Trauma Case Reports最新文献

{"title":"Management of periprosthetic humeral fractures after shoulder arthroplasty: A case report on open reduction and internal fixation with strut allograft.","authors":"Alexis Kapitanov, Alain Akiki, Geoffroi Lallemand","doi":"10.1016/j.tcr.2026.101350","DOIUrl":"https://doi.org/10.1016/j.tcr.2026.101350","url":null,"abstract":"<p><strong>Introduction: </strong>This case report details the management of a periprosthetic humeral shaft fracture treated by open reduction and internal fixation (ORIF) with a strut allograft. To date, only 50 patients treated with strut allografts for periprosthetic humeral fractures are documented in the literature. Four case series, two retrospective reviews, and one prospective review have been analyzed. Of these, four studies (40 patients) used strut allografts with plates, and three studies (10 patients) used strut allografts with cerclage alone. Fracture union occurred between 3 and 7 months postoperatively. This is the first case report of such a fracture treated with a strut allograft and documented follow-up nearing two years.</p><p><strong>Case report: </strong>A 77-year-old man with multiple prior right shoulder surgeries, including reverse shoulder arthroplasty in 2017, sustained a proximal periprosthetic humeral fracture in 2023 after a fall. Initial ORIF with a long plate failed due to early loss of reduction. A revision procedure was performed using a longitudinally split fibular strut allograft, with halves placed medially and anteriorly, secured by fiber wires and plate fixation. At two years post-op, the patient was pain-free and functional, with radiographs showing fracture consolidation and graft integration.</p><p><strong>Conclusion: </strong>Seven studies have reported outcomes of strut allografts in periprosthetic humeral fractures. Only one compared ORIF with and without allograft, finding no outcome difference. Strut allografts are a valuable option for failed ORIF, providing both biological and mechanical stability.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"63 ","pages":"101350"},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13145393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal cord infarction without radiologic evidence of trauma complicated by cerebellar infarction due to vertebral artery thrombosis: A case report.","authors":"Kazuki Hirose, Yuichi Saisaka, Ryo Ugawa, Yoshihiro Fujiwara, Maki Fukuda, Atsushi Morizane, Kouhei Miyashita, Toshiyuki Matsumoto","doi":"10.1016/j.tcr.2026.101358","DOIUrl":"https://doi.org/10.1016/j.tcr.2026.101358","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injury without radiographic evidence of trauma (SCIWORET) is a rare condition but remains relevant in elderly patients. Herein, we report the rare case of a 78-year-old woman who sustained a spinal cord injury after falling from a bicycle.</p><p><strong>Case report: </strong>Computed tomography (CT) at admission revealed an absence of bony abnormalities; however, motor and sensory deficits were observed below the C4 level, corresponding to Frankel grade B. Magnetic resonance imaging (MRI) demonstrated T2-weighted hyperintensity at levels C4-C7, indicative of spinal cord edema. Notably, axial MRI images revealed a loss of flow voids in the right vertebral artery, while contrast-enhanced CT identified a thrombotic occlusion accompanied by subsequent cerebellar infarction. Decompression surgery and coil embolization of the vertebral artery were accordingly performed. Despite early surgical intervention, no change in neurological status was observed, indicating complete spinal cord injury. The patient is consequently undergoing management in an intensive rehabilitation program focusing on optimizing respiratory function and preventing secondary complications.</p><p><strong>Conclusion: </strong>This case underscores the diagnostic value of flow void loss on axial MRI, which serves as a crucial indicator in the evaluation of patients with SCIWORET.</p>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"62 ","pages":"101358"},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Penetrating pancreatic injury treated with surgery and endoscopic pancreatic stenting: A case report.","authors":"Takahiro Terashi, Tetsuya Maeda, Eriko Shiona, Masanori Kawaguchi, Akihiko Yamamoto, Shoichi Inokuchi, Satoshi Tsutsumi, Masahiko Ikebe, Toshio Bandoh, Tohru Utsunomiya","doi":"10.1016/j.tcr.2026.101352","DOIUrl":"https://doi.org/10.1016/j.tcr.2026.101352","url":null,"abstract":"<p><strong>Background: </strong>Traumatic pancreatic injury is associated with high morbidity and mortality. We present a rare case of penetrating pancreatic injury caused by a knife.</p><p><strong>Case presentation: </strong>A 57-year-old man who stabbed himself in the abdomen during a suicide attempt presented to our hospital. A contrast-enhanced computed tomography scan revealed free air in the abdomen, and penetrating pancreatic injury was suspected. Emergency laparotomy was performed. Perforation of the stomach and penetrating injury to the pancreas were observed. The gastric perforation was repaired. Due to the fact that no obvious bleeding or leakage of pancreatic juice was observed, pancreatic repair was not performed. The endoscopic retrograde pancreatography after the operation revealed no obvious injury to the main pancreatic duct. To prevent pancreatic fistula, a stent was placed in the main pancreatic duct, after which the fistula improved.</p><p><strong>Conclusion: </strong>We present a rare case of penetrating pancreatic injury, which was treated by surgery and endoscopic pancreatic stenting.</p>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"63 ","pages":"101352"},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute spinal cord injury caused by high-voltage electrical burn requiring a multidisciplinary approach in a resource-limited setting: A case report.","authors":"Berhanu Shetie Sefene, Wondwosen Mengist Dereje, Shibabaw Fentahun, Abebe Gelaw, Hailemariam Yohannes Asefa, Andinet Azaje, Nebiyu Bekele","doi":"10.1016/j.tcr.2026.101347","DOIUrl":"https://doi.org/10.1016/j.tcr.2026.101347","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Tissue damage from an electrical burn could result from either direct electrical current and/or its conversion from electric to thermal energy. Although loss of consciousness, altered mentation, and peripheral neuropathy are the common neurologic sequelae of electrical burns, spinal cord injury can also be the only neurological complication of high-voltage electrical burn injuries. In this case report we present scalp soft tissue defect and acute spinal cord injury following high voltage electrical burn in a 35 years old male patient. We aim to emphasize the importance of multidisciplinary management in improving patient outcomes.</p><p><strong>Case presentation: </strong>A 35-year-old soldier experienced a high-voltage power live burn injury to the right frontal area of the head. Eight hours after the injury, he developed bilateral lower-extremity weakness and a tingling sensation. Basic investigations like CBC, renal function test, and ECG readings were normal. Both brain CT and spinal MRI studies reveal normal. Concomitant with wound management, physiotherapy was initiated, and he had significant improvement in his weakness by the end of the third week.</p><p><strong>Clinical discussion: </strong>Despite accounting for less than 4% of burn case, electrical burn have special concerns including the potential for cardiac arrhythmias and compartment syndromes with concurrent rhabdomyolysis. Other types of burns include flame burn and scald burn.</p><p><strong>Conclusion: </strong>High-voltage electrical burn injuries are serious problems causing variable degrees and types of neurologic impairments. Acute spinal cord injuries are among the less commonly reported problems. Given the limited effective treatment options for neurologic complications, appropriate preventive measures, multidisciplinary management, and long-term neurologic follow-up are important.</p>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"62 ","pages":"101347"},"PeriodicalIF":0.0,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovine forestomach matrix as a novel adjunct to promote healing of low output enterocutaneous fistulae in high-risk surgical patients.","authors":"Sophia Trinh, Joseph Mason, Paige Deville, Dhanushka Vitharana, John Hunt, Alan Marr, Lance Stuke, Patrick Greiffenstein, Alison Smith","doi":"10.1016/j.tcr.2026.101348","DOIUrl":"https://doi.org/10.1016/j.tcr.2026.101348","url":null,"abstract":"<p><strong>Background: </strong>The development of enterocutaneous fistulas (ECF) after emergency laparotomies is not uncommon. Management is difficult and options limited. Studies suggest ovine forestomach matrix (OFM) grafts may be viable treatment options for complex wounds. The goal of this study was to investigate the use of OFM in the treatment of ECFs.</p><p><strong>Methods: </strong>Patients with ECFs as a result of emergency laparotomy were treated with OFM. Wounds were appropriately debrided and OFM was applied. A secondary dressing was applied and left on for a minimum of 7 days. Patients were followed at regular intervals to monitor progression of wound healing.</p><p><strong>Results: </strong>Three patients were included in the case series. One patient developed ECF after bowel resection secondary to gunshot wounds. OFM was applied and upon follow up, the wound was significantly healed. The second patient developed ECF after bowel resection secondary to being struck by a vehicle. OFM was applied and at two week follow up the fistula was closed. The third patient developed ECF after major small bowel resection secondary to acute mesenteric ischemia. OFM was applied and the ECF was fully closed at one month.</p><p><strong>Conclusion: </strong>This case series highlights the utilization of OFM to augment wound healing in patients with ECFs. This pilot study demonstrates the excellent results achieved with OFM as an adjunct for difficult wounds such as ECFs with the ability to accelerate healing.</p>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"63 ","pages":"101348"},"PeriodicalIF":0.0,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When delay costs a limb: Severe chronic osteomyelitis in a patient with intravenous drug use.","authors":"Lucas Fontenelle Vieira, Paul Raymond Cardinal, Lauren Gibbs, Sharon M Henry, Marcelo Augusto Fontenelle Ribeiro","doi":"10.1016/j.tcr.2026.101354","DOIUrl":"https://doi.org/10.1016/j.tcr.2026.101354","url":null,"abstract":"<p><strong>Introduction: </strong>Intravenous drug use (IVDU) is strongly associated with severe infections including abscesses, endocarditis, necrotizing fasciitis, and osteomyelitis. When untreated, acute osteomyelitis can progress to chronic disease with biofilm-mediated antimicrobial resistance, soft tissue necrosis, and eventual limb loss. Reports of extreme cases requiring major amputation remain uncommon in the literature.</p><p><strong>Case presentation: </strong>We report the case of a 32-year-old female with a history of substance use disorder who presented with a chronic right forearm wound after more than one year without definitive treatment. Despite prior medical recommendations for amputation, the patient declined intervention and was lost to follow-up. She re-presented with worsening pain, soft tissue necrosis, exposed bone, and a pathological fracture. Operative management included a transhumeral amputation with confirmation of acute osteomyelitis and osteonecrosis on pathology.</p><p><strong>Discussion: </strong>This case highlights the clinical and social challenges of managing chronic osteomyelitis in patients with IVDU, including delayed care, limited adherence, and high rates of antimicrobial resistance. Optimal management requires a multifaceted approach combining aggressive surgical debridement or amputation with systemic and local antibiotic therapy. Emerging treatment frameworks, such as the Philadelphia Treatment Algorithm for Xylazine-Associated Wounds, provide evidence-based guidance for similarly complex infections.</p><p><strong>Conclusion: </strong>Patients with substance use disorder are at increased risk for devastating complications of chronic osteomyelitis, including limb loss. Early recognition, structured treatment algorithms, multidisciplinary management, and integration of addiction treatment are critical to improving outcomes in this vulnerable population.</p>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"62 ","pages":"101354"},"PeriodicalIF":0.0,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent distal radioulnar joint dislocation after surgical treatment of Galeazzi fracture-dislocation: A case report and review of the literature.","authors":"Minh Ngoc Dinh, Thy Gia Anh Le, Phi Duong Nguyen","doi":"10.1016/j.tcr.2026.101349","DOIUrl":"https://doi.org/10.1016/j.tcr.2026.101349","url":null,"abstract":"<p><p>Galeazzi fracture-dislocation is a complex injury involving a distal radius fracture and distal radioulnar joint (DRUJ) dislocation, typically treated through surgical intervention. However, persistent DRUJ dislocation remains a common complication following surgery. This report presents two cases of persistent DRUJ dislocation after surgical treatment of Galeazzi fractures. Both patients underwent initial radial fixation with plate and screws but developed limitations in forearm supination and pain due to residual DRUJ dislocation. Radiographs confirmed the dislocation, and subsequent surgeries addressed the causes, including radial malalignment, soft tissue entrapment, and untreated ulnar styloid fractures. Following reoperation, both patients achieved full recovery with pain relief and restored forearm mobility. This case report emphasizes the importance of comprehensive intraoperative evaluation and early detection of DRUJ dislocation to prevent long-term dysfunction and complications.</p>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"62 ","pages":"101349"},"PeriodicalIF":0.0,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior clamp-assisted reduction for retrograde nailing of infra-isthmic femoral fractures: technique and preliminary results on a short case series.","authors":"Ana Van-Breukelen-García, Marina Sabater-Jofre, Jordi Teixidor-Serra, Jordi Tomás-Hernández, Jordi Selga-Marsa, Carlos Alberto Piedra-Calle, Ferran Blasco-Casado, Yaiza García-Sanchez, José Vicente Andrés-Peiró","doi":"10.1016/j.tcr.2026.101338","DOIUrl":"https://doi.org/10.1016/j.tcr.2026.101338","url":null,"abstract":"<p><p>Infra-isthmal femoral fractures in elderly patients are difficult to stabilize due to the broad metaphyseal anatomy. In the absence of consensus on optimal management, this study assesses a minimally invasive technique combining anterior clamp-assisted reduction with retrograde intramedullary nailing. A retrospective case series was conducted on ten patients treated between January 2023 and April 2024. All underwent percutaneous fracture reduction via a limited anterior approach, followed by retrograde nailing. The mean patient age was 84.9 ± 6.2 years. All fractures were caused by low-energy trauma. Six involved native bone and four were periprosthetic. All cases progressed to union without infection or wound complications. One peri-implant fracture occurred at the proximal tip of the nail and was successfully treated with overlapping plate fixation. This technique was safe and effective for infra-isthmal spiral femoral fractures in elderly, frail patients. It allowed accurate reduction, minimized soft tissue disruption, and resulted in reliable fracture healing.</p>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"62 ","pages":"101338"},"PeriodicalIF":0.0,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Removal of broken solid intramedullary nail of femur: A case report on removal technique in a resource-limited setup.","authors":"Binyam Dagnaw Mengistu, Gemechis Regassa Idosa","doi":"10.1016/j.tcr.2026.101344","DOIUrl":"https://doi.org/10.1016/j.tcr.2026.101344","url":null,"abstract":"<p><strong>Introduction: </strong>Intramedullary nail is the mainstay of treatment for femur shaft fracture. One of the potential complications of intramedullary nailing is nail breakage, which can occur due to trauma or nonunion at any part of the nail. Removal of the distal end of a solid nail, which is away from the fracture or nonunion site, is a difficult procedure that requires special extraction devices.</p><p><strong>Case presentation: </strong>60-year-old male who sustained a road traffic injury 12 years back and was treated for a right floating knee injury (femur shaft fracture, patellar and tibial plateau fracture) managed with retrograde nail of femur, tension band wiring for patella, and plating for tibial plateau fracture. Currently presented with knee and distal thigh pain with decreased range of motion. Imaging shows right femur shaft nonunion with a broken intramedullary nail and interlocking screw at the level of the proximal dynamic hole. We removed the proximal part with a SIGN nail extraction system and the distal part of the solid nail was removed by pushing it upward to the piriformis using another broken nail after an entry hole was made over the piriformis.</p><p><strong>Discussion: </strong>Broken nails far from the previous fracture or nonunion site are quite difficult to remove at the distal end. It is a technically demanding procedure that requires different techniques and special extraction tools. Several techniques have been described, mostly for cannulated nails, including widening the canal, development of bony windows, and pushing or pulling using various instruments. Our technique can be done without special extraction devices with decreased operative time and also obviates the need for a large cortical window and opening of fracture or nonunion site.</p><p><strong>Conclusion: </strong>The broken distal end of a solid retrograde nail in a resource-limited setup can be removed by pushing with the tip of another broken nail to the piriformis or from the piriformis to the knee after an entry hole was made in the proximal or distal femur, respectively. Nail removal should be performed with meticulous preoperative planning and preparation of different extraction devices.</p>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"62 ","pages":"101344"},"PeriodicalIF":0.0,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated inferior phrenic artery injury following blunt trauma: A case report and literature review.","authors":"Shin-Ah Son","doi":"10.1016/j.tcr.2026.101340","DOIUrl":"https://doi.org/10.1016/j.tcr.2026.101340","url":null,"abstract":"<p><p>Inferior phrenic artery injuries are typically iatrogenic or result from penetrating trauma; however, injury following blunt trauma is rare. In most cases of active traumatic bleeding in thoracoabdominal organs, laparotomy or thoracotomy is considered a safe approach for controlling hemorrhage. We report the case of a 56-year-old male truck driver who was transferred to a local trauma center. A computed tomography (CT) scan revealed active contrast extravasation within the retrocrural space and from the right inferior phrenic artery, without evidence of active traumatic bleeding in thoracoabdominal organs. The patient was taken to the vascular intervention unit, where transcatheter arterial embolization (TAE) was successfully performed to control the hemorrhage. He was subsequently discharged in good condition. This case represents an unusual instance of right inferior phrenic artery injury without associated thoracoabdominal organ damage. TAE can be a less invasive, more precise, and reliable alternative to thoracotomy or laparotomy for managing inferior phrenic artery bleeding and controlling intrathoracic arterial hemorrhage.</p>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"63 ","pages":"101340"},"PeriodicalIF":0.0,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}