Surgical infections最新文献

{"title":"Impact of Whole Blood Resuscitation on Infection Risk in Trauma Patients Undergoing Hemorrhage Control Laparotomy.","authors":"Justin E Dvorak, Joseph Cuschieri, Todd W Costantini, Christopher A Guidry, Amy McDonald, Laura A Kreiner, Nimitt J Patel, Rondi B Gelbard","doi":"10.1177/10962964251410021","DOIUrl":"10.1177/10962964251410021","url":null,"abstract":"<p><strong>Background: </strong>There has been a renewed interest in the use of whole blood (WB) in trauma resuscitation, with studies showing improved mortality rate with WB. However, there is a paucity of studies assessing the impact of WB on infectious complications. The aim of this study was to assess the impact of WB during trauma resuscitation on infectious complications.</p><p><strong>Methods: </strong>A retrospective cohort study utilizing the National Trauma Databank of patients who underwent hemorrhage control laparotomy within one hour was performed. The primary outcome was the impact of receiving WB during trauma resuscitation on surgical infections. Secondary outcome included analysis of a dose-response relation between units of WB and infection. Subgroup analysis was performed on patients undergoing massive transfusion. Multi-variable logistic regression was performed to evaluate outcomes.</p><p><strong>Results: </strong>A total of 2,151 patients received WB compared with 10,641 patients who did not. Receiving WB was not associated with increased odds of infection (odds ratio [OR] = 1.12, 95% confidence interval [95% CI]: 0.94-1.32, p = 0.22). However, each unit of WB received was associated with a 4% increase in odds of infection (OR = 1.04, 95% CI: 1.00-1.08, p = 0.04). In the massive transfusion subgroup, receiving WB was not associated with increased risk of infection.</p><p><strong>Conclusions: </strong>Receiving WB during trauma resuscitation was associated with increased odds of infection in a dose-dependent manner, but not in patients undergoing massive transfusion. Further studies evaluating effects beyond mortality are needed to better evaluate the impact of WB use on trauma patients.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"225-230"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865508","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":"Echinococcal Cyst of the Liver Primarily Infected with <i>Candida glabrata</i>.","authors":"Helen Bolanaki, George Pappas-Gogos, Ioannis Tzimagiorgis, Anastasios J Karayiannakis","doi":"10.1177/10962964251393113","DOIUrl":"10.1177/10962964251393113","url":null,"abstract":"<p><strong>Background: </strong>The main complications of hepatic hydatid disease are infection and rupture into the biliary tree or into the peritoneal cavity. Fungal infections within the biliary tract and the liver are very rare, whereas cases of hepatic echinococcal cysts infected by fungi have not been previously reported.</p><p><strong>Case presentation: </strong>We report on a 63-year-old male patient with a 3-day history of dull, non-radiating pain in the right hypochondrium, low-grade fever, and malaise. His past medical history included a Roux-en-Y hepatico-jejunostomy and gastro-enteroanastomosis for locally extended adenocarcinoma of the intra-pancreatic common bile duct. Laboratory analyses showed elevated WBC and C-reactive protein levels. The computed tomography scan showed an infected hydatid cyst grade CE5 according to Gharbi's and WHO classifications. Catheterization was performed, and cultures revealed <i>Candida glabrata</i>. Anidulafungin was initiated with a loading dose of 200 mg, followed by a daily dose of 100 mg. After 23 days, cultures of the draining fluid showed no fungi or other bacteria. Two days later the catheter was removed, the patient was discharged, and at the time of follow-up at 1 and 2 months, remained well.</p><p><strong>Conclusion: </strong>Fungal infections should be considered in patients with an infected echinococcal cyst of the liver. Understanding of the etiology and epidemiology, along with early and rapid detection of <i>C. glabrata,</i> is necessary for prompt treatment.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"169-172"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446097","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":"Predictive Accuracy of the Complex 30-Day Model for Colon Surgical Site Infections after Traumatic Colon Injury: Any Better than a Coin Flip?","authors":"Annmarie Butare, William Irish, Michael D Honaker, Mark A Newell","doi":"10.1177/10962964251394603","DOIUrl":"10.1177/10962964251394603","url":null,"abstract":"<p><strong>Background and objectives: </strong>Colon surgical site infections (SSIs) impose clinical and financial burden. To guide reimbursement, the Centers for Medicare and Medicaid Services utilize the National Healthcare Safety Network's (NSHN) Complex 30-Day SSI Model for Colon Procedures, which is used to compare the observed number of SSIs to the expected number of SSIs for all colon surgeries, regardless of underlying etiology. This study assessed the predictive accuracy of the Complex 30-day SSI Model for inpatients undergoing emergent colon operations for trauma.</p><p><strong>Patients and methods: </strong>The Trauma Quality Program Participant Use File was used to identify all patients who underwent emergent colon surgery because of trauma between 2017 and 2021 (excluding 2020). The predicted probability of colon SSI was calculated using the NSHN Complex 30-day Model using the following variables: diabetes mellitus, gender, age, body mass index, closure technique, American Society of Anesthesiology Score, and oncology hospital status. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC) was calculated to evaluate the model's predictive accuracy.</p><p><strong>Results: </strong>In total, 292,688 patients were included. Among all patients, an SSI occurred in 0.33% (n = 1,097). For patients with complete data, the rate of SSI was 0.34%. The ROC curve for complete case analysis showed an AUC of 0.523 (95% confidence interval 0.506-0.541).</p><p><strong>Conclusion: </strong>The predictive accuracy of the NSHN Complex 30-Day SSI Model after colon injury is poor. The current model may not adequately capture the complexities and risk associated with trauma. An improved model is needed for more accurate risk assessment to improve patient care and accuracy of hospital reimbursement.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"97-103"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453239","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":"Should Urine Culture Be Performed Before Diagnostic Cystoscopy? Impact on Post-Procedural Infection Risk.","authors":"Alexandre Falkenrodt, Ali Bourgi, Franck Bruyère","doi":"10.1177/10962964251389155","DOIUrl":"10.1177/10962964251389155","url":null,"abstract":"<p><strong>Introduction: </strong>Urinary tract infection (UTI) is an infrequent complication of diagnostic cystoscopy, with an incidence below 5%. Current guidelines are unclear and remain silent regarding the necessity of performing a urine bacterial culture (UBC) before cystoscopy. The objective of this study was to evaluate whether asymptomatic bacteriuria before cystoscopy increases the risk of UTI afterward. In addition, we aimed to identify risk factors in patient characteristics.</p><p><strong>Patients and methods: </strong>We included all patients who underwent diagnostic cystoscopy at our center between September 2022 and May 2023 and performed a UBC within the preceding 15 days. Patients were excluded if they had received antibiotic treatment or did not provide UBC. Data on the UTI within four weeks post-cystoscopy were collected via telephone interviews. UTIs were defined on the clinical criteria established by the U.S. Centers for Disease Control and Prevention.</p><p><strong>Results: </strong>Six hundred eighteen cystoscopies were analyzed. Twenty-nine cases of UTI were reported, accounting for 4.7% of the procedures. Among these, 24 patients had sterile or polymicrobial UBC, whereas 5 had asymptomatic bacteriuria prior to cystoscopy. There was no significant association between asymptomatic bacteriuria and the occurrence of UTI (OR: 1.385, 95% confidence interval [0.513; 3.739], p = 0.52). In multivariable analysis, age was a protective factor (p = 0.01). There was an increase of UTI when the cystoscopy was performed for a suspected tumor (OR: 4.981, 95% confidence interval [1.122; 22.108], p = 0.035) or for a retention (OR: 7.910, 95% confidence interval [1.329; 47.093], p = 0.023). More UTIs occurred when cystoscopy was performed for suspected tumors (p = 0.035) or urinary retention (p = 0.023). There was a significant correlation between asymptomatic bacteriuria and consultation for urinary symptoms after (p = 0.043).</p><p><strong>Conclusion: </strong>We found no correlation between asymptomatic bacteriuria prior to cystoscopy and the subsequent occurrence of UTI. Routine UBC before cystoscopy appears unnecessary. Eliminating this practice could prevent the rescheduling of cystoscopies, which often leads to diagnostic delays. Moreover, it would contribute to reducing antibiotic consumption and combating antibiotic resistance.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"118-124"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309146","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":"The Value of Serum Ferritin and Hepcidin in Diagnosing Periprosthetic Joint Infection: A Single-Center Prospective Study.","authors":"Shao-Yun Zhang, Hong Xu, Jin-Wei Xie, Li Liu, Hui-Min Pi, Qiang Huang, Zong-Ke Zhou, Cong Xiao","doi":"10.1177/10962964251392231","DOIUrl":"10.1177/10962964251392231","url":null,"abstract":"<p><strong>Background: </strong>Preoperative diagnosis of periprosthetic joint infection (PJI) in patients undergoing revision arthroplasty is crucial, so we evaluated whether serum ferritin and hepcidin contribute to this diagnosis.</p><p><strong>Patients and methods: </strong>Patients who underwent revision hip or knee arthroplasty were prospectively divided into those who experienced PJI or not, based on the 2013 International Consensus Meeting Criteria. The serum levels of ferritin and hepcidin, as well as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were compared between the groups. The diagnostic values of the tested biomarkers and their combinations were compared based on the area under the receiver operating characteristic (ROC) curve using the z-test.</p><p><strong>Results: </strong>Of the 88 included patients, 44 were diagnosed with PJI. Serum ferritin in PJI patients was higher than that in non-PJI patients (p = 0.048), whereas there was no significant difference in serum hepcidin between the groups. The area under the ROC curve was 0.830 for CRP, 0.824 for ESR, and 0.643 for ferritin. The combination of serum ferritin with CRP and ESR did not give a higher area under the ROC curve than any pairwise combination.</p><p><strong>Conclusion: </strong>Serum ferritin and hepcidin are of limited value for diagnosing PJI.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"132-137"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446088","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":"<i>Letter:</i> Can We Predict Nosocomial Infections Following Neonatal Repair of Digestive System Atresias?","authors":"Mohamed Zouari, Manel Belhajmansour, Manar Hbaieb, Wiem Rhaiem, Hamdi Louati, Najoua Ben Kraiem, Mahdi Ben Dhaou, Riadh Mhiri","doi":"10.1177/10962964251381641","DOIUrl":"10.1177/10962964251381641","url":null,"abstract":"","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"175-176"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065541","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":"Surgical Site Infection Outbreak in Spinal Surgery: A Systematic Investigation Using Mutually Exclusive and Collectively Exhaustive Analysis.","authors":"Eitaro Okumura, Hiroki Eguchi, Yosuke Nakayama, Ryo Hashimoto, Motoo Kubota","doi":"10.1177/10962964251401443","DOIUrl":"10.1177/10962964251401443","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infections (SSIs) following spinal surgery remain a significant concern despite advances in infection control. We report an unexpected outbreak investigation at an institution with historically low infection rates.</p><p><strong>Methods: </strong>During April-June 2012, our spinal surgery department experienced 6 SSIs among 84 procedures (7.1%) compared with our baseline rate of 0.3%. We conducted a comprehensive MECE (Mutually Exclusive and Collectively Exhaustive) analysis, a systematic framework that ensures all potential factors are examined without overlap or omission, investigating all potential bacterial contamination routes: pre-operative, intra-operative, and post-operative factors. Statistical analysis was performed using Fisher exact test.</p><p><strong>Results: </strong>All infections occurred within 8 days post-operatively with skin commensal organisms as causative agents. Patient characteristics were similar between SSI-positive (n = 6) and SSI-negative (n = 78) groups. Environmental investigations revealed no abnormalities. Crucially, all SSI cases involved novice technicians (non-nursing staff responsible for instrument handling) with <6 months experience (100% vs. 10.3%, p < 0.001), all working in a smaller operating room.</p><p><strong>Conclusions: </strong>Traditional risk factor analysis failed to identify the outbreak cause. Only systematic MECE analysis identified a strong association with staff-related factors. Following targeted training interventions, infection rates returned to baseline levels. This investigation demonstrates that even institutions with excellent baseline infection control remain vulnerable to process failures requiring comprehensive systematic investigation beyond conventional risk factors.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"161-164"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145639969","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":"Utility of a C-Reactive Protein Declination Curve for Detecting Misadventure after Enterocutaneous Fistula Takedown: Opportunity for Early Detection?","authors":"Renceh B Flojo, Luke Caddell, Joseph D Forrester","doi":"10.1177/10962964251395439","DOIUrl":"10.1177/10962964251395439","url":null,"abstract":"<p><strong>Background: </strong>Enterocutaneous (EC) fistulae are a significant complication of abdominal surgery. The surgical takedown of EC fistulae carries a high risk of complications, including sepsis, recurrence, and mortality. Identifying biomarkers to detect complications early may improve outcomes. C-reactive protein (CRP), a marker of inflammation and tissue injury, has shown promise in predicting anastomotic leaks in colorectal surgery. This study evaluates the utility of post-operative CRP declination curves in detecting leaks after EC fistula takedown.</p><p><strong>Methods: </strong>This retrospective case series analyzed adult patients undergoing EC fistula takedown performed by a single surgeon at our institution over the past three years. Inclusion required documented EC fistulae, failure of nonoperative management, and at least three post-operative high-sensitivity CRP measurements. C-reactive protein, white blood cell (WBC), and temperature trends were analyzed alongside secondary outcomes: fistula recurrence, hospital stay, and complications.</p><p><strong>Results: </strong>Seven of 15 eligible cases met the inclusion criteria. C-reactive protein levels peaked immediately post-operatively and on average declined in patients without leaks, stabilizing by the second post-operative week. In patients with leaks, CRP levels deviated from this pattern, remaining elevated until managed. While WBC counts and temperatures showed variable trends, CRP demonstrated more consistent correlations with post-operative recovery and complications.</p><p><strong>Conclusion: </strong>High-sensitivity CRP may serve as a useful adjunct for early detection of post-operative leaks following EC fistula takedown. Preliminary findings support further prospective studies to validate CRP declination curves as a diagnostic tool, potentially improving monitoring and patient outcomes in this high-risk population.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"125-131"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551075","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":"Multi-factorial Hyperlactatemia Due to Linezolid and Metformin Treatment in the Setting of Vitamin C and B1 Deficiency.","authors":"Abdullah Amir, Anthony Iskarous, Amy VanderStoep, Harsh Patel, Stephen M Kavic, Hugo J R Bonatti","doi":"10.1177/10962964251401522","DOIUrl":"10.1177/10962964251401522","url":null,"abstract":"<p><strong>Background: </strong>Lactic acidosis can be a sign of poor tissue perfusion but may also be caused by some commonly used drugs, namely metformin and linezolid.</p><p><strong>Patients and methods: </strong>A 70-year-old overweight female presented to the emergency department with abdominal pain. Although there was concern for biliary sepsis, imaging and lab work were incompatible.</p><p><strong>Results: </strong>Her home medications included linezolid for osteomyelitis and metformin for type II diabetes mellitus. Once these were stopped, the lactate level normalized within 36 h. In addition, she was malnourished and found to be vitamin C and B1 deficient. She made a remarkable recovery after volume, electrolyte, and vitamin supplementation.</p><p><strong>Conclusions: </strong>Although surgeons seek infection and sepsis to explain an elevated lactate, in a patient with multiple co-morbidities, medications, and risk factors such as vitamin deficiencies, a thorough analysis of their history and presentation is vital to uncovering the underlying causes(s) of lactic acidosis.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"165-168"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744740","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 Analysis of the Chemical and Physical Properties of a Silver Carboxylate Titanium-Dioxide Polydimethylsiloxane Antimicrobial Matrix on Orthopedic Implant Materials.","authors":"Dioscaris R Garcia, Jose Navarro, Sai Allu, Neel Vishwanath, Ryan Bain, Dominique M Dockery, Olive Cooper, Nathaniel Kim, Valentin Antoci, Christopher T Born","doi":"10.1177/10962964251389154","DOIUrl":"10.1177/10962964251389154","url":null,"abstract":"<p><strong>Introduction: </strong>The use of silver (Ag) as an antimicrobial agent has gained attention for its multimodal mechanisms of activity. We have previously demonstrated the efficacy of a 95% titanium dioxide (TiO₂) and 5% polydimethylsiloxane (PDMS) silver carboxylate (AgCar)-eluting chemistry, which has been shown to prevent bacterial adherence, proliferation, and biofilm formation on orthopedic implants and prosthetic liners. This project examines the physical and chemical properties of AgCar on polyether ether ketone (PEEK) implant materials and silicone prosthetic liners, which are prone to bacterial colonization.</p><p><strong>Methods: </strong>PEEK implants were coated with varying concentrations of matrix, AgCar, or both. To determine physical properties, we used water contact angle for hydrophilicity, atomic force microscopy for surface roughness averages, and graphite furnace atomic absorption spectroscopy for Ag elution rate. For durability studies, silicone was coated and examined for compressive, frictional, and wear rate properties.</p><p><strong>Results: </strong>All implants demonstrated hydrophobicity in the presence of the matrix, AgCar, or both; in contrast, uncoated (UNC) PEEK implants were found to be hydrophilic. The 95% 10× matrix exhibited a delayed and extended elution of AgCar into solution compared with other solutions. Implant surface roughness increased as AgCar concentrations increased. Durability studies found no notable differences between UNC and 95% 10× coated implants.</p><p><strong>Conclusion: </strong>Consistent with previous work, the 10× AgCar coating demonstrated the best results for inhibitory behavior on two distinct fronts: mechanically, through roughness and increased hydrophobicity, and chemically, through AgCar elution activity. Furthermore, the 10× coating will likely not impair the durability or elasticity of the implant within the body or silicone prosthetic liners. Thus, the 95% TiO₂:5% PDMS matrix doped with a 10× AgCar concentration is a prime candidate for clinical application consideration.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"110-117"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329904","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}