Pediatric Investigation最新文献

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Safety and efficacy of Yupingfeng granules in children with recurrent respiratory tract infection: A randomized clinical trial. 玉屏风颗粒对反复呼吸道感染患儿的安全性和疗效:随机临床试验
IF 1.9 4区 医学
Pediatric Investigation Pub Date : 2022-06-02 eCollection Date: 2022-06-01 DOI: 10.1002/ped4.12326
Baoping Xu, Xinmin Li, Siyuan Hu, Yixiao Bao, Fengmei Chen, Zhimin Chen, Yonggang Du, Enmei Liu, Yufeng Liu, Qinghui Mou, Baoling Su, Bo Wang, Jianwen Xu, Guiping Xu, Qiaozhi Yang, Liwei Gao, Xiaohui Liu, Lei Li, Rong Ma, Kunling Shen
{"title":"Safety and efficacy of Yupingfeng granules in children with recurrent respiratory tract infection: A randomized clinical trial.","authors":"Baoping Xu, Xinmin Li, Siyuan Hu, Yixiao Bao, Fengmei Chen, Zhimin Chen, Yonggang Du, Enmei Liu, Yufeng Liu, Qinghui Mou, Baoling Su, Bo Wang, Jianwen Xu, Guiping Xu, Qiaozhi Yang, Liwei Gao, Xiaohui Liu, Lei Li, Rong Ma, Kunling Shen","doi":"10.1002/ped4.12326","DOIUrl":"10.1002/ped4.12326","url":null,"abstract":"<p><strong>Importance: </strong>Recurrent respiratory tract infection (RRTI) is common in children. Inappropriate RRTI treatment will lead to asthma and other diseases, thereby seriously affecting the growth and physical health of children. Immune function modulation can prevent and alleviate childhood RRTI. Yupingfeng (YPF), a patented traditional Chinese medicine (TCM), has immunomodulatory effects and is widely used in China to treat children with RRTI.</p><p><strong>Objective: </strong>To evaluate the safety and efficacy of YPF monotherapy in treating children with RRTI.</p><p><strong>Methods: </strong>This multicenter, randomized, double-blind, double-simulation, noninferiority clinical trial was conducted from January 2015 to August 2017, with an 8-week treatment period and 52-week follow-up after the drug withdrawal. Children aged 2-6 years with RRTI meeting the inclusion and exclusion criteria were enrolled in 13 hospitals in China and divided randomly into three groups (2:2:1 ratio) to receive YPF, pidotimod, or placebo. The primary outcome was the proportion of RRTI returning to normal standard level during the follow-up. The secondary outcomes were reduction in the number of RRTI recurrences, effect on clinical symptoms (in accord with TCM practice), effect per symptom, and safety. The trial was registered at the Chinese Clinical Trials Registry (www.chictr.org.cn) under the unique identifier ChiCTR-IPR-15006847.</p><p><strong>Results: </strong>Three hundred and fifty-one children were enrolled and randomly assigned to 3 groups; 124, 125, and 61 children in the YPF, pidotimod, and placebo groups, respectively, had completed the trial. During the follow-up, the proportion of RRTI returning to normal standard level was 73.13%, 67.15%, and 38.81% with YPF, pidotimod, and placebo, respectively (<i>P</i> < 0.0001). The proportion of cases who returned to normal standard level in the YPF group was 34.32% higher than that in the placebo group. The safety profile did not significantly differ among the groups.</p><p><strong>Interpretation: </strong>YPF granules were noninferior to the active control drug pidotimod oral solution for the treatment of RRTI in children, and were superior to placebo, with a high safety profile.</p>","PeriodicalId":19992,"journal":{"name":"Pediatric Investigation","volume":"6 2","pages":"75-84"},"PeriodicalIF":1.9,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ad/68/PED4-6-75.PMC9218971.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40551248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lost in translation: Evaluating traditional Chinese medicine by western standards. 迷失在翻译中:用西方标准评价中医。
IF 2.2 4区 医学
Pediatric Investigation Pub Date : 2022-06-02 eCollection Date: 2022-06-01 DOI: 10.1002/ped4.12327
Cynara S Leon, Julian L Allen
{"title":"Lost in translation: Evaluating traditional Chinese medicine by western standards.","authors":"Cynara S Leon, Julian L Allen","doi":"10.1002/ped4.12327","DOIUrl":"10.1002/ped4.12327","url":null,"abstract":"","PeriodicalId":19992,"journal":{"name":"Pediatric Investigation","volume":"6 2","pages":"144-146"},"PeriodicalIF":2.2,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/94/73/PED4-6-144.PMC9218987.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40551249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Issue InformationMEMBER LIST OF THE FIRST EDITORIAL BOARD OF PEDIATRIC INVESTIGATION 发布信息《儿科调查》第一编委会成员名单
IF 2.2 4区 医学
Pediatric Investigation Pub Date : 2022-06-01 DOI: 10.1002/ped4.12272
{"title":"Issue InformationMEMBER LIST OF THE FIRST EDITORIAL BOARD OF PEDIATRIC INVESTIGATION","authors":"","doi":"10.1002/ped4.12272","DOIUrl":"https://doi.org/10.1002/ped4.12272","url":null,"abstract":"","PeriodicalId":19992,"journal":{"name":"Pediatric Investigation","volume":"1 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88603196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Molecular targeted therapies for pediatric atypical teratoid/rhabdoid tumors. 儿科非典型畸胎瘤/横纹肌瘤的分子靶向疗法。
IF 1.9 4区 医学
Pediatric Investigation Pub Date : 2022-05-23 eCollection Date: 2022-06-01 DOI: 10.1002/ped4.12325
Chang Zhang, Hao Li
{"title":"Molecular targeted therapies for pediatric atypical teratoid/rhabdoid tumors.","authors":"Chang Zhang, Hao Li","doi":"10.1002/ped4.12325","DOIUrl":"10.1002/ped4.12325","url":null,"abstract":"<p><p>Atypical teratoid/rhabdoid tumors (AT/RTs) are lethal central nervous system tumors, which are primarily diagnosed in infants. Current treatments for AT/RTs include surgery, radiotherapy, and chemotherapy; these treatments have poor prognoses and challenging side effects. The pivotal genetic event in AT/RT pathogenesis comprises the inactivation of <i>SMARCB1</i> or <i>SMARCA4</i>. Recent epigenetic studies have demonstrated mutual and subtype-specific epigenetic derangements that drive tumorigenesis; the exploitation of these potential targets might improve the dismal treatment outcomes of AT/RTs. This review aims to summarize the literature concerning targeted molecular therapies for pediatric AT/RTs.</p>","PeriodicalId":19992,"journal":{"name":"Pediatric Investigation","volume":"6 2","pages":"111-122"},"PeriodicalIF":1.9,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/26/ed/PED4-6-111.PMC9218972.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Genetics of congenital hypothyroidism: Modern concepts. 先天性甲状腺功能减退症的遗传学:现代概念。
IF 1.9 4区 医学
Pediatric Investigation Pub Date : 2022-05-14 eCollection Date: 2022-06-01 DOI: 10.1002/ped4.12324
Athanasia Stoupa, Dulanjalee Kariyawasam, Michel Polak, Aurore Carré
{"title":"Genetics of congenital hypothyroidism: Modern concepts.","authors":"Athanasia Stoupa, Dulanjalee Kariyawasam, Michel Polak, Aurore Carré","doi":"10.1002/ped4.12324","DOIUrl":"10.1002/ped4.12324","url":null,"abstract":"<p><p>Congenital hypothyroidism (CH) is the most common neonatal endocrine disorder and one of the most common preventable causes of intellectual disability in the world. CH may be due to developmental or functional thyroid defects (primary or peripheral CH) or be hypothalamic-pituitary in origin (central CH). In most cases, primary CH is caused by a developmental malformation of the gland (thyroid dysgenesis, TD) or by a defect in thyroid hormones synthesis (dyshormonogenesis, DH). TD represents about 65% of CH and a genetic cause is currently identified in fewer than 5% of patients. The remaining 35% are cases of DH and are explained with certainty at the molecular level in more than 50% of cases. The etiology of CH is mostly unknown and may include contributions from individual and environmental factors. In recent years, the detailed phenotypic description of patients, high-throughput sequencing technologies, and the use of animal models have made it possible to discover new genes involved in the development or function of the thyroid gland. This paper reviews all the genetic causes of CH. The modes by which CH is transmitted will also be discussed, including a new oligogenic model. CH is no longer simply a dominant disease for cases of CH due to TD and recessive for cases of CH due to DH, but a far more complex disorder.</p>","PeriodicalId":19992,"journal":{"name":"Pediatric Investigation","volume":"6 2","pages":"123-134"},"PeriodicalIF":1.9,"publicationDate":"2022-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9d/93/PED4-6-123.PMC9218988.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40551246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The neurodevelopmental spectrum seen with CHD2 variants. CHD2变体的神经发育谱。
IF 1.9 4区 医学
Pediatric Investigation Pub Date : 2022-04-26 eCollection Date: 2022-06-01 DOI: 10.1002/ped4.12323
Alice G Willison, Rhys H Thomas
{"title":"The neurodevelopmental spectrum seen with <i>CHD2</i> variants.","authors":"Alice G Willison, Rhys H Thomas","doi":"10.1002/ped4.12323","DOIUrl":"10.1002/ped4.12323","url":null,"abstract":"","PeriodicalId":19992,"journal":{"name":"Pediatric Investigation","volume":"6 2","pages":"147-148"},"PeriodicalIF":1.9,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/a4/PED4-6-147.PMC9218968.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40551247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical analysis of CHD2 gene mutations in pediatric patients with epilepsy. 儿科癫痫患者CHD2基因突变的临床分析。
IF 1.9 4区 医学
Pediatric Investigation Pub Date : 2022-04-26 eCollection Date: 2022-06-01 DOI: 10.1002/ped4.12321
Weixing Feng, Fang Fang, Xiaohui Wang, Chunhong Chen, Junlan Lu, Jie Deng
{"title":"Clinical analysis of <i>CHD2</i> gene mutations in pediatric patients with epilepsy.","authors":"Weixing Feng, Fang Fang, Xiaohui Wang, Chunhong Chen, Junlan Lu, Jie Deng","doi":"10.1002/ped4.12321","DOIUrl":"10.1002/ped4.12321","url":null,"abstract":"<p><strong>Importance: </strong>CHD2 is a member of the chromodomain helicase DNA-binding (CHD) family of proteins, which have important roles in the regulation of gene expression. Dysregulation of this protein may lead to various disorders.</p><p><strong>Objective: </strong>To delineate the genotypes and phenotypes of CHD2-related epilepsy.</p><p><strong>Methods: </strong>We analyzed the medical history, magnetic resonance imaging findings, and video-electroencephalogram recordings of 17 patients with <i>CHD2</i> mutations in the Neurology Department of Beijing Children's Hospital from June 2016 to June 2021.</p><p><strong>Results: </strong>Age at seizure onset ranged from 6 months to 10 years; the median age at onset was 4 years. Generalized tonic-clonic, myoclonic, eyelid myoclonic, atonic, atypical absence, myoclonic-atonic, and spasm seizures were observed. Ten of the 17 patients had multiple types of seizures. One patient exhibited photosensitivity epilepsy and one patient exhibited grid image-induced visual reflex epilepsy. Developmental disability was present in 14 patients, while autism features were present in five patients. Sixteen patients had <i>de novo</i> mutations of <i>CHD2</i>; one patient had an inherited variant. Eleven mutations were novel. One patient had two mutations; that patient exhibited development delay and refractory epilepsy. Seizures were controlled in eight patients, improved in seven patients, and resistant to treatment in two patients.</p><p><strong>Interpretation: </strong>Phenotype severity in patients with <i>CHD2</i> variants ranged from drug-responsive seizures to severe epileptic encephalopathy. Most patients exhibited developmental disorders.</p>","PeriodicalId":19992,"journal":{"name":"Pediatric Investigation","volume":"6 2","pages":"93-99"},"PeriodicalIF":1.9,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/83/PED4-6-93.PMC9218986.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A 5-year-old child presenting with tumor-like primary angiitis of the central nervous system. 一名患有中枢神经系统肿瘤样原发性血管炎的 5 岁儿童。
IF 1.9 4区 医学
Pediatric Investigation Pub Date : 2022-04-20 eCollection Date: 2022-06-01 DOI: 10.1002/ped4.12322
Xiuwei Zhuo, Weixing Feng, Ji Zhou, Weihua Zhang, Shuai Gong, Fang Fang, Jiuwei Li
{"title":"A 5-year-old child presenting with tumor-like primary angiitis of the central nervous system.","authors":"Xiuwei Zhuo, Weixing Feng, Ji Zhou, Weihua Zhang, Shuai Gong, Fang Fang, Jiuwei Li","doi":"10.1002/ped4.12322","DOIUrl":"10.1002/ped4.12322","url":null,"abstract":"<p><strong>Introduction: </strong>Primary angiitis of the central nervous system (PACNS) is a vasculitis confined to the CNS. A small proportion of the lesions may present as a tumor-like mass, which is rarely seen in children.</p><p><strong>Case presentation: </strong>A 5-year-old girl was admitted to our hospital because of an intermittent headache. Brain imaging suggested a space-occupying lesion in the right cerebral hemisphere. The final diagnosis was PACNS with a lymphocytic pattern by stereotactic brain biopsy. Her condition improved after immunotherapy.</p><p><strong>Conclusion: </strong>Pediatricians should consider the possibility of PACNS when encountering intracranial tumor-like lesions. Early diagnosis of tumor-like PACNS and prompt immunotherapy could improve the long-term prognosis and avoid surgery.</p>","PeriodicalId":19992,"journal":{"name":"Pediatric Investigation","volume":"6 2","pages":"140-143"},"PeriodicalIF":1.9,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/91/97/PED4-6-140.PMC9218989.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Rhabdomyolysis and coronavirus disease-2019 in children: A case report and review of the literature. 儿童横纹肌溶解症和冠状病毒病-2019:病例报告和文献综述。
IF 1.9 4区 医学
Pediatric Investigation Pub Date : 2022-04-01 eCollection Date: 2022-06-01 DOI: 10.1002/ped4.12320
Maria Kontou, Konstantinos Kakleas, Vaso Kimioni, Dimitra Georgiadi, Vasiliki Spoulou, Athanasios Michos
{"title":"Rhabdomyolysis and coronavirus disease-2019 in children: A case report and review of the literature.","authors":"Maria Kontou, Konstantinos Kakleas, Vaso Kimioni, Dimitra Georgiadi, Vasiliki Spoulou, Athanasios Michos","doi":"10.1002/ped4.12320","DOIUrl":"10.1002/ped4.12320","url":null,"abstract":"<p><strong>Introduction: </strong>Coronavirus disease-2019 (COVID-19) presents with a variety of symptoms, but rhabdomyolysis has rarely been reported in children.</p><p><strong>Case presentation: </strong>We report a 10-year-old girl who presented with fever, myalgia, and limping. The patient was tested positive for severe acute respiratory syndrome coronavirus-2. On admission, creatine kinase (CK) level was 13 147 units per liter and the patient was diagnosed with rhabdomyolysis. She was treated with intravenous fluids, which resulted in CK levels decrease. There are currently seven case reports of children with rhabdomyolysis associated with acute COVID-19 infection and two reports with the multisystemic inflammatory syndrome.</p><p><strong>Conclusion: </strong>Children presenting with muscle pain and weakness in the acute phase or following COVID-19 infection, should alert physicians of the possibility of rhabdomyolysis.</p>","PeriodicalId":19992,"journal":{"name":"Pediatric Investigation","volume":"6 2","pages":"135-139"},"PeriodicalIF":1.9,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8e/a7/PED4-6-135.PMC9218973.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40551250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pediatric genitourinary tumors: Distribution, demographics, and outcomes. 小儿泌尿生殖系统肿瘤:分布、人口统计学和结果。
IF 1.9 4区 医学
Pediatric Investigation Pub Date : 2022-03-31 eCollection Date: 2022-06-01 DOI: 10.1002/ped4.12318
Azadeh Nazemi, Siamak Daneshmand, Andy Chang
{"title":"Pediatric genitourinary tumors: Distribution, demographics, and outcomes.","authors":"Azadeh Nazemi, Siamak Daneshmand, Andy Chang","doi":"10.1002/ped4.12318","DOIUrl":"10.1002/ped4.12318","url":null,"abstract":"<p><strong>Importance: </strong>The diversity of pediatric genitourinary malignancies requires a timely resource detailing tumor characteristics and survival.</p><p><strong>Objective: </strong>To determine the incidence, demographics, and outcomes of all pediatric genitourinary tumors within the United States.</p><p><strong>Methods: </strong>A population-based search for patients diagnosed with genitourinary cancers under age 15 was performed using the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 registry. Information on primary tumor location, histologic type, patient age, sex, year of diagnosis, race, treatment, cause of death, and survival months was extracted. Descriptive epidemiological and survival statistics were calculated for all variables.</p><p><strong>Results: </strong>A total of 4576 cases from 1973 through 2015 were identified. The most common primary tumor sites were the kidney (80.3%), testis (12.3%), bladder (2.8%), and vagina (1.5%). Nephroblastoma (87.9%) and sarcoma (3.4%) were the most common renal malignancies. Rhabdomyosarcoma was common in the vagina, bladder, and testis at rates of 66.2%, 61.2%, and 24.6%, respectively. Germ cell tumors (71.0%) were the most common primary tumor of the testis. Ten-year overall survival (OS) for renal nephroblastoma and sarcoma was 88% and 82%, respectively. Ten-year OS for RMS of the testis was 91%, the bladder was 79%, the vagina was 79%, and the prostate was 56%. Germ cell tumor 10-year OS were 96% in the testis and 100% in the vagina.</p><p><strong>Interpretation: </strong>A better understanding of the overall distribution and outcomes associated with pediatric genitourinary cancers allows physicians to best understand the patient's disease in the context of current frequency in a genitourinary setting and reported outcomes.</p>","PeriodicalId":19992,"journal":{"name":"Pediatric Investigation","volume":"6 2","pages":"85-92"},"PeriodicalIF":1.9,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/11/8d/PED4-6-85.PMC9218969.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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