Swiss medical weekly最新文献

{"title":"Supplementum 288: Abstracts of the of the annual meeting of the Swiss Society of Intensive Care Medicine (Interlaken, Switzerland, September 17-19, 2025).","authors":"Swiss Society Of Intensive Care Medicine","doi":"10.57187/s.4946","DOIUrl":"10.57187/s.4946","url":null,"abstract":"","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"Supplementum 288"},"PeriodicalIF":1.9,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856405","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":"Swiss recommendations on driving ability in patients with diabetes mellitus.","authors":"Roger Lehmann, Sandrina Bervini, Vojtech Pavlicek, Regula Wick, Barbara Lucchini, Ulrike Iten, Lia Bally","doi":"10.57187/s.4665","DOIUrl":"10.57187/s.4665","url":null,"abstract":"<p><p>Most people with diabetes mellitus operate motor vehicles safely without creating any meaningful risk on the road for themselves or others. A diagnosis of diabetes is, in itself, inadequate for determining a person's driving capability or safety. Diabetes-related traffic accidents are rare for most drivers with diabetes mellitus and occur less frequently than for many other diseases that can impair driving performance and that are tolerated by society. The incidence of hypoglycaemia, which impairs the ability to drive, severe retinopathy (including macular oedema) or cataract formation affecting visual acuity required to drive a motor vehicle, and peripheral neuropathy, which can severely impair sensation in the feet, is not so common as to justify restricting driving privileges for all drivers with diabetes mellitus. In recent years, several pharmacological and technological innovations have revolutionised diabetes care. Continuous glucose monitoring system (CGMS) technology has only recently become increasingly integrated into diabetes therapy. Today, except for insulin, none of the treatments recommended for type 2 diabetes mellitus causes hypoglycaemia, and the risk of hypoglycaemia with ultra-long-acting insulins is lower. As a result, recommendations for driving motor vehicles have had to be adjusted. Since hypoglycaemia is the greatest risk factor for impaired driving ability, the latest technology (CGMS coupled with hybrid closed-loop insulin pumps) can reduce the number of hypoglycaemic events and blood glucose fluctuations. In addition, HbA1c and time in target range can be improved. Patients with type 1 diabetes mellitus are now, in exceptional cases, allowed to be licensed in higher vehicle categories. With the analysis of CGMS data, an objective assessment of the frequency of hypoglycaemia is now possible; this was previously only partially possible with blood glucose logs. Patients who are treated with insulin should use a CGMS. This also applies to gestational diabetes and diabetes during pregnancy. Since these systems warn of impending hypoglycaemia, they will also improve road safety, and the safety margin for blood glucose, previously set at 5 mmol/l, can be lowered to 4 mmol/l. For CGMS users, blood glucose measurements every 2 hours while driving are no longer necessary.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4665"},"PeriodicalIF":1.9,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856406","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":"\"A good physician works full-time?\" - a mixed-methods study on (mis)conceptions about part-time work in hospitals.","authors":"Barbara Jarmila Germann, Julia Frey, Alain Soltermann, Janna Küllenberg","doi":"10.57187/s.4205","DOIUrl":"10.57187/s.4205","url":null,"abstract":"<p><strong>Study aims: </strong>While part-time employment is commonly discussed as a way to recruit and retain physicians, the average workload of hospital physicians has barely decreased in the past decade, and hospitals face persistent difficulties in adopting part-time work. This study aims to examine the attitudes of hospital physicians across various specialties and positions towards part-time employment, and to identify factors that hinder or facilitate the successful implementation of part-time arrangements in hospital settings.</p><p><strong>Methods: </strong>We conducted an exploratory mixed-method study, combining a qualitative interview study with reflexive thematic analysis of 19 participants, and an online quantitative survey of 553 physicians. Data were collected between August and November 2023 in seven public hospital organisations in Switzerland.</p><p><strong>Results: </strong>The quantitative data revealed a widespread desire for workload reduction across all roles, specialties, age groups and sexes, with an average ideal workload of 81%. Contrary to some statements in the qualitative interviews, the youngest cohort of physicians reported the highest ideal workload (88%). Most respondents (60%) believed they would be granted a workload reduction, yet an equal percentage at least partially agreed that working part-time would negatively impact advancement opportunities within the hospital. Other concerns about part-time work included the additional workload it might place on colleagues (76.5%) and a potential decline in medical quality (17.5%). These concerns varied across specialties and positions. The qualitative interviews identified both organisational and cultural barriers to the implementation of part-time work for hospital physicians, such as complex scheduling, additional effort and the prevailing \"ideal physician norm\" that prioritises physical presence and professional obligations over personal life. Conversely, factors facilitating part-time work included a supportive culture for part-time models and flexible organisational structures and processes.</p><p><strong>Conclusion: </strong>Addressing current perceptions of physicians' part-time work may be an essential first step towards establishing sustainable part-time solutions in hospitals. This includes the assumption that a physician's competence depends solely on his or her availability. Furthermore, the redesign of workplace structures, including shift schedules and training programmes, may be necessary to accommodate varying workloads. When accommodating part-time solutions for hospital physicians, implementing one-size-fits-all solutions may not be expedient, given the varying circumstances of different specialties and positions. Therefore, we recommend that solutions be tailored to the specific needs of each clinic and developed through a participatory process.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4205"},"PeriodicalIF":1.9,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856372","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":"Sensitivity of clinical screening for detecting developmental dysplasia of the hip: a retrospective study.","authors":"Enrica Pittaluga, Alexis Arnoux, Sophie Merckaert","doi":"10.57187/s.4077","DOIUrl":"10.57187/s.4077","url":null,"abstract":"<p><strong>Background: </strong>Detecting developmental dysplasia of the hip in infants is crucial. This study aimed to estimate the sensitivity of clinical screening for developmental dysplasia of the hip in a tertiary care setting. We compared clinical findings with ultrasound results to determine diagnostic accuracy.</p><p><strong>Methods: </strong>This retrospective study evaluated newborns aged 0-4 months treated for developmental dysplasia of the hip from May 2017 to June 2023 at a tertiary care centre in Switzerland. All patients underwent clinical examinations and a hip ultrasound scan (Graf method). The sensitivity of clinical findings was calculated, along with 95% confidence intervals (CI), and stratified by developmental dysplasia of the hip severity.</p><p><strong>Results: </strong>Among 122 newborns, clinical screening demonstrated an overall sensitivity of 66% (95% CI: 58-74%). Sensitivity was higher for unstable hips (91%, 95% CI: 82-99%) than for stable hips (50%, 95% CI: 38-62%). Differences in diagnostic timing were observed between groups.</p><p><strong>Conclusion: </strong>Clinical screening for developmental dysplasia of the hip showed limited sensitivity, particularly for stable cases. Universal ultrasound screening could improve early detection rates.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4077"},"PeriodicalIF":1.9,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856401","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":"Impact of COVID-19 lockdown-associated visitor restrictions on mother-child interaction and emotional state of women in the puerperium - a retrospective cohort study.","authors":"Irina Höhn, Anett Hernadi, Reto Zihlmann, Christina Coelius, Katharina Walter, Amr Hamza, Nicole Ochsenbein-Kölble, Leonhard Schäffer","doi":"10.57187/s.3894","DOIUrl":"10.57187/s.3894","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The aim of this study was to analyse the impact of maternal isolation during the COVID-19 lockdown. Two main aspects were examined: (1) What impact do these social restrictions have on maternal depressive symptoms? and (2) Is there an influence on mother-child interaction? As secondary endpoints, we defined the influence of the restrictions on breastfeeding, the length of hospital stay, patient satisfaction during the inpatient stay due to the reduced number of visitors, and postpartum complications after discharge.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;The study was conducted at a university-affiliated teaching hospital in Switzerland. Women who delivered in the first phase of the COVID-19 pandemic and who were not allowed to have any visitors including the child's father (group \"total ban\", n = 53; 20 March 2020 to 10 May 2020) and women who were only allowed to have a visit from the child's father (group \"partial ban\", n = 49; 11 May 2020 to 20 June 2020) were compared to a reference group of women who delivered prior to the restrictions (n = 61; 1 January 2020 to 16 February 2020). Participants completed a questionnaire one year after delivery to assess their situation one week and one year after giving birth. The primary outcomes were the state of mental health (measured by the Edinburgh Postnatal Depression Scale) and maternal bonding (measured by the Mother-to-Infant-Bonding Scale). Secondary outcome measures were breastfeeding status, postpartum complications and length of hospital stay.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 404 women eligible for participation, 241 declined to participate or could not be reached. Obstetric baseline characteristics were similar across all three groups. Analysis of signs of depression showed a 2-fold higher risk of postpartum depression after one week and one year in both isolation groups compared to the reference group (23% and 20% vs 9% at one week; 11% and 11% vs 5% at one year). However, this did not reach statistical significance (p = 0.158; p = 0.471). Analysis of the Mother-to-Infant-Bonding Scale revealed similar scores in all groups in the first week and after 12 months. There were no significant differences in the rates of breastfeeding and postpartum complications. Hospital stays were clearly shorter during the partial and total visitor bans (3.06 days and 2.55 days vs 3.51 days in the reference group [p &lt;0.001]). 45% of patients in the reference group would have been dissatisfied with a limitation to the number of visitors as compared to only 18% in the total and 9% in the partial visitor ban groups (p &lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We found an increased albeit non-statistically significant risk of postpartum depression one week and one year after delivery under different forms of isolation on the postpartum ward. We hypothesise that this is unlikely caused solely by isolation, as both groups were equally affected independently of the possibi","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"3894"},"PeriodicalIF":1.9,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856397","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 impact of the COVID-19 pandemic on cancer incidence, stage distribution and survival in Switzerland: a register-based cohort study.","authors":"Luzius Mader, Lea Wildisen, Dominik Menges, Flurina Suter, Gautier Defossez, Jean-Luc Bulliard, Sabine Rohrmann, Katharina Staehelin","doi":"10.57187/s.4354","DOIUrl":"10.57187/s.4354","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic disrupted healthcare systems worldwide. This raised concerns about delays in cancer diagnosis and treatment, with potentially worse patient outcomes. The aim of this nationwide, population-based cohort study was to investigate the impact of the COVID-19 pandemic on cancer incidence, stage distribution and one-year survival in Switzerland.</p><p><strong>Methods: </strong>We used national cancer registry data for the period 2017-2021 from the National Agency for Cancer Registration in Switzerland, covering all except three cantons. We estimated national cancer incidence counts and calculated age-standardised incidence rates for all cancers and separately for female breast cancer, colorectal cancer, lung cancer, melanoma and prostate cancer. We calculated proportional stage distributions for cancer types and estimated observed and relative one-year survival for all cancers and cancer types based on Swiss population life tables. Results were analysed descriptively.</p><p><strong>Results: </strong>We included 218,736 cancer cases diagnosed between 2017 and 2021. Annual incidence counts of all cancer cases increased in 2020 (2.1%) and 2021 (7.3%) compared to the mean of 2017-2019. When evaluating monthly incidence counts, we observed a substantial decrease during the COVID-19 lockdown period, which was largest in April 2020 (-19.9% for all cancers). This decrease was most pronounced for female breast cancer (-39.9%), followed by prostate cancer (-29.0%), colorectal cancer (-28.7%) and melanoma (-26.9%). An increase in incidence counts for all cancers was observed in March 2021 (18.8%). We observed no clear shift in stage distributions across 2017-2021. The observed and relative one-year survival for all cancers and individual cancer types was similar in 2020 and slightly higher in 2021 compared to 2017-2019.</p><p><strong>Conclusions: </strong>This nationwide study suggests that the pandemic had no major effect on short-term cancer patient outcomes. These findings are of importance for policymakers and the public health system regarding future pandemics.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4354"},"PeriodicalIF":1.9,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856407","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":"Sex- and gender-specific medicine: why it's a man's business too.","authors":"Rubén Fuentes Artiles, Vera Regitz-Zagrosek, Thorsten Buch","doi":"10.57187/s.4098","DOIUrl":"10.57187/s.4098","url":null,"abstract":"<p><p>Sex- and gender-specific medicine must expand to include the health disparities affecting men, who face distinct and under-researched health disparities just as women do in some medical fields. Despite its broad relevance, the field is still primarily led by women, which may inadvertently limit male engagement and distort its scope. Men should join women in actively shaping healthcare into a more inclusive and intersectional system that benefits all.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4098"},"PeriodicalIF":1.9,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856402","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":"Sexual assault reporting: a retrospective study on care provided in gynaecology emergency care settings after sexual assault.","authors":"Sara Cottler-Casanova, Véra Lourenço, Cécile Guillot, Antoine Poncet, Fartuun Musse, Romane Imbaud, Patrice Mathevet, Patrick Petignat, Michal Yaron, Tony Fracasso, Jasmine Abdulcadir","doi":"10.57187/s.3913","DOIUrl":"10.57187/s.3913","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the characteristics of all people reporting sexual assault at the obstetrics and gynaecology emergency departments of Geneva University Hospitals (HUG) and Lausanne University Hospitals (CHUV) between 2018 and 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Retrospective analysis of medicolegal reports for all people reporting sexual assault at the obstetrics and gynaecology emergency departments of HUG and CHUV between 2018 and 2021. Included: cisgender women, non-binary, queer persons, transgender men with a vulva and vagina and transgender women, regardless of sexual orientation, aged at least 14 years old. Excluded: Children and adolescents &lt;14, cisgender men and trans men with a penis (who usually do not consult obstetrics and gynaecology emergency departments after a sexual assault) and recurrent patients with more than three sexual assaults reported at a participating centre within the study period (the first three assaults were included). During the study period, the two regional university hospitals used the same forensic sexual assault reporting forms, which allows a uniform description of the sociodemographic and clinical characteristics of patients reporting sexual assault as well as the characteristics of the sexual assault itself.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;Of the 962 sexual assault records during the 48-month study, 740 were retained for the analysis. Median age of victims: 24 years (interquartile range: 19 to 33 years; range: 14 to 93 years). On weekend days, the number of assaults was twice as high as on weekdays (45% of all sexual assaults took place during the weekend, on either a Saturday or Sunday). During the summer, the monthly number of assaults was increased by half. The summer months had the highest number of consultations (34%). 58% of victims reported knowing their assaulter, 28% did not, and due to amnesia, 14% did not know whether they knew their attacker or not. 24% of the patients were unable to recall or specify which types of penetration they were subjected to (if any), because of amnesia. 67% of patients reported vaginal penetration, 17% anal and 21% oral. 63% of victims reported some type of substance use (alcohol, drugs) prior to the assault. The police or public prosecutor ordered 40% of the sexual assault medicolegal examinations, while 60% of the victims came to the emergency department seeking care on their own. 56% of assaults take place at someone's home (victim's home, assailant's home, friend/family member's home, couple's home). 83% of patients were examined within 72 hours of the sexual assault. Ano-genital injuries were found in 28% of patients who underwent a gynaecological exam (n = 705). 21% of patients who underwent a gynaecological exam and reported anal penetration presented with anal injury. 28% of patients who underwent a gynaecological exam and reported vaginal penetration presented with genital injury.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and recommendations: ","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"3913"},"PeriodicalIF":1.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856403","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":"Faecal incontinence in the era of sacral neuromodulation.","authors":"Sami Hosari, Michaela Ramser, Matthias Turina","doi":"10.57187/s.4298","DOIUrl":"10.57187/s.4298","url":null,"abstract":"<p><p>Faecal incontinence is a debilitating condition that significantly affects an individual's quality of life. Accurate assessment and a thorough understanding of the underlying aetiology are crucial in determining the appropriate management approach. Conservative management strategies, including dietary modifications, pelvic floor exercises and biofeedback therapy are the first therapeutic steps. If these measures are not effective, patients should be referred to a specialised pelvic floor centre for further treatment evaluations. With the latest updates on national and international guidelines, this review aims to provide a comprehensive overview of current best practices in the management of faecal incontinence, with a particular focus on the role of sacral neuromodulation.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4298"},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856379","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":"Genetically engineered T cell and tumour-infiltrating lymphocyte therapies.","authors":"Heinz Läubli, Andreas Holbro","doi":"10.57187/s.4279","DOIUrl":"10.57187/s.4279","url":null,"abstract":"<p><p>Haemato-oncology has made significant progress in recent years, particularly through the development of innovative immunotherapeutic approaches such as CAR T cell (chimeric antigen receptor T cell) and tumour-infiltrating lymphocyte therapies. Both methods use the patient's own immune system to treat cancer, but in different ways. CAR T cell therapy is a form of immunotherapy in which the patient's own T cells are genetically modified. CAR T cell therapies have proven to be particularly effective in haematological B-cell neoplasms, such as B-cell acute lymphoblastic leukaemia (B-ALL) and B-cell lymphomas, as well as in multiple myeloma. Tumour-infiltrating lymphocyte therapy, on the other hand, exploits the natural ability of T cells to recognise tumour-associated antigens of tumour cells with the T cell receptor. Tumour tissue is taken from the patient then tumour-infiltrating lymphocytes are isolated from it. These tumour-infiltrating lymphocytes are expanded ex vivo to increase their number and activity. This review discusses the principles of these innovative therapies. Both therapies represent significant advances in personalised cancer treatment and offer new hope for our cancer patients.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4279"},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856396","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}