Minerva obstetrics and gynecology最新文献

{"title":"Gynecologic oncology top-cited articles: an international analysis.","authors":"Gabriel Levin, Yoav Brezinov, Raanan Meyer, Noa Oranim","doi":"10.23736/S2724-606X.23.05391-5","DOIUrl":"10.23736/S2724-606X.23.05391-5","url":null,"abstract":"<p><p>The aim of this paper was to study the top-cited per year (CPY) original articles published in the leading subspecialty journals in gynecologic oncology and in the leading general obstetrics and gynecology journals. We used the Web of Science and iCite databases to mine the original articles and review articles in the field of gynecologic oncology in the following journals: Gynecologic Oncology, The International Journal of Gynecological Cancer, The American Journal of Obstetrics and Gynecology and the Obstetrics & Gynecology. Top CPY articles from the four journals were analyzed and compared in a two-time point analysis. A total of 23,252 original articles and reviews were identified. The 100 Top-CPY articles were published from 1983 to 2021. Seventy (70%) in Gynecologic Oncology journal, 20 (20%) in The International Journal of Gynecological Cancer, eight (8%) in Obstetrics & Gynecology and two (2%) in The American Journal of Obstetrics and Gynecology. The most common study methodology was observational studies (20%), followed by guidelines/consensus papers (19%). The most common study topic was ovarian cancer (41%). North America originating authors composed 62% of the top CPY publications, followed by Europe (21%). The most common country of authorship was the United States (52%) followed by Canada (10%). CPY were similar in the publications before vs. after 2014 (P=.19). Study designs, study topics and continent of authorship were similar in both periods. The proportion of multi-center studies was higher after 2014 (66.6% vs. 28.8%, P=0.002) and the proportion of open access publications was higher after 2014 (66.6% vs. 15.4%, P<.001). Funded studies were more common after 2014 (75.0% vs. 53.8%, P=0.028). Ovarian cancer is the top CPY area of research in gynecologic oncology. This field is leaded by authors from the United States with multi-center studies proportion increasing in recent years. It is important to promote further high-quality research in other countries to disseminate knowledge and equality.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"188-193"},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138299539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A vaginal birth is a cost-reduction strategy for women with a low-lying placenta.","authors":"Elisabetta Colciago, Pietro Ferrara, Isadora Vaglio Tessitore, Lorenzo G Mantovani, Patrizia Vergani, Sara Ornaghi","doi":"10.23736/S2724-606X.24.05443-5","DOIUrl":"https://doi.org/10.23736/S2724-606X.24.05443-5","url":null,"abstract":"<p><strong>Background: </strong>Alongside health consequences, cesarean delivery (CD) has been associated with increased healthcare resource utilization (HCRU). A CD should be performed in case of placenta previa; in turn, the most appropriate mode of birth in women with a low-lying placenta (LLP) is still controversial. Since no previous data are available on the topic, the aim of this study was to evaluate the HCRU and economic impact on the Italian HC system of vaginal birth (VB) and CD in women with a LLP.</p><p><strong>Methods: </strong>This retrospective study used patient-level real-world data of a cohort of women with a LLP confirmed at 28-30 weeks. A cost-minimization analysis (CMA) was conducted to compare VB and CD. Since Diagnosis-Related-Group payment may not reflect the actual use of hospital resources, a micro-costing analysis (MCA) was performed to more comprehensively evaluate the economic impact of VB and CD.</p><p><strong>Results: </strong>The study included 86 women with a LLP at the third trimester scan, of which 49 (57%) had a VB and 37 (43%) underwent a CD. The CMA showed an economically marginal difference between VB and CD, especially when considering opportunity costs associated with the resources needed to look after women. However, the MCA identified charges for each VB being about half of those for each CD.</p><p><strong>Conclusions: </strong>The use of patient-level real-world data allowed to generate basic information to assess the value of available interventions in case of LLP. A VB should be promoted in women with LLP, avoiding further burden on the HC system's limited resources.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140293947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights on obstetric outcomes in pregnant individuals with Marfan Syndrome: evidence from the National Inpatient Sample.","authors":"Saeed Baradwan, Majed S Alshahrani, Khalid Khadawardi, Maha Tulbah, Osama Alomar, Abdullah Alyousef, Ibtihal A Bukhari, Ahmed Abu-Zaid","doi":"10.23736/S2724-606X.23.05425-8","DOIUrl":"https://doi.org/10.23736/S2724-606X.23.05425-8","url":null,"abstract":"<p><strong>Background: </strong>We investigated the potential association between Marfan Syndrome (MFS) and adverse obstetric outcomes using the National Inpatient Sample (NIS) database.</p><p><strong>Methods: </strong>We utilized the International Classification of Diseases (ICD-10) system to identify relevant codes and extracted data from the NIS database covering the period 2016-2019. Descriptive statistics and χ² tests were employed to summarize and compare baseline characteristics. Univariate and multivariate regression analyses (adjusted for age, race, hospital region, smoking status, and alcohol misuse) were conducted to evaluate association between MFS and adverse obstetric outcomes. The regression analyses were summarized as Odds Ratios (OR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Among the 2,854,149 pregnant individuals, 179 had MFS. Baseline characteristics revealed significant associations between MFS and age, race, and hospital location. Univariate analysis showed MFS individuals had significantly increased risks of amniotic fluid/membrane abnormalities (AFAs, OR=1.64, 95% CI: 1.01-2.68, P=0.045) and postpartum hemorrhage (PPH, OR=3.73, 95% CI: 2.41-5.78, P<0.001). Several obstetric outcomes showed some trends towards increased (multiple gestation, placenta previa, and preterm labor) and decreased (premature rupture of membrane, gestational diabetes, and preeclampsia) obstetric risks with MFS; however, they were not statistically significant. Multivariate analysis showed MFS was significantly associated with increased risks of AFAs (adjusted OR=1.68, 95% CI: 1.03-2.74, P=0.037) and PPH (adjusted OR=3.62, 95% CI: 2.31-5.68, P<0.001).</p><p><strong>Conclusions: </strong>MFS is associated with increased risks of adverse obstetric outcomes, specifically AFAs and PPH. These results highlight the importance of monitoring these specific pregnancy outcomes in MFS individuals to ensure optimal maternal-fetal health.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140293948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between patient safety indicator events and hospital location for inpatient hysterectomy.","authors":"Sarah Sears, Diana Mitchell, Anne Sammarco, David Sheyn","doi":"10.23736/S2724-606X.24.05431-9","DOIUrl":"https://doi.org/10.23736/S2724-606X.24.05431-9","url":null,"abstract":"<p><strong>Background: </strong>Previous studies suggest surgical quality outcomes are similar between rural and urban hospitals, but data about gynecology in rural hospitals is sparse.</p><p><strong>Methods: </strong>This was a retrospective cohort study utilizing the National Inpatient Sample database from the Agency of Healthcare Research and Quality. Patients who underwent benign hysterectomy for non-prolapse indications between 2012-2016 were identified using ICD-9 and 10 codes. Patients were stratified into rural or urban non-teaching groups; urban teaching hospitals were the referent group. The primary outcome was the rate of patient safety indicator (PSI) events. PSI events were identified using ICD-9 and 10 codes. Statistical analysis was performed using analysis of variance and uni- and multivariate Poisson regressions.</p><p><strong>Results: </strong>154,810 patients met all inclusion criteria. The cumulative rate of PSI events was 11.9% at rural hospitals, 13.9% at urban non-teaching hospitals and 16.9% at urban teaching hospitals, P<0.001. The most common PSI events were postoperative metabolic derangement, hemorrhage, and accidental puncture. The rate of transfusion was highest in urban teaching hospitals (6.7%) and similar for rural (5.1%) and urban non-teaching hospitals (5.5%), P<0.001. The rate of genitourinary tract injury was between 1.4-1.6%, and similar across sites, P=0.89. After adjusting for confounders, the risk of PSI events was similar across locations. The risk of transfusion was lower at rural hospitals (aRR=0.84, 95% CI: 0.74-0.94).</p><p><strong>Conclusions: </strong>Hysterectomy performed at rural hospitals, typically thought of as having low surgical volume compared to urban hospitals, is associated with similar risk of PSI events and lower risk of transfusion.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal use of indomethacin for preterm labor and renal function among very low birth weight infants.","authors":"Mariateresa Sinelli, Sara Ornaghi, Daniela Doni, Giuseppe Paterlini, Anna Locatelli, Davide P Bernasconi, Patrizia Vergani, Maria L Ventura","doi":"10.23736/S2724-606X.22.05137-5","DOIUrl":"10.23736/S2724-606X.22.05137-5","url":null,"abstract":"<p><strong>Background: </strong>Indomethacin is administered as a tocolytic agent for threatening preterm labor <28weeks of gestation. Only a few, not conclusive, studies have investigated its nephrotoxicity in very low birth weight (VLBW) infants. We investigated whether indomethacin increases the incidence of acute kidney injury (AKI) among VLBW infants.</p><p><strong>Methods: </strong>This is a retrospective study including all VLBW infants born at our center between January 1, 2005, and December 31, 2013. Indomethacin was administered to women with preterm labor and intact membranes. Neonatal AKI was defined according to KDIGO classification. Univariate analyses were performed comparing VLBW infants exposed to and not exposed to indomethacin. In the multivariable model, the association of indomethacin and AKI was adjusted for patent ductus arteriosus, use of nephrotoxic medications, birth weight, and gestational age.</p><p><strong>Results: </strong>Five hundred seventy-five VLBW infants were included, 49 (8.5%) of whom were exposed to indomethacin in utero. The univariate analysis showed that infants exposed to indomethacin had lower birth weight, lower gestational age, and higher incidence of AKI than infants not exposed. The multivariable model adjusted for confounding factors confirmed an increased risk of AKI in relation to gestational age at birth <27 weeks, but not to indomethacin.</p><p><strong>Conclusions: </strong>Our data suggest that extreme prematurity, but not the use of indomethacin, is associated with AKI.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"36-42"},"PeriodicalIF":1.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9262325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An updated meta-analysis comparing the efficacy and safety of biosimilar medicinal products to the original follitropin alfa.","authors":"Maria C Budani, Stefania Fensore, Marco DI Marzio, Gian M Tiboni","doi":"10.23736/S2724-606X.22.05175-2","DOIUrl":"10.23736/S2724-606X.22.05175-2","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to provide an updated meta-analysis assessing the therapeutic equivalence between follitropin alfa biosimilars and the reference medication in women undergoing assisted reproductive technologies (ART).</p><p><strong>Evidence acquisition: </strong>The studies included in the analysis were pooled together in order to estimate the log odds ratio (OR) for binary outcomes and the mean difference (MD) for continuous outcomes along with the corresponding 95% confidence intervals (CI) by using a random effects model. The heterogeneity between the studies was evaluated with the Higgins and χ² tests.</p><p><strong>Evidence synthesis: </strong>No differences were found concerning the number of oocytes retrieved at ovum pick-up, the primary endpoint recommended by the European Medicines Agency (EMA) (MD -0.04 CI [-0.78, 0.71], P=0.92). A significantly higher clinical pregnancy rate (OR 0.70 CI [0.53, 0.93], P=0.01) was observed in the reference product group in comparison to the biosimilar follitropin alfa, whereas no statistically significant differences were found for biochemical pregnancy rate, take home baby rate, total follitropin alfa dose, duration of stimulation, and ovarian hyperstimulation syndrome risk.</p><p><strong>Conclusions: </strong>The non-inferiority of biosimilar formulations in comparison to the reference product, with respect to number of oocytes retrieved at ovum pick-up, was shown.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"70-79"},"PeriodicalIF":1.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10749241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training for da Vinci robotic surgery: the Intuitive experience.","authors":"Giorgia Gaia, Maria C Sighinolfi, Stefano Terzoni, Margarita Afonina, Alessandro Morandi, Veronica Iannuzzi, Simone Assumma, Antonio La Marca, Arsenio Spinillo, Anna M Marconi","doi":"10.23736/S2724-606X.23.05309-5","DOIUrl":"10.23736/S2724-606X.23.05309-5","url":null,"abstract":"","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"107-108"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41107152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current and future methods for embryo selection: on a quest for reliable strategies to reduce time to pregnancy.","authors":"Francesco Capodanno, Attilio Anastasi, Marialuisa Cinti, Francesca Bonesi, Andrea Gallinelli","doi":"10.23736/S2724-606X.23.05257-0","DOIUrl":"10.23736/S2724-606X.23.05257-0","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to analyze the usefulness of the principal embryological strategies to reduce time to pregnancy.</p><p><strong>Evidence acquisition: </strong>A systematic search of publications in the PubMed/MEDLINE, Embase and Scopus databases from inception to present including \"IVF,\" \"blastocyst,\" \"embryo colture,\" \"competent embryo,\" \"time to pregnancy,\" \"aneuploid,\" \"euploid,\" \"vitrification,\" \"preimplantation genetic,\" \"IVF strategies\" and \"embryo selection\" alone or in combinations has been done.</p><p><strong>Evidence synthesis: </strong>We have selected 230 articles and 9 of them have been included in this mini-review.</p><p><strong>Conclusions: </strong>Several embryological strategies aimed to select the most competent embryo and reduce time to pregnancy have been proposed, even if few publications on this specific topic are available. preimplantation genetic testing (PGT-A) represents the unique method able to assess the embryonic chromosomal status, but this does not mean that PGT-A is a reliable strategy to reduce time to pregnancy. There is no consensus on a specific method to reduce time to pregnancy, nevertheless this final goal could be probably reached through a harmonious combination of procedures. Thus, a reliable strategy to reduce time to pregnancy could be achieved when embryo culture, embryo cryopreservation and PGT-A are perfectly integrated and appropriately offered to selected patients.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"80-88"},"PeriodicalIF":1.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9432356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mosaic embryo: what it means for the doctor and the patient.","authors":"Ermanno Greco, Pier F Greco, Ilaria Listorti, Carlo Ronsini, Francesco Cucinelli, Anil Biricik, Manuel Viotti, Noemi Meschino, Francesca Spinella","doi":"10.23736/S2724-606X.23.05281-8","DOIUrl":"10.23736/S2724-606X.23.05281-8","url":null,"abstract":"<p><strong>Introduction: </strong>Mosaic embryos are embryos that on preimplantation genetic analysis are found to be composed of euploid and aneuploid cells. Although most of these embryos do not implant when transferred into the uterus following IVF treatment, some may implant and are capable of giving rise to babies.</p><p><strong>Evidence acquisition: </strong>There is currently an increasing number of reports of live births following the transfer of mosaic embryos. Compared to euploid, mosaic embryos have lower implantation rates and higher rates of miscarriage, and occasionally aneuploid component persists. However, their outcome is better than that obtained after the transfer of embryos consisting entirely of aneuploid cells. After implantation, the ability to develop into a full-term pregnancy is influenced by the amount and type of chromosomal mosaicism present in a mosaic embryo. Nowadays many experts in the reproductive field consider mosaic transfers as an option when no euploid embryos are available. Genetic counseling is an important part of educating patients about the likelihood of having a pregnancy with healthy baby but also on the risk that mosaicism could persist and result in liveborn with chromosomal abnormality. Each situation needs to be assessed on a case-by-case basis and counseled accordingly.</p><p><strong>Evidence synthesis: </strong>So far, the transfers of 2155 mosaic embryos have been documented and 440 live births resulting in healthy babies have been reported. In addition, in the literature to date, there are 6 cases in which embryonic mosaicism persisted.</p><p><strong>Conclusions: </strong>In conclusion, the available data indicate that mosaic embryos have the potential to implant and develop into healthy babies, albeit with lower success rates than euploids. Further clinical outcomes should be collected to better establish a refined ranking of embryos to transfer.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"89-101"},"PeriodicalIF":1.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9767082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Induction of labor with repeated prostaglandin administration after failure of dinoprostone vaginal insert: a retrospective study comparing dinoprostone and misoprostol.","authors":"Matteo Mancarella, Diego Costa Torro, Giulia Moggio, Valentina E Bounous, Nicoletta Biglia","doi":"10.23736/S2724-606X.23.05414-3","DOIUrl":"https://doi.org/10.23736/S2724-606X.23.05414-3","url":null,"abstract":"<p><strong>Background: </strong>Induction of labor in women with unfavorable cervix can be started with cervical ripening by dinoprostone vaginal insert. In cases of unsuccessful response, management is unclear: a possible option is a repeated induction with prostaglandins. The aim of this study was to assess the results of a second induction by either dinoprostone or misoprostol, comparing those treatments.</p><p><strong>Methods: </strong>A retrospective analysis was carried out on a cohort of 109 women with unsuccesful response to a first attempt of induction with dinoprostone vaginal insert, who required a second stimulation by either dinoprostone vaginal gel (56 patients) or oral misoprostol (53 patients). The outcomes assessed where the rates of active labor and vaginal delivery, and secondarily maternal and perinatal adverse events.</p><p><strong>Results: </strong>Overall 70.6% of patients reached active labor and 62.4% had a vaginal delivery; the efficacy of the double induction was similar for dinoprostone vaginal gel and oral misoprostol, with active labor in 69.6% and 71.7% (P=0.83), and vaginal delivery in 62.5% and 62.3% of patients (P=0.99) respectively. The incidence of adverse events was low, with no perinatal complications and similar rates of maternal complications, notably major post-partum hemorrhage in 1.8% and 3.8% of patients (P=0.61) for dinoprostone and misoprostol respectively.</p><p><strong>Conclusions: </strong>Dinoprostone vaginal gel and oral misoprostol as a second cycle of induction appear to be both effective in achieving active labor and vaginal delivery after failure of dinoprostone vaginal insert, without a significant rate of adverse events.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}