Neurocritical Care最新文献

{"title":"Cryptogenic Encephalitis: The New Abnormal.","authors":"Chiara Risso, Romain Sonneville","doi":"10.1007/s12028-025-02289-y","DOIUrl":"https://doi.org/10.1007/s12028-025-02289-y","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Neurocritical Care Guidelines Developed in High-Income Countries be Relevant to Low- and Middle-Income Countries?","authors":"Venkatakrishna Rajajee","doi":"10.1007/s12028-025-02292-3","DOIUrl":"https://doi.org/10.1007/s12028-025-02292-3","url":null,"abstract":"<p><p>Guideline-concordant care of patients with brain injury may improve outcomes. Guidelines developed in high-income countries (HICs) may overlook important considerations in low- and middle-income countries (LMICs), where resources are often constrained. Many LMICs lack resources for guideline development. Professional societies in HICs can achieve greater worldwide impact through a focus on LMIC concerns during guideline development. Guideline panels that address LMIC concerns should include experts from LMICs and frame population, intervention, comparison, and outcome (PICO) questions appropriate to these settings. The greatest challenge to LMIC-focused guidelines is the paucity of high-quality evidence. Recommendations may be weak or conditional because of reliance on indirect data and observational studies. Methods to evaluate cost-effectiveness developed by the World Health Organization may be useful in addressing the value of system-based interventions such as trauma centers. However, marked variability exists within LMICs in the ability of individuals and centers to access and afford treatments. It is challenging, therefore, for guidelines panels to recommend that expensive but potentially beneficial individual treatment options considered appropriate in HICs not be used in LMICs based on cost considerations alone. Rationing of intensive care unit beds and other resources is unfortunately common in resource-constrained regions. LMIC-focused guidelines on accurate prognostication may allow for better-informed counseling of surrogates and goals of care discussions. This may prevent potentially devastating out-of-pocket expenditure when the probability of meaningful recovery is low. A useful approach to LMIC-focused neurocritical care PICOs may be to posit a situation in which the expensive but potentially beneficial intervention is unavailable, and the question is framed around feasible alternatives in the local environment. This will allow for the possibility that the preferred expensive intervention may be available in some LMIC settings but unavailable in others. Examples include alternative management strategies when tools such as invasive intracranial pressure monitoring or continuous electroencephalography are unavailable. Guidelines that consider LMIC-specific concerns are feasible and may improve the care of critically ill patients with neurological illness worldwide.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Description and Acute Outcomes of Cryptogenic Encephalitis in the Intensive Care Unit.","authors":"Jackson A Roberts, Mohamed Ridha, Carla Y Kim, Yifei Sun, Elizabeth Carroll, Jan Claassen, Kiran T Thakur","doi":"10.1007/s12028-025-02287-0","DOIUrl":"https://doi.org/10.1007/s12028-025-02287-0","url":null,"abstract":"<p><strong>Background: </strong>Prognosis of acute encephalitis is variable and dependent on the underlying etiology, early treatment, and clinical course. Despite extensive evaluation, a cause of acute encephalitis may not be discovered, presenting a challenge to clinicians when discussing prognosis with families. We sought to determine whether clinical and radiographic features may discriminate short-term outcomes in patients with severe cryptogenic encephalitis.</p><p><strong>Methods: </strong>We performed a single-center, retrospective study of patients admitted with cryptogenic encephalitis (i.e., unknown etiology at time of discharge) to the Columbia University Irving Medical Center neurologic intensive care unit (ICU) and the Morgan Stanley Children's Hospital ICU from 2010 to 2020. A favorable discharge outcome was defined as Glasgow Outcome Scale score greater than or equal to 4. Using multivariable logistic regression modeling, we analyzed clinical and radiographic variables associated with favorable short-term outcome.</p><p><strong>Results: </strong>Among 204 total patients with encephalitis admitted to the ICU, 51.0% were classified as cryptogenic. The median age was 49.9 (interquartile range 31-64) years, and the most common presenting symptoms were altered mental status (74.0%), fever (56.7%), and headache (46.2%). Favorable outcome occurred in 63.5% of cryptogenic cases. In the fully adjusted model, age above 50 years (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.11-0.81; p = 0.017), active malignancy (OR 0.07, 95% CI 0.01-0.63; p = 0.018), and intubation (OR 0.20, 95% CI 0.07-0.55, p = 0.002) were associated with reduced odds of favorable outcome. Older age, active malignancy, and intubation were identified as predictors of lower Glasgow Outcome Scale score using ordinal logistic regression.</p><p><strong>Conclusions: </strong>Clinical characteristics may aid early prognostication of cryptogenic encephalitis. Further mechanistic study of the association between active malignancy among patients with cryptogenic encephalitis is warranted.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Head Gunshot Wounds, Clinical, Radiological, and Laboratory Findings: A Comprehensive Systematic Review and Meta-Analysis of 4012 Patients.","authors":"Ali Mortezaei, Bardia Hajikarimloo, Khaled M Taghlabi, Forough Yazdanian, Omar Sameer, Redi Rahmani, Amir H Faraji, Samer K Elbabaa","doi":"10.1007/s12028-025-02288-z","DOIUrl":"https://doi.org/10.1007/s12028-025-02288-z","url":null,"abstract":"<p><p>Gunshot wounds to the head (GSWH) constitute a significant cause of mortality among children. The present management of these firearm injuries is derived from adult traumatic brain injury guidelines. This study systematically evaluates the clinical, radiological, and laboratory findings in pediatric patients with GSWH using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A comprehensive literature search was conducted across four databases. Proportions and 95% confidence intervals were calculated using random-effects or common-effects models, and binary and continuous outcomes were analyzed using odds ratios (ORs) and standardized mean differences, respectively. We included 23 studies with 4012 pediatric patients with GSWH. The overall mortality rate, bilateral fixed pupils, hydrocephalus, St. Louis Scale (SLS) ≥ 5, bihemispheric injuries, and vascular injury on cerebral angiography were reported in 39.6%, 21.5%, 14.4%, 50.6%, 22.6%, and 22.8% of patients, respectively. Patients who died were significantly more likely (OR 25.56, p value = 0.0199) to have an admission Glasgow Coma Scale score of ≤ 8, a higher rate of bilateral fixed pupils (OR 50.98, p value < 0.0001), a higher mean SLS (standardized mean difference 0.98, p value < 0.0001), and greater number of patients with an SLS ≥ 5 (OR 9.97, p value < 0.0001) to receive no neurosurgical intervention (OR 9.03, p value < 0.0001) than those who survived. Radiologic and laboratory findings demonstrated a significant association with a transventricular projectile trajectory (OR 17.25, p value < 0.0001), midline shift (OR 2.27, p value = 0.0039), and deep nuclear or third ventricular injury (OR 9.73, p value < 0.0001), base deficit less than - 5.0 mEq/L (OR 3.67, p value = 0.0016), international normalized ratio > 1.5 (OR 4.28, p value = 0.029), and hematocrit < 30% (OR 2.7, p value = 0.016) compared with those who survived. Our meta-regression findings showed that only age was significantly associated with a higher mortality rate. This is the first and largest meta-analysis of pediatric GSWH. Our meta-analysis provides clinical, radiological, and laboratory factors associated with mortality in pediatric patients.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory Vasoplegia in a Patient with Acute Aneurysmal Subarachnoid Hemorrhage.","authors":"Amelia Morgan, Raj Ramanan, Estefany Villalobos, Lori Shutter, Sumit Kapoor","doi":"10.1007/s12028-025-02290-5","DOIUrl":"https://doi.org/10.1007/s12028-025-02290-5","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Anticoagulant Therapy for Cerebral Venous Sinus Thrombosis: A Propensity Score Matching Study and Inverse Probability Weighting.","authors":"Kai Liu, Mengmeng Zhang, Jiawei Zhao, Qinqin Dai, Yuan Gao, Shen Li, Lu Zhao, Yuming Xu, Bo Song","doi":"10.1007/s12028-025-02267-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02267-4","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Venous Sinus Thrombosis: Patient and Practice Patterns at a Major Trauma Center.","authors":"Deborah L Huang, Ritwik Bhatia, Rubinee Simmasalam, Jason F Talbott, Michael C Huang, Vineeta Singh","doi":"10.1007/s12028-025-02278-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02278-1","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury can lead to venous sinus injury and thrombosis, which may be associated with elevated intracranial pressure and poor outcomes. We sought to examine the risk factors, management, and clinical outcomes of traumatic venous sinus thrombosis (tVST).</p><p><strong>Methods: </strong>We conducted a comprehensive search of our institutional radiology database for final radiology reports from 2013 to 2022 that contained the terms \"venous sinus thrombosis,\" \"sinus thrombosis,\" or \"venous occlusion.\" tVST was detected on computed tomography and confirmed by a board-certified neuroradiologist.</p><p><strong>Results: </strong>We identified 135 patients on initial screening and entered 112 into our final analysis. Patients were predominantly male (76.8%) and had a mean age of 44 years. Initial Glasgow Coma Scale scores of 13-15, 9-12, and 3-8 were found in 60.7%, 12.5%, and 26.8% of our cohort, respectively. Eighty-nine patients (79.5%) were alive at hospital discharge. Most patients sustained skull fractures (n = 109, 97.3%), including skull base fractures. Seventeen patients required interventions for refractory intracranial hypertension, of whom 16 (94.1%) had multiple tVST. We observed heterogeneity in tVST monitoring and treatment practices. Patients received anticoagulation (AC; 13.4%), antiplatelet (AP; 34.8%), or conservative (no AC or AP; 51.8%) treatment for tVST. Follow-up imaging was available for 52 patients, showing recanalization of venous sinuses in 26 patients (50%) by 6 months post injury. Recanalization rates were higher in the AP group than in the AC group. However, this was likely the result of selection bias, in which patients with mild to moderate injuries were more likely to be assigned to AP therapy. We noted more bleeding complications in AC- and AP-treated patients (20.0% and 12.8%) than in conservatively managed patients (3.4%), even after adjusting for lower survival in the conservative group.</p><p><strong>Conclusions: </strong>Differences between treatment groups should be cautiously interpreted due to selection bias and confounding by indication. More studies are needed to determine the optimal management of tVST.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Necessary Intensity of Monitoring After Elective Craniotomies: A Prediction Score for Postoperative Complications to Stratify Postoperative Monitoring.","authors":"Elena Kurz, Darius Kalasauskas, Dominik Wesp, Harald Krenzlin, Alicia Schulze, Melek Bulut, Thomas Kerz, Florian Ringel, Naureen Keric","doi":"10.1007/s12028-025-02242-z","DOIUrl":"https://doi.org/10.1007/s12028-025-02242-z","url":null,"abstract":"<p><strong>Background: </strong>Postoperative complications requiring monitoring following elective craniotomies occur in ~ 2% of cases. Therefore, in most neurosurgical departments, an elective craniotomy is routinely followed by postoperative monitoring in an intensive or intermediate care unit. However, there is no systematic allocation to this procedure. Consequently, patients at risk are not monitored as a priority. The aim of this study was to develop a prediction score for the occurrence of postoperative complications after elective craniotomies and to redefine the monitoring algorithm.</p><p><strong>Methods: </strong>In this retrospective single-center analysis, all patients with elective craniotomy between 2018 and 2021 were included. Demographic data, diagnosis, location of the pathology (infratentorial/supratentorial), American Society of Anesthesiologists (ASA) score, Charlson comorbidity index (CCI), duration of surgery, blood loss, postoperative complications, and type and duration of monitoring were analyzed. The score was developed and validated internally to ensure its predictive reliability.</p><p><strong>Results: </strong>A total of 860 consecutive patients (376 male patients and 484 female patients) with a mean age of 60.6 years (range 19-93 years) were included. Forty-three patients experienced a postoperative adverse event that required monitoring. Independent predictors for postoperative complications were age (odds ratio [OR] 0.001, 95% confidence interval [CI] 1.0-1.04), CCI (OR 1.19, 95% CI 1.04-1.36), operative duration (OR 45.90, 95% CI 10.01-229.30), vestibular schwannoma as the treated pathology (OR 1.58, 95% CI 0.09-0.77), blood loss (OR 1.001, 95% CI 1.00-1.001), and ASA score (OR 1.1, 95% CI 1.01-1.2). The score was based on the most reliable characteristics and the calculated predictor error. The formula for score calculation is as follows: 1.3 age + 10 CCI + 65 1_{{vascular pathology = yes}} + 0.5 duration of surgery + 20.5 ASA score - 100. The discriminatory value for clinical outcomes achieved an area under the curve of 0.78 in validation data.</p><p><strong>Conclusions: </strong>This score provides a practical approach for individual risk assessment of patients undergoing elective craniotomy. Postoperative monitoring capacity can be optimally distributed, and fast-track pathways can be developed for low-risk patients to use this valuable resource effectively.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Exploratory Analysis of Chemical and Mechanical VTE Prophylaxis in Patients with High Rebleeding Risk Traumatic Brain Injury.","authors":"Heather X Rhodes-Lyons, Adel Elkbuli, Sanjan Kumar, Nikita Nunes Espat, Sarah E Johnson, David L McClure, Antonio Pepe","doi":"10.1007/s12028-025-02283-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02283-4","url":null,"abstract":"<p><strong>Background: </strong>There is little research on venous thromboembolism (VTE) prophylaxis (PPX) timing of the higher rebleeding risk groups based on size and type of traumatic brain injury (TBI) due to exclusion from previous observational studies, which prohibits the facilitation of an evidence-based strategy. We aim to determine the effect of VTE PPX timing on the high rebleeding risk TBI population based on the modified Berne Norwood Criteria.</p><p><strong>Methods: </strong>This retrospective cohort study used the American College of Surgeons Trauma Quality Program Participant Use File from 2017 to 2022. The study population consisted of adult patients who received chemical or mechanical PPX with no missing times and had a blunt high rebleeding risk TBI stratified by a comorbid history of anticoagulation or bleeding disorder with excluded polytrauma. There was a total of 12 exposure groups based on VTE PPX timing with the outcomes of interest being intensive care unit (ICU) stay, ventilation days, and mortality.</p><p><strong>Results: </strong>A total of 13,016 patients were included in the exploratory analysis. Early initiation of chemical VTE PPX (within ≤ 24 h) was associated with a reduced likelihood of prolonged ICU stay and ventilation days, regardless of prior anticoagulation use or bleeding disorder. In contrast, inferior vena cava filter placement within the > 24-h to < 72-h window was associated with increased ICU and ventilation duration.</p><p><strong>Conclusions: </strong>This study highlights the benefits of initiating chemical VTE PPX within 24 h for patients wih high rebleeding risk TBI, demonstrating significant reductions in ICU stays and ventilation days without an increase in mortality rates. Additionally, although inferior vena cava filters are associated with longer ICU stays and increased ventilation days, this may reflect the greater severity and potential mortality risk of the conditions being treated.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemoglobin and Perihematomal Edema After Intracerebral Hemorrhage: A Post Hoc Analysis of the i-DEF Trial.","authors":"Alexandros A Polymeris, Vasileios-Arsenios Lioutas, Sarah Marchina, David J Seiffge, David J Roh, Fernanda Carvalho Poyraz, Magdy H Selim","doi":"10.1007/s12028-025-02284-3","DOIUrl":"https://doi.org/10.1007/s12028-025-02284-3","url":null,"abstract":"<p><strong>Background: </strong>Anemia is common after intracerebral hemorrhage (ICH). It has been attributed to inflammation and is associated with poor outcomes. We investigated whether this could be related to the effects of hemoglobin (Hb) on perihematomal edema (PHE).</p><p><strong>Methods: </strong>We performed an exploratory post hoc analysis of the Intracerebral Hemorrhage Deferoxamine (i-DEF) randomized controlled trial. We included participants with primary supratentorial ICH, available baseline Hb levels, and computed tomography scans at baseline and follow-up after 72-96 h. We investigated the association of Hb and anemia (as continuous and dichotomous exposures, respectively) with edema extension distance (EED) as the main continuous outcome at baseline and follow-up and as its interscan change using Spearman correlation and unadjusted and adjusted linear models. We examined absolute and relative PHE in ancillary analyses.</p><p><strong>Results: </strong>We analyzed data from 276 of 293 (94%) i-DEF participants. The median age was 61 (interquartile range [IQR] 52-70) years, and 39% of participants were female. The median Hb level was 14.1 (IQR 13-15.2) g/dL, and 41 participants (15%) were anemic. The median EED was 4.4 (IQR 3.5-5.3) mm at baseline and 6.4 (IQR 5.3-7.3) mm at follow-up. Hb was weakly inversely correlated with baseline (ρ =  - 0.12, p = 0.05) and follow-up EED (ρ =  - 0.11, p = 0.07) but not with interscan EED change (ρ =  - 0.01, p = 0.89). Linear models showed similar relationships of Hb with baseline and particularly follow-up EED but not with EED change. In ancillary analyses, absolute and relative PHE showed no clear correlation with Hb but maintained similar relationships with Hb in linear models as in the main analysis.</p><p><strong>Conclusions: </strong>We identified signals for an association of baseline Hb with PHE after ICH. These findings may warrant further exploration in larger cohorts.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov identifier: NCT02175225.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}