Journal of the Korean Society of Coloproctology最新文献

{"title":"Intestinal Anastomosis by Use of a Memory-shaped Compression Anastomosis Clip (Hand CAC 30): Early Clinical Experience.","authors":"Hak-Youn Lee,&nbsp;Jin-Hee Woo,&nbsp;Si-Young Park,&nbsp;Nam-Wook Kang,&nbsp;Ki-Jae Park,&nbsp;Hong-Jo Choi","doi":"10.3393/jksc.2012.28.2.83","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.2.83","url":null,"abstract":"<p><strong>Purpose: </strong>The safety and the efficacy of the compression anastomosis clip (Hand CAC 30) have been demonstrated by animal studies. This study was designed to evaluate the clinical validity of the Hand CAC 30 in enterocolic side-to-side anastomosis after colonic or enteric resections.</p><p><strong>Methods: </strong>A non-randomized prospective data collection was performed for patients undergoing a side-to-side anastomosis using the Hand CAC 30. Eligibility criteria for the use of the Hand CAC 30 were for anastomoses between the colon and the ileum or between two small bowels. The primary short-term endpoint was the rate of anastomotic leakage. Other clinical outcomes, including intra- and postoperative complications, length of operation time and hospital stay, and the clip elimination time were recorded.</p><p><strong>Results: </strong>A total of 63 patients (male, 36) underwent an enteric or right-sided colonic resection followed by a side-to-side anastomosis using the Hand CAC 30. Laparoscopic surgery was performed in 36 patients, in whom one patient who underwent a laparoscopic right hemicolectomy was converted to an open procedure (1/32, 3.1%). One patient with ascending colon cancer showed postoperative anastomotic leakage and died of co-morbid ischemic heart disease. There were no other surgical mortalities. The exact date of expulsion of the clip could not be recorded because most patients were not aware of clip elimination. No patients manifested clinical symptoms of anastomotic stricture.</p><p><strong>Conclusion: </strong>Short-term evaluation of the Hand CAC 30 anastomosis in patients undergoing enterocolic surgery proved it to be a safe and efficacious alternative to the standard hand-sewn or stapling technique.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 2","pages":"83-8"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3393/jksc.2012.28.2.83","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30628433","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":"Oncologic Outcomes and Risk Factors for Recurrence after Tumor-specific Mesorectal Excision of Rectal Cancer: 782 Cases.","authors":"Sam Hee Kim,&nbsp;Ki Beom Bae,&nbsp;Jung Min Kim,&nbsp;Jae Ho Shin,&nbsp;Min Sung An,&nbsp;Tae Geun Ha,&nbsp;Sung Mok Ryu,&nbsp;Kwang Hee Kim,&nbsp;Tae Hyeon Kim,&nbsp;Chang Soo Choi,&nbsp;Jin Yong Shin,&nbsp;Minkyung Oh,&nbsp;Seung Hun Baek,&nbsp;Kwan Hee Hong","doi":"10.3393/jksc.2012.28.2.100","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.2.100","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to analyze the oncologic outcomes and the risk factors for recurrence after a tumor-specific mesorectal excision (TSME) of resectable rectal cancer in a single institution.</p><p><strong>Methods: </strong>A total of 782 patients who underwent a TSME for resectable rectal cancer between February 1995 and December 2005 were enrolled retrospectively. Oncologic outcomes included 5-year cancer-specific survival and its affecting factors, as well as risk factors for local and systemic recurrence.</p><p><strong>Results: </strong>The 5-year cancer-specific survival rate was 77.53% with a mean follow-up period of 61 ± 31 months. The overall local and systemic recurrence rates were 9.2% and 21.1%, respectively. The risk factors for local recurrence were pN stage (P = 0.015), positive distal resection margin, and positive circumferential resection margin (P < 0.001). The risk factors for systemic recurrence were pN stage (P < 0.001) and preoperative carcinoembryonic antigen level (P = 0.005). The prognostic factors for cancer-specific survival were pT stage (P < 0.001), pN stage (P < 0.001), positive distal resection margin (P = 0.005), and positive circumferential resection margin (P = 0.016).</p><p><strong>Conclusion: </strong>The oncologic outcomes in our institution after a TSME for patients with resectable rectal cancer were similar to those reported in other recent studies, and we established the risk factors that could be crucial for the planning of treatment and follow-up.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 2","pages":"100-7"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8d/dd/jksc-28-100.PMC3349807.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30627236","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":"Giant peritoneal loose body in the pelvic cavity.","authors":"Joung Teak Jang,&nbsp;Haeng Ji Kang,&nbsp;Ji Young Yoon,&nbsp;Seo Gue Yoon","doi":"10.3393/jksc.2012.28.2.108","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.2.108","url":null,"abstract":"<p><p>We report a case of a large peritoneal loose body diagnosed on computed tomography. The most common causes of a peritoneal loose body are thought to be torsion and separation of the appendices epiploicae. Peritoneal loose bodies are usually small, 0.5 to 2.5 cm in diameter. However, \"giant\" peritoneal loose bodies, larger than 4 cm in diameter, are an uncommon disease and present with various symptoms, and are difficult to diagnose preoperatively. Especially, abdominal large peritoneal loose bodies are frequently misdiagnosed as tumorous disease preoperatively. In our case, the loose body appeared as a round pelvic mass with central calcifications and a distinct fat plane separating it from adjacent organs. Preoperatively, we suspected a tumorous lesion from the wall of the upper rectum; however, at laparoscopy, a large peritoneal loose body was detected. An extraction of the giant peritoneal loose body was performed laparoscopically.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 2","pages":"108-10"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/2c/jksc-28-108.PMC3349808.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30627237","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":"Bezoar-induced Small Bowel Obstruction.","authors":"Se Heon Oh,&nbsp;Hwan Namgung,&nbsp;Mi Hyun Park,&nbsp;Dong-Guk Park","doi":"10.3393/jksc.2012.28.2.89","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.2.89","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to observe the clinical features of a bezoar-induced small bowel obstruction and to investigate the role of abdominal computed tomography (CT) in establishing the diagnosis.</p><p><strong>Methods: </strong>We retrospectively reviewed 20 cases of bezoar-induced small bowel obstruction in our hospital from 1996 to 2010.</p><p><strong>Results: </strong>Thirteen patients (65%) had a history of abdominal surgery. Nine patients (45%) were diagnosed with a bezoar before surgery, seven patients were diagnosed by using abdominal CT, and two patients were diagnosed with a small bowel series. Abdominal CT was performed in 15 patients, and the diagnostic accuracy was 47% (7/15). Surgery revealed ten bezoars in the jejunum and 11 in the ileum. Two patients had bezoars found concurrently in the stomach. Spontaneous removal took place in two patients. An enterotomy and bezoar extraction was performed in 15 patients. Fragmentation and milking, a small bowel resection, and a Meckel's diverticulectomy were performed in one patient each. Early operative treatment was possible (P = 0.036) once the bezoar had been diagnosed by using abdominal CT. There tended to be fewer postoperative complications in patients who were diagnosed with a bezoar by using abdominal CT, but the result was not statistically significant (P = 0.712).</p><p><strong>Conclusion: </strong>A preoperative diagnosis of bezoar-induced small bowel obstruction by using clinical features was difficult. Increased use of abdominal CT led to a more accurate diagnosis and to earlier surgery for bezoar-induced small bowel obstructions, thereby reducing the rate of complications.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 2","pages":"89-93"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/98/6f/jksc-28-89.PMC3349816.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30628434","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":"Clinical Characteristics and Surgical Safety in Patients with Acute Appendicitis Aged over 80.","authors":"Kwon Sang Moon,&nbsp;Yong Hwan Jung,&nbsp;Eun Hun Lee,&nbsp;Yong Hee Hwang","doi":"10.3393/jksc.2012.28.2.94","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.2.94","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to evaluate the clinical characteristics and treatment outcomes, including surgical safety, in patients over 80 years of age who underwent an appendectomy.</p><p><strong>Methods: </strong>This study involved 160 elderly patients who underwent an appendectomy for acute appendicitis: 28 patients over 80 years old and 132 patients between 65 and 79 years old.</p><p><strong>Results: </strong>The rate of positive rebound tenderness was significantly higher in the over 80 group (P = 0.002). Comparisons of comorbidity, diagnostic tool and delay in surgical treatment between the two groups were not statistically different. American Society of Anesthesiologists score was significantly higher in the over 80 group than in the 65 to 79 group (2.4 ± 0.5 vs. 1.6 ± 0.5; P < 0.00005). Comparisons of operative times and use of drainage between the two groups were not statistically different. In the pathologic findings, periappendiceal abscess was more frequent in the over 80 group (P = 0.011). No significant differences existed between the two groups when comparing the results of gas out and the time to liquid diet, but the postoperative hospital stay was significantly longer in the over 80 group (P = 0.001). Among the postoperative complications, pulmonary complication was significantly higher in the over 80 group (P = 0.005). However, operative mortality was zero in each group.</p><p><strong>Conclusion: </strong>In case of suspicious appendicitis in elderly patients, efforts should be made to use aggressive diagnostic intervention, do appropriate surgery and prevent pulmonary complications especially in patients over 80 years of age.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 2","pages":"94-9"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/63/75/jksc-28-94.PMC3349817.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30628435","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":"A case of primary ovarian lymphoma presenting as a rectal submucosal tumor.","authors":"Il Soon Jung,&nbsp;Seul Young Kim,&nbsp;Kyu Seup Kim,&nbsp;Kwang Hun Ko,&nbsp;Jae Kyu Sung,&nbsp;Hyun Young Jeong,&nbsp;Ji Yeoun Kim,&nbsp;Hee Seok Moon","doi":"10.3393/jksc.2012.28.2.111","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.2.111","url":null,"abstract":"<p><p>Primary ovarian lymphoma is a rare malignancy whose symptoms or signs are usually nonspecific. In this article, we report a very rare case initially presenting as a rectal submucosal-tumor-like lesion with a defecation disturbance caused by primary ovarian lymphoma with bilateral involvement. A 42-year-old woman visited chungnam national university hospital complaining of persistent defecation disturbance for 6 months. Colonoscopy demonstrated compression of the rectum by an extrinsic mass mimicking a rectal submucosal tumor. Magnetic resonance imaging detected bilateral ovarian tumors, 9.3 cm and 5.4 cm each in diameter, compressing the rectum without enlarged lymph nodes. The diagnosis was established following a bilateral adnexectomy and histological studies of the excised tissue. The tumor was classified as a diffuse large B-cell lymphoma. The patient was prescribed six cycles of standard CHOP (cyclophosphamide, hydroxydaunorubicin, vincristine, prednisolone) regimen and is presently on treatment.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 2","pages":"111-5"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a1/35/jksc-28-111.PMC3349809.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30627238","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":"Robotic colorectal surgery: is it still on the way to a landmark?","authors":"Nam Kyu Kim","doi":"10.3393/jksc.2012.28.1.1","DOIUrl":"10.3393/jksc.2012.28.1.1","url":null,"abstract":"","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6f/d9/jksc-28-1.PMC3296935.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40158959","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":"Extensive bowel ischemia with heavy alcohol consumption: report of a case.","authors":"Ji Hyoun Lee,&nbsp;Gyoung Tae Noh,&nbsp;Ryung-Ah Lee","doi":"10.3393/jksc.2012.28.1.61","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.1.61","url":null,"abstract":"<p><p>Alcohol is well-recognized systemic toxin that causes numerous adverse effects, including psychosocial problems, fatal myocardial infarction, stroke and atherosclerosis. The intra-abdominal complications caused by acute alcohol consumption have not been defined. We report an 80-year-old man with sub-acute small bowel and colonic ischemia after heavy alcohol intake in one sitting. We performed a resection of gangrenous bowel segments. Microscopically, there were diffuse infarction, with vasoconstriction of the mesenteric vessels in the ileum and colon without any thrombotic occlusion of the intestinal vessels. The clinicians should always be assured by confirmation of a history of recent substance abuse in patients with unexplained abdominal pain, and mesenteric ischemia should be considered in the differential diagnosis of acute or chronic abdominal pain in consumers of alcohol.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 1","pages":"61-5"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0a/4d/jksc-28-61.PMC3296946.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40160109","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":"Early detection of colorectal cancer, is it a guarantee for the cure of cancer?","authors":"Kang Young Lee","doi":"10.3393/jksc.2012.28.1.6","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.1.6","url":null,"abstract":"See Article on Page 49-55 \u0000 \u0000For the last several decades, the prognosis for colorectal cancer has improved. All aspects of colorectal cancer treatments, including new chemotherapeutic drugs and standardization of surgical treatment, have contributed to this improvement in survival. Among them, the most important contribution is early detection of cancer through screening programs, followed by a curative resection of the tumor. Even though early detection of the cancer and a curative resection offer the best chance for a cure, still 10% of the tumors will recur after treatment for early colorectal cancer [1, 2]. \u0000 \u0000Some clinicopathologic parameters, such as an infiltrative growth pattern of the tumor, lymphovascular invasion, and tumor budding, have been suggested as risk factors for treatment failure in early colorectal cancer. Pathologically, tumor budding is defined as a single cell or a small cluster of cells away from the tumor mass. Tumor budding is regarded as not only a prognostic factor in early and advanced colorectal cancer, but also a risk factor of regional lymph nodes metastasis [3], and Keum et al. [4] found tumor budding in a primary tumor, for which recurrence was diagnosed during follow-up. Lymphovascular invasion has also been reported as an independent risk factor for regional lymph nodes metastasis and as an independent prognostic factor in the management of early colorectal cancer [5]. There is no doubt that patients with these risk factors should be followed with careful attention. \u0000 \u0000In a study by Keum et al. [4], the recurrence pattern after a curative resection for early colorectal cancer was described. Interestingly, locoregional recurrence was observed only in rectal cancer. The anastomosis site, the presacral area, and the pelvic wall were the places of locoregional recurrence. This result might reflect the importance of complete total mesorectal excision in the management of rectal cancer, even in cases of early cancer. \u0000 \u0000Even in early colorectal cancer, patients with adverse clinicopathologic characteristics have a risk of treatment failure, so close follow-up is mandatory for these patients. In another aspect, the validation of molecular biological markers as prognostic factors should be mentioned. Since the clinicopathologic characteristics of the primary tunor are phenotypes of its biological characteristics, precise evaluation of molecular biological characteristics could be the next era of research on risk assessment for early colorectal cancer.","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/dc/jksc-28-6.PMC3296945.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40158962","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":"Clinicopathologic factors affecting recurrence after curative surgery for stage I colorectal cancer.","authors":"Min Ae Keum, Seok-Byung Lim, Sun A Kim, Yong Sik Yoon, Chan Wook Kim, Chang Sik Yu, Jin Cheon Kim","doi":"10.3393/jksc.2012.28.1.49","DOIUrl":"10.3393/jksc.2012.28.1.49","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of the current study was to identify the clinicopathological risk factors affecting recurrence after a curative resection for stage I colorectal cancer.</p><p><strong>Methods: </strong>We retrospectively studied 434 patients who underwent a curative resection for stage I colorectal cancer between January 1999 and December 2004. Postoperative oral chemotherapy was performed in 189 patients (45.3%). The following prognostic factors were correlated with recurrence: age, gender, preoperative carcinoembryonic antigen level, location of tumor, T stage, size of tumor, histologic differentiation, growth pattern, and lymphovascular invasion. The median follow-up duration was 65 months.</p><p><strong>Results: </strong>The overall recurrence rate was 4.6% (20/434). The median time to recurrence was 33 months. Two-thirds of the recurrence occurred more than two years after surgery. Risk factors associated with recurrence were rectal cancer (P = 0.009), T2 stage (P = 0.010), and infiltrative growth pattern (P = 0.020). A Cox proportional hazards regression analysis demonstrated that the infiltrative growth pattern was an independent predictor for recurrence. Tumor cell budding was observed in all pathologic reviews with recurrence.</p><p><strong>Conclusion: </strong>Long-term follow-up is necessary for stage I colorectal patients with high risk factors like rectal cancer, T2 stage, and infiltrative growth pattern.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 1","pages":"49-55"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/8a/jksc-28-49.PMC3296942.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40160107","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}