Journal of Vascular Surgery最新文献

{"title":"Frailty is associated with fewer hospital-free days following peripheral artery disease revascularization.","authors":"Stuthi Iyer, Hasan Nassereldine, Jason N Kennedy, Alexas Iams, Yash Pandya, Marissa C Jarosinski, Daniel E Hall, Edith Tzeng, Katherine M Reitz","doi":"10.1016/j.jvs.2026.07.001","DOIUrl":"10.1016/j.jvs.2026.07.001","url":null,"abstract":"<p><strong>Objective: </strong>Many patients with peripheral artery disease (PAD) are frail and experience an increased risk of adverse outcomes, regardless of revascularization status. Hospital-free days (HFDs) represent an important patient-centered outcome as it accounts for both the early- and long-term utilization of hospital and emergency department care, as well as survival. We hypothesized that frail patients would experience fewer HFDs after lower-extremity revascularization for PAD.</p><p><strong>Methods: </strong>We performed a retrospective analysis of adults undergoing an index lower-extremity revascularization for PAD (2016-2024) in a multihospital health care system. We defined frailty via the Risk Analysis Index adapted to the International Statistical Classification of Diseases, 10th Revision, Clinical Modification: not frail (<36) and frail (≥36). We defined our primary outcome, HFDs, as total days alive and outside of inpatient acute hospitals or emergency department visits, in a 90-day postoperative interval. Patients who died during the interval accrued zero additional HFDs after death. We modeled the association between frailty and PAD on HFDs using negative binomial regression, adjusting for age, demographics, and pertinent comorbidities not within the Risk Analysis Index. We generated adjusted rate ratios and 95% confidence intervals (CIs), as well as marginal adjusted mean HFDs. We compared secondary outcomes, including time-to-major amputation, major reintervention, and mortality using Kaplan-Meier curves and Cox models.</p><p><strong>Results: </strong>In total, 11,436 adults (age, 71.1 ± 0.3 years; 62% male, 67% White) underwent revascularization for PAD, of which 17% were frail. Frail patients were more commonly older, men, and with comorbid diabetes, as well as pulmonary and coronary artery disease. Observed median HFDs was lowest among the frail patients (83 days [interquartile range, 73-88] vs 86 days [interquartile range, 80-89]) with PAD. On multivariable adjustment, the rate of HFDs was lower among frail patients (adjusted rate ratio, 0.95; 95% CI, 0.94-0.97; P = .01), which corresponded to 76 (95% CI, 75-77) vs 80 (95% CI, 79-80) adjusted HFDs in the 90 days after reintervention. Further, after multivariable Cox modeling, frailty was associated with a higher risk of major amputation [adjusted hazard ratio (aHR), 1.44; 95% CI, 1.12-1.84; P = .004] and mortality (aHR, 1.69; 95% CI, 1.49-1.92; P = .01), but a lower risk of major reintervention (aHR, 0.78; 95% CI, 0.64-0.94; P < .001).</p><p><strong>Conclusions: </strong>Among patients with PAD undergoing lower-extremity revascularization, frailty was associated with fewer HFDs. Frailty adversely affects limb and mortality outcomes, especially in the early postoperative period, reiterating the need for routine frailty screening, advanced perioperative care planning, and using data like these to inform shared decision-making between patient and clinicians.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405083","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":"Acute kidney injury and long-term survival after type B aortic dissection: A meta-analysis.","authors":"Xander Jacquemyn, Rohit Ganduboina, Michel Pompeu Sá, Derek Serna-Gallegos, Irsa Hasan, Ibrahim Sultan","doi":"10.1016/j.jvs.2026.02.033","DOIUrl":"10.1016/j.jvs.2026.02.033","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":"244-246"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365792","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":"Corrigendum.","authors":"","doi":"10.1016/j.jvs.2026.03.001","DOIUrl":"10.1016/j.jvs.2026.03.001","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":"257"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574775","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":"Corrigendum.","authors":"","doi":"10.1016/j.jvs.2026.01.003","DOIUrl":"10.1016/j.jvs.2026.01.003","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":"1280"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142968","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":"Cost-effectiveness analysis of surgical repair versus observation of complex abdominal aortic aneurysms in elderly patients","authors":"Hataka R. Minami MD, MS,&nbsp;Erin K. Greenleaf MD, MS,&nbsp;Besma J. Nejim MD, MPH,&nbsp;Sai Prasada Rao Manikonda BS,&nbsp;Neal R. Barshes MD, MPH","doi":"10.1016/j.jvs.2025.09.051","DOIUrl":"10.1016/j.jvs.2025.09.051","url":null,"abstract":"<div><h3>Objective</h3><div>The operative risks and financial costs associated with fenestrated endovascular aneurysm repair (FEVAR) and open surgical repair (OSR) of complex abdominal aortic aneurysms may not be justified in elderly patients because of limited expected survival. We performed a cost-effectiveness analysis to determine whether FEVAR or OSR was preferable to observation in elderly patients with complex abdominal aortic aneurysms.</div></div><div><h3>Methods</h3><div>We constructed a probabilistic Markov model comparing lifetime costs and survival (in quality-adjusted life years or QALYs) among patients undergoing FEVAR vs OSR vs observation. Cohorts undergoing aneurysm repair were exposed to risk of complications, reintervention, or death, whereas those undergoing observation were exposed to risk of rupture. Baseline mortality was modeled from a national life table. Outcomes were costs in U.S. dollars, QALYs, and incremental cost-effectiveness ratios. Sensitivity analyses were performed for various combinations of age at the time of repair (range: 50-90 years), sex, and aneurysm size (range: 5.5-8.5 cm/5.0-8.5 cm in men/women, respectively).</div></div><div><h3>Results</h3><div>FEVAR tended to have better survival than OSR for 70-year-old men with 5.5-cm aneurysms (6.5 vs 5.7 QALYs, respectively) and 70-year-old women with 5.0-cm aneurysms (8.0 vs 7.2 QALYs, respectively). However, FEVAR and OSR led to comparable costs in these cohorts. As such, FEVAR was preferred over OSR in these cohorts. Incremental cost-effectiveness ratios of FEVAR vs observation were $27,621 and $21,653 per QALY gained in men and women, respectively. Both FEVAR and OSR were cost-effective compared with observation for most scenarios, except for age &gt;80 to 85 years with smaller aneurysms (≤7.0 cm in men and ≤6.0 cm in women).</div></div><div><h3>Conclusions</h3><div>FEVAR and OSR are cost-effective compared with observation for most patients, even among elderly.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 699-709.e5"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258500","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":"Nationwide outcomes of early thoracic endovascular aortic repair for type B aortic dissection","authors":"William Xu MBChB, BMedSc(Hos) ,&nbsp;Cheyaanthan Haran MBChB ,&nbsp;Eric Lim MBChB ,&nbsp;Haru Yasutomi MBChB ,&nbsp;Phillip Allan MBChB ,&nbsp;Esther Ewart MBChB ,&nbsp;Urata Sofai MBChB ,&nbsp;Simon Lai ,&nbsp;Anastasia Elise Dean MBChB, FRACS ,&nbsp;Manar Khashram MBChB, PhD, FRACS","doi":"10.1016/j.jvs.2025.10.037","DOIUrl":"10.1016/j.jvs.2025.10.037","url":null,"abstract":"<div><h3>Objective</h3><div>Early endovascular repair of the thoracic aorta (TEVAR) is the standard-of-care for complicated type B aortic dissection (cTBAD) but remains controversial in high-risk (hrTBAD) and uncomplicated TBAD (uTBAD). The aim of this study was to evaluate long-term survival and determine risk factors associated with survival and reintervention in cTBAD, hrTBAD, and uTBAD.</div></div><div><h3>Methods</h3><div>This population-based retrospective study included adults with acute TBAD from 2010 to 2022 in the National Minimum Dataset (NMDS), a database of all public hospital admissions across Aotearoa New Zealand. Chronic, traumatic, iatrogenic, or incidental TBAD and intramural hematoma without dissection were excluded. Clinical records were manually reviewed to verify diagnoses, survival, and comorbidities. Patients were classified as cTBAD if they had clinical malperfusion or signs of rupture, hrTBAD if there was rapid aortic expansion on interval imaging, refractory hypertension or pain, or radiological malperfusion, and uTBAD in the absence of these features. An early TEVAR was defined as a procedure within 90 days from the index dissection. Cox proportional hazard models were used for all-cause mortality and the need for further intervention.</div></div><div><h3>Results</h3><div>A total of 420 patients with acute TBAD were included (mean age, 64.3 years; 37.4% female; 22.4% with cTBAD). Initial management was medical in 70.5%, TEVAR in 26.0%, and open aortic repair in 3.6%. The median follow-up time was 3.2 years, accounting for mortality (interquartile range, 1.4-6.3 years). TEVAR was associated with lower adjusted all-cause mortality in cTBAD compared with best medical therapy (hazard ratio [HR], 0.06; 95% confidence interval [CI], 0.01-0.28; <em>P</em> &lt; .001), but not in uTBAD (HR, 0.89; 95% CI, 0.39-2.00; <em>P</em> = .770) or hrTBAD (HR, 0.49; 95% CI, 0.20-1.19; <em>P</em> = .115). TEVAR had a similar need for further intervention compared with best medical therapy in hrTBAD (HR, 0.66; 95% CI, 0.19-2.27; <em>P</em> = .513) and uTBAD (HR, 2.36; 95% CI, 0.82-6.81; <em>P</em> = .114).</div></div><div><h3>Conclusions</h3><div>This nationwide study found early TEVAR is associated with increased adjusted all-cause survival in cTBAD, but not in hrTBAD or uTBAD. The need for further aortic intervention in TBAD remains high regardless of initial medical or TEVAR management.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 664-674.e10"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431556","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":"Technical pitfalls and initial clinical experience using femoral staggered multibranch thoracoabdominal aneurysm repair technique","authors":"J.H. Park,&nbsp;G.G. Volpiani,&nbsp;A. Razuk,&nbsp;L. Ferber,&nbsp;L. Ruiter Kanamori,&nbsp;B.P. Schmid,&nbsp;S. Maximus,&nbsp;G.S. Oderich","doi":"10.1016/j.jvs.2025.12.340","DOIUrl":"10.1016/j.jvs.2025.12.340","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Page A17"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172611","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":"Editor’s Choice – Trends in Treatment Strategies and Peri-operative Outcomes for Complex Abdominal Aortic Aneurysms: A VASCUNET Report","authors":"L. Meuli,&nbsp;H. Gavali,&nbsp;J. Budtz-Lilly,&nbsp;M. Khashram,&nbsp;T. Lattmann,&nbsp;C. Lopez-Espada,&nbsp;C.M. Møller,&nbsp;N. McMillan,&nbsp;T.F. Ribeiro,&nbsp;M. Venermo,&nbsp;K. Mani","doi":"10.1016/j.jvs.2025.12.163","DOIUrl":"10.1016/j.jvs.2025.12.163","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Page 965"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173007","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":"Carotid artery percutaneous access with vessel closure devices in endovascular aortic arch repairs","authors":"Alessandro Grandi MD ,&nbsp;Nuno V. Dias MD ,&nbsp;Stephan Haulon MD ,&nbsp;Timothy Resch MD ,&nbsp;Gustavo S. Oderich MD ,&nbsp;Michele Piazza MD ,&nbsp;Giovanni Pratesi MD ,&nbsp;Luca Bertoglio MD","doi":"10.1016/j.jvs.2025.09.061","DOIUrl":"10.1016/j.jvs.2025.09.061","url":null,"abstract":"<div><h3>Objective</h3><div>To report the use of a percutaneous carotid access with vessel closure devices (VCDs) during complex endovascular aortic arch repair.</div></div><div><h3>Methods</h3><div>Seven international high-volume centers conducted a retrospective review of all patients receiving percutaneous carotid access with VCD during endovascular aortic arch procedures to investigate its feasibility and safety. The primary end point was the closure success defined according to the modified Valve Academic Research Consortium-2 definition (no need for adjunctive surgical or endovascular procedures to obtain vessel closure and no hemorrhagic/stenotic complications).</div></div><div><h3>Results</h3><div>A total of 46 patients (27 males [59%]; mean age, 74 years; range, 68-78 years) treated between January 2022 and September 2024 underwent endovascular arch procedures (eight urgent/emergent cases [19%]), all under general anesthesia and ultrasound guidance, using a micropuncture set in 32 cases (70%). The left common carotid artery was punctured in 41 cases (89%). The median introducer sheath inner diameter was 7F (range, 6F-8F). Only 1 VCD was used per access, with 19 cases (41%) using the preclose technique and 27 cases (59%) using the VCD after introduced sheath removal (all but one case treated with PerClose ProGlide [Abbott Vascular]). Closure success was achieved in 44 patients (96%): 1 patient required an intraoperative covered stent placement to cover the puncture site, and 1 patient required an open conversion 2 days after the procedure owing to a pseudoaneurysm diagnosed at the postoperative computed tomography scan. Four patients (9%) required prolonged manual compression after VCD tightening owing to oozing from the puncture site. The prolonged manual compression was correlated to the use of anticoagulants (40 vs 7%; <em>P</em> = .043). One case of a non-flow-limiting dissection was left untreated conservatively. Four patients (9%) suffered from postoperative stroke, two ischemic and two hemorrhagic, two on the same side of the carotid puncture and two on the contralateral side. No other complications were reported.</div></div><div><h3>Conclusions</h3><div>Percutaneous carotid access with a VCD appeared to be feasible and safe, with a high closure success rate. Further investigations are needed to compare open cutdown vs percutaneous access outcomes.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 656-661"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458876","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":"Laser in situ fenestrated endograft (LIFE) repair of complex aortic arch pathology: Early outcomes from the multicenter LIFE registry","authors":"Brant W. Ullery MD, MBA ,&nbsp;Fanny Alie-Cusson MD, MS ,&nbsp;Gregory A. Magee MD ,&nbsp;Sukgu M. Han MD ,&nbsp;Jordan R. Stern MD ,&nbsp;Andrew Barleben MD ,&nbsp;Jeromy S. Brink MD ,&nbsp;Robert Allen MD ,&nbsp;Mark Fugate MD ,&nbsp;Kenneth Tran MD ,&nbsp;Jason T. Lee MD ,&nbsp;Frank R. Arko MD ,&nbsp;Chase Schlesselman MPH ,&nbsp;Jonathan M. Bath MD","doi":"10.1016/j.jvs.2025.09.056","DOIUrl":"10.1016/j.jvs.2025.09.056","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Endovascular repair of aortic arch pathologies is limited by currently available device configurations, variation in aortic arch anatomy, access challenges, and frequent nonelective surgical acuity. The present study aims to assess the feasibility and midterm outcomes of laser in situ fenestrated endograft (LIFE) repair for supra-aortic arch branches during thoracic endovascular repair (TEVAR).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Patients who underwent LIFE during TEVAR for aortic arch pathologies (2017-2022) were retrospectively identified at six high-volume centers, and data were collected in the multicenter LIFE registry. Descriptive statistics and Kaplan-Meier analysis were used. Primary outcomes were technical success, stroke, and target vessel instability. Secondary outcomes included 30-day mortality, spinal cord ischemia, and reinterventions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 82 patients who underwent LIFE with supra-aortic arch involvement were included. The mean age was 62.4 years (29.3% female and 78.0% White). Select demographics of the cohort featured previous stroke in 17.1% of cases, chronic lung disease in 12.2%, and renal insufficiency in 30.5%. Indication(s) for TEVAR included type B aortic dissection in 70.7% of cases, aneurysm in 11.0%, and penetrating atherosclerotic ulcer/intramural hematoma in 4.9%. Repair was performed for nonelective pathologies in 47.9% of cases. Eighty-nine supra-aortic arch branch vessels (innominate, n = 6; left common carotid artery, n = 9; and left subclavian artery, n = 74) were incorporated via LIFE to achieve proximal seal in zone 0 (19%), zone 1 (5%), and zone 2 (75%). LIFE repair was performed for a single-branch vessel in 90% of cases and a double-branch vessel in 10%. Ten patients underwent adjunctive extra-anatomic bypass. Technical success was achieved in 95.1% of cases. Thirty-day mortality was 2.4% (n = 2). Early (&lt;30 days) neurologic outcomes included a stroke and spinal cord ischemia rate of 7.4% and 0%, respectively. At a mean follow-up of 15 months (range, 1-81 months), there were 5 additional late deaths (6.1%). A total of 8 patients (9.8%) required 11 unplanned reinterventions at a mean of 423 ± 555 days (range, 17-1479 days) postoperatively. Kaplan-Meier estimated survival was 94.5% at 36 months, and reintervention-free survival was 78.0% at 36 months.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Results from the multicenter LIFE registry demonstrate laser in situ fenestration of complex aortic arch anatomy to be technically feasible with a perioperative mortality and neurologic risk profile that is comparable to standard techniques. Despite a modest reintervention rate in this early experience, midterm survival is excellent, particularly given the high-risk aortic pathologies and patient demographics featured in this cohort. Although perioperative results and midterm outcomes remain promising, longitudinal data are needed to confirm durabil","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 647-655"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274966","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}