure Therapy on Post-Surgical Oedema and Lymphatic Activity","authors":"John C. Rasmussen,&nbsp;Marisa Schmidt,&nbsp;Janelle E. Morton,&nbsp;Samantha Mann,&nbsp;Kristine Kieswetter,&nbsp;Eva M. Sevick-Muraca","doi":"10.1111/iwj.70180","DOIUrl":"https://doi.org/10.1111/iwj.70180","url":null,"abstract":"<p>Closed incisional Negative Pressure Therapy (ciNPT) has demonstrated improved post-surgical healing with reduced oedema and hematoma/seroma formation in patients. The underlying mechanism of action is poorly understood, although evidence indicates that lymphatics play a role. The effects of ciNPT on oedema and lymphatic recovery were assessed following bilateral, surgical undermining of swine mammary tissues. One incision was treated with ciNPT, and the control covered with clear dressing. Near-infrared fluorescence imaging was used to visualise lymphatic activity. Oedema and lymph node size were measured using ultrasound. LYVE-1 and podoplanin were quantified with ELISA. Analysis of lymphatic activity revealed a contralateral effect of ciNPT on control sites. Statistically higher pulsatile rates were observed at both incisions when ciNPT was active, compared with when it was removed. Separate evaluations with dressings off and on showed no differences between treatments. While not significant, lower surgical site oedema, lymph node volume, and incidence/severity of seroma were observed in treated sites along with increased lymphatic vessel markers in lymph draining tissues. Taken together, evidence suggests that ciNPT may influence watersheds outside the treated area. Similar systemic impacts owing to manual lymphatic drainage have previously been reported in healthy individuals and those with cancer-related lymphedema.</p>","PeriodicalId":14451,"journal":{"name":"International Wound Journal","volume":"22 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iwj.70180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143908953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2-Methoxyestradiol Inhibits the Oxygen-Sensing Pathway in Keloid Fibroblasts by Targeting HIF-1α/PHD","authors":"Ming-Zi Zhang,&nbsp;Zhi-Jin Li,&nbsp;Wen-Bo Xia,&nbsp;Lou-Bin Si,&nbsp;Nanze Yu,&nbsp;Xiao-Jun Wang,&nbsp;Xiao Long","doi":"10.1111/iwj.70373","DOIUrl":"https://doi.org/10.1111/iwj.70373","url":null,"abstract":"<p>Maintaining oxygen homeostasis is a basic cellular process for adapting to physiological oxygen variations in which the oxygen-sensing pathway plays a critical role, especially in tumour progression. Little is known about the activity of the oxygen-sensing pathway in keloid tissue. In this study, key features of the oxygen-sensing pathway and its downstream effects were evaluated and compared between normal skin tissue and keloid tissue. Keloid tissue showed increased oxygen-sensing pathway activation and a higher expression of key downstream factors such as tumour necrosis factor-1α (TNF-α) and vascular endothelial growth factor (VEGF). In addition, the effects of 2-methoxyestradiol on the oxygen-sensing pathway in both hypoxic and normoxic keloid fibroblasts were evaluated. Our results suggest that 2-methoxyestradiol could be used to inhibit keloid fibroblast activity by inhibiting the oxygen-sensing pathway and its downstream effectors.</p>","PeriodicalId":14451,"journal":{"name":"International Wound Journal","volume":"22 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iwj.70373","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143908954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity, reliability and dimensionality of the Norwegian version of Wound-QoL","authors":"Monica Maria Schwartz,&nbsp;Tone Marte Ljosaa,&nbsp;Brita Solveig Pukstad,&nbsp;Britt Karin Utvær","doi":"10.1111/iwj.70051","DOIUrl":"https://doi.org/10.1111/iwj.70051","url":null,"abstract":"<p>The aim of the study was to explore the psychometric properties of the Norwegian version of the Wound-quality of life (QoL)-17. We included 204 patients with hard-to-heal wounds on the lower extremity. Patients filled out the Wound-QoL-17, SF-36 and Patients' Global Impression of Change at three time points over 14 weeks. Clinical and demographical data were collected at baseline. Wound severity was collected at baseline and 14 weeks follow-up (T2). Confirmatory factor analyses showed acceptable fit of the hypothesised three-factor model (i.e., body, psyche and everyday life) of the Wound-QoL as long as we accepted two correlated error terms within the Body factor (<i>χ</i>² = 203.14, <i>p</i> = 0.000, df = 99, <i>χ</i>²/df = 2.05, Root Mean Square Error of Approximation = 0.072, Standardised Root Mean Square Residual = 0.059, Comparative Fit Index = 0.943 and Tucker–Lewis Index = 0.930). Correlation showed moderate to strong associations between Wound-QoL and SF-36 (−0.400** to −0.777**), and significant associations between Wound-QoL and Patients' Global Impression of Change (0.199*), general wound pain intensity (0.435**), pain intensity at wound change (0.340**) and infection (0.174*). The intraclass correlations, ranging from 0.578** to 0.782**, suggested strong test–retest reliability. Cronbach's alphas for all subscales and the total score between 0.748 and 0.922, indicated good internal consistency. The Norwegian version of Wound-QoL demonstrates good reliability and construct validity and is suitable for evaluating QoL in patients with hard-to-heal wounds. However, some improvements were performed to achieve an acceptable fit.</p>","PeriodicalId":14451,"journal":{"name":"International Wound Journal","volume":"22 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iwj.70051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}