Otology & Neurotology最新文献

{"title":"Middle Ear Cholesteatoma in a Postmortem Temporal Bone: A Case Highlighting Variation in Regional Inflammation.","authors":"Nathan M Jacob, Amanda M Lauer, Zahra N Sayyid","doi":"10.1097/MAO.0000000000005048","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005048","url":null,"abstract":"<p><p>Cholesteatoma is an abnormal accumulation of keratinizing squamous epithelium within the middle ear that can behave in a locally destructive manner and erode the ossicular chain. Chronic inflammation and Eustachian tube dysfunction is thought to drive this process. We present a temporal bone specimen from a 38-year-old woman with a lifelong history of right-sided otorrhea and conductive hearing loss, who died of hypoxic-ischemic brain injury after cardiac arrest. Histologic examination revealed a cholesteatoma eroding the incus, with marked regional variation in perimatrix inflammation ranging from mild fibrosis to dense inflammatory infiltration with neovascularization. Notably, areas of more severe inflammation corresponded to a thicker, hyperplastic epithelial matrix, illustrating within a single specimen the spatial link between the inflammatory microenvironment and epithelial proliferation proposed to underlie cholesteatoma progression and local tissue destruction.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881152","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":"Twelve-Month Outcomes After Hearing Rehabilitation With an Active Middle Ear Implant and Latest Generation Vibroplasty Couplers in Adults And Children: A Prospective Multicenter Study.","authors":"Kristen Rak, Stefan K Plontke, Thomas Lenarz, Daniela Hollfelder, Piotr H Skarzynski, Georg M Sprinzl, Marcus Neudert, John-Martin Hempel, Wafaa Shehata-Dieler, Rudolf Hagen, Torsten Rahne, Anke Lesinski-Schiedat, Nicole Knölke, Susan Busch, Karl-Ludwig Bruchhage, Astrid Magele, Philipp Schörg, Marlene Pollotzek, Wilma Großmann, Nora M Weiss, Carmen Giefing-Kröll, Gabriella Bock, Robert Mlynski","doi":"10.1097/MAO.0000000000005034","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005034","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the audiological efficacy, patient-reported outcomes, and safety of an active middle ear implant (AMEI) in children and adults with distinct coupling options.</p><p><strong>Study design: </strong>Prospective, longitudinal, multicenter, noninterventional observational study with repeated within-subject measures and a 12-month follow-up.</p><p><strong>Setting: </strong>Nine tertiary referral centers in Germany, Austria, and Poland.</p><p><strong>Patients: </strong>Adults and children with sensorineural, conductive, or mixed hearing loss. Adults were grouped by coupling method: incus long process (LP), incus short process (SP), round window (RW), or stapes head (SH); multiple couplers were used in children.</p><p><strong>Intervention: </strong>AMEI with coupler.</p><p><strong>Main outcome measures: </strong>The primary outcome was the difference in speech recognition thresholds for 50% speech recognition (SRT50) in quiet between unaided preoperative and aided 12-month postactivation. Secondary outcomes included SRT50 in noise, sound-field thresholds, patient-reported outcomes, air- and bone-conduction thresholds, and adverse events.</p><p><strong>Results: </strong>Audiological outcomes were evaluated in 67 patients. SRT50 in quiet significantly improved across all subgroups, with large effect sizes (Cohen dz>0.8): 17.9±9.3 dB (LP), 18.3±8.4 dB (SP), 25.3±6.3 dB (RW), 23.1±17.6 dB (SH), and 21.6±9.4 dB in children. SRT50 in noise improved by 4.3 to 9.2 dB, and functional gains ranged from 18.3 to 39.2 dB. Patients reported positive impacts on quality of life and perceived quality of hearing. Two device explantations and 2 revision surgeries occurred. Exploratory analyses showed no statistically detectable differences between coupling approaches.</p><p><strong>Conclusion: </strong>AMEI use was associated with significant audiological and patient‑reported improvements in adults and children. Within the limitations of this observational study, including limited power and baseline heterogeneity, no statistically detectable differences in outcomes were observed between coupling approaches. Coupler selection should therefore remain guided by anatomic and clinical considerations.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874894","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":"Association of Superior Semicircular Canal Roof Thickness With Age and Sex on Photon-counting Detector CT in a Japanese Cohort.","authors":"Hiroshi Sakaida, Taishin Yamada, Yasutaka Ichikawa, Akio Yamazaki, Hirofumi Shibata","doi":"10.1097/MAO.0000000000005036","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005036","url":null,"abstract":"<p><strong>Objective: </strong>To quantify superior semicircular canal (SSC) roof thickness using ultra-high-resolution photon-counting detector CT (PCD-CT) and to evaluate its cross-sectional association with age and sex.</p><p><strong>Study design: </strong>Retrospective cross-sectional study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>576 ears from 288 consecutive patients (mean age 42.7±27.3 y; range 0-89; 154 males, 134 females) undergoing clinically indicated temporal bone PCD-CT.</p><p><strong>Main outcome measure: </strong>Minimal SSC roof thickness on Pöschl-plane reconstructions (0.2 mm slice thickness), with intrarater and inter-rater reliability assessed.</p><p><strong>Results: </strong>Reliability was excellent (intrarater ICC 0.966; inter-rater ICC 0.939). A linear mixed-effects model in the full cohort revealed a significant age × sex interaction (B=0.004, P=0.016): females showed no cross-sectional age-related change (B=0.000 mm/year), while males showed a small positive association (B=0.004 mm/year; ∼0.04 mm/decade). In a prespecified pediatric subgroup (<20 years; 84 patients), males showed significant cross-sectional thickening (+0.031 mm/year, P=0.001) and a similar trend in females (+0.020 mm/year), and females had thicker SSC roofs than males (0.88 vs. 0.70 mm at 7.7 years; P=0.039). The interaction was nonsignificant within both the pediatric (P=0.431) and adult (P=0.204) subgroups separately, indicating that the full-cohort interaction likely reflects the developmental phase difference between childhood and adulthood.</p><p><strong>Conclusions: </strong>SSC roof thickness does not decrease with age during adulthood, while active cross-sectional thickening occurs during childhood, suggesting that bony coverage is largely established during the first two decades of life. Adult-onset SSCDS likely reflects the interaction between congenitally thin coverage and secondary factors-intracranial pressure dynamics, mechanical events, and biomechanical changes-rather than progressive resorption.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875869","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":"Cultivating the Future of Otology & Neurotology.","authors":"Matthew L Bush","doi":"10.1097/MAO.0000000000005021","DOIUrl":"10.1097/MAO.0000000000005021","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"937"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584901","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":"Safety and Management of Magnetic Interactions Between Ipsilateral Cochlear Implantation and Programmable Ventriculoperitoneal Shunts.","authors":"Christian J Bernard, Prishae Wilson, Joseph Breen, Mallory Raymond","doi":"10.1097/MAO.0000000000004951","DOIUrl":"10.1097/MAO.0000000000004951","url":null,"abstract":"<p><strong>Objective: </strong>To describe 2 cases of ipsilateral programmable ventriculoperitoneal shunt placement and cochlear implantation, and provide recommendations on the specific risks and perioperative considerations related to magnetic interactions between devices.</p><p><strong>Patients: </strong>An 82 and 83-year-old male with a history of normal pressure hydrocephalus and 2 different types of programmable ventriculoperitoneal shunts, one of which was considered locking and the other non-locking.</p><p><strong>Intervention s: </strong>Ipsilateral cochlear implantation with and without preoperative ex vivo magnet interaction testing.</p><p><strong>Main outcome measures: </strong>Occurrence or non-occurrence of programmable ventriculoperitoneal shunt setting change secondary to cochlear implant magnetic interaction.</p><p><strong>Results: </strong>In case 1, the patient's non-locking valve setting was found to be significantly altered from baseline at 6 months postoperatively, prompting revision to a shunt with a locking mechanism, allowing resumption of cochlear implant use. In case 2, there was no interaction between the locking valve and cochlear implant observed during preoperative ex vivo device testing or through postoperative monitoring.</p><p><strong>Conclusions: </strong>Cochlear implantation in patients with programmable ventriculoperitoneal shunts is feasible but requires careful planning. In addition to avoiding direct magnetic overlap and verifying valve function before and after surgery, cochlear implant surgeons should consider avoiding ipsilateral cochlear implantation in the setting of a non-locking programmable ventriculoperitoneal shunt valve.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e984-e987"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163912","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":"Workplace Accommodations for Workers With Hearing Loss: A Scoping Review With Implications for the Health Setting.","authors":"Geethanjeli Mahendran, Heather McClure, Deborah Goss, Stacey Gray, Alicia Quesnel, Jenny X Chen","doi":"10.1097/MAO.0000000000004955","DOIUrl":"10.1097/MAO.0000000000004955","url":null,"abstract":"<p><strong>Objectives: </strong>To highlight current workplace accommodation for workers with hearing loss (WHL) with specific emphasis on those in the health care sector. To identify how current accommodations can be used to improve the experiences of health care workers with hearing loss.</p><p><strong>Data sources: </strong>Four databases (Embase, Ovid Medline, Web of Science, and CINAHL Complete) were searched using keywords related to workplace accommodations for WHL.</p><p><strong>Methods: </strong>Inclusion and exclusion criteria were applied by 2 authors independently reviewing each article, while a third author resolved any discrepancies. Results were reported according to PRISMA-ScR guidelines.</p><p><strong>Results: </strong>Among the 393 publications identified in the database searches and 8 publications identified from manual bibliographic searches, 11 studies were included. All articles were cross-sectional surveys or qualitative studies. These articles included 714 WHL in a range of workplace settings. One hundred fifty-one (21.1%) and 43 (60.2%) of the WHL used personal assistive listening devices (PALD) and American Sign Language, respectively. Among the WHL, 254 (35.6%) were health care workers. The most common accommodation was the use of captioning technology and PALD. Among health care WHL, the use of amplified stethoscopes was the only specific accommodation reported. Additional accommodations desired among health care WHL included increased advocacy, financial assistance with PALD, improved technology and the routine use of transparent face masks.</p><p><strong>Conclusion: </strong>While several workplace accommodations have been implemented, there is still room for improvement. Improved accommodation tailored to the needs of health care WHL could improve retention, productivity, and patient safety.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e967-e972"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148033914","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":"Beta-2 Transferrin May Not Be Specific for Presence of Cerebrospinal Fluid in Middle Ear Fluid.","authors":"Anthony Thai, Sasa Vasilijic, Lindsay S Moore, Peter J Kullar, Jennifer Y Lee, Alan G Cheng, Douglas R Sidell, Grace S Kim, Tulio A Valdez, Kay W Chang, Iram N Ahmad, Karthik Balakrishnan, Konstantina M Stankovic, Jennifer C Alyono","doi":"10.1097/MAO.0000000000004952","DOIUrl":"10.1097/MAO.0000000000004952","url":null,"abstract":"<p><strong>Objective: </strong>Quantify beta-2 transferrin (B2T)-positivity in the middle ear fluid of patients undergoing pressure equalization tube (PET) placement for recurrent acute otitis media (RAOM) or chronic otitis media with effusion (COME).</p><p><strong>Study design: </strong>Prospective.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>Eighty-one ears from 60 patients undergoing PET placement. Mean age was 12.1 years. Forty-three ears (60.6% of ears) were male. Forty-five ears (63.4%) had COME. Mean effusion duration was 6.2 months.</p><p><strong>Interventions: </strong>PET placement. B2T was measured in middle ear aspirates using quantitative ELISA. Ten ears were excluded due to coefficients of variance >20% between duplicate wells, likely from sample viscosity.</p><p><strong>Main outcome measures: </strong>B2T-positivity rate and quantitative levels.</p><p><strong>Results: </strong>Of 71 ears, 55 (77.5%) were B2T-positive. Compared with B2T-negative ears, B2T-positive ears were more likely to be younger (6.1 vs. 32.9 y, P =0.004), have mucoid effusion (70.9% vs. 20.0%, P =0.001), and have RAOM (45.6% vs. 12.5%, P =0.02). Fifty-three of 61 pediatric ears (86.9%) were B2T-positive, compared with 2 of 10 adult ears (20%). B2T-positivity was not associated with gender, effusion duration, or color of aspirate. No patients had chronic otorrhea after PET placement.</p><p><strong>Conclusions: </strong>Although B2T is considered the gold standard to detect cerebrospinal fluid (CSF), our study shows high B2T positivity rates in the middle ear fluid of patients undergoing PET placement for RAOM or COME. B2T may not be specific for CSF leak into the middle ear. Clinicians should exercise caution when interpreting results of B2T testing, particularly in the pediatric population and those with mucoid effusions.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"1044-1049"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974550","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":"Social Determinants of Health and Impact on Cochlear Implant Performance.","authors":"James W Bao, Sabina Dang, Karmela Dizdar, Dorina Kallogjeri, Cole Pavelchek, Mona Jawad, David Lee, Jordan Varghese, Amit Walia, Stephanie Youssef, Katelyn A Berg, Nedim Durakovic, Pawina Jiramongkolchai, Jay F Piccirillo, Jacques A Herzog, Craig A Buchman, Matthew A Shew","doi":"10.1097/MAO.0000000000004979","DOIUrl":"10.1097/MAO.0000000000004979","url":null,"abstract":"<p><strong>Objective: </strong>To explore the association of social determinants of health (SDH) on postoperative speech perception outcomes in adult CI recipients.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary academic center.</p><p><strong>Patients: </strong>Four hundred forty-seven post-lingually deafened adult CI recipients.</p><p><strong>Intervention: </strong>Cochlear implantation.</p><p><strong>Main outcome measures: </strong>The national Area Deprivation Index (ADI) is a ranking of neighborhood socioeconomic disadvantage with higher ADI suggesting greater disadvantage. The primary outcome was the change in ipsilateral CNC scores (delta CNC) at 3 months compared with pre-implant. Multivariable linear regression was used to explore the association of SDH factors on delta CNC scores at 3 months while controlling for confounders.</p><p><strong>Results: </strong>The mean (SD) ADI of patients in this study was 54.6 (23.9). CNC scores at 3 months increased by a mean (SD) of 31.5% (25.7%). In multivariable regression models, there was a significant interaction effect between national ADI and insurance type on delta CNC. After controlling for age and preoperative pure-tone average (PTA), for patients with Medicare insurance, every additional point increase in ADI is associated with 0.08% decrease in delta CNC. For patients with commercial insurance, every additional point increase in ADI is associated with 0.12% increase in delta CNC.</p><p><strong>Conclusions: </strong>National ADI is a well-established measure for SDH and should be explored to better understand equitable CI health care. In patients with Medicare, there was a significant association between higher ADI and smaller delta in CNC speech perception scores. This association of SDH and CI outcomes raises critical questions that need to be explored through larger, more diverse studies to better advance equitable hearing health care.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"971-977"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Migraine-Related Neurovascular Mechanisms in Meniere Disease.","authors":"Charlotte Chan, Hamid R Djalilian","doi":"10.1097/MAO.0000000000004982","DOIUrl":"10.1097/MAO.0000000000004982","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e1059"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405394","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":"From Residency to Fellowship: Gender and Race in Neurotology Fellowships Compared With Otolaryngology Residency.","authors":"Jazlyn Selvasingh, Taral K Jella, Tara P Menon, Theodore Huang, Justin R Shinn","doi":"10.1097/MAO.0000000000004946","DOIUrl":"10.1097/MAO.0000000000004946","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate temporal trends in gender and racial representation in neurotology fellowships and compare them with concurrent patterns in otolaryngology residencies to assess whether increasing diversity at the residency level has translated into advanced subspecialty training.</p><p><strong>Study design: </strong>Retrospective, cross-sectional analysis.</p><p><strong>Setting: </strong>Accreditation Council for Graduate Medical Education (ACGME)-accredited neurotology fellowship and otolaryngology residency programs in the United States.</p><p><strong>Patients: </strong>All trainees listed in ACGME Data Resource Books from academic years 2007 to 2008 through 2023 to 2024 for gender comparisons and 2011 to 2012 through 2023 to 2024 for race comparisons. Demographic categories analyzed included female versus male and 6 racial groups.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcome measures: </strong>Annual proportions of female and racial minority trainees. Trends were evaluated over time, comparing the fellowship and residency cohorts. Differences in proportions between the earliest and most recent years were analyzed.</p><p><strong>Results: </strong>Neurotology fellowship class size increased over time, accompanied by a rise in the proportion of female fellows. Racial diversity also increased, driven primarily by growth in Asian and Hispanic trainees, while proportions of White trainees declined. Black trainee representation remained low, and American Indian/Alaska Native representation decreased. Overall, improvements in neurotology diversity were more gradual than those of otolaryngology residencies, which demonstrated earlier and more pronounced gains.</p><p><strong>Conclusions: </strong>Gender and racial diversity in neurotology fellowships has improved but remains limited compared with residency-level progress. Persistent disparities suggest structural barriers influencing the transition from residency to subspecialty training. Targeted diversity and recruitment initiatives may help align fellowship programs with the evolving demographics of otolaryngology trainees.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e1041-e1050"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148016731","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}