Journal of Clinical Ultrasound最新文献

{"title":"Prevalence of Chronic Liver Disease Based on Ultrasound Shear Wave Elastography in an Adult Asian Indian Population Attending Outpatient Preventive Radiology Clinics in India","authors":"Rijo M. Choorakuttil,&nbsp;Rajas N. Chaubal,&nbsp;Thara Pratap,&nbsp;Venkatesh K. Arunachalam,&nbsp;S. Harish Kumar,&nbsp;Neha Bagri,&nbsp;Anjali Gupta,&nbsp;Amarnath Chelladurai,&nbsp;Praveen K. Nirmalan","doi":"10.1002/jcu.23888","DOIUrl":"10.1002/jcu.23888","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To determine the ultrasound shear wave elastography (SWE)-based prevalence of chronic liver disease in an adult Asian Indian population attending preventive radiology outpatient clinics in India.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Liver stiffness measures (LSMs) were ascertained using ultrasound SWE and interquartile range/median (IQR/M) ratio ≤ 30% kilopascal (kPa) units were considered a good quality measurement. Details of modifiable risk factors including comorbidity and personal risk behaviors were collected. The liver was graded based on the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement and Grades 4 and 5 indicated compensated advanced chronic liver disease (cACLD) and clinically significant portal hypertension (CSPH). A multivariate logistic regression model was used to analyze associations with chronic advanced liver disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median LSM in the study participants (<i>n</i> = 1145) was 8.0 (IQR 6.5, 9.85) kPa units. 10.65% of the study population had advanced chronic liver disease (cACLD and CSPH) and 22.79% had LSM that was suggestive of cACLD. cACLD and CSPH were significantly associated with comorbidities, personal risk behaviors, and lean and obese body mass indices. Modifiable risk factors were present in 20%–50% of participants with LSM between 7 and 13 kPa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Information on the prevalence of LSM-based cACLD and CSPH and modifiable risk factors in persons with LSM between 7 and 13 kPa will help to design preventative strategies using LSM as an objective imaging biomarker.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15386,"journal":{"name":"Journal of Clinical Ultrasound","volume":"53 3","pages":"459-468"},"PeriodicalIF":1.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604698","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":"Ultrasonic Image Characteristics of Palatine Tonsils in Healthy Children and Analysis of Factors Influencing Image Quality","authors":"Ying Cao,&nbsp;Lei Sun,&nbsp;XiaoPeng Li,&nbsp;Qi Zhang,&nbsp;Yue Gao,&nbsp;Hua Wang","doi":"10.1002/jcu.23882","DOIUrl":"10.1002/jcu.23882","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the ultrasonic image characteristics of palatine tonsils in healthy children and the factors affecting image quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 750 images of palatine tonsils were collected from 375 healthy children. According to ultrasonic image quality, the images were divided into three groups. Both systemic and local factors were analyzed among the different groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The palatine tonsils showed quasi-circular or flat oval, low echo or light and dark band arrangement, a striped medium echo, and a clear boundary. Age, height, weight, body mass index, body surface area, distance from the skin to the posterior margin of the tonsils, thickness of the anterior soft tissue of the tonsils, and thickness of the anterior submandibular gland of the tonsils were significantly different among the different image quality groups (<i>p</i> &lt; 0.05). Multivariate logistic regression analyses revealed that height, weight, thickness of the anterior soft tissue of the tonsils, and thickness of the anterior submandibular gland of the tonsils were independent factors affecting the quality of the ultrasonic images of the palatine tonsils.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There are characteristic ultrasonic image manifestations of the palatine tonsils. Tonsil ultrasound image quality is affected by individual and local factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15386,"journal":{"name":"Journal of Clinical Ultrasound","volume":"53 3","pages":"436-444"},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcu.23882","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case With Gallbladder Villous Tubular Adenoma With High-Grade Intraepithelial Neoplasia Combined With Rectal Villous Tubular Adenocarcinoma","authors":"Muhammad Asad Iqbal,&nbsp;Hui Zhou,&nbsp;Ziou Zhao,&nbsp;Nida Fatima Moazzam,&nbsp;Jie Hou,&nbsp;Hui Sun,&nbsp;Xian Wang","doi":"10.1002/jcu.23890","DOIUrl":"10.1002/jcu.23890","url":null,"abstract":"<div>\u0000 \u0000 <p>We present the rare case of a 79-year-old female patient with the coexistence of gallbladder villous tubular adenoma and rectal villous tubular adenocarcinoma. She initially presented with blood in the stool, prompting a diagnosis of rectal cancer. Further examination revealed findings suggestive of a gallbladder pathology. Subsequent imaging and histopathological analyses confirmed the presence of a gallbladder villous tubular adenoma, high-grade intraepithelial neoplasia, and rectal villous tubular adenocarcinoma. Surgical interventions included laparoscopic radical resection of the rectal cancer and cholecystectomy. Immunohistochemical examination differentiated between the two distinct adenomatous conditions. This case underscores the importance of thorough evaluation and multidisciplinary approaches for accurate diagnosis and management of complex presentations of gastrointestinal neoplasms.</p>\u0000 </div>","PeriodicalId":15386,"journal":{"name":"Journal of Clinical Ultrasound","volume":"53 3","pages":"572-576"},"PeriodicalIF":1.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576164","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":"Study of Risk Factors and Image Findings of Isolated Abdominal Incidentally Detected Aortic Dissection","authors":"Hiromasa Tsubouchi,&nbsp;Hidenori Onishi,&nbsp;Koji Maeno,&nbsp;Masaya Nakagaichi,&nbsp;Ikue Tsukushi,&nbsp;Youichi Kitano,&nbsp;Yoshitaka Makino,&nbsp;Hiroyuki Hayashi,&nbsp;Hidekazu Terasawa,&nbsp;Hiroko Kabuto,&nbsp;Toshihiro Misawa,&nbsp;Taku Sanada,&nbsp;Azusa Hisada,&nbsp;Kazuo Notsumata,&nbsp;Kazuhiro Okafuji,&nbsp;Osamu Yamamura","doi":"10.1002/jcu.23889","DOIUrl":"10.1002/jcu.23889","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Isolated abdominal aortic dissection (IAAD) has been reported to account for 1.1%–4.1% of all aortic dissections. If detected late, it is associated with a risk of aortic rupture. We investigated the risk factors and characteristic imaging findings of incidentally discovered IAAD using abdominal ultrasonography (AUS) during health check-up and hereby report our findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study sample included 41 patients with abdominal aortic abnormalities identified by AUS performed during a health check-up at our hospital and who were diagnosed with IAAD by contrast-enhanced computed tomography (CT); in addition, 205 patients were included in the nonevent group. Furthermore, risk factors and characteristic imaging findings of IAAD were examined retrospectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with the nonevent group, smoking and fatty liver were observed significantly more frequently in the IAAD group. Ultrasound findings indicated an intimal flap in 35 cases (85.4%), whereas CT scan revealed displacement of intimal calcifications in 32 cases (78.0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Compared with the nonevent group, there were significantly more cases of fatty liver and smoking habits in the IAAD group. In older patients with risk factors for fatty liver and smoking habits, if IAAD is suspected, it is important to monitor the abdominal aorta using ultrasonography during health check-ups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15386,"journal":{"name":"Journal of Clinical Ultrasound","volume":"53 3","pages":"429-435"},"PeriodicalIF":1.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcu.23889","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ludenbach Syndrome: The Feasibility of Prenatal Ultrasound Diagnosis","authors":"Tian-gang Li,&nbsp;Hai-bo Cao,&nbsp;Bin Ma,&nbsp;Bo-xi Li,&nbsp;Li-guo Yao","doi":"10.1002/jcu.23887","DOIUrl":"10.1002/jcu.23887","url":null,"abstract":"<div>\u0000 \u0000 <p>Lutembacher syndrome has been reported primarily in children and adults, but no prenatal cases have been reported. Our results indicated that lutembacher syndrome could be diagnosed by using prenatal ultrasound diagnosis. Accurate prenatal diagnosis of lutembacher syndrome is beneficial to neonatal prognosis and treatment options; it is very necessary to make a clear diagnosis in utero.</p>\u0000 </div>","PeriodicalId":15386,"journal":{"name":"Journal of Clinical Ultrasound","volume":"53 3","pages":"568-571"},"PeriodicalIF":1.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557962","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":"Abdominal POCUS Education for Clinicians: A Systematic Review of Teaching Methods for Point-of-Care Abdominal Ultrasonography","authors":"Birkir Örn Sveinsson,&nbsp;Olof Kristin Thorsteinsdottir,&nbsp;Alexander G. P. Browne,&nbsp;Benjamin S. B. Rasmussen,&nbsp;Anders Bo Nielsen,&nbsp;Pia Iben Pietersen","doi":"10.1002/jcu.23876","DOIUrl":"10.1002/jcu.23876","url":null,"abstract":"<p>This systematic review examines educational strategies in clinician-performed abdominal point-of-care ultrasound (POCUS), a critical skill with increasing relevance in medical care. Analyzing 28 studies, we highlight the strategies as well as advantages and disadvantages of various theoretical and practical components, including, for example, e-learning and simulation in training programs. The findings emphasize the necessity of blending various educational methods to enhance effectiveness and adaptability in training environments. Ultimately, robust training frameworks are essential to maximize diagnostic accuracy and improve patient outcomes in abdominal POCUS.</p>","PeriodicalId":15386,"journal":{"name":"Journal of Clinical Ultrasound","volume":"53 3","pages":"547-561"},"PeriodicalIF":1.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcu.23876","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antenatal Detection of a True Umbilical Cord Knot: Facilitating Optimal Delivery Management","authors":"Shin Hashiramoto,&nbsp;Hiroko Takita,&nbsp;Tatsuya Arakaki,&nbsp;Yuka Yamashita,&nbsp;Mayumi Kaneko,&nbsp;Ryu Matsuoka,&nbsp;Akihiko Sekizawa","doi":"10.1002/jcu.23873","DOIUrl":"10.1002/jcu.23873","url":null,"abstract":"<p>Prenatal diagnosis of a true umbilical cord knot is challenging. However, prenatal diagnosis is clinically valuable because it allows preparation for fetal distress during labor. Here, we report a case of prenatal diagnosis of true umbilical cord knot, with a favorable delivery management.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":15386,"journal":{"name":"Journal of Clinical Ultrasound","volume":"53 3","pages":"586-588"},"PeriodicalIF":1.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522043","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":"Visual Patterns of Diaphragmatic Motion in Acute Respiratory Failure: A Prospective Pilot Study","authors":"Thibaut Markarian,&nbsp;Matthieu Daniel,&nbsp;Kevin Guillemet,&nbsp;Florian Ajavon,&nbsp;Florent Femy,&nbsp;Romain Genre Grandpierre,&nbsp;Anne-Laure Feral-Pierssens,&nbsp;Xavier Bobbia","doi":"10.1002/jcu.23886","DOIUrl":"10.1002/jcu.23886","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Right diaphragmatic excursion is a reliable and reproducible technique used in intensive care to assess diaphragmatic function. The aim of this study was to investigate the relationship between the appearance of diaphragmatic motion and the etiological diagnosis of patients admitted to the emergency department with acute respiratory failure (ARF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials</h3>\u0000 \u0000 <p>A prospective, observational, and multicenter pilot study was conducted. All adult patients admitted in the emergency department with ARF were included. The different visual patterns of diaphragmatic motion were analyzed according to the three main etiologies of ARF encountered in emergency departments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 39 adult patients were included. We observed a different visual pattern in patients with pneumonia. A sum of plateau times of less than 0.2 s predicted that the main diagnosis was pneumonia, with sensitivity = 89% 95%CI [52%; 100%], specificity = 87% 95%CI [69%; 96%].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study seems to show that the shape of diaphragmatic motion in patients with ARF secondary to pneumonia is different from that in patients with exacerbation of chronic obstructive pulmonary disease or acute heart failure.</p>\u0000 \u0000 <p>\u0000 <b>Trial Registration:</b> ClinicalTrials.gov: NCT04591509</p>\u0000 </section>\u0000 </div>","PeriodicalId":15386,"journal":{"name":"Journal of Clinical Ultrasound","volume":"53 3","pages":"421-428"},"PeriodicalIF":1.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcu.23886","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Fetal Liver Calcifications: Case Report and Literature Review","authors":"Martina Derme,&nbsp;Adele Vasta,&nbsp;Maria Caterina Corigliano,&nbsp;Antonio Arnò,&nbsp;Valentina D'Ambrosio,&nbsp;Daniele Di Mascio,&nbsp;Giuseppe Rizzo,&nbsp;Antonella Giancotti","doi":"10.1002/jcu.23884","DOIUrl":"10.1002/jcu.23884","url":null,"abstract":"<div>\u0000 \u0000 <p>Fetal liver calcifications (FLCs) are isolated or multiple areas of increased echogenicity in the fetal liver, with an estimated prevalence of 5–10 per 10 000 births. However, their clinical importance remains still unclear. Although they are often linked to infections, chromosomal disorders, thrombotic events, or tumors, isolated FLCs generally have a favorable outcome. This article aims to present a case of a 29-year-old pregnant woman with a low-risk cfDNA test, who presented for the first trimester screening scan at our hospital at 12 weeks of pregnancy. The morphology scan at 20 weeks and 5 days revealed a normal fetal size with areas of increased echogenicity in the liver. No other fetal issues were identified. The patient was monitored throughout her pregnancy at our center, receiving genetic counseling and tests for detecting cystic fibrosis, STORCH (syphilis, cytomegalovirus, herpes virus 1;2, rubella, and toxoplasma), fetal echocardiography, and MRI, all of which were normal. At 35 weeks and 6 days, the patient gave birth to a healthy male, and all subsequent postnatal examinations confirmed the baby's health. This article aims to offer comprehensive insights into the management and postnatal outcomes of isolated FLCs, based on a review of the literature.</p>\u0000 </div>","PeriodicalId":15386,"journal":{"name":"Journal of Clinical Ultrasound","volume":"53 1","pages":"163-168"},"PeriodicalIF":1.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522044","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":"Klippel-Trénaunay-Weber Syndrome: Prenatal Diagnosis and Review of the Literature","authors":"Giuliana Orlandi,&nbsp;Laura Sarno,&nbsp;Antonio Angelino,&nbsp;Mariarosaria Motta,&nbsp;Raffaella Di Girolamo,&nbsp;Luigi Carbone,&nbsp;Marika Rovetto,&nbsp;Laura Letizia Mazzarelli,&nbsp;Gabriella Sglavo,&nbsp;Francesco D' Antonio,&nbsp;Ilenia Mappa,&nbsp;Daniele Di Mascio,&nbsp;Giuseppe Rizzo,&nbsp;Giuseppe Maria Maruotti","doi":"10.1002/jcu.23864","DOIUrl":"10.1002/jcu.23864","url":null,"abstract":"<p>Klippel-Trénaunay-Weber syndrome (KTW) is a rare congenital disease, representing a challenge in prenatal diagnosis due to overlapping characteristics with other syndromes and no specific genetic markers known to date. We have collected all the cases present in the literature on the prenatal diagnosis of KTW, emphasizing common ultrasound findings that can guide the clinician and genetics to the prenatal counseling. Thus, we collected all the information about the postnatal prognosis and the necessity for treatment. Our review of 44 cases highlights the typical common features: hemihypertrophy, predominantly affecting the right leg, with cystic lesions extending to the trunk or upper limbs and rare internal organ involvement. Prenatal complications, including hydrops and polyhydramnios, emphasize the need for a careful ultrasound follow-up. Despite no identified genetic mutation, genetic counseling and invasive testing are recommended. Mortality rate due to a severe complication known as Kasabach-Merritt syndrome, underlines the importance of early diagnosis and accurate management strategies. Prenatal diagnosis of KTW, guided by ultrasound findings and genetic counseling, could help with informed decision-making and optimal care planning.</p>","PeriodicalId":15386,"journal":{"name":"Journal of Clinical Ultrasound","volume":"53 3","pages":"535-546"},"PeriodicalIF":1.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcu.23864","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}