Prostate Cancer and Prostatic Diseases最新文献

{"title":"Sexual outcomes after MIST for BPH: Avoiding overgeneralization and improving patient selection.","authors":"Lei Wang, Zhihui Li, Liang Zhong, Dongxiang Zheng","doi":"10.1038/s41391-026-01115-6","DOIUrl":"https://doi.org/10.1038/s41391-026-01115-6","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of durability of the prostatic urethral lift (PUL) for benign prostatic hyperplasia.","authors":"Gregg Eure, Matt Ashley, Daniel B Rukstalis, Peter Chin, Neil Barber, Claus Roehrborn","doi":"10.1038/s41391-026-01101-y","DOIUrl":"https://doi.org/10.1038/s41391-026-01101-y","url":null,"abstract":"<p><strong>Background: </strong>There is a need to understand the predictors of prostatic urethral lift (PUL) durability to help physicians counsel patients and optimize outcomes.</p><p><strong>Methods: </strong>A simple logistic regression analysis was performed on a pooled dataset of 331 subjects across 5 PUL controlled studies with up to 5 years follow up. Predictors of \"surgical durability\" (no surgical treatment for return of symptoms) and \"total durability\" (no surgical or medical treatment for return of symptoms) were assessed at 1- and 5-year post-procedure.</p><p><strong>Results: </strong>Placing ≤4 implants regardless of baseline prostate volume was associated with increased surgical retreatment within the first year. Through one year, more implants were protective of retreatment; for every incremental implant placed, surgical retreatment odds decreased an additional 41.2% and risk of combined surgical or medical retreatment decreased 30.2%. Higher implant density was also protective through one year; for each additional implant placed per 10cc prostate volume, surgical retreatment odds decreased incrementally by 79.0%. Up to 5 years, a higher baseline pretreatment IPSS score predicted higher rates of surgical or medical retreatment; for every one-point score increase of baseline IPSS, surgical or medical retreatment odds increased 5.2%. Baseline demographics, medical history and baseline sexual function were not predictors of surgical or total durability.</p><p><strong>Conclusions: </strong>More implants, higher implant density, and lower baseline IPSS are all associated with decreased surgical and medical retreatment rates up to 5 years following PUL. These findings inform optimizing PUL technique, considering earlier intervention and counseling men on outcomes prior to PUL.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and surgical management of recto-urinary fistula after radical prostatectomy: a systematic review on current evidence.","authors":"Mario de Angelis, Pietro Scilipoti, Riccardo Leni, Mattia Longoni, Paolo Zaurito, Antonio Franco, Edoardo Beatrici, Stefano Resca, Andrea Noya Mourullo, Enrico Vecchio, Sara Tamburini, Claudio Brancelli, Vincenzo Cavarra, Alfonso Santangelo, Andrea Folcia, Armando Galdieri, Giorgio Gandaglia, Armando Stabile, Ettore Di Trapani, Gennaro Musi, Ruben De Groote, Alexandre Mottrie, Francesco Montorsi, Alberto Briganti, Marco Bandini","doi":"10.1038/s41391-026-01114-7","DOIUrl":"https://doi.org/10.1038/s41391-026-01114-7","url":null,"abstract":"<p><strong>Background: </strong>Management of rectourinary fistula (RUF) is challenging due to limited data and variability in presentation and treatment. We conducted a systematic review of radical prostatectomy (RP)-related RUF to assess clinical features, diagnostics, treatments, and outcomes, and to propose a structured algorithm to guide management.</p><p><strong>Methods: </strong>We conducted a systematic review in accordance with PRISMA guidelines to evaluate the clinical presentation, diagnostic strategies, management approaches, and outcomes of RUF following RP. A comprehensive search of PubMed, Embase, and Web of Science was performed from database inception to January 2025. Data were extracted on patient demographics, symptoms, diagnostic modalities, management strategies, surgical repair techniques and treatment outcomes.</p><p><strong>Results: </strong>A total of 455 cases of RUF following RP were identified across 34 studies. The reported incidence of RUF ranged from <0.01% to 1.5%. The most frequent presenting symptoms were urine leakage per rectum (60.7%), fecaluria (44.1%), and pneumaturia (50.0%). Fecal and/or urinary diversion was utilized in over 60% of cases, with a median stoma duration of 3 months and an indwelling urinary catheter duration of 1 month. Conservative management (observation, fluid replacement and antibiotic therapy) was attempted in a minority of patients and was generally associated with success rates below 50%. Surgical repair was performed in nearly all cases, with the transperineal and transsphincteric approaches being the most commonly employed techniques. The median time to fistula closure ranged from 0.5 to 30 months, with reported surgical success rates varying between 41% and 100%. We propose a management flowchart based on our clinical experience, outlining the diagnostic and therapeutic approach to rectal injury and RP-related RUF.</p><p><strong>Conclusions: </strong>RUF after RP remains a challenging complication, often requiring stepwise management. Conservative treatments rarely succeed, and surgery is often necessary. Our proposed algorithm aims to standardize the approach to RI and RUF, guiding treatment decisions and improving outcomes.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of fluoroquinolone-resistant bacterial colonization prior to prostate biopsy: a secondary analysis of two randomized trials.","authors":"Daniel Barbakoff, Gal Wald, Mary Oakley Strasser, Rebecca Yu, Joshua Winograd, Mitchell Huang, Conor B Driscoll, Nicole Handa, Andrew Vickers, Edward M Schaeffer, Jim C Hu","doi":"10.1038/s41391-026-01110-x","DOIUrl":"https://doi.org/10.1038/s41391-026-01110-x","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of fluoroquinolone resistant (FQR) rectal bacterial colonization ranges from 15-20%, and FQR colonization increases the risk of prostate biopsy infectious complications. FQR bacteria have been identified in 50% of prostate biopsy infectious complications. However, predictors of FQR remain unclear, so we aimed to elucidate these characteristics.</p><p><strong>Methods: </strong>A secondary analysis of two multicenter clinical trials (NCT04815876 and NCT04843566) comprising 11 sites was conducted on men who underwent rectal swab cultures prior to prostate biopsy. Rectal swab cultures were examined to identify FQR bacteria and factors associated with post-biopsy infections. Sites with fewer than 30 rectal swab results were aggregated. Multivariable logistic regression was used to identify whether age, race, ethnicity, diabetes, smoking history, or site were associated with FQR colonization.</p><p><strong>Results: </strong>FQR bacterial colonization was identified in 145 (16%, 95% CI: 13%, 18%) of 925 patients. One site within the same metropolitan area as the reference site had increased odds of FQR colonization [OR 3.68 (CI: 1.98, 6.83, p < 0.001)]. Transrectal biopsy infection risk increased with FQR rectal bacteria (3.9% vs. 0.8%; risk difference 3.2%; 95% CI: -1.3%, 7.5%; p = 0.017). There was an insignificantly increased odds of FQR colonization for Asian men (OR 1.94, 95% CI: 0.92, 3.89; p = 0.070).</p><p><strong>Conclusions: </strong>FQR rectal colonization was associated with higher rates of post-TR biopsy infection despite targeted prophylaxis. FQR colonization rates differed significantly across trial sites. Future research should continue to identify FQR predictors and their underlying causal pathways to reduce the risk of infectious complications.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and management of transient lower urinary tract symptoms (LUTS) after surgery for Benign prostatic obstruction (BPO): a systematic review.","authors":"Giacomo Gallo, Riccardo Lombardo, Antonio Cicione, Jean-Nicolas Cornu, Antonio Franco, Ferdinando Fusco, Sachin Malde, Celeste Manfredi, Christopher Netsch, Malte Rieken, Stavros Gravas, Mauro Gacci, Cosimo De Nunzio","doi":"10.1038/s41391-026-01082-y","DOIUrl":"https://doi.org/10.1038/s41391-026-01082-y","url":null,"abstract":"<p><strong>Background: </strong>The evaluation and management of lower urinary symptoms (LUTS) experienced in the immediate post-operative period after benign prostatic obstruction surgery (BPO), remain unclear. Aim of our study is to systematically report the evidence on management of post-operative transient urinary symptoms after BPO surgery.</p><p><strong>Methods: </strong>A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist (PRISMA). PubMed, Embase, Scopus and Cochrane databases were searched up to March 2025. Studies evaluating pharmacotherapy, phytotherapy and/or physical treatment for post-operative transient LUTS in men aged were evaluated. Only randomized clinical trials (RCTs) were included.</p><p><strong>Results: </strong>Overall, nine RCTs were included. Among the surgical techniques investigated, most data were available for transurethral resection of the prostate. The methods used to assess post-operative LUTS, as well as the timing of evaluation, varied considerably across studies. The most commonly submitted questionnaire was the International Prostate Symptom Score, and the most frequently performed diagnostic tool was uroflowmetry. Anticholinergic drugs seems to have the greatest efficacy in improving post-operative LUTS, even if the level of evidence is low. In contrast, alpha-blockers did not appear to offer significant additional benefits in this setting of patients. Phytocomplexes (Graminex G63, Curcumin complexes) were effective in improving patients' quality of life (QoL) after BPO surgery. Pelvic floor muscle exercises (PFME) also demonstrated a reduction in symptom-related bother.</p><p><strong>Conclusion: </strong>Current strategies for evaluating and managing transient postoperative LUTS are heterogeneous, and available evidence remains limited. Anticholinergic agents and phytotherapeutic compounds are among the most commonly prescribed treatments, though their efficacy is suboptimal. High-quality randomized trials are needed to provide robust clinical recommendations.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical management of hematuria after endoscopic surgery for benign prostatic obstruction.","authors":"Alexis E Te, Austen G Te, Ashwin Ramaswamy, Steven A Kaplan","doi":"10.1038/s41391-026-01111-w","DOIUrl":"https://doi.org/10.1038/s41391-026-01111-w","url":null,"abstract":"<p><p>Postoperative hematuria following transurethral prostate procedures ranges from self-limited bleeding to life-threatening hemorrhage. Clinically significant hematuria occurs in approximately 13-22% of patients after transurethral resection of the prostate (TURP), with clot retention in 1-5%. Bleeding risk increases with prostate size, and transfusion rates approach 9% for glands exceeding 60 g. This perspective synthesizes current evidence on the prevention and management of postoperative hematuria across transurethral prostate procedures, including standard TURP, laser techniques, and office-based minimally invasive surgical treatments (MISTs). Prevention begins preoperatively with risk stratification, anticoagulation management, and consideration of 5α-reductase inhibitors to reduce prostatic vascularity. Intraoperatively, bipolar energy and laser vaporization provide improved hemostasis compared with monopolar resection, while MISTs such as UroLift and Rezūm carry distinct bleeding profiles that warrant tailored postoperative management. Postoperative management follows a stepwise approach: large-lumen catheterization with continuous bladder irrigation, balloon traction for tamponade, antispasmodics for bladder spasm control, and tranexamic acid for pharmacologic hemostasis. Surgical escalation with cystoscopic clot evacuation, fulguration, or prostatic artery embolization is reserved for refractory cases. We present a device-agnostic outpatient workflow (Figure 1) applicable to ambulatory and office-based procedures. Most patients recover with conservative measures, and protocolized care improves safety and outcomes. Future research should focus on standardizing management pathways, identifying predictors of clinically significant bleeding, and exploring the role of AI-based risk stratification and novel hemostatic agents.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytoplasmic versus nuclear localization of androgen receptor splice variant 7 as a predictor of benefit from androgen receptor pathway inhibitors in metastatic castration-resistant prostate cancer (PROPHECY trial).","authors":"Santosh Gupta, Siyuan Guo, Susan Halabi, Chenxi Yu, Hyotae Kim, Jane McKenzie, Daniel J George, David M Nanus, Russell Z Szmulewicz, Daniel C Danila, Jun Luo, Emmanuel S Antonarakis, Andrew J Armstrong","doi":"10.1038/s41391-026-01113-8","DOIUrl":"https://doi.org/10.1038/s41391-026-01113-8","url":null,"abstract":"<p><strong>Background: </strong>Androgen receptor splice variant-7 (AR-V7), a constitutively active truncated protein, is linked to hormone therapy resistance. Nuclear AR-V7 in CTCs correlates with poor response and shorter progression-free survival (PFS) and overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC) treated with ARPIs. The predictive value of cytoplasmic AR-V7 localization remains unclear. This exploratory study evaluated whether an AR-V7-agnostic CTC scoring criterion, including cytoplasmic detection, better predicts ARPI in this mCRPC setting.</p><p><strong>Methods: </strong>Baseline blood from 107/118 pre-ARPI mCRPC patients in the PROPHECY trial (NCT02269982) was analyzed for nuclear and cytoplasmic AR-V7 using Epic's CTC platform. Associations with confirmed PSA50 response, OS, and PFS with abiraterone or enzalutamide treatment were examined. Correlations between AR overexpression, AR-V7 localization, and AR-V7 mRNA levels were assessed. Proportional hazards models adjusted for Halabi risk score and CellSearch CTC count (>5) evaluated cytoplasmic AR-V7 prognostic significance.</p><p><strong>Results: </strong>At baseline, 10% (11/107) had nuclear-localized AR-V7 and 14% (15/107) had cytoplasmic-only AR-V7, totaling 24% AR-V7-positive. All nuclear AR-V7 cases showed AR overexpression vs. 67% of cytoplasmic-only cases. PSA50 responses occurred in 0% nuclear, 13% cytoplasmic-only, and 30% AR-V7-negative patients. Cytoplasmic AR-V7+ patients had worse PFS and OS than AR-V7- patients, but similar PFS compared with nuclear AR-V7 + , despite numerically better PSA declines and OS.</p><p><strong>Conclusions: </strong>Cytoplasmic-only AR-V7 is more prevalent than nuclear AR-V7 in mCRPC and is associated with poor PFS and intermediate PSA and OS outcomes. Assessing both nuclear and cytoplasmic AR-V7 in CTCs may improve risk stratification before ARPI therapy.</p><p><strong>Clinical significance: </strong>This study clarifies the clinical relevance of cytoplasmic AR-V7 in circulating tumor cells from men with metastatic castration-resistant prostate cancer. While nuclear-localized AR-V7 predicts extremely poor response, PFS, and overall survival with AR pathway inhibitors, cytoplasmic AR-V7 expands the definition of AR-V7-positive status and identifies patients with equally poor PFS and intermediate response and overall survival outcomes. Assessing both nuclear and cytoplasmic AR-V7 fractions may thus improve risk stratification heterogeneity and could better guide poor-risk ARPI treatment decisions by avoiding ineffective ARPI treatment, helping personalize therapy, and improving outcomes in men with mCRPC.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to correspondence regarding \"The value of micro-ultrasound for prostate cancer screening: a retrospective real-world feasibility study\".","authors":"Johann J Wendler, Jonas Bechstein, Hannes Cash","doi":"10.1038/s41391-026-01112-9","DOIUrl":"https://doi.org/10.1038/s41391-026-01112-9","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitochondrial dysfunction in urologic disease.","authors":"Alexis E Adrian, Natalie J Boucher, Kevin T McVary, Donald B DeFranco, William A Ricke","doi":"10.1038/s41391-026-01097-5","DOIUrl":"https://doi.org/10.1038/s41391-026-01097-5","url":null,"abstract":"<p><strong>Purpose: </strong>Lower urinary tract symptoms (LUTS) can result from several conditions, including but not limited to benign prostatic hyperplasia, diabetes, stress urinary incontinence, and metabolic syndrome. In 2011, it was estimated that nearly 2 billion people (45.2% of the world population) experience one or more LUTS. To date, there is no single underlying mechanism identified in lower urinary tract symptoms or the associated conditions. However, a recent body of evidence has demonstrated that mitochondrial dysfunction may contribute to conditions associated with LUTS. Furthermore, patients with inherited mitochondrial disease exhibit lower urinary tract symptoms at rates above the general population. Given that mitochondrial dysfunction is an under-investigated area of urinary disease research, this review aims to summarize the existing literature in the field.</p><p><strong>Methods: </strong>PubMed was used as the primary database for literature search. Keywords included \"lower urinary tract symptoms\", \"mitochondria\", \"urinary dysfunction\"; additionally, once identified, further disease-specific searches were performed (e.g., \"urinary dysfunction in type 1 diabetes\"). Studies published earlier than August 2025 were included, and a specific focus was placed on clinical or human studies. Urologic conditions lacking at least three publications investigating mitochondrial dysfunction were not included; studies examining mitochondrial dysfunction in urologic cancers were also outside the scope of this review.</p><p><strong>Results and conclusions: </strong>Mitochondrial dysfunction is a potential novel intersection of diseases associated with LUTS, including aging, metabolic syndrome, diabetes, stress urinary incontinence, benign prostatic hyperplasia, and overactive bladder. While initial studies are promising, more investment into identifying underlying mechanisms and new potential treatments is needed. Additionally, as mitochondrial modulators undergo trial as treatments in other conditions, careful consideration should be given to their potential as treatments for LUTS.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifestyle matters: physical activity and prostate cancer progression.","authors":"Alanna Burwell, Maria P Mogollon, Gillian Gresham, Stephen J Freedland","doi":"10.1038/s41391-026-01105-8","DOIUrl":"10.1038/s41391-026-01105-8","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}