Postgraduate Medical Journal最新文献

{"title":"Challenges towards medical writing in a developing country: a post-graduate resident's perspective.","authors":"Ahsan Tameez-Ud-Din","doi":"10.1093/postmj/qgaf042","DOIUrl":"https://doi.org/10.1093/postmj/qgaf042","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649994","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}

{"title":"Helmet continuous positive airway pressure as noninvasive ventilation for COVID-19 patients; a systematic review and meta-analysis of randomized trials.","authors":"Yongke Zheng, Shihan Zhou, Nanyuan Gu, Xiaokang Zeng, Hayat Khizar, Longhuan Zeng","doi":"10.1093/postmj/qgaf038","DOIUrl":"https://doi.org/10.1093/postmj/qgaf038","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has challenged healthcare systems globally, highlighting the need for effective respiratory support strategies. Helmet continuous positive airway pressure (CPAP) has emerged as a potential noninvasive ventilation (NIV) method for COVID-19 patients.</p><p><strong>Methods: </strong>We searched PubMed, EMBASE, the Cochrane Library, and Scopus from December 1, 2019, to June 1, 2024. Randomized controlled trials (RCTs) comparing helmet CPAP therapy with standard oxygen therapy or other forms of NIV in COVID-19 patients with acute hypoxemic respiratory failure were included. Random effects meta-analyses were performed to calculate pooled risk ratios (RRs) with 95% confidence intervals (95% CIs).</p><p><strong>Results: </strong>Three RCTs involving 580 patients were included in this analysis. There was no significant differences (P > 0.05) in mortality at 28 d (RR, 1.20; 95% CI, 0.84-1.71), 60-90 d (1.02, 95% CI, 0.75-1.37), or 180 d (0.98, 95% CI, 0.76-1.25) between the helmet CPAP group and the control group as well as similar intubation rates (RR 0.90; 95% CI, 0.73-1.10) and times to intubation. However, helmet CPAP was associated with significantly shorter ICU stays and hospital stays. The adverse event rates were similar between the groups. Patient comfort, as measured by the EQ-VAS, was significantly better with the CPAP helmet.</p><p><strong>Conclusion: </strong>The use of helmet CPAP for the treatment of respiratory failure in patients with COVID-19 showed comparable intubation rates and shorter ICU and hospital stays without increasing mortality or adverse events. Key messages What is already known about this topic?  Noninvasive ventilation (NIV) methods, such as helmet CPAP, treat patients with acute hypoxemic respiratory failure. The effectiveness of helmet CPAP for COVID-19 patients is unknown. What this study adds?  This study shows that helmet CPAP has similar intubation and mortality rates to standard treatments in COVID-19 acute respiratory failure patients. It also highlights how helmet CPAP reduces ICU and hospital stays and improves patient comfort. How this study might affect research, practice, or policy?  The findings of this study could lead to future research into helmet CPAP approaches for COVID-19 and other respiratory failure patients. They could also influence clinical practice and healthcare policy by emphasizing helmet CPAP as a preferable noninvasive ventilation technique for similar patient populations.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649995","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}

{"title":"Blood biomarkers of Alzheimer's disease: findings from proteomics.","authors":"Yuye Wang, Xiaoqian Niu, Weizhe Zhen, Bin Zhang, Leian Chen, Yuchen Liu, Wei Sun, Dantao Peng","doi":"10.1093/postmj/qgaf039","DOIUrl":"https://doi.org/10.1093/postmj/qgaf039","url":null,"abstract":"<p><strong>Background: </strong>Alzheimer's disease, the most prevalent cause of dementia, is a worldwide health problem. Proteomics is the systematic study of proteins and peptides to provide comprehensive descriptions. Aiming to obtain a more accurate and convenient clinical diagnosis, researchers are working on blood biomarkers.</p><p><strong>Method: </strong>This review synthesizes findings from previous studies investigating blood biomarkers for Alzheimer's disease using proteomic approaches.</p><p><strong>Results: </strong>We summarized the application of blood proteomics as diagnostic biomarkers and associations with clinical indicators such as neuropsychological performances, Aβ deposition and brain atrophy in Alzheimer's disease, and mild cognitive impairment.</p><p><strong>Conclusion: </strong>In summary, blood proteomics is suggested to be promising in biomarkers of Alzheimer's disease.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649989","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}

{"title":"MVPA as the most influential factor for myocardial infarction through Bayesian Mendelian randomization among 11 behaviors.","authors":"Lei Pu, Peng Sun","doi":"10.1093/postmj/qgaf041","DOIUrl":"https://doi.org/10.1093/postmj/qgaf041","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The causal associations between behavioral factors (BF) and myocardial infarction (MI), as well as the potential mediators and dose-response relationships, are incompletely clear. Therefore, this study aimed to evaluate the association of 11 BF with MI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used two-sample Mendelian randomization (2SMR) to investigate he associations between BF and MI and applied a two-sample multivariable MR approach based on Bayesian model averaging (MR-BMA) to prioritize the BF identified by 2SMR. For significant BF, we conducted extra conducted mediation analysis and restricted cubic spline (RCS) analysis to reveal potential mediating pathways and their dose-response relationships. Furthermore, we conducted replication analysis and meta-analysis to further support the results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 11 BF, 2SMR identified 3 BF that were significantly associated with MI. Among them, MR-BMA identified moderate to vigorous intensity physical activity (MVPA) (Marginal inclusion probability (MIP) = 0.77) as the most influential factor. A potential mechanism underlying the MVPA-MI association was waist-hip ratio (WHR, 7.26%). RCS analysis further revealed that an MVPA of 1094-2043 MET minutes/week was associated with the lowest risk of MI. Finally, replication analysis and meta-analysis further supported the 3 BF and identified an extra association between tea intake and MI risk (Meta: OR = 0.991, P = .003).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Of the 11 BF, MVPA was the most influential factor independently associated with the reduced risk of MI, with WHR mediating this association. At least 39 minutes of MVPA per day is recommended to reduce the risk of MI. In addition, tea intake is a potential protective factor for MI that warrants further investigation. Key messages What is already known on this topic?  Previous studies have shown an association between behavioral factors and the risk of myocardial infarction (MI). However, the exact causal relationship, which behavioral factors is most influential for MI, and the potential dose-response relationship are incompletely clear. Mendelian randomization can provide genetic evidence of causal associations and reveal the underlying mechanisms. What this study adds?  This study provides novel genetic evidence that smoking initiation, leisure sedentary time, and moderate to vigorous intensity physical activity (MVPA) are associated with MI. MVPA is the most influential factor. Only MVPA is independently associated with MI, and waist-to-hip ratio mediated the association. In addition, we found that at least 39 minutes of MVPA per day resulted in the greatest reduction in MI. Finally, we also found a potential protective effect of tea drinking on MI. How this study might affect research, practice, or policy?  This study suggests that MVPA is independently associated with MI. In addition, this provides a basis for clinical exercise intervention. Final","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649997","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}

{"title":"Therapeutic targets for gastrointestinal diseases: proteome-wide Mendelian randomization and colocalization analyses.","authors":"Daqin Zhan, Zhihao Yang, Pengcheng Li, Jun Pan","doi":"10.1093/postmj/qgae140","DOIUrl":"10.1093/postmj/qgae140","url":null,"abstract":"<p><strong>Purpose: </strong>This study was aimed to identify serum proteins linked with gastrointestinal diseases by proteome-wide Mendelian randomization analysis.</p><p><strong>Methods: </strong>We determined the casual relationship between 732 kinds of circulating proteins and the 24 kinds of gastrointestinal diseases via Mendelian randomization analysis.</p><p><strong>Results: </strong>Four circulating proteins (FCGR3B, IL-12B, MAPKAPK2, and IL-23R) were associated with the occurrence of ulcerative colitis (UC), and IL23R was also correlated with risk of Crohn's disease (CD). Genetically predicted levels of IL23R were strongly correlated with the risk of UC and CD based on the high supporting evidence of colocalization analysis. Five circulating proteins (NOV, EFEMP1, ADGRE2, LCT, and SEMA3G) were associated with the risk of diverticulosis disease. With high supporting evidence of colocalization, genetically predicted levels of NOV and SEMA3G were inversely correlated with the risk of diverticulosis disease. Five circulating proteins (FUT3, FUT5, CRHBP, SULT2A1, and QPCTL) were associated with the occurrence of cholelithiasis. With high supporting evidence of colocalization, genetically predicted levels of FUT3 and CRHBP were inversely correlated with the risk of cholelithiasis.</p><p><strong>Conclusions: </strong>The proteome-wide Mendelian randomization investigation identified several circulating proteins associated with the risk of UC, CD, diverticular disease and cholelithiasis, which reinforced the understanding of molecular pathogenesis and design of therapeutic targets.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"283-290"},"PeriodicalIF":3.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472940","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}

{"title":"Long-term trends analysis of the incidence and mortality in patients with ovarian cancer: a large sample study based on SEER database.","authors":"Hongwei Zhao, Yu Zhang, Qianyong Zhu","doi":"10.1093/postmj/qgae143","DOIUrl":"10.1093/postmj/qgae143","url":null,"abstract":"<p><strong>Background: </strong>To analyze long-term trends of the incidence and mortality of ovarian cancer in the United States.</p><p><strong>Methods: </strong>Patients diagnosed with ovarian cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2017. Joinpoint regression analysis was used to analyze the incidence and mortality trend, and the changes were reported as average annual percentage change (AAPC) with a 95% confidence interval (CI). Kaplan-Meier survival curve and Cox regression analyses were utilized for survival analysis.</p><p><strong>Results: </strong>A total of 74 682 patients were included, among whom 49 491 (66.27%) died and 44 487 (59.57%) died from ovarian cancer. The mean age was 61.95 ± 15.23 years. The incidence of ovarian cancer showed a decreased trend from 2000 to 2017 with an AAPC of -1.9 (95%CI: -2.0, -1.7). Both the overall mortality and cancer-specific mortality for ovarian cancer decreased from 2000 to 2017, with AAPCs of -5.0 (95%CI: -5.7, -4.2) and -4.6 (95%CI: -5.4, -3.8), respectively. There was a significant decrease in the incidence and mortality of patients with the distant SEER stage, histological subtypes of serous and malignant Brenner carcinoma, and grades II and III from 2000 to 2017. Older age, Black race, histological subtypes of carcinosarcoma, higher tumor grade, and radiotherapy were associated with poorer overall survival and cancer-specific survival, whereas higher income, histological subtype of endometrioid, and surgery were associated with better survival.</p><p><strong>Conclusion: </strong>This study provided evidence of a statistically significant decrease in the incidence and mortality of ovarian cancer from 2000 to 2017. Key message What is already known on this topic?  Ovarian cancer is one of the most common tumors in women, with high morbidity and mortality. However, trends in long-term morbidity and mortality of patients with ovarian cancer have not been reported. What this study adds  Overall incidence and mortality for ovarian cancer showed a decreased trend from 2000 to 2017, and trends in incidence and mortality varied by stage, histological subtype, and tumor grade. Factors associated with overall survival and cancer-specific survival also differ. How this study might affect research, practice, or police  This study provides evidence of long-term trends in ovarian cancer incidence and mortality from 2000 to 2017.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"302-312"},"PeriodicalIF":3.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546944","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}

{"title":"An introduction to anatomical pathology.","authors":"Jack D Hywood, Albert H Yin","doi":"10.1093/postmj/qgae160","DOIUrl":"10.1093/postmj/qgae160","url":null,"abstract":"<p><p>Our experience in the Australian context is that medical students and clinicians receive minimal exposure to anatomical pathology throughout the course of their training. In this paper, we bring this topic to light by describing the process of converting an intact specimen into glass slides for microscopic analysis. We also explain how a pathological report is composed, along with brief discussions about ancillary tests, such as immunohistochemistry, special stains, and molecular testing. Our main goal is to familiarize clinicians with anatomical pathology in order to improve communication between clinicians and pathologists, as well as improve the quality of testing and patient care.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"366-370"},"PeriodicalIF":3.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695760","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}

{"title":"LLMs may improve medical communication: social science perspective.","authors":"Shuo Wang, Tianyu Liu, Shotaro Kinoshita, Hiromi M Yokoyama","doi":"10.1093/postmj/qgae101","DOIUrl":"10.1093/postmj/qgae101","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"384-385"},"PeriodicalIF":3.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141913736","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}

{"title":"Association between asthma and depression: results from the NHANES 2005-2018 and Mendelian randomization analysis.","authors":"Yikun Guo, Jun Yan","doi":"10.1093/postmj/qgae147","DOIUrl":"10.1093/postmj/qgae147","url":null,"abstract":"<p><strong>Objective: </strong>Asthma is a common respiratory disease that is believed to be associated with mental disorders. This study aims to assess the correlation and causal relationship between asthma and depression by combining observational and Mendelian randomization (MR) approaches.</p><p><strong>Methods: </strong>We collected relevant data from the National Health and Nutrition Examination Survey (NHANES) and employed multivariable logistic regression to evaluate the correlation between asthma and depression. Additionally, a two-sample MR analysis was conducted using inverse variance-weighted (IVW) method, along with multiple sensitivity analyses.</p><p><strong>Results: </strong>The observational study included a total of 23 648 participants, and the results showed that asthma patients had an increased risk of developing depression compared to non-asthma individuals (OR 1.26; 95% CI 1.04-1.57; P < 0.01). The IVW-MR results from two datasets indicated a potential causal relationship between asthma and depression (EBI dataset: OR 1.141; 95% CI 1.051-1.239; P = 0.01; UKB dataset: OR 1.009; 95% CI 1.005-1.013; P < 0.01). These findings suggest that asthma may be a risk factor for the onset of depression, increasing the risk of developing depression.</p><p><strong>Conclusion: </strong>There is a significant correlation and potential causal relationship between asthma and depression, with asthma being a risk factor for the onset of depression. These findings warrant further research for validation and exploration of preventive and therapeutic measures for depression in asthma patients. Key messages What is already known on this topic-There are some potential associations between asthma and depression based on observational studies, but the results of observational studies are often biased. This study aims to further explore the relationship between asthma and depression through a combination of observational studies and Mendelian randomization (MR) analysis. What this study adds-The observational study results from the National Health and Nutrition Examination Survey database and MR analysis are consistent, indicating that after adjusting for multiple covariates and confounding factors, asthma increases the risk of depression and is a risk factor for depression, with similar results obtained at the genetic level. How this study might affect research, practice or policy-Asthma patients not only need active medication treatment, but also need timely psychological attention, and psychological treatment is more important to a certain extent.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"291-301"},"PeriodicalIF":3.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546914","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}

{"title":"Over-the-scope clips for Nonvariceal upper gastrointestinal bleeding: a systematic review and meta-analysis of randomized studies.","authors":"Yuanzhi Ni, Kamran Ali, Penghao Tang, Khizar Hayat, Zhiwen Cheng, Benfeng Xu, Zhiwen Qin, Wu Zhang","doi":"10.1093/postmj/qgae155","DOIUrl":"10.1093/postmj/qgae155","url":null,"abstract":"<p><strong>Background & aims: </strong>Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common and potentially life-threatening condition. Over-the-scope clips (OTSCs) have emerged as a promising endoscopic treatment option for NVUGIB. We aimed to analyze the efficacy and safety of OTSCs compared to standard endoscopic treatments (ST) in patients with NVUGIB.</p><p><strong>Methods: </strong>We conducted a comprehensive search of PubMed, Embase, Scopus, and Cochrane Library databases from inception to June 2024 for randomized controlled trials (RCTs) comparing OTSCs with ST for NVUGIB. The primary outcomes were initial hemostasis and persistent bleeding. Secondary outcomes included rebleeding rates, mortality, hospital stays and others. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random/fixed-effects models.</p><p><strong>Results: </strong>Six RCTs involving 621 patients were included in the meta-analysis. OTSCs demonstrated significantly higher initial hemostasis (OR 4.80, 95% CI 1.78-12.96; P = 0.002) and lower persistent bleeding rates (OR 0.17, 95% CI 0.05-0.56; P = 0.003) compared to ST group. The rebleeding rate was significantly lower in the OTSC group 7-days re-bleeding (OR 0.27, 95% CI 0.14-0.53; P = 0.001); 30-days rebleeding (OR 0.40, 95%CI 0.22, 0.70; P = 0.002). No significant differences were observed in mortality (OR 0.65, 95% CI 0.31-1.33; P = 0.38) and hospital stay (mean difference 0.79 days 95%CI -0.57, 2.15) between the two groups.</p><p><strong>Conclusions: </strong>OTSCs are more effective than ST for achieving hemostasis and preventing rebleeding in patients with NVUGIB, without increasing mortality. Key message What is Already Known  Previous studies have shown that nonvariceal upper gastrointestinal bleeding (NVUGIB) is a serious medical condition that needs effective endoscopic interventions. The success rates of standard treatments for achieving hemostasis and preventing rebleeding are not consistent. What This Study Adds  According to this study, over-the-scope clips (OTSCs) have the same mortality rate as standard endoscopic treatments, but they significantly improve initial hemostasis and lower rebleeding rates. Impact on Research, Practice, or Policy  The findings support the use of OTSCs as a preferred intervention for NVUGIB, which could affect clinical guidelines and encourage additional research focused on improving endoscopic techniques and patient outcomes in the management of gastrointestinal bleeding.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"351-359"},"PeriodicalIF":3.6,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583935","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}