Journal of minimally invasive gynecology最新文献

{"title":"Multiple Hysteroscopic Surgery Combined With Fenestration for the Treatment of Diffuse Uterine Leiomyomatosis","authors":"Yong-Chang Chen MD ,&nbsp;Na Zuo MD ,&nbsp;Si-Lei Chen MD ,&nbsp;Ning-Ning Zhang PhD","doi":"10.1016/j.jmig.2025.02.002","DOIUrl":"10.1016/j.jmig.2025.02.002","url":null,"abstract":"<div><h3>Objective</h3><div>Diffuse uterine leiomyomatosis (DUL) is a unique growth pattern of fibroids that can lead to infertility. Due to numerous of myomas, a large amount of dilatant fluid as well as longer time are needed following traditional hysteroscopic myomectomy, and the absorption of irrigating fluids, combined with the pressure from uterine distension, can lead to fluid overload and/or dilutional hyponatremia, resulting in transurethral resection of the prostate (TURP) syndrome. In this study, we proposed a recommended technique for treating DUL to prevent above mentioned complications.</div></div><div><h3>Setting</h3><div>Shengjing Hospital of China Medical University.</div></div><div><h3>Participants</h3><div>A 37-year-old young woman was diagnosed with DUL. She presented with menorrhagia (a hemoglobin level of 80 g/L), along with symptoms of dizziness and fatigue.</div></div><div><h3>Interventions</h3><div>The patient underwent two hysteroscopic procedures to fully resect the fibroids. In the first surgery, some of the fibroids were excised using a combination of hysteroscopic fenestration. During the surgery, hysteroscopic fenestration began with an incision made on the endometrium covering each submucous fibroid using a needle-type electrode. The subsequent myomectomy was then performed with a loop-type electrode solely on the fibroid body. This surgery was finished and 8000 ml of 5% glucose uterine distention solution (the deficit was less than 1000 ml) was used. A second hysteroscopic procedure was then performed to evaluate and address any intrauterine adhesions and to remove the remaining fibroids.</div></div><div><h3>Conclusion</h3><div>For the patient who underwent two hysteroscopic surgeries combined with fenestration, no case of TURP syndrome were observed during or after the procedures. Her menstruation returned to normal, and no intrauterine adhesions developed postsurgery. The patient achieved pregnancy and delivered at full term, resulting in a favorable reproductive outcome. Combining multiple hysteroscopic surgeries with fenestration, proved effective and feasible for DUL patients seeking to preserve fertility, aiming to reduce the risk of TURP syndrome.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 5","pages":"Page 417"},"PeriodicalIF":3.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390898","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":"Endometriosis Influencers on Instagram: Who are They and What are They Posting?","authors":"Samantha N Shiplo, Mahsa Gholiof, Natasha Sarin, Mathew Leonardi","doi":"10.1016/j.jmig.2025.01.018","DOIUrl":"10.1016/j.jmig.2025.01.018","url":null,"abstract":"<p><strong>Study objective: </strong>To examine endometriosis-related content on Instagram, a platform increasingly used for health communication, to understand: 1) the identity of Instagram content creators; 2) themes, tones, and emotions evoked from posts; and 3) accuracy of educational information. The relevance of this study lies in its potential to inform healthcare providers on how to better engage with social media to support individuals with endometriosis.</p><p><strong>Design: </strong>This mixed methods cross-sectional observational study was performed on June 6, 2021. Instagram content was collected via two approaches: 1) searching hashtags related to endometriosis from a list of 30 hashtags and analyzing the top 20 and 10 most recent posts and 2) searching endometriosis-related terms under accounts to examine the first 30 accounts retrieved. Posts were categorized into themes and evaluated for tone and emotion, with educational posts also evaluated for accuracy.</p><p><strong>Setting: </strong>Publicly available data on Instagram.</p><p><strong>Participants: </strong>None.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The study analyzed 768 Instagram posts and 228 accounts. Of these, 59.9% of posts and 92.1% of accounts contained endometriosis-related content. Most posts (55.4%) and accounts (59.0%) were authored by people with endometriosis. Accounts owned by people with endometriosis were significantly more active and had more followers compared to those who identified as healthcare providers (mean difference of total # of posts = 714.4, p < .001, mean difference of total # of followers = 27,194.7, p < .001, respectively). Social support was the most common theme (67.2%). Many posts had a negative tone (43.7%) and evoked sadness (57.6%). Objective educational posts contained 85.0% accurate information. Allied healthcare providers were most likely to post accurate educational information compared to all other content creators (p < .001).</p><p><strong>Conclusion: </strong>Instagram is widely used by people with endometriosis, with posts predominantly centered around social support and personal narratives. Healthcare providers can use this information better understand the experiences of people with endometriosis, and to engage more effectively on Instagram.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374280","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":"Transforming the #Enzian Classification Into a Four-Stage System: A Feasibility Study by Comparison With the 2021 AAGL Endometriosis Classification.","authors":"Nikolaus Fadinger, Peter Oppelt, Philip Sebastian Trautner, Imre Szilagyi, Stefan Raidl, Simon-Hermann Enzelsberger","doi":"10.1016/j.jmig.2025.01.017","DOIUrl":"10.1016/j.jmig.2025.01.017","url":null,"abstract":"<p><strong>Study objective: </strong>To develop a translation model of the #Enzian classification into a 4-stage system and to evaluate its performance in a retrospective endometriosis cohort.</p><p><strong>Design: </strong>Feasibility study consisting of 2 parts: First, the allocation of points for the translation model of the #Enzian classification into a 4-stage system. Second, the comparison between the AAGL2021 stages and the new #Enzian stages in a retrospective cohort of patients with endometriosis surgery.</p><p><strong>Setting: </strong>Tertiary center in Europe.</p><p><strong>Participants: </strong>222 endometriosis patients who underwent laparoscopic surgery with perioperative documentation of both classifications.</p><p><strong>Interventions: </strong>The basic structure of the translation model was defined according to the point values used in the AAGL2021 classification for different anatomical locations. In the absence of a direct translation option, the corresponding points for the #Enzian compartments were determined in a survey of 3 experienced endometriosis surgeons. The final 4-stage system was then tested against the AAGL2021 classification in a retrospective dataset.</p><p><strong>Results: </strong>The distribution of endometriosis stages was similar between the 2 classifications, with a comparable percentage of patients in each stage (stage 1: 43% and 44%, stage 2: 20% and 24%, stage 3: 11% and 9%, stage 4: 27% and 21% for the #Enzian and AAGL2021 classifications, respectively). However, the composition of the stages differed slightly, especially in stages 2 and 3, which was shown in a Sankey diagram. Certain deep endometriotic lesions in compartment B and adenomyosis are not respected in the AAGL2021 classification.</p><p><strong>Conclusion: </strong>The #Enzian classification can be easily converted to a 4-stage scoring system similar to the AAGL2021 classification. Perhaps future research could help to determine appropriate point values based on different outcome parameters (e.g., pain, infertility, surgical complexity, …).</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374296","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 Beginning of a Paradigm Shift: Increase in Perioperative Complications Following Vaginal Hysterectomy Compared to Laparoscopic Hysterectomy Using the ACS-NSQIP 2016 to 2019 Database.","authors":"Abigail Cain, Brooke Andrews, Miriam Alvarez, Jennifer Travieso, Winifred Mak, Alison Brooks-Heinzman, Zachary Chipman, Michael Breen, Marian Yvette Williams-Brown, Christina Salazar","doi":"10.1016/j.jmig.2025.01.016","DOIUrl":"10.1016/j.jmig.2025.01.016","url":null,"abstract":"<p><strong>Study objective: </strong>This study aimed to compare the perioperative outcomes of laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) between 2016 and 2019.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>National database study.</p><p><strong>Patients: </strong>The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent elective LH or VH between 2016 and 2019.</p><p><strong>Interventions: </strong>Our primary outcome of interest was a composite incidence of perioperative complications. We generated a propensity score using a multiple logistic regression model to adjust for confounding factors and to reduce the selection bias between the 2 groups. We matched patients who underwent elective LH to patients who underwent elective VH on the logit of the propensity score.</p><p><strong>Measurements and main results: </strong>Of the 76 706 women in the cohort (2016-2019), 62 124 (80.9%) underwent LH and 14 582 (19.0%) underwent VH. After propensity matching (n = 8991 per group), the results of the matched cohort revealed significant differences in the primary composite outcome. The composite risk of death, complications, reoperation, and readmission was lower among patients who underwent LH than among those who underwent VH, such that the primary composite outcome occurred in 5.62% of LH patients compared to 6.65% of VH patients (relative risk [RR] 0.845, 95% confidence interval (CI) 0.753-0.947, p = .004). In addition, the risk of both transfusion and readmission was higher among patients who underwent VH than among those who underwent LH (transfusion: RR 1.372, 95% CI 1.078-1.745, p = .010; readmission: RR 1.546, 95% CI 1.216-1.966, p = .001).</p><p><strong>Conclusion: </strong>We have found that there is a lower 30-day composite morbidity for patients when undergoing LH compared to VH. These data demonstrate a higher risk of perioperative complications in women undergoing VH and should further inform a surgeon's surgical considerations when deciding the optimal route of hysterectomy, depending on the expertise of the surgeon.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365087","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":"A Presacral Fixation Simulation Surgical Training Model for Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Sacrocolpopexy","authors":"Zhiying Lu MD ,&nbsp;Yisong Chen MD ,&nbsp;Keqin Hua MD,&nbsp;Changdong Hu MD","doi":"10.1016/j.jmig.2024.10.002","DOIUrl":"10.1016/j.jmig.2024.10.002","url":null,"abstract":"<div><h3>Objective</h3><div>The number of sacrocolpopexies performed with transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is increasing, and presacral fixation is the most dangerous step. Therefore, the training opportunities for trainees to become competent in performing vNOTES sacrocolpopexy are very important. Simulation-based training is ideal for filling this gap. The objective of this video article is to demonstrate a simulation surgical training model in vNOTES presacral fixation.</div></div><div><h3>Setting</h3><div>The Department of Gynecology at a university hospital.</div></div><div><h3>Participants</h3><div>A urogynecological surgeon.</div></div><div><h3>Interventions</h3><div>(1) Establish presacral model (Fig. 1) and pelvic model (Fig. 2). (2) Establish vNOTES single-port platform. (3) Steps of vNOTES presacral fixation: (a) Identify the sacral promontory and right hypogastric nerve (rHN), and incise the right pelvic peritoneum. (b) Expose and open the presacral fascia to expose the middle sacral vessels and anterior longitudinal ligament (ALL). (c) Complete mesh fixation. (d) Close the pelvic peritoneum. This study is exempt from IRB approval. Model materials and corresponding costs are given in Table 1.</div></div><div><h3>Conclusion</h3><div>We present a presacral fixation simulation model during vNOTES sacrocolpopexy. A piece of rubber tissue is attached to pelvic model to accurately simulate the vagina, thus achieving the establishment of the vNOTES single-port platform. The presacral model displays the anatomic hierarchy of presacral exposure: pelvic peritoneum, presacral fascia, presacral space, as well as the ALL, rHN, ureter, and presacral vessels, which are embedded in these layers. Presacral slope design enables realistic presacral suture and mesh fixation. In case of nerve, blood vessel, or ureteral injury during dissection, this model simulates the manifestation through the leakage of different colored liquids. This new model allows the next generation of urogynecological surgeons to acquire adequate training to make them more prepared to perform their initial vNOTES sacrocolpopexy on a patient, possibly increasing future safety and effectiveness.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 108-110"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467859","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":"Prolapse of residual submucosal leiomyoma following hysteroscopic myomectomy.","authors":"Zachary M Ferraro, Nigel Pereira","doi":"10.1016/j.jmig.2025.01.013","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.01.013","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123007","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":"Language-Based Disparities in Route of Hysterectomy for Benign Disease","authors":"Tavia González Peña MD, MPH ,&nbsp;Nicholas J. Jesse MD ,&nbsp;Zhiguo Zhao MS ,&nbsp;Lara F.B. Harvey MD, MPH ,&nbsp;Olga M. Fajardo MD","doi":"10.1016/j.jmig.2024.09.013","DOIUrl":"10.1016/j.jmig.2024.09.013","url":null,"abstract":"<div><h3>Study Objective</h3><div>To assess the association between patient primary language and route of hysterectomy.</div></div><div><h3>Design</h3><div>A retrospective cohort study was conducted using the Healthcare Cost and Utilization Project's State Inpatient Database (SID) and State Ambulatory Surgery and Services Database (SASD).</div></div><div><h3>Setting</h3><div>All inpatient and outpatient hysterectomies from the most recent year of available data (2020–2021) from the six states that record patient primary language in the SID and SASD (Indiana, Iowa, Maryland, Michigan, Minnesota, and New Jersey) were queried.</div></div><div><h3>Patients or Participants</h3><div>Patients aged 18 and over undergoing an inpatient or ambulatory hysterectomy for benign indication.</div></div><div><h3>Interventions</h3><div>Minimally invasive hysterectomy compared to abdominal hysterectomy.</div></div><div><h3>Measurement and Main Results</h3><div>The association between patient primary language (English vs. non-English) and route of hysterectomy (abdominal vs minimally invasive) was evaluated. The cohort included 52,226 patients who met inclusion criteria. The majority of patients were non-Hispanic White (71%), with a median age of 46 years (IQR 40.0–53.0). 91.4% of patients spoke English as their primary language, 3.6% spoke Spanish, and 5.0% spoke another non-English language. Patients with a non-English primary language were significantly less likely to undergo minimally invasive hysterectomy compared to patients who spoke English (OR 0.60, 95% CI 0.56–0.64, p &lt;.001). This association remained significant following adjustments for age, race, insurance, median income, state, and fibroid, abnormal uterine bleeding, prolapse or endometriosis diagnosis (aOR 0.77, 95% CI 0.71–0.84). In a sensitivity analysis of English vs Spanish vs other non-English language, the association remained significant for other non-English languages (aOR 0.67, 95% CI 0.60–0.75) but not for Spanish (aOR 0.95, 95% CI 0.83–1.09).</div></div><div><h3>Conclusion</h3><div>Patients who are non-English speaking are significantly less likely to receive a minimally invasive hysterectomy. Addressing language disparities may improve access to a minimally invasive route of surgery, a possible surrogate for improved surgical outcomes, for our gynecologic patients.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 151-158"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Electrosurgical Energy and Hemostatic Sealant for Hemostasis in Laparoscopic Ovarian Cystectomy: A Randomized Controlled Phase III Study","authors":"Ok-Ju Kang MD,&nbsp;Joo-Hyun Nam MD, PhD,&nbsp;Jeong-Yeol Park MD, PhD","doi":"10.1016/j.jmig.2024.10.001","DOIUrl":"10.1016/j.jmig.2024.10.001","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate the efficacy of hemostatic sealant versus electrosurgical energy in achieving hemostasis and preserving postoperative ovarian reserve during laparoscopic ovarian cystectomy.</div></div><div><h3>Design</h3><div>Randomized controlled trial.</div></div><div><h3>Setting</h3><div>Single-center study.</div></div><div><h3>Patients</h3><div>A total of 121 patients undergoing laparoscopic ovarian cystectomy.</div></div><div><h3>Interventions</h3><div>Patients were randomized to receive either hemostatic sealant or electrosurgical energy for hemostasis during surgery.</div></div><div><h3>Measurements and Main Results</h3><div>The primary outcome measured was the time required to achieve hemostasis. Secondary outcomes included operating time, estimated blood loss, and assessment of postoperative ovarian reserve through hormone levels (anti-Müllerian hormone [AMH], follicle-stimulating hormone [FSH], E2, inhibin) at three follow-up intervals. The results showed comparable hemostasis times between the two groups. Postoperative hormone levels indicated no significant differences in the impact on ovarian reserve between the groups, except in cases of bilateral ovarian cystectomy, where the hemostatic sealant group exhibited a lesser decline in AMH levels.</div></div><div><h3>Conclusion</h3><div>Both hemostatic sealant and electrosurgical energy showed equivalent effectiveness in achieving hemostasis during laparoscopic ovarian cystectomy, with comparable results in hemostasis time, blood loss, postoperative complications, and ovarian reserve preservation. However, in cases of bilateral ovarian cystectomy, the hemostatic sealant group exhibited a lesser decline in AMH levels, suggesting a potential advantage in preserving ovarian reserve in these specific cases.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 177-184"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391167","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":"JMIG reviewer Spotlight – Megan Wasson","authors":"","doi":"10.1016/j.jmig.2024.11.010","DOIUrl":"10.1016/j.jmig.2024.11.010","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 194-197"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143347506","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":"A Challenging Case of IUD Retrieval From the Colon","authors":"Adi Dayan-Schwartz MD, MHA ,&nbsp;Saleh Agbaria MD ,&nbsp;Suzan Abd Elgani MD ,&nbsp;Liron Kogan MD","doi":"10.1016/j.jmig.2024.08.008","DOIUrl":"10.1016/j.jmig.2024.08.008","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 94-97"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017738","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}