Urologia Internationalis最新文献

{"title":"Who Changes Indwelling Urinary Catheters in Male Nursing Home Residents and Where? Results from a Nationwide Cross-Sectional Survey in Germany.","authors":"Jonas Czwikla, Guido Schmiemann, Tanja Schleef, Stephanie Stiel, Falk Hoffmann","doi":"10.1159/000542430","DOIUrl":"10.1159/000542430","url":null,"abstract":"<p><strong>Introduction: </strong>We examined the practice and variability of indwelling urinary catheter changes in male nursing home residents.</p><p><strong>Methods: </strong>Cross-sectional data from a nationwide survey conducted in a representative sample of German nursing homes in 2023 were analyzed. The professions conducting most transurethral/suprapubic catheter changes in men were identified, and proportions for whom respective catheters are changed in nursing homes were determined. Associations between these proportions and nursing home characteristics were investigated via multivariable logistic regressions.</p><p><strong>Results: </strong>Of 1,369 invited facilities, 330 (24.1%) participated. Urologists changed most catheters in 72.8% (transurethral catheters) and 88.3% (suprapubic catheters) of the facilities. The median proportion of men whose catheters were changed in nursing homes was 8.5% (transurethral catheters; interquartile range 0.6%-100.0%) and 1.0% (suprapubic catheters; interquartile range 0.0-100.0%). Facilities in which urologists changed most catheters were less likely to have a high proportion (≥90%) of in-home catheter changes compared to the reference group (odds ratio 0.44 [transurethral catheters; 95% confidence interval 0.24-0.82] and 0.30 [suprapubic catheters; 0.12-0.76]).</p><p><strong>Conclusion: </strong>The proportion of men whose catheters were changed in nursing homes varied considerably between facilities and was lower where urologists were involved.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1-7"},"PeriodicalIF":1.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668923","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":"Gender-Specific Differences in Urethral Swabs: A Retrospective Single-Centre Analysis.","authors":"Katharina Raude, Claudia Röbel, Stefan Schmidt, Jens-Uwe Stolzenburg, Henrike Beverungen","doi":"10.1159/000542457","DOIUrl":"10.1159/000542457","url":null,"abstract":"<p><strong>Introduction: </strong>Sexually transmitted infections (STIs) are on the rise globally, yet accurate data regarding infection rates remain scarce. There is the assumption that STIs among women with chronic urinary tract infections (UTIs) have been underestimated. This may arise from the reliance on specialised cultivation or nucleic acid amplification techniques for detection, which are more costly than standard urine culture and are typically only conducted by specialists like urologists.</p><p><strong>Methods: </strong>A retrospective, observational, single-centre study using medical records of patients who received a urethral swab in a German urological practice in the past 5 years has been conducted.</p><p><strong>Results: </strong>55% of patients had a STI requiring treatment. People with recurrent UTIs had a STI in 35% of the cases. Younger age is associated with the detection of STIs. The female gender is significantly associated with a positive swab result.</p><p><strong>Conclusion: </strong>Distinguishing between cystitis and urethritis, particularly in women with recurrent UTIs experiencing dysuria, presents a clinical challenge. The prevalence of asymptomatic infections suggests that the true burden of urethritis, particularly STIs, may be substantially higher in the general population than currently reported. This underscores the urgency of establishing guidelines for referral and diagnostic evaluation as delayed or inadequate treatment may contribute to escalating infection rates and antibiotic resistance.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1-8"},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629177","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 Programmatic Approach to En Bloc Transurethral Enucleation of the Prostate with Bipolar System: A Single-Center Retrospective Report.","authors":"Peng Lai, Ying Lu, Weihong Lu, Fan Chao, Jianping Zhang","doi":"10.1159/000542514","DOIUrl":"10.1159/000542514","url":null,"abstract":"<p><strong>Introduction: </strong>This study presents a systematic approach for en bloc transurethral enucleation of the prostate utilizing a bipolar system (TUEB), evaluating its effectiveness and safety. Furthermore, the research aims to pinpoint risk factors contributing to early stress urinary incontinence (SUI) after undergoing en bloc TUEB.</p><p><strong>Methods: </strong>The en bloc TUEB procedure is visually demonstrated through images and videos. A retrospective analysis was conducted based on the data of 88 patients diagnosed with benign prostatic hyperplasia (BPH) who underwent en bloc TUEB between January 2018 and April 2023. Detailed perioperative and follow-up clinical data were collected and analyzed. Patients were categorized based on the occurrence of SUI, and their clinical characteristics were analyzed.</p><p><strong>Results: </strong>The mean surgical duration was 113.1 ± 50.0 min, resulting in an excised prostate gland weighing 58.0 ± 34.3 g and a hemoglobin drop of 14.3 ± 11.2 g/L. The average enucleation rate was 79.00 ± 11.01%, enucleation efficiency was 0.54 ± 0.26 g/min and prostate-specific antigen reduction rate was 42.08 ± 22.85%. There were no major complications during operation. Twenty-three patients (26.13%) developed early SUI after catheter removal, and 74% of them were in remission within 1 month. Importantly, no cases of persistent SUI were observed. Lower urinary tract symptoms (LUTSs) duration was significantly different between patients with and without postoperative SUI. Residual urine volume, International Prostate Symptom Score (IPSS), and Quality of Life (QoL) score were significantly improved in BPH patients after surgery (p < 0.05). Twelve months after surgery, only 2 patients (2.27%) had urethral stricture, although it recovered after transurethral dilation.</p><p><strong>Conclusions: </strong>En bloc TUEB is proven to be effective, practical, efficient, and safe with minimal complications. This procedure could be standardized and widely adopted. LUTS duration can predict the risk of early SUI.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1-8"},"PeriodicalIF":1.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629174","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":"Gender-Specific Differences in Recurrence and Progression following Bacillus Calmette-Guérin Instillation for Non-Muscle-Invasive Bladder Cancer.","authors":"Laila Schneidewind, Bernhard Kiss, Jennifer Kranz, Friedemann Zengerling, Angelika Borkowetz, Sebastian Graf, Annabel Graser, Annemarie Uhlig","doi":"10.1159/000542473","DOIUrl":"10.1159/000542473","url":null,"abstract":"<p><strong>Introduction: </strong>To assess gender-specific differences in recurrence-free survival (RFS), progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) among patients with intermediate or high-risk non-muscle-invasive bladder cancer (NMIBC) receiving BCG was the primary aim of this systematic review and meta-analysis.</p><p><strong>Methods: </strong>In July 2023, we performed a literature search using MEDLINE, Embase, and the Cochrane Library. This study was prospectively registered at PROSPERO (CRD 2023443269). The detailed review protocol is accessible via CRD.</p><p><strong>Results: </strong>The systematic literature search identified 6,723 studies, of which 38 fulfilled the inclusion criteria. Random-effect meta-analysis for RFS, based on data from 24 studies, revealed no statistically significant gender-specific difference (HR comparing males to females = 0.9618, 95% CI: 0.8408-1.1003, p = 0.5707). Similarly, for PFS, incorporating data from 14 studies, no statistically significant difference (HR = 0.9540, 95% CI: 0.7709-1.1805, p = 0.6648), for CSS, analysis of data from three studies yielded no statistically significant difference (HR = 0.9228, 95% CI: 0.6196-1.3743, p = 0.6925), and for OS, based on data from two studies, no statistically significant difference was observed (HR = 1.1436, 95% CI: 0.5092-2.5684, p = 0.7452). The risk of bias assessment indicated an overall moderate to high risk of bias.</p><p><strong>Conclusion: </strong>The findings indicate no association between gender and oncologic outcomes following BCG.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1-13"},"PeriodicalIF":1.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606498","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":"Transformations in Benign Prostatic Hyperplasia Surgical Practices: A Longitudinal Study of Trends and Predictions.","authors":"Karin Lifshitz, Ziv Savin, Tomer Bashi, Snir Dekalo, Hen Hendel, Yaron Ehrlich, Omer Anis, Zohar Dotan, Guy Verhovsky, Ehud Genessin, Rabeea Moed, Nicola Mabjeesh, Mahmoud Abbas, Ilan Kafka, Ali Safadi, Ran Katz, Ofer Yossepowitch, Mario Sofer","doi":"10.1159/000541752","DOIUrl":"10.1159/000541752","url":null,"abstract":"<p><strong>Introduction: </strong>The workload for benign prostatic hyperplasia (BPH) surgery is expected to rise with an increase in life expectancy and a growing population. Surgical modalities for BPH have evolved, shifting toward minimally invasive transurethral procedures. This study aimed to investigate the trends in BPH surgical procedures across medical centers in Israel.</p><p><strong>Methods: </strong>Data from seven academic medical centers in Israel from 2010 to 2022 were analyzed. Procedures included open prostatectomy, transurethral prostatectomy (TURP), holmium laser enucleation of the prostate (HoLEP), and photovaporization of the prostate (PVP). Statistical analyses were employed, including t tests, ANOVA, and ARIMA models.</p><p><strong>Results: </strong>Over 12 years, 13,478 BPH procedures were performed. TURP was the most common (72%), followed by open surgery (12%), HoLEP (12%), and PVP (3%). Annual procedures increased by approximately 5% each year, with a cumulative surge of 63% cases by 2022. The average patient's age remained stable. TURP and HoLEP showed continual growth, while open surgery declined. HoLEP exhibited a shorter length of hospital stay compared to other modalities. Predictive models suggest open prostatectomy will cease within 2 years, while TURP and HoLEP will continue to rise.</p><p><strong>Conclusion: </strong>This study highlights a significant increase in BPH surgical procedures over time, with a notable preference for TURP and HoLEP. The findings emphasize the importance of size-independent techniques like HoLEP for optimal healthcare management in the future.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1-8"},"PeriodicalIF":1.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372986","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 clinical symptoms and psychological status of biofeedback electrical stimulation combined with pelvic floor muscle training during the treatment of mild stress urinary incontinence after holmium laser enucleation of the prostate.","authors":"Zhijie Zhang,Xiang Zhou,Zhichao Yang,Yuhang Tang,Anjie Hong,Chongrui Wei,Jian Wang,Liangwen Ye,Xiangyi Hou,Wei Xu,Xianghui Suo,Li Zhang","doi":"10.1159/000539813","DOIUrl":"https://doi.org/10.1159/000539813","url":null,"abstract":"Introduction：To study the clinical symptoms and psychological status of biofeedback electrical stimulation combined with pelvic floor muscle training during the treatment of mild stress urinary incontinence (SUI) after holmium laser enucleation of the prostate (HoLEP). Methods：Group A was treated by biofeedback and electrical stimulation; Group B was treated by pelvic floor muscle training; and Group C was treated by biofeedback and electrical stimulation combined with pelvic floor muscle training. Patients in the 3 groups had follow-up evaluations every 8, 16, and 24 weeks. Clinical symptoms of urinary incontinence were assessed using the 24-hour urinary pad test, the Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF); and psychological status was evaluated using the modified Hospital Anxiety Depression Scale (HADS). Results：The results of ICIQ-UI-SF showed that there were differences within and between the three groups at 8 weeks, 16 weeks, and 24 weeks (P&lt;0.05). The results of the 24-hour pad tests were similar (P&lt;0.05), except for no difference between Group B and Group C at 8 weeks(P＞0.05). In the study with the score of HADS &gt; 35, the differences among the three groups were statistically significant(P&lt;0.05). There was no significant difference among the three groups at 0 and 8 weeks (P&gt;0.05). There were differences in the results between Group C and the other two groups at 16 and 24 weeks of treatment (P&lt;0.05) .For patients with HADS &lt; 35 at week 0, the results were basically the same except for the difference between groups at week 8. HADS of all patients were no statistical difference (P &gt; 0.05). Conclusions：Biofeedback electrical stimulation combined with pelvic floor muscle training is an efficient non-surgical combination therapy for the symptoms of SUI after HoLEP for BPH. In addition, the recovery of the patient's psychological state does not coincide with the recovery of urinary incontinence; therefore, we propose that patients still need additional psychological treatment after SUI disappears.","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":"19 1","pages":"1-14"},"PeriodicalIF":1.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266299","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":"Financial distress in testicular cancer survivors and its impact on cancer survivors´ quality of life in the German health care system.","authors":"Desiree Louise Draeger,Julia Nolting,Vanessa Rossberg,Oliver W Hakenberg","doi":"10.1159/000541297","DOIUrl":"https://doi.org/10.1159/000541297","url":null,"abstract":"INTRODUCTIONTesticular cancer accounts for the largest proportion of solid tumors in young adult men. With an average age of onset under 40 years and a relative 5-year survival of 97%, it is one of the prognostically favorable tumors. Little is known about the relationship between the financial burden and physical and emotional health of testicular cancer survivors. We examined the association between financial problems caused by cancer and the self-reported quality of life in a cohort-based sample of testicular cancer patients.METHODSA cross-sectional analysis of testicular cancer patients (n = 87, average age 39 years) was performed. Self-reported data were collected on demographics, income, wealth, cost-coping strategies, out-of-pocket costs, supportive medication compliance, quality of life and perceived social isolation. A multivariable regression model was used to examine the relationship between the degree to which cancer caused financial burdens and the patients´ reported quality of life.RESULTSThe survey showed that, in addition to illness-related additional expenses, a disease-related loss of income can lead to severe financial disadvantages and impair quality of life. The study data show that concerns about the economic situation can increase the burden on patients which already results from cancer diagnosis and therapy. In this patient cohort, 32% reported financial stress.CONCLUSIONFinancial distress affects testicular cancer survivors in unique ways. To provide support, health professionals should consider survivors´ developmental life stage to understand their financial stress, and ultimately, to improve quality of life.","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":"85 1","pages":"1-10"},"PeriodicalIF":1.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180482","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":"Flexible ureteroscopy with a tip-flexible pressure-controlling ureteral access sheath for renal stones in children.","authors":"Guanghua Peng, Jin Kuang, Yijian Chen, Xin Huang, Leming Song, Xiaolin Deng","doi":"10.1159/000539311","DOIUrl":"https://doi.org/10.1159/000539311","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the safety and efficacy of flexible ureteroscopy using a tip-flexible pressure-controlling ureteral access sheath (TFPC-UAS) for renal stones in children.</p><p><strong>Methods: </strong>Consecutive patients aged 5-18 years with renal stones of diameter 1-3 cm were enrolled between January 2022 and November 2023 at Ganzhou People's Hospital. The patients were treated with flexible ureteroscopy using the TFPC-UAS. The renal pelvic pressure (RPP) parameters were set as follows: control value at -10 mmHg to 5 mmHg, warning value at 20 mmHg, and limit value at 30 mmHg. The infusion flow rate was set to 100-120 mL/min. A holmium laser (276 μm) was used to fragment the stone at 2.0-2.5 J/pulse with a frequency of 20-30 pulses/s. The cases were analyzed for RPP, operative time, stone-free rate, and complications.</p><p><strong>Results: </strong>A total of 21 consecutive patients were included. Two patients were switched to percutaneous nephrolithotomy owing to sheath placement failure. The RPP was -4.6±2.1 mmHg. The mean operative time was 56.5±17.1 min. The postoperative hospitalization time was 1.5±0.3 days. The stone-free rates at 1 day and 1 month after surgery were 81.0% and 85.7%, respectively. Residual stones in two patients were cleared after extracorporeal shockwave lithotripsy. Three cases of Clavien I complications and one case of Clavien II complications occurred. No major complications (Clavien grade III-V) were observed.</p><p><strong>Conclusions: </strong>Flexible ureteroscopy with a TFPC-UAS is safe and effective for renal stones in children.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959610","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":"Female Urethral Cavernous Hemangioma: Introducing Treatment and Follow-Up Course of Three Cases.","authors":"Nastaran Mahmoudnejad, Peyman Mohammadi Torbati, Narjes Saberi, Fatemeh Sodeifian","doi":"10.1159/000535464","DOIUrl":"10.1159/000535464","url":null,"abstract":"<p><p>Cavernous hemangioma is a benign vascular tumor occurring in all parts of the urinary system, including the kidney, bladder, prostate, ureter, and rarely urethra. Urethral cavernous hemangiomas are mostly seen in male patients, and only a few cases of female urethral hemangiomas are reported. Herein, we present the management and follow-up course of 3 cases of female urethral cavernous hemangioma. All 3 cases were menopause women complaining of lower urinary tract symptoms. Definitive diagnosis is made by histopathologic evaluation. In case of large or pedunculated masses, initial surgical resection is highly recommended. Regular follow-up of patients in order to prevent any recurrence is suggested.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"159-162"},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10994592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139075145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Techniques to Remove Residual Stone Fragments in the Urinary System.","authors":"Minhua Qiu, Ting Zhang, Yingying Zhang, Taisheng Liang, Jibing Chen, Hongjun Gao","doi":"10.1159/000535298","DOIUrl":"10.1159/000535298","url":null,"abstract":"<p><strong>Background: </strong>Although significant progress has been made in treatment techniques for renal and ureteral calculi, residual fragments (RF) persisting long after treatment pose a serious threat to patients' health. A variety of novel physical techniques and extraction devices are currently being developed to promote the removal of RF from the urinary system, and a series of in vivo experiments have demonstrated their safety and efficacy.</p><p><strong>Summary: </strong>External physical vibration lithecbole, magnetic extraction, biocompatible stone adhesive-based methods, and ultrasonic propulsion technologies are examples of innovative therapies that can promote the clearance of RF and improve the stone-free rate. In conclusion, the physical treatment of these RF needs to be optimized and improved. They are a promising technique for improving the efficiency of endovascular urology, and further in vivo studies are needed to confirm their safety and efficacy.</p><p><strong>Key messages: </strong>We have summarized the literature on removal of RF by physical methods in recent years, especially the new progress.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"9-19"},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138441326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}