{"title":"Increased complications of proximal femur fractures during the COVID-19 pandemic: a nationwide medical claims database study in Japan.","authors":"Hidetatsu Tanaka, Kunio Tarasawa, Yu Mori, Kiyohide Fushimi, Kenji Fujimori, Toshimi Aizawa","doi":"10.1007/s00774-025-01611-0","DOIUrl":"10.1007/s00774-025-01611-0","url":null,"abstract":"<p><strong>Introduction: </strong>Coronavirus disease 2019 (COVID-19) is a worldwide pandemic, and mortality increases in elderly patients with comorbidities. This study aims to examine the in-hospital complications and mortality for elderly patients with proximal femur fractures during the COVID-19 pandemic or countermeasure periods.</p><p><strong>Materials and methods: </strong>The proximal femur fractures undergoing surgery during the COVID-19 pandemic or countermeasure period were compared with the pre-pandemic in a Japanese national inpatient data. The assessed outcomes were the development of pneumonia, deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality during hospitalization in two periods, and those for COVID-19-positive patients.</p><p><strong>Results: </strong>A total of 284,922 proximal femur fractures aged over 65 years were included. In the COVID-19 pandemic period compared to the pre-pandemic, the odds of pneumonia, DVT, PE, and mortality decreased to 0.942 (95% confidence interval [CI]: 0.901 - 0.986, P = 0.0102) and 0.839 (95% CI: 0.745 - 0.946, P = 0.004), increased to 1.153 (95% CI: 1.112 - 1.195, P < 0.001), and 1.048 (95% CI: 0.982 - 1.118, P = 0.1554), respectively. For COVID-19 positivity at admission, the odds of PE increased significantly to 12.95 (95% CI: 8.795 - 19.06, P < 0.001). For COVID-19 positivity during hospitalization, the odds of pneumonia and mortality were increased to 2.896 (95% CI: 1.820 - 4.608, P < 0.001) and 6.303 (95% CI: 3.440 - 11.55, P < 0.001), respectively.</p><p><strong>Conclusion: </strong>These findings alert healthcare professionals and patients to the elevated complications, especially PE rate for proximal femoral fracture with COVID-19 positive.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266310","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":"Masafumi Fukagawa, MD, PhD : November 8, 1958 to November 9, 2024.","authors":"Hirotaka Komaba","doi":"10.1007/s00774-025-01602-1","DOIUrl":"https://doi.org/10.1007/s00774-025-01602-1","url":null,"abstract":"","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982071","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":"A critique on associations between bone material strength index and FRAX scores.","authors":"Hafiz Abdul Mughees, Umama Muskan, Abdur Rehman","doi":"10.1007/s00774-025-01601-2","DOIUrl":"10.1007/s00774-025-01601-2","url":null,"abstract":"","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000741","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":"Prevalence of vertebral fractures at death.","authors":"Noriko Ogawa, Masahiro Yamamoto, Rie Kobayashi, Atsuko Kawamura, Akihiro Matsumoto, Hiroki Otani, Keizo Kanasaki","doi":"10.1007/s00774-025-01577-z","DOIUrl":"10.1007/s00774-025-01577-z","url":null,"abstract":"<p><strong>Introduction: </strong>Despite many studies on the prevalence of vertebral fractures (VFs), the VF prevalence at death in the Japanese population remains unclear.</p><p><strong>Materials and methods: </strong>We evaluated the VF prevalence at death in a Japanese cohort using autopsy imaging computed tomography (AiCT). We enrolled 365 cadavers (188 men, 177 women, mean age of 84.6 years) donated for anatomical dissection at Shimane University School of Medicine. The VFs were diagnosed using the semiquantitative technique of Genant from the first cervical vertebra to the fifth lumbar vertebra.</p><p><strong>Results: </strong>The overall VF prevalence was 69.6% (58.5%/81.4% in men/women), of which 46.0% (29.8%/63.3% in men/women) had thoracic VFs, and 58.1% (50.5%/66.1% in men/women) had lumbar VFs. The most frequent fracture site was lumbar spine 1 (L1) with 31.5% (22.9%/40.7% in men/women), followed by thoracic spine 12 (T12) with 31.0% (20.7%/41.8% in men/women). In terms of severity, 3.8% (4.8%/2.8% in men/women), 23.8% (27.1%/20.3% in men/women), and 41.9% (26.6%/58.2% in men/women) were Grades 1, 2, and 3. The VFs from T3 to L5 and of Grade 3 severity were significantly higher in women. VF and Grade 3 fractures were associated with a history of surgical intervention for femoral neck fractures. VFs were not associated with the following underlying causes of death: cancer, heart disease, senile death, cerebrovascular disease, pneumonia, and aspiration pneumonia.</p><p><strong>Conclusion: </strong>The VF prevalence at death, assessed by AiCT in cadavers donated for anatomical dissection, was higher in both men and women compared with previous studies conducted on individuals aged ≥ 80 years in Japan.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"249-255"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978487","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}
Pamela Rufus-Membere, Kara B Anderson, Kara L Holloway-Kew, Mark A Kotowicz, Adolfo Diez-Perez, Julie A Pasco
{"title":"Associations between bone material strength index and FRAX scores.","authors":"Pamela Rufus-Membere, Kara B Anderson, Kara L Holloway-Kew, Mark A Kotowicz, Adolfo Diez-Perez, Julie A Pasco","doi":"10.1007/s00774-024-01575-7","DOIUrl":"10.1007/s00774-024-01575-7","url":null,"abstract":"<p><strong>Introduction: </strong>Impact microindentation (IMI) measures bone material strength index (BMSi) in vivo. However, its ability to predict fractures is still uncertain. This study aimed to determine the association between BMSi and 10 year fracture probability, as calculated by the FRAX algorithm.</p><p><strong>Materials and methods: </strong>BMSi was measured using the OsteoProbe in 388 men (ages 40-90 yr) from the Geelong Osteoporosis Study. The probabilities for a major osteoporotic fracture (MOF) and hip fracture (HF) were calculated using the Australian FRAX tool. Hip (HF) and major osteoporotic (MOF) fracture probabilities were computed with and without the inclusion of femoral neck bone mineral density (BMD). For each participant, four 10 year probability scores were therefore generated: (i) HF-FRAXnoBMD; (ii) HF-FRAXBMD; (iii) MOF-FRAXnoBMD; (iv) MOF-FRAXBMD.</p><p><strong>Results: </strong>BMSi was negatively correlated with age (r = - 0.114, p = 0.025), no associations were detected between BMSi and femoral neck BMD (r = + 0.035, p = 0.507). BMSi was negatively correlated with HF-FRAXnoBMD (r = - 0.135, p = 0.008) and MOF-FRAXnoBMD (r = - 0.153, p = 0.003). These trends held true for HF-FRAXBMD (r = - 0.087, p = 0.094) and MOF-FRAXBMD (r = - 0.111, p = 0.034), but only the latter reached significance.</p><p><strong>Conclusion: </strong>BMSi captures the cumulative effect of clinical risk factors in the FRAX algorithm, suggesting that it could provide additional information that may be useful in predicting risk of fractures. Further studies are warranted to establish its efficacy in predicting fracture risk.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"230-236"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005916","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}
Shiyi Luo, Zefei Liu, Xuanyan Gu, Wei Li, Ruofeng Jiao, Jiangling Sun, Shu Ma, Haijian Zhu, Zhu Chen, Jukun Song
{"title":"Association between serum homocysteine concentration level and tooth loss: a cross-sectional study from NHANES 2003-2006.","authors":"Shiyi Luo, Zefei Liu, Xuanyan Gu, Wei Li, Ruofeng Jiao, Jiangling Sun, Shu Ma, Haijian Zhu, Zhu Chen, Jukun Song","doi":"10.1007/s00774-025-01588-w","DOIUrl":"10.1007/s00774-025-01588-w","url":null,"abstract":"<p><strong>Introduction: </strong>This cross-sectional study aimed to investigate the associations between serum homocysteine levels and missing teeth, as well as to explore the threshold effect of serum homocysteine levels on the number of missing teeth.</p><p><strong>Materials and methods: </strong>This study involved 4746 participants (aged ≥ 40 years) from NHANES data 2003-2006. Negative binomial regression was used to assess the association between serum homocysteine levels and tooth loss. Non-linear and dose-response relationships were analyzed using smooth curve fitting and threshold effect analysis. In addition, we supplemented the relationship between serum homocysteine levels and tooth loss and conducted subgroup analysis to determine the impact of covariates on the relationship between serum homocysteine levels and tooth loss.</p><p><strong>Results: </strong>In a fully adjusted negative binomial regression model, higher levels of serum Hcy concentration in the Q2-Q4(Q2: IRR = 1.46, 95%CI (1.67,1.79)); Q3: IRR = 1.42, 95%CI (1.36,1.48); Q4: IRR = 1.47,95%CI (1.01,1.78)) groups increased the likelihood of tooth loss compared with quartile Q1 (low level of serum homocysteine). Threshold effect analysis revealed that the log2-transformed Hcy infection point was at 2.95 μmol/L.</p><p><strong>Conclusion: </strong>The likelihood of tooth loss increased by 47% for each unit increase in serum homocysteine level. There was a non-linear positive correlation between serum homocysteine and tooth loss, with a threshold effect of approximately log2(Hcy) = 2.95 μmol/L. This link emphasizes the importance of maintaining appropriate homocysteine levels to prevent oral health problems.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"293-303"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449102","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":"Misaligned cardiovascular safety warnings for romosozumab in Japan.","authors":"Hiroshi Kawaguchi","doi":"10.1007/s00774-025-01593-z","DOIUrl":"10.1007/s00774-025-01593-z","url":null,"abstract":"","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"315-316"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492080","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":"Thoracolumbar kyphosis prognoses poor results after proximal femoral fracture: a 3-year multicenter prospective cohort study.","authors":"Yutaro Sugawara, Hotaka Ishizu, Kosuke Arita, Tetsuro Oue, Komei Sato, Renya Takahashi, Kenichi Kusunoki, Shun Shimodan, Tsuyoshi Asano, Norimasa Iwasaki, Tomohiro Shimizu","doi":"10.1007/s00774-024-01576-6","DOIUrl":"10.1007/s00774-024-01576-6","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal femoral fractures are critically associated with increased risk of mortality and secondary fractures. Identifying prognosis predictors related to sagittal imbalance that are known to have negative impact on fracture risk and mortality is crucial. This study aimed to explore the relationship between various sagittal imbalance parameters and the prognosis of proximal femoral fractures to identify the most important prognostic indicators.</p><p><strong>Materials and methods: </strong>This multi-center prospective cohort study included patients with proximal femoral fractures treated surgically from April 2020 to March 2021. Spinal standing radiographs were obtained to measure various sagittal spine parameters. Postoperative follow-ups were conducted at 6, 12, 18, 24, and 36 months to assess mortality and secondary fracture rates and examine the predictors and their effects.</p><p><strong>Results: </strong>Among the 137 patients who underwent spinal standing radiographs, 22 died and 23 developed secondary fractures. Multivariate analyses identified the number of previous vertebral fractures and thoracolumbar kyphosis (TLK) as significant risk factors for mortality and secondary fractures. Survival analysis revealed that patients with TLK < 20° had significantly higher survival rates than those with TLK ≥ 20° (P = 0.002 and P < 0.001 for mortality and secondary fractures, respectively). In addition, serum albumin was associated with mortality, and the intake of sleeping pills and antidepressants was associated with secondary fractures.</p><p><strong>Conclusion: </strong>TLK after surgery and the number of previous vertebral fractures affected both mortality and secondary fractures. When each risk factor, such as low serum albumin levels, intake of sleeping pills and antidepressants, was also considered, it was found that comprehensive postoperative care is essential.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"237-248"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949377","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":"Impact of mechanotransduction on gene expression changes in periodontal ligament during orthodontic tooth movement.","authors":"Suzu Chida, Tomoki Chiba, Yutaro Uchida, Takahide Matsushima, Ryota Kurimoto, Takayuki Miyazaki, Lisa Yagasaki, Satoshi Nakamura, Emiko Mihara, Junichi Takagi, Keiji Moriyama, Hiroshi Asahara","doi":"10.1007/s00774-025-01581-3","DOIUrl":"10.1007/s00774-025-01581-3","url":null,"abstract":"<p><strong>Introduction: </strong>The periodontal ligament (PDL) is a structure between the alveolar bone and cementum, essential for tooth stability and composed of diverse cell types. Mohawk homeobox (Mkx) is a master transcription factor that regulates tendon and ligament homeostasis. However, the specific cell populations expressing Mkx and its role in mechanotransduction during orthodontic tooth movement (OTM) remain unclear.</p><p><strong>Materials and methods: </strong>We conducted single-cell RNA sequencing on wild-type rat PDL at 0 day, 1 week, and 2 weeks of post-OTM using coil springs to elucidate Mkx's function and the changes in cell populations under continuous mechanical stimulation. In addition, RT-qPCR was performed to assess the relationship between tenogenic gene expression and Mkx expression in human PDL cells.</p><p><strong>Results: </strong>The rat PDL was identified to consist of 14 clusters, with Mkx and Scleraxis (Scx) expressed in distinct cell populations. Collagen and ECM production increased throughout the OTM period, while the sterile inflammatory response was initially heightened and later diminished, indicating that bone remodeling occurs later in the inflammatory response. Overexpression of MKX in human PDL cells enhanced COL1A1 and DECORIN expression.</p><p><strong>Conclusion: </strong>Mechanical stimulation of the PDL appears to trigger an aseptic inflammatory response that disrupts PDL homeostasis and promotes bone remodeling. Mkx may exert a protective effect on the PDL during mechanical stimulation.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"216-229"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073203","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}
Dalal S Ali, Aliya A Khan, Reza D Mirza, Natasha M Appelman-Dijkstra, Maria Luisa Brandi, Thomas O Carpenter, Catherine Chaussain, Erik A Imel, Suzanne M Jan de Beur, Pablo Florenzano, Archibald Morrison, Hajar Abu Alrob, R Todd Alexander, Farah Alsarraf, Signe Sparre Beck-Nielsen, Martin Biosse-Duplan, Martine Cohen-Solal, Rachel K Crowley, Karel Dandurand, Guido Filler, Seiji Fukumoto, Claudia Gagnon, Paul Goodyer, Corinna Grasemann, Chelsey Grimbly, Salma Hussein, Muhammad K Javaid, Sarah Khan, Aneal Khan, Anna Lehman, Willem F Lems, E Michael Lewiecki, Ciara McDonnell, Emmett Morgante, Anthony A Portale, Yumie Rhee, Heide Siggelkow, Laura Tosi, Leanne M Ward, Gordon Guyatt
{"title":"Methodology for the international working group clinical practice guidelines on X-linked hypophosphatemia in children and adults.","authors":"Dalal S Ali, Aliya A Khan, Reza D Mirza, Natasha M Appelman-Dijkstra, Maria Luisa Brandi, Thomas O Carpenter, Catherine Chaussain, Erik A Imel, Suzanne M Jan de Beur, Pablo Florenzano, Archibald Morrison, Hajar Abu Alrob, R Todd Alexander, Farah Alsarraf, Signe Sparre Beck-Nielsen, Martin Biosse-Duplan, Martine Cohen-Solal, Rachel K Crowley, Karel Dandurand, Guido Filler, Seiji Fukumoto, Claudia Gagnon, Paul Goodyer, Corinna Grasemann, Chelsey Grimbly, Salma Hussein, Muhammad K Javaid, Sarah Khan, Aneal Khan, Anna Lehman, Willem F Lems, E Michael Lewiecki, Ciara McDonnell, Emmett Morgante, Anthony A Portale, Yumie Rhee, Heide Siggelkow, Laura Tosi, Leanne M Ward, Gordon Guyatt","doi":"10.1007/s00774-025-01585-z","DOIUrl":"10.1007/s00774-025-01585-z","url":null,"abstract":"<p><p>The guideline panel, comprising international experts in X-linked hypophosphatemia (XLH), patient partners from the XLH patient population, and guideline methodologists, held 18 teleconferences between January 2023 and July 2024 to develop comprehensive guidelines for the diagnosis and management of XLH in children and adults. For a subset of our questions, we utilized the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology, assessed the certainty of evidence and formulated GRADEd recommendations. For these questions, the panelists and methodologists collaboratively framed PICO (Population, Intervention, Control, and Outcomes) questions and conducted four systematic reviews assessing the impact of medical therapy-using either burosumab or phosphate and active vitamin D-on patient-important outcomes in the XLH population as well as the impact of medical intervention compared to no treatment. We assessed the risk of bias and transparently generated summary of findings tables using MAGICApp. The panel developed three GRADEd treatment recommendations for adults and two for children. Each GRADEd recommendation was linked to an underlying body of evidence, reflecting judgments on the certainty of evidence, recommendation strength, values, preferences, and considerations of costs, feasibility, acceptability, and equity. Due to the paucity of evidence, the panel developed very low-quality GRADEd recommendations on monitoring patients with XLH based on an expert clinical practice survey. Using a rigorous narrative literature review, the panel developed non-GRADEd recommendations including guidance for pregnant women, patients with dental complications, and other areas where evidence is limited. This article summarizes the methodology utilized for the development of both GRADEd and non-GRADEd recommendations for patients with XLH.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"193-202"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676966","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}