Journal of Brachial Plexus and Peripheral Nerve Injury最新文献

{"title":"The Surgical Strategy to Correct the Rotational Imbalance of the Glenohumeral Joint after Brachial Plexus Birth Injury","authors":"J. Bahm","doi":"10.1055/s-0036-1579763","DOIUrl":"https://doi.org/10.1055/s-0036-1579763","url":null,"abstract":"Abstract In upper brachial plexus birth injury, rotational balance of the glenohumeral joint is frequently affected and contracture in medial rotation of the arm develops, due to a severe palsy or insufficient recovery of the lateral rotators. Some of these children present with a severe glenohumeral joint contracture in the first months, although regular physiotherapy has been provided, a condition associated with a posteriorly subdislocated or dislocated humeral head. These conditions should be screened early by a pediatrician or specialized physiotherapist. Both aspects of muscular weakness affecting the lateral rotators and the initial or progressive glenohumeral deformity and/or subdislocation must be identified and treated accordingly, focusing on the reestablishment of joint congruence and strengthening of the lateral rotators to improve rotational balance, thus working against joint dysplasia and loss of motor function of the shoulder in a growing child. Our treatment strategy adapted over the last 20 years to results from retrospective studies, including biomechanical aspects on muscular imbalance and tendon transfers. With this review, we confront our actual concept to recent literature.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1579763","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58132380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal of Brachial Plexus and Peripheral Nerve Injury","authors":"Jörg Bahm","doi":"10.1055/s-0035-1570130","DOIUrl":"https://doi.org/10.1055/s-0035-1570130","url":null,"abstract":"I am grateful to Rolfe Birch who gave me the opportunity to participate as a board member in a journal dedicated to brachial plexus surgery, as this field concerns my daily clinical and scientific activities over the last ten years. Six months ago, I discovered the online Journal of Brachial Plexus and Peripheral Nerve Injury and was pleased by the idea of such a specific journal, providing open access and facilitating reaching colleagues all over the world, where our traditional and respected journals might not go. I also appreciate the technical opportunity, feasible within this journal, of publishing video documentation, as our operative results might be actually better expressed through this medium. I have to congratulate Dr Nath for his excellent initiative. I propose my input for this journal:-I expect that the journal will fulfill criteria of a scientifically honest, balanced and innovative platform for all interested colleagues;-I believe that an online journal with free access in all countries has large possibilities to share data, high quality photos and videos with critical readers-My goal is to join the Journal and uphold international scientific standards and basic rules when sharing high level medical and scientific expertise. I would like to encourage all colleagues to participate in the discussion by sharing their experience, comments, criticisms, starting with questions, observations, empiric conclusions and scientific contributions. The JBP&PNI started as an initiative to be an open-minded platform for an exchange of ideas and techniques in this particular field of clinics and surgery, brachial plexus pathology and related issues in severe peripheral nerve injuries. Colleagues from all countries who are involved in these treatment plans should feel free to communicate their experience and analysis of the existing literature. Senior colleagues should share their comments about trials and pitfalls, for the benefit of our continued education and thus better serve patients hit by severe nerve injuries, either children or adults. During the past 10 years, I have become aware of how many controversies might exist even between international colleagues sharing one particular medical problem, and this is for many reasons. I believe, however, that we should overcome these differences just by focusing on common, noble targets of scientific education, giving our very best, and respecting established rules that good medical practice has taught us. which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0035-1570130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58121403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Florid Suprascapular Neuropathy after Primary Rotator Cuff Repair Attributed to Suprascapular Notch Constriction in the Setting of Double Crush Syndrome","authors":"J. Skedros, C. Kiser, Bryce B Hill","doi":"10.1055/s-0035-1567807","DOIUrl":"https://doi.org/10.1055/s-0035-1567807","url":null,"abstract":"Abstract This report describes a patient who had an open repair of a small supraspinatus tendon tear performed 6 months after an arthroscopic acromioplasty with debridement had failed to provide pain relief. Three months prior to the tendon repair, he had a two-level cervical spine discectomy and fusion (C4–5, C5–6) that improved his neck pain. Florid suprascapular neuropathy was detected 10 weeks after the open rotator cuff repair. Evidence of some nerve recovery resulted in a long period of observation. But unsatisfactory improvement warranted decompression of the suprascapular notch, which was found to be very stenotic. At surgery, there was no evidence of neuroma, cyst, or other compressing lesion or tissue. Therefore, it was ultimately hypothesized that there was an exacerbation of a preexisting, but clinically unrecognized, entrapment of the suprascapular nerve in the suprascapular notch in the setting of cervical radiculopathy (primarily C5). Retrospectively it was also concluded that had this compressive etiology been recognized, it would have favored prompt decompression rather than the long observation period. Three years was required to achieve a good result following suprascapular notch decompression. The underlying C5 radiculopathy may have created a “double crush syndrome” that contributed to the propensity for injury and the prolonged recovery. There should be heightened awareness of this problem in patients who do not have satisfactory improvement in shoulder pain from previous shoulder and neck surgery.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2015-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0035-1567807","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58114385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scapular Winging Secondary to Apparent Long Thoracic Nerve Palsy in a Young Female Swimmer.","authors":"Shiro Nawa","doi":"10.1055/s-0035-1567806","DOIUrl":"10.1055/s-0035-1567806","url":null,"abstract":"<p><strong>Background: </strong> In neurological diseases, winging of the scapula occurs because of serratus anterior muscle dysfunction due to long thoracic nerve palsy, or trapezius muscle dysfunction due to accessory nerve palsy. Several sports can cause long thoracic nerve palsy, including archery and tennis. To our knowledge, this is the first report of long thoracic nerve palsy in an aquatic sport.</p><p><strong>Objective: </strong> The present study is a rare case of winging of the scapula that occurred during synchronized swimming practice.</p><p><strong>Methods: </strong> The patient's history with the present illness, examination findings, rehabilitation progress, and related medical literature are presented.</p><p><strong>Results: </strong> A 14-year-old female synchronized swimmer had chief complaints of muscle weakness, pain, and paresthesia in the right scapula. Upon examination, marked winging of the scapula appeared during anterior arm elevation, as did floating of the superior angle. After 1 year of therapy, right shoulder girdle pain and paresthesia had disappeared; however, winging of the scapula remained.</p><p><strong>Conclusions: </strong> Based on this observation and the severe pain in the vicinity of the second dorsal rib, we believe the cause was damage to the nerve proximal to the branch arising from the upper nerve trunk that innervates the serratus anterior.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2015-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0035-1567806","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58114372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Combined Injuries of the Axillary and Suprascapular Nerves with Scapulothoracic Dissociation","authors":"K. Sano, S. Ozeki","doi":"10.1055/s-0035-1566740","DOIUrl":"https://doi.org/10.1055/s-0035-1566740","url":null,"abstract":"Abstract A 20-year-old man suffered the combined axillary and suprascapular nerve palsies associated with scapulothoracic dissociation by motorcycle accident. The dislocated shoulder girdle was reduced and stabilized with osteosynthesis of the fractured clavicle and reattachment of the trapezius avulsed from the scapular spine for removal of continuous traction force to these damaged nerves. Because of no evidence of recovery on manual muscle test and electromyogram, exploration for these nerves was administered 6 weeks after injury. Although neurolysis of both nerves revealed neural continuity, excessive tension still existed on the suprascapular nerve. It was thought that previous operation in which the shoulder girdle had been reduced and stabilized as much as possible could not achieve complete anatomical reduction of the scapula. As an additional treatment, medial walls of the suprascapular and spinoglenoid notches were shaven to relax the suprascapular nerve. After a year, complete recovery of both the axillary and suprascapular nerve was identified. Although scapulothoracic dissociation is commonly recognized as massive injury of the shoulder girdle with poor prognosis because of existence of accompanied severe neurovascular injuries, there are more than a few cases in which partial damage on the infraclavicular brachial plexus is only accompanied. In case of them, there is the possibility of lesions in continuity of the nerves in which good prognosis might be expected with surgical intervention including early reduction of the shoulder girdle for removal of excessive tension to the damaged nerve.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2015-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0035-1566740","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58112349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of Upper Extremity Nerve Transfer in Cervical Spinal Cord Injury.","authors":"Sarah A Cain, Andreas Gohritz, Jan Fridén, Natasha van Zyl","doi":"10.1055/s-0035-1558427","DOIUrl":"10.1055/s-0035-1558427","url":null,"abstract":"<p><strong>Objective: </strong> Several nerve transfers have now been successfully performed for upper limb reanimation in tetraplegia. This study was performed to review the use of nerve transfers for upper limb reanimation in tetraplegia.</p><p><strong>Methods: </strong> Medline and Embase (1950 to February 11, 2015) were searched using a search strategy designed to include any studies that reported cases of nerve transfer in persons with cervical spinal cord injury (SCI).</p><p><strong>Results: </strong> A total of 103 manuscripts were selected initially and full-text analysis produced 13 studies with extractable data. Of these manuscripts, 10 reported single cases and 3 reported case series. Eighty-nine nerve transfers have been performed in 57 males and 2 females with a mean age of 34 years. The mean SCI level was C6 (range: C5-7), time to surgery post-SCI was 19.9 months (range: 4.1-156 months), and follow-up time was 18.2 months (range: 3-60 months). All case reports recorded a Medical Research Council (MRC) score of 3 or 4 for recipient muscle power, but two early case series reported more variable results.</p><p><strong>Conclusion: </strong> This review documents the current status of nerve transfer surgery for upper limb reanimation in tetraplegia and summarizes the functional results in 59 cases with 89 nerve transfers performed, including 15 cases of double-nerve transfer and 1 case of triple-nerve transfer.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2015-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5023083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58087019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Degree of Contracture Related to Residual Muscle Shoulder Strength in Children with Obstetric Brachial Plexus Lesions","authors":"Valerie M van Gelein Vitringa, A. van Noort, M. Ritt, B. V. van Royen, J. A. van der Sluijs","doi":"10.1055/s-0035-1558425","DOIUrl":"https://doi.org/10.1055/s-0035-1558425","url":null,"abstract":"Abstract Background and Objectives Little is known about the relation between residual muscle strength and joint contracture formation in neuromuscular disorders. This study aimed to investigate the relation between residual muscle strength and shoulder joint contractures in children with sequelae of obstetric brachial plexus lesion (OBPL). In OBPL a shoulder joint contracture is a frequent finding. We hypothesize that residual internal and external rotator strength and their balance are related to the extent of shoulder joint contracture. Methods Clinical assessment was performed in 34 children (mean 10.0 years) with unilateral OBPL and Narakas classes I–III. External and internal rotation strengths were measured with the shoulder in neutral position using a handheld dynamometer. Strength on the affected side was given as percentage of the normal side. Contracture was assessed by passive internal and external rotations in degrees (in 0° abduction). Mallet classification was used for active shoulder function. Results External and internal rotation strengths on the affected side were approximately 50% of the normal side and on average both equally affected: 56% (SD 18%) respectively 51% (SD 27%); r = 0.600, p = 0.000. Residual strengths were not related to passive internal or external rotation (p > 0.200). Internal rotation strength (r =  − 0.425, p <0.05) was related to Narakas class. Mallet score was related to external and internal rotation strengths (r = 0.451 and r = 0.515, respectively; p < 0.01). Conclusion The intuitive notion that imbalances in residual muscle strength influence contracture formation cannot be confirmed in this study. Our results are of interest for the understanding of contracture formation in OBPL.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2015-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0035-1558425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58087432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Idiopathic Brachial Neuritis in a Sport Medicine Physician","authors":"J. Wade, T. Taylor","doi":"10.1055/s-0035-1558424","DOIUrl":"https://doi.org/10.1055/s-0035-1558424","url":null,"abstract":"Abstract Idiopathic brachial neuritis is a distinctive condition that occurs most often in healthy individuals. It characteristically starts with an acute unilateral shoulder pain followed by a complex of symptoms, including weakness, paresthesias, and numbness. The cause of this syndrome is unknown and difficult to diagnose in the initial phase but may occur postsurgery, postinfection, posttrauma, or postvaccination. In this case, the patient's inciting event appeared to be a cesarean section. There was no trauma to the shoulder or upper extremity by way of positioning during the procedure. Several months after denervation of the supraspinatus and infraspinatus muscles, electromyography revealed some improvement. The diagnosis was made through a combination of clinical evaluation, ultrasound, magnetic resonance imaging, and electromyography. With the exception of weakness, this patient experienced few symptoms. Treatment is symptomatic including anti-inflammatories, opiates, and neuroleptics for pain. There is some evidence that immunotherapy may help decrease the length of symptoms, but there is no strong evidence to support steroid use. Physical therapy, the foundation of therapy in this case, is a useful adjunct for rehabilitation. In general, this condition has a good prognosis for recovery, although often slow, even when there is complete denervation. This patient made a full recovery and has no lingering symptoms.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2015-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0035-1558424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58087366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote Paraparesis due to a Traumatic Extradural Arachnoid Cyst Developing 2 Years after Brachial Plexus Root Avulsion Injury: Case Report and Review of the Literature","authors":"A. Rahimizadeh, S. Ehteshami, Touraj Yazdi, Shagayegh Rahimizadeh","doi":"10.1055/s-0035-1558426","DOIUrl":"https://doi.org/10.1055/s-0035-1558426","url":null,"abstract":"Abstract Traumatic extradural arachnoid cyst is a rare entity. However, late appearance of paraparesis due to formation of an extradural arachnoid cyst as a sequel of brachial plexus injury is extremely rare and the literature regarding this issue is scarce revealing only 11 cases. Herein, we report a patient with delayed progressive spastic paraparesis appearing after a multilevel brachial plexus root avulsion injury where imaging revealed formation of a large traumatic extradural arachnoid cyst at the cervicothoracic region. Furthermore, to propose that a high-energy trauma might simultaneously result in delayed formation of an extradural arachnoid cyst. However, preganglionic root avulsion injury with pseudomeningocele formation in association with extradural arachnoid cyst is not reported previously. A case of a 36-year-old man with spastic paraparesis developing 2 years after a multilevel brachial plexus root avulsion injury is presented. Root avulsion had immediately resulted in complete paralysis of the left upper limb that had not ameliorated. Imaging studies of the cervicothoracic region disclosed left-sided multilevel pseudomeningoceles and a large extradural arachnoid cyst extending from C5 to T2. After appropriate en bloc laminotomy, the cyst was excised and the causative dural tear was closed. Subsequently, three large defects of pseudomeningoceles were obliterated with artificial dural patch for the prevention of cord herniation. This was followed with laminoplasty of the corresponding levels after dural closure. The postoperative course was uneventful and paraparesis recovered steadily within 2 months. Paraparesis even years after brachial plexus injury should be regarded as a serious event that deserves extensive imaging survey for the possibility of the formation of an extradural arachnoid cyst. Careful review of the literature disclosed that the current case is the 12th case that an extradural arachnoid cyst has developed after brachial plexus injury and the first example that the pathogenic factor that might be implicated in occurrence of this rare association could be clarified with review of the MRI features. Actually, the presence of posttraumatic pseudomeningoceles in association with an arachnoid cyst in the current case is in favor of the belief that only preganglionic root injuries that are in close proximity to the spinal canal had been the cause dural tear with remote formation of extradural arachnoid cyst.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2015-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0035-1558426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58087448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Essentials of Spinal Disorders","authors":"J. Bahm","doi":"10.1055/S-0035-1551653","DOIUrl":"https://doi.org/10.1055/S-0035-1551653","url":null,"abstract":"Medicine and Surgery are split into a continuously increasing number of subspecialties; one single specialist hardly can follow. Spinal disorders and related surgery are a rather new field, interesting neurologists, radiologists, orthopaedic surgeons, and neurosurgeons. Beside huge multiauthored textbooks, there is a place for concise, well-documented textbooks where the interested colleague could find sound basic knowledge, essential information about major pathologies, and their treatment, in a compact textbook with an equilibrium between a well-organized text and enough informative figures. The new “Essentials of Spinal Disorders” issued in early 2014 responds to this challenge and brings up well-written chapters about spine pathology—traumatic, degenerative, inflammatory, or tumoral. The reader is first addressed with anatomy, imaging, and biomechanics of the spine, and then finds essential science about the major pathologies. Both authors are dedicated orthopaedic spine surgeons from the University of Massachusetts (Worcester, Massachusetts, United States) and did a very good job by bringing their knowledge into this book with a good general structure, wellreferenced chapters, and attracting figures. Of course, this book is not an encyclopedia, but it may be easily opened by all interested conservative and operative colleagues—and why not by related health professionals (physiotherapists) as they could rapidly find pertinent information about a particular pathology, an operative technique including well-descriptive figures, or basic knowledge once you get more interested in the spine. Dr. Eck and DiPaola wanted us to become curious about the spine, and they succeeded in having us engrossed into a chapter once we started to skim through it. Any confirmed spine specialist certainly will need to extend his knowledge with further reading, but all those looking for precise and short basic knowledge will be very satisfied.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2015-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0035-1551653","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58057461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}