Journal of endourology最新文献

{"title":"Validation of an Automated CT Image Analysis in the Prevention of Urinary Stones with Hydration Trial.","authors":"Gregory E Tasian, Naim M Maalouf, Jonathan D Harper, Sri Sivalingam, Joey Logan, Hussein R Al-Khalidi, John C Lieske, Antoine Selman-Fermin, Alana C Desai, Henry Lai, Ziya Kirkali, Charles D Scales, Yong Fan","doi":"10.1089/end.2024.0582","DOIUrl":"10.1089/end.2024.0582","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> Kidney stone growth and new stone formation are common clinical trial endpoints and are associated with future symptomatic events. To date, a manual review of CT scans has been required to assess stone growth and new stone formation, which is laborious. We validated the performance of a software algorithm that automatically identified, registered, and measured stones over longitudinal CT studies. <b><i>Methods:</i></b> We validated the performance of a pretrained machine learning algorithm to classify stone outcomes on longitudinal CT scan images at baseline and at the end of the 2-year follow-up period for 62 participants aged >18 years in the Prevention of Urinary Stones with Hydration (PUSH) randomized controlled trial. Stones were defined as an area of voxels with a minimum linear dimension of 2 mm that was higher in density than the mean plus 4 standard deviations of all nonnegative HU values within the kidney. The four outcomes assessed were: (1) growth of at least one existing stone by ≥2 mm, (2) formation of at least one new ≥2 mm stone, (3) no stone growth or new stone formation, and (4) loss of at least one stone. The accuracy of the algorithm was determined by comparing its outcomes to the gold standard of independent review of the CT images by at least two expert clinicians. <b><i>Results:</i></b> The algorithm correctly classified outcomes for 61 paired scans (98.4%). One pair that the algorithm incorrectly classified as stone growth was a new renal artery calcification on end-of-study CT. <b><i>Conclusions:</i></b> An automated image analysis method validated for the prospective PUSH trial was highly accurate for determining clinical outcomes of new stone formation, stone growth, stable stone size, and stone loss on longitudinal CT images. This method has the potential to improve the accuracy and efficiency of clinical care and endpoint determination for future clinical trials.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"953-959"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Effect of Using Automated Irrigation Systems on the Risk of Infectious Complications after Endoscopic Combined Intrarenal Surgery: A Retrospective Cohort Study\".","authors":"Emma M Waddell, Daniel A Wollin","doi":"10.1089/end.2025.0338","DOIUrl":"10.1089/end.2025.0338","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"879"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing the Minimal Clinically Important Difference for the Wisconsin Stone Quality of Life Questionnaire Using Distribution- and Anchor-Based Methods.","authors":"Carl A Ceraolo, David Song, Victor Sandoval, Soumya Konar, Changyong Feng, Rajat K Jain, Kristina L Penniston, Scott O Quarrier","doi":"10.1089/end.2025.0028","DOIUrl":"10.1089/end.2025.0028","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> The Wisconsin Stone Quality of Life (WISQOL) questionnaire is a survey-based tool that has been used to show worse health-related quality of life due to stone disease. The minimum clinically important difference threshold for determining whether changes in the WISQOL tool are meaningfully significant has not previously been estimated. Our study aimed to determine this threshold using distribution- and anchor-based methods. <b><i>Materials and Methods:</i></b> A retrospective single-center cohort of patients at a kidney stone clinic was administered the WISQOL questionnaire at initial and follow-up visits from January 2018 to November 2023. Baseline characteristics and WISQOL standardized scores and subdomain scores were recorded. Distribution-based estimates were calculated at the initial visit and at follow-up. Three anchor questions were used to create a global transition question scale. Cross-sectional, longitudinal within-group, and longitudinal between-group anchor-based estimates were calculated. <b><i>Results:</i></b> The cohort included 1197 individuals with both an initial clinic visit and a follow-up visit. The distribution-based minimum clinically important difference estimates ranged from 3.5 to 10.8. Cross-sectional anchor-based estimates ranged from 3.1 to 13.6. Within-group anchor-based estimates for improvement ranged from 8.5 to 10.3 and for deterioration ranged from 3.1 to 6.3. Between-group anchor-based estimates for improvement were 9.1 (adjusted confidence interval [CI]: 7.5-10.8) and for deterioration were 4.2 (adjusted CI: 2.3-6.1). <b><i>Conclusions:</i></b> A conservative threshold for clinical significance in total WISQOL score (standardized to scale of 0-100) is a difference of 9 for both improvement and deterioration. These findings can be used to further implement WISQOL in guiding clinical decision-making.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"941-947"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Partial Nephrectomy with Veriset: A Renorrhaphy-Less Approach\".","authors":"Jeni Elizabeth Mathew, Atanu Kumar Pal, Thekke Adiyat Kishore","doi":"10.1089/end.2024.0844","DOIUrl":"10.1089/end.2024.0844","url":null,"abstract":"<p><p><b><i>Introduction and Objectives:</i></b> Renorrhaphy during partial nephrectomy is technically challenging and can extend the warm ischemia time (WIT). This study investigates the use of Veriset™ as an alternative to renorrhaphy in robot-assisted partial nephrectomy (RAPN) and presents our findings. <b><i>Methods:</i></b> In this retrospective analysis, 43 patients who had Veriset patch placed on the tumor bed post resection were compared against 43 patients who underwent conventional single-layer renorrhaphy for RAPN from January 2023 to January 2024 at our institution. The two groups underwent propensity score matching based on age, body mass index, and R.E.N.A.L. nephrometry score. Data of all patients, including patient demographic details, tumor characteristics including size, location, pre- and postoperative blood investigations, intraoperative findings, blood loss, postoperative course, complications, and follow-up of 6 months duration, were recorded. <b><i>Results:</i></b> The mean age of the study population was 52.62 ± 13.31 years, and the mean nephrometry score was 6.64 ± 1.91. The Veriset patch application failed in three patients (6.97%) and cortical renorrhaphy had to be performed for hemostasis. The Veriset group (VG) had significantly less console time and WIT when compared with renorrhaphy group (RG) (82.02 ± 25.17 minutes and 11.95 ± 10.02 minutes, respectively, <i>vs</i> 95.53 ± 29.80 minutes and 17.63 ± 6.59 minutes; <i>p</i> = 0.014 and <i>p</i> < 0.001, respectively). The RG witnessed a significant reduction in estimated glomerular filtration rate (eGFR) on postoperative day 1 as opposed to VG (-7.56 ± 15.89 mL/min/1.73 m² <i>vs</i> -0.21 ± 11.12 mL/min/1.73 m²; <i>p</i> = 0.015). The intraoperative blood loss, need for blood transfusion, postoperative change in hemoglobin rates, readmission, and renal function at 6 months in the VG and RG were comparable. <b><i>Conclusions:</i></b> The Veriset application instead of renorrhaphy led to reduced WIT, decreased console time, and early return of renal function with no significantly increased rate of complications.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"911-916"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Sepsis after Endourologic Kidney Stone Surgery: A Machine Learning Approach.","authors":"Hriday P Bhambhvani, Adithya Balasubramanian, Justin Lee, Richard Berman, Ojas Shah","doi":"10.1089/end.2024.0922","DOIUrl":"10.1089/end.2024.0922","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Sepsis secondary to urinary tract infection after kidney stone surgery is associated with considerable morbidity. Limited research examines the use of hemoglobin A1c (HbA1c) to predict postoperative sepsis after endourologic procedures. We developed a machine learning (ML) model trained on demographic and clinical data to predict postoperative sepsis and better identify patients requiring preoperative optimization. <b><i>Methods:</i></b> Patients undergoing ureteroscopy, shockwave lithotripsy, or percutaneous nephrolithotomy at a tertiary care center were identified. Postoperative sepsis was defined as Systemic Inflammatory Response Syndrome (SIRS) scores ≥2. Five supervised ML models were developed: elastic-net penalized logistic regression, random forest, neural network, support vector machine, and naïve Bayes. The dataset was partitioned into training (80%) and testing (20%) sets; fivefold cross-validation was employed. Models were assessed for accuracy, discrimination via area under the receiver operating characteristic curve (AUCROC), calibration, and Brier score on the hold-out test set. <b><i>Results:</i></b> A total of 382 patients with complete data from a total cohort of 2,938 patients undergoing stone surgery from 2020 to 2023 were included with a mean age of 59.9 years (standard deviation [SD] ±14.9). Mean HbA1c was 6.34% (SD ±1.39). 15.2% (58/382) of patients in the study group developed postoperative sepsis, however the overall sepsis rate was 3.1% in the total cohort. Random forest modeling achieved the best performance in the hold-out test set with 91% accuracy, 0.88 AUCROC, calibration slope of 1.26, calibration intercept of -0.21, and Brier score of 0.09. The five most important urosepsis predictors, in descending order, were preoperative hemoglobin, HbA1c, stone size, length of surgery, and body mass index. The random forest model may be accessed at https://urol.shinyapps.io/sepsis_predict/. <b><i>Conclusions:</i></b> A random forest model performed well in predicting sepsis after kidney stone surgery. Our model may help guide preoperative surgical optimization and planning as well as postoperative monitoring, pending further validation.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"977-984"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An At-Home Monitoring Device and Remote Nursing Protocol to Prevent Nephrostomy Tube Dislodgement in Children: A Single-Center Retrospective Study.","authors":"Yi Chen, Ying Wang, Shengmei Zhu, Jiani Yuan, Wen Zong","doi":"10.1089/end.2023.0458","DOIUrl":"10.1089/end.2023.0458","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> The study was to assess the effects of an at-home monitoring device and remote nursing protocol (early warning system) for children undergoing nephrostomy. <b><i>Methods:</i></b> This observational, descriptive, and retrospective study recruited 58 children who underwent nephrostomy between January 2018 and December 2019 at Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. The patients were divided into an early warning system group (<i>n</i> = 32) and a conventional nurse group (<i>n</i> = 26), according to the catheter monitoring method. The primary endpoint was catheter-associated complications, whereas the secondary endpoints included parental satisfaction and the Pediatric Renal Caregiver Burden Scale (PR-CBS). <b><i>Results:</i></b> Patients in the early warning system group were associated with a reduced risk of catheter-associated complications compared to those in the conventional system group [OR, 0.019; 95% confidence interval (CI): 0.004-0.092; <i>P</i> < 0.001]. For specific catheter-associated complications, the risk of catheter detachment (OR, 0.060; 95% CI: 0.004-0.991; <i>P</i> = 0.048), poor drainage (OR: 0.061; 95% CI: 0.007-0.523; <i>P</i> = 0.011), and retrograde infection (OR: 0.195; 95% CI: 0.046-0.822; <i>P</i> = 0.026) in the early warning system group was lower than that in the conventional nurse group. Furthermore, overall parental satisfaction was higher in the early warning system group than in the conventional nurse group (<i>P</i> = 0.016). The PR-CBS score for each domain in the early warning system group was lower than that in the conventional nurse group (<i>P</i> < 0.001). <b><i>Conclusions:</i></b> Using an early warning system could improve catheter-associated complications, parental satisfaction, and PR-CBS in children undergoing nephrostomy during continuous nursing.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"917-923"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indications and Outcomes of Local Anesthetic Retrograde Ureteral Stent Insertion: A Systematic Review from EAU Endourology.","authors":"Arianna Pischetola, Victoria Jahrreiss, Olivier Traxer, Roberto M Scarpa, Francesco Esperto, Amelia Pietropaolo, Bhaskar K Somani","doi":"10.1089/end.2024.0772","DOIUrl":"10.1089/end.2024.0772","url":null,"abstract":"<p><p><b><i>Introduction and Objectives:</i></b> To evaluate the indications and clinical outcomes of local anesthetic stenting in urological procedures, assessing its effectiveness, adverse effects, and patient tolerance. <b><i>Materials and Methods:</i></b> The systematic review was conducted in line with Cochrane and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. MEDLINE, CINAHL, EMBASE, and the Cochrane Central Register were searched up to September 2024 (PROSPERO-CRD42024596866). Studies with at least five patients, focusing on Double-J stent placement or exchange under local anesthesia, published in English, were included. Case reports, reviews, pediatric studies, and redundant older data were excluded. Data on study characteristics, patient demographics, procedural details, and outcomes, including success and complication rates, were extracted. <b><i>Results:</i></b> A total of 1725 patients and 1873 ureteral units were included, with studies that varied in sample size (6-463 patients) and included both stent placements (77.6%) and exchanges (22.4%). The overall success rate for local anesthetic stenting was 89%, with failure rates averaging 11%. Of reported studies, complications were reported in 8.68% (<i>n</i> = 76), predominantly Clavien-Dindo Grades I-II (5.94%) and III-IV (2.74%). Lidocaine jelly was the primary local anesthetic, with adjunct pharmacological interventions in some studies. Fluoroscopic guidance was used in 86.3% of cases, and both flexible and rigid cystoscopes were employed. Cost analysis consistently demonstrated significant cost savings with local anesthesia compared to general anesthesia. Patient satisfaction and pain scores showed variability, with many studies highlighting minimal discomfort and a strong willingness among patients to undergo the procedure again. <b><i>Conclusions:</i></b> Local anesthetic stenting is an effective alternative to general anesthesia, achieving a good success rate with a low risk of major complications. Although it offers significant cost savings and patient satisfaction is usually high, it does highlight the need for careful patient selection and counseling.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"930-940"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altuğ Tuncel, MD, FEBU.","authors":"","doi":"10.1177/08927790251372287","DOIUrl":"10.1177/08927790251372287","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"871"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evaluation of Computer Vision-Based Automated Performance Metrics for Endoscopic Kidney Stone Surgery.","authors":"Jackson Cabo, Daiwei Lu, Chase Floyd, Tatsuki Koyama, Ipek Oguz, Nicholas Kavoussi","doi":"10.1089/end.2024.0895","DOIUrl":"10.1089/end.2024.0895","url":null,"abstract":"<p><p><b><i>Background:</i></b> The assessment of surgical competency is essential for clinical training and safety. No objective, real-time tools exist to evaluate competency during endoscopic stone operation. We sought to apply endoscopic computer vision models to define automated performance metrics (APMs) from videos of flexible ureteroscopy. <b><i>Materials and Methods:</i></b> We assessed three APMs for endoscopic treatment of kidney stones, including percentage of frames without stone visibility, screen occupancy by stone, and frame-to-frame change in stone occupancy. Surgical videos of a surgeon performing either stone localization or stone ablation were recorded. Using our previously validated computer vision model for endoscopic stone segmentation, APMs were compared between experts (fellowship-trained endourologists) and trainees. <b><i>Results:</i></b> Forty-six videos, including 28 of stone localization and 18 of stone laser ablation, were analyzed from nine surgeons (three experts and six trainees). During stone localization, trainee videos had a higher percentage of frames without visible stone (4% <i>vs</i> 27%, <i>p</i> < 0.01) and lower screen occupancy by stone (5% <i>vs</i> 14%, <i>p</i> = 0.03) compared with expert videos. During laser ablation, trainee videos had a higher frame-to-frame change in stone occupancy (3% <i>vs</i> 2%, <i>p</i> < 0.01) compared with expert videos. <b><i>Conclusions:</i></b> APMs from computer vision methods differ between expert and trainee surgical videos of endoscopic kidney stone treatment. These metrics could be used to objectively assess skill evaluation and acquisition.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"924-929"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Using Automated Irrigation Systems on the Risk of Infectious Complications after Endoscopic Combined Intrarenal Surgery: A Retrospective Cohort Study.","authors":"Chatporn Boonyapalanant, Rei Unno, Kazumi Taguchi, Sousuke Niwa, Koei Tori, Yasuhito Sue, Takahiro Yanase, Masahiko Isogai, Ryosuke Chaya, Tomoki Okada, Kengo Kawase, Teruaki Sugino, Shuzo Hamamoto, Atsushi Okada, Takahiro Yasui","doi":"10.1089/end.2024.0758","DOIUrl":"10.1089/end.2024.0758","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Endoscopic combined intrarenal surgery (ECIRS) is a treatment option for kidney stones comparable with other standard methods. One reported complication of ECIRS is infection associated with high intrarenal pressure (IRP), and the irrigation system is an important factor affecting the IRP. Therefore, this study aimed to compare the operative outcomes and infectious complications between manual and gravity irrigation and automated irrigation systems for ECIRS. <b><i>Materials and Methods:</i></b> This single-center, retrospective cohort study enrolled patients who underwent ECIRS between January 2016 and August 2021. We compared operative results and complications between the two irrigation systems, and a multivariate analysis was performed to identify the factors associated with each outcome. <b><i>Results:</i></b> A total of 294 patients were enrolled in this study. The operative time was significantly longer in the manual and gravity irrigation group than in the automated irrigation group (122 ± 45 <i>vs</i> 108 ± 37 minutes, <i>p</i> = 0.003). Postoperative fever occurred in 25% of the patients in the manual and gravity group compared with 10% in the automated group (<i>p</i> < 0.001). In multivariate analysis, the use of a manual and gravity irrigation system was a significant factor associated with postoperative fever (<i>p</i> = 0.001) and longer operative time (<i>p</i> < 0.001). <b><i>Conclusions:</i></b> Using an automated irrigation system for flexible ureteroscopy in ECIRS reduces the risk of postoperative fever and the operative time.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"872-878"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}